Osteochondral Fracture of the Fourth Metatarsal Head Treated by Open Reduction and Internal Fixation

Fracture of the metatarsal head is uncommon, and reports of isolated osteochondral fracture of the metatarsal head are rare. Because of the distal location of the fracture, it is difficult to achieve and maintain reduction, and potential complications include avascular necrosis and subchondral fatigue fracture. The authors present a case of an osteochondral fracture in a 40-year-old man, which was treated by open reduction and internal fixation with a single twist-off screw, with good results 12 months postoperatively.     

Association between HIV and blood pressure in adults and role of body weight as a mediator: Cross‐sectional study in Uganda

The authors sought to describe the association between human immunodeficiency virus (HIV) and blood pressure (BP) levels, and determined the extent to which this relationship is mediated by body weight in a cross‐sectional study of HIV‐infected and HIV‐uninfected controls matched by age, sex, and neighborhood. Mixed‐effects models were fit to determine the association between HIV and BP and amount of effect of HIV on BP mediated through body mass index. Data were analyzed from 577 HIV‐infected and 538 matched HIV‐uninfected participants. HIV infection was associated with 3.3 mm Hg lower systolic BP (1.2‐5.3 mm Hg), 1.5 mm Hg lower diastolic BP (0.2‐2.9 mm Hg), 0.3 m/s lower pulse wave velocity (0.1‐0.4 mm Hg), and 30% lower odds of hypertension (10%‐50%). Body mass index mediated 25% of the association between HIV and systolic BP. HIV infection was inversely associated with systolic BP, diastolic BP, and pulse wave velocity. Comprehensive community‐based programs to routinely screen for cardiovascular risk factors irrespective of HIV status should be operationalized in HIV‐endemic countries.     

Social spencerism not social darwinism

Social Darwinism, an historically inaccurate concept, originated from the social selection theories of Herbert Spencer, which maintained that might is right. The expression is an obstacle to understanding Darwinian evolution and should be discarded.     

Reversible cerebral vasoconstriction syndromes and primary angiitis of the central nervous system: clinical,imaging, and angiographic comparison

Reversible cerebral vasoconstriction syndromes (RCVS) and primary angiitis of the central nervous system (PACNS) are invariably considered in the differential diagnosis of new cerebral arteriopathies. However, prompt and accurate diagnosis remains challenging. Here we compared the features of 159 RCVS to 47 PACNS patients and developed criteria for prompt bedside diagnosis. Recurrent thunderclap headache (TCH), and single TCH combined with either normal neuroimaging, border zone infarcts, or vasogenic edema, have 100% positive predictive value for diagnosing RCVS or RCVS‐spectrum disorders. In patients without TCH and positive angiography, neuroimaging can discriminate RCVS (no lesion) from PACNS (deep/brainstem infarcts). Ann Neurol 2016;79:882–894     

Cerebral Malaria in Children with Cyanotic Heart Diseases: The Need for a Closer Look

We report four cases of encephalopathy admitted with fever, hypercyanosis, breathlessness, deep coma and convulsions considered of interest because these children had cyanotic heart diseases and concomitant cerebral malaria. Their presenting clinical features, which suggested cerebral malaria (decreased level of consciousness ranging in severity from drowsiness and severe headache to confusion, delirium and even deep coma) may equally characterise hypercyanotic episodes among children with uncorrected cyanotic cardiac defects. We also inferred that children with cyanotic cardiac defects may be prone to cerebral malaria and that those residing in the tropics may benefit from anti‐malarial prophylaxis.     

Orthotopic liver transplantation with selective use of venovenous bypass

: To determine the utility of selective use of venovenous bypass (VVB), an algorithm based upon hemodynamic criteria was instituted at Stanford University Medical Center: the bypass was used if the systolic blood pressure decreased below 100 mm Hg with a trial of caval and portal clamping. : Eleven consecutive patients underwent orthotopic liver transplantation (OLT) with use of VVB on a selective basis; using the hemodynamic exclusion criteria, none required VVB. A group of 20 patients undergoing OLT with VVB served as historical controls. : Overall patient and graft survival were identical in both groups (75%). Avoidance of VVB decreased operative and warm ischemia time and decreased peak transaminase and total bilirubin values, but increased rates of intraoperative blood loss. However, the absolute numbers of blood products administered were not different between groups. : Selective use of VVB for OLT does not incur increased morbidity or mortality. Potential advantages include cost savings with decreased operative and anesthetic time.