Pseudoaneurysm of the Supracoeliac Aorta Following Blunt Trauma in a 83-Year-Old Woman

We report on the case of an 83-year-old hemiplegic female patient presenting with post-traumatic pseudoaneurysm of the supracoeliac aorta, treated with 38 mm χ 100 mm Talent Endoluminal Stent-Graft (Medtronic Inc., Santa Rosa, CA) using local anaesthesia. The patient was discharged on day 3 and the 8 month follow-up was without complications.     

Renal Autotransplantation in Lynch Syndrome: A Viable Option in a Patient With Contralateral Metachronous Ureteral Cancer

The success of human kidney allotransplantation was realized over six decades ago. First described 50 years ago, renal autotransplantation has been utilized sparingly as a salvage procedure for patients at risk of losing renal function, either from a benign or malignant condition. While classically associated with colorectal malignancies, Lynch syndrome also carries a small yet significant risk for the development of ureteral carcinoma. For these patients who develop chronic kidney disease, allotransplantation may not be an option due to the lifelong risk of several malignancies. We report the first known case of renal autotransplantation in a patient with metachronous ureteral cancer due to Lynch syndrome.     

Revascularization without embolization: coronary bypass in the presence of a calcified aorta

The densely calcified ascending aorta presents a formidable challenge to the cardiac surgeon. Clamping such an aorta in the patient requiring myocardial revascularization may result in catastrophic cerebral embolism and mar an otherwise successful surgical outcome. Myocardial revascularization using ventricular fibrillation and hypothermia without aortic cross-clamping in 3 patients with severely calcified aortas is described.     

Femoral Head Fracture without Dislocation by Low-Energy Trauma in a Young Adult

We describe the case of a healthy young man with a femoral head fracture by low-energy trauma that occurred without evidence of hip dislocation. While plain radiographs showed no definite fracture or dislocation, computed tomography (CT) and magnetic resonance imaging (MRI) revealed a femoral head fracture with a wedge-shaped cortical depression at the superomedial aspect of the femoral head. Our patient reported feeling that the right hip had been displaced from its joint for a moment. This probably represented subluxation with spontaneous relocation. The characteristic findings and possible mechanisms of this fracture were postulated on the basis of the sequential 3 dimensional-CT and MRI. The clinical results of conservative treatment were better than those of previously reported indentation fractures.     

Burnout,coping and job satisfaction in service staff treating opioid addicts—from Athens to Zurich

The Treatment‐systems Research on European Addiction Treatment study (TREAT‐project) is a longitudinal multicenter study on predominantly opioid‐dependent patients and their health‐care system in six European cities. As part of the examination of the drug services, this study evaluates level of burnout, coping strategies, perceived self‐efficacy and job satisfaction among health‐care workers treating opioid addicts. Employees were recruited from organizations in Athens, London, Padua, Stockholm, Zurich and Essen. The Maslach burnout inventory, Brief COPE, general self‐efficacy questionnaire and a job satisfaction scale were filled in by about 383 drug service workers. One‐third of the staff suffer from severe burnout. London and Stockholm colleagues are significantly more burdened than Zurich personnel where job satisfaction is highest. No cross‐national differences could be detected concerning coping styles or level of perceived self‐efficacy. Burnout is positively correlated to passive coping strategies and negatively linked to self‐efficacy and job satisfaction. Males experience more depersonalization. Organizational features such as the entry‐threshold level of the institution or out‐ vs. inpatient setting are relevant for coping strategies and job satisfaction. These and other findings are discussed in relation to preliminary data from the TREAT‐project on characteristics of opioid addicted patients and other specific features of the drug treatment system. Copyright © 2009 John Wiley & Sons, Ltd.     

Arthroscopic Chondral Cyst Excision in a Stiff Perthes’ Hip

Persistent hip stiffness in Perthes’ disease indicates a poor prognosis and is a therapeutic challenge. We report a case of a 13-year-old boy with a stiff Perthes’ hip that was nonresponsive to prolonged nonsurgical treatment. Imaging revealed Catterall group IV Perthes’ disease in an advanced reossification stage, with a focal defect in the weight-bearing area of the capital femoral epiphysis. A focal, compressible chondral elevation was detected on hip arthroscopy; on incision, flocculent fluid was released. After the cyst was excised, microfracture revascularization of the chondral defect was undertaken. Postoperatively, the patient had immediate pain relief, correction of deformity, and restoration of painless range of motion; this has continued for 4 years since surgery was performed. Persistence of an unhealed necrotic segment in Perthes’ disease has traditionally been associated with osteochondritis dissecans; however, in this case, the unhealed and nonossified segment produced an elevated painful chondral cyst that caused spasm and stiffness of the hip. Although 2 distinct types of chondral lesions have been described in Perthes’ disease, stiffness arising because of these lesions has not been reported. Patients with this unusual third type of chondral lesion of the capital femoral epiphysis, which causes persistent stiffness in Perthes’ hip, may be identified and successfully treated with the use of arthroscopic techniques.     

Primary cardiac tumours — is there a place for cardiac transplantation?

Between 1979 and 1985, seven patients (five children and two adults) were treated for primary cardiac tumours other than benign atrial myxomas. There were five malignant neoplasms (two non-classifiable sarcomas, one haemangiosarcoma, one histiocytoma and one neurofibrosarcoma) and two benign tumours (fibromas). Echocardiography, cardiac catheterisation, computed tomography and magnetic resonance imaging provided diagnostic confirmation. The two patients with fibroma are alive and well 4 and 5 years after radical resection of the tumours from the interventricular septum. The patient with a neurofibrosarcoma underwent orthotopic cardiac transplantation and is well 5.5 years postoperatively with no evidence of residual disease or recurrence. One patient died awaiting a donor heart for transplantation. Another patient who was a candidate for heart and lung transplantation was found to have an unresectable tumour at the time of operation. One patient with sarcoma who underwent a successful emergency partial resection for relief of cardiac tamponade died 18 months later from wide-spread metastases. The seventh patient was inoperable due to multiple secondaries. It is concluded that radical resection of large, benign, cardiac tumours can give good results and that early cardiac transplantation probably offers the only hope for patients with malignant tumours of the heart.     

Drug maintenance of a second tumor necrosis factor alpha inhibitor in spondyloarthritis patients: A real-life multicenter study

ObjectivesFive TNF inhibitor (TNFi) agents are marketed for spondyloarthritis (SpA): 1 soluble receptor (SR) and 4 monoclonal antibodies (mAbs). From 15% to 30% of patients stop the first TNFi in the first 2 years, but we lack recommendations on the choice of the second TNFi. The aim here was to assess drug survival of a second TNFi in SpA and its determinants.MethodsThis was a multicenter observational study of SpA patients who started a first TNFi in 2013 and 2014 and were followed to 2018. For the first and second TNFi, we retrospectively collected data on initiation and discontinuation dates, type of TNFi, and reasons for withdrawal. Kaplan–Meier plots and log-rank tests were used to compare drug survival. Factors associated with drug survival of the second TNFi were analyzed by univariate Cox regression analyses.ResultsWe included 244 patients. During a follow-up of 7,838 patient-months, 101 (41%) received 1 TNFi, and 143 (59%) switched to a second TNFi. Mean drug intake duration was significantly greater with the first than second TNFi: 21.7 (SD 19.6) and 15.4 (SD 13.6) months (P < 0.001). When switching to another mAb or from an SR to an mAb (or the reverse), mean drug survival did not differ: 14.4 (SD 12.7) and 16 (SD 14.1) months (P = 0.35). Factors associated with retaining the second TNFi were male sex (P = 0.054) and age < 41 years at SpA diagnosis (P = 0.022). On multivariable analysis, only age < 41 years at diagnosis remained independently associated with maintenance of the second TNFi.ConclusionIn SpA patients, drug survival is significantly longer with the first than second TNFi. Male sex and age < 41 years at diagnosis were associated with retaining the second TNFi.     

Characteristics of a large cohort of patients with diabetes having at‐risk feet and outcomes in patients with foot ulceration referred to a tertiary care diabetes unit

To identify in a large population cohort the clinical and biochemical characteristics of patients with diabetes at risk of foot ulceration and outcomes in those with foot ulcers. All patients with diabetes attending Baqai Institute of Diabetology and Endocrinology from January 2004 to April 2012 included in the study. Clinical, biochemical and socio‐demographic data were collected and patients were categorised into those at no risk of ulceration, at risk of ulceration and those with foot ulcer, according to the University of Texas classification. Patients with foot ulceration followed for their final outcome, that is complete healing, persisted non‐healed ulcer, lower extremity amputation, lost to follow‐up or death. A total of 18 119 patients with diabetes underwent assessment, 3576 (19·7%) patients defined as at high risk for foot ulceration and 3731 (20·6%) presented with foot ulcer. Age, male gender, hypertension, higher glycated haemoglobin (HbA1c), history of smoking and presence of neuropathy were risk factors (P < 0·000) for foot ulceration. Amputation rate in patients with foot ulceration was significantly related to severity of ulceration at presentation. Preventive foot care practices were followed by 19·02% patients. One thousand eight hundred seventy three (50·2%) patients completely healed, 293 (11%) patients underwent amputation and 397 (10·1%) patients continued to be treated in the foot clinic. All patients with diabetes should be screened for neuropathy to identify those at risk of foot ulceration, as it is the major contributory factor for foot ulceration. The final outcome of foot ulceration was determined by the severity and grade of ulcer at presentation.     

Advances in Bone‐targeted Drug Delivery Systems for Neoadjuvant Chemotherapy for Osteosarcoma

Targeted therapy for osteosarcoma includes organ, cell and molecular biological targeting; of these, organ targeting is the most mature. Bone‐targeted drug delivery systems are used to concentrate chemotherapeutic drugs in bone tissues, thus potentially resolving the problem of reaching the desired foci and minimizing the toxicity and adverse effects of neoadjuvant chemotherapy. Some progress has been made in bone‐targeted drug delivery systems for treatment of osteosarcoma; however, most are still at an experimental stage and there is a long transitional period to clinical application. Therefore, determining how to combine new, polymolecular and multi‐pathway targets is an important research aspect of designing new bone‐targeted drug delivery systems in future studies. The purpose of this article was to review the status of research on targeted therapy for osteosarcoma and to summarize the progress made thus far in developing bone‐targeted drug delivery systems for neoadjuvant chemotherapy for osteosarcoma with the aim of providing new ideas for highly effective therapeutic protocols with low toxicity for patients with osteosarcoma.     

某院2014年度嗜麦芽窄食假单胞菌的耐药性及分布

目的探讨院内分离的嗜麦芽窄食假单胞菌的耐药性及分布,为临床经验用药提供理论依据。 方法应用WHONET 5.6软件对2014年1月至12月本院临床分离的163株嗜麦芽窄食假单胞菌的耐药性及分布进行分析。 结果163株嗜麦芽窄食假单胞菌对头孢他啶、替卡西林/克拉维酸、左旋氧氟沙星和复方新诺明的耐药率依次为65.0%（106/163）、39.9%（65/163）、3.7%（6/163）和1.2%（2/163）。其中78.5%（128/163）的标本来源于痰液,16.0%（26/163）的标本来源于血液;41.7%（68/163）的标本来自ICU重症监护病房;21.5%（35/163）的标本来自儿内科病房。 结论嗜麦芽窄食假单胞菌主要引起呼吸道感染,其次是血流感染。临床治疗嗜麦芽窄食假单胞菌引起的感染,经验用药可选用左旋氧氟沙星或复方新诺明。     

Optimal control applications in biomedical engineering—a survey

The concept of a biological system operating in an optimal manner is intriguing. When this system (e.g. a human) is in a disease state, how can one administer appropriate optimal therapeutic treatment so that it can resume functioning with, hopefully, its original undiseased attributes? Biomedical engineering has a significant role to play in this area. This article illustrates some of the current attempts at improving therapy and the biomedical understanding of a normal or a disease state by using methods of optimal control theory such as the Pontryagin minimum principle, dynamic programming, and the calculus of variations.     

Malnutrition is independently associated with skin tears in hospital inpatient setting—Findings of a 6‐year point prevalence audit

Skin tears cause pain, increased length of stay, increased costs, and reduced quality of life. Minimal research reports the association between skin tears, and malnutrition using robust measures of nutritional status. This study aimed to articulate the association between malnutrition and skin tears in hospital inpatients using a yearly point prevalence of inpatients included in the Queensland Patient Safety Bedside Audit, malnutrition audits and skin tear audits conducted at a metropolitan tertiary hospital between 2010 and 2015. Patients were excluded if admitted to mental health wards or were <18 years. A total of 2197 inpatients were included, with a median age of 71 years. The overall prevalence of skin tears was 8.1%. Malnutrition prevalence was 33.5%. Univariate analysis demonstrated associations between age (P ˂ .001), body mass index (BMI) (P < .001) and malnutrition (P ˂ .001) but not gender (P = .319). Binomial logistic regression analysis modelling demonstrated that malnutrition diagnosed using the Subjective Global Assessment was independently associated with skin tear incidence (odds ratio, OR: 1.63; 95% confidence interval, CI: 1.13‐2.36) and multiple skin tears (OR 2.48 [95% CI 1.37‐4.50]). BMI was not independently associated with skin tears or multiple skin tears. This study demonstrated independent associations between malnutrition and skin tear prevalence and multiple skin tears. It also demonstrated the limitations of BMI as a nutritional assessment measure.     

Patient profiles of below knee-amputation following road traffic accidents – An observational study from a level 1 trauma centre in India

BackgroundPrimary amputation below the level of the knee joint is the most frequently performed amputation following trauma; however, data about incidence, patient profiling, and causative factors are seldom available in India.ObjectiveTo evaluate the profile and incidence of trauma-related amputations below the level of the knee joint at a level 1 trauma center.MethodsAn observational study over six months was conducted at a level 1 trauma center of north India. Epidemiological data such as age, sex, occupation, socioeconomic status, mechanism of injury, time of surgery, single or staged procedure, and complications were recorded from the admission files.Observations125/3047 (4.1%) trauma patients underwent amputation, of which 32.8% (41 of 125) had amputation below the level of the knee joint. Unilateral transtibial amputation was the most common (85.3%) involving 40/41 males with a mean age of 37.2 years of low socioeconomic status. Road traffic accidents were the most common cause (85.36% of cases). 39 of 41 cases presented within 24 h of injury and underwent surgery within 24 h of presentation. Secondary surgery was needed in 24.4% of the patients and revision amputation was done in only 2.4% (n = 1/41). No patient developed medical complications, and the average hospital stay was 8.7 days with a range from 2 to 14 days.ConclusionWe have documented a significant amputation rate in trauma cases (4.1%) reflecting on the seriousness of patients seen at our center. Most patients are young males at the peak of their productive lives, and from low socioeconomic status. Road Safety is essential, and specialized services for the amputees may be the need of the hour.