Diagnosis and Treatment of Trichinosis

When your thyroid gland is overactive, it produces too much thyroid hormone for your body. This is called hyperthyroidism, and it can cause a number of problems.     

Combined traumatic occiput-C1 and C1-C2 dissociation: 2 case reports

Occiput-C1 and C1-C2 dissociations and dislocations have been well documented in the literature. However, after thorough review of the literature, we found very little in the literature regarding combined occiput-C1 and C1-C2 dissociations in adults who survived. We present 2 case reports describing the clinical presentation, initial management, operative treatment, and postoperative course of 2 patients who sustained traumatic combined occiput-C1 and C1-C2 dissociations. After initial stabilization, both patients underwent open reduction and posterior occipital-cervical fusion with segmental fixation. At recent follow-up, both patients maintain good sagittal alignment without loss of reduction, and they have radiographic progression to fusion, minimal pain, and improved neurologic function. Combined occiput-C1 and C1-C2 dissociations are rare but serious injuries. Incomplete dissociations may not be evident on initial radiographs. Computed tomography or magnetic resonance imaging is recommended for formal diagnosis. A traumatic dural tear may be present. We recommend open reduction and posterior occipital-cervical fusion with segmental fixation for these patients.     

Gastrointestinal symptoms and patient satisfaction more than 1?year after laparoscopic Nissen fundoplication

Background  

Symptoms from poorly controlled gastroesophageal reflux disease (GERD) such as heartburn and regurgitation often resolve after laparoscopic Nissen fundoplication. Unfortunately, new gastrointestinal symptoms such as bloating may occur for some patients. Accurate data regarding the gastrointestinal symptoms experienced by patients who have had a laparoscopic fundoplication may help patients to make more informed decisions about pursuing surgery for their reflux disease.     

Is repetitive intraoperative splash basin use a source of bacterial contamination in total joint replacement?

Splash basins are used in arthroplasty cases to wash instruments. Several studies in the literature have shown these basins being a potential source of bacterial infection. This study assesses the risk of contamination of intraoperative splash basins used to wash and store instruments. A total of 46 random clean primary arthroplasty cases (32 hips, 13 knees, and 1 unicondylar knee) were studied by taking cultures of sterile splash basins as soon as they are opened (controls) and again at wound closure after instruments and debris have come into contact with the sterile water. All cultures were taken with sterile culture swabs and sent to the laboratory for aerobic, anaerobic, and fungal culture. Outcome measured was any positive culture. A total of 92 cultures from 46 cases were tested. Only 1 (2.17%) control culture, which grew Streptococcus viridans, was positive for bacterial growth. One of 46 samples (2.17%) taken at wound closure was positive for coagulase-negative Staphylococcus. Mean time between basin opening and wound closure was 180±45 minutes. For the 1 infected sample taken at the conclusion of the case, it was 240 minutes. Previous studies show contamination rates as high as 74% for splash basins used intraoperatively. Our study contradicts the belief that splash basins are a high source of infection, with only 2.17% of basins showing contamination. Splash basins can be a potential source of contamination, but the risk is not as high as previously cited in the orthopedic literature.     

A segmented attenuation correction for PET

A segmented attenuation correction technique has been developed for positron emission tomography which computes attenuation correction factors automatically from transmission images for use in the final image reconstruction. The technique segments the transmission image into anatomic regions by thresholding the histogram of the attenuation values corresponding to different regions such as soft tissue and lungs. Average values of attenuation are derived from these regions and new attenuation correction factors are computed by forward projection of these regions into sinograms for correction of emission images. The technique has been tested with phantom studies and with clinical cardiac studies in patients for 30- and 10-min attenuation scan times. This method for attenuation correction was linearly correlated (slope = 0.937 and r2 = 0.935) with the standard directly measured method, reducing noise in the final image, and reducing the attenuation scan time.     

The impact of training under different visual-spatial conditions on reverse-alignment laparoscopic skills development

Background  

Circumstances may arise during laparoscopic procedures in which alignment of the laparoscope and the instruments is off by 180°, creating a mirror image of the operative field. It has been shown that task performance is degraded under these reverse-alignment conditions, and that the magnitude of performance impairment is directly related to laparoscopic experience and skill. The aim of this study was to determine if reverse-alignment surgical skills could be developed through training.