Pre-operative Two-Point Discrimination Predicts Response to Carpal Tunnel Release

HSS Journal ® - Limited evidence informs whether pre-operative values of two-point discrimination (2PD) in patients with carpal tunnel syndrome predict response to surgery. The primary aim of...     

Counter incision is a safe and effective method for alternative reservoir placement during inflatable penile prosthesis surgery

BackgroundAlternative reservoir placement is increasingly popular during inflatable penile prosthesis (IPP) surgery to prevent intraperitoneal positioning, bowel, bladder, or vascular injury in patients with prior pelvic surgeries. Counter incision (CI) can be used for submuscular reservoir placement in high risk patients, however series exploring the safety remain limited.MethodsA database of IPP surgeries was queried for use of a CI during reservoir placement to compare 90-day clinical outcomes in a retrospective case-control study. Primary outcome was device infections, with secondary outcomes including reservoir herniation, hematoma, device malfunction rates, and operative times. Groups were compared using Kruskal-Wallis and Chi-Squared tests, with multivariate logistic regression models to identify predictors of infectious complications.ResultsA total of 534 cases met criteria, of which 51 (9.6%) used a CI for reservoir placement. The CI cohort included significantly more removal and replacements, 45.1% vs. 20.9% (P<0.001). Thirty-one CI patients (61.0%) had undergone prior prostatectomy compared to 134 (27.7%) non-CI patients (P=0.001). The most common reasons for CI were prior prostatectomy and inguinal hernia repair. Median operative time was 17 minutes longer in the CI group (74 vs. 57 minutes, P<0.001). Device infection rates were similar (2.0% vs. 4.1%, P=0.71), as were rates of hematoma (5.9% vs. 2.7%, P=0.19), and device malfunction (0.0% vs. 1.4% P=1.00).ConclusionsComplication rates were similar between CI and non-CI cohorts, even in a subset where approximately half the cases were removal and replacements. For physicians not comfortable with alternative placement through a penoscrotal or infrapubic incision, this offers a reasonable alternative and permits use of three-piece devices in patients with a hostile pelvis.     

Primary and radiation induced skull base osteosarcoma: a systematic review of clinical features and treatment outcomes

Journal of Neuro-Oncology - We aim to systematically review and summarize the demographics, clinical features, management strategies, and clinical outcomes of primary and radiation-induced...     

Delayed presentation of thoracic esophageal perforation after blunt trauma

Thoracic esophageal perforation after blunt trauma is a rare injury with high mortality. Prompt recognition and aggressive treatment are paramount to survival. We report a case of delayed presentation that emphasizes the diagnostic difficulties in this traumatic injury. A review of the prevalence, diagnosis, and management is also discussed.     

The bumper stitch for drainage tube securement: preliminary study

Tube dislodgment is a common problem in drainage procedures. The present report compares a securement technique known as the bumper stitch, which aims to reduce tube motion and suture erosion, versus the traditional air knot. A total of 61 patients were enrolled, and 12 bumper stitches and 54 air knots were observed. Eighty-three percent of bumper tubes had no play (ie, in-and-out motion), versus 41% of the air knot tubes (P = .02); the mean amount of play with the bumper was 0.4 mm, versus 4.7 mm for the air knot (P = .007). The bumper stitch significantly reduces tube play and may therefore aid in reducing dislodgment.     

Clopidogrel use in coronary artery disease

Platelet adhesion, activation and aggregation are central to the pathophysiology of the acute coronary syndromes. Clopidogrel, an oral thienopyridine derivative, is a platelet adenosine diphosphate receptor antagonist capable of inhibiting platelet activation. During the last decade, the utility of clopidogrel has been evaluated in several common clinical scenarios in a large number of patients. The benefits of clopidogrel in patients with stable coronary artery disease undergoing elective percutaneous coronary interventions and in patients presenting with acute coronary syndromes are now well established. This review outlines the pharmacology of clopidogrel, highlights the results of clopidogrel trials in the setting of acute coronary syndromes, and presents areas of uncertainty and potential future work.