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Autoelimination of Retained Bullet: A Case Report
No full textCASE: A 25-year-old man presented to the hospital after a gunshot wound to the buttock. The suspected course of the bullet was transrectal, with it becoming lodged within the hip joint. The patient was jointly treated by acute care surgery and orthopaedic surgery. The bullet migrated into the pelvis with surgical attempts to remove it, and the decision was made to leave the bullet. The bullet was later spontaneously eliminated through the gastrointestinal tract.
CONCLUSION: This case demonstrates the rare phenomenon of autoelimination of a foreign body and highlights the importance of multidisciplinary communication and collaboration for optimal patient care
Associations of Obesity, Vitamin D, Adjusted Total Calcium, and Parathyroid Hormone in US from NHANES
No full textEvidence for obesity and vitamin D deficiency as components of a data phenotype for primary hyperparathyroidism (pHPT) is critical to understanding primary hyperparathyroidism. This study examined the association between vitamin D, body mass index (BMI), albumin total calcium, parathyroid hormone (PTH) and data from National Health and Nutrition Examination Survey (NHANES). Associations of 25-hydroxyvitamin D, albumin adjusted calcium, and BMI with elevated PTH were evaluated, with elevated PTH being defined as\u3e9.02 pmol/l. Outcomes were PTH (pmol/l), 25-hydroxyvitamin D (nmol/l), albumin adjusted calcium (mmol/l), and BMI. A weighted multivariable logistic regression model estimated the associations. A total of 9740 survey respondents were included in the study, 3.5% had elevated PTH. Mean vitamin D level was 57.7 (SD=22.6) nmol/l and BMI was 28.6 (SD=6.5) kg/m2. A one unit increase in BMI was associated with higher odds of elevated PTH [adjusted odds ratio (aOR)=1.04; 95% confidence interval (CI): 1.02, 1.06] whereas a one unit increase in vitamin D (aOR=0.97; 95% CI: 0.96, 0.98) or calcium (aOR=0.51; 95% CI: 0.29, 0.89) had decreased odds of elevated PTH. Higher BMI and lower levels of 25-hydroxyvitamin D are components of the primary hyperparathyroidism data phenotype. A refined data phenotype may improve detection/management of pHPT
No Panic in Hemodynamics: A Single-Access Axillary Impella-Assisted Balloon Aortic Valvuloplasty in Cardiogenic Shock
No full textA 68-year-old man with ischemic cardiomyopathy presented with critical aortic stenosis and Society for Cardiovascular Angiography and Interventions stage D cardiogenic shock. Because of occluded bilateral femoral vasculature, a right axillary single-access Impella balloon aortic valvuloplasty approach was successfully performed, improving the patient\u27s cardiac index from 1.5 to 2.5 L/min/m(2). This case highlights the use of pre-intravascular ultrasound imaging, the dry-exchange technique to enhance safety, and single-access Impella balloon aortic valvuloplasty to maintain cardiac output during repeated prolonged balloon inflations
Pulsed Dye Laser Treatment is Associated With Decreased Development of Subsequent Keratinocyte Carcinoma
No full textBACKGROUND: Keratinocyte carcinomas (KCs) are the most common cancers in the United States. Despite existing preventative strategies, their incidence continues to rise, highlighting a need for better intervention. The pulsed dye laser (PDL) has a myriad of medical indications but has not been studied in skin cancer prevention.
OBJECTIVE: The objective of this study was to assess the effect of PDL treatment on subsequent facial KC development.
MATERIALS AND METHODS: A retrospective cohort study was conducted on patients with a history of facial KC who received treatment at the Dermatology Laser and Cosmetic Center at Massachusetts General Hospital between 2000 and 2024.
RESULTS: Fifty-nine patients with a history of facial KC who received PDL treatment and 59 matched controls met inclusion criteria for the study. Subsequent facial KC was observed in 27.1% of PDL-treated patients, compared with 54.2% of controls (RR 0.50, p = .0047). After adjusting for age, sex, and skin type, control subjects remained at a higher risk for developing new facial KC compared with PDL-treated patients (HR 2.88, p = .0008).
CONCLUSION: These data suggest a potential association between PDL treatment and a reduced rate of subsequent facial KC development in patients with a history of KC
Predicting Traumatic Brain Injury Post-Trauma Using Temporal Attention on Sleep-Wake Data
No full textBACKGROUND: Traumatic Brain Injury (TBI) is a major public health concern, and accurate classification is essential for effective treatment and improved patient outcomes. Sleep/wake behavior has emerged as a potential biomarker for TBI classification, yet the optimal time window in which to identify sleep/wake changes after TBI remains unclear.
METHODS: We evaluated daily longitudinal sleep/wake data from a prospective cohort of more than 2,000 emergency department patients with and without blood biomarker-documented TBI (Glial Fibrillary Acidic Protein - GFAP ). We utilized a deep learning model to identify the impact of time from trauma and duration of data collection on the model\u27s ability to distinguish between TBI-positive (TBI+) and TBI-negative (TBI-) cases.
RESULTS: Our analysis showed that sleep/wake data from the first 7 days after TBI most accurately identified TBI. Sleep-wake data from the first 7, 14, and 21 days after trauma achieved sensitivity/specificity of 81%/25%, 40%/66%, and 45%/58%, respectively. F1 scores of deep learning models developed from the first 7, 14, and 21 days were 22%, 21%, and 20%, respectively.
CONCLUSIONS: The results suggest that early sleep/wake data has promise for assisting with TBI identification.
SIGNIFICANCE: In the future, the incorporation of sleep/wake derived biomarkers into TBI identification tools could assist in the identification of individuals with potential TBI for further screening and intervention
Transcutaneous closure of an enterocutaneous fistula using a cardiac septal occluder
No full textBackground and Aims: Enterocutaneous fistula (ECF) is an abnormal connection between the gastrointestinal tract and skin, often managed surgically with a recent shift toward endoscopic closure. We are presenting a case highlighting the off-label use of a septal occluder, placed transcutaneously under fluoroscopy, for the closure of an ECF.
Methods: We are presenting a case of a 61-year-old woman with a history of metastatic colon cancer status post sigmoid resection with loop ileostomy and palliative chemotherapy. Her course was complicated by ECF with high-volume leakage. She was deemed not a surgical candidate and failed glue injections and surgical interventions.
Results: Endoscopy including anterograde and retrograde single balloon enteroscopy failed to reach the fistula site. The patient underwent fluoroscopic ECF closure with off-label use of a septal occluder device.
Conclusions: We report a successful off-label use of a septal occluder for the closure of a refractory ECF under fluoroscopic guidance with emphasis on the importance of a multidisciplinary approach and the exploration of innovative solutions in challenging clinical scenarios
Does spinopelvic imbalance after minimally invasive lower lumbar fusion predispose patients to subsequent minimally invasive sacroiliac joint fusions? a case-control study
No full textPURPOSE: Sacroiliac joint (SIJ) dysfunction is a frequently overlooked source of persistent low back pain after lower lumbar surgery. The SIJ is an adjacent joint to the lower lumbar spine and can thus be subject to adjacent segment disease (ASD) after lower lumbar fusion. Spinopelvic imbalance can potentially predispose a patient to ASD in the SIJ, causing SIJ dysfunction. However, the impact of spinopelvic imbalance following minimally invasive (MIS) lower lumbar fusion on SIJ dysfunction and, thus, subsequent fusion remains inconclusive. We sought to determine whether spinopelvic imbalance after lower lumbar fusion predisposes patients to subsequent MIS SIJ fusion (SIJF).
METHODS: We retrospectively reviewed consecutive elective lower lumbar fusion patients (ending levels L5/S1) to select our cases and controls in a 1:1 match. We included patients who underwent MIS lower lumbar fusion from 10/2005 to 05/2021 at a single institution with an ending level including L5 or S1, a starting level at or below T12, and had at least two years of follow-up. We excluded patients with inadequate or absent postoperative X-rays, those who underwent lumbar fusion for trauma or infection, pelvic fixation, revision lumbar surgery, and prior SIJF. We performed a pilot study to determine the sample size as 190 per group. Confounders, including the number of pregnancies, were collected. Consistent with prior literature, we defined spinopelvic imbalance as a PI-LL mismatch of \u3c -10° or \u3e 10° [1-5]. We compared the groups using univariate analysis. The odds of developing SIJF related to PI-LL mismatch were calculated using Chi-Square. We performed multivariable analysis modeling on SIJF to adjust for covariates.
RESULTS: We included 488 patients (203 SIJF vs. 285 control). Between groups, the SIJF patients were significantly younger (52.55 ± 12.81 vs. 55.84 ± 14.71; P = 0.005), had a higher proportion of females (67.5% vs. 55.1%; P = 0.006), and increased levels fused (1.78 ± 0.97 vs. 1.38 ± 0.64; P \u3c 0.001). Interestingly, number of pregnancies was not significantly different (P = 0.791). PI-LL mismatch demonstrated a 3.54 increased odds of requiring subsequent SIJF (p \u3c 0.001). Multiple logistic regression adjusting for age at lumbar fusion, female sex, and number of levels demonstrated that PI-LL mismatch (OR 1.10; 95% CI 1.06-1.15; p \u3c 0.001) and operative levels (OR 1.84; 95% CI 1.42-2.39; p \u3c 0.001) were independently associated with significantly increased odds of requiring SIJF, while age (OR 0.98; 95% CI 0.96-0.99; p \u3c 0.001) and female sex (OR 0.54; 95% CI 0.36-0.81; p = 0.003) were associated with significantly decreased odds of requiring SIJF.
CONCLUSION: PI-LL mismatch following MIS lower lumbar fusion was independently associated with significant odds of requiring subsequent SIJF. Optimizing spinopelvic imbalance can decrease the odds of requiring subsequent SIJF after MIS lower lumbar surgery. Given the biases associated with the retrospective and observational nature of our study design, further prospective studies are needed
Vertical inheritance and unique differential phenotypes of reciprocal recombinant chromosome 18 within a multi-generation family
No full textCarriers of balanced pericentric inversions are at risk for producing unbalanced gametes because of meiotic recombination resulting in de novo deletion and duplication of distal chromosome ends. Recombinant chromosomes generally lead to significant imbalances resulting in anomalous clinical phenotypes in offspring, hence they are typically not inherited. Therefore, the vertical transmission of recombinant chromosomes is a clinically rare event. Using genomic microarray and karyotyping, we describe inheritance of recombinant chromosomes in a three-generation family with the grandmother carrying a mosaic pericentric inversion of chromosome 18. Three children inherited the balanced inversion and one child with a mild phenotype inherited a de novo recombinant chromosome 18. In the third generation, a newborn with a variant of holoprosencephaly inherited an unmodified recombinant chromosome from her mother. Despite having the same karyotype predicting loss of the TGIF1 gene from the 18p terminus, the mother exhibits a relatively unaffected phenotype. The cousin of the child with holoprosencephaly carries the reciprocal recombinant chromosome 18 with a much milder phenotype. We verified the cytogenetic mechanism and corresponding clinical phenotypes in affected individuals and illustrated possible recombinant chromosome consequences of the inversion of chromosome 18 in this three-generation family
