Surgical Repair of an Unstable Third Metatarsophalangeal Joint Dislocation via Direct Plantar Plate Repair: A Simple and Effective Technique
Christopher W Kinter, MD, Kevin J Kinter, MS and Christopher W Hodgkins, MD
Article Type: Case Report | First Published: August 12, 2019
Traumatic dislocation of a lesser metatarsophalangeal (MTP) joint is a rare case for a foot and ankle surgeon to encounter. These dislocations can be difficult to reduce due to the surrounding connective tissues that may be interposed in the joint space. These include the plantar plate, deep transverse metatarsal ligament, flexor tendons, and lumbricals. When the clinician is unable to reduce the phalanx, surgery is required to prevent sequelae such as further swelling, ecchymosis, joint damage, and impingement of the neurovascular bundle. In this case report, we present the case of a 53-year-...
Expression of P53 and Prognosis in Patients with Head and Neck Squamous Cell Carcinoma (HNSCC)
Amlani Lahin, Bellile Emily, Spector Matthew, Smith Joshua, Brenner Chad, Rozek Laura, Nguyen Ariane, Zarins Katie, Thomas Daffyd, McHugh Jonathan, Taylor Jeremy and Wolf T Gregory
Article Type: Original Article | First Published: August 09, 2019
Mutation of TP53 is the most common genetic abnormality in head and neck squamous cell carcinoma (HNSCC) and results in an accumulation and expression of p53 protein in tumor cells. Disruptive TP53 mutations are consistently associated with poor prognosis but correlations of p53 expression with mutation or prognosis have been variable and the usefulness of p53 as a target for immunotherapy is unknown. Favorable prognosis is associated with the accumulation of T lymphocytes (TILs) in the tumor microenvironment and an immune response to p53 has been suggested by demonstration of antibodies to p5...
The Bone Phone: Improving Time to Pain Medication Administration in Long Bone Patients
Brian Wagers, MD, Santhi Reddi, MD, Kara Kowalzyck, MD and Jessica Kanis, MD
Article Type: Research Article | First Published: September 05, 2019
Orthopedic complaints are one of the most frequent reasons for presentations to the pediatric emergency department (PED). National metrics have defined that each child should have a pain assessment and/or pain medication administered within one hour of arrival to an emergency department. Patient surges, transfers from referring hospitals, and acuity can affect the ability of a PED to meet this metric. We queried our electronic medical record (EMR) for all patients presenting to our level 1 trauma center PED pain for the 90 days prior to implementation and then for the 90 days post implementati...
Enhancement of NK Cell-Mediated Lysis of Osteosarcoma Cells by Up-Regulating the NKG2D Ligands using Spironolactone and Avemar
Sellamuthu Subbanna Gounder, Thamil Selvee Ramasamy, Sharaniza Ab Rahim and Baskar Subramani
Article Type: Original Article | First Published: September 04, 2019
Natural Killer (NK) cell has the capability to immunosensitize and cell-mediated lysis of many types of cancer cells, however, most of the cancer cells are evading the NK cell-mediated lysis by down-regulating the NK cell specific ligands. In the present study, we have evaluated the comparative and synergic effect of spironolactone (SPIR) and (AVE) in enhancing the susceptibility of osteosarcoma cells (MG-63) to NK cell-mediated lysis in vitro. NK cells used in this study was characterised by the expression of CD56 and NKG2D using flow cytometry. At an optimized concentration, SPRI (60 μM) an...
The 'SAFE PT' Handover: Impact on Safe Patient Handover between Shifts in the Emergency Department
Ahmed Mikky, MD, Mohamed Al Busafi, MD and Issa Al Salmi, MD, PHD
Article Type: Research Article | First Published: September 04, 2019
50 participants each were approached prior and post implementation of SAFE PT to fill descriptive questionnaires. The new SAFE PT tool was found to be clear and user friendly. It enhanced the handover process to a smooth one and was found to be systematic and highlighted the high acuity patients as well as red flags of each patient handed over. The bedside handover coupled with the prefilled written SAFE PT made it a safe process with increased patient satisfaction emphasized by the significant reduction in percentage of patient LOS in the ED. The SAFE PT handover proved to be a successful met...
Psychosocial Considerations for Pediatric Care in Emergency Departments
Julie Lerwick, PhD, LPC, NCC, RPT
Article Type: Case Study | First Published: August 26, 2019
When pediatric patients are admitted into emergency departments a different course of psychological care is required. Often, when admitted, children are scared and in pain. Fear and pain at any age introduces unexpected behavioral responses, and this is not an exception for children. This makes children quite vulnerable in emergency departments, regardless if caregivers are trained to work with pediatric patients. Within the urgency of delivering emergent medical care, as well as maintaining strong statistics noting minutes of care, there is little time for explanations or emotional containmen...
A Rare Coronary Anomaly: Congenital Absence of the Left Circumflex Artery
Robert Tonks, MD, Rajiv Sharma, MD and Raj Baljepally, MD, FACC
Article Type: Case Report | First Published: August 26, 2019
Congenital anomalies of the coronary vasculature are usually asymptomatic and rare with an incidence of less than 1% and there are few cases reported of congenital absence of the left circumflex artery. It is important to recognize this anomaly and define the anatomy by left heart catheterization or coronary angiography by computerized tomography when considering percutaneous intervention or coronary artery bypass surgery on patients without a left circumflex artery. 71 yo male that recently moved to the area from out of state who presented to clinic complaining of increased fatigue, exertiona...
A Case of Postural Instability with Unusual Aetiology in a Elderly Patient
Valerio Massimo Magro, MD, Carla Coppola, MD, Giovanni Scala, MD and Walter Verrusio, MD, PhD
Article Type: Case Report | First Published: August 28, 2019
Pneumocephalus or air within the cranial vault is usually associated with a series of symptoms caused by head trauma, the presence of neoplasms or after craniofacial surgical interventions or other causes. We report a case report of an elderly patient who presented with postural instability with an anamnestic history that didn’t talk about traumatic events. We review briefly the literature for nontraumatic causes causes of pneumocephalus, its symptoms and clinical manifestations and finally the therapy. The postural instability is a spatial orientation disorder with an erroneous perception o...
Epidural Anesthesia for a Caesarean Delivery in a Parturient with an Intrathecal Baclofen Pump and Sickle Cell Disease: A Case Report
Bastian J, Bauer A, Kern C and Robertson-Baeriswyl M
Article Type: Case Report | First Published: August 23, 2019
A 32-year-old primigravida woman received an epidural anesthetic at 38 weeks of gestation for an elective caesarean delivery. She had for the past 10 years an intrathecal baclofen infusion pump to relieve spastic tetraparesis secondary to perinatal cerebral anoxia. She otherwise also suffered from sickle cell disease complicated by several vaso-occlusive crisis during pregnancy and a recent history of thromboembolic disease. A recent CT scan showed the intrathecal catheter entering the L3-L4 interspace and extending proximally to the thoracic region. For the caesarean delivery, an epidural cat...