INTRODUCTION Chronic mesenteric ischemia (CMI), also known as intestinal ischemia, is a condition that occurs when plaque builds up in the major arteries that supply the small intestine.1,2 When discussing CMI, it is important to distinguish between acute and chronic mesenteric ischemia. Acute mesenteric ischemia is a medical emergency caused by an acute loss of blood flow to the small intestine, leading to bowel infarction. This is either secondary to arterial emboli, likely originating from the heart, or soft plaque rupture leading to arterial thrombosis.3 In contrast, CMI is a constant hypoperfusion of the small intestine due to significant atherosclerosis and vessel narrowing, without plaque rupture.4 CMI presents with weight loss, pain with eating, and food aversion often resulting in significant morbidity and a delayed diagnosis.4,5 The common risk factors that increase the likelihood of chronic mesenteric ischemia include age greater than 60 years, smoking history, uncontrolled dyslipidemia, diabetes, and hypertension.1,4 This is a case of an elderly female who was diagnosed with a 90% stenosis of the superior mesenteric artery (SMA), despite having few wellknown risk factors.
{"title":"Severe Abdominal Pain Eight Years after Renal Transplant: A Case of Renal Transplant Atherosclerosis","authors":"Nikhil Parimi, M. Lippmann, Jesse Richards","doi":"10.17161/kjm.v13i.14633","DOIUrl":"https://doi.org/10.17161/kjm.v13i.14633","url":null,"abstract":"INTRODUCTION Chronic mesenteric ischemia (CMI), also known as intestinal ischemia, is a condition that occurs when plaque builds up in the major arteries that supply the small intestine.1,2 When discussing CMI, it is important to distinguish between acute and chronic mesenteric ischemia. Acute mesenteric ischemia is a medical emergency caused by an acute loss of blood flow to the small intestine, leading to bowel infarction. This is either secondary to arterial emboli, likely originating from the heart, or soft plaque rupture leading to arterial thrombosis.3 In contrast, CMI is a constant hypoperfusion of the small intestine due to significant atherosclerosis and vessel narrowing, without plaque rupture.4 CMI presents with weight loss, pain with eating, and food aversion often resulting in significant morbidity and a delayed diagnosis.4,5 The common risk factors that increase the likelihood of chronic mesenteric ischemia include age greater than 60 years, smoking history, uncontrolled dyslipidemia, diabetes, and hypertension.1,4 This is a case of an elderly female who was diagnosed with a 90% stenosis of the superior mesenteric artery (SMA), despite having few wellknown risk factors.","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"13 1","pages":"242 - 243"},"PeriodicalIF":0.0,"publicationDate":"2020-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42315683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K. Schmanke, R. Zackula, Zachary A. Unruh, Wesley A. Burdiek, Jesse J. Trent, K. Ali
Introduction Efficient execution of image-guided percutaneous biopsy is a procedural competency milestone in radiology training. Despite the importance of achieving such mastery, literature on successful execution by residents is limited. The purpose of this study was to evaluate resident performance as measured by nondiagnostic biopsy and major complication percentages, on CT-guided transthoracic core needle biopsies (TTNB) of lung and mediastinal lesions. Methods A 12-year retrospective cohort study was conducted using charts from an academic hospital, 2006 – 2018, to evaluate TTNBs. Inclusion criteria were ≥ 18 years of age and ≥ 1 follow-up CT scan and chest x-ray. Bivariable associations by outcome(s) were evaluated. Results Of 1,191 biopsies conducted, case distribution was 41%, 26%, 18%, and 15% for postgraduate years (PGY) 2 – 5, respectively. Results from biopsies were 139 (11.7%) nondiagnostic, 218 (18.3%) benign, and 834 (70.0%) malignant cases. Resident year by nondiagnostic outcome was not significant; p = 0.430. There were 148 major complications. Complication rate by PGY 2 – 5 was 13.0%, 13.3%, 12.9%, and 9.2%, respectively; differences were not significant, p = 0.488. Of the 139 nondiagnostic cases, 42 were re-biopsied during the study period with 81% re-classified as malignant; no repeat biopsy was observed for the remaining 97 nondiagnostic cases. Conclusion Of 1,191 lung/mediastinal biopsies analyzed, nearly 12% were nondiagnostic and over 12% had major complications; neither associated with resident level of experience. Outcomes were not affected significantly by level of training. Residency programs may benefit from affording opportunities for newer PGY classes to participate in procedures. Nondiagnostic cases may benefit from timely, repeat biopsies.
{"title":"Resident Experience Associated with Lung Biopsy Outcomes: A Cross-Sectional Study of Diagnostic Radiology Residents. Does the Level of Training Matter?","authors":"K. Schmanke, R. Zackula, Zachary A. Unruh, Wesley A. Burdiek, Jesse J. Trent, K. Ali","doi":"10.17161/kjm.v13i.14632","DOIUrl":"https://doi.org/10.17161/kjm.v13i.14632","url":null,"abstract":"Introduction Efficient execution of image-guided percutaneous biopsy is a procedural competency milestone in radiology training. Despite the importance of achieving such mastery, literature on successful execution by residents is limited. The purpose of this study was to evaluate resident performance as measured by nondiagnostic biopsy and major complication percentages, on CT-guided transthoracic core needle biopsies (TTNB) of lung and mediastinal lesions. Methods A 12-year retrospective cohort study was conducted using charts from an academic hospital, 2006 – 2018, to evaluate TTNBs. Inclusion criteria were ≥ 18 years of age and ≥ 1 follow-up CT scan and chest x-ray. Bivariable associations by outcome(s) were evaluated. Results Of 1,191 biopsies conducted, case distribution was 41%, 26%, 18%, and 15% for postgraduate years (PGY) 2 – 5, respectively. Results from biopsies were 139 (11.7%) nondiagnostic, 218 (18.3%) benign, and 834 (70.0%) malignant cases. Resident year by nondiagnostic outcome was not significant; p = 0.430. There were 148 major complications. Complication rate by PGY 2 – 5 was 13.0%, 13.3%, 12.9%, and 9.2%, respectively; differences were not significant, p = 0.488. Of the 139 nondiagnostic cases, 42 were re-biopsied during the study period with 81% re-classified as malignant; no repeat biopsy was observed for the remaining 97 nondiagnostic cases. Conclusion Of 1,191 lung/mediastinal biopsies analyzed, nearly 12% were nondiagnostic and over 12% had major complications; neither associated with resident level of experience. Outcomes were not affected significantly by level of training. Residency programs may benefit from affording opportunities for newer PGY classes to participate in procedures. Nondiagnostic cases may benefit from timely, repeat biopsies.","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"13 1","pages":"235 - 241"},"PeriodicalIF":0.0,"publicationDate":"2020-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43565624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. T. Tung, J. Heyns, Lynne A. Dryer, Barbara Eitutis
INTRODUCTION Incidence of thoracic aortic dissection (TAD) in the general population is very low, ranging from 2.6 3.5 cases per 100,000 persons per year, but it is associated with a high rate of mortality and morbidity.1-3 Based on the nature of its onset and anatomical location, TAD is classified as either acute or chronic Stanford type-A dissection involving the ascending aorta and type-B distal to the left subclavian artery.4,5 Acute type-A dissection is highly lethal with a 30-day mortality of 50% compared to 10% of type B.2 Most acute TAD patients presented with a sudden onset of severe chest, abdominal, or back pain, but 6.4% of them may have painless dissection.6 The majority of patients with TAD were older with a mean age of 63 years while only 7% of them were less than 40 years of age.7 Common predisposing factors for TAD are hypertension, atherosclerosis, and a history of cardiac surgery2, while in young patients they are more likely Marfan’s syndrome, bicuspid aortic valve, and prior aortic surgery.7 We report a case of a healthy, young male veteran who presented with asymptomatic, chronic type-A dissection of a large aortic aneurysm, complicated by severe aortic regurgitation (AR). Several physical signs characteristic of chronic, severe AR were found in this patient.
{"title":"Asymptomatic, Chronic Type-A Dissection of a Large Ascending Thoracic Aortic Aneurysm in a Young Patient","authors":"R. T. Tung, J. Heyns, Lynne A. Dryer, Barbara Eitutis","doi":"10.17161/kjm.v13i.14634","DOIUrl":"https://doi.org/10.17161/kjm.v13i.14634","url":null,"abstract":"INTRODUCTION Incidence of thoracic aortic dissection (TAD) in the general population is very low, ranging from 2.6 3.5 cases per 100,000 persons per year, but it is associated with a high rate of mortality and morbidity.1-3 Based on the nature of its onset and anatomical location, TAD is classified as either acute or chronic Stanford type-A dissection involving the ascending aorta and type-B distal to the left subclavian artery.4,5 Acute type-A dissection is highly lethal with a 30-day mortality of 50% compared to 10% of type B.2 Most acute TAD patients presented with a sudden onset of severe chest, abdominal, or back pain, but 6.4% of them may have painless dissection.6 The majority of patients with TAD were older with a mean age of 63 years while only 7% of them were less than 40 years of age.7 Common predisposing factors for TAD are hypertension, atherosclerosis, and a history of cardiac surgery2, while in young patients they are more likely Marfan’s syndrome, bicuspid aortic valve, and prior aortic surgery.7 We report a case of a healthy, young male veteran who presented with asymptomatic, chronic type-A dissection of a large aortic aneurysm, complicated by severe aortic regurgitation (AR). Several physical signs characteristic of chronic, severe AR were found in this patient.","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"13 1","pages":"244 - 247"},"PeriodicalIF":0.0,"publicationDate":"2020-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42834948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Natalie Eisenach, Mason E Uvodich, S. Wolff, Valerie French
Introduction Contraception is a critical component of addressing the health needs of women in the postpartum period. We assessed contraception initiation by 90 days postpartum at a large, academic medical center in the Midwest. Methods In this retrospective cohort study, 299 charts were randomly sampled and 231 were analyzed from deliveries between May 1 to July 5, 2018. Contraceptive method, maternal demographics, and obstetric characteristics at hospital discharge were collected, as well as contraceptive method at the postpartum follow-up appointment. Methods and strata of contraception were categorized as follows: 1) highly effective methods (HEM) defined as sterilization, intrauterine device, or implant, 2) moderately effective methods (MEM) defined as injectable contraception, progestin-only pills, and combined estrogen/progestin pills, patches, and rings, and 3) less effective methods (LEM) defined as condoms, natural family planning, and lactational amenorrhea. Women lost to follow-up who had initiated a HEM or injectable contraception were coded as still using the method at 90 days. We used logistic regression to identity factors associated with HEM use. Results Of the 231 included patients, 118 (51%) received contraception before hospital discharge and 166 (83%) by 90 days postpartum. Postpartum visits were attended by 74% (171/231) of patients. Before hospital discharge, 28% (65/231) obtained a HEM and 41% (82/200) were using a HEM by 90 days postpartum. Patients obtaining HEM or injectable contraception before hospital discharge attended a follow-up visit less often than those who did not receive HEM before discharge (RR = 0.68, 95% CI: 0.54 – 0.86, p ≤ 0.01). Conclusion When readily available, many women will initiate contraception in the postpartum period. Health systems should work to ensure comprehensive access to contraception for women in the postpartum period.
{"title":"Initiation of Postpartum Contraception by 90 Days at a Midwest Academic Center","authors":"Natalie Eisenach, Mason E Uvodich, S. Wolff, Valerie French","doi":"10.17161/kjm.v13i.14564","DOIUrl":"https://doi.org/10.17161/kjm.v13i.14564","url":null,"abstract":"Introduction Contraception is a critical component of addressing the health needs of women in the postpartum period. We assessed contraception initiation by 90 days postpartum at a large, academic medical center in the Midwest. Methods In this retrospective cohort study, 299 charts were randomly sampled and 231 were analyzed from deliveries between May 1 to July 5, 2018. Contraceptive method, maternal demographics, and obstetric characteristics at hospital discharge were collected, as well as contraceptive method at the postpartum follow-up appointment. Methods and strata of contraception were categorized as follows: 1) highly effective methods (HEM) defined as sterilization, intrauterine device, or implant, 2) moderately effective methods (MEM) defined as injectable contraception, progestin-only pills, and combined estrogen/progestin pills, patches, and rings, and 3) less effective methods (LEM) defined as condoms, natural family planning, and lactational amenorrhea. Women lost to follow-up who had initiated a HEM or injectable contraception were coded as still using the method at 90 days. We used logistic regression to identity factors associated with HEM use. Results Of the 231 included patients, 118 (51%) received contraception before hospital discharge and 166 (83%) by 90 days postpartum. Postpartum visits were attended by 74% (171/231) of patients. Before hospital discharge, 28% (65/231) obtained a HEM and 41% (82/200) were using a HEM by 90 days postpartum. Patients obtaining HEM or injectable contraception before hospital discharge attended a follow-up visit less often than those who did not receive HEM before discharge (RR = 0.68, 95% CI: 0.54 – 0.86, p ≤ 0.01). Conclusion When readily available, many women will initiate contraception in the postpartum period. Health systems should work to ensure comprehensive access to contraception for women in the postpartum period.","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"13 1","pages":"202 - 208"},"PeriodicalIF":0.0,"publicationDate":"2020-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45661270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nikhil Parimi, Prince Sethi, Kirk A Hance, B. Vopat, J. Darche, K. Gupta
Debilitating Claudication in an Ultramarathon Runner: A Case of Iliac Artery Endofibrosis Nikhil Parimi, M.D.1, Prince Sethi, M.D.2, Kirk Hance, M.D.3, Bryan Vopat, M.D.4, Jean-Philippe Darche, M.D.5, Kamal Gupta, M.D.2 1University of Kansas Medical Center, Department of Internal Medicine, Kansas City, KS University of Kansas Health System, Kansas City, KS 2Department of Cardiovascular Medicine 3Division of Vascular Surgery 4Department of Orthopedic Surgery and Sports Medicine 5Department of Family Medicine
{"title":"Debilitating Claudication in an Ultramarathon Runner: A Case of Iliac Artery Endofibrosis","authors":"Nikhil Parimi, Prince Sethi, Kirk A Hance, B. Vopat, J. Darche, K. Gupta","doi":"10.17161/kjm.v13i.14566","DOIUrl":"https://doi.org/10.17161/kjm.v13i.14566","url":null,"abstract":"Debilitating Claudication in an Ultramarathon Runner: A Case of Iliac Artery Endofibrosis Nikhil Parimi, M.D.1, Prince Sethi, M.D.2, Kirk Hance, M.D.3, Bryan Vopat, M.D.4, Jean-Philippe Darche, M.D.5, Kamal Gupta, M.D.2 1University of Kansas Medical Center, Department of Internal Medicine, Kansas City, KS University of Kansas Health System, Kansas City, KS 2Department of Cardiovascular Medicine 3Division of Vascular Surgery 4Department of Orthopedic Surgery and Sports Medicine 5Department of Family Medicine","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"13 1","pages":"214 - 216"},"PeriodicalIF":0.0,"publicationDate":"2020-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43414105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Grace Nassim, M. Redmond, Samuel Ofei-Dodoo, M. Benton, Kelsey Lu
Introduction Nutrition is the key contributor to disparities in many chronic diseases. However, little is known about the dietary habits and nutrition self-efficacy beliefs of older African American women with chronic diseases. This study looked at the relationship between nutrition self-efficacy and dietary patterns among older African American women. Methods A total of 115 African American women 55 years and older, with one or more chronic diseases such as hypertension, diabetes, and hyperlipidemia, were recruited from a midwestern city in Kansas. Participants completed a survey comprised of dietary intake items and the Physical Activity and Nutrition Self-Efficacy (PANSE) scale. Data were analyzed with descriptive statistics, Spearman correlation, and Wilcoxon rank sum test (Mann-Whitney U Test). Results There was a 79% (91/115) participation rate. Participants were confident in their ability to maintain healthy behaviors (57.67/72; SD = 11.22). The mean dietary score for fats and carbohydrate consumption was 32.67 ± 2.48 compared to 5.89 ± 3.52 for fruit and vegetable intake. A significant positive correlation was observed between fruit and vegetable intake and nutrition self-efficacy. A higher fruit and vegetable intake were observed among married women (mean = 7.35; SD = 4.45). Conclusion Our findings shed new light on older African American women’s perceptions of healthy eating and the confidence to eat heathy. Based on these results, older African American women met the daily fruit and vegetable recommendations; however, more work is needed to understand how to intervene to improve dietary behaviors regarding fat and carbohydrate consumption in this population. While more research is needed, the findings indicated behavioral theories such as nutrition self-efficacy may have utility in tailoring nutrition interventions in an older African American population.
{"title":"Nutrition Self-Efficacy and Dietary Patterns among Older African American Women in Kansas","authors":"Grace Nassim, M. Redmond, Samuel Ofei-Dodoo, M. Benton, Kelsey Lu","doi":"10.17161/kjm.v13i.14565","DOIUrl":"https://doi.org/10.17161/kjm.v13i.14565","url":null,"abstract":"Introduction Nutrition is the key contributor to disparities in many chronic diseases. However, little is known about the dietary habits and nutrition self-efficacy beliefs of older African American women with chronic diseases. This study looked at the relationship between nutrition self-efficacy and dietary patterns among older African American women. Methods A total of 115 African American women 55 years and older, with one or more chronic diseases such as hypertension, diabetes, and hyperlipidemia, were recruited from a midwestern city in Kansas. Participants completed a survey comprised of dietary intake items and the Physical Activity and Nutrition Self-Efficacy (PANSE) scale. Data were analyzed with descriptive statistics, Spearman correlation, and Wilcoxon rank sum test (Mann-Whitney U Test). Results There was a 79% (91/115) participation rate. Participants were confident in their ability to maintain healthy behaviors (57.67/72; SD = 11.22). The mean dietary score for fats and carbohydrate consumption was 32.67 ± 2.48 compared to 5.89 ± 3.52 for fruit and vegetable intake. A significant positive correlation was observed between fruit and vegetable intake and nutrition self-efficacy. A higher fruit and vegetable intake were observed among married women (mean = 7.35; SD = 4.45). Conclusion Our findings shed new light on older African American women’s perceptions of healthy eating and the confidence to eat heathy. Based on these results, older African American women met the daily fruit and vegetable recommendations; however, more work is needed to understand how to intervene to improve dietary behaviors regarding fat and carbohydrate consumption in this population. While more research is needed, the findings indicated behavioral theories such as nutrition self-efficacy may have utility in tailoring nutrition interventions in an older African American population.","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"13 1","pages":"209 - 213"},"PeriodicalIF":0.0,"publicationDate":"2020-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46456380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
INTRODUCTION Staphylococcus and Streptococcus sp. are the most common pathogens causing a wide range of complications following joint replacement procedures.1 These microorganisms grow in biofilms attached to the prosthetic implants, which allows them to evade the host’s immune response and resist antibiotics.2 As a result, the rate of joint failure has been increasing steadily, which prompted research into the most optimal approach for treating prosthetic joint infections. Treatment usually consists of surgery and antibiotics capable of penetrating bone and biofilm producing pathogens. In this report, we focus on antibiotic therapy in prosthetic joint infections secondary to methicillin-resistant Staphylococcus aureus (MRSA). We present a case of relapsing MRSA bacteremia associated with development of rifampin resistance in a patient with L3-L4 discitis, ischial and lumbar osteomyelitis, and psoas abscess.
{"title":"An Overlooked Cause of Rifampin Resistance","authors":"Y. Agha, J. Millard, M. Assi","doi":"10.17161/kjm.v13i.14567","DOIUrl":"https://doi.org/10.17161/kjm.v13i.14567","url":null,"abstract":"INTRODUCTION Staphylococcus and Streptococcus sp. are the most common pathogens causing a wide range of complications following joint replacement procedures.1 These microorganisms grow in biofilms attached to the prosthetic implants, which allows them to evade the host’s immune response and resist antibiotics.2 As a result, the rate of joint failure has been increasing steadily, which prompted research into the most optimal approach for treating prosthetic joint infections. Treatment usually consists of surgery and antibiotics capable of penetrating bone and biofilm producing pathogens. In this report, we focus on antibiotic therapy in prosthetic joint infections secondary to methicillin-resistant Staphylococcus aureus (MRSA). We present a case of relapsing MRSA bacteremia associated with development of rifampin resistance in a patient with L3-L4 discitis, ischial and lumbar osteomyelitis, and psoas abscess.","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"13 1","pages":"217 - 218"},"PeriodicalIF":0.0,"publicationDate":"2020-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42712463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction Smokers and nicotine users have a higher risk of femoral neck fracture non-union and prolonged time to fracture union. The impact of smoking resulting in revision surgery after fixation of femoral neck fractures, however, rarely has been studied. The aim of this retrospective study was to review if cigarette smoking had an influence on re-operation and revision after femoral neck fracture treatment. Methods Three groups of patients (Group 1: active smokers; Group 2: former smokers; and Group 3: non-smokers) who sustained a femoral neck fracture from January 2012 through August 2018 were included. Outcomes investigated included femoral neck fracture type, operative fixation type, fixation failure, and time interval between initial fixation and revision. Results A total of 1,452 subjects were identified (Group 1: 165 subjects; Group 2: 507 subjects; and Group 3: 780 subjects). In the male population, Groups 1 and 2 had higher rates of femoral neck fracture than Group 3. Twelve cases required revisions (Group 1: three cases (6%); Group 2: two cases (2%); Group 3: seven cases (4%)), with all but one revision within the first year following initial fixation. Group 1 patients tended to be younger than the other two groups. Conclusion Smoking has a positive association with the risk of femoral neck fracture amongst active and former male smokers. This study concluded that active smokers have a higher risk of non-union compared with non-smokers or former smokers. Smoking history, especially heavy or long-term, should play a role in deciding which fixation construct type to use for femoral neck fractures.
{"title":"Impact of Cigarette Smoking on Re-operation and Revision Surgery after Femoral Neck Fracture Treatment","authors":"Mitchell K. Messner, A. Chong, B. Piatt","doi":"10.17161/kjm.v13i.14563","DOIUrl":"https://doi.org/10.17161/kjm.v13i.14563","url":null,"abstract":"Introduction Smokers and nicotine users have a higher risk of femoral neck fracture non-union and prolonged time to fracture union. The impact of smoking resulting in revision surgery after fixation of femoral neck fractures, however, rarely has been studied. The aim of this retrospective study was to review if cigarette smoking had an influence on re-operation and revision after femoral neck fracture treatment. Methods Three groups of patients (Group 1: active smokers; Group 2: former smokers; and Group 3: non-smokers) who sustained a femoral neck fracture from January 2012 through August 2018 were included. Outcomes investigated included femoral neck fracture type, operative fixation type, fixation failure, and time interval between initial fixation and revision. Results A total of 1,452 subjects were identified (Group 1: 165 subjects; Group 2: 507 subjects; and Group 3: 780 subjects). In the male population, Groups 1 and 2 had higher rates of femoral neck fracture than Group 3. Twelve cases required revisions (Group 1: three cases (6%); Group 2: two cases (2%); Group 3: seven cases (4%)), with all but one revision within the first year following initial fixation. Group 1 patients tended to be younger than the other two groups. Conclusion Smoking has a positive association with the risk of femoral neck fracture amongst active and former male smokers. This study concluded that active smokers have a higher risk of non-union compared with non-smokers or former smokers. Smoking history, especially heavy or long-term, should play a role in deciding which fixation construct type to use for femoral neck fractures.","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"13 1","pages":"195 - 201"},"PeriodicalIF":0.0,"publicationDate":"2020-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44608709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
INTRODUCTION Osmotic Demyelination Syndrome (ODS) occurs following rapid overcorrection of hyponatremia.1 It is characterized by destruction of neuronal myelin sheaths in either the central area of the pons or in other susceptible areas causing severe irreversible neurologic deficits. Methods described in the literature suggested varying sodium correction rates which lead to different definitions of overcorrection of hyponatremia.2 The incidence of ODS consequently would be expected to increase. However, no general consensus exists regarding the optimal treatment regimen for this disease. Nevertheless, evidence-based management is essential for those who are diagnosed. We present a case of ODS treated with plasmapheresis (PP), intravenous immunoglobulins (IVIG), and intravenous methylprednisolone with significant recovery of neurologic function.
{"title":"Favorable Outcomes Following the Use of Triple Therapy in a Patient with Osmotic Demyelination Syndrome","authors":"C. Eze, Y. Agha, Brent Duran","doi":"10.17161/kjm.v13i.13875","DOIUrl":"https://doi.org/10.17161/kjm.v13i.13875","url":null,"abstract":"INTRODUCTION Osmotic Demyelination Syndrome (ODS) occurs following rapid overcorrection of hyponatremia.1 It is characterized by destruction of neuronal myelin sheaths in either the central area of the pons or in other susceptible areas causing severe irreversible neurologic deficits. Methods described in the literature suggested varying sodium correction rates which lead to different definitions of overcorrection of hyponatremia.2 The incidence of ODS consequently would be expected to increase. However, no general consensus exists regarding the optimal treatment regimen for this disease. Nevertheless, evidence-based management is essential for those who are diagnosed. We present a case of ODS treated with plasmapheresis (PP), intravenous immunoglobulins (IVIG), and intravenous methylprednisolone with significant recovery of neurologic function.","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"13 1","pages":"191 - 193"},"PeriodicalIF":0.0,"publicationDate":"2020-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45683325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
INTRODUCTION Patients who present with an anterior mediastinal mass (AMM) pose complex risks for the anesthesiologist to consider. While AMMs are quite rare, especially in the adult patient population, they are related most commonly to lymphoma, thymoma, germ cell tumor, granuloma, bronchogenic carcinoma, thyroid tumors, bronchogenic cyst, and cystic hygromas, in order of frequency.1,2 Since the 1970s, intraoperative complication rates of 7 20% have been reported, ranging from mild hypoxia and hypotension to complete cardiovascular collapse, airway compression, and death.3,4 When the best practices for anesthetic management of AMM’s are adhered to, including maintenance of spontaneous ventilation and avoidance of supine positioning, mortality remains relatively low, ranging from 0.3 1.1%.5 However, some of these complications may be unavoidable despite adhering to standard practices for perioperative AMM management and require appropriate preparation and time-critical intervention to avoid serious injury or death.4 We present a brief overview of the important principles and practices concerning the management of AMM and suggest an updated algorithm with emphasis on preoperative risk stratification. Furthermore, we describe a unique case of significant hypoxemia with normotension in the setting of severe contralateral tracheobronchial and pulmonary artery compression to illustrate these points.
{"title":"Perioperative Management of a Patient with Large Anterior Mediastinal Mass and Cardiopulmonary Compromise: An Updated Algorithm","authors":"Dean B Flaten, M. Marcotte, James Walker","doi":"10.17161/kjm.v13i.13874","DOIUrl":"https://doi.org/10.17161/kjm.v13i.13874","url":null,"abstract":"INTRODUCTION Patients who present with an anterior mediastinal mass (AMM) pose complex risks for the anesthesiologist to consider. While AMMs are quite rare, especially in the adult patient population, they are related most commonly to lymphoma, thymoma, germ cell tumor, granuloma, bronchogenic carcinoma, thyroid tumors, bronchogenic cyst, and cystic hygromas, in order of frequency.1,2 Since the 1970s, intraoperative complication rates of 7 20% have been reported, ranging from mild hypoxia and hypotension to complete cardiovascular collapse, airway compression, and death.3,4 When the best practices for anesthetic management of AMM’s are adhered to, including maintenance of spontaneous ventilation and avoidance of supine positioning, mortality remains relatively low, ranging from 0.3 1.1%.5 However, some of these complications may be unavoidable despite adhering to standard practices for perioperative AMM management and require appropriate preparation and time-critical intervention to avoid serious injury or death.4 We present a brief overview of the important principles and practices concerning the management of AMM and suggest an updated algorithm with emphasis on preoperative risk stratification. Furthermore, we describe a unique case of significant hypoxemia with normotension in the setting of severe contralateral tracheobronchial and pulmonary artery compression to illustrate these points.","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"13 1","pages":"188 - 190"},"PeriodicalIF":0.0,"publicationDate":"2020-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43568755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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