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Green CC, Stelzer JW, Kerr MS, Tang A, Menken LG, Romanelli F, Miller JM, Liporace FA, Haidukewych GJ, Yoon RS. Risk Factors for Revision Surgery Following Revision Total Knee Arthroplasty Using a Hinged Knee Prosthesis for Septic and Aseptic Indications. J Am Acad Orthop Surg 2023; 31:e798-e814. [PMID: 37235694 DOI: 10.5435/jaaos-d-22-00746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 04/21/2023] [Indexed: 05/28/2023] Open
Abstract
INTRODUCTION The use of hinged knee replacements (HKRs) for limb salvage is a popular option for revision total knee arthroplasty (RTKA). Although recent literature focuses on the outcomes of HKR for septic and aseptic RTKAs, little is reported on the risk factors of returning to the operating room. The purpose of this study was to evaluate risk factors of revision surgery and revision after receiving HKR for septic versus aseptic etiology. METHODS A multicenter, retrospective review was conducted on consecutive patients who received HKR from January 2010 to February 2020 with a minimum follow-up of 2 years. Patients were separated into two groups: septic and aseptic RTKAs. Demographic, comorbidity, perioperative, postoperative, and survivorship data were collected and compared between groups. Cox hazard regression was used to identify risk factors associated with revision surgery and revision. RESULTS One-hundred fifty patients were included. Eighty-five patients received HKR because of prior infection, and 65 received HKR for aseptic revision. A larger proportion of septic RTKA returned to the OR versus aseptic RTKA (46% vs 25%, P = 0.01). Survival curves revealed superior revision surgery-free survival favoring the aseptic group ( P = 0.002). Regression analysis revealed that HKR with concomitant flap reconstruction was associated with a three-fold increased risk of revision surgery ( P < 0.0001). DISCUSSION HKR implantation for aseptic revision is more reliable with a lower revision surgery rate. Concomitant flap reconstruction increased the risk of revision surgery, regardless of indication for RTKA using HKR. Although surgeons must educate patients about these risk factors, HKR remains a successful treatment option for RTKA when indicated. LEVEL OF EVIDENCE prognostic, level III evidence.
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Affiliation(s)
- Cody C Green
- From the Department of Orthopaedic Surgery, Division of Orthopaedic Trauma and Adult Reconstruction, Orlando Regional Medical Center, Orlando, FL (Dr. Green, Dr. Kerr, and Dr. Haidukewych); Department of Orthopaedic Surgery, Division of Orthopaedic Trauma and Adult Reconstruction, Jersey City Medical Center, Jersey City, NJ (Dr. Tang, Dr. Menken, Dr. Romanelli, Dr. Miller, Dr. Liporace, and Dr. Yoon); and Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, CT (Dr. Stelzer)
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Patel HA, Wellington IJ, Lubonja K, Stelzer JW, Antonacci CL, Coskun E, Cote MP, Singh H, Mallozzi SS, Moss IL. Current Trends in Recombinant Human Bone Morphogenetic Protein 2 (rhBMP2) Usage for Spinal Fusion Surgery. Medicina (Kaunas) 2023; 59:medicina59050878. [PMID: 37241110 DOI: 10.3390/medicina59050878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/25/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023]
Abstract
(1) Background: Since first approved by the FDA, on-label and off-label usage of recombinant human bone morphogenetic protein 2 (rhBMP2) for spinal fusion surgeries has become widespread. While many studies have investigated the safety and efficacy of its use, as well as its economic impact, few have looked at the current trends in its on- and off-label use. The goal of this study is to evaluate the current trends of on- and off-label rhBMP2 use for spinal fusion surgery. (2) Methods: A deidentified survey was created and electronically distributed to members of two international spine societies. Surgeons were asked to report their demographic information, surgical experience, and current usage of rhBMP2. They were then presented with five spinal fusion procedures and asked to report if they use rhBMP2 for these indications in their current practice. Responses were stratified between rhBMP2 users vs. non-users and on-label vs. off-label use. Data were analyzed using chi-square with Fisher's exact test for categorical data. (3) Results: A total of 146 respondents completed the survey with a response rate of 20.5%. There was no difference in overall rhBMP2 usage based on specialty, experience, or number of cases per year. Fellowship-trained surgeons and those who practice in the United States were more likely to use rhBMP2. Surgeons who were trained in the Southeast and Midwest regions reported the highest usage rates. rhBMP2 use was more common among fellowship-trained and US surgeons for ALIFs; non-US surgeons for multilevel anterior cervical discectomy and fusions; and fellowship-trained and orthopedic spine surgeons for lateral lumbar interbody fusions. Non-US surgeons were more likely to use rhBMP2 for off-label indications compared to surgeons from the US. (4) Conclusions: While various demographics of surgeons report different rates of rhBMP2 use, off-label use remains relatively commonplace amongst practicing spine surgeons.
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Affiliation(s)
- Harshadkumar A Patel
- Westchester Medical Center, Department of Orthopaedic Surgery, Valhalla, NY 10595, USA
| | - Ian J Wellington
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT 06108, USA
| | - Klair Lubonja
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT 06108, USA
| | - John W Stelzer
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT 06108, USA
| | | | - Ergin Coskun
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT 06108, USA
| | - Mark P Cote
- Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Hardeep Singh
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT 06108, USA
| | - Scott S Mallozzi
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT 06108, USA
| | - Isaac L Moss
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT 06108, USA
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Arciero EJ, Stelzer JW, Geaney LE. Characterization of Social Media Presence among Orthopedic Residency Programs. Arch Bone Jt Surg 2022; 10:986-988. [PMID: 36561226 PMCID: PMC9749124 DOI: 10.22038/abjs.2022.66317.3172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Emily J. Arciero
- University of Connecticut School of Medicine, 200 Academic Way, Farmington CT, USA
| | - John W. Stelzer
- UConn Health, Department of Orthopaedic Surgery, 120 Dowling Way, Farmington CT, USA
| | - Lauren E. Geaney
- UConn Health, Department of Orthopaedic Surgery, 120 Dowling Way, Farmington CT, USA
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Block AM, Tamburini LM, Zeng F, Mancini MR, Jackson CA, Antonacci CL, Karsmarski OP, Stelzer JW, Wellington IJ, Lee MC. Surgical Treatment of Pediatric Scoliosis: Historical Origins and Review of Current Techniques. Bioengineering (Basel) 2022; 9:bioengineering9100600. [PMID: 36290568 PMCID: PMC9598649 DOI: 10.3390/bioengineering9100600] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/09/2022] [Accepted: 10/17/2022] [Indexed: 11/16/2022] Open
Abstract
The treatment of scoliosis has been explored and debated in medicine since the first recorded texts. Scoliosis treatment has shifted over time from external modalities, such as traction and bracing, to internal stabilization techniques that leverage surgical advances. Surgical fixation constructs can generally be separated into two different modalities: dynamic vs. static constructs. For skeletally immature individuals with progressive deformities, surgical options range from traditional or magnetically controlled growing rods to vertebral body staples or tethering. For individuals who have reached skeletal maturity, many devices have been developed that provide static length constructs. Understanding the surgical options available is critical for the appropriate management of this varied patient population. With this article, we sought to provide a summary of past and present techniques and devices used in the treatment of scoliosis.
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Affiliation(s)
- Andrew M. Block
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT 06032, USA
| | - Lisa M. Tamburini
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT 06032, USA
| | - Francine Zeng
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT 06032, USA
| | - Michael R. Mancini
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT 06032, USA
| | - Casey A. Jackson
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT 06032, USA
| | | | - Owen P. Karsmarski
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT 06032, USA
| | - John W. Stelzer
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT 06032, USA
| | - Ian J. Wellington
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT 06032, USA
- Correspondence:
| | - Mark C. Lee
- Department of Orthopaedic Surgery, Connecticut Children’s Medical Center, Hartford, CT 06106, USA
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Wellington IJ, Garvin PM, Stelzer JW, Morgan C, Alessi A, Hall M, Rodner C, Edgar C. Transient Exertional Compressive Radial Neuropathy in a Collegiate Baseball Pitcher: A Case Report. JBJS Case Connect 2022; 12:01709767-202212000-00043. [PMID: 36820758 DOI: 10.2106/jbjs.cc.22.00352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 09/06/2022] [Indexed: 02/24/2023]
Abstract
CASE A 21-year-old collegiate baseball pitcher presented with transient lateral arm pain and wrist extension weakness after pitching more than 1 inning. Physical examination was unremarkable at rest. Ultrasound-guided injection of the radial nerve at the level of the lateral intramuscular septum improved his symptoms. After decompression of the radial nerve, the patient noted resolution of his symptoms while pitching. CONCLUSION Atraumatic radial neuropathy is a rare but documented phenomenon. As far as we know, this is the first reported case of a transient exertional radial neuropathy in an athlete at the level of the lateral intermuscular septum.
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Affiliation(s)
- Ian J Wellington
- UConn Health, Department of Orthopaedic Surgery, Farmington, Connecticut
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Wellington IJ, Schneider TJ, Hawthorne BC, McCarthy MB, Stelzer JW, Connors JP, Dorsey C, Williams V, Lindsay A, Solovyova O. Prevalence of Bacterial Burden on Macroscopic Contaminants of Orthopaedic Surgical Instruments Following Sterilization. J Hosp Infect 2022; 130:52-55. [PMID: 36087803 DOI: 10.1016/j.jhin.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 08/23/2022] [Accepted: 08/30/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Macroscopic contamination of orthopaedic instruments with particulates, including cortical bone and polymethyl methacrylate (PMMA) cement, having previously undergone preoperative sterilization, is frequently encountered peri- or intraoperatively, calling into question the sterility of such instruments. AIM The purpose of this study is to determine if macroscopic contaminants of orthopaedic surgical instrumentation maintain a bacterial burden following sterile processing. Additionally, this manuscript looks to determine the most commonly contaminated instruments and what the most common contaminants are. METHODS At a single tertiary referral centre, we prospectively collected available macroscopic contaminants in orthopaedic instrument trays over a six month period from August 2021 to May 2022. When identified, these specimens were swabbed and plated on sheep blood agar. All specimens were incubated at 37°C for 14 days, and visually inspected for colony formation. When bacterial colony formation was identified, samples were sent for species identification. RESULTS A total of 33 contaminants were tested, with only one contaminant growing bacterial colonies which was found to be Corynebacterium. The items most commonly found to have macroscopic contamination were surgical trays (9) and cannulated drills. The identifiable contaminants were bone (10), PMMA bone cement (4), and hair (4). There were 11 macroscopic contaminants that were not identifiable. CONCLUSION This study found that 97% of macroscopic orthopaedic surgical instrument contaminants that underwent sterile processing did not possess a bacterial burden. Contaminants discovered during a procedure are likely to be sterile and do not pose a substantially increased risk of infection to a patient.
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Affiliation(s)
- Ian J Wellington
- University of Connecticut Department of Orthopedics, 120 Dowling Way, Farmington, CT, 06032.
| | - Thomas J Schneider
- University of Connecticut Department of Orthopedics, 120 Dowling Way, Farmington, CT, 06032
| | - Benjamin C Hawthorne
- University of Connecticut Department of Orthopedics, 120 Dowling Way, Farmington, CT, 06032
| | - Mary Beth McCarthy
- University of Connecticut Department of Orthopedics, 120 Dowling Way, Farmington, CT, 06032
| | - John W Stelzer
- University of Connecticut Department of Orthopedics, 120 Dowling Way, Farmington, CT, 06032
| | - John P Connors
- University of Connecticut Department of Orthopedics, 120 Dowling Way, Farmington, CT, 06032
| | - Caitlin Dorsey
- University of Connecticut Department of Orthopedics, 120 Dowling Way, Farmington, CT, 06032
| | - Vincent Williams
- University of Connecticut Department of Orthopedics, 120 Dowling Way, Farmington, CT, 06032
| | - Adam Lindsay
- University of Connecticut Department of Orthopedics, 120 Dowling Way, Farmington, CT, 06032
| | - Olga Solovyova
- University of Connecticut Department of Orthopedics, 120 Dowling Way, Farmington, CT, 06032
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Wellington IJ, Stelzer JW, Connors JP, Garvin PM, Geaney LE. Prevalence of Change in Orthopaedic Subspecialty Fellowship Preference During Residency Training: A Survey Study. Arch Bone Jt Surg 2022; 10:733-734. [PMID: 36258742 PMCID: PMC9569135 DOI: 10.22038/abjs.2022.65269.3129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Ian J. Wellington
- University of Connecticut, Department of Orthopaedics, Farmington, Connecticut
| | - John W. Stelzer
- University of Connecticut, Department of Orthopaedics, Farmington, Connecticut
| | - John P. Connors
- University of Connecticut, Department of Orthopaedics, Farmington, Connecticut
| | - Patrick M. Garvin
- University of Connecticut, Department of Orthopaedics, Farmington, Connecticut
| | - Lauren E. Geaney
- University of Connecticut, Department of Orthopaedics, Farmington, Connecticut
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Kia C, Stelzer JW, Lee MC. Delayed Postoperative Spinal Cord Injury with Complete Paralysis After Adolescent Idiopathic Surgery: A Case Report. JBJS Case Connect 2022; 12:01709767-202203000-00034. [PMID: 35081063 DOI: 10.2106/jbjs.cc.21.00497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We report a 14-year-old girl with adolescent idiopathic scoliosis who experienced bilateral lower extremity paralysis related to postoperative hypotension 10 hours after posterior spinal fusion. She returned to the operating room for spinal cord decompression and hardware removal. Six weeks later, reinstrumentation was performed, and complete neurologic recovery was achieved. CONCLUSION Delayed presentation of neurologic injury after scoliosis surgery is particularly uncommon. Close postoperative monitoring, with an emphasis on hypotensive etiologies and a low threshold to remove the instrumentation, is essential to rapidly diagnose and treat these catastrophic events.
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Affiliation(s)
- Cameron Kia
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut
| | - John W Stelzer
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut
| | - Mark C Lee
- Department of Orthopaedic Surgery, Connecticut Children's Medical Center, Hartford, Connecticut
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Wellington IJ, Stelzer JW, Silver J, Solovyova O. Operative efficiency: comparison of methods to optimize the use of chlorhexidine gluconate applicators. J Hosp Infect 2021; 118:59-62. [PMID: 34637851 DOI: 10.1016/j.jhin.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/04/2021] [Accepted: 10/05/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND With the high costs of operating room time, minimizing potential causes of time waste is financially beneficial to surgeons and hospitals. The time needed to activate a chlorhexidine gluconate surgical solution applicator presents an opportunity for optimization. Many techniques are employed to expedite the process, but there have been no studies comparing these techniques. AIM To determine the most efficient method for utilizing a chlorhexidine gluconate surgical prep applicator. METHODS Six techniques were tested to determine which caused the sponge of a Chloraprep™ applicator to become saturated quickest. These were a single squeeze (control), up-and-down shaking, side-to-side shaking, pressing the sponge on a surface (dab), pressing with cotton swabs (poke), and continuously squeezing the lever of the applicator. The time between the internal glass breaking in the applicator to the time of sponge saturation with solution was measured for each technique. Times were then compared to determine which technique best expedited the process. FINDINGS The side-to-side shake, up-and-down shake, and 'dab' techniques were each significantly faster than the control group. Side-to-side shaking had the fastest time to sponge saturation on average. The average difference in time to saturation between the side-to-side shake technique and the 'poke' technique may be as much as 27.5 s. CONCLUSIONS Utilization of the side-to-side shake technique, as well as the up-and-down shake and 'dab' techniques, significantly expedite the time it takes to use a chlorhexidine gluconate applicator. The time savings from employing these techniques could result in significant financial benefits.
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Affiliation(s)
- I J Wellington
- University of Connecticut Department of Orthopaedics, University of Connecticut Health Center, Farmington, CT, USA.
| | - J W Stelzer
- University of Connecticut Department of Orthopaedics, University of Connecticut Health Center, Farmington, CT, USA
| | - J Silver
- University of Connecticut Department of Orthopaedics, University of Connecticut Health Center, Farmington, CT, USA
| | - O Solovyova
- University of Connecticut Department of Orthopaedics, University of Connecticut Health Center, Farmington, CT, USA
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Stelzer JW, Wellington IJ, Trudeau MT, Mancini MR, LeVasseur MR, Messina JC, Mazzocca AD. Readability assessment of patient educational materials for shoulder arthroplasty from top academic orthopedic institutions. JSES Int 2021; 6:44-48. [PMID: 35141675 PMCID: PMC8811415 DOI: 10.1016/j.jseint.2021.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Previous studies have demonstrated that online patient educational materials are written at reading levels too advanced for the average patient. The average American reads at the eighth-grade reading level. To date, the readability of online educational material of academic centers for shoulder arthroplasty has not been analyzed. Methods Online patient educational materials from the top 25 orthopedic institutions, as ranked by U.S. News & World Report, were assessed utilizing the following readability assessments: Flesch-Kincaid (FK), Flesch Reading Ease, Gunning Fog Index, Coleman-Liau Index, Simple Measure of the Gobbledygook Index, Automated Readability Index, FORCAST, and the New Dale and Chall Readability. All of these scores, with the exception of the Flesch Reading Ease, provide an output indicating reading difficulty based on grade level. Correlations between academic institutional ranking and FK scores were evaluated using a Spearman regression. Lastly, additional factors including geographical location, private versus public institution, and use of concomitant multi-media modalities that may impact institutional readability scores (as determined by FK) were evaluated. Results Only 16.0% of the top 25 institutions included online material at or below the eighth-grade reading level. Moreover, half of the online resources evaluated (those with FK score ≥9.3) were not at a suitable reading level for more than two-thirds of the general United States population (∼70%). Overall, the composite mean scores were 9.5 ± 2.1 for FK, 52.8 ± 9. for 4 Flesch Reading Ease, 12.2 ± 2.4 for Gunning Fog, 11.6 ± 1.8 for Coleman-Liau, 12.3 ± 1.7 for Simple Measure of the Gobbledygook Index, 9.6 ± 2.6 for Automated Readability, 11.1 ± 0.6 for FORCAST, and 5.9 ± 0.6 for New Dale and Chall. There was no correlation between institutional ranking and FK scores (ρ = −0.15; P = .946). Geographical location, private versus public institution, and use of concomitant multi-media modalities were not significantly associated with readability. Conclusion Shoulder arthroplasty online patient educational material at top-ranked orthopedic institutions have poor readability and are likely not suitable for the majority of patients in the United States.
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Rajappa R, Nazal MR, Stelzer JW, Hsu HP, Conaway WK, Rokkappanavar S, Niu W, Upadhyaya S, Alpaugh K, Spector M, Martin SD. Translational relevance of the goat as a preclinical model of the human labrum and chondrolabral junction-histological study. J Orthop Res 2020; 38:1070-1080. [PMID: 31788831 DOI: 10.1002/jor.24546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 11/24/2019] [Indexed: 02/04/2023]
Abstract
The purpose of this study was to evaluate the histologic features of the caprine labrum, with emphasis on the chondrolabral junction, with the goal of informing the feasibility of the goat as an animal model. The left hip joint of six adolescent Spanish goats (Capra pyrenaica) was harvested and subjected to anatomical and histological assessments. Human acetabular and femoral head samples, collected during total hip arthroplasty, served as comparison samples. The caprine labrum was found to consist of mostly type I collagen with uniform crimp, with an average crimp length of 20.8 µm. Upon histological assessment, acetabular articular chondrocytes were found to express substance-P, especially near or in the chondrolabral junction. And the majority of nonvascular cells expressed α-smooth muscle actin (SMA), with no notable elastin and laminin expression. Human labrum demonstrated similar staining patterns. Overall, the goat hip was found to be homologous to the human hip, demonstrating potential as a useful animal model for future studies. This is the first report of a crimped collagen structure in the labrum. Crimped type I collagen at the chondrolabral junction imparts an extension-recovery property which allows for toleration of stress without permanent deformation, underlying the importance of its preservation during surgery. The high expression of substance-P reflects the degree to which the labrum is innervated. Finally, the expression of α-SMA with contractile characteristics could indicate the potential for chondrocyte (i.e., myochondrocytes) modeling of the extracellular matrix. Statement of Clinical Significance: Establishment of a large animal model and deeper knowledge of the histological composition of the hip joint will enhance our study of the acetabular labrum, including repair techniques. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:1070-1080, 2020.
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Affiliation(s)
- Ravikumar Rajappa
- Tissue Engineering Laboratories, VA Boston Healthcare System, 150S Huntington Avenue, Boston, Massachusetts, 02130.,Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, Massachusetts, 02115
| | - Mark R Nazal
- Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Partners Heath System, Boston, Massachusetts, 02114
| | - John W Stelzer
- Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Partners Heath System, Boston, Massachusetts, 02114
| | - Hu Ping Hsu
- Tissue Engineering Laboratories, VA Boston Healthcare System, 150S Huntington Avenue, Boston, Massachusetts, 02130.,Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, Massachusetts, 02115
| | - William K Conaway
- Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Partners Heath System, Boston, Massachusetts, 02114
| | - Swetha Rokkappanavar
- Tissue Engineering Laboratories, VA Boston Healthcare System, 150S Huntington Avenue, Boston, Massachusetts, 02130.,Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, Massachusetts, 02115
| | - Wanting Niu
- Tissue Engineering Laboratories, VA Boston Healthcare System, 150S Huntington Avenue, Boston, Massachusetts, 02130.,Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, Massachusetts, 02115
| | - Shivam Upadhyaya
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, Massachusetts, 02115
| | - Kyle Alpaugh
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, Massachusetts, 02115
| | - Myron Spector
- Tissue Engineering Laboratories, VA Boston Healthcare System, 150S Huntington Avenue, Boston, Massachusetts, 02130.,Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, Massachusetts, 02115.,Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, Massachusetts, 02139
| | - Scott D Martin
- Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Partners Heath System, Boston, Massachusetts, 02114
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Stelzer JW, Esplin NE, Sbeih F, Ben Khallouq BA, Field M. Commentary: The Florida Youth Concussion Law: A Survey-Based Observational Study of Physician Practices and Their Legislative Awareness. Neurosurgery 2020; 85:E592-E598. [PMID: 31215636 DOI: 10.1093/neuros/nyz217] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 03/18/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- John W Stelzer
- University of Central Florida, College of Medicine, Orlando, Florida
| | - Nathan E Esplin
- University of Central Florida, College of Medicine, Orlando, Florida
| | - Firas Sbeih
- University of Central Florida, College of Medicine, Orlando, Florida
| | | | - Melvin Field
- Florida Hospital Neuroscience Institute, Orlando, Florida
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13
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Parsa A, Nazal MR, Stelzer JW, Sieff CA, Martin SD. A Successful Collaborative Approach to the Perioperative Management After Hip Arthroscopy of a Patient with Heterozygous Prothrombin G20210A Mutation: A Case Report. JBJS Case Connect 2019; 9:e0376. [PMID: 31085938 DOI: 10.2106/jbjs.cc.18.00376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We report on a patient with heterozygous prothrombin G20210A mutation (PTM) and a history of venous thromboembolism (VTE) after knee arthroscopy, who was undergoing hip arthroscopy. This common mutation has an overall prevalence of 2.0% and results in a 280% to 420% likelihood of thrombosis compared to patients without the mutation. CONCLUSIONS Hip arthroscopy is associated with a low risk of VTE with currently no guidelines for thromboprophylaxis. Patients should be managed in relation to their risk factors utilizing a collaborative, individualized approach. Treatment with short-term low-molecular-weight heparin resulted in no thromboembolism at 18-month follow-up for this patient with PTM.
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Affiliation(s)
- Ali Parsa
- Department of Orthopaedic Surgery, Sports Medicine, Massachusetts General Hospital, Partners Heath System, Boston, Massachusetts.,Orthopedic Research Center, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran
| | - Mark R Nazal
- Department of Orthopaedic Surgery, Sports Medicine, Massachusetts General Hospital, Partners Heath System, Boston, Massachusetts
| | - John W Stelzer
- Department of Orthopaedic Surgery, Sports Medicine, Massachusetts General Hospital, Partners Heath System, Boston, Massachusetts
| | - Colin A Sieff
- Division of Hematology/Oncology, Dana-Farber and Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Scott D Martin
- Department of Orthopaedic Surgery, Sports Medicine, Massachusetts General Hospital, Partners Heath System, Boston, Massachusetts
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Conaway WK, Agrawal R, Nazal MR, Stelzer JW, Martin SD. Changing MRI after subchondroplasty with partial meniscectomy for knee osteoarthritis. Clin Imaging 2019; 56:13-16. [PMID: 30831532 DOI: 10.1016/j.clinimag.2019.02.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/05/2019] [Accepted: 02/19/2019] [Indexed: 11/29/2022]
Abstract
A 54-year old woman with primary osteoarthritis and a tibial bone marrow lesion underwent subchondroplasty with injectable calcium phosphate. Post-operatively, the patient's symptoms worsened, and she lost the ability to bear weight. Follow-up MRI revealed previously absent, diffuse STIR hyperintensity in the tibia extending far beyond the surgical site. Twelve months post-operatively, symptoms spontaneously resolved. As the prevalence of subchondroplasty grows it will be important to recognize potential complications. To the authors' best knowledge this is the first report of significantly worsening pain and difficulty bearing weight corresponding with diffuse hyperintense T2 signal in the tibia after a calcium phosphate subchondroplasty.
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Affiliation(s)
- William K Conaway
- Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Partners Heath System, Suite 400, 175 Cambridge Street, Boston, MA, USA
| | - Ravi Agrawal
- Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Partners Heath System, Suite 400, 175 Cambridge Street, Boston, MA, USA.
| | - Mark R Nazal
- Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Partners Heath System, Suite 400, 175 Cambridge Street, Boston, MA, USA
| | - John W Stelzer
- Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Partners Heath System, Suite 400, 175 Cambridge Street, Boston, MA, USA
| | - Scott D Martin
- Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Partners Heath System, Suite 400, 175 Cambridge Street, Boston, MA, USA.
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15
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DiSciullo AA, Stelzer JW, Martin SD. Dynamic Ischiofemoral Impingement: Case-Based Evidence of Progressive Pathophysiology from Hip Abductor Insufficiency: A Report of Two Cases. JBJS Case Connect 2018; 8:e107. [PMID: 30601277 DOI: 10.2106/jbjs.cc.18.00153] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
CASE We describe 2 patients with no historical, examination, or imaging evidence of ischiofemoral impingement; they both developed hip abductor insufficiency and subsequent ischiofemoral impingement with progression that was confirmed by examination and advanced imaging. CONCLUSION Hip abductor insufficiency may lead to dynamic progressive ischiofemoral impingement. Hemipelvic instability from hip abductor weakness results in a Trendelenburg gait, narrowing the ischiofemoral space and impinging the quadratus femoris muscle. Treatment options for dynamic ischiofemoral impingement potentially can focus on treatment of the underlying cause of the hemipelvic instability, preventing additional ischiofemoral-space narrowing and quadratus femoris damage by minimizing the Trendelenburg gait.
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Affiliation(s)
- Alexander A DiSciullo
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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16
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Stelzer JW, Martin SD. Use of Bone Marrow Aspirate Concentrate with Acetabular Labral Repair for the Management of Chondrolabral Junction Breakdown. Arthrosc Tech 2018; 7:e981-e987. [PMID: 30377577 PMCID: PMC6203226 DOI: 10.1016/j.eats.2018.06.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 06/04/2018] [Indexed: 02/03/2023] Open
Abstract
Despite advances in techniques for acetabular labral repair, strategies for mitigating or reversing damage to the chondrolabral junction do not yet exist. Cartilage repair techniques such as autologous chondrocyte implantation, matrix-induced autologous chondrocyte implantation, osteochondral autograft transfer, microfracture, and bone marrow aspirate concentrate (BMAC) have all been suggested to restore joint congruity and minimize further chondral deterioration. However, chondrocyte implantation techniques and osteochondral grafts are technically challenging in the hip because of its constrained nature, and many cell-based therapies have shown suboptimal results near the chondrolabral junction because of the increased shear forces at the peripheral acetabulum and increased stress at the weight-bearing region of the joint. By using BMAC to augment labral repairs and coat chondrolabral junction breakdown, we are able to introduce mesenchymal stem cells to peripheral acetabular tissue with little to no drawbacks, while avoiding donor-site morbidity, open procedures, and multiple surgeries. The purpose of this Technical Note is to describe a reproducible method for harvesting, processing, and applying BMAC to the chondrolabral surface of the hip during hip arthroscopy without the need for donor-site morbidity or increased labral repair time.
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Affiliation(s)
- John W. Stelzer
- Address correspondence to John W. Stelzer, M.S., Massachusetts General Hospital, Sports Medicine Center, 175 Cambridge St, Ste 400, Boston, MA 02114, U.S.A.
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17
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Stelzer JW. Relative Comfort. Acad Pediatr 2018; 18:601-602. [PMID: 29545083 DOI: 10.1016/j.acap.2018.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 02/06/2018] [Accepted: 03/01/2018] [Indexed: 11/28/2022]
Affiliation(s)
- John W Stelzer
- University of Central Florida College of Medicine, Orlando, Fla.
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18
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Abstract
Background Spontaneous regression has been defined as occurring when the malignant tumor mass partially or completely disappears without any treatment or as a result of a therapy considered inadequate to influence systemic neoplastic disease. Recently, studies have implicated immunological responses as likely being involved. We report a case of a patient with squamous cell carcinoma of the lung who experienced spontaneous regression following biopsy without other intervention. Case presentation A 57-year-old white man was referred to our pulmonary clinic after an incidental finding of a nodule in the lower lobe of his left lung. Thoracic computed tomography revealed a 2.0 × 1.4 × 1.5 cm spiculated nodule in the superior segment of the left lower lobe. Workup identified the mass as a squamous cell carcinoma that was clinically staged as T1M0N0. The patient deferred treatment of this lesion. He undertook no significant lifestyle or medical changes. Three months later, computed tomography revealed that, compared with the initial study, the solitary mass had decreased in size to 1.6 × 0.9 × 0.9 cm. Follow-up computed tomography 1 year after the original workup demonstrated that the nodule had stabilized to its smaller size. Conclusions Studies have shown that immunological response can be initiated by trauma to an area. Because the tumor regression became evident in our patient only after the tissue biopsy, his immune response to the surgical procedure seems to be a plausible contributor to the spontaneous regression. Further understanding of spontaneous regression can potentially impact the identification of neoplastic drug targets or even the course of a patient’s treatment plan and goals.
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Affiliation(s)
- Nathan Esplin
- University of Central Florida College of Medicine, 6850 Lake Nona Boulevard, Orlando, FL, 32827, USA.
| | - Khadija Fergiani
- University of Central Florida College of Medicine, 6850 Lake Nona Boulevard, Orlando, FL, 32827, USA
| | - Timothy B Legare
- University of Central Florida College of Medicine, 6850 Lake Nona Boulevard, Orlando, FL, 32827, USA
| | - John W Stelzer
- University of Central Florida College of Medicine, 6850 Lake Nona Boulevard, Orlando, FL, 32827, USA
| | - Hammad Bhatti
- Department of Internal Medicine, Orlando VA Medical Center, 13800 Veterans Way, Orlando, FL, 32827, USA
| | - Sayed K Ali
- Department of Internal Medicine, Orlando VA Medical Center, 13800 Veterans Way, Orlando, FL, 32827, USA
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19
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Mayl JJ, Flores MA, Stelzer JW, Liu B, Messina SA, Murray JV. Recognizing intraventricular silicone. Emerg Radiol 2018; 25:215-218. [PMID: 29397464 DOI: 10.1007/s10140-018-1582-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 01/15/2018] [Indexed: 10/18/2022]
Abstract
Retinal detachment with subsequent silicone oil retinopexy is not uncommon. A known complication of silicone retinopexy is intraventricular migration of the intraocular silicone oil. While the oil itself does not result in direct pathology, misdiagnosis may lead to an unnecessary diagnostic workup and possibly predispose the patient to surgery intervention. Silicone oil typically appears hyperdense on computer tomography (CT) and hyperintense on T1-weighted magnetic resonance (MR). These imaging findings may mimic a mass or blood products. However, MR imaging of silicone results in chemical shift artifact which should help narrow the imaging differential. We present a patient with incidental CT and MRI findings which resulted in a prolonged hospital course following misidentification of intraventricular silicone oil. Although the imaging differential for an intraventricular lesion may include metastasis, lymphoma, hemorrhage, choroid plexus papilloma/carcinoma, meningioma, subependymoma, and ependymoma, secondary imaging findings should be noted to ensure an accurate diagnosis. In patients with evidence of prior silicone retinopexy, visualization of an intraventricular lesion with associated chemical shift artifact should raise the possibility of intraventricular silicone oil migration.
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Affiliation(s)
- Jonathan J Mayl
- University of Central Florida College of Medicine, Orlando, FL, USA
| | - Miguel A Flores
- Department of Diagnostic Radiology Residency, Florida Hospital, Orlando, FL, USA
| | - John W Stelzer
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Bo Liu
- Department of Diagnostic Radiology Residency, Florida Hospital, Orlando, FL, USA
| | - Steven A Messina
- Department of Radiology, Radiology Specialists of Florida, Maitland, FL, USA
| | - John V Murray
- Department of Radiology, Radiology Specialists of Florida, Maitland, FL, USA
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20
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Brown BD, Steinert JN, Stelzer JW, Yoon RS, Langford JR, Koval KJ. Increased risk for complications following removal of hardware in patients with liver disease, pilon or pelvic fractures: A regression analysis. Injury 2017; 48:2705-2708. [PMID: 28988807 DOI: 10.1016/j.injury.2017.09.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 09/05/2017] [Accepted: 09/28/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE Indications for removing orthopedic hardware on an elective basis varies widely. Although viewed as a relatively benign procedure, there is a lack of data regarding overall complication rates after fracture fixation. The purpose of this study is to determine the overall short-term complication rate for elective removal of orthopedic hardware after fracture fixation and to identify associated risk factors. MATERIALS AND METHODS Adult patients indicated for elective hardware removal after fracture fixation between July 2012 and July 2016 were screened for inclusion. Inclusion criteria included patients with hardware related pain and/or impaired cosmesis with complete medical and radiographic records and at least 3-month follow-up. Exclusion criteria were those patients indicated for hardware removal for a diagnosis of malunion, non-union, and/or infection. Data collected included patient age, gender, anatomic location of hardware removed, body mass index, ASA score, and comorbidities. Overall complications, as well as complications requiring revision surgery were recorded. Statistical analysis was performed with SPSS 20.0, and included univariate and multivariate regression analysis. RESULTS 391 patients (418 procedures) were included for analysis. Overall complication rates were 8.4%, with a 3.6% revision surgery rate. Univariate regression analysis revealed that patients who had liver disease were at significant risk for complication (p=0.001) and revision surgery (p=0.036). Multivariate regression analysis showed that: 1) patients who had liver disease were at significant risk of overall complication (p=0.001) and revision surgery (p=0.039); 2) Removal of hardware following fixation for a pilon had significantly increased risk for complication (p=0.012), but not revision surgery (p=0.43); and 3) Removal of hardware for pelvic fixation had a significantly increased risk for revision surgery (p=0.017). CONCLUSIONS Removal of hardware following fracture fixation is not a risk-free procedure. Patients with liver disease are at increased risk for complications, including increased risk for needing revision surgery following hardware removal. Patients having hardware removed following fixation for pilon fractures also are at increased risk for complication, although they may not require a return trip to the operating room. Finally, removal of pelvic hardware is associated with a higher return to the operating room.
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Affiliation(s)
- Bryan D Brown
- Department of Orthopedics, Orlando Regional Medical Center, United States
| | - Justin N Steinert
- Department of Orthopedics, Orlando Regional Medical Center, United States
| | - John W Stelzer
- Department of Orthopedics, Orlando Regional Medical Center, United States
| | - Richard S Yoon
- Department of Orthopedics, Orlando Regional Medical Center, United States.
| | - Joshua R Langford
- Department of Orthopedics, Orlando Regional Medical Center, United States
| | - Kenneth J Koval
- Department of Orthopedics, Orlando Regional Medical Center, United States
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21
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Esplin N, Stelzer JW, All S, Kumar S, Ghaffar E, Ali S. A Case of Streptococcus anginosus Brain Abscess Caused by Contiguous Spread from Sinusitis in an Immunocompetent Patient. Cureus 2017; 9:e1745. [PMID: 29218260 PMCID: PMC5714405 DOI: 10.7759/cureus.1745] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Brain abscesses are infections of the brain parenchyma that can arise from either contiguous spread from local infection or by hematogenous spread from a distant site. Streptococcus anginosus of the Streptococcus anginosus group (SAG) is a commensal microbe of the mucosae of the oral cavity, gastrointestinal tract, and urogenital tract. We present a case of mono-microbial brain abscess caused by contiguous spread from relatively asymptomatic sinusitis that initially presented as a subdural hemorrhage on computed tomography. A 70-year-old male presented, obtunded, with a Glasgow Coma Score of eight. The patient seized on arrival. A computed tomography scan was read as a subdural hemorrhage, and magnetic resonance imaging showed a heterogeneous area at the anterior tip of the left frontal lobe interpreted as a frontoparietal abscess, along with pansinusitis. Craniotomy revealed a loculated abscess. Culture grew only Streptococcus anginosus. The patient did well postoperatively, was extubated by day five with rapidly improving neurological function, and was discharged to inpatient rehab by hospital-day eight for the continuation of intravenous antibiotics. This case represents a frontal lobe abscess caused by the contiguous spread of Streptococcus anginosus from a frontal sinus infection. This is a relatively rare presentation of SAG infection in an immunocompetent patient. The case outlines the importance of imaging modality choice in the various stages of brain abscess formation, and the necessity of maintaining an index of suspicion for brain abscess in patients with few traditional risk factors and little to no history on presentation.
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Affiliation(s)
| | | | - Sean All
- University of Central Florida College of Medicine
| | | | - Ejaz Ghaffar
- Department of Internal Medicine, Osceola Regional Medical Center
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22
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Abstract
We present a case of severe acquired acrodermatitis enteropathica in a vegan adult female with multiple underlying comorbidities. Acquired acrodermatitis enteropathica or zinc-deficiency dermatitis is the most common diagnosis than many practitioners realize with up to 10% of the patients in developed nations with the risk of zinc deficiency. The condition can be difficult to diagnose due to many similarly-presenting conditions. Furthermore, comorbid conditions in the patients can serve as confounders to the diagnosis. The symptoms are often extremely distressing for the patients, though the treatment is simple and clinical improvement occurs rapidly with appropriate care. We recommend a high index of suspicion to practitioners as well as a low-threshold for initiating treatment in the patients with any clinical symptoms of the condition.
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Affiliation(s)
- Steven Kelly
- Medical Student, University of Central Florida College of Medicine
| | | | | | - Ahsan Farooq
- Internal Medicine, University of Central Florida College of Medicine
| | - Olga Karasik
- Internal Medicine, University of Central Florida College of Medicine
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23
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Ramirez A, Grekoski V, Valente M, Tissavirasingham F, Fahey A, Guevara N, Stelzer JW, Ma MJ, Burt J. Concurrent Multiple Myeloma and Metastatic Osteosarcoma: A Case Report and Literature Review. Cureus 2017; 9:e1634. [PMID: 29104842 PMCID: PMC5663324 DOI: 10.7759/cureus.1634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Multiple myeloma (MM) and osteosarcoma (OS) are two common bone malignancies, however, the simultaneous occurrence of both primary bone tumors in the same patient has not been reported in the United States to date. We present a unique case in which both malignancies present concurrently in a 72-year-old man. Results of spinal magnetic resonance imaging (MRI), radiographic skeletal survey, and hematological workup established the initial diagnosis of MM. Approximately three months later, the patient was admitted with severe right hip pain and shortness of breath and was evaluated with computed tomography (CT) of the right hip, abdomen, pelvis, and chest, revealing an osseous mass with a “sunburst” pattern in the right hip, and several calcified nodules in the lungs. Subsequent wedge resection and histological evaluation of the lung nodules confirmed the diagnosis of metastatic OS to the lungs, with a presumptive diagnosis of primary OS of the right hip. The clinical findings and imaging characteristics in this case are presented. Two similar cases found in the literature are also briefly discussed. The findings of this case report suggest that, in rare instances, MM patients with sclerotic bone findings may have a concurrent diagnosis of OS.
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Affiliation(s)
| | | | | | | | | | | | | | - M Joe Ma
- Pathology, Florida Hospital-Orlando
| | - Jeremy Burt
- Diagnostic Radiology, Florida Hospital-Orlando
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Cosio-Lima LM, Desai B, Stelzer JW, Schuler PB. Effects of 4:1 carbohydrate/protein solution versus a carbohydrate-alone solution on IL-6, TNF-α, and cortisol during prolonged cycling in hot environmental conditions. Open Access J Sports Med 2012; 3:21-6. [PMID: 24198583 PMCID: PMC3781895 DOI: 10.2147/oajsm.s28176] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Intense or prolonged exercise and/or heat stress might affect the immune system creating a response similar to trauma or inflammation, resulting in an increase in the susceptibility to viral infections. For example, during prolonged exercise, inflammatory cytokines, such as tumor necrosis factor (TNF)-α, interleukin (IL)-6, and the stress hormone cortisol are produced and released. Although there have been several studies examining the effects of nutritional supplementation on cytokine release in elite athletes, few studies have investigated the effects of different energy drinks during exercise in adverse environmental conditions. Therefore, the purpose of this study was to compare plasma levels of inflammatory cytokines TNF-α and IL-6, and the stress hormone cortisol, during prolonged cycling under hot environmental conditions while ingesting fluid that contains a ratio of 4:1 carbohydrates and protein (4:1 CHO/PRO) versus a carbohydrate-only drink (CHO). Methods Six male cyclists (aged 27 ± 8 years; weight 75.5 ± 3.4 kg; VO2max = 66 ± 2.7 mL/kg/min, mean ± standard error) rode on a stationary ergometer on two separate sessions for 2.5 hours at 75% VO2max in an environmental chamber set at 35°C and 60% relative humidity. During the first session the cyclists were given 4 mL/kg body weight of a 6% carbohydrate solution every 15 minutes. During the second session they were given 4 mL/kg body weight of a 4:1 carbohydrate/protein drink every 15 minutes. Subjects were not aware of which drink they were given in each trial. Blood samples were taken pre-, immediately post-, and 12 hours post-exercise. SPSS (IBM Corp, Armonk, NY) was utilized to analyze data through repeated measures analysis of variance. Results No significant main effect was observed between treatments in either cortisol (P = 0.97), IL-6 (P = 0.64), or TNF-α (P = 0.37) responses. Total cortisol concentrations were significantly elevated (P < 0.05) immediately post-exercise, and from pre- to 12 hours post-exercise with both the 4:1 CHO/PRO and the CHO-alone solutions. TNF-α concentrations were only significantly (P = 0.045) elevated post-exercise with the CHO-alone solution. A significant (P < 0.05) elevation of IL-6 was seen immediately post-exercise and 12 hours post-exercise with both the CHO-alone and 4:1 CHO/PRO solutions. Conclusions Consuming a 4:1 CHO/PRO solution during prolonged cycling under hot environmental conditions has comparable effects on inflammatory cytokines to drinking a CHO-alone solution.
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Affiliation(s)
- Ludmila M Cosio-Lima
- Department of Health, Leisure, and Exercise Science, University of West Florida, Pensacola, FL, USA
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