Filum Terminale Needle Placement During Caudal Epidural Steroid Injection.

OBJECTIVE: Caudal epidural steroid injections (ESIs) are commonly used to treat lumbar radicular pain. Touhy needles are placed under live fluoroscopic guidance to ensure epidural administration of medication. This is a case report of direct needle and catheter placements into and through the filum terminale during a caudal approach to the epidural space. DESIGN: Single case report. SETTING: Beth Israel Deaconess Medical Center. PATIENT: A 69-year-old woman who suffered from chronic low back and leg pain from lumbosacral radiculopathy, failed back surgery syndrome, and lumbar facet arthropathy. INTERVENTIONS: Caudal epidural steroid injection. OUTCOME MEASURES: Patient safety. RESULTS: The needle and catheter placement were confirmed via intrathecal contrast spread to be in the filum terminale, which prompted abortion of the procedure. CONCLUSIONS: Although caudal ESI is a relatively safe and routine intervention, care must be taken to ensure proper placement of needle, catheter, and injectate. While contrast is injected to ensure appropriate epidural spread, it serves also to reveal unexpected and unwanted spread. We present the first report of a needle being inserted directly into the filum terminale during a caudal ESI.

Paediatric Femoral Diaphyseal Fractures in a South Wales Tertiary Centre: An Account of Trend in Management and Complications Over 16 Years.

Femoral shaft fractures in children have seen a number of interesting developments over the past 20 years. This is a retrospective cohort study looking into epidemiological and outcomes data of femoral shaft fractures in children treated at a tertiary centre in Wales from 2005-2021. Over a period of 16 years, there has been a significant increase in the number of rigid or elastic nailing and submuscular plating, coinciding with a dramatic reduction of external fixation for definitive treatment of diaphyseal femoral fractures. All patients above five years of age underwent operative fixation, with elastic or rigid intramedullary nailing the treatment of choice. Following multiple linear regression with 16 possible explanatory factors, this study found a statistically significant increase in time to union for open fractures, pre-operative translation, and operation time. Furthermore, there was a significant increase in post-operative leg length discrepancy for right versus left-sided fractures. Overall complication rates were 4% for minor and 8% for major complications. Complication rates were lowest for rigid intramedullary nailing and highest for external fixation. No cases of avascular necrosis were found for 27 rigid intramedullary nails inserted. Overall this study reports treatment choices and outcomes in keeping with current trends in management for paediatric femoral shaft fractures.

Bilateral Pseudoaneurysms Following Percutaneous Achilles Tenotomy for Congenital Talipes Equinovarus.

Pseudoaneurysm following percutaneous tendoachilles (TA) tenotomy is a rare complication found in children with congenital talipes equinovarus (CTEV). It is postulated that associated aberrant vascular anatomy in combination with CTEV may be the underlying aetiology. In this case report, we describe a case of a toddler who developed bilateral pseudoaneurysms following percutaneous tendoachilles tenotomy and explore the management and outcome in relation to this. Based on this case report and a review of the literature, the consistent clinical findings of swelling and/or discolouration due to pseudoaneurysm occur at three weeks post-tenotomy, and should raise suspicion for the diagnosis. Furthermore to the best of our knowledge, this is the first case report of bilateral pseudoaneurysms in the same setting, and we propose the possibility of an aberrant vessel arising from the peroneal artery that may be prone to injury.

Multimodal Perioperative Ultrasound Course for Interns Allows for Enhanced Acquisition and Retention of Skills and Knowledge.

The ability to apply perioperative ultrasound techniques is a desirable skill for clinicians. We implemented a multimodal 13-day basic ultrasound course for 6 anesthesia interns. Their scores on a knowledge test increased after the course and were sustained and similar to those of 6 senior residents 90 days later. The interns acquired images of the heart in volunteers with little assistance after the course. They maintained their ability to acquire echocardiographic images on a simulator 90 days later with kinematic measures superior to the same seniors. Through this course, interns gained knowledge and skills equal to or greater than seniors.

Outcomes from a postgraduate biomedical technology innovation training program: the first 12 years of Stanford Biodesign.

The Stanford Biodesign Program began in 2001 with a mission of helping to train leaders in biomedical technology innovation. A key feature of the program is a full-time postgraduate fellowship where multidisciplinary teams undergo a process of sourcing clinical needs, inventing solutions and planning for implementation of a business strategy. The program places a priority on needs identification, a formal process of selecting, researching and characterizing needs before beginning the process of inventing. Fellows and students from the program have gone on to careers that emphasize technology innovation across industry and academia. Biodesign trainees have started 26 companies within the program that have raised over $200 million and led to the creation of over 500 new jobs. More importantly, although most of these technologies are still at a very early stage, several projects have received regulatory approval and so far more than 150,000 patients have been treated by technologies invented by our trainees. This paper reviews the initial outcomes of the program and discusses lessons learned and future directions in terms of training priorities.