Ultrasound investigation of leg position to enhance femoral vein exposure for cannulation.

BACKGROUND: Femoral venous access is an essential part of patient care in the emergency department (ED). However, current medical literature and texts have not dealt with it much using actual patient anatomy. OBJECTIVES: This study aimed to show that manipulation of the lower extremities may alter the anatomy to a more favorable position for cannulation. METHODS: Ultrasound examination was conducted on a prospective sample of ED patients to evaluate anatomical variance of the femoral artery and vein overlap as well as the change in femoral vein diameter with leg position. Bilateral measurements of the diameter of the vein were taken at three different leg positions (straight, abduction, and abduction with external rotation). RESULTS: This study enrolled a total of 132 ED patients. Of these, 122 (92%) patients showed some degree of overlap on the right and 126 (95%) patients showed some degree of overlap on the left. There was a statistically significant decrease in the percentage of overlap when moving the leg from a straightened position to an abducted position, and an additional decrease when moving the leg into an abducted and externally rotated position. There was also a statistically significant increase in the size of the femoral vein with each of these positions. CONCLUSIONS: Up to 95% of people have some degree of overlap of the femoral vein by the femoral artery. By positioning the leg in an abducted and externally rotated position, the amount of overlap is reduced and the diameter of the vein is increased, maximizing the percentage of the vein available for cannulation.

Lymphocutaneous nocardiosis from commercially treated lumber: a case report.

GOAL: To understand nocardiaI infections to better manage patients with the condition. OBJECTIVES: 1. Identify the organisms causing nocardial infections in humans. 2. Describe the presenting symptoms of nocardial infections. 3. Explain the treatment of nocardial infections.

Biomechanical comparison of ulnar collateral ligament reconstruction techniques.

BACKGROUND: Incompetence of the ulnar collateral ligament (UCL) of the elbow is career-threatening for high-performance throwing athletes. Although multiple reconstructions have been described, a procedure that combines a larger graft with improved fixation may demonstrate more favorable loading characteristics than current techniques. HYPOTHESIS: Ulnar collateral ligament reconstructions utilizing a semitendinosus graft and interference knot fixation will be biomechanically superior to previously reported techniques. STUDY DESIGN: Controlled laboratory study. METHODS: Thirty cadaveric elbows were stripped of all medial soft tissue superficial to the UCL. The proximal humeri were mounted on a materials testing system with the elbows flexed 90 degrees . The intact UCL was loaded to failure at 4.5 deg/s. The torsional failure moment, torsional stiffness, and mode of failure were recorded. Three groups of 10 specimens were created. Group 1 underwent reconstruction using a palmaris tendon graft secured with interference knot fixation. Group 2 reconstructions utilized a palmaris graft and the docking technique. Group 3 specimens were reconstructed using a semitendinosus graft and interference knot fixation. All specimens were loaded to failure and the same parameters recorded. RESULTS: The torsional failure moments for group 1 (13.28 N x m) and group 2 (12.81 N x m) reconstructions were significantly (P < .05) inferior to that of their respective native values (21.3 N x m and 23.5 N x m). Semitendinosus reconstructions (20.5 N.m) were not significantly different (P = .24) from their native UCLs (23.0 N.m). All reconstructions were torsionally less stiff (P < .001) than the native UCL. There were no statistically significant differences in stiffness between the groups (P = .4). CONCLUSION: Ulnar collateral ligament reconstruction utilizing semitendinosus graft and interference knot fixation restores the torsional strength of the intact UCL. CLINICAL RELEVANCE: Reconstructions using semitendinosus grafts may allow for accelerated rehabilitation and earlier return to competition.