Evaluation for occult sepsis incorporating NIRS and emergency sonography.

PURPOSE: We aim to determine whether the combination of regional tissue oxygen saturation (StO2) measurement using near-infrared spectroscopy (NIRS), inferior vena cava (IVC) collapsibility and ejection fraction (EF) is able to detect occult sepsis. METHODS: We included adult patients in the emergency department with at least one of the following: fever; any one component of the quick sepsis-related organ function assessment (SOFA) score; heart rate≥100 beats per minute; or white cell count <4.0×109/L or >12.0×109/L. StO2 parameters, IVC collapsibility and EF were assessed. Primary outcome was composite of admission to intensive care unit, hypotension requiring fluid resuscitation or vasopressor use, and antibiotic escalation. RESULTS: We included 184 patients with mean age of 55.4years and slight male predominance (51.6%). Increase in temperature (adjusted odds ratio [aOR] 3.05; 95% confidence interval [CI] 1.16 to 8.02), higher white cell counts (aOR 1.10; 95% CI 1.03 to 1.19), increase in time taken to new StO2 baseline (aOR 1.03; 95% CI 1.01 to 1.06) and reduced EF (aOR 33.9; 95% CI 2.19 to 523.64) had higher odds of achieving the primary outcome. CONCLUSION: Change in StO2 and time taken to reach new StO2 baseline, combined with EF could potentially predict sepsis among patients with infection.

Spontaneous healing of a tear of an anterior cruciate ligament graft: A case report.

BACKGROUND: Almost 30% of young athletic patients sustain a second anterior cruciate ligament (ACL) injury within 24months of their ACL reconstruction and returning to pivoting sports. Most patients with high athletic demand and significant anteroposterior instability often require ACL revision surgery to restore their pre-injury activity levels. CASE REPORT: A 24-year old gentleman ruptured his hamstring tendon autograft during a twisting injury seven months after his ACL reconstruction. Eight months post-injury, it was observed that spontaneous healing of his graft had occurred. This was confirmed with clinical examination and radiological imaging. CONCLUSION: Hamstring tendon autografts may demonstrate some self-reparative potential. This could be due to the higher response of extra-articular ligaments and tendons in response to growth factors observed in some studies. Limitations in diagnostic magnetic resonance imaging could also lead to over-interpretation of a partially torn graft.