Patient exposure during videofluoroscopic swallowing studies performed by speech-language pathologists.

Videofluoroscopic swallowing studies (VFSSs) are fluoroscopic examinations performed by speech and language pathologists (SLPs), for the evaluation of the oral and pharyngeal phases of swallowing, in patients who are diagnosed with symptoms like dysphagia and speech impairment. The study was focused on the evaluation of the patient doses from VFSS performed at Hamad Medical Corporation hospitals. Data on the patient exposure and examination parameters were extracted from the Radiation Dose Monitoring system, statistically analysed and compared with literature. For adult patients, the mean (median) values for fluoroscopy time and kerma-air product were 2.8 (2.7) min and 181 (144) cGycm2, respectively. For children, the respective mean (median) values were 2.6 (2.4) min and 15.3 (9.2) cGycm2. The results of the study indicate that the VFSS are performed by well-trained health professionals, and as a result, image quality sufficient for a confident diagnosis is obtained at relatively low dose levels.

Novel perspectives of sodium handling in type 2 diabetes mellitus.

INTRODUCTION: As a key regulator of body water, sodium homeostasis forms an essential component of human physiology. Type 2 Diabetes Mellitus (T2D)-associated sodium overload stems from chronic renal retention of sodium, contributing toward the development of adverse cardiovascular sequelae. AREAS COVERED: Our traditional model of sodium regulation invokes two compartments: extracellular fluid (ECF [plasma and interstitial fluid]) and intracellular fluid (ICF). Data from the Mars program reveal inconsistencies with this two-space model, including mismatches between net body sodium and water. Recent data utilizing 23Na magnetic resonance imaging (MRI) show a preponderance of bound sodium within human dermis, consistent with a third space repository and providing compelling evidence to support a three-space model in which dermal sodium binding facilitates sodium homeostasis within the ECF and ICF. This buffer is impaired in T2D, with diminishment of dermal bound sodium that may promote deleterious sequelae of sodium overload within the ECF and ICF. EXPERT OPINION: Future studies should focus on novel therapeutic opportunities for sodium regulation in T2D and other conditions of sodium dysregulation. The ratio of free:bound dermal sodium (reflecting sodium storage capacity) could be utilized as a clinical biomarker for salt and water balance, to improve diagnostic accuracy and facilitate clinical decision-making.

Human growth hormone and the development of osteochondritis dissecans lesions.

No single etiology regarding the cause of osteochondritis dissecans (OCD) lesions is unanimously accepted. This report documents a novel case of multiple OCD lesions affecting the left knee and a solitary defect of the right elbow in a patient with acquired human growth hormone (hGH) deficiency and supplementation. hGH deficiency and hormone replacement may be related to the development of OCD lesions.

A late vascular complication due to component migration after revision total hip arthroplasty.

Although vascular injuries associated with primary and revision total hip arthroplasty are infrequent, these complications can have devastating effects that can lead to morbidity and even mortality. No previous reports have described embolic distal limb ischemia secondary to a failed and migrated acetabular implant in discontinuity with the pelvis. We present a novel case in which a screw from a failed and migrated acetabular cage construct led to injury of the superficial femoral artery. While awaiting the construction of a custom prosthesis, the patient developed thromboembolism leading to distal extremity ischemia. The patient was treated with thrombolytic therapy, anticoagulation, removal of the offending hardware, forefoot amputation, and later hip reconstruction. Recognition of the risks associated with failed and migrated components may prevent this complication in the future.

Mitigation of seawater intrusion in coastal aquifers using coastal earth fill considering future sea level rise.

Saltwater intrusion (SWI) is a physical problem that threatens many coastal aquifers all over the world. Saltwater intrusion is increasing with abstraction and rise in sea level. Coastal aquifer protection is essential to protect groundwater resources in these areas. A number of methods have been developed to protect coastal aquifers from SWI. This paper presents the impact of sea level rise on SWI in coastal aquifers and application of coastal earth fill as a new technique to control SWI. Different future sea level rise scenarios were studied and different coastal earth fill with an appropriate soil to extend the coastline towards the sea in order to control SWI was studied using SEAWAT model. The proposed control measure is numerically assessed by Henry's problem and then applied to a real case study of Biscayne aquifer, Florida, USA. For each aquifer, the corresponding relation was developed between the intrusion length of saltwater wedge and the width of fill. The results showed that increasing the fill width resulted in decreasing the intrusion length. In the case of Biscayne aquifer, increasing the fill width by 10, 20, 30, and 40% of the aquifer length resulted in retarding the intrusion to 329, 192, 42, and - 48 m respectively. Using 150- and 300-m fill widths retards the intrusion length by 32.3% and 60.5%. In addition, increasing the fill width to 465 m can retard SWI by 91.3%. This approach is capable to control the future risks of SWI and sea level rise.

Effectiveness of the Taut-Line Hitch Knot in Reducing and Splinting Lower Extremity Fractures.

Techniques for single-provider reductions are valuable methods for provisional stabilization of fractures. In the setting of a lower extremity fracture, these techniques often use stockinette or kerlex to suspend an extremity while a reduction maneuver is performed, cast padding is applied, and a plaster splint is placed with subsequent molding to maintain reduction. Obtaining and maintaining a suitable amount of tension to the soft material while securing the limb to the stretcher or hospital bed continues to make these reduction maneuvers difficult to perform. This challenge is exacerbated in the obese patient population. As such, we describe the adaptation of the taut-line hitch knot in the setting of single-provider reductions. This knot type permits adjustable tensioning of kerlex or stockinette while suspending a limb when force is applied perpendicular to the direction of tension. This facilitates positioning and maintenance of limb suspension during reductions of unstable lower extremity injuries.

Stable Fixation and Immediate Weight-Bearing After Combined Retrograde Intramedullary Nailing and Open Reduction Internal Fixation of Noncomminuted Distal Interprosthetic Femur Fractures.

With an aging population, treatment of interprosthetic femur fractures continues to pose a challenge to the orthopaedic surgeon. Retrograde intramedullary nailing combined with open reduction internal fixation using a tissue-preserving plating technique was used in our series of 9 patients with noncomminuted, distal femur fractures. No interfragmentary screws, cables, cerclage wires, or supplemental bone grafts of any type were used. Each patient initiated weight-bearing as tolerated after operative intervention. Every fracture healed at an average of 20 weeks (range 18-24 weeks). Use of a lateral locking plate combined with a retrograde intramedullary nailing enables immediate postoperative weight-bearing and stable fixation for patients with interprosthetic femur fractures.