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OBJECTIVE: Review the effectiveness of surgical and non-surgical management strategies for isolated pars flaccida and combined pars tensa and flaccida tympanic membrane retractions in preventing progression or recurrence, improving hearing and preventing development of cholesteatoma. DESIGN: Narrative review. SETTING: ENT and otology services worldwide. PARTICIPANTS: Patients with non-cholesteatoma tympanic membrane retractions. MAIN OUCTOME MEASURE: Changes in retraction (progression or resolution, or development of a known sequela such as perforation). RESULTS: Eight full text papers are included: three randomised controlled trials and five case series or cohort studies of more than five patients (a total of 238 ears). Data exists for the use of conservative management, ventilation tubes, laser tympanoplasty, cartilage and fascia tympanoplasty, lateral attic reconstruction as well as mastoid procedures. CONCLUSION: Few high-quality studies on the management of isolated and combined pars flaccida retractions exist. For isolated pars flaccida retractions deemed to require surgical intervention, this review suggests that lateral attic reconstruction and cartilage tympanoplasty carries least risk of recurrence.
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High-pressure injection injuries of the hand are uncommon but are associated with significant morbidity and require urgent surgical intervention. We describe a case of high-pressure injection of cement into the digit of a male patient while using an airless spray gun. We outline the initial assessment and surgical intervention, patient counselling regarding definitive management, and long-term outcomes of his injury. We also discuss mechanisms of high-pressure injection injuries, reconstructive options, and present a review of outcomes in patients sustaining similar injuries.
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Each year, more than 250,000 Americans will suffer a broken hip from a fall from no more than standing height. The National Osteoporosis Foundation estimates that more than 500,000 acute hip fractures will occur annually by the year 2040. The costs associated with this healthcare phenomenon are staggering and will continue to increase with an aging population.Hospitalists routinely comanage orthopedic patients as either consultants or as primary physicians in the hospital setting. A unique set of problems exists in this population. Among them are perioperative cardiac risk, perioperative anemia from acute blood loss, venous thromboembolism prophylaxis, and problems with the timing of surgery. It is imperative that hospitalists understand the orthopedic surgeon's point of view in managing these particular problems and become familiar with the evidence supporting or refuting treatment modalities related to these subject areas. In addition, an understanding of the anatomy and surgical options and complications related to each type of fracture allows the hospitalist to become familiar with postoperative rehabilitation needs. It cannot be overstated that addressing hip fracture prevention must be a part of every patient's perioperative care because the incidence of a repeat fracture is significant. Morbidity related to the fracture and comorbidities also need close examination.This article aims to provide a solid understanding of the issues associated with the acute hip fracture population to enhance practice and allow for the best outcome for patients.
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Three component coupling of a 2-methylenetetrahydropyran, an activated aldehyde or ketone and a secondary nucleophile provides an efficient preparation of tetrahydropyranyl ketides, a unit common to many complex natural products.