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Recent advancements in computer-assisted surgery have led to a renewed interest in robotic-assisted hip arthroplasty. This technology assists with component position which is especially useful in prior trauma or dysplasia cases. We present a case of a surgical hip fusion conversion to total hip arthroplasty with the use of robotic-assisted technology. Enhanced preoperative planning with the ability to manipulate implant position before execution can be invaluable during complex procedures. Further research is warranted before revision cases using computerized navigation systems becomes more prevalent.
RESUMEN
"Vaping" is a rapidly growing habit seen worldwide, especially amongst the younger population. Several aspects of vaping have made it more appealing than cigarettes and have lead to the conversion of many smokers. Appeal resides in the belief that it is a healthier alternative to cigarettes. It also has the ability to interchange flavors and type of oil used. The focus of advertisement for vaporized products is its use as a smoking cessation aid. Systematic reviews have failed to display evidence of harmful processes other than exposure to nicotine (Bullen et al., 2013; Burstyn, 2013) [1,2]. We report a clinical case of a woman who suffered diffuse alveolar hemorrhage correlated with e-cigarette usage due to history and negative findings of extensive rheumatologic and infectious disease workup. Her presentation, clinical course, and effective therapy are outlined here.
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ADDITION TO ORTHOPEDIC LITERATURE: Posterolateral knee dislocations are extremely rare and generally require open reduction; however, we were able to provide closed reduction by reproducing mechanism of injury with a technique described in the literature. This is the second reported case of such accomplishment. INTRODUCTION: Posterolateral knee dislocation is the most common form of "irreducible" knee dislocations. Buttonholing of the medial femoral condyle through medial soft tissues of the knee results in entrapment. We report the second known case of successful closed reduction. CASE PRESENTATION: A 51-year-old female with morbid obesity sustained a right posterolateral knee dislocation shown on plain radiograph. This was accompanied by lateral patella dislocation and a dimple sign at the medial joint line after a fall from standing height produced a rotational mechanism. CONCLUSION: This is the second reported case of successful closed reduction to an injury that has been generally established to be "irreducible." The technique used closely matches that described in the only other reported case and involves reproduction of the mechanism of injury. This establishes additional evidence to a previously isolated report of successful acute treatment that counters the current narrative.
RESUMEN
BACKGROUND: A grave complication of thyrotoxicosis, or thyroid storm, is the development of heart failure and cardiomyopathy. Recognizing this condition is imperative in preventing further left ventricular dysfunction and cardiogenic shock. This manuscript aims to review the literature on cardiogenic shock associated with thyrotoxicosis and present management recommendations on this rare condition. METHODS: A literature search was performed in December of 2018, using the PubMed medical search engine. A systematic search was carried out using the keywords Thyroid Storm AND Cardiogenic Shock and Thyrotoxicosis AND Shock. MANAGEMENT: Decrease of thyroid hormone levels using therapeutic plasma exchange LV Unloading and ventilation by Impella and Extracorporeal Mechanical Ventilation (ECMO). CONCLUSION: Patients presenting with thyroid storm-induced shock may not be suitable candidates for traditional management with ß -adrenergic blockers (ß-blockers). The use of ß-blockers could exasperate their condition. Through extensive literature review on this rare condition, the most effective management was found to be therapeutic plasma exchange in order to decrease thyroid hormone levels, which have direct toxic effect on the heart. Furthermore, the use of ECMO and Impella is advised to reduce pressure on the heart and ensure the patient's organs are well oxygenated and perfused while the left ventricle is recovering.