14-year median follow-up using the press-fit condylar sigma design for total knee arthroplasty.

Median 14-year follow-up (mean 11.8 years) of a cemented primary posterior cruciate-retaining total knee arthroplasty (TKA) utilizing the Press-Fit Condylar (PFC) Sigma design was evaluated in 77 patients (79 TKA). Follow-up assessment included implant survivorship, x-rays, Knee Society rating system, and clinical evaluation. Radiographic analysis demonstrated minor non-progressive osteolysis in 40% (10/25) knees. Two revisions, one for instability at 4 years and one for polyethylene wear at 10 years were performed. Survivorship of the PFC Sigma knee implant was 97% using revision for any reason and 100% using aseptic loosening as endpoints. The PFC Sigma had excellent survivorship at 14 years, the longest clinical follow-up reported.

A case of pseudohyperkalemia in a patient presenting with leucocytosis and high potassium level: a Case Report.

Pseudohyperkalemia can appear in a variety of settings and should be recognized early. Treatment of pseudohyperkalemia can lead to an inappropriate decrease of actual serum potassium levels which may lead to life threatening conditions. In the case presented, an 81-year-old male presented with massive leucocytosis and an extremely elevated potassium level. This case report emphasizes the importance of recognizing pseudohyperkalemia in a patient with a severely increased potassium and WBC level; such patients may be clinically asymptomatic or may have a normal ECG.

Parenchymal thoracic splenosis: history and nuclear imaging without invasive procedures may provide diagnosis.

UNLABELLED: Splenosis is a rare finding of ectopic splenic tissue found within the thoracic cavity, abdomen or peritoneal cavity. Most cases occur in the abdomen and the thoracic location is a comparatively rare finding. In thoracic splenosis the splenic tissue most often grows in the form of a nodule and the autotransplantation is usually caused by a previous operation and/or most commonly a penetrating or blunt trauma to the thoracoabdominal region, resulting in splenic rupture and in some cases left diaphragmatic tear. In majority of the cases the patients are asymptomatic and are incidentally diagnosed with left hemithorax pulmonary lesions found via chest radiography or thoracic computed tomography. We present a 45-year-old Caucasian male who was incidentally diagnosed with parenchymal thoracic splenosis secondary to a gunshot wound to the abdomen 13 years ago that resulted in distal pancreatectomy, splenectomy and gastrorrhaphy. In this case report we will briefly discuss the current updates in the literature regarding thoracic splenosis, and highlight the fact that the findings raise the suspicion of malignancy requiring numerous investigations yet early recognition of thoracic splenosis can prevent unnecessary tests and procedures. Preoperative diagnosis of splenosis should be made with the use of nuclear imaging studies such as the (99m)Tc heat-damaged erythrocyte study rather than computed tomography-guided biopsy or invasive surgery. KEYWORDS: Thoracic splenosis; Computed tomography; Ppancreatectomy; Splenectomy; Gastrorrhaphy.

A comparison of a preparticipation evaluation history form and a symptom-based concussion survey in the identification of previous head injury in collegiate athletes.

OBJECTIVE: The purpose of this study was to compare the incidence of prior head injury reported on preparticipation physical evaluation (PPE) history forms with a retrospective symptom-based survey. DESIGN: A comparison of 2 retrospective survey instruments. SETTING: NCAA Division I varsity athletic program. PARTICIPANTS: A total of 93 male and 79 female athletes participating in intercollegiate contact/collision sports. MAIN OUTCOME MEASURES: Athletes were administered a concussion symptom survey (CSS) with questions about symptom incidence after head injury. These responses were compared with answers given about previous concussion/head injury on the university's PPE history form. The numbers of positive responses were analyzed using descriptive statistics, and differences between the PPE medical history form and the concussion symptom survey were assessed using chi analysis. Factor analysis was performed to assess for possible variance structure between reported symptoms. RESULTS: Seventy-one percent of athletes reporting symptoms consistent with concussion were not identified as having a history of head injury on the PPE medical history form. The most common symptom on the CSS was headache, which accounted for 46 (56.1%) positive responses. CONCLUSIONS: The CSS revealed greater numbers of athletes experiencing symptomatic head injuries than the screening questions on the PPE history form. Screening for signs and symptoms of concussion may enhance the sensitivity of the PPE in detecting a prior history of concussion.