Implementation of TeamSTEPPS in Orthopaedic Surgery.

An Institute of Medicine report published in 2000 brought attention to the devastating consequences of medical errors. The report estimated that 98,000 deaths occurred in US hospitals each year as a result of medical errors and spawned investigations into factors that are associated with medical errors as well as strategies to avoid them. Taking cues from high-reliability organizations, such as the airline industry, evidence-based tools were developed to minimize human risk factors and foster teamwork, communication, and other skills that are essential to patient safety and quality. Orthopaedic surgeons are in a unique position to advocate for patients and to lead healthcare teams through the cultural changes that are necessary to avoid harm and improve outcomes. The American Academy of Orthopaedic Surgeons has made a commitment to educate interdisciplinary healthcare teams and uses TeamSTEPPS to educate orthopaedic surgeons on the knowledge, skills, and attitudes that are necessary to develop teamwork and improve patient safety and the quality of care. Orthopaedic surgeons should understand the need for improved teamwork and the resources that are available to shape the cultural changes that are necessary to avoid harm and improve outcomes.

Effect of phytase on zinc absorption from a millet-based porridge fed to young Burkinabe children.

BACKGROUND/OBJECTIVES: Fortifying cereal staples with zinc is a strategy for increasing zinc intake in young children in developing countries. However, phytic acid (PA) naturally present in cereals strongly decreases zinc absorption. A stable-isotope zinc absorption study was conducted in young children to investigate the ability of the PA-degrading enzyme phytase to improve zinc absorption, when added to a cereal porridge immediately before consumption. SUBJECTS/METHODS: Fractional absorption of zinc (FAZ) was estimated in 35 young healthy Burkinabe children using the double-isotopic tracer ratio method with 67Zn as oral tracer and 70Zn as intravenous tracer, in a crossover design. The test meals were: (a) a millet-based porridge containing 1.4 mg total zinc (native plus 1 mg added as ZnSO4) with a PA:Zn molar ratio of 7.7; (b) the same porridge with the enzyme phytase (20.5 phytase units (FTU)) added immediately before consumption. The exchangeable zinc pool (EZP) was determined as a potential measure of long-term zinc intake in 20 of the 35 children and compared with FAZ. RESULTS: Mean FAZ increased from 9.5±3.4 to 16.0±5.1% (P<0.0001), when phytase was added to the meal. The mean EZP was 3.6±0.5 mg/kg. There was no correlation between the EZP and FAZ values for either of the two test meals. CONCLUSIONS: Adding phytase immediately prior to consumption of a zinc-fortified cereal-based complementary food can improve zinc absorption in young children.

Osteonecrosis in Sickle Cell Disease.

Osteonecrosis is one of the most devastating musculoskeletal manifestations of sickle cell disease and most commonly affects the femoral head. Although the exact pathophysiology of this condition in patients with sickle cell disease is unknown, it is suggested that red cell sickling and repetitive vaso-occlusion may be associated with tissue hypoxia, inflammation, and subsequent bone necrosis and collapse. If left untreated, osteonecrosis can be extremely debilitating and may lead to severe pain, loss of function, and degenerative joint changes. Although several conservative management approaches exist, total joint arthroplasty remains the most effective treatment intervention. A multidisciplinary approach among the primary care physician, hematologist, and orthopedic surgeon is essential in optimizing patient management.

Cone shell envenomation: epidemiology, pharmacology and medical care.

The marine environment presents much danger, specifically in regards to the numerous venomous inhabitants within tropical and subtropical waters. The toxins from one such group of venomous marine snails, commonly referred to as 'cone snails', have been well documented in causing human fatalities. Yet information regarding medical treatment for cone snail envenomation is limited and poorly accessible. To correct this, medical and scientific expertise and literary review on Conus provide a basic and comprehensive directive focused on the medical treatment and post-mortem investigative analysis of cone snail envenomation. We emphasize what we expect to be the most lethal feeding group of Conus and provide a brief background to the epidemiology of their stings. We describe the venom apparatus of Conus and its utility of rapid venom delivery. We have compiled the documented incidences of Conus envenomation to offer thorough reference of known signs and symptoms - this too drawing on personal experiences in the field. We have also made available a brief background to the biochemistry and pharmacology of Conus venoms to highlight their complex nature.

[Surgical abdomen caused by traditional treatment. Five-case report in teaching hospital Yalgado Ouédraogo of Ouagadougou]. / Les abdomens chirurgicaux dus au traitement traditionnel. À propos de cinq cas au Centre hospitalier Yalgado Ouédraogo de Ouagadougou.

The traditional products used to treat some pains can cause serious complications of which surgical abdomen. We listed in two years five cases of surgical abdomen complicating a traditional treatment in the service of digestive and general surgery of the hospital complex Yalgado Ouédraogo. There were two men and three women with an average age of 34,4 years. These traditional products were used to treat constipation, sexual impotence, sterility and to "posses" her husband. Oral and rectal routes were used by one and three patients respectively, another patient used triple routes (oral, rectal and vaginal). The digestive lesions were in the upper tract in one case (gastric phytobezoar), two patients presented acute intestinal occlusion and two others acute generalized peritonitis. All the five patients underwent laparotomy. Two patients died in immediately post-operative course. The prevention of severe surgical complications of the digestive tract induced by traditional treatments has to be broadcasted through information, education and communication.

Case report of hepatic mucormycosis after liver transplantation: successful treatment with liposomal amphotericin B followed by posaconazole sequential therapy.

Mucormycosis is a rare but emerging fungal infection complicating solid organ transplantation (SOT), with a cumulative incidence of around 2% during the first year after SOT. The associated mortality rate is high, and surgical debridement is frequently required as part of the treatment along with antifungal therapy based mostly on amphotericin B formulations, We describe here an unusual case of hepatic mucormycosis in a liver transplant recipient that was successfully treated with clinical therapy based on liposomal amphotericin B followed by posaconazole, without surgical resection.

Molecular interpretation of fluorescence solvent relaxation of Patman and 2H NMR experiments in phosphatidylcholine bilayers.

The analysis of time-dependent fluorescence shifts of the bilayer probe 6-hexadecanoyl-2-(((2-(trimethylammonium)ethyl)methyl)amino)naphthalene chloride (Patman) offers valuable information on the hydration and dynamics of phospholipid headgroups. Quenching studies on vesicles composed of four phosphatidylcholines with different hydrocarbon chains (18:1c9/18:1c9, DOPC; 16:0/18:1c9, POPC; 18:1c9/16:0, OPPC; 18:1c6/18:1c6, PCDelta6) show that the chromophore of Patman is defined located at the level of the sn-1 ester-group in the phospholipid, which is invariant to the hydrocarbon chain. The so-called solvent relaxation (SR) approach as well as solid-state 2H NMR reveals that DOPC and PCDelta6 are more hydrated than POPC and OPPC. A strong dependence of SR kinetics on the position of double bond in the investigated fatty acid chains was observed. Apparently, the closer the double bond is located to the hydrated sn-1 ester-group, the more mobile this group becomes. This work demonstrates that the SR approach can report mobility changes within phospholipid bilayers with a remarkable molecular resolution.

Twenty years of liver transplantation in Brazil.

This paper summarizes the 20 years of liver transplantation in Brazil, in the context of the Western world scenario. More than 5000 liver transplantations have been performed in the country since September 1, 1985. The living-donor liver transplantation, one of the landmarks in liver transplantation, was first described by our team in 1989. Brazil is the seventh country in number of liver transplants in the Western world and the first in Latin America. Almost 1000 procedures were performed in 2004, 19% of them involving living donors.

Clear cell sarcoma of the kidney with invasion of the inferior vena cava.

OBJECTIVE: We present a case of clear cell sarcoma of the kidney (CCSK) in 53-year-old white man who was treated with surgery. This case represents the oldest patient with CCSK published in the English literature. METHODS: Right radical nephrectomy with lymphadenectomy and thrombectomy was performed. RESULTS: Histological findings indicated a CCSK. Tumor cells showed positive vimentin staining. CONCLUSION: CCSK is considered a rare and highly malignant renal tumor. The malignant nature may relate not only to the biological features of these tumor cells, but also to the high resistance against radiation and chemotherapy. The treatment of CCSK has been a subject of controversy.

Opsoclonus-myoclonus syndrome as a paraneoplastic manifestation of renal cell carcinoma. a case report and review of the literature.

Opsoclonus is a rare but distinctive disorder of ocular motility, characterized by irregular, continual and conjugated chaotic saccades of the eyes. It is increased with eye closure and fixation, and it persists during sleep. Opsoclonus appears more commonly in children and in half of such cases in association with neuroblastoma. In adults the most frequent causes are idiopathic (50%) and paraneoplastic (20%). Among the second group, different types of tumors involving a wide variety of organs have been reported. Opsoclonus when accompanied by other symptoms of central nervous system involvement (head, appendicular myoclonus and truncal ataxia) constitutes a clinical picture, known as opsoclonus-myoclonus syndrome. We report the case of a young patient affected by renal cell carcinoma associated with opsoclonus-myoclonus syndrome which did not respond to medical therapy but dramatically improved after cancer ablation.

[Rare renal tumors (neoplasms other than conventional renal cell carcinoma). Clinico-pathologic aspects and review of the literature]. / Tumori renali rari (neoplasms other than conventional renal cell carcinoma). Aspetti clinico-patologici e revisione della letteratura.

The clinical and pathological findings in 94 patients with surgically confirmed renal neoplasm from 1990 to 1998 have been retrospectively reviewed and a literature review is made. The heterogeneous group of rare renal tumours has been particularly considered: renal oncocytoma and oncocytomatosis, renal angiomyolipoma and renal medullary fibroma; chromophobe renal cell carcinoma (RCC), papillary RCC, multiple primary malignant RCC, hereditary RCC, renal sarcoma and sarcomatoid RCC, renal malignant fibrous histiocytoma, renal hemangiopericytoma and renal lymphoma.

Immunohistochemical evaluation of the safety of transurethral electrovaporization of the prostate and its clinical results.

Short term follow up studies on transurethral electrovaporization (TUEVP) have shown a relative low morbidity over TURP. The use of high power current has been claimed as a source of possible damage on the neuronal structures surrounding the prostate. The aims of our study were to assess longer follow up results as well as the safety of this technique. Over an 18 month mean follow up period symptom relief remained relatively stable. Postoperative dysuria was detected in a higher percentage of patients and was seen for a longer period in comparison with previous reports. Immunohistochemical staining performed using S-100 and NF monoclonal antibodies showed anatomical integrity of the prostatic neuronal fibres surrounding the vaporization edge. In conclusion, although the effectiveness and safety of TUEVP are confirmed by the present study, the occurrence of a significant rate of long-lasting postoperative irritative symptoms must be taken into account.

[Biophysical principles of tissue electrovaporization]. / Fondamenti biofisici dell'elettrovaporizzazione dei tessuti.

The principles of electrosurgery are based upon well defined physical grounds, explaining the type and extent of the lesions induced by the electric current. Technological evolution has led to the creation of dedicated equipment, allowing efficient use of electrosurgical cutting and coagulation of tissues, both in open and endoscopic surgery. Electrovaporization is the thermal effect obtained when an alternating high power-high frequency current (300 W, 400-500 kHz) is applied to the tissue using an electrode with particular geometric aspects. The main feature is the presence of higher and lower current density zones. The first induce electrovaporization, whilst the second produce simultaneous hemostatic coagulation of the rims. New effective vaporizing electrodes have been recently introduced into clinical practice. Their use in the endoscopical treatment of bladder outlet obstructions, a stimulating alternative to standard resection or laser applications, is currently under evaluation.

[Renal multifocal carcinoma with adrenal gland metastasis in a patient previously treated with radical nephrectomy: what kind of therapy. Review of the literature]. / Carcinoma renale multifocale con metastasi surrenaliche multiple in paziente già sottoposto a nefrectomia radicale dell'adelfo: quale terapia? Revisione della letteratura.

A case of multiple adrenal metastases due to renal cells carcinoma, associated with a multifocal simultaneous renal cells carcinoma has been observed in a female patient previously submitted to radical contralateral nephrectomy for the same disease. In particular, stress is laid on computerized tomography scan diagnosis and surgical procedure.

[Renal agenesis and homolateral seminal vesicle cyst. Case report]. / Agenesia renale e cisti della vescicola seminale omolaterale. Caso clinico.

The authors present a case of renal agenesis and seminal vesicle cyst in a young man, diagnosed because of several micturion disorders partially cleared up with antibiotic therapy. We discuss about the diagnosis technique which includes Ultrasound Scanner, Computed Tomography, Magnetic Resonance and pelvic arteriography. Then we describe the surgical approach and finally we discuss about embryogenesis.