Results of JESS (Joshi's External Stabilizing System) in Relapsed, Neglected and Neurogenic Clubfoot in an Age Group of 2-10 Years.

BACKGROUND: Joshi's External Stabilization System (JESS) is an external fixator based methodology to correct different deformities of club foot using differential distraction. MATERIAL AND METHODS: 31 difficult clubfeet feet in 24 patients who were neglected, neurogenic or relapsed were treated using JESS between July 2013 to June 2015 with an average follow-up of 4. 2 years. There were 16 males and 8 females in an age group of 2-10 years. 30 feet belonged to the severe and most severe group as per the Dimeglio Scoring System. All patients achieved correction of all components of the clubfoot. RESULTS: However, one patient required tibialis anterior transfer for dynamic forefoot adduction at the end of treatment. The mean total duration in JESS fixation was 69.5 days/foot (range 44-123 days) and the mean time to achieve correction within JESS averaged 52 days. The deformities improved from a mean Dimeglio score of 14.06 to 2.93. The objective radiological assessment of the deformities revealed improvements in the talocalcaneal angle on AP view from 16.39° to 34.52° and on lateral view from 15.97° to 33.03°. The Talo-1st metatarsal angle (AP view) improved from 35.29° to 7°. Complications included 11 cases of superficial pin tract infection, two instances of pin loosening and a case of pin cut out. There were three cases of 1st metatarsophalangeal dislocation that were managed by reversing the process of distraction. CONCLUSION: JESS is an effective method for managing difficult clubfeet.

Challenges in Establishing a Transfusion Medicine Service: The Cleveland Clinic Abu Dhabi Experience.

CONTEXT.­: Opening a new hospital is a once in a lifetime experience and can be very inspiring for those involved in its activation. However, establishing a safe transfusion practice in a greenfield environment comes with unique challenges and opportunities. OBJECTIVE.­: To highlight critical activation components such as on-boarding of new personnel, establishing clinical practices, and integrating critical laboratory software. DESIGN.­: Our staff initially faced challenges in standardizing transfusion medicine clinical practice inside the laboratory. Our efforts were mainly focused on the appropriate use of various transfusion orders, creating comprehensive policies for type and screening, cost effective utilization of blood products, and establishment of the maximum surgical blood order schedule. The transfusion service was launched with 2 information technology programs that separately facilitated steps in the transfusion process, but did not provide centralized access to the entire process. In these circumstances, we partnered with the laboratory information system team to create a series of interfaces that streamlined each system's functionality and implemented the existing infrastructure with upgrades that enable remote location and management of blood products. RESULTS.­: The transfusion medicine team spent more than a year training and monitoring workflows to avoid individual variations between technologists and to adopt our own standards of practice. Participation in a structured training plan was also necessary between clinical caregivers to know the safe and efficient use of these standards. CONCLUSIONS.­: Although laboratory and clinical staff are knowledgeable in care delivery, it is always a learning experience to establish a new system because of the natural tendency of resorting to previous practices and resistance to new approaches.

Uncomplicated spontaneous rupture of the pancreatic pseudocyst into the gut--CT documentation: a series of two cases.

Spontaneous rupture of the pancreatic pseudocyst into the surrounding hollow viscera is rare and, may be associated with life-threatening bleeding. Such cases require emergency surgical intervention. Uncomplicated rupture of pseudocyst is an even rarer occurrence. We present herein two cases of uncomplicated spontaneous rupture of a pancreatic pseudocyst into the stomach with complete resolution.