Lumbar Epidural Blood Patch via a Caudal Catheter After Surgical Dural Tear and Failed Repair: A Case Report.

We report a patient who developed a positional headache and pseudomeningocele after multiple lumbar surgeries for low back and radicular pain. An epidural blood patch via a lumbar approach was not feasible as a result of distorted lumbar anatomy after multiple back surgeries. An epidural blood patch was performed via catheter-threaded cephalad from a caudal approach. The patient had immediate relief after the procedure and at 1 year was still symptom-free. This combination technique may be considered as an alternative approach when a percutaneous lumbar epidural blood patch is disadvantageous.

Solid Solution Quantum Dots with Tunable Dual or Ultrabroadband Emission for LEDs.

Quantum dots that efficiently emit white light directly or feature a "candle-like" orange photoluminescence with a high Stokes shift are presented. The key to obtaining these unique emission properties is through controlled annealing of the core Cu-In-Ga-S quantum dots in the presence of zinc ions, thus forming Zn-Cu-In-Ga-S solid solutions with different distributions of the substitution and dopant elements. The as-obtained nanocrystals feature excellent quantum yields of up to 82% with limited or even eliminated reabsorption and a color rendering index of bare particles of up to 88, enabling the production of high-quality white LEDs using a single color converter layer. Furthermore, the color properties can be tuned by changing the experimental conditions as well as by varying the excitation wavelength. The multicomponent luminescence mechanism is discussed in detail based on similar literature reports. White LEDs with unparalleled color quality and competitive luminous efficacies are presented herein.

Normoglycemic Diabetic Ketoacidosis in a Pregnant Patient with Type II Diabetes Mellitus Presenting for Emergent Cesarean Delivery.

The development of acute abdominal pain in a laboring parturient after a previous cesarean delivery is of concern and may be the result of a potentially life-threatening condition such as uterine rupture. We present a case of a parturient with type II diabetes mellitus, who had undergone 2 previous cesarean deliveries and now presented in labor with increasing abdominal pain. An emergency cesarean delivery was performed for probable uterine rupture. Intraoperatively, the patient was noted to be severely hypocarbic with significant metabolic acidosis, and the diagnosis of diabetic ketoacidosis was established.

Retrograde submucosal tunneling technique for management of complete esophageal obstruction.

Complete esophageal obstruction is a challenging problem that is not amendable to standard dilation techniques. Multiple endoscopic techniques as well as radical surgical procedures have been developed with the goal of restoring a patent esophageal lumen. In patients with complete esophageal obstruction, an antegrade-retrograde technique has been described, but this generally depends on the ability to transilluminate across the stricture. Successful transillumination allows for safe direct puncture across the stricture, followed by dilation. In long-segment strictures (greater than 2-3 cm), transillumination may not be possible. We report a case of a 63 year-old woman who developed a complete esophageal obstruction from radiation therapy (RT) for hypopharyngeal squamous cell carcinoma. She did have enteral access via a percutaneous endoscopic gastrostomy (PEG) tube which had been placed prior to beginning RT. A combined antegrade (through the mouth) and retrograde (through PEG site) approach was done, but transillumination across the stricture failed. Fluoroscopy demonstrated a 4 cm long stricture. The creation of a submucosal tunnel from the retrograde direction decreased the stricture length to 15 mm and transillumination was achieved. This allowed safe puncture of the stricture, placement of a guidewire, then successful dilation. The patient can now tolerate soft foods and maintain her weight. Submucosal tunneling can be used to achieve transillumination for the combined antegrade-retrograde approach to complete esophageal obstruction.