Real-time Ultrasound-Guided Manual Testicular Detorsion: A Case Report.

INTRODUCTION: Acute testicular torsion is a surgical emergency due to acute testicular ischemia. Manual testicular detorsion is a testis-saving, bedside therapeutic when performed correctly and in a timely fashion. This procedure is most commonly performed blindly with pain relief as the endpoint for detorsion. However, up to one-third of patients continued to show signs of residual torsion in the operating room even using pain relief as the stopping point for the procedure. CASE REPORT: We present a case demonstrating the utility of color Doppler ultrasound to confirm complete manual detorsion in a 14-year-old male with acute testicular torsion. The patient underwent 360-degree detorsion and had relief of pain; however, color Doppler demonstrated incomplete return of flow to the testis. After an additional 180-degree turn was made, color Doppler demonstrated complete return of normal vascular flow to the torsed testis. CONCLUSION: When it comes to testicular viability, timely restoration of blood flow to the testicle is of utmost importance. Manual detorsion is a non-invasive intervention that can be quickly and effectively performed at the bedside. Moreover, using color Doppler ultrasound guidance can ensure that physicians detorse in the proper direction and to completion, by providing instant visualization of restorative flow and ensuring reperfusion of the testis while awaiting definitive surgical management.

Typologies of collaborative governance for scaling nature-based solutions in two strategic South African river systems.

Scaled up planning and implementation of nature-based solutions requires better understanding of broad characteristics (typologies) of the current governance and financing landscape, collaborative approaches amidst local complexities, and factors of scalability. An inventory was compiled of water-related ecological infrastructure intervention projects in two river systems in South Africa, incorporating actor, environmental, social, and financial dimensions and benefits. Qualitative participatory analysis revealed eight typologies. Post-hoc classification analysis determined similarities and/or unique characteristics of seven quantitative typologies. Key characterising factors included the complexity/size of financial flows, complexity of partnership/governance arrangements, mandates/goals of actors, type of ecological infrastructure, trade-offs in investment in ecological/built infrastructure, and the model used for social benefits. Identified scalable typologies offer structures suited to increased investment, with other typologies offering specialised local value. A range of ecological infrastructure intervention typologies with differing biophysical and socioeconomic outcomes provide choices for investors with specific goals, and benefits to landscape actors.

Duplication of radiology imaging studies in the emergency department: what is the cost?

OBJECTIVE: To quantify the rate of preventable duplication of imaging studies in the Emergency Department. Previously, to estimate potential savings from the Health Information Exchange, figures used to be based on expert opinion, as the actual rate of redundant imaging is unknown. MATERIALS AND METHODS: We prospectively quantified the frequency of duplicate CT scans in tertiary care and community hospital emergency departments (ED) through a short questionnaire at the time the studies were ordered. RESULTS: During the study period, 9246 CT scans were performed with a preventable duplicate rate of 0.42%. Both sites had equivalent rates of preventable duplicates. DISCUSSION AND CONCLUSIONS: We used two EDs to quantify the rate of preventable duplicate CT scans ordered. Our results demonstrate that only 0.4% of CT scans performed in our EDs are preventable duplicates. Our rate of preventable duplicate studies was much lower than what experts and emergency practitioners suspected, which suggests that potential cost savings from elimination of preventable duplicates may also be much lower than currently estimated.