Doctors Hospital is a 213-bed tertiary care teaching hospital located in Columbus in the U.S. state of Ohio. Doctors Hospital operates the second largest osteopathic medical training program in the United States. Each year, the hospital trains 160 physicians in residencies and fellowships.In 2013, Doctors Hospital was ranked #30 in the State of Ohio, #4 in the Columbus, Ohio metropolitan area, and ranked highly in pulmonology by the U.S. News & World Report. In the last year with available data, Doctors Hospital had 9,338 admissions, performed 1,841 inpatient and 3,736 outpatient surgeries, and its emergency department had 67,840 visits.Doctors Hospital is accredited by the American Osteopathic Association's Healthcare Facilities Accreditation Program. Doctors Hospital is also an Accredited Chest Pain Center by The Joint Commission. The cancer care program is accredited as a Teaching Hospital Cancer Program with commendations in clinical research and community education by the American College of Surgeons Commission on Cancer.S. Doctors Hospital is also an Accredited Chest Pain Center by The Joint Commission. The cancer care program is accredited as a Teaching Hospital Cancer Program with commendations in clinical research and community education by the American College of Surgeons Commission on Cancer..
ECG findings suggestive of STEMI often lead to emergent left heart catheterization (LHC). Occasionally, non-coronary conditions mimic ECG findings of STEMI resulting in increased risk and expenses from emergent transportation and procedures. While the overall incidence is declining over the last decade given advances in guideline directed medical therapy, this still accounts for a substantial amount of ED visits. We report a case of 1:1 atrial flutter in a patient with dextrocardia presenting as STEMI.
Joint-spanning external fixation in acute ankle trauma is a means to provide temporary stability and restoration of length, alignment, and articular congruency. This allows for soft-tissue consolidation before definitive fixation to decrease the risk of wound complications. Traction is commonly used during definitive fixation to aid in fracture reduction and to maintain reduction during placement of internal hardware. Ankle arthroscopy for ankle fractures is also becoming increasingly popular to identify and treat intra-articular injury and uses traction for visual assistance and increased working space for instruments. We present a technique that uses a previously placed calcaneus external fixation pin and the TRIMANO (Arthrex, Naples, FL) external positioning arm to apply skeletal traction during arthroscopic and open definitive fixation procedures. This technique is extremely simple, can be used in both the supine and prone positions, and can be used during arthroscopic and open procedures.
Thousands of external fixators are applied for distraction osteogenesis each year. Determining when it is safe to remove the fixator can be difficult. The purpose of this study was to survey an international group of external fixation surgeons to determine their current practice patterns surrounding external fixator removal. A 10-question, open-ended survey was emailed to members of the Limb Lengthening and Reconstruction Society. Responses were recorded, and statistical analysis was performed. Pearson's chi-square test and likelihood ratio were used when indicated. A total of 124 surveys were sent, and 44 responses were received (35% response rate). The top 5 responses for determining when it is safe to remove a fixator were full weight bearing (75%), 3 cortices (71%), no pain (55%), after dynamization (55%), and duration of time (30%). Forty-eight percent of respondents routinely dynamized the frame prior to removal. Significantly fewer surgeons who dynamized the frame protected the limb after removal (P=.046). Physicians who dynamized the frame tended to use a less-constricting device for protection (boot or brace vs cast) than those who did not dynamize (P=.016). This study showed that most surgeons used radiographs and clinical evaluation to determine timing of fixator removal. Only 23% reported using computed tomography. Most surgeons dynamized the fixator prior to removal. Those who dynamized the frame were more confident in the regenerate healing. Although this study offers insight into what experienced surgeons do in their daily practice, it reveals many areas for improvement in the literature. [Orthopedics. 2017; 40(5):e876-e879.].
Patients with metastatic or locally aggressive cutaneous squamous-cell carcinoma (cSCC) have historically had limited and noneffective treatment options. The mainstay treatment has been surgery, which can be disfiguring and may not be technically feasible for larger lesions. A retrospective review of 18 patients treated with nivolumab (n = 17) or pembrolizumab (n = 1) anti–programmed cell death protein 1 (PD-1) inhibitors for metastatic or locally advanced cSCC from March 2015 to present was performed. Three patients had metastatic disease, 5 patients had locally aggressive plus regional nodal disease, 8 patients had locally advanced disease, and 2 had multifocal skin disease. Seventeen patients had undergone at least 1 surgery, 12 also had received radiotherapy, 8 had disease that had failed to respond to other systemic treatments, and 2 had chronic lymphocytic leukemia. Of 18 patients treated, 14 had dramatic responses with improvement in clinical symptoms and impressive tumor reduction with equally impressive duration. Objectively, 4 patients had complete response, 10 had partial response, 3 had stable disease, and 1 patient had progression of disease. Three patients died, 1 from an ischemic cerebrovascular incident possibly related to treatment, 1 likely not related to neither treatment nor disease, and 1 due to disease progression. Therapy was otherwise well tolerated, and 10 patients currently continue to receive the therapy. Thirteen patients continue to have stable or no new disease at a median time of 12 months since the start of treatment. PD-1 blocking agents may provide clinically meaningful and palliative therapy for patients with aggressive cSCC who are not surgical candidates.
