Notes

Methicillin-resistant Staphylococcus schleiferi subspecies coagulans linked to otitis externa and pyoderma inside canines.
Stress fractures are chronic fatigue failure of bone from repetitive subthreshold loads. Insufficiency fractures occur in bones that are already osteopenic and fail to withstand normal loads over time. Stress fractures of cuneiform bones are extremely rare and usually reported to happen in athletes or recruits. We describe a case of middle cuneiform insufficiency fracture that occurred in a young trainee physician with severe hypovitaminosis D, who joined his training a few weeks before it happened. Magnetic resonance imaging remains the modality of choice of diagnosis of foot stress injuries because it detects even stress reactions with reasonable sensitivity. Cuneiform stress fractures, like other low-risk stress fractures, heal with immobilization only and do not require surgical intervention.Midfoot arthrodesis is the accepted surgical treatment for symptomatic midfoot arthritis. The published literature has focused on joint-spanning static fixation. Several companies have developed diamond-shaped locked dorsal compression plates, which allow for longitudinal joint compression. After dorsal plate insertion, a spreader device opens the arms of the plate mediolaterally, which allows the plate to compress longitudinally. This work describes outcomes of such locked dorsal compression plates for midfoot arthritis at a single institution. see more reviewed 62 patients who underwent midfoot arthrodesis for symptomatic midfoot arthritis using locked dorsal compression plates over a 7-year period. A total of 173 joints were spanned for fusion. The primary outcome measure was radiographic union and visual analog scale pain scores. Characteristics of patients who experienced nonunion versus those who had union were evaluated. Of the 173 joints, there was a 81.5% fusion rate (141/173 joints) and 14 patients experienced nonunion. #link# There was a statistically significant difference in the average number of joints spanned in patients with nonunion (3.6) and patients with union (2.5) (p = .02). Locked dorsal compression plate arthrodesis is a viable technique for achieving midfoot fusion. This mechanical method of compression does not, however, lend itself to improved fusion rates compared with prior reports. A greater number of arthrodesis sites is associated with a higher nonunion rate. Emerging technology using newer materials and improved biomechanical designs may show improved results.Graduating podiatric medicine and surgery residents are increasingly likely to pursue fellowship training. Nonetheless, there has been a lack of formal characterization of fellowship training in the field. The present study aimed to characterize fellowship training through an online survey. Two separate surveys were created, 1 for fellowship directors and 1 for fellows. Fellowship directors and fellows were asked questions pertaining to daily responsibilities, quality of training, work-life balance, the application process, fellow selection, and program selection. A total of 33 fellowship directors and 49 fellows responded to the survey, which was delivered over a 2-year period. Overall, fellows were generally satisfied with their respective programs, though greater satisfaction was associated with increased time allowed for research, as well as greater perceived quality of research training, clinical training, surgical training, and practice management training. When selecting a program, the 3 highest-rated factors were focus of the program, reputation of the fellowship director, and career options, and the 3 most important foot and ankle topics were hindfoot/ankle arthrodesis surgery, arthroscopy, and trauma. link2 Open-ended responses from both fellowship directors and fellows reflected a range of opinions and recommendations, which may be helpful for future fellows or for fellowship program faculty. Notably, both fellowship directors and fellows commonly reported that the application process was in need of improvement, with increased standardization of the application process suggested. The results of the present study reflect baseline data on the topic, and may help facilitate improvement of the fellowship experience.Equinus contracture carries 3- and 4-fold associations with diabetes and plantar foot ulceration, respectively. Percutaneous tendo-Achilles lengthening is a useful method to alleviate peak plantar pressure resulting from equinus. We aimed to evaluate the effectiveness of percutaneous tendo-Achilles lengthening and estimate the relative longevity of the approach in reducing ulcer recurrence. The medical records of patients with equinus contracture who underwent percutaneous tendo-Achilles lengthening from 2010 to 2017 were reviewed. Included patients presented with plantar ulcers and a gastroc-soleus equinus of any angle less then 10° of ankle dorsiflexion with the affected knee extended and flexed. Patients who received concomitant tendon lengthening procedures (including anterior tibial tendon or flexor digitorum longus) were excluded. Outcome measures included time to wound healing, time to ulcer recurrence, and development of transfer lesion. Ninety-one patients underwent percutaneous tendo-Achilles lengthening with subsequent pedal ulceration without concomitant procedures. A total of 69 (75.8%) patients had a plantar forefoot ulcer, 7 (7.7%) had midfoot ulcers, 5 (5.5%) had hindfoot ulcers, and 3 (3.3%) had ulcers in multiple locations. Seven patients received prophylactic tendo-Achilles lengthening. At a mean follow-up of 31.6 months (±26), 66 (78.6%) wounds healed at a median 12.9 weeks. A total of 29 patients (43.9%) experienced ulcer recurrence at a mean of 12 months. Twelve patients (13%) experienced a transfer lesion at a mean of 16.6 months. Tendo-Achilles lengthening can be an effective adjunctive approach to achieve wound healing and reduce long-term ulcer recurrence in patients with equinus contracture and neuropathic plantar foot ulcers. A relengthening procedure may be needed within approximately 12 months from index surgery.
Laparoscopic major anatomical liver resection is challenging. The robotic liver resection (RLR) approach, with Firefly indocyanine green (ICG) imaging, was proposed to overcome the limitations of laparoscopy. The aim of this multi-centre international study was to evaluate the use of Firefly ICG imaging in anatomical RLR.

A retrospective study of consecutive patients undergoing RLR anatomical resection with intra-operative ICG administration from January 2015 to July 2018 were enrolled. Patients who underwent simultaneous or en-bloc resections of other organs were excluded.

A total of 52 patients were recruited of which 32 patients were healthy donors, 17 with malignancy and 3 for benign conditions. 12 patients had cirrhosis. 28 patients underwent a right hepatectomy (53.8%) with left hepatectomy performed with 18 patients. 40 patients underwent negative staining and 12 patients via direct portal vein injection for positive staining. ICG demarcation line was visualized in 43 patients and was clearer than the ischaemic demarcation line in 29 patients. All resections for malignancy had clear margins. There were no 30-day/inpatient mortalities.

Robotic ICG guided hepatectomy technique for anatomical liver resection is safe, feasible and has the benefit for improved visualization in healthy donors and cirrhotic patients.
Robotic ICG guided hepatectomy technique for anatomical liver resection is safe, feasible and has the benefit for improved visualization in healthy donors and cirrhotic patients.
Single-stage unifocalisation for pulmonary atresia (PA) with ventricular septal defect (VSD) and major aortopulmonary collateral arteries (MAPCA) requires a high degree of three-dimensional (3D) anatomical imagination. A previous study has reported the application of a 3D-printed heart model with virtual reality (VR) or mixed reality (MR). However, few studies have evaluated the surgical outcomes of the 3D model with VR or MR in PA/VSD patients.

Three-dimensional (3D) heart models of five selected PA/VSD patients were derived from traditional imageology of their hearts. Using VR glasses, the 3D models were also visualised in the operating room. Both the 3D-printed heart models and preoperative evaluation by VR were used in the five selected patients for surgical simulation and better anatomical understanding. Mixed reality holograms were used as perioperative assistive tools. Surgical outcomes were assessed, including in-hospital and early follow-up clinical data.

The use of these three new technologies had favourable feedback from the surgeons on intraoperative judgment. There were no in-hospital or early deaths. No reintervention was required until the last follow-up. Three (3) patients developed postoperative complications one had right bundle branch block and ST-segment change, one had chest drainage >7 days (>40 mL/day) and one had pneumonia.

The preoperative application of a 3D-printed heart model with VR or MR helped in aligning the surgical field. These technologies improved the understanding of complicated cardiac anatomy and achieved acceptable surgical outcomes as guiding surgical planning.
The preoperative application of a 3D-printed heart model with VR or MR helped in aligning the surgical field. These technologies improved the understanding of complicated cardiac anatomy and achieved acceptable surgical outcomes as guiding surgical planning.
Coronary artery disease (CAD) remains a major public health problem in Australia and globally. A variety of imaging techniques allow for both anatomical and functional assessment of CAD and selection of the optimal investigation pathway is challenging. Cardiovascular magnetic resonance (CMR) is not widely used in Australia, partly due to perceived cost and lack of Federal Government reimbursement compared to the alternative techniques. The aim of this study was to estimate the cost-effectiveness of different diagnostic strategies in identifying significant CAD in patients with chest pain suggestive of angina using the evidence gathered in the Clinical Evaluation of Magnetic Resonance Imaging in Coronary Heart Disease 2 (CE-MARC trial), analysed from the Australian health care perspective.

A decision analytic model coupled with three distinct Markov models allowed eight potential clinical investigation strategies to be considered; combinations of exercise electrocardiogram stress testing (EST), single-photAustralian health care system.
This economic evaluation shows that an investigative strategy of stress CMR if EST is inconclusive or positive is the most cost-effective approach for diagnosing significant coronary disease in chest pain patients within the Australian health care system.Thyroid hormones are crucial for normal pregnancy and fetal development. Large physiological changes occur during pregnancy, posing challenges for the correct interpretation of thyroid function tests. TSH concentrations are the principal first test to rule out thyroid disease taking into account trimester-specific reference ranges. Free T4 (FT4) measurements by immuno-assays may be subject to interference by endogenous and exogenous factors. The relevance of measuring free T3 (FT3) during pregnancy is unclear. Thyroid autoimmunity is well-reflected by the presence of antibodies against TPO. link3 TPO-antibody positivity is associated with an increased risk of adverse pregnancy outcomes.
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