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Laser goniopuncture is an effective outpatient procedure which has been shown to maintain reduced intraocular pressure 5 years following initial laser treatment in patients who have had viscocanalostomy (with or without phacoemulsification).

To establish the long term (5 year) efficacy of neodymium-dopedyttrium aluminium-garnet laser goniopuncture to lower intraocular pressure following viscocanalostomy or phacoviscocanalostomy in patients with glaucoma.

This retrospective study analysed patients who underwent laser goniopuncture following viscocanalostomy+/-phacoemulsification between 2009 to 2012 at the Stanley Eye Unit in Abergele. Reason for further intervention included either increasing intraocular pressure outside target range or worsening visual fields. Statistical analyses were performed comparing pre-goniopucture values to those taken up to 5 years later.

Of the 620 viscocanalostomy and phacoviscocanalostomy procedures performed between 2009-2012, 218 eyes underwent laser goniopuncture afterh maintains a statistically significant reduction in intraocular pressure in the long term.

A 33-year-old woman, who underwent bilateral ceramic-on-ceramic total hip arthroplasty 3 years previously, presented with right groin pain and mechanical grinding without a history of trauma. Radiographs revealed luxation of the femoral head, and computerized tomography showed perforation of the ceramic femoral head. The patient underwent revision with a metal-on-polyethylene articulation and retained femoral stem. Two years of follow-up yielded good clinical outcome with no evidence of osteolysis or polyethylene wear.

The perforation of a ceramic femoral head should be kept in mind as one of the possible implant failure mechanisms after primary hip arthroplasty.

The perforation of a ceramic femoral head should be kept in mind as one of the possible implant failure mechanisms after primary hip arthroplasty.

Calcineurin inhibitor (CNI) based immunosuppression in liver transplantation (LTx) is associated with acute and chronic deterioration of kidney function. Delaying CNI initiation by using induction rabbit anti-thymocyte globulin (rATG) may provide kidneys with adequate time to recover from a perioperative insult reducing the risk of early post-LTx renal deterioration.

This was an open-label, multicenter, randomized controlled clinical trial comparing use of induction rATG with delayed CNI initiation (day-10) against upfront CNI commencement (SOC; standard of care) in those patients deemed at standard risk of postoperative renal dysfunction following LTx. The primary end point was change in (delta) creatinine from baseline to month-12.

Fifty-five patients were enrolled in each study arm. Mean Tacrolimus levels remained comparable in both groups from day-10 throughout the study period. A significant difference in delta creatinine was observed between rATG and SOC groups at 9-months (p=0.03) but not at montcceptable safety and treatment efficacy.COVID-19 necessitated significant care redesign, including new ambulatory workflows to handle surge volumes, protect patients and staff, and ensure timely reliable care. Opportunities also exist to harvest lessons from workflow innovations to benefit routine care. We describe a dedicated COVID-19 ambulatory unit for closing testing and follow-up loops characterized by standardized workflows and electronic communication, documentation, and order placement. More than 85% of follow-ups were completed within 24 hours, with no observed staff, nor patient infections associated with unit operations. Identified issues include role confusion, staffing and gatekeeping bottlenecks, and patient reluctance to visit in person or discuss concerns with phone screeners.

A 40-year-old man was admitted to our emergency department with a painful and swollen calf. There was no history of significant trauma, and the physical examination revealed a pulseless, swollen left lower leg. Clinical history revealed a diagnosis of primary myelofibrosis, and magnetic resonance imaging showed a rupture of the gastrocnemius medial head. The diagnosis of spontaneous acute extremity compartment syndrome (AECS) secondary to myelofibrosis was established. An open fasciotomy procedure was performed, and recombinant factor VIIa treatment was applied to control bleeding. Postoperatively, fasciotomy wounds were closed with skin grafts.

AECS may develop in patients with bleeding disorders, and recombinant factor VII may help control bleeding.

AECS may develop in patients with bleeding disorders, and recombinant factor VII may help control bleeding.

We present 3 patients who underwent ulnar nerve transposition and wrapping of the nerve with human amniotic membrane (HAM). All 3 patients subsequently required a reoperation for the original pathologic condition (not for ulnar nerve symptoms), necessitating the exploration and dissection of the transposed ulnar nerve. We demonstrate the lack of scar formation and ease of separation between nerve and surrounding tissue, as well as histology in one case taken from the perineural tissues (previous amniotic membrane), demonstrating no inflammatory cells or absence of scar tissue formation.

Exploration and dissection of a previously transposed ulnar nerve can be facilitated by wrapping the nerve with HAM to prevent scarring and perineural fibrosis.

Exploration and dissection of a previously transposed ulnar nerve can be facilitated by wrapping the nerve with HAM to prevent scarring and perineural fibrosis.

This is a case of a 44-year-old man with 10 years of history of painful callus-like swellings of bilateral index fingers. Sudden enlargement of the left index finger prompted biopsy, which revealed aggressive digital papillary adenocarcinoma (ADPA) that was treated with partial amputation. Biopsy of the contralateral finger revealed acanthotic skin with no evidence of malignancy.

Several case reports cite antecedent insult and chronic swelling before diagnosis. We describe a case of bilateral lesions with similar gross appearances, a long history of occupational repetitive trauma, and sudden enlargement of 1 lesion leading to the diagnosis of ADPA.

Several case reports cite antecedent insult and chronic swelling before diagnosis. AS101 We describe a case of bilateral lesions with similar gross appearances, a long history of occupational repetitive trauma, and sudden enlargement of 1 lesion leading to the diagnosis of ADPA.

Traumatic brain injury (TBI) initiates immune responses involving infiltration of monocyte-derived macrophages (MDMs) in the injured brain tissue. These MDMs play a key role in perioperative neurocognitive disorders (PNDs). We tested the hypothesis that preanesthetic treatment with dexmedetomidine (DEX) could suppress infiltration of MDMs into the hippocampus of TBI model mice, ameliorating PND.

We first performed bone marrow transplantation from green fluorescent protein-transgenic mice to C57BL/6 mice to identify MDMs. We used only male mice for homogeneity. Four weeks after transplantation, a controlled cortical impact model of TBI was created using recipient mice. Four weeks after TBI, mice received pretreatment with DEX before general anesthesia (GA). Mice performed the Barnes maze test (8-12 mice/group) 2 weeks after GA and were euthanized for immunohistochemistry (4-5 mice/group) or immunoblotting (7 mice/group) 4 weeks after GA.

In Barnes maze tests, TBI model mice showed longer primary latency ; primary path length 414.9 [120.0-709.9], P = .0002 versus DEX; primary errors 6.6 [2.1-11.2], P = .0005 versus TBI-DEX; expression of MDMs 2.9 [1.4-4.4], P = .0001 versus TBI-DEX; expression of MCP1 0.4 [0.05-0.67], P = .017 versus TBI-DEX; expression of interleukin-1β 1.8 [0.34-3.35], P = .01 versus TBI-DEX).

Preanesthetic treatment with DEX suppressed infiltration of MDMs in the hippocampus and ameliorated PND in TBI model mice. Preanesthetic treatment with DEX appears to suppress infiltration of MDMs in the hippocampus and may lead to new treatments for PND in patients with a history of TBI.

Preanesthetic treatment with DEX suppressed infiltration of MDMs in the hippocampus and ameliorated PND in TBI model mice. Preanesthetic treatment with DEX appears to suppress infiltration of MDMs in the hippocampus and may lead to new treatments for PND in patients with a history of TBI.

A 37-year-old man presented with an absent right elbow joint secondary to trauma, subsequent ankylosis, total elbow arthroplasty (TEA), and TEA explantation after infection. The patient also had a contralateral complete brachial plexus injury, but an intact elbow joint. Given that the patient had a functional right hand/wrist, composite vascularized autograft elbow transplant was performed from left to right upper extremity. Four years postoperatively, the patient could independently complete activities of daily living.

This case is the first to report composite vascularized autograft elbow transplant. Although indications are limited, this case illuminates novel uses of standard techniques for a difficult problem.

This case is the first to report composite vascularized autograft elbow transplant. Although indications are limited, this case illuminates novel uses of standard techniques for a difficult problem.

This report describes a case of bilateral femoral head avascular necrosis during pregnancy with a subsequent anterior dislocation of the femoral head during labor in a 40-year-old woman.

Many physiologic and hormonal changes occur during pregnancy. Although rare, hip pathologies may cause life-changing health outcomes, demonstrating a need for more research and careful monitoring throughout pregnancy.

Many physiologic and hormonal changes occur during pregnancy. Although rare, hip pathologies may cause life-changing health outcomes, demonstrating a need for more research and careful monitoring throughout pregnancy.

Increasing the percentage of academic faculty who are female and/or an under-represented minority (URM) is a goal in radiation oncology. When studying diversity changes in our University Radiation Oncology Department, we found that increases in resident diversity preceded changes in faculty diversity in every major category. To illustrate these findings, we plotted resident versus faculty diversity each year over the 52-year history of our program.

Plots were generated of the percent of residents versus faculty in our program each year between 1967 and 2020 in the following categories female, URM, and people of color.

By 1995, substantial levels of diversity were present among both residents and faculty with approximate median annual values between 1995 and 2020 of 30% female for both residents and faculty, 15% URM for both residents and faculty, and 30% persons of color for residents and 15% for faculty. In all analyses, increase in resident diversity preceded an increase in faculty diversity and, in the great majority of years, resident diversity was greater than faculty diversity.

Our experience suggests that it may be easier to increase resident than faculty diversity and that increases in resident diversity may facilitate increasing faculty diversity.

Our experience suggests that it may be easier to increase resident than faculty diversity and that increases in resident diversity may facilitate increasing faculty diversity.