Gaskill T.,Naval Medical Center Portsmouth |
Millett P.J.,Steadman Clinic
Journal of the American Academy of Orthopaedic Surgeons | Year: 2013
Scapulothoracic bursitis and snapping scapula syndrome are rare diagnoses that contribute to considerable morbidity in some patients. These conditions represent a spectrum of disorders characterized by pain with or without mechanical crepitus. They are commonly identified in young, active patients who perform repetitive overhead activities. Causes include anatomic scapular or thoracic variations, muscle abnormalities, and bony or soft-tissue masses. Three-dimensional CT and MRI aid in detecting these abnormalities. Nonsurgical therapy is the initial treatment of choice but is less successful than surgical management in patients with anatomic abnormalities. In many cases, scapular stabilization, postural exercises, or injections eliminate symptoms. When nonsurgical treatment fails, open and endoscopic techniques have been used with satisfactory results. Familiarity with the neuroanatomic structures surrounding the scapula is critical to avoid iatrogenic complications. Although reported outcomes of both open and endoscopic scapulothoracic decompression are encouraging, satisfactory outcomes have not been universally achieved. Copyright 2013 by the American Academy of Orthopaedic Surgeons.
Bennett B.L.,Uniformed Services University of the Health Sciences |
Littlejohn L.,Naval Medical Center Portsmouth
Military Medicine | Year: 2014
This review analyzes the new (2008–2013) hemostatic agents and dressings for enhanced efficacy in preclinical studies, and investigates supportive findings among case reports of effectiveness and safety in hospital and prehospital literature. A literature search was conducted using PubMed, National Library of Medicine using key words and phrases. The search revealed a total of 16 articles that fit the criteria established for third-generation hemostatic dressings. There were a total of 9 preclinical, 5 clinical, and 2 prehospital studies evaluated. Evaluation of these thirdgeneration studies reveals that mucoadhesive (chitosan) dressings, particularly Celox Gauze and ChitoGauze, clearly show equal efficacy to Combat Gauze across many dependent variables. Chitosan-based products are ideal prehospital dressings because they are shown to work independently from the physiological clotting mechanisms. Many first-, second-, and third-generation chitosan-based dressings have been in use for years by the United States and other NATO militaries at the point of injury, and during tactical evacuation, in Operation Enduring Freedom and Operation Iraqi Freedom without reported complications or side effects. Based on the reported efficacy and long-term safety of chitosan-based products, increased use of Celox Gauze and ChitoGauze within the Department of Defense and civilian venues merits further consideration and open debate. © AMSUS - The Society of Federal Health Professionals, 2014 Printed in U.S.A. All rights reserved.
Frumkin K.,Naval Medical Center Portsmouth
Journal of Emergency Medicine | Year: 2013
Background: Epidemiologic issues of testing, treatment, prevention, immunization, mandated reporting, and post-exposure prophylaxis do not often intrude on the Emergency Department management of the well-appearing adolescent or adult with a couple of weeks of cough. Objectives: Considering that waning immunity to pertussis, the only vaccine-preventable disease with increasing cases and deaths in the United States, is responsible for 12-35% of such illness, such issues need to be considered. Discussion: Mostly self-limited in adults, transmission of pertussis to infants places them at risk for hospitalization and death. Pertussis is highly contagious (80% transmission), and atypical presentations are the rule in adults (cough alone) and infants (apnea, bradycardia, poor feeding). Treatment in the first few weeks can impact the clinical course, and later treatment can still prevent transmission. Clinical features like paroxysmal cough, inspiratory "whoop," and post-tussive emesis have mildly increased predictive values and may be absent in adults. Testing is unreliable after 3 weeks of cough. Treatment reduces communicability within 5 days and is suggested without regard to test results within 3 weeks of cough onset for those aged > 1 year (within 6 weeks of cough for < 1 year). Reporting requirements are based on the clinical case definition: ([Cough ≥2 weeks] + [paroxysms OR whoop OR post-tussive emesis]). Lower reporting thresholds are appropriate during an outbreak or when vulnerable populations are at risk. Post-exposure prophylaxis is recommended for at-risk contacts. Tdap is encouraged for all adults. Conclusion: Practical recommendations consistent with the most current guidelines are offered. © 2013 Published by Elsevier Inc.
Shenenberger D.W.,Naval Medical Center Portsmouth
American Family Physician | Year: 2012
Cutaneous malignant melanoma accounts for 3 to 5 percent of all skin cancers and is responsible for approximately 75 percent of all deaths from skin cancer. Persons with an increased number of moles, dysplastic (also called atypical) nevi, or a family history of the disease are at increased risk compared with the general population. An important tool to assist in the evaluation of potential melanomas for patients and health care professionals is the ABCDE mnemonic, which takes into account asymmetry, border irregularities, color variation, diameter, and evolution. Any suspicious pigmented lesion should be biopsied. Appropriate methods of biopsy can vary, and include deep shave, punch, and excisional biopsy. Regardless of the procedure selected, it is essential that the size of the specimen be adequate to determine the histologic depth of lesion penetration, which is known as the Breslow depth. The Breslow depth is the most important prognostic parameter in evaluating the primary tumor. Because early detection and treatment can lead to identification of thinner lesions, which may increase survival, it is critical that physicians be comfortable with evaluating suspicious pigmented lesions and providing treatment or referral as necessary. © 2012 American Academy of Family Physicians.
Buryk M.,Naval Medical Center Portsmouth |
Bloom D.,Naval Medical Center Portsmouth |
Shope T.,Naval Medical Center Portsmouth
Pediatrics | Year: 2011
BACKGROUND: Ankyloglossia has been associated with a variety of infant-feeding problems. Frenotomy commonly is performed for relief of ankyloglossia, but there has been a lack of convincing data to support this practice. OBJECTIVES: Our primary objective was to determine whether frenotomy for infants with ankyloglossia improved maternal nipple pain and ability to breastfeed. A secondary objective was to determine whether frenotomy improved the length of breastfeeding. METHODS: Over a 12-month period, neonates who had difficulty breastfeeding and significant ankyloglossia were enrolled in this randomized, single-blinded, controlled trial and assigned to either a frenotomy (30 infants) or a sham procedure (28 infants). Breastfeeding was assessed by a preintervention and postintervention nipple-pain scale and the Infant Breastfeeding Assessment Tool. The same tools were used at the 2-week follow-up and regularly scheduled follow-ups over a 1-year period. The infants in the sham group were given a frenotomy before or at the 2-week follow-up if it was desired. RESULTS: Both groups demonstrated statistically significantly decreased pain scores after the intervention. The frenotomy group improved significantly more than the sham group (P<.001). Breastfeeding scores significantly improved in the frenotomy group (P = .029) without a significant change in the control group. All but 1 parent in the sham group elected to have the procedure performed when their infant reached 2 weeks of age, which prevented additional comparisons between the 2 groups. CONCLUSIONS: We demonstrated immediate improvement in nipplepain and breastfeeding scores, despite a placebo effect on nipple pain. This should provide convincing evidence for those seeking a frenotomy for infants with signficant ankyloglossia. Copyright © 2011 by the American Academy of Pediatrics.
Zook J.D.,Naval Medical Center Portsmouth
The spine journal : official journal of the North American Spine Society | Year: 2012
Acinic cell carcinoma is the fourth most common tumor of the parotid gland, and spinal metastases are thought to be exceedingly rare. Only two other reported presentations are found in the literature, both presumably secondary to incomplete surgical resections. To present the first known case of metastasis to the lumbar spine causing vertebral body involvement, after complete resection of the parotid gland. Case report. A case of a patient who presented with low back pain and had imaging studies showing an expansive destructive lesion of the L4 vertebral body. The patient underwent a radical parotidectomy and radiation therapy for dedifferentiated, high-grade acinic cell carcinoma 2 years prior. The patient underwent anterior L4 corpectomy and strut cage placement and posterior pedicle screw fixation from L2 to L5 on the same day, followed by radiation and oral chemotherapy 3 weeks later. Histopathologic examination confirmed metastatic dedifferentiated acinic cell carcinoma, present in the L4 vertebral body and overlying psoas muscle. This case report underscores the importance of careful evaluation of patients presenting with back pain with a history of malignancy. It also calls into question the traditional low-grade classification ascribed to these tumors, given their ability to metastasize after complete excision and adjuvant therapy. Copyright © 2012 Elsevier Inc. All rights reserved.
Dicarlo-Meacham L.T.A.,Naval Medical Center Portsmouth |
Dahlke L.J.,Naval Medical Center Portsmouth
Obstetrics and Gynecology | Year: 2011
Background: Physiologic changes of pregnancy can predispose women to cardiac arrhythmias. Atrial fibrillation is rare in pregnancy and usually occurs in women with underlying cardiac anomalies. Case: A young woman at 22 weeks of gestation presented with new-onset atrial fibrillation with rapid ventricular response. Thorough evaluation revealed atrial fibrillation with no underlying cause and ultimately required treatment with electrical cardioversion. Conclusion: Lone atrial fibrillation in pregnancy requires exclusion of all possible etiologies before diagnosis. Cardioversion is the treatment of choice. Women with persistent atrial fibrillation require anticoagulation and rate control, as well as fetal growth surveillance and antenatal testing. © 2011 by The American College of Obstetricians and Gynecologists. Published by Lippincott Williams & Wilkins.
Henebry A.,Naval Medical Center Portsmouth |
Gaskill T.,Naval Medical Center Portsmouth
American Journal of Sports Medicine | Year: 2013
Background: Radiographic indices of acetabular coverage are crucial to objectively characterize femoroacetabular impingement and plan bony decompression. It is established that changes in pelvic inclination result in alterations of acetabular crossover; however, it is unclear what influence this has on other measures of acetabular anatomy. Hypothesis: The objective of the present study was to determine if, and to what degree, a variation in pelvic tilt alters 4 measures of acetabular anatomy: the angle of Sharp, Tö nnis angle, percentage of acetabular crossover, and lateral center edge angle (LCEA). The hypothesis was that pelvic tilt would significantly alter all measures of acetabular coverage. Study Design: Descriptive laboratory study. Methods: Fluoroscopic images of 8 adult hemipelvises were obtained at 7 positions of rotation in the sagittal plane to investigate the change of each measurement in response to pelvic orientation. Two reviewers obtained measurements from each image at 2 separate time points. Results: Each increment of pelvic inclination resulted in increased measures of acetabular coverage for all measurements, whereas each increment of decreased pelvic inclination resulted in decreased measures of acetabular coverage for all measurements. Significant differences in the measured LCEA, acetabular crossover, and Tö nnis angle were identified at each increment of tilt as compared with neutral radiographs. No significant differences could be identified for the angle of Sharp. Conclusion: Pelvic tilt significantly alters the measures of LCEA, crossover, and Tö nnis angle in this cadaveric study. Pelvic inclination results in increased measures of acetabular coverage, whereas decreasing inclination decreases each measure. Clinical Relevance: Given the known individual and positional pelvic tilt variability, standing anteroposterior pelvic radiographs may provide a more physiological representation of acetabular coverage in the young adult population. © 2013 The Author(s).
Pullen W.M.,Naval Medical Center Portsmouth |
Henebry A.,Naval Medical Center Portsmouth |
Gaskill T.,Naval Medical Center Portsmouth
American Journal of Sports Medicine | Year: 2014
Background: Radiographic measures of acetabular coverage are essential screening tools used to characterize bony structure contributing to femoroacetabular impingement (FAI). Small changes in pelvic tilt result in altered radiographic measures of acetabular coverage. Positional changes in pelvic tilt are known to occur between the supine and weightbearing positions. It is unclear whether alteration of pelvic tilt between these positions is clinically sufficient to influence measures of acetabular coverage.Purpose/Hypothesis: To determine whether, and to what degree, imaging position (supine vs weightbearing) is capable of altering several measures of acetabular orientation: pubic symphysis to sacrococcygeal distance (PSSC), angle of Sharp (SA), To nnis angle (TA), percentage of acetabular crossover (CO), and lateral center-edge angle of Wiberg (LCEA). The hypothesis was that imaging position would significantly alter all measures of acetabular orientation.Study Design: Cohort study (diagnosis); Level of evidence, 2.Methods: A total of 50 consecutive symptomatic hips referred to a single provider for FAI were evaluated with standardized supine and weightbearing anteroposterior pelvic radiographs. Two independent reviewers blinded to patient positioning reviewed each radiograph at 2 separate time points. Mean measurements in each position were compared by use of paired Student t tests, and a Bonferroni-adjusted significance level of P = .01 was used to represent significance.Results: Statistically significant differences between the supine and weightbearing radiographs were identified for PSSC and all measures of acetabular coverage (P<.003). The mean PSSC decreased between the supine and weightbearing positions by an average of 13.4 mm (P<.001), thereby resulting in decreased mean LCEA, TA, SA, and CO of 1.2°, 1.3°, 0.8°, and 6.3%, respectively (P<.002). The change in positional pelvic tilt was not uniformly predictable and accounted for large measurement changes in some individuals. PSSC also demonstrated considerable inter- and intrasubject variability but averaged 55.8 mm supine and 44.9 mm weightbearing for females and 37.0 mm supine and 20.6 mm weightbearing for males.Conclusion: In this study of nonarthritic adult patients with hip pain, the data indicate that positional changes are capable of significantly altering pelvic tilt and radiographic measures of acetabular coverage. It appears that the weightbearing position typically, but not universally, correlates with additional posterior pelvic tilt and decreased measures of acetabular coverage. Individual positional variability can contribute to large-magnitude changes in radiographic acetabular measures. ©2013 The Author(s).
Whiddon D.R.,Naval Medical Center Portsmouth
American journal of orthopedics (Belle Mead, N.J.) | Year: 2011
Digital radiography is becoming the standard of care for many hospitals and clinics worldwide. The introduction of this new standard has led to the development of arthroplasty templating software. We sought to compare our results using the standard acetate method with the new software method. Our digital preoperative plan was accurate to within 1 size in 78% of the acetabular components and 90% of the femoral components. The manually templated plan was accurate to within 1 size in 67% of the acetabular components and 82% of the femoral components. There did not appear to be any correlation between body mass index and inaccuracies in the preoperative template. Digital templating is an accurate tool to preoperatively plan total hip arthroplasty. The accuracy demonstrated in this study should be achieved easily with any digital templating software. The benefit comes from the ability to scale the templates to the actual x-ray magnification. We expect that this improved accuracy over traditional acetate templating will enhance our ability to restore normal hip biomechanics.