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San Diego, CA, United States

Egan C.,Naval Medical Center San Diego
Clinical nuclear medicine | Year: 2013

This is a 66-year-old female patient being treated for diffuse large B-cell lymphoma. She reported to her physician in late January 2012 with a left flank pruritic painful rash. She was diagnosed with herpes zoster and treated with antiviral medication. Her chemotherapy regimen was delayed due to the zoster infection. In March 2012, the patient underwent a PET/CT as a lymphoma surveillance scan prior to reinstituting the chemotherapy treatment. As an incidental finding, the PET showed increased metabolic activity in a dermatomal distribution along the left flank, which corresponded to the patient's zoster infection. Source

Gordon R.J.,Naval Medical Center San Diego | Gordon R.J.,University of San Diego
Anesthesia and Analgesia | Year: 2015

The role of the anesthesiologist in reducing the incidence of surgical-site infections by the administration of prophylactic parenteral beta-lactam antibiotics is reviewed. Suggestions are made with regard to timing, dosing, and method of administration of these drugs to potentially reduce the risk of surgical-site infection. © 2015 International Anesthesia Research Society. Source

Kroonen L.T.,Naval Medical Center San Diego
Orthopedic Clinics of North America | Year: 2012

Compression of the ulnar nerve at the elbow, or cubital tunnel syndrome, is the second most common peripheral nerve compression syndrome in the upper extremity. Diagnosis is made through a good history and physical examination. Electrodiagnostic testing can confirm the diagnosis and severity of injury to the nerve. Surgical intervention is indicated when nonoperative treatment does not relieve the symptoms. There is currently no consensus on the best surgical treatment of cubital tunnel syndrome. However, the only randomized prospective studies to compare treatment options to date indicate that simple decompression and anterior transposition yield comparable results. © 2012. Source

Mikals S.J.,U.S. National Institutes of Health | Brigger M.T.,Naval Medical Center San Diego
JAMA Otolaryngology - Head and Neck Surgery | Year: 2014

IMPORTANCE: Adenoidectomy at initial tympanostomy tube placement (TT) may reduce the rate of repeated surgery for otitis media. OBJECTIVE: To assess the effectiveness of primary adenoidectomy as an adjuvant to TT (Ad + TT) compared with TT alone. DATA SOURCES: PubMed and EMBASE electronic databases were searched with no publication year restrictions beyond those of the individual databases. STUDY SELECTION: Articles that compared outcomes of children having undergone primary Ad + TT with children having undergone TT alone for middle ear disease. DATA EXTRACTION: Medical literature addressing Ad + TT was systematically reviewed. Data extracted included study design, age of children, and follow-up time frame. Level of evidence was assessed, and data were pooled where possible. MAIN OUTCOMES AND MEASURES: Proportion of children requiring repeated TT (r-TT). Secondary outcomes included proportion of children with recurrent acute otitis media (RAOM), otitis media with effusion (OME), otorrhea, or any combination of the 3. RESULTS: Fifteen articlesmet inclusion criteria. Ten studies (n = 71 353) reported that primary Ad + TT decreased the risk of r-TT or risk of RAOM, OME, or otorrhea compared with TT alone. Four studies (n = 538) reported no difference between Ad + TT groups compared with TT-only groups in the prevention of r-TT or of RAOM, OME, or otorrhea. Despite significant heterogeneity, limited meta-analysis and pooling of data revealed that the estimated rate of r-TT for children undergoing primary adenoidectomy was 17.2%(95%CI, 12.2%-22.2%) vs 31.8%(95%CI, 23.9%-39.8%) for children undergoing primary TT only. When stratified by age younger than 4 years, the protective effects of adenoidectomy were diminished. CONCLUSIONS AND RELEVANCE: The current evidence suggests that primary Ad + TTmay be superior to TT only in decreasing the risk of r-TT and the risk of RAOM, OME, or otorrhea. Limitations include heterogeneity of the source data, with the predominance of retrospective data as well as studies with older children supporting the superiority of adjuvant adenoidectomy. The practice of Ad + TTmay decrease the risk of repeated surgery in children older than 4 years. Copyright 2014 American Medical Association. All rights reserved. Source

Tumialan L.M.,Barrow Neurological Institute | Gluf W.M.,Naval Medical Center San Diego
Spine | Year: 2011

Study Design. Case report. Objective. To review the management of a patient with progressive osteolysis of the vertebral body after undergoing cervical arthroplasty for management of a refractory radiculopathy. Summary of Background Data. Since the Food and Drug Administration's (FDA) approval of cervical arthroplasty devices in 2007, many surgeons have incorporated this technology into clinical practice. As arthroplasty becomes more widespread, complications unique to this technology are inevitable. To date, only a limited number of complications have been reported in the literature suggesting the safety of this device. To the authors' knowledge, this report represents the first complication of osteolysis from a keel based arthroplasty device. Methods. A 30-year-old man underwent an uneventful C5-C6 total disc arthroplasty with initial benefit. Progressively worsening neck pain prompted repeat imaging at 9 and 15 months, which showed a progressive osteolytic process in the vicinity of the keel of the superior alloy endplate. This necessitated exploration of the surgical site, explantation of the implant and conversion of the disc arthroplasty to an arthrodesis. Results. Examination of the osteolytic area did not reveal any gross abnormalities. Testing of the device by the manufacturer did not reveal any defects. A comprehensive infectious workup was negative. The osteolytic process halted after the explantation of the device. A bony arthrodesis was achieved at 6 months and the patient remains symptom free 29 months after the initial procedure and 14 months after the revision. Conclusion. This report illustrates an exceptional case of a progressive osteolysis with a keel based arthroplasty device. An immune mediated osteolytic process appears to be a plausible explanation for the clinical symptoms and radiographic progression seen in this case. Given the years of use of the ProDisc-C since its FDA approval in 2007, complications with this device are rare. This represents the first reported case of osteolysis from such an implant. © 2011 Lippincott Williams & Wilkins. Source

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