Background and Purpose: Low-energy hip fractures are common in elderly women with osteoporosis. The trend of using intramedullary devices is increasing for treatment of extracapsular proximal femoral fractures. However, the blade screw cutout has been reported as the major complication of the intramedullary devices. In this study, we hypothesized the tip-apex distance and Cleveland zone within femoral head are related to blade screw cutout. Materials and Methods: A retrospective review was collected with 206 extracapsular proximal femoral fractures treated with PFNA II at Cathy General Hospital during November 2009 and September 2014. The charts were reviewed and the fractures were classified according to Orthopaedic Trauma Association (OTA) classification. Screw blade positions within the femoral head (tip-apex distance and Cleveland zone) were recorded from intraoperative and immediate postoperative radiographs to evaluate the short-term implant-related complication of screw blade cutout. Results: We selected a total of 131 patients with intertrochanteric and subtrochanteric fractures. This study observed 10 surgical-implant-related complications (7.6% out of total patients). Six cases of the screw blade cutout, perforation of the femoral head, had postoperative radiograph tip-apex distance (TAD) shorter than 20 mm, and four cases without cutout but were observed with implant migration. Conclusion: Fixation failure, ie the screw blade cutout, after proximal femoral nailing remains a major issue for surgeons. This study demonstrated the correlation between TAD and Cleveland zone for preventing screw blade perforation with the use of proximal femoral nail antirotation II (PFNA II; Synthes, Solothurn, Switzerland). With our discovery, we found that the TAD between the screw blade and the femoral head has a significant relationship (p<0.05) with the surgical complication cutout rate.
Objective: The attitude towards enabling a good death for patients and handling end-of-life (EOL) care is important for young nurses in terms of their professionalism and personal psychosocial health. The aim of the current prospective study was to assess factors associated with these caring practices in nurses. Methods This cross-sectional study used a purposive sampling design. A total of 104 medical, surgical and intensive care unit (ICU) nurses with at least 3 months of work experience were recruited from a teaching hospital in northern Taiwan. Descriptive and inferential statistics were used for data analysis, including the Student's t-test, Pearson's correlation coefficient, one-way analysis of variance, and multiple linear regression. Results The mean age of the 104 nurses was 28.87 (±5.77) years and they had worked for an average of 6.99 (±5.49) years. The attitude of good death and competence in handling end-of-life patients were 170.50 (±16.56) and 134.13 (±23.07), respectively. In the regression analysis, nurses with a good understanding of a good death, with practical experience at an emergency department, or with good patient-nurse communication skills regarding death and dying, showed good competence in handling end-of-life issues. Conclusion These findings may guide other healthcare professionals in providing references for continuing education within the nursing specialty. The authors recommend that nurses involved in hospice palliative care should have a broad knowledge of a good death and good communication skills for discussing the issues surrounding death and dying with their patients.
Gastrointestinal bleeding is a common disease seen in the emergency department. In the majority of patients, endoscopy should be the initial diagnostic procedure. However, a surgical consultation should be considered in patients with high-risk clinical features and ongoing hematochezia. We present a 76-year-old man who visited the emergency department with a large, fresh, bloody stool passage at night and hemodynamic instability despite resuscitation with intravenous fluids and blood product transfusion. Computed tomography angiography showed a ruptured descending aortic penetrating atherosclerotic ulcer with aorto-enteric fistula. Endovascular aneurysm repair was performed, and the patient was discharged 10 days after admission.
Spondylodiscitis is an inflammatory disease characterized by primary infection of the intervertebral disc and/or secondary infection to the adjacent vertebrae. Fungal etiology is rare. Fungal spondylodiscitis is a rare spinal infection and usually develops in immunocompromised patients, especially in those with a malignant tumor, chronic urogenital tract infections, diabetes, or advanced age or in those taking immunosuppressive drugs for organ transplantations. Chronic pyelonephritis is a complication of repeated bouts of acute pyelonephritis. In the present report, two patients diagnosed with chronic pyelonephritis were treated with antibiotics for more than six months. They presented with symptoms of sudden-onset low back pain and fever. Magnetic resonance imaging revealed fungal spondylodiscitis with abscess, which was confirmed with surgery and culture. Fungal spondylodiscitis may result from chronic pyelonephritis. The patients received intravenous antifungal agents after spinal surgery, followed by oral antifungal agents. Their symptoms improved with treatment, and they were discharged after surgery.
A 60-year-old women suffered from pathologic fracture of right femur and received open reduction and internal fixation. The pathologic report of bone specimen was metastatic carcinoma. After tumor survey, she received diagnostic dilatation and curettage and a diagnosis of endometrial endometrioid carcinoma (EEC) was made. PET scan showed multiple metastases including bone, brain, and lung metastases. A stage IVB endometrial EEC was impressed. The patient refused further chemotherapy and radiotherapy. She passed away due to progression of brain metastases 3 months after operation. Bone metastases from endometrial carcinoma is an unusual condition. It indicates delayed of diagnosis and is associated with poor outcome. A bone biopsy with immunohistochemical staining may help in the differential diagnosis of the primary tumor site.
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