Carcinoma ex pleomorphic adenoma, an uncommon neoplasm of the parotid gland, accounts for less than 4% of salivary gland tumors. It arises from a benign pleomorphic adenoma presenting in the sixth to eighth decades of life. We present this as a unique account of a primary parotid gland carcinoma, arising from myoepithelial cells, without a known precursor lesion, in a 28-year-old woman. This presentation seeks to provide familiarity of an unusual presentation of an unexpected rare pathology in a young female patient and the tools utilized for an accurate diagnosis.
Obesity is a modifiable risk factor that causes mechanical forces to be exerted within the joints, further contributing to the debilitating effects of osteoarthritis. Total Knee Arthroplasty (TKA) can have a profound impact on patients with osteoarthritis, providing them with increased quality of life, improved function, reduction of pain, while simultaneously preventing the development of additional comorbidities. Although there is inconclusive evidence that increased body mass index (BMI) is linked to increased perioperative complications among TKA patients, recent studies suggest this association exists. The aim of this study is to provide conclusive data on the effects of BMI on perioperative complications in TKA using the national risk-adjusted database, ACS-NSQIP. Our study demonstrated that there was a correlation between increased BMI and perioperative outcomes, particularly with surgical site infections, renal, and respiratory complications. (Journal of Surgical Orthopaedic Advances 29(4):205-208, 2020).
Objective To explore whether older adults with isolated hip fractures benefit from treatment in high-volume hospitals. Design Population-based observational study. Setting All acute hospitals in California, USA. Participants All individuals aged ≥65 that underwent an operation for an isolated hip fracture in California between 2007 and 2011. Patients transferred between hospitals were excluded. Primary and secondary outcomes Quality indicators (time to surgery) and patient outcomes (length of stay, in-hospital mortality, unplanned 30-day readmission, and selected complications). Results 91 401 individuals satisfied the inclusion criteria. Time to operation and length of stay were significantly prolonged in low-volume hospitals, by 1.96 (95% CI 1.20 to 2.73) and 0.70 (0.38 to 1.03) days, respectively. However, there were no differences in clinical outcomes, including in-hospital mortality, 30-day re-admission, and rates of pneumonia, pressure ulcers, and venous thromboembolism. Conclusions These data suggest that there is no patient safety imperative to limit hip fracture care to high-volume hospitals.
The Model for End-Stage Liver Disease (MELD) score is predictive of trauma outcomes.To determine whether a decrease in MELD score is associated with improved mortality in critically ill trauma patients.We performed a retrospective registry study of critically ill trauma patients 18 years or older with chronic liver disease treated between August 3, 1998, and January 5, 2012, at 2 level I trauma centers in Boston, Massachusetts. The consecutive sample included 525 patients (male, 373 [71.0%]; white, 399 [76.0%]; mean [SD] age, 55.0 [12.4] years).Change in MELD score from intensive care unit (ICU) admission to 48 to 72 hours later.Thirty-day all-cause mortality.The mean (SD) MELD score at ICU admission was 19.3 (9.7). The 30-day mortality was 21.9%. The odds of 30-day mortality with a change in MELD score of less than -2, -2 to -1, +1 to +4, and greater than +4 were 0.23 (95% CI, 0.10-0.51), 0.30 (95% CI, 0.10-0.85), 0.57 (95% CI, 0.27-1.20), and 1.31 (95% CI, 0.58-2.96), respectively, relative to a change in MELD score of 0 and adjusted for age, sex, race, Charlson/Deyo Index, sepsis, number of acute organ failures, International Classification of Diseases, Ninth Revision-based injury severity score, and ICU admission MELD score.A decrease in MELD score within 72 hours of ICU admission is associated with improved mortality.
