The incidental finding of a retained ‘throat pack’

A postoperative radiograph demonstrated a folded radio-opaque structure in the nasopharynx, resembling a retained throat pack, despite her not having any respiratory symptoms. Retention of a throat pack is a never event.

Migration measurement of the cemented Lubinus SP II hip stem – a 10-year follow-up using radiostereometric analysis

In a previous radiostereometric analysis (RSA) of the Lubinus SP II (Link, Hamburg, Germany), which is one of the most often used cemented hip stems worldwide, our research group detected a very small but statistically significant distal migration of -0.03±0.17 mm 2 years after surgery compared to the postoperative radiograph. Maximum subsidence occurred between 6 and 12 months. The implant appeared to have stabilized after 2 years. The mean value of maximum total point motion (MTPM) was 0.99±0.69 mm, which was detected 2 years after surgery. The purpose of this study was to analyze the migration pattern and to verify the predictive value of short-term RSA of the Lubinus SP II stem after 10 years. After a follow-up of 5 and 10 years, 38 and 27 out of 100 patients remained available for further assessment, respectively. No statistically significant implant translation or rotation was found along or about the axes of the global coordinate system 5 and 10 years after surgery with respect to the postoperative radiograph. Furthermore, the MTPM was stable in both follow-up periods. The results suggest that the Lubinus SP II hip stem is still stable 10 years after surgery, supporting that determining prognosis by short-term RSA follow-up of 2 years could be an appropriate tool for appraisal of implant behavior 10 years after surgery.

Paralyzed Diaphragm

Diaphragmatic dysfunction may be unilateral or bilateral, with symptoms ranging from dyspnea only on extreme exertion to ventilator dependence. The etiology, treatment, and prognosis are quite different in unilateral and bilateral paralysis. A paralyzed hemidiaphragm may occur in isolation or as part of a systemic disease, whereas bilateral diaphragmatic paralysis usually occurs as a result of a traumatic or neuromuscular degenerative process. This review covers clinical evaluation, investigative studies, and management of diaphragmatic dysfunction. Figures show diaphragmatic motion during respiration, a postoperative radiograph from a 55-year-old woman who underwent left upper lobectomy, a postoperative radiograph of a 70-year-old man who underwent left upper lobectomy for removal of a peripheral 3 cm lesion, three chest radiographs of a 25-year-old man with a residual anterior mediastinal mass after treatment for germ cell tumor, chest radiograph showing left diaphragmatic paralysis in a breast cancer patient with malignant adenopathy involving the left phrenic nerve near the left main pulmonary artery, several parallel rows of sutures placed in the muscular portion and central tendon of the diaphragm and tied with the aid of a knot pusher, a laparoscopic mapping probe held onto the left diaphragm with suction and which receives electrical stimuli from an external clinical station, an electrode implant device that houses the electrode in the needle and is placed into the diaphragm tangentially, and the diaphragm pacing system programmed for conditioning and attached via percutaneously placed diaphragm electrodes in a spinal cord-injured child for early conditioning and weaning from the ventilator. Tables list causes of isolated diaphragmatic paralysis, general causes of unilateral and bilateral diaphragmatic paralysis, and differential diagnosis of elevated hemidiaphragm on chest radiograph. A video shows current technique of laparoscopic diaphragm pacemaker insertion. This review contains 9 highly rendered figures, 3 tables, 1 video, and 22 references