Perioperative Hyperglycemia Increases Risk for Deep Wound Infection after Major Orthopedic Surgery

Total hip and knee replacement surgery are one of the most frequent major surgeries performed in the USA. In 2002, the number of primary hip and knee arthroplasty was 119,000 and 381,000, respectively. By year 2030 the number is projected to increase to 572,000 and 3,481,000 respectively. Deep wound infection after major orthopedic surgery is one of the most serious complications causing increase in morbidity and mortality and health care costs. Various risk factors for developing infection after hip and knee replacement surgery were described including age, ASA PS status, obesity, patients\u27 comorbidities and surgical technique factors. Perioperative hyperglycemia may increase the risk for infection after the surgery, but it is unknown if increases the risk after major orthopedic surgery. We investigated whether high blood glucose increases a risk for periprosthetic joint infection (PJI) after total hip and knee arthroplasty

Benign splenic epithelial cyst accompanied by elevated Ca 19-9 level: A case report

We report the case of a 30-year-old woman with a benign epidermoid splenic cyst and a high CA 19-9 serum level (268 U/mL). The patient underwent resection of the cyst and splenectomy. After removal of the cyst, the serum CA 19-9 level decreased to a normal level within 6 weeks. True non-parasitic splenic cysts are rare. Approximately 30 cases of benign true splenic cysts with a high CA 19-9 serum level have been published. © The Mount Sinai Journal of Medicine

Efficacy of Intraoperative Neuromonitoring during the Treatment of Cervical Myelopathy

Objective The accuracy of intraoperative neuromonitoring (IONM) during surgery for cervical spondylotic myelopathy (CSM) to detect iatrogenic nervous system injuries while they are reversible remains unknown. We evaluated a cohort of patients who had IONM during surgery to assess accuracy. Methods Patients who underwent surgical treatment of CSM that included IONM from January 2018 through August 2018 were retrospectively identified. A standardized protocol was used for operative management. Clinical changes and postoperative neurological deficits were evaluated. Results Among 131 patients in whom IONM was used during their procedure, 42 patients (age 58.2 ± 16.3 years, 54.8% males) showed IONM changes and 89 patients had no change. The reasons for IONM changes varied, and some patients had changes detected via multiple modalities: electromyography (n = 25, 59.5%), somatosensory-evoked potentials (n = 14, 33.3%), motor evoked potentials (n = 13, 31.0%). Three patients, all having baseline deficits before surgery, had postoperative deficits. Among the 89 patients without an IONM change, 4 showed worsened postoperative deficits, which were also seen at last follow-up. The sensitivity of IONM for predicting postoperative neurological change was 42.86% and the specificity was 68.55%. However, most patients (124, 94.7%) in whom IONM was used showed no worsened neurological deficit. Conclusions IONM shows potential in ensuring stable postoperative neurological outcomes in most patients; however, its clinical use and supportive guidelines remain controversial. In our series, prediction of neurological deficits was poor in contrast to some previous studies. Further refinement of clinical and electrophysiological variables is needed to uniformly predict postoperative neurological outcomes