#NONOPE PLEASE BE CAREFUL

[dutyfound]

"Hey, I'm kinda... Not stuck, but still stuck, in Kugane at the moment. Don't really feel right enough to take the aetheryte back. Also happened to have busted up my vocal cords, so I can't really talk. I'll be back at some point later~ PS. Don't tell Nonotome he'll kill me." - A letter in a bottle, signed with the name 'Nonope Nope'

Oyuu stared at the bottle that had shoved carelessly into his hands by a passing mail moogle, wondering why an envelope couldn’t suffice. Popping off the cork and shaking out the rolled up paper, he quickly unravelled it and read the contents. All the Xaela could manage throughout reading the letter is sigh, then frown, then frown even more. Especially at the last sentence. So, he was meant to keep this a secret, alright. From her rather terrifying stepfather, okay. Manageable, right? Oyuu would just do his best to avoid him. What could go wrong? The Xaela burnt the letter and uttered a quick thank you to Nonope through the linkpearl, if she even heard it. 

(( @nonogrump @nonotome ))

[medicalequipments10]

Jb Medical N95 Face Mask, Fda Permitted 50 Depend

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This provider profile was extracted from the dataset publicized on Mar 4th, 2022 by the Centers for Medicare and Medicaid Services . If you came upon something that is incorrect and wish to change it, please comply with this Update Data guide. 

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Innovation Center Executive Director Peter Pfanner led the tour and showcased the work being accomplished at the center as Yellen, Lightfoot, Pritzker and Amiridis walked via the site. Pfanner pointed out the designs and prototypes on show, including a bust of a person’s head to indicate how the expertise worked. Students additionally explained the initiatives they are working on for purchasers. 

Lightfoot stated UIC’s Innovation Center is an instance of how native and federal entities can work together to advance the way ahead for all individuals. four, for patients seen within the GST standalone platform, holding times were beneath 12 hours for 85% of operative patients and 42% of nonoperative patients.

The variability of resupply and evacuation instances elicited from this survey underscores the significance of this instruction. Teams that may mobilize transport sooner and obtain the suitable resupply faster are at a big benefit for offering optimal care. A class roster of all surgeons who took the GST Phase 1 course was used to identify 87 surgeons who educated since inception of the course in April 2017 to September 2020.

The standalone GST median and common surgical procedures carried out were 2 and 3.9 respectively, while the “larger MTF” respondents had a median and average surgeries carried out of 7 and 34.5 respectively. 

Surgeries carried out through the first hour following injury had been reported by 5 surgeons (28%), and four of those surgeons (80%) reported that the majority of these casualties’ accidents necessitated intervention inside an hour. 1, resupply typically took greater than 2 weeks Rental medical equipment , with 36% of respondents reporting it taking more than a month, and three surgeons reporting that they by no means obtained resupplied. Many elements, including train habits, food regimen, and basic health, have an result on an individual's ability to reply to treatment. 

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In doing so, Roche claims the defendants and their "co-conspirators" made millions of dollars in illicit profits, https://en.wikipedia.org/wiki/Durable_medical_equipment costing  Roche as a lot as $89 million in wrongful rebates and bonafide gross sales. View contacts for J&B Medical to entry new leads and connect with decision-makers. 

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[lupine-publishers-scsoaj]

Lupine Publishers | Surgical Stabilization of Rib Fractures: Emerging Indications

Lupine Publishers | Journal of Surgery & Case Studies 

Abstract

Introduction: Rib fractures are a common injury after road traffic accidents. While most simple rib fractures heal well, multiple rib fractures may result in acute life-threatening complications or chronic disability and work loss. Though surgical fixation of rib fractures has most commonly been restricted to multiple rib fractures with flail chest, there has been a recent interest in fixation of multiple rib fractures with chest deformity to preclude chronic disability and loss of work.

Case Report: We report the case of a 34 year male with multiple rib fracture and chest deformity due to multiple, displaced fractures of 3rd to 10th ribs on the left side. He was treated with open reduction and internation fixation of ribs with 2.4mm titanium reconstruction plates and screws. The emerging indications of rib fracture fixation, as seen in this patient, are discussed.

Conclusion: Longer duration of hospital stays and delay in returning to normal life result in poor quality of life and add to direct and indirect treatment expenses. A case-based approach is essential in the decision-making for surgical fixation of multiple displaced rib fractures.

Keywords: Rib Fractures; Fracture Fixation; Chest Deformity

Introduction

Rib fractures are one of the most common injuries after road traffic accidents. Most simple rib fractures heal well with minimum intervention. But multiple rib fractures may require use of mechanical ventilation and sometimes surgical management [1]. Thoracic trauma comprises 10-15 % of all trauma and are the causes of death in 25 % of all fatalities due to trauma [2]. We present a case of multiple rib fractures and chest deformity and present the outcome of surgical fixation and its significance.

Case Summary

A 34 year male, a bus conductor, was brought to our hospital in the emergency room with an alleged history of road traffic accident. He sustained mild head injury with a history of loss of consciousness and there were multiple abrasions all over his body. He complained of severe excruciating pain during breathing and movements of left arm, with a pain score in VAS scale at 8-9(0-10). Pain was nonresponsive to analgesics. He had significant depression of the chest wall on the left side; chest wall movements were equal bilaterally. Computed tomography of the brain showed no parenchymal injury. Plain chest radiograph (Figure 1) and computed tomography with 3D reconstruction (Figure 2) demonstrated multiple, displaced fractures of 3rd to 10th ribs on the left side. There was no evidence of pneumothorax, hemothorax or lung contusional injury.

Figure 1: Anteroposterior radiograph of the chest demonstrating fracture of 3rd to 11th ribs.

Figure 2: 3-D computed tomography demonstrating the displaced fractures.

Figure 3: Intraoperative picture demonstrating placement of 2.4 mm titanium reconstruction plates and screws to fix the fractures.

Figure 4: Postoperative radiograph showing surgical fixation of 6th to 10th ribs.

Considering the presence of chest wall deformity and multiple consecutive rib fractures, surgical stabilization of the ribs was planned. Under general anesthesia, patient was positioned on left lateral position, and through a single lazy- S incision starting from lower border of scapula with a length of 6 cm, lattisimus dorsi muscle was exposed and split along the fibers and access to the ribs was made by stripping off the intercostal muscles. The 6th to 10th ribs were reduced and fixed with 2.4 mm titanium reconstruction plates and screws (Figures 3 & 4).

There were no signs of pleural tear after fixation, as clinically confirmed by positive pressure ventilation. The wound was closed in layers with a vacuum drain in-situ. He made a rapid recovery with marked reduction in his pain and discomfort (VAS score of 5) on post-operative day 1. The chest wall deformity was fully corrected. He was discharged on the 3rd post-operative day. Patient was last followed-up at 7months. The fractures had united (Figure 5) and recovery was uneventful. He had returned to work 3weeks following surgery.

Figure 5: Anteroposterior chest radiograph at 7 months following surgery showing fracture consolidation.

Discussion

Incidence of rib fracture reported by various studies ranges between 7 - 40 %. Most commonly 4th - 9th ribs are fractured. Fractures of upper ribs (1st & 2nd) usually signify severe trauma with increased risk of great vessel injuries [2]. Recently there has been a resurgence of interest in the surgical management of rib fractures [3,4]. Indications for surgical fixation of rib fractures include flail chest, severe chest wall deformity, failure to wean from mechanical ventilation, chronic pain or disability, pulmonary herniation, nonunion and “on the way out” after thoracotomy [5]. Initial research suggests that in select patients, operative management of chest wall injuries is a promising treatment option. Granetzy et al. [4] in 2005 randomised 40 patients who experienced fractures of 3 or more ribs to receive either conservative or surgical treatment and the results showed that patients in the surgical group experienced significantly fewer days on mechanical ventilation, decreased stay in the Intensive Care Unit and hospital stay and less restrictive pattern on pulmonary function tests 2 months after treatment [6]. Similar results were found by Nirula et al. [5] in 2006 where they treated 60 patients with rib fractures [7]. Favourable long term outcomes of patients undergoing surgical chest wall stabilization was documented from a prospective study by Lardinois et al. [8], who had done surgical stabilization of 60 patients of chest wall injuries from 1990-1999.

Rib fractures have been associated with significant disability and loss of work [9]. Hence selected patients with multiple rib fractures but without flail chest have been hypothesized to benefit better from open reduction with internal fixation than from nonoperative treatment [10,11]. All existing surgical indications are relative. Surgical repair has been attributed to possible sooner return to work and usual activities [5,12]. In a retrospective study by Solberg et al on 16 patients of unilateral rib fracture and chest wall deformity, the overall recovery of the surgically treated patient was much earlier than that of those who were treated conservatively [13]. However, no cohort study is available to confirm the beneficial effects of surgical fixation for multiple rib fractures without flail chest [5,12]. Treatment must be individualized on the basis of the patient’s fracture pattern, overall medical condition, and functional status [12]. This patient presents an ideal scenario where a surgical fixation of the rib fracture would result in better clinical outcomes and reduce the morbidity of prolonged pain and disability and loss of work.

Conclusion

The most preferred modality of treatment of rib fractures is non-operative, with analgesics and active chest physiotherapy. However recovery is prolonged or associated with complications, especially in the presence of multiple rib fracture, floating ribs or a flail chest. Longer duration of hospital stay and delay in returning to normal life also result in poor quality of life and add to direct and indirect treatment expenses. Hence, it is rational to manage certain patients with multiple rib fracture surgically to reduce morbidy, mortality and loss of work. Clinical message: The report stresses the need to make a case-based approach in decision-making and the need to have a lower threshold for surgical fixation in the presence of multiple displaced rib fractures. Further cohort studies are needed to confirm the benefits of internal fixation of multiple rib fractures in the absence of flail chest.

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[myspinemd-blog]

Everything You Need To Know About Lumbar Fusion Treatment

A spinal lumbar fusion operation is a surgical procedure that can provide support to a patient with back pain, a patient whose spine has instability, or a patient with abnormal curvature to the spine.

 The procedure focuses on the lumbar region of the low back. When new bone grows together and becomes a single entity, the process is known as fusion. In the lumbar fusion, two or more vertebral bodies in the lumbar region of the spine are fused for stability.

 In the process known as grafting, scaffolding materials are placed across the interbody space to immobilize the spine as the fusion takes place. Several different materials can aid in promoting bone growth to speed up fusion.

 Bone extracted from another part of the patient’s body was the material of choice in the early days of this procedure. Within the past ten years, a plethora of other options have emerged, allowing the dependence on the patient’s bone to become less frequent.

 For extra stability during the months required for complete bone fusion, the surgeon may take advantage of surgical implants in the spine.

 Reasons for the Spinal Lumbar Fusion Surgery

 When performed successfully, spinal lumbar fusion surgery can dramatically reduce the patient’s low back pain. Other reasons to have the surgery include immobilization of the spine at the level where the instability is occurring and restoration of more regular shape of the spine.

Treatment options for specific ailments, such as a compressed nerve due to thickening of the ligament and arthritis, can lead to the removal of a substantial quantity of bone. This can be the case, for example, in a lumbar laminectomy to relieve pressure on the nerve.

The removal of so much bone can cause spinal instability, and the surgeon may decide on lumbar fusion during the same surgical session to prevent the later need for lumbar fusion surgery.

 Spinal Fusion Procedures: Description of Types

 The surgery takes place when the patient is unconscious due to the administration of general anesthesia. The use of antibiotics at this time is also common for the prevention of infections.

After the medical team gently positions the patient in the correct position in the operating room, the surgery can proceed. With the guidance of an x-ray, the surgeon makes the surgical incision in the proper location.

 The types of spinal fusion procedures are quite similar, but they differ in where the surgeon makes the surgical incision to approach the lumbar region of the spine that requires the fusion.

 PLIF and TLIF – The posterior     lumbar interbody fusion, or PLIF, and transforaminal lumbar interbody     fusion, or TLIF, take place when the patient is on his or her stomach, so     that the surgeon may make the surgical cut along the midline of the back.

In a PLIF, the surgeon places the     grafting materials along both sides of the spine so that they can grow     together and stimulate bone fusion. In a TLIF, the surgeon places the     grafting materials diagonally across the spine. The PLIF and TLIF can both     require supporting materials that go across the disc space. These     stabilize the region during the healing process.

DLIF and XLIF – The direct lateral     interbody fusion, or DLIF, and extreme lateral interbody fusion, or XLIF,     take place as the surgeon makes the surgical incision on the side of the     patient to get to the spine. As in the PLIF and TLIF, the patient may     require scaffolding materials across the disc space or interspace for     extra support.

ALIF – An anterior lumbar     interbody fusion, or ALIF, occurs when the patient is on his or her back.     Carefully avoiding the abdominal muscles, the surgeon makes a cut in the     front of the body to get to the spine.

AXIALIF – An axial lumbar     interbody fusion, or AXIALIF, takes place as the surgeon works from the     lower region of the spine. The surgical incision is behind the end of the     lower spine, and the surgical instruments are under the sacrum and coccyx,     thus allowing the surgeon to access the front of the spine.

“360” fusion – A “360” fusion is a     more extensive procedure in which fusion occurs at the front at the back     of the spine. At the back, the fusion can take place between two facet     joints, which are connectors between different levels of the spine, or     between two transverse processes, which are bones that are directed toward     the back of the spine. The front part of the fusion involves the union of     vertebral bodies.

  The surgeon can access the area through the back of the patient, through the front of the patient, or both. Another approach is to perform a “360” fusion by going from the side.

 Lumbar fusion surgery is likely to require screws to be implanted into the spine to increase immobility and reduce the risk of poor fusion or non-union as the patient recovers from surgery.

Screws may be inserted into the pedicles of the vertebral bodies, or they may go through the facet joints. An open technique and a minimally invasive approach are two possible strategies for the placement of the screws.

 Posterolateral fusion – In cases where more extensive immobilization support is warranted, the surgeon can add additional fusion materials by placing bone on the back and side of the spine. This should fuse as the rest of the patient’s lumbar fusion heals.

 What Happens After Surgery

 The patient is frequently permitted to return home in one to four days after the completion of the operation. To prevent jarring that could disrupt the fusion, the patient may need to wear a back brace at home.

 Besides, bending, twisting, and lifting should not occur because they can interrupt the healing process. Until receiving clearance at an office visit a week to 10 days after surgery, patients should not allow the surgery wound to become wet or dirty.

 They may suffer from back pain and back spasms, but these symptoms typically decrease within a week or two after surgery. Patients can go back to work when their physicians determine that they are sufficiently healed and that their job duties do not lead to health risks.

 At SpineMD, what makes us stand out is our caring philosophy of being very conservative with our treatment approach; we reserve surgical treatment as a last resort and only consider surgery if all other nonoperative treatments have failed.

Please visit our spine doctor, Dr. Anil Kesani, the best spine Surgeon for a thorough systematic evaluation of your spine problem. Log onto our website www.myspinemd.com for more information.