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BackgroundCompared with similarly injured patients of a younger age, elderly patients have worse outcomes from acute injury. One factor adversely affecting outcomes is sarcopenia, which has been assessed in healthy elderly populations through established clinical and radiological criteria. However, in the acute care setting, no such criteria have been established. Sarcopenia has been opportunistically assessed via radiographic means but there is as of yet no gold standard. The purpose of this review is to summarize the radiological methods used to diagnose sarcopenia in the acute care setting, and suggest ways in which these methods may lead to a consensus definition of sarcopenia and its relationship to patient outcomes.MethodsA systematic survey of medical databases was conducted, with 902 unique publications identified. After screening and application of inclusion and exclusion criteria, data regarding study population, outcome, imaging modality, and criteria for assessment of sarcopenia were extracted from 20 studies. Quality was assessed with the Newcastle-Ottawa Scale.ResultsCT was the imaging modality for 18 of the studies, with total psoas muscle cross-sectional area at the level of L3 and L4 being the dominant method for assessing sarcopenia. Adjustment for body morphology most commonly used patient height or L4 vertebral body area. The majority of articles found radiographically assessed sarcopenia to be significantly correlated to outcomes such as mortality, length of hospital stay, morbidity, and in-hospital complicationsConclusionsEstablishing a consistent definition would strengthen its applicability and generalizability to admission and discharge planning.Level of evidenceSystematic review, level III.

A brief survey of physicians revealed that health care professionals may have preconceived notions about patients with different disease states and their pain sources, and aberrant behaviors may be misinterpreted in complex medical illnesses such as acquired immunodeficiency syndrome, sickle cell anemia, cancer, and former intravenous drug abuse. 8 Physician perceptions of aberrant behaviors have a great degree of variability. 8 Illegal behaviors such as the sale of prescription drugs, forging prescriptions, and altering a route of delivery were perceived to be more problematic than behaviors such as unkempt appearance, unsanctioned dose escalation, and hoarding of drugs. Because the interpretation of such behaviors is dependent on a provider's perception and experience—as well as the patient's clinical context—caution should be taken to avoid making spurious correlations. 8 To promote a dispassionate interpretation of a patient's current state, the pattern of behavior in the setting of opiate use across multiple clinical environments needs to be established over the life course of a patient. Behavior monitoring is important to determine the success or failure of treatment, whether for patients receiving proper pain management with appropriate titration of opioids or for intentional withdrawal of opioid-dependent patients. No single tool is available that can be uniformly applied to the current practice of pain management.8 At least 12 tools exist for clinical use, including the widely applied Opioid Risk Tool (ORT), the Current Opioid Misuse Measure, Pain Management Questionnaire, Screening Tool for Addiction Risk, and the Screener and Opioid Assessment for Patients with Pain. Ultimately, physicians and their health care systems are responsible for recognizing the potential for and occurrence of opioid abuse and to develop a means of predictive opioid abuse assessment, determination, and treatment.8 1.

The risks of indoor skydiving have not been extensively studied. Indoor skydiving facilities are often used for corporate events and parties and by relatively inexperienced participants who may not appreciate the risks involved. The abducted and externally rotated shoulder position, combined with nearby walls, tight spaces, and the strong airstream, has resulted in a pattern of shoulder dislocation injuries. A 26-year-old male presented with recurrent left shoulder instability after developing an engaging Hill-Sachs lesion following traumatic anterior shoulder dislocation while indoor skydiving. He entered the wind tunnel with his arms abducted and externally rotated. The wind created an upward force that held his arms in this position. As he reached with his left arm for the side of the tunnel to exit, his arm was forced into further external rotation, dislocating the shoulder. The patient was treated arthroscopically with a remplissage procedure and repair of the glenoid labrum. Postoperatively, he resumed his active lifestyle and sports without further dislocations or instability. Indoor skydiving may pose a high risk of anterior dislocation because the shoulder is forced into abduction and external rotation in the free-fall position. We advise caution before participation in indoor skydiving by any individual, but especially those with a history of shoulder instability.

This secondary analysis of a randomized clinical trial examines the effect of androgen deprivation therapy (ADT) during radiotherapy in patients who were classified as having either favorable intermediate-risk or unfavorable intermediate-risk prostate cancer.

The diagnosis and treatment of multiple endocrine neoplasias type 2A (MEN 2A) requires interdisciplinary management. The association of RET proto-oncogene mutations and medullary thyroid carcinoma (MTC) in children is well-known, but the optimal timing for elective surgery is controversial. Besides the risk of MTC, associated anomalies like hyperparathyroidism have to be considered. We report the results of molecular genetic investigations, the pentagastrin stimulation test, pre- and postoperative staging, and histologic examinations of four children who had a positive family history for MEN 2A. Histologic specimens of the removed thyroid glands showed MTC in all four cases. The patients had an uneventful postoperative clinical course. In view of the recent literature and our patients' results, we suggest a concept for diagnostic strategy and timing of the elective thyroidectomy.