Introduction: This study aims to develop a simple diagnostic criterion that could be used to justify arthrocentesis in adults with suspected septic arthritis. Our hypothesis is that no single factor will be predictive for a decision to aspirate a questionable septic joint. Methods: A prospective observational cohort study was performed at a Level 1 Trauma institution including all patients over the age of 18 years referred to Orthopaedics through the Emergency Department or inpatient orthopaedic consultations for a suspected septic joint. Patient information recorded was age, laboratory markers (white blood cell count, erythrocyte sedimentation rate, C-reactive protein, physical exam findings (fever, pain with range-of-motion), and presence of smoking, diabetes, end-stage renal disease (ESRD) on dialysis, and body mass index > 30. Continuous data was analyzed using logistic regression, and nominal data was analyzed using a two-tailed Fisher’s exact test. Results: A total of 128 patients met inclusion criteria for this study; 71 patients underwent arthrocentesis for suspected septic joint. On analysis of risk factors, the demographics, laboratory markers, physical exam and comorbidities were not significant between the two groups. On subset analysis of the septic joints, we found the only risk factor to be significantly predictive of whether a joint was septic was the presence of ESRD on dialysis ( p = 0.042). Conclusion: Past data have looked solely at predictive risk factors for septic arthritis; however, this study aims to predict what drives physicians towards aspirating a joint even before it is determined to be septic. We found no single factor was predictive of joint aspiration. Only ESRD on dialysis is predictive of whether a joint with concern for septic arthritis would ultimately be septic in our institution. The decision to aspirate continues to be best determined by clinician judgment in light of experience and available clinical information.

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At upstream oil and gas production sites, separators frequently allow saline produced water aerosols to be entrained into flares, a phenomenon known as liquid carryover. This study assesses the impacts on gas-and solid-phase emissions from adding saline solutions to a lab-scale flare. Atomized aqueous solutions containing NaCl, KCl, or NaOH were added to a vertical turbulent diffusion flame burning a hydrocarbon gas mixture representative of flares in Alberta, Canada. The combustion products were analyzed to quantify emission rates of major pollutants and optical properties of the particulate. Over the range of test conditions yields of gas-phase pollutants increased by as much as fortyfold with added NaCl, while black carbon emissions increased by up to three times. Emitted particulate had a greater absorption capacity contributing to an increase in expected radiative forcing effects in the climate. Empirical guidelines for liquid separation requirements to avoid severe increases in emissions were developed.

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Chronic exertional compartment syndrome is an activity-induced condition that occurs when intracompartmental pressures within an osteofascial envelope increase during exercise, leading to reversible ischemic symptoms such as pain, cramping, numbness, or weakness. Nonoperative treatment options for this condition have shown limited success and are often undesirable for the patient given the requirement for activity modification. Traditional surgical treatment options involving open or subcutaneous fasciotomies have more favorable results, but these techniques are associated with significant morbidity. Endoscopically assisted fasciotomy techniques afford the advantages of being minimally invasive, providing excellent visualization, and allowing accelerated rehabilitation. The purpose of this article is to describe a technique for performing endoscopically assisted fasciotomies for chronic exertional compartment syndrome of the lower leg using an entirely endoscopic thermal ablating device. The endoscopic thermal fasciotomy technique is associated with minimal morbidity, ensures excellent hemostasis, and affords an early return to sports.