No abstract

Testicular cancer is one of the greatest threats to health and wellness among 15- to 40-year old males. A concerted effort in the literature promoting awareness, risk factors, and preventative measures is warranted. There is limited discussion on the validity of interventions aimed at promoting testicular self-examination (TSE) performance; the existing body of evidence offers little discussion on what specific factors motivate performance. To assist in making Healthy People 2020 an all-inclusive success, a comprehensive assessment of existing evidence is necessary to assist in closing this research gap. A systematic review of interventions promoting TSE performance discovered moderate levels of effectiveness among 10 studies promoting the behavior. Concerning methodological quality, nine were of average quality and one was of high quality. In terms of significant TSE reporting between intervention and control/comparison groups, 3 out of 10 did not achieve the statistical causal threshold. Based on our assessment of TSE intervention quality and outcomes pertaining to behavior adoption, a best-practices guideline is presented for researchers in the field to consult as they design their interventions. This guideline aims to improve on internal and external validity of TSE promotion research in order to make them more effective.

Closure of thoracolumbar wounds and vertebral osteomyelitis after scoliosis surgery often proves difficult due to tautness and lack of usable tissue, and the resulting dead space containing metallic fixation devices is predisposed to infections and complications. The authors present their experience with 33 patients in whom massive thoracolumbar wounds and vertebral osteomyelitis developed following scoliosis surgery. Postoperative infection, due to the lack of vascularized tissue and presence of metallic hardware near the wound, is common and extremely counterproductive; within these cavernous wounds lie infected vertebrae, metallic hardware, and bone graft. The use of a modified and extended latissimus dorsi myocutaneous flap to close and supply blood to wounds in the lower thoracic and thoracolumbar areas is described. This surgical approach, predicated on effective débridement along with reconstruction by transposition of vascularized tissue, allows the wound to close and drastically decreases the risk of postoperative infection. Furthermore, for wounds already infected, the procedure allows for closure and increased blood supply to the area, thus giving the wound a much greater ability to heal. For wounds involving the lumbosacral area, the authors combine this with a transposed gluteus maximus muscle flap to obtain coverage over the caudal extent of the wound. In this study, all flaps accomplished their intended purpose: to secure the healing of once-infected wounds and to allow preservation of orthopedic instrumentation and bone graft. Follow-up revealed no flap losses, pseudarthroses, or loss of orthopedic instrumentation in the study group.