BackgroundThe prosthetic devices the military uses to restore function and mobility to our wounded warriors are highly advanced, and in many instances not publically available. There is considerable research aimed at this population of young patients who are extremely active and desire to take part in numerous complex activities. While prosthetists design and manufacture numerous devices with standard materials and limb assemblies, patients often require individualized prosthetic design and/or modifications to enable them to participate fully in complex activities.MethodsProsthetists and engineers perform research and implement digitally designs in collaboration to generate equipment for their patient’s rehabilitation needs. 3D printing allows for these devices to be manufactured from an array of materials ranging from plastic to titanium alloy. Many designs require form fitting to a prosthetic socket or a complex surface geometry. Specialty items can be scanned using computed tomography and digitally reconstructed to produce a virtual 3D model the engineer can use to design the necessary features of the desired prosthetic, device, or attachment. Completed devices are tested for fit and function.ResultsNumerous custom prostheses and attachments have been successfully translated from the research domain to clinical reality, in particular, those that feature the use of computed tomography (CT) reconstructions. The purpose of this project is to describe the research pathways to implementation for the following clinical designs: sets of bilateral hockey skates; custom weightlifting prosthetic hands; and a wine glass holder.ConclusionThis article will demonstrate how to incorporate CT imaging and 3D printing in the design and manufacturing process of custom attachments and assistive technology devices. Even though some of these prosthesis attachments may be relatively simple in design to an engineer, they have an enormous impact on the lives of our wounded warriors.

Aggressive hemangioma is a rare vertebral lesion in pediatric patients which can present with deteriorating neurological function. It can mimic malignancy on imaging, particularly as it regularly has an extrasosseous soft tissue component. We present a case of a 13-year-old male who presented with a three month history of lower extremity weakness that was found to have an infiltrative mass at T10 with associated cord compression from epidural extension of the lesion. In this report we review the characteristic imaging findings associated with aggressive hemangioma, including its appearance on read-out segmented diffusion-weighted images. It is imperative that radiologists who interpret studies of children be aware that this lesion exists and what it looks like, as it can be associated with massive hemorrhage if encountered unexpectedly during surgery.

Background: Of the 2.7 -3.4 million Americans estimated to have some form of epilepsy, approximately 25-30% of these individuals do not have adequate seizure control and suffer from intractable epilepsy. The objective of this study was to report outcomes of patients with epilepsy monitoring unit (EMU) admissions using data from a level 4 epilepsy center. Methods:We performed a retrospective review of electronic medical records for 433 EMU patient visits between January 2016 and May 2019 at a level 4 comprehensive epilepsy center. The EMU protocols followed in these admissions were those listed in the guidelines by the National Association of Epilepsy Centers (NAEC). Patients were monitored by a medical team that included electroencephalogram technicians, neurophysiologists, and epileptologists.Results: Of the 433 patients assessed, 384 met inclusion criteria. Mean length of stay in the EMU was 4 days. Of the patients, 73.4% had EMU stays resulting in new information which led to interventions including further diagnostic testing, surgical treatment, and medication changes. The most frequent intervention was a change in medication (68.8% of patients). Of the patients, 90.1% received a definitive diagnosis at the conclusion of their admission, with the most common diagnosis being epileptic seizures (66.7%), followed by non-epileptic physiologic events (14.3%) and psychogenic nonepileptic seizures (8.6%). Conclusions:This study sought to describe outcomes from patients who stayed in our level 4 epilepsy center's EMU after the implementation of the revised NAEC guidelines made in 2010. We investigated patient demographics as well as diagnosis and/or treatment changes after the EMU stay. We conclude that under the new NAEC guidelines, an EMU admission remains diagnostically useful in identifying if a patient has epilepsy or not. Our goal for this retrospective review is to inform future prospective outcomes studies and add to the body of literature demonstrating an EMU evaluation as a valuable diagnostic tool for epilepsy patients.