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Purpose Canada has the second-highest opioid use in the world. Despite knee and shoulder arthroscopy being among the most commonly performed orthopaedic procedures, there exists little guidelines for pain management. Methods A survey was developed and distributed to members of the Arthroscopy Association of Canada. The objectives were to understand opioid prescribing patterns after knee and shoulder arthroscopy, to determine if surgeons believe opioid over-prescription is an issue and to identify other pain management strategies surgeons are regularly using. Results A total of 38 responses were included (38.3%). Eighty-two percent of surgeons felt opioid over-prescription was an issue in arthroscopic surgery. The average post-operative knee or shoulder arthroscopy prescription included a total of 156 +/- 84.4 (0-400) mg of oral morphine equivalents (OMEs). Less than one-third of respondents (29%) had received formal peri-operative pain management training. Fifty-five percent of respondents felt that non-opioid medications do not provide adequate pain relief after arthroscopic surgery. this website Nearly all respondents (95%) stated they would change their prescription practice if high-quality evidence were to suggest that they should do so. Conclusions The majority of respondents identified opioid over-prescription as a problem after arthroscopic surgery. Surgeons are prescribing five times the amount of OMEs to patients that previous literature suggests the median patient uses after arthroscopic knee surgery. Surgeons generally state they would reduce or eliminate opioid prescriptions to arthroscopy patients if high-level evidence were to emerge suggesting that adequate pain control could be achieved without the use of narcotics.We report a patient who presented with anxiety, hyperventilation, perioral paresthesia, and tingling in the fingers associated with hypomagnesemia, hypocalcemia, and hypokalemia. We discuss the possible mechanistic basis for sequence of events that may have led to this presentation.Paradoxical vocal cord motion (PVCM) is a condition characterized by inappropriate adduction of the vocal cords during respiration. Usually seen in children and adolescents, PVCM presentation in infants is uncommon. Once thought to be a product of psychiatric disease, there are now several other proposed etiologies including irritant-induced and secondary to neurologic disease. Previous studies showed that the treatment of gastric reflux in this age group leads to a resolution of symptoms. We present a case of PVCM in an infant with hydrocephalus and Chiari II malformation. She received reflux therapy and ventriculoperitoneal (VP) shunting with two revisions. Despite these interventions, she continued with symptoms and eventually progressed to bilateral vocal cord paralysis (VCP). There is a paucity of literature describing PVCM as a precursor to VCP. Clinicians should be aware that in this population, refractory PVCM may serve as a warning sign for further vocal cord function decline.A 29-year-old caucasian woman who presented to the hospital with an acute onset of right eye visual disturbance and headache was found to have an acute left occipital lobe infarction. Past medical history was significant for iron deficiency anemia (IDA) secondary to menorrhagia. Her initial hemoglobin level was 7.8 G/DL, and her symptoms improved after iron and blood transfusions. Hypercoagulable studies were completed in the outpatient setting, and the results were unremarkable. Her acute stroke was most likely related to IDA as she had low cardiovascular risk factors along with a negative complete stroke workup.A maxillary central incisor presenting with more than one root or root canal is an exceptionally rare scenario considering the fact that most of the anatomic studies describe maxillary central incisor as a single rooted tooth with single canal. However, several case reports have shown the presence of up to four canals in maxillary central incisors. The aim of this article is to present a case report of maxillary central incisor with a rare anatomic variation, i.e. Vertucci’s type V root canal anatomy. Failure to locate and clean additional root canal system may lead to post treatment disease. Hence, an astute clinician should be aware of possible anatomic variations this tooth might present with.Introduction Surgery is an option for patients with large, symptomatic primary tumors affecting the brain. However, surgery might not be suitable for all tumors, especially those located in sensitive areas such as the pineal region and the hypothalamus. Single-session stereotactic radiosurgery (SRS) might not provide an adequate dose for long-term local control due to the initial tumor volume and the involvement of radiation sensitive organs at risk (OARs). Two-session radiosurgery has been described as a feasible strategy for dose escalation in large secondary brain tumors. This report describes a series of patients treated upfront with two-session radiosurgery for primary tumors affecting the brain. Materials and methods From May 2017 to January 2020, eight patients with primary tumors affecting the brain were treated with two-session radiosurgery due to either an initial large tumor volume or tumor localization and the involvement of OARs. The response was assessed by imaging and clinical evaluations. Resuays (range, 65 to 962 days), seven patients were alive, five tumors had a partial response (PR), and three had stable disease in accordance to Response Evaluation Criteria in Solid Tumors (RECIST) criteria. One patient died 435 days after treatment, the Karnofsky Performance Status (KPS) was 90 at the first session, 90 at the second session, and was maintained at last follow-up. No adverse radiation effects were reported. Conclusions Two-stage SRS proved to be a safe method to escalate dose in proportionately large volume primary brain tumors whose histology is expected to have a quick biological response to radiation. Longer follow-up is needed to determine the long-term effectiveness by tumor subtypes of two-stage SRS in the same manner as it has been proven in single session SRS series in smaller tumor volumes.