A review of 10 years of scapula injuries sustained by UK military personnel on operations

Background

Scapula fractures are relatively uncommon injuries, mostly occurring due to the effects of high-energy trauma. Rates of scapula fractures are unknown in the military setting. The aim of this study is to analyse the incidence, aetiology, associated injuries, treatment and complications of these fractures occurring in deployed military personnel.

Methods

All UK military personnel returning with upper limb injuries from Afghanistan and Iraq were retrospectively reviewed using the Royal Centre for Defence Medicine database and case notes (2004–2014).

Results

Forty-four scapula fractures out of 572 upper limb fractures (7.7%) were sustained over 10 years. Blast and gunshot wounds (GSW) were leading causative factors in 85%. Over half were open fractures (54%), with open blast fractures often having significant bone and soft tissue loss requiring extensive reconstruction. Multiple injuries were noted including lung, head, vascular and nerve injuries. Injury Severity Scores (ISS) were significantly higher than the average upper limb injury without a scapula fracture (p<0.0001). Brachial plexus injuries occurred in 17%. While military personnel with GSW have a favourable chance of nerve recovery, 75% of brachial plexus injuries that are associated with blast have poorer outcomes. Fixation occurred with either glenoid fractures or floating shoulders (10%); these were as a result of high velocity GSW or mounted blast ejections. There were no cases of deep soft tissue infection or osteomyelitis and all scapula fractures united.

Conclusion

Scapula fractures have a 20 times higher incidence in military personnel compared with the civilian population, occurring predominantly as a result of blast and GSW, and a higher than average ISS. These fractures are often associated with multiple injuries, including brachial plexus injuries, where those sustained from blast have less favourable outcome. High rates of union following fixation and low rates of infection are expected despite significant contamination and soft tissue loss.

from # All Medicine by Alexandros G. Sfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/2xsvhVk
via IFTTT

Evolving dispatching rules for optimising many-objective criteria in the unrelated machines environment

Abstract

Dispatching rules are often a method of choice for solving various scheduling problems. Most often, they are designed by human experts in order to optimise a certain criterion. However, it is seldom the case that a schedule should optimise a single criterion all alone. More common is the case where several criteria need to be optimised at the same time. This paper deals with the problem of automatic design of dispatching rules (DRs) by the use of genetic programming, for many-objective scheduling problems. Four multi-objective and many-objective algorithms, including nondominated sorting genetic algorithm II, nondominated sorting genetic algorithm III, harmonic distance based multi-objective evolutionary algorithm and multi-objective evolutionary algorithm based on decomposition, have been used in order to obtain sets of Pareto optimal solutions for various many-objective scheduling problems. Through experiments it was shown that automatically generated multi-objective DRs not only achieve good performance when compared to standard DRs, but can also outperform automatically generated single objective DRs for most criteria combinations.

from # All Medicine by Alexandros G. Sfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/2wlH17j
via IFTTT

What are the risks of oestrogens in women assigned male at birth and how should they be monitored?

As a general practitioner, I am uncertain about hormonal treatment and its monitoring in patients with gender dysphoria. Barrett mentions that women who were assigned male at birth do not need...

from # All Medicine by Alexandros G. Sfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/2h0hfQ6
via IFTTT

Mitteilungen der DGSM

from # All Medicine by Alexandros G. Sfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/2wWc6Ss
via IFTTT

Do stress coping strategies influence chronotype-related differences in sleep quality?

Abstract

Background

Chronotype manifestation often has a broad influence on sleep quality. One possible explanation for daytime impairments in evening types is the concept of "social jetlag". Social jetlag is caused by an incompatibility between circadian preference and the socially accepted rhythm. This can be declared as a social stressor.

Objective

The association between chronotype, stress coping, and sleep quality was assessed in a pilot study.

Materials and methods

A total of 75 female adults aged 20–41 years participated in the study and completely answered all questions. Various questionnaires including sociodemographic data, information about sleep quality (Pittsburgh Sleep Quality Index, PSQI), chronotype (morningness–eveningness questionnaire, MEQ), and stress coping (Stress Coping Style Questionnaire, SVF78) were applied.

Results

Heightened use of maladaptive coping strategies is associated with a reduction in sleep quality. Chronotypes did not differ in terms of sleep quality and the coping strategies used.

Conclusion

Maladaptive coping strategy use seems to have a negative influence on sleep quality. Preventive education in adaptive stress coping strategies and avoidance of maladaptive stress coping thus seems useful to reduce these adverse influences on sleep quality.

from # All Medicine by Alexandros G. Sfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/2wlACcf
via IFTTT

Promotional effect of rare earth-doped manganese oxides supported on activated semi-coke for selective catalytic reduction of NO with NH 3

Abstract

A composite catalyst for the selective catalytic reduction (SCR) of NO_x with NH₃ is investigated, in which the rare earth (RE, including La, Ce, Pr, and Nd) is doped into manganese oxides supported on activated semi-coke (MnO_x/ASC) via hydrothermal method at the molar ratio of Mn:RE = 1:5. It is evidenced that the addition of RE at a rather low molar ratio can enhance the catalytic activity of MnO_x/ASC. The catalyst with a Mn:Ce molar ratio of 10:1 yields an over 90% NO_x removal efficiency in the temperature range of 150–250 °C. An approximate 100% NO conversion and 95% N₂ selectivity are achieved at about 200 °C. The catalysts are characterized by N₂ physisorption, X-ray powder diffraction (XRD), scanning electron microscope (SEM), hydrogen temperature-programmed reduction (H₂-TPR) and X-ray photoelectron spectroscopy (XPS). The results indicated that the Ce additive is conducive to the NO_x adsorption and then accelerates the SCR reaction due to the formation of more chemisorbed oxygen (O_β), which is favored during the oxidation of NH₃ and NO. Moreover, the in situ diffused reflectance infrared Fourier transform spectroscopy (DRIFTS) results confirm that the Ce additive on MnO_x/ASC catalyst could provide more active Brønsted acid sites, which eventually contributes to the SCR reaction. The generation of ad-NH₄⁺ and nitrite species is proved to play the crucial role in the promotional effect of RE addition.

from # All Medicine by Alexandros G. Sfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/2gXia7J
via IFTTT

Chemical characteristics of soluble aerosols over the central Himalayas: insights into spatiotemporal variations and sources

Abstract

In order to investigate the spatial and temporal variations of aerosols and its soluble chemical compositions of the data gap zone in the central Himalayan region, aerosol samples were collected at four sites. The sampling location were characterized by four different categories, such as urban (Bode), semi-urban site in the northern Indo-Gangetic Plain (Lumbini), rural (Dhunche), and semiarid rural (Jomsom). A total of 230 aerosol samples were collected from four representative sites for a yearlong period and analyzed for water-soluble inorganic ions (WSIIs). The annual average aerosol mass concentration followed the sequence as Bode (238.24 ± 162.24 μg/m³)> Lumbini (161.14 ± 105.95 μg/m³)> Dhunche (112.40 ± 40.30 μg/m³)> Jomsom (78.85 ± 34.28 μg/m³), suggesting heavier particulate pollution in the urban and semi-urban sites. The total soluble ions contributed to 12.61–28.19% of TSP aerosol mass. The results revealed that SO₄²⁻ and NO₃⁻ were the major anion and Ca²⁺ and NH₄⁺ were the major cation influencing the aerosol composition over the central Himalayas. Calcium played a major role in neutralizing aerosol acidity followed by NH₄⁺ at all the sites. The major compound of aerosol was (NH₄)₂SO₄ and NH₄HSO₄ in the central Himalayas. Clear seasonality was observed at three observation sites, with higher concentrations during non-monsoon (dry periods) and lower during monsoon (wet period), suggesting washing out of aerosol particles by heavy precipitation during monsoon. In contrast, semiarid sites did not show the clear seasonal trend due to limited precipitation. Stationary sources were predominant over the mobile sources mostly in the remote sites. Principal component analysis confirmed that the major sources of WSIIs in the region were industrial emissions, fossil fuel and biomass burning, and crustal fugitive dusts. Nevertheless, transboundary aerosol transport over the region from polluted cities from south Asia could not be ignored as indicated by the clusters of air mass backward trajectory analysis.

from # All Medicine by Alexandros G. Sfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/2wW90fR
via IFTTT

Bloody Epiphora (Hemolacria) Years After Repair of Orbital Floor Fracture

Surgical repair of orbital fractures with implants is a widely used treatment modality. While a variety of established complications are associated with this technique, most are directly understood and treated. Bloody epiphora is a finding with potentially ominous causes. The authors present a unique case of bloody epiphora, accompanied by orbital hemorrhage arising several years after orbital floor fracture repair, due to erosion of the nasolacrimal drainage system by a displaced implant combined with anticoagulation. The collection and evaluation of all protected patient health information was compliant with the regulations and conditions set forth in the Health Insurance Portability and Availability Act of 1996.

from # All Medicine by Alexandros G. Sfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/2wWq1Io
via IFTTT

An Alternative for Permanent Punctal Occlusion: Labial Mucous Membrane Graft in the Management of Severe Dry Eye

No abstract available

from # All Medicine by Alexandros G. Sfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/2w2XnGs
via IFTTT

A Single- Versus Double-Layered Closure Technique in Anophthalmic Surgery

Purpose: To compare the frequency of orbital implant exposure and extrusion following eye removal with a simplified closure technique, closing Tenon's capsule and conjunctiva in 1 layer versus the classic technique of closure in 2 separate layers. Methods: The authors conducted a retrospective case note review of patients who underwent evisceration or enucleation treated by 1 surgeon between 2001 and 2013. Between 2001 and 2004, Tenon's capsule and conjunctiva were closed in separate layers; after 2004, a simplified 1-layer closure following eye removal was used. The primary outcome parameters were presence or absence of implant exposure or extrusion. Results: One hundred fifty-seven patients who underwent evisceration and 172 patients who underwent enucleation were included. Following evisceration, 2.5% developed exposure or extrusion of the implant, this was 2.5% in the 1-layer closure technique and 2.7% in the 2-layer closure technique (p = 0.95). Following enucleation, 1.7% developed exposure or extrusion of the implant, this was 1.8% in the 1-layer closure technique and 1.7% in the 2-layer closure technique (p = 0.96). Overall implant exposure and extrusion was 2.1%, this was 2.2% in the 1-layer closure technique and 2.1% in the 2-layer closure technique (p = 0.96). Conclusions: No difference was found in the frequency of spheric acrylic implant exposure or extrusion in patients who underwent eye removal with single-layer closure of Tenon's capsule and conjunctiva compared with patients treated with separate closure of these layers.

from # All Medicine by Alexandros G. Sfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/2w2TFNj
via IFTTT

Endovascular Management of a Traumatic Infraorbital Pseudoaneurysm Causing Orbital Compartment Syndrome

An 89-year-old woman presented after blunt injury to the left orbit from a fall. Examination findings were suggestive of left-sided orbital compartment syndrome, unresponsive to emergent lateral canthotomy and cantholysis. CT revealed a left-sided orbital floor blowout fracture involving the infraorbital canal, with a large maxillary and infraorbital hematoma. Angiography revealed a pseudoaneurysm supplied by the infraorbital artery. Interventional neuroradiology successfully achieved hemorrhage control by endovascular obliteration of the parent artery close to the pseudoaneurysm. To our knowledge, this is the first reported case of successfully managing active intraorbital hemorrhage causing orbital compartment syndrome by endovascular vessel sacrifice of an infraorbital artery pseudoaneurysm.

from # All Medicine by Alexandros G. Sfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/2w28JL3
via IFTTT

Efficacy of Orbital Color Doppler Imaging and Neuroimaging in the Diagnosis of Carotid Cavernous Fistulas

Purpose: To evaluate the diagnostic sensitivity and specificity of orbital color Doppler imaging (CDI) and conventional neuroimaging (CT/MRI) compared with cerebral angiography in patients with carotid-cavernous fistulas (CCFs). Methods: The study design was a retrospective patient chart and imaging review. The authors reviewed 655 charts of all patients who underwent CDI and neuroimaging (CT/MRI) between 2006 and 2015 at one institution. Sixty patients had a presumptive diagnosis of CCF without thrombosis. Thirty-seven patients with 43 events met the inclusion criteria of the study. The diagnostic sensitivity of the 3 noninvasive imaging modalities (CDI, CT, MRI) for CCF was compared with the gold standard 6-vessel cerebral angiography. Significance testing was performed using the 2-tailed Fisher test. Results: Color Doppler imaging had high sensitivity (96.8%) but low specificity (41.7%) for the diagnosis of CCFs with anterior orbital findings. A negative CDI had more diagnostic value than a positive CDI. While an arterial wave form in the superior ophthalmic vein was the most common finding of CCF on CDI, enlargement of the superior ophthalmic vein was the only statistically significant finding. Posterior cortical venous drainage was noted in about 10% of the patients with indirect (low-flow) fistulas, who presented with unilateral orbital signs and symptoms, a finding not previously reported in the literature. Conclusion: Color Doppler imaging is a useful noninvasive, radiation-free modality for diagnosis of CCF with anterior drainage, with higher sensitivity than CT or MRI, but equivalent specificity. A significant limitation of CDI is the lack of usefulness in diagnosing fistulas with posterior cortical venous drainage, which carry a risk of intracerebral hemorrhage and stroke. In this series, 10% of unilateral CCFs with anterior orbital signs and symptoms showed angiographic evidence of posterior cortical venous drainage.

from # All Medicine by Alexandros G. Sfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/2w2Wn5d
via IFTTT

Comparative Evaluation of the Ostium After External and Nonendoscopic Endonasal Dacryocystorhinostomy Using Image Processing (Matlabs and Image J) Softwares

Purpose: The purpose of this study was to compare the characteristics of the ostium after external dacryocystorhinostomy and nonendoscopic endonasal dacryocystorhinostomy (NEN-DCR). Methods: This cross-sectional study included patients who underwent a successful external dacryocystorhinostomy or NEN-DCR and had ≥1 month follow up. Pictures of the ostium were captured with a nasal endoscope (4 mm, 30°) after inserting a lacrimal probe premarked at 2 mm. Image analyses were performed using Image J and Contour softwares. Results: Of the 113 patients included, external dacryocystorhinostomy group had 53 patients and NEN-DCR group had 60 patients. The mean age of patients in the NEN-DCR group (38 years) was significantly (p 0.05) in mean follow up (6 vs. 4 months), maximum diameter of ostium (8 vs. 7 mm), perpendicular drawn to it (4 vs. 4 mm), area of ostium (43 vs. 36 mm2), and the minimum distance between common internal punctum and edge of the ostium (1 vs. 1 mm) between the external and NEN-DCR groups. Conclusions: Image processing softwares offer simple and objective method to measure the ostium. While ostia are comparable in size, their relative position differs with posteriorly placed ostia in external compared with inferior in NEN-DCR.

from # All Medicine by Alexandros G. Sfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/2fe20TV
via IFTTT

Orbitocutaneous Fistula Secondary to Buried Polyethylene Mesh Implant 12 Years After Injury

Fabric monofilament polyethylene mesh is an implant primarily used in the repair of abdominal and chest walls. However, there have been isolated reports of using this implant in facial reconstruction. The authors describe a patient who underwent prior orbital floor fracture repair with polyethylene mesh and subsequently developed a recurrent orbital abscess 12 years later. Despite incorporation of the fabric monofilament polyethylene mesh within healed bone, an orbitocutaneous fistula developed after a secondary injury, causing hyperglobus and cicatricial lower eyelid retraction.

from # All Medicine by Alexandros G. Sfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/2ff5buy
via IFTTT

Rates of Positive Findings on Positron Emission Tomography and Bone Marrow Biopsy in Patients With Ocular Adnexal Lymphoma

Purpose: The aim of this study was to determine rates of positive findings on positron emission tomography (PET) and bone marrow biopsy performed during staging workup for ocular adnexal lymphoma (OAL). Methods: A retrospective review of OAL patients was conducted. Demographics, primary versus secondary OAL, histologic subtype, and findings on PET and bone marrow biopsy performed as part of the initial staging workup for OAL were recorded. Results: The study included 119 patients with OAL. There were 85 primary and 34 secondary OALs. The main histologic subtypes of lymphoma were mucosa-associated lymphoid tissue (n = 61), follicular (n = 26), diffuse large B-cell (n = 17), and mantle cell (n = 10). Positive PET findings were seen in 42 of 68 patients (62%) with primary OAL and 19 of 24 (79%) with secondary OAL. Positive PET findings were seen in 24 of 47 patients (51%) with mucosa-associated lymphoid tissue, 13 of 17 (76%) with follicular, 14 of 15 (93%) with diffuse large B-cell, and 9 of 10 (90%) with mantle cell lymphoma. Positive findings on bone marrow biopsy were seen in 7 of 59 patients (12%) with mucosa-associated lymphoid tissue, 4 of 23 (17%) with follicular, 1 of 17 (6%) with diffuse large B-cell, and 2 of 9 (22%) with mantle cell lymphoma. Conclusions: Our findings suggest that a significant proportion of patients with primary and secondary OAL have positive findings on PET and bone marrow biopsy at initial diagnosis, suggesting a reasonable yield for these tests as part of the initial staging workup in patients with a new diagnosis of OAL.

from # All Medicine by Alexandros G. Sfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/2fdPTWO
via IFTTT

Conjunctival Melanoma Responsive to Combined Systemic BRAF/MEK Inhibitors

This report demonstrates a unique case of conjunctival melanoma harboring a BRAF V600E mutation responsive to systemic therapy with BRAF and MEK inhibitors. While systemic therapy would not be appropriate in patients with local disease alone, it may act therapeutically in cases of higher stage ocular surface and eyelid melanoma.

from # All Medicine by Alexandros G. Sfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/2feoRP8
via IFTTT

Amelanotic Cellular Blue Nevus of the Eyelid

The authors describe an isolated, yellowish papular lesion of the upper eyelid in a 63-year-old man. Following excision, histopathologic analysis showed the features of a benign hypopigmented cellular blue nevus, the first and only case involving the eyelid skin.

from # All Medicine by Alexandros G. Sfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/2feYN6g
via IFTTT

An Anatomical Murine Model of Heterotopic Periorbital Subunit Transplantation

Background: Conventional reconstructive methods fail to achieve satisfactory results in total eyelid defect cases. Vascularized composite tissue allotransplantation might provide both good appearance and function for these patients. The structure of the eyelid is exceptional because it simultaneously consists of skin, connective tissue, the striated muscle, fiber structure, aponeuroses, and mucosa. Thus, before clinical application of eyelid allotransplantation, more experiments are needed to clarify the impact of ischemia, immunal suppressive agents, and deinnervation effects on these sophisticated structures. We developed an heterotopic periorbital transplantation model in rats to facilitate further experiment in this field. Methods: Twenty-five inbred male Lewis rats were used for anatomy study (n=10), and as donors or recipients of the operations (n=10). In the anatomy study, the vascular distribution and innervation to the periorbital unit was identified and recorded. Then, according to the anatomy study, 10 heterotopic transplantations and 2 transplantations with pedicle ligated were performed. The posterior facial vein and the external carotid artery are selected as the graft pedicle. All transplanted eyelids were assessed daily. Micro-CT scanning and hematoxylin and eosin staining of the grafts were performed 60 days after the operation. Results: All recipients tolerated the operation well. All grafts without pedicles ligated survived and new hair growth was observed. All of the transplanted eyelids were pink and pliable during the entire observation period, and we did not observe any signs of arterial or venous occlusion. In the recipients with graft pedicle ligated, the grafts were necrosed and mummified within 4 to 5 days. MicroCT of the survived grafts showed good blood supply and histologic staining revealed normal histologic morphologies. Conclusions: Our study proved the anatomical feasibility of periorbital transplantation by establishing a heterotopic transplantation model, which might facilitate future eyelid allotransplantation-related experiments.

from # All Medicine by Alexandros G. Sfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/2fenlg0
via IFTTT

Pott’s Puffy Tumor: A Rare Presentation

No abstract available

from # All Medicine by Alexandros G. Sfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/2w2zTkQ
via IFTTT

Determination of the optimal inspiratory pressure providing adequate ventilation while minimizing gastric insufflation using real-time ultrasonography in Chinese children: a prospective, randomized, double-blind study

During facemask ventilation, gastric insufflation is defined as appearance of a comet-tail or an acoustic shadow on ultrasonography. Ultrasonographic measurement of antral cross-section area (CSA) may reflect ...

from # All Medicine by Alexandros G. Sfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/2y1fbPG
via IFTTT