(P1-26) Abdominal Trauma: Arteriography versus Laparotomy

Selective non-operative management of abdominal visceral lesions is one of the most important and challenging changes that occurred in trauma patient care over the last 20 years. The main advantage of this type of management is the avoidance of unnecessary/non-therapeutic laparotomies. Trauma surgeons who deal with this type of treatment are worried of missed abdominal injuries. Modern diagnostic tools (spiral computed tomography, ultrasound, angiography, laparoscopy) allow trauma surgeons to accurately characterize the lesions to be addressed non-operatively. This presentation discusses the main elements of selective, non-operative management of principle solid visceral lesions (liver, spleen, and kidney). The advantages and limitations of the main diagnostic instruments used for evaluation of trauma patients allocated to non-operative management will be highlighted. Polytrauma patients in a Leve-1 trauma center over the last five years were selected and outcomes were analyzed. Pancreatic trauma remains an operative injury. However, surgeons must temper the enthusiasm for non-operative management of patients with solid organ injury, and exclude patients who would best be treated with surgery from this management scheme. Emergency care of the patients according the golden hour and team ability must be considere

(P2-13) Pitfalls for Upper Limb Injuries in Emergency

Sternoclavicular dislocation usually requires a Computed Tomography (CT) scan and surgery. This injury is rare because costoclavicular ligaments are strong. They appear in motorcycle accidents and sports collisions. Compression of the neurovascular structures or trachea involving the vital prognosis is not rare. Practitioners must be aware of symptoms such as dysphagia, dyspnea, hoarseness, or neurologic disorders. On the printing of thoracic standards, the medial clavicle appears misplaced superiorly in previous dislocations and posterior inferior dislocations. Fracture of the scapula (less than 1% of all fractures) rarely requires surgery, but should not be ignored because they signal a very high-energy trauma. The posterior shoulder dislocation is 2-4% of all delayed dislocations. Diagnosis is most often attributed to inadequate x-ray photographs. The main causes of this dislocation are epilepsy and electrocution. Radiography in front and profile observed a duplication of the humeral head. Joint space is not completely in view, and the CT scan can confirm the diagnostic if there is any doubt. Fracture of the clavicle is common in young patients. Fractures with lesions of the clavicular vessels and nerves are common. Practitioners also must be wary of intermediate fragments, which can puncture skin. Pneumothorax should always be excluded by a complete chest auscultation. The stump of the shoulder must be minimized in young patients, or an active patient operative indication can have negative functional and aesthetic consequences. Neurovascular examination must be complete, and circonflex nerve damage should not be confused with injury of the rotator cuff. These two injuries reduce abduction. The elbow is complex and a number of lesions could be missed, including: (1) the tip of the coronoid process; (2) epitrochlea and epicondyle; (3) radial head fractures; or (4) pullout capitelu

Obscuration model of Variability in AGN

There are strong suggestions that the disk-like accretion flow onto massive black hole in AGN is disrupted in its innermost part (10-100 Rg), possibly due to the radiation pressure instability. It may form a hot optically thin quasi spherical (ADAF) flow surrounded by or containing denser clouds due to the disruption of the disk. Such clouds might be optically thick, with a Thompson depth of order of 10 or more. Within the frame of this cloud scenario (Collin-Souffrin et al. 1996, Czerny & Dumont 1998), obscuration events are expected and the effect would be seen as a variability. We consider expected random variability due to statistical dispersion in location of clouds along the line of sight for a constant covering factor. We discuss a simple analytical toy model which provides us with the estimates of the mean spectral properties and variability amplitude of AGN, and we support them with radiative transfer computations done with the use of TITAN code of Dumont, Abrassart & Collin (1999) and NOAR code of Abrassart (1999).Comment: to appear in Proc. of 5th Compton Symposium on Gamma-Ray Astronomy and Astrophysic

Anatomy of the anterior cruciate ligament

The anterior cruciate ligament (ACL) is a band of dense connective tissue which courses from the femur to the tibia. The ACL is a key structure in the knee joint, as it resists anterior tibial translation and rotational loads. When the knee is extended, the ACL has a mean length of 32mm and a width of 7-12mm. There are two components of the ACL, the anteromedial bundle (AMB) and the posterolateral bundle (PLB). They are not isometric with the main change being lengthening of the AMB and shortening of the PLB during flexion. The ACL has a microstructure of collagen bundles of multiple types (mostly type I) and a matrix made of a network of proteins, glycoproteins, elastic systems, and glycosaminoglycans with multiple functional interactions. The complex ultrastructural organization and abundant elastic system of the ACL allow it to withstand multiaxial stresses and varying tensile strains. The ACL is innervated by posterior articular branches of the tibial nerve and is vascularized by branches of the middle genicular arter

X-ray emission from active galactic nuclei with intermediate mass black holes

We present a systematic X-ray study of eight AGNs with intermediate mass black holes (M_BH 8-95x10^4 Msun) based on 12 XMM-Newton observations. The sample includes the two prototype AGNs in this class - NGC4395 and POX52 and six other AGNs discovered with the SDSS. These AGNs show some of the strongest X-ray variability with the normalized excess variances being the largest and the power density break time scales being the shortest observed among radio-quiet AGNs. The excess variance -- luminosity correlation appears to depend on both the BH mass and the Eddington luminosity ratio. The break time scale -- black hole mass relations for AGN with IMBHs are consistent with that observed for massive AGNs. We find that the FWHM of the Hbeta or Halpha line is uncorrelated with the BH mass, but shows strong anticorrelation with the Eddington luminosity ratio. Four AGNs show clear evidence for soft X-ray excess emission (kT_in~150-200eV). X-ray spectra of three other AGNs are consistent with the presence of the soft excess emission. NGC4395 with lowest L/L_Edd lacks the soft excess emission. Evidently small black mass is not the primary driver of strong soft X-ray excess emission from AGNs. The X-ray spectral properties and optical-to-X-ray spectral energy distributions of these AGNs are similar to those of Seyfert 1 galaxies. The observed X-ray/UV properties of AGNs with IMBHs are consistent with these AGNs being low mass extension of more massive AGNs; those with high Eddington luminosity ratio looking more like narrow-line Seyfert 1s while those with low $L/L_{Edd}$ looking more like broad-line Seyfert 1s.Comment: 19 pages, ApJ, Submitte