Pan-viral serology implicates enteroviruses in acute flaccid myelitis.

Since 2012, the United States of America has experienced a biennial spike in pediatric acute flaccid myelitis (AFM)1-6. Epidemiologic evidence suggests non-polio enteroviruses (EVs) are a potential etiology, yet EV RNA is rarely detected in cerebrospinal fluid (CSF)2. CSF from children with AFM (n = 42) and other pediatric neurologic disease controls (n = 58) were investigated for intrathecal antiviral antibodies, using a phage display library expressing 481,966 overlapping peptides derived from all known vertebrate and arboviruses (VirScan). Metagenomic next-generation sequencing (mNGS) of AFM CSF RNA (n = 20 cases) was also performed, both unbiased sequencing and with targeted enrichment for EVs. Using VirScan, the viral family significantly enriched by the CSF of AFM cases relative to controls was Picornaviridae, with the most enriched Picornaviridae peptides belonging to the genus Enterovirus (n = 29/42 cases versus 4/58 controls). EV VP1 ELISA confirmed this finding (n = 22/26 cases versus 7/50 controls). mNGS did not detect additional EV RNA. Despite rare detection of EV RNA, pan-viral serology frequently identified high levels of CSF EV-specific antibodies in AFM compared with controls, providing further evidence for a causal role of non-polio EVs in AFM

Cerebral arterial air embolism with anterior spinal cord syndrome after CT-guided hook-wire localization of Lung mass and pulmonary nodule

Systemic arterial air embolism (SAAE) is a rare but serious complication of CT-guided hook wire localization of pulmonary nodule usually with catastrophic and poor outcome. Hook wire needle localization is done pre-operatively by placing wire around or into the pulmonary nodule to provide the thoracic surgeon accurate location guidance of the target nodule for Video-Assisted Thoracoscopic Surgery (VATS) wedge resection with safety margins. Physicians should be aware of this possible complication during the procedure in order to rescue the patient promptly as it requires rapid diagnosis and management. We describe a 55-year-old male who underwent a CT-guided hook wire needle localization of left upper lobe lung cancer and left lower lobe pulmonary nodule prior to planned VATS wedge resection who developed altered mental status and bilateral lower extremities paralysis after wire placement was completed. His CT head demonstrated small air embolism in the left occipital area, confirming the diagnosis of cerebral air embolism and follow up CT and MRI of the head revealed multiple areas of brain infarction. In addition, he was diagnosed with anterior spinal cord syndrome (ACS), most likely due to anterior spinal artery ischemia from micro air embolism on the basis of clinical findings but with negative ischemic changes on MRI of the spinal cord. His mental status recovered but he remained paraplegic and transferred to inpatient rehabilitation service

Cardiac Pneumatic Nail Gun Injury

Pneumatic nail guns deliver discrete, low-velocity penetrating trauma causing limited injury.1 Kinetic energy is centered on the nail’s advancing tip, and therefore such injuries are similar to stab wounds. This is reflected in the 11% mortality rate after accidental discharges. Mortality rates might, however, exceed 40% when these injuries are self-inflicted.1 and 2 In the case presented the patient attempted suicide, shooting himself 17 times in the chest with a pneumatic nail gun. The optimal diagnostic and therapeutic approach to this unusual injury is described

Cardiac Pneumatic Nail Gun Injury

Pneumatic nail guns deliver discrete, low-velocity penetrating trauma causing limited injury.1 Kinetic energy is centered on the nail’s advancing tip, and therefore such injuries are similar to stab wounds. This is reflected in the 11% mortality rate after accidental discharges. Mortality rates might, however, exceed 40% when these injuries are self-inflicted.1 and 2 In the case presented the patient attempted suicide, shooting himself 17 times in the chest with a pneumatic nail gun. The optimal diagnostic and therapeutic approach to this unusual injury is described

Cardiac Pneumatic Nail Gun Injury

Pneumatic nail guns deliver discrete, low-velocity penetrating trauma causing limited injury.1 Kinetic energy is centered on the nail’s advancing tip, and therefore such injuries are similar to stab wounds. This is reflected in the 11% mortality rate after accidental discharges. Mortality rates might, however, exceed 40% when these injuries are self-inflicted.1 and 2 In the case presented the patient attempted suicide, shooting himself 17 times in the chest with a pneumatic nail gun. The optimal diagnostic and therapeutic approach to this unusual injury is described

Outcome Following Non-Operative Management in Blunt Aortic Trauma

Purpose: Aortic injury following blunt trauma is an indication for urgent thoracic aortic repair. Reports from centers using thoracic endografts have suggested that the strategy of delayed aortic repair can improve survival in these patients. Experience has also demonstrated that non-operative management without aortic repair is appropriate in selected patients. The purpose of this study was to determine the outcome of patients with blunt aortic injury managed non-operatively. Methods: All patients admitted to a single institution Level I trauma center were prospectively enrolled in a registry. Those patients identified with blunt aortic injury that were managed non-operatively between January 2005 to December 2010 were reviewed. In-hospital mortality, length of stay and survival following discharge were assessed in this patient cohort. Results: A total of 53 patients were identified with blunt aortic injury during the study period. Thirty of the patients were managed operatively; 17 underwent open repair and 13 endovascular repair. Twenty-four patients (45%) were managed non-operatively and underwent further analysis. The male to female ratio was 15:8 with an average age of 44 (range 18-85) years. In hospital mortality occurred in only 1 patient (4%) managed non-operatively. This patient expired in the first 24 hours due to multiple co-morbidities and extensive associated traumatic injuries. The mean length of hospital stay in the remaining 23 survivors was 20 days. Follow-up was available in 22 of 23 patients following discharge. All patients were alive at the last time of contact, mean 19 (range 1 to 67) months. Conclusions: Improved survival with endografts for blunt aortic injury is felt related to strategies of delayed repair. The present study demonstrates patients can be managed medically with excellent survival. Therefore, when considering delayed aortic repair for blunt aortic injury, medical management should be considered in selected patients

Outcome Following Non-Operative Management in Blunt Aortic Trauma

Purpose: Aortic injury following blunt trauma is an indication for urgent thoracic aortic repair. Reports from centers using thoracic endografts have suggested that the strategy of delayed aortic repair can improve survival in these patients. Experience has also demonstrated that non-operative management without aortic repair is appropriate in selected patients. The purpose of this study was to determine the outcome of patients with blunt aortic injury managed non-operatively. Methods: All patients admitted to a single institution Level I trauma center were prospectively enrolled in a registry. Those patients identified with blunt aortic injury that were managed non-operatively between January 2005 to December 2010 were reviewed. In-hospital mortality, length of stay and survival following discharge were assessed in this patient cohort. Results: A total of 53 patients were identified with blunt aortic injury during the study period. Thirty of the patients were managed operatively; 17 underwent open repair and 13 endovascular repair. Twenty-four patients (45%) were managed non-operatively and underwent further analysis. The male to female ratio was 15:8 with an average age of 44 (range 18-85) years. In hospital mortality occurred in only 1 patient (4%) managed non-operatively. This patient expired in the first 24 hours due to multiple co-morbidities and extensive associated traumatic injuries. The mean length of hospital stay in the remaining 23 survivors was 20 days. Follow-up was available in 22 of 23 patients following discharge. All patients were alive at the last time of contact, mean 19 (range 1 to 67) months. Conclusions: Improved survival with endografts for blunt aortic injury is felt related to strategies of delayed repair. The present study demonstrates patients can be managed medically with excellent survival. Therefore, when considering delayed aortic repair for blunt aortic injury, medical management should be considered in selected patients

Outcome Following Non-Operative Management in Blunt Aortic Trauma

Purpose: Aortic injury following blunt trauma is an indication for urgent thoracic aortic repair. Reports from centers using thoracic endografts have suggested that the strategy of delayed aortic repair can improve survival in these patients. Experience has also demonstrated that non-operative management without aortic repair is appropriate in selected patients. The purpose of this study was to determine the outcome of patients with blunt aortic injury managed non-operatively. Methods: All patients admitted to a single institution Level I trauma center were prospectively enrolled in a registry. Those patients identified with blunt aortic injury that were managed non-operatively between January 2005 to December 2010 were reviewed. In-hospital mortality, length of stay and survival following discharge were assessed in this patient cohort. Results: A total of 53 patients were identified with blunt aortic injury during the study period. Thirty of the patients were managed operatively; 17 underwent open repair and 13 endovascular repair. Twenty-four patients (45%) were managed non-operatively and underwent further analysis. The male to female ratio was 15:8 with an average age of 44 (range 18-85) years. In hospital mortality occurred in only 1 patient (4%) managed non-operatively. This patient expired in the first 24 hours due to multiple co-morbidities and extensive associated traumatic injuries. The mean length of hospital stay in the remaining 23 survivors was 20 days. Follow-up was available in 22 of 23 patients following discharge. All patients were alive at the last time of contact, mean 19 (range 1 to 67) months. Conclusions: Improved survival with endografts for blunt aortic injury is felt related to strategies of delayed repair. The present study demonstrates patients can be managed medically with excellent survival. Therefore, when considering delayed aortic repair for blunt aortic injury, medical management should be considered in selected patients