Posterior Instrumentation for Occipitocervical Fusion

Since 1995, 29 consecutive patients with craniocervical spine instability due to several pathologies were managed with posterior occipitocervical instrumentation and fusion. Laminectomy was additionally performed in nineteen patients. The patients were divided in two groups: Group A which included patients managed with screw-rod instrumentation, and Group B which included patients managed with hook-and-screw-rod instrumentation. The patients were evaluated clinically and radiographically using the following parameters: spine anatomy and reconstruction, sagittal profile, neurologic status, functional level, pain relief, complications and status of arthrodesis. The follow-up was performed immediately postoperatively and at 2, 6, 12 months after surgery, and thereafter once a year. Fusion was achieved in all but one patient. One case of infection was the only surgery related complication. Neurological improvement and considerable pain relief occurred in the majority of patients postoperatively. There were neither intraoperative complications nor surgery related deaths. However, the overall death rate was 37.5% in group A, and 7.7% in group B. There were no instrument related failures. The reduction level was acceptable and was maintained until the latest follow-up in all of the patients. No statistical difference between the outcomes of screw-rod and hook-and-screw-rod instrumentation was detected. Laminectomy did not influence the outcome in either group. Screw-rod and hook-and-screw-rod occipitocervical fusion instrumentations are both considered as safe and effective methods of treatment of craniocervical instability

A True AR Authoring Tool for Interactive Virtual Museums

In this work, a new and innovative way of spatial computing that appeared recently in the bibliography called True Augmented Reality (AR), is employed in cultural heritage preservation. This innovation could be adapted by the Virtual Museums of the future to enhance the quality of experience. It emphasises, the fact that a visitor will not be able to tell, at a first glance, if the artefact that he/she is looking at is real or not and it is expected to draw the visitors' interest. True AR is not limited to artefacts but extends even to buildings or life-sized character simulations of statues. It provides the best visual quality possible so that the users will not be able to tell the real objects from the augmented ones. Such applications can be beneficial for future museums, as with True AR, 3D models of various exhibits, monuments, statues, characters and buildings can be reconstructed and presented to the visitors in a realistic and innovative way. We also propose our Virtual Reality Sample application, a True AR playground featuring basic components and tools for generating interactive Virtual Museum applications, alongside a 3D reconstructed character (the priest of Asinou church) facilitating the storyteller of the augmented experience.Comment: This is a preprint of a chapter for a planned book that was initiated by "Visual Computing in Cultural Heritage" and that is expected to be published by Springer. The final book chapter will differ from this preprin

Suicide Attempts from Height and Injury Patterns: An Analysis of 64 Cases

Falls from height are a common cause of death and disability. A majority of free falls occur accidentally and only a minority result from suicidal behaviour. Adolescents in many countries show high rates of suicide attempts and their repetition is a common feature. We describe the demographic characteristics of these patients, their psychiatric diagnosis at the time of the attempt and the injury patterns. We present 64 patients who sustained injuries as a result of a fall from height. They were divided into those without mental disorders (n = 32, group I) and those with mental disorders (n = 32, group II). The mean height from which the fall occurred was 5.4 m (range, 3–25 m). The mean injury severity score was 19 (range, 6–58) for all fall victims. Upper extremity fractures were found in 37 patients, while pelvic and lower extremity fractures were found in 198 cases. Spinal fractures were noted in 32 patients. Head injuries were revealed by CT scan in 16 patients. Patients following a suicidal high fall mostly had lower limb fractures, pelvis fractures, spinal fractures and head injuries

Outcomes of polytrauma patients with diabetes mellitus.

BACKGROUND: The impact of diabetes mellitus in patients with multiple system injuries remains obscure. This study was designed to increase knowledge of outcomes of polytrauma in patients who have diabetes mellitus. METHODS: Data from the Trauma Audit and Research Network was used to identify patients who had suffered polytrauma during 2003 to 2011. These patients were filtered to those with known outcomes, then separated into those with diabetes, those known to have other co-morbidities but not diabetes and those known not to have any co-morbidities or diabetes. The data were analyzed to establish if patients with diabetes had differing outcomes associated with their diabetes versus the other groups. RESULTS: In total, 222 patients had diabetes, 2,558 had no past medical co-morbidities (PMC), 2,709 had PMC but no diabetes. The diabetic group of patients was found to be older than the other groups (P <0.05). A higher mortality rate was found in the diabetic group compared to the non-PMC group (32.4% versus 12.9%), P <0.05). Rates of many complications including renal failure, myocardial infarction, acute respiratory distress syndrome, pulmonary embolism and deep vein thrombosis were all found to be higher in the diabetic group. CONCLUSIONS: Close monitoring of diabetic patients may result in improved outcomes. Tighter glycemic control and earlier intervention for complications may reduce mortality and morbidity

Surgical outcome after spinal fractures in patients with ankylosing spondylitis

<p>Abstract</p> <p>Background</p> <p>Ankylosing spondylitis is a rheumatic disease in which spinal and sacroiliac joints are mainly affected. There is a gradual bone formation in the spinal ligaments and ankylosis of the spinal diarthroses which lead to stiffness of the spine.</p> <p>The diffuse paraspinal ossification and inflammatory osteitis of advanced Ankylosing spondylitis creates a fused, brittle spine that is susceptible to fracture. The aim of this study is to present the surgical experience of spinal fractures occurring in patients suffering from ankylosing spondylitis and to highlight the difficulties that exist as far as both diagnosis and surgical management are concerned.</p> <p>Methods</p> <p>Twenty patients suffering from ankylosing spondylitis were operated due to a spinal fracture. The fracture was located at the cervical spine in 7 cases, at the thoracic spine in 9, at the thoracolumbar junction in 3 and at the lumbar spine in one case. Neurological defects were revealed in 10 patients. In four of them, neurological signs were progressively developed after a time period of 4 to 15 days. The initial radiological study was negative for a spinal fracture in twelve patients. Every patient was assessed at the time of admission and daily until the day of surgery, then postoperatively upon discharge.</p> <p>Results</p> <p>Combined anterior and posterior approaches were performed in three patients with only posterior approaches performed on the rest. Spinal fusion was seen in 100% of the cases. No intra-operative complications occurred. There was one case in which superficial wound inflammation occurred. Loosening of posterior screws without loss of stability appeared in two patients with cervical injuries.</p> <p>Frankel neurological classification was used in order to evaluate the neurological status of the patients. There was statistically significant improvement of Frankel neurological classification between the preoperative and postoperative evaluation. 35% of patients showed improvement due to the operation performed.</p> <p>Conclusion</p> <p>The operative treatment of these injuries is useful and effective. It usually succeeds the improvement of the patients' neurological status. Taking into consideration the cardiovascular problems that these patients have, anterior and posterior stabilization aren't always possible. In these cases, posterior approach can be performed and give excellent results, while total operation time, blood loss and other possible complications are decreased.</p