A case of recurrent giant cell tumor of bone with malignant transformation and benign pulmonary metastases

Giant cell tumor (GCT) of bone is a locally destructive tumor that occurs predominantly in long bones of post-pubertal adolescents and young adults, where it occurs in the epiphysis. The majority are treated by aggressive curettage or resection. Vascular invasion outside the boundary of the tumor can be seen. Metastasis, with identical morphology to the primary tumor, occurs in a few percent of cases, usually to the lung. On occasion GCTs of bone undergo frank malignant transformation to undifferentiated sarcomas. Here we report a case of GCT of bone that at the time of recurrence was found to have undergone malignant transformation. Concurrent metastases were found in the lung, but these were non-transformed GCT

Evaluating Long-Term Outcomes of a High School-Based Impaired and Distracted Driving Prevention Program

Motor vehicle crashes are one of the leading causes of death among teenagers. Many of these deaths are due to preventable causes, including impaired and distracted driving. You Drink, You Drive, You Lose (YDYDYL) is a prevention program to educate high school students about the consequences of impaired and distracted driving. YDYDYL was conducted at a public high school in Southern Nevada in March 2020. A secondary data analysis was conducted to compare knowledge and attitudes of previous participants with first-time participants. Independent-samples-t test and χ2 test/Fisher’s exact test with post-contingency analysis were used to compare pre-event responses between students who had attended the program one year prior and students who had not. Significance was set at p \u3c 0.05. A total of 349 students participated in the survey and were included for analysis; 177 had attended the program previously (50.7%) and 172 had not (49.3%). The mean age of previous participants and first-time participants was 16.2 (SD ± 1.06 years) and 14.9 (SD ± 0.92 years), respectively. Statistically significant differences in several self-reported baseline behaviors and attitudinal responses were found between the two groups; for example, 47.4% of previous participants compared to 29.4% of first-time participants disagreed that reading text messages only at a stop light was acceptable. Students were also asked how likely they were to intervene if a friend or family member was practicing unsafe driving behaviors; responses were similar between the two groups. The baseline behaviors and attitudes of participants regarding impaired and distracted driving were more protective among previous participants compared to first-time participants, suggesting the program results in long-term positive changes in behaviors and attitudes. The results of this secondary retrospective study may be useful for informing the implementation of future impaired and distracted driving prevention programs

Outcomes in patients with gunshot wounds to the brain.

Introduction:Gunshot wounds to the brain (GSWB) confer high lethality and uncertain recovery. It is unclear which patients benefit from aggressive resuscitation, and furthermore whether patients with GSWB undergoing cardiopulmonary resuscitation (CPR) have potential for survival or organ donation. Therefore, we sought to determine the rates of survival and organ donation, as well as identify factors associated with both outcomes in patients with GSWB undergoing CPR. Methods:We performed a retrospective, multicenter study at 25 US trauma centers including dates between June 1, 2011 and December 31, 2017. Patients were included if they suffered isolated GSWB and required CPR at a referring hospital, in the field, or in the trauma resuscitation room. Patients were excluded for significant torso or extremity injuries, or if pregnant. Binomial regression models were used to determine predictors of survival/organ donation. Results:825 patients met study criteria; the majority were male (87.6%) with a mean age of 36.5 years. Most (67%) underwent CPR in the field and 2.1% (n=17) survived to discharge. Of the non-survivors, 17.5% (n=141) were considered eligible donors, with a donation rate of 58.9% (n=83) in this group. Regression models found several predictors of survival. Hormone replacement was predictive of both survival and organ donation. Conclusion:We found that GSWB requiring CPR during trauma resuscitation was associated with a 2.1% survival rate and overall organ donation rate of 10.3%. Several factors appear to be favorably associated with survival, although predictions are uncertain due to the low number of survivors in this patient population. Hormone replacement was predictive of both survival and organ donation. These results are a starting point for determining appropriate treatment algorithms for this devastating clinical condition. Level of evidence:Level II

Outcome After Surgical Stabilization of Rib Fractures Versus Nonoperative Treatment in Patients With Multiple Rib Fractures and Moderate to Severe Traumatic Brain Injury (CWIS-TBI)

BACKGROUND Outcomes after surgical stabilization of rib fractures (SSRF) have not been studied in patients with multiple rib fractures and traumatic brain injury (TBI). We hypothesized that SSRF, as compared with nonoperative management, is associated with favorable outcomes in patients with TBI. METHODS A multicenter, retrospective cohort study was performed in patients with rib fractures and TBI between January 2012 and July 2019. Patients who underwent SSRF were compared to those managed nonoperatively. The primary outcome was mechanical ventilation-free days. Secondary outcomes were intensive care unit length of stay and hospital length of stay, tracheostomy, occurrence of complications, neurologic outcome, and mortality. Patients were further stratified into moderate (GCS score, 9–12) and severe (GCS score, ≤8) TBI. RESULTS The study cohort consisted of 456 patients of which 111 (24.3%) underwent SSRF. The SSRF was performed at a median of 3 days, and SSRF-related complication rate was 3.6%. In multivariable analyses, there was no difference in mechanical ventilation-free days between the SSRF and nonoperative groups. The odds of developing pneumonia (odds ratio [OR], 0.59; 95% confidence interval [95% CI], 0.38–0.98; p = 0.043) and 30-day mortality (OR, 0.32; 95% CI, 0.11–0.91; p = 0.032) were significantly lower in the SSRF group. Patients with moderate TBI had similar outcome in both groups. In patients with severe TBI, the odds of 30-day mortality was significantly lower after SSRF (OR, 0.19; 95% CI, 0.04–0.88; p = 0.034). CONCLUSION In patients with multiple rib fractures and TBI, the mechanical ventilation-free days did not differ between the two treatment groups. In addition, SSRF was associated with a significantly lower risk of pneumonia and 30-day mortality. In patients with moderate TBI, outcome was similar. In patients with severe TBI a lower 30-day mortality was observed. There was a low SSRF-related complication risk. These data suggest a potential role for SSRF in select patients with TBI. LEVEL OF EVIDENCE Therapeutic, level IV

Non-operative management strategy for blunt pulmonary artery pseudoaneurysm: A case report

Traumatic pulmonary artery pseudoaneurysms (PAP) are rare findings and are often associated with penetrating trauma to the chest. We present a case of a pulmonary artery pseudoaneurysm following blunt trauma. A 49-year-old man presented after a motor vehicle collision. Contrast enhanced computed tomography scans of the neck, chest, abdomen, and pelvis were obtained demonstrating a proximal right pulmonary artery pseudoaneurysm, small volume hemopericardium, left first rib fracture, and focal non-flow limiting dissection of left subclavian artery. For the management of right PAP, we adopted a non-operative management strategy with an esmolol infusion for strict heart rate and blood pressure control. An echocardiogram was obtained the next day revealing no cardiac tamponade. Angiography of the chest was done after 24 h which showed stable appearance of the right PAP and hemopericardium. Patient was discharged home on hospital day 11