Simultaneous Avulsion Fractures of the Tibial Tuberosity of Both Knees in a 14-Year-Old Boy: A Case Report

Fractures of the tibial tuberosity are uncommon injuries in adolescents, representing an estimated 0.4% to 2.7% of all pediatric fractures. Most of these injuries occur in young, active males commonly between the ages of 12 to 17 years. Sports, particularly those involving jumping or sudden starts and stops, are most often implicated. Injuries of the tibial tuberosity of both knees are especially rare, with little more than 30 cases reported in the past 60 years. We present a 14-year-old male football player with simultaneous avulsion fractures of the tibial tuberosity of both knees. We reviewed the anatomy, mechanisms of injury, classification systems, treatment strategies, and complications regarding this rare injury

Late Holocene Paleoecology of Southeastern Iowa: Development of Riparian Vegetation at Nichols Marsh

Pollen, vascular plant and bryophyte macrofossils from peat and silt deposits that filled an oxbow lake near Nichols, Iowa provide a 2500- year record of wetland succession and of upland habitats. Radiocarbon dates of 2320 ± 90 yr B. P. (BETA 12514) near the base and 1260 ±70 yr B.P. (BETA-12513) midway up one section, and 1050 ±70 (BETA 12515) in another provide chronologic control. The pollen diagram indicates substantial changes in local wetland habitats, but less change in upland vegetation in the last 2500 years. Plant macrofossils record changes from a deep to a shallow oxbow lake during the first few hundred years after the meander was cut off. About 1600 yr B.P. marsh vegetation began to encroach as the lake filled with sediment. A somewhat weedy marsh that existed from about 1400 to 900 yr B. P., developed into a rich mire that persisted until the 1840\u27s, when Europeans began cultivating the upland areas. A rise of ragweed pollen (from 7 to 25%) documents the beginning of cultivation in the area, and is accompanied by a sudden increase in diversity and in numbers and taxa of weedy species on the marsh. The presence of abundant charcoal and macrofossils of such prairie taxa as Amorpha and Petalosteinum imply warmer conditions from about 1400 to 900 B. P.; their absence and the appearance of the bryophyte Meesia suggest cooler conditions during the last thousand years

Early hemostatic responses to trauma identified with hierarchical clustering analysis

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/111900/1/jth12919.pd

The immunologic effect of early intravenous two and four gram bolus dosing of tranexamic acid compared to placebo in patients with severe traumatic bleeding (TAMPITI): A randomized, double-blind, placebo-controlled, single-center trial

Background: The hemostatic properties of tranexamic acid (TXA) are well described, but the immunological effects of TXA administration after traumatic injury have not been thoroughly examined. We hypothesized TXA would reduce monocyte activation in bleeding trauma patients with severe injury. Methods: This was a single center, double-blinded, randomized controlled trial (RCT) comparing placebo to a 2 g or 4 g intravenous TXA bolus dose in trauma patients with severe injury. Fifty patients were randomized into each study group. The primary outcome was a reduction in monocyte activation as measured by human leukocyte antigen-DR isotype (HLA-DR) expression on monocytes 72 h after TXA administration. Secondary outcomes included kinetic assessment of immune and hemostatic phenotypes within the 72 h window post-TXA administration. Results: The trial occurred between March 2016 and September 2017, when data collection ended. 149 patients were analyzed (placebo, Conclusion: In trauma patients with severe injury, 4 g intravenous bolus dosing of TXA has minimal immunomodulatory effects with respect to leukocyte phenotypes and circulating cytokine levels. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT02535949

Severe traumatic injury during long duration spaceflight: Light years beyond ATLS

Traumatic injury strikes unexpectedly among the healthiest members of the human population, and has been an inevitable companion of exploration throughout history. In space flight beyond the Earth's orbit, NASA considers trauma to be the highest level of concern regarding the probable incidence versus impact on mission and health. Because of limited resources, medical care will have to focus on the conditions most likely to occur, as well as those with the most significant impact on the crew and mission. Although the relative risk of disabling injuries is significantly higher than traumatic deaths on earth, either issue would have catastrophic implications during space flight. As a result this review focuses on serious life-threatening injuries during space flight as determined by a NASA consensus conference attended by experts in all aspects of injury and space flight

Pharmacological adjuncts to stop bleeding: options and effectiveness

Severe trauma and massive haemorrhage represent the leading cause of death and disability in patients under the age of 45 years in the developed world. Even though much advancement has been made in our understanding of the pathophysiology and management of trauma, outcomes from massive haemorrhage remain poor. This can be partially explained by the development of coagulopathy, acidosis and hypothermia, a pathological process collectively known as the “lethal triad” of trauma. A number of pharmacological adjuncts have been utilised to stop bleeding, with a wide variation in the safety and efficacy profiles. Antifibrinolytic agents in particular, act by inhibiting the conversion of plasminogen to plasmin, therefore decreasing the degree of fibrinolysis. Tranexamic acid, the most commonly used antifibrinolytic agent, has been successfully incorporated into most trauma management protocols effectively reducing mortality and morbidity following trauma. In this review, we discuss the current literature with regard to the management of haemorrhage following trauma, with a special reference to the use of pharmacological adjuncts. Novel insights, concepts and treatment modalities are also discussed

The evolution of the adenoidectomy: analysis of different power-assisted techniques.

Techniques and instruments for adenoidectomy have considerably changed over the years. With the introduction in Otolaryngology of power-assisted instruments for endoscopic sinus surgery, the classic adenoidectomy performed with curette or adenotome has evolved, with an improved patients' outcome and a better satisfaction of the surgeon. The purpose of this article is to describe and critically analyze the literature reports about different methods of power-assisted adenoidectomy. We performed a literature search (Medline) to identify all available reports. We discussed the surgical techniques and reviewed advantages and disadvantages of each method. The techniques can be schematically divided in non-endoscopic, usually performed with a laryngeal mirror, and endoscopic-assisted. The endoscopic control can be obtained either trans-nasally or trans-orally, as well as the microdebrider can be inserted in the nasal cavity or maneuvered through the oral cavity. Some authors reported the usage of the power-assisted instruments in performing the entire adenoidectomy; while, according with other authors, the microdebrider can be used as a step of the surgical procedure, for a combined adenoidectomy. In conclusion, all the methods seem to be safe and effective, and the personal experience of the surgeon should guide the choice of the instruments. However, we personally consider the endoscopic techniques as the most suitable, and among these the Transoral Endonasal-Controlled Combined Adenoidectomy (TECCA) should be considered as the most ergonomic technique to perform a power-assisted adenoidectomy

The evolution of the adenoidectomy: analysis of different power-assisted techniques

Techniques and instruments for adenoidectomy have considerably changed over the years. With the introduction in Otolaryngology of power-assisted instruments for endoscopic sinus surgery, the classic adenoidectomy performed with curette or adenotome has evolved, with an improved patients' outcome and a better satisfaction of the surgeon. The purpose of this article is to describe and critically analyze the literature reports about different methods of power-assisted adenoidectomy. We performed a literature search (Medline) to identify all available reports. We discussed the surgical techniques and reviewed advantages and disadvantages of each method. The techniques can be schematically divided in non-endoscopic, usually performed with a laryngeal mirror, and endoscopic-assisted. The endoscopic control can be obtained either trans-nasally or trans-orally, as well as the microdebrider can be inserted in the nasal cavity or maneuvered through the oral cavity. Some authors reported the usage of the power-assisted instruments in performing the entire adenoidectomy; while, according with other authors, the microdebrider can be used as a step of the surgical procedure, for a combined adenoidectomy. In conclusion, all the methods seem to be safe and effective, and the personal experience of the surgeon should guide the choice of the instruments. However, we personally consider the endoscopic techniques as the most suitable, and among these the Transoral Endonasal-Controlled Combined Adenoidectomy (TECCA) should be considered as the most ergonomic technique to perform a power-assisted adenoidectomy