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Sample records for avulsions

  1. Avulsion and storage media.

    PubMed

    Hiremath, Geeta; Kidiyoor, Krishnamurthy H

    2011-05-01

    Avulsion of a tooth caused by trauma, and its successful treatment is a challenging situation that a dentist encounters in clinical practice. There is a definitive treatment for the avulsed tooth, which depends on many factors. The immediate replacement and replantation of the avulsed tooth is necessary, but it cannot always be accomplished for a number of reasons. Thus, the tooth should be transported in a suitable medium to maintain the cell viability. The storage medium is one of the important factors that will help the dentist in rendering successful treatment for the avulsed tooth. There is a continuing search for an ideal storage medium. This review paper focuses on the various storage media, with special reference to coconut water. PMID:25426601

  2. Umbilical cord avulsion in waterbirth.

    PubMed

    Schafer, Robyn

    2014-01-01

    Umbilical cord avulsion (or "cord snapping") is often cited as a risk associated with waterbirth. This article discusses a case study in which a cord avulsed during a waterbirth and uses it as a basis to explore the incidence, etiology, and associated risk factors of umbilical cord avulsion. The diagnosis, clinical presentation, and management of cord avulsion in waterbirth is presented along with a thorough review of the literature and relevant professional standards. This article offers recommendations for clinical practice to minimize the risk of a cord avulsion and highlights the need for additional research and provider education to ensure optimal care of women and newborns. PMID:24588881

  3. Tooth Avulsion in the School Setting

    ERIC Educational Resources Information Center

    Krause-Parello, Cheryl A.

    2005-01-01

    Tooth avulsions occur when a tooth is displaced from its socket. Tooth avulsions are common dental injuries that may occur before, during, or after school. Therefore, it is essential that school nurses be well prepared to intervene when such a dental emergency arises. It is also imperative that school nurses and school personnel are fully equipped…

  4. First-Aid Algorithms in Dental Avulsion

    ERIC Educational Resources Information Center

    Baginska, Joanna; Wilczynska-Borawska, Magdalena

    2012-01-01

    Almost one fourth of traumatic dental injuries occur at schools or in their surroundings. Prevalence of tooth avulsion varies from 0.5% to 16% of all cases of dental trauma. Children with dental avulsion may seek help from school nurses so they should be able to provide first-aid treatment. However, many studies showed that the general level of…

  5. Patterns in ritual tooth avulsion at Roonka.

    PubMed

    Durband, Arthur C; Littleton, Judith; Walshe, Keryn

    2014-08-01

    Tooth avulsion is the intentional removal of one or more teeth for ritual or aesthetic reasons, or to denote group affiliation. Typically the maxillary incisors are the teeth most often selected for removal. Previous authors have discussed the presence of tooth avulsions in several individuals recovered from Roonka, but those papers did not examine any patterns in those removals that might be present. Analysis of the tooth avulsions at Roonka reveals a change in the practice over time, with the older burials from phase II typically showing removal of both maxillary central incisors with a left side bias when only one tooth is removed, and the more recent phase III burials showing only one incisor avulsed and a right side bias for removal. Frequencies in the practice also changed over time, with avulsions being much more common in the older phase II burials. Historical evidence suggests that any particular regional or social group would have its own particular pattern of tooth avulsion, so these changes in tooth avulsions at Roonka suggest that the site was either used by multiple groups of people for burials, or that there was significant cultural change during the occupation of the site. PMID:24827419

  6. Backwater controls of avulsion location on deltas

    NASA Astrophysics Data System (ADS)

    Chatanantavet, Phairot; Lamb, Michael P.; Nittrouer, Jeffrey A.

    2012-01-01

    River delta complexes are built in part through repeated river-channel avulsions, which often occur about a persistent spatial node creating delta lobes that form a fan-like morphology. Predicting the location of avulsions is poorly understood, but it is essential for wetland restoration, hazard mitigation, reservoir characterization, and delta morphodynamics. Following previous work, we show that the upstream distance from the river mouth where avulsions occur is coincident with the backwater length, i.e., the upstream extent of river flow that is affected by hydrodynamic processes in the receiving basin. To explain this observation we formulate a fluvial morphodynamic model that is coupled to an offshore spreading river plume and subject it to a range of river discharges. Results show that avulsion is less likely in the downstream portion of the backwater zone because, during high-flow events, the water surface is drawn down near the river mouth to match that of the offshore plume, resulting in river-bed scour and a reduced likelihood of overbank flow. Furthermore, during low-discharge events, flow deceleration near the upstream extent of backwater causes enhanced deposition locally and a reduced channel-fill timescale there. Both mechanisms favor preferential avulsion in the upstream part of the backwater zone. These dynamics are fundamentally due to variable river discharges and a coupled offshore river plume, with implications for predicting delta response to climate and sea level change, and fluvio-deltaic stratigraphy.

  7. Modeling coupled avulsion and earthquake timescale dynamics

    NASA Astrophysics Data System (ADS)

    Reitz, M. D.; Steckler, M. S.; Paola, C.; Seeber, L.

    2014-12-01

    River avulsions and earthquakes can be hazardous events, and many researchers work to better understand and predict their timescales. Improvements in the understanding of the intrinsic processes of deposition and strain accumulation that lead to these events have resulted in better constraints on the timescales of each process individually. There are however several mechanisms by which these two systems may plausibly become linked. River deposition and avulsion can affect the stress on underlying faults through differential loading by sediment or water. Conversely, earthquakes can affect river avulsion patterns through altering the topography. These interactions may alter the event recurrence timescales, but this dynamic has not yet been explored. We present results of a simple numerical model, in which two systems have intrinsic rates of approach to failure thresholds, but the state of one system contributes to the other's approach to failure through coupling functions. The model is first explored for the simplest case of two linear approaches to failure, and linearly proportional coupling terms. Intriguing coupling dynamics emerge: the system settles into cycles of repeating earthquake and avulsion timescales, which are approached at an exponential decay rate that depends on the coupling terms. The ratio of the number of events of each type and the timescale values also depend on the coupling coefficients and the threshold values. We then adapt the model to a more complex and realistic scenario, in which a river avulses between either side of a fault, with parameters corresponding to the Brahmaputra River / Dauki fault system in Bangladesh. Here the tectonic activity alters the topography by gradually subsiding during the interseismic time, and abruptly increasing during an earthquake. The river strengthens the fault by sediment loading when in one path, and weakens it when in the other. We show this coupling can significantly affect earthquake and avulsion

  8. Anorectal avulsion: an exceptional rectal trauma.

    PubMed

    Ibn Majdoub Hassani, Karim; Ait Laalim, Said; Benjelloun, El Bachir; Toughrai, Imane; Mazaz, Khalid

    2013-01-01

    Anorectal avulsion is an exceptional rectal trauma in which the anus and sphincter no longer join the perineum and are pulled upward. As a result, they ventrally follow levator ani muscles. We present a rare case of a 29-years old patient who was admitted in a pelvic trauma context; presenting a complete complex anorectal avulsion. The treatment included a primary repair of the rectum and a diverting colostomy so as to prevent sepsis. Closure of the protective sigmoidostomy was performed seven months after the accident and the evolution was marked by an anal stenosis requiring iterative dilatations. PMID:24094142

  9. Management of full-length complete ureteral avulsion

    PubMed Central

    Tang, Kaifa; Sun, Fa; Tian, Yuan; Zhao, Yili

    2016-01-01

    ABSTRACT Introduction Complete ureteral avulsion is one of the most serious complications of ureteroscopy. The aim of this report was to look for a good solution to full-length complete ureteral avulsion. Case presentation A 40-year-old man underwent ureteroscopic management. Full-length complete avulsion of ureter occurred during ureteroscopy. Pyeloureterostomy plus greater omentum investment outside the avulsed ureter and ureterovesical anastomosis were performed 6 hours after ureteral avulsion. The patient was followed-up during 34 months. Double-J tube was removed at 3 months after operation. Twenty three months after the first operation, the patient developed hydronephrosis because of a new ureter upside stone, then rigid ureteroscopy and holmium laser lithotripsy were used successfully. Conclusion Pyeloureterostomy plus greater omentum investment outside the avulsed ureter and ureterovesical anastomosis may be a good choice for full-length complete ureteral avulsion. PMID:27136483

  10. Anterior Inferior Iliac Spine Avulsion Fracture

    PubMed Central

    Serbest, Sancar; Tosun, Hacı Bayram; Tiftikçi, Uğur; Oktas, Birhan; Kesgin, Engin

    2015-01-01

    Abstract Avulsion fractures of the pelvic apophyses rarely occur in adolescent athletes in the course of sudden strong contraction of muscle attached to growth cartilage. This injury may usually be misdiagnosed for tendon or muscle strain. Patient's history, physical examination, and radiologic studies are important for diagnosis. The literature includes only a few case reports but no case series as yet. The aim of this study was to present the results of 5 cases of anterior inferior iliac spine (AIIS) avulsion fractures treated conservatively. The study included 5 patients (4 male, 1 female, mean age 13.6 years) who underwent conservative treatment for AIIS avulsion fractures and had an adequate follow-up. All patients were admitted to the emergency department and misdiagnosed as muscle strain. Three of them were football player, 1 skier, and 1 fighter. Each patient was treated with immobilization and nonsteroidal anti-inflammatory drugs. At follow-up, all patients showed relief from their pain and mechanical symptoms and regained full range of motion and returned to their previous levels of activity. Diagnosis requires careful attention to the physical examination and imaging. In this series, all pelvic avulsion fractures (100%) were managed successfully with a conservative approach. Good results and return to previous levels of activity can be achieved with conservative treatment. PMID:25700329

  11. Parental behavior regarding traumatically avulsed teeth: case reports.

    PubMed

    Barreira, Alice Kelly; Gotze, Gabriela da Rosa; Primo, Laura Salignac de Souza Guimaraes; Maia, Lucianne Cople

    2008-01-01

    The prognosis for an avulsed tooth depends primarily on appropriate emergency management, which usually must be provided by lay people prior to the child's initial dental contact. As immediate replantation is considered the best therapy for an avulsed tooth in permanent dentition, parents should be made aware of first aid procedures for this situation. This article describes three cases involving avulsed teeth in children and discusses the parents' approaches concerning emergency procedures. PMID:18348377

  12. Triceps tendon avulsion and associated injuries of the elbow

    PubMed Central

    Canbora, Kerem; Ozyurek, Selahattin; Gumussuyu, Gurkan; Kose, Ozkan

    2013-01-01

    A rupture or avulsion of the triceps tendon is very rare but concomitant elbow injuries with avulsion of the triceps tendon are even rarer. In this study, an extraordinary and unusual injury combination (radial head and trochlear fracture associated with triceps tendon avulsion), which happened during a fall onto the elbow with outstretched hand, was identified and has been discussed in the literature. PMID:23667221

  13. Biomechanical analysis of the splenic avulsion mechanism.

    PubMed

    Chebil, Omar; Behr, Michel; Auriault, Florent; Arnoux, Pierre-Jean

    2014-08-01

    The spleen is a frequently injured abdominal organ in road accidents, with an injury frequency close to 30%. The splenic avulsion exhibit a significant ratio of morbidity. It is clinically described as the complete failure of the pancreatico-splenic ligament (PSL) which is composed of splenic vessels and connective tissues. What are the biomechanical mechanisms involved with spleen avulsion? Is it possible to quantify tolerance levels of PSL structure? The current work combines both experimental and finite element (FE) investigations to determine the splenic avulsion process. Tensile tests on 13 PSL samples were performed up to failure. The experimental results provide reference data for model validation and showed a failure process starting at a peak force of 70±34 N combined with a peak strain of 105±26%. In an attempt to identify possible vessel ruptures within the PSL, a FE model of the PSL was developed including both vessels and connective tissues. The vessel wall behaviour up to failure was reproduced using an Ogden law and calibrated by inverse analysis according to literature data. The connective tissues function was modelled by a cohesion-loss interface. Once model correlation to experimental results was achieved, numerical simulation revealed that haemorrhage could occur even before the maximum peak is reached. Indeed, the first vessel ruptures were recorded at a strain of 92% at the upper lobe vein. PMID:24944004

  14. Suture Bridge Fixation Technique for Posterior Cruciate Ligament Avulsion Fracture

    PubMed Central

    Lee, Kwang Won; Lee, Gyu Sang; Choy, Won Sik

    2015-01-01

    We presented a surgical technique including a suture bridge technique with relatively small incision for the reduction and fixation of posterior ligament avulsion fractures. A suture anchor was used to hold the avulsed fragment and a knotless anchor was used to continuously compress the bony fragment into the fracture site, thereby maintaining reduction during healing. PMID:26640635

  15. Replantation of an avulsed ear, using a single arterial anastamosis.

    PubMed

    O'Toole, G; Bhatti, K; Masood, S

    2008-01-01

    Avulsion of the ear is relatively uncommon and replantation a technical challenge. A case in which an avulsed ear was successfully replanted using a single arterial anastamosis is described. The surgical difficulties encountered, the pharmaceutical approach to postoperative care and the problems which resulted from the lack of venous drainage are discussed. PMID:18061545

  16. Avulsion of permanent teeth: theory to practice.

    PubMed

    Trope, Martin

    2011-08-01

    This paper presents clinical protocols for the emergency, early and post treatment complications of the avulsed tooth. The biological basis for these protocols is presented so that the reader understands the clinical decisions that have been made. Most of the protocols described in this article, but not all, have been adopted in the official guidelines of the International Association of Dental Traumatology. Some experimental results are promising and they have therefore been included in the review to stimulate colleagues to further research. PMID:21635689

  17. The Geomorphic Role of Large Woody Debris in River Avulsions

    NASA Astrophysics Data System (ADS)

    Stout, J. C.; Grove, J. R.; Rutherfurd, I.; Marren, P.

    2014-12-01

    The avulsion or abandonment of a river channel in favor of a new course on the floodplain is integral to the development and maintenance of anabranching planforms. Avulsions tend to occur on rivers where the rate of vertical aggradation outpaces lateral migration. In fine cohesive floodplain sediments, avulsions evolve through five stages dependent on the amount of flow and sediment being captured by the new channel. There is limited data available to allow the prediction of autogenic and allogenic controls on: the time over which an avulsion is active; its likely location; the frequency of occurrence; and the length of the interavulsion period. The delivery of wood to the river channel is an autogenic process which has received much attention over the last three decades. Surprisingly it has not previously been considered in anabranch avulsions, apart from where log-jams entirely block channels. The presence of large woody debris in the channel acts as a roughness element, trapping, and impeding the movement of sediments and deflecting flow onto the floodplain. We hypothesize that the delivery rates of wood to the channel, and its subsequent configuration (i.e. dimension, amount, volume, spatial arrangement and blockage ratio), alters flow and sediment routing through the channel. These changes directly influence the stages of avulsion development. To test this conceptual model we have used eleven floodplain cores to reconstruct the timing of a Holocene avulsion. The morphology of the channel in each evolutionary stage was used to estimate the relative role of wood as a roughness element. This was done by coupling a mass balance wood delivery model, run in a Monte Carlo simulation, to the geomorphic processes of each evolutionary stage of the avulsion. Our results allow us to quantify the importance of in-channel wood during each stage of the avulsion. These data highlight that there are critical points in the evolution of anabranching channels when large wood

  18. Combined Tibial Tubercle Avulsion Fracture and Patellar Avulsion Fracture: An Unusual Variant in an Adolescent Patient.

    PubMed

    Stepanovich, Matthew T; Slakey, Joseph B

    2016-01-01

    Traumatic extensor dysfunction of the knee in children is a rare injury, with the majority resulting from tibial tubercle avulsion fracture or patellar sleeve fracture. We report a rare case of combined patellar avulsion fracture and tibial tubercle fracture. With open anatomic reduction, both injuries were successfully treated. While many variations of tibial tubercle fracture have been reported, the authors believe this to be the first report in the English-language literature of this particular combined injury to the knee extensor mechanism in an adolescent. Advanced imaging with computed tomography provided vital information to aid with operative planning, especially since the majority of the unossified tubercle was not seen on plain radiographs, and all fracture fragments were originally believed to be from the tibial tubercle. Computed tomography distinguished the patellar fracture from the tibial tubercle fragments, verifying preoperatively the complexity of the injury. PMID:26761925

  19. APOPHYSEAL FRACTURE OR AVULSION OF THE GREATER TROCHANTER

    PubMed Central

    FREITAS, ANDERSON; MACEDO, SÍLVIO LEITE DE

    2016-01-01

    ABSTRACTS The apophyseal fracture or avulsion of the greater trochanter occurs in skeletally immature patients. It has at etiological factors indirect mechanisms (avulsion) and direct mechanisms (trauma on the trochanter), the latter being the most common. The clinical presentation is easily identified and a simple X- ray can confirm the diagnosis. Regardless of the treatment chosen, this pathology has a high correlation with osteonecrosis of the femoral head, even as a rare fact, however with innocent appearance, on this pathology. PMID:27217820

  20. Dorsoradial avulsion of the triangular fibrocartilage complex with an avulsion fracture of the sigmoid notch of the radius.

    PubMed

    Morisawa, Y; Nakamura, T; Tazaki, K

    2007-12-01

    We report two extremely rare cases of dorsal radial avulsion injury of the triangular fibrocartilage complex accompanied by an avulsion fracture of the sigmoid notch of the radius. Anatomical reduction of the bone fragment in conjunction with reattachment of the dorsal portion of the radioulnar ligament to the radial sigmoid notch were necessary to restore stability of the distal radioulnar joint and tension of the triangular fibrocartilage proper. PMID:17993436

  1. What is the Best Root Surface Treatment for Avulsed Teeth?

    PubMed Central

    Tuna, Elif B; Yaman, Duygu; Yamamato, Seiko

    2014-01-01

    Dental avulsion is the most severe type of traumatic tooth injuries since it causes damage to several structures and results in avulsion of the tooth from its socket. Management protocols for avulsed teeth should include management of the pulp and periodontal ligament (PDL) cells in order to improve the long-term prognosis and survival of these teeth. The prognosis of the treatment as well as the survival of an avulsed tooth depends on intrinsic and extrinsic factors, such as the duration of the tooth’s extra-alveolar period, replantation time, the type of storage medium, PDL status and duration of splinting. Recent research has led to the development of storage media. However, there is not yet a single solution that fulfills all requirements to be considered as the ideal medium for temporary storage of avulsed teeth, and research on this field should carry on. On the other hand in case of delayed replantation, due to the great risk of tooth loss after avulsion, different root surface treatments have been proposed to prevent and delay root resorption before replantation. For this purpose, researchers have applied some different root surface treatment modalities in delayed replantation of avulsed teeth. Several protocols have been used to maintain PDL viability; some involve fluorides, steroids, sodium alendronate, enamel matrix derivatives (EMD) and basic fibroblast growth factor (bFGF, FGF-2). Among these applications, bFGF shows promising results in the regeneration of natural tooth structures and tissues. Better understanding of mechanism of bFGF may help to improve new technologies of regeneration of tooth structures. PMID:25317212

  2. [Aspects of expert opinions of avulsion fractures].

    PubMed

    Schröter, F

    2016-03-01

    The apophyses as secondary ossification centers are connected with the bone by cartilage. During the growth phase of puberty, the apophyseal plate is a mechanical weak spot. Especially, apophyses in the hip and pelvic area are exposed to considerable tensile and sheer stresses due to the strong muscles which are inserted here. The frequency of injuries to the apophyses correlates with the extent of sporting activities. For athletes participating in "Youth Train for the Olympics", this is the most common injury of all. Most often, the apophysis of the rectus femoris muscle is affected at the anterior inferior iliac spine. In adults, after complete ossification of the apophyseal plate such injuries are rare. However, in a very unusual mechanism of injury with maximum forced hip flexion and simultaneous maximum knee extension, avulsions of the ischial tuberosity are observed in adults. During the causality test-especially in the legal area of statutory accident insurance-the question is always whether the alleged course of events has to be regarded as a legally significant (partial) cause or if a longer period of time has been involved, so that the resulting morbid apophysis detachment was predominately due to fate, in which the alleged event must be interpreted as legally immaterial. PMID:26924516

  3. Human impact and avulsion: a long-standing relationship

    NASA Astrophysics Data System (ADS)

    Heyvaert, Vanessa M. A.; Walstra, Jan

    2015-04-01

    This study demonstrates that avulsions in Upper and Lower Khuzestan (Iran) are the result of interplay between human-induced and natural causes. The importance of human interference during all stages of river avulsion and the long-term consequences for alluvial fan development is proven. Avulsion can be defined as the diversion of flow from an existing channel onto the floodplain (or the fan surface), eventually resulting in a new channel belt (Allen, 1965). It represents the response of a river system to a wide range of autogenic factors, such as river meandering and vertical accretion, and allogenic controls, such as tectonics, climate change and sea-level change (Jones & Schumm, 1999). The framework used in this study is based on concepts introduced by Slingerland & Smith (2004), regarding avulsion style (i.e. through annexation, progradation or incision), and Makaske (2012), regarding the different phases in the process leading to avulsion (i.e. preconditioning, triggering and post-triggering)on megafans. This study primarily focusses on actions that directly affect river hydraulics, such as the construction and maintenance of dams, embankments, irrigation and diversion canals, the destruction of dams, channel modifications, etc. For several avulsion events, style and controlling factors are examined, and the ways by which human activities have interfered with the natural processes are highlighted. All case-studies are based on an integrated analysis of historical, archaeological, geomorphological and geological datasets. References: Allen, J.R.L., 1965. A review of the origin and characteristics of recent alluvial sediments. Sedimentology, 5, 89-91. Jones, L.S. & Schumm, S.A., 1999. Causes of avulsion: an overview, In: Smith, N.D. & Rogers, J. (Eds.), Fluvial Sedimentology VI, Blackwell Science, Oxford, UK, 171-178. Makaske, B., Maathuis, B.H.P., Padovani, C.R., Stolker, C., Mosselman, E. & Jongman, R.H.G., 2012. Upstream and downstream controls of recent

  4. Microsurgical Replantation of a Two-Segment Total Scalp Avulsion.

    PubMed

    Hu, Weiguo; Henry, Anne-Sophie; Lucas, Camille; Ta, Pierre; Philandrianos, Cécile; Kerfant, Nathalie

    2016-06-01

    Total scalp avulsion is a rare and severe injury that may be life threatening and can result in devastating disfigurement and psychological trauma. Microsurgical hair-bearing scalp replantation is considered the procedure of choice and should be performed by a skilled surgical team. Replantation of a multifragmented scalp is even rarer and shows random results. Only 2 patients have been reported, resulting in partial or total necrosis of implanted fragments. The authors describe the successful replantation of a totally avulsed 2-segment scalp in a 63-year-old woman whose hair was entrapped in the propeller shaft of a ship. The avulsed scalp involved both eyebrows, the frontal region, the upper part of both ears, and most of the occipital portion. After initial management including correction of hemorrhagic shock, the patient underwent emergency scalp replantation by microsurgical anastomosis of 3 arteries and 4 veins and the use of 2 vein grafts.According to authors' experience, multifragmented scalp avulsion imposes emergency relocation using as many microsurgical sutures as possible and implementation of vein grafts to ensure optimal revascularization of the avulsed scalp. PMID:27171945

  5. Delayed Replantation of Avulsed Teeth: Two Case Reports

    PubMed Central

    Savas, Selcuk; Kucukyilmaz, Ebru; Akcay, Merve; Koseoglu, Serhat

    2015-01-01

    This case report presents two cases of delayed replantation of avulsed maxillary central incisors after an extended dry extra-alveolar period. Eight-year-old boy and 10-year-old boy presented with avulsed maxillary central incisors due to trauma occurring 27 and 7 hours earlier, respectively. Treatment guidelines for avulsed mature/immature permanent teeth with prolonged extra-oral time were carried out for the teeth and the extra-oral endodontic treatment was completed. After having been repositioned, the teeth were stabilized for 4 weeks and prophylactic antibiotic was prescribed. Clinical and radiographic controls were done after 18 months for Case I and 12 months for Case II. During the follow-up periods the teeth reported in these cases have remained in a stable, functional position but revealed clinical initial replacement resorption and ankylosis. PMID:25810928

  6. Iliac Crest Avulsion Fracture in a Young Sprinter

    PubMed Central

    Casabianca, L.; Rousseau, R.; Loriaut, P.; Massein, A.; Mirouse, G.; Gerometta, A.; Khiami, F.

    2015-01-01

    Avulsion fracture of the iliac crest is an uncommon pathology. It usually occurs in teenagers during sport activities, more common in boys. We report a case of 16-year-old male competitive sprinter, who had an avulsion of a part of the iliac crest and the anterior-superior iliac spine during a competition. The traumatism occurred during the period of acceleration phase out of the blocks which corresponds to the maximum traction phase on the tendons. Then a total loss of function of the lower limb appears forcing him to stop the run. X-ray and CT scan confirmed the rare diagnosis of avulsion of the quasitotality of the iliac crest apophysis, corresponding to Salter 2 fracture. We performed an open reduction and internal fixation with two screws, allowing a return to sport after 3 months and his personal best record in the 100 meters at the 6th postoperative month. PMID:26421205

  7. New Treatments for Spinal Nerve Root Avulsion Injury

    PubMed Central

    Carlstedt, Thomas

    2016-01-01

    Further progress in the treatment of the longitudinal spinal cord injury has been made. In an inverted translational study, it has been demonstrated that return of sensory function can be achieved by bypassing the avulsed dorsal root ganglion neurons. Dendritic growth from spinal cord sensory neurons could replace dorsal root ganglion axons and re-establish a reflex arch. Another research avenue has led to the development of adjuvant therapy for regeneration following dorsal root to spinal cord implantation in root avulsion injury. A small, lipophilic molecule that can be given orally acts on the retinoic acid receptor system as an agonist. Upregulation of dorsal root ganglion regenerative ability and organization of glia reaction to injury were demonstrated in treated animals. The dual effect of this substance may open new avenues for the treatment of root avulsion and spinal cord injuries. PMID:27602018

  8. Subtle Radiological Features of Splenic Avulsion following Abdominal Trauma

    PubMed Central

    Rehim, S. A.; Dagash, H.; Godbole, P. P.; Raghavan, A.; Murthi, G. V.

    2010-01-01

    Splenic trauma in children following blunt abdominal injury is usually treated by nonoperative management (NOM). Splenectomy following abdominal trauma is rare in children. NOM is successful as in the majority of instances the injury to the spleen is contained within its capsule or a localised haematoma. Rarely, the spleen may suffer from an avulsion injury that causes severe uncontrollable bleeding and necessitates an emergency laparotomy and splenectomy. We report two cases of children requiring splenectomy following severe blunt abdominal injury. In both instances emergency laparotomy was undertaken for uncontrollable bleeding despite resuscitation. The operating team was unaware of the precise source of bleeding preoperatively. Retrospective review of the computed tomography (CT) scans revealed subtle radiological features that indicate splenic avulsion. We wish to highlight these radiological features of splenic avulsion as they can help to focus management decisions regarding the need/timing for a laparotomy following blunt abdominal trauma in children. PMID:21209813

  9. New Treatments for Spinal Nerve Root Avulsion Injury.

    PubMed

    Carlstedt, Thomas

    2016-01-01

    Further progress in the treatment of the longitudinal spinal cord injury has been made. In an inverted translational study, it has been demonstrated that return of sensory function can be achieved by bypassing the avulsed dorsal root ganglion neurons. Dendritic growth from spinal cord sensory neurons could replace dorsal root ganglion axons and re-establish a reflex arch. Another research avenue has led to the development of adjuvant therapy for regeneration following dorsal root to spinal cord implantation in root avulsion injury. A small, lipophilic molecule that can be given orally acts on the retinoic acid receptor system as an agonist. Upregulation of dorsal root ganglion regenerative ability and organization of glia reaction to injury were demonstrated in treated animals. The dual effect of this substance may open new avenues for the treatment of root avulsion and spinal cord injuries. PMID:27602018

  10. [Bony avulsions of the rotator cuff : Arthroscopic concepts].

    PubMed

    Greiner, S; Scheibel, M

    2011-01-01

    Bony avulsions of the rotator cuff and isolated greater or lesser tuberosity fractures are rare injuries and a clear consensus regarding classification and therapy does not yet exist. Conservative therapy is limited, especially in injuries with displaced fragments and in these cases surgical treatment is frequently indicated. The ongoing development of arthroscopic techniques has led to quite a number of reports about arthroscopically assisted or total arthroscopic techniques in the treatment of these injuries. The advantages and disadvantages of arthroscopic concepts for the treatment of bony avulsions of the rotator cuff are presented with reference to the current literature. PMID:21153534

  11. Simultaneous bilateral patellar tendon avulsion in an adolescent.

    PubMed

    Yee, P K; Poon, K C; Chiu, S Y

    2012-12-01

    A 13-year-old boy sustained an injury to both knees upon landing after a forceful jump in a soccer game. Plain radiography and magnetic resonance imaging demonstrated bilateral distal patellar tendon avulsions without fracture of the tibial tuberosities and the physes. To our knowledge, this particular injury has not been previously described in the literature. Open surgeries and internal fixation were performed with excellent functional outcome. This type of injury was similar to the well-recognised acute tibial tuberosity avulsion fracture in terms of the pathogenesis and treatment. We propose a further subtype of this injury pattern. PMID:23223656

  12. Neglected lesser tuberosity avulsion in an adolescent elite gymnast

    PubMed Central

    Karavasili, Alexandra; Manolarakis, Manolis; Paxinos, Thrasivoulos; Papavasiliou, Athanasios

    2014-01-01

    We report the case of a 16-year-old elite gymnast who presented with recurring pain in the left shoulder after training. The athlete recalled an injury to the shoulder 2 years ago. Clinically a localized tenderness to the anterior shoulder and loss of strength and range of motion was noted. Imaging investigation suggested a neglected lesser tuberosity avulsion. The athlete was treated with open excision of the deformed tuberosity and direct repair of the subscapularis to the humeral head. Following a careful postoperative rehabilitation protocol the athlete was able to return to unrestricted gymnastics after 6 months. After surgery the athlete followed a intense rehabilitation program that allowed him to return to sports at 6 months. At 5-years follow-up, the athlete was asymptomatic and competing at an international level. Avulsion fractures of the lesser tuberosity are extremely rare injuries with significant shoulder disability if left untreated. Anatomic repair can yield excellent results, even in neglected cases.

  13. Atypical stress-avulsion fracture of the Lisfranc joint complex.

    PubMed

    O'Neill, Barry J; Sweeney, Laura A; Moroney, Paul J; Mulhall, Kevin J

    2014-04-01

    Antiphospholipid syndrome and systemic erythematosus have been associated with metatarsal stress fractures. Stress fractures of the Lisfranc joint complex are uncommon injuries but have been reported to occur most frequently in ballet dancers. We present a case of an avulsion fracture of the Lisfranc joint complex that occurred spontaneously. We have reviewed the association between systemic conditions and metatarsal fractures and proposed a series of hypothetical pathological events that may have contributed to this unusual injury. PMID:24521754

  14. Direct Repair without Augmentation of Patellar Tendon Avulsion following TKA

    PubMed Central

    Kumar, Nishikant; Yadav, Chandrashekhar; Kumar, Ashok

    2015-01-01

    Complications involving the extensor mechanism after TKA are potentially disastrous. We are reporting a case of patellar tendon rupture from tibial tuberosity following total knee arthroplasty. We managed it by direct repair with fiberwire using Krackow suture technique without augmentation. Our long term result has been very encouraging. Our method is a safe and better method of management of patellar tendon avulsion following TKA when it happens without any tissue loss. PMID:25632362

  15. Tooth replantation after traumatic avulsion: a 27-year follow up.

    PubMed

    Martins, Wilson Denis; Westphalen, Vania Portela Ditzel; Westphalen, Fernando Henrique

    2004-04-01

    This report presents a case of replantation of a traumatically avulsed central incisor in a 32-year-old woman. The tooth was replanted after a 30-min extra-alveolar period. Emergency unconventional immobilization was performed, using 2-0 chromic gut, and a restorative composite made Gunning-type splint. The tooth is still in place 27 years after replantation (1976 to date) without marked resorption. PMID:15025692

  16. TIBIAL TUBERCLE AVULSION FRACTURE IN A MALE ADOLESCENT.

    PubMed

    Matoković, Damir; Šimić-Klarić, Andrea; Rajić, Marijana Tomić; Crnković, Helena Tesari; Jurinić, Mislav; Jovanović, Savo

    2015-06-01

    Tibial tuberosity fractures are rare in childhood, most frequently due to excessive quadriceps muscle contraction. On performing long jump, a 15-year-old boy sustained tibial tuberosity avulsion fracture type II according to Watson-Jones. The patient was treated operatively with fragment repositioning and screw fixation. Ten months after the injury and rehabilitation, he resumed his sports activities with full range knee motion. PMID:26415319

  17. Simultaneous percutaneous nephrolithotomy and early endoscopic ureteric realignment for iatrogenic ureteropelvic junction avulsion during ureteroscopy

    PubMed Central

    Tayeb, Marawan El; Mellon, Matthew J.; Lingeman, James E.

    2015-01-01

    We present a case report of successful management of ureteropelvice junction avulsion during ureteroscopy successfully managed with simultaneous percutaneous nephrolithotomy and early endoscopic ureteral realignment. PMID:26834898

  18. Storage media for avulsed teeth: a literature review.

    PubMed

    Poi, Wilson Roberto; Sonoda, Celso Koogi; Martins, Christine Men; Melo, Moriel Evangelista; Pellizzer, Eduardo Pizza; de Mendonça, Marcos Rogério; Panzarini, Sônia Regina

    2013-01-01

    Dental avulsion is the most severe type of traumatic tooth injuries because it causes damage to several structures and results in the complete displacement of the tooth from its socket in the alveolar bone. The ideal situation is to replant an exarticulated tooth immediately after avulsion because the extraoral time is a determinant factor for treatment success and for a good prognosis. However, it is not always possible. The success of replantation depends on a number of factors that may contribute to accelerate or minimize the occurrence of root resorption or ankylosis, among which is the type and characteristics of the medium used for temporary storage during the time elapsed between avulsion and replantation. Maintaining the tooth in an adequate wet medium that can preserve, as longer as possible, the vitality of the periodontal ligament cells that remain on root surface is the key to success of replantation. Recent research has led to the development of storage media that produce conditions that closely resemble the original socket environment, with adequate osmolality (cell pressure), pH, nutritional metabolites and glucose, and thus create the best possible conditions for storage. Although these storage media can now be purchased in the form of retail products, the most common scenario is that such a product will not be readily available at the moment of the accident This paper reviews the literature on the different storage media that have been investigated for avulsed teeth based on full-length papers retrieved from PubMed/Medline, Lilacs, BBO and SciELO electronic databases using the key words 'storage medium', 'transportation medium', 'avulsion', 'tooth avulsion', 'replantation', 'tooth replantation', 'milk' and 'propolis'. After application of inclusion and exclusion criteria, 39 papers were selected and critically reviewed with respect to the characteristics, efficacy and ease of access of the storage medium. The review of the literature showed that a

  19. Diagnosing pubovisceral avulsions: a systematic review of the clinical relevance of a prevalent anatomical defect.

    PubMed

    Lammers, Karin; Fütterer, Jurgen J; Prokop, Mathias; Vierhout, Mark E; Kluivers, Kirsten B

    2012-12-01

    The aims of this systematic literature review were to assess whether the detection of pubovisceral avulsions using magnetic resonance (MR) imaging or perineal ultrasonography was clinically relevant in women with pelvic floor dysfunction and to evaluate the relation with anatomy, symptoms, and recurrence after surgery. We performed a systematic literature review using three bibliographical databases (PubMed, Embase, and CINAHL) as data sources. Clinical studies were included in which pubovisceral avulsions were studied in relation to pelvic organ prolapse (POP) stage, pelvic floor symptoms, and/or recurrence of POP after surgery. Ultimately, 21 studies met the inclusion criteria. POP stage and recurrence of POP after surgery were strongly associated with pubovisceral avulsions. Contradictory results were found regarding the relation between pubovisceral avulsions and urinary symptoms and symptoms of anorectal dysfunction. Pubovisceral avulsions, as diagnosed by MR imaging or perineal ultrasonography, are associated with higher stages of POP and recurrence of POP after surgery. PMID:22581241

  20. Diagnosing adductor muscle avulsion at the symphysis pubis with ultrasound.

    PubMed

    Chen, David J; Caldera, Franklin E; Kim, Woojin

    2014-04-01

    A 58-yr-old woman presented after experiencing left hip and groin pain for 1 mo. She denies any history of trauma, falls or any bruising, or history of sports injury or extreme physical exertion before her symptoms. On ultrasonography, she was found to have an avulsion tear at the origin of the adductor muscles, predominantly involving the adductor longus and brevis muscles. The treatment course was conservative: nonsteroidal anti-inflammatory drugs for pain control and physical therapy for muscle strengthening and balance improvement. Upon follow-up, she demonstrated significant improvement and resolution of her pain. PMID:24196970

  1. Microsurgical replantation of partial avulsion of the scalp. Case report.

    PubMed

    Svensson, H; Njalsson, T

    1995-06-01

    An 8-year-old girl was bitten by a dog and, as well as minor wounds, had a complete avulsion of the central part of the scalp covering an area of 8 x 10 cm. By rotating the replant 180 degrees and by using 5 cm long vein grafts, two sleeve anastomoses, and two end-to-end anastomoses the blood supply was restored. The operation lasted nine hours, and she stayed in hospital for 12 days. Her clinical course was uneventful. At follow-up 23 months later the cosmetic and functional results were good. PMID:7569816

  2. Traumatic avulsion of the tricuspid valve after gas bottle explosion

    PubMed Central

    Krisper, Maximilian; Köhncke, Clemens; Pieske, Burkert

    2016-01-01

    Summary We present a very rare example of chronic right heart failure caused by torrent tricuspid regurgitation. Massive right heart dilatation and severe tricuspid regurgitation due to avulsion of the tricuspid valve apparatus occurred as a result of a blunt chest trauma following the explosion of a gas bottle 20 years before admission, when the patient was a young man in Vietnam. After this incident, the patient went through a phase of severe illness, which can retrospectively be identified as an acute right heart decompensation with malaise, ankle edema, and dyspnea. Blunt chest trauma caused by explosives leading to valvular dysfunction has not been reported in the literature so far. It is remarkable that the patient not only survived this trauma, but had been managing his chronic heart failure well without medication for over 20 years. Learning points Thorough clinical and physical examination remains the key to identifying patients with relevant valvulopathies.With good acoustic windows, TTE is superior to TEE in visualizing the right heart.Traumatic avulsion of valve apparatus is a rare but potentially life-threatening complication of blunt chest trauma and must be actively sought for. Transthoracic echocardiography remains the method of choice in these patients. PMID:27249554

  3. A Case of Nonunion Avulsion Fracture of the Anterior Tibial Eminence

    PubMed Central

    Atsumi, Satoru; Arai, Yuji; Nakagawa, Shuji; Inoue, Hiroaki; Ikoma, Kazuya; Fujiwara, Hiroyoshi; Kubo, Toshikazu

    2016-01-01

    Avulsion fracture of the anterior tibial eminence is an uncommon injury. If bone union does not occur, knee extension will be limited by impingement of the avulsed fragment and knee instability will be induced by dysfunction of the anterior cruciate ligament (ACL). This report describes a 55-year-old woman who experienced an avulsion fracture of the right anterior tibial eminence during recreational skiing. Sixteen months later, she presented at our hospital with limitation of right knee extension. Plain radiography showed nonunion of the avulsion fracture region, and arthroscopy showed that the avulsed fragment impinged the femoral intercondylar notch during knee extension. The anterior region of the bony fragment was debrided arthroscopically until the knee could be extended completely. There was no subsequent instability, and the patient was able to climb a mountain 6 months after surgery. These findings indicate that arthroscopic debridement of an avulsed fragment for nonunion of an avulsion fracture of the anterior tibial eminence is a minimally invasive and effective treatment for middle-aged and elderly patients with a low level of sports activity. PMID:27119035

  4. Penile erectile dysfunction after brachial plexus root avulsion injury in rats

    PubMed Central

    Fu, Guo; Qin, Bengang; Jiang, Li; Huang, Xijun; Lu, Qinsen; Zhang, Dechun; Liu, Xiaolin; Zhu, Jiakai; Zheng, Jianwen; Li, Xuejia; Gu, Liqiang

    2014-01-01

    Our previous studies have demonstrated that some male patients suffering from brachial plexus injury, particularly brachial plexus root avulsion, show erectile dysfunction to varying degrees. However, the underlying mechanism remains poorly understood. In this study, we evaluated the erectile function after establishing brachial plexus root avulsion models with or without spinal cord injury in rats. After these models were established, we administered apomorphine (via a subcutaneous injection in the neck) to observe changes in erectile function. Rats subjected to simple brachial plexus root avulsion or those subjected to brachial plexus root avulsion combined with spinal cord injury had significantly fewer erections than those subjected to the sham operation. Expression of neuronal nitric oxide synthase did not change in brachial plexus root avulsion rats. However, neuronal nitric oxide synthase expression was significantly decreased in brachial plexus root avulsion + spinal cord injury rats. These findings suggest that a decrease in neuronal nitric oxide synthase expression in the penis may play a role in erectile dysfunction caused by the combination of brachial plexus root avulsion and spinal cord injury. PMID:25422647

  5. Avulsion Fracture and Myositis Ossificans in a Professional Teenage Dancer: A Case Report.

    PubMed

    Tosun, Ozgur; Koralp, Muhabbet D; Tosun, Aliye; Celebi, Levent; Bulakbaşi, Nail

    2015-06-01

    Fractures of the transverse processes in the lumbar vertebrae occur as the result of major forces such as direct blunt trauma, violent lateral flexion-extension forces, avulsion of the psoas muscle, or Malgaigne fractures of the pelvis. Dancers make repeated and forceful hyperextension and flexions of the spine, which may cause fractures of the transverse processes of the lumbar vertebrae. Repeated trauma of muscles in dancers may cause avulsion fractures and myositis ossificans. Herein, we report MRI and CT findings of an avulsion from the right transverse process of the L2 and L3 vertebrae in a 16-year-old professional teenage dancer, who responded to conservative treatment. PMID:26046617

  6. Avulsion fracture of the iliac crest in a child☆☆☆

    PubMed Central

    Mortati, Rafael Borghi; Borghi Mortati, Lucas; Silva Teixeira, Matheus; Itiro Takano, Marcelo; Armelin Borger, Richard

    2014-01-01

    Avulsion fractures of the apophysis of the iliac crest have rare incidence and are little known. In this article, we report the case of an 11-year-old female patient who presented this injury after indirect trauma. From careful radiographic analysis, an avulsion fracture of the iliac crest was identified. It was decided to use nonsurgical treatment comprising analgesia and load restriction. This case report emphasizes the importance of suspecting avulsion fractures in cases of low-energy trauma, and also guides the treatment, so as to prevent functional deficit and deformities. PMID:26229818

  7. Successful Nonoperative Treatment of Isolated Popliteus Tendon Avulsion Fractures in Two Adolescents

    PubMed Central

    McKay, Scott D.; Holt, Andrew; Stout, Thomas; Hysa, Viola Qafalijaj

    2014-01-01

    Isolated popliteal tendon avulsion fractures are relatively uncommon in the pediatric population as other posterolateral lateral structures are often involved. This report describes two skeletally immature male patients who presented with knee injuries without ligamentous instability and were subsequently diagnosed with isolated popliteus tendon avulsion fractures. Both of these patients were managed nonoperatively and had subjectively full recoveries. As the treatment for isolated popliteal tendon avulsion fractures is still unclear, the report here may contribute to strategies regarding conservative treatment of these injuries. PMID:25197598

  8. Partial salvage of avulsed tissue after dog bite.

    PubMed

    Øregaard, J S; Lang, C L; Venzo, A

    2016-02-01

    Injuries to the nose can be severe from both a functional and cosmetic perspective. After suffering a dog bite to the central part of the face, an 18-year old woman underwent replantation of the avulsed tissue with the help of microsurgical arterial anastomosis. A venous anastomosis was impossible and venous congestion was treated with leech therapy. Subsequent skin necrosis occurred after a few days and the replantation was revised, revealing healthy tissue immediately below. The defect was covered with a full-thickness skin graft. At follow-up review eight months later, the functional and cosmetic result was satisfactory. To our knowledge, this is one of few cases where an injury of this severity healed with a cosmetically acceptable result. PMID:26673050

  9. Avulsion fracture of the straight and reflected heads of rectus femoris.

    PubMed

    Deehan, D J; Beattie, T F; Knight, D; Jongschaap, H

    1992-09-01

    We present a rare case of avulsion fracture of the reflected head of rectus femoris. This occurred in a 13-year-old male footballer. Diagnosis was made with pelvic radiology and treatment was bed rest and analgesia. PMID:1449579

  10. Avulsion threshold in a large Himalayan river: the case of the Kosi, India and Nepal

    NASA Astrophysics Data System (ADS)

    Sinha, R.; Kommula, S.

    2010-12-01

    Avulsion, the relatively rapid shift of a river to a new course on a lower part of a floodplain, is considered as a major fluvial hazard in large population centers such as the north Bihar plains, eastern India and the adjoining areas of Nepal. This region witnessed one of the most recent avulsions of the Kosi River on 18 August, 2008 when the river shifted by ~120 km eastward. This was perhaps one of the greatest avulsions in a large river in recent years triggered by the breach of the eastern afflux bund at Kusaha in Nepal at a location 12 km upstream of the Kosi barrage and affecting more than 3 million people in Nepal and north Bihar. The trigger for an avulsion largely depends upon the regional channel-floodplain slope relationships and the lowest elevation available in the region. Most of the available assessments of avulsion threshold have therefore been based on the examination of channel slopes- longitudinal and cross-sectional. However, planform dynamics in a sediment-charged river such as the Kosi also plays an important role in pushing the river towards threshold for avulsion. The present study has made use of SRTM DEM, temporal satellite images and maps to compute the avulsion threshold for a ~50 km long reach of the Kosi river after incorporating planform dynamics in a GIS environment. Flow accumulation paths generated from the SRTM data match closely with the zones of high avulsion threshold. Not just that the Kusaha plots in a high avulsion threshold zone, we also identify several critical points where breach (avulsion) can occur in near future. This study assumes global significance keeping in view the most recent flooding in the Indus River in Pakistan. Like the Kusaha breach in Kosi in August 2008, the Indus flood trauma started with the breach of the eastern marginal embankment in the upstream of Taunsa barrage and was apparently triggered by rise of bed level due to excessive sediment load. The mega avulsion of the Kosi on 18th August 2008

  11. [Treatment of complete traumatic avulsion of an incisor tooth in adults].

    PubMed

    Benmansour, A

    2013-05-01

    It is possible to replant an incisor tooth completely avulsed after trauma in adults. These cases are relatively frequent among athletes. It is essential to conserve the tooth in saline solution. The time before replantation must be as short as possible. The simple technique described here, which requires a minimum of material and no dental chair, makes it possible to replant an avulsed incisor with a good success rate. PMID:23803559

  12. SIMULTANEOUS BILATERAL AVULSION FRACTURE OF THE TIBIAL TUBEROSITY IN A TEENAGER: CASE REPORT AND THERAPY USED

    PubMed Central

    e Albuquerque, Rodrigo Pires; Giordano, Vincenzo; Carvalho, Antônio Carlos Pires; Puell, Thiago; e Albuquerque, Maria Isabel Pires; do Amaral, Ney Pecegueiro

    2015-01-01

    Simultaneous bilateral avulsion fracture of the tibial tuberosity in teenagers is a rare lesion. We describe the first case in the literature, in a teenage girl who sustained a fall while jumping during a volleyball match. No predisposing factors were iden tified. The lesions were treated with open surgical reduction and internal fixation. The aim of the present study was to present a case of simultaneous bilateral avulsion fracture of the tibial tuberosity in a teenage girl and the therapy used. PMID:27042651

  13. Surgical management of a completely avulsed adductor longus muscle in a professional equestrian rider.

    PubMed

    Quah, Conal; Cottam, Andrew; Hutchinson, James

    2014-01-01

    Avulsion injuries of the adductor longus muscle tendon are rare and a challenge to manage especially in athletes. There has been little published literature on the outcome of conservative and operative treatment for these injuries. We report the first case of an acute adductor longus avulsion injury which was surgically repaired in a professional equestrian rider. Return to full preinjury function was achieved at 3 months with surgical repair using 3 suture anchors. PMID:24711943

  14. The Riverbed Evolution, Avulsions and Backwater Hydrodynamics on the Huanghe River Delta

    NASA Astrophysics Data System (ADS)

    Chu, Z.; Ganti, V.; Lamb, M. P.

    2013-12-01

    The Huanghe River is known for high suspended sediment concentration and resultant heavy sedimentation and frequent channel-shifting among major rivers in the world. This plain coastal river is the main contributor of terrestrial sediment to the Bohai Sea and the Yellow Sea. Since 1855, there have been 11 major avulsions (versus 4 avulsions on the Mississippi River during the Holocene) on the lower reach with an recurrence interval of ~10 years, developing individual lobes that build up the modern Huanghe River delta. We summarize the main features of riverbed evolution on the delta with a database of measured data. The observed avulsions on the delta often occurred along a persistent spatial node, whose distance from the shoreline scales with the computed backwater length. In order to explain the avulsion locations on the delta, and meanwhile to test the viewpoint of river backwater controls on avulsion locations on deltas, we simulate the long profile evolution of the riverbed on the delta considering river discharge, river plume spreading, land subsidence and sea level rise, with a 1D fluvial morphodynamic model. The main results from the numerical simulations provide insights into how the long profile of the river on the delta evolves at the time scales of flood events and avulsions.

  15. Sequential avulsions of the tibial tubercle in an adolescent basketball player.

    PubMed

    Huang, Ying Chieh; Chao, Ying-Hao; Lien, Fang-Chieh

    2010-05-01

    Tibial tubercle avulsion is an uncommon fracture in physically active adolescents. Sequential avulsion of tibial tubercles is extremely rare. We reported a healthy, active 15-year-old boy who suffered from left tibial tubercle avulsion fracture during a basketball game. He received open reduction and internal fixation with two smooth Kirschner wires and a cannulated screw, with every effort to reduce the plate injury. Long-leg splint was used for protection followed by programmed rehabilitation. He recovered uneventfully and returned to his previous level of activity soon. Another avulsion fracture happened at the right tibial tubercle 3.5 months later when he was playing the basketball. From the encouragement of previous successful treatment, we provided him open reduction and fixation with two small-caliber screws. He recovered uneventfully and returned to his previous level of activity soon. No genu recurvatum or other deformity was happening in our case at the end of 2-year follow-up. No evidence of Osgood-Schlatter disease or osteogenesis imperfecta was found. Sequential avulsion fractures of tibial tubercles are rare. Good functional recovery can often be obtained like our case if we treat it well. To a physically active adolescent, we should never overstate the risk of sequential avulsion of the other leg to postpone the return to an active, functional life. PMID:20093955

  16. Hydraulic and sediment transport properties of autogenic avulsion cycles on submarine fans with supercritical distributaries

    NASA Astrophysics Data System (ADS)

    Hamilton, Paul B.; Strom, Kyle B.; Hoyal, David C. J. D.

    2015-07-01

    Submarine fans, like other distributive systems, are built by repeated avulsion cycles. However, relative to deltas and alluvial fans, much less is known about avulsions in subaqueous settings. In this study, we ran a set of subaqueous fan experiments to investigate the mechanics associated with autogenic avulsion cycles of self-formed channels and lobe deposits on steep slopes. The experiments used saline density currents with crushed plastic to emulate sustained turbidity currents and bed load transport. We collected detailed hydraulic and bathymetric measurements and made use of a 1-D laterally expanding density current model to better understand different aspects of the avulsion cycle. Our results reveal three major components of the avulsion cycles: (1) distributary channel incision, extension, and stagnation; (2) mouth bar aggradation and hydraulic jump initiation; and (3) hydraulic jump sedimentation and upstream retreat. Interestingly, in all but one experiment, the avulsion cycles led to fans that remained perched above the basin slope break. Experimental data and hydraulic theory were used to unravel actual mechanics associated with cycles. We found that channels stopped extending into the basin due to a decay in sediment transport capacity relative to sediment supply and that the reduction in capacity was primarily an outcome of expansion-driven velocity reduction; dilution played a secondary role. Once channel extension ceased, mouth bar deposits aggraded to a thickness approximately equal to the critical step height needed to create a choked flow condition. The choke then initiated a hydraulic jump on the upstream side of the bar. Once formed, the jump detained a majority of the incoming sediment and forced the channel-to-lobe transition upstream, filling the channel with steep backset bedding and capping the entire channel with a mounded lobate deposit. These intrinsic processes repeated through multiple avulsion cycles to build the fan.

  17. Dual Nerve Transfers for Restoration of Shoulder Function After Brachial Plexus Avulsion Injury.

    PubMed

    Chu, Bin; Wang, Huan; Chen, Liang; Gu, Yudong; Hu, Shaonan

    2016-06-01

    The purpose of this study was to investigate the effectiveness of shoulder function restoration by dual nerve transfers, spinal accessory nerve to the suprascapular nerve and 2 intercostal nerves to the anterior branch of the axillary nerve, in patients with shoulder paralysis that resulted from brachial plexus avulsion injury. It was a retrospective analysis to assess the impact of a variety of factors on reanimation of shoulder functions with dual nerve transfers. A total of 19 patients were included in this study. Most of these patients sustained avulsions of C5, C6, and C7 nerve roots (16 patients). Three of them had avulsions of C5 and C6 roots only. Through a posterior approach, direct coaptation of the intercostal nerves and the anterior branch of the axillary nerve was performed, along with accessory nerve transfer to the suprascapular nerve. Satisfactory shoulder function recovery (93.83° of shoulder abduction and 54.00° of external rotation on average) was achieved after a 62-month follow-up. This dual nerve transfer procedure provided us with a reliable and effective method for shoulder function reconstruction after brachial plexus root avulsion, especially C5/C6/C7 avulsion. The level of evidence is therapeutic IV. PMID:26835823

  18. Effects of medial meniscal posterior horn avulsion and repair on meniscal displacement.

    PubMed

    Hein, Christopher N; Deperio, Jennifer Gurske; Ehrensberger, Mark T; Marzo, John M

    2011-06-01

    Medial meniscal posterior root avulsion (MMRA) leads to deleterious alteration of medial joint compartment loading profiles and increased risk of medial degenerative changes. Surgical repair restores more normal biomechanics to the knee. Our hypothesis is that MMRA will cause medial meniscal (MM) extrusion and gap formation between the root attachment site and MM. Meniscal root repair will restore the ability of the meniscus to resist extrusion, and reduce gap formation at the defect. Seven fresh frozen human cadaveric knees were dissected and mechanically loaded using a servo-hydraulic load frame (MTS ®) with 0 and 1800 N. The knees were tested under three conditions: native, avulsed, and repaired. Four measurements were obtained: meniscal displacement anteriorly, medially, posteriorly, and gap distance between the root attachment site and MM after transection and repair. The medial displacement of the avulsed MM (3.28 mm) was significantly greater (p < 0.001) than the native knee (1.60mm) and repaired knee (1.46 mm). Gap formation is significantly larger in the avulsed compared to repaired state at 0 (p < 0.02) and 1800N (p < 0.02) and also larger with loading in both avulsed (p < 0.05) and repaired (p < 0.02) conditions. Therefore, MMRA results in MM extrusion from the joint and gap formation between the MM root and the MM. Subsequent surgical repair reduces meniscal displacement and gap formation at the defect. PMID:20684881

  19. Avulsion fractures of the pelvis – a qualitative systematic review of the literature

    PubMed Central

    Porr, Jason; Lucaciu, Calin; Birkett, Sarah

    2011-01-01

    Objective To assess a causal relationship between physical activity or boney surgical intervention and the occurrence of avulsion fracture in the pelvis. Secondarily to assess the average age at which avulsion fracture occurs in cases associated with physical activity or boney surgery. Method A literature search was performed on a variety of databases using text words and MeSH terms. Results were limited to English language. Cases involving trauma or pathological disease were excluded. Causation Criteria scores were calculated for each paper to establish a link between the suspected mechanism of injury and avulsion fracture. Results 48 papers were retrieved encompassing 66 cases of avulsion fracture. 88% of cases were associated with physical activity while 12% were associated with a history of surgery. Average age in the physical activity cases was 16.8(range 13–43) and 56.4(range 31–74) in the surgery related cases. Causation Criteria scores were definite in 76% of activity related cases and probable in 60% of boney surgery related cases. Conclusions Avulsion fractures of the pelvis represent a highly prevalent pathology among the adolescent athletic population. A population of skeletally mature patients with history of boney surgical intervention are also at risk. PMID:22131561

  20. First dorsal metacarpal artery adiposofascial flap for venous conduit and soft tissue cover in an avulsed thumb: case report.

    PubMed

    Dodakundi, Chaitanya; Hattori, Yasunori; Doi, Kazuteru

    2012-06-01

    Skin loss, need for vein grafts, and secondary surgeries are often encountered in avulsion injuries of the thumb. We report a case of successful salvage of an avulsion type of near total amputation of the thumb following a conveyor belt injury in which the first dorsal metacarpal artery adiposofascial flap was used for combined soft tissue cover and venous conduit. PMID:22517573

  1. Avulsion fracture of the posterior cruciate ligament in an uncommon location associated with distal injury to the patellar ligament☆

    PubMed Central

    e Albuquerque, Rodrigo Pires; da Palma, Idemar Monteiro; Cobra, Hugo; de Paula Mozella, Alan; Vaques, Victor

    2015-01-01

    Avulsion fractures of the posterior cruciate ligament in unusual locations are rare injuries. We report the first case in the literature of an avulsion fracture of the posterior cruciate ligament associated with distal injury to the patellar ligament. The aim of this study was to present a novel case, the therapy used and the clinical follow-up. PMID:27218089

  2. Isolated avulsion of the vastus lateralis tendon insertion in a weightlifter: a case report

    PubMed Central

    Trikha, Paul S; Wood, David G

    2009-01-01

    Introduction We report a case of isolated, unilateral avulsion of the vastus lateralis tendon from its insertion at the patella. This was diagnosed by magnetic resonance imaging, and underwent successful surgical repair. Case presentation A healthy 32-year-old national level power lifter presented with an isolated avulsion of the vastus lateralis tendon. After a failed course of conservative therapy he underwent surgical repair and a graded physical therapy programme. One year later he returned to full training with no evidence of re-rupture. Conclusion This is the first reported case of an isolated vastus lateralis avulsion. Our experience suggests that magnetic resonance imaging is invaluable in the diagnosis of this condition and that surgical repair provides a good outcome in high demand patients. PMID:19918436

  3. A Rare Combination of Avulsion Fractures Around the Knee –A Case Report

    PubMed Central

    Reddy, Hanumantha; Thonse, Chirag; Chikkanna, Jayanth Kumar Bangalore

    2015-01-01

    Patella fractures, tibial spine avulsion and Segond fractures are mainly due to trauma to the knee which may be direct or indirect injuries. While each entity is well documented when occurring in isolation, but bilateral inferior pole patella fracture, tibial spine avulsion in the right knee and bilateral segond fracture in a same patient is a rare occurrence. We report a case of 24-year-old male with such an injury. The diagnosis was confirmed by X-ray, CT scan and MRI imaging of right knee. Then the patient was treated with arthroscopic anterior cruciate ligament (ACL) avulsion fixation with pull through technique and suture disc; bilateral inferior pole patella was treated conservatively with knee brace, segond fracture was treated conservatively similarly. To the best of our knowledge, this is the rare case in the medical literature with all these injuries occurring simultaneously. PMID:26500971

  4. Avulsion fracture of the anterior inferior iliac spine with abundant reactive ossification in the soft tissue.

    PubMed

    Resnick, J M; Carrasco, C H; Edeiken, J; Yasko, A W; Ro, J Y; Ayala, A G

    1996-08-01

    Patients who have sustained an avulsion fracture and present clinically during the healing phase of the injury may manifest a mass that clinically and radiographically mimics a malignant neoplasm. A 15-year-old male soccer goalkeeper presented with a large ossified mass in the soft tissues overlying the right hip 6 months after experiencing a popping sensation in his hip joint during a game. Although an osteosarcoma was suspected clinically and radiographically, a Tru-Cut needle biopsy of the lesion revealed reactive bone formation. Correlation of the clinical, radiographic, and pathologic findings indicated an avulsion fracture of the anterior inferior iliac spine with abundant reactive ossification in the soft tissues. The healing phase of an avulsion fracture may clinically and radiographically be mistaken for neoplasia. In such cases, a Tru-Cut needle biopsy may reveal the reactive nature of the process. PMID:8865496

  5. Avulsed Immature Permanent Central Incisors Obturated With Mineral Trioxide Aggregate: A Case Report

    PubMed Central

    Al-Kahtani, Ahmed

    2013-01-01

    The endodontic management of immature permanent incisors in young children can be challenging. This case reported an avulsed immature maxillary central incisors that underwent complete endodontic obturation using mineral trioxide aggregate. A 10-year-old male who suffered a fall injury avulsed both his central incisors. The revascularization process was not possible due to patient compliance and geographic reasons. Mineral trioxide aggregate was utilized as a novel endodontic treatment. After one year post-injury, the teeth remained symptom-free, the clinical and radiographic follow-up showed evidence of healthy periodontium. How to cite this article: Al-Kahtani A. Avulsed Immature Permanent Central Incisors Obturated With Mineral Trioxide Aggregate: A Case Report. J Int Oral Health 2013; 5(3):88-96. PMID:24155609

  6. Avulsion-fracture of the anterior superior iliac spine with meralgia paresthetica: a case report.

    PubMed

    Hayashi, Shinya; Nishiyama, Takayuki; Fujishiro, Takaaki; Kanzaki, Noriyuki; Kurosaka, Masahiro

    2011-12-01

    We present a rare case of avulsion-fracture of the anterior superior iliac spine with meralgia paresthetica in a 16-year-old male basketball player. He had sensory disturbance affecting his left lateral thigh 10 days after the injury. Tinel's sign was elicited on percussing the avulsed bony fragment of the anterior superior iliac spine. He underwent open reduction and internal fixation. The lateral femoral cutaneous nerve was noted to be entrapped by one third of the avulsed bony fragment. That fragment was removed, and the remaining portion was reduced and fixed with 2 screws. At week 6, the patient had returned to basketball playing without pain. At week 8, sensory distribution in the left lateral thigh had returned to normal. PMID:22184178

  7. Rehabilitation of avulsion fracture of the tibial tuberosity following Osgood-Schlatter disease.

    PubMed

    Baltaci, G; Ozer, H; Tunay, V B

    2004-03-01

    A sixteen-year-old boy suffered from sharp pain in the knee during a jump while playing basketball. He had a positive history of Osgood Schlatter disease. Radiographic evaluation demonstrated an avulsion fracture of the tibial tuberosity Type III according to the classification of Watson-Jones. Rehabilitation after avulsion fracture of the tibial tuberosity is an important consideration for this relatively uncommon adolescent injury. In such avulsion fractures, landing on the ground with the knee fully extended after a jump is the most likely cause. This case report reviews the rehabilitation program, and selected functional outcome measures after rehabilitation are reported. The patient returned to sporting activity after 12 months. PMID:12910334

  8. Enhanced regeneration and functional recovery after spinal root avulsion by manipulation of the proteoglycan receptor PTPσ

    PubMed Central

    Li, Heng; Wong, Connie; Li, Wen; Ruven, Carolin; He, Liumin; Wu, Xiaoli; Lang, Bradley T.; Silver, Jerry; Wu, Wutian

    2015-01-01

    Following root avulsion, spinal nerves are physically disconnected from the spinal cord. Severe motoneuron death and inefficient axon regeneration often result in devastating motor dysfunction. Newly formed axons need to extend through inhibitory scar tissue at the CNS-PNS transitional zone before entering into a pro-regenerative peripheral nerve trajectory. CSPGs are dominant suppressors in scar tissue and exert inhibition via neuronal receptors including PTPσ. Previously, a small peptide memetic of the PTPσ wedge region named ISP (Intracellular Sigma Peptide) was generated, and its capabilities to target PTPσ and relieve CSPG inhibition were validated. Here, we demonstrate that after ventral root avulsion and immediate re-implantation, modulation of PTPσ by systemic delivery of ISP remarkably enhanced regeneration. ISP treatment reduced motoneuron death, increased the number of axons regenerating across scar tissue, rebuilt healthy neuromuscular junctions and enhanced motor functional recovery. Our study shows that modulation of PTPσ is a potential therapeutic strategy for root avulsion. PMID:26464223

  9. Tibial Tuberosity Avulsion Fracture and Open Proximal Tibial Fracture in an Adult

    PubMed Central

    Liu, Yu-Ping; Hao, Qing-Hai; Lin, Feng; Wang, Ming-Ming; Hao, Yue-Dong

    2015-01-01

    Abstract A displaced tibial tuberosity avulsion fracture associated with an open extra-articular proximal tibial diaphyseal fracture is an uncommon fracture pattern. This case report describes the successful management of such a fracture pattern in a 45-year old male using an open reduction and lag screw fixation of the tuberosity with a minimally invasive reduction and plate fixation of the proximal tibial diaphyseal fracture. A literature search was done to determine the expected clinical outcome of this fracture pattern. This is the first reported adult case of an avulsion fractures of the tibial tuberosity associated with an open proximal tibial diaphyseal fracture successfully treated by an anatomical reduction and fixation of the avulsion fracture of the tibial tuberosity combined with minimally invasive percutaneous plate osteosynthesis of the proximal tibial diaphyseal fractures. PMID:26426669

  10. Splinting rationale and contemporary treatment options for luxated and avulsed permanent teeth.

    PubMed

    Lambert, Douglas L

    2015-01-01

    The continued growth in athletic participation among children and adults has increased the potential incidence of sports-related dental injuries. Regardless of preventive measures, damage and injury to the oral cavity can occur during participation in sports. Luxations, root fractures, bony fractures, and avulsions involving 1 or more teeth are a possibility. Many of these injuries require specific protocols for splinting of the traumatized tooth or teeth to allow the best possible outcomes. This article identifies luxation and avulsion injuries, explains the rationale for splinting, reviews guidelines for splint duration, and discusses contemporary material options available to stabilize affected permanent dentition. PMID:26545276

  11. Lumbar nerve root avulsions with secondary ipsilateral hip dysplasia in a child.

    PubMed

    Polyzoidis, Konstandinos; Petropoulou, Calliope; Argyropoulou, Paraskevi I; Vranos, Georgios; Sarmas, Ioannis; Argyropoulou, Maria I

    2002-09-01

    We report on an 8-year-old child with avulsions of the left L3, L4 and L5 nerve roots and traumatic meningoceles that were not associated with lumbar spine or pelvic girdle fractures. The patient had a history of a road traffic accident. Plain radiographs of the pelvis revealed left hip dysplasia. The magnetic resonance imaging findings of the lumbar spine are illustrated. The pathogenesis of lumbar nerve root avulsions and their association with ipsilateral hip dysplasia are discussed. PMID:12221453

  12. Replantation of an avulsed tooth with an extended extra oral period.

    PubMed

    Kubasad, Girish; Ghivari, Sheetal; Garg, Khushboo

    2012-01-01

    In this study, we have reported a case of the replantation of a maxillary incisor with an extended extraoral period following a traumatic avulsion. After storage in normal saline, the root surface of the avulsed tooth was conditioned with citric acid and treated with a triple antibiotic solution. The tooth socket was filled with Emdogain before replantation. A 12 month, 18 month and a 5 year follow-up clinical examination revealed the patient to be asymptomatic, and the tooth was functional. The recall radiograph showed no evidence of renewed periradicular breakdown and apical root resorption. PMID:23649072

  13. Avulsion of the brachial plexus in a great horned owl (Bubo virginaus)

    USGS Publications Warehouse

    Moore, M.P.; Stauber, E.; Thomas, N.J.

    1989-01-01

    Avulsion of the brachial plexus was documented in a Great Horned Owl (Bubo virginianus). A fractured scapula was also present. Cause of these injuries was not known but was thought to be due to trauma. Differentiation of musculoskeletal injury from peripheral nerve damage can be difficult in raptors. Use of electromyography and motor nerve conduction velocity was helpful in demonstrating peripheral nerve involvement. A brachial plexus avulsion was suspected on the basis of clinical signs, presence of electromyographic abnormalities in all muscles supplied by the nerves of the brachial plexus and absence of median-ulnar motor nerve conduction velocities.

  14. Avulsion threshold and planform dynamics of the Kosi River in north Bihar (India) and Nepal: A GIS framework

    NASA Astrophysics Data System (ADS)

    Sinha, R.; Sripriyanka, K.; Jain, Vikrant; Mukul, Malay

    2014-07-01

    Models for river avulsions have identified the ratio between down-valley and cross-valley slopes of channels as the triggering factors for the sudden channel shift but have remained untested in the field. The August 2008 avulsion of the Kosi River at Kusaha, 12 km upstream of the Kosi barrage in Nepal, provided an opportunity to study a large-scale avulsion (~ 120 km) for its causal factors and driving mechanisms. We used the SRTM-based digital elevation model and remotely sensed data coupled with field topographic mapping with a kinematic GPS and a Total Station to characterise a ~ 50-km-long stretch of the Kosi River. We have computed reach-scale avulsion threshold index (ATI) integrating SRTM-derived slopes and planform dynamics on a GIS platform. We show that several reaches along the Kosi River are avulsion-prone, including the Kusaha point that is consistent with the August 2008 avulsion. We suggest that apart from cross-valley and down-valley slopes, planform dynamics such as thalweg shift, sinuosity variation, and channel multiplicity significantly influence the avulsion threshold in alluvial reaches of the rivers such as the Kosi.

  15. Possible complications of ureteroscopy in modern endourological era: two-point or "scabbard" avulsion.

    PubMed

    Gaizauskas, Andrius; Markevicius, Marius; Gaizauskas, Sergejus; Zelvys, Arunas

    2014-01-01

    Indication has led ureteroscopy to be a worldwide technique, with the expected appearance of multiple types of complications. Severe complications are possible including ureteral perforation or avulsion. Ureteral avulsion has been described as an upper urinary tract injury related to the action of blunt trauma, especially from traffic accidents, being the mechanism of injury, the result of an acute deceleration/acceleration movement. With the advent of endourology, that term is also applied to the extensive degloving injury resulting from a mechanism of stretching of the ureter that eventually breaks at the most weakened site, or ureteral avulsion is referred to as a discontinuation of the full thickness of the ureter. The paper presents a case report and literature review of the two-point or "scabbard" avulsion. The loss of long segment of the upper ureter, when end-to-end anastomosis is not technically feasible, presents a challenge to the urological surgeon. In the era of small calibre ureteroscopes these complications, due to growing incidence of renal stones will become more and more actual. Our message to other urologists is to know such a complication, to know the ways of treatment, and to analyse ureteroscopic signs, when to stop or pay attention. PMID:25610699

  16. Reduction and fixation of the avulsion fracture of the tibial eminence using mini-open technique.

    PubMed

    Lu, Xiong-Wei; Hu, Xiao-Peng; Jin, Chen; Zhu, Tong; Ding, Yong; Dai, Li-Yang

    2010-11-01

    The purpose of this prospective study is to present and evaluate a new technique using suture anchors for the treatment of the avulsion fractures of the tibial eminence. Twenty-three consecutive patients with the displaced avulsion fracture of the tibial attachment of anterior cruciate ligament were treated using mini-open technique with suture anchors between 2005 and 2008. According to the classification of Meyers and McKeever, there were 5 type II, 13 type III, and 5 type IV fractures. The median follow-up period was 18 months (range, 12-32 months). The patient assessment included Lysholm score, Tegner score, IKDC score, and radiographic evaluation. The median Lysholm score improved from 32 (range, 28-48) preoperatively to 98 (range, 85-100) postoperatively. The median preoperative Tegner score was 3 (range, 2-5), and the median postoperative Tegner score was 7 (range, 5-9). The global IKDC objective score was normal (A) in 21 knees and nearly normal (B) in 2 knees. At final follow-up, the Lachman test and anterior drawer test were negative. The results showed that mini-open reduction and fixation of avulsion fracture of the tibial eminence with suture anchors have achieved satisfactory results. We suggest the use of this technique for treating avulsion fractures of the tibial eminence. PMID:20127313

  17. Evaluation of sixth grade primary schoolchildren's knowledge about avulsion and dental reimplantation.

    PubMed

    Castilho, Lithiene Ribeiro; Sundefeld, Maria Lucia Marçal Mazza; de Andrade, Dalton Francisco; Panzarini, Sônia Regina; Poi, Wilson Roberto

    2009-08-01

    Dental trauma, particularly tooth avulsion, is a frequent cause of tooth loss in children, adolescents, and young adults. The avulsed tooth should be immediately reimplanted in its alveolus. This procedure can be performed by anyone at the accident site and not only by dental surgeons. Therefore, the purpose of this study is to evaluate the knowledge of sixth graders of the city of Araçatuba, SP, about dental avulsion and tooth reimplantation through a structured and standardized survey. Our sample consisted of 778 students. The data collected was processed using the program EPIINFO 2000. Most students were around 12 years of age and 94.5% related to practice some kind of sports. Results demonstrated that the possibility of tooth reimplantation after dental avulsion is not acknowledged among these students and dental traumatism was associated to caries, toothache, and use of orthodontic appliances. Only 18.9% of the students associated dental traumatism to an impact trauma; 3.6% would store the tooth in milk, and 3.1% believed the tooth could be reimplanted by anyone present at the accident site. In summary, the results show an overall the lack of knowledge about dental traumatism and highlight the need of special programs designed to educate school-aged students about emergency procedures to handle cases of dental traumatisms. PMID:19459922

  18. All-arthroscopic repair of arcuate avulsion fracture with suture anchor.

    PubMed

    Zhang, Hui; Hong, Lei; Wang, Xue-Song; Zhang, Jin; Liu, Xin; Feng, Hua

    2011-05-01

    Arcuate avulsion fractures are very rare but present pathologic posterolateral rotation instability. Untreated instability may lead to overload of the reconstructed posterior cruciate ligament (PCL) graft. Surgical treatment and clinical results have not yet been reported to our knowledge. This study presents the case of a 45-year-old man with PCL injury and an arcuate avulsion fracture of the fibular head. The dial test was positive preoperatively, and magnetic resonance imaging showed an "arcuate" sign. The avulsed bone fragment was reduced and fixed with a suture anchor by an all-arthroscopic technique. At the 1-year follow-up, the patient had resumed all his normal activities, including sports. He scored 1+ on the posterior drawer test, and external rotation was 1° less than that in his contralateral normal knee. Compared with the values in the contralateral normal knee, the posterior tibial translation was reduced from 15.5 mm preoperatively to 6.3 mm postoperatively. The postoperative magnetic resonance imaging and computed tomography scans showed that the reconstructed PCL graft and the osseous fragment of the styloid process of the fibular head attached to the popliteofibular ligament were reduced. This technical note describes an all-arthroscopic reduction and fixation technique of arcuate avulsed fracture of the fibular head. PMID:21398077

  19. Migration and Differentiation of Neural Progenitor Cells after Recurrent Laryngeal Nerve Avulsion in Rats

    PubMed Central

    Zhao, Wan; Xu, Wen

    2014-01-01

    To investigate migration and differentiation of neural progenitor cells (NPCs) from the ependymal layer to the nucleus ambiguus (NA) after recurrent laryngeal nerve (RLN) avulsion. All of the animals received a CM-DiI injection in the left lateral ventricle. Forty-five adult rats were subjected to a left RLN avulsion injury, and nine rats were used as controls. 5-Bromo-2-deoxyuridine (BrdU) was injected intraperitoneally. Immunohistochemical analyses were performed in the brain stems at different time points after RLN injury. After RLN avulsion, the CM-DiI+ NPCs from the ependymal layer migrated to the lesioned NA. CM-DiI+/GFAP+ astrocytes, CM-DiI+/DCX+ neuroblasts and CM-DiI+/NeuN+ neurons were observed in the migratory stream. However, the ipsilateral NA included only CM-DiI+ astrocytes, not newborn neurons. After RLN avulsion, the NPCs in the ependymal layer of the 4th ventricle or central canal attempt to restore the damaged NA. We first confirm that the migratory stream includes both neurons and glia differentiated from the NPCs. However, only differentiated astrocytes are successfully incorporated into the NA. The presence of both cell types in the migratory process may play a role in repairing RLN injuries. PMID:25202908

  20. Avulsion fracture of the straight and reflected heads of rectus femoris.

    PubMed Central

    Deehan, D J; Beattie, T F; Knight, D; Jongschaap, H

    1992-01-01

    We present a rare case of avulsion fracture of the reflected head of rectus femoris. This occurred in a 13-year-old male footballer. Diagnosis was made with pelvic radiology and treatment was bed rest and analgesia. Images Fig. 1 Fig. 2 PMID:1449579

  1. All-arthroscopic treatment of tibial avulsion fractures of the posterior cruciate ligament

    PubMed Central

    Gwinner, Clemens; Hoburg, Arnd; Wilde, Sophie; Schatka, Imke; Krapohl, Björn Dirk; Jung, Tobias M.

    2016-01-01

    Background: The posterior cruciate ligament (PCL) avulsion fracture from its tibial insertion is a rare condition. Despite the further technical advent in refixation of avulsion fractures, the reported failure rate of current approaches remains high and the optimal surgical technique has not been elucidated yet. The purpose of the current study is to present an all-inside arthroscopic reconstruction technique for bony tibial avulsion fractures of the PCL and initial clinical outcomes. Methods: Patients underwent a thorough clinical and radiological examination of both knees at 3, 6, 12, 18, and if possible also at 24 months. Clinical evaluation included subjective and objective IKDC 2000, Lysholm score, and KOOS score. Radiographic imaging studies included CT scans for assessment of osseous integration and anatomic reduction of the bony avulsion. In addition to that posterior stress radiographs of both knees using the Telos device (Arthrex, Naples, USA) were conducted to measure posterior tibial translation. Results: A total of four patients (1 female, 3 male; ø 38 (± 18) years), who underwent arthroscopic refixation of a PCL avulsion fracture using the Tight Rope device were enrolled in this study. Mean follow up was 22 [18–24] months. The mean subjective IKDC was 72.6% (± 9.9%). Regarding the objective IKDC three patients accounted for grade A, one patient for grade C. The Lysholm score yielded 82 (± 6.9) points. The KOOS score reached 75% (± 13%; symptoms 76%, pain 81%, function 76%, sports 66%, QoL 64%). All patients showed complete osseous integration and anatomic reduction of the bony avulsion. The mean posterior tibial translation at final follow up was 2.8 [0–7] mm. Conclusions: All-arthroscopic treatment of tibial avulsion fractures of the posterior cruciate ligament provides satisfactory clinical results in a preliminary patient cohort. It is a reproducible technique, which minimizes soft tissue damage and obviates a second surgery for hardware

  2. Tectonics of Modhupur Tract, its Effects on the Cenozoic Sediments and Jamuna River Avulsion

    NASA Astrophysics Data System (ADS)

    Hosain, A.

    2014-12-01

    Bangladesh is a country characterized by numerous natural disasters. These natural hazards occur both on the surface (e.g., flooding due to river avulsions) and within the subsurface (e.g., earthquakes) (see figure), and both types have been related to regional tectonic activity. Bangladesh is also one of the most highly populated countries in the world with a capital city, Dhaka, host to 17 million people. This urban center is located only 40 km south east from the Madhupur Tract, a potentially tectonically hazardous region. In order to determine this region's tectonic hazard potential, recent studies have attempted to detect and identify significant neotectonic signatures of the tract, such as faults, lineaments, and weak zones within the region. Recent earthquake evidence along the Madhupur Fault strongly supports the fact that the area is tectonically unstable and quite vulnerable to further seismicity, placing the fast-growing and densely populated Dhaka city in potential danger (see figure). The Madhupur Tract is in central Bangladesh, and is surrounded by the Jamuna-Brahmaputra river floodplain. Previous research suggests the uplift of the Madhupur Tract may have exerted a significant control on the avulsion history of the Jamuna River. The Jamuna river avulsion history is cyclic, with a periodicity of about 2000 years. Within these cycles, the Jamuna's position has fluctuated from west to east and east to west, repeatedly (Pickering et al. 2013). As this avulsion history is thought to be, at least partly, related to seismicity in the region, future seismicity has the potential to cause future river avulsions and related flooding. The Madhupur Tract is an exposed Quaternary deposit. It is believed that 1885 Bengal earthquake may have been caused by the rupture of the Madhupur blind fault (see figure). However, there is no paleo-seismological evidence, since it is an intra-plate active fault. The principle aim of this research is to identify the location of

  3. Knowledge about tooth avulsion and its management among dental assistants in Riyadh, Saudi Arabia

    PubMed Central

    2014-01-01

    Background Studies evaluating dental assistants’ knowledge about tooth avulsion and its management are rare. The purpose of this study was to evaluate the level of knowledge about tooth avulsion and its management among dental assistants in Riyadh, Saudi Arabia and to assess its relationship with their educational background. Methods A convenience sampling methodology was employed for sample selection. Over a period of four months starting in February, 2013, 691 pretested 17-item questionnaires were distributed. A total of 498 questionnaires were returned for an overall response rate of 72.1%. Six questions were related to knowledge about permanent tooth avulsion and one question was related to knowledge about primary tooth avulsion. Correct answers to these questions were assigned one point each, and based on this scoring system, an overall knowledge score was calculated. An analysis of covariance was used to test the association between the level of knowledge (total score) and the educational qualifications of the respondents (dental degree and others). A P-value of 0.05 was considered the threshold for statistical significance. Results The majority of the respondents (n = 387; 77.7%) were non-Saudis (377 were from the Philippines), and 79.1% (n = 306) of the Filipinos had a dental degree. The question about recommendations for an avulsed tooth that is dirty elicited the highest number of correct responses (n = 444; 89.2%), whereas the question about the best storage media elicited the lowest number of correct responses (n = 192; 38.6%). The overall mean score for knowledge about tooth avulsion was 6.27 ± 1.74. The mean knowledge score among the respondents with a dental degree was 6.63 ± 1.37, whereas that among the respondents with other qualifications was 5.71 ± 2.08. Conclusions The educational qualifications of the surveyed dental assistants were strongly correlated with the level of knowledge about tooth avulsion and its

  4. Delayed replantation of an avulsed maxillary premolar with open apex: a 24 months follow-up case report.

    PubMed

    Ravi, K S; Pinky, C; Kumar, Shikhar; Vanka, Amit

    2013-01-01

    Avulsion of permanent teeth is most serious of all dental injuries and accounts for 1-16% of all traumatic injuries, of which maxillary incisors are most commonly involved. However, in this report a rare case of isolated avulsed immature premolar has been described. The patient had reported more than 3 hours after the trauma with a tooth stored in dry condition and soil contamination. The prognosis depends on measures taken at the place of accident or the time immediately after avulsion. Replantation is the treatment of choice, but cannot always be performed immediately. An appropriate emergency management and treatment plan is important for good prognosis. In this report stepwise management of an avulsed immature maxillary premolar with extended period of dry storage has been described followed up for a period of 2 yrs. PMID:24021335

  5. A tuber calcanei avulsion fracture developed on the basis of idiopathic osteoporosis in a young male: a case report.

    PubMed

    Terzi, R; Özer, T

    2015-09-01

    Calcaneus fractures constitute 1.2 % of all fractures. Tuber calcanei avulsion fractures constitute 1.3-2.7 % of calcaneus fractures. Osteoporosis, osteomalacia, and diabetes mellitus have been reported to increase the risk of development of these fractures. It has been reported that tuber calcanei avulsion fractures in elderly females might develop due to osteoporosis. As far as we know, no tuber calcanei avulsion fracture developing on the basis of osteoporosis without presence of a trauma has been reported in young males in the literature. In the current case report, a 41-year-old male patient who was admitted with complaints of pain in the left heel and diagnosed with calcaneal avulsion fracture that developed on the basis of idiopathic osteoporosis and who was treated with conservative methods was presented. PMID:25851698

  6. Radiographic and Arthroscopic Assessment of DRUJ Instability Due to Foveal Avulsion of the Radioulnar Ligament in Distal Radius Fractures

    PubMed Central

    Nakamura, Toshiyasu; Iwamoto, Takuji; Matsumura, Noboru; Sato, Kazuki; Toyama, Yoshiaki

    2014-01-01

    Background As the triangular fibrocartilage complex (TFCC) anchors the distal radius to the ulna via the radioulnar ligament (RUL), a severely displaced distal fragment of the radius may be associated with a foveal avulsion of the TFCC. The purpose of this retrospective study was to assess, radiographically and arthroscopically, the relationship between displacement of the radius, the ulnar styloid, and avulsion of the RUL resulting in distal radioulnar joint (DRUJ) instability. Materials and Methods Twenty-nine wrists of 29 patients with intra- and extra-articular distal radius fractures/malunion who underwent reduction or a corrective osteotomy of the displaced/malunited fracture, and/or wrist arthroscopy, were assessed radiographically and arthroscopically. Radial translation, radial inclination, radial shortening, volar or dorsal tilt, and the presence of an ulnar styloid fracture with more than 4 mm of displacement were measured from the initial films. Radiocarpal arthroscopy was used to assess peripheral lesions of the TFCC, while DRUJ arthroscopy was used to assess the foveal attachment. The relationship between displacement of the distal radius or the ulnar styloid fracture and the TFCC injury, including avulsion of the RUL, was recorded. Results Univariate analysis revealed that increased radial translation, decreased radial inclination, increased radial shortening, and an ulnar styloid fragment radially displaced by more than 4 mm were significant predictors of RUL avulsion at the fovea. Volar or dorsal tilt of the radius and ulnar variance did not correlate with RUL avulsion or TFCC injuries. Multiple logistic regression analysis revealed that radial translation was an independent risk factor of foveal avulsion of the RUL. Conclusions Increased radial translation and radial shortening and decreased radial inclination of the distal fragment can be associated with a foveal avulsion of the RUL. Radial translation can be an independent risk

  7. Radiographic and Arthroscopic Assessment of DRUJ Instability Due to Foveal Avulsion of the Radioulnar Ligament in Distal Radius Fractures.

    PubMed

    Nakamura, Toshiyasu; Iwamoto, Takuji; Matsumura, Noboru; Sato, Kazuki; Toyama, Yoshiaki

    2014-02-01

    Background As the triangular fibrocartilage complex (TFCC) anchors the distal radius to the ulna via the radioulnar ligament (RUL), a severely displaced distal fragment of the radius may be associated with a foveal avulsion of the TFCC. The purpose of this retrospective study was to assess, radiographically and arthroscopically, the relationship between displacement of the radius, the ulnar styloid, and avulsion of the RUL resulting in distal radioulnar joint (DRUJ) instability. Materials and Methods Twenty-nine wrists of 29 patients with intra- and extra-articular distal radius fractures/malunion who underwent reduction or a corrective osteotomy of the displaced/malunited fracture, and/or wrist arthroscopy, were assessed radiographically and arthroscopically. Radial translation, radial inclination, radial shortening, volar or dorsal tilt, and the presence of an ulnar styloid fracture with more than 4 mm of displacement were measured from the initial films. Radiocarpal arthroscopy was used to assess peripheral lesions of the TFCC, while DRUJ arthroscopy was used to assess the foveal attachment. The relationship between displacement of the distal radius or the ulnar styloid fracture and the TFCC injury, including avulsion of the RUL, was recorded. Results Univariate analysis revealed that increased radial translation, decreased radial inclination, increased radial shortening, and an ulnar styloid fragment radially displaced by more than 4 mm were significant predictors of RUL avulsion at the fovea. Volar or dorsal tilt of the radius and ulnar variance did not correlate with RUL avulsion or TFCC injuries. Multiple logistic regression analysis revealed that radial translation was an independent risk factor of foveal avulsion of the RUL. Conclusions Increased radial translation and radial shortening and decreased radial inclination of the distal fragment can be associated with a foveal avulsion of the RUL. Radial translation can be an independent risk

  8. Arthroscopic Suture Fixation in Femoral-Sided Avulsion Fracture of Anterior Cruciate Ligament

    PubMed Central

    Prasathaporn, Niti; Umprai, Vantawat; Laohathaimongkol, Thongchai; Kuptniratsaikul, Somsak; Kongrukgreatiyos, Kitiphong

    2015-01-01

    A femoral-sided avulsion fracture of the anterior cruciate ligament (ACL) is a rare and challenging condition. Most reported cases have occurred in childhood or adolescence. Many techniques of ACL repair have been reported, and in recent years, techniques in arthroscopic surgery have been developed and have become ever more popular with orthopaedic surgeons. We created a technique of arthroscopic ACL repair with suture anchor fixation for a femoral-sided ACL avulsion fracture. This technique saves the natural ACL stump. It is available for cases in which creation of a tibial tunnel is not allowed. Moreover, it does not require a skin incision for fixation on the far femoral cortex and, therefore, does not require a second operation to remove the fixation device. The arthroscopic technique also has a good cosmetic outcome. PMID:26258035

  9. Full-thickness skin avulsion of right leg following car accident trauma.

    PubMed

    Hosseinzadeh, Ahmad Zaghi

    2008-05-15

    The report presents a 24 year-old man who admitted at the orthopedic center with full-thickness skin avulsion of the right leg, due to his leg being caught under the wheel of a truck and subsequently traumatized. The day after injury, plastic and reconstructive surgery consult was done. After thoroughly irrigation, the 20 cm laceration was repaired above the knee. There was full-thickness skin necrosis below the knee down to the dorsal surface of the right leg (atypical form of skin avulsion). Debridment and graft was performed for the first stage. During the second stage, re-grafting was performed and the gasterocnemious flap was transposed to cover the Tibia bone. This study confirms early Plastic and reconstructive surgery consult from the trauma of lower extremities associated with skin lesion. PMID:18817278

  10. Surgical treatment of avulsion fractures at the tibial insertion of the posterior cruciate ligament: functional result☆

    PubMed Central

    Barros, Marcos Alexandre; Cervone, Gabriel Lopes de Faria; Costa, André Luis Serigatti

    2015-01-01

    Objective To objectively and subjectively evaluate the functional result from before to after surgery among patients with a diagnosis of an isolated avulsion fracture of the posterior cruciate ligament who were treated surgically. Method Five patients were evaluated by means of reviewing the medical files, applying the Lysholm questionnaire, physical examination and radiological examination. For the statistical analysis, a significance level of 0.10 and 95% confidence interval were used. Results According to the Lysholm criteria, all the patients were classified as poor (<64 points) before the operation and evolved to a mean of 96 points six months after the operation. We observed that 100% of the posterior drawer cases became negative, taking values less than 5 mm to be negative. Conclusion Surgical methods with stable fixation for treating avulsion fractures at the tibial insertion of the posterior cruciate ligament produce acceptable functional results from the surgical and radiological points of view, with a significance level of 0.042.

  11. Concomitant Vesicouterine Rupture with Avulsion of Ureter: A Rare Complication of Vaginal Birth after Cesarean Section

    PubMed Central

    Thiek, J Lalnunnem; Sialo, Stephen; Ahanthem, Santa Singh

    2016-01-01

    Uterine rupture is the most serious and life threatening complication and occurs in 0.7-0.9% of vaginal birth after lower segment caesarean section. Cases of bladder rupture along with uterine rupture have been rarely reported and avulsion of ureter, required ureteric implantation is even rarer. This case report describe a very rare case of vesicouterine rupture with avulsion of ureter following vacuum assisted delivery in a grandmulti with previous lower segment cesarean section (LSCS). Haematuria is the most common presentation of bladder rupture. Antenatal counseling regarding this entity is recommended if woman opted for vaginal birth after cesarean section. Intrapartum and postpartum high index of suspicion are important in clinching the diagnosis. PMID:27134952

  12. EGb761 protects motoneurons against avulsion-induced oxidative stress in rats

    PubMed Central

    2010-01-01

    Background Root avulsion of the brachial plexus causes an oxidative stress reaction in the spinal cord and induces dramatic spinal motoneuron death, while EGb761 is a natural free radical cleaning agent. This study was designed to investigate the protective effects of intraperitoneally injected EGb761 against neural damage following brachial root avulsion. Methods The effect of EGb761 on avulsion-induced motoneuron injury was studied in 26 total groups of (n) rats, treated as follows. Animals in singular number groups received EGb761(50 mg/kg.d) and those in complex number groups received normal saline solution (i.p.), serving as controls. Groups 1-8 were used for the determination of nitric oxide (NO) levels in the serum and injured spinal cord at the 5 d, 2 w, 4 w, and 6 w time points. Groups 9-16 were used for determination of constitutive nitric oxide synthase (cNOS) and inducible nitric oxide synthase (iNOS) levels in injured spinal cord at the 5 d, 2 w, 4 w, and 6 w time points. Groups 17-26 were used for determination of the number of neuronal nitric oxide synthase (nNOS)-positive and surviving motoneurons in injured C7 ventral horn at the 5 d, 2 w, 4 w, 6 w and 8 w time points. Results Compared to control groups, the EGb761 treatment group not only had significant decreased levels of NO in serum at 2 w and 6 w after avulsion, but also had reduced levels of NO specifically in the spinal cord at 2 w, 4 w and 6 w. The cNOS activity in the spinal cord was also significant decreased at 2 w and 4 w, while the iNOS activity in injured C6-T1 spinal segments was reduced at 2 w, 4 w and 6 w. All together, the percentages of NADPH-d positive motoneurons in an injured C7 segment were down-regulated and the number of surviving motoneurons in injured C7 ventral horn was increased at 2 w, 4 w, 6 w and 8 w in treated versus untreated animals. Conclusions Intraperitoneal administration of EGb761 after root avulsion of the brachial plexus exerted protective effects by

  13. Coracoid Process Avulsion Fracture at the Coracoclavicular Ligament Attachment Site in an Osteoporotic Patient with Acromioclavicular Joint Dislocation

    PubMed Central

    Umemoto, Takahisa; Fukuda, Kimitaka; Kajino, Tomomichi

    2016-01-01

    Coracoid fractures are uncommon, mostly occur at the base or neck of the coracoid process (CP), and typically present with ipsilateral acromioclavicular joint (ACJ) dislocation. However, CP avulsion fractures at the coracoclavicular ligament (CCL) attachment with ACJ dislocation have not been previously reported. A 59-year-old woman receiving glucocorticoid treatment fell from bed and complained of pain in her shoulder. Radiographs revealed an ACJ dislocation with a distal clavicle fracture. Three-dimensional computed tomography (3D-CT) reconstruction showed a small bone fragment at the medial apex of the CP. She was treated conservatively and achieved a satisfactory outcome. CP avulsion fractures at the CCL attachment can occur in osteoporotic patients with ACJ dislocations. Three-dimensional computed tomography is useful for identifying this fracture type. CP avulsion fractures should be suspected in patients with ACJ dislocations and risk factors for osteoporosis or osteopenia. PMID:27493819

  14. Coracoid Process Avulsion Fracture at the Coracoclavicular Ligament Attachment Site in an Osteoporotic Patient with Acromioclavicular Joint Dislocation.

    PubMed

    Onada, Yoshihiro; Umemoto, Takahisa; Fukuda, Kimitaka; Kajino, Tomomichi

    2016-01-01

    Coracoid fractures are uncommon, mostly occur at the base or neck of the coracoid process (CP), and typically present with ipsilateral acromioclavicular joint (ACJ) dislocation. However, CP avulsion fractures at the coracoclavicular ligament (CCL) attachment with ACJ dislocation have not been previously reported. A 59-year-old woman receiving glucocorticoid treatment fell from bed and complained of pain in her shoulder. Radiographs revealed an ACJ dislocation with a distal clavicle fracture. Three-dimensional computed tomography (3D-CT) reconstruction showed a small bone fragment at the medial apex of the CP. She was treated conservatively and achieved a satisfactory outcome. CP avulsion fractures at the CCL attachment can occur in osteoporotic patients with ACJ dislocations. Three-dimensional computed tomography is useful for identifying this fracture type. CP avulsion fractures should be suspected in patients with ACJ dislocations and risk factors for osteoporosis or osteopenia. PMID:27493819

  15. Avulsion of the direct head of rectus femoris following arthroscopic subspine impingement resection: a case report.

    PubMed

    Devitt, Brian M; Smith, Bjorn; Stapf, Robert; O'Donnell, John M

    2016-04-01

    Arthroscopic resection of the anterior inferior iliac spine (AIIS) for subspine impingement has become a relatively common procedure. The AIIS is the origin of the direct head of rectus femoris (dhRF). Previous studies have reported that removal of the contributing portion of the AIIS causing impingement is unlikely to weaken the attachment of the dhRF. The purpose of this article is to report a case of avulsion of the dhRF, following revision hip arthroscopy for the treatment of subspine impingement. A 23-year-old professional footballer underwent revision left hip arthroscopy for the treatment of subspine impingement. 5-mm of bone was resected inferior to the AIIS. Two-weeks post-operatively, he presented with sudden onset, severe left anterior thigh pain following a fall and hyperextension of his left hip. The patient felt a pop over the anterior aspect of his hip. He noticed immediate swelling, severe pain and stiffness. Examination revealed diffuse swelling, 4/5-power on straight-leg-raise, focal tenderness over the AIIS but no palpable gap. MRI confirmed the clinical suspicion of a dhRF avulsion. Given the minimal loss of power and the lack of significant retraction, the patient was treated conservatively. He was instructed to avoid excessive hip extension. He returned to full participation at 3-months. This article highlights a case of avulsion of the dhRF due to a hyperextension injury of the hip following arthroscopic resection of subspinal impingement, a previously unreported complication. Resection of soft and bone from the AIIS may weaken the insertion of the dhRF. Care should be taken during post-operative rehabilitation to avoid trauma and excessive forces on the dhRF tendon, which may lead to rupture. Rehabilitation should be focused on range of motion of the hip. PMID:27026819

  16. Propolis as storage media for avulsed teeth: microscopic and morphometric analysis in rats.

    PubMed

    Mori, Graziela Garrido; Nunes, Daniele Clapes; Castilho, Lithiene Ribeiro; de Moraes, Ivaldo Gomes; Poi, Wilson Roberto

    2010-02-01

    The maintenance of the avulsed teeth in appropriate media for preserving the cellular viability has been important for repairing the periodontal ligament and preventing the root resorption after tooth reimplantation. Propolis is a substance capable of preserving cellular viability. This study aimed to analyze the propolis substance as a storage media for maintaining the avulsed teeth, besides to determine the ideal time period for keeping the tooth inside it. Thus, 60 maxillary right central incisors of rats were extracted and divided into five groups. In groups I and II, teeth were kept in propolis for 60 min and 6 h, respectively; in group III, teeth were kept in milk for 6 h; in group IV, teeth were kept dry for 60 min; and in group V, they were immediately reimplanted. All teeth had their root canals filled with calcium hydroxide paste. Following, teeth were reimplanted in their sockets. After 15 and 60 days, animals were killed and the obtained samples were processed in laboratory for microscopic and morphometric analyzing. The results showed that the occurrence of inflammatory resorption, dental ankylosis and the formation of the connective tissue parallel to the root surface were similar among groups. It could be verified a greater occurrence of replacement resorption in group IV when comparing to other groups. In groups I and IV, the presence of periodontal ligament-like connective tissue was substantially smaller than the other groups. Regarding to the cementum amount over the root, it could be observed that this was present in smaller amount in groups I and IV. Group II was similar to groups III and IV. Therefore, according to the results of this study, the use of propolis as a storage media for maintaining avulsed teeth could be highlighted, and the 6-h period was more appropriate than the 60-min period. PMID:20089064

  17. Bilateral atraumatic tibial tubercle avulsion fractures: case report and review of the literature.

    PubMed

    Khoriati, Al-Achraf; Guo, Shigong; Thakrar, Raj; Deol, Rupinderbir S; Shah, Khalil Y

    2015-04-01

    An avulsion fracture of the tibial tubercle is an uncommon injury, comprising less than 1% of all physeal injuries. The occurrence of such injuries bilaterally is even rarer. We report a case of bilateral atraumatic tibial tubercle avulsion fractures and its presentation, mechanism of injury, surgical management, post-operative rehabilitation and implications for clinical practice. A 17-year-old healthy male presented to the emergency department with severe pain on the anterior aspect of both knees and was unable to walk, having been brought in by ambulance after hearing a crack whilst jogging. On examination, there was significant swelling of both knees which were held in extension. On both sides there was a prominent deformity on the region of the tibial tubercle with a palpable gap, although no open skin wound. He was unable to actively move either knee joint. No neurovascular deficit was present. Plain radiographs revealed bilateral tibial tubercle avulsion fractures. Gentle manipulation was performed in the emergency department to the fragments in order to remove the tension from the skin. The fragments were reduced and fixed surgically with 4mm cannulated screws in an anterior to posterior direction. Both limbs were placed in temporary casts in 20 degrees of flexion. Postoperatively, the patient was kept non-weight bearing for four weeks then placed into a range of motion brace and movement commenced. Full weight bearing was permitted at the one month stage and he was advised to avoid any sporting activity until the 8 week stage and contact sports until the 10 week stage. Full movement of both joints was regained and the patient returned to full sporting activity in the absence of symptoms. This case emphasises the need for a high degree of vigilance when faced with such a presentation and a low threshold for further investigation and surgical intervention. PMID:25638599

  18. Traumatic avulsion of tibialis anterior following an industrial accident: A case report

    PubMed Central

    Rajeev, Aysha; McDonald, Mhiari; Newby, Mike; Patterson, Paul

    2015-01-01

    Introduction Rupture of the tibialis anterior tendon is uncommon and can occur spontaneously or following trauma. If suspected, it should be diagnosed promptly, enabling early surgical management and good restoration of function. Presentation of case A 48 year old male sustained a crush injury to his right foot when it became stuck in a vertical industrial fan at work. He attended A & E complaining of swelling of the dorsum of foot. On examination, there was tenderness at the base of the first metatarsal. X-ray revealed an avulsion fracture of the first metatarsal, and MRI showed rupture of tibialis anterior. The patient underwent surgical repair 10 days later, with post-operative management in a non-weight bearing, then weight bearing cast. X-ray at 8 weeks showed that the fracture had healed. The patient had a course of physiotherapy and was followed up at 6 months to assess pain and function. Discussion Tibialis anterior rupture should be considered if the history is suggestive, and can be diagnosed clinically based on the triad of a ‘pseudotumour’ of the ruptured tendon, loss of tendon contour, and reduced dorsiflexion of the ankle. In our case, the avulsion fracture prompted further imaging to confirm the diagnosis and plan surgery. There are various operative technique described in the literature. We used a whip stitch with anchors to reattach the tendon to the base of first metatarsal. Conclusion A prompt and early diagnosis of surgical repair of tibialis anterior tendon avulsion is important to ensure that the patients return to work as an industrial worker. PMID:26263452

  19. Avulsion of the direct head of rectus femoris following arthroscopic subspine impingement resection: a case report

    PubMed Central

    Devitt, Brian M.; Smith, Bjorn; Stapf, Robert; O’Donnell, John M.

    2016-01-01

    Arthroscopic resection of the anterior inferior iliac spine (AIIS) for subspine impingement has become a relatively common procedure. The AIIS is the origin of the direct head of rectus femoris (dhRF). Previous studies have reported that removal of the contributing portion of the AIIS causing impingement is unlikely to weaken the attachment of the dhRF. The purpose of this article is to report a case of avulsion of the dhRF, following revision hip arthroscopy for the treatment of subspine impingement. A 23-year-old professional footballer underwent revision left hip arthroscopy for the treatment of subspine impingement. 5-mm of bone was resected inferior to the AIIS. Two-weeks post-operatively, he presented with sudden onset, severe left anterior thigh pain following a fall and hyperextension of his left hip. The patient felt a pop over the anterior aspect of his hip. He noticed immediate swelling, severe pain and stiffness. Examination revealed diffuse swelling, 4/5-power on straight-leg-raise, focal tenderness over the AIIS but no palpable gap. MRI confirmed the clinical suspicion of a dhRF avulsion. Given the minimal loss of power and the lack of significant retraction, the patient was treated conservatively. He was instructed to avoid excessive hip extension. He returned to full participation at 3-months. This article highlights a case of avulsion of the dhRF due to a hyperextension injury of the hip following arthroscopic resection of subspinal impingement, a previously unreported complication. Resection of soft and bone from the AIIS may weaken the insertion of the dhRF. Care should be taken during post-operative rehabilitation to avoid trauma and excessive forces on the dhRF tendon, which may lead to rupture. Rehabilitation should be focused on range of motion of the hip. PMID:27026819

  20. Onyx embolization of an avulsed thalamoperforator following endoscopic colloid cyst and lamina terminalis fenestration

    PubMed Central

    Turner, Raymond D; Chaudry, Imran; Turk, Aquilla; Spiotta, Alejandro

    2014-01-01

    A patient presented with headaches and was found to have a colloid cyst in the third ventricle and ventriculomegaly. The patient underwent endoscopic colloid cyst resection and third ventriculostomy without incidence. Prior to emergence, a blown right pupil was acutely noted, and bright red blood emanated from the ventricular drain that was routinely placed in the endoscopy tract at the conclusion of the procedure. CTangiography demonstrated active extravasation from the pre-pontine cistern into the third ventricle and subarachnoid space. Emergency DSA confirmed active extravasation from an avulsed thalamoperforator arising from the proximal right P1 posterior cerebral artery, which was immediately embolized without incident. PMID:25053667

  1. Onyx embolization of an avulsed thalamoperforator following endoscopic colloid cyst and lamina terminalis fenestration.

    PubMed

    Turner, Raymond D; Chaudry, Imran; Turk, Aquilla; Spiotta, Alejandro

    2015-08-01

    A patient presented with headaches and was found to have a colloid cyst in the third ventricle and ventriculomegaly. The patient underwent endoscopic colloid cyst resection and third ventriculostomy without incidence. Prior to emergence, a blown right pupil was acutely noted, and bright red blood emanated from the ventricular drain that was routinely placed in the endoscopy tract at the conclusion of the procedure. CTangiography demonstrated active extravasation from the pre-pontine cistern into the third ventricle and subarachnoid space. Emergency DSA confirmed active extravasation from an avulsed thalamoperforator arising from the proximal right P1 posterior cerebral artery, which was immediately embolized without incident. PMID:25063695

  2. Penetrating head injury with bilateral eye avulsion due to Himalayan bear bite.

    PubMed

    Roka, Yam B; Roka, Narayani; Shrestha, Manzil; Puri, Puspa R; Adhikari, Hari B

    2012-12-01

    The Himalayan black bear (Ursus thibetanus or Selenarctos thibetanus), although an omnivore, is more carnivorous than its American counterpart. It is also more aggressive towards humans and is a threatened species because of the deforestation in the Himalayas. Furthermore, poverty, encroachment of the forest, extensive deforestation, lack of education and living near the forest are factors that increase the probability of such animal injuries. We report the case of a 35-year-old woman who suffered a severe penetrating head injury with scalp and bilateral eye avulsion, which was managed successfully. PMID:23216732

  3. Complete Cervical Avulsion with Intravaginal Misoprostol for Second Trimester Pregnancy Termination

    PubMed Central

    Sajjan, G. R.; Patil, Neelamma; Kaur, Manpreet; Shirgur, Shobha; Nandi, Suvarna; Ashwini, V.

    2012-01-01

    Intravaginal misoprostol, a synthetic PGE1 analogue, has largely replaced all other techniques for pregnancy termination in II trimester, because of its successful results. Incidence of II trimester pregnancy termination has also increased in the present days, because of prenatal diagnosis of pregnancies with serious fetal abnormalities like cardiovascular and skeletal malformations. But there are serious and life threatening complications reported with the use of intravaginal misoprostol. Here we are reporting a case of complete avulsion of cervix from lower part of the uterus, with the use of intravaginal misoprostol, for II trimester termination of pregnancy. So, clinicians dealing with II trimester termination of pregnancy should be aware of such complications. PMID:22919526

  4. An evidence-based appraisal of splinting luxated, avulsed and root-fractured teeth.

    PubMed

    Kahler, Bill; Heithersay, Geoffrey S

    2008-02-01

    The evidence-based methodology involves framing a well defined PICO (problem, intervention, comparison and outcome) question related to a clinical problem and then comprehensively searching for the evidence, which is evaluated to appraise the value of the treatment intervention. For this systematic review of splinting of teeth that have been luxated, avulsed or root-fractured, the clinical PICO question is (P) what are splinting intervention decisions for luxated, avulsed and root-fractured teeth (I) considering that the splinting intervention choice may include (i) no splinting, (ii) rigid or functional splinting for the different types of trauma and (iii) different durations of the splinting period (C) when comparing these splinting choices for the different types of trauma and their effect on (O) healing outcomes for the teeth. A keyword search of PubMed was used. Reference lists from identified articles and dental traumatology texts were also appraised. The inclusion criterion for this review was either a multivariate analysis or controlled stratified analyses as many variables have the potential to confound the assessment and evaluation of healing outcomes for teeth that have been luxated, avulsed or root-fractured. A positive statistical test is not proof of a causal conclusion, as a positive statistical relationship can arise by chance, and so this review also appraises animal studies that reportedly explain biological mechanisms that relate to healing outcomes of splinted teeth. The clinical studies were ranked using the 'Centre of Evidence-based Medicine' categorization (levels 1-5). All 12 clinical studies selected were ranked as level 4. The studies generally indicate that the prognosis is determined by the type of injury rather than factors associated with splinting. The results indicate that the types of splint and the fixation period are generally not significant variables when related to healing outcomes. This appraisal identified difficulties in the

  5. Stress avulsion fracture of the tarsal navicular. An uncommon sports-related overuse injury.

    PubMed

    Orava, S; Karpakka, J; Hulkko, A; Takala, T

    1991-01-01

    We report nine cases of stress-related avulsion fracture of the tarsal navicular in athletes. This uncommon over-use injury is thought to occur following repetitive cyclic compressive loading secondary to an impingement of the tarsal navicular. The small dorsal triangular fragment is best seen in weightbearing lateral view radiographs and isotope scan and/or tomography help confirm the diagnosis. We feel that operative treatment is the method of choice in highly symptomatic cases and among top athletes because of the shorter recovery time. PMID:1897656

  6. Nonoperative Damage Control: The Use of Extracorporeal Membrane Oxygenation in Traumatic Bronchial Avulsion as a Bridge to Definitive Operation.

    PubMed

    Schmoekel, Nathan H; O'Connor, James V; Scalea, Thomas M

    2016-06-01

    The conventional treatment for an avulsed bronchus is emergent thoracotomy and repair or lobectomy. The principles of damage control thoracic operations include initial hemorrhage control with delayed definite repair after physiologic resuscitation. We report a multiply injured patient with avulsion of the left lower lobe bronchus. Profound acidosis, hypercarbia, and hypoxia precluded an emergent operation, and venovenous extracorporeal membrane oxygenation (V-V ECMO) was used for organ support during physiologic resuscitation. After the achievement of physiologic repletion, a thoracotomy and lobectomy were performed while the patient was supported by V-V ECMO. PMID:27211954

  7. The Effectiveness of Oral Rehydration Solution at Various Concentrations as a Storage Media for Avulsed Teeth

    PubMed Central

    Eskandarian, Tahereh; Badakhsh, Samaneh; Esmaeilpour, Tahereh

    2013-01-01

    Introduction Following avulsion, the periodontal ligament (PDL) cells are at risk of necrosis. To achieve a favorable survival prognosis, the PDL cells must be kept viability. Therefore, immediate replantation is considered as the treatment of choice and in case it is not possible, storing the tooth in an appropriate storage media should be considered. Oral Rehydration Solution (ORS) is a glucose-electrolyte solution which can keep the optimal osmolality as well as pH and can even provide nutrients which are necessary for cellular growth. The present study aimed to evaluate the effectiveness of different concentrations of ORS in maintaining the viability of the PDL cells at different time points. Materials and Methods PDL cells were obtained from healthy extracted human premolars. Then, 8×10³ cells were seeded in each well of 96-well plate. Afterwards, each well was treated with ORS in three different concentrations and DMEM for 1, 3, 6, and 9 hours. Cell viability was determined by using the MTT assay. One way-ANOVA and post hoc (LSD) test were used for comparing the study groups. Results According to the results, 25% and 50% concentrations of ORS were more effective in preserving the PDL cell viability and could maintain 79.98% and 68.34% of the PDL cells, respectively, at least for the last experimental time point (up to 9 hours). Conclusions Therefore, our findings indicate that ORS might be a suitable storage medium for avulsed teeth. PMID:23412137

  8. The Use of Aloe Vera Extract as a Novel Storage Media for the Avulsed Tooth

    PubMed Central

    Badakhsh, Samaneh; Eskandarian, Tahereh; Esmaeilpour, Tahereh

    2014-01-01

    Background: Tooth avulsion is one of the most severe dental traumas which most often occur in children. When immediate replantation is not possible, storage in a proper media may lead to a prolonged survival rate. Aloe Vera is a cactus like plant with green, tapered leaves that are filled with a transparent viscous gel. This medicinal plant has significant anti-inflammatory, antioxidant, antibacterial and antifungal effects. The purpose of this study was to assess the effectiveness of different concentrations of Aloe Vera extract compared to DMEM (cell culture medium) and egg white. Methods: The periodontal ligament (PDL) cells were cultured and certain number of cells were treated with Aloe Vera extract (in four different concentrations), egg white and culture media for 1, 3, 6, and 9 hours. Cell viability was determined by using the (3-[4, 5-dimethylthiazolyl-2]-2, 5-diphenyltetrazolium bromide) assay. Moreover, One-way ANOVA and post hoc (LSD) test were used for analyzing the study groups. Results: The results indicate that culture media and Aloe Vera extract (10, 30, and 50% concentration) were statistically similar and significantly preserved more PDL cells compared to other experimental storage media. Conclusion: Aloe Vera 10, 30, and 50% may be recommended as a suitable storage media for avulsed teeth. PMID:25031484

  9. Neuroprotection and immunomodulation by xenografted human mesenchymal stem cells following spinal cord ventral root avulsion

    PubMed Central

    Ribeiro, Thiago B.; Duarte, Adriana S. S.; Longhini, Ana Leda F.; Pradella, Fernando; Farias, Alessandro S.; Luzo, Angela C. M.; Oliveira, Alexandre L. R.; Olalla Saad, Sara Teresinha

    2015-01-01

    The present study investigates the effects of xenotransplantation of Adipose Tissue Mesenchymal Stem Cells (AT-MSCs) in animals after ventral root avulsion. AT-MSC has similar characteristics to bone marrow mesenchymal stem cells (BM-MSCs), such as immunomodulatory properties and expression of neurotrophic factors. In this study, Lewis rats were submitted to surgery for unilateral avulsion of the lumbar ventral roots and received 5 × 105 AT-MSCs via the lateral funiculus. Two weeks after cell administration, the animals were sacrificed and the moto neurons, T lymphocytes and cell defense nervous system were analyzed. An increased neuronal survival and partial preservation of synaptophysin-positive nerve terminals, related to GDNF and BDNF expression of AT-MSCs, and reduction of pro-inflammatory reaction were observed. In conclusion, AT-MSCs prevent second phase neuronal injury, since they suppressed lymphocyte, astroglia and microglia effects, which finally contributed to rat motor-neuron survival and synaptic stability of the lesioned motor-neuron. Moreover, the survival of the injected AT- MSCs lasted for at least 14 days. These results indicate that neuronal survival after lesion, followed by mesenchymal stem cell (MSC) administration, might occur through cytokine release and immunomodulation, thus suggesting that AT-MSCs are promising cells for the therapy of neuronal lesions. PMID:26548646

  10. Neuroprotection and immunomodulation by xenografted human mesenchymal stem cells following spinal cord ventral root avulsion.

    PubMed

    Ribeiro, Thiago B; Duarte, Adriana S S; Longhini, Ana Leda F; Pradella, Fernando; Farias, Alessandro S; Luzo, Angela C M; Oliveira, Alexandre L R; Olalla Saad, Sara Teresinha

    2015-01-01

    The present study investigates the effects of xenotransplantation of Adipose Tissue Mesenchymal Stem Cells (AT-MSCs) in animals after ventral root avulsion. AT-MSC has similar characteristics to bone marrow mesenchymal stem cells (BM-MSCs), such as immunomodulatory properties and expression of neurotrophic factors. In this study, Lewis rats were submitted to surgery for unilateral avulsion of the lumbar ventral roots and received 5 × 10(5) AT-MSCs via the lateral funiculus. Two weeks after cell administration, the animals were sacrificed and the moto neurons, T lymphocytes and cell defense nervous system were analyzed. An increased neuronal survival and partial preservation of synaptophysin-positive nerve terminals, related to GDNF and BDNF expression of AT-MSCs, and reduction of pro-inflammatory reaction were observed. In conclusion, AT-MSCs prevent second phase neuronal injury, since they suppressed lymphocyte, astroglia and microglia effects, which finally contributed to rat motor-neuron survival and synaptic stability of the lesioned motor-neuron. Moreover, the survival of the injected AT- MSCs lasted for at least 14 days. These results indicate that neuronal survival after lesion, followed by mesenchymal stem cell (MSC) administration, might occur through cytokine release and immunomodulation, thus suggesting that AT-MSCs are promising cells for the therapy of neuronal lesions. PMID:26548646

  11. Arthroscopic-assisted repair of triangular fibrocartilage complex foveal avulsion in distal radioulnar joint injury

    PubMed Central

    Woo, Sung Jong; Jegal, Midum; Park, Min Jong

    2016-01-01

    Background: Disruption of the triangular fibrocartilage complex (TFCC) foveal insertion can lead to distal radioulnar joint (DRUJ) instability accompanied by ulnar-sided pain, weakness, snapping, and limited forearm rotation. We investigated the clinical outcomes of patients with TFCC foveal tears treated with arthroscopic-assisted repair. Materials and Methods: Twelve patients underwent foveal repair of avulsed TFCC with the assistance of arthroscopy between 2011 and 2013. These patients were followed up for an average of 19 months (range 14–25 months). The avulsed TFCC were reattached to the fovea using a transosseous pull-out suture or a knotless suture anchor. At the final followup, the range of motion, grip strength and DRUJ stability were measured as objective outcomes. Subjective outcomes were assessed using the Visual Analog Scale (VAS) for pain, patient rated wrist evaluation (PRWE), Disabilities of the Arm, Shoulder and Hand questionnaire (DASH score) and return to work. Results: Based on the DRUJ stress test, 5 patients had normal stability and 7 patients showed mild laxity as compared with the contralateral side. Postoperatively, the mean range of pronation supination increased from 141° to 166°, and the mean VAS score for pain decreased from 5.3 to 1.7 significantly. The PRWE and DASH questionnaires also showed significant functional improvement. All patients were able to return to their jobs. However, two patients complained of persistent pain. Conclusions: Arthroscopically assisted repair of TFCC foveal injury can provide significant pain relief, functional improvement and restoration of DRUJ stability. PMID:27293286

  12. Human Embryonic Stem Cell-Derived Progenitors Assist Functional Sensory Axon Regeneration after Dorsal Root Avulsion Injury

    PubMed Central

    Hoeber, Jan; Trolle, Carl; Konig, Niclas; Du, Zhongwei; Gallo, Alessandro; Hermans, Emmanuel; Aldskogius, Hakan; Shortland, Peter; Zhang, Su-Chun; Deumens, Ronald; Kozlova, Elena N.

    2015-01-01

    Dorsal root avulsion results in permanent impairment of sensory functions due to disconnection between the peripheral and central nervous system. Improved strategies are therefore needed to reconnect injured sensory neurons with their spinal cord targets in order to achieve functional repair after brachial and lumbosacral plexus avulsion injuries. Here, we show that sensory functions can be restored in the adult mouse if avulsed sensory fibers are bridged with the spinal cord by human neural progenitor (hNP) transplants. Responses to peripheral mechanical sensory stimulation were significantly improved in transplanted animals. Transganglionic tracing showed host sensory axons only in the spinal cord dorsal horn of treated animals. Immunohistochemical analysis confirmed that sensory fibers had grown through the bridge and showed robust survival and differentiation of the transplants. Section of the repaired dorsal roots distal to the transplant completely abolished the behavioral improvement. This demonstrates that hNP transplants promote recovery of sensorimotor functions after dorsal root avulsion, and that these effects are mediated by spinal ingrowth of host sensory axons. These results provide a rationale for the development of novel stem cell-based strategies for functionally useful bridging of the peripheral and central nervous system. PMID:26053681

  13. BONY AVULSION INJURY OF THE PECTORALIS MAJOR IN A 19 YEAR-OLD MALE JUDO ATHLETE: A CASE REPORT

    PubMed Central

    Westrick, Richard B.; Owens, Brett D.; Johnson, Michael R.

    2013-01-01

    Background and Purpose: Bony avulsion of the pectoralis major muscle is a rare but potentially devastating injury for athletes. Pectoralis major rupture typically occurs in 20 to 39 year‐old males. The shoulder region is one of the most frequently injured areas in Judo athletes. The purpose of this case report is to describe diagnosis and treatment following a pectoralis major bony avulsion due to an atypical mechanism of injury in a young Judo athlete. Case Description: A 19‐year‐old military cadet and competitive judo athlete reported to a direct‐access sports physical therapy clinic 7 weeks after incurring a shoulder injury during a judo match. He complained of shoulder pain and weakness with the inability to perform pushups. He presented with horizontal adduction weakness and visible discontinuity of the pectoralis muscle with resisted adduction. Outcomes: Radiographs demonstrated a bony avulsion of the pectoralis major from its humeral attachment. The patient underwent surgical repair of the lesion the next week and was able to resume most military cadet activities within 5 months post‐operation. Discussion: Bony avulsions are exceptionally rare injuries, and are even more uncommon in athletes under the age of 20. It is important for clinicians to perform a thorough history and physical examination in order to avoid missing this diagnosis. Surgery is likely the best option for a young athletic population; while conservative management may be optimal for the older, inactive population. Level of Evidence: 4 PMID:24377072

  14. Simultaneous Bilateral Tibial Tubercle Avulsion Fracture in a case of Pre-Existing Osgood-Schlatter Disease (OSD)

    PubMed Central

    Narayana Gowda, BS; Mohan Kumar, J

    2012-01-01

    Introduction: Osgood-Schlatter disease (OSD) is a well known condition, characterized by pain over the tibial tubercle with subsequent tubercle prominence. Avulsion fracture following OSD is a rare complication. We report an unusual case of simultaneous bilateral tibial tubercle avulsion fracture in a 16 year old boy who was a known case of OSD. Case presentation: A 16 year old boy a known case of OSD presented to the outpatient department with history of jumping from the school compound wall (two feet height) while playing, followed by severe pain around anterior aspect of both knees and difficulty in walking. Radiographs showed bilateral tibial tubercle avulsion fracture. He was treated successfully with open reduction and internal fixation with tension band wiring. At the end of 22 months the patient was symptomatically relieved and both the tuberosities were united with the main bone. Conclusion: Even though bilateral Osgood-Schlatter disease (OSD) is a well known condition, one should always keep in mind the risk of tibial tubercle avulsion fractures while treating a case of OSD. Patient should be advised not to involve in strenuous activities till the disease subsides radiologically or till skeletal maturity.

  15. PARTIAL ARTICULAR SUPRASPINATUS TENDON AVULSION (PASTA) LESION. CURRENT CONCEPTS IN REHABILITATION

    PubMed Central

    2016-01-01

    ABSTRACT Rotator cuff pathology can contribute to shoulder pain and may affect the performance of sport activities, work, and activities of daily living. The partial articular supraspinatus tendon avulsion (PASTA) lesion represents a very common type of rotator cuff pathology seen in rehabilitation. When conservative treatment fails, surgery is generally required. Success of recovery depends on several factors, including: repair techniques, healing process related to timing, rehabilitation programs, and patient compliance with home exercises. To date, most treatment modalities and rehabilitation programs are based on clinical experience rather than scientific evidence. Therefore, the purpose of this clinical commentary is to provide an overview on the PASTA lesion, discuss the common treatment approaches adopted to date and to propose a rehabilitation program based on the available scientific evidence. Level of Evidence 5 PMID:27274431

  16. Type IV FDP avulsion: lessons learned clinically and through review of the literature.

    PubMed

    Henry, Steven L; Katz, Mark A; Green, David P

    2009-12-01

    The type IV flexor digitorum profundus avulsion is a rare injury involving fracture of the volar base of the distal phalanx and separation of the tendon from the fracture fragment. Recommendations for management are sparse and are substantiated only by a few isolated case reports. We recently encountered two of these injuries, both of which proved challenging, particularly with regard to joint incongruity and tendon adhesions. In reviewing the literature, it is apparent that no consensus exists regarding surgical strategies. However, based on our experience and that of other authors, we can suggest the following: (1) high index of suspicion of this potentially deceptive injury, with use of magnetic resonance imaging or ultrasound if preoperative confirmation is needed; (2) rigid bony fixation that prevents dorsal subluxation of the distal phalanx; (3) tendon repair that is independent of the bony fixation; and (4) early range of motion therapy. PMID:19399559

  17. Brachial Plexopathy/Nerve Root Avulsion in a Football Player: The Role of Electrodiagnostics

    PubMed Central

    Radecki, Jeffrey; Wolfe, Scott W.; Strauss, Helene L.; Mintz, Douglas N.

    2008-01-01

    Electromyography (EMG) studies are a useful tool in anatomical localization of peripheral nerve and brachial plexus injuries. They are especially helpful in distinguishing between brachial plexopathy and nerve root injuries where surgical intervention may be indicated. EMG can also assist in providing prognostic information after nerve injury as well as after nerve repair. In this case report, a football player presented with weakness in his right upper limb after a traction/traumatic injury to the right brachial plexus. EMG studies revealed evidence of both pre- and postganglionic injury to multiple cervical roots. The injury was substantial enough to cause nerve root avulsions involving the C6 and C7 levels. Surgical referral led to nerve grafts targeted at regaining function in shoulder abduction and elbow flexion. After surgery, the patient’s progress was monitored utilizing EMG to assist in identifying true axonal regeneration. PMID:18751870

  18. Ischiofemoral impingement resulting from a chronic avulsion injury of the hamstrings

    PubMed Central

    Hayat, Zara; Konan, Sujith; Pollock, Rob

    2014-01-01

    Significantly reduced distance between the ischium and the femur can result in symptomatic hip pain as a result of impingement. We present the case of a 16-year-old boy who presented with groin pain which had been affecting him for a year and a half following an innocuous football injury. Plain radiograph revealed a chronic apophyseal avulsion fracture of the ischium with excessive callus formation. CT scan and MRI revealed that the bony protuberance was responsible for symptomatic ischiofemoral impingement. In this case, he was successfully treated with non-operative management involving slow re-introduction to exercise. An unusual example of acquired ischiofemoral impingement, unrelated to surgery or significant trauma, this case highlights the need to consider such a diagnosis in otherwise unexplained groin pain. PMID:24966262

  19. Ventral root re-implantation is better than peripheral nerve transplantation for motoneuron survival and regeneration after spinal root avulsion injury

    PubMed Central

    2013-01-01

    Background Peripheral nerve (PN) transplantation and ventral root implantation are the two common types of recovery operations to restore the connection between motoneurons and their target muscles after brachial plexus injury. Despite experience accumulated over the past decade, fundamental knowledge is still lacking concerning the efficacy of the two microsurgical interventions. Methods Thirty-eight adult female Sprague–Dawley rats were divided into 5 groups. Immediately following root avulsion, animals in the first group (n = 8) and the second group (n = 8) received PN graft and ventral root implantation respectively. The third group (n = 8) and the fourth group (n = 8) received PN graft and ventral root implantation respectively at one week after root avulsion. The fifth group received root avulsion only as control (n = 6). The survival and axonal regeneration of severed motoneurons were investigated at 6 weeks post-implantation. Results Re-implantation of ventral roots, both immediately after root avulsion and in delay, significantly increased the survival and regeneration of motoneurons in the avulsed segment of the spinal cord as compared with PN graft transplantation. Conclusions The ventral root re-implantation is a better surgical repairing procedure than PN graft transplantation for brachial plexus injury because of its easier manipulation for re-implanting avulsed ventral roots to the preferred site, less possibility of causing additional damage and better effects on motoneuron survival and axonal regeneration. PMID:23799915

  20. Sports‐related acute and chronic avulsion injuries in children and adolescents with special emphasis on tennis

    PubMed Central

    Vandervliet, Everhard J M; Vanhoenacker, Filip M; Snoeckx, Annemie; Gielen, Jan L; Van Dyck, Pieter; Parizel, Paul M

    2007-01-01

    Acute and chronic sports‐related muscle and tendon injuries are not infrequent in youngsters. In particular, the physis is prone to trauma as it constitutes the weakest part of the immature skeleton. The type of sports activity determines the location of the lesion. Most commonly, apophyses of the hip and pelvis are subject to avulsion. The purpose of this paper is to give a short overview of the pathogenesis, location, prevalence and imaging characteristics of acute and chronic avulsion injuries in the immature skeleton, with special emphasis on tennis‐related injuries. Tennis‐related injuries particularly involve apophyses of the ischial tuberosity, the anterior inferior or superior iliac spine and the iliac crest. PMID:17586583

  1. Rehabilitation of Avulsed Teeth in Fractured Jaws via Bone Grafting and Implant Placement: Report of Two Cases.

    PubMed

    Jain, Anshul; Baliga, Shridhar

    2015-07-01

    The maxillofacial region is one of the most injury-prone areas during road traffic accidents, personal violence, falls and sports. Maxillofacial trauma can lead to breakage or avulsion of upper anterior teeth, which may cause significant aesthetic and functional problems. There are many treatment options available for rehabilitation including removable partial dentures, fixed partial dentures, crown and bridges and implant-supported prostheses. Herein, two cases are presented where implant placement was done for upper anterior teeth, which were traumatized or avulsed following maxillofacial trauma. Both patients demonstrated a history of maxillofacial trauma and had undergone open reduction and internal fixation. The first patient had a severe maxillary alveolar defect treated via autogenous bone grafting and a six-month period was given for proper integration of the bone graft. The second patient was a smoker with very poor oral hygiene and a deep bite. Thus, implant placement was not initially justified. PMID:26877745

  2. Rehabilitation of Avulsed Teeth in Fractured Jaws via Bone Grafting and Implant Placement: Report of Two Cases

    PubMed Central

    Baliga, Shridhar

    2015-01-01

    The maxillofacial region is one of the most injury-prone areas during road traffic accidents, personal violence, falls and sports. Maxillofacial trauma can lead to breakage or avulsion of upper anterior teeth, which may cause significant aesthetic and functional problems. There are many treatment options available for rehabilitation including removable partial dentures, fixed partial dentures, crown and bridges and implant-supported prostheses. Herein, two cases are presented where implant placement was done for upper anterior teeth, which were traumatized or avulsed following maxillofacial trauma. Both patients demonstrated a history of maxillofacial trauma and had undergone open reduction and internal fixation. The first patient had a severe maxillary alveolar defect treated via autogenous bone grafting and a six-month period was given for proper integration of the bone graft. The second patient was a smoker with very poor oral hygiene and a deep bite. Thus, implant placement was not initially justified. PMID:26877745

  3. Dry Endoscopic-Assisted Mini-Open Approach With Neuromonitoring for Chronic Hamstring Avulsions and Ischial Tunnel Syndrome

    PubMed Central

    Gómez-Hoyos, Juan; Reddy, Manoj; Martin, Hal D.

    2015-01-01

    Chronic hamstring origin avulsions and ischial tunnel syndrome are common causes of posterior hip pain. Although physical therapy has shown benefits in some cases, recent evidence has reported better outcomes with surgical treatment in appropriately selected patients. The full-open approach has been the classic procedure to address this problem. However, the complications related to extensive tissue exposure and the proximity of the incision to the perianal zone have led to the description of full-endoscopic techniques. Achieving an accurate hamstring repair could be technically demanding with a full-endoscopic procedure. Accurate reattachment is crucial in hamstring repair because of the functional demand of the muscles crossing of 2 major joints (hip and knee). This surgical note describes a mixed technique including a mini-open approach, neuromonitoring, and dry endoscopic-assisted repair of the hamstring origin as an alternative for treating patients with chronic hamstring avulsions and ischial tunnel syndrome that remain symptomatic despite nonoperative treatment. PMID:26258031

  4. Evaluation of Avulsion-Induced Neuropathology in Rat Spinal Cords with 18F-FDG Micro-PET/CT.

    PubMed

    Ling, Ze-Min; Tang, Ying; Li, Ying-Qin; Luo, Hao-Xuan; Liu, Lin-Lin; Tu, Qing-Qiang; Zhou, Li-Hua

    2015-01-01

    Brachial plexus root avulsion (BPRA) leads to dramatic motoneuron death and glial reactions in the corresponding spinal segments at the late stage of injury. To protect spinal motoneurons, assessment of the affected spinal segments should be done at an earlier stage of the injury. In this study, we employed 18F-FDG small-animal PET/CT to assess the severity of BPRA-induced cervical spinal cord injuries. Adult Sprague-Dawley rats were randomly treated and divided into three groups: Av+NS (brachial plexus root avulsion (Av) treated with normal saline), Av+GM1 (treated with monosialoganglioside), and control. At time points of 3 day (d), 1 week (w), 2 w, 4 w and 8 w post-injury, 18F-FDG micro-PET/CT scans and neuropathology assessments of the injured spinal roots, as well as the spinal cord, were performed. The outcomes of the different treatments were compared. The results showed that BPRA induced local bleeding and typical Wallerian degeneration of the avulsed roots accompanied by 18F-FDG accumulations at the ipsilateral cervical intervertebral foramen. BPRA-induced astrocyte reactions and overexpression of neuronal nitric oxide synthase in the motoneurons correlated with higher 18F-FDG uptake in the ipsilateral cervical spinal cord during the first 2 w post-injury. The GM1 treatment reduced BPRA-induced astrocyte reactions and inhibited the de novo nNOS expressions in spinal motoneurons. The GM1 treatment also protected spinal motoneurons from avulsion within the first 4 w post-injury. The data from this study suggest that 18F-FDG PET/CT could be used to assess the severity of BPRA-induced primary and secondary injuries in the spinal cord. Furthermore, GM1 is an effective drug for reducing primary and secondary spinal cord injuries following BPRA. PMID:26010770

  5. Evaluation of Avulsion-Induced Neuropathology in Rat Spinal Cords with 18F-FDG Micro-PET/CT

    PubMed Central

    Li, Ying-Qin; Luo, Hao-Xuan; Liu, Lin-Lin; Tu, Qing-Qiang; Zhou, Li-Hua

    2015-01-01

    Brachial plexus root avulsion (BPRA) leads to dramatic motoneuron death and glial reactions in the corresponding spinal segments at the late stage of injury. To protect spinal motoneurons, assessment of the affected spinal segments should be done at an earlier stage of the injury. In this study, we employed 18F-FDG small-animal PET/CT to assess the severity of BPRA-induced cervical spinal cord injuries. Adult Sprague-Dawley rats were randomly treated and divided into three groups: Av+NS (brachial plexus root avulsion (Av) treated with normal saline), Av+GM1 (treated with monosialoganglioside), and control. At time points of 3 day (d), 1 week (w), 2 w, 4 w and 8 w post-injury, 18F-FDG micro-PET/CT scans and neuropathology assessments of the injured spinal roots, as well as the spinal cord, were performed. The outcomes of the different treatments were compared. The results showed that BPRA induced local bleeding and typical Wallerian degeneration of the avulsed roots accompanied by 18F-FDG accumulations at the ipsilateral cervical intervertebral foramen. BPRA-induced astrocyte reactions and overexpression of neuronal nitric oxide synthase in the motoneurons correlated with higher 18F-FDG uptake in the ipsilateral cervical spinal cord during the first 2 w post-injury. The GM1 treatment reduced BPRA-induced astrocyte reactions and inhibited the de novo nNOS expressions in spinal motoneurons. The GM1 treatment also protected spinal motoneurons from avulsion within the first 4 w post-injury. The data from this study suggest that 18F-FDG PET/CT could be used to assess the severity of BPRA-induced primary and secondary injuries in the spinal cord. Furthermore, GM1 is an effective drug for reducing primary and secondary spinal cord injuries following BPRA. PMID:26010770

  6. Lithium accelerates functional motor recovery by improving remyelination of regenerating axons following ventral root avulsion and reimplantation.

    PubMed

    Fang, Xin-Yu; Zhang, Wen-Ming; Zhang, Chao-Fan; Wong, Wai-Man; Li, Wen; Wu, Wutian; Lin, Jian-Hua

    2016-08-01

    Brachial plexus injury (BPI) often involves the complete or partial avulsion of one or more of the cervical nerve roots, which leads to permanent paralysis of the innervated muscles. Reimplantation surgery has been attempted as a clinical treatment for brachial plexus root avulsion but has failed to achieve complete functional recovery. Lithium is a mood stabilizer drug that is used to treat bipolar disorder; however, its effects on spinal cord or peripheral nerve injuries have also been reported. The purpose of this study was to investigate whether lithium can improve functional motor recovery after ventral root avulsion and reimplantation in a rat model of BPI. The results showed that systemic treatment with a clinical dose of lithium promoted motor neuron outgrowth and increased the efficiency of motor unit regeneration through enhanced remyelination. An analysis of myelin-associated genes showed that the effects of lithium started during the early phase of remyelination and persisted through the late stage of the process. Efficient remyelination of the regenerated axons in the lithium-treated rats led to an earlier functional recovery. Therefore, we demonstrated that lithium might be a potential clinical treatment for BPI in combination with reimplantation surgery. PMID:27185485

  7. Integrating Delta Building Physics & Economics: Optimizing the Scale of Engineered Avulsions in the Mississippi River Delta

    NASA Astrophysics Data System (ADS)

    Kenney, M. A.; Mohrig, D.; Hobbs, B. F.; Parker, G.

    2011-12-01

    Land loss in the Mississippi River Delta caused by subsidence and erosion has resulted in habitat loss, interference with human activities, and increased exposure of New Orleans and other settled areas to storm surge risks. Prior to dam and levee building and oil and gas production in the 20th century, the long term rates of land building roughly balanced land loss through subsidence. Now, however, sediment is being deposited at dramatically lower rates in shallow areas in and adjacent to the Delta, with much of the remaining sediment borne by the Mississippi being lost to the deep areas of the Gulf of Mexico. A few projects have been built in order to divert sediment from the river to areas where land can be built, and many more are under consideration as part of State of Louisiana and Federal planning processes. Most are small scale, although there have been some proposals for large engineered avulsions that would divert a significant fraction of the remaining available sediment (W. Kim, et al. 2009, EOS). However, there is debate over whether small or large diversions are the economically optimally and socially most acceptable size of such land building projects. From an economic point of view, the optimal size involves tradeoffs between scale economies in civil work construction, the relationship between depth of diversion and sediment concentration in river water, effects on navigation, and possible diminishing returns to land building at a single location as the edge of built land progresses into deeper waters. Because land building efforts could potentially involve billions of dollars of investment, it is important to gain as much benefit as possible from those expenditures. We present the result of a general analysis of scale economies in land building from engineered avulsions. The analysis addresses the question: how many projects of what size should be built at what time in order to maximize the amount of land built by a particular time? The analysis

  8. Treatment of posterior cruciate ligament avulsion fractures of the tibia using a toothed plate and hollow lag screw

    PubMed Central

    Chen, Wei; Luo, Wei; Chen, Zhiqing; Jiang, Yi

    2016-01-01

    INTRODUCTION To investigate the feasibility and clinical efficacy of using a toothed plate and hollow lag screw in the surgical treatment of posterior cruciate ligament (PCL) avulsion fractures of the tibia. METHODS A total of 21 patients were treated with open reduction and internal fixation using a toothed plate and hollow lag screw, through a posteromedial approach using an inverted L-shaped incision. The patients were allowed appropriate functional exercises, including knee flexion and extension, after removal of the plaster at postoperative weeks 3–6. The follow-up period was between six months and two years. RESULTS This was a retrospective study of patients with PCL avulsion fractures of the tibia caused by road traffic accidents (n = 9), sports-related injuries (n = 6), falls (n = 5) and machinery-related injuries (n = 1). 20 patients presented with fresh fractures and one with an old fracture. The patients (13 men, eight women) had a mean age of 41.5 (range 19–72) years. Anatomical reduction of the fracture and satisfactory fixation were achieved in all 21 patients. Bony union was achieved in all patients at 8–12 weeks after surgery. Six months after surgery, knee flexion was 121.9° ± 10.4° and extension was 0°. According to the Lysholm Knee Scoring Scale, 19 patients were rated as ‘excellent’ and two as ‘good’. CONCLUSION The use of a toothed plate and hollow lag screw could be a simple and reliable approach for PCL avulsion fractures of the tibia. Patients achieved good knee function after surgery. PMID:26831316

  9. Delta distributary dynamics in the Skagit River Delta (Washington, USA): Extending, testing, and applying avulsion theory in a tidal system

    NASA Astrophysics Data System (ADS)

    Hood, W. Gregory

    2010-11-01

    Analysis of historical aerial photos shows that Skagit Delta (Washington, USA) distributary dynamics are consistent with the Slingerland and Smith model of avulsion dynamics where the ratio of the water surface slopes of the two branches of a bifurcation predicts avulsion stability. This model was extended to predict distributary inlet (upstream) width and bankfull cross-sectional area. The water surface gradient ratio for a bifurcation pair predicted distributary width well; the lowest R2 was 0.61 for the 1937 data points, but R2 ranged from 0.83 to 0.90 for other year-specific regression lines. Gradient ratios were not constant over the historical record; from 1937 to 1972 the mainstem river channel lengthened by 1250 m in the course of marsh progradation, while distributary lengthening was comparatively negligible. Consequently, the gradient advantage of the distributaries increased and their channels widened. After the mainstem river terminus stabilized from 1972 to the present, the distributaries continued to lengthen with marsh progradation, so that distributary gradient advantage steadily declined and the distributaries narrowed. While distributary cross sections were not available for the historical period, they were surveyed in 2007 near the distributary inlets. Gradient ratio was more closely related to distributary inlet bankfull cross-sectional area ( R2 = 0.95) than to minimum distributary width for any photo year examined. Applying this form of analysis to Skagit Delta distributaries that have been dammed in the course of agricultural development suggests that their restoration to stabilize eroding marshes at their outlets and recover salmon migration pathways would be feasible without significant risk of full river avulsion.

  10. Clinical Study of Endometrial Polyp and Role of Diagnostic Hysteroscopy and Blind Avulsion of Polyp

    PubMed Central

    Remadevi, Chithra; Sumathy, Sudha; Sharma, Deepti; Sreedhar, Sarala; Jose, Amrutha

    2016-01-01

    Introduction Endometrial polyp is one of the common causes of Abnormal Uterine Bleeding (AUB) in the reproductive age group as well as postmenopausal age group. Aim To study the clinical features of endometrial polyp and the safety and feasibility of blind polypectomy following diagnostic hysteroscopy. Materials and Methods Total of 256 women who were diagnosed to have endometrial polyp by transvaginal ultrasound and underwent diagnostic hysteroscopy and blind polypectomy by simple avulsion in the period of January 2008 to December 2014 were included in our study. Polyp was confirmed by the histopathology. Results The prevalence of polyp among women who underwent diagnostic hysteroscopy and blind polypectomy was more common in the age group of 40-49years. Polyps manifested as AUB in 45.6% of our study population. The mean size of the polyp was not significantly different between premenopausal and postmenopausal women and single and multiple polyps. Histopathological study of the polyp showed two malignant polyps in our study population. Premalignant lesions i.e., endometrial hyperplasia without atypia and with atypia was found in 33 women. There was one uterine perforation, one cervical tear; one false passage and one patient had mild bleeding after the procedure. In our study, in the mean follow-up period of 37.57±28.12 months, 3.9% (7 women) had recurrence. In the follow-up period of 16.56±18.96 months, 78.9% women didn’t have recurrence. Conclusion Diagnostic hysteroscopy and blind polypectomy has low complication rate and recurrence rate and technically feasible for the practicing gynaecologists which don’t need much training and is cost-effective also. PMID:27504357

  11. Function of transected or avulsed rectus muscles following recovery using an anterior orbitotomy approach

    PubMed Central

    Pineles, Stacy L.; Laursen, Jessica; Goldberg, Robert A.; Demer, Joseph L.; Velez, Federico G.

    2013-01-01

    PURPOSE To assess the function of muscles retrieved from a retrobulbar location using an anterior orbitotomy approach and to identify the prognostic factors favoring a good outcome. METHODS The records of all patients undergoing anterior orbitotomy for the retrieval of a transected or avulsed muscle in a retrobulbar location were reviewed. Ocular motility, before and after retrieval (with ductions scaled from −4 to +4), was evaluated. RESULTS Record review identified 11 patients who had suffered trauma to 12 muscles (5 inferior, 6 medial, and 1 lateral rectus muscle). Ductions improved from −4 ± 0.4 preoperatively to −2.7 ± 0.9 postoperatively (P = 0.002); mean primary position deviation improved from 34Δ ± 14Δ-15Δ ± 9Δ (P < 0.001), and mean deviation in the field of action improved from 47Δ ± 20Δ-20Δ ± 22Δ (P = 0.02). Ductions improved by at least two units in three patients, all of whom had medial rectus trauma. Single binocular vision in primary gaze was achieved in 6 patients. Patients with medial rectus muscle injury and patients injured by sinus surgery had the lowest likelihood of recovering single binocular vision. CONCLUSIONS Our results are similar to historical series in which muscles were not retrieved and transpositions performed; however, muscle retrieval avoids risks associated with transposition surgeries such as anterior segment ischemia. Muscle recovery via the anterior orbitotomy approach may be reasonable to consider in those cases with a reasonable possibility of having active force generation postoperatively. PMID:22835914

  12. Total ureteral avulsion leading to early nephrectomy as a rare complication of simple lumbar discectomy; a case report

    PubMed Central

    Omidi-Kashani, Farzad; Mousavi, Seyed Mahdi

    2015-01-01

    Introduction: Lumbar discectomy constitutes the most common and probably easiest spine surgery but it is not without complications. The aim of this work is to report a case with total ureteral avulsion during lumbar discectomy due to careless advancement of the pituitary rongeur. Methods: A 59-year-old male presented with refractory left L5-S1 lumbar disc herniation. During the surgery, left sided total ureteral avulsion occurred. Early postoperative progressive abdominal pain was the main clue for further investigation and diagnostic work-up. Results: Abdominal ultrasonography, intravenous pyelography, and abdominal contrast-enhanced computed tomography (CT) detected a left ureteral injury. Although the injury was detected early, ureteral repair or renal autotransplantation was not possible and nephrectomy was finally indicated, due to a significant ureteral loss. Discussion: Careful use of discectomy instruments, avoidance of excessive advancement of pituitary rongeurs (more than 3 cm), and thorough knowledge of the relevant anatomy are critical in preventing ureteral injury. PMID:27163085

  13. Avulsion at a drift-dominated mesotidal estuary: The Chubut River outlet, Patagonia, Argentina

    NASA Astrophysics Data System (ADS)

    Isla, Federico; Espinosa, Marcela; Rubio, Belén; Escandell, Alejandra; Gerpe, Marcela; Miglioranza, Karina; Rey, Daniel; Vilas, Federico

    2015-10-01

    The Chubut River flows from the Andes to the Atlantic Ocean, and is interrupted by a single dam built at the middle valley. The lower valley is dominated by the aggradation of an alluvial plain induced by a complex of spits that enclosed the inlet in the last 5000 years. The river has reduced its flow because the blocking of the upper basin by terminal moraines during the Upper Pleistocene. At least the last two marine transgressions have flooded this estuary, and contributed to the aggradation during regressions. The area is of particular interest in regard to irrigation channels practiced since the XIX century. Today, the mean monthly flow is less than 10 m3/s although peaks of 95 m3/s have been recorded in Gaiman in July 2001. The dynamics of the estuary is dominated by waves (wave-dominated estuary) as tidal effects attenuate in less than 5 km. Three vibracores were collected within this floodplain: (a) at Gaiman, an area without any effect of the sea (35 km from the coast); (b) at Trelew, at the former avulsion plain of the river (18 km from the coast); and (c) at Playa Magagna, a saltmarsh located 0.4 km from the beach. At the Gaiman core (1.54 m long) fresh-water epiphytic diatoms dominate (Epithemia sorex, Cocconeis placentula, Ulnaria ulna) suggesting the aggradation of an alluvial plain. The Trelew core (2.19 m long) was collected from a deltaic plain. It was composed by fine sand with organic matter at the base that evolved into silty layers to the top. Several unconformities and laminae with heavy minerals were detected by their geochemical composition analysed by micro X-ray fluorescence (Itrax XRF core scanner). Fine-sand laminated layers were perfectly detected by their high content in S and Cl. On the other hand, mud layers presented lower content in Mg and Al with increments in Ca and V. The core from the marsh area (1.67 m long) was analysed in terms of the diatom evolution in order to detect Holocene sea-level and salinity effects. The sand flats

  14. Large-scale avulsion of the late Quaternary Sutlej river in the NW Indo-Gangetic foreland basin

    NASA Astrophysics Data System (ADS)

    Singh, Ajit; Gupta, Sanjeev; Sinha, Rajiv; Carter, Andrew; Thomsen, Kristina J.; Mark, Darren F.; Buylaert, Jan-Pieter; Mason, Philippa J.; Murray, Andrew S.; Jain, Mayank; Paul, Debajyoti

    2015-04-01

    River avulsions are important processes in the spatial evolution of river systems in tectonically active sedimentary basins as they govern large-scale patterns of sediment routing. However, the pattern and timing of avulsions in large river systems are poorly documented and not well understood. Here we document late Quaternary paleo-river channel changes in the Indo-Gangetic basin of northwest India. Using a combination of satellite remote sensing and detailed sediment coring, we analyse the large-scale planform geometry, and detailed sedimentary and stratigraphic nature of a major fluvial sedimentary deposit in the shallow subsurface. This sediment body records aggradation of multiple fluvial channel fills. Satellite remote sensing analysis indicates the trace of the buried channel complex and demonstrates that it exists in region of the Himalayan foreland where no major rivers are currently present. Thus it records the former drainage pathway of a major river, which has since been diverted. We use optically stimulated luminescence dating techniques to develop an age model for the stratigraphic succession and hence constrain the timing of river channel existence and diversion. Provenance analysis based on U-Pb dating of detrital zircons and detrital mica Ar-Ar ages indicate sediment sources in the Higher Himalayan Crystalline and Lesser Himalayan Crystalline Series indicating that this paleo-river channel system formed a major perennial river derived from the main body of the Himalaya. Specifically we are able to fingerprint bedrock sources in the catchment of the present-day Sutlej river indicating that the paleo-fluvial system represents the former course of the Sutlej river prior to a major nodal avulsion to its present day course. Our results indicate that on geologically relatively short time-scales, we observe dramatic along strike shifts in the location of major Himalayan rivers. Our sediment records when combined with high-resolution dating and

  15. Geomorphology, facies architecture, and high-resolution, non-marine sequence stratigraphy in avulsion deposits, Cumberland Marshes, Saskatchewan

    USGS Publications Warehouse

    Farrell, K.M.

    2001-01-01

    This paper demonstrates field relationships between landforms, facies, and high-resolution sequences in avulsion deposits. It defines the building blocks of a prograding avulsion sequence from a high-resolution sequence stratigraphy perspective, proposes concepts in non-marine sequence stratigraphy and flood basin evolution, and defines the continental equivalent to a parasequence. The geomorphic features investigated include a distributary channel and its levee, the Stage I crevasse splay of Smith et al. (Sedimentology, vol. 36 (1989) 1), and the local backswamp. Levees and splays have been poorly studied in the past, and three-dimensional (3D) studies are rare. In this study, stratigraphy is defined from the finest scale upward and facies are mapped in 3D. Genetically related successions are identified by defining a hierarchy of bounding surfaces. The genesis, architecture, geometry, and connectivity of facies are explored in 3D. The approach used here reveals that avulsion deposits are comparable in process, landform, facies, bounding surfaces, and scale to interdistributary bayfill, i.e. delta lobe deposits. Even a simple Stage I splay is a complex landform, composed of several geomorphic components, several facies and many depositional events. As in bayfill, an alluvial ridge forms as the feeder crevasse and its levees advance basinward through their own distributary mouth bar deposits to form a Stage I splay. This produces a shoestring-shaped concentration of disconnected sandbodies that is flanked by wings of heterolithic strata, that join beneath the terminal mouth bar. The proposed results challenge current paradigms. Defining a crevasse splay as a discrete sandbody potentially ignores 70% of the landform's volume. An individual sandbody is likely only a small part of a crevasse splay complex. The thickest sandbody is a terminal, channel associated feature, not a sheet that thins in the direction of propagation. The three stage model of splay evolution

  16. Legacy Morphologies: Channel Avulsions and Historical Engineering Structures Drive Form and Process in the Lower Yuba and Feather Rivers, California

    NASA Astrophysics Data System (ADS)

    James, L. A.; Singer, M. B.; Aalto, R.

    2008-12-01

    Geomorphic changes in the lower Yuba and Feather Rivers due to hydraulic mining provide a chance to study centennial-scale processes. Channel changes over 150 years were determined using channel-bank stratigraphy, geochemical signatures (total Hg, grain-size distributions, bulk geochemistry, fallout radionuclides, and Sr/Nd isotopes), and spatial analyses of high-resolution topographic data, historical maps, and aerial photos. Repeated avulsions and broad erosion/deposition patterns are shown, including a downstream shift in activity through time. In the 20th century, both rivers experienced deep main-channel incision and floodplain alluviation of natural levees and abandoned channels. Buried trees rooted in pre- mining soils indicate the Feather has not returned to pre-mining base levels below the Yuba confluence. Early engineering works controlled channel responses and recovery. For example, the Feather River avulsed into a channel dredged through Shanghai Bend (c.1907) so it now crosses resistant Quaternary alluvium over a 3-m knickpoint bench that could soon be breached. Moreover, levees and channelization near the Yuba-Feather confluence at Marysville (c.1905) narrowed and deepened flows, encouraging the bed incision noted by Gilbert. Effects of legacy sediment on channel processes are well known. Here, channel recovery was also constrained by channel morphologies engineered with boulder wing dams and revetment in the Yuba and channelization and levees in the Feather. The resulting bed incision reduces lateral connectivity between channels and floodplains and increases sediment conveyance. Historical and anthropogenic perspectives are essential to explaining channel dynamics at these scales. Unless models of channel and floodplain evolution recognize historical changes and engineering works, they may miss crucial components of geomorphic change and potential impacts downstream. In such systems, the historical dimension is essential to river management, water

  17. Avulsion in action: Reconstruction and modelling sedimentation pace and upstream flood water levels following a Medieval tidal-river diversion catastrophe (Biesbosch, The Netherlands, 1421-1750 AD)

    NASA Astrophysics Data System (ADS)

    Kleinhans, Maarten G.; Weerts, Henk J. T.; Cohen, Kim M.

    2010-05-01

    Deltaic land inundated by storm surges may reform by sedimentation from natural or human-induced river diversions. This is a well-known trigger mechanism for creation of new channels in coastal plains and deltas, which may develop into main channels and lead to abandonment of older (avulsion), particularly in the downstream parts of deltas that host tidal rivers. These new channels develop as part of deltaic splay complexes that heal initial diversion scars and fill up flooded basins at a certain pace. We study a case with excellent historical and geological data of a diversion of the river Rhine following catastrophic inundations (1421-1424 AD) into medieval reclaimed land. Numerical modelling of deltaic splay and channel development is combined with reconstructions from historical maps and geological data. This yields detailed insight in pacing of splay sedimentation and changing hydrodynamics in the channel upstream of the diversion in the two centuries following the inundation. The equivalent of the full sand budget of the river Rhine was effectively trapped in the developing splay. The tidal-avulsion splay evolution on aspects is similar to that of fluvial crevassing into flood basins documented for settings lacking 'downstream' tidal control. The typical small-scale delta-lobe avulsion cycles: mouth bar formation, backward sedimentation, upstream avulsion, channel progradation and mouth bar formation are reproduced in the splay-modelling. The pacing of splay development, however, is relatively fast due to the presence of tides and the water depth in the receiving basin. The diversion had a strong upstream impact, in particular on water levels in the feeding river channel at stages of peak flow. For two centuries levels were significantly raised, because bifurcation-imposed reduced transport capacity and associated sedimentation at the diversion site increased hydraulic roughness and hampered flow. These findings have implications regarding flood mitigation

  18. Results after replantation of avulsed permanent teeth. II. Periodontal healing and the role of physiologic storage and antiresorptive-regenerative therapy.

    PubMed

    Pohl, Yango; Filippi, Andreas; Kirschner, Horst

    2005-04-01

    The status of the periodontal ligament (PDL) and of the pulp are decisive for the healing of avulsed and replanted teeth. A tooth rescue box was developed and distributed to offer optimal storage conditions for avulsed teeth. The therapy comprised extraoral endodontic treatment and applications of medicaments to enhance periodontal healing. In this long-term clinical study the healing results following avulsion and replantation were investigated. Twenty-eight permanent teeth in 24 patients were evaluated. The extraoral storage media and periods varied considerably. Soon after avulsion six teeth were stored in a cell culture medium (tooth rescue box Dentosafe) for 1-53 h; the PDL was defined as not compromised. Sixteen teeth were stored in a non-physiologic situation temporarily, the PDL was considered as compromised. Six teeth were stored in non-physiologic conditions for longer periods; the condition of the PDL was defined as hopeless. On 14 teeth antiresorptive-regenerative therapy (ART) with the local application of glucocorticoids and enamel matrix derivative and the systemic administration of doxycyclin was used. In all teeth extraoral endodontic treatment by retrograde insertion of posts was performed. The mean observation period was 31.2 months (+/-24.1; 5.1-100.2; median: 23.8). All six teeth rescued physiologically healed with a functional PDL (functional healing, FH) irrespective of the storage period. Of eight teeth with a compromised PDL on which ART was used, three teeth healed with a functional PDL. All other teeth showed replacement resorption, in three teeth additionally infection-related resorption was recorded. The predominant influence on the healing results was the immediate physiologic rescue of avulsed teeth (chi-square, P = 0.0001). The use of ART seemed to support FH (chi-square, P = 0.0547) in teeth with a compromised PDL. No other factors (maturity of roots, crown fractures, gender, age, antibiotics) were related to healing. In a linear

  19. Common Peroneal Nerve Palsy with Multiple-Ligament Knee Injury and Distal Avulsion of the Biceps Femoris Tendon

    PubMed Central

    Oshima, Takeshi; Nakase, Junsuke; Numata, Hitoaki; Takata, Yasushi

    2015-01-01

    A multiple-ligament knee injury that includes posterolateral corner (PLC) disruption often causes palsy of the common peroneal nerve (CPN), which occurs in 44% of cases with PLC injury and biceps femoris tendon rupture or avulsion of the fibular head. Approximately half of these cases do not show functional recovery. This case report aims to present a criteria-based approach to the operation and postoperative management of CPN palsy that resulted from a multiple-ligament knee injury in a 22-year-old man that occurred during judo. We performed a two-staged surgery. The first stage was to repair the injuries to the PLC and biceps femoris. The second stage involved anterior cruciate ligament reconstruction. The outcomes were excellent, with a stable knee, excellent range of motion, and improvement in the palsy. The patient was able to return to judo competition 27 weeks after the injury. To the best of our knowledge, this is the first case report describing a return to sports following CPN palsy with multiple-ligament knee injury. PMID:26064740

  20. The slow Wallerian degeneration gene in vivo protects motor axons but not their cell bodies after avulsion and neonatal axotomy.

    PubMed

    Adalbert, Robert; Nógrádi, Antal; Szabó, András; Coleman, Michael P

    2006-10-01

    The slow Wallerian degeneration gene (Wld(S)) delays Wallerian degeneration and axon pathology for several weeks in mice and rats. Interestingly, neuronal cell death is also delayed in some in vivo models, most strikingly in the progressive motoneuronopathy mouse. Here, we tested the hypothesis that Wld(S) has a direct protective effect on motoneurone cell bodies in vivo. Cell death was induced in rat L4 motoneurones by intravertebral avulsion of the corresponding ventral roots. This simultaneously removed most of the motor axon, minimizing the possibility that the protective effect toward axons could rescue cell bodies secondarily. There was no significant difference between the survival of motoneurones in control and Wld(S) rats, suggesting that the Wld(S) gene has no direct protective effect on cell bodies. We also tested for any delay in apoptotic motoneurone death following neonatal nerve injury in Wld(S) rats and found that, unlike Wld(S) mice, Wld(S) rats show no delay in cell death. However, the corresponding distal axons were preserved, confirming that motoneurone cell bodies and motor axons die by different mechanisms. Thus, Wld(S) does not directly prevent death of motoneurone cell bodies. It follows that the protection of neuronal cell bodies observed in several disease and injury models where axons or significant axonal stumps remain is most probably secondary to axonal protection. PMID:17074042

  1. Variable scale channel avulsion history using fan architecture and stratigraphy, and sediment provenance of Sutlej-Yamuna fans in northwest Gangetic plains during Late Quaternary

    NASA Astrophysics Data System (ADS)

    Singh, Ajit; Gupta, Sanjeev; Sinha, Rajiv; Densmore, Alexander; Buylaert, Jan-Pieter; Carter, Andrew; Van-Dijk, Wout M.; Joshi, Suneel; Nayak, Nibedita; Mason, Philippa J.; Kumar, Dewashish; Mondal, Setbandhu; Murray, Andrew; Rai, Shiv P.; Shekhar, Shashank

    2016-04-01

    Channel avulsion during fan development controls distribution and deposition of channel sandbodies and hence alluvial architecture of a fan system. Variable scale spatio-temporal information of fluvial responses to past climate changes is stored in these channel sandbodies. Further these channel sandbodies form fluvial aquifers in alluvial fans and therefore understanding of alluvial architecture and stratigraphy of a fan is crucial for development of groundwater management strategies. In this study we used multiple approaches to map subsurface fluvial aquifer architecture and alluvial stratigraphy, and to estimate sediment provenance using U-Pb dating of detrital zircon grains of Sutlej-Yamuna fan system in northwest India. Satellite imagery based geomorphic mapping shows two large fan system with interfan area. The fan surfaces show presence of major and minor paleochannels. 2D resistivity tomography along several transects across fan surfaces shows distinct layers with contrasting resistivity values. These geo-electric facies corresponds to presence of channel sandbodies beneath surface signature of paleochannels and finer floodplain deposits useful to demarcate lateral extent of subsurface channel sandbodies. A more detailed subsurface stratigraphy using ~50m deep sediment cores and their luminescence ages from across fan surface shows presence of multi-storey sandbodies (MSB) separated by floodplain fines. Within the MSB, individual channel deposits are identified by presence of channel scour surfaces located at coarse sand overlying fine sand layer. Depositional ages of MSB's ranges from ~81 ka (late MIS5) to ~15 ka (MIS2) with major depositional break during MIS3 in parts of the fans. Sediment aggradation rate varies laterally across fan surface as well as vertically down the depth with an average rate of 0.54 mm/year. Fluvial channel persistence for studied time interval (about last 81 ka BP) shows major depositional breaks (and possible incision) at ~41 ka

  2. Quaternary megafans, large rivers and other avulsive systems: a potential "who is who" in the geological record

    NASA Astrophysics Data System (ADS)

    Latrubesse, E. M.

    2012-12-01

    A fascinating discussion has been recently calling the attention of sedimentologists and geomorphologists regarding to the dominant fluvial styles preserved in the geological record. While some authors postulate that distributary (or distributive) patterns are the most important systems likely to dominate the alluvial rock record (Weissmann et al.2010, among others) others suggest that a variety of fluvial styles are remarkably preserved in the geological record, rejecting the importance of the distributary systems (such as megafans and other like fans coastal systems) (Fielding et al, 2012 among others). However, the Quaternary record of the largest depositional tracks on Earth has been not assessed in a comparative and detailed way. Here I present results from some of the most important Quaternary areas of sedimentation of the world such as the alluvial belts of the largest rivers, the largest megafans and other impressive fluvial dominated wetlands in active tectonic basins. My study is based on field work I carried out in many of the analyzed areas, a literature review and remote sensing products. Specific examples are discussed from several rivers of the Amazon basin, the Parana River, the Mississippi River, among others. Large depositional tracks in forelands, platforms and intracratonic basins such as the Chaco, the Orinoco Llanos, the Bananal and Pantanal basin, the Ucamara depression, and the Indo-Gangetic plain, which contain a variety of complex avulsive systems and megafans, are discussed. A main conclusion is that megafans and similar distributary systems, avulsive systems with a variety of channel patterns and linear fluvial belts of major rivers, have the potential for preservation in the geological record. The scarcity of purely braided systems in large rivers is noticeable and they are mainly constrained to small-medium size channels, short length piedmont courses or related to relatively small alluvial fans. Meandering and anabranching systems are

  3. Computerized tomography myelography with coronal and oblique coronal view for diagnosis of nerve root avulsion in brachial plexus injury

    PubMed Central

    2007-01-01

    Background The authors describe a new computerized tomography (CT) myelography technique with coronal and oblique coronal view to demonstrate the status of the cervical nerve rootlets involved in brachial plexus injury. They discuss the value of this technique for diagnosis of nerve root avulsion compared with CT myelography with axial view. Methods CT myelography was performed with penetration of the cervical subarachnoid space by the contrast medium. Then the coronal and oblique coronal reconstructions were created. The results of CT myelography were evaluated and classified with presence of pseudomeningocele, intradural ventral nerve rootlets, and intradural dorsal nerve rootlets. The diagnosis was by extraspinal surgical exploration with or without spinal evoked potential measurements and choline acetyl transferase activity measurement in 25 patients and recovery by a natural course in 3 patients. Its diagnostic accuracy was compared with that of CT myelography with axial view, correlated with surgical findings or a natural course in 57 cervical roots in 28 patients. Results Coronal and oblique coronal views were superior to axial views in visualization of the rootlets and orientation of the exact level of the root. Sensitivity and specificity for coronal and oblique coronal views of unrecognition of intradural ventral and dorsal nerve root shadow without pseudomeningocele in determining pre-ganglionic injury were 100% and 96%, respectively. There was no statistically significant difference between coronal and oblique coronal views and axial views. Conclusion The information by the coronal and oblique coronal slice CT myelography enabled the authors to assess the rootlets of the brachial plexus and provided valuable data for helping to decide whether to proceed with exploration, nerve repair, primary reconstruction. PMID:17651476

  4. Quaternary evolution of the rivers of northeast Hainan Island, China: Tracking the history of avulsion from mineralogy and geochemistry of river and delta sands

    NASA Astrophysics Data System (ADS)

    Pe-Piper, Georgia; Piper, David J. W.; Wang, Ying; Zhang, Yongzhan; Trottier, Corwin; Ge, Chendong; Yin, Yong

    2016-03-01

    The mineralogy and geochemistry of sands were investigated in the Nandu and Wanquan rivers, Hainan Island, China, to determine the history of avulsion in the lower reaches of the Nandu River. The study also provided the opportunity to assess the utility of geochemical analysis of sands as a provenance tool. Much of the heavy mineral fraction in the rivers consists of subangular Fe-Ti oxide and Fe-(hydr)oxide minerals, and less stable minerals such as amphibole, epidote, and andalusite, whereas rounded resistant ilmenite, rutile, tourmaline and zircon predominate on the deltaic coast. Mineral assemblage and chemical composition of individual samples are related to specific source areas and river tributaries. The results demonstrate northwestwards flow of the Nandu River during the mid-Holocene and earlier avulsion of the river to the northeast coast, probably during a Late Pleistocene marine highstand. Minor basement tilting, producing little relief, was sufficient to divert the lower reaches of rivers, and this effect was enhanced where basalt flows dammed former river courses. Bulk sample REE geochemistry is largely controlled by the relative abundance of monazite, allanite, titanite, zircon and epidote, derived principally from granites. Detrital geochemistry alone shows too much variability to interpret provenance. However, a smaller number of heavy mineral analyses provide an understanding of the mineralogical origins of geochemical variation, thus enabling interpretations of provenance.

  5. Spontaneous bilateral avulsion fracture of the tuberositas tibiae in a New Zealand White rabbit - a counterpart to Osgood-Schlatter disease in humans?

    PubMed

    Nehrbass, D; Arens, D; Zeiter, S

    2015-02-01

    The first reported case describing a spontaneous bilateral avulsion fracture of the tuberositas tibiae in a New Zealand White rabbit is presented. So far in animals, this condition has been only described in dogs and horses. In humans, this condition is also called Osgood-Schlatter disease (OSD) or syndrome, traction apophysitis of the tibial tubercle (ATT) or patellar tendon enthesopathy of the tibial tuberosity respectively. It is mainly seen in young adolescents coinciding with periods of growth spurts. In humans, its pathogenesis is believed to be caused by repetitive tendon/muscle strain at the insertion of the patellar tendon to the immature tibial tuberosity, which has its own secondary ossification center. Morphologically this case is characterized by bilateral chronic avulsion with incomplete separation of the tuberositas tibae, and proximal dislocation of the patella (patella alta). Despite these marked pathological changes, the animal was clinically without findings. Nevertheless, this case emphasizes the need for thorough clinical and radiological examination of rabbits intended for preclinical research studies prior to study begin, especially in orthopedic research. PMID:25435475

  6. A Middle to Late Holocene avulsion history of the Euphrates river: a case study from Tell ed-Dēr, Iraq, Lower Mesopotamia

    NASA Astrophysics Data System (ADS)

    An Heyvaert, Vanessa Mary; Baeteman, Cecile

    2008-12-01

    Geoarchaeological research was performed to reconstruct the floodplain history in the surroundings of two ancient Mesopotamian cities: Tell ed-Dēr and Sippar. The mapping of the floodplain is based on facies analyses of the sedimentary succession of 225 hand-operated boreholes. The archaeological sites Tell ed-Dēr and Sippar are closely linked to a palaeochannelbelt of the Euphrates, located in the western part of the study area. Channel activity started at least in ca 3100 BC/5050 cal BP, until ca 1400-1000 BC/3350-2950 cal BP. The channel belt was part of an avulsion driven multiple Euphrates channel network that gradually became abandoned from the second half of the 2nd millennium BC. A second mapped Euphrates, Tigris or Joint Euphrates -Tigris palaeochannel belt became abandoned well before 3100 BC. Examples of natural processes as well as human interactions triggering avulsion are given. Moreover, textual, archaeological and geological data show clearly that flood-control techniques and the construction of large-scale dikes seemed to be a common practice.

  7. Unusual Transalveolar and Transmuco-Gingival Root Avulsion of a Fractured Primary Central Incisor: A Case with an 8-Year Follow-Up

    PubMed Central

    Ferrés-Amat, E.; Díaz-Martínez, C.; Herrera-Martínez, S.; Maura-Solivellas, I.; Ferrés-Padró, E.

    2015-01-01

    The purpose of this unique case report is to describe a very unusual dentoalveolar fracture associated with avulsion of the near-complete root. A 3-year-old male patient came for consultation after a dentoalveolar trauma with a “fragment that looks like canine” found in his mouth by his mother. This boy suffered root fracture of the upper primary central right incisor, accompanied by transalveolar and transmuco-gingival avulsion of the tooth root fragment, leaving the crown in its position in the dental arch. Clinical and radiological examinations were performed in order to follow up the case: 15 days, one month, and three months after trauma, the crown had a slight mobility without other clinical or radiological signs. After six months, the upper primary central right incisor's crown was exfoliated. Open bite due to the persistence of the pacifier habit favored the crown retention in the mouth. This case emphasizes the importance of primary diagnosis and follow-up of trauma cases. To the best of our knowledge, this kind of dental injury has not been previously described in the literature nor in the current Dental Trauma guidelines for the management of traumatic dental injuries in the primary dentition. PMID:25793129

  8. Rehabilitation Considerations of a Brachial Plexus Injury with Complete Avulsion of C5 and C6 Nerve Roots in a College Football Player

    PubMed Central

    Saliba, Susan; Saliba, Ethan N.; Pugh, Kelli F.; Chhabra, Abhinav; Diduch, David

    2009-01-01

    Severe brachial plexus injuries are rare in sports, but they have catastrophic results with a significant loss of function in the involved upper extremity. Nerve root avulsions must be timely managed with prompt evaluation, accurate diagnosis, and surgical treatment to optimize the potential for a functional outcome. This case report describes the mechanism of injury, diagnostic evolution, surgical management, and rehabilitation of a college football player who sustained a traumatic complete nerve root avulsion of C5 and C6 (upper trunk of the brachial plexus). Diagnostics included clinical evaluation, magnetic resonance imaging, computed tomography myelogram, and electromyogram. Surgical planning included nerve grafting and neurotization (nerve transfer). Rehabilitation goals were to bring the hand to the face (active biceps function), to stabilize the shoulder for abduction and flexion, and to reduce neuropathic pain. Direct current stimulation, bracing, therapeutic exercise, and biofeedback were used to maximize the use of the athlete’s upper extremity. Although the athlete could not return to sport or normal function by most standards, his results were satisfactory in that he regained an ability to perform many activities of daily living. PMID:23015895

  9. Avulsion processes at the terminus of low-gradient semi-arid fluvial systems: Lessons from the Río Colorado, Altiplano endorheic basin, Bolivia

    NASA Astrophysics Data System (ADS)

    Donselaar, M. E.; Cuevas Gozalo, M. C.; Moyano, S.

    2013-01-01

    The Río Colorado dryland river system in the southeast of the endorheic Altiplano Basin (Bolivia) terminates on a very flat coastal plain at the edge of the Salar de Uyuni, the world's largest salt pan with an area of ca. 12,500 km2. Since the Pleistocene the basin has experienced several lake expansion and contraction cycles in response to wetter and drier climate periods, respectively. At present the basin is in a dry climate period which results in a lake level lowstand and progradation of fluvial systems such as the Río Colorado onto the former lake bottom. The present field study of the terminus of the Río Colorado shows that the river experiences a gradual downstream decrease of bankfull width and depth. This bankfull decrease is caused by the combined effects of: (1) extremely low gradient of the lake bottom and, hence, loss of flow energy, and (2) downstream transmission losses due to high evaporation potential and river water percolation through the channel floor. Peak water discharge in seasonal, short-duration rain periods causes massive overbank flooding and floodplain inundation. On satellite images the morphology of the river terminus has a divergent pattern and resembles a network of coeval sinuous distributary channels. However, field observations show that only one channel is active at low flow stage, and at high-flow stage an abandoned, partially infilled channel may be active as well. The active channel at its termination splits into narrow and shallow anastomosing streams before its demise on the lacustrine coastal plain. The rest of the channels which form the divergent network are older sediment-filled abandoned sinuous river courses with multiple random avulsion points. These channel deposits, together with extensive amalgamated crevasse-splay deposits, form an intricate network of fluvial sand deposits. Successive stages of progressively deeper crevasse-channel incision into the floodplain are the result of waning-stage return flow of

  10. Morphological and sedimentological evidences of repeated avulsions of Someşu Mic River (Romania), associated to salt tectonics

    NASA Astrophysics Data System (ADS)

    Persoiu, I.; Radoane, M.

    2009-04-01

    . Four palaeochannels are visible on the floodplain's surface, these being also evident in the sedimentary structure of the valley infill, as revealed by the electrical imaging and drilling. Former channel infills consist mainly of massive and sandy clays (low electrical resistivity - 5.8 ohm.m), whereas the sectors between them are filled by pebbles and sands interpreted to be channel deposits (high values of the electrical resistivity - 80 ohm.m).The absence of coarse gravels from the bottom, direct disposal of fine sediments on marls and the presence of massive clay suggests 3 stages in the channels evolution. The first one is a long period of stability, supposed to be associated to a low sinuous course, when river incised the sedimentary complex of the floodplain, until it was intersected the valley bottom. The second stage is an abrupt avulsion to the right, produced probably during an important flood, and the third stage corresponds to the period of complete abandonment of it and the evolution as oxbow lake. If we take in consideration the presence of the diapiric syncline on the right side of the valley, and the disposal of parallel channels with it (including the present-day one), we conclude that this behavior is caused by a lateral tilting of the floodplain trough the right.

  11. Identification and management of chronic shoulder pain in the presence of an MRA-confirmed humeral avulsion of the inferior glenohumeral ligament (HAGL) lesion

    PubMed Central

    Karmali, Arif; McLeod, Jennifer

    2016-01-01

    Objective: To present the assessment and conservative management of chronic shoulder pain in the presence of a humeral avulsion of the inferior glenohumeral ligament (HAGL) lesion in an active individual. Clinical Features: A 47 year-old female office-worker with constant, deep, right shoulder pain with occasional clicking and catching claimed to have “tore something” in her right shoulder five years ago while performing reverse bicep curls. A physical exam led to differential diagnoses of a Superior Labrum Anterior to Posterior (SLAP) lesion, Bankart lesion, and bicipital tendinopathy. A Magnetic Resonance Arthrogram revealed a HAGL lesion. Intervention and Outcome: A conservative chiropractic treatment plan in addition to physical therapy was initiated. The patient reported 75% improvement in symptoms after 4 treatments over a four-week duration. Summary: This case demonstrates the successful implementation of a conservative plan of management suggesting that the treatment provided to this patient should be considered and attempted prior to arthroscopic surgery. PMID:27385837

  12. Successful Nonoperative Management of HAGL (Humeral Avulsion of Glenohumeral Ligament) Lesion With Concurrent Axillary Nerve Injury in an Active-Duty US Navy SEAL.

    PubMed

    Ernat, Justin J; Bottoni, Craig R; Rowles, Douglas J

    2016-01-01

    Humeral avulsion of the glenohumeral ligament (HAGL) is a lesion that has been recognized as a cause of recurrent shoulder instability. To our knowledge there are no reports of successful return to full function in young, competitive athletes or return to manual labor following nonoperative management of a HAGL lesion. A 26-year-old Navy SEAL was diagnosed with a HAGL injury, and associated traction injury of the axillary nerve as well as a partial tear of the rotator cuff. Operative intervention was recommended; however, due to issues with training and with inability to properly rehab with the axillary nerve injury, surgical plans were delayed. Interestingly, the patient demonstrated both clinical and radiographic magnetic resonance imaging healing of his lesion over an 18-month period. At 18 months the patient had returned to full active duty without pain or instability as a Navy SEAL. PMID:27552458

  13. Case report: endodontic and surgical treatment of an upper central incisor with external root resorption and radicular cyst following a traumatic tooth avulsion.

    PubMed

    Lux, Hans-Christian; Goetz, Falko; Hellwig, Elmar

    2010-11-01

    In the age group between 6 and 12 years, trauma to the upper incisors happens frequently. In the case of avulsion, a replantation is the state-of-the-art treatment; however, it may lead to several complications, particularly if suitable posttraumatic management is not carried out. External cervical resorptions as well as apical granuloma and cysts due to microbial contamination of the root canal are common complications. In the presented trauma case, a conservative approach was chosen to treat a large cystic lesion combined with cervical and apical resorptions. After initial placement of Ledermix and calcium hydroxide into the root canal, a marsupialization with the temporary insertion of an obturator was performed. The gradual reduction led to a fast recovery of the bony defect and a root canal filling was placed. The 2-year follow-up showed an improved condition. All adjacent teeth remained vital during the course of the treatment. PMID:20692191

  14. Efficacy of two cannabis based medicinal extracts for relief of central neuropathic pain from brachial plexus avulsion: results of a randomised controlled trial.

    PubMed

    Berman, Jonathan S; Symonds, Catherine; Birch, Rolfe

    2004-12-01

    The objective was to investigate the effectiveness of cannabis-based medicines for treatment of chronic pain associated with brachial plexus root avulsion. This condition is an excellent human model of central neuropathic pain as it represents an unusually homogenous group in terms of anatomical location of injury, pain descriptions and patient demographics. Forty-eight patients with at least one avulsed root and baseline pain score of four or more on an 11-point ordinate scale participated in a randomised, double-blind, placebo-controlled, three period crossover study. All patients had intractable symptoms regardless of current analgesic therapy. Patients entered a baseline period of 2 weeks, followed by three, 2-week treatment periods during each of which they received one of three oromucosal spray preparations. These were placebo and two whole plant extracts of Cannabis sativa L.: GW-1000-02 (Sativex), containing Delta(9)tetrahydrocannabinol (THC):cannabidiol (CBD) in an approximate 1:1 ratio and GW-2000-02, containing primarily THC. The primary outcome measure was the mean pain severity score during the last 7 days of treatment. Secondary outcome measures included pain related quality of life assessments. The primary outcome measure failed to fall by the two points defined in our hypothesis. However, both this measure and measures of sleep showed statistically significant improvements. The study medications were generally well tolerated with the majority of adverse events, including intoxication type reactions, being mild to moderate in severity and resolving spontaneously. Studies of longer duration in neuropathic pain are required to confirm a clinically relevant, improvement in the treatment of this condition. PMID:15561385

  15. Arthroscopic fixation of an avulsion fracture of the tibia involving the posterior cruciate ligament: a modified technique in a series of 22 cases.

    PubMed

    Chen, L B; Wang, H; Tie, K; Mohammed, A; Qi, Y J

    2015-09-01

    A total of 22 patients with a tibial avulsion fracture involving the insertion of the posterior cruciate ligament (PCL) with grade II or III posterior laxity were reduced and fixed arthroscopically using routine anterior and double posteromedial portals. A double-strand Ethibond suture was inserted into the joint and wrapped around the PCL from anterior to posterior to secure the ligament above the avulsed bony fragment. Two tibial bone tunnels were created using the PCL reconstruction guide, aiming at the medial and lateral borders of the tibial bed. The ends of the suture were pulled out through the bone tunnels and tied over the tibial cortex between the openings of the tunnels to reduce and secure the bony fragment. Satisfactory reduction of the fracture was checked arthroscopically and radiographically. The patients were followed-up for a mean of 24.5 months (19 to 28). Bone union occurred six weeks post-operatively. At final follow-up, all patients had a negative posterior drawer test and a full range of movement. KT-1000 arthrometer examination showed that the mean post-operative side-to-side difference improved from 10.9 mm (standard deviation (sd) 0.7) pre-operatively to 1.5 mm (sd 0.6) (p = 0.001). The mean Tegner and the International Knee Documentation Committee scores improved significantly (p = 0.001). The mean Lysholm score at final follow-up was 92.0 (85 to 96). We conclude that this technique is convenient, reliable and minimally invasive and successfully restores the stability and function of the knee. PMID:26330588

  16. Avulsion in Action: Reconstruction and Modelling Sedimentation Pace and Upstream Flood Water Levels Following a Medieval Tidal-River Diversion and Storm Surge Catastrophe, The Netherlands, 1421-1750 AD

    NASA Astrophysics Data System (ADS)

    Cohen, K.; Kleinhans, M. G.; Weerts, H.

    2010-12-01

    Deltaic land inundated by storm surges may reform by sedimentation from natural or human-induced river diversions. This is a well-known trigger mechanism for creation of new channels in coastal plains and deltas, which may develop into main channels and lead to abandonment of older (avulsion), particularly in the downstream parts of deltas that host tidal rivers. These new channels develop as part of deltaic splay complexes that heal initial diversion scars and fill up flooded basins at a certain pace. We study a case with excellent historical and geological data of a diversion of the river Rhine following catastrophic inundations (1421-1424 AD) into medieval reclaimed land. Numerical modelling of deltaic splay and channel development is combined with reconstructions from historical maps and geological data. This yields detailed insight in pacing of splay sedimentation and changing hydrodynamics in the channel upstream of the diversion in the two centuries following the inundation. The equivalent of the full sand budget of the river Rhine was effectively trapped in the developing splay. The tidal-avulsion splay evolution on aspects is similar to that of fluvial crevassing into flood basins documented for settings lacking ‘downstream’ tidal control. The typical small-scale delta-lobe avulsion cycles: mouth bar formation, backward sedimentation, upstream avulsion, channel progradation and mouth bar formation are reproduced in the splay-modelling. The pacing of splay development, however, is relatively fast due to the presence of tides and the water depth in the receiving basin. The diversion had a strong upstream impact, in particular on water levels in the feeding river channel at stages of peak flow. For two centuries levels were significantly raised, because bifurcation-imposed reduced transport capacity and associated sedimentation at the diversion site increased hydraulic roughness and hampered flow. These findings have implications regarding flood

  17. Correlation of preoperative MRI with the long-term outcomes of dorsal root entry zone lesioning for brachial plexus avulsion pain.

    PubMed

    Ko, Andrew L; Ozpinar, Alp; Raskin, Jeffrey S; Magill, Stephen T; Raslan, Ahmed M; Burchiel, Kim J

    2016-05-01

    OBJECT Lesioning of the dorsal root entry zone (DREZotomy) is an effective treatment for brachial plexus avulsion (BPA) pain. The role of preoperative assessment with MRI has been shown to be unreliable for determining affected levels; however, it may have a role in predicting pain outcomes. Here, DREZotomy outcomes are reviewed and preoperative MRI is examined as a possible prognostic factor. METHODS A retrospective review was performed of an institutional database of patients who had undergone brachial plexus DREZ procedures since 1995. Preoperative MRI was examined to assess damage to the DREZ or dorsal horn, as evidenced by avulsion of the DREZ or T2 hyperintensity within the spinal cord. Phone interviews were conducted to assess the long-term pain outcomes. RESULTS Between 1995 and 2012, 27 patients were found to have undergone cervical DREZ procedures for BPA. Of these, 15 had preoperative MR images of the cervical spine available for review. The outcomes were graded from 1 to 4 as poor (no significant relief), good (more than 50% pain relief), excellent (more than 75% pain relief), or pain free, respectively. Overall, DREZotomy was found to be a safe, efficacious, and durable procedure for relief of pain due to BPA. The initial success rate was 73%, which declined to 66% at a median follow-up time of 62.5 months. Damage to the DREZ or dorsal horn was significantly correlated with poorer outcomes (p = 0.02). The average outcomes in patients without MRI evidence of DREZ or dorsal horn damage was significantly higher than in patients with such damage (3.67 vs 1.75, t-test; p = 0.001). A longer duration of pain prior to operation was also a significant predictor of treatment success (p = 0.004). CONCLUSIONS Overall, the DREZotomy procedure has a 66% chance of achieving meaningful pain relief on long-term follow-up. Successful pain relief is associated with the lack of damage to the DREZ and dorsal horn on preoperative MRI. PMID:26406799

  18. Successful Outflow Reconstruction to Salvage Traumatic Hepatic Vein-Caval Avulsion of a Normothermic Machine Ex-Situ Perfused Liver Graft

    PubMed Central

    Athanasopoulos, Panagiotis G.; Hadjittofi, Christopher; Dharmapala, Arinda Dinesh; Orti-Rodriguez, Rafael Jose; Ferro, Alessandra; Nasralla, David; Konstantinidou, Sofia K.; Malagó, Massimo

    2016-01-01

    Abstract Donor organ shortage continues to limit the availability of liver transplantation, a successful and established therapy of end-stage liver diseases. Strategies to mitigate graft shortage include the utilization of marginal livers and recently ex-situ normothermic machine perfusion devices. A 59-year-old woman with cirrhosis due to primary sclerosing cholangitis was offered an ex-situ machine perfused graft with unnoticed severe injury of the suprahepatic vasculature due to road traffic accident. Following a complex avulsion, repair and reconstruction of all donor hepatic veins as well as the suprahepatic inferior vena cava, the patient underwent a face-to-face piggy-back orthotopic liver transplantation and was discharged on the 11th postoperative day after an uncomplicated recovery. This report illustrates the operative technique to utilize an otherwise unusable organ, in the current environment of donor shortage and declining graft quality. Normothermic machine perfusion can definitely play a role in increasing the graft pool, without compromising the quality of livers who had vascular or other damage before being ex-situ perfused. Furthermore, it emphasizes the importance of promptly and thoroughly communicating organ injuries, as well as considering all reconstructive options within the level of expertise at the recipient center. PMID:27082550

  19. Comparative evaluation of four transport media for maintaining cell viability in transportation of an avulsed tooth – An in vitro study

    PubMed Central

    Bharath, Makonahalli Jaganath; Sahadev, Chickmagravalli Krishnegowda; Ramachandra, Praveen Kumar Makonahalli; Rudranaik, Sandeep; George, Jijo; Thomas, Ashna

    2015-01-01

    Objectives: The study was performed to compare and evaluate the efficacy of four experimental storage media (Hank's balanced salt solution, Ringer's lactate solution, tender coconut water, and green tea extract) for maintaining cell viability of human periodontal cells at different time intervals of 15 min 30 min, 60 min, and 90 min. Materials and Methods: Human periodontal cells were cultured and stored in the four media. After 15 min 30 min, 60 min, and 90 min, the different media were examined under optical microscope and viabilities analyzed using an optical calorimeter. Mean and standard deviation were estimated from the results that were statistically analyzed using one-way analysis of variance (ANOVA) to identify the significant groups. Results: The results indicated that there was no difference in cell viability between the four media up to a period of 60 min, whereas green tea extract showed a lower cell viability after 90 min. Conclusion: Within the limitations of the present study, it appears that due to superior osmolality, cost effectiveness, and easier availability, Ringer's lactate, tender coconut water, and green tea extract can be used as alternate storage media for avulsed tooth. PMID:25767771

  20. The Effect of Propolis As A Biological Storage Media on Periodontal Ligament Cell Survival in An Avulsed Tooth: An In Vitro Study

    PubMed Central

    Ahangari, Zohreh; Alborzi, Samiye; Yadegari, Zahra; Dehghani, Fatemeh; Ahangari, Leila; Naseri, Mandana

    2013-01-01

    Objective: Both the length of extra-alveolar time and type of storage media are significant factors that can affect the long-term prognosis of replanted teeth. This study aims to compare propolis 50%, propolis 10%, Hank’s balanced salt solution (HBSS), milk and egg white on periodontal ligament (PDL) cell survival for different time points. Materials and Methods: : In this in vitro experimental study, we divided 60 extracted teeth without any periodontal diseases into five experimental and two control groups that consisted each experimental group with 10 and each control group with 5 teeth. The storage times were one and three hours for each media. The controls corresponded to 0-minute (positive) and 12-hour (negative) dry time. Rinsing in the experimental media, the teeth were treated with dispase and collagenase for one hour. Cell viability was determined by using trypan blue exclusion. Statistical analysis of the data was accomplished by using two-way analysis of variance (ANOVA) complemented by the Tukey’s HSD post-hoc. Results: Within one hour, there was no significant difference between the two propolis groups, however these two groups had significantly more viable PDL cells compared to the other experimental media (p<0.05). The results of the three-hour group showed that propolis 10% was significantly better than egg white, whereas both propolis 10% and 50% were significantly better than milk (p<0.05). Conclusion: Based on PDL cell viability, propolis could be recommended as a suitable biological storage media for avulsed teeth. PMID:24027666

  1. Nerve Wrapping of the Sciatic Nerve With Acellular Dermal Matrix in Chronic Complete Proximal Hamstring Ruptures and Ischial Apophyseal Avulsion Fractures

    PubMed Central

    Haus, Brian M.; Arora, Danny; Upton, Joseph; Micheli, Lyle J.

    2016-01-01

    Background: Patients with chronic injuries of the proximal hamstring can develop significant impairment because of weakness of the hamstring muscles, sciatic nerve compression from scar formation, or myositis ossificans. Purpose: To describe the surgical outcomes of patients with chronic injury of the proximal hamstrings who were treated with hamstring repair and sciatic neurolysis supplemented with nerve wrapping with acellular dermal matrix. Study Design: Retrospective case series; Level of evidence, 4. Methods: Fifteen consecutive patients with a diagnosis of chronic complete proximal hamstring rupture or chronic ischial tuberosity apophyseal avulsion fracture (mean age, 39.67 years; range, 14-69 years) were treated with proximal hamstring repair and sciatic neurolysis supplemented with nerve wrapping with acellular dermal matrix. Nine patients had preoperative sciatica, and 6 did not. Retrospective chart review recorded clinical outcomes measured by the degree of pain relief, the rate of return to activities, and associated postoperative complications. Results: All 15 patients were followed in the postoperative period for an average of 16.6 months. Postoperatively, there were 4 cases of transient sciatic nerve neurapraxia. Four patients (26%) required postoperative betamethasone sodium phosphate (Celestone Soluspan) injectable suspension USP 6 mg/mL. Among the 9 patients with preoperative sciatica, 6 (66%) had a good or excellent outcome and were able to return to their respective activities/sports; 3 (33%) had persistent chronic pain. One of these had persistent sciatic neuropathy that required 2 surgical reexplorations and scar excision after development of recurrent extraneural scar formation. Among the 6 without preoperative sciatica, 100% had a good or excellent outcomes and 83% returned to their respective activities/sports. Better outcomes were observed in younger patients, as the 3 cases of persistent chronic sciatic pain were in patients older than 45

  2. Successful Outflow Reconstruction to Salvage Traumatic Hepatic Vein-Caval Avulsion of a Normothermic Machine Ex-Situ Perfused Liver Graft: Case Report and Management of Organ Pool Challenges.

    PubMed

    Athanasopoulos, Panagiotis G; Hadjittofi, Christopher; Dharmapala, Arinda Dinesh; Orti-Rodriguez, Rafael Jose; Ferro, Alessandra; Nasralla, David; Konstantinidou, Sofia K; Malagó, Massimo

    2016-04-01

    Donor organ shortage continues to limit the availability of liver transplantation, a successful and established therapy of end-stage liver diseases. Strategies to mitigate graft shortage include the utilization of marginal livers and recently ex-situ normothermic machine perfusion devices.A 59-year-old woman with cirrhosis due to primary sclerosing cholangitis was offered an ex-situ machine perfused graft with unnoticed severe injury of the suprahepatic vasculature due to road traffic accident.Following a complex avulsion, repair and reconstruction of all donor hepatic veins as well as the suprahepatic inferior vena cava, the patient underwent a face-to-face piggy-back orthotopic liver transplantation and was discharged on the 11th postoperative day after an uncomplicated recovery.This report illustrates the operative technique to utilize an otherwise unusable organ, in the current environment of donor shortage and declining graft quality. Normothermic machine perfusion can definitely play a role in increasing the graft pool, without compromising the quality of livers who had vascular or other damage before being ex-situ perfused. Furthermore, it emphasizes the importance of promptly and thoroughly communicating organ injuries, as well as considering all reconstructive options within the level of expertise at the recipient center. PMID:27082550

  3. Comparative evaluation of maintenance of cell viability of an experimental transport media “coconut water” with Hank's balanced salt solution and milk, for transportation of an avulsed tooth: An in vitro cell culture study

    PubMed Central

    Thomas, Toby; Gopikrishna, Velayutham; Kandaswamy, Deivanayagam

    2008-01-01

    The purpose of this study was to evaluate the efficiency of a new storage medium, coconut water, in comparison with other traditional storage media like Hank's balanced salt solution (HBBS) and milk, in maintaining the viability of an established cell line BHK-21/C13 (baby hamster kidney fibroblasts) using the direct suspension cell culture technique. The storage media tested in the study were divided into three major groups and two control groups - Group A: HBBS, Group B: milk, and Group C: coconut water. The positive and negative controls corresponded to 0-minute and 24-hour dry times respectively. The three groups were then divided into five subgroups, each denoting the storage time periods 15 min, 30 min, 45 min, 60 min and 120 min respectively. The cell line BHK-21/C13 was subcultured and the number of cells was standardized by making a cell suspension using Minimal Essential Medium in five culture plates. One ml of each experimental group (HBBS, milk and coconut water) was added to eight wells of each culture plate. The culture plates containing the cells and the experimental groups were incubated for the respective time periods. The cells were then counted with a Neubauer counting chamber, under light microscope. The results were statistically analyzed using One-way ANOVA and Multiple Range Test using the Tukey-HSD procedure to identify the significant groups at p ≤ 0.05. Within the parameters of this study, it appears that coconut water may be a better alternative to HBSS or milk, in terms of maintaining cell viability. Coconut water can be used as a superior transport medium for avulsed teeth. PMID:20142880

  4. Serotonergic 5-HT(1A) receptor agonist (8-OH-DPAT) ameliorates impaired micturition reflexes in a chronic ventral root avulsion model of incomplete cauda equina/conus medullaris injury.

    PubMed

    Chang, Huiyi H; Havton, Leif A

    2013-01-01

    Trauma to the thoracolumbar spine commonly results in injuries to the cauda equina and the lumbosacral portion of the spinal cord. Both complete and partial injury syndromes may follow. Here, we tested the hypothesis that serotonergic modulation may improve voiding function after an incomplete cauda equina/conus medullaris injury. For this purpose, we used a unilateral L5-S2 ventral root avulsion (VRA) injury model in the rat to mimic a partial lesion to the cauda equina and conus medullaris. Compared to a sham-operated series, comprehensive urodynamic studies demonstrated a markedly reduced voiding efficiency at 12 weeks after the VRA injury. Detailed cystometrogram studies showed injury-induced decreased peak bladder pressures indicative of reduced contractile properties. Concurrent external urethral sphincter (EUS) electromyography demonstrated shortened burst and prolonged silent periods associated with the elimination phase. Next, a 5-HT(1A) receptor agonist, 8-hydroxy-2-(di-n-propylamino)-tetralin (8-OH-DPAT), was administered intravenously at 12 weeks after the unilateral L5-S2 VRA injury. Both voiding efficiency and maximum intravesical pressure were significantly improved by 8-OH-DPAT (0.3-1.0 mg/kg). 8-OH-DPAT also enhanced the amplitude of EUS tonic and bursting activity as well as duration of EUS bursting and silent period during EUS bursting. The results indicate that 8-OH-DPAT improves voiding efficiency and enhances EUS bursting in rats with unilateral VRA injury. We conclude that serotonergic modulation of the 5-HT(1A) receptor may represent a new strategy to improve lower urinary tract function after incomplete cauda equina/conus medullaris injuries in experimental studies. PMID:23099413

  5. Anal avulsion caused by abdominal crush injury.

    PubMed

    Terrosu, G; Rossetto, A; Kocjancic, E; Rossitti, P; Bresadola, V

    2011-12-01

    We report the case of a pelvic and lower abdomen crushing trauma in 37-year-old male patient. The patient had an open lumbar wound, laceration of the psoas muscle, pelvic fracture, a ruptured urogenital diaphragm, and extensive urogenital lacerations. An emergency laparotomy was performed with debridment, urethral reconstruction, and osteosynthesis of the pubic bone. The mobilization of the patient revealed a deep gap, about 8 × 8 cm, in the perineum, with the anus and rectum displaced from their original site. Anal reimplantation was performed, suturing the median raphe, inserting two pelvic drainage tubes, and fashioning a loop transverse colostomy. Closed rectal traumas account for only 4-11% of all rectal traumas. Crushing of the pelvis causes a sudden reduction in its anteroposterior diameter and a corresponding increase in its latero-lateral diameter, together with an abrupt rise in intra-abdominal pressure. The anus is pushed out of the perineal plane due to the divarication of the levator muscles. As suggested in the literature, the standard treatment is wound debridement with immediate or deferred repair, fashioning a diversion colostomy, and repair of the rectum, wherever possible. PMID:21556880

  6. River diversions, avulsions and captures in the Tortuguero coastal plain

    NASA Astrophysics Data System (ADS)

    Galve, Jorge Pedro; Alvarado, Guillermo; Pérez Peña, José Vicente; Azañón, José Miguel; Mora, Mauricio; Booth-Rea, Guillermo

    2016-04-01

    The Tortuguero area is a coastal plain that forms part of the North Limón sedimentary basin, the back-arc region of the Caribbean side of Costa Rica. This coastal plain is characterised by an abnormal drainage pattern with river captures, diversions and shifts in channel directions. We are analyzing this anomalous drainage network adopting a classical geomorphological approach combined with geomorphometric techniques. The SRTM DEM at 1 arc-second of resolution (~30 m) from NASA, topographic maps 1:50,000, satellital images and the digital cartography of the drainage network have been used for inventorying the channel pattern anomalies. River segments were categorized according to sinuosity, orientation, slope changes and incision using GIS tools. Initially, anomalies in the analyzed river courses suggested that buried thrust fronts could disrupt their natural pattern. However, we have not identified any evidence to link the activity of buried structures with the disruption of natural drainage. Blind thrusts detected through seismic subsurface exploration in the SE sector of the Tortuguero plain do not seem to produce changes in the sinuosity, orientation, slope and incision of rivers as those observed in the deeply studied tectonically active area of the Po Plain (Italy). The identified river pattern anomalies have been explained due to other alternative causes: (1) the migration of the mouths of Reventazón, Pacuare and Matina rivers is produced by sand sedimentation in the coast because of a successive ridge beach formation. This migration to the SE has the same direction than the main ocean currents those deposited the sand. (2) The anomalous course of Parismina river is most probably conditioned by the fracturation of the dissected volcanic apron of Turrialba volcano. (3) Channel migration and capture of Barbilla river by Matina river can be triggered by the tectonic tilting of the coastal plain towards the SE. The subsidence of the SE sector of the plain was documented before the Limón earthquake in 1991. (4) The Sucio, North Chirripó and Toro Amarillo rivers form a channel that takes an abnormal direction towards the NW instead of taking their natural direction towards the Caribbean Sea in the E. This anomalous behaviour is conditioned by the existence of a megafan recently recognized by using topographic data from the SRTM mission. The developed analysis is the first step towards improving the knowledge about the processes behind the observed anomalies. Current research is analyzing the role of active vulcanism and tectonics on Tortuguero rivers behaviour. This has implications on the consequences of torrent-related hazards (flash floods and lahars) that may divert river channels and change the landscape of the coastal plain in only one event.

  7. Hypergravity effects on normal and avulsed developing avian radii

    NASA Technical Reports Server (NTRS)

    Negulesco, J. A.; Clark, D. L.

    1976-01-01

    Rhode Island red female chicks were subjected to complete closed fracture of the right radius at 2 weeks post-hatching. The animals were allowed to heal for 1 week at either earth-gravity or 2-G-hypergravity state with control and estrogen-injected groups. Intact and fractured radial length, weight, average epiphysial-diaphysial diameters, and length, width, and weight of healing fracture callus were measured. Daily 2000 IU estrogen administration for 7 d increased intact radial length. Estrogen augments the effects of the 2-G state by inhibiting growth and depleting the mass of both intact and fractured radii and by decreasing the average distal epiphysial diameter of fractured bones. Animals exposed to the hypergravity state without hormonal treatment showed decreased fractured radial length, weight, and smaller proximal epiphysial diameters. The measurable parameters of the fracture callus (width, length, and weight) were depressed by the hypergravity state regardless of whether the animal was untreated or supplemented with estrogen.

  8. Airbag-induced thumb avulsion: two case reports.

    PubMed

    Stoel, Anne-Marie C C; Vanhaecke, Jeroen; Dezillie, Marleen; Oosterlinck, Dirk; Stockmans, Filip

    2015-03-01

    Although airbags are designed to save lives and protect victims from serious injuries, airbag deployment can cause unwanted lesions. In this case report, two cases are presented of young women who sustained an important fracture dislocation of the first carpometacarpal joint (CMC I joint) caused by airbag deployment during a car collision. PMID:25762890

  9. Avulsion of the auricle in an anticoagulated patient: is leeching contraindicated? A review and a case.

    PubMed

    Mommsen, Jens; Rodríguez-Fernández, Javier; Mateos-Micas, Mario; Vázquez-Bouso, Olga; Gumbao-Grau, Victor; Forteza-Gonzalez, Gabriel

    2011-06-01

    Amputation of the auricle is a periodic occurrence leading to disfigurement if not treated properly. Venous stasis is a common complication in reattachments and requires decongestant and anticoagulant treatment. Today, leech therapy is the treatment of choice. Common problems are that it is not available everywhere and that it is usually contraindicated in anticoagulated patients. The peculiarities of leech therapy and the various aspects of surgical management are reviewed. A case of a partial amputation of the auricle in a patient under concomitant anticoagulation therapy with warfarin is presented. The amputated part was reattached in another hospital without microvascular anastomosis. The patient presented to our department with early signs of venous congestion. Leech therapy was started 35 hours after trauma, and the patient continued his anticoagulation therapy. With this treatment, 90% of the amputated part was rescued. The anticoagulation therapy of the patient may have played an important role in the first hours after reattachment, preventing capillary thrombosis and in consequence facilitating the minimal oxygenation necessary. The claim that anticoagulation therapy is a contraindication to leeching should be questioned in cases of reattachments in well-controllable locations without arterial anastomosis. PMID:22655116

  10. Avulsion of the Auricle in an Anticoagulated Patient: Is Leeching Contraindicated? A Review and a Case

    PubMed Central

    Mommsen, Jens; Rodríguez-Fernández, Javier; Mateos-Micas, Mario; Vázquez-Bouso, Olga; Gumbao-Grau, Victor; Forteza-Gonzalez, Gabriel

    2011-01-01

    Amputation of the auricle is a periodic occurrence leading to disfigurement if not treated properly. Venous stasis is a common complication in reattachments and requires decongestant and anticoagulant treatment. Today, leech therapy is the treatment of choice. Common problems are that it is not available everywhere and that it is usually contraindicated in anticoagulated patients. The peculiarities of leech therapy and the various aspects of surgical management are reviewed. A case of a partial amputation of the auricle in a patient under concomitant anticoagulation therapy with warfarin is presented. The amputated part was reattached in another hospital without microvascular anastomosis. The patient presented to our department with early signs of venous congestion. Leech therapy was started 35 hours after trauma, and the patient continued his anticoagulation therapy. With this treatment, 90% of the amputated part was rescued. The anticoagulation therapy of the patient may have played an important role in the first hours after reattachment, preventing capillary thrombosis and in consequence facilitating the minimal oxygenation necessary. The claim that anticoagulation therapy is a contraindication to leeching should be questioned in cases of reattachments in well-controllable locations without arterial anastomosis. PMID:22655116

  11. Arthroscopic treatment of avulsed tibial spine fractures using a transosseous sutures technique.

    PubMed

    Wagih, Ahmad M

    2015-03-01

    Severely displaced tibial spine fractures should be treated surgically to restore joint congruity and cruciate integrity with reduction and fixation through an arthrotomy or arthroscopic techniques. Arthroscopy is preferred as it allows for accurate diagnosis and treatment of associated injuries and reduction and fixation of all types of tibial spine fractures while reducing the morbidity associated with open techniques. We report the clinical and radiographical results of 11 cases treated with a technique of arthroscopic internal fixation with non-absorbable sutures, after an average follow-up of 16.3 months (range, 11 to 21 months). The clinical examination using the IKDC system revealed all patients to have a negative Lachman test and no quadriceps weakness except one patient with some laxity (hard end 1+ Lachman test). One patient had a minor extension deficit of approximately 5°. The other patients showed a full range of motion without extension loss. This technique is simple, reproducible and very useful in dealing with these fractures. PMID:26280867

  12. Knowledge and Awareness Regarding Avulsion and Its Immediate Treatment in School Teachers in Bangalore City (South)

    PubMed Central

    Prathyusha, P; Harshini, T; Haripriya, B; Pramod, I John; Swathi, K; Samyuktha, C Lalitha

    2015-01-01

    Background: Dental traumas are most common in children in school environment. Teachers often come across such emergency situations. The purpose of this study was to evaluate aware-ness of teachers regarding traumas & emergency management. Material and Methods: A total of 123 teachers participated in this survey. Questionnaire forms were distributed among teachers. The data was collected and analysed. Results: Results showed that 97.5%of teachers received no orientation regarding this, 33.3% of them felt they cannot identify the tooth, 52% opined they would not pick up the tooth, 62.6% felt they should clean with water, 44.7% said they would take the child to dental office, 38.2% would seek professional help immediately, 63.4% of them said they would not be able to replace the tooth back & 40.7% of them felt they prefer water to store the tooth. Conclusion: Overall the knowledge in this regard is grossly inadequate. Their answers were based on intuition rather than information. This study suggests urgent need for campaigns & training programs for instructors who are usually the first to witness traumas in schools. PMID:26464548

  13. Oral Trauma and Tooth Avulsion Following Explosion of E-Cigarette.

    PubMed

    Rogér, James M; Abayon, Maricelle; Elad, Sharon; Kolokythas, Antonia

    2016-06-01

    Electronic cigarettes (E-cigarettes), or personal vaporizers, were introduced in 2003 and have been available in the United States since 2007. In addition to the health and safety concerns of the aerosol delivery of nicotine through E-cigarettes, during the past 8 years, reports of explosions and fires caused by the E-cigarette devices have led the US Fire Administration to evaluate the safety of these devices. These explosions have been observed frequently enough that the US Department of Transportation has recently banned E-cigarette devices in checked baggage aboard airplanes. This report contributes to existing knowledge about the hazards related to E-cigarettes by describing oral hard and soft tissue injuries from an E-cigarette explosion. PMID:26850869

  14. Decompression–Avulsion of the Auriculotemporal Nerve for Treatment of Migraines and Chronic Headaches

    PubMed Central

    Sanniec, Kyle; Borsting, Emily; Amirlak, Bardia

    2016-01-01

    Summary: Surgical decompression of peripheral branches of the trigeminal and occipital nerves has been shown to alleviate migraine symptoms. Site II surgery involves decompression of the zygomaticotemporal branch of the trigeminal nerve by the technique developed by Guyuron. Failure of site II surgery may occur secondary to an inability to recognize a second temporal trigger: site V, the auriculotemporal nerve. A direct approach for site V has been used with no clear description in the literature. Herein, we describe a safe and efficient method for auriculotemporal nerve decompression during the Guyuron endoscopic approach. Close attention to all temporal sites is necessary to avoid potential failure of migraine decompression surgery. PMID:27200240

  15. [Subtotal avulsion of the lower limb after traumatic section in a 2 and a half-year-old child].

    PubMed

    Costecalde, M; Gaubert, J; Bourse, P; Hornus, D; Fries, F; Thillaye du Boullay, C; Bardier, M

    1989-01-01

    Reimplantation after subtotal section of the right lower limb under the Scarpa triangle was been attempted and was successful. Section and contusion of the femoral artery and vein required 2 end-to-end saphenous bypass grafts. The use of the lower limb is correct, after to a follow up of 4 years. The risks, inherent to all proximal section, with important muscular masses, in a small child, are described. Functional prognosis depends on three aspects: bone, vessels, and nerves. A tibial pseudarthrosis had to be operated secondarily with significant lengthening. A partial stenosis of the graft was demonstrated arteriographically. Pes equinus, a result of paralysis, has been fitted with an orthesis. This observation is almost an experimental one: what can be the future of a reimplanted lower limb in the child. PMID:2930140

  16. Bilateral Simultaneous Avulsion Fractures of the Proximal Tibia in a 14-Year-Old Athlete with Vitamin-D Deficiency

    PubMed Central

    Harb, Ziad; Malhi, Arfan

    2015-01-01

    Fractures involving the proximal tibial epiphysis are rare and form 0.5% of all epiphyseal injuries. The specific anatomical and developmental features of the proximal tibial epiphysis make it vulnerable to unique patterns of fractures. Vitamin-D plays a vital role in bone homeostasis and its deficiency has an impact on fracture risk and healing. We present the first ever reported case of simultaneous bilateral proximal tibial physeal fractures in an athlete with vitamin-D deficiency. Treatment consisted of plaster immobilisation, and the patient made a full recovery and returned to preinjury level of activities. We report this case for its uniqueness and as an educational review of the importance of the developmental anatomy of the proximal tibia. We review the literature and discuss how the stages of the growing physis determine the type of fracture sustained. PMID:26425381

  17. Below Level Central Pain Induced by Discrete Dorsal Spinal Cord Injury

    PubMed Central

    Ellis, Amanda L.; McFadden, Andrew; Brown, Kimberley; Starnes, Charlotte; Maier, Steven F.; Watkins, Linda R.; Falci, Scott

    2010-01-01

    Abstract Central neuropathic pain occurs with multiple sclerosis, stroke, and spinal cord injury (SCI). Models of SCI are commonly used to study central neuropathic pain and are excellent at modeling gross physiological changes. Our goal was to develop a rat model of central neuropathic pain by traumatizing a discrete region of the dorsal spinal cord, thereby avoiding issues including paralysis, urinary tract infection, and autotomy. To this end, dorsal root avulsion was pursued. The model was developed by first determining the number of avulsed dorsal roots sufficient to induce below-level hindpaw mechanical allodynia. This was optimally achieved by unilateral T13 and L1 avulsion, which resulted in tissue damage confined to Lissauer's tract, dorsal horn, and dorsal columns, at the site of avulsion, with no gross physical changes at other spinal levels. Behavior following avulsion was compared to that following rhizotomy of the T13 and L1 dorsal roots, a commonly used model of neuropathic pain. Avulsion induced below-level allodynia that was more robust and enduring than that seen after rhizotomy. This, plus the lack of direct spinal cord damage associated with rhizotomy, suggests that avulsion is not synonymous with rhizotomy, and that avulsion (but not rhizotomy) is a model of central neuropathic pain. The new model described here is the first to use discrete dorsal horn damage by dorsal root avulsion to create below-level bilateral central neuropathic pain. PMID:20649467

  18. Broken or knocked out tooth

    MedlinePlus

    Pfenninger JL, Fowlder GC. Management of dental injuries and reimplantation of an avulsed tooth. In: Pfenninger JL, Fowlder GC, eds. Pfenninger & Fowler's Procedures for Primary Care . 3rd ed. Philadelphia, PA: ...

  19. Mallet finger - aftercare

    MedlinePlus

    Baseball finger - aftercare; Drop finger - aftercare; Avulsion fracture - mallet finger - aftercare ... Mallet finger occurs when you cannot straighten your finger: when you try to straighten it, the tip of your ...

  20. Current developments in interim transport (storage) media in dentistry: an update.

    PubMed

    Malhotra, N

    2011-07-01

    Healing following avulsion and replantation is dependent on the extent of pulpal and periodontal ligament (PDL) tissue damage. Therefore, immediate replantation is the recommended treatment of choice for an avulsed permanent tooth. To achieve a more favourable prognosis following tooth replantation, use of an appropriate interim transport medium is usually advocated. Numerous studies have researched and advocated the use of media like saliva, milk, Hank's Balanced Salt Solution (HBSS) and ViaSpan. However, current research has indicated the use of few newer media as promising interim transport media for an avulsed tooth. This review summarises the current developments regarding the introduction of newer interim transport media for the treatment of avulsed teeth. PMID:21738189

  1. Morphology of Red Creek, Wyoming, an arid-region anastomosing channel system

    USGS Publications Warehouse

    Schumann, R.R.

    1989-01-01

    The narrow, deep, and sinuous main channel is flanked by anastomosing flood channels, or anabranches. Most anabranches are initiated at meander bends. The primary mechanism of anabranch initiation is avulsion during overbank floods. -from Author

  2. Evaluating the Influence of Floodplain-filling Styles on Channel-belt Stacking and Basin-scale Fluvial Architecture

    NASA Astrophysics Data System (ADS)

    Chamberlin, E.; Hajek, E. A.

    2014-12-01

    Recent work in modern and ancient systems has shown a range of characteristic floodplain sedimentation patterns acting over a range of temporal and spatial scales. In aggradational fluvial systems floodplain sedimentation style influences where rivers relocate during avulsion, which in turn influences the distribution of channel-belt sandstones in stratigraphy over long timescales. Exploring the link between floodplain-sedimentation patterns and avulsions is therefore important for both predicting stratigraphic architecture and using stratigraphy to interpret paleo-floodplain sedimentation dynamics. Here we use an object-based model of basin filling to explore how different floodplain aggradation styles (including both uniform and exponential decay) affect the stratigraphic preservation of three different avulsion patterns: random (channels are equally likely to relocate anywhere on the floodplain), compensational (channels relocate to the lowest point on the floodplain), and clustered (channels relocate to a point near the previous channel position). Preliminary modeling results suggest that only clustered avulsion patterns are identifiable under uniform floodplain aggradation conditions, but that different avulsion patterns generate unique sand-body distributions under exponential floodplain sedimentation. This suggests that floodplain-aggradation styles influence how well we can interpret paleo-avulsion patterns in ancient deposits. We apply these insights to the Paleocene-Eocene Wasatch Formation in western Colorado to explore the relationship between preserved floodplain deposits and basin-scale sand-body architecture. We compare proxies for paleo-floodplain-aggradation patterns (including paleosol development, lateral continuity of paleosol horizons, and occurrence and distribution of splays) in three different members with quantitative metrics of channel-body organization at both sand-body and outcrop scales. Changes in floodplain deposits and sand

  3. Extreme river response to climate-induced aggradation in a forested, montane basin, Carbon River, Mount Rainier National Park, Washington, United States

    NASA Astrophysics Data System (ADS)

    Beyeler, J. D.; Rossi, R. K.; Kennard, P. M.; Beason, S. R.

    2013-12-01

    Climate change is drastically affecting the alpine landscape of Mount Rainier, encouraging glacial retreat, changes in snowpack thickness and longevity, and sediment delivery to downstream fluvial systems, leading to an extremely transport limited system and aggradation of the river valleys. River aggradation encourages devastating interactions between the pro-glacial braided fluvial systems and streamside floodplain ecosystems, in most places occupied by old-growth conifer forests. Current aggradation rates of the channels, bordered by late seral stage riparian forests, inhibit floodplain development, leading to an inverted relationship between perched river channels and lower-elevation adjacent floodplains. This disequilibrium creates a steeper gradient laterally towards the floodplains, rather than downstream; promoting flooding of streamside forest, removal and burial of vegetation with coarse alluvium, incision of avulsion channels, tree mortality, wood recruitment to channels, and ultimately widening the alluviated valley towards the glacially carved hillslopes. Aggradation and loss of streamside old-growth forest poses a significant problem to park infrastructure (e.g. roads, trails, and campgrounds) due to flood damage with as frequent as a two-year event. Other park rivers, the White River and Tahoma Creek, characterize two end-member cases. Despite an extremely perched channel, the White River is relatively stable; experiencing small avulsions while the old-growth streamside forest has remained mostly intact. These relatively small avulsions however severely impact park infrastructure, causing extensive flood damage and closure of the heavily trafficked state highway. Conversely debris flows on Tahoma Creek destroyed the streamside forest and migration across the valley is uninhibited. Mature streamside forests tend to oppose avulsions, sieving wood at the channel margins, promoting sediment deposition and deflection of erosive flows. Our study seeks to

  4. Arthroscopic repair of "peel-off" lesion of the posterior cruciate ligament at the femoral condyle.

    PubMed

    Rosso, Federica; Bisicchia, Salvatore; Amendola, Annunziato

    2014-02-01

    Posterior cruciate ligament (PCL) injuries are uncommon, and most occur in association with other lesions. The treatment of PCL injuries remains controversial; in addition, PCL injuries have been documented to have a propensity to heal. In the literature several different patterns of PCL injury have been described including midsubstance tears/injuries, tibial bony avulsions, femoral bony avulsions, and femoral "peel-off" injuries. A peel-off injury is a complete or incomplete soft-tissue disruption of the PCL at its femoral attachment site without associated bony avulsion. In recent years arthroscopic repair of femoral avulsion and peel-off lesions of the PCL has been reported. In most of these articles, a transosseous repair with sutures passed through 2 bone tunnels into the medial femoral condyle has been described. We present a case of a femoral PCL avulsion in a 20-year-old collegiate football player with an associated medial collateral ligament injury, and we report about a novel technique for PCL repair using 2 No. 2 FiberWire sutures and two 2.9-mm PushLock anchors (Arthrex) to secure tensioning the ligament at its footprint. PMID:24749037

  5. Late quaternary dynamics in the Madeira River basin, southern Amazonia (Brazil), as revealed by paleomorphological analysis.

    PubMed

    Hayakawa, Ericson H; Rossetti, Dilce F

    2015-03-01

    Ancient drainage systems are being increasingly documented in the Amazon basin and their characterization is crucial for reconstructing fluvial evolution in this area. Fluvial morphologies, including elongate belts, are well preserved along the Madeira River. Digital Elevation Model from the Shuttle Radar Topography Mission favored the detection of these features even where they are covered by dense rainforest. These paleomorphologies are attributed to the shifting position of past tributaries of the Madeira River through avulsions. These radial paleodrainage networks produced fan-shaped morphologies that resemble distributary megafans. Distinguishing avulsive tributary systems from distributary megafans in the sedimentary record is challenging. Madeira´s paleodrainage reveals the superposition of tributary channels formed by multiple avulsions within a given time period, rather than downstream bifurcation of coexisting channels. Channel avulsion in this Amazonian area during the late Quaternary is related to tectonics due to features as: (i) straight lineaments coincident with fault directions; (ii) northeastward tilting of the terrain with Quaternary strata; and (iii) several drainage anomalies, including frequent orthogonal drainage inflections. These characteristics altogether lead to propose that the radial paleodrainage present at the Madeira River margin results from successive avulsions of tributary channels over time due to tectonics. PMID:25806978

  6. Medial and lateral segond fractures in a skeletally immature patient: a radiographic marker for the multiply injured knee.

    PubMed

    Kwon, Oh Soo; Park, Min Jung; Tjoumakaris, Fotios P

    2011-11-01

    Marginal fractures of the medial tibial plateau have been reported in the literature as a secondary type of Segond fracture. Some reports described this entity in the setting of combined injuries such as root avulsions of the medial meniscus, complete disruption of the posterior cruciate ligament (PCL), partial tear of the anterior cruciate ligament (ACL), and tears of the medial meniscus and medial collateral ligament. It has been postulated that medial marginal fractures are secondary to compression of the medial aspect of the femoral condyle and tibial plateau with a corresponding posterolateral corner injury. However, this mechanism of injury may not always be as straightforward.This article presents a case of an alternate injury pattern in a skeletally immature patient. A 16-year-old boy sustained a varus force and twisting injury to his knee, resulting in radiographic evidence of multiple avulsion fractures of the knee, including a fibular epiphyseal avulsion fracture and medial and lateral Segond fractures. Usually, the avulsion fractures serve as markers for significant ligamentous injuries in adult patients, but our patient had minimal injury to the PCL, ACL, and posterolateral corner. Further physical examination and imaging studies revealed an anterior horn root avulsion, meniscocapsular separation, and anterior cortical rim fracture. A combination of imaging modalities helped us further characterize the injury pattern to devise the optimal surgical plan, especially the fixation of the anterior cortical fracture of the tibia. PMID:22049962

  7. Lithium Enhances Axonal Regeneration in Peripheral Nerve by Inhibiting Glycogen Synthase Kinase 3β Activation

    PubMed Central

    Su, Huanxing; Yuan, Qiuju; Qin, Dajiang; Yang, Xiaoying; So, Kwok-Fai; Wu, Wutian

    2014-01-01

    Brachial plexus injury often involves traumatic root avulsion resulting in permanent paralysis of the innervated muscles. The lack of sufficient regeneration from spinal motoneurons to the peripheral nerve (PN) is considered to be one of the major causes of the unsatisfactory outcome of various surgical interventions for repair of the devastating injury. The present study was undertaken to investigate potential inhibitory signals which influence axonal regeneration after root avulsion injury. The results of the study showed that root avulsion triggered GSK-3β activation in the injured motoneurons and remaining axons in the ventral funiculus. Systemic application of a clinical dose of lithium suppressed activated GSK-3β in the lesioned spinal cord to the normal level and induced extensive axonal regeneration into replanted ventral roots. Our study suggests that GSK-3β activity is involved in negative regulation for axonal elongation and regeneration and lithium, the specific GSK-3β inhibitor, enhances motoneuron regeneration from CNS to PNS. PMID:24967390

  8. Pure Varus Injury to the Knee Joint.

    PubMed

    Yoo, Jae Ho; Lee, Jung Ha; Chang, Chong Bum

    2015-06-01

    A 30-year-old male was involved in a car accident. Radiographs revealed a depressed marginal fracture of the medial tibial plateau and an avulsion fracture of the fibular head. Magnetic resonance imaging showed avulsion fracture of Gerdy's tubercle, injury to the posterior cruciate ligament (PCL), posterior horn of the medial meniscus, and the attachments of the lateral collateral ligament and the biceps femoris tendon. The depressed fracture of the medial tibial plateau was elevated and stabilized using a cannulated screw and washer. The injured lateral and posterolateral corner (PLC) structures were repaired and augmented by PLC reconstruction. However, the avulsion fracture of Gerdy's tubercle was not fixed because it was minimally displaced and the torn PCL was also not repaired or reconstructed. We present a unique case of pure varus injury to the knee joint. This case contributes to our understanding of the mechanism of knee injury and provides insight regarding appropriate treatment plans for this type of injury. PMID:26217477

  9. Non-invasive monitoring of vascularization of grafted engineered human oral mucosa

    NASA Astrophysics Data System (ADS)

    Wolf, D. E.; Seetamraju, M.; Gurjar, R. S.; Kuo, R. S.; Fasi, A.; Feinberg, S. E.

    2012-03-01

    Accident victims and victims of explosive devices often suffer from complex maxillofacial injuries. The lips are one of the most difficult areas of the face to reconstruct after an avulsion. Lip avulsion results in compromised facial esthetics and functions of speech and mastication. The process of reconstruction requires assessment of the vascularization of grafted ex vivo engineered tissue while it is buried underneath the skin. We describe the design and animal testing of a hand-held surgical probe based upon diffuse correlation spectroscopy to assess vascularization.

  10. Longitudinal tear of the inferior rectus muscle in orbital floor fracture.

    PubMed

    Kashima, Tomoyuki; Akiyama, Hideo; Kishi, Shoji

    2012-06-01

    We report a case of longitudinal avulsion of the inferior rectus muscle following orbital floor fracture and describe its clinical presentation, computed tomography (CT) features and management. A 53-year-old man felt vertical diplopia in all gaze immediately after the trauma. Orthoptic assessment showed left over right hypertropia of 20 prism diopters and left exotropia of 10 prism diopters in primary position. The left orbital floor fracture and the prolapse of orbital contents into the maxillary sinus were presented by CT. Exploration of the orbit was performed under general anesthesia. The displaced bone fragment was elevated and repositioned below the slastic implant. Diplopia continued in all directions of gaze, although the impairment of depression was reduced postoperatively. A residual left hypertropia of 10 prism diopters and exotropia of 10 prism diopters was present in primary position 1 month after surgery, though there were no enopthalmos or worsening of hypesthesia. Repeated CT revealed the muscle avulsion of inferior rectus at the lateral portion of the belly. The avulsion of a small segment of the inferior rectus and its herniation into maxillary sinus in more posterior views was detected by review of the preoperative images. Muscle avulsion should be considered in the management of orbital fracture if orbital tissue entrapment and nerve paresis are excluded as causes of reduction in ocular motility. A thorough review of the imaging studies for possible muscle injury is required before surgery in all cases of orbital fracture. PMID:22551369

  11. Traumatic Hallux Varus Treated by Minimally Invasive Extensor Hallucis Brevis Tenodesis

    PubMed Central

    Cheung, C. N.; Lui, T. H.

    2015-01-01

    A case of traumatic hallux varus due to avulsion fracture of the lateral side of the base of proximal phalanx was reported. The lateral instability of the first metatarsophalangeal joint was believed to be due to the disruption of adductor hallucis function. It was successfully managed by minimally invasive extensor hallucis brevis tenodesis. PMID:26793399

  12. Right main bronchus rupture from blunt chest trauma in a child.

    PubMed

    Alimi, Faouzi; Alijla, Hazem; Neily, Asma; Ghannouchi, Chams; El Hadj Sidi, Chighali; Jerbi, Sofian

    2016-09-01

    We report the case of a 6-year-old boy with right main bronchus avulsion after blunt chest trauma. Reimplantation of the right main bronchus at the carina was performed via a right posterolateral thoracotomy, with satisfactory long-term morphological and functional results. PMID:27298476

  13. Incisor reduction: a provisional aesthetic technique for traumatised teeth.

    PubMed

    Darby, L J; O'Connell, A C

    2010-12-11

    Patients in the mixed dentition who have suffered severe extrusion or avulsion injuries often present with difficult treatment decisions, especially when the initial emergency care has been compromised. Here we describe a well-tolerated, aesthetically acceptable and conservative method for treating such patients until a definitive treatment plan is possible. PMID:21151063

  14. Physical education undergraduates and dental trauma knowledge.

    PubMed

    Panzarini, Sônia Regina; Pedrini, Denise; Brandini, Daniela Atili; Poi, Wilson Roberto; Santos, Manoel Ferreira; Correa, João Paulo Toscani; Silva, Fernando Ferreira

    2005-12-01

    The aim of the present study was to assess the level of knowledge of undergraduates from the College of Physical Education (Toledo, Araçatuba) concerning dental avulsion injuries. Data showed that 95% of the respondents did not know what dental avulsion is, 73.5% said they know how to define dental replantation, however, only 26% were able to do it correctly. When asked about first emergency measures after an avulsion, 50% of the respondents said they know what they should do, and the most cited measure was to seek a dentist. When asked about optimal storage media, 45.5% would keep it in a favorable one, and 28% did not know where to keep the tooth until treatment. Only 25.6% indicated a suitable extra-oral time for replantation; 90.3% of the respondents had received no advice about the emergency management of dental avulsion; 90% said they consider this an important and necessary subject. The results indicated that educational campaigns are necessary to improve the emergency management of dental injuries by those future P.E. professors for a better prognosis of dental replantation. PMID:16262617

  15. Major complications and risk factors associated with surgical correction of congenital medial patellar luxation in 124 dogs.

    PubMed

    Cashmore, R G; Havlicek, M; Perkins, N R; James, D R; Fearnside, S M; Marchevsky, A M; Black, A P

    2014-01-01

    Dogs treated for congenital medial patellar luxation were reviewed for the purpose of determining the incidence of postoperative major complications requiring surgical revision and the risk factors for their occurrence. Major complications occurred in 18.5% of the patellar luxation stabilization procedures with implant associated complications being the most frequent, patellar reluxation the second, and tibial tuberosity avulsion the third most common major complication. Other complications included patellar ligament rupture and trochlear wedge displacement. When recession trochleoplasty was performed in addition to tibial tuberosity transposition, a 5.1-fold reduction in the rate of patellar reluxation was observed. Release of the cranial belly of the sartorius muscle further reduced the incidence of patellar reluxation, while patella alta (pre- or postoperative) and patellar luxation grade were not found to influence the rate of reluxation. Tibial tuberosity avulsion was 11.1-times more likely when using a single Kirschner wire to stabilize a transposition, compared with two Kirschner wires. Independent to the number of Kirschner wires used, the more caudodistally the Kirschner wires were directed, the higher the risk for tibial tuberosity avulsion. Tension bands were used in 24.4% of the transpositions with no tuberosity avulsion occurring in stifles stabilized with a tension band. Overall, grade 1 luxations had a significantly lower incidence of major complications than other grades, while body weight, age, sex, and bilateral patellar stabilization were not associated with risk of major complication development. PMID:24817090

  16. [Postpartum levator ani muscle injuries. Diagnosis and treatment].

    PubMed

    Chojnacki, Michał; Borowski, Dariusz; Wielgoś, Mirosław; Węgrzyn, Piotr

    2015-01-01

    Levator ani muscle (LAM) injuries are much more frequent than trauma to sphincter ani muscles, but so far they have been omitted in obstetric handbooks. Levator ani avulsion is observed only after vaginal delivery. Forceps delivery second stage of labor ≥ 110 min., fetal head circumference ≥ 35 cm, episiotomy and coincidence of anal sphincter trauma are risk factors for levator ani avulsion. The most vital issue in that type of trauma is pelvic organ prolapse and 2-4-fold higher risk of recurrence after prolapse surgery. The current level of evidence does not allow to conclusively determine the of role of levator avulsion in urinary incontinence. Levator injuries are occult, what constitutes the main diagnostic problem. Until recently magnetic resonance imaging has been the only diagnostic method until the development of 3-dimensional ultrasound. Nowadays, 3-D ultrasound is an essential technique in static and functional diagnosis of the levator ani. There are no effective methods of levator trauma prevention. Except the risk factors reduction, there are some pilot data about positive role of antepartal perineal muscle training. Physiotherapy plays the main role in reducing the effects of levator trauma. Mesh techniques are the most effective operative methods in coincident pelvic organ prolapse with levator avulsion, but there is still a 2-fold higher risk of recurrence. PMID:25775878

  17. Long-Term Spinal Ventral Root Reimplantation, but not Bone Marrow Mononuclear Cell Treatment, Positively Influences Ultrastructural Synapse Recovery and Motor Axonal Regrowth

    PubMed Central

    Barbizan, Roberta; Castro, Mateus V.; Ferreira Jr., Rui Seabra; Barraviera, Benedito; Oliveira, Alexandre L. R.

    2014-01-01

    We recently proposed a new surgical approach to treat ventral root avulsion, resulting in motoneuron protection. The present work combined such a surgical approach with bone marrow mononuclear cells (MC) therapy. Therefore, MC were added to the site of reimplantation. Female Lewis rats (seven weeks old) were subjected to unilateral ventral root avulsion (VRA) at L4, L5 and L6 levels and divided into the following groups (n = 5 for each group): Avulsion, sealant reimplanted roots and sealant reimplanted roots plus MC. After four weeks and 12 weeks post-surgery, the lumbar intumescences were processed by transmission electron microscopy, to analyze synaptic inputs to the repaired α motoneurons. Also, the ipsi and contralateral sciatic nerves were processed for axon counting and morphometry. The ultrastructural results indicated a significant preservation of inhibitory pre-synaptic boutons in the groups repaired with sealant alone and associated with MC therapy. Moreover, the average number of axons was higher in treated groups when compared to avulsion only. Complementary to the fiber counting, the morphometric analysis of axonal diameter and “g” ratio demonstrated that root reimplantation improved the motor component recovery. In conclusion, the data herein demonstrate that root reimplantation at the lesion site may be considered a therapeutic approach, following proximal lesions in the interface of central nervous system (CNS) and peripheral nervous system (PNS), and that MC therapy does not further improve the regenerative recovery, up to 12 weeks post lesion. PMID:25353176

  18. [Chronic sports injuries of the knee joint].

    PubMed

    Mannil, M; Andreisek, G; Weishaupt, D; Fischer, M A

    2016-05-01

    Chronic sports injuries of the knee joint are common and mainly caused by repetitive (micro) trauma and exertion. Chronic insertion tendinopathies and avulsion fractures and symptoms related to entrapment, friction and impingement can be pathophysiologically distinguished in athletes. In this review, we depict the characteristic magnetic resonance imaging (MRI) findings of the most commonly occurring pathologies. PMID:27118369

  19. Examination and Treatment of Hamstring Related Injuries

    PubMed Central

    2012-01-01

    Context: There is a wide spectrum of hamstring-related injuries that can occur in the athlete. Accurate diagnosis is imperative to prevent delayed return to sport, injury recurrence, and accurate clinical decision making regarding the most efficacious treatment. Evidence Acquisition: This review highlights current evidence related to the diagnosis and treatment of hamstring-related injuries in athletes. Data sources were limited to peer-reviewed publications indexed in MEDLINE from 1988 through May 2011. Results: An accurate diagnostic process for athletes with posterior thigh–related complaints should include a detailed and discriminative history, followed by a thorough clinical examination. Diagnostic imaging should be utilized when considering hamstring avulsion or ischial apophyseal avulsion. Diagnostic imaging may also be needed to further define the cause of referred posterior thigh pain. Conclusions: Differentiating acute hamstring strains, hamstring tendon avulsions, ischial apophyseal avulsions, proximal hamstring tendinopathies, and referred posterior thigh pain is critical in determining the most appropriate treatment and expediting safe return to play. PMID:23016076

  20. Experimental Investigation of the Morphodynamic Controls on Delta-Lobe Formation and Shoreline Rugosity

    NASA Astrophysics Data System (ADS)

    Chadwick, A. J.; Ganti, V.; Lamb, M. P.

    2014-12-01

    River deltas grow primarily through repeated avulsions, where abrupt redistribution of sediment and water delivered to the ocean creates new delta lobes and rugose shorelines. Previous work isolates sediment caliber and cohesion as a primary control on the planform morphology of deltas; however, the effect of varying water discharges and backwater hydrodynamics on the creation of new delta lobes and development of shoreline rugosity is yet to be explored. Here we report on two physical experiments conducted with non-cohesive sediment in the river-ocean facility at Caltech, where a 7 m long, 7 cm wide alluvial river drains into a 6 m by 3 m "ocean" basin, building its own delta under subcritical flow and constant sea level conditions. The first experiment was conducted under constant sediment and water discharge, while in the second experiment we alternated between a low flow and a high flow such that the backwater hydrodynamics are persistent through time. We find that in the first experiment, channel dynamics are dominated by pronounced channel migration and avulsions at the location of imposed change in flow confinement, which result in smooth shorelines that are radially symmetric. However, in the second experiment, channel migration is arrested due to the creation (during low flow) and destruction (during high flow) of bars, which results in progradation of the delta front in a localized area, producing significant shoreline rugosity. The avulsion length in this experiment is determined by the backwater length, and delta progradation results in downstream translation of the avulsion node, thus determining the delta-lobe size and consequently the degree of shoreline rugosity. Our results indicate that deltas can exhibit rugose shorelines in the absence of cohesive sediment, and the time-iterative process of downstream-translating avulsion locations that are controlled by backwater hydrodynamics offer an alternative mechanism for development of shoreline rugosity.

  1. Experimental alluvial fan evolution: Channel dynamics, slope controls, and shoreline growth

    NASA Astrophysics Data System (ADS)

    Reitz, Meredith D.; Jerolmack, Douglas J.

    2012-06-01

    River deltas and alluvial fans have channelization and deposition dynamics that are not entirely understood, but which dictate the evolution of landscapes of great social, economic, and ecologic value. Our lack of a process-based understanding of fan dynamics hampers our ability to construct accurate prediction and hazard models, leaving these regions vulnerable. Here we describe the growth of a series of experimental alluvial fans composed of a noncohesive grain mixture bimodal in size and density. We impose conditions that simulate a gravel/sand fan prograding into a static basin with constant water and sediment influx, and the resulting fans display realistic channelization and avulsion dynamics. We find that we can describe the dynamics of our fans in terms of a few processes: (1) an avulsion sequence with a timescale dictated by mass conservation between incoming flux and deposit volume; (2) a tendency for flow to reoccupy former channel paths; and (3) bistable slopes corresponding to separate entrainment and deposition conditions for grains. Several important observations related to these processes are: an avulsion timescale that increases with time and decreases with sediment feed rate; fan lobes that grow in a self-similar, quasi-radial pattern; and channel geometry that is adjusted to the threshold entrainment stress. We propose that the formation of well-defined channels in noncohesive fans is a transient phenomenon resulting from incision following avulsion, and can be directly described with dual transport thresholds. We present a fairly complete, process-based description of the mechanics of avulsion and its resulting timescale on our fans. Because the relevant dynamics depend only on threshold transport conditions and conservation of mass, we show how results may be directly applied to field-scale systems.

  2. Late Quaternary dynamics of a South African floodplain wetland and the implications for assessing recent human impacts

    NASA Astrophysics Data System (ADS)

    Tooth, S.; Rodnight, H.; McCarthy, T. S.; Duller, G. A. T.; Grundling, A. T.

    2009-05-01

    Knowledge of the long-term geomorphological dynamics of wetlands is limited, so currently there is an inadequate scientific basis for assessing anthropogenically induced changes and for developing conservation, remediation, and/or sustainable management guidelines for these fragile ecosystems. Along the upper Klip River, eastern South Africa, geomorphological and sedimentological investigations, geochronology, and remote sensing have been used to establish the late Quaternary dynamics of some internationally important floodplain wetlands, thus providing a reference condition against which to assess the extent of recent human impacts. Optically stimulated luminescence dating reveals that the wetlands have developed over at least the last 30 ky as a result of slow meander migration (< 0.2 m y - 1 ), irregular cutoff events, and infrequent avulsions (approximately one every 3-6 ky) that have occurred autogenically as a natural part of meander-belt development. Following European settlement in the Klip valley (late nineteenth century), however, modifications to local flora and fauna, as well as the initiation of local wetland drainage schemes, have had major impacts. In particular, proliferation of exotic willows and associated debris jams, and the artificial excavation of a 1.2-km-long channel section across the wetlands have initiated an ongoing avulsion that is characterised by failure (gradual abandonment) of the main channel and rapid incision of a headcutting channel. Compared to the pre-settlement condition, little change in lateral migration activity has occurred, but this avulsion provides a clear example of anthropogenically accelerated change, occurring only ~ 1 ky after the last natural avulsion and in a part of the wetlands where avulsions have not occurred previously. Subsequent human interventions have included installing weirs in an attempt to control the resulting erosion and promote reflooding, but ongoing maintenance has been required. In areas that

  3. Atypical tibial tuberosity fracture in an adolescent.

    PubMed

    Jalgaonkar, Azal A; Dachepalli, Sunil; Al-Wattar, Zaid; Rao, Sudhir; Kochhar, Tony

    2011-06-01

    Avulsion fractures of the tibial tuberosity are typically sustained by adolescent males during sporting activities. Tibial tuberosity avulsions with simultaneous proximal tibial epiphyseal fractures are rare injuries. We present an unusual case of Ogden type IIIA avulsion fracture of tibial tuberosity with a Salter Harris type IV posterior fracture of proximal tibial epiphysis in a 13-year-old boy. We believe that the patient sustained the tibial tuberosity avulsion during the take-off phase of a jump while playing basketball due to sudden violent contraction of the quadriceps as the knee was extending. This was then followed by the posterior Salter Harris type IV fracture of proximal tibial physis as he landed on his leg with enormous forces passing through the knee. Although standard radiographs were helpful in diagnosing the complex fracture pattern, precise configuration was only established by computed tomography (CT) scan. The scan also excluded well-recognized concomitant injuries including ligament and meniscal injuries. Unlike other reported cases, our patient did not have compartment syndrome. Anatomic reduction and stabilization with a partially threaded transepiphyseal cannulated screw and a metaphyseal screw followed by early mobilization ensured an excellent recovery by the patient.Our case highlights the importance of vigilance and a high index of suspicion for coexisting fractures or soft tissue injuries when treating avulsion fractures of tibial tuberosity. A CT scan is justified in such patients to recognize complex fracture configurations, and surgical treatment should be directed appropriately to both the fractures followed by early rehabilitation. Patients with such injuries warrant close monitoring for compartment syndrome during the perioperative period. PMID:21667912

  4. Intraarticular Entrapment of Os Subfibulare Following a Severe Inversion Injury of the Ankle: A Case Report

    PubMed Central

    Kose, Ozkan; Kilicaslan, Omer Faruk; Guler, Ferhat; Aktan, Cemil

    2015-01-01

    Introduction: Anterior Talofibular Ligament (ATFL) rupture is the most commonly injured anatomic structure in lateral ankle sprain. In some cases, ATFL avulsion fracture from the lateral malleolus may occur instead of purely ligamentous injuries. The ATFL avulsion fracture is detected as a small ossicle at the tip of lateral malleolus on direct radiographs, which is called os subfibulare in chronic cases. Case Presentation: Severe displacement of this ossicle to the tibiotalar joint space is an extremely rare injury. Herein, a case of intra-articular entrapment of os subfibulare following a severe inversion injury of the ankle, which caused a diagnostic challenge was presented. Conclusions: To the best of our knowledge, this is the first case of entrapment of os subfibulare in the talotibial joint space. Fixation of the os subfibulare to lateral malleolus resulted in union and excellent functional results. PMID:26101763

  5. [Spontaneous compensation of severe mitral insufficiency secondary to rupture of chordae tendineae in an athlete].

    PubMed

    Ordzhonikidze, Z G; Pavlov, V I; Mazxerkina, I A; Druzhinin, A E

    2007-01-01

    The article describes an observation of spontaneous compensation of severe mitral insufficiency due to chordal avulsion in a 52-year-old sportsman adapted to hard physical load. After a physical load, the sportsman developed symptoms of acute mitral insufficiency. EchoCG revealed myxomatous degeneration of mitral cusps, chordal avulsion, severe mitral insufficiency, and volume overload of the left heart. The patient refused surgical treatment; conservative therapy was conducted. A three-year follow-up revealed an unexpectedly fast decrease in the size of heart cavities and the speed of regurgitation. The authors reckon that the these fast changes took place due to the sportsmen's heart adaptation to volume overload. PMID:17564044

  6. Autotransplantation combined with orthodontic treatment: a case involving the maxillary central incisors with root resorption after traumatic injury

    PubMed Central

    Ferreira, Hugo M.; Botelho, Filomena; Carrilho, Eunice

    2015-01-01

    Traumatic dental injury can result in avulsion of anterior teeth. In young patients, it is a challenge to the dental professional because after replantation, late complications such as ankylosis require tooth extraction. Although prosthetic and orthodontic treatment, and implant placement have been described as the options for intervention, autogenous tooth transplantation could be an effective procedure in growing patients if there is a suitable donor tooth available. This case presents the treatment of a patient who suffered a traumatic injury at 9 years old with avulsion of tooth 21, which had been replanted, and intrusion of tooth 11. Both teeth ankylosed; thus they were removed and autotransplantation of premolars was carried out. After transplantation, the tooth underwent root canal treatment because of pulpal necrosis. Orthodontic treatment began 3 months after transplantation and during 7 years' follow-up the aesthetics and function were maintained without signs of resorption. PMID:26295028

  7. Bilateral Proximal Tibial Sleeve Fractures in a Child: A Case Report

    PubMed Central

    Williams, Daniel; Kahane, Steven; Chou, Daud; Vemulapalli, Krishna

    2015-01-01

    Introduction: A sleeve fracture classically describes an avulsion of cartilage or periosteum with or without osseous fragments and usually occurs at the inferior margin of the patella. Tibial tubercle sleeve fractures in the skeletally immature are extremely rare. Case Presentation: In this report the authors describe a 12-year-old boy with no systemic disease and no steroid use who sustained bilateral proximal tibial sleeve fractures whilst playing football. Both ruptures were associated with rupture of the medial patellofemoral ligament and tear of the medial retinaculum. Treatment was performed with primary end-to-end repair, reinforcement with bone anchors and cerclage wires with an excellent outcome. Conclusions: We feel this rare, currently unclassified variant of a tibial tubercle avulsion fracture should be recognised and consideration taken to adding it to existing classification systems. PMID:26566509

  8. Double free gracilis muscle transfer after complete brachial plexus injury: First Canadian experience

    PubMed Central

    Elzinga, Kate; Zuo, Kevin J; Olson, Jaret L; Morhart, Michael; Babicki, Sasha; Chan, K Ming

    2014-01-01

    Traumatic brachial plexus root avulsions are devastating injuries, and are complex and challenging to reconstruct. Double free muscle transfer using the gracilis muscles is a potentially effective method of restoring upper extremity function. The authors report on the first two patients treated using this technique in Canada. Both sustained traumatic brachial plexus root avulsion injuries resulting in a flail arm. In the first step of this two-stage procedure, a gracilis muscle was transferred to restore elbow flexion, and wrist and digit extension. Months later, the transfer of the second gracilis muscle was performed to enhance elbow flexion and to enable wrist and digit flexion. Postoperatively, both patients achieved Medical Research Council grade 4 elbow flexion, functional handgrip and were able to return to gainful employment. Patient satisfaction was high and active range of motion improved substantially. The authors’ experience supports the use of this technique following severe brachial plexus injury. PMID:25152644

  9. [Acute post-traumatic aortic insufficiency: transesophageal echocardiography in the diagnosis and therapy of the lesions].

    PubMed

    Brandstätt, P; Carlioz, R; Fontaine, B; Hémery, Y; Pats, B; Chapuis, O; Lang-Lazdunsky, L; Jancovici, R; Burlaton, J P; Hvass, U

    1998-10-01

    A 58-year-old car driver suffered a road accident responsible for severe blunt thoraco-abdominal trauma. Transoephageal echocardiography, performed following the secondary development of a diastolic murmur, confirmed the presence of aortic incompetence due to commissural avulsion and guided the surgical treatment, which consisted of commissural suspension under cardiopulmonary bypass via a mini transverse trans-sternal incision. The rarity of acute aortic valve incompetence following non-penetrating thoracic trauma is illustrated by the data of the literature. This lesion is due to either avulsion of a sigmoid cusp or commissure, or laceration of the valvular tissue. Transthoracic echocardiography confirms the reality of aortic incompetence suggested clinically by appearance of a diastolic murmur, but confirmation of the mechanism of the lesions is based on transoesophageal echocardiography which allows perfectly safe and rapid visualization of the mechanism of the valvular lesion, investigation of associated lesions and guidance of therapeutic management. PMID:9809140

  10. Management of traumatic tooth injuries in the dental office.

    PubMed

    Coulter, John M; Wilson, O Lee; Marks, Murray K

    2014-01-01

    Dental trauma is sudden, unscheduled, and the dentist and staff must be adequately equipped to expeditiously and properly treat the patient to assure the best possible outcome. This paper reviews current dental trauma guidelines to provide the correct treatment protocol to ensure the best prognosis. The case report illustrates the technique of avulsion care, RCT care, and functional splinting in a successful manner. PMID:25842465

  11. Clinical Implications of Preserving Subvalvular Apparatus During Mitral Valve Replacement for Acute Ischemic Papillary Muscle Rupture.

    PubMed

    de Cannière, Didier; Vandenbossche, Jean-Luc; Nouar, Elias; Faict, Sebastian; Falchetti, Alessandro; Unger, Philippe

    2016-07-01

    We report the case of a patient who presented with sequential rupture of two papillary muscle bellies after emergent mitral valve replacement with subvalvular apparatus preservation for acute severe mitral regurgitation and cardiogenic shock during acute myocardial infarction. We discuss the possibility that the remaining chordae may have meanwhile contributed to muscle avulsion by exerting traction on ischemic myocardium and prevented embolization of the secondarily detached papillary muscle heads. PMID:27343501

  12. Rescue Surgery 19 Years after Composite Root and Hemiarch Replacement

    PubMed Central

    Seeburger, Joerg; Etz, Christian D.; Sauer, Matthias; Lehmkuhl, Lukas; Misfeld, Martin; Mohr, Friedrich W.

    2013-01-01

    A 59-year-old male patient with Marfan's syndrome was referred to our clinic due to acute chest pain. His medical history contains complex surgery for type A aortic dissection 19 years ago including composite root replacement using a mechanical aortic valve. Immediate computed tomography indicated perforation at the distal ascending aortic anastomosis plus complete avulsion of both coronary ostia. The patient underwent successful rescue surgery with ascending aortic and arch replacement using a modified Cabrol technique. PMID:23662240

  13. The Teenage Terrible Triad A Case Report.

    PubMed

    Whyte, Graeme; Rokito, Andrew

    2016-06-01

    Anterior shoulder dislocation in the athlete may result in an assortment of injuries that often benefit from surgical stabilization procedures. These injury patterns can be complex, requiring a multimodal approach to treatment. We present a rare case of a traumatic anterior shoulder dislocation in a teenage athlete that resulted in humeral avulsion of the glenohumeral ligament, rotator cuff tear, and axillary nerve palsy. Surgical treatment enabled return to football within 1 year of injury, and full function was restored. PMID:27281325

  14. Extraordinary sediment delivery and rapid geomorphic response following the 2008–2009 eruption of Chaitén Volcano, Chile

    USGS Publications Warehouse

    Major, Jon J.; Bertin, Daniel; Pierson, Thomas C.; Amigo, Alvaro; Iroume, Andres; Ulloa, Hector; Castro, Jonathan M.

    2016-01-01

    The 10 day explosive phase of the 2008–2009 eruption of Chaitén volcano, Chile, draped adjacent watersheds with a few cm to >1 m of tephra. Subsequent lava-dome collapses generated pyroclastic flows that delivered additional sediment. During the waning phase of explosive activity, modest rainfall triggered an extraordinary sediment flush which swiftly aggraded multiple channels by many meters. Ten kilometer from the volcano, Chaitén River channel aggraded 7 m and the river avulsed through a coastal town. That aggradation and delta growth below the abandoned and avulsed channels allow estimates of postdisturbance traction-load transport rate. On the basis of preeruption bathymetry and remotely sensed measurements of delta-surface growth, we derived a time series of delta volume. The initial flush from 11 to 14 May 2008 deposited 0.5–1.5 × 106 m3 of sediment at the mouth of Chaitén River. By 26 May, after channel avulsion, a second delta amassed about 2 × 106 m3 of sediment; by late 2011 it amassed about 11 × 106 m3. Accumulated sediment consists of low-density vesicular pumice and lithic rhyolite sand. Rates of channel aggradation and delta growth, channel width, and an assumed deposit bulk density of 1100–1500 kg m−3 indicate mean traction-load transport rate just before and shortly after avulsion (∼14–15 May) was very high, possibly as great as several tens of kg s−1 m−1. From October 2008 to December 2011, mean traction-load transport rate declined from about 7 to 0.4 kg−1 m−1. Despite extraordinary sediment delivery, disturbed channels recovered rapidly (a few years).

  15. Frog Appliance- An Innovative Treatment Option for the Replacement of Missing Teeth in An Epileptic Child

    PubMed Central

    Goyal, Anita; Reddy, Hanumanth; Sajjnar, Arun B; Jain, Sonal

    2015-01-01

    Epilepsy is a chronic neurological disease which may result in various oro-facial injuries among which fracture of crown and avulsion of tooth are commonly reported. Challenges come in growing epileptic children where fixed prosthesis could not be delivered and it demands a fixed semi-permanent prosthesis that needs strength along with esthetics. The present paper reports an innovative appliance which has fulfilled fore mentioned criteria; with the appliance named-frog appliance. PMID:26155578

  16. Frog Appliance- An Innovative Treatment Option for the Replacement of Missing Teeth in An Epileptic Child.

    PubMed

    Shetty, Raghavendra M; Goyal, Anita; Reddy, Hanumanth; Sajjnar, Arun B; Jain, Sonal

    2015-05-01

    Epilepsy is a chronic neurological disease which may result in various oro-facial injuries among which fracture of crown and avulsion of tooth are commonly reported. Challenges come in growing epileptic children where fixed prosthesis could not be delivered and it demands a fixed semi-permanent prosthesis that needs strength along with esthetics. The present paper reports an innovative appliance which has fulfilled fore mentioned criteria; with the appliance named-frog appliance. PMID:26155578

  17. Value of ultrasonography in assessment of recent injury of anterior talofibular ligament in children

    PubMed Central

    Ciszkowska-Łysoń, Beata; Śmigielski, Robert; Zdanowicz, Urszula

    2015-01-01

    Introduction Sprained ankle is a very common injury in children. Proper treatment of ligament injuries enables full recovery. X-ray and US examinations are commonly available diagnostic methods. Material and methods Two hundred and six children (113 girls and 93 boys, mean age 10.6) with recent ankle joint sprain (up to 7 days of injury) were subject to a retrospective analysis. All patients underwent an X-ray and US examination of the ankle joint within 7 days of injury. In 19 patients, anterior talofibular ligament reconstruction was conducted. Results X-ray failed to visualize a pathology in 129 children (63%); in 24 patients (12%), avulsion fracture of the lateral malleolus was found, and in 36 cases (17%), effusion in the talocrural joint was detected. Ultrasonography failed to visualize a pathology in 19 children (9%); in 60 patients (29%), it showed avulsion fracture of the lateral malleolus involving the attachment of the anterior talofibular ligament (ATFL); in 34 cases (17%), complete ATFL tear was detected, and in 51 patients (25%), partial ATFL injury was found. Other injuries constituted 19%. The surgeries conducted to repair the anterior talofibular ligament (19) confirmed the US/X-ray diagnoses in 100% of cases. Avulsion ATFL injury, i.e. the one that involves the ligament attachment site, is usually found in younger children (median: 8 years of age). Complete ATFL tears (not involving the attachment site) concern older children (median: 14 years of age). Conclusions Since X-ray is of limited value in diagnosing ankle joint pathologies in recent sprain injuries in children, soft tissue imaging, i.e. ultrasonography, is the basic examination to assess the ligament complex. Avulsion fractures, which involve the ATFL attachment site and are usually found in younger children, are a consequence of the incomplete ossification and require urgent diagnosis and orthopedic consultation. PMID:26674100

  18. Review of antifungal therapy and the severity index for assessing onychomycosis: part I.

    PubMed

    Baran, Robert; Hay, Rod J; Garduno, Javier I

    2008-01-01

    This review outlines recent data on treatment modalities and outcomes with antifungal therapy in onychomycosis. Included are topical, mechanical, chemical and systemic treatments or a combination thereof. Topical treatments, or transungual drug delivery systems (TUDDS), including ciclopirox and amorolfine were shown to be effective if used alone for mild-moderate nail involvement. Specifically, superficial white onychomycosis (SWO) restricted to the dorsum of the nail plate and moderate distal lateral subungual onychomycosis (DLSO). Mechanical treatments were mostly effective as adjuncts to topical therapy which include nail avulsion and abrasion. In particular, partial nail avulsion aids topical therapy in DLSO and partial subungual onychomycosis for a more effective therapy. Chemical avulsion is a painless method of debridement which uses a keratinolysis formula that is effective only in limited and early disease. Systemic therapies have been shown to be effective with terbinafine and itraconazole is suggested as being the most cost-effective therapy. Systemic therapies require consideration of side effects and monitoring by both patient and physician prior to treatment application. An effective suggestion is the use of a topical with debridement for mild-moderate onychomycosis and systemic (terbinafine) plus topical for severe onychomycosis. Most treatment modalities will require long-term use from 3 to 9 months to be most effective, with strategies presented in Part II of this review. PMID:18484426

  19. Lunate Osteochondral Fracture Treated by Excision: A Case Report and Literature Review

    PubMed Central

    Saberi, Sadegh; Arabzadeh, Aidin; Farhoud, Amir Reza

    2016-01-01

    Introduction Lunate fracture is a rare injury. Most reports are associated with other wrist injuries such as perilunate dislocation and distal radius fracture. Isolated lunate fracture has been reported even more rarely. The choice of treatment and outcomes are consequently undetermined. Case Presentation In this case report we will describe a lunate avulsion fracture as an isolated injury after a fall from nine meters treated operatively by excision of the comminuted avulsed fragment. After 33 months of follow-up radiographs showed no sign of degenerative joint disorder on simple X-ray, but slight Volar Intercalated Segment Instability (VISI) by a capitolunate angle of 26 degrees was noted. Clinically, the patient was pain free near full wrist and forearm range of motion and could perform his previous vocational and recreational tasks without any limitations. Conclusions Despite apparently good short and mid-term clinical outcome, slight volar intercalated segment instability after 33 months of follow-up revealed that lunotriquetral ligament function was probably lost, which led to static instability. This ligament injury may be missed primarily. Excision of the avulsed osteochondral fragment should be the last option of treatment and most attempts should be tried to fix and/or restore the normal anatomy of ligamentous structure.

  20. Oral health: treatment of dental trauma and pain.

    PubMed

    Martonffy, Andrea Ildiko

    2015-01-01

    Dental trauma is common among adults and children. As children become mobile, they frequently experience trauma to their primary teeth because of falls. Injuries to permanent teeth are common results of falls, motor vehicle accidents, sports injuries, and violence. Trauma can affect the tooth enamel, dentin, pulp, root, periodontal ligament, gum, or alveolar bone. Avulsions are characterized by complete displacement of the tooth from the socket. Avulsed primary teeth should not be replanted because replantation is associated with a risk of damage to the developing permanent tooth. Avulsed permanent teeth are considered a dental emergency and should be replanted by the first individual capable of doing so. If immediate replantation is not possible, the tooth should be stored in cold animal or human milk; it also can be stored in the mouth, adjacent to the buccal mucosa, if the patient is capable of doing so. Water should be avoided as a storage medium because it impedes healing of the periodontal ligament, but storage in water is superior to dry storage. Intruded teeth (ie, pushed into the jaw) may need immediate extraction, depending on their orientation. All patients with dental trauma should follow up promptly with a dentist. Patients presenting with chronic dental pain without an obvious treatable etiology will benefit from ongoing support from their family physicians. PMID:25594450

  1. Biomechanical Characterization of a Model of Noninvasive, Traumatic Anterior Cruciate Ligament Injury in the Rat.

    PubMed

    Maerz, Tristan; Kurdziel, Michael D; Davidson, Abigail A; Baker, Kevin C; Anderson, Kyle; Matthew, Howard W T

    2015-10-01

    The onset of post-traumatic osteoarthritis (PTOA) remains prevalent following traumatic joint injury such as anterior cruciate ligament (ACL) rupture, and animal models are important for studying the pathomechanisms of PTOA. Noninvasive ACL injury using the tibial compression model in the rat has not been characterized, and it may represent a more clinically relevant model than the common surgical ACL transection model. This study employed four loading profiles to induce ACL injury, in which motion capture analysis was performed, followed by quantitative joint laxity testing. High-speed, high-displacement loading repeatedly induces complete ACL injury, which causes significant increases in anterior-posterior and varus laxity. No loading protocol induced valgus laxity. Tibial internal rotation and anterior subluxation occurs up to the point of ACL failure, after which the tibia rotates externally as it subluxes over the femoral condyles. High displacement was more determinative of ACL injury compared to high speed. Low-speed protocols induced ACL avulsion from the femoral footprint whereas high-speed protocols caused either midsubstance rupture, avulsion, or a combination injury of avulsion and midsubstance rupture. This repeatable, noninvasive ACL injury protocol can be utilized in studies assessing PTOA or ACL reconstruction in the rat. PMID:25777293

  2. Effects of tectonic deformation and sea level on river path selection: Theory and application to the Ganges-Brahmaputra-Meghna River Delta

    NASA Astrophysics Data System (ADS)

    Reitz, Meredith D.; Pickering, Jennifer L.; Goodbred, Steven L.; Paola, Chris; Steckler, Michael S.; Seeber, Leonardo; Akhter, Syed H.

    2015-04-01

    The set of active rivers of the Ganges-Brahmaputra-Meghna (GBM) Delta in Bangladesh overlies an active plate boundary that continually modifies the landscape of the delta by deformation. The response of rivers to spatially variable subsidence, from tectonic tilting or other causes, has been thought to include preferred occupation of regions of higher subsidence. In this paper, we develop further the theoretical framework for analysis of the interplay of tectonics and river dynamics, and apply this model to conditions in the GBM Delta. First, we examine the overall competition between variable subsidence and channel dynamics, and find that tilting in Bangladesh should be strong enough to influence river path selection. We then present new theory for the effect of subsidence that is spatially (not temporally) variable. We find a constant residence timescale on different parts of the delta, and differing frequencies of avulsion to these locations, and describe the effects of incision or floodplain deposition on these quantities. We present estimates of the channel residence timescale of the Jamuna (Brahmaputra) River reconstructed from the lithology, provenance, and dating of sediment cores. We apply our framework to a map of regional subsidence to predict the effects on avulsion for the Jamuna River. Comparison between our predicted (2150 years) and our stratigraphically based estimates of avulsion timescale (1800 years) shows encouraging consistency.

  3. Prolonged Second Stage of Labor and Levator Ani Muscle Injuries

    PubMed Central

    Marsoosi, Vajihe; Jamal, Ashraf; Eslamian, Laleh; Oveisi, Sonia; Abotorabi, Shokohossadat

    2015-01-01

    Objective: To determine the effect of pregnancy and vaginal delivery on the pelvic floor and levatorani morphology and function. Methods: Design. Cross-sectional study. Setting. Tertiary care teaching hospital. Population. 75 primigravid women were recruited for assessment at 6 weeks postpartum compared with 25 nulliparous women. Hiatal morphology and levator ani muscle avulsion were assessed by 4-dimensional translabial ultrasound examination. The volume achievement obtained by ultrasound was performed in supine position with empty bladder at rest, on maximum Valsalva maneuver, and on maximum pelvic floor muscle contraction. Main Outcome Measures. Hiatal diameter and area were measured at the plane of minimal hiatal dimension as defined in the midsagittal plane and Levator avulsion was assessed. Results: There were significant differences in hiatal area morphology at rest, on Valsalva maneuver and during contraction of muscles among the study groups, but there was no difference in pelvic diameter at rest, on Valsalva maneuver, and during contraction. There were 21 cases of puborectalis avulsion (42%) with no significant difference between non-progressive labor (8 cases) and Normal Vaginal Delivery (NVD) (13 cases) groups. Conclusions: The results of the present study showed that non-progressive labor is the main risk factor for pelvic muscle injuries, indicating the necessity of a better management and timely cesareans in women with prolonged second stage of labor. PMID:25560352

  4. Orthodontic-endodontic treatment planning of traumatized teeth.

    PubMed

    Steiner, D R; West, J D

    1997-03-01

    Occasionally, an orthodontic patient will accidentally traumatize a maxillary anterior tooth before or during orthodontic treatment. In some situations, the trauma will be substantial and avulse the tooth. In other accidents, the tooth may not avulse, but the pulp becomes nonvital. If the pulp is devitalized, and the root has not fully formed, the apex of the root canal may be wide. In this situation, the endodontist may recommend apexification procedures to help close the apex before conventional obturation of the root canal. If the patient is currently undergoing orthodontic movement of the traumatized incisor, what effect will the tooth movement have on the success of the apexification? If the tooth were avulsed, replanted, and then ankylosed, should it be extracted? If so, when should the ankylosed incisor be removed? What effect will further facial growth have on the ankylosed tooth and the potential to achieve a successful esthetic restoration? The answers to these questions are important during the interdisciplinary treatment planning of the patient with traumatized teeth. This article will elucidate the endodontic-orthodontic considerations for patients with traumatized anterior teeth. PMID:9206471

  5. Rehabilitation and Return to Sport Following Surgical Repair of the Rectus Abdominis and Adductor Longus in a Professional Basketball Player: A Case Report.

    PubMed

    Short, Steven M; Anloague, Philip A; Strack, Donald S

    2016-08-01

    Study Design Case report. Background Acute traumatic avulsion of the rectus abdominis and adductor longus is rare. Chronic groin injuries, often falling under the athletic pubalgia spectrum, have been reported to be more common. There is limited evidence detailing the comprehensive rehabilitation and return to sport of an athlete following surgical or conservative treatment of avulsion injuries of the pubis or other sports-related groin pathologies. Case Description A 29-year-old National Basketball Association player sustained a contact injury during a professional basketball game. This case report describes a unique clinical situation specific to professional sport, in which a surgical repair of an avulsed rectus abdominis and adductor longus was combined with a multimodal impairment- and outcomes-based rehabilitation program. Outcomes The patient returned to in-season competition at 5 weeks postoperation. Objective measures were tracked throughout rehabilitation and compared to baseline assessments. Measures such as the Copenhagen Hip and Groin Outcome Score and numeric pain-rating scale revealed progress beyond the minimal important difference. Discussion This case report details the clinical reasoning and evidence-informed interventions involved in the return to elite sport. Detailed programming and objective assessment may assist in achieving desired outcomes ahead of previously established timelines. Level of Evidence Therapy, level 4. J Orthop Sports Phys Ther 2016;46(8):697-706. Epub 3 Jul 2016. doi:10.2519/jospt.2016.6352. PMID:27374014

  6. Influence of Delivery Method on Neuroprotection by Bone Marrow Mononuclear Cell Therapy following Ventral Root Reimplantation with Fibrin Sealant

    PubMed Central

    Barbizan, Roberta; Castro, Mateus V.; Barraviera, Benedito; Ferreira, Rui S.; Oliveira, Alexandre L. R.

    2014-01-01

    The present work compared the local injection of mononuclear cells to the spinal cord lateral funiculus with the alternative approach of local delivery with fibrin sealant after ventral root avulsion (VRA) and reimplantation. For that, female adult Lewis rats were divided into the following groups: avulsion only, reimplantation with fibrin sealant; root repair with fibrin sealant associated with mononuclear cells; and repair with fibrin sealant and injected mononuclear cells. Cell therapy resulted in greater survival of spinal motoneurons up to four weeks post-surgery, especially when mononuclear cells were added to the fibrin glue. Injection of mononuclear cells to the lateral funiculus yield similar results to the reimplantation alone. Additionally, mononuclear cells added to the fibrin glue increased neurotrophic factor gene transcript levels in the spinal cord ventral horn. Regarding the motor recovery, evaluated by the functional peroneal index, as well as the paw print pressure, cell treated rats performed equally well as compared to reimplanted only animals, and significantly better than the avulsion only subjects. The results herein demonstrate that mononuclear cells therapy is neuroprotective by increasing levels of brain derived neurotrophic factor (BDNF) and glial derived neurotrophic factor (GDNF). Moreover, the use of fibrin sealant mononuclear cells delivery approach gave the best and more long lasting results. PMID:25157845

  7. Ligament-induced sacral fractures of the pelvis are possible.

    PubMed

    Steinke, Hanno; Hammer, Niels; Lingslebe, Uwe; Höch, Andreas; Klink, Thomas; Böhme, Jörg

    2014-07-01

    Pelvic ring stability is maintained passively by both the osseous and the ligamentous apparatus. Therapeutic approaches focus mainly on fracture patterns, so ligaments are often neglected. When they rupture along with the bone after pelvic ring fractures, disrupting stability, ligaments need to be considered during reconstruction and rehabilitation. Our aim was to determine the influence of ligaments on open-book injury using two experimental models with body donors. Mechanisms of bone avulsion related to open-book injury were investigated. Open-book injuries were induced in human pelves and subsequently investigated by anatomical dissection and endoscopy. The findings were compared to CT and MRI scans of open-book injuries. Relevant structures were further analyzed using plastinated cross-sections of the posterior pelvic ring. A fragment of the distal sacrum was observed, related to open-book injury. Two ligaments were found to be responsible for this avulsion phenomenon: the caudal portion of the anterior sacroiliac ligament and another ligament running along the ventral surface of the third sacral vertebra. The sacral fragment remained attached to the coxal bone by this second ligament after open-book injury. These results were validated using plastination and the structures were identified. Pelvic ligaments are probably involved in sacral avulsion caused by lateral traction. Therefore, ligaments should to be taken into account in diagnosis of open-book injury and subsequent therapy. PMID:24452928

  8. Pulp revascularization for immature replanted teeth: a case report.

    PubMed

    Nagata, J Y; Rocha-Lima, T F; Gomes, B P; Ferraz, C C; Zaia, A A; Souza-Filho, F J; De Jesus-Soares, A

    2015-09-01

    Immature avulsed teeth are not usually treated with pulp revascularization because of the possibility of complications. However, this therapy has shown success in the treatment of immature teeth with periapical lesions. This report describes the case of an immature replanted tooth that was successfully treated by pulp revascularization. An 8-year-old boy suffered avulsion on his maxillary left lateral incisor. The tooth showed incomplete root development and was replanted after 30 minutes. After diagnosis, revascularization therapy was performed by irrigating the root canal and applying a calcium hydroxide paste and 2% chlorhexidine gel for 21 days. In the second session, the intracanal dressing was removed and a blood clot was stimulated up to the cervical third of the root canal. Mineral trioxide aggregate was placed as a cervical barrier at the entrance of the root canal and the crown was restored. During the follow-up period, periapical repair, apical closure and calcification in the apical 4 mm of the root canal was observed. An avulsed immature tooth replanted after a brief extra-alveolar period and maintained in a viable storage medium may be treated with revascularization. PMID:26219350

  9. Awareness of emergency management of dental trauma

    PubMed Central

    Namdev, Ritu; Jindal, Ayushi; Bhargava, Smriti; Bakshi, Lokesh; Verma, Reena; Beniwal, Disha

    2014-01-01

    Aim: Traumatic dental injuries frequently occur in society and may occur at home. The ultimate prognosis of an avulsed tooth occurring in a child may depend on the parents’ knowledge of appropriate emergency measures. This study is aimed at evaluating the awareness level of a sample of Indian (Rohtak, Haryana) parents in the management of dental trauma. Materials and Methods: A total of 1500 parents were surveyed using a self-administered structured questionnaire. The questionnaire was divided into three parts. The tabulated data were statistically analyzed using the Chi-square test. Result: This study indicated a low level of knowledge regarding tooth avulsion and replantation procedures to be followed in emergency. The residing area and age of parent did not affect the knowledge and awareness of parents. Moreover, well-educated parents also had very little or no information about dental trauma first-aid. The lack of significance in correct answers between those with and without such experience indicated that past experience did not seem to have increase the knowledge of the correct emergency procedures. Very little or no information about tooth avulsion and replantation had been given to most of them. Conclusion: Dental injury prevention and management should be recognized as a major public health issue and adequate resources to be allocated for research in this area. Educational programs to improve the knowledge and awareness among the parents have to be implemented. PMID:25395768

  10. Magnetic resonance imaging in brachial plexus injury.

    PubMed

    Caranci, F; Briganti, F; La Porta, M; Antinolfi, G; Cesarano, E; Fonio, P; Brunese, L; Coppolino, F

    2013-08-01

    Brachial plexus injury represents the most severe nerve injury of the extremities. While obstetric brachial plexus injury has showed a reduction in the number of cases due to the improvements in obstetric care, brachial plexus injury in the adult is an increasingly common clinical problem. The therapeutic measures depend on the pathologic condition and the location of the injury: Preganglionic avulsions are usually not amenable to surgical repair; function of some denervated muscles can be restored with nerve transfers from intercostals or accessory nerves and contralateral C7 transfer. Postganglionic avulsions are repaired with excision of the damaged segment and nerve autograft between nerve ends or followed up conservatively. Magnetic resonance imaging is the modality of choice for depicting the anatomy and pathology of the brachial plexus: It demonstrates the location of the nerve damage (crucial for optimal treatment planning), depicts the nerve continuity (with or without neuroma formation), or may show a completely disrupted/avulsed nerve, thereby aiding in nerve-injury grading for preoperative planning. Computed tomography myelography has the advantage of a higher spatial resolution in demonstration of nerve roots compared with MR myelography; however, it is invasive and shows some difficulties in the depiction of some pseudomeningoceles with little or no communication with the dural sac. PMID:23949940

  11. Axillary nerve neurotization with the anterior deltopectoral approach in brachial plexus injuries.

    PubMed

    Jerome, J Terrence Jose; Rajmohan, Bennet

    2012-09-01

    Combined neurotization of both axillary and suprascapular nerves in shoulder reanimation has been widely accepted in brachial plexus injuries, and the functional outcome is much superior to single nerve transfer. This study describes the surgical anatomy for axillary nerve relative to the available donor nerves and emphasize the salient technical aspects of anterior deltopectoral approach in brachial plexus injuries. Fifteen patients with brachial plexus injury who had axillary nerve neurotizations were evaluated. Five patients had complete avulsion, 9 patients had C5, six patients had brachial plexus injury pattern, and one patient had combined axillary and suprascapular nerve injury. The long head of triceps branch was the donor in C5,6 injuries; nerve to brachialis in combined nerve injury and intercostals for C5-T1 avulsion injuries. All these donors were identified through the anterior approach, and the nerve transfer was done. The recovery of deltoid was found excellent (M5) in C5,6 brachial plexus injuries with an average of 134.4° abduction at follow up of average 34.6 months. The shoulder recovery was good with 130° abduction in a case of combined axillary and suprascapular nerve injury. The deltoid recovery was good (M3) in C5-T1 avulsion injuries patients with an average of 64° shoulder abduction at follow up of 35 months. We believe that anterior approach is simple and easy for all axillary nerve transfers in brachial plexus injuries. PMID:22434572

  12. Mallet finger: a simulation and analysis of hyperflexion versus hyperextension injuries.

    PubMed

    Kreuder, Andrea; Pennig, Dietmar; Boese, Christoph Kolja; Eysel, Peer; Oppermann, Johannes; Dargel, Jens

    2016-05-01

    The goal of this study was to simulate the mechanisms of hyperflexion and hyperextension injuries of the distal interphalangeal (DIP) joint of the hand and to analyze the resulting extensor tendon injury patterns. The hypotheses were raised that hyperflexion trauma leads to a plastic deformation of the extensor tendon aponeurosis, with or without a small bony avulsion fragment but without joint surface involvement, and that hyperextension injuries can create a shear fracture of the dorsal lip of the distal phalanx, without injury to the extensor tendon aponeurosis. Loading was applied with a swinging pendulum impacting the distal phalanx in 103 human specimens in either an extended or flexion position. After loading, injury patterns were analyzed radiologically and histologically. There was evidence that hyperflexion trauma leads to a plastic deformation or rupture of the extensor tendon. Bony tendon avulsion was evident in 12.2 % of cases. With hyperextension, the extensor tendon remained intact in all cases, but there were large fracture fragments involving the articular surface in 4.1 % of cases. The results of the study show that force on the flexed joint leads to overstretching of the extensor tendon, and to an associated dorsal bony avulsion with intact joint line. Force applied to the joint in extension can lead to a bony dorsal edge fracture with articular involvement and with it, a palmar DIP joint capsule rupture. The results illuminate a direct correlation between the mechanism of injury and the pattern of injury in the clinical picture of mallet finger. PMID:26498933

  13. High-resolution sequence stratigraphy of fluvio-deltaic systems: Prospects of system-wide chronostratigraphic correlation

    NASA Astrophysics Data System (ADS)

    Dalman, Rory; Weltje, Gert Jan; Karamitopoulos, Pantelis

    2015-02-01

    A basin-scale numerical model with a sub-grid parameterization of fluvio-deltaic processes and stratigraphy was used to study the relation between alluvial sedimentation and marine deltaic deposition under conditions of time-invariant forcing. The experiments show that delta evolution is governed by a robust morphodynamic feedback loop, which provides a link between major avulsions, delta-lobe switches, and sequestration of sediments on the delta plain. Major avulsions, driven by local superelevation, result in abandonment of delta lobes and initiation of new lobes. Progradation of the delta front lengthens the fluvial profile and reduces its gradient, which induces aggradation upstream. The aggradation, in turn, causes local superelevation of the channel belt. Each major avulsion causes a wave of incision to migrate upstream, whereas downstream of the avulsion point, the rate of aggradation temporarily increases until a new equilibrium situation has been established. The feedback loop explains storage and release of fluvial sediments without the need to invoke changes in upstream or downstream controls and provides a plausible mechanism for the generation of high-frequency incision-aggradation cycles as the sole result of compensational stacking. The stratigraphic expression of a depocentre shift is an essentially isochronous surface. Hence, the stratigraphic record of fluvio-deltaic systems may be subdivided into a series of units representing intervals during which a channel belt and delta lobe were forming at a fixed location in the basin, so-called chronosomes. Fluvio-deltaic chronosomes are bounded by abandonment surfaces, which are clearly expressed in the marine as well as the fluvial domain. The surface marking the abandonment of a particular channel belt and delta lobe correlates with the surface at the base of a new delta lobe. Landward, this surface forms the base of an aggradational package of fluvial sediments downstream of an avulsion site associated

  14. Dam-induced and natural channel changes in the Saskatchewan River below the E.B. Campbell Dam, Canada

    NASA Astrophysics Data System (ADS)

    Smith, Norman D.; Morozova, Galina S.; Pérez-Arlucea, Marta; Gibling, Martin R.

    2016-09-01

    The E.B. Campbell Dam on the Saskatchewan River, east-central Saskatchewan, was constructed in 1962, forming Tobin Lake (2.2 billion m3 capacity), which today impounds most fluvial sediment and disrupts normal outflow patterns. Thirty-five kilometers below the dam, the river diverts into a 500 km2 belt of alluvial sediment initiated by an avulsion ~ 140 years ago, rejoining the parent channel 108 km from the dam. Effects of the dam on channel geomorphology, including the historical channel (reach I) and the more recent avulsion-affected channels, were investigated by pre- and post-dam cross section surveys combined with grain-size and bedload measurements. Twenty-three sites were surveyed at least twice, and 14 were resurveyed annually in 2003-2014 (except 2007) during which significant floods occurred in 2005, 2011, and 2013. All channel cross sections up to 81 km below the dam have coarsened and enlarged since closure, resulting in excavation of 35.4 × 106 m3 of channel-perimeter sediment since 1962. The most proximal segment is armored and has changed little in recent years. Since 2003, channel enlargement has been greatest in the 35-81 km segment between the avulsion site and the Forks (reaches II, III), manifested as widening and deepening. Enlargement rates were greatest during the three floods, and the paucity of bedload has prevented degraded portions of the channel bed from replenishment following flooding. Budget calculations based on bedload measurements and channel cross-section areas suggest that > 30 years would be required to replace the sediment removed between 2003 and 2014, assuming all available bedload remains in the affected reach. Dam effects appear to be absent or uncertain beyond 81 km, a multichanneled region of varied stages of activity (reach IV), recombining and eventually rejoining the parent Saskatchewan River channel at km 108 (reach V). Sediment evacuated from reaches I-III is sufficient to sustain modest aggradation in some distal

  15. Long-term interactions between man and the fluvial environment - case of the Diyala alluvial fan, Iraq

    NASA Astrophysics Data System (ADS)

    Heyvaert, Vanessa M. A.; Walstra, Jan; Mortier, Clément

    2014-05-01

    The Mesopotamian alluvial plain is dominated by large aggradading river systems (the Euphrates, Tigris and their tributaries), which are prone to avulsions. An avulsion can be defined as the diversion of flow from an existing channel onto the floodplain, eventually resulting in a new channel belt. Early civilizations depended on the position of rivers for their economic survival and hence the impact of channel shifts could be devastating (Wilkinson 2003; Morozova 2005; Heyvaert & Baeteman 2008). Research in the Iranian deltaic part of the Mesopotamian plain has demonstrated that deliberate human action (such as the construction of irrigation canals and dams) triggered or obstructed the alluvial processes leading to an avulsion on fluvial megafans (during preconditioning, triggering and post-triggering stages) (Walstra et al. 2010; Heyvaert et al. 2012, Heyvaert et al.2013). Thus, there is ample evidence that the present-day alluvial landscapes in the region are the result of complex interactions between natural and anthropogenic processes. Here we present a reconstruction of the Late Holocene evolution of the Diyala alluvial fan (one of the main tributaries of the Tigris in Iraq), with particular attention to the relations between alluvial fan development, changes in channel pattern, the construction of irrigation networks and the rise and collapse of societies through historic times. The work largely draws on the use of remote sensing and GIS techniques for geomorphological mapping, and previously published archaeological field data (Adams 1965). By linking archaeological sites of known age with traces of ancient irrigation networks we were able to establish a chronological framework of alluvial activity of the Diyala alluvial fan. Our results demonstrate that centralized and technologically advanced societies were able to maintain a rapidly aggradading distibutary channel system, supplying water and sediment across the entire alluvial fan. As a consequence

  16. Tipping Points in Texas Rivers

    NASA Astrophysics Data System (ADS)

    Phillips, Jonathan

    2016-04-01

    Anticipating geomorphic tipping points requires that we learn from the past. Major geomorphic changes in coastal plain rivers of Texas resulting in river metamorphosis or regime shifts were identified, and the major driving factors determined. Nine fluvial tipping points were identified from contemporary observations, historical records, and Quaternary reconstructions. Two of the tipping points (between general aggrading and degrading valley states) are associated with reversals in a fundamental system control (sea-level). One (stable or aggrading vs. degrading channels) is associated with an abrupt change in sediment supply due to dam construction, and two others (changes from meandering to anastomosing channel patterns, and different anastomosis styles) are similarly related to changes in sediment supply and/or transport capacity, but with additional elements of historical contingency. Three tipping points are related to avulsions. One, from a regime dominated to reoccupation of former channels to one dominated by progradation into flood basins, is driven by progressive long term filling of incised valleys. Another, nodal avulsions, are driven by disturbances associated with tectonics or listric faults. The third, avulsions and related valley metamorphosis in unfilled incised valleys, is due to fundamental dynamical instabilities within the fluvial system. This synthesis and analysis suggests that geomorphic tipping points are sometimes associated with general extrinsic or intrinsic (to the fluvial system) environmental change, independent of any disturbances or instabilities. Others are associated with natural (e.g., tectonic) or human (dams) disturbances, and still others with intrinsic geomorphic instabilities. This suggests that future tipping points will be equally diverse with respect to their drivers.

  17. A simple sterile polypropylene fingernail substitute.

    PubMed

    Tos, P; Artiaco, S; Coppolino, S; Conforti, L G; Battiston, B

    2009-06-01

    Traumatic nail injuries are often observed in clinical practice. Usually the fingernail can be preserved, cleaned and disinfected in order to use it in the reconstructive procedure. However, in some cases the nail can be avulsed and lost or too damaged to be used. In cases when the nail is not available it should be replaced by a substitute in order to protect nail bed and avoid adherences along the proximal nail bed and the nail fold. Furthermore the substitute serves to protect the tender nail bed from painful stimuli during the healing process. We used, as fingernail substitute, a polypropylene sheet in eight patients with fingernail avulsion or disruption. The polypropylene foil was trimmed reproducing the profile of the avulsed fingernail and thinned at the proximal edge to reduce thickness in order to ease the insertion into the nail fold. A small hole was then created in the center of the foil to allow blood drainage. The substitute was usually removed one month after the application. In our clinical experience we had not complications related to the polypropylene device. The new fingernail had good cosmetic appearance in most cases and all the patients reported a good protection of the fingertip during the healing period. The substitute used in this series is sterile, inexpensive and easily available in emergency and elective operatory theater. This polypropylene foil is flexible and can be shaped and adapted to the nail curvature radius. The substitute used in our clinical series protected the nail bed during healing until the growth of the new fingernail and respected our functional expectations. PMID:19428284

  18. Diversion of water flow from a floodplain wetland stream: an analysis of geomorphological setting and hydrological and ecological consequences.

    PubMed

    Ellery, W N; Dahlberg, A C; Strydom, R; Neal, M J; Jackson, J

    2003-05-01

    Diversion of water has been ongoing in the Mkuze Wetland for several decades. Two canals form the focus of this study; the Mpempe-Demazane Canal and the Tshanetshe Canal. The former involved an ambitious excavation over a distance of 13.5 km in the lower part of the wetland, while the latter was a minor excavation over a distance of approximately 100 m in the upper part of the wetland. Although ambitious and costly, the Mpempe-Demazane Canal resulted in little downward or headward erosion, and there was minor diversion of flow. However, the minor excavation of the Tshanetshe Canal resulted in erosion downstream of the excavation (the Tshanetshe Stream), downward and lateral erosion of the excavated section, and headward erosion that has propagated almost 4 km upstream along the Mkuze River. Most of the flow of the Mkuze River has been captured by the Tshanetshe Canal and Stream. The impact of canalisation on floodplain wetlands is thus more dependent on the location than the scale of activity. The avulsion of the Mkuze River into the Tshanetshe Canal and Stream is due to a large difference in elevation between the Mkuze River and floodplain into which it was diverted, and the fact that in this region the river typically has high discharges. This avulsion may have been inevitable as a result of natural processes of sedimentation. In contrast, the difference in elevation between the Mkuze River and the basin into which it was diverted via the Mpempe Canal was small as is discharge of the Mkuze River in this part of the wetland. Thus, the diversion was unsuccessful. The presence of hippos that create hydraulically efficient pathways that are oriented parallel to the regional hydraulic slope, may accelerate avulsion in large African wetlands. Overall, it is argued that the environmental consequences of excavation need to be viewed against the background that wetlands are dynamic features within the landscape. PMID:12767862

  19. The Owens River as a tiltmeter for Long Valley caldera, California

    SciTech Connect

    Reid, J.B. Jr )

    1992-05-01

    In the lower 11 km of its course around the resurgent dome of Long Valley caldera, the Owens River displays two parallel meander belts, comparable in meander wavelength and amplitude but unequal in age, elevation, and discharge. It appears the two belts take turns carrying the river's flow depending on whether the dome is inflating or subsiding. The inboard belt, some 200-300 m closer to the dome and now 30-60 cm higher in elevation, contains an underfit stream and is now being abandoned. The outboard channel formed in a series of avulsions apparently induced by recent uplift of the dome. In the upper 4 km of the two-channel reach, avulsion occurred between 1856 and 1878 as inferred from the original US Coast and Geodetic Survey mapping the caldera. Avulsion had already occurred by 1856 in the lower 4 km of the river, suggesting a possible migration of the center of uplift through time. More ancient meander scars at the inboard and outboard limits of the floodplain imply additional earlier episodes of inflation and subsidence. Projection of surveyed topographic profiles across the river's floodplain to the center of the dome suggests that cumulative recent uplift is on the order of 15-35 m, or about 30-70 times greater than that measured for the caldera since 1979 (Castle et al. 1984). The duration of the era of subsidence can be estimated by comparing oxbow densities in the old and new meander belts in the upper two-channel reach; the data suggest that the dome may have been in subsidence for a period of at least 500 to 1,000 yr ending about 150 yr ago. No eruptions of the Long Valley volcanic system have accompanied these inflations and subsidings.

  20. The need for complementary hydraulic analysis in post-restoration monitoring of river restoration projects

    NASA Astrophysics Data System (ADS)

    Endreny, T. A.; Soulman, M. M.

    2011-03-01

    River restoration design methods are incrementally improved by studying and learning from monitoring data in previous projects. In this paper, we report post-restoration monitoring data for a Natural Channel Design (NCD) restoration project along 1600 m (10 channel wavelengths) of the Batavia Kill in the Catskill Mountains, NY, implemented in 2001 and 2002. The NCD project used a reference-reach to determine channel form, empirical relations between the project site and reference site bankfull dimensions to size channel geometry, and hydraulic and sediment computations to test channel capacity and sediment stability. In addition 12 cross-vanes and 48 j-hook vanes used in NCD for river training were installed to protect against bank erosion and maintain scour pools for fish habitat. Changes in pool depths were monitored with surveys from 2002-2004, and then after the channel-altering April 2005 flood. Aggradation in pools was attributed to cross-vane arms not concentrating flow in the center of the channel, which subsequently caused flow splitting and 4 partial point bar avulsions during the 2005 flood. Hydrodynamic simulation at the 18 m3s-1 bankfull flow suggested avulsions occurred where vanes allowed erosive bank scour to initiate the avulsion cut, and once the flow was split, the diminished in-channel flow caused more aggradation in the pools. In this project post-restoration monitoring had detected aggradation and considered it a problem. The lesson for the larger river restoration community is monitoring protocol should include complementary hydraulic and sediment analysis to comprehend potential consequences and develop preventative maintenance. River restoration and monitoring teams should be trained in robust hydraulic and sediment analytical methods that help them extend project restoration goals.

  1. The rivers of civilization

    NASA Astrophysics Data System (ADS)

    Macklin, Mark G.; Lewin, John

    2015-04-01

    The hydromorphic regimes that underpinned Old World river-based civilizations are reviewed in light of recent research. Notable Holocene climatic changes varied from region to region, whilst the dynamics of floodplain environments were equally diverse, with river channel changes significantly affecting human settlement. There were longer-term trends in Holocene hydroclimate and multi-centennial length 'flood-rich' and 'flood-poor' episodes. These impacted on five identified flooding and settlement scenarios: (i) alluvial fans and aprons; (ii) laterally mobile rivers; (iii) rivers with well-developed levees and flood basins; (iv) river systems characterised by avulsions and floodouts; and (v) large river-fed wetlands. This gave a range of changes that were either more or less regular or incremental from year-to-year (and thus potentially manageable) or catastrophic. The latter might be sudden during a flood event or a few seasons (acute), or over longer periods extending over many decades or even centuries (chronic). The geomorphic and environmental impacts of these events on riparian societies were very often irreversible. Contrasts are made between allogenic and autogenic mechanism for imposing environmental stress on riverine communities and a distinction is made between channel avulsion and contraction responses. Floods, droughts and river channel changes can precondition as well as trigger environmental crises and societal collapse. The Nile system currently offers the best set of independently dated Holocene fluvial and archaeological records, and the contrasted effects of changing hydromorphological regimes on floodwater farming are examined. The persistence of civilizations depended essentially on the societies that maintained them, but they were also understandably resilient in some environments (Pharaonic Egypt in the Egyptian Nile), appear to have had more limited windows of opportunity in others (the Kerma Kingdom in the Nubian Nile), or required

  2. Historical adjustments by Walker River to lake-level fall over a tectonically tilted half-graben floor, Walker Lake Basin, Nevada

    NASA Astrophysics Data System (ADS)

    Blair, Terence C.; McPherson, John G.

    1994-08-01

    Historical records of lake and river adjustments in the tectonically active, north—south elongated, Walker Lake extensional basin of west-central Nevada provide important insight to the style and rate that rivers react to tectonic tilt in half grabens. The northern part of this basin, historically containing Walker Lake, is now occupied by the south-flowing Walker River. Walker Lake, presently restricted to the central basin sector, is a perennial water body 30 m deep sustained by, and forming the terminus of, Walker River. Both the river and lake have a strongly asymmetric distribution, located preferentially near the active Walker Lake fault bounding the western basin margin. Walker Lake has withdrawn from the northern basin sector since 1882 due to a 45 m drop in lake level caused by human diversion of the river upstream. This withdrawal has forced Walker River to incrementally lengthen, and to sequentially reposition its delta along the retreating northern lake margin. Twelve deltas have been deposited since 1882 in response to these changes. The initiation of eight of the twelve post-1882 deltas was associated with channel avulsion, and four with channel lengthening. Ten of the twelve channel and delta relocation events entailed significant westward lateral movements toward the Walker Lake fault, illustrating the dominating influence of the basin-floor tectonic tilt on river adjustments. The two eastward shifts were triggered intrinsically by avulsions resulting from erosion of the outer bank of channel meanders. The three phases of progressive westward shifting of the river towards the Walker Lake fault occurred over periods of 18, 6, and 16 years, respectively, documenting the rapid response time of Walker River to basin-floor tectonic tilt despite the countering effects of the intrinsic avulsions, and hindrances to lateral migration caused by the muddy substrate of the former lake bottom deposits within which the river is incised.

  3. Complex channel responses to changes in stream flow and sediment supply on the lower Duchesne River, Utah

    USGS Publications Warehouse

    Gaeuman, D.; Schmidt, J.C.; Wilcock, P.R.

    2005-01-01

    Channel responses to flow depletions in the lower Duchesne River over the past 100 years have been highly complex and variable in space and time. In general, sand-bed reaches adjusted to all perturbations with bed-level changes, whereas the gravel-bed reaches adjusted primarily through width changes. Gravel-bed reaches aggraded only when gravel was supplied to the channel through local bank erosion and degraded only during extreme flood events. A 50% reduction in stream flow and an increase in fine sediment supply to the study area occurred in the first third of the 20th century. The gravel-bed reach responded primarily with channel narrowing, whereas bed aggradation and four large-scale avulsions occurred in the sand-bed reaches. These avulsions almost completely replaced a section of sinuous channel about 14 km long with a straighter section about 7 km long. The most upstream avulsion, located near a break in valley slope and the transition from a gravel bed upstream and a sand bed downstream, transformed a sinuous sand-bed reach into a braided gravel-bed reach and eventually into a meandering gravel-bed reach over a 30-year period. Later, an increase in flood magnitudes and durations caused widening and secondary bed aggradation in the gravel-bed reaches, whereas the sand-bed reaches incised and narrowed. Water diversions since the 1950s have progressively eliminated moderate flood events, whereas larger floods have been less affected. The loss of frequent flooding has increased the duration and severity of drought periods during which riparian vegetation can establish along the channel margins. As a result, the channel has gradually narrowed throughout the study area since the late 1960s, despite the occasional occurrence of large floods. No tributaries enter the Duchesne River within the study area, so all reaches have experienced identical changes in stream flow and upstream sediment supply. ?? 2004 Elsevier B.V. All rights reserved.

  4. Evaluation of the topical effect of alendronate on the root surface of extracted and replanted teeth. Microscopic analysis on rats' teeth.

    PubMed

    Lustosa-Pereira, Adriana; Garcia, Roberto Brandão; de Moraes, Ivaldo Gomes; Bernardineli, Norberti; Bramante, Clovis Monteiro; Bortoluzzi, Eduardo Antunes

    2006-02-01

    The treatment of choice for tooth avulsion is replantation. The ideal replantation should be realized as quickly as possible, or at least, the avulsed tooth should be kept in an adequate solution to preserve the periodontal ligament attached to the root. If that is not possible, treatment of the radicular surface should be done in order to prevent radicular resorption. The purpose of this study was to test sodium alendronate as a substance for topical treatment of the radicular surface of avulsed teeth in an attempt to prevent the occurrence of dental resorptions. Fifty-four rat maxillary right central incisors were extracted and replanted. Group I--extra-alveolar dry period of 15 min, intracanal dressing with calcium hydroxide (CALEN, S.S. White, Artigos Dentários LTDA, Rio de Janeiro, Brazil) and replantation; Groups II and III - extra-alveolar dry periods of 30 and 60 min, respectively, immersion in 1% sodium hypochlorite for 30 min for removal of the periodontal ligament, washing in saline solution for 5 min, and treatment of the radicular surface with 3.2 mg/l sodium alendronate solution for 10 min. Intracanal dressing with calcium hydroxide and replantation followed. At 15, 60, and 90 days post-reimplantation, the animals were killed and the samples obtained and processed for microscopic analysis. The results indicated that sodium alendronate was able to reduce the incidence of radicular resorption, but not of dental ankylosis. No significant differences were observed regarding variations in the extra-alveolar periods among the groups. PMID:16422756

  5. Delayed riluzole treatment is able to rescue injured rat spinal motoneurons.

    PubMed

    Nógrádi, A; Szabó, A; Pintér, S; Vrbová, G

    2007-01-19

    The effect of delayed 2-amino-6-trifluoromethoxy-benzothiazole (riluzole) treatment on injured motoneurons was studied. The L4 ventral root of adult rats was avulsed and reimplanted into the spinal cord. Immediately after the operation or with a delay of 5, 10, 14 or 16 days animals were treated with riluzole (n=5 in each group) while another four animals remained untreated. Three months after the operation the fluorescent dye Fast Blue was applied to the proximal end of the cut ventral ramus of the L4 spinal nerve to retrogradely label reinnervating neurons. Three days later the spinal cords were processed for counting the retrogradely labeled cells and choline acetyltransferase immunohistochemistry was performed to reveal the cholinergic cells in the spinal cords. In untreated animals there were 20.4+/-1.6 (+/-S.E.M.) retrogradely labeled neurons while in animals treated with riluzole immediately or 5 and 10 days after ventral root avulsion the number of labeled motoneurons ranged between 763+/-36 and 815+/-50 (S.E.M.). Riluzole treatment starting at 14 and 16 days after injury resulted in significantly lower number of reinnervating motoneurons (67+/-4 and 52+/-3 S.E.M., respectively). Thus, riluzole dramatically enhanced the survival and reinnervating capacity of injured motoneurons not only when treatment started immediately after injury but also in cases when riluzole treatment was delayed for up to 10 days. These results suggest that motoneurons destined to die after ventral root avulsion are programmed to survive for some time after injury and riluzole is able to rescue them during this period of time. PMID:17084537

  6. Management of Otic and Nasopharyngeal, and Nasal Polyps in Cats and Dogs.

    PubMed

    Greci, Valentina; Mortellaro, Carlo Maria

    2016-07-01

    Feline inflammatory polyps are the most common nonneoplastic lesion of ear and nasopharynx in cats. Minimally invasive techniques for polyp removal, such as traction avulsion combined with curettage of the tympanic cavity and per-endoscopic transtympanic traction, have been successful for long-term resolution. Feline nasal hamartomas are benign lesions of the nasopharynx, and most have a good prognosis after surgical removal. Canine aural and nasopharyngeal inflammatory polyps are rare and have a similar clinical presentation as cats with these lesions. In dogs, it is important to achieve an accurate histologic diagnosis of these masses before appropriate surgical treatment can be planned. PMID:26947114

  7. Myelography in the Age of MRI: Why We Do It, and How We Do It

    PubMed Central

    Ozdoba, Christoph; Gralla, Jan; Rieke, Alexander; Binggeli, Ralph; Schroth, Gerhard

    2011-01-01

    Myelography is a nearly ninety-year-old method that has undergone a steady development from the introduction of water-soluble contrast agents to CT myelography. Since the introduction of magnetic resonance imaging into clinical routine in the mid-1980s, the role of myelography seemed to be constantly less important in spinal diagnostics, but it remains a method that is probably even superior to MRI for special clinical issues. This paper briefly summarizes the historical development of myelography, describes the technique, and discusses current indications like the detection of CSF leaks or cervical root avulsion. PMID:22091378

  8. A preclinical dental trauma teaching module.

    PubMed

    Marriot-Smith, Charlotte; Marino, Victor; Heithersay, Geoffrey Sinclair

    2016-06-01

    A dental trauma exercise using the anterior segment of a sheep mandible as a model has been incorporated into the undergraduate dental programme at the University of Adelaide since 2011. Students are required to replant a simulated tooth avulsion, reposition a laterally luxated tooth injury and then apply a flexible splint consisting of 40 lb fishing nylon attached with a resin-modified glass ionomer cement, GC Fuji Ortho LC. The exercise concludes with the simple removal of the splint with a spoon excavator. The acrylic mounted formalin-fixed sheep mandible is reusable, which has obvious economic and practical advantages. PMID:26667108

  9. Radiology of skeletal trauma

    SciTech Connect

    Rogers, L.F.

    1982-01-01

    This 1000-page book contains over 1700 illustrations, is presented in two volumes and subdivided into 23 chapters. After brief chapters of Introduction and General Anatomy, a section on Skeletal Biomechanics is presented. The Epidemiology of Fractures chapter examines, among other things, the effects of age on the frequency and distribution of fractures. In the chapter on Classifications of Fractures, the author describes the character of traumatic forces such as angulating, torsional, avulsive, and compressive, and then relates these to the resultant fracture configurations. The Fracture Treatment chapter presents an overview of treatment principles. Other chapters deal with specific problems in pediatric trauma, fracture healing and nonhealing, and fracture complications.

  10. Growth of river delta networks: Thresholds, periodicity, aging and self similarity (Invited)

    NASA Astrophysics Data System (ADS)

    Jerolmack, D. J.; Reitz, M. D.

    2010-12-01

    The surfaces of river deltas and alluvial fans (collectively fans) are often dissected by a small number of channels radiating from the fan apex. These dispersive, depositional systems do not exhibit the fractal scaling typical of erosional drainage networks. On long timescales, fan channels migrate via avulsion - the process of channel bed deposition and abandonment. What governs the selection of new flow paths, or the ultimate number of active channels, is poorly understood. Here we present results of an experimental fan that allow us to examine the growth of a depositional channel network. Flow over the fan collapses into a single channel whose dimensions adjust to threshold transport conditions for the imposed sediment load. This channelization causes localized shoreline growth, which diminishes transport capacity of the channel until the slope drops below the threshold value. This leads to deposition within the channel and widespread flooding; avulsion is completed when a new channel path is selected. This cycle is remarkably periodic, and dynamics suggest that fan slope oscillates between two thresholds - entrainment and distrainment - analogous to static and dynamic angles of repose in grain flows. Selection of a new flow path is inherently stochastic, but previously abandoned channels act as significant attractors for the flow. In the early stages of fan growth, new channels are likely to be created. Once a critical density of flow paths has been established, however, the flow oscillates among the same 3-5 channels indefinitely. These dynamics are similar to the aging phenomenon observed in the growth of fractures in brittle materials under stress. We demonstrate that a directed random walk model with memory quantitatively reproduces these dynamics and limiting behavior, and is consistent with natural fans. Because our experimental fan is built by the recurring avulsion sequence, its shoreline shape is a series of lobes that indicate persistent upstream

  11. Fluvial fan evolution during Late Quaternary climate changes: field and chronological constraints from the Indo-Gangetic basin

    NASA Astrophysics Data System (ADS)

    Singh, A.; Gupta, S.; Sinha, R.; Densmore, A.; Thomsen, K. J.; Nayak, N.; Joshi, S. K.; van Dijk, W. M.; Buylaert, J. P.; Mondal, S.; Kumar, D.; Mason, P. J.; Murray, A. S.; Kumar, M.; Shekhar, S.; Rai, S. P.

    2015-12-01

    The stratigraphic evolution of fluvial fans is to a large extent governed by channel avulsion. Spatial variations in alluvial architecture are influenced by avulsion magnitude and frequency. However due to the absence of long-term chronostratigraphic records of fan stratigraphy, it has proved difficult to test patterns of fan evolution against records of climate variability. In order to understand the processes of channel avulsion during fan evolution, it is important to determine the spatio-temporal pattern of fluvial channel aggradation, incision, and migration. In this study, we reconstruct the shallow sub-surface alluvial stratigraphy of fluvial fan systems formed by the major Himalayan rivers, the Sutlej and Yamuna, in the northwestern Indo-Gangetic basin. We map the spatial distribution of channel sand bodies deposited by these rivers and develop a chronostratigraphic model for the fluvial succession in a depositional dip perpendicular transect. Sediment cores up to ~50 m deep along two transects are used to reconstruct the shallow stratigraphy of the fan systems. Discontinuous channel sand bodies are separated by floodplain fines which occasionally show weak pedogenesis that mark the end of episodes of channel aggradation. Optically stimulated luminescence (OSL) dating is used to bracket the timing of channel-filling episodes, and their spatial distribution. Mapping of sand bodies coupled with chronostratigraphic constraints allows reconstruction of channel migration patterns and their timing across the Sutlej-Yamuna fans. Chronostratigraphy permits temporal correlation with published measures of monsoon variability. We find that fluvial aggradation at the western end of studied transects, near the middle of the Sutlej fan, terminated around ~20 ka. We also show that abandonment of the paleo-Sutlej and major fan-scale avulsion occurred after ~15 ka, and was followed by formation of incised valleys that confined the modern fluvial system in northwestern Indo

  12. Replantation: current concepts and outcomes.

    PubMed

    Bueno, Reuben A; Battiston, Bruno; Ciclamini, Davide; Titolo, Paolo; Panero, Bernardino; Tos, Pierluigi

    2014-07-01

    Techniques to improve the chance of successful replantation of digits are well established. Indications and contraindications for replantation are generally agreed on, but they continue to evolve as excellent outcomes are achieved at centers with experience and expertise. Form and function can be restored with avulsion injuries and distal amputations, with good results and high patient satisfaction. Increased financial pressure to control the costs of health care and increased accountability for evidence-based outcomes may lead to the regionalization of replantation care and shared decision making in recommending replantation or revision amputation. PMID:24996460

  13. Severe limb pain suppresses chest pain in a patient with anterior myocardial infarction.

    PubMed

    Canpolat, U; Kaya, E B; Aytemir, K; Kabakçı, G

    2012-09-01

    Cardiac complications of chest trauma range from arrhythmias and valvular avulsions to myocardial contusion, rupture, and--rarely--myocardial infarction. Herein, we described a 44-year-old male patient who presented to the hospital after receiving a blow from a fist directly to the chest and fingertip amputation during a fight; anterior myocardial infarction without any chest pain was coincidentally detected. Our case illustrates the importance of electrocardiography in the initial evaluation of patients with chest trauma and suspected injury to the coronary arteries. PMID:22407423

  14. An expanded phenotype of maternal SSA/SSB antibody-associated fetal cardiac disease

    PubMed Central

    CUNEO, BETTINA F.; STRASBURGER, JANETTE F.; NIKSCH, ALISA; OVADIA, MARC; WAKAI, RONALD T.

    2010-01-01

    Objectives Conventional manifestations of fetal Sjögren’s antibodies (SSA/SSB) associated cardiac disease include atrio-ventricular block (AVB), transient sinus bradycardia, endocardial fibroelastosis (EFE) and dilated cardiomyopathy. We describe other manifestations of cardiac disease. Methods We describe three fetuses with unique myocardial and conduction system disease. Results One had isolated EFE with subsequent mitral and tricuspid valve chordal avulsion, the second had sinoatrial and infrahissian conduction system disease, and in both, neonatal progression to life threatening disease occurred. The third had sinus node dysfunction and atrial flutter. Conclusion These findings expand the clinical phenotype of maternal SSA/SSB antibody associated fetal cardiac disease. PMID:19330707

  15. Intrauterine Fetal Death in Gunshot Injury to the Gravid Uterus: Forensic Perspective.

    PubMed

    Bansal, Yogender Singh; Kumar, Senthil; Rao, Murali G

    2015-08-01

    Assault on pregnant women is not a rare event; however forensic analysis of gunshot injuries among the same group requires a greater deliberation. This is the report of a 38-week-old fetus which succumbed following gunshot injuries to the mother while the latter survived. The uniqueness of fetal injuries in the form of avulsed wound with complete detachment of anus is of great forensic interest. Such unusual wound pattern could have been the result of a blast wave effect created due to the high velocity projectile affecting the fluid filled uterine cavity. PMID:26435965

  16. [Isolated injury of the subscapular muscle tendon].

    PubMed

    Thielemann, F W; Kley, U; Holz, U

    1992-03-01

    Avulsion of the subscapularis tendon is caused by a combined abduction and external rotation trauma of the upper limb. Weakness of internal rotation and a positive apprehension test are clinical signs of the injury. A fracture of the lesser tuberosity in the x-ray film or a disruption of the subscapularis tendon documented in dynamic sonography of the shoulder clarify the diagnosis. Operative treatment is indicated of prevent weakness of internal rotation as well as anterior instability. This recommendation is supported by four cases with full range of motion and good anterior stability after surgery. PMID:1585252

  17. Complications of sodium hydroxide chemical matrixectomy: nail dystrophy, allodynia, hyperalgesia.

    PubMed

    Bostancı, Seher; Koçyiğit, Pelin; Güngör, Hilayda Karakök; Parlak, Nehir

    2014-11-01

    Ingrown toenails are seen most commonly in young adults, and they can seriously affect daily life. Partial nail avulsion with chemical matrixectomy, generally by using either sodium hydroxide or phenol, is one of the most effective treatment methods. Known complications of phenol matrixectomy are unpredictable tissue damage, prolonged postoperative drainage, increased secondary infection rates, periostitis, and poor cosmetic results. To our knowledge, there have been no reports about the complications related to sodium hydroxide matrixectomy. Herein, we describe three patients who developed nail dystrophy, allodynia, and hyperalgesia after sodium hydroxide matrixectomy. PMID:25514278

  18. Attempted auto-enucleation in two incarcerated young men with psychosis

    PubMed Central

    Reichstein, David; Esmaili, Neda; Wells, Timothy; Kim, Judy E.

    2014-01-01

    Auto-enucleation is a sign of untreated psychosis. We describe two patients who presented with attempted auto-enucleation while being incarcerated. This is an observation two-case series of two young men who suffered untreated psychosis while being incarcerated. These young men showed severe self-inflicted ocular trauma during episodes of untreated psychosis. Injuries included orbital bone fracture and dehiscence of the lateral rectus in one patient and severe retinal hemorrhage and partial optic nerve avulsion in the second patient. Auto-enucleation is a severe symptom of untreated psychosis. This urgent finding can occur in a jail setting in which psychiatric care may be minimal. PMID:25892940

  19. The triceps preserving approach to total elbow arthroplasty.

    PubMed

    Pierce, T D; Herndon, J H

    1998-09-01

    Elbow arthroplasty most commonly is performed through a posterior approach by detaching or reflecting the triceps off the olecranon. Surgical approaches to the elbow joint that dissociate the triceps from the olecranon have distinct disadvantages. Triceps avulsion, triceps weakness, and wound healing problems have been reported. Such complications necessitate more surgery and predispose the joint to an infection. To avoid these complications a modified posterior approach to the elbow joint that preserves the triceps muscle insertion on the olecranon was used in 10 consecutive elbow arthroplasties. This method provides adequate exposure, allows early rehabilitation, and avoids triceps weakness. PMID:9755773

  20. Intrauterine Fetal Death in Gunshot Injury to the Gravid Uterus: Forensic Perspective

    PubMed Central

    Kumar, Senthil; Rao, Murali G

    2015-01-01

    Assault on pregnant women is not a rare event; however forensic analysis of gunshot injuries among the same group requires a greater deliberation. This is the report of a 38-week-old fetus which succumbed following gunshot injuries to the mother while the latter survived. The uniqueness of fetal injuries in the form of avulsed wound with complete detachment of anus is of great forensic interest. Such unusual wound pattern could have been the result of a blast wave effect created due to the high velocity projectile affecting the fluid filled uterine cavity. PMID:26435965

  1. Exceptional Bedload Flux Following the 2008 Eruption of Chaitén Volcano, Chile

    NASA Astrophysics Data System (ADS)

    Major, J. J.; Pierson, T. C.; Amigo, A.; Bertin, D.

    2015-12-01

    The 10-day explosive phase of the May 2008 eruption of Chaitén Volcano, Chile, draped adjacent watersheds with a few cm to >1m of tephra. Subsequent lava-dome collapses generated pyroclastic flows that delivered additional channel sediment. During waning phases of explosive activity, modest rainfall (~20 mm in 24 hours; peak intensity ~3-5 mm h-1) triggered an exceptional sediment flush from multiple watersheds. This flush swiftly aggraded channels by many meters, mostly by fluvial transport; in some basins, earliest transport was by hyperconcentrated-flow lahars. Ten km from the volcano, Chaitén River avulsed through coastal Chaitén town owing to 7m of channel aggradation. That aggradation and delta growth downstream of the abandoned and newly avulsed channels allow estimates of post-disturbance bedload flux. On the basis of pre-eruption bathymetry of Chaitén Bay (by the Chilean Navy) and measurements of delta-surface changes from satellite images, we derived time-series estimates of averaged delta volume. The initial flush from 11-14 May 2008 deposited 1-3 million m3 of sandy sediment at the mouth of Chaitén River. By 26 May, after channel avulsion, a second delta contained about 7 million m3 sediment. Delta volume increased at a logarithmically decreasing rate until late 2011 when it reached about 16 million m3. Subsequently, delta area and volume decreased slightly by wave erosion. The deltas, especially the latter, grew through bedload transport. Sediment particles in the river channel and on deltas are composed of lithic rhyolite and poorly vesicular pumice sand. Channel width through town ranged from 50 to 75 m. Rates of channel aggradation and delta growth, channel width, and an assumed bulk deposit density of 1100-1500 kg/m3 indicate that unit-width bedload flux just before and shortly after avulsion (~14-15 May) was exceptional and perhaps as great as 100-200 kg/m/s. From October 2008 to December 2011, unit-width flux rates declined logarithmically

  2. Two cases of chronic knee pain caused by unusual injuries to the popliteus tendon

    PubMed Central

    DAVALOS, ERIC A.; BARANK, DAVID; VARMA, RAJEEV K.

    2016-01-01

    Injuries to the popliteus tendon are less frequent than injuries to the menisci or ligamentous structures of the knee. When they do occur, injuries to the popliteus tendon tend to be the result of trauma and associated with injuries to other components of the knee. The most commonly seen injuries include tears at the musculotendinous junction and avulsion tears at the lateral femoral condyle insertion site. This report presents two unusual injuries of the popliteus tendon in patients with chronic knee pain: an isolated split tear of the tendon and a subluxed tendon residing within the lateral joint space. PMID:27386449

  3. Knowledge on dental trauma and orthodontic tooth movement held by a group of orthodontists.

    PubMed

    Tondelli, Pedro Marcelo; Mendonça, Marcos Rogério de; Cuoghi, Osmar Aparecido; Pereira, Alex Luiz Pozzobon; Busato, Mauro Carlos Agner

    2010-01-01

    The objective of this work was to assess the knowledge about orthodontic tooth movement and dental trauma held by a group of orthodontists in specific areas of Brazil. For this purpose, 166 questionnaires with 15 objective questions about this subject were distributed. One hundred and five questionnaires were properly filled and collected after 30 days. It was concluded that, except for avulsion, the knowledge on dental injuries held by the professionals interviewed was considered unsatisfactory, and about 40% of them were not acquainted with the recommendations for the orthodontic movement of traumatized teeth. PMID:20339718

  4. First aid for dental trauma caused by sports activities: state of knowledge, treatment and prevention.

    PubMed

    Emerich, Katarzyna; Kaczmarek, Jan

    2010-05-01

    In view of the widespread lack of knowledge of first aid procedures in cases of dental trauma, this article describes the current state of knowledge and highlights the need for education of those likely to witness or be victims of dental trauma while practising sports. Dental and oral injuries, the commonest type of orofacial injuries, are often sustained by athletes playing contact sports; indeed, they represent the most frequent type of sporting injury. Studies of a large group of children and adults have shown that as many as 31% of all orofacial injuries are caused by sporting activities. Furthermore, current literature on the subject emphasizes that awareness of appropriate triage procedures following dental trauma is unsatisfactory. Delay in treatment is the single most influential factor affecting prognosis. What should we know and, more importantly, what should we do? Immediate replantation of an avulsed tooth is the best treatment option at the site of the accident. If replantation is impossible, milk is the preferred transport medium for the avulsed tooth. There is a general low level of awareness about the need for prompt triage of traumatic dental injuries sustained in sports, despite their relative frequency. When a cohort of Swiss basketball players was interviewed, only half were aware that an avulsed tooth could be replanted. Cheap, commercially available tooth storage devices containing an isotonic transport medium (so-called 'Save-a-Tooth boxes'), can maintain the viability of an avulsed tooth for up to 72 hours, prior to replantation. More readily available storage media such as milk, sterile saline or even saliva may be used, but knowledge of this information is rare among sports participants. For example, just 6.6% of the Swiss basketball players interviewed were aware of the 'Tooth Rescue box' products. Sporting organizations seem to offer very little information about sports-related risks or preventive strategies for orodental trauma. Having

  5. Two Pelvic Digits on Same Side: Double Trouble?

    PubMed

    Khatri, Kavin; Goyal, Darsh; Paul, Rajesh; Sandhu, H S

    2015-06-01

    Pelvic digit is a rare congenital anomaly of pelvis usually discovered incidentally on plain radiography. It usually develops in the soft tissue adjacent to the normal skeletal tissue. Its importance lays in its differentiation from heterotopic ossification, osteochondroma, Fong's disease and traumatic avulsion injuries of pelvis to avoid any unnecessary investigations and interventions. Here, we report a 32-year-old male presenting with complain of pain in right hip, was subjected to radiographic examination and two pelvic digits were noticed arising from the iliac bone in addition to features of osteoarthritis of hip joint. The symptomatology was attributed to osteoarthritis of hip after thorough physical examination and imaging investigations. PMID:26266172

  6. [Legal aspects of sports injuries].

    PubMed

    Allard, R H B

    2005-05-01

    Victims of sports injuries have to be advised about aspects of legal liablity, especially in case of luxation or avulsion of teeth, since there still may be dental consequences years later. The transference of information by the first-aid-dentist to the sportsman's own dentist should take place with care. If the patient has no family dentist, the first-aid-dentist should at least keep the sportsman free of pain, for example by starting endodontic treatment. Because sports injuries mostly occur beyond normal practice-hours, there may be reasons to deviate from the clinical guideline. PMID:15932047

  7. Proper care of early wounds to optimize healing and prevent complications.

    PubMed

    Pitzer, Geoffrey B; Patel, Krishna G

    2011-08-01

    Proper wound care has broad applications for all clinicians. Much of the future direction for enhancing wound repair focuses on key cells and growth factors, which is why possessing a strong understanding of the basic physiology of wound healing is imperative. This article first provides a thorough review of the phases of wound healing followed by a discussion on the latest wound management strategies. Wound conditions and surgical techniques are important components for optimizing wound healing and preventing complications. Special consideration has been given to the unique settings of contaminated wounds, open wounds, or avulsed tissue. PMID:21856537

  8. Patterns of Hamstring Muscle Tears in the General Population: A Systematic Review

    PubMed Central

    Kuske, Barbara; Hamilton, David F.; Pattle, Sam B.; Simpson, A. Hamish R. W.

    2016-01-01

    Background Hamstring tears are well recognised in the sporting population. Little is known about these injuries in the general population. Purpose Evaluating the rates, patterns and risk factors of non-sporting hamstring tears, compared to sporting related hamstring tears. Data Sources MEDLINE, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials (1989–2015). Study Selection Studies reporting patients with a grade 2 or 3 hamstring muscle tear, identified clinically, confirmed by MRI imaging or direct visualisation during surgical exploration. Data Synthesis 144 sets of linked data were extracted for analysis. Most injuries were in males (81.3%), where mean age at injury was lower (30.2, 95% CI 29.1–31.3) than in females (35.4, 95% CI 32.4–38.4) p = 0.06. Key differences were found in the proportion of non-sporting injuries in patients under and over the age 40 (p = 0.001). The proportion of non-sporting injuries was significantly higher in females compared to males (25.9% female non-sporting injuries, versus 8.5% male; p = 0.02). Avulsions were more frequently reported in non-sporting activities (70.5%). The proportion of such injuries was notably higher in females, though this failed to meet significance (p = 0.124). Grouped by age category a bimodal distribution was noted, with the proportion of avulsions greater in younger (age <15) and older patients (age > 40) (p = 0.008). 86.8% of patients returned to pre-injury activity levels with a similar frequency across all study variables; age, activity (sporting vs non-sporting) and injury type (avulsion vs tear). Conclusion This review highlights a proportion of adults suffering grade 2 or 3 hamstring injuries from activities other than the classic sports trauma. The majority of these non-sporting injuries were avulsion injuries that clustered in older female and skeletally immature patients suggesting a potential link to bone mineral density. PMID:27144648

  9. Nasolabial Flap in Maxillofacial Gunshot Trauma: A Case Series

    PubMed Central

    Rahpeyma, Amin; Khajehahmadi, Saeedeh

    2016-01-01

    Introduction The nasolabial flap (NLF) has many advantages in oromaxillary reconstruction, but the majority of cases are reconstructions after pathologic resections. Its usage in trauma surgery, especially in the management of gunshot wounds, is rarely mentioned. Case Presentation Three cases involving gunshot injuries to the face are presented: one for reconstruction of the nasal ala, another for bone graft coverage in mandibular reconstruction, and the third for the repair of premaxillary hard and soft tissue avulsive defects. Conclusions The NLF is a thin, pliable flap and is useful for intraoral and facial reconstruction of trauma patients with small to moderate soft tissue loss. PMID:27148497

  10. Attempted auto-enucleation in two incarcerated young men with psychosis.

    PubMed

    Reichstein, David; Esmaili, Neda; Wells, Timothy; Kim, Judy E

    2015-01-01

    Auto-enucleation is a sign of untreated psychosis. We describe two patients who presented with attempted auto-enucleation while being incarcerated. This is an observation two-case series of two young men who suffered untreated psychosis while being incarcerated. These young men showed severe self-inflicted ocular trauma during episodes of untreated psychosis. Injuries included orbital bone fracture and dehiscence of the lateral rectus in one patient and severe retinal hemorrhage and partial optic nerve avulsion in the second patient. Auto-enucleation is a severe symptom of untreated psychosis. This urgent finding can occur in a jail setting in which psychiatric care may be minimal. PMID:25892940

  11. Distal radius fracture: diagnosis, treatment, and controversies.

    PubMed

    Tang, Jin Bo

    2014-07-01

    This article presents the diagnosis and treatment of distal radius fractures with emphasis on (1) current common principles, (2) the author's current practices, and (3) controversies. The author emphasizes that displaced distal radius fractures should be approached first with a trial of closed reduction, with or without percutaneous pinning. If this reduction is unstable or unsuccessful, open reduction is indicated. Early treatments include percutaneous pinning through the distal radioulnar joint, early or delayed reattachment/repair of the avulsed dorsal periphery of the triangular fibrocartilage complex (TFCC), reattachment of the TFCC to the ulna fovea, and late reconstruction. PMID:24996466

  12. Tectonic Uplift and Fan Delta Incision along the Conway Coast, NZ

    NASA Astrophysics Data System (ADS)

    Burtt, D. G.; Bassett, K. N.

    2015-12-01

    The Conway Coast features a unique confluence of fan deltas, terrace uplift, and transpressional faulting. Thrust faults have caused the uplift of the Hawkeswood Range which provides sediment sources for local Gilbert-type fan deltas uplifting to form terraces. Sediments are characterized by steeply dipping foreset beds, horizontal topset beds and tangential bottomset beds. These fan deltas tend to form on steep basin margins often associated with extensional faulting. However, the Conway coast is dominated by thrust faulting. The Rafa terrace, dated between 52.4±4.5 and 79.0±3.5 ka with Optically Stimulated Luminescence, is exposed in cliff faces on the beach. Local creek channels deposited the fan deltas and later incised older deposits to reveal a three-dimensional perspective of the fan delta. This perspective is vital to the recreation of the fan delta position and channel avulsion, leading to a better understanding of the role of uplift superimposed by sea level change in the formation of the terraces. Forty-three photographs were stitched together to form an extensive photomosaic. The types of sediments, significant structures and relationships between adjacent beds were noted and analyzed. Correlations between the sedimentary architecture and sea level change were made using a sea level curve of the South Pacific over the last 140 ka. The incision of mud by gravel producing large flame structures suggests that there was a drop in sea level and a subsequent progradation of the fan delta. Based on the sea level curve, this drop occurred between ~66-79 ka. Higher in the fan delta, a fining-upward sequence points to a rise in sea level. This correlates with a rise on the sea level curve between ~52-63 ka. Upsection there is another coarsening-upward sequence of 5-10 m thick beds suggesting a fall in sea level before the uplift and incision of the terrace and the subsequent formation of the Ngaroma terrace. Due to their lateral extent, the gravels seem to

  13. Management of Traumatized Permanent Incisors. Revascularization and Delayed Replantation.

    PubMed

    Gharechahi, Maryam; Shojaeian, Shiva

    2016-01-01

    This article reports a clinical case of a 9-year-old boy with a traumatic injury to the maxillary central incisors 24 hours after a fall in his schoolyard. The upper left central incisor was avulsed and was kept in saliva for four hours from the moment of trauma until its replantation. The right one was necrotized after one month. We describe successful revascularization treatment of right necrotic immature upper incisor and delayed replantation of left one. After 18 months, radiolucent lesions in the periapical areas of both maxillary central incisors had healed, and root apex development was noted with thickening of the walls in tooth #8. PMID:26939157

  14. Tillaux fracture of the ankle in an adult: a rare injury.

    PubMed

    Kumar, Narinder; Prasad, Manish

    2014-01-01

    The Tillaux fracture of the ankle is an external rotation ankle injury resulting in an avulsion fracture of the anterolateral tibial plafond. This injury is known to occur in adolescents, although it has rarely been reported in adults. We report a case of a Tillaux fracture in an adult. A brief description of the history, mechanism of injury, required imaging, and treatment and other management options are provided in the present report. Anatomic reduction, rigid fixation, and early mobilization are emphasized to obtain a satisfactory functional outcome, shown by the long-term follow-up findings. PMID:25128312

  15. Posterior Tibial Labrum Injury in a Professional Soccer Player: A Case Report.

    PubMed

    Batista, Jorge Pablo; del Vecchio, Jorge Javier; Maestu, Rodrigo

    2016-01-01

    Ankle ligament injuries are one of the most frequent lesions identified in professional soccer players. In most cases, the ligaments involved are the anterior talofibular ligament and the calcaneal fibular ligament. In the present report, we describe a professional soccer player who sustained an ankle sprain that did not respond to initial therapy. The findings from radiographic and magnetic resonance images were inconclusive. Ultimately, rupture of the posterior, transverse ligament with avulsion of the tibial labrum was identified as the cause of his ongoing ankle pain. Confirmation of the pathologic findings and successful treatment were performed arthroscopically. PMID:25459088

  16. [Neurorehabilitation for Neuropathic Pain].

    PubMed

    Hozumi, Jun; Osumi, Michihiro; Ogata, Toru; Sumitani, Masahiko

    2015-07-01

    Deafferentation, like as in limb amputation, brachial plexus avulsion injury and spinal cord injury, is usually followed by neuropathic pain. Neuropathic pain is a debilitating condition and it impairs the quality of life profoundly. Based on recent advances in the cognitive neuroscience, we explain intimate relationships among neuropathic pain, reorganization of primary sensory and motor cortices and the sensorimotor integration of the deafferentated limb. From the standpoint of the sensorimotor integration theory for emerging phantom limb pain, we further discuss the analgesic mechanism of neurorehabilitation techniques such as mirror visual feedback treatment and its related neurorobotics advancement for neuropathic pain. PMID:26422941

  17. Meniscal Root Tears: Identification and Repair.

    PubMed

    Doherty, David B; Lowe, Walter R

    2016-01-01

    Intact menisci are capable of converting the axial load of tibiofemoral contact into hoop stress that protects the knee joint. Total meniscectomy leads to rapid degeneration of the knee. Strong clinical and biomechanical data show meniscal root tears and avulsions are the functional equivalent of total meniscectomy. Lateral root tears commonly occur with knee ligament sprains and tears. Medial root tears are generally more chronic, and can be caused by preexisting knee arthritis. Meniscal root repair is indicated when there is identification of a meniscal root tear in a knee with minimal to no arthritis. Chronic root tears in the setting of osteoarthritis are treated conservatively. Meniscal root tears can acutely occur with cruciate ligament tears, can exaggerate symptoms of instability, and will have negative ramifications on outcomes of anterior cruciate ligament reconstruction if not addressed concomitantly. In this review, we describe the importance of the menisci for knee joint longevity through anatomy and biomechanics, the diagnostic workup, and ultimately a transosseous technique for repair of meniscal root tears and avulsions. PMID:27004274

  18. Medial and Lateral Canthal Reconstruction with an Orbicularis Oculi Myocutaneous Island Flap

    PubMed Central

    Han, Jihyeon; Kwon, Sung Tack; Kim, Suk Wha

    2015-01-01

    Background The eyelid and canthal areas are common locations for cutaneous tumors. The medial canthus includes, among many other apparatuses, the canthal tendon and lacrimal canaliculi, and its characteristic thin and supple skin is hard to mimic and restore using tissue from other regions. Accordingly, reconstruction of the canthal area can prove challenging for surgeons. Although various methods, such as skin grafts and local flaps from adjacent regions, have been utilized for reconstructive purposes, they present known disadvantages. However, we were able to successfully reconstruct both lateral and medial canthal area defects by using orbicularis oculi myocutaneous island flaps. Methods Our study included seven patients who underwent medial or lateral canthal region reconstruction, using orbicularis oculi myocutaneous island flaps, between 2011 and 2014, following either cutaneous tumor excision or traumatic avulsion injury. Results Five patients had basal cell carcinoma, one had squamous cell carcinoma of the eyelid, and one had sustained a traumatic avulsion injury of the eyelid and canthal area. Entire flap loss was not observed in any patient, but one-a heavy smoker-showed partial flap loss, which healed with secondary intention and yielded acceptable results. Donor site morbidity was not observed, and all patients were satisfied with their surgical outcomes. Conclusions The canthal regions can be successfully reconstructed with orbicularis oculi myocutaneous island flaps. These flaps offer several key advantages, including similarity in texture, color, and thickness to the recipient site and a negligible incidence of donor site morbidity. PMID:25606488

  19. Combining tangential hydrodissection, panniculectomy, and negative pressure wound therapy in treating extensive degloving injury of the leg

    PubMed Central

    Albu, E; Alexandru, A; Marinescu, B; Ene, R; Cârstoiu, C

    2014-01-01

    Major degloving injuries of the lower limb are daunting lesions because they are relatively rare and always produce larger soft tissue defects than direct visual inspection that could be predicted in the emergency room. Enough body of the medical literature supports the excision of the avulsed tissue and replaces it as a full-thickness skin graft. However, almost paradoxically, there is little support for the use of pristine large full-thickness skin graft in the treatment of these lesions. This article focuses on the use of tangential hydrodissection (VERSAJET Hydrosurgery System, Smith & Nephew) in preparing the avulsed wound and defatting of a large piece of full thickness skin graft taken from the abdomen by using a standard panniculectomy excision pattern and securing survival and integration of the graft with negative pressure wound therapy. The patient, a 60-year-old obese and diabetic woman, suffered a roadside accident producing a degloving injury of her leg and was treated with the presented method; the final result was excellent and the reduction of the abdominal panniculus was a bonus. PMID:25870709

  20. Experimental river delta size set by multiple floods and backwater hydrodynamics

    PubMed Central

    Ganti, Vamsi; Chadwick, Austin J.; Hassenruck-Gudipati, Hima J.; Fuller, Brian M.; Lamb, Michael P.

    2016-01-01

    River deltas worldwide are currently under threat of drowning and destruction by sea-level rise, subsidence, and oceanic storms, highlighting the need to quantify their growth processes. Deltas are built through construction of sediment lobes, and emerging theories suggest that the size of delta lobes scales with backwater hydrodynamics, but these ideas are difficult to test on natural deltas that evolve slowly. We show results of the first laboratory delta built through successive deposition of lobes that maintain a constant size. We show that the characteristic size of delta lobes emerges because of a preferential avulsion node—the location where the river course periodically and abruptly shifts—that remains fixed spatially relative to the prograding shoreline. The preferential avulsion node in our experiments is a consequence of multiple river floods and Froude-subcritical flows that produce persistent nonuniform flows and a peak in net channel deposition within the backwater zone of the coastal river. In contrast, experimental deltas without multiple floods produce flows with uniform velocities and delta lobes that lack a characteristic size. Results have broad applications to sustainable management of deltas and for decoding their stratigraphic record on Earth and Mars. PMID:27386534

  1. An Isolated Displaced Fracture of the Coracoid Process Treated with Open reduction and internal fixation - A Case Report and Review of Literature

    PubMed Central

    Archik, Shreedhar; Nanda, Saurav Narayan; Tripathi, Sanjay; Choudhari, Ashlesh; Rajadhyaksha, Harshada

    2016-01-01

    Introduction: Isolated coracoid fractures are rare and few scattered cases are reported in literature. Coracoid fractures can be missed and the treatment for coracoid process fractures is still controversial. The case presented here is of an isolated coracoid process fracture which was treated surgically. Case Report: A 15-years old male presented after 4 days of injury complaining of persistent pain in the right shoulder following a jerk during bowling. Physical examination revealed tenderness in the left shoulder. There was pain on abduction and external rotation. The neurovascular examination was normal. Osseous avulsion of the distal tip of the coracoid process was confirmed by CT and MRI. The short head of the biceps and coracobrachialis was attached to the avulsed tip, while the pectoralis minor was attached to the coracoid base. The case was managed by open reduction and fixation with a 3.5mm cannulated screw and washer. Conclusion: Isolated coracoid fracture is a rare entity causing impairment of upper limb movement. It can be diagnosed more accurately by MRI scan and CT scan. In case of young highly demanding individuals like athletes surgical management may be a better option as compared to conservative treatment to achieve early use of the extremity, good radiological union and clinical function. PMID:27299123

  2. The geomorphic evolution of Somesu Mic River (Romania) over the past two millenia

    NASA Astrophysics Data System (ADS)

    Persoiu, Ioana; Persoiu, Aurel

    2010-05-01

    In this paper we present the dynamics of Somesu Mic River (NW Romania) in relation with the climatic changes over the past 2000 years. The results and discussions are based on 1) documentary evidences of important floods in the area (starting with 1200 AD), 2) the spatial position of old bridges, roads, human settlements related to river position (from the Roman Epoch though the Medieval Period), 3) historical planform river dynamic, based on successive cartographic maps (past 250 years) and 4) OSL and 14C absolute dating of channel fills exposed in the river's bank. The climate in the area was reconstructed using stable isotopes of oxygen and hydrogen in ice cores retrieved from Scarisoara Ice Cave, which display two colder (and possibly more humid) periods between 400 - 900 AD (dark Ages Cold Period - DACP) and 1300-1850 AD (Little Ice Age - LIA), and two warmer (and possibly drier) periods, between 0-400AD (Roman Warm Period - RWP) and 900-1300 AD (Medieval Warm Period - MWP) Our results shows that during periods with high incidence of important floods (LIA), the river readjusts its planform morphology trough meander cut-offs or avulsions on a larger scale, while during periods of reduced incidence of important floods (RWP and MWP), lateral migration became the main river planform process. This behaviour is complicated by geology, reflected in specific local adjustments (e.g. high planform stability, preferential channel migration, avulsion).

  3. Ultrasonographic characteristics of volar-lateral ligament constrains after proximal interphalangeal joint injuries.

    PubMed

    Saito, Susumu; Sawabe, Kazuma; Suzuki, Yoshihisa; Suzuki, Shigehiko

    2016-08-01

    Objective To characterise posttraumatic constrains of the volar-lateral ligaments by analysing volar plate (VP) dynamics after proximal interphalangeal (PIP) joint injuries using ultrasonography. Materials and methods From the anatomical and biomechanical perspectives of the VP and its surrounding structures, posttraumatic constrains of the volar-lateral ligament were evaluated by analysing the changes of VP motion. Using ultrasound, VP motion during active flexion of 0-60° was recorded in the central sagittal plane at 12 weeks after injury. VP trajectories visualised by 5-point tracing on the VP were analysed qualitatively to detect differential patterns of the ligament constrains. Quantitatively, correlation between averaged constrain index determined by measuring volar locational values of the 5 points on the VP and limitation in extension at the final follow-up was assessed. Results Eleven patients with PIP joint injuries involving five VP avulsions, three volar intra-articular fractures, or three dorsal fracture-dislocations were included. All patients with VP avulsion revealed a totally-constrained pattern, whereas patients with intra-articular or fracture-dislocation injuries showed distally-constrained pattern or normal. Averaged constrain index was negatively correlated with limitation in extension, indicating positive contribution of volar-lateral ligament constrains to residual flexion contracture. Conclusion Ultrasonographic visualisation of VP motion characterised posttraumatic constrained conditions of the volar-lateral ligaments. Knowledge of the manner of ligament damages might be useful to set treatment strategies for PIP joint injuries. PMID:26981745

  4. Three-dimensional Ultrasound Appearance of Pelvic Floor in Nulliparous Women and Postpartum Women One Week after Their First Delivery

    PubMed Central

    Liu, Feifei; Xu, Lian; Ying, Tao; Tao, Junjia; Hu, Bing

    2014-01-01

    This study investigated the morphology and structure of pelvic floor in 50 nulliparous and 95 postpartum women (47 vaginal delivery, 48 Cesarean section) using translabial three-dimensional (3D) ultrasound. All the primiparae underwent ultrasound examination within one week after their first delivery. Volume datasets were acquired and analyzed to determine the alterations of levator hiatus after childbirth. Significant differences were observed in the levator hiatus of postpartum women compared with that of nullipara women. In postpartum women, the levator hiatus, with their dimensions increased, expanded into a circular shape. Puborectalis was avulsed in eight cases (accounting for 8.42% of all) and pelvic organ prolapse was found in 12 cases (accounting for 12.63%). The hiatal dimensions were larger and the incidence of pubrectalis muscle avulsion (17.02% vs. 0%) and pelvic organ prolapse (21.28% vs. 4.17%) was significantly higher in Vaginal delivery group than Cesarean section group. In summary, 3D ultrasound is an effective tool to detect the pelvic floor of postpartum women who present with morphological abnormalities, and such abnormalities are more likely to show in vaginal delivery women compared to Cesarean section. PMID:24522119

  5. Anatomy and growth pattern of Amazon deep-sea fan as revealed by long-range side-scan sonar (GLORIA) and high-resolution seismic studies

    SciTech Connect

    Damuth, J.E.; Flood, R.D.; Kowsmann, R.O.; Belderson, R.H.; Gorini, M.A.

    1988-08-01

    Imaging of the Amazon deep-sea fan with long-range side-scan sonar (GLORIA) has, for the first time, revealed the anatomy, trends, and growth pattern of distributary channels on this fan. Only one channel-levee system was active at any given time and extended from the Amazon Submarine Canyon downslope onto the lower fan (> 4,200 m). Formation of new channel-levee systems occurred when a currently active channel-levee system was cut off and abandoned through avulsion, and a new channel-levee system was established nearby. Through time, successive channel-levee formation and abandonment built two broad levee complexes consisting of groups of overlapping, coalescing segments of channel-levee systems across the present fan surface. These, plus older, now buried levee complexes, indicate that fan growth is radially outward and downslope through development of successive levee complexes. The most striking characteristic of the distributary channels is their intricate, often recurving, meanders with sinuosities of up to 2.5. Cutoffs and abandoned meander loops indicate that the channels migrate laterally through time. Channel bifurcation results predominantly from avulsion when flows breach a channel levee, thereby abandoning the present channel and establishing a new channel-levee segment nearby. No clear evidence of channel branching (i.e., division of a single channel into two active segments) or braiding was observed. 22 figs.

  6. Effect of Coconut Water Concentration on Survival of Bench-Dried Periodontal Ligament Cells

    PubMed Central

    Al-Haj Ali, Sanaa; Mhaidat, Nizar; Awawdeh, Lama; Naffa, Randa

    2011-01-01

    ABSTRACT Background : Coconut water is a biological and sterile liquid. It contains a variety of electrolytes, sugars and amino acids. The purpose of this study is to evaluate the effect of concentration and maturity of coconut water on its ability to preserve human PDL cell viability after exposure to dry time of up to 120 minutes using an in vitro cell culture model. Methods : PDL cells were obtained from sound permanent first molars which were cultured in Dulbecco’s Modified Eagle’s Medium (DMEM). Cultures were subjected to 0, 30, 60, 90 and 120 minutes dry periods then incubated with 100 and 50% young and mature coconut water for 45 minutes at room temperature (18-26°C). Untreated cells at 0 and 120 minutes, and cells incubated in DMEM served as controls. PDL cell viability was assessed by MTT assay. Statistical analysis of data was accomplished by using one-way analysis of variance complemented by Tukey test, and the level of significance was 5% (p < 0.05). Results : 100% mature coconut water (MCW) was better than 50% dilutions obtained from mature or young coconuts. However, no significant benefit to the cells was noticed from the addition of the soaking step prior to 30 minutes dry time. Conclusion : Avulsed teeth which are left dry for > 30 minutes may be benefited from soaking in 100% mature coconut water; further studies on simulated avulsion in animal models are needed to verify the above results.

  7. Twin Valve Caval Stent for Functional Replacement of Incompetent Tricuspid Valve: A Feasibility Animal Study

    SciTech Connect

    Sochman, Jan; Peregrin, Jan H.; Pavcnik, Dusan Uchida, Barry T. Timmermans, Hans A.; Shimohira, Masashi; Choi, Young Ho; Keller, Frederick S. Roesch, Josef

    2011-02-15

    Objective: To evaluate feasibility of a twin valve caval stent (TVCS) for functional replacement of an incompetent tricuspid valve (TV) in an acute animal study. Methods: One swine and three sheep were used in the study. TVCS placement was tested in a swine with a normal TV. TVCS function was tested in three sheep with TV regurgitation created by papillary muscle avulsion. Cardiac angiograms and pressure measurements were used to evaluate TVCS function. Two sheep were studied after fluid overload. Results: TVCS was percutaneously placed properly at the central portions of the superior vena cava (SVC) and inferior vena cava (IVC) in the swine. Papillary muscle avulsion in three sheep caused significant tricuspid regurgitation with massive reflux into the right atrium (RA) and partial reflux into the SVC and IVC. TVCS placement eliminated reflux into the SVC and IVC. After fluid overload, there was enlargement of the right ventricle and RA and significant increase in right ventricle, RA, SVC, and IVC pressures, but no reflux into the IVC and SVC. Conclusion: The results of this feasibility study justify detailed evaluation of TVCS insertion for functional chronic replacement of incompetent TV.

  8. Detailed river stage mapping and head gradient analysis during meander cutoff in a laboratory river

    NASA Astrophysics Data System (ADS)

    Han, Bangshuai; Endreny, Theodore A.

    2014-02-01

    Analytical models of river evolution predict meander narrowing and elongation which creates sinuosity-driven hyporheic exchange across the meander neck, by decreasing flow distance and increasing head loss. We used a laboratory river table and close range photogrammetry to map and analyze sinuosity as a driver of head gradients and hyporheic exchange during cutoff. The river valley had relatively high slopes (1.8%) and moderately cohesive sediment (10% talc, 90% sand) to facilitate cutoff, and ratios of horizontal to vertical scaling were distorted to achieve dynamic similitude (Re = 3200). Incipient to cutoff, the head gradient across the neck increased due to a narrowing neck, upstream aggradation, and downstream degradation. Longitudinal and transverse river surface slopes around the meander bend increased as the meander approached cutoff. The steep head gradient across the moderately cohesive meander neck generated seepage erosion and scour that formed a low-sinuosity avulsion. Sediment-rich flow in the avulsed channel aggraded the downstream bed and separated the active channel and oxbow lake. The limitation in geometric and dynamic similitude in the river table limits extrapolation to natural rivers, yet river evolution may involve aggradation and degradation induced channel head loss and turnover hyporheic exchange as well as seepage-induced meander neck erosion. Our submillimeter maps of meander morphology and water stage provide data to parameterize river evolution and hyporheic exchange models, and may inform analysis and mapping of field sites.

  9. Comparison of loading rate-dependent injury modes in a murine model of post-traumatic osteoarthritis

    PubMed Central

    Lockwood, Kevin A.; Chu, Bryce T.; Anderson, Matthew J.; Haudenschild, Dominik R.; Christiansen, Blaine A.

    2014-01-01

    Post-traumatic osteoarthritis (PTOA) is a common long-term consequence of joint injuries such as anterior cruciate ligament (ACL) rupture. In this study we used a tibial compression overload mouse model to compare knee injury induced at low speed (1 mm/s), which creates an avulsion fracture, to injury induced at high speed (500 mm/s), which induces midsubstance tear of the ACL. Mice were sacrificed at 0 days, 10 days, 12 weeks, or 16 weeks post-injury, and joints were analyzed with micro-computed tomography, whole joint histology, and biomechanical laxity testing. Knee injury with both injury modes caused considerable trabecular bone loss by 10 days post-injury, with the Low Speed Injury group (avulsion) exhibiting a greater amount of bone loss than the High Speed Injury group (midsubstance tear). Immediately after injury, both injury modes resulted in greater than 2-fold increases in total AP joint laxity relative to control knees. By 12 and 16 weeks post-injury, total AP laxity was restored to uninjured control values, possibly due to knee stabilization via osteophyte formation. This model presents an opportunity to explore fundamental questions regarding the role of bone turnover in PTOA, and the findings of this study support a biomechanical mechanism of osteophyte formation following injury. PMID:24019199

  10. Abdominal musculature abnormalities as a cause of groin pain in athletes. Inguinal hernias and pubalgia.

    PubMed

    Taylor, D C; Meyers, W C; Moylan, J A; Lohnes, J; Bassett, F H; Garrett, W E

    1991-01-01

    There has been increasing interest within the European sports medicine community regarding the etiology and treatment of groin pain in the athlete. Groin pain is most commonly caused by musculotendinous strains of the adductors and other muscles crossing the hip joint, but may also be related to abdominal wall abnormalities. Cases may be termed "pubalgia" if physical examination does not reveal inguinal hernia and there is an absence of other etiology for groin pain. We present nine cases of patients who underwent herniorrhaphies for groin pain. Two patients had groin pain without evidence of a hernia preoperatively (pubalgia). In the remaining seven patients we determined the presence of a hernia by physical examination. At operation, eight patients were found to have inguinal hernias. One patient had no hernia but had partial avulsion of the internal oblique fibers from their insertion at the public tubercle. The average interval from operation to return to full activity was 11 weeks. All patients returned to full activity within 3 months of surgery. One patient had persistent symptoms of mild incisional tenderness, but otherwise there were no recurrences, complications, or persistence of symptoms. Abnormalities of the abdominal wall, including inguinal hernias and microscopic tears or avulsions of the internal oblique muscle, can be an overlooked source of groin pain in the athlete. Operative treatment of this condition with herniorrhaphy can return the athlete to his sport within 3 months. PMID:1831010

  11. Arthroscopically assisted fixation of the lesser trochanter fracture: a case series

    PubMed Central

    Khemka, Aditya; Raz, Guy; Bosley, Belinda; Ludger, Gerdesmeyer; Al Muderis, Munjed

    2014-01-01

    Avulsion fractures of the lesser trochanter in adolescents are uncommon. This injury is a result of a sudden forceful contraction of the iliopsoas tendon. It usually occurs during vigorous sport activity. Historically, these injuries were treated non-operatively, with guarded results, including weak hip flexor strength and non-union, hindering return to competitive sport. We report a series of three arthroscopically assisted fracture fixations performed by the senior author, using cannulated screw fixation in two cases and an anchor in one case. Mobilization was commenced immediately following surgery, allowing weight bearing as tolerated using crutches for 4 weeks, thereafter unaided walking was allowed. Patients were assessed at 2 weeks, 6 weeks, 3 months and 1-year post-operatively. Radiographs were utilized to confirm full union. All three patients were able to mobilize unaided by 4 weeks post-operatively and two of the three patients returned to competitive sport at 3 months. Near—anatomical union was achieved in all cases. No complications were noted during surgery and the peri-operative period in our series. The utilization of arthroscopic reduction and fixation of avulsion of the lesser trochanter results in good fixation and allows a faster recovery with a return to sports activity, and therefore, we suggest it as a viable treatment option for such injuries. PMID:27011799

  12. Arthroscopically assisted fixation of the lesser trochanter fracture: a case series.

    PubMed

    Khemka, Aditya; Raz, Guy; Bosley, Belinda; Ludger, Gerdesmeyer; Al Muderis, Munjed

    2014-07-01

    Avulsion fractures of the lesser trochanter in adolescents are uncommon. This injury is a result of a sudden forceful contraction of the iliopsoas tendon. It usually occurs during vigorous sport activity. Historically, these injuries were treated non-operatively, with guarded results, including weak hip flexor strength and non-union, hindering return to competitive sport. We report a series of three arthroscopically assisted fracture fixations performed by the senior author, using cannulated screw fixation in two cases and an anchor in one case. Mobilization was commenced immediately following surgery, allowing weight bearing as tolerated using crutches for 4 weeks, thereafter unaided walking was allowed. Patients were assessed at 2 weeks, 6 weeks, 3 months and 1-year post-operatively. Radiographs were utilized to confirm full union. All three patients were able to mobilize unaided by 4 weeks post-operatively and two of the three patients returned to competitive sport at 3 months. Near-anatomical union was achieved in all cases. No complications were noted during surgery and the peri-operative period in our series. The utilization of arthroscopic reduction and fixation of avulsion of the lesser trochanter results in good fixation and allows a faster recovery with a return to sports activity, and therefore, we suggest it as a viable treatment option for such injuries. PMID:27011799

  13. Flood plain and channel dynamics of the Quinault and Queets Rivers, Washington, USA

    USGS Publications Warehouse

    O'Connor, J. E.; Jones, M.A.; Haluska, T.L.

    2003-01-01

    Observations from this study and previous studies on the Queets River show that channel and flood-plain dynamics and morphology are affected by interactions between flow, sediment, and standing and entrained wood, some of which likely involve time frames similar to 200–500-year flood-plain half-lives. On the upper Quinault River and Queets River, log jams promote bar growth and consequent channel shifting, short-distance avulsions, and meander cutoffs, resulting in mobile and wide active channels. On the lower Quinault River, large portions of the channel are stable and flow within vegetated flood plains. However, locally, channel-spanning log jams have caused channel avulsions within reaches that have been subsequently mobile for several decades. In all three reaches, log jams appear to be areas of conifer germination and growth that may later further influence channel and flood-plain conditions on long time scales by forming flood-plain areas resistant to channel migration and by providing key members of future log jams. Appreciation of these processes and dynamics and associated temporal and spatial scales is necessary to formulate effective long-term approaches to managing fluvial ecosystems in forested environments.

  14. [In Process Citation

    PubMed

    Manner; Koeth; Geelhaar; Stickel

    1999-01-01

    Cryophlebectomy, a more recent technique in varicose veins surgery, was evaluated in comparision with conventional techniques. Group IA: Microphlebectomy, invaginative stripping of the long saphenous vein, tourniquet, n = 90; group IB: only microphlebektomie and tourniquet, n = 72. Group IIA: Cryostripping of the long saphenous vein in combination with cryosurgical distal avulsion of varicosities and microphlebectomy, n = 112; gr. IIB: only cryosurgical distal avulsion of varicosities and microphlebectomy. Data were compared regarding duration of operation and hospitalisation and cosmetic outcome. Hospital stay (gr. IA: 9.1 +/- 5.1 d vs. gr. IIA: 6.1 +/- 2.1 d, gr. IB: 5.5 +/- 2.3 d vs. gr. IIB: 4.8 +/- 2.5 d) and duration of operation (gr. IA: 113.6 +/- 35 min vs. gr. IIA: 67 +/- 21.3 min, gr. IB: 74.4 +/- 35.3 min vs. gr. IIB: 53.3 +/- 15.5 min) were found to be significantly shorter and cosmetic result and postoperative discomforts improved in the cryophlebectomy-group. We conclude that the use of this combination of methods reduces invasivity, rises the patient's well-being and helps in cost-reduction. PMID:10068835

  15. Experimental river delta size set by multiple floods and backwater hydrodynamics.

    PubMed

    Ganti, Vamsi; Chadwick, Austin J; Hassenruck-Gudipati, Hima J; Fuller, Brian M; Lamb, Michael P

    2016-05-01

    River deltas worldwide are currently under threat of drowning and destruction by sea-level rise, subsidence, and oceanic storms, highlighting the need to quantify their growth processes. Deltas are built through construction of sediment lobes, and emerging theories suggest that the size of delta lobes scales with backwater hydrodynamics, but these ideas are difficult to test on natural deltas that evolve slowly. We show results of the first laboratory delta built through successive deposition of lobes that maintain a constant size. We show that the characteristic size of delta lobes emerges because of a preferential avulsion node-the location where the river course periodically and abruptly shifts-that remains fixed spatially relative to the prograding shoreline. The preferential avulsion node in our experiments is a consequence of multiple river floods and Froude-subcritical flows that produce persistent nonuniform flows and a peak in net channel deposition within the backwater zone of the coastal river. In contrast, experimental deltas without multiple floods produce flows with uniform velocities and delta lobes that lack a characteristic size. Results have broad applications to sustainable management of deltas and for decoding their stratigraphic record on Earth and Mars. PMID:27386534

  16. Three-dimensional ultrasound appearance of pelvic floor in nulliparous women and postpartum women one week after their first delivery.

    PubMed

    Liu, Feifei; Xu, Lian; Ying, Tao; Tao, Junjia; Hu, Bing

    2014-01-01

    This study investigated the morphology and structure of pelvic floor in 50 nulliparous and 95 postpartum women (47 vaginal delivery, 48 Cesarean section) using translabial three-dimensional (3D) ultrasound. All the primiparae underwent ultrasound examination within one week after their first delivery. Volume datasets were acquired and analyzed to determine the alterations of levator hiatus after childbirth. Significant differences were observed in the levator hiatus of postpartum women compared with that of nullipara women. In postpartum women, the levator hiatus, with their dimensions increased, expanded into a circular shape. Puborectalis was avulsed in eight cases (accounting for 8.42% of all) and pelvic organ prolapse was found in 12 cases (accounting for 12.63%). The hiatal dimensions were larger and the incidence of pubrectalis muscle avulsion (17.02% vs. 0%) and pelvic organ prolapse (21.28% vs. 4.17%) was significantly higher in Vaginal delivery group than Cesarean section group. In summary, 3D ultrasound is an effective tool to detect the pelvic floor of postpartum women who present with morphological abnormalities, and such abnormalities are more likely to show in vaginal delivery women compared to Cesarean section. PMID:24522119

  17. Predicting the planform configuration of the braided Toklat River, AK with a suite of rule-based models

    USGS Publications Warehouse

    Podolak, Charles J.

    2013-01-01

    An ensemble of rule-based models was constructed to assess possible future braided river planform configurations for the Toklat River in Denali National Park and Preserve, Alaska. This approach combined an analysis of large-scale influences on stability with several reduced-complexity models to produce the predictions at a practical level for managers concerned about the persistence of bank erosion while acknowledging the great uncertainty in any landscape prediction. First, a model of confluence angles reproduced observed angles of a major confluence, but showed limited susceptibility to a major rearrangement of the channel planform downstream. Second, a probabilistic map of channel locations was created with a two-parameter channel avulsion model. The predicted channel belt location was concentrated in the same area as the current channel belt. Finally, a suite of valley-scale channel and braid plain characteristics were extracted from a light detection and ranging (LiDAR)-derived surface. The characteristics demonstrated large-scale stabilizing topographic influences on channel planform. The combination of independent analyses increased confidence in the conclusion that the Toklat River braided planform is a dynamically stable system due to large and persistent valley-scale influences, and that a range of avulsive perturbations are likely to result in a relatively unchanged planform configuration in the short term.

  18. Adolescent Segond fracture with an intact anterior cruciate ligament.

    PubMed

    Reddy, Deepak; Alexander, Reginald; Hussain, Waqas M; Leland, J Martin

    2012-07-01

    Segond fractures, or avulsion fractures of the proximal lateral tibial plateau, have been well documented and studied since their original description in 1878. Segond fractures have a widely recognized pathognomonic association with anterior cruciate ligament (ACL) injuries and often prompt orthopedic surgeons to consider reconstruction following radiographic and clinical evaluation. Adolescent patients are particularly vulnerable to these fractures due to the relative weakness of their physeal growth plates compared with the strength of their accompanying ligamentous structures. This article describes a case of a 13-year-old boy who sustained a Segond fracture that was not coupled with an ACL avulsion or tear. The patient sustained a twisting injury to his knee. He presented to the emergency room with an effusion and radiographic findings consistent with a Segond fracture. On follow-up examination 1 week after injury, the ACL was intact. The patient was followed for 5 months of conservative treatment. At final follow-up, the patient had reestablished his previous level of activity. This article describes the history, physical examination, and radiographic findings necessary to care for patients who present with a Segond fracture. Although considered pathognomonic for an associated ACL injury, this article describes a Segond fracture that occurred in isolation. PMID:22784911

  19. Review of Acute Traumatic Closed Mallet Finger Injuries in Adults

    PubMed Central

    Salazar Botero, Santiago; Hidalgo Diaz, Juan Jose; Benaïda, Anissa; Collon, Sylvie; Facca, Sybille

    2016-01-01

    In adults, mallet finger is a traumatic zone I lesion of the extensor tendon with either tendon rupture or bony avulsion at the base of the distal phalanx. High-energy mechanisms of injury generally occur in young men, whereas lower energy mechanisms are observed in elderly women. The mechanism of injury is an axial load applied to a straight digit tip, which is then followed by passive extreme distal interphalangeal joint (DIPJ) hyperextension or hyperflexion. Mallet finger is diagnosed clinically, but an X-ray should always be performed. Tubiana's classification takes into account the size of the bony articular fragment and DIPJ subluxation. We propose to stage subluxated fractures as stage III if the subluxation is reducible with a splint and as stage IV if not. Left untreated, mallet finger becomes chronic and leads to a swan-neck deformity and DIPJ osteoarthritis. The goal of treatment is to restore active DIPJ extension. The results of a six- to eight-week conservative course of treatment with a DIPJ splint in slight hyperextension for tendon lesions or straight for bony avulsions depends on patient compliance. Surgical treatments vary in terms of the approach, the reduction technique, and the means of fixation. The risks involved are stiffness, septic arthritis, and osteoarthritis. Given the lack of consensus regarding indications for treatment, we propose to treat all cases of mallet finger with a dorsal glued splint except for stage IV mallet finger, which we treat with extra-articular pinning. PMID:27019806

  20. Incidence of Soft-Tissue Injuries in Patients with Posterolateral Tibial Plateau Fractures: A Retrospective Review from 2009 to 2014.

    PubMed

    Wang, Yanqing; Cao, Fujiang; Liu, Minghui; Wang, Jiantao; Jia, Shikong

    2016-08-01

    Objective The goal of this study was to determine the incidence of soft-tissue injuries in patients with posterolateral tibial plateau fractures. Methods The data of 265 patients who had sustained posterolateral tibial plateau fractures between May 2009 and Aug 2014 were retrospectively reviewed using a picture archiving and communication system. Fractures were classified according to the Schatzker, AO/OTA, and quadrant classification systems. Soft-tissue injuries, including anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), lateral collateral ligament (LCL), medial collateral ligament (MCL), lateral meniscus, and medial meniscus injuries, were assessed using magnetic resonance imaging (MRI) data. Results The overall incidence of ACL and PCL tears was 80 and 36%, respectively. Nine (36%) patients sustained ACL footprint avulsions and three (12%) had complete ACL tears. A total of 19 (76%) patients had LCL injuries, and 15 (64%) had MCL injuries. The incidence of lateral meniscus tears was 48%, while that of medial meniscus tears was 4%. Conclusion Posterolateral tibial plateau fractures were associated with a high incidence of soft-tissue injuries, especially ACL footprint avulsions and lateral meniscus tears. The preoperative MRI examination was important for surgeons to decide whether the ligament and meniscal injuries should be treated simultaneously with the repair of the bone fractures. PMID:27183240

  1. Channel Extension in Deep-Water Distributive Systems

    NASA Astrophysics Data System (ADS)

    Hoyal, D. C.; Sheets, B. A.

    2007-12-01

    The cyclic nature of channel and lobe formation in submarine fans is the result of the unstable and ephemeral nature of newly formed distributary channels. Avulsion cycles are initiated as unconfined sheet flow immediately following avulsion followed by stages of channel incision and extension, deposition of channel mouth deposits, and often channel backfilling. In contrast with those in alluvial and deltaic environments, avulsion cycles in submarine fans are relatively poorly understood due to the difficulty of observing deep ocean processes, either over short timescales needed to measure the hydrodynamics of active turbidity currents, or over longer timescales needed for the morphodynamic evolution of individual distributary channels and avulsion events. Here we report the results of over 80 experiments in a 5m x 3m x1m deep tank using saline (NaCl) density flows carrying low-density plastic sediment (SG 1.5) flowing down an inclined ramp. These experiments were designed to investigate trends observed in earlier self-organized experimental submarine fans with well-developed avulsion cycles, in which distributive lobes were observed to form on relatively high slopes. In particular, we were interested in investigating the relationship between channel extension length (distance from the inlet to the point where the flow becomes de-channelized, transitioning into a mouth-bar/lobe) and slope. The results of the experiments are clear but counter-intuitive. Channels appear to extend in discrete segments and channel extension length is inversely related to slope over a wide range of slopes (5-17 degrees). In addition, channel extension seems largely independent of inlet flow density (salt concentration) over the experimental range (10-24 g/cc). Measurements of densimetric Froude number (Fr') indicate Fr' increases downstream to near critical conditions at the channel lobe transition. Our preliminary interpretation is that distributary channels become unstable due to

  2. Fluvial geomorphic elements in modern sedimentary basins and their potential preservation in the rock record: A review

    NASA Astrophysics Data System (ADS)

    Weissmann, G. S.; Hartley, A. J.; Scuderi, L. A.; Nichols, G. J.; Owen, A.; Wright, S.; Felicia, A. L.; Holland, F.; Anaya, F. M. L.

    2015-12-01

    specific morphologic patterns. Tributary rivers tend to increase in size in the downstream direction. Because axial tributary rivers are present in confined settings in the sedimentary basin, they migrate back and forth within a relatively narrow belt (relative to the overall size of the sedimentary basin). Thus, axial tributary rivers tend to display amalgamated channel belt form with minimal preservation potential of floodplain deposits. Chute and neck cutoff avulsions are also common on meandering rivers in these settings. Where rivers on DFS exit their confining valley on the basin margin, sediment transport capacity is reduced and sediment deposition occurs resulting in development of a 'valley exit' nodal avulsion point that defines the DFS apex. Rivers may incise downstream of the basin margin valley because of changes in sediment supply and discharge through climatic variability or tectonic processes. We demonstrate that rivers on DFS commonly decrease in width down-DFS caused by infiltration, bifurcation, and evaporation. In proximal areas, channel sands are amalgamated through repeated avulsion, reoccupation of previous channel belts, and limited accumulation space. When rivers flood on the medial to distal portions of a DFS, the floodwaters spread across a large area on the DFS surface and typically do not re-enter the main channel. In these distal areas, rivers on DFS commonly avulse, leaving a discrete sand body and providing high preservation potential for floodplain deposits. Additional work is needed to evaluate the geomorphic character of modern sedimentary basins in order to construct improved facies models for the continental sedimentary rock record. Specifically, models for avulsion, bifurcation, infiltration, and geomorphic form on DFS are required to better define and subsequently predict facies geometries. Studies of fluvial systems in sedimentary basins are also important for evaluating flood patterns and groundwater distributions for populations in

  3. Histopathological evaluation of the effects of variable extraoral dry times and enamel matrix proteins (enamel matrix derivatives) application on replanted dogs' teeth.

    PubMed

    Barbizam, Joao V B; Massarwa, Rasha; da Silva, Lea Assed Bezerra; da Silva, Raquel Assed Bezerra; Nelson-Filho, Paulo; Consolaro, Alberto; Cohenca, Nestor

    2015-02-01

    The extra-alveolar dry period and storage medium in which the tooth was kept prior to replantation remain the critical factors affecting the survival and regeneration of the damaged periodontium. When the replantation is delayed, replacement root resorption is the most common complication following replantation of an avulsed tooth. The aim of this histological study was to evaluate the periodontal healing of replanted dogs' teeth after 20 min (short) and 60 min (long) extraoral dry time with and without the application of enamel matrix proteins. Eighty mature premolar roots (40 teeth) maxillary and mandibular premolars were extracted, the root canals were accessed, instrumented, and filled using a lateral condensation technique, and the access cavity was restored with amalgam. Each root was randomly assigned to one of experimental groups: Groups I and II: Roots were replanted after an extraoral dry time of 20 min. In group II, Emdogain(®) (Biora, Malmo, Sweden) was applied directly to the external root surface with complete coverage. Groups III and IV: Roots were replanted after an extraoral dry time of 60 min. In group IV, Emdogain(®) was applied to the whole external root surface before replantation. Roots that replanted within a total extraoral dry time of 10 min were used as negative controls, while those replanted after 90 min of extraoral dry time were assigned as positive controls. After 4 months, the dogs were euthanized, and the maxillary and mandibular processes were processed for histology and microscopically evaluated. Statistical analysis showed no significant differences (P = 0.1075) among the experimental groups. The results of this study show that 20 min of extraoral dry time is as detrimental to the PDL cells as 60 or 90 min of extraoral dry time, with avulsed dogs' teeth, even when replanted with an inductive material such as EMD. This study provides strong evidence in relation to the threshold of the extraoral dry time of avulsed teeth

  4. Historical perspectives on channel pattern in the Clark Fork River, Montana and implications for post-dam removal restoration

    NASA Astrophysics Data System (ADS)

    Woelfle-Erskine, C. A.; Wilcox, A. C.

    2009-12-01

    Active restoration approaches such as channel reconstruction have moved beyond the realm of small streams and are being applied to larger rivers. Uncertainties arising from limited knowledge, fluvial and ecosystem variability, and contaminants are especially significant in restoration of large rivers, where project costs and the social, infrastructural, and ecological costs of failure are high. We use the case of Milltown Dam removal on the Clark Fork River, Montana and subsequent channel reconstruction in the former reservoir to examine the use of historical research and uncertainty analysis in river restoration. At a cost of approximately $120 million, the Milltown Dam removal involves the mechanical removal of approximately 2 million cubic meters of sediments contaminated by upstream mining, followed by restoration of the former reservoir reach in which a single-thread meandering channel is being constructed. Historical maps, surveys, photographs, and accounts suggest a conceptual model of a multi-thread, anastomosing river in the reach targeted for channel reconstruction, upstream of the confluence of the Clark Fork and Blackfoot Rivers. We supplemented historical research with analysis of aerial photographs, topographic data, and USGS stage-discharge measurements in a lotic but reservoir-influenced reach of the Clark Fork River within our study area to estimate avulsion frequency (0.8 avulsions/year over a 70-year period) and average rates of lateral migration and aggradation. These were used to calculate the mobility number, a dimensionless relationship between channel filling and lateral migration timescales that can be used to predict whether a river’s planform is single or multi-threaded. The mobility number within our study reach ranged from 0.6 (multi-thread channel) to 1.7 (transitional channel). We predict that, in the absence of active channel reconstruction, the post-dam channel pattern would evolve to one that alternates between single and multi

  5. Investigating the impact of vegetation on alluvial fans using laboratory experiments

    NASA Astrophysics Data System (ADS)

    Clarke, Lucy; McLelland, Stuart; Tom, Coutlhard

    2016-04-01

    Riparian vegetation can significantly influence the geomorphology of fluvial systems, affecting channel geometry and flow dynamics. However, there is still limited understanding of the role vegetation plays in the development of alluvial fans, despite the large number of vegetated fans located in temperate and humid climates. An understanding of the feedback loops between water flow, sediment dynamics and vegetation is key to understanding the geomorphological response of alluvial fans. But it is difficult to investigate these relationships in the natural world due to the complexity of the geomorphic and biological processes and timescales involved, whereas the controlled conditions afforded by laboratory experiments provide the ideal opportunity to explore these relationships. To examine the effects of vegetation on channel form, flow dynamics and morphology during fan evolution, a series of experiments were conducted using the Total Environment Simulator (operated by the University of Hull). The experiments followed a 'similarity of processes' approach and so were not scaled to a specific field prototype. Live vegetation (Medicago Sativa) was used to simulate the influence of vegetation on the fan development. A range of experiments were conducted on 2x2m fan plots, the same initial conditions and constant water discharge and sediment feed rates were used, but the vegetation density and amount of geomorphic time (when the sediment and water were running and there was active fan development) between seeding / vegetation growth varied between runs. The fan morphology was recorded at regular intervals using a laser scanner (at 1mm resolution) and high resolution video recording and overhead photography were used to gain near-continuous data quantifying fan topography, flow patterns, channel migration and avulsion frequency. Image analysis also monitored the spatial extent of vegetation establishment. The use of these techniques allowed collection of high resolution

  6. Clinical outcome of arthroscopic reduction and suture for displaced acute and chronic tibial spine fractures.

    PubMed

    Ahn, Jin Hwan; Yoo, Jae Chul

    2005-03-01

    This paper reports the clinical outcome of the arthroscopic reduction and pull-out suture technique in acute and chronic displaced tibial spine anterior cruciate ligament (ACL) avulsion fractures. Between April 1997 and December 2000, 14 patients received an arthroscopic reduction and pull-out suturing of displaced tibial spine fractures (ACL avulsion fractures of tibia). Of 14 cases, ten were acute fractures and four were chronic nonunion fractures, in which all patients showed extension limitation. The mean follow-up period was 51 months (ranging from 30 to 80 months). At final follow-up, review of range of motion, Lachman test, anterior drawer test, KT-2000 arthrometer, Lysholm knee score, and Hospital for Special Surgery (HSS) score were evaluated. Compared to conventional pull-out suturing, several key modifications to surgical techniques were used. In all 14 patients, radiological bony union was detected at mean 12.3 weeks (range, 8-16 weeks) after surgery. All patients were able to return to their preinjury activity and sports level. At final follow-up, full range of motion was achieved in all patients. Anterior draw test, Lachman test, and KT-2000 (less than 3 mm side-to-side) were all negative in 13 patients. One female patient, who was 6 years old at the time of surgery, complained of no subjective instability, but showed Lachman grade I, and 5 mm side-to-side difference in KT-2000. She also revealed 10 degrees difference of genu recurvatum deformity. Two children (including the previously-mentioned 6-year-old female patient) showed leg-length discrepancy of 1 cm-the affected legs being longer-at final follow-up. The mean Lysholm knee scores were 95.6 (range, 92-100) and HSS knee scores were 96.4 (range, 91-100). Arthroscopic reduction with modified pull-out suturing technique in displaced tibial spine ACL avulsion fractures showed excellent union rate for both acute and chronic cases, without instability or extension limitations at minimum two

  7. Patterns and processes of fluvial discontinuity and sediment residence times on the lower Macquarie River, Murray-Darling Basin, Australia

    NASA Astrophysics Data System (ADS)

    Larkin, Zacchary; Ralph, Timothy; Hesse, Paul

    2014-05-01

    The supply, transport and deposition of fine-grained sediment are important factors determining the morphology of lowland rivers that experience channel breakdown and have wetlands on their lower reaches. Sediment supply and residence time determine whether reaches accumulate sediment (wetland areas) or erode sediment (channelised areas). This research investigated how processes of sedimentation and erosion drive channel breakdown and reformation in the Macquarie Marshes, a large anastomosing wetland system in the Murray-Darling Basin, Australia. Channel breakdown is attributed to a dominance of in-stream sedimentation that leads to a point where single-thread river channels cannot be maintained and so avulsion and floodout processes create smaller distributary channels and wetlands. Avulsions may reconnect channels, changing the sediment supply regime in those particular channels. Channel reformation occurs on the trunk stream where the floodplain gradient steepens enough to allow convergence of small tributaries, locally increasing stream power (and erosive energy in channels). As each river reach reforms following channel breakdown, the channel is smaller, shallower and straighter than the previous reach. One reach in this system recently (in the 1970s) became connected with a parallel channel through avulsion and has morphological characteristics that indicate a significant change in flow and sediment supply. In a pilot study using uranium-series disequilibrium methods and OSL dating, a sediment residence time of 58 +/- 2 ka was determined for sediment in the base of the active channel and a sediment residence time of 153 +/- 5 ka was determined for sediment buried in an adjacent meander that was cut off from the main channel 1,000 years ago. The apparent dramatic decrease in sediment residence time to this active channel poses an interesting question about the role of relatively new channels in transporting and depositing sediment more rapidly than the

  8. Augmentation of partially regenerated nerves by end-to-side side-to-side grafting neurotization: experience based on eight late obstetric brachial plexus cases

    PubMed Central

    2006-01-01

    Objective The effect of end-to-side neurotization of partially regenerated recipient nerves on improving motor power in late obstetric brachial plexus lesions, so-called nerve augmentation, was investigated. Methods Eight cases aged 3 – 7 years were operated upon and followed up for 4 years (C5,6 rupture C7,8T1 avulsion: 5; C5,6,7,8 rupture T1 avulsion:1; C5,6,8T1 rupture C7 avulsion:1; C5,6,7 ruptureC8 T1 compression: one 3 year presentation after former neurotization at 3 months). Grade 1–3 muscles were neurotized. Grade0 muscles were neurotized, if the electromyogram showed scattered motor unit action potentials on voluntary contraction without interference pattern. Donor nerves included: the phrenic, accessory, descending and ascending loops of the ansa cervicalis, 3rd and 4th intercostals and contralateral C7. Results Superior proximal to distal regeneration was observed firstly. Differential regeneration of muscles supplied by the same nerve was observed secondly (superior supraspinatus to infraspinatus regeneration). Differential regeneration of antagonistic muscles was observed thirdly (superior biceps to triceps and pronator teres to supinator recovery). Differential regeneration of fibres within the same muscle was observed fourthly (superior anterior and middle to posterior deltoid regeneration). Differential regeneration of muscles having different preoperative motor powers was noted fifthly; improvement to Grade 3 or more occurred more in Grade2 than in Grade0 or Grade1 muscles. Improvements of cocontractions and of shoulder, forearm and wrist deformities were noted sixthly. The shoulder, elbow and hand scores improved in 4 cases. Limitations The sample size is small. Controls are necessary to rule out any natural improvement of the lesion. There is intra- and interobserver variability in testing muscle power and cocontractions. Conclusion Nerve augmentation improves cocontractions and muscle power in the biceps, pectoral muscles, supraspinatus

  9. Megafans of the Northern Kalahari Basin

    NASA Technical Reports Server (NTRS)

    Wilkinson, M. J.; Miller, R. McG.; Eckardt, F.; Kreslavsky, M. A.

    2016-01-01

    We identify eleven megafans (partial cones of fluvial sediment, >80 km radius) in the northern Kalahari Basin, using several criteria based on VIS and IR remotely sensed data and SRTM-based surface morphology reconstructions. Two other features meet fewer criteria of the form which we class as possible megafans. The northern Kalahari megafans are located in a 1700 km arc around the southern and eastern flanks of the Angola's Bié Plateau, from northern Namibia through northwest Botswana to western Zambia. Three lie in the Owambo subbasin centered on the Etosha Pan, three in the relatively small Okavango rift depression, and five in the Upper Zambezi basin. The population includes the well-known Okavango megafan (150 km), Namibia's Cubango megafan, the largest megafan in the region (350 km long), and the largest nested group (the five major contiguous megafans on the west slopes of the upper Zambezi Valley). We use new, SRTM-based topographic roughness data to discriminate various depositional surfaces within the flat N. Kalahari landscapes. We introduce the concepts of divide megafans, derived megafans, and fan-margin rivers. Conclusions. (i) Eleven megafan cones total an area of 190,000 sq km. (ii) Different controls on megafan size operate in the three component basins: in the Okavango rift structural controls become the prime constraint on megafan length by controlling basin dimensions. Megafans in the other les constricted basins appear to conform to classic relationships fan area, slope, and feeder-basin area. (iii) Active fans occupy the Okavango rift depression with one in the Owambo basin. The rest of the population are relict but recently active fans (surfaces are relict with respect to activity by the feeder river). (iv) Avulsive behavior of the formative river-axiomatic for the evolution of megafans-has resulted in repeated rearrangements of regional drainage, with likely effects in the study area well back into the Neogene. Divide megafans comprise the

  10. Treatment of extensive comminuted mandibular fracture between both mandibular angles with bilateral condylar fractures using a reconstruction plate: a case report

    PubMed Central

    Lee, Kwonwoo; Yoon, Kyuho; Cheong, Jeongkwon; Shin, Jaemyung; Bae, Jungho; Ko, Inchan; Park, Hyungkoo

    2014-01-01

    This following case report describes the open reduction, internal fixation and the reconstruction of an extensive comminuted mandibular fracture with bilateral condylar fractures in a 19-year-old male patient with an intellectual disability and autistic disorder. He suffered fall trauma, resulting in shattered bony fragments of the alveolus and mandibular body between both mandibular rami, the fracture of both condyles and the avulsion or dislocation of every posterior tooth of the mandible. The patient underwent open reduction and internal fixation between both mandibular rami using a reconstruction plate, open reduction and internal fixation of the shattered fragments using miniplates and screws, and the closed reduction of the bilateral condylar fractures. PMID:25045641

  11. A Complex Facial Trauma Case with Multiple Mandibular Fractures and Dentoalveolar Injuries

    PubMed Central

    Guven, Yeliz; Zorlu, Sevgi; Cankaya, Abdulkadir Burak; Aktoren, Oya; Gencay, Koray

    2015-01-01

    The principles of management of mandibular fractures differ in children when compared to adults and depend on the specific age-related status of the growing mandible and the developing dentition. This paper presents a case report with a complex facial trauma affecting the mandibular body and condyle region and dentoalveolar complex. Clinical examination revealed soft tissue injuries, limited mouth opening, lateral deviation of the mandible, an avulsed incisor, a subluxated incisor, and a fractured crown. CBCT examination revealed a nondisplaced fracture and an oblique greenstick fracture of the mandibular body and unilateral fracture of the condyle. Closed reduction technique was chosen to manage fractures of the mandible. Favorable healing outcomes on multiple fractures of the mandible throughout the 6-year follow-up period proved the success of the conservative treatment. This case report is important since it presents a variety of pathological sequelae to trauma within one case. PMID:26339511

  12. Management of a Central Incisor with Horizontal Root Fracture for Esthetic and Functional Rehabilitation.

    PubMed

    Jepsen, Karin; Schneider, Eva; Dommisch, Henrik; Jepsen, Søren

    2016-01-01

    Severely traumatized incisors in young adults are a very common problem, and one that is difficult to treat because healing of these teeth is not always predictable and implant placement has to be delayed until adulthood. This case report of a horizontal root fracture in an avulsed central incisor illustrates the ability to maintain crucial tooth structure. A lateral socket augmentation procedure after extraction of a root fragment combined with an endodontic and regenerative periodontal treatment approach could preserve natural esthetics and function, which are directly related to quality of life. The preservation of alveolar bone volume following partial root removal will eventually facilitate later placement of a dental implant with an improved esthetic and functional prosthodontic result in a patient with a high-risk esthetic profile. PMID:26697554

  13. Delayed supratentorial intracerebral hemorrhage following posterior fossa surgery

    PubMed Central

    Salunke, Pravin; Malik, Vinod; Kovai, Priyamvadha; Aggarwal, Ashish; Khandelwal, Niranjan K.

    2016-01-01

    Delayed supratentorial intracerebral hematoma after posterior fossa surgery is uncommon. Only few cases have been reported in the past. The cause has been attributed to sitting position leading to changes in intracranial arterial and venous pressures. We report two cases of delayed intracerebral hematoma following posterior fossa surgery, none of which were operated in sitting position. MR venogram done in one patient showed venous sinus thrombosis. Intracererbal hematoma following infratentorial surgery is uncommon and is possibly due to venous sinus thrombosis leading to venous hypertension. Control of bleeding from venous sinuses due to avulsion of emissary veins during craniotomy/craniectomy possibly induces sinus thrombosis that may propagate antegrade or retrograde, leading to venous hypertension and parenchymal bleed. PMID:27366274

  14. Review of Spaceflight Dental Emergencies

    NASA Technical Reports Server (NTRS)

    Menon, Anil

    2012-01-01

    All exploration class missions--extending beyond earth's orbit--differ from existing orbital missions by being of longer duration and often not having a means of evacuation. If an exploration mission extends beyond a year, then there will be a greater lapse since the crewmembers last terrestrial dental exams, which routinely occur each year. This increased time since professional dental care could increase the chance of a dental emergency such as intractable pain, dental decay requiring a temporary filling, crown replacement, exposed pulp, abscess, tooth avulsion, or toothache. Additionally, any dental emergency will have to be treated in-flight with available resources and personnel who may not have extensive training in dental care. Thus, dental emergencies are an important risk to assess in preparation for exploration missions.

  15. Spontaneous fracture of the mandibular genial tubercles. A case report.

    PubMed

    Gallego, Lorena; Junquera, Luis; Villarreal, Pedro; de Vicente, Juan Carlos

    2007-12-01

    Fracture of the mandibular genial tubercles is an uncommon pathology affecting edentulous patients with severe maxillary atrophy. Usually occurs spontaneously which complicates the diagnosis. Their importance lies in the functional alterations, which occur as a consequence of the disinsertion of the genihyoid and genioglossus muscles. The treatment of fracture of the genial tubercles is controversial, including no surgical intervention, excision of the avulsed bone fragments, and muscular repositioning. There have been only 11 cases reported in the literature of this fracture, most of them spontaneous. We present a difficult diagnosis situation of spontaneous fracture of the genial tubercles in an 86-year-old edentulous female with a painful sublingual and submental hematoma and anterior cervical echimosis. Computerized Tomography should be made to confirm the diagnosis. Surgical treatment was not necessary, and follow-up at 6 months revealed complete symptomatic recovery, and full return of function. PMID:18059247

  16. Tracheobronchial injury due to blunt chest trauma.

    PubMed

    Mahmodlou, Rahim; Sepehrvand, Nariman

    2015-01-01

    Tracheobronchial avulsion resulting from blunt trauma is a very rare and serious condition, mostly due to high-speed traffic crashes. In this article, we briefly report the case of an 18-year-old man who was injured in a car accident and because of massive persistent air leakage (despite appropriate chest tube drainage), deemed to have a deep tracheobronchial injury. Due to a rapid drop in the patient's O2 saturation, he underwent an anterolateral thoracotomy. Endotracheal intubation was performed under direct visualization. The right mainstem bronchus was disrupted from the carina with a 1.5-cm stump remaining on the carina, and the remainder was crushed to the origin of the right superior lobe bronchus. Hence, a right superior lobectomy was performed and the postoperative course was uneventful. PMID:26157657

  17. Life cycles of traumatized teeth: long-term observations from a cohort of dental trauma victims.

    PubMed

    Heithersay, G S

    2016-03-01

    Life cycles of dental trauma victims can provide important clinical information, especially when viewed over many years. In this first series of life cycles, the pulp and periodontal responses to traumatic injuries of four patients are documented over periods varying from 26 to 51 years. The dynamics of pulp survival following an intrusive luxation and two avulsions are followed, with particular reference to pulp canal calcification to which a new term, root canal stenosis, has been proposed. The life cycles include the successful management of inflammatory root resorption in a replanted tooth with an open apex contrasting with the early prophylactic endodontic treatment of two replanted teeth in a patient with mature apices. The long-term development of invasive cervical resorption in one of the patient's life cycle highlights the importance of ongoing follow-up examinations for dental trauma victims. PMID:26923453

  18. Nonoperative Treatment of Distal Biceps Brachii Musculotendinous Partial Rupture: A Report of Two Cases

    PubMed Central

    López-Zabala, I.; Fernández-Valencia, J. A.

    2013-01-01

    Musculotendinous ruptures of the distal biceps brachii are extremely rare injuries whose clinical presentation is similar to distal biceps avulsion. We describe two cases of patients who suffered a distal biceps brachii musculotendinous partial rupture. The first patient was playing soccer as goalkeeper and experienced sudden pain while throwing the ball overhead with his left arm. The second patient experienced sudden pain while weightlifting with his right arm. The mechanism of injury was the same in the two cases, as both involved glenohumeral elevation with elbow extension and forearm supination. Neither of these two patients underwent surgical repair or rehabilitation, and both had perfect scores of 100 on the Mayo Clinic Performance Index for the Elbow at one-year followup. PMID:23956903

  19. Pectoralis Major Muscle Rupture Repair: Technique Using Unicortical Buttons

    PubMed Central

    Metzger, Paul D.; Bailey, James R.; Filler, Robert D.; Waltz, Robert A.; Provencher, Matthew T.; Dewing, Christopher B.

    2012-01-01

    Over the past few decades, there has been increased awareness of pectoralis major muscle injuries necessitating further evaluation of management options and, in particular, surgical repair. Injury typically occurs when an eccentric load is applied to the muscle, such as with bench pressing, and failure usually occurs through the tendon. Although nonoperative management is sometimes appropriate, given the injury's propensity for young, active male patients, surgical intervention is often warranted. Because the injury typically occurs at the muscle-tendon interface, surgery focuses on repair of the avulsed tendon into its anatomic attachment site. We describe the use of a unicortical suture button to repair the ruptured tendon. This technique achieves the goals of strong fixation and anatomic repair of the tendon back into its native footprint. PMID:23766966

  20. Approach to Management of Eyes with no Light Perception after Open Globe Injury.

    PubMed

    Bhagat, Neelakshi; Turbin, Roger; Langer, Paul; Soni, N G; Bauza, A M; Son, J H; Chu, David; Dastjerdi, Mohammad; Zarbin, Marco

    2016-01-01

    Loss of light perception (LP) after open globe injury (OGI) does not necessarily mean the patient will have permanent complete visual loss. Findings that seem to be associated reliably with permanent profound vision loss after OGI include optic nerve avulsion, optic nerve transection, and profound loss of intraocular contents, which can be identified with CT/MRI imaging albeit with varying degrees of confidence. Eyes with NLP after OGI that undergo successful primary repair with intact optic nerves may be considered for additional surgery, particularly if there is: (1) recovery of LP on the first day after primary repair; (2) treatable pathology underlying NLP status (e.g., extensive choroidal hemorrhage, dense vitreous and subretinal hemorrhage); (3) NLP in the fellow eye. We counsel patients that the chance of recovering ambulatory vision under these circumstances is very low (~5%). PMID:27621791

  1. Esthetic rehabilitation of single anterior edentulous space using fiber-reinforced composite

    PubMed Central

    Kim, Hyeon; Song, Min-Ju; Shin, Su-Jung; Lee, Yoon

    2014-01-01

    A fiber-reinforced composite (FRC) fixed prosthesis is an innovative alternative to a traditional metal restoration, as it is a conservative treatment method. This case report demonstrates a detailed procedure for restoring a missing anterior tooth with an FRC. A 44-year-old woman visited our department with an avulsed tooth that had fallen out on the previous day and was completely dry. This tooth was replanted, but it failed after one year. A semi-direct technique was used to fabricate a FRC fixed partial prosthesis for its replacement. The FRC framework and the pontic were fabricated using a duplicated cast model and nanofilled composite resin. Later on, interproximal contact, tooth shape, and shade were adjusted at chairside. This technique not only enables the clinician to replace a missing tooth immediately after extraction for minimizing esthetic problems, but it also decreases both tooth reduction and cost. PMID:25110647

  2. [Arthroscopic studies of the stifle of dogs].

    PubMed

    Fehr, M; Behrends, I; Meyer-Lindenberg, A

    1996-04-01

    Diagnosis by arthroscopy and arthrotomy of 36 dogs with stifle lesions (18 left, 18 right) assessed by physical and radiological examination were compared. 48 of 68 observations during arthrotomy had been diagnosed before by arthroscopy (accuracy 70.6%). Arthroscopical diagnosis of anterior cruciate ligament rupture (ACL) (n = 11), partial ACL (n = 11), avulsion of m. extensor digitorum longum (n = 2) and immune-mediated arthritis (n = 2) confirmed the diagnosis by arthrotomy in all patients. Arthroscopy failed to detect meniscal lesions in 50% (18 of 36). Nine of 20 normal medial and lateral meniscus, eight of 14 medial and one of two lateral meniscal lesions were detected by arthroscopy. Six meniscal tears (two transverse, two longitudinal, one bucket-handle type, one caudal horn) were not diagnosed. These results indicate that other known human portals have to be proven or new portals have to be evaluated. PMID:8650682

  3. Eyelid Reconstruction: Everything Is Not Lost When All Is Lost.

    PubMed

    Gupta, Ashish; Gupta, Ashok K; Patil, Kiran; Arora, Kamal

    2015-12-01

    Eyelid injuries are a common emergency room challenge in patients presenting with history of road traffic accidents. Overzealous debridement can result in tissue loss in which primary repair becomes impossible along with loss of critical landmarks especially in tissue as fragile as the eyelids. We present a 45-year-old male with avulsion injury of the right lower eyelid compounded by debridement at a primary health care facility. Nasolabial flap reconstruction was done with release of the bulbar conjunctiva to achieve aesthetic and functional endpoints. Adhering to the fundamental guidelines of repair of the eyelids as a primary and definitive surgery holds the crux to the best cosmetic and functional outcome. PMID:27011590

  4. Bidirectional Dislocation of the Distal Radioulnar Joint After Distal Radius Fracture: Case Report.

    PubMed

    Arimitsu, Sayuri; Moritomo, Hisao

    2016-02-01

    We report a patient with bidirectional dislocation of the distal radioulnar joint after malunited distal radius fracture, in which the ulnar head dislocated dorsally during forearm pronation and palmarly during supination without manual compression of the ulnar head. The patient had chronic ulnar wrist pain and experienced a painful clunk during forearm rotation. The distal radioulnar joint ballottement test was positive in both the dorsal and palmar directions. Her distal radius was malunited with a 20° dorsal angulation and 18° pronation deformity. A corrective osteotomy of the radius with open repair of the triangular fibrocartilage complex foveal avulsion yielded success. At the 7-year follow-up, there was almost a normal range of wrist and forearm motion, 83% grip strength, no arthritis, and a stable distal radioulnar joint. PMID:26723478

  5. Common medial elbow injuries in the adolescent athlete.

    PubMed

    Leahy, Ian; Schorpion, Melissa; Ganley, Theodore

    2015-01-01

    Recently there has been increased year-round sports participation among children and adolescents with limited to no rest periods. This has led to increases in pediatric repetitive stress injuries, once considered a rarity. Whether in the throwing athlete or in the athlete that experiences repetitive axial loading; increased medial tension and overload syndromes can lead to stress reactions and fractures. This occurs in the developing athlete due to the bone being weaker than the surrounding tendons and ligaments. The medial elbow is a high stress area and is susceptible to many conditions including apophysitis , avulsion fractures and ulnar collateral ligament disruption. Valgus stress can cause injury to the medial elbow which can lead to increased lateral compression, Panner's disease and osteochondral lesions of the capitellum and olecranon. The purpose of this manuscript is to review common elbow disorders in the adolescent population, outline management and highlight important features of rehabilitation. PMID:25840494

  6. Review for the generalist: evaluation of pediatric hip pain

    PubMed Central

    Houghton, Kristin M

    2009-01-01

    Hip pathology may cause groin pain, referred thigh or knee pain, refusal to bear weight or altered gait in the absence of pain. A young child with an irritable hip poses a diagnostic challenge. Transient synovitis, one of the most common causes of hip pain in children, must be differentiated from septic arthritis. Hip pain may be caused by conditions unique to the growing pediatric skeleton including Perthes disease, slipped capital femoral epiphysis and apophyseal avulsion fractures of the pelvis. Hip pain may also be referred from low back or pelvic pathology. Evaluation and management requires a thorough history and physical exam, and understanding of the pediatric skeleton. This article will review common causes of hip and pelvic musculoskeletal pain in the pediatric population. PMID:19450281

  7. MDCT and MRI for the diagnosis of complex fractures of the tibial plateau: A case control study

    PubMed Central

    XU, YUNQIN; LI, QIANG; SU, PEIHUA; SHEN, TUGANG; ZHU, YAZHONG

    2014-01-01

    The aim of this study was to evaluate the clinical value of multidetector-row computed tomography (MDCT) and magnetic resonance imaging (MRI) in the diagnosis and treatment of complex fractures of the tibial plateau. A total of 71 patients with complex fractures of the tibial plateau (estimated Schatzker classifications III, V and VI) were included in this study. The X-ray, MDCT and MRI data obtained from the patients were analyzed. MDCT was the most sensitive method in the diagnosis of tibial articular surface collapse, cruciate ligament tibial avulsion fracture, degree of fracture comminution and degree of fracture displacement (P<0.01). MRI was the most sensitive method in the diagnosis of injuries of the cruciate and collateral ligaments, menisci and cartilage peeling of the articular surfaces (P<0.01). MDCT and MRI were demonstrated to be more sensitive than X-rays for the diagnosis of insidious damage around the knee. PMID:24348790

  8. Pattern of injury in those dying from traumatic amputation caused by bomb blast.

    PubMed

    Hull, J B; Bowyer, G W; Cooper, G J; Crane, J

    1994-08-01

    Traumatic amputation of limbs caused by bomb blast carries a high risk of mortality. This paper describes 73 amputations in 34 deaths from bomb blast in Northern Ireland. The principal aim was to determine the sites of traumatic amputation to provide a biophysical basis for the development of protective measures. Few amputations were through joints; nearly all were through the bone shafts. The most common site in the tibia was the upper third. The distribution of femoral sites resulting from car bombs differed from that characterizing other types of explosion. For car bombs the principal site of amputation was the upper third; for other types of device it was the lower third. It is concluded that flailing is not a notable contributor to limb avulsion. The pattern of amputation is consistent with direct local pressure loads leading to bone fracture; the amputation itself is a secondary event arising from the flow of combustion products. PMID:7953338

  9. “Don Juan-Fracture” as a Hint to Aortic Isthmus Rupture

    PubMed Central

    Suksompong, Sirilak; von Bormann, Benno

    2014-01-01

    We report a case of thoracic aortic rupture after blunt trauma in a 23-year-old male patient. The initial investigation found no external injury or bleeding, only a slightly widened mediastinum and a broken left calcaneus. Abdominal lavage was negative, biochemistry was normal, and breathing and oxygenation were not compromised. When changing his position during diagnostics, the patient all of a sudden developed cardiac arrest and typical signs of hypovolemic shock. An immediate sternotomy was done without any further diagnostics on suspicion of aortic isthmus injury. A circular avulsion at the ligamentum arteriosum was found as assumed and repaired under cardiopulmonary bypass. The patient left the hospital for rehabilitation after 12 days in adequate health status. Biodynamics of blunt trauma after high-speed frontal impact and the relationship between calcaneus fracture, called “Don-Juan fracture,” and aortic rupture at the site of ligamentum arteriosum are discussed. PMID:25478249

  10. Three-dimensional ultrasound appearance of pelvic floor in nulliparous women and pelvic organ prolapse women.

    PubMed

    Ying, Tao; Li, Qin; Xu, Lian; Liu, Feifei; Hu, Bing

    2012-01-01

    The present study investigated the morphology and structure of pelvic floor in 50 nulliparous and 50 pelvic organ prolapse (POP) women using translabial three-dimensional (3D) ultrasound. The levator hiatus in POP women was significantly different from that in nullipara women. In POP women, the size of pelvic floor increased, with a circular shape, and the axis of levator hiatus departed from the normal position in 36 (72%) cases. The puborectalis was avulsed in 18 (36%) cases and the pelvic organs arranged abnormally in 23 (46%) cases. In summary, 3D ultrasound is an effective tool to detect the pelvic floor in POP women who presented with abnormalities in the morphology and structure of pelvic floor. PMID:23155363

  11. Three-dimensional Ultrasound Appearance of Pelvic Floor in Nulliparous Women and Pelvic Organ Prolapse Women

    PubMed Central

    Ying, Tao; Li, Qin; Xu, Lian; Liu, Feifei; Hu, Bing

    2012-01-01

    The present study investigated the morphology and structure of pelvic floor in 50 nulliparous and 50 pelvic organ prolapse (POP) women using translabial three-dimensional (3D) ultrasound. The levator hiatus in POP women was significantly different from that in nullipara women. In POP women, the size of pelvic floor increased, with a circular shape, and the axis of levator hiatus departed from the normal position in 36 (72%) cases. The puborectalis was avulsed in 18 (36%) cases and the pelvic organs arranged abnormally in 23 (46%) cases. In summary, 3D ultrasound is an effective tool to detect the pelvic floor in POP women who presented with abnormalities in the morphology and structure of pelvic floor. PMID:23155363

  12. Extensive posterior exposure of the elbow. A triceps-sparing approach.

    PubMed

    Bryan, R S; Morrey, B F

    1982-06-01

    Difficulty with triceps avulsion or loss of continuity after total elbow arthroplasty has prompted the development of a modified posterior approach to the elbow joint. The characteristic feature of this approach is that the triceps mechanism is reflected from medial to lateral in continuity with the forearm fascia and the olecranon and ulnar periosteum. A variant of the technique reflects the extensor mechanism from lateral to medial. The ulnar collateral ligament may be released from the humerus to provide more exposure, but the ligament must then be securely reattached. This approach, which provides extensive exposure to the elbow joint, has been employed in 49 consecutive total elbow arthroplasties and results show no loss of triceps function and no significant weakness. The approach has proved useful for treatment of intra-articular fractures of the distal end of the humerus and with synovectomy in the rheumatoid arthritic patient. PMID:7083671

  13. Flow dynamics in lowland rivers and influence on fluvial-deltaic stratigraphy: Comparing the modern Mississippi River system to the Campanian Castlegate Sandstone

    NASA Astrophysics Data System (ADS)

    Nittrouer, J. A.; Petter, A. L.

    2012-12-01

    Where rivers enter the coastal zone, gradually varied non-uniform flow conditions develop in the river channel. The section of the river affected by non-uniform flow is commonly referred to as the backwater segment, and for large lowland rivers, backwater flow can extend many tens to hundreds of kilometers upstream of the river outlet. Here we show the results of field-observation and modeling studies from the modern Mississippi River that document the persistence of backwater hydrodynamics, which influence sediment mobility through the lower five-hundred kilometers of the river. Reach-average shear stress varies temporally in the backwater segment, in accordance with the annual hydrograph, thereby affecting the timing, magnitude, and grain size of sediment in transport. Importantly, a net reduction in shear stress restricts the movement of the coarse-grain sediment in the Mississippi River, to the extent that this portion of the river's sediment load does not reach the ocean receiving basin. Instead, coarse sediment is caught at the backwater hydrodynamic transition and is sequestered in the river channel, thereby producing channel bed aggradation. We use this information in conjunction with stratigraphic data collected from the Campanian Castlegate Sandstone (Utah) to present a theoretical framework for the movement of coarse sediment from a river to the receiving basin: over time, channel bed aggradation will push the backwater transition toward the ocean outlet, thereby facilitating the downstream movement of coarse sediment into the receiving basin. However, an aggrading channel bed will also promote super elevation of the channel bed and therefore facilitate avulsions, whereby the active channel is abandoned in favor of an alternative path to the ocean basin. Given an avulsion event, the abandoned, inactive channel and its coarse-grain sediment fill are incorporated into the long-term stratigraphy of the river's distributary system. Therefore, the tendency

  14. Sonographic diagnosis of an acute Stener lesion: a case report.

    PubMed

    Mattox, Ross; Welk, Aaron B; Battaglia, Patrick J; Scali, Frank; Nunez, Mero; Kettner, Norman W

    2016-01-01

    This case report describes the use of diagnostic ultrasound to diagnose a Stener lesion in a patient who presented for conservative care of thumb pain following a fall on an outstretched hand. Conventional radiographic images demonstrated an avulsion fracture at the ulnar aspect of the base of the first proximal phalanx. Diagnostic ultrasound revealed a torn ulnar collateral ligament of the thumb that was displaced proximal to the adductor aponeurosis, consistent with a Stener lesion. Dynamic imaging with ultrasound confirmed displacement of the fully torn ligament. Surgical repair followed the diagnosis. Diagnostic ultrasound in this case provided an accurate diagnosis obviating further imaging. This allowed an optimal outcome due to early intervention. PMID:27298646

  15. Scapulothoracic dissociation: An emerging high-energy trauma in medical literature

    PubMed Central

    McCague, Andrew; Schulte, Adam; Davis, Joseph Vivian

    2012-01-01

    Scapulothoracic dissociation (STD) is a devastating consequence of high-energy trauma sustained by the shoulder girdle that can easily result in rapid mortality. Since described by Oreck et al. in 1984, STD has been reported in a handful of journals and individual case series, though is still considered a rare occurrence in the context of shoulder injuries. In this report, we examine the case of a 25-year-old female involved in a high-speed rollover auto accident. Unique to this case was the discovery of a completely transected axillary artery and vein with intracorporeal bleeding and complete avulsion of the ipsilateral brachial plexus requiring immediate ligation of the vessels followed by interval above-elbow-amputation and later glenohumeral disarticulation. PMID:23248512

  16. An Everting Ureteral Access Sheath: Concepts and In Vitro Testing

    NASA Astrophysics Data System (ADS)

    Lee, Keith L.; Stoller, Marshall L.

    2007-04-01

    Ureteral access sheaths have been a recent innovation in facilitating ureteral stone surgery. Once properly placed, access sheaths allow the movement of ureteroscopes and other instruments through the ureter with minimal injury to the urothelium. However, there are shortcomings of the current device designs. Initial sheath placement requires significant force, and shear stress can injure the ureter. In addition, inadvertent advancement of the outer sheath without the inner introducer stylet can tear and avulse the ureter. A novel eversion design incorporating a lubricous film provides marked improvement over current access sheaths. In bench top and animal models, the eversion shealths require less force during advancement, cause less injury to the urothelial tissue, and have a lower potential of introducing extraneous materials (e.g., microbes) into a simulated urinary tract. While, the everting design provides important advantages over traditional non-everting designs, further preclinical and clinical trials are required.

  17. Common conditions in the overhead athlete.

    PubMed

    Edmonds, Eric W; Dengerink, Douglas D

    2014-04-01

    The overhead athlete is at unique risk for injury because of the mechanics associated with rapid shoulder elevation, abduction, and external rotation. Angulation of the humeral head against the posterosuperior glenoid can cause rotator cuff tendon and labral impingement. The throwing or striking motion of baseball, softball, water polo, tennis, racquetball, and volleyball may result in scapular dyskinesis, partial articular-sided supraspinatus avulsions, and posterosuperior labral tears. The SICK scapula syndrome (scapular malposition, inferior medial border prominence, coracoid pain and malposition, and dyskinesis of scapular movement) is thought to increase the risk of injury in the overhead athlete. Special physical examination maneuvers and magnetic resonance imaging may be helpful in diagnosing intra-articular pathology. Rehabilitation of injuries associated with internal impingement of the shoulder should include three basic components: strengthening, stretching, and sport-specific exercises. Arthroscopic surgery may be considered if symptoms do not improve after three months of conservative management. PMID:24695599

  18. Operative management of traumatic cervical spine distraction and complete cord transection in a 3-year-old patient.

    PubMed

    Davern, Monica Salazar; Garg, Sumeet; Hankinson, Todd C

    2015-02-01

    This report describes the presentation and operative treatment of a 3-year-old boy who survived a motor vehicle accident that resulted in a C6-7 distraction injury, complete avulsion of the spinal cord, and gross spinal instability. Only 5%-10% of all spinal cord and vertebral column injuries occur in children. Survival after such an injury is exceptionally rare in very young patients and is associated with severe neurological deficits. The authors discuss the substantial ethical challenges involved in the care of a patient with this injury. To their knowledge, only two other cases of survival have been reported in pediatric patients following motor vehicle trauma resulting in complete injury to the lower cervical spinal cord. PMID:25415253

  19. Groin pain in athletes.

    PubMed

    Weber, M-A; Rehnitz, C; Ott, H; Streich, N

    2013-12-01

    Groin pain in athletes is one of the most difficult to treat clinical entities in sports medicine. The reasons are the amount of differential diagnoses, complexity of pathophysiologic causes and the long time of limited participation in sport. In order to maximize efficient treatment, thorough diagnostics and a clear therapeutic regimen are crucial. To succeed with this issue, a close cooperation between physicians and radiologists is mandatory. MRI is gold standard in the diagnostic work-up of the principal differential diagnoses, such as muscle tears, avulsion injuries, stress fractures, tears of acetabular labrum, and osteitis pubis. The article gives a comprehensive overview of the special anatomy and biomechanics of the pubic region and of typical MRI findings in athletes with groin pain. The use of dedicated imaging protocols is also discussed. PMID:23893752

  20. Benign Vascular Malformation at the Ischial Tuberosity.

    PubMed

    Said, Rami; Bevelaqua, Anna-Christina

    2016-07-01

    A 31-year-old female student was referred to physical therapy with a chief complaint of proximal, posterior left thigh pain that began insidiously 12 months prior, and progressively worsened while training for a half-marathon. A mobile, soft mass was identified just inferior to the ischial tuberosity that was tender and painful to palpation, recreating the patient's chief complaint. Radiographic findings were negative for a suspected avulsion fracture at the ischial tuberosity. Therefore, the physician performed musculoskeletal ultrasonography, which revealed a superficial hypoechoic mass with vascular flow. Magnetic resonance imaging and a subsequent biopsy led to the diagnosis of a benign vascular malformation. J Orthop Sports Phys Ther 2016;46(7):607. doi:10.2519/jospt.2016.0410. PMID:27363574

  1. Medial epicondyle fractures in the pediatric population.

    PubMed

    Gottschalk, Hilton P; Eisner, Eric; Hosalkar, Harish S

    2012-04-01

    Humeral medial epicondyle fractures in the pediatric population account for up to 20% of elbow fractures, 60% of which are associated with elbow dislocation. Isolated injuries can occur from either direct trauma or avulsion. Medial epicondyle fractures also occur in combination with elbow dislocations. Traditional management by cast immobilization increasingly is being replaced with early fixation and mobilization. Relative indications for surgical fixation include ulnar nerve entrapment, gross elbow instability, and fractures in athletic or other patients who require high-demand upper extremity function. Absolute indications for surgical intervention are an incarcerated fragment in the joint or open fractures. Radiographic assessment of these injuries and their true degree of displacement remain controversial. PMID:22474092

  2. Insertional Characteristics of the Peroneus Tertius Tendon: Revisiting the Anatomy of an Underestimated Muscle.

    PubMed

    Ercikti, Nurcan; Apaydin, Nihal; Kocabiyik, Necdet; Yazar, Fatih

    2016-01-01

    The present study was performed to describe the morphologic characteristics of the peroneus tertius (PT) tendon, evaluate the variations in its insertion point, investigate the interconnections with the tendons of the extensor digitorum longus, and discuss whether these insertion differences of the muscle tension might have an effect on fracture formation. The length and width of the PT tendon and the width at its midpoint were measured in 44 lower extremities. The data obtained were compared statistically. The PT was found to occur in 2 types according to the number of tendons: type 1, a single tendon without a slip; and type 2, 2 tendons with a slip. It has been suggested that the PT tendon could contribute to avulsion fractures of the tuberosity of the fifth metatarsal bone. Therefore, to understand the mechanism of Jones fracture, knowledge of the PT tendon would be beneficial to determine the insertion points. PMID:26860045

  3. Ganges-Brahmaputra Delta: Balance of Subsidence, Sea level and Sedimentation in a Tectonically-Active Delta (Invited)

    NASA Astrophysics Data System (ADS)

    Steckler, M. S.; Goodbred, S. L.; Akhter, S. H.; Seeber, L.; Reitz, M. D.; Paola, C.; Nooner, S. L.; DeWolf, S.; Ferguson, E. K.; Gale, J.; Hossain, S.; Howe, M.; Kim, W.; McHugh, C. M.; Mondal, D. R.; Petter, A. L.; Pickering, J.; Sincavage, R.; Williams, L. A.; Wilson, C.; Zumberge, M. A.

    2013-12-01

    Bangladesh is vulnerable to a host of short and long-term natural hazards - widespread seasonal flooding, river erosion and channel avulsions, permanent land loss from sea level rise, natural groundwater arsenic, recurrent cyclones, landslides and huge earthquakes. These hazards derive from active fluvial processes related to the growth of the delta and the tectonics at the India-Burma-Tibet plate junctions. The Ganges and Brahmaputra rivers drain 3/4 of the Himalayas and carry ~1 GT/y of sediment, 6-8% of the total world flux. In Bangladesh, these two great rivers combine with the Meghna River to form the Ganges-Brahmaputra-Meghna Delta (GBMD). The seasonality of the rivers' water and sediment discharge is a major influence causing widespread flooding during the summer monsoon. The mass of the water is so great that it causes 5-6 cm of seasonal elastic deformation of the delta discerned by our GPS data. Over the longer-term, the rivers are also dynamic. Two centuries ago, the Brahmaputra River avulsed westward up to 100 km and has since captured other rivers. The primary mouth of the Ganges has shifted 100s of km eastward from the Hooghly River over the last 400y, finally joining the Brahmaputra in the 19th century. These avulsions are influenced by the tectonics of the delta. On the east side of Bangladesh, the >16 km thick GBMD is being overridden by the Burma Arc where the attempted subduction of such a thick sediment pile has created a huge accretionary prism. The foldbelt is up to 250-km wide and its front is buried beneath the delta. The main Himalayan thrust front is <100 km north, but adjacent to the GBMD is the Shillong Massif, a 300-km long, 2-km high block of uplifted Indian basement that is overthrusting and depressing GBMD sediments to the south. The overthrusting Shillong Massif may represent a forward jump of the Himalayan front to a new plate boundary. This area ruptured in a ~M8 1897 earthquake. Subsidence from the tectonics and differential

  4. [Bullet injuries in the maxillary-facial range. Report on experiences of treatment of 60 patients at the Gondar College of Medical Sciences in Ethiopia].

    PubMed

    Fröhlich, M

    1989-08-01

    A report on the management of 60 patients with missile injuries to the soft and bony tissues of the maxillofacial region is given. The period between the injury and the beginning of the treatment was on the average 2.2 days. There were 15 penetrating, 36 perforating and 9 avulsive wounds. A primary wound closure was carried out after gentle debridement of the soft and bony tissues and the using of the bone suturing as the only method of fixation. In 4 cases the secundary wound closure was performed following an open wound management. There was a primary wound healing in 31 patients. The 22 cases of disturbed wound healing partly associated with osteomyelitis occurred frequently in patients suffering from perforating wounds who came to the the hospital more than 4 days following the injury. PMID:2637527

  5. Effects of Extreme Monsoon Precipitation on River Systems Form And Function, an Early Eocene Perspective

    NASA Astrophysics Data System (ADS)

    Plink-Bjorklund, P.; Birgenheier, L.

    2013-12-01

    Here we document effects of extreme monsoon precipitation on river systems with mountainous drainage basin. We discuss the effects of individual extreme monsoon seasons, as well as long-term changes in Earth surface system's form and function. The dataset spans across 1000 m of stratigraphy across ca 200 km of Paleocene and Early Eocene river deposits. The excessive 3-dimensional outcrops, combined with our new Carbon isotope, ichnological and paleosols record allow reconstruction of long-term river system's evolution during the Paleocene-Eocene Thermal Maximum (PETM) ca 56 million years ago, the transient global warming events during Early Eocene Climate Optimum (EECO) ca 53 to 51.5 million years ago, as well as the effects of highly peaked precipitation events during single monsoon seasons. On the single season scale, the increase in precipitation peakedness causes high discharge flooding events that remove large quantities of sediment from the drainage basin, due to stream erosion and landslide initiation. The initiation of landslides is especially significant, as the drainage basin is of high gradient, the monsoon intensification is accompanied by significant vegetation decline, as the monsoon cycle changes to multi-year droughts interrupted by extreme monsoon precipitation. These large discharge floods laden with sediment cause rapid deposition from high-velocity currents that resemble megaflood deposits in that they are dominated by high-velocity and high deposition rate sedimentary structures and thick simple depositional packages (unit bars). Such high deposition rates cause locally rapid channel bed aggradation and thus increase frequency of channel avulsions and cause catastrophic high-discharge terrestrial flooding events across the river basin. On long time scales, fluvial megafan systems, similar to those, e.g. in the Himalayan foreland, developed across the ca 200 km wide river basin, causing significant sediment aggradation and a landscape with high

  6. Delayed Carotid Dissection Following Lower Lip Revascularization in the Setting of Hyoid Fracture--A Case Report and Review of the Literature.

    PubMed

    Misra, Shantum; Haas, Corbett A; August, Meredith; Eberlin, Kyle R

    2016-01-01

    Traumatic injuries to the lip are common, but injuries that require revascularization of the lower lip are infrequent and pose a major challenge to the reconstructive surgeon. This report describes the case of a 53-year-old woman who sustained a lower lip avulsion injury, a comminuted mandibular parasymphyseal fracture, and a hyoid bone fracture secondary to a bicycle accident. Trauma workup included computed tomographic angiography of the head and neck, which did not show vascular injury. Despite successful revascularization of the lower lip, on postoperative day 11 the patient developed a large internal carotid artery dissection and middle cerebral artery stroke. This case highlights the importance of careful postoperative monitoring after high-energy facial trauma, particularly in the setting of vascular and bony injuries. PMID:26435401

  7. Occipital Condyle Fracture with Accompanying Meningeal Spinal Cysts as a result of Cervical Spine Injury in 15-Year-Old Girl.

    PubMed

    Wiktor, Łukasz; Tomaszewski, Ryszard

    2015-01-01

    The occipital condyle fracture is rare injury of the craniocervical junction. Meningeal spinal cysts are rare tumors of the spinal cord. Depending on location, these lesions may be classified as extradural and subdural, but extradural spinal cysts are more common. We present the case of a 15-year-old girl who suffered from avulsion occipital condyle fracture treated with use of "halo-vest" system. We established that clinical effect after completed treatment is very good. Control MRI evaluation was performed 12 months after removal of "halo-vest" traction, and clinically silent extradural meningeal spinal cysts were detected at the ventral side of the spinal cord in the cervical segment of the spine. Due to clinically silent course of the disease, we decided to use the conservative treatment. The patient remains under control of our department. PMID:26543656

  8. Massive rotator cuff tear associated with acute traumatic posterior shoulder dislocation: report of two cases and literature review.

    PubMed

    Luenam, Suriya; Kosiyatrakul, Arkaphat

    2013-12-01

    A massive rotator cuff tear in association with acute traumatic posterior glenohumeral dislocation is rare. To our knowledge, only four documented cases have been reported in the literature. We present two additional cases of such injury secondary to the traffic accident. The first patient had an unsuccessful closed reduction due to the posterior instability while the second developed the profound shoulder weakness following the reduction. From the findings of our cases together with the previous reports, every patient had a unique injury mechanism of high-energy directed axial loading on an outstretched, adducted, and internally rotated arm. The glenohumeral capsule and rotator cuff were uniformly avulsed from the humeral attachment, and the supraspinatus and infraspinatus were always involved. However, the clinical presentations were variable based on the severity of the associated rotator cuff tear. The outcomes of operative treatment in this type of injury with the open repair were favorable. PMID:22782426

  9. Dental problems in athletes.

    PubMed

    Inouye, Jill; McGrew, Chris

    2015-01-01

    Orofacial injuries and diseases occur in athletes, and they may not always have access to dentists. Therefore team physicians should be aware of the common injuries and initial management. Treatment of dental injuries will depend on whether the teeth are primary or permanent. The most common type of fracture is crown fracture, but there are other dental injuries that can lead to future complications if not treated promptly and monitored closely. Tooth avulsions need to be handled properly, and athletes should see a dentist as soon as possible. Despite the urgency of some injuries, other orofacial injuries or diseases, such as lacerations and caries, should not be overlooked. Proper education and use of mouth guards can assist athletes in reducing their risk of orofacial injuries. PMID:25574879

  10. Approach to Management of Eyes with no Light Perception after Open Globe Injury

    PubMed Central

    Bhagat, Neelakshi; Turbin, Roger; Langer, Paul; Soni, NG; Bauza, AM; Son, JH; Chu, David; Dastjerdi, Mohammad; Zarbin, Marco

    2016-01-01

    Loss of light perception (LP) after open globe injury (OGI) does not necessarily mean the patient will have permanent complete visual loss. Findings that seem to be associated reliably with permanent profound vision loss after OGI include optic nerve avulsion, optic nerve transection, and profound loss of intraocular contents, which can be identified with CT/MRI imaging albeit with varying degrees of confidence. Eyes with NLP after OGI that undergo successful primary repair with intact optic nerves may be considered for additional surgery, particularly if there is: (1) recovery of LP on the first day after primary repair; (2) treatable pathology underlying NLP status (e.g., extensive choroidal hemorrhage, dense vitreous and subretinal hemorrhage); (3) NLP in the fellow eye. We counsel patients that the chance of recovering ambulatory vision under these circumstances is very low (~5%). PMID:27621791

  11. Acute myocardial infarction due to left anterior descending coronary artery dissection after blunt chest trauma.

    PubMed

    Oghlakian, Gerard; Maldjian, Pierre; Kaluski, Edo; Saric, Muhamed

    2010-03-01

    Cardiac complications of chest trauma range from arrhythmias to valvular avulsions to myocardial contusion, rupture, and rarely myocardial infarction. We describe a case of a young patient with blunt chest trauma after a motor vehicle accident in whom the diagnosis of myocardial infarction was established a week later because no electrocardiogram or cardiac biomarkers were obtained on presentation. Retrospective review of contrast-enhanced computed tomography (CT) of the chest done on presentation demonstrated a perfusion defect in the distribution of the left anterior descending artery (LAD). Subsequent coronary angiography demonstrated dissection in the proximal LAD. Our case illustrates the importance of electrocardiography and contrast-enhanced chest CT in initial evaluation of patients with blunt chest trauma and suspected injury to the coronary arteries. PMID:19214607

  12. Hip ultrasound.

    PubMed

    Martinoli, Carlo; Garello, Isabella; Marchetti, Alessandra; Palmieri, Federigo; Altafini, Luisa; Valle, Maura; Tagliafico, Alberto

    2012-12-01

    In newborns, US has an established role in the detection and management of developmental dysplasia of the hip. Later in childhood, when the limping child is a major diagnostic dilemma, US is extremely helpful in the identification of the varied disease processes underlying this condition, as transient synovitis, septic arthritis, Perthes disease and slipped femoral capital epiphysis. In adolescent practicing sporting activities, US is an excellent means to identify apophyseal injures about the pelvic ring, especially when avulsions are undisplaced and difficult-to-see radiographically. Later on, in the adulthood, US is an effective modality to diagnose tendon and muscle injuries about the hip and pelvis, identify effusion or synovitis within the hip joint or its adjacent bursae and guide the treatment of these findings. The aim of this article is to provide a comprehensive review of the most common pathologic conditions about the hip, in which the contribution of US is relevant for the diagnostic work-up. PMID:21571471

  13. Anterior hip pain.

    PubMed

    O'Kane, J W

    1999-10-15

    Anterior hip pain is a common complaint with many possible causes. Apophyseal avulsion and slipped capital femoral epiphysis should not be overlooked in adolescents. Muscle and tendon strains are common in adults. Subsequent to accurate diagnosis, strains should improve with rest and directed conservative treatment. Osteoarthritis, which is diagnosed radiographically, generally occurs in middle-aged and older adults. Arthritis in younger adults should prompt consideration of an inflammatory cause. A possible femoral neck stress fracture should be evaluated urgently to prevent the potentially significant complications associated with displacement. Patients with osteitis pubis should be educated about the natural history of the condition and should undergo physical therapy to correct abnormal pelvic mechanics. "Sports hernias," nerve entrapments and labral pathologic conditions should be considered in athletic adults with characteristic presentations and chronic symptoms. Surgical intervention may allow resumption of pain-free athletic activity. PMID:10537384

  14. 'Hip' pain.

    PubMed

    Zacher, Josef; Gursche, Angelika

    2003-02-01

    'Hip' pain is usually located in the groin, upper thigh or buttock and is a common complaint. Slipped capital femoral epiphysis, avascular femoral head necrosis and apophyseal avulsion are the most common diagnoses in childhood and adolescents. Strains and fractures are common in sport-active adults. Osteoarthritis occurs in middle-aged and older adults. Trauma may result in femoral head fracture or typical muscle and tendon sprains and bursitis. Septic or inflammatory arthritis can occur at every age. Septic arthritis, fractures and acute epiphyseal slipping are real emergency cases. Congenital dysplasia of the hip joint may lead to labral tears and early osteoarthritis. The most important hip problems in children, adolescents, adult and older people are discussed; these problems originate from intra-articular disorders and the surrounding extra-articular soft tissues. Medical history, clinical examination and additional tests, including imaging, will be demonstrated. Principles of treatment are given for specific disorders. PMID:12659822

  15. Anastomosing Rivers are Disequilibrium Patterns

    NASA Astrophysics Data System (ADS)

    Lavooi, E.; de Haas, T.; Kleinhans, M. G.; Makaske, B.; Smith, D. G.

    2010-12-01

    Anastomosing rivers have multiple interconnected channels that enclose floodbasins. Various theories have been proposed to explain this pattern, including an increased discharge conveyance and sediment transport capacity of multiple channels, or, alternatively, a tendency to avulse due to upstream sediment overloading. The former implies an equilibrium pattern whereas the latter implies a temporary increase of the number of channels. Our objective was to test these hypotheses on a well-documented case: the upper Columbia River. We combined a geological approach with physics-based morphological modelling. Three geological sections across the entire valley were constructed based on hand auger data, covering a depth up to 8.6 m corresponding to the last 4000 years, corroborated by 14C dating. The sections were integrated with surface mapping to derive proportions of channel and floodplain sediment volumes and sedimentation rates along the river. Existing sediment transport measurements at a location upstream and downstream of the study area were re-analysed and time-integrated for comparison. A network model was built based on gradually varied flow equations, sediment transport prediction, mass conservation and detailed transverse slope and spiral meander flow effects at the bifurcations. The geological sections show a clear downstream trend of decreasing number of channels and decreasing bed sediment deposition in channels and crevasses, indicating bed sediment overloading from upstream and subsequent avulsions. The measured suspended sediment is much larger than the amount captured in the floodplains, indicating that this is not limiting the aggradation in the valley. Extensive crevasse splays in the upstream section and an increased bed elevation and gradient demonstrate a tendency to avulse due to overloading of bed sediment. The measured bedload transport indeed indicates bed material overloading. The 14C dating confirms that long-term average floodplain

  16. Nonfatal air embolism during shoulder arthroscopy.

    PubMed

    Pandey, Vivek; Varghese, Elsa; Rao, Madhu; Srinivasan, Nataraj M; Mathew, Neethu; Acharya, Kiran K V; Rao, P Sripathi

    2013-06-01

    An air embolism is a rare but potentially fatal complication of shoulder arthroscopy. In this article, we report the case of a patient who developed a nonfatal air embolism during shoulder arthroscopy for an acute bony Bankart lesion and a greater tuberosity avulsion fracture. The venous air embolism occurred immediately after the joint was insufflated with air for diagnostic air arthroscopy. The diagnosis was based on a drop in end-tidal carbon dioxide and blood pressure and presence of mill wheel (waterwheel) murmur over the right heart. Supportive treatment was initiated immediately. The patient recovered fully and had no further complications of air embolism. This patient's case emphasizes the importance of being aware that air embolisms can occur during shoulder arthroscopy performed for acute intra-articular fractures of the shoulder. Monitoring end tidal carbon dioxide can be very useful in early detection of air embolisms. PMID:23805421

  17. Orthodontic treatment of a mandibular incisor fenestration resulting from a broken retainer.

    PubMed

    Farret, Marcel M; Farret, Milton M B; da Luz Vieira, Gustavo; Assaf, Jamal Hassan; de Lima, Eduardo Martinelli S

    2015-08-01

    This article describes the orthodontic relapse with mandibular incisor fenestration in a 36-year-old man who had undergone orthodontic treatment 21 years previously. The patient reported that his mandibular 3 × 3 bonded retainer had been partially debonded and broken 4 years earlier. The mandibular left lateral incisor remained bonded to the retainer and received the entire load of the incisors; consequently, there was extreme labial movement of the root, resulting in dental avulsion. As part of the treatment, the root was repositioned lingually using a titanium-molybdenum segmented archwire for 8 months, followed by endodontic treatment, an apicoectomy, and 4 months of alignment and leveling of both arches. The treatment outcomes were excellent, and the tooth remained stable, with good integrity of the mesial, distal, and lingual alveolar bones and periodontal ligament. The 1-year follow-up showed good stability of the results. PMID:26232842

  18. Atrophy of submandibular gland by the duct ligation and a blockade of SP receptor in rats

    PubMed Central

    Hishida, Sumiyo; Ozaki, Noriyuki; Honda, Takashi; Shigetomi, Toshio; Ueda, Minoru; Hibi, Hideharu; Sugiura, Yasuo

    2016-01-01

    ABSTRACT To clarify the mechanisms underlying the submandibular gland atrophies associated with ptyalolithiasis, morphological changes were examined in the rat submandibular gland following either surgical intervention of the duct or functional blockade at substance P receptors (SPRs). Progressive acinar atrophy was observed after duct ligation or avulsion of periductal tissues. This suggested that damage to periductal tissue involving nerve fibers might contribute to ligation-associated acinar atrophy. Immunohistochemically labeled-substance P positive nerve fibers (SPFs) coursed in parallel with the main duct and were distributed around the interlobular, striated, granular and intercalated duct, and glandular acini. Strong SPR immunoreactivity was observed in the duct. Injection into the submandibular gland of a SPR antagonist induced marked acinar atrophy. The results revealed that disturbance of SPFs and SPRs might be involved in the atrophy of the submandibular gland associated with ptyalolithiasis. PMID:27303108

  19. The knee: Surface-coil MR imaging at 1. 5 T

    SciTech Connect

    Beltran, J.; Noto, A.M.; Mosure, J.C.; Weiss, K.L.; Zuelzer, W.; Christoforidis, A.J.

    1986-06-01

    Seven normal knees (in five volunteers) and seven injured knees (in seven patients) were examined by high-resolution magnetic resonance (MR) imaging at 1.5 T with a surface coil. Seven medial meniscal tears, three anterior cruciate ligament tears, one posterior cruciate ligament avulsion, an old osteochondral fracture, femoral condylar chondro-malacia, and one case of semimembranous tendon reinsertion were identified. MR images correlated well with recent double-contrast arthrograms or results of surgery. All tears were identified in both the sagittal and coronal planes. Because of its ability to demonstrate small meniscal lesions and ligamentous injuries readily, MR imaging with a surface coil may eventually replace the more invasive arthrography.

  20. Total knee arthroplasty using subvastus approach in stiff knee: A retrospective analysis of 110 cases

    PubMed Central

    Shah, Nilen A; Patil, Hitendra Gulabrao; Vaishnav, Vinod O; Savale, Abhijit

    2016-01-01

    Background: Subvastus approach used in total knee arthroplasty (TKA) is known to produce an earlier recovery but is not commonly utilized for TKA when the preoperative range of motion (ROM) of the knee is limited. Subvastus approach is known for its ability to give earlier recovery due to less postoperative pain and early mobilization (due to rapid quadriceps recovery). Subvastus approach is considered as a relative contraindication for TKA in knees with limited ROM due to difficulty in exposure which can increase risk of complications such as patellar tendon avulsion or medial collateral injury. Short stature and obesity are also relative contraindications. Tarabichi successfully used subvastus approach in knees with limited preoperative ROM. However, there are no large series in literature with the experience of the subvatus approach in knees with limited preoperative ROM. We are presenting our experience of the subvastus approach for TKA in knees with limited ROM. Materials and Methods: We conducted retrospective analysis of patients with limited preoperative ROM (flexion ≤90°) of the knee who underwent TKA using subvastus approach and presenting the 2 years results. There were a total 84 patients (110 knees) with mean age 64 (range 49–79 years) years. The mean preoperative flexion was 72° (range 40°–90°) with a total ROM of 64° (range 36°–90°). Results: Postoperatively knee flexion improved by mean 38° (P < 0.05) which was significant as assed by Student's t- test. The mean knee society score improved from 36 (range 20–60) to 80 (range 70–90) postoperatively (P < 0.05). There was one case of partial avulsion of patellar tendon from the tibial tubercle. Conclusions: We concluded that satisfactory results of TKA can be obtained in knees with limited preoperative ROM using subvastus approach maintaining the advantages of early mobilization. PMID:27053806

  1. Coevolution of hydrodynamics, vegetation and channel evolution in wetlands of a semi-arid floodplain

    NASA Astrophysics Data System (ADS)

    Seoane, Manuel; Rodriguez, Jose Fernando; Rojas, Steven Sandi; Saco, Patricia Mabel; Riccardi, Gerardo; Saintilan, Neil; Wen, Li

    2015-04-01

    The Macquarie Marshes are located in the semi-arid region in north western NSW, Australia, and constitute part of the northern Murray-Darling Basin. The Marshes are comprised of a system of permanent and semi-permanent marshes, swamps and lagoons interconnected by braided channels. The wetland complex serves as nesting place and habitat for many species of water birds, fish, frogs and crustaceans, and portions of the Marshes was listed as internationally important under the Ramsar Convention. Some of the wetlands have undergone degradation over the last four decades, which has been attributed to changes in flow management upstream of the marshes. Among the many characteristics that make this wetland system unique is the occurrence of channel breakdown and channel avulsion, which are associated with decline of river flow in the downstream direction typical of dryland streams. Decrease in river flow can lead to sediment deposition, decrease in channel capacity, vegetative invasion of the channel, overbank flows, and ultimately result in channel breakdown and changes in marsh formation. A similar process on established marshes may also lead to channel avulsion and marsh abandonment, with the subsequent invasion of terrestrial vegetation. All the previous geomorphological evolution processes have an effect on the established ecosystem, which will produce feedbacks on the hydrodynamics of the system and affect the geomorphology in return. In order to simulate the complex dynamics of the marshes we have developed an ecogeomorphological modelling framework that combines hydrodynamic, vegetation and channel evolution modules and in this presentation we provide an update on the status of the model. The hydrodynamic simulation provides spatially distributed values of inundation extent, duration, depth and recurrence to drive a vegetation model based on species preference to hydraulic conditions. It also provides velocities and shear stresses to assess geomorphological

  2. Dickkopf-3 is upregulated in osteoarthritis and has a chondroprotective role

    PubMed Central

    Snelling, S.J.B.; Davidson, R.K.; Swingler, T.E.; Le, L.T.T.; Barter, M.J.; Culley, K.L.; Price, A.; Carr, A.J.; Clark, I.M.

    2016-01-01

    Summary Objective Dickkopf-3 (Dkk3) is a non-canonical member of the Dkk family of Wnt antagonists and its upregulation has been reported in microarray analysis of cartilage from mouse models of osteoarthritis (OA). In this study we assessed Dkk3 expression in human OA cartilage to ascertain its potential role in chondrocyte signaling and cartilage maintenance. Methods Dkk3 expression was analysed in human adult OA cartilage and synovial tissues and during chondrogenesis of ATDC5 and human mesenchymal stem cells. The role of Dkk3 in cartilage maintenance was analysed by incubation of bovine and human cartilage explants with interleukin-1β (IL1β) and oncostatin-M (OSM). Dkk3 gene expression was measured in cartilage following murine hip avulsion. Whether Dkk3 influenced Wnt, TGFβ and activin cell signaling was assessed in primary human chondrocytes and SW1353 chondrosarcoma cells using qRT-PCR and luminescence assays. Results Increased gene and protein levels of Dkk3 were detected in human OA cartilage, synovial tissue and synovial fluid. DKK3 gene expression was decreased during chondrogenesis of both ATDC5 cells and humans MSCs. Dkk3 inhibited IL1β and OSM-mediated proteoglycan loss from human and bovine cartilage explants and collagen loss from bovine cartilage explants. Cartilage DKK3 expression was decreased following hip avulsion injury. TGFβ signaling was enhanced by Dkk3 whilst Wnt3a and activin signaling were inhibited. Conclusions We provide evidence that Dkk3 is upregulated in OA and may have a protective effect on cartilage integrity by preventing proteoglycan loss and helping to restore OA-relevant signaling pathway activity. Targeting Dkk3 may be a novel approach in the treatment of OA. PMID:26687825

  3. Scale-dependent interactions between wood and channel dynamics: Modeling jam formation and sediment storage in gravel-bed streams

    NASA Astrophysics Data System (ADS)

    Eaton, B. C.; Hassan, M. A.

    2013-12-01

    A stochastic model is used to investigate how the geomorphic function of wood changes with watershed scale, assuming wood recruitment occurs due to the mortality of individual trees, not to mass recruitment events such as landslides or episodic bank erosion. The model replicates the downstream decline in total wood load observed in the field, but predicts that the functional wood load peaks in channels having bankfull widths about 33% of the characteristic riparian tree height. The model also predicts that the greatest potential impact of jams on channel pattern—both in terms of sediment stored behind individual jams and the potential for jams to trigger avulsions—will typically be associated with channel widths between 25% and 67% of the riparian tree height. The simulation results are used to refine the categories that describe wood in alluvial channels, and the equivalent terms that describe the size of streams with forested riparian areas: small channels (or channels with large wood) are associated with widths less than 25% of the tree height; large channels (or channels with small wood) are associated with widths greater than 67% of tree height; and medium channels (or channels with intermediate wood) have widths between 25% and 67% of the tree height. We surmise that large wood acts primarily to store bed material (in small channels); intermediate wood tends to form channel-spanning jams, which can induce channel avulsions and create anabranched channel patterns (in medium channels); and small wood may increase the morphologic diversity, but does not store significant quantities of bed material or form channel-spanning jams capable of inducing stream avulsions (in large channels).

  4. Biomechanical Analysis of Internal Bracing for Treatment of Medial Knee Injuries.

    PubMed

    Gilmer, Brian B; Crall, Timothy; DeLong, Jeffrey; Kubo, Takanori; Mackay, Gordon; Jani, Sunil S

    2016-05-01

    The internal brace technique uses a high-strength suture tie to augment injured tissues or a primary repair, allowing early rehabilitation. Anatomic repair with internal bracing is a novel and promising treatment for femoral-sided medial knee avulsion injuries of the medial collateral ligament and posterior oblique ligament. Unfortunately, biomechanical and clinical data are lacking. To evaluate this technique compared with other treatment options, 3 assays of 9 cadaveric matched pairs (54 knees) were tested to failure at 30° under valgus load in a biomechanical testing apparatus. The primary outcome measure was moment at failure (Nm), with secondary outcome measures of stiffness (Nm/°), valgus angulation at 10 Nm (°), and valgus angulation at failure (°). Repair with internal bracing was compared with the intact state, repair alone, and allograft reconstruction. The mean moment to failure (62.5±24.9 Nm) for internal bracing was significantly lower than that for intact specimens (107.2±39.7 Nm) (P=.009). Mean moment to failure and valgus angle at failure were significantly greater for internal bracing (95±31.9 Nm) than for repair (73.4±27.6 Nm) (P=.05). Internal bracing was similar to reconstruction for the primary outcome measure (53.5±26.3 Nm vs 66.9±28.8 Nm) (P=.227) and for all secondary outcome measures. These findings indicate that posteromedial knee repair with internal bracing for femoral-sided avulsions is superior to repair alone and is similar to allograft reconstruction for all parameters measured; however, this technique did not recreate biomechanical properties equivalent to the intact state. [Orthopedics. 2016; 39(3):e532-e537.]. PMID:27135459

  5. Climatic, geomorphic, and archaeological implications of a late Quaternary alluvial chronology for the lower Salt River, Arizona, USA

    NASA Astrophysics Data System (ADS)

    Huckleberry, Gary; Onken, Jill; Graves, William M.; Wegener, Robert

    2013-03-01

    Recent archaeological excavations along the lower Salt River, Arizona resulted in the unexpected discovery of buried late Pleistocene soils and cultural features dating 5800-7100 cal YBP (Early Archaic), the latter representing the earliest evidence of human activity in the lower Salt River floodplain thus far identified. Because the lower Salt River floodplain has been heavily impacted by recent agriculture and urbanization and contains few stratigraphic exposures, our understanding of the river's geological history is limited. Here we present a late Quaternary alluvial chronology for a segment of the lower Salt River based on 19 accelerator mass spectrometry 14C and four optically stimulated luminescence ages obtained during two previous geoarchaeological investigations. Deposits are organized into allostratigraphic units and reveal a buried late Pleistocene terrace inset into middle-to-late Pleistocene terrace deposits. Holocene terrace fill deposits unconformably cap the late Pleistocene terrace tread in the site area, and the lower portion of this fill contains the Early Archaic archaeological features. Channel entrenchment and widening ~ 900 cal YBP eroded much of the older terrace deposits, leaving only a remnant of fill containing the buried latest Pleistocene and middle-to-late Holocene deposits preserved in the site area. Subsequent overbank deposition and channel filling associated with a braided channel system resulted in the burial of the site by a thin layer of flood sediments. Our study confirms that the lower Salt River is a complex mosaic of late Quaternary alluvium formed through vertical and lateral accretion, with isolated patches of buried soils preserved through channel avulsion. Although channel avulsion is linked to changes in sediment load and discharge and may have climatic linkages, intrinsic geomorphic and local base level controls limit direct correlations of lower Salt River stratigraphy to other large rivers in the North American

  6. Posterior Urethral Valves in Children: Pattern of Presentation and Outcome of Initial Treatment in Ile-Ife, Nigeria

    PubMed Central

    Talabi, Ademola Olusegun; Sowande, Oludayo Adedapo; Etonyeaku, Amarachukwu Chiduziem; Salako, Abdulkadir A; Adejuyigbe, Olusanya

    2015-01-01

    Background: The management of posterior urethral valves (PUV) and its sequelae is still a challenge to most pediatric surgeons in our environment due to late presentation and inadequate facilities for long-term evaluation and treatment. Despite initial successful treatment about 40% would develop chronic renal failure. The aim is to describe the presentation, management and outcome of the initial treatment in boys with PUV. Materials and Methods: It is a retrospective analysis of PUV in boys 8 years and below over a 17 years period. Demographic characteristics, clinical features, investigations, and treatment outcome were reviewed. Results: Thirty-seven cases were analyzed. The median age was 5 months (range from birth to 8 years). Three (8.1%) patients had prenatal ultrasound diagnosis. The most common presentation was voiding dysfunction 37 (100%). Part of the preoperative investigation included micturating cystourethrogram (n = 31: 83.8%) and abdomino-pelvic ultrasonography (n = 37:(100%). The mean serum creatinine value of those who presented within the first 30 days of life and those who presented afterwards were 325 (±251) µmol/L and 141 (±100) µmol/L respectively, P = 0.003. Surgical interventions included trans-vesical excision of valves (n = 9: 28.1%), valvotomy (n = 10: 31.3%), balloon avulsion (n = 8: 25.0%), vesicostomy (n = 4: 12.5%) and endoscopic valve avulsion (n = 1: 3.1%). Seventeen (56.7%) patients had serum creatinine >70.4 µmol/L after 1-month of valve excision. Five (13.5%) patients had postrelief complications and 5 (13.5%) died on admission. Ninety percentage (27/30) of patients had poor prognostic indices. Conclusions: The initial treatment outcome was good but most had poor prognostic factors. PMID:26425072

  7. Traumatic Floating 1st Metacarpal in a 14-Year-Old Boy Managed by Close Reduction and Thumb Spica Immobilization: A Rare Case Report

    PubMed Central

    Tyagi, Himanshu Ravindra; Kamat, Nandan; Wajekar, Sagar; Mandalia, Saumil H

    2014-01-01

    Introduction: Double dislocation of thumb metacarpal (MC) is a rare injury which may be secondarily complicated by growth plate injury in children. The management of floating 1st MC is also controversial since the treatment ranges from simple reduction to complex reconstruction surgeries. It is also important to understand the long-term results of different management strategies (close reduction, K-wire fixation, ligament reconstruction) as any residual stiffness or instability of thumb may result in severe disability of the hand. Case Report: A 14-year-old boy with an alleged history of injury to the thumb due to a fall. The postulated mechanism of injury was forced hyperextension of thumb and axial loading of hand in the prone position. On examination, there was prominent bony swelling over the dorsal aspect of carpometacarpal (CMC) and metacarpophalangeal (MCP) joints which was very tender with diffuse swelling over entire thumb. X-ray showed dorsal dislocation of both MCP and CMC joints, without any fracture (bony avulsion) or volar plate avulsion. Treatment was by way of closed reduction performed by axial traction followed by forced flexion at MCP joint with continuous pressure over the dorsal aspect of the joint. The reduction of CMC joint was done by direct pressure over the dorsal aspect and full abduction of thumb. Following reduction, the thumb was immobilized in a thumb spica. Conclusion: Thus, we conclude it is possible to manage a case of floating 1st MC by closed reduction and immobilization, using proper reduction technique. However, a careful clinical and radiological assessment should be done beforehand for signs of bony injury or ligamentous instability. PMID:27299001

  8. Rotator cuff injuries in adolescent athletes.

    PubMed

    Weiss, Jennifer M; Arkader, Alexandre; Wells, Lawrence M; Ganley, Theodore J

    2013-03-01

    The cause of rotator cuff injuries in the young athlete has been described as an overuse injury related to internal impingement. Abduction coupled with external rotation is believed to impinge on the rotator cuff, specifically the supraspinatus, and lead to undersurface tears that can progress to full-thickness tears. This impingement is believed to be worsened with increased range of motion and instability in overhead athletes. A retrospective review of seven patients diagnosed with rotator cuff injuries was performed to better understand this shoulder injury pattern. The type of sport played, a history of trauma, diagnosis, treatment method, and outcome were noted. Six patients were male and one was a female. Baseball was the primary sport for four patients, basketball for one, gymnastics for one, and wrestling for one. The following injury patterns were observed: two patients tore their subscapularis tendon, two sustained avulsion fractures of their lesser tuberosity, one tore his rotator interval, one tore his supraspinatus, and one avulsed his greater tuberosity. Only four patients recalled a specific traumatic event. Three patients were treated with arthroscopic rotator cuff repair, three with miniopen repair, and one was treated with rehabilitation. Six of the seven patients returned to their preinjury level of sport after treatment. Rotator cuff tears are rare in the adolescent age group. The injury patterns suggest that acute trauma likely accounts for many rotator cuff tears and their equivalents in the young patient. Adolescents with rotator cuff tears reliably return to sports after treatment. The possibility of rotator cuff tears in skeletally immature athletes should be considered. The prognosis is very good once this injury is identified and treated. PMID:22668571

  9. Range of motion and strength after surgery for brachial plexus birth palsy

    PubMed Central

    2011-01-01

    Background There is little information about the range of motion (ROM) and strength of the affected upper limbs of patients with permanent brachial plexus birth palsy. Patients and methods 107 patients who had brachial plexus surgery in Finland between 1971 and 1998 were investigated in this population-based, cross-sectional, 12-year follow-up study. During the follow-up, 59 patients underwent secondary procedures. ROM and isometric strength of the shoulders, elbows, wrists, and thumbs were measured. Ratios for ROM and strength between the affected and unaffected sides were calculated. Results 61 patients (57%) had no active shoulder external rotation (median 0° (-75–90)). Median active abduction was 90° (1–170). Shoulder external rotation strength of the affected side was diminished (median ratio 28% (0–83)). Active elbow extension deficiency was recorded in 82 patients (median 25° (5–80)). Elbow flexion strength of the affected side was uniformly impaired (median ratio 43% (0–79)). Median active extension of the wrist was 55° (-70–90). The median ratio of grip strength for the affected side vs. the unaffected side was 68% (0–121). Patients with total injury had poorer ROM and strength than those with C5–6 injury. Incongruity of the radiohumeral joint and avulsion were associated with poor strength values. Interpretation ROM and strength of affected upper limbs of patients with surgically treated brachial plexus birth palsy were reduced. Patients with avulsion injuries and/or consequent joint deformities fared worst. PMID:21142823

  10. The Impact of Different Degrees of Injured C7 Nerve Transfer: An Experimental Rat Study

    PubMed Central

    Tzou, Chieh-Han John; Chang, Tommy Nai-Jen; Lu, Johnny Chuieng-Yi

    2014-01-01

    Background: Ipsilateral C7 nerve transfer is an available procedure in C5C6 2-root avulsion injury of the brachial plexus. However, concomitant injury of a normal-looking C7 cannot be ruled out. The efficiency of a concomitant injury of C7 transfer was investigated. Methods: Forty-two Sprague-Dawley rats were randomly assigned to 5 groups. They all underwent a 2-stage procedure. In the first stage from dorsal spine approach, left C5 and C6 roots were avulsed and C7 was crushed with jeweler’s forceps with different degrees: group A (n = 6), C7 not injured; group B (n = 10), C7 crushed for 10 seconds; group C (n = 10), C7 crushed for 30 seconds; group D (n = 10), C7 doubly crushed for 60 seconds; and group E (n = 6), C7 transected and not repaired. Four weeks later in the second stage, the C7 was reexplored via volar approach, transected, and coapted to the musculocutaneous nerve. At 12 weeks following the nerve transfer, functional outcomes were assessed. Results: Grooming test, muscle weight, electromyography, and muscle tetanic contraction force all showed that the biceps muscles were significantly worse in group C (moderate crush) and group D (severe crush). Group B (mild crush) and group A (uninjured) showed no difference. Group E (C7 cut and not repaired) was the worst. Conclusions: An injured but grossly normal-looking ipsilateral C7 can be used as a motor source but with variable results. The result is directly proportional to the severity of injury, potentially implying that better results will be achieved when longer regeneration time is allowed. PMID:25426347

  11. Viability of fibroblasts in a novel probiotic storage media.

    PubMed

    Caglar, E; Sandalli, N; Kuscu, O O; Durhan, M A; Pisiriciler, R; Caliskan, E Ak; Kargul, B

    2010-10-01

    A number of storage media have been investigated as to their ability to maintain the viability of the periodontal ligament (PDL) cells and thus to permit longer extra-alveolar periods prior to replantation of avulsed teeth. The aim of the present in vitro study was to evaluate the number of viable PDL cells of avulsed teeth treated by Hank's Balanced Salt Solutions (HBSS), saline, a novel probiotic solution and milk. Thirty-six freshly extracted single-rooted human teeth with closed apices were divided into one of the four experimental groups and two control groups (N = 6 each). The positive and negative controls corresponded to 0 min and an 8-h dry time respectively. Following extraction, the coronal 3 mm of PDL tissue was scraped with a #15 scalpel to remove cells that might have been damaged. The experimental teeth were dried for 30 min followed by a 45 min immersion in one of the four experimental media. Each experimental tooth, after drying and soaking, was incubated for 30 min with a 2.5 ml solution of 0.2 mg ml(-1) of collagenase CLS II and a 2.4 mg ml(-1) solution of dispase grade II in phosphate buffer saline (PBS). The cells were then labelled with 0.4% Trypan blue for determination of viability. The teeth stored in positive control demonstrated the highest number of viable PDL cells followed in rank order by HBSS, saline, Lactobacillus reuteri solution and milk. There was no significant difference in the number of viable PDL cells between HBSS, milk, L. reuteri solution and saline. Within the parameters of this study, it appears that probiotic may be able to maintain PDL cell viability as HBSS, milk, or saline. PMID:20738362

  12. Comparison of Coconut Water and Jordanian Propolis on Survival of Bench-dried Periodontal Ligament Cells: An in vitro Cell Culture Study

    PubMed Central

    Al-Jundi, Suhad; Mhaidat, Nizar

    2013-01-01

    ABSTRACT Aim: The aim of this study is to assess and compare the efficacy of Jordanian propolis and full concentration mature coconut water in their ability to preserve periodontal ligament (PDL) cell viability after exposure of PDL cells to up to 120 minutes dry storage. Materials and methods: PDL cells were obtained from sound permanent first molars which were cultured in Dulbecco's Modified Eagles Medium (DMEM). Cultures were subjected to 0, 30, 45, 60, 90 and 120 minutes dry storage times then incubated with 100% mature coconut water, Jordanian propolis and DMEM for 45 minutes at room temperature (18-26°C). Untreated cells served as controls at each dry storage time tested. PDL cell viability was assessed by MTT assay. Statistical analysis of data was accomplished by using one-way analysis of variance complemented by Tukey test and the level of significance was 5% ( p < 0.05). Results: Up to 60 minutes dry storage, no significant improvement on the percentage of viable cells was found from soaking in all tested media. On the other hand, soaking in mature coconut water only resulted in higher percentages of viable cells at >60 minutes dry storage. However, this improvement was not significant (p > 0.05). Conclusion: Avulsed teeth which have been left dry for <45 minutes should be replanted immediately, whereas avulsed teeth which have been left dry for >45 minutes may benefit from soaking for 45 minutes in mature coconut water. How to cite this article: Al-Haj Ali SN, Al-Jundi S, Mhaidat N. Comparison of Coconut Water and Jordanian Propolis on Survival of Bench-dried Periodontal Ligament Cells: An in vitro Cell Culture Study. Int J Clin Pediatr Dent 2013;6(3):161-165. PMID:25206215

  13. Constraints on the duration of the Paleocene-Eocene Thermal Maximum by orbitally-influenced fluvial sediment records of the northern Bighorn Basin, Wyoming, USA

    NASA Astrophysics Data System (ADS)

    van der Meulen, Bas; Abels, Hemmo; Meijer, Niels; Gingerich, Philip; Lourens, Lucas

    2016-04-01

    The addition of major amounts of carbon to the exogenic carbon pool caused rapid climate change and faunal turnover during the Paleocene-Eocene Thermal Maximum (PETM) around 56 million years ago. Constraints are still needed on the duration of the onset, main body, and recovery of the event. The Bighorn Basin in Wyoming provides expanded terrestrial sections spanning the PETM and lacking the carbonate dissolution present in many marine records. Here we provide new carbon isotope records for the Polecat Bench and Head of Big Sand Coulee sections, two parallel sites in the northern Bighorn Basin, at unprecedented resolution. Cyclostratigraphic analysis of these fluvial sediment records using descriptive sedimentology and proxy records allows subdivision into intervals dominated by avulsion deposits and intervals dominated by overbank deposits. These sedimentary sequences alternate in a regular fashion and are related to climatic precession. Correlation of the two, 8-km-spaced sections shows that the avulsion-overbank cycles are laterally consistent. The presence of longer-period alternations, related to modulation by the 100-kyr eccentricity cycle, corroborates the precession influence on the sediments. Sedimentary cyclicity is then used to develop a floating precession-scale age model for the PETM carbon isotope excursion (CIE). We find a CIE body encompassing 95 kyrs aligning with marine cyclostratigraphic age models. The duration of the CIE onset is estimated at 5 kyrs, but difficult to determine because sedimentation rates vary at the sub-precession scale. The CIE recovery starts with a 2 to 4 per mille step and lasts 40 or 90 kyrs, depending on what is considered the carbon isotope background state.

  14. Hamstring injuries: anatomy, imaging, and intervention.

    PubMed

    Linklater, James M; Hamilton, Bruce; Carmichael, James; Orchard, John; Wood, David G

    2010-06-01

    Injury to the hamstring muscle complex (HMC) is extremely common in the athletic community. Anatomical and functional aspects of the HMC predispose it to injury, including the fact that the muscles cross two joints and undergo eccentric contraction during the gait cycle. Injury most commonly occurs at the muscle tendon junction but may occur anywhere between the origin and insertion. Complete hamstring avulsions require early surgical repair. The principal indication for imaging is in a triage role to rule out or confirm proximal hamstring avulsion. Acute onset and chronic posterior thigh and buttock pain may relate to pathology at the hamstring origin or muscle tendon junction that can be readily defined on magnetic resonance imaging or, less frequently, ultrasound. Some cases of buttock and thigh pain may relate to spinal pathology. In the elite athlete there is an increasing emphasis on optimizing the rehabilitation process after hamstring injury, to minimize the absence from sports and improve the final outcome. Imaging has a role in confirming the site of injury and characterizing its extent, providing some prognostic information and helping plan treatment. There is increasing interest in the use of growth factors to accelerate healing after muscle and tendon injury. Animal studies have demonstrated clear benefits in terms of accelerated healing. There are various methods of delivery of the growth factors, all involving the release of growth factors from platelets. These include plasma rich in platelets and autologous blood. Clinical studies in humans are very limited at this stage but are promising. At present the World Anti-Doping Authority bans the intramuscular administration of these agents. Other percutaneous injection therapies include the use of Actovegin and Traumeel S and antifibrotic agents. PMID:20486024

  15. Morpho-dynamics of the Brahmaputra-Jamuna River, Bangladesh

    NASA Astrophysics Data System (ADS)

    Sarker, Maminul H.; Thorne, Colin R.; Aktar, M. Nazneen; Ferdous, Md. Ruknul

    2014-06-01

    The Jamuna River is the downstream continuation of the Brahmaputra in Bangladesh. It is one of the largest sand-bed braided rivers in the world and every year it erodes thousand hectares of mainland floodplain, rendering tens of thousands of people landless and/or homeless. Understanding the morpho-dynamics of this river and its responses to the various drivers of morphological change that act on it is essential to improving the livelihoods of millions of floodplain dwellers in Bangladesh, especially given the threats posed by climate change. Reliable data, information and knowledge of river process are sparse and so progress in linking the impacts of multiple drivers (including neo-tectonics, earthquakes, large-scale avulsions and engineering interventions) to complex morphological responses depends on making best use of historical maps, time-series satellite images, hydro-morphological data, expert judgment and local knowledge. This paper draws on all these sources to chronicle the morphological evolution of the Jamuna River since the avulsion that created it about 200 years ago, and to establish temporal trends and spatial patterns in the changes that have characterized process-response mechanisms in this fluvial system since then. The understanding gained from these investigations then supports deeper analyses to: explain how historical migration of the river westward has produced significant contrasts between left and right (west) bank material properties; elucidate the relationships between discharge, fluvial processes, anabranch instability and floodplain erosion rates, and; identify causal links between drivers and morphological responses at a variety of time and space scales. Finally, the new knowledge generated by the analyses developed herein are combined with existing, conceptual and empirical process-response models for the Jamuna to predict possible future morphological adjustments in ways helpful in identifying appropriate strategies for climate

  16. Perfusion Assessment with the SPY System after Arterial Venous Reversal for Upper Extremity Ischemia

    PubMed Central

    2014-01-01

    Background: The timing and pattern of reperfusion following arterial- venous reversal (AVR) in patients with terminal ischemia of an upper extremity is not well understood. Methods: The current case series describes the timing and pattern of reperfusion observed in patients with terminal upper extremity ischemia who underwent AVR and repeated postoperative indocyanine green (ICG) angiography between 2004 and 2009. For all included patients, the SPY Near-Infrared Perfusion Assessment System permitted visualization of ICG-labeled blood flow for 60-second sampling periods at scheduled postoperative time points; outflow and rate and amplitude of inflow were objectively quantified with SPY-Q Analysis Toolkit image analysis software. Results: The series comprised 6 male patients (mean age, 46 years) who presented with upper extremity ischemia related to hypothenar hammer syndrome (n = 2), embolism with patent foramen ovale (n = 2), atherosclerosis (n = 1), and avulsion amputation of the thumb (n = 1); the patient with the avulsion amputation was diagnosed with thromboangiitis obliterans at the time of replantation. AVR was successful in all 6 patients. In 5 of 6 patients, ICG angiography and SPY-based visualization/quantification showed that venous outflow and arterial inflow gradually normalized (versus unaffected digits) between postoperative days (PODs) 0 and 3 and was maintained at long-term follow-up (≥3 months); for the patient who underwent thumb replantation, perfusion normalized between POD 3 and month 5 follow-up. Conclusions: AVR effectively reestablished blood flow in patients with terminal upper extremity ischemia. ICG angiography with SPY technology revealed that, in most cases, kinetic curves, timing, and patterns of perfusion gradually normalized over several PODs. PMID:25426368

  17. The Risk Factors for Failure of an Upper Extremity Replantation: Is the Use of Cigarettes/Tobacco a Significant Factor?

    PubMed Central

    He, Ji-Yin; Chen, Shih-Heng; Tsai, Tsu-Min

    2015-01-01

    Background The purpose of this study was to explore the potential risk factors associated with the failure of an upper extremity replantation with a focus on cigarette or tobacco use. Patients and Methods A cohort of 102 patients with 149 replants (6 extremities, 143 digits) and a mean age of 41 years (range 5 to 72 years) was enrolled in this study. The data collected included age, gender, tobacco/cigarettes use, trauma mechanism, underlying disease (e.g., hypertension (HTN), diabetes mellitus (DM), etc.), and vein graft use. An analysis with a multivariable regression was conducted to identify the risk factors of replant failure and their respective odds ratios (ORs). Results Multilevel generalized linear mixed models (GLMMs) with a binomial distribution and logit link showed that smoking did not increase the risk of replant failure (p = 0.234). In addition, the survival of replants was not affected by DM or HTN (p = 0.285 and 0.938, respectively). However, the replantation results were significantly affected by the age of the patients and the mechanism of injury. Patients older than 50 years and those with avulsion or crush injuries tended to have a higher risk of replant failure (OR = 2.29, 6.45, and 5.42, respectively; p = 0.047, 0.028, and 0.032, respectively). Conclusions This study showed that the use of cigarettes/tobacco did not affect the replantation outcome. The main risks for replant failure included being older than 50 years and the trauma mechanism (avulsion or crush injuries). PMID:26513147

  18. Dynamic response to strike-slip tectonic control on the deposition and evolution of the Baranof Fan, Gulf of Alaska

    USGS Publications Warehouse

    Walton, Maureen A. L.; Gulick, Sean P. S.; Reece, Robert S.; Barth, Ginger A.; Christeson, Gail L.; VanAvendonk, Harm J.

    2014-01-01

    The Baranof Fan is one of three large deep-sea fans in the Gulf of Alaska, and is a key component in understanding large-scale erosion and sedimentation patterns for southeast Alaska and western Canada. We integrate new and existing seismic reflection profiles to provide new constraints on the Baranof Fan area, geometry, volume, and channel development. We estimate the fan’s area and total sediment volume to be ∼323,000 km2 and ∼301,000 km3, respectively, making it among the largest deep-sea fans in the world. We show that the Baranof Fan consists of channel-levee deposits from at least three distinct aggradational channel systems: the currently active Horizon and Mukluk channels, and the waning system we call the Baranof channel. The oldest sedimentary deposits are in the northern fan, and the youngest deposits at the fan’s southern extent; in addition, the channels seem to avulse southward consistently through time. We suggest that Baranof Fan sediment is sourced from the Coast Mountains in southeastern Alaska, transported offshore most recently via fjord to glacial sea valley conduits. Because of the translation of the Pacific plate northwest past sediment sources on the North American plate along the Queen Charlotte strike-slip fault, we suggest that new channel formation, channel beheadings, and southward-migrating channel avulsions have been influenced by regional tectonics. Using a simplified tectonic reconstruction assuming a constant Pacific plate motion of 4.4 cm/yr, we estimate that Baranof Fan deposition initiated ca. 7 Ma.

  19. Validation of a Parcel-Based Reduced-Complexity Model for River Delta Formation (Invited)

    NASA Astrophysics Data System (ADS)

    Liang, M.; Geleynse, N.; Passalacqua, P.; Edmonds, D. A.; Kim, W.; Voller, V. R.; Paola, C.

    2013-12-01

    Reduced-Complexity Models (RCMs) take an intuitive yet quantitative approach to represent processes with the goal of getting maximum return in emergent system-scale behavior with minimum investment in computational complexity. This approach is in contrast to reductionist models that aim at rigorously solving the governing equations of fluid flow and sediment transport. RCMs have had encouraging successes in modeling a variety of geomorphic systems, such as braided rivers, alluvial fans, and river deltas. Despite the fact that these models are not intended to resolve detailed flow structures, questions remain on how to interpret and validate the output of RCMs beyond qualitative behavior-based descriptions. Here we present a validation of the newly developed RCM for river delta formation with channel dynamics (Liang, 2013). The model uses a parcel-based 'weighted-random-walk' method that resolves the formation of river deltas at the scale of channel dynamics (e.g., avulsions and bifurcations). The main focus of this validation work is the flow routing model component. A set of synthetic test cases were designed to compare hydrodynamic results from the RCM and Delft3D, including flow in a straight channel, around a bump, and flow partitioning at a single bifurcation. Output results, such as water surface slope and flow field, are also compared to field observations collected at Wax Lake Delta. Additionally, we investigate channel avulsion cycles and flow path selection in an alluvial fan with differential styles of subsidence and compare model results to laboratory experiments, as a preliminary effort in pairing up numerical and experimental models to understand channel organization at process scale. Strengths and weaknesses of the RCM are discussed and potential candidates for model application identified.

  20. Risk of Fragments in Ulnar Collateral Ligament Injuries Of Baseball Players

    PubMed Central

    Furushima, Kozo; Itoh, Yoshiyasu; Mitsui, Yasuhiro; Kusano, Hiroshi

    2016-01-01

    Objectives: Many baseball players with UCL injuries have avulsed persistent fragments by throwing disorder in the youth. The presence of fragments results in discontinuity of the medial elbow joint support structures; therefore, a ligament with fragments is considered more fragile than the normal ligament. This study compared three types (fragment, malunion, and normal) of throwing-related UCL injuries and prospectively examined the risk of surgical treatment. Methods: The total subjects were 439 baseball players (age 14-30 years; mean age, 17.5 years) diagnosed with UCL injuries at our hospital between November 2009 and June 2013. At the time of the initial examination, the medial epicondyle was assessed on plain frontal radiographs with the elbow flexed at 45°. Based on this assessment, subjects were divided into three groups: group with persistent fragments (fragment [F] group), group with complete union following avulsion fracture (malunion [M] group), and a group with no history of avulsion fracture (normal [N] group). Each patient’s ability to return to playing baseball was assessed after at least 3 months of systematic rehabilitation. Subjects who failed to comply with rehabilitation, played only recreationally, or with pain in sites other than the elbow were excluded. In this series, 220 cases were left for investigation. The Conway-Jobe scale was used as a standard to assess the return to playing after conservative therapy; subjects with excellent or good ratings were deemed able to return to playing baseball, whereas those with fair or poor ratings were deemed unable to return to playing baseball. The return rates were calculated for the F, M, and N groups respectively. The Magnetic resonance (MR) images consisted of three slices along the long axis of the anterior oblique ligament; these images were used to classify injuries as severe or mild, which were then compared with each other. SPSS 20.0 was used to perform the statistical analysis. Results: A

  1. Laws, Place, History and the Interpretation of Earth Surface Systems

    NASA Astrophysics Data System (ADS)

    Phillips, Jonathan

    2016-04-01

    The state of an Earth surface system (ESS is determined by three sets of factors: Laws, place, and history. Laws (L = L1, L2, . . . , Ln) are the n general principles, relationships, and representations applicable to any such system at any time. Place factors (P = P1, P2, . . . , Pm) are the m relevant properties or characteristics of the local or regional environment - e.g., climate, tectonic setting, geology, traits of the local biota, etc. History factors (H = H1 , H2, . . . , Hq) include the previous evolutionary pathway of the ESS, its stage of development, past disturbance, and in some contexts initial conditions. Geoscience investigation may be focused on laws (e.g., theoretical deductions, process modeling, laboratory experiments), place (e.g., regional geology or geography, soil-landscape studies), or history (e.g., paleoenvironmental studies, environmental history, historical geology or geography). Ultimately, however, all three sets of factors are necessary to fully understand and explain ESS. Beyond providing a useful checklist (analogous to the factorial models often used in pedology and ecology), the LPH framework gives us analytical traction to some difficult research problems. For example, studies of the avulsions of three southeast Texas rivers showed substantial differences in avulsion regimes and resulting alluvial morphology, despite the proximity and superficial similarity of the systems. Avulsion dynamics are governed by the same laws in all three cases [L(A) = L(B) = L(C)], and the three rivers, once part of a single system at lower sea-levels, have undergone the same sea-level, climate, and tectonic histories, as well as the same general types of anthropic impacts [H(A) ≈ H(B) ≈ H(C)]. Though the regional-scale environmental controls are similar, local details such as the location of the modern main channel relative to Pleistocene meander channels differ, and thus these place factors explain the differences between the rivers. The LPH

  2. Coastal morphodynamics and Chenier-Plain evolution in southwestern Louisiana, USA: A geomorphic model

    NASA Astrophysics Data System (ADS)

    McBride, Randolph A.; Taylor, Matthew J.; Byrnes, Mark R.

    2007-08-01

    ridge, and spit. To understand the long-term evolution of a coastal depositional system, primary process-response mechanisms and patterns found along the modern Chenier-Plain coast were first identified, especially tidal-inlet processes associated with the Sabine, Calcasieu, and Mermentau Rivers. Tidal prism ( Ω) and quantity of littoral transport ( Mtotal) are the most important factors controlling inlet stability. Greater discharge and/or tidal prism increase the ability of river and estuarine systems to interrupt longshore sediment transport, maintain and naturally stabilize tidal entrances, and promote updrift deposition. Thus, prior to human modification and stabilization efforts, the Mermentau River entrance would be classified as wave-dominated, Sabine Pass as tide-dominated, and Calcasieu Pass as tide-dominated to occasionally mixed. Hoyt [Hoyt, J.H., 1969. Chenier versus barrier, genetic and stratigraphic distinction. Am. Assoc. Petrol. Geol. Bull., 53: 299-306] presented the first detailed depositional model for chenier genesis and mudflat progradation, which he attributed to changes in Mississippi River flow direction (i.e., delta switching) caused by upstream channel avulsion. However, Hoyt's model oversimplifies Chenier-Plain evolution because it omits ridges created by other means. Thus, the geologic evolution of the Chenier Plain is more complicated than channel avulsions of the Mississippi River, and it involved not only chenier ridges (i.e., transgressive), but also ridges that are genetically tied to regression (beach ridges) and lateral accretion (recurved spits). A six-stage geomorphic process-response model was developed to describe Chenier-Plain evolution primarily as a function of: (i) the balance between sediment supply and energy dissipation associated with Mississippi River channel avulsions, (ii) local sediment reworking and lateral transport, (iii) tidal-entrance dynamics, and (iv) possibly higher-than-present stands of Holocene sea level

  3. Analysis of the 2006 block-and-ash flow deposits of Merapi Volcano, Java, Indonesia, using high-spatial resolution IKONOS images and complementary ground based observations

    NASA Astrophysics Data System (ADS)

    Thouret, Jean-Claude; Gupta, Avijit; Liew, Soo Chin; Lube, Gert; Cronin, Shane J.; Surono, Dr

    2010-05-01

    On 16 June 2006 an overpass of IKONOS coincided with the emplacement of an active block-and-ash flow fed by a lava dome collapse event at Merapi Volcano (Java, Indonesia). This was the first satellite image recorded for a moving pyroclastic flow. The very high-spatial resolution data displayed the extent and impact of the pyroclastic deposits emplaced during and prior to, the day of image acquisition. This allowed a number of features associated with high-hazard block-and-ash flows emplaced in narrow, deep gorges to be mapped, interpreted and understood. The block-and-ash flow and surge deposits recognized in the Ikonos images include: (1) several channel-confined flow lobes and tongues in the box-shaped valley; (2) thin ash-cloud surge deposit and knocked-down trees in constricted areas on both slopes of the gorge; (3) fan-like over bank deposits on the Gendol-Tlogo interfluves from which flows were re-routed in the Tlogo secondary valley; (4) massive over bank lobes on the right bank from which flows devastated the village of Kaliadem 0.5 km from the main channel, a small part of this flow being re-channeled in the Opak secondary valley. The high-resolution IKONOS images also helped us to identify geomorphic obstacles that enabled flows to ramp and spill out from the sinuous channel, a process called flow avulsion. Importantly, the avulsion redirected flows to unexpected areas away from the main channel. In the case of Merapi we see that the presence of valley fill by previous deposits, bends and man-made dams influence the otherwise valley-guided course of the flows. Sadly, Sabo dams (built to ameliorate the effect of high sediment load streams) can actually cause block-and-ash flows to jump out of their containing channel and advance into sensitive areas. Very-high-spatial resolution satellite images are very useful for mapping and interpreting the distribution of freshly erupted volcanic deposits. IKONOS-type images with 1-m resolution provide opportunities to

  4. Imaging beneath the skin of large tropical rivers: Clay controls on system morphodynamics revealed by novel CHIRP sub-surface sonar and deep coring along the Fly and Strickland Rivers, Papua New Guinea (Invited)

    NASA Astrophysics Data System (ADS)

    Aalto, R. E.; Grenfell, M.; Lauer, J. W.

    2010-12-01

    Tropical rivers dominate Earth’s fluvial fluxes for water, carbon, and mineral sediment. They are characterized by large channels and floodplains, old system histories (in comparison to many temperate rivers), frequent and prolonged periods of flooding, and a clay-dominated sediment flux transported above a sandy bed. However, limited insight is available regarding the underlying bed & floodplain strata -- material that underpins system mobility and morphodynamics. Available data commonly stems from “skin-deep” approaches such as GIS analysis of imagery, shallow sampling of a surface veneer, & topographic profiling during lower river stages. Given the large temporal & spatial scales of such systems, new approaches are needed to see below lag deposits on mobile sandy beds & deep into expansive floodbasins. Furthermore, such data are needed to test whether we can usefully interpret large tropical river morphology using direct analogies to observations from small temperate sytems. Systems responding to sea level rise, pending avulsions, or an increase/contrast in sediment load would provide especially valuable insight. We conducted a field campaign along the Fly and Strickland Rivers in Papua New Guinea (discharge ~ 5,400 CMS). Immediate results were obtained using a dual-frequency CHIRP sub-bottom profiler optimized for fluvial environments, with which we were able to image 10-20m below the river/lake bed. We were able to distinguish sandy deposits from harder clay and silt lenses and also collected bed grab samples to verify our sonar results. Deep borehole samples (5-15m), push cores, and cutbank profiles of material strength confirmed observations from the sonar profiling. We simultaneously collected side-scan sonar imagery plus DGPS water/bed elevations. Findings include: 1) The prevalence of hard clay beneath the bed at many locations along the Lower Fly and Strickland Rivers, retarding migration; 2) Unusual bed morphology along the lower Middle Fly River

  5. A Framework for the Ecogeomorphological Modelling of the Macquarie Marshes, Australia

    NASA Astrophysics Data System (ADS)

    Rodriguez, J. F.; Seoane Salazar, M.; Sandi Rojas, S.; Saco, P. M.; Riccardi, G.; Saintilan, N.; Wen, L.

    2014-12-01

    The Macquarie Marshes is a system of permanent and semi-permanent marshes, swamps and lagoons interconnected by braided channels. The Marshes are located in the semi-arid region in north western NSW, Australia, and constitute part of the northern Murray-Darling Basin. The wetland complex serves as nesting place and habitat for many species of water birds, fish, frogs and crustaceans, and portions of the Marshes was listed as internationally important under the Ramsar Convention. Over the last four decades, some of the wetlands have undergone degradation, which has been attributed to flow abstraction and regulation at Burrendong Dam upstream of the marshes. Among the many characteristics that make this wetland system unique is the occurrence of channel breakdown and channel avulsion, which are associated with decline of river flow in the downstream direction typical of dryland streams. Decrease in river flow can lead to sediment deposition, decrease in channel capacity, vegetative invasion of the channel, overbank flows, and ultimately result in channel breakdown and changes in marsh formation. A similar process on established marshes may also lead to channel avulsion and marsh abandonment. All the previous geomorphological evolution processes have an effect on the established ecosystem, which will produce feedbacks on the hydrodynamics of the system and affect the geomorphology in return. In order to simulate the complex dynamics of the marshes we have developed an ecogeomorphological framework that combines hydrodynamic, vegetation and channel evolution modules. The hydrodynamic simulation provides spatially distributed values of inundation extent, duration, depth and recurrence to drive a vegetation model based on species preference to hydraulic conditions. It also provides velocities and shear stresses to assess geomorphological changes. Regular updates of stream network, floodplain surface elevations and vegetation coverage provide feedbacks to the hydrodynamic

  6. Alluvial architecture of the Holocene Lower Mississippi Valley (U.S.A.) and a comparison with the Rhine Meuse delta (The Netherlands)

    NASA Astrophysics Data System (ADS)

    Gouw, Marc J. P.; Autin, Whitney J.

    2008-02-01

    The proportion and arrangement of channel-belt deposits in alluvial successions (alluvial architecture) is not known in detail for most modern settings. Therefore, the alluvial architecture of the Holocene Lower Mississippi Valley (LMV) between Greenville, Mississippi and Baton Rouge, Louisiana was studied to improve estimation of parameters relevant to alluvial-architecture modeling. Alluvial-architecture parameters (sand-body width/thickness ratio SBW/SBT, channel-belt deposit proportion CDP, overbank-deposit proportion ODP, and connectedness ratio CR) are estimated from three cross-valley sections based on lithologic borings. SBW/SBT and CDP decrease in a downstream direction. For example, CDP is ~ 0.6 upstream and ~ 0.3 downstream. ODP shows an opposite trend and is at a maximum (0.7) in the downstream part of the study area. CR is low throughout the study area because most channel belts in our cross sections are unconnected. The alluvial architecture in the LMV also seems to change over time, because Late Holocene channel belts tend to be wider than the Early Holocene channel belts. The observed trends in the alluvial-architecture parameters are related to the ratio between channel-belt width and floodplain width, variations in aggradation rate, location of the cross sections relative to avulsion sites, and differential subsidence. The alluvial architecture of the LMV is compared to that of the Holocene Rhine-Meuse delta to identify common controls on alluvial architecture. Despite differences in geographic setting, the alluvial architecture of the LMV is similar to that of the Rhine-Meuse delta. We conclude that alluvial architecture of both fluvial systems is strongly controlled by channel-belt geometry, floodplain geometry, and aggradation rate. These in turn are influenced by extrinsic factors (i.e. base level, discharge, sediment supply, tectonics, and pre-existing topography) as well as intrinsic factors (i.e. lateral channel migration rate, subsoil

  7. Assessment of landscape change associated with tropical cyclone phenomena in Baja California Sur, Mexico, using satellite remote sensing

    NASA Astrophysics Data System (ADS)

    Martinez-Gutierrez, Genaro

    Baja California Sur (Mexico), as well as mainland Mexico, is affected by tropical cyclone storms, which originate in the eastern north Pacific. Historical records show that Baja has been damaged by intense summer storms. An arid to semiarid climate characterizes the study area, where precipitation mainly occurs during the summer and winter seasons. Natural and anthropogenic changes have impacted the landscape of southern Baja. The present research documents the effects of tropical storms over the southern region of Baja California for a period of approximately twenty-six years. The goal of the research is to demonstrate how remote sensing can be used to detect the important effects of tropical storms including: (a) evaluation of change detection algorithms, and (b) delineating changes to the landscape including coastal modification, fluvial erosion and deposition, vegetation change, river avulsion using change detection algorithms. Digital image processing methods with temporal Landsat satellite remotely sensed data from the North America Landscape Characterization archive (NALC), Thematic Mapper (TM), and Enhanced Thematic Mapper (ETM) images were used to document the landscape change. Two image processing methods were tested including Image differencing (ID), and Principal Component Analysis (PCA). Landscape changes identified with the NALC archive and TM images showed that the major changes included a rapid change of land use in the towns of San Jose del Cabo and Cabo San Lucas between 1973 and 1986. The features detected using the algorithms included flood deposits within the channels of active streams, erosion banks, and new channels caused by channel avulsion. Despite the 19 year period covered by the NALC data and approximately 10 year intervals between acquisition dates, there were changed features that could be identified in the images. The TM images showed that flooding from Hurricane Isis (1998) produced new large deposits within the stream channels

  8. Insights into the October-November 2010 Gunung Merapi eruption (Central Java, Indonesia) from the stratigraphy, volume and characteristics of its pyroclastic deposits

    NASA Astrophysics Data System (ADS)

    Cronin, Shane J.; Lube, Gert; Dayudi, Devi S.; Sumarti, Sri; Subrandiyo, S.; Surono

    2013-07-01

    The 2010 eruption of Merapi was the second most deadly in the historic record of this volcano, claiming over 380 lives. By relating the observations of this eruption with detailed examination of deposit distribution, stratigraphy and sedimentology, a reconstruction of the properties of the pyroclastic density currents (PDCs) is presented, including the valley controlled block-and-ash flows (BAFs) and widespread, energetic pyroclastic surges. The distribution, volume and mobility characteristics of all types of PDC during the eruption sequence show evidence for levels of intensity unseen since the large-scale 1872 and 1930 eruption phases, especially during the climactic events of October 26 and November 5. Many tephra falls interbedded with PDC units show that most dome-collapse events occurred along with and between explosive vulcanian eruptions. The 2010 eruption produced very long-runout BAFs, reaching 16.1 km in the Kali Gendol on November 5. This runout could be explained by its large-volume (20 million m3), around 10 times that of previous Merapi BAFs during the last 130 years. Major avulsion of these dense BAFs to form overbank deposits became more common through the eruptive sequence as the valley was progressively filled with successive PDC deposits. Spreading avulsed BAFs were a particular hazard downstream of ~ 10 km where the landscape is less dissected. Less clear, however, is why pyroclastic surges extended up to 10 km from the vent on November 5 and > 6.4 km on October 26. These expanded much farther from BAF margins (~ 2 km) than ever seen before at Merapi. In one location they were decoupled from valley-centered BAFs with high momentum, traveling initially laterally across steep valley systems, before draining downslope. At this site, on the western side of the upper Gendol at around 3 km from source, surge decoupling was apparently exacerbated by upstream collision and deflection of high-flux, hot and gas-rich BAFs against the cliffs of Gunung

  9. Constraints on Environmental Conditions on Mars during Periods of Alluvial Fan Formation: Results from Landform Evolution Modeling

    NASA Astrophysics Data System (ADS)

    Morgan, A. M.; Howard, A. D.; Moore, J. M.

    2015-12-01

    As depositional systems forming within enclosed crater basins, the Late Noachian and Hesperian -aged [1] alluvial fans on Mars (including the Peace Vallis fan in Gale crater) may be representative of the last vestiges of widespread fluvial activity on the planet's surface, an era during which the climate transitioned from a wetter early Mars to the cold and dry planet we observe today. We have constructed a landform evolution model that combines sediment transport with channel avulsion to study the evolution of a fan-forming channel network over timescales of decades to hundreds of thousands of years. We aim to address two related questions: (1) what were the characteristics of water discharge (flow magnitude and duration); and (2) what are the associated implications for the responsible climatic environment (e.g. amount and frequency of precipitation sourcing the fans). The model uses a cellular network with a grid spacing set equal to the channel width. Two end-members of sediment are transported through the channel network: gravel bedload and fine grained material that is deposited overbank as a function of distance and elevation difference from an active channel. Overbank deposition creates channel levees, which must be overtopped for the channel to undergo an avulsion. By recording the relative amounts of bedload and overbank deposition, the 3-D stratigraphy is recorded as the fan is constructed. Using measures such as channel width, relative proportions of channel versus overbank deposited sediment, and frequency of channel branching, output is statistically compared with digital elevation models that we been produced from high-resolution CTX and HiRISE stereo pairs. Our modeling suggests that the fans formed from many flow events over many thousands of years, in agreement with estimations based on geomorphological observations by [2]. We are continuing to refine the model to test for varying patterns of precipitation, duricrusts, and limits on sediment

  10. The Late Miocene paleogeography of the Amazon Basin and the evolution of the Amazon River system

    NASA Astrophysics Data System (ADS)

    Latrubesse, Edgardo M.; Cozzuol, Mario; da Silva-Caminha, Silane A. F.; Rigsby, Catherine A.; Absy, Maria Lucia; Jaramillo, Carlos

    2010-05-01

    On the basis of paleontological content (vertebrates and palynology) and facies analysis from river banks, road cuts, and three wells, we have assigned the uppermost levels of the Solimões Formation in western Amazonia, Brazil, to the Late Miocene. The vertebrate fossil record from outcropping sediments is assigned to the Huayquerian-Mesopotamian mammalian biozones, spanning 9-6.5 Ma. Additionally, we present results that demonstrate that deposits in Peruvian Amazonia attributed to Miocene tidal environments are actually fluvial sediments that have been misinterpreted (both environmentally and chronologically) by several authors. The entire Late Miocene sequence was deposited in a continental environment within a subsiding basin. The facies analysis, fossil fauna content, and palynological record indicate that the environment of deposition was dominated by avulsive rivers associated with megafan systems, and avulsive rivers in flood basins (swamps, lakes, internal deltas, and splays). Soils developed on the flatter, drier areas, which were dominated by grasslands and gallery forest in a tropical to subtropical climate. These Late Miocene sediments were deposited from westward of the Purus arch up to the border of Brazil with Peru (Divisor Ranges) and Bolivia (Pando block). Eastward of the Iquitos structural high, however, more detailed studies, including vertebrate paleontology, need to be performed to calibrate with more precision the ages of the uppermost levels of the Solimões Formation. The evolution of the basin during the late Miocene is mainly related to the tectonic behavior of the Central Andes (˜ 3°-15°S). At approximately 5 Ma, a segment of low angle of subduction was well developed in the Nazca Plate, and the deformation in the Subandean foreland produced the inland reactivation of the Divisor/Contamana Ranges and tectonic arrangements in the Eastern Andes. During the Pliocene southwestern Brazilian Amazonia ceased to be an effective sedimentary

  11. Dorsal Wrist Capsular Tears in Association with Scapholunate Instability: Results of an Arthroscopic Dorsal Capsuloplasty

    PubMed Central

    Binder, Adeline Cambon; Kerfant, Nathalie; Wahegaonkar, Abhijeet L.; Tandara, Andrea A.; Mathoulin, Christophe L.

    2013-01-01

    Purpose The purpose of this study is to report the association of dorsal wrist capsular avulsion with scapholunate ligament instability and to evaluate the results of an arthroscopy-assisted repair. Methods We retrospectively reviewed 10 patients with a mean age of 39.1 years suffering from chronic dorsal wrist pain. They underwent a wrist arthroscopy with an evaluation of the scapholunate ligament complex from the radiocarpal and midcarpal compartments. An avulsion of the dorsal intercarpal ligament (DICL) from the scapholunate interosseous ligament (SLIL) was visible from the radiocarpal compartment in all cases, while the SLIL was intact. The DICL tear was repaired with an arthroscopy-assisted dorsal capsuloplasty. Patients were assessed preoperatively and postoperatively by the QuickDASH (Disabilities of the Arm, Shoulder, and Hand) questionnaire, by the Visual Analog Scale (VAS) for pain, and by a clinical and radiological examination. Results Preoperatively, all patients had reduced flexion and radial deviation of the affected wrist. On the lateral radiograph, 5 of the 10 patients showed an increase of the scapholunate angle (60 to 85°). The scapholunate instability was graded as Messina–European Wrist Arthroscopy Society (EWAS) II in five cases and as grade IIIB in five cases. A tear of the ulnar part of the triangular fibrocartilage complex (TFCC) was found in seven cases. At a mean followup of 16 months, the wrist range of motion (ROM), the grip strength, the QuickDASH, and the VAS of pain improved significatively. The scapholunate angle was normalized in all cases. Discussion Isolated tears of the DICL at its insertion from the dorsal part of the SLIL can be associated with scapholunate instability in the absence of an injury to the SLIL. The diagnosis is made arthroscopically. The arthroscopic dorsal capsuloplasty is a minimally invasive technique that provides short-term satisfactory results. Further studies are needed to determine whether

  12. Fluvial response to sudden input of pyroclastic sediments during the 2008-2009 eruption of the Chaitén Volcano (Chile): The role of logjams

    NASA Astrophysics Data System (ADS)

    Umazano, Aldo M.; Melchor, Ricardo N.; Bedatou, Emilio; Bellosi, Eduardo S.; Krause, Javier M.

    2014-10-01

    The rhyolitic Plinian eruption of the Chilean Chaitén Volcano, initiated on May 2, 2008, suddenly introduced abundant pyroclastic sediments in the Blanco River catchment area, which experienced important modifications. Before May 2, the river was characterised by gravelly and moderate to low-sinuosity channels crossing a vegetated and locally urbanised (Chaitén City) floodplain. This river, limited by steep and densely forested highlands, was connected with the Pacific Ocean via a tidally-influenced delta plain. After heavy rains in May 11-20, the river discharge increased and triggered several responses including logjam formation and breakage, crevassing, avulsion (and channel abandonment), changes in the pattern and dimensions of channels, and construction of a new delta plain area. In this context, the goals of this contribution were: i) to document the sedimentological processes within a detailed geomorphic framework and ii) to understand the influence of logjams on fluvial dynamics. Upstream of the logjam zone, the deposits are mostly composed of ash and lapilli with abundant palaeovolcanic (epiclastic) sediments, which were produced by dilute currents and debris flows. Downstream of the logjam zone, deposits are composed by ash and lapilli, both pumice-rich and lacking important participation of older (epiclastic) sediments. The abandoned and filled palaeochannel, and the proximal part of crevasse splays experienced transient dilute flows with variable sediment concentration and, subordinately, hyperconcentrated flows. The distal sectors of crevasse splays mostly record settling from suspension. At the delta plain, tephra transported by the Blanco River was mixed with older sediments by tide and wave action (dilute flows). We conclude that immediately after eruption, both geomorphic and sedimentary processes of the river were mainly controlled by a combination of high availability of incoherent pyroclastic sediments on steep slopes, abundant rains, large

  13. Fluvial system response to late Pleistocene-Holocene sea-level change on Santa Rosa Island, Channel Islands National Park, California

    NASA Astrophysics Data System (ADS)

    Schumann, R. Randall; Pigati, Jeffrey S.; McGeehin, John P.

    2016-09-01

    Santa Rosa Island (SRI) is one of four east-west aligned islands forming the northern Channel Islands chain, and one of the five islands in Channel Islands National Park, California, USA. The island setting provides an unparalleled environment in which to record the response of fluvial systems to major changes of sea level. Many of the larger streams on the island occupy broad valleys that have been filled with alluvium and later incised to form steep- to vertical-walled arroyos, leaving a relict floodplain as much as 12-14 m above the present channel. The period of falling sea level between the end of the last interglacial highstand at ~ 80 ka and the last glacial lowstand at ~ 21 ka was marked by erosion and incision in the uplands and by deposition of alluvial sediment on the exposed marine shelf. Sea level rose relatively rapidly following the last glacial lowstand of - 106 m, triggering a shift from an erosional to a depositional sedimentary regime. Accumulation of sediment occurred first through vertical and lateral accretion in broad, shallow channels on the shelf. Channel avulsion and delta sedimentation produced widespread deposition, creating lobes or wedges of sediment distributed across relatively large areas of the shelf during the latest Pleistocene. Backfilling of valleys onshore (landward of present sea level) appears to have progressed in a more orderly and predictable fashion throughout the Holocene primarily because the streams were confined to their valleys. Vertical aggradation locally reduced stream gradients, causing frequent overbank flooding and lateral channel shift by meandering and/or avulsion. Local channel gradient and morphology, short-term climate variations, and intrinsic controls also affected the timing and magnitudes of these cut, fill, and flood events, and are reflected in the thickness and spacing of the episodic alluvial sequences. Floodplain aggradation within the valleys continued until at least 500 years ago, followed by

  14. Preliminary analysis of the Baranof Fan system, Gulf of Alaska, based on 2D seismic reflection and multibeam bathymetry data

    NASA Astrophysics Data System (ADS)

    LeVoir, M. A.; Gulick, S. P.; Reece, R.; Barth, G. A.; Childs, J. R.; Everson, E. D.; Hart, P. E.; Johnson, K. M.; Lester, W. R.; Sliter, R. W.

    2011-12-01

    The Baranof Fan is a large marine sedimentary system in the eastern Gulf of Alaska, straddling the border between the U.S. and Canada. The volume of the Fan is estimated to be > 200,000 km3. Little is known about the depositional timing, the tectonic and morphologic processes influencing its development, or the role of channel aggradation and avulsion in its progression. Both tectonic and climatic transitions likely influenced the formation and evolution of the Fan, with events including the onset of northern hemisphere glaciation, the Mid-Pleistocene transition, the transport of the Yakutat Terrane along the southeast Alaskan margin, and the uplift of the Coast Mountains. 2D seismic reflection and multibeam bathymetry data were collected in the Gulf of Alaska in June 2011 aboard the R/V Marcus G. Langseth as a part of the U.S. Extended Continental Shelf (ECS) program assessing potential opportunities under the United Nations Law of the Sea Convention. The purpose of the 2011 survey was to determine sediment thickness, velocity structure, stratigraphic architecture, and crustal structure on of the Gulf of Alaska seafloor in support of U.S. continental shelf maritime zone definition. The surveyed geologic features include the Surveyor and Baranof sedimentary systems, which control active sediment distribution in the Gulf of Alaska. Preliminary analysis of these data show four distinct buried channels throughout the mid to distal Baranof Fan, ranging in width from 5 - 9 km, which may have evolved into modern surface channels (ranging in width from 2 - 7 km) visible in both the seismic data and multibeam bathymetry. The location and trajectory of these buried channels, however, appears distinct from the modern Horizon and Mukluk Channels; the buried channels may have avulsed into the modern channel systems, or could possibly be older and now abandoned branches instrumental in building the westward part of the Fan. All of the imaged channels appear to be depositional

  15. Treatment of tibial eminence fractures with arthroscopic suture fixation technique: a retrospective study

    PubMed Central

    Yuan, Yanhao; Huang, Xiaohan; Zhang, Yanjie; Wang, Zhanchao

    2015-01-01

    Aims: The present study aims to investigate the clinical outcomes of arthroscopic suture fixation in treating tibial eminence fracture with a retrospective study design of two years’ follow-up. Methods: A total of 33 patients with imaging evidence of tibial eminence avulsion fractures who underwent arthroscopic surgery between 2008 and 2012 were included in this study. The inclusion criteria for the study were a displaced tibial eminence avulsion fracture and anterior knee instability of grade II or higher inskeletally mature patients. These patients were treated with arthroscopic suture fixation and followed with a mean period of 24 months. Anteroposterior and lateral radiographs were obtained 3 months postoperatively to assess fracture healing. At 24 months after surgery, all patients were evaluated by an independent orthopaedic professor with clinical examination like anteroposterior laxity (Lachman-Noulis and anterior drawer tests) and Rolimeter knee tester (Aircast, Vista, CA). Knee range of motion was evaluated actively and passively with a goniometer. Knee function was evaluated by the Lysholm and International Knee Documentation Committee (IKDC) scores. Knee radiographs in standing anteroposterior, standing lateral, and Merchant views were examined for alignment, joint space narrowing, and degenerative knee changes. Results: No major complication like infection, deep venous thrombosis, or neurovascular deficit happened peri-operatively. At the final follow-up, there were no symptoms of instability and no clinical signs of ACL deficiency. Radiographs showed that all fractures healed 3 months post-operative, but at the last follow-up, there was one person with degenerative changes like joint space narrowing in radiographs. Anterior translation of the tibia was 0.47 mm on average (0 to 2.5 mm) compared with the uninjured side. Range-of-motion measurement showed a mean extension deficit of 1.5° (0° to 5°) and a mean flexion deficit of 2.7° (0° to 10

  16. Changes in alluvial architecture associated with Eocene hyperthermals: Preliminary results from the Bighorn Basin Coring Project

    NASA Astrophysics Data System (ADS)

    Acks, R.; Kraus, M. J.

    2012-12-01

    The Paleocene-Eocene Thermal Maximum (PETM) was followed by two lesser hyperthermal events: ETM2 and H2 both at ~53.7 Ma. The carbon isotope excursion for ETM2 was approximately half that of the PETM and the H2 excursion even smaller, indicating lower increases in temperature than during the PETM. The paleohydrologic responses to these events are less well understood than the response to PETM warming. Although the ETM2 and H2 events are better known from marine than continental strata, both events have been identified from outcrops of the alluvial Willwood Formation from the Deer Creek and Gilmore Hill areas of the Bighorn Basin, Wyoming (Abels et al., 2012). Here, we analyze two cores drilled from stratigraphically equivalent Willwood strata from Gilmore Hill. The cores provide an opportunity to examine the impact of these events on the architecture of fluvial strata. Willwood strata are composed largely of channel sandstones, heterolithic deposits generated by channel avulsion, and paleosols that formed on overbank deposits. The paleosols provide qualitative and quantitative information on changes in soil moisture and precipitation through this interval. The cores also show a distinct change in the stacking of paleosols The core is subdivided into three parts: (1) the lowest ~third has thinner, more densely spaced paleosols, (2) the middle has thicker paleosols that are more widely spaced, and (3) the upper third has thicker and more common channel sandstones interspersed with avulsion deposits and fewer red paleosols; this corresponds to the hyperthermal interval. In particular, a ~20 m thick sandstone complex caps the section and appears to truncate part of the hyperthermal interval. Although vertical variations in alluvial architecture can reflect tectonic or climatic change, the correspondence of the sandstone-rich part of the cores with the hyperthermals suggests climate was the major control on their formation. Thick purple paleosols associated with the

  17. Expression of proliferating cell nuclear antigen in pulp cells of extracted immature teeth preserved in two different storage media.

    PubMed

    Tekin, Uğur; Filippi, Andreas; Pohl, Yango; Kirschner, Horst

    2008-02-01

    A specially composed medium for storing avulsed teeth has been developed. In experimental and clinical studies it could be shown that PDL cells could be kept viable during storage in the medium for up to 53 h. In the present study the medium was tested on pulp cells. A total of 40 immature unerupted third molars with open apices were removed surgically and the teeth were stored in a special cell culture medium (SCCM) or in Hank's balanced salt solution (HBSS) at room temperature for 6, 12, 18 or 24 h. Five teeth were assigned to each group. A total of seven consecutive pulp cross-sections per tooth were examined, resulting in a total of 280 specimens. Viable cells were marked using proliferating cell nuclear antigen (PCNA). The pulp was divided in three regions: apical region (0-0.5 mm), middle region (>0.5-1.5 mm) and coronal region (>1.5 mm). The labelling index (LI) was calculated for the whole cut (regions 1, 2 and 3) and for each region separately. The statistical evaluation was made using the One-way anova and Mann-Whitney Test. Pulp cells of all teeth expressed PCNA. About 110 of 140 specimens in the SCCM and 101 of 140 specimens in the HBSS group showed PCNA-positive cells. The highest LI was observed within the apical region and decreased with increased distance from the medium. No marked cells were observed at a distance of more than 1.5 mm. The LI for both media showed a significant increase with storage intervals (P < 0.05). The pulp cells of teeth stored in SCCM showed a LI nearly twice as high compared to pulp cells of teeth stored in HBSS for the apical and middle region (time interval 6, 18 and 24 h: P < 0.05). The LI for the apical region was found to be 8.43% for the SCCM and 4.50% for the HBSS after 24 h. For the middle region the LI was found to be 2.02% for the SCCM and 0.81% for the HBSS after 24 h. Within the parameters of this study, it appears that the SCCM is able to maintain pulp cell viability better than HBSS. The use of special cell

  18. Resistivity imaging of strata and faults in Bangladesh

    NASA Astrophysics Data System (ADS)

    Hosain, A.; Steckler, M. S.; Akhter, S. H.

    2015-12-01

    The Ganges-Brahmaputra-Meghna Delta, the largest in the world, is subject to deformation by active tectonics and dynamic river systems. It lies near the juncture of the Indian, Eurasian and Burmese plates and is being overthrust by both the Shillong Massif and the Indo-Burman Ranges. There are multiple major and minor active faults in Bangladesh, many of which are buried by the sedimentation. For example, the Madhupur tract is a Pleistocene upland in the middle part of Bengal Basin. Whether it is a passive interfluve of the river system or a tilted and tectonically uplifted block has been debated for decades. The Tippera Surface, in Comilla at the eastern part of the basin, is composed of uplifted and oxidized Holocene strata and overlies buried anticlines of the Indo-Burman fold belt. Furthermore, the rivers are subject to migrations, avulsions and other changes in course. The last major avulsion of the Brahmaputra River was only ~200 years ago. During the sea level fall in the last glaciation the major rivers created large incised valleys. In much of the exposed uplands there was the development of a weathered clay surface. This now forms a clay layer separating the Pleistocene and Holocene strata in large parts of Bangladesh. We use electrical resistivity surveying and hand-drilled borehole lithological data to better understand the subsurface discontinuities and structures. The resistivity system consists of an 84 electrode array powered by 2 car batteries and is capable of imaging lithologies to ~100m depth, similar to the depths of the boreholes used to calibrate the data. We extend our previous work on the western margin of the Madhupur Tract with additional lines on the eastern flank of Madhupur. Resistivity lines along the exposed Lalmai anticline in Comilla image the now tilted Holocene-Pleistocene clay layer. Additional lines along the subsurface continuation of the anticline provide additional information on the subsurface lithologies associated with

  19. New observations of sinuous channels on the Amazon Fan

    NASA Astrophysics Data System (ADS)

    Flood, R. D.

    2014-12-01

    High-sinuosity submarine fan channels on the Amazon Fan were first observed using long-range (GLORIA) side-scan sonar in 1982 and mapped in greater detail using multibeam sonar in 1984. These data have provided important insights into the nature and evolution of submarine channel systems. Subsequent studies on the Amazon Fan have focused on avulsion patterns, sedimentation patterns, fan growth and the climate record contained in fan sediments, and there has been relatively little additional work on the details of sinuous channel morphology. Channels on the Amazon Fan have been imaged by multibeam sonar on several occasions since 1984 during focused studies, regional mapping and ship transit. These multibeam data are being compiled and studied to better characterize these iconic channels. One observation of particular interest is that, on the Amazon Fan, channel-wall slumps appear to be more common than previously thought. Drilling of a cut-off meander during ODP Leg 155 on the Amazon Fan showed the presence of slumped material deeper in the channel suggesting that failure of the channel wall was in part responsible for the abandonment and filling of that meander loop. The failure also apparently created a sandy debris flow with clasts of fine-grained levee material transported in a sandy matrix. This sandy debris flow may have been able to flow along the channel and deposit at the seaward end where similar sediments can be found. Disturbed zones now visible on the inner walls of channels at several other places along the channels suggest that these kinds of inner-wall slumps may play important roles in channel evolution and fan growth. Channel-blocking slumps can isolate channel loops which can then fill with sandy sediments, and avulsions are likely if this kind of slump fills the channel. The failure of channel walls can also lead to new channel segments that tend to straighten the channel. Dramatic changes to the shape of the channel can likely lead to large and

  20. Flood Deposition Patterns and Channel Migration due to a 10-year flood event: the case of the Indus River flood 2010

    NASA Astrophysics Data System (ADS)

    Kettner, A. J.; Syvitski, J. P.; Overeem, I.; Brakenridge, G. R.

    2013-12-01

    Fluvial geomorphological processes evolve the landscape and are often referred to as processes that act for hundred to thousands of years before making a noticeable change in landforms. For the Indus River, landscape evolution has been intensified due to human interference. Failure in repairing its levees from previous floods led in July 2010 during a not exceptional discharge event (~10 year recurrence interval) to a large avulsion and flooding disaster that caused ~2,000 fatalities. Examining pre- and post flood maps by analyzing MODIS and ASTER-A1 data allowed us to determine the extent of sandy flood deposits and to quantify channel migration patterns. The typical pattern of inner bend deposition (due to helical flow) and outer bend erosion were less pronounced. We hypothesize that when flow exceeds bankfull conditions, deposition is more uniform and no longer constrained by the streambed geometry. We observe that the inner and the outer river bend receive similar amounts of sandy deposits (43% versus 57% respectively). Crevasse splaying was widespread and appeared to occur as a flow stripping process again both upon the point bars as well as in river outer bends. Channel activity (defined as the areal shift of the pre- and post river centerline), sinuosity, slope and lateral sediment deposition were determined for 50km river stretches. Analyzes reveal that flood deposits extend generally less than 2 km from the main channel axis. Furthermore, channel activity correlates negatively with channel sinuosity and lateral distance of sediment deposition and positively with slope. The river channel migrated over 100's of meters during the July 2010 flood event. Lateral migration averaged ~340m along a 1000km stretch of the Indus River over a period of just 52 days. Although this discharge event was not exceptional, lateral migration was significant and deposition impacts the active river floodplain. Remarkably, most sediments are deposited downstream the large

  1. Below Knee Impact Responses using Cadaveric Specimens.

    PubMed

    Balasubramanian, Sriram; Beillas, Philippe; Belwadi, Aditya; Hardy, Warren N; Yang, King H; King, Albert I; Masuda, Mitsutoshi

    2004-11-01

    Knee injuries represent about 10% of all injuries suffered during car crashes. Efforts to assess the injury risk to the posterior cruciate ligament (PCL) have been based on a study available in the literature (Viano et al., 1978), in which only two of the five knees tested had PCL ruptures. The aims of the current study were to repeat the study with a higher number of samples, study the effects of other soft tissues on knee response, and assess the adequacy of the experimental setup for the identification of a PCL tolerance. A total of 14 knees were tested using a high-speed materials testing machine. Eight were intact knees (with the patella and all the muscular and ligamentous structures), three were PCL-only knees (patella and all the muscular and ligamentous structures other than the PCL removed), and the last three were PCL-only knees with the tibia protected from bending fracture. Of the eight intact knees tested, only one had PCL mid substance rupture, one had a partial articular fracture of the tibia below the plateau, and six had simple transverse fracture of the tibial metaphysis. Of the three PCL-only knees without tibial protection, one had PCL mid substance rupture, one had avulsion at the posterior intercondylar attachment point, and the last one had a simple oblique fracture of the tibial metaphysis. Of the three PCL only knees with tibia protection, two had PCL mid-substance ruptures and the third one had an avulsion at the tibial insertion site with partial articular fracture of the lateral plateau. Overall, the results of the current study were similar to those observed by Viano et al. (1978). The average displacement at failure for all PCL related injuries was 17.2+/-2.8 mm for the current study (n=6) and 16.2+/-3.9 mm for Viano et al. (1978) (n=4). This value is higher than the Injury Assessment Reference Value of 15 mm proposed by Mertz (1984) and used in various regulations. Both studies suggest that the existence of the soft tissues other

  2. Prevalence and patterns of combat sport related maxillofacial injuries

    PubMed Central

    Shirani, Gholamreza; Kalantar Motamedi, Mohammad Hosein; Ashuri, Alireza; Eshkevari, Pooyan Sadr

    2010-01-01

    Aim: This study was designed to assess the prevalence, distribution, and patterns of injury among athletes engaged in combat sports and compare the prevalence, pattern, and types of oral and maxillofacial trauma in these athletes. Materials and Methods: A total of 120 male athletes engaged in four combat sports (boxing, taekwondo, kickboxing, and Muay Thai) who had sustained bodily trauma were studied; 95 subjects with at least one traumatic injury to the face requiring treatment were referred to us by the physician team. The type of injury (facial laceration, facial fractures, jaw dislocation, etc.), site of facial injury (jaw, nose, malar bone, teeth, etc.), dental injuries (tooth fracture, displacement, luxation, and avulsion), causative sport (boxing, taekwondo, kickboxing, and Muay Thai) as well as demographic data were recorded. Injuries were examined clinically and radiographically, and treated accordingly by a specialist. Treatment data and demographics were recorded for each subject. Recorded data were assessed, and χ2, ANOVA, and Kruskal–Wallis tests were used to statistically analyze and compare the data. Results: Of 120 subjects, 95 male subjects (79.2%), aged 18–25 years (avg. 20 years), had at least one traumatic injury to the face requiring medical treatment. These injuries included facial laceration, bone fractures (nose, mandible, and zygoma), dental injuries (displacement, luxation, fracture, and avulsion), and mandibular dislocation which were recorded in 83 (69.2%), 55 (45.1%), 53 (44.2%), and 8 (6.7%) cases respectively. Statistically significant differences were encountered among various injuries and the sports; kickboxing caused the most maxillofacial injuries and was identified as more injurious. Tooth fractures (59.7%) were the most common dental injuries, and the nose (84.7%) was the most frequently fractured facial bone. Lacerations were more common in Thai-boxers (93.3%). Injuries were significantly greater in professional rather

  3. The raft of the Saint-Jean River, Gaspé (Québec, Canada): A dynamic feature trapping most of the wood transported from the catchment

    NASA Astrophysics Data System (ADS)

    Boivin, Maxime; Buffin-Bélanger, Thomas; Piégay, Hervé

    2015-02-01

    The rivers of the Gaspé Peninsula, Québec (Canada), a coastal drainage system of the St. Lawrence River, receive and transport vast quantities of large wood. The rapid rate of channel shifting caused by high-energy flows and noncohesive banks allows wood recruitment that in turn greatly influences river dynamics. The delta of the Saint-Jean River has accumulated wood since 1960, leading to frequent avulsions over that time period. The wood raft there is now more than 3-km in length, which is unusual but natural. This jam configuration allows a unique opportunity to estimate a wood budget at the scale of a long river corridor and to better understand the dynamics of large wood (LW) in rivers. A wood budget includes the evaluation of wood volumes (i) produced by bank erosion (input), (ii) still in transit in the river corridor (deposited on sand bars or channel edges), and (iii) accumulated in the delta (output). The budget is based on an analysis of aerial photos dating back to 1963 as well as surveys carried out in 2010, all of which were used to locate and describe large wood accumulations along a 60-km river section. The main results of this paper show that the raft formation in the delta is dynamic and can be massive, but it is a natural process. Considering the estimated wood volume trapped in the delta from 1963 to 2013 (≈ 25,000 m3), two important points are revealed by the quantification of the wood recruitment volume from 1963 to 2004 (≈ 27,000 m3 ± 400 m3) and of the wood volume stored on the bars in 2010 (≈ 5950 m3). First, the recruitment of large wood from lateral migration for the 40-year period can account for the volume of large wood in the delta and in transit. Second, the excess wood volume produced by lateral migration and avulsion represents a minimum estimation of the large wood trapped on the floodplain owing to wood volume that has decomposed and large wood that exited the river system. Rafts are major trapping structures that provide

  4. Sediment Dynamics Affecting the Threatened Santa Ana Sucker in the Highly-modified Santa Ana River and Inset Channel, Southern California, USA

    NASA Astrophysics Data System (ADS)

    Minear, J. T.; Wright, S. A.

    2015-12-01

    In this study, we investigate the sediment dynamics of the low-flow channel of the Santa Ana River that is formed by wastewater discharges and contains some of the last remaining habitat of the Santa Ana Sucker (Catostomus santaanae). The Santa Ana River is a highly-modified river draining the San Bernardino Mountains and Inland Empire metropolitan area east of Los Angeles. Home to over 4 million people, the watershed provides habitat for the federally-threatened Santa Ana Sucker, which presently reside within the mainstem Santa Ana River in a reach supported by year-round constant discharges from water treatment plants. The nearly constant low-flow wastewater discharges and infrequent runoff events create a small, approximately 8 m wide, inset channel within the approximately 300 m wide mainstem channel that is typically dry except for large flood flows. The sediment dynamics within the inset channel are characterized by constantly evolving bed substrate and sediment transport rates, and occasional channel avulsions. The sediment dynamics have large influence on the Sucker, which rely on coarse-substrate (gravel and cobble) for their food production. In WY 2013 through the present, we investigated the sediment dynamics of the inset channel using repeat bathymetric and substrate surveys, bedload sampling, and discharge measurements. We found two distinct phases of the inset channel behavior: 1. 'Reset' flows, where sediment-laden mainstem discharges from upstream runoff events result in sand deposition in the inset channel or avulse the inset channel onto previously dry riverbed; and 2. 'Winnowing' flows, whereby the sand within the inset channel is removed by clear-water low flows from the wastewater treatment plant discharges. Thus, in contrast to many regulated rivers where high flows are required to flush fine sediments from the bed (for example, downstream from dams), in the Santa Ana River the low flows from wastewater treatment plants serve as the flushing

  5. Holocene evolution of the western Orinoco Delta, Venezuela

    USGS Publications Warehouse

    Aslan, A.; White, W.A.; Warne, A.G.; Guevara, E.H.

    2003-01-01

    The pristine nature of the Orinoco Delta of eastern Venezuela provides unique opportunities to study the geologic processes and environments of a major tropical delta. Remote-sensing images, shallow cores, and radiocarbon-dating of organic remains form the basis for describing deltaic environments and interpreting the Holocene history of the delta. The Orinoco Delta can be subdivided into two major sectors. The southeast sector is dominated by the Rio Grande-the principal distributary-and complex networks of anastomosing fluvial and tidal channels. The abundance of siliciclastic deposits suggests that fluvial processes such as over-bank flooding strongly influence this part of the delta. In contrast, the northwest sector is represented by few major distributaries, and overbank sedimentation is less widespread relative to the southeast sector. Peat is abundant and occurs in herbaceous and forested swamps that are individually up to 200 km2 in area. Northwest-directed littoral currents transport large volumes of suspended sediment and produce prominent mudcapes along the northwest coast. Mapping of surface sediments, vegetation, and major landforms identified four principal geomorphic systems within the western delta plain: (1) distributary channels, (2) interdistributary flood basins, (3) fluvial-marine transitional environments, and (4) marine-influenced coastal environments. Coring and radiocarbon dating of deltaic deposits show that the northern delta shoreline has prograded 20-30 km during the late Holocene sea-level highstand. Progradation has been accomplished by a combination of distributary avulsion and mudcape progradation. This style of deltaic progradation differs markedly from other deltas such as the Mississippi where distributary avulsion leads to coastal land loss, rather than shoreline progradation. The key difference is that the Orinoco Delta coastal zone receives prodigious amounts of sediment from northwest-moving littoral currents that transport

  6. Fluvial system response to late Pleistocene-Holocene sea-level change on Santa Rosa Island, Channel Islands National Park, California

    USGS Publications Warehouse

    Schumann, R. Randall; Pigati, Jeffery S.; McGeehin, John P.

    2016-01-01

    Santa Rosa Island (SRI) is one of four east-west aligned islands forming the northern Channel Islands chain, and one of the five islands in Channel Islands National Park, California, USA. The island setting provides an unparalleled environment in which to record the response of fluvial systems to major changes of sea level. Many of the larger streams on the island occupy broad valleys that have been filled with alluvium and later incised to form steep- to vertical-walled arroyos, leaving a relict floodplain as much as 12–14 m above the present channel. The period of falling sea level between the end of the last interglacial highstand at ~ 80 ka and the last glacial lowstand at ~ 21 ka was marked by erosion and incision in the uplands and by deposition of alluvial sediment on the exposed marine shelf. Sea level rose relatively rapidly following the last glacial lowstand of − 106 m, triggering a shift from an erosional to a depositional sedimentary regime. Accumulation of sediment occurred first through vertical and lateral accretion in broad, shallow channels on the shelf. Channel avulsion and delta sedimentation produced widespread deposition, creating lobes or wedges of sediment distributed across relatively large areas of the shelf during the latest Pleistocene. Backfilling of valleys onshore (landward of present sea level) appears to have progressed in a more orderly and predictable fashion throughout the Holocene primarily because the streams were confined to their valleys. Vertical aggradation locally reduced stream gradients, causing frequent overbank flooding and lateral channel shift by meandering and/or avulsion. Local channel gradient and morphology, short-term climate variations, and intrinsic controls also affected the timing and magnitudes of these cut, fill, and flood events, and are reflected in the thickness and spacing of the episodic alluvial sequences. Floodplain aggradation within the valleys continued until at least 500 years ago

  7. Terrestrial astronomical age model for Eocene Thermal Maximum 2 and H2 hyperthermal events

    NASA Astrophysics Data System (ADS)

    Abels, Hemmo; Lourens, Lucas; Gingerich, Philip

    2013-04-01

    Knowledge of the duration and the rates of onset and recovery of early Paleogene hyperthermal events is crucial for understanding Earth's system response to massive input of greenhouse gases into the exogenic carbon pool. The second largest hyperthermal, Eocene Thermal Maximum 2 (ETM2), and its immediate successor H2 occur around 54 million years ago. Relative chronologies have been constructed for ETM2 and H2 in deep-sea records at Walvis Ridge in the southern Atlantic Ocean (Stap et al. 2009). Here, we construct an independent astronomical age model for these hyperthermals in terrestrial successions in the Bighorn Basin, Wyoming (Abels et al. 2012). We first generated parallel carbon isotope records of the ETM2-H2 interval in the Creek Star Hill, West Branch, and Purple Butte sections located between 1 and 3 km of the previously analyzed Upper Deer Creek (UDC) section. The carbon isotope patterns in the three new sections mimic both in time and magnitude the ETM2-H2 carbon isotope patterns from the UDC section. This confirms the reproducibility of the carbon isotope time series in these floodplain successions. The four sections were subsequently correlated by lateral tracing of distinctive paleosol horizons representing time lines at the sub-precession time scale. The correlation was confirmed by overbank-avulsion sedimentation cycles coevally occurring in the four sections. The constructed stratigraphic fence panel allows disentangling local fluvial variability in sedimentation from the regional signal. Coeval overbank-avulsion cyclicity at the precession time scale (Abels et al. 2013) are then used to construct an astronomical age model for the ETM2-H2 hyperthermal events. References Abels, H.A., W.C. Clyde, P.D. Gingerich, F.J. Hilgen, H.C. Fricke, G.J. Bowen, L.J. Lourens, 2012. Terrestrial carbon isotope excursions and biotic change during Palaeogene hyperthermals. Nature Geoscience 5, 326-329. Abels, H.A., M.J. Kraus, P.D. Gingerich, 2013. Precession

  8. Legacy Sediments and Channel Morphology in the Feather and Yuba Rivers, California

    NASA Astrophysics Data System (ADS)

    James, A.; Ghoshal, S.; Megison, M. E.; Singer, M. B.; Aalto, R.

    2007-12-01

    Channel aggradation and morphologic change following 19th century hydraulic gold-mining in the Sierra Nevada, California, differed substantially between the lower Feather and Yuba Rivers. These differences can be explained in part by topographic position in the Sacramento Valley but also by differences in early 20th century engineering structures and management policies. Both rivers experienced extreme aggradation by mining sediment and substantial avulsions but the timing and mechanics of channel adjustments were dissimilar, in part due to varying strategies in river-training and flood control. River engineering and management in the late 19th century identified the lower Yuba River as a repository zone where mining sediment could be sequestered to reduce deliveries to navigable rivers downstream. Levees were set back up to 4 km allowing formation of a multi-thread channel system across a broad floodplain that is now deeply buried by mining sediment. In contrast, levees along the lower Feather were given narrow spacings to encourage self-scouring of channels and promote navigability of channels. The lower Feather River drains a larger basin and has a lower gradient than the Yuba River. Construction of Fremont Weir across the mouth of the Yolo Basin raised flood levels in the lower Feather River and may have reduced transport of bed sediment. This could explain the persistence of large sand sheets at and below the Bear River confluence. Data from historical maps, topographic surveys, aerial photographs, and 1999 LiDAR swath mapping are used to document and contrast channel changes and floodplain evolution between these two rivers. Topographic changes derived by differencing detailed 1906-1909 topographic maps and 1999 LiDAR data indicate substantial channel morphologic changes including channel filling, lateral migration, and evolution towards single-thread channel systems. Modern streambank stratigraphy reflects the differences in channel responses. Sites where

  9. Management of toenail onychomycosis with 2% butenafine and 20% urea cream: a placebo-controlled, double-blind study.

    PubMed

    Syed, T A; Ahmadpour, O A; Ahmad, S A; Shamsi, S

    1998-10-01

    Onychomycosis is an increasingly common and recalcitrant fungal nail infection world-wide. The purpose of this placebo-controlled, double-blind study was to determine the clinical efficacy, chemical avulsion, and tolerability of 2% butenafine hydrochloride and 20% urea incorporated in a cream to cure toenail onychomycosis in a preselected population. Sixty patients (38M, 22F), ranging between 18 and 60 years (mean 27.4), with more than 25% involvement of the big toenail were enrolled in the study. The diagnosis of onychomycosis was established by mycologic identification and reconfirmed by positive fungal culture. A precoded 25-g tube was randomly assigned to each patient (50 active and 10 placebo) with instructions to apply the trial medication to their infected toenail twice daily with an occlusive dressing for one week. The affected nail was removed with a nail clipper. No occlusive dressing was maintained after the initial one week regimen. To assess the chemical avulsion of the infected toenail, mycologic cure, clinical effectiveness of the treatment, and overall success, patients were examined twice a week for 16 weeks and thereafter on a weekly basis for a further 36 weeks. The treatment was well tolerated by all the patients throughout the study, with no dropouts. Marked improvement was seen in 73.3% patients after weeks 8, 16 and 24 with clinically and mycologically confirmed negative fungal culture. Code disclosure revealed that active butenafine and urea cream cured significantly more patients than placebo (88% versus 0%; p < 0.0001). Of the 60 patients 91.6% reported no drug-related adverse symptoms. Five patients reported non-objective mild inflammation without discontinuation of the treatment. During one year follow-up of the study phase, none of the cured patients had a relapse. In conclusion, the mycologic and overall assessment of this study demonstrate that 2% butenafine HCl and 20% urea incorporated in a cream for keratinolysis is safe to use and

  10. Massachusetts Emergency Departments’ Resources and Physicians’ Knowledge of Management of Traumatic Dental Injuries

    PubMed Central

    Needleman, Howard L.; Stucenski, Keri; Forbes, Peter; Chen, Qiaoli (Lily); Stack, Anne M.

    2012-01-01

    Background Hospital emergency departments (ED) are confronted with triaging and managing dental emergencies of both traumatic and non-traumatic origin. However, the literature suggests that there exists inadequate knowledge of the management of traumatic dental injuries (TDI) among medical professionals who must be knowledgeable and have the appropriate resources needed to triage or treat patients presenting with TDI. Aim The aims of this study were to; 1) evaluate the resources of Massachusetts emergency departments (MED) for TDI, 2) determine the knowledge of management of TDI among MED physicians, and 3) investigate potential factors that affect their knowledge. Material and Methods Surveys were mailed to MED directors and their physicians. The director survey contained questions regarding institutional information for each emergency department (ED). The physician survey contained questions about physician characteristics and tested their knowledge of managing dental trauma. Results A total of 72 surveys (16 MED directors and 56 physicians) were returned and included in the analysis. Only 50% of the MED had on-site dental coverage, 43.8% had 24-hour off-site dental coverage and none had a formal written dental trauma protocol. MED physician’s knowledge of the appropriate management of luxations and avulsions was generally good, but poor for dental fractures. The MED physician’s knowledge for the emergent nature of the various injuries was generally good with that of avulsions being the best. Physicians were more likely to have a better knowledge of managing dental trauma if they were specialists in pediatric emergency medicine (p=0.001) or their hospitals had an academic affiliation (p=0.05). Conclusions Based on the findings from this study educational campaigns must be undertaken to improve both the resources available to the ED, as well as to improve the knowledge of physicians regarding emergency management of TDI. In addition, efforts should be made by

  11. Anatomy of the Adductor Magnus Origin

    PubMed Central

    Obey, Mitchel R.; Broski, Stephen M.; Spinner, Robert J.; Collins, Mark S.; Krych, Aaron J.

    2016-01-01

    Background: The adductor magnus (AM) has historically been a potential source of confusion in patients with suspected proximal hamstring avulsion injuries. Purpose: To investigate the anatomic characteristics of the AM, including its osseous origin, anatomic dimensions, and relationship to the proximal hamstring tendons. Study Design: Descriptive laboratory study. Methods: Dissection of the AM origin was performed in 11 (8 cadavers) fresh-frozen hip-to-foot cadaveric hemipelvis specimens. The gross anatomy and architecture of the proximal hamstring and AM tendons were studied. After dissecting the hamstring tendons away from their origin, the dimension, shape, and orientation of the tendon footprints on the ischial tuberosity were determined. Results: The AM was identified in all cadaveric specimens. The mean tendon thickness (anterior to posterior [AP]) was 5.7 ± 2.9 mm. The mean tendon width (medial to lateral [ML]) was 7.1 ± 2.2 mm. The mean tendon length was 13.1 ± 8.7 cm. The mean footprint height (AP dimension) was 12.1 ± 2.9 mm, and mean footprint width (ML dimension) was 17.3 ± 7.1 mm. The mean distance between the AM footprint and the most medial aspect of the conjoint tendon footprint was 8.5 ± 4.2 mm. Tendon measurements demonstrated a considerable degree of both intra- and interspecimen variability. Conclusion: The AM tendon is consistently present just medial to the conjoint tendon at the ischial tuberosity, representing the lateral-most portion of the AM muscle. This study found wide variation in the dimensional characteristics of the AM tendon between specimens. Its shape and location can mimic the appearance of an intact hamstring (conjoint or semimembranosus) tendon intraoperatively or on diagnostic imaging, potentially misleading surgeons and radiologists. Therefore, detailed knowledge of the AM tendon anatomy, footprint anatomy, and its relationship to the hamstring muscle complex is paramount when planning surgical approach and technique

  12. Paleomagnetic constrains in the reconstruction of the recent stratigraphic evolution of the Po delta

    NASA Astrophysics Data System (ADS)

    Correggiari, Annamaria; Vigliotti, Luigi; Remia, Alessandro; Perini, Luisa; Calabrese, Lorenzo; Luciani, Paolo

    2014-05-01

    The delta and prodelta deposits are characterized by a complex stratigraphic architecture that can be approached with several multidisciplinary tools. We present an example from the Po delta system characterized by alternating phases of rapid advance and abandonment of its multiple deltaic lobes that has been investigated through: (1) a review of historical cartography extending back several centuries; (2) integrated surveys of VHR seismic profiles recorded offshore of the modern delta from water depths as shallow as 5 m to the toe of the prodelta in about 30 m; and (3) sedimentological and geochronological data from precisely positioned sediment cores. Within this well known stratigraphic framework we have acquired seismic data and sediment cores in the area of the post roman Po delta system. However a precise dating of the recent evolution of depositional delta lobes is difficult because of the lack of suitable dating methods. To constrain the emplacement timing of the Renaissance lobes a paleomagnetic studies was carried out on a sedimentary sequence representing a seismic facies well correlated in the cores by whole core magnetic susceptibility profile. Forty eight samples were collected from a core section (RER96-1) characterized by a fine grained lithology suitable for paleomagnetic investigations. The characteristic remanent magnetization (ChRM) of the sediments has been obtained by applying an AF cleaning between 10 and 30 millitesla. The results have been compared with the directions recorded by the historical lavas of the Etna and Vesuvius. The combination of the trends observed in the declination and inclination suggests that the results can be compatible with the directions of the secular variation of the earth magnetic field occurring during the XVII century. This allow to date the sismic unit as representative of the beginning of the new delta following the Porto Viro avulsion made by the Venice Republic in 1604 AD. This delta history reflects the

  13. Influence of logjam-formed hard points on the formation of valley-bottom landforms in an old-growth forest valley, Queets River, Washington, USA

    NASA Astrophysics Data System (ADS)

    Montgomery, David R.; Abbe, Tim B.

    2006-01-01

    Field surveys and radiocarbon dating of buried logjams in the floodplain of an old-growth forest river demonstrate the formation of erosion-resistant "hard points" on the floodplain of the Queets River, Washington. These hard points provide refugia for development of old-growth forest patches in frequently disturbed riparian environments dominated by immature forest. Our surveys show that local bed aggradation associated with logjams not only influences channel patterns and profiles but leads to development of a patchwork of elevated landforms that can coalesce to form portions of the valley bottom with substantial (i.e., 1 to >4 m) relief above the bankfull elevation. In addition, logjam-formed hard points promote channel avulsion, anastomosing morphology, and growth of mature patches of floodplain forest that, in turn, provide large logs needed to form more logjam-formed hard points. Hence, our findings substantiate the potential for a feedback mechanism through which hard points sustain complex channel morphology and a patchwork floodplain composed of variable-elevation surfaces. Conversely, such a feedback further implies that major changes in riparian forest characteristics associated with land use can lead to dramatic simplification in channel and floodplain morphology.

  14. Channel Evolution on the Lower Elwha River, Washington, 1939-2006

    USGS Publications Warehouse

    Draut, Amy E.; Logan, Joshua B.; McCoy, Randall E.; McHenry, Michael; Warrick, Jonathan A.

    2008-01-01

    Analyses of historical aerial photographs of the lower Elwha River, Clallam County, Washington, reveal rates and patterns of channel change in this dammed, anabranching river between 1939 and 2006. Absolute positional changes of the active-floodplain margins, which commonly exceeded 50 m over that interval, have exceeded 400 m locally. Annualized rates of channel movement were typically ~2 to 10 m/yr; higher annualized rates over some time intervals are attributable to the formation of new channels by episodic avulsion. Channel movement by more gradual lateral meander migration was also common. Anthropogenic modification of the floodplain between the 1940s and 1980s substantially altered channel form and position. This analysis of rates and patterns of channel change over nearly 70 years on the lower Elwha River is intended to characterize the evolution of the river throughout most of the time interval when two large dams have been in place upstream. Channel morphology and rates of channel movement are expected to change significantly in response to removal of the dams and re-establishment of the upstream sediment supply during a major river-restoration project.

  15. The EpiNo® Device: Efficacy, Tolerability, and Impact on Pelvic Floor—Implications for Future Research

    PubMed Central

    Kavvadias, Tilemachos; Hoesli, Irene

    2016-01-01

    Aims. The aim of this review is to provide a comprehensive overview of the available literature on preventing perineal trauma with the EpiNo. Methods. We perfomed a literature research in the MedLine and EMBASE databases for studies referring to EpiNo published between 1990 and 2014, without restrictions for language and study type. Results. Five published studies were identified, regarding the effect of EpiNo on the rate of episiotomy and perineal tears, pelvic floor muscle function, and fetal outcome. The device seems to reduce episiotomy and perineal tears' rate, as well as the risk for levator ani microtrauma and avulsion, though not always statistically significant. It does not seem to have an effect on duration of second stage of labour and fetal outcome. The device is well tolerated and the adverse events are rare and mild. However, design and reporting bias in the reviewed articles do not allow evidence based conclusions. Conclusions. The EpiNo device seems to be promising, with potential positive effects on natural birth, while being uncomplicated to use and without major complications. Well designed, randomized trials are needed in order to understand the effects of EpiNo on pelvic floor and make evidence based recommendations on its use. PMID:26981126

  16. Human amniotic epithelial cell transplantation for the repair of injured brachial plexus nerve: evaluation of nerve viscoelastic properties

    PubMed Central

    Jin, Hua; Yang, Qi; Ji, Feng; Zhang, Ya-jie; Zhao, Yan; Luo, Min

    2015-01-01

    The transplantation of embryonic stem cells can effectively improve the creeping strength of nerves near an injury site in animals. Amniotic epithelial cells have similar biological properties as embryonic stem cells; therefore, we hypothesized that transplantation of amniotic epithelial cells can repair peripheral nerve injury and recover the creeping strength of the brachial plexus nerve. In the present study, a brachial plexus injury model was established in rabbits using the C6 root avulsion method. A suspension of human amniotic epithelial cells was repeatedly injected over an area 4.0 mm lateral to the cephal and caudal ends of the C6 brachial plexus injury site (1 × 106 cells/mL, 3 μL/injection, 25 injections) immediately after the injury. The results showed that the decrease in stress and increase in strain at 7,200 seconds in the injured rabbit C6 brachial plexus nerve were mitigated by the cell transplantation, restoring the viscoelastic stress relaxation and creep properties of the brachial plexus nerve. The forepaw functions were also significantly improved at 26 weeks after injury. These data indicate that transplantation of human amniotic epithelial cells can effectively restore the mechanical properties of the brachial plexus nerve after injury in rabbits and that viscoelasticity may be an important index for the evaluation of brachial plexus injury in animals. PMID:25883625

  17. Titanium anchors for the repair of distal Achilles tendon ruptures: preliminary report of a new surgical technique.

    PubMed

    Maniscalco, P; Bertone, C; Bonci, E; Donelli, L; Pagliantini, L

    1998-01-01

    From January 1995 to July 1996, the authors used Mitek GIV titanium anchors to treat seven patients with acute rupture of the Achilles tendon (four men, three women; average age 52.42 years; range, 33-62 years). All subjects had a total rupture of the most distal aspect of the tendon; none had an avulsion fracture. After dissection down to the paratenon, the reinsertion site was selected and a 2 to 3-cm-long trough carved through the cortex. Three holes were drilled at a distance of 0.5 cm one from the other and 1 cm parallel and distal to the trough. The anchors were then threaded, inserted into the holes, and engaged. Surgery was completed by resection of the frayed ends, reparation of the tendon, and insertion of the terminal end into the trough. At 6 months postoperative, a modified Mandelbaum and Pavanini clinical assessment indicated five excellent and two good outcomes. There were no cases of deep of superficial wound infection or skin necrosis. Despite the small number of patients and the short follow-up period, the authors believe this technique shows promise and that in selected cases the use of titanium anchors can facilitate the task of the surgeon and enable patients to return to normal and sports activities within 5 months after surgery. PMID:9571455

  18. Posterior cervical spinal fusion in a 3-week-old infant with a severe subaxial distraction injury.

    PubMed

    Holland, Christopher M; Kebriaei, Meysam A; Wrubel, David M

    2016-03-01

    Unstable spinal injuries in the neonate pose particular challenges in the clinical and radiographic assessment as well as the surgical stabilization of the spine. In this report, the authors present the unfortunate case of a 3-week-old infant who suffered a severe subaxial cervical fracture dislocation with spinal cord injury that occurred as a result of nonaccidental trauma. Imaging demonstrated severe distraction at C5-6 and near-complete spinal cord transection resulting in quadri-paresis. Open surgical reduction was performed with noninstrumented posterior fusion augmented with split rib autograft and recombinant human bone morphogenetic protein-2. Postoperative imaging demonstrated progressive bony fusion at 2 months, and clinical examination findings progressed to a motor examination classification of ASIA C. At 2 years, the fusion mass is stable and cervical alignment is maintained. The patient remains flaccid in the bilateral lower extremities, but has movement with some dexterity in both hands. Follow-up MRI shows severe spinal cord injury with evidence of bilateral C-5 nerve root avulsions. This case represents the first report of spinal fusion in an infant of less than 1 month of age. Given the extreme young age of the patient, the diagnostic challenges as well as the mechanical and technical considerations of surgical fusion are discussed. PMID:26613276

  19. Reduced functional connectivity within the primary motor cortex of patients with brachial plexus injury.

    PubMed

    Fraiman, D; Miranda, M F; Erthal, F; Buur, P F; Elschot, M; Souza, L; Rombouts, S A R B; Schimmelpenninck, C A; Norris, D G; Malessy, M J A; Galves, A; Vargas, C D

    2016-01-01

    This study aims at the effects of traumatic brachial plexus lesion with root avulsions (BPA) upon the organization of the primary motor cortex (M1). Nine right-handed patients with a right BPA in whom an intercostal to musculocutaneous (ICN-MC) nerve transfer was performed had post-operative resting state fMRI scanning. The analysis of empirical functional correlations between neighboring voxels revealed faster correlation decay as a function of distance in the M1 region corresponding to the arm in BPA patients as compared to the control group. No differences between the two groups were found in the face area. We also investigated whether such larger decay in patients could be attributed to a gray matter diminution in M1. Structural imaging analysis showed no difference in gray matter density between groups. Our findings suggest that the faster decay in neighboring functional correlations without significant gray matter diminution in BPA patients could be related to a reduced activity in intrinsic horizontal connections in M1 responsible for upper limb motor synergies. PMID:27547727

  20. Crevasse-splay sedimentation processes revealed through high resolution modelling

    NASA Astrophysics Data System (ADS)

    Hackney, Christopher; Darby, Stephen; Parsons, Daniel; Leyland, Julian; Aalto, Rolf; Nicholas, Andrew; Best, Jim

    2015-04-01

    During rapid rise flood events, crevasse-splay complexes are a dominant conduit through which sediment and water are passed from the main channel onto the floodplain, particularly for large rivers. These crevasse-splay systems are, therefore, key in controlling rates of floodplain sedimentation, as well as conditioning the location of avulsions. Despite recent advances in our capabilities to model the development and evolution of these systems, our understanding of the passage, storage and reworking of water and sediment across them remains relatively poor. A key limitation concerns the point that, since floodplain topography is a first-order control on the hydrodynamics of crevasse-splays, publicly available topographic data sets (e.g. SRTM) are currently unable to resolve key processes at the necessary spatial resolution. Here we employ Structure-from-Motion (SfM) on low-level aerial photography to obtain high-resolution (3m grid cell) georectified topographic data (horizontal error = 0.02 m; vertical error = 0.5 m) for a series of three representative crevasse-splay complexes located along the Mekong River, Cambodia. We use the coupled hydrodynamic and morphodynamic model, Delft-3D to simulate sedimentation patterns for a series of flood events. We model floodplain deposition and erosion and validate simulated spatial and temporal variations against observed patterns. We show how the spatial and temporal patterns of floodplain development via crevasse-splays are conditioned by key hydrological characteristics.

  1. Multiple cervical spinous process fractures in a novice golf player.

    PubMed

    Kim, Sei-Yoon; Chung, Sang Ki; Kim, Dong-Yun

    2012-12-01

    Avulsion of spinous process, also called Clay-shoveler's fracture, is most prevalent among those engaged in hard physical labor. To the best of the author's knowledge, only one case of multiple spinous process fractures of the upper thoracic spine in a novice golfer has been reported. A 45-year-old female presented with intractable posterior neck pain. The patient experienced a sharp, sudden pain on the neck while swinging a golf club, immediately after the club head struck the ground. Dynamic cervical radiographic findings were C6 and C7 spinous process fractures. Magnetic resonance imaging revealed C6 and C7 spinous process fractures without spinal cord pathology. The patient was treated with pain medications and cervical bracing. The patient's pain gradually improved. The injury mechanism was speculated to be similar to Clay-shoveler's fracture. Lower cervical spinous process fractures can be associated with a golf swing. If the patient complains of long lasting neck pain and has a history of golf activity, further study should be conducted to rule out lower cervical spinous fracture. PMID:23346334

  2. Perianal injuries resulting from sexual abuse: a longitudinal study.

    PubMed

    McCann, J; Voris, J

    1993-02-01

    Four children who incurred perianal injuries as a result of a sexual assault were followed on a longitudinal basis to document the anatomical changes that ensued. The subjects, whose ages ranged from 4 to 8 years, were followed from 1 week to 14 months. They were examined in both supine and prone knee-chest positions and a 35-mm camera mounted on a colposcope was used to record their injuries. At the time of the initial examination, there were a variety of findings including erythema of the tissues, edema of the skin folds, localized venous engorgement, dilation of the external anal sphincter, and lacerations of different depths. Superficial lacerations reepithelized within 1 to 11 days. The second-degree wounds in two of the children were healed by the 1- and 5-week return visits, leaving narrow bands of scar tissue. In the two subjects who were followed the longest, signs of both a second-degree laceration and a surgically repaired third-degree injury had virtually disappeared by 12 to 14 months after the assaults. The wounds in one subject, infected with a herpes simplex type 2 virus, remained erythematous for a longer period of time than did similar injuries in the other children. A skin tag created by the avulsion of the tissues in one subject persisted, although it became less obvious as it retracted into the redundant folds of the perianal tissues over time. PMID:8424016

  3. Antibiotic prophylaxis in pediatric odontology. An update.

    PubMed

    Planells del Pozo, Paloma; Barra Soto, Ma José; Santa Eulalia Troisfontaines, Eva

    2006-07-01

    Most orofacial infections are of odontogenic origin, and are of a self-limiting nature, characterized by spontaneous drainage. The causal bacteria are generally saprophytes. On the other hand, invasive dental interventions give rise to transient bacteremia. When an oral lesion is contaminated by extrinsic bacteria, the required antibiotic treatment should be provided as soon as possible. In the case of pulpitis, such treatment is usually not indicated if the infection only reaches the pulp tissue or the immediately adjacent tissues. In the event of dental avulsion, local antibiotic application is advised, in addition to the provision of systemic antibiotics. The dental professional must know the severity of the infection and the general condition of the child in order to decide referral to a medical center. Prophylaxis is required in all immunocompromised patients, as well as in individuals with cardiac problems associated with endocarditis, vascular catheters or prostheses. Penicillin V associated to clavulanic acid and administered via the oral route is known to be effective against odontogenic infections. In the case of allergies to penicillin, an alternative drug is clindamycin. Most acute infections are resolved within 3-7 days. In recent years, the tendency is to reduce general antibiotic use for preventive or therapeutic purposes. PMID:16816822

  4. Facial and Dental Injuries Facial and Dental Injuries in Karate.

    PubMed

    Vidovic-Stesevic, Vesna; Verna, Carlalberta; Krastl, Gabriel; Kuhl, Sebastian; Filippi, Andreas

    2015-01-01

    Karate is a martial art that carries a high trauma risk. Trauma-related Swiss and European karate data are currently unavailable. This survey seeks to increase knowledge of the incidence of traumatic facial and dental injuries, their emergency management, awareness of tooth rescue boxes, the use of mouthguards and their modifications. Interviews were conducted with 420 karate fighters from 43 European countries using a standardized questionnaire. All the participants were semi-professionals. The data were evaluated with respect to gender, kumite level (where a karate practitioner trains against an adversary), and country. Of the 420 fighters interviewed, 213 had experienced facial trauma and 44 had already had dental trauma. A total of 192 athletes had hurt their opponent by inflicting a facial or dental injury, and 290 knew about the possibility of tooth replantation following an avulsion. Only 50 interviewees knew about tooth rescue boxes. Nearly all the individuals interviewed wore a mouthguard (n = 412), and 178 of them had made their own modifications to the guard. The results of the present survey suggest that more information and education in wearing protective gear are required to reduce the incidence of dental injuries in karate. PMID:26345152

  5. Multiple traumatic injury to maxillary incisors in an adolescent female: treatment outcome with two years follow-up.

    PubMed

    Biagi, Roberto; Cardarelli, Filippo; Storti, Ennio; Majorana, Alessandra; Farronato, Giampietro

    2013-01-01

    Number, type and severity of dental injuries per patient differ according to the patient's age and the cause of accident. The trauma group resulting from pedestrian-, bicycle-, and car-related injuries is usually dominated by multiple dental injuries, injuries to the supporting bone and soft-tissue injuries. This report describes a case of a 16.2-year-old female who suffered traumatic injuries to her permanent maxillary incisors after a car accident. Concussion of tooth 12, extrusive luxation of tooth 11, avulsion of tooth 21 and subluxation with complicated crown fracture of tooth 22 were observed at the emergency visit 75 minutes after the trauma. Tooth 21 was dry stored for 15 minutes, then in milk for 60 minutes. The treatment plan according to IADT guidelines was performed with the satisfaction of the dentists and the patient. After 1 year follow- up a replacement root resorption of tooth 21 was diagnosed; it was then considered severe at the time of the 2 year control visit. Educational programs are essential to optimize the treatment outcome both at the accident site and also at the dental office. PMID:23991273

  6. Channel Morphological Changes in the Yuba River, California, in the Post-Hydraulic Mining Period

    NASA Astrophysics Data System (ADS)

    Ghoshal, S.; James, A.; Singer, M.; Aalto, R.

    2007-12-01

    Hydraulic gold mining in the Sierra Nevada of California (1853-1884) produced large volumes of sediment from upland placer gravels. The prevailing belief has been that piedmont storage of this sediment is volumetrically negligible or inactive. This study tests the hypothesis that large deposits of historical sediment remaining in the bed, banks and terraces of the lower Yuba River have been remobilized by floods and that erosion has continued over the past few decades. Remote sensing and GIS analyses of topographic and planimetric data from historical maps, surveys, aerial photographs, and LiDAR data document historic changes and the timing of sediment erosion and deposition within the channel and floodplain system. Planimetric and volumetric measurements of channel enlargement, lateral migration, avulsions, and channel filling provide magnitudes of erosion and deposition of historic sediments in the lower Yuba River. In 1906, the California Debris Commission produced a detailed large-scale topographic map of the lower Yuba floodplain showing it as a multi-thread channel system. The paleochannel scars remain evident on air photos, LiDAR images, and in the field. Differencing of topographic data derived from the 1906 topographic maps and 1999 LiDAR data provide volumetric measures of substantial channel morphologic changes including channel shifting, filling, and evolution towards a single- thread channel system. These measures identify processes and rates of sediment production relevant to broader issues of flood hazards in the region.

  7. Assessment of awareness amongst school teachers regarding prevention and emergency management of dentoalveolar traumatic injuries in school children in Pune City, before and 3 months after dental educational program.

    PubMed

    Karande, Namrata; Shah, Preetam; Bhatia, Mitali; Lakade, Laxmi; Bijle, Mohammed Nadeem Ahmed; Arora, Nitin; Bhalla, Monika

    2012-01-01

    Children have boundless energy, so, they are continuously engaged in some or the other physical activity. It is seen that when child reaches school age, accidents in the school environment in the form of falls, injuries due to contact sports, fights, abuse, etc. are very common and the main cause of traumatic dental injuries. Trauma may vary from minor enamel chipping or avulsion to extensive maxillofacial damage, more serious neck and brain injury, which may cause pain, disfigurement and mental agony, having immediate and long lasting effects. In such cases, a school teacher is in the right position to handle such an emergency and refer the child to the concerned dental surgeon or a pedodontist for further needful care. The main reason for delayed treatment of dental trauma is that people present at the site of injury are unaware of protocol of rapid and appropriate management leading to improper first aid treatment. The purpose of this study was to investigate the awareness of a group of school teachers from different schools about the prevention and emergency management of dental trauma in school children, by means of a questionnaire. Then educating them and reassessing their knowledge after a period of 3 months. Unfortunately, the public is unaware of the risks and does not have enough information about first aid emergency treatment or to avoid traumatic injuries. PMID:23404018

  8. Comparative in vitro study of the effectiveness of Green tea extract and common storage media on periodontal ligament fibroblast viability

    PubMed Central

    Adeli, Fahimeh; Zabihi, Ebrahim; Abedian, Zeinab; Gharekhani, Samane; Pouramir, Mahdi; Khafri, Soraya; Ghasempour, Maryam

    2016-01-01

    Objective: Green tea extract (GTE) was shown to be effective in preserving periodontal ligament fibroblasts (PDLFs) of avulsed teeth. This study aimed at determining the potential of GTE in preserving the viability of PDLFs comparing with different storage media. Materials and Methods: Periodontal ligament cells were obtained from freshly extracted healthy impacted third molars and cultured in Dulbecco's Modified Eagle Medium (DMEM). Cell viability was determined by storing the cells in seven media; DMEM, tap water, Hank's balanced salt solution (HBSS), whole milk, hypotonic sucrose solution, GTE, and GTE + sucrose for 1, 2, 4, and 24 h at 37°C using tetrazolium salt-based colorimetric (3-[4, 5-dimethylthiazol-2-yl]-2, 5-diphenyl tetrazolium bromide) assay. Statistical analysis was performed by one-way analysis of variance and post hoc tests. Results: GTE showed significantly higher protective effect than HBSS at 2, 4, and 24 h (P = 0.009, P = 0.02, P = 0.016), DMED at 2 h (P = 0.003), and milk at 4 h (P = 0.039). Conclusion: Although with undesirable osmolality and pH, GTE had a good ability in preserving the PDLFs comparing with other studied media. PMID:27403063

  9. Multi-disciplinary management of a patient with a post-traumatised incisor presenting concurrent replacement and inflammatory resorption: a case report.

    PubMed

    Doğramaci, Esma J; Rossi-Fedele, Giampiero; Jonest, Allan G

    2015-11-01

    This case report describes the multidisciplinary management of a young male who presented with a Class I incisor relationship and bi-maxillary dento-alveolar protrusion on a Class I skeletal base. The occlusion was complicated by an ankylosed and moderately infra-positioned upper left permanent central incisor, an anterior crossbite, crowding, a reduced overbite and centreline discrepancy. The incisor was traumatised and avulsed when the root was immature and the tooth was reimplanted with delay. On referral for orthodontic treatment at age 11 .5 years, the upper left central incisor was experiencing ankylosis-related (osseous replacement) resorption and external root resorption simultaneously. Aside from the orthodontic aims, it was important to address the disrupted alveolar development to facilitate later prosthodontic replacement of the upper left permanent central incisor by idealising the inter-coronal and inter-radicular spaces. Treatment consisted of fixed orthodontic appliances in conjunction with the extraction of all second premolars and the upper left permanent central incisor with episodic surgical curettage. An upper Hawlix retainer was provided immediately at debond and a cantilevered resin-retained bridge was placed four months later. PMID:26999896

  10. [Percutaneous treatment of unstable spine fractures - OP video and results from over 300 cases].

    PubMed

    Prokop, A; Chmielnicki, M

    2014-02-01

    Minimally invasive surgery for vertebral fractures results in less approach-related morbidity, decreased postoperative pain, and rapid mobilisation of patients. Such procedures can be performed even in elderly patients. However, along with the many advantages, minimally invasive procedures are technically demanding, require sophisticated tools, and there is a learning curve for surgeons. Intraoperative visualisation is often possible only radiologically, and implants are generally much more expensive. Using the data from over 300 unstable vertebral fracture cases treated over the past 3.5 years, we have developed a differentiated treatment concept, depending on the age of the patient and the fracture characteristics. Unstable fractures with involvement of the posterior edge are stabilised from posterior, percutaneously with a fixator. In patients under 60 years, monoaxial screws with inserted rods (top loading) are used, with which distraction and restoration of lordosis are also possible. Patients over 60 years are treated percutaneously with a polyaxial sextant system with rods inserted to avoid avulsion of the pedicle screws from the vertebral body. To avoid cutting through the vertebra, the fenestrated screws can be augmented with cement. The operation technique is demonstrated by a video. PMID:24578107

  11. Irrigation-coupled bipolar cautery unit: A practical, economical, and simple version

    PubMed Central

    Sharma, Shekhar; Haji, Altaf Gauhar; Vijaykumar, D. K.; Shaji, A. K.

    2008-01-01

    Hemostasis is a fundamental principle of surgery for which electrocoagulation is universally used. Bipolar electrocautery has an advantage over monopolar electrocautery in terms of the precision of the extent of tissue coagulation and the lateral extent of thermal tissue injury. However, secondary to the thermal changes induced in the tissue due to electric current passage, there is charring of tissue, which adheres to the cautery tip. This, not only decreases its effectiveness, but also, by getting avulsed while removing the cautery tip from the surgical field, causes rebleeding and more trauma to the tissue. Irrigation of the surgical field during application of cautery reduces the charring effect, thereby improving the efficiency and efficacy. Irrigation-coupled electrocautery devices are available but are costly to acquire and maintain. We describe a simple and reliable version of an irrigation-coupled cautery device, which is of immense functional utility in our experience. It decreases the amount of charring of the tissue and its adherence to the bipolar forceps tips, thereby decreasing the frustrating loss of effectiveness and also increases the life of the bipolar forceps as cleaning needs to be less frequent. By virtue of its simplicity and cost-effectiveness, it can be used in almost all hospitals and situations. PMID:19753257

  12. Evolution of fixed-channel alluvial plains in response to Carboniferous vegetation

    NASA Astrophysics Data System (ADS)

    Davies, Neil S.; Gibling, Martin R.

    2011-09-01

    The establishment of terrestrial plants during the Palaeozoic era was one of the most significant changes to the Earth system during the Phanerozoic eon. The continuing evolution and expansion of land plants irrevocably altered the alluvial landscape: the broad, unconfined and unconsolidated blankets of coarse sediment found at the start of the Cambrian period were replaced by a diverse array of braided and meandering channel styles and stable floodplains by the end of the Devonian period. Here we show that the first appearance of a sedimentary facies suite attributed to low-energy, organic-rich river systems with multiple channels and stable alluvial islands, known as anabranching or anastomosing rivers, occurred during the Carboniferous period. Our field studies and literature review demonstrate that the appearance of these rivers coincides with the continuing evolution of tree-like plants. We suggest that increased floodplain stability and new triggers for channel avulsion were provided by the increase in complexity and diversity of root assemblages, density of floodplain forests and production of woody debris associated with expansion of arborescence. We conclude that the expansion of tree habitats led to the crossing of a threshold in vegetative control of floodplain and river morphology during the Carboniferous.

  13. The potential for dams to impact lowland meandering river floodplain geomorphology.

    PubMed

    Marren, Philip M; Grove, James R; Webb, J Angus; Stewardson, Michael J

    2014-01-01

    The majority of the world's floodplains are dammed. Although some implications of dams for riverine ecology and for river channel morphology are well understood, there is less research on the impacts of dams on floodplain geomorphology. We review studies from dammed and undammed rivers and include influences on vertical and lateral accretion, meander migration and cutoff formation, avulsion, and interactions with floodplain vegetation. The results are synthesized into a conceptual model of the effects of dams on the major geomorphic influences on floodplain development. This model is used to assess the likely consequences of eight dam and flow regulation scenarios for floodplain geomorphology. Sediment starvation downstream of dams has perhaps the greatest potential to impact on floodplain development. Such effects will persist further downstream where tributary sediment inputs are relatively low and there is minimal buffering by alluvial sediment stores. We can identify several ways in which floodplains might potentially be affected by dams, with varying degrees of confidence, including a distinction between passive impacts (floodplain disconnection) and active impacts (changes in geomorphological processes and functioning). These active processes are likely to have more serious implications for floodplain function and emphasize both the need for future research and the need for an "environmental sediment regime" to operate alongside environmental flows. PMID:24587718

  14. Floodplain morphology, sedimentology, and development processes of a partially alluvial channel

    NASA Astrophysics Data System (ADS)

    Thayer, James B.; Ashmore, Peter

    2016-09-01

    The floodplain morphology, sediment deposits, and development mechanisms of a partially alluvial, low-moderate energy channel flowing over a mixed gravel/cobble-till bed are investigated and compared to existing ideas of floodplain development. The findings partially support the idea of a floodplain developed through lateral accretion capped with vertically accreted sediments as predicted by the energy-based classification scheme of Nanson and Croke (1992), though oblique accretion and partial channel avulsion are also important. Channel migration consists of limited cross-valley migration and downstream meander translation. Because of low channel sinuosity, well-formed neck cutoffs are rare, and instead the channel cuts headward along the insides of confined or underdeveloped meander bends forming a localized anabranching pattern. The floodplain architecture can be divided into gravel bar and bed deposits (GB), lateral accretion deposits (LA), overbank deposits (FF), and abandoned channel deposits (FF(CH)), which are described with four alluvial facies. Owing to the limited supply of coarse and fine sediment, none of the architectural elements are particularly thick, with total floodplain thickness being < 3 m. Floodplain development for partially alluvial channels is compared within a new floodplain discrimination framework. Comparisons with common facies models of single-thread, coarse-grained channels show important differences that suggest that the floodplain deposits and formative processes described herein represent a subset of single-thread systems that may be common in partially alluvial channels, particularly in slightly sinuous, coarse-grained channels of low-moderate energy with partly confined floodplains.

  15. Analysis of the transport of sediment by the Suncook River in Epsom, Pembroke, and Allenstown, New Hampshire, after the May 2006 flood

    USGS Publications Warehouse

    Flynn, Robert H.

    2011-01-01

    in the model with the Laursen (Copeland) sediment-transport function best describing the sediment load, transport behavior, and changes in streambed elevation for the specified spatial and temporal conditions of the 400-day calibration period. Simulation results from the model and field-collected sediment data indicate that, downstream of the avulsion channel, for the average daily mean flow during the study period, approximately 100 to 400 tons per day of sediment (varying with daily mean flow) was moving past the Short Falls Road Bridge over the Suncook River in Epsom, while approximately 0.05 to 0.5 tons per day of sediment was moving past the Route 28 bridge in Pembroke and Allenstown, and approximately 1 to 10 tons per day was moving past the Route 3 bridge in Pembroke and Allenstown. Changes in water-surface elevation that the model predicted for the end of water year 2010 to be a result of changes in streambed elevation ranged from a mean increase of 0.20 feet (ft) for the 50-percent annual exceedence-probability flood (2-year recurrence-interval flood) due to an average thalweg increase of 0.88 ft between the Short Falls Road Bridge and the Buck Street Dams in Pembroke and Allenstown to a mean decrease of 0.41 ft for the 50-percent annual exceedence-probability flood due to an average thalweg decrease of 0.49 ft above the avulsion in Epsom. An analysis of shear stress (force created by a fluid acting on sediment particles) was undertaken to determine potential areas of erosion and deposition. Based on the median grain size (d50) and shear stress analysis, the study found that in general, for floods greater than the 50-percent annual exceedence probability flood, the shear stress in the streambed is greater than the critical shear stress in much of the river study reach. The result is an expectation of streambed-sediment movement and erosion even at high exceedence-probability events, pending although the stream ultimately attains equilibrium through stream

  16. [Osteotomy for approaches to the knee joint. Tibial tubercle, lateral epicondyle of the femur and head of the fibula].

    PubMed

    Lorbach, O; Anagnostakos, K; Kohn, D

    2013-05-01

    The present article summarizes the different osteotomy techniques for an extension of standard surgical approaches to the knee joint in selected patients. The aim is to achieve satisfactory exposure and reduce potential postoperative complications compared to alternative techniques, such as the V-Y plasty or the quadriceps snip procedures. Osteotomy of the tibial tubercle is a reasonable extension of the anteromedial or the anterolateral surgical approach in selected patients undergoing revision total knee replacement. This osteotomy will provide excellent surgical exposure of the knee without the risk of avulsion of the patellar tendon and will preserve the blood supply of the patella and the surrounding soft tissue. Moreover, functional clinical outcome will be improved by minimizing damage to the extensor mechanism. Osteotomy of the lateral femoral condyle gives excellent exposure of the posterolateral aspect of the knee joint which might be necessary in some patients with fractures of the posterolateral tibial plateau as well as patients undergoing open allograft transplantation of the lateral meniscus. An alternative option for an extended exposure to the posterolateral knee joint is accomplished by osteotomy or partial resection of the fibular head which is also described as having good clinical results and a low complication rate. PMID:23632649

  17. Challenges in Measuring Outcomes Following Digital Replantation

    PubMed Central

    Sebastin, Sandeep J.; Chung, Kevin C.

    2013-01-01

    In the early period of replantation surgery, the emphasis was on digit survival. Subsequently, with better microsurgical techniques and instrumentation, the focus has shifted to function and in recent years to consideration of cost-effectiveness. Despite over 40 years of effort in refining digital replantation surgery, a rigorous evaluation of the outcomes of digital replantation has not been performed. This is because of the many confounding variables that influence outcome comparisons. These variables include the mechanism of injury (guillotine, crush, avulsion), the injury itself (total, near total, subtotal, partial amputation), and the surgical procedure (replantation, revascularization). In addition, the traditional outcome measures (two-point discrimination, range of motion, grip strength, or the ability to return to work) are reported inconsistently and vary widely among publications. All these factors make meaningful comparison of outcomes difficult. The recent emphasis on outcome research and cost-effectiveness necessitates a rethinking in the way we report outcomes of digital replantation. In this article, the authors summarize the challenges in assessing outcomes of digital replantation and explain the need to measure outcomes using rigorous clinical research designs that incorporate cost-effectiveness studies in the research protocol. PMID:24872766

  18. [Non pharmacologic treatment of neuropathic pain].

    PubMed

    Guastella, Virginie; Mick, Gérard; Laurent, Bernard

    2008-02-01

    Nondrug treatments of neuropathic pain should always begin at the same time as pharmacologic treatment. There are three types of nondrug treatment for neuropathic pain: physical, surgical, and "psychocorporal" and psychotherapeutic treatment. Transcutaneous electrical nerve stimulation (TENS) is a simple physical treatment that strengthens local inhibitory controls and is indicated in focal neuropathic pain when upstream stimulation is possible for a superficial sensitive nerve trunk. Destructive surgery is represented today by "DREZotomy", destruction of nociceptive fibers and their dorsal root entry zones. It is indicated essentially in intractable pain due to plexus avulsion. Functional surgery is implanted electric stimulation--either spinal or central (encephalic)--of structures that exert inhibitory control on the pain pathways. Spinal stimulation is performed at the level of the posterior spinal cord and is indicated essentially in segmental mononeuropathies refractory to drug treatment. Central stimulation is performed at the motor cortex and is indicated for refractory central pain. "Psychocorporal" techniques (relaxation, sophrology, hypnosis) are useful to reduce anxiety and neurovegetative hypertonicity, both factors that aggravate neuropathic pain. PMID:18191370

  19. Common Dental Injury Management in Athletes

    PubMed Central

    Young, Eliot J.; Macias, C. Roger; Stephens, Lindsay

    2015-01-01

    Context: Orofacial and dental trauma continues to be a commonly encountered issue for the sports medicine team. All sports have some risk for dental injury, but “contact sports” presumably incur more risk. Immediate evaluation and proper management of the most common injuries to dentition can result in saving or restoration of tooth structure. Despite the growing body of evidence, mouth guard use and dental protection have not paralleled the increase in sports participation. Evidence Acquisition: A PubMed search from 1960 through April 2012 was conducted, as well as a review of peer-reviewed online publications. Results: Common dental injuries in sports include tooth (crown) fractures; tooth intrusion, extrusion, and avulsion; and temporomandibular joint dislocation. Mouth guards help prevent most injuries and do not significantly affect ventilation or speech if fitted properly. Conclusion: A working knowledge of the presentation as well as management of commonly encountered dental trauma in sports is essential to the immediate care of an athlete and returning to play. Mouth guard use should be encouraged for athletes of all ages in those sports that incur significant risk. PMID:26131303

  20. Particulates from Hydrophilic-Coated Guiding Sheaths Embolize to the Brain

    PubMed Central

    Stanley, James R.L.; Tzafriri, Abraham R.; Regan, Kathryn; LaRochelle, Alan; Wong, Gee; Zani, Brett G.; Markham, Peter M.; Bailey, Lynn; Spognardi, Anna; Kopia, Gregory A.; Edelman, Elazer R.

    2015-01-01

    Aims We sought to evaluate the incidence of embolic material in porcine brain following vascular interventions using hydrophilic-coated sheaths. Methods and results A new self-expanding stent and delivery system (SDS) were deployed through a hydrophilic-coated (Cook® Flexor Ansel) Guiding Sheath into iliac and/or carotid arteries of 23 anesthetized Yucatan miniswine. Animals were euthanized at 3, 30, 90 and 180 days and brains were removed for histological analysis. In an additional single control animal, the guiding sheath was advanced but no SDS was deployed. Advancement of the coated guiding sheath with or without the SDS was associated with frequent foreign material in the arterioles of the brain. The embolic material was amorphous, non-refractile, non-crystalline, and non-birefringent and typically lightly basophilic with a slight stippled appearance on hematoxylin and eosin (H&E) stain. Material was observed at all time points involving 54% of all study animals (ie, test and control) and in vitro after incubation in 0.9% saline. Conclusions The hydrophilic coating on a clinically used guiding sheath readily avulses and embolizes to the brain during deployment in a porcine model. Further documentation of this effect and monitoring in clinical scenarios is warranted. PMID:25735934

  1. Flexible Ureteroscopy Can Be More Efficacious in the Treatment of Proximal Ureteral Stones in Select Patients

    PubMed Central

    Alkan, Erdal; Sarıbacak, Ali; Ozkanli, Ahmet Oguz; Basar, Mehmet Murad; Acar, Oguz; Balbay, Mevlana Derya

    2015-01-01

    Purpose. We aimed to compare and evaluate the outcomes and complications of two endoscopic treatment procedures, semirigid ureteroscopy (SR-URS) and flexible ureteroscopy (F-URS), in the treatment of proximal ureteral stones (PUS). Methods. SR-URS (group 1) was done on 68 patients whereas 64 patients underwent F-URS (group 2) for the treatment of PUS. Success rate was defined as the absence of stone fragments or presence of asymptomatic insignificant residual fragments < 2 mm. Outcomes and complications were recorded. Results. The differences were statistically not significant in age, gender, body mass index (BMI), and stone characteristics between groups. Mean ureteral stone size was 9.1 ± 0.4 mm and 8.9 ± 0.5 mm for groups 1 and 2. Mean operative time was 34.1 ± 1.5 min and 49.4 ± 2.3 min for groups 1 and 2 (p = 0.001). SFRs were 76.5% and 87.5% for groups 1 and 2 (p = 0.078). Two major complications (ureteral avulsion and ureteral rupture) occurred in group 1. Conclusion. F-URS is safer and less invasive than SR-URS in patients with PUS. There is no statistically significant difference in the efficacy of either technique. Nonetheless we recommend F-URS in the management of PUS as a first-line treatment option in select cases of proximal ureteral calculi. PMID:26617636

  2. Integrating engineering principles into the medico-legal investigation of a rare fatal rollover car accident involving complex dynamics.

    PubMed

    Grassi, Vincenzo M; Castagnola, Flaminia; Miscusi, Massimo; De-Giorgio, Fabio

    2016-09-01

    Rollover car accidents can be the result of forceful steering or hitting an obstacle that acts like a ramp. Mortality from this type of car accident is particularly high, especially when occupants are thrown out of the vehicle. We report a case of a 67-year-old man who died after a rollover accident that occurred when he was driving a car equipped with a glass moonroof. He was found inside his car with his safety belt correctly fastened and the roof shattered. At autopsy, a wide avulsion injury of the head was observed, which was associated with an atlanto-axial dislocation and full-thickness fracture of the cervical body and posterior facet joints of the seventh cervical vertebra. The data collected at the scene of the accident were integrated with the autopsy results to yield a forensic engineering reconstruction. This reconstruction elucidated the dynamics of the event and correctly ascribed the lesions observed at autopsy to the phases of the rollover. Afterward, an analysis of the scientific literature concerning rollover crash tests was conducted to understand why the driver sustained fatal injuries even though his seatbelt was properly fastened. PMID:27406628

  3. Epidemiologic study of dogs with the displacement or deformity of the medial and lateral fabellae in Japan.

    PubMed

    Yasukawa, Shinji; Edamura, Kazuya; Tanegashima, Koji; Kai, Hirotaka; Higuchi, Go; Nagasawa, Momoyo; Teshima, Kenji; Asano, Kazushi; Nakayama, Tomohiro

    2016-02-01

    The prevalences of displacement and deformity of the medial and lateral fabellae in dogs were investigated. This was a retrospective epidemiologic study. Radiographs of canine stifle joints (1022 limbs, 534 dogs) were obtained. The images were taken at the Nihon University Animal Medical Center and three private animal hospitals from January 2003 to July 2012. The position and morphology of the medial or lateral fabella were evaluated on the radiographs. The prevalence of displacement of the medial and lateral fabellae was 1.7% and 0.3%, respectively. The prevalence of deformity of the medial and lateral fabellae was 6.9% and 4.6%, respectively. Aplasia or hypoplasia of the fabella was detected more frequently in the medial fabella. On the other hand, a bipartite or multipartite fabella was observed more frequently in the lateral fabella. Nearly all cases of displacement or deformity of the fabella occurred in dogs weighing less than 10 kg. Abnormalities of the fabella were observed in the medial and lateral fabella. We found that abnormal fabellae were closely associated with medial patellar luxation and to a lesser extent with cranial cruciate ligament rupture. No clinical signs were associated with an abnormality of the fabella, with the exception of two dogs with traumatic avulsion of the lateral head of the gastrocnemius muscle. PMID:27348887

  4. Influence of Biochemical Composition on Endplate Cartilage Tensile Properties in the Human Lumbar Spine

    PubMed Central

    Fields, Aaron J.; Rodriguez, David; Gary, Kaitlyn N.; Liebenberg, Ellen C.; Lotz, Jeffrey C.

    2014-01-01

    Endplate cartilage integrity is critical to spine health and is presumably impaired by deterioration in biochemical composition. Yet, quantitative relationships between endplate biochemical composition and biomechanical properties are unavailable. Using endplate cartilage harvested from human lumbar spines (six donors, ages 51–67 years) we showed that endplate biochemical composition has a significant influence on its equilibrium tensile properties and that the presence of endplate damage associates with a diminished composition–function relationship. We found that the equilibrium tensile modulus (5.9±5.7 MPa) correlated significantly with collagen content (559±147 μg/mg dry weight, r2=0.35) and with the collagen/GAG ratio (6.0±2.1, r2=0.58). Accounting for the damage status of the adjacent cartilage improved the latter correlation (r2=0.77) and indicated that samples with adjacent damage such as fissures and avulsions had a diminished modulus–collagen/GAG relationship (p=0.02). Quasi-linear viscoelastic relaxation properties (C, t1, and t2) did not correlate with biochemical composition. We conclude that reduced matrix quantity decreases the equilibrium tensile modulus of human endplate cartilage and that characteristics of biochemical composition that are independent of matrix quantity, that is, characteristics related to matrix quality, may also be important. PMID:24273192

  5. Treatment of root surface in delayed tooth replantation: a review of literature.

    PubMed

    Panzarini, Sônia Regina; Gulinelli, Jéssica Lemos; Poi, Wilson Roberto; Sonoda, Celso Koogi; Pedrini, Denise; Brandini, Daniela Atili

    2008-06-01

    The time elapsed between a trauma and tooth replantation usually ranges from 1 to 4 h. The chances of root surface damage are higher when tooth replantation is not performed immediately or if the avulsed tooth is not stored in an adequate medium. This invariably leads to necrosis of pulp tissue, periodontal ligament cells and cementum, thus increasing the possibility of root resorption, which is the main cause of loss of replanted teeth. This paper presents a comprehensive review of literature on root surface treatments performed in cases of delayed tooth replantation with necrotic cemental periodontal ligament. Journal articles retrieved from PubMed/MedLine, Bireme and Scielo databases were reviewed. It was observed that, when there are no periodontal ligament remnants and contamination is under control, replacement resorption and ankylosis are the best results and that, although these events will end up leading to tooth loss, this will happen slowly with no loss of the alveolar ridge height, which is important for future prosthesis planning. PMID:18410388

  6. Dental trauma involving root fracture and periodontal ligament injury: a 10-year retrospective study.

    PubMed

    Panzarini, Sônia Regina; Pedrini, Denise; Poi, Wilson Roberto; Sonoda, Celso Koogi; Brandini, Daniela Atili; Monteiro de Castro, José Carlos

    2008-01-01

    The purpose of this retrospective study was to analyze the cases of traumatic dental injuries involving root fracture and/or periodontal ligament injury (except avulsion) treated at the Discipline of Integrated Clinic, School of Dentistry of Araçatuba, São Paulo State University (UNESP), Brazil, from January 1992 to December 2002. Clinical and radiographic records from 161 patients with 287 traumatized teeth that had sustained root fracture and/or injuries to the periodontal ligament were examined. The results of this survey revealed that subluxation (25.09%) was the most common type of periodontal ligament injury, followed by extrusive luxation (19.86%). There was a predominance of young male patients and most of them did not present systemic alterations. Among the etiologic factors, the most frequent causes were falls and bicycle accidents. Injuries on extraoral soft tissues were mostly laceration and abrasion, while gingival and lip mucosa lacerations prevailed on intraoral soft tissues injuries. Radiographically, the most common finding was an increase of the periodontal ligament space. The most commonly performed treatment was root canal therapy. Within the limits of this study, it can be concluded that traumatic dental injuries occur more frequently in young male individuals, due to falls and bicycle accidents. Subluxation was the most common type of periodontal ligament injury. Root canal therapy was the type of treatment most commonly planned and performed. PMID:18949308

  7. Intracanal dressing and root canal filling materials in tooth replantation: a literature review.

    PubMed

    Panzarini, Sônia Regina; Trevisan, Carolina Lunardelli; Brandini, Daniela Atili; Poi, Wilson Roberto; Sonoda, Celso Koogi; Luvizuto, Eloá Rodrigues; Dos Santos, Cláudia Letícia Vendrame

    2012-02-01

    The prognosis of tooth replantation is usually related to the need of endodontic treatment, which has a direct relationship with the occurrence of root resorptions. Several studies have been undertaken in an attempt to prevent, delay, or treat these complications, which are the main causes of loss of replanted teeth. This literature review examines research evidence on intracanal dressings and root canal filling materials used in cases of tooth replantation. A comprehensive search was performed in the Medline/Pubmed, Bireme and Scielo full-text electronic journal databases to retrieve English-language articles referring to these topics that had been published between 1964 and 2010. Calcium hydroxide (CH) remains the usually recommended choice as an intracanal medicament in replanted teeth; however, there is evidence to support the initial use of a corticosteroid-antibiotic combination such as Ledermix paste to control potential early resorption, prior to the introduction of CH where the beneficial effect in the treatment of progressive root resorption has been well proven. Regarding root filling materials, CH-containing sealers are a good option because of their biological properties. Accurate diagnosis and adequate treatment plan may constitute very complex tasks, particularly in tooth avulsion because several variables are involved. In addition to the technical knowledge and clinical experience directed toward the quality of treatment, patient education may favorably influence the survival of replanted teeth. PMID:22230725

  8. Holocene floodplain soils along the Río Mamoré, northern Bolivia, and their implications for understanding inundation and depositional patterns in seasonal wetland settings

    NASA Astrophysics Data System (ADS)

    May, Jan-Hendrik; Plotzki, Anna; Rodrigues, Leonor; Preusser, Frank; Veit, Heinz

    2015-12-01

    The Llanos de Moxos (LM) in the Bolivian Amazon basin host one of the largest seasonally inundated savannah landscapes on Earth. Very little is known of this area with regard to sedimentary dynamics, soil formation, or their relationship to longer-term climatic and hydrological variability in this setting. Here we present a detailed study of three floodplain depositional sequences building up the inundation savannah along the Mamoré River in the central LM. Pleistocene sands and silts (unit 1) are overlain by thick overbank deposits of mostly Holocene age (unit 2) on both sides of the Mamoré River, and underline the importance of extensive flooding processes for the late Quaternary sedimentary and geomorphic evolution of the LM. The fine-grained distal overbank sediments show signs of strong modification by hydromorphic processes and reflect spatial and temporal variations in flood inundation patterns. In addition, widespread dark gray to blackish soil and paleosol horizons are intercalated with the overbank sediments, but lack evidence for significant weathering. These horizons are likely the result of cumulative incorporation of organic material under conditions of particularly low sedimentation rates. Therefore, their formation should be linked to processes such as channel migration, longer-term meanderbelt evolution, avulsive drainage reorganization, changes in sediment supply or climatically induced variations in flooding type, frequency or magnitude. The common occurrence of these floodplain soils in the early to mid-Holocene may thus reflect the combined effects of hydrological, geomorphic and sedimentary changes during a drier mid-Holocene.

  9. Trichophytum rubrum endonyx onychomycosis resistant to standard oral and topical therapies.

    PubMed

    Mulvaney, Patrick M; Telang, Gladys H; Jellinek, Nat

    2015-01-01

    We present a 45 year-old man with an eight-year history of discoloration of the nail plate on his left hallux. He had been treated with two courses of oral terbinafine and topical 8% ciclopirox for presumed onychomycosis. On exam, his left great toenail contained a wide yellow-white longitudinal band involving a majority of the nail plate. No subungual debris, hyperkeratosis, or paronychial inflammation was present in the affected nail. Histopathology of the nail plate revealed numerous fungal elements arranged transversely and longitudinally, solely within the keratin layers of the nail plate; these were highlighted with periodic acid-Schiff (PAS) stain confirming endonyx onychomycosis. Cultures grew Trichophyton rubrum. All types of onychomycosis under the new classification system proposed by Hay et al. have now been associated with T. rubrum. Endonyx related to T. rubrum may be a particularly difficult infection to treat with oral or topical agents owing to the absence of robust local immune response and limited drug penetration to the interior nail plate. Physicians should be aware that this type of infection may require treatment with dual-agent therapy or alternative modalities including chemical or surgical plate avulsion or photodynamic therapy. PMID:26437286

  10. Implantable Port Devices, Complications and outcome in Pediatric Cancer, a Retrospective Study

    PubMed Central

    Esfahani, H; Ghorbanpor, M; Tanasan, A

    2016-01-01

    Background Peripheral blood vessels, due to availability are used for many years in cancer patients, however in patients with potentially harmful drugs to skin (vesicant drugs) or difficult accessibility to vessels, the use of implantable port (totally implantable venous access port-TIVAP) devices with central vascular access are important. Materials and Methods In this retrospective study, 85 pediatric cancer patients younger than 16 years, with TIVAP implantation, were followed for their complications and outcome. In addition to demographic data, patients’ port complications were assessed and compared with published articles. Results Mean days of implanted port usage were 531 ± 358 days in all patients. This period was 287 ±194 days in complicated patients. Complications included as infection (tunnel infection and catheter related blood-stream infection), malfunction and thrombosis, skin erosion, tube avulsion, and tube adhesion to the adjacent vessels were seen in 30.6% of patients. Conclusion According to the published data and this experience, the most common complications in TIVAP are infection and catheter malfunction. It is important to notice that in order to prolong its efficacious life, effective sterilization methods, prevention of clot formation and trauma, are the most useful measures. PMID:27222696

  11. Long-term results of cementless primary total hip arthroplasty with a threaded cup and a tapered, rectangular titanium stem in rheumatoid arthritis and osteoarthritis.

    PubMed

    Zwartele, Rob; Peters, Anil; Brouwers, Johannes; Olsthoorn, Paul; Brand, Ronald; Doets, Cornelis

    2008-10-01

    The aim of this study was to assess the outcome of primary cementless total hip arthroplasty in rheumatoid arthritis patients and to compare the results with osteoarthritis patients. Sixty-four patients (77 hips) with rheumatoid arthritis and 120 patients (135 hips) with osteoarthritis had a conical-shaped Zweymueller threaded cup and a tapered, rectangular Zweymueller stem implanted and were assessed after an average of 12.5 years. The endpoints for survival analysis were failure of one or both components due to radiographic loosening or revision. Revision was defined as exchange of cup, stem or both. When the PE-insert or the ceramic ball head were exchanged leaving cup and stem in place, e.g. for PE-wear or dislocation, this was not considered a revision but a re-intervention. No differences were found in survival rates; however, in the rheumatoid arthritis group there was an increased rate of malposition of the cup, avulsions of the greater trochanter, and increased bone resorption in the trochanteric region. This study shows that despite altered biomechanical properties of rheumatoid bone, mechanical stability and osseous integration of cementless prosthesis are not compromised and, although a higher complication rate did occur, long-term survival is excellent. PMID:17609955

  12. Compartmentalized Toxoplasma EB1 bundles spindle microtubules to secure accurate chromosome segregation

    PubMed Central

    Chen, Chun-Ti; Kelly, Megan; de Leon, Jessica; Nwagbara, Belinda; Ebbert, Patrick; Ferguson, David J. P.; Lowery, Laura Anne; Morrissette, Naomi; Gubbels, Marc-Jan

    2015-01-01

    Toxoplasma gondii replicates asexually by a unique internal budding process characterized by interwoven closed mitosis and cytokinesis. Although it is known that the centrosome coordinates these processes, the spatiotemporal organization of mitosis remains poorly defined. Here we demonstrate that centrosome positioning around the nucleus may signal spindle assembly: spindle microtubules (MTs) are first assembled when the centrosome moves to the basal side and become extensively acetylated after the duplicated centrosomes reposition to the apical side. We also tracked the spindle MTs using the MT plus end–binding protein TgEB1. Endowed by a C-terminal NLS, TgEB1 resides in the nucleoplasm in interphase and associates with the spindle MTs during mitosis. TgEB1 also associates with the subpellicular MTs at the growing end of daughter buds toward the completion of karyokinesis. Depletion of TgEB1 results in escalated disintegration of kinetochore clustering. Furthermore, we show that TgEB1’s MT association in Toxoplasma and in a heterologous system (Xenopus) is based on the same principles. Finally, overexpression of a high-MT-affinity TgEB1 mutant promotes the formation of overstabilized MT bundles, resulting in avulsion of otherwise tightly clustered kinetochores. Overall we conclude that centrosome position controls spindle activity and that TgEB1 is critical for mitotic integrity. PMID:26466679

  13. Surface and subsurface features of the upper Pleistocene Beaumont Formation as studied in a proposed super collider site in Liberty and Hardin counties, southeastern Texas

    SciTech Connect

    Aronow, S.

    1994-12-31

    In 1987 an area in Hardin and Libery Counties in southeastern Texas was a much-studied candidate site for the ill-fated Superconducting Super Collider. The site is on the outcrop of the upper Pleistocene Beaumont Formation, which locally was deposited by a sequence of meandering, avulsing, suspended-load, paleo-Trinity River courses, now preserved as a well-defined to poorly defined depositional topography. Test holes in meanderbelt ridges showed that channel and point-bar silty fine to very fine sands are almost everywhere covered by approximately 10 to 40 ft ({approximately}3 to 12 m) of CH and CL overbank clays. Where completely penetrated, sand bodies are approximately 20 to 50 ft ({approximately}6 to 15 m) thick. Pedogenic calcareous deposits and slickensides at depths well below any influence from present-day surface processes are probably parts of lower horizons of truncated now-buried soils generated during the accumulation of the Beaumont, or on the surface of the underlying Lissie Formation. The relationship of one of the paleo-meanderbelts to the uplifted topographic surface of the Hull salt dome suggests that the rise of the surface postdated deposition of the Beaumont.

  14. Prevalence of Traumatic Dental Injuries in Patients Attending University of Alberta Emergency Clinic

    PubMed Central

    Alkhadra, Thamer; Preshing, William; El-Bialy, Tarek

    2016-01-01

    Objectives: This study evaluated the prevalence of dental trauma for patients attending the emergency dental clinic at the University of Alberta Hospital between 2006-2009. Patients’ examination and treatment charts were reviewed. Methods: Total number of patients’ charts was 1893.The prevalence of different types of trauma was 6.4 % of the total cases (117 patients). Trauma cases were identified according to Ellis classification and as modified by Holland et al., 1988. Results: Logistic statistical model showed that 21.7% were Ellis class I trauma, 16.7% were Ellis class II trauma, and 6.7% were Ellis class III. In addition, 11.7 % presented with avulsion, 7.5 % presented with dentoalveolar fracture and 7.5% presented with sublaxation. Also, 17.55 % presented with tooth displacement within the alveolar bone, 3.3 % presented with crown fracture with no pulp involvement, 4.16 % presented with crown fracture with pulp involvement and 3.3 % presented with root fracture. In conclusion, the general prevalence of dentoalveolar trauma in patients attending the emergency clinic at the University of Alberta is less than other reported percentages in Canada or other countries. PMID:27398104

  15. Orofacial injuries associated with prehospital management of febrile convulsion in Nigerian children.

    PubMed

    Ndukwe, Kizito C; Folayan, Morenike O; Ugboko, Vincent I; Elusiyan, Jerome B E; Laja, Olajumoke O

    2007-04-01

    The aim of this prospective study was to determine in a population of pediatric patients with febrile convulsions the prevalence and pattern of orofacial and dental injuries caused by traditional remedies used in a suburban Nigerian community. Over the study period of 28 months, 75 cases of febrile convulsion presented to the Children's Emergency unit of our hospital. Of these, 27 children (36%) sustained orofacial injuries caused by forceful insertion of a spoon into the mouth (96.3%) or a bite (3.7%) during convulsive episodes. The ages of the patients ranged from 12 to 84 months with a mean 39.8 +/- 18.3 months. There were 15 males and 11 females with a male to female ratio of 1.4:1. The orofacial and dental injuries sustained from prehospital treatment at home were lacerations and bruising of soft tissues including lips, tongue, mucosa and commissures and tooth subluxation, displacement or avulsion. Other injuries sustained outside the mouth include second-degree burns to the feet, a chin laceration and facial bruises resulting from a fall. Many oral injuries were overlooked by pediatricians. Prompt recognition and appropriate management of febrile convulsion would be of great benefit to the pediatric patients. PMID:17367452

  16. Effects of Jackson Lake Dam on the Snake River and its floodplain, Grand Teton National Park, Wyoming, USA

    NASA Astrophysics Data System (ADS)

    Marston, Richard A.; Mills, John D.; Wrazien, David R.; Bassett, Beau; Splinter, Dale K.

    2005-10-01

    In 1906, the Bureau of Reclamation created Jackson Lake Dam on the Snake River in what later became Grand Teton National Park. The geomorphic, hydrologic and vegetation adjustments downstream of the dam have yet to be documented. After a larger reservoir was completed further downstream in 1957, the reservoir release schedule from Jackson Lake Dam was changed in a manner that lowered the magnitude and frequency of floods. The stability of the Snake River exhibited a complex response to the change in flow regime. Close to major tributaries, the Snake River increased in total sinuosity and rates of lateral channel migration. Away from the influence of tributaries, the river experienced fewer avulsions and a decrease in sinuosity. Vegetation maps were constructed from 1945 and 1989 aerial photography and field surveys. Using these data, we determined how vegetation is directly related to the number of years since each portion of the floodplain was last occupied by the channel. The vegetation has changed from a flood-pulse dominated mosaic to a more terrestrial-like pattern of succession. Changes in the Snake River and its floodplain have direct implications on bald eagle habitat, moose habitat, fish habitat, safety of rafting and canoeing, and biodiversity at the community and species levels.

  17. Catchment- and reach-scale controls on the distribution and expectation of geomorphic channel adjustment

    NASA Astrophysics Data System (ADS)

    Lisenby, Peyton E.; Fryirs, Kirstie A.

    2016-05-01

    Variability in channel function (behavior) can be assessed by characterizing different forms of adjustment over time. Here, historical channel adjustments in three tributary systems of the Lockyer Valley, Southeast Queensland (SEQ) are analyzed in order to evaluate the range of catchment- and reach-scale controls on channel behavior. Over 300 individual adjustments and 13 forms of adjustment were identified over a ˜130 year time span. We measured the width-to-depth ratio (W:D), mean stream power (ω), and basin area (A) at the location of all observed adjustments. The most common forms of adjustment were avulsions, lateral expansion of the channel, and bend adjustments. The tributary systems behave distinctly different from one another according to statistical comparisons between the W:D, ω, and A data for these forms of adjustment. We find that it is possible to develop process domains or typologies for forms of geomorphic adjustment found in the Lockyer Valley. These domains or typologies provide the foundations for synoptic comparisons between catchments and assessing the expectation of channel adjustment (forecasting), which should be included in process-based river management practice.

  18. Pelvic floor ultrasound: a review.

    PubMed

    Dietz, Hans Peter

    2010-04-01

    Imaging currently plays a limited role in the investigation of pelvic floor disorders. It is obvious that magnetic resonance imaging has limitations in urogynecology and female urology at present due to cost and access limitations and due to the fact that it is generally a static, not a dynamic, method. However, none of those limitations apply to sonography, a diagnostic method that is very much part of general practice in obstetrics and gynecology. Translabial or transperineal ultrasound is helpful in determining residual urine; detrusor wall thickness; bladder neck mobility; urethral integrity; anterior, central, and posterior compartment prolapse; and levator anatomy and function. It is at least equivalent to other imaging methods in visualizing such diverse conditions as urethral diverticula, rectal intussusception, mesh dislodgment, and avulsion of the puborectalis muscle. Ultrasound is the only imaging method able to visualize modern mesh slings and implants and may predict who actually needs such implants. Delivery-related levator trauma is the most important known etiologic factor for pelvic organ prolapse and not difficult to diagnose on 3-/4-dimensional and even on 2-dimensional pelvic floor ultrasound. It is likely that this will be an important driver behind the universal use of this technology. This review gives an overview of the method and its main current uses in clinical assessment and research. PMID:20350640

  19. The role of two- and three-dimensional dynamic ultrasonography in pelvic organ prolapse.

    PubMed

    Dietz, Hans Peter

    2010-01-01

    The assessment of pelvic organ prolapse has to date been limited to the clinical evaluation of surface anatomy. This is clearly insufficient. As a result, imaging of pelvic floor function and anatomy is moving from the fringes to the mainstream of obstetrics and gynecology. This is mainly due to the realization that pelvic floor trauma in labor is common, generally overlooked, and a major factor in the causation of pelvic organ prolapse. Modern imaging methods such as magnetic resonance and 3-dimensional ultrasonography have enabled us to diagnose such abnormalities reliably and accurately, most commonly in the form of an avulsion of the puborectalis muscle off its insertion on the os pubis. However, ultrasonography has other advantages in the assessment of pelvic organ prolapse, most notably in the differential diagnosis of posterior compartment prolapse, which can be due to at least 5 different conditions. In this review I will try to summarize the methods of prolapse and pelvic floor assessment by translabial ultrasonography and to describe the most common abnormalities and their consequences. This article will not deal with magnetic resonance imaging because I consider this technology to be of limited clinical utility due to technical restrictions, expense, and access issues. PMID:20171938

  20. Pelvic floor ultrasonography: an update.

    PubMed

    Shek, K L; Dietz, H-P

    2013-02-01

    Female pelvic floor dysfunction encompasses a number of highly prevalent clinical conditions such as female pelvic organ prolapse, urinary and fecal incontinence, and sexual dysfunction. The etiology and pathophysiology of those conditions are, however, not well understood. Recent technological advances have seen a surge in the use of imaging, both in research and clinical practice. Among the techniques available such as sonography, X-ray, computed tomography and magnetic resonance imaging, ultrasound is superior for pelvic floor imaging, especially in the form of perineal or translabial imaging. The technique is safe with no radiation, simple, cheap, easily accessible and provides high spatial and temporal resolutions. Translabial or perineal ultrasound is useful in determining residual urinary volume, detrusor wall thickness, bladder neck mobility and in assessing pelvic organ prolapse as well as levator function and anatomy. It is at least equivalent to other imaging techniques in diagnosing, such diverse conditions as urethral diverticula, rectal intussusception and avulsion of the puborectalis muscle. Ultrasound is the only imaging method capable of visualizing modern slings and mesh implants and may help selecting patients for implant surgery. Delivery-related levator injury seems to be the most important etiological factor for pelvic organ prolapse and recurrence after prolapse surgery, and it is most conveniently diagnosed by pelvic floor ultrasound. This review gives an overview of the methodology. Its main current uses in clinical assessment and research will also be discussed. PMID:23412016

  1. Modified arthroscopic suture fixation of a displaced tibial eminence fracture.

    PubMed

    Lehman, Ronald A; Murphy, Kevin P; Machen, M Shaun; Kuklo, Timothy R

    2003-02-01

    This study describes a new arthroscopic method using a whip-stitch technique for treating a displaced type III tibial eminence fracture. A 12-year-old girl who sustained a displaced type III tibial eminence fracture was treated with arthroscopic fixation using the Arthrosew disposable suture device (Surgical Dynamics, Norwalk, CT) to place a whip stitch into the anterior cruciate ligament (ACL). The Arthrex ACL guide (Arthrex, Naples, FL) was used to reduce the avulsed tibial spine fragment. Sutures were then passed through the tibial tunnel and secured over a bony bridge with the knee in 20 degrees of flexion. At 9 months, the patient has a full range of motion with normal Lachman and anterior drawer testing, and she has returned to competitive basketball. Radiographs show complete fracture healing. KT-1000 and isokinetic testing at 9-month follow-up show only minimal side-to-side differences. The Arthrosew device provides a significant advantage in the treatment of type III and IV fractures of the tibial eminence by obtaining arthroscopic fixation within the substance of the ACL, thus obviating arthrotomy and hardware placement. This technique also restores the proper length and tension to the ACL, and provides a simplified, reproducible method of treatment for this injury. PMID:12579135

  2. Modeling flood dynamics along the superelevated channel belt of the Yellow River over the last 3000 years

    NASA Astrophysics Data System (ADS)

    Chen, Yunzhen; Overeem, Irina; Kettner, Albert J.; Gao, Shu; Syvitski, James P. M.

    2015-07-01

    The Yellow River, China, experienced >1000 levee breaches during the last 3000 years. A reduced-complexity model is developed in this study to explore the effects of climate change and human activity on flood levels, levee breaches, and river avulsions. The model integrates yearly morphological change along a channel belt with daily river fluxes and hourly evolution of levee breaches. Model sensitivity analysis reveals that under natural conditions, superelevation of the channel belt dominates flood frequency. When there is significant human-accelerated basin erosion and breach repair, the dominant factors shift to a combination of mean annual precipitation, superelevation, critical shear stress of weak channel banks, and the time interval between breach initiation and its repair. The effect of precipitation on flood frequency is amplified by land use changes in the hinterland, particularly in the erodible Loess Plateau. Uncertainty analysis estimates the most likely values of the dominant factors for six historical periods between 850 B.C. and A.D. 1839, which are used to quantitatively reconstruct flood dynamics. During 850 B.C. to A.D. 1839, when the sediment load increased fourfold, the breach recurrence interval was shortened from more than 500 years to less than 6 years, and the breach outflow rate increased ~27 times. River management practices during A.D. 1579 to A.D. 1839 focused on levees and triggered a severe positive feedback of increased levee heights and flood hazard exacerbation. Raising the levee heights proved to be ineffective for sustainable flood management.

  3. Influence of contralateral homologous cortices on motor cortical reorganization after brachial plexus injuries in rats.

    PubMed

    Zhang, Jie; Chen, Liang; Gu, Yu-dong

    2015-10-01

    Brachial plexus injuries induce corresponding cortical representations to be occupied by adjacent cortices. The purpose of this study was to clarify if contralateral homologous motor regions of adjacent cortices influence occupation of deafferented motor cortex. 36 rats were divided into 3 groups of 12 each. In group 1, total brachial plexus root avulsion (tBPRA) was made on the left side. In group 2, rats underwent left tBPRA combined with corpus callosum transection (CCX). In group 3, only CCX was performed. 6 rats in each group were used for intracortical microstimulation (ICMS) to map representations of motor cortex in the right hemisphere at 7 days and the other 6 rats, at 3 months. 18 more rats without any operation underwent ICMS, with 6 each taken to serve as normal control for motor cortical representations' changes caused by different surgery. Results showed that in groups 1 and 2, sites for motor cortical representations of vibrissae, of neck and of the hindlimb was statistically more than that of control, respectively, and statistically more sites were found at 3 months than at 7 days, respectively. At the two time points, sites for vibrissa cortices and that for the hindlimb were statistically more in group 2 than in group 1, respectively. CCX alone did not induce change of site number for motor cortical representations. We conclude that after tBPRA, contralateral homologous motor cortices may, to some extent, prevent neighboring cortices from encroachment on motor cortical representations of the brachial plexus. PMID:26314511

  4. MR arthrogram findings of luxatio erecta in a pediatric patient-arthroscopic confirmation and review of the literature.

    PubMed

    Stensby, J Derek; Fox, Michael G

    2014-08-01

    Luxatio erecta or inferior glenohumeral dislocation is a rare type of shoulder dislocation, accounting for less than 1 % of all reported shoulder dislocations. We describe a 15-year-old male who presented with luxatio erecta following an injury to his shoulder that resulted from a mountain biking accident. Clinically, the patient had shoulder pain and fixed abduction of the arm. Radiographs confirmed the diagnosis of luxatio erecta. A magnetic resonance arthrogram (MRA) performed 9 days after presentation demonstrated both a greater tuberosity fracture and avulsion of the anterior and posterior inferior glenohumeral ligaments from their humeral attachment. The MR findings were confirmed on arthroscopy. The bone and soft tissue injury pattern seen in our patient clearly supports the described mechanism of injury for luxatio erecta and lends credence to the theory that a fracture of the greater tuberosity spares injury to the rotator cuff, especially in children. A review of the literature failed to reveal any prior description of the MRI or MRA findings of luxatio erecta in a pediatric patient or any publication with arthroscopic confirmation of the MR findings. PMID:24695879

  5. Eustatic and tectonic control of sedimentation in the Pennsylvanian strata of the Central Appalachian Basin

    SciTech Connect

    Chesnut, D.R. Jr. . Kentucky Geological Survey)

    1992-01-01

    Analysis of the Breathitt Group of the Central Appalachian Basin reveals three orders of depositional cycles or trends. The Breathitt coarsening-upward trend (20 million years (my)) represents increasing intensity of the Alleghenian Orogeny. The major transgression (MT) cycle (2.5 my) was controlled by an unknown eustatic or tectonic mechanism. The major coal beds and intervening strata make up the coal-clastic cycle (CC cycle) (=Appalachian cyclothem) which has a 0.4 my periodicity. This periodicity supports eustatic control of sedimentation modulated by an orbital periodicity. Extensive coastal peats deposited at lowstand (CC cycle) were preserved as coals, whereas highstand peats were eroded during the subsequent drop in sea level. Autocyclic processes such as delta switching and avulsion occurred within CC cycles. An Early Pennsylvanian unconformity represents uplift and erosion of mid-Carboniferous foreland basin deposits. Alluvial deposits (Breathitt Group) derived from the highlands were transported to the northwest toward the forebulge. During lowstand, the only outlet available to further sediment transport (Lee sandstones) was toward the southwest (Ouachita Trough), along the Black Warrior-Appalachian foreland basins. The Middle Pennsylvanian marks a period of intermittent overfilling of the foreland basin and cresting of the forebulge. Marine transgressions entered through the foreland basins and across saddles in the forebulge. After the Ouachita Trough was destroyed during the late Middle Pennsylvanian, marine transgressions migrated only across saddles in the forebulge. In the Late Pennsylvanian, marine waters entered the basin only across the diminished forebulge north of the Jessamine Dome.

  6. Fractured rheumatoid elbow: treatment with Souter elbow arthroplasty--a clinical and radiologic midterm follow-up study.

    PubMed

    Ikävalko, M; Lehto, M U

    2001-01-01

    We report the results in 26 patients who had 32 preoperative fractures treated with Souter elbow arthroplasty. All were rheumatoid patients with a mean disease duration of 29.7 years (range, 10 to 43). Six of the fractures were of the olecranon and 26 of the distal humerus. The time interval between fracture and arthroplasty was 9 months (mean; range, 0 to 48). Fragments were not excised, and osteosynthesis was performed. The follow-up was 2.6 years (mean; range, 0.5 to 8), when 20 of the fractures had united and 12 had not. K-wire fixation, either alone or in combination with cerclage or PDS suture, and bone grafting led to satisfactory results. Union was verified in 14 of 17 cases treated with this technique. There were no severe early complications. Six patients had late complications. In 3 cases, loosening of the humeral component was observed radiologically. One patient had a hematogenous deep infection 4 years after the operation, and 2 patients had avulsion rupture of the triceps tendon. Fracture in the badly destroyed elbow can be more reasonably treated with an arthroplasty than with an attempt of osteosynthesis before arthroplasty. If excision of the fragments is avoided, original, or near original, anatomy of the elbow joint can be better restored and acceptable outcome obtained with elbow arthroplasty. PMID:11408908

  7. The osteo-anconeus flap. An approach for total elbow arthroplasty.

    PubMed

    Wolfe, S W; Ranawat, C S

    1990-06-01

    Twenty-seven consecutive primary total elbow arthroplasties were done with a technique that preserved the continuity of the attachment of the triceps brachii muscle with a wafer of bone from the reflected extra-articular portion of the olecranon and with the lateral fascia of muscles of the forearm. During closure, the wafer was reattached to the broad cancellous surface of the olecranon with sutures through the bone. The elbows were immobilized for an average of sixteen days postoperatively. The patients who were available for follow-up were re-examined at an average of 3.9 years, and the strength of the triceps muscle was checked. No extensor lag or avulsion of the triceps occurred, and mild extensor weakness was seen in only two elbows. No patient had early or late drainage of the wound or infection. The average range of motion compared favorably with that in other reported series. This osteo-anconeus posterior approach is advocated for total elbow arthroplasty because it provides rapid and wide exposure, it is associated with a low rate of complications related to the wound, and it preserves the strength of the triceps. PMID:2355029

  8. Interactions of Growth-faulting with Incised Valleys and Channels on the Late Miocene to Recent Mississippi River Delta, LA

    NASA Astrophysics Data System (ADS)

    Armstrong, C. P.; Mohrig, D.; Steel, R. J.

    2011-12-01

    The interaction between incised valleys and growth-fault related subsidence is poorly understood in the Late Miocene to Recent Mississippi River Delta. Previous work has found little evidence that growth-faults are able to affect the course or geometry of small (< 200m in width and 20m in depth) channels. However, the relationship between growth-faults and larger scale valleys (> 1km in width and 25m in depth) has not been previously evaluated in this area. We use a 1400 km2 3D seismic volume located under Breton Sound, LA, integrated with a selection of well logs to document the effect of growth-faults on 12 valleys and 14 channels present within the upper 1.5 kilometers of the seismic volume. In contrast to the majority of smaller distributary channels found within the survey, valleys appear to be steered along or away from growth-faults. This observation suggests that faults are able to affect the course of valleys to a greater extent than small channels. We suggest that this is because valleys are long lived features which do not avulse before being influenced by shorter time scale faulting events. This study contributes to our understanding of the dynamics of growth-faults and valleys in the subsurface and has important long term societal implications for populations living near large rivers in areas with active growth-faulting.

  9. Influences of Relative Sea-Level Rise and Mississippi River Delta Plain Evolution on the Holocene Middle Amite River, Southeastern Louisiana

    NASA Astrophysics Data System (ADS)

    Autin, Whitney J.

    1993-01-01

    The Holocene geomorphic history of southeastern Louisiana's middle Amite River is recorded in the stratigraphy of three alloformations, identified in decreasing age as the Watson (WAT), Denham Springs (DS), and Magnolia Bridge (MAG). The WAT meander belt formed by at least 9000 yr B.P., when sea level was lower and the Amite River was tributary to a larger ancestral drainage basin. The DS became an active meander belt by at least 3000 yr B.P., in response to relative sea-level rise and eastward progradation of the Mississippi River delta plain. The MAG developed its meander belt, in part, during the European settlement of the drainage basin, and is now attempting to adjust to modern anthropogenic influences. Geomorphic influences on the middle Amite River floodplain have temporal and spatial components that induce regional- and local-scale effects. Regional extrinsic influences caused meander belt avulsion that produced alloformations. However, local influences produced intrinsic geomorphic thresholds that modified channel morphology within a meander belt but did not induce alloformation development. Base-level influences of the relative sea-level rise and the Mississippi River delta plain were so dominant that the effects of possible climate change were not recognized in the Holocene Amite River system.

  10. The Mississippi Delta Region: Past, Present, and Future

    NASA Astrophysics Data System (ADS)

    Blum, Michael D.; Roberts, Harry H.

    2012-05-01

    The Mississippi delta region of south Louisiana houses a wealth of resources within a dynamic, subsiding landscape. Foundations for the delta region reflect Neogene evolution of the depocenter, whereas details of the modern landscape reflect late Pleistocene to Holocene evolution of the alluvial-deltaic plain. The Holocene delta plain was constructed by cyclical growth of deltaic headlands, followed by avulsion and relocation of the fluvial sediment source. Abandoned headlands were then submerged and reworked while a new headland was created at the site of active fluvial sediment input. Historic-period levees have decoupled the delta plain from its fluvial sediment source at the same time global sea-level rise was accelerating, which has accelerated delta-plain submergence. Diversions of Mississippi River water and sediment are necessary to achieve delta plain sustainability, but upstream dams trap ˜50% of the total sediment load, and there is not enough supply to keep pace with subsidence and accelerated sea-level rise. The future delta region will not resemble the recent past, and significant drowning is inevitable.

  11. The Potential for Dams to Impact Lowland Meandering River Floodplain Geomorphology

    PubMed Central

    Marren, Philip M.; Grove, James R.; Webb, J. Angus; Stewardson, Michael J.

    2014-01-01

    The majority of the world's floodplains are dammed. Although some implications of dams for riverine ecology and for river channel morphology are well understood, there is less research on the impacts of dams on floodplain geomorphology. We review studies from dammed and undammed rivers and include influences on vertical and lateral accretion, meander migration and cutoff formation, avulsion, and interactions with floodplain vegetation. The results are synthesized into a conceptual model of the effects of dams on the major geomorphic influences on floodplain development. This model is used to assess the likely consequences of eight dam and flow regulation scenarios for floodplain geomorphology. Sediment starvation downstream of dams has perhaps the greatest potential to impact on floodplain development. Such effects will persist further downstream where tributary sediment inputs are relatively low and there is minimal buffering by alluvial sediment stores. We can identify several ways in which floodplains might potentially be affected by dams, with varying degrees of confidence, including a distinction between passive impacts (floodplain disconnection) and active impacts (changes in geomorphological processes and functioning). These active processes are likely to have more serious implications for floodplain function and emphasize both the need for future research and the need for an “environmental sediment regime” to operate alongside environmental flows. PMID:24587718

  12. Dynamic Magnetic Resonance Imaging and pelvic floor disorders: how and when?

    PubMed

    Pizzoferrato, Anne-Cécile; Nyangoh Timoh, Krystel; Fritel, Xavier; Zareski, Elise; Bader, Georges; Fauconnier, Arnaud

    2014-10-01

    Pelvic Floor Disorders (PFD) are a major public health problem in the world and decrease seriously the patient's quality of life. In case of recurrence after surgery or complex prolapse, imaging techniques can be used. Dynamic MRI, introduced in the early 1990s, offers information of the four compartments of the pelvis with a high resolution and a direct visualization of muscles and fascias in multiple planes. But for a practical use, such an expensive exam should be well correlated to symptoms and clinical examination or change surgical approach. The aim of our review was to precise the evidence regarding techniques, and indication of dynamic MRI in the assessment of pelvic floor disorders in daily practice. The first part is a review of available studies on methods of carrying out the dynamic MRI. The second part consists on the comparison of dynamic MRI to other assessment methods in case of pelvic floor disorders. Results emphasize the lack of strong level studies about the interest of dynamic MRI in the diagnosis and surgical management of pelvic organ prolapse. Although dynamic MRI appears highly reproducible between examiners, especially for the anterior compartment, its correlation with the degree of prolapse or the symptoms appears low. The most interesting field of application seems the detection of levator ani (LA) avulsion with a higher risk of prolapse and recidive in case of LA defects. More prospective, randomized, comparative studies have to be done. PMID:25212114

  13. Arthroscopic treatment for tibial "Peel off" tears in anterior cruciate ligament-case report.

    PubMed

    Ahn, Jin Hwan; Han, Kye Young; Yu, In Sang; Koh, Kyoung Hwan

    2013-11-01

    Anterior cruciate ligament (ACL) injury was very common, and its reconstruction is one of the most commonly performed orthopaedic surgeries. A standard treatment option for ACL complete rupture in active young patients is debridement of remnant tissue and reconstruction with various types of tendon graft. However, "A tibial peel off tear" of ACL without bony avulsion can be treated using preservation of original ACL and trans-osseous pullout suture repair. The IKDC subjective score was 90, the objective score was A, and the Lysholm score was 95 at 24 months after surgery. KT-2000 arthrometer showed 2 mm side-to-side difference. Pivot shift test and Lachman test were negative, and there was no limitation in range of motion. Patient returned to full activities including sports and satisfied with the surgical results. In the postoperative MRI at 6 months after the surgery, the continuity of ACL was well maintained without any Cyclops lesion. We believe that trans-osseous pullout suture repair could be included as an alternative method in this "tibial peel off" type ACL injury instead of the usual removal of remnant tissue and reconstruction with a graft. PMID:23412240

  14. Evaluation and comparison of efficacy of three different storage media, coconut water, propolis, and oral rehydration solution, in maintaining the viability of periodontal ligament cells

    PubMed Central

    Sanghavi, Tulsi; Shah, Nimisha; Parekh, Vaishali; Singbal, Kiran

    2013-01-01

    Background: Two of the most critical factors affecting the prognosis of an avulsed tooth after replantation are extra oral dry time and the storage medium in which the tooth is placed before treatment is rendered. However, the ability of a storage/transport medium to support cell viability can be more important than the extra oral time to prevent ankylosis and replacement resorption. Aim: Purpose of this study was evaluation and comparison of efficacy of a new storage medium, oral rehydration solution (ORS) with coconut water, and propolis in maintaining the viability of periodontal ligament (PDL) cells by using a collagenase-dispase assay. Materials and Methods: 40 teeth were selected with intact crown which were advised for Orthodontic extraction having healthy PDL. Teeth were then randomly divided into three experimental storage solution groups. Other 10 were divided into positive and negative control groups (5 each). Statistical Analysis and Result: The results were statistically analyzed with analysis of variance and multiple range by using post hoc tests. The results of the prevailing study indicated that coconut water group demonstrated a significantly higher number of viable PDL cells than propolis 50%, and ORS. There was no significant difference between coconut water and propolis 50% groups. PMID:23349581

  15. High-Energy Traumatic Maxillofacial Injury.

    PubMed

    Christensen, Jacob; Sawatari, Yoh; Peleg, Michael

    2015-07-01

    High-energy blunt or penetrating impact leads to great variability in facial injury patterns. Although the mechanism, pattern, and distribution of forces vary, the resultant damage to hard and soft tissues requires dedicated planning and execution of debridement and reconstructive procedures. This article evaluates the initial management of patients sustaining high-energy facial impact injuries resulting in one or more comminuted or displaced facial fractures, with accompanying severe facial lacerations and/or soft tissue defects and avulsion injuries. Seventy-three patients met the criteria for high-energy traumatic injuries at Jackson Memorial/University of Miami Medical Center between 2003 and 2013 and are included in this article. Thirty-nine patients sustained one or more gunshot wounds to the face, and 34 patients were involved in high-speed motor vehicle collisions; all patients met our criteria for high-energy trauma. The treatment protocol for these injuries involves meticulous surgical exploration and assessment, aggressive debridement, early definitive reduction/fixation, and reconstruction as necessary. PMID:26114523

  16. Properties and applications of calcium hydroxide in endodontics and dental traumatology.

    PubMed

    Mohammadi, Z; Dummer, P M H

    2011-08-01

    Calcium hydroxide has been included within several materials and antimicrobial formulations that are used in a number of treatment modalities in endodontics. These include, inter-appointment intracanal medicaments, pulp-capping agents and root canal sealers. Calcium hydroxide formulations are also used during treatment of root perforations, root fractures and root resorption and have a role in dental traumatology, for example, following tooth avulsion and luxation injuries. The purpose of this paper is to review the properties and clinical applications of calcium hydroxide in endodontics and dental traumatology including its antibacterial activity, antifungal activity, effect on bacterial biofilms, the synergism between calcium hydroxide and other agents, its effects on the properties of dentine, the diffusion of hydroxyl ions through dentine and its toxicity. Pure calcium hydroxide paste has a high pH (approximately 12.5-12.8) and is classified chemically as a strong base. Its main actions are achieved through the ionic dissociation of Ca(2+) and OH(-) ions and their effect on vital tissues, the induction of hard-tissue deposition and the antibacterial properties. The lethal effects of calcium hydroxide on bacterial cells are probably due to protein denaturation and damage to DNA and cytoplasmic membranes. It has a wide range of antimicrobial activity against common endodontic pathogens but is less effective against Enterococcus faecalis and Candida albicans. Calcium hydroxide is also an effective anti-endotoxin agent. However, its effect on microbial biofilms is controversial. PMID:21535021

  17. Multidisciplinary approach on rehabilitation of primary teeth traumatism repercussion on the permanent successor: 6-year follow-up case report.

    PubMed

    Mello-Moura, A C V; Bonini, G A V C; Suga, S S; Navarro, R S; Wanderley, M T

    2009-01-01

    Traumatic lesions in primary teeth are frequent in pediatric patients and can cause problems both to the deciduous tooth and permanent successor. The impact strength on deciduous tooth can reach the growing permanent tooth, affecting its morphology, structure and position, or even hampering its proper development. This report describes an aesthetic-functional rehabilitation process in an 8 year 10 month old boy during a multidisciplinary treatment held at the Clinical Center of Dental Trauma in Primary Teeth of the Pediatric Dentistry of Dental College of University of São Paulo, Brazil. The patient presented bilateral posterior cross bite and the permanent left upper central incisor with ectopic eruption and enamel hypoplasy, preceded by avulsion of element 61, occurred when the patient was 1.6 years old. After diagnosis and treatment planning, a quick expansion of jaws was recommended with Hass-type rapid expander and orthodontic leveling with fixed braces. Due to the ectopic eruption, the gingival contour had been altered and hypertrophia was found, compromising aesthetics and avoiding local hygienic procedures. Gingivoplasty was carried out with high-intensity Diode Laser, followed by aesthetic restoration with compound resin. It was concluded that after deciduous teeth traumatism it is important that the patient undergoes clinic and radiographic assistance until the permanent teeth erupt so that an adequate multidisciplinary treatment can be offered to the patient. PMID:19736508

  18. Effects of Active Subsidence Vs. Existing Basin Geometry on Fluviodeltaic Channels and Stratal Architecture

    NASA Astrophysics Data System (ADS)

    Liang, M.; Kim, W.; Passalacqua, P.

    2015-12-01

    Tectonic subsidence and basin topography, both determining the accommodation, are fundamental controls on the basin filling processes. Their effects on the fluvial organization and the resultant subsurface patterns remain difficult to predict due to the lack of understanding about interaction between internal dynamics and external controls. Despite the intensive studies on tectonic steering effects on alluvial architecture, how the self-organization of deltaic channels, especially the distributary channel network, respond to tectonics and basin geometry is mostly unknown. Recently physical experiments and field studies have hinted dramatic differences in fluviodeltaic evolution between ones associated with active differential subsidence and existing basin depth. In this work we designed a series of numerical experiments using a reduced-complexity channel-resolving model for delta formation, and tested over a range of localized subsidence rates and topographic depression in basin geometry. We also used a set of robust delta metrics to analyze: i) shoreline planform asymmetry, ii) channel and lobe geometry, iii) channel network pattern, iv) autogenic timescales, and v) subsurface structure. The modeling results show that given a similar final thickness, active subsidence enhances channel branching with smaller channel sand bodies that are both laterally and vertically connected, whereas existing topographic depression causes more large-scale channel avulsions with larger channel sand bodies. In general, both subsidence and existing basin geometry could steer channels and/or lock channels in place but develop distinct channel patterns and thus stratal architecture.

  19. A review of terminology for equine juvenile osteochondral conditions (JOCC) based on anatomical and functional considerations.

    PubMed

    Denoix, J-M; Jeffcott, L B; McIlwraith, C W; van Weeren, P R

    2013-07-01

    This manuscript describes a new classification of the various joint-related lesions that can be seen in the young, growing horse based on their anatomical and functional aetiopathogenesis. Juvenile osteochondral conditions (JOCC) is a term that brings together specific disorders according to their location in the joint and their biomechanical origin. When a biomechanical insult affects the process of endochondral ossification different types of osteochondrosis (OC) lesions may occur, including osteochondral fragmentation of the articular surface or of the periarticular margins, or the formation of juvenile subchondral bone cysts. In severe cases, osteochondral collapse of the articular surface or the epiphysis or even an entire small bone may occur. Tension on ligament attachments may cause avulsion fractures of epiphyseal (or metaphyseal) ossifying bone, which are classified as JOCC, but do not result from a disturbance of the process of endochondral ossification and are not therefore classified as a form of OC. The same applies to 'physitis' which can result from damage to the physeal growth plate. PMID:23683533

  20. Acromioclavicular joint cyst formation.

    PubMed

    Hiller, Andrew D; Miller, Joshua D; Zeller, John L

    2010-03-01

    Acromioclavicular joint (ACJ) cysts are an uncommon and unusual sequela associated with shoulder pathophysiology. The majority of literature on ACJ cysts consists of individual case reports with no definitive literature review currently available. In addition to a comprehensive literature review, four clinical cases are presented in this report. First described by Craig (1984), a total of 41 cases have been previously reported in the literature. Of these cases, five occurred with the rotator cuff musculature intact. The remaining 36 cases of ACJ cysts occurred in patients with a complete tear/avulsion of the rotator cuff. Previous attempts at compiling a complete record of all reported cases have combined several distinct conditions into a single category. This article presents two distinct etiologies for the pathogenesis of ACJ cyst formation. In the presence of an intact rotator cuff, a Type 1 cyst can form superficially and be limited to the ACJ. Following a massive or traumatic tear of the rotator cuff, mechanical instability of the humeral head can cause a deterioration of the inferior acromioclavicular capsule (cuff tear arthropathy) and an overproduction of synovial fluid. Overtime, a "geyser" of fluid can form between the glenohumeral and the ACJ, forming a Type 2 cyst. This differentiation and categorization is essential for appropriate classification and treatment. PMID:20069645

  1. Reconstruction of large defect of foot with extensive bone loss exclusively using a latissimus dorsi muscle free flap: a potential new indication for this flap.

    PubMed

    Gomez, Manuel Macemino; Casal, Diogo

    2012-01-01

    In cases of extensive damage to the foot, with significant bone loss, it is generally accepted that reconstruction must include bone flaps or grafts either in the emergency setting or subsequently. In this report, we describe the case of an 18-year-old student with an avulsion injury of the dorsum of his right foot. Consequently, he lost most of the soft tissue over the dorsum of the foot and the cuboid, navicular, and cuneiform bones. A latissimus dorsi free flap was used to reconstruct the defect. A functional pseudoarthrosis developed between the remaining bones of the foot, and the patient experienced satisfactory foot function after rehabilitation. For this reason, no additional reconstructive procedure was undertaken. This case suggests that it might be adequate to use the latissimus dorsi muscle flap more liberally than previously reported in the reconstruction of extensive defects of the dorsum of the foot, including cases with significant bone loss. This option could avoid the morbidity and inconvenience of a second surgery and the need to harvest a bone flap or graft. PMID:21945400

  2. The use of fabricated chimeric flap for reconstruction of extensive foot defects.

    PubMed

    Song, Baoqiang; Chen, Jianwu; Han, Yan; Hu, Yalan; Su, Yingjun; Li, Yang; Zhang, Juan; Guo, Shuzhong

    2016-05-01

    Repair of extensive foot defects requires both adequate tissues for wound coverage and special tissues for functional reconstruction. To maximize its function reconstruction, fabricated chimeric flaps consisting of multiple separate flaps were designed to reconstruct such defects. Five patients suffered extensive foot defects with sizes ranging from 23 × 12 cm to 38 × 14 cm(2) in multiple regions including heel, forefoot, dorsum, ankle, anterior leg, and even toes. Causes included crushing injuries, avulsion injuries, and scar excision. Most areas of the defects except heel were first covered by latissimus dorsi muscle flap or anterolateral thigh flap and their pedicles were anastomosed with recipient vessels. Then free medial plantar flaps were transferred for heel reconstruction and their pedicles were further attached to either side branches of the main source vessel or to its distal continuation. All chimeric flaps survived uneventfully and all patients were able to walk in normal footwear during the 1.5- to 4-years follow-up. None of the flaps developed ulcer and flap breakdown. The assessment by Maryland Foot Score showed that four of the five patients gained a "good" recovery and one patient showed moderate improvement of foot functions. Appearances of reconstructed heels were near-normal. The results indicate that fabricated chimeric flap has good design flexibility and may provide an option for functional reconstruction of extensive foot defects. © 2015 Wiley Periodicals, Inc. Microsurgery 36:303-309, 2016. PMID:25752811

  3. The EpiNo® Device: Efficacy, Tolerability, and Impact on Pelvic Floor-Implications for Future Research.

    PubMed

    Kavvadias, Tilemachos; Hoesli, Irene

    2016-01-01

    Aims. The aim of this review is to provide a comprehensive overview of the available literature on preventing perineal trauma with the EpiNo. Methods. We perfomed a literature research in the MedLine and EMBASE databases for studies referring to EpiNo published between 1990 and 2014, without restrictions for language and study type. Results. Five published studies were identified, regarding the effect of EpiNo on the rate of episiotomy and perineal tears, pelvic floor muscle function, and fetal outcome. The device seems to reduce episiotomy and perineal tears' rate, as well as the risk for levator ani microtrauma and avulsion, though not always statistically significant. It does not seem to have an effect on duration of second stage of labour and fetal outcome. The device is well tolerated and the adverse events are rare and mild. However, design and reporting bias in the reviewed articles do not allow evidence based conclusions. Conclusions. The EpiNo device seems to be promising, with potential positive effects on natural birth, while being uncomplicated to use and without major complications. Well designed, randomized trials are needed in order to understand the effects of EpiNo on pelvic floor and make evidence based recommendations on its use. PMID:26981126

  4. Flexible Ureteroscopy Can Be More Efficacious in the Treatment of Proximal Ureteral Stones in Select Patients.

    PubMed

    Alkan, Erdal; Sarıbacak, Ali; Ozkanli, Ahmet Oguz; Basar, Mehmet Murad; Acar, Oguz; Balbay, Mevlana Derya

    2015-01-01

    Purpose. We aimed to compare and evaluate the outcomes and complications of two endoscopic treatment procedures, semirigid ureteroscopy (SR-URS) and flexible ureteroscopy (F-URS), in the treatment of proximal ureteral stones (PUS). Methods. SR-URS (group 1) was done on 68 patients whereas 64 patients underwent F-URS (group 2) for the treatment of PUS. Success rate was defined as the absence of stone fragments or presence of asymptomatic insignificant residual fragments < 2 mm. Outcomes and complications were recorded. Results. The differences were statistically not significant in age, gender, body mass index (BMI), and stone characteristics between groups. Mean ureteral stone size was 9.1 ± 0.4 mm and 8.9 ± 0.5 mm for groups 1 and 2. Mean operative time was 34.1 ± 1.5 min and 49.4 ± 2.3 min for groups 1 and 2 (p = 0.001). SFRs were 76.5% and 87.5% for groups 1 and 2 (p = 0.078). Two major complications (ureteral avulsion and ureteral rupture) occurred in group 1. Conclusion. F-URS is safer and less invasive than SR-URS in patients with PUS. There is no statistically significant difference in the efficacy of either technique. Nonetheless we recommend F-URS in the management of PUS as a first-line treatment option in select cases of proximal ureteral calculi. PMID:26617636

  5. Experience with 25 years of dorsal root entry zone lesioning at a single institution

    PubMed Central

    Awad, Ahmed J.; Forbes, Jonathan A.; Jermakowicz, Walter; Eli, Ilyas M.; Blumenkopf, Bennett; Konrad, Peter

    2013-01-01

    Background: The authors sought to assess long-term efficacy, surgical morbidity, and postoperative quality of life in patients who have undergone dorsal root entry zone (DREZ) lesioning. Methods: We utilized the electronic chart system at our institution to identify patients who underwent DREZ lesioning since 1986. Of the patients that were able to be identified, 19 (12 males and 7 females) patients were able to be contacted at time of data collection. The mean age was 47 years (ranging from 23 to 70 years) with average preoperative pain duration of 12.5 years and average follow-up of 4.9 years. Results: Of the 19 patients we were able to contact, 7 (37%) patients experienced “excellent” postoperative (complete) pain relief with another 6 (32%) reporting “good” improvement. Three (16%) patients reported “mild” pain relief, while three (16%) patients reported poor results. Sixteen patients (84%) stated they would undergo DREZ lesioning again, if given a choice. Two patients (11%) had objective evidence of a new, mild motor deficit postoperatively. More than half of the patients, who answered, reported “good” quality of life. Two-sample unequal variance t-test showed no statistically significant difference in pain improvement between brachial plexus avulsion and end-zone spinal cord injury pain. Conclusion: With appropriate patient selection, DREZ lesioning is an efficacious and durable procedure that can be performed with low morbidity and good patient outcomes. PMID:23772334

  6. Ankle dislocation without accompanying malleolar fracture. A case report.

    PubMed

    Hatori, Masahito; Kotajima, Satoshi; Smith, Richard A; Kokubun, Shoichi

    2006-01-01

    Dislocation of the tibiotalar joint without associated fracture is rare. We present here a 21-year-old man who sustained open posteromedial dislocation of the left ankle without malleolar facture when he jumped and sprained his right ankle while playing basketball. The most likely mechanism is forced flexion applied to the ankle joint leading to a rupture of the anterior capsule and lateral structures of the ankle followed by an accelerating inversion stress leading to a posteromedial dislocation of the talus from the tibial condyle. Transient paresthesia was noted in the area of the superficial peroneal nerve. At surgery, the anterior part of the tibiotalar joint capsule and anterior talofibular ligament were detached from their original sites. The calcaneofibular ligament was also detached with its associated periosteum and a tiny avulsed bony fragment. The articular facets of the tibia and talus were intact. The treatment consisted of wound irrigation, debridement, reduction and capsular suture followed by immobilization with a short leg cast. About 10 degrees of loss in the range of dorsiflexion was observed. The patient achieved good long-term functional results. PMID:16961183

  7. Superior Peroneal Retinaculum Tear in a High School Athlete: A Case Report

    PubMed Central

    Sanchioli, Gaetano

    2000-01-01

    Objective: To present the case of an 18-year-old football player who chose conservative treatment for a superior peroneal retinaculum tear and to review alternatives. Background: Superior peroneal retinaculum tears are often mistaken for lateral ankle instability. These tears often do not heal readily by themselves and must be identified so that proper treatment can begin. Differential Diagnosis: Superior peroneal retinaculum tear, peroneal subluxation, peroneal retinacular avulsion, snapping ankle. Treatment: This athlete chose conservative treatment, which may have cost him 4 weeks and the chance to return to his senior season. Surgical treatment can reduce recovery time. Uniqueness: This case history presents an athlete who was thought to have a grade II lateral ankle sprain. After weeks of rehabilitation, pain and effusion diminished, but the athlete was still unable to perform any functional activity without symptoms of pain and catching. Conclusions: Making the correct clinical diagnosis and understanding the time frame involved in rehabilitative versus surgical treatment are necessary to return the athlete to play in a timely manner. ImagesFigure 1.Figure 2. PMID:16558599

  8. Stratigraphic evolution of the late Holocene Ganges Brahmaputra lower delta plain

    NASA Astrophysics Data System (ADS)

    Allison, M. A.; Khan, S. R.; Goodbred, S. L.; Kuehl, S. A.

    2003-02-01

    Sediment cores from the Ganges-Brahmaputra delta in Bangladesh were examined for sedimentological character, clay mineralogy, elemental trends (C, N, S), and 14C geochronology to develop a model for the sedimentary sequence resulting from lower delta plain progradation in the late Holocene. A widespread facies succession from Muddy Sand to Interbedded Mud records progradation of shoal-island complexes and the transition from subtidal to intertidal conditions. Mangrove-vegetated islands and peninsulas represent the final phase of progradation; a Mottled Mud that is deposited by penetration of turbid coastal water into the mangroves during high water events. Organic matter preservation is generally low (<1% TOC) in most of these well-drained deposits that are characterized by a permeable, silt-dominated granulometry. Clay mineralogy in the cores records the relative influence of smectite and kaolinite-rich Ganges sediments and illite and chlorite-rich Brahmaputra material. The lower delta plain west of the modern river mouths was deposited as a Ganges-dominated delta in three phases since 5000 cal years BP, with Brahmaputra influence confined to the Meghna estuary area and to the supratidal section of western delta deposits. Evolution of the lower delta plain in the late Holocene was influenced by regional subsidence patterns in the tectonically active Bengal Basin, which controlled distributary channel avulsion and migration, and the creation of accommodation space.

  9. [Decoronation: treatment protocol for ankylotic root resorption as a consequence of dental trauma].

    PubMed

    Lin, S; Fuss, Z; Wigler, R; Karawani, M; Ashkenazi, M

    2013-10-01

    Severe dental traumatic injuries, such as the complete displacement of a tooth from its socket (Avulsion) or the displacement of a tooth within its socket (Intrusive Luxation), may result in extensive injury to the root surface. As a result, the root surface injury heals without cementum and there is fusion between the alveolar bone and the exposed dentin or anorganic exposed cementum, without any attachment apparatus between them. This phenomenon is known as "dento-alveolar ankylosis" and is accompanied by ankylotic resorption of the root. In a process that results subsequent to the ankylosis, the root surface resorbs, and this is part of the remodeling of the alveolar bone (ankylotic resorption). When the traumatic injury occurs at a young age, lateral and apical growth of the alveolar bone continues without continued physiological eruption of the tooth. As a result, the position of the ankylotic tooth does not change, and with time thetooth appears infra-occluded resulting in severe esthetic and functional consequences. Extraction of the ankylotic tooth is difficult and sometimes even impossible due to the rigid fusion between the bone and the tooth. In addition, attempted extraction of the ankylotic tooth may lead to fracture of the buccal plate and resorption of the alveolar bone. Retention of the ankylotic tooth may lead to damage in bone deposition in the verticaldimension, leading to difficulties in future prosthodonticrehabilitation, research-based information has been incorporated PMID:24660573

  10. The role of rivers in ancient societies, or how man transformed the alluvial landscapes of Khuzestan (SW Iran)

    NASA Astrophysics Data System (ADS)

    Walstra, J.; Heyvaert, V.; Verkinderen, P.

    2012-04-01

    For many thousands of years the alluvial plains of Khuzestan (SW Iran) have been subject to intensive settlement and agriculture. Ancient societies depended on the position of major rivers for their economic survival and hence, there is ample evidence of human activities trying to control the distribution of water. Throughout the plains ancient irrigation and settlement patterns are visible, although traces are rapidly disappearing due to expanding modern land use. Aim of this study is to unlock and integrate the rich information on landscape and archaeology, which only survives through the available historical imagery and some limited archaeological surveys. A GIS-based geomorphological mapping procedure was developed, using a variety of imagery, including historical aerial photographs, CORONA, Landsat and SPOT images. In addition, supported by the evidence from previous geological field surveys, archaeological elements were identified, mapped and included in a GIS database. The resulting map layers display the positions of successive palaeochannel belts and extensive irrigation networks, together indicating a complex alluvial history characterized by avulsions and significant human impact. As shown in several case-studies, integrating information from multiple disciplines provides valuable insights in the complex landscape evolution of this region, both from geological and historical perspectives. Remote sensing and GIS are essential tools in such a research context. The presented work was undertaken within the framework of the Interuniversity Attraction Pole "Greater Mesopotamia: Reconstruction of its Environment and History" (IAP 6/34), funded by the Belgian Science Policy.

  11. Characterisation of the weapon used in a patricide by SEM/EDS analysis of a microscopic trace from the object.

    PubMed

    Muccino, Enrico; Giovanetti, Giulio Federico; Crudele, Graziano Domenico Luigi; Gentile, Guendalina; Marchesi, Matteo; Rancati, Alessandra; Zoja, Riccardo

    2016-07-01

    This article presents a case of patricide. The murder was characterised by multiple blunt traumas and asphyxia. A mass of contused wounds was localised to the head and neck, and included the complete avulsion of the left eye (by an unknown tool), which was recovered near the cadaver. This case is of interest due to the possibility of identifying microscopic traces of the object that was used for the homicide by examining the skin margins around the ocular injury. The analysis was conducted using scanning electron microscopy combined with energy dispersive X-ray analysis (SEM/EDX). Analysis of the skin margins allowed microscopic inorganic traces to be detected, which were identified as ceramic material. This result focused the attention of the investigation on a small fish-shaped statue that had been previously found by the police when examining the crime scene. The use of SEM/EDX was therefore essential in determining a match between the microscopic traces detected on the perilesional skin and the composition of the statue. This led to the suspicion that the statue was the murder weapon. PMID:26700496

  12. Pulp Revascularization- It’s your Future Whether you Know it or Not?

    PubMed Central

    Dudeja, Pooja Gupta; Grover, Shibani; Srivastava, Dhirendra; Sharma, Vivek

    2015-01-01

    Pulpal regeneration after tooth injury is not easy to accomplish. In teeth with immature apices and exposed vital pulp tissue, partial or complete pulpotomy is indicated to preserve pulpal function and allow continued root development. In many cases, injury causes loss of pulp vitality and arrested root development leading to a tooth with poor crown root ratio, a root with very thin walls, an open blunderbuss apex and development of apical pathosis. The ideal treatment in such cases would be to obtain further root development and thickening of dentinal walls by stimulating the regeneration of a functional pulp dentin complex. This outcome has been observed after reimplantation in avulsed immature permanent teeth but has been thought impossible in a necrotic infected tooth. This case series evaluates the efficacy of revascularization procedure in immature, non vital permanent teeth. Pulp regeneration was attempted in four patients at Department of Conservative Dentistry, ESIC Dental College, New Delhi using blood clotting approach. The cases were treated and followed up regularly at regular intervals ranging from 6 months to 3 years to assess the treatment response clinically and radiographically. The patients remained clinically asymptomatic with three out of four patients even responding positively to pulp responsiveness tests. Radiographic examination also revealed increased root formation and thickening of dentinal walls. It was concluded that the triad of a disinfected canal, a matrix (blood clot) in to which new tissue could grow and an effective coronal seal produced the desirable environment for successful revascularization. PMID:26023665

  13. Pulp Revascularization- It's your Future Whether you Know it or Not?

    PubMed

    Dudeja, Pooja Gupta; Grover, Shibani; Srivastava, Dhirendra; Dudeja, Krishan Kumar; Sharma, Vivek

    2015-04-01

    Pulpal regeneration after tooth injury is not easy to accomplish. In teeth with immature apices and exposed vital pulp tissue, partial or complete pulpotomy is indicated to preserve pulpal function and allow continued root development. In many cases, injury causes loss of pulp vitality and arrested root development leading to a tooth with poor crown root ratio, a root with very thin walls, an open blunderbuss apex and development of apical pathosis. The ideal treatment in such cases would be to obtain further root development and thickening of dentinal walls by stimulating the regeneration of a functional pulp dentin complex. This outcome has been observed after reimplantation in avulsed immature permanent teeth but has been thought impossible in a necrotic infected tooth. This case series evaluates the efficacy of revascularization procedure in immature, non vital permanent teeth. Pulp regeneration was attempted in four patients at Department of Conservative Dentistry, ESIC Dental College, New Delhi using blood clotting approach. The cases were treated and followed up regularly at regular intervals ranging from 6 months to 3 years to assess the treatment response clinically and radiographically. The patients remained clinically asymptomatic with three out of four patients even responding positively to pulp responsiveness tests. Radiographic examination also revealed increased root formation and thickening of dentinal walls. It was concluded that the triad of a disinfected canal, a matrix (blood clot) in to which new tissue could grow and an effective coronal seal produced the desirable environment for successful revascularization. PMID:26023665

  14. An unexpected presentation of a traumatic wound on the lower lip: a case report

    PubMed Central

    2014-01-01

    Introduction Traumatic lip injuries present major challenges in terms of reconstructive options and the outcome of surgical management. The aetiology of lip injuries includes human bite as interpersonal violence. Bite wounds are always considered to be complex injuries contaminated with unique polymicrobial inoculum. A classification of facial bite injuries has been included and the surgical management of these lesions has also been discussed. We report a rare bite injury on the lower lip that resembled an ulcerative process. Case presentation A 30-year-old African man presented with a severe tissue defect on his lower lip to a Dental and Oral Department in Tanzania. He explained that 12 days ago he had been involved in a fight and someone had bitten his lower lip. An orofacial examination confirmed a serious loss of lip tissue that resembled a chronic ulcerative process. Accurate assessment of the lesion was made by a thorough evaluation of some parameters such as size, depth, presence of granulation tissue, fibrin coverage, wound edges, exudates and/or necrosis. A surgical debridement under local anaesthesia was carried out. Afterwards a layered suture was performed. Eventually the healing was complete and satisfactory. Conclusions A severe bite avulsive wound on the lower lip, despite the elapsed time before treatment, may have an excellent prognosis after a simple surgical procedure. PMID:25196423

  15. Compartmentalized Toxoplasma EB1 bundles spindle microtubules to secure accurate chromosome segregation.

    PubMed

    Chen, Chun-Ti; Kelly, Megan; Leon, Jessica de; Nwagbara, Belinda; Ebbert, Patrick; Ferguson, David J P; Lowery, Laura Anne; Morrissette, Naomi; Gubbels, Marc-Jan

    2015-12-15

    Toxoplasma gondii replicates asexually by a unique internal budding process characterized by interwoven closed mitosis and cytokinesis. Although it is known that the centrosome coordinates these processes, the spatiotemporal organization of mitosis remains poorly defined. Here we demonstrate that centrosome positioning around the nucleus may signal spindle assembly: spindle microtubules (MTs) are first assembled when the centrosome moves to the basal side and become extensively acetylated after the duplicated centrosomes reposition to the apical side. We also tracked the spindle MTs using the MT plus end-binding protein TgEB1. Endowed by a C-terminal NLS, TgEB1 resides in the nucleoplasm in interphase and associates with the spindle MTs during mitosis. TgEB1 also associates with the subpellicular MTs at the growing end of daughter buds toward the completion of karyokinesis. Depletion of TgEB1 results in escalated disintegration of kinetochore clustering. Furthermore, we show that TgEB1's MT association in Toxoplasma and in a heterologous system (Xenopus) is based on the same principles. Finally, overexpression of a high-MT-affinity TgEB1 mutant promotes the formation of overstabilized MT bundles, resulting in avulsion of otherwise tightly clustered kinetochores. Overall we conclude that centrosome position controls spindle activity and that TgEB1 is critical for mitotic integrity. PMID:26466679

  16. Early Clinical and Radiographic Results of Minimally Invasive Anterior Approach Hip Arthroplasty

    PubMed Central

    Alexandrov, Tamara; Ahlmann, Elke R.; Menendez, Lawrence R.

    2014-01-01

    We present a retrospective review of the early results and complications in a series of 35 consecutive patients with 43 total hip arthroplasties performed through an anterior muscle sparing minimally invasive approach. We found the early complication rates and radiographic outcomes comparable to those reported from arthroplasties performed via traditional approaches. Complications included dislocation (2%), femur fracture (2%), greater trochanteric fracture (12%), postoperative periprosthetic intertrochanteric fracture (2%), femoral nerve palsy (5%), hematoma (2%), and postoperative iliopsoas avulsion (2%). Radiographic analysis revealed average cup anteversion of 19.6° ± 6.6, average cup abduction angle of 48.4° ± 7, stem varus of 0.9° ± 2, and a mean leg length discrepancy of 0.7 mm. The anterior approach to the hip is an attractive alternative to the more traditional approaches. Acceptable component placement with comparable complication rates is possible using a muscle sparing technique which may lead to faster overall recovery. PMID:24715984

  17. Tectonic control on the distribution on calcic paleosols in the Plio-Pleistocene Palomas half graben, southern Rio Grande Rift

    SciTech Connect

    Mack, G.H. . Dept. Earth Sciences); James, W.C. . Dept. of Geological Sciences)

    1992-01-01

    The number and degree of development of calcic paleosols in the Palomas Formation, which was deposited during Pliocene to middle Pleistocene time in the Palomas half graben of south-central New Mexico, are related to position within the basin and asymmetrical subsidence. Numerous stage 2 morphology calcic paleosols, characterized by an argillic B horizon (Bt) overlying a horizon of distinct calcic nodules and tubules (Bk), developed on intermittently inactive parts of the broad (up to 20 km wide) bajada deposited on the hanging wall dip slope. During periods of movement of the basin-bounding fault, the gradient of the hanging wall dip slope increased resulting in channel incision and transportation of coarse detritus to the toe of the bajada. Stage 3 and 4 morphology calcic paleosols, which consist of Bt-K profiles up to 2 m thick, formed on terraces adjacent to the incised channels. In contrast, only a few stage 2 morphology calcic paleosols are present within footwall-derived alluvial-fan sediment, as the result of relatively rapid lateral shifting of depocenters on the small (less than 3 km[sup 2]) fans. However, some paleosols within footwall-derived by shallow phreatic cementation by coarse calcite. Rapid channel avulsion across the narrow (less than 5 km) axial-fluvial plain of the Ancestral Rio Grande inhibited development of paleosols except for a few rhizolith horizons. The spatial distribution of paleosols in the Palomas half graben may provide a predictive tool in interpreting ancient basin symmetry.

  18. Floodplain Formation and Cottonwood Colonization Patterns on the Willamette River, Oregon, USA.

    PubMed

    Dykaar; Wigington

    2000-01-01

    / Using a series of aerial photographs taken between 1936 and 1996, we trace coevolution of floodplain and riparian forest on the Willamette River. Within-channel barforms appear to be the predominant incipient floodplain landform and habitat for primary succession. Interlinked development of bar(s) and erosion of near banks, filling of channels, and establishment and growth of cottonwoods and willows results in coalescence with older floodplain. Sizeand internal structure of riparian forest patches reflect evolution of underlying barforms or channel beds. Floodplain matures as the active channel migrates away by repetition of the bar formation and near-bank erosion process, or is progressively abandoned by infilling and/or constriction with a bar. Other parts of the floodplain are recycled as eroding banks provide the coarse sediment and large woody debris for building new bars. A multichannel planform is maintained as building bars split flow; channels lengthen as bars and islands join into larger assemblages. Avulsion appears to cut new channels only short distances. Given the central role of bars and islands in building new floodplain habitat, we identify their area as a geomorphic indicator of river-floodplain integrity. We measure an 80% decline in bar and island area between 1910 and 1988 within a 22-km section. Dams, riprap, logging, and gravel mining may all be contributing to diminished bar formation rates. Removing obstacles to natural riparian forest creation mechanisms is necessary to regenerate the river-floodplain system and realize its productive potential. PMID:10552104

  19. Fluvial sedimentology and basin analyses of the Permian Fairchild and Buckley formations, Beardmore Glacier region, and the Weller Coal Measures, southern Victoria Land, Antarctica

    SciTech Connect

    Isbell, J.L.

    1990-01-01

    The Beardmore Glacier region contains a 1-km-thick Permian fluvial sequence that was deposited in an elongate basin along the margin of the East Antarctica craton. Fluvial architecture, sandstone composition and paleocurrents within the basin record a change from an early Permian cratonic to a late Permian foreland basin. The Lower Permian Fairchild Formation consists entirely of overlapping channel-form sandstone bodies deposited by braided streams. Arkosic sandstone was deposited by SE flowing streams. Fairchild strata record slow subsidence within a broad cratonic basin. The Lower to Upper Permian Buckley Formation consists of an arkosic lower member and a volcaniclastic upper member. Paleocurrents which consist of transverse and longitudinal paleocurrents, suggest a cratonward migration of the basin axis through time. The Buckley Formation was deposited within a braided stream setting and is an important unit because it contains interstratified channel-sandstone sheets, shale and coal, along with evidence of channel-belt avulsions. Sandstone sheets predominate at the base of the formation, while flood-plain deposits thicken and increase in abundance upward. The interaction between fluvial processes and subsidence rates produced this alluvial stratigraphy. The Lower Permian Weller Coal Measures in southern Victoria Land were deposited within a narrow basin located cratonward of the foreland basin. Basin geometry and depositional patterns are similar to those of fault-bounded basins. Although basin formation is not constrained, deposition of the Weller was contemporaneous with the development of the foreland basin. This suggests a relationship between subsidence within the two basins.

  20. Adult tibial eminence fracture fixation: arthroscopic procedure using K-wire folded fixation.

    PubMed

    Bonin, Nicolas; Jeunet, Laurent; Obert, Laurent; Dejour, David

    2007-07-01

    The purpose of this article is to describe a new and simple technique for arthroscopic fixation of tibial intercondylar eminence avulsion fractures using folded surgical pin. This technique allows reduction and fixation of the bone fragment without using special equipment. After standard arthroscopic procedure to explore the knee and to remove fracture debris and blood clot, the bone block is reduced and advanced with the spike of the anterior cruciate ligament tibial drill guide. A 1.8-mm K-wire is drilled through the guide from the proximal tibia into the reduced fragment. It is bent on its end into the joint with a strong needle case. The K-wire is then pulled back until good fragment compression to the tibia appears with the wire starting unbending. Next, the other side is bent on the anterior tibial cortex and cut. This arthroscopic fixation allows elastic compression fragment stabilization that authorizes early weight bearing and rehabilitation programs. The material is extracted by traction after 6 months. PMID:17235617