Tezel, Huseyin; Atalayin, Cigdem; Kayrak, Gul
The aim of this report is to present the case of an accidentally avulsed maxillary central incisor kept in saline solution from the moment of trauma until its replantation 3 h later in a 13-year-old girl. The avulsed tooth was replanted back into the alveolar socket and splinted with composite resin. Calcium hydroxide intracanal dressing was used to prevent inflammatory root resorption. Radiographic and clinical examinations were performed during 27 months follow-up. During the 15 months follow-up period, the tooth remained in a stable functional position and did not reveal replacement resorption. But mild infraocclusion and root resorption were developed 21 months after replantation. The amount of damage to tooth and supporting structures, emergency treatment and follow-up period play a role in the prognosis of the avulsed tooth. It can be recommended to keep the avulsed tooth in saline solution at least when more appropriate storage media are not on handle immediately.
Tezel, Huseyin; Atalayin, Cigdem; Kayrak, Gul
The aim of this report is to present the case of an accidentally avulsed maxillary central incisor kept in saline solution from the moment of trauma until its replantation 3 h later in a 13-year-old girl. The avulsed tooth was replanted back into the alveolar socket and splinted with composite resin. Calcium hydroxide intracanal dressing was used to prevent inflammatory root resorption. Radiographic and clinical examinations were performed during 27 months follow-up. During the 15 months follow-up period, the tooth remained in a stable functional position and did not reveal replacement resorption. But mild infraocclusion and root resorption were developed 21 months after replantation. The amount of damage to tooth and supporting structures, emergency treatment and follow-up period play a role in the prognosis of the avulsed tooth. It can be recommended to keep the avulsed tooth in saline solution at least when more appropriate storage media are not on handle immediately. PMID:24883032
Orava, S.; Ala-Ketola, L.
34 cases of avulsion fractures are described. Each fracture took place during athletic training or competition. Excepting six sportsmen participating in a general fitness programme, every patient was an active competitive athlete. There were six women and 28 men; their average age was 20.1 years, raised by a few middle-aged "fitness sportsmen". Most avulsion fractures took place in sprinters and hurdlers; next were middle and long distance renner, footballers, fitness joggers, skiers and ice-hockey players. The most usual location of a fracture was the anterior pelvic spines; avulsion fractures were also detected in various parts of lower limbs. There were fewer avulsion fractures in the area of the trunk and upper extremities. Roetgenologically, the diagnosis of an avulsion fracture is generally easy to make. However, the diagnosis is facilitated by knowing the mechanism of the injury, the technique of the athletic event, and some of the training methods. Generally, a fracture heals well, even if it requires both sufficient immobilisation and some delay in resuming physical exertion. PMID:884433
Chin, C H; Chew, K C
Lumbosacral nerve root avulsion is a rare clinical entity. Since the first description in 1955, only 35 cases have been reported. It is often associated with pelvic fractures and may be missed in the initial clinical examination as these patients usually present with multiple injuries. We present three such cases with clinical and radiological findings. These patients were involved in road traffic accidents. Two had fractures of the sacroiliac joint with diastasis of the symphysis pubis (Tile type C 1.2) and one had fractures of the public rami (Tile type B 2.1). All three had various degrees of sensory and motor deficit of the lower limbs. Lumbar myelogram shows characteristic pseudomeningoceles in the affected lumboscral region. Magnetic resonance (MR) imaging provides an additional non-invasive modality to diagnose this condition.
Fay, Kristin; Mannem, Rajeev; Baynes, Keith; Sarin, Dhruv; DuBois, Melissa
Avulsion injuries of the knee are common sequelae of significant trauma given the number of ligamentous and tendinous insertions around the joint. Commonly discussed avulsion fractures of the lateral knee include the Segond fracture of the lateral tibial plateau and the arcuate complex avulsion fracture of the fibular styloid process. A less common avulsion fracture is the iliotibial (IT) band avulsion fracture involving the anterolateral corner of the tibia (Gerdy's tubercle). It is crucial to identify IT band avulsion fractures because of the frequent associated internal derangements of the knee. This case report describes the imaging of an acute IT band avulsion fracture and compares these findings with other lateral knee avulsion fractures.
Baginska, Joanna; Wilczynska-Borawska, Magdalena
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…
... weeks on crutches if you have an avulsion fracture around your hip. If the bone fragment and main bone are too far apart to fuse naturally, surgery may be necessary to reunite them. In children, avulsion fractures that involve the growth plates also might require ...
Karuppiah, S V; Knox, D
Radio-ulnar Fracture dislocation of the elbow is a high-energy trauma which can be associated with significant ligamentous injury in adults. We report an unusual triad of injury in a patient with avulsion injury of the triceps. This injury can be thought of as a variant of "terrible triad" with dislocation of radio-ulnar joint, radial head fracture, and medial collateral ligament injury with avulsion of the triceps. Elbow has to be stabilized with early repair of the ligaments for a successful outcome.
Karuppiah, S. V.; Knox, D.
Radio-ulnar Fracture dislocation of the elbow is a high-energy trauma which can be associated with significant ligamentous injury in adults. We report an unusual triad of injury in a patient with avulsion injury of the triceps. This injury can be thought of as a variant of “terrible triad” with dislocation of radio-ulnar joint, radial head fracture, and medial collateral ligament injury with avulsion of the triceps. Elbow has to be stabilized with early repair of the ligaments for a successful outcome. PMID:24876982
Lui, T H
Achilles tendon ruptures occur commonly in the midsubstance of the tendon, usually 2-6 cm proximal to the insertion to the calcaneus. Ruptures near its insertion into the calcaneus are less common and mostly found in hyperpronators with a heel spur (Haglund's deformity). Avulsion of the bony insertion of the Achilles tendon at the calcaneus is infrequent and is diagnosed by radiography. Open reduction and internal fixation is indicated to achieve bone to bone healing and restoration of the function and continuity of the triceps surae mechanism. Screw fixation is not effective to resist the pull out tension of the triceps surae. Moreover, the prominent screw head may cause skin impingement. More secure fixation method is necessary in order to allow early functional rehabilitation. We describe a technique to fix the avulsed fragment of Achilles tendon insertion with 2 suture anchors. This can neutralize the pull of the triceps surae and early post-operative rehabilitation programme is allowed.
Stout, J. C.; Grove, J. R.; Rutherfurd, I.; Marren, P.
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
Cruceru, Adelina Maria; Paun, Sorin; Negoi, Ruxandra Irina; Beuran, Mircea
Introduction. The objective of this case report is to illustrate a severe perineal impalement injury, associated with anorectal avulsion and hemorrhagic shock. Results. A 32-year-old male patient was referred to our hospital for an impalement perineal trauma, associated with complex pelvic fracture and massive perineal soft tissue destruction and anorectal avulsion. On arrival, the systolic blood pressure was 85 mm Hg and the hemoglobin was 7.1 g/dL. The patient was transported to the operating room, and perineal lavage, hemostasis, and repacking were performed. After 12 hours in the Intensive Care Unit, the abdominal ultrasonography revealed free peritoneal fluid. We decided emergency laparotomy, and massive hemoperitoneum due to intraperitoneal rupture of pelvic hematoma was confirmed. Pelvic packing controlled the ongoing diffuse bleeding. After 48 hours, the relaparotomy with packs removal and loop sigmoid colostomy was performed. The postoperative course was progressive favorable, with discharge after 70 days and colostomy closure after four months, with no long-term complications. Conclusions. Severe perineal injuries are associated with significant morbidity and mortality. Their management in high volume centers, with experience in colorectal and trauma surgery, allocating significant human and material resources, decreases the early mortality and long-term complications, offering the best quality of life for patients. PMID:27891285
Caglar, Esber; Tanboga, Ilknur; Süsal, Seckin
The present case report describes the reimplantation of avulsed teeth with the treatment of Emdogain. Case was avulsed right maxillary permanent central and lateral incisor in a 9-year-old girl suffering from a traumatic injury. After pretreatment of avulsed teeth, Emdogain was applied to the root surface and into the extraction socket with subsequent replantation of the tooth. Evaluation parameters included horizontal and vertical percussion sound and periapical radiographs. At 1-2-6-12-month follow-up period, the clinical and radiographic appearance of the teeth showed resolution of mobility and no signs of replacement resorbption.
Ganti, Vamsi; Chadwick, Austin J.; Hassenruck-Gudipati, Hima J.; Lamb, Michael P.
River deltas grow in large part through repeated cycles of lobe construction and channel avulsion. Understanding avulsion cycles is important for coastal restoration and ecology, land management, and flood hazard mitigation. Emerging theories suggest that river avulsions on lowland deltas are controlled by backwater hydrodynamics; however, our knowledge of backwater-controlled avulsion cycles is limited. Here we present results from an experimental delta that evolved under persistent backwater hydrodynamics achieved through variable flood discharges, shallow bed slopes, and subcritical flows. The experimental avulsion cycles consisted of an initial phase of avulsion setup, an avulsion trigger, selection of a new flow path, and abandonment of the parent channel. Avulsions were triggered during the largest floods (78% of avulsions) after the channel was filled by a fraction (0.3 ± 0.13) of its characteristic flow depth at the avulsion site, which occurred in the upstream part of the backwater zone. The new flow path following avulsion was consistently one of the shortest paths to the shoreline, and channel abandonment occurred through temporal decline in water flow and sediment delivery to the parent channel. Experimental synthetic stratigraphy indicates that bed thicknesses were maximum at the avulsion sites, consistent with our morphologic measurements of avulsion setup and the idea that there is a record of avulsion locations and thresholds in sedimentary rocks. Finally, we discuss the implications of our findings within the context of sustainable management of deltas, their stratigraphic record, and predicting avulsions on deltas.
Kostka, Eckehard; Meissner, Simon; Finke, Christian H; Mandirola, Manlio; Preissner, Saskia
Background: Avulsion of permanent front teeth is a rare accident, mostly affecting children between seven and nine years of age. Replanted and splinted, these teeth often develop inflammation, severe resorption or ankylosis affecting alveolar bone development and have to be extracted sooner or later. Objectives: The purpose of this study was to evaluate different therapy concepts to create a structured concept for the treatment of avulsions. Results: Based on existing therapy concepts, a concept for different initial conditions (dry time, age, growth, tooth, hard and soft tissues) was developed and is presented here. Conclusion: A great deal of research has been performed during recent years and guidelines for the management of avulsions have been published. With the help of this literature it is possible to identify the best treatment procedure for each tooth. Clinical Relevance: The prognosis of avulsed teeth can be improved by considering evidence-based therapy concepts. Resorption, ankylosis and tooth loss could be minimized. PMID:25352922
Treatment outside the dental office: Replant immediately after gentle washing if practical. If replantation is not practical, store the tooth in the best medium available. Storage media in order of preference are Hank's Balanced Salt Solution (HBSS), milk, saline, and saliva (buccal vestibule). Water is the least desirable storage medium. Treatment in the office: Emergency visit; Place tooth in HBSS while exam is conducted and history is taken. Prepare socket for gentle repositioning of the tooth. Prepare the root. Extraoral dry time < 20 minutes: Closed apex--replant immediately after gentle washing. Open apex--soak in 1 mg doxycycline in 20 mg saline for 5 minutes. Extraoral dry time 20 to 60 minutes: Soak in HBSS for 30 minutes and replant. Extraoral dry time > 60 minutes: soak in citric acid, 2% stannous fluoride, and doxycycline and replant. Endodontics can be done extraorally. Semirigid splint for 7 to 10 days. (If alveolar fracture is present, rigid splint for 4 to 8 weeks). Suture soft-tissue lacerations, particularly in the cervical area. Administer systemic antibiotics (penicillin V potassium if possible) Chlorhexidine rinses and stringent oral hygiene while the splint is in place (7 to 10 days). Analgesics as required. Second visit after 7 to 10 days: Endodontic treatment: Tooth with open apex and extraoral dry time of < 60 minutes: No endodontic treatment initially. Recall every 3 to 4 weeks to examine for evidence of pathosis. If pathosis is noted, disinfect the pulp space and start apexification procedure. Tooth with open apex and extraoral dry time > 60 minutes: If endodontics was not completed in the emergency visit, start endodontics and follow apexification procedure. Tooth with closed apex: Endodontics should be initiated after 7 to 10 days. Careful chemomechanical instrumentation under strict asepsis. Splint removed at end of visit. Obturation visit: If endodontics was initiated 7 to 10 days after the avulsion, obturation can take place after
Bège, Thierry; Ménard, Jérémie; Tremblay, Jaelle; Denis, Ronald; Arnoux, Pierre-Jean; Petit, Yvan
Mesenteric avulsion, corresponding to a tearing of intestine's root, generally results from high deceleration in road accidents. The biomechanical analysis of bowel and mesenteric injuries is a major challenge for injury prevention, particularly because seat belt restraint may paradoxically increase their risk of occurrence. The aim of this study was to identify the biomechanical behavior of mesentery and small bowel (MSB) tissue samples under dynamical loading conditions. A dedicated test bench was designed in order to perform tensile tests on fresh MSB porcine specimens, with quasi-static (1 mm/s) and dynamic (100 mm/s) loading conditions. The mechanical behavior of MSB specimens was investigated and compared to isolated mesenteric and isolated small bowel specimens. The results show a high sensitivity of MSB stiffness (1.0 ± 0.2 and 1.3 ± 0.3 N/mm at 1 and 100 mm/s, p = 0.001) and ultimate force (22 ± 5 and 35 ± 8 N at 1 and 100 mm/s, p = 0.001) to the loading rate but not for the displacement at failure. This leads to postulate on a failure criteria based on strain level regardless of the strain rate. These experimental results could be further used to develop refined finite element models and to further investigate on injury mechanisms associated to seat belt restraints, as well as to evaluate and improve protective devices.
Heyvaert, Vanessa M. A.; Walstra, Jan
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
Casabianca, L.; Rousseau, R.; Loriaut, P.; Massein, A.; Mirouse, G.; Gerometta, A.; Khiami, F.
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
Savas, Selcuk; Kucukyilmaz, Ebru; Akcay, Merve; Koseoglu, Serhat
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
Winther, Annika Kloster Norland; Øhlenschlæger, Tommy F
Golf is a sport with much repetitive actions often causing overuse injuries. We report a case of a left side avulsion fracture of the anterior serratus at the insertion on costa 4-6. A professionel golfer experienced sudden onset of pain of the chest during a golfswing. Clinically the patient had winging of the scapula and pain at the lateral side of costa 4-6. Ultrasonography showed an avulsion fracture of costa 5 at the insertion of the anterior serratus. The patient was referred to scapula-stabilising rehabilitation and fully recovered.
Ajike, S O; Oladigbolu, K K; Ogbeifun, J O; Samaila, E; Omisakin, O O; Ajike, B A
Blunt trauma to the globe may cause rupture or avulsion of the globe with its attendant consequences. Traumatic avulsion of the globe and optic nerve are rare because of the protection offered by the bony socket and the resistance of the globe due to its pressure and the thickness of the nerve tissues. However, there are a few documented cases of avulsion of the globe and optic nerve in the literature. We report a case of traumatic avulsion of the left globe in a 38-year-old female Nigerian. Primary enucleation of the avulsed globe with insertion of orbital prosthesis was done.
Haider, Ali S; Watson, Ian T; Sulhan, Suraj; Arrey, Eliel N; Khan, Umair; Nguyen, Phu; Layton, Kennith F
Cervical nerve root avulsion is a well-documented result of motor vehicle collision (MVC), especially when occurring at high velocities. These avulsions are commonly traction injuries of nerve roots that may be accompanied by a tear in the meninges through the vertebral foramina with associated collections of cerebrospinal fluid (CSF), thereby resulting in a pseudomeningocele. We present a case of a 19-year-old male who experienced an MVC and was brought to the emergency department (ED) with right arm paralysis and other injuries. A neurological examination demonstrated intact sensation but 0/5 muscle strength in the right upper extremity. A magnetic resonance imaging (MRI) of the spinal cord demonstrated massive epidural hematomas extending the length of the cervical spine caudally from C2. An MRI of the right brachial plexus showed C3-C7 anterior horn cell edema and associated traumatic nerve root avulsion with pseudomeningoceles on the right from C5-C8. The development of spinal cord hematoma with these injuries has rarely been documented in the literature and the multiple level avulsion described here with extensive hematoma is a rare clinical presentation. A literature review was conducted to determine the diagnostic requirements, treatment strategies, and complications of such an injury. Our patient received conservative treatment of the right brachial plexus injury and was transferred to an inpatient rehabilitation facility 13 days later. PMID:28352498
Esser, Stephan; Jantz, David; Hurdle, Mark F.; Taylor, Walter
Objective To present a case of ultrasonic diagnosis and nonoperative management of a complete proximal rectus femoris avulsion in a National Collegiate Athletic Association Division 1 soccer goalkeeper. Background While delivering a goal kick, a previously uninjured 24-year-old collegiate soccer goalkeeper had the sudden onset of right anterior thigh pain. He underwent rehabilitation with rapid resolution of his presenting pain but frequent intermittent recurrence of anterior thigh pain. After he was provided a definitive diagnosis with musculoskeletal ultrasound, he underwent an extended period of rehabilitation and eventually experienced complete recovery without recurrence. Differential Diagnosis Rectus femoris avulsion, rectus femoris strain or partial tear, inguinal hernia, or acetabular labral tear. Treatment Operative and nonoperative options were discussed. In view of the player's recovery, nonoperative options were pursued with a good result. Uniqueness Complete proximal rectus femoris avulsions are rare. Our case contributes to the debate on whether elite-level kicking and running athletes can return to full on-field performance without surgery. Conclusions Complete proximal rectus femoris avulsions can be treated effectively using nonoperative measures with good preservation of function even in the elite-level athlete. In addition, musculoskeletal ultrasound is an excellent tool for on-site evaluation and may help guide prognosis and management. PMID:25978099
Paxinos, Odysseas; Karavasili, Alexandra; Manolarakis, Manolis; Paxinos, Thrasivoulos; Papavasiliou, Athanasios
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.
Alabi, Sulyman Biodun; Aremu, Shuaib Kayode; Abdulkadir, A Y; Legbo, J N; Akande, Halima J
A 6-year-old girl who claimed to have fallen while playing with metal rod that resulted in palatal avulsion injuries was presented. Neither of the parents was around when the incidence happened. She was brought to the hospital because of pain, bleeding from the mouth, drooling of saliva mixed with blood and inability to feed or phonate appropriately. Examinations of the oral cavity revealed a triangular area of avulsion in the posterior aspect of the hard palate extending to the soft palate. She had examination under anaesthesia and wound repaired with 3-0 vicryl interrupted sutures after thorough wound debridement. She did well and was discharged from the clinic. PMID:22605851
Mariani, Pier Paolo; Iannella, Germano; Cerullo, Guglielmo; Giacobbe, Marco
A rare case of acute avulsion of both posterior meniscal roots concomitant with an acute anterior cruciate ligament (ACL) tear in a professional soccer player is described. While avulsion of the lateral meniscal root has been extensively reported in association with ACL injuries, medial root avulsion has never been reported in association with acute ACL. A review of the video documentation of the match accident revealed the exact mechanism of injury was a forceful external rotation of the standing limb.
D-AiBB 265 MANAGEMENT OF HARD TISSUE AVULSIVE WOUNDS AND / MANAGEMENT OF OROFACIAL FRACTURESLU) BATTELLE COLUMBUS DIV ON C R HASSLER 30 APR 85 DAMD17...AVULSIVE WOUNDS AND MANAGEMENT OF OROFACIAL FRACTURES Annual Report April 30, 1985 nSupported by U.S. ARMY MEDICAL RESEARCH AND DEVELOPMENT COMMAND Fort...775A825 AA 044 11. TITLE (Include Security Clasification) (U) Management of Hard Tissue Avulsive Wounds and Management of Orofacial Fractures 12
Kumar, Nishikant; Yadav, Chandrashekhar; Kumar, Ashok
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
Dharmani, Umesh; Jadhav, Ganesh Ranganath; Kamal, Charan; Rajput, Akhil; Dua, Ankur
In traumatic dental injury, concomitant occurrence of avulsion and intrusive luxation is exceptional. This is because the vectors of forces responsible for both avulsive and intrusive injuries are in different directions. The present case report reviews the management of a rare combination of avulsion in right maxillary lateral incisor (tooth #12) and intrusive luxation in right maxillary central incisor (tooth #11) in a 22-year-old Asian male. Clinical and radiographic evaluation was done at 12-month follow-up. Various treatment modalities and complications associated with both avulsion and intrusion are also discussed in the paper. PMID:25506151
Poi, Wilson Roberto; Sonoda, Celso Koogi; Martins, Christine Men; Melo, Moriel Evangelista; Pellizzer, Eduardo Pizza; de Mendonça, Marcos Rogério; Panzarini, Sônia Regina
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
Winkler, A R; Barnes, J C; Ogden, J A
A case of chronic, progressive avulsion of the anterior superior iliac spine leading to the formation of a long, attenuated spur of bone in an 18-year-old black male break dancer is described. The mechanism of formation appeared to be repetitive avulsion from break dancing.
Puricelli, Michael D; Newberry, Christopher Ian; Gov-Ari, Eliav
Nasoenteric tubes provide short-term nutrition support to patients unable to take an adequate oral diet. Bridling systems may be used to secure tubes to guard against displacement. We present the first case of an avulsed magnet from a bridling system to raise awareness of this potential complication. The primary methods of securing a nasogastric tube are reviewed, and comparative assessment of the 3 main systems is presented. Diagnosis and management of nasal foreign bodies relevant to this case are reviewed and prevention/safety considerations discussed.
Lam, Justin Chak Yiu; Lee, Ka Lok Ryan; Griffith, James F
Brachialis periosteal avulsion injury is an uncommon injury occurring in young children. The injury may be misinterpreted or overlooked because of misleading or subtle radiological findings. A case of 7-year-old child with post-traumatic elbow pain and subtle findings on elbow radiography is presented. The injury was initially misinterpreted as an avulsion fracture of the medial epicondyle. Following radiological review, a diagnosis of brachialis periosteal avulsion injury was made. The radiographic and magnetic resonance imaging (MRI) findings of this injury are presented to stress the value of comparing the radiographic findings with previous imaging and to increase awareness of this uncommon injury.
Reitz, M. D.; Steckler, M. S.; Paola, C.; Goodbred, S. L.; Petter, A. L.; Pickering, J.; Williams, L. A.
In Bangladesh, the set of active rivers of the Ganges-Brahmaputra Delta overlie a landscape that is being continually modified by tectonics. The response of rivers to a surface being altered by tectonic tilting or other causes of spatially variable subsidence is generally understood to be a preferred path direction toward regions of higher subsidence. Quantifying the magnitude of the effect of variable subsidence on the timescale and path direction of channel avulsion remains, however, an open question. Recent experimental work has suggested an equilibrium-slope explanation for the timescale and conditions for avulsion, which provides a way forward on understanding how varied subsidence conditions would affect the avulsion process. Here we adapt this model for avulsion to the context of variable subsidence, developing a new framework to quantify its effect on channel avulsions. We find that variable subsidence results in two effects: differing timescales between avulsions on different parts of the delta, and differing frequencies of avulsion to these locations. Regions of higher subsidence both draw avulsions more frequently, and result in longer channel residence times in these locations. We also describe the effect of incision or aggradation due to sea level changes within this framework: incisional events lengthen avulsion timescales everywhere on the delta, while periods of sea-level rise drive the timescales back toward their minimum values. Finally, we apply this theory to the Ganges-Brahmaputra Delta, where we use a map of regional variable subsidence that we derived from GPS and published stratigraphic data, to predict the variation in avulsion timescale and frequency for the Brahmaputra River due to this variable subsidence. We make estimates for two different tectonic history interpretations, and for the cases with or without the estimated incision from the most recent sea-level fall. Comparison between our predictions and our stratigraphy
D-A134 143 MANAGEMENT OF HARD TISSUE AVULSIVE WOUNDS AND i/I MANAGEMENT OF OROFACIAL FRACTURES(U) BATTELLE COLUMBUS LABS OH L G MCCOV El AL- AUG 88...TISSUE AVULSIVE WOUNDS AND MANAGEMENT OF OROFACIAL FRACTURES . 4 •ANNUAL REPORT Larry G. McCoy and Craig R. Hasuler .9 A August 1980 ". Supported by U.S...10 28 006 REPORT NUMBER 6 MANAGEMENT OF HARD TISSUE AVULSIVE WOUNDS AND MANAGEMENT OF OROFACIAL FRACTURES -4., ANNUAL REPORT Larry G. McCoy and Craig R
Tosun, Ozgur; Koralp, Muhabbet D; Tosun, Aliye; Celebi, Levent; Bulakbaşi, Nail
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.
Sonnery-Cottet, Bertrand; Barbosa, Nuno Camelo; Tuteja, Sanesh; Gardon, Roland; Daggett, Matt; Monnot, Damien; Kajetanek, Charles; Thaunat, Mathieu
Background: Rectus femoris injuries are common among athletes, especially in kicking sports such as soccer; however, proximal rectus femoris avulsions in athletes are a relatively rare entity. Purpose/Hypothesis: The purpose of this study was to describe and report the results of an original technique of surgical excision of the proximal tendon remnant followed by a muscular suture repair. Our hypothesis was that this technique limits the risk of recurrence in high-level athletes and allows for rapid recovery without loss of quadriceps strength. Study Design: Case series; Level of evidence, 4. Methods: Our retrospective series included 5 players aged 31.8 ± 3.9 years with acute proximal rectus femoris avulsion injuries who underwent a surgical resection of the proximal tendon between March 2012 and June 2014. Four of these players had recurrent rectus femoris injuries in the 9 months before surgery, while 1 player had surgery after a first injury. Mean follow-up was 18.2 ± 12.6 months, and minimum follow-up was 9 months. We analyzed the age, sex distribution, physical examination outcomes, type and mechanism of injury, diagnosis, treatment and complications during surgery, postoperative follow-up, and time to return to play. The Lower Extremity Functional Scale (LEFS) and Marx scores were obtained at 3-month follow-up, and isokinetic tests were performed before return to sports. A telephone interview was completed to determine the presence of recurrence at an average follow-up of 18.2 months. Results: At 3-month follow-up, all patients had Marx activity scores of 16 and LEFS scores of 80. Return to the previous level of play occurred at a mean of 15.8 ± 2.6 weeks after surgery, and none of the athletes suffered a recurrence. Isokinetic test results were comparable between both sides. Conclusion: The surgical treatment of proximal rectus femoris avulsions, consisting of resection of the tendinous part of the muscle, is a reliable and safe technique allowing a
Arango, Dillon; Tiedeken, Nathan C.; Ayzenberg, Mark; Raphael, James
Perilunate dislocations are a devastating injury to the carpus that carry a guarded long-term prognosis. Mayfield type 4 perilunate dislocations are rare, high-energy injuries that carry a risk for avascular necrosis (AVN) of the lunate. When AVN ensues and the carpus collapses, primary treatment with a proximal row carpectomy or arthrodesis has been advocated. This case reports a successful clinical result and revascularization of an extruded lunate with open reduction and internal fixation. This type 4, Gustilo grade 1 open perilunate dislocation exhibited complete avulsion of all lunate ligamentous attachments. Management included open reduction and internal fixation as well as carpal tunnel release through a combined dorsal and volar approach. Despite concerns for lunate AVN due to complete disruption of lunate vascularity, a 10-month postoperative clinical and radiographic examination demonstrated no pain with activities of daily living as well as a revascularized lunate. PMID:24876511
Avulsion fractures of the pelvic and proximal femoral apophyseal centres are not uncommonly seen in adolescent athletes engaged in vigorous sports. They are the result of strong or uncoordinated muscular traction, and are the equivalents of muscle or tendon pulls in mature athletes. They are particularly seen in athletics, soccer, rugby, ice hockey and break dance. They involve the anterior third of the iliac crest, the anterior iliac spines, the tuber ischiadicum, the symphysis pubis and the trochanter minor. The radiographic and clinical diagnosis, symptoms and signs, treatment and prognosis are well described in the orthopaedic literature and this literature is evaluated here. The fractures are easily and almost exclusively treated conservatively, and will only in a few cases result in a lasting functional disability.
Øregaard, JS; Lang, CL; Venzo, A
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
Hsu, Sanford P C; Shih, Yang-Hsin; Huang, Ming-Chao; Chuang, Tien-Yow; Huang, Wen-Cheng; Wu, Hsiu-Mei; Lin, Pei-Hsin; Lee, Liang-Shong; Cheng, Henrich
To obtain easier access to avulsed roots in the intradural space for patients suffering cervical root avulsion, the authors of this study developed a novel repair method. This involves using nerve grafts to bridge corresponding segments of the spinal cord and the trunk or cord level of the plexus, respectively, in two surgical stages. All eight patients admitted to this study received pre- and post-operative workups of electrophysiological evaluations and muscle power grading through Medical Research Council (MRC) scores. The degrees of impairment were also graded according to a modified version of Dumitru's and Wilbourn's scale (mild = 1; moderate = 2; severe = 3). The preoperative versus post-operative differences in the severity of the injuries and in the grading of the target muscle power were calculated according to the Wilcoxon signed-rank test. The preoperative degree of the severity of the injuries, as measured by electromyography (EMG), was 3.00 +/- 0.00 (mean +/- S.D.). The post-operative result was 2.125 +/- 0.641. Significant change took place after repair (P = 0.0313). Moreover, although little improvement was observed in the triceps, brachioradialis (BR), extensor carpi radialis (ECR), flexor digitorum profundus (FDP) and intrinsic hand muscles, the MRC grading showed significant yet not prominent motor recovery in the deltoid and biceps brachii (both P = 0.0313). We were impressed that the initial significant statistical results of differences in pre- and post-operative severity of the injuries and muscle power grading, demonstrated that regeneration does occur with this repair strategy.
e Albuquerque, Rodrigo Pires; Giordano, Vincenzo; Carvalho, Antônio Carlos Pires; Puell, Thiago; e Albuquerque, Maria Isabel Pires; do Amaral, Ney Pecegueiro
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
Chu, Z.; Ganti, V.; Lamb, M. P.
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.
Hamilton, Paul B.; Strom, Kyle B.; Hoyal, David C. J. D.
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.
Chang, Rei-Yeuh; Chen, Chien-Chang; Hsu, Wei-Pang; Hsiao, Pei-Ching; Tsai, Han-Lin; Hsiao, Ping-Gune; Wu, Jiann-Der; Guo, How-Ran
Abstract Background: Avulsion of the aortic valve commissure as a cause of acute aortic valve regurgitation is mostly due to trauma, infective endocarditis, or ascending aortic dissection. Nontraumatic avulsion of the aortic valve commissure is very rare. We reviewed the literature and analyzed potential risk factors of nontraumatic avulsion. Case presentation: An 80-year-old male with hypertension was seen in the emergency department with acute onset dyspnea. Echocardiogram revealed left ventricular hypertrophy with adequate systolic function, prolapse of the noncoronary cusp, and incomplete coaptation of the right coronary and noncoronary cusps with severe aortic valve regurgitation. Surgery revealed an avulsion between the left coronary and noncoronary cusps. Histopathology examination of the aortic valve showed myxoid degeneration, fibrosis, and calcification. Examination of the ascending aorta revealed myxoid degeneration and fragmentation of elastic fibers. Aortic valve replacement was performed, and the patient was alive and well 4 years after surgery. A review of the literature showed that more than three-fourths of the similar cases occurred in males, and about half in patients with hypertension and those 60 years of age or older. Conclusions: In the case of acute aortic regurgitation without a history of trauma, infection, or valvotomy, when 2 prolapsed aortic cusps are observed by echocardiography in the absence of an intimal tear of the ascending aorta, an avulsion of the aortic commissure should be suspected, especially in males with hypertension who are 60 years of age or older. PMID:27749570
Chadwick, A. J.; Lamb, M. P.; Ganti, V.; Hassenruck-Gudipati, H. J.
River deltas earn their name from a characteristic planform-triangular shape, but in reality demonstrate a wide range of morphologies. The sinuosity of delta shorelines, i.e. shoreline rugosity, is particularly variable worldwide even among deltas where waves and tides are not dominant processes. We hypothesize that river-dominated deltas built through construction of depositional lobes develop a characteristic shoreline rugosity that is determined by long-term patterns in avulsion location, avulsion timing, and channel migration, all of which can be strongly influenced by backwater hydrodynamics. Scaling arguments predict that shoreline rugosity should increase linearly with avulsion timescale, inversely with avulsion lengthscale, and inversely with channel lateral migration rate. We present results from two scaled flume experiments that confirm this hypothesis, and furthermore illustrate the importance of backwater hydrodynamics in controlling the dominant rates and scales in a growing delta. Under the case of variable discharge floods that maintain a dynamic backwater zone, avulsions occur at a fixed distance from the shoreline, resulting in the construction of lobes of constant size even during shoreline progradation. In addition, erosion caused by drawdown hydrodynamics during floods eliminates alternating bars, which slows lateral migration of the channel and allows for more elongate delta lobes. Based on these results, and a compilation of modern river-dominated deltas, we propose a new dimensionless phase space for the occurrence backwater-mediated deltas with rugose shorelines.
Porr, Jason; Lucaciu, Calin; Birkett, Sarah
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
E Albuquerque, Rodrigo Pires; da Palma, Idemar Monteiro; Cobra, Hugo; de Paula Mozella, Alan; Vaques, Victor
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.
Li, Heng; Wong, Connie; Li, Wen; Ruven, Carolin; He, Liumin; Wu, Xiaoli; Lang, Bradley T.; Silver, Jerry; Wu, Wutian
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
Resnick, J M; Carrasco, C H; Edeiken, J; Yasko, A W; Ro, J Y; Ayala, A G
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.
Wingert, Nathaniel C; Beck, John D; Harter, G Dean
In addition to neurologic injuries such as peripheral nerve palsy, axillary vessel injury should be recognized as a possible complication of reverse total shoulder arthroplasty. Limb lengthening associated with Grammont-type reverse total shoulder arthroplasty places tension across the brachial plexus and axillary vessels and may contribute to observed injuries. The Grammont-type reverse total shoulder arthroplasty prosthesis reverses the shoulder ball and socket, shifts the shoulder center of rotation distal and medial, and lengthens the arm. This alteration of native anatomy converts shearing to compressive glenohumeral joint forces while augmenting and tensioning the deltoid lever arm. Joint stability is enhanced; shoulder elevation is enabled in the rotator cuff–deficient shoulder. Arm lengthening associated with reverse total shoulder arthroplasty places a longitudinal strain on the brachial plexus and axillary vessels. Peripheral nerve palsies and other neurologic complications of reverse total shoulder arthroplasty have been documented. The authors describe a patient with rotator cuff tear arthropathy and a history of radioulnar synostosis who underwent reverse total shoulder arthroplasty complicated by intraoperative injury to the axillary artery and postoperative radial, ulnar, and musculocutaneous nerve palsies. Following a seemingly unremarkable placement of reverse shoulder components, brisk arterial bleeding was encountered while approximating the incised subscapularis tendon in preparation for wound closure. Further exploration revealed an avulsive-type injury of the axillary artery. After an unsuccessful attempt at primary repair, a synthetic arterial bypass graft was placed. Reperfusion of the right upper extremity was achieved and has been maintained to date. Postoperative clinical examination and electromyographic studies confirmed ongoing radial, ulnar, and musculocutaneous neuropathies.
Servant, C. T.; Jones, C. B.
A case is reported of an adolescent sprinter who was chronically disabled by pain after non-operative management for an acute hamstring injury. He had sustained an avulsion fracture of the ischial apophysis with displacement of 2.5 cm. Avulsion fractures of the ischial apophysis with displacement of 2 cm or more are unusual, but they frequently result in a symptomatic non-union, and early diagnosis, open reduction, and internal fixation is to be encouraged. PMID:9773178
Moore, M.P.; Stauber, E.; Thomas, N.J.
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.
OROFACIAL FRACTURES(U) BATTELLE COLUMBUS LABS OH C R HASSLER ET AL...8217, ,,, . ’ ’. - . - -,-. . . .. .- . . ."’ " . . . . . . . .. . ,+ + , , ,+. . .+, - , . . . ..+ • , , ,. ,, . • . . . - V.- #/sa REPORT NUMBER 7 VIMAANA WENT OF HARD TISSUE AVULSIMV WOUNDS AND MNAGEMENT OF OROFACIAL FRACTURES . ~ I) ANNUAL REPORT Craig 1. Hassler...authorized documents. -*. o . C,. °. *.. .. . . . REPORT NUMBER 7 MANAGEMENT OF HARD TISSUE AVULSIVE WOUNDS AND MANAGEMENT OF OROFACIAL
Ralston, David J.; Scherm, Michael J.
OBJECTIVE: To present the case of a high school football player who sustained avulsion of 2 branches of the splenic artery from his spleen as he was tackled and landed on the football. BACKGROUND: A high school football player was tackled and fell onto the football, left side first. He was examined by a certified athletic trainer and an internist. On evaluation, he had a positive Kehr sign, exquisite left upper abdominal quadrant tenderness, and complaint of nausea. He also exhibited signs of the onset of shock, including diaphoresis, a rapid pulse, and hypotension. He was immediately transported by ambulance to the local emergency facility. DIFFERENTIAL DIAGNOSIS: Splenic rupture, splenic laceration, splenic artery avulsion, or ruptured viscus. TREATMENT: Emergency surgery was performed, with removal of 2800 mL of blood and ligation of the 2 arterial branches avulsed from the spleen. The patient fully recovered within 6 weeks and was cleared to resume all sports activities. UNIQUENESS: Injury to the spleen in football is a known yet very uncommon injury. Even more unusual is the avulsion of splenic artery branches from the spleen. CONCLUSIONS: It is critical that athletic trainers and team physicians have an understanding of the mechanisms, signs, and symptoms of splenic injury. Because the spleen is a highly vascular organ, severe hemorrhage can be fatal in just minutes if not recognized and appropriately treated.
Aylward, G W; Ohri, R
We present a case in which trauma from a broken glass resulted in complete amputation of the upper lid and severe lacerations to the lower lid but with an intact and functioning globe. The avulsed upper lid was repaired as a composite autograft. The possible management of such an unusual case is discussed.
Castilho, Lithiene Ribeiro; Sundefeld, Maria Lucia Marçal Mazza; de Andrade, Dalton Francisco; Panzarini, Sônia Regina; Poi, Wilson Roberto
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.
Schjøtt, M; Andreasen, J O
Emdogain has been shown in clinical and experimental studies to promote regeneration of all periodontal tissues: cementum with anchoring fibres, a functional, periodontal ligament and alveolar bone in connection with treatment of marginal periodontitis. The intention of this study was to analyse whether this regenerative capacity upon the periodontal ligament also worked in a trauma situation where a significant number of PDL cells have been eliminated because of unphysiologic storage or actual damage during avulsion or replantation. Furthermore if ankylosis sites already established because of earlier replantation after avulsion could be surgical removed and application of Emdogain could revert the ankylosis stage to a normal PDL situation. The first treatment situation was tested in seven patients with a total of 16 avulsed teeth with varying time of extra oral storage. The teeth were extra-orally endodontically treated and the root and socket covered with Emdogain before replantation. All teeth demonstrated subsequent ankylosis, primarily diagnosed by a percussion test. The second treatment situation where an ankylosis was already established constituted of seven patients with a total of 11 teeth because of previous replantation after avulsion. These teeth were all extracted, the ankylosis sites removed and the root and socket treated with Emdogain. After 6 months all teeth showed recurrence of ankylosis. It is concluded that Emdogain was not able to prevent or cure ankylosis.
Gaizauskas, Sergejus; Zelvys, Arunas
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
Gaizauskas, Andrius; Markevicius, Marius; Gaizauskas, Sergejus; Zelvys, Arunas
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.
Larkin, Zacchary T.; Tooth, Stephen; Ralph, Timothy J.; Duller, Geoff A. T.; McCarthy, Terence; Keen-Zebert, Amanda; Humphries, Marc S.
Avulsion (relocation of a river course to a new position) typically is assumed to occur more frequently in rivers with faster sedimentation rates, yet supporting field data are limited and the influence of sedimentation rate on avulsion style remains unclear. Using analysis of historical aerial photographs, optically stimulated luminescence dating of fluvial sediments, and field observations, we document three avulsions that have occurred in the last 650 years along the lower reaches of the semiarid Tshwane River in northern South Africa. Study of the modern river and abandoned reaches reveals that a downstream decrease in discharge and stream power leads to reduced channel size and declining sediment transport capacity. Bank erosion drives an increase in channel sinuosity, leading to a decline in local channel slope, and to a further decrease in discharge and sediment transport. Local sedimentation rates > 10 mm a- 1 occur within and adjacent to the channel, so over time levees and an alluvial ridge develop. The resulting increase in cross-floodplain gradient primes a reach for avulsion by promoting erosion of a new channel on the floodplain, which enlarges and extends by knickpoint retreat during periods of overbank flow. Ultimately, the new channel diverts the discharge and bedload sediment from the older, topographically higher channel, which is then abandoned. Our findings support the assumption that avulsion frequency and sedimentation rate are positively correlated, and we demonstrate that incisional avulsions can occur in settings with relatively rapid net vertical aggradation. The late Holocene avulsions on the semiarid Tshwane River have been driven by intrinsic (autogenic) processes during meander belt development, but comparison with the avulsion chronology along a river in subhumid South Africa highlights the need for additional investigations into the influence of hydroclimatic setting on the propensity for avulsion.
Gwinner, Clemens; Hoburg, Arnd; Wilde, Sophie; Schatka, Imke; Krapohl, Björn Dirk; Jung, Tobias M.
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
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
Usui, Akihito; Kawasumi, Yusuke; Hosokai, Yoshiyuki; Saito, Haruo; Igari, Yui; Funayama, Masato
Gallbladder injuries are extremely rare in blunt trauma, with a reported incidence of <2%. We report an autopsy case of fatal hemorrhagic shock due to intra-abdominal bleeding resulting from complete avulsion of the gallbladder associated with liver cirrhosis. Multiplanar images derived from multislice computed tomography (MSCT) performed as part of pre-autopsy screening showed complete avulsion of the gallbladder without any other associated intra-abdominal injuries, facilitating forensic autopsy planning. In this report, we discuss the role of MSCT in cases of fatal intra-abdominal bleeding caused by avulsion of the gallbladder and discuss the mechanism of this injury. PMID:23986858
Wang, Su-Hsin; Chung, Ming-Pang; Su, Wen-Song; Cheng, Jen-Chan; Shieh, Yi-Shing
This case report describes the continued root formation following replantation and conventional root canal therapy of a traumatically avulsed open-apex tooth with suppurative apical periodontitis. A 7-year-old male patient had an avulsed upper left central incisor (tooth 21) replanted approximately 50 min after traumatic avulsion. A root canal procedure was initiated due to pulp necrosis and periapical abscess detected in the follow-up period. After endodontic treatment with calcium hydroxide (Ca(OH)(2)) dressing, a normal root length developed including an apical segment beyond the hard tissue barrier. Regeneration of the root occurred without pathology or ankylosis at 1-year of follow up.
Hartzog, T. R.; Goodbred, S. L.
The Brahmaputra River, one of the world's largest braided streams, is a major component of commerce, agriculture, and transportation in India and Bangladesh. Hence any significant change in course, morphology, or behavior would be likely to influence the regional culture and economy that relies on this major river system. The history of such changes is recorded in the stratigraphy deposited by the Brahmaputra River during the Holocene. Here we present stratigraphic analysis of sediment samples from the boring of 41 tube wells over a 120 km transect in the upper Bengal Basin of northern Bangladesh. The transect crosses both the modern fluvial valley and an abandoned fluvial valley about 60 km downstream of a major avulsion node. Although the modern Brahmaputra does not transport gravel, gravel strata are common below 20 m with fluvial sand deposits dominating most of the stratigraphy. Furthermore, the stratigraphy preserves very few floodplain mud strata below the modern floodplain mud cap. These preliminary findings will be assessed to determine their importance in defining past channel migration, avulsion frequency, and the reoccupation of abandoned fluvial valleys. Understanding the avulsion and valley reoccupation history of the Brahmaputra River is important to assess the risk involved with developing agriculture, business, and infrastructure on the banks of modern and abandoned channels. Based on the correlation of stratigraphy and digital surface elevation data, we hypothesize that the towns of Jamalpur and Sherpur in northern Bangladesh were once major ports on the Brahmaputra River even though they now lie on the banks of small underfit stream channels. If Jamalpur and Sherpur represent the outer extent of the Brahmaputra River braid-belt before the last major avulsion, these cities and any communities developed in the abandoned braid-belt assume a high risk of devastation if the next major avulsion reoccupies this fluvial valley. It is important to
Dinowitz, M; Trumble, T; Hanel, D; Vedder, N B; Gilbert, M
To determine if small avulsion fractures of the thumb ulnar collateral ligament (UCL) with minimal (< or = 2.0 mm) displacement can successfully be treated by cast immobilization, the authors reviewed 9 patients with minimally displaced fractures initially treated by casting. Despite immobilization within an average of 2 days of the initial injury (range, 0-6 days), a minimum of 6 weeks of immobilization in a cast, and adequate rehabilitation, all 9 patients had persistent thumb pain, especially with activities requiring strong pinch. After undergoing open reduction and internal fixation, the patients had relief of thumb pain and pinch strength improved from 36% of the contralateral side to 89% (p < .01). Grip strength increased from 77% to 93% (p < .05), but the ranges of motion of the thumb metacarpophalangeal and interphalangeal joints were not significantly altered. Minimally displaced UCL avulsion fractures frequently have significant rotation that prevents successful fracture healing even with prompt cast immobilization.
Feucht, Matthias J; Minzlaff, Philipp; Saier, Tim; Lenich, Andreas; Imhoff, Andreas B; Hinterwimmer, Stefan
Injuries of the meniscus roots have become increasingly recognised as a serious pathology of the knee joint. However, the current available literature focuses primarily on posterior meniscus root tears. In this article, a case with an isolated avulsion of the anterior medial meniscus root is presented, and a new arthroscopic technique to treat this type of injury is described. The anterior horn of the medial meniscus was sutured with a double-looped nonabsorbable suture and reattached to the tibial plateau using a knotless suture anchor. This technique may also be useful to treat avulsion injuries of the anterolateral or posteromedial meniscus root, and symptomatic subluxation of the medial meniscus in case of a variant insertion anatomy with an absent attachment of the anterior horn of the medial meniscus to the tibial plateau. Level of evidence V.
Sasi, P. Kiran; Mahapatra, Swagath; Raj Pallapati, Samuel C.; Thomas, Binu P.
Traumatic musculotendinous junction avulsions are rare injuries except in avulsion amputations. They pose a significant challenge to the treating surgeon. We present a 24-year-old male who sustained an open musculotendinous avulsion of the flexor pollicis longus tendon. He was treated with primary tendon transfer using the flexor digitorum superficialis of ring finger, in flexor zone 3. The functional result at 10 months following surgery was excellent. PMID:27019757
FIELD GROUP SUB-GROUP Bioceramics Prosthetic Materials Avulsive Wounds 6 03 Ceramic Implants Implant Materials Porous Ceramics 02 Biomaterials...ceramics that can successfully serve as a scaffold for bone ingrowth. Later studies at Battelle were aimed at increasing the strength of the bioceramic ...serve as a scaffold for bone ingrowth. Later studies at Battelle were aimed at increasing the strength of the bioceramic , as well as simultaneously
Akova, Bedrettin; Okay, Ertan
In this case a seventeen-years-old male soccer player, who sustained an injury while playing football, diagnosed as ischial tuberosity avulsion was reported. Following six-months of a conservative rehabilitation program, the athlete returned to his sports' activities. Six years along he had no complaints and his athletic performance was not deteriorated. In this case report diagnosis, treatment and six-years follow-up results were discussed.
Chin, Tan Yew; Kiat, Sim Sze; Faizul, Hizal Ghazali; Wu, Wutian; Abdullah, Jafri Malin
Background The neuroprotective role of minocycline in the treatment of brachial plexus injury is controversial. Objective To study the neuroprotective effect of minocycline via different routes in adult Sprague Dawley rats with brachial plexus injury. Methods The C7 nerve roots of the animals were avulsed via an anterior extravertebral approach. Traction force was used to transect the ventral motor nerve roots at the preganglionic level. Intraperitoneal and intrathecal minocycline (50 mg/kg for the first week and 25 mg/kg for the second week) were administered to promote motor healing. The spinal cord was harvested six weeks after the injury, and structural changes following the avulsion injury and pharmacological intervention were analysed. Results Motor neuron death and microglial proliferation were observed after the administration of minocycline via two different routes (intraperitoneal and intrathecal) following traumatic avulsion injury of the ventral nerve root. The administration of intraperitoneal minocycline reduced the microglia count but increased the motor neuron count. Intrathecal minocycline also reduced the microglial count, with a greater reduction than in the intraperitoneal group, but it decreased the motor neuron count. Conclusions Intraperitoneal minocycline increased motor neuron survival by inhibiting microglial proliferation following traumatic avulsion injury of the nerve root. The inhibitory effect was augmented by the use of intrathecal minocycline, in which the targeted drug delivery method increased the bioavailability of the therapeutic agent. However, motor neuron survival was impaired at a higher concentration of minocycline via the intrathecal route due to the more efficient method of drug delivery. Microglial suppression via minocycline can have both beneficial and damaging effects, with a moderate dose being beneficial as regards motor neuron survival but a higher dose proving neurotoxic due to impairment of the glial response and
Lui, Tun Hing
An avulsion fracture of part of the tibial tuberosity can occur as a result of a tophaceous tuberosity or Osgood-Schlatter disease. We describe an endoscopic technique of debridement, bone fragment resection, and tendon repair. This technique has the potential advantage of fewer wound complications. It is performed through proximal and distal portals on the sides of the patellar tendon. The working space is deep to the tendon. After debridement of the tendon and resection of the bone fragment, the tendon gap is assessed. Endoscopic-assisted side-by-side repair is performed to close the gap if the gap is less than 30% of the width of the tendon. If the gap is more than 30% of the width of the tendon, the proximal stump of the avulsed tendon can be retrieved through the proximal portal. Krackow suture with stay stitches is applied to the proximal stump. The stump is put back and sutured to the tibial insertion through a bone tunnel or suture anchor. This is augmented by side-by-side suturing of the avulsed tendon with the adjacent normal tendon.
Chen, H J; Tu, Y K
Brachial plexus avulsion injury is one of the major complications after traffic, especially motorcycle accidents and machine injuries. Intractable pain and paralysis of the affected limbs are the major neurological deficits. During the past 18 years, we have encountered and treated more than 500 cases with brachial plexus avulsion injuries. Dorsal root entry zone lesions (DREZ) made by thermocoagulation were performed for intractable pain in 60 cases. Forty cases were under regular follow-up for 5-18 years. In early postoperative stage, the pain relief rate was excellent or good in 32 cases (80%). The pain relief rate dropped to 60% in 5 year follow-up period and only 9 cases (50%) had excellent or good result in 10 year follow-up. Reconstructive procedures were performed in almost all patients in the last 10 years. Dorsal root entry zone lesion is an effective procedure for pain control after brachial plexus avulsion injuries.
DePasse, J Mason; Varner, Kevin; Cosculluela, Pedro; Incavo, Stephen
While uncommon, isolated avulsion fractures of the lesser trochanter occur in children and adolescents prior to the fusion of this apophysis as a result of athletic activities. In the elderly, isolated fractures of the lesser trochanter are rare but can occur as a result of trauma. They have been identified in patients with primary or secondary bone malignancies, which were previously considered pathognomonic for metastatic disease. In the absence of trauma, weakening of the bone due to systemic disorders such as osteoporosis or osteomalacia chronica renal failure may also be responsible. Diagnosis may be difficult with physical examination and radiographs alone. This case report details this rare fracture in 2 patients suffering from debilitating chronic disease. Patient 1 was a 30-year-old woman with an 18-year history of type 1 diabetes mellitus, a 6-year history of end-stage renal disease, hypertension, hypothyroidism, peripheral vascular disease, and a 3-year history of systemic lupus erythematosus with antiphospholipid syndrome treated with warfarin. Patient 2 was a 66-year-old woman with a history of type 2 diabetes mellitus, peripheral neuropathy, obesity, chronic obstructive pulmonary disease, gout, hypertension, and chronic neck and low back pain. Both were assessed with magnetic resonance imaging following physical examination, which revealed atraumatic avulsion of the distal iliopsoas tendon from the lesser trochanter. Following retraction of the iliopsoas tendon, the patients were treated with conservative therapy and anti-inflammatory medication. These 2 cases broaden the range of patients for whom spontaneous avulsion of the distal iliopsoas tendon should be considered in the differential diagnosis.
MCCOY FT AL 15 JUL...Larry G. McCoy and Craig R. Hassler July 15, 1977 Supported by U.S. ARMY MEDICAL RESEARCH AND DEVELOPMENT COMMAND Fort Detrick, Frederick, Maryland...34 "" " " """"’" "" ’".....’......... " -"." . %% " .% " % +% %" ° " "" ’ "" AD MANAGEMENT OF HARD TISSUE AVULSIVE WOUNDS AND MANAGEMENT OF OROFACIAL FRACTURES ANNUAL REPORT Larry G. McCoy and Craig R. Hassler July 15,
Blikslager, A T; Bristol, D G
A 3-month-old foal was examined because of lameness and fracture of the left lateral trochlear ridge of the femur. Arthroscopy of the left femoropatellar joint was elected. After induction of general anesthesia and placement of the foal in dorsal recumbency, it was noticed that the left hind limb was extended at the tibiotarsal joint and flexed at the femorotibial joint. Avulsion fracture at the origin of the peroneus tertius tendon was diagnosed. Fracture fragments were excised. The horse had mild left hind limb lameness at the time of follow-up evaluation 1 year after discharge.
Mannem, Rajeev; DuBois, Melissa; Koeberl, Matthew; Kosempa, Damian; Erickson, Scott
Shoulder dislocations are frequently seen in the general population and can be a cause of instability. Instability can lead to debilitating symptoms and morbidity as a result of progressive damage to the shoulder. Anterior shoulder dislocations are the most frequent type of dislocations and have been studied extensively with MRI. The soft tissue Bankart lesion is the most well-known entity associated with anterior instability; however, additional structural lesions arising from traumatic events have been described in recent literature which also predispose to anterior shoulder instability. One of these lesions, the glenoid avulsion of the glenohumeral ligament (GAGL), involves avulsion of the inferior glenohumeral ligament from the glenoid and involves separation from an intact labrum. In contrast to the Bankart lesion, there has been limited discussion of the GAGL lesion in the literature and very few imaging examples. We report a case of a GAGL diagnosed on MRI and confirmed with arthroscopy. It is discussed in the context of the anatomy of the inferior glenohumeral ligament and the imaging findings.
Miyamura, Satoshi; Ota, Haruka; Okamoto, Michio; Namba, Jiro; Yamamoto, Koji
Avulsion fractures of the calcaneus are relatively uncommon and are seen most frequently in elderly or osteoporotic patients. A surgical method that avoids displacement of the avulsed fragment after fixation has not been developed. We report the cases of 3 patients (a 73-year-old male, an 85-year-old male, and an 81-year-old female) treated by open reduction and internal fixation using titanium wire and cannulated cancellous screws. The posterior approach was used by way of a vertical midline incision. The fracture was fixed with 2 screws, and then a titanium wire was passed through the holes of the cannulated screws. A small incision on the lateral side of planter was added for the exit and return of the wire. The wire knot was bent inside the proximal Achilles tendon bursa in 2 patients and was directed to the plantar side in 1 to avoid irritation. Bony union was achieved without repeat displacement of the fragment in all 3 patients. Normal ankle function was restored, and the patients recovered the activities of daily living almost to the original level. Although an additional plantar incision is required, this surgical technique provides strong internal fixation.
Perumal, Colin Jerome; Robson, Martin
Introduction and objective: Traumatic avulsive injuries present complex therapeutic decisions. Radical and repeated debridement of all foreign material, necrotic tissue, bacteria, and deleterious chemicals followed by control of the bacterial bioburden and wound closure has been the gold standard. However, when such injuries occur in the face, the treatment requires modification. Specialized structures, nerves, and a maximum amount of tissue must be preserved. Topical antimicrobials may lead to dessication and further injury to tissue. Therefore, alternative treatments must be considered. Recently, a hydroconductive dressing has been demonstrated to decrease edema by removing excess exudate, to remove debris and necrotic tissue, and to decrease bacteria and deleterious cytokines in wounds. Methods: Regular dressings were done between 1 and 3 days by dedicated personnel, using a hydroconductive dressing. Following an initial conservative debridement and reconstruction while attempting to preserve as much of the normal structure as possible, the wounds were dressed with a hydroconductive dressing. Results: Using only selective conservative debridement following bony reconstruction and repeated hydroconductive dressing changes, this severe injury healed with preservation of the important facial features. No further extensive surgical procedures were required. On discharge, the patient was able to function well with a reasonably good aesthetic result. She was subsequently lost to follow-up. Conclusion: This case report demonstrates that a hydroconductive dressing can be useful for traumatic avulsive injuries. PMID:22848776
Ozan, Fatih; Polat, Zübeyde Akin; Er, Kürsat; Ozan, Ulkü; Değer, Orhan
Propolis is a multifunctional material used by bees in the construction and maintenance of their hives. Propolis possesses several biologic activities such as anti-inflammatory, antibacterial, antioxidant, antifungal, antiviral, and tissue regenerative, among others. The purpose of this study was to determine the ability of propolis to serve as a temporary storage medium for the maintenance of periodontal ligament (PDL) cell viability of avulsed teeth. PDL cells were obtained from healthy third molars and cultured in Dulbecco's Modified Eagles Medium (DMEM). Cultures were subjected to 10% propolis solution, 20% propolis solution, long-shelf life light milk with lower fat content (milk), Hank's Balanced Salt Solution, tap water as the negative control, and DMEM as the positive control. Tissue culture plates were incubated with experimental media at 37 degrees C for 1, 3, 6, 12, or 24 hours. PDL cell viability was assessed by trypan blue exclusion. Statistical analysis of the data was accomplished by using one-way analysis of variance complemented by the Tukey test. The level of significance was 5% (p<0.05). The results showed that 10% propolis was a more effective storage medium than other groups. In conclusion, propolis can be recommended as a suitable transport medium for avulsed teeth.
Maslin, Mark; Knutz, Paul C.; Ramsay, Tony
The Late Quaternary Amazon deep-sea fan provides a modern analogue to ancient fan systems containing coarse-grained hydrocarbon reservoirs. Sand lenses deposited within the Amazon Fan, due to abrupt shifts in channel pathways called avulsion events, were drilled as part of ODP Leg 155. The hemipelagic sediment directly on top of the avulsion sands was dated using primarily AMS radio carbon dating. This dating shows that these large sand lobes (˜1 km 3) are triggered by relatively small, millennial scale changes in marine transgression and regression (±5-10 m). Relative sea level also controls the architecture of the Channel-levee distributive systems within the Amazon Fan. For example prior to 22 k calendar years BP there is a tripartite channel system. After 22 ka there is only one active Channel-levee system. Transitions between the multi-channel and single channel configurations are related to variations in the volume of sediment supply resulting in aggradation or erosion of channel floor and levee growth in the canyon-channel transition area. The sensitivity of the Amazon deep-sea Fan sedimentation to relatively small changes in sea level supports one of the central assumptions of the theory of Sequence Stratigraphy. In addition this study demonstrates how traps for hydrocarbons may have been formed in ancient fan systems.
Barros, Marcos Alexandre; Cervone, Gabriel Lopes de Faria; Costa, André Luis Serigatti
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. PMID:27218073
Vedova, Franco Della; Ibáñez, Maximiliano; Alvarez, Victoria; Lépore, Salvador; Sulzle, Vanina Ojeda; Galan, Hernán; Slullitel, Daniel
Introduction: Bankart lesion is the anterior glenohumeral instability most common associated injury. Tears at glenohumeral ligaments can be intra substance or at humeral insertion, this location may be the cause of instability. Posterior humeral avulsion of the glenohumeral ligament (PHAGL) can be an isolated or associated cause of instability and it is usually related to the posterior glenohumeral instability. The aim of this article is to report the clinical assessment and postoperative outcomes of 6 patients with PHAGL with anterior shoulder instability. Materials and Methods: We evaluated six patients with PHAGL due to anterior glenohumeral instability arthroscopically repaired. All 6 patients developed the lesion after a sports-related trauma. Sixty six per cent of patients had associated intra-articular shoulder pathologies. The diagnosis with MRI arthrogram (with gadolinium) was performed preoperatively in 50% of patients. Postoperative evaluation was made with Rowe, ASES and WOSI scores. Results: All patients returned to their previous sports level. One patient had a recurrence. Postoperative scores results are WOSI: 13.13%, Rowe 83.33 and ASES 95.83. Discussion: Humeral avulsions of glenohumeral ligaments represent 25% of capsulolabral injuries. PHAGL injury was initially described as a cause of posterior instability, but according to two other series, our study shows that this lesion may also cause anterior instability. It is critical to have a high index of suspicion and make a correct arthroscopic examination to diagnose this injury, because arthroscopic repair of PHAGL has good postoperative outcomes.
Woo, Sung Jong; Jegal, Midum; Park, Min Jong
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
Niknejad, Hamid Reza; van Calenbergh, Frank; Demaerel, Philippe; van Loon, Johannes
Injuries to the craniocervical support structures are frequently observed in neurotrauma cases. Stability of this region is of vital importance. Literature has mainly focused on three major ligaments of the craniocervical junction: The tectorial membrane, the transverse ligament, and the alar ligaments. However, the accessory atlantoaxial ligament (ALL) also seems to be involved in craniocervical stability as shown in cadaveric specimens. Still, the biomechanical importance of this structure needs to be determined, especially in trauma settings. Here, we describe a case of isolated traumatic injury to this structure and discuss the clinical outcome. A 64-year-old polytrauma patient with a remarkable avulsion fracture at the site of the insertion of the ALL was admitted to our center. We evaluated the patient both clinical and radiological at admission, after 3 months and after 1 year. We clinically assessed the upper cervical rotational stability using the cervical flexion-rotation test. We observed no rotational instability or any other clinical repercussions at the long-term after an isolated ALL injury. This case shows that isolated traumatic damage to the ALL is possible. Unilateral damage to the ALL probably does not cause rotational instability of the craniocervical junction. In case a similar avulsion fracture is observed, we recommend performing a magnetic resonance imaging of the craniovertebral region to assess for any ligamentous lesions. PMID:27891038
Carlstedt, T; Grane, P; Hallin, R G; Norén, G
Avulsion of nerve roots from the spinal cord is widely regarded as an untreatable injury. However, a series of experiments in animals has shown that, if continuity is restored between spinal cord and ventral roots, axons from spinal motor neurons can regrow into the peripheral nerves with recovery of motor function. These observations were applied in the treatment of a man with avulsion of the 6th cervical (C6) to 1st thoracic roots due to brachial plexus injury. Two ventral roots were implanted into the spinal cord through slits in the pia mater, C6 directly and C7 via sural nerve grafts. Voluntary activity in proximal arm muscles was detected electromyographically after nine months and clinically after one year. After three years the patient had voluntary activity (with some co-contraction) in the deltoid, biceps, and triceps muscles. To determine whether the improvement was due to spontaneous recovery from C5, the C5 root was blocked pharmacologically, and the results indicated that the repaired roots were contributing substantially to motor function. Repair of spinal nerve roots deserves further exploration in management of brachial plexus injury.
Mahendru, Sanjay; Khazanchi, Rakesh Kumar; Brajesh, Vimalendu; Jawed, Akram; Aggarwal, Aditya; Singh, Hardeep; Singh, Sukhdeep; Krishnan, S.
Replantations for major amputations of upper extremity have been widely performed. We report a unique case of successful replantation of scapulothoracic avulsion amputation in a child. In this manuscript, we discuss the various challenges faced during the procedure and chances of neural recovery. PMID:27833298
Heydari, Azar; Tahmasbi, Soodeh; Badiee, Mohammadreza; Izadi, SeyedSadra; Mashhadi Abbas, Fatemeh; Mokhtari, Sepideh
Introduction: Tooth avulsion is a real dental emergency. If immediate replantation is not performed, the avulsed tooth may be lost due to inflammatory or replacement resorption. This animal study aimed to evaluate the bone response to the titanium coating of the root surface as an artificial barrier, and prevention of resorption of avulsed teeth. Methods and Materials: This experimental study was conducted on four male dogs. The dogs were randomly divided into two groups for assessment at two and eight weeks. Four teeth were extracted in each animal. The root surfaces of the test group were coated with a titanium layer using the Electron Beam Deposition system. After 24 h, replantation of the teeth was performed. Two animals were sacrificed after two weeks and the remaining dogs were killed after eight weeks. The presence of inflammation, inflammatory resorption, replacement resorption, periodontal regeneration, periapical granuloma and ankylosis were evaluated through histological analyses. Results: Inflammatory root resorption was not present in any tooth except one tooth in the coated group after eight weeks. Replacement resorption was noted just in three of the non-coated teeth after two weeks and two teeth after eight weeks. The McNemar's test revealed that the frequency of replacement resorption in the non-coated group was significantly higher than the coated group (P=0.031). Conclusion: Based on the results of this study, it seems that coating the root surfaces of avulsed teeth with titanium may control the replacement root resorption. PMID:27790261
Al-Zoubi, Nabil A.; Yaghan, Rami J.; Qandeel, Haitham A.; Mazahreh, Tagleb D.
Patient: Female, 53 Final Diagnosis: Spontaneous non-traumatic anterior tibial artery avulsion and tibio-peroneal trunk transection Symptoms: Pain Medication: — Clinical Procedure: Autogenous popliteal-tibioperoneal trunk bypass Specialty: Surgery Objective: Rare disease Background: Popliteal fossa pseudoaneurysms as a result of trauma are not uncommon. However, spontaneous pseudoaneurysms as a result of non-traumatic rupture of posterior tibial artery (PTA), anterior tibial artery (ATA), or tibioperoneal trunk (TPT) artery segment are extremely rare. We report a case of spontaneous popliteal fossa pseudoaneurysm resulting from spontaneous avulsion of the ATA and transection of the TPT. Despite a thorough workup, no underlying associated disease was found. The extreme rarity of this disease presentation prompted us to report this case. Case Report: A 53-year-old female patient presented with a 10-day history of sudden onset of non-traumatic left popliteal fossa pain and swelling. A popliteal fossa pseudoaneurysm was diagnosed by duplex ultrasound examination. Computed tomography angiography (CTA) was performed to confirm the diagnosis and to plan treatment. Surgical exploration revealed avulsion of the ATA and transection of the TPT leading to a pseudoaneurysm. Autogenous popliteal-tibioperoneal trunk bypass was performed with uneventful recovery. Conclusions: A spontaneous popliteal fossa pseudoaneurysm caused by non-traumatic ATA avulsion and complete transection of TPT is extremely rare. Yet, it can be the cause of limb loss if not recognized early and treated promptly. Awareness by the medical community will help reduce the potential morbidity associated with this condition. PMID:28123173
Yuan, Qiuju; Hu, Bing; Chu, Tak-Ho; Su, Huanxing; Zhang, Wenming; So, Kwok-Fai; Lin, Zhixiu; Wu, Wutian
Neuronal nitric oxide synthase (nNOS) is induced after axonal injury. The role of induced nNOS in injured neurons is not well established. In the present study, we investigated the co-expression of nNOS with GAP-43 in spinal motoneurons following axonal injury. The role of induced nNOS was discussed and evaluated. In normal rats, spinal motoneurons do not express nNOS or GAP-43. Following spinal root avulsion, expression of nNOS and GAP-43 were induced and colocalized in avulsed motoneurons. Reimplantation of avulsed roots resulted in a remarkable decrease of GAP-43- and nNOS-IR in the soma of the injured motoneurons. A number of GAP-43-IR regenerating motor axons were found in the reimplanted nerve. In contrast, the nNOS-IR was absent in reimplanted nerve. These results suggest that expression of GAP-43 in avulsed motoneurons is related to axonal regeneration whereas nNOS is not.
Mumcuoglu, Tarkan; Durukan, Hakan A; Erdurman, Cuneyt; Hurmeric, Volkan; Gundogan, Fatih C
Partial optic nerve avulsion (ONA) secondary to finger gouging is an uncommon but devastating injury. A 21-year-old man who had an acute vision loss after accidentally getting poked by himself in his right eye when he fell down during jogging is reported. The patient was diagnosed with partial ONA. Magnetic resonance imaging revealed intact optic nerve. Optical coherence tomography (OCT) revealed deep cavity at the inferior-temporal half of the optic disc. Retinal nerve fiber layer thickness was also thin at the inferior quadrant with circumpapillary OCT scan. Visual field test and electrophysiological tests showed functional abnormality compatible with optic nerve lesion. Diagnostic tools for anatomical and functional evaluation may reveal the course of this injury. PMID:20952839
Yüksel, F; Karacaoğlu, E; Ulkür, E; Güler, M M
A foot avulsion case, with the dismembered body part submerged in sea water for 1 hour, is presented. This report is unique in that it is the first to document the reattachment of a body part that had been submerged in sea water. It was not known how salt-water exposure would affect wound management. Differences in osmolarity and bacterial flora between the sea water and foot tissues have not caused any problems, and the patient has not suffered any vascular or infectious complications after replantation. Neurotization of the plantar surface by the tibial nerve, which was stripped off during amputation and replaced in its original traces, was the most critical part of convalescence. After management of such an interesting case, we conclude that exposure to sea water of the dismembered part should not be a contraindication for replantation surgery.
Freitas, Maria Carolina Masiero; de Castilho, Aline Rogéria Freire; Marta, Sara Nader; Francischone, Leda Aparecida; Carrara, Carlos Eduardo; Franzolin, Solange de Oliveira Braga
The prevalence of traumatisms with avulsion of deciduous teeth varies from 7 to 13%, usually involving one tooth only. In this case report, a trauma with multiple losses of deciduous teeth and laceration of soft tissue is described as a consequence of a horse backward kick. After suture of extra-oral tissue wounds and application of anti-tetanic vaccine, the patient was referred to the emergency ambulatory of Sacred Heart University. Treatment procedures included radiographic analysis, removal of bone fragments and of a residual root of the tooth involved, remodeling and suture of intra-oral tissues. The patient was observed periodically and after full recovery, a prosthetic appliance was installed for functional and esthetic rehabilitation.
Langer, Phillip R; Selesnick, Harlan
Quadriceps injuries, ranging from simple strains to disabling muscle ruptures, are common athletic injuries. The rectus femoris is the most commonly injure portion of the quadriceps musculature. This article is, to our knowledge, the first report of a proximal rectus femoris avulsion in an elite, Olympic-level 100-meter sprinter, acutely managed with surgical repair. Several key factors must be considered and carefully assessed when determining the appropriate course of management (ie, deciding between operative and nonoperative treatment): amount of distal retraction of the tendon, severity of associated soft-tissue trauma, physical examination, and postoperative goals (eg, return to elite-level competitive sports involving running or kicking vs resuming basic activities of daily living). We believe that these factors in our elite, high-performance athlete dictated an operative course of management.
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
Gajendran, Varun K; Bishop, Julius A
Terrible triad elbow injuries, consisting of fractures of the radial head and coronoid with ulnohumeral dislocation, are challenging to treat. They require a comprehensive understanding of the complex anatomy of the elbow to effectively treat all of the pathology and create a stable, congruent joint. The authors present a case of a terrible triad injury with avulsion of the triceps and flexor-pronator mass after a low-energy fall in a young patient. Although most terrible triad fracture-dislocations can be successfully treated with coronoid fixation, radial head fixation or replacement, and repair of the lateral collateral ligament complex, this case involved a completely circumferential injury to the elbow. The coronoid and anterior capsule were disrupted anteriorly, the radial head and lateral collateral ligament complex were disrupted laterally, the triceps was disrupted posteriorly, and the flexor-pronator mass was disrupted medially. Although the authors prefer to address most terrible triad injuries through a lateral approach, they suspected a circumferential injury preoperatively and elected to use a single posterior incision to address all of the pathology conveniently. This injury required treatment of all disrupted structures, because the elbow remained unstable until the triceps and flexor-pronator mass avulsions were ultimately repaired. With any elbow fracture-dislocation, surgeons should look for evidence of additional injuries that do not fit the commonly described patterns, because they may necessitate modifications to the treatment plan. Given the relatively common complications of stiffness and instability despite modern surgical techniques, additional injuries may further compromise functional outcomes unless they are addressed properly.
Background During the clinical treatment of the brachial plexus root avulsion (BPRA), reimplantation surgery can not completely repair the motor function of the hand because the axonal growth velocity of the spinal motoneurons (MNs) is too slow to re-innervate the intrinsic hand muscles before muscle atrophy. Here, we investigated whether lithium can enhance the regenerative capacity of the spinal MNs in a rat model of BPRA. Results The avulsion and immediate reimplantation of the C7 and C8 ventral roots were performed and followed with daily intraperitoneal administration of a therapeutic concentrationof LiCl. After a 20 week long-term rehabilitation, the motor function recovery of the injured forepaw was studied by a grasping test. The survival and regeneration of MNs were checked by choline acetyltransferase (ChAT) immunofluorescence and by Fluoro-Gold (FG) retrograde labeling through the median and ulnar nerves of the ventral horn MNs. The number and diameter of the nerve fibers in the median nerve were assessed by toluidine blue staining. Our results showed that lithium plus reimplantation therapy resulted in a significantly higher grasping strength of the digits of the injured forepaw. Lithium plus reimplantation allowed 45.1% ± 8.11% of ChAT-positive MNs to survive the injury and increased the number and diameter of nerve fibers in the median nerve. The number of FG-labeled regenerative MNs was significantly elevated in all of the reimplantation animals. Our present data proved that lithium can enhance the regenerative capacity of spinal MNs. Conclusions These results suggest that immediate administration of lithium could be used to assist reimplantation surgery in repairing BPRA injuries in clinical treatment. PMID:24985061
River deltas are highly dynamic, often fan-shaped depositional systems that form when rivers drain into a standing body of water. They host over a half billion people and are currently under threat of drowning and destruction by relative sea-level rise, subsidence, and anthropogenic interference. Deltas often develop planform fan shapes through avulsions, whereby major river channel shifts occur via "channel jumping" about a spatial node, thus determining their fundamental length scale. Emerging theories suggest that the size of delta lobes is set by backwater hydrodynamics; however, these ideas are difficult to test on natural deltas, which evolve on centennial to millennial timescales. In this presentation, I will show results from the first laboratory delta built through successive deposition of lobes that maintain a constant size that scales with backwater hydrodynamics. The characteristic size of deltas emerges because of a preferential avulsion node that remains fixed spatially relative to the prograding shoreline, and is a consequence of multiple river floods that produce persistent morphodynamic river-bed adjustment within the backwater zone. Moreover, river floods cause erosion in the lowermost reaches of the alluvial river near their coastline, which may leave erosional boundaries in the sedimentary record that may appear similar to those previously interpreted to be a result of relative sea-level fall. I will discuss the implications of these findings in the context of sustainability management of deltas, decoding their stratigraphic record, and identifying ancient standing bodies of water on other planets such as Mars. Finally, I will place this delta study in a broader context of recent work that highlights the importance of understanding and quantifying variability in sedimentology and geomorphology.
Gómez-Hoyos, Juan; Reddy, Manoj; Martin, Hal D.
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
Vandervliet, Everhard J M; Vanhoenacker, Filip M; Snoeckx, Annemie; Gielen, Jan L; Van Dyck, Pieter; Parizel, Paul M
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.
Markeson, Daniel B; Mughal, Maleeha; Subramanian, Padmanabhan; Iyer, Srinivasan
Avulsion injuries of the flexor digitorum profundus tendon can be with or without a bony fragment. Types 3, 4, and 5 injuries often have a sizeable bony fragment. In the past, they have been repaired with either a screw, plate, or pull-out wire with a dorsal button, often in combination with a K wire to immobilize the distal interphalangeal joint. We illustrate with 2 cases a simple technique for secure repair of the flexor digitorum profundus avulsions with a bony fragment. In contrast to previously described techniques, our technique involves minimal dissection, has a significantly reduced risk of fracture to the bony fragment, is completely internalized thereby reducing the risk of postoperative infection and allows immediate mobilization.
Kuhn, K M; Dao, K D; Shin, A Y
Avulsion fractures of the base of the proximal phalanx associated with collateral ligament instability, excluding the thumb, are relatively rare. While the indications for surgical intervention vary, dorsal approaches have been advocated despite the volar location of the fracture fragment and orientation of the collateral ligaments. Ten patients with 11 avulsion fractures at the base of the proximal phalanx associated with collateral ligament instability were treated with open reduction and internal fixation using a volar A1 pulley approach. Anatomic restoration of the articular surface and collateral ligament stability were obtained in all patients. All fractures healed between 5 and 9 weeks (average, 6 weeks). After an average 19.4-month follow-up period all patients had full range of motion of the metacarpophalangeal joint, collateral ligament stability, and grip strength of at least 90% of the uninjured hand. No perioperative complications occurred. The average DASH score at last follow-up examination was 1.8 (range, 0-6). All patients were satisfied with the outcome of surgery. The volar A1 pulley approach is a direct and effective approach for reduction and fixation of avulsion fractures of the base of the proximal phalanx associated with collateral ligament instability.
Bernal, Carolina; Christophoul, Frédéric; Darrozes, José; Laraque, Alain; Bourrel, Luc; Soula, Jean-Claude; Guyot, Jean-Loup; Baby, Patrice
Avulsion is the main process at the origin of anastomosing rivers. This study illustrates 3 examples of avulsions resulting from crevasse splays evolving in anastomosed channels along the Rio Pastaza, a tropical humid river sourced in the Ecuadorian Andean Cordillera and flowing into the Amazonian foreland. The Lower Pastaza flows in an alluvial plain, with no tectonic influence and an average monthly rainfall equally distributed throughout the year. Based on the analysis of satellite image recorded over the period 1977-2008, three cases have been studied. The first one began in 1990 with crevassing of natural levees of the right bank of the Pastaza main channel and the formation of a small channel linking up with a pre-existing tributary to this main channel. A splay formed at the confluence beheaded the tributary which became an anabranch of the main river. Downstream, two other avulsions developed from crevasse splays on a low gradient floodplain. In both cases, capture of one of the distributary channels flowing on the splay by a pre-existing drain of the floodplain and consecutive headward erosion arrives to disconnect the other drains and capture their flow into a single-thread channel. As this channel rejoins the Pastaza main channel downstream, this process gives rise to the larger-scale anastomosing system which characterizes the lower reach of the Rio Pastaza.
Fang, Xin-Yu; Zhang, Wen-Ming; Zhang, Chao-Fan; Wong, Wai-Man; Li, Wen; Wu, Wutian; Lin, Jian-Hua
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.
Introduction Injury of the gallbladder after blunt abdominal trauma is an unusual finding; the reported incidence is less than 2%. Three groups of injuries are described: simple contusion, laceration, and avulsion, the last of which can be partial, complete, or total traumatic cholecystectomy. Case presentation A case of isolated complete avulsion of the gallbladder (near traumatic cholecystectomy) from its hepatic bed in a 46-year-old Caucasian man without any other sign of injury is presented. The avulsion was due to blunt abdominal trauma after a car accident. The rarity of this injury and the stable condition of our patient at the initial presentation warrant a description. The diagnosis was made incidentally after a computed tomography scan, and our patient was treated successfully with ligation of the cystic duct and artery, removal of the gallbladder, coagulation of the bleeding points, and placement of a drain. Conclusions Early diagnosis of such injuries is quite difficult because abdominal signs are poor, non-specific, or even absent. Therefore, a computed tomography scan should be performed when the mechanism of injury is indicated. PMID:21851630
Kenney, M. A.; Mohrig, D.; Hobbs, B. F.; Parker, G.
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
Moran, Kaitlin E.; Nittrouer, Jeffrey A.; Perillo, Mauricio M.; Lorenzo-Trueba, Jorge; Anderson, John B.
The Trinity River system provides a natural laboratory for linking fluvial morphodynamics to stratigraphy produced by sea-level rise, because the sediments occupying the Trinity incised valley are well constrained in terms of timing of deposition and facies distribution. Herein, the Trinity River is modeled for a range of base-level rise rates, avulsion thresholds, and water discharges to explore the effects of backwater-induced in-channel sedimentation on channel avulsion. The findings are compared to observed sediment facies to evaluate the capability of a morphodynamic model to reproduce sediment deposition patterns. Base-level rise produces mobile locations of in-channel sedimentation and deltaic channel avulsions. For scenarios characteristic of early Holocene sea-level rise (4.3 mm yr-1), the Trinity fluvial-deltaic system progrades 13 m yr-1, followed by backstepping of 27 m yr-1. Avulsion is reached at the position of maximum sediment deposition (located 108 km upstream of the outlet) after 3,548 model years, based on sedimentation filling 30% of the channel. Under scenarios of greater base-level rise, avulsion is impeded because the channel fill threshold is never achieved. Accounting for partitioning of bed-material sediment between the channel and floodplain influences the timing and location of avulsion over millennial time scales: the time to avulsion is greatly increased. Sedimentation patterns within the valley, modeled and measured, indicate preference toward sandy bed material, and the rates of deposition are substantiated by previous measurements. Although the results here are specific to the Trinity River, the analysis provides a framework that is adaptable to other lowland fluvial-deltaic systems.
Htut, M; Misra, V P; Anand, P; Birch, R; Carlstedt, T
Forty-four patients with severe traction brachial plexus avulsion injuries were studied following surgical repairs. In eight patients, re-implanting avulsed spinal roots directly to the spinal cord was performed with other repairs and motor recovery in the proximal limb was similar to that achieved by conventional nerve grafts and transfers when assessed using the MRC clinical grades, Narakas scores, EMG and Transcranial Magnetic Stimulation (TMS). Thirty-four of the 37 patients had co-contractions of agonist and antagonist muscle groups. Spontaneous contractions of limb muscles in synchrony with respiration, the "breathing arm", were noted in 26 of 37 patients: in three patients, the source of the breathing arm was from spinal cord re-connection, providing evidence of regeneration from the CNS to the periphery. Our study shows that re-connection of avulsed spinal roots can produce good motor recovery and provides a clinical model for developing new treatments which may enhance nerve regeneration.
Chen, Wei; Luo, Wei; Chen, Zhiqing; Jiang, Yi
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
Ahmed, Shameem; Ifthekar, Syed; Ahmed Khan, R Pathan Rameez; Ranjan, Rahul
Introduction: The management of heel pad avulsion injuries has been challenging because of the precarious blood supply. The difficulties get compounded when it is associated with tendo-achilles rupture and calcaneal fracture. Here, it is a description of a case with the above features managed with a unique technique. Case Report: A 63-year-old woman presented to casualty with injury to right ankle after a road traffic accident. On clinical and radiological examination, there was avulsion of heel pad with calcaneal tuberosity fracture and tendo-achilles rupture. It was managed with debridement of the wound, repair of tendo-achilles, and fixation of calcaneal tuberosity and heel pad. The functional outcome was assessed in terms of the ability of the patient to return to painless barefoot weight bearing. The uniqueness of this method is the combined use of suture material (Ethibond) and stainless steel (cannulated cancellous screws [CCS]), by tying the Ethibond from tendo-achilles to the head of CCS rather than bone. When the CCS were tightened, two things were achieved; one being the reduction of the fracture and the second to bring a good apposition of tendo-achilles with the calcaneum. As this method worked on tension band principle and Ethibond was used instead of stainless steel wire, if no objections, this technique can be called as “soft tension band technique.” Conclusion: This case report illustrates a method of preserving heel pad when it is viable along with definitive treatment of associated soft tissue and bony injuries by a simple technique. This method has described the fixation of open fracture of calcaneal tuberosity with tendo-achilles rupture with heel pad avulsion in one sitting with excellent clinical results. PMID:27299125
Larrain, Mario; Rocco, Eduardo Di; Riatti, Patricio; Ferreyra, Facundo; Cianciosi, Juan Sebastián
Introduction: Given the infrequency and lack of consensus in the treatment of children and adolescents with these injuries, we decided to write this report with the aim of present a case of PCL tibial avulsion in a contact athlete teen with open physis and a review of the literature published. Materials and Methods: RF.male, 13 years, rugby, suffers French tackle and fall on knees flexed. 3 months post-trauma consultation with left knee pain, joint fluid and sport limitation. Whidout instability but "not feeling well". The posterior drawer test + + / ++++, gravitational test +. Rx posterior drawer: 8mm difference between the two nenes. MRI: tibial avulsion PCL. We interpreted as symptomatic PCL injury in athletes, surgery (arthroscopy + posterior approach) is decided reintegration of chondral fragment in 1 time P.OP: no load 4 Weeks . plaster wedge extension 6 weeks, then 3 months and passive immobilizer progressive mobility. Results: 0-90 mobility achieving in 8th week. The 3rd month drawer rx 4mm. MRI posterior translation of the 4th month reintegration of LCP with anchor . 6ª month later minimally elongated drawer with stop net. 11th month continuous strengthening recrearional and sports activities. Discussion and Conclusion: Most avulsion of PCL in patients with open physis probably be for greater strength and endurance ligament compared with the phisis and bone at this age. We suspected in patients with vague knee pain, with or without instability, history of trauma and normal Rx a correct examination and MRI to be essential for diagnosis. We beleave that athletes with open physis, because of the risk of joint degeneration, surgery is justified to restore kinematics, prevent osteoarthritis and resume activity prior to the injury.
Wang, Yi; Lu, Liangyu; Lu, Zhe; Xiao, Lei; Kang, Yifan; Wang, Zimin
Objective: To evaluate clinical efficacy of arthroscopic transtendinous repair of partial articular-sided PASTA (partial articular supraspinatus tendon avulsion) injury. Methods: From February 2011 to July 2014, 12 cases of PASTA, aged 29 to 72 years with an average of 52.9 ± 13.3 years, were treated arthoscopically. To repair PASTA, articular-sided rotator cuff tear was explored, injury site was punctured and labeled with PDS absorbable monofilament suture (Ethicon, Somerville, NJ, USA) suture, subacromial bursa was cleaned up with acromioplasty, and integrity of bursa-side rotator cuff was assessed. Then with arthroscope in glenohumeral joint, footprint of the bursa-side supraspinatus tendon was preserved, rivets were introduced into the joint through supraspinatus tendon, joint-side partial tear was sutured, and anatomical reconstruction of the rotator cuff footprint was established. The patients were followed up post-operatively for 12-36 months, average 22 ± 7.3 months. The clinical outcomes were emulated with ASES (American Shoulder and Elbow Surgeons) Shoulder Score system and UCLA (University of California at Los Angeles) Shoulder rating scale. Results: The post-operative ASES score was 89.7 ± 5.6, higher than the pre-operative one 49.8 ± 9.8 (t = 12.25, P <0.0001). While UCLA scale increased from the pre-operative 17.3, ± 3.3 to the post-operative 30.4 ± 3.2 points (t = 9.87, P <0.0001), with a satisfaction rate of 11/12 (91.7%). Conclusion: Trans-tendon repair is ideal for PASTA with advantage of maximal preservation of the normal rotator cuff tissue, anatomical reconstruction of the rotator cuff footprint and stable fixation of tendon-bone interface. PMID:25784979
Deutsch, Stephanie Anne; Long, Christopher J; Srinivasan, Arun K; Wood, Joanne N
Sexual abuse of children is prevalent in today's society. In 2012, approximately 686,000 children (9.2 per 1000) in the United States were determined to be victims of substantiated child abuse and neglect, according to national data compiled by child protective service agencies; victimization rates were highest for children younger than 1 year. Nearly 9.3% of maltreated children were victims of sexual abuse, this finding was reported by US Department of Health and Human Services (http://www.acf.hhs.gov/programs/cb/research-data-technology/statistics-research/child-maltreatment). Previous research has shown that as many as 1 in 3 girls and 1 in 7 boys will be sexually abused during childhood (Child Abuse Negl. 2003;27:1205-1222). Although sexual abuse seems to be less common in boys than girls, this may be partly due to underdiagnosis and underreporting of sexual abuse in boys (Arch Dis Child. 2007;92:328-331). Clinicians should therefore consider the possibility of sexual abuse when boys present with genital injuries, because failing to recognize and diagnose sexual abuse can pose an ongoing safety risk to a child. However, an erroneous diagnosis of sexual abuse can have equally hazardous repercussions, including removal of a child from their caregivers or prosecution of an innocent individual. A number of medical conditions can mimic child sexual abuse injuries, including anal fissures, failure of midline fusion, perianal streptococcal dermatitis, and straddle injury (J Pediatr Health Care. 2009;23:283-288 and Acta Paediatr. 2011;100:590-593). The following case involves a 5-week-old male infant who presented to the pediatric emergency department with an avulsion injury to his penis concerning for sexual abuse. He was ultimately diagnosed with a relatively rare anatomic variant of the genitalia and determined to have sustained an accidental injury whose appearance mimicked abuse.
Lim, Hyoseob; Han, Dae Hee; Lee, Il Jae
Background Extensive degloving injuries of the extremities usually result in necrosis of the flap, necessitating comprehensive skin grafting. Provided there is a sufficient tool to evaluate flap viability, full-thickness skin can be used from a nonviable avulsed flap. We used a Wood's lamp to determine the viability of avulsed flaps in the operation field after intravenous injection of fluorescein dye. Methods We experienced 13 cases during 16 months. Fifteen minutes after the intravenous injection of fluorescein dye, the avulsed skin flaps were examined and non-fluorescent areas were marked under Wood's lamp illumination. The marked area was defatted for full-thickness skin grafting. The fluorescent areas were sutured directly without tension. The non-fluorescent areas were covered by defatted skin. Several days later, there was soft tissue necrosis within the flap area. We measured necrotic area and revised the flap. Results Among all the cases, necrotic area was 21.3% of the total avulsed area. However, if we exclude three cases, one of a carelessly managed patient and two cases of the flaps were inappropriately applied, good results were obtained, with a necrotic area of only 8.4%. Eight patients needed split-thickness skin grafts, and heel pad reconstruction was performed with free flap. Conclusions A full-thickness skin graft from an avulsed flap is a good method for addressing aesthetic concerns without producing donor site morbidity. Fluorescein dye is a useful, simple, and cost-effective tool for evaluating flap viability. Avulsed flap injuries can be managed well with Wood's lamp illumination and a full-thickness skin graft. PMID:24665420
Barbizan, Roberta; Seabra Ferreira, Rui
Axonal injuries at the interface between central and peripheral nervous system, such as ventral root avulsion (VRA), induce important degenerative processes, mostly resulting in neuronal and motor function loss. In the present work, we have compared two different fibrin sealants, one derived from human blood and another derived from animal blood and Crotalus durissus terrificus venom, as a promising treatment for this type of injury. Lewis rats were submitted to VRA (L4–L6) and had the avulsed roots reimplanted to the surface of the spinal cord, with the aid of fibrin sealant. The spinal cords were processed to evaluate neuronal survival, synaptic stability, and glial reactivity, 4 and 12 weeks after lesion. Sciatic nerves were processed to investigate Schwann cell activity by p75NTR expression (4 weeks after surgery) and to count myelinated axons and morphometric evaluation (12 weeks after surgery). Walking track test was used to evaluate gait recovery, up to 12 weeks. The results indicate that both fibrin sealants are similarly efficient. However, the snake-derived fibrin glue is a potentially safer alternative for being a biological and biodegradable product which does not contain human blood derivatives. Therefore, the venom glue can be a useful tool for the scientific community due to its advantages and variety of applications. PMID:27642524
Omidi-Kashani, Farzad; Mousavi, Seyed Mahdi
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
Isla, Federico; Espinosa, Marcela; Rubio, Belén; Escandell, Alejandra; Gerpe, Marcela; Miglioranza, Karina; Rey, Daniel; Vilas, Federico
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
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
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
Chan, Jeffrey C Y; Purcell, Elizabeth M; Kelly, John L
The purpose of this study is to describe our technique of central slip repair using the Mitek bone anchor and to evaluate the treatment outcome. Eight digits in eight patients were reconstructed using the bone anchor: three little fingers, two middle fingers, two index fingers and one ring finger. There were two immediate and six delayed repairs (range from one day to eight months). Four patients had pre-operative intensive splinting and physiotherapy to restore passive extension of the proximal interphalangeal joint prior to central slip reconstruction. All patients have made good progress since surgery. No patient requires a second procedure and none of the bone anchors have dislodged or loosened. We conclude that the Mitek bone anchor is a reliable technique to achieve soft tissue to bone fixation in central slip avulsion injuries. We recommend that this technique be considered as a treatment option for patients requiring surgical repair.
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
Pickering, J.; Grall, C.; Spiess, V.; Schwenk, T.; Palamenghi, L.; Sincavage, R.; Diamond, M. S.; Goodbred, S. L., Jr.
Holocene sediments of the Brahmaputra-Jamuna River in the upper delta plain of the Bengal basin unconformably overlie latest Pleistocene alluvium. Previously drilled borehole data reveal that the unconformity is marked by a basal gravel unit of early Holocene age with boulders up to 30-cm in diameter atop a compacted but unlithified sand and gravel conglomerate (D50=0.6mm) of latest Pleistocene age. We tie these borehole data to a 2D marine multichannel seismic survey along a 255-km reach of the Brahmaputra-Jamuna River, the first survey to image the lowstand valley from the India-Bangladesh border to the confluence with the Ganges (Padma) River. A prominent reflector is imaged along the length of the survey demarcating the valley base and Holocene-Pleistocene unconformity, sloping from ~40m below water level upstream to ~90m below water level at the downstream confluence. The average slope of this paleosurface is ~3x steeper than that of the modern channel bed, which may be the result of lower base level and propagation of a low-relief knickpoint during the last glacial lowstand. Alternatively or in conjunction, the steeper channel gradient may be due to increased basinward subsidence. In addition, the lowstand reflector is tectonically deformed at multiple locations, defining 4 distinct tectonic domains along the length of the survey. We place these tectonic influences on the stream channel in the context of its avulsion history during the Holocene, with evidence that the most recent avulsion of the Old Brahmaputra into the modern Jamuna course ~200ya was induced by tectonic uplift along the western margin of the Shillong Massif (Meghalaya, India). We further propose locations of the modern river that may be affected by tectonically-induced planform changes.
Martins, Christine Men; Hamanaka, Elizane Ferreira; Hoshida, Thayse Yumi; Sell, Ana Maria; Hidalgo, Mirian Marubayashi; Silveira, Catarina Soares; Poi, Wilson Roberto
Tooth replantation success depends on the condition of cementum periodontal ligament after tooth avulsion; which is influenced by storage medium. The dragon's blood (Croton lechleri) sap has been suggested as a promising medium because it supports collagen formation and exhibits healing, anti-inflammatory and antimicrobial properties. Thus, the aim of this study was to evaluate the efficacy of dragon's blood sap as a storage medium for avulsed teeth through evaluation of functional and metabolic cell viability. This in vitro study compared the efficacy of different storage media to maintain the viability of human peripheral blood mononuclear and periodontal ligament cells. A 10% dragon's blood sap was tested while PBS was selected as its control. Ultra pasteurized whole milk was used for comparison as a commonly used storage medium. DMEM and distilled water were the positive and negative controls, respectively. The viability was assessed through trypan blue exclusion test and colorimetric MTT assay after 1, 3, 6, 10 and 24 h of incubation. The dragon's blood sap showed promising results due to its considerable maintenance of cell viability. For trypan blue test, the dragon's blood sap was similar to milk (p<0.05) and both presented the highest viability values. For MTT, the dragon's blood sap showed better results than all storage media, even better than milk (p<0.05). It was concluded that the dragon's blood sap was as effective as milk, the gold standard for storage medium. The experimental sap preserved the membrane of all cells and the functional viability of periodontal ligament cells.
Baisden, T.; Hajek, E. A.; Chamberlin, E.; Toms, L.; Foreman, B.
Comparing ancient channel and floodplain deposits provides insight into long-term channel and floodplain dynamics in alluvial basins. Channel lateral migration and avulsion behavior may be affected by floodplain characteristics, including sediment cohesion, vegetation cover, and floodplain-drainage conditions. Channel-deposit architecture reflects paleo-channel dynamics; for example, channel form, migration, and reworking can be inferred from bar deposits, while multi-storied sand bodies can indicate a complex history of channel avulsion, reoccupation and migration. Furthermore, associated floodplain deposits can be used to reconstruct some aspects of floodplain sedimentation patterns, drainage, and soil development. In order to better understand how channel mobility may be linked to floodplain conditions, we compare the three members of the Paleocene-Eocene Wasatch Formation, which were deposited under broadly similar basin subsidence conditions, and straddle the Paleocene-Eocene Thermal Maximum (PETM) climate-change event. These ancient deposits show varying styles of channel and floodplain deposits. The Atwell Gulch (pre-PETM) and Shire (post-PETM) members of the Wasatch Formation are both mud-stone dominated, with abundant, well-developed paleosol deposits. In contrast, the middle Molina Member is sand-rich and contains more weakly developed paleosols. Using terrestrial lidar scans and high-resolution photo panels of outcrops, along with detailed field measurements, we identify key surfaces (including bar-accretion, and story-bounding surfaces) and facies within channel deposits, and describe floodplain deposits within each member. Concurrent changes in paleo-channel architecture and floodplain deposits observed within the succession suggest that floodplain conditions are important controls on channel mobility in Wasatch rivers.
Kemp, Mark A; Barnes, James R; Thorpe, Paul L; Williams, James L
In this report, we describe the case of an adult male who developed an acute compartment syndrome localized to the anterior compartment of the leg following an ankle sprain. Compartment syndrome in association with ankle sprain is unusual, and has been previously described in association with avulsion of the perforating peroneal artery. Because of the potential for severe morbidity, we feel that it is important to make foot and ankle surgeons aware of this unusual injury.
Ratliff, K. M.; Murray, A. B.; Hutton, E. W. H.; Piliouras, A.; Kim, W.
Deltas and their flat, fertile lands have become the most densely populated places on earth, but, partly because of anthropogenic interactions with fluvial, coastal, and wetland processes, their inhabitants are increasingly susceptible to natural disasters. Humans have decreased sediment supply delivered to rivers and ultimately wetlands and the coast, causing accelerating subsidence. The natural course and processes of many rivers have been altered through channelization, artificial levees, and dams, which 'perch' the river above its floodplain. As the rate of relative sea-level rise (RSLR) increases, so will surface aggradation and channel backfilling, resulting in a fluvial system that is more vulnerable to flooding and frequent avulsions. To investigate the effects of increasing RSLR and anthropogenic manipulations on delta morphodynamics, we create new avulsion and floodplain modules to couple with the 3D mode of Sedflux (Hutton and Syvitski, 2008), a stratigraphic basin-filling model. We replace the probabilistic approach of channel avulsion previously used in the model with a module incorporating the steepest-decent methodology used in Jerolmack and Paola (2007), and a floodplain algorithm to deposit sediment on subaerial cells. Model experiments with Sedflux and the new modules address the effects on delta morphodynamics of varying rates of RSLR (affecting base-level), changes in sediment delivery (adjusting the upstream boundary conditions), and restriction of natural fluvial dynamics (inhibiting avulsions). The work presented here is the first step in a more expansive project to develop a new 3D eco-morphodynamic delta model system that will be based on further model couplings, including a vegetation module (that will affect fluvial and floodplain dynamics) and a coastline module (that will re-work the shoreline based on wave-driven alongshore sediment transport). The model system results will be tested and calibrated based on comparisons with
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
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
Latrubesse, E. M.
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
Chuang, D C; Lai, J B; Cheng, S L; Jain, V; Lin, C H; Chen, H C
Major replantation of a traction avulsion amputation is undertaken with the goal of not only the reestablishment of circulation, but also functional outcome. This type of amputation is characterized by different levels of soft-tissue divisions involving crushing, traction, and avulsion injuries to various structures. Between 1985 and 1998, 27 cases were referred for secondary reconstruction following amputation of the upper extremity involving both arm and forearm. Replantation was performed by at least 12 qualified plastic surgeons using different approaches and management, resulting in different outcomes. Initial replantation management significantly affects the later reconstruction. For comparing studies and prognostic implications, the authors propose a new classification according to the level of injury to muscles and innervated nerves: type I, amputation at or close to the musculotendinous aponeurosis with muscles remaining essentially intact; type II, amputation within the muscle bellies but with the proximal muscles still innervated; type III, amputation involving the motor nerve or neuromuscular junction, thereby causing total loss of muscle function; and type IV, amputation through the joint; i.e., disarticulation of the elbow or shoulder joint. Some patients required further reconstruction for functional restoration after replantation, but some did not. Through this retrospective study based on the proposed classification system, prospective guidelines for the management of different types of traction avulsion amputation are provided, including the value of replantation, length of bone shortening, primary or delayed muscle or nerve repair, necessity of fasciotomy, timing for using free tissue transfer for wound coverage, and the role of functioning free muscle transplantation for late reconstruction. The final functional outcome can also be anticipated prospectively through this classification system.
Konstantinos, Stamatiou; Georgios, Ilias; Christos, Chlopsios; Vasilissa, Karanasiou; Nikolaos, Kavouras; Fred, Lebrun; John, Heretis; Frank, Sofras
Introduction Rupture of the diaphragm is almost always due to major trauma. Diaphragmatic injuries are rare (5–7%), usually secondary to blunt, or more rarely to penetrating, thoracic or abdominal trauma. No single investigation provides a reliable diagnosis of diaphragmatic rupture when a patient first arrives at hospital. Almost 33% are suspected on initial chest x-ray, but the percentage is lower in patients who are immediately intubated. Mortality in patients with diaphragmatic rupture following blunt abdominal trauma is generally associated with coexistent vascular and visceral injuries that could be rapidly fatal. It's mandatory that the right diagnosis is reached as soon as possible given that mortality is influenced by the time elapsing between trauma and diagnosis. Case presentation A 35-year-old worker was hit by a heavy object while working in the factory. He was transferred immediately to our emergency room. Chest x-ray showed massive left hemothorax without any additional signs to suggest diaphragmatic injury. It was decided to perform immediate surgical exploration before further radiological examination. During surgery, the right kidney and liver appeared normal, but the left kidney and spleen were not found in their anatomical position. The left hemidiaphragm had a10-cm oblique posterior tear. The left kidney was found lacerated in the left side of the chest, separated completely from its vascular pedicle and ureter, along with the entire spleen which was also separated from its vascular tree. Conclusion The avulsion of both kidney and spleen following abdominal trauma is uncommon and survival depends on prompt diagnosis and treatment. PMID:18076752
Pe-Piper, Georgia; Piper, David J. W.; Wang, Ying; Zhang, Yongzhan; Trottier, Corwin; Ge, Chendong; Yin, Yong
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.
Persoiu, I.; Radoane, M.
. 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.
Prabhu, Jagadish; Faqi, Mohammed Khalid; Alkhalifa, Fahad; Tayara, Bader Kamal; Awad, Rashad Khamis
Injuries to the pectoralis major muscle are relatively infrequent. The mechanism of injury is usually an eccentric shortening of the pectoralis major under heavy load, such as when performing a bench press exercise. We report a case that presented to us with a history of sudden pain in the left pectoral region while doing heavy bench press exercise. The patient sustained a type III D pectoralis muscle –tendon avulsion. Surgical repair was done through a bi-cortical tendon sliding technique using two cortical buttons. In this article we describe our modifications to the previously described surgical technique for the pectoralis major tendon repair using the EndoButton and tension – slide technique, aiming to overcome the possible complications. PMID:28217216
Ernat, Justin J; Bottoni, Craig R; Rowles, Douglas J
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.
Shah, Aakash A; Selesnick, F Harlan
Traumatic anterior shoulder instability has been well documented to have associated lesions such as a Bankart tear, humeral avulsion of the glenohumeral ligament (HAGL), Hill-Sachs lesion, fracture, and nerve injury. To our knowledge, the combined Bankart and HAGL injury in a single acute anterior shoulder dislocation has not yet been reported. We describe a traumatic first-time anterior-inferior shoulder dislocation in a professional basketball player with a combined Bankart and HAGL lesion. The patient underwent arthroscopic Bankart repair followed by open repair of the HAGL lesion with an open capsular shift reconstruction. At 3 years' follow-up, the patient had returned to an elite level of play, with an excellent outcome.
Karmali, Arif; McLeod, Jennifer
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
Berman, Jonathan S; Symonds, Catherine; Birch, Rolfe
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.
[Lesion of the Lissauer tract and of the posterior horn of the gray substance of the spinal cord and the electrical stimulation of the central nervous system for the treatment of brachial plexus avulsion pain].
Teixeira, M J; De Souza, E C; Yeng, L T; Pereira, W C
We analyze the effectiveness of the treatment of 10 patients of brachial plexus avulsion pain. Seven underwent dorsal root entry zone lesions (DREZ), 3, dorsal column stimulation (DCS) and, 2 thalamic stimulation (TS). DCS resulted in immediate improvement of pain in 50% of the patients. After a long term follow up period, just 25% of the patients were still better. TS resulted the in temporary improvement of 2 patients. Both had full recurrence few months after the operation. Immediate improvement of the symptoms occurred in all patients treated by DREZ. After a long term follow up period, excellent results were observed in 71.4% of the patients and good results in the remainder. The complication rate was higher among DREZ patients. It is concluded that DREZ is a better procedure for treatment of brachial plexus avulsion pain than DCS and TS (p = 0.0046); however, DCS and TS are safer.
Ko, Andrew L; Ozpinar, Alp; Raskin, Jeffrey S; Magill, Stephen T; Raslan, Ahmed M; Burchiel, Kim J
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.
Athanasopoulos, Panagiotis G.; Hadjittofi, Christopher; Dharmapala, Arinda Dinesh; Orti-Rodriguez, Rafael Jose; Ferro, Alessandra; Nasralla, David; Konstantinidou, Sofia K.; Malagó, Massimo
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
Najefi, Ali; Jeyaseelan, Lucksmana; Patel, Anand; Kapoor, Akhil; Auplish, Sunil
Introduction: Simultaneous contraction of the extensor carpi radialis longus (ECRL) with forced hyperflexion of the wrist can result in avulsion of the tendon and its bony attachment at its insertion at the dorsum of the base of the second metacarpal. This is a rare and often unreported fracture pattern. Case Presentation: We present a 31- year- old male who sustained a hyperflexion injury. He was managed surgically and had good post-operative outcomes. A literature search revealed 16 papers covering 18 cases of similar injuries. 12 were initially managed surgically and 6 were managed conservatively. Conclusions: Of the open reductions and internal fixations, 11 (92%) were successful and patients made a full recovery. Conservative management was unsuccessful in 4 cases; one patient required surgery for metacarpal boss, one patient had retraction of the tendon at one week follow up and another had weak flexion of the wrist. We recommend open reduction and internal fixation for these injuries. It may allow a faster recovery and therefore allow an earlier return to work and activity. PMID:27148501
Tu, Yuan-Kun; Tsai, Yi-Jung; Chang, Chih-Han; Su, Fong-Chin; Hsiao, Chih-Kun; Tan, Jacqueline Siau-Woon
Purpose: We conducted a clinical study to evaluate the effects of neurotization, especially comparing the total contralateral C7 (CC7) root transfer to hemi-CC7 transfer, on total root avulsion brachial plexus injuries (BPI). Methods: Forty patients who received neurotization for BPI were enrolled in this prospective study. Group 1 (n = 20) received hemi-CC7 transfer for hand function, while group 2 (n = 20) received total-CC7 transfer. Additional neurotization included spinal accessory, phrenic, and intercostal nerve transfer for shoulder and elbow function. The results were evaluated with an average of 6 years follow-up. Results: Group 1 had fewer donor site complications (15%) than group 2 (45%); group 2 had significantly better hand M3 and M4 motor function (65%) than group 1 (30%; P = 0.02). There was no difference in sensory recovery. Significantly, better shoulder function was obtained by simultaneous neurotization on both suprascapular and axillary nerves. Conclusions: Total-CC7 transfer had better hand recovery but more donor complications than hemi-CC7. Neurotization on both supra-scapular and axillary nerves improved shoulder recovery. © 2013 The Authors. Microsurgery published by Wiley Periodicals, Inc. Microsurgery 34:91–101, 2014. PMID:23913440
Pan, Feng; Wei, Hai-feng; Chen, Liang; Gu, Yu-dong
Clinically, contralateral C7 transfer is used for nerve reconstruction in brachial plexus injuries. Postoperatively, synchronous motions at the donor limb are noteworthy. This study studied if different recipient nerves influenced transhemispheric functional reorganization of motor cortex after this procedure. 90 young rats with total root avulsion of the brachial plexus were divided into groups 1-3 of contralateral C7 transfer to anterior division of the upper trunk, to both the musculocutaneous and median nerves, and to the median nerve, respectively. After reinnervation of target muscles, number of sites for forelimb representations in bilateral motor cortices was determined by intracortical microstimulation at 1.5, 3, 6, 9, and 12 months postoperatively. At nine months, transhemispheric reorganization of nerves neurotized by contralateral C7 was fulfilled in four of six rats in group 1, one of six in group 2 and none in group 3, respectively; at 12 months, that was fulfilled in five of six in group 1, four of six in groups 2 and 3, respectively. Logistic regression analysis showed that rate of fulfilled transhemispheric reorganization in group 1 was 12.19 times that in group 3 (95% CI 0.006-0.651, p=0.032). At 12 months, number of sites for hindlimb representations which had encroached upon original forelimb representations on the uninjured side was statistically more in group 3 than in group 2 (t=9.5, p<0.0001). It is concluded that contralateral C7 transfer to upper trunk or to both the musculocutaneous and median nerves induces faster transhemispheric functional reorganization of motor cortex than that to median nerve alone in rats.
Haus, Brian M.; Arora, Danny; Upton, Joseph; Micheli, Lyle J.
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
Erosion and deposition by supercritical density flows during channel avulsion and backfilling: Field examples from coarse-grained deepwater channel-levée complexes (Sandino Forearc Basin, southern Central America)
Lang, Jörg; Brandes, Christian; Winsemann, Jutta
Erosion and deposition by supercritical density flows can strongly impact the facies distribution and architecture of submarine fans. Field examples from coarse-grained channel-levée complexes from the Sandino Forearc Basin (southern Central America) show that cyclic-step and antidune deposits represent common sedimentary facies of these depositional systems and relate to the different stages of avulsion, bypass, levée construction and channel backfilling. During channel avulsion, large-scale scour-fill complexes (18 to 29 m deep, 18 to 25 m wide, 60 to > 120 m long) were incised by supercritical density flows. The multi-storey infill of the large-scale scour-fill complexes comprises amalgamated massive, normally coarse-tail graded or widely spaced subhorizontally stratified conglomerates and pebbly sandstones, interpreted as deposits of the hydraulic-jump zone of cyclic steps. The large-scale scour-fill complexes can be distinguished from small-scale channel fills based on the preservation of a steep upper margin and a coarse-grained infill comprising mainly amalgamated hydraulic-jump zone deposits. Channel fills include repeated successions deposited by cyclic steps with superimposed antidunes. The deposits of the hydraulic-jump zone of cyclic steps comprise regularly spaced scours (0.2 to 2.6 m deep, 0.8 to 23 m long) infilled by intraclast-rich conglomerates or pebbly sandstones, displaying normal coarse-tail grading or backsets. These deposits are laterally and vertically associated with subhorizontally stratified, low-angle cross-stratified or sinusoidally stratified sandstones and pebbly sandstones, which were deposited by antidunes on the stoss side of the cyclic steps during flow re-acceleration. The field examples indicate that so-called spaced stratified deposits may commonly represent antidune deposits with varying stratification styles controlled by the aggradation rate, grain-size distribution and amalgamation. The deposits of small-scale cyclic
Dorsal root entry zone lesioning for pain after brachial plexus avulsion: results with special emphasis on differential effects on the paroxysmal versus the continuous components. A prospective study in a 29-patient consecutive series.
Aichaoui, Faycal; Mertens, Patrick; Sindou, Marc
Pain after brachial plexus avulsion (BPA) is generally characterized by 2 main different components: paroxysmal (electrical shooting-like) pain, and continuous (burning) pain. Dorsal root entry zone (DREZ) lesioning, namely, the microsurgical DREZotomy (MDT) used in our practice, has proved to be a worthwhile neurosurgical treatment for this indication. However, according to previous studies, the method does not seem to demonstrate as good effectiveness in patients in whom the continuous background of pain was predominant as in patients with the paroxysmal component predominating. To obtain more insight into this problem, a prospective study on an eventual differential effect of the MDT procedure on the 2 components was undertaken. The presented series included 29 consecutive patients affected with pain after BPA who underwent an operation over the 10 last years. Pain intensity was evaluated using a visual analogue scale (VAS). At last evaluation of the 26 patients followed for 12 to 122 months (60 months on average) after MDT, 76.9% had a good or excellent global pain relief after surgery, ie, pain control with or without additional nonopioid medications, respectively. According to the component types of pain, 84.6% of patients had good or excellent control of the paroxysmal pain, and 73.1% of the continuous pain. Kaplan-Meier prediction of lasting global pain control at 120 months of follow-up was calculated at 41.1%. Comparison of the 2 corresponding Kaplan-Meier curves at long term, namely, pain control in 76.2% for the paroxysmal component and in 43.1% for the continuous component, showed a statistically significant difference (P=.038). Hypotheses for this relative differential effect are discussed.
Negulesco, J. A.; Clark, D. L.
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.
Galve, Jorge Pedro; Alvarado, Guillermo; Pérez Peña, José Vicente; Azañón, José Miguel; Mora, Mauricio; Booth-Rea, Guillermo
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.
Carr, James B; John, Quincy E; Rajadhyaksha, Evan; Carson, Eric W; Turney, Kelly L
A 19-year-old female collegiate rower presented with a new, painful mass along her right anterolateral chest wall after competition. The patient was diagnosed with a rupture of the serratus anterior muscle from its costal attachments, as confirmed by magnetic resonance imaging. The patient fully recovered after a period of rest followed by a graduated 2-month physical therapy regimen consisting of stretching and scapulothoracic and core strengthening. A traumatic rupture of the serratus anterior muscle should be suspected in athletes who present with a painful chest wall mass after exertion of large forces through the scapulothoracic region. Athletes can return to play after nonoperative management.
Rogér, James M; Abayon, Maricelle; Elad, Sharon; Kolokythas, Antonia
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.
submitted for verification analysis. Materials were then fired and analyzed by X-ray defraction to determine the crystalline phases that might be... defraction to determine the crystalline phases that might be present in the finished implants. The results of the study indicated that preparation of a
and analyzed by X-ray defraction to deter mne the crystalline phases that might be present in the finished implants.rvhe results of the study indicated...were made at Battelle, the powders were mill-blended and submitted for verification analysis. Materials were then fired and analyzed by X-ray defraction
toluidine (Eastman 646), and Cobalt Naphthenate (Pfaltz and Bauer C23710) were employed to help speed the crosslinking reaction. Poly - lactic acid and...have been achieved. A com- position containing poly -(propylene fumarate), an unsaturated crosslinkable polymer made from fumaric acid , one of the Krebs...property is of concern with respect to developing adhesion between bone and a surgical repair material. 0 In formulating to obtain a plasticity which will
Kusnezov, Nicholas; Rensing, Nicholas
Fracture of the calcaneal tuberosity with a concomitant Achilles tendon rupture presents a difficult challenge for the treating surgeon. The ultimate goal of treatment is to restore function of both the gastrocnemius-soleus complex and the Achilles tendon. This particular subset of fractures occurs often in diabetics and elderly patients with osteoporosis making fixation of the displaced fragment rather complex. If the Achilles tendon disruption is only discovered later once the fracture is healed, subsequent management is difficult with surgical treatment being more morbid. While this is a rare injury, the consequences of a missed chronic Achilles tendon disruption are severe with significant dysfunction. It is therefore important to have a high index of suspicion for concomitant injury and to be prepared for dual fixation. We present a novel hybrid surgical fixation technique, which may be used in this instance. PMID:28357147
Patel, Brijesh B; Andrade, Christian; Doraiswamy, Vignesh; Amodeo, Donald
Placement of a percutaneous endoscopic gastrostomy (PEG) tube is a common procedure to allow for enteral nutrition in patients with multiple indications. PEG tube placement is a safe procedure with minor complications such as site infection and irritation. One of the more severe complications is splenic laceration, which may result in intra-peritoneal bleeding and manifest as an acute abdomen. We present a rare case of intra-abdominal bleeding secondary to catastrophic splenic injury 12 hours after PEG tube placement resulting in hemodynamic compromise. The patient underwent splenectomy and had an uneventful recovery.
Pure ligamentous flexion-distraction injuries of the lumbar spine are relatively rare and even less commonly associated with neurologic compromise. They are largely related to the use of lap belt restrains during motor vehicle accidents. We report a 19-year-old female backseat passenger wearing a lap belt who was involved in a head-on collision. On admission she was paraplegic, with a T12 sensory level and no motor and sensory function of S4-S5 (American Spinal Injury Association (ASIA) A). Plain X-ray and computerized axial tomography (CAT) spine showed a flexion-distraction injury at the L3-L4 level. During surgery in the interspinous space a conus medullaris was identified, which was completely severed from the spinal cord. The patient underwent a fusion procedure and made a good recovery. Twelve months after surgery she was able to walk with a knee-ankle-foot orthosis, she has no motor function below knees, no sensation below L2, and no voluntary bladder control. Although described type of injury is very rare, one should always have in mind devastating consequences of inadequate or improperly worn seatbelts.
a polyethylene container with *. aluminum oxide balls. To convert the hydroxyl-apatite to whitlockite, the * powder was calcined for 3-1/2 hours at...agglomerates, the calcined powder was ball milled with hexane for 12 hours in a polyethylene jar with aluminum oxide balls. The following characterization was...performed on the powder. TABLE 1. POWDER CHARACTERIZATION Ball Milled Calcined at 155OF As Produced 2 Hours HexaneBalIMilled Bulk density percent
Mommsen, Jens; Rodríguez-Fernández, Javier; Mateos-Micas, Mario; Vázquez-Bouso, Olga; Gumbao-Grau, Victor; Forteza-Gonzalez, Gabriel
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.
Mommsen, Jens; Rodríguez-Fernández, Javier; Mateos-Micas, Mario; Vázquez-Bouso, Olga; Gumbao-Grau, Victor; Forteza-Gonzalez, Gabriel
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
Van Slyke, Aaron C; Jansen, Leigh A; Hynes, Sally; Hicks, Jane; Bristol, Sean; Carr, Nicholas
In cases of median nerve injury alongside an unsalvageable ulnar nerve, a vascularized ulnar nerve graft to reconstruct the median nerve is a viable option. While restoration of median nerve sensation is consistently reported, recovery of significant motor function is less frequently observed. The authors report a case involving a previously healthy man who sustained upper arm segmental median and ulnar nerve injuries and, after failure of sural nerve grafts, was treated with a pedicled vascularized ulnar nerve graft to restore median nerve function. Long-term follow-up showed near full fist, with 12 kg of grip strength, key pinch with 1.5 kg of strength and protective sensation in the median nerve distribution. The present case demonstrates that pedicled ulnar vascularized nerve grafts can provide significant improvements to median nerve sensory and motor function in a heavily scarred environment. PMID:26665144
Gifuni, P; Strada, U
Between 1995 and 1997 a total of 5 patients with injury of the distal tendon of the biceps brachii were treated by reattachment to the radial tuberosity using Henry anterior access to the elbow. The results obtained through a clinical and instrumental evaluation, and the answers to a questionnaire, were good or excellent. What was particular about our work was that we treated all of the patients by a single Henry anterior access and not a double Boyd and Anderson one, which is more commonly used. Our decision was based on the minor amount of surgical invasiveness, the simpler method of reinsertion of the tendon and the minor incidence of possible radio-ulnar synostoses. This surgical approach requires particular care with regard to possible injuries of the radial nerve, that, moreover, are easily avoidable if surgery is performed by experts, with accurate and limited preparation of the site of reattachment.
Harb, Ziad; Malhi, Arfan
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
Baseball finger - aftercare; Drop finger - aftercare; Avulsion fracture - mallet finger - aftercare ... away from the rest of the bone (avulsion fracture) Mallet finger most often occurs when something hits ...
Dorrell, Robert M.; Burns, Alan D.; McCaffrey, William D.
New analytical models demonstrate that under aggradational flow conditions, seafloor channel-levee systems are inherently unstable; both channel area and stability necessarily decrease at long timescales. In time such systems must avulse purely through internal (autogenic) forcing. Although autogenic instabilities likely arise over long enough time for additional allogenic forcing to be expected, channel-levee sensitivity to variations in flow character depends on the prior degree of system evolution. Recalibrated modern Amazon Fan avulsion timings are consistent with this model, challenging accepted interpretations of avulsion triggering.
Lee, Chee Hwee; Tan, Chih Feng; Kim, Okwha; Suh, Kyung Jin; Yao, Min-Szu; Chan, Wing P; Wu, Jim S
One of the most common knee injuries is ligament tear, which may initially manifest as an osseous injury in radiographs. Radiologists should therefore be able to recognize ligament tears of the knee as osseous abnormalities in images. This review focuses on the imaging features of knee ligament injuries and their related osseous injuries: anterior cruciate ligament (ACL) tear with Segond fracture; associated marrow contusion; ACL avulsion fracture; posterior cruciate ligament (PCL) tear with osseous avulsion of the ligament including arcuate sign; reverse Segond fracture; PCL avulsion fracture; medial collateral ligament tear with Pellegrini-Stieda disease; lateral collateral ligament tear with avulsion fracture of the fibular head; and patellar ligament injuries with Osgood-Schlatter and Sinding-Larsen-Johansson.
... the banks of a body of water by deposition of water-borne soil. (c) Avulsed lands have the meaning... channel. (d) Actual shoreline means the line which is washed by the water wherever it covers the bed of...
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
MANCINI, FEDERICO; BERNARDI, GABRIELE; DE LUNA, VINCENZO; TUDISCO, COSIMO
Rupture or avulsion of the distal triceps tendon is one of the least common tendon injuries. The most common clinical presentation of the injury is avulsion from the olecranon. The diagnosis of acute triceps tendon rupture may be missed and this can result in prolonged disability. We report the case of a 42-year-old man with isolated triceps rupture treated by an open surgical repair technique involving the use of bone suture anchors. PMID:28217662
Sollender, J L; Rayan, G M; Barden, G A
Triceps tendon avulsion injuries are rare. We report four weight lifters with triceps tendon raptures, two of whom had received local steroid injections for pain in the triceps. All four patients had taken oral anabolic steroids before injury. All patients had closed avulsion of the triceps tendon from its insertion into the olecranon. Three patients were injured while bench pressing heavy weights, and one patient was injured while swinging a baseball bat. Satisfactory results were achieved after surgical reinsertion of the tendon.
Beyeler, J. D.; Rossi, R. K.; Kennard, P. M.; Beason, S. R.
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
Traumatic avulsion of nerve roots from the spinal cord is a devastating event that usually occurs in the brachial plexus of young adults following motor vehicle or sports accidents or in newborn children during difficult childbirth. A strategy to restore motor function in the affected arm by reimplanting into the spinal cord the avulsed ventral roots or autologous nerve grafts connected distally to the avulsed roots has been developed. Surgical outcome is good and useful recovery in shoulder and proximal arm muscles occurs. Pain is alleviated with motor recovery but sensory improvement is poor when only motor conduits have been reconstructed. In experimental studies, restoration of sensory connections with general improvement in the outcome from this surgery is pursued.
Su, Huanxing; Yuan, Qiuju; Qin, Dajiang; Yang, Xiaoying; So, Kwok-Fai; Wu, Wutian
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
Alla, Sreenivasa R; Deal, Nicole D; Dempsey, Ian J
Loss of the extensor mechanism at the distal interphalangeal (DIP) joint leads to mallet finger also known as baseball finger or drop finger. This can be secondary to tendon substance disruption or to a bony avulsion. Soft tissue mallet finger is the result of a rupture of the extensor tendon in Zone 1, and a bony mallet finger is the result of an avulsion of the extensor tendon from the distal phalanx with a small fragment of bone attached to the avulsed tendon. Mallet finger leads to an imbalance in the distribution of the extensor force between the proximal interphalangeal (PIP) and DIP joints. If left untreated, mallet finger leads to a swan neck deformity from PIP joint hyper extension and DIP joint flexion. Most mallet finger injuries can be managed non-surgically, but occasionally surgery is recommended for either an acute or a chronic mallet finger or for salvage of failed prior treatment.
Salter, G.; Paola, C.; Voller, V. R.
Distributary networks are formed by channels which bifurcate downstream in a river delta. Sediment and water fluxes are often split unequally in delta bifurcations. Understanding flux asymmetry in distributary networks is important for predicting how a delta will respond to sea-level rise. We present results of a quasi-1D model of a delta bifurcation. Consistent with previous results, in the absence of deposition, stable bifurcations may be either symmetric or asymmetric, depending on flow conditions. However, in a depositional setting, a stable asymmetric flow partitioning is no longer possible, as the dominant branch becomes less and less steep relative to the other branch. This feedback eventually causes the second branch to become favored. For the depositional case, we identify three regimes of bifurcation behavior: 1) stable symmetric bifurcation, 2) "soft" avulsions where the dominant branch switches without complete abandonment of the previous channel, and 3) complete avulsions where one branch is completely abandoned. In each case, the bifurcation is symmetric in the long-term average, but the latter two allow for short-term asymmetry. We find that keeping upstream sediment and water discharges fixed, as downstream channel length increases the regime shifts from symmetric to soft avulsions to complete avulsions. In the two avulsion regimes we examine the effect of upstream sediment and water discharges and downstream channel length on avulsion period and maximum discharge ratio. Finally, we compare numerical modeling results to a fixed-wall bifurcation experiment. As in the numerical model, the presence or absence of a downstream sink exerts a strong control on system behavior. If a sink is present, a bifurcation may be asymmetric indefinitely. Conversely, without a sink the system is depositional, and the feedback between sediment discharge asymmetry and slope causes the bifurcation to remain symmetric in the long-term average.
Aagaard, KE; Lunsjö, K
The adolescent avulsion of the lesser tuberosity of the humerus has historically been considered as very rare. The youngest patient reported in the literature is 11 years old. We report a case of a 9-year-old girl who suffered a subscapularis tendon tear with an occult avulsion of the lesser tuberosity. Late repair restored function. Despite that late repair in this present case resulted in excellent outcome, we strongly recommend the additional axillary lateral view of the plain radiographs, as well as proper physical examination to facilitate early diagnosis. PMID:28122897
Oseni, O G; Olaitan, P B; Badmus, T O; Olajide, A O
Injury to male external genitalia is very rare because of some intrinsic factors like location, strong investing tunica albuginea and cremasteric muscles. However, when it occurs it is considered a urological emergency. Child labour with poor understanding of risks and safety precautions, especially under harsh supervision, surely poses major challenges. This case illustrates degloving injury of the penis and avulsion of the scrotum in a young boy while operating a roller type machine used in palm trees plantation. The penis was primarily regloved and avulsed skin primarily repaired. A good cosmetic outcome was observed from this treatment. This case also illustrates the importance of early presentation and emergency intervention in this condition.
Denadai, Rafael; Raposo-Amaral, Cassio Eduardo; Marques, Frederico Figueiredo; Raposo-Amaral, Cesar Augusto
The temporoparietal fascia flap has been extensively used in craniofacial reconstructions. However, its use for eyebrow reconstruction has been sporadically reported. We describe a successfully repaired hair-bearing temporoparietal fascia flap after traumatic avulsion of eyebrow. Temporoparietal fascia flap is a versatile tool and should be considered as a therapeutic option by all plastic surgeons. PMID:25993077
recurrent decay or a separate carious lesion, score that surface as decayed. MISSING TEETH Permanent teeth extracted because of caries or periodontal...category are teeth that have been avulsed and those extracted for orthodontic reasons. No marks should be placed in the individual surface columns for
Mannil, M; Andreisek, G; Weishaupt, D; Fischer, M A
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.
extrapolated to complex traumatic civilian injuries that likewise pose significant issues with available autologous skin coverage (e.g. necrotizing ... fasciitis , motor vehicle accidents or other trauma with associated soft tissue avulsion injuries, etc.). Important data on the mechanism of action
... applicable law. In general, they are lands gradually uncovered when water recedes permanently. (h) State... by applicable law. In general, they are lands that have been gradually and imperceptibly formed along the banks of a body of water by deposition of water-borne soil. (c) Avulsed lands have the...
... by the Bureau of Land Management or its predecessors and the actual shoreline of a body of water are... the issue; or (C) The lands are accreted, relicted or avulsed and are no longer lands of the United States, including submission for the uplands portion of the body of water affected a copy of an...
process-imitating rules. The model aggrades an alluvial floodplain, creating floodplain architecture by differentiating between sediment deposited by...meandering rivers. The results suggest that the channel aggradation rate influenced heavily the relative channel avulsion frequency during floodplain...composition and organization of the river basin and its floodplain (Schumm 1968). In an actively building ( aggrading ) floodplain, the river channel is
Jalgaonkar, Azal A; Dachepalli, Sunil; Al-Wattar, Zaid; Rao, Sudhir; Kochhar, Tony
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.
Tooth, S.; Rodnight, H.; McCarthy, T. S.; Duller, G. A. T.; Grundling, A. T.
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
Ralph, Timothy; Larkin, Zacchary; Hesse, Paul; Westaway, Kira; Heijnis, Henk
Anthropogenic impacts on hydrology and sediment supply are recognized as leading factors contributing to change in many rivers and wetlands. However it is difficult to distinguish between key causes and forms of channel adjustment in fluvial systems where intrinsic geomorphic processes lead to change on a timeframe similar to that of human disturbance. In the Macquarie Marshes, a large (circa 2,500 square kilometres) floodplain wetland in southeastern Australia, intermittent flooding drives sedimentation and erosion leading to levee development, avulsion and floodout. Some contemporary channel change is attributed to human disturbance in the system (e.g. channel incision), which, together with river regulation and recent droughts, have left much of the floodplain high and dry. Distributary channels formed since European settlement in the early 19th century have low sinuosity (1.1 to 1.2), show little evidence of lateral migration, accumulate fine sediment rapidly (0.5 to 10 mm/yr) in levees and floodouts, and avulse or terminate in wetlands. Avulsion appears to occur rapidly; within 100 years. In contrast, the older, discontinuous trunk stream of the lower Macquarie River is more sinuous (1.3 to 1.5) and there is abundant evidence of lateral migration over time followed by levee development on top of ridges and swales. ITRAX core scanning and XRF from sediment profiles in a Macquarie River meander abandoned around 1 ka and subsequently filled with overbank fines revealed no laminations and no evidence of significant geochemical enrichment near the surface that is usually associated with anthropogenic sources (e.g. Pb and Cu). These results indicate a transition in depositional regime and channel adjustment processes from lateral migration to vertical accretion with greater levee development and avulsion in the late Holocene. A clear anthropogenic signal was not found in the sediment record, despite earthworks and other activities contributing to channel change. We
Lindå, Hans; Sköld, Mattias K; Ochsmann, Thomas
Activating transcription factor 3 (ATF3) is induced in various tissues in response to stress. In this experiment, ATF3 expression was studied in adult rats subjected either to a dorsal or ventral root avulsion (VRA; L4-6), or sciatic nerve transection (SNT). Post-operative survival times varied between 1.5 h and 3 weeks. In additional experiments an avulsed ventral root was directly replanted to the spinal cord. Dorsal root ganglias (DRGs) from humans exposed to traumatic dorsal root avulsions were also examined. After SNT ATF3 immunoreactivity (ATF3 IR) was detected in a few DRG neurons already 6 h after the lesion. After 24 h the number had clearly increased and still at 3 weeks DRG neurons remained labeled. In the ventral horn, ATF3 IR in motoneurons (MN) was first detected 24 h after the SNT, and still 3 weeks post-operatively lesioned MN showed ATF3 labeling. After a VRA many spinal MN showed ATF3 IR already after 3 h, and after 6 h all MN were labeled. At 3 weeks a majority of the lesioned MN had died, but all the remaining ones were labeled. When an avulsed ventral root was directly replanted, MN survived and were still labeled at 5 weeks. In DRG, a few neurons were labeled already at 1.5 h after a dorsal root avulsion. At 24 h the number had increased but still only a minority of the neurons were labeled. At 3 days the number of labeled neurons was reduced, and a further reduction was at hand at 7 days and 3 weeks. In parallel, in humans, 3 days after a traumatic dorsal root avulsion, only a few DRG neurons showed ATF3 IR. At 6 weeks no labeled neurons could be detected. These facts imply that ATF3 response to axotomy involves a distance-dependent mechanism. ATF3 also appears to be a useful and reliable neuronal marker of nerve lesions even in humans. In addition, ATF3 up-regulation in both motor and sensory neurons seems to be linked to regenerative competence.
Bolhari, Behnam; Pirmoazen, Salma; Taftian, Ensieh; Dehghan, Somayeh
Trauma to primary teeth can lead to devastating sequels in development of permanent successors. The disturbance may range from enamel hypoplasia and/or hypo-calcification to arrest of dental bud development. Crown dilaceration of permanent teeth is one of the consequences of trauma to deciduous teeth mainly due to intrusion or avulsion. This report presents a mandibular central incisor with dilacerated crown and yellowish discoloration with symptomatic apical abscess. History revealed avulsion of primary mandibular central incisors. The purpose of this report is to present: 1. Reasons of dilacerated crown, yellowish discoloration and necrotic pulp in this case, 2. Treatment options in different types of crown dilacerations and also in this case. The tooth was successfully managed by nonsurgical root canal therapy and restoration with composite resin to restore esthetics. We emphasize that trauma to deciduous teeth should not be understated, and regular follow up is essential.
Ferreira, Hugo M.; Botelho, Filomena; Carrilho, Eunice
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
Anastomosing rivers constitute an important category of multi-channel rivers on alluvial plains. Most often they seem to form under relatively low-energetic conditions near a (local) base level. It appears to be impossible to define anastomosing rivers unambiguously on the basis of channel planform only. Therefore, the following definition, which couples floodplain geomorphology and channel pattern, is proposed in this paper: an anastomosing river is composed of two or more interconnected channels that enclose floodbasins. This definition explicitly excludes the phenomenon of channel splitting by convex-up bar-like forms that characterize braided channels. In present definitions of anastomosing rivers, lateral stability of channels is commonly coupled with their multi-channel character. Here, it is suggested that these two properties be uncoupled. At the scale of channel belts, the terms 'straight', 'meandering' and 'braided' apply, whereas at a larger scale, a river can be called anastomosing if it meets the definition given above. This means that, straight, meandering and braided channels may all be part of an anastomosing river system. Straight channels are defined by a sinuosity index; i.e., the ratio of the distance along the channel and the distance along the channel-belt axis is less than 1.3. They are the type of channel that most commonly occurs in combination with anastomosis. The occurrence of straight channels is favoured by low stream power, basically a product of discharge and gradient, and erosion-resistant banks. Anastomosing rivers are usually formed by avulsions, i.e., flow diversions that cause the formation of new channels on the floodplain. As a product of avulsion, anastomosing rivers essentially form in two ways: (1) by formation of bypasses, while bypassed older channel-belt segments remain active for some period; and (2) by splitting of the diverted avulsive flow, leading to contemporaneous scour of multiple channels on the floodplain. Both
Kose, Ozkan; Kilicaslan, Omer Faruk; Guler, Ferhat; Aktan, Cemil
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
Limb salvage in tumor surgery has encouraged the development of megaprostheses. However, reattaching the ligamentum patellae poses a particular problem: avulsion and/or extensor lag may lead to poor function. We describe a new technique of patellar ligament reconstruction. The technique involves reattachment of the patellar ligament to the tibial tuberosity of the proximal tibial megaprosthesis, which has a porous surface created, and the repair is protected with a cerclage wire through the patella and the prosthesis. In 10 consecutive patients, the range of motion averaged 95° (median, 90°; range, 70°–120°), and the mean extension lag averaged 4° (median, 0°; range, 0°–20°). We had one case of patellar ligament avulsion. This technique resulted in good quadriceps function and a low incidence of complications. Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence. PMID:18425561
Zermeño-Rivera, Jaime; Gutiérrez-Amavizca, Bianca Ethel
Brachial plexus avulsion results from excessive stretching and can occur secondary to motor vehicle accidents, mainly in motorcyclists. In a 28-year-old man with panavulsive brachial plexus palsy, we describe an alternative technique to repair brachial plexus avulsion and to stabilize and preserve shoulder function by transferring the contralateral spinal accessory nerve to the suprascapular nerve. We observed positive clinical and electromyographic results in sternocleidomastoid, trapezius, supraspinatus, infraspinatus, pectoralis, triceps, and biceps, with good outcome and prognosis for shoulder function at 12 months after surgery. This technique provides a unique opportunity for patients suffering from severe brachial plexus injuries and lacking enough donor nerves to obtain shoulder stability and mobility while avoiding bone fusion and preserving functionality of the contralateral shoulder with favorable postoperative outcomes.
Transarticular external skeletal fixation usually involves rigid bars that result in a stable but stiff joint. This study describes the technique and the outcome of an elastic transarticular external fixator (ETEF) applied to the elbow joint. Four cases of elbow luxation with collateral ligament injuries were managed with closed reduction and application of an ETEF to maintain the reduction. A triceps tendon avulsion was surgically managed before applying an ETEF. The clinical outcome was considered excellent in 2 cats, good in 2 dogs (1 elbow luxation and the avulsion of the triceps tendon), and poor in 1 dog presented for elbow luxation and a permanent neurological defect. The procedure was rapid, easy to perform, and inexpensive. All animals except the one with a neurological defect had an early return to weight bearing. This method maintains extension of the joint while permitting its motion thereby promoting rehabilitation.
Wiens, J P
Trauma from motor vehicle accidents is one of the leading causes of death in the United States; moreover, the costs related to personal harm are only second to cancer. Head and neck injuries predominate and involve contact with the vehicle's interior (80%), contact with the vehicle's exterior (12%), or noncontact with the vehicle (8%). The patient with maxillofacial defects resulting from motor vehicle accident will have numerous soft tissue and hard tissue injuries ranging from neurologic involvement to fractures and/or avulsions of the temporomandibular joint, maxillae, mandible, teeth, and supporting structures. Tooth avulsions, pulpitis, and fractures without pulpitis have been found in a 4:2:1 ratio. The prosthodontist plays an important team role by anticipating the increased functional demands that may be placed on the required prostheses and by anticipating the preprosthetic procedures and counseling that may be necessary to assist in the total treatment.
Terzi, Erdinc; Guvenc, Ulas; Türsen, Belma; Kaya, Tamer İrfan; Erdem, Teoman; Türsen, Ümit
Ingrown toenail is an often painful clinical condition that usually affects the big toe. Chemical matricectomy with phenol has a low recurrence rate and good cosmetic results. However, it produces extensive tissue destruction that can result in drainage and delayed healing. Alternatives such as sodium hydroxide and trichloroacetic acid (TCA) have therefore come into vogue. A total of 39 patients with 56 ingrown toenail edges underwent chemical matricectomy with 90% TCA after partial nail avulsion. In most of the patients, adverse effects such as postoperative pain and drainage were minimal. One patient who underwent matricectomy had recurrence in a single nail edge (1.8%) at 12 months follow-up. No recurrence was observed among 38 patients during the mean follow-up period. This was considered to be statistically significant (P < 0.001). Partial nail avulsion followed by TCA matricectomy is a safe, simple, and effective method with low rates of postoperative morbidity and high rates of success. PMID:25657908
Bolhari, Behnam; Pirmoazen, Salma; Taftian, Ensieh
Trauma to primary teeth can lead to devastating sequels in development of permanent successors. The disturbance may range from enamel hypoplasia and/or hypo-calcification to arrest of dental bud development. Crown dilaceration of permanent teeth is one of the consequences of trauma to deciduous teeth mainly due to intrusion or avulsion. This report presents a mandibular central incisor with dilacerated crown and yellowish discoloration with symptomatic apical abscess. History revealed avulsion of primary mandibular central incisors. The purpose of this report is to present: 1. Reasons of dilacerated crown, yellowish discoloration and necrotic pulp in this case, 2. Treatment options in different types of crown dilacerations and also in this case. The tooth was successfully managed by nonsurgical root canal therapy and restoration with composite resin to restore esthetics. We emphasize that trauma to deciduous teeth should not be understated, and regular follow up is essential. PMID:28243307
Gutmacher, Zvi; Peled, Eli; Norman, Doron; Lin, Shaul
Aim: Dental injuries, especially luxation and avulsion, are common. Dental trauma can cause alveolar bone fracture that can lead to tooth loss and malocclusion. Single tooth alveolar bone fractures are difficult to identify unless it protrudes through the overlying mucosa and can be visualized. Pain, malocclusion, and tooth mobility provide signs of suspected alveolar bone fractures. Integrity of the proximate alveolar bone should be examined for fractures where avulsion, luxation, or other tooth trauma is detected. Any suggestion of alveolar fractures should be further investigated with an appropriate radiograph. Summary: This case report shows a pathognomonic sign that detects and diagnosis single tooth alveolar bone fractures, i.e., a localized hematoma crossing the attached gingiva from the free gingival margin to the vestibular mucosa. This should serve as a warning for localized alveolar bone fracture. A visualized hematoma and gentle, careful palpation may help detect covered fractures when the overlying mucosa is not perforated.
Journeau, Pierre; Polirzstok, E; Launay, F; Barbier, D
Sport injuries are common in children and teenaggers, especially overuse injuries. Typical musculoskelotal disorders include apophyseal pains or avulsion, stess fractures, and also epiphyseal ostoochondritis. Some lesions are specific according the practice, such spine or wrist lesions. Prevention of sport injury should be the main priority as well for the parents than the coaches and children themselves. Proper education and preparation, specific training and streching are essential for all sports activities.
Ding, Yuetong; Qu, Yibo; Feng, Jia; Wang, Meizhi; Han, Qi; So, Kwok-Fai; Wu, Wutian; Zhou, Libing
Brachial plexus injury (BPI) and experimental spinal root avulsion result in loss of motor function in the affected segments. After root avulsion, significant motoneuron function is restored by re-implantation of the avulsed root. How much this functional recovery depends on corticospinal inputs is not known. Here, we studied that question using Celsr3|Emx1 mice, in which the corticospinal tract (CST) is genetically absent. In adult mice, we tore off right C5–C7 motor and sensory roots and re-implanted the right C6 roots. Behavioral studies showed impaired recovery of elbow flexion in Celsr3|Emx1 mice compared to controls. Five months after surgery, a reduced number of small axons, and higher G-ratio of inner to outer diameter of myelin sheaths were observed in mutant versus control mice. At early stages post-surgery, mutant mice displayed lower expression of GAP-43 in spinal cord and of myelin basic protein (MBP) in peripheral nerves than control animals. After five months, mutant animals had atrophy of the right biceps brachii, with less newly formed neuromuscular junctions (NMJs) and reduced peak-to-peak amplitudes in electromyogram (EMG), than controls. However, quite unexpectedly, a higher motoneuron survival rate was found in mutant than in control mice. Thus, following root avulsion/re-implantation, the absence of the CST is probably an important reason to hamper axonal regeneration and remyelination, as well as target re-innervation and formation of new NMJ, resulting in lower functional recovery, while fostering motoneuron survival. These results indicate that manipulation of corticospinal transmission may help improve functional recovery following BPI. PMID:25003601
Haddad, Vidal; Duarte, Marcelo R; Neto, Domingos Garrone
Lizards of the Teiidae family are large reptiles measuring up to 2 meters long. If threatened, they can demonstrate aggressive behavior by whipping their tail and occasionally biting. Here, we report a severe injury following a Teiidae lizard bite on the right index finger of a human. There was significant soft tissue damage and an avulsion fracture of the distal phalanx. He was treated with conservative wound care and prophylactic antibiotics. He developed no evidence of secondary infection and underwent delayed skin grafting.
Major, Jon J.; Bertin, Daniel; Pierson, Thomas C.; Amigo, Alvaro; Iroume, Andres; Ulloa, Hector; Castro, Jonathan M.
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).
Major, Jon J.; Bertin, Daniel; Pierson, Thomas C.; Amigo, Álvaro; Iroumé, Andrés.; Ulloa, Héctor; Castro, Jonathan
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).
Montané, J; Marco, I; López, J; Manteca, X; Lavín, S
Multiple bilateral fractures of the lumbar transverse processes were radiographically identified postmortem in a recently captured roe deer (Capreolus capreolus). These fractures were probably caused by an avulsion of the psoas major occurring during introduction into the transport box. The deer probably died from shock caused by the fractures, muscle damage, and subsequent hemorrhage. Although easily overlooked, fractured lumbar transverse processes may indicate inadequate postcapture management practices.
Chodakiewitz, Yosef G; Daniels, Alan H; Kamal, Robin N; Weiss, Arnold-Peter C
Post-traumatic Raynaud's phenomenon following non-penetrating or non-repetitive injury is rare. We report a case of Raynaud's phenomenon occurring in a single digit 3 months following volar plate avulsion injury. Daily episodes of painless pallor of the digit occurred for 1 month upon any exposure to cold, resolving with warm water therapy. Symptoms resolved after the initiation of hand therapy, splinting, and range-of- motion exercises.
Koul, Ashok Raj; Cyriac, Asha; Khaleel, V M; Vinodan, K
Bilateral high amputation of upper limbs in a child is a very unusual injury. In the present case, although the amputation was high and significant avulsion was present, the age of the child (6 years) made the case both challenging and encouraging--challenging because of the anticipated systemic effects of reperfusion, and encouraging because the long-term prognosis is always more encouraging in a child.
Jerolmack, Douglas; Reitz, Meredith
The surfaces of alluvial fans and river deltas (collectively fans) are often dissected by a small number of channels radiating from the fan apex. On long timescales, channels migrate via avulsion, the process of channel bed deposition and abandonment that often results in catastrophic flooding and loss of life on densely populated fans. 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 noncohesive fan that creates realistic channel patterns by avulsion. The system strongly channelizes in one location until localized shoreline progradation diminishes transport capacity of the channel, resulting in backfilling and subsequent widespread flooding; avulsion is completed when a new channel path is selected. This cycle occurs with a periodicity that is predictable from conservation of mass, and results in fluctuations around an equilibrium slope analogous to sand piles. Selection of a new flow path is inherently stochastic; we observe, however, that previously abandoned channels act as significant attractors for the flow, so that the system tends to oscillate among the same 3-5 channels indefinitely. We demonstrate that a directed random walk model with memory quantitatively reproduces these dynamics and limiting behavior, and is consistent with natural fans. Thus, channel migration behaves as a history-dependent, threshold-driven, stochastic process. Because our experimental fan is built by the recurring avulsion sequence, its shoreline shape is a series of lobes that indicate persistent channel locations. Progradation lengthens lobes, while backfilling results in diffusive widening. These dynamics result in self-similar radial growth of fan lobes, which can be described using a simple geometric model. Together, this work provides a complete description of the statistical spatio-temporal dynamics of fan growth. Experiments also provide another example of realistic
Guibert, M.; Chaouat, M.; Boccara, D.; Marco, O.; Lavocat, R.; Alameri, O.; Deslandes, E.; Montlahuc, C.; Mimoun, M.
Summary La greffe de peau mince expansée est très employée dans le traitement des brûlures aiguës. Nous avons étudié l’influence de la préparation du sous-sol sur le taux de prise et le délai de cicatrisation des greffes expansées. Nous avons analysé rétrospectivement les 1 129 greffes expansées réalisées dans notre service entre 1995 et 2005 pour le traitement des brûlures aiguës. Leur taux de prise a été significativement meilleur après une préparation du sous-sol par avulsion (82%) par rapport à une préparation du sous-sol par excision tangentielle (75%). Ce taux était meilleur lorsque l’avulsion était pratiquée dans les 7 jours suivant la brûlure (83% vs 73%). Pour une prise en charge entre 7 et 21 jours, ce taux a semblé être meilleur après excision tangentielle, mais de façon non significative. La durée d’évolution jusqu’à cicatrisation était significativement raccourcie pour une préparation du sous-sol par excision tangentielle par rapport à une préparation du sous-sol par avulsion. Ces résultats montrent, paradoxalement, qu’une préparation du sous-sol par avulsion favorise la prise des greffes expansées mais rallonge leur délai de cicatrisation au contraire de l’excision tangentielle. PMID:28149235
Jubel, A; Faymonville, C; Andermahr, J; Boxberg, S; Schiffer, G
Background: Ankle fractures are extremely common in the elderly, with an incidence of up to 39 fractures per 100,000 persons per year. We found a discrepancy between intraoperative findings and preoperative X-ray findings. It was suggested that many relevant lesions of the ankle joint in the elderly cannot be detected with plain X-rays. Methods: Complete data sets and preoperative X-rays of 84 patients aged above 60 years with ankle fractures were analysed retrospectively. There were 59 women and 25 men, with a mean age of 69.9 years. Operation reports and preoperative X-rays were analysed with respect to four relevant lesions: multifragmentary fracture pattern of the lateral malleolus, involvement of the medial malleolus, posterior malleolar fractures and bony avulsion of anterior syndesmosis. Sensitivity, specificity, positive predictive value, negative predictive value, accuracy and prevalence were calculated. Results: The prevalence of specific ankle lesions in the analyzed cohort was 24 % for the multifragmentary fracture pattern of the lateral malleolus, 38 % for fractures of the medial malleolus, 25 % for posterior malleolar fractures and 22.6 % for bony avulsions of the anterior syndesmosis. Multifragmentary fracture patterns of the lateral malleolus (sensitivity 0 %) and bony avulsions of the anterior syndesmosis (sensitivity 5 %) could not be detected in plain X-rays of the ankle joint at all. Fractures of the medial malleolus and involvement of the dorsal tibial facet were detected with a sensitivity of 96.8 % and 76.2 %, respectively, and specificity of 100 % in both cases. Conclusions: This study confirms that complex fracture patterns, such as multifragmentary involvement of the lateral malleolus, additional fracture of the medial malleolus, involvement of the dorsal tibial facet or bony avulsion of the anterior syndesmosis are common in ankle fractures of the elderly. Therefore, CT scans should be routinely considered for primary
Singh, Ishwar; Gupta, Monika; Singh, Tarun K
The Bain co-axial circuit is fully established in general anaesthesia practice. A major concern is the potential malfunctioning of the circuit due to avulsion of the inner fresh gas delivery tube at the machine end of the circuit. The following case report presents a case in which a patient connected to the Bain circuit developed severe hypercapnia in the early intraoperative period due to the above mentioned defect.
Kenny, David J
Emdogain has been available commercially for just over a decade. It is used currently in clinical practice of periodontics and has been investigated in four clinical outcome studies of replanted teeth. This review covers the origin and concepts behind the use of this amelogenin derivative, the unique conditions associated with an avulsed tooth, and the laboratory and clinical characteristics of this material. Emdogain continues to be an experimental material for replantation applications.
received no further dilations (over seven months). Endoscopic examination showed that no esophageal constric- tions were present and that the epithelium of...7 AG 396 ARMY INST OF DENTAL RESEARCH WASHINGTON DC FIG 6/5 REGENERATION OF SURGICALLY EXCISED SEGMENTS OF DOG ESOPHAGUS US-ETC(W) U15 G’OE UN8 N F...which will yield effective long-term functional results. The current therapy for repair and replacement of the diseased or avulsed esophagus is by the
Nagata, J Y; Rocha-Lima, T F; Gomes, B P; Ferraz, C C; Zaia, A A; Souza-Filho, F J; De Jesus-Soares, A
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.
Saberi, Sadegh; Arabzadeh, Aidin; Farhoud, Amir Reza
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. PMID:27626007
Heidelbaugh, Joel J; Lee, Hobart
Ingrown toenail, or onychocryptosis, most commonly affects the great toenail. Many anatomic and behavioral factors are thought to contribute to ingrown toenails, such as improper trimming, repetitive or inadvertent trauma, genetic predisposition, hyperhidrosis, and poor foot hygiene. Conservative treatment approaches include soaking the foot in warm, soapy water; placing cotton wisps or dental floss under the ingrown nail edge; and gutter splinting with or without the placement of an acrylic nail. Surgical approaches include partial nail avulsion or complete nail excision with or without phenolization. Electrocautery, radiofrequency, and carbon dioxide laser ablation of the nail matrix are also options. Oral antibiotics before or after phenolization do not improve outcomes. Partial nail avulsion followed by either phenolization or direct surgical excision of the nail matrix are equally effective in the treatment of ingrown toenails. Compared with surgical excision of the nail without phenolization, partial nail avulsion combined with phenolization is more effective at preventing symptomatic recurrence of ingrowing toenails, but has a slightly increased risk of postoperative infection.
Peltola, Erno K; Lindahl, Jan; Koskinen, Seppo K
The aims of this study were to assess the incidence of reverse Segond fracture, to examine the associated ligamentous injuries, and to examine how often reverse Segond fracture coexists with a knee dislocation. At a level 1 trauma center, an 11-year period of emergency department multidetector-row computed tomography (MDCT) examinations for knee trauma was evaluated for reverse Segond and Segond fractures. Surgical findings served as the reference standard for intra-articular injuries. The hospital discharge register was searched for the diagnosis of knee dislocation from August 2000 through the end of August 2011. A total of 1,553 knee MDCT examinations were evaluated. Ten patients with a reverse Segond fracture were found, comprising 0.64 % of emergency room acute knee trauma MDCT examinations. Seven patients who had a reverse Segond fracture were operated: Three had an avulsion fracture of the anterior cruciate ligament, one had an avulsion fracture of posterior cruciate ligament, two had a lateral meniscal tear, and two had a medial collateral ligament tear. The ratio of reverse Segond fractures to Segond fractures was 1:4. None of the 71 knee dislocation patients had a reverse Segond fracture. Reverse Segond fracture is a rare finding even in a level 1 trauma center. Cruciate ligament injuries appear to be associated with avulsion fracture, but every patient does not have PCL injury, as previously reported. Our results do not support the association of knee dislocation with reverse Segond fracture.
Short, Steven M; Anloague, Philip A; Strack, Donald S
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.
Nelson-Filho, Paulo; Silva, Lea Assed Bezerra; Silva, Raquel Assed Bezerra; de Carvalho, Fabricio Kitazono; de Queiroz, Alexandra Mussolino
The aim of this paper is to present the clinical and radiological outcome of the treatment involving a delayed tooth replantation after an avulsed immature permanent incisor, with a follow-up of 1 year and 6 months. An 8-year-old boy was referred after dental trauma that occurred on the previous day. The permanent maxillary right central incisor (tooth 11) had been avulsed. The tooth was hand-held during endodontic therapy and an intracanal medication application with calcium hydroxide-based paste was performed. An apical plug with mineral trioxide aggregate (MTA) was introduced into the apical portion of the canal. When the avulsed tooth was replanted with digital pressure, a blood clot had formed within the socket, which moved the MTA apical plug about 2 mm inside of the root canal. These procedures developed apical revascularization, which promoted a successful endodontic outcome, evidenced by apical closure, slight increase in root length, and absence of signs of external root resorption, during a follow-up of 1 year and 6 months. PMID:27882250
Dumont, J. F.; Santana, E.; Valdez, F.; Tihay, J. P.; Usselmann, P.; Iturralde, D.; Navarette, E.
The San Lorenzo area belongs to the Esmeraldas-Tumaco seismic zone where some of the strongest earthquakes of South America occurred during the 20th century. This paper provides evidence for a succession of geomorphic changes characterized by the disruption of the Quaternary drainage network and the reshaping of the Cayapas-Santiago estuary. The rise of the La Boca uplift bordered by the La Boca and San Lorenzo faults is responsible for the southward diversion of the Palabi, Tululbi, Bogotá and Carolina rivers toward the Santiago and Cayapas rivers. The increase of the discharge directed to the Cayapas River generated the change of the channel pattern downstream from the confluence, and the avulsion of a new estuary through the coastal plain. According to the dating of beach ridges the avulsion occurred in the period 3200-2800 BP. This period corresponds also to a faster accretion of the beach ridge margin, interpreted as a response to a small uplift of the shore. The coherency of the three morphologic evidences—diversion of drainage network, avulsion and increase of coastal accretion—suggest a unique morphotectonic event, in relation with the activity of the Esmaraldas-Tumaco seismic zone. The opening of a direct communication through the mangrove margin may have brought favorable conditions for the development of the La Tolita archaeological site after 3000 BP.
van den Berg, Wilco; de Haas, Tjalling; Braat, Lisanne; Kleinhans, Maarten
Alluvial fans develop their semi-conical shape by cyclic avulsion of their geomorphologically active sector from a fixed fan apex. These cyclic avulsions have been attributed to both allogenic and autogenic forcings and processes. Autogenic dynamics have been extensively studied on fluvial fans through physical scale experiments, and are governed by cyclic alternations of aggradation by unconfined sheet flow, fanhead incision leading to channelized flow, channel backfilling and avulsion. On debris-flow fans, however, autogenic dynamics have not yet been directly observed. We experimentally created debris-flow fans under constant extrinsic forcings, and show that autogenic dynamics are a fundamental intrinsic process on debris-flow fans. We found that autogenic cycles on debris-flow fans are driven by sequences of backfilling, avulsion and channelization, similar to the cycles on fluvial fans. However, the processes that govern these sequences are unique for debris-flow fans, and differ fundamentally from the processes that govern autogenic dynamics on fluvial fans. We experimentally observed that backfilling commenced after the debris flows reached their maximum possible extent. The next debris flows then progressively became shorter, driven by feedbacks on fan morphology and flow-dynamics. The progressively decreasing debris-flow length caused in-channel sedimentation, which led to increasing channel overflow and wider debris flows. This reduced the impulse of the liquefied flow body to the flow front, which then further reduced flow velocity and runout length, and induced further in-channel sedimentation. This commenced a positive feedback wherein debris flows became increasingly short and wide, until the channel was completely filled and the apex cross-profile was plano-convex. At this point, there was no preferential transport direction by channelization, and the debris flows progressively avulsed towards the steepest, preferential, flow path. Simultaneously
Dorrell, R. M.; McCaffrey, W. D.; Burns, A. D.
Seafloor channel avulsion events recorded in the stratigraphic architecture of submarine fans are often identified as signals of boundary change of the associated sediment supply system. However, interpretation of such signals that are persevered in the rock record is complicated by the interplay between internal (autogenic) forcing and external (allogenic) forcing on the system which may have caused the avulsion of the channel. To investigate the importance of autogenic forcing on seafloor channel evolution, novel models have been constructed which calculate the width-averaged growth of a channel levee system with progressive deposition. These models demonstrate that seafloor channel-levee systems are inherently unstable and will avulse purely subject to autogenic forcing. It is demonstrated that this instability arises as a function of geometric constraints on the cross-sectional shape of the evolving channel and its bounding levees under aggradational flow conditions. Analytical solutions to these simplified models demonstrate that change in the area of the channel is given by the comparative rate at which the bounding outer levee and channel are built up. Whilst the outer levee is built up faster than the channel, there is a relative increase in channel size - increasing the degree by which a flow is confined and thus the decreasing the likelihood of an avulsion. However, if the channel is built up faster than the outer levee the degree by which the flow is confined by the channel will decrease, and thus the likelihood of avulsion will increase. It is seen that as bounding levees become large, and thus cannot be built up as fast as the channel, the evolution of the channel is inherently limited. However, autogenic channel-levee instability likely arises over very long time periods, with the half-life of channel decay proportional to the channel-levee system size. Thus, it is expected that additional external (allogenic) forcing, such as boundary condition
Dalman, Rory; Weltje, Gert Jan; Karamitopoulos, Pantelis
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
Background Post-traumatic lumbosacral plexus injuries seem to be rare events, spontaneously recovering in high percentage: as surgery is often challenging and results in poor outcome, many Authors have advocated conservative treatment only. Nevertheless surgery should not be ruled out: in invalidating injuries, it can restore basic function in the lower extremities. Therefore, it might be necessary to establish guidelines for the management and the indication to surgery in such cases. This study aims to identify indicators predicting spontaneous recovery or the need for surgery. Method The clinical and radiological data of 72 patients with a post-traumatic lumbosacral plexus injury were reviewed. A follow up equal or superior to 3 years is available in 42 cases. Results Lumbosacral plexus injuries mostly occurred during road accidents. The incidence of associated lesions was relevant: bone injuries were found in 85% of patients, internal lesions in 30% and vascular injuries in 8%. Lumbosacral trunk and sacral plexus palsies were the most frequent injury patterns. Root avulsions were revealed in 23% of cases and only in sacral plexus and complete lumbosacral plexus injuries: L5 and S1 were the roots more prone to avulsions. About 70% of cases recovered spontaneously, mostly in 18 months. Spontaneous recovery was the rule in lumbar plexus and lumbosacral trunk injuries (where root avulsions never occurred) or in sacral and complete lumbosacral plexus palsies due to compression injuries. The causative mechanism correlated with the injury pattern, the associated bone injury being often predictive of the severity of the nerve injury. Lumbosacral plexus injuries occurred in car crashes were generally associated with fractures causing compression on the nerves, thus resulting in injuries often amenable of spontaneous recovery. Motorcycle accidents implied high kinetic energy traumas where traction played an important role, as the high percentage of sacroiliac joint
Smith, Norman D.; Morozova, Galina S.; Pérez-Arlucea, Marta; Gibling, Martin R.
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
Heyvaert, Vanessa M. A.; Walstra, Jan; Mortier, Clément
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
Macklin, Mark G.; Lewin, John
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
Ellery, W N; Dahlberg, A C; Strydom, R; Neal, M J; Jackson, J
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.
Gaeuman, D.; Schmidt, J.C.; Wilcock, P.R.
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.
Nicholas, A. P.; Aalto, R. E.; Schwendel, A.; Sambrook Smith, G.
Floodplain construction involves the interplay between channel belt sedimentation and avulsion, overbank deposition of fines, and sediment reworking by channel migration. Each of these processes is controlled, in part, by within-channel and/or overbank hydraulics. However, while spatially-distributed hydrodynamic models are used routinely to simulate floodplain inundation and overbank sedimentation during individual floods, most existing models of long-term floodplain construction and alluvial architecture do not account for flood hydraulics explicitly. Instead, floodplain sedimentation is typically modeled as an exponential function of distance from the river, and avulsion thresholds are defined using topographic indices (e.g., lateral:downstream slope ratios or metrics of channel belt super-elevation). Here we examine the importance of incorporating a physically-based representation of flooding within models of long-term floodplain construction. We combine a simple model of meander migration, cutoff and avulsion with a 2D grid-based model of flood hydrodynamics and overbank sedimentation. The latter involves a finite volume solution of the shallow water equations and an advection-diffusion model for suspended sediment transport. We evaluate model realism over annual to multi-decadal time periods using data quantifying floodplain evolution along the Rio Beni, Bolivia. The Beni is a large (width ~500 m), meandering sand-bed river characterized by very high rates of channel migration (locally >100 m per year) and rapid floodplain sedimentation (~5 cm per year on average adjacent to the channel). We utilise information on planform channel change obtained from satellite imagery, and measurements of floodplain deposit grain size characteristics and overbank sedimentation rates over the past century derived from Pb-210 analysis of floodplain sediment cores. Following model evaluation, we carry out a series of numerical experiments to quantify hydrodynamic controls on
Jerolmack, Douglas J.
Recent research has identified two fundamental unit processes that build delta distributary channels. The first is mouth-bar deposition at the shoreline and subsequent channel bifurcation, which is driven by progradation of the shoreline; the second is avulsion to a new channel, a result of aggradation of the delta topset. The former creates relatively small, branching networks such as Wax Lake Delta; the latter generates relatively few, long distributaries such as the Mississippi and Atchafalaya channels on the Mississippi Delta. The relative rate of progradation to aggradation, and hence the creation of accommodation space, emerges as a controlling parameter on channel network form. Field and experimental research has identified sea level as the dominant control on Holocene delta growth worldwide, and has empirically linked channel network changes to changes in the rate of sea level rise. Here I outline a simple modeling framework for distributary network evolution, and use this to explore large-scale changes in Holocene channel pattern that have been observed in deltas such as the Rhine-Meuse and Mississippi. Rapid early- to mid-Holocene sea level rise forced many deltas into an aggradational mode, where I hypothesize that avulsion and the generation of large-scale branches should dominate. Slowing of sea level rise in the last ˜6000 yr allowed partitioning of sediment into progradation, facilitating the growth of smaller-scale distributary trees at the shorelines of some deltas, and a reduction in the number of large-scale branches. Significant antecedent topography modulates delta response; the filling of large incised valleys, for example, caused many deltas to bypass the aggradational phase. Human effects on deltas can be cast in terms of geologic controls affecting accommodation: constriction of channels forces rapid local progradation and mouth-bar bifurcation, while accelerated sea level rise increases aggradation and induces more frequent channel
Guenot, Marc; Bullier, Jean; Rospars, Jean-Pierre; Lansky, Petr; Mertens, Patrick; Sindou, Marc
Despite the key role played by the dorsal horn of the spinal cord in pain modulation, single-unit recordings have only been performed very rarely in this structure in humans. The authors report the results of a statistical analysis of 64 unit recordings from the human dorsal horn. The recordings were done in three groups of patients: patients with deafferentation pain resulting from brachial plexus avulsion, patients with neuropathic pain resulting from peripheral nerve injury, and patients with pain resulting from disabling spasticity. The patterns of neuronal activities were compared among these three groups. Nineteen neurons were recorded in the dorsal horns of five patients undergoing DREZotomy for a persistent pain syndrome resulting from peripheral nerve injury (i.e., nondeafferented dorsal horns), 31 dorsal horn neurons were recorded in nine patients undergoing DREZotomy for a persistent pain syndrome resulting from brachial plexus avulsion (i.e., deafferented dorsal horns), and 14 neurons were recorded in eight patients undergoing DREZotomy for disabling spasticity. These groups were compared in terms of mean frequency, coefficient of variation of the discharge, other properties of the neuronal discharge studied by the nonparametric test of Wald-Wolfowitz, and the possible presence of bursts. The coefficient of variation tended to be higher in the deafferented dorsal horn group than in the other two groups. Two neurons displaying burst activity could be recorded, both of which belonged to the deafferented dorsal horn group. A significant difference was found in term of neuronal behavior between the peripheral nerve trauma group and the other groups: The brachial plexus avulsion and disabling spasticity groups were very similar, including various types of neuronal behavior, whereas the peripheral nerve lesion group included mostly neurons with "nonrandom" patterns of discharge (i.e., with serial dependency of interspike intervals).
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.
Novikova, Liudmila N.; Orädd, Greger; Wiberg, Mikael; Novikov, Lev N.
Brachial plexus injury (BPI) is a devastating type of nerve injury, potentially causing loss of motor and sensory function. Principally, BPI is either categorized as preganglionic or postganglionic, with the early establishment of injury level being crucial for choosing the correct treatment strategy. Despite diagnostic advances, the need for a reliable, non-invasive method for establishing the injury level remains. We studied the usefulness of in vivo magnetic resonance imaging (MRI) of the spinal cord for determination of injury level. The findings were related to neuronal and glial changes. Rats underwent unilateral L4 & L5 ventral roots avulsion or sciatic nerve axotomy. The injuries served as models for pre- and postganglionic BPI, respectively. MRI of the L4/L5 spinal cord segments 4 weeks after avulsion showed ventral horn (VH) shrinkage on the injured side compared to the uninjured side. Axotomy induced no change in the VH size on MRI. Following avulsion, histological sections of L4/L5 revealed shrinkage in the VH grey matter area occupied by NeuN-positive neurons, loss of microtubular-associated protein-2 positive dendritic branches (MAP2), pan-neurofilament positive axons (PanNF), synaptophysin-positive synapses (SYN) and increase in immunoreactivity for the microglial OX42 and astroglial GFAP markers. Axotomy induced no changes in NeuN-reactivity, modest decrease of MAP2 immunoreactivity, no changes in SYN and PanNF labelling, and a modest increase in OX42 and SYN labeling. Histological and radiological findings were congruent when assessing changes after axotomy, while MRI somewhat underestimated the shrinkage. This study indicates a potential diagnostic value of structural spinal cord MRI following BPI. PMID:28036395
Reid, J.B. Jr )
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.
Karamitopoulos, P.; Weltje, G.; Dalman, R.
Spatial and temporal variability of sediment storage in fluvio-deltaic sedimentary systems is controlled by the interplay of allogenic and autogenic processes. In order to investigate the effects of this interplay on the resulting stratigraphy at varying spatio-temporal scales, we carried out a series of numerical experiments using an aggregated process-based model of fluvio-deltaic systems (SIMCLAST), which combines diffusive and advective transport with sub-grid channel stability algorithms in the fluvial domain. New distributary channels occur by avulsions under conditions of local superelevation or through bifurcations due to mouth bar deposition. A series of numerical experiments were performed under forcing by glacio-eustatic sealevel cycles in the order of 100 kyr. Initial conditions of all experiments are represented by classic continental-margin topography with a shelf break. In this scenario, erosional features (canyons) are developed when sea level falls below the shelf break. Sediment supply and liquid discharge remain constant throughout the experiments. In order to characterize the topographic variability during the experiments, we used a difference measure obtained by summation of local changes in net sediment accumulation rates across the entire model domain. Long-term average variability (10 kyr resolution) correlates strongly with the allogenic sea-level signal. The long-term variability reaches a maximum around the time interval corresponding to isochronous maximum flooding surfaces, when retrogradation gives way to a new episode of progradation. Long-term mean variability is lowest during periods of sea-level fall, when incision restricts sediment dispersal. Increasing the time resolution of our difference measure allows recognition of numerous small peaks which correspond to local changes in sediment accumulation rates induced by autogenic processes (avulsions and bifurcations). The amplitudes of these peaks are related to the rate of change of
Jerolmack, D. J.; Reitz, M. D.
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
Gharechahi, Maryam; Shojaeian, Shiva
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.
Schöffl, V; Winkelmann, H-P
Tendon lesions are the second most common injury in the hand and therefore an important factor in orthopedic patients. Most injuries are open injuries to the flexor or extensor tendons; nevertheless, also less frequent injuries such as damage to the functional system of tendon sheath and pulley or dull avulsions need to be considered. Besides the clinical examination, ultrasound and MRI have proven to be important diagnostic tools. In the postoperative course of flexor tendon injuries, the principle of early passive movement is important to trigger "intrinsic" tendon healing to guarantee a good outcome.
Kumar, Senthil; Rao, Murali G
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
Valverde, J A; Albiñana, J; Certucha, J A
Early posttraumatic arrest of the distal radial physis is an uncommon complication and usually appears after type II physeal injury. We report a 13-year-old boy who sustained an injury to his right wrist, incurring an avulsion fracture of ulnar styloid process. Twenty-one months later, a uniform closure of the distal radial physis was observed. An ulnar shortening osteotomy and distal ulnar epiphysiodesis were performed. We discuss different factors of this complication, but crush injury of germinal cells of the growthplate is considered the main etiology.
Chuang, David Chwei-Chin
Significant progress has been achieved in the science and management of peripheral nerve injuries over the past 40 years. Yet there are many questions and few answers. The author, with 30 years of experience in treating them at the Chang Gung Memorial Hospital, addresses debates on various issues with personal conclusions. These include: (1) Degree of peripheral nerve injury, (2) Timing of nerve repair, (3)Technique of nerve repair, (4) Level of brachial plexus injury,(5) Level of radial nerve injury,(6) Traction avulsion amputation of major limb, (7) Proximal Vs distal nerve transfers in brachial plexus injuries and (8) Post paralysis facial synkinesis.
In a comparative Level III study, Achtnich et al. compared suture anchor repair of acute proximal anterior cruciate ligament avulsion tears with single-bundle anterior cruciate ligament reconstruction with the quadrupled semitendinosus tendon. Short-term follow-up at a mean of 28 months showed that the between-group differences were not different. These results are encouraging but not different from other published series 25+ years ago. Only time will tell whether the long-term outcomes are identical and whether these techniques will also die a slow death. Hopefully history is not repeating itself.
Chung, Hyunsook; Kim, Miri; Yang, Wonkyung; Ko, Hyunjung
A case of an avulsed upper left central incisor that was replanted after 3 h in a 7-year-old girl is presented. The tooth showed signs of an acute periapical abscess at 2 weeks after replantation. Apexification with mineral trioxide aggregate (MTA) following application of calcium hydroxide was attempted. At 3-year and 6-month follow-up, the tooth was asymptomatic with adequate clinical function. The radiograph showed resolution of the periapical lesion and apparent radiopaque tissue under MTA plug resembling root end morphology.
Marriot-Smith, Charlotte; Marino, Victor; Heithersay, Geoffrey Sinclair
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.
Goldfarb, Charles A; Puri, Sameer K; Carlson, Michelle Gerwin
Hand and wrist injuries in the high-level athlete are challenging because they may be underestimated by the patient, family, and team, and return to play may be longer than desired. The needs of the player and the team must be balanced with the long-term functional ramifications of the injury. Four common soft-tissue sports injuries are flexor digitorum profundus avulsion, flexor pulley rupture, extensor carpi ulnaris dislocation, and thumb metacarpophalangeal joint ulnar collateral ligament injury. For each of these injuries, the assessment, treatment, and considerations for return to play should be individualized on the basis of the patient, the sport, and the timing of the injury.
Mattox, Ross; Welk, Aaron B; Battaglia, Patrick J; Scali, Frank; Nunez, Mero; Kettner, Norman W
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.
DeFinney, John; Clements, David; Staines, Marilyn; Mior, Silvano
Mechanical pain in the region of the groin poses an interesting and at times confusing clinical dilemma. This is especially true for osteitis pubis, an inflammatory condition affecting the symphysis pubis. Recently it has been recognized as a potential source of pain in athletes. In this report, we will review the typical presentation of osteitis pubis, including the clinical, examination and radiographic features of this condition. A proposed plan of management, based on previous work on avulsion injuries is presented. A case report has been included to illustrate the salient features. ImagesFigure 1Figure 2Figure 4
Bellaiche, Gilbert; Loncke, Lies; Gaullier, Virginie; Mascle, Jean; Courp, Thierry; Moreau, Alain; Radan, Silviu; Sardou, Olivier
The meandrous leveed channels of the Nile Cone show clear evidence of avulsions. Their sedimentary architecture is founded on numerous stacked lens-shaped acoustic units. In the areas of the distal fan, lobe deposits are apparent from multichannel imagery. Huge debris flow deposits, sometimes associated with pockmarks, are recognized. Mud volcanoes and gas seeping are closely associated with faulting. In the East, a very long north-trending channel, originating from the Egyptian coast, merges with a network of channels, very probably originating from the Levantine coasts. Both networks outlet in the sedimentary basin located south of Cyprus.
CUNEO, BETTINA F.; STRASBURGER, JANETTE F.; NIKSCH, ALISA; OVADIA, MARC; WAKAI, RONALD T.
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
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.
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
Davalos, Eric A; Barank, David; Varma, Rajeev K
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.
DAVALOS, ERIC A.; BARANK, DAVID; VARMA, RAJEEV K.
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
Ellanti, Prasad; O'Farrell, Dermot
Traumatic dislocation of the elbow is rare in children and can most often be managed in the emergency department using procedural sedation and closed reduction with good functional outcome. Radiographs must be evaluated for associated avulsions and fractures around the elbow. We present the case of a 14-year-old girl who sustained a fracture of the radial neck subsequent to repeated attempts at closed reduction of a pure posterior elbow dislocation that was missed on postreduction radiographs. Careful use of reduction techniques and avoidance of repeated forceful manipulations is emphasized.
Merican, A M; Kwan, M K; Cheok, C Y; Wong, E L W; Sara, T A
Near total amputation of the upper limb if unsalvageable would cause severe disability. However, delayed revascularisation can be life threatening. We report two cases of revascularisation of the upper limb following near total amputation that was successful and functional after a warm ischaemic time of ten hours. The first was a traction avulsion injury of the arm leaving major nerves contused but in continuity. The second was a sharp injury through the mid-forearm attached by only a bridge of skin. Attempting revascularisation of a proximal injury beyond 6 hours, in selected cases is worthwhile.
Isenberg, J Scott
A recent 12-month review of the emergent replantation/revascularization experience of a solo practice microsurgeon in a community hospital environment is presented. A total of 67 digits and/or hands/limbs were operated on in 51 patients with a success rate of 87 percent. There were nine failures, all in digits with crush-avulsion etiologies. These results support the position that the single microsurgeon practicing in a community hospital environment can provide levels of care for patients with amputated or devascularized digits and parts comparable to tertiary medical centers.
Liang, Kailu; Zhong, Gang; Yin, Jiahui; Xiang, Zhou; Cen, Shiqiang; Huang, Fuguo
A 40-year-old woman had her right extremity avulsed at the proximal upper arm level and the wrist and hand of her left extremity irretrievably injured in a traffic accident. The right distal forearm was surgically amputated and replanted onto the stump of the left distal forearm. New strategy for nerve repair was applied and the function recovery of the cross-replanted hand was favorable. We thought that cross-extremity replantation was indicated when the patient suffered from bilateral total or subtotal amputation at different levels and orthotopic replantation was impossible.
Stefanato, Catherine M; Verdolini, Roberto
Nondermatophytic toenail infection with Scopulariopsis brevicaulis is rare, but may occur often in association with dermatophytes. We report a case of an 84-year-old man who presented with onychomycosis of the big toenail. Histopathologic examination of the avulsed nail showed evidence of S. brevicaulis coinfection with a dermatophyte, despite negative mycology results for the latter. Our case underscores the importance of histopathologic examination of nail specimens as an additional invaluable tool in the diagnosis of onychomycosis, as it may unmask false-negative mycology findings.
Earley, Edward; Rawlinson, Jennifer T
This article discusses the classification systems for dental fractures and how the assessment affects treatment options. Diagonal incisor malocclusion is discussed in relation to skull asymmetry and how this commonly relates to premolar and molar occlusion. Oral and radiographic assessment of incisive bone fracture and incisor avulsion is reviewed for determining treatment options. A summary of incisor and canine resorption and hypercementosis is presented. Clinical presentations, staging, and classifications of tooth resorption as well as canine odontoplasty are discussed. Excessive plaque and calculus formation on lower canines leading to periodontal disease and abscess is examined.
characterized by open wounds and comminuted fractures , and in severe cases, complicated by avulsion of soft tissue and burns [9, 10]. Currently...compression are shown in figure 3. As listed in table 1, the CPC failed due to brittle fracture at 1.0 ± 0.2% strain and exhibited compressive strength of...15.9 ± 3.4 MPa. In contrast, the biocomposite exhibited plastic behavior and did not fracture at strains up to 50% 4 Biomed. Mater. 7 (2012) 024112 J
De Baere, Tom; Dubuc, Jean-Emile; Joris, Daniel; Delloye, Christian
The influence of acromioplasty in long standing rotator cuff deficiency with intractable pain was retrospectively evaluated in a consecutive series of 13 patients who were followed for a mean period of 19 months (range, 12 to 42 months) after arthroscopic acromioplasty. The Constant score improved from 59.3 (range, 39.9 to 90.3) preoperatively to 98.7 (69.1 to 122.7) postoperatively. Pain and motion improved significantly whereas strength did not improve. Arthroscopic acromioplasty in painful chronic rotator cuff avulsion was found to be an effective means to control pain and improve motion; it can be recommended when conservative treatment has failed.
Kumar, Narinder; Prasad, Manish
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.
Pithon, Matheus Melo
The aim of this article is to report the clinical case of non-surgical treatment of a Class II malocclusion with anterior open bite, associated with absence of a maxillary central incisor avulsed due to trauma. Treatment proceeded with the use of orthodontic mini-implants as an anchorage device for intrusion of the maxillary molars and for mesial movement of the lateral incisor to replace the central incisor. Treatment resulted in good occlusion, with anterior and lateral guides, enhancement of the facial profile, and good dental esthetic appearance without the need for prosthetic treatment. The treatment outcome was satisfactory but needs long-term or permanent retention.
Major, J. J.; Pierson, T. C.; Amigo, A.; Bertin, D.
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
Steiner, Adrian; Anderson, David E; Desrochers, André
Contracted flexor tendon leading to flexural deformity is a common congenital defect in cattle. Arthrogryposis is a congenital syndrome of persistent joint contracture that occurs frequently in Europe as a consequence of Schmallenberg virus infection of the dam. Spastic paresis has a hereditary component, and affected cattle should not be used for breeding purposes. The most common tendon avulsion involves the deep digital flexor tendon. Tendon disruptions may be successfully managed by tenorrhaphy and external coaptation or by external coaptation alone. Medical management alone is unlikely to be effective for purulent tenosynovitis.
Bencardino, Jenny T; Beltran, Javier
The glenohumeral ligaments, particularly the inferior one, are the major passive stabilizers of the joint, and the labrum functions as a site of ligamentous attachment. The strong union between the collagen fibers of the glenohumeral ligaments and the glenoid labrum is more resistant to injury than the union between the glenoid rim and the labrum. Labral tears associated with glenohumeral instability are therefore usually secondary to avulsion rather than impaction. This article reviews the normal MR imaging anatomy, variants and pitfalls of the glenohumeral ligaments, and the basic biomechanics of the glenohumeral ligaments. Examples of injuries involving these structures are provided.
Emerich, Katarzyna; Kaczmarek, Jan
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
Holan, Gideon; Needleman, Howard L
Traumatic dental injuries (TDIs) can result in the premature loss of primary anterior teeth due to an immediate avulsion, extraction later after the injury because of poor prognosis or late complications, or early exfoliation. There are a number of potential considerations or sequelae as a result of this premature loss that have been cited in the dental literature, which include esthetics, quality of life, eating, speech development, arch integrity (space loss), development and eruption of the permanent successors, and development of oral habits. This article provides a comprehensive review of the dental literature on the possible consequences of premature loss of maxillary primary incisors following TDI.
Prevot, Flavien; Berna, Pascal; Badoux, Louise; Regimbeau, Jean-Marc
In the event of injury to the vena cava, the surgeon's goal is to control the bleeding and then repair the vascular damage. Given the wide range of lesions observed, the repair step has not been standardized. There are a few case reports of simple venoplasty or cavocaval bypass with a polytetrafluoroethylene graft. The present report introduces another treatment option for total avulsion of the suprahepatic inferior vena cava when a lack of remnant venous tissue below the heart prevents direct repair: cavo-atrial bypass with a polytetrafluoroethylene graft.
Sonmez, Ayse B; Castelnuovo, Jacopo
Recent developments in research have been based on the maintenance and regeneration of natural organs and tissues; among such developments is the use of growth factors (GFs). The use of basic fibroblastic growth factors (bFGF) may be indicated in different disciplines of dentistry such as periodontics and dental traumatology. These cells' ability to induce proliferation and differentiation of cells may make GFs a useful source for the development of natural structures. This mini-review will discuss how bFGF can be beneficial to dentistry in relation to 1) re-implantation/autotransplantation of avulsed teeth and 2) periodontal regeneration.
Tang, Jiyuan; Tang, Qiao
Postherpetic neuralgia (PHN) is a difficult medical issue and symptomatic treatment with medication is common. One case of PHN was cured by nerve avulsion and microtherm plasma nerve block. The male patient was 48-year-old with PHN on the right side of the nose, suffering recurrent pains within one year. The symptoms occurred irregularly and lasted for several minutes to hours every time. Electroacupuncture and Chinese medicine treatments in other hospitals made little efficacy. Physical examination showed skin of right side of the nose and nasal mucosa was normal and all laboratory reports confirmed negative. After microtherm plasma treatment in nasal cavity and corresponding area of nasal septum, the pain disappeared.
Burtt, D. G.; Bassett, K. N.
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
Smith, R. J.
This report documents a patient with an open pelvic fracture with gross contamination and partial avulsion of soft tissues with transection of femoral artery and vein, femoral nerve, and a stretch injury to the sciatic nerve. Initially, an attempt was made to treat with above-knee amputation, but due to massive soft tissue loss, this was not feasible. A left hemipelvectomy was done with closure of the wound. The patient required 14 units of blood. He was discharged and is now ambulatory with a prosthesis. Images Figure 1 Figure 2 Figure 6 PMID:2038088
Kennedy, Robert; Alibhai, Mustansir; Shakib, Kaveh
Tetracyclines are used to treat a range of oral conditions. Their efficacy in the treatment of periodontitis is well established, and they are authoritatively recommended in the management of avulsed teeth. There is a growing evidence base to support the use of tetracycline to treat recurrent aphthous stomatitis, but its use in white spongy naevus is limited to a handful of case reports. The mechanism of action in these conditions is either unknown or indicated to be through the inhibition of matrix metalloproteinases (MMP). The use of a single agent to treat diverse oral conditions has important implications for oral medicine.
Vyloppilli, Suresh; Prathap, Akhilesh
The tongue is an important structure for speech, mastication and deglutition. Avulsion of a portion of tongue can significantly limit the range of motion thereby impairing its functions. This is the case report of a traumatically amputated tongue which was reconstructed to fulfill its function effectively. Z-plasty is one of the most commonly used soft tissue corrective procedures in plastic surgery. Here we describe the use of a modification of the Z-plasty-multiple series Z-plasty for a tongue frenectomy.
Sammartino, G; Nicolò, M; Battagliese, G; Amato, M
The therapeutic effectiveness of benzoyloxymethyl-thiamin in controlling post-operative pain in odontostomatological surgery has been examined. The double blind study used a placebo and concerned 100 patients subjected to avulsion of the third molar in dysodontiasis on an out-patient basis. The results point to the effectiveness of benzoyloxymethyl-thiamin in the symptomatic treatment of post-operative pain symptomatology both as regards its duration and intensity; the drug also proved to be very well tolerated and its administration was not accompanied by any unwanted side-effects.
subjects with open femur fractures or soft tissue injury to the thigh resulting in VML. The primary endpoint will be changes in graft site muscle...postoperative, or other avulsive VML. Cohort 2 will include 20 subjects with open femur fractures or soft tissue injury to the thigh resulting in VML. The...in the Prevention of Tissue Fibrosis, DMRDP, D10-I-AR-J8-981 2011-Present. (PI - $750,000) Virtual Stress Test of Healing Fractures , G190VV
Manner; Koeth; Geelhaar; Stickel
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.
Mullane, E M; Dong, Z; Sedgley, C M; Hu, J C-C; Botero, T M; Holland, G R; Nör, J E
The long-term outcome of replanted avulsed permanent teeth is frequently compromised by lack of revascularization, resulting in pulp necrosis. The purpose of this study was to evaluate the effects of vascular endothelial growth factor (VEGF) and fibroblast growth factor (FGF-2) on the revascularization of severed human dental pulps. Tooth slices were prepared from non-carious human molars and treated with 0-50 ng/mL rhVEGF(165) or rhFGF-2 for 7 days in vitro. Both angiogenic factors enhanced pulp microvessel density compared with untreated controls (p < 0.05). Tooth slices were also treated with 0 or 50 ng/mL rhVEGF(165) for one hour prior to implantation into the subcutaneous space of immunodeficient mice. Treatment with rhVEGF(165) increased pulp microvessel density in vivo (p < 0.05). These results demonstrate that rhVEGF(165) enhanced neovascularization of severed human dental pulps and suggest that topical application of an angiogenic factor prior to replantation might be beneficial for the treatment of avulsed teeth.
Taylor, D C; Meyers, W C; Moylan, J A; Lohnes, J; Bassett, F H; Garrett, W E
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.
Al-Haj Ali, Sanaa; Mhaidat, Nizar; Awawdeh, Lama; Naffa, Randa
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. PMID:27616852
Ganti, Vamsi; Chadwick, Austin J.; Hassenruck-Gudipati, Hima J.; Fuller, Brian M.; Lamb, Michael P.
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
Vidović, Dina; Gorseta, Kristina; Bursac, Danijel; Glavina, Domagoj; Skrinjarić, Tomislav
The aim of this study was to assess level of knowledge about prevention and dental trauma management among taekwondo coaches in Croatia. The questionnaire submitted to the taekwondo coaches contained 16 items about dental trauma prevention and management. The questionnaires were filled in by 131 taekwondo coaches; 28 females and 103 males. Descriptive statistics was used to describe and analyze the obtained data. The coaches were familiar with dental injuries in high percentage: 41 (31.3%) have observed dental injury and 36 (27.5%) have experienced a dental injury themselves. Eight of them had tooth avulsion, fourteen crown fracture, and eight had tooth luxation. About half of all interviewed coaches 68 (52.7%) were aware of the possibility of replanting avulsed teeth. Twenty six (19.8%) were familiar with the tooth rescue kit. Only 99 out of 131 coaches (75.6%) have used a mouthguard. The obtained results show low knowledge about possibilities for prevention of dental trauma. Insufficient use of mouthguards in this contact sport requires more attention of dentists and coaches education about dental trauma prevention.
Galpern, David W; Tsai, Tsu-Min
Crush avulsion injuries to the hand with concomitant traumatic amputation of multiple digits can be a devastating injury to the patient. These injuries have multiple issues occurring under emergency conditions. When feasible, replantation of the multiple digits is optimal, but in many cases, it is not possible. Because of the crushing force on the digits, they are not viable candidates for replantation. The usual course of treatment for these patients is a two stage procedure, usually involving a groin flap. Here, we present the case of a patient who had a left hand skin avulsion of the whole palm and P1 of index, long, ring and small fingers. The left index finger had a complete amputation at the P2 level, the long, ring and small fingers all had complete amputations at the P1 level. This injury was dealt with by a left foot second and third toe transplant, a sensory free flap from the left big toe and a fourth toe microvascular free transfer to the left hand. The remainder of the defect was managed with a 10 × 14 cm reversed radial forearm flap and a combination of full and split thickness skin grafts. The procedure was performed in a single operation, obviating the need for a second surgery. This procedure optimized the patient's outcome during a single setting, making it an ideal choice in an emergency setting.
Pederson, Christopher A.; Santi, Paul M.; Pyles, David R.
Compensational stacking is the tendency for sediment transport systems to fill topographic lows through avulsion. This article quantitatively relates, for the first time, compensational stacking patterns within debris fans to characteristics of their internal stratigraphy and discusses implications to geologic hazard assessment and mitigation. Three exceptionally well-exposed debris fans were selected in Colorado for quantitative stratigraphic analyses. In each fan, the cross-sectional stratigraphy was subdivided into discrete depositional units (debris-flow and stream-flow deposits). The bounding surfaces between the depositional units were used to analyze the compensation index (κcv) of the fans, which is a measure of their compensational or avulsion tendencies. In the measured datasets, κcv ranged from 0.63 to 1.03. Values close to 0.5 represent intermediate levels of compensation, whereas values approaching 1.0 reflect high levels of compensation. The compensational values (κcv) were statistically compared to some physical, observable characteristics of the fans including: (1) debris-flow size, (2) amount of stream-flow deposits, (3) debris-flow composition, and (4) longitudinal position on the fan. These parameters correlated, either positively or negatively, to κcv, supporting their use as proxies for assessing the degree of compensational stacking in settings where large-scale cross-sections of a fan are unavailable. Such empirical results can be used by geologists and engineers for avoidance and mitigation measures of land use on debris fans.
Moazzami, Fariborz; Asheghi, Bahar; Sahebi, Safoura
Statement of the Problem: The maintenance of viable periodontal ligament cells is the most important issue in the long-term preservation of avulsed teeth. Purpose: The aim of this study was to assess aloe vera as a new storage media in maintaining the cell viability of dry-stored teeth in comparison with soy milk, Hank`s balanced salt solution (HBSS), and milk. Materials and Method: Twenty one extracted dog premolar teeth were dried for 30 minutes and stored in soy milk, HBSS, milk, and aloe vera extract (50%) for 45 minutes (n=6 for each). Furthermore, positive and two negative control groups (n=6), corresponding to 0 min, 30 min, and 2-hour drying times were also prepared respectively. The number of viable cells was counted following storage using Trypan blue exclusion. Data were statistically analyzed using the one-way ANOVA and post hoc Tukey-HSD test. Results: Statistical analysis showed no significant differences in cell viability among aloe vera, soymilk, and HBSS- stored teeth; however, they were all superior to milk. Conclusion: Aloe vera extract can be recommended as a suitable storage media for avulsed teeth. PMID:28280756
Introduction Acute posterolateral rotator elbow dislocation in a child is rare and can be easily misdiagnosed due to immaturity of the epiphysis. This is the first case of occult posterolateral rotator elbow dislocation in combination with an olecranon fracture. We report our experience with this case, which was not diagnosed correctly by plain radiographs. Case presentation An 11-year-old Asian boy suffered severe pain and swelling of his right elbow after his outstretched arm hit a car dashboard in a motor vehicle accident. Plain radiographs showed only a minimally displaced olecranon fracture and a tiny lateral epicondylar avulsion fracture. However, stress radiographs under general anesthesia revealed severe posterolateral rotatory instability. During surgery, we found that the cartilaginous lateral epicondylar apophysis was much larger than the epicondylar fragment on the radiographs. After the lateral epicondylar osteochondral fragment and lateral collateral ligament complex were fixed, the instability disappeared. Conclusion Our experience with this case shows that it is important to check for instability with pediatric elbow fractures, because a tiny avulsion fracture was able to cause severe posterolateral rotatory instability in a child. PMID:22943424
Micic, Ivan; Kim, Shin-Yoon; Park, Il-Hyung; Kim, Poong-Taek
The purpose of this study was to describe soft tissue injury patterns and report the clinical results of primary ligament repair with use of protected early mobilisation in unstable elbow dislocations with pure capsulo-ligamentous injuries. Twenty-four patients who presented with traumatic unstable elbow dislocation without associated intra-articular fracture were reviewed. Anatomical repair was performed using metal anchor screws and the bone tunnel method. Ligament avulsion was noted in 55% for the medial collateral ligament, 80% for the lateral collateral ligament, 60% for the flexor tendon and 80% for the extensor tendon. The overall mean Mayo Elbow Performance Score was 93.2. Brachial artery injuries occurred in two elbows. Heterotopic calcification was noted in 14 patients and there was one severe traumatic arthrosis. This study showed a high incidence of reattachable avulsion injuries to ligaments, tendon/muscle and capsule in unstable elbow dislocations. Primary ligament repair coupled with early rehabilitation provided satisfactory outcomes at two to four years postoperatively. PMID:18677481
Dagum, Alexander B; Slesarenko, Yury; Winston, Lucy; Tottenham, Virginia
We report a successful replantation of a proximal-third avulsed left arm in a 26-year-old female with maintenance of good functional, clinical, Short Form 36, and the Disabilities of the Arm, Shoulder, and Hand outcomes results at 10 years. An organized approach combining staged surgical reconstruction and intense hand therapy allowed for both successful replantation and outcome. There exist no clear guidelines in making the decision between replantation and revision amputation. Controversy regarding the value of upper limb replantation seems to increase with ascending levels of amputation. A case report cannot provide guidelines, but several points can be made that may be of help to hand surgeons confronting this uncommon situation. In a highly motivated patient with realistic expectation, a preoperatively intact functioning shoulder should be considered an indication for attempt at replantation. With further staged reconstruction, a helper arm can still be achieved even in an avulsion-type amputation. Current operative and perioperative aspects of microsurgical replantation and subsequent reconstruction are discussed.
Chiu, David T W; Lee, Jonathan
The proximal interphalangeal joint (PIP) joint is the most crucial joint for the functionality of a finger. For a child with complex injury of the hand every effort should be exercised to maximize function restoration. If the PIP joint is irreparably damaged, its reconstruction is indicated. The technique of autogenic heterotopic vascularized toe joint transplantation provides unique advantage of a composite transfer of skin, tendons, bone and joint alone with growth plate and its efficacy has been affirmed in children. It has been suggested that such transfers require intact flexor tendon to achieve satisfactory results, our experience however indicates quite the contrary. As evidenced by this report of a 7-year-old boy with abrasion and avulsion injury to his dominant right hand resulting in a complex defect with skin lose, extensor, flexor avulsion along with cominution of the PIP joint of his long finger. A surgical formulation of staged reconstruction scheme including an autogenic heterotopic vascularized toe joint transplantation led to complete functional restoration to his right hand.
Ford, G S; Baisden, M; Hoen, M; Quigley, N; Camp, L
External root resorption is a multifactorial process with many causes. Except for transient surface resorption, it is usually considered an irreversible process. Treatment can arrest or retard the resorptive process. Many factors that have been associated with this process include physiologic resorption, local factors, systemic conditions, and idiopathic resorption. This case report documents a 29-year-old white male who suffered a motor vehicle accident and dental trauma nine years ago. The accident resulted in the lateral displacement of the maxillary right canine. The maxillary right lateral incisor, right central incisor and left central incisors were avulsed. The right central incisor was never recovered from the accident site. The other teeth were replanted 90 minutes after the accident and rigidly splinted for six months. They then received root canal treatment, approximately one month after the splint was removed (seven months from time of the trauma). On annual examination, the patient complained of a loose maxillary fixed prosthesis. He was diagnosed with severe external resorption on the right lateral and left central incisors, and severe external replacement resorption on the right canine. This case report reviews the current trends in the treatment of avulsed teeth and the resorptive process.
Barrett, Edward J; Kenny, David J; Tenenbaum, Howard C; Sigal, Michael J; Johnston, Douglas H
The aim of this study was to determine whether application of an enamel matrix protein derivative, Emdogain (Biora AB Malmo, Sweden) to the root surface of avulsed permanent incisors would improve postreplantation outcomes in a pediatric population. Between June 1999 and May 2002, 25 avulsed permanent maxillary incisors (22 centrals and three laterals) were treated with Emdogain and followed for up to 32 months, mean duration 20.6 months (range: 6.9-32.5 months). Mean patient age at the time of treatment was 12.0 years (range: 7.7-17.6 years) and mean extra-alveolar duration was 185 min (range: 100-300 min). At the end of their follow-up each of the replanted incisors demonstrated radiographic evidence of replacement root resorption and clinical evidence of ankylosis. None of the replanted teeth were affected by inflammatory root resorption and there was no evidence of infection. When compared with the control samples from Barrett and Kenny (Endod Dent Traumatol 1997;15:269-72.) and Andersson et al. (Endod Dent Traumatol 1989;5:38-47.) this sample treated with the Emdogain protocol demonstrated significantly less root resorption than either of the control samples (anova, P < 0.0001). Although the Emdogain protocol did not produce periodontal regeneration, it did eliminate inflammatory resorption and infection and led to significantly less root resorption compared with the two historical controls.
Schöffl, Volker; Heid, Andreas; Küpper, Thomas
Tendon injuries are the second most common injuries of the hand and therefore an important topic in trauma and orthopedic patients. Most injuries are open injuries to the flexor or extensor tendons, but less frequent injuries, e.g., damage to the functional system tendon sheath and pulley or dull avulsions, also need to be considered. After clinical examination, ultrasound and magnetic resonance imaging have proved to be important diagnostic tools. Tendon injuries mostly require surgical repair, dull avulsions of the distal phalanges extensor tendon can receive conservative therapy. Injuries of the flexor tendon sheath or single pulley injuries are treated conservatively and multiple pulley injuries receive surgical repair. In the postoperative course of flexor tendon injuries, the principle of early passive movement is important to trigger an “intrinsic” tendon healing to guarantee a good outcome. Many substances were evaluated to see if they improved tendon healing; however, little evidence was found. Nevertheless, hyaluronic acid may improve intrinsic tendon healing. PMID:22720265
Salazar Botero, Santiago; Hidalgo Diaz, Juan Jose; Benaïda, Anissa; Collon, Sylvie; Facca, Sybille
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
Han, Bangshuai; Endreny, Theodore A.
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.
Maier, K.L.; Fildani, A.; Paull, C.K.; Graham, S.A.; McHargue, T.R.; Caress, D.W.; McGann, M.
New high-resolution autonomous underwater vehicle (AUV) seafloor images, with 1 m lateral resolution and 0.3 m vertical resolution, reveal unexpected seafloor rugosity and low-relief (<10 m), discontinuous conduits over ~70 km2. Continuous channel thalwegs were interpreted originally from lower-resolution images, but newly acquired AUV data indicate that a single sinuous channel fed a series of discontinuous lower-relief channels. These discontinuous channels were created by at least four avulsion events. Channel relief, defined as the height from the thalweg to the levee crest, controls avulsions and overall stratigraphic architecture of the depositional area. Flowstripped turbidity currents separated into and reactivated multiple channels to create a distributary pattern and developed discontinuous trains of cyclic scours and megaflutes, which may be erosional precursors to continuous channels. The diverse features now imaged in the Lucia Chica channel system (offshore California) are likely common in modern and ancient systems with similar overall morphologies, but have not been previously mapped with lower-resolution detection methods in any of these systems. ?? 2011 Geological Society of America.
O'Connor, J. E.; Jones, M.A.; Haluska, T.L.
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.
Ganti, Vamsi; Chadwick, Austin J; Hassenruck-Gudipati, Hima J; Fuller, Brian M; Lamb, Michael P
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.
Sochman, Jan; Peregrin, Jan H.; Pavcnik, Dusan Uchida, Barry T. Timmermans, Hans A.; Shimohira, Masashi; Choi, Young Ho; Keller, Frederick S. Roesch, Josef
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.
Bencardino, J T; Rosenberg, Z S; Brown, R R; Hassankhani, A; Lustrin, E S; Beltran, J
Magnetic resonance (MR) imaging is the imaging modality of choice for evaluation of acute traumatic musculotendinous injuries of the knee. Three discrete categories of acute injuries to the musculotendinous unit can be defined: muscle contusion, myotendinous strain, and tendon avulsion. Among the quadriceps muscles, the rectus femoris is the most susceptible to injury at the myotendinous junction due to its superficial location, predominance of type II fibers, eccentric muscle action, and extension across two joints. Among the muscles of the pes anserinus, the sartorius is the most susceptible to strain injury due to its superficial location and biarticular course. The classic fusiform configuration of the semimembranosus along with a propensity for eccentric actions also make it prone to strain injury. MR imaging findings associated with rupture of the iliotibial tract include discontinuity and edema, which are best noted on coronal images. The same mechanism of injury that tears the arcuate ligament from its fibular insertion can also result in avulsion injury of the biceps femoris. The gastrocnemius muscle is prone to strain injury due to its action across two joints and its superficial location. Injuries of the muscle belly and myotendinous junction of the popliteus are far more common than tendinous injuries.
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.
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
Clarke, Lucy; McLelland, Stuart; Tom, Coutlhard
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
Woelfle-Erskine, C. A.; Wilcox, A. C.
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
Larkin, Zacchary; Ralph, Timothy; Hesse, Paul
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
Ratliff, K. M.; Hutton, E. W. H.; Murray, A. B.
Society has become increasingly reliant on deltas for agriculture, resource extraction, transportation and trade, yet these landforms and their inhabitants have become increasingly vulnerable to submergence and natural disasters (e.g., flooding, storm surges). Although we know that many 'natural' processes influence large-scale delta morphology, we do not yet know the relative importance of anthropogenic influences (e.g., climate and land-use change) in shaping modern deltas. In particular, the processes and feedbacks that shape delta morphology over large space and timescales (i.e. timescales of multiple river avulsions and the evolution of multiple delta lobes) are not well understood. To explore the long-term combined effects of sea-level rise, subsidence and anthropogenic manipulations, we have developed a new morphodynamic delta model that links fluvial, floodplain, and deltaic dynamics over large space and timescales. Using the framework and tools of the Community Surface Dynamics Modeling System, we couple a new river and floodplain module to the Coastline Evolution Model (CEM, Ashton and Murray, 2001). In the fluvial module, cell width is assumed to be larger than the channel belt width (including natural levees that are maintained at a bankfull channel-depth above the riverbed elevation). The river course is determined using a steepest-descent methodology, and erosion and deposition along the course is modeled as a linear diffusive process. An avulsion occurs when the riverbed becomes super-elevated above the surrounding floodplain, and the new steepest-descent path to sea level is shorter than the previous course. Floodplain deposition is modeled by blanket (uniform) deposition and crevasse splay deposition (after a 'failed' avulsion; if the riverbed is super-elevated, but the new steepest path to sea level is longer than the prior path). Preliminary results indicate that anthropogenic manipulations of the river (e.g., levees) can propagate hundreds of
Barbizam, Joao V B; Massarwa, Rasha; da Silva, Lea Assed Bezerra; da Silva, Raquel Assed Bezerra; Nelson-Filho, Paulo; Consolaro, Alberto; Cohenca, Nestor
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
Clarke, Lucy; McLelland, Stuart; Coulthard, Tom
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 at the Deep, an experimental facility 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 fan plots 2x2m in size, 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
Flynn, Robert H.
On May 15, 2006, a breach in the riverbank caused an avulsion in the Suncook River in Epsom, NH. The breach in the riverbank and subsequent avulsion changed the established flood zones along the Suncook River; therefore, a new flood study was needed to reflect this change and aid in flood recovery and restoration. For this flood study, the hydrologic and hydraulic analyses for the Suncook River were conducted by the U.S. Geological Survey, in cooperation with the Federal Emergency Management Agency. This report presents water-surface elevations and profiles determined using the U.S. Army Corps of Engineers one-dimensional Hydrologic Engineering Center River Analysis System model, also known as HEC-RAS. Steady-state water-surface profiles were developed for the Suncook River from its confluence with the Merrimack River in the Village of Suncook (in Allenstown and Pembroke, NH) to the upstream corporate limit of the town of Epsom, NH (approximately 15.9 river miles). Floods of magnitudes that are expected to be equaled or exceeded once on the average during any 2-, 5-, 10-, 25-, 50-, 100-, or 500-year period (recurrence interval) were modeled using HEC-RAS. These flood events are referred to as the 2-, 5-, 10-, 25-, 50-, 100-, and 500-year floods and have a 50-, 20-, 10-, 4-, 2-, 1-, and 0.2-percent chance, respectively, of being equaled or exceeded during any year. The 10-, 50-, 100-, and 500-year flood events are important for flood-plain management, determination of flood-insurance rates, and design of structures such as bridges and culverts. The analyses in this study reflect flooding potentials that are based on existing conditions in the communities of Epsom, Pembroke, and Allenstown at the time of completion of this study (2009). Changes in the 100-year recurrence-interval flood elevation from the 1979 flood study were typically less than 2 feet with the exception of a location 900 feet upstream from the avulsion that, because of backwater from the dams in the
Wilkinson, M. J.; Miller, R. McG.; Eckardt, F.; Kreslavsky, M. A.
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
Kumar, Vineet; Dharap, Satish Balkrishna
Blunt Cardiac Rupture (BCR) is a life threatening injury. Majority of patients do not reach the hospital and in those who reach the emergency department, timely diagnosis and treatment is a challenge. The case is about a patient with multiple blunt injuries who presented in shock. Cardiac tamponade was suspected on clinical grounds and on evidence of mediastinal widening on radiograph. In the absence of songography, the diagnosis was confirmed by subxiphoid pericardial window. Emergency thoracotomy revealed a right atrial appendage rupture which was surgically corrected. The patient also underwent splenectomy for grade IV splenic injury. Liver injury, pubic diastasis and tibial spine avulsion fracture was managed conservatively. He recovered well. Systematic observance of trauma resuscitation guidelines can help salvage patients with life threatening complex injuries even in the absence of specialized imaging investigations. PMID:28050441
Hein, C.J.; FitzGerald, D.M.; Barnhardt, W.A.
Recent multi-beam, backscatter, and bottom sediment data demonstrate that a large sand sheet was formed in the inner shelf by the reworking of the Merrimack River lowstand delta and braid plain (12 kya) during the Holocene transgression. Seismic data reveal the presence of widespread channel cut-and-fill structures landward of the delta suggesting that much of the sand sheet consists of braided stream deposits. These features map into several sets of cut-and-fill structures, indicating the avulsion of the primary river channels, which creates the lobes of the paleo-delta. Truncations of these, cut-and-fill structures suggest that the braid plain deposits were probably reworked during the Holocene transgression and may have contributed sand to developing barriers that presently border the Merrimack Embayment.
Moazami, Fariborz; Mirhadi, Hosein; Geramizadeh, Bita; Sahebi, Safoura
The purpose of this study was to evaluate the ability of soymilk, powdered milk, and Hank's balanced salt solution (HBSS) to maintain human periodontal ligament (PDL) cell viability in vitro. PDL cells were obtained from extracted healthy third molars and cultured in Dulbecco's modified Eagles medium (DMEM). The cultures were exposed for 1, 2, 4, and 8 h to experimental solutions (tap water served as negative control and DMEM as positive control) at 37°C. The viable cells were then counted using the trypan blue exclusion technique. Data were analyzed by using one-way anova, post hoc Scheffe and two-way anova test. Statistical analysis showed that HBSS, powdered baby formula, and soymilk maintain cell viability equally well in different periods of times. Tap water cannot keep cells viable as well as other solutions. Soymilk and powdered baby formula can be recommended as suitable storage media for avulsed teeth for up to 8 h.
Yonezawa, Hisanobu; Yanamoto, Souichi; Hoshino, Tomonori; Yamada, Shin-Ichi; Fujiwara, Taku; Umeda, Masahiro
An 11-year-old male who injured his maxilla and right maxillary central incisor and lip during a fall was presented to our hospital. His lower lip and upper gingiva were lacerated with swelling and epistaxis, and he had a maxillary alveolar bone fracture and severe intrusion of the right maxillary central incisor, which had penetrated the floor of the nasal cavity with avulsion. Under local anesthesia, we repositioned the incisor and bone segment and fixed them with a titanium micromesh plate and self-tapping screws and splints. The incisor was also treated by root canal 3 days after the operation and was restored with a crown. We performed root canal filling 1 month later. Five months later, the plate and screws were removed. In prognosis of our case, no symptoms of inflammatory root resorption or ankylosis have observed for more than 1 year and 6 months of follow up based on both clinical and radiographic findings.
Singh, Dhanpal; Kumar, K Arun; Dinesh, Mc; Raj, Ranju
Chronic triceps insufficiency, causing prolonged disability, occurs due to a missed diagnosis of an acute rupture. We report a 25 year old male with history of a significant fall sustaining multiple injuries. Since then, he had inability in extending his right elbow for which he sought intervention after a year. Diagnosis of triceps rupture was made clinicoradiologically and surgery was planned. Intraoperative findings revealed a deficient triceps with a fleck of avulsed bone from olecranon. Ipsilateral double tendon graft including extensor carpi radialis longus and palmaris longus were anchored to triceps and secured with the olecranon. Six-months follow revealed a complete active extension of elbow and a full function at the donor site.
Shimizu, Toshio; Komori, Tetsuo; Hayashi, Hideaki
A 68-year-old woman with Parkinson disease (PD) presented with acute monoplegia of her left upper extremity after the neck and limb immobilization for several hours. Her sensory function was normal, and the chest X-ray showed left phrenic nerve palsy. Electrophysiological studies showed multi-segment muscle involvement (C3 to T1) including denervation potentials and reduced interference of motor units in needle electromyography. M wave amplitude in peripheral nerve stimulation was preserved except for the ulnar nerve, suggesting both axonal injury and conduction block at the anterior spinal roots. The patient showed fair recovery in several months, suggesting sufficient reinnervation and recovery of conduction block. Incomplete root avulsion was thought to be the pathomechanism of acute cervical motor radiculopathy.
Ali, Sajid; Luni, Faraz Khan; Hashmi, Fayyaz; Taleb, Mohammed
Blunt trauma to chest cause injury to various cardiac structures. Isolated rupture of aortic valve without aortic dissection is rare complication of blunt chest trauma and can be caused by a tear or avulsion of the valve. We report a case of a 35-year-old male who presented with severe aortic insufficiency due to rupture of a non-infected congenital bicuspid aortic valve following non-penetrating chest trauma. The diagnosis was suggested by echocardiography and was confirmed by intra-operative and histological findings. The patient was successfully treated with surgical valve replacement with uneventful postoperative course and recovery. We describe patho-physiology, clinical manifestations, management and the literature review of traumatic rupture of bicuspid aortic valve. PMID:28164016
Suksompong, Sirilak; von Bormann, Benno
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
Suksompong, Sirilak; von Bormann, Benno
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.
Filippi, A; Pohl, Y; von Arx, T
A 12-year-old patient sustained avulsions of both permanent maxillary central incisors. Subsequently, both teeth developed replacement resorption. The left incisor was extracted alio loco. The right incisor was treated by decoronation (removal of crown and pulp, but preservation of the root substance). Comparison of both sites demonstrated complete preservation of the height and width of the alveolar bone at the decoronation site, whereas the tooth extraction site showed considerable bone loss. In addition, some vertical bone apposition was found on top of the decoronated root. Decoronation is a simple and safe surgical procedure for preservation of alveolar bone prior to implant placement. It must be considered as a treatment option for teeth affected by replacement resorption if tooth transplantation is not feasible.
van Koningsbruggen, Martijn; Koller, Kristin; Rafal, Robert D.
Two visual signals appearing simultaneously are detected more rapidly than either signal appearing alone. Part of this redundant target effect (RTE) can be attributed to neural summation that has been proposed to occur in the superior colliculus (SC). We report direct evidence in two neurological patients for neural summation in the SC, and that it is mediated by afferent visual information transmitted through its brachium. The RTE was abolished in one patient with a hemorrhage involving the right posterior thalamus that damaged part of the SC and that disrupted its brachium; and in another patient in whom the SC appeared intact but deafferented due to traumatic avulsion of its brachium. In addition reaction time for unilateral targets in the contralesional field was slowed in both patients, providing the first evidence that visual afferents to the SC contribute to the efficiency of target detection. PMID:28286472
Farret, Marcel M; Farret, Milton M B; da Luz Vieira, Gustavo; Assaf, Jamal Hassan; de Lima, Eduardo Martinelli S
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.
Spock, Christopher R; Salomon, Jeffrey C; Narayan, Deepak
A log splitter is a gasoline- or diesel-powered machine that uses a hydraulic-powered cutting wedge to do the work of an axe. Log-splitter injuries that do not result in amputation of digits or limbs are uncommon and not well described in the literature. We present a unique case of a patient who sustained a log-splitter injury that resulted in thrombosis of the radial artery and avulsion laceration of the ulnar artery leading to acute hand ischemia, in addition to scapholunate ligament disruption leading to a DISI deformity. In this case, thrombolytic therapy was contraindicated and surgical revascularization was the best possible treatment option. Our case illustrates the pitfalls of using this modality in a crush injury, since the use of thrombolytics in this instance would have resulted in severe hemorrhage. An important clinical caveat is the potentially misleading arteriographic diagnosis of thrombosis and/or spasm.
Ahn, Joong Mo; El-Khoury, Georges Y
The unique ability of magnetic resonance (MR) imaging to visualize injuries of bone, cartilage, bone marrow, and supporting soft tissue structure makes it ideally suited for the evaluation of musculoskeletal trauma. Magnetic resonance imaging also offers exquisitely detailed anatomical information on the musculoskeletal system. The widespread availability of MR imaging and the constantly improving technology make it the imaging modality of choice for the patients with a musculoskeletal trauma. This review discusses the role and applications of MR imaging for musculoskeletal trauma. It covers traumatic conditions of the musculoskeletal system, including hemarthrosis, lipohemarthrosis, stress fracture, occult fractures, cartilage injuries, the muscle and tendon trauma, avulsion injuries, extensor mechanism injuries, and traumatic conditions of joints.
Jedrzejewski, T; Sokołowski, J; Połać, B
The authors measured the effect of the convergence angle of the ground tooth on the fastening of cast crowns. The study was carried out on phantom models of teeth made of stainless steel with abutement convergence angles from 1 to 10 degrees. The force of the connection was measured using the Instron testing device. The avulsing force acted along the long axis of the abutement. Additionally the fixing force of phosphate, polycarboxylate and ionomer-glass was compared. A fall of the force of crown fastening was observed with increasing value of the convergence angle of the abutement, especially for phosphorus and ionomer-glass cement. The crowns fastened with polycarboxylate cement showed a threefold smaller fall of the fastening force with increasing value of the convergence angle of the abutement.
Li, Xiaozhong; Shi, Lenian; Liu, Taiyun; Wang, Lin
Sesamoid bones and accessory ossicles are research focuses of foot and ankle surgery. Pains of the foot and ankle are related to sesamoid bones and accessory ossicles. The specific anatomical and functional relationship of sesamoid bones and accessory ossicles can cause such bone diseases as the dislocation of sesamoid bones and accessory bones, infection, inflammation and necrosis of sesamoid bones, cartilage softening, tenosynovitis of sesamoid bones and the sesamoid bone syndrome. However, these bone diseases are often misdiagnosed or mistreated. In patients with trauma history, relevant diseases of sesamoid bones and accessory ossicles as above mentioned are highly probable to be misdiagnosed as avulsion fractures. In such cases, radiographic findings may provide a basis for clinical diagnosis.
Oueis, Hassan; Tann, Richard; Stenger, James
It is estimated that 4.5 million Americans are bitten by dogs each year, and half of those are children. One in five dog bites results in injuries that require some form of medical attention. Children between 5 and 9 years of age are the most affected age group for this type of injury. A 19-month-old boy was admitted to the emergency department of Children's Hospital of Michigan for treatment of injuries due to a dog attack. Injuries were limited to the face of the child. Dental injuries included avulsion of upper lateral incisors, severe luxation of upper central incisors, and fracture of the facial alveolus bone. Surgical management of facial wounds was accomplished through irrigation, debridement and suturing. Dental treatment included extraction of central incisors and suturing soft tissues.
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.
Loffroy, Romaric; Yeguiayan, Jean-Michel; Guiu, Boris; Cercueil, Jean-Pierre; Krausé, Denis
Extraperitoneal bleeding from the inferior epigastric artery (IEA) and its branches is a rare complication of blunt pelvic trauma; however, it can result in life-threatening hemorrhage, even in cases of minimally displaced fractures of the pelvic ring. We report the case of a patient who had posttraumatic pelvic hematoma and cardiovascular collapse caused by avulsion of the right pubic branch of the IEA related to undisplaced fractures of the pubic rami. CT scanning followed by angiography showed leakage of contrast from the IEA. Transcatheter arterial embolization was performed to successfully control the hemorrhage. There have been very few previous reports of IEA injury related to stable fractures of the pubic rami successfully treated by transcatheter arterial embolization.
Lancaster, R L; Haut, R C; DeCamp, C E
Diabetes mellitus is known to involve a wide range of musculoskeletal disorders including tendon contracture, tenosynovitis, joint stiffness, and osteoporosis. Recent studies with experimentally induced models of diabetes show that insulin therapy mitigates such alterations. These data are from relatively short-term experiments. This manuscript reports the results of tensile failure experiments on the canine patella-patellar tendon-tibia complex from a group of juvenile diabetic animals that received insulin therapy. The duration of the disease was 4-9 yr. The stiffness of the diabetic preparations in a physiological range of loading was approximately 13% greater than controls (P < 0.05). On the other hand, the strength of the tendon preparation from the diabetic population was not different from controls, but the mode of structural failure for controls was by substance and avulsion fractures while the diabetics failed by tensile fracture of the patella.
Elbashir, Mohamed; Domos, Peter; Latimer, Mark
Elbow fractures are not uncommon in children, and some are associated with neurovascular injuries. Having a nerve injury in an elbow fracture without dislocation is rare and was not described in the literature. Here, we have reported probably the first case of an ulnar nerve injury in an elbow fracture without dislocation. A 9-year-old female presented to the emergency department after falling off a monkey bar. She had a painful, swollen and tender right elbow with no history or clinical signs of an elbow dislocation but had complete ulnar nerve palsy. She was managed initially with analgesia and plaster application and was taken directly to the operating theatre. Examination under anaesthesia revealed no elbow joint instability. The ulnar nerve was found entrapped between the trochlea and proximal ulna, intra-articularly. The medial epicondyle was also found avulsed from the humerus, with an incarcerated medial epicondylar fragment in the elbow joint.
van Wagenberg, Jan-Maarten F; van Huijstee, Pieter J; Verhofstad, Michiel H J
A divergent dislocation of the elbow is a very rare injury, and only a few cases have been described in the literature. It is characterized as a dorsal dislocation of the ulnohumeral joint combined with a lateral dislocation of the proximal radius. All three articulations of the elbow joint are involved. Like in our case, it can be accompanied by an avulsion fracture of the coronoid and a distal radius fracture. For correct understanding of the injury, proper radiographic studies are imperative. In contrast to some earlier reports that advise a conservative approach, we performed a very aggressive operative treatment. To ensure anatomic reconstruction of the elbow, surgical exposure of the various injuries was performed first. After gross reduction of the joint dislocation, definitive osteosynthesis of the distal radius fracture was performed. Subsequently, the coronoid process and lateral collateral ligament could be repaired anatomically, improving the stability of the elbow. An uneventful recovery with excellent elbow motion and stability was achieved.
Kaczmarzyk, Janusz; Kocieba, Ryszard; Jabłecki, Jerzy
Replantations and revascularizations on the level of the arm are performed in the smallest number. The achieved functional results are poor. The paper presents a result achieved in a patient who sustained an avulsion amputation of an upper arm in the year 1974. The first long-term control was made 11 years after the revascularization of the limb which rated the result as III acc. to Chen's score system. The patient was steadily highly motivated for hand rehabilitation process. The second control performed 33 years after the accident proved the increase of sensibility, muscle strength as well as the range of movements. The result was up-graded as II (good). No degenerative changes in hand bones of mutilated hand were found.
Yang, Jianyun; Wang, Tao; Yu, Cong; Gu, Yudong; Jia, Xiaotian
Fingertip injury commonly results in avulsion of the nail bed. For large area defects of the nail bed with distal phalanx exposure, methods for reconstruction of soft tissue defects are scarcely mentioned in the literature.From May 2014 to January 2016, 6 patients with large area defects of the nail bed with distal phalanx exposure were enrolled. A new surgical method, cross finger fascial flap combined with thin split-thickness toe nail bed graft, was applied in all patients.All the 6 patients were followed-up at least 3 months. Good blood supply and no infections were observed. The lengths of the thumb or fingers were preserved. Acceptable appearance and nail bed growth were noted. The donor sites showed no dysfunction or deformity.Cross finger fascial flap combined with thin split-thickness toe nail bed graft is a new and rewarding surgical method to reconstruct large area defect of the nail bed with distal phalanx exposure.
Lavooi, E.; de Haas, T.; Kleinhans, M. G.; Makaske, B.; Smith, D. G.
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
Chicarilli, Z.N.; Ariyan, S.; Cuono, C.B.
Microsurgical techniques have developed numerous territories suitable for free tissue transfer. However, the demand for thin cutaneous resurfacing limits the choice of flaps available to the reconstructive microsurgeon. The radial forearm flap is a thin, axial, fasciocutaneous flap, offering pliable cutaneous resurfacing, with or without sensation. We have used 15 flaps to reconstruct defects in the head and neck and lower extremity resulting from burns, blunt and avulsive trauma, radiation necrosis, and tumor ablation. Two flaps (15 percent) developed venous congestion and were salvaged by reoperation. One retrograde flap (7.5 percent) developed partial necrosis from arterial insufficiency. Neural re-innervation was successful in two out of three patients in whom it was attempted. Two patients (15%) sustained minor donor site skin graft loss that healed secondarily. In our series of predominantly older patients the donor sites have been relatively inconspicuous at one year follow-up. A functional restoration was achieved in all patients.
Yang, Jianyun; Wang, Tao; Yu, Cong; Gu, Yudong; Jia, Xiaotian
Abstract Fingertip injury commonly results in avulsion of the nail bed. For large area defects of the nail bed with distal phalanx exposure, methods for reconstruction of soft tissue defects are scarcely mentioned in the literature. From May 2014 to January 2016, 6 patients with large area defects of the nail bed with distal phalanx exposure were enrolled. A new surgical method, cross finger fascial flap combined with thin split-thickness toe nail bed graft, was applied in all patients. All the 6 patients were followed-up at least 3 months. Good blood supply and no infections were observed. The lengths of the thumb or fingers were preserved. Acceptable appearance and nail bed growth were noted. The donor sites showed no dysfunction or deformity. Cross finger fascial flap combined with thin split-thickness toe nail bed graft is a new and rewarding surgical method to reconstruct large area defect of the nail bed with distal phalanx exposure. PMID:28178151
Flato, Russell; Passanante, Giovanni J; Skalski, Matthew R; Patel, Dakshesh B; White, Eric A; Matcuk, George R
The iliotibial tract, also known as Maissiat's band or the iliotibial band, and its associated muscles function to extend, abduct, and laterally rotate the hip, as well as aid in the stabilization of the knee. A select group of associated injuries and pathologies of the iliotibial tract are seen as sequela of repetitive stress and direct trauma. This article intends to educate the radiologist, orthopedist, and other clinicians about iliotibial tract anatomy and function and the clinical presentation, pathophysiology, and imaging findings of associated pathologies. Specifically, this article will review proximal iliotibial band syndrome, Morel-Lavallée lesions, external snapping hip syndrome, iliotibial band syndrome and bursitis, traumatic tears, iliotibial insertional tendinosis and peritendonitis, avulsion fractures at Gerdy's tubercle, and Segond fractures. The clinical management of these pathologies will also be discussed in brief.
Al-Qattan, Mohammad M; Al-Tamimi, A S
This is a retrospective study of 32 cases with localized hand burns from fireworks. All cases occurred during two national festivals of our country. The majority (54%) were children between 5 and 14 years, and 94% were males. All patients had localized hand burns. Patients were divided into two groups. Group I (n=10) patients had isolated burn injuries and Group II (n=22) patients had other concurrent hand injuries from the 'blast' of the fireworks such as tendon avulsion, nerve injury, fracture, dislocations, and amputations. Primary management of concurrent injuries along with dressing to the burn injury in a "flamazine bag" was done. All burns healed within 3 weeks and all surgical wounds/fractures healed without infection. Three patients required secondary release of contractures and skin grafting. Eventually, all patients were able to use their injured hands in daily activities.
Erickson, Benjamin P; Ko, Audrey C; Lee, Wendy W
An 89-year-old woman presented with a canalicular-involving laceration/avulsion of the right lower eyelid after a fall. The inferior canaliculus was severed deep within the wound, and the ends were difficult to identify. Novel pigtail cannulas, designed by the authors, were used for lacrimal system intubation and suture passage. Satisfactory cosmetic and functional results were achieved. These cannulas facilitate repair by integrating multiple functionalities in a single instrument. Once a cannula has been inserted and rotated, the location of fluid egress provides important clues. If injected saline appears in the nasopharynx but not in the wound, absence of a common canaliculus can be suspected. Injection of viscoelastic, air or fluorescein-impregnated saline also permits easier identification of the cut end of the canaliculus within the wound and facilitates appropriate rotation of the pigtail.
Ramer, Matt S; Bishop, Thomas; Dockery, Peter; Mobarak, Makarim S; O'Leary, Donald; Fraher, John P; Priestley, John V; McMahon, Stephen B
Injured dorsal root axons fail to regenerate into the adult spinal cord, leading to permanent sensory loss. We investigated the ability of intrathecal neurotrophin-3 (NT3) to promote axonal regeneration across the dorsal root entry zone (DREZ) and functional recovery in adult rats. Quantitative electron microscopy showed robust penetration of CNS tissue by regenerating sensory axons treated with NT3 at 1 and 2 weeks postrhizotomy. Light and electron microscopical anterograde tracing experiments showed that these axons reentered appropriate and ectopic laminae of the dorsal horn, where they formed vesicle-filled synaptic buttons. Cord dorsum potential recordings confirmed that these were functional. In behavioral studies, NT3-treated (but not untreated or vehicle-treated) rats regained proprioception. Recovery depended on NT3-mediated sensory regeneration: preventing regeneration by root excision prevented recovery. NT3 treatment allows sensory axons to overcome inhibition present at the DREZ and may thus serve to promote functional recovery following dorsal root avulsions in humans.
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.
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
Lee, Keith L.; Stoller, Marshall L.
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.
Bhagat, Neelakshi; Turbin, Roger; Langer, Paul; Soni, NG; Bauza, AM; Son, JH; Chu, David; Dastjerdi, Mohammad; Zarbin, Marco
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
Gould, C Frank; Ly, Justin Q; Lattin, Grant E; Beall, Douglas P; Sutcliffe, Joseph B
Whether discovered incidentally or as part of a focused diagnostic evaluation, the finding of a benign osseous lesion that has radiologic features resembling a bone tumor is not uncommon. Some of the more common benign and nonneoplastic entities that can sometimes be confused with tumors are the following: cortical desmoid, Brodie abscess, synovial herniation pit, pseudocyst, enostosis, intraosseous ganglion cyst, fibrous dysplasia, stress fracture, avulsion fracture (healing stage), bone infarct, myositis ossificans, brown tumor, and subchondral cyst. Accurate diagnosis and management of these lesions require a basic understanding of their epidemiology, clinical presentations, anatomic distributions, imaging features, differential considerations, and therapeutic options. This in-depth review of 13 potential bone tumor mimics will assist the radiologist in correctly identifying these benign lesions and in avoiding misdiagnosis and related morbidity. This review will also aid the radiologist in making appropriate recommendations to the referring physician for management or further imaging.
Hishida, Sumiyo; Ozaki, Noriyuki; Honda, Takashi; Shigetomi, Toshio; Ueda, Minoru; Hibi, Hideharu; Sugiura, Yasuo
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.
Hishida, Sumiyo; Ozaki, Noriyuki; Honda, Takashi; Shigetomi, Toshio; Ueda, Minoru; Hibi, Hideharu; Sugiura, Yasuo
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
Elbashir, Mohamed; Domos, Peter; Latimer, Mark
Elbow fractures are not uncommon in children, and some are associated with neurovascular injuries. Having a nerve injury in an elbow fracture without dislocation is rare and was not described in the literature. Here, we have reported probably the first case of an ulnar nerve injury in an elbow fracture without dislocation. A 9-year-old female presented to the emergency department after falling off a monkey bar. She had a painful, swollen and tender right elbow with no history or clinical signs of an elbow dislocation but had complete ulnar nerve palsy. She was managed initially with analgesia and plaster application and was taken directly to the operating theatre. Examination under anaesthesia revealed no elbow joint instability. The ulnar nerve was found entrapped between the trochlea and proximal ulna, intra-articularly. The medial epicondyle was also found avulsed from the humerus, with an incarcerated medial epicondylar fragment in the elbow joint. PMID:26546588
Houghton, Kristin M
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
Lisanti, Christopher J; Hartness, Christopher
We present a radiologic case report of a combined flexion and extension cervical spine fractures with associated vascular injury in a young patient who presented after a motorcycle crash with bilateral upper extremity paresthesias. CT and MRI examinations demonstrated an unstable anterior spondylolisthesis at C7/T1 with laminar/spinous process fracture of C7 and posterior longitudinal ligament avulsion requiring emergent surgery. Patient also had an extension teardrop fracture of C2 and focal right vertebral artery dissection. The case report reviews the classification of cervical spine injuries both by mechanism of injury and by stability/instability classification. Finally, we discuss the etiology and diagnosis of vascular injury including injury patterns that predispose to vascular trauma.
Vu, Davis; McDiarmid, Todd; Brown, Marcy; Aukerman, Douglas F
For acute Jones' fractures in recreationally active patients, early intramedullary screw fixation results in lower failure rates and shorter times to both clinical union and return to sports than non-weightbearing short leg casting (strength of recommendation [SOR]: A, based on 2 randomized controlled trials [RCT]). Non-weightbearing short leg casting achieves union in 56% to 100% of patients but can require prolonged casting (SOR: B, based on 2 prospective cohorts and multiple retrospective, follow-up studies). Stress fractures were not included in this review. For avulsion fractures of the fifth metatarsal tuberosity, a soft Jones' dressing allows earlier return to pre-injury levels of activity than rigid short leg casting (SOR: B, based on a lower-quality RCT).
Rashid, Haroon; Vohra, Fahim; Lillywhite, Graeme R.
Sports trauma frequently involves insult to oral soft and hard tissues resulting in loss of tooth structure and tooth loss. Multiple sporting equipment's are employed to prevent irreversible damage to oro-facial structures, and to reduce the overall cost of treatment. However in the undesired consequence of loss of oral structures, multiple treatment options are utilized to restore, esthetics, comfort and function. Osseointegrated implant supported rehabilitation of oral structures in trauma cases provides highly predictable treatment outcomes along with preservation of remaining tissues. This case report presents the management of avulsed teeth caused by hockey stick injury, with osseointegrated dental implant supported fixed partial dentures in esthetic zone using contemporary restorative techniques. PMID:28042278
Brown, H. C.
Hand injuries are among the most frequent accidents seen in sports medicine. All too commonly they are considered trivial since the athlete may continue to participate actively and neglect his injury. The consequent delay in diagnosis and proper treatment may result in long-standing or even permanent disability. This paper describes the more commonly encountered hand injuries, their diagnosis and their optimal treatment. Included are soft-tissue injuries, ligamentous injuries, fractures and tendon avulsions. The basic principles applicable to skeletal and soft-tissue trauma of the hand, which physicians at all levels of sports medicine may encounter, are stressed. Images FIG. 1A FIG. 1B FIG. 1C FIG. 2A FIG. 2B FIG. 2C FIG. 2D FIG. 3 FIG. 4 FIG. 5 FIG. 6 FIG. 7 FIG. 8A FIG. 8B FIG. 9 FIG. 10A FIG. 10B PMID:332313
Gallego, Lorena; Junquera, Luis; Villarreal, Pedro; de Vicente, Juan Carlos
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.
Weber, M-A; Rehnitz, C; Ott, H; Streich, N
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.
Bhandari, Prem Singh; Maurya, Sanjay
Management of brachial plexus injury is a demanding field of hand and upper extremity surgery. With currently available microsurgical techniques, functional gains are rewarding in upper plexus injuries. However, treatment options in the management of flail and anaesthetic limb are still evolving. Last three decades have witnessed significant developments in the management of these injuries, which include a better understanding of the anatomy, advances in the diagnostic modalities, incorporation of intra-operative nerve stimulation techniques, more liberal use of nerve grafts in bridging nerve gaps, and the addition of new nerve transfers, which selectively neurotise the target muscles close to the motor end plates. Newer research works on the use of nerve allografts and immune modulators (FK 506) are under evaluation in further improving the results in nerve reconstruction. Direct reimplantation of avulsed spinal nerve roots into the spinal cord is another area of research in brachial plexus reconstruction. PMID:25190913
Wiktor, Łukasz; Tomaszewski, Ryszard
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
Plink-Bjorklund, P.; Birgenheier, L.
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
Le Corroller, Thomas; Dediu, Melania; Champsaur, Pierre
Medial dislocation of the patella is an unusual entity. It is usually an iatrogenic complication of surgical lateral retinacular release. We describe the clinical, ultrasound (US), and magnetic resonance (MR) imaging features of a transient medial patellar dislocation in a 19-year-old patient with trochlear groove dysplasia presenting no surgical history. US showed acute injury to the lateral patellar retinaculum with complete avulsion at its patellar insertion. MR imaging confirmed the complete tear of the lateral patellar retinaculum and disclosed contusion of the anteromedial portion of the medial femoral condyle and lateral patella. This case is noteworthy because the injury patterns of patellar soft tissue restraints differ markedly from the classical features of lateral patellar dislocation.
Broz, L; Kripner, J
The Centre for Burns can help by its means (material, technical and personal) in the treatment of burns with extensive and deep losses of the skin cover and other tissue structures and in some affections with a different etiology (non-thermic affections). Indicated for admission are, in particular, extensive exfoliative affections--Stevens-Johnson's syndrome (SJS), Lyell's syndrome--toxic epidermal necrolysis (TEN) and staphylococcal scalded skin syndrome (SSSS), deep skin and tissue affections associated with fulminant purpura (PF), possibly other affections (epidermolysis bullosa, posttraumatic avulsions etc.). The similarity with burn injuries with loss of the skin cover grade II is typical, in particular in exfoliative affections with a need for adequate fluid replacement in the acute stage and aseptic surgical treatment of the affected area from the onset of the disease. In conditions leading to full thickness skin loss, in addition to general treatment rapid plastic surgical interventions dominate.
Guanche, Carlos A.
There is a continuum of hamstring injuries that can range from musculotendinous strains to avulsion injuries. Although the proximal hamstring complex has a strong bony attachment on the ischial tuberosity, hamstring injuries are common in athletic population and can affect all levels of athletes. Nonoperative treatment is mostly recommended in the setting of low-grade partial tears and insertional tendinosis. However, failure of nonoperative treatment of partial tears may benefit from surgical debridement and repair. The technique presented on this article allows for the endoscopic management of proximal hamstring tears and chronic ischial bursitis, which until now has been managed exclusively with much larger open approaches. The procedure allows for complete exposure of the posterior aspect of the hip in a safe, minimally invasive fashion. PMID:27011828
Ledon, Jennifer A; Savas, Jessica; Franca, Katlein; Chacon, Anna; Nouri, Keyvan
More than just a cosmetic concern, onychomycosis is a prevalent and extremely difficult condition to treat. In older and diabetic populations, severe onychomycosis may possibly serve as a nidus for infection, and other more serious complications may ensue. Many treatment modalities for the treatment of onychomycosis have been studied, including topical lacquers and ointments, oral antifungals, surgical and chemical nail avulsion, and lasers. Due to their minimally invasive nature and potential to restore clear nail growth with relatively few sessions, lasers have become a popular option in the treatment of onychomycosis for both physicians and patients. Laser or light systems that have been investigated for this indication include the carbon dioxide, neodymium-doped yttrium aluminum garnet, 870/930-nm combination, and femtosecond infrared 800-nm lasers, in addition to photodynamic and ultraviolet light therapy. This systematic review will discuss each of these modalities as well as their respective currently published, peer-reviewed literature.
Padilla-Fernandez, B.; Diaz-Alferez, F.J.; Garcia-Garcia, M.A.; Herrero-Polo, M.; Velasquez-Saldarriaga, J.F.; Lorenzo-Gomez, M.F.
Pelvic-abdominal injuries caused by goring are serious lesions which require rapid diagnosis and urgent treatment in the context of a polytraumatized patient. The simultaneous rupture of both the bladder and the prostatic-membranous urethra occurs in 10%–29% of males with pelvic fractures but bladder neck injuries in adults are rarer. Unstable pelvic fractures, bilateral fractures of the ischiopubic branches (also referred to as fractures from falling astride) and the diastasis of the pubic symphysis are those that have the greatest likelihood of injuring both the posterior urethra and the bladder. We present a case of perineal bull horn injury with muscle laceration, bone fractures, scrotal avulsion and rupture of the bladder neck involving the right ureter which required two operations to be repaired. PMID:23066348
Del Corso, Marco; Vervelle, Alain; Simonpieri, Alain; Jimbo, Ryo; Inchingolo, Francesco; Sammartino, Gilberto; Dohan Ehrenfest, David M
Platelet concentrates for surgical use are innovative tools of regenerative medicine, and were widely tested in oral and maxillofacial surgery. Unfortunately, the literature on the topic is contradictory and the published data are difficult to sort and interpret. In periodontology and dentoalveolar surgery, the literature is particularly dense about the use of the various forms of Platelet-Rich Plasma (PRP) - Pure Platelet-Rich Plasma (P-PRP) or Leukocyte- and Platelet-Rich Plasma (L-PRP) - but still limited about Platelet-Rich Fibrin (PRF) subfamilies. In this first article, we describe and discuss the current published knowledge about the use of PRP and PRF during tooth avulsion or extraction, mucogingival surgery, Guided Tissue Regeneration (GTR) or bone filling of periodontal intrabony defects, and regeneration of alveolar ridges using Guided Bone Regeneration (GBR), in a comprehensive way and in order to avoid the traps of a confusing literature and to highlight the underlying universal mechanisms of these products. Finally, we particularly insist on the perspectives in this field, through the description and illustration of the systematic use of L-PRF (Leukocyte- and Platelet- Rich Fibrin) clots and membranes during tooth avulsion, cyst exeresis or the treatment of gingival recessions by root coverage. The use of L-PRF also allowed to define new therapeutic principles: NTR (Natural Tissue Regeneration) for the treatment of periodontal intrabony lesions and Natural Bone Regeneration (NBR) for the reconstruction of the alveolar ridges. In periodontology, this field of research will soon find his golden age by the development of user-friendly platelet concentrate procedures, and the definition of new efficient concepts and clinical protocols.
Al-Jundi, Suhad; Mhaidat, Nizar
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
Huckleberry, Gary; Onken, Jill; Graves, William M.; Wegener, Robert
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
He, Ji-Yin; Chen, Shih-Heng; Tsai, Tsu-Min
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
Makaske, Bart; Smith, Derald G.; Berendsen, Henk J. A.; de Boer, Arjan G.; van Nielen-Kiezebrink, Marinka F.; Locking, Tracey
The upper Columbia River, British Columbia, Canada, shows typical anastomosing morphology — multiple interconnected channels that enclose floodbasins — and lateral channel stability. We analysed field data on hydraulic and sedimentary processes and show that the anastomosing morphology of the upper Columbia River is caused by sediment (bedload) transport inefficiency, in combination with very limited potential for lateral bank erosion because of very low specific stream power (≤ 2.3 W/m 2) and cohesive silty banks. In a diagram of channel type in relation to flow energy and median grain size of the bed material, data points for the straight upper Columbia River channels cluster separately from the data points for braided and meandering channels. Measurements and calculations indicate that bedload transport in the anastomosing reach of the upper Columbia River decreases downstream. Because of lateral channel stability no lateral storage capacity for bedload is created. Therefore, the surplus of bedload leads to channel bed aggradation, which outpaces levee accretion and causes avulsions because of loss of channel flow capacity. This avulsion mechanism applies only to the main channel of the system, which transports 87% of the water and > 90% of the sediment in the cross-valley transect studied. Because of very low sediment transport capacity, the morphological evolution of most secondary channels is slow. Measurements and calculations indicate that much more bedload is sequestered in the relatively steep upper anastomosing reach of the upper Columbia River than in the relatively gentle lower anastomosing reach. With anastomosing morphology and related processes (e.g., crevassing) being best developed in the upper reach, this confirms the notion of upstream rather than downstream control of upper Columbia River anastomosis.
Walton, Maureen A. L.; Gulick, Sean P. S.; Reece, Robert S.; Barth, Ginger A.; Christeson, Gail L.; VanAvendonk, Harm J.
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.
Sarker, Maminul H.; Thorne, Colin R.; Aktar, M. Nazneen; Ferdous, Md. Ruknul
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
Sparks, B.; Kasdan, M.; Wilhelmi, B.
Objective: We report a case in which an avulsion-amputation of the thumb proximal to the lunula was repaired by reattaching the amputated segment as a composite graft. The graft demonstrated complete survival with only a minimal sacrifice in length. Methods: A 23-year-old man presented 4 hours after an avulsion injury of the thumb with associated distal and proximal phalanx fractures. The amputated segment included the sterile and germinal matrix. He underwent defatting and composite grafting of the amputated segment followed by K-wire fixation of his proximal phalanx fracture. Results: In his 1-week follow-up, the patient's composite graft—including his nail bed—demonstrated complete survival. At one month, the composite graft maintained stable soft tissue coverage and showed signs of nail plate regrowth. Four months after repair, he was able to return to light duty and was advanced to full duty within 5 months. He continued to report gradually improving hypersensitivity at the margins of the graft and stiffness of the interphalangeal joint. At five months he regained full mobility of his carpometacarpal joint. The range of motion of his interphalangeal and metacarpophalangeal joint were 0 to 10 degrees and 0 to 25 degrees, respectively. He was able to oppose his thumb to all 4 digits. Six months after repair, he demonstrated protective sensation of the tip of the thumb. Conclusion: Composite grafting of the thumb, even in less than ideal cases, can still provide useful length for function as a opposable post and can be considered in reconstruction of thumb amputations at or proximal to the lunula. PMID:25848442
Seoane, Manuel; Rodriguez, Jose Fernando; Rojas, Steven Sandi; Saco, Patricia Mabel; Riccardi, Gerardo; Saintilan, Neil; Wen, Li
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
Plotzki, A.; May, J.-H.; Preusser, F.; Veit, H.
Aerial photography and satellite imagery reveal manifold geomorphological evidence of a dynamic evolution of past and present rivers in the Bolivian Amazon. Comparison of oxbow lake and meander scar dimensions along an inactive meander belt of the Río Mamoré (Llanos de Moxos, north-eastern Bolivia) and its modern counterpart suggests significant regional paleohydrological variability. We used these features as geomorphological and sedimentary archives to enhance our understanding of longer-term variations of the fluvial system. Late Pleistocene to Holocene hydrological changes of the Río Mamoré are inferred from: (i) the analysis of satellite imagery, (ii) discharge estimates from meander morphology, (iii) stratigraphic, and (iv) chronological information based on luminescence and radiocarbon dating. The combined data from three oxbows indicate that the now abandoned meander belt - the paleo-Mamoré - continued to be active at least until ∼5 ka, and likely even postdating 3 ka. An up to threefold increase in discharge is estimated for the modern Río Mamoré versus the paleo-Mamoré. The altered runoff regime may have triggered an avulsive shift towards the currently active Río Mamoré. The preceding increase in discharge in turn, was possibly related to a shift in climatic conditions, which changed markedly between the mid- and late Holocene in tropical South America. In addition, it may have been the indirect result of capturing the avulsive Río Grande system to the east of the Río Mamoré. Alternative explanations for the differences in dimensions of the paleo versus the modern Río Mamoré, i.e. contemporaneous activity of both rivers or alteration of site factors such as the channel/floodplain relationship, are considered to be unlikely.
Francis, Ashish; Baynosa, Richard C.
Significance: Tissue grafts and flaps are used to reconstruct wounds from trauma, chronic disease, tumor extirpation, burns, and infection. Despite careful surgical planning and execution, reconstructive failure can occur due to poor wound beds, radiation, random flap necrosis, vascular insufficiency, or ischemia–reperfusion (IR). Traumatic avulsions and amputated composite tissues—compromised tissue—may fail from crush injury and excessively large sizes. While never intended, these complications result in tissue loss, additional surgery, accrued costs, and negative psychosocial patient effects. Recent Advances: Hyperbaric oxygen (HBO) has demonstrated utility in the salvage of compromised grafts/flaps. It can increase the likelihood and effective size of composite graft survival, improve skin graft outcomes, and enhance flap survival. Mechanisms underlying these beneficial effects include increased oxygenation, improved fibroblast function, neovascularization, and amelioration of IR injury. Critical Issues: Common strategies for the compromised graft or flap include local wound care, surgical debridement, and repeated reconstruction. These modalities are associated with added costs, time, need for reoperation, morbidity, and psychosocial effects. Preservation of the amputated/avulsed tissues minimizes morbidity and maximizes the reconstructive outcome by salvaging the compromised tissue and obviating additional surgery. HBO is often overlooked as a potential tool that can limit these issues. Future Directions: Animal studies demonstrate a benefit of HBO in the treatment of compromised tissues. Clinical studies support these findings, but are limited to case reports and series. Further research is needed to provide multicenter prospective clinical studies and cost analyses comparing HBO to other adjunctive therapies in the treatment of compromised grafts/flaps. PMID:28116225
Hantes, Michael; Raoulis, Vasilios
Background: In the last years, basic research and arthroscopic surgery, have improved our understanding of shoulder anatomy and pathology. It is a fact that arthroscopic treatment of shoulder instability has evolved considerably over the past decades. The aim of this paper is to present the variety of pathologies that should be identified and treated during shoulder arthroscopy when dealing with anterior shoulder instability cases. Methods: A review of the current literature regarding arthroscopic shoulder anatomy, anatomic variants, and arthroscopic findings in anterior shoulder instability, is presented. In addition, correlation of arthroscopic findings with physical examination and advanced imaging (CT and MRI) in order to improve our understanding in anterior shoulder instability pathology is discussed. Results: Shoulder instability represents a broad spectrum of disease and a thorough understanding of the pathoanatomy is the key for a successful treatment of the unstable shoulder. Patients can have a variety of pathologies concomitant with a traditional Bankart lesion, such as injuries of the glenoid (bony Bankart), injuries of the glenoid labrum, superiorly (SLAP) or anteroinferiorly (e.g. anterior labroligamentous periosteal sleeve avulsion, and Perthes), capsular lesions (humeral avulsion of the glenohumeral ligament), and accompanying osseous-cartilage lesions (Hill-Sachs, glenolabral articular disruption). Shoulder arthroscopy allows for a detailed visualization and a dynamic examination of all anatomic structures, identification of pathologic findings, and treatment of all concomitant lesions. Conclusion: Surgeons must be well prepared and understanding the normal anatomy of the glenohumeral joint, including its anatomic variants to seek for the possible pathologic lesions in anterior shoulder instability during shoulder arthroscopy. Patient selection criteria, improved surgical techniques, and implants available have contributed to the enhancement of
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.
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
Talabi, Ademola Olusegun; Sowande, Oludayo Adedapo; Etonyeaku, Amarachukwu Chiduziem; Salako, Abdulkadir A; Adejuyigbe, Olusanya
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
Blaker, Carina L; Little, Christopher B; Clarke, Elizabeth C
Anterior cruciate ligament (ACL) tears are a common knee injury with a known but poorly understood association with secondary joint injuries and post-traumatic osteoarthritis (OA). Female sex and age are known risk factors for ACL injury but these variables are rarely explored in mouse models of injury. This study aimed to further characterize a non-surgical ACL injury model to determine its clinical relevance across a wider range of mouse specifications. Cadaveric and anesthetized C57BL/6 mice (9-52 weeks of age) underwent joint loading to investigate the effects of age, sex, and body mass on ACL injury mechanisms. The ACL injury load (whole joint load required to rupture the ACL) was measured from force-displacement data, and mode of failure was assessed using micro-dissection and histology. ACL injury load was found to increase with body mass and age (p < 0.001) but age was not significant when controlling for mass. Sex had no effect. In contrast, the mode of ACL failure varied with both age and sex groups. Avulsion fractures (complete or mixed with mid-substance tears) were common in all age groups but the proportion of mixed and mid-substance failures increased with age. Females were more likely than males to have a major avulsion relative to a mid-substance tear (p < 0.01). This data compliments studies in human cadaveric knees, and provides a basis for determining the severity of joint injury relative to a major ACL tear in mice, and for selecting joint loading conditions in future experiments using this model. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
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
McBride, Randolph A.; Taylor, Matthew J.; Byrnes, Mark R.
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
Thouret, Jean-Claude; Gupta, Avijit; Liew, Soo Chin; Lube, Gert; Cronin, Shane J.; Surono, Dr
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
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)
Aalto, R. E.; Grenfell, M.; Lauer, J. W.
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
Furushima, Kozo; Itoh, Yoshiyasu; Mitsui, Yasuhiro; Kusano, Hiroshi
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
A comprehensive view of Late Quaternary fluvial sediments and stratal architecture in a tectonically active basin: Influence of eustasy, climate, and tectonics on the Bengal Basin and Brahmaputra River system
Sincavage, R.; Goodbred, S. L.; Williams, L. A.; Pickering, J.; Wilson, C.; Steckler, M. S.; Seeber, L.; Reitz, M. D.; Hossain, S.; Akhter, S. H.; Mondal, D. R.; Paola, C.
More than 130 closely-spaced (~3-5 km) boreholes have been drilled along five transects in the upper Bengal Basin, providing the first detailed record of the stratigraphic architecture and provenance of the entire Late Quaternary fluviodeltaic sedimentary succession of the Ganges-Brahmaputra-Meghna Delta (GBMD). This effort is part of BanglaPIRE, an interdisciplinary, multi-institutional research effort aimed at unraveling the history and mechanisms of river-tectonic-basin interactions in the GBMD and Bengal basin, around which three tectonic plates converge. Following the Younger-Dryas, the onset of a strong summer monsoon coincident with continued eustatic sea-level rise initiated construction of the modern delta and rapid development of a thick (up to 80 m) succession of fluvial and deltaic sediments. These deposits illustrate several (3-4) avulsions and asymmetric occupations of the Brahmaputra River in the tectonically active Sylhet Basin. We hypothesize that the longer occupation periods (10 3 years) may be classified as major river avulsions driven by autogenic fluvial processes, whereas shorter occupation periods (10 2 years) reflect minor distributive events that may have been initiated by allogenic forcing via floods or earthquakes. Subsidence rates in Sylhet Basin, driven by an active foredeep, are relatively high (~5 mm/yr); however, the Brahmaputra River does not regularly migrate towards this side of the delta. Annual widespread flooding of Sylhet Basin may negate the potential topographic attraction for the system to be steered in this direction. Furthermore, a gentle westward topographic tilt of the active thrust front of the Tripura fold belt appears to have forced lateral steering of the Brahmaputra River and initiated erosion of a bench-cut terrace into an adjacent Pleistocene landform. Tectonic effects over longer timescales (10 3 years) are revealed by the presence of sediment with a unique provenance at the core of regional anticlines, which
Adema, G. W.; Podolak, C.
Maintaining infrastructure in the vicinity of a dynamic braided river is a challenging, yet necessary activity in Alaska and it requires some understanding of likely future river planform configurations. The intersection of the 150-kilometer-long gravel road which carries all of the traffic in the Denali National Park, AK, with the Toklat River, draining the north side of the glaciated Alaska Range, highlights several of these challenges. Immediately downstream from two bridges and a causeway crossing the 800-meter-wide braid plain, park infrastructure (a rest stop and a maintenance facility) is being threatened by bank erosion. In order to better protect this section of the park the National Park Service sought a geomorphic assessment of the Toklat River from the USGS. The assessment of likely planform configurations was conducted with a four-method approach - analyzing 1) channel patterns in the downstream direction, 2) changes in the lateral slope of the braidplain over time, 3) influences on the geometry of a significant tributary junction, and 4) probable post-avulsion channel configurations. This suite of analyses based on a series of cross section surveys and a large airborne LiDAR dataset were carried out using MATLAB, Quick Terrain Modeler, and ArcGIS. Patterns in the down- and cross-valley slopes, the braid plain width, and the cross-sectional forms demonstrate persistent forcings on the channel planform. Temporal trends in the cross section surveys, photographic evidence, and vegetation patterns show a braidplain that is regularly reworked. Relative discharge was estimated from two basins using a USGS-developed empirical method. The discharge was used along with confluence geometry constrain likely planform patterns downstream of a significant tributary junction. A simple momentum-based model showed a likely persistence of the current planform. The LiDAR-derived topography was used in a probabilistic analysis of likely avulsion scenarios and the likely
Ismail, Heba M.; Didangelos, Athanasios; Vincent, Tonia L.
Objective Mechanical injury to cartilage predisposes to osteoarthritis (OA). Wounding of the articular cartilage surface causes rapid activation of MAP kinases and NF‐κB, mimicking the response to inflammatory cytokines. This study was undertaken to identify the upstream signaling mechanisms involved. Methods Cartilage was injured by dissecting it from the articular surface of porcine metacarpophalangeal (MCP) joints or by avulsing murine proximal femoral epiphyses. Protein phosphorylation was assayed by Western blotting of cartilage lysates. Immunolocalization of phosphorylated activating transcription factor 2 (ATF‐2) and NF‐κB/p65 was detected by confocal microscopy. Messenger RNA (mRNA) was measured by quantitative reverse transcriptase–polymerase chain reaction (qRT‐PCR). Receptor associated protein 80 (RAP‐80) ubiquitin interacting motif agarose was used in a pull‐down assay to obtain K63‐polyubiquitinated proteins. Ubiquitin linkages on immunoprecipitated transforming growth factor β–activated kinase 1 (TAK‐1) were analyzed with deubiquitinases. Results Sharp injury to porcine cartilage caused rapid activation of JNK and NF‐κB pathways and the upstream kinases MKK‐4, IKK, and TAK‐1. Pharmacologic inhibition of TAK‐1 in porcine cartilage abolished JNK and NF‐κB activation and reduced the injury‐dependent inflammatory gene response. High molecular weight species of phosphorylated TAK‐1 were induced by injury, indicating its ubiquitination. An overall increase in K63‐linked polyubiquitination was detected upon injury, and TAK‐1 was specifically linked to K63‐ but not K48‐polyubiquitin chains. In mice, avulsion of wild‐type femoral epiphyses caused similar intracellular signaling that was reduced in cartilage‐specific TAK‐1–null mice. Epiphyseal cartilage of MyD88‐null and TRAF‐6–null mice responded to injury, suggesting the involvement of a ubiquitin E3 ligase other than TRAF‐6. Conclusion
Umazano, Aldo M.; Melchor, Ricardo N.; Bedatou, Emilio; Bellosi, Eduardo S.; Krause, Javier M.
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
Flood, R. D.
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
Latrubesse, Edgardo M.; Cozzuol, Mario; da Silva-Caminha, Silane A. F.; Rigsby, Catherine A.; Absy, Maria Lucia; Jaramillo, Carlos
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
Boivin, Maxime; Buffin-Bélanger, Thomas; Piégay, Hervé
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
Hosain, A.; Steckler, M. S.; Akhter, S. H.
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
Minear, J. T.; Wright, S. A.
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
Foreman, B. Z.; Heller, P.; Clementz, M. T.
The Willwood and Wasatch formations of northwest Wyoming and western Colorado record alluvial deposition within the intermontane Bighorn and Piceance Creek basins, respectively. Both display substantial shifts in the character of fluvial sand-bodies coincident with an abrupt negative carbon isotope excursion linked to the Paleocene Eocene Thermal Maximum (PETM) climate change event at ~55 Ma. In the northern Bighorn Basin, an anomalously thick and laterally persistent multi-story fluvial sand-body crops out within the main body of the PETM isotopic excursion. The internal architecture and lithofacies within the sand-body are similar to pre- and post-PETM sand-bodies, and mean paleo-flow depths do not appear to change substantially. The most significant change is the increase in vertical and lateral amalgamation within the PETM sand-body. Long-term basin sedimentation rates are constant spanning the event implying a transient increase in channel mobility via avulsion and meandering processes during the PETM, which preferentially evacuated fine-grained overbank material out of the basin to the north. Similarly, fluvial sand-bodies are more laterally and vertically amalgamated during the PETM in the Piceance Creek Basin. Yet here the sand-bodies are a recurrent phenomenon throughout the PETM, persist after the PETM, and show dramatic internal architectural changes. Flow depths increase by ~50% and are twice as variable during the PETM, lithofacies are dominated by upper flow regime structures, and crevasse splay deposits are ubiquitous in the associated floodplain strata. In both basins enhanced channel mobility was likely facilitated by a combination of vegetation overturn and alteration of precipitation patterns. Sediment stored higher in the catchment and on related hill-slopes was released, choked basin river systems, instigated greater in-channel deposition, and caused more rapid avulsions. Introduction of coarser sediment loads and vegetation change would have
Lin, Shaul; Pilosof, Nir; Karawani, Munir; Wigler, Ronald; Kaufman, Arieh Y.; Teich, Sorin T.
Background This study explores the pattern of complications occurrence resulting from traumatic dental injuries, the relation of this pattern to the number of years from the time of the injury to its first diagnosis, and other contributing characteristics such as root development and trauma characteristic. Material and Methods Patients’ data treated following dental trauma from 2002 to 2014 were classified and grouped according to age, gender, tooth type, injury type, diagnosis and the time that elapsed between the traumatic event and the diagnosis of complications (TIC). The distribution function of the quantitative parameters was determined with the Kolmogorov-Smirnov test. Fisher exact test was used to test differences between categorical parameters. Results The review identified 166 patients (114 male and 52 female), with a total of 287 traumatized teeth, and a mean of 1.8 injured teeth per incident. Maxillary teeth were involved significantly more often in traumatic dental injuries. The follow-up period range (TIC) had a mean of 2.99 years. The most frequent complication was pulp necrosis (34.2%). The most frequent complication related to avulsion was ankylotic root resorption (50%) diagnosed after a median TIC of 1.18 years. Open apices at the occurrence of trauma were observed in 52 teeth. Of these, 54.9% experienced pulp necrosis and 9.8% inflammatory root resorption with a median TIC of 1.63 years. Teeth that experienced multiple traumatic events showed significantly more late pulp necrosis compared to teeth that experienced a single traumatic injury (61.9% vs. 25.3%, respectively, p<0.0001). Conclusions Follow-up periods should be based on the type of traumatic dental injury and the severity of the potential complications for the tooth. Current recommendations for follow-up after traumatic dental injury should be revised to reflect the need for more frequent and overall prolonged follow-up. Key words:Dental trauma, avulsion, open apex, pulp necrosis
Shirani, Gholamreza; Kalantar Motamedi, Mohammad Hosein; Ashuri, Alireza; Eshkevari, Pooyan Sadr
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
Acks, R.; Kraus, M. J.
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
James, A.; Ghoshal, S.; Megison, M. E.; Singer, M. B.; Aalto, R.
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
Correggiari, Annamaria; Vigliotti, Luigi; Remia, Alessandro; Perini, Luisa; Calabrese, Lorenzo; Luciani, Paolo
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
Schumann, R. Randall; Pigati, Jeffery S.; McGeehin, John P.
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
Morgan, A. M.; Howard, A. D.; Moore, J. M.
As depositional systems forming within enclosed crater basins, the Late Noachian and Hesperian -aged  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 . We are continuing to refine the model to test for varying patterns of precipitation, duricrusts, and limits on sediment
Magirl, C. S.; Ritchie, A.; Bountry, J.; Randle, T. J.; East, A. E.; Hilldale, R. C.; Curran, C. A.; Pess, G. R.
The 2011-2014 staged removals of two nearly century-old dams on the Elwha River in northwest Washington State, the largest dam-removal project in the United States, exposed 21 million m3 of reservoir-trapped sand and gravel to potential fluvial transport. The river downstream from the dams is gravel bedded with a pool-riffle morphology. The river flows 20 km to the marine environment through a riparian corridor lined with large wood and having relatively few anthropogenic alterations. This moderately natural pre-dam-removal condition afforded an unprecedented opportunity to study river response to an anticipated massive sediment release. Four years into the project, 12 million m3 of sediment eroded from the former reservoirs with about 90% of the total load transported to the marine environment. Annualized sediment discharge was as great as 20 times the background natural load. Initial river response to the arrival of the first large sediment pulse was the nearly complete filling of the river's previously sediment-starved pools, widespread filling of side channels, and increased braiding index. In year 2, during maximum aggradation, the river graded to a plane-bedded system, efficiently conveying sediment to the marine environment. Modest peak flows (<2-yr return period) in year 2 promoted sediment transport but caused little large-scale geomorphic disturbance by channel migration or avulsions. As the river processed the sediment pulse, pools returned and the braiding index decreased in years 3-4. Higher peak flows in year 4 caused localized channel widening and migration but no major avulsions. Gauging indicated sand dominated the first stages of sediment release, but fluvial loads coarsened through time with progressive arrival of larger material. The literature suggests the Elwha River sediment wave should have evolved through dispersion with little translation. However, morphologic measurements and data from a stage-gauge network indicated patterns of
Cronin, Shane J.; Lube, Gert; Dayudi, Devi S.; Sumarti, Sri; Subrandiyo, S.; Surono
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
Rodriguez, J. F.; Seoane Salazar, M.; Sandi Rojas, S.; Saco, P. M.; Riccardi, G.; Saintilan, N.; Wen, L.
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
Peedikayil, Faizal C; Premkumar, Chandru T; Narasimhan, Dhanesh; Jose, Deepak
Introduction Dental trauma can overtake dental caries and periodontal disease as the most significant threat to dental health among young people. The prognosis of traumatized teeth depends on prompt and appropriate treatment. The role of school teachers in the prevention of traumatic dental injuries is a topic that has received a great deal of attention in recent years. However, studies conducted in different regions of the world have demonstrated that teachers and other lay people’s knowledge about traumatic dental injuries is inadequate and their behavior does not contribute to reduce the sequelae. Aim The purpose of this study was to evaluate the knowledge of school teachers about dental trauma and its management in Kannur district. Materials and Methods The survey was conducted under the Department of Paedodontics and Preventive Dentistry; Kannur Dental College among 303 school teachers randomly selected from 16 schools. Four schools were selected from 16 schools using stratified cluster sampling technique. A cross sectional study design was used. A stratified cluster sampling method was done to select the study subjects. The nature and purpose of the study was first explained to the teachers in local language. Following this the printed questionnaire was distributed to school teachers. The questionnaire was prepared based on the needs of the study after referring similar questionnaires used in studies conducted in different parts of the world. Results A statistically significant association was found between the teacher’s knowledge regarding trauma and their teaching experience. Out of the total school teachers who participated in the study, 90.1% responded correctly that the teeth most frequently affected by traumatic accidents are the upper front teeth. Nearly 23.4% responded correctly regarding management of traumatic tooth fracture. Almost 46.5% had correct knowledge regarding the reimplantation of avulsed permanent teeth. Only 14.2% responded
Spencer, F C; Galloway, A C; Colvin, S B
Experiences with 14 patients undergoing rupture of the left ventricle following mitral valve replacement over a period of 9 years have been described. Three different types have been recognized. Before 1978, most injuries occurred in the atrioventricular groove, apparently resulting from traction that insidiously avulsed the mitral annulus from the underlying left ventricular muscle. Several changes in operative technique, described in the text, were made to prevent this traction avulsion. Following the adoption of these principles, rupture in the atrioventricular groove virtually disappeared. A second type of injury, strut perforation, has been recognized in only one patient, a small 81-year-old female in whom the prosthesis inserted was too large for the ventricular cavity. Translucent obturators were subsequently developed not only to size the left ventricle but also to note the location of the post of the porcine prosthesis before insertion. Further problems of this type have not been seen. The most puzzling, and currently the most significant, problem is a third type of rupture, the mid-ventricular rupture, suggested as Type III by Miller in 1978 and described in detail by Cobbs in 1977 and 1980. The phenomenon seems to be a true spontaneous rupture of a thin left ventricle, usually occurring in small elderly women with mitral valve disease. If the friability of the left ventricle is transiently increased with potassium cardioplegia, such ventricles may spontaneously rupture following division of the chordae to the annulus of the mural leaflet. If this concept is correct, a rupture in some patients can best be prevented by preserving these chordae. It is well realized, of course, that a fortunate narrative experience of 3 1/2 years does not have any statistical value concerning a complication that occurs in 1 to 2% of operations. The experiences are reported, however, because to our knowledge, the untethered loop hypothesis has not been previously evaluated in
Abels, Hemmo; Lourens, Lucas; Gingerich, Philip
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
Schumann, R. Randall; Pigati, Jeffrey S.; McGeehin, John P.
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
Aslan, A.; White, W.A.; Warne, A.G.; Guevara, E.H.
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
Oliveira, Lorenna Fonseca Braga de; Souza, João Gabriel Silva; Mendes, Rafael Inácio Pompeu; Oliveira, Rodrigo Caldeira Nunes; Oliveira, Carolina de Castro; Lima, Carolina Veloso; Martins, Andréa Maria Eleutério de Barros Lima
Our objective was to evaluate whether there is an association with the different levels of dental fluorosis and the presence of dental trauma amongst school children. A transversal study was conducted amongst school children from the age of 12. Dental examinations were conducted by 24 well trained and fully qualified dental surgeons. Data was collected from 36 randomly selected public schools amongst 89 schools in a municipality. The criteria used to diagnose dental fluorosis was based on the Dean's fluorosis Index and for diagnosing dental trauma we looked for clinical signs of crown fractures and dental avulsions. Multiple descriptive analysis, which was bivariate, was carried out. Amongst the 2,755 school children that took part in the study 1,089 (39.6%) were diagnosed with dental fluorosis and 106 (3.8%) had one tooth or more with dental trauma. We noted a high prevalence of dental fluorosis, independent of the level of severity, amongst individuals with one tooth or more who had dental trauma. This association was even more evident where there were severely high levels of fluorosis. We also noted that the presence of fluorosis was greater amongst those that actively paid more attention to discoloration on their teeth and who received treatment from a dental professional at their schools. Nevertheless dental fluorosis was associated with the presence of dental trauma, independent of its severity.
Lévesque, H; Péron, J-M
Anti-thrombin, anti-platelet and anti-vitamin K agents are common treatments given for the prevention of thrombotic or embolic events. In oral or maxillofacial surgery, the question is whether oral anticoagulants or anti-platelets should be discontinued or not: temporary interruption could limit the risk of bleeding, but would increase the risk of thrombosis, and inversely. The best risk/benefit ratio must be achieved, but in many cases anti-platelet agents or even anti-vitamin K agents can be continued. In case of "potentially hemorrhagic" oral surgery, anti-platelet agents should be interrupted about ten days before the intervention. Anti-vitamin K agents should be interrupted four days before surgery and if required, replaced by low-molecular weight heparin at preventive or curative doses. In the very large majority of patients however, surgery (avulsion for example) can be performed without interrupting anticoagulation. Data in the literature have demonstrated that despite the theoretical risk of hemorrhage, bleeding is minimal and can be easily controlled by local treatments; the risk of thrombotic or thromboembolic events after discontinuing anticoagulation is much greater. A close collaboration between the dentist, the stomatologist, and the clinician is required to determine whether anti-thrombosis prevention should be continued and whether the anticoagulation level is adapted to the thrombotic risk. Good surgical technique and local anti-hemorrhagic treatment are essential in oral surgery, particularly in patients taking anti-platelets or oral anticoagulants.
Draut, Amy E.; Logan, Joshua B.; McCoy, Randall E.; McHenry, Michael; Warrick, Jonathan A.
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.
Berne, S. P.; Bassetti, M. A.; Baumann, J.; Dennielou, B.; Jouet, G.; Mauffrey, M.; Sierro, F. J.
The Promess boreholes in the Gulf of Lions (NW Mediterranean) provide precise chrono-stratigraphic constraints of the last ca 500 ky, that were nicely preserved at the shelf edge due to high accommodation and important sediment supply from the Rhone River. The major stratigraphic elements in this physiographic domain are Falling Stage Systems Tracts (in the sense of SEPM) linked to 100-ky eustatic cycles. They form wedges pinching out on the middle shelf, and thickening seaward on the outer shelf/upper slope (about 30-40m thick on the outer shelf). Within the uppermost sequence, linked to the last Glacial-Interglacial cycle, internal discontinuities were long described, but they were assigned to autogenic processes such as lobe avulsion or bedform migration. However, careful interpretation of a dense grid of very high resolution seismic data, together with precise chronostratigraphic constraints from borehole data and long piston cores, reveal that distinct parasequences, correlable at the regional scale, correspond to relatively minor sea-level changes linked (a) to Bond Cycles during the end of the Last Glacial, and (b) to an early Melt Water Pulse at the onset of Deglacial sea-level rise. These regressive and transgressive (respectively) parasequences are particularly well preserved in canyon heads, due to better accommodation. We propose that such features are important building blocks of the stratigraphic record, that might be recognized elsewhere on modern continental margins, as well as in the rock record.
Sharma, Sanjay; Reddy, Y. G.; Mittal, Rakesh; Agarwal, Vishal; Singh, Chanchal; Singh, Amandeep
Objectives: This study was undertaken to evaluate the viability of periodontal ligament (PDL) cells of avulsed teeth in three different storage media. Materials and Methods: Forty-five premolars extracted for orthodontic therapeutic purposes were randomly and equally divided into three groups based on storage media used [Group I: milk (control); Group II: aloe vera (experimental); Group III: egg white (experimental)]. Following extractions, the teeth were placed in one of the three different storage media for 30 minutes, following which the scrapings of the PDL from these teeth were collected in Falcon tubes containing collagenase enzyme in 2.5 mL of phosphate buffered saline. The tubes were subsequently incubated for 30 minutes and centrifuged for five minutes at 800 rpm. The obtained PDL cells were stained with Trypan Blue and were observed under optical microscope. The percentage of viable cells was calculated. Results: Aloe vera showed the highest percentage of viable cells (114.3±8.0), followed by egg white (100.9±6.3) and milk (101.1±7.3). Conclusion: Within the limitations of this study, it appears that aloe vera maintains PDL cell viability better than egg white or milk. PMID:26877742
Dudeja, Pooja Gupta; Grover, Shibani; Srivastava, Dhirendra; Sharma, Vivek
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
Chesnut, D.R. Jr. . Kentucky Geological Survey)
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.
Young, Eliot J.; Macias, C. Roger; Stephens, Lindsay
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
Schöffl, Isabelle; Baier, Thomas; Schöffl, Volker
After a pulley rupture, most climbers regain the full function of their previously uninjured fingers. However, in some cases of pulley rupture, a persistent inflammation of the tendon sheath is observed. In this study, 16 cadaver fingers were loaded until pulley rupture and then studied for the rupturing mechanism. In addition, two patients with this pathology were investigated using ultrasound and MRI, and received surgery. In 13 fingers, a rupture of one or several pulleys occurred and almost always at the medial or lateral insertion. In one finger, a capsizing of the pulley underneath the intact tendon sheath was observed, leading to an avulsion between tendon and tendon sheath. A similar pathology was observed in the ultrasound imaging, in MRI, and during surgery in two patients with prolonged recovery after minor pulley rupture. In cases of prolonged tenosynovitis after minor pulley rupture, a capsizing of the pulley stump is probably the cause for constant friction leading to inflammation. In those cases, a surgical removal of the remaining pulley stump and sometimes a pulley repair may be necessary.
Alkhadra, Thamer; Preshing, William; El-Bialy, Tarek
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
Alkan, Erdal; Sarıbacak, Ali; Ozkanli, Ahmet Oguz; Basar, Mehmet Murad; Acar, Oguz; Balbay, Mevlana Derya
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
Sanghavi, Tulsi; Shah, Nimisha; Parekh, Vaishali; Singbal, Kiran
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
Saini, Jasdeep; McPhee, Jamie S; Al-Dabbagh, Sarah; Stewart, Claire E; Al-Shanti, Nasser
Ageing is characterised by progressive deterioration of physiological systems and the loss of skeletal muscle mass is one of the most recognisable, leading to muscle weakness and mobility impairments. This review highlights interactions between the immune system and skeletal muscle stem cells (widely termed satellite cells or myoblasts) to influence satellite cell behaviour during muscle regeneration after injury, and outlines deficits associated with ageing. Resident neutrophils and macrophages in skeletal muscle become activated when muscle fibres are damaged via stimuli (e.g. contusions, strains, avulsions, hyperextensions, ruptures) and release high concentrations of cytokines, chemokines and growth factors into the microenvironment. These localised responses serve to attract additional immune cells which can reach in excess of 1×10(5) immune cell/mm(3) of skeletal muscle in order to orchestrate the repair process. T-cells have a delayed response, reaching peak activation roughly 4 days after the initial damage. The cytokines and growth factors released by activated T-cells play a key role in muscle satellite cell proliferation and migration, although the precise mechanisms of these interactions remain unclear. T-cells in older people display limited ability to activate satellite cell proliferation and migration which is likely to contribute to insufficient muscle repair and, consequently, muscle wasting and weakness. If the factors released by T-cells to activate satellite cells can be identified, it may be possible to develop therapeutic agents to enhance muscle regeneration and reduce the impact of muscle wasting during ageing and disease.
Adani, R; Busa, R; Castagnetti, C; Castagnini, L; Caroli, A
The treatment of a degloving injury is one of the most difficult problems in hand surgery. Various reconstructive procedures have been adopted in the past years, all with poor results. Between 1988 and 1995, nine patients with degloving injuries of the hand and fingers were treated by microsurgical replantation. The injury involved the thumb in three patients, the ring finger in three patients, the little finger in one patient, and multiple fingers in two patients. Successful complete revascularization was obtained in seven patients. In one case a superficial necrosis of the replanted thumb skin occurred with good preservation of the subcutaneous layer. In one patient with a degloving injury involving multiple fingers, revascularization was achieved only in the middle finger, and the first ray was secondarily resurfaced by a free flap from the foot. In our experience revascularization of the degloved skin does represent the best solution and must be managed as an emergency procedure. Coverage obtained in this way offers the best cosmetic result and allows early mobilization with good recovery of joint movement. Reestablishing sensibility is more difficult. It is not always possible to suture the nerves damaged by the trauma, and even when a careful primary nerve anastomosis is performed, the results often are unsatisfactory, probably because of the avulsive mechanism of nerve injury.
Mishra, Ravi; Pandey, D K; Ramesh, Prerna; Clift, Peter D
Deep sea channel systems are recognized in most submarine fans worldwide as well as in the geological record. The Indus Fan is the second largest modern submarine fan, having a well-developed active canyon and deep sea channel system. Previous studies from the upper Indus Fan have reported several active channel systems. In the present study, deep sea channel systems were identified within the middle Indus Fan using high resolution multibeam bathymetric data. Prominent morphological features within the survey block include the Raman Seamount and Laxmi Ridge. The origin of the newly discovered channels in the middle fan has been inferred using medium resolution satellite bathymetry data. Interpretation of new data shows that the highly sinuous deep sea channel systems also extend to the east of Laxmi Ridge, as well as to the west of Laxmi Ridge, as previously reported. A decrease in sinuosity southward can be attributed to the morphological constraints imposed by the elevated features. These findings have significance in determining the pathways for active sediment transport systems, as well as their source characterization. The geometry suggests a series of punctuated avulsion events leading to the present array of disconnected channels. Such channels have affected the Laxmi Basin since the Pliocene and are responsible for reworking older fan sediments, resulting in loss of the original erosional signature supplied from the river mouth. This implies that distal fan sediments have experienced significant signal shredding and may not represent the erosion and weathering conditions within the onshore basin at the time of sedimentation.
Schöffl, I; Oppelt, K; Jüngert, J; Schweizer, A; Bayer, T; Neuhuber, W; Schöffl, V
In this study we investigated the influence of the loading condition (concentric vs. eccentric loading) on the pulley system of the finger. For this purpose 39 cadaver finger (14 hands, 10 donors) were fixed into an isokinetic loading device. The forces in the flexor tendons and at the fingertip were recorded. In the concentric loading condition A2 and A4 ruptures as well as alternative events such as fracture of a phalanx or avulsion of the flexor tendons were almost equally distributed, whereas the A2 pulley rupture was the most common event (59%) in the eccentric loading condition and alternative events were rare (23.5%). The forces in the deep flexor tendon, the fingertip and in the pulleys were significantly lower in the eccentric loading condition. As the ruptures occurred at lower loads in the eccentric than in the concentric loading condition it can be concluded that friction may be an advantage for climbers, supporting the holding force of their flexor muscles but may also increase the susceptibility to injury.
Savi, Sara; Schildgen, Taylor F.; Tofelde, Stefanie; Wittmann, Hella; Scherler, Dirk; Mey, Jürgen; Alonso, Ricardo N.; Strecker, Manfred R.
In the Central Andes, several studies on alluvial terraces and valley fills have linked sediment aggradation to periods of enhanced sediment supply. However, debate continues over whether tectonic or climatic factors are most important in triggering the enhanced supply. The Del Medio catchment in the Humahuaca Basin (Eastern Cordillera, NW Argentina) is located within a transition zone between subhumid and arid climates and hosts the only active debris-flow fan within this intermontane valley. By combining 10Be analyses of boulder and sediment samples within the Del Medio catchment, with regional morphometric measurements of nearby catchments, we identify the surface processes responsible for aggradation in the Del Medio fan and their likely triggers. We find that the fan surface has been shaped by debris flows and channel avulsions during the last 400 years. Among potential tectonic, climatic, and autogenic factors that might influence deposition, our analyses point to a combination of several favorable factors that drive aggradation. These are in particular the impact of occasional abundant rainfall on steep slopes in rock types prone to failure, located in a region characterized by relatively low rainfall amounts and limited transport capacity. These characteristics are primarily associated with the climatic transition zone between the humid foreland and the arid orogen interior, which creates an imbalance between sediment supply and sediment transfer. The conditions and processes that drive aggradation in the Del Medio catchment today may provide a modern analog for the conditions and processes that drove aggradation in other nearby tributaries in the past.
Mack, G.H. . Dept. Earth Sciences); James, W.C. . Dept. of Geological Sciences)
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.
Boccard, Sandra G J; Pereira, Erlick A C; Aziz, Tipu Z
Deep brain stimulation (DBS) is a neurosurgical intervention popularised in movement disorders such as Parkinson's disease, and also reported to improve symptoms of epilepsy, Tourette's syndrome, obsessive compulsive disorders and cluster headache. Since the 1950s, DBS has been used as a treatment to relieve intractable pain of several aetiologies including post stroke pain, phantom limb pain, facial pain and brachial plexus avulsion. Several patient series have shown benefits in stimulating various brain areas, including the sensory thalamus (ventral posterior lateral and medial), the periaqueductal and periventricular grey, or, more recently, the anterior cingulate cortex. However, this technique remains "off label" in the USA as it does not have Federal Drug Administration approval. Consequently, only a small number of surgeons report DBS for pain using current technology and techniques and few regions approve it. Randomised, blinded and controlled clinical trials that may use novel trial methodologies are desirable to evaluate the efficacy of DBS in patients who are refractory to other therapies. New imaging techniques, including tractography, may help optimise electrode placement and clinical outcome.
Guastella, Virginie; Mick, Gérard; Laurent, Bernard
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.
P, Basavaraj; Singla, Ashish; Kote, Sunder; Singh, Shilpi; Jain, Swati; Singh, Khushboo; Vashishtha, Vaibhav
Introduction: Violence against women is one of the major public health and human rights problem in the world today. Hence, the present study was conducted with the aim to assess the effect of domestic violence on oral health behavior and oral health status of females attending community outreach programmes in and around Modinagar. Materials and Methods: A cross-sectional study was conducted through the community outreach programmes organized in Modinagar. A structured questionnaire was used to illicit information regarding socio demographic characteristics, oral health behavior and domestic violence. The dental health examination was done to record dental health status, intraoral and extraoral soft tissue injury, tooth fracture and tooth avulsion due to the injury. Results: Out of the total 304 women, 204(67.1%) reported positive domestic violence. Psychological violence was found to be severe whereas sexual violence was found to be mild in most of the cases. Significant difference was found between oral hygiene aids used , frequency of tooth brushing, periodontal status, missing teeth, intraoral soft tissue injuries and fractures between both the groups (p<0.05). Conclusion: The present study confirmed that domestic violence had significant influence on oral health behavior and oral health status of women. Thus, the dental professionals also should make an attempt to help victims gain access to support and referral services and to provide adequate treatment to them so as to make a positive difference in their lives. PMID:25584297
Kirjavainen, Mikko O; Remes, Ville M; Peltonen, Jari; Helenius, Ilkka J; Rautakorpi, Sanna M; Vähäsarja, Vesa J; Pöyhiä, Tiina H; Nietosvaara, Yrjänä
Permanent brachial plexus birth palsy (BPBP) impairs the function of the affected upper limb. Avulsion type root injuries may damage the cervical spinal cord. Whether abnormal function of an upper limb affected by BPBP has any observable effects on the development of the locomotion system and overall motor function has not been clarified in depth. A total of 111 patients who had undergone brachial plexus surgery for BPBP in infancy were examined after a mean follow-up time of 13 (5-32) years. Patients' physical activities were recorded by a questionnaire. No significant inequalities in leg length were found and the incidence of structural scoliosis (1.7%) did not differ from that of the reference population. Nearly half of the patients (43%) had asynchronous motion of the upper limbs during gait, which was associated with impaired upper limb function. Data obtained from the completed questionnaires indicated that only few patients were unable to participate in normal activities such as: bicycling, cross-country skiing or swimming. Not surprisingly, 71% of the patients reported problems related to the affected upper limb, such as muscle weakness and/or joint stiffness during the aforementioned activities.
Stefanopoulos, P K; Tarantzopoulou, A D
Bite wounds are frequently located on the face; injuries inflicted by dogs are most common, especially in children. Bacteriology of infected dog and cat bite wounds includes Pasteurella multocida, Staphylococcus aureus, viridans streptococci, Capnocytophaga canimorsus, and oral anaerobes. Infected human bites yield a similar spectrum of bacteria except for Pasteurellae and C. canimorsus; instead human bites are frequently complicated by Eikenella corrodens. Antibiotic therapy against these bacteria is indicated both for infected bite wounds and fresh wounds considered at risk for infection. Amoxicillin-clavulanate (and other combinations of extended-spectrum penicillins with beta-lactamase inhibitors) and moxifloxacin offer the best in vitro coverage of the pathogenic flora. Initial wound management consisting in irrigation and debridement is at least equally important with antibiotics for prevention of infection. The need for prophylaxis against systemic infectious complications, particularly tetanus, should also be evaluated. Primary surgical repair is the treatment of choice for most clinically uninfected facial bite wounds, whereas delayed closure should be reserved for certain high risk or already infected wounds. Avulsive injuries with significant tissue loss represent the most difficult cases for definitive management and are also those most likely to require hospitalization.
Yasukawa, Shinji; Edamura, Kazuya; Tanegashima, Koji; Kai, Hirotaka; Higuchi, Go; Nagasawa, Momoyo; Teshima, Kenji; Asano, Kazushi; Nakayama, Tomohiro
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.
Marren, Philip M; Grove, James R; Webb, J Angus; Stewardson, Michael J
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.
Esper, Helen Ramon; Panzarini, Sônia Regina; Poi, Wilson Roberto; Sonoda, Celso Koogi; Casatti, Cláudio Aparecido
One of the important factors accounting for successful delayed replantation of avulsed teeth is seemingly the type of root surface treatment. Removal of necrotic cemental periodontal ligament remnants may prevent the occurrence of external root resorption, which is the major cause of loss of teeth replanted in such conditions. The purpose of this study was to compare the efficacy of two mechanical techniques for removal of root-adhered periodontal ligament. Preservation or removal of the cementum layer concomitantly with these procedures was also assessed. Forty-five roots of healthy premolars extracted for orthodontic purposes were selected. After extraction, the teeth were kept dry at room temperature for 1 h and then immersed in saline for rehydration for an additional 10 min. Thereafter, the roots were assigned to three groups, as follows: group 1 (control)--the cemental periodontal ligament was preserved; group 2--removal of the periodontal ligament by scraping root surface with a scalpel blade (SBS); group 3--periodontal ligament remnants were removed using a Robinson bristle brush at low-speed with pumice/water slurry (RBP). The specimens were analysed histomorphometrically and examined by scanning electron microscopy. The quantitative and qualitative analyses of the results showed that the RBP technique was significantly more effective than the SBS technique for removal of the periodontal ligament remnants adhered to root surface. Both techniques preserved the cementum layer.
Shkrum, Michael J; McClafferty, Kevin J; Nowak, Edwin S; German, Alan
Real world motor vehicle collision research of injuries due to deployment of "first-generation" air bags has been conducted by Transport Canada since 1993. Fifty-three fatal crashes (36 frontal impacts; 17 side collisions) involving 48 drivers and 10 right front passengers were reviewed. In the Canadian data, air bag deployment in five of nine low severity frontal crashes (delta-V (deltaV) < 25 km/h or 15 mph) was linked to five deaths, four of whom were autopsied (four adults with craniocervical (basal skull and C2 fracture with brainstem avulsion; "closed head injury"--no autopsy) or chest trauma (aortic or pulmonary artery tears); one child with atlanto-occipital dislocation). An occupant who is close ("out-of-position") to the air bag at the time of deployment is at risk for injury. In 27 high severity frontal impacts, unusual (e.g., pulmonary "blast" hemorrhage in one autopsied case) or isolated potentially survivable injuries (e.g., clinically documented ruptured right atrium; probable flail chest observed during the autopsy on a decomposed body) localized to the head, neck or chest in three possibly out-of-position drivers pointed to the deployed air bag as a source of injury. In one of 17 side collisions an out-of-position driver sustained a radiographically confirmed C1-C2 dislocation in a minimally intruded vehicle.
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.
Leung, K-S.; Li, Y-H.; Liu, Y.; Wang, H.; Tam, K-F.; Chow, D.H.K.; Wan, Y.; Ling, S.; Dai, Z.; Qin, L.; Cheung, W-H.
Objectives: To investigate deterioration of musculoskeletal system due to prolonged disuse and the potential of daily short-duration weight-bearing as countermeasures. Methods: Twenty-four adult male Sprague-Dawley rats were divided into Control Group (CG, no intervention), Tail-suspension Group (TG, tail-suspension without treatment), and Weight-Bearing Group (WBG, tail-suspension with 20 min/day, 5 days/week body weight loading). After four weeks of treatment, femur and tibia, soleus and extensor digitorum longus were evaluated for bone and muscle quality respectively. Tensile properties of bone-tendon insertion (BTI) were evaluated using patella-patellar tendon complex. Results: Disuse induced deterioration on bone, muscle, and BTI after four weeks. Compared with CG, TG and WBG showed significant decrease in bone mineral density (BMD) of trabecular bone in distal femur (4.3-15.2%), muscle mass (31.3-52.3%), muscle cross-sectional area (29.1-35%), and failure strength of BTI (23.9-29.4%). Tensile test showed that the failure mode was avulsion of bone at the BTI. No significant difference was detected between TG and WBG for all assessments on bone, muscle, and BTI. Conclusions: Disuse caused deterioration of bone, muscle, and BTI while daily short-duration of weight-bearing did not prevent this deterioration. Mechanical stimulation with higher intensity and longer duration may be necessary to prevent musculoskeletal deterioration resulted from prolonged disuse. PMID:26032214
Tuncer, Serdar; Karaca, Sinan
Degloving injury is the avulsion of the skin off the underlying muscle and bone, which may also involve the latter structures in high-energy trauma. This study reports the case of a 33-year-old male patient who sustained a motorcycle accident and presented with hypovolemic shock, multiple fractures, and multiplanar degloving injury of the leg. The foot and distal leg was not salvageable, and a transtibial amputation with anterior transposition of the posterior compartment muscles was performed; however, a circumferential skin necrosis involving the stump and the knee joint occurred. The wound granulated rapidly using circumferential vacuum-assisted closure therapy and subsequently repaired with split thickness skin grafts. The authors found the topical negative pressure using the Vacuum Assisted Closure (VAC) technique Trademark KCI, Texas, USA, method to be helpful in the care of lower extremity degloving injury, enabling less frequent dressing changes and facilitating formation of granulation tissue with rapid preparation of the wound bed for salvage of the knee joint.
Durban, Claire Marie C; Lee, Seung-Yup; Lim, Hong-Chul
Replantation of an amputated limb is generally contraindicated in crushing and traction injuries. Injury to muscle tissue and skin also creates difficulties in coverage, and bony fractures may shorten limb length which can impede lower extremity function. Numerous cases have been reported on the successful replantation of the lower limb in children; however, review of previous English literature has documented only very few replantation at the thigh level, and those with severe crushing injury resulted in subsequent amputation. We report a case of successful thigh-level replantation in a 3-year-old child who sustained a crushing-traction type of injury with a follow-up of 24 years. After the replantation, early and late complications developed but these were successfully managed. On her last visit, the patient had pain-free ambulation without assistance, had intact protective sensation distal to the injury, and was very satisfied with the outcome. Replantation of the lower limb in children with crushing or avulsion type of injuries is still a worthwhile procedure. However, both the patient and the family should be aware that multiple surgeries may be needed to accommodate to long-term complications such as joint stiffness, scar contractures, and limb length discrepancies.
Potini, Vishnu C; Reilly, Mark C; Gehrmann, Robin M
Patellar sleeve fractures are easily missed injuries since plain radiographs may not show a bony fragment at the time of injury. Failure to diagnose these injuries can result in patellar instability, extensor lag, and anterior knee pain. We report a novel treatment using a Taylor spatial frame as part of a staged reconstruction to regain length of the extensor mechanism and maintain knee motion prior to performing primary repair of the avulsed patellar sleeve fragment. In our case, an 11-year-old male presented to our institution six months after sustaining a patellar sleeve fracture. Radiographic examination with the knee in extension revealed a 23-mm gap between the inferior patellar pole fragment and the remaining patella. The patient was ultimately taken to the operating room twelve months after the initial injury for placement of a Taylor spatial frame to regain length of the extensor mechanism. The patient began immediate knee range-of-motion exercises, and performed daily soft tissue lengthening of two millimeters. After four weeks of treatment the patient underwent removal of the fixator and primary repair of the patella. At final follow up six years after patellar reconstruction, the patient had an active knee range-of-motion from five degrees of hyperextension to 140° of flexion. Where current literature reports suboptimal results even when treatment is delayed for two months, in our case the patient was able to obtain a high level of function after treatment with a two-stage reconstruction using a Taylor spatial frame.
Dahlin, Lars B.; Andersson, Gert; Backman, Clas; Svensson, Hampus; Björkman, Anders
Recovery after surgical reconstruction of a brachial plexus injury using nerve grafting and nerve transfer procedures is a function of peripheral nerve regeneration and cerebral reorganization. A 15-year-old boy, with traumatic avulsion of nerve roots C5–C7 and a non-rupture of C8–T1, was operated 3 weeks after the injury with nerve transfers: (a) terminal part of the accessory nerve to the suprascapular nerve, (b) the second and third intercostal nerves to the axillary nerve, and (c) the fourth to sixth intercostal nerves to the musculocutaneous nerve. A second operation—free contralateral gracilis muscle transfer directly innervated by the phrenic nerve—was done after 2 years due to insufficient recovery of the biceps muscle function. One year later, electromyography showed activation of the biceps muscle essentially with coughing through the intercostal nerves, and of the transferred gracilis muscle by deep breathing through the phrenic nerve. Voluntary flexion of the elbow elicited clear activity in the biceps/gracilis muscles with decreasing activity in intercostal muscles distal to the transferred intercostal nerves (i.e., corresponding to eighth intercostal), indicating cerebral plasticity, where neural control of elbow flexion is gradually separated from control of breathing. To restore voluntary elbow function after nerve transfers, the rehabilitation of patients operated with intercostal nerve transfers should concentrate on transferring coughing function, while patients with phrenic nerve transfers should focus on transferring deep breathing function. PMID:28316590
Cindolo, Luca; Castellan, Pietro; Primiceri, Giulia; Hoznek, Andras; Cracco, Cecilia M; Scoffone, Cesare M; Galfano, Antonio; Petralia, Giovanni; DE Angelis, Michele; Annino, Filippo; Malacasa, Emilio; Cormio, Luigi; Acquati, Pietro; DE Lorenzis, Elisa; Maugeri, Orazio; Arena, Giuseppe; Celia, Antonio; Giusti, Guido; Schips, Luigi
Retrograde ureteroscopy (URS) has become a common procedure for the management of urinary stones. Although its efficacy and safety are well known, the literature about major complications is still poor. This study highlighted some cases of life-threatening complications after semirigid ureteroscopy (s-URS) or flexible ureteroscopy (f-URS). We enrolled experienced endourologists (more than 75 cases/year in the last 3 years) and we performed a survey asking to review their series and report the cases encumbered by major complications (Clavien-Dindo IIIb-IV grade). Eleven urologists reported on 12 major complications (4 after s-URS, 8 after f-URS). Eight patients developed a kidney injury, 1 an arteriovenous fistula, 2 a ureter avulsion and 1 acute sepsis. Six patients underwent open nephrectomy, two surgical repair, one open pyeloplasty, one coil artery embolization and two superselective artery embolization. Guidelines and clinical practice give useful recommendations about intraoperative safety and prevention of life-threatening events. The careful postoperative observation and the surgical active treatment of this complications play a key role in reducing morbidity, kidney loss and mortality. This study encourages a strict and active care of patients, supports a routine reporting of complications, and highlights the need for systematic use of standardized classification systems.
Smith, J.J.; Hasiotis, S.T.; Kraus, M.J.; Woody, D.T.
Vertical changes in distribution, abundance, and ichnodiversity of ichnocoenoses in alluvial deposits of the Willwood Formation suggest significantly drier moisture regimes in the Bighorn Basin, Wyoming, during the Paleocene-Eocene Thermal Maximum (PETM), a transient period of global warming. The Willwood Formation at Polecat Bench contains an abundant assemblage of ichnofossils, including various types of rhizoliths and invertebrate trace fossils, such as Naktodemasis bowni, Camborygma litonomos, Edaphichnium lumbricatum, cf. Cylindricum isp., cf. Planolites isp., cf. Steinichnus, and cocoon traces. These comprise six distinct ichnocoenoses, which are categorized as dominantly terraphilic, hygrophilic, or hydrophilic based on the inferred moisture regimes of their most abundant ichnofossil morphotypes and associated pedogenic features, including other trace fossils and rhizoliths. The interpreted moisture regimes correlate well with the paleoenvironments of their host lithofacies, as inferred from sedimentology and paleopedology. Outside the PETM interval at Polecat Bench, abundant avulsion deposits and thin, compound paleosols containing hygrophilic and hydrophilic ichnocoenoses suggest frequent depositional events and predominantly poor to imperfect soil-drainage conditions. Within the PETM interval, thick, cumulative paleosol profiles with abundant terraphilic to hygrophilic ichnocoenoses suggest significantly improved drainage conditions. Lithofacies and ichnocoenoses above the PETM interval are not significantly different from those below the interval, indicating a return to pre-PETM moisture regimes. These conclusions support previous studies that suggest the Bighorn Basin experienced transient drying during this interval. This study demonstrates that ichnocoenoses and their ichnopedologic associations can be used to refine paleohydrologic and paleoclimatic generalizations inferred from paleoclimate models. Copyright ?? 2008, SEPM (Society for Sedimentary
Marston, Richard A.; Mills, John D.; Wrazien, David R.; Bassett, Beau; Splinter, Dale K.
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.
Scott, E A; Snyder, S P; Schmotzer, W B; Pool, R
Probable cause of fracture in a Paint gelding was a congenital bone defect involving the extensor process area of the right and left forelimb distal phalanges. Radiographically and histologically, subchondral bone cysts at the fracture lines were suspected. These cysts were thought to have developed in association with abnormal ossification centers at the extensor process areas of the third phalanx. Partial avulsion of weak extensor processes would then occur from natural forces exerted on these weakened bony prominences via the common digital extensor tendon. Support for osteochondrosis as a cause of this bone cyst formation was seen in histologic examination of fragments removed. Within the bony trabeculae, a dysplastic focus of cartilage with mineralized plaques and osseous tissues was observed. Findings supported a diagnosis of osteochondrosis, to the extent that the disease is presently understood in horses. Surgical correction by fragment removal was performed to circumvent progression of degenerative joint disease, which was evident as partial cartilage erosion of the distal dorsal articular surface of the second phalanx and fracture fragments. Recovery from surgery was rapid, and several months after surgery, the horse was sound for pleasure riding.
Denoix, J-M; Jeffcott, L B; McIlwraith, C W; van Weeren, P R
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.
Downey, Michael W.; Duncan, Kyle; Kosmopoulos, Victor; Motley, Travis A.; Carpenter, Brian B.; Ogunyankin, Fadeke; Garrett, Alan
The traditional stainless steel wire tension band (WTB) has been popularized for small avulsion fractures at the medial malleolus. Despite the tension band principle creating a stable construct, complications continue to arise utilizing the traditional stainless steel WTB with patients experiencing hardware irritation at the tension band site and subsequent hardware removal. Coupled with hardware irritation is fatigue failure with the wire. The goal of this investigation was to retrospectively compare this traditional wire technique to an innovative knotless tension band (KTB) technique in order to decrease costly complications. A total of 107 patients were reviewed with a minimum follow-up of 1 year. Outcome measures include descriptive data, fracture classification, results through economic costs, and fixation results (including hardware status, healing status, pain status, and time to healing). The KTB group had a 13% lower true cost as compared to the WTB group while the fixation results were equivocal for the measured outcomes. Our results demonstrate that the innovative KTB is comparable to the traditional WTB while offering a lower true cost, an irritation free reduction all without the frustration of returning to the operating room for additional hardware removal, which averages approximately to $8,288. PMID:27293969
Mersa, Berkan; Kabakas, Fatih; Pürisa, Hüsrev; Özçelik, Ismail Bülent; Yeşiloğlu, Nebil; Sezer, Ilker; Tunçer, Serdar
Providing adequate venous outflow is essential in finger replantation surgeries. For a successful result, the quality and quantity of venous repairs should be adequate to drain arterial inflow. The digital dorsal venous plexus is a reliable source of material for venous repairs. Classically, volar digital veins have been used only when no other alternative was available. However, repairing volar veins to augment venous outflow has a number of technical advantages and gives a greater chance of survival. Increasing the repaired vein:artery ratio also increases the success of replantation. The volar skin, covering the volar vein, is less likely to be avulsed during injury and is also less likely to turn necrotic, than dorsal skin, after the replantation surgery. Primary repair of dorsal veins can be difficult due to tightness ensuing from arthrodesis of the underlying joint in flexion. In multiple finger replantations, repairing the volar veins after arterial repair and continuing to do so for each finger in the same way without changing the position of the hand and surgeon save time. In amputations with tissue loss, the size discrepancy is less for volar veins than for dorsal veins. We present the results of 366 finger replantations after volar vein repairs.
May, Jan-Hendrik; Plotzki, Anna; Rodrigues, Leonor; Preusser, Frank; Veit, Heinz
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.
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.
Gerard, Emilie; Prevezas, Christos; Doutre, Marie-Sylvie; Beylot-Barry, Marie; Cogrel, Olivier
Retronychia is a form of post-traumatic ingrowing nail disease that involves proximal nail plate embedding into the proximal nail fold, with multiple generations of nail plate beneath the proximal nail. This disease is probably underdiagnosed because of incomplete clinical forms. The aim of this study was to report clinical and aetiological variants of retronychia and to evaluate their therapeutic outcome. A retrospective review was performed on 18 patients who were seen in our institution between 2007 and 2013. The diagnostic criteria for retronychia were paronychia and interruption of nail growth. A female predominance (83.3%) was reported. Various precipitating factors were found, including traumatisms in 10 patients (55%), pregnancy and postpartum period in two patients (11%), and compartment syndrome in one patient (5%). The mean duration of paronychia was eight months (15 days to four years). The fingers most affected were the great toes. Retronychia occurred bilaterally in five cases (27%) and unilaterally in one case (61%). The commonest signs were, in decreasing order, xanthonychia (yellow discolouration of nail plate), longitudinal nail over-curvature, swelling of proximal nail fold, elevation of the proximal nail plate, granulation tissue, subungual hyperkeratosis, superficial leuconychia, distal onycholysis, subungueal haemorrhage, and Beau's lines. Most of the cases improved after proximal nail plate avulsion. Recurrence occurred in three cases (16.6%). In our opinion, ischaemic damage is the main cause of retronychia. Evaluation of clinical variants is mandatory to propose appropriate treatment. The limitations of this study include the retrospective design.
Brasil, Oswaldo Ferreira Moura; Brasil, Oswaldo Moura
Traumatic macular hole is a disease whose pathogenesis is not fully understood and the best treatment guideline is controversial. We report 2 cases of traumatic macular hole with different treatment approaches. In the first case, a 9-year-old boy presented with a traumatic macular hole secondary to blunt ocular trauma with a stone, and initial vision of 20/300. He underwent surgical repair and his final vision was 20/70 with hole closure after a 1 year follow-up. In the second case, a 20-year-old woman suffered a penetrating bullet wound on the left side of her forehead. The injury caused optic nerve head avulsion in the left eye with loss of light perception. The right eye had a traumatic macular hole and signs suggestive of sclopetaria chorioretinitis, with 20/60 vision. This case was initially observed and vision improved to 20/30 with reduction of the hole diameter. Vision and hole diameter remained stable after 8 months.
Mibu, Akira; Nishigami, Tomohiko; Tanaka, Katsuyoshi; Osumi, Michihiro; Tanabe, Akihito
A 43-year-old man had deafferentation pain in his right upper extremity secondary to brachial plexus avulsion from a traffic accident 23 years previously. On our initial examination, he had severe tingling pain with numbness in the right fingers rated 10 on the numerical rating scale. The body perception of the affected third and fourth fingers was distorted in the flexed position. Although he performed traditional mirror therapy (TMT) for 4 weeks in the same methods as seen in previous studies, he could not obtain willed motor imagery and pain-alleviation effect. Therefore, we modified the task of TMT: Graded mirror therapy (GMT). GMT consisted of five stages: (1) observation of the mirror reflection of the unaffected side without imagining any movements of the affected side; (2) observation of the mirror reflection of the third and fourth fingers changing shape gradually adjusted from a flexed position to a extended position; (3) observation of the mirror reflection of passive movement; (4) motor imagery of affected fingers with observation of the mirror reflection (similar to TMT); (5) motor imagery of affected fingers without mirror. Each task was performed for 3 to 4 weeks. As a result, pain intensity during mirror therapy gradually decreased and finally disappeared. The body perception of the affected fingers also improved, and he could imagine the movement of the fingers with or without mirror. We suggested that GMT starting from the observation task without motor imagery may effectively decrease deafferentation pain compared to TMT.
Horbe, Adriana M C; Behling, Hermann; Nogueira, Afonso C R; Mapes, Russell
The sediments from the Coari lake, a "terra firme" lake sculpted into Plio-Pleistocene deposits, and the Acará lake, a flooding-type lake developed on Quaternary sediments in the floodplain of the mid-Solimões river, in the western Amazônia, Brazil, were studied to investigate the environmental condition of their developing. This study includes mineral composition, geochemistry, Pb isotope, palinology, radiocarbon-age and morphological framework of the lakes obtained from SRTM satellite images. The geological and the environmental conditions in the two lakes are highly variable and suggest that their evolution reflect autogenic processes under humid rainforest condition. Although kaolinite, quartz, muscovite, illite, and smectite are the main minerals in both lakes, the geochemistry indicates distinct source, the Acará lake sediments have higher concentrations of Al(2)O(3), Fe(2)O(3), FeO, CaO, K(2)O, MgO, Na(2)O, P(2)O(5), Ba, V, Cu, Ni, Zn, Pb, Sr, Li, Y and La and have more radiogenic Pb than the Coari lake sediments. The radiocarbon ages suggest that at 10160 yr BP the Coari lake started to be developed due to avulsion of the Solimões river, and the Acará lake was formed by the meander abandonment of Solimões river retaining its grass dominated shore at ca. 3710 yr BP.
A fluvial island is a landform, elevated above and surrounded by stream-channel branches or waterways, that persists sufficiently long to establish permanent vegetation. Natural fluvial islands occur in any part of a drainage network but most commonly in montane, piedmont-valley, and coastal flood-plain environments. Processes, often interactive, by which islands form include avulsion (the sudden separation of land by a flood or by an abrupt change in the course of a stream), rapid and gradual channel incision, channel migration, dissection of both rapidly and slowly deposited bed sediment, and deposition of bed sediment on a vegetated surface or behind a channel obstruction. Products of high-energy conditions, fluvial islands typically lack stability over decades to millennia. Fluvial islands in Plum Creek, Colorado, USA, results of sorting processes following a recent high-magnitude flood, and in the Snake River, Idaho, USA, partly results of the Pleistocene Bonneville Flood, illustrate how islands form, develop, and disappear. The examples consider differing conditions of island shape, size, height, sediment, and vegetation.
This study evaluates channel-planform adjustment on an alluvial reach of the Little Colorado River and documents the geomorphic evolution of the channel through an analysis of aerial photographs and orthophotographs for the period 1936–2010. The Little Colorado River has adjusted to the effects of an extreme flood in 1923 and a subsequent decline in peak discharge and mean annual flow by channel narrowing: the channel width and area of the river have decreased by approximately 90 percent over the study period. Although deposition historically exceeds erosion, lateral migration exacerbates localized erosion, particularly near hydraulic controls. Despite repeated cutoff and avulsion, the Little Colorado River has steadily increased in length and sinuosity over a period of 74 years. Changes in temperature and precipitation are likely affecting the discharge of the Little Colorado River near and downstream of Winslow, Ariz. Nonparametric methods of trend detection determine whether the probability distribution of temperature, precipitation, and peak streamflow has changed over time. Time-series plots of temperature and precipitation show statistically significant trends at the 99-percent-confidence level when evaluated with a Mann-Kendall test. An increasing trend was indicated in mean daily minimum air temperature (Tmin), whereas decreasing trends were indicated in both annual precipitation (Pann) and monsoon-seasonal precipitation (Pjas), as well as in peak discharge.
Gomez, Manuel Macemino; Casal, Diogo
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.
FARINIUK, Luiz Fernando; de SOUSA, Maria Helena; WESTPHALEN, Vânia Portela Dietzel; CARNEIRO, Everdan; SILVA NETO, Ulisses X; ROSKAMP, Liliane; CAVALI, Ana Égide
Objectives The aim of this study was to evaluate cases of dental trauma treated at the specialized center of Pontifical Catholic University of Paraná, Curitiba, Brazil, during a period of 2 years. Material and Methods A total of 647 patients were evaluated and treated between 2003 and 2005. Data obtained from each patient were tabulated and analyzed as to gender, age, etiology, time elapsed after the injury, diagnosis (type of trauma), and affected teeth. Results The results revealed that male individuals aged 7 to 13 years presented the highest prevalence of injury, and falling was the main causal factor. In most cases, the time elapsed between the accident and the first care ranged from 4 to 24 h. A total of 1,747 teeth were affected, with higher incidence of concussion/subluxation and coronal fracture, followed by lateral luxation and avulsion. The permanent maxillary central incisors were the most commonly affected teeth. Conclusion The frequency and causes of dentoalveolar trauma should be investigated for identification of risk groups, treatment demands and costs in order to allow for the establishment of effective preventive measures that can reduce the treatment duration and costs for both patients and oral health services. PMID:20835567
Shuker, Sabri T
Current weaponry possesses unobserved new, biodynamic wounding effects. For many victims, high velocity, large shell fragments have resulted in massive lower jaw "chopped off" hard and soft tissues injuries accompanied by tongue prolapse. The management challenges begin with lifesaving which is possibly complicated by airway compromise, severe hemorrhage, massive lower jaw loss, and a prolapsed tongue. Consequently, the goal shall be "No patient should die from massive facial tissue injuries alone". That is, if feasible, sensible, lifesaving techniques are applied at the appropriate time. Following general condition stabilization, the surgical management steps of massive lower jaw tissue loss should begin with immediate lost tissue reconstruction. Seventeen cases were selected from an unquantified number patients who had massive mandibular tissue losses in which the tongue, surprisingly, remained intact. In these cases, definitive, early scaffolding stabilization was accomplished by joining the remaining two lower jaw intact segments. The successful procedure consists of using a 2 mm horseshoe shaped Kirschner wire bridging the gap of the mandibular arch which effectively is used as a "scaffold" for rebuilding the soft tissue. Proper, initial, surgical management resulted in protecting lacerated tissue, diminishing subsequent morbidity and disfigurement, preventing a prolapsed tongue and preserving the intact tissues physiological functions. As the spectrum of injuries continues to evolve the clinical characterization of the severity of facial wounds need an expanded classification, appropriate to massive facial injuries. It is suggested it has the following descriptors: blast, penetration, perforation, avulsions and "chopping off" (BPPAC).
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
Lädermann, Alexandre; Denard, Patrick J.; Kolo, Frank C.
Purpose: The purpose of this report is to describe a new full-thickness tear pattern of the posterosuperior rotator cuff with reversal healing. We describe the specific radiologic signs associated with this tear pattern and the arthroscopic rotator cuff repair technique. Materials and Methods: A prospective radiologic and clinical study collected all patients with a magnetic resonance imaging arthrogram that underwent an arthroscopic rotator cuff repair over a 1 year period. Results: Among 97 patients, five demonstrated a tear of the posterosuperior rotator cuff with reversal healing. Characteristic radiographic findings included a thicker tendon than normal, the presence of a stump and accumulation of liquid in the superior-medial part of the subacromial bursa, and adhesions between the supraspinatus tendon and the wall of the subacromial bursa. Conclusion: Avulsion of the posterosuperior rotator cuff with reversal healing on its bursal-side is a less common condition. This type of lesion and distinct radiographic signs that can be recognized to facilitate anatomic repair of the rotator cuff. Level of evidence: Level IV. PMID:25709239
Shahabpour, Maryam; Staelens, Barbara; Van Overstraeten, Luc; De Maeseneer, Michel; Boulet, Cedric; De Mey, Johan; Scheerlinck, Thierry
The scapholunate joint is one of the most involved in wrist injuries. Its stability depends on primary and secondary stabilisers forming together the scapholunate complex. This ligamentous complex is often evaluated by wrist arthroscopy. To avoid surgery as diagnostic procedure, optimization of MR imaging parameters as use of three-dimensional (3D) sequences with very thin slices and high spatial resolution, is needed to detect lesions of the intrinsic and extrinsic ligaments of the scapholunate complex. The paper reviews the literature on imaging of radial-sided carpal ligaments with advanced computed tomographic arthrography (CTA) and magnetic resonance arthrography (MRA) to evaluate the scapholunate complex. Anatomy and pathology of the ligamentous complex are described and illustrated with CTA, MRA and corresponding arthroscopy. Sprains, mid-substance tears, avulsions and fibrous infiltrations of carpal ligaments could be identified on CTA and MRA images using 3D fat-saturated PD and 3D DESS (dual echo with steady-state precession) sequences with 0.5-mm-thick slices. Imaging signs of scapholunate complex pathology include: discontinuity, nonvisualization, changes in signal intensity, contrast extravasation (MRA), contour irregularity and waviness and periligamentous infiltration by edema, granulation tissue or fibrosis. Based on this preliminary experience, we believe that 3 T MRA using 3D sequences with 0.5-mm-thick slices and multiplanar reconstructions is capable to evaluate the scapholunate complex and could help to reduce the number of diagnostic arthroscopies.
Dudeja, Pooja Gupta; Grover, Shibani; Srivastava, Dhirendra; Dudeja, Krishan Kumar; Sharma, Vivek
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.
Rineer, Craig A; Ruch, David S
Lateral and medial epicondylitis are common causes of elbow pain in the general population, with the lateral variety being more common than the medial by a ratio reportedly ranging from 4:1 to 7:1. Initially thought to be an inflammatory condition, epicondylitis has ultimately been shown to result from tendinous microtearing followed by an incomplete reparative response. Numerous nonoperative and operative treatment options have been employed in the treatment of epicondylitis, without the emergence of a single, consistent, universally accepted treatment protocol. Tendon ruptures about the elbow are much less frequent, but result in more significant disability and loss of function. Distal biceps tendon ruptures typically occur in middle-aged males as a result of an event that causes a sudden, eccentric contraction of the biceps. Triceps tendon ruptures are exceedingly rare but usually have a similar etiology with a forceful eccentric contraction of the triceps that causes avulsion of the tendon from the olecranon. The diagnosis of these injuries is not always readily made. Complete ruptures of the biceps or triceps tendons have traditionally been treated surgically with good results. With regard to biceps ruptures, there continues to be debate about the best surgical approach, as well as the best method of fixation of tendon to bone. This article is not meant to be an exhaustive review of the broad topics of elbow tendinopathy and tendon ruptures, but rather is a review of recently published information on the topics that will assist the clinician in diagnosis and management of these conditions.
Kamiya, K; Kuyama, H; Symon, L
A baboon model of subarachnoid hemorrhage (SAH) has been developed to study the changes in cerebral blood flow (CBF), intracranial pressure (ICP), and cerebral edema associated with the acute stage of SAH. In this model, hemorrhage was caused by avulsion of the posterior communicating artery via a periorbital approach, with the orbit sealed and ICP restored to normal before SAH was produced. Local CBF was measured in six sites in the two hemispheres, and ICP monitored by an implanted extradural transducer. Following sacrifice of the animal, the effect of the induced SAH on ICP, CBF, autoregulation, and CO2 reactivity in the two hemispheres was assessed. Brain water measurements were also made in areas of gray and white matter corresponding to areas of blood flow measurements, and also in the deep nuclei. Two principal patterns of ICP change were found following SAH; one group of animals showed a return to baseline ICP quite quickly and the other maintained high ICP for over an hour. The CBF was reduced after SAH to nearly 20% of control values in all areas, and all areas showed impaired autoregulation. Variable changes in CO2 reactivity were evident, but on the side of the hemorrhage CO2 reactivity was predominantly reduced. Differential increase in pressure lasting for over 7 minutes was evident soon after SAH on the side of the ruptured vessel. There was a significant increase of water in all areas, and in cortex and deep nuclei as compared to control animals.
McAninch, J W; Kahn, R I; Jeffrey, R B; Laing, F C; Krieger, M J
Major injuries to the testicles, penis, and genital skin from trauma and infection were seen in 62 patients over a 6-year period (1977 to 1983). Urethral injuries were excluded. In the past blunt testicle injuries were infrequently diagnosed and surgically ignored because of large surrounding hematomas. With the use of real-time ultrasound, 17 of 18 cases of testicle rupture were correctly diagnosed preoperatively. Surgical repair resulted in testicle salvage in 16 patients. Penetrating testicle injuries resulted in a high orchiectomy rate secondary to the infrequently described but recognized entity of self-emasculation in transsexuals. Penile rupture from blunt injuries (8) was successfully repaired and complete function was recovered. Penetrating penile injuries (4) were extensive and involved the urethra in two cases; full function returned after reconstruction. Major skin loss of the penis and/or scrotum (19) occurred from necrotizing fasciitis, burns, avulsion and penetrating injuries. Early debridement, bowel and urinary diversion followed by penile skin grafting, thigh pouches to protect testicles, and scrotal reconstruction resulted in acceptable cosmetic and functional results in all cases of major skin loss.
Guzmdn, R; Rincón, D; Camacho, J
Elbow dislocation in children is a very infrequent traumatic event which was first described by Stimson in 1900 and then by Tachdjian in 1990. Its estimated incidence ranges from 3% to 6% of all elbow injuries, peaking at 13-14 years. Elbow trauma is classified considering the direction in which the proximal radioulnar joint shifts with respect to the humerus, into posterior and anterior dislocation. The former is the most frequent and accounts for 95% of cases. Elbow fracture dislocation is an even rarer event. The incidence rate of avulsion fracture of the medial epicondyle is 25-36%, of the lateral condyle 4%, of the olecranon 1.7%, of the radial head 8%, of the coronoid process 3.5%, and others, 3.5%. At present there is no consensus in the literature on how to treat this type of lesions, particularly because some authors advocate nonsurgical management, while others propose surgical management as the definitive treatment. What is clear, however, is that a late diagnosis or untimely treatment may affect the child's growth and lead to serious complications. The purpose of this study is to share our experience and good results with the surgical management of these infrequent cases.
Schoeller, Thomas; Wechselberger, Gottfried; Hussl, Heribert; Huemer, Georg M
Major upper arm amputations are often accompanied by different levels of soft-tissue divisions involving crushing, traction, and avulsion injuries to various structures. In these cases the goal is not only the re-establishment of circulation, but also functional outcome. Some patients require further reconstruction for functional restoration of elbow flexion and additional soft tissue coverage. Five patients underwent functional latissimus dorsi transfer for restoration of elbow flexion after successful upper arm replantation at our institution. The transfer was unipolar in four patients and bipolar in one. The patients' ages ranged from seven to 55 years. The time period between replantation and transfer ranged from two weeks to 12 months. All flaps healed well with minimal donor site morbidity. At mean 43-month follow-up (range: 22-65 months), functional results were good with M4 in three patients and M3 in two patients for elbow flexion. The pedicled latissimus dorsi muscle flap is a valuable tool to restore elbow flexion and provide coverage of soft tissue defects after major upper arm replantations.
Raimondi, P L; Petrolati, M; Delaria, G
If one looks at the final results obtained in children, one should conclude that replantation of large segments is more often indicated in children than in adult patients. Nevertheless, the more common components of crush or avulsion and the frequent severe associated lesions must restrain the surgeon's enthusiasm when indicating replantation of a large segment in children. The possible dramatic consequences of a late revascularization syndrome can be easily foreseen as an outcome of replantation of a large segment in children. Moreover, the problem of growth must be faced from the start, programming secondary surgery either for soft tissue assessment (skin retraction treatments, tendon lengthening, muscle sliding) or for bone lengthening. The final outcome being a functional arm, special care has to be taken in nerve repair integrated with possible secondary tendon transfers to compensate the functional deficit. With all these limitations in indications, care in emergency, and correct timing and planning for secondary surgery, the final functional results of macroreplantations in children will certainly be improved.
Jabłecki, Jerzy; Kaczmarzyk, Janusz; Kaczmarzyk, Leszek; Lapczyński, Deodat; Kocieba, Ryszard
The problems in replantation of arms were analysed on the ground of nine such replantations performed in Center of Replantations of Limbs in Trzebnica in the same number of patients (7 men, 2 children, 1 woman) during the seven year period 1993-2000. The range of age of the patients was from 12 to 62 years (35.5 on average). Among the problems discussed were such as qualification for the operation, operative technique (limb shortening, perfusion of vessels, half-open anastomosis of veins, neurotisation of remaining nerves) evaluation scale. Eight of the amputations were the results of crush-avulsion mechanism, one was guillotine-type. The patients required 15 secondary operations; all of them were able to perform an arm abduction and active flexion of the elbow joint. They all had at least protective sensibility on the palm. The results were rated (acc. to Chen-Yu scale) III(o)--four patients, IV(o)--four patients (one patient did not appear for control check-up). Despite of such a poor evaluation, all of the patients are satisfied with the operation.
The Santa Cruz River, an ephemeral river that drains 8,581 square miles in southeastern Arizona, has a long history of channel instability. Since the late 19th century, lateral channel erosion has caused extensive property damage, particularly in Pima County. During the flood of 1983, about $100 million damage was caused in the Tucson area alone; most damage resulted from bank erosion on the Santa Cruz River and its tributaries. The nature, magni- tude, location, and frequency of channel change on the Santa Cruz River were highly variable in time and space from 1936 through 1986 along a 70-mile reach in Pima County, Arizona. Four mechanisms of lateral channel change--channel migration, avulsion and meander cutoff, channel widening, and arroyo widening--were identified on the Santa Cruz River. The dominant mechanism in a reach depends on channel morphology and flood magnitude. The dominant vertical change has been degradation. The timing and magnitude of channel change at a particular location are controlled primarily by hydroclimatic factors such as magnitude, duration, intensity, and frequency of precipitation and floods. The location of channel change and its magnitude in response to a given discharge are controlled largely by topographic, geologic, hydraulic, and artificial factors. Although much of the present morphology of the Santa Cruz River is the result of recent large floods, a direct link between hydroclimatic con- ditions and channel change is not always evident because resistance of the channel to erosion varies with time. (USGS)
Flores, Leandro Pretto
Some patients who sustain C5 to C7 nerve root injuries may demonstrate a natural recovery of elbow extension via the lower trunk; however the surgical effect of the reinnervation of the triceps brachii in such cases is still unknown. This study aims to determine the incidence of spontaneous recovery of the tricipital function and to identify the clinical and/or radiological predictors of poor spontaneous functional rehabilitation of elbow extension resulting from injuries of the upper roots of the brachial plexus. We conducted a review of the charts of 24 subjects sustaining an upper trunk syndrome with complete elbow extension palsy and who did not undergone any intervention for reinnervation of the triceps brachii in the primary brachial plexus surgery. Two years posttrauma, the muscle was scored as M0 in 12 patients (50%), M1 in 3 (12.5%), M2 in 1 (4.1%), M3 in 4 (16.6%), and M4 in 4 subjects (16.6%). The number of avulsed roots and the preoperative power of the latissimus dorsi did not demonstrate any significance in predicting the outcome of spontaneous elbow extension recovery; whereas the preoperative paralysis of the muscles for wrist extension was determined to be reliable predictive parameter for poor natural recovery of tricipital function.
Das, Sakti Prasad; Pradhan, Sudhakar; Ganesh, Shankar; Sahu, Pabitra Kumar; Mohanty, Ram Narayan; Das, Sanjay Kumar
Background: Severe crouch gait in adolescent cerebral palsy is a difficult problem to manage. The patients develop loading of patellofemoral joint, leading to pain, gait deviation, excessive energy expenditure and progressive loss of function. Patella alta and avulsion of patella are the other complications. Different treatment options have been described in the literature to deal with this difficult problem. We evaluated outcome of supracondylar femoral extension osteotomy (SCFEO) and patellar tendon advancement (PTA) in the treatment of crouch gait in patients with cerebral palsy. Materials and Methods: Fourteen adolescents with crouch gait were operated by SCFEO and PTA. All subjects were evaluated pre and postoperatively. Clinical, radiographic, observational gait analysis and functional measures were included to assess the changes in knee function. Results: Cases were followed up to 3 years. The patients walked with increased knee extension and improvement in quadriceps muscle strength. Knee pain was decreased and improvements in functional mobility and radiologic improvement were found. Conclusion: SCFEO and PTA for adolescent crouch gait is effective in improving knee extensor strength, reducing knee pain and improving function. PMID:22448063
Barreiros, Hugo; Matos, Diogo; Goulão, João; Serrano, Pedro; João, Alexandre; Brandão, Francisco Menezes
BACKGROUND Ingrown nails are a very common problem. There are different stages of disease and diverse therapeutic options. Phenol and sodium hydroxide are commonly used agents for chemical matricectomy but both frequently entail excessive healing times. OBJECTIVE This prospective study aimed mainly to evaluate the efficacy of partial nail avulsion and selective chemical cauterization of the matrix using 80% TCA in the treatment of the ingrowing nail. METHODS One-hundred-and-thirty-three patients with 197 ingrown toenails were included in this study. Preoperatively, we tried to find predisposing factors to the disease. In the postoperative period, patients were evaluated for potential complications at days 3, 30, 180, 270 and 360. Pain was measured before surgery, as well as 24 hours and 72 hours after surgery. RESULTS There were only 3 cases (out of 197) of ingrown nail recurrence. Preoperatively, we found the presence of drainage in 82% of patients, which, following the first visit after surgery, was reduced to 19%. Persistent granulation tissue was found in 3% of the patients (versus 75% prior to surgery). The most frequent predisposing factors for the ingrown nail were excessive trimming of the lateral nail plate (63%), plantar hyperhidrosis (58%) and heavy nail folds (39%). Pain was substantially reduced after surgery. CONCLUSION It is assumed that chemical procedures for the ingrown toenail are associated with delayed healing times but our results demonstrated quick recovery. Using 80% TCA for selective matricectomy in the ingrown toenail is an effective, quick and easy method. PMID:24474095
Shamberger, R C; Ottinger, L W; Malt, R A
In all common forms of inguinal herniorrhaphy, stitches pass either just superficial to the internal iliac artery and vein or through their sheath. Despite the potential for arterial injury, documented cases seem to exist only in the foreign-language literature. We report four cases of arterial injury following inguinal herniorrhaphy in adults. The artery is placed in jeopardy when the transversalis fascia is incorporated in the stitches used to close the medial aspect of the internal inguinal ring. The depth of penetration of the needle and the proximity of the external iliac artery must be accurately judged. Injury can result from direct puncture of the artery or avulsion of one of its branches. Immediate repair of any arterial injury is paramount, and newly subnormal pulses below the inguinal injury are unacceptable. Exposure must be adequate, and division of the floor of the inguinal canal may be necessary for this purpose. Repair may require a simple hemostatic suture, a patch graft, or an interposition graft. PMID:6732332
Kraeutler, Matthew J.; Garabekyan, Tigran; Mei-Dan, Omer
Summary Background In recent years, platelet-rich plasma (PRP) has gained popularity within the orthopaedic community as a treatment modality to enhance tissue healing. Purpose This review aims to concisely present the current indications for PRP injections in the treatment of hip and pelvic pathologies and to describe some novel applications for PRP which have not yet been reported in the literature. Methods We reviewed the literature on the non-operative and operative indications for PRP in the treatment of hip and pelvic pathologies. Conclusions With regard to hip and pelvic pathologies, PRP injections are used most commonly as a non-operative intervention, and have been described in the literature to treat osteoarthritis of the hip joint as well as tendinopathy of the hamstrings, adductor longus, and gluteus medius. In contrast, most of the surgical applications of PRP for the hip are novel, with few reported studies in the literature. Because of the increasing awareness of PRP’s beneficial effects on musculoskeletal healing and thus the growing number of indications for its use, this review also describes some novel applications for PRP, including osteitis pubis, post-microfracture of the hip, tears of the rectus femoris, and avulsion of the sartorius muscle. Level of evidence V. PMID:28066748
Rey, Tony; Lefevre, David; Vella, Claude
The deltaic plain of the Petite Camargue which constitutes the western part of the Rhone Delta, began its main progradation around 2000 yr ago. Several delta lobes follow each other and have participated in the deltaic evolution. The deltaic lobes have distinct morphologies which reflect the dynamic fluvial and marine processes under the influence of climatic and human controls. Two delta lobe systems were built by the Daladel and Peccaïs channels, after which a deflected wave-influenced delta lobe was formed by the La Ville and Saint-Roman channels. The latest channel, the Rhone Vif channel, is skewed because this channel was completely canalized and engineered up to its mouth in the beginning of the 16th century. Since the avulsion of this channel about 1550 A.D., the coastline of the Petite Camargue has been especially affected by the influence of waves and currents. The spits replaced the beach ridges which juxtaposed themselves and have migrated westward since the 16th century. The formation of the western part of the delta in the last 2000 yr is affected by not only the fluvial sedimentary fluxes and the coastal dynamics to the mouth but also climatic change and human influence.
Kayaoğlu, E Esin; Binnet, Mehmet S
The incidence of traumatic chondral and osteochondral fractures and their role in the development of joint degeneration are not fully elucidated. While assessing traumatic knee injuries, one important criterion for the diagnosis of chondral fractures is to remember the possibility of a chondral or osteochondral fracture. Symptoms in osteochondral fractures are more obvious and cause severe pain and difficulty in movement of knee with hemarthrosis. The presence of hemarthrosis facilitates the diagnosis of an osteochondral fracture. Chondral and osteochondral fractures may be associated with other intra-articular pathologies. There are two main mechanisms of these fractures, including a direct effect causing avulsion or impaction and, a more common mechanism, flexion-rotation force to the knee, which is also the mechanism for an acute patellar dislocation. It is known that arthroscopic treatment is the best method for the diagnosis and treatment of chondral and osteochondral fractures. In osteochondral lesions, the aim of treatment is to restore the congruity of articular surfaces. In agreement with literature data, our clinical experience favors internal fixation as the most effective method for the treatment of osteochondral fractures.
Chen, Chun-Ti; Kelly, Megan; de Leon, Jessica; Nwagbara, Belinda; Ebbert, Patrick; Ferguson, David J. P.; Lowery, Laura Anne; Morrissette, Naomi; Gubbels, Marc-Jan
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
Karsidag, Semra; Akcal, Arzu; Sirvan, Selami Serhat; Guney, Soner; Ugurlu, Kemal
Major scrotal defects may result from infection due to Fournier's gangrene, excision of scrotal skin diseases, traumatic avulsion of scrotal and penile skin, and genital burns. The wide spectrum of bacterial flora of the perineum, difficulty in providing immobilisation, and obtaining a natural contour of the testes make testicular cover very difficult. Various methods have been reported to cover the penoscrotal area, including skin grafting, transposing them to medial thigh skin, and use of local fasciocutaneous or musculocutaneous flaps. In this report, reconstruction using six local medial circumflex femoral artery perforator (MCFAP) flaps was undertaken in five male patients (mean age, 47 years) with complex penoscrotal or perineal wounds. The cause of the wounds in four patients was Fournier's gangrene, and was a wide papillomateous lesion in the other patient. Flap width was 6-10 cm and flap length was 10-18 cm. The results showed that a MCFAP flap provided the testes with a pliable local flap without being bulky and also protected the testicle without increasing the temperature. The other advantage of the MCFAP flap was that the donor-site scar could be concealed in the gluteal crease. Our results demonstrated that the MCFAP flap is an ideal local flap for covering penoscrotal defects.
Liu, L; Lioudyno, M; Tao, R; Eriksson, P; Svensson, M; Aldskogius, H
We have examined the role of complement component 5 (C5) in peripheral nerve fiber degeneration and regeneration, as well as in glial and neuronal cell responses in the central nervous system (CNS). Adult congenic mice lacking C5 (C5(-)) and the corresponding normal strain (C5(+)) were used. Macrophage recruitment as well as axonal and myelin sheath elimination were delayed from 1 to 21 days postinjury in C5(-) mice compared to the C5(+) group after sciatic nerve crush. Despite this, recovery of motor function was not delayed. In the CNS, microglial cells and astrocytes responded in the same way from 3 to 21 days after sciatic nerve injury in C5(-) and C5(+) mice, and the extent of neuron death following hypoglossal nerve avulsion was the same in both groups. These findings suggest that C5 and/or its derivatives play an important role in initiating the recruitment of macrophages to the injured nerve and, probably indirectly, in early remyelination of regenerating axons, but does not influence the longterm functional restoration or axotomy-induced nerve cell death. C5-derived molecules do not appear to participate in central glial cell responses to peripheral nerve injury. These findings elucidate new aspects on the functional role of the complement system in the peripheral nervous system following peripheral nerve injury.
Shiers, M. N.; Mountney, N. P.; Hodgson, D. M.; Cobain, S. L.
The stratigraphic architecture of marginal marine successions records the interplay of autogenic and allogenic processes, and discerning their relative role in governing the morphology of the palaeoenvironment and the architecture of the preserved sedimentary succession is not straightforward. The Campanian Neslen Formation, Mesaverde Group, Utah, is a tidally influenced fluvial succession sourced from the Sevier Orogen, which prograded eastwards into the Western Interior Seaway. Detailed mapping in three dimensions of architectural relationships between sandstone bodies has enabled documentation of lateral and vertical changes in the style of channel-body stacking and analysis of the distribution of sedimentary evidence for tidal influence. Upwards, through the succession, sandstone channel bodies become larger and more amalgamated. Laterally, the dominant style of channel bodies changes such that ribbon channel-fills are restricted to the east of the study area whereas lateral accretion deposits dominate to the west. Combined allogenic and autogenic controls gave rise to the observed stratigraphy. A temporal decrease in the rate of accommodation generation resulted in an upward increase in amalgamation of sand-bodies. Autogenic processes likely played a significant role in moderating the preserved succession: up-succession changes in the style of stacking of channelized bodies could have arisen either from progradation of a distributive fluvial system or from an upstream nodal avulsion of a major trunk channel; accumulation of tide influenced, wave dominated units likely record episodes of delta-lobe abandonment, subsidence and submergence to allow accumulation of near shore sand bars with associated washover complexes.
Al-Asfour, Adel; Farzad, Payam; Andersson, Lars; Joseph, Bobby; Dahlin, Christer
Dentoalveolar ankylosis with osseous replacement is often seen after replantation of avulsed teeth, and this process may be used for preservation of alveolar crests after trauma. Its exact mechanisms with regard to osteoinductive properties are not yet fully understood and need to be systematically investigated. Dentin can possibly act as a slow-releasing carrier of bone morphogenic proteins (BMP), and this property of dentin has been proposed to be used as an alternative or supplement to bone grafting in the maxillofacial region. We aimed to initially asses host tissue reactions to dentin by implanting dentin blocks of autogenic and xenogenic human origin in rabbit connective tissue of the abdominal wall and femoral muscle. Animals were sacrificed after a period of 3 months, and histological processing, sectioning and examinations were carried out. Bone formation, cell counts and thickness of capsule surrounding the grafts were evaluated. Only minor signs of heterotopic bone formation were seen. There were no significant differences between autografts and xenografts or grafts implanted in connective tissue or muscle with regards to tissue reactions except for a significant difference (P = 0.018) in findings of more local inflammatory cells in relation to grafts placed in connective tissue in the autograft group. We conclude that during the time frame of this study, non-demineralized dentin, whether autogenous or xenogenic did not have the potential to induce bone formation when implanted in non-osteogenic areas such as the abdominal wall and abdominal muscle of rabbits.
Liang, M.; Kim, W.; Passalacqua, P.
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.
Schuster, Robert L.; Costa, John E.; ,
The most common types of mass movements that form landslide dams are rock and soil slumps and slides; mud, debris, and earth flows: and rock and debris avalanches. The most common initiation mechanisms for dam-forming landslides are excessive rainfall and snow melt, and earthquakes. Most landslide dams are remarkable short-lived. In a sample of 63 documented cases, 22 percent of the landslide dams failed in less than 1 day after formation, and half failed within 10 days. Overtopping was by far the most frequent cause of landslide-dam failure. Backwater flooding behind landslide dams can inundate communities and valuable agricultural land. Floods from the failure of landslide dams are smaller than floods from constructed dams impounding bodies of water with the same potential energy, but larger than floods from failure of ice dams. Secondary effects of landslide-dam failures include additional landslides as reservoir levels drop rapidly, aggradation of valleys upstream and downstream of the dams, and avulsive channel changes downstream.
Nuttall, Tim; Cole, Lynette K
Ear cleaning helps maintain the normal otic environment and is important in the treatment of otitis. Over cleaning, however, may trigger otitis through maceration of the epidermal lining. Simple manual cleaning is useful for routine cleansing but doesn't remove tightly adherent debris. Bulb syringes are more vigorous but may damage the ear in inexperienced hands. Devices using mains water pressure or dental machines are also available. Thorough cleaning of the ear canals and middle ear cavity can only be achieved by retrograde flushing using specially adapted catheters, feeding tubes or video otoscopes under anaesthesia. Myringotomy, inspection and cleaning of the middle should be performed if the tympanic membrane appears abnormal. There are a wide variety of cleaning fluids available. Ceruminolytics soften and dissolve cerumen to facilitate cleaning. Surfactants emulsify debris, breaking it up and keeping it in solution. Astringents dry the ear canal surface, preventing maceration. Maintaining a low pH and incorporating antimicrobial agents can inhibit microbial proliferation and glucocorticoids can be used to reduce inflammation. Adverse effects and contraindications following ear cleaning can include maceration, contact reactions, otitis media, ear canal avulsion, vestibular syndrome, Horner's syndrome, facial nerve paralysis and deafness. Care should be exercised in selecting cleaning fluids if the tympanic membranes are ruptured.
Iglesias, Martin; Butrón, Patricia; León-López, Daniela Alejandra; García-Mancilla, Sofía; Espino-Gaucin, Israel; Rubio, Alethia
Although there is a wide list of free flaps options for soft tissue reconstruction of complex upper extremity injuries, the omental flap has some useful anatomical and biochemical advantages. We report 13 patients who underwent hand or upper extremity reconstruction with omental free flaps. Nine patients had extensive tissue damage, resulting with digital cyanosis and hypothermia, and some of them with areas of cutaneous necrosis, or avulsed tissues with tendons and bones exposed or infected. The remaining four patients had minor extensive tissue damage without circulatory problems. Patient's average age was 34.6 years. Twelve flaps were harvested through laparotomy and one laparoscopically. All flaps were covered with a skin graft. None of the flaps were lost. The average follow-up time was 20 months. There was one major and two minor donor site complications. One patient had minor loss of the skin graft in the recipient site, and two required minor additional surgeries to improve the appearance or function of the hand or upper extremity. There were no late abdominal complications in any patient. The morphological appearance and functional results were favorable in 11 of them, and permitted their reincorporation into society without the need for additional complex surgeries. Only two patients had a poor outcome. Our experience confirms that the omental flap may be a good option for reconstruction of some complex hand and upper extremity injuries.
Berrocoso, Esther; Mico, Juan-Antonio; Vitton, Olivier; Ladure, Philippe; Newman-Tancredi, Adrian; Depoortère, Ronan; Bardin, Laurent
Milnacipran, a serotonin/norepinephrine reuptake inhibitor (SNRI), has shown efficacy against several chronic pain conditions, including fibromyalgia. Here, we evaluated, in rats, its anti-allodynic effects following acute or sub-chronic treatment in a model of neuropathic pain (chronic constriction injury, CCI, of the sciatic nerve). Amitriptyline, a tricyclic antidepressant active pre-clinically and clinically against neuropathic pains, was added as a comparison compound. Upon acute i.p. administration, milnacipran was potently efficacious in the CCI model. It significantly reduced thermal allodynia in the cold (4°C) plate test (MED=2.5mg/kg), and attenuated mechanical allodynia in the von Frey filaments test (MED=10mg/kg). Given sub-chronically (7day, b.i.d.), milnacipran was effective at 10mg/kgi.p. in both tests. Acute amitriptyline (10mg/kgi.p.) was efficacious against mechanical, but less so against cold allodynia; under sub-chronic conditions, it was only active against mechanical allodynia. These data show that milnacipran is as efficacious as the reference compound amitriptyline in a pre-clinical model of injury-induced neuropathy, and demonstrate for the first time that it is active acutely and sub-chronically against cold allodynia. They also suggest that milnacipran has the potential to alleviate allodynia associated with nerve compression-induced neuropathic pain in the clinic (for example following discal hernia, avulsion or cancer-induced tissue damage).
Peck, Louis; Billiar, Kristen; Ray, Malcolm
The goal of this study was to model the dynamic failure properties of ligaments and their attachment sites to facilitate the development of more realistic dynamic finite element models of the human lower extremities for use in automotive collision simulations. Porcine medial collateral ligaments were chosen as a test model due to their similarities in size and geometry with human ligaments. Each porcine medial collateral ligament-bone complex (n = 12) was held in a custom test fixture placed in a drop tower to apply an axial impulsive impact load, applying strain rates ranging from 0.005 s(-1) to 145 s(-1). The data from the impact tests were analyzed using nonlinear regression to construct model equations for predicting the failure load of ligament-bone complexes subjected to specific strain rates as calculated from finite element knee, thigh, and hip impact simulations. The majority of the ligaments tested failed by tibial avulsion (75%) while the remaining ligaments failed via mid-substance tearing. The failure load ranged from 384 N to 1184 N and was found to increase with the applied strain rate and the product of ligament length and cross-sectional area. The findings of this study indicate the force required to rupture the porcine MCL increases with the applied bone-to-bone strain rate in the range expected from high speed frontal automotive collisions.
Mendenhall, Shaun D; Sawyer, Justin D; Adkinson, Joshua M
Objective: Ear replantation poses a significant technical challenge even for the skilled microsurgeon. Many ear amputations result from avulsion and thus have damaged and often diminutive vessels with a paucity of veins. Artery-only replantation is an option for ear salvage, but little is published on the clinical course and appearance after this procedure. Methods: A subtotal ear replantation was performed on a 10-year-old boy without a venous anastomosis. Leech therapy was used to manage venous congestion postoperatively, and daily photography was performed to document the clinical course. Results: Postoperative venous congestion was successfully managed with leech therapy. Four days after the replantation, arterial thrombosis occurred that required a take back and salvage with an interposition vein graft for arterial repair. Native venous drainage and arterial revascularization from skin edges were evident by postoperative day 12, and leeches were discontinued on day 14. The patient required debridement of the posterior ear and superior helix necrotic skin, with burying of the upper portion of the ear in a superior auricular skin flap. The ear was subsequently released from the head, and the exposed portions were covered successfully with a full-thickness skin graft. Conclusions: While arterial and venous anastomoses should always be attempted, arterial-only ear replantation can provide excellent results when venous congestion is properly managed. Daily photography can be a useful tool to monitor subtle skin color changes that may indicate native venous drainage and arterial revascularization.
Bartoníček, J; Rammelt, S; Tuček, M; Naňka, O
Despite an increasing awareness of injuries to PM in ankle fracture-dislocations, there are still many open questions. The mere presence of a posterior fragment leads to significantly poorer outcomes. Adequate diagnosis, classification and treatment require preoperative CT examination, preferably with 3D reconstructions. The indication for surgical treatment is made individually on the basis of comprehensive assessment of the three-dimensional outline of the PM fracture and all associated injuries to the ankle including syndesmotic instability. Anatomic fixation of the avulsed posterior tibiofibular ligament will contribute to syndesmotic stability and restore the integrity of the incisura tibiae thus facilitating anatomic reduction of the distal fibula. A necessary prerequisite is mastering of posterolateral and posteromedial approaches and the technique of direct reduction and internal fixation. Further clinical studies with higher numbers of patients treated by similar methods and evaluation of pre- and postoperative CT scans will be necessary to determine reliable prognostic factors associated with certain types of PM fractures and associated injuries to the ankle.
Domes, Christopher M; Petering, Ryan C; Chesnutt, James C; Mirarchi, Adam
Little leaguer's elbow and Little leaguer's shoulder are overuse pathologies seen in overhead-throwing athletes. No instance of simultaneously occurring pathologies has been published. A 15-year-old baseball pitcher and football quarterback developed pain in his throwing shoulder and elbow during spring baseball, which partially resolved with several months of rest. During fall football practice, he felt a pop and pain over his medial throwing elbow. Five days after the initial injury, medial elbow tenderness, mild swelling, and decreased range of motion were noted. Radiographs revealed a Salter I avulsion fracture of the medial humeral epicondyle (Little leaguer's elbow) and a periosteal reaction along the lateral aspect of the humeral metadiaphysis with slight widening (Little leaguer's shoulder). Surgical fixation of the medial epicondyle fracture and nonoperative treatment of the shoulder pathology were performed. Two-year follow-up radiographs showed a healed medial epicondylar fracture and resolution of the periosteal reaction of the humeral metadiaphysis. The patient returned to full activity and was starting quarterback for his football team. Biomechanical forces specific to overhead-throwing activities are associated with the development of Little leaguer's elbow and shoulder. Treatments of both pathologies remain controversial, with either initial operative vs nonoperative care. In this patient, a good outcome was achieved with surgical fixation of the elbow fracture and conservative management of the shoulder pathology. Educating coaches and parents on proper throwing technique and pitching limits should be the first step in reducing the occurrence of either pathology in this population.
Sano, Kazufumi; Ozeki, Satoru
A 20-year-old man suffered the combined axillary and suprascapular nerve palsies associated with scapulothoracic dissociation by motorcycle accident. The dislocated shoulder girdle was reduced and stabilized with osteosynthesis of the fractured clavicle and reattachment of the trapezius avulsed from the scapular spine for removal of continuous traction force to these damaged nerves. Because of no evidence of recovery on manual muscle test and electromyogram, exploration for these nerves was administered 6 weeks after injury. Although neurolysis of both nerves revealed neural continuity, excessive tension still existed on the suprascapular nerve. It was thought that previous operation in which the shoulder girdle had been reduced and stabilized as much as possible could not achieve complete anatomical reduction of the scapula. As an additional treatment, medial walls of the suprascapular and spinoglenoid notches were shaven to relax the suprascapular nerve. After a year, complete recovery of both the axillary and suprascapular nerve was identified. Although scapulothoracic dissociation is commonly recognized as massive injury of the shoulder girdle with poor prognosis because of existence of accompanied severe neurovascular injuries, there are more than a few cases in which partial damage on the infraclavicular brachial plexus is only accompanied. In case of them, there is the possibility of lesions in continuity of the nerves in which good prognosis might be expected with surgical intervention including early reduction of the shoulder girdle for removal of excessive tension to the damaged nerve.
Hiller, Andrew D; Miller, Joshua D; Zeller, John L
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.
Closs, Luciane Quadrado; Reston, Eduardo Galia; Vargas, Ivana Ardenghi; de Figueiredo, Jose Antonio Poli
This case report refers to an 11-year-old boy with avulsion of the upper left central and lateral incisors. The teeth were replanted after 4 h, splinted with a semi-rigid splint for 12 days, and then endodontically treated. Severe progressive root resorption was seen after 2 years and the teeth were extracted. The boy had a normal occlusion with spacing in both jaws and slight protrusion of the anterior teeth. The treatment objectives were to close some of the spaces by mesial movement of the buccal segments in the upper jaw to minimize bone loss for a future single osseointegrated implant. Fixed appliance in combination with a removable plate was used for the mesial movements, levelling, and alignment of the upper jaw. Fixed appliance in the lower jaw and Class II traction were used for the final adjustment of the occlusion. A good occlusion with coincident upper and lower midlines and up-righted anterior teeth were achieved. A Maryland bridge was performed as a temporary solution for a future osseointegrated implant.
Russo, Ethan; Guy, Geoffrey W
This study examines the current knowledge of physiological and clinical effects of tetrahydrocannabinol (THC) and cannabidiol (CBD) and presents a rationale for their combination in pharmaceutical preparations. Cannabinoid and vanilloid receptor effects as well as non-receptor mechanisms are explored, such as the capability of THC and CBD to act as anti-inflammatory substances independent of cyclo-oxygenase (COX) inhibition. CBD is demonstrated to antagonise some undesirable effects of THC including intoxication, sedation and tachycardia, while contributing analgesic, anti-emetic, and anti-carcinogenic properties in its own right. In modern clinical trials, this has permitted the administration of higher doses of THC, providing evidence for clinical efficacy and safety for cannabis based extracts in treatment of spasticity, central pain and lower urinary tract symptoms in multiple sclerosis, as well as sleep disturbances, peripheral neuropathic pain, brachial plexus avulsion symptoms, rheumatoid arthritis and intractable cancer pain. Prospects for future application of whole cannabis extracts in neuroprotection, drug dependency, and neoplastic disorders are further examined. The hypothesis that the combination of THC and CBD increases clinical efficacy while reducing adverse events is supported.
Parker, John T.C.; ,
Lateral channel change on the mainly ephemeral Santa Cruz River, Pima County, Arizona, causes damage and has spawned costly efforts to control bank erosion. Aerial photographs, historical data, and field observations are used to document the history of channel change since 1936. Variability in the nature and degree of channel change over time and space is shown. Three major channel change processes are: (1) migration by bank erosion during meander migration or initiation; (2) avulsion by overbank flooding and flood plain incision; (3) widening by erosion of low, cohesionless banks during floods and arroyo widening by undercutting and mass wasting of deeply incised vertical walls. The first process generally is a product of low to moderate flows or waning high flows; the others result mainly from higher flows, though sensitive arroyo walls may erode during relatively low flows. Channel morphology, bank resistance, and hydrology are factors determining the dominant channel-changing process on a particular reach of the river. Present river morphology reflects high flows since the 1960's.
Kagan, R A
Decades after the problem was first identified, power line electrocution continues to be a cause of avian mortality. Currently, several federal laws protect eagles and other migratory birds, meaning that utility companies may be liable for electrocution-related deaths. Veterinarians and veterinary pathologists called upon to diagnose and treat electrocuted birds should keep this in mind when conducting clinical and postmortem examinations. This review details necropsy findings and methods used to diagnose electrocution. A combination of gross, subgross, and radiographic examinations can aid in identification of subtle injury. Diagnosis is made based on the presence of skin and/or feather burns. Other necropsy findings may include skin lacerations, subcutaneous burns, bruising, limb avulsion, hemopericardium, and vascular rupture. At the US Fish and Wildlife Service's National Forensics Laboratory, from 2000 to 2015, 417 raptor deaths were determined to have been caused by electrocution. Bald eagles and golden eagles were the most commonly submitted species. In a retrospective review of 377 cases, for which whole bodies were submitted, 18% of the electrocuted birds had only a single, small (less than 3 cm in diameter) external burn. Small, isolated burns tended to occur on the undersides of the wings at and distal to the elbow and on the lower legs and feet. These areas should be most carefully examined in cases where electrocution injury is not immediately apparent.
Ndukwe, Kizito C; Folayan, Morenike O; Ugboko, Vincent I; Elusiyan, Jerome B E; Laja, Olajumoke O
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.
Wiegand, Annette; Attin, Thomas
The objective of the current systematic review was to evaluate the efficacy of enamel matrix derivative (EMD) (Emdogain) on healing of replanted or autotransplanted permanent teeth. A review of the published literature [search term: (Emdogain OR enamel matrix derivative OR enamel matrix protein] AND [avulsion OR replantation OR autotransplantation)] was conducted by two independent investigators according to defined selection criteria. For data extraction of the identified animal studies, the following histomorphometric findings were considered: (i) healed PDL, (ii) surface resorption, (iii) inflammatory resorption and (iv) replacement resorption. The heterogeneity of data collection and the small amount of identified publications did not allow for statistical analysis. Four controlled trials (CT) conducted in animals, but no randomized controlled trials (RCT) or clinical controlled trials (CCT) could be received from the systematic search. From the selected studies, two CT gave evidence of EMD treatment to be effective in inducing healing of replanted teeth, while one CT found no differences between EMD treated teeth and controls. Finally, one CT compared EMD and sodium fluoride application, but revealed no differences between the treatments. The data of controlled trials available are limited and conflicting. No firm conclusion regarding the efficacy of EMD application on healing of replanted or autotransplanted permanent teeth can be drawn because of lack of RCT and CCT.
Hussein, E A; Al-Kreedees, A; Saad, A; Wahba, T; Al-Shamimi, S
A male patient who sustained a blunt trauma to the right knee and chest resulting in posterior dislocation of the knee joint and avulsion injury to the right popliteal artery (segments II and III) had a vascular repair by interposition saphenous vein graft. Postoperatively an episode of hypotension resulted in thrombotic occlusion of the graft and acute limb ischemia. Graft and distal thrombectomy, though successful, resulted in a stenotic segment with two perforations. To shorten the operating time this was managed by Viabahn Endoprothesis stent-graft through both native popliteal artery and vein graft. Immediate regain of pedal pulses was achieved, and at 6 months follow up Viabahn endograft is still patent, foot well perfused with normal pedal pulses and patient fully active. In complicated popliteal artery injuries, with complex time consuming revascularization procedures, an endovascular graft as a back up or bail-out technique might be a valid option in some selected cases with high anesthetic risk, to shorten operating time. In this context Viabahn endoprosthesis seems to be both efficient and durable on the short term.