Treatment of horizontal root fracture: a case report

PubMed Central

Cantore, Stefania; Ballini, Andrea; Grassi, Felice Roberto

2009-01-01

Radicular fractures in permanent teeth are uncommon injuries among dental traumas, being only 0.5-7% of the cases. Traumatic dental injuries occur more frequently in young patients, and vary in severity from enamel fractures to avulsions. The magnitude of these problems is confirmed by statistical data on the prevalence of dental trauma during childhood and adolescence. Fracture occurs often in the middle-third of the root and rarely at the apical-third. The present paper reports a clinical case of a horizontal radicular fracture located between the middle- and apical-third of a upper left-central incisors followed-up over 4 years. PMID:19830049

Effect of bisphosphonates on root resorption after tooth replantation - a systematic review.

PubMed

Najeeb, Shariq; Siddiqui, Fahad; Khurshid, Zohaib; Zohaib, Sana; Zafar, Muhammad Sohail; Ansari, Shazia Akbar

2017-04-01

Replantation of avulsed teeth may lead to root resorption. Bisphosphonates (BPs), a class of drugs of used to treat resorptive diseases of the bone such as osteoporosis and Paget's disease, have been observed to exert an antiresorptive effect on periodontal bone as well. The antiresorptive properties of BPs could prove them useful in preventing root resorption of replanted avulsed teeth. The aim of this systematic review was to analyze and summarize the currently available literature concerning the use of BPs in preventing root resorption of avulsed teeth. PubMed/MEDLINE, Google Scholar, ISI Web of Knowledge, and Embase databases were searched using keywords 'bisphosphonate', 'replantation', and 'tooth'. Quality assessment of each study was carried out. In addition, general characteristics and outcomes of each study were summarized. After exclusion of 116 irrelevant articles, 10 animal studies were included in this review. The majority of the studies suggest that surface application of zoledronate or alendronate reduces root resorption of replanted teeth in animal models. Surface treatment with etidronate had no significant effect on root resorption, and intracanal etidronate accelerated resorption. Surface application of zoledronate and alendronate reduces root resorption of replanted teeth in animal models. However, the efficacy of intracanal usage of BPs is still debatable. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Replantation of 45 avulsed permanent teeth: a 1-year follow-up study.

PubMed

Chappuis, Vivianne; von Arx, Thomas

2005-10-01

Thirty-four patients with 45 avulsed and replanted permanent teeth were followed for 1 year. All teeth were soaked in tetracycline before replantation. In addition, enamel matrix derivative was used in teeth with dry storage times exceeding 30 min. Splinting was carried out with a non-rigid titanium splint and was limited to 7-10 days. Within that period, root canal treatment was begun in all teeth with a closed apex, whereas teeth with an open apex and ideal post-traumatic storage were not instrumented. All patients were given tetracycline systematically for 10 days. The survival rate of replanted avulsed permanent teeth was 95.6% at the 1-year follow-up. In 82.2%, root canal treatment was performed. Pulp survival was never observed, but three teeth had pulp canal obliteration. Normal periodontal healing was observed in 57.7% of teeth; 42.3% of teeth showed external root resorption (28.9% replacement resorption, 6.7% infection-related resorption, 6.7% surface resorption). The occurrence of replacement resorption correlated with the period of extraoral dry storage. Compared with other clinical studies on avulsed and replanted teeth, the present study reports a higher percentage of periodontal healing. The favorable treatment outcome may be associated with a strict protocol to enforce endodontic treatment, the use of topical and systemic tetracycline, and the relatively high number of ideally stored teeth following avulsion. In contrast, the present study has a follow-up period limited to 1 year.

Functional Motor Recovery from Motoneuron Axotomy Is Compromised in Mice with Defective Corticospinal Projections

PubMed Central

Ding, Yuetong; Qu, Yibo; Feng, Jia; Wang, Meizhi; Han, Qi; So, Kwok-Fai; Wu, Wutian; Zhou, Libing

2014-01-01

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

A clinical sign to detect root avulsions of the posterior horn of the medial meniscus.

PubMed

Seil, Romain; Dück, Klaus; Pape, Dietrich

2011-12-01

The goal of the present report was to describe a new clinical sign to make a clinical diagnosis of meniscal extrusion related to medial meniscal root avulsion. Description of an easy clinical sign to detect extrusion of the medial meniscus at the anteromedial joint line. A varus stress test was applied in full extension before and after transosseous repair of an isolated traumatic avulsion of the posterior root of the medial meniscus in a 21-year-old patient. The clinical sign was verified by sectioning of the meniscotibial ligament during knee arthroplasty surgery in 3 patients. With a deficient posterior root, the clinical sign was positive, showing anteromedial extrusion under varus stress. After repair and at clinical follow-up, extrusion was normalized. Making the clinical diagnosis of medial meniscus extrusion after knee injury by applying a simple varus stress test to the knee and palpating the anteromedial meniscal extrusion might help physicians to suspect a medial meniscus root tear in the early stages after the injury as well as to evaluate its reduction after repair. A varus stress test in full extension should be performed systematically in patients where a root tear of the medial meniscus is suspected as well as after surgery to evaluate the success of the repair.

ATG5 overexpression is neuroprotective and attenuates cytoskeletal and vesicle-trafficking alterations in axotomized motoneurons.

PubMed

Leiva-Rodríguez, Tatiana; Romeo-Guitart, David; Marmolejo-Martínez-Artesero, Sara; Herrando-Grabulosa, Mireia; Bosch, Assumpció; Forés, Joaquim; Casas, Caty

2018-05-24

Injured neurons should engage endogenous mechanisms of self-protection to limit neurodegeneration. Enhancing efficacy of these mechanisms or correcting dysfunctional pathways may be a successful strategy for inducing neuroprotection. Spinal motoneurons retrogradely degenerate after proximal axotomy due to mechanical detachment (avulsion) of the nerve roots, and this limits recovery of nervous system function in patients after this type of trauma. In a previously reported proteomic analysis, we demonstrated that autophagy is a key endogenous mechanism that may allow motoneuron survival and regeneration after distal axotomy and suture of the nerve. Herein, we show that autophagy flux is dysfunctional or blocked in degenerated motoneurons after root avulsion. We also found that there were abnormalities in anterograde/retrograde motor proteins, key secretory pathway factors, and lysosome function. Further, LAMP1 protein was missorted and underglycosylated as well as the proton pump v-ATPase. In vitro modeling revealed how sequential disruptions in these systems likely lead to neurodegeneration. In vivo, we observed that cytoskeletal alterations, induced by a single injection of nocodazole, were sufficient to promote neurodegeneration of avulsed motoneurons. Besides, only pre-treatment with rapamycin, but not post-treatment, neuroprotected after nerve root avulsion. In agreement, overexpressing ATG5 in injured motoneurons led to neuroprotection and attenuation of cytoskeletal and trafficking-related abnormalities. These discoveries serve as proof of concept for autophagy-target therapy to halting the progression of neurodegenerative processes.

Boosted Regeneration and Reduced Denervated Muscle Atrophy by NeuroHeal in a Pre-clinical Model of Lumbar Root Avulsion with Delayed Reimplantation.

PubMed

Romeo-Guitart, David; Forés, Joaquim; Navarro, Xavier; Casas, Caty

2017-09-20

The "gold standard" treatment of patients with spinal root injuries consists of delayed surgical reconnection of nerves. The sooner, the better, but problems such as injury-induced motor neuronal death and muscle atrophy due to long-term denervation mean that normal movement is not restored. Herein we describe a preclinical model of root avulsion with delayed reimplantation of lumbar roots that was used to establish a new adjuvant pharmacological treatment. Chronic treatment (up to 6 months) with NeuroHeal, a new combination drug therapy identified using a systems biology approach, exerted long-lasting neuroprotection, reduced gliosis and matrix proteoglycan content, accelerated nerve regeneration by activating the AKT pathway, promoted the formation of functional neuromuscular junctions, and reduced denervation-induced muscular atrophy. Thus, NeuroHeal is a promising treatment for spinal nerve root injuries and axonal regeneration after trauma.

A 12-Year Retrospective Study of Avulsion Cases in a Public Brazilian Dental Trauma Service.

PubMed

Mesquita, Gabriela Campos; Soares, Priscilla Barbosa Ferreira; Moura, Camilla Christian Gomes; Roscoe, Marina Guimarães; Paiva, Saul Martins; Soares, Carlos José

2017-01-01

This study assessed the epidemiological characteristics and management of the permanent teeth avulsion cases attended in a Brazilian dental trauma service from December 2005 to August 2016. A retrospective study was conducted of case records of 93 patients involving 139 avulsed teeth. Data included sex, age, trauma etiology, location of the accident, number and position of avulsed teeth, and presence and type of associated traumatic lesions. Management of the avulsed teeth was addressed as: time elapsed until teeth were retrieved from the accident's location; teeth's cleaning method and storage media; time elapsed until seeking treatment and replantation. The majority of the patients were children from 6-10 (31.2%) and 11-15 years old (26.9%). Male patients were more affected than female. Bicycle accident was the main etiological factor (31.2%). In 56 (60.2%) cases, traumatic lesions to neighboring teeth were present. In 55 (59.1%) cases, lesions to adjacent soft tissues were reported. In 82 (88.2%) cases, patients requested treatment at the same day of the accident. Sixty-four teeth (46.0%) were immediately retrieved and 28 (20.1%) were not found. Forty-two teeth (30.2%) were kept dry. Only one tooth (0.7%) was immediately replanted at the accident's site, while 51 teeth (36.7%) were not replanted. Numerous avulsed teeth were inappropriately managed and immediate replantation was not frequent. Public policies must be created to raise awareness towards the particularities of avulsion cases.

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

PubMed Central

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

2014-01-01

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

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

PubMed Central

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

2014-01-01

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

Acute repair of traumatic pan-brachial plexus injury: technical considerations and approaches.

PubMed

Abou-Al-Shaar, Hussam; Karsy, Michael; Ravindra, Vijay; Joyce, Evan; Mahan, Mark A

2018-01-01

Particularly challenging after complete brachial plexus avulsion is reestablishing effective hand function, due to limited neurological donors to reanimate the arm. Acute repair of avulsion injuries may enable reinnervation strategies for achieving hand function. This patient presented with pan-brachial plexus injury. Given its irreparable nature, the authors recommended multistage reconstruction, including contralateral C-7 transfer for hand function, multiple intercostal nerves for shoulder/triceps function, shoulder fusion, and spinal accessory nerve-to-musculocutaneous nerve transfer for elbow flexion. The video demonstrates distal contraction from electrical stimulation of the avulsed roots. Single neurorrhaphy of the contralateral C-7 transfer was performed along with a retrosternocleidomastoid approach. The video can be found here: https://youtu.be/GMPfno8sK0U .

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

PubMed Central

Trikha, Paul S; Wood, David G

2009-01-01

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

Direct Spinal Ventral Root Repair following Avulsion: Effectiveness of a New Heterologous Fibrin Sealant on Motoneuron Survival and Regeneration

PubMed Central

Barbizan, Roberta; Seabra Ferreira, Rui

2016-01-01

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

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

PubMed

Phadnis, Joideep; Trikha, Paul S; Wood, David G

2009-08-25

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

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

PubMed Central

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

2015-01-01

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

Effects of medial meniscus posterior horn avulsion and repair on tibiofemoral contact area and peak contact pressure with clinical implications.

PubMed

Marzo, John M; Gurske-DePerio, Jennifer

2009-01-01

Avulsion of the posterior horn attachment of the medial meniscus can compromise load-bearing ability, produce meniscus extrusion, and result in tibiofemoral joint-space narrowing, articular cartilage damage, and osteoarthritis. Avulsion of the posterior horn of the medial meniscus will increase peak contact pressure and decrease contact area in the medial compartment of the knee, and posterior horn repair will restore contact area and peak contact pressures to values of the control knee. Controlled laboratory study. Eight fresh-frozen human cadaveric knees had tibiofemoral peak contact pressures and contact area measured in the control state. The posterior horn of the medial meniscus was avulsed from its insertion and knees were retested. The meniscal avulsion was repaired by suture through a transosseous tunnel and the knees were tested a third time. Avulsion of the posterior horn attachment of the medial meniscus resulted in a significant increase in medial joint peak contact pressure (from 3841 kPa to 5084 kPa) and a significant decrease in contact area (from 594 mm(2) to 474 mm(2)). Repair of the avulsion resulted in restoration of the loading profiles to values equal to the control knee, with values of 3551 kPa for peak pressure and 592 mm(2) for contact area. Posterior horn medial meniscal root avulsion leads to deleterious alteration of the loading profiles of the medial joint compartment and results in loss of hoop stress resistance, meniscus extrusion, abnormal loading of the joint, and early knee medial-compartment degenerative changes. The repair technique described restores the ability of the medial meniscus to absorb hoop stress and eliminate joint-space narrowing, possibly decreasing the risk of degenerative disease.

First-aid algorithms in dental avulsion.

PubMed

Baginska, Joanna; Wilczynska-Borawska, Magdalena

2012-04-01

Almost one fourth of traumatic dental injuries occur at schools or in their surroundings. Prevalence of tooth avulsion varies from 0.5% to 16% of all cases of dental trauma. Children with dental avulsion may seek help from school nurses so they should be able to provide first-aid treatment. However, many studies showed that the general level of knowledge of medical staff concerning tooth avulsion is unsatisfactory and that it could be improved by educational activities. This article attempts to give short algorithms of first-aid management of avulsed tooth.

Suture Anchor Fixation for Fifth Metatarsal Tuberosity Avulsion Fractures: A Case Series and Review of Literature.

PubMed

Hong, Choon Chiet; Nag, Kushal; Yeow, Huifen; Lin, Adrian Zhigao; Tan, Ken Jin

2018-05-17

Fifth metatarsal tuberosity avulsion fractures are common. Despite good outcomes with nonoperative treatment, acute fractures with displacement, intra-articular involvement, comminution, or painful nonunion have been reported to benefit from early open reduction and internal fixation, especially in athletes. No consensus has been reached regarding the best surgical fixation technique. We present a case series of 4 patients with displaced fifth metatarsal tuberosity avulsion fractures and an innovative technique of fixation for the tuberosity avulsion fractures using a suture anchor. Copyright © 2018 The American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

A Simple Strategy in Avulsion Flap Injury: Prediction of Flap Viability Using Wood's Lamp Illumination and Resurfacing with a Full-thickness Skin Graft.

PubMed

Lim, Hyoseob; Han, Dae Hee; Lee, Il Jae; Park, Myong Chul

2014-03-01

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. 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. 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. 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.

Break dance hip: chronic avulsion of the anterior superior iliac spine.

PubMed

Winkler, A R; Barnes, J C; Ogden, J A

1987-01-01

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.

A novel rat model of brachial plexus injury with nerve root stumps.

PubMed

Fang, Jintao; Yang, Jiantao; Yang, Yi; Li, Liang; Qin, Bengang; He, Wenting; Yan, Liwei; Chen, Gang; Tu, Zhehui; Liu, Xiaolin; Gu, Liqiang

2018-02-01

The C5-C6 nerve roots are usually spared from avulsion after brachial plexus injury (BPI) and thus can be used as donors for nerve grafting. To date, there are no appropriate animal models to evaluate spared nerve root stumps. Hence, the aim of this study was to establish and evaluate a rat model with spared nerve root stumps in BPI. In rupture group, the proximal parts of C5-T1 nerve roots were held with the surrounding muscles and the distal parts were pulled by a sudden force after the brachial plexus was fully exposed, and the results were compared with those of sham group. To validate the model, the lengths of C5-T1 spared nerve root stumps were measured and the histologies of the shortest one and the corresponding spinal cord were evaluated. C5 nerve root stump was found to be the shortest. Histology findings demonstrated that the nerve fibers became more irregular and the continuity decreased; numbers and diameters of myelinated axons and thickness of myelin sheaths significantly decreased over time. The survival of motoneurons was reduced, and the death of motoneurons may be related to the apoptotic process. Our model could successfully create BPI model with nerve root stumps by traction, which could simulate injury mechanisms. While other models involve root avulsion or rupturing by distal nerve transection. This model would be suitable for evaluating nerve root stumps and testing new therapeutic strategies for neuroprotection through nerve root stumps in the future. Copyright © 2017. Published by Elsevier B.V.

[Avulsion of the Proximal Hamstring Insertion. Case Reports].

PubMed

Mizera, R; Harcuba, R; Kratochvíl, J

2016-01-01

Proximal hamstring avulsion is an uncommon muscle injury with a lack of consensus on indications and the timing and technique of surgery. Poor clinical symptoms and difficulties in the diagnostic process can lead to a false diagnosis. The authors present three cases of proximal hamstring avulsion, two complete and one partial ruptures of the biceps femoris muscle. MRI and ultrasound scans were used for optimal treatment alignment. Acute surgery reconstruction (< 4 weeks) was done in two patients. Re-attachment of the full thickness ruptures was performed to the original place and secured by suture anchors, the partial rupture was fixed by a simple suture. Two patients were free of any symptoms at 6 months after surgery, the last one had pain in the subgluteal area and a mild deficit in hamstring strength. Two interesting systematic reviews published on the treatment of proximal hamstring avulsion are discussed in the final part of the paper. Key words: hamstring, rupture, avulsion.

Does the prevalence of levator ani muscle avulsion differ when assessed using tomographic ultrasound imaging at rest vs on maximum pelvic floor muscle contraction?

PubMed

van Delft, K; Thakar, R; Sultan, A H; Kluivers, K B

2015-07-01

It has been suggested that transperineal ultrasound images obtained during maximum pelvic floor muscle contraction improve the diagnosis of levator ani muscle (LAM) avulsion by comparison with those obtained at rest. The objective of this study was to establish, using transperineal tomographic ultrasound imaging (TUI), the correlation between LAM avulsion diagnosed at rest and that on contraction. Primiparous women were examined 3 months postpartum by Pelvic Organ Prolapse Quantification (POP-Q) assessment and for LAM avulsion clinically by digital palpation and by transperineal TUI performed at rest and on pelvic floor muscle contraction. LAM avulsion was diagnosed on TUI when the three central slices were abnormal. A comparison was made between LAM avulsion diagnosed at rest and on maximum contraction. Two independent blinded investigators performed the analyses and a third investigator resolved discrepancies. One hundred and ninety primiparae were analyzed providing 380 results for comparison, as right and left LAM were analyzed independently. LAM avulsion was found in 36 (9.5%) images obtained at rest and in 35 (9.2%) on contraction, revealing moderate correlation between the two (ICC, 0.58 (95% CI, 0.51-0.64)). Twenty-two cases of LAM avulsion were identified both at rest and on contraction. One woman had LAM avulsion on palpation, which was seen on TUI as LAM avulsion on contraction, but not at rest. More cases of anterior and posterior compartment prolapse were found in women with LAM avulsion diagnosed on contraction only compared to LAM avulsion observed at rest only (POP-Q assessment point Ba, -1.8 vs -2.5 (P = 0.075) and point Bp, -2.5 vs -2.8 (P = 0.072)). Findings on transperineal TUI performed in women at rest and on contraction correlate reasonably well. However, given the trend towards an association with signs of pelvic floor dysfunction, diagnosis of LAM avulsion on contraction seems to be more reliable. Consistency in technique and interpretation should be maintained. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd.

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

PubMed

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

2008-01-01

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

The phrenic nerve transfer in the treatment of a septuagenarian with brachial plexus avulsion injury: a case report.

PubMed

Jiang, Ye; Lao, Jie

2018-05-01

Phrenic nerve transfer has been a well-established procedure for restoring elbow flexion function in patients with brachial plexus avulsion injury. Concerning about probably detrimental respiratory effects brought by the operation, however, stirred up quite a bit of controversy. We present a case report of the successful application of phrenic nerve as donor to reinnervate the biceps in a septuagenarian with brachial plexus avulsion injury, not accompanied with significant clinical respiratory problem.

A rare presentation of flexor digitorum profundus type V avulsion injury with associated intra-articular fracture: A case report.

PubMed

Rizis, D; Mahoney, Jl

2011-01-01

Traumatic avulsions of the flexor digitorum profundus tendon are associated with young adults engaged in athletic activities such as football and rugby. The current report presents a case involving a 30-year-old man with traumatic avulsion of his flexor digitorum profundus and associated intra-articular distal phalangeal fracture secondary to injury during martial arts - an unusual cause of this injury. Increased attention to injuries acquired during this form of sporting activity is suggested.

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

PubMed

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

2010-05-01

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

Nonoperative treatment for proximal avulsion of the rectus femoris in professional American football.

PubMed

Gamradt, Seth C; Brophy, Robert H; Barnes, Ronnie; Warren, Russell F; Thomas Byrd, J W; Kelly, Bryan T

2009-07-01

Avulsion of the rectus femoris origin is a rare injury. The only previous report of this injury in professional American football has been limited to the kicking athlete. To describe the incidence and treatment of proximal rectus femoris avulsion in the National Football League (NFL). Case series; Level of evidence, 4. The NFL Injury Surveillance System (NFLISS) was reviewed for any proximal rectus femoris avulsion injuries from 1986 to 2006, including the type and mechanism of injury, player demographics, method of treatment, and time to return to play. The NFL team physicians and trainers were surveyed as to their experience with these injuries as well. A total of 11 cases of proximal rectus femoris avulsion were identified starting in 1997. These injuries occurred in athletes in a variety of positions. All of these were treated nonoperatively, and the mean return to play was 69.2 days. Rectus femoris avulsions are uncommon injuries in the NFL, occurring about once a year in the entire league (once magnetic resonance imaging facilitated correct diagnosis of these injuries). Conservative treatment of these injuries usually results in return to play after 6 to 12 weeks. Proximal avulsions of the rectus femoris can be treated nonoperatively with a high degree of predictability for return to full, unrestricted participation in professional American football.

Efficiency of different storage media for avulsed teeth in animal models: a systematic review.

PubMed

Longo, Daniele L; Fumes, Ana C; Küchler, Erika C; Paula-Silva, Francisco W G; Nelson-Filho, Paulo; Silva, Léa A B

2018-02-01

Tooth avulsion consists of the complete displacement of a tooth from the alveolar socket. When immediate replantation is not possible, the avulsed tooth should be kept in a storage medium capable of maintaining the viability of periodontal ligament (PDL) cells on the root surface. However, there is no consensus on the best storage medium able to prevent sequels such as ankylosis and tooth resorption. The aim of this study was to perform a systematic review to evaluate the in vivo effectiveness of different storage media for avulsed teeth. Two reviewers performed a database search for studies published between January 1950 and December 2015 which were indexed in the PubMed, Scopus, Web of Science, and Bireme databases. An additional manual search was performed. Studies with animal models that evaluated tooth avulsion, storage media, and replantation were included. After full-text analysis of the potentially relevant studies, the selected studies were included in the systematic review. The database search found 157 distinct studies evaluating avulsed teeth storage media. However, only six studies met the selection criteria and were included in the review. There was a high variability in the study estimates for the parameters analyzed. When assessing the quality and level of evidence of each study, one study was rated as having a very low level of evidence, four studies had low levels of evidence, and one had a moderate level of evidence. As a result of data heterogeneity and limitations of the studies, there was insufficient evidence to determine the most effective storage medium for avulsed teeth. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

First-Aid Algorithms in Dental Avulsion

ERIC Educational Resources Information Center

Baginska, Joanna; Wilczynska-Borawska, Magdalena

2012-01-01

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

Neuroprotective Drug for Nerve Trauma Revealed Using Artificial Intelligence.

PubMed

Romeo-Guitart, David; Forés, Joaquim; Herrando-Grabulosa, Mireia; Valls, Raquel; Leiva-Rodríguez, Tatiana; Galea, Elena; González-Pérez, Francisco; Navarro, Xavier; Petegnief, Valerie; Bosch, Assumpció; Coma, Mireia; Mas, José Manuel; Casas, Caty

2018-01-30

Here we used a systems biology approach and artificial intelligence to identify a neuroprotective agent for the treatment of peripheral nerve root avulsion. Based on accumulated knowledge of the neurodegenerative and neuroprotective processes that occur in motoneurons after root avulsion, we built up protein networks and converted them into mathematical models. Unbiased proteomic data from our preclinical models were used for machine learning algorithms and for restrictions to be imposed on mathematical solutions. Solutions allowed us to identify combinations of repurposed drugs as potential neuroprotective agents and we validated them in our preclinical models. The best one, NeuroHeal, neuroprotected motoneurons, exerted anti-inflammatory properties and promoted functional locomotor recovery. NeuroHeal endorsed the activation of Sirtuin 1, which was essential for its neuroprotective effect. These results support the value of network-centric approaches for drug discovery and demonstrate the efficacy of NeuroHeal as adjuvant treatment with surgical repair for nervous system trauma.

A Case of Nonunion Avulsion Fracture of the Anterior Tibial Eminence

PubMed Central

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

2016-01-01

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

Avulsion of the common hamstring tendon origin in an active duty airman.

PubMed

Johnson, Anthony E; Granville, Robert R; DeBerardino, Thomas M

2003-01-01

Hamstring injuries are common in active athletic populations, such as military service members. Ruptures of the hamstring origin from the ischial tuberosity are rare injuries and missed if not considered in the differential diagnosis of ischial pain. Unlike other hamstring injuries, complete hamstring avulsions must be treated surgically. Results of untreated hamstring avulsions are poor. The purpose of this article is to describe the case of an active duty airman who presented for an unrelated complaint and was discovered to have a 5-week-old hamstring avulsion. Surgical repair of the hamstring avulsion 6 weeks after injury yielded an excellent result and return to full duty. Hamstring avulsions recognized early by history and physical examination and diagnostic imaging permits early and effective treatment. Early surgical repair of the tendon to bone can result in return to full duty.

Perioperative Avulsion of a Left Internal Mammary Artery Graft in a Patient with Syphilis

PubMed Central

Kaleda, Vasily I.; Belash, Sergei A.; Barsuk, Alexei V.; Barbuhatti, Kirill O.

2014-01-01

Avulsion of a graft after coronary artery bypass grafting surgery is a rare but very serious complication which leads to massive bleeding and possible life-threatening cardiac tamponade. In this paper we report a very rare case of a left internal mammary artery graft avulsion on the day of surgery in a patient with syphilis. PMID:25374955

Three cases of successful microvascular ear replantation after bite avulsion injury.

PubMed

Schonauer, Fabrizio; Blair, James W; Moloney, Dominique M; Teo, T C; Pickford, Mark A

2004-01-01

We present three cases of sub-total amputation of the external ear caused by bite avulsion injury. The ears were all successfully replanted despite us being unable to perform a venous anastomosis in one case. These outcomes support attempted microsurgical replantation for total or sub-total amputations of the ear, as successful replantation is the most effective surgical option.

Microvascular management of ring avulsion injuries.

PubMed

Urbaniak, J R; Evans, J P; Bright, D S

1981-01-01

Microsurgical revascularization has proved to be a useful method in managing the ring avulsion injury where both neurovascular bundles are damaged with only partial skin avulsion. Representative cases are used to illustrate guidelines for a practical classification for helping to decide the optimal method of treatment of acute ring avulsion injuries in light of digital revascularization techniques. Nine ring fingers were successfully revascularized of 24 acute ring avulsion injuries reviewed. Sensibility recovery was good and a functional range of motion obtained. No patient who has had his ring finger revascularized has requested its amputation because of appearance, painful neuromas, stiffness, or cold intolerance. Complete amputations, especially proximal to the superficialis insertion, and complete degloving injuries of the ring finger are usually best managed by surgical amputation of the digit.

Knowledge of Dentists on the Management of Tooth Avulsion Injuries in Rio de Janeiro, Brazil.

PubMed

Menezes, Mariana Cezário; Carvalho, Ricardo G; Accorsi-Mendonça, Thais; De-Deus, Gustavo; Moreira, Edson J L; Silva, Emmanuel J N L

2015-01-01

To evaluate dentists' professional experience and knowledge of emergency management of tooth avulsion injuries in Rio de Janeiro, Brazil. A total of 100 questionnaires were evaluated. The first part of the questionnaire consisted of questions regarding personal information. The second part evaluated dentists' knowledge of emergency management in cases of dental avulsion. The responses for each question were counted and expressed as percentages. All dentists had a college degree or above. Only three dentists had a Master's or PhD degree. Most of the dentists (94.5%) considered time and storage media important for the prognosis of avulsed teeth. However, the dentists did not show consistent responses about the adequate time and ideal storage media to transport avulsed teeth. The study highlighted Brazilian dentists' need for continuing education in order to improve current knowledge in emergency management of avulsed teeth.

Diagnosis and expedited surgical intervention of a complete hamstring avulsion in a military combatives athlete: a case report.

PubMed

O'Laughlin, Shaun J; Flynn, Timothy W; Westrick, Richard B; Ross, Michael D

2014-05-01

Hamstring injuries are frequent injuries in athletes, with the most common being strains at the musculotendinous junction or within the muscle belly. Conversely, hamstring avulsions are rare and often misdiagnosed leading to delay in appropriate surgical interventions. The purpose of this case report is to describe the history and physical examination findings that led to appropriate diagnostic imaging and the subsequent diagnosis and expedited surgical intervention of a complete avulsion of the hamstring muscle group from the ischium in a military combatives athlete. The patient was a 25 year-old male who sustained a hyperflexion injury to his right hip with knee extension while participating in military combatives, presenting with acute posterior thigh and buttock pain. History and physical examination findings from a physical therapy evaluation prompted an urgent magnetic resonance imaging (MRI) study, which led to the diagnosis of a complete avulsion of the hamstring muscle group off the ischium. Expedited surgical intervention occurred within 13 days of the injury potentially limiting comorbidities associated with delayed diagnosis. Recognition of the avulsion led to prompt surgical evaluation and intervention. Literature has shown that diagnosis of hamstring avulsions are frequently missed or delayed, which results in a myriad of complications. Level 4.

Complete Ureteral Avulsion

PubMed Central

Gupta, V.; Sadasukhi, T. C.; Sharma, K. K.; Yadav, R. G.; Mathur, R.; Tomar, V.; Yadav, S. S.; Priyadarshi, S.; Gupta, P.

2005-01-01

Complete avulsion of the ureter is one of the most serious complications of ureteroscopy. It requires open or laparoscopic intervention for repair. This case report emphasizes its management and presents recommendations for prevention in current urological practice. PMID:15702225

Isolated Avulsion of the Tendon of Insertion of the Infraspinatus and Supraspinatus Muscles in Five Juvenile Labrador Retrievers.

PubMed

Mikola, Karoliina; Piras, Alessandro; Hakala, Laura

2018-06-02

 Five juvenile Labrador Retrievers between the ages of 6 and 8 months were presented to our referral centres with a history of intermittent forelimb lameness.  The clinical examination revealed the presence of bilateral orthopaedic problems in four out of five cases.  Radiographic and computed tomography examinations showed the presence of a radiolucent defect corresponding to the area of insertion of the infraspinatus or supraspinatus tendons on the proximal humerus. Three dogs were concurrently affected by elbow disease on the contralateral forelimb and one dog with bilateral infraspinatus avulsion also had osteochondritis dissecans affecting both shoulder joints.  Avulsion of the insertion of the infraspinatus tendon in four dogs and of the supraspinatus tendon in one dog.  According to the current literature, the incidence of infraspinatus and supraspinatus tendinopathies in adult Labrador Retrievers is higher than in other breeds. In our five cases, the patients were juvenile and the nature of the injury was an avulsion of the tendinous insertion. Avulsion of the tendon of insertion of the infraspinatus or supraspinatus has been poorly described in the veterinary literature, and this would represent the first series of cases affecting juvenile Labrador Retrievers. Schattauer GmbH Stuttgart.

Transposition of branches of radial nerve innervating supinator to posterior interosseous nerve for functional reconstruction of finger and thumb extension in 4 patients with middle and lower trunk root avulsion injuries of brachial plexus.

PubMed

Wu, Xia; Cong, Xiao-Bing; Huang, Qi-Shun; Ai, Fang-Xin; Liu, Yu-Tian; Lu, Xiao-Cheng; Li, Jin; Weng, Yu-Xiong; Chen, Zhen-Bing

2017-12-01

This study aimed to investigate the reconstruction of the thumb and finger extension function in patients with middle and lower trunk root avulsion injuries of the brachial plexus. From April 2010 to January 2015, we enrolled in this study 4 patients diagnosed with middle and lower trunk root avulsion injuries of the brachial plexus via imaging tests, electrophysiological examinations, and clinical confirmation. Muscular branches of the radial nerve, which innervate the supinator in the forearm, were transposed to the posterior interosseous nerve to reconstruct the thumb and finger extension function. Electrophysiological findings and muscle strength of the extensor pollicis longus and extensor digitorum communis, as well as the distance between the thumb tip and index finger tip, were monitored. All patients were followed up for 24 to 30 months, with an average of 27.5 months. Motor unit potentials (MUP) of the extensor digitorum communis appeared at an average of 3.8 months, while MUP of the extensor pollicis longus appeared at an average of 7 months. Compound muscle action potential (CMAP) appeared at an average of 9 months in the extensor digitorum communis, and 12 months in the extensor pollicis longus. Furthermore, the muscle strength of the extensor pollicis longus and extensor digitorum communis both reached grade III at 21 months. Lastly, the average distance between the thumb tip and index finger tip was 8.8 cm at 21 months. In conclusion, for patients with middle and lower trunk injuries of the brachial plexus, transposition of the muscular branches of the radial nerve innervating the supinator to the posterior interosseous nerve for the reconstruction of thumb and finger extension function is practicable and feasible.

Characterization and Surgical Management of Achilles Tendon Sleeve Avulsions.

PubMed

Huh, Jeannie; Easley, Mark E; Nunley, James A

2016-06-01

An Achilles sleeve avulsion occurs when the tendon ruptures distally from its calcaneal insertion as a continuous "sleeve." This relatively rare injury pattern may not be appreciated until the time of surgery and can be challenging to treat because, unlike a midsubstance rupture, insufficient tendon remains on the calcaneus to allow for end-to-end repair, and unlike a tuberosity avulsion fracture, any bony element avulsed with the tendon is inadequate for internal fixation. This study aimed to highlight the characteristics of Achilles sleeve avulsions and present the outcomes of operative repair using suture anchor fixation. A retrospective analysis was conducted on 11 consecutive Achilles tendon sleeve avulsions (10 males, 1 female; mean age 44 years) that underwent operative repair between 2008 and 2014. Patient demographics, injury presentation, and operative details were reviewed. Postoperative outcomes were collected at a mean follow-up of 38.4 (range, 12-83.5) months, including the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot score, visual analog scale (VAS) for pain, plantarflexion strength, patient satisfaction, and complications. Eight patients (72.7%) had preexisting symptoms of insertional Achilles disease. Ten of 11 (90.9%) injuries were sustained during recreational athletic activity. An Achilles sleeve avulsion was recognized preoperatively in 7 of 11 (64%) cases, where lateral ankle radiographs demonstrated a small radiodensity several centimeters proximal to the calcaneal insertion. Intraoperatively, 90.9% of sleeve avulsions had a concomitant Haglund deformity and macroscopic evidence of insertional tendinopathy. All patients healed after suture anchor repair. The average AOFAS score was 92.8 and VAS score was 0.9. Ten patients (90.9%) were completely satisfied. One complication occurred, consisting of delayed wound healing. Achilles tendon sleeve avulsions predominantly occurred in middle-aged men with preexisting insertional disease, while engaged in athletic activity. Suture anchor fixation, combined with addressing concomitant insertional pathology, was a reliable and safe technique for the operative management of Achilles tendon sleeve avulsions. The majority of patients returned to their preinjury levels of work and recreational activity. Level IV, retrospective case series. © The Author(s) 2016.

Crevasse Splays Versus Avulsions: A Recipe for Land Building With Levee Breaches

NASA Astrophysics Data System (ADS)

Nienhuis, Jaap H.; Törnqvist, Torbjörn E.; Esposito, Christopher R.

2018-05-01

Natural-levee breaches can not only initiate an avulsion but also, under the right circumstances, lead to crevasse splay formation and overbank sedimentation. The formative conditions for crevasse splays are not well understood, yet such river sediment diversions form an integral part of billion-dollar coastal restoration projects. Here we use Delft3D to investigate the influence of vegetation and soil consolidation on the evolution of a natural-levee breach. Model simulations show that crevasse splays heal because floodplain aggradation reduces the water surface slope, decreasing water discharge into the flood basin. Easily erodible and unvegetated floodplains increase the likelihood for channel avulsions. Denser vegetation and less potential for soil consolidation result in small crevasse splays that are not only efficient sediment traps but also short-lived. Successful crevasse splays that generate the largest land area gain for the imported sediment require a delicate balance between water and sediment discharge, vegetation root strength, and soil consolidation.

Intracanal bisphosphonate does not inhibit replacement resorption associated with delayed replantation of monkey incisors.

PubMed

Thong, Yo Len; Messer, Harold H; Zain, Rosnah Binti; Saw, Lip Hean; Yoong, Lai Thong

2009-08-01

Progressive replacement resorption following delayed replantation of avulsed teeth has proved to be an intractable clinical problem. A wide variety of therapeutic approaches have failed to result in the predictable arrest of resorption, with a good long-term prognosis for tooth survival. Bisphosphonates are used in the medical management of a range of bone disorders and topically applied bisphosphonate has been reported to inhibit root resorption in dogs. This study evaluated the effectiveness of a bisphosphonate (etidronate disodium) as an intracanal medicament in the root canals of avulsed monkey teeth, placed before replantation after 1 h of extraoral dry storage. Incisors of six Macaca fascicularis monkeys were extracted and stored dry for 1 h. Teeth were then replanted after canal contamination with dental plaque (negative control) or after root canal debridement and placement of etidronate sealed in the canal space. A positive control of calcium hydroxide placed 8-9 days after replantation was also included. All monkeys were sacrificed 8 weeks later and block sections were prepared for histomorphometric assessment of root resorption and periodontal ligament status. Untreated teeth showed the greatest extent of root resorption (46% of the root surface), which was predominantly inflammatory in nature. Calcium hydroxide treated teeth showed the lowest overall level of resorption (<30% of the root surface), while the bisphosphonate-treated group was intermediate (39%). Ankylosis, defined as the extent of the root surface demonstrating direct bony union to both intact and resorbed root surface, was the lowest in the untreated control group (15% of the root surface), intermediate in the calcium hydroxide group (27%) and the highest in the bisphosphonate group (41%). Bony attachment to the tooth root was divided approximately equally between attachment to intact cementum and to previously resorbed dentin. Overall, bisphosphonate resulted in a worse outcome than calcium hydroxide in terms of both root resorption and ankylosis.

Ureteral Avulsion Associated with Ureteroscopy: Insights from the MAUDE Database.

PubMed

Tanimoto, Ryuta; Cleary, Ryan C; Bagley, Demetrius H; Hubosky, Scott G

2016-03-01

Flexible and semirigid ureteroscopy (URS) are widely performed for the treatment of upper tract calculi and tumors. Ureteral avulsion is a rare, but devastating complication of endoscopic stone removal having multiple possible etiologies. Awareness and avoidance of this rare complication depend on identifying responsible mechanisms. This study examines the situations in which ureteral avulsion occurs as described anonymously in the Manufacturer and User facility Device Experience (MAUDE) database. The MAUDE database was systematically reviewed to account for all reported complications of flexible and semirigid URS. Keywords "ureteroscopy, injury, death, malfunction and other" were entered in the database and medical device reports were reviewed to capture any cases resulting in ureteral avulsion. Attention was paid to the type of ureteroscope involved and the mechanism for avulsion. A total of 104 entries were found detailing the reported complications of flexible and semirigid URS. Ureteral avulsion was clearly noted in six reports with flexible (2) and semirigid ureteroscopes (4). Potential mechanisms included locked deflection of a flexible ureteroscope (1), bunching of the distal bending rubber in a flexible ureteroscope (1), scabbard avulsion (3), and stone basketing (1). Although the incidence of ureteral avulsion cannot truly be determined from this study, some potentially novel mechanisms for this rare complication are observed. This may target future educational efforts to maximize awareness and avoidance of this complication.

Knowledge of general dentists in the current guidelines for emergency treatment of avulsed teeth and dental trauma prevention.

PubMed

de Vasconcellos, Luis Gustavo Oliveira; Brentel, Aline Scalone; Vanderlei, Aleska Dias; de Vasconcellos, Luana Marotta Reis; Valera, Márcia Carneiro; de Araújo, Maria Amélia Máximo

2009-12-01

A high prevalence of dental trauma exists and its effects on function and esthetics deserve the attention of general dentists. The aim of this study was to assess the level of general dental practitioners' (GDPs) knowledge about guidelines for dental avulsion and its prevention using a questionnaire. The 21-item questionnaire was distributed among 264 GDPs and the survey was realized between August-November 2006. The data obtained were statistically analyzed using descriptive analysis and Pearson's Chi-square test to determine associations between knowledge regarding emergency treatment and dentists from public or private dental schools and years of experience. The results showed that the participants exhibited appropriate knowledge concerning procedures in cases of tooth avulsion and its prevention. The number of correct answers was low in relation to recommended treatment at the site of injury. Storage medium, preparation of the alveolus and splint time for receiving the avulsed tooth received a high number of correct answers. One statistically significant association between years of experience and recommended treatment at the site of the injury in the case an avulsed tooth (chi(2) = 9.384, P = 0.009). In conclusion, this survey showed appropriate knowledge of dental avulsion management and its prevention among the surveyed dentists. The findings also showed that communication between dentists and the population is deficient, especially concerning practitioners of high risk and contact sports.

Proximal hamstring reconstruction using semitendinosus and gracilis autograft: a novel technique.

PubMed

Muellner, Thomas; Kumar, Sandeep; Singla, Amit

2017-01-01

The complete proximal hamstring avulsion is relatively uncommon injury and predominantly occurs in young athletes but causes significant functional impairment. In chronic cases, the muscle mass is so much retracted that primary repair is not possible. A surgical technique for reconstruction of chronic proximal hamstring avulsion using contralateral semitendinosus and gracilis autograft is described in this case report. V.

Isolated avulsion fracture of the first metatarsal base at the peroneus longus tendon attachment: a case report.

PubMed

Weinberg, Maxwell W; Krähenbühl, Nicola; Davidson, Nathan P; Hanrahan, Christopher J; Barg, Alexej

2018-05-01

Avulsion fractures of the first metatarsal (MT1) base at the peroneus longus (PL) tendon attachment are rare and may be undiagnosed during an emergency visit. If the injury is not treated properly, chronic pain or persistent impairment for inversion and plantar-flexion of the first ray may occur. This case report presents a 30-year-old woman who presented 10 weeks post trauma to a foot and ankle surgeon due to a swollen right midfoot with diffuse tenderness over the medial Lisfranc joint. Further evaluation showed an isolated avulsion fracture of the first metatarsal, which was undiagnosed during the emergent visit following the accident. In this case, the patient was successfully treated conservatively. The goal of this article is to raise awareness of this rare injury for radiologists and orthopedic surgeons.

Combined acromioclavicular joint dislocation and coracoid avulsion in an adult.

PubMed

Naik, Monappa; Tripathy, Sujit Kumar; Goyal, Saumitra; Rao, Sarath K

2015-05-20

Avulsion fracture of coracoid process with acromioclavicular joint dislocation is extremely rare. We report a case of coracoid avulsion with acromioclavicular disruption in a 24-year-old man who sustained injuries in a road traffic accident. Although acromioclavicular (AC) dislocation was obvious from an initial radiograph, coracoid avulsion was picked up in a CT scan. Open reduction and internal fixations of the coracoid with a 4 mm cannulated screw, an AC joint with two K-wires and an anchor suture, resulted in rapid recovery. The patient had complete range of shoulder movements at the end of 3 months and he resumed his professional activities. After 1 year, he had normal shoulder movement without any functional limitations. 2015 BMJ Publishing Group Ltd.

Combined acromioclavicular joint dislocation and coracoid avulsion in an adult

PubMed Central

Naik, Monappa; Tripathy, Sujit Kumar; Goyal, Saumitra; Rao, Sarath K

2015-01-01

Avulsion fracture of coracoid process with acromioclavicular joint dislocation is extremely rare. We report a case of coracoid avulsion with acromioclavicular disruption in a 24-year-old man who sustained injuries in a road traffic accident. Although acromioclavicular (AC) dislocation was obvious from an initial radiograph, coracoid avulsion was picked up in a CT scan. Open reduction and internal fixations of the coracoid with a 4 mm cannulated screw, an AC joint with two K-wires and an anchor suture, resulted in rapid recovery. The patient had complete range of shoulder movements at the end of 3 months and he resumed his professional activities. After 1 year, he had normal shoulder movement without any functional limitations. PMID:25994429

[Application of Halo-vest head ring in replantation of total scalp avulsion].

PubMed

Jian, Lin; Lizhi, Wu; Yuhua, Guo; Tianhao, Zhang; Shilin, Gu; Cheng, Wang; Zhongyi, Chen; Haixiao, Chen

2015-11-01

To investigate the clinical effect of Halo-vest head ring in the treatment of replantation of total scalp avulsion. We treated 11 cases of total scalp avulsion with the anastomosis of arteriovenous vessels and Halo-vest head ring from December 2006 to February 2015. One patient's replanted scalp got necrosis because of serious contusion which was healed without hair growth after free skin graft and dressing. All the scalp flaps in the other 10 patients survived. After 3-96 months follow-up, the wound completely healed, the scalp and hair grew well with satisfactory appearance. The use of Halo-vest head ring for replantation of total scalp avulsion can effectively improve the survival rate and survival area.

Morphometric and microscopic evaluation of the effect of a solution of alendronate as an intracanal therapeutic agent in rat teeth submitted to late reimplantation.

PubMed

Mori, Graziela Garrido; Garcia, Roberto Brandão; Gomes de Moraes, Ivaldo; Bramante, Clóvis Monteiro; Bernardineli, Norberti

2007-08-01

The use of substances that inhibit root resorption may be an alternative for cases of unsuccessful reimplants. Hence, the purpose of this study was to test a solution of alendronate, a resorption inhibitor, as an intracanal therapeutic agent for teeth submitted to late reimplantation. Thirty rat maxillary right central incisors were avulsed and kept dry for 30 min. The teeth were instrumented, and the root surfaces treated with 1% hypochlorite solution followed by application of 2% sodium fluoride. Thereafter, the teeth were divided in two groups according to the intracanal dressing: (i) group I, solution of alendronate and (ii) group II, calcium hydroxide paste. Teeth were then reimplanted in their respective sockets. The animals were killed at 15, 30 and 60 days after reimplantation and the samples processed for morphometric and microscopic analysis. The results demonstrated that the solution of alendronate and the calcium hydroxide paste limited the root resorption, yet did not impair its occurrence. It may be concluded that alendronate and calcium hydroxide paste demonstrated similar behavior.

Evaluation of nerve transfer options for treating total brachial plexus avulsion injury: a retrospective study of 73 participants

PubMed Central

Gao, Kai-ming; Hu, Jing-jing; Lao, Jie; Zhao, Xin

2018-01-01

Despite recent great progress in diagnosis and microsurgical repair, the prognosis in total brachial plexus-avulsion injury remains unfavorable. Insufficient number of donors and unreasonable use of donor nerves might be key factors. To identify an optimal treatment strategy for this condition, we conducted a retrospective review. Seventy-three patients with total brachial plexus avulsion injury were followed up for an average of 7.3 years. Our analysis demonstrated no significant difference in elbow-flexion recovery between phrenic nerve-transfer (25 cases), phrenic nerve-graft (19 cases), intercostal nerve (17 cases), or contralateral C7-transfer (12 cases) groups. Restoration of shoulder function was attempted through anterior accessory nerve (27 cases), posterior accessory nerve (10 cases), intercostal nerve (5 cases), or accessory + intercostal nerve transfer (31 cases). Accessory nerve + intercostal nerve transfer was the most effective method. A significantly greater amount of elbow extension was observed in patients with intercostal nerve transfer (25 cases) than in those with contralateral C7 transfer (10 cases). Recovery of median nerve function was noticeably better for those who received entire contralateral C7 transfer (33 cases) than for those who received partial contralateral C7 transfer (40 cases). Wrist and finger extension were reconstructed by intercostal nerve transfer (31 cases). Overall, the recommended surgical treatment for total brachial plexus-avulsion injury is phrenic nerve transfer for elbow flexion, accessory nerve + intercostal nerve transfer for shoulder function, intercostal nerves transfer for elbow extension, entire contralateral C7 transfer for median nerve function, and intercostal nerve transfer for finger extension. The trial was registered at ClinicalTrials.gov (identifier: NCT03166033). PMID:29623932

Evaluation of nerve transfer options for treating total brachial plexus avulsion injury: A retrospective study of 73 participants.

PubMed

Gao, Kai-Ming; Hu, Jing-Jing; Lao, Jie; Zhao, Xin

2018-03-01

Despite recent great progress in diagnosis and microsurgical repair, the prognosis in total brachial plexus-avulsion injury remains unfavorable. Insufficient number of donors and unreasonable use of donor nerves might be key factors. To identify an optimal treatment strategy for this condition, we conducted a retrospective review. Seventy-three patients with total brachial plexus avulsion injury were followed up for an average of 7.3 years. Our analysis demonstrated no significant difference in elbow-flexion recovery between phrenic nerve-transfer (25 cases), phrenic nerve-graft (19 cases), intercostal nerve (17 cases), or contralateral C 7 -transfer (12 cases) groups. Restoration of shoulder function was attempted through anterior accessory nerve (27 cases), posterior accessory nerve (10 cases), intercostal nerve (5 cases), or accessory + intercostal nerve transfer (31 cases). Accessory nerve + intercostal nerve transfer was the most effective method. A significantly greater amount of elbow extension was observed in patients with intercostal nerve transfer (25 cases) than in those with contralateral C 7 transfer (10 cases). Recovery of median nerve function was noticeably better for those who received entire contralateral C 7 transfer (33 cases) than for those who received partial contralateral C 7 transfer (40 cases). Wrist and finger extension were reconstructed by intercostal nerve transfer (31 cases). Overall, the recommended surgical treatment for total brachial plexus-avulsion injury is phrenic nerve transfer for elbow flexion, accessory nerve + intercostal nerve transfer for shoulder function, intercostal nerves transfer for elbow extension, entire contralateral C 7 transfer for median nerve function, and intercostal nerve transfer for finger extension. The trial was registered at ClinicalTrials.gov (identifier: NCT03166033).

Proximal Rectus Femoris Avulsion: Ultrasonic Diagnosis and Nonoperative Management

PubMed Central

Esser, Stephan; Jantz, David; Hurdle, Mark F.; Taylor, Walter

2015-01-01

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

Arthroscopically assisted reconstruction of triangular fibrocartilage complex foveal avulsion in the ulnar variance-positive patient.

PubMed

Kim, ByungSung; Yoon, Hong-Kee; Nho, Jae-Hwi; Park, Kang Hee; Park, Sung-Yong; Yoon, Jun-Hee; Song, Hyun Seok

2013-11-01

Our aim was to evaluate the clinical results of patients treated by arthroscopically assisted reconstruction of foveal avulsion injury of the triangular fibrocartilage complex (TFCC) using a suture anchor. We retrospectively reviewed the results of 15 patients (11 men and 4 women; mean age, 30.5 years) who underwent surgical procedures for the treatment of TFCC foveal avulsion at our hospital. The patients were followed up for a mean of 29 months. The patients had TFCC foveal avulsion caused by sprains (n = 8), falls (n = 4), playing baseball (n = 2), and a motor vehicle accident (n = 1). All the patients underwent magnetic resonance imaging. Radiographs obtained to assess ulnar variance (UV), ulnar-dorsal subluxation, and function of the wrist based on grip power; Disabilities of the Arm, Shoulder and Hand score; and Mayo wrist score were examined for all patients both preoperatively and postoperatively. On preoperative magnetic resonance imaging, TFCC foveal avulsion was observed in 13 of 15 cases. The mean UV value based on preoperative simple radiographic findings was 1.7 ± 1.0 mm, and dorsal subluxation at the distal ulna improved from 2.9 ± 3.0 mm to 0.2 ± 0.9 mm (P = .017). In all cases the distal radioulnar joint instability disappeared postoperatively. Grip power (compared with the uninvolved limb) was 79.3% preoperatively and 82.9% postoperatively (P = .086). The Disabilities of the Arm, Shoulder and Hand scores were 28.4 points preoperatively and 16.6 points postoperatively (P = .061). The Mayo wrist scores were excellent in 10 cases, good in 2, and fair in 3, and the mean score improved significantly from 64 points preoperatively to 84 points postoperatively (P = .007). Arthroscopic-assisted suture anchor reattachment of the TFCC in patients with traumatic TFCC foveal avulsion can prevent or reduce distal radioulnar joint instability and reduce pain even in chronic cases with positive UV. Level IV, therapeutic case series. Copyright © 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Meniscus root repair.

PubMed

Vyas, Dharmesh; Harner, Christopher D

2012-06-01

Root tears are a subset of meniscal injuries that result in significant knee joint pathology. Occurring on either the medial or lateral side, root tears are defined as radial tears or avulsions of the posterior horn attachment to bone. After a root tear, there is a significant increase in tibio-femoral contact pressure concomitant with altered knee joint kinematics. Previous cadaver studies from our institution have shown that root repair of the medial meniscus is successful in restoring joint biomechanics to within normal limits. Indications for operative management of meniscal root tears include (1) a symptomatic medial meniscus root tear with minimal arthritis and having failed non-operative treatment, and (2) a lateral root tear in associated with an ACL tear. In this review, we describe diagnosis, imaging, patient selection, and arthroscopic surgical technique of medial and lateral meniscus root injuries. In addition we highlight the pearls of repair technique, associated complications, post-operative rehabilitation regimen, and expected outcomes.

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

NASA Astrophysics Data System (ADS)

Sinha, R.; Kommula, S.

2010-12-01

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

Nerve transfer to relieve pain in upper brachial plexus injuries: Does it work?

PubMed

Emamhadi, Mohammadreza; Andalib, Sasan

2017-12-01

Patients with C5 and C6 nerve root avulsion may complain from pain. For these patients, end-to-side nerve transfer of the superficial radial nerve into the median nerve is suggested to relieve pain. Eleven patients (with a primary brachial plexus reconstruction) undergoing end-to-side nerve transfer of the superficial radial nerve into the ulnovolar part of the median nerve were assessed. Pain before surgery was compared to that at 6-month follow-up using visual analog scale (VAS) scores. A significant difference was seen between the mean VAS before (8.5) and after surgery (0.7) (P=0.0). After the six-month follow-up, 6 patients felt no pain according to VAS, notwithstanding 5 patients with a mild pain. The evidence from the present study suggests that end-to-side nerve transfer of the superficial radial nerve into the ulnovolar part of the median nerve is an effective technique in reducing pain in patients with C5 and C6 nerve root avulsion. Copyright © 2017 Elsevier B.V. All rights reserved.

Primary school teachers' knowledge regarding emergency management of avulsed permanent incisors.

PubMed

Touré, B; Benoist, F Léye; Faye, B; Kane, Aw; Kaadioui, S

2011-01-01

The goal of this study was to evaluate primary school teachers' knowledge regarding emergency management of avulsed permanent incisors. The study was conducted in fifty randomly chosen primary schools from Casablanca, Morocco. All teachers of the selected schools were included in the study. The data were collected by self administered questionnaires. The questions focused on the teachers' general characteristics, experience of avulsed teeth and the importance of emergency management. The data were analyzed using chi square test. A total of 501 teachers, of which 23.6% were male and 75.4% were female, answered the questionnaire. The results showed that 44.5 % of the teachers had an experience of avulsed tooth at school, 82.82% of them knew the importance of emergency management and 32.6% would look for a dentist for treatment of the cases. Only 15.8% would reimplant the tooth themselves. Regarding the storage media, 21.95% would keep the avulsed tooth in milk. There was no significant difference between gender and education level (p>0.05). This study shows school teachers' lack of knowledge regarding dental trauma and especially tooth avulsion. Therefore, the results indicated that educational programs are necessary for improvement in their level of knowledge.

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

PubMed

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

2006-02-01

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

Posterior root tear of the medial and lateral meniscus.

PubMed

Petersen, Wolf; Forkel, Philipp; Feucht, Matthias J; Zantop, Thore; Imhoff, Andreas B; Brucker, Peter U

2014-02-01

An avulsion of the tibial insertion of the meniscus or a radial tear close to the meniscal insertion is defined as a root tear. In clinical practice, the incidence of these lesions is often underestimated. However, several biomechanical studies have shown that the effect of a root tear is comparable to a total meniscectomy. Clinical studies documented progredient arthritic changes following root tears, thereby supporting basic science studies. The clinical diagnosis is limited by unspecific symptoms. In addition to the diagnostic arthroscopy, MRI is considered to be the gold standard of diagnosis of a meniscal root tear. Three different direct MRI signs for the diagnosis of a meniscus root tear have been described: Radial linear defect in the axial plane, vertical linear defect (truncation sign) in the coronal plane, and the so-called ghost meniscus sign in the sagittal plane. Meniscal extrusion is also considered to be an indirect sign of a root tear, but is less common in lateral root tears. During arthroscopy, the function of the meniscus root must be assessed by probing. However, visualization of the meniscal insertions is challenging. Refixation of the meniscal root can be performed using a transtibial pull-out suture, suture anchors, or side-to-side repair. Several short-term studies reported good clinical results after medial or lateral root repair. Nevertheless, MRI and second-look arthroscopy revealed high rates of incomplete or absent healing, especially for medial root tears. To date, most studies are case series with short-term follow-up and level IV evidence. Outerbridge grade 3 or 4 chondral lesions and varus malalignment of >5° were found to predict an inferior clinical outcome after medial meniscus root repair. Further research is needed to evaluate long-term results and to define evident criteria for meniscal root repair.

[Avulsion fracture of the calcaneal tuberosity in athletes].

PubMed

Glanzmann, M; Veréb, L; Habegger, R

2005-04-01

Avulsion fractures of the calcaneal tuberosity are rare injuries. Several surgical treatment options have been described. The size of the calcaneal fragment is the limiting factor in choosing the method for restoration. Finding the right type of fixation modality remains challenging in this rare kind of injury. In the case presented one Mitek Super Anchor was used to reattach the small fragment of the tuberosity to the calcaneus. Stable fixation with bony reunion and excellent functional outcome were achieved by this technique within 10 weeks. Therefore, we recommend the use of an anchor system for the treatment of small fragment calcaneal avulsion fractures.

Splenic Artery Avulsion in a High School Football Player: A Case Report

PubMed Central

Scherm, Michael J.

2004-01-01

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. PMID:15173873

Treatment options and outcome after bony avulsion of the flexor digitorum profundus tendon: a review of 29 cases.

PubMed

Halát, Gabriel; Negrin, Lukas; Erhart, Jochen; Ristl, Robin; Hajdu, Stefan; Platzer, Patrick

2017-02-01

The objective of this retrospective review was to evaluate the functional and esthetic outcomes in patients with non- or minimally (<2 mm), and severely (>2 mm) displaced bony avulsions of the flexor digitorum profundus (FDP) tendon. Between 1996 and 2010, 29 patients with a bony avulsion of the FDP tendon were treated. The displacement magnitude of the avulsed fragment determined, whether conservative or surgical treatment was performed. Persisting functional deficit, radiological findings, remaining disabilities using the Disability of the Arm, Shoulder, and Hand (DASH) score, as well as treatment-related deformities and complications were evaluated retrospectively and at a mean follow-up of 7 years. In 16 patients, conservative therapy by initial static splinting due to a fragment displacement of <2 mm was conducted. These patients reported no functional impairment at follow-up. In 13 cases, major displacement (>2 mm) of the bony fragment led to an open reconstruction of the avulsion injury either by screw fixation or a Lengemann pull-out wire. In a majority, an extension deficit in the DIP joint and a decrease of tip pinch strength by 25% was present at follow-up. In five patients, peri- or short-term postoperative complications occurred and in five, a nail deformity remained. DASH score revealed satisfying results after both therapeutic approaches. Conservative treatment in non- or minimally displaced avulsions leads to satisfying functional results. Patients receiving surgery after major fragment displacement need to be aware of a possible impaired ROM at the DIP joint. The use of the Lengemann pull-out wire may place patients at an increased complication risk and frequently induces nail deformities. Therapeutic, level IV.

Avulsion Fracture of the Calcaneus Treated With a Soft Anchor Bridge and Lag Screw Technique: A Report of Two Cases.

PubMed

Yoshida, Kazushige; Kasama, Kentaro; Akahane, Tsutomu

2016-01-01

The displaced extra-articular avulsion fracture of the calcaneus has been classified as a Böhler type 1c calcaneal fracture, and most cases will require surgical repair. In the present report, we describe 2 patients in whom we performed the soft anchor bridge technique using single loaded suture anchors with lag screws for the repair of Böhler type 1c avulsion fractures of the calcaneus. In one of these patients, clinically relevant osteoporosis complicated the injury. In both cases, bone union was achieved, and by 1.5 months after surgery satisfactory recovery was observed. To our knowledge, the soft anchor bridge technique was first used for the treatment of rotator cuff tears, and the greatest merit of this technique is the ability to generate vertical compression force to the pulled out rotator cuff through the use of knotting sutures. In recent years, the soft anchor bridge technique using 4 suture anchors has also been used for fractures of the greater tuberosity of the humerus, an injury that poses operative difficulties similar to those encountered with an avulsion fracture of the calcaneus owing to the traction force of the rotator cuff and relative weakness of adjacent bone. The outcomes of our patients suggest that the soft anchor bridge technique combined with adjunct lag screws is useful in the fixation of avulsion fractures of the calcaneus. In addition, the result in the elderly patient indicates the possibility of using this technique for patients with osteoporosis. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Post-traumatic Unilateral Avulsion of the Abducens Nerve with Damage to Cranial Nerves VII and VIII: Case Report.

PubMed

Yamasaki, Fumiyuki; Akiyama, Yuji; Tsumura, Ryu; Kolakshyapati, Manish; Adhikari, Rupendra Bahadur; Takayasu, Takeshi; Nosaka, Ryo; Kurisu, Kaoru

2016-07-01

Traumatic injuries of the abducens nerve as a consequence of facial and/or head trauma occur with or without associated cervical or skull base fracture. This is the first report on unilateral avulsion of the abducens nerve in a 29-year-old man with severe right facial trauma. In addition, he exhibited mild left facial palsy, and moderate left hearing disturbance. Magnetic resonance imaging (MRI) using fast imaging employing steady-state acquisition (FIESTA) revealed avulsion of left sixth cranial nerve. We recommend thin-slice MR examination in patients with abducens palsy after severe facial and/or head trauma.

Nonsurgical Clinical Management of Periapical Lesions Using Calcium Hydroxide-Iodoform-Silicon-Oil Paste

PubMed Central

Al Khasawnah, Qusai; Hassan, Fathi; Malhan, Deeksha; Engelhardt, Markus; Daghma, Diaa Eldin S.; Obidat, Dima; Lips, Katrin S.; Heiss, Christian

2018-01-01

Background The study aim is to avoid tooth extraction by nonsurgical treatment of periapical lesion. It assesses healing progress in response to calcium hydroxide-iodoform-silicon oil paste (CHISP). Numeric Pain Rating Scale was used to validate the approach. Furthermore, CHISP was used to treat cystic lesions secondary to posttraumatic avulsion of permanent teeth. Materials and Methods Over 200 patients with radicular cysts were treated with CHISP through the root canal. Radiographs were used to verify lesion size and position, ensure correct delivery to the site, and monitor the progress of bone healing in the lesion area. Ten males and 10 females were randomly selected for statistical assessment. Results No severe pain, complications, or failure in cyst healing was reported. Complete healing was achieved in an average of 75 days. Furthermore, healing of radicular cyst secondary to posttraumatic tooth avulsion was successful. Conclusion CHISP indicated an antiseptic effect, which enhanced and shortened healing time of periapical lesions. The less invasive procedure avoids tooth extraction and reduces bone resorption. Cyst management with CHISP can remedy failed root canal treatments. The results show a bone regenerative capacity of CHISP suggested in first rapid phase and a second slow phase. PMID:29619378

New Insights About Large-Scale Delta Morphodynamics from a Coupled Model of Fluvial-Coastal Processes

NASA Astrophysics Data System (ADS)

Murray, A. B.; Ratliff, K. M.; Hutton, E.

2017-12-01

We use a newly developed delta model to explore the combined effects of sea-level rise (SLR) and variable wave influence on delta morphology, avulsion behavior, and autogenic sediment flux variability. Using the Community Surface Dynamics Modeling System framework and tools, we couple the River Avulsion and Floodplain Evolution Model (RAFEM) to the Coastline Evolution Model (CEM). RAFEM models the fluvial processes, including river profile evolution, floodplain deposition, and avulsions. CEM uses gradients in alongshore sediment transport to distribute the fluvial sediment along the coastline. A suite of recent experiments using the coupled model and the Dakota software toolkit lead to several new insights: 1) A preferential avulsion location (which scales with the backwater length) can arise for geometric reasons that are independent of the recently suggested importance of alternation between flood and inter-flood periods. 2) The angular distribution of waves, as well as the wave height, affect the avulsion timescale. Previous work suggested that the time between avulsions will increase with greater wave influence, and we find that this is true for an angular mix of waves that tends to smooth a fairly straight coastline (coastline diffusion), where river mouth progradation is slowed and avulsions are delayed. However, if the angular distribution of waves leads to locally smooth shorelines but large amplitude coastline features (anti-diffusive coastline evolution), then avulsion timescales are barely affected, even when wave influence is high. 3) Increasing SLR rates are expected to cause more frequent avulsions, and it does in laboratory deltas. Unexpectedly, we find that this is not the case for the river-dominated deltas in our coupled model, in which SLR-related transgression effectively decreases progradation, offsetting base-level-rise effects. This finding raises potentially important questions about the geometric differences between prototypical and laboratory deltas that have not previously been addressed. 4) The magnitude and timescale of autogenic variability in the sediment flux at the river mouth depends on the SLR rate (for some wave climates), wave characteristics, and the how high the river channel must be super-elevated relative to the floodplain in order to trigger an avulsion.

Pure Varus Injury to the Knee Joint.

PubMed

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

2015-06-01

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

[Treatment of ulnar collateral ligament avulsion fracture of thumb metacarpophalangeal joint using a combination of Kirschner wire and silk tension band].

PubMed

Gao, Shunhong; Feng, Shiming; Jiao, Cheng

2012-12-01

To investigate the effectiveness of Kirschner wire combined with silk tension band in the treatment of ulnar collateral ligament avulsion fracture of the thumb metacarpophalangeal joint. Between September 2008 and October 2011, 14 patients with ulnar collateral ligament avulsion fracture of the thumb metacarpophalangeal joint were treated using a combination of Kirschner wire and silk tension band. There were 8 males and 6 females, aged 23-55 years (mean, 40.8 years). The causes of injury were machinery twist injury in 5 cases, manual twist injury in 4 cases, falling in 4 cases, sports injury in 1 case. The time from injury to operation was 2 hours-14 days. All the patients presented pain over the ulnar aspect of the metacarpophalangeal joint of the thumb, limitation of motion, and joint instability with pinch and grip. The lateral stress testing of the metacarpophalangeal joint was positive. Function training was given at 2 weeks after operation. All incisions healed by first intention. The lateral stress testing of the metacarpophalangeal joint was negative. All the patients were followed up 6-18 months (mean, 13.1 months). The X-ray films showed good fracture reduction and healing with an average time of 7 weeks (range, 4-10 weeks). At last follow-up, the thumbs had stable flexion and extension of the metacarpophalangeal joint, normal opposition function and grip and pinch strengths. According to Saetta et al. criteria for functional assessment, the results were excellent in 11 cases and good in 3 cases; the excellent and good rate was 100%. It is an easy and simple method to treat ulnar collateral ligament avulsion fracture of the thumb metacarpophalangeal joint using Kirschner wire combined with silk tension band, which can meet the good finger function.

Bifocal osseous avulsion of the patellar tendon from the distal patella and tibial tuberosity in a child.

PubMed

Hermansen, Lars L; Freund, Knud G

2016-03-01

This case report describes a 12-year-old boy, who suffered an injury to the right knee in a skateboard accident. Radiographs and surgery confirmed the extremely rare bifocal avulsion fracture including the distal patellar pole and tibial tuberosity. Open reduction and internal fixation was accomplished, and 4-month follow-up demonstrated a good outcome.

Neurotization of elements of the brachial plexus.

PubMed

Friedman, A H

1991-01-01

Satisfactory therapy for an avulsion injury of the brachial plexus has yet to be described. Dorsal root entry zone lesions will usually mitigate the searing pain which is so disabling in some of these patients. Neurotization procedures are effective in restoring limited function to these patients. The most useful isolated movement of the upper extremity is elbow flexion, which is thus the primary target of neurotization procedures. Intercostal nerves and elements of the cervical plexus are the most commonly used donor nerves for neurotization procedures. From our experience and from a review of the literature, it appears that these procedures will be successful in approximately 50% of cases. It must be stressed that before performing a nerve transfer, the surgeon must be certain that the patient is not a candidate for a simple nerve graft.

[Effectiveness of arthroscopic treatment of anterior cruciate ligament tibial eminence avulsion fracture with non-absorbable suture fixation combined with mini-plate].

PubMed

Wang, Suiyuan; Xiao, Yang; Tong, Zuoming; Li, Guiqiu; Jiang, Juhua; Yao, Jinghui; Wu, Zhiyong; Li, Tengfei; Wu, Qun

2013-09-01

To evaluate the surgical techniques and effectiveness of arthroscopic treatment of anterior cruciate ligament (ACL) tibial eminence avulsion fracture with non-absorbable suture fixation combined with the miniplate. Between January 2009 and March 2012, 32 patients with ACL tibial eminence avulsion fractures were treated. There were 18 males and 14 females, aged 12-40 years (mean, 17.5 years). The injury causes included traffic accident injury in 15 cases, sport injury in 6 cases, and falling injury in 11 cases. The time from injury to operation ranged 7-18 days with an average of 9.5 days. Before operation, the results of Lachman test were all positive; the Lysholm score was 52.13 +/- 4.22 and the International Knee Documentation Committee (IKDC) score was 44.82 +/- 2.44. According to Meyers-McKeever classification criteria, there were 12 cases of type II and 20 cases of type III. After arthroscopic poking reduction of fracture, tibial eminence avulsion fractures were fixed with the Ethibond non-absorbable sutures bypass figure-of-eight tibial tunnel combined with the metacarpal and phalangeal mini-plate. Primary healing was obtained in all incisions; no joint infection or skin necrosis occurred after operation. All patients were followed up with an average time of 22.4 months (range, 12-50 months). The patients showed negative Lachman test at 12 weeks after operation. Except 3 patients having knee extension limitation at last follow-up, the knee extension range of motion (ROM) was normal in the other patients; the knee flexion ROM was normal in all patients. The Lysholm score and IKDC score were significantly improved to 94.19 +/- 0.93 and 94.35 +/- 1.22 at last follow-up, showing significant differences when compared with preoperative values (t = 55.080, P = 0.000; t = 101.715, P = 0.000). The arthroscopic treatment of ACL tibial eminence avulsion fracture with Ethibond non-absorbable suture fixation combined with mini-plate is an effective procedure with the advantages of minimal trauma, reliable fixation, and satisfactory recovery of the knee joint function.

[MINIMALLY INVASIVE TREATMENT OF POSTERIOR CRUCIATE LIGAMENT AVULSION FRACTURE IN A FLOPPY LATERAL POSITION].

PubMed

Zhao, Junchao; Wang, Hao

2016-09-08

To conclude the effectiveness of arthroscopy combined with Burks and SchaVer's approach in the treatment of posterior cruciate ligament (PCL) avulsion fractures in a floppy lateral position. Between May 2010 and March 2014, 21 patients with PCL avulsion fractures were treated. There were 13 males and 8 females, aged 21 to 62 years (mean, 39.1 years). The causes included traffic accident injury in 10 cases, sports injury in 5 cases, and falling injury from height in 6 cases. The time from injury to hospital was 1-6 days (mean, 2.5 days). The results of posterior drawer test were all positive, and the results of anterior drawer test and lateral stress test were all negative. The Lysholm score was 28.0±5.5 before operation. And the American Orthopaedic Foot and Ankle Society (IKDC) score was 46.2±7.6 before operation. According to Meyer standards for fractures classification, 11 cases were rated as type II and 10 cases as type III. Arthroscopy was used to inspect and treat the intra-articular lesions, then avulsion fracture was fixed by Burks and SchaVer's approach in lateral position. Postoperative functional exercises were performed. Primary healing of incision was obtained, without nerve and vascular injury or joint infection. All patients were followed up 18-36 months (mean, 27.2 months). The X-ray films of the knee joint showed good fractures reduction and healing at 3 months after operation. The results of posterior drawer test and reverse Lachman test were negative. The knee range of motion was recovered to normal level. At last follow-up, the Lysholm score of the knee joint was significantly improved to 90.9±1.4 from preoperative one ( t =54.584, P =0.000), and the IKDC score was significantly increased to 90.5±5.3 from preoperative one ( t =15.638, P =0.000), including 19 cases of grade A and 2 cases of grade B. A combination of arthroscopy and Burks and SchaVer's approach for the treatment of PCL avulsion fractures in a floppy lateral position has the advantages of minimal invasion and safe approach, short operative time, and early postoperative rehabilitation exercises, so it can provide satisfactory function recovery of the knee joint.

[ARTHROSCOPIC TREATMENT OF ANTERIOR CRUCIATE LIGAMENT TIBIAL EMINENCE AVULSION FRACTURE IN ADOLESCENTS WITH EPIPHYSEAL UNCLOSURE].

PubMed

Liu, Yang; Sun, Xuebin; Zhang, Keyuan; Li, Gang; Ni, Jiati

2015-06-01

To evaluate the clinical results of arthroscopic treatment of anterior cruciate ligament (ACL) tibial eminence avulsion fractures in adolescents with epiphyseal unclosure. Between January 2011 and October 2013, 35 knees with ACL tibial eminence avulsion fractures (35 patients with epiphyseal unclosure) were arthroscopically treated with suture fixation. There were 25 males and 10 females, aged 8-16 years (mean, 14.7 years). The causes included sports injury in 24 cases, traffic accident injury in 9 cases, and daily life injury in 2 cases. According to Meyers-McKeever classification criteria, there were 27 cases of type II and 8 cases of type III. Five cases had meniscus injury. The preoperative the International Knee Documentation Committee (IKDC) score was 48.7 ± 3.2, and Lysholm score was 51.2 ± 4.5. The time from injury to operation was 2-16 days (mean, 5 days). Primary healing of incision was obtained in all patients. The mean follow-up time was 22.4 months (range, 12-32 months). Anatomical reduction was achieved in 28 cases and satisfactory reduction in 7 cases. X-ray films showed all fractures healing at last follow-up. There was no limb shortening deformity, varus knee, or valgus knee. Lachman test results were all negative. The other knees had normal range of motion except 1 knee with limited flexion, whose range of motion returned to 0-120° after treatment. At last follow-up, the IKDC score was significantly improved to 93.2 ± 4.1 (t = -53.442, P = 0.000), and the Lysholm score was significantly increased to 96.2 ± 2.5 (t = -56.242, P = 0.000). The arthroscopic fixation technique has satisfactory results for the reduction and fixation of ACL tibial eminence avulsion fracture in the adolescents with epiphyseal unclosure because of little trauma and quick recovery.

Tooth replantation after use of Euro-Collins solution or bovine milk as storage medium: a histomorphometric analysis in dogs.

PubMed

Sottovia, André Dotto; Sottovia Filho, Dagoberto; Poi, Wilson Roberto; Panzarini, Sônia Regina; Luize, Danielle Shima; Sonoda, Celso Koogi

2010-01-01

Euro-Collins solution was developed for the preservation of organs for transplantation, whose characteristics have raised interest for its use as a storage medium for avulsed teeth before replantation. This study evaluated histologically and morphometrically the healing process of dog teeth replanted after storage in Euro-Collins solution or bovine milk. Eighty roots of 4 young adult mongrel dogs were randomly assigned to 4 groups (n = 20) and the root canals were instrumented and obturated with gutta-percha and a calcium hydroxide-based sealer. After 2 weeks, the teeth were extracted and subjected to the following protocols: GI (negative control), replantation immediately after extraction; GII (positive control), bench-drying for 2 hours before replantation; GIII and GIV, immersion in 10 mL of whole bovine milk and Euro-Collins solution at 4 degrees C, respectively, for 8 hours before replantation. The animals were sacrificed 90 days postoperatively. The pieces containing the replanted teeth were subjected to routine processing for histologic and histometric analyses under light microscopy and polarized light microscopy. Root resorption was observed in all groups. GII exhibited the greatest loss of dental structure (P < .01), and inflammatory resorption was predominant in this group. Storage in milk showed poorer results than immediate replantation and storage in Euro-Collins solution (P < .01). The teeth stored in Euro-Collins solution presented similar extension of root resorption and periodontal ligament reorganization to those of immediately replanted teeth. The findings of this study suggest that the Euro-Collins solution is an adequate storage medium for keeping avulsed teeth for up to 8 hours before replantation.

16-Year follow-up of an avulsed maxillary central incisor after replantation following 10-h storage: An unusual case.

PubMed

Kırzıoğlu, Zuhal; Erken Güngör, Özge; Erdoğan, Yıldırım

2017-07-01

Tooth avulsion is a type of dental injury defined as the complete displacement of a tooth out of the alveolar socket, and the lack of prompt treatment measures can result in the loss of function, poor quality of life, and psychological and social problems. However, several factors may not permit the immediate replantation of an avulsed tooth; therefore, delayed replantation has emerged as an alternative to meet the esthetic, functional, and psychological demands of patients. Here it was described that the successful replantation of an avulsed maxillary central incisor in a 9-year-old boy who presented at the clinic with the tooth stored in unfavorable conditions as dry and then in olive oil-milk mixture almost 10 h after the event. The tooth has remained in its socket healthy for 16 years after treatment. The patient was satisfied with both esthetics and function. © 2017 Special Care Dentistry Association and Wiley Periodicals, Inc.

Histologic evaluation of the effect of mineral trioxide aggregate-Fillapex as a root canal sealer in rat teeth submitted to late replantation

PubMed Central

Ferreira, Manuel Marques; Botelho, Maria Filomena; Abrantes, Margarida; Carvalho, Lina; Carrilho, Eunice

2017-01-01

Objective: This study aims to analyze the effect of new root canal based silicate cement, in rat teeth after late replantation, comparing with calcium hydroxide (CH) in preventing tooth root resorption. Materials and Methods: The study group included 16 Wistar rats in which the upper right central incisors were extracted and were left on a worktable for 60 min, simulating a case of tooth avulsion, after had been anesthetized. One group, (Group I), the canals were filled with CH past, before replantation. The second groups of teeth, (Group II), the canals were filled with mineral trioxide aggregate-Fillapex (MTAF). After removal, the blood clot of the socket, with saline solution irrigation, the teeth were replanted into their original socket, and splinted with silk 3/0. The rats were sacrificed 8 weeks after replantation and the specimens were prepared for histologic and histomorphometric analyses. The areas of inflammatory and replacement resorptions were selected and quantified. These data for each group of teeth were evaluated and analyzed using the Mann–Whitney test (P = 0.05). Result and Conclusion: All the replanted teeth in both groups survived. Although root canal filled with MTAF provide better results than with CH past concerning inflammatory and replacement resorption, there was no statistical difference (P = 0.527). PMID:28435372

Avulsed Nasoenteric Bridle System Magnet as an Intranasal Foreign Body.

PubMed

Puricelli, Michael D; Newberry, Christopher Ian; Gov-Ari, Eliav

2016-02-01

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. © 2015 American Society for Parenteral and Enteral Nutrition.

Effect of zoledronic acid used in the root surface treatment of late replanted teeth: a study in rats.

PubMed

Mori, Graziela Garrido; Janjacomo, Daniela Maria de Mendonça; Nunes, Daniele Clapes; Castilho, Lithiene Ribeiro

2010-01-01

This study evaluated the use of zoledronic acid, a resorption inhibitor, as a medication for root resorption treatment of late replanted teeth. Twenty-four maxillary right central incisors of rats were avulsed and kept dry for 30 min. Then, the teeth were divided into 2 groups. In group I, root surface was treated with 2% sodium fluoride for 20 min; in group II, 10-6M zoledronic acid solution was used for 20 min. All root canals were filled with calcium hydroxide. Next, teeth were replanted in their respective sockets. After 15 and 60 days post-replantation, the animals were killed and the anatomic pieces were obtained and prepared for microscopic and morphometric analyses. The results showed that zoledronic acid was capable of limiting the occurrence of root resorption and preserving cementum resorption. Further research must be performed to confirm the use of zoledronic acid in root surface treatment of late replanted teeth.

Neglected lesser tuberosity avulsion in an adolescent elite gymnast

PubMed Central

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

2014-01-01

We report the case of a 16-year-old elite gymnast who presented with recurring pain in the left shoulder after training. The athlete recalled an injury to the shoulder 2 years ago. Clinically a localized tenderness to the anterior shoulder and loss of strength and range of motion was noted. Imaging investigation suggested a neglected lesser tuberosity avulsion. The athlete was treated with open excision of the deformed tuberosity and direct repair of the subscapularis to the humeral head. Following a careful postoperative rehabilitation protocol the athlete was able to return to unrestricted gymnastics after 6 months. After surgery the athlete followed a intense rehabilitation program that allowed him to return to sports at 6 months. At 5-years follow-up, the athlete was asymptomatic and competing at an international level. Avulsion fractures of the lesser tuberosity are extremely rare injuries with significant shoulder disability if left untreated. Anatomic repair can yield excellent results, even in neglected cases. PMID:27582934

[Ultrabraid SUTURE WITH FOOTPRINT RIVET FOR ANTERIOR CRUCIATE LIGAMENT TIBIAL EMINENCE AVULSION FRACTURE IN ADOLESCENTS UNDER ARTHROSCOPY].

PubMed

Liang, Jinying; Zheng, Jiapeng; Ll, Qiang; Zhong, Shuyu; Chen, Minzhen

2015-06-01

To investigate the clinical effects of the Ultrabraid suture with FOOTPRINT rivet by arthroscopic technique for the treatment of anterior cruciate ligament (ACL) tibial eminence avulsion fracture. Between May 2011 and December 2013, 19 adolescent patients with ACL tibial eminence avulsion fracture were treated with arthroscopic reduction and fixation by Ultrabraid sutures with FOOTPRINT rivet. There were 13 males and 6 females with an average age of 15.8 years (range, 8-18 years). The left knees were involved in 10 cases and the right knees in 9 cases. The injury causes included traffic accident injury in 8 cases, sport injury in 6 cases, and sprain injury in 5 cases. Three patients had old fractures, and the others had fresh fractures. The results of Lachman test and anterior drawer test were both positive. The International Knee Documentation Committee (IKDC) subject score was 54.2 ± 4.0. Based on Meyers-McKeever classification, there were 3 cases of type II, 10 cases of type III, and 6 cases of type IV. The operation time was 50-60 minutes (mean, 55.2 minutes). X-ray film showed satisfactory fracture reduction at 1 day after operation. Primary healing of incision was obtained with no infection. Eighteen patients were followed up for 1-3 years (mean, 1.7 years). All fractures healed with smooth joint surface on the X-ray film at 3 months after operation. The results of Lachman test and anterior drawer test were both negative in 17 cases, and the results was negative for anterior drawer test and was weakly positive for Lachman test in 1 case. The IKDC subject score was significantly improved to 96.1 ± 2.1 at last follow-up (t = 34.600, P = 0.000). It could achieve early restoration of knee joint function to treat the ACL tibial eminence avulsion fracture by arthroscopic technique of the Ultrabraid suture with FOOTPRINT rivet because of satisfactory reduction, reliable fixation, small wound, and early rehabilitation.

Medial Meniscal Root Avulsion: A Biomechanical Comparison of 4 Different Repair Constructs.

PubMed

Mitchell, Richard; Pitts, Ryan; Kim, Young-Mo; Matava, Matthew J

2016-01-01

To evaluate the time-zero load-to-failure strength of 4 different constructs used to repair medial meniscal root avulsions. Sixty fresh-frozen cadaveric knees with a mean age of 74 years were used for this study. Each knee was dissected to isolate the attachment of the posterior root of the medial meniscus to the tibial plateau. An Instron machine (Instron, Norwood, MA) with a custom-designed clamp was used to avulse the intact posterior meniscal root in 12 control specimens. An additional 48 specimens were tested after transection of the native meniscal root to evaluate the pullout strength of 4 different repair constructs using No. 0 FiberWire suture (Arthrex, Naples, FL): a single suture (n = 12), a double suture (n = 12), a loop stitch (n = 12), and a locking loop stitch (n = 12). Analysis of variance was used to compare load to failure and stiffness of all 4 groups; pair-wise, between-group differences were also assessed. Repair failure occurred most commonly by suture pullout in 94% of the specimens in the repair groups. For the controls, failure occurred most commonly at the meniscus-clamp interface. Failure load was highest for the control group (mean, 359.5 ± 168 N), followed in descending order by the locking loop stitch (191.4 ± 45.1 N), loop stitch (119.6 ± 55.0 N), double suture (96.2 ± 51.4 N), and single suture (58.2 ± 29.6 N). The control group was significantly stronger than 3 of the experimental groups (single suture [95% CI, 3.8 to 11.3], double suture [95% CI, 2.1 to 6.4], and loop stitch [95% CI, 2.0 to 4.5]; P < .0001) but not the locking loop stitch (P = .003; 95% CI, 1.2 to 3.2). The locking loop stitch was significantly stronger than the single suture (P < .0001; 95% CI, 2.0 to 5.4) and double suture (P = .003; 95% CI, 1.2 to 2.9). The locking loop stitch was significantly stiffer than the single suture (P < .0001; 95% CI, 3.8 to 20.3), double suture (P < .0001; 95% CI, 2.0 to 9.8), and loop stitch (P = .03; 95% CI, 1.1 to 5.5) but not significantly different from the control group (P = .93; 95% CI, 0.3 to 1.9). Age and gender had no effect on pullout strength. The results of this study show that the locking loop stitch provided time-zero load-to-failure strength that most closely approximated the strength of the native meniscal root in addition to being significantly stronger and stiffer than 3 other commonly used repair methods. The true strength of the native meniscal root is unknown based on limitations with our testing methodology. The locking loop stitch exhibited the highest load to failure and stiffness of the 4 fixation methods tested, despite the fact that none of the fixation methods replicated the strength of the intact meniscal root. It is currently unknown what strength of fixation is required for healing of meniscal root repairs. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Different patterns of lateral meniscus root tears in ACL injuries: application of a differentiated classification system.

PubMed

Forkel, Philipp; Reuter, Sven; Sprenker, Frederike; Achtnich, Andrea; Herbst, Elmar; Imhoff, Andreas; Petersen, Wolf

2015-01-01

Posterior lateral meniscus root tears (PLMRTs) affect the intra-articular pressure distribution in the lateral compartment of the knee. The biomechanical consequences of these injuries are significantly influenced by the integrity of the meniscofemoral ligaments (MFLs). A newly introduced arthroscopic classification system for PLMRTs that takes MFL integrity into account has not yet been clinically applied but may be useful in selecting the optimal method of PLMRT repair. Prospective ACL reconstruction data were collected. Concomitant injuries of the lateral meniscus posterior horn were classified according to their shape and MFL status. The classifications were: type 1, avulsion of the root; type 2, radial tear of the lateral meniscus posterior horn close to the root with an intact MFL; and type 3, complete detachment of the posterior meniscus horn. Between January 2011 and May 2012, 228 consecutive ACL reconstructions were included. Lateral and medial meniscus tears were identified in 38.2% (n = 87) and 44.7% (n = 102), respectively. Of the 87 lateral meniscus tears, 32 cases had PLMRTs; the overall prevalence of PLMRTs was 14% (n = 32). Two medial meniscus root tears were detected. All PLMRTs were classified according to the classification system described above, and the fixation procedure was adapted to the type of meniscus tear. The PLMRT tear is a common injury among patients undergoing ACL repair and can be arthroscopically classified into three different types. Medial meniscus root tears are rare in association with ACL tears. The PLMRT classification presented here may help to estimate the injury's impact on the lateral compartment and to identify the optimal treatment. These tears should not be overlooked, and the treatment strategy should be chosen with respect to the type of root tear. IV.

Biomechanical consequences of a posterior root tear of the lateral meniscus: stabilizing effect of the meniscofemoral ligament.

PubMed

Forkel, Philipp; Herbort, Mirco; Schulze, Martin; Rosenbaum, Dieter; Kirstein, Lars; Raschke, Michael; Petersen, Wolf

2013-05-01

The purpose of this study was to evaluate the effects of different types of lateral meniscus root tears in terms of tibiofemoral contact stress. Ten porcine knees each underwent five different testing conditions with the menisci intact, a simulated lateral posterior root tear with and without cutting the meniscofemoral ligament and with an artificial tear of the posterior root of the medial meniscus. Biomechanical testing was performed at 30° of flexion with an axial load of 100 N. A pressure sensor (st Sensor Type S2042, Novel, Munich) was used to measure the tibiofemoral contact area and the tibiofemoral contact pressure. Data were analyzed to assess the differences in contact area and tibiofemoral peak contact pressure among the five meniscal conditions. There was no significant difference in mean contact pressure between the state with the menisci intact and an isolated posterior root tear of the lateral meniscus. In case of a root tear and a tear of the meniscofemoral ligament, the contact area decreased in comparison with the intact state of the menisci. After additional cutting of the meniscofemoral ligament, the tibiofemoral contact pressure was significantly higher in comparison with the intact state and the avulsion injury. In the medial compartment, joint compression forces were significantly increased in comparison with the intact state after cutting the posterior root of the medial meniscus (P < 0.05). The consequence of a medial meniscus root tear is well known and was verified by this analysis. The results of the present study show that the biomechanical consequences of a lateral meniscus root tear depend on the state of the meniscofemoral ligament. An increase in tibiofemoral contact pressure is only to be expected in combined injuries of the meniscus root and the meniscofemoral ligaments. Posterior lateral meniscus root tear might have a better prognosis in terms of the development of osteoarthritis when the meniscofemoral ligament is intact.

Delayed replantation of rat teeth after use of reconstituted powdered milk as a storage medium.

PubMed

dos Santos, Cláudia Letícia Vendrame; Sonoda, Celso Koogi; Poi, Wilson Roberto; Panzarini, Sônia Regina; Sundefeld, Maria Lúcia Marçal Mazza; Negri, Márcia Regina

2009-02-01

Minimal extraoral dry storage period and moist storage for the avulsed tooth are identified as key steps for the treatment protocol of tooth replantation. Among the possible moist storage media, bovine milk has stood out because of its capacity of preserving the integrity of the periodontal ligament (PDL) fibers. This condition has attracted the attention to investigate the use of powdered milk, which is one of the presentation forms of bovine milk, as a feasible storage medium in cases of delayed tooth replantation. The aim of this study was to evaluate the healing process after delayed replantation of rat teeth stored in reconstituted powdered milk and long shelf-life (ultra high temperature) whole milk. Forty maxillary right rat incisors were assigned to four groups (n = 10): group I--the teeth were extracted and immediately replanted into theirs sockets; group II--the teeth were stored for 60 min in 200 ml of freshly reconstituted powdered milk; group III--the teeth were stored for 60 min in 200 ml of long shelf-life whole milk; group IV--the teeth were kept dry for the same time. All procedures were performed at room temperature. Next, the root canals of teeth in groups II, III, and IV were instrumented, filled with a calcium hydroxide-based paste, and replanted into their sockets. All animals received systemic antibiotic therapy and were killed by anesthetic overdose 60 days after replantation. The pieces containing the replanted teeth were removed, fixed, decalcified, and paraffin-embedded. Semi-serial 6-microm-thick sections were obtained and stained with hematoxylin and eosin for histomorphological analysis. There was statistically significant difference (P < 0.05) between groups I and IV regarding the presence of replacement resorption and PDL remnants on root surface. The powdered milk and long shelf-life whole milk presented similar results to each other and may be indicated as storage media for avulsed teeth.

Periodontal healing by periodontal ligament cell sheets in a teeth replantation model.

PubMed

Zhou, Yefang; Li, Yusheng; Mao, Ling; Peng, Hao

2012-02-01

Successful transplantation of avulsed teeth is to restore the attachment and regenerate the periodontal support. Different strategies have been applied in treatment from modification of teeth storage, antibiotic usage to peridontium tissue replacement. We developed a novel periodontal ligament cell-sheet delivery system to apply on delayed replanted teeth in promoting periodontal healing in a canine model. Autologous periodontal ligament (PDL) fibroblasts were isolated from extracted premolars of beagle dog. The cell-sheets were fabricated using normal culture dish after stimulation of extracellular matrix formation. Teeth were surgically extracted and attached soft tissues were removed. After root canal treatment, the root of teeth were wrapped by the PDL cell-sheets and replanted back to prior socket accordingly whilst teeth without cell sheets as a control. Eight weeks after surgery, the animals were sacrificed and decalcified specimens were prepared. Regeneration of periodontal tissue was evaluated through histology assay. Multi-layered PDL cell-sheet could be attached on tooth root and most cells on sheet-tooth constructs were viable before replantation. Minimum clinical signs of inflammation were observed in experiment. PDL cell-sheets group show significant higher occurrence of favourable healing (88.4%) than control group with low healing (5.3%). Periodontal ligament and cememtum tissue regeneration was observed in the experimental group, and the regenerated tissues showed high collagen type III, type I and fibronectin expression. The periodontal ligament cell-sheets fabricated through normal cell culture dish has a potential for regeneration of periodontal ligament and may become a novel therapy for avulsed teeth replantation. Copyright © 2011 Elsevier Ltd. All rights reserved.

Is it necessary to diagnose levator avulsion on pelvic floor muscle contraction?

PubMed

Dietz, H P; Pattillo Garnham, A; Guzmán Rojas, R

2017-02-01

Avulsion of the levator ani muscle commonly occurs at vaginal birth. This condition is usually diagnosed by translabial ultrasound (TLUS) during pelvic floor muscle contraction (PFMC). Some patients are unable to achieve a satisfactory PFMC and in these cases avulsion is assessed at rest. The aim of this study was to validate the diagnosis of levator avulsion by means of TLUS at rest. This was a retrospective study of 233 women seen at a tertiary urogynecological center. All women underwent four-dimensional TLUS in the supine position and after voiding. Volumes were obtained on maximal PFMC and at rest. Analysis of the volumes was performed with the observer blinded against all clinical data. Avulsion was defined as an abnormal levator ani muscle insertion that was visible in at least three consecutive axial plane slices, at and above the level of minimal hiatal dimensions, at 2.5-mm intervals. We examined the correlation between both assessment methods using Cohen's kappa coefficient and tested the association of each method with female pelvic organ prolapse on clinical examination, organ descent on ultrasound and hiatal ballooning. In total, datasets from 202 women were available for analysis. The correlation between a diagnosis of avulsion in volumes obtained at rest and those on PFMC was moderate, with a kappa value of 0.583 (95% CI, 0.484-0.683). Agreement for defects visualized on single slices was moderate, with a kappa value of 0.556 (95% CI, 0.520-0.591). When avulsion diagnoses at rest and on PFMC were tested against symptoms of prolapse, and prolapse on clinical examination and on ultrasound, neither of the two methods was superior. Although tomographic ultrasound imaging during PFMC enhances tissue discrimination, this may not translate to superior diagnostic performance. Hence, volumes obtained at rest may be used in women unable to contract their pelvic floor. The diagnosis of levator avulsion by tomographic pelvic floor ultrasound is equally valid when performed at rest or on PFMC. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.

Calcaneal apophyseal avulsion fracture.

PubMed

Imai, Yuuki; Kitano, Toshio; Nakagawa, Keisuke; Takaoka, Kunio

2007-07-01

Isolated fracture of the calcaneal apophysis is a rare injury in children and adolescents. In this study, we report on a case of a displaced calcaneal apophyseal avulsion fracture in a child treated with open reduction and internal fixation, as well as a review of the literature. A 9-year-old female child presented to the senior surgeon complaining of acute heel pain after a gymnastic injury. She was diagnosed with a displaced, isolated fracture of the proximal calcaneal apophysis for which she underwent open reduction and internal fixation. On the magnetic resonance imaging (MRI) examination, we could diagnose that her injury was not chronic but acute because there was no change of intensity in the metaphyseal area. A combination of bioabsorbable suture tacks and pins was used to anatomically fix the fragment using the tension band wiring technique. At 2 years and 6 months follow-up, she had full range of motion, complete return of strength. We report here on the successful surgical treatment and the first case evaluated by MRI of an avulsion fracture of the calcaneal apophysis in a child.

Use of GDNF-Releasing Nanofiber Nerve Guide Conduits for the Repair of Conus Medullaris/Cauda Equina Injury in the Non-Human Primate

DTIC Science & Technology

2012-10-01

peripheral nerve graft to bridge the tissue gap. A comprehensive set of electrodiagnostic, imaging , behavioral and anatomical studies will provide...spinal cord and avulsed ventral roots. All 20 surgeries have been completed and collections of comprehensive functional and imaging data are in...gap. A comprehensive set of electrodiagnostic, imaging , behavioral and anatomical studies will provide detailed information about the outcome of the

Concepts of nerve regeneration and repair applied to brachial plexus reconstruction.

PubMed

Bertelli, Jayme Augusto; Ghizoni, Marcos Flávio

2006-01-01

Brachial plexus injury is a serious condition that usually affects young adults. Progress in brachial plexus repair is intimately related to peripheral nerve surgery, and depends on clinical and experimental studies. We review the rat brachial plexus as an experimental model, together with its behavioral evaluation. Techniques to repair nerves, such as neurolysis, nerve coaptation, nerve grafting, nerve transfer, fascicular transfer, direct muscle neurotization, and end-to-side neurorraphy, are discussed in light of the authors' experimental studies. Intradural repair of the brachial plexus by graft implants into the spinal cord and motor rootlet transfer offer new possibilities in brachial plexus reconstruction. The clinical experience of intradural repair is presented. Surgical planning in root rupture or avulsion is proposed. In total avulsion, the authors are in favor of the reconstruction of thoraco-brachial and abdomino-antebrachial grasping, and on the transfer of the brachialis muscle to the wrist extensors if it is reinnervated. Surgical treatment of painful conditions and new drugs are also discussed.

An Autopsy Case of a Pregnant Woman With Severe Placental and Fetal Damage From Domestic Violence.

PubMed

Kanawaku, Yoshimasa; Takahashi, Shirushi; Kanetake, Jun; Funayama, Masato

2015-09-01

We present an autopsy case of a pregnant woman who was a victim of domestic violence. The deceased showed injuries mainly to her head and abdomen. Postmortem examination revealed 1400 mL of abdominal hemorrhage, ablation of the perimetrium, placental avulsion, and intracranial hematoma. The cause of death was diagnosed as hemorrhagic shock. The uterus contained a fetus of 7 months' gestational age. Fetal autopsy revealed laceration of the lungs, laceration and avulsion of the liver, and 15 mL of hemoperitoneum. Both placental and fetal injuries suggested repeated severe attacks to the abdomen, such as those expected to result from kicking or hitting.

Construction of avulsion potential zone model for Kulik River of Barind Tract, India and Bangladesh.

PubMed

Sarkar, Debabrata; Pal, Swades

2018-04-21

Avulsion is a natural fluvial process but considered it as a hazard in the populated region due to the chance of immense failure of lives and properties. So, early warning indicates that the zone of avulsion can facilitate the people living there. About 317 numbers of local and regional historical imprints of channel cutoff along river Kulik claim the need of this work. The present study tried to identify avulsion potential zone (APZ) of Kulik river of Indo-Bangladesh using multi-parametric weighted combination approach. Analytic hierarchy approach (AHP) is applied for weighting the used parameters. Avulsion potential model clearly exhibits that 9.51-km stream segment of middle and lower catchment is highly susceptible for avulsion especially during sudden high discharge and earthquake incidents. There is also high chance of channel avulsion following the existing Paleo-avulsion courses and left channels. Hard points can also be erected alongside the main channel for resisting channel avulsion propensity.

Open scapulothoracic dissociation.

PubMed

Fischer, P J; Kent, R B

2001-04-01

Scapulothoracic dissociation refers to the traumatic separation of the shoulder from the chest wall. This most commonly occurs as a closed injury. We present a case of open scapulothoracic dissociation and emphasize clinical features unique to this injury. In both closed and open scapulothoracic dissociation, the force necessary to shear the scapula from its thoracic attachments results in vascular disruption and neurologic injury to the upper extremity. As a consequence, patients have a pulseless, flail upper extremity with a significant chest wall hematoma (closed) or active bleeding (open). The first priority is to resuscitate and address life-threatening injuries. If the patient has active bleeding, immediate vascular control to prevent exsanguination is essential. Patients with ischemia and an incomplete injury or unreliable neurologic examination need revascularization. Outcome is based on the extent of brachial plexus or cervical nerve root avulsion. Patients with loss of neurologic function ultimately benefit from amputation at the appropriate level.

Characterizing avulsion stratigraphy in ancient alluvial deposits

NASA Astrophysics Data System (ADS)

Jones, H. L.; Hajek, E. A.

2007-11-01

Guidelines for identifying ancient avulsion deposits were set forth by Kraus and Wells [Kraus, M.J., Wells, T.M., 1999. Recognizing avulsion deposits in the ancient stratigraphical record. In: Smith, N.D., Rogers, J. (Eds.), Fluvial Sedimentology VI, Special Publication of the International Association of Sedimentologists, vol. 28, pp. 251-268], building on the study by Smith et al. [Smith, N.D., Cross, T.A., Dufficy, J.P., Clough, S.R., 1989. Anatomy of an avulsion. Sedimentology 36, 1-23] of the modern Saskatchewan River system (Cumberland Marshes, central Canada), and serve to characterize avulsion depositional sequences in the ancient Willwood and Fort Union Formations (Paleogene, Bighorn Basin, NW Wyoming, USA). We recognize, however, that the model is not universally applicable to avulsion-dominated successions, specifically systems which lack defining "heterolithic avulsion deposits", set forth by Kraus and Wells [Kraus, M.J., Wells, T.M., 1999. Recognizing avulsion deposits in the ancient stratigraphical record. In: Smith, N.D., Rogers, J. (Eds.), Fluvial Sedimentology VI, Special Publication of the International Association of Sedimentologists, vol. 28, pp. 251-268]. Observations in several fluvial intervals suggest that the avulsion stratigraphy outlined by Kraus and Wells [Kraus, M.J., Wells, T.M., 1999. Recognizing avulsion deposits in the ancient stratigraphical record. In: Smith, N.D., Rogers, J. (Eds.), Fluvial Sedimentology VI, Special Publication of the International Association of Sedimentologists, vol. 28, pp. 251-268] represents one category of avulsion stratigraphy found in the rock record, but does not capture the nature of avulsion deposits everywhere. Based on observations (using measured sections, outcrop photo-panels, and aerial photographs) in the Willwood Formation (Eocene, Wyoming) and Ferris Formation (Cretaceous/Paleogene, Wyoming), we present two end-member categories of avulsion stratigraphy in ancient deposits; stratigraphically abrupt, when a main paleochannel is stratigraphically juxtaposed directly atop floodplain/overbank deposits, and stratigraphically transitional, where crevasse splays and other non-floodplain/-overbank deposits stratigraphically precede a main paleochannel. This characterization provides a broader, more inclusive way to recognize and describe avulsion stratigraphy in ancient deposits and may be an important factor to consider when modeling connectivity in fluvial reservoirs. Furthermore, our observations show that one type of avulsion channel stratigraphy may prevail over another within an ancient basin, suggesting that system-wide factors such as splay-proneness or avulsion style (i.e. aggradational, incisional, etc.; [Slingerland, R., Smith, N.D., 2004. River avulsions and their deposits. Annual Review of Earth and Planetary Sciences 32, 257-285]) may be primary controls on the type of avulsion stratigraphy deposited and preserved in ancient basin-fills.

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

NASA Astrophysics Data System (ADS)

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

2013-12-01

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

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

PubMed

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

2016-08-01

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

Polish school nurses' knowledge of the first-aid in tooth avulsion of permanent teeth.

PubMed

Baginska, Joanna; Rodakowska, Ewa; Milewski, Robert; Wilczynska-Borawska, Magdalena; Kierklo, Anna

2016-03-09

The frequency of dental trauma in schools is secondary only to accidents at home. The aim of this study was to evaluate the knowledge of first aid in the avulsion of permanent teeth presented by Polish school nurses from different areas. A cross-sectional study with the use of a structured self-administrative questionnaire was conducted in 2014 on school nurses working in randomly selected Polish provinces. The instrument consisted of demographic questions, questions referring to nurses' experience and training in dental trauma and questions checking knowledge of first-aid in the avulsion of permanent teeth. The maximum number of points to be scored was eight. Data were analyzed with the Kruskal-Wallis, the Mann-Whitney U and Chi(2) tests with the level of statistical significance at p < 0.05. The final sample consisted of 164 nurses of which 70.1 % had experience with dental injuries and 45.7 % witnessed a tooth avulsion in pupils. 10.4 % nurses participated in training courses concerning tooth avulsion and 67.1 % of them independently broadened their knowledge. The knowledge of the first-aid management of an avulsed tooth was moderate (4.72 ± 1.95 points). 78.1 % of nurses chose a correct definition of the term of 'tooth avulsion'. Only 7.3 % of them were aware that the replantation could be conducted by any witness of an accident. Saline was most often chosen as a proper transport medium for an avulsed tooth (57.9 %), whereas 16.1 % of nurses indicated milk. 13.4 % of evaluated nurses showed readiness to conduct an immediate replantation. Most respondents preferred calling child's parents and advising them to bring the child to a dentist (63.4 %). The main factor influencing nurses' level of knowledge was self-education (p < 0.001). Being a witness to dental trauma (p = 0.0032) and working in schools with sports classes (p = 0.0423) were positive determinants of improved knowledge. Nurses from large agglomerations had significantly lower knowledge (p = 0.005). The main source of information for self-education was the Internet. The evaluated nurses were in need of education with regard to the management of dental trauma cases. The Internet should be used to deliver evidence-based knowledge to medical staff working at schools.

High prevalence of all complex Segond avulsion using ultrasound imaging.

PubMed

Klos, Burt; Scholtes, Marlon; Konijnenberg, Stephan

2017-04-01

The aim of this study was to determine the prevalence of a Segond avulsion fractures in acute ACL tears with ultrasound and to investigate whether other injuries can predict the avulsion. One hundred thirty-eight ultrasound analyses of acute knee trauma were collected and scored for diagnosed injuries. The reports of patients with an ACL tear (N = 87) were evaluated to determine possible increased prevalence of Segond avulsion fracture with ultrasound. The associations between the diagnosed injuries and presence of a Segond avulsion were scored. The sports carried out at the time of injury were evaluated as possible prognostic factor. In 25/87 (29%) of the patients with an ACL tear, a Segond avulsion was observed in ultrasound. Lateral femoral condyle (LFC) impaction showed the strongest individual association with a Segond avulsion and was the best predicting variable. LFC impaction, sustained during low-risk pivoting sport, shows a stronger association with a Segond avulsion, as compared to LFC impaction sustained during high-risk pivoting sports. Ultrasound shows a higher prevalence of Segond avulsions as literature shows with MRI or radiography. LFC impaction is the best variable in predicting this type of avulsion. Ultrasound examination should be considered, if this fracture was not diagnosed with MRI or radiographic analysis. IV.

Records of transient avulsion-related river patterns in ancient deposits: evidence for different styles of channel-floodplain coupling

NASA Astrophysics Data System (ADS)

Hajek, E. A.; Edmonds, D.; Millard, C.; Toms, L.; Fogaren, C.

2012-12-01

River mobility and avulsion are important controls on how course and fine sediment are distributed across alluvial basins. In some systems, broad distributary channel networks that form during channel avulsions contribute significantly to overbank aggradation within the basin and help transport relatively coarse sediment from the channel out onto the floodplain. In contrast, avulsion-related deposits are virtually absent in other systems, which primarily avulse either through incision or with no significant aggradational phase preceding channel relocation; in these systems, overbank sedimentation primarily comprises relatively fine floodplain deposits. In order to constrain the conditions under which distributary-channel networks develop during avulsions, we evaluate channel, avulsion, and floodplain deposits in several ancient units including the Ferris (Maastrichtian/Paleocene, Wyoming), Fort Union (Paleocene, Wyoming), Wasatch (Paleocene/Eocene, Colorado), and Willwood (Paleocene/Eocene, Wyoming) formations. Ancient deposits afford the opportunity to observe multiple (tens to hundreds) channel-avulsion realizations and evaluate characteristic spatial and temporal variability in channel, avulsion, and floodplain deposits within a basin. In each formation, spatial relationships and grain-size distributions of channel, proximal-overbank, distal-overbank, and, where present, avulsion deposits are compared. The thickness, width, and stratigraphic frequency of crevasse-splay and avulsion deposits are characterized in each formation, and paleosol development is documented in order to provide information about relative differences in floodplain conditions (particularly sedimentation rate and floodplain drainage) throughout each unit. We compare these results to modern systems and numerical models. Several formations contain abundant and distinctive evidence of prograding sediment wedges preceding avulsed channels (Willwood Formation and some members of the Wasatch formation), while others contain virtually no avulsion-associated deposits (Ferris Formation). The Fort Union Formation and one member of the Wasatch Formation show a mix of both. These results largely reflect depositional processes and not preservation bias within ancient deposits. Evidence from ancient deposits also suggests sediment partitioning between channels and floodplains was mediated by crevasse-splay production and avulsion, where some systems were "tuned" to produce large splay deposits and other systems produced only infrequent, small splays. Systems that readily produced splay deposits are associated with more prominent avulsion deposits, and splay production seems to be influenced by the particle-size distribution of sediment carried in the channel and floodplain drainage conditions (where abundant fine-sand and coarse-silt sediment and relatively well-drained floodplain conditions promote crevasse-splay production). Avulsion deposits reflect a transient distributary phase associated with a marked increase in local overbank sedimentation rates, but this phase is not ubiquitous to all avulsive systems. The persistence of conditions that promote or inhibit crevasse-splay and avulsion-deposit production may strongly influence channel-floodplain coupling in aggrading fluvial systems.

Late Glacial and Holocene avulsions of the Rio Pastaza Megafan (Ecuador-Peru): frequency and controlling factors

NASA Astrophysics Data System (ADS)

Bernal, Carolina; Christophoul, Frédéric; Darrozes, José; Soula, Jean-Claude; Baby, Patrice; Burgos, José

2011-10-01

The geomorphological study by means of remote sensing imagery of the Rio Pastaza Megafan (Ecuador and northern Peru) reveals the traces of numerous avulsions. One hundred and eight avulsion sites have been defined. The location of these sites, the available radiocarbon ages as well as historical maps of the seventeenth century, enable us to propose an evolution history of the migration and avulsions of the Rio Pastaza since the Last Glacial Maximum. The first avulsions of the Río Pastaza occurred after the LGM in a zone close to and roughly parallel to the sudandean front, where the developed avulsion gave a distributive pattern to the ancient stream of the Río Pastaza in an area located between the modern Río Morona and Pastaza, where they caused the Rio Pastaza to develop a fan-like distributary pattern. This is interpreted as a response to thrust-related forelimb tilt, progressively shifting eastward the Rio Pastaza and the apex of the megafan. This sequence of events ended with the Great Diversion of the Rio Pastaza towards the modern Rios Corrientes and Tigre. Avulsions occurred in the Tigre-Corrientes Area between 9200 and 8,500 years Cal BP. Afterwards, the Río Pastaza was diverted to its present-day north-south course. This last significant avulsion occurred before AD 1691. In the area located between the modern Río Morona and Pastaza, avulsion frequency—probably overestimated—ranges between 100 and 200 years. In the Ríos Tigre and Corrientes area, avulsion frequency—probably underestimated—ranges from 300 to 400 years. Regional tectonics is likely to have triggered most of the avulsions in the Morona Pastaza area but its influence is restricted to this area. The factors controlling the avulsions in the Tigre-Corrientes area are less clear because the frequently described "hydrologic"-driven avulsion as observed in areas characterized by contrasted hydrologic cycles are inconsistent with the characteristics of the hydrologic cycles of the Rio Pastaza.

A Quantitative Analysis of a Probiotic Storage Media for Avulsed Teeth

PubMed Central

2015-01-01

Aim The aim of the present in vitro study was to investigate the potential of a storage medium, probiotic yogurt (Bifidibacterium animalis DN 173010) in comparison with Hank's balanced salt solution (HBSS), saline and milk in maintaining viable periodontal ligament (PDL) cells on simulated avulsed teeth. Materials and methods Thirty-six freshly extracted single-rooted human teeth with closed apices were divided into six experimental groups (N=6). The teeth were extracted as atraumatically as possible and washed in sterile saline solution to eliminate residual blood. Following extractions, the coronal 3 mm of PDL tissues were scraped with a #15 scalpel to remove cells that may have been damaged. The positive and negative controls corresponded to 0 minutes and an 8-hour dry time, respectively. After extraction, the positive control teeth were immediately treated with dispase and collagenase. The negative control teeth were bench-dried for 8 h, with no follow-up storage solution time, and then placed in the dispase and collagenase. The number of viable protective least significant difference PDL cells were counted under a light microscope with a hemocytometer at 20× magnification and analyzed. Statistical analysis of the data was accomplished using Nonparametric ANOVA complemented by Kruskal-Wallis Test and Dunn's Multiple Comparisons Test. Results Positive control was found to be significantly better than the others, there were statistically significant differences between positive control and other test groups (p=0.000). The teeth stored in positive control demonstrated the highest number of viable PDL cells followed in order by probiotic yogurt, HBSS, saline and milk. Conclusion Bifidibacterium animalis DN 173010 seems to be an alternative for the temporary storage of avulsed teeth, due to high number of viable PDL cells. Probiotics may be suitable transport media for avulsed teeth, but further research is warranted using the commercially available products. PMID:27688382

Traumatic tracheal diverticulum corrected with resection and anastomosis during one-lung ventilation and total intravenous anesthesia in a cat.

PubMed

Sayre, Rebecca S; Lepiz, Mauricio; Wall, Corey; Thieman-Mankin, Kelley; Dobbin, Jennifer

2016-11-01

This report describes the clinical findings and diagnostic images of a traumatic intrathoracic tracheal avulsion with a tracheal diverticulum in a cat. Furthermore, a complete description of the tracheal resection and anastomosis using one-lung ventilation (OLV) with total and partial intravenous anesthesia is made. A 3-year-old neutered male domestic shorthair cat weighing 6.8 kg was presented to the University Teaching Hospital for evaluation of increased respiratory noise 3 months following unknown trauma. Approximately 12 weeks prior to presentation, the cat had been seen by the primary care veterinarian for respiratory distress. At that time, the cat had undergone a tracheal ballooning procedure for a distal tracheal stricture diagnosed by tracheoscopy. The tracheal ballooning had provided only temporary relief. At presentation to our institution, the cat had increased respiratory effort with harsh upper airway noise auscultated during thoracic examination. The remainder of the physical examination was normal. Diagnostics included a tracheoscopy and a thoracic computed tomographic examination. The cat was diagnosed with tracheal avulsion, pseudotrachea with a tracheal diverticulum, and stenosis of the avulsed tracheal ends. Surgical correction of the tracheal stricture via a thoracotomy was performed using OLV with total and partial intravenous anesthesia. The cat recovered uneventfully and at last follow-up was active and doing well. This case report describes OLV using standard anesthesia equipment that is available at most private practices. Furthermore, this case describes the computed tomographic images of the intrathoracic tracheal avulsion and offers a positive outcome for tracheal resection and anastomosis. © Veterinary Emergency and Critical Care Society 2015.

[Treatment of posterior cruciate ligament avulsion fracture with rivet-assisted hollow nail:a case-control study].

PubMed

Zhu, Jia-Fu; Ma, Gou-Ping; Xu, Wei-Xing; Guo, Qiao-Feng; Liu, Hong

2017-04-25

To retrospectively investigate the clinical effect of the rivet-assisted hollow screw in the treatment of posterior cruciate ligament avulsion fracture. Total 49 patients with knee cruciate ligament avulsion fracture in the ending point of the ligament from January 2010 to December 2014 were divided into the treatment group and the control group. Thirty-one patients in treatment group were treated with rivet-assisted double cannulate nail, including 13 males and 18 females, ranging in age from 38 to 51 years old, with a mean of (40.6±5.1) years old; according to Meyers classification, 23 cases of type 2, 8 cases of type 3; 5 patients were caused by the low energy injury and 26 patients were caused by the high energy injury. Eighteen patients in control group were treated with double gold hollow screw fixation, including 5 males and 13 females, ranging in age from 36 to 52 years old, with an average age of (4.16±4.7) years old; according to Meyers classification, 14 cases of type 2 and 4 cases of type 3;2 patients were caused by the low energy injury and 16 patients were caused by the high energy injury. The operation time, postoperative complications, fracture healing time and the last AKS scoring system were compared between the two groups. All the patients were followed up, and the duration ranged from 12 to 24 months, with an average of 14.2 months. The patients in treatment group had no displacement of fracture fragments and internal fixation failure. The results of AKS score:pain was 48.1±1.5, activity was 21.3±2.7, stability was 20.9±2.5, walking ability was 47.3±1.9, under the stairs ability was 43.4±2.1, the total score was 190.7±2.9. There were 2 cases in control group had fracture fragment displacement and 1 patient had nail withdraw. The results of AKS score:pain was 40.1±2.2, activity was 20.1±0.2, stability was 18.1±3.2, walking ability was 46.3±1.7, under the stairs ability was 40.2 ±1.3, the total score was 180.2±1.4. Therefore, the comparison of the above indicators, the results of the treatment group were better than those of the control group. Rivet-assisted hollow screw fixation in the treatment of cruciate ligament avulsion fracture in the ending, has some advantages such as follows:accurate reduction, less postoperative complications and better postoperative knee function recovery, therefore it is an effective way to treat posterior cruciate ligament avulsion fracture.

Early nerve repair in traumatic brachial plexus injuries in adults: treatment algorithm and first experiences.

PubMed

Pondaag, Willem; van Driest, Finn Y; Groen, Justus L; Malessy, Martijn J A

2018-01-26

OBJECTIVE The object of this study was to assess the advantages and disadvantages of early nerve repair within 2 weeks following adult traumatic brachial plexus injury (ATBPI). METHODS From 2009 onwards, the authors have strived to repair as early as possible extended C-5 to C-8 or T-1 lesions or complete loss of C-5 to C-6 or C-7 function in patients in whom there was clinical and radiological suspicion of root avulsion. Among a group of 36 patients surgically treated in the period between 2009 and 2011, surgical findings in those who had undergone treatment within 2 weeks after trauma were retrospectively compared with results in those who had undergone delayed treatment. The result of biceps muscle reanimation was the primary outcome measure. RESULTS Five of the 36 patients were referred within 2 weeks after trauma and were eligible for early surgery. Nerve ruptures and/or avulsions were found in all early cases of surgery. The advantages of early surgery are as follows: no scar formation, easy anatomical identification, and gap length reduction. Disadvantages include less-clear demarcation of vital nerve tissue and unfamiliarity with the interpretation of frozen-section examination findings. All 5 early-treatment patients recovered a biceps force rated Medical Research Council grade 4. CONCLUSIONS Preliminary results of nerve repair within 2 weeks of ATBPI are encouraging, and the benefits outweigh the drawbacks. The authors propose a decision algorithm to select patients eligible for early surgery. Referral standards for patients with ATBPI must be adapted to enable early surgery.

Avulsion of the fibular head post-total knee replacement.

PubMed

Phadnis, Ashish; Johnston, Phillip; Glasgow, Malcom

2007-11-01

We report a case of an avulsion of part of the fibular head during a primary total knee replacement for osteoarthritis. Post-operatively the patient developed a foot-drop. However, there was no clinically demonstrable instability of the knee. The patient was managed conservatively, the foot-drop recovered completely and the knee remained clinically stable. We observed that excessive hyperextension and/or a varus strain on the knee during pressurisation while cementing could have led to the injury. We advise caution while using this manoeuvre for pressurisation. This is the first injury of its kind reported in the literature.

A new surgical technique for traumatic dislocation of posterior tibial tendon with avulsion fracture of medial malleolus.

PubMed

Jeong, Soon-Taek; Hwang, Sun-Chul; Kim, Dong-Hee; Nam, Dae-Cheol

2015-01-01

We introduce a case of traumatic dislocation of the posterior tibial tendon with avulsion fracture of the medial malleolus in a 52-year-old female patient who was treated surgically with periosteal flap and suture anchor fixation. Based in the posteromedial ridge of the distal tibia, a quadrilateral periosteal flap was created and folded over the tendon, followed by fixation on the lateral aspect of the groove by use of multiple suture anchors. Clinical and radiological findings 25 months postoperatively showed well-preserved function of the ankle joint with stable tendon gliding.

Atypical Chronic Ankle Instability in a Pediatric Population Secondary to Distal Fibula Avulsion Fracture Nonunion.

PubMed

El Ashry, Saad R; El Gamal, Tarek A; Platt, Simon R

Chronic ankle instability is a disabling condition, often occurring as a result of traumatic ankle injury. A paucity of published data is available documenting chronic ankle instability in the pediatric population. Much of the data has been confined to the adult population. We present 2 cases of chronic ankle instability, 1 in a 12-year-old and 1 in a 9-year-old patient. Unlike the typical adult etiology, the cause of instability was a dysfunctional lateral ligamentous complex as a consequence of bony avulsion of the tip of the fibula. Both patients had sustained a twisting injury to the ankle. The fractures failed to unite. The nonunion resulted in dysfunction of the anterior talofibular ligament with consequent chronic ankle instability. At the initial clinical assessment, magnetic resonance imaging was requested for both patients. In patient 1 (12 years old), the fracture was fixed with 2 headless screws and was immobilized in a plaster cast for 6 weeks. In patient 2 (9 years old), because of the small size of the avulsed fragment, fixation was not possible. A modified Gould-Broström procedure was undertaken, facilitating repair of the avulsed fragment using anchor sutures. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Channel Evolution Following Avulsion: an Example from the Yellow River Delta

NASA Astrophysics Data System (ADS)

Zheng, S.

2017-12-01

Long-term field observation of morphological adjustments of rivers following avulsions is lacked when studying the evolution of avulsive channel on deltas. Avulsion at the Yellow River Delta (YRD) is frequent with average lifespan of channels of only about a decade. The Qing-shui-gou channel, the recent lobe on the YRD, provides a rare opportunity for investigating channel evolution following artificial avulsion. The reasons for its longer lifespan also needs investigation of the channel evolution. In this study, we comprehensively analyzed the geomorphic adjustment of the channel based on filed survey data during 1976-2014. The evolution of the channel was impacted by anthropogenic activities, including artificial avulsion at the downstream channel reaches in 1996, alteration of runoff and sediment load through Water and Sediment Regulation Scheme (WSRS), construction of levees and dikes. Analysis on channel geometry showed that avulsions in 1976 and in 1996 both caused short-term (1 2 years) erosion at the upstream channel reaches. Following the avulsion in 1976, massive aggradation occurred at the channel reaches at the downstream of the avulsion point. A single-thread channel gradually formed, widened and enlarged as channel bed under-cut on the deposition material. As delta extended seaward and the longitudinal slope decreased with time, aggradation occurred and an alluvial ridge formed. The ratio of lateral slope to the longitudinal slope (i.e. gradient advantage) and the relative super-elevation of the channel were calculated to estimate the possibility of avulsion at the channel in the late 1990. Results showed that the slope ratio was greater than 20 locally and super-elevation near its critical value for avulsion. The fact, that natural avulsion did not occurred despite of high values of gradient advantage and super elevation, may indicate that they are not sufficient conditions for avulsion at highly human-controlled rivers, where channel boundaries are constrained by dikes and bankfull discharge rarely occur. The Qing-shui-gou channel has been eroded and deepened since 2002 when the WSRS was implemented. Although channel erosion rates caused by WSRS decreased with time, the risk of avulsion has been reduced. This may also help explain the relative longer life-span of the Qing-shui-gou channel.

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

PubMed Central

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

2016-01-01

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

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

PubMed

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

2016-04-01

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

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

PubMed Central

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

2015-01-01

Objective To objectively and subjectively evaluate the functional result from before to after surgery among patients with a diagnosis of an isolated avulsion fracture of the posterior cruciate ligament who were treated surgically. Method Five patients were evaluated by means of reviewing the medical files, applying the Lysholm questionnaire, physical examination and radiological examination. For the statistical analysis, a significance level of 0.10 and 95% confidence interval were used. Results According to the Lysholm criteria, all the patients were classified as poor (<64 points) before the operation and evolved to a mean of 96 points six months after the operation. We observed that 100% of the posterior drawer cases became negative, taking values less than 5 mm to be negative. Conclusion Surgical methods with stable fixation for treating avulsion fractures at the tibial insertion of the posterior cruciate ligament produce acceptable functional results from the surgical and radiological points of view, with a significance level of 0.042. PMID:27218073

Avulsion of the puborectalis muscle is associated with asymmetry of the levator hiatus.

PubMed

Dietz, H P; Bhalla, R; Chantarasorn, V; Shek, K L

2011-06-01

To determine the degree of levator hiatal asymmetry in women with unilateral avulsion of the puborectalis muscle in order to estimate the likely effect of successful reconstruction. We reviewed datasets of women seen between May 2005 and January 2009 in a tertiary urogynecological unit. Archived ultrasound volume datasets were analyzed for hiatal dimensions and puborectalis muscle trauma in patients with unilateral avulsion. From 929 eligible datasets we identified 71 patients with isolated complete unilateral tears. Unilateral avulsion was associated with a significant increase in hiatal area (P ≤ 0.002). Relative to a hypothetical normal hiatus (intact hemi-area × 2), avulsion was associated with a larger hiatus on Valsalva maneuver (+2.1 cm(2) or 7%). Unilateral puborectalis muscle avulsion results in an asymmetric increase in the size of the levator hiatus. This increase is relatively minor, accounting for < 10% of hiatal area. Surgical repair of an avulsion may have only limited effects on hiatal dimensions. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd.

A Novel Approach for Effectively Treating SCI Pain, Improving Opioid Efficacy, and Preventing Opioid-Induced Constipation: Key Role of Toll-Like Receptor 4 (TLR4)

DTIC Science & Technology

2014-10-01

RESPONSIBLE PERSON USAMRMC a. REPORT U b. ABSTRACT U c. THIS PAGE U UU 17 19b. TELEPHONE NUMBER (include area code ) 2 Table of Contents...after dorsal root avulsion, during the acute stages of injury? 3b. SNAP surgery and testing (Hargreaves, motor function and constipation tests during the...first week post- surgery with co-administration of morphine and (+)-naltrexone (vs. vehicles) starting 1 or 24 hr post surgery ; von Frey and motor

Proteomic analysis of trans-hemispheric motor cortex reorganization following contralateral C7 nerve transfer

PubMed Central

Yuan, Yin; Xu, Xiu-yue; Lao, Jie; Zhao, Xin

2018-01-01

Nerve transfer is the most common treatment for total brachial plexus avulsion injury. After nerve transfer, the movement of the injured limb may be activated by certain movements of the healthy limb at the early stage of recovery, i.e., trans-hemispheric reorganization. Previous studies have focused on functional magnetic resonance imaging and changes in brain-derived neurotrophic factor and growth associated protein 43, but there have been no proteomics studies. In this study, we designed a rat model of total brachial plexus avulsion injury involving contralateral C7 nerve transfer. Isobaric tags for relative and absolute quantitation and western blot assay were then used to screen differentially expressed proteins in bilateral motor cortices. We found that most differentially expressed proteins in both cortices of upper limb were associated with nervous system development and function (including neuron differentiation and development, axonogenesis, and guidance), microtubule and cytoskeleton organization, synapse plasticity, and transmission of nerve impulses. Two key differentially expressed proteins, neurofilament light (NFL) and Thy-1, were identified. In contralateral cortex, the NFL level was upregulated 2 weeks after transfer and downregulated at 1 and 5 months. The Thy-1 level was upregulated from 1 to 5 months. In the affected cortex, the NFL level increased gradually from 1 to 5 months. Western blot results of key differentially expressed proteins were consistent with the proteomic findings. These results indicate that NFL and Thy-1 play an important role in trans-hemispheric organization following total brachial plexus root avulsion and contralateral C7 nerve transfer. PMID:29557385

The Geomorphic Role of Large Woody Debris in River Avulsions

NASA Astrophysics Data System (ADS)

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

2014-12-01

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

Posterior Root Meniscal Tears: Preoperative, Intraoperative, and Postoperative Imaging for Transtibial Pullout Repair.

PubMed

Palisch, Andrew R; Winters, Ronald R; Willis, Marc H; Bray, Collin D; Shybut, Theodore B

2016-10-01

The menisci play an important biomechanical role in axial load distribution of the knees by means of hoop strength, which is contingent on intact circumferentially oriented collagen fibers and meniscal root attachments. Disruption of the meniscal root attachments leads to altered biomechanics, resulting in progressive cartilage loss, osteoarthritis, and subchondral edema, with the potential for development of a subchondral insufficiency fracture. Identification of meniscal root tears at magnetic resonance (MR) imaging is crucial because new arthroscopic surgical techniques (transtibial pullout repair) have been developed to repair meniscal root tears and preserve the tibiofemoral cartilage of the knee. An MR imaging classification of posterior medial meniscal root ligament lesions has been recently described that is dedicated to the posterior root of the medial meniscus. An arthroscopic classification of meniscal root tears has been described that can be applied to the anterior and posterior roots of both the medial meniscus and the lateral meniscus. This arthroscopic classification includes type 1, partial stable root tears; type 2, complete radial root tears; type 3, vertical longitudinal bucket-handle tears; type 4, complex oblique tears; and type 5, bone avulsion fractures of the root attachments. Knowledge of these classifications and the potential contraindications to meniscal root repair can aid the radiologist in the preoperative reporting of meniscal root tear types and the evaluation of the tibiofemoral cartilage. As more patients undergo arthroscopic repair of meniscal root tears, familiarity with the surgical technique and the postoperative radiographic and MR imaging appearance is important to adequately report the imaging findings. © RSNA, 2016.

Hypovolemic Shock and Hemoperitoneum from Spontaneous Avulsion of a Large Pedunculated Uterine Leiomyoma.

PubMed

Mizrahi, Daniel J; Kaushik, Chhavi; Adamo, Robert

2017-03-01

Hemoperitoneum with hypovolemic shock from avulsion of a pedunculated leiomyoma is a rare but highly fatal condition that can occur spontaneously or as a result of trauma. We report a case of hemoperitoneum and hypovolemic shock secondary to a bleeding leiomyoma detected via computed tomography (CT) scan in a 39 year old premenopausal, gravida 0 female that presented with abdominal pain and became hemodynamically unstable in the emergency department. A preoperative bimanual exam revealed a mass consistent with a 20 week gestational uterus. Following fluid resuscitation, the patient underwent emergent myomectomy and ligation of the right uterine artery and was discharged home in good condition.

Landslide-induced river channel avulsions in mountain catchments of southwest New Zealand

NASA Astrophysics Data System (ADS)

Korup, Oliver

2004-11-01

Pulsed or chronic supply of landslide debris to valley floors has historically caused substantial aggradation and channel instability in several alpine catchments of SW New Zealand. In this regional investigation of landslide impacts on river morphology, three types of landslide-induced channel avulsion are discerned: (i) upstream/backwater avulsions, (ii) contact avulsions, and (iii) downstream/loading avulsions. The basis for this qualitative geomorphic process-response framework is the principal direction of fluvial response with respect to its position relative to the causative landslide emplacement site. Downstream avulsions have the highest damage potential to land use and infrastructure on unconfined mountain-fringe alluvial fans. In the wake of such events, catastrophic aggradation may obliterate up to several km 2 of mature floodplain forests by burial under several metres within a few decades. Estimates of mean aggradation rates are high (<220 mm year -1) and exceed long-term (10 3 year) trends of fluvial degradation by an order of magnitude. Future potential avulsion routeways may be detected by geomorphic mapping of abandoned channels, which are preferentially reactivated in the wake of landslide-induced sediment waves.

Clinical and Practical Implications of Storage Media used for Tooth Avulsion.

PubMed

Is Khinda, Vineet; Kaur, Gurpreet; S Brar, Gurlal; Kallar, Shiminder; Khurana, Heena

2017-01-01

Replantation is being widely accepted as an effective treatment option for an avulsed tooth. However, the long-term fate of replanted teeth is unpredictable; it is dependent on various factors, such as the time interval between avulsion and replantation, extra-alveolar storage period (dry storage or storage media), the vitality status of pulp or periodontal tissues and the type and period of splinting. The appropriate use of storage media is an important clinical factor affecting the postoperative prognosis of avulsed teeth following replantation. Hank's balanced salt solution and pasteurized milk are considered to be the most appropriate and clinically recommended storage media for avulsed teeth. The present review discusses the various available storage media for avulsed teeth and their potential maintenance of the vitality of periodontal ligament cells. A brief overview of the effect of clinical factors, such as the storage time, pH, and the osmolar-ity of storage media on their efficacy is included. Khinda VIS, Kaur G, Brar GS, Kallar S, Khurana H. Clinical and Practical Implications of Storage Media used for Tooth Avulsion. Int J Clin Pediatr Dent 2017; 10(2): 158-165.

The effects of topical application of bisphosphonates on replanted rat molars.

PubMed

Choi, Sung Chul; Kwon, Yong-Dae; Kim, Kwang Chul; Kim, Gue-Tae

2010-12-01

The purpose of this study was to evaluate the potential usefulness of two bisphosphonates (BPs) (etidronate and zoledronate), compared with that of alendronate, which is a well-known drug for delayed replantation, in decreasing or preventing inflammatory root resorption and replacement root resorption in replanted teeth. Eighty-four Sprague Dawley rat maxillary first molars were extracted, dried for 60 min and then replanted after root treatment. The rats were divided into four groups (control, alendronate, etidronate, zoledronate) as following treatments of avulsed root before replantation. At 7, 14, and 28 days postreplantation, the animals were sacrificed and the samples obtained and process for microscopic analysis. The data were statistically analyzed with the SPSS procedure, anova test and each test was complemented by the Tukey's post hoc test. The result indicated that topical application of alendronate and zoledronate, both nitrogen containing BPs, prevented inflammatory root resorption and inflammatory cell response in the delayed replantation model. Both drugs were demonstrated similar effects in the delayed tooth replantation model (P = 0.9). Etidronate did not prevent inflammatory root resorption and inflammation in the delayed replantation (P < 0.05). No significant differences in replacement root resorption were observed among all drugs. These results suggest that when teeth are dried and not replanted immediately, zoledronate, like alendronate, may prevent root resorption and facilitates the regeneration of periodontal tissues after replantation. © 2010 John Wiley & Sons A/S.

Repair of Acute Superficial Deltoid Complex Avulsion During Ankle Fracture Fixation in National Football League Players.

PubMed

Hsu, Andrew R; Lareau, Craig R; Anderson, Robert B

2015-11-01

Infolding and retraction of an avulsed deltoid complex after ankle fracture can be a source of persistent increased medial clear space, malreduction, and postoperative pain and medial instability. The purpose of this descriptive case series was to analyze the preliminary outcomes of acute superficial deltoid complex avulsion repair during ankle fracture fixation in a cohort of National Football League (NFL) players. We found that there is often complete avulsion of the superficial deltoid complex off the proximal aspect of the medial malleolus during high-energy ankle fractures in athletes. Between 2004 and 2014, the cases of 14 NFL players who underwent ankle fracture fixation with open deltoid complex repair were reviewed. Patients with chronic deltoid ligament injuries or ankle fractures more than 2 months old were excluded. Average age for all patients was 25 years and body mass index 34.4. Player positions included 1 wide receiver, 1 tight end, 1 safety, 1 running back, 1 linebacker, and 9 offensive linemen. Average time from injury to surgery was 7.5 days. Surgical treatment for all patients consisted of ankle arthroscopy and debridement, followed by fibula fixation with plate and screws, syndesmotic fixation with suture-button devices, and open deltoid complex repair with suture anchors. Patient demographics were recorded with position played, time from injury to surgery, games played before and after surgery, ability to return to play, and postoperative complications. Return to play was defined as the ability to successfully participate in at least 1 full regular-season NFL game after surgery. All NFL players were able to return to running and cutting maneuvers by 6 months after surgery. There were no significant differences in playing experience before surgery versus after surgery. Average playing experience before surgery was 3.3 seasons, 39 games played, and 22 games started. Average playing experience after surgery was 1.6 seasons, 16 games played, and 15 games started. Return to play was 86% for all players. There were no intraoperative or postoperative complications noted, and no players had clinical evidence of medial pain or instability at final follow-up with radiographic maintenance of anatomic mortise alignment. Superficial deltoid complex avulsion during high-energy ankle fractures in athletes is a distinct injury pattern that should be recognized and may benefit from primary open repair. The majority of NFL players treated surgically for this injury pattern are able to return to play after surgery with no reported complications or persistent medial ankle pain or instability. Level IV, retrospective case series. © The Author(s) 2015.

Knowledge and attitude of some nigerian school teachers on the emergency management of avulsed permanent incisor.

PubMed

Olatosi, O O; Iwuala, S O; Isiekwe, G I; Oredugba, F A; Adenaike, A S; Oluwo, A O

2013-01-01

Tooth avulsion has been known to be the most severe of all dental injuries. The immediate action taken at the accident site will determine the prognosis of the tooth. Replantation of an avulsed tooth is the treatment of choice. To assess the knowledge and attitude of primary and secondary (Basic educational) school teachers on the emergency management of avulsed permanent incisors. Twenty public and private basic educational schools were randomly selected from Lagos State. Descriptive cross-sectional study. A 23 item self administered questionnaire was distributed to teachers to determine their knowledge and attitude on the emergency management of avulsed permanent incisors. Data was analysed using SPSS (Statistical Package for Social Sciences), Version 21.0. The responses obtained were tabulated and expressed as frequency distributions and then computed in percentages. Chi-square was used to test the association between knowledge of the schools teachers regarding the emergency management of avulsed permanent incisors and their socio-demographic variables. Multivariate analysis was used to adjust for confounding variables. The level of significance was set at P ≤0.05. A total of 320 teachers answered the questionnaires. Most of the teachers were female (63.1%). Only (30.9%) had received first aid training which included emergency management of dental trauma. Forty- two percent (134) didn't know that an avulsed permanent tooth could be replanted. Twenty teachers (44.4%) would clean an avulsed tooth with toothbrush and toothpaste. A greater proportion of the respondents 130 (40.6%) would transport an avulsed tooth using a clean white handkerchief. The overall knowledge of the school teachers was poor (84%).There was a statistically significant association between the knowledge of the school teachers and the inclusion of emergency management of dental trauma in the first aid training of the teachers P=0.05. Predictors of teachers' level of knowledge of emergency management of avulsed teeth were receipt of advise on management of traumatic dental injuries (OR= 2.5, CI=1.19-4.28) and type of school (OR=0.93, CI=0.206-0.750). The school teachers had insufficient knowledge about the emergency management of avulsed permanent teeth. School oral health campaigns with regards to emergency management of avulsed teeth will help improve teachers' knowledge and modify their behaviour.

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

NASA Astrophysics Data System (ADS)

An Heyvaert, Vanessa Mary; Baeteman, Cecile

2008-12-01

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

Replantation of an avulsive amputation of a foot after recovering the foot from the sea.

PubMed

Yüksel, F; Karacaoğlu, E; Ulkür, E; Güler, M M

2000-04-01

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.

Fracture of the fabella.

PubMed

Woo, C C

1988-10-01

A very rare case of traumatic avulsion fracture of the fabella in a middle-age lady, presented as intermittent posterolateral localized knee pain accentuated by compression against the lateral femoral condyle and by active and passive knee extension, is illustrated. The accumulated chronic microtrauma of the osteoarthritic fabello femoral joint in this lady especially during the whip-kick of daily breaststroke swimming for over 30 yr, may precipitate a fabella stress fracture. Radiographs reveal bilateral fabellae with a left bipartite fabella as a stress fracture traversing it without displacement; this later became a completely displaced bipartite avulsion fracture after accidental knee hyperextension. Conservative treatment consisted of anti-inflammatory/analgesic cream, cryotherapy, TENS, strapping and avoiding knee hyperextension.

Avulsion fracture of an ossified pes anserinus tendon post-lateral patellar dislocation.

PubMed

Albtoush, Omar M; Taib, Abtehag A; Horger, Marius; Springer, Fabian

2018-05-01

The pes anserinus is a common tendon comprising the tendinous insertions of the sartorius, gracilis, and semitendinosus muscles. It inserts at the anteromedial aspect of the tibia and plays a significant role in stabilization of the medial side of the knee joint. The current article presents a case with recurrent lateral patellar dislocations causing chronic stress along the medial knee stabilizers and consecutive enthesophyte formation at the insertion of the pes anserinus tendon that showed a transverse fracture upon a subsequent incident of traumatic lateral patellar dislocation. Avulsion injuries of the pes anserinus tendon are rarely encountered, and to our knowledge, association with recurrent lateral patellar dislocations has not been described before.

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

PubMed

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

2012-12-01

The Himalayan black bear (Ursus thibetanus or Selenarctos thibetanus), although an omnivore, is more carnivorous than its American counterpart. It is also more aggressive towards humans and is a threatened species because of the deforestation in the Himalayas. Furthermore, poverty, encroachment of the forest, extensive deforestation, lack of education and living near the forest are factors that increase the probability of such animal injuries. We report the case of a 35-year-old woman who suffered a severe penetrating head injury with scalp and bilateral eye avulsion, which was managed successfully. © 2012 The Authors. EMA © 2012 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

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

PubMed Central

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

2015-01-01

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

Use of platelet-rich fibrin as an autologous biologic rejuvenating media for avulsed teeth - an in vitro study.

PubMed

Hiremath, Hemalatha; Kulkarni, Sadanand; Sharma, Robin; Hiremath, Vishwanath; Motiwala, Tejas

2014-12-01

The prognosis of replanted avulsed tooth depends on the existence of viable cells in the periodontal ligament and also on those cells which are able to proliferate on the damaged areas of the root. The purpose of this study was to evaluate the survival of periodontal ligament cells (PDL) when soaked in an autologous biologic rejuvenating media after an extra-oral dry time of 40 min. Thirty teeth were selected with intact crown which were advised for Orthodontic extraction having healthy PDL. They were divided into two experimental and two control groups. The positive and negative controls corresponded to 0-min and 1-h dry time, respectively. The experimental teeth were stored dry for 40 min and then immersed in one of the two media, combination of platelet-rich fibrin and platelet poor plasma (PRF+PPP) and PPP for 45 min. The teeth in each group were treated with dispase II and collagenase for 30 min and later centrifuged for 5 min at 50.17 g. The supernatant was removed with sterile micropipette, the cells labelled with 0.4% trypan blue, and the number of viable PDL cells was counted with a haemocytometer, under a light microscope. anova and Mann-Whitney U-test demonstrated statistically significant differences in the viability of PDL cells among experimental groups. Within the parameters of this study, a combination of platelet-rich fibrin and PPP demonstrated higher number of viable PDL cells and hence could be a good biologic rejuvenating media for avulsed teeth. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Achilles tenodesis for calcaneal insufficiency avulsion fractures associated with diabetes mellitus.

PubMed

Choi, Youngrak; Kwon, Young-Woo; Sim, Young-Suk; Kim, Taeho; Song, Dayoung; Lee, Soohyun

2017-12-13

Calcaneal insufficiency avulsion (CIA) fractures often present with neuropathic etiology, such as Charcot neuroarthropathy (CN). Under the same surgical procedures, the outcomes of CIA fractures are less desirable, compared to the outcomes of the traumatic calcaneal avulsion fractures. Here, the study suggests Achilles tenodesis technique using suture anchor after resection of the CIA fracture fragments could provide satisfactory clinical results in the cases of surgically indicated CIA fractures. This retrospective study included seven patients of calcaneal avulsion fracture who had underlying diabetes mellitus (DM) and no specific traumatic event. The patients were treated with Achilles tenodesis techniques for their CIA fractures. Achilles tenodesis was performed using suture anchor with removal of the fracture fragments. The patients were evaluated with the Foot and Ankle Outcome Score (FAOS), visual analogue scale (VAS), single-heel rise test, and X-ray images on their final follow-ups. Initially, three of the CIA fracture cases treated with traditional open reduction and internal fixation reported pullout failure. Consequently, all patients received Achilles tenodesis using suture anchor after bone fragment resection and had good clinical outcomes. Only one subject with low compliance reported poor outcome. The FAOS of each patient were obtained at a mean of 16.3 months after surgery. The results are as follows: pain 80.6 (SD = 6.2), symptom 83.8 (SD = 4.9), activities of daily living 80.5 (SD = 8.0), sport and recreation function 75.6 (SD = 11.93), and foot- and ankle-related quality of life 77.9 (SD = 6.7). On their final follow-ups, the average VAS was 2.6 (range, 1 to 4). Achilles tenodesis using suture anchor after bone fragment resection achieved competent clinical results in the patients with CIA fractures. The study proposes that this surgical procedure could be an appropriate treatment option for patients with CIA fractures. The study was approved by the institutional review board (IRB) of our medical center (IRB File No. 2016-07-043), retrospectively registered.

Life cycles of traumatized teeth: long-term observations from a cohort of dental trauma victims.

PubMed

Heithersay, G S

2016-03-01

Life cycles of dental trauma victims can provide important clinical information, especially when viewed over many years. In this first series of life cycles, the pulp and periodontal responses to traumatic injuries of four patients are documented over periods varying from 26 to 51 years. The dynamics of pulp survival following an intrusive luxation and two avulsions are followed, with particular reference to pulp canal calcification to which a new term, root canal stenosis, has been proposed. The life cycles include the successful management of inflammatory root resorption in a replanted tooth with an open apex contrasting with the early prophylactic endodontic treatment of two replanted teeth in a patient with mature apices. The long-term development of invasive cervical resorption in one of the patient's life cycle highlights the importance of ongoing follow-up examinations for dental trauma victims. © 2016 Australian Dental Association.

Different functional reorganization of motor cortex after transfer of the contralateral C7 to different recipient nerves in young rats with total brachial plexus root avulsion.

PubMed

Pan, Feng; Wei, Hai-feng; Chen, Liang; Gu, Yu-dong

2012-12-07

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. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Tooth Avulsion in the School Setting

ERIC Educational Resources Information Center

Krause-Parello, Cheryl A.

2005-01-01

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

Autogenic erosional surfaces on backwater-mediated deltas from floods and avulsions

NASA Astrophysics Data System (ADS)

Ganti, V.; Chadwick, A. J.; Lamb, M. P.; Fischer, W. W.; Trower, L.

2016-12-01

Erosional surfaces provide key bounds on the architecture of fluvio-deltaic stratigraphy and are attributed to relative sea level fall and sediment supply changes modulated by secular changes in climate; however, major knowledge gap exists in detangling the record of internal sedimentary dynamics from that of allogenic forcings. Recent work suggests that river flood variability through persistent backwater hydrodynamics exerts a primary control on lobe-scale avulsions on deltas, and floods and avulsions play an important role in driving transient channel incision even in deltas experiencing net aggradation. Here, we identify and quantify two autogenically generated mechanisms that result in erosional boundaries within fluvio-deltaic stratigraphy, namely, flood-induced and avulsion-induced scours. We developed a theoretical model based on mass conversation that suggests that flood-induced scours resulting from river drawdown propagate approximately one backwater length (Lb) from the shoreline, and the scour depth is maximum near the shoreline and scales with flood variability and the bankfull depth (hbf). Avulsion-induced scours result from river steepening due to shortening of the new river path. This mechanism results in an erosional pulse whose maximum depth scales with the critical in-channel sedimentation that induces an avulsion (scales with hbf) and initiates at the avulsion site and propagates upstream by Lb. Together, autogenically generated erosional scours can extend 1-2Lb from the shoreline and their depths are a function of hbf and flood variability. We validate these theoretical predictions using a recent experiment of river delta evolution governed by persistent backwater hydrodynamics under constant sea level conditions. Finally, we reinterpret outcrop scale observations within the Castlegate sandstone, Utah—type example for sequence stratigraphy—and show that field observations are consistent with scours resulting from floods and avulsions alone.

Prospective multicentre study of the clinical and functional outcomes following quadriceps tendon repair with suture anchors.

PubMed

Mille, F; Adam, A; Aubry, S; Leclerc, G; Ghislandi, X; Sergent, P; Garbuio, P

2016-01-01

Quadriceps tendon avulsions are typically treated by reattaching the tendon through bone tunnels, with or without tendon or hardware augmentation. The operated knee joint can be moved right away; however, tendon grafting or tension banding will be required to protect the repair, and the hardware must be removed later on. The goal of this study was to evaluate the clinical and functional outcomes when suture anchors are used to reattached torn quadriceps tendon, and also to assess tendon healing using MRI. Thirteen consecutive patients with avulsed quadriceps tendons were operated and then followed prospectively. The surgical technique consisted of tendon reattachment using at least three anchors, in addition to intratendinous weaving of the sutures. Weight bearing was allowed while using a splint. Rehabilitation was initiated immediately after surgery according to a set protocol. Eleven patients were followed for a mean of 14.7 months. Two retears occurred in patients who did not wear the splint. Eighty-two per cent of patients were satisfied or very satisfied with the outcome. The mean knee flexion was 124.5°. All patients were able to return to their pre-injury activity levels. The mean time for clinical and functional recovery was 3 months. MRI performed 6 months after the surgical repair revealed good tendon healing. This was the first prospective study performed on quadriceps avulsion patients undergoing suture anchor repair. Prior clinical case reports have shown that this method leads to predictable clinical and functional results. Our results were comparable to those in published cases. The procedure is simpler when only suture anchors are used. Tendon healing was observed on MRI in all cases. This simple, reproducible technique is free of the drawbacks associated with the typical repair augmentation.

Ischiofemoral impingement and hamstring dysfunction as a potential pain generator after ischial tuberosity apophyseal fracture non-union/malunion.

PubMed

Spencer-Gardner, Luke; Bedi, Asheesh; Stuart, Michael J; Larson, Christopher M; Kelly, Bryan T; Krych, Aaron J

2017-01-01

The purpose of this study was to describe the occurrence of ischiofemoral impingement (IFI) and hamstring dysfunction following malunion or non-union of ischial tuberosity apophyseal avulsion fractures and report the short-term outcomes of surgical treatment with regard to alleviating symptomatic extra-articular impingement. All patients who underwent surgery for recalcitrant hip and buttock pain in the setting of prior ischial tuberosity avulsion fracture at three tertiary-level hip preservation centres were included for this review. A total of ten patients met our inclusion criteria and underwent sciatic neurolysis, resection of the ischial tuberosity fragment and hamstring reattachment. Clinical outcomes scores were collected post-operatively including the Modified Harris Hip Score (mHHS) and the Hip Outcomes Score (HOS). Ten patients with a mean age of 18 years (range 14-28) underwent surgery for symptomatic ischiofemoral impingement after ischial tuberosity avulsion fracture. At a mean of 2.2-year follow-up (range 1.7-3.5), the median post-operative mHHS was 89.7 (65.7-96.8) and HOS ADL and Sport subscales were 90 % or greater in all cases. Five patients (50 %) rated their hip as normal, and five patients (50 %) rated their hip as near normal. Malunion or non-union following ischial tuberosity apophyseal fracture can lead to IFI and hamstring dysfunction. Clinically, the resultant pain and dysfunction is often chronic, and can be debilitating. In select cases, a reliable surgical technique is presented to improve hamstring function and correct ischiofemoral impingement in this setting with good-to-excellent outcomes in the majority of cases at short-term follow-up. IV.

Child neurology: Brachial plexus birth injury: what every neurologist needs to know.

PubMed

Pham, Christina B; Kratz, Johannes R; Jelin, Angie C; Gelfand, Amy A

2011-08-16

While most often transient, brachial plexus birth injury can cause permanent neurologic injury. The major risk factors for brachial plexus birth injury are fetal macrosomia and shoulder dystocia. The degree of injury to the brachial plexus should be determined in the neonatal nursery, as those infants with the most severe injury--root avulsion--should be referred early for surgical evaluation so that microsurgical repair of the plexus can occur by 3 months of life. Microsurgical repair options include nerve grafts and nerve transfers. All children with brachial plexus birth injury require ongoing physical and occupational therapy and close follow-up to monitor progress.

Repair of Double Head Pectoralis Major Tendon Avulsion into its Native Footprint Using Bi-cortical EndoButtons and Tendon Sliding Technique.

PubMed

Prabhu, Jagadish; Faqi, Mohammed Khalid; Alkhalifa, Fahad; Tayara, Bader Kamal; Awad, Rashad Khamis

2017-01-01

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.

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

NASA Astrophysics Data System (ADS)

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

2014-05-01

The Mesopotamian alluvial plain is dominated by large aggradading river systems (the Euphrates, Tigris and their tributaries), which are prone to avulsions. An avulsion can be defined as the diversion of flow from an existing channel onto the floodplain, eventually resulting in a new channel belt. Early civilizations depended on the position of rivers for their economic survival and hence the impact of channel shifts could be devastating (Wilkinson 2003; Morozova 2005; Heyvaert & Baeteman 2008). Research in the Iranian deltaic part of the Mesopotamian plain has demonstrated that deliberate human action (such as the construction of irrigation canals and dams) triggered or obstructed the alluvial processes leading to an avulsion on fluvial megafans (during preconditioning, triggering and post-triggering stages) (Walstra et al. 2010; Heyvaert et al. 2012, Heyvaert et al.2013). Thus, there is ample evidence that the present-day alluvial landscapes in the region are the result of complex interactions between natural and anthropogenic processes. Here we present a reconstruction of the Late Holocene evolution of the Diyala alluvial fan (one of the main tributaries of the Tigris in Iraq), with particular attention to the relations between alluvial fan development, changes in channel pattern, the construction of irrigation networks and the rise and collapse of societies through historic times. The work largely draws on the use of remote sensing and GIS techniques for geomorphological mapping, and previously published archaeological field data (Adams 1965). By linking archaeological sites of known age with traces of ancient irrigation networks we were able to establish a chronological framework of alluvial activity of the Diyala alluvial fan. Our results demonstrate that centralized and technologically advanced societies were able to maintain a rapidly aggradading distibutary channel system, supplying water and sediment across the entire alluvial fan. As a consequence, during these periods (Parthian, Sasanian and again in modern times), significant human modification of the landscape took place. Periods of societal decline are associated with reduced human impact and the development of a single-threaded incising river system. Adams, R.M. (1965). Land behind Baghdad: A history of settlement on the Diyala plains. University of Chicago Press, Chicago, Illinois. Heyvaert, V.M.A. & Baeteman, C. (2008). A Middle to Late Holocene avulsion history of the Euphrates river: a case study from Tell ed-D-er, Iraq, Lower Mesopotamia. Quaternary Science Reviews, 27, 2401-2410. Heyvaert, V. M. A., Walstra, J., Verkinderen, P., Weerts, H. J. T. & Ooghe, B. (2012). The role of human interference on the channel shifting of the river Karkheh in the Lower Khuzestan plain (Mesopotamia, SW Iran). Quaternary International, 251, 52-63. Heyvaert, V.M.A., Walstra, J., Weerts, H.J.T. (2013). Human impact on avulsion and fan development in a semi-arid region: examples from SW Iran. Abstractbook of the 10th International Fluvial Sedimentology Conference, July 2013,Leeds, United Kingdom. Morozova, G.S. (2005). A review of Holocene avulsions of the Tigris and Euphrates rivers and possible effects on the evolution of civilizations in lower Mesopotamia. Geoarchaeology, 20, 401-423. Walstra, J., Heyvaert, V. M. A. & Verkinderen, P. (2010). Assessing human impact on alluvial fan development: a multidisciplinary case-study from Lower Khuzestan (SW Iran). Geodinamica Acta, 23, 267-285. Wilkinson, T.J. (2003). Archaeological Landscapes of the Near East. The University of Arizona Press, Tucson, Arizona.

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

PubMed Central

2014-01-01

Background Studies evaluating dental assistants’ knowledge about tooth avulsion and its management are rare. The purpose of this study was to evaluate the level of knowledge about tooth avulsion and its management among dental assistants in Riyadh, Saudi Arabia and to assess its relationship with their educational background. Methods A convenience sampling methodology was employed for sample selection. Over a period of four months starting in February, 2013, 691 pretested 17-item questionnaires were distributed. A total of 498 questionnaires were returned for an overall response rate of 72.1%. Six questions were related to knowledge about permanent tooth avulsion and one question was related to knowledge about primary tooth avulsion. Correct answers to these questions were assigned one point each, and based on this scoring system, an overall knowledge score was calculated. An analysis of covariance was used to test the association between the level of knowledge (total score) and the educational qualifications of the respondents (dental degree and others). A P-value of 0.05 was considered the threshold for statistical significance. Results The majority of the respondents (n = 387; 77.7%) were non-Saudis (377 were from the Philippines), and 79.1% (n = 306) of the Filipinos had a dental degree. The question about recommendations for an avulsed tooth that is dirty elicited the highest number of correct responses (n = 444; 89.2%), whereas the question about the best storage media elicited the lowest number of correct responses (n = 192; 38.6%). The overall mean score for knowledge about tooth avulsion was 6.27 ± 1.74. The mean knowledge score among the respondents with a dental degree was 6.63 ± 1.37, whereas that among the respondents with other qualifications was 5.71 ± 2.08. Conclusions The educational qualifications of the surveyed dental assistants were strongly correlated with the level of knowledge about tooth avulsion and its management. PMID:24885584

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

PubMed

Halawany, Hassan Suliman; AlJazairy, Yousra Hussain; Alhussainan, Nawaf Sulaiman; AlMaflehi, Nassr; Jacob, Vimal; Abraham, Nimmi Biju

2014-05-06

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

Knowledge of the management of paediatric dental traumas by non-dental professionals in emergency rooms in South Araucanía, Temuco, Chile.

PubMed

Díaz, Jaime; Bustos, Luís; Herrera, Samira; Sepulveda, Jaqueline

2009-12-01

The objective of this study was to investigate the level of knowledge and attitudes regarding first aid for dental trauma in children (TDI) by non-dental professionals and paramedical technicians of hospital emergency rooms in the South Araucanía Health Service, Chile, which was attained through application of a survey. Samples were collected from people with occupations in the respective emergency rooms. The participants were 82 people that were interviewed using a questionnaire regarding management of dental trauma. Paramedic technicians, general and specialist doctors, and nurses were included in this survey. The appraisal covered diverse aspects: birth date, age, sex, years of experience in the emergency room, and questions regarding specific dental trauma topics, which focused on crown fractures, luxation injuries in permanent dentition, avulsion in primary and permanent teeth, and the respective emergency treatments. Of the participants, 78.1% reported to have been presented with a TDI patient. The majority (90.2%) had not received formal training on TDI. These results revealed a wide distribution of responses. The overall dental trauma knowledge among the participants was relatively poor. For crown fractures management 54.9% indicated that they would ask the affected child about the crown remnants. In regard to transport and storage medium of avulsed permanent teeth, only 9.8% of the participants answered correctly and 43.9% of respondents stated that they would not replant an avulsed permanent tooth, since that procedure is considered the responsibility of a dentist. The majority of the respondents were not knowledgeable regarding TDI or the management and benefits of timely care, particularly in cases of avulsed permanent teeth. Therefore, formal education and training on the topic is suggested during undergraduate studies.

Dural closure for the treatment of superficial siderosis.

PubMed

Egawa, Satoru; Yoshii, Toshitaka; Sakaki, Kyohei; Inose, Hiroyuki; Kato, Tsuyoshi; Kawabata, Shigenori; Tomizawa, Shoji; Okawa, Atsushi

2013-04-01

Superficial siderosis (SS) of the CNS is a rare disease caused by repeated hemorrhages in the subarachnoid space. The subsequent deposition of hemosiderin in the brain and spinal cord leads to the progression of neurological deficits. The causes of bleeding include prior intradural surgery, carcinoma, arteriovenous malformation, nerve root avulsion, and dural abnormality. Recently, surgical treatment of SS associated with dural defect has been reported. The authors of the present report describe 2 surgically treated SS cases and review the literature on surgically treated SS. The patients had dural defects with fluid-filled collections in the spinal canal. In both cases, the dural defects were successfully closed, and the fluid collection was resolved postoperatively. In one case, the neurological symptoms did not progress postoperatively. In the other case, the patient had long history of SS, and the clinical manifestations partially deteriorated after surgery, despite the successful dural closure. In previously reported surgically treated cases, the dural defects were closed by sutures, patches, fibrin glue, or muscle/fat grafting. Regardless of the closing method, dural defect closure has been shown to stop CSF leakage and subarachnoid hemorrhaging. Successfully repairing the defect can halt the disease progression in most cases and may improve the symptoms that are associated with CSF hypovolemia. However, the effect of the dural closure may be limited in patients with long histories of SS because of the irreversibility of the neural tissue damage caused by hemosiderin deposition. In patients with SS, it is important to diagnose and repair the dural defect early to minimize the neurological impairments that are associated with dural defects.

Reconstruction of massive facial avulsive injury, secondary to animal bite.

PubMed

Motamed, Sadrollah; Niazi, Feizollah; Moosavizadeh, Seyed Mehdi; Gholizade Pasha, Abdolhamid; Motamed, Ali

2014-02-01

Management of facial soft tissue trauma requires complex reconstruction surgery. Animal bite on face is a common cause of facial tissue trauma with severe destruction. Evaluation of unit involvement is the first effort, followed by designation of reconstruction. In this case, we performed multiple reconstruction options.

Mallet finger - aftercare

MedlinePlus

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 ...

Small flake, big problem: an unreported cause of extensor pollicis longus tendon rupture.

PubMed

Durrant, C A T; Bantick, G

2010-01-01

Fracture of the base of the third metacarpal with associated avulsion of the extensor carpi radialis brevis tendon is a rare injury. We report such a fracture and the unusual resulting complication of division of the extensor pollicis longus tendon by the avulsed bony fragment. Careful monitoring using lateral radiographs is needed to make the diagnosis and displacement of the avulsed fragment warrants open reduction and internal fixation.

Double Outlet Right Ventricle With Intact Ventricular Septum: Avulsion or Exclusion.

PubMed

Menon, Sabarinath; Kumar, C J Ashok; Mathew, Thomas; Venkateshwarn, S; Jayakumar, K; Dharan, Baiju S

2016-03-01

Double outlet right ventricle (DORV) is almost always associated with a ventricular septal defect. The variant of DORV with intact ventricular septum is very uncommon and may be associated with fetal demise or death immediately after birth. Reports of successful palliation of these patients to the stage of superior cavopulmonary anastomosis (bidirectional Glenn shunt) are rare. We describe the case of a child with DORV with intact ventricular septum who underwent successful palliation. This condition often provides a diagnostic, interventional, and surgical challenge. Patients generally require either balloon atrial septostomy or surgical atrial septectomy for survival, with the addition of a Blalock-Tausig shunt or pulmonary artery band depending on the pulmonary blood flow. Very few patients survive to a Glenn procedure. For those who do survive, a decision must be made regarding the management of the hypertensive and hypoplastic left ventricle (LV) and associated mitral regurgitation. The LV can be excluded by either mitral valve avulsion or closure (exclusion) of the mitral valve with a patch. The choice of the technique should be carefully made and depends in part on the size of the LV. In our patient, who was successfully palliated by bidirectional Glenn shunt, the LV was managed by means of mitral valve avulsion. © The Author(s) 2015.

Experimental investigation of channel avulsion frequency on river deltas under rising sea levels

NASA Astrophysics Data System (ADS)

Silvestre, J.; Chadwick, A. J.; Steele, S.; Lamb, M. P.

2017-12-01

River deltas are low-relief landscapes that are socioeconomically important; they are home to over half a billion people worldwide. Many deltas are built by cycles of lobe growth punctuated by abrupt channel shifts, or avulsions, which often reoccur at a similar location and with a regular frequency. Previous experimental work has investigated the effect of hydrodynamic backwater in controlling channel avulsion location and timing on deltas under constant sea level conditions, but it is unclear how sea-level rise impacts avulsion dynamics. We present results from a flume experiment designed to isolate the role of relative sea-level rise on the evolution of a backwater-influenced delta. The experiment was conducted in the river-ocean facility at Caltech, where a 7m long, 14cm wide alluvial river drains into a 6m by 3m "ocean" basin. The experimental delta grew under subcritical flow, a persistent backwater zone, and a range of sea level rise rates. Without sea level rise, lobe progradation produced in-channel aggradation and periodic avulsions every 3.6 ± 0.9 hours, which corresponded to when channels aggraded to approximately one-half of their flow depth. With a modest rate of sea-level rise (0.25 mm/hr), we observed enhanced aggradation in the backwater zone, causing channels to aggrade more quickly and avulse more frequently (every 2.1 ± 0.6 hours). In future work, we expect further increases in the rate of relative sea-level rise to cause avulsion frequency to decrease as the delta drowns and the backwater zone retreats upstream. Experimental results can serve as tests of numerical models that are needed for hazard mitigation and coastal sustainability efforts on drowning deltas.

A NOVEL APPROACH TO TREATMENT FOR CHRONIC AVULSION FRACTURE OF THE ISCHIAL TUBEROSITY IN THREE ADOLESCENT ATHLETES: A CASE SERIES

PubMed Central

Nilsson, Kurt J.

2014-01-01

Background and Incidence: Ischial tuberosity fracture and its associated complications are an under recognized diagnosis in the adolescent athlete. Apophyseal injuries of the pelvis in the skeletally immature athlete can occur in multiple locations but are most common at the ischial tuberosity, affecting males more commonly than females. Description of Injury and Current Management: The most common cause of ischial tuberosity avulsion fracture is a quick eccentric load to the proximal hamstrings, occurring with kicking as in soccer, football, or dance. Signs and symptoms are similar to a proximal hamstring injury but avulsion injuries often go undiagnosed, as radiographs are not frequently obtained. In acute cases, rest and relative immobilization are the recommended course of care. In chronic cases, including those with delayed diagnosis, or those that remain symptomatic after initial care due to non‐union or associated sciatic nerve adhesions, surgery is often performed in order to restore normal anatomy, alleviate symptoms, and help return the athlete to full activity. Purpose: The authors' share a novel treatment approach consisting of ultrasound guided percutaneous needle fenestration for the treatment of three adolescent athletes with symptomatic delayed diagnoses of ischial tuberosity fractures. Needle fenestration was followed by a physical therapy progression which was developed based on tissue healing rates, symptom presentation, and the available literature related to proximal hamstring injuries. Outcomes: Two athletes reported elimination of pain, full functional recovery and return to sport without limitations as measured by use of the Numeric Pain Rating Scale, the Global Rating of Change Scale, and the Lower Extremity Functional Scale. One athlete reported elimination of pain and full functional recovery and chose to return to a new sport. Symptoms of possible concurrent hamstring syndrome are discussed as well the management of this condition. Discussion/Conclusions: This case series introduced a novel approach for treatment of symptomatic delayed union ischial tuberosity fractures in three adolescents prior to consideration of surgical intervention. Percutanous needle fenestration and the described subsequent rehabilitation provided positive treatment outcomes in the presented cases, including full return to athletic and recreational endeavors. Level of Evidence: Level 5 PMID:25540712

Knowledge and Awareness of First Aid of Avulsed Tooth among Physicians and Nurses of Hospital Emergency Department.

PubMed

Iyer, Sudeep Sreepad; Panigrahi, Antarmayee; Sharma, Shalini

2017-01-01

Physicians and nurses of emergency department are often the first line of qualified health-care providers attending the patient in person or parent's query over phone reporting immediately following the dental avulsion. Prompt action by them becomes the decisive factor in survival and prognosis of the tooth. Although a few researchers have evaluated knowledge of emergency room physicians, there is scanty of reports concerning nurses who play a climacteric role. A 10-item questionnaire regarding clinical situation apropos dental injury and tooth avulsion, inquiring knowledge of physicians and nurses was administered to 150 each of nursing professionals and physicians of the emergency department. With 100% response rate, the data obtained was subjected to statistical analysis. Results showed lack of knowledge and confidence in both groups. About 66.7% ( n = 100) nurses and 74.7% ( n = 112) considered reimplantation of avulsed tooth. There was overbalanced confusion regarding storage/transport media and handling of avulsed tooth. The findings from the results suggested a definite inadequacy in knowledge, demanding need for appropriate training for delivering treatment with more predictability and better prognosis.

A novel, simple method for achieving hemostasis of fingertip dermal avulsion injuries.

PubMed

Lin, Brian Wai

2015-06-01

Distal fingertip pad dermal avulsion injuries can be challenging for emergency physicians. A common occurrence with these injuries is difficult-to-control bleeding. The nature of these wounds is such that conventional primary closure to achieve hemostasis is not feasible. Often, direct pressure, even for prolonged periods, will not adequately control the bleeding. Currently recommended techniques are inadequate to control bleeding, and commercially available hemostatic products may be more costly and not widely available. To present a simple method to achieve permanent hemostasis of these injuries using a tourniquet and tissue adhesive glue. A tourniquet is placed around the proximal digit, and the digit is exsanguinated and elevated to achieve short-term hemostasis. Several layers of commercially available tissue adhesive glue are applied sequentially over the avulsed region of the digit and allowed to dry. The tourniquet is then removed. A clean, bloodless dressing is created over the avulsed fingertip. This technique provides a rapid, simple, and likely safe means to control bleeding from a fingertip dermal avulsion injury. Copyright © 2015 Elsevier Inc. All rights reserved.

Pelvic floor morphometry and function in women with and without puborectalis avulsion in the early postpartum period.

PubMed

Cyr, Marie-Pierre; Kruger, Jennifer; Wong, Vivien; Dumoulin, Chantale; Girard, Isabelle; Morin, Mélanie

2017-03-01

Pelvic floor muscles are subject to considerable stretching during vaginal birth. In 13-36% of women, stretching results in avulsion injury whereby the puborectalis muscle disconnects from its insertion points on the pubis bone. Until now, few studies have investigated the effect of this lesion on pelvic floor muscles in the early postpartum period. The primary aim of this study was to compare pelvic floor muscle morphometry and function in primiparous women with and without puborectalis avulsion in the early postpartum period. Our secondary objective was to compare the 2 groups for pelvic floor disorders and impact on quality of life. In all, 52 primiparous women diagnosed with (n = 22) or without (n = 30) puborectalis avulsion injury were assessed at 3 months postpartum. Pelvic floor muscle morphometry was evaluated with 3-/4-dimensional transperineal ultrasound at rest, maximal contraction, and Valsalva maneuver. Different parameters were measured in the midsagittal and axial planes: bladder neck position, levator plate angle, anorectal angle, and levator hiatus dimensions. The dynamometric speculum was used to assess pelvic floor muscle function including: passive properties (passive forces and stiffness) during dynamic stretches, maximal strength, speed of contraction, and endurance. Pelvic floor disorder-related symptoms (eg, urinary incontinence, vaginal and bowel symptoms) and impact on quality of life were evaluated with the International Consultation on Incontinence Questionnaire and the Pelvic Floor Impact Questionnaire-Short Form. Pelvic Organ Prolapse Quantification was also assessed. In comparison to women without avulsion, women with avulsion presented an enlarged hiatus area at rest, maximal contraction, and Valsalva maneuver (P ≤ .013) and all other ultrasound parameters were found to be significantly altered during maximal contraction (P ≤ .014). They showed lower passive forces at maximal and 20-mm vaginal apertures as well as lower stiffness at 20-mm aperture (P ≤ .048). Significantly lower strength, speed of contraction, and endurance were also found in women with avulsion (P ≤ .005). They also presented more urinary incontinence symptoms (P = .040) whereas vaginal and bowel symptoms were found to be similar in the 2 groups. Pelvic Organ Prolapse Quantification revealed greater anterior compartment descent in women with avulsion (P ≤ .010). The impact of pelvic floor disorders on quality of life was found to be significantly higher in women with avulsion (P = .038). This study confirms that pelvic floor muscle morphometry and function are impaired in primiparous women with puborectalis avulsion in the early postpartum period. Moreover, it highlights specific muscle parameters that are altered such as passive properties, strength, speed of contraction, and endurance. Copyright © 2016 Elsevier Inc. All rights reserved.

Investigation of Severe Craniomaxillofacial Battle Injuries Sustained by U.S. Service Members: A Case Series

DTIC Science & Technology

2012-11-05

advancement flaps and reconstructive advancement of lower lip and a buccal mucosa advancement flap to reconstruct maxillary lip. (C) Incision markings for...Maxillofac Surg 2007;65:1215 1218 6 Clark N, Birely B, Manson PN, et al. High energy ballistic and avulsive facial injuries: classification, patterns, and

Avulsion Clusters in Alluvial Systems: An Example of Large-Scale Self-Organization in Ancient and Experimental Basins

NASA Astrophysics Data System (ADS)

Hajek, E.; Heller, P.; Huzurbazar, S.; Sheets, B.; Paola, C.

2006-12-01

The stratigraphic record of at least some alluvial basins exhibits a spatial structure that may reflect long time- scale (103-105 yr in natural basins) autogenic organization of river avulsions. Current models of avulsion-dominated alluvial sequences emphasize the spatial and temporal distribution of coarse-grained channel-belt deposits amid fine-grained floodplain materials. These models typically assume that individual avulsions move, either randomly or deterministically, to low spots distributed throughout the model space. However, our observations of ancient deposits and experimental stratigraphy indicate a previously unrecognized pattern of channel-belt organization, where clusters of closely-spaced channel-belt deposits are separated from each other by extensive intervals of overbank deposits. We explore potential causes of and controls on avulsion clustering with outcrop and subsurface data from Late Cretaceous/Early Paleogene fluvial deposits in the Rocky Mountains (including the Ferris, Lance, and Fort Union formations of Wyoming) and results of physical stratigraphy experiments from the St. Anthony Falls Lab, University of Minnesota. We use Ripley's K-function to determine the degree and scales of clustering in these basins with results that show moderate statistical clustering in experimental deposits and strong clustering in the Ferris Formation (Hanna Basin, Wyoming). External controls (base level, subsidence rate, and sediment/water supplies) were not varied during the experiment, and therefore not factors in cluster formation. Likewise, the stratigraphic context of the ancient system (including the absence of incised valleys and lack of faulting) suggests that obvious extrinsic controls, such as base level change and local tectonics, were not major influences on the development of clusters. We propose that avulsion clusters, as seen in this study, reflect a scale of self-organization in alluvial basins that is not usually recognized in stratigraphy. However cursory examination of other ancient systems suggests that such structure may be common in the rock record. Understanding mechanisms driving avulsion clustering will shed light on the dominant processes in alluvial basins over long time scales. Furthermore, characterizing autogenic avulsion clusters will be an important factor to consider when interpreting allogenic signals in ancient basin fills.

Quantifying and Validating Rapid Floodplain Geomorphic Evolution, a Monitoring and Modelling Case Study

NASA Astrophysics Data System (ADS)

Scott, R.; Entwistle, N. S.

2017-12-01

Gravel bed rivers and their associated wider systems present an ideal subject for development and improvement of rapid monitoring tools, with features dynamic enough to evolve within relatively short-term timescales. For detecting and quantifying topographical evolution, UAV based remote sensing has manifested as a reliable, low cost, and accurate means of topographic data collection. Here we present some validated methodologies for detection of geomorphic change at resolutions down to 0.05 m, building on the work of Wheaton et al. (2009) and Milan et al. (2007), to generate mesh based and pointcloud comparison data to produce a reliable picture of topographic evolution. Results are presented for the River Glen, Northumberland, UK. Recent channel avulsion and floodplain interaction, resulting in damage to flood defence structures make this site a particularly suitable case for application of geomorphic change detection methods, with the UAV platform at its centre. We compare multi-temporal, high-resolution point clouds derived from SfM processing, cross referenced with aerial LiDAR data, over a 1.5 km reach of the watercourse. Changes detected included bank erosion, bar and splay deposition, vegetation stripping and incipient channel avulsion. Utilisation of the topographic data for numerical modelling, carried out using CAESAR-Lisflood predicted the avulsion of the main channel, resulting in erosion of and potentially complete circumvention of original channel and flood levees. A subsequent UAV survey highlighted topographic change and reconfiguration of the local sedimentary conveyor as we predicted with preliminary modelling. The combined monitoring and modelling approach has allowed probable future geomorphic configurations to be predicted permitting more informed implementation of channel and floodplain management strategies.

Use of an elastic transarticular external fixator construct for immobilization of the elbow joint.

PubMed

Vedrine, Bertrand

2017-04-01

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.

Use of an elastic transarticular external fixator construct for immobilization of the elbow joint

PubMed Central

Vedrine, Bertrand

2017-01-01

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. PMID:28373726

Radiographic diagnosis of occult distal fibular avulsion fracture in children with acute lateral ankle sprain.

PubMed

Kwak, Yoon-Hae; Lim, Jae-Young; Oh, Min-Kyung; Kim, Woo-Jin; Park, Kun-Bo

2015-06-01

Skeletally immature children with ankle sprain are presumed to have distal fibula fracture than ligamentous injury. The purpose of this study is to determine the incidence of associated occult avulsion fracture in children with lateral ankle sprain and the efficacy of identifying fractures using anterior talofibular ligament view. Patients who were diagnosed with distal fibular fracture in the initial ankle anteroposterior, lateral, and mortise were excluded and 78 patients (below 16 y of age) who had been initially diagnosed as ankle sprain were included. The initial and 4 weeks' follow-up ankle series and additional anterior talofibular ligament view suggested by Haraguchi were evaluated. Twenty patients were diagnosed with occult distal fibular avulsion fracture. Ten patients were diagnosed in anterior talofibular ligament view and others were diagnosed in the follow-up radiography. Displacement was highest on the anterior talofibular ligament view. This study found 20 (26%) of 78 ankle sprain show occult avulsion fracture in the anterior talofibular ligament view or follow-up radiography. The anterior talofibular ligament view is an appropriate radiologic view for the diagnosis of distal fibular avulsion fracture. Level IV--diagnostic study.

Results of operative treatment of avulsion fractures of the iliac crest apophysis in adolescents.

PubMed

Li, Xigong; Xu, Sanzhong; Lin, Xiangjin; Wang, Quan; Pan, Jun

2014-04-01

Avulsion fracture of the iliac crest apophysis is a rare condition that commonly occurs in adolescent athletes. Conservative treatment for this injury can produce excellent functional outcomes. However, the rehabilitation process requires a rather long immobilisation period. This study aimed to evaluate the use of cannulated screws for fixation of avulsion fractures of iliac crest apophysis. Ten patients with avulsion fractures of iliac crest apophysis were treated by open reduction and internal fixation using cannulated screws. The mean age of patients was 14.6 years (range, 13-15 years). The mean intraoperative blood loss was 14.9 ml (range, 10-25 ml). The mean operative time was 40.3 min (range, 33-52 min). The mean follow-up period was 11.2 months (range, 6-20 months). At the 4-week follow-up, all patients returned to previously normal activity without pain and had no evidence of lower extremity muscle weakness. At the final follow-up, all patients resumed their athletic activity without any complications. Open reduction and internal fixation for the treatment of avulsion fracture of iliac crest apophysis can be recommended for patients requiring rapid rehabilitation. Copyright © 2013 Elsevier Ltd. All rights reserved.

Modified tension band wiring fixation for avulsion fractures of the calcaneus in osteoporotic bone: a review of three patients.

PubMed

Nagura, Issei; Fujioka, Hiroyuki; Kurosaka, Masahiro; Mori, Hiroyuki; Mitani, Makoto; Ozaki, Akihiro; Fujii, Hideo; Nabeshima, Yuji

2012-01-01

Calcaneal avulsion fractures are not uncommon, and they are probably more likely in patients with osteoporosis. Closed manipulation for this type of fracture often fails to achieve acceptable reduction, and open reduction and internal fixation are usually required. However, open reduction and internal fixation with either a lag screw or Steinmann pins do not provide satisfactory fixation in patients with diabetes and elderly patients because of the presence of porotic bone. Levi described a tension band fixation system used to treat a calcaneal avulsion fracture using a simple technique performed with a transverse Kirschner wire through the os calcaneus, securing a figure-of-8 metal tension band wiring to the fragment. We report the successful treatment of 3 patients with calcaneal avulsion fractures using a modified tension band wiring technique, resulting in satisfactory recovery. Re-displacement of the fragment during the initial follow-up period was not reported, and bony union was achieved in all patients. We believe this technique is a useful surgical option for the treatment of calcaneal avulsion fractures. Copyright © 2012 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Greenspan, A.; Norman, A.

Five cases of a rare developmental anomaly involving extraskeletal bone formation are described - four in the pelvis and one arising from the 12th rib. Three of these bony growths, called 'Pelvic digits' had well developed 'joints' or pseudoarticulations. The similarity of this anomaly to posttraumatic myositis ossificans and avulsion injuries of the pelvis (rectus femoris) is pointed out and a differential diagnosis offered.

A Quasi-2D Delta-growth Model Accounting for Multiple Avulsion Events, Validated by Robust Data from the Yellow River Delta, China

NASA Astrophysics Data System (ADS)

Moodie, A. J.; Nittrouer, J. A.; Ma, H.; Carlson, B.; Parker, G.

2016-12-01

The autogenic "life cycle" of a lowland fluvial channel building a deltaic lobe typically follows a temporal sequence that includes: channel initiation, progradation and aggradation, and abandonment via avulsion. In terms of modeling these processes, it is possible to use a one-dimensional (1D) morphodynamic scheme to capture the magnitude of the prograding and aggrading processes. These models can include algorithms to predict the timing and location of avulsions for a channel lobe. However, this framework falls short in its ability to evaluate the deltaic system beyond the time scale of a single channel, and assess sedimentation processes occurring on the floodplain, which is important for lobe building. Herein, we adapt a 1D model to explicitly account for multiple avulsions and therefore replicate a deltaic system that includes many lobe cycles. Following an avulsion, sediment on the floodplain and beyond the radially-averaged shoreline is redistributed across the delta topset and along the shoreline, respectively, simultaneously prograding and aggrading the delta. Over time this framework produces net shoreline progradation and forward-stepping of subsequent avulsions. Testing this model using modern systems is inherently difficult due to a lack of data: most modern delta lobes are active for timescales of centuries to millennia, and so observing multiple iterations of the channel-lobe cycle is impossible. However, the Yellow River delta (China) is unique because the lobe cycles here occur within years to decades. Therefore it is possible to measure shoreline evolution through multiple lobe cycles, based on satellite imagery and historical records. These data are used to validate the model outcomes. Our findings confirm that the explicit accounting of avulsion processes in a quasi-2D model framework is capable of capturing shoreline development patterns that otherwise are not resolvable based on previously published delta building models.

Complex Channel Avulsion in the Meghna River Foodplain During the Mid to Late Holocene: The Potential Effect of Tectonic and Co-Seismic Uplift

NASA Astrophysics Data System (ADS)

Dunham, A.; Grall, C.; Mondal, D. R.; Steckler, M. S.; Rajapara, H.; Kumar, B.; Philibosian, B.; Akhter, S. H.; Singhvi, A. K.

2016-12-01

Channel migrations and river avulsions in deltaic river systems are mainly driven by differential changes of surface topography, such as the superelevation of channels due to sedimentation. In addition to such autocyclic processes, tectonic events, such as earthquakes, may also lead to avulsions from sudden uplift. The eastern part of the Ganges-Brahmaputra-Meghna Delta (GBMD) is underlain by the blind megathrust of the IndoBurma subduction zone. In this region we investigate a 100 km long sinuous abandoned channel of the Meghna River. Immediately south of the channel, it has been previously shown that the topography is slightly higher than on the rest of the Delta and there is an oxidized Holocene exposure surface. Part of the Titas River flows northward from this area into the abandoned channel belt, opposite of the southward flowing rivers of the delta. We provide results from a detailed investigation of this abandoned channel of the Meghna River using stratigraphic logs of hand-drilled wells, resistivity profiles, sediment analyses and OSL and C14 dating, The OSL ages to be presented constrain the possible date of the event. We employ numerical modeling to evaluate the hypothesis that the co-seismic uplift associated to an earthquake can trigger the channel migration. Our modeling approach aims to estimate the co-seismic uplift associated with potential seismic events using an elastic Coulomb's dislocation model. The geometry fault in our model is estimated using geologic and GPS constraints with standard elastic parameters (Young's modulus = 80 GPa; Poisson's ratio = 0.3). We explored different potential earthquakes geometries that involve the megathrust, a splay fault, or the megathrust terminating in the splay. The magnitude and distribution of co-seismic slip are also varied between a rupture length of 112.5km and 180km along a 225km long fault. We show that any class of models can produce the amount of uplift (1-2 m) necessary for triggering the river avulsion. Thus the avulsion could be due to a >M8 megathrust earthquake or a M7 splay fault rupture. In either case, the rupture cannot extend west of the abandoned channel to the current Meghna River, and thus did not rupture to the deformation front, where the megacity of Dhaka now lies.

Relative stability of tension band versus two-cortex screw fixation for treating fifth metatarsal base avulsion fractures.

PubMed

Husain, Z S; DeFronzo, D J

2000-01-01

This study assesses the strength of fixating avulsion fractures of the fifth metatarsal base with a 4.0-mm partially threaded cancellous screw crossing two cortices as compared to tension banding. Our data showed statistically significant fixation strength improvement over tension banding for avulsion fractures (p < 0.02) in both polystyrene foam models and fresh, nonpreserved frozen cadaveric samples. In cadavers, the screw fixations were able to withstand more than three times the load sustained by the tension band fixations. The study utilized the Instron 8500 tensiometer to apply physiologic loads to test the constructs until failure. The displacement and load data at failure show the limitations of both fixations. By increasing the load resistance while maintaining compression, the bicortical cancellous screw fixation created greater stability at the avulsion fracture of the fifth metatarsal base as compared to tension band stabilization.

Laws, Place, History and the Interpretation of Earth Surface Systems

NASA Astrophysics Data System (ADS)

Phillips, Jonathan

2016-04-01

The state of an Earth surface system (ESS is determined by three sets of factors: Laws, place, and history. Laws (L = L1, L2, . . . , Ln) are the n general principles, relationships, and representations applicable to any such system at any time. Place factors (P = P1, P2, . . . , Pm) are the m relevant properties or characteristics of the local or regional environment - e.g., climate, tectonic setting, geology, traits of the local biota, etc. History factors (H = H1 , H2, . . . , Hq) include the previous evolutionary pathway of the ESS, its stage of development, past disturbance, and in some contexts initial conditions. Geoscience investigation may be focused on laws (e.g., theoretical deductions, process modeling, laboratory experiments), place (e.g., regional geology or geography, soil-landscape studies), or history (e.g., paleoenvironmental studies, environmental history, historical geology or geography). Ultimately, however, all three sets of factors are necessary to fully understand and explain ESS. Beyond providing a useful checklist (analogous to the factorial models often used in pedology and ecology), the LPH framework gives us analytical traction to some difficult research problems. For example, studies of the avulsions of three southeast Texas rivers showed substantial differences in avulsion regimes and resulting alluvial morphology, despite the proximity and superficial similarity of the systems. Avulsion dynamics are governed by the same laws in all three cases [L(A) = L(B) = L(C)], and the three rivers, once part of a single system at lower sea-levels, have undergone the same sea-level, climate, and tectonic histories, as well as the same general types of anthropic impacts [H(A) ≈ H(B) ≈ H(C)]. Though the regional-scale environmental controls are similar, local details such as the location of the modern main channel relative to Pleistocene meander channels differ, and thus these place factors explain the differences between the rivers. The LPH framework can also be used to determine the source of similarities among disparate systems. A classic example is the topology of fluvial channel networks, which have similar characteristics despite a great variety in place and history factors. Since P(i) ≠ P(j), H(i) ≠ H(j), this points to L factors as the controls of the similarities. Similar trends are emerging in the study of root-rock interactions in forest regoliths, where similar phenomena occur despite variations in underlying geology, vegetation, and disturbance regimes. The LPH framework, or very similar types of reasoning, is implicit in many types of geoscience analysis. More explicit attention to the triad can help us solve or address many specific problems and remind us of the importance of all three sets of factors.

[Conventional X-Rays of Ankle Joint Fractures in Older Patients are Not Always Predictive].

PubMed

Jubel, A; Faymonville, C; Andermahr, J; Boxberg, S; Schiffer, G

2017-02-01

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 diagnosis, in addition to plain X-rays. Georg Thieme Verlag KG Stuttgart · New York.

Residual defects of the external anal sphincter following primary repair: an observational study using transperineal ultrasound.

PubMed

Shek, K L; Guzman-Rojas, R; Dietz, H P

2014-12-01

Obstetric anal sphincter tears are common and an important factor in the etiology of anal incontinence. The objective of the study was to evaluate the prevalence of residual defects of the external anal sphincter (EAS) after primary repair of obstetric anal sphincter injury using four-dimensional (4D) transperineal ultrasound and to correlate sonographic findings of residual defects and levator avulsion with significant symptoms of anal incontinence, defined as St Mark's fecal incontinence score (SMIS) of ≥ 5. This was a retrospective observational study. One-hundred and forty women were seen after primary repair of obstetric anal sphincter tears in a dedicated perineal clinic at a tertiary hospital in Australia. They all underwent a standardized interview, and physical and 4D transperineal ultrasound examination. Mean follow-up interval was 1.9 months after delivery. Eighty-nine (64%) women had a 3a/3b tear, 28 (20%) a 3c/4(th) degree tear and 23 (16%) an unclassified 3(rd) degree tear. Thirty-five (25%) patients reported symptoms of anal incontinence. Nine had an SMIS of ≥ 5. A residual defect was found in 56 (40%) cases and levator avulsion in 27 (19%). On multivariate logistic regression, residual defects (P = 0.03; odds ratio (OR) = 6.38; 95% CI, 1.23-33.0) and levator avulsion (P = 0.047; OR = 4.38; 95% CI, 1.02-18.77) were found to be independent risk factors for anal incontinence. Residual defects of the EAS were found on transperineal ultrasound in 40% of women after primary repair of obstetric anal sphincter injuries. Although most were asymptomatic, residual anal sphincter defects and levator avulsion were associated with significant symptoms of anal incontinence as quantified using the SMIS. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd.

Surgical Management of Rectus Femoris Avulsion Among Professional Soccer Players

PubMed Central

Sonnery-Cottet, Bertrand; Barbosa, Nuno Camelo; Tuteja, Sanesh; Gardon, Roland; Daggett, Matt; Monnot, Damien; Kajetanek, Charles; Thaunat, Mathieu

2017-01-01

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 fast recovery in professional athletes. PMID:28203599

[Staple fixation for the treatment of hamate metacarpal joint injury].

PubMed

Tang, Yang-Hua; Zeng, Lin-Ru; Huang, Zhong-Ming; Yue, Zhen-Shuang; Xin, Da-Wei; Xu, Can-Da

2014-03-01

To investigate the effcacy of the staple fixation for the treatment of hamate metacarpal joint injury. From May 2009 to November 2012,16 patients with hamate metacarpal joint injury were treated with staple fixation including 10 males and 6 females with an average age of 33.6 years old ranging from 21 to 57 years. Among them, 11 cases were on the fourth or fifth metacarpal base dislocation without fractures, 5 cases were the fourth or fifth metacarpal base dislocation with avulsion fractures of the back of hamatum. Regular X-ray review was used to observe the fracture healing, joint replacement and position of staple fixation. The function of carpometacarpal joint and metacarpophalangeal joint were evaluated according to ASIA (TAM) system evaluation method. All incision were healed well with no infection. All patients were followed up from 16 to 24 months with an average of (10.0 +/- 2.7) months. No dislocation recurred, the position of internal fixator was good,no broken nail and screw withdrawal were occurred. Five patients with avulsion fracture of the back of hamatum achieved bone healing. The function of carpometacarpal joint and metacarpophalangeal was excellent in 10 cases,good in 5 cases, moderate in 1 case. The application of the staple for the treatment of hamatometacarpal joint injury has the advantages of simple operation, small trauma, reliable fixation, early postoperative function exercise and other advantages, which is the ideal operation mode for hamatometacarpal joint injury.

Making a case for anterior inferior iliac spine/subspine hip impingement: three representative case reports and proposed concept.

PubMed

Larson, Christopher M; Kelly, Bryan T; Stone, Rebecca M

2011-12-01

Femoroacetabular impingement is typically described as occurring due to a conflict between the femoral head-neck junction and acetabular rim. A prior case report described an open decompression of the anterior inferior iliac spine (AIIS) due to impingement against the proximal femur. AIIS impingement may be developmental or the result of a prior AIIS avulsion or pelvic osteotomy. We describe 3 representative cases with minimum 1-year follow-up treated with an arthroscopic AIIS decompression. Copyright © 2011 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Avulsion of the tibial tuberosity in a litter of greyhound puppies.

PubMed

Skelly, C M; McAllister, H; Donnelly, W J

1997-10-01

Avulsion of the tibial tuberosity was diagnosed in six of seven greyhound littermates aged five and a half months. The puppies showed hindlimb lameness of varying severity. Radiological assessment of affected stifle joints revealed partial or complete avulsion of the tibial tuberosities. In four puppies the lesions were bilateral. Euthanasia of the two most severely affected puppies was performed; the changes observed on histopathological examination of their cranioproximal tibiae suggested that the underlying lesion was that of osteochondrosis. A hereditary predisposition in greyhounds to osteochondrosis of the physis between the apophysis and the cranioproximal tibial diaphysis is postulated.

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

USGS Publications Warehouse

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

1989-01-01

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

Effect of a leaflet given to parents on knowledge of tooth avulsion.

PubMed

Ghaderi, F; Adl, A; Ranjbar, Z

2013-03-01

Parents can play an important role in improving the prognosis of avulsed permanent teeth if they are properly informed about the necessary dental first-aid steps at the time of an accident. The purpose of this study was to assess the knowledge of Shirazi parents in traumatic a simple leaflet on improving their knowledge about this topic. One hundred and fifty parents of children receiving dental care at the Shiraz Dental School participated in this study. Half of the participants received an informative leaflet with the possibility of asking questions about it to an operator, while the other half did not receive any leaflets and served as a control group. Using a questionnaire and a scoring system, the level of knowledge of parents was measured in the following categories: general knowledge of tooth avulsion, knowledge of replantation and primary/permanent teeth, knowledge of how to clean an avulsed tooth, knowledge of extra- oral time, and knowledge of storage, methods and transporting media. The results showed that knowledge level was low among Shirazi parents. Improvements were observed in all the categories of knowledge as a result of reading the leaflet and answering the questions. A simple leaflet is a suitable tool to impart knowledge to parents and improve awareness about tooth avulsion.

Digging for Lost Rivers in Thailand: Locating and Dating Paleochannels in the Chiang Mai Intermontane Basin

NASA Astrophysics Data System (ADS)

Teo, Elisha A.; Ziegler, Alan D.; Wasson, Robert J.; Morthekai, Paulramasamy

2017-04-01

The drainage of the Chiang Mai basin has a dynamic but largely forgotten history. In the late 1980s, an ancient lost city was excavated near the Ping River in Chiang Mai, Thailand. Archaeologists had unearthed Wiang Kum Kam, the former royal capital of the Lanna Civilisation founded in 1286 CE. Former investigations revealed that flood sediments buried the capital and remnants of an abandoned river channel were discovered beneath the surface. This concurs with historical descriptions of the Ping River being on the eastern bank of the capital, despite being presently located on the western bank. The paleochannel drained 500 years ago after diverting west of the ancient city. This switch, an avulsion, coincided with a large flood, which could have triggered and/or caused the avulsion. Local oral histories also recount other Ping avulsions across the basin, but these were not documented. Some of these paleochannels residually remain as unusually sinuous irrigation canals, with historically suggestive names such as the Old Ping and the Small Ping Rivers. Here, the geomorphological evolution of the Ping River is investigated, as a future avulsion in this extensively populated area would be catastrophic. Evidence shows that the drainage of the Chiang Mai basin evolved from a braided system, to an avulsing anastomosing system, to a primarily single channel system. Two-dimensional electrical resistivity tomography and augering detected a large continuous body of fluvial sand 4 m below the surface, across the 10 km distance between the Ping and Kuang Rivers. This sand continues to the depth of at least 30 m and is typical of a braided system. Further augering along paleochannels revealed buried levees that protrude from the braided river deposits to near the surface, separated by fine floodplain sediments. This may have formed as the braided system evolved into an anastomosing system, where distinct channels stabilised and floodplain deposits could develop between channels. These paleochannels were eventually abandoned through avulsion, decreased significantly in size, and were converted into irrigation canals with settlement. Thirty-five sediment samples were dated using optically stimulated luminescence (OSL) and accelerator mass spectrometry radiocarbon dating. Sediments from within the upper braided deposits were 40,000 years old and the transition to an anastomosing system occurred 3,000 years ago. Age estimates and the spatial pattern of the paleochannels indicate that the Ping River has sequentially avulsed at least 5 times in approximately 600 years, from the east to 10 km west where the Ping River is currently located. The most recent avulsion occurred about 200 years ago, from a paleochannel 2.2 km east of the present Ping. This pattern of migration is reminiscent of basinal tilting resulting from the basin's west-east extending half-graben structure. It is possible that tilting increases channel instability and then large floods and/or earthquakes trigger avulsions. If so, future avulsions are conceivable. In addition to standard luminescence dating procedures, a new method of applying pulsed OSL was also explored to distinguish quartz and feldspar signals for more accurate age results.

Anastomosing rivers: a review of their classification, origin and sedimentary products

NASA Astrophysics Data System (ADS)

Makaske, Bart

2001-04-01

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 genetic types of anastomosis may coexist in one river system, but whereas the first may be a long-lived floodplain-wide phenomenon, the latter only represents a stage in the avulsion process on a restricted part of the floodplain. Long-lived anastomosis is caused by frequent avulsions and/or slow abandonment of old channels. Avulsions are primarily driven by aggradation of the channel belt and/or loss of channel capacity by in-channel deposition. Both processes are favoured by a low floodplain gradient. Also of influence are a number of avulsion triggers such as extreme floods, log and ice jams, and in-channel aeolian dunes. Although some of these triggers are associated with a specific climate, the occurrence of anastomosis is not. A rapid rise of base level is conductive to anastomosis, but is not a necessary condition. Anastomosing rivers can be considered an example of equifinality, since anastomosis may result from different combinations of processes or causes. Anastomosing river deposits have an alluvial architecture characterized by a large proportion of overbank deposits, which encase laterally connected channel sand bodies. Laterally extensive, thick lenses of lithologically heterogeneous, fine-grained avulsion deposits can be an important element of the overbank deposits of anastomosing rivers. These deposits may also fully surround anastomosing channel sandstones. Anastomosing channel sand bodies frequently have ribbon-like geometries and may possess poorly developed upward-fining trends, as well as abrupt flat tops. The overbank deposits commonly comprise abundant crevasse splay deposits and thick natural levee deposits. Lacustrine deposits and coal are common in association with anastomosing river deposits. None of these characteristics is unique to anastomosing river deposits, and in most cases, anastomosis (coexistence of channels) cannot be demonstrated in the stratigraphic record.

Morphine amplifies mechanical allodynia via TLR4 in a rat model of spinal cord injury

PubMed Central

Ellis, Amanda; Grace, Peter M.; Wieseler, Julie; Favret, Jacob; Springer, Kendra; Skarda, Bryce; Hutchinson, Mark R.; Falci, Scott; Rice, Kenner C.; Maier, Steven F.; Watkins, Linda R.

2016-01-01

Central neuropathic pain (CNP) is a pervasive, debilitating problem that impacts thousands of people living with central nervous system disorders, including spinal cord injury (SCI). Current therapies for treating this type of pain are ineffective and often have dose-limiting side effects. Although opioids are one of the most commonly used CNP treatments, recent animal literature has indicated that administering opioids shortly after a traumatic injury can actually have deleterious effects on long-term health and recovery. In order to study the deleterious effects of administering morphine shortly after trauma, we employed our low thoracic (T13) dorsal root avulsion model (Spinal Neuropathic Avulsion Pain, SNAP). Administering a weeklong course of 10 mg/kg/day morphine beginning 24 hr after SNAP resulted in amplified mechanical allodynia. Co-administering the non-opioid toll-like receptor 4 (TLR4) antagonist (+)-naltrexone throughout the morphine regimen prevented morphine-induced amplification of SNAP. Exploration of changes induced by early post-trauma morphine revealed that this elevated gene expression of TLR4, TNF, IL-1β, and NLRP3, as well as IL-1β protein at the site of spinal cord injury. These data suggest that a short course of morphine administered early after spinal trauma can exacerbate CNP in the long term. TLR4 initiates this phenomenon and, as such, may be potential therapeutic targets for preventing the deleterious effects of administering opioids after traumatic injury. PMID:27519154

Examination and Treatment of Hamstring Related Injuries

PubMed Central

2012-01-01

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

Arthroscopic Pullout Fixation for a Small and Comminuted Avulsion Fracture of the Posterior Cruciate Ligament from the Tibia

PubMed Central

Nakagawa, Shuji; Arai, Yuji; Hara, Kunio; Inoue, Hiroaki; Hino, Manabu; Kubo, Toshikazu

2017-01-01

We describe a patient who underwent arthroscopic pullout fixation for a posterior cruciate ligament (PCL) avulsion fracture. A 46-year-old female, injured in a fall while riding a motorcycle, was diagnosed with a right knee PCL tibial attachment avulsion fracture and underwent arthroscopic osteosynthesis. A Kirschner wire was drilled to a point just medial to the medial border of the anterior tibial bony bed. A suture wire was folded into a loop and introduced into the posteromedial compartment via the bone tunnel. A fixation thread was inserted from the posteromedial portal, through the medial and lateral loop wires, and into the posteromedial compartment. The lateral and medial loop wires attached to the thread were pulled to the outside, and the thread was fixed onto the tibia. Three months post-surgery, she returned to her job. This procedure represents a minimally invasive method of treating avulsion fractures of the tibial attachment of the PCL. PMID:29172392

The Brahmaputra River: a stratigraphic analysis of Holocene avulsion and fluvial valley reoccupation history

NASA Astrophysics Data System (ADS)

Hartzog, T. R.; Goodbred, S. L.

2011-12-01

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 scrutinize the entire Holocene stratigraphic record of Brahmaputra River avulsion and valley reoccupation to provide evidence for the assessment of risk involved with future occurrences. Thomas R. Hartzog, Steven L. Goodbred, Jr., Jennifer L. Pickering, Haley E. Briel, Dhiman R. Mondal, Zobayer Mahmud, Saddam Hossain

Measuring Paleolandscape Relief in Alluvial River Systems from the Stratigraphic Record

NASA Astrophysics Data System (ADS)

Hajek, E. A.; Trampush, S. M.; Chamberlin, E.; Greenberg, E.

2017-12-01

Aggradational alluvial river systems sometimes generate relief in the vicinity of their channel belts (i.e. alluvial ridges) and it has been proposed that this process may define important thresholds in river avulsion. The compensation scale can be used to estimate the maximum relief across a landscape and can be connected to the maximum scale of autogenic organization in experimental and numerical systems. Here we use the compensation scale - measured from outcrops of Upper Cretaceous and Paleogene fluvial deposits - to estimate the maximum relief that characterized ancient fluvial landscapes. In some cases, the compensation scale significantly exceeds the maximum channel depth observed in a deposit, suggesting that aggradational alluvial systems organize to sustain more relief than might be expected by looking only in the immediate vicinity of the active channel belt. Instead, these results indicate that in some systems, positive topographic relief generated by multiple alluvial ridge complexes and/or large-scale fan features may be associated with landscape-scale autogenic organization of channel networks that spans multiple cycles of channel avulsion. We compare channel and floodplain sedimentation patterns among the studied ancient fluvial systems in an effort to determine whether avulsion style, channel migration, or floodplain conditions influenced the maximum autogenic relief of ancient landscapes. Our results emphasize that alluvial channel networks may be organized at much larger spatial and temporal scales than previously realized and provide an avenue for understanding which types of river systems are likely to exhibit the largest range of autogenic dynamics.

Disruption of Alluvial Fan Processes in a Cascade Range Stream, and Attempts to Address the Resulting Problems...

NASA Astrophysics Data System (ADS)

DeVries, P.

2016-12-01

Alluvial fan processes have been altered in two ways on Mouse Creek, tributary of the Sauk River, WA. A county road and low profile bridge were built in the vicinity of a large scale break in slope, and a berm was built upstream along one bank to confine flows. The system has a high sediment load from episodic mass wasting upstream. Over 10 years of survey data and analyses provide a case study of aggradation, flooding, and avulsion processes above the road crossing, and of efforts to address the resulting problems. The berm precluded fan deposition upstream, and appears to have shifted the deposition zone downstream closer to the bridge, leading to an avulsion and impacting upstream migration of salmon to spawning habitat. In addition, the bed elevation of the channel is now higher than the historic fan surface on the other side of the berm. The bridge was raised to reduce the road crossing influence on sediment transport and deposition, which worked for a while locally until the avulsion developed, which accelerated aggradation in the former main channel above the bridge. Plans have been developed for removing the berm and allowing the stream to re-engage its fan. The key design question presently is: should the berm be excavated to its toe on the channel side to accelerate restoration of depositional processes, or should a semblance of bankfull morphology be retained?

Reconstruction of a total avulsion of the hepatic veins and the suprahepatic inferior vena cava secondary to blunt thoracoabdominal trauma.

PubMed

Kaemmerer, Daniel; Daffner, Wolfgang; Niwa, Martin; Kuntze, Thomas; Hommann, Merten

2011-02-01

Blunt injury to the inferior vena cava is a rare but dramatic event having a high mortality up to 80%. The mortality increases after total avulsion especially in combination with secondary intra-abdominal injuries. We report on a 15-year-old boy who sustained a blunt trauma with a total, partially covered avulsion of the hepatic veins and the suprahepatic inferior vena cava. We treated the patient under internal bypassing of the retrohepatic vena cava by using the heart-lung machine and reconstructed the hepatic veins and suprahepatic vena cava with a conduit made of pericard.

The importance of sand in the formation of avulsion channels within experimental fans that develop from sediment mixtures of mud and sand

NASA Astrophysics Data System (ADS)

Iscen, N.; Strom, K.

2017-12-01

Autogenic channel migration and avulsion has long been recognized as important drivers of alluvial fan dynamics. In the literature, several field studies have documented that the presence and the amount of sand transport through a channel is important for channel incision in alluvial fans and deltas. In our experiments, we present the general autogenic avulsion cycle of experimental alluvial fans with mixtures of cohesive sediment and sand with a range of boundary conditions, and we detail the importance of mobile sand fraction in the development of channels that lead to avulsion. Experimental observations demonstrate that new channels form at topographically low regions within the floodplain providing that sand is transported to these topographic lows due to overbank flow or levee breaching. In addition to the sediment transported from upstream, erosion of a previous deposit and an ongoing backfilling nearby are observed as the possible sources of sand getting into the ghost channels. We explore whether the presence of sand is important for channel development because it increases abrasion of the channel or because it changes the roughness characteristics of the flow. We also examine the affect of sediment and water supply change on the newly described channelization process and link distinctive channel morphologies to different stages of described channel development and the avulsion process.

Avulsion of Ampulla of Vater Secondary to a Blunt Abdominal Injury Treated with Pancreatoduodenectomy; A Case Report and Literature Review.

PubMed

Ozsoy, Mustafa; Ersen, Ogun; Ozsoy, Zehra; Yilmaz, Sezgin; Arıkan, Yüksel

2018-04-01

The incidence of complex hepatobiliary injury secondary to blunt abdominal injuries varies between 3.4 and 5%. A 25-year old male patient underwent an urgent operation due to a motorcycle accident. During intraabdominal exploration, Grade 4 laceration was detected at the liver and bleeding was controlled through primary repair. In the postoperative seventh day, he was referred due to 1500 cc bile leakage from the drainage tube. During the operation, an extensive Kocher maneuver was done and the second part of duodenum was observed to be exposed to total avulsion from the head of the pancreas. Pancreatoduodenectomy was planned due to presence of ischemic changes in the second part of duodenum. In the postoperative follow-up, the abdomen was closed with a controlled abdominal closure procedure. The clinical findings of biliary tract injuries secondary to blunt abdominal injuries often manifest themselves late and early diagnosis is possible only with suspicion.

Arthroscopic Management of Tibial Spine Avulsion Fractures: Principles and Techniques.

PubMed

Strauss, Eric J; Kaplan, Daniel James; Weinberg, Maxwell E; Egol, Jonathan; Jazrawi, Laith M

2018-05-15

Tibial spine fractures are uncommon injuries affecting the insertion of the anterior cruciate ligament on the tibia. They typically occur in skeletally immature patients aged 8 to 14 years and result from hyperextension of the knee with a valgus or rotational force. Diagnosis is based on history, physical examination, and standard radiographs. The use of MRI can identify entrapped soft tissue that may prevent reduction. Open or arthroscopic repair is indicated in patients with partially displaced fractures (>5 mm) with one third to one half of the avulsed fragment elevated, in patients who have undergone unsuccessful nonsurgical reduction and long leg casting or bracing, and in patients with completely displaced fractures. Arthroscopy offers reduced invasiveness and decreased morbidity. Suture fixation and screw fixation have produced successful results. Suture fixation can eliminate the risk of fracture fragment comminution during screw insertion, the risk of neurovascular injury, and the need for hardware removal. Suture fixation is ideal in cases in which existing comminution prevents screw fixation.

Diagnostic accuracy of 3.0 T magnetic resonance imaging for the detection of meniscus posterior root pathology.

PubMed

LaPrade, Robert F; Ho, Charles P; James, Evan; Crespo, Bernardo; LaPrade, Christopher M; Matheny, Lauren M

2015-01-01

The purpose of this study was to determine the diagnostic accuracy of 3 T MRI, including sensitivity, specificity, negative and positive predictive values, for detection of posterior medial and lateral meniscus root tears and avulsions. All patients who had a 3 T MRI of the knee, followed by arthroscopic surgery, were included in this study. Arthroscopy was considered the gold standard. Meniscus root tears diagnosed at arthroscopy and on MRI were defined as a complete meniscus root detachment within 9 mm of the root. All surgical data were collected prospectively and stored in a data registry. MRI exams were reported prospectively by a musculoskeletal radiologist and reviewed retrospectively. There were 287 consecutive patients (156 males, 131 females; mean age 41.7 years) in this study. Prevalence of meniscus posterior root tears identified at arthroscopy was 9.1, 5.9% for medial and 3.5% for lateral root tears (one patient had both). Sensitivity was 0.770 (95% CI 0.570, 0.901), specificity was 0.729 (95% CI 0.708, 0.741), positive predictive value was 0.220 (95% CI 0.163, 0.257) and negative predictive value was 0.970 (95% CI 0.943, 0.987). For medial root tears, sensitivity was 0.824 (95% CI 0.569, 0.953), specificity was 0.800 (95% CI 0.784, 0.808), positive predictive value was 0.206 (95% CI 0.142, 0.238) and negative predictive value was 0.986 (95% CI 0.967, 0.996). For lateral meniscus posterior root tears, sensitivity was 0.600 (95% CI 0.281, 0.860), specificity was 0.903 (95% CI 0.891, 0.912), positive predictive value was 0.181 (95% CI 0.085, 0.261) and negative predictive value was 0.984 (95% CI 0.972, 0.994). This study demonstrated moderate sensitivity and specificity of 3 T MRI to detect posterior meniscus root tears. The negative predictive value of 3 T MRI to detect posterior meniscus root tears was high; however, the positive predictive value was low. Sensitivity was higher for medial root tears, indicating a higher risk of missing lateral root tears on MRI. Imaging has an important role in identifying meniscus posterior horn root tears; however, some root tears may not be identified until arthroscopy. Prognostic study (diagnostic), Level II.

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

PubMed Central

2006-01-01

Objective The effect of end-to-side neurotization of partially regenerated recipient nerves on improving motor power in late obstetric brachial plexus lesions, so-called nerve augmentation, was investigated. Methods Eight cases aged 3 – 7 years were operated upon and followed up for 4 years (C5,6 rupture C7,8T1 avulsion: 5; C5,6,7,8 rupture T1 avulsion:1; C5,6,8T1 rupture C7 avulsion:1; C5,6,7 ruptureC8 T1 compression: one 3 year presentation after former neurotization at 3 months). Grade 1–3 muscles were neurotized. Grade0 muscles were neurotized, if the electromyogram showed scattered motor unit action potentials on voluntary contraction without interference pattern. Donor nerves included: the phrenic, accessory, descending and ascending loops of the ansa cervicalis, 3rd and 4th intercostals and contralateral C7. Results Superior proximal to distal regeneration was observed firstly. Differential regeneration of muscles supplied by the same nerve was observed secondly (superior supraspinatus to infraspinatus regeneration). Differential regeneration of antagonistic muscles was observed thirdly (superior biceps to triceps and pronator teres to supinator recovery). Differential regeneration of fibres within the same muscle was observed fourthly (superior anterior and middle to posterior deltoid regeneration). Differential regeneration of muscles having different preoperative motor powers was noted fifthly; improvement to Grade 3 or more occurred more in Grade2 than in Grade0 or Grade1 muscles. Improvements of cocontractions and of shoulder, forearm and wrist deformities were noted sixthly. The shoulder, elbow and hand scores improved in 4 cases. Limitations The sample size is small. Controls are necessary to rule out any natural improvement of the lesion. There is intra- and interobserver variability in testing muscle power and cocontractions. Conclusion Nerve augmentation improves cocontractions and muscle power in the biceps, pectoral muscles, supraspinatus, anterior and lateral deltoids, triceps and in Grade2 or more forearm muscles. As it is less expected to improve infraspinatus power, it should be associated with a humeral derotation osteotomy and tendon transfer. Function to non improving Grade 0 or 1 forearm muscles should be restored by muscle transplantation. Level of evidence Level IV, prospective case series. PMID:17147803

Cytotoxicity evaluation of sodium alendronate on cultured human periodontal ligament fibroblasts.

PubMed

Correia, Vera de Fátima Padrão; Caldeira, Celso L; Marques, Márcia Martins

2006-12-01

External root resorption processes are usually associated with dental trauma, mainly avulsion and intrusion. In such cases endodontic therapy aims to prevent this process by using medications that can inhibit osteoclastic activity, such as bisphosphonates. However, these drugs must be biocompatible to the periapical tissues. The aim of this study was to analyze the cytotoxicity of a bisphosphonate (sodium alendronate) on human periodontal ligament fibroblasts (PDL cells). Cells were plated in a density of 1 x 10(3) cells per dish. The experimental groups were GI (control) no sodium alendronate, and GII, GIII, and GIV with sodium alendronate at the concentrations of 10(-5), 10(-6), and 10(-7) M, respectively. The experimental times were 1, 6, 12, and 24 h (short-term) for viability and 2, 4, 6, and 8 days (long-term) for cell survival. Data in triplicate were statistically analyzed. Cultures treated with the highest alendronate concentration (GII) showed cell viability percentages significantly lower (P < 0.01) than those of the other groups (GI, GIII, and GIV), at 12 and 24 h. Cell growth on GII and GIII groups was similar. GII presented smaller growth than the other groups (P < 0.05). We concluded that sodium alendronate, on direct contact with human periodontal ligament fibroblasts, is cytotoxic in concentrations higher than of 10(-6) M.

Comparative study of phrenic nerve transfers with and without nerve graft for elbow flexion after global brachial plexus injury.

PubMed

Liu, Yuzhou; Lao, Jie; Gao, Kaiming; Gu, Yudong; Zhao, Xin

2014-01-01

Nerve transfer is a valuable surgical technique in peripheral nerve reconstruction, especially in brachial plexus injuries. Phrenic nerve transfer for elbow flexion was proved to be one of the optimal procedures in the treatment of brachial plexus injuries in the study of Gu et al. The aim of this study was to compare phrenic nerve transfers with and without nerve graft for elbow flexion after brachial plexus injury. A retrospective review of 33 patients treated with phrenic nerve transfer for elbow flexion in posttraumatic global root avulsion brachial plexus injury was carried out. All the 33 patients were confirmed to have global root avulsion brachial plexus injury by preoperative and intraoperative electromyography (EMG), physical examination and especially by intraoperative exploration. There were two types of phrenic nerve transfers: type1 - the phrenic nerve to anterolateral bundle of anterior division of upper trunk (14 patients); type 2 - the phrenic nerve via nerve graft to anterolateral bundle of musculocutaneous nerve (19 patients). Motor function and EMG evaluation were performed at least 3 years after surgery. The efficiency of motor function in type 1 was 86%, while it was 84% in type 2. The two groups were not statistically different in terms of Medical Research Council (MRC) grade (p=1.000) and EMG results (p=1.000). There were seven patients with more than 4 month's delay of surgery, among whom only three patients regained biceps power to M3 strength or above (43%). A total of 26 patients had reconstruction done within 4 months, among whom 25 patients recovered to M3 strength or above (96%). There was a statistically significant difference of motor function between the delay of surgery within 4 months and more than 4 months (p=0.008). Phrenic nerve transfers with and without nerve graft for elbow flexion after brachial plexus injury had no significant difference for biceps reinnervation according to MRC grading and EMG. A delay of the surgery after the 4 months might imply a bad prognosis for the recovery of the function. Copyright © 2012 Elsevier Ltd. All rights reserved.

The risk of sacrificing the PCL in cruciate retaining total knee arthroplasty and the relationship to the sagittal inclination of the tibial plateau.

PubMed

Sessa, Pasquale; Fioravanti, Giulio; Giannicola, Giuseppe; Cinotti, Gianluca

2015-01-01

In cruciate retaining total knee arthroplasty (TKA), a partial avulsion of PCL may occur when en-bloc tibial osteotomy is performed. We evaluated the effects of a tibial cut performed with different degrees of posterior slope on PCL insertion and whether the results are affected by the sagittal inclination of the patient's tibial plateau. We selected 83 MRIs of knees showing mild or no degenerative changes. The effects of a simulated tibial cut performed with a posterior slope of 0°, 3°, 5° and parallel to the patient's tibial plateau inclination on PCL insertion in the proximal tibia were investigated. The results were correlated with the degree of posterior inclination of the tibial plateau. Every angle we used for the tibial cut caused a PCL avulsion greater than 50%. The percentage of PCL avulsion significantly increased with increasing the posterior slope of the tibial cut. Patients with sagittal tibial plateau inclination <5° showed greater PCL avulsion than those with sagittal inclination >8°. Most of the PCL insertion is likely to be sacrificed when resection of the proximal tibia is performed en-block. The risk of PCL avulsion is reduced in patients showing a marked posterior inclination of the tibial plateau, but even in this group of patients a surgical technique aimed at sparing most of the PCL insertion is necessary. Copyright © 2014 Elsevier B.V. All rights reserved.

Sciatic Nerve Injury After Proximal Hamstring Avulsion and Repair.

PubMed

Wilson, Thomas J; Spinner, Robert J; Mohan, Rohith; Gibbs, Christopher M; Krych, Aaron J

2017-07-01

Muscle bellies of the hamstring muscles are intimately associated with the sciatic nerve, putting the sciatic nerve at risk of injury associated with proximal hamstring avulsion. There are few data informing the magnitude of this risk, identifying risk factors for neurologic injury, or determining neurologic outcomes in patients with distal sciatic symptoms after surgery. To characterize the frequency and nature of sciatic nerve injury and distal sciatic nerve-related symptoms after proximal hamstring avulsion and to characterize the influence of surgery on these symptoms. Cohort study; Level of evidence, 3. This was a retrospective review of patients with proximal partial or complete hamstring avulsion. The outcome of interest was neurologic symptoms referable to the sciatic nerve distribution below the knee. Neurologic symptoms in operative patients were compared pre- and postoperatively. The cohort consisted of 162 patients: 67 (41.4%) operative and 95 (58.6%) nonoperative. Sciatic nerve-related symptoms were present in 22 operative and 23 nonoperative patients, for a total of 45 (27.8%) patients (8 [4.9%] motor deficits, 11 [6.8%] sensory deficits, and 36 [22.2%] with neuropathic pain). Among the operative cohort, 3 of 3 (100.0%) patients showed improvement in their motor deficit postoperatively, 3 of 4 (75.0%) patients' sensory symptoms improved, and 17 of 19 (89.5%) patients had improvement in pain. A new or worsening deficit occurred in 5 (7.5%) patients postoperatively (2 [3.1%] motor deficits, 1 [1.5%] sensory deficit, and 3 [4.5%] with new pain). Predictors of operative intervention included lower age (odds ratio [OR], 0.952; 95% CI, 0.921-0.982; P = .001) and complete avulsion (OR, 10.292; 95% CI, 2.526-72.232; P < .001). Presence of neurologic deficit was not predictive. Sciatic nerve-related symptoms after proximal hamstring avulsion are underrecognized. Currently, neurologic symptoms are not considered when determining whether to pursue operative intervention. Given the high likelihood of improvement with surgical treatment, neurologic symptoms should be considered when making a decision regarding operative treatment.

Smartphone App as an aid in the emergency management of avulsed teeth.

PubMed

Al-Musawi, Ala; Al-Sane, Mona; Andersson, Lars

2017-02-01

The initial response by bystanders to an avulsed tooth is a significant factor that can affect its survival and long-term outcome. This study was to assess the knowledge of emergency management of tooth avulsion in a group of schoolteachers and to compare the effects of three different educational interventions. Baseline knowledge was assessed using a questionnaire developed for this study. The same questionnaire was used to test changes in the knowledge level following each educational intervention. A convenience sample of elementary and intermediate school teachers (n = 87) participated in this study. Teachers were divided into three groups: Group 1 (Lecture only) was given a 30-min lecture on the emergency management of tooth avulsion. Their knowledge was assessed immediately after the lecture. Group 2 (Lecture and App), the same lecture was given, but participants also had access to a smartphone App, Dental Trauma App (Dental Trauma AB, Linköping, Sweden), when assessed on their knowledge after the lecture. Group 3 (App), this group was only given the smartphone App to explore and had access to that when being assessed. All three interventions increased the knowledge of tooth avulsion management. A marked increase in the knowledge, regardless of the type of intervention, was observed in the following areas: handling the tooth on the ground (16-96.8%); holding the tooth while being cleansed (19.1-62.5%); and on the best storage medium (10.1-59.3%). Participants using the App only had a significantly higher mean score than participants receiving the lecture only (group 3; P = 0.019) and participants subjected to both Lecture and App (group 1; P = 0.000). The Dental Trauma App alone is an effective means of providing accessible knowledge to guide laypeople in managing tooth avulsion, and it can be superior to a lecture-based delivery of information. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Dental Injuries in a Sample of Portuguese Militaries - A Preliminary Research.

PubMed

Azevedo, Luís; Martins, David; Veiga, Nélio; Fine, Peter; Correia, André

2018-05-23

Traumatic dental and maxillofacial injuries are very common and appear to affect approximately 20-30% of permanent dentition, with often serious psychological, economic, functional, and esthetic consequences. Militaries are a highest risk group for orofacial trauma, not only because they are constantly engaged in physical activity (which increase the risk of traumatic injuries) but also because they are exposed to many risk factors. The aim of this study was to evaluate the prevalence of orofacial injuries, militaries knowledge about first-aid procedures following a dental avulsion and the use of mouthguards in a sample of Portuguese militaries. An observational cross-sectional study was conducted for forces of the Infantry Regiment n°14 of Viseu, Portugal. The study involved 122 members of the armed forces who were asked to complete a questionnaire, which enquired about: the occurrence of dental trauma, the use of mouthguards and militaries knowledge with regard to first-aid management of dental avulsions. In our sample, 5.7% reported having experienced a dental trauma. This was further broken down to reveal that 2.5% had experienced an avulsion and 3.3% had a dental fracture. All respondents who reported having suffered dental trauma, reported that this was the only time that they had experienced dental trauma. Within this group, 71.4% visited a dentist, however only one (20%) visited the dentist during the same day that the trauma occurred. In addition, 21.3% mentioned that they had seen a dental trauma in at least one colleague during military trainings/operations. In the case of dental avulsion, the majority (54.9%) did not know how to act. The rate of mouthguard's use among militaries was very low (6.4%). The main reason reported for not using a mouthguard was thinking that it is not necessary (53.3%). Besides that, 31.1% did not know what a mouthguard was for. Prevention programs and promoting actions with this population are important reflections and should be adopted to reduce the incidence of orofacial trauma and to increase knowledge about this topic.

Lacustrine-fluvial interactions in Australia's Riverine Plains

NASA Astrophysics Data System (ADS)

Kemp, Justine; Pietsch, Timothy; Gontz, Allen; Olley, Jon

2017-06-01

Climatic forcing of fluvial systems has been a pre-occupation of geomorphological studies in Australia since the 1940s. In the Riverine Plain, southeastern Australia, the stable tectonic setting and absence of glaciation have combined to produce sediment loads that are amongst the lowest in the world. Surficial sediments and landforms exceed 140,000 yr in age, and geomorphological change recorded in the fluvial, fluvio-lacustrine and aeolian features have provided a well-studied record of Quaternary environmental change over the last glacial cycle. The region includes the Willandra Lakes, whose distinctive lunette lakes preserve a history of water-level variations and ecological change that is the cornerstone of Australian Quaternary chronostratigraphy. The lunette sediments also contain an ancient record of human occupation that includes the earliest human fossils yet found on the Australian continent. To date, the lake-level and palaeochannel records in the Lachlan-Willandra system have not been fully integrated, making it difficult to establish the regional significance of hydrological change. Here, we compare the Willandra Lakes environmental record with the morphology and location of fluvial systems in the lower Lachlan. An ancient channel belt of the Lachlan, Willandra Creek, acted as the main feeder channel to Willandra Lakes before channel avulsion caused the lakes to dry out in the late Pleistocene. Electromagnetic surveys, geomorphological and sedimentary evidence are used to reconstruct the evolution of the first new channel belt following the avulsion. Single grain optical dating of floodplain sediments indicates that sedimentation in the new Middle Billabong Palaeochannel had commenced before 18.4 ± 1.1 ka. A second avulsion shifted its upper reaches to the location of the present Lachlan River by 16.2 ± 0.9 ka. The timing of these events is consistent with palaeohydrological records reconstructed from Willandra Lakes and with the record of palaeochannels on the Lachlan River upstream. Willandra Lakes shows high inflows during the Last Glacial Maximum (∼22 ka), but their subsequent drying between 20.5 ka and 19 ka was caused by river avulsion rather than regional aridity. This case study highlights the benefits of combining fluvial with lacustrine archives to build complementary records of hydrological change in lowland riverine plains.

Deterministic chaos in a model of a simple delta network

NASA Astrophysics Data System (ADS)

Salter, G.; Voller, V. R.; Paola, C.

2017-12-01

An important aspect of delta dynamics is how sediment flux is partitioned to different parts of the delta through time, affecting patterns of land-building/loss, and the formation of stratigraphy. Here, we present results from a model of a simple distributary network consisting of two orders of bifurcations: an upstream channel splits into two branches, each of which splits into two additional branches. The 1D bed elevation profiles of each branch are modeled through time, and a nodal condition accounting for a transverse bed slope just upstream of the bifurcation is used to partition the flow at bifurcations. The model generates surprisingly complex dynamics despite its simplicity. Constrained by the need to distribute sediment evenly between branches in the long-run, the system undergoes repeated full and partial avulsions. We find that the solution to the system is aperiodic, but bounded. We also observe a sensitive dependence on the initial conditions: simulations started with slightly different initial conditions diverge exponentially. These observations are the hallmark of chaos, summarized by Edward Lorenz as "where the present determines the future, but the approximate present does not approximately determine the future." In our model, chaos results from the two-way coupling between upstream and downstream bifurcations. We find that a single bifurcation may be periodic, but it is never chaotic. However, when coupled, avulsions in the upstream channel change the upstream boundary conditions for the downstream bifurcations, and conversely, avulsions in the downstream bifurcations affect the slope of their feeder channel, propagating upstream to the first bifurcation. We explore how the system generates stratigraphy, using the Shields stress at the time of deposition as a proxy. We compare the stratigraphy to the single bifurcation case, which is periodic rather than chaotic. We also examine stratigraphic completeness, and find that hiatuses in the upstream portion of the domain tend to be erosional, whereas hiatuses further downstream tend to represent pauses. Our work suggests that deltas have a limited window of predictability, and indicates that chaotic and cyclic avulsion sequences should be distinguishable in the stratigraphic record.

Magnetic Resonance Imaging of Nonneoplastic Musculoskeletal Pathologies in the Pelvis.

PubMed

Alapati, Sindhura; Wadhwa, Vibhor; Komarraju, Aparna; Guidry, Carey; Pandey, Tarun

2017-06-01

Musculoskeletal pathologies in the pelvis encompass a wide variety of lesions including femoroacetabular impingement, athletic pubalgia, ischiofemoral impingement, and apophyseal avulsion injuries. Magnetic resonance imaging is the noninvasive imaging modality of choice for the diagnosis and management of these lesions. In this article, the authors discuss the nonneoplastic musculoskeletal lesions in the pelvis, with illustrations and relevant case examples. Copyright © 2017 Elsevier Inc. All rights reserved.

[EFFECTIVENESS OF ONE-STAGE REPAIR AND RECONSTRUCTION FOR KNEE DISLOCATION WITH MULTIPLE LIGAMENT INJURIES].

PubMed

Sun, Zhengyu; Zhang, Chenghao; Tang, Xin; Chen, Gang; Li, Jian

2016-06-08

To evaluate the surgical procedure and short-term effectiveness of one-stage repair and reconstruction of knee dislocation with multiple ligament injuries (KDMLI). Between September 2010 and April 2014, 9 cases (9 knees) of KDMLI were treated. There were 7 males and 2 females with an average age of 42 years (range, 27-57 years). Injury was caused by traffic accident in 3 cases, heavy-weight crushing in 3 cases, sports sprain in 2 cases, and falling from height in 1 case. The average time from injury to operation was 11 days (range, 3-19 days). The results of posterior drawer test and Lachman test were positive in all patients. The results of varus stress testing were three-degree positive in 4 cases, and the results of valgus stress testing were three-degree positive in 6 cases. The Lysholm score of knee was 27.2±6.3; the International Knee Documentation Committee (IKDC) score was 29.7±6.5; and the range of motion (ROM) was (52.6±12.8)°. All patients suffered from posterior cruciate ligament (PCL) injury and femoral avulsion injury of anterior cruciate ligament (ACL). Combined injuries included medial collateral ligament (MCL) injury in 4 cases (medial meniscus injury in 1 case), lateral collateral ligament (LCL) injury in 2 cases, and MCL and LCL injuries in 2 cases (medial meniscus and lateral meniscus injuries in 1 case). Autologous harmstring tendon was used to reconstruct PCL under arthroscopy combined with limited open in situ suture for repair of femoral avulsion injury of ACL, and repair of MCL, LCL, and other injury in one-stage operation. All incisions healed by first intention. Joint effusion of knee occurred in 1 case and was cured after removal of fluid combined with pressure bandage. All patients were followed up 12-36 months with an average of 22 months. At last follow-up, the result of posterior drawer test was negative in all patients. The results of Lachman test were one-degree positive in 2 cases; the result of varus stress testing was one-degree positive in 1 case; the results of valgus stress testing were one-degree positive in 2?cases; and flexion dysfunction of the knee was observed in 1 case. The Lysholm score of knee was 87.3±6.6; the IKDC score was 88.9±6.8; and the ROM was (121.7±12.3)°, all showing significant differences when compared with preoperative ones ( t =44.246, P =0.000; t =37.903, P =0.000; t =19.894, P =0.000). For KDMLI, one-stage repair and reconstruction using autologous harmstring tendon to reconst ruct PCL under arthroscopy combined with limited open in situ suture repair of femoral avulsion injury of ACL, and repair MCL, LCL, and other injury has such advantages as minimal invasiveness, reliable fixation, less complications, and fast recovery, which can significantly improve the stability, ROM, and function of knee and obtain good short-term effectiveness.

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

PubMed Central

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

2007-01-01

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

Conservative management of a spleen trauma using radiofrequency.

PubMed

Stella, Mattia; Percivale, Andrea; Pasqualini, Massimo; Pittaluga, Michele; Gandolfo, Nicola; Pellicci, Riccardo

2005-01-01

Conservative operative management of a splenic injury has become more and more employed in order to preserve the immune function of the organ. A case of a rupture of the spleen successfully treated with the use of a radiofrequency thermal energy generator is eported. The parenchymal tear was coagulated by a one cooled tip needle electrode. There were no postoperative complications and the function of the spleen was preserved. The technique cannot be applied in case of lesion of the major vessels or in case of avulsion of the hilum. This technique integrates to the others to make the operative conservative management of a splenic injury more and more feasible.

The meniscal ossicle revisited: etiology and an arthroscopic technique for treatment.

PubMed

Raustol, Ole A; Poelstra, Kornelis A; Chhabra, Annikar; Diduch, David R

2006-06-01

We describe a new arthroscopic technique for repair of meniscal ossicles in support of the theory that meniscal ossicles are traumatic in nature. Using a standard inferolateral portal, the arthroscope is passed under the posterior cruciate ligament to permit visualization of the "root" of the medial meniscus with a matching donor lesion on the tibia. A limited debridement should be performed of the donor site as well as the posterior horn of the meniscus if it has healed over with fibrocartilage to allow bone-to-bone healing. A posteromedial working portal is made at an angle amenable to the repair and a 6-mm cannula is placed. A Beath passing pin commonly used for anterior cruciate ligament reconstruction is used to pass suture for the outside-inside-out repair. The pin is passed through the cannula in the posterior medial portal. The root of the medial meniscus and the avulsed ossicle are pierced with the Beath pin and tensioned, after which the pin is drilled into the matching donor site and out through the tibia. Two passes are used to create a mattress suture through the ossicle, and the suture is tied over a bone bridge on the anterolateral tibia.

Experimental Investigation of River Avulsion and Land-Loss on a Backwater-Influenced Delta Undergoing Sea Level Rise

NASA Astrophysics Data System (ADS)

Sikes, K.; Chadwick, A. J.; Lamb, M. P.; Fuller, B. M.

2016-12-01

Predicting the frequency of river channel avulsions and the rate of land-loss on deltas is important for hazard mitigation, ecological protection, and coastal sustainability, especially given modern rates of relative sea level rise. Previous work has investigated the effect of hydrodynamic backwater in mediating sedimentation patterns and channel avulsions on deltas, but the effect of sea-level rise on backwater-influenced deltas has yet to be explored in experiments. We will present preliminary results from a flume experiment designed to explore the role of sea-level rise on the evolution of a backwater-mediated delta. The experiment was conducted in the river-ocean facility at Caltech, where a 7m long, 14cm wide alluvial river drains into a 6m by 3m "ocean" basin under subcritical flow conditions. We used periodic flood events with different discharges to produce persistent non-uniform flow with a backwater length of 1m. Using a combination of image processing and topographic scans, we will characterize the frequency of backwater-mediated avulsions and the evolution of discrete deltaic lobes under a series of steady sea-level rise rates of different magnitude. We predict that, under moderate rise rates, enhanced aggradation will cause channels to avulse at an accelerated pace, replenishing inactive lobes more quickly and naturally acting to mitigate the extent of drowning along the delta shoreline. However, for higher rise rates, we hypothesize that rapid shoreline retreat may shift the backwater zone upstream, leading to the complete abandonment of deltaic lobes.

Use of a halo frame for optimum intra- and post-operative management after scalp replantation/revascularization.

PubMed

Koul, Ashok R; Nahar, Sushil; Valandi, Beena; Praveen, Kumar H P

2012-09-01

We present a new technique for stabilizing an avulsed scalp during and after replantation/revascularization. We used an aluminium "halo" frame with 4 screws. This technique can rigidly stabilize an avulsed scalp and eliminate the possibility of shearing/pressure necrosis. This device can make perioperative management easier and more comfortable for the patient and caregivers.

Avulsion vs Continuous Shifting: the Dynamics of Delta Distributary Channels Controlled by Basin Water Depth

NASA Astrophysics Data System (ADS)

Muto, T.; Naruse, H.

2015-12-01

An open question in the experimental study of surface processes is how basin water depth controls the dynamics of delta distributary channels. A recently suggested idea as to the issue is that, if a set of peculiar conditions is assumed, all of delta progradation, channel migration, alluvial aggradation and attainment of, or how close to, alluvial grade can be given by an identical formula with the same numerical value that is specified with dimensionless basin water depth. As one step ahead from this notion, we here report the finding obtained from a new series of tank experiments that basin water depth can also affect the modes by which active distributary channels change their locations, i.e. which one of avulsion and continuous shifting is predominant over the other. The results of the experiments clearly indicate that continuous shifting tends to become more predominant over avulsion as basin water depth increases. This tendency is related to a progressive decrease/increase in rate of alluvial aggradation which directly controls avulsion frequency. The present experimental notion can be examined with stratigraphic records of river deltas that accumulated with increasing or decreasing basin water depth.

Medial meniscus posterior horn avulsion.

PubMed

Marzo, John M

2009-05-01

Avulsion of the posterior horn of the medial meniscus can occur from acute trauma or chronic degeneration, leading to meniscus extrusion, articular cartilage loss, osteophyte formation, and medial joint space narrowing. With meniscus extrusion, the meniscus is unable to resist hoop stresses and cannot shield the adjacent articular cartilage from excessive axial load. Over time, this can lead to symptomatic knee osteoarthritis. Patients typically report pain, swelling, mechanical symptoms, and general functional loss. Although nonsurgical care may relieve symptoms, it is unlikely to alter either the natural history of meniscal loss or the fate of the medial compartment. Surgical repair of posterior horn meniscal avulsion is done in an attempt to restore the anatomy and biomechanical function of the meniscus, and to slow or prevent degenerative joint disease. Meniscal transplantation is reserved for salvage situations.

The effect of using an educational poster on elementary school health teachers' knowledge of emergency management of traumatic dental injuries.

PubMed

Ghadimi, Sara; Seraj, Bahman; Keshavarz, Hooman; Shamshiri, Ahmad Reza; Abiri, Razieh

2014-11-01

The purpose of this study was to evaluate the effect of an educational poster on elementary school health teachers' knowledge about emergency management of traumatic dental injuries. Before poster presentation, a questionnaire was distributed to 40 health teachers (30 in the study group and 10 in the control group). One month after poster distribution, the subjects were re-evaluated in both groups using the same questionnaire. The percentage of participating health teachers who answered the questions correctly after poster distribution regarding crown fracture was 93.3% in the test group vs. 60% in controls; for management of luxation and avulsion, the percentages for cases and controls were 63.3% vs. 40% and 100% vs. 60%, respectively. One month after distribution of the educational poster, rate of correct responses increased in management of crown fracture, luxation, and avulsion in the test group, but there was no improvement in controls (P<0.001). Use of an educational poster enhanced the knowledge of health teachers. Use of posters is an effective way to inform teachers of the management of traumatic dental injuries.

16 CFR 1500.49 - Technical requirements for determining a sharp metal or glass edge in toys and other articles...

Code of Federal Regulations, 2014 CFR

2014-01-01

... intended for use by children under 8 years of age. (a) Objective. The sharp edge test method prescribed by... and articles, present a potential risk of injury by laceration or avulsion under section 2(s) of the... articles with edges that are identified as presenting a potential risk of laceration or avulsion injury to...

16 CFR 1500.49 - Technical requirements for determining a sharp metal or glass edge in toys and other articles...

Code of Federal Regulations, 2011 CFR

2011-01-01

... intended for use by children under 8 years of age. (a) Objective. The sharp edge test method prescribed by... and articles, present a potential risk of injury by laceration or avulsion under section 2(s) of the... articles with edges that are identified as presenting a potential risk of laceration or avulsion injury to...

16 CFR 1500.49 - Technical requirements for determining a sharp metal or glass edge in toys and other articles...

Code of Federal Regulations, 2010 CFR

2010-01-01

... intended for use by children under 8 years of age. (a) Objective. The sharp edge test method prescribed by... and articles, present a potential risk of injury by laceration or avulsion under section 2(s) of the... articles with edges that are identified as presenting a potential risk of laceration or avulsion injury to...

16 CFR 1500.49 - Technical requirements for determining a sharp metal or glass edge in toys and other articles...

Code of Federal Regulations, 2012 CFR

2012-01-01

... intended for use by children under 8 years of age. (a) Objective. The sharp edge test method prescribed by... and articles, present a potential risk of injury by laceration or avulsion under section 2(s) of the... articles with edges that are identified as presenting a potential risk of laceration or avulsion injury to...

Use of a halo frame for optimum intra- and post-operative management after scalp replantation/revascularization

PubMed Central

Koul, Ashok R.; Nahar, Sushil; Valandi, Beena; Praveen, Kumar H. P.

2012-01-01

We present a new technique for stabilizing an avulsed scalp during and after replantation/revascularization. We used an aluminium “halo” frame with 4 screws. This technique can rigidly stabilize an avulsed scalp and eliminate the possibility of shearing/pressure necrosis. This device can make perioperative management easier and more comfortable for the patient and caregivers. PMID:23450655

Sciatic Nerve Injury After Proximal Hamstring Avulsion and Repair

PubMed Central

Wilson, Thomas J.; Spinner, Robert J.; Mohan, Rohith; Gibbs, Christopher M.; Krych, Aaron J.

2017-01-01

Background: Muscle bellies of the hamstring muscles are intimately associated with the sciatic nerve, putting the sciatic nerve at risk of injury associated with proximal hamstring avulsion. There are few data informing the magnitude of this risk, identifying risk factors for neurologic injury, or determining neurologic outcomes in patients with distal sciatic symptoms after surgery. Purpose: To characterize the frequency and nature of sciatic nerve injury and distal sciatic nerve–related symptoms after proximal hamstring avulsion and to characterize the influence of surgery on these symptoms. Study Design: Cohort study; Level of evidence, 3. Methods: This was a retrospective review of patients with proximal partial or complete hamstring avulsion. The outcome of interest was neurologic symptoms referable to the sciatic nerve distribution below the knee. Neurologic symptoms in operative patients were compared pre- and postoperatively. Results: The cohort consisted of 162 patients: 67 (41.4%) operative and 95 (58.6%) nonoperative. Sciatic nerve–related symptoms were present in 22 operative and 23 nonoperative patients, for a total of 45 (27.8%) patients (8 [4.9%] motor deficits, 11 [6.8%] sensory deficits, and 36 [22.2%] with neuropathic pain). Among the operative cohort, 3 of 3 (100.0%) patients showed improvement in their motor deficit postoperatively, 3 of 4 (75.0%) patients’ sensory symptoms improved, and 17 of 19 (89.5%) patients had improvement in pain. A new or worsening deficit occurred in 5 (7.5%) patients postoperatively (2 [3.1%] motor deficits, 1 [1.5%] sensory deficit, and 3 [4.5%] with new pain). Predictors of operative intervention included lower age (odds ratio [OR], 0.952; 95% CI, 0.921-0.982; P = .001) and complete avulsion (OR, 10.292; 95% CI, 2.526-72.232; P < .001). Presence of neurologic deficit was not predictive. Conclusion: Sciatic nerve–related symptoms after proximal hamstring avulsion are underrecognized. Currently, neurologic symptoms are not considered when determining whether to pursue operative intervention. Given the high likelihood of improvement with surgical treatment, neurologic symptoms should be considered when making a decision regarding operative treatment. PMID:28758137

Assessment of pelvic floor by three-dimensional-ultrasound in primiparous women according to delivery mode: initial experience from a single reference service in Brazil.

PubMed

Araujo Júnior, Edward; de Freitas, Rogério Caixeta Moraes; Di Bella, Zsuzsanna Ilona Katalin de Jármy; Alexandre, Sandra Maria; Nakamura, Mary Uchiyama; Nardozza, Luciano Marcondes Machado; Moron, Antonio Fernandes

2013-03-01

To evaluate changes to the pelvic floor of primiparous women with different delivery modes, using three-dimensional ultrasound. A prospective cross-sectional study on 35 primiparae divided into groups according to the delivery mode: elective cesarean delivery (n=10), vaginal delivery (n=16), and forceps delivery (n=9). Three-dimensional ultrasound on the pelvic floor was performed on the second postpartum day with the patient in a resting position. A convex volumetric transducer (RAB4-8L) was used, in contact with the large labia, with the patient in the gynecological position. Biometric measurements of the urogenital hiatus were taken in the axial plane on images in the rendering mode, in order to assess the area, anteroposterior and transverse diameters, average thickness, and avulsion of the levator ani muscle. Differences between groups were evaluated by determining the mean differences and their respective 95% confidence intervals. The proportions of levator ani muscle avulsion were compared between elective cesarean section and vaginal birth using Fisher's exact test. The mean areas of the urogenital hiatus in the cases of vaginal and forceps deliveries were 17.0 and 20.1 cm(2), respectively, versus 12.4 cm(2) in the Control Group (elective cesarean). Avulsion of the levator ani muscle was observed in women who underwent vaginal delivery (3/25), however there was no statistically significant difference between cesarean section and vaginal delivery groups (p=0.5). Transperineal three-dimensional ultrasound was useful for assessing the pelvic floor of primiparous women, by allowing pelvic morphological changes to be differentiated according to the delivery mode.

Improving the colour match of free tissue transfers to the face with non-cultured autologous cellular spray--a case report on a chin reconstruction.

PubMed

Hivelin, M; MacIver, Colin; Heusse, J L; Atlan, M; Lantieri, L

2012-08-01

Animal bites can result in extensive avulsion injuries of the face justifying microsurgical replantation attempts. Reconstruction using local tissue harvesting increases the local morbidity while distant tissues can result in colour and skin texture mismatching. Skin grafting of the skin paddle by a split-thickness skin graft is a conventional approach to help overcome this problem. An 18-year-old patient was treated for a chin avulsion after a dog bite injury. The avulsed segment included the whole chin aesthetic unit and one-fifth of the lower lip. The segment was replanted on the inferior labial artery. The replantation failed and a reconstruction with a parascapular free flap was performed. Despite a debulking at 1 month, the aesthetic result had a poor colour match. The technique used to improve this was to de-epithelialise the skin and apply non-cultured autologous epidermal cells (NCAECs) 100 days after the reconstruction. The reconstruction was uneventful. At 3 months follow-up, the patient was able to purse her lips and had regained sensation. After 5 months, the free flap paddle was consistent in colour, pigmentation and texture with the surrounding skin. At 10 months, the patient's only complaint was residual firmness in her scar and flap. The long-term follow-up, over 23 months, confirmed the stability of the results. The use of an NCAEC spray to treat the dyschromia on a parascapular flap used for facial reconstruction is less invasive than split-thickness overgrafting and could extend the use of distant flaps that have been avoided due to poor colour match. Copyright © 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Outcomes after arthroscopic excision of the bony prominence in the treatment of tibial spine avulsion fractures.

PubMed

Shelbourne, K Donald; Urch, Scott E; Freeman, Heather

2011-06-01

The purpose of this study was to determine the outcomes after arthroscopic excision of the bony prominence after a tibial spine avulsion fracture. This study included 7 subjects (5 female and 2 male subjects; mean age, 21.4 years). All subjects underwent preoperative rehabilitation focused on range of motion (ROM) and swelling control. Postoperative rehabilitation focused on regaining symmetric knee hyperextension and flexion. Objective examinations and subjective surveys were obtained at least 1 year after surgery. All subjects achieved normal knee extension; 6 patients achieved normal knee flexion, whereas 1 patient had nearly normal flexion. Physical examination showed a negative Lachman test with a firm end point in all patients, and the mean side-to-side difference for the KT-1000 manual maximum test (MEDmetric, San Diego, CA) was 1.3 mm. No subjects required subsequent anterior cruciate ligament reconstruction. All subjects returned to their previous level of activity without instability symptoms. At a mean of 5.7 years after surgery, the mean International Knee Documentation Committee subjective survey score was 90.6 points overall, with 4.7 out of 5 possible points for the instability question. At latest follow-up, the mean ROM was from 6° of hyperextension to 147° of flexion in the involved knee, compared with 6° of hyperextension to 148° of flexion for the noninvolved knee. The results of arthroscopic excision of the bony fragment after type II, III, or III+ tibial spine avulsion fracture are positive, with good stability, symmetric ROM, and high subjective scores. Most importantly, this procedure allows patients to regain full, symmetric hyperextension of the knee, avoiding the complications associated with extension loss. Level IV, therapeutic case series. Copyright © 2011 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Patient satisfaction and self-reported outcomes after complete brachial plexus avulsion injury.

PubMed

Franzblau, Lauren E; Shauver, Melissa J; Chung, Kevin C

2014-05-01

Reconstructive surgery for complete brachial plexus avulsion injuries only partially restores function, and many patients are dissatisfied with results that surgeons consider good. Preoperative expectations have been shown to influence postoperative satisfaction but are poorly understood in patients with complete brachial plexus avulsion injuries. Qualitative methodology can elucidate patient beliefs and attitudes, which are difficult to quantify. The purpose of this study was to examine patient-reported outcomes, including satisfaction, and to understand the patient perspective. We used qualitative interviews and questionnaires to assess patient-reported outcomes. Two members of the research team analyzed interview data using Grounded Theory methodology. Data from participants who had and did not have reconstructive surgery were compared. Twelve patients participated in this study. Of the 7 participants who had reconstructive surgery, 4 felt their expectations had been met and 5 were satisfied with their outcomes. Reconstruction did not produce statistically significant improvements in upper extremity function, pain, or work ability. All patients reported dissatisfaction with upper extremity ability, and 9 expressed hope for innovative treatments (e.g., stem cell therapy, nerve reinsertion) that could potentially provide better outcomes than existing procedures and enable return to work. Satisfaction with surgical outcomes after complete avulsion brachial plexus injury depends heavily on whether preoperative expectations are met, but patients are unfamiliar with nerve avulsion and do not always know what to expect. Low satisfaction with upper extremity ability and the lack of statistically significant differences produced by reconstruction suggest that current treatments may not be meeting patients' needs. Physicians must provide robust preoperative education to encourage realistic expectations and direct patients toward resources for pain management to facilitate comprehensive rehabilitation. Therapeutic III. Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

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

NASA Astrophysics Data System (ADS)

Reitz, Meredith D.; Jerolmack, Douglas J.

2012-06-01

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

Emergency management of dental trauma: knowledge of Hong Kong primary and secondary school teachers.

PubMed

Young, Cecilia; Wong, K Y; Cheung, L K

2012-10-01

OBJECTIVES. To investigate the level of knowledge about emergency management of dental trauma among Hong Kong primary and secondary school teachers. DESIGN. Questionnaire survey. SETTING. A teachers' union that unites 90% of teachers in Hong Kong. PARTICIPANTS. Randomly selected primary and secondary school teachers. RESULTS. Only 32.8% of respondents correctly stated that a person sustaining dental trauma should go to dentists directly. In all, 73.1% of teachers correctly stated that a dental trauma patient should go for treatment immediately. Only 32.5% knew that a fractured tooth should be put in liquid. Even fewer (23.2%) realised that the displaced tooth should be repositioned back to the original position. Relatively more respondents (74.7%) understood that an avulsed baby tooth should not be put back. Disappointingly, only 16.3% of teachers knew that an avulsed permanent tooth should be replanted. Furthermore, only 29.6% of teachers thought that they were able to distinguish between deciduous teeth and permanent teeth, whilst 20.4% correctly identified at least one of the appropriate mediums: milk, physiological saline or saliva, for storing an avulsed tooth. Teachers who previously received first-aid training with dental content or acquired dental injury information from other sources, scored significantly higher than teachers without such training or acquired information. CONCLUSION. The knowledge on emergency management of dental trauma among primary and secondary school teachers in Hong Kong is insufficient, particularly on the handling of permanent tooth avulsion and the appropriate storage medium for avulsed teeth. Receipt of first-aid training with dental contents and acquisition of dental injury information from other sources were positively correlated with knowledge in managing dental trauma.

Regeneration and Repair in Endodontics—A Special Issue of the Regenerative Endodontics—A New Era in Clinical Endodontics

PubMed Central

Saoud, Tarek Mohamed A.; Ricucci, Domenico; Lin, Louis M.; Gaengler, Peter

2016-01-01

Caries is the most common cause of pulp-periapical disease. When the pulp tissue involved in caries becomes irreversibly inflamed and progresses to necrosis, the treatment option is root canal therapy because the infected or non-infected necrotic pulp tissue in the root canal system is not accessible to the host's innate and adaptive immune defense mechanisms and antimicrobial agents. Therefore, the infected or non-infected necrotic pulp tissue must be removed from the canal space by pulpectomy. As our knowledge in pulp biology advances, the concept of treatment of pulpal and periapical disease also changes. Endodontists have been looking for biologically based treatment procedures, which could promote regeneration or repair of the dentin-pulp complex destroyed by infection or trauma for several decades. After a long, extensive search in in vitro laboratory and in vivo preclinical animal experiments, the dental stem cells capable of regenerating the dentin-pulp complex were discovered. Consequently, the biological concept of ‘regenerative endodontics’ emerged and has highlighted the paradigm shift in the treatment of immature permanent teeth with necrotic pulps in clinical endodontics. Regenerative endodontics is defined as biologically based procedures designed to physiologically replace damaged tooth structures, including dentin and root structures, as well as the pulp-dentin complex. According to the American Association of Endodontists’ Clinical Considerations for a Regenerative Procedure, the primary goal of the regenerative procedure is the elimination of clinical symptoms and the resolution of apical periodontitis. Thickening of canal walls and continued root maturation is the secondary goal. Therefore, the primary goal of regenerative endodontics and traditional non-surgical root canal therapy is the same. The difference between non-surgical root canal therapy and regenerative endodontic therapy is that the disinfected root canals in the former therapy are filled with biocompatible foreign materials and the root canals in the latter therapy are filled with the host's own vital tissue. The purpose of this article is to review the potential of using regenerative endodontic therapy for human immature and mature permanent teeth with necrotic pulps and/or apical periodontitis, teeth with persistent apical periodontitis after root canal therapy, traumatized teeth with external inflammatory root resorption, and avulsed teeth in terms of elimination of clinical symptoms and resolution of apical periodontitis. PMID:29563445

Regeneration and Repair in Endodontics-A Special Issue of the Regenerative Endodontics-A New Era in Clinical Endodontics.

PubMed

Saoud, Tarek Mohamed A; Ricucci, Domenico; Lin, Louis M; Gaengler, Peter

2016-02-27

Caries is the most common cause of pulp-periapical disease. When the pulp tissue involved in caries becomes irreversibly inflamed and progresses to necrosis, the treatment option is root canal therapy because the infected or non-infected necrotic pulp tissue in the root canal system is not accessible to the host's innate and adaptive immune defense mechanisms and antimicrobial agents. Therefore, the infected or non-infected necrotic pulp tissue must be removed from the canal space by pulpectomy. As our knowledge in pulp biology advances, the concept of treatment of pulpal and periapical disease also changes. Endodontists have been looking for biologically based treatment procedures, which could promote regeneration or repair of the dentin-pulp complex destroyed by infection or trauma for several decades. After a long, extensive search in in vitro laboratory and in vivo preclinical animal experiments, the dental stem cells capable of regenerating the dentin-pulp complex were discovered. Consequently, the biological concept of 'regenerative endodontics' emerged and has highlighted the paradigm shift in the treatment of immature permanent teeth with necrotic pulps in clinical endodontics. Regenerative endodontics is defined as biologically based procedures designed to physiologically replace damaged tooth structures, including dentin and root structures, as well as the pulp-dentin complex. According to the American Association of Endodontists' Clinical Considerations for a Regenerative Procedure, the primary goal of the regenerative procedure is the elimination of clinical symptoms and the resolution of apical periodontitis. Thickening of canal walls and continued root maturation is the secondary goal. Therefore, the primary goal of regenerative endodontics and traditional non-surgical root canal therapy is the same. The difference between non-surgical root canal therapy and regenerative endodontic therapy is that the disinfected root canals in the former therapy are filled with biocompatible foreign materials and the root canals in the latter therapy are filled with the host's own vital tissue. The purpose of this article is to review the potential of using regenerative endodontic therapy for human immature and mature permanent teeth with necrotic pulps and/or apical periodontitis, teeth with persistent apical periodontitis after root canal therapy, traumatized teeth with external inflammatory root resorption, and avulsed teeth in terms of elimination of clinical symptoms and resolution of apical periodontitis.

Using a Numerical Model to Assess the Geomorphic Impacts of Forest Management Scenarios on Streams

NASA Astrophysics Data System (ADS)

Davidson, S. L.; Eaton, B. C.

2014-12-01

In-stream large wood governs the morphology of many small to intermediate streams, while riparian vegetation influences bank strength and channel pattern. Forest management practices such as harvesting and fire suppression therefore dramatically influence channel processes and associated aquatic habitat. The primary objective of this research is to compare the impacts of three common forest scenarios - natural fire disturbance, forest harvesting with a riparian buffer, and fire suppression - on the volume of in-channel wood and the complexity of aquatic habitat in channels at a range of scales. Each scenario is explored through Monte Carlo simulations run over a period of 1000 years using a numerical reach scale channel simulator (RSCS), with variations in tree toppling rate and forest density used to represent each forest management trajectory. The habitat complexity associated with each scenario is assessed based on the area of the bed occupied by pools and spawning sized sediment, the availability of wood cover, and the probability of avulsion. Within the fire scenario, we also use the model to separately investigate the effects of root decay and recovery on equilibrium channel geometry by varying the rooting depth and associated bank strength through time. The results show that wood loading and habitat complexity are influenced by the timing and magnitude of wood recruitment, as well as channel scale. The forest harvesting scenario produces the lowest wood loads and habitat complexity so long as the buffer width is less than the average mature tree height. The natural fire cycle produces the greatest wood loading and habitat complexity, but also the greatest variability because these streams experience significant periods without wood recruitment as forests regenerate. In reaches that experience recurrent fires, width increases in the post-fire period as roots decay, at times producing a change in channel pattern when a threshold width to depth ratio is exceeded, and decreases as the forest regenerates. In all cases, the effects are greatest in small to intermediate sized streams where wood is the dominant driver of channel morphology, and become negligible in large streams governed by fluvial processes.

Comparison of CT and MRI in patients with tibial plateau fracture: can CT findings predict ligament tear or meniscal injury?

PubMed

Mui, Leonora W; Engelsohn, Eliyahu; Umans, Hilary

2007-02-01

(1) To determine the accuracy of computed tomography (CT) in the evaluation of ligament tear and avulsion in patients with tibial plateau fracture. (2) To evaluate whether the presence or severity of fracture gap and articular depression can predict meniscal injury. A fellowship-trained musculoskeletal radiologist retrospectively reviewed knee CT and MRI examinations of 41 consecutive patients presenting to a level 1 trauma center with tibial plateau fractures. Fracture gap, articular depression, ligament tear and footprint avulsions were assessed on CT examinations. The MRI studies were examined for osseous and soft tissue injuries, including meniscal tear, meniscal displacement, ligament tear, and ligament avulsion. CT demonstrated torn ligaments with 80% sensitivity and 98% specificity. Only 2% of ligaments deemed intact on careful CT evaluation had partial or complete tears on MRI. Although the degree of fracture gap and articular depression was significantly greater in patients with meniscal injury compared with those without meniscal injury, ROC analysis demonstrated no clear threshold for gap or depression that yielded a combination of high sensitivity and specificity. In the acute setting, CT offers high sensitivity and specificity for depicting osseous avulsions, as well as high negative predictive value for excluding ligament injury. However, MRI remains necessary for the preoperative detection of meniscal injury.

Suture anchor tenodesis in repair of distal Achilles tendon injuries.

PubMed

Kiliçoğlu, Onder; Türker, Mehmet; Yildız, Fatih; Akalan, Ekin; Temelli, Yener

2014-01-01

Distal Achilles tendon avulsions are in the form of either bony and nonbony avulsion of Achilles tendon from its calcaneal insertion. Four patients with distal Achilles tendon avulsions or ruptures which were treated with tendon to bone repair using suture anchors are presented here. Operated leg was immobilized in above-knee cast for 4 weeks while the patient walked non-weight-bearing. Then, cast was changed to below knee, and full weight-bearing was allowed. Patients underwent gait analysis minimum at first postoperative year. Mean American Orthopedics Foot Ankle Society ankle/hindfoot score of patients at last visit was 88.75 (range 85-100), and Achilles tendon total rupture score was 77.75 (range 58-87). Mean passive dorsiflexion of injured ankles (14° ± 5°) was lower than uninjured ankles (23° ± 9°). All the kinematic parameters of gait analysis were comparable to the uninjured side. Maximum plantar flexion power of injured ankle was 1.40 W/kg, and this was significantly lower than the contralateral side value 2.38 W/kg; (P = 0.0143). There were no visually altered gait or problems in daily life. Suture anchor tenodesis technique of distal Achilles tendon avulsions was successful in achieving durable osteotendinous repairs.

Life cycles of traumatized teeth: long-term observations from a cohort of dental trauma victims - series 2.

PubMed

Heithersay, G S

2016-09-01

In this the second of a series of life cycles of dental trauma victims, the short and particularly long-term responses of four survivors of either multiple luxation injuries or avulsions have been documented over periods varying up to 41 years. The development of ankylosis, either in the short or longer term post trauma, proved a common feature in the series and management strategies have been outlined. External invasive resorption was also identified as a complicating response for which the topical application of trichloracetic acid, intracanal dressing and root canal obturation proved effective in resorption management. Long-term observations indicate that some compromised teeth can be functionally and aesthetically retained for extended periods, but follow-up examinations are important so that treatment interventions can be implemented if adverse responses are diagnosed. © 2016 Australian Dental Association.

Karolinska institutet 200-year anniversary. Symposium on traumatic injuries in the nervous system: injuries to the spinal cord and peripheral nervous system - injuries and repair, pain problems, lesions to brachial plexus.

PubMed

Sköld, Mattias K; Svensson, Mikael; Tsao, Jack; Hultgren, Thomas; Landegren, Thomas; Carlstedt, Thomas; Cullheim, Staffan

2011-01-01

The Karolinska Institutet 200-year anniversary symposium on injuries to the spinal cord and peripheral nervous system gathered expertise in the spinal cord, spinal nerve, and peripheral nerve injury field spanning from molecular prerequisites for nerve regeneration to clinical methods in nerve repair and rehabilitation. The topics presented at the meeting covered findings on adult neural stem cells that when transplanted to the hypoglossal nucleus in the rat could integrate with its host and promote neuron survival. Studies on vascularization after intraspinal replantation of ventral nerve roots and microarray studies in ventral root replantation as a tool for mapping of biological patterns typical for neuronal regeneration were discussed. Different immune molecules in neurons and glia and their very specific roles in synapse plasticity after injury were presented. Novel strategies in repair of injured peripheral nerves with ethyl-cyanoacrylate adhesive showed functional recovery comparable to that of conventional epineural sutures. Various aspects on surgical techniques which are available to improve function of the limb, once the nerve regeneration after brachial plexus lesions and repair has reached its limit were presented. Moreover, neurogenic pain after amputation and its treatment with mirror therapy were shown to be followed by dramatic decrease in phantom limb pain. Finally clinical experiences on surgical techniques to repair avulsed spinal nerve root and the motoric as well as sensoric regain of function were presented.

Karolinska Institutet 200-Year Anniversary. Symposium on Traumatic Injuries in the Nervous System: Injuries to the Spinal Cord and Peripheral Nervous System – Injuries and Repair, Pain Problems, Lesions to Brachial Plexus

PubMed Central

Sköld, Mattias K.; Svensson, Mikael; Tsao, Jack; Hultgren, Thomas; Landegren, Thomas; Carlstedt, Thomas; Cullheim, Staffan

2011-01-01

The Karolinska Institutet 200-year anniversary symposium on injuries to the spinal cord and peripheral nervous system gathered expertise in the spinal cord, spinal nerve, and peripheral nerve injury field spanning from molecular prerequisites for nerve regeneration to clinical methods in nerve repair and rehabilitation. The topics presented at the meeting covered findings on adult neural stem cells that when transplanted to the hypoglossal nucleus in the rat could integrate with its host and promote neuron survival. Studies on vascularization after intraspinal replantation of ventral nerve roots and microarray studies in ventral root replantation as a tool for mapping of biological patterns typical for neuronal regeneration were discussed. Different immune molecules in neurons and glia and their very specific roles in synapse plasticity after injury were presented. Novel strategies in repair of injured peripheral nerves with ethyl-cyanoacrylate adhesive showed functional recovery comparable to that of conventional epineural sutures. Various aspects on surgical techniques which are available to improve function of the limb, once the nerve regeneration after brachial plexus lesions and repair has reached its limit were presented. Moreover, neurogenic pain after amputation and its treatment with mirror therapy were shown to be followed by dramatic decrease in phantom limb pain. Finally clinical experiences on surgical techniques to repair avulsed spinal nerve root and the motoric as well as sensoric regain of function were presented. PMID:21629875

Management of a type two avulsion fracture of the tibial intercondylar eminence in children: arthroscopic suture fixation versus conservative immobilization.

PubMed

Zhao, Chen; Bi, Qing; Bi, Mingguang

2018-06-01

Treatment of a type II tibial eminence avulsion fracture was controversial. The aim of this study was to compare the clinical outcomes of a modified arthroscopic suture fixation versus conservative immobilization in treatment of this type fracture in immature population. A total of 43 type II avulsion fractures of tibial intercondylar eminence in immature patients were retrospectively enrolled in the study. Twenty-two (13 males, 9 females) were treated with arthroscopic suture fixation and 21(12 males, 9 females) with conservative cast immobilization. Radiograph, Lachman test, anterior drawer test (ADT), International Knee Documentation Committee (IKDC) 2000 subjective score, and Lysholm score were used to evaluate clinical outcomes in follow-up. All 43 paediatric or adolescent patients with a mean of 11.3 years (range, 8-16 years) were followed up for a median period of 34.5 months (range, 24-46 months). Radiographic evaluation showed optimal reduction immediately after surgery and bone union within three months. At the final follow-up, no limitation of knee motion range was found in any children. Grade II laxity was found in one case from surgical group and six from conservation group, showing significant difference based on ADT (χ2 = 7.927, P = 0.005) and Lachman tests (χ2 = 9.546, P = 0.002). IKDC and Lysholm scores were significantly improved; however, there were significant differences in the IKDC score (91.7 ± 4.34 vs. 84.7 ± 6.11, t = 4.35, P < 0.001) and Lysholm score (93.4 ± 4.04 vs. 87.1 ± 5.24, t = 4.53, P < 0.001), and the improvement of IKDC value (40.2 ± 7.83 vs. 31.4 ± 8.4, t = 3.57, P = 0.001) and Lysholm value (43.8 ± 6.55 vs. 35.4 ± 5.97, t = 4.36, P < 0.001) between the surgical group and the nonsurgical group. In treatment of type II tibial eminence avulsion fracture, a modified, 8 shape suture fixation under arthroscopy showed superior clinical outcomes than nonsurgical immobilization in term of restoring the laxity of paediatric ACL.

The Location of Anterior Cruciate Ligament Tears: A Prevalence Study Using Magnetic Resonance Imaging

PubMed Central

van der List, Jelle P.; Mintz, Douglas N.; DiFelice, Gregory S.

2017-01-01

Background: Over the past decade, there has been a resurgence of interest in anterior cruciate ligament (ACL) preservation. Proximal and distal avulsion tears have been treated with arthroscopic primary repair, while augmented repair, remnant tensioning, primary repair with biological scaffold, and remnant preservation have been proposed for different types of midsubstance tears. Currently, the incidence of these different tear types is unknown. Purpose: To propose a magnetic resonance imaging (MRI) classification system for different tear types based on clinical relevance and to assess the distribution of these different ACL tear types. Study Design: Case series; Level of evidence, 4. Methods: A retrospective search in an institutional radiographic database was performed for patients who underwent knee MRI at our institution between June 2014 and June 2016. Patients younger than 18 years and those with reports of chronic tears, partial tears, multiligamentous injuries, were excluded. Tear types were graded as proximal avulsion (distal remnant length >90% of total ligament length, type I), proximal (75%-90%, type II), midsubstance (25%-75%, type III), distal (10%-25%, type IV), and distal avulsion (<10%, type V). An orthopaedic surgeon, a radiologist, and a research fellow graded the tear type on 30 MRIs to determine reliability, and the research fellow graded all MRIs. Inter- and intraobserver reliability were measured using kappa statistics. Results: A total of 353 patients (57% male; mean age, 37.1 years; range, 18.1-81.2 years) were included. Interobserver reliability was 0.670 (95% confidence interval, 0.505-0.836), and intraobserver reliability ranged from 0.741 to 0.934. Incidence of type I tears was 16%, type II tears 27%, type III tears 52%, type IV tears 1%, and type V tears 3% (2.5% with bony avulsion). Type I tears were more common in patients older than 35 years compared with those younger than 35 years (23% vs 8%; P < .001). Conclusion: This classification system was reliable in assessing tear location in acute ACL injuries. Type I tears were seen in 16%, type II in 27%, and type III in 52% of patients in our cohort. These data suggest that there may be greater potential application for ACL preservation techniques. PMID:28680889

Unintentional parathyroidectomy and postoperative hypocalcaemia. Conventional thyroidectomy versus miniinvasive thyroidectomy.

PubMed

Del Rio, Paolo; De Simone, Belinda; Viani, Lorenzo; Arcuri, Maria Francesca; Sianesi, Mario

2014-01-01

Hypocalcemia and unintentional parathyroidectomy would be associated as cause of post-thyroidectomy hypocalcemia. We analysed the cases treated with total thyroidectomy by two experienced endocrine surgeons from January 2010 to December 2011 at the Unit of General Surgery and Organ Transplantation of the University Hospital of Parma. These cases were divided in two groups: "Group A" included patients for whom a histological report was made that was negative for a parathyroid avulsion, and "Group B" included patients for whom an inadvertent avulsion of the intracapsular parathyroid glands had occurred. In total, 538 patients were treated with a total thyroidectomy from January 2010 to December 2011. In 26 cases, the histological report highlighted the presence of an intracapsular parathyroid gland. The values of pre-operative calcaemia in group A and group B were 9.204 ± 0.2703 mg/dl versus 9.283 ± 0.401 mg/dl, respectively (p=0.32). The values of post-operative calcaemia were 8.039 ± 0.596 mg/dl for group A versus 7.569 ± 0.618 mg/dl for group B (p=0.0002) In Group A, 91/512 patients were treated with the minimally invasive video-assisted thyroidectomy (MIVAT) technique (17,7%), while 1/26 patients in group B was treated with a MIVAT (3,8%). Unintentional parathyroidectomies can occur with experienced surgeons, but this complication is not related to a substantial difference in the incidence of hypocalcemia. MIVAT can helps the endocrine surgeon in the detection of the parathyroids glands, but when the parathyroid is intracapsular, is difficult to preserve it, during surgical dissection.

Novel avulsion pattern of the left principal bronchus with involvement of the carina and caudal thoracic trachea in a cat.

PubMed

Schmierer, Philipp A; Schwarz, Andrea; Bass, Danielle A; Knell, Sebastian Christoph

2014-08-01

A 2-year-old, 4.5 kg, neutered male domestic shorthair cat was presented to the emergency service with dyspnoea, anorexia and apathetic behaviour. Thoracic radiographs showed typical signs for a thoracic trauma and a tracheal lesion in the region of the carina, consistent with pseudoairway formation. Computed tomography (CT) was performed in the conscious cat to avoid aggravation of air leakage associated with ventilation. The additional CT findings were consistent with a novel pattern of a traumatic avulsion of the left principal bronchus expanding into the carina and caudal thoracic trachea. Despite the complex avulsion pattern, successful treatment was achieved surgically by performing an end-to-end anastomosis via a fifth right intercostal lateral thoracotomy. The cat was ventilated with a feeding tube and jet ventilation throughout. The cat showed excellent recovery 6 months after surgery. © ISFM and AAFP 2013.

[Clinical application of continuous douche and vacuum sealing drainage in refractory tissue, bone and joint infections after debridement].

PubMed

Yang, Ping-lin; He, Xi-jing; Li, Hao-peng; Wang, Guo-yu; Zang, Quan-jin

2010-01-01

To explore effect and the application value of continuous douche and vacuum sealing drainage (VSD) in refractory tissue, and joint infections after complete debridement. As retrospective analysis of treatment time and restoration or recurrence, from Jan. 2006 to Dec. 2007, 61 cases of refractory tissue, bone and joint infections underwent continuous douche and VSD combined with the treatment of anti-inflammatory and rehabilitation training after debridement in our hospital. The 61 patients included 39 males and 22 females with age ranging from 10 to 58 years with an average of (35 +/- 12) years, among whom 61 identified to have ankle ulcers combined with infections,open fracture combined with infections, sacrococcygeal pressure ulcers combined with infections, infections after hip replacement, infections after open fracture, and infections after skin avulsion postoperation were 11, 15, 9, 3, 5 and 18 cases respectively. The course was from 2 weeks to 11 months with an average of 4 months. In all 61 patients,the mean healing time was 17, 36, 42, 24, 32, 29 and 28 days in ankle ulcers and infections, tibia and fibula open fracture and infections, femoral shaft fracture and infections, sacrococcygeal pressure ulcers and infections, infections after hip replacement, infections after open fracture, and infections after skin avulsion postoperation respectively. The replacement of VSD was 1, 2-4, 3-5, 1-3, 2-4, 2-3 and 1-3 times in each group respectively. There was no wound recurrence except for 2 cases with recurrent in 61 cases with external fixation nail hole semi-pathological fracture in 1 case of femoral shaft fracture and infection and 1 case of tibia and fibula fracture and infection after follow-up at least one year. Application of continuous douche and VSD can effectively decrease incidence of complications and promote the refractory tissue, bone and joint infections wound growth, healing and considerably shorten the healing time.

Conservative treatment of an ankylosed tooth after delayed replantation: a case report.

PubMed

Díaz, Jaime Andrés; Sandoval, Hector Paulo; Pineda, Patricia Irene; Junod, Pablo Antonio

2007-10-01

An 8-year-old boy sustained avulsion of his upper right maxillary central incisor and lateral luxation of his upper left maxillary incisors. Subsequently, the upper right maxillary central incisor developed replacement resorption, and both upper left maxillary incisors developed pulpal canal obliteration. In the ankylosed tooth, decoronation procedure was performed, and in the 44-month follow-up period the involved alveolar site showed vertical apposition of bone and continuing replacement resorption. Decoronation is a surgical procedure that allows preservation of the bone volume for the future, avoiding aesthetic disturbances and more aggressive treatments in cases where other therapeutic alternatives are not feasible.

Coexistence of Extraskeletal Mesenchymal Chondrosarcoma and Isolated Hemihyperplasia: A Case Report

PubMed Central

Demirkiran, Nihat Demirhan; Akdeniz, Olcay; Hapa, Onur; Havıtçıoğlu, Hasan

2016-01-01

Introduction: Arthroscopic fixation of tibial spine fracture without damage to the growth plate is very important in patients with open physis. The present article describes a simple and effective technique being used for the first time to treat this condition. Case report: A 16-year-old boy sustained avulsion fractures of tibial spine while playing. He was treated arthroscopically with excellent result. Conclusion: Arthroscopic fixation of tibial spine fracture in patients with open physis with two cannulated screws perpendicular to each other is a very simple technique which provides strong construct, and allows early mobilization without risk of damage to the growth plate. PMID:27703933

Fixed orthodontic appliances in the management of severe dental trauma in mixed dentition: a case report.

PubMed

Ebrahim, Fouad-Hassan; Kulkarni, Gajanan

2013-01-01

We describe a case of complex trauma to the early mixed dentition in which tooth avulsion, intrusion, extrusion and lateral luxation were managed effectively using a fixed, non-rigid orthodontic splint after treatment with a traditional wire-composite splint had failed. The use of orthodontic brackets and flexible wires provided several advantages, such as the ability to splint severely malpositioned teeth; easy assessment without removing the splint; slow, gentle repositioning of traumatized teeth; and gradual reestablishment of the arch form allowing for ease of future prosthodontic rehabilitation. Therefore, orthodontic appliances should be considered as a viable option for managing complex dental trauma.

Dental trauma management awareness among primary school teachers in the Emirate of Ajman, United Arab Emirates.

PubMed

Hashim, R

2011-06-01

To assess, by means of self-administered structured questionnaire, the level of knowledge of primary schools teachers in Ajman with regards to the immediate emergency management of dental trauma. The questionnaire was sent to teachers in randomly selected primary schools in Ajman. A total of 161 teachers responded (response rate 84.4%). The questionnaire surveyed teachers' background, knowledge and management of tooth fracture, avulsion, and also investigated teachers' attitudes and self-assessed knowledge. Ninety-one percent of the teachers were females, 51.6% in their thirties and 61.5% had university qualification. Fifty teachers had received formal first aid training, and only thirteen of them recalled that they had received training on the management of dental trauma. Concerning the management of tooth fracture, 138 respondents (85.8%) gave the appropriate management for fractured tooth. One hundred twenty-one (75%) of the respondents indicated that is very urgent to seek professional assistance if a permanent tooth is avulsed, but they had little knowledge on the correct media for transporting the avulsed tooth. Most teaches were unsatisfied with their level of knowledge for dental trauma and the majority were interested in having further education on the topic. The findings revealed that the level of knowledge of management of dental trauma (especially tooth avulsion) among school teachers in Ajman is inadequate, and education campaigns are necessary to improve their emergency management of dental injuries.

The Effect of Using an Educational Poster on Elementary School Health Teachers’ Knowledge of Emergency Management of Traumatic Dental Injuries

PubMed Central

Ghadimi, Sara; Seraj, Bahman; Keshavarz, Hooman; Shamshiri, Ahmad Reza; Abiri, Razieh

2014-01-01

Objective: The purpose of this study was to evaluate the effect of an educational poster on elementary school health teachers’ knowledge about emergency management of traumatic dental injuries. Materials and Methods: Before poster presentation, a questionnaire was distributed to 40 health teachers (30 in the study group and 10 in the control group). One month after poster distribution, the subjects were re-evaluated in both groups using the same questionnaire. Results: The percentage of participating health teachers who answered the questions correctly after poster distribution regarding crown fracture was 93.3% in the test group vs. 60% in controls; for management of luxation and avulsion, the percentages for cases and controls were 63.3% vs. 40% and 100% vs. 60%, respectively. One month after distribution of the educational poster, rate of correct responses increased in management of crown fracture, luxation, and avulsion in the test group, but there was no improvement in controls (P<0.001). Conclusion: Use of an educational poster enhanced the knowledge of health teachers. Use of posters is an effective way to inform teachers of the management of traumatic dental injuries. PMID:25628691

Arthroscopic Treatment of a Displaced Nonunion of the Anterior Inferior Iliac Spine Causing Extra-articular Impingement.

PubMed

Shibahara, Motoi; Ohnishi, Yasuo; Honda, Eisaburo; Matsuda, Dean K; Uchida, Soshi

2017-07-01

This report describes a case of nonunion of an anterior inferior iliac spine (AIIS) apophyseal avulsion fracture with resultant subspine impingement combined with symptomatic femoroacetabular impingement (FAI). A 16-year-old male soccer player presented with a 6-month history of right groin pain exacerbated by kicking and running. The patient was diagnosed with a displaced nonunion of the AIIS apophysis avulsion fracture causing secondary extra-articular impingement beyond cam-type FAI by physical examination and radiological findings. The authors performed arthroscopic AIIS decompression, with concurrent FAI correction and labral repair and capsular closure. At 4 months after surgery, a radiograph and a computed tomography scan showed complete bony union of the AIIS apophyseal nonunion. Modified Harris Hip Sore and Nonarthritic Hip Score improved from 74.8 and 61, respectively, to 100 for both at final follow-up. The effectiveness of arthroscopic decompression of the AIIS as part of a comprehensive minimally invasive surgery including FAI correction and labral repair resulted in complete union of the AIIS and pain-free return to sport and bony union. [Orthopedics. 2017; 40(4):e725-e728.]. Copyright 2017, SLACK Incorporated.

Driver's side curtain air bag-related globe rupture.

PubMed

Porter, Ashley J; Hayes, Rylan; Lee, Lawrence; O'Hagan, Stephen

2018-06-04

A 35-year-old man presented after a high-speed motor vehicle accident and the driver's side curtain air bag causing blunt force trauma rupturing his right globe. The tangential force of the air bag resulted in an unusual arcuate horseshoe-shaped rupture through the lateral rectus insertion, causing avulsion of the muscle and tearing the sclera, with the apices of the tear extending anteriorly towards the limbus. Repair of the globe rupture was undertaken, and secondary vitrectomy revealed that the scleral tear had not involved the retina abutting the ora serrata. Silicone oil tamponade was used to fill the globe and the postoperative best corrected vision was 6/9. This is the first reported case of a ruptured globe caused by a side curtain air bag, resulting in a uniquely shaped arcuate scleral wound combined with lateral rectus avulsion, not associated with rhegmatogenous retinal damage, and is the first air bag-related globe rupture with scleral involvement to report a final best-corrected visual acuity better than 6/60. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

[Scabies of the nail unit in an infant].

PubMed

Finon, A; Desoubeaux, G; Nadal, M; Georgescou, G; Baran, R; Maruani, A

2017-05-01

There are no guidelines regarding the management of scabies in infants and recurrence is common at this age. We report the case of an infant with subungual hyperkeratosis and ungual lesions subsequent to classic scabies. A 7-month-girl, treated 6 weeks earlier with esdepallethrin for scabies, consulted for acquired lesions on 3 toe nails. These nails were thickened and displayed subungual hyperkeratosis. Physical examination of the skin, the finger nails and mucous membranes was otherwise normal. Fungal analyses were negative, but direct microscopic examination revealed numerous larvae of Sarcoptes scabiei as well as ovular debris. The child was treated with urea 40% to obtain chemical avulsion of the nails, and with topical esdepallethrin and a quarter tablet of ivermectin orally; there was no follow-up of the child. Ungual scabies has already been reported in crusted scabies and very rarely in classic scabies. Subungual and ungual locations of S. scabiei may constitute a source of reinfestation with scabies in infants. Treatment is not well defined and currently involves chemical avulsion of the nails and the application of topical antiscabies treatment. Copyright © 2016. Published by Elsevier Masson SAS.

Nonoperative treatment of distal biceps brachii musculotendinous partial rupture: a report of two cases.

PubMed

López-Zabala, I; Fernández-Valencia, J A

2013-01-01

Musculotendinous ruptures of the distal biceps brachii are extremely rare injuries whose clinical presentation is similar to distal biceps avulsion. We describe two cases of patients who suffered a distal biceps brachii musculotendinous partial rupture. The first patient was playing soccer as goalkeeper and experienced sudden pain while throwing the ball overhead with his left arm. The second patient experienced sudden pain while weightlifting with his right arm. The mechanism of injury was the same in the two cases, as both involved glenohumeral elevation with elbow extension and forearm supination. Neither of these two patients underwent surgical repair or rehabilitation, and both had perfect scores of 100 on the Mayo Clinic Performance Index for the Elbow at one-year followup.

MR arthrography of the posterior labrocapsular complex: relationship with glenohumeral joint alignment and clinical posterior instability.

PubMed

Tung, Glenn A; Hou, David D

2003-02-01

The purpose of our study was to investigate the relationship between tears of the posterior labrocapsular complex and glenohumeral alignment on MR arthrography and the presence and extent of posterior labrocapsular tears in patients with posterior instability. Posterior labrocapsular tears identified on 24 MR arthrograms and surgically confirmed were evaluated for length of tear and labrocapsular avulsion. These examinations and a comparison cohort of 70 normal MR arthrograms with normal findings were also evaluated for humeral head position relative to the glenoid fossa. Medical records were reviewed for clinical diagnosis of posterior instability and history of shoulder trauma. The position of the humeral head relative to the glenoid was significantly more posterior in patients with posterior labral tear than in patients with a normal posterior labrum (4.9 mm versus 0.7 mm; p < 0.0001). The mean length (+/- SD) of posterior labral tear was 15.9 +/- 1.7 mm, and a direct correlation was found between tear length and posterior humeral translation (r = -0.65; p = 0.002). Posterior labral tears were significantly longer (18.6 vs 13.1 mm; p = 0.04), and posterior humeral translation was greater (6.4 vs 3.4 mm; p = 0.006) in patients with labrocapsular avulsion than in those without avulsion. Twelve (50%) of the patients with posterior labrocapsular tear had posterior instability, and 10 (83%) had a history of macrotrauma. On MR arthrography, the mean posterior humeral translation was greater (6.2 mm +/- 0.08; p = 0.019), posterior labral tears were longer (19.4 mm +/- 1.7; p = 0.0008), and labrocapsular avulsion was more common (83%; p = 0.0001) in patients with posterior instability than in patients who had a posterior labral tear but a clinically stable shoulder. Clinical posterior instability is associated with excessive posterior humeral translation, long posterior labral tears, and posterior labrocapsular avulsion.

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

NASA Astrophysics Data System (ADS)

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

2009-05-01

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

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

PubMed

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

1991-01-01

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

Total knee replacement with tibial tubercle osteotomy in rheumatoid patients with stiff knee.

PubMed

Eid, Ahmed Salem; Nassar, Wael Ahmed Mohamed; Fayyad, Tamer Abdelmeguid Mohamed

2016-11-01

Total knee arthroplasty (TKA) is a well-proven modality that can provide pain relief and restore mobility for rheumatoid arthritis (RA) patients with advanced joint destruction. Patellar ligament avulsion, especially in presence of poor bone quality and knee stiffness, is one of the special considerations that must be addressed in this unique population of patients. This study aimed to determine the functional results in a series of rheumatoid patients with stiff knee and end-stage joint destruction who underwent tibial tubercle osteotomy during TKA. Twenty-three knees in 20 patients (16 women; four men) at a mean age of 54 years with end-stage arthritis and knee stiffness due to RA were operated upon for TKA using tibial tubercle osteotomy as a step during the operation. Patients were reviewed clinically and radiographically with a minimum follow-up of two years. Complications were noted. Hospital for Special Surgery (HSS) score was recorded pre-operatively and at six and 12 months postoperatively. Union occurred at the osteotomy site in 21 of 23 cases. One case had deep venous thrombosis (DVT). There was no infection or periprosthetic fracture, and at last follow-up, no patient required revision. HSS score improved from 46 (15-60) pre-operatively to 85 (71-96) post-operatively. Tibial tubercle osteotomy during TKA in patients with RA and stiff knee is technically demanding yet proved to be effective in improving post-operative range of movement and minimising the complication of patellar ligament avulsion.

Knowledge about emergency dental trauma management among school teachers in Colombia: A baseline study to develop an education strategy.

PubMed

Marcano-Caldera, Maytté; Mejía-Cardona, Jose Luis; Parra Sanchez, José Hernán; Méndez de la Espriella, Catalina; Covo Morales, Eduardo; Sierra Varón, Gustavo; Gómez Díaz, Martha; Fortich Mesa, Natalia; Escobar Villegas, Paola; Bermúdez Reyes, Patricia; Rodríguez Sanchez, Patricia; Mejia Fernández, Pedro; Gómez-Scarpetta, Ruth Ángela; Bernal Alfaro, Vanessa; Cifuentes Aguirre, Olga Lucia; López Soto, Olga Patricia; Sigurdsson, Asgeir

2018-06-01

Dental trauma in school populations has a high frequency and school teachers are often close to the place where such injuries occur. However, many studies have confirmed the lack of knowledge as to how to act in these cases. The aim of this study was to determine the knowledge in regard to dental trauma of school teachers in Colombia. A multicentre, descriptive cross-sectional study was performed in 251 schools using a stratified randomized sampling. A structured hard copy survey was personally delivered to 2390 school teachers in the selected schools. The survey contained questions related to work experience, teaching level and demographic data, as well as questions related to their knowledge of and attitude towards emergency dental trauma management. The response rate was 96%. Most of the school teachers (95%) had never received training related to dental trauma, although 35% had witnessed at least 1 case. Of 2296 school teachers surveyed, only 5.8% would have replanted an avulsed tooth. An association was found between work experience and appropriate management of an avulsed tooth. No significant differences were found in regard to school location (city), school type (private/public), gender and school teachers' education level. The knowledge of school teachers in Colombia about emergency dental trauma management is inadequate. The findings strongly suggest a need for an education strategy with the involvement of the government, dentistry schools and private organizations. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Bone scanning in the adductor insertion avulsion syndrome.

PubMed

Mahajan, Madhuri Shimpi

2013-05-01

A thigh splint (adductor insertion avulsion syndrome) is a relatively uncommon diagnosis analogous to shin splints. This article reports a 19-year-old female patient NOT a regular athlete who presented with groin pain. Physical examination was non-specific; magnetic resonance imaging pelvis did not reveal any abnormality. Patient referred for whole body bone scan, especially to locate any abnormality in the spine. This study highlights the role of whole body bone scan in the evaluation of groin pain and importance of evaluation of whole lower extremity.

Pain and brachial plexus lesions: evaluation of initial outcomes after reconstructive microsurgery and validation of a new pain severity scale.

PubMed

Bonilla, Gonzalo; Di Masi, Gilda; Battaglia, Danilo; Otero, José María; Socolovsky, Mariano

2011-01-01

Peripheral nerve lesions usually are associated with neuropathic pain. In the present paper, we describe a simple scale to quantify pain after brachial plexus injuries and apply this scale to a series of patients to determine initial outcomes after reconstructive surgery. Fifty-one patients with traumatic brachial plexus avulsion injuries were treated over the period of one calendar year at one center by the same surgical team. Of these, 28 patients who were available for follow-up reported some degree of neuropathic pain radiating towards the hand or forearm and underwent reconstructive microsurgery and direct pain management, including trunk and nerve neurolysis and repair. A special pain severity rating scale was developed and used to assess patients' pain before and after surgery, over a minimum follow-up of 6 months. An independent researcher, not part of the surgical team, performed all pre- and postoperative evaluations. Of the 28 patients with brachial plexus traction injuries who met eligibility criteria, 93% were male, and most were young (mean age, 27.6 years). The mean preoperative severity of pain using our scale was 30.9 out of a maximum of 37 (± 0.76 SD), which fell to a mean of 6.9 (± 0.68 SD) 6 months post-procedure. On average, pain declined by 78% across the whole series, a decline that was statistically significant (p < .001). Subset analysis revealed similar improvements across all the different parameters of pain. We have designed and tested a simple and reliable method by which to quantify neuropathic pain after traumatic brachial plexus injuries. Initial surgical treatment of the paralysis--including nerve, trunk and root reconstruction, and neurolysis--comprises an effective means by which to initially treat neuropathic pain. Ablative or neuromodulative procedures, like dorsal root entry zone, should be reserved for refractory cases.

Sonographic Findings of Chondral Avulsion Fractures of the Lateral Ankle Ligaments in Children.

PubMed

Maeda, Manabu; Maeda, Nana; Takaoka, Takanori; Tanaka, Yasuhito

2017-02-01

In this series, we aimed to describe the sonographic findings of chondral avulsion fractures that develop concomitant with lateral ankle ligament injury in children. We performed stress sonography during a manual anterior drawer stress procedure of the ankle in 9 skeletally immature patients who had recently had a lateral ankle sprain. Echo videos were obtained through the course of treatment, and all videos were reviewed. We elucidated the common features of chondral avulsion fractures of the lateral ankle ligaments in the children. The features of avulsion fractures on conventional sonography included absence of a fracture with hyperechoic spots (sonographic occult fracture type), cortical discontinuity with hyperechoic spots (cortical disruption fracture type), fracture line in the cortical bone (double-line fracture type), and a step-off deformity of the cortical bone with cartilage (displaced fracture type). In contrast, the features of chondral fractures on stress sonography included abnormal motion of the chondral lesions and mobility/fluidity of hyperechoic spots along the chondral fracture site. The presence of hyperechoic spots around the chondral lesion is an important sonographic sign for diagnosing chondral fractures concomitant with ankle lateral ligament injury. Hence, we believe that stress sonography should be considered for the detection of chondral fractures concomitant with radiographically negative ankle lateral ligament injuries in skeletally immature patients with lateral ankle pain and ankle sprains, if hyperechoic spots are present in the cartilage of the distal fibula. © 2017 by the American Institute of Ultrasound in Medicine.

Control of Delta Avulsion by Downstream Sediment Sinks

NASA Astrophysics Data System (ADS)

Salter, Gerard; Paola, Chris; Voller, Vaughan R.

2018-01-01

Understanding how fluxes are partitioned at delta bifurcations is critical for predicting patterns of land loss and gain in deltas worldwide. Although the dynamics of river deltas are influenced from both upstream and downstream, previous studies of bifurcations have focused on upstream controls. Using a quasi-1-D bifurcation model, we show that flow switching in bifurcations is strongly influenced by downstream sediment sinks. We find that coupling between upstream and downstream feedbacks can lead to oscillations in water and sediment flux partitioning. The frequency and initial rate of growth/decay of the oscillations depend on both upstream and downstream conditions, with dimensionless bifurcate length and bypass fraction emerging as key downstream parameters. With a strong offshore sink, causing bypass in the bifurcate branches, we find that bifurcation dynamics become "frozen"; that is, the bifurcation settles on a permanent discharge ratio. In contrast, under depositional conditions, we identify three dynamical regimes: symmetric; soft avulsion, where both branches remain open but the dominant branch switches; and full avulsion. Finally, we show that differential subsidence alters these regimes, with the difference in average sediment supply to each branch exactly compensating for the difference in accommodation generation. Additionally, the model predicts that bifurcations with shorter branches are less asymmetric than bifurcations with longer branches, all else equal, providing a possible explanation for the difference between backwater length distributaries, which tend to be avulsive, and relatively stable mouth-bar-scale networks. We conclude that bifurcations are sensitive both quantitatively and qualitatively to downstream sinks.

[Treatment of postherpetic neuralgia on the right side of nose: a case report].

PubMed

Tang, Jiyuan; Tang, Qiao

2015-11-01

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.

Hemipelvectomy for trauma: case report.

PubMed Central

Smith, R. J.

1991-01-01

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

Phrenic nerve transfer to the musculocutaneous nerve for the repair of brachial plexus injury: electrophysiological characteristics

PubMed Central

Liu, Ying; Xu, Xun-cheng; Zou, Yi; Li, Su-rong; Zhang, Bin; Wang, Yue

2015-01-01

Phrenic nerve transfer is a major dynamic treatment used to repair brachial plexus root avulsion. We analyzed 72 relevant articles on phrenic nerve transfer to repair injured brachial plexus that were indexed by Science Citation Index. The keywords searched were brachial plexus injury, phrenic nerve, repair, surgery, protection, nerve transfer, and nerve graft. In addition, we performed neurophysiological analysis of the preoperative condition and prognosis of 10 patients undergoing ipsilateral phrenic nerve transfer to the musculocutaneous nerve in our hospital from 2008 to 201 3 and observed the electromyograms of the biceps brachii and motor conduction function of the musculocutaneous nerve. Clinically, approximately 28% of patients had brachial plexus injury combined with phrenic nerve injury, and injured phrenic nerve cannot be used as a nerve graft. After phrenic nerve transfer to the musculocutaneous nerve, the regenerated potentials first appeared at 3 months. Recovery of motor unit action potential occurred 6 months later and became more apparent at 12 months. The percent of patients recovering ‘excellent’ and ‘good’ muscle strength in the biceps brachii was 80% after 18 months. At 12 months after surgery, motor nerve conduction potential appeared in the musculocutaneous nerve in seven cases. These data suggest that preoperative evaluation of phrenic nerve function may help identify the most appropriate nerve graft in patients with an injured brachial plexus. The functional recovery of a transplanted nerve can be dynamically observed after the surgery. PMID:25883637

Phrenic nerve transfer to the musculocutaneous nerve for the repair of brachial plexus injury: electrophysiological characteristics.

PubMed

Liu, Ying; Xu, Xun-Cheng; Zou, Yi; Li, Su-Rong; Zhang, Bin; Wang, Yue

2015-02-01

Phrenic nerve transfer is a major dynamic treatment used to repair brachial plexus root avulsion. We analyzed 72 relevant articles on phrenic nerve transfer to repair injured brachial plexus that were indexed by Science Citation Index. The keywords searched were brachial plexus injury, phrenic nerve, repair, surgery, protection, nerve transfer, and nerve graft. In addition, we performed neurophysiological analysis of the preoperative condition and prognosis of 10 patients undergoing ipsilateral phrenic nerve transfer to the musculocutaneous nerve in our hospital from 2008 to 201 3 and observed the electromyograms of the biceps brachii and motor conduction function of the musculocutaneous nerve. Clinically, approximately 28% of patients had brachial plexus injury combined with phrenic nerve injury, and injured phrenic nerve cannot be used as a nerve graft. After phrenic nerve transfer to the musculocutaneous nerve, the regenerated potentials first appeared at 3 months. Recovery of motor unit action potential occurred 6 months later and became more apparent at 12 months. The percent of patients recovering 'excellent' and 'good' muscle strength in the biceps brachii was 80% after 18 months. At 12 months after surgery, motor nerve conduction potential appeared in the musculocutaneous nerve in seven cases. These data suggest that preoperative evaluation of phrenic nerve function may help identify the most appropriate nerve graft in patients with an injured brachial plexus. The functional recovery of a transplanted nerve can be dynamically observed after the surgery.

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

NASA Astrophysics Data System (ADS)

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

2012-03-01

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

Bone Scanning in the Adductor Insertion Avulsion Syndrome

PubMed Central

Mahajan, Madhuri Shimpi

2013-01-01

A thigh splint (adductor insertion avulsion syndrome) is a relatively uncommon diagnosis analogous to shin splints. This article reports a 19-year-old female patient NOT a regular athlete who presented with groin pain. Physical examination was non-specific; magnetic resonance imaging pelvis did not reveal any abnormality. Patient referred for whole body bone scan, especially to locate any abnormality in the spine. This study highlights the role of whole body bone scan in the evaluation of groin pain and importance of evaluation of whole lower extremity. PMID:25126001

Changing central nervous system control following intercostal nerve transfer.

PubMed

Malessy, M J; Thomeer, R T; van Dijk, J G

1998-10-01

The goal of this study was to find which central nervous system (CNS) pathways are involved in volitional control over reinnervated biceps or pectoral muscles. Intercostal nerves (ICNs) were coapted to the musculocutaneous nerve (MCN) or the medial pectoral nerve (MPN) in 23 patients with root avulsions of the brachial plexus to restore biceps or pectoral muscle function. The facilitatory effects of respiration and voluntary contraction on cortical motor-evoked potentials of biceps or pectoral muscles were used to study CNS control over the reinnervated muscles. The time course of the facilitatory effect of respiration and voluntary contraction differed significantly. In the end stage of nerve regeneration, the facilitatory effect of voluntary contraction was significantly larger than that of respiration, indicating that the CNS control network over the muscle comes to resemble that of the recipient nerve (MCN or MPN) rather than that of the donor nerve (ICN). The strengthening of previously subthreshold synaptic connections in a CNS network connecting ICN to MCN or MPN neurons may underlie changing excitability.

Long digital extensor tendon mineralization and cranial cruciate ligament rupture in a dog.

PubMed

Kennedy, Katie C; Perry, James A; Duncan, Colleen G; Duerr, Felix M

2014-07-01

To report clinical and histopathologic features of long digital extensor (LDE) tendon mineralization with concurrent cranial cruciate ligament (CCL) rupture in a dog. Case report. 1.5-year-old, male castrated, English bulldog mix weighing 31.5 kg. Pre- and postoperative orthogonal radiographs, arthroscopic evaluation, arthrotomy with en bloc surgical excision, and histopathologic analysis of the excised LDE tendon. There was radiographic evidence of mineralization in the region of the proximal LDE and stifle instability suggestive of CCL rupture. Arthroscopy, and subsequent arthrotomy, showed complete tearing of the CCL and an intact but grossly thickened LDE. No evidence of avulsion or bony proliferation associated with the LDE was appreciated. Tibial plateau leveling osteotomy (TPLO) and tenectomy of the LDE returned the dog to normal weight-bearing. No evidence of ectopic mineralization in the affected limb or similar clinical signs in the contralateral limb have been observed in 12 months follow-up. LDE tenectomy followed by stabilization of the stifle by TPLO resulted in a functional outcome. Mineralization without concurrent avulsion of the LDE has not been reported in dogs; however, posterolateral tendon injury in people has been linked to knee instability and cruciate ligament rupture. © Copyright 2014 by The American College of Veterinary Surgeons.

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

PubMed

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

2016-04-01

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

The influence of sex and trauma impact on the rupture site of the ulnar collateral ligament of the thumb.

PubMed

Boesmueller, Sandra; Huf, Wolfgang; Rettl, Gregor; Dahm, Falko; Meznik, Alexander; Muschitz, Gabriela; Kitzinger, Hugo; Bukaty, Adam; Fialka, Christian; Vierhapper, Martin

2017-01-01

Although sex- and gender-specific analyses have been gaining more attention during the last years they have rarely been performed in orthopaedic literature. The primary purpose of this study was to investigate whether for injuries of the UCL the specific location of the rupture is influenced by sex. A secondary study question addressed the sex-independent effect of trauma intensity on the rupture site of the UCL. This study is a retrospective analysis of all patients with either a proximal or distal bony avulsion or with a mid-substance tear or ligament avulsion of the UCL treated surgically between 1992 and 2015 at two level-I trauma centres. Trauma mechanisms leading to the UCL injury were classified into the following categories: (1) blunt trauma (i.e., strains), (2) low-velocity injuries (e.g., fall from standing height, assaults), and (3) high-velocity injuries (e.g., sports injuries, motor vehicle accidents). After reviewing the surgical records, patients were divided into three groups, depending upon the ligament rupture site: (1) mid-substance tears, (2) proximal ligament or bony avulsions and (3) distal ligament or bony avulsions. Dependencies between the specific rupture site and the explanatory variables (sex, age, and trauma intensity) were evaluated using χ2 test and logistic regression analysis. In total, 1582 patients (1094 males, 488 females) met the inclusion criteria. Mean age was 41 years (range: 9-90 years). Taking into account the effects of sex on trauma intensity (p<0.001) and of trauma intensity on rupture site (p<0.001), mid-substance tears occurred more frequently in women, whereas men were more prone to distal ligament or bony avulsions (p<0.001). In other words, sex and rupture site correlated due to the effects of sex on trauma intensity and of trauma intensity on rupture site, but taking into account those effects there still was a significant effect of sex on rupture site. The results of this study demonstrate that with regression analysis both sex and trauma intensity allow to predict rupture site in UCL injuries.

Double row anchor fixation: a novel technique for a diabetic calanceal insufficiency avulsion fracture.

PubMed

Greenhagen, Robert M; Highlander, Peter D; Burns, Patrick R

2012-01-01

Avulsion fractures of the calcaneal tuberosity represent only 1.3% to 2.7% of calcaneal fractures. These fractures are common pathologically in nature and attributed to decreased bone mineral density. Calcaneal insufficiency avulsion (CIA) fracture in patients with diabetes mellitus is most likely due to Charcot neuroarthropathy (CN) as described by the Brodsky classification (Brodsky 3B). Traditional open reduction and internal fixation is difficult in all calcaneal avulsion fractures because of poor bone quality. The authors report the first known description of the use of fracture fragment excision and double row anchor fixation.A 39-year-old woman with type I diabetes mellitus and a history of CN presented with an avulsion fracture of the calcaneal tuberosity. Excision of the fracture fragment and a gastrocnemius recession and reattachment of the Achilles tendon with double row anchor fixation to the calcaneus were performed. At 1 year, the patient's American Orthopaedic Foot & Ankle Society rearfoot score improved from 27/100 to 88/100. CIA fractures are an infrequently described injury. Because diabetes mellitus is frequently associated with this disease, it most likely represents a CN event. Traditionally, CIA fractures have been operatively treated with open reduction internal fixation. Previous authors have described difficulty with fixation because of poor quality. In the current report, the authors describe a novel operative approach to CIA fractures through the use of double row anchor fixation and excision of the fracture fragments. The authors feel that this previously undescribed treatment is superior to traditional methods and may serve as a new treatment option for all patients who have sustained this unusual pathology regardless of the underlying cause. The current authors provide a novel operative technique that provides inherent advantages to the traditional repair of CIA fractures. We believe CIA fractures represent a CN-type event and care should be taken when evaluating and treating these patients to prevent further sequelae. Copyright © 2012 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

The influence of sex and trauma impact on the rupture site of the ulnar collateral ligament of the thumb

PubMed Central

Huf, Wolfgang; Rettl, Gregor; Dahm, Falko; Meznik, Alexander; Muschitz, Gabriela; Kitzinger, Hugo; Bukaty, Adam; Fialka, Christian; Vierhapper, Martin

2017-01-01

Purpose and hypothesis Although sex- and gender-specific analyses have been gaining more attention during the last years they have rarely been performed in orthopaedic literature. The primary purpose of this study was to investigate whether for injuries of the UCL the specific location of the rupture is influenced by sex. A secondary study question addressed the sex-independent effect of trauma intensity on the rupture site of the UCL. Methods This study is a retrospective analysis of all patients with either a proximal or distal bony avulsion or with a mid-substance tear or ligament avulsion of the UCL treated surgically between 1992 and 2015 at two level-I trauma centres. Trauma mechanisms leading to the UCL injury were classified into the following categories: (1) blunt trauma (i.e., strains), (2) low-velocity injuries (e.g., fall from standing height, assaults), and (3) high-velocity injuries (e.g., sports injuries, motor vehicle accidents). After reviewing the surgical records, patients were divided into three groups, depending upon the ligament rupture site: (1) mid-substance tears, (2) proximal ligament or bony avulsions and (3) distal ligament or bony avulsions. Dependencies between the specific rupture site and the explanatory variables (sex, age, and trauma intensity) were evaluated using χ2 test and logistic regression analysis. Results In total, 1582 patients (1094 males, 488 females) met the inclusion criteria. Mean age was 41 years (range: 9–90 years). Taking into account the effects of sex on trauma intensity (p<0.001) and of trauma intensity on rupture site (p<0.001), mid-substance tears occurred more frequently in women, whereas men were more prone to distal ligament or bony avulsions (p<0.001). In other words, sex and rupture site correlated due to the effects of sex on trauma intensity and of trauma intensity on rupture site, but taking into account those effects there still was a significant effect of sex on rupture site. Conclusions The results of this study demonstrate that with regression analysis both sex and trauma intensity allow to predict rupture site in UCL injuries. PMID:28738083

Postextraction Dental Implant in the Aesthetic Zone, Socket Shield Technique Versus Conventional Protocol.

PubMed

Bramanti, Ennio; Norcia, Antonio; Cicciù, Marco; Matacena, Giada; Cervino, Gabriele; Troiano, Giuseppe; Zhurakivska, Khrystyna; Laino, Luigi

2018-06-01

The aim of this randomized controlled trial was to evaluate the survival rate, the marginal bone level, and the aesthetic outcome; at 3 years' follow-up, of dental implants placed into a high-esthetic aesthetic zone by comparing 2 techniques of postextraction implant with immediate loading: the socket shied technique and the conventional insertion technique.Several clinical studies suggested that the avulsion of a dental element causes dimensional alterations of both soft and hard tissues at the postextractive site. To increase the aesthetic outcomes, the "socket-shield technique" has been proposed. This method involves maintaining the vestibular root portion and immediate insertion of the dental implant in close proximity to the root.Patients enrolled in this study were randomized to receive a postextraction implant in the aesthetic zone, either with the socket shied technique or with the conventional insertion technique. Implant survival, marginal bone level, and the pink aesthetic score were the outcomes evaluated.Implant survival rate was 100% in both the groups at 3 years. Implants inserted with the socket shield technique showed better values of both marginal bone level and pink aesthetic score (P < 0.05).Although such preliminary results need to be further confirmed, the socket shield technique seems to be a safe surgical technique that allows an implant rehabilitation characterized by better aesthetic outcomes.

Hemostatic Effects of Microbubble-Enhanced Low-Intensity Ultrasound in a Liver Avulsion Injury Model

PubMed Central

Feng, Guiying; Liu, Jianhua; Zhao, Xiaochen; Wei, Jinglu; Ou, Wencai; Xiao, Shuyi; Hu, Zhiwen; Wei, Hongqin; Liu, Zheng

2014-01-01

Objectives Microbubble-enhanced therapeutic ultrasound (MEUS) can block the blood flow in the organs. The aim of this study was to evaluate the hemostatic effect of microbubble-enhanced pulsed, low-intensity ultrasound in a New Zealand White rabbit model of avulsion trauma of the liver. The therapeutic ultrasound (TUS) transducer was operated with the frequency of 1.2 MHz and an acoustic pressure of 3.4 MPa. Microbubble-(MB) enhanced ultrasound (MEUS) (n = 6) was delivered to the distal part of the liver where the avulsion was created. Livers were treated by TUS only (n = 4) or MB only (n = 4) which served as controls. Bleeding rates were measured and contrast enhanced ultrasound (CEUS) was performed to assess the hemostatic effect, and liver hemoperfusion before and after treatment. Generally, bleeding rates decreased more than 10-fold after the treatment with MEUS compared with those of the control group (P<0.05). CEUS showed significant declines in perfusion. The peak intensity value and the area under the curve also decreased after insonation compared with those of the control group (P<0.05). Histological examination showed cloudy and swollen hepatocytes, dilated hepatic sinusoids, perisinusoidal spaces with erythrocyte accumulation in small blood vessels, obvious hemorrhage around portal areas and scattered necrosis in liver tissues within the insonation area of MEUS Group. In addition, necrosis was found in liver tissue 48 h after insonation. We conclude that MEUS might provide an effective hemostatic therapy for serious organ trauma such as liver avulsion injury. PMID:24788757

Scale dependant compensational stacking of channelized sedimentary deposits

NASA Astrophysics Data System (ADS)

Wang, Y.; Straub, K. M.; Hajek, E. A.

2010-12-01

Compensational stacking, the tendency for sediment transport system to preferentially fill topographic lows, thus smoothing out topographic relief is a concept used in the interpretation of the stratigraphic record. Recently, a metric was developed to quantify the strength of compensation in sedimentary basins by comparing observed stacking patterns to what would be expected from simple, uncorrelated stacking. This method uses the rate of decay of spatial variability in sedimentation between picked depositional horizons with increasing vertical stratigraphic averaging distance. We explore how this metric varies as a function of stratigraphic scale using data from physical experiments, stratigraphy exposed in outcrops and numerical models. In an experiment conducted at Tulane University’s Sediment Dynamics Laboratory, the topography of a channelized delta formed by weakly cohesive sediment was monitored along flow-perpendicular transects at a high temporal resolution relative to channel kinematics. Over the course of this experiment a uniform relative subsidence pattern, designed to isolate autogenic processes, resulted in the construction of a stratigraphic package that is 25 times as thick as the depth of the experimental channels. We observe a scale-dependence on the compensational stacking of deposits set by the system’s avulsion time-scale. Above the avulsion time-scale deposits stack purely compensationally, but below this time-scale deposits stack somewhere between randomly and deterministically. The well-exposed Ferris Formation (Cretaceous/Paleogene, Hanna Basin, Wyoming, USA) also shows scale-dependant stratigraphic organization which appears to be set by an avulsion time-scale. Finally, we utilize simple object-based models to illustrate how channel avulsions influence compensation in alluvial basins.

One-Dimensional Hydraulic Theory Applied to Experimental Subaqueous Fans with Supercritical Distributaries

NASA Astrophysics Data System (ADS)

Hamilton, P.; Strom, K.; Hoyal, D. C. J. D.

2015-12-01

Subaqueous fans are distributive channel systems that form in a variety of settings including offshore marine, sub-lacustrine, and reservoirs. These distributive systems create complex sedimentation patterns through repeated avulsion to fill in a basin. Here we ran a series of experiments to explore the intrinsic controls on avulsion cycles on subaqueous fans. Experiments are a convenient way to study these systems since the time-scale of fan development is dramatically shortened compared to natural settings, all boundary conditions can be controlled, and the experimental domain can be instrumented to monitor the pertinent hydraulic and morphologic variables. Experiments in this study used saline underflows and crushed plastic sediment fed down an imposed slope covered in the sediment. Avulsion cycles are a central feature in these experiments which are characterized by: (1) channel extension and stagnation; (2) bar aggradation and hydraulic jump initiation; (3) upstream retreat; and (4) flow avulsion. Looking at and analyzing these cycles yield the following conclusions: (1) distributive channels cease progradation due to a drop in sediment transport capacity in an expanded region ahead of the channel; (2) mouth bar aggradation leads to a large flow obstacle to cause the hydraulic jump feedback; (3) hydraulic jump regions are a significant locus of deposition; and (4) the upstream retreat rate is a function of sediment supply and the strength of the jump. We found that simple one-dimensional hydraulic principles such as the choked flow condition and the sequent depth ratio help to explain hydraulic jump initiation and emplaced lobe thickness respectively.

The use of a single-step regenerative approach for the treatment of a replanted mandibular central incisor with severe resorption.

PubMed

Chaniotis, A

2016-08-01

To report the clinical and radiographic treatment outcome of an immature replanted mandibular incisor with severe inflammatory external root resorption following a single-step regenerative approach. A 7-year-old female patient was referred 1 week following an extrusion injury to her mandibular central incisor (tooth 31). There was a history of a 6 months previous avulsion injury to the same tooth, which had been replanted after 20 min of extra-oral time. On clinical examination, all teeth were asymptomatic and there was an arch wire splint placed on the mandibular incisors. Radiographic examination revealed severe inflammatory external root resorption of tooth 31. A diagnosis of necrotic pulp and asymptomatic apical periodontitis was made. Under local anaesthesia and rubber dam isolation, an access cavity was prepared. The canal was irrigated using 6% NaOCl solution delivered through the EndoVac negative pressure irrigation system (Endo Vac, Axis/SybronEndo, Coppell, TX, USA). A 17% EDTA solution was used for 5 min followed by a final rinse of sterile water. The periapical tissues were probed using a K-file, and bleeding was induced. A blood clot was allowed to form filling the entire canal. A thick plug of MTA was placed in direct contact with the blood clot. The tooth was restored with composite resin. All procedures were performed in a single visit. The splint was removed 2 weeks later. Recall examination after 24 months revealed healthy soft tissues with normal periodontal probing and mobility. The 24 months radiographic evaluation revealed healing of the severe inflammatory external root resorption and continuous root development/dentine wall thickening of the apical third. No signs of ankylosis or significant discoloration was present. © 2015 International Endodontic Journal. Published by John Wiley & Sons Ltd.

False penile fracture: report of 16 cases.

PubMed

Feki, W; Derouiche, A; Belhaj, K; Ouni, A; Ben Mouelhi, S; Ben Slama, M R; Ayed, M; Chebil, M

2007-01-01

We determined the value of diagnostic and therapeutic approaches of false penile fractures and the outcome of treatment. We retrospectively reviewed 16 cases of presumed penile fracture with a negative surgical exploration. Clinical presentation, technique of treatment and outcome were noted. The mean age was 39 years (17-64). Nine patients were injured during sexual intercourse. All the patients presented with the presumptive diagnosis of penile fracture. False penile fracture was evoked in one patient presenting a new erection. Surgical penile exploration was carried out for all the patients without any radiological explorations. It revealed nonspecific dartos bleeding in 10 cases and avulsed superficial dorsal vein in six cases requiring venous ends ligation. All the patients regained penile appearance and potency. We can hardly distinguish false penile fracture from 'true' penile fracture with certainty either clinically or radiologically, thus, surgical exploration is mostly necessary. The prognosis is excellent.

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

PubMed Central

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

2015-01-01

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

Traumatic fifth finger amputation due to pontoon boat railing design.

PubMed

Sullivan, John C; Buckner, Billy; Pigott, David C

2012-12-01

Boating is a common recreational activity that may subject its participants to specific patterns of injury. We describe two unrelated cases of fifth-finger amputation associated with a specific pontoon boat guardrail design. The individuals in these cases sustained an avulsion-type amputation injury to the fifth finger when their fingers became entrapped in a narrowed portion of the boat railing before jumping into the water. Given the widespread use of this type of recreational boat, this apparent design flaw may place additional individuals at risk of significant hand injury with cosmetic and functional loss. Methods to reduce the public health impact of this type of injury are also discussed. Copyright © 2012 Elsevier Inc. All rights reserved.

Evaluation of goat milk as storage media to preserve viability of human periodontal ligament cells in vitro.

PubMed

Ulusoy, Ayça Tuba; Kalyoncuoglu, Elif; Kaya, Senay; Cehreli, Zafer Cavit

2016-08-01

The purpose of this study was to evaluate the effectiveness of goat milk as a storage media for maintenance of periodontal ligament (PDL) cell viability of avulsed teeth and compare it with commonly used and/or investigated storage media. PDL cells were obtained from the root surface of healthy premolars and were cultured in Eagle's maintenance medium (EMM). Cell cultures were treated with the following storage media: tap water (negative control); EMM (positive control); Hank's balanced salt solution; ultra high temperature (UHT) long-shelf-life lactose-free cow milk; UHT long-shelf-life whole cow milk; UHT long-shelf-life skimmed cow milk; UHT long-shelf-life soy milk; UHT long-shelf-life goat milk, UHT long-shelf-life follow on milk with probiotic, 20% propolis, and egg white. Culture plates were incubated with experimental media at 20°C for 1, 3, 6, 12, and 24 h. PDL cell viability was assessed by tetrazolium salt-based colorimetric (MTT) assay at each test period. One-way anova was used to evaluate the effects of storage solutions at each time point, followed by post hoc Duncan's multiple comparison test (P = 0.05). A dendrogram was constructed to show the arrangement of hierarchical clustering. Goat milk displayed the highest capacity to maintain cell viability at all test intervals (P < 0.001). Between 3 and 24 h, milk with the probiotic showed the lowest time-dependent PDL cell viability among all test media (P < 0.001). Compared with all milks, HBSS performed significantly less effectively in maintaining PDL cell viability during the entire test period (P < 0.001). Based on PDL viability, goat milk can be recommended as a suitable storage medium for avulsed teeth. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

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

NASA Astrophysics Data System (ADS)

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

2016-04-01

Channel avulsion during fan development controls distribution and deposition of channel sandbodies and hence alluvial architecture of a fan system. Variable scale spatio-temporal information of fluvial responses to past climate changes is stored in these channel sandbodies. Further these channel sandbodies form fluvial aquifers in alluvial fans and therefore understanding of alluvial architecture and stratigraphy of a fan is crucial for development of groundwater management strategies. In this study we used multiple approaches to map subsurface fluvial aquifer architecture and alluvial stratigraphy, and to estimate sediment provenance using U-Pb dating of detrital zircon grains of Sutlej-Yamuna fan system in northwest India. Satellite imagery based geomorphic mapping shows two large fan system with interfan area. The fan surfaces show presence of major and minor paleochannels. 2D resistivity tomography along several transects across fan surfaces shows distinct layers with contrasting resistivity values. These geo-electric facies corresponds to presence of channel sandbodies beneath surface signature of paleochannels and finer floodplain deposits useful to demarcate lateral extent of subsurface channel sandbodies. A more detailed subsurface stratigraphy using ~50m deep sediment cores and their luminescence ages from across fan surface shows presence of multi-storey sandbodies (MSB) separated by floodplain fines. Within the MSB, individual channel deposits are identified by presence of channel scour surfaces located at coarse sand overlying fine sand layer. Depositional ages of MSB's ranges from ~81 ka (late MIS5) to ~15 ka (MIS2) with major depositional break during MIS3 in parts of the fans. Sediment aggradation rate varies laterally across fan surface as well as vertically down the depth with an average rate of 0.54 mm/year. Fluvial channel persistence for studied time interval (about last 81 ka BP) shows major depositional breaks (and possible incision) at ~41 ka (mid MIS3) and ~31 ka (late MIS3). U-Pb age patterns of detrital zircon grains from cores located at paleochannels on the fan system show prominent age peaks at ~480 Ma and ~1800 Ma that respectively corresponds to modern Sutlej and Yamuna rivers. Luminescence ages of these samples suggest that major channel activity of Sutlej river at its fan system ceased around ~15 ka (post last-glacial maxima) and thereafter it avulsed to its modern course. Our surface study results clearly show that alluvial fan system have well developed longitudinal channel sandbodies that may or may not have surface expression in the form of paleochannel and/or longitudinal ridges. However our geophysical studies show that such channel sandbodies can be delineated in shallow surface on the basis of characteristic resistivity values. The subsurface stratigraphy results show development of MSB possibly due to series of small scale (intravalley) avulsion punctuated by large scale (intervalley) avulsion across the fan surface. Our provenance studies clearly identifies two major large scale channel avulsions of Sutlej and Yamuna rivers. Our study has importance for groundwater management policies in this water-stressed agricultural hotspot of India. Thus, understanding the variability in sand body stratigraphy, channel avulsion history, and aggradation rates is important for understanding aquifer geometry of alluvial fan system.

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

USGS Publications Warehouse

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

2016-01-01

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

A novel MIS technique for posterior cruciate ligament avulsion fractures.

PubMed

Gavaskar, Ashok S; Karthik, Bhupesh; Gopalan, Hitesh; Srinivasan, Parthasarathy; Tummala, Naveen C

2017-08-01

Open surgical approaches to treat tibial avulsion fractures of the posterior cruciate ligament (PCL) often use large incisions involving extensive muscle dissection and retraction. The objective of this study was to describe a new mini-invasive approach targeting the fractured zone, to minimize surgical dissection and improve recovery and rehabilitation. The new approach was used in 15 males and seven females with isolated PCL avulsions. The length of the surgical incision, surgical time, need for conversion to open technique, visual analog scores (VAS) and duration of hospital stay were studied to assess the efficacy, learning curve and advantages of the new technique. Neurovascular complications were recorded. At the two-year follow-up, International Knee Documentation Committee (IKDC) scores were recorded to assess function. Patients were followed up for a mean of 29months (range: 34-41). The mean length of the incision was 4.1cm (range: 3.4 to five) measured at the end of the procedure. None of the patients required conversion to an open technique and no neurovascular complications were recorded. The mean surgical time was 40min (range: 25-50). The mean VAS on discharge was 2.2 (range: one to four) and patients stayed at the hospital for a mean of 2.2days (range: one to three). The mean IKDC score at one-year post surgery was 86.4 (range: 83.9-90.8). The new mini-invasive targeted approach provides adequate exposure for performing internal fixation of PCL avulsion fractures without the surgical morbidity associated with conventional open surgical approaches. The procedure is safe, fast and does not require a long learning curve. Copyright © 2017 Elsevier B.V. All rights reserved.

Reattachment of flexor digitorum profundus avulsion: biomechanical performance of 3 techniques.

PubMed

Brar, Ravinder; Owen, John R; Melikian, Raymond; Gaston, R Glenn; Wayne, Jennifer S; Isaacs, Jonathan E

2014-11-01

To investigate whether inclusion of the volar plate in repair of flexor digitorum profundus avulsions increases the strength of the repair and resists gapping. Cadaveric fingers (n = 18) were divided into 3 equal groups. The first technique involved 2 micro-suture anchors only (A). The second used only volar plate repair (VP). The third group was a hybrid, combining a micro-suture anchor with volar plate augmentation (AVP). Specimens were loaded cyclically to simulate passive motion rehabilitation before being loaded to failure. Clinical failure was defined as 3 mm of gapping, and physical failure as the highest load associated with hardware failure, suture breakage, anchor pullout, or volar plate avulsion. Gapping throughout cycling was significantly greater for the A group than VP and AVP with no difference detected between VP and AVP groups. Gapping exceeded 3 mm during cycling of 3 A specimens, but in none of the VP or AVP specimens. Load at clinical and physical failure for A was significantly lower than for VP and AVP, whereas no difference was detected between VP and AVP. In this cadaveric model, incorporating the volar plate conferred a significant advantage in strength, increasing the mean load to physical failure by approximately 100 N. According to previous biomechanical studies, current reconstructive strategies for flexor digitorum profundus zone I avulsions are not strong enough to withstand active motion rehabilitation. We demonstrated the potential use of volar plate augmentation and the prospective advantageous increase in strength in this cadaveric model. In vivo performance and effects on digital motion are not known. Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Assessment of knowledge and attitude before and after a health education program in East Madurai primary school teachers with regard to emergency management of avulsed teeth.

PubMed

Taranath, M; Senaikarasi, R M; Manchanda, Kavita

2017-01-01

Children attend primary school from as early as 6 years to the mixed dentition stage of about 9 years and spend most of their time in school along with the teachers. School teachers are likely to be among the first to see a child immediately after an injury has occurred, and their knowledge regarding emergency procedures is critical to ensure good prognosis of the clinical treatment. The purpose of the study was to evaluate, by means of a questionnaire, the primary school teacher's knowledge and attitude with regard to emergency management of traumatized avulsed teeth and to test the effectiveness of a health education tool. A total of 214 primary school teachers from 24 government schools, in and around East Madurai Panchayat, participated in a 3-month long study. Baseline data were collected using a pretested questionnaire in the 1st month. Based on that data, a health educational tool was prepared. The final assessment was made using the same questionnaire in the 3rd month. Baseline data and final data were compared using Z-test. The knowledge level of 70.83% of primary school teachers was in the very good category after the health education tool, which was initially nil. Similarly, the attitude level also raised drastically with 0.90% initially in the very good category, and after the health education tool, it was 41.20%. From this study, the importance of the need for the steps to increase the knowledge about the emergency management of avulsion is clearly understood. Thus, the main implication of the study is that a health educational tool regarding the emergency management of avulsion is necessary for the primary school teachers during their teacher training program.

Effet paradoxal du type d’excision sur la prise et le délai de cicatrisation des greffes expansées pour le traitement des brûlures aiguës: a propos de 1129 cas

PubMed Central

Guibert, M.; Chaouat, M.; Boccara, D.; Marco, O.; Lavocat, R.; Alameri, O.; Deslandes, E.; Montlahuc, C.; Mimoun, M.

2016-01-01

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

An avulsed radial artery with a high take-off.

PubMed

Rojas-Marte, Geurys; Chen, On; Verma, Shivani; Rao, Atul; Shani, Jacob; Ayzenberg, Sergey

2015-04-01

A 63-year-old female was diagnosed with severe aortic stenosis, who underwent a diagnostic coronary angiography via transradial approach prior an aortic-valve replacement. After imaging the left coronary system, entrapment of the diagnostic catheter was encountered as a result of spasm of the radial artery. An arteriogram of the arm revealed an anatomical variation in the radial artery (high take-off). Several attempts to remove the entrapped catheter resulted in avulsion of the artery, which was managed successfully with coil embolization. To our knowledge, no such complication has been reported. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Double-Row Suture Anchor Repair of Posterolateral Corner Avulsion Fractures.

PubMed

Gilmer, Brian B

2017-08-01

Posterolateral corner avulsion fractures are a rare variant of ligamentous knee injury primarily described in the skeletally immature population. Injury is often related to a direct varus moment placed on the knee during sporting activities. Various treatment strategies have been discussed ranging from nonoperative management, to excision of the bony fragment, to primary repair with screws or suture. The described technique is a means for achieving fixation of the bony avulsion using principles familiar to double-row transosseous equivalent rotator cuff repair. Proximal anchors are placed in the epiphysis, and sutures are passed in horizontal mattress fashion. Once tied, the limbs of these same sutures are then passed to more distal anchors. Remaining eyelet sutures can be used to manage peripheral tissue. The final repair provides anatomic reduction and compression of the fragment to its bony bed with minimal extracortical hardware prominence and no violation of the physis. Risks include potential for physeal injury or chondral damage to the lateral femoral condyle through aberrant anchor placement. Postoperative care includes toe-touch weight-bearing restrictions and range of motion restrictions of 0°-90° in a hinged brace for 6 weeks followed by gradual return to activity.

Outcomes in Patients Treated with a Novel, Simple Method for Hemostasis of Dermal Avulsion Injuries.

PubMed

Dowling, Sean Taylor; Lin, Brian Wai

2017-10-01

A recently described technique proposes a simple method to achieve permanent hemostasis of distal fingertip dermal avulsion injuries. It is simple to learn and easy to perform with readily available materials found in most emergency departments. However, long-term outcomes for patients treated with this technique have not yet been evaluated. A primary objective of the current article is to provide safety data for the technique using an off-label product indication. Emergency department of Kaiser Permanente Medical Center, San Francisco, California. Six patients were treated in the emergency department for fingertip dermal avulsion injuries using a tourniquet and tissue adhesive glue (Dermabond by Ethicon, Somerville, New Jersey). Patients were subsequently contacted to assess healing and satisfaction with cosmetic outcome through interview and photographs of their wounds at 9 months following the date of injury. All 6 patients were satisfied with the cosmetic outcome of treatment, and none received a diagnosis of serious complications. This series demonstrates cosmetic outcomes for injuries treated with the technique, highlights potential problems that may be perceived by patients during their clinical course, and creates the groundwork for a larger clinical study examining the use of the technique.

[Application of three-dimensional printing technology in treatment of internal or external ankle distal avulsed fracture].

PubMed

Shi, Weixiang; Luo, Xiaozhong; Wu, Gang; Ding, Yong; Zhou, Xin

2018-02-01

To explore the effectiveness and advantage of three-dimensional (3D) printing technology in treatment of internal or external ankle distal avulsed fracture. Between January 2015 and January 2017, 20 patients with distal avulsed fracture of internal or external ankle were treated with the 3D guidance of shape-blocking steel plate fixation (group A), and 18 patients were treated with traditional plaster external fixation (group B). There was no significant difference in gender, age, injury cause, disease duration, fracture side, and fracture type between 2 groups ( P >0.05). Recording the fracture healing rate, fracture healing time, the time of starting to ankle functional exercise, residual ankle pain, and evaluating ankle function recovery of both groups by the American Orthopaedic Foot and Ankle Society (AOFAS) score. All patients were followed up 8-24 months, with an average of 15.5 months. In group A: all incisions healed by first intention, the time of starting to ankle functional exercise was (14±3) days, fracture healing rate was 100%, and the fracture healing time was (10.15±2.00) weeks. At 6 months, the AOFAS score was 90.35±4.65. Among them, 13 patients were excellent and 7 patients were good. All patients had no post-operative incision infection, residual ankle pain, or dysfunction during the follow-up. In group B: the time of starting to ankle functional exercise was (40±10) days, the fracture healing rate was 94.44%, and the fracture healing time was (13.83±7.49) weeks. At 6 months, the AOFAS score was 79.28±34.28. Among them, 15 patients were good, 2 patients were medium, and 1 patient was poor. During the follow-up, 3 patients (16.67%) had pain of ankle joint with different degrees. There were significant differences in the postoperative fracture healing rate, fracture healing time, the time of starting to ankle functional exercise, and postoperative AOFAS score between 2 groups ( P <0.05). Application of 3D printing technology in treatment of internal or external ankle distal avulsed fracture is simple, safe, reliable, and effective. In particular, it is an ideal treatment for avulsed fracture.

What would happen if the Mississippi River changed its course to the Atchafalaya?

NASA Astrophysics Data System (ADS)

Xu, Y. J.

2017-12-01

The Mississippi River Delta faces an uncertain future as sea level keeps rising while the land continues to subside. In its latest Master Plan draft of 2017, the Louisiana Coastal Protection and Restoration Authority has outlined a $50 billion investment for 120 projects designed to build and maintain coastal Louisiana. These projects are all developed under the assumption that the Mississippi River (MR) would remain on its current course, which is artificially maintained through a control structure built in 1963 (also known as the Old River Control Structure, or ORCS) after it was realized that the river attempted to change its course back to its old river channel - the Atchafalaya River (AR). Since the ORCS is in operation of controlling only about 25% of the MR flow into the AR, little attention has been paid to the importance of possible riverbed changes downstream the avulsion node on the MR course switch. As one of the largest alluvial river in the world, the MR avulsed every 1,000-1,500 years in the past. Alluvial rivers avulse when two conditions are met: a sufficient in-channel aggradation and a major flood. In our ongoing study on sediment transport and channel morphology of the lower Mississippi River, we found that the first 30-mile reach downstream the ORCS has been experiencing rapid bed aggradation and channel narrowing in the past three decades. A mega flood could be a triggering point to overpower the man-made ORCS and allow the river abandon its current channel - the MR main stem. This is not a desirable path; however, nature has its own mechanism of choosing river flows, which do not bow to our expectation. The Missisippi River's flow is projected to increase in the future as global temperature continues to rise and hydrologic cycle intensifies. Additionally, rapid urbanization in the river basin will create conditions that foster the emergence of mega floods. It would be impractical to spend considerable resources for a river delta without assessing the future avulsion risk of the river upstream. My presentation will discuss the possibility of a Mississippi River avulsion, its consequences, as well as what assessment data we need to develop rational strategies.

Stabilization and treatment of dental avulsions and fractures by emergency physicians using just-in-time training.

PubMed

McIntosh, Mark S; Konzelmann, Jason; Smith, Jeffrey; Kalynych, Colleen J; Wears, Robert L; Schneider, Howard; Wylie, Todd; Kaminski, Anne; Matar-Joseph, Madeline

2009-10-01

The objective of this investigation is to use a dental simulation model to compare splinting and bandaging methods for managing tooth avulsions and fractures, as measured by dentist evaluators for quality and time to complete each stabilization procedure. This was a randomized crossover study comparing 3 splinting techniques for managing a traumatically avulsed tooth (periodontal pack, wire, and bondable reinforcement ribbon) and 2 bandage techniques for managing a fractured tooth (calcium hydroxide paste and light-cured composite). After viewing a Just-in-Time training video, a convenience sample of emergency physicians performed the 5 stabilization techniques on dental models containing extracted teeth embedded in clay to simulate a segment of the human dentition. Data collected included time to complete each procedure, the evaluation of dentists about whether the procedure was performed satisfactorily or unsatisfactorily, and the ranking of dentists' and participants' preferred technique. Twenty-five emergency physicians participated in the study: 17 residents, 2 pediatric emergency medicine fellows, and 6 attending physicians. Reported median time, as well as minimum and maximum times to complete each splinting technique for an avulsed tooth, was as follows: periodontal pack 4.4 minutes (2.5 to 6.5 minutes), wire 8.6 minutes (5.8 to 12.9 minutes), and bondable reinforcement ribbon 8.9 minutes (5.6 to 15 minutes). Median time (and minimum and maximum times) to complete each protective bandaging technique for a fractured tooth was calcium hydroxide paste 4.6 minutes (3 to 9.6 minutes) and light-cured composite 7.1 minutes (5.5 to 14.1 minutes). When asked to choose a preferred splinting and bandaging technique according to the performance of the physicians, the dentists chose the bondable reinforcement ribbon 96% (24/25) and the light-cured composite 100% (25/25) of the time. Study participants had no measurable or agreeable preference for a particular splinting or bandaging technique. The results of this study suggest that of the stabilization procedures completed by emergency physicians, dentists preferred the bondable reinforcement ribbon for managing an avulsed tooth and the light-cured composite technique for managing a fractured tooth over the commonly taught and more frequently used procedures in emergency medicine.

Autogenic dynamics of debris-flow fans

NASA Astrophysics Data System (ADS)

van den Berg, Wilco; de Haas, Tjalling; Braat, Lisanne; Kleinhans, Maarten

2015-04-01

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, the debris flows started to channelize, forced by increasingly effective concentration of the flow impulse to the flow front, which caused more effective lateral levee formation and an increasingly well-defined channel. This process continued until the debris flows reached their maximum possible extent and the cycle was reverted. Channelization occurred in the absence of erosion, in contrast with fluvial fans. Backfilling and channelization cycles were gradual and symmetric, requiring multiple debris flows to be completed. These results add debris-flow fans to the spectrum of fan-shaped aqueous systems that are affected by autogenic dynamics, now ranging from low-gradient rivers systems to steep-gradient mass-flow fans.

Management of traumatic macular holes: case report.

PubMed

Brasil, Oswaldo Ferreira Moura; Brasil, Oswaldo Moura

2008-01-01

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.

Intracapsular origin of the long head of the biceps tendon with glenoid avulsion of the glenohumeral ligaments.

PubMed

Parikh, Shital N; Bonnaig, Nicolas; Zbojniewicz, Andrew

2011-11-09

An 18-year-old woman presented with a history of recurrent glenohumeral dislocations involving her right dominant shoulder. Physical examination suggested physiologic hyperlaxity and anterior instability. Magnetic resonance arthrography demonstrated an anomalous intracapsular origin of the long head of the biceps tendon (LHBT), with normal-appearing LHBT in the intertubercular groove. Diagnostic arthroscopy confirmed the absence of the LHBT attachment on the superior labrum. Instead, the LHBT originated from the capsule of the shoulder joint. Diagnostic arthroscopy also revealed glenoid avulsion of the glenohumeral ligaments (GAGL) lesion as a tear in the anterior-inferior capsule near its insertion on the glenoid and labrum. An arthroscopic anterior capsulolabral repair was performed with rotator interval closure by imbrication of superior and middle glenohumeral ligaments. A retrospective review of the magnetic resonance arthrogram identified irregularity and interposition of contrast between the capsule and the anterior-inferior labrum that was reproduced in the abduction-external rotation view corresponding with the GAGL lesion seen at arthroscopy. At 12 months postoperatively, the patient demonstrated full range of motion and no signs of instability. This case report helps to raise awareness about 2 rare shoulder lesions: the anomalous origin of LHBT and the GAGL lesion. Diagnosing such lesions on preoperative magnetic resonance imaging may aid in operative planning and avoid unexpected intraoperative findings. Copyright 2011, SLACK Incorporated.

An Unusual Log-splitter Injury Leading to Radial Artery Thrombosis, Ulnar Artery Laceration, and Scapholunate Dissociation

PubMed Central

Spock, Christopher R.; Salomon, Jeffrey C.; Narayan, Deepak

2008-01-01

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. PMID:18827886

Platelet-Rich Fibrin: An Autologous Fibrin Matrix in Surgical Procedures: A Case Report and Review of Literature

PubMed Central

Eshghpour, Majid; Majidi, Mohamad Reza; Nejat, Amir Hossein

2012-01-01

Introduction: The healing process after surgery is a challenging issue for surgeons. Various materials and techniques have been developed to facilitate this process and reduce its period. Fibrin adhesives are often used in cardiothoracic and vascular surgery to seal diffuse microvascular bleeding and in general and plastic surgery to seal wound borders. This Case report and literature review will introduce the various usages of platelet-rich fibrin in different surgical procedures and the method of producing the matrix. Case Report: A 24-year old man with periorbital skin avulsion treated with PRF membrane has been reported and discussed in this paper. Conclusion: Platelet-rich fibrin is a natural autologous fibrin matrix, which can be produced with a simple blood sample and a table centrifuge. The material has been used in a wide range of surgical procedures to shorten the healing period and reduce post-surgical complications. PMID:24303410

Arthroscopic Management of Triangular Fibrocartilage Complex Peripheral Injury.

PubMed

Haugstvedt, Jan Ragnar; Søreide, Endre

2017-11-01

Patients suffering from ulnar-sided wrist pain after trauma may develop tenderness, clicking, a positive fovea sign, or instability of the distal radioulnar joint. If the pain is persistent, conservative treatment does not help, and the patient agrees to surgery, arthroscopy may reveal a triangular fibrocartilage complex (TFCC) injury with capsular detachment, foveal avulsion, or a combination thereof. Capsular reattachment is possible using an arthroscopic assisted technique. The reattachment can be performed with an inside-out, outside-in, or all-inside technique, providing good to excellent results, which tend to persist over time, in 60% to 90% of cases. Copyright © 2017 Elsevier Inc. All rights reserved.

[Onychocola canadensis Sigler in onychomycosis : A new dermatophyte-like mould in Germany].

PubMed

Nenoff, P; Schorlemmer, B; Uhrlaß, S; Baunacke, A; Baunacke, A; Friedrichs, C; Iffländer, J; Syhre, E; Schneider, A; Krüger, C; Maier, T

2016-09-01

Moulds or non-dermatophyte moulds (NDM) are being increasingly isolated as causative agent of onychomycoses. Known causes of a NDM-OM are Scopulariopsis brevicaulis, Fusarium, Aspergillus, Acremonium, Neoscytalidium dimidiatum, Arthrographis kalrae, and Chaetomium. In this article, 5 patients with suspected nail infection due to Onychocola canadensis are reported for the first time in Germany. Systemic antifungal agents are not considered to be effective in NDM onychomycosis. In individual cases, however, terbinafine seems to be effective in Onychocola canadensis infection of the nails. Treatment of choice represents, however, nontraumatic nail avulsion using 40 % urea ointment followed by antifungal nail lacquer with ciclopirox olamine or amorolfine.

Magnetic resonance imaging atlas of the cervical spine musculature.

PubMed

Au, John; Perriman, Diana M; Pickering, Mark R; Buirski, Graham; Smith, Paul N; Webb, Alexandra L

2016-07-01

The anatomy of the cervical spine musculature visible on magnetic resonance (MR) images is poorly described in the literature. However, the correct identification of individual muscles is clinically important because certain conditions of the cervical spine, for example whiplash associated disorders, idiopathic neck pain, cervical nerve root avulsion and cervical spondylotic myelopathy, are associated with different morphological changes in specific muscles visible on MR images. Knowledge of the precise structure of different cervical spine muscles is crucial when comparisons with the contralateral side or with normal are required for accurate description of imaging pathology, management and assessment of treatment efficacy. However, learning the intricate arrangement of 27 muscles is challenging. A multi-level cross-sectional depiction combined with three-dimensional reconstructions could facilitate the understanding of this anatomically complex area. This paper presents a comprehensive series of labeled axial MR images from one individual and serves as a reference atlas of the cervical spine musculature to guide clinicians, researchers, and anatomists in the accurate identification of these muscles on MR imaging. Clin. Anat. 29:643-659, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Endodontic treatment of mandibular molars with atypical root canal anatomy: reports of 4 cases.

PubMed

Chauhan, Raju; Singh, Shweta

2015-01-01

The variations in root canal anatomy of multirooted teeth represent a continuous challenge to endodontic diagnosis and treatment. Although the most common configuration of mandibular molars is one containing 2 roots and 3 root canals, there are many different combinations. Very rarely, an additional third (supernumerary) root is seen. When it is located distolingually to the main distal root, this third root is called radix entomolaris (RE), and when it is located mesiobuccally to the mesial root, it is called radix paramolaris (RP). Variations of root canal systems need not always be in the form of extra roots or extra canals. Single roots with single canals can also occur. A general dentist should be aware of these unusual root canal morphologies in mandibular molars for the success of endodontic treatment. These case reports describe the root canal treatment of a case of RE in the mandibular first molar, 2 rare cases of RP (1 each in the mandibular first and second molars), and a mandibular second molar with a single root and root canal.

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

PubMed Central

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

2016-01-01

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

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

PubMed

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

2016-01-01

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

[Treatment of calcaneal avulsion fractures with twinfix suture anchors fixation].

PubMed

Zhao, Bin-xiu; Wang, Kun-zheng; Wang, Chun-sheng; Xie, Yue; Dai, Zhi-tang; Liu, Gang; Liu, Wei-dong

2011-06-01

For the calcaneal avulsion fracture, the current method is more commonly used screws or Kirschner wire to fix fracture fragment. This article intended to explore the feasibility and clinical efficacy for the treatment of avulsion fractures with TwinFix suture anchors. From July 2007 to November 2010, 21 patients were reviewed, including 15 males and 6 females, ranging in age from 49 to 65 years,with a mean of 58.7 years. Twelve patients had nodules in the right heel and 9 patients had nodules in the left heel. All the patients had closed fractures. The typical preoperative symptoms of the patients included pain in the upper heel and weak in heel lift. Body examination results: palpable sense of bone rubbing in the back of the heel, and swelling in the heel. Surgery treatment with TwinFix suture anchors performed as follows : to fix TwinFix suture anchors into the calcaneal body, then to drill the fracture block, to make the double strand suture through the fracture holes, to knot the suture eachother to fix the block, and to use stitch to fix the remaining suture in the Achilles tendon in order to improve the block fixation. The criteria of the AOFAS Foot and Ankle Surgery by the United States Association of ankle-rear foot functional recovery was used to evaluate the Achilles tendon. Total average score was (95.5 +/- 3.12) points, including pain items of(38.5 +/- 2.18) points,the average score of functional items of (49.5 +/- 3.09) points,and power lines of 10 points in all patients. Twenty-one patients got an excellent result, 16 good and 5 poor. The methods of treatment for the calcaneal avulsion fractures with TwinFix suture anchors is a simple operation, and have excellent clinical effect, which is worthy of promotion.

Triple Achilles Tendon Rupture: Case Report.

PubMed

Saxena, Amol; Hofer, Deann

We present a case report with 1-year follow-up data of a 57-year-old male soccer referee who had sustained an acute triple Achilles tendon rupture injury during a game. His triple Achilles tendon rupture consisted of a rupture of the proximal watershed region, a rupture of the main body (mid-watershed area), and an avulsion-type rupture of insertional calcific tendinosis. The patient was treated surgically with primary repair of the tendon, including tenodesis with anchors. Postoperative treatment included non-weightbearing for 4 weeks and protected weightbearing until 10 weeks postoperative, followed by formal physical therapy, which incorporated an "antigravity" treadmill. The patient was able to return to full activity after 26 weeks, including running and refereeing, without limitations. Copyright © 2017 The American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Concomitant Avulsion Injury of the Subclavian Vessels and the Main Bronchus Caused by Blunt Trauma.

PubMed

Noh, Dongsub; Lee, Chan-Kyu; Hwang, Jung Joo; Cho, Hyun Min

2018-04-01

Concomitant rupture of the subclavian vessels and the left main bronchus caused by blunt trauma is a serious condition. Moreover, the diagnosis of a tracheobronchial injury with rupture of the subclavian vessels can be difficult. This report describes the case of a 33-year-old man who suffered from blunt trauma that resulted in the rupture of the left subclavian artery and vein. The patient underwent an operation for vascular control. On postoperative day 3, the left main bronchus was found to be transected on a computed tomography scan and bronchoscopy. The transected bronchus was anastomosed in an end-to-end fashion. He recovered without any notable problems. Although the bronchial injury was not detected early, this case of concomitant rupture of the great vessels and the airway was successfully treated after applying extracorporeal membrane oxygenation.

[Successful repair of complete pancreatic rupture and subtotal duodenal avulsion after blunt abdominal trauma in childhood--a case report].

PubMed

Knoop, M; Vorwerk, T

2003-03-01

We report the case of a 12-year-old boy who presented after a bicycle accident with handlebar injury of the epigastrium with clinical signs of hollow visceral injury and elevated pancreatic enzymes. Upon emergency laparotomy, a complete rupture of the pancreatic isthmus and a nearly total transsection of the postpyloric duodenum were encountered (Grade IV according to Lucas). Reconstruction consisted of reanastomosis of the proximal duodenum, closure of the distal end of the pancreatic head and internal drainage of the left pancreas into a Roux-en-Y jejunal loop. The postoperative course was uneventful. For rare traumatic pancreaticoduodenal lesions only individual surgical concepts are promising depending on the extent of damage. However, effort should be made to preserve as much pancreatic tissue as possible.

Pectoralis Major Repair With Unicortical Button Fixation And Suture Tape.

PubMed

Sanchez, Anthony; Ferrari, Marcio B; Frangiamore, Salvatore J; Sanchez, George; Kruckeberg, Bradley M; Provencher, Matthew T

2017-06-01

Although injuries of the pectoralis major muscle are generally uncommon, ruptures of the pectoralis major are occasionally seen in younger, more active patients who participate in weightlifting activities. These injuries usually occur during maximal contraction of the muscle, while in extension and external rotation. In the case of a rupture, operative treatment is advocated especially in young, active patients regardless of the chronicity of the injury. Various surgical techniques for reattachment of the avulsed tendon have been described, but bone tunnel and suture anchor repair techniques are most widely used. In this Technical Note, we present our preferred technique for acute pectoralis major rupture repair involving use of cortical buttons for tendon stump-to-bone fixation.

The knee: Surface-coil MR imaging at 1. 5 T

DOE Office of Scientific and Technical Information (OSTI.GOV)

Beltran, J.; Noto, A.M.; Mosure, J.C.

1986-06-01

Seven normal knees (in five volunteers) and seven injured knees (in seven patients) were examined by high-resolution magnetic resonance (MR) imaging at 1.5 T with a surface coil. Seven medial meniscal tears, three anterior cruciate ligament tears, one posterior cruciate ligament avulsion, an old osteochondral fracture, femoral condylar chondro-malacia, and one case of semimembranous tendon reinsertion were identified. MR images correlated well with recent double-contrast arthrograms or results of surgery. All tears were identified in both the sagittal and coronal planes. Because of its ability to demonstrate small meniscal lesions and ligamentous injuries readily, MR imaging with a surface coilmore » may eventually replace the more invasive arthrography.« less

Dental trauma that require fixation in a children's hospital.

PubMed

Bruns, Timothy; Perinpanayagam, Hiran

2008-02-01

Children and adolescents who suffer traumatic injuries often seek emergency treatment at a Children's Hospital. Complex injuries to permanent teeth and their periodontium require immediate repositioning and stabilization. Many of these emergencies are treated by pediatric dental residents at the Women and Children's Hospital of Buffalo, Buffalo, New York. The purpose of this study was to characterize these complex injuries of permanent teeth that require emergency treatment in a Children's Hospital. All of the cases of dental trauma which had involved permanent teeth and which had been treated with a splint in 2001 and 2002 were reviewed. There were 79 patients that were between 5 and 19 years of age with twice as many males (54) as females (25). The number of males increased from childhood (5-10 years) to early adolescence (11-15 years) and then decreased rapidly in late adolescence (16-19 years), whereas the number of females decreased steadily with age. Most of the incidents occurred during the summer months (72%), particularly in June and July (42%), and Fridays and Saturdays were the busiest days of the week. Most of the injuries were caused by organized and recreational sporting activities (39%) and accidental falls (33%), followed by interpersonal violence (15%) and a few motor vehicle accidents (7%). The 173 permanent tooth injuries were mostly luxations (62%) or avulsions (20%), with only a few fractures of the alveolar bone (5%) or tooth root (1%). Most of the displacements were lateral luxations (40%) or extrusions (18%) with only a few intrusions (3%). These injuries most commonly afflicted the maxillary central incisors (54%), followed by the maxillary laterals (18%) and mandibular centrals (17%). The emergency treatment that was provided at the Children's Hospital included replantation and repositioning, and the placement of a semi-rigid or flexible splint.

Co-evolution of Riparian Vegetation and Channel Dynamics in an Aggrading Braided River System, Mount Pinatubo, Philippines

NASA Astrophysics Data System (ADS)

Gran, K. B.; Michal, T.

2014-12-01

Increased bank stability by riparian vegetation in braided rivers can decrease bed reworking rates and focus the flow. The magnitude of influence and resulting channel morphology are functions of vegetation strength vs. channel dynamics, a concept encapsulated in a dimensionless ratio between timescales for vegetation growth and channel reworking known as T*. We investigate this relationship in an aggrading braided river at Mount Pinatubo, Philippines, and compare results to numerical and physical models. Gradual reductions in post-eruption sediment loads have reduced bed reworking rates, allowing vegetation to persist year-round and impact channel dynamics on the Pasig-Potrero and Sacobia Rivers. From 2009-2011, we collected data detailing vegetation extent, type, density, and root strength. Incorporating these data into RipRoot and BSTEM models shows cohesion due to roots increased from zero in unvegetated conditions to >10.2 kPa in densely-growing grasses. Field-based parameters were incorporated into a cellular model comparing vegetation growth and sediment mobility effects on braided channel dynamics. The model shows that both low sediment mobility and high vegetation strength lead to less active systems, reflecting trends observed in the field. An estimated T* between 0.8 - 2.3 for the Pasig-Potrero River suggests channels were mobile enough to maintain the braidplain width clear of vegetation and even experience slight gains in area through annual removal of existing vegetation. However, persistent vegetation focused flow and thus aggradation over the unvegetated fraction of braidplain, leading to an aggradational imbalance and transition to a more avulsive state. While physical models predict continued narrowing of the active braidplain as T* declines, the future trajectory of channel-vegetation interactions at Pinatubo as sedimentation rates decline appears more complicated due to strong seasonal variability in precipitation and sediment loads. By 2011, seasonal incision in the dry season had started to occur, lowering the water-table, and impeding vegetation growth.

C-shaped root canal in a maxillary first molar: a case report.

PubMed

Yilmaz, Z; Tuncel, B; Serper, A; Calt, S

2006-02-01

This case report presents an unusual C-shaped root canal system in a maxillary first molar tooth. Although C-shaped root canals are most frequently seen in the mandibular second molar, they may also appear in maxillary molars. A literature search revealed only a few case reports of C-shaped root canal systems in maxillary molars. The present case describes a C-shaped canal in the buccal root of a maxillary first molar. The endodontic access cavity displayed two canal orifices, one leading to the canal system in the buccal root, the other into the palatal root canal system. In the buccal root, what appeared to be the mesial and distal canals joined to form a single C-shaped canal. --Careful examination of radiographs and the internal anatomy of teeth is essential.-- The location and morphology of root canals should be identified at high magnification under the microscope.

The Physiology of Adventitious Roots1

PubMed Central

Steffens, Bianka; Rasmussen, Amanda

2016-01-01

Adventitious roots are plant roots that form from any nonroot tissue and are produced both during normal development (crown roots on cereals and nodal roots on strawberry [Fragaria spp.]) and in response to stress conditions, such as flooding, nutrient deprivation, and wounding. They are important economically (for cuttings and food production), ecologically (environmental stress response), and for human existence (food production). To improve sustainable food production under environmentally extreme conditions, it is important to understand the adventitious root development of crops both in normal and stressed conditions. Therefore, understanding the regulation and physiology of adventitious root formation is critical for breeding programs. Recent work shows that different adventitious root types are regulated differently, and here, we propose clear definitions of these classes. We use three case studies to summarize the physiology of adventitious root development in response to flooding (case study 1), nutrient deficiency (case study 2), and wounding (case study 3). PMID:26697895

Management of High-energy Avulsive Ballistic Facial Injury: A Review of the Literature and Algorithmic Approach.

PubMed

Vaca, Elbert E; Bellamy, Justin L; Sinno, Sammy; Rodriguez, Eduardo D

2018-03-01

High-energy avulsive ballistic facial injuries pose one of the most significant reconstructive challenges. We conducted a systematic review of the literature to evaluate management trends and outcomes for the treatment of devastating ballistic facial trauma. Furthermore, we describe the senior author's early and definitive staged reconstructive approach to these challenging patients. A Medline search was conducted to include studies that described timing of treatment, interventions, complications, and/or aesthetic outcomes. Initial query revealed 41 articles, of which 17 articles met inclusion criteria. A single comparative study revealed that early versus delayed management resulted in a decreased incidence of soft-tissue contracture, required fewer total procedures, and resulted in shorter hospitalizations (level 3 evidence). Seven of the 9 studies (78%) that advocated delayed reconstruction were from the Middle East, whereas 5 of the 6 studies (83%) advocating immediate or early definitive reconstruction were from the United States. No study compared debridement timing directly in a head-to-head fashion, nor described flap selection based on defect characteristics. Existing literature suggests that early and aggressive intervention improves outcomes following avulsive ballistic injuries. Further comparative studies are needed; however, although evidence is limited, the senior author presents a 3-stage reconstructive algorithm advocating early and definitive reconstruction with aesthetic free tissue transfer in an attempt to optimize reconstructive outcomes of these complex injuries.

Management of High-energy Avulsive Ballistic Facial Injury: A Review of the Literature and Algorithmic Approach

PubMed Central

Vaca, Elbert E.; Bellamy, Justin L.; Sinno, Sammy

2018-01-01

Background: High-energy avulsive ballistic facial injuries pose one of the most significant reconstructive challenges. We conducted a systematic review of the literature to evaluate management trends and outcomes for the treatment of devastating ballistic facial trauma. Furthermore, we describe the senior author’s early and definitive staged reconstructive approach to these challenging patients. Methods: A Medline search was conducted to include studies that described timing of treatment, interventions, complications, and/or aesthetic outcomes. Results: Initial query revealed 41 articles, of which 17 articles met inclusion criteria. A single comparative study revealed that early versus delayed management resulted in a decreased incidence of soft-tissue contracture, required fewer total procedures, and resulted in shorter hospitalizations (level 3 evidence). Seven of the 9 studies (78%) that advocated delayed reconstruction were from the Middle East, whereas 5 of the 6 studies (83%) advocating immediate or early definitive reconstruction were from the United States. No study compared debridement timing directly in a head-to-head fashion, nor described flap selection based on defect characteristics. Conclusions: Existing literature suggests that early and aggressive intervention improves outcomes following avulsive ballistic injuries. Further comparative studies are needed; however, although evidence is limited, the senior author presents a 3-stage reconstructive algorithm advocating early and definitive reconstruction with aesthetic free tissue transfer in an attempt to optimize reconstructive outcomes of these complex injuries. PMID:29707453

Ligament-induced sacral fractures of the pelvis are possible.

PubMed

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

2014-07-01

Pelvic ring stability is maintained passively by both the osseous and the ligamentous apparatus. Therapeutic approaches focus mainly on fracture patterns, so ligaments are often neglected. When they rupture along with the bone after pelvic ring fractures, disrupting stability, ligaments need to be considered during reconstruction and rehabilitation. Our aim was to determine the influence of ligaments on open-book injury using two experimental models with body donors. Mechanisms of bone avulsion related to open-book injury were investigated. Open-book injuries were induced in human pelves and subsequently investigated by anatomical dissection and endoscopy. The findings were compared to CT and MRI scans of open-book injuries. Relevant structures were further analyzed using plastinated cross-sections of the posterior pelvic ring. A fragment of the distal sacrum was observed, related to open-book injury. Two ligaments were found to be responsible for this avulsion phenomenon: the caudal portion of the anterior sacroiliac ligament and another ligament running along the ventral surface of the third sacral vertebra. The sacral fragment remained attached to the coxal bone by this second ligament after open-book injury. These results were validated using plastination and the structures were identified. Pelvic ligaments are probably involved in sacral avulsion caused by lateral traction. Therefore, ligaments should to be taken into account in diagnosis of open-book injury and subsequent therapy. Copyright © 2014 Wiley Periodicals, Inc.

The Clay Shoveler's Fracture: A Case Report and Review of the Literature.

PubMed

Posthuma de Boer, Jantine; van Wulfften Palthe, Alexander F Y; Stadhouder, Agnita; Bloemers, Frank W

2016-09-01

A clay-shoveler's fracture is a very rarely occurring stress-type avulsion fracture of the lower cervical or upper thoracic spinous processes owing its name to the clay shovelers of past times. Currently, this type of injury is mainly encountered in individuals practicing sports involving rotational movements of the upper spine. We present a case of a man sustaining a clay-shoveler's injury during his work in a horse-riding school. Treatment consisted of a period of rest and analgesics, followed by mobilization as was tolerated. We give a brief historical account of clay shoveler's fractures. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Clay-shoveler's fractures are frequently overlooked due to their rareness; however, they have specific clinical features that should alert an attending physician to set the correct diagnosis. This report describes a typical case of a clay-shoveler's fracture, relates to the historical entity of clay-shoveler's fractures, and summarizes existing literature on this topic. Copyright © 2016 Elsevier Inc. All rights reserved.

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

NASA Astrophysics Data System (ADS)

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

2009-12-01

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

Role of motor-evoked potential monitoring in conjunction with temporary clipping of spinal nerve roots in posterior thoracic spine tumor surgery.

PubMed

Eleraky, Mohammed A; Setzer, Matthias; Papanastassiou, Ioannis D; Baaj, Ali A; Tran, Nam D; Katsares, Kiesha M; Vrionis, Frank D

2010-05-01

The vascular supply of the thoracic spinal cord depends on the thoracolumbar segmental arteries. Because of the small size and ventral course of these arteries in relation to the dorsal root ganglion and ventral root, they cannot be reliably identified during surgery by anatomic or morphologic criteria. Sacrificing them will most likely result in paraplegia. The goal of this study was to evaluate a novel method of intraoperative testing of a nerve root's contribution to the blood supply of the thoracic spinal cord. This is a clinical retrospective study of 49 patients diagnosed with thoracic spine tumors. Temporary nerve root clipping combined with motor-evoked potential (MEP) and somatosensory-evoked potential (SSEP) monitoring was performed; additionally, postoperative clinical evaluation was done and reported in all cases. All cases were monitored by SSEP and MEPs. The nerve root to be sacrificed was temporarily clipped using standard aneurysm clips, and SSEP/MEP were assessed before and after clipping. Four nerve roots were sacrificed in four cases, three nerve roots in eight cases, and two nerve roots in 22 cases. Nerve roots were sacrificed bilaterally in 12 cases. Most patients (47/49) had no changes in MEP/SSEP and had no neurological deficit postoperatively. One case of a spinal sarcoma demonstrated changes in MEP after temporary clipping of the left T11 nerve root. The nerve was not sacrificed, and the patient was neurologically intact after surgery. In another case of a sarcoma, MEPs changed in the lower limbs after ligation of left T9 nerve root. It was felt that it was a global event because of anesthesia. Postoperatively, the patient had complete paraplegia but recovered almost completely after 6 months. Temporary nerve root clipping combined with MEP and SSEP monitoring may enhance the impact of neuromonitoring in the intraoperative management of patients with thoracic spine tumors and favorably influence neurological outcome. Copyright 2010 Elsevier Inc. All rights reserved.

Early detection of myocardial infarction following blunt chest trauma by computed tomography: a case report.

PubMed

Lee, Thung-Lip; Hsuan, Chin-Feng; Shih, Chen-Hsiang; Liang, Huai-Wen; Tsai, Hsing-Shan; Tseng, Wei-Kung; Hsu, Kwan-Lih

2017-02-10

Blunt cardiac trauma encompasses a wide range of clinical entities, including myocardial contusion, cardiac rupture, valve avulsion, pericardial injuries, arrhythmia, and even myocardial infarction. Acute myocardial infarction due to coronary artery dissection after blunt chest trauma is rare and may be life threatening. Differential diagnosis of acute myocardial infarction from cardiac contusion at this setting is not easy. Here we demonstrated a case of blunt chest trauma, with computed tomography detected myocardium enhancement defect early at emergency department. Under the impression of acute myocardial infarction, emergent coronary angiography revealed left anterior descending artery occlusion. Revascularization was performed and coronary artery dissection was found after thrombus aspiration. Finally, the patient survived after coronary stenting. Perfusion defects of myocardium enhancement on CT after blunt chest trauma can be very helpful to suggest myocardial infarction and facilitate the decision making of emergent procedure. This valuable sign should not be missed during the initial interpretation.

Concomitant Avulsion Injury of the Subclavian Vessels and the Main Bronchus Caused by Blunt Trauma

PubMed Central

Noh, Dongsub; Lee, Chan-kyu; Hwang, Jung Joo

2018-01-01

Concomitant rupture of the subclavian vessels and the left main bronchus caused by blunt trauma is a serious condition. Moreover, the diagnosis of a tracheobronchial injury with rupture of the subclavian vessels can be difficult. This report describes the case of a 33-year-old man who suffered from blunt trauma that resulted in the rupture of the left subclavian artery and vein. The patient underwent an operation for vascular control. On postoperative day 3, the left main bronchus was found to be transected on a computed tomography scan and bronchoscopy. The transected bronchus was anastomosed in an end-to-end fashion. He recovered without any notable problems. Although the bronchial injury was not detected early, this case of concomitant rupture of the great vessels and the airway was successfully treated after applying extracorporeal membrane oxygenation. PMID:29662817

Subungual and periungual congenital blue naevus.

PubMed

Gershtenson, Platina Coy; Krunic, Aleksandar; Chen, Helen; Konanahalli, Madhuri; Worobec, Sophie

2009-05-01

Subungual pigmented lesions should raise concern about malignant melanoma. Blue naevus of the nail apparatus is a rare entity, with only ten cases described in the literature. We report a 21-year-old Hispanic woman with a slowly enlarging 1.7 x 2.3-cm subungual and periungual pigmented plaque present since birth on her right second toe. Initial biopsy was consistent with a blue naevus of the cellular type and, given the recent clinical change and periungual extension, complete excision was recommended. The entire nail unit was resected down to periosteum with prior avulsion of the nail plate. Reconstruction was performed with a full-thickness skin graft. Follow up at 1 year revealed well-healed graft and donor sites with complete return of function. We present a case of a congenital subungual and periungual blue naevus of the cellular type and review the literature on this rare presentation of a congenital blue naevus.

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

PubMed Central

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

2016-01-01

Background: Patients with chronic injuries of the proximal hamstring can develop significant impairment because of weakness of the hamstring muscles, sciatic nerve compression from scar formation, or myositis ossificans. Purpose: To describe the surgical outcomes of patients with chronic injury of the proximal hamstrings who were treated with hamstring repair and sciatic neurolysis supplemented with nerve wrapping with acellular dermal matrix. Study Design: Retrospective case series; Level of evidence, 4. Methods: Fifteen consecutive patients with a diagnosis of chronic complete proximal hamstring rupture or chronic ischial tuberosity apophyseal avulsion fracture (mean age, 39.67 years; range, 14-69 years) were treated with proximal hamstring repair and sciatic neurolysis supplemented with nerve wrapping with acellular dermal matrix. Nine patients had preoperative sciatica, and 6 did not. Retrospective chart review recorded clinical outcomes measured by the degree of pain relief, the rate of return to activities, and associated postoperative complications. Results: All 15 patients were followed in the postoperative period for an average of 16.6 months. Postoperatively, there were 4 cases of transient sciatic nerve neurapraxia. Four patients (26%) required postoperative betamethasone sodium phosphate (Celestone Soluspan) injectable suspension USP 6 mg/mL. Among the 9 patients with preoperative sciatica, 6 (66%) had a good or excellent outcome and were able to return to their respective activities/sports; 3 (33%) had persistent chronic pain. One of these had persistent sciatic neuropathy that required 2 surgical reexplorations and scar excision after development of recurrent extraneural scar formation. Among the 6 without preoperative sciatica, 100% had a good or excellent outcomes and 83% returned to their respective activities/sports. Better outcomes were observed in younger patients, as the 3 cases of persistent chronic sciatic pain were in patients older than 45 years. Conclusion: This study suggests that when used as an adjunct to sciatic neurolysis, nerve wrapping with acellular dermal matrix can be a safe and effective method of treating younger patients with and preventing the development of sciatic neuropathic pain after chronic injury of the proximal hamstrings. PMID:27081655

Forceps delivery is associated with increased risk of pelvic organ prolapse and muscle trauma: a cross-sectional study 16-24 years after first delivery.

PubMed

Volløyhaug, I; Mørkved, S; Salvesen, Ø; Salvesen, K Å

2015-10-01

To study possible associations between mode of delivery and pelvic organ prolapse (POP) and pelvic floor muscle trauma 16-24 years after first delivery and, in particular, to identify differences between forceps and vacuum delivery. This was a cross-sectional study including 608 women who delivered their first child in 1990-1997 and were examined with POP quantification (POP-Q) and pelvic floor ultrasound in 2013-2014. Outcome measures were POP ≥ Stage 2 or previous prolapse surgery, levator avulsion and levator hiatal area on Valsalva. Univariable and multivariable logistic regression analyses and ANCOVA were applied to identify outcome variables associated with mode of delivery. Comparing forceps to vacuum delivery, the adjusted odds ratios (aOR) were 1.72 (95% CI, 1.06-2.79; P = 0.03) for POP ≥ Stage 2 or previous prolapse surgery and 4.16 (95% CI, 2.28-7.59; P < 0.01) for levator avulsion. Hiatal area on Valsalva was larger, with adjusted mean difference (aMD) of 4.75 cm(2) (95% CI, 2.46-7.03; P < 0.01). Comparing forceps with normal vaginal delivery, the adjusted odds ratio (aOR) was 1.74 (95% CI, 1.12-2.68; P = 0.01) for POP ≥ Stage 2 or surgery and 4.35 (95% CI, 2.56-7.40; P < 0.01) for levator avulsion; hiatal area on Valsalva was larger, with an aMD of 3.84 cm(2) (95% CI, 1.78-5.90; P < 0.01). Comparing Cesarean delivery with normal vaginal delivery, aOR was 0.06 (95% CI, 0.02-0.14; P < 0.01) for POP ≥ Stage 2 or surgery and crude OR was 0.00 (95% CI, 0.00-0.30; P < 0.01) for levator avulsion; hiatal area on Valsalva was smaller, with an aMD of -8.35 cm(2) (95% CI, -10.87 to -5.84; P < 0.01). No differences were found between vacuum and normal vaginal delivery. We found that mode of delivery was associated with POP and pelvic floor muscle trauma in women from a general population, 16-24 years after their first delivery. Forceps was associated with significantly more POP, levator avulsion and larger hiatal areas than were vacuum and normal vaginal deliveries. There were no statistically significant differences between vacuum and normal vaginal deliveries. Cesarean delivery was associated with significantly less POP and pelvic floor muscle trauma than were normal or operative vaginal delivery. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.

Endodontic treatment of mandibular canine with two roots and two canals.

PubMed

Moogi, Prashant P; Hegde, Reshma S; Prashanth, B R; Kumar, G Vinay; Biradar, Nandini

2012-11-01

In majority of cases, mandibular canines have one root and one root canal, although 15% may have two canals. Literature report shows incidence of two-rooted canine as low as 1.7%. This article reports a clinical case of endodontic treatment of mandibular canine with two roots and two canals.

Novel Model of Somatosensory Nerve Transfer in the Rat.

PubMed

Paskal, Adriana M; Paskal, Wiktor; Pelka, Kacper; Podobinska, Martyna; Andrychowski, Jaroslaw; Wlodarski, Pawel K

2018-05-09

Nerve transfer (neurotization) is a reconstructive procedure in which the distal denervated nerve is joined with a proximal healthy nerve of a less significant function. Neurotization models described to date are limited to avulsed roots or pure motor nerve transfers, neglecting the clinically significant mixed nerve transfer. Our aim was to determine whether femoral-to-sciatic nerve transfer could be a feasible model of mixed nerve transfer. Three Sprague Dawley rats were subjected to unilateral femoral-to-sciatic nerve transfer. After 50 days, functional recovery was evaluated with a prick test. At the same time, axonal tracers were injected into each sciatic nerve distally to the lesion site, to determine nerve fibers' regeneration. In the prick test, the rats retracted their hind limbs after stimulation, although the reaction was moderately weaker on the operated side. Seven days after injection of axonal tracers, dyes were visualized by confocal microscopy in the spinal cord. Innervation of the recipient nerve originated from higher segments of the spinal cord than that on the untreated side. The results imply that the femoral nerve axons, ingrown into the damaged sciatic nerve, reinnervate distal targets with a functional outcome.

Morphodynamics and Sediment Transport on the Huanghe (Yellow River) Delta: Work in Progress

NASA Astrophysics Data System (ADS)

Kineke, G. C.; Calson, B.; Chadwick, A. J.; Chen, L.; Hobbs, B. F.; Kumpf, L. L.; Lamb, M. P.; Ma, H.; Moodie, A. J.; Mullane, M.; Naito, K.; Nittrouer, J. A.; Parker, G.

2017-12-01

Deltas are perhaps the most dynamic of coastal landforms with competing processes that deliver and disperse sediment. As part of the NSF Coastal SEES program, an interdisciplinary team of scientists from the US and China are investigating processes that link river and coastal sediment transport responsible for morphodynamic change of the Huanghe delta- an excellent study site due to its high sediment load and long history of natural and engineered avulsions, that is, abrupt shifts in the river course. A fundamental component of the study is a better understanding of sediment transport physics in a river system that transports mostly silt. Through theory and data analysis, we find that fine-grained rivers fail to develop full scale dunes, which results in faster water flow and substantially larger sediment fluxes as compared to sandy rivers (e.g. the Mississippi River). We also have developed new models for sediment-size dependent entrainment that are needed to make longer term predictions of river sedimentation patterns. On the delta front, we are monitoring the high sediment flux to the coast, which results in steep foresets and ideal conditions for off-shore sediment delivery via gravity flows. These constraints on sediment transport are being used to develop new theory for where and when rivers avulse - including the effects of variable flood discharge, sediment supply, and sea level rise -and how deltas ultimately grow through repeated cycles of lobe development. Flume experiments and field observations are being used to test these models, both in the main channel of the Huanghe and in channels abandoned after historic avulsions. Abandoned channels and floodplains are now dominated by coastal sediment transport through a combination of wave resuspension and tidal transport, settling lag and reverse estuarine circulation. Finally, the field and laboratory tested numerical models are being used as inputs to define a cost curve for efficient avulsion management of the Huanghe delta by minimizing expected flood-damage cost. Taken together, these studies can inform management policies and promote consideration of the natural evolution of deltas to achieve sustainability.

Avulsion research using flume experiments and highly accurate and temporal-rich SfM datasets

NASA Astrophysics Data System (ADS)

Javernick, L.; Bertoldi, W.; Vitti, A.

2017-12-01

SfM's ability to produce high-quality, large-scale digital elevation models (DEMs) of complicated and rapidly evolving systems has made it a valuable technique for low-budget researchers and practitioners. While SfM has provided valuable datasets that capture single-flood event DEMs, there is an increasing scientific need to capture higher temporal resolution datasets that can quantify the evolutionary processes instead of pre- and post-flood snapshots. However, flood events' dangerous field conditions and image matching challenges (e.g. wind, rain) prevent quality SfM-image acquisition. Conversely, flume experiments offer opportunities to document flood events, but achieving consistent and accurate DEMs to detect subtle changes in dry and inundated areas remains a challenge for SfM (e.g. parabolic error signatures).This research aimed at investigating the impact of naturally occurring and manipulated avulsions on braided river morphology and on the encroachment of floodplain vegetation, using laboratory experiments. This required DEMs with millimeter accuracy and precision and at a temporal resolution to capture the processes. SfM was chosen as it offered the most practical method. Through redundant local network design and a meticulous ground control point (GCP) survey with a Leica Total Station in red laser configuration (reported 2 mm accuracy), the SfM residual errors compared to separate ground truthing data produced mean errors of 1.5 mm (accuracy) and standard deviations of 1.4 mm (precision) without parabolic error signatures. Lighting conditions in the flume were limited to uniform, oblique, and filtered LED strips, which removed glint and thus improved bed elevation mean errors to 4 mm, but errors were further reduced by means of an open source software for refraction correction. The obtained datasets have provided the ability to quantify how small flood events with avulsion can have similar morphologic and vegetation impacts as large flood events without avulsion. Further, this research highlights the potential application of SfM in the laboratory and ability to document physical and biological processes at greater spatial and temporal resolution. Marie Sklodowska-Curie Individual Fellowship: River-HMV, 656917

Aircast walking boot and below-knee walking cast for avulsion fractures of the base of the fifth metatarsal: a comparative cohort study.

PubMed

Shahid, Mohammad Kamran; Punwar, Shahid; Boulind, Caroline; Bannister, Gordon

2013-01-01

Acute avulsion fractures of the base of the fifth metatarsal are common and are treated in a variety of ways. The aims of this study were to compare pain, functional outcome, and time taken off work after treatment with a walking boot or a short-leg cast. Of 39 patients with acute avulsion fractures of the base of the fifth metatarsal, 23 were treated with a short-leg cast and 16 with a walking boot, according to the preference of the consultant present at outpatient clinic. Functional outcome was assessed by the Visual Analogue Scale Foot and Ankle Questionnaire (VAS FA), pain, and other complaints on presentation and at 3, 6, 9, and 12 weeks after injury. The VAS FA scores were compared between the 2 groups by a paired Student t test. The mean time to return to the level of pain and function before injury was approximately 9 weeks after treatment in the walking boot group and 12 weeks with a short-leg cast. Patients with walking boots reported less pain between 3 and 12 weeks than did those with short-leg casts after 6 (P = .06), 9 (P = .020), and 12 weeks (P = .33). Function was significantly better with Aircast walking boots after 3 (P = .006), 6 (P = .002), and 9 weeks (P = .002) but not after 12 weeks (P = .09). Patients returned to their preinjury level of driving after 6 weeks with walking boots and 12 weeks with short-leg casts (P = .006). Employed patients took a mean of 35.8 days off work (range, 28-42 days), fewer with boots (31.5 days) than with short-leg casts (39.2 days). The walking boot was better treatment than a short-leg cast for avulsion fractures of the base of the fifth metatarsal. Patients had an improved combined level of pain and function 3 weeks earlier, at 9 weeks post injury, when managed in a walking boot. Level II, prospective comparative series.

Long-term observation of endodontic surgical intervention to treat root perforation and apical periodontitis: a case report of an amalgam-restored tooth.

PubMed

Tsurumachi, Tamotsu; Hayashi, Makoto

2003-10-01

A case of crestal root perforation and periapical lesion in a maxillary left lateral incisor is reported. Teeth with root perforation present technical difficulties in their clinical management because of their complex defects. In the present case, surgical endodontic treatment was chosen. The apical and lateral pathology was curetted, the tooth root was resected, and a retrograde root restoration of amalgam was placed in a root-end cavity and perforation site. A 10-year follow-up clinical and radiographic examination showed an asymptomatic tooth with osseous healing proceeding.

Endodontic management of an unusual maxillary first molar with a single buccal root.

PubMed

Nayak, Gurudutt; Dahiya, Surya; Singh, Inderpreet; Mohammad, Faiz Hasan

2014-05-01

The aim of this clinical article is to describe the unusual anatomy that was detected in a maxillary first molar during routine endodontic treatment. Variation in Root and Root canal morphology especially in multirooted teeth presents a constant challenge for a clinician in their detection and management. The literature is replete with cases that have extra canal or Root but cases with fused Root and fewer numbers of canals are sparse. This case report describes the endodontic management of one such unusual case of maxillary first molar presenting with a single fused buccal and a palatal Root. The confirmatory diagnosis of this morphologic aberration was done with the help of spiral computerized tomography, which revealed that the contralateral tooth also had a similar morphology. Dental practitioners should always be aware of the fact that abnormalities need not be in form of extra Roots or Root canals; anomalies can also be in form of fewer number of Roots or Root canals. A thorough knowledge of the complexities and variations of the Root canal system would help in avoiding some of the common iatrogenic access opening errors like perforations and excessive tooth removal caused during the search for the missing or extracanal.

Common lower limb sport-related overuse injuries in young athletes.

PubMed

Lau, Leok Lim; Mahadev, Arjandas; Hui, James Hp

2008-04-01

Sports injuries in children and adolescent present a unique challenge to the physician. They are often seen for clinical conditions unique to their age group. This paper highlights the epidemiological aspect of sports-related overuse injuries in this age group. This retrospective study reviewed all the paediatric patients diagnosed with overuses injuries during a 5 years and 7 months period. The overuse injuries were anterior superior iliac spine avulsion fracture, Osgood-Schlatter disease, Sinding-Larson-Johansson disease, osteochondritis dissecan and Sever's disease. We reviewed the literature and attempted to give an overview for each condition and the anatomical differences that contributed to their occurrence in this age group. A total of 506 cases of the overuse injuries were seen during the study period. Seventy-three per cent were male patients. The knee joint was the commonest affected joint while the hip was the least affected joint. The mean age at diagnosis was younger in female compared to male for all conditions except in Sinding-Larson Johansson syndrome. Female was diagnosed at a mean age of 11.7 years while male at 10.8 years. Osgood-Schlatter disease was the commonest among the overuse injuries. There was no discernible racial predilection for these conditions except in the patients with anterior superior iliac spine avulsion. Overuse injuries are not uncommon in children and adolescent. An adequate understanding of the anatomy of the sports the children participated in as well as the anatomical differences between adult and children may assist the primary care providers better meet parents' and coaches' expectations.

[Repair and functional reconstruction of the penis (a report of 62 cases)].

PubMed

Wang, Zhong; Cai, Zhi-Kang; Cheng, Kai-Xiang; Da, Jun; Jiang, Yue-Qing; Lu, Mu-Jun; Ren, Xiao-Min; Zhang, Ke; Xu, Ming-Xi; Yao, Hai-Jun; Chen, Qi; Wang, Hao; Dong, Guo-Qin

2009-08-01

To investigate the effects of surgery treatment on serious penile lesions and malformation. Sixty-two patients, aged from 19 to 63 years old (mean 35 ys), were included in the study. Among them, 4 patients suffered from penis partial defection were respectively treated with restoring defective penis, penis lengthening and urethroplasty; three patients with penis completely missing were treated with penis reconstruction surgery; 22 cases with serious penile curvature were treated with the 16-dot plication technique (Lue's procedure); 15 cases with penile fracture were treated with conservative treatment for 1 case and with patch penis, corpus spongiosum, and deep penile dorsal vein ligation for 14 cases; 5 cases with post-operative complications of 3-pieces of penile prosthesis, including the prosthesis perforating to the urethra, water pump failure, broken connection tube, erection angle < 60 degrees and failure to expansion the corpus cavernosum, were treated by taking out prostheses, urethral repair cracks, replacement of the prostheses, excision of fibrosis scar and re-implantation prostheses respectively. Four cases with penis complete amputation were treated with the penis replantation; three cases of avulsion injury were treated with the replantation and free flap skin; 6 with Paget's disease of penises were treated with the lesion free skin buried in the scrotum and penis. All these patients were followed up for 3 months to 4 years, with the average of 9 months. Among the 4 cases of penis partial defection, 2 patients were satisfied with the penile appearance and sexual function; 1 got some satisfactory and 1 was unsatisfied. Three cases with the loss of the penis completely were satisfied with both the postoperative appearance and urination, and 1 was not satisfied. Twenty-two cases of penile curvature deformities were corrected, and one case was recurrence. Fourteen of the 15 patients with penile fracture were followed, and all got the restoration of sexual function. Among them, 5 cases with post-operative complications, including mild bending, algopareunia, subcutaneous induration, poor hardness and poor sexual pleasure, were not further treated, and another case lost; Five cases with post-operative complications of three-pieces penile prosthesis were treated successfully, and 4 of their spouses were satisfied with their sexual function after operation, only 1 of their spouse not satisfied. Among four cases with complete amputation of penis, two cases of penis were replanted successfully while two necrosis. Three cases with avulsion were treated with skin grafting successfully. All 6 cases with penile Paget's disease were followed for 2 -4 years, and free skin grafts were all survival. One patient died of brain metastases 18 months after operation and five cases were disease-free survival. The patients should be treated based on the procedure of andrological and urological surgery, together with microsurgical, flap or skin graft technique. The urologist should design personalized surgical procedure. Most of the patient's penis shape and erectile dysfunction can be reconstructed by our procedures, but some patients can not achieve the desired appearance or function of penis. New approaches of the treatment ought to be developed to restore both of the shape and function for those severe injury of the penis.

Endodontic management of permanent mandibular molars with 6 root canals: report of 3 cases.

PubMed

Malhotra, Amit; Ahlawat, Jyoti; Bansal, Chirag; Tahiliani, Divya

2016-01-01

Aberrations in the internal dental anatomy present challenges for clinicians performing endodontic therapy. These challenges have been partly resolved in recent years by a more comprehensive knowledge of root canal anatomy as well as advancements in the endodontic armamentarium. The aim of this case series is to describe successful root canal treatment, under magnification, in 3 cases of mandibular first molars with 6 root canals. Two of these teeth had 2 roots (mesial and distal) with 3 canals in each root; the third tooth had 3 root canals located mesially and 3 present distally as well as a radix entomolaris. A distal root with 3 canals is rare; however, it is important to look for such anatomical variations to ensure successful endodontic therapy.

Part II: arthroscopic treatment of tibial plateau fractures: intercondylar eminence avulsion fractures.

PubMed

Lubowitz, James H; Elson, Wylie S; Guttmann, Dan

2005-01-01

Arthroscopic reduction and internal fixation (ARIF) of tibial intercondylar eminence fractures is the emerging state-of-the-art. ARIF is recommended for displaced type III fractures and should be considered for all cases of displaced type II fractures. Fractures without displacement after closed reduction require careful evaluation to rule out meniscal entrapment. Subjective results of ARIF are uniformly excellent, despite reports of objective anteroposterior laxity. Early range-of-motion exercises are essential to prevent loss of extension. Repair using nonabsorbable suture fixation, when of adequate strength to allow early range-of-motion, has the advantages of eliminating the risks of comminution of the fracture fragment, posterior neurovascular injury, and need for hardware removal, compared with ARIF using screws.

The treatment of an osteochondral shearing fracture-dislocation of the head of the proximal phalanx: a case report.

PubMed

Harness, Neil; Jupiter, Jesse B

2004-09-01

We report the morphology and treatment of a proximal interphalangeal joint dislocation resulting in an injury to the articular surface of the proximal phalanx and avulsion of the radial collateral ligament from its proximal origin. A large osteochondral fragment was sheared from the radial articular surface of the proximal phalanx and remained displaced volarly after reduction of the joint. Plain radiographs and 2- and 3-dimensional computed tomography images were used to evaluate this unusual injury before surgery. Open reduction and internal fixation using a small K-wire and figure-of-eight wire technique restored the articular surface of the head of the proximal phalanx and gave a satisfactory functional result.

Avulsion Fracture: How Is It Treated?

MedlinePlus

... Marx JA, et al., eds. General principles of orthopedic injuries. In: Rosen's Emergency Medicine: Concepts and Clinical ... trademarks of Mayo Foundation for Medical Education and Research. © 1998-2018 Mayo Foundation for Medical Education and ...

Orthodontic treatment for oral rehabilitation after multiple maxillofacial bone fractures.

PubMed

Nakamura, Yoshiki; Ogino, Tomoko Kuroiwa; Hirashita, Ayao

2008-09-01

We present the orthodontic treatment of a patient with occlusal dysfunction after plastic surgery for multiple maxillofacial bone fractures caused by a traffic accident. The patient had mandibular deviation to the right because of inappropriate repositioning and fixation of the fractured bone and complete avulsion of both mandibular central incisors. The bilateral mandibular incisors, canines, and premolars were also suspected of partial avulsion or alveolar bone fracture. Several tests, including percussion and dental computed tomography, were performed on these teeth to rule out ankylosis and confirm tooth movement. Camouflage orthodontic treatment was carried out with expansion of the maxillary arch, alignment of both arches, and space closure between the mandibular lateral incisors to improve the occlusion. Good occlusion and interdigitation were obtained. Orthodontic treatment is useful for the rehabilitation of occlusal dysfunction caused by multiple maxillofacial bone fractures.

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

PubMed Central

2016-01-01

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

Tipping Points in Texas Rivers

NASA Astrophysics Data System (ADS)

Phillips, Jonathan

2016-04-01

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

The reverse Segond fracture: not associated with knee dislocation and rarely with posterior cruciate ligament tear.

PubMed

Peltola, Erno K; Lindahl, Jan; Koskinen, Seppo K

2014-06-01

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.

Human periodontal fibroblasts viability stored in Custodiol® , coconut water and propolis. An ex vivo study.

PubMed

Awawdeh, Lama; Haimour, Rana Naman; Al-Jundi, Suhad Hussein; Al-Qaoud, Khaled

2018-04-17

Successful replantation of an avulsed tooth depends on the regeneration of periodontal ligament (PDL) attachment which is affected by the transport medium, dry time and storage time. Various storage media have been studied but the search for the optimum storage medium is still needed to determine the ideal material and storage time to maintain PDL cells. The aim of this study was to determine the ability of Custodiol ® , coconut water from different stages of maturity and propolis as storage media for avulsed teeth by evaluating the viability of PDL cells for different time intervals. PDL cultures were subjected to Cutodiol ® , immature, half mature, and mature coconut water, and different concentrations of propolis in DMEM. Culture plates with the tested media were incubated for 1, 2, 6, 24, 48, 72 and 168 h. PDL fibroblast cell viability was assessed by MTT assay. Coconut water showed significantly higher viability of cells than other groups at 6 h with half mature coconut water being superior. Propolis at 6.25 mg/mL in DMEM resulted in 138% viable PDL and it was able to preserve PDL cells for up to 168 h. Half mature and mature coconut water are superior storage media if replantation of avulsed teeth is within 6 h. Propolis in DMEM could be a potential storage media for prolonged storage intervals up to 48 h. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Maxillary First Molars with 2 Distobuccal Canals: A Case Series.

PubMed

Fogel, Howard M; Cunha, Rodrigo Sanches

2017-11-01

An appreciation of the anatomic complexity of the root canal system is essential at every step of endodontic treatment. Endodontic treatment of teeth with unusual root canal anatomy presents a unique challenge. Eight patients underwent nonsurgical root canal treatment of 3-rooted maxillary first molars in a specialty endodontic private practice. Four cases of Weine type II and 4 cases of Weine type III canal configurations in the distobuccal root of maxillary first molars were presented.This article highlighted an uncommon anatomic variation of 2 canals in the distobuccal root of the maxillary first molar. Copyright © 2017 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

A mandibular third molar with three mesial roots: a case report.

PubMed

Plotino, Gianluca

2008-02-01

Although its most common configuration is 2 roots and 3 root canals, mandibular molars might have many different combinations. A case of unusual root canal morphology is presented to demonstrate anatomic variations in mandibular molars. Endodontic therapy was performed in a mandibular third molar with 3 separate mesial roots. The appearance of the pulp chamber floor revealed 4 separate canal orifices. Radiographically the 4 root canals ended in their own distinct foramen. Many reports deal with 3 orifices or 3 independent canals in the mesial root, but none described 3 mesial canals in 3 separate mesial roots, indicating a rare anatomic configuration. This report points out the importance of looking for additional canals and unusual canal morphology, because knowledge of their existence might occasionally enable clinicians to treat a case successfully that otherwise might have ended in failure.

Single-rooted maxillary first molar with a single canal: endodontic retreatment.

PubMed

de la Torre, Francisco; Cisneros-Cabello, Rafael; Aranguren, José Luis; Estévez, Roberto; Velasco-Ortega, Eugenio; Segura-Egea, Juan José

2008-12-01

This case report presents an unusual root canal system in a maxillary first molar tooth: a single canal in a single root. The endodontic access cavity displayed only 1 canal orifice. This case demonstrated that: 1) clinicians must have adequate knowledge about root canal morphology and its variations; 2) the location and morphology of root canals should be identified radiologically before the root canal treatment; and 3) careful examination of radiographs and the internal anatomy of teeth is essential.

Report of a Rare Case: A Maxillary First Molar with Seven Canals Confirmed with Cone-Beam Computed Tomography

PubMed Central

Kumar, Rahul

2014-01-01

Introduction: Coronal anatomic variations in permanent maxillary molars are unusual; conversely variations involving the number of root canals or number of roots are more common. Methods and Materials: This case report presents a successful nonsurgical endodontic therapy of left maxillary first molar with three roots and seven root canals. This unusual morphology was diagnosed using a dental operating microscope (DOM) and confirmed with the help of cone-beam computed tomography (CBCT) images. Results: CBCT axial images showed that both of the palatal and distobuccal roots had Vertucci type II canal pattern, whereas the mesiobuccal root canal showed a Sert and Bayirli’s type XV configuration. Conclusion: The use of a DOM and CBCT imaging in endodontically challenging cases can facilitate a better understanding of the complex root canal anatomy, which ultimately enables the clinician to explore the root canal system, and therefore treat it far more efficiently. PMID:24688587

Nonreconstruction Options for Treating Medial Ulnar Collateral Ligament Injuries of the Elbow in Overhead Athletes.

PubMed

Clark, Nicholas J; Desai, Vishal S; Dines, Joshua D; Morrey, Mark E; Camp, Christopher L

2018-03-01

This review aims to describe the nonreconstructive options for treating ulnar collateral ligament (UCL) injuries ranging from nonoperative measures, including physical therapy and biologic injections, to ligament repair with and without augmentation. Nonoperative options for UCL injuries include guided physical therapy and biologic augmentation with platelet-rich plasma (PRP). In some patients, repair of the UCL has shown promising return to sport rates by using modern suture and suture anchor techniques. Proximal avulsion injuries have shown the best results after repair. Currently, there is growing interest in augmentation of UCL repair with an internal brace. The treatment of UCL injuries involves complex decision making. UCL reconstruction remains the gold standard for attritional injuries and complete tears, which occur commonly in professional athletes. However, nonreconstructive options have shown promising results for simple avulsion or partial thickness UCL injuries. Future research comparing reconstructive versus nonreconstructive options is necessary.

Oral trauma and dental emergency management recommendations of first-aid textbooks and manuals.

PubMed

Zadik, Yehuda

2007-10-01

The recommendations of oral trauma and dental emergencies management of nine first-aid textbooks and manuals from the last two decades were evaluated. Only one book includes all the relevant topics: dental anatomy, management of tooth luxations and avulsion, tooth fracture, mandible dislocation, jaw fracture, intraoral bleeding and dental pain. Two books recommend self-replantation of an avulsed tooth, but four books detail the storage media and evaluate the importance of a quick referral to a dental surgery. In three first-aid books, the only mention of oral trauma is the hazard of choking from tooth fragments, and in one other book, only mandible dislocation is mentioned as oral trauma. The insufficient information of oral trauma management in these first-aid texts partly explains the previous reports of poor and inadequate knowledge in that topic among medics, teachers and the general public.

Tendon injuries of the hand

PubMed Central

Schöffl, Volker; Heid, Andreas; Küpper, Thomas

2012-01-01

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

A rare variant of internal anatomy of a third mandibular molar: a case report.

PubMed

Nimigean, V; Nimigean, Vanda Roxana; Sălăvăstru, D I

2011-01-01

The several anatomical variations existing in the root canal system may contribute to failure of the root canal therapy. Knowledge of the internal dental morphology is a complex and extremely important point for planning and performing endodontic therapy. This paper reports the case of a left mandibular third molar that presented only one dental conical root and only one aberrant radicular canal with an initial annular portion situated in the coronar third of the root and a linear portion at the level of the other two thirds of the dental root, which opened through an apical foramen. Root canal therapy and case management are described. Features like wide crown access, adequate illumination and use of exploring files where important for successful completion of the endodontic treatment. The treatment was performed through conventional methods. This clinical case constitutes a rare anatomical variant of internal radicular morphology.

Acupuncture for retained placenta: a retrospective case series.

PubMed

Djakovic, Ivka; Bilic, Nada

2014-12-01

A placenta is considered to be retained when it remains undelivered 30 or 60 min after the birth of the baby following active or physiological management of the third stage of labour, respectively. It can be life threatening for the mother. We retrospectively examined the influence of acupuncture on the delivery of retained placentas in the third stage of labour in 70 women. In all cases the third stage of labour was actively managed, and acupuncture was provided 30 min after delivery at points KI16 and SP6 for 15 min. After acupuncture 77% of placentas separated successfully. In 10% of cases some retained placental tissue was detected and manual removal of the avulsed cotyledon was performed, while in 13% the entire placenta was retained and manual removal of the placenta under general anaesthesia was necessary. Acupuncture may help to facilitate placental separation but further controlled trials are needed. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Surgical management of vertical root fractures for posterior teeth: report of four cases.

PubMed

Floratos, Spyros G; Kratchman, Samuel I

2012-04-01

The objective of this article was to present a surgical treatment option for teeth with incomplete vertical root fracture in maxillary and mandibular posterior teeth. Four cases are presented in which 1 endodontically treated maxillary or mandibular molar had an incomplete vertical root fracture involving 1 of the roots. The tooth underwent a flap elevation procedure to visualize the pattern of bone loss and assess the extent of root fracture. The fracture line was eliminated by resecting the root in a beveled manner, after which root-end preparation and root-end filling were performed by using mineral trioxide aggregate. The osteotomy was covered with an absorbable collagen membrane. Cases were followed up for 8-24 months after surgery. The procedure was shown to be predictable and successful in this series. Root length was preserved, and tooth extraction was avoided. The microsurgical treatment option for multirooted teeth with incomplete vertical root fracture resulted in long-term clinical success. Copyright © 2012 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Work-related traumatic dental injuries: Prevalence, characteristics and risk factors.

PubMed

Ugolini, Alessandro; Parodi, Giovanni Battista; Casali, Claudia; Silvestrini-Biavati, Armando; Giacinti, Flavio

2018-02-01

The prevalence of work-related oral trauma is underestimated because minor dental injuries are often not reported in patients with several injuries in different parts of the body. In addition, little data are available regarding their characteristics. The aim of this epidemiological study was to determine the prevalence, types, and characteristics of occupational traumatic dental injuries (TDIs) in a large working community. Work-related TDIs that occurred during the period between 2011 and 2013 in the District of Genoa (Northwest of Italy, 0.86 million inhabitants) were analyzed. Patients' data were obtained from the National Institute for Insurance against Accidents at Work database. During the 2 year period, 112 TDIs (345 traumatized teeth) were recorded. The prevalence was 5.6‰ of the total amount of occupational trauma. The highest prevalence was found in the fourth and fifth decades of life (OR=3.6, P < .001), and males were injured more often than females (70.5% vs 29.5%, OR=2.8, P < .001). Service and office workers represented 52% of the sample, and construction/farm/factory workers and craftsmen were 48%. TDIs involved only teeth and surrounding tissue in 66% of cases, or in combination with another maxillofacial injury in 34%. They were statistically associated with construction/farm/factory workers group (Chi squared P < .01). Crown fracture was recorded in 34.5% of cases, subluxation/luxation in 10.7%, avulsion in 9%, root fracture in 3.8%, and concussion in 3.5%. Thirty-two subjects (28.6%, 133 teeth, OR=4.3, P < .001) presented at least 1 traumatized tooth with previous dental treatment. Among 212 (61.4%) traumatized teeth, 67.5% were upper incisors, 17.5% were lower incisors, 3.3% were upper canines, 1.9% were lower canines, and 9.9% were bicuspids and molars. Work-related TDIs had a low overall prevalence, and fractures were the most frequent dental injury. Age, gender, and preexisting dental treatments represented risk factors for work-related TDIs. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

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

PubMed Central

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

2016-01-01

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

Efficiency of Castor Oil as a Storage Medium for Avulsed Teeth in Maintaining the Viability of Periodontal Ligament Cells.

PubMed

Nabavizadeh, Mohammadreza; Abbaszadegan, Abbas; Khodabakhsi, Afrooz; Ahzan, Shamseddin; Mehrabani, Davood

2018-03-01

Researchers always seek a new storage medium for avulsed teeth. Castor oil is a vegetable oil with several advantages such as antimicrobial and antioxidant properties, low toxicity, and glutathione preservation capability, low cost, and high availability. The purpose of this study was to evaluate and compare the capacity of castor oil as a new storage medium in preserving the viability of periodontal ligament (PDL) cells compared to Hank's balanced salt solution (HBSS) and milk. Forty freshly extracted human teeth were divided into 3 experimental and 2 control groups. The experimental teeth were stored dry for 30 min and then immersed for 45 min in one of the following media; castor oil, HBSS, and milk. The positive and negative control groups were exposed to 0 min and 2 h of dry time respectively with no immersion in any storage medium. The teeth were then treated with dispase grade II and collagenase and the number of viable PDL cells were counted. Data were analyzed using Kruskal- Wallis test. The percentage of viable cells treated with castor oil, HBSS and milk counted immediately after removal from these media were 46.93, 51.02 and 55.10 % respectively. The statistical analysis revealed that the value for castor oil was significantly lower than HBSS and milk ( p > 0.05). Within the parameters of this study, it appears that castor oil cannot be served as an ideal medium for storage of avulsed tooth. More investigations under in vivo conditions are required to justify the results of this study.

Dragon's Blood Sap (Croton Lechleri) As Storage Medium For Avulsed Teeth: In Vitro Study Of Cell Viability.

PubMed

Martins, Christine Men; Hamanaka, Elizane Ferreira; Hoshida, Thayse Yumi; Sell, Ana Maria; Hidalgo, Mirian Marubayashi; Silveira, Catarina Soares; Poi, Wilson Roberto

2016-01-01

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.

Treatment of posterior cruciate ligament tibial avulsion by a minimally-invasive open posterior approach.

PubMed

Abdallah, Ahmed Abdelbadie; Arafa, Mohammed S

2017-07-01

To assess the surgical technique and report the outcomes following fixation of PCL bony avulsions through mini-invasive posterior knee approach as described by Burks and Schaffer. From June 2012 to July 2015, 27 patients enrolled in the study (21 males and 6 females). Fixation of tibial PCL avulsion fractures was done with one or two cannulated screws, or sutures through Burks and Schaffer's approach. The mean interval before surgery was 16days (1-70) .Patients was followed up for an average of 51 weeks. The outcome measures evaluated at final follow-up were (1) clinical stability as assessed by posterior drawer test, (2) radiologic union, (3) functional assessment by Lysholm score, and (4) gastrocnemius muscle strength as a measure of morbidity. Average operative time was 43min. Improvement of both subjective Lysholm score (mean 93) and objective stability testing by posterior drawer test (returns to normal in 81.1% of patients) at the final follow-up. Good radiographic union at average of 5.6 weeks. No morbidity of the gastrocnemius with few complications. The approach was fast and safe with excellent visualization. It allows surgeons to address other injuries in the same setting. It can be considered as a minimally-invasive open surgery without surgery-related morbidity. It is a reproducible technique that can be done at any trauma centre by surgeons with average experience. The subjective and objective results of the technique are excellent and comparable to the arthroscopic procedures that needs more specific centres with well-trained surgeons. Copyright © 2017 Elsevier Ltd. All rights reserved.

Two-rooted maxillary first molars with two canals: a case series.

PubMed

Shakouie, Sahar; Mokhtari, Hadi; Ghasemi, Negin; Gholizadeh, Seddigheh

2013-01-01

Thorough understanding of the anatomic and internal morphology of a root canal system is absolutely essential for the success of endodontic treatment. Since permanent maxillary first molars have shown variation in internal anatomy, morphology, this tooth has been reviewed extensively. Presence of two canals in a two-rooted maxillary first molar has rarely been reported in studies describing tooth and root canal anatomies. In this report, three cases are presented, which involve the root canal treatment of maxillary first molars with fusion of the two buccal roots.

Endodontic management of mesiobuccal-2 canal in four-rooted and five-canalled mandibular third molar.

PubMed

Garg, Amit Kumar; Bhardwaj, Anuj; Mantri, Vijay R; Agrawal, Neha

2014-05-01

A case of unusual Root morphology is presented to demonstrate anatomic variations in mandibular third molar. The most common configuration of mandibular third molar is two Roots and three canals; however they may have many different combinations. Endodontic treatment was performed in mandibular third molar having aberrant anatomy. Four Root canal orifices were located with the aid of dental operating microscope (DOM) and three separate Roots were diagnosed with radiographs. Spiral computed tomography (SCT) showed the presence of an extra canal and extra Root, indicating a rare anatomic configuration. Looking for additional canals and Roots are important part of successful endodontics, as the knowledge of their existence enable clinicians to treat a case successfully that otherwise might end in failure. The use of DOM and SCT in this case greatly contributed toward making a confirmatory diagnosis and successful endodontic treatment of four-rooted and five-canalled mandibular third molar. Variation in Root canal anatomy is very common. Knowledge of these variations is very essential for successful Root canal outcome, inability to do so can lead to missed canals and failures. Hence, thorough knowledge of Root canal anatomy and advances in diagnostic aids are essential.

The radix entomolaris in mandibular first molars: an endodontic challenge.

PubMed

De Moor, R J G; Deroose, C A J G; Calberson, F L G

2004-11-01

To present cases of mandibular first molars with an additional distolingual root (radix entomolaris, RE) and to survey the literature on the incidence of this anatomical feature. A major anatomical variant of the two-rooted mandibular first molar is a tooth with an additional distolingual and third root: the RE. The prevalence of these three-rooted mandibular first molars appears to be less than 3% in African populations, not to exceed 4.2% in Caucasians, to be less than 5% in Eurasian and Asian populations, and to be higher than 5% (even up to 40%) in populations with Mongolian traits. A total of 18 cases (12 root filled and six extracted mandibular first molars) with an RE were collected during the years 2000-2003 in patients of Caucasian origin. As far as the access was concerned, entering the root canal in the RE required a modification of the opening in a distolingual direction resulting in a trapezoidal opening cavity. None of the orifices was located midway between the mesial and distal root component. Based on the anatomy of the extracted samples and the bending of ISO 10 files after scouting of the root canal in the RE, three types of curvature were detected: (I) straight or no curvature (two cases); (II) coronal third curved and straight continuation to the apex (five cases); and (III) curvature in the coronal third and buccal curvature from the middle third or apical third of the root (11 cases). Clinicians should be aware of this unusual root morphology in mandibular first molars in Caucasian people. Radiographs exposed at two different horizontal angles are needed to identify this additional root. The access cavity must be modified in a distolingual direction in order to visualize and treat the RE, this results in a trapezoidal access cavity.

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

PubMed

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

2012-08-01

To assess the function of muscles retrieved from a retrobulbar location using an anterior orbitotomy approach and to identify the prognostic factors favoring a good outcome. The records of all patients undergoing anterior orbitotomy for the retrieval of a transected or avulsed muscle in a retrobulbar location were reviewed. Ocular motility, before and after retrieval (with ductions scaled from -4 to +4), was evaluated. Record review identified 11 patients who had suffered trauma to 12 muscles (5 inferior, 6 medial, and 1 lateral rectus muscle). Ductions improved from -4 ± 0.4 preoperatively to -2.7 ± 0.9 postoperatively (P = 0.002); mean primary position deviation improved from 34(Δ) ± 14(Δ)-15(Δ) ± 9(Δ) (P < 0.001), and mean deviation in the field of action improved from 47(Δ) ± 20(Δ)-20(Δ) ± 22(Δ) (P = 0.02). Ductions improved by at least two units in three patients, all of whom had medial rectus trauma. Single binocular vision in primary gaze was achieved in 6 patients. Patients with medial rectus muscle injury and patients injured by sinus surgery had the lowest likelihood of recovering single binocular vision. Our results are similar to historical series in which muscles were not retrieved and transpositions performed; however, muscle retrieval avoids risks associated with transposition surgeries such as anterior segment ischemia. Muscle recovery via the anterior orbitotomy approach may be reasonable to consider in those cases with a reasonable possibility of having active force generation postoperatively. Copyright © 2012 American Association for Pediatric Ophthalmology and Strabismus. Published by Mosby, Inc. All rights reserved.

Arthroscopic Findings in Anterior Shoulder Instability

PubMed Central

Hantes, Michael; Raoulis, Vasilios

2017-01-01

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 clinical and functional outcomes to the point that arthroscopic treatment is considered nowadays the standard of care. PMID:28400880

Arthroscopic transtendinous repair of articular-sided pasta (partial articular supraspinatus tendon avulsion) injury.

PubMed

Wang, Yi; Lu, Liangyu; Lu, Zhe; Xiao, Lei; Kang, Yifan; Wang, Zimin

2015-01-01

To evaluate clinical efficacy of arthroscopic transtendinous repair of partial articular-sided PASTA (partial articular supraspinatus tendon avulsion) injury. 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. 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%). 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.

Endodontic treatment of a maxillary central incisor with two roots.

PubMed

Maghsoudlou, Amir; Jafarzadeh, Hamid; Forghani, Maryam

2013-03-01

This clinical report presents a rare case of maxillary central incisor with two separate roots. Unusual morphology of the roots and root canals may exist in any tooth. Recognition of the dental anatomy and its variations is necessary for successful endodontic therapy. It is well known that maxillary incisors are usually single-rooted teeth. The root canals were instrumented with conventional hand files and Gates Glidden and obturated by using the lateral technique. Recall radiograph after 1 year shows the healing process of the preoperative apical periodontitis. Clinicians should be aware of unexpected root canal morphology when performing root canal therapy. The present case demonstrated the importance of accurate preoperative radiograph and adequate access preparation.

Interspecific olfactory communication in the southern pine bark beetle guild

Treesearch

T. L. Payne; M. T. Smith; M. C. Birch; A. Ascoli

1991-01-01

The southern pine bark beetle guild consists of many species, the most economically significant of which are the five scolytid species, Dendructonus frontalis Zimmermann, D. terebrans (Olivier), Ips calligraphus (Germar), I. avulses (Eichhoff), and I. grandicollis (Eichhoff...

Progress in the clinical imaging research of bone diseases on ankle and foot sesamoid bones and accessory ossicles

PubMed Central

Li, Xiaozhong; Shi, Lenian; Liu, Taiyun; Wang, Lin

2012-01-01

Summary 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. PMID:25343083

Comminuted mandibular fracture in child victim of dog bite.

PubMed

de Carvalho, Matheus Furtado; Hardtke, Luiz Augusto Paixão; de Souza, Max Filipe Cota; de Oliveira Araujo, Vasco

2012-08-01

Dog bites represent lesions commonly found in Hospital Emergency Clinic. This type of lesion may cause severe harm to patients, but it rarely affects the underlying bone structure causes facial fracture. This study aims to illustrate a rare clinical case in which a pediatric patient presented a comminuted fracture in the mandible which evolved into a unilateral avulsion of the mandibular condyle, body fractures as well as a mandibular ramus and hemiface that had been deformed, with multiple lacerations and loss of soft-tissue mass. Intermaxillary fixation was performed using the Ivy method, followed by internal rigid fixation using miniplates and screws in attempt to reconstruct the child's mandible. After 2 years of follow-up, a satisfactory esthetics and functional results could be observed. © 2011 John Wiley & Sons A/S.

Hydrodynamic controls on the long-term construction of large river floodplains and alluvial ridges

NASA Astrophysics Data System (ADS)

Nicholas, Andrew; Aalto, Rolf; Sambrook Smith, Gregory; Schwendel, Arved

2017-04-01

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 modelled as an exponential function of distance from the river, and avulsion thresholds are defined using topographic indices that quantify alluvial ridge morphology (e.g., lateral:downstream slope ratios or metrics of channel belt super-elevation). Herein, we apply a hydraulically driven model of floodplain evolution, in order to quantify the controls on alluvial ridge construction and avulsion likelihood in large lowland rivers. We combine a simple model of meander migration and cutoff 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. The model is used to carry out a series of numerical experiments to investigate floodplain construction for a range of flood regimes and sediment supply scenarios, and results are compared to field data from the Rio Beni system, northern Bolivia. Model results, supported by field data, illustrate that floodplain sedimentation is characterised by a high degree of intermittency that is driven by autogenic mechanisms (i.e. even in the absence of temporal variations in flood magnitude and sediment supply). Intermittency in overbank deposits occurs over a range of temporal and spatial scales, and is associated with the interaction between channel migration dynamics and crevasse splay formation. Moreover, alluvial ridge construction, by splay deposition, is controlled by the balance between in-channel and overbank sedimentation rates, and by ridge reworking linked to channel migration. The resulting relationship between sedimentation rates, ridge morphology and avulsion likelihood is more complex than that which is incorporated with existing models of long-term floodplain construction that neglect flood hydraulics. These results have implications for the interpretation of floodplain deposits as records of past flood regimes, and for the controls on the alluvial architecture of large river floodplains.

Rivers turned to rock: Late Quaternary alluvial induration influencing the behaviour and morphology of an anabranching river in the Australian monsoon tropics

NASA Astrophysics Data System (ADS)

Nanson, Gerald C.; Jones, Brian G.; Price, David M.; Pietsch, Timothy J.

2005-09-01

Late Quaternary alluvial induration has greatly influenced contemporary channel morphology on the anabranching Gilbert River in the monsoon tropics of the Gulf of Carpentaria. The Gilbert, one of a number of rivers in this region, has contributed to an extensive system of coalescing low-gradient and partly indurated riverine plains. Extensive channel sands were deposited by enhanced flow conditions during marine oxygen isotope (OI) Stage 5. Subsequent flow declined, probably associated with increased aridity, however, enhanced runoff recurred again in OI Stages 4-3 (˜65-50 ka). Aridity then capped these plains with 4-7 m of mud. A widespread network of sandy distributary channels was incised into this muddy surface from sometime after the Last Glacial Maximum (LGM) to the mid Holocene during a fluvial episode more active than the present but less so than those of OI Stages 5 and 3. This network is still partly active but with channel avulsion and abandonment now occurring largely proximal to the main Gilbert flow path. A tropical climate and reactive catchment lithology have enhanced chemical weathering and lithification of alluvium along the river resulting in the formation of small rapids, waterfalls and inset gorges, features characteristic more of bedrock than alluvial systems. Thermoluminescence (TL) and comparative optically stimulated luminescence (OSL) ages of the sediments are presented along with U/Th ages of pedogenic calcrete and Fe/Mn oxyhydroxide/ oxide accumulations. They show that calcrete precipitated during the Late Quaternary at times similar to those that favoured ferricrete formation, possibly because of an alternating wet-dry climate. Intense chemical alteration of the alluvium leading to induration appears to have prevailed for much of the Late Quaternary but, probably due to exceptional dryness, not during the LGM. The result has been restricted channel migration and a reduced capacity for the channel to adjust and accommodate sudden changes in bedload. Consequent avulsions have caused local stream powers to increase by an order of magnitude, inducing knickpoint erosion, local incision and the sudden influx of additional bedload that has triggered further avulsions. The Gilbert River, while less energetic than its Pleistocene ancestors, is clearly an avulsive system, and emphasizes the importance in some tropical rivers of alluvial induration for reinforcing the banks, generating nickpoints, reworking sediment and thereby developing and maintaining an indurated and anabranching river style.

Pathological Features of Fatal Crocodile Attacks in Northern Australia, 2005-2014.

PubMed

Sinton, Terence J; Byard, Roger W

2016-11-01

Eleven deaths from crocodile attacks in the Northern Territory, Australia were reviewed. The male:female ratio was 8:3; age range-10-62 years, average 29.4 years. Four children were included (one boy and three girls, aged 10, 11, and two at 12 years), and there were seven aboriginal victims (64%). The attacks were witnessed in eight cases with the victims swimming in freshwater N = 5, standing on a river bank N = 1, fishing in fresh water N = 1, or diving in the sea N = 1. At autopsy, several distinct patterns of injury were observed ranging from complete traumatic disruption of the body with only incomplete remains for examination (N = 5), to crushing of the head with fractures of the skull (N = 4), crushing of the chest with fractures of the ribs and sternum (N = 2), and avulsion of limbs (N = 4). In one case, there was decapitation. Autopsy evaluations were complicated by decomposition and loss of body parts. © 2016 American Academy of Forensic Sciences.

[Effect of revascularization treatment of immature permanent teeth with endodontic infection].

PubMed

Huang, Yibin; Chen, Ke; Zhang, Ying; Xiong, Huacui; Liu, Caiqi

2013-05-01

To observe the effect of revascularization for treatment of immature teeth with endodontic infection mediated by calcium hydroxide. Seventeen pediatric patients with endodontic infections of the permanent teeth were treated with routine root canal and pulp cavity irrigation and disinfection followed by application of calcium hydroxide paste to the root canal orifice to induce revascularization. Another 17 patients received conventional apexification procedures to serve as the control group. The patients were followed up to observe the therapeutic effect of the treatments. In the revascularization treatment group, 4 cases showed healed periapical lesions 6 to 18 months after the surgery with thickened root canal walls and closure of the apical foramen; in 10 cases, the periapical lesions healed 12 to 18 months postoperatively with lengthened root, thickened root canal wall, and narrowed apical foramen. One patient reported pain and swelling at 2 months, and 2 patients showed the formation of gum fistula and ceased development of the roots at 7 and 8 months. In the control group, the periapical lesions healed in 1 cases at 12 months postoperatively with apical foramen closure; in 11 cases, hard tissues formed in the root apex without obviously lengthened roots 6 to 8 months after the surgery; in 5 cases, no apical barrier formed even 12 to 18 months after the surgery. The overall effective rates were similar between the two groups (P>0.05). Revascularization by calcium hydroxide sealing can promote root development of immature permanent teeth with pulpitis or periradicular periodontitis.

Dilemmas pertaining to three canals in the mesiobuccal root of a maxillary second molar: a case report.

PubMed

Arora, Ankit; Acharya, Shashi Rashmi; Saraswathi, Muliya Vidya; Sharma, Padmaja; Ather, Amber

2013-08-01

The mesiobuccal root of the maxillary molars is well known to pose a hindrance during endodontic therapy. Presented here is a case of a maxillary left second molar where three canals were located in its mesiobuccal root with the use of visual and diagnostic aids. Difficulties encountered during the process of unveiling the tooth's internal anatomy were discussed. The dilemmas encountered pertained to the root canal configuration, the nomenclature of the extra canals, and the justification for the presence of a third canal. The root canal configuration of 3-2-1 was confirmed for the mesiobuccal root using information gained from clinical, radiographic, and multi-detector computed tomography (MDCT) scan findings. This case demonstrates the need for efforts to locate extra canals in the mesiobuccal root of the maxillary molars as their internal anatomy remains a mystery.

Orthodontic treatment in patient with idiopathic root resorption: a case report.

PubMed

Rey, Diego; Smit, Rosana Martínez; Gamboa, Liliana

2015-01-01

Multiple idiopathic external root resorption is a rare pathological condition usually detected as an incidental radiographic finding. External root resorption of permanent teeth is a multifactorial process related to several local and systemic factors. If an etiological factor cannot be identified for root resorption, the term "idiopathic" is applied. This report presents a case of multiple idiopathic apical root resorption. The condition was found in a young female patient seeking orthodontic treatment due to malocclusion. This kind of resorption starts apically and progresses coronally, causing a gradual shortening and rounding of the remaining root. Patients with this condition are not the ideal candidates for orthodontic treatment; however, the aim of this report is to describe an unusual case of idiopathic root resorption involving the entire dentition, and to present the orthodontic treatment of this patient. It describes the progress and completion of orthodontic therapy with satisfactory end results.

Four canals in the mesial root of a mandibular first molar. A case report under the operating microscope.

PubMed

Kontakiotis, Evangelos G; Tzanetakis, Giorgos N

2007-08-01

In this era of microscope-assisted endodontics, finding variations in root canal system anatomy is not uncommon. Operating microscopes combined with careful clinical examination and radiographic interpretation can aid the clinician to successfully treat cases with such internal anatomy. The understanding of this view enables the possible location of additional canals in any tooth requiring endodontic treatment. The present clinical article demonstrates a rare anatomical complexity in the mesial root of a mandibular first molar. Four independent root canal orifices were found in this root by clinical detection with the aid of a dental operating microscope. This case shows that additional canals can be located in any root undergoing endodontic treatment and clinicians should always be aware of aberrant internal anatomy.

Residual neurological function after sacral root resection during en-bloc sacrectomy: a systematic review.

PubMed

Zoccali, Carmine; Skoch, Jesse; Patel, Apar S; Walter, Christina M; Maykowski, Philip; Baaj, Ali A

2016-12-01

Sacrectomy is a highly demanding surgery representing the main treatment for primary tumors arising in the sacrum and pelvis. Unfortunately, it is correlated with loss of important function depending on the resection level and nerve roots sacrificed. The current literature regarding residual function after sacral resection comes from several small case series. The goal of this review is to appraise residual motor function and gait, sensitivity, bladder, bowel, and sexual function after sacrectomies, with consideration to the specific roots sacrificed. An exhaustive literature search was conducted. All manuscripts published before May 2015 regarding residual function after sacrectomy were considered; if a clear correlation between root level and functioning was not present, the paper was excluded. The review identified 15 retrospective case series, totaling 244 patients; 42 patients underwent sacrectomies sparing L4/L4, L4/L5 and L5/L5; 45 sparing both L5 and one or both S1 roots; 8 sparing both S1 and one S2; 48 sparing both S2; 11 sparing both S2 and one S3, 54 sparing both S3, 9 sparing both S3 and one or both S4, and 27 underwent unilateral variable resection. Patients who underwent a sacrectomy maintained functionally normal ambulation in 56.2 % of cases when both S2 roots were spared, 94.1 % when both S3 were spared, and in 100 % of more distal resections. Normal bladder and bowel function were not present when both S2 were cut. When one S2 root was spared, normal bladder function was present in 25 % of cases; when both S2 were spared, 39.9 %; when one S3 was spared, 72.7 %; and when both S3 were spared, 83.3 %. Abnormal bowel function was present in 12.5 % of cases when both S1 and one S2 were spared; in 50.0 % of cases when both S2 were spared; and in 70 % of cases when one S3 was spared; if both S3 were spared, bowel function was normal in 94 % of cases. When even one S4 root was spared, normal bladder and bowel function were present in 100 % of cases. Unilateral sacral nerve root resection preserved normal bladder function in 75 % of cases and normal bowel function in 82.6 % of cases. Motor function depended on S1 root involvement. Total sacrectomy is associated with compromising important motor, bladder, bowel, sensitivity, and sexual function. Residual motor function is dependent on sparing L5 and S1 nerve roots. Bladder and bowel function is consistently compromised in higher sacrectomies; nevertheless, the probability of maintaining sufficient function increases progressively with the roots spared, especially when S3 nerve roots are spared. Unilateral resection is usually associated with more normal function. To the best of our knowledge, this is the first comprehensive literature review to analyze published reports of residual sacral nerve root function after sacrectomy.

Pelvic fracture urethral injuries in girls.

PubMed

Podestá, M L; Jordan, G H

2001-05-01

Injuries to the female urethra associated with pelvic fracture are uncommon. They may vary from urethral contusion to partial or circumferential rupture. When disruption has occurred at the level of the proximal urethra, it is usually complete and often associated with vaginal laceration. We retrospectively reviewed the records of a series of girls with pelvic fracture urethral stricture and present surgical treatment to restore urethral continuity and the outcome. Between 1984 and 1997, 8 girls 4 to 16 years old (median age 9.6) with urethral injuries associated with pelvic fracture were treated at our institutions. Immediate therapy involved suprapubic cystostomy in 4 cases, urethral catheter alignment and simultaneous suprapubic cystostomy in 3, and primary suturing of the urethra, bladder neck and vagina in 1. Delayed 1-stage anastomotic repair was performed in 1 patient with urethral avulsion at the level of the bladder neck and in 5 with a proximal urethral distraction defect, while a neourethra was constructed from the anterior vaginal wall in a 2-stage procedure in 1 with mid urethral avulsion. Concomitant vaginal rupture in 7 cases was treated at delayed urethral reconstruction in 5 and by primary repair in 2. The surgical approach was retropubic in 3 cases, vaginal-retropubic in 1 and vaginal-transpubic in 4. Associated injuries included rectal injury in 3 girls and bladder neck laceration in 4. Overall postoperative followup was 6 months to 6.3 years (median 3 years). Urethral obliteration developed in all patients treated with suprapubic cystostomy and simultaneous urethral realignment. The stricture-free rate for 1-stage anastomotic repair and substitution urethroplasty was 100%. In 1 girl complete urinary incontinence developed, while another has mild stress incontinence. Retrospectively the 2 incontinent girls had had an associated bladder neck injury at the initial trauma. Two recurrent vaginal strictures were treated successfully with additional transpositions of lateral labial flaps. This study emphasizes that combined vaginal-partial transpubic access is a reliable approach for resolving complex obliterative urethral strictures and associated urethrovaginal fistulas or severe bladder neck damage after traumatic pelvic fracture injury in female pediatric patients. Although our experience with the initial management of these injuries is limited, we advocate early cystostomy drainage and deferred surgical reconstruction when life threatening clinical conditions are present or extensive traumatized tissue in the affected area precludes immediate ideal surgical repair.

Nonsurgically retreated root filled teeth--radiographic findings after 20-27 years.

PubMed

Fristad, I; Molven, O; Halse, A

2004-01-01

To identify periapical changes in nonsurgically retreated root-filled teeth 20-27 years after root canal treatment. From an original material of 429 roots, retreated by undergraduate students in a teaching clinic, 112 roots in 70 individuals could be evaluated radiographically 20-27 years after treatment. The same roots had been studied 10-17 years earlier. The periapical condition was registered and compared by three observers in two series of intraoral radiographs taken 10-17 and 20-27 years after treatment. A retrospective analysis was performed to gain information about probable endodontic and nonendodontic reasons for extractions of lost roots, by evaluating their periapical status immediately after retreatment and at the 10-17-year follow-up. Favourable outcomes were observed in 11 roots that had radiolucencies at the 10-17-year follow-up. Eight of these roots had periapical pathosis preoperatively, five of them filled with surplus root filling material. The percentage of cases recorded as normal condition at the final follow-up was 95.5%, including five cases initially recorded with increased width of the apical periodontal space. Delayed healing as a result of surplus root filling material explained most of the cases with favourable outcome assessed many years after treatment. Twenty-eight roots were lost because of extraction during the observation period, 17 during the last 10 years. Based on status at previous follow-ups, endodontic failure seems to represent a minor reason for extraction in the material. Late periapical changes, with more successful cases, were recorded when a 10-17-year follow-up after root canal treatment was extended for another 10 years. Persistent asymptomatic periapical radiolucencies, especially those with overfill, should generally not be classified as failures, as many of them will heal after an extended observation period.

Asymmetry in mesial root number and morphology in mandibular second molars: a case report

PubMed Central

Shetty, Shashit; Shekhar, Rhitu

2014-01-01

Ambiguity in the root morphology of the mandibular second molars is quite common. The most common root canal configuration is 2 roots and 3 canals, nonetheless other possibilities may still exist. The presence of accessory roots is an interesting example of anatomic root variation. While the presence of radix entomolaris or radix paramolaris is regarded as a typical clinical finding of a three-rooted mandibular second permanent molar, the occurrence of an additional mesial root is rather uncommon and represents a possibility of deviation from the regular norms. This case report describes successful endodontic management of a three-rooted mandibular second molar presenting with an unusual accessory mesial root, which was identified with the aid of multiangled radiographs and cone-beam computed tomography imaging. This article also discusses the prevalence, etiology, morphological variations, clinical approach to diagnosis, and significance of supernumerary roots in contemporary clinical dentistry. PMID:24516829

[Retrospective study about periodontal ligament healing of replanted permanent teeth in children].

PubMed

Bai, J; Zhao, Y M; Qin, M

2015-04-18

To analyze the prognosis about periodontal ligament healing of replanted permanent teeth in children and to examine the associated factors. The sample consisted of 49 children with 61 avulsed permanent teeth, whose injuries had been managed in the period from 2000 to 2012. The clinical data of replanted teeth were collected, and the follow-up period was no less than 12 months. The factors were analyzed in relation to postoperative outcomes, classified as functional periodontal healing (FH), infection-related (inflammatory) resorption (IRR) and replacement resorption (RR). The functional healing rate was 23.0%, while replacement resorption rate was 72.1%. The replacement resorption (ankylosis) was usually observed earlier by clinical examination than by radiographic examination. 86.0% (40/47) resorptive processes were diagnosed within the first year. Physiological storages, such as milk, saline and saliva were significantly better to periodontal ligament healing than nonphysiological storages, such as tap water and sterilizing solutions (chloramine and alcohol). Functional healing was found significantly more frequent in canines and premolars. The factor significantly affecting periodontal ligament healing is storage medium. Replacement resorption is the most common type of root resorption. The replacement resorption diagnosis must combine the radiographic examination with the clinical examination. It is better to follow up more than 1 year after tooth replantation.

A method for retrieving endodontic or atypical nonendodontic separated instruments from the root canal: a report of two cases.

PubMed

Monteiro, Jardel Camilo do Carmo; Kuga, Milton Carlos; Dantas, Andrea Abi Rached; Jordão-Basso, Keren Cristina Fagundes; Keine, Katia Cristina; Ruchaya, Prashant Jay; Faria, Gisele; Leonardo, Renato de Toledo

2014-11-01

This clinical report presents a new method for retrieving separated instruments from the root canal with minimally invasive procedures. The presence of separated instrument in root canal may interfere in the endodontic treatment prognosis. There are several recommended methods to retrieve separated instruments, but some are difficult in clinically practice. This study describes two cases of separated instrument removal from the root canal using a stainless-steel prepared needle associated with a K-file. Case 1 presented a fractured gutta-percha condenser within the mandibular second premolar, it was separated during incorrect intracanal medication calcium hydroxide placement. Case 2 had a fractured sewing needle within the upper central incisor that the patient used to remove food debris from the root canal. After cervical preparation, the fractured instruments were fitted inside a prepared needle and then an endodontic instrument (#25 K-file) was adapted with clockwise turning motion between the needle inner wall and the fragment. The endodontic or atypical nonendodontic separated instrument may be easily pull on of the root canal using a single and low cost device. The methods for retrieving separated instruments from root canal are difficult and destructive procedures. The present case describes a simple method to solve this problem.

SEM observations of resected root canal ends following apicoectomy.

PubMed

Furusawa, Masahiro; Asai, Yasuhiro

2002-02-01

The purpose of this study was to examine the apical foramen of root apices extracted during apicotomies. A total of 25 teeth extracted from 25 patients admitted to the Department of Conservative Dentistry at Tokyo Dental College's Chiba Hospital were used for the study. All patients were between 22 to 56 years of age at the time of the study, and each of the 25 cases was determined clinically on radiographs to be chronic apical suppurative periodontitis. Microsurgery was performed on all cases, and the extracted root apices were then observed using SEM. The results demonstrated a wide opening, greater than 350 microns as measured along the major axis, of the apical foramen in 80% of the cases. Various characteristics indicative of resorption were observed around the apical foramen. These features included those believed to have been caused by overinstrumentation during root canal treatment as well as irregularly shaped areas presumed to be apical lesions that had enlarged and eroded. We observed a high frequency of manifestations of cementum resorption surrounding the root apices of teeth with apical lesions. Furthermore, we concluded that in the majority of cases in the present study, due to the fact that the apical foramen exceeded normal opening dimensions as a result of overinstrumentation during root canal treatment or resorption around the root apex, prolongation of the lesions had occurred in response to direct contact of microbial infectious matter and tissues surrounding the root apex over a large area. The above finding suggested that, in cases in which the apical foramen is destroyed through overinstrumentation larger than #35 or in which the apical foramen opens up to dimensions greater than 350 microns due to pathologic resorption, surgical intervention may be indicated. On the other hand, in 64% of the cases, an accessory canal was observed in the root apical lesion. Based on this observation, the presence of an accessory canal in the root apex may contribute to some degree to the prolongation of the lesion.

Perinatal Outcomes Associated With Isolated Velamentous Cord Insertion in Singleton and Twin Pregnancies.

PubMed

Sinkin, Joshua A; Craig, Wendy Y; Jones, Michael; Pinette, Michael G; Wax, Joseph R

2018-02-01

To evaluate perinatal outcomes in singleton and twin pregnancies with pathologically confirmed velamentous cord insertion without vasa previa. This retrospective case-control study included all nonanomalous singleton and twin pregnancies with pathologically confirmed velamentous cord insertion delivered in a single institution between January 1, 2005, and July 1, 2015, and having an ultrasound examination by maternal-fetal medicine. For each case, the next 2 consecutive deliveries matched for gestational age at delivery ± 1 week and, in twins, amnionicity and chorionicity served as controls. Primary outcomes included surgical delivery for a nonreassuring intrapartum fetal heart rate tracing, umbilical arterial cord pH of less than 7.2, 5-minute Apgar score of less than 7, birth weight below the 10th percentile, neonatal intensive care unit admission, fetal or neonatal death, and cord avulsion necessitating manual placental extraction. Outcomes were available for 53 singletons with 103 matched controls and 33 twin pregnancies with 65 matched controls. In singletons, velamentous cord insertion was associated with cord pH of less than 7.2 (odds ratio [OR] 3.5; 95% confidence interval [CI], 1.1-11.2; P = .039), 5-minute Apgar score of less than 7 (OR, 5.3; 95% CI, 0.99-28.1; P = .045), and cord avulsion requiring manual placental extraction (7.5% versus 0%; P = .012). Associations were suggested with increased surgical delivery for a nonreassuring intrapartum fetal heart rate tracing (OR, 2.4; 95% CI, 0.9-6.9; P = .14), birth weight below the 10th percentile (OR, 2.1; 95% CI, 0.8-5.9; P = .21), and fetal or neonatal death (3.8% versus 0%; P = .11). Velamentous cord insertions were also associated with placental abruption in singletons (7.5% versus 0%; P = .013). Among twins, velamentous cord insertion was associated with fetal or neonatal death (9.1% versus 0%; P = .036). Isolated confirmed velamentous cord insertion is associated with adverse perinatal outcomes in singleton and twin gestations. © 2017 by the American Institute of Ultrasound in Medicine.

Foster replantation of fingertip using neighbouring digital artery in a young child.

PubMed

Xu, Jing-Hong; Gao, Zheng-Jun; Yao, Jing-Ming; Tan, Wei-Qiang; Dawreeawo, Javed

2010-06-01

Reconstruction of an amputated fingertip in a young child demands special techniques for success. We report a 2.5-year-old female patient with an amputated left index fingertip with the vascular defect being too severe to perform the usual replantation. Comparing several methods, we used the neighbouring digital artery as the feeding artery to perform foster replantation. Finally, the patient was satisfied with the appearance and function of her fingers. The clinical case, techniques, results are described and discussed. We consider it a useful technique, especially for those with a rather severe vascular defect. A 2.5-year-old girl suffered a crush amputation of the left index fingertip. Only the flexor tendon of the amputated fingertip was connected to the proximal finger tissue and the blood supply was completely lost (Figure 1). The distal amputated fingertip was fixed using Kirschner wire under general anaesthesia. Then, microsurgery operation was carried out immediately to replant this amputated fingertip. Both ulnar and radial digital arteries were avulsed, while the dorsal vein was intact and the digital nerve was also surviving. The integrity of blood vessels was too traumatised to connect to the proximal part. In the case of the distal part of the ulnar artery of the injured index finger, the blood supply was established by anastomosing the distal end of the amputated tip and the radial artery of the middle finger, which was the feeding artery (Figure 2). A 11/0 nylon suture was used. The dorsal vein and digital nerve were repaired by means of microsurgical anastomosis. The wound was covered with the dorsal skin of the middle finger and the palmar skin of the index finger to form a skin pedicle, and then, immobility of the two fingers was maintained to prevent avulsion. The index tip obtained good blood supply and survived completely (Figure 3). Detachment of the index and middle finger was performed after 3 weeks, and both of the fingers showed good blood supply (Figure 4). The appearance and function of the index and middle fingers were satisfactory 3 months postoperatively. Copyright 2009 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Endodontic Microsurgical Treatment of a Three-rooted Mandibular First Molar with Separate Distolingual Root: Report of One Case.

PubMed

Wang, Han Guo; Xu, Ning; Yu, Qing

The separate distolingual (DL) roots of three-rooted mandibular first molars are thought to be too difficult for performing apical surgery. This article represents microsurgical treatment of a three-rooted mandibular first molar with a separate DL root. The procedure includes incision and flap retraction, osteotomy, apicoectomy, retropreparation and retrofilling of the root canal, using micro instruments, ultrasonic retrotips and mineral trioxide aggregate (MTA) under a dental operating microscope. Two mm in length of apical root resection, 2 mm in depth of root canal retropreparation with a personalised ultrasonic retrotip, and 2 mm in length of retrofilling with MTA are the key points for accomplishment of apical surgery on separate DL roots. The case was followed up for 15 months after surgery. Clinical and radiographic examinations revealed complete healing of periapical tissue. Separate DL roots of three-rooted mandibular first molars can be treated by endodontic microsurgery with modifications from standard protocol.

[A mandibular second molar with three mesial roots: report of one case].

PubMed

Zhang, Ping

2010-02-01

A case of unusual root canal morphology was presented to demonstrate anatomic variations in mandibular second molars. This case report presented the endodontic therapy of a mandibular second molar with three canals in the mesial root. A mesial middle canal was found between the mesiobuccal and mesiolingual canals. This report indicated the importance of looking for additional canals and unusual canal morphology, because knowledge of their existence might occasionally enable clinicians to treat a case successfully that otherwise to fail.

Endodontic management of radix paramolaris with six canals: a clinical case report.

PubMed

Acharya, N; Singh, A; Samant, P S; Gautam, V

2013-01-01

Endodontic therapy of mandibular molars is a challenging task due to its varied root canal morphology. A mandibular first molar with additional buccal root (Radix paramolaris) and additional distolingual root (Radix Entomolaris) is an example of its varied anatomy. A successful management of atypical root canal configurations is an important aspect in determining the success rate of root canal therapy. The detail knowledge of the root morphology and canal anatomy allows the clinician for accurate location of the extra roots and canals and accordingly the refinement of the access cavity for the stress free entry of complex anatomy. Hence, for a successful root canal therapy, clinician must be aware of the external and internal anatomic variations .The aim of this clinical case report is to present and describe the unusual presence of two separate mesial roots and six root canals in mandibular first molar, detected during routine endodontic therapy.

Channel Extension in Deep-Water Distributive Systems

NASA Astrophysics Data System (ADS)

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

2007-12-01

The cyclic nature of channel and lobe formation in submarine fans is the result of the unstable and ephemeral nature of newly formed distributary channels. Avulsion cycles are initiated as unconfined sheet flow immediately following avulsion followed by stages of channel incision and extension, deposition of channel mouth deposits, and often channel backfilling. In contrast with those in alluvial and deltaic environments, avulsion cycles in submarine fans are relatively poorly understood due to the difficulty of observing deep ocean processes, either over short timescales needed to measure the hydrodynamics of active turbidity currents, or over longer timescales needed for the morphodynamic evolution of individual distributary channels and avulsion events. Here we report the results of over 80 experiments in a 5m x 3m x1m deep tank using saline (NaCl) density flows carrying low-density plastic sediment (SG 1.5) flowing down an inclined ramp. These experiments were designed to investigate trends observed in earlier self-organized experimental submarine fans with well-developed avulsion cycles, in which distributive lobes were observed to form on relatively high slopes. In particular, we were interested in investigating the relationship between channel extension length (distance from the inlet to the point where the flow becomes de-channelized, transitioning into a mouth-bar/lobe) and slope. The results of the experiments are clear but counter-intuitive. Channels appear to extend in discrete segments and channel extension length is inversely related to slope over a wide range of slopes (5-17 degrees). In addition, channel extension seems largely independent of inlet flow density (salt concentration) over the experimental range (10-24 g/cc). Measurements of densimetric Froude number (Fr') indicate Fr' increases downstream to near critical conditions at the channel lobe transition. Our preliminary interpretation is that distributary channels become unstable due to acceleration to Fr'-critical conditions and the formation of a depositional hydraulic jump, which perturbs sediment transport and ends channel extension. Similar morphodynamic length scale controls are observed in shallow water fan-delta experiments (e.g., SAFL DB-03) and in 2-D depositional cyclic steps. The experiments seem to explain two interesting observations from the earlier self-organized fan experiments and from real submarine fans. Firstly, the observation of 'perched' fills at the steep entrances to salt withdrawal minibasins (e.g., in the Gulf of Mexico) suggesting higher sedimentation rates (or inefficient sediment transport) on higher slopes (initially higher than at the slope break downstream). Secondly, strong progradation as the fan evolves and slope decreases in 'perched' fans suggests increasing flow efficiency on lower slopes, at least over a certain window of parameter space. Apparently deep water systems have a tendency to self-regulate even when flows differ significantly in initial density. The observed modulation to Fr'-critical flow appears to be an important control on length scales in deep- water distributive channel systems, potentially explaining strong deepwater progradation or 'delta-like' patterns that have remained paradoxical. Near critical conditions have been inferred from observations of many active submarine fans but the extent to which these results from conservative density currents apply to non-conservative and potentially 'ignitive' turbidity currents is the subject of ongoing investigation.

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

USGS Publications Warehouse

Farrell, K.M.

2001-01-01

This paper demonstrates field relationships between landforms, facies, and high-resolution sequences in avulsion deposits. It defines the building blocks of a prograding avulsion sequence from a high-resolution sequence stratigraphy perspective, proposes concepts in non-marine sequence stratigraphy and flood basin evolution, and defines the continental equivalent to a parasequence. The geomorphic features investigated include a distributary channel and its levee, the Stage I crevasse splay of Smith et al. (Sedimentology, vol. 36 (1989) 1), and the local backswamp. Levees and splays have been poorly studied in the past, and three-dimensional (3D) studies are rare. In this study, stratigraphy is defined from the finest scale upward and facies are mapped in 3D. Genetically related successions are identified by defining a hierarchy of bounding surfaces. The genesis, architecture, geometry, and connectivity of facies are explored in 3D. The approach used here reveals that avulsion deposits are comparable in process, landform, facies, bounding surfaces, and scale to interdistributary bayfill, i.e. delta lobe deposits. Even a simple Stage I splay is a complex landform, composed of several geomorphic components, several facies and many depositional events. As in bayfill, an alluvial ridge forms as the feeder crevasse and its levees advance basinward through their own distributary mouth bar deposits to form a Stage I splay. This produces a shoestring-shaped concentration of disconnected sandbodies that is flanked by wings of heterolithic strata, that join beneath the terminal mouth bar. The proposed results challenge current paradigms. Defining a crevasse splay as a discrete sandbody potentially ignores 70% of the landform's volume. An individual sandbody is likely only a small part of a crevasse splay complex. The thickest sandbody is a terminal, channel associated feature, not a sheet that thins in the direction of propagation. The three stage model of splay evolution proposed by Smith et al. (Sedimentology, vol. 36 (1989) 1) is revised to include facies and geometries consistent with a bayfill model. By analogy with delta lobes, the avulsion sequence is a parasequence, provided that its definition is modified to be independent from sea level. In non-marine settings, facies contacts at the tops of regional peats, coals, and paleosols are analogous to marine flooding surfaces. A parasequence is redefined here as a relatively conformable succession of genetically related strata or landforms that is bounded by regional flooding surfaces or their correlative surfaces. This broader definition incorporates the concept of landscape evolution between regional flooding surfaces in a variety of depositional settings. With respect to landscape evolution, accommodation space has three spatial dimensions - vertical (x), lateral (y), and down-the-basin (z). A flood basin fills in as landforms vertically (x) and laterally accrete (y), and prograde down-the-basin (z). Vertical aggradation is limited by the elevation of maximum flood stage (local base level). Differential tectonism and geomorphology control the slope of the flood basin floor and the direction of landscape evolution. These processes produce parasequences that include inclined stratal surfaces and oriented, stacked macroforms (clinoforms) that show the magnitude and direction of landscape evolution. ?? 2001 Elsevier Science B.V. All rights reserved.

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

NASA Astrophysics Data System (ADS)

Farrell, K. M.

2001-02-01

This paper demonstrates field relationships between landforms, facies, and high-resolution sequences in avulsion deposits. It defines the building blocks of a prograding avulsion sequence from a high-resolution sequence stratigraphy perspective, proposes concepts in non-marine sequence stratigraphy and flood basin evolution, and defines the continental equivalent to a parasequence. The geomorphic features investigated include a distributary channel and its levee, the Stage I crevasse splay of Smith et al. (Sedimentology, vol. 36 (1989) 1), and the local backswamp. Levees and splays have been poorly studied in the past, and three-dimensional (3D) studies are rare. In this study, stratigraphy is defined from the finest scale upward and facies are mapped in 3D. Genetically related successions are identified by defining a hierarchy of bounding surfaces. The genesis, architecture, geometry, and connectivity of facies are explored in 3D. The approach used here reveals that avulsion deposits are comparable in process, landform, facies, bounding surfaces, and scale to interdistributary bayfill, i.e. delta lobe deposits. Even a simple Stage I splay is a complex landform, composed of several geomorphic components, several facies and many depositional events. As in bayfill, an alluvial ridge forms as the feeder crevasse and its levees advance basinward through their own distributary mouth bar deposits to form a Stage I splay. This produces a shoestring-shaped concentration of disconnected sandbodies that is flanked by wings of heterolithic strata, that join beneath the terminal mouth bar. The proposed results challenge current paradigms. Defining a crevasse splay as a discrete sandbody potentially ignores 70% of the landform's volume. An individual sandbody is likely only a small part of a crevasse splay complex. The thickest sandbody is a terminal, channel associated feature, not a sheet that thins in the direction of propagation. The three stage model of splay evolution proposed by Smith et al. (Sedimentology, vol. 36 (1989) 1) is revised to include facies and geometries consistent with a bayfill model. By analogy with delta lobes, the avulsion sequence is a parasequence, provided that its definition is modified to be independent from sea level. In non-marine settings, facies contacts at the tops of regional peats, coals, and paleosols are analogous to marine flooding surfaces. A parasequence is redefined here as a relatively conformable succession of genetically related strata or landforms that is bounded by regional flooding surfaces or their correlative surfaces. This broader definition incorporates the concept of landscape evolution between regional flooding surfaces in a variety of depositional settings. With respect to landscape evolution, accommodation space has three spatial dimensions — vertical ( x), lateral ( y), and down-the-basin ( z). A flood basin fills in as landforms vertically ( x) and laterally accrete ( y), and prograde down-the-basin ( z). Vertical aggradation is limited by the elevation of maximum flood stage (local base level). Differential tectonism and geomorphology control the slope of the flood basin floor and the direction of landscape evolution. These processes produce parasequences that include inclined stratal surfaces and oriented, stacked macroforms (clinoforms) that show the magnitude and direction of landscape evolution.

Assessment of Root Resorption and Root Shape by Periapical and Panoramic Radiographs: A Comparative Study.

PubMed

Ahuja, Puneeta D; Mhaske, Sheetal P; Mishra, Gaurav; Bhardwaj, Atul; Dwivedi, Ruby; Mangalekar, Sachin B

2017-06-01

One of the common findings encountered by the clinician at the end of orthodontic treatment is the apical root resorption. Root resorption occurs to various degrees. A severe form of root resorption is characterized by shortening of root for more than 4 mm or more than one-third of the total tooth length. A low incidence rate of resorption is observed based on radiographic findings for the diagnosis of root resorption, panoramic radiography, and periapical radiography. Hence, we evaluated the accuracy of panoramic radiographic films for assessing the root resorption in comparison with the periapical films. This study included the assessment of all the cases in which pre- and post-treatment radiographs were available for analysis of the assessment of the amount of root resorption. Complete records of 80 patients were analyzed. Examination of a total of 900 teeth was done. Mean age of the patients in this study was 21 years ranging from 11 to 38 years. The majority of the patients in the present study were females. All the treatments were carried out by registered experienced orthodontists having minimum experience of more than 10 years. All the cases were divided into two study groups. Group I comprised panoramic radiographic findings, while group II consisted of periapical radiographic findings. For the measurement of crown portion, root portion, and the complete root length, magnification loops of over 100 powers with parallax correction with inbuilt grids were used. Assessment of the tooth length and the crown length was done by the same observers. All the results were analyzed by Statistical Package for the Social Sciences software version 6.0. Maximum amount of root resorption was observed in case of maxillary central incisors and canines among group I and II cases respectively. However, nonsignificant difference was obtained while comparing the mean root resorption in relation to maxillary incisors and canines among the two study groups. While comparing the overall value of root resorption among the two study groups, a significant difference was obtained. The maximum value of tooth length in both the groups was observed in cases of maxillary canines. Significant differences were observed while comparing the tooth length of various teeth among the two study groups. Among the deviated forms of root shape, dilacera-tion was the most common form of root shape detected in both the study groups. Periapical radiographs are more efficient in the assessment of the shape and resorption of the root. Thorough evaluation of periapical radiographs is necessary for detection of even minute levels of root resorption.

Complex Apical Intraradicular Infection and Extraradicular Mineralized Biofilms as the Cause of Wet Canals and Treatment Failure: Report of 2 Cases.

PubMed

Ricucci, Domenico; Candeiro, George T M; Bugea, Calogero; Siqueira, José F

2016-03-01

This article describes 2 cases that showed persistent intracanal exudation (wet canal) even after several visits of antimicrobial endodontic treatment. Histologic and histobacteriologic investigation was conducted for determination of the cause. The 2 cases involved teeth with apical periodontitis lesions, which presented persistent exudation refractory to treatment after several visits. In case 1, it was not possible to achieve a dry canal, and surgery had to be performed. In case 2, attempts to dry the canal succeeded and the canal was filled, but follow-up examination showed an enlarged apical periodontitis lesion and extraction was performed. Biopsy specimens consisting of the root apex and apical periodontitis lesion for case 1 and the whole root for case 2 were subjected to histologic and histobacteriologic analyses. Both cases showed complex bacterial infection in the apical root, affecting both the intraradicular space and the outer root surface. Case 1 showed bacterial biofilms in ramifications, on untouched walls, and extending to the external root surface to form a thick and partially mineralized structure with high bacterial density. Different bacterial morphotypes were evidenced. Case 2 had a ledge on the apical canal wall created during instrumentation, which was filled with necrotic debris, filling material, and bacteria. The walls of the apical portion of the canal were covered by a bacterial biofilm, which was continuous with a thick extraradicular biofilm covering the cementum and dentin in resorptive defects. The extraradicular biofilm showed areas of mineralization and was dominated by filamentous bacteria. The 2 cases with wet canals and treatment failure were associated with complex persistent infection in the apical part of the root canal system extending to form thick and partially mineralized biofilm structures (calculus) on the outer apical root surface. Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Endodontic management of maxillary first molar with atypical canal morphology: Report of three cases

PubMed Central

Sherwani, Osama Adeel Khan; Kapoor, Bhumika; Sharma, Rajat; Mishra, Surendra Kumar

2016-01-01

Maxillary first molar with three roots and 3–4 canals is a common occurrence. However, extreme variations in their canal morphology have been reported ranging from one single canal and one root to as many as eight root canals. This article presents three cases of successful endodontic management of maxillary first molars with atypical canal morphologies, thus highlighting the fact that variations do occur and an endodontist should always be aware of aberrancies in root canal system apart from the knowledge of normal root canal anatomy. PMID:27994427

Root coverage of a previously restored tooth. A case report with a 7-year follow-up

PubMed Central

Corsair, Alexander

2009-01-01

This case report describes the treatment of a maxillary canine that had 4 mm of marginal gingival recession. The exposed root had been previously restored with a composite class 5 restoration. The restoration was removed and the root planed and demineralized. The root was then covered by a subepithelial connective tissue graft harvested from the palate. The flap was coronally positioned to completely cover the graft and exposed root. The healing was photographed post-operatively at one month, six months, and seven years. Root coverage increased to 100% after seven years. The zone of attached gingiva also increased. PMID:23674903

Root coverage of a previously restored tooth. A case report with a 7-year follow-up.

PubMed

Corsair, Alexander

2009-01-01

This case report describes the treatment of a maxillary canine that had 4 mm of marginal gingival recession. The exposed root had been previously restored with a composite class 5 restoration. The restoration was removed and the root planed and demineralized. The root was then covered by a subepithelial connective tissue graft harvested from the palate. The flap was coronally positioned to completely cover the graft and exposed root. The healing was photographed post-operatively at one month, six months, and seven years. Root coverage increased to 100% after seven years. The zone of attached gingiva also increased.

Variability Matters: New Insights into Mechanics of River Avulsions on Deltas and Their Deposits

NASA Astrophysics Data System (ADS)

Ganti, V.

2015-12-01

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.

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

NASA Astrophysics Data System (ADS)

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

2011-03-01

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

The rivers of civilization

NASA Astrophysics Data System (ADS)

Macklin, Mark G.; Lewin, John

2015-04-01

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

Stratigraphy and paleohydrology of delta channel deposits, Jezero crater, Mars

NASA Astrophysics Data System (ADS)

Goudge, Timothy A.; Mohrig, David; Cardenas, Benjamin T.; Hughes, Cory M.; Fassett, Caleb I.

2018-02-01

The Jezero crater open-basin lake contains two well-exposed fluvial sedimentary deposits formed early in martian history. Here, we examine the geometry and architecture of the Jezero western delta fluvial stratigraphy using high-resolution orbital images and digital elevation models (DEMs). The goal of this analysis is to reconstruct the evolution of the delta and associated shoreline position. The delta outcrop contains three distinct classes of fluvial stratigraphy that we interpret, from oldest to youngest, as: (1) point bar strata deposited by repeated flood events in meandering channels; (2) inverted channel-filling deposits formed by avulsive distributary channels; and (3) a valley that incises the deposit. We use DEMs to quantify the geometry of the channel deposits and estimate flow depths of ∼7 m for the meandering channels and ∼2 m for the avulsive distributary channels. Using these estimates, we employ a novel approach for assessing paleohydrology of the formative channels in relative terms. This analysis indicates that the shift from meandering to avulsive distributary channels was associated with an approximately four-fold decrease in the water to sediment discharge ratio. We use observations of the fluvial stratigraphy and channel paleohydrology to propose a model for the evolution of the Jezero western delta. The delta stratigraphy records lake level rise and shoreline transgression associated with approximately continuous filling of the basin, followed by outlet breaching, and eventual erosion of the delta. Our results imply a martian surface environment during the period of delta formation that supplied sufficient surface runoff to fill the Jezero basin without major drops in lake level, but also with discrete flooding events at non-orbital (e.g., annual to decadal) timescales.

Association of dental trauma experience and first-aid knowledge among rugby players in Malaysia.

PubMed

Abdullah, Dalia; Liew, Amy Kia Cheen; Wan Noorina, Wan Ahmad; Khoo, Selina; Wee, Fay Chwee Lin

2015-10-01

To assess and compare the knowledge of rugby players regarding first-aid measures for dental injuries. A cross-sectional study was conducted at rugby tournaments in 2009 and 2010 on players aged 16 and over. Convenient sampling was performed. A total of 456 self-administered questionnaires were returned. Data collected were analysed using SPSS 21. Descriptive analysis was undertaken for the demographic data. The subjects were classified according to their experience of sustaining each type of injury. Cross-tabulation and chi-square tests were carried out to compare the responses. When the expected cell count was less than five, Fisher's exact test was used. The level of significance was set at P < 0.05. The prevalence of self-reported dental injuries was as follows: tooth fracture (19.3%), luxation (6.6%) and avulsion (1.1%). Significant differences were found, whereby 52.2% of those who had no history of tooth fracture were more likely to seek immediate treatment (P < 0.001), whereas 42% of those who previously experienced tooth fracture claimed that they would only visit a dentist if they experienced pain (P = 0.001). Management of luxation and avulsion did not differ significantly between the groups. However, about half of those who did not have a history of tooth avulsion admitted to not knowing the correct answer, while three of five casualties would keep the tooth iced. Knowledge of the management of tooth fracture and storage medium differs between previous casualties and non-casualties. Overall, knowledge of dental trauma management was insufficient, suggesting the need to educate and train the players. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Analysis of the 2006 block-and-ash flow deposits of Merapi Volcano, Java, Indonesia, using high-spatial resolution IKONOS images and complementary ground based observations

NASA Astrophysics Data System (ADS)

Thouret, Jean-Claude; Gupta, Avijit; Liew, Soo Chin; Lube, Gert; Cronin, Shane J.; Surono, Dr

2010-05-01

On 16 June 2006 an overpass of IKONOS coincided with the emplacement of an active block-and-ash flow fed by a lava dome collapse event at Merapi Volcano (Java, Indonesia). This was the first satellite image recorded for a moving pyroclastic flow. The very high-spatial resolution data displayed the extent and impact of the pyroclastic deposits emplaced during and prior to, the day of image acquisition. This allowed a number of features associated with high-hazard block-and-ash flows emplaced in narrow, deep gorges to be mapped, interpreted and understood. The block-and-ash flow and surge deposits recognized in the Ikonos images include: (1) several channel-confined flow lobes and tongues in the box-shaped valley; (2) thin ash-cloud surge deposit and knocked-down trees in constricted areas on both slopes of the gorge; (3) fan-like over bank deposits on the Gendol-Tlogo interfluves from which flows were re-routed in the Tlogo secondary valley; (4) massive over bank lobes on the right bank from which flows devastated the village of Kaliadem 0.5 km from the main channel, a small part of this flow being re-channeled in the Opak secondary valley. The high-resolution IKONOS images also helped us to identify geomorphic obstacles that enabled flows to ramp and spill out from the sinuous channel, a process called flow avulsion. Importantly, the avulsion redirected flows to unexpected areas away from the main channel. In the case of Merapi we see that the presence of valley fill by previous deposits, bends and man-made dams influence the otherwise valley-guided course of the flows. Sadly, Sabo dams (built to ameliorate the effect of high sediment load streams) can actually cause block-and-ash flows to jump out of their containing channel and advance into sensitive areas. Very-high-spatial resolution satellite images are very useful for mapping and interpreting the distribution of freshly erupted volcanic deposits. IKONOS-type images with 1-m resolution provide opportunities to study and map the meter-scale detail of volcanic deposits. When such high-spatial-resolution satellite remote sensing data are combined with in situ field work, geomorphic analyses can be applied that allow us to more fully understand the dynamics and hazards of eruptions. In the case given here, IKONOS imagery allowed two qualitative hazard assessments for block-and-ash flow activity in drainages around Merapi. Firstly, the interpretation of IKONOS images provides insights in factors that control the propagation of secondary flows as the avulsion of the main flows is driven by longitudinal change in channel capacity due to increased sinuosity in the valley and decreased containment space. Secondly, the sinuosity and obstacles (including Sabo dams) may create over bank flows over adjacent low relief, allowing them to reach unexpectedly vulnerable areas distant from an active dome and away from the volcanically active valleys. Hazard assessment should therefore consider the geometry of secondary channels outside the principal valleys.

Clinical results with two different methods of root-end preparation and filling in apical surgery: mineral trioxide aggregate and adhesive resin composite.

PubMed

von Arx, Thomas; Hänni, Stefan; Jensen, Simon Storgård

2010-07-01

The aim of apical surgery is to hermetically seal the root canal system after root-end resection, thereby enabling periradicular healing. The objective of this nonrandomized prospective clinical study was to report results of 2 different root-end preparation and filling methods, ie, mineral trioxide aggregate (MTA) and an adhesive resin composite (Retroplast). The study included 353 consecutive cases with endodontic lesions limited to the periapical area. Root-end cavities were prepared with sonic microtips and filled with MTA (n = 178), or alternatively, a shallow concavity was prepared in the cut root face, with subsequent placement of an adhesive resin composite (Retroplast) (n = 175). Patients were recalled after 1 year. Cases were defined as healed when no clinical signs or symptoms were present and radiographs demonstrated complete or incomplete (scar tissue) healing of previous radiolucencies. The overall rate of healed cases was 85.5%. MTA-treated teeth demonstrated a significantly (P = .003) higher rate of healed cases (91.3%) compared with Retroplast-treated teeth (79.5%). Within the MTA group, 89.5%-100% of cases were classified as healed, depending on the type of treated tooth. In contrast, more variable rates ranging from 66.7%-100% were found in the Retroplast group. In particular, mandibular premolars and molars demonstrated considerably lower rates of healed cases when treated with Retroplast. MTA can be recommended for root-end filling in apical surgery, irrespective of the type of treated tooth. Retroplast should be used with caution for root-end sealing in apical surgery of mandibular premolars and molars. Copyright 2010 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Regenerative Endodontics Versus Apexification in Immature Permanent Teeth with Apical Periodontitis: A Prospective Randomized Controlled Study.

PubMed

Lin, Jiacheng; Zeng, Qian; Wei, Xi; Zhao, Wei; Cui, Minyi; Gu, Jing; Lu, Jiaxuan; Yang, Maobin; Ling, Junqi

2017-11-01

The aim of the study was to compare the outcomes of regenerative endodontic treatment (RET) and apexification on immature permanent teeth with pulp necrosis and apical periodontitis. A total of 118 patients (118 teeth) were recruited and randomly assigned to either RET or apexification treatment. Each treatment group was divided into 2 subgroups according to the etiology: dens evaginatus or trauma. Clinical symptoms and complications were recorded, and cone-beam computed tomographic imaging with a limited field of view was used to measure the change of root length, root thickness, and apical foramen size at the 12-month follow-up. The t test/rank sum test and Fisher exact test were applied to compare the change of root morphology between RET and apexification. One hundred three of 118 cases were completed at the 12-month follow-up. The survival rate was 100% for both treatment groups. All cases were asymptomatic with apical healing. The RET group showed a significant increase in root length and root thickness compared with the apexification group (P < .05). In the RET group, the cases caused by dens evaginatus achieved increased root length and root thickness compared with those caused by trauma (P < .05). RET and apexification achieved a comparable outcome in regard to the resolution of symptoms and apical healing. RET showed a better outcome than apexification regarding increased root thickness and root length. The etiology had an impact on the outcome of RET. Dens evaginatus cases showed better prognoses than trauma cases after RET. Copyright © 2017 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

HDAC inhibition inhibits brachial plexus avulsion induced neuropathic pain.

PubMed

Zhao, Yingbo; Wu, Tianjian

2018-05-09

Introduction Neuropathic pain induced by brachial plexus avulsion (BPA) is a pathological condition. We hypothesized that inhibition of histone deacetylase (HDAC) could suppress BPA-induced neuropathic pain through inhibition of transient reception potential (TRP) overexpression and protein kinase B (Akt) mediated mammalian target of rapamycin (mTOR) activation. Methods We generated a rat BPA model, administered HDAC inhibitor Tricostatin A (TSA) for 7 days post-surgery and assessed the effects on HDAC expression, Akt phosphorylation, neuroinflammation and mTOR activation. Results TSA treatment alleviated BPA induced mechanical hyperalgesia, suppressed Akt phosphorylation and increased HDAC. We found suppressed pro-inflammatory cytokine levels, TRP cation channel subfamily V member 1 (TRPV1) and TRP melastatin 8 (TRPM8) expression and mTOR activity in TSA treated BPA rats. Discussion Our results suggest that altered HDAC and Akt signaling are involved in BPA-induced neuropathic pain and that inhibition of HDAC could be an effective therapeutic approach in reducing neuropathic pain. This article is protected by copyright. All rights reserved. © 2018 Wiley Periodicals, Inc.

Multiple idiopathic external apical root resorption: report of four cases.

PubMed

Cholia, S S; Wilson, P H R; Makdissi, J

2005-07-01

Multiple idiopathic external root resorption is an unusual condition that may present in a cervical or an apical form. In this article, we review the published literature relating to multiple idiopathic external apical root resorption and present four clinical cases. We consider the aetiology of this condition and discuss the various treatment options.

The flexor digitorum profundus "demi-tendon"--a new technique for passage of the flexor profundus tendon through the A4 pulley.

PubMed

Elliot, D; Khandwala, A R; Ragoowansi, R

2001-10-01

The flexor digitorum profundus (FDP) tendon may retract after avulsion or division in Zone 1. When treatment has been delayed, the oedematous tendon can be too swollen to pass freely through the A4 pulley. We present a new technique for dealing with this situation which depends on the "double-barrelled" nature of the distal part of the FDP tendon. One half of the tendon is excised longitudinally and the remaining "demi-tendon" is passed through the intact A4 pulley to allow tendon repair or re-attachment. This technique has been used in six cases in which passage of the FDP tendon through the A4 pulley would otherwise have been impossible. Copyright 2001 The British Society for Surgery of the Hand.

Influence of a parafunctional oral habit on root fracture development after trauma to an immature tooth.

PubMed

dos Santos, Cláudia Letícia Vendrame; Saito, Célia Tomiko Matida Hamata; Luvizzuto, Eloá Rodrigues; Poi, Wilson Roberto; Panzarini, Sônia Regina; Sonoda, Celso Koogi

2011-07-01

Root fractures in immature teeth are rare because the resilience of the alveolar bone is more favorable to the occurrence of luxation. This article reports a case of traumatic injury in an immature permanent tooth that progressed to root fracture, having a parafunctional oral habit as the possible modifying factor of case evolution. A 12-year-old boy presented for treatment complaining of a defective restoration and mild pain on the maxillary right central incisor. The patient had a history of crown fracture in this tooth due to trauma 2 years before. The clinical examination showed healthy gingival tissues and no abnormal tooth mobility, whereas radiographic projections revealed healthy periradicular tissues, incomplete root formation, and no visible root fracture. As pulp necrosis was diagnosed, calcium hydroxide therapy was started for canal disinfection and subsequent obturation. However, after 4 weeks of treatment, a horizontal fracture line was observed radiographically in the root's middle third. The patient denied a new traumatic injury, but revealed the habit of chewing on a pencil. Refraining from the deleterious oral habit was strongly advised, and root canal filling with mineral trioxide aggregate was performed to treat the root fracture. After 4 years of follow-up, the tooth has normal function and no abnormal mobility. Images suggestive of remodeling at the apical end of the coronal segment and replacement resorption of the apical segment are seen radiographically. This case demonstrates the need of following cases of dental trauma and the possible influence of parafunctional oral habits as modifying factors of case progression.

Maxillary first molar with an O-shaped root morphology: report of a case.

PubMed

Shin, Yooseok; Kim, Yemi; Roh, Byoung-Duck

2013-12-01

This case report is to present a maxillary first molar with one O-shaped root, which is an extended C-shaped canal system. Patient with chronic apical periodontitis in maxillary left first molar underwent replantation because of difficulty in negotiating all canals. Periapical radiographs and cone-beam computed tomography (CBCT) were taken. All roots were connected and fused to one root, and all canals seemed to be connected to form an O-shape. The apical 3 mm of the root were resected and retrograde filled with resin-modified glass ionomer. Intentional replantation as an alternative treatment could be considered in a maxillary first molar having an unusual O-shaped root.

Horizontal root fracture treated with MTA, a case report with a 10-year follow-up.

PubMed

Roig, Miguel; Espona, José; Mercadé, Montse; Duran-Sindreu, Fernando

2011-12-01

Root fractures occur more frequently in fully erupted permanent teeth with closed apices in which the completely formed root is solidly supported in the bone and periodontium. The consequences can be complex because of combined damage to the pulp, dentine, cementum, bone, and periodontium. Management of horizontal root fractures and lateral luxation depends on several factors, with the result that various clinical modalities have been suggested. This case report describes the treatment and 10-year follow-up of two maxillary central incisors, one with horizontal root fracture and the other with lateral luxation, treated with mineral trioxide aggregate and root canal treatment, respectively. © 2011 John Wiley & Sons A/S.

A Rare Case of Apical Root Resorption during Orthodontic Treatment of Patient with Multiple Aplasia.

PubMed

Agrawal, Chintan M; Mahida, Khyati; Agrawal, Charu C; Bothra, Jitendrakumar; Mashru, Ketan

2015-07-01

External apical root resorption is an adverse effect of orthodontic treatment. It reduces the length of root and breaks the integrity of teeth and dental arch. Orthodontics is the only dental specialty that clinically uses the inflammatory process to correct the mal-aligned teeth. Hence, it is necessary to know the risk factors of root resorption and do everything to reduce the rate of root resorption. Hence, all predisposing factors which are systemic as well as local should be considered before treatment begins. This case report describes the incidence of root resorption following orthodontic treatment and the teeth affected in the patient with multiple aplasia.

Maxillary first molar with three buccal roots evaluated with cone-beam computed tomography: a rare case report.

PubMed

Kottoor, Jojo; Nandini, Suresh; Velmurugan, Natanasabapathy

2012-01-01

This case report describes the nonsurgical endodontic management of a maxillary first molar with the unusual morphology of three separate buccal roots. An accurate assessment of this morphology was made with the help of cone-beam computed tomography (CBCT). This report also describes the varied root morphology associated with maxillary first molars and the role of CBCT as a diagnostic tool for managing these complex cases successfully.

A review of microvascular ear replantation.

PubMed

Jung, Sung Won; Lee, Junsang; Oh, Suk Joon; Koh, Sung Hoon; Chung, Chul Hoon; Lee, Jong Wook

2013-03-01

Microvascular ear replantation is a significant challenge because of the small size of the vessels and the fact that traumatic amputations are frequently avulsed. The zone of trauma is therefore extended and the primary repair of the injured vessel is rendered unlikely. The purpose of this study is to review the literature of ear replantation. A review of the relevant literature that has been published since 1980 revealed 47 cases reported in 37 publications. We present 5 cases from our own experience and analyze a total 52 cases of microvascular ear replantation. The patient's age, sex, degree of amputation, cause of injury, ischemic time, method of arterial and venous anastomosis, complications, any additional outflow used, postoperative medications, the requirement for transfusions, and the number of hospital admission days are described. Successful microvascular ear replantations require anastomosis of the vessels if possible. Rather than a vein graft, primary repair of the vessels, or at least pedicled repair of the artery, should be considered to ensure flap survival. In addition, vein repair should be considered if possible to ensure the secure drainage of blood from the replant. With secure circulation, the replant can survive, resulting in a very satisfactory outcome. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Treatment of Necrotic Teeth by Apical Revascularization: Meta-analysis.

PubMed

He, Ling; Zhong, Juan; Gong, Qimei; Kim, Sahng G; Zeichner, Samuel J; Xiang, Lusai; Ye, Ling; Zhou, Xuedong; Zheng, Jinxuan; Liu, Yongxing; Guan, Chenyu; Cheng, Bin; Ling, Junqi; Mao, Jeremy J

2017-10-24

Each year ~5.4 million children and adolescents in the United States suffer from dental infections, leading to pulp necrosis, arrested tooth-root development and tooth loss. Apical revascularization, adopted by the American Dental Association for its perceived ability to enable postoperative tooth-root growth, is being accepted worldwide. The objective of the present study is to perform a meta-analysis on apical revascularization. Literature search yielded 22 studies following PRISMA with pre-defined inclusion and exclusion criteria. Intraclass correlation coefficient was calculated to account for inter-examiner variation. Following apical revascularization with 6- to 66-month recalls, root apices remained open in 13.9% cases (types I), whereas apical calcification bridge formed in 47.2% (type II) and apical closure (type III) in 38.9% cases. Tooth-root lengths lacked significant postoperative gain among all subjects (p = 0.3472) or in subgroups. Root-dentin area showed significant increases in type III, but not in types I or II cases. Root apices narrowed significantly in types II and III, but not in type I patients. Thus, apical revascularization facilitates tooth-root development but lacks consistency in promoting root lengthening, widening or apical closure. Post-operative tooth-root development in immature permanent teeth represents a generalized challenge to regenerate diseased pediatric tissues that must grow to avoid organ defects.

Clinical features and endodontic treatment of two-rooted mandibular canines: report of four cases.

PubMed

Stojanac, Igor; Premović, Milica; Drobac, Milan; Ramić, Bojana; Petrović, Ljubomir

2014-01-01

Predictable endodontic treatment depends on the dentist's knowledge about root canal morphology and its possible anatomic variations. The majority of mandibular canines have one root and root canal, but 15% may have two canals and a smaller number may have two distinct roots. The following clinical reports describe endodontic treatment of mandibular canines with two roots and two root canals. OUTLINE OF CASES Four clinical case reports are presented to exemplify anatomical variation in the human mandibular canine. Detailed analysis of the preoperative radiographs and careful examination of the pulp chamber floor detected the presence of two root canal orifices in all canines. Working length was determined with an electronic apex locator and biomechanical preparation was carried out by using engine driven BioRaCe Ni-Ti rotary instruments in a crown-down manner, followed by copious irrigation with 1% sodium hypochlorite. Definitive obturation was performed using cold lateral condensation with gutta-percha cones and Top Seal paste. The treatment outcome was evaluated using postoperative radiographs. Endodontists should be aware of anatomical variations of the treated teeth, and should never presume that canal systems are simple.

Aconitum Alkaloid Poisoning Related to the Culinary Uses of Aconite Roots

PubMed Central

Chan, Thomas Y. K.

2014-01-01

Aconite roots (roots or root tubers of the Aconitum species) are eaten as root vegetables and used to prepare herbal soups and meals, mainly for their purported health benefits. Aconite roots contain aconitine and other Aconitum alkaloids, which are well known cardiotoxins and neurotoxins. To better understand why Aconitum alkaloid poisoning related to the culinary uses of aconite roots can occur and characterize the risks posed by these “food supplements”, relevant published reports were reviewed. From 1995 to 2013, there were eight reports of aconite poisoning after consumption of these herbal soups and meals, including two reports of large clusters of cases (n = 19–45) and two reports of cases (n = 15–156) managed by two hospitals over a period of 4.5 to 5 years. The herbal formulae used did not adhere to the suggested guidelines, with regarding to the doses (50–500 g instead of 3–30 g per person) and types (raw instead of processed) of aconite roots used. The quantities of Aconitum alkaloids involved were huge, taking into consideration the doses of aconite roots used to prepare herbal soups/meals and the amounts of aconite roots and herbal soups/meals consumed. In a large cluster of cases, despite simmering raw “caowu” (the root tuber of A. kusnezoffii) in pork broth for 24 h, all 19 family members who consumed this soup and boiled “caowu” developed poisoning. Severe or even fatal aconite poisoning can occur after consumption of herbal soups and foods prepared from aconite roots. Even prolonged boiling may not be protective if raw preparations and large quantities of aconite roots are used. The public should be warned of the risk of severe poisoning related to the culinary and traditional medicinal uses of aconite roots. PMID:25184557

Aconitum alkaloid poisoning related to the culinary uses of aconite roots.

PubMed

Chan, Thomas Y K

2014-09-02

Aconite roots (roots or root tubers of the Aconitum species) are eaten as root vegetables and used to prepare herbal soups and meals, mainly for their purported health benefits. Aconite roots contain aconitine and other Aconitum alkaloids, which are well known cardiotoxins and neurotoxins. To better understand why Aconitum alkaloid poisoning related to the culinary uses of aconite roots can occur and characterize the risks posed by these "food supplements", relevant published reports were reviewed. From 1995 to 2013, there were eight reports of aconite poisoning after consumption of these herbal soups and meals, including two reports of large clusters of cases (n = 19-45) and two reports of cases (n = 15-156) managed by two hospitals over a period of 4.5 to 5 years. The herbal formulae used did not adhere to the suggested guidelines, with regarding to the doses (50-500 g instead of 3-30 g per person) and types (raw instead of processed) of aconite roots used. The quantities of Aconitum alkaloids involved were huge, taking into consideration the doses of aconite roots used to prepare herbal soups/meals and the amounts of aconite roots and herbal soups/meals consumed. In a large cluster of cases, despite simmering raw "caowu" (the root tuber of A. kusnezoffii) in pork broth for 24 h, all 19 family members who consumed this soup and boiled "caowu" developed poisoning. Severe or even fatal aconite poisoning can occur after consumption of herbal soups and foods prepared from aconite roots. Even prolonged boiling may not be protective if raw preparations and large quantities of aconite roots are used. The public should be warned of the risk of severe poisoning related to the culinary and traditional medicinal uses of aconite roots.

Treatment of horizontal root fractures using MTA as apical plug: report of 3 cases.

PubMed

Kusgoz, Adem; Yildirim, Tahsin; Tanriver, Mehmet; Yesilyurt, Cemal

2009-05-01

Root fractures are rare occurrences through all dental injuries. They comprise only 0.5% to 7.0% of traumas affecting the permanent teeth. Generally the cervical and middle thirds of the roots are affected. The healing of these lesions depends on the health of the pulp, dentine, cementum, and alveolar bone. These case reports describe the management and 2-year follow-up of 3 maxillary central incisors with horizontal root fractures treated with mineral trioxide aggregate (MTA) as apical plug.

[Root canal treatment of mandibular first premolar with 4 root canals: a case report].

PubMed

Liu, Xin-yang; Zhan, Fu-Liang

2015-10-01

The mandibular first premolar can be considered one of the most challenging teeth to treat, due to the complexity of its root canal morphology and increased incidence of multiple canals. A case of endodontic treatment of a mandibular first premolar exhibiting a total of 4 distinct root canals and 4 apical foramina was described. Anatomic variation of root canal morphology should be considered in endodontic treatment to ensure a favorable healing outcome, and its identification could be enhanced by careful examination using a dental operating microscope. Obturation of root canals using a warm vertical compaction technique with a highly-radiopaque root canal sealer, such as AH Plus, after careful ultrasonic activated irrigation might allow the flow of sealer into the narrowed but unprepared part of the canal, thereby facilitating optimum chemo-mechanical debridement of the root canal system.

Technological advances in endodontics: treatment of a mandibular molar with internal root resorption using a reciprocating single-file system.

PubMed

de Souza, Samir Noronha; Marques, André Augusto Franco; Sponchiado-Júnior, EmÍlio Carlos; Roberti Garcia, Lucas da Fonseca; da Frota, Matheus Franco; de Carvalho, Fredson Márcio Acris

2017-01-01

The field of endodontics has become increasingly successful due to technological advances that allow clinicians to solve clinical cases that would have been problematic a few years ago. Despite such advances, endodontic treatment of teeth with internal root resorption remains challenging. This article presents a clinical case in which a reciprocating single-file system was used for endodontic treatment of a mandibular molar with internal root resorption. Radiographic examination revealed the presence of internal root resorption in the distobuccal root canal of the mandibular right first molar. A reciprocating single-file system was used for root canal instrumentation and final preparation, and filling was obtained through a thermal compaction technique. No painful symptoms or periapical lesions were observed in 12 months of follow-up. The results indicate that a reciprocating single-file system is an adequate alternative for root canal instrumentation, particularly in teeth with internal root resorption.

Maxillary molars with morphologic variations of the palatal root canals: a report of four cases.

PubMed

Holderrieth, Silke; Gernhardt, Christian Ralf

2009-07-01

The purpose of this article was to show the importance of the knowledge of the anatomy of root canals. Unusual root and root canal morphologies associated with both buccal roots of upper molars have been recorded in several studies in the literature. However, scientific information focusing on variations of the palatal root is rare. In this report, four cases are presented involving the root canal treatment of maxillary first and second molars with unusual morphologic configurations of the palatal root canals. During root canal treatment, type IV and V configurations as defined by Vertucci of the palatal canals of two first and two second maxillary molars were identified. After mechanical instrumentation, the canals were obturated. Radiologic and clinical re-evaluation showed no signs of inflammation. This report describes and discusses the possibility of different root and canal variations of the maxillary molars from a clinical point of view. Anatomic variations can occur in any tooth, and palatal roots of maxillary first and second molars are no exception. Therefore, careful examination of radiographs and internal anatomy of teeth is essential.

Endodontic management of mandibular third molar with three mesial roots using spiral computed tomography scan as a diagnostic aid: a case report.

PubMed

Tomar, Deepak; Dhingra, Anil; Tomer, Anil; Sharma, Shalini; Sharma, Vivek; Miglani, Anjali

2013-05-01

Aberrant root canal anatomy is diagnostically and clinically challenging for clinicians. The most common root canal configuration of human molars is 2 roots and 3 canals, but various combinations may still exist. Third molars are known to have the most unusual anatomy among human teeth. Restorative, prosthetic, and orthodontic considerations often require endodontic treatment of third molars in order for them to be retained as functional components of the dental arch. The present case report demonstrates unusual root canal morphology of the mandibular third molar. Roentgenographic examination, which included spiral CT scan, revealed 3 separate mesial roots in tooth #48 with 3 independent canals and 3 canal orifices, indicating an endodontic rarity. The present case report puts impetus on exploration of additional canals using advanced diagnostic aids, such as spiral computed tomography, which can have a huge impact on the successful outcome of endodontic therapy. Copyright © 2013 Elsevier Inc. All rights reserved.

Geometrical Solutions of Some Quadratic Equations with Non-Real Roots

ERIC Educational Resources Information Center

Pathak, H. K.; Grewal, A. S.

2002-01-01

This note gives geometrical/graphical methods of finding solutions of the quadratic equation ax[squared] + bx + c = 0, a [not equal to] 0, with non-real roots. Three different cases which give rise to non-real roots of the quadratic equation have been discussed. In case I a geometrical construction and its proof for finding the solutions of the…

'It's good enough': Swedish general dental practitioners on reasons for accepting substandard root filling quality.

PubMed

Dahlström, L; Lindwall, O; Rystedt, H; Reit, C

2018-04-01

The concept of 'good enough' is central and necessary in the assessment of root filling quality. The aim was to explore the concept by analysing reasons and arguments for the acceptance or rejection of substandard root filling quality as reported by general dental practitioners (GDPs) in Sweden. The study was designed as a qualitative and exploratory study based on seven videotaped focus group interviews analysed by means of qualitative content analysis. Thirty-three GDPs employed in the Public Dental Health Service in Gothenburg, Sweden, participated (4-6 GDPs/interview). In all, nine predetermined questions were followed. Before each focus group, the participants received radiographs of 37 root fillings and were asked to assess the root filling quality. The three cases representing the most divergent assessments served as a basis for the discussion. The cases were presented without clinical information; the dentists would relate to the cases as being just root filled by themselves. The radiographs did not provide a sufficient basis for decisions on whether or not to accept the root filling. This study emphasized that dentists did not primarily look for these arguments in the technical details of the root filling per se, but instead, they considered selected features of the contextual situation. The GDPs constantly introduced relevant 'ad hoc considerations' to account for the decisions they made. These contextual considerations were related to aspects of pulpal and periapical disease, risks (e.g. technical complications) or to consumed resources (personal and/or economic). It was obvious that the concept of 'good enough' does not exist as a general formula ready to be applied in particular situations. Instead, it is necessarily and irremediably tied to contextual properties that emerge from case to case. © 2017 International Endodontic Journal. Published by John Wiley & Sons Ltd.

Tree-root control of shallow landslides

NASA Astrophysics Data System (ADS)

Cohen, Denis; Schwarz, Massimiliano

2017-08-01

Tree roots have long been recognized to increase slope stability by reinforcing the strength of soils. Slope stability models usually include the effects of roots by adding an apparent cohesion to the soil to simulate root strength. No model includes the combined effects of root distribution heterogeneity, stress-strain behavior of root reinforcement, or root strength in compression. Recent field observations, however, indicate that shallow landslide triggering mechanisms are characterized by differential deformation that indicates localized activation of zones in tension, compression, and shear in the soil. Here we describe a new model for slope stability that specifically considers these effects. The model is a strain-step discrete element model that reproduces the self-organized redistribution of forces on a slope during rainfall-triggered shallow landslides. We use a conceptual sigmoidal-shaped hillslope with a clearing in its center to explore the effects of tree size, spacing, weak zones, maximum root-size diameter, and different root strength configurations. Simulation results indicate that tree roots can stabilize slopes that would otherwise fail without them and, in general, higher root density with higher root reinforcement results in a more stable slope. The variation in root stiffness with diameter can, in some cases, invert this relationship. Root tension provides more resistance to failure than root compression but roots with both tension and compression offer the best resistance to failure. Lateral (slope-parallel) tension can be important in cases when the magnitude of this force is comparable to the slope-perpendicular tensile force. In this case, lateral forces can bring to failure tree-covered areas with high root reinforcement. Slope failure occurs when downslope soil compression reaches the soil maximum strength. When this occurs depends on the amount of root tension upslope in both the slope-perpendicular and slope-parallel directions. Roots in tension can prevent failure by reducing soil compressive forces downslope. When root reinforcement is limited, a crack parallel to the slope forms near the top of the hillslope. Simulations with roots that fail across this crack always resulted in a landslide. Slopes that did not form a crack could either fail or remain stable, depending on root reinforcement. Tree spacing is important for the location of weak zones but tree location on the slope (with respect to where a crack opens) is as important. Finally, for the specific cases tested here, intermediate-sized roots (5 to 20 mm in diameter) appear to contribute most to root reinforcement. Our results show more complex behaviors than can be obtained with the traditional slope-uniform, apparent-cohesion approach. A full understanding of the mechanisms of shallow landslide triggering requires a complete re-evaluation of this traditional approach that cannot predict where and how forces are mobilized and distributed in roots and soils, and how these control shallow landslides shape, size, location, and timing.

Repair of distal biceps tendon rupture with the Biotenodesis screw.

PubMed

Khan, W; Agarwal, M; Funk, L

2004-04-01

Distal biceps tendon ruptures are uncommon injuries with only around 300 cases reported in the literature. Current management tends to favour anatomical reinsertion of the tendon into the radial tuberosity, especially in young and active individuals. These injuries are commonly repaired using either a single anterior incision with suture anchors or the Boyd-Anderson dual incision technique. We report the use of a bioabsorbable interference screw for the repair of distal biceps tendon rupture using a minimal incision technique. In this technique the avulsed tendon and a bioabsorbable screw are secured in a drill hole on the radial tuberosity using whip stitch and fibre wire sutures according to Biotenodesis system guidelines. The technique described requires minimal volar dissection that is associated with a reduced number of synostosis and posterior interosseous nerve injuries. The bioabsorbable interference screw has all the advantages of being biodegradable and has been shown to have greater pullout strength than suture anchors. It is also a reasonable alternative to titanium screws in terms of primary fixation strength. The strong fixation provided allows early active motion and return to previous activities as seen in our case.

Latissimus Dorsi and Teres Major Tendon Avulsions in Cricketers: A Case Series and Literature Review.

PubMed

Naidu, Krishant S; James, Trefor; Rotstein, Andrew H; Balster, Simon M; Hoy, Gregory A

2017-05-01

Acute latissimus dorsi tendon injuries are uncommon, having not previously been described in cricketers. The leg spinner's stock ball bowling technique and the fast bowler's back-of-the-hand slow ball, which is used much more widely in T20 cricket, produce a significant eccentric contraction load on the latissimus dorsi muscle. A retrospective review of a case series of acute latissimus dorsi tendon injuries in 3 elite cricketers (2 fast bowlers and a leg-spin bowler). We compare the outcomes using patient-rated scales and objective strength testing. Two patients underwent operative repair and had excellent outcomes. One of the nonoperatively managed patients had mild ongoing symptoms at 7 months. An associated injury to teres major did not affect the outcome of this injury. Operative repair is a viable alternative and may produce better outcomes in cricketers. The short T20 form of cricket has lead to an increase in the number of back-of-the-hand slow balls, a risk factor for Latissimus injury, whereas leg-spin bowling is another risk.

[Vertical fractures: apropos of 2 clinical cases].

PubMed

Félix Mañes Ferrer, J; Micò Muñoz, P; Sánchez Cortés, J L; Paricio Martín, J J; Miñana Laliga, R

1991-01-01

The aim of the study is to present a clinical review of the vertical root fractures. Two clinical cases are presented to demonstrates the criteria for obtaining a correct diagnosis of vertical root fractures.

Endodontic treatment of a mandibular second premolar with three root canals.

PubMed

Aguiar, Carlos; Mendes, Daniela; Câmara, Andréa; Figueiredo, Jose

2010-03-01

The purpose of this case report is to describe a nonsurgical endodontic treatment of a mandibular left second premolar with two separate roots and three distinct root canals. In endodontics, the possible existence of extra canals must be considered before endodontic treatment is instituted. A wide morphological variation of the root canal system is known to exist. A 36-year-old male patient was referred for endodontic treatment on the left mandibular second premolar. Radiographic examination of the involved tooth revealed an unusual, complex root canal anatomy. There was an irregular root morphology consisting of two distinct roots and three canals. This case report describes the successful nonsurgical endodontic treatment of a mandibular left second premolar with two separate roots and three distinct root canals filled using size 35 Thermafil gutta-percha carriers and AH Plus sealer. On the one-year follow-up radiograph, the tooth was asymptomatic, confirming adequate healing with no complications. Even in a tooth with an extremely complex root canal morphology, conventional endodontic treatment without surgical intervention can result in adequate healing without any complications.

Maxillary premolar resorption by canines: three case reports.

PubMed

Cooke, M E; Nute, S J

2005-05-01

Three unusual cases of maxillary premolar root resorption are reported. Three teenage patients were referred to the orthodontic department for management of ectopic maxillary canines. Radiographic examination revealed unilateral premolar root resorption in all three patients. This represents an unusual finding. Whereas the prevalence of maxillary lateral incisor root resorption secondary to palatally ectopic canines has been reported, the prevalence of premolar root resorption is unknown. This report discusses the findings in the context of the available literature. The postulated aetiology and the need for early diagnosis are highlighted.

An evaluation of root resorption after orthodontic treatment.

PubMed

Thomas, E; Evans, W G; Becker, P

2012-08-01

Root resorption is commonly seen, albeit in varying degrees, in cases that have been treated orthodontically. In this retrospective study the objective was to compare the amount of root resorption observed after active orthodontic treatment had been completed with one of three different appliance systems, namely, Tip Edge, Modified Edgewise and Damon. The sample consisted of pre and post-treatment cephalograms of sixty eight orthodontic cases. Root resorption of the maxillary central incisor was assessed from pre- and post- treatment lateral ce phalograms using two methods. In the first, overall tooth length from the incisal edge to the apex was measured on both pre and post-treatment lateral cephalograms and root resorption was recorded as an actual millimetre loss of tooth length. There was a significant upward linear trend (p = 0.052) for root resorption from the Tip Edge Group to the Damon Group. In the second method root resorption was visually evaluated by using the five grade ordinal scale of Levander and Malmgren (1988). It was found that the majorty of cases in the sample came under Grade 1 and Grade 2 category of root resorption. Statistical evaluation tested the extent of agree ment in this study between visual measurements and actual measurements and demonstrated a significant association (p = 0.018) between the methods.

[Instability of the distal radioulnar joint: Treatment options for ulnar lesions of the triangular fibrocartilage complex].

PubMed

Spies, C K; Prommersberger, K J; Langer, M; Müller, L P; Hahn, P; Unglaub, F

2015-08-01

Injuries of the triangular fibrocartilage complex (TFCC) may be fatal to the distal radioulnar joint (DRUJ). This structure is one of the crucial stabilizers and guarantees unrestricted pronosupination of the forearm. A systematic examination is mandatory to diagnose DRUJ instability reliably. A clinical examination in comparison to the contralateral side is obligatory. Plain radiographs are required to exclude osseous lesions or deformities. Computed tomography of both wrists in neutral, pronation and supination is necessary to verify DRUJ instability in ambiguous situations. Based on a systematic examination wrist and DRUJ arthroscopy identify lesions clearly. Injuries of the radioulnar ligaments which entail DRUJ instability, should be reconstructed preferably anatomically. Ulnar-sided TFCC lesions may often cause DRUJ instability. Osseous ligament avulsions are mostly treated osteosynthetically. Ligament tears may be refixated using anchor or transosseous sutures. Tendon transplants are necessary for an anatomical reconstruction in cases of irreparable ruptures.

Management of genitourinary injuries in patients with pelvic fractures.

PubMed Central

Weems, W L

1979-01-01

Associated injuries frequently occur in patients who sustain fractures of the pelvis. Hemorrhage from intrapelvic vessels, rupture of the urinary bladder and avulsion of the membranous urethra in males are among the integral risks in this trauma. Non-operative methods of managing hemorrhage have gained favor in recent experience. The case records of 282 male patients with pelvic fractures were reviewed to evaluate experience with lower genitourinary injuries. Early recognition is important in bladder injuries, and surgical repair is advised, except in selected patients who may be managed by catheter drainage alone. Delayed complications of bladder injury are rare. Membranous urethral injuries entail a high risk of chronic stricture disease and sexual impotence. The rationale of early repair versus delayed repair of these injuries is discussed. The results in this series show advantage for delayed repair. Images Fig. 2. Fig. 3. PMID:453943

Endodontic treatment of a maxillary first molar with seven root canals confirmed with cone beam computer tomography - case report.

PubMed

Martins, Jorge N R

2014-06-01

The most common configuration of the maxillary first molar is the presence of three roots and four root canals, although the presence of several other configurations have already been reported. The objective of this work is to present a rare anatomic configuration with seven root canals diagnosed during an endodontic therapy. Endodontic treatment was performed using a dental operating microscope. Exploring the grooves surrounding the main canals with ultrasonic troughing was able expose unexpected root canals. Instrumentation with files of smaller sizes and tapers was performed to prevent root physical weakness. The anatomic configuration was confirmed with a Cone Beam Computer Tomography image analysis which was able to clearly show the presence of seven root canals. An electronic database search was conducted to identify all the published similar cases and the best techniques to approach them are discussed.

[Early operative treatment of pelvic fractures associated with urethral disruption].

PubMed

Jia, Jian; Guo, Lu-Zeng; Wu, Chang-Lin; Chen, Jia-Geng; Zhang, Tie-Liang; Pei, Fu-Xing

2007-02-15

To evaluate the early operative treatment and clinical results of pelvic fractures associated with urethra disruption. From January 1995 to January 2005, 25 patients suffered from pelvic fractures combined urethra disruption treated by operation were retrospectively analyzed. According to Tile's classification, 1 case was stable pelvic fracture, 17 rotational unstable fractures, and 7 rotational combined vertical unstable fractures. The complete urethra rupture were in 23 cases and incomplete in 2 cases. The operative methods included: (1) emergency open reduction and internal fixation of the pelvis combined primary urethra suturing in 2 cases, partial suturing after realignment in 4 cases, realignment in 2 cases, and urethrovaginal penetrating wound repairing in 1 case; (2) primary urethra realignment only and delayed (range, 7 to 21 days) pelvic internal fixation in 10 cases; (3) early cystostomy and delayed (range, 3 to 21 days) urethra realignment and pelvic internal fixation in 6 cases. The mean follow-up time of all patients was 34 months (range from 6 to 120 months). According to Majeed's evaluation, 17 cases of pelvic injury showed excellent results, 5 good, and 3 fare. After urinary catheter removed, the mean maximal urine flow rate of 19 (76%) patients was 18.6 ml/s and the mean scar length between both disrupted ends on the film of excretion urethrography was 0.51 cm. Five (20%) cases suffered in dysuria needed urethral dilatation or further surgery. One (4%) female could not control urination who need a second-look operation. The primary suprapubic soft tissue avulsion wound infection secondary to retropubic abscess was found in 1 case, posterior urethra-stenosis in 5 cases, sexual impotence in 3 cases, and incontinence in 1 case. The satisfactory reduction and effective fixation of the pelvic fractures is an anatomical basis for receiving "tension-free urethral anastomosis".

An In vitro Comparison of Coconut Water, Milk, and Saline in Maintaining Periodontal Ligament Cell Viability

PubMed Central

D’Costa, Vivian Flourish; Bangera, Madhu Keshava; Kini, Shravan; Kutty, Shakkira Moosa; Ragher, Mallikarjuna

2017-01-01

Background and Objectives: Two of the most critical factors affecting the prognosis of an avulsed tooth after replantation are extraoral dry time and the storage media in which the tooth is placed before treatment is rendered. The present study is undertaken to evaluate the periodontal ligament (PDL) cell viability after storage of teeth in different storage media, namely, coconut water, milk, and saline. Materials and Methods: Forty sound human premolars undergoing extraction for orthodontic purpose were selected. The teeth were allowed to lie dry on sand/mud for 30 min followed by which they were randomly divided and stored in three different media, i.e., coconut water, milk, and saline. After 45-min storage in their respective media, the root surface was then scraped for PDL tissue. Results: The ANOVA and Newman–Keuls post hoc procedure for statistical analysis of viable cell count under a light microscope using hemocytometer demonstrated that coconut water preserved significantly more PDL cells viable (P < 0.05) compared with milk and saline. Conclusion: Storage media help in preserving the viability of PDL cells when immediate replantation is not possible. This study evaluated the posttraumatic PDL cells’ viability following storage in three different storage media. Within the parameters of this study, it was found that coconut water is the most effective media for maintaining the viability of PDL. PMID:29284947

Management of a maxillary first molar having atypical anatomy of two roots diagnosed using cone beam computed tomography.

PubMed

Sharma, Sarang; Mittal, Meenu; Passi, Deepak; Grover, Shibani

2015-01-01

Most often, a clinician working on maxillary first molar when anticipates an aberration thinks of an extra canal but rarely does he preempt fewer canals. Maxillary first molar is a tooth, which has been extensively reviewed with respect to its external and internal morphology. Abundant literature related to its anatomy is available, but reports on incidence of two roots and two root canals in maxillary first molar are very limited. Here, a case of maxillary first molar is presented that had two roots: one palatal root with Type I canal configuration and one bulbous fused buccal root with Type V canal configuration; a unique root and canal configuration not seen in any of the earlier reported cases. Diagnosis of root canal aberrancy and subsequently, accurate management of the tooth was greatly facilitated by cone beam computed tomography (CBCT) scan. The relevance of CBCT in improving treatment prognosis is greatly emphasized in this report.

Orthodontic movement of a horizontally fractured tooth: a case report.

PubMed

Erdemir, Ali; Ungor, Mete; Erdemir, Ebru Olgun

2005-06-01

Intra-alveolar root fractures are relatively uncommon, and sometimes may be healed without treatment. Diagnosis of intra-alveolar root fracture is frequently made by exclusion of clinical signs of other traumatic injury, and by radiographic examination with films taken at different tube angulations. This case report presents a horizontal root fractured tooth that was healed satisfactory without treatment and moved orthodontically after prolonged time from trauma.

Management of gingival recession by the use of an acellular dermal graft material: a 12-case series.

PubMed

Santos, A; Goumenos, G; Pascual, A

2005-11-01

Different soft tissue defects can be treated by a variety of surgical procedures. Most of these techniques require the palatal area as a donor site. Recently, an acellular dermal graft has become available that can substitute for palatal donor tissue. This study describes the surgical technique for gingival augmentation and root coverage and the results of 12 clinical cases. A comparison between the three most popular mucogingival procedures for root coverage is also presented. The results of the 12 patients and the 26 denuded surfaces have shown that we can obtain a mean root coverage of 74% with the acellular dermal graft. Thirteen out of the 26 denuded surfaces had complete root coverage. The average increase in keratinized tissue was 1.19 mm. It seems that the long-term results of the cases are stable. The proposed technique of root coverage with an acellular dermal graft can be a good alternative to soft tissue grafts for root coverage, and it should be part of our periodontal plastic surgery armamentarium.

Attraction of Southern Pine Engravers and Associated Bark Beetles (Coleoptera: Scolytidae) to Ipsenol, Ipsdienol, and Lanierone in Southeastern United States

Treesearch

D. R. Miller; C. Asaro; C. W. Berisford

2005-01-01

We determined the response of the small southern pine engraver, Ips avulses (Eichhoff); eastern fivespined ips, Ips grandicollis (Eichhoff); sixspined ips, Ips calligraphus (Germar); and pine engraver, Ips pini (Say) to the pheromones (±)-ipsenol, (±)-ipsdienol, and lanierone in the...

Geomorphic processes affecting meadow ecosystems [chapter 3

Treesearch

Jerry R. Miller; Dru Germanoski; Mark L. Lord

2011-01-01

Three geomorphic processes are of primary concern with respect to the current and future state of wet meadow ecosystems: channel incision, avulsion (the abrupt movement of the channel to a new location on the valley floor), and gully formation. Gully formation often is accompanied by upvalley headcut migration and a phenomenon referred to as "groundwater sapping...

Botulinum toxin-assisted endoscopic repair of traumatic vocal fold avulsion.

PubMed

Abraham, Rima F; Shapshay, Stanley; Galati, Lisa

2010-09-01

Blunt traumatic laryngeal injury in children often leads to intralaryngeal soft-tissue damage, which can quickly compromise an already small airway. Injuries requiring operative intervention have historically been repaired via open approaches such as thyrotomy and laryngofissure. These approaches carry significant long-term sequelae that can compromise the airway, deglutition, and voice. We describe a safe and effective alternative to open repair that includes the use of a botulinum toxin chemical myotomy to ensure optimal healing. We used this procedure to treat a 13-year-old boy who had experienced a traumatic avulsion of the true vocal folds. Postoperatively, his voice outcome was satisfactory, as evidenced by a marked improvement in his pediatric Voice Handicap Index score. No complication or compromise of the airway or swallowing occurred, and resolution of the botulinum effect was observed by 6 months postoperatively. The endoscopic approach supplemented by botulinum toxin injection avoids scarring and allows for safe postoperative extubation. Compared with open repair, it is associated with a shorter hospital stay and a lower risk of stenosis and fibrosis.

The elusive character of discontinuous deep-water channels: New insights from Lucia Chica channel system, offshore California

USGS Publications Warehouse

Maier, K.L.; Fildani, A.; Paull, C.K.; Graham, S.A.; McHargue, T.R.; Caress, D.W.; McGann, M.

2011-01-01

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.

Comparison of coconut water, propolis, HBSS, and milk on PDL cell survival.

PubMed

Gopikrishna, Velayutham; Baweja, Parvinder Singh; Venkateshbabu, Nagendrababu; Thomas, Toby; Kandaswamy, Deivanayagam

2008-05-01

Coconut water is biologically pure and sterile, with a rich presence of amino acids, proteins, vitamins, and minerals. The purpose of this study was to use a collagenase-dispase assay to investigate the potential of a new storage medium, coconut water, in comparison with propolis, Hank's balanced salt solution (HBSS), and milk in maintaining viable periodontal ligament (PDL) cells on simulated avulsed teeth. Seventy freshly extracted human teeth were divided into 4 experimental groups and 2 control groups. The positive and negative controls corresponded to 0-minute and 8-hour dry times, respectively. The experimental teeth were stored dry for 30 minutes and then immersed in 1 of the 4 media (coconut water, propolis, HBSS, and milk). The teeth were then treated with dispase grade II and collagenase for 30 minutes. The number of viable PDL cells was counted with a hemocytometer and analyzed. Statistical analysis showed that coconut water kept significantly more PDL cells viable compared with propolis, HBSS, or milk. Coconut water can be used as a superior transport medium for avulsed teeth.

Arthroscopic repair of a chondrolabral lesion associated with anterior glenohumeral dislocation.

PubMed

Page, Richard; Bhatia, Deepak N

2010-12-01

Chondrolabral lesions are uncommon after anteroinferior glenohumeral dislocations. This report describes a new dual-lesion complex that involved an avulsion of the anteroinferior glenoid labrum and a flap tear of the adjacent articular cartilage [glenoid labral tear and articular cartilage flap (GLAF) lesion]. The chondral component involved a large undermined region of the anterior half of the lower glenoid articular cartilage, and the labral component involved an avulsion from the 2.30-6 o'clock position on the glenoid. The labral tear was reconstructed with 3 suture anchors to form a neo-labrum in an attempt to overlap and stabilize the periphery of the chondral flap. A meniscal repair device was used to place a mattress stitch in the cartilage periphery to further stabilize the flap. This technique resulted in a secure repair without any chondral damage, and this remained intact on an MRI performed at a 3-month follow-up. A final 12-month follow-up showed complete recovery, as assessed by the Oxford shoulder instability score and Rowe score, and by a return to the pre-injury sporting level.

Circumvallate papilla of dog following suture of the hypoglossal and glossopharyngeal nerves.

PubMed

State, F A

1977-01-01

20 adult dogs were classified into five groups; in two animals of each group hypoglossa-glossopharyngeal suturing was done. In the other two animals glossopharyngeal nerve transection with concomitant central segment avulsion was done and these two animals were used as controls. The animals of the five groups were sacrified at 4-week intervals starting by the first group on the 4th post-operative week and ending by the fifth group on the 20th week; the circumvallate papillae were studied. On the 4th week following either operative procedure, few taste buds persisted on the circumvallate papillae. Invasion of the papillae by regenerating hypoglossal fibres from the 8th week onwards was not followed by any appreciable increase in the number of taste buds. The difference in number of taste buds between hypoglossal-glossopharyngeal suture and glossopharyngeal avulsion procedures was not statistically significant. from the 8th weeks following cross-innervation the reaction for acetylcholinesterase was more intense than in denervated papillae which showed a persistent weakly positive reaction up to the 20th post-operative week.

Acute traumatic rupture of the patellar tendon in pediatric population: Case series and review of the literature.

PubMed

Ali Yousef, Mohamed Abdelhamid; Rosenfeld, Scott

2017-11-01

Intact knee extensor mechanism is required for the normal function of the lower extremity. Patellar tendon rupture is a relatively rare injury with peak age incidence around 40 years and usually occurs midsubstance. The occurrence of pure patellar tendon rupture without bony avulsion is an extremely rare injury in the pediatric population with few cases reported in the literature with limited information regarding frequency, complications, and outcomes in children. However, due to increased participation in sports and high-energy recreational activities during childhood, the frequency of such injuries has progressively increased. To evaluate the frequency of pediatric patellar tendon rupture injuries and describe the radiological findings, treatment modalities, and outcome of such injuries. Demographic and clinical data on a series of patients who sustained patellar tendon rupture were reviewed. These data included age at time of injury, sex, laterality, mechanism of injury, associated injuries, complications, presence or absence of Osgood-Schlatter disease, diagnostic imaging such as plain radiographs and magnetic resonance images (MRI), surgical technique, method of fixation, period of postoperative immobilization, total duration of physiotherapy, time to return to sports activities and follow-up duration. Insall-Salvati ratio was calculated on the preoperative lateral x-ray. The functional outcome was evaluated with regard to final knee active range of motion (AROM), manual quadriceps muscle testing, and presence or the absence of terminal extension lag. Clinical outcome rating using knee society score (KSS) was performed and functional outcome was further classified according to the calculated score. Five male patients with patellar tendon rupture (7%) were identified among 71 pediatric patients who sustained acute traumatic injury of the knee extensor mechanism. The mean age at the time of injury was 13.6 years (range: 12-15 years). The injury occurred in relation to sports activities in 4 patients. Osteogenesis imperfecta and Osgood-Schlatter disease were identified in 2 patients. High riding patella is the hallmark diagnostic sign detected in plain x-ray with preoperative Insall-Salvati ratio ranged from 1.7 to 2.5. Three patients had pure soft tissue avulsion distally from the proximal tibia, 1 patient had pure soft tissue avulsion proximally from the inferior patellar pole, and 1 patient with midsubstance tendinous disruption. No associated intra-articular lesions were identified. Suture bridge double row technique, transpatellar suturing, and transosseous suturing through the proximal tibia were used for patellar tendon reinsertion. After a mean follow-up period of 18. 4 weeks (range: 10-30 weeks), patients achieved AROM ranging from 0 to 120° to 0-137° without terminal extension lag. The mean time to return to sports activity was 22 weeks (range: 13-30 weeks). Quadriceps muscle strength was 5/5 at the final follow-up visit in all patients; however, relative muscle atrophy was noted in comparison to the other side in one patient. The mean KSS was 91.8 points (range: 79-100 points) with excellent outcome in 4 patients and good outcome in 1 patient. Patellar tendon rupture is rare in the pediatric population and represents 7% of pediatric patients who sustained acute traumatic injury of the knee extensor mechanism. Ruptures may occur midsubstance, or from proximal or distal insertions. High riding patella is the hallmark diagnostic sign for such injury. Although rare, it is considered a serious injury that necessitates early diagnosis and surgical intervention. Functional range of motion was obtained in all patients with different modalities of treatment. Copyright © 2017 Elsevier Ltd. All rights reserved.

Magnetic resonance imaging evidence of meniscal extrusion in medial meniscus posterior root tear.

PubMed

Choi, Chul-Jun; Choi, Yun-Jin; Lee, Jae-Jeong; Choi, Chong-Hyuk

2010-12-01

The purpose of this study was to evaluate the relation between meniscal extrusion on magnetic resonance imaging (MRI) and tearing of the posterior root of the medial meniscus, as well as to understand the relation between meniscal extrusion and chondral lesions. From January 2007 to December 2008, 387 consecutive cases of medial meniscal tears were treated arthroscopically. Of these cases, 248 (64.1%) with MRI were reviewed. Arthroscopic findings were reviewed for the type of tear and medial compartment cartilage lesion. Root tear was defined as a radial tear in the posterior horn of the medial meniscus near the tibial spine (i.e., within 5 mm of the root attachment). An MRI scan of the knee was used to evaluate the presence and extent of meniscal extrusion. Meniscal extrusion of 3 mm or greater was considered pathologic. Arthroscopic findings were compared with respect to the extent of meniscal extrusion. There were 98 male patients and 150 female patients. The mean age was 53.5 years (range, 15 to 81 years). The results showed 127 cases (51.2%) in which the medial meniscus had meniscal extrusion of 3 mm or greater. Posterior root tears were found in 66 (26.6%) of the 248 knees. The mean meniscal extrusion in patients with root tear was 3.8 ± 1.4 mm, whereas the mean extrusion of those who had no root tear was 2.7 ± 1.3 mm. We found an association between pathologic meniscal extrusion and root tear (P < .001). Meniscal extrusion showed a low positive predictive value (39%) and specificity (58%) with regard to the meniscal root tear. Meniscal extrusion was also significantly correlated with severity of chondral lesions (P < .001). Considerable extrusion (≥3 mm) can be associated with tearing of the medial meniscus root and chondral lesion of the medial femoral condyle. Level IV, therapeutic case series. Copyright © 2010 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

An Early Pennsylvanian threshold for the influence of vegetation on fluvial landscapes, based on the geological record of Atlantic Canada

NASA Astrophysics Data System (ADS)

Gibling, Martin; Ielpi, Alessandro; Bashforth, Arden; Davies, Neil

2015-04-01

Vegetation profoundly influences modern fluvial systems, depending on plant life-history strategies, tolerance to disturbance, and habitat drainage. However, direct evidence for these dynamic relationships is cryptic and has commonly been overlooked in ancient deposits. We report evidence for profound interactions between channels, in situ and transported vegetation in Lower Pennsylvanian formations of Atlantic Canada (~310 Ma), attributed to braided, meandering and fixed-channel (anastomosing) systems. Plant groups include lycopsids that preferred stable wetland settings, disturbance-tolerant calamitaleans, and deeply rooted cordaitaleans (early gymnosperms) that originated in the late Mississippian and colonised both wetland and dryland settings. For the meandering and anastomosing channel deposits, upright vegetation was observed within channel-based bedforms and bars and on channel margins. Lycopsids and calamitalean groves colonized the channel bed and bank-attached bars during periods of reduced flow, nucleating bar growth after flow resumed. Upright lycopsids and cordaitaleans are common along channel cutbanks and are locally tilted towards the channel, implying involvement in bank stabilization. Rhizoconcretions that formed around deep cordaitalean roots may have aided bank reinforcement. Tetrapod and arthropod trackways in the channel deposits indicate a close linkage between riparian and aquatic ecosystems. In the braided systems, sediments that contain abundant cordaitalean logs constitute nearly 20% of channel deposits, and the logs form channel-base lags, fill channels up to 6 m deep, and form nuclei for shallow sandbars. Log accumulations overlain by shale lenses imply a contribution to channel avulsion. Rooted channel-sandstones containing upright trees are interpreted as vegetated islands in an island-braided system. Anastomosing systems are abundant in these Lower Pennsylvanian formations but rare in older strata, and the multi-channel island-braided systems are the oldest yet described. The rise to prominence of these two anabranching styles, broadly coinciding with the rise of cordaitaleans, implies that fluvial landscapes had crossed a threshold from a geomorphic and biogeomorphic mode of operation into a fully ecological mode with feedback loops between vegetation and fluvial processes. Thereafter, patterns of interaction between rivers and vegetation broadly resembled those of today, with prominent riparian corridors and profound consequences for aquatic, soil and other terrestrial ecosystems. Our field observations confirm the co-evolution of river systems, vegetation and animals, and highlight a need to incorporate vegetation more fully into earth-system and landscape models.

[Root resorption after orthodontic treatment: a study of age factor and prevalence in anterior teeth].

PubMed

Tian, Yu-lou; Wang, Kun; Wang, Jing; Liu, Fang; Piao, Mei-ling

2013-04-01

To investigate the impact of age factor on root resorption and the prevalence in anterior teeth during orthodontic treatment. Sixty extraction cases treated with straight wire appliance were divided into adult group and child group, with 30 cases in each group.The panoramic radiographs pre-treatment and post-treatment were examined to measure the degrees of root resorption. A total of 360 anterior teeth in each group were evaluated. SPSS 13.0 software package was applied to perform statistical analysis. There was significant difference in root resorption index before and after treatment(P<0.01). The incidence of root resorption increased remarkably after orthodontic treatment. There was significant difference in the degree of root resorption in two groups (P<0.01). The prevalence of root resorption in anterior teeth was: upper central incisors, upper lateral incisors, lower central incisors, lower lateral incisors, upper canines and lower canines. The root resorption in adult patients are more obvious than child patients. The prevalence of root resorption in anterior teeth is different. Moderate or severe root resorption is prone to happen in upper central incisors or lateral incisors in adult patients.

Late Glacial and Holocene gravity deposits in the Gulf of Lions deep basin, Western Mediterranean

NASA Astrophysics Data System (ADS)

Dennielou, B.; Bonnel, C.; Sultan, N.; Voisset, M.; Berné, S.; Beaudouin, C.; Guichard, F.; Melki, T.; Méar, Y.; Droz, L.

2003-04-01

Recent investigations in the Gulf of Lions have shown that complex gravity processes and deposits occurred in the deep basin since the last Glacial period. Besides the largest western Mediterranean turbiditic system, Petit-Rhône deep-sea fan (PRDSF), whose built-up started at the end of Pliocene, several sedimentary bodies can be distinguished: (1) The turbiditic Pyreneo-Languedocian ridge (PLR), at the outlet of the Sète canyon network, whose activity is strongly connected to the sea level and the connection of the canyons with the rivers. It surface shows long wave-length sediment waves, probably in relation with the turbiditic overspill. (2) An acoustically chaotic unit, filling the topographic low between the PRDSF and the PLR, the Lower Interlobe Unit. Possible source areas are the Sète canyon and/or the Marti Canyon. (3) An acoustically transparent unit, below the neofan, filling the same topographic low, the Western Transparent Unit, interpreted as a debris-flow. Recent sediment cores have shown that this sedimentary is composed of folded, laminated mud, both in its northern and southern fringes. (4) The Petit-Rhône neofan, a channelized turbiditic lobe resulting from the last avulsion of the Petit-Rhône turbiditic channel and composed of two units. The lower, acoustically chaotic facies unit, corresponding to an initial stage of the avulsion, similar to the HARP facies found on the Amazon fan. The upper, transparent, slightly bedded, channel-levee shaped unit, corresponding to the channelized stage of the avulsion. (5) Up to ten, Deglacial to Holocene, thin, fine sand layers, probably originating from shelf-break sand accumulations, through the Sète canyon network. (6) Giant scours, in the southern, distal part of the neofan, possibly linked to turbiditic overflow from the neo-channel, probably corresponding to channel-lobe transition zone features (Wynn et al. 2002). Recent investigations have shown no evidence of bottom current features.

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

USGS Publications Warehouse

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

2005-01-01

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

Late Holocene lowland fluvial archives and geoarchaeology: Utrecht's case study of Rhine river abandonment under Roman and Medieval settlement

NASA Astrophysics Data System (ADS)

van Dinter, Marieke; Cohen, Kim M.; Hoek, Wim Z.; Stouthamer, Esther; Jansma, Esther; Middelkoop, Hans

2017-06-01

Fluvial lowlands have become attractive human settling areas all around the world over the last few millennia. Because rivers kept changing their course and networks due to avulsion, the sedimentary sequences in these areas are archives of both fluvial geomorphological and archaeological development. We integrated geological and archaeological datasets to demonstrate the concurrence of the gradual abandonment of a major Rhine channel (Utrecht, The Netherlands), the development of human habitation in the area, and the interactions between them. The Utrecht case study highlights the stage-wise abandonment of a natural river channel, due to avulsion, coincident with intensifying human occupation in Roman and Early Medieval times (1st millennium AD). The analyses make maximum use of very rich data sets available for the study area and the tight age control that the geo-archaeological dataset facilitates, offering extra means of time-control to document the pacing of the abandonment process. This allows us to quantify change in river dimensions and meander style and to provide discharge estimates for successive stages of the abandonment phase over a 1000-year period of abandonment succession, from mature river to eventual Late Medieval overbuilt canal when the Rhine branch had lost even more discharge. Continued geomorphic development during this period - which includes the 'Dark Ages' (450-1000 AD) - appears to have been crucial in the development of Utrecht from Roman army fortress to Medieval ecclesial centre. The settlement dynamics in and around the city of Utrecht changed during the various phases of abandonment. In the bifurcating network of river branches forming the Rhine-Meuse delta, the main Rhine branch hosted the Roman limes military border and transport route. The Rhine- Vecht bifurcation at Utrecht provided an excellent location to raise a Roman fort. Continued geomorphic activity during abandonment in Early Medieval times was characterised by enhanced overbank sedimentation and shifts in the position of bifurcations. River flooding became more incidental in this stage, and alluvial-ridge occupancy became sensitive to flooding events for several centuries. We conclude by demonstrating that similar human-river interactions during Roman times occurred in several other deltas within the former Roman empire, with differences depending on the position of a settlement within the delta, the overall hydrological situation, and the ability of societies to control the changing environment.

Clinical Management of Two Root Resorption Cases in Endodontic Practice

PubMed Central

2016-01-01

Root resorption is a pathological process involving loss of hard dental tissues. It may occur as a consequence of dental trauma, orthodontic treatment, and bleaching, and occasionally it accompanies periodontal disease. Although the mechanism of resorption process is examined in detail, its etiology is not fully understood. Wide open apical foramen is more difficult to manage and the root canal may often overfill. In this report we present two cases of root resorption and describe means for its clinical management. We conclude that useful measure of a success or failure in managing root resorption is the persistence of the resorption process. It is a clear sign of an active ongoing inflammatory process and shows the clinical need for retreatment. PMID:27648314

Combined effects of photodynamic therapy and irrigants in disinfection of root canals.

PubMed

Susila, Anand V; Sugumar, R; Chandana, C S; Subbarao, C V

2016-06-01

In this study, the combined effects of photodynamic therapy and irrigants in eradicating common endodontic pathogens are evaluated. Roots of 80 extracted single rooted teeth are divided into 2 groups (1) mechanical flushing; (2) antibacterial irrigation. After cleaning and shaping, they are inoculated with either (A) Streptococcus mutans or (B) Enterococcus faecalis and incubated. They are again subdivided and either only irrigated or irrigated and lased. Dentin shavings are taken from root canal walls and cultured. Statistical analysis using One-Way ANOVA and Post-hoc tests are done. The combination eradicated both bacteria. Antibacterial irrigants controlled S. mutans better than PDT (p = 0.041). The combination of PDT and antibacterial irrigation proposed in this study can be used in all primary cases for thorough and reliable disinfection of root canals but may be highly effective in resistant cases like endodontic failures, as E. faecalis is prevalent in such cases. © 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Endodontic Management of the Three-Rooted Mandibular First Permanent Molar: a Case Report.

PubMed

Štamfelj, Iztok

2014-09-01

The distal root of the mandibular first permanent molar (MFPM) contains one or two canals. More rarely, the second/third distal canal is found in a separate root in a distolingual (DL) position - a radix entomolaris (RE). In Caucasians, this occurs in less than 4% of cases, but it is equally important to be aware of this possibility. Careful examination of the preoperative periapical radiographs (orthoradial and mesially angled) and inspection of the pulp chamber floor during endodontic management may indicate that this radicular variant is present. RE's lingual inclination and buccolingual curvature must be taken into account during cleaning and shaping of the canal within this root to avoid procedural errors, such as straightening and ledging of the root canal, perforation or instrument fracture. The aim of the present paper was to discuss a case report of a young patient, referred to an endodontic office after a ledge was created by inappropriate instrumentation of a buccolingually curved RE canal.

Impact of the quality of coronal restoration and root canal filling on the periapical health in adult syrian subpopulation

PubMed Central

Alafif, Hisham

2014-01-01

Background: The purpose of this study was to determine the status of periapical tissues of endodontically treated teeth according to coronal restorations and root canal fillings separately and in concomitant in adult Syrian subpopulation. Methods: 784 endodontically treated teeth from two hundred randomly selected Syrian adult patients were radiographically evaluated. According to predetermined criteria, the quality of coronal restorations and root canal filling of each tooth was scored as adequate or inadequate. The status of periapical tissues was also classified as healthy or diseased. Results were analyzed using Chi-squared test. Results: Adequate coronal restorations were determined in 58.54% of cases which was accompanied with less periapical pathosis than that in teeth with inadequate restorations (P < 0.01). 14% of teeth were restored by posts which showed no significant impact on the periapical tissues health. 18.5% of endodontic treatments were evaluated as adequate with less number of periapical radiolucencies than that of inadequate root canal fillings (P < 0.01). Absence of periapical pathosis was 96.6% in cases with both adequate coronal restorations and root canals fillings. The rate was 88.5% in cases with only adequate root canals fillings, and about 70% in cases with only adequate coronal restorations. When the treatment was inadequate in both coronal and root canals fillings, success rate was only observed in 48.8%. Conclusion: The most important factor with regard to the periradicular tissue health is the quality of root canal filling without neglecting the influence of coronal restoration (regardless of its type). There is a high prevalence rate of periapical pathosis in Syrian subpopulation due to poor dental practice. PMID:25565729

The ability of Reciproc instruments to reach full working length without glide path preparation: a clinical retrospective study.

PubMed

Bartols, Andreas; Robra, Bernt-Peter; Walther, Winfried

2017-01-01

Reciproc instruments are the only contemporary root canal instruments where glide path preparation is no longer strictly demanded by the manufacturer. As the complete preparation of root canals is associated with success in endodontic treatment we wanted to assess the ability and find predictors for Reciproc instruments to reach full working length (RFWL) in root canals of maxillary molars in primary root canal treatment (1°RCTx) and retreatment (2°RCTx) cases. This retrospective study evaluated 255 endodontic treatment cases of maxillary molars. 180 were 1°RCTx and 75 2°RCTx. All root canals were prepared with Reciproc instruments. The groups were compared and in a binary logistic regression model predictors for RFWL were evaluated. A total of 926 root canals were treated with Reciproc without glide path preparation. This was possible in 885 canals (95.6%). In 1°RCTx cases 625 of 649 (96.3%) canals were RFWL and in 2°RCTx cases 260 of 277 (93.9%). In second and third mesiobuccal canals (MB2/3) 90 out of 101 (89.1%) were RFWL with Reciproc in 1°RCTx and in the 2°RCTx treatment group 49 out of 51 cases (96.1%). In mesio-buccal (MB1) canals "2°RCTx" was identified as negative predictor for RFWL (OR 0.24 (CI [0.08-0.77])). In MB2/3 canals full working length was reached less often (OR 0.04 (CI [0.01-0.31])) if the tooth was constricted and more often if MB2/3 and MB1 canals were convergent (OR 4.60 (CI [1.07-19.61])). Using Reciproc instruments, the vast majority of root canals in primary treatment and retreatment cases can be prepared without glide path preparation.

One- versus two-visit endodontic treatment of teeth with apical periodontitis: a histobacteriologic study.

PubMed

Vera, Jorge; Siqueira, José F; Ricucci, Domenico; Loghin, Simona; Fernández, Nancy; Flores, Belina; Cruz, Alvaro G

2012-08-01

This study analyzed the in vivo microbiological status of the root canal systems of mesial roots of mandibular molars with primary apical periodontitis after 1- or 2-visit endodontic treatment. Mesial root canals were instrumented by using either a combination of K3 and LightSpeed instruments (mesiobuccal canals) or the ProTaper system (mesiolingual canals), with 5% NaOCl irrigation. Patency files were used. Smear layer was removed, and a final rinse with 5 mL of 2% chlorhexidine was performed. In the 2-visit group (7 roots, 14 canals), canals were medicated with calcium hydroxide for 1 week and then obturated by using the continuous wave of compaction technique. In the 1-visit group (6 roots, 12 canals), canals were immediately obturated after chemomechanical procedures. Teeth were extracted 1 week after root canal instrumentation and processed for histobacteriologic analysis. In the 1-visit group, no case was completely free of bacteria; residual bacteria occurred in the main root canal (5 of 6 cases), isthmus (5 of 6), apical ramifications (4 of 6), and dentinal tubules (5 of 6). In the 2-visit group, 2 cases were rendered bacteria-free; residual bacteria were found in the main canal only in 2 cases (none of them with persistent dentinal tubule infection), in the isthmus (4 of 7 cases), and in ramifications (2 of 7). The 2 instrumentation techniques performed similarly. When filling material was observed in ramifications, it was usually intermixed with necrotic tissue, debris, and bacteria. The 2-visit protocol by using an interappointment medication with calcium hydroxide resulted in improved microbiological status of the root canal system when compared with the 1-visit protocol. Residual bacteria were more frequent and abundant in ramifications, isthmuses, and dentinal tubules when root canals were treated without an interappointment medication. Apical ramifications and isthmuses were never completely filled. The use of an antibacterial interappointment agent is necessary to maximize bacterial reduction before filling. Copyright © 2012 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

43 CFR 1864.0-5 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... sudden change in alignment of the channel of a river, or by a comparable change in some other body of water, or that remain as uplands following such a change, or that are located in the bed of the new... the banks of a body of water by deposition of water-borne soil. (c) Avulsed lands have the meaning...

43 CFR 1864.0-5 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... sudden change in alignment of the channel of a river, or by a comparable change in some other body of water, or that remain as uplands following such a change, or that are located in the bed of the new... the banks of a body of water by deposition of water-borne soil. (c) Avulsed lands have the meaning...

43 CFR 1864.0-5 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-10-01

... sudden change in alignment of the channel of a river, or by a comparable change in some other body of water, or that remain as uplands following such a change, or that are located in the bed of the new... the banks of a body of water by deposition of water-borne soil. (c) Avulsed lands have the meaning...

43 CFR 1864.0-5 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... sudden change in alignment of the channel of a river, or by a comparable change in some other body of water, or that remain as uplands following such a change, or that are located in the bed of the new... the banks of a body of water by deposition of water-borne soil. (c) Avulsed lands have the meaning...

Posttraumatic eyebrow reconstruction with hair-bearing temporoparietal fascia flap

PubMed Central

Denadai, Rafael; Raposo-Amaral, Cassio Eduardo; Marques, Frederico Figueiredo; Raposo-Amaral, Cesar Augusto

2015-01-01

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

Magnetic resonance imaging of the sacral plexus and piriformis muscles.

PubMed

Russell, J Matthew; Kransdorf, Mark J; Bancroft, Laura W; Peterson, Jeffrey J; Berquist, Thomas H; Bridges, Mellena D

2008-08-01

The objective was to evaluate the piriformis muscles and their relationship to the sacral nerve roots on T1-weighted MRI in patients with no history or clinical suspicion of piriformis syndrome. Axial oblique and sagittal T1-weighted images of the sacrum were obtained in 100 sequential patients (200 pairs of sacral roots) undergoing routine MRI examinations. The relationship of the sacral nerve roots to the piriformis muscles and piriformis muscle size were evaluated, as were clinical symptoms via a questionnaire. The S1 nerve roots were located above the piriformis muscle in 99.5% of cases (n=199). The S2 nerve roots were located above the piriformis muscle in 25% of cases (n=50), and traversed the muscle in 75% (n=150). The S3 nerve roots were located above the piriformis muscle in 0.5% of cases (n=1), below the muscle in 2.5% (n=5), and traversed the muscle in 97% (n=194). The S4 nerve roots were located below the muscle in 95% (n=190). The piriformis muscles ranged in size from 0.8-3.2 cm, with an average size of 1.9 cm. Nineteen percent of patients had greater than 3 mm of asymmetry in the size of the piriformis muscle, with a maximum asymmetry of 8 mm noted. The S1 nerve roots course above the piriformis muscle in more than 99% of patients. The S2 roots traverse the piriformis muscle in 75% of patients. The S3 nerve roots traverse the piriformis muscle in 97% of patients. Piriformis muscle size asymmetry is common, with muscle asymmetry of up to 8 mm identified.

A Review on Root Anatomy and Canal Configuration of the Maxillary Second Molars

PubMed Central

Ghasemi, Negin; Rahimi, Saeed; Shahi, Shahriar; Samiei, Mohammad; Frough Reyhani, Mohammad; Ranjkesh, Bahram

2017-01-01

Introduction: The complexity of the root canal system presents a challenge for the practitioner. This systematic review evaluated the papers published in the field of root canal anatomy and configuration of the root canal system in permanent maxillary second molars. Methods and Materials: All articles related to the root morphology and root canal anatomy of the permanent maxillary second molars were collected by suitable keywords from PubMed database. The exhaustive search included all publications from 1981 to December 2015. The articles relevant to the study were evaluated and data was extracted. The author/year of publication, country, number of the evaluated teeth, type of study (method of the evaluation), number of roots and the canals, type of canals and the morphology of the apical foramen was noted. Results: The highest studied populations were in Brazil and United States. A total of 116 related papers were found, which had investigated 11945 teeth in total. Across all the studied populations, the three-rooted anatomy was most common, while the four-rooted anatomy had the lowest prevalence. The presence of the second mesiobuccal canal ranged from 11.53 % to 93.7%, where type II (2-1) configuration was the predominant type in Brazil and USA and types II and III (1-2-1) in Chinese populations. In 8.8-44% of cases, fusion was observed. The main reported cases were related to palatal root. The major method of anatomical investigation in case reports was periapical radiography, and the chief method in morphological studies was CBCT. Conclusion: The clinicians should be aware of normal morphology and anatomic variations to reduce the treatment failure. PMID:28179915

Open bite as a risk factor for orthodontic root resorption.

PubMed

Motokawa, Masahide; Terao, Akiko; Kaku, Masato; Kawata, Toshitsugu; Gonzales, Carmen; Darendeliler, M Ali; Tanne, Kazuo

2013-12-01

The purpose of the present study was to clarify the prevalence and degree of root resorption induced by orthodontic treatment in patients with and without open bite. One hundred and eleven patients treated with multibracket appliances were retrospectively selected from the patients and divided into non-open bite (NOB) and open bite (OB) groups. The severity of root resorption and the root shape were classified into five groups on periapical radiographs before and after treatment. Moreover, only in the OB group, all teeth were sub-divided into functional and hypofunctional ones that are occluding and non-occluding. As the results of multiple linear regression analysis of patient characteristics and clinical variables with the number of overall root resorption, the independent variables that were found to contribute significantly to root resorption were bite and abnormal root shape. The prevalences of root resorption evaluated in the number of patients were significantly higher in OB group than in NOB group, and those in the number of teeth were significantly higher in OB group than in NOB group, in particular anterior and premolar teeth. The prevalence of resorbed teeth with abnormal root shapes was also significantly higher in OB group than in NOB group. On the other hand, in OB group, the prevalences of root resorption and teeth with abnormal root shape were significantly greater in hypofunctional teeth than in normal functional teeth. There are more teeth with root resorption and abnormal root shape in open bite cases than in normal bite cases, and more teeth with abnormal root shapes and root resorption in hypofunctional teeth than in functional teeth.

Hydraulic Redistribution: A Modeling Perspective

NASA Astrophysics Data System (ADS)

Daly, E.; Verma, P.; Loheide, S. P., III

2014-12-01

Roots play a key role in the soil water balance. They extract and transport water for transpiration, which usually represents the most important soil water loss in vegetated areas, and can redistribute soil water, thereby increasing transpiration rates and enhancing root nutrient uptake. We present here a two-dimensional model capable of describing two key aspects of root water uptake: root water compensation and hydraulic redistribution. Root water compensation is the ability of root systems to respond to the reduction of water uptake from areas of the soil with low soil water potential by increasing the water uptake from the roots in soil parts with higher water potential. Hydraulic redistribution is a passive transfer of water through the root system from areas of the soil with greater water potential to areas with lower water potential. Both mechanisms are driven by gradients of water potential in the soil and the roots. The inclusion of root water compensation and hydraulic redistribution in models can be achieved by describing root water uptake as a function of the difference in water potential between soil and root xylem. We use a model comprising the Richards equation for the water flow in variably saturated soils and the Darcy's equation for the water flow in the xylem. The two equations are coupled via a sink term, which is assumed to be proportional to the difference between soil and xylem water potentials. The model is applied in two case studies to describe vertical and horizontal hydraulic redistribution and the interaction between vegetation with different root depths. In the case of horizontal redistribution, the model is used to reproduce the fluxes of water across the root system of a tree subjected to uneven irrigation. This example can be extended to situations when only part of the root system has access to water, such as vegetation near creeks, trees at the edge of forests, and street trees in urban areas. The second case is inspired by recent agro-ecosystems experiments that combined different vegetation species to increase crop yield. The presence of deep rooted plants (nursing species) near shallow rooted crops (nursed species) enhanced crop growth thanks to vertical and horizontal hydraulic redistribution. The model is able to reproduce the patterns of water redistribution observed in this scenario.

Conservative treatment of a cervical horizontal root fracture and a complicated crown fracture: a case report.

PubMed

Belobrov, I; Weis, M V; Parashos, P

2008-09-01

Abstract This case report describes successful long-term conservative management of a cervical root fracture and a complicated crown fracture of the maxillary central incisors in a 12-year-old patient. A mineral trioxide aggregate partial pulpotomy was performed on the maxillary right central incisor, while the maxillary left central incisor was splinted to the neighbouring lateral incisor using an acid-etch technique. Both teeth remained asymptomatic throughout the 3.5 years of a review period, with the cervical root fracture having mostly healed with the formation of a calcified tissue between the fragments. Two different treatment methods were used for two different injuries that resulted in pulp preservation in both cases. This in turn has provided for normal root development to occur while also allowing for preservation of bone.

Bilateral presence of two root canals in maxillary central incisors: A rare case study.

PubMed

Kavitha, M; Gokul, Kannan; Ramaprabha, B; Lakshmi, Amudha

2014-04-01

Success in root canal treatment is achieved after thorough cleaning and shaping followed by complete obturation of the canal system. Therefore, endodontic therapy requires specific and complete knowledge of the internal and external dental anatomy, and its variations in presentation. The internal anatomy of the maxillary central incisor is well-known and usually presents one root canal system. This case report describes an endodontic treatment of traumatized both maxillary central incisors with two canal systems. Knowledge of dental anatomy is fundamental for proper endodontic practice. When root canal treatment is performed, the clinician should be aware that both external and internal anatomy may be abnormal.

Microbiome in the Apical Root Canal System of Teeth with Post-Treatment Apical Periodontitis

PubMed Central

Siqueira, José F.; Antunes, Henrique S.; Rôças, Isabela N.; Rachid, Caio T. C. C.

2016-01-01

Introduction Bacteria present in the apical root canal system are directly involved with the pathogenesis of post-treatment apical periodontitis. This study used a next-generation sequencing approach to identify the bacterial taxa occurring in cryopulverized apical root samples from root canal-treated teeth with post-treatment disease. Methods Apical root specimens obtained during periradicular surgery of ten adequately treated teeth with persistent apical periodontitis were cryogenically ground. DNA was extracted from the powder and the microbiome was characterized on the basis of the V4 hypervariable region of the 16S rRNA gene by using paired-end sequencing on Illumina MiSeq device. Results All samples were positive for the presence of bacterial DNA. Bacterial taxa were mapped to 11 phyla and 103 genera composed by 538 distinct operational taxonomic units (OTUs) at 3% of dissimilarity. Over 85% of the sequences belonged to 4 phyla: Proteobacteria, Firmicutes, Fusobacteria and Actinobacteria. In general, these 4 phyla accounted for approximately 80% of the distinct OTUs found in the apical root samples. Proteobacteria was the most abundant phylum in 6/10 samples. Fourteen genera had representatives identified in all cases. Overall, the genera Fusobacterium and Pseudomonas were the most dominant. Enterococcus was found in 4 cases, always in relatively low abundance. Conclusions This study showed a highly complex bacterial community in the apical root canal system of adequately treated teeth with persistent apical periodontitis. This suggests that this disease is characterized by multispecies bacterial communities and has a heterogeneous etiology, because the community composition largely varied from case to case. PMID:27689802

Microbiome in the Apical Root Canal System of Teeth with Post-Treatment Apical Periodontitis.

PubMed

Siqueira, José F; Antunes, Henrique S; Rôças, Isabela N; Rachid, Caio T C C; Alves, Flávio R F

Bacteria present in the apical root canal system are directly involved with the pathogenesis of post-treatment apical periodontitis. This study used a next-generation sequencing approach to identify the bacterial taxa occurring in cryopulverized apical root samples from root canal-treated teeth with post-treatment disease. Apical root specimens obtained during periradicular surgery of ten adequately treated teeth with persistent apical periodontitis were cryogenically ground. DNA was extracted from the powder and the microbiome was characterized on the basis of the V4 hypervariable region of the 16S rRNA gene by using paired-end sequencing on Illumina MiSeq device. All samples were positive for the presence of bacterial DNA. Bacterial taxa were mapped to 11 phyla and 103 genera composed by 538 distinct operational taxonomic units (OTUs) at 3% of dissimilarity. Over 85% of the sequences belonged to 4 phyla: Proteobacteria, Firmicutes, Fusobacteria and Actinobacteria. In general, these 4 phyla accounted for approximately 80% of the distinct OTUs found in the apical root samples. Proteobacteria was the most abundant phylum in 6/10 samples. Fourteen genera had representatives identified in all cases. Overall, the genera Fusobacterium and Pseudomonas were the most dominant. Enterococcus was found in 4 cases, always in relatively low abundance. This study showed a highly complex bacterial community in the apical root canal system of adequately treated teeth with persistent apical periodontitis. This suggests that this disease is characterized by multispecies bacterial communities and has a heterogeneous etiology, because the community composition largely varied from case to case.

Peroxidases, lignin and anatomy during in vitro and ex vitro rooting of gardenia (Gardenia jasminoides Ellis) microshoots.

PubMed

Hatzilazarou, Stefanos P; Syros, Thomas D; Yupsanis, Traianos A; Bosabalidis, Artemios M; Economou, Athanasios S

2006-07-01

In vitro and ex vitro rooting of gardenia (Gardenia jasminoides Ellis) microshoots with or without indolic-3-butyric acid (IBA) was studied in order to improve acclimatization of microplants after root formation and transplantation. Peroxidase (POD) activity and isoforms, lignin content and anatomical observations were evaluated in the course of the three interdependent phases (induction, initiation and expression) of microshoot rooting. Microshoots treated or not treated with IBA achieved high rooting percentages both in vitro and ex vitro. At the end of the 2-week acclimatization period, the percentage of surviving microplants ranged from 80% to 100%, for in vitro and ex vitro rooted microshoots, respectively. Microshoots rooted in vitro and ex vitro showed a relationship between rooting and POD activity but in a different time course. It appeared that root formation occurred after the microshoots had reached and passed a peak of maximum enzyme activity. In all treatments, electrophoretic analysis (native PAGE) of PODs revealed the appearance of one anionic and three cationic POD isoforms (C(1), C(3) and C(4)). An additional cationic POD isoform (C(2)) appeared only in the ex vitro rooting. The lignin content was similar in microshoots rooted both in vitro and ex vitro. The sequential anatomical changes during the rooting process were similar in both in vitro and ex vitro rooting treatments. In the case of in vitro rooting, pith cells had vacuoles entirely filled with a dark substance, while in the case of ex vitro rooting, pith cells contained many amyloplasts. The origin of the adventitious roots, in both rooting conditions, was located in the cambial ring. Roots with organized tissue systems emerged from the microshoot stem 10-14 days after the root induction treatments; on day 10 for rooting in vitro, while a 4-day delay was noted in microshoots rooted ex vitro.

Concrescence of permanent maxillary second and third molars: case report of non-surgical root canal treatment.

PubMed

Foran, Denise; Komabayashi, Takashi; Lin, Louis M

2012-03-01

Concrescence is a rare developmental anomaly with an overall incidence of 0.8% in the permanent dentition. While many case reports describe the treatment of concrescence with extraction, there are few reports of non-surgical root canal treatment (NSRCT), due to the atypical root form, canal morphology, and technical difficulties involved in concrescence. This unique case report describes a technical modification of NSRCT that can retain joined posterior maxillary teeth to maintain natural posterior occlusion without surgical intervention or dental implants, thereby avoiding the risk of damage to a large portion of the alveolar bone near the maxillary sinus.

Efficacy of enamel matrix protein applied to spontaneous periodontal disease in two dogs.

PubMed

Watanabe, Kazuhiro; Kikuchi, Masahiro; Okumura, Masahiro; Kadosawa, Tsuyoshi; Fujinaga, Toru

2003-09-01

Enamel matrix protein (EMP) was applied for regeneration of periodontal tissue in 2 dogs with spontaneous periodontal disease. Case 1 had bony resorption around the root and root apex of the maxillary fourth premolars. Case 2 had vertical resorption of bone between the mandibular first and second molars. A flap was formed in the buccal gingiva, and EMP was applied onto the surface of the exposed root. One or 4 months postoperatively, increased bone level and clinical attachment were recognized. EMP was therefore suggested to be effective to induce regeneration of periodontal tissues in the cases with periodontal disease.

Use of piezosurgery device in management of oral surgery complications: clincal case and clinical experience report.

PubMed

Sammartino, G; Riccitiello, F; Trosino, O; Marenzi, G; Cioffi, A; Mortellaro, C

2012-05-01

The root displacement into the maxillary sinus could be a complication of oral surgery in the upper jaw. In these cases, the root removal is needed in order to avoid the occurrence of sinus pathologies. Piezosurgery techniques could assure a safer management of such complications, because of the clear surgical visibility and the selective ability of cut. The aim of this article is to present a case of oral surgery complication (root displacement in the right maxillary sinus), in which piezosurgery technique helped for a correct and safe clinical management, allowing to reduce the soft tissue damage.

Neurotization to innervate the deltoid and biceps: 3 cases.

PubMed

Dy, Christopher J; Kitay, Alison; Garg, Rohit; Kang, Lana; Feinberg, Joseph H; Wolfe, Scott W

2013-02-01

To describe our experience using direct muscle neurotization as a treatment adjunct during delayed surgical reconstruction for traumatic denervation injuries. Three patients who had direct muscle neurotization were chosen from a consecutive series of patients undergoing reconstruction for brachial plexus injuries. The cases are presented in detail, including long-term clinical follow-up at 2, 5, and 10 years with accompanying postoperative electrodiagnostic studies. Postoperative motor strength using British Medical Research Council grading and active range of motion were retrospectively extracted from the clinical charts. Direct muscle neurotization was performed into the deltoid in 2 cases and into the biceps in 1 case after delays of up to 10 months from injury. Two patients had recovery of M4 strength, and the other patient had recovery of M3 strength. All 3 patients had evidence on electrodiagnostic studies of at least partial muscle reinnervation after neurotization. Direct muscle neurotization has shown promising results in numerous basic science investigations and a limited number of clinical cases. The current series provides additional clinical and electrodiagnostic evidence that direct muscle neurotization can successfully provide reinnervation, even after lengthy delays from injury to surgical treatment. Microsurgeons should consider direct muscle neurotization as a viable adjunct treatment and part of a comprehensive reconstructive plan, especially for injuries associated with avulsion of the distal nerve stump from its insertion into the muscle. Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

The effect of complete radial lateral meniscus posterior root tear on the knee contact mechanics: a finite element analysis.

PubMed

Bao, H R C; Zhu, D; Gong, H; Gu, G S

2013-03-01

In recent years, with technological advances in arthroscopy and magnetic resonance imaging and improved biomechanical studies of the meniscus, there has been some progress in the diagnosis and treatment of injuries to the roots of the meniscus. However, the biomechanical effect of posterior lateral meniscus root tears on the knee has not yet become clear. The purpose of this study was to determine the effect of a complete radial posterior lateral meniscus root tear on the knee contact mechanics and the function of the posterior meniscofemoral ligament on the knee with tear in the posterior root of lateral meniscus. A finite element model of the knee was developed to simulate different cases for intact knee, a complete radial posterior lateral meniscus root tear, a complete radial posterior lateral meniscus root tear with posterior meniscofemoral ligament deficiency, and total meniscectomy of the lateral meniscus. A compressive load of 1000 N was applied in all cases to calculate contact areas, contact pressure, and meniscal displacements. The complete radial posterior lateral meniscus root tear decreased the contact area and increased the contact pressure on the lateral compartment under compressive load. We also found a decreased contact area and increased contact pressure in the medial compartment, but it was not obvious compared to the lateral compartment. The lateral meniscus was radially displaced by compressive load after a complete radial posterior lateral meniscus root tear, and the displacement took place mainly in the body and posterior horn of lateral meniscus. There were further decrease in contact area and increases in contact pressure and raidial displacement of the lateral meniscus in the case of the complete posterior lateral meniscus root tear in combination with posterior meniscofemoral ligament deficiency. Complete radial posterior lateral meniscus root tear is not functionally equivalent to total meniscectomy. The posterior root torn lateral meniscus continues to provide some load transmission and distribution functions across the joint. The posterior meniscofemoral ligament prevents excessive radial displacement of the posterior root torn lateral meniscus and assists the torn lateral meniscus in transmitting a certain amount of stress in the lateral compartment.

Generalized Lotka—Volterra systems connected with simple Lie algebras

NASA Astrophysics Data System (ADS)

Charalambides, Stelios A.; Damianou, Pantelis A.; Evripidou, Charalambos A.

2015-06-01

We devise a new method for producing Hamiltonian systems by constructing the corresponding Lax pairs. This is achieved by considering a larger subset of the positive roots than the simple roots of the root system of a simple Lie algebra. We classify all subsets of the positive roots of the root system of type An for which the corresponding Hamiltonian systems are transformed, via a simple change of variables, to Lotka-Volterra systems. For some special cases of subsets of the positive roots of the root system of type An, we produce new integrable Hamiltonian systems.

[Percutaneous treatment of unstable spine fractures - OP video and results from over 300 cases].

PubMed

Prokop, A; Chmielnicki, M

2014-02-01

Minimally invasive surgery for vertebral fractures results in less approach-related morbidity, decreased postoperative pain, and rapid mobilisation of patients. Such procedures can be performed even in elderly patients. However, along with the many advantages, minimally invasive procedures are technically demanding, require sophisticated tools, and there is a learning curve for surgeons. Intraoperative visualisation is often possible only radiologically, and implants are generally much more expensive. Using the data from over 300 unstable vertebral fracture cases treated over the past 3.5 years, we have developed a differentiated treatment concept, depending on the age of the patient and the fracture characteristics. Unstable fractures with involvement of the posterior edge are stabilised from posterior, percutaneously with a fixator. In patients under 60 years, monoaxial screws with inserted rods (top loading) are used, with which distraction and restoration of lordosis are also possible. Patients over 60 years are treated percutaneously with a polyaxial sextant system with rods inserted to avoid avulsion of the pedicle screws from the vertebral body. To avoid cutting through the vertebra, the fenestrated screws can be augmented with cement. The operation technique is demonstrated by a video. Georg Thieme Verlag KG Stuttgart · New York.

[Root resorption associated to orthodontic treatment: a clinical case].

PubMed

Houb-Dine, Afaf; Rerhrhaye, Mariam; Ismaili, Zouheir; Rerhrhaye, Wiam

2011-12-01

Root resorption associated to orthodontic treatment is of multiple etiologies and a non intentional iatrogenic side effect which exists in almost all the orthodontic treatment. This clinical case of an apparently healthy patient illustrates the occurrence during the orthodontic treatment of a root resorption interesting the left central incisor, victims of previous traumatism and presenting a moderate periodontal attachment loss. The orthodontic treatment was carried out with light and continuous forces and a per-orthodontic periodontal maintenance in respect of periodontal requirements. As soon as the root resorption on the left central incisive was diagnosed, the active orthodontic treatment was interrupted in order to stabilize the lesion and a regular clinical and radiological monitoring was established.

Three rooted, four canalled mandibular first molar (Radix Entomolaris).

PubMed

Parolia, Abhishek; Kundabala, M; Thomas, M S; Mohan, M; Joshi, N

2009-01-01

A mandibular first molar with two distal roots is an interesting example of anatomic variation. This paper describes case reports of mandibular first molar with three roots (one mesial and two distal) and four canals (two in mesial and one in each distobuccal and distolingual root). The canals were shaped with protaper rotary files and irrigated with 5.25% sodium hyochlorite, 0.2 %w/v of chlorhexidine gluconate and normal saline as the fi nal irrigant. The canals were then obturated with gutta- percha and AH plus sealer. These case reports show an anatomic variation of internal morphology of the tooth and points out the importance of searching for additional canals.

Properties of multivariable root loci. M.S. Thesis

NASA Technical Reports Server (NTRS)

Yagle, A. E.

1981-01-01

Various properties of multivariable root loci are analyzed from a frequency domain point of view by using the technique of Newton polygons, and some generalizations of the SISO root locus rules to the multivariable case are pointed out. The behavior of the angles of arrival and departure is related to the Smith-MacMillan form of G(s) and explicit equations for these angles are obtained. After specializing to first order and a restricted class of higher order poles and zeros, some simple equations for these angles that are direct generalizations of the SISO equations are found. The unusual behavior of root loci on the real axis at branch points is studied. The SISO root locus rules for break-in and break-out points are shown to generalize directly to the multivariable case. Some methods for computing both types of points are presented.

Radix Distolingualis: A Case Report, Review and Endodontic Treatment Guidelines

PubMed Central

Subbiya, Arunajatesan; Banu, Sherin; Malarvizhi, Dhakshinamoorthy

2017-01-01

Variation in the root and canal morphology of maxillary second molars is quite common. The most common configuration is three roots and three or four canals. But the presence of an additional palatal root is rather uncommon and has been reported to have an incidence of 1.4%. The extra root is located mesiolingual or distolingual to the primary palatal root. This is a unique case report that describes the successful endodontic management of a maxillary second molar with Radix Distolingualis (RDL). Identification of this variation was done through clinical examination, multi-angled radiographs, surgical operating microscope and an accurate assessment of this morphology was made with the help of Cone Beam Computed Tomography (CBCT) imaging. In addition, this article also discusses the literature review, guidelines for diagnosis and treatment of RDL. PMID:28764306

Endodontic Management of Maxillary First Molar With Two Palatal Canals Aided With Cone Beam Computed Tomography: A Case Report.

PubMed

Pamboo, Jaya; Hans, Manoj Kumar; Chander, Subhas; Sharma, Kapil

2017-04-01

The success of endodontic therapy is based on having sufficient endodontic access, correct cleaning and shaping, and adequate root canal obturation. However, endodontic treatment is also dependent on having a sound knowledge of the internal anatomy of human teeth, especially when anatomic variations are present. Reporting these alterations is important for improving the understanding and expertise of endodontists. The aim of this case report is to describe a unique case of maxillary first molar with 2 palatal canals within a single root, as confirmed by cone-beam computed tomography (CBCT) scans. This article also reviews recent case reports of extra palatal root canals in the maxillary first molars and the role of CBCT analysis in successfully diagnosing them.

Subtle Lisfranc Injury: Low Energy Midfoot Sprain

DTIC Science & Technology

2007-09-01

include the plantar fascia , the foot intrinsic muscles and tendons, and the insertions of the anterior tibialis, the posterior tibialis, and the...second additional avulsion fracture (Figure 1F, arrowhead) was noted adjacent to the plantar aspect of the base of the second metatarsal...fragment adjacent to the plantar surface of the base of the second metatarsal (white arrowhead). Discussion The tarsometatarsal articulation, also

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

USGS Publications Warehouse

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

2003-01-01

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

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

PubMed

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

2016-05-01

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

Chemical matricectomy with 10% sodium hydroxide for the treatment of ingrown toenails in people with diabetes.

PubMed

Tatlican, Semih; Eren, Cemile; Yamangokturk, Burcu; Eskioglu, Fatma; Bostanci, Seher

2010-02-01

Treatment of ingrown toenails using chemical matricectomy in patients with diabetes has been difficult, because delayed wound healing, wound infections, and digital ischemia can interfere with the procedure. Chemical matricectomy with 10% sodium hydroxide is an effective treatment for ingrown toenails in a normal population. Investigation of the effectiveness and safety of chemical matricectomy with 10% sodium hydroxide solution for ingrown toenails in patients with diabetes. Thirty patients with diabetes with 40 ingrown toenails and 30 patients without diabetes with 41 ingrown toenails were enrolled in the study. After partial avulsion of the affected edge, germinal matrix was treated for 1 minute with 10% sodium hydroxide. Patients were observed on alternate days until complete healing was achieved and followed for up to 24 months for recurrence. Assessment of the treatment in both groups for complete healing, postoperative pain, tissue damage, drainage, infections, and rate of recurrences revealed no statistically significant difference. The partial avulsion of the affected edge and the treatment of the germinal matrix for 1 minute with 10% sodium hydroxide preceded by matrix curettage is an effective and safe treatment modality for ingrown toenails in people with diabetes.

Experimental river delta size set by multiple floods and backwater hydrodynamics

PubMed Central

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

2016-01-01

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

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

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sochman, Jan, E-mail: jan.sochman@medicon.cz; Peregrin, Jan H., E-mail: jape@medicon.cz; Pavcnik, Dusan, E-mail: pavcnikd@ohsu.edu

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 cavamore » (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.« less