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https://www.readbyqxmd.com/read/28345068/how-much-risk-are-emergency-department-patients-willing-to-accept-to-avoid-diagnostic-testing
#1
Jeremy Padalecki, K Tom Xu, Cynthia Smith, Lynn Carrasco, Justin Hensley, Peter B Richman
OBJECTIVES: There is a paucity of research evaluating the risk tolerance of Emergency Department (ED) patients. We hypothesized that a significant percentage of ED patients surveyed would be comfortable with ≥5% risk of adverse outcome if they avoided testing in several hypothetical scenarios. MATERIALS AND METHODS: This was a cross-sectional study of a convenience sample of stable inner-city ED patients. Patients completed a written survey and were asked four closed-answer questions regarding risk tolerance/willingness to refuse a test/procedure, including the following scenarios: #1: LP following CT head; #2 overnight serial troponins for rule out myocardial infarction; #3 CT for possible appendicitis, #4 parent deciding whether child should undergo head CT for low risk head injury...
March 2017: Turkish Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28342925/epidemiology-and-characteristics-of-neurosurgical-conditions-at-mbarara-regional-referral-hospital
#2
Jihad Abdelgadir, Emily R Smith, Maria Punchak, Joao Ricardo Vissoci, Catherine Staton, Alex Muhindo, David Kitya, Lawrence P Park, Michael M Haglund
BACKGROUND: The unmet surgical need, specifically neurosurgical need, in Uganda is significant, yet only two public hospitals currently perform neurosurgery in the country. This study examines the epidemiology and outcomes of neurosurgical conditions presenting to one of 12 regional referral hospitals in Uganda, in an effort to understand the neurosurgical needs of this population. METHODS: The study was conducted at Mbarara Regional Referral Hospital (MRRH), in southwestern Uganda...
March 23, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28338593/clinical-correlates-to-assist-with-cte-diagnosis-insights-from-a-novel-rodent-repeat-concussion-model
#3
Gretchen M Thomsen, Ara Ko, Megan Y Harada, Annie Ma, Livia Wyss, Patricia Haro, Jean-Philippe Vit, Pablo Avalos, Navpreet Dhillon, Noell Cho, Oksana Shelest, Eric J Ley
INTRODUCTION: Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease linked to repetitive head injuries. CTE symptoms include changes in mood, behavior, cognition and motor function, however CTE is only currently diagnosed post-mortem. Using a rat model of recurrent traumatic brain injury (TBI) we demonstrate rodent deficits that predict the severity of CTE-like brain pathology. METHODS: Bilateral, closed skull, mild TBI was administered once per week to 35 WT rats, 8 rats received 2 injuries ('2xTBI'), 27 rats received 5 injuries ('5xTBI') and 13 rats were sham controls...
March 23, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28330802/orofacial-trauma-in-rural-india-a-clinical-study
#4
Sunita Malik, Gurdarshan Singh, Gagandeep Kaur, Sunil Yadav, Hitesh C Mittal
PURPOSE: Orofacial trauma is becoming a leading medical problem worldwide. Most of the studies pertaining to orofacial trauma have been done in urban areas but very little scientific literature is available for rural areas. METHODS: A prospective medical institute-based study of orofacial injury patients was carried out from May 2013 to April 2016 (36 Months). Data regarding incidence, age and sex distribution, causes, types and site of injury, treatment modalities and trauma associated complications were collected and analysed...
February 24, 2017: Chinese Journal of Traumatology, Zhonghua Chuang Shang za Zhi
https://www.readbyqxmd.com/read/28326890/functional-and-molecular-correlates-following-single-and-repeated-rat-closed-head-concussion-indices-of-vulnerability-following-brain-injury
#5
Andrea Mountney, Angela Boutte, Casandra M Cartagena, William J Flerlage, David Johnson, Chanyang Rho, Xi-Chun M Lu, Angela M Yarnell, Sean R Marcsisin, Jason Sousa, Chau Vuong, Victor E Zottig, Lai Yee Leung, Ying Deng-Bryant, Janice Gilsdorf, Frank C Tortella, Deborah A Shear
Closed-head concussive injury is one of the most common causes of traumatic brain injury (TBI). Isolated concussions frequently produce acute neurological impairments; however, individuals typically recover spontaneously within a short time frame. In contrast, brain injuries resulting from multiple concussions can result in cumulative damage and elevated risk of developing chronic brain pathologies, including chronic traumatic encephalopathy (CTE). Increased attention has focused on identification of diagnostic markers that can prognostically serve as indices of brain health after injury, revealing the temporal profile of vulnerability to a second insult...
March 22, 2017: Journal of Neurotrauma
https://www.readbyqxmd.com/read/28325100/lateral-ventricle-attenuates-underlying-traumatic-axonal-injury-after-closed-head-injury-in-the-mouse
#6
James Bouley, Nils Henninger
Using model systems it has been suggested that the lateral ventricles could act as strain relievers and thereby mitigate traumatic axonal injury (TAI) in adjacent tissues by absorbing energy. We describe attenuated TAI at 48 hours after traumatic brain injury within the corpus callosum overlying the lateral ventricle of wild-type C57BL/6 mice subjected to weight-drop closed head injury. Specifically, there was a conspicuous attenuation of TAI beneath the lateral ventricle under the impact center as assessed by beta amyloid precursor protein staining...
March 22, 2017: Journal of Neurotrauma
https://www.readbyqxmd.com/read/28319479/brainstem-evoked-potential-indices-of-subcortical-auditory-processing-after-mild-traumatic-brain-injury
#7
Kathy R Vander Werff, Brian Rieger
OBJECTIVES: The primary aim of this study was to assess subcortical auditory processing in individuals with chronic symptoms after mild traumatic brain injury (mTBI) by measuring auditory brainstem responses (ABRs) to standard click and complex speech stimuli. Consistent with reports in the literature of auditory problems after mTBI (despite normal-hearing thresholds), it was hypothesized that individuals with mTBI would have evidence of impaired neural encoding in the auditory brainstem compared to noninjured controls, as evidenced by delayed latencies and reduced amplitudes of ABR components...
March 17, 2017: Ear and Hearing
https://www.readbyqxmd.com/read/28298170/concussion-induces-hippocampal-circuitry-disruption-in-swine
#8
John A Wolf, Brian N Johnson, Victoria E Johnson, Mary E Putt, Kevin D Browne, Constance J Mietus, Daniel P Brown, Kathryn L Wofford, Douglas H Smith, M Sean Grady, Akiva S Cohen, D Kacy Cullen
Hippocampal-dependent deficits in learning and memory formation are a prominent feature of traumatic brain injury (TBI), however the role of the hippocampus in cognitive dysfunction after concussion (mild TBI) is unknown. We therefore investigated functional and structural changes in the swine hippocampus following TBI using a model of head rotational acceleration that closely replicates the biomechanics and neuropathology of closed-head TBI in humans. We examined neurophysiological changes using a novel ex vivo hippocampal slice paradigm with extracellular stimulation and recording in the dentate gyrus and CA1 occurring at 7 days following non-impact inertial TBI in swine...
March 16, 2017: Journal of Neurotrauma
https://www.readbyqxmd.com/read/28296780/type-iii-monteggia-fracture-with-posterior-interosseous-nerve-injury-in-a-child-a-case-report
#9
Jing Wang, Min Chen, Jiang Du
RATIONALE: Elbow injury in children by improper treatment or a delay of more than 3 weeks could lead to old unreduced Monteggia fracture, which are difficult to manage. Conservative or normal surgical methods usually fail. PATIENT CONCERNS: Herein, we present a 6-year-old boy with sustaining injury approximately 1 month to his left elbow. Activity in his elbow was restricted, and his ability to extend his wrist and fingers was impaired. DIAGNOSES: Type III Monteggia elbow fracture-dislocation consisting of radial head dislocation and malunion of the ulna associated with posterior interosseous nerve palsy were confirmed, which requiring surgical treatment...
March 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28289137/nursery-product-related-injuries-treated-in-united-states-emergency-departments
#10
Christopher E Gaw, Thiphalak Chounthirath, Gary A Smith
OBJECTIVE: The goal of this study was to determine the epidemiology of injuries associated with nursery products among young children treated in US emergency departments. METHODS: Data from the National Electronic Injury Surveillance System were retrospectively analyzed for patients aged <3 years who sustained an injury associated with a nursery product from 1991 through 2011. RESULTS: An estimated 1 391 844 (95% confidence interval, 1 169 489-1 614 199) nursery product-related injuries among children aged <3 years were treated in US emergency departments during the 21-year study period, averaging 56...
March 13, 2017: Pediatrics
https://www.readbyqxmd.com/read/28288551/repetitive-closed-head-impact-model-of-engineered-rotational-acceleration-induces-long-term-cognitive-impairments-with-persistent-astrogliosis-and-microgliosis-in-mice
#11
Huazhen Chen, Abhishek Desai, Hee-Yong Kim
Repeated mild traumatic brain injury (rmTBI) has been identified as a high-risk factor for dementia at a later stage by epidemiology. The animal models to replicate complex features of human rmTBI and/or to evaluate long-term effects on brain function have not been established. In this study, we used a novel Closed-Head Impact Model of Engineered Rotational Acceleration (CHIMERA) to investigate long-term neuropathological and cognitive functional consequences of rmTBI. Adult C57BL/6 male mice were subjected to CHIMERA for three consecutive days 24 h apart...
March 13, 2017: Journal of Neurotrauma
https://www.readbyqxmd.com/read/28284770/point-of-care-ultrasonography-to-assist-in-the-diagnosis-and-management-of-subluxation-of-the-radial-head-in-pediatric-patients-a-case-series
#12
Faruk Güngör, Taylan Kılıç
BACKGROUND: A subluxation of the radial head (SRH) is a clinical condition that commonly occurs in children under 6 years of age. History and physical examination findings typically include a child who presents with an elbow held in extension and with forearm pronation, after having suffered significant longitudinal traction on the arm, or after a fall on an outstretched hand. The diagnosis is often clinically obvious. The injury responds dramatically to closed reduction, and usually no imaging is required...
March 8, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28277415/mortality-risk-stratification-after-traumatic-brain-injury-and-hazard-of-death-with-titrated-hypothermia-in-the-eurotherm3235trial
#13
Peter J D Andrews, Aryelly Rodriguez, Peter Suter, Claire G Battison, Jonathan K J Rhodes, Irene Puddu, Bridget A Harris
OBJECTIVES: Hypothermia reduces intracranial hypertension in patients with traumatic brain injury but was associated with harm in the Eurotherm3235Trial. We stratified trial patients by International Mission for Prognosis and Analysis of Clinical Trials in [Traumatic Brain Injury] (IMPACT) extended model sum scores to determine where the balance of risks lay with the intervention. DESIGN: The Eurotherm3235Trial was a randomized controlled trial, with standardized and blinded outcome assessment...
March 8, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28274861/defining-the-biomechanical-and-biological-threshold-of-murine-mild-traumatic-brain-injury-using-chimera-closed-head-impact-model-of-engineered-rotational-acceleration
#14
Dhananjay R Namjoshi, Wai Hang Cheng, Asma Bashir, Anna Wilkinson, Sophie Stukas, Kris M Martens, Tom Whyte, Zelalem A Abebe, Kurt A McInnes, Peter A Cripton, Cheryl L Wellington
CHIMERA (Closed Head Impact Model of Engineered Rotational Acceleration) is a recently described animal model of traumatic brain injury (TBI) that primarily produces diffuse axonal injury (DAI) characterized by white matter inflammation and axonal damage. CHIMERA was specifically designed to reliably generate a variety of TBI severities using precise and quantifiable biomechanical inputs in a nonsurgical user-friendly platform. The objective of this study was to define the lower limit of single impact mild TBI (mTBI) using CHIMERA by characterizing the dose-response relationship between biomechanical input and neurological, behavioral, neuropathological and biochemical outcomes...
March 6, 2017: Experimental Neurology
https://www.readbyqxmd.com/read/28271364/does-preliminary-optimisation-of-an-anatomically-correct-skull-brain-model-using-simple-simulants-produce-clinically-realistic-ballistic-injury-fracture-patterns
#15
P F Mahoney, D J Carr, R J Delaney, N Hunt, S Harrison, J Breeze, I Gibb
Ballistic head injury remains a significant threat to military personnel. Studying such injuries requires a model that can be used with a military helmet. This paper describes further work on a skull-brain model using skulls made from three different polyurethane plastics and a series of skull 'fills' to simulate brain (3, 5, 7 and 10% gelatine by mass and PermaGel™). The models were subjected to ballistic impact from 7.62 × 39 mm mild steel core bullets. The first part of the work compares the different polyurethanes (mean bullet muzzle velocity of 708 m/s), and the second part compares the different fills (mean bullet muzzle velocity of 680 m/s)...
March 7, 2017: International Journal of Legal Medicine
https://www.readbyqxmd.com/read/28258840/increased-prognostic-accuracy-of-tbi-when-a-brain-electrical-activity-biomarker-is-added-to-loss-of-consciousness-loc
#16
Dallas Hack, J Stephen Huff, Kenneth Curley, Roseanne Naunheim, Samanwoy Ghosh Dastidar, Leslie S Prichep
BACKGROUND: Extremely high accuracy for predicting CT+ traumatic brain injury (TBI) using a quantitative EEG (QEEG) based multivariate classification algorithm was demonstrated in an independent validation trial, in Emergency Department (ED) patients, using an easy to use handheld device. This study compares the predictive power using that algorithm (which includes LOC and amnesia), to the predictive power of LOC alone or LOC plus traumatic amnesia. PARTICIPANTS: ED patients 18-85years presenting within 72h of closed head injury, with GSC 12-15, were study candidates...
February 20, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28252480/delayed-treatment-of-a-neonatal-type-i-monteggia-fracture-dislocation-a-case-report
#17
William R Smith, Scott H Kozin, Dan A Zlotolow
Delayed diagnosis of a Monteggia fracture-dislocation changes a straightforward, treatable injury into a complex problem. Acute neonatal injuries may be missed because of the inability to visualize the unossified skeleton on radiography, interpreted later as 'congenital' dislocations. We report the case of a 14-month-old with a neonatal Monteggia type-I fracture-dislocation secondary to birth trauma, with anterior radial head dislocation and plastic deformation of the ulna. Uniplanar external fixation was used to restore ulnar length and correct angulation, with subsequent radiocapitellar joint closed reduction...
March 1, 2017: Journal of Pediatric Orthopedics. Part B
https://www.readbyqxmd.com/read/28236839/lack-of-eye-discipline-during-headers-in-high-school-girls-soccer-a-possible-mechanism-for-increased-concussion-rates
#18
Joseph F Clark, Hagar T Elgendy-Peerman, Jon G Divine, Robert E Mangine, Kimberly A Hasselfeld, Jane C Khoury, Angelo J Colosimo
The sport of soccer is the fastest growing and most popular sport worldwide. With this growth and popularity, attention needs to be given to this athletic population. Sports related concussions is a topic that has gained attention both in the media and by governmental organizations, with growing initiatives in diagnosis, prevention and treatment. The act of soccer heading is thought to contribute to increased concussion incidence. Current evidence reveals that within the high school soccer athletic population, female athletes incur a higher concussion rate than males...
March 2017: Medical Hypotheses
https://www.readbyqxmd.com/read/28228900/intraneural-hemorrhage-in-traumatic-oculomotor-nerve-palsy
#19
Thomas Sartoretti, Elisabeth Sartoretti, Christoph Binkert, David Czell, Sabine Sartoretti-Schefer
Isolated traumatic oculomotor nerve palsy without internal ophthalmoplegia is a rare condition after closed head trauma. The nerve strain leads to intraneural edema with nerve swelling on T2-weighted magnetic resonance (MR) images and traumatic disruption of the blood peripheral nerve barrier with contrast enhancement on T1-weighted MR images. In this patient, susceptibility-weighted MR imaging allowed the direct visualization of the intraneural hemorrhage after suspected traumatic diffuse neuronal axonal injury...
March 2017: Radiology case reports
https://www.readbyqxmd.com/read/28215852/lingual-nerve-measurements-in-cadaveric-dissections-clinical-applications
#20
Somsak Sittitavornwong, Michael Babston, Douglas Denson, Steven Zehren, Jonathan Friend
PURPOSE: Lingual nerve (LN) injury is quite prevalent despite its long-known anatomic course. The purpose of this study was to accurately predict the LN pathway by identifying and measuring close anatomic landmarks; these measurements should help lessen the incidence of LN injury. MATERIALS AND METHODS: LN dissection was carried out on 15 halved cadaver skulls (total, 28 specimens). RESULTS: On average, the LN position was approximately 7 mm below the alveolar crest at the distal end of the mandibular second molar, 5...
January 26, 2017: Journal of Oral and Maxillofacial Surgery
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