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Eur Arch Otorhinolaryngol. 2000;257(8):449-52.
Infraorbital nerve recovery after minimally dislocated facial fractures.
Peltomaa J, Rihkanen H.
Department of Otolaryngology, Head, and Neck Surgery, Helsinki University Hospital, Finland.
There is evidence that rigid fixation of zygomaticomaxillary suture enhances the recovery of the infraorbital nerve compared with other means of surgical treatments. There is, however, no agreement as to whether any surgery decreases the number of sensory disturbance in cases with little or no dislocation, or whether infraorbital numbness alone should be considered an indication for surgery. An operation may even increase the edema and hemorrhage around the nerve. This retrospective study was carried out among patients with infraorbital hypesthesia but little or not at all dislocated midfacial fractures. Two special types of trauma patients were selected; those with a blow-out fracture but an intact infraorbital rim (BO) and those with a zygomaticomaxillary complex fracture (ZMC). A questionnaire was sent to the patients (n = 226) 2.2 years (mean) after the accident. There were 128 responses (BO n = 41, ZMC n = 87). Of these, 27 BO and 29 ZMC patients had been treated by observation. An orbital exploration had been carried out in 14 BO patients, and 58 ZMC patients had received malar bone elevation without rigid fixation. At the end of the follow-up period nontreated patients had fewer symptoms than those who had had surgery. This was clearer in the ZCM group (symptom free 69% vs. 52%) than in the BO group (69% vs. 50%). The differences between surgically and nontreated BO or ZMC patients, however, were statistically nonsignificant. According to our findings, exploration of the orbital floor or an attempted elevation of a minimally or nondislocated fracture of the ZMC does not enhance the recovery of the infraorbital nerve. On the contrary, the procedure may itself increase the morbidity and sensory dysfunction. Further studies are needed to determine whether the results could be improved by selective decompression of the infraorbital nerve and a rigid fixation.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11073197&dopt=Abstract hemorrhage
Forensic Sci Int. 2001 Jan 15;115(3):189-97.
Brain injury after survived gunshot to the head: reactive alterations at sites remote from the missile track.
Oehmichen M, Meissner C, Konig HG.
Department of Legal Medicine, Medical University of Lubeck, Kahlhorststrasse 31-35, D-23562, Lubeck, Germany. oehmicmed.mu-luebeck.de
Gunshot wounds to the brain usually lead to acute respiratory arrest or death after a brief survival period, even in cases involving only slight direct tissue damage. It can be assumed therefore that the damage extends beyond the zone of recognizable destruction and hemorrhages. To determine the true extent of the tissue injury resulting from gunshot wounds to the brain, we carried out microscopic investigations for reactive changes (emigration of leukocytes and macrophages, axonal expression of beta-amyloid precursor protein (beta-APP) in 10 cases of gunshot wound to the narrow channel of the brain with survival times >2h. Demonstration of leukocytes expressing naphthol AS-D chloroacetate esterase activity in the brain tissue at the border of the missile track established the vitality of the gunshot effect. The presence of macrophages (CD68-epitope) allowed demarcation of a 1-2mm wide necrotic zone around the permanent cavity. Within this zone and beyond, beta-APP showed an initial increase followed by a decline in the number of injured axons. Three types of beta-APP positive staining could be differentiated. In the immediate vicinity of the missile track beta-APP positive neurons were present at a distance of 2-4mm from the margin of the permanent cavity (type 1) as a result of primary injured neuronal tissue by the gunshot itself. At longer distances from the narrow channel and the permanent cavity single beta-APP positive axons or axon fragments and two additional types were found; type 2 shows a parallel, wave-like arrangement of the damaged fibers, which suggests that the injury was produced by mechanical acceleration of the brain tissue created by the energy the projectile expended within the brain; irregular aggregation of beta-APP positive axons or axon fragments within a local edema represents type 3, which may be attributed to secondary ischemia or edema.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11074174&dopt=Abstract hemorrhage
J Emerg Med. 2000 Nov;19(4):347-9.
Massive hemoperitoneum due to rupture of a retroperitoneal varix.
Kosowsky JM, Gibler WB.
Department of Emergency Medicine and Center for Emergency Care, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
Intra-abdominal hemorrhage from ruptured varices is an unusual, life-threatening complication of portal hypertension. We present the case of a 58-year-old man with alcoholic cirrhosis who presented with increasing abdominal girth, hypovolemic shock, and profound anemia due to rupture of a retroperitoneal varix into the peritoneal cavity. The clinical presentation of this rare problem is remarkably consistent among published reports. Early recognition may help the treating physician reduce the likelihood of a catastrophic outcome.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11074328&dopt=Abstract hemorrhage
Lasers Surg Med. 2000;27(4):319-28.
Liver repair and hemorrhage control by using laser soldering of liquid albumin in a porcine model.
Wadia Y, Xie H, Kajitani M.
Oregon Medical Laser Center, Providence St. Vincent Medical Center, Portland, Oregon 97225, USA. yasminwadiahoo.com
BACKGROUND AND OBJECTIVE: We evaluated laser soldering by using liquid albumin for welding liver injuries. Major liver trauma has a high mortality because of immediate exsanguination and a delayed morbidity from septicemia, peritonitis, biliary fistulae, and delayed secondary hemorrhage. STUDY DESIGN/MATERIALS AND METHODS: Eight laceration (6 x 2 cm) and eight nonanatomic resection injuries (raw surface, 6 x 2 cm) were repaired. An 805-nm laser was used to weld 50% liquid albumin-indocyanine green solder to the liver surface, reinforcing it with a free autologous omental scaffold. The animals were heparinized and hepatic inflow occlusion was used for vascular control. All 16 soldering repairs were evaluated at 3 hours. RESULTS: All 16 laser mediated liver repairs had minimal blood loss as compared with the suture controls. No dehiscence, hemorrhage, or bile leakage was seen in any of the laser repairs after 3 hours. CONCLUSION: Laser fusion repair of the liver is a reliable technique to gain hemostasis on the raw surface as well as weld lacerations. 2000 Wiley-Liss, Inc.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11074508&dopt=Abstract hemorrhage
Am J Hematol. 2000 Dec;65(4):285-8.
Utilization and outcomes of enoxaparin treatment for deep-vein thrombosis in a tertiary-care hospital.
Gilbert KB, Rodgers GM.
Office of Performance Monitoring and Improvement, The University of Utah Health Sciences Center, Salt Lake City, Utah 84132, USA.
The availability of a low-molecular-weight heparin, enoxaparin, to treat deep-vein thrombosis (DVT) offers the option for outpatient therapy for certain DVT patients. We monitored the utilization and outcomes of enoxaparin treatment for DVT in our tertiary-care hospital. A retrospective chart survey was performed for all DVT patients treated at our facility between October 1998 and September 1999. We tracked treatment received (unfractionated heparin or enoxaparin), clinical outcomes (recurrent thromboembolism or bleeding), and whether the patient would have met practice guideline criteria for outpatient enoxaparin therapy. A total of 266 patients were either admitted to the hospital for DVT or experienced DVT during their hospitalization. Of 266 DVT patients, 73 (27%) received enoxaparin. Sixty-four (88%) patients receiving enoxaparin met practice guideline criteria. Nine patients (12%) who did not meet criteria also received the drug. Major bleeding occurred in 3 patients (4%) receiving enoxaparin; one patient had a life-threatening hemorrhage. Two of the three patients with major bleeding had contraindications to enoxaparin use. Only 45% of our DVT patients were appropriate candidates for outpatient enoxaparin therapy. We conclude that in tertiary-care hospitals with acutely ill patients, most DVT patients will not be candidates for outpatient therapy with enoxaparin. Limitations to enoxaparin use are not widely appreciated. 2000 Wiley-Liss, Inc.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11074554&dopt=Abstract hemorrhage
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How long can hair grow before it stops growing eventually if it does?
Given that the hair growth rate is quite uniform and constant, somewhere between 0.3-0.5 millimeters per day, it's believed that the length of anagen, the growth phase, differs among individuals, and this is the major determinant to the maximum hair length. For some individuals, anagen may last ten years. Of course the length of the anagen is governed by genes, and the genetic background of the individuals. Non-genetic factors such as nutritional condition, weather, seasonal changes (hair may grow a bit faster during winter), taking medications, health condition may of course influence the rate of
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The shape of the hair, straight or curly, is dependent on the shape of the follicle. A circular or round hair follicle would generate straight hair, while the follicle with oval or elliptical shapes (in its cross-section) would produce a curly hair.
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