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At least 757 records · Page 42Linked to original sources
PubMed2003

Delayed diagnosis of a false aneurysm after lumbar arterial injury: treatment with endovascular embolization: a case report.

STUDY DESIGN: A case report is presented. OBJECTIVES: To report a case of lumbar artery pseudoaneurysm that was primarily missed, and to discuss therapeutic options. SUMMARY OF BACKGROUND DATA: In the literature, only a few cases of lumbar artery pseudoaneurysms have been reported. The diagnosis is difficult and often delayed, with a sometimes fatal outcome. The treatment is either surgery or endovascular embolization. METHODS: In a patient who survived after a fall from 20 feet (6 m) height, a relatively small retroperitoneal hematoma detected during urgent splenectomy was underestimated. Two weeks later, the underlying laceration of the lumbar artery led to the formation of a pseudoaneurysm, which then ruptured causing a large retroperitoneal hematoma and gradual complete femoral nerve palsy. RESULTS: Complete occlusion of the pseudoaneurysm and progressive regression of the retroperitoneal hematoma were achieved by two stages of endovascular embolization. The size of the hematoma was diminished gradually during a period of 12 months, whereas the femoral nerve has completely recovered. CONCLUSIONS: Traumatic rupture of a lumbar artery is a rare complication of a blunt abdominal trauma. This condition leads to a potentially massive retroperitoneal hemorrhage and shock, or to subsequent pseudoaneurysm formation and delayed retroperitoneal hematoma. This condition can be managed with either surgical or preferably endovascular intervention provided the patient is hemodynamically stable.

Accidental Falls↗
PubMed2000

Surgical management of traumatic thoracic aortic rupture from falling.

A 40-year-male was admitted to our hospital after falling from a four-story height. Thoracic aortic rupture was suspected based on chest roentgenography and helical computed tomography. The patient was in the operating room within 6 hours after admission to the hospital. A median sternotomy with a left thoracotomy in the fifth intercostal space was done after left femoral arterial cannulation. Profound hypothermic circulation arrest with retrograde cerebral perfusion was applied. The site of aortic rupture was the descending aorta, just distal to the origin of the left subclavian artery. There were two areas of rupture within 2 cm of each other. The ruptured aorta was grafted with a 20-mm woven double-velour Hemashield graft. The total circulatory arrest time was 80 minutes and the cardiopulmonary bypass time was 290 minutes. The postoperative course was complicated by prolonged mechanical ventilation support due to pulmonary contusion. The patient was discharged 30 days after surgery without neurologic deficit.

Accidental Falls↗
PubMed2004

After the fall: women's views of fractures in relation to bone health at midlife.

Past research has established the link between low energy fractures and the risk for future fractures. These fractures are potential markers for investigation of bone health, and may be precursors for osteoporosis. In spite of its significant public health burden, including burden of illness and economic costs, many individuals are not aware of the risk factors for and consequences of osteoporosis. This is a study of women aged 40 and older who experienced low energy fractures (e.g., from non-trauma sources and falls from no higher than standing height). We gathered data, using focus group interviews, about their experiences and understanding of the fractures in relation to bone health. Women often attributed the fractures to particular situations and external events (e.g., slipping on ice, tripping on uneven ground), and viewed the fractures as accidents. Women often felt that others are at risk for poor bone health, but believed that they themselves are different from those really at risk. Although the fractures are potential triggers for preventive efforts, few women connected their fracture to future risk. What is perceived by women (and others) as random and an accident is often a predictable event if underlying risk factors are identified. Only when there is more awareness of poor bone health as a disease process and fractures as markers for bone fragility will women, men and health care providers take action to prevent future fractures and established bone disease.

Accidental Falls↗
PubMed2005

Finite element method based stress analysis of zone I and zone II sacral fractures.

BACKGROUND: Sacral bone fractures after direct traumas such as gunshot wounds and blunt sacral traumas are rarely, whereas those occurring after indirect traumas with vertical shear mechanisms ( car accidents or falls) are more frequently seen. METHODS: A cadaver sacrum was modelled 3-dimensionally using finite element software. Left sacroiliac joint was modeled to simulate a 75- kg man falling on one leg from a height of 5 meters. An impact load of 10 kN was transferred to the sacrum via intervertebral disc surface and two facets. Von Mises equivalent stress distribution was estimated. RESULTS: Von Mises stress distribution was calculated for sacral ala (430 MPa), S1 pedicle (225 MPa), and S1 lamina (35 MPa). Stress values were 200 Mpa, 130 Mpa, 105 Mpa, and 55 MPa on ventrolateral, dorsomedial, ventromedial and dorsolateral sides of S1 foramen respectively. Vertical shear injury caused stress distribution to concentrate at sacral ala and S1 pedicle (zone I). Local stress distribution around S1 foramen is concentrated ventrolaterally CONCLUSION: High incidence of zone I sacral fractures and low incidence of neurological deficits could be explained by concentration of stress at sacral ala. Zone II fractures might be due to by transfer of triggered stresses from sacral ala and S1 pedicle to ventrolateral side of S1 foramen.

Accidental Falls↗
PubMed2006

Gender differences in body mass index in rural India are determined by socio-economic factors and lifestyle.

A survey of the nutritional status of women in 6 villages of the Pune district of Maharashtra, India, found young women to have a significantly lower BMI than their male peers. The purpose of this study was to identify social and economic factors associated with this difference in thinness and to explore the behavior in men and women that might underlie these associations. We compared men and women in 90 families in this part of Maharashtra by taking measurements of the height and weight of the married couple of child-bearing age in each family and assessing their social and economic details, fasting practices, and oil consumption. In this agricultural community, women were thinner in joint land-owning families, where the main occupation was farming, than those in nonfarming families. This was not true of men in this type of family. Men in "cash-rich" families had higher BMI than men in families without this characteristic. There was no corresponding difference in women's BMI. We then examined the lifestyles of men and women in a subset of 45 of these families. Women were more likely to work full time in farming than men, to carry the burden of all household chores, to have less sleep, and to eat less food away from home than men. Women fasted more frequently and more strictly than men. Despite identifying significant differences in behavior between men and women in the same household, we did not find a direct link between behavior and BMI. We conclude that being married into a farming family is an important factor in determining the thinness of a woman in rural Maharashtra.

Adult↗
PubMed2005

Comparative analysis of Cystic Fibrosis Registry data from the UK with USA, France and Australasia.

BACKGROUND: Using the UK Cystic Fibrosis Database, we analysed the health of the UK CF paediatric population (UKPP) in terms of their biographical, clinical and infection status and compared outcomes with the US, French and Australasian CF Registries. METHODS: UKPP data were collected for 2,673 patients aged less than 18 years in 2001 and used as a reference base for comparison with the most recent equivalent CF Registry reports. RESULTS: Although differences exist between National CF Registries, all record similar demographic factors and key outcomes. Where plausible comparisons can be made, we report that the UKPP had the oldest median age (15.0 years), the Australasian population had the lowest median age at diagnosis (1.8 months). Approximately, double the expected number of UKPP patients (23% and 19%, respectively) fall below the 10th centile for height and weight with similar outcomes in Australasia. UKPP and French populations had similar proportions with FEV1 >80% predicted (53% and 54%, respectively). CONCLUSION: Each Registry's data systems have developed independently providing a first step towards international comparisons. Standardisation of data collection criteria and definition for national CF Registries is required and we propose a standardised minimum data set, which would facilitate data integration as part of a global Registry for CF.

Adolescent↗
PubMed2003

Interfacial deformation between an impacting water drop and a silicone-oil surface.

Detailed observations have been conducted on the interfacial deformation of a silicone oil surface and a water drop falling on it. Eleven kinds of silicone oils with wide variations of kinematic viscosity, nu(T)=1-10(5) mm(2)/s, have been tested. The oil surface is disturbed by a water drop with a diameter d(L)=3.1 mm, which falls freely on it from a height of 100-1000 mm. Special attention has been directed to the maximum depth of the cavity formed on the oil surface D(M) and to the maximum diameter of the water drop spreading on the oil surface d(M). We have categorized the configurations of the oil cavity into seven patterns, and those of the water drop at the oil-water interface into five patterns. The maximum cavity depth D(M)/d(L) can be well correlated by a dimensionless group Re(TL)We(TL), where Re(TL) is Reynolds number based on d(L) and nu(T) and We(TL) is Weber number with the water density and surface tension of oil. The maximum diameter of the impacting water drop d(M)/d(L) can be correlated by the Reynolds number with a viscosity of water (Re(L)) and the Ohnesorge number (Oh). Moreover, the condition under which the impacting water drop is smashed into pieces has been also examined based on Re(L) and Oh.

Journal Article↗
PubMed2004

Extraskeletal risk factors for fractures of the proximal femur.

Fractures of the proximal femur cause a heavy public health burden, as they are both common and costly. In addition to bone tissue characteristics, several extraskeletal factors influence the risk of proximal femoral fractures: height, femoral neck length, body fat, falls and their many causes, age, gender, ethnicity, geographic area of birth, and level of physical activity. Among these extraskeletal factors, some are amenable to corrective measures that can help to prevent these life-threatening fractures.

Accidental Falls↗
PubMed1981

Effects of the oral angiotensin-converting enzyme inhibitor MK-421 in human hypertension.

1. The effects of the new oral angiotensin-converting enzyme (ACE) inhibitor MK-421 on blood pressure, plasma renin activity, angiotensin-II, aldosterone and converting enzyme activity were assessed in 16 hypertensive patients followed for 6--18 weeks. 2. After an initial titration period, maintenance doses of 2.5--40 mg once daily produced satisfactory blood pressure control in 11 and a partial but significant decrease in the remainder. 3. Treatment was associated with no change in heart rate and no orthostatic hypotension. At 24 h after the first effective dose, blood pressure was still decreased, plasma ACE was suppressed to 16% of the baseline, plasma angiotensin to 58%, aldosterone to 42%, and plasma renin activity was elevated to 228% of the baseline. 4. Magnitude of blood pressure fall was significantly correlated with the height of pretreatment blood pressure but not with baseline levels of plasma renin activity.

Adult↗
PubMed1998

Pulmonary function correlates in the prediction of long-term weight gain in cystic fibrosis patients with gastrostomy tube feedings.

BACKGROUND: Gastrostomy tube feedings have a positive effect on nutritional status and are currently recommended for cystic fibrosis patients who fall below 85% ideal weight for height. However, the impact of pulmonary function at the time of gastrostomy tube placement on long-term nutritional status has not been ascertained. METHODS: We retrospectively evaluated whether nutrition status and/or pulmonary function at gastrostomy tube placement surgery were predictive of subsequent long-term (> or =2 yrs) weight velocity. We identified 21 cystic fibrosis patients (12 male), ages 5-18 years at gastrostomy tube insertion. Patients were divided into two groups according to their weight gain response after 2 years on gastrostomy tube feeding. Responders were defined as having a positive change in weight/age z-score (deltaWAZpost) at 2 years follow-up compared to the 2 year period preceding gastrostomy tube insertion (deltaWAZpre). Nonresponders were defined as having a negative WAZpost. RESULTS: Responders had significantly better FEV1 at surgery (61 +/- 26 [SE] vs. 24 +/- 3 %pred.; p < 0.05). In responders, epsilonWAZpre was -0.37 +/- 0.08 and was -0.46 +/- 0.07 in nonresponders (p-NS). In contrast, AWAZpost was 0.92 +/- 0.11 in responders and -0.40 +/- 0.07 in nonresponders (p < 0.001). Furthermore, a significant correlation between weight/age z-score change and pulmonary function was found when FEV1 <40% predicted (r = 0.88; p < 0.004) whereas no significant correlation was present when FEV1 > or =40% predicted. CONCLUSIONS: We conclude that the long-term nutritional benefit of gastrostomy tube placement is critically dependent on pre-surgical pulmonary function. Our findings suggest that gastrostomy tube insertion in malnourished cystic fibrosis patients should be considered an early intervention rather than one of last resort.

Adolescent↗
PubMed2002

Noncontiguous unstable spine fractures.

STUDY DESIGN: Evaluation of 1054 patient charts and 100 random roentgenogram charts as well as clinical investigation of 39 patients. OBJECTIVES: Noncontiguous unstable spine fractures are rare, easy overlooked, and difficult to treat. The purpose of the study was to evaluate the delay in diagnosis and clinical and radiologic outcome of these fractures. SUMMARY OF BACKGROUND DATA: Noncontiguous spine fractures are reported in about 1.6-16.7% in the literature. In most of the studies stable fractures, which did not need any special treatment, were also included. Therefore, in this study only unstable fractures requiring treatment were reinvestigated. METHODS: A total of 1054 patients with fractures of the spine were treated over a period of 14 years in the spinal cord injury unit and retrospectively reviewed; 141 (13.4%) of the patients had multiple fractures, but only 39 (3.7%) had a noncontiguous spine fracture, most frequently from a fall or jump from a greater height, or traffic accidents. RESULTS: Thirty patients (76.9%) had all fractures diagnosed at the first examination. Nine patients (23.1%) had a delayed diagnosis of the secondary lesion, but this delay resulted in no neurologic deterioration. A total of 32 extraspinal injuries were diagnosed and treated 14 times surgically. Loss of correction was seen after surgical treatment (n = 21), and increasing deformity occurred after conservative treatment (n = 18). The neurologic deficit improved in 10 conservatively (4) and operatively (6) treated patients and deteriorated in one patient after surgery. CONCLUSION: A delayed diagnosis of the second fracture was frequently seen without clinical consequences, and neurologic improvement occurred after conservative and operative treatment. Surgical treatment resulted in significantly earlier mobilization and less kyphotic deformity.

Adolescent↗
PubMed1985

Two years' experience with laser trabeculoplasty.

A series of 115 argon laser trabeculoplasties on 109 eyes in 84 patients over a two-year period is reviewed. Control of glaucoma was achieved in 85%. There was correlation of a greater fall in intraocular pressure with initial height of intraocular pressure and degree of pigmentation of the angle. Gonioplasty proved an effective means of treating cases with a narrowed angle to gain access to the trabecular meshwork.

Acetazolamide↗
PubMed1990

Results of surgical treatment of severe vesicoureteric reflux. Retrospective study of reflux grades 4 and 5.

A series of 80 children underwent surgery in the Sophia Children's Hospital for gross reflux grades 4 and 5. In this retrospective study the success rate for ureteric reimplantation was 90%. Analysis of growth showed that after surgery the children tended to fall within the normal ranges for height and weight. Deterioration in renal function was progressive in 3 children. New renal scars developed in 13% of renal units. Initially non-refluxing kidneys showed no further deterioration. Moderate hypertension was found in only 4 patients.

Adolescent↗
PubMed1984

Periovulatory changes in steroid C17,20-lyase activity in ovaries of immature rats treated with pregnant mare serum gonadotropin.

It has been established that the effect of LH on ovarian steroid formation results initially in a rise of overall steroid production, which 2-4 h later is followed by a decrease in the formation of C19-steroids. To determine the reason for this decrease, the course of 17 alpha-hydroxyprogesterone (17 alpha-OHP) metabolism in immature rat ovaries (10,000 X g supernatant) stimulated to ovulate with pregnant mare serum gonadotropin (PMSG) was investigated. Employing optimal conditions the C17,20-lyase was estimated from the formation of androstenedione from 17 alpha-OHP as substrate. The Michaelis-Menten constant Km was 61 +/- 4 microM and V varied according to the time after PMSG administration. The initial activity at 0 h was 340 pmol min-1 mg-1 protein. It decreased 48 h after PMSG to 160 pmol, followed by a slight rise at 54 h and followed by a 60% fall at 57 h, at the height of the LH-surge. The activity declined to undetectable levels at 60 and 64 h (8 h before ovulation) and remained undetectable after ovulation at 72 and 96 h after PMSG. The enzymes 5 alpha-reductase and 20 alpha-hydroxysteroid dehydrogenase were estimated from the formed 3 alpha, 17 alpha-dihydroxy-5 alpha-pregnan-20-one and 17 alpha, 20 alpha-dihydroxy-4-pregn-en-3-one, respectively. In the unstimulated ovary the 5 alpha-reductase was 405 pmol; it decreased to 110 pmol 48 h after PMSG and continued to decrease. The 20 alpha-hydroxysteroid dehydrogenase activity which was undetectable in untreated rats, rose to 330 pmol 60 h after PMSG, 8 h before ovulation. The changes in enzyme activities when tracer amounts of [3H] 17 alpha-OHP were used agreed with the pattern of kinetic studies. From these incubations eight metabolites were isolated, one of them, 5 alpha-pregnane-3 alpha,17 alpha, 20 alpha-trioi, has not been previously identified. It is concluded that the decrease in C17,20-lyase activity limit the formation of C19-steroids in preovulatory follicles shortly before ovulation.

Aldehyde-Lyases↗
PubMed1992

[Isolated rupture of the external iliac vein in indirect blunt injuries].

The authors described an in this country hitherto unpublished observation of an isolated rupture of the external iliac vein following the fall of a patient from a height on her left side. The rupture developed most probably as a result of narrowing of the external iliac vein which crosses the left internal iliac artery. A mechanism of acute expansion of the external iliac vein due to a blast wave of venous blood expelled by an impact on the thigh and recoiled from the impediment at the site of crossing with the internal iliac vein was probably involved. After severing of the compressing artery, thrombectomy and suture of the lesion, the patient recovered ad integrum.

Adult↗
PubMed2003

Visual outcome of pressurised bottled drinks related eye injuries in Ibadan.

Records of 15 patients presenting with pressurised bottled drinks related eye injuries between January 1996 and 2001 were reviewed to identify factors contributing to accidental eye injuries from pressurised bottled drinks, reason for poor outcome and to make recommendations. In all, 16 eyes of 15 patients were studied out of which 7 were males (M:F, ratio 1:1.1). Age range, 3 years-49 years, mean 23.6 years. The majority of those affected were students 46.7%, and traders 26.7%. The commonest activity leading to injury was explosion during the process of arranging the bottles or crates of drinks (43.8%) and accidental fall of bottle from hand or height (37.5%). Drinks implicated include, Coca-cola 50%, beer 25%, others (Fanta, Legend stout, Mirinda, Grape juice) 25%. Complications arising from the injury included, hyphema 43.8%, vitreous haemorrhage 12.5%, and retinal detachment 12.5%. The globes were retained in 12 (75%) cases, 3 defaulted and one eye became phthisical. The final visual acuity was 6/18 or better in 25%, between 6/24 and 6/60 in 12.5% and less than 6/60 in 31.3%. The final visual acuities of three patients who were lost to follow up were unknown. Reason for poor visual outcome include severity of injury with resultant serious complications, and delay with instituting surgical treatment. Eye injuries resulting from exploding bottled drinks are potentially very serious and therefore best prevented. It is recommended that conversion of bottled drinks to canned or plastic containers be considered by the manufacturers. Greater care should be taken with the handling of bottled drinks by the sellers, factory workers and consumers. High risk occupations such as bottled drink sellers and factory workers may need to wear protective goggles during handling. Public health education on need to seek prompt and proper treatment as well as need for Government to institute the National health insurance scheme to cater for indigent patients.

Adolescent↗
PubMed2005

Unusual mechanism of Chance fracture in an adult.

Flexion-distraction injuries of the upper lumbar spine typically occur in case of a head-on motor vehicle collision, while wearing a lap seat belt without shoulder strap. According to Smith and Kaufer the axis of flexion is situated at the point of contact of the belt with the abdominal wall. This results in a horizontal separation of the anterior, middle and posterior columns. The lesion is called a Chance fracture when it involves primarily bone, rather than ligaments. However, a Chance fracture can happen in unbelted persons: the present case concerns a 30-year-old man who fell from a height.

Accidental Falls↗