Incidence of intracranial injury in orbital wall fracture patients not classified as traumatic brain injury

Publication date: Available online 24 February 2018
Source:Injury
Author(s): Hyung-Joo Lee, Youn-Jung Kim, Dong-Woo Seo, Chang Hwan Sohn, Seung Mok Ryoo, Shin Ahn, Yoon-Seon Lee, Won Young Kim, Kyoung Soo Lim
ObjectiveThe detection of intracranial injury in patients with facial injury rather than traumatic brain injury (TBI) remains a challenge for emergency physicians. This study aimed to evaluate the incidence and risk factors of intracranial injury in patients with orbital wall fracture (OWF), who were classified with a chief complaint of facial injury rather than TBI.MethodsThis retrospective case-control study enrolled adult OWF patients (age ≥ 18 years) who presented at the hospital between January 2004 and March 2016. Patients with definite TBI were excluded because non-contrast head computed tomography (CT) is recommended for such patients.ResultsA total of 1220 patients with OWF were finally enrolled. CT of the head was performed on 677 patients, and the incidence of concomitant intracranial injury was found to be 9% (62/677). Patients with definite TBI were excluded. Symptoms raising a suspicion of TBI, such as loss of consciousness, alcohol intoxication, or vomiting, were present in 347 of the patients, with 44 of these patients (13%) showing a concomitant intracranial injury. Of the 330 patients without such symptoms, 18 (6%) demonstrated a concomitant intracranial injury. In OWF patients, superior wall fracture (odds ratio [OR], 4.15; 95% confidence interval [CI], 2.06–8.34; P < 0.001), associated frontal bone fracture (OR, 4.38; 95% CI, 2.08–9.23; P < 0.001), and older age (decades) (OR, 1.03; 95% CI, 1.01–1.04; P = 0.002) were independent risk factors for concomitant intracranial injury.ConclusionsEmergency physicians should maintain a high degree of suspicion of TBI, even when their primary concern is facial trauma with OWF. Head CT is recommended for OWF patients with a superior OWF, frontal bone fracture, or increased age.



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Blood vessel occlusion with erythrocyte aggregates causes burn injury progression: microvasculature dilation as a possible therapy

Abstract

Other than radiation, caustic strong alkali insults, and massive over-reactive inflammation (pyoderma gangrenosum), injury progression after trauma is usually secondary to ischemia from decreased blood vessel perfusion. Impeded blood flow contributes to injury progression in a variety of disorders including venous stasis ulcers, arterial ulcers, diabetic ulcers, flap and graft necrosis, sickle cell disease, cryoglobulinemia and other vasculopathies, vasculitis, post-myocardial infarction, and post stroke. The cause of impeded blood flow in these disorders/diseases is well known.

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Comparison of cyclic fatigue resistance and bending properties of two reciprocating nickel-titanium glide path files

Abstract

Aim

To compare the cyclic fatigue resistance and bending properties of R-Pilot and WaveOne Gold (WOG) Glider files, at intracanal temperature (35°C).

Methodology

Forty R-Pilot and 40 WOG Glider files were subjected to a cyclic fatigue resistance test (n = 20), calculating the time to fracture (TTF) in an artificial stainless-steel canal. The length of the fractured file tips (FL) was also measured. The fracture surface of fragments was examined with a scanning electron microscope and the cross-sectional area of the fractured surfaces were measured. Flexibility of the tested files (n = 20) was determined by 45° bending test. Data were analyzed statistically using the Mann-Whitney U test at 5% significance level.

Results

Time to fracture value was found to be significantly higher in the R-Pilot group compared to the WOG Glider (P < 0.05). There was no significant difference between groups according to the fracture length. The bending resistance of R-Pilot files was significantly higher than WOG Glider files (P < 0.05).

Conclusions

A significant greater cyclic fatigue resistance was observed for R-Pilot files compared to WOG Glider instruments, although the bending resistance of WOG Glider files was lower.

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Prevalence of vertical root fractures in teeth planned for apical surgery. A retrospective cohort study

Abstract

Aim

To evaluate retrospectively the prevalence of vertical root fractures (VRF) in a cohort of patients during apical surgery and the factors possibly associated with VRF.

Methodology

The sample consisted of 944 root filled teeth belonging to 768 patients (49.3% males and 50.7% females; mean age 43.5±11.2 years, range 22-68 years), consecutively referred for endodontic surgery over a six-year period. All patients underwent a clinical assessment of their signs and symptoms. Periapical radiographs of teeth that were candidates for endodontic surgery were taken. Sixty-eight teeth with VRF were identified. Vertical root fractures were identified in pre-surgical screenings in 32 cases (47.1%) and these did not undergo surgery. Another 36 cases of VRF were noted during the intervention for root-end resection. The influence of posts, post type, tooth type, periodontal probing defects, spontaneous pain, sinus tract, and follow-up duration was assessed using a logistic regression analysis.

Results

Vertical root fractures occurred significantly more frequently (P<0.001) when a post was present (61 VRF out of 377 teeth with post, prevalence 16.2%) than in teeth without a post (1.2%). Threaded posts and cast posts were significantly more involved in VRF than fibre, silica or carbide posts (P<0.001). Most fractures (80.9%) occurred 1 to 5 years after root canal treatment. Sinus tracts, probing defects and spontaneous pain were significantly more associated with VRF cases than with non-fractured teeth.

Conclusions

In the present group of teeth, the major risk for VRF was represented by posts retained by actively engaging the canal via mechanical design (thread), or by frictional fit (cast).

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Higher than reported adolescent and young adult clinical trial enrollment during the “Golden Age” of melanoma clinical trials

Abstract

Clinical trial enrollments in adolescents and young adults (AYA) with cancer have historically been lower than those in pediatric and older adult populations. We sought to examine therapeutic trial enrollment rates at our cancer center. We performed a retrospective evaluation of AYA patients treated before and after the first checkpoint inhibitor trial opened at our cancer center in 2007. We examined gender, stage at presentation and insurance status in terms of trial enrollment. We compared the trial participation rate of AYA patients with that of older adults. In this adult facility, 12.7% (1,831) of total patients were between age 15 and 39. Overall therapeutic clinical trial rate was 17.6% which increased to 19.8% since 2007. Both nodal disease or metastatic disease at presentation was associated with increasing odds of trial enrollment (OR = 5.36 and P < 0.001 for nodal disease and OR = 7.96 and P < 0.001 for metastatic disease). There was a nonstatistically significant trend toward improved 3-year overall survival in the AYA patients with advanced presentation that enrolled on clinical trials compared with those not enrolled on trials since 2007. AYA clinical trial enrollment at a comprehensive care center melanoma program was higher than reported in the literature overall for AYA patients. This 1,831 patient cohort may provide a foundation for more detailed investigation toward quantifying the effects of clinical trial enrollment in terms of age-specific benefits and toxicities for AYA patients with malignancies that have their peak incidence in older adults.

Adolescents and young adult (AYA) patients have had lower clinical trial accruals over the past few decades and this has led to fewer survival benefits when comparing these patients to children and older adults with cancer. Here we report nearly 1 out of 5 AYA melanoma patients enrolled on trials during the past decade when these trials improved survival substantially.

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Humoral immune responses to infection: common mechanisms and unique strategies to combat pathogen immune evasion tactics

Ismail Sebina | Marion Pepper

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“The pen is mightier than the sword” – suicidal trans-orbital intracranial penetrating injury from a pencil

Abstract

A 40-year-old drug addict, who was being treated with methadone and occupational therapy, committed suicide by striking a wooden pencil into his right eye socket. While still conscious, he hit his head hard against a table, jamming the pencil even deeper into his head. The autopsy showed that the pencil missed the globe and lodged in the inner part of the right eye socket. It pierced the orbital part of the right ethmoid bone, the right ethmoid cells, and the right superior nasal concha, then passed through the body of the sphenoid bone and the clivus of the occipital bone before stopping in the brain tissue. The basilar artery was transected at the pontomedullary junction, where the tip of the pencil had lodged. Also, at the pontomedullary junction, an approximately 3 mm deep laceration of the brainstem was evident together with flecks of green paint. Histological examination revealed that laceration at the pontomedullary junction was even deeper than the macroscopic appearance had suggested, with several small lateral cracks, focal deep hemorrhage, and disruption of both gray and white matter of the brainstem. Fragments of cellulose originating from the wooden pencil could also be clearly distinguished. Toxicological analysis was performed using liquid chromatography with mass spectrometry, and it showed traces of methadone in the blood and humor vitreous samples. The cause of death was damage to the vital structures in the brainstem, resulting from a penetrating injury to the head by a pencil. Herein, we present a self-inflicted trans-orbital penetrating injury by a non-missile, low-velocity object – a pencil, with a rather unusual, immediately incapacitating outcome.

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