Coynemarsh5726

nterpreting the resultant model-based estimates. Depending on the clinical intent, the improved TCP with higher dose regimens should be weighed against the potential risks for greater toxicity. We encourage future reports to provide full dosimetric data correlated with tumor local control to allow future efforts of modeling pooled data.

Trauma is the leading cause of morbidity and mortality in the pediatric population. However, during the societal disruptions secondary to the coronavirus (COVID-19) stay-at-home regulations, there have been reported changes to the pattern and severity of pediatric trauma. We review our two-institution experience.

Pediatric trauma emergency department (ED) encounters from the National Trauma Registry for a large, tertiary, metropolitan level 1 pediatric trauma center and pediatric burn admission at the regional burn center were extracted for children less than 19 years from March 15th thru May 15th during the years 2015-2020. The primary outcome was the difference in encounters during the COVID-19 (2020) epoch versus the pre-COVID-19 epoch (2015-2019).

There were 392 pediatric trauma encounters during the COVID-19 epoch as compared to 451, 475, 520, 460, 432 (mean 467.6) during the pre-COVID-19 epoch. Overall trauma admissions and ED trauma encounters were significantly lower (p<0.001) during COVID-19ever, the proportion of penetrating and burn injuries increased. Owing to increased stressors and time spent at home, healthcare professionals should keep a high suspicion for abuse and neglect.

Stay-at-home regulations alter societal patterns, leading to decreased overall and blunt traumas. However, the proportion of penetrating and burn injuries increased. Owing to increased stressors and time spent at home, healthcare professionals should keep a high suspicion for abuse and neglect.The objective of this study was to evaluate the replacement of part of the pork from Cuiabana sausage by a brewery by-product on the physicochemical and microbiological properties during storage. Brewery by-product (BW) concentration influenced sausage colouration, with reduced luminosity, L* 52.060 in the 6% (w/w) treatment compared to the 0% treatment controls (L* 63.956). Titratable acidity showed higher (1.162 g/100 g) compared to the 0% treatment controls (1.093 g/100 g) of lactic acid. Proteins and total enzymatic fibers increased, 19.068 and 9.233 g/100 g of sample respectively. It was observed that the by-product did not interfere in the oxidation of the lipids and the best model to describe the oxidation of lipids is Van Bertalanffy model (P less then 0.05). Escherichia coli and Staphylococcus sp. levels were within the prescribed limits and Listeria monocytogenes colonies were observed. The addition of by-products had no interference on the formation of oxidation compounds in the sausage and has increased fiber content.

Joint arthrocentesis is a commonly performed procedure by the emergency physician (EP). Point of care ultrasound (POCUS) has demonstrated promise in identifying joint effusions and guiding arthrocentesis procedures. EP-performed talonavicular joint arthrocentesis has not been previously described in the literature. We present a case in which an isolated talonavicular joint effusion was identified and then subsequently aspirated using POCUS.

A 65-year-old man presented with atraumatic right ankle pain. On arrival, he was noted to have diffuse warmth and edema around the ankle and midfoot. POCUS was performed to evaluate for an ankle joint effusion, which was not present. The ultrasound was then moved distally, where a talonavicular joint effusion was noted. Inflammatory markers were found to be elevated. A magnetic resonance imaging scan revealed an isolated talonavicular joint effusion without additional acute findings. POCUS was then used to perform an arthrocentesis, which revealed monosodium urate crysn isolated talonavicular joint effusion without additional acute findings. POCUS was then used to perform an arthrocentesis, which revealed monosodium urate crystals consistent with an initial episode of gouty arthritis. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS? POCUS provides the EP with an efficient tool to diagnose joint effusions and guide arthrocentesis procedures. The foot is composed of several small joints where ultrasound can be particularly helpful. Similar to the ankle joint, these joints can be afflicted with pyogenic infections and crystalline arthropathies. To our knowledge, we present the first report of EP-performed talonavicular arthrocentesis guided by POCUS. The approach to this joint and technique for arthrocentesis are presented.

Our objective in this work was to compare visual acuity, complication rate, rate of unplanned visits in the month following the procedure, and patient satisfaction between patients who received a corneal transplant as an outpatient or inpatient.

Our work focused on 19 patients (6 inpatients and 13 outpatients), who had undergone unilateral keratoplasty between May 2018 and December 2018. The indications for corneal transplant were keratoconus, Fuchs dystrophy and graft rejection.

All patients who were followed for at least one month had an improvement in their VA. There were on average as many postoperative consultations in the inpatient group as in the outpatient group. Selumetinib in vivo Complications occurred in 77% of inpatients versus 40% of outpatients. The rate of consultations in the month following the operation was similar in both groups. Patients were satisfied with outpatient management.

No similar studies have been conducted to our knowledge. This preliminary work is limited by the small number of patients and questionnaires received and the length of follow-up. The criteria for outpatient care are very important to limit complications. For corneal transplantation, hospitalisation is most often performed with an average stay of 2to 5days. Outpatient management seems, according to our preliminary work, to be able to be extended into more centres without changing the postoperative follow-up or increasing the rate of complications, allowing lower cost and patient satisfaction.

The previous lack of this type of study, as well as the encouraging results of this work, open the way to larger scale prospective comparative as well as medico-economic studies.

The previous lack of this type of study, as well as the encouraging results of this work, open the way to larger scale prospective comparative as well as medico-economic studies.

Requests for cosmetic eyelid surgery are frequent. The surgeon must carry out a complete clinical examination in order to rule out any orbital pathologies responsible for eyelid pockets.

Study of ten patients who have consulted in the oculopalpebral surgery department of La Fondation Ophtalmologique de Rothschild for cosmetic surgery of the eyelid pockets and in whom an underlying pathology was diagnosed.

The clinical examination allows to look for signs of alarms, such as medical history, unilateral involvement, pain and the presence of exophthalmos. These should lead to perform orbital imaging and surgical biopsy if an orbital mass has been identified for histological analysis which will make the diagnosis. We identified four cases of orbital lymphoma, one foreign body granuloma, chronic bilateral dacryoadenitis, sarcoidosis involvement, AAPOX syndrom, cavernous hemangioma, and simple fatty hernia.

These cases shows the importance of not ignoring an underlying orbital pathology before proposing cosmetic surgery for eyelid pockets.

These cases shows the importance of not ignoring an underlying orbital pathology before proposing cosmetic surgery for eyelid pockets.Tractional retinal detachments (TRD) occur as a consequence of various retinal pathologies but is most commonly associated with proliferative diabetic retinopathy (PDR). Monitoring for diabetic eye disease and early identification of TRD are crucial for preventing vision loss.

Pulp and nail atrophy and asymmetry are commonly seen in thumb duplication. In hypoplasia of both digits, conventional reconstruction or Bilhaut-Cloquet procedure and its modifications may not be possible or may lead to a poor cosmetic outcome. The purpose of the study was to review a reconstruction technique with a neurovascular island flap developed to improve the aesthetic and functional results of treatment.

Fourteen patients with thumb duplication aged 8 to 18 months were operated between 2002 and 2013 in our center. All patients had significant hypoplasia and asymmetry of the pulp and nail of the digit planned to be retained. A neurovascular island flap including part of the pulp tissue, nail bed, with or without the associated phalangeal bone, was raised from the planned ablated digit base on its single neurovascular bundle. The nail bed, nail fold, and pulp tissue from the 2 digits were apposed with fine sutures under magnification. All patients were followed to monitor the aesthetic, functional, and radiological outcome.

The mean follow-up period was 7 years, 11 months. Thirteen patients underwent theflap procedure and all flaps survived. In 1 patient, the flap procedure was aborted because the vascular pedicle was not well formed. The nail width and pulp circumference were restored to a similar size as the contralateral thumb.

In selected cases of thumb duplication with significant pulp hypoplasia and nailasymmetry, the neurovascular island flap is a safe and effective means to restore size andsymmetry.

Therapeutic IV.

Therapeutic IV.

This study aimed at finding out the effect of exit height, trajectory and number of pins on the stability of cross and divergent-lateral pins used in the fixation of extension-type, transverse supracondylar humerus fracture (SHF) in children, based on finite element analysis.

Distal humerus model consisting of the ossific nucleus of the capitellum (ONC) and distal cartilage of a 6-year-old boy was developed via three-dimensional finite modeling. Various cross and divergent-lateral pinning models with either two or three pins were simulated on an extension-type, transverse SHF and tested in six loading directions.

Two-cross pins and 2-divergent-lateral pins were more stable against torsional and translation forces respectively, while 3-cross pins were the most stable against all forces. The cross pins exiting at the upper border of the distal metaphyseal-diaphyseal junction (MDJ) had the best stiffness among the 2-cross pins, while the lateral pins with a middle third ONC distal pin provided the best stieral pins with a distal pin going through the middle third of the ONC provides the best mechanical stability against translation forces for these transverse fractures. Three-cross pins however offer the best mechanical stability against both translation and torsional forces. This study offers important clues in the preoperative evaluation and management of extension-type supracondylar fractures in children.

Epidural analgesia is considered the preferred analgesic choice during labour. Post dural puncture headache (PDPH) is considered a potential complication of this analgesic technique and is a frequently hypothesis for any headache occurring after delivery. It is essential that anaesthetists and obstetricians are familiar with other possible differential diagnosis for postpartum headache (PPH).

37-year-old female presented after delivery with intense occipital pulsatile headache associated with neck radiation, nausea and vomiting, hemodynamically stable and normal neurologic physical examination. Abnormalities in thyroid hormone levels were found. CT-scan findings suggested pituitary apoplexy.

There are many differential diagnoses for PPH and some are rarely considered, such as pituitary apoplexy. It is essential to differentiate signs and symptoms of each diagnosis, since many of them overlap.

Not all postpartum headaches are PDPH and the first suspected diagnosis may not always be accurate.

Not all postpartum headaches are PDPH and the first suspected diagnosis may not always be accurate.