An explanation of renal hemodynamics in acute renal failure based on sequential CT in patients with Korean hemorrhagic fever

The pattern of renal enhancement and washout of contrast medium was observed on sequential follow-up CT in 12 patients with Korean hemorrhagic fever, in which acute renal failure is one of the most important clinical features. Renal contrast enhancement and contrast medium washout were delayed longer in patients with severe oliguric renal failure. The delayed washout peaked at 4-5 days and did not return to normal until 8-9 days in the patients with severe oliguria; in the patients without severe oliguria the times were 1-2 days and 3-4 days, respectively. A characteristic "cart-wheel" pattern was observed during the washout stage in patients without severe oliguria. This "cart-wheel" pattern of washout is thought to result from relief of vasoconstriction and repair of tubular function. Multifocal "wedge-shaped" nonenhanced areas of the kidney, seen on the 2 week follow-up postcontrast CT, are thought to be ischemic zones due to persistent vasoconstriction. On the 6 week follow-up postcontrast CT in one patient, scarring of the kidney was detected in the same area that did not enhance on the 2 week CT. This scarring is thought to be a result of permanent vasoconstriction.     

Risk factors for haemoptysis after percutaneous transthoracic needle biopsies in 4,172 cases: Focusing on the effects of enlarged main pulmonary artery diameter

Objectives

To evaluate the risk factors for haemoptysis after cone-beam computed tomography (CBCT)-guided percutaneous transthoracic needle biopsy (PTNB), particularly on whether the enlargement of main pulmonary artery diameter (mPAD) is a risk factor for PTNB-related haemoptysis.

Methods

4,172 cases of CBCT-guided PTNBs in 3,840 patients were retrospectively included in this study. Various data including mPAD measured on preprocedural CT images were evaluated using logistic regression analyses to determine significant risk factors for both haemoptysis and severe haemoptysis, designated as when blood transfusion, vascular embolisation or cardiopulmonary resuscitation were required to manage patients with haemoptysis.

Results

Haemoptysis occurred in 5.78 % (241/4172) of all PTNB procedures, while severe haemoptysis occurred in 0.18 % (7/4172). Female sex, history of antiplatelet or anticoagulative drugs, prolonged activated partial thromboplastin time, subsolid nodules, cavitary nodules and long pleura-to-target distance were revealed to be independent risk factors for haemoptysis, while mPAD enlargement (> 29.5 mm) was not. Regarding severe haemoptysis, however, mPAD enlargement was demonstrated to be an independent risk factor along with the presence of subsolid and cavitary target nodules.

Conclusion

mPAD enlargement was not a significant risk factor for PTNB-related haemoptysis; however, it was a significant risk factor for severe haemoptysis.

Key points

? mPAD enlargement was a significant risk factor for severe PTNB-related haemoptysis. ? mPAD can be useful in screening high-risk patients for severe haemoptysis. ? Subsolid or cavitary nodule was another significant risk factor for severe haemoptysis.

     

Posterior reversible encephalopathy syndrome in infection, sepsis, and shock

BACKGROUND AND PURPOSE: The cause of "posterior reversible encephalopathy syndrome" (PRES) is not established. We recently encountered several patients who developed PRES in the setting of severe infection. In this study, we comprehensively reviewed the clinical and imaging features in a large cohort of patients who developed PRES, with particular attention to those with isolated infection, sepsis, or shock (I/S/S). METHODS: The clinical/imaging features of 106 patients who developed PRES were comprehensively evaluated. In 25 of these patients, PRES occurred in association with severe I/S/S separate from transplantation. The clinical/imaging features (computer tomography, MR imaging, and MR angiography [MRA]) of the patients with I/S/S were further evaluated, including organ/tissue/blood culture results, mean arterial blood pressure (MAP) at toxicity, extent of cerebral edema, and presence of vasospasm. RESULTS: PRES occurred in association with I/S/S in 25 of 106 patients (23.6%), in addition to 4 other major clinical settings, including cyclosporine/FK-506 (post-transplant) neurotoxicity (46.2%), autoimmune disease (10.4%), postchemotherapy (3.7%), and eclampsia (10.4%). In the 25 patients with I/S/S, available cultures demonstrated a predominance of gram-positive organisms (84%). Blood pressure was "normal" at toxicity in 10 patients (MAP, 95 mm Hg); "severe" hypertension was present in 15 patients (MAP, 137 mm Hg). Extent of brain edema graded on imaging studies was greater in the normal MAP group compared with the severe hypertension group (P < .05). MRA demonstrated vasospasm in patients with severe hypertension and vessel "pruning" in the normal MAP group. CONCLUSION: Infection/sepsis/shock may be an important cause of PRES, particularly in relation to infection with gram-positive organisms.     

Temporomandibular joint internal derangements: CT diagnosis

Two hundred patients with suspected displaced temporomandibular joint meniscus were studied with computed tomography. In 75 cases confirmation of the CT diagnosis was subsequently obtained via surgery or arthrography; correlation was found in 73 cases (97%), with one false-negative and one false-positive examination. When meniscus displacement was graded as "mild," "moderate," or "severe," those cases diagnosed as moderate or severe were more likely to require surgery. The technique and interpretation of this technique is described; in most cases CT can replace arthrography in diagnosing displaced temporomandibular joint menisci.     

Magnetic resonance colonography in severe attacks of ulcerative colitis

Objectives

To evaluate the ability of MR colonography (MRC) to detect lesions in severe attacks of ulcerative colitis (UC) and to assess its concordance with rectosigmoidoscopy.

Methods

Eighteen patients underwent MRC and rectosigmoidoscopy. MRC consisted of a water-filled colonic procedure followed by T1/T2w images. Image quality was recorded. Inflammatory lesions and the existence of signs of severity were analysed. We calculated MR accuracy in the diagnosis of inflammatory lesions, as well as per segment and per patient concordance depending on the presence or absence of severe lesions.

Results

The MR image quality of the 108 segments was satisfactory. Endoscopy was used to study 36 segments (rectum and sigmoid). MRC had a positive predictive value of 100% and a sensitivity of 64% in the diagnosis of inflammatory lesions. Concordance for the diagnosis of severe lesions was excellent for the rectum (k?=?0.85) and good for the sigmoid (k?=?0.64). MRC diagnosed signs of severity in all patients affected at endoscopy. MRC also disclosed signs of severity located higher in the colon in four patients with nonsevere lesions at rectosigmoidoscopy.

Conclusions

MRC can accurately diagnose inflammatory lesions in severe attacks of UC and significantly correlates with rectosigmoidoscopy in the diagnosis of severe lesions.

Key Points

? Magnetic Resonance Colonography (MRC) is increasingly used to investigate the large bowel. ? MRC seems accurate in diagnosing inflammatory lesions in severe attacks of UC. ? MRC findings significantly correlate with rectosigmoidoscopy findings for severe lesions. ? Unlike rectosigmoidoscopy, MRC can identify severe lesions throughout the colon.     

Destructive discovertebral degenerative disease of the lumbar spine

The uncommon variant of degenerative hip joint disease, termed rapidly progressive osteoarthritis, and highlighted by severe joint space loss and osteochondral disintegration, is well established. We present a similar unusual subset in the lumbar spine termed destructive discovertebral degenerative disease (DDDD) with radiological features of vertebral malalignment, severe disc resorption, and "bone sand" formation secondary to vertebral fragmentation. Co-existing metabolic bone disease is likely to promote the development of DDDD of the lumbar spine, which presents with back pain and sciatica due to nerve root compression by the "bone sand" in the epidural space. MRI and CT play a complimentary role in making the diagnosis.     

The impact of generalized joint laxity on clinical outcomes of total knee arthroplasty

Purpose

The aim of this study was to investigate whether the severity of generalized joint laxity influences preoperative and postoperative clinical outcomes and if patients with severe generalized joint laxity would require a thicker polyethylene (PE) liner during total knee arthroplasty (TKA).

Methods

A total of 338 female patients undergoing TKA were divided into two groups according to generalized joint laxity. Preoperative and postoperative (at 3 years) patellofemoral scale, AKS, WOMAC, ROM, and satisfaction VAS were compared between the two groups. Additionally, PE liner thickness was compared.

Results

Preoperatively, flexion contracture and WOMAC stiffness scores in the severe laxity group were significantly lower than those in the no to moderate laxity group (p?<?0.001 for both). There was no significant difference in postoperative clinical outcomes of patellofemoral scale, AKS, WOMAC, or ROM or in satisfaction VAS between the two groups. There was a significant difference in PE liner thickness between the two groups (10.3?±?1.3 versus 11.4?±?1.2, p?=?0.043).

Conclusions

There was no significant difference of clinical outcomes between the patients with and without severe generalized joint laxity after 3 years of follow-up after TKA, even though preoperative clinical outcomes indicated that the patients with severe generalized joint laxity showed significantly smaller flexion contraction and better WOMAC stiffness score. Since patients with generalized joint laxity require a thicker PE liner, care should be taken to avoid cutting too much bone from patients with severe generalized joint laxity.

Level of evidence

Retrospective comparative study, Level III.

     

Radiology-guided forceps biopsy and airway stenting in severe airway stenosis

PURPOSE

We aimed to determine the feasibility, safety, and effectiveness of radiology-guided forceps biopsy and airway stenting in patients with severe airway stenosis.

MATERIALS AND METHODS

This study involved 28 patients with severe airway stenosis who underwent forceps biopsy between October 2006 and September 2011. Chest multislice computed tomography was used to determine the location and extent of stenosis. Sixteen patients had tracheal stenosis, two patients had stenosis of the tracheal carina, six patients had stenosis of the left main bronchus, and four patients had stenosis of the right main bronchus. Forceps biopsy and stenting of the stenosed area were performed under fluoroscopic guidance in digital subtraction angiography and the biopsy specimens were analyzed histopathologically. We contacted the patients via phone call and utilized a standardized questionnaire to determine their medical condition during a postoperative three-month follow-up.

RESULTS

The technical success rate of radiology-guided forceps biopsy was 100%. Biopsy specimens were obtained in all patients. Dyspnea was relieved immediately after stent placement. No serious complications, such as tracheal hemorrhage or perforation, mediastinal emphysema, or asphyxia, occurred.

CONCLUSION

Radiology-guided forceps biopsy and airway stenting can be used for the emergency treatment of severe airway stenosis. This method appears to be safe and effective, and it may be an alternative therapeutic option in patients who cannot tolerate fiberoptic bronchoscopy.Dyspnea due to severe airway stenosis is a serious, acute respiratory condition that can cause death due to asphyxiation. In patients with moderate airway stenosis, fiberoptic bronchoscopy and biopsy can be used to determine the underlying disease pathology and direct further treatment (1). However, bronchoscopy and biopsy are difficult in patients with severe airway stenosis, especially in those with a highly vascular stenosed segment. A severely stenosed airway may be too narrow to allow the insertion of a fiberoptic bronchoscope; moreover, there is a risk of hemorrhage during the bronchoscopy and biopsy. Such patients have difficulty in breathing, and may even choke to death. This retrospective analysis involved 28 patients with severe airway stenosis who underwent forceps biopsy in our Department of Interventional Radiology. Timely placement of airway stents can release airway strictures and relieve dyspnea (2, 3).     

Diagnosis of ascending transtentorial herniation by cranial computed tomography.

The secondary effects of large infratentorial masses may include ascending transtentorial herniation. Rostral displacement of the superior vermis through the tentorial incisura can be accurately detected by cranial computed tomography. Signs of early or impending upward herniation are compression and slight posterior flattening of the quadrigeminal plate cistern. Progressively more severe herniation produces amputation of the peritcetal cerebrospinal fluid diamond, leading to a triangle or "squared off" appearance of the confluent quadrigeminal and superior cerebellar cisterns. When the disorder is severe, the herniated vermis plugs the incisura, completely effacing these cisterns and flattening the posterior third ventricle. Obstructive hydrocephalus may also occur with moderate or severe herniation.     

Patients with severe emphysema have a low risk of radiation pneumonitis following stereotactic body radiotherapy

Objective:

To evaluate the risk of radiation pneumonitis (RP) after stereotactic radiotherapy (SBRT) for patients presenting with severe pulmonary emphysema.

Methods:

This study included 40 patients with Stage I non-small-cell lung cancer who underwent SBRT, 75 Gy given in 30 fractions, at the Tokyo Medical University, Tokyo, Japan, between February 2010 and February 2013. The median age of the patients was 79 years (range, 49–90 years), and the male:female ratio was 24:16. There were 20 T1 and 20 T2 tumours. 17 patients had emphysema, 6 had slight interstitial changes on CT images and the remaining 17 had no underlying lung disease. The level of emphysema was classified into three groups according to the modified Goddard''s criteria (severe: three patients, moderate: eight patients and mild: six patients). Changes in the irradiated lung following SBRT were evaluated by CT.

Results:

On CT images, RP was detected in 34 (85%) patients, and not in 6 (15%) patients, during a median observation period of 313 days. Of the six patients, three had severe emphysema and three had no underlying lung disease. Patients with severe emphysema had lower risk of RP than those with moderate emphysema (p = 0.01), mild emphysema (p = 0.04) and no underlying lung disease (p = 0.01).

Conclusion:

Patients with severe emphysema had a low risk of RP following SBRT.

Advances in knowledge:

Little is known about the association between RP and pulmonary emphysema. Patients with severe emphysema had lower risk of RP than those with no underlying lung disease.In addition to smoking, lung cancer has various causes, including emphysema and chronic obstructive pulmonary disease (COPD), which are common with underlying lung diseases.^1,2 Thus, patients with underlying lung diseases have a high possibility of having cancer.¹ Stereotactic body radiotherapy (SBRT) for Stage I non-small-cell lung cancer (NSCLC) has an excellent overall survival rate and local control; therefore, SBRT is widely considered a cure with fewer treatment-related toxicities.³ Accordingly, an increasing number of patients with co-morbidities, especially underlying lung diseases, are undergoing SBRT.Radiation pneumonitis (RP) is the most severe adverse event of SBRT. Some potential predictors for the risk factors of RP are reported;⁴ however, little is known about the association between RP and underlying lung diseases, such as pulmonary emphysema. Thus, we evaluated the relation between RP and pulmonary emphysema following SBRT in patients with Stage I NSCLC.     

"Low infusion resuscitation" in the treatment of wounded and injured with acute massive blood loss

Acute massive blood loss (AMBL) of severe and extremely severe degree is still one of the leading causes of unfavourable traumatic disease. 95% of potentially preventable lethal outcomes in severe gunshot trauma is reported to depend largely on the adequacy of AMBL correction (Howard P., 2003). An alternate approach to the issue studied was the development of preparations of hyperosmotic saline solutions (7.5% sodium chloride) combined with hyperoncotic colloid solutions (dextrans, hetastarch). As a result, solutions were developed (so-called, hyperosmotic hyperoncotic volume expanders) allowing to achieve rapid and stable volemic and hemodynamic effect in case of low volume infusion (usually, 4 ml/kg of body weight). The present study allowed to conclude that "low infusion resuscitation" technique in patients with multiple trauma accompanied by acute massive blood loss of extremely severe degree enables to reduce lethality, to achieve early subcompesatory hemodynamic state in acute traumatic disease.     

“Adult T-cell leukemia/lymphoma” with bone demineralization

Two patients with T-cell malignancy having radiographic manifestations of generalized and localized bone demineralization are reported. One, a 53-year-old man, had marked osteoporosis and severe hypercalcemia, but no clinical evidence of leukemia throughout his illness. At autopsy there was no definite evidence of bone involvement. Histologic proof was obtained from abdominal skin which revealed adult T-cell leukemia/lymphoma (ATLL). The second case, a 33-year-old man, complained of arthralgia in his hands and feet; radiographs showed severe localized demineralization and pathologic fractures. Specimens of his peripheral blood, cervical lymph nodes, and bone marrow revealed ATLL cells.     

Hyperintense Vessels on FLAIR: Hemodynamic Correlates and Response to Thrombolysis

BACKGROUND AND PURPOSE:Hyperintense vessels on baseline FLAIR MR imaging of patients with ischemic stroke have been linked to leptomeningeal collateralization, yet the ability of these to maintain viable ischemic tissue remains unclear. We investigated whether hyperintense vessels on FLAIR are associated with the severity of hypoperfusion and response to thrombolysis in patients treated with intravenous tissue-plasminogen activator.MATERIALS AND METHODS:Consecutive patients with ischemic stroke with an MR imaging before and within 24 hours of treatment, with proved vessel occlusion and available time-to-maximum maps were included (n = 62). The severity of hypoperfusion was characterized on the basis of the hypoperfusion intensity ratio (volume with severe/mild hypoperfusion [time-to-maximum ≥ 8 seconds / time-to-maximum ≥ 2 seconds]). The hypoperfusion intensity ratio was dichotomized at the median to differentiate moderate (hypoperfusion intensity ratio ≤ 0.447) and severe (hypoperfusion intensity ratio > 0.447) hypoperfusion. Good outcome was defined as a modified Rankin Scale score of ≤2.RESULTS:Hyperintense vessels on FLAIR were identified in 54 patients (87%). Patients with extensive hyperintense vessels on FLAIR (>4 sections) had higher NIHSS scores, larger baseline lesion volumes, higher rates of perfusion-diffusion mismatch, and more severe hypoperfusion (hypoperfusion intensity ratio). In stepwise backward multivariate regression analysis for the dichotomized hypoperfusion intensity ratio (including stroke etiology, age, perfusion deficit, baseline lesion volume, smoking, and extent of hyperintense vessels on FLAIR), extensive hyperintense vessels on FLAIR were independently associated with severe hypoperfusion (OR, 6.8; 95% CI, 1.1–42.7; P = .04). The hypoperfusion intensity ratio was an independent predictor of a worse functional outcome at 3 months poststroke (OR, 0.2; 95% CI, 0.5–0.6; P < .01).CONCLUSIONS:Hyperintense vessels on FLAIR are associated with larger perfusion deficits, larger infarct growth, and more severe hypoperfusion, suggesting that hyperintense vessels on FLAIR most likely indicate severe ischemia as a result of insufficient collateralization.

While most studies agree that hyperintense vessels on FLAIR (FHV) are highly associated with large-vessel occlusion, results on the underlying pathophysiology are seemingly split.¹ Several studies suggest FHV to be indicative of hemodynamic stress, inadequate collateralization, and poor functional recovery.^2–5 Conversely, others attributed FHV to increased leptomeningeal collateralization and found an association with smaller lesions, slower infarct progression, and better prognosis.^6–10The apparent contradiction of these studies may stem from the use of different methodologies and the diversity of populations studied, making the plethora of results challenging to analyze. Nevertheless, 2 critical questions remain due to lack of comprehensive imaging data and long-term clinical follow-up: Do FHV represent good collateralization or indicate the insufficiency of established collaterals to maintain ischemic tissue? Second, does FHV have clinical relevance in terms of functional recovery?The difficulty in determining collateral status poses a major challenge in answering these questions because digital subtraction angiography is not always readily available and associated risks may not be justified in most cases. Bang et al¹¹ used a hypoperfusion intensity ratio (HIR: time-to-maximum [Tmax] ≥ 8 seconds/Tmax ≥ 2 seconds) on baseline MR perfusion imaging as a surrogate marker of collateral status and found that excellent and intermediate collateral grades were highly associated with lower HIRs.In the PRE-FLAIR study, patients with FHV had larger initial lesion volumes and more severe clinical impairment¹²; therefore, we hypothesized that patients with FHV would have more severe hypoperfusion, suggesting the insufficiency of established collaterals to maintain ischemic tissue before reperfusion is achieved. In this study, we investigated whether the extent of FHV is correlated with the severity of hypoperfusion by using Tmax perfusion maps and whether this plays a role in response to thrombolysis in patients with arterial occlusion treated with intravenous recombinant tissue plasminogen activator.     

The duff, no duff casualty

A patient who presented with "hyperventilation syndrome" was initially mis-treated as severe crush injury, illustrating the need for thorough assessment of all casualties whilst on exercise prior to arranging casualty treatment and evacuation.     

Injuries caused by in-flight ejection

The localization, causes and severity of 214 "ejection-associated" injuries occurred in 160 pilots are discussed. Spine, upper and lower extremities are affected most frequently. The severe injures prevail (57.8%). The main causes of severe injuries are the impact + Gz accelerations of ejection and the impact + Gz accelerations of landing.     

Combined Use of Mechanical Thrombectomy with Angioplasty and Stenting for Acute Basilar Occlusions with Underlying Severe Intracranial Vertebrobasilar Stenosis: Preliminary Experience from a Single Chinese Center

BACKGROUND AND PURPOSE:Acute basilar occlusions have a poor prognosis without recanalization. Many have underlying severe atherosclerotic intracranial stenosis coexisting with acute thrombosis, requiring treatment of both pathologies in the same session, though technical risks may be encountered. The purpose of this study was to evaluate the technical feasibility and safety of combined treatment by using stent retrievers for the thrombosis, together with angioplasty and stent placement for the underlying stenosis.MATERIALS AND METHODS:This was a retrospective review of 13 patients with basilar occlusions treated with thrombectomy by the Solitaire stent retriever and angioplasty and intracranial stent placement for underlying severe vertebrobasilar stenosis in the same session. Reperfusion was assessed in terms of the TICI score. Perioperative complications were recorded. Clinical outcomes were assessed by the NIHSS at discharge and the mRS on follow-up at 90 days.RESULTS:Of the 30 patients with acute basilar artery occlusions treated with stent retrievers during the study period, 18 had coexisting severe intracranial stenosis. Thirteen patients meeting the criteria for our study received combined mechanical thrombectomy and angioplasty with stent placement. The successful recanalization rate was 100%. Distal vessel embolizations occurred in 3 patients. There were 2 mortalities. On discharge, 10 patients (77%) had an improvement in NIHSS of ≥10 points. At 90 days, 6 patients (46%) had a good functional outcome with an mRS of ≤2.CONCLUSIONS:The combined use of mechanical thrombectomy with angioplasty and stent placement for acute basilar occlusions with underlying severe intracranial atherosclerotic stenosis is technically feasible and safe.

Acute basilar artery occlusion (BAO) carries a high morbidity and mortality. Among patients treated conventionally with antiplatelets or anticoagulation, the death and dependency rate was 80%.¹ Even with intravenous or intra-arterial thrombolysis, the overall death or dependency rate is not much improved. Without recanalization, the mortality can be up to 85%–95% and the likelihood of good outcome was only 2%.² The mechanism of occlusion includes acute local thrombosis over an underlying severe atherosclerotic stenosis and embolization from distant sources. There has not yet been any epidemiologic data on the proportion of acute BAO attributed to atherosclerotic stenosis in Asians, though deducing from the higher prevalence of intracranial atherosclerosis observed in Asians, and especially in the Chinese population,³ the proportion of patients with BAO and underlying atherosclerotic stenosis may be higher than the 26%–36% reported on imaging studies from the white population.⁴ For the treatment of BAO, mechanical thrombectomy with stent retrievers has emerged in recent years as a promising method with a higher recanalization rate and better functional outcome.^5,6 However, for those with underlying severe stenosis, there have been concerns over the feasibility and safety of these devices: Reperfusion may fail to be achieved by mechanical thrombectomy devices alone in patients with severe stenosis⁷; retrieval of the stent retrievers past the stenosis may damage the endothelium or the atherosclerotic plaque, leading to an increased risk of acute thrombosis and reocclusion; and the resistance posed by the stenosis may cause distortion of the natural course of the vessel during the tug of the retrievers past the stenosis, leading to tearing of the perforator vessels and intracerebral hemorrhage. We hereby report our experience with 13 patients treated with a combination of mechanical thrombectomy with the Solitaire device (Covidien, Irvine, California) for the thrombosis and angioplasty with stent placement for the underlying stenosis.     

Clinical and radiographic "reankylosis" following hip surgery in ankylosing spondylitis.

Eleven patients with ankylosing spondylitis underwent reconstructive hip surgery (21 hips). In 10 of these hips multiple surgical procedures had been performed. The final procedure included total hip arthroplasties (16 hips), femoral cup arthroplasties (four hips) and an Austin-Moore prosthetic replacement (one hip). A clinical and radiographic evaluation in the postoperative period revealed a high incidence of decreased joint motion and heterotopic ossification. Clinically moderate to severe restriction of motion was noted in 12 hips, and in six of these "reankylosis" was present. Radiographically moderate to severe new bone formation was seen in 11 hips, and in nine of these "reankylosis" was suggested. An association of excessive ossification and multiple surgical procedures was evident. It would appear that when the prime indication for hip surgery in patients with ankylosing spondylitis is restricted motion, the operation may not be beneficial.     

Neuromuscular exercises prevent severe knee injury in adolescent team handball players

Purpose

Team handball is associated with a high risk of severe knee injury that needs to be reduced, particularly at the youth level. The purpose of this study was to show how an injury-prevention programme effectively reduces severe knee injury in adolescent team handball players.

Methods

Of 23 adolescent handball teams of both sexes, 13 were randomly allocated into the intervention group (168 players) and 10 into the control group (111 players). Players of the intervention group regularly participated in an injury-prevention programme for one season. Handball exposure and sustained injuries were documented for both groups on a monthly basis. The primary outcome parameter of the injury-prevention programme was the incidence of severe knee injury.

Results

Of the 279 included players, 68 (24%) sustained 82 injuries yielding an overall incidence of 1.85 injuries per 1000 h handball exposure (intervention group: 50 injuries/incidence: 1.90/1000 h; control group: 32 injuries/incidence: 1.78/1000 h). Knee injury was the second most frequent injury in adolescent team handball. The primary outcome parameter, severe knee injury occurred significantly more often in the control group [mean age (SD) 15.1 (1.0), injury incidence 0.33/1000 h] than in the intervention group [mean age (SD) 14.9 (0.9), injury incidence 0.04/1000 h]. The odds ratio was 0.11 (95% CI 0.01–0.90), p?=?0.019. Other injuries to the lower extremities showed no significant difference between the two groups.

Conclusions

Frequent neuromuscular exercises prevent severe knee injury in adolescent team handball players and should thus be included in the practical routine as well as in the education of team coaches.

     

Severe Neutropenia at the Time of Implantable Subcutaneous Chest Port Insertion Is Not a Risk Factor for Port Removal at a Tertiary Pediatric Center

Purpose

To determine if severe neutropenia at the time of chest port insertion is a risk factor for port removal and central catheter–associated bloodstream infection (CCABSI) in pediatric patients.

Nonoperative management of blunt liver injury in hemodynamically stable versus unstable patients: a retrospective study

Purpose

The success rate of nonoperative management (NOM) of traumatic liver injury is approximately 90%. Although NOM has become the standard treatment when patients’ vital signs are stable, open surgical hemostasis is often selected when these signs are unstable. At our hospital, we extensively use NOM along with transcatheter arterial embolization (TAE) to treat patients with severe abdominal trauma, as per our original protocol. We also apply NOM for severe liver injury with unstable hemodynamics. This retrospective study aimed to investigate the efficacy of NOM for blunt liver injury in hemodynamically stable and unstable patients.

Methods

We retrospectively examined 23 patients with severe liver injuries who underwent NOM after visiting our emergency outpatient department between 2007 and 2017. Patients were assigned to either the stable group with stable hemodynamics or the unstable group with unstable hemodynamics.

Results

The stable group comprised 13 patients, and the unstable group comprised 10 patients. All patients underwent TAE. While all patients in the stable group were discharged alive, one patient in the unstable group died during the hospital stay. The response rate to NOM was 90%, and no patient switched from NOM to open surgery. A higher rate of complications with a significantly longer average stay in the intensive care unit was observed in the unstable group.

Conclusions

Even in the unstable group, NOM with TAE performed under careful general management facilitated avoidance of open surgery and provided high survival rates.