Bedside ultrasound in the diagnosis of uterine rupture following surgical abortion

Reports of uterine rupture following surgical abortion are rare but may result in hemorrhage, sepsis, and even death. In this unique case, we describe how a transabdominal pelvic ultrasound performed at the bedside by an emergency department physician identified uterine rupture with retained products of conception and led to an emergent laparotomy and hysterectomy. This case illustrates how bedside ultrasound may be used in patients presenting with abdominopelvic pain following surgical abortion to shorten the time to definitive treatment and ultimately lower the morbidity and mortality associated with a diagnosis of life-threatening uterine rupture.     

Branching Pattern of the Cerebral Arterial Tree

Quantitative data on branching patterns of the human cerebral arterial tree are lacking in the 1.0–0.1 mm radius range. We aimed to collect quantitative data in this range, and to study if the cerebral artery tree complies with the principle of minimal work (Law of Murray). To enable easy quantification of branching patterns a semi-automatic method was employed to measure 1,294 bifurcations and 2,031 segments on 7 T-MRI scans of two corrosion casts embedded in a gel. Additionally, to measure segments with a radius smaller than 0.1 mm, 9.4 T-MRI was used on a small cast section to characterize 1,147 bifurcations and 1,150 segments. Besides MRI, traditional methods were employed. Seven hundred thirty-three bifurcations were manually measured on a corrosion cast and 1,808 bifurcations and 1,799 segment lengths were manually measured on a fresh dissected cerebral arterial tree. Data showed a large variation in branching pattern parameters (asymmetry-ratio, area-ratio, length-radius-ratio, tapering). Part of the variation may be explained by the variation in measurement techniques, number of measurements and location of measurement in the vascular tree. This study confirms that the cerebral arterial tree complies with the principle of minimum work. These data are essential in the future development of more accurate mathematical blood flow models. Anat Rec, 302:1434–1446, 2019. © 2018 The Authors. The Anatomical Record published by Wiley Periodicals, Inc. on behalf of American Association of Anatomists.     

The Relationship of Tinnitus to Craniocervical Mandibular Disorders

Patients with craniocervical mandibular (TMD) disorders can present with tinnitus as a primary or secondary complaint. The embryology and functional anatomy of the middle ear, temporomandibular joint, muscles of mastication and associated tendons, ligaments, blood vessels, nerves and lymphatics was found to be helpful in establishing etiologic concepts which relate tinnitus to these temporomandibular disorders. In addition to etiologic concepts, treatment modalities are described. The authors relate their experiences as well as those of others with different patient populations.     

The effects of varying levels of hemispheric activation on episodic memory

Bilateral saccadic eye movements enhance episodic memory retrieval; however, this usually only occurs for consistent-handed, not inconsistent-handed, individuals. It was hypothesized that inconsistent-handers begin closer to the peak of a Yerkes–Dodson-type inverted-U curve and increasing activation pushes them along the curve eventually decreasing performance, while consistent-handers start at a lower baseline and therefore increasing activation increases their performance. The current study tested this hypothesis by using hand clenching (grip strength) to increase activation at 5 different levels for both consistent- and inconsistent-handers. A total of 316 participants were presented with a list of 36 words after which they squeezed a hand dynamometer to induce cortical activation, and then recalled as many of the words as they could. Results showed that, as predicted, both inconsistent- and consistent-handers demonstrated an inverted-U pattern of memory performance as the strength of squeeze increased with inconsistent-handers peaking at a lower level of grip strength than consistent-handers. These results may help explain past findings, not only with episodic memory but also a variety of other cognitive tasks. They may also have interesting theoretical and real-world implications, which are discussed.     

Outcomes following emergency laparotomy in Australian public hospitals

Background

International studies reporting outcomes following emergency laparotomies have consistently demonstrated wide inter‐hospital variation and a 30‐day mortality in excess of 10%. The UK then prioritized the funding of the National Emergency Laparotomy Audit. In a prospective Western Australian audit there was minimal inter‐hospital variation and a 6.6% 30‐day mortality. In the absence of any multi‐hospital Australian data the aim of the present study was to compare national administrative data with that previously reported.

Methods

Data on emergency laparotomies performed in Australian public hospitals during 2013/2014 and 2014/2015 were extracted from admitted patient activity and costing data sets collated by the Independent Hospital Pricing Authority. The data sets, containing episode‐level data relating to admitted acute and sub‐acute care patients, included administrative, demographic and clinical information such as patient age, cost, length of stay, in‐hospital mortality, diagnosis and surgical procedure details.

Results

Ninety‐nine public hospitals undertaking at least 50 emergency laparotomies performed 20 388 procedures over the 2 years. The overall in‐hospital mortality was 5.2%. There was a wide interstate and inter‐hospital variation in risk‐adjusted in‐hospital mortality (4.8–6.6% and 0–9.3%, respectively), length of stay (12.5–16.8 days and 5.8–18.9 days, respectively) and intensive care unit admissions (24.5–40.2% and 0–75.7%, respectively).

Conclusion

This data suggest the wide variation in outcomes and care process observed overseas exist in Australia. However, administrative data has considerable limitations and is not a substitute for high quality prospective data. Minimizing variations through prospective quality improvement processes will improve patient outcomes.