Avulsion of the gall bladder in blunt abdominal trauma

T raumatic avulsion of the gall bladder, and its subsequent dislodgement into the pelvis has not previously been reported. The case described records severe damage to the biliary system without much damage to other viscera.     

The 'double headed slug flap': A simple technique to reconstruct large helical rim defects

Reconstructing partial defects of the ear can be challenging, balancing the creation of the details of the ear with scarring, morbidity and number of surgical stages. Common causes of ear defects are human bites, tumour excision and burn injuries. Reconstructing defects of the ear with tube pedicled flaps and other local flaps requires an accurate measurement of size of the defect with little room for error, particularly under estimation. We present a simple method of reconstruction for partial defects of the ear using a two-stage technique with post auricular transposition flaps. This allows for under or over estimation of size defects permitting accurate tissue usage giving good aesthetic outcomes.     

Gelatin hydrogel carrier with the W9-peptide elicits synergistic effects on BMP-2-induced bone regeneration

ObjectivesGelatin hydrogel (GH) has been proven to be an appropriate carrier for the sustained release of proteins. The W9 peptide (W9) inhibits osteoclastogenesis and accelerates bone morphogenetic protein (BMP)-2-induced ectopic bone formation through type 1 collagen (Col1) as a carrier. The aim of this study was to assess whether GH coupled with W9 elicited improved synergistic effects on BMP-2-induced local bone formation compared to Col1.MethodsThe kinetics of W9 release from GH and Col1 were determined using a spectrofluorometer. A calvarial defect model was employed in 5-week-old male C57BL/6 mice (n=24). Each carrier was loaded with BMP-2, BMP-2+W9, or vehicle, and was applied on the defect site. The mice were sacrificed on day 28 after surgery to create the calvarial defect. Radiographic and bone histomorphometric analyses were performed to assess the healing of the defect.ResultsOur in vitro kinetic study showed the sustained release of W9 from the GH compared to Col1. Radiographic analyses of the defect site showed that the combined delivery of BMP-2 and W9 from GH induced higher radio-opacity compared to that induced by combined delivery from Col1. Dual-energy X-ray absorptiometry confirmed these observations. Histomorphometric analyses revealed that the combined delivery of BMP-2 and W9 from GH induced higher bone formation and lower osteoclast number than those related to the delivery from Col1.ConclusionsGH could facilitate the anabolic effects of W9 on BMP-2-induced bone regeneration in a better manner, compared to Col1.     

Abnormal visual phenomena in posterior cortical atrophy

Individuals with posterior cortical atrophy (PCA) report a host of unusual and poorly explained visual disturbances. This preliminary report describes a single patient (CRO), and documents and investigates abnormally prolonged colour afterimages (concurrent and prolonged perception of colours complimentary to the colour of an observed stimulus), perceived motion of static stimuli, and better reading of small than large letters. We also evaluate CRO's visual and vestibular functions in an effort to understand the origin of her experience of room tilt illusion, a disturbing phenomenon not previously observed in individuals with cortical degenerative disease. These visual symptoms are set in the context of a 4-year longitudinal neuropsychological and neuroimaging investigation of CRO's visual and other cognitive skills. We hypothesise that prolonged colour after-images are attributable to relative sparing of V1 inhibitory interneurons; perceived motion of static stimuli reflects weak magnocellular function; better reading of small than large letters indicates a reduced effective field of vision; and room tilt illusion effects are caused by disordered integration of visual and vestibular information. This study contributes to the growing characterisation of PCA whose atypical early visual symptoms are often heterogeneous and frequently under-recognised.