Review of techniques for the removal of trapped rings on fingers with a proposed new algorithm

Various removal techniques for rings trapped on the finger have been described in the current literature. However, despite this being a frequently encountered situation in emergency departments, there is no comprehensive algorithm to manage and follow these patients in the current literature. The purposes of this study were to describe the most commonly used ring removal techniques and to establish an algorithm for the removal of rings trapped on fingers. We performed a comprehensive literature search in several databases to identify all articles, case reports, letters, and book chapters that focus on ring removal techniques in English language from 1960 to the present. There are 2 methods of removal: (1) noncutting techniques in which the rings can be removed without breaking the integrity of the ring and (2) various ring-cutting equipments and tools. All these techniques are classified into distinct groups and described in detail with illustrations. Furthermore, an algorithm for handling such patients is established according to case-based patient care. Following an algorithm for the removal of trapped rings on the finger will be useful for patients and emergency physicians. It will also prevent possible complications and will save time.     

The cost-effectiveness of treating chronic hepatitis B patients in a median endemic and middle income country

Background/aims

Chronic hepatitis B (CHB) infection is a serious public health problem due to its potential liver disease sequelae and highly expensive medical costs such as the need for liver transplantation. The aim of this study was to quantify the burden of active CHB in terms of mortality and morbidity, the eligibility of antiviral treatment and to assess various treatment scenarios and possible salvage combinations for cost-effectiveness.

Methods

A population cohort from a large data base of chronic hepatitis B patients was constructed and stratified according to 10-year age groups, the prevalence of HBsAg, HBV DNA level, ALT level, HBeAg status and the presence of cirrhosis. An age-specific Markov model for disease progression and cost-effectiveness analysis was constructed and calibrated for the specific population setting.

Results

Of about 3.2 million estimated HBsAg carriers, 25?% are eligible for treatment. If the active cohort remains untreated, 31?% will die due to liver related complications. Within a 20-year period, 11?% will have developed decompensated cirrhosis, 12?% liver cancer and 6?% will need liver transplantation. Quality adjusted life years (QALYs) for the no treatment scenario ranged from 9.3 to 14.0. For scenarios with antiviral treatment, QALYs ranged from 9.9 to 14.5 for lamivudine, 13.0–17.5 for salvage therapy, and 16.6–19.0 for the third generation drugs entecavir and tenofovir.

Conclusion

In a country with considerable amount of active CHB patients, monotherapy with a highly potent third generation drug has the most health-gain, and is cost-effective in both HBeAg-positive and negative in all stages of liver disease.     

Morphometric analysis of the maxillary sinus in patients with nasal septum deviation

The aim of this study was to evaluate the relationship between nasal septum deviation, which is common in the general population, and maxillary sinus volume. A retrospective assessment was made for 96 patients with nasal septum deviation without coexisting sinonasal morbidity and compared to 60 healthy individuals. A three-dimensional reconstruction of computed tomography images was used to assess a total of 312 maxillary sinus volumes. Septal deviation angles and volumes were also measured to standardize and determine the severity of the septal deviations. Septal deviations were right-sided in 36.5 % of the cases (n = 35) and left-sided in 63.5 % (n = 61). Deviation angles varied between 5° and 24.4°, with a mean value of 12.9 ± 5.0. The mean value for the deviation volume was 4.6 ± 1.5 cm³ (range 1.7–9.4). The right and left maxillary sinus volumes were 11.8 ± 4.7 cm³ and 11.5 ± 4.4 cm³, respectively, in control group. Statistically significant discrepancy was observed between the ipsilateral and contralateral maxillary sinus volumes, in regard to the side of the septal deviation in study group. Maxillary sinus volumes were found to be significantly smaller on the ipsilateral side of septal deviation compared with the contralateral side.     

Bilateral multiple pulmonary tuberculous nodules mimicking metastatic disease

We present CT findings of a young woman who has bilateral pulmonary nodules mimicking metastases. Clinical presentation with active multiple pulmonary macronodules without cavitation responsive to treatment is an atypical manifestation of pulmonary tuberculosis. We reviewed the causes of multiple pulmonary nodules, role of radiological findings in differential diagnosis and parenchymal manifestations of pulmonary tuberculosis in this report.