Iatrogenic brachial artery injury during pinning of supracondylar fracture of humerus: A rare injury

Complications following supracondylar fracture of humerus are well-known. Pre- and post-operative complications have been documented in the literature. Neurovascular injury due to fracture fragments following this type of fracture is described. Iatrogenic brachial artery during surgical treatment of this fracture is unknown to the literature. So we report a rare case of iatrogenic brachial artery injury during pinning of supracondylar fracture of humerus and try to create awareness to the surgeons that such injuries can occur with improper operative techniques.     

Residual Strength Prediction of Aluminum Panels with Multiple Site Damage Using Artificial Neural Networks

Multiple site damage (MSD) cracks are small fatigue cracks that may accumulate at the sides of highly loaded holes in aging aircraft structures. The presence of MSD cracks can drastically reduce the residual strength of fuselage panels. In this paper, artificial neural networks (ANN) modeling is used for predicting the residual strength of aluminum panels with MSD cracks. Experimental data that include 147 unique configurations of aluminum panels with MSD cracks are used. The experimental dataset includes three different aluminum alloys (2024-T3, 2524-T3, and 7075-T6), four different test panel configurations (unstiffened, stiffened, stiffened with a broken middle stiffener, and bolted lap-joints), many different panel widths and thicknesses, and the sizes of the lead and MSD cracks. The results presented in this paper demonstrate that a single ANN model can predict the residual strength for all materials and configurations with high accuracy. Specifically, the overall mean absolute error for the ANN model predictions is 3.82%. Furthermore, the ANN model residual strength predictions are compared to those obtained using the most accurate semi-analytical and computational approaches from the literature. The ANN model predictions are found to be at the same accuracy level of these approaches, and they even outperform the other approaches for many configurations.     

Posterior reversible encephalopathy syndrome in a patient of organophosphate poisoning

A 32-year-old male presented with a history of consuming some organophosphorous compound with suicidal intention. He was treated with atropine, pralidoxime, ventilator support. During stay patient had persistent irritability, tachycardiaand hypertension despite sedation and labetalol infusion. He developed headache, visual blurring hemiparesis and focal seizures. Magnetic resonance imaging of the brain revealed multifocal hyperintensities mainly in subcortical areas of parietal and occipital regions in T2-weighted images, with increased values of Apparent Diffusion Coefficient, suggesting posterior reversible encephalopathy syndrome (PRES). The possibilities of PRES caused by organophosphorous poisoning either due to hypertension caused by autonomic deregulation or direct neurological toxicity has been discussed.     

A point-by-point response to recent arguments against the use of statins in primary prevention: this statement is endorsed by the American Society for Preventive Cardiology

Recently, a debate over the merits of statin therapy in primary prevention was published in the Wall Street Journal. The statin opponent claimed that statins should only be used in secondary prevention and never in any primary-prevention patients at risk for cardiovascular events. In this evidence-based rebuttal to those claims, we review the evidence supporting the efficacy of statin therapy in primary prevention. Cardiovascular risk is a continuum in which those at an elevated risk of events stand to benefit from early initiation of therapy. Statins should not be reserved until after a patient suffers the catastrophic consequences of atherosclerosis. Contrary to the assertions of the statin opponent, this principle has been demonstrated through reductions in heart attacks, strokes, and mortality in numerous randomized controlled primary-prevention statin trials. Furthermore, data show that once a patient tolerates the initial treatment period, the few side effects that subsequently emerge are largely reversible. Accordingly, every major guidelines committee endorses statin use in secondary prevention and selectively in primary prevention for those with risk factors. The foundation for prevention remains increased physical activity, better dietary habits, and smoking cessation. However, prevention of heart attacks, strokes, and death from cardiovascular disease does not have to be all or none-all statin or all lifestyle. In selected at-risk individuals, the combination of pharmacotherapy and lifestyle changes is more effective than either alone. Future investigation in prevention should focus on improving our ability to identify these at-risk individuals.     

Uterine intravenous lipoleiomyomatosis: uncommon manifestation as a huge retroperitoneal mass with intracaval/intracardiac extensions

Lipoleiomyomas are benign mesenchymal tumours of smooth muscle and adipose tissue and uncommonly occur in the uterus. Here we report a case of uterine lipoleiomyoma that manifested purely as intravenous component and clinically presented as a large retroperitoneal mass with extension into inferior vena cava and right atrium. The connection of the mass to the corneal end of the uterus was noted only at surgery.