Distal thoracic oesophageal perforation secondary to blunt trauma: Case report

Background  

Traumatic perforation of the distal oesophagus due to blunt trauma is a very rare condition and is still associated with a significant morbidity and mortality. This is further exacerbated by delayed diagnosis and management as symptoms and signs are often masked by or ascribed to more common blunt thoracic injuries.     

Endovascular stent-graft treatment of type A dissection: case report and review of literature.

We report a successful endovascular stent-graft treatment of a patient with type A dissection with primary entry tear at the ascending aorta. Simultaneous coronary stenting was performed. A literature review was performed and the possible use of endovascular treatment for ascending aortic dissections is discussed.     

Rapid prototype patient-specific drill template for cervical pedicle screw placement.

OBJECTIVE: To assess the feasibility and accuracy of a drill template for the placement of a cervical pedicle screw in a single vertebral level. MATERIALS AND METHODS: A volumetric CT scan was performed on a cadaver cervical spine. Using computer software, a drill template with a predefined trajectory was constructed that was designed to match the posterior surface of the right side of the fifth cervical vertebra. A physical template was created from the computer model using a rapid prototyping machine. The drill template was used to guide drilling of a pilot hole, and a CT scan was performed to assess the accuracy of this hole. A 3.5-mm diameter pedicle screw was placed in the pilot hole. The spine was then dissected to separate the vertebrae and the trajectory of the screw was visually inspected. RESULTS: The feasibility of this patient-specific rapid prototyping technique was demonstrated. Imaging and visual inspection confirmed accurate placement of the pilot hole and cervical pedicle screw without cortical violation. CONCLUSIONS: The potential use of drill templates to place cervical pedicle screws is promising. Our initial methodology appears to provide an accurate technique and trajectory for pedicle screw placement in the cervical spine.     

Altered central micro-opioid receptor binding after psychological trauma.

BACKGROUND: Functional neuroimaging studies have detected abnormal limbic and paralimbic activation to emotional probes in posttraumatic stress disorder (PTSD), but few studies have examined neurochemical mechanisms that underlie functional alterations in regional cerebral blood flow. The mu-opioid neurotransmitter system, implicated in responses to stress and suppression of pain, is distributed in and is thought to regulate the function of brain regions that are implicated in affective processing. METHODS: Here we examined the micro-opioid system with positron emission tomography and the micro-opioid receptor-selective radiotracer [11C] carfentanil in 16 male patients with PTSD and two non-PTSD male control groups, with (n = 14) and without combat exposure (n = 15). Differences in micro-opioid receptor binding potential (BP2) were detected within discrete limbic and paralimbic regions. RESULTS: Relative to healthy controls, both trauma-exposed groups had lower micro-opioid receptor BP2 in extended amygdala, nucleus accumbens, and dorsal frontal and insular cortex but had higher BP2 in the orbitofrontal cortex. PTSD patients exhibited reduced BP2 in anterior cingulate cortex compared with both control groups. Micro-opioid receptor BP2 in combat-exposed subjects without PTSD was lower in the amygdala but higher in the orbitofrontal cortex compared with both PTSD patients and healthy controls. CONCLUSIONS: These findings differentiate the general response of the micro-opioid system to trauma from more specific changes associated with PTSD.