Occult femoral artery injury in a case of closed fracture of the femur revealed during guillotine above-knee amputation: a case report

Arterial injury is most commonly seen with penetrating injuries. An arterial disruption in a closed fracture is rare. It has been reported in only 0.3% of long bone fractures. The authors report a case of femoral artery injury in a polytrauma patient associated with a closed femoral fracture. The arterial injury was not apparent until the patient had an above-knee guillotine amputation done to revise his ipsilateral below-knee traumatic amputation, which released the soft -tissue tamponade effect on the leak. Unless the possibility of this injury is kept in mind, above-knee amputation or any other open procedure on a patient with a femoral fracture can cause exsanguination of the patient.     

A leak quantification method using sulfur hexafluoride as tracer gas

Filter holders and continuous air monitors are used extensively in the nuclear industry. It is important to minimize leakage in these devices, and, in recognition of this consideration, a limit on leakage for sampling systems is specified in; however, the protocol given in the standard is really germane to measurement of significant leakage, e.g., several percent of the sampling flow rate. In the present study, we developed a technique for quantifying leakage and used that approach to measure the sealing integrity of a continuous air monitor and two kinds of filter holders. The methodology involves use of sulfur hexafluoride as a tracer gas with the device being tested operated under dynamic flow conditions. The leak rates in these devices were determined in the pressure range from 2.49 kPa (10 inches H2O) vacuum to 2.49 kPa (10 inches H2O) pressure at a flow rate of 56.6 L min-1 (2 cfm). For the two filter holders, the leak rates were less than 0.007% of the nominal flow rate. The leak rate in the continuous air monitors was less than 0.2% of the nominal flow rate. These values are well within the limit prescribed in the ANSI standard, which is 5% of the nominal flow rate. We suggest that the limit listed in the ANSI standard should be reconsidered as lower values can be achieved, and the methodology presented herein can be used to quantify lower leakage values in sample collectors and analyzers.     

A non-fatal case of sodium toxicity

A non-fatal case of sodium toxicity in a six-year-old boy is presented. Hypernatremia is the clinical term for an excessive concentration of sodium relative to water in the body. The diagnosis of hypernatremia was made at serum sodium (Na(+)) concentrations exceeding 150 mEq/L, and few people have been reported to survive concentrations greater than 160 mEq/L. This case involves a six-year-old boy who was taken to the hospital following a seizure attack, and lab analyses revealed serum sodium (Na(+)) levels of 234 mEq/L and serum chloride (Cl(-)) levels of 205 mEq/L. Clinical tests ruled out diabetes insipidus, dehydration, renal pathology, and other primary causes of hypernatremia. The child's purported history of pica, and the lab results indicating corresponding increases in levels of serum sodium (Na(+)) and serum (Cl(-)), led to a diagnosis of acute sodium toxicity by ingestion of sodium chloride. A search of the boy's house led to the discovery of rock salt in the cabinet and a container of table salt. Extrapolating from the serum sodium (Na(+)) level, it was estimated that the child had ingested approximately four tablespoons of rock salt, leading to the acute toxicity. A literature search revealed that the serum sodium (Na(+)) concentration in the present report was the highest documented level of sodium in a living person.     

Chronomics: circadian and circaseptan timing of radiotherapy, drugs, calories, perhaps nutriceuticals and beyond

We suggest a putative benefit from timing nutriceuticals (substances that are both nutrients and pharmaceuticals) such as antioxidants for preventive or curative health care, based on the proven merits of timing nutrients, drugs, and other treatments, as documented, i.a., in India. The necessity of timing melatonin, a major antioxidant, is noted. A protocol to extend the scope of chronoradiotherapy awaits testing. Imaging in time by mapping rhythms and broader time structures, chronomes, for earliest diagnoses, for example detection of vascular disease risk, is recommended. The study of rhythms and broader chronomes leads to a dynamic functional genomics, guided by imaging in time of free radicals and antioxidants, amongst many other variables.     

Congenital corneal anesthesia: a series of four case reports

PURPOSE: Discussion of four cases of congenital corneal anesthesia with varied systemic associations and modes of presentation. Classification and systemic associations of congenital corneal anesthesia along with the importance of multi-specialty evaluation of such patients. METHODS: Clinical examination of all four cases and corneal sensation assessment with Cochet-Bonnet esthesiometer. Thorough systemic examination and investigations including serum bio-chemical analysis, roentgenography, ultrasonography, nerve conduction studies, and CT scan of the patients to identify systemic associations. RESULTS: All four patients proved to have bilateral congenital corneal anesthesia with Cochet-Bonnet esthesiometry confirming corneal anesthesia. Systemic examination revealed associated congenital mesenchymal anomalies in the first case. The second case had generalized reduction in pain sensitivity confirmed by nerve conduction studies. The third case was an isolated bilateral congenital corneal anesthesia, while the fourth was a case of congenital trigeminal nerve anesthesia involving all three divisions of both trigeminal nerves. Other causes of corneal anesthesia and self-inflicted corneal injuries were ruled out by clinical multi-specialty evaluation and appropriate investigations. Correct diagnosis and symptomatic treatment aided speedy relief of symptoms of all the patients. CONCLUSION: Congenital corneal anesthesia is a rare condition and is often a diagnostic dilemma. Although more common conditions that cause corneal anesthesia can mislead the clinician, the congenital variant should be kept in mind in any case of intractable corneal ulceration in children. Early diagnosis, symptomatic treatment and measures to prevent further corneal damage will immensely help in retaining useful vision for the affected children.     

Providing health information to women. The role of magazines

OBJECTIVES: We were interested in health coverage in women's magazines in the United States and how it compared with articles in medical journals, women's health interests, and women's greatest health risks. METHODS: We examined 12 issues of Good Housekeeping (GH) and Woman's Day (WD) and 63 issues of the New England Journal of Medicine (NEJM) and the Journal of the American Medical Association (JAMA). We tallied the most common health questions of women presenting to the University of Michigan's Women's Health Resource Center (WHRC) during the same period. RESULTS: Less than a fifth of the magazine articles dealt with health-related topics. Of those, a third dealt with diet, with the majority emphasizing weight loss rather than eating for optimal health. Few of the articles cited research studies, and even fewer included the name of the journal in which the study was published. In JAMA and NEJM, less than one-fifth of original research studies dealt with women's health topics, most commonly pregnancy-related issues, hormone replacement therapy, breast and ovarian cancer, and birth defects. At the same time, the most common requests for information at the WHRC related to pregnancy, fertility, reproductive health, and cancer. CONCLUSION: The topics addressed in women's magazines do not appear to coincide with the topics addressed in leading medical journals, nor with women's primary health concerns or greatest health risks. Information from women's magazines may be leading women to focus on aspects of health and health care that will not optimize risk reduction.     

Growth hormone levels in relation to birth weight and gestational age

Growth hormone levels were measured in 33 umbilical cord blood samples collected from babies born at JIPMER Hospital during April and May-1998. The study was done to evaluate the growth hormone profile in relation to birth weight and gestational age. There was statistically significant difference in the cord blood growth hormone levels between babies weighing > 2500 gms (28.1 ± 12.83 ng/dl) and low birth weight babies (76.8 ± 55.7 ng/dl). The difference in growth hormone levels between term babies weighing >2500 gms and preterm babies (72.5 ± 29.4 ng/dl) was also statistically significant. However, there was no significant difference in the cord blood growth hormone levels between term low birth weight and preterm babies. Growth hormone levels were higher in preterm babies and low birth weight babies as compared to term babies weighing >2500 gms indicating that growth hormone has an important role to play in intrauterine growth along with other growth promoting factors.     

Laryngocele - A Case Report and Review of Literature

This is case report of 35-year old male patient presented with hoarseness and swelling on left side of neck. The swelling was noticed by the patient for 8 months. It has been diagnosed clinically and radiologically as a combined laryngocele. The laryngocele has been successfully excised using and combined approach i.e., external and endoscopic methods. This case has been reported for its rarity at this age.