Search

A wide variety of diseases present with intracranial lesions. In this case report, a 67-year-old man initially presented to an outside hospital with nausea, headache, and ataxia and was found to have multiple intracranial lesions. Diagnostic workup was ultimately unrevealing, and his condition improved after a course of steroids and antibiotics. Unfortunately, symptoms returned three months later. MRI brain revealed progression of his intracranial lesions. This case highlights a diagnostic approach and general management strategy for patients presenting with undifferentiated intracranial pathology. A final diagnosis is ultimately reached and raises further discussion.

In this work, we consider the system of partial differential equations describing one-dimensional (1D) radially symmetric (i.e., cylindrical or spherical) flow of a nonideal gas with small solid dust particles. We analyze the implosion of cylindrical and spherical symmetric strong shock waves in a mixture of a nonideal gas with small solid dust particles. An evolution equation for the strong cylindrical and spherical shock waves is derived by using the Maslov technique based on the kinematics of 1D motion. The approximate value of the similarity exponent describing the behavior of strong shocks is calculated by applying a first-order truncation approximation. The obtained approximate values of similarity exponent are compared with the values of the similarity exponent obtained from Whitham’s rule and Guderley’s method. All the above computations are performed for the different values of mass fraction of dust particles, relative specific heat, and the ratio of the density of dust particle to the density of the mixture and van der Waals excluded volume.

The anterolateral thigh (ALT) flap is a workhorse soft tissue flap. Anteromedial thigh (AMT) flap has been used as a savior flap when lateral thigh perforators are absent. ALT and AMT flaps are based on cutaneous perforators arising from the descending branch of the lateral circumflex femoral artery (LCFA), a branch of the profunda femoris artery (PFA). Here, we present a case report of a chimeric ALT and AMT flap where the perforators were directly arising from the superficial femoral artery (SFA). This case highlights an unusual origin of the vascular pedicle in the ALT and AMT flaps and promotes the freestyle perforator flap harvest theory. Level of evidence: Level V, therapeutic study.

Children with minor head injuries (MHI) are routinely transferred to a pediatric trauma center for definitive care. Unwarranted transfers result in minimal benefit to the patient and add substantially to healthcare costs. The purpose of this study is to explore the factors associated with avoidable interhospital transfers of children with MHI.We conducted a retrospective cohort study of children18 years of age transferred to our pediatric emergency department (PED) for MHI between January 2013 and December 2018. Patients transferred for non-accidental trauma, and those with a history of coagulopathies, underlying neurological conditions, intraventricular shunts and developmental delay were excluded. Transfers were categorized as avoidable if none of the following interventions were required at our PED: procedural sedation, anticonvulsant initiation, subspecialty consultation, intensive care unit admission or hospital admission for ≥2 nights, intubation or operative intervention. We collected demographics, injury mechanism, neuroimaging results, interventions performed and PED disposition. Binary logistic regression was conducted to provide adjusted associations between patient characteristics and the risk of avoidable interhospital transfers.We analyzed 1078 transfers for MHI, of which 450 (42%) transfers were classified as avoidable. Children in the avoidable transfer group tended to be younger, less likely to have experienced loss of consciousness, and more likely to belong to the the group at lowest risk for a clinically important traumatic brain injury (ciTBI). Our multivariable model determined that children less than 2 years of age (OR = 1.75; 95% CI = 1.3-2.37), low-risk group for ciTBI (OR = 1.66; 95% CI = 1.22-0.1), and a positive head CT at the transferring hospital (OR = 0.06; 95% CI = 0.02-0.1) were all significantly associated with avoidable transfers.There is a high rate of avoidable transfers in children with MHI. Focused interventions targeting risk factors associated with avoidable transfers may reduce unwarranted interhospital transfers.

Children with traumatic head injury are often transferred from community Emergency Departments (ED) to a Pediatric Emergency Department (PED). The primary objective of this study was to describe the outcomes of minor head injury (MHI) transfers to a PED. The secondary objective was to report Computed Tomography (CT) utilization rates for MHI.We conducted a retrospective study of children aged ≤18 years transferred to our PED for MHI from 2013 to 2018. Patients with Glasgow Coma Scale (GCS) 14, coagulopathies, history of brain mass/shunt and suspected non-accidental trauma were excluded. Data collected included demographics, interventions performed, and disposition. MHI risk stratification and clinically important traumatic brain injury (ciTBI) were defined per the Pediatric Emergency Care Applied Research Network (PECARN) head injury guidelines. Descriptive statistics were reported using general measures of frequency and central tendency.A total of 1078 children with MHI were analyzed based on eligibility criteria. The majority of patients were male (62%) and ≥ 2 years of age (69.3%). Subspecialist consultation (57.2%) and neuroimaging (27.4%) were the most commonly performed interventions in the PED. Only 14 children (1.3%) required neurosurgical intervention. One-third of the transferred patients required no additional work-up. Two-thirds of the patients (66.6%) were directly discharged from the PED. Though the total number of MHI transfers per year declined steadily during the study period (from 271/year to 119/year), CT head utilization remained relatively similar across the study years (60.3% to 70.8%). A higher proportion of children received CT in the ED when compared to the PED for low-risk (28.9% vs 15.8%) and intermediate-risk groups (42.8% vs 29.4%).The majority of pediatric MHI transfers are discharged home following a subspecialty consultation and/or neuroimaging. Despite guidelines and a low incidence of ciTBI, CT utilization remains high in the intermediate and low risk MHI groups, especially in the community settings. Targeted interventions are needed to reduce the potentially avoidable transfers and low-value performance of CT in children with MHI.

Minor head injury (MHI) in children is a common emergency department (ED) presentation. It is well established that majority of these patients don't require imaging and can be safely discharged. What is less known is how often these children come back to the ED and the outcome of their revisits? The objective of this study was to describe the frequency and outcome of unscheduled return visits (RVs) for MHI in a pediatric ED.A retrospective chart review of emergency department RV's database was conducted from August 2016 to July 2019. MHI patients18 years of age who came back to the ED within 72 h of their index visit - for head injury related complaints - were eligible for inclusion.Return visit rate for MHI was around 1% (61/6225). Of these, 55.7% (34/61) were female and 85.5% (53/61) were in the age group 2-17 years. Three-fourths of the revisits were for concussion-related symptoms. Nearly two-thirds of the patients required one or more interventions upon revisit. Missed clinically important traumatic brain injury was rare. Only one patient required operative intervention upon revisit. Though largely unpreventable, 5% (3/61) of the revisits were deemed potentially avoidable.RVs secondary to MHI in children remain low and are associated with good outcomes.

In this article, a system of partial differential equations governing the one-dimensional motion of an inviscid gas with solid dust particles is considered. The evolutionary behavior of cylindrical and spherical shock waves in dusty gas is determined. To accomplish this, we used a technique that is based on the kinematics of the one-dimensional motion of shock waves. This allowed us to derive an infinite hierarchy of transport equations that describe the strength of shock waves and the induced discontinuity behind them. These equations are used to determine both the decay and growth behaviors of shock waves in dusty gas. Considering the first two truncation approximations, the results so obtained are compared with the results obtained by Guderley’s exact solution and CCW approximation.

Background There is a steep learning curve to attain a consistently good result in microvascular surgery. The venous anastomosis is a critical step in free-tissue transfer. The margin of error is less and the outcome depends on the surgeon’s skill and technique. Mechanical anastomotic coupling device (MACD) has been proven to be an effective alternative to hand-sewn (HS) technique for venous anastomosis, as it requires lesser skill. However, its feasibility of application in emerging economy countries is yet to be established. Material and Method We retrospectively analyzed the data of patients who underwent free-tissue transfer for head and neck reconstruction between July 2015 and October 2020. Based on the technique used for the venous anastomosis, the patients were divided into an HS technique and MACD group. Patient characteristics and outcomes were measured. Result A total of 1694 venous anastomoses were performed during the study period. There were 966 patients in the HS technique group and 719 in the MACD group. There was no statistically significant difference between the two groups in terms of age, sex, prior radiotherapy, prior surgery, and comorbidities. Venous thrombosis was noted in 62 (6.4%) patients in the HS technique group and 7 (0.97%) in the MACD group (p = 0.000). The mean time taken for venous anastomosis in the HS group was 17 ± 4 minutes, and in the MACD group, it was 5 ± 2 minutes (p = 0.0001). Twenty-five (2.56%) patients in the HS group and 4 (0.55%) patients in MACD group had flap loss (p = 0.001). Conclusion MACD is an effective alternative for HS technique for venous anastomosis. There is a significant reduction in anastomosis time, flap loss, and return to operation theater due to venous thrombosis. MACD reduces the surgeon’s strain, especially in a high-volume center. Prospective randomized studies including economic analysis are required to prove the cost-effectiveness of coupler devices.

Studies on Non-linear evolutionary equations have become more critical as time evolves. Such equations are not far-fetched in fluid mechanics, plasma physics, optical fibers, and other scientific applications. It should be an essential aim to find exact solutions of these equations. In this work, the Lie group theory is used to apply the similarity reduction and to find some exact solutions of a (3+1) dimensional nonlinear evolution equation. In this report, the groups of symmetries, Tables for commutation, and adjoints with infinitesimal generators were established. The subalgebra and its optimal system is obtained with the aid of the adjoint Table. Moreover, the equation has been reduced into a new PDE having less number of independent variables and at last into an ODE, using subalgebras and their optimal system, which gives similarity solutions that can represent the dynamics of nonlinear waves.

Song et al. reported an anterolateral thigh (ALT) flap as a septocutaneous flap in 1984. Conventionally anterolateral thigh flap is based on the perforators arising from the descending branch of the lateral circumflex femoral artery (LCFA), accompanied by two venae comitantes, one on either side. We present an infrequent anatomical presentation of descending branch of LCFA in which two arteries accompanied a single central vein. This pattern was exactly the opposite of conventional anatomy. One of the arteries (lateral) was arising from the LCFA main trunk, and the other (medial) artery was emerging from the LCFA branch to the rectus femoris muscle. The larger artery was used for arterial anastomosis, and the lone vein was used for venous anastomosis. The patient had an uneventful recovery. To the best of our knowledge, the unusual pattern described above is not reported before. Level of Evidence: Level V, risk / prognostic study

In this paper, the surface theory and compatibility conditions are used to describe the behavior of wave propagation and their culmination into a shock wave in a non-ideal reacting gas with dust particles. The one-dimensional steepening of waves is considered. A Bernoulli-type transport equation for the velocity gradient is obtained. A numerical approach is used to explain the effects of van der Waals excluded volume of the medium, radiation parameter, ratio of specific heats and dust particles.

Blast waves are produced when there is a sudden deposition of a substantial amount of energy into a confined region. It is an area of pressure moving supersonically outward from the source of the explosion. Immediately after the blast, the fore-end of the blast wave is headed by the shock waves, propagating in the outward direction. As the considered problem is highly nonlinear, to find out its solution is a tough task. However, few techniques are available in literature that may give us an approximate analytic solution. Here, the blast wave problem in magnetogasdynamics involving cylindrical shock waves of moderate strength is considered, and approximate analytic solutions with the help of the power series method (or Sakurai’s approach [1]) are found. The magnetic field is supposed to be directed orthogonally to the motion of the gas particles in an ideal medium with infinite electrical conductivity. The density is assumed to be uniform in the undisturbed medium. Using power series method, we obtain approximate analytic solutions in the form of a power series in ( a 0 / U ) 2 ${\left({a}_{0}/U\right)}^{2}$ , where a 0 and U are the velocities of sound in an undisturbed medium and shock front, respectively. We construct solutions for the first-order approximation in closed form. Numerical computations have been performed to determine the flow-field in an ideal magnetogasdynamics. The numerical results obtained in the absence of magnetic field recover the existing results in the literature. Also, these results are found to be in good agreement with those obtained by the Runge–Kutta method of fourth-order. Further, the flow variables are illustrated through figures behind the shock front under the effect of the magnetic field. The interesting fact about the present work is that the solutions to the problem are obtained in the closed form.