Management of orbitozygomatic fractures

Background: Management of orbitozygomatic fractures forms part of the scope of practice of many oral and maxillofacial Surgeons. As aspects of management vary among surgeons who treat such injuries, this confidential study was undertaken to examine some of the protocols of Australian and New Zealand oral and maxillofacial surgeons. Results: Eighty-one per cent of the respondents treated orbitozygomatic fractures and on average. each treated approximately 24 cases per year. Also, about one in five cases required orbital floor exploration. Further, the preferred imaging baseline was computed tomography plus plain X-rays. while the preferred implant materials for orbital floor reconstruction were autologous bone and resorbable membrane. The incidence of postoperative retrobulbar haemorrhage was estimated at approximately 1:1000. Conclusion: Most oral and maxillofacial surgeons treat orbitozygomatic injuries as part of their surgical scope.

A survey of dental and oral trauma in south-east Queensland during 1998

Background: This project investigated the aetiology of dental and oral trauma in a population in southeast Queensland. The literature shows there is a lack of dental trauma studies which are representative of the general Australian population. Method: Twelve suburbs in the south-east district of Queensland were randomly selected according to population density in these suburbs for each 25th percentile. All dental clinics in these suburbs were eligible to participate. Patients presenting with dental and oral trauma were eligible to participate. Results: A total of 197 patients presented with dental/oral trauma over a 12 month period. The age of patients ranged from 1-64 years whilst the most frequently presenting age group was 6-10 years. There was a total of 363 injured teeth with an average of 1.8 injured teeth per patient. Males significantly outnumbered females in the incidence of trauma. Conclusions: The highest frequency of trauma occurred in the 6-10 year age group. Most injuries in this group occurred while playing or riding bicycles. In the next most prevalent trauma group, 16-20 years, trauma occurred as a result of fighting and playing sport. Overall, males significantly outnumbered females by approximately 1.8:1.0. The majority of injuries in the deciduous dentition were to periodontal tissues. In the secondary dentition most injuries were to hard dental tissue and pulp.

Responses to a clinical test of mechanical provocation of nerve tissue in whiplash associated disorder

Involvement of nerve tissue may contribute to the persistence of pain following a whiplash injury. This study aimed to investigate responses to the brachial plexus provocation test (BPPT) in 156 subjects with chronic whiplash associated disorder (WAD) with and without associated arm pain and 95 asymptomatic control subjects. The range of elbow extension (ROM) and visual analogue scale (VAS) pain scores were measured. Subjects with chronic WAD demonstrated significantly less ROM and higher VAS scores with the BPPT than the asymptomatic subjects (P

A rapid screen of the severity of mild traumatic brain injury

This study investigated the sensitivity of information processing, recall and orientation tasks to the presence of mild Traumatic Brain Injury (mTBI). Fifty-six (40 male, 16 female) mTBI patients and 85 (57 male and 28 female) controls with orthopaedic injuries were tested within 24 hr of injury in the Department of Emergency Medicine. mTBI patients answered fewer orientation questions and recalled fewer words in delayed recall than orthopaedic patients. mTBI patients judged fewer sentences in 2 min than orthopaedic controls, and female mTBI patients judged fewer sentences than male mTBI patients. Male mTBI patients correctly recalled fewer words during immediate memory and learning than female mTBI patients and orthopaedic controls. Those mTBI patients with a history of previous head injuries did not perform more poorly than those mTBI patients without previous head injuries. These results indicate that tests of speed of information processing, word learning and orientation questions are sensitive to the acute effects of mTBI.

Pea mania: deranged behaviour in cattle grazing a pea crop (Pisum sativum var arvense)

Hypersensitivity to external stimuli, progressing in some animals to manic behaviour, occurred in a cattle herd that grazed a crop of field peas (Pisum sativum var arvense) in the pre-flowering stage. Haematological and biochemical analyses eliminated hypomagnesaemia and ketosis as diagnoses. Other than two steers euthanased due to injuries sustained during manic episodes, all affected animals survived, recovering over 3 days when moved to alternative pasture. No necropsies were conducted. No microbial pathogens or endophytes were found on or in the plants. A previously reported incident in Victoria in 1987 in cattle grazing peas appeared to be of a similar nature. Environmental factors leading to these incidents were not clearly identified.

Unsaturated liquid percolation flow through nonwetted packed beds

The unsaturated flow of liquid through packed beds of large particles was studied using six different liquids, all with contact angles greater than 90degrees on the bed packing (wax spheres of 9, 15 and 19.4 mm diameter). The liquid flow was discrete in nature, as drops for low flow rates and rivulets for high flow rates. For unsaturated liquid flows, the actual percolation velocity, not superficial velocity, should be used to characterize the flow. The percolation velocity did not vary with packed-bed depth, but was a strong function of liquid flow rate, liquid and particle properties. Effects of liquid and particle properties (but not flow rate) are well captured by a simple correlation between the liquid-particle friction factor and Reynolds number based on actual percolation velocities. Liquid dispersion, characterized by the maximum dispersion angle, varies significantly with liquid and particle properties. The tentative correlation suggested here needs further validation for a wider range of conditions.

Ventilatory effects of neurophysiological facilitation and passive movement in patients with neurological injury

Thirteen intubated, high dependency patients with neurological injuries were studied in order to investigate the short term respiratory effects of neurophysiological facilitation and passive movement on tidal volume (V-T), minute ventilation (V-E), respiratory rate (V-R) and oxygen saturation (SpO(2)). The subjects were studied under four conditions: no intervention (control) and during periods of neurophysiological facilitation, passive movement and sensory stimulation. All periods were standardised to three minutes duration and all parameters were recorded before and after each intervention. Neurophysiological facilitation produced significant increases (p < 0.01) in V-E and SpO(2) (p < 0.05) when compared with control values, with an overall mean increase in V-E of 14.6%. Similarly, passive movement increased V-E (p < 0.01) by an average of 9.8% and also increased SpO(2) (p < 0.01). In contrast, sensory stimulation produced significant increases (p < 0.01) in SpO(2) with control levels, with no significant change in V-T or V-E. There was no significant difference in V-R with all treatments. This study provides preliminary evidence of improved short term ventilatory function following neurophysiological facilitation, independent of generalised sensory stimulation, which has not been previously examined in the literature, supporting its use in the management of high dependency neurological patients.

Beware the boogie board: blunt abdominal trauma from bodyboarding

Riding waves on a bodyboard (boogie board) at the beach is popular with children. Three teenagers who sustained blunt abdominal trauma during bodyboarding are described. Two suffered lacerated livers, one a lacerated spleen. Serious blunt abdominal injuries from bodyboarding mishaps have not previously been reported. The usual method of riding a bodyboard may place the rider at risk of abdominal trauma.

Iatrogenic bile duct injury: The scourge of laparoscopic cholecystectomy

Background: Laparoscopic cholecystectomy (LC) has become the first-line surgical treatment of calculous gall-bladder disease and the benefits over open cholecystectomy are well known. In the early years of LC, the higher rate of bile duct injuries compared with open cholecystectomy was believed to be due to the 'learning curve' and would dissipate with increased experience. The purpose of the present paper was to review a tertiary referral unit's experience of bile duct injuries induced by LC. Methods: A retrospective analysis was performed on all patients referred for management of an iatrogenic bile duct injury from 1981 to 2000. For injuries sustained at LC, details of time between LC and recognition of the injury, time from injury to definitive repair, type of injury, use of intraoperative cholangiography (IOC), definitive repair and postoperative outcome were recorded. The type of injury sustained at open cholecystectomy was similarly classified to allow the severity of injury to be compared. Results: There were 131 patients referred for management of an iatrogenic bile duct injury that occurred at open cholecystectomy (n = 62), liver resection (n = 5) and at LC (n = 64). Only 39% of bile duct injuries were recognized at the time of LC. Following conversion to open operation, half the subsequent procedures were considered inappropriate. When the injury was not recognized during LC, 70% of patients developed bile leak/peritonitis, almost half of whom were referred, whereas the rest underwent a variety of operative procedures by the referring surgeon. The remainder developed jaundice or abnormal liver function tests and cholangitis. An IOC was performed in 43% of cases, but failed to identify an injury in two-thirds of patients. The bile duct injuries that occurred at LC were of greater severity than with open cholecystectomy. Following definitive repair, there was one death (1.6%). Ninety-two per cent of patients had an uncomplicated recovery and there was one late stricture requiring surgical revision. Conclusions: The early prediction that the rate of injury during LC would decline substantially with increased experience has not been fulfilled. Bile duct injury that occurs at LC is of greater severity than with open cholecystectomy. Bile duct injury is recognized during LC in less than half the cases. Evidence is accruing that the use of cholangiography reduces the risk and severity of injury and, when correctly interpreted, increases the chance of recognition of bile duct injury during the procedure. Prevention is the key but, should an injury occur, referral to a specialist in biliary reconstructive surgery is indicated.

A review of guidelines and standards for telemedicine

We conducted a review to establish the range and scope of current telemedicine guidelines and standards. Published guidelines were identified by searching the Medline and Telemedicine Information Exchange (TIE) databases, and by performing a Google search using the term 'telemedicine guidelines'. Three types of guidelines were identified, namely clinical, operational and technical. Clinical guidelines included those for teleradiology, telepsychiatry, home telenursing, minor injuries telemedicine, surgical telemedicine, teledermatology and telepathology. Operational guidelines included those for email communication, Internet access and videoconferencing. Technical guidelines included those from the American Telemedicine Association and the US Office for the Advancement of Telehealth. The main standards relevant to telemedicine include those of the International Telecommunication Union and the DICOM standard. The scarcity of guidelines and standards suggests that telemedicine is not yet near to routine use. If an international telemedicine organization were to take responsibility for defining guidelines, under the direction of clinicians with appropriate telemedicine experience, this might speed up their development.

Starch degradation in 'Kensington' mango fruit following heat treatments

Changes in carbohydrate metabolism of 'Kensington' mango fruit from 2 major production regions in Queensland were measured after conditioning fruit with hot air at 40degreesC for 0, 2, 4, 8 and 16 h or at 22degreesC for 16 h (control) followed by hot-water treatment at either 45degreesC fruit-core temperature for 30 min or 47degreesC fruit-core temperature held for 15 min. Advancing physiological maturity of 'Kensington' mango fruit was correlated with increased starch concentration within the mesocarp. An alpha-amylase inhibitor was present in unripe 'Kensington' mesocarp. alpha-Amylase activity was promoted by conditioning fruit at 40degreesC for 8 h, and this enhanced enzyme activity persisted until the fruit were ripe. Consequently, starch degradation was accelerated and the concentration of total soluble solids was higher in fruit conditioned at 40degreesC for 8 h than in fruit left at the lower temperature of 22degreesC for 16 h or not conditioned. Immediately on removal of fruit from hot-water treatment, activities of alpha-amylase and phosphorylase were inhibited. This inhibition was correlated with higher starch concentration and starch layer and starch spot injuries in these fruit. A positive correlation was also found between increased sucrose concentration and greater starch loss in 40degreesC conditioned 'Kensington' fruit. It is proposed that increased sugar concentration in the mesocarp increased the level of fruit heat tolerance.

Appropriate indicators for injury control?

Indicators are valuable tools used to measure progress towards a desired health outcome. Increased awareness of the public health burden due to injury has lead to a concomitant interest in monitoring the impact of national initiatives that aim to reduce the size of the burden. Several injury indicators have now been proposed. This study examines the ability of each of the suggested indicators to reflect the nature and extent of the burden of non-fatal injury. A criterion validity, population-based, prospective cohort study was conducted in Brisbane, a sub-tropical Metropolitan City on the eastern seaboard of Australia, over a 12-month period between 1 January and 31 December 1998. Neither the presence of a long bone fracture nor the need for hospitalisation for 4 or more days were sensitive or specific indicators for 'serious' or major injury as defined by the 'Gold Standard' Injury Severity Score (ISS). Subsequent analysis, using other public health outcome measures demonstrated that the major component of the illness burden of injury was in fact due to 'minor' not serious injury. However, the suggested indicators demonstrated low sensitivity and specificity for these outcomes as well. The results of the study support the need to include at least all hospitalisations in any population-based measure of injury and not attempt to simplify the indicator to a more convenient measure aimed at identifying just those cases of,serious' injury.

Phytophthora sojae avirulence genes Avr4 and Avr6 are located in a 24kb, recombination-rich region of genomic DNA

A cross between two different races (race 7 x race 25) of the soybean root and stem rot pathogen Phytophthora sojae was analyzed to characterize the genomic region flanking two cosegregating avirulence genes, Anur4 and Anur6. Both genes cosegregated in the ratio of 82:17 (avirulent:virulent) in an F-2 population, suggestive of a single locus controlling both phenotypes. A chromosome walk was commenced from RAPD marker OPE7.1C, 2.0 cM distant from the Anur4/6 locus. Three overlapping cosmids were isolated which included genetic markers that flank the Anur4/6 locus. The chromosome walk spanned a physical distance of 67 kb which represented a genetic map distance of 22.3cM, an average recombination frequency of 3.0kb/cM and 11.7-fold greater than the predicted average recombination frequency of 35.3 kb/cM for the entire P. sojae genome. Six genes (cDNA clones) expressed from the Anur4/6 genomic region encompassed by the cosmid contig were identified. Single nucleotide polymorphisms and restriction fragment length polymorphisms showed these six genes were closely linked to the Anur4/6 locus. Physical mapping of the cDNA clones within the cosmid contig made it possible to deduce the precise linkage order of the cDNAs. None of the six cDNA clones appear to be candidates for Anur4/6. We conclude that two of these cDNA clones flank a physical region of approximately 24 kb and 4.3 cM that appears to include the Anur4/6 locus. (C) 2003 Elsevier Inc. All rights reserved.