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Cureus Dec 2022Introduction Animal attacks cause a considerable number of injuries and lead to morbidity and mortality among children and adults. Bull gore injuries following...
Introduction Animal attacks cause a considerable number of injuries and lead to morbidity and mortality among children and adults. Bull gore injuries following bullfighting and other provoked attacks have been frequently described in literature. Our study describes the pattern of injuries and the unique mechanisms and management of blunt and penetrating trauma associated with unprovoked bull attacks. Methods In this retrospective study, we collected the data of 36 patients presenting to our emergency department with a history of bullhorn injury. The data comprised age, sex, location of injury, type and description of the injury, surgical procedure performed if any, requirement of postoperative intensive care unit (ICU) admission, and mortality. The data were then compiled and analyzed with MS Excel. Results Among the 36 patients, blunt injuries constituted 58.3% of cases, whereas penetrating injuries were seen in 41.7%. Men were commonly injured with a mean age of 39.1 years. Thorax (36%) and abdomen (33%) were the common sites of injury followed by perineum (17%), head (5%), spine (6%), and extremity (2%). Fall following the impact of bull led to indirect injuries, such as intracranial hemorrhage, parietal bone fracture, cervical spine injuries, and tibial fracture. More than half of the patients (n=19, 52.8%) required some form of surgery under local or general anesthesia. Among the operated patients, seven required postoperative ICU care and two expired. Conclusion Animal attack injuries represent a less explored niche of surgical conditions. Management in the emergency department includes prompt resuscitation to achieve hemodynamic stability, thorough wound wash to remove the contaminants, and appropriate imaging, if indicated. Wound exploration is recommended for penetrating injuries and on a case-to-case basis for blunt injuries. The complications of these wounds are due to multiple wound paths, muscle tearing, evisceration of internal organs, and high risk of wound infection.
PubMed: 36721567
DOI: 10.7759/cureus.33075 -
Brain Tumor Research and Treatment Jan 2022Intradiploic encephalocele is a rare condition of herniation of the brain parenchyma through the diploic space. A 52-year-old man presented with a parietal intradiploic...
Intradiploic encephalocele is a rare condition of herniation of the brain parenchyma through the diploic space. A 52-year-old man presented with a parietal intradiploic encephalocele manifesting as an intermittent headache for 7 months. CT revealed an osteolytic lesion involving the right parietal bone. MRI demonstrated brain herniation within the diploic space. Surgery may be unnecessary in the absence of concurrent symptoms or neurological deficits. After 2 years of follow-up, symptoms were improved without neurological deficits and CT findings. We report the X-ray, CT, and MRI findings of an extremely rare case of parietal intradiploic encephalocele in adulthood.
PubMed: 35118847
DOI: 10.14791/btrt.2022.10.e20 -
European Spine Journal : Official... Jul 2018Chance fracture of the high thoracic spine is rare, and its impact on the adjacent cervical spine can be important.
PURPOSE
Chance fracture of the high thoracic spine is rare, and its impact on the adjacent cervical spine can be important.
METHODS
We present the case of a 16-year-old male, who fell down from a 2 m height, in an unknown context as he has a mental retardation, and no witness saw the accident. Initial CT scan revealed a comminuted depressed fracture of the right parietal bone, associated with a chance fracture at the level of T3 with a kyphosis and bilateral lung contusion.
RESULTS
The patient underwent neurosurgical treatment for elevation and reconstruction of the parietal fracture; he also underwent, 2 days later, a posterior spinal correction and fusion with T1-to-T5 instrumentation. The patient returned to normal walking on day 7 with a satisfactory clinical and radiological result at 1 year.
CONCLUSION
Literature is sparse on the treatment of high thoracic chance fractures. The current case shows that early surgical management should prevent a secondary kyphotic deformity that may need a more aggressive treatment at a later stage.
Topics: Adolescent; Humans; Male; Spinal Fractures; Thoracic Vertebrae
PubMed: 28795268
DOI: 10.1007/s00586-017-5247-8 -
The International Journal of... 2016The aim of this in vivo microcomputed tomographic (μCT) experiment was to assess in real time the efficacy of a combination of recombinant human bone morphogenetic...
Bone Regeneration Using Bone Morphogenetic Protein-2 and Biphasic Calcium Phosphate With and Without Collagen Membrane in Calvarial Standardized Defects: An In Vivo Microcomputed Tomographic Experiment in Rats.
The aim of this in vivo microcomputed tomographic (μCT) experiment was to assess in real time the efficacy of a combination of recombinant human bone morphogenetic protein-2 (rhBMP-2) and biphasic calcium phosphate (BCP), with and without resorbable collagen membrane (CM), in regeneration of standardized calvarial defects (SCDs) in rats. A total of 30 female Wistar albino rats (n = 10/group) with a mean age and weight of 7.5 months and 275 g, respectively, were used. With the rats under general anesthesia, the calvaria were exposed using full-thickness periosteal flaps and unilateral SCDs of 4.6 mm diameter were created on the left parietal bone. Defects were left untreated (control group) or randomly filled with either BCP soaked in rhBMP-2 and then covered with CM (BMP + BCP + CM group) or BCP soaked in rhBMP-2 alone (BMP + BCP group). In vivo μCT scans were done at baseline and 2, 4, 6, and 8 weeks. Newly formed bone (NFB) and remaining BCP particles were assessed for their volumes (NFBV, BCPV, respectively) and mineral densities (NFBMD, BCPMD, respectively). In vivo μCT results showed scanty amounts of new bone at the peripheries of the defect in the control group. In the other two groups, near complete defect closure was evident at 8 weeks. The mean NFBV after 8 weeks was 4.63 ± 0.96 mm(3), 11.82 ± 1.17 mm(3), and 13.85 ± 1.89 mm(3) for the control, BMP + BCP + CM, and BMP + BCP groups, respectively. After 8 weeks, the mean NFBMD was 0.38 ± 0.03 g/mm(3), 0.24 ± 0.07 g/mm(3), and 0.35 ± 0.03 g/mm(3) for the control, BMP + BCP + CM, and BMP + BCP groups, respectively. After 8 weeks, the mean BCPV and BCPMD values for the BMP + BCP + CM and BMP + BCP groups were 2.73 ± 0.65 mm(3), 0.33 ± 0.08 g/mm(3), 2.49 ± 0.71 mm(3), and 0.28 ± 0.03 g/mm(3), respectively. The present real-time in vivo μCT experiment demonstrated that BMP + BCP, either with or without CM, was effective in promoting bone regeneration within rat SCDs and enabled new bone formation starting as early as 2 weeks.
Topics: Animals; Bone Morphogenetic Protein 2; Bone Regeneration; Bone and Bones; Collagen; Female; Humans; Hydroxyapatites; Osteogenesis; Rats; Rats, Wistar; Recombinant Proteins; X-Ray Microtomography
PubMed: 27031630
DOI: 10.11607/prd.2375 -
Open Medicine (Warsaw, Poland) 2021In this study, a rare case with hemophilia pseudotumor in the skull was reported.
BACKGROUND
In this study, a rare case with hemophilia pseudotumor in the skull was reported.
CASE PRESENTATION
The case was a 34-year-old male patient who was admitted to the hospital, with the complaint of dizziness for more than 1 month. The physical examination indicated that the patient was conscious, who could give right answers to the questions. Moreover, there was a bulge on the left frontal-temporal parietal bone. The head CT showed abnormal density lesions on the left frontal-temporal parietal bone, with multiple irregular calcifications within the border. Skull MRI showed a large clump-like mixed signal at the top of the left frontal ridge. After admission, the patient was subjected to complete preoperative preparation and surgical treatment. Neurological navigation was used to determine the extent of skull defect before surgery to make a surgical incision. Clotting factor VIII substitution therapy was used for the intraoperative and postoperative treatments. The lesion was completely removed.
CONCLUSIONS
These results suggest that the skull hemophilia pseudotumor has been rarely seen. According to imaging examination, in combination with family history, the diagnosis can be confirmed. If there is no obvious occupying effect, conservative treatment can be tried. On the contrary, if there is an obvious occupying effect, surgical treatment might be effective, and coagulation factor VIII should be supplemented during the perioperative period.
PubMed: 33778161
DOI: 10.1515/med-2021-0245 -
The Journal of Craniofacial Surgery 2019Over 500,000 bone grafting procedures are performed every year in the United States for neoplastic and traumatic lesions of the craniofacial skeleton, costing $585...
INTRODUCTION
Over 500,000 bone grafting procedures are performed every year in the United States for neoplastic and traumatic lesions of the craniofacial skeleton, costing $585 million in medical care. Current bone grafting procedures are limited, and full-thickness critical-sized defects (CSDs) of the adult human skull thus pose a substantial reconstructive challenge for the craniofacial surgeon. Cell-based strategies have been shown to safely and efficaciously accelerate the rate of bone formation in CSDs in animals. The authors recently demonstrated that supraphysiological transplantation of macrophages seeded in pullalan-collagen composite hydrogels significantly accelerated wound healing in wild type and diabetic mice, an effect mediated in part by enhancing angiogenesis. In this study, the authors investigated the bone healing effects of macrophage transplantation into CSDs of mice.
METHODS
CD1 athymic nude mice (60 days of age) were anesthetized, and unilateral full-thickness critical-sized (4 mm in diameter) cranial defects were created in the right parietal bone, avoiding cranial sutures. Macrophages were isolated from FVB-L2G mice and seeded onto hydroxyapatite-poly (lactic-co-glycolic acid) (HA-PLGA) scaffolds (1.0 × 10 cells per CSD). Scaffolds were incubated for 24 hours before they were placed into the CSDs. Macrophage survival was assessed using three-dimensional in vivo imaging system (3D IVIS)/micro-CT. Micro-CT at 0, 2, 4, 6, and 8 weeks was performed to evaluate gross bone formation, which was quantified using Adobe Photoshop. Microscopic evidence of bone regeneration was assessed at 8 weeks by histology. Bone formation and macrophage survival were compared at each time point using independent samples t tests.
RESULTS
Transplantation of macrophages at supraphysiological concentration had no effect on the formation of bones in CSDs as assessed by either micro-CT data at any time point analyzed (all P > 0.05). These results were corroborated by histology. 3D IVIS/micro-CT demonstrated survival of macrophages through 8 weeks.
CONCLUSION
Supraphysiologic delivery of macrophages to CSDs of mice had no effect on bone formation despite survival of transplanted macrophages through to 8 weeks posttransplantation. Further research into the physiological effects of macrophages on bone regeneration is needed to assess whether recapitulation of these conditions in macrophage-based therapy can promote the healing of large cranial defects.
Topics: Animals; Bone Regeneration; Collagen; Cranial Sutures; Diabetes Mellitus, Experimental; Durapatite; Hydrogels; Macrophages; Mice; Mice, Nude; Osteogenesis; Parietal Bone; Skull; Tissue Scaffolds; X-Ray Microtomography
PubMed: 31609958
DOI: 10.1097/SCS.0000000000005797 -
Acta Histochemica Apr 2017Surgical hemostasis is critical in reducing the likelihood of excessive bleeding and blood transfusion. In treating some cases, commonly used hemostatic agent showed...
Surgical hemostasis is critical in reducing the likelihood of excessive bleeding and blood transfusion. In treating some cases, commonly used hemostatic agent showed limited efficacy and prolonged degradation and clearance, causing an inhibition of bone healing. Starch absorbable polysaccharide (SAPH) is a novel hemostatic agent made from a plant starch, which can be completely absorbed and achieve better hemostatic effects than many commonly used hemostatic agents. However, whether SAPH can induce a promotion of bone healing remains unknown. In this study, we used a model of rabbit parietal bone defect and a mouse osteoblast cell line MC3T3-E1 to evaluate the effects of SAPH on bone healing. We found that SAPH significantly decreased bone healing scores, reduced defective area of parietal bone, and increased the areas of bone trabeculae and cavitas medullaris. In addition, SAPH enhanced MC3T3-E1 osteoblasts proliferation, up-regulated the expressions of alkaline phosphatase (ALP) and osteocalcin and increased the level of bone morphogenetic protein 2 (BMP-2) in MC3T3-E1 osteoblasts. These SAPH-induced benefits in MC3T3-E1 osteoblasts were significantly abolished by the application of BMP-2-siRNA. These findings suggested that SAPH enhances bone healing, promotes the proliferation, differentiation and maturation of osteoblast by up-regulating BMP-2 expression in osteoblastic cells.
Topics: Absorbable Implants; Alkaline Phosphatase; Animals; Bone Morphogenetic Protein 2; Cell Differentiation; Cell Line; Cell Proliferation; Gene Expression Regulation; Hemostasis, Surgical; Mice; Osteoblasts; Osteocalcin; Parietal Bone; Rabbits; Starch
PubMed: 28168995
DOI: 10.1016/j.acthis.2017.01.011 -
Anatomical Record (Hoboken, N.J. : 2007) Jan 2024Cranial bony projections ("headgear") have diverse forms and functions, such as defense, species recognition, mate selection, and thermoregulation. Most commonly, they...
Cranial bony projections ("headgear") have diverse forms and functions, such as defense, species recognition, mate selection, and thermoregulation. Most commonly, they are associated with the artiodactyl infraorder, Pecora. All pecoran headgear-antlers, horns, ossicones, and pronghorns-are osseous protrusions of the frontal or parietal bone with an integumentary covering, although there is taxonomic, developmental, and compositional variation. However, compared with other pecorans, there is a dearth of literature addressing extant antilocaprids-Antilocapra americana. This study provides a foundational osteohistological description of A. americana pronghorn cores in order to start building a framework to better understand the complex interplay among microanatomy, development, behavior, environment, and phylogenetic history of pronghorn headgear. Osteohistological analysis of adult A. americana pronghorn cores reveal the inner medullary region is composed of trabecular bone. Based on similar studies in bovids, we propose that these trabeculae may function to reduce the effects of repeated loading incurred by intraspecific combat. The deep aspect of the outer region was found to be composed of compacted coarse cancellous bone and primary bone remodeled to dense Haversian bone, in both male and female specimens, respectively, and superficially composed of highly vascularized fibrolamellar bone. The presence of fibrolamellar bone may indicate that the bone is fast-growing, and its presence at the periosteal surface suggests protracted growth of the pronghorn core beyond sexual maturity.
PubMed: 38168904
DOI: 10.1002/ar.25370 -
Surgical Neurology International 2022Angiomatous meningioma is a rare subtype of meningiomas. To the best of our knowledge, there have been no reports of intradiploic angiomatous meningioma.
BACKGROUND
Angiomatous meningioma is a rare subtype of meningiomas. To the best of our knowledge, there have been no reports of intradiploic angiomatous meningioma.
CASE DESCRIPTION
A 53-year-old previously healthy woman was diagnosed with a calvarial lesion during a brain checkup. Cerebral magnetic resonance imaging showed an intradiploic tumor, 11 × 14 × 12 mm, in the right parietal bone. It was an enhancing, lobular tumor presenting as isointensity on T1- and hyperintensity on T2-weighted sequences, with an intense enhancement of the adjacent dura mater. Computed tomography revealed bone erosion at the tumor site, extending predominantly into the inner side, and sclerotic changes in the surrounding bone. Total resection was performed. Microscopically, the tumor tissue comprised cells with low-grade meningioma and intervening prominent vasculatures, consistent with angiomatous meningioma.
CONCLUSION
Angiomatous meningioma should be considered as a differential diagnosis when an intradiploic tumor shows a lobular structure, intense enhancement of the adjacent dura mater, and sclerotic changes in the surrounding skull. These findings can support prompt tumor resection.
PubMed: 36128095
DOI: 10.25259/SNI_520_2022 -
Journal of the Mechanical Behavior of... Aug 2021The pediatric skull differs drastically from the adult skull in terms of composition, rigidity, and structure. However, there is limited data which quantifies the...
The pediatric skull differs drastically from the adult skull in terms of composition, rigidity, and structure. However, there is limited data which quantifies the mechanical properties of the pediatric skull. The lack of mechanical data may inhibit desired pediatric craniofacial surgical outcomes as current methodologies and materials employed for the pediatric population are adapted from those used for adults. In this study, normally discarded parietal bone tissue from eight pediatric craniosynostosis surgery patients (aged 4 to 10 months) was collected during reconstructive surgery and prepared for microstructural analysis and mechanical testing. Up to 12 individual coupon samples of fresh, never frozen tissue were harvested from each specimen and prepared for four-point bending testing to failure. The microstructure of each sample was analyzed using micro-computed tomography before and after each mechanical test. From this analysis, effective geometric and mechanical properties were determined for each sample (n = 68). Test results demonstrated that the pediatric parietal skull was 2.0 mm (±0.4) thick, with a porosity of 36% (±14). The effective modulus of the tissue samples, determined from the initial slope of the sample stress-strain response using Euler beam theory and a nonlinear Ramberg-Osgood stress-strain relationship, was 4.2 GPa (±2.1), which was approximately three times less stiff than adult skull tissue reported in the literature. Furthermore, the pediatric skull was able to bend up to flexural failure strains of 6.7% (±2.0), which was approximately five times larger than failure strains measured in adult skull. The disparity between the measured mechanical properties of pediatric skull tissue and adult skull tissue points towards the need to reevaluate current surgical technologies, such as pediatric cranial surgical hardware, so that they are more compatible with pediatric tissue.
Topics: Adult; Child; Humans; Parietal Bone; Porosity; Skull; Stress, Mechanical; X-Ray Microtomography
PubMed: 34010796
DOI: 10.1016/j.jmbbm.2021.104578