PURPOSE: Non-operative management (NOM) has been validated for blunt liver and splenic injuries. Literature on continuous intra-abdominal pressure (IAP) monitoring as a part of NOM remains to be equivocal. The study aimed to find any correlation between clinical parameters and IAP, and their effect on the NOM of patients with blunt liver and splenic injury. METHOD: A prospective cross-sectional study conducted at a level I trauma center from October 2018 to January 2020 including 174 patients who underwent NOM following blunt liver and splenic injuries. Hemodynamically unstable patients or those on ventilators were excluded, as well as patients who suffered significant head, spinal cord, and/or bladder injuries. The study predominantly included males (83.9%) with a mean age of 32.5 years. IAP was monitored continuously and the relation of IAP with various parameters, interventions, and outcomes were measured. Data were summarized as frequency (percentage) or mean ± SD or median (Q₁, Q₃) as indicated. χ² or Fisher's exact test was used for categorical variables, while for continuous variables parametric (independent t-test) or nonparametric tests (Wilcoxon rank sum test) were used as appropriate. Clinical and laboratory correlates of IAP < 12 with p < 0.200 in the univariable logistic regression analysis were included in the multivariable analysis. A p < 0.05 was used to indicate statistical significance. RESULTS: Intra-abdominal hypertension (IAH) was seen in 19.0% of the study population. IAH was strongly associated with a high injury severity score (p < 0.001), and other physiological parameters like respiratory rate (p < 0.001), change in abdominal girth (AG) (p < 0.001), and serum creatinine (p < 0.001). IAH along with the number of solid organs involved, respiratory rate, change in AG, and serum creatinine was associated with the intervention, either operative or non-operative (p = 0.001, p = 0.002, p < 0.001, p < 0.001, p = 0.013, respectively). On multivariable analysis, IAP (p = 0.006) and the mean change of AG (p = 0.004) were significantly associated with the need for intervention. CONCLUSION As a part of NOM, IAP should be monitored as a continuous vital. However, the decision for any intervention, either operative or non-operative cannot be guided by IAP values alone.
Humans ; Male ; Adult ; Female ; Wounds, Nonpenetrating/physiopathology* ; Spleen/injuries* ; Prospective Studies ; Cross-Sectional Studies ; Liver/injuries* ; Middle Aged ; Monitoring, Physiologic/methods* ; Pressure ; Abdominal Injuries/physiopathology* ; Intra-Abdominal Hypertension ; Young Adult

Dermoid cysts originate from embryonic tissues trapped in the cranial fusion lines and typically manifest extra-axially. However, intradiploic dermoid cysts are rare among cranial tumors, and their rupture has been sparsely documented. We present a case showcasing a remarkable phenomenon—the spontaneous rupture of an intradiploic dermoid cyst into the subarachnoid space, displaying a distinct “volcano-like” appearance on CT and MRI scans. This case represents the first documented instance of spontaneous intracranial rupture of an intradiploic dermoid cyst into the subarachnoid space. Although uncommon, this rupture poses a risk of severe complications, such as chemical meningitis and vasospasm. This extraordinary presentation of an uncommon lesion at an atypical location may contribute to a better understanding of the potential mechanisms of rupture, thereby emphasizing the importance of recognition and exploration.

Dermoid cysts originate from embryonic tissues trapped in the cranial fusion lines and typically manifest extra-axially. However, intradiploic dermoid cysts are rare among cranial tumors, and their rupture has been sparsely documented. We present a case showcasing a remarkable phenomenon—the spontaneous rupture of an intradiploic dermoid cyst into the subarachnoid space, displaying a distinct “volcano-like” appearance on CT and MRI scans. This case represents the first documented instance of spontaneous intracranial rupture of an intradiploic dermoid cyst into the subarachnoid space. Although uncommon, this rupture poses a risk of severe complications, such as chemical meningitis and vasospasm. This extraordinary presentation of an uncommon lesion at an atypical location may contribute to a better understanding of the potential mechanisms of rupture, thereby emphasizing the importance of recognition and exploration.

Dermoid cysts originate from embryonic tissues trapped in the cranial fusion lines and typically manifest extra-axially. However, intradiploic dermoid cysts are rare among cranial tumors, and their rupture has been sparsely documented. We present a case showcasing a remarkable phenomenon—the spontaneous rupture of an intradiploic dermoid cyst into the subarachnoid space, displaying a distinct “volcano-like” appearance on CT and MRI scans. This case represents the first documented instance of spontaneous intracranial rupture of an intradiploic dermoid cyst into the subarachnoid space. Although uncommon, this rupture poses a risk of severe complications, such as chemical meningitis and vasospasm. This extraordinary presentation of an uncommon lesion at an atypical location may contribute to a better understanding of the potential mechanisms of rupture, thereby emphasizing the importance of recognition and exploration.

An undifferentiated carcinoma (UC) of the gall bladder behaves aggressively and has a grave prognosis. Small cell type undifferentiated carcinoma of the gall bladder is a rare variant. This paper reports a case of UC of gall bladder with PAS-positive diastase-resistant eosinophilic hyaline globules present as liver mass (on imaging) in a male patient. The microscopic findings of the liver and gall bladder after a right tri-segmentectomy showed an un-differentiated malignant neoplasm composed of cells with round to oval nuclei, prominent nucleoli, and scanty neoplasm. No definite cell pattern was identified with these neoplastic cells. A section from the gall bladder revealed a tumor arising from the lining epithelium and infiltrating through the muscularis. This tumor was infiltrating the adherent liver tissue directly and forming a mass of undifferentiated malignant cells. The focal area within the tumor mass showed the presence of PAS-positive, diastase-resistant, eosinophilic hyaline globules within the neoplastic cells. The immunohistochemistry test was diffusely positive for perinuclear anti-neutrophil cytoplasmic antibodies and negative for chromogranin, vimentin, Desmin, alpha-fetoprotein, leukocyte common antigen, CD34, and bcl2. When the clinical and radiological data are inconclusive, careful analysis of the histological and immunophenotypic features is needed to make the final diagnosis of UC of the gall bladder. The biological behavior and prognosis of this tumor remain unclear because of its rarity. Further studies will be needed to understand the characteristics of this deadly tumor and to establish an effective therapy for it.

Background: Young age in osteonecrosis of the femoral head (ONFH) demands bone-preserving, short-stem arthroplasty. Several designs including neck-preserving stems and neck-resecting, shortened, standard stems are classified as short stems. There is a paucity of literature investigating risk factors and outcomes of intraoperative complications of neck preserving, short-stem arthroplasty in ONFH. Methods: A total of 107 hips operated with METHA short-stem arthroplasty for ONFH were retrospectively evaluated. The mean age of patients was 43.7 years (range, 27–60 years). Nine patients had an intraoperative fracture. Seven hips received prophylactic cerclage wiring for poor bone quality. Patients were invited for clinical and radiological evaluation at the latest follow-up. Results: The mean follow-up of patients was 47.2 months. Significant association with intraoperative fractures and the need for prophylactic cerclage wiring were found in steroids-, alcohol-, and chronic renal failure-induced ONFH. However, patient sex, body mass index, traumatic/idiopathic ONFH, previous implant in situ, prosthesis size, and single-sitting bilateral total hip replacement (THA) were not the risk factors. All hips showed signs of osteointegration at final follow-up. No revision was done during the study period for any cause. Conclusions METHA short-stem THA offers excellent functional and radiological outcomes in ONFH. However, precaution must be exercised in patients with steroids-, alcohol-, and renal disorders-induced ONFN due to poor bone quality and higher chances of intraoperative fractures. Also, additional measures such as the use of a high-speed burr and prophylactic cerclage wiring in ONFH may allow predictable and safe use of short stems.

Background: Inferior alveolar nerve block (IANB) is known to have a lower success rate for anesthesia in patients with irreversible pulpitis. This calls for supplementary techniques to effectively anesthetize such patients.This systematic review aimed to evaluate the published literature for determining the success rate of anesthesia induction using post-IANB intraligamentary (IL) injection in the mandibular teeth of patients with symptomatic irreversible pulpitis. The review question was, “What is the success rate of IL injection in the mandibular teeth of patients with irreversible pulpitis as a supplementary technique for endodontic treatment?” Methods: A thorough search of electronic databases and manual searches were performed. The protocol of the review was framed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist and was registered in the International Prospective Register of Ongoing Systematic Reviews (PROSPERO) with a proper criterion for inclusion and exclusion of studies. The included studies were analyzed using the Cochrane Collaboration ‘‘Risk of Bias’’ tool. A meta-analysis that included a comparison of primary nerve block and supplemental IL injection was performed. The success rate was evaluated using the combined risk ratio (RR) with a random risk model. A funnel plot was created to measure publication bias. Results: After all analyses, four studies were included. In the forest plot representation, RRs were 3.56 (95% CI: 2.86, 4.44), which were in favor of the supplemental IL injections. Statistical heterogeneity was found to be 0%. These values suggest that supplemental IL injections provide better success rates for anesthesia. Conclusion According to the pooled qualitative and quantitative analyses, supplemental IL injections increased anesthetic efficacy.

Historically, osteoarticular tuberculosis (TB), including spinal TB, was treated with prolonged course of antitubercular therapy (ATT). Due to various challenges, there has been reluctance to explore the use of short-course ATT in spinal TB. However, with the success of short-course ATT being demonstrated in other forms of extrapulmonary TB, the subject is open for debate again. Therefore, we systematically reviewed various published literature to determine whether short-course treatment regimen (6 months) of ATT provides equivalent results in terms of disease healing as long-course treatment regimen (≥9 months) in the management of spinal TB. Five electronic databases (PubMed, MEDLINE, EMBASE, CENTRAL, and Web of Science) and their reference lists were searched to identify relevant randomized controlled trials with at least 1 year of follow-up that compared short-course with standard-course ATT for treatment of spinal TB. The methodological quality of included studies was assessed, and their data were extracted. A meta-analysis was used to calculate pooled effect sizes and 95% confidence interval (CI). The outcome measure was healed status of the disease at the final follow-up. Of 331 publications identified through literature search, eight publications describing six randomized studies were included. Moreover, 375 of 414 patients (90.58%) who received 6 months of ATT had healed status at their final follow-up compared to 404 of 463 patients (87.26%) who received ≥9 months of ATT. Overall, the healed status of spinal TB was equivalent in patients in both groups (pooled relative risk, 0.98; 95% CI, 0.92–1.04; p =0.439). However, there was considerable heterogeneity among the trials (I2=40.8%, p =0.149). The results suggest that the use of short-course (6 months) chemotherapy may be considered for the treatment of spinal TB in view of the similarity in the healing response achieved compared to treatment regimens of longer duration.

Methods: In a double-blinded setup, 124 patients randomly received either of the following injections: 2% lidocaine with 1:80,000 epinephrine, 2% lidocaine with 1:80,000 epinephrine mixed with 2 mg dexamethasone, or plain 2% lidocaine mixed with 2 mg dexamethasone, which were injected as a primary IANB. Ten minutes after injection, patients with profound lip numbness underwent electric and thermal pulp sensibility tests. Patients who responded positively to the tests were categorized as “failed” anesthesia and received supplemental anesthesia. The remaining patients underwent endodontic treatment using a rubber dam. Anesthetic success was defined as “no pain or faint/weak/mild pain” during endodontic access preparation and instrumentation (HP visual analog scale score < 55 mm). The effect of the anesthetic solutions on the maximum change in heart rate was also evaluated. The Pearson chi-square test at 5% and 1% significance was used to analyze anesthetic success rates. Results: The 2% lidocaine with 1:80,000 epinephrine, 2% lidocaine with 1:80,000 epinephrine mixed with 2 mg dexamethasone, and plain 2% lidocaine mixed with 2 mg dexamethasone groups had anesthetic success rates of 34%, 59%, and 29%, respectively. The addition of dexamethasone resulted in significantly better results (P < 0.001, χ 2 = 9.07, df = 2). Conclusions The addition of dexamethasone to 2% lidocaine with epinephrine, administered as an IANB, can improve the anesthetic success rates during the endodontic management of symptomatic mandibular molars with irreversible pulpitis.