Compartment Syndrome Resulting From Improper Intraosseous Cannulation: A Case Report

Obtaining adequate vascular access is imperative for effective resuscitative, therapeutic, and diagnostic interventions. The intraosseous (IO) route is indicated when immediate vascular access is needed, and standard central or peripheral intravenous (IV) access is unattainable or would delay therapy in a critical patient. We present a rare case of improper IO line placement in the right proximal tibia of a 30-year-old female involved in a motor vehicle collision, resulting in extravasation of blood products into the surrounding tissue and development of acute compartment syndrome. Emergency Medical Services was unable to obtain IV access in a timely manner, thus a right proximal tibia 45mm IO line was placed, and a unit of whole blood was given with a high-pressure infusor in the field. At the trauma center, the patient's right lower extremity was severely tense and edematous with no palpable right lower extremity pulses and no Doppler signals. Computed tomography revealed the IO catheter extending through both the proximal and distal cortices of the right tibia. Medial and lateral fasciotomy of the right lower extremity was performed in which all four compartments of the right lower leg were released and a significant hematoma was evacuated from the superficial posterior compartment. This case highlights the importance of IO access as a life-saving intervention while also underscoring the need to educate and familiarize pre-hospital and hospital healthcare personnel in delivering IO access so as to mitigate risks and improve outcomes for critically ill patients.

Validation of a photogrammetric technique for computing equine hoof volume

Assessment of equine foot conformation is often based on linear and angular measurements performed on lateral digital photographs. However, quantification of external foot conformation requires more comprehensive assessments to capture the shape of the entire foot. Volumetric measurements of the hoof capsule represent a summary measure quantifying foot shape. The aim of this study was to develop a method for computation of virtual foot models from digital foot images allowing precise and accurate volumetric measurements. This photogrammetric technique was then assessed for the characterization of foot volume changes associated with foot trimming. Using the technique, three different photographers imaged feet from 18 cadavers at different time points and one analyst processed their images to generate virtual computer models. Volumetric measurements were obtained from these models to determine their precision in the context of 'Photographer', 'Time' and the effect of 'Trimming'. Computed tomographic (CT) imaging was used to assess the accuracy of the photogrammetric method. Pre-trim photogrammetric measurements showed excellent precision and accuracy and the results did not depend on the person acquiring the images. The accuracy of post-trim photogrammetric measurements deteriorated in comparison with the average differences measured by CT imaging (19 cm(3)). Precise volumetric measurements were obtained using the photogrammetric method, but average differences in foot volume after trimming as measured by CT imaging are likely too small to be detected with confidence.

Management of gastroentero-pancreatic neuroendocrine tumors (GEP-NETs)

Neuroendocrine tumors (NETs) are relatively rare neoplasms that often present as diagnostic dilemmas due to obscure or non-specific symptoms. The ability of carcinoid tumors to cause clinical symptoms by secretion of hormones or biogenic amines is best recognised in the form of the carcinoid syndrome. Although generally slow growing, a significant minority demonstrate aggressive tumor growth. Ten-twenty percent of pancreatic NETs may be associated with hereditary disorders such as multiple endocrine neoplasia-1 (MEN-1) and less frequently, Von Hippel Lindau, which should be considered in the investigation and management of these patients. A small percentage of NETs are associated with co-existing synchronous non-carcinoid neoplasm. The aim of this paper was to review the optimal management in patients with NETs. The therapeutic options which are reviewed, including the use of somatostatin analogues, the role of surgery, the use of chemotherapy, biotherapy using interferon, peptide receptor targeted therapy. In addition, the challenging interventional management of liver metastases is discussed, including the role of hepatic-artery embolization, radiofrequency ablation and the place of orthotoptic liver transplantation in selected patients. Authors have focused on the newest therapeutic modalities, e.g., radionuclide peptide receptor targeted therapy with Yttrium-90 and Lutetium-177, the newest somatostatin analogues such as pasireotide and angiogenic inhibitors. In conclusion, with the increasing number of investigative procedures and therapeutic options available to diagnose and treat carcinoid tumors, it is vital to have a multidisciplinary approach. Furthermore, additional scientific research and controlled clinical trials are needed to determine the efficacy of the many treatment options, which for these rare tumors can only be achieved by collaboration.

Study of ground water quality for irrigation in some villages of Surat District, Gujarat (India)

40 ground water samples of 10 villages in Surat district, Gujarat (India) were analyzed for their suitability for irrigation purpose. The mean values of 4 samples taken from each village have been reported in the present study. Ground water of the study area was classified according to sodium adsorption ratio (SAR), percentage sodium (PS), residual sodium carbonate (RSC), Kelley's ratio and electrical conductivity. The value of sodium adsorption ratio indicated that majority of samples (9 out of 10) fall in low sodium hazard category. As per classification made by Wilcox (1948), on the basis of percentage sodium and electrical conductivity, only 1 sample (Vesu) not found suitable for irrigation purpose while only 1 sample (Gaviyar) found in good category. The remaining 8 samples were in good to permissible and permissible to doubtful category. Ground water was also classified according to the classification of United States Salinity Laboratory based on sodium and salinity hazard.

CT demonstration of postpneumonectomy tumor recurrence

Seven patients with suspected recurrent tumor who had undergone pneumonectomy for carcinoma of the lung were studied by computed tomography (CT) to evaluate the location, extent, and nature of the tumor. In six patients with proven recurrence in the chest, CT demonstrated the tumor in five, four as a mass near the bronchial stump and one as a parasternal mass. (In one patient, surgical clip artifacts prevented interpretation). This information was useful in planning radiation therapy treatments in four patients.