Atraumatic Reciprocal Scapula Fracture - A Case Report and Review of Literature

Introduction

Scapula fractures are very rare and bilateral reciprocal involvement is rarest of all. Due to the protective nature of surrounding musculature, it is least prone to fracture with reported incidence of 1% of all skeletal fractures. However, synchronized firing of the periscapular muscles could overcome the bone strength resulting into the fracture as in the cases of electrocution and seizure attack.

Case Report

We present a case of 54-year-old ex-military male patient with a history of acute onset seizure of multiple episodes. Magnetic resonance imaging showed cerebrovascular thrombosis. The patient was admitted in the intensive care and complained pain over bilateral shoulder with restricted movement in the post-ictal phase. X-ray showed bilateral comminuted extra-articular scapular fractures. The severity of the injury and displacement of the fracture pronounced operative intervention. Modified Judet approach was used to approach the fractures. After a successful surgery, rehabilitation protocol constituted of passive range of motion exercises with gradual active exercises of shoulder. One-year follow-up showed good consolidation of both fracture with full recovery of function.

Conclusion

Periscapular musculature protects the scapula from traumatic events due to the significant bulk that it provides but these can on the other hand be source of deforming force in the patient who has history of simultaneous contraction as in the case of recurrent episodic seizure or electrocution. Scapular fracture should always be suspected in the patient with insidious development of shoulder pain following strong seizure attack. These fractures if indicated should be managed operatively.

Blood transfusion practices in a tertiary care hospital in Nepal

Background: Blood transfusion is an integral part of patient management. Good transfusion practice guided by standard protocols is considered ideal for optimal use of resources and manpower. Cross-match requests disproportionate to the actual requirement causes overestimation of blood usage and potential wastage. This study aims to determine the crossmatch, transfusion, and utilization rates for blood using transfusion index, and cross-match to transfusion ratio in the various departments of the hospital for the evaluation of transfusion practices. Materials and Methods: A retrospective study was conducted using the records from the hospital blood bank for 12 months to obtain transfusion and cross-match records from various clinical units. Transfusion requests, units cross-matched, and completed transfusions were used to calculate the cross-match to transfusion ratio, and transfusion index for each department. Results: A total of 5156 units of blood were cross-matched for 3437 transfusion requests, out of which 3752 were transfused, giving a mean cross-match to transfusion ratio of 1.37. The non-usage of blood was 27.2% and the transfusion index stood at 1.09. The cross-match to transfusion ratio for the individual clinical units ranged from 1.75 (Surgery) to 1.14 (Medicine). Conclusions: The cross-match to transfusion ratio and transfusion index were within recommended ranges, showing good utilization and low blood wastage. The establishment of a blood ordering protocol via a multidisciplinary approach should be considered to further optimize blood transfusion practices.

Precision Measurement of the First Ionization Potential of Nobelium

One of the most important atomic properties governing an element's chemical behavior is the energy required to remove its least-bound electron, referred to as the first ionization potential. For the heaviest elements, this fundamental quantity is strongly influenced by relativistic effects which lead to unique chemical properties. Laser spectroscopy on an atom-at-a-time scale was developed and applied to probe the optical spectrum of neutral nobelium near the ionization threshold. The first ionization potential of nobelium is determined here with a very high precision from the convergence of measured Rydberg series to be 6.626 21±0.000 05  eV. This work provides a stringent benchmark for state-of-the-art many-body atomic modeling that considers relativistic and quantum electrodynamic effects and paves the way for high-precision measurements of atomic properties of elements only available from heavy-ion accelerator facilities.

Probing Sizes and Shapes of Nobelium Isotopes by Laser Spectroscopy

Until recently, ground-state nuclear moments of the heaviest nuclei could only be inferred from nuclear spectroscopy, where model assumptions are required. Laser spectroscopy in combination with modern atomic structure calculations is now able to probe these moments directly, in a comprehensive and nuclear-model-independent way. Here we report on unique access to the differential mean-square charge radii of ^{252,253,254}No, and therefore to changes in nuclear size and shape. State-of-the-art nuclear density functional calculations describe well the changes in nuclear charge radii in the region of the heavy actinides, indicating an appreciable central depression in the deformed proton density distribution in ^{252,254}No isotopes. Finally, the hyperfine splitting of ^{253}No was evaluated, enabling a complementary measure of its (quadrupole) deformation, as well as an insight into the neutron single-particle wave function via the nuclear spin and magnetic moment.

Plagiarism: A New Challenge For Scientific Publication

Not available.Birat Journal of Health SciencesVol.2/No.1/Issue 2/ Jan - April 2017, Page: 148-149

Retroperitoneal pararenal castleman’s disease: a case report

Castleman’s diseas is a rare lymphoproliferative disorder of unknown etiology. We report a 28 years old woman with solitary Castleman’s disease in the left pararenal space. This case was diagnosed preoperatively as renal cell carcinoma. The patient underwent a radical nephrectomy with dissection of pararenal mass. Histopathological examination of the surgically resected specimen showed the hyaline vascular type of Castleman’s disease. A preoperative diagnosis of Castleman’s disease is difficult; therefore, a surgical resection and histopathological evaluation can provide an accurate diagnosis of tumor. Taking this case into consideration, we suggest that Castleman’s disease should be included in the differential diagnosis of renal tumors. DOI: http://dx.doi.org/10.3126/jpn.v3i6.9004 Journal of Pathology of Nepal (2013) Vol. 3, 509-511

Giant Cell Tumor Arising from Anterior Arc of First Rib- A Rare Presentation

We report a case of Giant Cell Tumor (GCT) arising from anterior are of first rib along with literature review which was treated with excision of rib through its normal margin along with tumor mass. GCT of rib is rare and if found mostly arises from the posterior aspect. However, GCT should be considered as differential diagnosis when bony mass is present in the anterior are of rib. It poses surgical challenge for excision because of the delicate and vital neurovascular structures passing above it between clavicle and first rib. Keywords: first rib, giant cell tumor.

Giant cell tumor arising from anterior arc of first rib: a rare presentation

We report a case of Giant Cell Tumor (GCT) arising from anterior are of first rib along with literature review which was treated with excision of rib through its normal margin along with tumor mass. GCT of rib is rare and if found mostly arises from the posterior aspect. However, GCT should be considered as differential diagnosis when bony mass is present in the anterior are of rib. It poses surgical challenge for excision because of the delicate and vital neurovascular structures passing above it between clavicle and first rib.