Ultrasound-guided regional anaesthesia and reduction of distal radius fractures in an emergency department.

OBJECTIVES: Distal radius fractures are among the most common fractures. Ultrasound is gaining importance in the treatment of and as a tool to diagnose distal radius fractures, guide regional anaesthesia and support reductions. Our aim was to demonstrate safety, feasibility and outcome in patients with a distal radius fractures undergoing ultrasound-guided regional anaesthesia (UGRA) with ultrasound-guided reduction (UGR), as compared with procedural sedation for the reduction. METHODS: This retrospective cohort study was carried out in the emergency department of the University Hospital Basel (Switzerland) between February 2014 and October 2017. Adults with an isolated forearm fracture were eligible. The intervention group was treated with UGRA of the brachial plexus and subsequent ultrasound-assisted fracture reduction. Patients in the control group received usual care, which is blind fracture reduction with extension and immobilisation under procedural sedation. RESULTS: 71 patients were enrolled in the intervention group and 142 were to the control group. There was one (1.4%) complication (pneumothorax) in the UGR group. Twenty-five patients (35%) in the intervention group and 67 patients (47%) in the control group underwent surgery. The association between surgery and study group was not significant (p = 0.08). The patient’s age was negatively associated with surgery (p <0.001). The association between surgery and study group was significant in patients ≥60 years (p = 0.035). CONCLUSION: The combination of ultrasound-guided regional anaesthesia and ultrasound-guided reduction of distal radius fractures is feasible. Safety was shown by 70 out of 71 cases of UGRA being without complication. Effectiveness regarding the necessity of subsequent operation was comparable to usual care; in patients over 60 it may be lower with UGR.

PAH and PCB in soils of Switzerland--status and critical review.

The surface soil concentrations (0-20 cm) of the Swiss soil monitoring network (NABO) with 105 observation sites representing all major land use types ranged for the sum of 16 EPA PAH (PAH(16)) from 32 to 8465 microg kg(-1) (median 163 microg kg(-1)), for benzo[a]pyrene (BaP) from 0.5 to 1129 microg kg(-1) (median 13 microg kg(-1)) and for the sum of seven IRMM PCB (PCB(7)) from 0.5 to 12 microg kg(-1) (median 1.6 microg kg(-1)). The legal guide values of Switzerland were exceeded for PAH(16) at only three and for BaP at two sites. The PCB(7) concentrations were clearly below any assessment value. The concentration ranges were overlapping between all land use types. Tendencies for higher concentrations were observed at urban and viticulture sites. The overall measurement precision at repeatability conditions ranged from 1 to 37% RSD for PAH(16), BaP and PCB(7). The median bias for the chemical analysis was around zero for PAH(16), +5% for BaP and -5% for PCB(7) with spreads ranging from less than -20% up to more than +30%. The PAH profiles were clearly dominated by phenanthrene. Stratification by land use revealed a prevalence of benzo[a]pyrene at urban and naphthalene at conservation sites. For PCB, the general congener rank order was PCB no. 153 > 138 > 101 > 180. From a broad correlation screening only PAH(16)/BaP (r = 0.88**) were relevant for practical soil protection. The extensive comparison with other studies was severely biased by the lack of harmonisation, especially concerning sampling depth, sampling support, analytical method and the sum calculation procedure.

Critical evaluation of PAH source apportionment tools using data from the Swiss soil monitoring network.

In this study a large dataset on the polycyclic aromatic hydrocarbon (PAH) content of Swiss soils was analysed to evaluate two source apportionment tools, i.e., characteristic PAH ratios/molecular markers and a linear mixing model. Population density and total organic carbon (TOC) content were identified by a multiple regression model as independently and positively influencing the PAH concentrations in Swiss background soil. Specifically, TOC was more strongly positively correlated with the sum of light PAH (naphthalene to phenanthrene) than with the sum of heavy PAH (anthracene to benzo[ghj]perylene), whereas population density was more strongly positively correlated with the sum of heavy PAH than with light PAH. In addition, the sum of the heavy PAH as well as the total sum correlated negatively with sample site altitude. It is therefore hypothesised that heavy PAH are less mobile, whereas light PAH were closer to equilibrium with TOC in the soil. Similar results were found for polychlorinated biphenyls (PCB). The characteristic ratios and molecular markers pointed to pyrogenic origin of PAH in Swiss background soil but did not allow for further differentiation of individual fuel contributions, even though attempts to take environmental fractionation processes into account were made. The comparison of three soil profiles identified with a linear mixing model from the pattern of 16 PAH with >300 PAH emission profiles from the literature suggested urban dust, wood combustion and binders from asphalt as PAH sources. However, also here, environmental fractionation processes probably obscured source characteristic PAH ratios and fingerprints, which thus need to be interpreted with caution.