ABSTRACT
INTRODUCTION AND IMPORTANCE: Lung herniation following trauma is a rare occurrence, and consensus on optimal surgical repair techniques remains limited. While small herniations may resolve without surgery, intervention becomes necessary in cases of unsuccessful non-operative management or concurrent rib fracture stabilization. Mesh application in repair poses a dilemma, often providing physical support but raising infection concerns, particularly in trauma scenarios with delayed closure. Surgical stabilization of rib fractures, employing hardware similar to orthopedic procedures, may necessitate prophylactic antibiotics, though empirical evidence supporting routine use is scant. Polytrauma patients often resort to delayed chest closure techniques during methodical surgical planning, but these carry potential consequences compared to immediate closure. CASE PRESENTATION: Presented is a case involving a patient in a motorcycle collision sustaining multiple injuries, necessitating a massive transfusion protocol, multiple surgeries, including delayed chest closure, and eventual surgical rib fixation four days post-injury. During rib stabilization, exacerbation of traumatic lung herniation mandated mesh repair, prompting the cautious use of prophylactic vancomycin powder to mitigate infection risks. DISCUSSION: A review of the literature revealed a scarcity of similar cases, particularly those involving lung herniation with delayed chest closure, the use of prophylactic antibiotics and mesh in polytrauma. CONCLUSION: This case underscores the lack of depth of comprehensive research guiding surgical decisions concerning lung herniation and the prophylactic use of vancomycin powder in trauma patients.
ABSTRACT
Type 2 diabetes mellitus and osteoarthritis (OA) often present as comorbidities. We examined the role of plasma IL-6, chondrocyte MMP-13, and col10a expression in the development of OA in obese diabetic mice. We further investigated dietary genistein and exercise training as potential mitigators of OA. One hundred adult mice (50 females, 50 males) aged 6 weeks were randomized into 5 groups, including lean controls, obese diabetic controls, and obese diabetic mice treated with genistein, exercise training, and genistein plus exercise training. The obese diabetic state was induced by feeding the mice a high-fat, high-sugar diet. Genistein was incorporated into the diet at a concentration of 600 mg genistein/kg. Exercise training was performed on a treadmill and consisted of daily 30 min sessions at 12 m/min, 5 days/week for a 12-week period. After treatment, plasma was collected, and proximal tibias were removed for analysis. Plasma IL-6 and MMP-13 were elevated while col10a was reduced in obese diabetic mice in comparison to lean controls. Dietary genistein treatment reduced IL-6 and MMP-13 expression and increased col10a expression. Histological examination of articular cartilage showed reduced thickness of the uncalcified zones and proteoglycan content in the cartilage of diabetic mice in comparison to mice fed genistein. Exercise training had no significant effect. In conclusion, genistein (and not exercise training) attenuates OA by reducing IL-6 and MMP-13 expression in diabetic mice.
ABSTRACT
BACKGROUND: Intentional injuries are the second leading cause of death in the U.S. between the ages of 1 and 44. Each traumatic event is approached best with a multiagency and multidisciplinary approach. Family Justice Centers (FJCs) are structured as one-stop centers for victims of all forms of violence to provide services. OBJECTIVE: The purpose of this study is to describe trauma patients evaluated in an FJC and determine the effect of the referrals on injury-related hospital recidivism. METHOD: This is a cross-sectional descriptive study of traumatically injured patients that were evaluated in an adult level II trauma center for 3 years and were referred to Ventura County's FJC. RESULTS: There were 415 trauma admissions for intentional injuries, which accounted for 10.4% of the total trauma-related hospital admissions. Of these patients, 203 (49%) were evaluated in Ventura County's FJC. The remaining 212 (51%) had an open judicial case, thus, were not processed through the FJC due to conflict of interest. The mechanisms of injuries of patients that were evaluated at the FJC (N = 203) were mostly assaults (83%). Majority of the patients were of the Hispanic race (70%), males (69%), English speaking (77%), and aged 18-59 (84%). 573 individual services were provided to these patients. The patients evaluated through the FJC (N = 203) had zero recidivism, while those with open cases had a 1% recidivism rate (P = NS). CONCLUSION: By collaborating with FJCs, trauma center outcomes contribute to a pathway for healing and may prevent future acts of intentional injuries.
Subject(s)
Crime Victims , Wounds and Injuries , Adult , Male , Humans , Infant , Child, Preschool , Child , Adolescent , Young Adult , Trauma Centers , Cross-Sectional Studies , Violence/prevention & control , Hospitalization , Wounds and Injuries/epidemiology , Wounds and Injuries/therapyABSTRACT
INTRODUCTION: Ischemic fasciitis is a rare pseudosarcomatous fibroblastic lesion. It is considered benign and generally occurs in the elderly. Long-term follow-up is rare therefore; the natural history is largely unknown. It is excised without specific attention to margins. CASE PRESENTATION: We present a case of a 94-year-old female with ischemic fasciitis on the shoulder for which we have three years of follow-up. During this time, multiple re- excisions for recurrence were required. This lesion eventually progressed to myxofibrosarcoma. CLINICAL DISCUSSION: We suggest ischemic fasciitis may be a precursor to malignancy. Ischemic fasciitis itself is noted to have features similar to sarcoma on histopathology. Simple excision of ischemic fasciitis without margins may be inadequate therapy. CONCLUSION: Ischemic fasciitis or pseudosarcomatous fibroblastic lesion and myxofibrosarcoma have many histological similarities. A pseudosarcomatous fibroblastic lesion may be a precursor to myxofibrosarcoma and we recommend complete excision with negative margins at the initial treatment to prevent a recurrence.
