[Thyroid cartilage fracture following sneezing as a cause of spontaneous pneumomediastinum]. / Perelom shchitovidnogo khryashcha vsledstvie chikhan'ya kak prichina spontannogo pnevmomediastinuma.

OBJECTIVE: To evaluate the possible etiological factors of spontaneous pneumomediastinum and to describe a case that was unusual in its etiology: a thyroid cartilage fracture as a result of sneezing. MATERIAL AND METHODS: Six patients (four male, two female, aged 16-82 years) were hospitalized with spontaneous pneumomediastinum diagnosed with a chest X-ray in five patients and 100% with computed tomography. Treatment was symptomatic. RESULTS: The commonest symptoms (cough, shortness of breath, hoarseness) were in four patients. Spontaneous pneumomediastinum developed in three cases as a result of bronchospasm during an attack of bronchial asthma, in one patient after exercise, in one after fibrogastroscopy, in one after sneezing. We report a 30-year-old man who presenting subcutaneous emphysema on the neck, hoarseness, pain when swallowing, hemoptysis developed after sneezing. His computed tomography revealed a pneumomediastinum due to fistula of the fracture of the thyroid cartilage following sneezing while simultaneously obstructing both nostrils. At laryngoscopy, there was a linear hematoma in the resolution stage on the anterior wall of the larynx. He was treated conservatively and recovered rapidly. There are no previous published reports of spontaneous pneumomediastinum following fracture of the thyroid cartilage. CONCLUSION: Fracture of the thyroid cartilage as a result of a sharp rapid increase in airway pressure during a sneeze with blocked nasal passages can be one of the rare causes of spontaneous pneumomediastinum. Avoid closing both nostrils at the same time when sneezing.

The Impact of a Robotic Digital Microscope on the Ergonomics in a Neurosurgical Operating Theatre (A Single-Centre Experience).

Ergonomics is an emerging concept in the neurosurgical operating theatre, where neurosurgeons work under great concentration and frequently neglect their uncomfortable body posture. Work-related musculoskeletal disorders (WMSD) are becoming a widespread burden in the neurosurgical community. WMSD have a negative impact on surgical performance and decrease the surgeons' quality of life. Here we present our single-centre 2-month experience with the Aesculap AEOS® Robotic Digital Microscope (RDM) and prospectively calculate the REBA (Rapid Entire Body Assessment) scores and compare them with similar neurosurgical cases operated with a conventional operative microscope (OPMI).Materials and Methods: For a period of 2 months at the Department of Neurosurgery of the University Hospital Pirogov, Sofia, Bulgaria, 41 consecutive patients were operated on using RDM. The REBA employee assessment worksheets were filled in prospectively to assess the ergonomics of the senior author (N.G.) while using the RDM and the OPMI.Results and Conclusion: The ergonomics during neurosurgical operations could be substantially improved with the implementation of the exoscope. For challenging cranial approaches, where the operator must frequently "look around corners" the exoscope has a major advantage compared with the OPMI-the REBA score is 2.6 times lower for the exoscope and reaches a low risk for WMSD. For spinal operations, the neck score as part of the REBA score is three times lower for the exoscope.

Development and testing of secondary ion accelerator for ITER neutral particle diagnostic system.

This paper presents the results of the development and testing of a secondary ion accelerator for the diagnostic complex of neutral particle analyzers at ITER. The accelerator is part of an analyzer designed to measure fluxes of neutral deuterium and tritium particles escaping from reactor plasma in a total range of 10-200 keV. The aim of the accelerator is to improve the signal/background ratio of the analyzer. It is especially important for the region with a relatively low energy of 10-50 keV. The accelerator has the function of converting atoms into secondary ions and accelerating them in an electrostatic field with a voltage of up to +100 kV. The accelerator is based on two high-voltage accelerating tubes. A special unit is built into the central electrode of the accelerator, which provides the replacement of stripping foils used for the conversion of the flux of neutral particles into a flux of secondary ions. The high-voltage tube assembly is encompassed by a sealed steel housing, in which electrical insulation is provided by a gas gap (nitrogen at 6 bar). The results of tests of the accelerator under ITER relevant conditions, namely, under high-intensity gamma irradiation and seismic loads, have shown its high reliability for use in the diagnostic complex of the fusion reactor.

Bilateral posterior fracture - dislocation of the shoulders after epileptic seizure in patients with cerebral meningiomas. Triple E syndrome - Review of the literature.

Bilateral posterior fracture-dislocation of the shoulders is a very rare entity with an average rate of 0.6/100000 per year. It was first described in 1902 by Mynter. Only a few cases have been published so far. The "triple E syndrome" is used to describe the causative factors involved in this injury - epilepsy, electrocution, extreme trauma. We present our experience since 2019 with 2 cases of bilateral posterior fracture-dislocation of the shoulders after an epileptic seizure in patients with cranial meningiomas. Total removal of the meningiomas was performed in both cases and afterwards the patients were operated on by the traumatology team. The shoulder joint is the most commonly dislocated joint in the body with less than 4 % being posteriorly dislocated. Bilateral fracture-dislocation of the shoulders is associated with "triple E syndrome" and 90 % of the cases are related to seizures. The diagnosis is usually delayed due to the lack of signs of trauma. Early diagnosis and proper surgical treatment can maximize the final functional results and patient recovery.

A rare case of posttraumatic meningitis presenting with acute hydrocephalus.

Posttraumatic meningitis is a severe complication of traumatic brain injury (TBI) that dramatically increases its mortality. Skull-base fractures increase the risk of posttraumatic meningitis. Posttraumatic hydrocephalus was encountered in 0.7 %-29 % of the patients with severe head injury. Posttraumatic hydrocephalus should be differentiated from ventriculomegaly due to brain atrophy. We present a clinical case of a 52-year-old patient after a mild TBI and a linear skull base fracture who developed acute hydrocephalus in the context of a posttraumatic meningitis within the first week after the injury. The occurrence of hydrocephalus in patients with posttraumatic meningitis is not well studied but could lead to rapid deterioration of the patient. It results from injury-induced disturbance of CSF flow either through obstruction or lack of CSF reabsorption. Factors increasing the risk of posttraumatic meningitis are - operative interventions, skull base fractures and CSF leakage. Patients with meningitis usually present with lower GCS score. The lower GCS is a harbinger of worse prognosis. Therefore, aggressive medical treatment is warranted. With this case study we show that meningitis presenting with PTH can develop rapidly over 24 h within the first week post mild head injury with basilar skull fracture. A swift response in providing timely ventricular drainage, together with an appropriate antimicrobial coverage, can greatly reduce any lasting neurological deficits and produce a good clinical outcome.

Subjective workload measurement of the transition from a conventional operative microscope to a Robotic Digital Microscope. A pilot study.

•Evaluate the subjective workload for transition of an experienced neurosurgeon from a conventional operative microscope /OPMI/ to a Robotic Digital Microscope /RDM/.•Show a single center initial experience of the use an exoscope.•The exoscope improves ergonomics.•Operative exoscope could reduce work-related musculoskeletal disorders.

Surface plasmon excitation on a grating assisted by a cholesteric liquid crystal layer.

While surface plasmon excitation assisted by nematic liquid crystal layers has been comprehensively studied in different aspects, application of cholesteric structures for surface plasmon excitation remains an unexplored area. Moreover, structures including cholesteric layers and metal grating for surface plasmon excitation have never been considered, to the best of our knowledge. We studied theoretically and experimentally such structures focusing on different regimes of propagation of normal modes in the cholesteric liquid crystal layer. The application of such structures for sensing is accordingly discussed.

Raman scattering model of the spin noise.

The mechanism of formation of the polarimetric signal observed in the spin noise spectroscopy (SNS) is analyzed from the viewpoint of the light scattering theory. A rigorous calculation of the polarimetric signal (Faraday rotation or ellipticity) recorded in the SNS is presented in the approximation of single scattering. We show that it is most correctly to consider this noise as a result of scattering of the probe light beam by fluctuating susceptibility of the medium. Fluctuations of the gyrotropic (antisymmetric) part of the susceptibility tensor lead to appearance of the typical for the SNS Faraday rotation noise at the Larmor frequency. At the same time, fluctuations of linear anisotropy of the medium (symmetric part of the susceptibility tensor) give rise to the ellipticity noise of the probe beam spectrally localized at the double Larmor frequency. The results of the theoretical analysis well agree with the experimental data on the ellipticity noise in cesium vapor.

Bench tests of a helium ion source for the neutral particle diagnostic system of the ITER tokamak.

Bench tests of a 15 keV helium ion source, which has been developed for the neutral particle diagnostic system of the International Thermonuclear Experimental Reactor (ITER), are described. Being part of the diagnostic system, the ion source will be used to monitor the intactness of carbon stripping foils as well as to check the detection and dispersion systems of the main diagnostic instruments-neutral particle analyzers (NPAs). The ion source produces a wide 5-cm diameter (FWHM) ion beam at a distance of about 50 cm; the ion beam uniformity at a 2-cm area corresponding to the size of the stripping foil is not worse than 10%. The beam current over the area of the stripping foil can be adjusted in the range of 0.1 pA-1 pA. After initial heating, the temporal stability of the ion beam is better than 10%. Pulse height measurements of registered signals show that 15 keV He+ ions can be reliably registered by the NPA detector system. The obtained results allow us to conclude that the developed ion source can provide a reliable check of the NPA system during the diagnostic performance on the ITER tokamak.

Reconstruction of Fingers Using Skin-Bone Grafts with Microvascular Anastomoses.

The aim of the study was to present a clinical and anatomical rationale for transplantation of skin-bone grafts with microvascular anastomoses for treating terminal and segmental defects of the hand and fingers. MATERIALS AND METHODS: Finger and metacarpal bones were reconstructed in 25 hands of 25 patients by transplanting skin-bone tubular fragments with microvascular anastomoses. Transplants from the second metatarsal bone (n=22) and fibula (n=3) were used. Clinical, radiological, morphological, biomechanical, biophysical, and statistical research methods were used. The developed technology is adjustable to individual vascular anatomy of the foot. The proposed use of non-free skin-fat flaps and skin-bone fragments with microvascular anastomoses has been implemented for reconstructing lost segments. RESULTS: The engraftment of skin-bone fragments was observed in 25 cases. In two cases, partial necrosis of the transplants was detected. Sufficient resistance of the transplanted bone graft to resorption was noted. According to the X-ray evidence, the length of the finger with the metacarpal bone after surgery was 8.44±0.32 cm, in the short term after surgery - 8.10±0.36 cm, and in the long term - 7.87±0.45 cm, indicating mild resorption. We used an individual approach to the transplant selection, which made it possible to obtain generally good long-term results in 3 patients, and satisfactory results - in 22 patients. CONCLUSION: The study showed the feasibility of transplanting skin-bone fragments with microvascular anastomoses for replacing various anatomical defects of the hand and fingers. The proposed modification takes into account the variability of vascular anatomy of the donor region.