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Background The surge in electric scooter (e-scooter) adoption in 2019 fueled by sharing platforms has raised safety concerns, leading to an increased incidence of e-scooter-related injuries. Despite regulatory efforts, there has been a notable rise in accidents, prompting a comprehensive investigation. This study conducted at the Republican Vilnius University Hospital (RVUH), a level 1 trauma center, is one of the first in the Baltic States aiming to analyze the causes, severity, and frequency of e-scooter injuries from 2018 to 2021. This research addresses a critical gap in understanding e-scooter safety in the Baltic States, providing valuable insights for informed policy and preventive measures. Methodology This retrospective study analyzed e-scooter-related injuries in Vilnius, Lithuania, from April to September during 2018-2021. Data from the RVUH emergency department were examined. Using keywords such as "scooter" and "electric," relevant cases were extracted from the RVUH electronic health system. Included were individuals, both riders and pedestrians, with clear e-scooter involvement, excluding duplicates, those under 18, and users of other types of scooters. Extracted medical records provided data on demographics, injury specifics, helmet use, alcohol consumption, and more. Trauma severity was assessed through the New Injury Severity Score (NISS) and Abbreviated Injury Scale (AIS). Statistical analysis utilized GraphPad Prism software and Excel, adhering to ethical guidelines with RVUH Bioethics Committee approval. Results Over four years, 1,036 e-scooter-related injuries at RVUH revealed a gender-based shift, with males sustaining more injuries. The introduction of rentals in 2019 triggered a 334% surge in injuries compared to 2018. Despite an annual 208% increase from 2018 to 2021, 2021 saw a 710.93% rise. Trauma severity remained consistent, with AIS scores 1 and 2 being prevalent. Non-helmet wearers constituted 97.97%, and soft tissue damage was predominant. Ownership patterns shifted toward rentals (81.15%), reflecting the popularity of sharing platforms. Alcohol influence showed no significant change, but intoxicated patients had a higher surgery rate during four years. Mechanism analysis highlighted tripping as the primary cause. Injury characteristics revealed fractures in 34.56% of cases, primarily affecting upper limbs (53.35%). Soft tissue trauma was prominent (65.44%), with lower limbs being significantly impacted. Conclusions The surge in e-scooter injuries demands urgent preventive action. While most injuries are mild, a significant proportion is moderate to severe, even fatal. Inadequate education, lax enforcement, and uneven infrastructure contribute to the risk. Urgent measures, including road maintenance, speed reduction, and mandatory helmet use, are crucial. Clarity in government directives for designated e-scooter areas is vital. Further research is needed to understand the broader impact of informed policymaking and safer urban mobility. Expanding research to other Lithuanian regions would enhance the current study.
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Background The periorbital area undergoes transformative changes with age, influencing both aesthetic appearance and functional aspects of the eyelids. Age-related alterations involve volume loss, shifts in eyelid crease position, drooping eyebrows, reduced skin elasticity, and the presence of dermatochalasis. Dermatochalasis, characterized by redundant upper eyelid skin folds, poses aesthetic and functional challenges, impacting visual acuity and eyelid elevation efficiency. Upper blepharoplasty addresses these age-related changes. Despite the elective nature of upper blepharoplasty, the procedure can evoke preoperative anxiety and discomfort. Various premedication strategies, including benzodiazepines, aim to alleviate anxiety and enhance the overall patient experience. However, ongoing debates persist regarding the optimal strategy for implementation. The study aims to contribute insights into the effectiveness of different premedication approaches in optimizing patient comfort during and after upper blepharoplasty. Methods The research design involves 182 patients divided into three groups: control group (CG) (n = 45) receiving no premedication, Group 1 (n = 98) receiving oral midazolam (a benzodiazepine), and Group 2 (n = 39) receiving a combination of midazolam, eutectic mixture of local anesthetics (EMLA) eyelid ointment, and oral paracetamol with codeine phosphate hemihydrate. The study assesses anxiety levels, pain perception during local anesthetic injection, surgery, and postoperatively, as well as the use of painkillers and adverse effects. Ethical approval was obtained for the study. Results Significant differences were noted among the groups during local anesthetic injection (p < 0.0001), surgery (p < 0.0001), and post surgery (p < 0.0197). CG patients experienced higher pain levels during local anesthetic injection and surgery compared to Groups 1 and 2. Group 1 reported more pain during surgery than Group 2. Substantial differences were observed in preoperative (p < 0.0001), during-surgery (p < 0.0001), and after-surgery (p < 0.0001) anxiety levels. The CG exhibited higher preoperative anxiety compared to Group 1, while Group 1 had lower anxiety during surgery compared to the CG. Group 1 also reported lower anxiety after surgery than both the CG and Group 2. A significant difference was found in post-surgery painkiller usage among the groups (p = 0.0003). Group 2 showed significantly lower usage compared to Group 1 (p = 0.0004) and the CG (p = 0.0006). A significant difference was observed in the duration of painkiller use after surgery (p < 0.0014). The CG had a longer duration than Group 1 (p = 0.0049) and Group 2 (p = 0.0495). Conclusions Midazolam alone as premedication effectively reduced anxiety before, during, and after surgery. EMLA administration for injection pain did not produce superior results, likely due to its delayed onset. Paracetamol with codeine phosphate hemihydrate effectively reduced surgical pain and postoperative pain duration and decreased the need for painkillers.
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A giant intermuscular lipoma, an exceedingly rare occurrence, constitutes a non-malignant neoplasm originating from the mesodermal germ cell layer, with dimensions surpassing 10 cm. Its differentiation from liposarcoma and other malignant tumours is imperative. We present a case involving a 75-year-old woman who initially raised suspicions of liposarcoma due to pronounced enlargement and fullness in the upper quadrants of the left breast. After comprehensive imaging evaluations, the identification of a sizable BI-RADS 4a lesion positioned between the major and minor pectoral muscles of the left breast was found. The definitive diagnosis of an exceedingly rare giant intramuscular lipoma was validated solely subsequent to the surgical excision of the lipoma, through histological analysis.
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We report the case of a 35-year-old female patient who presented with stabbing pain on inspiration and expiration, fever, and dyspnea. The patient had undergone breast augmentation with mastopexy and upper quadrant liposuction 5 days earlier. Seven days after hospitalization, a fistula ruptured in the left breast at the suture, and copious outflow of thick whitish fluid was observed. The breast implants were then removed. During surgery, a small amount of fluid was found, and bacterial culture revealed a Cutibacterium acnes infection, for which antibiotics were prescribed. Fifteen days after implant removal, the patient complained of uncomfortable tingling sensations, similar to breastfeeding. A dressing was applied, which resulted in the copious discharge of whitish, viscous fluid through the wound and nipple. The prolactin level was four times higher than the normal range. The patient was diagnosed with hyperprolactinemia and prescribed bromocriptine treatment, which restored her prolactin levels to normal within 4 days. After 4 weeks of hospitalization, the patient was discharged in good condition. This is the first case in the world to show that, in addition to infection, galactorrhea can be an extremely rare complication, which in our case was detected at a late stage at a similar clinic.
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Background: Autologous fat grafting is widely used in plastic and reconstructive surgery. Liposuction methods play a key role in surgeons' work efficiency, adipocyte viability, graft survival, and outcomes. We investigated the effect of four liposuction methods on adipocyte viability, debris, and surgeons' work efficiency by measuring the active energy expenditure and changes in heart rate. Methods: Human lipoaspirate was harvested from patients' removed abdominal flaps using four different liposuction methods, and we counted calories per aspirated volume and surgeons' heart rate. Adipocytes were separated from the lipoaspirate immediately by digestion with 0.1% type I collagenase. After digestion, parts of the cells and debris were measured. Adipocytes were plated in an adipocyte maintenance medium containing Alamar blue reagent. The adipocyte metabolic activity was measured using a spectrophotometer. Results: After evaluating the active energy expenditure and changes in surgeons' heart rate, the ultrasonic-assisted liposuction (UAL) method was determined to be the most ergonomic liposuction device for surgeons. In addition, adipocyte viability was higher in the UAL group than in the other groups, and debris was the lowest in the power-assisted liposuction 1 group (PAL1). Conclusions: Adipocyte viability is crucial for improving fat grafting outcomes. This study revealed that the viability of adipocytes is best preserved using the UAL and PAL1 liposuction methods. The UAL and PAL1 methods caused the least damage to the cells. The UAL method yielded the best results for surgeons' work efficiency.
