Conservative Treatment Research Articles

Improving access: Multi-analytical survey of the Norwegian Sea trade archive to establish storage conditions, digitisation priorities and conservation treatments

The Norwegian Sea Trade Archive (NST Archive) from the University of Bergen Library, Norway, is part of the UNESCO documentary heritage and contains unique documentation of the activity of companies that traded in stock fish in Norway and Europe (16th-20th century). The archive consists primarily of bound paper manuscripts written mostly in brown ink. We have surveyed this collection using a multi-analytical approach focused on the material characterization and condition of the paper carrier and inks. Our main aim was to support decision-making on establishing storage conditions, digitisation priorities, and type and extent of conservation treatments necessary to make the collection accessible.After a first visual examination to detect and quantify damages, for the paper support analysis we measured surface pH, paper thickness and water absorbency. Additionally, on a quarter of all tested materials, we performed a SurveNIR analysis, providing information regarding paper pulp type, lignin, protein and rosin content, degree of polymerization, and mechanical properties. The archival material was grouped into three periods characterising the three milestones in paper production: handmade gelatine-sized rag papers, machine-made rag papers with gelatine and rosin sizing, and papers made from processed wood pulp.Regarding the manuscripts’ inks, we used iron and copper tests to determine the presence of Fe2, Cu2+ and Cu+ions, respectively. For the visual characterization and condition rating of the inks, we used the protocols described by the Netherlands Institute for Cultural Heritage. The variety of ink colours and thickness of the inked lines encountered in each document was noted down. Thus specific tendencies present in each historical period became apparent. Results of the solubility of ink in water and alcohol significantly narrowed treatment options.General tendencies of paper and ink degradation based on differences in papermaking were observed. Surface pH measurement, SurveNIR pH, rosin and protein concentration data showed that most rag papers were of poor to fair quality (pH ≤ 6.0 and low protein content (< 5 %)). Rosin-sized papers dated after 1840 had a lower pH (from 3.3 ± 0.2 to 5.0 ± 0.2) compared to gelatine-sized ones. Based on the obtained results, the overall condition of all the papers is good – slightly damaged but stable. The inks are not severely corroded, and there is no loss of text, although 20 % of the collection does show signs of iron-gall ink (IGI) corrosion. A limited number of documents, mostly before 1800, would require local antioxidative treatment. Due to the low pH of all the papers and the detection of ink corrosion, the collection should be stored in a cool environment, with low relative humidity.After the survey, digitisation priorities were also established.

Unraveling the mummy's shroud: A multi-analytical study of a rare painted textile from Roman Egypt

This article describes a multi-analytical technical study of a rare painted shroud still wrapped around a female Egyptian mummy (MCABo EG 1974) in the collection of the Museo Civico Archeologico of Bologna, Italy. Long stored in the museum's warehouses, these mummified human remains were recently rediscovered within the Bologna Mummy Project (BOmp), an interdisciplinary endeavor promoted by the Museo Civico Archeologico and the Institute for Mummy Studies of Eurac Research, Bolzano, Italy. Dating to the Roman period (1st-2nd century C.E.), as confirmed by radiocarbon dating, this mummy displays a unique series of technical features, including the exceptional finding of a colorful painted shroud still preserved in its original location around the wrapped body, to which it is secured with textile straps and resin. In this context, scientific analysis aimed to deepen our current knowledge of the artistic practices of Roman Egypt through an in-depth study of the painting technique, context of production, and possible provenance of the mummy, while promoting a science-informed, enhanced approach to the preservation of the mummified human remains. This research relied on an integrated analytical protocol based on the combined use of imaging and mapping techniques, non-invasive point analysis, and micro-invasive investigation of minute samples, each carried out at the different partnering institutions. Computed tomography (CT) highlighted varying radio-densities for some of the flesh tones and red decorations. Visible photography and multiband imaging provided information on the nature and distribution of various materials on the surface. Fiber optics reflectance spectroscopy (FORS), X-ray fluorescence (XRF) spectroscopy, and Raman spectroscopy contributed to the characterization of the shroud's color palette along with optical microscopy (OM), scanning electron microscopy with energy-dispersive X-ray spectroscopy (SEM/EDS), as well as high-performance liquid chromatography coupled with diode-array detection and mass spectrometry (HPLC/DAD and HPLC/MS). Materials detected include a limited number of mineral pigments and plant-derived dyes such as red lead, red ocher, madder, an unknown yellow dye, Egyptian blue and green, and a carbon-based black. Through access to MOLAB equipment and expertise, macro-XRF (MA-XRF), as well as combined X-ray diffraction (XRD) spot analysis and mapping, enhanced pigment identification. A combination of transmission Fourier-transform infrared (FTIR) spectroscopy with gas chromatography / mass spectrometry (GC/MS) was used to identify the paint binders and any additional organic substances possibly involved in embalming practices and ritual traditions, including animal fat, plant lipid, Pinaceae resin, gum, and beeswax. Mineralogical data gathered by XRD on surface deposits and soil residues collected from within the shroud's inner folds was crucial to put forward hypotheses, in support of the stylistic study of the shroud, concerning a possible provenance from Upper Egypt, most likely West Thebes. Both the shroud and inner bandages were found to be made with linen using OM. After undergoing scientific analysis and conservation treatment, the mummy was displayed in the “Mummies. Unwrapping the past” exhibition and was featured at the 10th World Congress on Mummy Studies, both held in Bolzano in the fall of 2022.

The Role of Consumers’ Knowledge of Native and Pollinator-friendly Plants and Their Prioritization of Plant Characteristics in Purchase Decisions

There is a growing trend toward planting native and pollinator-friendly plants in residential gardens and landscapes due to concerns about invasive plant species, water conservation, and urban land management. Yet, understanding consumer purchase behavior and how knowledge affects their purchase intent is largely unknown. In this analysis, we integrated national online and in-person surveys to determine the influence of consumers’ subjective and objective knowledge of native and pollinator-friendly ornamental plants on their purchase decisions. Factors influencing plant purchase decisions were measured using a 7-point Likert rating scale. We found that participants with relatively higher knowledge of native and pollinator-attractive plants placed more emphasis on sustainable production methods relative to the plant’s physical attributes (e.g., plant size, shape, etc.) and care-related characteristics (e.g., plant health, easiness of care, etc.). Plant lovers (i.e., frequent purchasers who spent relatively more money on plants than infrequent purchasers) were more likely to prioritize sustainable production methods over the plants’ physical attributes. In contrast, participants primarily buying plants from mass merchandisers/box stores tend to focus on visual appeal or aesthetic characteristics. Consumer marketing implications for the nursery and greenhouse industry stakeholders are discussed.

Soil Microbial Community Structure and Its Contribution to Carbon Cycling in the Yalu River Estuary Wetland

Wetland microbial communities play a vital role in ecosystem functioning, particularly in the intricate processes of carbon cycling. This study employed metagenomic sequencing to investigate the diversity, composition, structural differences, carbon cycling functional gene, and microbial species of soil microbial communities in five distinct soil types of the Yalu River estuary wetland, including shoal soil, bog soil, paddy soil, meadow soil, and brown forest soil. We further explored the influence of environmental factors on both the microbial community structure and carbon cycling functional genes. Our results revealed a bacterial-dominated soil microbial community, constituting about 97.6%. Archaea and fungi represented relatively minor fractions, at 1.9% and 0.4%, respectively. While no significant differences were observed in Chao1 indices between bacterial and fungal communities, the Shannon index revealed notable differences. Both Chao1 and Shannon indices exhibited significant variations within the archaeal communities. The dominant bacterial phyla were Proteobacteria, Actinobacteria, Acidobacteria, Bacteroidetes, and Nitrospirae. Thaumarchaeota, Crenarchaeota, and Euryarchaeota formed the major archaeal phyla, while Ascomycota, Mucoromycota, and Basidiomycota were the dominant fungal phyla. Non-metric multidimensional scaling (NMDS) analysis based on Bray-Curtis distance revealed notable differences in the bacterial, archaeal, and fungal community structures across the samples. Redundancy analysis (RDA) identified key environmental factors for the major phyla. Soil pH, soil organic carbon (SOC), electrical conductivity (EC), and total phosphorus (TP) were the main influencing factors for bacteria, while soil TP, EC, total sulfur (TS), and SOC were the primary drivers for archaeal phyla. Soil total nitrogen (TN) and EC were the main influencing factors for fungal phyla. Analysis of key carbon cycling pathway genes utilizing the Kyoto Encyclopedia of Genes and Genomes (KEGG) database and clustering heatmap revealed some variations in functional gene composition across different soil types. Mantel test indicated that pH, TN, and SOC were the primary environmental factors influencing microbial functional genes associated with soil carbon cycling. Stratified bar chart analysis further demonstrated that the major contributors to carbon cycling originated from corresponding dominatnt phyla and genera of Proteobacteria, Thaumarchaeota, Actinomycetota, Euryarchaeota, and Bacteroidota. The species and relative abundance of microorganisms associated with carbon cycling pathways varied among the samples. These findings provide a crucial reference for informing the conservation and sustainable management of wetland ecosystems in the Yalu River estuary.

Conservative treatment of thyroid abscess in a child with thyroglossal duct cyst

Conservative treatment of thyroid abscess in a child with thyroglossal duct cyst

Two consecutive melioidosis septic arthritis successfully cured with conservative and operative treatment respectively: a case report

Melioidosis or Whitmore’s disease is an uncommon infectious condition caused by the gram-negative bacterium Burkholderia pseudomallei. The clinical manifestation of melioidosis varies, including septicemia, pneumonia, deep organ and soft tissue abscess. Septic arthritis is a rare manifestation of melioidosis, which is associated with high mortality rate, especially in immunocompromised patients. We present here a 60-year-old male who was admitted to our hospital with high fever and acute left hip pain, who was subsequently confirmed to have hematogenous melioidosis septic arthritis with positive blood and synovial fluid cultures. His condition fully responded to a 2-week administration of intravenous meropenem plus oral trimethoprim+sulfamethoxazole, before he was transferred to his provincial hospital to continue the antibiotic regimen. For some reason, he inadvertently stopped the regimen and came back to us with a right elbow septic arthritis caused by the same microbial agent a month later. This time, he received an urgent elbow arthroscopic debridement and completed intensive antibiotic therapy before being discharged to continue the eradication phase for 6 months. Until now, he has recovered completely without recurrence. Melioidosis septic arthritis is rare but should be considered in high-risk patients and can be successfully treated with prompt antibiotics alone or in combination with surgery. Regardless of the method, eradication treatment is extremely important.

Lumbar Disc Herniation—the Significance of Symptom Duration for the Indication for Surgery.

Lumbar disc surgery is among the more common spinal procedures. In this paper, we report the current treatment recommendations for patients with symptomatic disc herniation. This review is based on pertinent publications retrieved by a selective literature search in PubMed using the terms [timing] AND [lumbar disc herniation], supplemented by other relevant articles and guidelines. Symptoms resolve in 60% to 80% of patients with herniated discs in 6-12 weeks, and in 80% to 90% over the long term (≥ 1 year). According to the guidelines, 6-12 weeks of conservative treatment are recommended in the absence of significant neurologic deficits. Early surgery is indicated in case of worsening pain or new onset of neurologic deficits. Lumbar disc herniation associated bladder or bowel dysfunction (cauda equina syndrome) is considered an absolute surgical emergency that requires immediate decompression (within 24 to 48 hours). Patients with severe motor deficits (MRC ≤ 3/5) benefit from early intervention and should be offered surgery within three days, if possible, for the best chance of recovery. The degree of weakness and the duration of symptoms have been identified as risk factors for incomplete recovery. Early surgery can be considered in patients with mild paresis (MRC 4/5) in case of functional impairment (e.g., quadriceps paresis). Longer symptom duration and lower motor scores are associated with worse outcome and a lower chance of neurologic recovery. The recovery rate for motor deficits ranges from 33% to 75%, depending on the timing and modality of treatment as well as the motor score.

Efficacy and safety of percutaneous transhepatic biliary radiofrequency ablation in patients with malignant obstructive jaundice.

Percutaneous transhepatic cholangiodrainage (PTCD) and endoscopic retrograde cholangiopancreatography/endoscopic nasobiliary drainage are the most common clinical procedures for jaundice control in patients with unresectable malignant obstructive jaundice, yet the safety and effect of endobiliary radiofrequency ablation (EB-RFA) combined PTCD is rarely reported, in this article, we report our experience of EB-RFA combined PTCD in such patients. To retrospectively study the efficacy and safety of EB-RFA combined PTCD in patients with unresectable malignant obstructive jaundice. Patients with unresectable malignant obstructive jaundice treated with EB-RFA under PTCD were selected, the bile ducts of the right posterior lobe was selected as the target bile ducts in all cases. The general conditions of all patients, preoperative tumour markers, total bilirubin (TBIL), direct bilirubin (DBIL), albumin (ALB), alkaline phosphatase (ALP), and glutamyl transferase (GGT) before and on the 7th day after the procedure, as well as perioperative complications, stent patency time and patient survival were recorded. All patients successfully completed the operation, TBIL and DBIL decreased significantly in all patients at the 7th postoperative day (P = 0.009 and 0.006, respectively); the values of ALB, ALP and GGT also decreased compared with the preoperative period, but the difference was not statistically significant. Perioperative biliary bleeding occurred in 2 patients, which was improved after transfusion of blood and other conservative treatments, pancreatitis appeared in 1 patient after the operation, no serious complication and death happened after operation. Except for 3 patients with loss of visits, the stent patency rate of the remaining 14 patients was 100% 71% and 29% at the 1st, 3rd, and 6th postoperative months respectively, with a median survival of 4 months. EB-RFA under PTCD in patients with unresectable malignant obstructive jaundice has a satisfactory therapeutic effect and high safety, which is worthy of further clinical practice.

Percutaneous kyphoplasty in the treatment of Kümmell disease in lumbar scoliosis: A case report

BACKGROUND Due to mechanical imbalance in the spine, elderly scoliosis patients tend to develop vertebral fracture nonunion, i.e. , Kümmell disease, when osteoporotic vertebral compression fractures occur. However, accompanying vertebral rotational deformities make surgical procedures challenging risky. Such patients are usually compelled to undergo conservative treatment and there are very few reports on minimally invasive surgeries for them. We first-time report a patient with Kümmell disease and lumbar scoliosis treated with percutaneous kyphoplasty (PKP) under O-arm guidance. CASE SUMMARY An 89-year-old female was admitted to the hospital due to delayed low back pain after a fall. She was diagnosed with Kümmell disease based on physical and radiologic examinations. The patient experienced severe scoliosis and subsequently underwent O-arm-guided kyphoplasty, resulting in a significant alleviation of low back pain. CONCLUSION PKP has good efficacy in treating Kümmell disease. However, surgical risks are elevated in scoliosis patients with Kümmell disease due to the abnormal anatomical structure of the spine. O-arm assisted operations play a crucial role in decreasing surgical risks.

Pancreatic and cardiometabolic complications of severe hypertriglyceridaemia.

This review endeavours to explore the aetiopathogenesis and impact of severe hypertriglyceridemia (SHTG) and chylomicronaemia on cardiovascular, and pancreatic complications and summarizes the novel pharmacological options for management. SHTG, although rare, presents significant diagnostic and therapeutic challenges. Familial chylomicronaemia syndrome (FCS), is the rare monogenic form of SHTG, associated with increased acute pancreatitis (AP) risk, whereas relatively common multifactorial chylomicronaemia syndrome (MCS) leans more towards cardiovascular complications. Despite the introduction and validation of the FCS Score, FCS continues to be underdiagnosed and diagnosis is often delayed. Longitudinal data on disease progression remains scant. SHTG-induced AP remains a life-threatening concern, with conservative treatment as the cornerstone while blood purification techniques offer limited additional benefit. Conventional lipid-lowering medications exhibit minimal efficacy, underscoring the growing interest in novel therapeutic avenues, that is, antisense oligonucleotides (ASO) and short interfering RNA (siRNA) targeting apolipoprotein C3 (ApoC3) and angiopoietin-like protein 3 and/or 8 (ANGPTL3/8). Despite advancements in understanding the genetic basis and pathogenesis of SHTG, diagnostic and therapeutic challenges persist. The rarity of FCS and the heterogenous phenotype of MCS underscore the need for the development of predictive models for complications and tailored personalized treatment strategies. The establishment of national and international registries is advocated to augment disease comprehension and identify high-risk individuals.

Navicular bone fractures in horses: Prognosis after conservative and surgical treatment

The aim of this retrospective study is to describe and compare conservative and surgical treatment of navicular fractures in horses. An attempt is made to identify critical points that can favorably influence the prognosis of this orthopedic disease. All horses treated for a navicular fracture at the Equine Clinic, Vetsuisse Faculty, University of Zurich between 2005 and 2017 were included in this study. The severity of lameness at initial examination, radiographic assessment, hoof conformation, treatment (conservative or surgical), complications and outcome were determined from the medical records. Conservative and surgical treatment consisted of stable rest, a controlled exercise program and therapeutic orthopedic shoeing. During surgical treatment, fracture reduction was also carried out with a cortical screw. Computer assisted surgery were used in five horses and computer tomography in three horses. Follow-up examinations included clinical and radiographic examinations. The outcome was divided into three categories: 1 = very good; 2 = good; 3 = poor. Twelve horses met the inclusion criteria; Four horses were treated conservatively and eight were treated surgically. After conservative treatment, two horses (50 %) had a very good outcome and two (50 %) had a good outcome. After surgical treatment, four horses (50 %) had a very good outcome and four (50 %) had a poor outcome. Overall, 67 % of horses had a very good or good outcome, although radiographic signs of bone healing was not present in any of these cases. Various complications were identified, such as the fracture of a screw, the fragmentation of the small navicular bone fragment, the development of osteoarthrosis in the coffin joint and progressive podotrochosis. This study shows that the prognosis of navicular fractures is generally cautious and that degenerative changes to the navicular apparatus worsen the prognosis. In the present study, surgical treatment did not improve the prognosis of navicular fractures despite the intrasurgical use of three-dimensional imaging. However, technical advances could reduce the complication rate in the future.

Global shortfalls in documented actions to conserve biodiversity.

Threatened species are by definition species that are in need of assistance. In the absence of suitable conservation interventions, they are likely to disappear soon1. There is limited understanding of how and where conservation interventions are applied globally, or how well they work2,3. Here, using information from the International Union for Conservation of Nature Red List and other global databases, we find that for species at risk from three of the biggest drivers of biodiversity loss-habitat loss, overexploitation for international trade and invasive species4-many appear to lack the appropriate types of conservation interventions. Indeed, although there has been substantial recent expansion of the protected area network, we still find that 91% of threatened species have insufficient representation of their habitats within protected areas. Conservation interventions are not implemented uniformly across different taxa and regions and, even when present, have infrequently led to substantial improvements in the status of species. For 58% of the world's threatened terrestrial species, we find conservation interventions to benotably insufficient or absent. We cannot determine whether such species are truly neglected, or whether efforts to recover them are not included in major conservation databases. If they are indeed neglected, the outlook for many of the world's threatened species is grim without more and better targeted action.

Management of acute appendicitis in pediatric patients with acute leukemia: Insights from a single-center study.

Acute appendicitis (AA) in pediatric patients with acute leukemia mandates prompt treatment. Diagnosis presents challenges, relying on clinical and radiological assessments, often leading to treatment delays that may disrupt leukemia management. Our study on 14 such cases underscores the pivotal role of swift intervention. While conservative AA treatment may pose no risk to healthy children, our findings mandate the performance of laparoscopic appendectomy within 24hours of diagnosis. This strategy yielded successful surgical outcomes while ensuring uninterrupted leukemia care. Our experience contributes important insights to the limited understanding of navigating this complex clinical scenario.

Implant-Based Gluteal Augmentation:Comparing Complications Between Single- and Double-Incision Techniques.

Gluteal implants are gaining popularity as an alternative to fat grafting for gluteal augmentation. This study aims to compare complication rates between single- and double-incision techniques for implant placement in gluteal augmentation from a single surgeon's experience. Retrospective analysis of a single surgeon's implant-based gluteal augmentations was conducted between October 2018 and August 2022. Consecutive patient cases were reviewed at the beginning and end of the designated period to compare both incision techniques after switching from the single- to double-incision technique in September 2020. Demographics and postoperative complications were compared. Statistical comparisons were made using the independent sample t-test for quantitative variables and the Fisher's exact test for categorical variables. The study included 134 single-incision patients (247 implants) and 47 double-incision patients (91 implants). Baseline demographic and clinical characteristics between the two groups were similar. Overall complication rate per implant was higher in the single-incision group (16.6% vs. 6.6%, p = 0.02). The most common complication per implant was delayed wound healing (single incision: 9.7%, double incision: 5.5%). The odds ratio of developing at least one complication in the double compared to the single-incision group was 0.44 (95% CI: 0.19, 0.92). The double incision techniquedemonstrates a lower complication rate than the single-incision technique for implant-based gluteal augmentation. The most common complication in both groups was delayed wound healing which responded in most patients to conservative wound care. These results support using the double-incision technique for implant-based gluteal augmentation. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Management of spontaneous pyogenic spondylodiscitis: a descriptive cohort study

BackgroundSpontaneous spondylodiscitis (SD) is an inflammation of the vertebral endplate and the intervertebral disc with no prior surgery or intervention. The treatment of spontaneous pyogenic SD mainly consists of systemic antibiotics and rest. Some cases require surgery due to failure of medical treatment or due to neurological compromise. Due to the disease heterogeneity, there are no standardized, widely adopted treatment protocols. We conducted this study to assess the clinical outcome of the different treatment modalities.ResultsThis is a retrospective analysis of prospectively collected data of patients with spontaneous non-tuberculous spondylodiscitis. Thirty-eight patients were identified, including 14 males and 24 females. The mean age was 49 years. Twenty-three patients underwent surgery from the start while 15 patients received conservative medical treatment. Among the latter, 8 patients showed disease progression and required surgical intervention. The ODI/NDI at 1 year (mean = 8) was significantly better than before treatment (mean = 18). Among 11 patients with motor deficit at presentation, 8 improved and 3 remained stable. There were 14 complications, including 11 minor and 3 major, requiring one revision surgery.ConclusionsSurgical decompression and debridement with or without instrumented fusion for complicated SD cases is a safe and effective treatment modality. Close follow-up is needed in case of conservative treatment for early detection of treatment failure and disease progression. Baseline characteristic variabilities in patients with spontaneous pyogenic SD could predict conservative treatment failure, but this needs to be validated in larger series.

Case series: Management and outcomes of five cases of blunt and open pancreatic trauma

Introduction Pancreatic trauma is notably less frequent than injuries affecting other solid organs, such as the liver or spleen. Despite their infrequency, pancreatic injuries can pose significant risks, with mortality rates ranging from 5 to 30% and morbidity rates reaching 50%. Managing such injuries remains contentious because of the anatomical complexity, lesion extent, and close proximity to neighboring organs. Methods Our study aimed to delineate the clinical and biological characteristics of pancreatic trauma and specify diagnostic and therapeutic modalities. This study was conducted retrospectively from 2010 to 2021 at Mahmoud El Matri Hospital’s General Surgery Department in Ariana, TUNISIA, and included five cases of blunt and open pancreatic trauma. Results Although rare, pancreatic injuries can lead to serious consequences, prompting the development of a diverse array of therapeutic options. Pancreatic trauma presents a complex clinical challenge, necessitating a comprehensive approach that considers various factors, such as injury severity, anatomical location, and patient condition. Advanced imaging techniques, including computed tomography (CT) scanning, Wirsung-MRI, and ERCP, aid in the accurate diagnosis and assessment of canal involvement. Conservative management was considered for cases with limited canal rupture, whereas endoscopic treatments showed promise for hemodynamically stable cases. Surgical interventions, such as duodenopancreatectomy, are reserved for exceptional cases with severe injuries. Conclusion Pancreatic trauma requires a comprehensive approach that considers factors such as injury severity, anatomical location, and patient condition. Ongoing research and collaboration are vital for refining pancreatic trauma management and proposing guidelines for facilitating decision-making.

Chinese guideline for the clinical management of patients with unruptured intracranial aneurysms (2024)

Unruptured intracranial aneurysm (UIA) has an estimated prevalence of about 7% among adults aged 35-75 in China. With the aging population trend, the detection rate of UIA is increasing. Most UIA are incidentally discovered and typically asymptomatic. There has been ongoing debate regarding the choice between aggressive treatment and conservative management. Although UIA has a low annual risk of rupture, once rupture occurs, the mortality and disability rates are high. Based on evidence-based medicine, this clinical management guideline provides 44 recommendations on population screening, clinical imaging diagnosis, risk assessment of growth and rupture, treatment strategies and selection, postoperative follow-up, and management of special populations with UIA. Aiming to provide clinical guidance for clinical doenrs and relevant professionals.

Traumatic Delayed Posterior Cranial Fossa Epidural Hematoma: A Rare Entity

AbstractPosterior fossa epidural hematomas (EDHs) are much rarer entities than supratentorial EDHs which are reported only 4 to 7% in the literature. Due to the tight space and critical structures in posterior fossa, only a few cases can go with the conservative management but even then patients can deteriorate anytime with enlargement of hematoma and compression effects on brain stem and require urgent evacuation. This letter aims to provide a case of a young kid who presented initially with less-volume EDH and later required urgent evacuation because of hematoma expansion.

ANATOMY OF THE TIBIAL NERVE IN RELATION TO THE TARSAL TUNNEL: A CADAVERIC STUDY

IntroductionTibial nerve anatomy has not been studied profoundly in comparison to Tarsal Tunnel Syndrome (TTS). Assuming symptoms are caused by an anatomical variant or mechanical cause regarding the tibial nerve, it is essential to investigate the anatomy of this structure taking in consideration that surgical and conservative treatments have shown poor results.Methods40 lower-leg specimens were obtained. Dissection started 20 centimeters proximal to the Dellon-McKinnon (DM) line towards the medial aspect of the naviculo-cuneiform joint distally. Anteriorly, dissection began at the tibio-talar medial gutter until the medial aspect of the Achilles tendon posteriorly. The plantar aspect extended from medial to lateral within the parameters previously described, ending at the level of the second metatarsal.ResultsThe flexor retinaculum had a denser consistency in 22.5% of the cases and the average length was 51.9 mm. The flexor retinaculum as an independent structure was found absent and 77.2% of cases as undistinguished extension of the crural fascia. The lateral plantar nerver (LPN) and abductor digiti minimi (ADM) nerve shared same origin in 80% of cases, 34.5% bifurcated proximal to the DM line, 31.2% distally and 34.3% at the same level. The medial calcaneal nerve (MCN) emerged proximal to the DM line in 100% of specimens. The medial plantar nerve (MPN) has its origin proximal to the DM line in 95% of cases.ConclusionThe flexor retinaculum is an extension of the crural fascia and not an independent structure. The LPN and ADM have the same origin in most cases and this presents as an important finding that must be studied in detail for clinical correlations between the motor and sensatory affections of the ADM and LPN respectively. Finally, the branches of the MCN and MPN are the most constant in their distribution and proximal origin in relation to the Dellon-McKinnon line.

Conservative fracture treatment in old people

The numbers of osteoporotic fractures will increase due to the demographic change, which particularly affects the proximal femur, pelvis, proximal humerus, wrist and vertebral column. Surgical treatment is superior to conservative treatment of proximal femoral fractures. Non-dislocated fractures of the wrist can also be treated with a plaster cast but studies suggest that the results in the first 12months are better after surgical treatment. The situation is similar for fractures of the proximal humerus and non-dislocated fractures in particular can also be treated conservatively. Ascore and classification were recently developed for making decisions on the treatment of osteoporotic vertebral fractures. Fractures of the anterior and posterior pelvic ring can be treated conservatively with the patient under sufficient analgesia as long as there is no substantial dislocation. The highest priority in geriatric traumatology is fast remobilization.