Laceration Injury Research Articles

Generalized tetanus complicated with Takotsubo-cardiomyopathy in a septuagenarian following a laceration injury with soil contamination – a case report

BackgroundTetanus is a clinical rarity due to the successful globally adopted childhood vaccination programme. The rising elderly population in the United Kingdom creates a subset of individuals whom are prone to develop Tetanus as they preceded this vaccination drive.Case summaryA 76 year old Caucasian lady presented with a soil contaminated laceration injury on her knee following a fall. Though she received urgent assessment and wound care, the relevance of the injury in the backdrop of her age was not appreciated and her tetanus post exposure prophylaxis was overlooked. She readmitted seeking further management 1 week later with an infected wound with Trismus and clinical features favoring Generalized tetanus. During her stay she developed Takotsubo-cardiomyopathy with congestive cardiac failure and required prolonged care in the intensive unit with mechanical ventilation and rehabilitation before being discharged home.ConclusionFirst contact physicians should have a greater appreciation of the types of injuries and at-risk individuals who are more prone to develop tetanus upon exposure to ensure early and appropriate identification. There should be greater situational awareness with regard to the elderly in view of their heightened risk of development of tetanus specially those born before the vaccination drive. Knowledge regarding post exposure prophylaxis measures for tetanus should be regularly updated using local guidance to ensure awareness, so as to despite its rarity Tetanus remains an adequately appreciated disease.

A Retrospective Study of Lateral Antebrachial Cutaneous Nerve Neuropathy: Electrodiagnostic Findings and Etiologies in 49 Cases.

The lateral antebrachial cutaneous nerve (LACN) is the terminal sensory branch of the musculocutaneous nerve and is rarely entrapped or injured. This study describes the electrodiagnostic (EDX) findings and etiologies of LACN neuropathy. This is a review of 49 patients with pain and/or paresthesia of the forearm who underwent EDX studies. The diagnosis of LACN neuropathy was based on clinical and sensory conduction abnormalities. The most common etiology of LACN neuropathy was iatrogenic injury in 30 (61.2%) patients, primarily due to biceps tendon repair at the elbow (11 [36.7%]) and phlebotomy (5 [16.7%]). Fifteen (30.6%) patients sustained a non-iatrogenic injury at the proximal forearm/elbow, consisting of six (60%) laceration injuries and five (33.3%) stretch injuries. Four (8.2%) patients comprised the "other" etiology category, including two mass lesions causing LACN compression. Pain, paresthesia, and/or numbness in the LACN distribution were reported in 33 (67.3%), 27 (55.1%), and 23 (46.9%) patients, respectively. Hypoesthesia was detected in 45 (91.8%) patients, and dysesthesia in 7 (14.3%). The sensory nerve action potentials (SNAPs) of the LACN on the symptomatic side were absent in 44 (89.8%) patients. Of the five patients whose SNAPs of the LACN were detected, all had a decreased amplitude, and two had increased sensory latency. The most common etiology for LACN neuropathy in this series was iatrogenic injury; repair of biceps tendon at the elbow was the most frequent provoking cause. Protection of the LACN during surgical procedures at the elbow and forearm is vital to prevent iatrogenic injury.

Epidemiology of work-related hand and wrist injuries in a referral center: A descriptive study.

Occupational hand and wrist injuries (OHWIs) account for 25% of work-related accidents in low- and middle-income countries. In Colombia, more than 500000 occupational accidents occurred in 2021, and although the rate declined to less than 5% in 2020 and 2021, at least one in four accidents involved a hand or wrist injury. To describe the OHWIs in workers seen at the emergency room at a second-level hospital in Colombia. An observational study was performed using data from workers who experienced OHWIs and attended a second-level hospital, between June, 2020 and May, 2021. The overall frequency of OHWIs, as well as their distribution by sociodemographic, clinical, and occupational variables, are described. Furthermore, association patterns between sex, anatomical area (fingers, hand, wrist), and type of job were analyzed by correspondence analysis (CA). There were 2.101 workers treated for occupational accidents, 423 (20.3%) were cases of OHWIs, which mainly affected men (93.9%) with a median age of 31 years and who worked mainly in mining (75.9%). OHWIs were more common in the right upper extremity (55.3%) and comprised different types of injuries, such as contusion (42.1%), laceration (27.9%), fracture (18.7%), and crush injury (15.6%). They primarily affected the phalanges (95.2%), especially those of the first finger (25.7%). The CAs showed associations between the injured anatomical area and the worker's job that differed in men and women (explained variance > 90%). One out of five workers who suffered occupational accidents in Cundinamarca, Columbia had an OHWI, affecting mainly males employed in mining. This occupational profile is likely to lead to prolonged rehabilitation, and permanent functional limitations. Our results might be useful for adjusting preventive measures in cluster risk groups.

Fabrication of ECM protein coated hollow collagen channels to study peripheral nerve regeneration

Peripheral nerve injury is a prevalent clinical problem that often leads to lifelong disability and reduced quality of life. Although peripheral nerves can regenerate, recovery after severe injury is slow and incomplete. The current gold standard treatment, autologous nerve transplantation, has limitations including donor site morbidity and poor functional outcomes, highlighting the need for improved repair strategies. We developed a reproducible in vitro hollow channel collagen gel construct to investigate peripheral nerve regeneration (PNR) by exploring the influence of key extracellular matrix (ECM) proteins on axonal growth and regeneration. Channels were coated with ECM proteins: collagen IV, laminin, or fibronectin and seeded with dorsal root ganglia (DRG) collected from E16 rat embryos to compare the ability of the ECM proteins to enhance axonal growth. Robust axonal extension and Schwann cell (SC) infiltration were observed in fibronectin-coated channels, suggesting its superiority over other ECM proteins. Differential effects of ECM proteins on axons and SCs indicated direct growth stimulation beyond SC-mediated guidance. In vitro laceration injury modeling further confirmed fibronectin’s superior pro-regenerative effects, showcasing its potential in enhancing axonal regrowth post-injury. Advancing in vitro modeling that closely replicates native microenvironments will accelerate progress in overcoming the limitations of current nerve repair approaches.

In the Catheterization Laboratory, Most Iatrogenic Cardiac Tamponades Require Only Pericardiocentesis: A Single-Center Experience.

Cardiac tamponade (CT) is a rare but life-threatening complication of cardiac interventions, requiring immediate pericardial cavity pressure relief. While pericardiocentesis often suffices, and some cases necessitate open-chest surgery. This decision is frequently based on individual physician's experience. This study aims to identify high-risk CT patients following cardiac intervention, advocating for early, decisive surgical intervention. A retrospective analysis was conducted on 51 patients who developed iatrogenic CT at our center between October 2013 and October 2023. Patients were classified based on the necessity for open-chest surgery. The study evaluated a variety of factors, including baseline characteristics, therapeutic approaches, and outcomes. Of the 51 patients with iatrogenic CT, 49 patients were successfully treated without open-chest surgery, with an average immediate drainage volume of 208.2 173.8 mL. In contrast, the two patients requiring open-chest surgery had significantly higher drainage volumes, exceeding 500 mL, with over 300 mL drained in the first hour, indicating laceration injuries. Patients not requiring open-chest surgery demonstrated favorable outcomes. The majority of patients with iatrogenic CT and non-lacerated injuries experienced a favorable prognosis following pericardiocentesis. However, in cases of lacerated injuries with drainage volume was above 300 mL per hour, pericardiocentesis alone could not stabilize the hemodynamics due to persistent bleeding. Immediate surgery may be needed in these cases.

Laceration of the Distal Biceps Femoris Tendon

BACKGROUND: Rehabilitation strategies addressing impairments caused by hamstring laceration injuries remain insufficiently explored in current literature. CASE PRESENTATION: This case study presents the effective management of a 62-year-old male who experienced pain, weakness, and range-of-motion loss secondary to a distal biceps femoris tendon laceration. Treatment incorporated interventions traditionally utilized for acute athletic hamstring injury. OUTCOME AND FOLLOW-UP: Clinically meaningful improvements were made in active knee extension range of motion, as well as isometric knee flexor and hip extensor strength over 10 weeks. He was able to return to running for aerobic fitness and improved his Lower Extremity Functional Scale score from 13/80, initially, to 76/80 at 12 months. DISCUSSION: This case suggests the use of evidence-based interventions for hamstring strain may be useful for management of partial tendon laceration injuries. JOSPT Cases 2024;4(2):74-78. Epub 2 May 2024. doi:10.2519/josptcases.2024.0003

Sympathetic Ophthalmia in Paediatric Post-Surgical Repair, A Case Report

Introduction : Sympathetic Ophthalmia (SO) is a rare and devastating complication of ocular trauma. Incidence reached 0.26% among cohort in paediatric open globe injury. We present a case report of pediatric Sympathetic Ophthalmia.
 Case Illustration : An 8-year-old boy is present in an outpatient clinic with a history of corneal lacerating injury on LE 1 month ago and had surgical repair 7 days after the injury. The patient complained of redness and blurry vision in both eyes. VA RE 0.5 and LE 0.05. RE revealed ciliary injection, flare/cell (f/s) +2/+2, and vitreous cell +1. LE revealed ciliary injection, corneal scars, f/s +2/+2, and vitreous cell +2 (Fig. 1). Fundus and OCT revealed macular oedema with exudative retinal detachment RE and bilateral optic nerve head swelling (Fig. 2). Patient was diagnosed with sympathetic ophthalmia and treated with prednisolone acetate 8x per day for RLE with high-dose oral steroid methylprednisolone 1 mg/kg body weight (32 mg). One week after treatment, clinical findings were improved, and the steroid was tapered. After 2 months f/s, macular oedema, exudative retinal detachment and optic nerve head swelling were resolved with VA RE 1.0 and LE 0.4.
 Discussion : Although the etiology of SO is currently unknown, it is believed that hypersensitivity following trauma to the fellow eye may be the trigger. The severity of SO's clinical presentation might range from mild to severe.
 Conclusion : Sympathetic ophthalmia is a serious complication that rarely occurs after trauma, especially in the pediatric population. Prompt treatment of oral and topical corticosteroids may lower the inflammatory response.

Analysis of Injury Patterns in Railway Track Death and their correlation with Manner of Death in the Bhopal Region- An Autopsy Based Study

Cases of deaths due to railway injuries are important in respect to medico- legal investigation to find out the underlying cause and manner of death. This study was undertaken for assessment of load and to study the cases of railway fatalities for the pattern of injuries sustained, manner and cause of death with the evaluation of factors responsible for such events and to suggest recommendations for curbing such events. The primary goal of this study, which focused on 107 railway-related deaths at the Gandhi Medical College in Bhopal, was to identify the cause of death from the pattern of injuries. In our study we found 91.6% of the 107 victims were men, while 8.4% were women. Most victims (54.2%) were in the age range of 21 to 40. 90.7% of 107 incidents resulted in spot deaths. In case of the visceral injuries brain and liver are maximum affected organs. Externally abrasion and contusions are commonly seen in both type of cases, abrasion found in almost 100 percent cases. Laceration and crushed injuries are more commonly seen in accidental cases and decapitation seen only in suicidal cases. There were no homicide cases in this study; instead, 66.4% of the cases were accidental and 33.6 percent of the cases were suicide. Our study's analysis suggests that after detailed examination of spot and body position at the scene of crime, closely checking for injury pattern and their frequency in same type of cases, obtaining detailed history from police, relatives and eye witnesses we can opine a possible manner of death.

Occurrence and Characteristics of Cut Injuries in Hedgehogs in Germany: A Collection of Individual Cases.

The number of European hedgehogs (Erinaceus europaeus) is in long-term decline across Europe. Recently, an additional threat to hedgehogs' lives has been cutting injuries caused by garden care equipment, but to date, there have been no reliable data on their spatial and temporal occurrence as well as characteristics such as mortality rate. Usually, found injured hedgehogs are admitted to care centres. In this study, data on hedgehogs with cutting injuries were collected from care centres throughout Germany. Over a period of 16 months, data on a total of 370 hedgehogs with cut injuries were reported by 71 care centres. At least 60% of these hedgehogs were found more than 12 h after the accident and at least 47% did not survive as a result of the injury. The comparatively high mortality rate coupled with a possible high number of unreported cases of hedgehogs with laceration injuries show that these accidents pose an additional, serious danger to hedgehogs, both impacting the welfare of individual animals and having a broader effect on the conservation potential of this species. Moreover, the data collected objectify the current discussion on the need for possible technical or political solutions to prevent such injuries.

Electrophysiological and Ultrasonographic Evaluation of Palmar Digital Nerve Injury in Distal Finger

Electrophysiological evaluation of distal lesions in the palmar digital branch of the median nerve presents a significant challenge. We present a case of lateral palmar digital neuropathy of the median nerve, which was confirmed through clinical, electrophysiological, and ultrasonographic assessments. A 54-year-old woman was referred to our electrophysiology laboratory for persistent numbness and a tingling sensation on the radial side of the distal phalanx of her left second finger. She had a laceration injury on the middle phalanx of the second finger and underwent neurorrhaphy of the lateral branch of the palmar digital nerve 8 months ago. Sensory nerve conduction studies, both antidromic and orthodromic, showed low amplitude responses for the lateral branch of the palmar digital nerve. Ultrasonography revealed swelling of this nerve branch within the middle phalanx of the second finger. When patients report sensory symptoms in a specific area, it is important to evaluate for potential cutaneous nerve injuries using electrophysiological studies. Additionally, high-resolution ultrasonography is a valuable tool for investigating small cutaneous nerve lesions, even in the distal finger.

Chitosan nonwoven fabric composited calcium alginate and adenosine diphosphate as a hemostatic bandage for acute bleeding wounds

Acute bleeding following accidental injury is a leading cause of mortality. However, conventional hemostatic bandages impede wound healing by inducing excessive blood loss, dehydration, and adherence to granulation tissue. Strategies such as incorporating active hemostatic agents and implementing chemical modifications can augment the properties of these bandages. Nevertheless, the presence of remote thrombosis and initiators may pose risks to human health. Here, a hemostatic bandage was developed by physically combined chitosan nonwoven fabric, calcium alginate sponge, and adenosine diphosphate. The presented hemostatic bandage not only exhibits active and passive mechanisms for promoting clotting but also demonstrates excellent mechanical properties, breathability, ease of removal without causing damage to the wound bed or surrounding tissues, as well as maintaining an optimal moist environment conducive to wound healing. In vitro evaluation results indicated that the hemostatic bandage possesses favorable cytocompatibility with low levels of hemolysis. Furthermore, it effectively aggregates various blood cells while activating platelets synergistically to promote both extrinsic and intrinsic coagulation pathways. In an in vivo rat model study involving liver laceration and femoral artery injury scenarios, our developed hemostatic bandage demonstrated rapid clot formation capabilities along with reduced blood loss compared to commercially available fabrics.

HUBUNGAN PERAWATAN LUKA PERINEUM DENGAN PENYEMBUHAN LUKA PERINEUM IBU POST PARTUM

Labor often result in the birth canal laceration, laceration occurred in nearly all deliveries the first time and not infrequently in the next birth. Resulting in laceration injuries that lead to treatment and should be done so that the perineal wounds can heal normally. This study aimed to determine whether there is a relationship between the perineal wound care with perineal wound healing in post partum. The research design used in this research using correlational analytic methods to the type design Cohort. The population in this study were 27 post partum at BPS Mrs. Aida W., Amd.Keb Dlanggu Village near Lamongan District. Sample was used as many as 26 respondents in accordance with inclusion criteria, and were taken by Simple Random Sampling is, taking samples from members of the population conducted randomly without regard to strata that exist in this population, with a variable is a treatment depedennya perineal wound healing was the independent variable is perineal wound. Data obtained and processed using the Chi square test with α = 0.05. Results showed that respondents who do care very well and recovered to normal as much as nine respondents (90%), while the treatment is not good and slow recovery is nine respondents (56.2%). From the results of the chi-square test p value = 0.018 where p <0.05. This shows that H0 is rejected. It can be concluded from this study that there is relationship between the perineal wound care perineumnya with healing wounds, so in this case is expected for post partum mothers to be more better in the treatment of wounds can be healed wounds perineumnya supaya to normal.

Comparison of Ultrasound Contrast between H2O2-Responsive Nanoparticles and Microbubble Contrast According to Muscle Injury in Rat Models.

Ultrasound contrast agents are clinically used for diagnosis of internal organs, but ultrasound contrast agents are rarely applied clinically in musculoskeletal disorders. Our study aims to comparatively analyze the differences between ultrasonographic images through peri-injury injection of the clinically used microbubble and researched nanoparticle contrast agents in various muscular injury models. To compare contrast-enhanced images in different muscle injury models, we prepared groups of rats with sham, laceration, punch, contusion, and toxin injection injuries. We measured H2O2 levels using the Amplex Red assay by extracting tissue from the damaged area. As comparative contrast agents, SonoVue®, a commercially available microbubble contrast agent, and poly(vanillinoxalte) (PVO) nanoparticles, which are H2O2-responsive nanoparticles, were used. The difference in contrast between the two contrast agents was recorded as an ultrasound movie, and J-image software 1.53p was used to quantify and analyze the maximum and minimum echogenicity values of the images after contrast enhancement. In the Amplex red assay for the highest H2O2 level in each muscle injury model, the maximum level showed 24 h after the modeling. In the sham rats, PVO injection showed no increased echogenicity except at the needle insertion site, but SonoVue® injection showed increased echo signal throughout the injected muscle immediately after injection. One day after the preparation of the lesion, PVO and SonoVue® were injected into the lesion site and ultrasound was performed on the lesion site. After the injection of PVO nanoparticles, contrast enhancement was observed at the lesion site immediately. SonoVue® injections, on the other hand, showed a widespread pattern of echo signals and an increase in echo retention only at the lesion site over time, but this was not clear. There were statistically significant differences between the highest and lowest echogenicity in PVO and SonoVue® contrast-enhanced images in all models. Contrast enhancement lasted more than 3 h in the PVO injection, but disappeared within 3 h in the SonoVue® injection. PVO nanoparticles showed the possibility of physiologic contrast by CO2 generated by conjugation with H2O2 generated by muscle injuries, and SonoVue® injection observed the possibility of microbubble contrast as a contrast agent with a pooling effect that lasts longer on the lesion. Further research is needed to investigate the use of various ultrasound contrast agents, including nanoparticles, in musculoskeletal disorders, as well as the potential for further utilities of microbubble contrast agents.

Shinbaro2 enhances axonal extension beyond the glial scar for functional recovery in rats with contusive spinal cord injury

Spinal cord injury (SCI) is a devastating event that often results in the inflammatory condition of glial scar tissue formation, impeding neural regeneration and recovery. Reducing the inflammatory response and inhibiting glial formation are promising strategies for improving SCI outcomes. Here, we introduce a new role for Shinbaro2 (Sh2), known for its anti-inflammatory and pain-reducing effects, in ameliorating glial scars formed in the damaged spinal cord and promoting axon growth after SCI. Sh2 was applied at various concentrations to cultivate primary spinal cord neurons. Concentrations of 1 and 2 mg/mL effectively enhanced cell viability and axonal outgrowth in spinal cord neurons subjected to hydrogen peroxide or laceration injury. Sh2 helped reduce neuroinflammation by increasing anti-inflammatory M2 macrophages (arginase 1) and decreasing inflammatory cells, ultimately reducing lesion size. In scar formation, Sh2 inhibited the expression of β-catenin and nestin in reactive astrocytes in the injured spinal cord. Moreover, Sh2 suppressed the expression of chondroitin sulfate proteoglycans and SOX9, which are involved in scar formation. Furthermore, Sh2 promoted the sprouting of serotonergic axons and the growth of neurofibrillary tangles, enhancing motor function recovery in SCI. These findings highlight the potential of Sh2 as an SCI therapeutic intervention, offering hope for neural and functional restoration in individuals with this debilitating condition.

Neuro-regenerative behavior of adipose-derived stem cells in aligned collagen I hydrogels.

Peripheral nerve injuries persist as a major clinical issue facing the US population and can be caused by stretch, laceration, or crush injuries. Small nerve gaps are simple to treat, and the nerve stumps can be reattached with sutures. In longer nerve gaps, traditional treatment options consist of autografts, hollow nerve guidance conduits, and, more recently, manufactured fibrous scaffolds. These manufactured scaffolds often incorporate stem cells, growth factors, and/or extracellular matrix (ECM) proteins to better mimic the native environment but can have issues with homogenous cell distribution or uniformly oriented neurite outgrowth in scaffolds without fibrous alignment. Here, we utilize a custom device to fabricate collagen I hydrogels with aligned fibers and encapsulated adipose-derived mesenchymal stem cells (ASCs) for potential use as a peripheral nerve repair graft. Initial results of our scaffold system revealed significantly less cell viability in higher collagen gel concentrations; 3mg/mL gels showed 84.8±7.3% viable cells, compared to 6mg/mL gels viability of 76.7±9.5%. Mechanical testing of the 3mg/mL gels showed a Young's modulus of 6.5±0.8kPa nearly matching 7.45kPa known to support Schwann cell migration. Further analysis of scaffolds coupled with stretching in vitro revealed heightened angiogenic and factor secretion, ECM deposition, fiber alignment, and dorsal root ganglia (DRG) neurite outgrowth along the axis of fiber alignment. Our platform serves as an in vitro testbed to assess neuro-regenerative potential of ASCs in aligned collagen fiber scaffolds and may provide guidance on next-generation nerve repair scaffold design.

Animal Bites in ENT

Introduction:
 Animal bites can range from abrasions to laceration injury and are notorious for causing infectious diseases like rabies. Four such animal bite cases presented to ENT emergency, two of them assaulted by the Royal Bengal Tiger and the remaining two were bitten by their pet dogs. The management protocol has been discussed for the four cases.
 
 Case reports:
 The first two case reports deal with tiger attack and the other two involve bites by the pet dogs. The primary management of the cases has been described, followed by definite treatment.
 
 Conclusion:
 Primary management of the case involves washing the wounds with normal saline. Anti-rabies vaccination followed by regular antiseptic dressing was done and the definite repair was done in the second sitting.

Developing failure criteria for laceration injury of dermal tissue

Despite its importance, there is a poor understanding of human injury tolerance to trauma generally, and more specifically understanding of the mechanics of skin penetration or laceration. The objective of this analysis is to determine the failure criteria that will allow the evaluation of the laceration risk of blunt-tipped edges within a computational modeling environment. An axisymmetric tissue finite element model was set up in Abaqus 2021 to match the experimental set-up from a previous study. The model simulated the pressing of penetrometer geometries into dermal tissue, and stress and strain outputs were evaluated at the experimental failure force. Two separate nonlinear hyperelastic material models were calibrated for the dermis to data from the literature (high and low stiffness models). For both the high-stiffness and low-stiffness skin models, the failure force appears to occur near a local maximum in the principal strain. All failures occurred after the maximum strain near or at the top surface is or above 59%, with mid-thickness strain at a similar level. The strain energy density is concentrated near the edge tip for each configuration, indicating highly localized material damage at the point of loading, and increases rapidly prior to the approximate failure force. As the edge is further compressed into the tissue, the stress triaxiality near the edge contacting point decreases towards zero. This study has identified general failure criteria for skin laceration which can be implemented in a computational model. A higher risk for laceration would be indicated with strain energy density larger than 60 mJ/mm3, dermal strain larger than 55%, and stress triaxiality below 0.1. These findings were largely insensitive to the dermal stiffness and broadly applicable across different indenter geometries. It is expected that this framework may be implemented to evaluate hazardous forces for product edges, interactions with robots, and interfaces with medical and drug delivery devices.

PO-02-056 REAL-TIME VIDEO ASSISTED THORACOSCOPIC SURGERY IN HIGH-RISK TRANSVENOUS LEAD EXTRACTION

Laceration injury to the superior vena cava (SVC) remains the most feared complication of transvenous lead extraction (TLE). Early recognition is crucial to prevent catastrophic complications. Use of real time video assisted thoracoscopic surgery (VATS) during high risk TLE can potentially be useful for prompt recognition of SVC injury. We describe the use of video assisted thorascopic surgery (VATS) guidance for complex transvenous lead extractions (TLE). We conducted a retrospective analysis of all patients that underwent TLE at our institution from September 2018 to November 2022. Our TLE protocol uses a risk stratification scheme of level 1, 2 and 3 based on perceived risk. Defibrillation leads with a dwell time of >10 years or presence of 3 leads with oldest lead >10 years qualify as level 3 TLE cases. All procedures are performed with surgical back up with the use of VAT via a right thoracoscopic approach in level 3 cases. During single lung ventilation, the surgeon places a camera port to provide visualization of the SVC and right atrium for direct visualization during the laser/mechanical sheath manipulation in the great vessels. Out of 41 patients that underwent TLE during the study period, 10 patients underwent concomitant right VATS. Mean age of cohort was 61.5 + 15.2 years and 70% were males. Mean BMI and LVEF was 28.8 + 7.9 & 28.5 + 5.9 % respectively. Indications for TLE included lead malfunction (50%), infection (40%) and removal of abandoned leads in 1 patient. Mean lead dwell time was 10.4 + 5.6 years. Laser sheath was used in all cases with 2 patients requiring use of additional mechanical sheaths. One case demonstrated externalized ICD coil and extraction was abandoned. A femoral approach with snaring was done in 1 patient. All patients had adequate visualization of the SVC via VATS during TLE. Average procedure duration was 134 + 79.1 minutes. There were no immediate procedural complications. VATS port was removed and a chest drain was placed which was removed on post operative day 1 in all patients. VATS allows for direct visualization of the venous structures, provides real time information regarding impending venous injury, and is feasible with minimal impact on procedural risk and length of stay.

Identifying Risk Factors and Evaluating Occupational Safety in South Korean Forestry Sector

The forestry industry poses a higher risk of occupational accidents than other sectors, and understanding the occurrence and characteristics of injuries and fatalities is crucial for improving the safety and health of workers and establishing future strategies. In South Korea, although occupational injuries have declined since 2010, the number of occupational accidents in forestry remains higher than that in other sectors. Occupational injuries and fatalities present considerable challenges, and thus, our objective was to analyze and compare forestry accidents between 2010 and 2020. The results indicate that the highest average number of injuries occurred among workers older than 51 years and those with less than 6 months of experience. Timber harvesting and silviculture are among the most dangerous operations in forestry. Based on the analyzed dataset, amputation and laceration injuries, as well as slip and trip injuries, were the most common, accounting for 29.2% and 22.3% of total annual occupational accidents, respectively. These results may be explained by the labor-intensive, steep terrain operations in forestry. Our findings represent an essential resource for improving worker safety and health.

Laminectomy for the Removal of Thoracic Ossification of the Ligamentum Flavum (TOLF) Using Ultrasonic and Conventional Osteotomes.

Thoracic ossification of the ligamentum flavum (TOLF) is a common cause of progressive thoracic myelopathy. TOLF is typically treated with surgical decompression. A variety of surgical techniques, including laminoplasty, laminectomy, and lamina fenestration, are used for the effective treatment of TOLF. However, traditional methods are associated with a substantial risk of perioperative complications, including dural laceration and/or iatrogenic spinal cord injury. Therefore, it is important to develop an efficient and secure surgical technique for TOLF. Herein, we describe a method for laminectomyperformed at the thoracic spine using an ultrasonic osteotome combined with a conventional osteotome. This technique can reduce intraoperative complications. This is a relatively safe and easy-to-learn method that should be recommended for the treatment of TOLF.