Notes

[The expression and position associated with interleukin-8 within persistent rhinosinusitis].
We present the rare case of an open femoral condyle fracture (Gustilla IIIA) combined with a vertical patella fracture due to sharp injury after a traffic collision in a 17-year-old female. During subsequent operation, a locking compression plate was used for definitive fixation of the distal femur and the patella was reduced and fixated with two screws. Four months after surgery, the patient had practically full range of motion again and no secondary complications occurred. On control X-ray, there was consolidation of the fracture.This study examined the treatment, clinical course, and prognosis of two patients who visited our institution with severe ocular fishhook-related injuries with complications. The first patient was a 57-year-old man injured in the right eye by a fishhook lacerating the right upper eyelid. Although no aqueous humor leakage was observed, intraocular hemorrhage was severe, and the best-corrected visual acuity (BCVA) was "counting fingers" at 15 cm. The eyelid was sutured and vitreous surgery with cataract surgery was performed for traumatic cataract, vitreous hemorrhage, and retinal detachment. The patient experienced recurring iritis and the BCVA recovered to 20/100 eight months postoperatively. The second patient was a 62-year-old man who incurred a penetrating right-eye fishhook injury on a ship with BCVA of "hand motion." The sclera and iris were ruptured with severe hemorrhage and a shallow anterior chamber without leakage of aqueous humor. A damaged lens and vitreous hemorrhage were observed with intraoculaeyes might result in irreversible visual impairment. It is important to pay attention and protect the eyes from moving fishhooks during fishing.
There are few reports on fishhook injury of the eye with resulting complications such as retinal detachment. We present the characteristics of the injury, treatment, clinical course, and prognosis of two patients with severe fishhook-related injuries of the eye with complications. Following treatment, most complications, including vitreous hemorrhage, detached lens, and retinal detachment, safely resolved in these cases; however, both patients required further treatment for recurring inflammation of the iris or glaucoma. The visual acuity of both patients improved over several months. Fishhook-related injuries of the eyes might result in irreversible visual impairment. It is important to pay attention and protect the eyes from moving fishhooks during fishing.An atypical course of the vertebral artery can be medically relevant in displaced Hangman fractures, especially if the artery course runs within the fracture gap of the C2 isthmus. During surgical reduction, the artery can be occluded inside the fracture, potentially leading to ischemic conditions of the brain. The aim of this study was to report two cases according to the CARE (case reporting) guidelines, in which intraoperative color-coded duplex-ultrasound was performed to secure safe surgical reduction of hangman fractures in two patients with an atypical course of the vertebral artery. Two patients with displaced hangman fractures (Effendi-Levine type II) were diagnosed with an atypical course of the vertebral artery running inside the fracture gap. This endangered safe surgical management with the risk of iatrogenic occlusion or injury during reduction through entrapment of the vessel inside the fracture gap. Therefore, an intraoperative color-coded duplex-ultrasound of the vertebral artery was conducted before and after reduction of the fracture, as well as at the end of the surgery. The surgical treatment in both cases included posterior unilateral spondylodesis, followed by anterior cervical discectomy and fusion (ACDF). In both patients, a safe reduction of the fracture was performed. Neither occlusion nor dissection of the vertebral artery occurred. The duplex ultrasound before and after reduction, and at the end of the procedure showed normal blood flow and morphology of both vertebral arteries. At follow-up examinations, the patients showed a favorable clinical outcome, radiographic signs of fusion, and no irregularity of the vertebral arteries. This case report serves as proof-of-concept, demonstrating the feasibility of this regimen to minimize the risk of entrapment or occlusion of the vertebral artery in the surgical management of displaced Hangman fractures with atypical course of the vertebral artery running inside the fracture gap.A 53-year-old man underwent thoracic endovascular aortic repair for persistent false lumen perfusion and limb salvage because of type A aortic dissection, severe lower-limb ischemia, and bleeding (mediastinal hematoma, bilateral lung contusion, liver injury, and splenic injury) caused by blunt trauma. We embolized the left supreme intercostal artery to control active mediastinal hemorrhage. Acute hemorrhage and leg ischemia were well controlled; however, residual blood flow in the false lumen persisted. We performed a Zone 2 thoracic endovascular aortic repair and discharged the patient on day 67. Thoracic endovascular aortic repair is a practical option for treating traumatic type A dissection.Low-energy blunt brachial artery injury is very rare and can be easily missed. Moreover, brachial artery injury in an amateur volleyball player is extremely rare. A 33-year-old woman was referred to our emergency department with swelling on her left upper arm after playing volleyball. Paresis or paralysis was not observed. The pulse of the left brachial artery was palpable, but relatively weak. An ultrasound examination and a computed tomography, both, revealed a pseudoaneurysm on the posterior wall of the left brachial artery in the antecubital fossa. Protoporphyrin IX in vitro A massive hematoma was also observed beneath the artery. The examination ruled out any concomitant injuries such as fracture and dislocation of the joints. An emergency surgery was performed. A hockey stick skin incision was made from the distal brachium to the antecubital fossa. The left brachial artery was detected in the hematoma. A 15 mm-long laceration was observed on the posterior wall of the artery. The condition of the vessel wall around laceration was poor. Therefore, we resected the injured lesions. The defect was so long that the lesion was interposed by a reversed saphenous vein graft. Heparin was administered one day after the surgery, which was later changed to apixaban on the sixth day after the surgery. Apixaban was discontinued after a month post-surgery. During the follow-up period, the patient did not report any complications and the graft was unobstructed.Two young patients with a Pauwels type 3 femoral neck fracture were treated with cannulated screws and the addition of an anteromedial buttress plate on the femoral neck. Both developed a non-union necessitating a salvage procedure. A Pauwels' osteotomy led to uneventful and complete healing in both patients. The purpose of this report is to describe the current literature on anteromedial buttress plating in femoral neck fractures and discusses a reproducible hip preserving salvage option when a non-union develops.We present the case of a 12-year- old boy who suffered from a combination of Monteggia fracture-dislocation along with ipsilateral distal radius fracture. The patient underwent closed reduction of the Monteggia lesion and the distal radius followed by percutaneous pinning. The postoperative course was satisfactory. Associated Monteggia fracture-dislocation and ipsilateral distal forearm fracture are rare. Our case and the literature review highlight the presence of common clinical features in pediatric patients with these particular injuries, including male dominance, age around 9 years, fall from a height, and lateral displacement of the dislocated radial head.Candida pericarditis is a rare condition which has previously been described after cardiothoracic surgery and immunosuppressive states (Geisler et al., 1981; Eng et al., 1981; Kraus et al., 1988; Kaufman et al., 1988; Tang et al., 2009; Glower et al., 1990; Carrel et al., 1991; Rabinovici et al., 1997; Canver et al., 1998; Farjah et al., 2005; Gronemeyer et al., 1982 [1-11]). We describe the case of a 19-year-old male blunt trauma patient, who survived a damage control thoracotomy and laparotomy with splenectomy, who later developed a loculated Candida pericardial effusion, complicated with cardiac tamponade and multiple organ failure, and required antifungals and surgical reintervention with thoracotomy for drainage. A literature search of the reported cases demonstrates that Candida pericarditis is indeed a rare but fatal condition if not identified and treated appropriately. This article discusses the difficulties we encountered while recognizing the disorder in our patient and proposes a guideline to adequately treat the condition in an effective and timely manner. Candida pericarditis poses a special challenge for the physician since its correct diagnosis and management requires a multidisciplinary approach.A virtual clinic was developed from an existing telemedicine system to manage hand trauma in the Queen Victoria Hospital, East Grinstead, UK, during the first wave of the COVID-19 pandemic. This study evaluates the accuracy of the assessments made and makes comparisons to the traditional face-to-face clinic. The accuracy of assessment was analysed by comparing diagnosis with findings at surgery. One hundred and eighty-nine virtual assessments conducted by telephone with photographic data or by video were compared to 129 face-to-face assessments conducted prior to the pandemic. There was no difference in the accuracy of virtual and face-to-face clinics for patients treated surgically (p=0.27); treatment was correctly predicted for 87% of the virtual group and 78% of the face-to-face group. However, fewer virtual assessments led to a surgical outcome (p=0.0064); 68% of the virtual group had surgical outcomes compared to 82% of the face-to-face group. Most face-to-face assessments were done by a specialty trainee compared to a range of clinicians in the virtual clinic. Accuracy of assessment among trainees was significantly associated with experience for the virtual (p=0.045) but not face-to-face clinics (p=0.94). Virtual assessment by video versus telephone plus photographs were similarly accurate. We conclude that virtual triage serves as a successful alternative to face-to-face appointments. It is robust and succeeds in reducing footfall to the hospital site in line with recent social distancing measures against COVID-19. We have shown that video conferencing triage is no better than telemedicine triage with telephone and photographs.
The COVID-19 pandemic has compounded existing training issues for plastic surgeons. The issues that exist result from a complex interplay of system, generational and individual factors, and can be hard to tease out by quantitative means. This pilot study aimed to investigate the perceptions of trainees and trainers of plastic surgical training in the UK.

Ten semi-structured interviews were performed using purposive sampling in a central London plastic surgical unit. These were coded into and discussed in four themes Medical directives and service demands; Sociocultural norms within plastic surgical training; Equity and access; and Plastic surgery training methods.

This study showed that current plastic surgery training is not optimised for learning or well-being, and that inequities are fostered, to the detriment of the specialty. Investment and planning are required to support our trainers and protect the diversity of our trainee group, with efficient and monitored learning essential to maintain our breadth and competence of practice.
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