A rare case of severe third degree friction burns and large Morel-Lavallee lesion of the abdominal wall.

BACKGROUND: Morel-Lavallee lesions (MLLs) are rare internal degloving injuries typically caused by blunt traumatic injuries and most commonly occur around the hips and in association with pelvic or acetabular fractures. MLL is often overlooked in the setting of poly-trauma; therefore, clinicians must maintain a high degree of suspicion and be familiar with the management of such injuries, especially in obese poly-trauma patients. CASE PRESENTATION: We present a 30-year-old female pedestrian struck by a motor vehicle who sustained multiple long bone fractures, a mesenteric hematoma, and full-thickness abdominal skin friction burn which masked a significant underlying abdominal MLL. The internal degloving caused significant devascularization of the overlying soft tissue and skin which required surgical drainage of hematoma, abdominal wall reconstruction with tangential excision, allografting, negative pressure wound therapy, and ultimately autografting. CONCLUSION: MLL is a rare, often overlooked, internal degloving injury. Surgeons must maintain a high index of suspicion when dealing with third degree friction burns as they may mask underlying injuries such as MLL, and a delay in diagnosis can lead to increased morbidity.

Comparison of trans-nasal laryngoscopic office based biopsy of laryngopharyngeal lesions with traditional operative biopsy.

The objectives of this study are to compare the pathological results from office-based biopsy (OBB) and operative biopsy (ORB) of laryngopharyngeal lesions from 26 patients. Lesion location, specimen concordance, efficacy, cost savings, and patient management are discussed. OBB can provide a sample of laryngopharyngeal tissue that can be used to diagnose lesions in these sites. This study design is retrospective review and involved retrospective analysis and chart review of 26 cases of patients who had an OBB followed by and ORB of the same site; oropharyngeal or laryngopharyngeal lesion. CPT 31576 was to identify patients. Twenty six patients had both OBB and operative biopsy performed of a lesion within the oropharynx and laryngopharynx. All OBB attempts resulted in diagnostic tissue samples. Vocal fold biopsy (69 %) was most common. The most common OBB diagnosis was squamous cell carcinoma or moderate-to-severe dysplasia (54 %). OBB and ORB pathological results were the same in 81 % of patients. Of the benign samples obtained by OBB, 83 % of the ORB were deemed benign. Of the non-benign samples obtained via OBB, 80 % of the ORB were deemed non-benign in the operating room samples. Office-based biopsy is a simple procedure that can be performed in an outpatient setting, avoiding an operating room and the need for general anesthesia. Comparison of results from OBB to ORB together with patient characteristics resulted in very reliable results that can help to guide further patient management.

Measures of vocal attack time for healthy young adults.

OBJECTIVE: To determine the vocal attack time (VAT) in a healthy young adult population. STUDY DESIGN: Sound pressure (SP) and electroglottographic (EGG) recordings were obtained for 57 female and 55 male subjects while performing multiple tokens of three tasks (sustained /a/, "always," and "hallways") at comfortable pitch and loudness. METHODS: Generalized sinusoidal models were obtained for SP and EGG signals to compare rates of amplitude change. VAT was computed from the time lag of the cross-correlation function using a fully automated process accompanied by operator validation. RESULTS: Adjusted mean VAT values were significantly shorter for females than for males. There was no systematic effect of age on VAT. However, 25- to 29-year-old men showed longer VAT than did the other age and sex subgroups. CONCLUSIONS: Normative data are presented for a new measure of the duration of vocal initiation, VAT. Acquiring this measure requires very little intervention by the user and, thereby, eliminates the influence of subjective decision making. Although beyond the scope of this article, we suggest several factors that might underlie VAT as a function of speaker sex and age.