Utilization of Imaging in the Management of Pediatric Dog Bites.

INTRODUCTION: We hypothesized that imaging is overused in the initial workup of dog bite patients. To reduce radiation exposure, we aim to determine which circumstances surrounding dog bites, patient population, and injury patterns would necessitate imaging studies for management. METHODS: A retrospective review was performed on all patients presenting with dog bites to our level I pediatric trauma center between 2013 and 2015. Data collected included: circumstances surrounding the injury, patient demographics, injuries, and imaging studies performed. Our analysis focused on maxillofacial and head CT scans, and plain radiographic studies of the limbs, hands, and feet. Imaging studies were considered positive if there was evidence of bony injury. RESULTS: We identified 615 patients with dog bites, with 114 patients having had at least one imaging study performed (a total of 145 imaging studies to analyze). Only 13 (11%) patients had a positive study. In the CT scan group, 6 (22.2%) of 27 studies were positive. In the plain radiographic group, 7 (5.9%) of 118 studies were positive. CONCLUSIONS: Our review indicates that imaging studies are overused in the initial workup of these patients, and the majority of these studies are negative. This study confirms that it is feasible to institute guidelines for ordering imaging studies in dog bite patients. This will ultimately reduce radiation exposure and the cost of care for these injuries.

Comparison of prospective head motion correction with NMR field probes and an optical tracking system.

PURPOSE: The aim of this study was to compare prospective head motion correction and motion tracking abilities of two tracking systems: Active NMR field probes and a Moiré phase tracking camera system using an optical marker. METHODS: Both tracking systems were used simultaneously on human subjects. The prospective head motion correction was compared in an MP2RAGE and a gradient echo sequence. In addition, the motion tracking trajectories for three subjects were compared against each other and their correlation and deviations were analyzed. RESULTS: With both tracking systems motion artifacts were visibly reduced. The precision of the field probe system was on the order of 50 µm for translations and 0.03° for rotations while the camera's was approximately 5 µm and 0.007°. The comparison of the measured trajectories showed close correlation and an average absolute deviation below 500 µm and 0.5°. CONCLUSION: This study presents the first in vivo comparison between NMR field probes and Moiré phase tracking. For the gradient echo images, the field probes had a similar motion correction performance as the optical tracking system. For the MP2RAGE measurement, however, the camera yielded better results. Still, both tracking systems substantially decreased image artifacts in the presence of subject motion. Thus, the motion tracking modality should be chosen according to the specific requirements of the experiment while considering the desired image resolution, refresh rate, and head coil constraints.

Delayed Allergic Reactions to Jellyfish Stings: Usefulness of Ultrasonographic Evaluation.

Jellyfish stings often cause immediate local skin reactions, and, less frequently, the affected individuals may develop delayed allergic reactions days or months after the sting. Here, we present 4 such cases. In all cases, color Doppler ultrasonography was performed at the time of diagnosis, and in 3 of the cases, clinical follow-ups with ultrasonographic evaluations were performed. Ultrasonography initially showed dermal thickening with decreased echogenicity that progressively normalized during follow-up. Ultrasonography was useful in quantifying inflammation by measuring the thickness of the dermis and was more precise than standard clinical follow-up of cutaneous lesions in these cases.

Whiptail Stingray Injury.

Stingray injuries to the chest are rare but potentially life-threatening. They may occur in remote areas where advanced emergency healthcare services are unavailable. We describe the case of a 24-year-old man with tension pneumothorax due to a Himantura fai stingray injury to the left chest. The chest wound was unremarkable, with no external bleeding or evidence of a foreign body. Decompression was performed at the scene with an improvised knife procedure and a hollow writing pen, which served as a chest tube. At the local hospital, a standard-sized chest tube was inserted, the wound cleaned, and the patient given antibiotics active against marine organisms. Computed tomography visualized the stinger and revealed hemopneumothorax and pneumomediastinum. The local hospital did not have a thoracic surgeon, and the patient was transferred to a larger hospital with a thoracic surgery center. After surgical removal of the stinger, segmental lung resection was required to control bleeding. Management of life-threatening stingray injuries to the chest should begin at the scene. After stabilization, the patient should be transferred to a hospital equipped for cardiovascular and thoracic surgery. Surgery may be required to remove the retroserrated stinger and can be challenging.

Rat-bite fever complicated by vertebral osteomyelitis: A case report.

Rat-bite fever (RBF) is a challenging diagnosis transmitted by the bite of the rats. We present the first reported case of RBF complicated by vertebral osteomyelitis. It is important to consider performing the MRI to differentiate vertebral osteomyelitis from simple back pain to determine the appropriate duration of antibiotic therapy.

Marine stingray injuries to the extremities: Series of three cases with emphasis on imaging.

Stingray injuries are usually reported from coastal regions. The injury is caused by the tail spine of the stingray, which can penetrate deep into the soft tissues, and the venom in the tail can cause extensive tissue damage. Imaging plays a very important role in patients with stingray injuries, especially to detect the presence of retained foreign bodies and its complications. We present three cases of stingray injuries to the extremities, with a special emphasis on radiographic findings. Embedded foreign bodies that were radiographically visualized were removed in two of the patients (one patient was discharged at request and was lost to follow-up). We also discuss the types of injuries, clinical presentation, importance of imaging and management considerations in stingray injuries.

Case report: surviving a tiger attack.

Attacks on humans by large predators are rare, especially in Northern Europe. In cases of involvement of the craniocervical compartment, most of the attacks are not survived. We report on a case where the patient survived a tiger attack despite severe head trauma and discuss the circumstances leading to the patient's survival and excellent outcome. The patient we report on is a 28-year-old tamer, who was attacked by three tigers during an evening show. A bite to the head resulted in multiple injuries including left-sided skull penetration wounds with dislocated fractures, dural perforations, and brain parenchyma lesions. The patient recovered without neurological deficits after initial ICU treatment. No infection occurred. In order to understand the mechanism of the tiger's bite to the patient's cranium, a simulation of the attack was performed using a human and a tiger skull put together at identical positions to the bite marks in a CT scan. It seems that during the bite, the animal was not able to clamp down on the patient's skull between its canine teeth and therefore reduced bite forces were applied. Survival of an attack by a large predator that targeted the cervical-cranial compartment with an excellent outcome is not described in the literature. We were surprised to find only minor lesions of the brain parenchyma despite the obvious penetration of the skull by the tiger's canines. This seems to be related to the specific dynamics of the cranial assault and the reduced forces applied to the patient's head demonstrated in a 3D bite simulation.

'Tailception': using neural networks for assessing tail lesions on pictures of pig carcasses.

Tail lesions caused by tail biting are a widespread welfare issue in pig husbandry. Determining their prevalence currently involves labour intensive, subjective scoring methods. Increased societal interest in tail lesions requires fast, reliable and cheap systems for assessing tail status. In the present study, we aimed to test the reliability of neural networks for assessing tail pictures from carcasses against trained human observers. Three trained observers scored tail lesions from automatically recorded pictures of 13 124 pigs. Nearly all pigs had been tail docked. Tail lesions were classified using a 4-point score (0=no lesion, to 3=severe lesion). In addition, total tail loss was recorded. Agreement between observers was tested prior and during the assessment in a total of seven inter-observer tests with 80 pictures each. We calculated agreement between observer pairs as exact agreement (%) and prevalence-adjusted bias-adjusted κ (PABAK; value 1=optimal agreement). Out of the 13 124 scored pictures, we used 80% for training and 20% for validating our neural networks. As the position of the tail in the pictures varied (high, low, left, right), we first trained a part detection network to find the tail in the picture and select a rectangular part of the picture which includes the tail. We then trained a classification network to categorise tail lesion severity using pictures scored by human observers whereby the classification network only analysed the selected picture parts. Median exact agreement between the three observers was 80% for tail lesions and 94% for tail loss. Median PABAK for tail lesions and loss were 0.75 and 0.87, respectively. The agreement between classification by the neural network and human observers was 74% for tail lesions and 95% for tail loss. In other words, the agreement between the networks and human observers were very similar to the agreement between human observers. The main reason for disagreement between observers and thereby higher variation in network training material were picture quality issues. Therefore, we expect even better results for neural network application to tail lesions if training is based on high quality pictures. Very reliable and repeatable tail lesion assessment from pictures would allow automated tail classification of all pigs slaughtered, which is something that some animal welfare labels would like to do.

Radial artery pseudoaneurysm formation after cat bite to the wrist.

Pseudoaneurysms may occur in the groin after catheterization of the femoral artery but may also occur in arteriovenous shunting for dialysis after placement of indwelling catheters or after direct trauma to an artery. We report a unique cause of radial artery pseudoaneurysm at the wrist related to a cat bite sustained by an elderly woman. The patient underwent successful operative repair of the aneurysm, with ligation of the radial artery.

Enterocutaneous fistula as a result of chronic bite wound repair in a dog.

A 6-year-old castrated male Maltese weighing 4.8 kg was presented with a non-healing wound exhibiting purulent discharge after surgery on scar tissue of a chronic twelve-month-old bite wound on the left caudal abdominal region. The dog had previously undergone four surgeries and had been on continuous antibiotic therapy for eight months. Following radiographic and ultrasonographic examinations, the problem was diagnosed as an enterocutaneous fistula of a herniated bowel loop under the skin. Surgical resection of the fistula involving the bowel loop resolved all symptoms.

Penetrating injuries in dogs and cats. A study of 16 cases.

The objective of this retrospective study was to assess radiographical and surgical findings, surgical management and outcome of penetrating injuries in dogs and cats by evaluating patient records. Sixteen patients were identified (15 dogs and one cat), four with gunshot wounds, and 12 with fight wounds (11 with bite wounds, one struck by a claw). The thoracic cavity was affected in six patients, the abdominal cavity in three cases. Both cavities were affected in five dogs and the trachea in two cases. All of the patients with fight wounds were small breed dogs. Multiple injuries to internal organs that required intervention were found surgically after gunshot wounds and a high amount of soft tissue trauma requiring reconstruction was present after fight wounds. Radiography diagnosed body wall disruption in two cases. All of the affected thoracic body walls in the fight group had intercostal muscle disruptions which was diagnosed surgically. Fourteen patients survived until discharge and had a good outcome. In conclusion, penetrating injuries should be explored as they are usually accompanied by severe damage to either the internal organs or to the body wall. A high level of awareness is required to properly determine the degree of trauma of intercostal muscle disruption in thoracic fight wounds.

Feasibility of Cryopreserved Conduits for Complex Vascular Reconstruction in the Pediatric Population: The Case of a 3-Year-Old With Femoral Vessels Transections.

This report presents an unusual case of traumatic iliofemoral vessel transection in a 3-year-old patient successfully reconstructed using a cryopreserved greater saphenous conduit. Five years after injury, the patient continues to do well with normal ambulation. An arterial duplex demonstrated graft patency free of aneurysmal dilatation. These encouraging results suggest that the natural history of cryopreserved conduits may differ in the pediatric population and cryopreserved conduits could be used for complex vascular reconstructions.

Near-death Thoracic Trauma Caused by a Stingray in the Indian Ocean.

Stingray injuries are frequent, and although mostly benign, some can be life-threatening. We present the case of a 24-year-old man who suffered from a stingray attack in the Indian Ocean with a thoracic penetrating trauma, and its management.

[The Vulnerable Heel of Achilles: Intratendinous Abscess Following a Cat Bite]. / Die vulnerable Ferse des Achilles ­ intratendinöser Abszess nach Katzenbiss.

An 83-year-old patient suffered a cat bite dorsally to the Achilles tendon. In the further course, he developed an isolated intratendinous abscess of the Achilles tendon, which was surgically revised twice and subsequently healed with antibiotic treatment. In Germany, about 40,000 bite injuries of different origins occur annually. Most of these injuries are cat or dog bites, while human bites are rare. Although the course is often complicated, there are no standard recommendations for treatment. An intratendinous abscess after animal bite injury has not been described in the literature as yet.

Diagnostic imaging of injuries caused by venomous and traumatogenic catfish.

Injuries caused by fish are common in marine and freshwater environments. Catfish of the Ariidae and Pimelodidae families cause about 80% of those injuries. One of the complications of injuries caused by fish is the retention of fragments of the stinger in the wounds. Here we report five cases (of a total of 127 injuries caused by catfish in the Brazilian coast) in which the retained fragments were detected by radiological examination. Retained fragments should be considered in patients stung by catfish. A simple X-ray is sufficient to detect fragments of stingers in the wounds.

Zone 3 ruptured globe from a dog bite.

Periocular injuries from dog bites are relatively common in school-age children, but intraocular trauma is exceedingly rare. We present a 7-year-old boy who sustained a zone 3 ruptured globe injury after attack by a Perro de Presa Canario. At presentation, visual acuity in the injured eye was counting fingers. Surgical exploration revealed an inferotemporal corneoscleral laceration extending 15 mm posterior to the limbus, with protrusion of uveal tissue, which was repaired. Visual acuity improved to 20/40 by the first postoperative month.

Horse bite injury.

Bite wounds are relatively frequent, the order of frequency being, dogs, cats and humans. The clinical importance of other types of bites depends on the severity of the injury or any subsequent infection. We report on the case of a woman bitten on her thigh by a horse, producing severe haematoma, fat necrosis and muscle rupture, without an external wound. We emphasize the importance of the ultrasound examination in the evaluation of the extent of the crush injury.