Combined endoscopic and microsurgical approach for the drainage of a multisegmental thoracolumbar epidural abscess: illustrative case.

BACKGROUND: Spinal epidural abscess is a rare but serious infectious disease that can rapidly develop into a life-threatening condition. Therefore, the appropriate treatment is indispensable. Although conservative treatment is justifiable in certain cases, surgical treatment needs to be considered as an alternative early on because of complications such as (progressive) neurological deficits or sepsis. However, traditional surgical techniques usually include destructive approaches up to (multilevel) laminectomies. Such excessive approaches do have biomechanical effects potentially affecting the long-term outcomes. Therefore, minimally invasive approaches have been described as alternative strategies, including endoscopic approaches. OBSERVATIONS: The authors describe a surgical technique involving a combination of two minimally invasive approaches (endoscopic and microsurgical) to drain a multisegmental (thoracolumbar) abscess using the physical phenomenon of continuous pressure difference to minimize collateral tissue damage. LESSONS: The combination of minimally invasive approaches, including the endoscopic technique, may be an alternative in draining selected epidural abscesses while achieving a similar amount of abscess removal and causing less collateral approach damage in comparison with more traditional techniques.

The cutting edge-an investigation into the pressure necessary for cutting skin with different knife blade types.

Sharp force trauma is routinely encountered in forensic practice. Often the question is posed, how much pressure or energy would have been necessary to inflict a cut with a specific knife, in order to further characterize the perpetrator or determine his intent to cause harm. This paper investigates two knife blades and its individual pressures needed to cut through the epidermis and dermis. In order to examine the necessary force for cutting through the skin, we performed experiments on a piglet skin-on-gelatin phantom. Two similarly small knives-a paring knife with a serrated blade and a Swiss Army pocket knife with a smooth blade-were moved over the phantom surface using a mobile cutting apparatus with varying weight on the load arm with the knife. The depth of the cut was to be determined according to a scale from zero to three: grade 0 = no cut; grade 1 = cut into epidermis only; grade 2 = cut into dermis; grade 3 = complete transection of the entire skin. Each cut inflicted at a specific pressure force was assessed closely in order to ascertain depth, calculate the velocity, and ultimately determine the point at which a cut would inflict grade 3 damage. The smooth blade of a pocket knife needed at least 1900g pressure in order to slice through pig skin mounted on a thick gelatin block, whereas a serrated blade of a paring knife managed to cut into or through the dermis at a comparatively lower force of 700g. Our study shows that at the same cutting velocity, a significant difference in pressure is necessary to inflict the same degree of damage.

Penetration Depths of Conducted Electrical Weapon Probes Into Human Skull Phantoms.

Occasional case reports have described isolated cases of conducted electrical weapon (CEW) probes piercing the human skull. In an experimental setting, we examined whether these cases were just unfortunate incidents, how deeply such probes can pierce the skull, and whether firing distance and CEW probe type play a role in the skull-piercing capability.We fired 5 different CEW cartridges (XP 10.6 m, XP 7.6 m, smart 10.6 m, smart 7.6 m, and smart probe 7.6 m) from 4 different distances (0.5, 1, 2, and 4 m) at head phantoms made of either 5- or 7-mm-thick polyurethane spheres covered with a thin layer of gelatine and buckskin. The piercing depths were recorded by computed tomographic scanning.All tested cartridges managed to pierce the head phantoms. Piercing depths of up to 6.6 mm in the 5-mm heads and depths of almost 5 mm in the 7-mm heads were recorded. Deepest piercing depths were attained with firing distances of 2 m or less.Our results showed that all tested CEW probes are capable of piercing the skull and that shorter firing distances tend to lead to deeper piercing depths.

[Dentigerous cyst in a pediatric patient with acute lymphoblastic leukemia type 1]. / Quiste dentígero en un niño con leucemia linfoblástica aguda tipo 1.

OBJECTIVE: To report medical and surgical treatment in a patient with acute lymphoblastic leukemia type 1 who developed a dangerous cyst. CLINICAL CASE: A male of 8 years with acute lymphoblastic leukemia type 1, whose treatment was in induction. In one month, the patient presented a facial asymmetry due to mandibular growth and acute pain, hyperthermia and malaise. In the examination, we identified lip parestesia, a second temporal molar treated with chromium steel and expansion involving the cortical of the lateral permanent incisive until the first permanent molar was identified. Since we suspected of bone metastasis, we performed an orthopantomography. We established the diagnosis of dentigerous cyst. Enucleation, curettage, and extraction of decay teeth were done in order to avoid and prevent infectious sources. CONCLUSIONS: The most frequent clinical manifestations of acute lymphoblastic leukemia are anemia, leukopenia, and thrombocytopenia. This leukemia may be manifested also as infiltration of the jaw bone. In this case, the results showed no presence of bone metastasis. As a first step before to begin treatment, the physician ought to make sure that the patient is free of infectious processes anywhere that may influence the clinical development of leukemia. Due to the surgical intervention and to a successful bone marrow transplant, the patient is on remission.

OBJETIVO: describir el tratamiento médico-quirúrgico en un niño con leucemia linfoblástica aguda tipo 1 que desarrolló un quiste dentígero. CASO CLÍNICO: niño de ocho años de edad con leucemia linfoblástica aguda, cuyo tratamiento estaba en fase de inducción. En el transcurso de un mes, el niño presentó asimetría facial por aumento de la mandíbula, así como dolor agudo, hipertermia y malestar general. A la exploración se identificó parestesia labial, segundo molar temporal con restauración de corona de acero cromo y expansión de la cortical del incisivo lateral permanente hasta primer molar permanente. Por sospecha de metástasis ósea se realizó una ortopantomografía con la que se estableció el diagnóstico de quiste dentígero. Se realizó enucleación, curetaje y extracción de órganos dentarios cariados para prevenir infecciones. CONCLUSIONES: las manifestaciones clínicas más frecuentes de la leucemia linfoblástica aguda suelen ser anemia, trombocitopenia, leucopenia y ocupación de la médula ósea por blastos. También puede manifestarse con infiltrado óseo en mandíbula; en el paciente descrito no se demostró metástasis ósea. Antes de iniciar el tratamiento de la leucemia linfoblástica aguda, se debe verificar que los pacientes estén libres de fuentes de infección que pudieran influir en su evolución. Debido a la intervención quirúrgica oportuna y al trasplante autólogo de médula, al momento de este informe el paciente se encontraba en remisión.

Estudio del diseño y operación de una planta de tratamiento primario con adición de reactivos químicos, que trata aguas residuales domésticas

En este trabajo se presentó el diseño y operación de una Planta de tratamiento cuyo tren consta de un pretratamiento (desarenador), coagulación-floculación, sedimentación, cloración y tratamiento de lodos.Se realizaron monitoreos intensivos durante una semana, siendo los objetivos de este trabajo el de analizar y evaluar cada unidad de proceso del sistema de tratamiento, probar reactivos químicos que mejoren la eficiencia de la Planta, las conclusiones llevaron a recomendar algunas modificaciones