Reconstruction After Grizzly Bear Attack in Wyoming.

Bear attacks are rare, although global incidents have been increasing. Injury patterns of bear attacks against humans consistently include injuries to the face, head, neck, chest, and upper extremities. Here, we have a brief report of a 59-year-old male hunter who was attacked by a grizzly bear in Wyoming. He sustained multiple lacerations to his face which included an avulsion of his nose and upper lip, as well as extensive associated facial fractures. Additional injuries included soft tissue and bony injuries to the upper extremities. He underwent 53 operations during his first hospitalization, primarily of facial reconstruction, which required nose and upper lip replant to his arm. His course was complicated by pressure ulcers, bacteria, acute kidney injury, and a urinary tract infection. After successful coordinated multidisciplinary care and a prolonged hospitalization, he was ultimately discharged to his home.

Expedient Endovascular Hemorrhage Control During Anterior Lumbar Spinal Exposure Allows Procedural Completion in Rescued Patients.

OBJECTIVES: To propose a contemporary management strategy for venous injury during anterior lumbar spinal exposure that incorporates endovascular treatment. METHODS: Vein injuries suffered by patients treated in a single practice were reviewed. A treatment algorithm based on these experiences was formulated. RESULTS: Between 2015 and 2018, 914 patients received anterior access procedures for indicated lumbar interbody fusions. Of these patients, 15 (1.6%) suffered minor vascular injuries treated with manual pressure or suture repair. Four (0.4%) patients undergoing anterior lumbar spine surgery suffered major venous injuries, all of whom received the indicated spinal hardware following endovascular rescue. Primary repair was attempted in three patients before endovascular control and not at all in one. Vascular access was obtained via the bilateral femoral veins in 2 patients, unilateral femoral in one, and bilateral femoral plus right internal jugular vein in one. Stent choice included both uncovered (5, 63%) and covered stents (3, 38%). Deep venous thrombosis occurred in 2 patient's post-treatment. 1 DVT was encountered in the setting of a covered stent and 1 uncovered stent thrombosis was treated with catheter-directed lysis 4 weeks post-operatively. Ultimately, 3 patients were therapeutically anticoagulated. Mean follow-up is 13 months (range 1-36) with duplex ultrasounds available at 6 months or later in 3 of 4 patients. There is no evidence of post-thrombotic syndrome in the 2 patients that developed DVT's or in-stent stenosis in the 3 patients with available follow-up imaging. CONCLUSIONS: Endovascular techniques are important adjuncts when controlling large-volume hemorrhage associated with venous tears during anterior spinal exposure. Adequate direct compression allowing occlusion balloon inflation are key steps to reduce blood loss. Covered and uncovered stents are both appropriate choices to treat injuries. Patients must be anticoagulated post-operatively and surveilled for the sequelae of venous insufficiency. With expedient hemostasis, the indicated spinal surgery may be safely completed.

Ollieopteryx, a new genus of caddisflies from Madagascar (Trichoptera: Dipseudopsidae).

New taxa of Dipseudopsidae from Madagascar are described, including a new genus, Ollieopteryx, and three new species, Ollieopteryx fianarana, O. inopinata, and O. dakshan. The hypothetical phylogenetic tree of the Dipseudopsidae (Weaver Malicky 1994) is revised to include Ollieopteryx, an isolated relic. Scenarios on the historical biogeography of the family are hypothesized.

First records of Cyclorhipidion fukiense (Eggers) (Coleoptera: Curculionidae: Scolytinae: Xyleborini), an ambrosia beetle native to Asia, in North America.

The Asian ambrosia beetle, Cyclorhipidion fukiense (Eggers) was detected for the first time in North America based on three specimens trapped in 2012 from three localities in South Carolina and two other specimens intercepted at the port of Savannah, Georgia, in 2010. The species is characterized, illustrated with high-resolution images, and compared with two other congeneric, adventive species (C. bodoanum and C. pelliculosum) presently established in eastern North America. Morphometric measurements are provided and a provisional key is presented to the species of Cyclorhipidion occurring in North America.

The genus Palaeagapetus Ulmer (Trichoptera, Hydroptilidae, Ptilocolepinae) in North America.

The genus Palaeagapetus Ulmer (Trichoptera, Hydroptilidae, Ptilocolepinae) is revised in North America. Descriptions of the western species, P. nearcticus Banks 1938, are provided with the first descriptions of the female, pupa, larva, egg and case and with notes on food, habitat and annual life cycle. The male and female of the eastern species, P. celsus Ross 1936, are described or redescribed with some ecological notes. Distributions of the two species are summarized.

Insulation failure in laparoscopic instruments.

BACKGROUND: Electrosurgery is used in virtually every laparoscopic operation. In the early days of laparoscopic surgery, capacitive coupling, associated with hybrid trocars, was thought to be the major cause of laparoscopic electrosurgery injuries. Modern laparoscopy has reduced capacitive coupling, and now insulation failure is thought to be the main cause of electrosurgical complications. The aim of this study was (1) to determine the incidence of insulation failures, (2) to compare the incidence of insulation failure in reusable and disposable instruments, and (3) to determine the location of insulation failures. METHODS: At four major urban hospitals, reusable laparoscopic instruments were checked for insulation failure using a high-voltage porosity detector. Disposable L-hooks were collected following laparoscopic cholecystectomy and similarly evaluated for insulation failure. Instruments were determined to have insulation failure if 2.5 kV crossed the instrument's insulation to create a closed loop circuit. Statistical analysis was performed using Fisher's exact or chi(2) analysis (*denotes significance set at p < 0.05). RESULTS: Two hundred twenty-six laparoscopic instruments were tested (165 reusable). Insulation failure occurred more often in reusable (19%; 31/165) than in disposable instruments (3%; 2/61; *p < 0.01). When reusable sets were evaluated, 71% (12/17) were found to have at least one instrument with insulation failure. Insulation failure incidence in reusable instruments was similar between hospitals that routinely checked for insulation failure (19%; 25/130) and hospitals that do not routinely check for insulation failures (33%; 7/21; p = 0.16). Insulation failure was most common in the distal third of the instruments (54%; 25/46) compared to the middle or proximal third of the instruments (*p < 0.05). CONCLUSION: One in five reusable laparoscopic instruments has insulation failure; a finding that is not altered by whether the hospital routinely checks for insulation defects. Disposable instruments have a lower incidence of insulation failure. The distal third of laparoscopic instruments is the most common site of insulation failure.