Penetrating deep pelvic injury due to “less-lethal” beanbag munitions: a case report and policy implications

“Less-lethal” munitions are designed to cause incapacitation and are often used by law enforcement officers. Although these munitions are not designed to cause severe injury, recent reports have demonstrated that they can cause severe injury, permanent disability, and death. The long-term consequences of injury due to less-lethal munitions are not well understood. We present a case of osteomyelitis and pelvic abscess secondary to a retained beanbag munition following penetrating injury in the setting of a patient with delayed presentation for care. The patient underwent surgical removal of the retained beanbag munition and irrigation and debridement of the osteomyelitis and pelvic abscess with an excellent functional outcome. We discuss the public health and policy implications of serious injury due to less-lethal munitions.

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Occupational injury in Swedish fishery: 1. Analysis of injury statistics

Occupational Ergonomics ◽

10.3233/oer-2000-2202 ◽

1999 ◽

Vol 2 (2) ◽

pp. 81-89

Author(s):

Marianne T\"orner ◽

Per-Olov Nordling

Keyword(s):

Occupational Injury ◽

Time Of Day ◽

Occupational Accidents ◽

Age Group ◽

Permanent Disability ◽

Repair Work ◽

Trawl Fishing ◽

Common Activity ◽

Serious Injury ◽

Yearly Rate

The purpose of the present study was to make a thorough inventory of all serious accidents in Swedish fishery, reported to the Swedish Labour Market No-fault Liability Insurance, July 1983--June 1995 (431 cases, corresponding to a yearly rate of 12 per 1000 fishermen). No age group was over represented among the victims of such serious accidents. The most accident-prone activity was hauling of the trawl and the most common contacts in connection to this were getting jammed by a wire or hit by a falling object/receiving a blow by an object. The second most common activity at the time of accident was repair work/work by the wharf, often connected to the contacts pricks or cuts or falls. Falls to the same level was the most common contact over all, followed by falls to a lower level. The most frequent mechanism behind the accidents was working in an exposed position, and second most common was slipping. Hands and wrists were most commonly injured. The median value for sick listing due to serious injury in occupational accidents in fishery, was 48 days. Approximately one third of the victims suffered permanent disability (mean degree 7%). Trawl fishing was over represented in serious accidents. Half of the accidents occurred on deck. January had the highest portion of accidents (14%) followed by October and November (10% each). The most accident-prone time of day was 9.30--10.30 am.

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Evaluation of Outcome of Timing of Surgical Intervention on Cauda Equina Syndrome

Medical Journal of Shree Birendra Hospital ◽

10.3126/mjsbh.v20i1.26686 ◽

2021 ◽

Vol 20 (1) ◽

pp. 19-23

Author(s):

Rajesh Pratap Shah ◽

Bishnu Babu Thapa ◽

Sushil Rana Magar ◽

Ritesh Sinha ◽

Pankaj Chand ◽

...

Keyword(s):

Cauda Equina Syndrome ◽

Tertiary Care ◽

Cauda Equina ◽

Timing Of Surgery ◽

Bladder Function ◽

Delayed Presentation ◽

Inclusion Criteria ◽

Permanent Disability ◽

Number Of Patients

Introduction: Cauda equina syndrome (CES) is a rare clinical entity caused by compression of lumbar and sacral nerve roots resulting in various neurological dysfunctions. Early diagnosis of the syndrome and timely intervention is required to prevent permanent disability. Methods: This is a retrospective study conducted from January 2013 to December 2017 in a tertiary care centre in Kathmandu, Nepal. All the cases meeting the inclusion criteria were included in the study. Patients were operated using posterior open discectomy and the outcome was evaluated at two weeks , one month, three months, six months and one year. Result: Total number of patients meeting the inclusion criteria was 10, two females and eight males with a mean age of 40.30 + 6.58 years. The mean time for onset of symptom to timing of surgery was 142 hrs. VAS for leg improved from 5.90 + 0 .738 to 0.70 + 0.483 and VAS for back pain improved from 3.20 + 1.476 to 0.5 + 0.572 post operatively. There was improvement in sensory and motor function in all the cases. Bowel and bladder function improved in all the cases postoperatively at the time of final follow up. Sexual function was impaired in six patients preoperatively but postoperatively four had improved and two patients had poor result at the time of final follow up. Conclusions: Timing of surgery may not be the most important determining factor for the outcome of the CES. Surgical decompression in delayed presentation have good clinical outcome in CES.

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Autoamputation of the Appendix in a Chronic Adnexal Abscess

Case Reports in Obstetrics and Gynecology ◽

10.1155/2018/6010568 ◽

2018 ◽

Vol 2018 ◽

pp. 1-3

Author(s):

C. Michele Markey ◽

Lauren E. Vestal

Keyword(s):

Gastrointestinal Disease ◽

Pelvic Mass ◽

Vermiform Appendix ◽

Pelvic Abscess ◽

Definitive Diagnosis ◽

Pathological Examination ◽

Preoperative Imaging ◽

Surgical Removal ◽

Pathological Review ◽

The Right

Autoamputation of the appendix has rarely been described in the literature. We present a case of a pelvic mass, thought to be a dermoid cyst based on preoperative imaging. After surgical removal and pathological examination, the mass was found to be a chronic pelvic abscess containing the right adnexa as well as an autoamputated vermiform appendix. Differentiating between gynecologic and gastrointestinal disease preoperatively can be difficult and often a definitive diagnosis cannot be made until surgical exploration and pathological review. However, to our knowledge, this is the first described case of a chronic pelvic abscess containing an autoamputated vermiform appendix.

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Association of a history of falls or syncope with intracranial bleeding in patients with atrial fibrillation

European Heart Journal ◽

10.1093/ehjci/ehaa946.0632 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

Z Oqab ◽

A Alak ◽

W.F McIntyre ◽

Y.Y Liu ◽

S.J Connolly ◽

...

Keyword(s):

Myocardial Infarction ◽

Atrial Fibrillation ◽

Intracranial Hemorrhage ◽

Major Bleeding ◽

Permanent Disability ◽

Risk Of Death ◽

Increased Risk ◽

History Of ◽

Serious Injury ◽

Critical Injury

Abstract Background In patients with atrial fibrillation (AF), anticoagulation effectively reduces the risk of ischemic stroke. However, up to 50% of patients are not receiving this treatment. A history of falls or syncope and an associated risk of intracranial hemorrhage are commonly reported reasons for undertreatment, though these have not been well studied. Purpose To investigate the association of a history of falls or syncope with the risk of intracranial hemorrhage in patients with AF. Methods Patients with a history of AF from the RE-LY, AVERROES and ACTIVE A and W trials were combined into a large cohort. “Critical injury” was defined as any injury that resulted in death, was deemed to be life-threatening or resulted in permanent disability. A “serious injury” was defined as an injury that required hospitalization. “Other injuries” were defined as those that did not meet criteria for critical or serious injury. We used logistic regression and propensity-matched Cox models to assess the association between falls or syncope and adverse outcomes. Results Among 37,973 patients, 11.9% (n=4503) had a history of falls, 17.5% (n=6655) had a history of syncope and 25.1% (n=9518) had a history of either falls or syncope. The mean age of the cohort was 71±9.3 years and 58% were male. The median CHADS2 score was 2. A history of falls or syncope was not associated with the risk of incident intracranial hemorrhage (HR 1.11, 95% CI 0.88–1.4). In propensity-matched multivariable models, a history of falls or syncope was associated with an increased risk of death (HR 1.14, 95% CI 1.07–1.22), stroke (HR 1.17, 95% CI 1.05–1.3), myocardial infarction (HR 1.28, 95% CI 1.09–1.52) and major bleeding (HR 1.27, 95% CI 1.16–1.4). Moreover, a history of falls or syncope was associated with increased risk of critical injury (OR 1.97, 95% CI 1.52–2.54), serious injury (OR 2.06, 95% CI 1.75–2.43) and “other injury” (OR 1.58, 95% CI 1.46–1.72). Conclusions A history of falls or syncope is common in patients with atrial fibrillation; however, neither history was associated with increased risk of intracranial hemorrhage. These patients were at an increased risk of death, stroke, myocardial infarction and major bleeding, suggesting that they should receive anticoagulation for stroke prevention. Funding Acknowledgement Type of funding source: None

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Seed Protectants Safen Sorghum (Sorghum bicolor) Against Chloroacetamide Herbicide Injury

Weed Technology ◽

10.1017/s0890037x00026592 ◽

1990 ◽

Vol 4 (4) ◽

pp. 886-891 ◽

Cited By ~ 4

Author(s):

Chester L. Foy ◽

Harold L. Witt

Keyword(s):

Sorghum Bicolor ◽

Weed Control ◽

Field Experiments ◽

Grain Sorghum ◽

Severe Injury ◽

Early Season ◽

Minor Injury ◽

Crop Injury ◽

Annual Grasses ◽

Serious Injury

Alachlor at 3.4 and 6.7 kg ha-1, metolachlor at 2.8 and 5.6 kg ha-1, and propachlor at 4.5 and 9.0 kg ha-1were applied to grain sorghum in field experiments conducted in 1981 and 1982. ‘Dekalb E-59’ and ‘Pioneer 8311’ grain sorghum were tested with and without the seed protectants cyometrinil and flurazole in both experiments. ‘Funk's G-1350’ was tested with and without cyometrinil and CGA-92194 in one experiment. Alachlor and metolachlor caused serious injury (stunting and, in some instances, reductions in stand and yield) to grain sorghum without the seed protectants. Less severe injury to grain sorghum occurred with alachlor and metolachlor at high rates even in the presence of the seed protectants. The three seed protectants were equally effective in preventing crop injury. Only minor injury to grain sorghum, with or without the seed protectants, occurred with propachlor at both rates. Overall, early-season weed control was 81 to 100%; however, propachlor at the rates tested was noticeably weaker than alachlor and metolachlor against some annual grasses.

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The AMA Guides in Pennsylvania “Post-Protz”: Act 111 and Case Law Update

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2020.mayjun02 ◽

2020 ◽

Vol 25 (3) ◽

pp. 12-19

Author(s):

Justin D. Beck ◽

Judge David B. Torrey

Keyword(s):

Case Law ◽

General Assembly ◽

Disability Benefits ◽

Permanent Disability ◽

Sixth Edition ◽

Legal Questions ◽

The Supreme Court ◽

Recent Edition ◽

Impairment Ratings

Abstract Medical evaluators must understand the context for the impairment assessments they perform. This article exemplifies issues that arise based on the role of impairment ratings and what edition of the AMA Guides to the Impairment of Permanent Impairment (AMA Guides) is used. This discussion also raises interesting legal questions related to retroactivity, applicability of prior precedent, and delegation. On June 20, 2017, the Supreme Court of Pennsylvania handed down its decision, Protz v. WCAB (Derry Area Sch. Dist.), which disallows use of the “most recent edition” of the AMA Guides when determining partial disability entitlement under the Pennsylvania Workers’ Compensation Act. An attempted solution was passed by the Pennsylvania General Assembly and was signed into law Act 111 on October 24, 2018. Although it affirms that the AMA Guides, Sixth Edition, must be used for impairment ratings, the law reduces the threshold for total disability benefits from 50% to 35% impairment. This legislative adjustment benefited injured workers but sparked additional litigation about whether, when, and how the adjustment should be applied (excerpts from the laws and decisions discussed by the authors are included at the end of the article). In using impairment as a threshold for permanent disability benefits, evaluators must distinguish between impairment and disability and determine an appropriate threshold; they also must be aware of the compensation and adjudication process and of the jurisdictions in which they practice.

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State-by-State Use of AMA Guides

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2019.sepoct01 ◽

2019 ◽

Vol 24 (5) ◽

pp. 3-7, 16

Keyword(s):

Expert Testimony ◽

Narrow Range ◽

The United States ◽

Workers Compensation ◽

Federal Employees ◽

Permanent Disability ◽

Sixth Edition ◽

History Of ◽

Canadian Provinces

Abstract This article presents a history of the origins and development of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), from the publication of an article titled “A Guide to the Evaluation of Permanent Impairment of the Extremities and Back” (1958) until a compendium of thirteen guides was published in book form in 1971. The most recent, sixth edition, appeared in 2008. Over time, the AMA Guides has been widely used by US states for workers’ compensation and also by the Federal Employees Compensation Act, the Longshore and Harbor Workers’ Compensation Act, as well as by Canadian provinces and other jurisdictions around the world. In the United States, almost twenty states have developed some form of their own impairment rating system, but some have a narrow range and scope and advise evaluators to consult the AMA Guides for a final determination of permanent disability. An evaluator's impairment evaluation report should clearly document the rater's review of prior medical and treatment records, clinical evaluation, analysis of the findings, and a discussion of how the final impairment rating was calculated. The resulting report is the rating physician's expert testimony to help adjudicate the claim. A table shows the edition of the AMA Guides used in each state and the enabling statute/code, with comments.

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