Obesity and age as factors in leg amputations in fatal motorcycle crashes

The autopsy files at Forensic Science South Australia were searched over an 11-year period from January 2008 to December 2018 for all cases of motorcycle fatalities in which there had been lower-limb amputations. Six cases were identified, consisting of five male riders and one female pillion passenger. The age range was 48–67 years (average 59 years), which was significantly older than the control group (40.6 years; p < 0.01). All the decedents were overweight, with a body mass index (BMI) of 28.7–43.5 kg/m2 (average 34.9 kg/m2), which again was significantly greater than the control group (28.8 kg/m2; p < 0.05). Five of the incidents involved a collision between a motorcycle and a motor vehicle; the remaining case involved a collision with a tree. Five of the amputations were on the right side in the motorcycle-vehicle impacts, and they varied in severity from loss of a foot to a hind-quarter amputation. There was a single left lower-leg amputation which occurred during the collision with a tree, which was beside the road on the motorcyclist’s left. This study has shown that motorcyclists at greatest risk of lower-limb/pelvis amputations are older than the average rider with higher BMIs. This may be significant information given the increase in both BMI and age in many populations.

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Young Driver Crashes with Cyclists: Identifying Training Opportunities

Transportation Research Record Journal of the Transportation Research Board ◽

10.1177/0361198119860118 ◽

2019 ◽

Vol 2673 (12) ◽

pp. 679-689 ◽

Cited By ~ 2

Author(s):

Narelle Haworth ◽

Matthew Legge ◽

Divera Twisk ◽

Jennifer Bonham ◽

Tyler O’Hare ◽

...

Keyword(s):

Traffic Management ◽

Motor Vehicle ◽

South Australia ◽

Learning Opportunities ◽

Driver Training ◽

Novice Drivers ◽

Young Driver ◽

The Road ◽

On The Road ◽

Training Opportunities

To understand where driver training should focus to contribute to improving the safety of cyclists, this study compared bicycle-motor-vehicle (BMV) crashes involving novice drivers (under 25 years) with those involving experienced drivers in the Australian states of Victoria, Queensland, and South Australia. Novice drivers were involved in only a small proportion of BMV crashes and were not over-represented on a per-license basis. For both driver groups, most crashes happened on lower speed roads, at intersections, and during the day. In contrast to expectations, the distribution of types of BMV crashes differed little between experienced and novice drivers. The absence of major differences between experienced and novice drivers may result from learning opportunities being too infrequent in low-volume cycling countries, but this hypothesis needs further testing. A comparison between Queensland and Victoria showed three situations with a higher proportion of young driver crashes: in the evening in both states, Right through-opposing directions (Victoria only), and From footway-maneuvering (Queensland only). These patterns are likely to be indicative of young driver experiences. When their time on the road increases, so does their exposure to risk and to challenging driving conditions (e.g., driving in darkness). On the other hand, these patterns may also point to effects of legislation on young driver crashes, for instance cycling on the sidewalk in Queensland. The results suggest that training for novice drivers needs to supplement a wider strategy to improve cyclist safety (including infrastructure and traffic management improvements) and that training needs to be tailored to state-specific conditions.

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A Prospective Study of Postoperative Lymphedema After Surgery for Cervical Cancer

International Journal of Gynecological Cancer ◽

10.1111/igc.0b013e3181da29d0 ◽

2010 ◽

Vol 20 (5) ◽

pp. 900-904 ◽

Cited By ~ 18

Author(s):

Michael J. Halaska ◽

Marta Novackova ◽

Ivana Mala ◽

Marek Pluta ◽

Roman Chmel ◽

...

Keyword(s):

Cervical Cancer ◽

Lower Limb ◽

Bioelectrical Impedance ◽

Impedance Analysis ◽

Conservative Surgery ◽

Cancer Surgery ◽

Lower Limbs ◽

Control Group ◽

The Right ◽

A Prospective Study

Objective:Lymphedema is a severe postoperative complication in oncological surgery. Multifrequency bioelectrical impedance analysis (MFBIA) is a new method for early lymphedema detection. The objective was to establish the methodology of MFBIA for lower-limb lymphedema and to detect a lymphedema in patients undergoing cervical cancer surgery.Methods:From a population of 60 patients undergoing cervical cancer surgery, 39 underwent radical hysterectomy Wertheim III (RAD group), and 21 underwent conservative surgery (laparoscopic lymphadenectomy plus simple trachelectomy/simple hysterectomy - CONS group). A control group of 29 patients (CONTR group) was used to determine the SD of impedance at zero frequency (R0). Patients were examined before surgery and at 3 and 6 months after surgery by MFBIA and by measuring the circumference of the lower limbs.Results:No differences were found between the CONS and RAD groups on age, height, weight, and histopathologic type of tumor. However, the number of dissected lymph nodes differed significantly between the groups (17.3 in the CONS group vs 25.8 in the RAD group,P= 0.0012). The SD ofR0in the CONTR group was 36.0 and 39.0 for the right and the left leg, respectively. No difference in prevalence of lymphedema based on circumference method was found (35.9% in the RAD and 47.6% in the CONS groups, not statistically significant).Conclusions:No difference in the prevalence of lymphedema was found between the CONS and RAD groups. A methodology for MFBIA for the detection of lower-limb lymphedema was described.

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The effect of civil and military flights on coagulation, fibrinolysis and blood flow: insight from a rat model

Thrombosis Journal ◽

10.1186/s12959-020-00237-8 ◽

2020 ◽

Vol 18 (1) ◽

Author(s):

Anna Levkovsky ◽

Rima Dardik ◽

Daniel Barazany ◽

David M. Steinberg ◽

Mark Dan Kirichenko ◽

...

Keyword(s):

Blood Flow ◽

Rat Model ◽

Lower Limb ◽

Air Travel ◽

Male Rats ◽

Rank Test ◽

Control Group ◽

Clear Correlation ◽

The Right ◽

Exposure Conditions

Abstract Background Air travel thrombosis continues to be a controversial topic. Exposure to hypoxia and hypobaric conditions during air travel is assumed a risk factor. The aim of this study is to explore changes in parameters of coagulation, fibrinolysis and blood flow in a rat model of exposure to hypobaric conditions that imitate commercial and combat flights. Methods Sixty Sprague-Dawley male rats, aged 10 weeks, were divided into 5 groups according to the type and duration of exposure to hypobaric conditions. The exposure conditions were 609 m and 7620 m for 2 and 12 h duration. Blood count, thrombin– antithrombin complex, D-dimer, interleukin-1 and interleukin-6 were analyzed. All rats went through flight angiography MRI at day 13-post exposure. Results No effect of the various exposure conditions was observed on coagulation, fibrinolytic system, IL-1 or IL-6. MRI angiography showed blood flow reduction in lower limb to less than 30% in 50% of the rats. The reduction in blood flow was more pronounced in the left vessel than in the right vessel (p = 0.006, Wilcoxon signed rank test). The extent of occlusion differed across exposure groups in the right, but not the left vessel (p = 0.002, p = 0.150, respectively, Kruskal-Wallis test). However, these differences did not correlate with the exposure conditions. Conclusion In the present rat model, no clear correlation between various hypobaric conditions and activation of coagulation was observed. The reduction in blood flow in the lower limb also occurred in the control group and was not related to the type of exposure.

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Severe lower limb ischemia by massive arterial thrombosis revealing an acute myeloid leukemia needing for leg amputation: clinical and emotional aspects related to the communication with the patient and his family

Pediatric Reports ◽

10.4081/pr.2016.6885 ◽

2016 ◽

Vol 8 (4) ◽

Author(s):

Paolo D'Angelo ◽

Calogero Taormina ◽

Clara Mosa ◽

Floriana Di Marco ◽

Fabrizio Valentino ◽

...

Keyword(s):

Acute Myeloid Leukemia ◽

Lower Limb ◽

Myeloid Leukemia ◽

External Iliac Artery ◽

Acute Ischemia ◽

Thrombotic Complication ◽

Emotional Aspects ◽

The Right ◽

Leg Amputation ◽

Acute Myeloid

Large vessel thrombosis is a very rare clinical presentation of acute leukemia, generally associated with coagulopathy, usually characteristic of acute promyelocytic leukemia. A 13- year-old boy with a previously undiagnosed acute myeloid leukemia was referred to our hospital with acute ischemia of the right lower limb due to occlusion of the right external iliac artery, treated with emergency double surgical thromboembolectomy and chemotherapy. The thrombotic complication resulted in leg amputation. Now the boy is well in complete remission, with a good social integration and quality of life, 30 months after completing treatment. The report highlights the crucial role of early diagnosis and subsequent chemotherapy in avoiding amputation. We particularly focused critical and emotional aspects related to the communication about the leg amputation with the patient and his family.

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Simulation of a Motor Vehicle Momentarily Accelerating in Various Road Conditions

Journal of Konbin ◽

10.2478/jok-2021-0010 ◽

2021 ◽

Vol 51 (1) ◽

pp. 149-158

Author(s):

Jarosław Zalewski

Keyword(s):

Motor Vehicle ◽

Initial Speed ◽

The Road ◽

Straight Line ◽

On The Road ◽

The Right ◽

Final Speed ◽

Simulation Time

Abstract In this paper some selected conclusions have been drawn from the simulated maneuver of a vehicle’s momentary acceleration in various road conditions. The aim of this paper was to answer the question whether the random irregularities of the road could decrease the final speed of the vehicle and cause it to deviate from the straight line motion and to what extent. These irregularities had three different maximum amplitudes which enabled analysis of vehicle’s acceleration on the less and the more uneven road. Also, almost the same and almost different profiles were assumed for the left and the right wheels of the vehicle’s model. Some additional phenomena such as the ice on the road have been taken into account. The initial speed was 20 km/h and after 2 s the vehicle started to accelerate. Then, after 8 s the simulation stopped, which gave the whole simulation time equal to 10 s.

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Dissociation between red and white stimulus perception: A perimetric quantification of protanopic color vision deficiencies

PLoS ONE ◽

10.1371/journal.pone.0260362 ◽

2021 ◽

Vol 16 (12) ◽

pp. e0260362

Author(s):

Denise Wetzel ◽

Judith Ungewiss ◽

Michael Wörner ◽

Helmut Wilhelm ◽

Ulrich Schiefer

Keyword(s):

Visual Field ◽

Color Vision ◽

Field Extension ◽

Control Group ◽

Horizontal Meridian ◽

Field Extensions ◽

Kinetic Perimetry ◽

Color Vision Deficiencies ◽

The Right ◽

Age Range

Significance Horizontal visual field extension was assessed for red and white stimuli in subjects with protanopia using semi-automated kinetic perimetry. In contrast to a conventional anomaloscope, the “red/white dissociation ratio” (RWR) allows to describe protanopia numerically. For the majority of subjects with protanopia a restriction for faint red stimuli was found. Purpose Comparing the horizontal visual field extensions for red and white stimuli in subjects with protanopia and those with normal trichromacy and assessing the related intra-subject intra-session repeatability. Methods The subjects were divided into groups with protanopia and with normal trichromacy, based on color vision testing (HMC anomaloscope, Oculus, Wetzlar/FRG). Two stimulus characteristics, III4e and III1e, according to the Goldmann-classification, were presented with semi-automated kinetic perimetry (Octopus 900 perimeter, Haag-Streit, Köniz/CH). They moved along the horizontal meridian, with an angular velocity of 3°/s towards the visual field center, starting from either the temporal or nasal periphery. If necessary, a 20° nasal fixation point offset was chosen to capture the temporal periphery of the visual field. For each condition the red/white dissociation ratio (RWR); Pat Appl. DPMA DRN 43200082D) between the extent of the isopter for red (RG610, Schott, Mainz/ FRG) and white stimuli along the horizontal meridian was determined. Results All data are listed as median/interquartile range: Five males with protanopia (age 22.1/4.5 years) and six males with normal trichromacy (control group, age 30.5/15.2 years) were enrolled. The RWR is listed for the right eye, as no clinically relevant difference between right and left eye occurred. Protanopes’ RWR for mark III4e (in brackets: control group) was 0.941/0.013 (0.977/0.019) and for mark III1e 0.496/0.062 (0.805/0.051), respectively. Conclusions In this exploratory “proof-of-concept study” red/white dissociation ratio perimetry is introduced as a novel technique aiming at assessing and quantifying the severity of protanopia. Further effort is needed to understand the magnitude of the observed red-/white dissociation and to extend this methodology to a wider age range of the sample and to anomalous trichromacies (protanomalia) with varying magnitude.

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ASYMMETRICAL DISLOCATION OF BILATERAL HIP IN AN ADOLESCENT

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00032 ◽

2020 ◽

Vol 8 (5_suppl5) ◽

pp. 2325967120S0003

Author(s):

Terence ◽

TS Tan ◽

S Jagjoth ◽

N. Yogeshwaran

Keyword(s):

Lower Limb ◽

Motor Vehicle ◽

Motor Vehicle Accident ◽

Hip Dislocation ◽

Long Bone ◽

Common Mechanism ◽

Rare Injury ◽

Masquelet Technique ◽

Pelvic Radiograph ◽

The Right

Hip joint being an inherently stable joint requires a significant amount of force to dislocate. Different mechanism of injury causing different pattern of dislocation. We presented a rare injury of simultaneous asymmetrical dislocation of bilateral hip in an adolescent patient following motor vehicle injury. Presentation: 15 years old girl, pillion rider sustained a motor vehicle accident whereby she was thrown forward with her right hip adducted and flexed, the knee hit on the motorcycle bumper and her left hip in abduction and knee in flexion hit on the road divider. On admission her left lower limb was flexed, abducted, and externally rotated; in contrast, the right lower limb was flexed, adducted, and internally rotated. A pelvic radiograph (figure1) revealed bilateral hip dislocation with the femoral head displaced antero-inferiorly on the left side and posteriorly on the right side. Closed reduction of the joints was done under sedation and subsequently put on traction. Repeated radiograph showed both hip joints well reduced (Figure 2), skin traction was applied for 5 days and subsequently she was allowed for wheelchair ambulation. [Figure: see text][Figure: see text] Discussion: Bilateral simultaneous hip dislocations are an extremely rare injury (1.25%)1, however bilateral asymmetric dislocations of hip are even rarer. Based on described mechanisms, they ranged from pedestrian being hit by a car to head on collision of vehicles and motorcycle crash. The single common mechanism involved in most of these cases was a sudden deceleration injury which occurred in motor vehicle accidents. Treatment for asymmetrical dislocations are still similar, with concentric reduction still the main goal either closed or open reduction. Conclusion: Asymmetric bilateral hip dislocation is a rare entity especially in adolescents and requires high velocity collision with sudden deceleration injury. Reference: Management of shotgun induced open fractures of the humerus with Ilizarov fixator;2015 The Masquelet Technique for Thumb Metacarpal Reconstruction Following Trauma ; JBJS; 2018 Muscle reconstruction in reconstructive surgery: soft tissue repair and long bone reconstruction; 2003

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Vehicle fatalities involving collisions with kangaroos

Medicine Science and the Law ◽

10.1177/0025802420962684 ◽

2020 ◽

pp. 002580242096268 ◽

Cited By ~ 1

Author(s):

Roger W Byard

Keyword(s):

Motor Vehicle ◽

South Australia ◽

Motor Vehicles ◽

Careful Examination ◽

Cervical Region ◽

Vehicle Crashes ◽

Female Ratio ◽

Evidence Of Impact ◽

Age Range ◽

Male To Female

A search was undertaken of the Forensic Science South Australia (FSSA), Australia, autopsy database over a 20-year period from 2000 to 2019 for all cases where vehicle crashes had involved kangaroos. There were six cases with an age range of 18–62 years ( M=42 years) and a male-to-female ratio of 5:1. There were three crashes involving motor vehicles and three involving motorcycles. The three motor-vehicle crashes were initiated by impact with a kangaroo followed by a head-on crash with a truck ( n=1) and a tree ( n=2). In two of the motorcycle crashes, the cycle hit a kangaroo, resulting in the rider being unseated. In the third case, following impact with the animal, the cyclist hit a tree. In one of the latter cases, the only evidence of impact with a kangaroo was fur found by investigating officers adherent to the front-right indicator. Lethal injuries were located in the chest in six cases, the cranio-cervical region in five cases and the abdomen in three cases. Thus, in the majority of cases ( n=5), death was due to multiple injuries. In the remaining case, death was caused by blunt chest trauma. This study shows that kangaroo–vehicle impacts may result in very significant blunt-force trauma. Motorcycle riders are particularly vulnerable. It may be only by careful examination of the vehicle/motorcycle for animal residues that the nature of the incident will be clarified.

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Controlled Trial of the Sequential Use of Streptokinase and Ancrod in the Treatment of Deep Vein Thrombosis of Lower Limb

Thrombosis and Haemostasis ◽

10.1055/s-0038-1649223 ◽

1977 ◽

Vol 37 (02) ◽

pp. 222-232 ◽

Cited By ~ 12

Author(s):

D. A Tibbutt ◽

C. N Chesterman ◽

E. W Williams ◽

T Faulkner ◽

A. A Sharp

Keyword(s):

Deep Vein Thrombosis ◽

Clinical Improvement ◽

Anticoagulant Therapy ◽

Lower Limb ◽

Oral Anticoagulant ◽

Controlled Trial ◽

Oral Anticoagulant Therapy ◽

Control Group ◽

Vein Thrombosis ◽

Deep Vein

SummaryTreatment with streptokinase (‘Kabikinase’) was given to 26 patients with venographically confirmed deep vein thrombosis extending into the popliteal vein or above. Treatment was continued for 4 days and the patients were allocated randomly to oral anticoagulant therapy or a course of treatment with ancrod (‘Arvin’) for 6 days followed by oral anticoagulant therapy. The degree of thrombolysis as judged by further venographic examination at 10 days was not significantly different between the 2 groups. The majority of patients showed clinical improvement but there was no appreciable difference between the groups at 3 and 6 months. Haemorrhagic complications were a more serious problem during the period of treatment with ancrod than during the equivalent period in the control group.

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Correlation of Metabolic Risk Factors with Sessile Serrated Lesions

Journal of Gastrointestinal and Liver Diseases ◽

10.15403/jgld-507 ◽

2020 ◽

Vol 29 (2) ◽

pp. 175-179

Author(s):

Melania Macarie ◽

Simona Bataga ◽

Simona Mocan ◽

Monica Pantea ◽

Razvan Opaschi ◽

...

Keyword(s):

Risk Factors ◽

Statistical Significance ◽

Interval Cancer ◽

Metabolic Risk Factors ◽

Control Group ◽

Anatomical Site ◽

Metabolic Risk ◽

Right Colon ◽

Serrated Lesions ◽

The Right

Background and Aims: The importance of sessile serrated lesions (SSLs) in the pathogenesis of colorectal carcinoma has been recently established. These are supposed to cause the so-called “interval cancer”, having a rapidly progressive growth and being difficult to detect and to obtain an endoscopic complete resection. We aimed to establish the most important metabolic risk factors for sessile serrated lesions. Methods: We performed a retrospective case-control study, on a series of 2918 consecutive patients who underwent colonoscopy in Gastroenterology and Endoscopy Unit, County Clinical Emergency Hospital, Târgu-Mureș, Romania between 1 st of January 2015-31 th of December 2017. In order to evaluate the metabolic risk factors for polyps’ development, enrolled participants were stratified in two groups, a study group, 33 patients with SSLs lesions, and a control group, 138 patients with adenomatous polyps, selected by systematic sampling for age and anatomical site. Independent variables investigated were: gender, smoking, alcohol consumption, obesity, arterial hypertension, diabetes, hypercholesterolemia, hypertriglyceridemia, hyperuricemia, nonalcoholic liver disease. Results: For SSLs the most common encountered localization was the right colon in 30.55% of cases. By comparative bivariate analysis between SSLs group and control group, it was observed that hypertension (p=0.03, OR 2.33, 95 %CI 1.03-5.24), obesity (p=0.03, OR 2.61, 95 %CI 1.08-6.30), hyperuricemia (p=0.04, OR 2.72, 95 %CI 1.28-7.55), high cholesterol (p=0.002, OR 3.42; 95 %CI 1.48-7.87), and high triglycerides level (p=0.0006, OR 5.75; 95 %CI 1.92-17.2) were statistically associated with SSLs development. By multivariate analysis hypertension and hypertriglyceridemia retained statistical significance. Conclusions: Our study showed that the highest prevalence of SSLs was in the right colon and hypertension and increased triglycerides levels were associated with the risk of SSLs development. These risk factors are easy to detect in clinical practice and may help identifying groups with high risk for colorectal cancer, where screening is recommended.

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