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Peripheral vascular injury (PVI) is a major concern in the Emergency Department (ED). According to the CDC, there were 33,594 mortalities related to firearms in 2014.1 There were 803,007 cases of aggravated assault that occurred in 2016. Nearly 24% of these (190,000) were performed with firearms and 16% (120,000) with cutting instruments.2 Inevitably, many of these result in damage to the vasculature, leading to blood loss and presentation to the ED. While some forms of injury are immediately life threatening and require emergent intervention, some present asymptomatically, which can lead to delayed or missed diagnoses. Emergency physicians should be well versed in the diagnosis, management, and disposition of these patients. This chapter will focus on the management of penetrating extremity trauma with vascular injury.
The morphology and growth habits of Evactinopora species of the Evactinoporidae (new family) are documented. This distinctive family of free-living bryozoans has a radial colony form at all growth stages. During a brief attachment phase on a hard substrate, the colony morphology grew as an expanding cone with vertical folds. Following detachment of the nascent colony from this hard substrate, it settled on soft sediment and the free-living expanding colony acquired a star-like form by producing slender outrigger rays. Continued growth produced a radial array of vertical vanes containing feeding autozooecia. The colony maintained a vertical orientation on soft sediment by means of outrigger rays and secretion of solid skeleton on the colony base that provided ballast. The radial growth pattern, outrigger rays, and vertical vanes developed as adaptive characters suitable for free-living life on soft sediment. North American species of Evactinopora are redefined and described taxonomically on the basis of zoarial and zooecial characters and a new species, Evactinopora mangeri, erected. The new family Evactinoporidae is established on the basis of the novel characters of early colony detachment from a hard surface, radial growth pattern through life, generation of outrigger rays, and growth of vertical vanes from the top of rays.
The use of three-dimensional printing has been rapidly expanding over the last several decades. Virtual surgical three-dimensional simulation and planning has been shown to increase efficiency and accuracy in various clinical scenarios.
To report the feasibility of three-dimensional printing in paediatric laryngotracheal stenosis and discuss potential applications of three-dimensional printed models in airway surgery.
Retrospective case series in a tertiary care aerodigestive centre.
Three-dimensional printing was undertaken in two cases of paediatric laryngotracheal stenosis. One patient with grade 4 subglottic stenosis with posterior glottic involvement underwent an extended partial cricotracheal reconstruction. Another patient with grade 4 tracheal stenosis underwent tracheal resection and end-to-end anastomosis. Models of both tracheas were printed using PolyJet technology from a Stratasys Connex2 printer.
It is feasible to demonstrate stenosis in three-dimensional printed models, allowing for patient-specific pre-operative surgical simulation. The models serve as an educational tool for patients’ understanding of the surgery, and for teaching residents and fellows.
This carefully targeted and rigorous new textbook introduces engineering students to the fundamental principles of applied Earth science, highlighting how modern soil and rock mechanics, geomorphology, hydrogeology, seismology and environmental geochemistry affect geotechnical and environmental practice. Key geological topics of engineering relevance including soils and sediments, rocks, groundwater, and geologic hazards are presented in an accessible and engaging way. A broad range of international case studies add real-world context, and demonstrate practical applications in field and laboratory settings to guide site characterization. End-of-chapter problems are included for self-study and evaluation, and supplementary online materials include electronic figures, additional examples, solutions, and guidance on useful software. Featuring a detailed glossary introducing key terminology, this text requires no prior geological training and is essential reading for senior undergraduate or graduate students in civil, geological, geotechnical and geoenvironmental engineering. It is also a useful reference and bridge for Earth science graduates embarking on engineering geology courses.