Comparison of intraosseous access and central venous catheterization in Chinese adult emergency patients: A prospective, multicenter, and randomized study

BACKGROUND: It is challenging to establish peripheral intravenous access in adult critically patients. This study aims to compare the success rate of the first attempt, procedure time, operator satisfaction with the used devices, pain score, and complications between intraosseous(IO) access and central venous catheterization(CVC) in critically ill Chinese patients.METHODS: In this prospective clustered randomized controlled trial, eight hospitals were randomly divided into either the IO group or the CVC group. Patients who needed emergency vascular access were included. From April 1, 2017 to December 31, 2018, each center included 12 patients. We recorded the data mentioned above.RESULTS: A total of 96 patients were enrolled in the study. There were no statistically significant differences between the two groups regarding sex, age, body mass index, or operator satisfaction with the used devices. The success rates of the first attempt and the procedure time were statistically significant between the IO group and the CVC group(91.7% vs. 50.0%, P<0.001;52.0 seconds vs. 900.0 seconds, P<0.001). During the study, 32 patients were conscious. There was no statistically significant difference between the two groups regarding the pain score associated with insertion. There were statistically significant differences between the two groups regarding the pain score associated with IO or CVC infusion(1.5 vs. 0.0, P=0.044). Complications were not observed in the two groups.CONCLUSIONS: IO access is a safe, rapid, and effective technique for gaining vascular access in critically ill adults with inaccessible peripheral veins in the emergency departments.

MR neurography in intraosseous median nerve entrapment

Intraosseous entrapment of the median nerve is an uncommon complication of elbow dislocation and fractures.The condition is seen to occur in adolescent age group with a remote history of trauma.We report two rare cases of type 2 intraosseous median nerve entrapment.Though the diagnosis of median neuropathy is made with clinical tests and neurophysiological studies,however exact site of entrapment and presurgical mapping of nerve is done accurately with MR neurography.Imaging thus plays a pivotal role in management of this condition.

Coronary Perfusion Pressure Response to High-Dose Intraosseous versus Standard-Dose Intravenous Epinephrine Administration after Prolonged Cardiac Arrest

Background: This study was done to compare coronary perfusion pressure (CPP) prior to the first rescue shock (RS) among a group of animals that received intraosseous (IO) epinephrine 0.1 mg/ kg (high-dose epinephrine [HDE]) with a group that received intravenous (IV) epinephrine 0.01 mg/kg (standard-dose epinephrine [SDE]) during cardiac arrest resuscitation using a swine model of prolonged out-of-hospital ventricular fibrillation (VF) cardiac arrest. Methods: This was a secondary analysis of prospectively collected data from two IACUC approved protocols. Seventy-nine Yorkshire swine (25 - 35 kg) were surgically instrumented under anesthesia and VF was electrically induced. After 10 minutes of untreated VF in the IO study (n = 26) and 12 minutes of untreated VF in the IV study (n = 53), resuscitation commenced with closed chest compressions (CCC). A single dose of epinephrine (HDE IO or SDE IV, respectively) was given and flushed with saline. The CCC and RS attempts were standardized for all animals. The CPP was defined as aortic diastolic pressure minus right atrial diastolic pressure measured 2.5 minutes after medication delivery. Descriptive statistics were used to analyze the data. Results: Baseline group characteristics were mathematically the same. Just prior to the first RS, HDE IO resulted in a mean CPP of 33.2 mmHg (95%CI: 26.6, 39.9), while SDE IV resulted in a mean CPP of 25.0 mmHg (95%CI: 20.5, 29.4). Conclusion: This observation study reaffirms the assertion that HDE IO may be required to generate CPP values similar to SDE IV during resuscitation of prolonged VF.

Spinal intraosseous schwannoma without spinal canal and neuroforamina involvement:A case report

BACKGROUND Spinal intraosseous schwannomas(SIS)are rare,and as yet have not been fully described in the literature.The first case of SIS was reported in 1971,and 24 cases of SIS have been reported so far.However,including the present case,there are only seven cases without spinal canal and neuroforamina involvement.CASE SUMMARY A 56-year-old man presented with a history of neck pain for 2 years.An obvious osteolytic destruction of the seventh cervical(C7)vertebra was observed on imaging examination.Magnetic resonance imaging of the cervical spine showed space-occupying lesions in the C7 vertebra,and destruction of the anterior cortex of the vertebra.The lesions had an exophytic component that extended from the C7 vertebra into the soft tissue on the front side.The foramen transversarium on both sides were intact.The patient underwent surgical biopsy and focal excision of the C7 lesion.The diagnosis of“schwannoma”was verified by postoperative pathological examinations.In a review of the literature,this is the seventh case of SIS without spinal canal and neuroforamina involvement,and the third reported case of type VIII SIS.We discussed our case with respect to reported classification characteristics of SIS.CONCLUSION SIS is a very rare tumor.We report a rare case that may be important for further classification of osteo-schwannoma.The establishment of a complete disease classification is of high importance for the treatment and prognosis of this disease.Thus,more basic studies and retrospective analysis of related cases are necessary.

Secondary Reconstruction of Recurrent Primary Intraosseous Meningioma of the Calvarium Using a Fasciocutaneous Anterolateral Thigh Free Flap

We present a patient with a primary intraosseous meningioma of the calvarium that recurred three years after initial resection and reconstruction with a free anterolateral thigh (ALT) flap. The patient re-presented with progressive swelling in the same area. Imaging confirmed aggressive tumour recurrence with both intra- and extra-cranial diseases and also extension to the ipsilateral orbit. The original anterolateral free flap was raised on anterior pedicle and further debulking of the tumour was performed. Histology confirmed widely infiltrative atypical meningioma (WHO grade II). This case highlights the benefit of using a fasciocutaneous free flap for reconstruction given the potential for tumour recurrence.

Intraosseous Lipoma with Subsequent Esophageal Carcinoma Metastasis

Background: This case report describes a well documented proximal femoral metadiaphysis intraosseous lipoma which later developed metastasis from a new esophageal cancer. Metastatic disease to benign conditions is a rare finding. To the best of our knowledge, this is the first reported case of metastatic disease to an intraosseous lipoma. Case Description: The metastatic deposit was initially detected by plain-film radiography, performed to evaluate new onset right hip pain, as possible new cortical breakthrough with irregularity in the site of previously known proximal right femur intraosseous lipoma. Concurrent follow-up PET/CT study showed a new hypermetabolic focus within the known intraosseous lipoma indicating a new metastasis that was confirmed with an MRI as a new enhancing mass within the preexisting intraosseous lipoma. Subsequently, an MRI-guided biopsy and eventually surgical excision was performed providing the histological samples for radiologic-pathologic correlation. Purpose and Clinical Relevance: Clinicians need to be aware that unusual, complex patterns within benign lesions may be a reflection of unexpected conditions, such as insufficiency injury, malignant transformation and secondary metastatic disease, as exemplified by our case report.

Primary diffuse intraosseous meningioma

rimary intraosseous meningiomas are a subset of primary extradural meningiomas that arise in bones,and represent about two thirds of primary extradural meningiomas. Here we present a case of primary intraosseous meningioma with diffuse and symmetrical invasion of skull and scalp, which was preoperatively diagnosed as fibrous dysplasia. We described the clinical and radiological characteristics, discussed the potential pathogenesis of the diffuse lesion, and presented surgical management.

Intraosseous lipoma of adjacent upper cervical vertebral bodies with significant paravertebral expansion

Intraosseous lipomas are rare, benign bone tumors,comprising less than 0. 1% of all primary bone tumors.Common sites of intraosseous lipomas include the os calcis and the metaphyses of the long bones of the lower limbs.2 Cases involving the spine are extremely rare; a meta-analysis of 206 cases reported that intraosseous lipomas involving the spine （including the sacrum）accounted for 6% of all cases.2 A review of the English literature reveals only 14 reported cases involving the spine （Table）.

Clinicopathological study of malignant peripheral nerve sheath tumors in the head and neck:Case reports and review of literature

BACKGROUND Malignant peripheral nerve sheath tumor(MPNST)is a rare and aggressive soft tissue sarcoma that poses a major diagnostic and therapeutic challenge.CASE SUMMARY We retrospectively reviewed patients with head and neck MPNSTs treated in our hospital from 2000 to 2021.The clinical features,pathological manifestations,treatments,and prognoses were summarized.We also reviewed the literature,focusing on MPNST in the mandible and maxilla.The study population consisted of five women and five men aged 22–75 years(mean age,49 years).Of the 10 patients,7 were initial cases and 3 were recurrent cases.All lesions were sporadic.The most common site was the mandible.The most frequently encountered symptoms were a progressive mass and local swelling.Complete or partial loss of trimethylation at lysine 27 of histone H3(H3K27me3)was evident on staining in four of nine cases(one case was excluded due to lack of tissue for evaluation of loss of H3K27me3).The 2-and 5-year disease-specific survival rates were 86%a nd 43%,respectively.The average survival time was 64 mo.CONCLUSION MPNST is a highly malignant tumor with a poor prognosis,prone to a high risk of recurrence and distant metastasis.Complete surgical resection is the main treatment.

DIAGNOSIS AND TREATMENT OF IDIOPATHIC NECROSIS OF THE FEMORAL HEAD

Fifteen cases,27 hips,of idiopathic necrosis of the femoral head (INFH) were included iour series.The role of radiography,isotopic bone scanning,intraosseous pressure measure-ment and intraosseous venography in the diagnosis of INFH were evaluated.Radiologicalexamination could not reveal early cases,while isotopic bone scanning was more sensitive.There was an increase of intraosseous pressure in most of the diseased hips.and intraos-seous venography showed abnormalities in all examined hips.The latter two tests couldtherefore detect early INFH.Core decompression was performed in 23 hips,21 of whichwere followed for 7 to 27 months.Functional evaluation was good or excellent in 18 hips.Radiological re-examination remained unchanged in 19 hips.Postoperative intraosseouspressure measurement and intraosseous venography revealed a decrease of intraosseous pres-sure and improvement of venous drainage.Core decompression is therefore an ideal methodof treatment for early INFH.

Os calcis lipoma: To graft or not to graft?——A case report and literature review

BACKGROUND Intraosseous lipoma is a rare benign lesion, commonly affecting the os calcis. Its pathogenesis and natural history are not fully understood, and its management remains controversial.CASE SUMMARY A 56-year-old male complaining of heel pain was diagnosed with an os calcis lipoma. The lesion was treated with curettage and it was filled with impacted allograft and demineralized bone matrix. Histological examination confirmed the above diagnosis. Six months postoperatively, the patient returned to recreational long-distance running. Repeated computed tomography scanning, up to five years postoperatively, showed almost complete resorption of the graft over time.CONCLUSION The treatment of an os calcis lipoma should be individualized, depending on the symptoms, the location and size of the lesion. Surgeons, electing to proceed with bone grafting, should consider the probability of bone graft resorption.

A Brief Note on Pathogenesis and Treatment of Perthes Disease

Measurement of intraosseous pressure in the proximal femur, stress test and venography performed on 49 hips with perthes disease and 38 hips of normal children revealed an increase in intrasoseous pressure in Perthes disease group with abnormal stress test and venography. It means that there is venous obstruction in the diseased proximal femur in accompany with raised intraosseous pressure. Core decompression performed on 31 hips with Perthes disease gaves good response in 84% of the hips, whereas Chiari pelvic osteotomy done in 18 hips with late stage disease, 77% of the hips improved fairly well. The anthore' opinion is that core decompression is effective for Perthes disease in early stage, and the Chiaripelvic osteotomy could be recommended in late stage cases.

Reduced delay in diagnosis of odontogenic keratocysts with malignant transformation:A case report

BACKGROUND In rare cases,odontogenic keratocysts(ODs)transform into squamous cell carcinoma.Intervals between the first attendance of a patient and the diagnosis of OD with malignant transformation vary from weeks to years.In this article,we report a case of malignancy derived from OD with a five-day delay in diagnosis.CASE SUMMARY A 54-year-old woman was referred to Tongji Hospital in Wuhan,China with complaints of moderate pain,recurrent swelling,and pus discharge around her left maxillary lateral incisor for over 10 years.Physical examination revealed a fistula at the palatine-side mucoperiosteum of the left maxillary lateral incisor and enlarged lymph node in the left neck.Cone beam computed tomography revealed a cystic lesion with massive bone destruction from the left maxillary central incisor to the left secondary maxillary premolar and local bony destruction in the left first mandibular molar.The patient was clinically diagnosed with OD.Enucleation rather than marsupialization was performed given the risk factors of long history,recent aggravated pain,and massive bony destruction.Malignant transformation of OD was confirmed by pathologists 3 d after the operation.Radical surgery was performed,and lymph node metastasis was observed.The patient was subjected to postoperative radiotherapy and synchronous chemotherapy,and no local recurrence or distant metastasis was noted at one-year follow-up.CONCLUSION Our case suggests that clinicians should be aware of the malignant transformation of OD,especially when patients present with a long history,massive cyst,chronic inflammation,recent persistent infections,aggravated pain,numbness around the cystic lesion,and lymph node enlargement.

Investigation on the Physico－Chemical Properties of Lipiodol Anticancerous Chemo－Embolizing Agents

Measurement of intraosseous pressure in the proximal femur, stress test and venography performed on 49 hips with perthes disease and 38 hips of normal children revealed an increase in intrasoseous pressure in Perthes disease group with abnormal stress test and venography. It means that there is venous obstruction in the diseased proximal femur in accompany with raised intraosseous pressure. Core decompression performed on 31 hips with Perthes disease gaves good response in 84% of the hips, whereas Chiari pelvic osteotomy done in 18 hips with late stage disease, 77% of the hips improved fairly well. The anthore' opinion is that core decompression is effective for Perthes disease in early stage, and the Chiaripelvic osteotomy could be recommended in late stage cases.

The Structure of Internal Blood Vessels in Mongolian Fetal Vertebral Bodies

Purpose: Investigate specific characteristic of blood supply of fetal vertebral bodies. Material & Methods: 16 - 30 week aged 20 fetuses (10 male, 10 female) were used for the study. Norms and requirements of Bio-Medical Ethics have not been violated in the use of human material in the study. Black-ink perfusion and cast of substance absorbing X-ray were applied in the fetuses. Results: Three concentric zones could be distinguished in the vascular architecture of the fetal vertebral bodies. 1) The peripheral zone of perichondrial vessels;2) The intermediate zone of radial vessels. 3. The central zone of the ossification centre vessels. We used black-ink perfusion and cast of substance absorbing X-ray were applied in the fetuses. Periosteum of fetal vertebral bodies are distributed originating from fine arteries of 70 - 120 diameter and arterioles of 30 - 50 diameter which are part of arteries of network of micro blood circulation. Venules are followed along two sides of this arteriole and short precapillaries are branched out in tree-like manner from it forming capillary network surrounding arteriole and capillary plexuses. Postcapillaries branched from the network are being emerged the venules accompanied arterioles. Conclusions: Micro blood circulatory system of the vertebrae has angion structure. The peripheral zone of perichondrial vessels has combined blood supply surrounded by blindly ending capillary network drained up and down from the central zone. The central zone of vertebral body is supplied with blood by the main arteriole.

Case Report: An Unusual Osseous Lesion

The intraosseous benign notochordal cell tumor (BNCT) is an intravertebral lesion derived from notochordal tissue. The notochord develops in humans during the third week of embryonic life and persists in adults as the nucleus pulposus of the vertebral disks. The most common locations of such tumors are the saccrococcygeal region and the skull base. Most tumors are asymptomatic and small. Magnetic resonance imaging is useful in their detection and precise localization. Histologically, these lesions consist of sheets of adipocyte-like vacuolated or less vacuolated eosinophilic tumor cells with eccentrically located round nuclei without myxoid matrix. The tumor cells express the epithelial markers, vimentin and S100 protein. Main differential diagnosis is chordoma. Intraosseous BNCT do not require any surgical management and should be recognized by pathologists to prevent unnecessary radical surgery. These lesions should be followed-up with conventional MRI.