WUTH publication: Imaging of the Tibionavicular Ligament, and Its Potential Role in Adult Acquired Flatfoot Deformity

Citation: Foot and ankle international. 2018, 39(5), 629-635
Author: Ormsby N, Jackson G, Evans P, Platt S
Abstract: BACKGROUND: The spring ligament is an important medial arch stabilizer. However, when disrupted, it does not cause planovalgus deformity until the foot is cyclically loaded. We propose that the tibionavicular (TN) ligament plays an important role. However, this ligament is not imaged in routine magnetic resonance imaging (MRI) sequences.
METHODS: A prospective case-control study using a novel MRI sequence to image the TN ligament in 20 normal feet creating a baseline appearance of the ligament. We then scanned 20 patients with adult acquired flatfoot deformity (AAFD). All patients had weightbearing anteroposterior and lateral radiographs. We followed up patients, the end point being surgery or 18 months' follow-up.
RESULTS: The normal ligament was reliably identified on the novel sequences. It had a reproducible appearance in 2 views, and consistent length and width. Two groups of patients were identified in the AAFD cohort: Normal TN (11/20) (The mean Meary angle was 6.8 degrees) and Abnormal TN (9/20). The ligament was thickened proximally, with distal attenuation and intrasubstance edema. On sagittal sequence, it had dorsal bulging and high signal. The mean Meary angle was 13.2 degrees ( P = .013). All patients had posterior tibial tendon dysfunction and 8 had spring ligament complex attenuation. Five patients have undergone corrective surgery compared to none in the other group.
CONCLUSION: This study adds to the evidence that AAFD is multifactorial. With this imaging technique, we were able to reliably image the TN ligament. We hope that including this sequence into routine scanning will help us understand its role in flatfoot deformity. This poses the question of whether this structure will play a role in reconstructive surgery in future.
LEVEL OF EVIDENCE: Level II, prospective comparative study.
KEYWORDS: AAFD; PTTD; adult acquired flatfoot disorder; deltoid ligament; spring ligament

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WUTH publication: Videolaryngoscopy versus direct laryngoscopy for emergency orotracheal intubation outside the operating room: a systematic review and meta-analysis

Citation: British Journal of Anaesthesia. 2018, 120(4), 712-724
Author: Arulkumaran N, Lowe J, Ions R, Ruano MM, Bennett V, Dunser MW
Abstract: Videolaryngoscopy (VL) may improve the success of orotracheal intubation compared with direct laryngoscopy (DL). We performed a systematic search of PubMed, Embase, and CENTRAL databases for studies comparing VL and DL for emergency orotracheal intubations outside the operating room. The primary outcome was rate of first-pass intubation, with subgroup analyses by location, device used, clinician experience, and clinical scenario. The secondary outcome was complication rates. Data are presented as [odds ratio (95% confidence intervals); P-values]. We identified 32 studies with 15 064 emergency intubations. There was no difference in first-pass intubation with VL compared with DL [OR=1.28, (0.99-1.65); P=0.06]. First-pass intubations were increased with VL compared with DL in the intensive care unit (ICU) [2.02 (1.43-2.85); P<0.001], and similar in the emergency department or pre-hospital setting. First-pass intubations were similar with GlideScope®, but improved with the CMAC® [1.32 (1.08-1.62); P=0.007] compared with DL. There was greater first-pass intubation with VL compared with DL amongst novice/trainee clinicians [OR=1.95 (1.45-2.64); P<0.001], but not amongst experienced clinicians or paramedics/nurses. There was no difference in first-pass intubation with VL compared with DL during cardiopulmonary resuscitation or trauma. VL compared with DL was associated with fewer oesophageal intubations [OR=0.32 (0.14-0.70); P=0.003], but more arterial hypotension [OR=1.49 (1.00-2.23); P=0.05]. In summary, VL compared with DL is associated with greater first-pass emergency intubation in the ICU and amongst less experienced clinicians, and reduces oesophageal intubations. However, VL is associated with greater incidence of arterial hypotension. Further trials investigating the utility of VL over DL in specific situations are required.
KEYWORDS: emergencies; laryngoscopy; meta-analysis

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WUTH publication: Renal injury in a patient with lumbar scoliosis

Citation: BMJ Case Reports. 2018 Mar 21
Author: Riyat H, Jones R, Sarkar D, Stephenson R
Abstract: Kidney laceration following blunt trauma is responsible for up to 3% of trauma cases. The risk factors associated with renal injury are attributed to the risks of mechanical injury. However, anatomical variations that may accelerate the insult of injury are poorly documented. This case report describes a 25-year-old with degenerative lumbar scoliosis who presented with flank pain and visible haematuria following a low-impact injury. The patient had a grade IV renal injury. The curvature of the spine, shown on CT imaging, revealed a reduced retroperitoneal space around the left kidney. This case explores lumbar scoliosis as a risk factor for kidney laceration. We hypothesise that this increased risk is associated with asymmetry of the spine and reduced anatomical space in the retroperitoneum. Patients with lumbar scoliosis may be considered a high-risk category for renal injury, following low-impact trauma.
KEYWORDS: drugs: musculoskeletal and joint diseases; hematuria; urological surgery

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Mark Allen Group - MA Healthcare Current Awareness Bulletin - March

Depression, Suicide and Self-harm

Relevant articles from MA Healthcare journals to support your staff’s education and practice 

March 2018

Depression is becoming an increasingly common condition in the UK and affects people of all age groups, including young children. It is important for health professionals today to be aware of its complex psychological, physical and social symptoms and implications. This month MA Healthcare is raising awareness about the importance of understanding and responding appropriately to people at risk of depression, self-harm and suicide.

We have provided a list of relevant articles from MA Healthcare journals dealing with this area, thereby providing your NHS staff with research, information and tips that will support both their work and their patients.

(Links only work on the desktop version of our MAG Online Library platform)

British Journal of Nursing:

·         Being equipped to care for patients at risk of self-harm and suicide http://www.magonlinelibrary.com/doi/10.12968/bjon.2015.24.15.787

·         Preventing suicide in England: saving lives http://www.magonlinelibrary.com/doi/10.12968/bjon.2014.23.4.236

Journal of Health Visiting:

·         Postnatal depression: Student health visitors' perceptions of their role in supporting fathers http://www.magonlinelibrary.com/doi/full/10.12968/johv.2017.5.3.143

·         The influence of women's perceived entitlement to have postnatal depression on the disclosure process

http://www.magonlinelibrary.com/doi/10.12968/johv.2016.4.1.41

British Journal of Hospital Medicine:

·         Management of patients presenting with self-harm http://www.magonlinelibrary.com/doi/10.12968/hmed.2016.77.9.C144

·         Imaging and neurobiological changes in late-life depression http://www.magonlinelibrary.com/doi/10.12968/hmed.2014.75.1.25

British Journal of Community Nursing:

·         Depression and mental health in the community and the role of the nurse http://www.magonlinelibrary.com/doi/10.12968/bjcn.2015.20.5.253

·         Mental and physical long-term conditions in the UK: spanning the boundaries http://www.magonlinelibrary.com/doi/10.12968/bjcn.2015.20.4.190

British Journal of Midwifery:

·         Paternal postnatal depression: How midwives can support families http://www.magonlinelibrary.com/doi/10.12968/bjom.2016.24.7.470

·         Post traumatic stress disorder post childbirth versus postnatal depression: a guide for midwives

http://www.magonlinelibrary.com/doi/10.12968/bjom.2017.25.8.484

British Journal of School Nursing:

·         Improving children and young people's resilience to depression http://www.magonlinelibrary.com/doi/10.12968/bjsn.2015.10.7.349

·         Self-harm in children and young people: A case study http://www.magonlinelibrary.com/doi/10.12968/bjsn.2014.9.4.183

British Journal of Mental Health Nursing:

·         Attitudes to pharmacological treatments for depression http://www.magonlinelibrary.com/doi/10.12968/bjmh.2017.6.1.44

·         Establishing a self-harm surveillance register to improve care in a general hospital http://www.magonlinelibrary.com/doi/10.12968/bjmh.2015.4.1.20

British Journal of Healthcare Assistants:

·         Men's health 12: men and suicide http://www.magonlinelibrary.com/doi/10.12968/bjha.2015.9.10.492

·         Suicide: connect to the clinical, social and mental health aspects of care in a joined-up way http://www.magonlinelibrary.com/doi/10.12968/bjha.2014.8.9.462 

Practice Nursing:

·         Self-harm: working with vulnerable adolescents http://www.magonlinelibrary.com/doi/10.12968/pnur.2014.25.5.245

·         Managing depression in primary care http://www.magonlinelibrary.com/doi/10.12968/pnur.2015.26.12.594

British Journal of Cardiac Nursing:

·         A look at antidepressant use—and cardiovascular risk http://www.magonlinelibrary.com/doi/10.12968/bjca.2017.12.10.480

·         Heart disease and mental health http://www.magonlinelibrary.com/doi/10.12968/bjca.2017.12.10.473

WUTH publication: Virtual autopsy: Machine Learning and AI provide new opportunities for investigating minimal tumor burden and therapy resistance by cancer patients

Citation: Autopsy and Case Reports. 2018 8(1), e2018003
Author: O'Sullivan S, Holzinger A, Wichmann D, Saldiva PHN, Sajid MI, Zatloukal K

Link to PubMed record