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MRI Protocol for the Diagnosis and Follow-up of MS
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MRI Protocol for the Diagnosis and Follow-up of MS
Anthony Traboulsee, MD; David Li, MD; Joseph Frank, MD;
Jack Simon, MD; Patricia Coyle, MD; Jerry Wolinsky, MD; Donald Paty, MD
June 2003
I. CLINICAL GUIDELINES for Brain and Spinal Cord MRI in MS
Suspected MS:
Baseline evaluation:
• Brain MRI recommended (with gadolinium)
• Spinal Cord MRI if presenting symptoms are at the level of the spinal cord and have not
resolved, or if the Brain MRI is non-diagnostic.
Follow-up evaluation:
• Brain MRI recommended to demonstrate new disease activity
Established MS indications:
Baseline evaluation:
• Brain MRI recommended (gadolinium optional)
Follow-up of MS:
• Unexpected clinical worsening
• Re-assessment of disease burden before starting or modifying therapy
• Suspicion of a secondary diagnosis
II. MRI PROTOCOLS for Brain and Spinal Cord
Field Strength: 1.0 Tesla or higher recommended for brain or spinal cord.
(Note: 1T open ring magnets have an effective field strength of approximately 0.7 Tesla and are
only recommended when patients can not tolerate the closed magnet).
Slice Thickness: < 3mm and no gap and in plane resolution of < 1mm x 1 mm for both Brain and spinal cord. (Note: < 5mm and no gap is acceptable for Brain MRI for centers that are unable to acquire 3mm slices in the allotted time).
Scan Orientation and Coverage:
Reproducible coverage and orientation for the axial slices using the subcallosal line as a reference on an appropriate Sagittal localizer is critical for longitudinal comparisons.
Brain MRI Sequences:
1st: Sagittal FLAIR (fluid attenuating inversion recovery).
2nd: Axial PD/T2 (proton density and T2 weighted T1 usually 80ms)
3rd: Axial FLAIR
4th: Gadolinium enhanced T1 (if suspicious lesions seen on FLAIR).
Note: all 4 sequences recommended for a diagnostic MRI in suspected MS. The Sagittal FLAIR and gadolinium enhanced T1 are optional in the follow-up study for established MS.
Spinal Cord Sequences:
1st: Sagittal PD/T2
2nd: Sagittal pre-Gad T1
3rd: Sagittal post-Gad T1
4th: Axial post-Gad T1 through suspicious lesions.
5th: Axial T2 through suspicious lesions.
• The recommended dose is 0.1 mmol/kg IV
• The minimum delay after giving gadolinium is 5 minutes before acquiring the axial T1 weighted axial post contrast images.
• Gadolinium does not need to be given for a spinal cord MRI if it follows a contrast Brain MRI study.
Time saving strategies:
• Omit the axial Fast Spin Echo PD
• Only cover the corpus callosum with the Sagittal FLAIR.
• Acquire the axial FLAIR after giving gadolinium and before the axial T1 weighted axial post contrast images.
The report should use common language and be descriptive including:
• Lesion number, location, size, shape, character and a qualitative assessment of brain atrophy.
• Comparison with previous studies for new, enlarging and/or enhancing lesions and atrophy.
• Interpretation and differential diagnosis.
An optional standardized reporting table may be helpful to the radiologist and neurologist.
Archival and Storage:
Copies of these MRI studies should be retained permanently and be available. They should be stored in a standard format (example DICOM). It may be useful for patients to keep their own studies on portable digital media.
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Three separate farming scenes with inset of man sowing grain by hand with another plowing in background. Two other images show many horse-drawn plows and drills plowing soil and sowing grain on a Bonanza farm, likely in the Red River Valley.
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Likes: Ramen, Anime, Drawing, Singing, Music, stargazing, Penguins, wolves, White Tigers, Miso Soup, Grape Soda, The .hack// Series, Reading, Audio Books, Traveling, Sherlock Holmes series
Dislikes: Friends fighting, bullies, dancing, spinach, Bocoli, spiders, giving up on video games, procrastinating, anime that drags on and on for one arc or series of episodes
Movies and Shows:
Anime currently addicted to: Katekyo Hitman Reborn, Prince of Tennis, Bleach, Monochrome Factor, Soul Eater, Hetlaia, Major, Kuroshitsuji, Hanasekeru Seishounan, and more. ;3
Asian dramas: Stand Up!, Yamada Tarou Monogatari, Bloody Monday, Yoiko no Mikata, 15 sai no Blues, Maou, Gachibaka, Noubuta Wo Produce, Hana Kimi, Hana Yori Dango,
Favorite actor: Matumoto Jun(Domyoji Tsukasa in Hana Yori Dango), Ninomiya Kazunari(Yamada Taro in Yamada Taro Monogatari, Asai Shouhei in Stand Up!, Kumada Masayoshi in Maou),Sakurai Sho(Mimura Takuya in Yamada Taro Monogatari), Nicolas Cage, Will Smith, Morgan Freeman, and more.
favorite Movies: Detective Conan 1-13, Prince of Tennis Movie, Bleach 1-3, Major movie,Sorcerer's Apprentice, Sherlock Holmes,
Music:Arashi, Tegomass, Prince of Tennis Seiyuu, Chieko Kawabe, Cherry Blossom, L.M.C, Rei Fu, Rascal Flatts, Shania Twain, Lady Gaga...
Books: Looking For Group, Dark Tower Series, The Sight, Chronicles of Ancient Darkness, The Amulet of Samarkand, Entire Sherlock Holmes series, Manga, Gundam 00 Novels...
9,002 total episodes
I love Dist the reaper while you hate him. haha
You probably hate him for the same reason that I love him XD


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Lovers Karaoke With Kath & Mo [Updated]
Kathleen Ndongmo and Mister Mobility teamed up to bring you Karaoke With A Tweep last christmas, and it was a blast. In case you missed the teaser video, view or download it here. Now, we bring you a special Valentine's edition of our raving karaoke event. Come prepared to sing love songs only. Come with a friend. Come with a lover!
Event Details
Saturday, February 16 from 3:00 PM to 8:00 PM
Upper Room (Quagus), 13 Alhaja Kofoworola crescent, Off Obafemi Awolowo Way, (Balogun bus-stop, by Lagoon Hospital), Ikeja, Lagos.
The Karaoke Sound, 08074965044
**Do come along with N3,000 only for food and drinks.
Click here to register!
PS: Don't forget to download our Karaoke With A Tweep teaser for a glimpse of the sort of fun that awaits you! (16MB MP4 video format).
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Gaming Deal Of The Week: The Walking Dead Season One & Two StickTwiddlers
]]>I'll be incredibly surprised if anyone doesn't already own the debut series of Telltale Games The Walking Dead, but for those of you who have yet to snatch up Season Two now is a great opportunity. With the return of the AMC TV series returning on February 9th, what better way to pass the time?
Telltale Games The Walking Dead follows the story of Lee and Clementine as they fight for survival and redemption in this adventure game adaptation of Robert Kirkman's critically acclaimed comic book series. Like all Telltale games, the choices you make in each episode will affect the story and overall outcome of the game.
The Walking Dead and The Walking Dead Season Two are currently available on Steam at a 75% discount for £4.74. You can also pick up the season one DLC, The Walking Dead: 400 Days, which follows five new characters fighting for survival, for the insanely low price of 99p.
If you're interested in some of the more recent Telltale Games titles, make sure you check out our reviews for Game Of Thrones – Episode One and Tales From The Borderlands – Episode One.
Until next week, happy gaming!
Got a tip for our Gaming Deal Of The Week? Let us know in the comments below or hit us up on Twitter and Facebook.
Gaming Deal Of The Week: The Walking Dead Season One & Two StickTwiddlers
]]>Unless you grew up with the games, it's difficult to describe the sensation that comes over you when you're greeted with the LucasArts logo – knowing that you're about to embark on a fantastic journey. Inspired by the Day of the Dead and film noir classics like Casablanca, Grim Fandango follows the story of Manuel "Manny" Calavera, a travel agent working off his debt at the Department of Death. Over the space of four consecutive years, players follow Manny and his story in the Underworld as he attempts to unravel a conspiracy that has been hindering him reaching his final resting place.
Launching on the PC, PS4 and the PS Vita, Grim Fandango Remastered serves up several control options including remappable keyboard input, full controller support, and point and click with a "verb coin" thanks to Double Fine's work with Tobias Pfaff – the creator of the point and click mod for the original Grim Fandango who was brought onto the Remastered project as a consultant. The game also supports "tank controls" with a special achievement for playing the entire game using them – quoted in the achievement as being included at the "demand" of the game's project leader, Tim Schafer.
Some features of other adventure games that have been given the remaster treatment, such as hints and object highlighting, won't be found here – presumably as Schafer wanted to preserve the "literal" feel of the original Grim Fandango. There's also no autosave feature, which the game makes specific note of when you being the game – something that feels rather odd for someone who grew up with games before autosaving became an almost standard feature.
The biggest benefits for those revisiting Manny in the Land of the Dead can be found in the Remastered versions special features. Here you will find a full director's commentary featuring thoughts and insights from 14 of the original team, as well as a collection of unlockable concept art. If you're one of those adventure gamers who can still remember the solution to every puzzle to a game, despite playing it over a decade ago, playing with the commentary offers up a wonderful new experience.
But enough about how great the core game is! How does the remaster shape up? Double Fine promised plenty of upgrades to the original game, including restored and high resolution graphics (having to increase the size of the originals by at least sixteen fold), new lighting, and remastered audio (including a new live orchestral score recorded by the Melbourne Symphony Orchestra, who also contributed to Broken Age). – and they deliver for the most part.
Outside of the lighting, which really hones in on that film noir feel and helped add a new level of depth and beauty to the games design, the updated graphics are really only noticeably different on the characters and anything with animation. Environments have been upscaled and smoothed for modern hardware, but they haven't been given the same overhaul treatment. You can also choose to play either with either the remastered or original graphics in the options, or by hitting the Backspace key on your keyboard. Sadly for some fans though, there isn't an option to switch between the original and new score.
With the original developed on the then brand new GrimE engine, which primarily functions by placing 3D objects over a pre-rendered background, the environments have been able to stand the test of time, so you can understand why the focus has been put on the 3D models. However, it would have been great to have seen the environments updated to coincide with the models as you can see in certain places where they would have benefited from a lick of digital paint. However, Schafer noted that they didn't really want to "crack into re-authoring anything" and leaving the background art as it was originally crafted.
Despite Schafer noting in the "Making Of Grim Fandango Remastered" videos to wanting to keep the game to its original aspect ratio ("I think Wes Anderson has made that cool again, right?"), the final game does support widescreen, as well as the original square, and a square with borders display option. Even with conceptual artist Peter Chan's original storyboards only being made to the original aspect, Double Fine have done a superb job at making sure Grim Fandango Remastered looks absolutely superb whichever way you want to play it.
For a game whose original copies have been lost to the ages, with even Double Fine questioning whether or not they'd be able to secure the original assets from the now defunct LucasArts, Grim Fandango Remastered is a superb piece of fan-service. With development choices such as working with the modders for input to getting the original team back together to record the commentary, it's undeniable that Double Fine wanted to bring Manny back to life with everybody who helped bring him to life (and keep him alive) over the past 16 years.
So should you buy Grim Fandango Remastered? Absolutely. It's one of the best adventure games of all time, and the Remastered version with its shiny new graphical upgrades has made it even more accessible to the new wave of adventure game fans, as well as bringing a reliably working version of the game crammed full of bonus features to the long-serving fans of the iconic title.
Grim Fandango Remastered is out now for PS4, PS Vita, PC, Mac, and Linux. A PC copy of the game was provided for this review.
]]>StickTwiddlers Podcast 51: Forgive Us, Father StickTwiddlers
]]>It's a mailbag special as the team are challenged to craft the ultimate Twiddler, are asked to pay for their crimes, and Alan gives another history lesson.
01:44 – For this weeks intro, Alan introduces the StickTwiddlers D&D characters
06:25 – It's a Mailbag Special, kicking things off with a question from Constance
11:36 – Our next email asks Sarah if she actually enjoys hanging out with her co-hosts
20:14 – Gandalf The Red asks if we think we'll be seeing Star Wars Amiibo-type figures
15:00 – Amanda compliments our "hot British cast" and Ben accidentally invents the Jackgestive
28:35 – A suggestion from Jim Jam The Pipers Man gives birth to a new regular podcast section
31:47 – Alan gives us "The Brief History Of The Good Samaritan"
38:47 – Jennifer poses a special question to each of the Twiddlers
55:30 – Jay Knight asks one of the most amazing questions ever been posed to a gamer
64:45 – A listener has mailed in to pick a fight… 1V1 style!
66:20 – Grimsham Bisham challenges the team to put together the ultimate StickTwiddler
77:15 – Uh oh, we're in trouble…
89:24 – Ben swoops in with a last minute mailbag entry!
91:21 – And that's it for this weeks episode!
– StickTwiddlers Podcast 49: Big Drunk Gaming Quiz Of The Year 2014
– StickTwiddlers SpecialEffect Gameblast 2014 Highlights
– Top Geek Podcasts For 2015
– StickTwiddlers Twitch channel
– StickTwiddlers YouTube channel
– Listen to Stickmare Season 1
– Listen to Stickmare Season 2
You can submit your questions, requests, comments, shout outs and stories by dropping us a line at email@example.com where you might be featured in one of our Listener Mailbags, where our favourite email will win an awesome piece of digital nonsense!
Got some feedback for the StickTwiddlers Podcast gang? Let us know in the comments below, send us an email at firstname.lastname@example.com, or hit us up on Twitter and Facebook.
StickTwiddlers Podcast 51: Forgive Us, Father StickTwiddlers
]]>Two things that have always stood out for me in The Dark Eye series of games are the beautifully crafted animated sketches in the cutscenes, and the high quality performances of the voice acting – something important to all games, but even moreso when you're being asked by the developers to fully immerse yourself in this RPG universe they have created. I'm pleased to report that Blackguards 2 delivers fantastically on both accounts.
Set a few years before the debut Blackguards game, this story centres around Cassia of Tenos, who finds herself thrown into the labyrinth where she begins to plot her rebellion and ultimately rule over the land. However, as Game Of Throne's Daenerys Targaryen knows all too well, you need an army to take a throne, and Cassia sets about recruiting a few of the old Blackguards who helped to overthrow the Nine Hordes by capturing (and at time recapturing) various towns and cities in the realm.
At its core, Blackguards 2 is an RPG with all the customisable complexity you'd expect of the pen and paper game it is inspired by. However unlike most modern titles in the genre, Daedalic have stripped out the free-roaming to focus on the tactical side. Gameplay is primarily controlled with the mouse, with the exception of a few hotkeys in combat for actions such as highlighting interactive objects and showing lines of sight. It's incredibly easy to navigate and customise your HUD to suit your particular playstyle.
Outside of combat, Cassia will be able to visit certain cities where she can interact with the locals via dialogue trees, purchase weapons and items, and learn new skills from instructors. Later in the game you get access to your own camp where you and your party rest between battles – which offers up the chance to learn more about them – as well as trade goods, carry out practice fights, and interrogate prisoners.
Once unlocked, it's here that you can also check the abilities and equipment of your mercenaries that also fight with you and your party members in battle. Mercenaries are broken up into three separate classes – swordsman, spearmen, and archers – and it'll be up to you to decide which are best suited for each battle. If you choose poorly, you can always hit the "Try Again" button in the menu and jump back to the loadout screen and restart the fight.
However, the combat is where the real meat of the game lies. This is played out in a turn-based fashion, with each player and enemy character taking turns based on their initiative, and works on hex-based system. During your turn, you can choose to move you character within a small radius and carry out an action (attacking or activating an item/spell) in the Ring system, or to move them a greater distance within the larger radius. Battles typically end once all the enemies have been defeated and/or your characters reach a designated exit area of the map.
In addition to standard combat, maps also feature interactive elements such as traps and levers to pull. The biggest issue with this is that there is a lot of trial and error involved as it's not explained what these elements do. A couple examples of this are when I got my dwarf, Naurim, trapped under a stack of boxes that toppled on him after I assumed they were destructible like the other smaller boxes, and another when I shot a rope and a chandelier came down and killed half my party.
At the end of each battle, you typically receive a cash payout and items based on your performance and any treasure chests you opened in the map, as well as a chunk of AP to spend on upgrading your characters. You can upgrade any ability your party member already knows directly from the menu without the aid of an instructor, but if you want to learn something new you'll have to seek one out at the camp or a nearby city.
The upgrade system is where a lot of players not used to more complex RPG games can get a bit overwhelming as it's incredibly intricate. Upgrades fall under five main columns; Weapon Talents, where you can upgrade a characters proficiency with a weapon; Talents, where you can increase core buffs such as endurance and resistance; Spells; Special Manoeuvres; and Special Abilities, which features a tree system where you can unlock abilities that focus on melee, ranged, or magic.
As you can tell from the sheer length of this review, Blackguards 2 is an incredibly complex game, courtesy of its inspiration from the traditional RPG model. Combined with the trial and error nature of its combat, it does have a bit of a barrier for entry for those looking for a more casual experience, but it is immensely rewarding in both story and gameplay for those players who enjoy an in-depth RPG and who choose to stick it out.
The Dark Eye is a superb narrative and the way that Blackguards 2 chooses to portray it with great art and dialogue means it does a fantastic job of bringing a player deep into its universe, with the added bonus of giving the players consequential choices to make that affect the story – even potentially killing off a party member. If you're looking for a fantasy RPG with some solid tactical combat, and enjoy a solid piece of strategic warfare, I highly recommend picking it up.
Blackguards 2 is out now for PC and Mac. A PC copy of the game was provided for this review.
]]>Gaming Deal Of The Week: Assassin's Creed Unity StickTwiddlers
]]>Released towards the end of last year, Assassin's Creed Unity introduces fans to new assassin Arno Dorian as he explores 18th century Paris in a quest to expose the true powers behind the French Revolution. The game also brings co-operative multiplayer to the series for the very first time, supporting up to four players diving and dicing their way through the massive open-world.
For those who enjoy a good duel, Unity also features an overhauled combat system with a stronger focus on fencing and the inclusion of a customisation and upgrade system – allowing you to add new abilities to your Arno. There's also a brand new silent weapon to get to grips with – the Phantom Blade – which acts as a stealth ranged attack by firing a blade from a gauntlet mounted crossbow. Bad. Ass.
Assassin's Creed Unity is currently available from CDKeys for a beefy 72% discount for Xbox One, priced at £13.95, and a tidy 54% discount for PC, priced at at £22.99. Sadly we couldn't find a decent deal for PS4 owners, with the exception of eBay where you can currently pick up the game for around £33.
Some other bonus deals for PC gamers to look out for this week are Theme Hospital, which is currently free on Origin. You should also keep an eye over at Bundle Stars who are releasing two new themed gaming bundles every day this week as part of their Bundle Fest.
Until next week, happy gaming!
Got a tip for our Gaming Deal Of The Week? Let us know in the comments below or hit us up on Twitter and Facebook.
Gaming Deal Of The Week: Assassin's Creed Unity StickTwiddlers
]]>One of the most recently released collector's editions on our list, the Dragon Age Inquisition: Inquisitor's Edition is a true sight to behold. The crowning jewel of the piece is definitely the case which features individually wrapped in faux reptile skin, with the mark of the Inquisitor stamped on top in gold foil, and an interior fitted with imprinted red silk.
Ubisoft are fairly notorious for releasing multiple limited/collector's editions of their games, and the Assassin's Creed: Unity Guillotine Collector's Case is an absolute beauty. Statuettes and playing cards were a big feature of collector's editions from the past couple of years, and this has both and more!
Another collector's edition from last year that came housed in its own unique case, the Panzerhund Edition of Wolfenstein: The New Order featured a large high quality box modeled after a footlocker with a metal clasp and hinges and a numberplate. Oddly enough, and despite it's $100 price tag on release, it doesn't actually include a copy of the game!
Sadly this entry on our list never made it to retail outside of Japan and was sold exclusively through Amazon.co.jp and GameCity. Whilst the digital costume set bonuses are cool enough, fans were really snatching this up for the iconic Tri-Force table clock and treasure chest (and of course, that stunning scarf).
The king of the physical extras however comes courtesy of the Dark Souls II: Webhallen Edition which in addition to its Warrior Knight statue included an engraved ring and a totally badass hood, all bundled up in a limited edition numbered bag to carry your souls in (or to stash snacks in, if that's what you prefer).
So those were our top five collector's editions of 2014! Do you have a favourite that didn't make it on the list? What trends do you expect to see in 2015? Let us know in the comments below, or hit us up on Twitter and Facebook.
]]>Gat Out Of Hell puts in you control of fan-favourite Johnny Gat who, along with former FBI agent turned Saint Kinzie Kensington, use a "Wee-Ja" board to travel to the pits of Hell in order to rescue The President (the leader of the Saints) who has been kidnapped by Satan himself. The player must progress through the story by completing activities to fill the "Satan's Wrath" meter (ultimately doing stuff to piss off the Devil) and stop The President from being married off to Satan's daughter.
As you take on Satan's minions in the main story, there's also many side-mission to tackle across the city of New Hades; broken up into Challenges and the cheekily called Diversions. Diversions include mini-games such as the flying challenges Hellblazing and Barnstorming, and the typical battling against waves of enemies. Each mission will give you incremental rewards of money and XP depending on how you succeed with a bronze, silver or gold medal finish.
Challenges will also reward the player in XP, and there is a challenge for just about everything you can do in the game – 102, in fact – from using a particular weapon or power, to running or flying a certain distance. Tied in with the main story and you have a good few additional hours of gameplay, which for fans of the series will be great fun but could perhaps be a little bit repetitive for anyone newcomers.
Where Saints Row IV introduced superpowers to the universe, Gat Out Of Hell continues the trend, albeit now in a demonic nature – including the new ability to fly courtesy of some impressive wings. As you progress through the game you will be able to upgrade these abilities by collecting and spending Soul Clusters which are scattered throughout the world. Powers can also be earned through the variety of new characters you meet throughout the story; including historical figures such as Vlad the Impaler, Blackbeard, and William Shakespeare.
Along with new powers comes new firepower with The Seven Deadly Weapons, each based on the Seven Deadly Sins. These include the Gallows Dodger pistol based on Pride; the Diamond Sting SMG which turns enemies to cash; the Ark Of The Covenant explosive which sucks in and propels souls; the lusty Boom Chicka shotgun; the fiery Uriels Edge melee weapon; the Last Supper special weapon that covers enemies in frosting; and the infamous Armchair-A-Geddon – taking Sloth to the next level with dual-miniguns and heat-seeking missiles.
What is vital to a Saints Row story is the bare-knuckle humour, and Gat Out Of Hell has some great laugh out loud moments with the returning voice cast joined by new voices, all delivering great dialogue and comedy timing that is right on with what is expected. An awesome touch was the surprise to discover the game has five multiple endings, allowing the player to choose how it finishes, with a nice tease to where the series could go next.
I find Saints Row IV to be the perfect example of old school gaming with a modern twist. It's fun, has great comedy moments, holds no punches, and delivers on its hype. The main campaign story is for me by far the most entertaining in the series, and with the use of superpowers just takes the arcade fun to new levels that with the now shinier new generation clean up, more than deserving of a place in your collection.
As one of the first big releases of 2015, Saints Row: Gat Of Hell is full of fantastically fun moments and solid gameplay. It's a refreshing new taste of Saints Row gaming, and not just because it's the first title where you don't play as the customisable protagonist. The game compliments the release of Saints Row IV: Re-Elected perfectly, which essentially offers the same experience fans know and love, but looking even better on new gen consoles.
For me the series has always been about co-op play and with Gat Out Of Hell also playable in co-op, this remastered edition is great for those evenings where you just want to pick up a controller and have fun with a friend. As a standalone title, or packaged together with Saints Row IV: Re-Elected for the most most definitive edition of the game yet, it's a must-buy for any Saints Row fan.
Saints Row IV Re-Elected & Saints Row: Gat Out of Hell is scheduled for release on January 23rd, 2015 for Xbox One and PS4 and as a standalone expansion on PC, Xbox 360 and PS3. A PS4 copy of Saints Row: Re-Elected with Saints Row: Gat Out Of Hell was provided for review.
]]>In related news, we should be streaming some Saints Row shenanigans this weekend as part of the Steam "free weekend" and to celebrate the impending release of Saints Row: Gat Out Of Hell. Steam are also celebrating with special discounts on the entire franchise, with the best deal being the Saints Row Ultimate Franchise Pack, currently discounted by 80% for £9.99.
You can catch the StickTwiddlers team streaming every Saturday and at random intervals throughout the week on our Twitch channel. Make sure to follow us on Twitter and Like us on Facebook in order to keep up to date with when and what we'll be streaming next!


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Chileans protest pro-Pinochet tribute
SANTIAGO — Chilean police fired tear gas and clashed with demonstrators who protested against an event honoring a former military officer imprisoned for killings during the dictatorship of Gen. Augusto Pinochet.
At least seven people were injured, including six police officers, during the clashes Monday night outside an exclusive club in Santiago, where about 1,000 protesters had congregated.
Protesters hurled rocks at police, and nine demonstrators were arrested.
Chilean human rights activists organized the protest to condemn the gathering in honor of ex-Brigadier Miguel Krassnoff, who is serving a 144-year prison sentence for crimes related to the kidnappings and killings of government opponents during Pinochet's rule from 1973 to 1990.
Several hundred people attended the tribute.
Many famine victims afraid to return home
DOLO — Lush patches of green dot this once-barren land, allowing goats and camels to graze. A nearby field is full of large, purple onions thanks to a U.N.-funded project.
Four months after the U.N. declared famine in much of Somalia, some regions are beginning a slow recovery from a disaster that has killed tens of thousands of people.
But many Somalis - women, mostly - living in a stick-hut camp in this border town say they won't return home because they're afraid of hard-line Islamist militants stalking the country, and of being unable to feed themselves and their children.
The U.N. last week reduced the number of famine zones in Somalia from six to three and said the number of people at risk of starvation has dropped from 750,000 to 250,000.
Since the July 20 famine declaration, the U.N. has received $800 million in aid for Somalia, and the U.S. has provided $650 million to drought-stricken Horn of Africa nations, including Somalia.
Still, the fate of 13 million people affected by East Africa's worst drought in decades remains in doubt.
Border screening creates security alert
OTTAWA — Canada's flawed visa system may be letting in terrorists, mobsters or travelers carrying deadly diseases, officials warned Tuesday.
In a report to parliament, Auditor-General John Wiersema said immigration and border officials "need to do a much better job of managing the health, safety and security risks associated with determining admissibility before issuing a visa."
He cited shortcomings in the training of visa officers and out-of-date indicators used to identify high-risk applicants as the main problems.
Canada is one of few nations actively encouraging immigration to boost its population of 34.5 million.
Officials say oil slick has shrunk significantly
SAO PAULO — The size of the oil slick at a well operated by U.S.-based Chevron Corp. off the coast of Rio de Janeiro state is more than 80 percent smaller than it was four days ago, said Brazil's National Petroleum Agency Tuesday.
The agency said in a statement that the slick at the water's surface covered 0.78 square miles, compared to the 4.63 square miles registered on Nov. 18.
The agency also said the oil slick continues moving away from Brazil's coastline.
Despite the announcement, Rio de Janeiro state's Environment Secretary Carlos Minc told reporters that in two weeks to a month the oil could reach beaches west of the city of Rio that are popular with tourists.
University hit by new climate leak ahead of talks
LONDON — The British university whose stolen emails caused a global climate science controversy in 2009 says those behind the breach have apparently released a second and potentially far larger batch of old messages.
University of East Anglia spokesman Simon Dunford said that while academics didn't have the chance yet to examine the roughly 5,000 emails apparently dumped into the public domain Tuesday, a small sample examined by the university "appears to be genuine."
The university said in a statement that the emails did not appear to be the result of a new breach.
Instead, the statement said that the emails appeared to have been stolen two years ago and held back until now "to cause maximum disruption" to the imminent U.N. climate talks next week in Durban, South Africa.
If that is confirmed, the timing and nature of the leak would follow the pattern set by the so-called "Climategate" emails, which caught prominent scientists stonewalling critics and discussing ways to keep opponents' research out of peer-reviewed journals.
Those hostile to climate science claimed the exchanges proved that the threat of global warming was being hyped.
• From wire dispatches and staff reports


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The median home value in Highland, CA is $225,800. This is higher than the county median home value of $224,900. The national median home value is $170,100. The average price of homes sold in Highland, CA is $225,800. Approximately 59.69% of Highland homes are owned, compared to 33.61% rented, while 6.7% are vacant. Highland real estate listings include condos, townhomes, and single family homes for sale. Commercial properties are also available. If you see a property you're interested in, contact a Highland real estate agent to arrange a tour today! Learn more about Highland Real Estate.
1234 sqft home on 22,500 sqft fenced lot could be used for Commercial or Residential; PLUS an additional 33,000 sqft parcel behind this property that can be used for a Residential use. House will be sold AS IS. Owner may allocate up to $8,000 toward repairs with a full price offer.Home is tenant occupied and can be shown by appointment only. Owner has never lived in the home.
Very well maintained 1 story home within walking distance to Emmerton elementary and San Gorgonio High School. Just a couple of blocks to the 210 on ramp that will connect you to the rest of Southern California. Open concept and vely light and airy entryway takes you to the formal living room and the family room with fire burning fireplace connects to the dining area and kitchen. Lage 8453 sqft lot with large front lawn and possible RV access to the side of the house. Bedrooms are rather large and the guest bathroom has a dual vanity with rich granite. Come show this property and you will not be disappointed.
Standard Sale!!! Beautifully Remodeled 3 Bed. 1 Bath. 1,326 sqft Two Story Condominium!!! Gourmet Kitchen with New Granite Countertops, New Glass and Stone Mosaic Backsplash, New Stainless Steel Appliances, New Premium Interior Paint, New Tiled Floors downstairs and New Carpet Upstairs. Backyard Patio and Fenced Front Courtyard, Storage Room. Open Floorplan. New Low E Energy Efficient Windows. No one above or bellow the unit. HOA Dues include Water. Assigned Carport Parking. Check out our Virtual Tour for More Photos!
Great house on corner lot! Brand new carpet and flooring. 4 bed 2 bath open concept. landscaped front yard and good sized back yard! Large finished garage and fenced and gated drive way. Built in 2011 but looks brand new! Open kitchen with beautiful cabinets. High ceilings and lots of light! Walk-in master closet
For rent but also for Sale!!! Corner fenced lot with a large front and back yard! This 3/1B has a large living room area and 3 bedrooms + bonus room. Trees, landscaping, grass, sprinklers, fresh exterior paint and natural slate stone walkway are just a few of the exterior improvements. Interior improvements currently in progress included stainless steel appliances, countertops, new flooring and paint, new fixtures, bathroom and more! This home is going to look wonderful when completed! Work to be completed before year end. Please feel free to set up an appointment to see the home while we are finishing up.
beautiful home with huge back yard. must see to believe. please see pics
These two lots are located directly east of 26811 5th St., Highland, CA (The home is not part of the property for sell but merely a landmark to help locate the lots for sale ). Consisting of two 17550 sq. ft. vacant lots, Apn#119256105 & 06 property per the City of Highland is zoned Business Park. Buyer to verify zoning and availability of all utilities including water, gas, electric, and sewer. Home west of property is on septic system. This information has not been verified by broker.
2 bed 1 bath Condo. No neighbors above or on either side. Fireplace in living room, central air and heat.
Outstanding 2 story,3 bedroom, two and a half bath, family room home. Featuring a beautiful kitchen with custom cabinetry and granite counters, lovely fireplace, three car garage and RV parking. The exterior design is hi-lighted with a gorgeous pool, spa and fire pit and beautiful patio. Truly a great home! This information has not been verified by broker.
Beautiful home in an exclusive neighborhood. Assessors office says 5 bedrooms but has a 6th bedroom in place of the 3rd garage now used as an office with built-in desk and shelves. Spacious 2 car garage, Pool and huge back yard, fully landscaped front and back. New paint inside and out and new carpet throughout. Large bedroom and office/6th bedroom both downstairs, and the remaining 4 large bedrooms are upstairs and all have ceiling fans. Bar area, formal dining room, sunken living room with fireplace and spacious kitchen with pantry opening up to the oversized family room sporting a 2nd fireplace. Recessed lighting in many rooms and tons of storage everywhere. A very large back yard has a view of the mountains and is ready for a party with a nice patio separate from the beautiful fenced in pool. This is a great home for a growing family located in a quite mature neighborhood full of great neighbors. Don't let this one slip away, it will sell quickly.
Real Living Premier Realty 23180 Hemlock Moreno Valley, CA 92557 Email Us | Visit our Real Estate Website


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Industrial Nations Criticize Draft Climate Pact
COPENHAGEN--Tens of thousands of protesters marched through the chilly Danish capital, and 968 were detained Saturday, in a mass rally to demand an ambitious global climate pact just as talks here hit a snag over rich nations' demands on China and other emerging economies.
The mostly peaceful demonstrations provided the centerpiece of a day of global climate activism stretching from Europe to Asia. Police assigned extra officers to watch protesters demanding that their leaders act now to fight climate change, as the demonstrators marched toward the suburban site where the 192-nation United Nations climate conference is being held.
Police estimated their numbers at 40,000, while organizers said as many as 100,000 had joined the march from downtown Copenhagen. It ended with protesters holding aloft candles and torches as they swarmed by night outside the Bella Center.
Police said they rounded up between nearly 1,000 people in a preventive action against a group of youth activists at the tail end of the demonstration. Officers in riot gear moved in when some of the activists, masking their faces, threw cobblestones through the windows of the former stock exchange and Foreign Ministry buildings.
A police officer received minor injuries when he was hit by a rock thrown from the group and one protester was injured by fireworks, police spokesman Flemming Steen Munch said.
Earlier, police said they had detained 19 people, mainly for breaking Denmark's strict laws against carrying pocket knives or wearing masks during demonstrations.
Inside the Bella Center, the European Union, Japan and Australia joined the U.S. in criticizing a draft global warming pact that says major developing nations must rein in greenhouse gases, but only if they have outside financing. Rich nations want to require developing nations to limit emissions, with or without financial help.
Swedish Environment Minister Andreas Carlgren, representing the 27-nation EU, told The Associated Press that "there has been a growing understanding that there must be commitments to actions by emerging economies as well.''
He said those commitments "must be binding, in the sense that states are standing behind their commitments.''
Indian Environment Minister Jairam Ramesh said his country, the world's No. 5 greenhouse-gas emitter, won't offer more than its current pledge to slow its growth rate of emissions. It has offered to cut greenhouse gases measured against production by 20% to 25% by 2020.
"National interest trumps everything else,'' Mr. Ramesh told the AP. "Whatever I have to do, I've said in my Parliament. We'll engage them [the U.S. and China]. I'm not here to make new offers.''
China has made voluntary commitments to rein in its carbon emissions but doesn't want to be bound by international law to do so. In China's view, the U.S. and other rich countries have a heavy historical responsibility to cut emissions and any climate deal in Copenhagen should take into account a country's level of development.
Alden Meyer of the Union of Concerned Scientists told the AP that rich nations are trying to re-negotiate the deal they reached two years ago on the island of Bali, calling on developing nations to limit emissions with financial help. "It's going to blow up in their faces,'' he said. "The rich countries are trying to move the goal posts. And developing countries are not going to agree to that, no matter how loudly the rich countries demand it."
The tightly focused negotiating text was meant to lay out the crunch themes for environment ministers to wrestle with as they prepare for a summit of some 110 heads of state and government at the end of next week.
U.S. delegate Jonathan Pershing said the draft failed to address the contentious issue of carbon emissions by emerging economies.
"The current draft didn't work in terms of where it is headed,'' Mr. Pershing said in the plenary, supported by the European Union, Japan and Norway.
But the EU also directed criticism at the U.S., insisting it could make greater commitments to push the talks forward without stretching the legislation pending in Congress. Both the U.S. and China should be legally bound to keep whatever promises they make, Mr. Carlgren said.
The United Nations' climate chief said Saturday that countries must commit to more ambitious cuts in their emissions of greenhouse gases, and called on rich countries to be more generous in their pledges to aid poorer nations
"What I am looking for is for all countries to raise their level of ambition in terms of emission reductions, and what I am looking for industrialized countries to do is raise their level of ambition in terms of the financial support" they can provide to developing countries, said Yvo de Boer, executive secretary of the U.N. Framework Convention on Climate Change, during a news conference in the sixth day of negotiations
Also on Saturday, thousands participated in a "Walk Against Warming'' in major cities across Australia, and about 200 Filipino activists staged a festive rally in Manila to mark the Global Day of Action on climate change. Dozens of Indonesian environmental activists rallied in front of the U.S. Embassy in Jakarta.
Environmentalists staged stunts and protests in 100 piazzas across Italy, from Venice's St. Mark's Square to a historical piazza in downtown Rome. They carried banners that read ``stop the planet's fever'' and asked passers-by to sign a petition calling on world leaders to reach a deal to reduce emissions.
In Copenhagen, Archbishop Desmond Tutu, a Nobel Peace laureate, and Greenpeace leader Kumi Naidoo were among those ratcheting up the pressure for a fair, ambitious and binding treaty.
Mr. Naidoo exhorted politicians to act bravely by crafting a fair, ambitious and binding treaty, so they can later "look their children and grandchildren in the eyes'' and tell them they did the right thing. "Failure to do so will be the worst political crime that they would have committed,'' he said.
Inside the Bella Center, delegates gathered around flat-screen TVs showing both the larger peaceful rally and the police crackdown on the young activists. Riot police tied them up with plastic cuffs and made them sit down on a closed-off street before busing them to a detention center set up for the climate conference.
Britain's Ed Miliband, the climate change secretary, said dealmakers have a long ways to go. ``There are difficult issues to overcome,'' he said, "around emissions, around finance, and around transparency and they are all issues we need to tackle in the coming days.''
But conference president Connie Hedegaard sought to reassure people that world leaders have come to seriously confront climate change. "It has taken years to build up the pressure ... that we're also seeing unfolding today in many capitals around the world,'' Ms. Hedegaard said. "And I believe that that has contributed to making the political price for not delivering in Copenhagen so high.''
—The Associated Press contributed to this report.


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Using brain waves to control artificial hand
10/29/2013Dr. Erik Engeberg has been awarded a $250,000 grant from the National Science Foundation to explore different methods for people with upper limb amputation or congenital limb absence to control dexterous artificial hands with brain waves.
Dr. Erik Engeberg
"When people move, or imagine moving their hands, characteristic electrical signatures are generated on top of the head that can be detected noninvasively," says Engeberg, an assistant professor with a joint appointment in the mechanical and biomedical engineering departments in the College of Engineering. "The goal of this research is to develop biomedical signal processing techniques to enable this with a single, small recording electrode placed noninvasively on subjects' heads."
The recorded brain waves will be wirelessly transmitted to the artificial hand in real time. A top-level controller will be developed to interpret the intent of the test subjects while a low-level controller will be used to synchronize the dexterous grasp motions of the artificial hand. Algorithms will also be developed using tactile feedback from the fingertips to automatically prevent grasped objects from being accidentally dropped when they are transported or disturbed. Participants in the study will help to compare the newly developed artificial hand control techniques with brain waves to conventional control techniques with muscle signals during common tasks of daily life.
If successful, this research will result in a noninvasive and economical method for people with an upper limb amputation or congenital absence to control a dexterous artificial hand with brain waves. This could substantially improve the functionality of prosthetic hands for many people. The use of minimal hardware will facilitate the clinical adoption of this technique and the autonomous low-level control algorithms will produce a brain machine interface that places a low cognitive burden on the operator.
Media contact: Sarah Steidl, 330-471-8142 or firstname.lastname@example.com .
In this issue
Submit UA-themed baking/decorating pics
'Tis the season for family, decorations and Zippy cookies! -
Alumna makes a difference in the life of a UA student
Stewart became a Roo Crew mentor to help influence students. With no children of her own, she says she truly enjoys being around college students and wants to be a supportive adult figure for them. -
Ken Taylor invests in UA business students, is named Honorary Alumnus
A generous gift from Kenneth E. Taylor, president of Ohio CAT, means University of Akron business students are one step closer to a more dynamic and rewarding learning experience. -
$1 million prize awarded to UA and Northeast Ohio partners
Competing against 57 other cities across the nation, the Akron metropolitan area has won the top prize in the Talent Dividend competition, producing an impressive 20 percent increase in college degree holders between 2009 and 2013, the largest increase among the competing regions. -
Inaugural dean for health college appointed
Dr. David Gordon says he will strive to develop top health professionals who know how to work in integrated teams to achieve the triple aims of health care: Excellent care, best improved health status and the most affordable cost.
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Written on: 28/05/2012 by Lyndsay (1 review written)
I used spot on flea treatment on my 7.5 month old kitten on Thursday he's now pulled all of his fur out of his neck and is extremley inflamed and sore. I've taken him to the vets and he has treatment but I'm so angry that this product is still allowed to be sold in the shops. I wish I'd read the reviews before I bought it!
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Assassin's Creed 3 very first DLC 'Hidden Secrets Pack' adds three missions, Season Pass only for now
The very first piece of Assassin's Creed 3 downloadable content has arrived, at least for Season Pass holders. The "Hidden Secrets Pack" hit Xbox 360, PS3, and PC today via their respective distribution platforms, with a Wii U release planned for "a later date."
The DLC adds three more missions to the core game: Lost Mayan Ruins, Ghost of war, and Dangerous Secret. According to Ubisoft's own estimate, these missions make up about an hour of additional gameplay, and success will be rewarded with in-game weapons.
In addition to actual playable content, Hidden Secrets also introduces two more costumes -- a Captain of the Aquila uniform and traditional Colonial Assassin outfit -- for Connor in the campaign. On the multiplayer side of things, you're getting access to two new multiplayer characters, the Redcoat and Sharpshooter.
If you don't actually own the Season Pass but still kind of want the DLC, Hidden Secrets will be available to all starting December 11.
Upcoming DLC includes the what-if scenario "Tyranny of King Washington," and a "Battle Hardened Pack."
quote RabidChinaGirlYeah, I know. Which means that they're probably getting the additional content at a cheaper price than those who had to pre-order, and only a month after the release of the game. Personally, I don't think that was such a wise decision for Ubisoft to make. I think they should have got the "Tyranny of King Washington" DLC out of the way before they thought about releasing this kind of content, honestly.Dragoon To be fair, the Season Pass does give you an overall 25% discount on the DLC. I assume that's what you're referring to, anyway.
I brought a Season pass for a reason ffs.
Will play it tomorrow when Ubi fix the goddamn servers.
Oh and I wondered why I got the sharpshooter. Majorly pissed now though because EVERYBODY is going to be using the Redcoat. Gutted.
quote intoxicationProbably 10-15 for it. You know its a given.Oh yeah, I've completely forgot about these. Unfortunately, my standard copy only came with "Dangerous Secret" but I dont think I'll be getting the other two, and will just wait for "Tyranny of King Washington" dlc, IF they dont over price it.
There's a glitch with this DLC, deleting the game save. A solution is written in the link I gave, but you should still backup your save before downloading it, just in case .
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Programming note: For comprehensive 49ers coverage, watch SportsNet Central today at 6, 10:30 p.m. and midnight on Comcast SportsNet Bay Area
Editor's note: 49ers offensive coordinator Greg Roman addressed the media from Santa Clara on Thursday. Below is a full transcript of his comments.
Programming note: Jim Harbaugh is scheduled to address the media this afternoon at 12:10 p.m. Watch the l
Programming note: Watch 49ers Press Conference Live today at Noon on Comcast SportsNet Bay Area, or streaming live
Through the first seven games of the season, the 49ers have won the battle of the passing games.


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The Indian journal of surgery (Indian J Surg )
Publisher: Association of Surgeons of India
Impact factor 0.27
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- Other titlesIndian journal of surgery (Online)
- Material typeDocument, Periodical, Internet resource
- Document typeInternet Resource, Computer File, Journal / Magazine / Newspaper
Publications in this journal
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ABSTRACT: Incisional hernia during pregnancy with whole of gravid uterus as the content of the hernia sac is a rare occurrence. When such hernia is associated with skin defect over the sac the management gets complicated. Very few such cases are reported in the literature. There is no consensus on the management of these cases in the available literature. Here we are reporting two such cases managed in different ways and reviewed the literature.The Indian journal of surgery 01/2015; Accepted. - [Show abstract] [Hide abstract]
ABSTRACT: Appendicitis is a common surgical abdominal disease with various presentations. Its diagnosis may be obscured by asymptomatic congenital anatomical anomalies like midgut malrotation. Midgut malrotation is a rare fetal anomaly resulting from incomplete or failure of midgut rotation and fixation. It is mostly presented with bowel obstruction or volvulus in early life. Presentation in adult is rare. Here, we report an elderly patient presented with left lower abdominal pain and urinary tract infection. Abdominal computed tomography revealed left-sided appendicitis with non-rotational-type midgut malrotation. Clinicians should bear in mind the possibility of underlying midgut malrotation, as appendicitis could be the first presentation of this rare congenital condition.The Indian journal of surgery 11/2014; - [Show abstract] [Hide abstract]
ABSTRACT: Abstract Congenital cystic dilation of the biliary duct is defined as choledochal cyst (CDC). CDC presenting with the classical triad of abdominal pain, lump, and jaundice is seen in only 6 % cases. Cyst excision with hepaticojejunostomy is the standard treatment worldwide. We hereby report five cases of CDC with unusual presentations (gastric outlet obstruction, cyst perforation, giant cystolithiasis, giant cyst, and mixed type) and discuss the challenges faced during the diagnosis and perioperative management of these cases.The Indian journal of surgery 08/2014; - [Show abstract] [Hide abstract]
ABSTRACT: Traumatic abdominal wall hernia after blunt trauma is a rare entity. They can easily be overlooked in patients who have multiple trauma, as its signs and symptoms may be variable due to the presence of multiple injuries. Imaging with computed tomography or ultrasound confirms the diagnosis as well as identifying any associated injuries. Although surgery is the standard treatment for traumatic abdominal wall hernias, there is no consensus on the early or late repair of the defect. Some authors recommend early surgical intervention in order to avoid the risk of intra-abdominal organ injury, incarceration, and strangulation. In this study, we report our experience in three cases, which did not involve emergency surgery. Long-term outcome is successful. Elective hernia repair may be safe and feasible in stable patients.The Indian journal of surgery 05/2014; - [Show abstract] [Hide abstract]
ABSTRACT: Tracheotomy is commonly performed for the management of upper airway compromise. Trauma and head and neck cancers are the most frequent indications. The objective of this study was to share our experience with tracheotomy performed for a broad range of malignancies including but not limited to head and neck cancer. This study is a retrospective case series of patients who underwent tracheotomy from January 2004 to June 2012 at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan. A total of 130 patients were included in the study. Patient demographics, indications for tracheotomy, underlying malignancy, and duration of follow-up were assessed. Main indications were elective (prolonged intubation and/or as a prerequisite for head and neck cancer surgery) and emergency (stridor). Outcome was assessed on a basis of successful decannulation and complications related to tracheotomy. Indications for tracheotomy were elective in 55 (44.7 %) and emergent in 75 (55.3 %) patients. Most common underlying malignancy was leukemia/lymphoma in 38 (29.2 %) patients. There were seven (5.3 %) complications in emergency tracheotomies including bleeding in three, emphysema in two, and dislodgement and infection in one patient each. In the elective setting, three (2.3 %) complications were observed with dislodgement in one and stomal stenosis in two patients. Decannulation was successfully carried out in 23 (18 %) patients. Median follow-up of patients was 1 month (range 0–86). No tracheotomy-related mortality was observed. Tracheotomy was performed with relative safety in cancer patients, but low rate of successful decannulation predominantly due to persistent nature of disease.The Indian journal of surgery 04/2014; - The Indian journal of surgery 01/2014;
Article: Two Etiological Reasons of Constipation: Anterior Rectocele and Internal Mucosal Intussusception
The Indian journal of surgery 01/2014; - The Indian journal of surgery 11/2013;
Article: Combined use of Mathieu and incised plate techniques for repair of distal penile hypospadias
The Indian journal of surgery 10/2013; - The Indian journal of surgery 08/2013;
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ABSTRACT: Abstract: Primary hyperparathyroidism is a disease commonly seen in patients above 60 years of age. It is the most common cause of asymptomatic or symptomatic hypercalcemia, usually found incidentally on routine check-ups Surgical treatment is the only definitive treatment of choice in the symptomatic patient; however, it can also be employed in asymptomatic patients. First described in 1925, bilateral neck exploration is the gold standard of treatment for primary hyperparathyroidism. The recent interest in minimally invasive surgeries has led to better and improved techniques of neck exploration with improved cosmetic results and lesser chances of transient or permanent hypoparathyroidism due to inadvertent removal of normally functioning parathyroid tissue. These include unilateral neck explorations, minimally invasive parathyroidectomies and minimally invasive radioguided parathyroidectomy. The intact parathyroid hormone assays have greatly added to the detection of normal and abnormal functioning glands, hence better surgical outcomes.The Indian journal of surgery 03/2013; - [Show abstract] [Hide abstract]
ABSTRACT: The pedicle of the anterolateral thigh flap is formed by the descending branch of the lateral circumflex femoral artery. Recently, an oblique branch of lateral circumflex femoral artery was described by Wei et al., which can also be used as an alternative to the descending branch. We describe a case in which both the pedicles were used to create two free flaps (twin flaps) from the same thigh for post tumour reconstruction of breast.The Indian journal of surgery 03/2013; -
Article: Demographic Profile of Hand Injuries in an Industrial Town of North India: A Review of 436 Patients
The Indian journal of surgery 01/2013; -
Article: Contralateral spinal accessory nerve transfer: a new technique in panavulsive brachial plexus palsy
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ABSTRACT: Brachial plexus avulsion results from excessive stretching and can occur secondary to motor vehicle accidents, mainly in motorcyclists. In a 28-year-old man with panavulsive brachial plexus palsy, we describe an alternative technique to repair brachial plexus avulsion and to stabilize and preserve shoulder function by transferring the contralateral spinal accessory nerve to the suprascapular nerve. We observed positive clinical and electromyographic results in sternocleidomastoid, trapezius, supraspinatus, infraspinatus, pectoralis, triceps, and biceps, with good outcome and prognosis for shoulder function at 12 months after surgery. This technique provides a unique opportunity for patients suffering from severe brachial plexus injuries and lacking enough donor nerves to obtain shoulder stability and mobility while avoiding bone fusion and preserving functionality of the contralateral shoulder with favorable postoperative outcomes.The Indian journal of surgery 01/2013; -
Article: Impact of increased use of pre-operative imaging and laparoscopy on outcomes of Appendicectomy
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ABSTRACT: The diagnosis of appendicitis is based on clinical picture. The aim of this retrospective study was to analyse variation of outcomes and impact of increasing use of radiological investigations and laparoscopy over a 5-year period. A retrospective audit of appendicectomies over the last 5 years (01 January 2007–31 December 2011) was conducted. The negative appendicectomy rate (NAR), perforation rate and complication rate were used as outcome endpoints. A statistical analysis was performed to evaluate the difference in outcomes with surgical approach and use of radiology. One thousand fifty-five appendicectomies were performed in this period. The NAR was 22.65 % (21 % for open and 28 % for laparoscopic) and perforation rate was 14 %. There was no statistically significant difference in NAR with the use of ultrasound (P 0.3814) but there was a significant reduction in NAR with the use of computed tomography (CT) (P <0.0001). Intra-abdominal abscess (2.3 %) and wound infection (1.4 %) were the common complications with the former being higher with laparoscopy and the latter with open appendicectomy. Over 5 years, there were no significant changes in appendicectomy outcomes. The impact of diagnostic imaging on NAR varies with age, gender and the use of CT. CT can significantly reduce the negative appendicectomy rate in equivocal presentations. Complication rates vary with surgical approach.The Indian journal of surgery 01/2013;
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