Urban trauma centres have recently noted a shift in the causative mechanism of facial fractures away from motor vehicle crashes (MVC) to blunt assaults (BA). This study was conducted to examine the incidence and aetiology of facial fractures at our institution as well as the relationship with alcohol and protective device use. Trauma registry records of all patients admitted to a level I trauma centre from 1 January 1988 to 1 January 1999 were reviewed. There were 13594 trauma admissions during the 11-year period. Facial fractures were sustained by 1429 patients (10.5%) and this group forms the subject of this study. MVC was the predominant aetiology (59.9%) followed by BA (18.8%). Facial fractures were found in 9.5% of restrained MVC patients compared to 15.4% of unrestrained patients (P<0.00l). Non-helmeted motorcyclists were four times more likely to sustain facial fractures (4.3% vs. 18.4%) than helmeted patients (P<0.00l). 39.6% of patients in the MVC group were legally intoxicated compared to 73.5% in the BA group (P<0.00l). 45.4% of unrestrained patients with facial fractures were intoxicated compared to 11.8% of restrained MVC patients with facial fractures (P<0.001). MVC continue to be the primary aetiology of facial fractures in our trauma population. Protective devices decrease the incidence of facial fractures. Lack of protective device use and the consumption of alcohol correlate with sustaining facial fractures.

Background: Urethral catheterization is a routinely perfonned procedure in hospitalized patients. Numerous complications have been reported secondary to urethral catheter placement.Methods: The medical literature was searched using the following key words: "urethral catheter," "complications," and "management." A case report is described and a review of the literature is provided to assist in managing the nondetlating urethral catheter balloon.

A hypovascular solid splenic mass by Doppler ultrasound or CT scan suggests the diagnosis of inflammatory pseudotumor. Stellate central calcifications seen on CT scan make the diagnosis very likely. Laparoscopic splenectomy can be used for definitive diagnosis and symptomatic relief with minimal morbidity and mortality.

2-Octyl cyanoacrylate tissue adhesive is increasingly being used for closure of traumatic lacerations. Data regarding the strength of incisions closed with 2-octyl cyanoacrylate are limited. We compared the strength of disruption of closure with glue with that of more conventional methods of wound closure. Segments of fresh porcine skin measuring 3.5 x 10 cm were approximated by one of four methods: 1) 2-octyl cyanoacrylate glue, 2) surgical staples, 3) 0.5 inch Steri-Strips, and 4) interrupted 4–0 poliglecaprone 25 sutures in a subcuticular fashion. Fifteen specimens were used to test each type of closure. The strength of closure was tested on an Instron 4502 tensionometer. The peak force required for disruption of the closure was recorded and the strength of the closure was compared. Staples provided the strongest closure. Skin glue proved superior to Steri-Strips but inferior to stapled closure. The difference between skin glue and suture closure was not statistically significant ( P = 0.12). Patterns of failure differed between the groups. Skin glue failed because of disruption of the skin-glue interface. 2-Octyl cyanoacrylate glue provides a wound closure that is similar to closure with an interrupted subcuticular absorbable suture. This study validates the clinical use of skin glue for closure of surgical incisions. The technique should be used with caution in areas of the body that are subject to tension.

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Background: The length of patients’ stay in the emergency room is a key measure of service delivery and a marker to measure the quality of care. Studies have shown that patients with psychiatric and substance use disorders have a prolonged length of stay in the emergency room compared to medical and surgical patients. Various factors have been found to contribute to this disparity. Method: This is a retrospective case by case review of four hundred and ninety-three consecutive patients who presented to a community psychiatric emergency. Results: Our results show a length of stay ranging between 1.21 – 33.48 hours. The mean length of stay of 8.72 hours and the median was 7.41 hours. Furthermore, the utilization of emergency medication and age above 44 have a significant influence on patients’ length of stay in the psychiatric emergency room (p<0.05). Conclusion: The length of stay in the psychiatric emergency room deserves more study in literature as it remains a metric for service delivery. Although, factors contributing to a prolonged length of stay may vary, in different settings and situations, understanding these factors will improve outcomes for patients in psychiatric emergency rooms.

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