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Sample records for blunt aortic injury

  1. Blunt thoracic aortic injuries: an autopsy study.

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    Teixeira, Pedro G R; Inaba, Kenji; Barmparas, Galinos; Georgiou, Chrysanthos; Toms, Carla; Noguchi, Thomas T; Rogers, Christopher; Sathyavagiswaran, Lakshmanan; Demetriades, Demetrios

    2011-01-01

    The objective of this study was to identify the incidence and patterns of thoracic aortic injuries in a series of blunt traumatic deaths and describe their associated injuries. All autopsies performed by the Los Angeles County Department of Coroner for blunt traumatic deaths in 2005 were retrospectively reviewed. Patients who had a traumatic thoracic aortic (TTA) injury were compared with the victims who did not have this injury for differences in baseline characteristics and patterns of associated injuries. During the study period, 304 (35%) of 881 fatal victims of blunt trauma received by the Los Angeles County Department of Coroner underwent a full autopsy and were included in the analysis. The patients were on average aged 43 years±21 years, 71% were men, and 39% had a positive blood alcohol screen. Motor vehicle collision was the most common mechanism of injury (50%), followed by pedestrian struck by auto (37%). A TTA injury was identified in 102 (34%) of the victims. The most common site of TTA injury was the isthmus and descending thoracic aorta, occurring in 67 fatalities (66% of the patients with TTA injuries). Patients with TTA injuries were significantly more likely to have other associated injuries: cardiac injury (44% vs. 25%, p=0.001), hemothorax (86% vs. 56%, pinjury (74% vs. 49%, pinjury. Patients with a TTA injury were significantly more likely to die at the scene (80% vs. 63%, p=0.002). Thoracic aortic injuries occurred in fully one third of blunt traumatic fatalities, with the majority of deaths occurring at the scene. The risk for associated thoracic and intra-abdominal injuries is significantly increased in patients with thoracic aortic injuries.

  2. Ascending aortic injuries following blunt trauma.

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    Sun, Xiumei; Hong, Jenny; Lowery, Robert; Goldstein, Steven; Wang, Zuyue; Lindsay, Joseph; Hill, Peter C; Corso, Paul J

    2013-11-01

    The diagnosis and the management of traumatic thoracic aortic injuries have undergone significant changes due to new technology and improved prehospital care. Most of the discussions have focused on descending aortic injuries. In this review, we discuss the recent management of ascending aortic injuries. We found 5 cohort studies on traumatic aortic injuries and 11 case reports describing ascending aortic injuries between 1998 to the present through Medline research. Among case reports, 78.9% of cases were caused by motor vehicle accidents (MVA). 42.1% of patients underwent emergent open repair and the operative mortality was 12.5%. 36.8% underwent delayed repair. Associated injuries occurred in 84.2% of patients. Aortic valve injury was concurrent in 26.3% of patients. The incidence of ascending aortic injury ranged 1.9-20% in cohort studies. Traumatic injuries to the ascending aorta are relatively uncommon among survivors following blunt trauma. Aortography has been replaced by computed tomography and echocardiography as a diagnostic tool. Open repair, either emergent or delayed, remains the treatment of choice. © 2013 Wiley Periodicals, Inc.

  3. Multiple subfailures characterize blunt aortic injury.

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    Stemper, Brian D; Yoganandan, Narayan; Pintar, Frank A; Brasel, Karen J

    2007-05-01

    Blunt aortic injuries result from rapid deceleration of the thorax as may occur during automotive impacts and falls from extreme heights. Pathological findings can range from failure of specific vessel layers to immediate vessel wall rupture. The purpose of this investigation was to determine the sequence of local structural events that may lead to aortic wall disruption. Fourteen porcine aorta specimens were opened to expose the intima and longitudinally distracted until rupture. Longitudinal mechanics were quantified and subfailures were identified. Histology was used to examine internal layer subfailure. Videography demonstrated that subfailures propagated into complete vessel wall rupture. Subfailures occurred before complete vessel rupture in 93% of specimens. Intimal and medial subfailures were present at 74% of the stress and 82% of the strain to rupture. Multiple subfailures were evident in 79% of specimens. Present results supported the clinical theory that nonimmediate death as a result of blunt aortic injury is commonly caused by propagation of lesser lesions, initiating on the intimal layer, into complete vessel rupture including the adventitial layer. This finding, along with histologic evidence of subfailure pathological findings, confirms the presence of an acute window during which recognition and initiation of permissive hypotension may be lifesaving.

  4. Blunt Cardiac Injury in Trauma Patients with Thoracic Aortic Injury

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    Kaewlai, Rathachai; de Moya, Marc A.; Santos, Antonio; Asrani, Ashwin V.; Avery, Laura L.; Novelline, Robert A.

    2011-01-01

    Trauma patients with thoracic aortic injury (TAI) suffer blunt cardiac injury (BCI) at variable frequencies. This investigation aimed to determine the frequency of BCI in trauma patients with TAI and compare with those without TAI. All trauma patients with TAI who had admission electrocardiography (ECG) and serum creatine kinase-MB (CK-MB) from January 1999 to May 2009 were included as a study group at a level I trauma center. BCI was diagnosed if there was a positive ECG with either an eleva...

  5. Blunt abdominal aortic injury: a Western Trauma Association multicenter study.

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    Shalhub, Sherene; Starnes, Benjamin W; Brenner, Megan L; Biffl, Walter L; Azizzadeh, Ali; Inaba, Kenji; Skiada, Dimitra; Zarzaur, Ben; Nawaf, Cayce; Eriksson, Evert A; Fakhry, Samir M; Paul, Jasmeet S; Kaups, Krista L; Ciesla, David J; Todd, S Rob; Seamon, Mark J; Capano-Wehrle, Lisa M; Jurkovich, Gregory J; Kozar, Rosemary A

    2014-12-01

    Blunt abdominal aortic injury (BAAI) is a rare injury. The objective of the current study was to examine the presentation and management of BAAI at a multi-institutional level. The Western Trauma Association Multi-Center Trials conducted a study of BAAI from 1996 to 2011. Data collected included demographics, injury mechanism, associated injuries, interventions, and complications. Of 392,315 blunt trauma patients, 113 (0.03%) presented with BAAI at 12 major trauma centers (67% male; median age, 38 years; range, 6-88; median Injury Severity Score [ISS], 34; range, 16-75). The leading cause of injury was motor vehicle collisions (60%). Hypotension was documented in 47% of the cases. The most commonly associated injuries were spine fractures (44%) and pneumothorax/hemothorax (42%). Solid organ, small bowel, and large bowel injuries occurred in 38%, 35%, and 28% respectively. BAAI presented as free aortic rupture (32%), pseudoaneurysm (16%), and injuries without aortic external contour abnormality on computed tomography such as large intimal flaps (34%) or intimal tears (18%). Open and endovascular repairs were undertaken as first-choice therapy in 43% and 15% of cases, respectively. Choice of management varied by type of BAAI: 89% of intimal tears were managed nonoperatively, and 96% of aortic ruptures were treated with open repair. Overall mortality was 39%, the majority (68%) occurring in the first 24 hours because of hemorrhage or cardiac arrest. The highest mortality was associated with Zone II aortic ruptures (92%). Follow-up was documented in 38% of live discharges. This is the largest BAAI series reported to date. BAAI presents as a spectrum of injury ranging from minimal aortic injury to aortic rupture. Nonoperative management is successful in uncomplicated cases without external aortic contour abnormality on computed tomography. Highest mortality occurred in free aortic ruptures, suggesting that alternative measures of early noncompressible torso hemorrhage

  6. Associated injuries, management, and outcomes of blunt abdominal aortic injury.

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    de Mestral, Charles; Dueck, Andrew D; Gomez, David; Haas, Barbara; Nathens, Avery B

    2012-09-01

    Blunt abdominal aortic injury (BAAI) is very rare, and current literature is limited to case series of single-center experience. Through an analysis of the National Trauma Data Bank, the largest aggregation of United States trauma registry data, our aim was to characterize the associated injury pattern, contemporary management, and in-hospital outcomes of patients with BAAI. We used a nested case-control design. The overall cohort consisted of adult patients (age ≥ 16 years) severely injured (Injury Severity Score ≥ 16) after blunt trauma who were treated at a level 1 or 2 trauma center in years 2007 to 2009. Cases were patients with BAAI and were frequency-matched by age group and mechanism to randomly selected controls at a one-to-five ratio. Multivariable matched analysis (conditional logistic regression) was used to derive adjusted measures of association between BAAI and adjacent arterial, intra-abdominal, and bony injuries. We identified 436 patients with BAAI from 180 centers. The mean Injury Severity Score was 35 ± 14, and most patients were injured in motor vehicle crashes (84%). Multivariable analysis showed injury to the thoracic aorta, renal and iliac artery, small bowel, colon, liver, pancreas, and kidney, as well as lumbar spine fractures were independently associated with BAAI. A total of 394 patients (90%) were managed nonoperatively, and 42 (10%) underwent repair. Of these 42 patients, 29 (69%) underwent endovascular repair, with 11 patients undergoing open aortic repair and two extra-anatomic bypasses. Median time from admission to repair was 1 day (interquartile range, 1-2 days). Overall mortality was 29%. A total of 271 (69%) patients managed nonoperatively survived to hospital discharge. The index of suspicion for BAAI should be raised in severely injured patients by the presence of injuries to the lumbar spine, bowel, retroperitoneal organs, and adjacent major arteries. Although endovascular repair is the most common intervention, most

  7. Blunt Cardiac Injury in Trauma Patients with Thoracic Aortic Injury

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    Rathachai Kaewlai

    2011-01-01

    Full Text Available Trauma patients with thoracic aortic injury (TAI suffer blunt cardiac injury (BCI at variable frequencies. This investigation aimed to determine the frequency of BCI in trauma patients with TAI and compare with those without TAI. All trauma patients with TAI who had admission electrocardiography (ECG and serum creatine kinase-MB (CK-MB from January 1999 to May 2009 were included as a study group at a level I trauma center. BCI was diagnosed if there was a positive ECG with either an elevated CK-MB or abnormal echocardiography. There were 26 patients (19 men, mean age 45.1 years, mean ISS 34.4 in the study group; 20 had evidence of BCI. Of 52 patients in the control group (38 men, mean age 46.9 years, mean ISS 38.7, eighteen had evidence of BCI. There was a significantly higher rate of BCI in trauma patients with TAI versus those without TAI (77% versus 35%, P<0.001.

  8. Blunt traumatic aortic injuries of the ascending aorta and aortic arch: a clinical multicentre study.

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    Mosquera, Victor X; Marini, Milagros; Muñiz, Javier; Gulias, Daniel; Asorey-Veiga, Vanesa; Adrio-Nazar, Belen; Herrera, José M; Pradas-Montilla, Gonzalo; Cuenca, José J

    2013-09-01

    To report the clinical and radiological characteristics, management and outcomes of traumatic ascending aorta and aortic arch injuries. Historic cohort multicentre study including 17 major trauma patients with traumatic aortic injury from January 2000 to January 2011. The most common mechanism of blunt trauma was motor-vehicle crash (47%) followed by motorcycle crash (41%). Patients sustaining traumatic ascending aorta or aortic arch injuries presented a high proportion of myocardial contusion (41%); moderate or greater aortic valve regurgitation (12%); haemopericardium (35%); severe head injuries (65%) and spinal cord injury (23%). The 58.8% of the patients presented a high degree aortic injury (types III and IV). Expected in-hospital mortality was over 50% as defined by mean TRISS 59.7 (SD 38.6) and mean ISS 48.2 (SD 21.6) on admission. Observed in-hospital mortality was 53%. The cause of death was directly related to the ATAI in 45% of cases, head and abdominal injuries being the cause of death in the remaining 55% cases. Long-term survival was 46% at 1 year, 39% at 5 years, and 19% at 10 years. Traumatic aortic injuries of the ascending aorta/arch should be considered in any major thoracic trauma patient presenting cardiac tamponade, aortic valve regurgitation and/or myocardial contusion. These aortic injuries are also associated with a high incidence of neurological injuries, which can be just as lethal as the aortic injury, so treatment priorities should be modulated on an individual basis. Copyright © 2012 Elsevier Ltd. All rights reserved.

  9. Blunt traumatic aortic injury: initial experience with endovascular repair.

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    Azizzadeh, Ali; Keyhani, Kourosh; Miller, Charles C; Coogan, Sheila M; Safi, Hazim J; Estrera, Anthony L

    2009-06-01

    Endovascular treatment of traumatic aortic injury (TAI) is an alternative to open repair (OR) in patients with blunt trauma. We report our initial experience after integration of endovascular repair using thoracic devices. A retrospective review of a prospectively collected institutional trauma registry was performed. Between September 2005 and November 2008, 71 patients with TAI presented to our institution. Based on imaging, TAIs were classified into grade 1-4 in severity. These included: grade 1, intimal tear; grade 2, intramural hematoma; grade 3, aortic pseudoaneurysm; and grade 4, free rupture. Initial management included resuscitation, blood pressure control, and treatment of associated injuries. After stabilization, all patients were considered for thoracic endovascular aortic repair (TEVAR) using a thoracic device. If contraindicated, candidates underwent OR. Outcome measures were mortality, stroke, paraplegia, intensive care unit (ICU), and hospital stay. The mean age was 39.8 years, with 50 males. The mean injury severity score (ISS) was 42.6. Nineteen (27%) patients with a mean ISS of 60 died shortly after arrival prior to any vascular intervention. Ten (14%) patients with grade 1 injuries were managed medically. The remaining 42 (59%) patients with grade 2 and 3 injuries underwent repair. Median interval between admission and repair was 4.3 days (range, 0-109 days). Fifteen (21%) patients with a mean ISS of 34.4 underwent OR with no mortality, stroke, or paraplegia. Twenty-seven (38%) patients with a mean ISS of 36.7 underwent TEVAR with no mortality or paraplegia. One TEVAR patient suffered a perioperative stroke. Twenty-two patients had a TAG (W.L. Gore & Associates, Flagstaff, Ariz) device. Four patients had a Talent Thoracic (Medtronic Vascular, Santa Rosa, Calif), and 1 patient had an Excluder (W.L. Gore) device. The left subclavian artery was covered in 13 (48%) patients. Patients who underwent TEVAR were older than those who had OR (47.8 vs 31

  10. Concomitant aortic valve and internal mammary artery injuries in blunt chest trauma: report of a case.

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    Yeh, Chun-Chieh; Hsieh, Chi-Hsun; Wang, Yu-Chun; Chung, Ping-Kuei; Chen, Ray-Jade

    2009-01-01

    We report a case of concomitant injury to the aortic valve and internal mammary artery (IMA) from nonpenetrating chest trauma. To our knowledge, this is the first such case to be reported. Transcatheter arterial embolization (TAE) following diagnostic angiography offers an effective and minimally invasive treatment for traumatic IMA injuries. Because there might be an asymptomatic interval after traumatic aortic valve injuries, serial physical examinations and repeated echocardiography should be mandatory for patients with de novo heart failure after blunt chest trauma. Transesophageal echocardiography can provide a clearer image of cardiac injuries than transthoracic echocardiography, particularly if there is extensive anterior mediastinal hematoma resulting from IMA trauma.

  11. Results of a multicenter, prospective trial of thoracic endovascular aortic repair for blunt thoracic aortic injury (RESCUE trial).

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    Khoynezhad, Ali; Azizzadeh, Ali; Donayre, Carlos E; Matsumoto, Alan; Velazquez, Omaida; White, Rodney

    2013-04-01

    To evaluate the early outcomes of patients undergoing thoracic endovascular aortic repair for blunt thoracic aortic injuries. A prospective, nonrandomized, multicenter trial using the Medtronic Valiant Captivia stent graft was conducted at 20 sites in North America. Fifty patients with blunt thoracic aortic injuries were enrolled between April 2010 and January 2012 and will be followed for 5 years. The injuries were classified into categories (grades I-IV) based on severity: intimal tear, intramural hematoma, pseudoaneurysm, or rupture. The primary end point was 30-day all-cause mortality. Secondary end points were adverse events occurring within 30 days that were related to the procedure, device or aorta, and aortic-related mortality. Technical success was measured as successful device delivery and deployment. Seventy-six percent (38/50) of patients were male with mean age of 41 ± 17 years. Fifty-one Medtronic Valiant Captivia thoracic stent grafts and a single Talent thoracic stent graft were implanted within a median of 1.0 days following injury (mean, 1.8 ± 4.0 days). Seventy percent (35/50) of aortic injuries were grade III or higher, including one patient with free rupture. Mean injury severity score was 38 ± 14. Fifty-four percent of stent grafts were ≤26 mm (28/52). The left subclavian artery was completely covered in 40% of patients (20/50) and partially covered in 18% of patients (9/50). Four patients underwent subclavian artery revascularization: one at the time of the endograft procedure and three others after developing arm ischemia after the initial endograft procedure. Cerebral spinal fluid was drained in two patients. The median procedure time was 91 minutes, and median hospital stay was 12 days. There was 100% successful device delivery and deployment. Four (8%) patients died within 30 days. Nonfatal adverse events within 30 days that were related to the procedure, device, or aorta were experienced by 12% (6/50) of patients. No nonfatal

  12. Delayed management of Grade III blunt aortic injury: Series from a Level I trauma center.

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    Smeds, Matthew R; Wright, Mark P; Eidt, John F; Moursi, Mohammed M; Escobar, Guillermo A; Spencer, Horace J; Ali, Ahsan T

    2016-06-01

    Blunt aortic injuries (BAIs) are traditionally treated as surgical emergencies, with the majority of repairs performed in an urgent fashion within 24 hours, irrespective of the grade of aortic injury. These patients are often underresuscitated and often have multiple other trauma issues that need to be addressed. This study reviews a single center's experience comparing urgent (24 hours) TEVAR for Grade III BAI. All patients undergoing TEVAR for BAI at a single institution between March 2004 and March 2014 were reviewed (n = 43). Patients with Grade I, II, or IV aortic injuries as well as those who were repaired with an open procedure or who lacked preoperative imaging were excluded from the analysis. Demographics, intraoperative data, postoperative survival, and complications were compared. During this period, there were 43 patients with blunt thoracic aortic injury. There were 29 patients with Grade III or higher aortic injuries. Of these 29 patients, 1 declined surgery, 2 were repaired with an open procedure, 10 underwent urgent TEVAR, and 16 had initial observation. Of these 16, 13 underwent TEVAR in a delayed fashion (median, 9 days; range, 2-91 days), and 3 died of non-aortic-related pathology. Comparing the immediate repair group versus the delayed repair group, there were no significant demographic differences. Trauma classification scores were similar, although patients in the delayed group had a higher number of nonaortic injuries. The 30-day survival was similar between the two groups (9 of 10 vs. 12 of 16), with no mortalities caused by aortic pathology in either group. Watchful waiting may be permissible in patients with Grade III BAI with other associated multisystem trauma. This allows for a repair in a more controlled environment. Therapeutic study, level V.

  13. Injury grade is a predictor of aortic-related death among patients with blunt thoracic aortic injury.

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    Fortuna, Gerald R; Perlick, Alexa; DuBose, Joseph J; Leake, Samuel S; Charlton-Ouw, Kristofer M; Miller, Charles C; Estrera, Anthony L; Azizzadeh, Ali

    2016-05-01

    The current Society for Vascular Surgery Clinical Practice Guidelines suggest urgent (grade (G) II to G IV blunt thoracic aortic injuries (BTAIs). The purpose of this study was to determine whether some patients may require more emergency treatment. We reviewed imaging variables of prospectively collected BTAI patients between 1999 and 2014. We used computed tomographic angiography to classify BTAIs into four categories: G I, intimal tear; G II, intramural hematoma; G III, aortic pseudoaneurysm; and G IV, free rupture. Specific examination of G III injuries was undertaken in an effort to predict aortic-related mortality (ARM) before repair. For this subset, we examined pseudoaneurysm size, lesion/normal aortic diameter ratio, and mediastinal hematoma location and size. Among 331 patients with BTAIs, 86 died before imaging. Admission computed tomographic angiography was available for 205 patients (71.2% male; mean age, 39.3 years) with BTAIs (24 G I, 49 G II, 124 G III, 8 G IV). The mean Injury Severity Score was 35.6, and 22.4% had hypotension (grade is a predictor of ARM among patients with BTAIs. Aggressive use of the current Society for Vascular Surgery Clinical Practice Guidelines at a busy level I trauma center resulted in low rates of ARM. In this setting, identification of additional physiologic and radiographic criteria indicating the need for emergency (vs urgent) repair of aortic pseudoaneurysms remains elusive. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  14. Blunt thoracic aortic injury with small pseudoaneurysm may be managed by nonoperative treatment.

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    Tanizaki, Shinsuke; Maeda, Shigenobu; Matano, Hideyuki; Sera, Makoto; Nagai, Hideya; Nakanishi, Taizo; Ishida, Hiroshi

    2016-02-01

    The efficacy of nonoperative management of blunt thoracic aortic injury (BTAI) was evaluated in patients with pseudoaneurysm. A retrospective review was done for patients with BTAI at Fukui Prefectural Hospital during a 9-year period. Charts were reviewed for age, gender, Injury Severity Score, Abbreviated Injury Scale for each body area, initial type of aortic injury, site of aortic injury, type of definitive management, complications, and outcomes. Eighteen patients with BTAI were treated at Fukui Prefectural Hospital. Of 18 patients with pseudoaneurysm, seven patients were hemodynamically unstable and four patients died because of associated injuries; there were no aortic-related deaths. All 14 surviving patients were followed up for an average of 40.9 months. Only two patients with pseudoaneurysm required operative management because of the progression of the pseudoaneurysm. The pseudoaneurysm/normal aortic diameter ratio of those with any intervention was higher than that of those with nonoperative management. BTAI with pseudoaneurysm can be managed nonoperatively, with about 10% risk of progression to require surgical repair. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  15. Endovascular versus open repair for blunt thoracic aortic injury: short-term results.

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    Kokotsakis, John; Kaskarelis, Ioannis; Misthos, Panagiotis; Athanasiou, Thanos; Kanakakis, Konstantinos; Athanasiou, Chariklia; Romana, Constantina; Skouteli, Elian; Lioulias, Achilles

    2007-12-01

    Endovascular stent grafting has been increasingly used as an alternative treatment modality. The aim of this study is to evaluate the immediate and short-term results of endovascular stent grafting repair after blunt thoracic aortic injury due to trauma. A review of a tertiary trauma center registry identified all patients who suffered blunt thoracic aortic injury from 2002 to 2006. All patients underwent either open repair with synthetic graft interposition or endovascular stent grafting (EVS) of the descending thoracic aorta. Type and severity of injury, concomitant injuries, clinical factors, and outcome were compared between groups. Univariate and multivariate analysis was performed. Endovascular stent grafting was performed in 22 patients, and 10 patients underwent open surgical repair. In the open group, the 30-day mortality rate was 10%, the paraplegia rate was 10%, and incidence of major complications was 30%, which were comparable with the incidences observed in the EVS group of 4.5%, 4.5%, and 13.6%, respectively. No statistically significant differences were demonstrated. Multivariate regression analysis identified associated thoracic injury as the main independent predictor of hospital length of stay (p = 0.03, 95% confidence interval: 0.53 to 18.85). In the EVS group, 1 patient died in the short-term follow-up period and 2 cases of endovascular leak required additional treatment. Although postoperative mortality and morbidity between open and endovascular repair were comparable, EVS can be considered a safe alternative treatment modality in the therapeutic algorithm of blunt thoracic aortic injury particularly for the higher risk multitrauma patients.

  16. Open Treatment of Blunt Injuries of Supra-Aortic Branches: Case Series.

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    Sladojevic, Milos; Markovic, Miroslav; Ilic, Nikola; Pejkic, Sinisa; Banzic, Igor; Djoric, Predrag; Koncar, Igor; Tomic, Ivan; Davidovic, Lazar

    2016-02-01

    Blunt injuries of the supra-aortic branches are rare entity, and majority of patients die before arrival at the hospital. Those who arrive alive require complex and fast procedure that requires sternotomy. We report 3 successfully managed cases. We report 3 patients with injury of supra-aortic branches. One was treated urgently due to longitudinal rupture on the posterior wall of innominate artery after car accident, and another 2 had chronic false aneurysm located at the very orifice of the right subclavian and left common carotid artery. In first and second patient bypass grafting with a hand-made, Y-shaped, 8-mm Dacron graft from the ascending aorta to the right common carotid and proximal right subclavian artery were performed, whereas in last 1 bypass grafting from the ascending aorta to the cervical part of the left common carotid artery was performed. In our facility, there were no possibilities for any endovascular treatment. When endovascular technology is not available, open surgical repair of blunt injuries of supra-aortic vessels can be performed without complications. No matter to that, endovascular and hybrid procedures should be considered whenever possible. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Treatment of blunt thoracic aortic injury in Germany-Assessment of the TraumaRegister DGU®.

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    Gombert, Alexander; Barbati, Mohammad E; Storck, Martin; Kotelis, Drosos; Keschenau, Paula; Pape, Hans-Christoph; Andruszkow, Hagen; Lefering, Rolf; Hildebrand, Frank; Greiner, Andreas; Jacobs, Michael J; Grommes, Jochen

    2017-01-01

    Using the data delivered by the German Trauma Register DGU® from 2002 till 2013, the value of different therapies of blunt thoracic aortic injury (BTAI) in Germany was analyzed. Prospectively collected data of patients suffering from BTAI were retrospectively analyzed with focus on the different treatment modalities for grade I-IV injuries. 821 patients suffering from BTAI were identified: 51.6% (424) grade I injury, 35.4% (291) grade II or III injury and 12.9% (106) grade IV injury (77.5% men [44.94 ± 20.6 years]). The main patterns of injury were high- speed accidents and falls (78.0% [n = 640], 21.8% [n = 171] respectively). Significant differences between grade I and grade II/III as well as IV injuries could be assessed for the incidence of cardiopulmonary resuscitation, a Glasgow Coma Scale score below 8 and a systolic blood pressure below 90 mmHg (p-value: injuries and cardiac arrest. Endovascular therapy became the treatment of choice for BTAI in Germany. Patients who have been treated by surgical means showed the highest survival rate, especially endovascular therapy showed a favorable low mortality rate.

  18. Thoraco-lumbar fractures with blunt traumatic aortic injury in adult patients: correlations and management.

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    Santoro, Giorgio; Ramieri, Alessandro; Chiarella, Vito; Vigliotta, Massimo; Domenicucci, Maurizio

    2018-04-16

    Traumatic thoraco-lumbar spine fracture spine with a concomitant blunt aortic injury is uncommon but potentially a fatal association. Our aim was to clarify: morphology of spinal fractures related to vascular damages and vice versa, diagnostic procedures and decision-making process for the best treatment options for spine and vessels. We enrolled 42 cases culled from the literature and five personal ones, reviewing in detail by AO Spine Classification, Society of Vascular Surgery classification and Abbreviated Injury Scale for neurological evaluation. Most fractures were at T11-L2 (29 cases; 62%) and type C (17; 70%). 17 (38%) were neurological. Most common vascular damage was the rupture (20; 43%), followed by intimal tear (13; 28%) and pseudoaneurysm (9; 19%). Vascular injury often required open or endovascular repair before spinal fixation. Distraction developed aortic intimal damage until rupture, while flexion-distraction lumbar artery pseudoaneurysm and rotation-torsion full laceration of collateral branches. CT and angio-CT were investigations of choice, followed by angiography. Neurological condition remained unchanged in 28 cases (90%). Overall mortality was 30%, but it was higher in AIS A. Relationship between thoraco-lumbar fracture and vascular lesion is rare, but potentially fatal. Comprehension of spinal biomechanics and vascular damages could be crucial to avoid poor results or decrease mortality. Frequently, traction of the aorta and its vessels is realized by C-dislocated fractures. CT and angio-CT are recommended. Spine stabilization should always follow the vascular repair. Early severe deficits worse the prognosis related to neurological recovery and survival. These slides can be retrieved under Electronic Supplementary Material.

  19. Endovascular repair for blunt thoracic aortic injury: 11-year outcomes and postoperative surveillance experience.

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    Spiliotopoulos, Konstantinos; Kokotsakis, John; Argiriou, Michalis; Dedeilias, Panagiotis; Farsaris, Dimosthenis; Diamantis, Theodore; Charitos, Christos

    2014-12-01

    Surveillance for patients undergoing thoracic endovascular aortic repair (TEVAR) for blunt thoracic aortic injury (BTAI) varies. Annual chest computed tomographic angiography (CTA) is often recommended but concerns about the risks and costs have emerged. The aim of this study was to examine the optimal follow-up frequency based on 11-year outcomes and surveillance experience. Seventy-six patients with BTAI received TEVAR from May 2002 to July 2013. Demographics, cardiovascular risk factors, Injury Severity Score (ISS), types, sizes, timing, and outcomes of stent grafts were collected retrospectively. Mean age was 39.7 years (range, 17-85 years); 8 (11%) were women. Mean ISS was 46.2 ± 18.5 (deceased, 61.0 ± 19.2; surviving, 44.2 ± 17.6; P = .023). Technical success was achieved in 71 patients (93.4%). All-cause mortality was 7 (9.2%), 1 (1.3%) of which was related to the procedure. Six were lost to follow-up (8%). To examine the effect of surveillance frequency on outcomes, after excluding the 2 most recent (6 months after scheduled annual visit). No significant differences were found for survival, graft-related complications, need for reintervention, except for postoperative hypertension, which was higher in the first group. All surviving patients had excellent outcomes, with no cerebrovascular accidents, paraplegia, or paraparesis; the median follow-up for both groups was 3 years (interquartile range 2.0-3.5, 1.5-5.4 years). Midterm outcomes of TEVAR for patients with stable repair after BTAI are excellent, both with timely (1.0-1.5 years) and delayed (>1.5 years) follow-up intervals after a median surveillance period of 3 years. A larger prospective randomized study could lead to a more relaxed, but equally safe surveillance schedule for these patients, lowering risks and costs. Copyright © 2014 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  20. Evolution in management of adolescent blunt aortic injuries--a single institution 22-y experience.

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    Brinkman, Adam S; Rogers, Andrew P; Acher, Charles W; Wynn, Martha M; Nichol, Peter F; Ostlie, Daniel J; Gosain, Ankush

    2015-02-01

    In children, severe, life-threatening traumatic injuries of the thoracic aorta can be seen after motor vehicle collisions (MVCs) resulting in a sudden deceleration. Concurrent injuries in the thorax and abdomen can make treatment prioritization difficult and require early recognition and prompt intervention. With the increased utilization of minimally invasive endovascular approaches to traumatic aortic (TA) injuries, patients are often spared the increased surgical morbidity (spinal cord ischemia and renal insults) that can be seen with an open technique. The aim of this study was to evaluate a single American College of Surgeons level 1 pediatric trauma center's 22-y experience with TA injuries in children. After the Institutional Review Board approval, a 22-y (January 1990-April 2013) retrospective review of all pediatric trauma patients admitted with TA injuries was performed. Patient demographics including age, injury detail, treatment, and outcomes were recorded for analysis. 17 children (mild mental deficits as a result of head trauma. TA injuries are an uncommon injury in children and can result from MVCs or other sudden deceleration mechanisms. Surgical intervention is required in most of the cases and can be performed safely and effectively with low morbidity using an endovascular approach, which is the evolving approach of choice for thoracic aortic injuries. Lengthy follow-up care is recommended in children treated with an endovascular device to monitor for endoleaks and device complications. Copyright © 2015 Elsevier Inc. All rights reserved.

  1. Cardiac tamponade associated with delayed ascending aortic perforation after blunt chest trauma: a case report

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    Ryu, Dae Woong; Lee, Mi Kyung

    2017-01-01

    Background Cardiac tamponade due to aortic injury after blunt trauma is a rare and potentially fatal injury. Most aortic injuries caused by blunt trauma present as aortic dissection or rupture of the aortic isthmus. Several cases of delayed aortic injury have been reported. However, all of these injuries were observed in the descending aorta because they had been caused by a posterior rib fracture. Case presentation We report the first case of cardiac tamponade associated with delayed ascendi...

  2. Stent-graft repair for blunt traumatic aortic injury: functional and survival outcomes.

    Science.gov (United States)

    González Sánchez, S; Martín Conejero, A; Moñux Ducajú, G; Martínez López, I; Hernando Rydings, M; Serrano Hernando, F J

    2013-02-01

    Traumatic aortic injury is usually lethal, most often because of serious associated wounds. The short- and midterm outcome of endovascular exclusion was assessed as the current treatment of choice due to a lower mortality and morbidity than open surgical treatment. We reviewed the cases of 8 patients (5 male, mean age 33 years) undergoing endovascular repair of a traumatic thoracic aortic lesion, confirmed by computed tomographic angiography, at our centre. Most patients showed a contained lesion limited to the aortic isthmus and severe associated injuries. Intrahospital mortality was 37.5% (N.=3) and mostly due to posttraumatic brain injury (N.=2). Most patients were hemodynamically stable at the time of endovascular repair (N.=6). The median time to surgery was 12 hours (3-48 hours). The endografts used were TAG® (W.L. Gore and Associates, Flagstaff) in three patients, and Valiant® (Medtronic, Santa Rosa, CA) in four. The technical success rate was 100%. In one case, the left subclavian artery was occluded without signs of arm ischemia. There were no cases of paraplegia or stroke related to treatment. No revision procedures were needed during follow-up. Endovascular repair shortly after injury seems to be effective and safe with a low associated morbidity and mortality.

  3. Cardiac tamponade associated with delayed ascending aortic perforation after blunt chest trauma: a case report.

    Science.gov (United States)

    Ryu, Dae Woong; Lee, Mi Kyung

    2017-06-17

    Cardiac tamponade due to aortic injury after blunt trauma is a rare and potentially fatal injury. Most aortic injuries caused by blunt trauma present as aortic dissection or rupture of the aortic isthmus. Several cases of delayed aortic injury have been reported. However, all of these injuries were observed in the descending aorta because they had been caused by a posterior rib fracture. We report the first case of cardiac tamponade associated with delayed ascending aortic perforation 2 weeks after blunt trauma. The patient was an 81-year-old man. In cases of blunt chest trauma, delayed ascending aortic injury causing cardiac tamponade is possible associated with various causes such as direct injury by fractured rib or delayed aortic perforation of initial blunt injury.

  4. Traumatic Aortic Injury

    Directory of Open Access Journals (Sweden)

    Brianna Miner

    2016-09-01

    Full Text Available History of present illness: A 48-year-old male with unknown past medical history presents as a trauma after being hit by a car traveling approximately 25 miles per hour. On initial presentation, the patient is confused, combative, and not answering questions appropriately. The patient is hypotensive with a blood pressure of 68/40 and a heart rate of 50 beats per minute, with oxygen saturation at 96% on room air. FAST scan is positive for fluid in Morrison’s pouch, splenorenal space, and pericardial space. Significant findings: The initial chest x-ray showed an abnormal superior mediastinal contour (blue line, suggestive of a possible aortic injury. The CT angiogram showed extensive circumferential irregularity and outpouching of the distal aortic arch (red arrows compatible with aortic transection. In addition, there was a circumferential intramural hematoma, which extended through the descending aorta to the proximal infrarenal abdominal aorta (green arrow. There was also an extensive surrounding mediastinal hematoma extending around the descending aorta and supraaortic branches (purple arrows. Discussion: Traumatic aortic injury is a life-threatening event. The incidence of blunt thoracic aortic injury is low, between 1 to 2 percent of those patients with blunt thoracic trauma.1 However, approximately 80% of patients with traumatic aortic injury die at the scene.2 Therefore it is imperative to diagnose traumatic aortic injury in a timely fashion. The diagnosis can be difficult due to the non-specific signs and symptoms and other distracting injuries. Clinical suspicion should be based on the mechanism of the injury and the hemodynamic status of the patient. In any patient with blunt or penetrating trauma to the chest that is hemodynamically unstable, traumatic aortic injury should be on the differential. Chest x-ray can be used as a screening tool. A normal chest x-ray has a negative predictive value of approximately 97%. CTA chest is the

  5. Abdominal wall hernia and aortic injury secondary to blunt trauma: Case report and review of the literature

    Directory of Open Access Journals (Sweden)

    David H. Ballard

    2014-01-01

    CONCLUSION: The patient with blunt trauma to the abdomen is at risk for TAWH and TAAI, which are often associated with other injuries. Investigations should include thorough clinical exam through secondary survey and radiologic imaging in the hemodynamically normal patient.

  6. Blunt cardiac injury.

    Science.gov (United States)

    Bock, Jeremy S; Benitez, R Michael

    2012-11-01

    Blunt chest trauma represents a spectrum of injuries to the heart and aorta that vary markedly in character and severity. The setting, signs, and symptoms of chest trauma are often nonspecific, which represents a challenge to emergency providers. Individuals with suspected blunt chest trauma who have only mild or no symptoms, a normal electrocardiogram (ECG), and are hemodynamically stable typically have a benign course and rarely require further diagnostic testing or long periods of close observation. Individuals with pain, ECG abnormalities, or hemodynamic instability may require rapid evaluation of the heart by echocardiography and the great vessels by advanced imaging. Copyright © 2012 Elsevier Inc. All rights reserved.

  7. Understanding traumatic blunt cardiac injury.

    Science.gov (United States)

    El-Menyar, Ayman; Al Thani, Hassan; Zarour, Ahmad; Latifi, Rifat

    2012-01-01

    Cardiac injuries are classified as blunt and penetrating injuries. In both the injuries, the major issue is missing the diagnosis and high mortality. Blunt cardiac injuries (BCI) are much more common than penetrating injuries. Aiming at a better understanding of BCI, we searched the literature from January 1847 to January 2012 by using MEDLINE and EMBASE search engines. Using the key word "Blunt Cardiac Injury," we found 1814 articles; out of which 716 articles were relevant. Herein, we review the causes, diagnosis, and management of BCI. In conclusion, traumatic cardiac injury is a major challenge in critical trauma care, but the guidelines are lacking. A high index of suspicion, application of current diagnostic protocols, and prompt and appropriate management is mandatory.

  8. Understanding traumatic blunt cardiac injury

    Directory of Open Access Journals (Sweden)

    Ayman El-Menyar

    2012-01-01

    Full Text Available Cardiac injuries are classified as blunt and penetrating injuries. In both the injuries, the major issue is missing the diagnosis and high mortality. Blunt cardiac injuries (BCI are much more common than penetrating injuries. Aiming at a better understanding of BCI, we searched the literature from January 1847 to January 2012 by using MEDLINE and EMBASE search engines. Using the key word "Blunt Cardiac Injury," we found 1814 articles; out of which 716 articles were relevant. Herein, we review the causes, diagnosis, and management of BCI. In conclusion, traumatic cardiac injury is a major challenge in critical trauma care, but the guidelines are lacking. A high index of suspicion, application of current diagnostic protocols, and prompt and appropriate management is mandatory.

  9. Blunt traumatic aortic rupture of the proximal ascending aorta repaired by resection and direct anastomosis.

    Science.gov (United States)

    Harmouche, Majid; Slimani, Eric Karim; Heraudeau, Adeline; Verhoye, Jean-Philippe

    2013-10-01

    Traumatic aortic injury represents 15% of motor vehicle related deaths with death occurring at the scene in 85% of the cases. Aortic disruptions usually occur at the isthmus in a transverse fashion with all three of the aortic layers being involved. Herein, we report the case of a 68-year old man with no prior medical history who was struck by a vehicle while riding his bicycle. The ruptured segment of aorta was resected circumferentially and interrupted horizontal mattress pledgeted prolene sutures were used to ensure full thickness aortic integrity of the proximal and distal aortic segments. The aorta was closed with a single-layer technique using 4/0 prolene suture. There were no postoperative complications and patient was discharged on Day 44. The case here discussed demonstrates a rare presentation of blunt aortic injury. The proximal ascending aorta is an unusual site of transection following blunt trauma with few reports in the literature. We were able to repair the aorta with direct suture, thus avoiding the use of artificial material.

  10. Core curriculum case illustration: blunt traumatic thoracic aortic pseudo aneurysm.

    Science.gov (United States)

    Ramzan, Muhammad Mubashir; Fadl, Shaimaa Abdelhassib; Robinson, Jeffrey D

    2017-06-19

    Core Curriculum Illustration: [blunt thoracic aortic pseudo aneurysm]. This is the [40th] installment of a series that will highlight one case per publication issue from the bank of cases available online as part of the American Society of Emergency Radiology (ASER) educational resources. Our goal is to generate more interest in and use of our online materials. To view more cases online, please visit the ASER Core Curriculum and Recommendations for Study online at: http://www.aseronline.org/curriculum/toc.html.

  11. MR imaging for blunt pancreatic injury

    Energy Technology Data Exchange (ETDEWEB)

    Yang Lin [Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000 (China); Zhang Xiaoming, E-mail: cjr.zhxm@vip.163.co [Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000 (China); Xu Xiaoxue; Tang Wei; Xiao Bo; Zeng Nanlin [Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000 (China)

    2010-08-15

    Objective: To study the MR imaging features of blunt pancreatic injury. Materials and methods: Nine patients with pancreatic injury related to blunt abdominal trauma confirmed by surgery performed MR imaging. Two abdominal radiologists conducted a review of the MR images to assess pancreatic parenchymal and pancreatic duct injury, and associated complications. Result: Diagnostic quality MR images were obtained in each of the nine patients. In the nine patients, pancreatic fracture, laceration and contusion were depicted on MR imaging in five, one and three patients, respectively. There were six patients with pancreatic duct disruption, eight patients with peripancreatic fluid collections, and four patients with peripancreatic pseudocyst or hematoma, respectively. All of the MR imaging findings was corresponded to surgical findings. Conclusion: MR imaging is an effective method to detect blunt pancreatic injury and may provide information to guide management decisions.

  12. Endovascular Treatment of Blunt Traumatic Abdominal Aortic Occlusion With Kissing Stent Placement

    International Nuclear Information System (INIS)

    Idoguchi, Koji; Yamaguchi, Masato; Okada, Takuya; Nomura, Yoshikatsu; Sugimura, Kazuro; Okita, Yutaka; Sugimoto, Koji

    2012-01-01

    Blunt traumatic abdominal aortic dissection is extremely rare and potentially deadly. We present the case of a 62-year-old man involved in a frontal car crash. After emergency undergoing laparotomy for bowel injuries, he was referred to our hospital due to acute ischemia of bilateral lower extremities on day 3 after the trauma. Computed tomography and aortography showed an aortobiiliac dissection with complete occlusion. This injury was successfully treated by endovascular treatment with “kissing”-technique stent placement, which appears to be a safe, effective, and minimally invasive treatment.

  13. Endovascular Treatment of Blunt Traumatic Abdominal Aortic Occlusion With Kissing Stent Placement

    Energy Technology Data Exchange (ETDEWEB)

    Idoguchi, Koji, E-mail: idoguchi@ares.eonet.ne.jp; Yamaguchi, Masato; Okada, Takuya [Kobe University Hospital, Department of Radiology and Center for Endovascular Therapy (Japan); Nomura, Yoshikatsu [Kobe University Hospital, Department of Cardiovascular Surgery (Japan); Sugimura, Kazuro [Kobe University Hospital, Department of Radiology and Center for Endovascular Therapy (Japan); Okita, Yutaka [Kobe University Hospital, Department of Cardiovascular Surgery (Japan); Sugimoto, Koji [Kobe University Hospital, Department of Radiology and Center for Endovascular Therapy (Japan)

    2012-10-15

    Blunt traumatic abdominal aortic dissection is extremely rare and potentially deadly. We present the case of a 62-year-old man involved in a frontal car crash. After emergency undergoing laparotomy for bowel injuries, he was referred to our hospital due to acute ischemia of bilateral lower extremities on day 3 after the trauma. Computed tomography and aortography showed an aortobiiliac dissection with complete occlusion. This injury was successfully treated by endovascular treatment with 'kissing'-technique stent placement, which appears to be a safe, effective, and minimally invasive treatment.

  14. Atypical Presentation of Traumatic Aortic Injury

    Directory of Open Access Journals (Sweden)

    Andrew Fu Wah Ho

    2014-01-01

    Full Text Available Background. Blunt thoracic aorta injury (BAI is second only to head injury as cause of mortality in blunt trauma. While most patients do not survive till arrival at the hospital, for the remainder, prompt diagnosis and treatment greatly improve outcomes. We report an atypical presentation of BAI, highlighting the diagnostic challenges of this condition in the emergency department. Case Presentation. A previously well 25-year-old male presented 15 hours after injury hemodynamically stable with delirium. There were no signs or symptoms suggestive of BAI. Sonography showed small bilateral pleural effusions. Chest radiograph showed a normal mediastinum. Eventually, CT demonstrated a contained distal aortic arch disruption. The patient underwent percutaneous endovascular thoracic aortic repair and recovered well. Conclusion. This catastrophic lesion may present with few reliable signs and symptoms; hence, a high index of suspicion is crucial for early diagnosis and definitive surgical management. This paper discusses the diagnostic utility of clinical features, injury mechanism, and radiographic modalities. Consideration of mechanism of injury, clinical features, and chest radiograph findings should prompt advanced chest imaging.

  15. GASTROINTESTINAL INJURIES FROM BLUNT ABDOMINAL ...

    African Journals Online (AJOL)

    hi-tech

    2004-04-04

    %) patients had associated extraabdominal injuries. Treatment consisted of simple closure of perforations, over sewing of contusions, resection and anastomosis for gangrene and repair with protective stoma for the rectal injury.

  16. Isolated gallbladder rupture following blunt abdominal injury

    African Journals Online (AJOL)

    2015-05-26

    May 26, 2015 ... A retrospective review consisting of. 1449 patients reported the incidence around 0.067%.[3]. Here, we presented a case of isolated gallbladder rupture following a blunt abdominal injury. Case Report. A 39‑year‑old man with history of cholelithiasis, alcoholism‑related liver cirrhosis, and chronic pancreatitis.

  17. Spiral CT aortography: an efficient technique for the diagnosis of traumatic aortic injury

    International Nuclear Information System (INIS)

    Wicky, S.; Capasso, P.; Meuli, R.; Schnyder, P.; Fischer, A.; Segesser, L. von

    1998-01-01

    The objective of this study was to assess the efficiency of spiral CT (SCT) aortography for diagnosing acute aortic lesions in blunt thoracic trauma patients. Between October 1992 and June 1997, 487 SCT scans of the chest were performed on blunt thoracic trauma patients. To assess aortic injury, the following SCT criteria were considered: hemomediastinum, peri-aortic hematoma, irregular aspect of the aortic wall, aortic pseudodiverticulum, intimal flap and traumatic dissection. Aortic injury was diagnosed on 14 SCT examinations (2.9 %), five of the patients having had an additional digital aortography that confirmed the aortic trauma. Twelve subjects underwent surgical repair of the thoracic aorta, which in all but one case confirmed the aortic injury. Two patients died before surgery from severe brain lesions. The aortic blunt lesions were confirmed at autopsy. According to the follow-up of the other 473 patients, we are aware of no false-negative SCT examination. Our limited series shows a sensitivity of 100 % and specificity of 99.8 % of SCT aortography in the diagnosis of aortic injury. It is concluded that SCT aortagraphy is an accurate diagnostic method for the assessment of aortic injury in blunt thoracic trauma patients. (orig.)

  18. Blunt cerebrovascular injuries Traumatismo cerebrovascular contuse

    Directory of Open Access Journals (Sweden)

    C. Clay Cothren

    2005-12-01

    Full Text Available Over the past decade, the recognition and subsequent management of blunt cerebrovascular injuries has undergone a marked evolution. Originally thought to be a rare occurrence, blunt cerebrovascular injuries are now diagnosed in approximately 1% of blunt trauma patients. The recognition of a clinically silent period allows for angiographic screening for injuries based upon the mechanism of trauma and the patient's constellation of injuries. Comprehensive screening of patients has resulted in the early diagnosis of blunt cerebrovascular injuries during the asymptomatic phase, thus allowing treatment that could prevent neurologic sequelae. Although the ideal regimen of antithrombotic therapy is yet to be determined, treatment with either antiplatelet or anticoagulant agents has been shown to reduce the blunt cerebrovascular injuries related stroke rate. Blunt cerebrovascular injury is a rare but potentially devastating injury; appropriate angiographic screening in high-risk patients should be performed and prompt treatment initiated to prevent ischemic neurologic events.Durante a década passada, o reconhecimento e tratamento do traumatismo cerebrovascular contuso, sofreu importante evolução. Este tipo de ferimento era considerado como ocorrência rara, mas atualmente o quadro é diagnosticado em cerca de 1% dos pacientes. O reconhecimento da existência de um período clínico silencioso permite uma seleção angiográfica baseada no mecanismo de trauma e na sistematização dos ferimentos dos pacientes. A avaliação sistemática e a suspeita diagnóstica precoce destes pacientes tem resultado em rápido confirmação durante a fase assintomática, permitindo a instauração de tratamento cuja meta é impedir o desenvolvimento de seqüelas neurológicas. Embora o tratamento ideal, antitrombótico, ainda precise ser determinado, o uso de agentes antiplaquetários ou anticoagulantes reduz a incidência de lesões cerebrovasculares relacionada a

  19. A CLINICAL STUDY ON BLUNT INJURY ABDOMEN

    Directory of Open Access Journals (Sweden)

    G. Kishore Babu

    2016-10-01

    Full Text Available BACKGROUND Abdominal trauma continues to account for a large number of trauma-related injuries and deaths. Motor vehicle accidents and urban violence, respectively, are the leading causes of blunt and penetrating trauma to this area of the body. Unnecessary deaths and complications can be minimized by improved resuscitation, evaluation and treatment. The new techniques and diagnostic tools available are important in the management of abdominal trauma. These improved methods, however, still depend on experience and clinical judgment for application and determination of the best care for the injured patient. The aim of the study is to 1. Analyse the incidence, clinical characteristics, diagnosis, indications for laparotomy, therapeutic methods and morbidity & mortality rates. 2. To study nature of blunt abdominal trauma. 3. To assess patient for surgical intervention and to avoid negative laparotomy. 4. To assess morbidity rate in different organs injury. 5. To evaluate modalities of treatment, complications and prognosis. MATERIALS AND METHODS This study is a prospective study on 97 patients with Blunt injuries to the abdomen admitted in S.V.R.R.G.G. Hospital, Tirupati during October 2013-15. Inclusion Criteria Patients > 13 years, with Blunt injury to abdomen either by RTA, fall, object contact, assault giving written informed consent. Exclusion Criteria Patients <13 yrs. Blunt injuries due to blasts, patients with severe cardiothoracic and head injuries who are hemodynamically unstable. CONCLUSION Blunt Trauma to abdomen is on rise due to excessive use of motor vehicles. It poses a therapeutic and diagnostic dilemma for the attending surgeon due to wide range of clinical manifestations ranging from no early physical findings to progression to shock. So, the Trauma surgeon should rely on his physical findings in association with use of modalities like x-ray abdomen, USG abdomen and abdominal paracentesis. Hollow viscus perforations are

  20. Endovascular repair of blunt popliteal arterial injuries

    Energy Technology Data Exchange (ETDEWEB)

    Zhong, Shan; Zhang, Xiquan; Chen, Zhong; Zhu, Wei; Pan, Xiaolin [Dept. of nterventional Vascular, The 148th Hospital of Chinese People' s Liberation Army, Zibo (China); Dong, Peng; Sun, Yequan [Dept. of Medical Imaging, Weifang Medical University, Weifang (China); Qi, Deming [Dept. of Medical Imaging, Qilu Medical University, Zibo (China)

    2016-09-15

    To evaluate the feasibility and effectiveness of endovascular repair for blunt popliteal arterial injuries. A retrospective analysis of seven patients with clinical suspicion of popliteal arterial injuries that were confirmed by arteriography was performed from September 2009 to July 2014. Clinical data included demographics, mechanism of injury, type of injury, location of injury, concomitant injuries, time of endovascular procedures, time interval from trauma to blood flow restoration, instrument utilized, and follow-up. All patients were male (mean age of 35.9 ± 10.3 years). The type of lesion involved intimal injury (n = 1), partial transection (n = 2), complete transection (n = 2), arteriovenous fistula (n = 1), and pseudoaneurysm (n = 1). All patients underwent endovascular repair of blunt popliteal arterial injuries. Technical success rate was 100%. Intimal injury was treated with a bare-metal stent. Pseudoaneurysm and popliteal artery transections were treated with bare-metal stents. Arteriovenous fistula was treated with bare-metal stent and coils. No perioperative death and procedure-related complication occurred. The average follow-up was 20.9 ± 2.3 months (range 18–24 months). One patient underwent intra-arterial thrombolysis due to stent thrombosis at 18 months after the procedure. All limbs were salvaged. Stent migration, deformation, or fracture was not found during the follow-up. Endovascular repair seems to be a viable approach for patients with blunt popliteal arterial injuries, especially on an emergency basis. Endovascular repair may be effective in the short-term. Further studies are required to evaluate the long-term efficacy of endovascular repair.

  1. [Airway injuries due to blunt chest trauma].

    Science.gov (United States)

    Okabayashi, Kan; Hamatake, D; Yoshida, Y; Nakajima, H; Shirakusa, T; Yamasaki, S

    2006-10-01

    Although the incidence of blunt chest trauma is very high, the mediastinal tracheobronchial injuries are quite rare. The airway injuries are thought to be one of the most urgent clinical conditions in thoracic surgery, and we are requested to make not only a rapid and sharp diagnosis but also an appropriate treatment plan considering combined injuries. We present 9 cases of tracheobronchial injuries due to blunt chest trauma in recent years. The average age of these patients is 26.1 years, and they are consisted of 6 male and 3 female. The cause of trauma is traffic accident in 7, and occupational crane accident in 2. Bronchoplasty were done in 5 cases (right main bronchus in 2, left main bronchus in 1, trunks intermediate bronchus in 1, and the spur between middle and lower lobe in 1), membranous-tracheoplasty with right pneumonectomy in 1, left pneumonectomy in 1, conservative treatment in 2. Postoperative mortality is occurred in 1 case who was suffering from multiple injuries including severe head injury and contralateral lung contusion. Tracheobronchial plasties should be chosen if possible to preserve lung function for the patient suffering from airway injuries.

  2. Isolated chyle duct injury in blunt trauma.

    Science.gov (United States)

    Dissanaike, Sharmila; Griswold, John A; Halldorsson, Ari; Frezza, Eldo E

    2006-02-01

    We present a case of a patient sustaining an isolated injury to the right main branch of the cysterna chyli due to a high-speed motor vehicle accident. A 42-year-old man presented after a high-speed collision. CT revealed a collection of hypodense fluid in the gallbladder fossa, which was the clue to take him to the OR. We proceeded to laparoscopic exploration, and based on the milky white color of the fluid, identified a chyle leak. In an open fashion, the retroperitoneum was explored and the injury was identified as disruption of the right lumbar branch entering the cisterna chyli, and this was ligated with silk ties. Chyle duct injury secondary to blunt trauma is a rare finding. The use of CT imaging can identify this injury. Laparoscopy can confirm the injury. Open ligation of the injured duct is the best treatment.

  3. Tracheobronchial injuries in blunt chest trauma

    Directory of Open Access Journals (Sweden)

    vahid Montazeri

    2004-01-01

    Full Text Available Introduction: Tracheobronchial injuries are uncommon but potentially fatal complication of blunt thoracic trauma harboring a high morbidity and mortality if not diagnosed early . A recent series gleaning cases from four major Trauma Center in Los Angeles nine cases in a seven- year period , but the incidence of these injuries has been increasing recently. This has been attributed to improvement in hospital care and advanced Trauma Centers and earlier diagnosis of such injuries. Disruption of tight main bronchus is more common, such injuries are often associated with rib or clavicular fractures. Findings: Clinical and paraclinical data gathered from records of three patients referred with tracheobronchial injuries during the recent ten years have been reviewed .These include clinical manifestations, diagnostic findings, treatment modality and clinical course. The outcome has been satisfactory in all three patients who have undergone operation 2-5 hours after sustaining the injury. We have not had any mortality. Conclusion: These results are similar to those of other series emphasizing over early diagnosis and treatment of such injuries .

  4. Pancreatic injuries after blunt abdominal trauma: an analysis of 110 ...

    African Journals Online (AJOL)

    This study evaluated the management of blunt pancreatic injuries using a previously defined protocol to determine which factors predicted morbidity and mortality. Methods. The study design was a retrospective chart review of all adult patients with blunt pancreatic injuries treated at a level 1 trauma centre between March ...

  5. Determinants of splenectomy in splenic injuries following blunt ...

    African Journals Online (AJOL)

    Discussion. MVA injury and falls accounted for the vast majority of blunt abdominal trauma in this study. The rate and magnitude of energy transferred versus splenic protective mechanisms at the time of blunt abdominal trauma seems to determine the grade of splenic injury. Interest in splenic salvage surgery, availability of ...

  6. Advances in Imaging and Management Trends of Traumatic Aortic Injuries

    Energy Technology Data Exchange (ETDEWEB)

    Nagpal, Prashant, E-mail: drprashantnagpal@gmail.com, E-mail: Prashant-nagpal@uiowa.edu; Mullan, Brian F. [University of Iowa Hospitals and Clinics, Department of Radiology (United States); Sen, Indrani [Mayo Clinic, Department of Vascular and Endovascular Surgery (United States); Saboo, Sachin S. [UT Southwestern Medical Center, Department of Radiology (United States); Khandelwal, Ashish [Mayo Clinic, Department of Radiology (United States)

    2017-05-15

    Acute traumatic aortic injury (ATAI) is a life-threatening injury. CT is the imaging tool of choice, and the knowledge of direct and indirect signs of injury, grading system, and current management protocol helps the emergency radiologist to better identify and classify the injury and provide additional details that can impact management options. Newer dual-source CT technology with ultrafast acquisition speed has also influenced the appropriate protocol for imaging in patients with suspected ATAI. This review highlights the imaging protocol in patients with blunt trauma, CT appearance and grading systems of ATAI, management options, and the role of the multidisciplinary team in the management of these patients. We also briefly review the current literature on the definition, treatment, and follow-up protocol in patients with minimal aortic injury.

  7. Advances in Imaging and Management Trends of Traumatic Aortic Injuries

    International Nuclear Information System (INIS)

    Nagpal, Prashant; Mullan, Brian F.; Sen, Indrani; Saboo, Sachin S.; Khandelwal, Ashish

    2017-01-01

    Acute traumatic aortic injury (ATAI) is a life-threatening injury. CT is the imaging tool of choice, and the knowledge of direct and indirect signs of injury, grading system, and current management protocol helps the emergency radiologist to better identify and classify the injury and provide additional details that can impact management options. Newer dual-source CT technology with ultrafast acquisition speed has also influenced the appropriate protocol for imaging in patients with suspected ATAI. This review highlights the imaging protocol in patients with blunt trauma, CT appearance and grading systems of ATAI, management options, and the role of the multidisciplinary team in the management of these patients. We also briefly review the current literature on the definition, treatment, and follow-up protocol in patients with minimal aortic injury.

  8. [Penetrating cardiac injury in blunt trauma: a case report].

    Science.gov (United States)

    Dereli, Yüksel; Öncel, Murat

    2015-05-01

    Cardiac injuries may rarely be observed due to blunt thoracic traumas. Cardiac injury often creates a life-threatening condition requiring urgent surgical intervention, and follow-up of these patients should be carefully carried out in the perioperative period. These injuries depend on various factors including clinical presentation, type of injury, the time that passes until the patient reaches the hospital, bleeding, cardiac tamponade, or additional injuries. This article aimed to report a case who suffered penetrating cardiac injury in blunt thoracic trauma. Evaluated in the emergency department due to a motor vehicle accident, the 61-year-old male patient's chest x-ray revealed pulmonary contusion, rib fractures and cardiac tamponade. The patient was operated emergently. Right atrial injury was observed in the operation. The cardiac injury was repaired with primary suture technique. Cardiac injury in patients with blunt thoracic trauma is likely to be observed. In these patients, careful physical examination, early diagnosis, and treatment are very important.

  9. Identification of blunt abdominal injuries in children.

    Science.gov (United States)

    Hynick, Nina H; Brennan, Maureen; Schmit, Pierre; Noseworthy, Steve; Yanchar, Natalie L

    2014-01-01

    The use of computed tomography (CT) to screen for injuries in pediatric blunt abdominal trauma (BAT) is increasing, concurrent with increasing concern over long-term risk of radiation-associated malignancies. We proposed to determine features that could be identified in the early assessment of these patients, which can predict the likelihood of clinically important intra-abdominal injuries warranting imaging by CT. We further queried if these were discrepant from factors associated with the decision to obtain an abdominal CT. Data of patients admitted with BAT to one of two Level I pediatric trauma centers were reviewed retrospectively. Clinical, laboratory, radiographic, and epidemiologic data were collected. Logistic regression was used to determine associations between pre-CT findings and ultimate diagnoses of "notable" or "clinically important" intra-abdominal injuries. Similar analyses were performed to determine which findings were associated with actually receiving an abdominal CT scan. Of 571 patients, 37% had a notable intra-abdominal injury and 18% a clinically important intra-abdominal injury. After adjusting for all covariates, hematuria (gross or microscopic), elevated serum alanine aminotransferase, and documentation of clinically concerning abdominal findings upon examination remained significant predictors (odds ratio (OR), 3.5; 95% confidence interval [CI], 1.8-6.8; OR, 10.9; 95% CI, 2.5-47, respectively) of a clinically important injury. Undergoing a CT head and the presence of hematuria were significantly associated with obtaining a CT of the abdomen (OR, 3.4; 95% CI, 1.5-7.7; OR, 2.9; 95% CI, 1.1-7.3, respectively), while concerning abdominal findings and decreased Glasgow Coma Scale (GCS) score were not. Clinical variables may be used to predict intra-abdominal injuries after pediatric BAT that may warrant imaging with CT scanning. Combined with findings from similar studies, it may be possible to derive and validate a decision-making rule both

  10. [Observations on injuries by blunt objects].

    Science.gov (United States)

    Terazawa, Koichi

    2010-12-01

    Based on my personal experience publishing case reports on blunt injuries, I hereby focus on issues that have recently come to my attention. 1. Abrasions: 1) As to whether they occurred ante-mortem or post-mortem; those reddish in color cannot always have occurred antemortem. When they overlap with reddish (-purple) discoloration, as in hypostasis, post-mortem abrasions look reddish as well. Abrasions larger than the tip of the finger or the palm of the hand are often seen post-mortem and are thought to occur due to the touching of putrefied skin post-mortem. 2) There are cases where the direction in which the epidermis peeled-off is not apparent, when it peels off in many directions or where there is no residual epidermis. 3) The shape and size of an abrasion can indicate the structure of the offending blunt object. When there is an abrasion on the scalp 3 to 4 cm in diameter, with structures 5 mm in diameter at the margins of the abrasion, it can be inferred that the victim fell on a paved gravel road. 2. Bruises: 1) Inferring the nature of a blunt object: (1) Evidence of a fist blow: Co-existence of the following three features indicates a blow by the fist : 1. macular discoloration, 2. within an area of approximately 8 cm by 5 cm, 3. with an abrasion from the thumb nail. (2) Evidence of being grabbed:Try to grab the corpse with your own hand during autopsy to find how the person was grabbed. Bruise-like discoloration can be generated post-mortem on the upper arm, when a body is being drawn out of water, for example. 2) Tram-line bruises: These appear when a victim was struck by a stick. To estimate the diameter of the object, it is useful to measure two parts of the bruising : the width of the pale part between the bruises and the width between the outer margins of the bruises. 3. Intradermal bleeding: There tends to be a grouping of hemorrhagic spots, the interval between which 1 mm or less. It can be generated by both direct and indirect force. Abrasions may

  11. Determinants of splenectomy in splenic injuries following blunt abdominal trauma.

    Science.gov (United States)

    Akinkuolie, A A; Lawal, O O; Arowolo, O A; Agbakwuru, E A; Adesunkanmi, A R K

    2010-02-01

    The management of splenic injuries has shifted from splenectomy to splenic preservation owing to the risk of overwhelming post-splenectomy infection (OPSI). This study aimed to identify the factors that determine splenectomy in patients with isolated splenic injuries, with a view to increasing the rate of splenic preservation. Files of 55 patients managed for isolated splenic injuries from blunt abdominal trauma between 1998 and 2007 were retrospectively analysed using a pro forma. Management options were classified into nonoperative, operative salvage and splenectomy. The majority of patients suffered splenic injury as a result of motor vehicle accident (MVA) trauma or falls. Splenectomy was undertaken in 33 (60%) patients, 12 (22%) had non-operative management, and operative salvage was achieved in 10 (18%) patients. Significant determinants of splenectomy were grade of splenic injury, hierarchy of the surgeon, and hierarchy of the assistant. MVA injury and falls accounted for the vast majority of blunt abdominal trauma in this study. The rate and magnitude of energy transferred versus splenic protective mechanisms at the time of blunt abdominal trauma seems to determine the grade of splenic injury. Interest in splenic salvage surgery, availability of technology that enables splenic salvage surgery, and the experience of the surgeon and assistant appear to determine the surgical management. Legislation on vehicle safety and good parental control may reduce the severity of splenic injury in blunt abdominal trauma. When surgery is indicated, salvage surgery should be considered in intermediate isolated splenic injury to reduce the incidence of OPSI.

  12. Upper abdominal visceral injury resulting from blunt trauma

    African Journals Online (AJOL)

    Two patients who sustained severe blunt injury to the pelvis without external injury to the upper abdomen or lower chest, yet who were found to have a ruptured solid upper abdominal viscus, are reported. The first patient on delayed arrival revealed clinical features suggestive of intra-abdominal bleeding and was found to.

  13. Blunt injuries to the abdomen in Makurdi, Benue State: Nigeria ...

    African Journals Online (AJOL)

    Splenic rupture was the commonest intra abdominal injury and was managed by splenectomy in all cases. Delay in presentation and slow reaction time were observed. These worsened the haemodynamic instability and further accounted for the high mortality rate of 26.6%. Keywords: blunt injuries, road traffic accidents

  14. Gastrointestinal injuries following blunt abdominal trauma in children.

    Science.gov (United States)

    Chirdan, L B; Uba, A F; Chirdan, O O

    2008-09-01

    Gastrointestinal (GI) injuries in children following blunt abdominal trauma is rare; early diagnosis and treatment is important for good outcome. The purpose of this report is to describe the management problems encountered in children with GI injuries following blunt abdominal trauma. From January 1996 June 2006, 168 children were treated at our centre for abdominal trauma. Twenty three had GI injuries, 19 were due to blunt trauma while four were due to penetrating trauma. We retrospectively reviewed the clinical data of the 19 children that had GI injuries as a result of blunt abdominal trauma to document the presentation, clinical features, diagnosis and outcome. There were 19 patients, 14 were boys, and five were girls. The median age at presentation was nine years (range 1.5 15 years). Road traffic accident was responsible for injuries in 10, fall from heights in six and assault in two children. In one child the cause of injury was not recorded. Most children presented late and at presentation over 80% had abdominal signs. Diagnosis was mainly by physical examination supported by plain abdominal x-ray in 15 children. All 19 children had laparotomy. There were a total of 23 injuries. Gastric and duodenal injuries accounted for one each. Most of the injuries were in the jejunum and ileum (10 perforations, two contusions with one mesenteric haematoma and one mesenteric tear). There was one caecal perforation and six colonic injuries, one of which was associated with intraperitoneal rectal injury. Five children had other associated injuries (three splenic injuries, one renal injury, one bladder contusion associated with long bone fractures and one severe closed head injury). Treatment included segmental resection with end to end anastomosis, wedge resection with anastomosis, exteriorizations stomas, simple excision of the perforation and closure in two layers (gastric perforation). The total mortality was four (21.1%), two of them due to associated injuries

  15. CT scanning for diagnosing blunt ureteral and ureteropelvic junction injuries

    Directory of Open Access Journals (Sweden)

    Chu Peter

    2008-02-01

    Full Text Available Abstract Background Blunt ureteral and ureteropelvic (UPJ injuries are extremely rare and very difficult to diagnose. Many of these injuries are missed by the initial trauma evaluation. Methods Trauma registry data was used to identify all blunt trauma patients with ureteral or UPJ injuries, from 1 April 2001 to 30 November 2006. Demographics, injury information and outcomes were determined. Chart review was then performed to record initial clinical and all CT findings. Results Eight patients had ureteral or UPJ injuries. Subtle findings such as perinephric stranding and hematomas, and low density retroperitoneal fluid were evident on all initial scans, and prompted delayed excretory scans in 7/8 cases. As a result, ureteral and UPJ injuries were diagnosed immediately for these seven patients. These findings were initially missed in the eighth patient because significant associated visceral findings mandated emergency laparotomy. All ureteral and UPJ injuries have completely healed except for the case with the delay in diagnosis. Conclusion Most blunt ureteral and UPJ injuries can be identified if delayed excretory CT scans are performed based on initial CT findings of perinephric stranding and hematomas, or the finding of low density retroperitoneal fluid.

  16. Headache in traumatic brain injuries from blunt head trauma

    OpenAIRE

    Chelse, Ana B.; Epstein, Leon G.

    2015-01-01

    Investigators from New York Presbyterian Morgan Stanley Children’s Hospital examined whether having an isolated headache following minor blunt head trauma was suggestive of traumatic brain injury (TBI) among a large cohort of children 2-18 years of age.

  17. Successful Nonoperative Management of High-Grade Blunt Renal Injuries.

    Science.gov (United States)

    May, Allison M; Darwish, Oussama; Dang, Brian; Monda, John J; Adsul, Prajakta; Syed, Johar; Siddiqui, Sameer A

    2016-01-01

    Current management of high-grade blunt renal trauma favors a nonoperative approach when possible. We performed a retrospective study of high grade blunt renal injuries at our level I trauma center to determine the indications and success of nonoperative management (NOM). 47 patients with blunt grade IV or V injuries were identified between October 2004 and December 2013. Immediate operative patients (IO) were compared to nonoperatively managed (NOM). Of the 47 patients, 3 (6.4%) were IO and 44 (95.6%) NOM. IO patients had a higher heart rate on admission, 133 versus 100 in NOM ( P = 0.01). IO patients had a higher rate of injury to the renal vein or artery (100%) compared to NOM group (18%) ( P = 0.01). NOM failed in 3 of 44 patients (6.8%). Two required nonemergent nephrectomy and one required emergent exploration resulting in nephrectomy. Six NOM patients had kidney-related complications (13.6%). The renal salvage rate for the entire cohort was 87.2% and 93.2% for NOM. Nonoperative management for hemodynamically stable patients with high-grade blunt renal trauma is safe with a low risk of complications. Management decisions should consider hemodynamic status and visualization of active renal bleeding as well as injury grade in determining operative management.

  18. Gastrointestinal injuries from blunt abdominal trauma in children ...

    African Journals Online (AJOL)

    Design: A retrospective study. Setting: Ahmadu ... Results: In the l9 year period, 1984-2002, 92 children were treated for blunt abdominal trauma, 21(23%) of who had injuries to the gastrointestinal tract. ... One patient each developed prolonged ileus, urinary tract infection and chest infection, respectively postoperatively.

  19. Gastrointestinal Injuries Following Blunt Abdominal Trauma In ...

    African Journals Online (AJOL)

    Treatment included segmental resection with end to end anastomosis, wedge resection with anastomosis, exteriorizations stomas, simple excision of the perforation and closure in two layers (gastric perforation). The total mortality was four (21.1%), two of them due to associated injuries. Conclusion: Gastrointestinal injuries ...

  20. Blunt intraabdominal arterial injury in pediatric trauma patients: injury distribution and markers of outcome.

    Science.gov (United States)

    Hamner, Chad E; Groner, Jonathon I; Caniano, Donna A; Hayes, John R; Kenney, Brian D

    2008-05-01

    The epidemiology of pediatric blunt intraabdominal arterial injury is ill defined. We analyzed a multiinstitutional trauma database to better define injury patterns and predictors of outcome. The American College of Surgeons National Trauma Database was evaluated for all patients younger than 16 years with blunt intraabdominal arterial injury from 2000 to 2004. Injury distribution, operative treatment, and variables associated with mortality were considered. One hundred twelve intraabdominal arterial injuries were identified in 103 pediatric blunt trauma patients. Single arterial injury (92.2%) occurred most frequently: renal (36.9%), mesenteric (24.3%), and iliac (23.3%). Associated injuries were present in 96.1% of patients (abdominal visceral, 75.7%; major extraabdominal skeletal/visceral, 77.7%). Arterial control was obtained operatively (n = 46, 44.7%) or by endovascular means (n = 6, 5.8%) in 52 patients. Overall mortality was 15.5%. Increased mortality was associated with multiple arterial injuries (P = .049), intraabdominal venous injury (P = .011), head injury (P = .05), Glasgow Coma Score less than 8 (P cardiac arrest (P Trauma Score [P Injury Severity Score [P = .001], and TRISS [P = .002]). Blunt intraabdominal arterial injury in children usually affects a single vessel. Associated injuries appear to be nearly universal. The high mortality rate is influenced by serious associated injuries and is reflected by overall injury severity scores.

  1. Massive hemothorax after blunt transverse cervical artery injury.

    Science.gov (United States)

    Tanizaki, Shinsuke; Hayashi, Hiroyuki

    2012-12-01

    Blunt injuries to the thyrocervical trunk or its branches are rare because these vessels are well protected and located deep in the neck. To the best of our knowledge, we describe the first case of a massive hemothorax after blunt injury to the transverse cervical artery. A 42-year-old man was brought to our Emergency Department after he fell from a height of 10 meters. On work-up, a massive left hemothorax with extravasation from the left transverse cervical artery and pelvic fractures were detected. Endovascular embolization was successfully performed. There was no evidence of direct injury to the neck, lung laceration, or significant vascular injury that might have caused the massive hemothorax. A shearing mechanism associated with sudden deceleration caused by the 10-meter fall might have caused the transverse cervical artery injury in our patient. Consideration of injury to the thyrocervical trunk or its branches by the emergency physician will result in more frequent consideration and more timely diagnosis when there is no chest injury and massive hemothorax. Crown Copyright © 2012. Published by Elsevier Inc. All rights reserved.

  2. Penetrating cardiac injuries in blunt chest wall trauma.

    Science.gov (United States)

    Kanchan, Tanuj; Menezes, Ritesh G; Sirohi, Parmendra

    2012-08-01

    The present photocase illustrates the possible mechanism of direct cardiac injuries from broken sharp jagged fractured ends of ribs in blunt force trauma to the chest in run over traffic mishaps. We propose that the projecting fractured ends of the ribs penetrate the underlying thoracic organs due to the transient phenomenon of deformation of chest cavity under pressure in run over traffic mishaps. Copyright © 2012 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

  3. Cardiac injuries caused by blunt trauma: an autopsy based assessment of the injury pattern.

    Science.gov (United States)

    Turan, Arzu Akcay; Karayel, Ferah Anik; Akyildiz, Elif; Pakis, Isil; Uzun, Ibrahim; Gurpinar, Kagan; Atilmis, Umit; Kir, Ziya

    2010-01-01

    Nonpenetrating chest trauma with injury to the heart and aorta has become increasingly common, particularly as a result of rapid deceleration in high-speed vehicular accidents, over the past 2-3 decades. The high mortality rate of cardiac injuries and possible late onset complications make blunt cardiac injuries an important challenging point for legal medicine. One hundred and ninety cases with blunt cardiac injuries in a period of 3 years were analyzed retrospectively in terms of patterns of cardiac injury, survival times, and demographic profiles of the cases in this study.

  4. Aortic Wall Injury Related to Endovascular Therapy for Aortic Coarctation.

    Science.gov (United States)

    Tretter, Justin T; Jones, Thomas K; McElhinney, Doff B

    2015-09-01

    Aortic wall complications can occur in unrepaired aortic coarctation (CoA) and after surgical repair or endovascular treatment. This review summarizes the available literature and current understanding of aortic wall injury (AWI) surrounding the management of CoA, focusing specifically on acute and follow-up AWI after endovascular treatment. There have been 23 reported cases of aortic rupture after endovascular treatment for CoA, including angioplasty alone, bare metal stenting, and primary covered stent therapy. Even if these published cases represent only a minority of ruptures that have actually occurred, the incidence is substantially treatment of CoA seems to be declining in frequency with increasing experience and improving technology, it remains one of the most important potential adverse outcomes. Long-term surveillance for new AWI and monitoring of existing AWI is mandatory, with institution of appropriate treatment when necessary. A central research focus in this population should be determination of the appropriate treatment for both native and recurrent CoA across various ages with regard to limiting recurrent CoA and preventing associated aortic wall complications, in addition to determining the appropriate treatment of various AWI. Consistent definitions and reporting are necessary to truly understand the incidence of, risk factors for, and measures protective against AWI after angioplasty or stent implantation for CoA. © 2015 American Heart Association, Inc.

  5. Blunt Traumatic Extracranial Cerebrovascular Injury and Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    Paul M. Foreman

    2017-04-01

    Full Text Available Background: Ischemic stroke occurs in a significant subset of patients with blunt traumatic cerebrovascular injury (TCVI. The patients are victims of motor vehicle crashes, assaults or other high-energy collisions, and suffer ischemic stroke due to injury to the extracranial carotid or vertebral arteries. Summary: An increasing number of patients with TCVI are being identified, largely because of the expanding use of computed tomography angiography for screening patients with blunt trauma. Patients with TCVI are particularly challenging to manage because they often suffer polytrauma, that is, numerous additional injuries including orthopedic, chest, abdominal, and head injuries. Presently, there is no consensus about optimal management. Key Messages: Most literature about TCVI and stroke has been published in trauma, general surgery, and neurosurgery journals; because of this, and because these patients are managed primarily by trauma surgeons, patients with stroke due to TCVI have been essentially hidden from view of neurologists. This review is intended to bring this clinical entity to the attention of clinicians and investigators with specific expertise in neurology and stroke.

  6. Blunt Cardiac Injury in the Severely Injured - A Retrospective Multicentre Study.

    Science.gov (United States)

    Hanschen, Marc; Kanz, Karl-Georg; Kirchhoff, Chlodwig; Khalil, Philipe N; Wierer, Matthias; van Griensven, Martijn; Laugwitz, Karl-Ludwig; Biberthaler, Peter; Lefering, Rolf; Huber-Wagner, Stefan

    2015-01-01

    Blunt cardiac injury is a rare trauma entity. Here, we sought to evaluate the relevance and prognostic significance of blunt cardiac injury in severely injured patients. In a retrospective multicentre study, using data collected from 47,580 patients enrolled to TraumaRegister DGU (1993-2009), characteristics of trauma, prehospital / hospital trauma management, and outcome analysis were correlated to the severity of blunt cardiac injury. The severity of cardiac injury was assessed according to the abbreviated injury score (AIS score 1-6), the revised injury severity score (RISC) allowed comparison of expected outcome with injury severity-dependent outcome. N = 1.090 had blunt cardiac trauma (AIS 1-6) (2.3% of patients). Predictors of blunt cardiac injury could be identified. Sternal fractures indicate a high risk of the presence of blunt cardiac injury (AIS 0 [control]: 3.0%; AIS 1: 19.3%; AIS 2-6: 19.1%). The overall mortality rate was 13.9%, minor cardiac injury (AIS 1) and severe cardiac injury (AIS 2-6) are associated with higher rates. Severe blunt cardiac injury (AIS 4 and AIS 5-6) is associated with a higher mortality (OR 2.79 and 4.89, respectively) as compared to the predicted average mortality (OR 2.49) of the study collective. Multiple injured patients with blunt cardiac trauma are at high risk to be underestimated. Careful evaluation of trauma patients is able to predict the presence of blunt cardiac injury. The severity of blunt cardiac injury needs to be stratified according to the AIS score, as the patients' outcome is dependent on the severity of cardiac injury.

  7. Blunt Cardiac Injury in the Severely Injured – A Retrospective Multicentre Study

    Science.gov (United States)

    Hanschen, Marc; Kanz, Karl-Georg; Kirchhoff, Chlodwig; Khalil, Philipe N.; Wierer, Matthias; van Griensven, Martijn; Laugwitz, Karl-Ludwig; Biberthaler, Peter; Lefering, Rolf; Huber-Wagner, Stefan

    2015-01-01

    Background Blunt cardiac injury is a rare trauma entity. Here, we sought to evaluate the relevance and prognostic significance of blunt cardiac injury in severely injured patients. Methods In a retrospective multicentre study, using data collected from 47,580 patients enrolled to TraumaRegister DGU (1993-2009), characteristics of trauma, prehospital / hospital trauma management, and outcome analysis were correlated to the severity of blunt cardiac injury. The severity of cardiac injury was assessed according to the abbreviated injury score (AIS score 1-6), the revised injury severity score (RISC) allowed comparison of expected outcome with injury severity-dependent outcome. N = 1.090 had blunt cardiac trauma (AIS 1-6) (2.3% of patients). Results Predictors of blunt cardiac injury could be identified. Sternal fractures indicate a high risk of the presence of blunt cardiac injury (AIS 0 [control]: 3.0%; AIS 1: 19.3%; AIS 2-6: 19.1%). The overall mortality rate was 13.9%, minor cardiac injury (AIS 1) and severe cardiac injury (AIS 2-6) are associated with higher rates. Severe blunt cardiac injury (AIS 4 and AIS 5-6) is associated with a higher mortality (OR 2.79 and 4.89, respectively) as compared to the predicted average mortality (OR 2.49) of the study collective. Conclusion Multiple injured patients with blunt cardiac trauma are at high risk to be underestimated. Careful evaluation of trauma patients is able to predict the presence of blunt cardiac injury. The severity of blunt cardiac injury needs to be stratified according to the AIS score, as the patients’ outcome is dependent on the severity of cardiac injury. PMID:26136126

  8. Blunt Cardiac Injury in the Severely Injured - A Retrospective Multicentre Study.

    Directory of Open Access Journals (Sweden)

    Marc Hanschen

    Full Text Available Blunt cardiac injury is a rare trauma entity. Here, we sought to evaluate the relevance and prognostic significance of blunt cardiac injury in severely injured patients.In a retrospective multicentre study, using data collected from 47,580 patients enrolled to TraumaRegister DGU (1993-2009, characteristics of trauma, prehospital / hospital trauma management, and outcome analysis were correlated to the severity of blunt cardiac injury. The severity of cardiac injury was assessed according to the abbreviated injury score (AIS score 1-6, the revised injury severity score (RISC allowed comparison of expected outcome with injury severity-dependent outcome. N = 1.090 had blunt cardiac trauma (AIS 1-6 (2.3% of patients.Predictors of blunt cardiac injury could be identified. Sternal fractures indicate a high risk of the presence of blunt cardiac injury (AIS 0 [control]: 3.0%; AIS 1: 19.3%; AIS 2-6: 19.1%. The overall mortality rate was 13.9%, minor cardiac injury (AIS 1 and severe cardiac injury (AIS 2-6 are associated with higher rates. Severe blunt cardiac injury (AIS 4 and AIS 5-6 is associated with a higher mortality (OR 2.79 and 4.89, respectively as compared to the predicted average mortality (OR 2.49 of the study collective.Multiple injured patients with blunt cardiac trauma are at high risk to be underestimated. Careful evaluation of trauma patients is able to predict the presence of blunt cardiac injury. The severity of blunt cardiac injury needs to be stratified according to the AIS score, as the patients' outcome is dependent on the severity of cardiac injury.

  9. Long-Term Survival on Medical Therapy Alone after Blunt-Trauma Aortic Regurgitation: Report of a New Case with Summary of 95 Others.

    Science.gov (United States)

    Tsugu, Toshimitsu; Murata, Mitsushige; Mahara, Keitaro; Iwanaga, Shiro; Fukuda, Keiichi

    2016-10-01

    Aortic regurgitation resulting from blunt chest trauma has been reported only 95 times, to our knowledge. The noncoronary and right coronary cusps are the cardiac structures most often injured. Although the aortic leaflets can appear to be undamaged after nonpenetrating trauma, they can have pathologic abnormalities and insufficient function. Some cases of posttraumatic aortic regurgitation progress slowly. Aortic valve replacement is the optimal treatment. We present the case of a then-62-year-old man who has lived more than 5 years after blunt-trauma aortic regurgitation. His is the only case of long-term survival on medical therapy alone among the 96 cases summarized in this report.

  10. Traumatic eye injuries as a result of blunt impact

    Science.gov (United States)

    Clemente, Chiara; Esposito, Luca; Bonora, Nicola; Limido, Jerome; Lacome, Jean-Luc; Rossi, Tommaso

    2013-06-01

    The detachment or tearing of the retina in the human eye as a result of a collision is a phenomenon that occurs very often. This research is aimed at identifying and understanding the actual dynamic physical mechanisms responsible for traumatic eye injuries accompanying blunt impact, with particular attention to the damage processes that take place at the retina. To this purpose, a numerical and experimental investigation of the dynamic response of the eye during an impact event was performed. Numerical simulation of both tests was performed with IMPETUS-FEA, a general non-linear finite element software which offers NURBS finite element technology for the simulation of large deformation and fracture in materials. Computational results were compared with the experimental results on fresh enucleated porcine eyes impacted with airsoft pellets. The eyes were placed in a container filled with 10 percent ballistic gelatin simulating the fatty tissue surrounding the eye. A miniature pressure transducer was inserted into the eye bulb through the optic nerve in order to measure the pressure of the eye during blunt-projectile impacts. Each test was recorded using a high speed video camera. The ocular injuries observed in the impacted eyes were assessed by an ophthalmologist in order to evaluate the correlation between the pressure measures and the risk of retinal damage.

  11. Endovascular stent graft treatment of acute thoracic aortic transections due to blunt force trauma.

    LENUS (Irish Health Repository)

    Bjurlin, Marc A

    2012-02-01

    Endovascular stent graft treatment of acute thoracic aortic transections is an encouraging minimally invasive alternative to open surgical repair. Between 2006 and 2008, 16 patients with acute thoracic aortic transections underwent evaluation at our institution. Seven patients who were treated with an endovascular stent graft were reviewed. The mean Glasgow Coma Score was 13.0, probability of survival was .89, and median injury severity score was 32. The mean number of intensive care unit days was 7.7, mean number of ventilator support days was 5.4, and hospital length of stay was 10 days. Mean blood loss was 285 mL, and operative time was 143 minutes. Overall mortality was 14%. Procedure complications were a bleeding arteriotomy site and an endoleak. Endovascular treatment of traumatic thoracic aortic transections appears to demonstrate superior results with respect to mortality, blood loss, operative time, paraplegia, and procedure-related complications when compared with open surgical repair literature.

  12. Traumatic diaphragmatic rupture with combined thoracoabdominal injuries: Difference between penetrating and blunt injuries

    Directory of Open Access Journals (Sweden)

    Gao Jinmou

    2015-07-01

    Full Text Available Purpose: Traumatic diaphragmatic rupture (TDR needs early diagnosis and operation. However, the early diagnosis is usually difficult, especially in the patients without diaphragmatic hernia. The objective of this study was to explore the early diagnosis and treatment of TDR. Methods: Data of 256 patients with TDR treated in our department between 1994 and 2013 were analyzed retrospectively regarding to the diagnostic methods, percentage of preoperative judgment, incidence of diaphragmatic hernia, surgical procedures and outcome, etc. Two groups were set up according to the mechanism of injury (blunt or penetrating. Results: Of 256 patients with a mean age of 32.4 years (9e84, 218 were male. The average ISS was 26.9 (13e66; and shock rate was 62.9%. There were 104 blunt injuries and 152 penetrating injuries. Preoperatively diagnostic rate was 90.4% in blunt injuries and 80.3% in penetrating, respectively, P < 0.05. The incidence of diaphragmatic hernia was 94.2% in blunt and 15.1% in penetrating respectively, P < 0.005. Thoracotomy was performed in 62 cases, laparotomy in 153, thoracotomy plus laparotomy in 29, and combined thoraco-laparotomy in 12. Overall mortality rate was 12.5% with the average ISS of 41.8; and it was 21.2% in blunt injuries and 6.6% in penetrating, respectively, P < 0.005. The main causes of death were hemorrhage and sepsis. Conclusions: Diagnosis of blunt TDR can be easily obtained by radiograph or helical CT scan signs of diaphragmatic hernia. For penetrating TDR without hernia, “offside sign” is helpful as initial assessment. CT scan with coronal/sagittal reconstruction is an accurate technique for diagnosis. All TDR require operation. Penetrating injury has a relatively better prognosis.

  13. Blunt cardiac injuries in children: a postmortem study.

    Science.gov (United States)

    Scorpio, R J; Wesson, D E; Smith, C R; Hu, X; Spence, L J

    1996-08-01

    We reviewed the records of the Chief Coroner for all pediatric (< 16 years of age) trauma fatalities in Ontario (pediatric population of 2 million) for the period January 1, 1988 through December 31, 1990. Forty-one (14.5%) of 282 patients for which complete autopsy data were available had sustained cardiac injuries. Nineteen patients (46%) died at the scene of the accident, 15 patients (37%) died in an emergency department, and seven patients (17%) died during hospitalization. Rupture of a cardiac chamber occurred in 16 cases; it was the main cause of death in eight cases and a contributing factor in the remainder. Cardiac contusion without chamber rupture was present in 25 cases, but in none of the cases was it the cause of death. Brain injury was the cause of death in 16 (64%) of the cases of cardiac contusion. Cardiac injuries are more common among children who die from blunt trauma than previous reports have suggested. However, because these injuries are often rapidly fatal, many patients die before they reach a hospital. With improvements in emergency medical services and the resulting reduction in transit time, more patients may reach trauma centers alive. A high index of suspicion and rapid diagnosis and treatment of these injuries can save the lives of some of these patients.

  14. Headache in traumatic brain injuries from blunt head trauma.

    Science.gov (United States)

    Dayan, Peter S; Holmes, James F; Hoyle, John; Atabaki, Shireen; Tunik, Michael G; Lichenstein, Richard; Miskin, Michelle; Kuppermann, Nathan

    2015-03-01

    To determine the risk of traumatic brain injuries (TBIs) in children with headaches after minor blunt head trauma, particularly when the headaches occur without other findings suggestive of TBIs (ie, isolated headaches). This was a secondary analysis of a prospective observational study of children 2 to 18 years with minor blunt head trauma (ie, Glasgow Coma Scale scores of 14-15). Clinicians assessed the history and characteristics of headaches at the time of initial evaluation, and documented findings onto case report forms. Our outcome measures were (1) clinically important TBI (ciTBI) and (2) TBI visible on computed tomography (CT). Of 27 495 eligible patients, 12 675 (46.1%) had headaches. Of the 12 567 patients who had complete data, 2462 (19.6%) had isolated headaches. ciTBIs occurred in 0 of 2462 patients (0%; 95% confidence interval [CI]: 0%-0.1%) in the isolated headache group versus 162 of 10 105 patients (1.6%; 95% CI: 1.4%-1.9%) in the nonisolated headache group (risk difference, 1.6%; 95% CI: 1.3%-1.9%). TBIs on CT occurred in 3 of 456 patients (0.7%; 95% CI: 0.1%-1.9%) in the isolated headache group versus 271 of 6089 patients (4.5%; 95% CI: 3.9%-5.0%) in the nonisolated headache group (risk difference, 3.8%; 95% CI: 2.3%-4.5%). We found no significant independent associations between the risk of ciTBI or TBI on CT with either headache severity or location. ciTBIs are rare and TBIs on CT are very uncommon in children with minor blunt head trauma when headaches are their only sign or symptom. Copyright © 2015 by the American Academy of Pediatrics.

  15. Perioperative management of tracheobronchial injury following blunt trauma

    Directory of Open Access Journals (Sweden)

    Nilesh M Juvekar

    2013-01-01

    Full Text Available We describe tracheobronchial injury (TBI in a 17-year-old teenager following blunt trauma resulting from a road traffic accident. The patient presented to a peripheral hospital with swelling over the neck and face associated with bilateral pneumothorax for which bilateral intercostal drains were inserted and the patient was transferred to our institute. Fiber-optic videobronchoscopy (FOB was performed, the trachea and bronchi were visualized, and the site and extent of injury was assessed. Spontaneous respiration was maintained till assessment of the airway. Then the patient was anesthetized with propofol and paralyzed using succinylcholine and a double-lumen endobronchial tube was inserted; thereafter, the adequacy of controlled manual ventilation and air-leak through intercostal drains was assessed and the patient was transferred to operating room (OR for repair of the airway injury. The OR was kept ready during FOB to manage any catastrophe. This case describes the need for proper preparation and communication between health care team members to manage all possible scenarios of traumatic TBI.

  16. Non-invasive Respiratory Support in Blunt Chest Injury

    Directory of Open Access Journals (Sweden)

    T. V. Lobus

    2006-01-01

    Full Text Available Objective. To optimize the results of treatment in patients with acute respiratory failure (ARF due to lung contusion, by using the methods of non-invasive mask respiratory support. Materials and methods. The study covered 31 patients with severe blunt chest injury, multiple costal fractures, and hypoxemic ARF. The patients underwent assisted ventilation (AV in the CPAP+PSV mode through a facial or nasal mask. Physiological parameters were recorded during non-invasive mask ventilation (NIMV in the stepwise fashion. A control group comprised 25 patients with the similar severity of injury and ARF who were given conventional AV.Results. In 67.7% of the study group patients, NIMV was effective in improving oxygenation and external respiration, without exerting negative hemodynamic effects. Endotracheal intubation and AV could be avoided in these patients. Comparison of the study and control groups revealed a significant reduction in the incidence of secondary pneumonias in the NIMV group and in the duration of treatment. Mask ventilation could decrease mortality from 44% in the control group to 9.7% in the NIMV group.Conclusion. NIMV applied to patients with hypoxemic ARF in the presence of lung contusion improves pulmonary function and, in the bulk of patients, allows endotracheal intubation and AV and consequently their associated complications. When mask ventilation is employed, management of patients becomes shorter and simpler and mortality rates substantially decrease. 

  17. Optic nerve injury-associated blunt cerebrovascular injury: Three case reports.

    Science.gov (United States)

    Li, Dan-Dong; Hu, Liu-Xun; Sima, Linyuan; Xu, Shang-Yu; Lin, Jian; Zhang, Nu; Yin, Bo

    2017-11-01

    Blunt cerebrovascular injury (BCVI) is a rare complication that may occur after craniocervical trauma. The current literature is limited to extracranial carotid artery injuries; however, no reports have been published on blunt intracranial carotid injury (BICI), especially those associated with optic nerve injury. Here we report on 3 BICI cases that demonstrated optic nerve injuries after craniofacial injuries. All 3 patients showed post-trauma vision loss on the injured side. Optical canal fractures can be found in these patients, and carotid sulcus was compressed by the fragments. Computed tomography angiography (CTA) and digital subtraction angiography (DSA) were performed in all 3 patients. Case 1 was given no further treatment, except for symptomatic support and rehabilitation therapy. Case 2 was treated with antiplatelet therapy for 3 days, and then a stent was inserted in the injured internal carotid. Case 3 received antiplatelet therapy and a internal carotid compression test was performed simultaneously for 2 weeks, then the injured internal carotid was completely blocked. Case 1 developed cerebral infarction that resulted in unilateral hemiplegia. Due to timely treatment, the remaining 2 patients had a better prognosis. CTA should be performed primarily to exclude vascular injury and for CTA-positive patients, a further DSA should be performed to investigate pathological changes and for a definitive diagnosis. At last, the current therapeutic protocols for BCVI are not entirely applicable to intracranial vascular injury, and appropriate protocols for the treatment of BICI should be selected based on the combination of test results and the actual condition of the patient.

  18. Outcome of children with blunt liver or spleen injuries: Experience from a single institution in Korea.

    Science.gov (United States)

    Kim, Ki Hoon; Kim, Jin Soo; Kim, Woon-Won

    2017-02-01

    The aim of this study is to evaluate the demographics, injury pattern, and treatment outcomes among children hospitalized for the management of blunt liver and spleen injury at a single institution in Korea, and to document trends in treatment strategies of children with blunt torso trauma. Children (injuries, hospitalized at our center between May 2010 and February 2016, were included in the present study. Data were retrospectively analyzed for demographic and injury-related information were obtained. During the study period, 34 patients with blunt liver injury and 21 patients with blunt spleen injury presented at the center. The most common cause of liver and spleen injury was motor vehicle collision, followed by fall. Thirty patients (88.2%) with liver injuries and 18 patients (85.7%) with spleen injuries were managed conservatively. No cases of mortality occurred in patients with spleen injury group; one patient (2.9%) died in patients with liver injury due to uncontrolled bleeding. Our data demonstrated that 85.7% of patients with spleen injuries and 88.2% of patients with liver injuries were managed nonoperatively. Operative management was chosen more selectively, being applied in patients with high grade organ injury scores or abrupt changes in vital status. Our findings will contribute to the available data concerning children with traumatic injuries in Korea. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  19. Bilateral blunt carotid artery injury: A case report and review of the ...

    African Journals Online (AJOL)

    2013-05-02

    May 2, 2013 ... Cervical spine fracture. • Basilar skull fracture with carotid canal involvement. • Diffuse axonal injury with GCS <6. • Near-hanging with anoxic brain injury. CT = computed tomography; BCI = blunt carotid injury; GCS = Glasgow Coma Score. Table 2. Biffl grading system – relation of grade to prognosis and ...

  20. Airway management in laryngotracheal injuries from blunt neck trauma in children.

    Science.gov (United States)

    Chatterjee, Debnath; Agarwal, Rita; Bajaj, Lalit; Teng, Sarena N; Prager, Jeremy D

    2016-02-01

    Pediatric laryngotracheal injuries from blunt neck trauma are extremely rare, but can be potentially catastrophic. Early diagnosis and skillful airway management is critical in avoiding significant morbidity and mortality associated with these cases. We present a case of a patient who suffered a complete tracheal transection and cervical spine fracture following a clothesline injury to the anterior neck. A review of the mechanisms of injury, clinical presentation, initial airway management, and anesthetic considerations in laryngotracheal injuries from blunt neck trauma in children are presented. © 2015 John Wiley & Sons Ltd.

  1. Delayed Death from Complete Aortic Transection: Case Report

    Directory of Open Access Journals (Sweden)

    Sakda Sathirareuangchai, M.D.

    2017-09-01

    Full Text Available Blunt chest trauma is a common cause of morbidity and mortality in road traffic accident. One of the life- threatening injuries is traumatic aortic injury. The authors reported a case of delayed death from blunt chest trauma in a young Thai male, who had a traffic accident 2 weeks prior to his death. The autopsy revealed complete transection of thoracic aorta at the isthmus and false aneurysm formation. The clinical findings and mechanism of traumatic aortic injury are reviewed. Traumatic aortic injury is a fatal blunt chest trauma in which the victims rarely survive to the hospital. Prompt diagnosis and early surgical treatment can decrease morbidity and mortality.

  2. Imaging in blunt cardiac injury: Computed tomographic findings in cardiac contusion and associated injuries.

    Science.gov (United States)

    Hammer, Mark M; Raptis, Demetrios A; Cummings, Kristopher W; Mellnick, Vincent M; Bhalla, Sanjeev; Schuerer, Douglas J; Raptis, Constantine A

    2016-05-01

    Blunt cardiac injury (BCI) may manifest as cardiac contusion or, more rarely, as pericardial or myocardial rupture. Computed tomography (CT) is performed in the vast majority of blunt trauma patients, but the imaging features of cardiac contusion are not well described. To evaluate CT findings and associated injuries in patients with clinically diagnosed BCI. We identified 42 patients with blunt cardiac injury from our institution's electronic medical record. Clinical parameters, echocardiography results, and laboratory tests were recorded. Two blinded reviewers analyzed chest CTs performed in these patients for myocardial hypoenhancement and associated injuries. CT findings of severe thoracic trauma are commonly present in patients with severe BCI; 82% of patients with ECG, cardiac enzyme, and echocardiographic evidence of BCI had abnormalities of the heart or pericardium on CT; 73% had anterior rib fractures, and 64% had pulmonary contusions. Sternal fractures were only seen in 36% of such patients. However, myocardial hypoenhancement on CT is poorly sensitive for those patients with cardiac contusion: 0% of right ventricular contusions and 22% of left ventricular contusions seen on echocardiography were identified on CT. CT signs of severe thoracic trauma are frequently present in patients with severe BCI and should be regarded as indirect evidence of potential BCI. Direct CT findings of myocardial contusion, i.e. myocardial hypoenhancement, are poorly sensitive and should not be used as a screening tool. However, some left ventricular contusions can be seen on CT, and these patients could undergo echocardiography or cardiac MRI to evaluate for wall motion abnormalities. Copyright © 2015 Elsevier Ltd. All rights reserved.

  3. Judge of surgical indication for blunt injuries of liver and spleen by CT imaging

    International Nuclear Information System (INIS)

    Nakagawa, Takao; Yokoyama, Toshimitsu; Suga, Hiroyasu; Deguchi, Yoshizumi; Hasegawa, Yasuhiro; Muraoka, Ryusuke; Ishikawa, Masatake; Suzuki, Tadashi.

    1997-01-01

    Recent studies have elucidated that the findings of injuries of parenchimatous organs such as liver and spleen by computed tomography (CT) are consistent with those by surgical operation. But it is still unclear whether CT findings can determine operative indication for blunt injuries of liver and spleen. We performed a retrospective study on 35 lesions of blunt injuries of liver and spleen in 33 cases for blunt injuries of liver and spleen at our hospitals to examine whether CT findings can determine the severity of damage and surgical indication for the injuries, and the following results were obtained. Based on CT findings, the presence of injury was confirmed in all cases except for one lesion. Comparison of CT findings and operative or laparoscopic findings in 12 cases undergoing operation or laparoscopy for liver/spleen injury revealed that the findings of each method were almost the same with few exceptions. When liver/spleen injuries were classified according to the Japanese Association for the Surgery of Trauma (JAST) Classification of injury of liver and spleen, cases with emergency operation had severe injury of Type IIIb for the liver and Type IIIb or higher for the spleen, while conservative treatment was possible for injury cases of Type IIIa or lower of the liver and spleen. From these results, the JAST Classification of these injuries based upon CT imaging was found to be a suitable method for selecting an appropriate treatment for blund injury of liver and spleen. (author)

  4. Judge of surgical indication for blunt injuries of liver and spleen by CT imaging

    Energy Technology Data Exchange (ETDEWEB)

    Nakagawa, Takao; Yokoyama, Toshimitsu; Suga, Hiroyasu; Deguchi, Yoshizumi; Hasegawa, Yasuhiro; Muraoka, Ryusuke [Fukui Medical School (Japan); Ishikawa, Masatake; Suzuki, Tadashi

    1997-10-01

    Recent studies have elucidated that the findings of injuries of parenchimatous organs such as liver and spleen by computed tomography (CT) are consistent with those by surgical operation. But it is still unclear whether CT findings can determine operative indication for blunt injuries of liver and spleen. We performed a retrospective study on 35 lesions of blunt injuries of liver and spleen in 33 cases for blunt injuries of liver and spleen at our hospitals to examine whether CT findings can determine the severity of damage and surgical indication for the injuries, and the following results were obtained. Based on CT findings, the presence of injury was confirmed in all cases except for one lesion. Comparison of CT findings and operative or laparoscopic findings in 12 cases undergoing operation or laparoscopy for liver/spleen injury revealed that the findings of each method were almost the same with few exceptions. When liver/spleen injuries were classified according to the Japanese Association for the Surgery of Trauma (JAST) Classification of injury of liver and spleen, cases with emergency operation had severe injury of Type IIIb for the liver and Type IIIb or higher for the spleen, while conservative treatment was possible for injury cases of Type IIIa or lower of the liver and spleen. From these results, the JAST Classification of these injuries based upon CT imaging was found to be a suitable method for selecting an appropriate treatment for blund injury of liver and spleen. (author)

  5. Iliac Artery and Vein Injury Without Pelvic Fracture Due To Blunt Trauma: A Rare Case

    Directory of Open Access Journals (Sweden)

    Mustafa Cuneyt Cicek

    2014-08-01

    Full Text Available Iliac vascular injuries have high morbidity and mortality rates. Penetrant abdominal and pelvic vascular injuries are more common compared to blunt traumas. Pelvic vascular injuries associated with blunt trauma are quite likely to occur in accompaniment with pelvic fracture. A 23 year old male patient was admitted to the emergency room due to a motorcycle accident. Shock picture was prevalent in the patient. Shaft fracture was present in left femur and flow was not detected in arterial and venous colour Doppler ultrasonography. Patient underwent emergency surgery. Left main iliac artery and vein were normal, however, external iliac vein was lacerated in two spots, and blood vessel wall integrity was damaged in one part of left external iliac artery. Clinical presentation and traumatic retroperitoneal hematoma management of iliac artery and venous injuries due to blunt trauma without pelvic fracture are discussed in the presented case.

  6. Severe renal injuries in children following blunt abdominal trauma: selective management and outcome.

    Science.gov (United States)

    Nerli, Rajendra B; Metgud, Tanmaya; Patil, Shivagouda; Guntaka, Ajaykumar; Umashankar, P; Hiremath, Murigendra; Suresh, S N

    2011-11-01

    Blunt trauma accounts for the majority of pediatric renal injuries. Most injuries are often minor and can be managed without surgical intervention. We have retrospectively reviewed our series of children with severe (grade IV/V) renal injuries, their management and outcome. Medical records of children less than 18 years with renal injuries were reviewed. The cause of injury, time following injury, management and outcome in these children were recorded. The outcome data were analyzed. During the period between January 1996 and December 2008, 43 children with grade IV/V renal injuries were admitted with blunt abdominal trauma. Ten of these 43 children underwent exploration and 33 initially managed non-operatively. Two of these 33 children on non-operative management needed nephrectomy for vascular injury and delayed haemorrhage. Most children with grade IV/V renal injury following blunt trauma can be managed non-operatively. Management can be properly planned and executed based on clinical features, CT imaging and staging of renal injuries. Surgical intervention is needed for associated abdominal organ injuries and renal vascular injuries.

  7. [Alleged assault in a forest: An unusual case of self-inflicted blunt injury].

    Science.gov (United States)

    Kunz, Sebastian Niko; Tutsch-Bauer, Edith

    2014-01-01

    The medico-legal assessment of potentially self-inflicted injuries is an important field of clinical forensic medicine. Compared with sharp force injuries, it is much more difficult to distinguish blunt injuries caused by another party from self-inflicted lesions. We present a case of a young female doctor, who was allegedly attacked by an unknown stranger during her evening walk in the woods. She claimed to have been hit repeatedly on the head and arms with a stone. During the forensic investigation, blunt injuries could be confirmed on her head and forearms. Based on the arrangement and intensity of the injuries, together with the result of a bloodstain pattern analysis of the weapon, the victim's statement could be disproved. After being confronted with the results of the investigation, the woman admitted to have inflicted the injuries herself. This case is an unusual and rare example of self-inflicted blunt injury. It shows that the criteria of self-inflicted injuries can also be applied to blunt trauma. However, due to the small number of cases, a high degree of caution is required from the forensic expert.

  8. Bilateral blunt carotid artery injury: A case report and review of the ...

    African Journals Online (AJOL)

    A 22-year-old man sustained a strangulation-type injury to the neck, with bilateral blunt carotid artery injuries detected on computed tomography (CT) angiography. His Glasgow Coma Score was 15/15, and he was managed conservatively with therapeutic lowmolecular- weight heparin and antiplatelet therapy. A repeat CT ...

  9. Pleural effusion following blunt splenic injury in the pediatric trauma population.

    Science.gov (United States)

    Kulaylat, Afif N; Engbrecht, Brett W; Pinzon-Guzman, Carolina; Albaugh, Vance L; Rzucidlo, Susan E; Schubart, Jane R; Cilley, Robert E

    2014-09-01

    Pleural effusion is a potential complication following blunt splenic injury. The incidence, risk factors, and clinical management are not well described in children. Ten-year retrospective review (January 2000-December 2010) of an institutional pediatric trauma registry identified 318 children with blunt splenic injury. Of 274 evaluable nonoperatively managed pediatric blunt splenic injures, 12 patients (4.4%) developed left-sided pleural effusions. Seven (58%) of 12 patients required left-sided tube thoracostomy for worsening pleural effusion and respiratory insufficiency. Median time from injury to diagnosis of pleural effusion was 1.5days. Median time from diagnosis to tube thoracostomy was 2days. Median length of stay was 4days for those without and 7.5days for those with pleural effusions (ppleural effusions managed medically or with tube thoracostomy (p=0.006), respectively. In multivariate analysis, high-grade splenic injury (IV-V) (OR 16.5, p=0.001) was associated with higher odds of developing a pleural effusion compared to low-grade splenic injury (I-III). Pleural effusion following pediatric blunt splenic injury has an incidence of 4.4% and is associated with high-grade splenic injuries and longer lengths of stay. While some symptomatic patients may be successfully managed medically, many require tube thoracostomy for progressive respiratory symptoms. Copyright © 2014 Elsevier Inc. All rights reserved.

  10. Blunt cerebrovascular injury is poorly predicted by modeling with other injuries: analysis of NTDB data.

    Science.gov (United States)

    Cook, Alan; Osler, Turner; Gaudet, Matthew; Berne, John; Norwood, Scott

    2011-07-01

    Traumatic blunt cerebrovascular injury (BCVI) may portend catastrophic complications if untreated. Who should be screened for BCVI is controversial. The purpose of this study was to develop and validate a prediction score (pBCVI) to identify those at sufficient risk to warrant dedicated screening. We conducted a cohort study using data for years 2002-2007 from the National Trauma Data Bank. Blunt trauma patients aged 16 years and older were randomly divided into two groups for score creation and validation. Final prediction model included age, sex, Trauma Mortality Prediction Model p(death), traumatic intracranial hemorrhage, cerebellar/brain stem injury, malar/maxillary fracture, mandible fracture, cervical spine fracture, cervical spinal cord injury, thoracic spinal cord injury, and chest Abbreviated Injury Scale ≥3. pBCVI was evaluated using receiver operating characteristic curve area and the Hosmer-Lemeshow statistic. The Youden Index estimated an optimal cut-point (J) of the pBCVI. The cohort numbered 1,398,310 patients, including 2,125 with BCVI. The overall incidence of BCVI was 0.15%. Cervical spine fracture had the strongest association with BCVI (odds ratio 4.82, p < 0.001). The receiver operating characteristic curve for pBCVI was 0.93 and the Hosmer-Lemeshow statistic was 206.3, p < 0.01. The optimal cut-point (J) of pBCVI was 0.0013 (sensitivity 0.91, specificity 0.82) and would miss 186 (8.8%) injuries in our cohort. To identify all BCVI using this model, an unrealistic 96% of the cohort would require screening. A model based on a pattern of other injuries cannot be used as a stand-alone instrument to determine screening for BCVI. "Optimal" model cut-points are not ideal for all injuries. Clinical suspicion that integrates energy of mechanism and associated injuries remains essential to effectively screen for BCVI and minimize patient risk for a catastrophic missed injury.

  11. Secondary left ventricular injury with haemopericardium caused by a rib fracture after blunt chest trauma

    Directory of Open Access Journals (Sweden)

    Somsekhar Ganti

    2006-03-01

    Full Text Available Abstract Trauma is the third most common cause of death in the West. In the US, approximately 90,000 deaths annually are traumatic in nature and over 75% of casualties from blunt trauma are due to chest injuries. Cardiac injuries from rib fractures following blunt trauma are extremely rare. We report the unusual case of a patient who fell from a height and presented with haemopericardium and haemothorax as a result of left ventricular and lingular lacerations and was sucessfully operated upon.

  12. Role of imaging in penetrating and blunt traumatic injury to the heart.

    Science.gov (United States)

    Co, Steven J; Yong-Hing, Charlotte J; Galea-Soler, Sandro; Ruzsics, Balazs; Schoepf, U Joseph; Ajlan, Amr; Aljan, Amr; Farand, Paul; Nicolaou, Savvas

    2011-01-01

    Cardiac injury due to blunt or penetrating chest trauma is common and is associated with significant morbidity and mortality. Understanding the mechanisms, types, and complications of cardiac injuries and the roles of various imaging modalities in characterizing them is important for appropriate diagnosis and treatment. These injuries have not been well documented at imaging, but there are now fast and accurate methods for evaluating the heart and associated mediastinal structures. The authors review the broad spectrum of injuries that can result from blunt or penetrating trauma to the chest, as well as the imaging modalities commonly used in the acute trauma setting for evaluation of the heart and mediastinal structures. A pictorial review of both common and, to date, rarely documented cardiac injuries imaged with a variety of modalities is also presented. While many imaging modalities are available, the authors demonstrate the value of multidetector computed tomography (CT) for the initial evaluation of patients with blunt or penetrating chest trauma. With the advent of multidetector CT, imaging of cardiac injury has increased and accurate identification of these rare but potentially lethal injuries has become paramount for improving survival. Selection of the most appropriate modality for evaluation and recognition of the imaging findings in cardiac injuries in the acute trauma setting is important to expedite treatment and improve survival.

  13. Forensic medical study on morphology and formative mechanism of blunt head injury

    Directory of Open Access Journals (Sweden)

    LI Hong-wei

    2012-12-01

    Full Text Available 【Abstract】 Objective: To study the patterns and morphologic characteristics of blunt head injury and analyse its formative mechanism in attempt to provide references for medicolegal expertise. Methods: The statistical analysis was done in terms of gender, age, as well as the nature, pattern, location, and feature of the injuries. Results: Among the 202 cases of head injury-induced death, 124 were male and 78 female with the age ranging from 1-81 years. Death caused by homicide was dominant (106, 52.5%, followed by suicide (49, 24.3% and accident (44, 21.8%. The majority of suicide-induced death were by falling from height, and traffic crash was responsible for majority of unexpected death cases. The morphology and pathogenesis of the injuries varied according to differences on the mode, magnitude, and orientation of the outside force giving rise to blunt injury as well as the character of vulnerants. Conclusion: Studies on the morphology and its forma-tive rationale of blunt head injury will offer easy access to medicolegal expertise on the mode and character of the injury. Key words: Brain; Head injuries, closed; Cranioce-rebral trauma; Forensic medicine

  14. Endovascular management of lap belt-related abdominal aortic injury in a 9-year-old child.

    Science.gov (United States)

    Papazoglou, Konstantinos O; Karkos, Christos D; Kalogirou, Thomas E; Giagtzidis, Ioakeim T

    2015-02-01

    Blunt abdominal aortic trauma is a rare occurrence in children with only a few patients having been reported in the literature. Most such cases have been described in the context of lap belt injuries. We report a 9-year-old boy who suffered lap belt trauma to the abdomen during a high-speed road traffic accident resulting to the well-recognized pattern of blunt abdominal injury, that is, the triad of intestinal perforation, fractures of the lumbar spine, and abdominal aortic injury. The latter presented with lower limb ischemia due to dissection of the infrarenal aorta and right common iliac artery. Revascularization was achieved by endovascular means using 2 self-expanding stents in the infrarenal aorta and the right common iliac artery. This case is one of the few reports of lap belt-related acute traumatic abdominal aortic dissection in a young child and highlights the feasibility of endovascular management in the pediatric population. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. TRIAGE OF PATIENTS TO ANGIOGRAPHY FOR DETECTION OF AORTIC RUPTURE AFTER BLUNT CHEST TRAUMA - COST-EFFECTIVENESS ANALYSIS OF USING CT

    NARCIS (Netherlands)

    HUNINK, MGM; BOS, JJ

    OBJECTIVE. The purpose of this study was to evaluate the cost-effectiveness of dynamic chest CT, compared with plain chest radiography and immediate angiography, in deciding when angiography should be performed in hemodynamically stable patients with suspected aortic rupture after blunt chest

  16. Observation Versus Embolization in Patients with Blunt Splenic Injury After Trauma: A Propensity Score Analysis

    NARCIS (Netherlands)

    Olthof, Dominique C.; Joosse, Pieter; Bossuyt, Patrick M. M.; de Rooij, Philippe P.; Leenen, Loek P. H.; Wendt, Klaus W.; Bloemers, Frank W.; Goslings, J. Carel

    2016-01-01

    Non-operative management (NOM) is the standard of care in hemodynamically stable patients with blunt splenic injury after trauma. Splenic artery embolization (SAE) is reported to increase observation success rate. Studies demonstrating improved splenic salvage rates with SAE primarily compared SAE

  17. Observation Versus Embolization in Patients with Blunt Splenic Injury After Trauma : A Propensity Score Analysis

    NARCIS (Netherlands)

    Olthof, Dominique C.; Joosse, Pieter; Bossuyt, Patrick M. M.; de Rooij, Philippe P.; Leenen, Loek P. H.; Wendt, Klaus W.; Bloemers, Frank W.; Goslings, J. Carel

    Non-operative management (NOM) is the standard of care in hemodynamically stable patients with blunt splenic injury after trauma. Splenic artery embolization (SAE) is reported to increase observation success rate. Studies demonstrating improved splenic salvage rates with SAE primarily compared SAE

  18. Penile injury due to blunt trauma after circumcision in a male child: A case report

    Directory of Open Access Journals (Sweden)

    Hulya Ozturk

    2014-08-01

    Full Text Available Injury in the case presented here is different from the cause of penile trauma. Our case has been exposed to blunt trauma after circumcision. Type developments of the penile trauma, treatment, and precautions have been discussed with the literature.

  19. Concomitant rib fractures and minor liver or spleen injuries in blunt trauma: what is the potential for missed diaphragmatic injuries?

    Science.gov (United States)

    Plurad, David S; Nielsen, Jamison S; Hancock, James; Navaran, Prashanth; Green, Donald J; Lam, Lydia; Inaba, Kenji; Demetriades, Demetrios

    2010-04-01

    Nonoperative management (NOM) of blunt liver or spleen injuries (LSI) is widely accepted, but diaphragmatic injuries (DI) can be elusive. We hypothesize that rib fractures and minor LSI (RF+ minor LSI) are associated with DI. Patients with blunt injury undergoing exploratory laparotomy between January 1, 2000, and December 31, 2007, were identified from our registry. The association between injury variables and DI was examined with logistic regression. Organ Injury Scores of the liver and spleen of Grade I/II were defined as "minor." A potentially nonoperative (PNO) patient had a rib fracture and minor LSI but no bowel injury or hypotension (systolic blood pressure less than 90 mmHg). The incidence of DI was 7.5 per cent (53 of 705) overall but 20 per cent (seven of 35) in patients with RF + minor LSI. Nineteen PNO patients had four (21.1%) DIs. RF + LSI (3.26 [1.74-6.12], P < 0.001) and motor vehicle collisions (4.93 [2.36-10.32], P < 0.001) were independently associated with DI. The incidence of laparotomy in all critically ill blunt injury patients (n = 2177) decreased significantly (P = 0.003). RF + minor LSI are associated with DI even when there are no other operative injuries. Because NOM is increasingly accepted, the potential for missed DI exists. When high-quality imaging is not available or is equivocal, further studies should be considered.

  20. Does the mechanism of injury in pediatric blunt trauma patients correlate with the severity of genitourinary organ injury?

    Science.gov (United States)

    Tojuola, Bayo D; Gu, Xiao; Littlejohn, Nathan R; Sharpe, John P; Williams, Mark A; Giel, Dana W

    2014-12-01

    Blunt abdominal trauma can result in injury to genitourinary (GU) organs. Children may be more susceptible to some GU injuries due to anatomic differences compared to adults. Mechanism of injury (MOI) has been thought to relate to both the likelihood and severity of GU injury in children, although this has not definitively been proven. Our purpose was to determine if MOI has any correlation to the severity of GU injury in children treated at our institution. We reviewed records of all pediatric blunt trauma patients presenting to our institution from January 2005-December 2010 using the LeBonheur Children's Hospital Trauma Registry. All patients with GU injuries were included in this study. Data collected included demographic information, MOI, type and grade of GU injury, associated injuries, and clinical outcome. Continuous variables were tested with ANOVA and categorical variables were tested with chi-square test. Records of 5151 children with blunt trauma were reviewed; 76 patients were found to have GU organ injury. There were 47 males (61.8%) and 29 females (38.2%). Categories of MOI included motor vehicle accident, sports injury, bicycle accident, all-terrain vehicle accident (ATV), pedestrian struck accident, falls, and animal injury. MOI did not have any statistically significant association with the severity of GU organ injury (p = 0.5159). In addition, there was no association between MOI and either gender or side of injury. There was a statistically significant association between MOI and patient age (p = 0.04); older pediatric patients were more likely to experience GU injury due to sports injury and ATV accidents, where as younger patients were more likely to experience GU injury due to pedestrian struck, bicycle accidents or animal bite. Although specific MOI would seem to relate to presence and severity of injury in children, MOI alone does not correlate with the severity of GU organ injury in our pediatric trauma population. Age of pediatric

  1. Multiplicity of solid organ injury: influence on management and outcomes after blunt abdominal trauma.

    Science.gov (United States)

    Malhotra, Ajai K; Latifi, Rifat; Fabian, Timothy C; Ivatury, Rao R; Dhage, S; Bee, Tiffany K; Miller, Preston R; Croce, Martin A; Yelon, Jay A

    2003-05-01

    The current study was undertaken to examine how concomitant injury to liver and spleen after blunt abdominal trauma affects management and outcomes. This study was a retrospective chart review of all blunt abdominal trauma patients admitted with a diagnosis of liver or spleen injury at two Level I trauma centers over a 4-year period. Presentation, injury grade, management, and outcomes were analyzed. Patients with single-organ injury (liver or spleen) were compared with patients having injury to both organs (liver and spleen). Significance was set at 95% confidence intervals. Of 1,288 patients who met entry criteria, 1,125 had single (spleen, 573; liver, 552) organ injury (group S) and 163 had injury to both organs (group B). Group B patients had significantly higher Injury Severity Score, higher admission lactate, and lower admission systolic blood pressure and base excess. Eighty-one percent (915 of 1,125) of group S and 69% (112 of 163) of group B patients were managed nonoperatively (p < 0.05). Of the nonoperatively managed patients, 5.8% (53 of 915) in group S and 11.6% (13 of 112) in group B failed this form of therapy (p < 0.05). Higher failure rate in group B was because of bleeding from injured solid organ(s), and not non-solid organ related failures. Mortality, intensive care unit and hospital lengths of stay, and transfusion requirements were all significantly higher in group B. Blunt trauma patients with concomitant injury to liver and spleen have higher Injury Severity Score, mortality, lengths of stay, and transfusion requirements. There is a higher failure rate with nonoperative management, and therefore extra vigilance is warranted when choosing this form of therapy in the presence of injury to both organs.

  2. Spinal cord injury and its association with blunt head trauma

    OpenAIRE

    Paiva, Wellingson S; Oliveira, Arthur MP; Andrade, Almir F; Amorim, Robson LO; Lourenço, Leonardo JO; Teixeira, Manoel J

    2011-01-01

    Wellingson S Paiva, Arthur MP Oliveira, Almir F Andrade, Robson LO Amorim, Leonardo JO Lourenço, Manoel J TeixeiraDivision of Neurosurgery, University of São Paulo, BrazilBackground: Severe and moderate head injury can cause misdiagnosis of a spinal cord injury, leading to devastating long-term consequences. The objective of this study is to identify risk factors involving spine trauma and moderate-to-severe brain injury.Methods: A prospective study involving 1617 patien...

  3. Abdominal wall injuries occurring after blunt trauma: incidence and grading system.

    Science.gov (United States)

    Dennis, Ryan W; Marshall, Andre; Deshmukh, Harshal; Bender, Jeffrey S; Kulvatunyou, Narong; Lees, Jason S; Albrecht, Roxie M

    2009-03-01

    Traumatic abdominal wall injuries (AWIs) are being increasingly recognized after blunt force injury. All available abdominal/pelvic computed axial tomography (CAT) scans of blunt trauma patients evaluated at our level I trauma center from January 2005 to August 2006 were reviewed for the presence of AWI. AWI was graded using a severity-based numeric system. AWI grade was then compared with variables from a prospectively maintained trauma registry. Of 1,549 reviewed CAT scans, 9% showed AWI (grade I = 53%, grade II = 28%, grade III = 9%, grade IV = 8%, and grade V = 2%). There was no association between AWI and seatbelt use, Injury Severity Score, weight, or need for abdominal surgery. AWI occurs in 9% of blunt trauma patients undergoing abdominal/pelvic CAT scans. The incidence of herniation on CAT at presentation after blunt trauma is .2%, and the incidence of patients at risk of future hernia formation is 1.5%. AWI can be effectively cataloged using a straightforward numeric grading system.

  4. Pancreatic injuries after blunt abdominal trauma: an analysis of 110 ...

    African Journals Online (AJOL)

    One hundred and one patients underwent a total of 123 operations, including drainage of the pancreatic injury (N=73), distal pancreatectomy (N=39) and Whipple resection (N=5). The overall complication rate was 74.5% and the mortality rate 16.4%. Only 2 of the 18 deaths were attributable to the pancreatic injury.

  5. Determinants of splenectomy in splenic injuries following blunt ...

    African Journals Online (AJOL)

    Introduction. The management of splenic injuries has shifted from splenectomy to splenic preservation owing to the risk of overwhelming post-splenectomy infection (OPSI). This study aimed to identify the factors that determine splenectomy in patients with isolated splenic injuries, with a view to increasing the rate of splenic ...

  6. Delayed presentation of a sigmoid colon injury following blunt abdominal trauma: a case report

    Directory of Open Access Journals (Sweden)

    Ertugrul Gokhan

    2012-08-01

    Full Text Available Abstract Introduction The low incidence of colon injury due to blunt abdominal trauma and the lack of a definitive diagnostic method for the same can lead to delays in diagnosis and treatment, subsequently resulting in high morbidity and mortality. Case presentation A 66-year-old woman with sigmoid colon injury was admitted to our emergency department after sustaining blunt abdominal trauma. Her physical examination findings and laboratory results led to a decision to perform a laparotomy; exploration revealed a sigmoid colon injury that was treated by sigmoid loop colostomy. Conclusions Surgical abdominal exploration revealed gross fecal contamination and a perforation site. Intra-abdominal irrigation and a sigmoid loop colostomy were performed. Our patient was discharged on post-operative day six without any problems. Closure of the sigmoid loop colostomy was performed three months after the initial surgery.

  7. Lower Urinary Tract Injuries Following Blunt Trauma: A Review of Contemporary Management

    Science.gov (United States)

    Kong, Jennifer P. L; Bultitude, Matthew F; Royce, Peter; Gruen, Russell L; Cato, Alex; Corcoran, Niall M

    2011-01-01

    Lower urinary tract trauma, although relatively uncommon in blunt trauma, can lead to significant morbidity when diagnosed late or left untreated; urologists may only encounter a handful of these injuries in their career. This article reviews the literature and reports on the management of these injuries, highlighting the issues facing clinicians in this subspecialty. Also presented is a structured review detailing the mechanisms, classification, diagnosis, management, and complications of blunt trauma to the bladder and urethra. The prognosis for bladder rupture is excellent when treated. Significant intraperitoneal rupture or involvement of the bladder neck mandates surgical repair, whereas smaller extraperitoneal lacerations may be managed with catheterization alone. With the push for management of trauma patients in larger centers, urologists in these hospitals are seeing increasing numbers of lower urinary tract injuries. Prospective analysis may be achieved in these centers to address the current lack of Level 1 evidence. PMID:22114545

  8. The validity of abdominal examination in blunt trauma patients with distracting injuries.

    Science.gov (United States)

    Rostas, Jack; Cason, Benton; Simmons, Jon; Frotan, Mohammed A; Brevard, Sidney B; Gonzalez, Richard P

    2015-06-01

    Many trauma care providers often disregard the abdominal clinical examination in the presence of extra-abdominal distracting injuries and mandate abdominal computed tomographic scan in these patients. Ignoring the clinical examination may incur undue expense and radiation exposure. The purpose of this study was to assess the efficacy of abdominal clinical examination in patients with distracting injuries. During a 1-year period, all awake and alert blunt trauma patients with Glasgow Coma Scale (GCS) score of 14 or 15 were entered into a prospective study. Abdominal clinical examination was performed and documented prospectively on all patients. Abdominal clinical examination included four-quadrant anterior abdominal palpation, flank palpation, lower thoracic palpation, pelvis examination, and palpation of the thoracolumbar spine. Following examination documentation, all patients underwent computed tomographic scan of the abdomen and pelvis with intravenous contrast. A total of 803 patients were enrolled: 451 patients had distracting injuries, and 352 patients did not. Of the 352 patients without distracting injuries, 19 (5.4%) had intra-abdominal injuries, of whom 2 (10.5%) had negative clinical examination result. Of the 451 patients with distracting injuries, 48 (10.6%) were diagnosed with intra-abdominal injury, of whom 5 (10.4%) had negative clinical examination result. All five missed injuries in patients with distracting injuries were solid organ injuries, none of which required surgical intervention or blood transfusion. The sensitivity and negative predictive value of abdominal examination for patients with distracting injuries were 90.0% and 97.0%, respectively. The sensitivity and negative predictive value of abdominal examination for surgically significant and transfusion-requiring injuries were both 100%. Distracting injuries do not seem to diminish the efficacy of clinical abdominal examination for the diagnosis of clinically significant abdominal

  9. Spinal cord injury and its association with blunt head trauma

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    Paiva WS

    2011-09-01

    Full Text Available Wellingson S Paiva, Arthur MP Oliveira, Almir F Andrade, Robson LO Amorim, Leonardo JO Lourenço, Manoel J TeixeiraDivision of Neurosurgery, University of São Paulo, BrazilBackground: Severe and moderate head injury can cause misdiagnosis of a spinal cord injury, leading to devastating long-term consequences. The objective of this study is to identify risk factors involving spine trauma and moderate-to-severe brain injury.Methods: A prospective study involving 1617 patients admitted in the emergency unit was carried out. Of these patients, 180 with moderate or severe head injury were enrolled. All patients were submitted to three-view spine series X-ray and thin cut axial CT scans for spine trauma investigations.Results: 112 male patients and 78 female patients, whose ages ranged from 11 to 76 years (mean age, 34 years. The most common causes of brain trauma were pedestrians struck by motor vehicles (31.1%, car crashes (27.7%, and falls (25%. Systemic lesions were present in 80 (44.4% patients and the most common were fractures, and lung and spleen injuries. 52.8% had severe and 47.2% moderate head trauma. Fourteen patients (7.8% suffered spinal cord injury (12 in cervical spine, one in lumbar, and one thoracic spine. In elderly patients, the presence of associated lesions and Glasgow Coma Scale (GCS < 9 were statistically significant as risk factors (P < 0.05 for spine injury.Conclusion: Spinal cord injury related to moderate and severe brain trauma usually affects the cervical spine. The incidence of spinal lesions and GCS < 9 points were related to greater incidence of spinal cord injury.Keywords: head injury, spine trauma, risk factors

  10. Blunt cardiac injury in critically ill trauma patients: a single centre experience.

    Science.gov (United States)

    Skinner, D L; Laing, G L; Rodseth, R N; Ryan, L; Hardcastle, T C; Muckart, D J J

    2015-01-01

    This study describes the incidence and outcomes of blunt cardiac injury (BCI) in a single trauma intensive care unit (TICU), together with the spectrum of thoracic injuries and cardiac abnormalities seen in BCI. We performed a retrospective observational study of 169 patients with blunt thoracic trauma admitted from January 2010 to April 2013. BCI was diagnosed using an elevated serum troponin in the presence of either clinical, ECG or transthoracic echocardiography (TTE) abnormalities in keeping with BCI. The mechanism of injury, associated thoracic injuries and TTE findings in these patients are reported. The incidence of BCI among patients with blunt thoracic trauma was 50% (n=84). BCI patients had higher injury severity scores (ISS) (median 37 [IQR 29-47]; p=0.001) and higher admission serum lactate levels (median 3.55 [IQR 2.4-6.2], p=0.008). In patients with BCI, the median serum TnI level was 2823ng/L (IQR 1353-6833), with the highest measurement of 64950ng/L. TTEs were performed on 38 (45%) patients with BCI, of whom 30 (79%) had abnormalities. Patients with BCI had a higher mortality (32% vs. 16%; p=0.028) and trended towards a longer length of stay (17.0 days [standard deviation (SD) 13.5] vs. 13.6 days [SD 12.0]; p=0.084). BCI was associated with an increased mortality and a trend towards a longer length of stay in this study. It is a clinically relevant diagnosis which requires a high index of suspicion. Screening of high risk patients with significant blunt thoracic trauma for BCI with serum troponins should be routine practise. Patients diagnosed with BCI should undergo more advanced imaging such as TTE or TOE to exclude significant cardiac structural injury. Copyright © 2014 Elsevier Ltd. All rights reserved.

  11. Current Trends in the Management of Blunt Solid Organ Injuries.

    Science.gov (United States)

    Taviloglu, Korhan; Yanar, Hakan

    2009-04-01

    The management of patients with solid organ injuries has changed since the introduction of technically advanced imaging tools, such as ultrasonography and multiple scan computerized tomography, interventional radiological techniques and modern intensive care units. In spite of this development in the management of these patients, major solid organ traumas can still be challenging. There has been great improvement in the non-operative management (NOM) of intra-abdominal solid organ injury in recent decades. In most cases treatment of injuries has shifted from early surgical treatment to NOM.

  12. The Role of Troponin in Blunt Cardiac Injury After Multiple Trauma in Humans.

    Science.gov (United States)

    Kalbitz, Miriam; Pressmar, Jochen; Stecher, Johanna; Weber, Birte; Weiss, Manfred; Schwarz, Stephan; Miltner, Erich; Gebhard, Florian; Huber-Lang, Markus

    2017-01-01

    The incidence of cardiac injury in immediate fatalities after blunt trauma remains underestimated, and reliable diagnostic strategies are still missing. Furthermore, clinical data concerning heart-specific troponin serum levels, injury severity score (ISS), catecholamine treatment and survival of patients on admission to the hospital have rarely been interrelated so far. Therefore, the object of the present study was to identify predictive parameters for mortality in the context of blunt cardiac injury. This retrospective observational study included 173 severely injured patients with an ISS ≥25 admitted to the University Hospital of Ulm, a level 1 trauma center, during 2009-2013 . Furthermore, 83 blunt trauma victims who died before hospital admission were subjected to postmortem examination at the Institute of Legal Medicine, University of Ulm, during 2009-2014. ISS, cardiac injury and associated thoracic injuries were determined in both groups. Furthermore, in the hospitalized patients, serum troponin and IL-6 levels were measured. Macroscopic heart injury was observed in 18 % of the patients who died at the scene and only in 1 % of the patients admitted to the hospital, indicating that macroscopic heart injury is associated with an immediate life-threatening condition. Troponin levels were elevated in 43 % of the patients after admission to the hospital. Moreover, troponin serum concentrations were significantly higher in patients treated with norepinephrine (26.4 ± 4 ng/l) and in non-survivors (84.9 ± 22.8 ng/l) compared to patients without catecholamines and survivors, respectively. Macroscopic heart injury was 20 times more frequent in non-survivors than in survivors. Serum troponin levels correlated with mortality after multiple injury and therefore may represent a valuable prognostic marker in trauma patients.

  13. Blunt chest trauma: An audit of injuries diagnosed by the MDCT examination

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    Turkalj Ivan

    2014-01-01

    Full Text Available Background/Aim. Multidetector computed tomography (MDCT characterized by speed and precision is increasingly accessible in emergency wards. The aim of our study was to determine the most common injuries to the chest region, as well as type associated extrathoracic injuries, and the treatment outcome. Methods. This prospective study included 61 patients with blunt trauma who were submitted to computed tomography (CT of the thorax. The number of injuries was evaluated by organs and organ systems of the chest. The cause of the injury, the length and the outcome of the treatment, and the presence of injuries in other regions were assessed. Results. Chest injuries were associated with injuries to other regions in 80.3% cases, predominantly injuries to extremities or pelvic bones in 54.1% cases, followed by head injuries in 39.3% patients. Associated thoracic injuries were present in 90.9% of patients with lethal outcome. Lung parenchymal lesions, pleural effusions and rib fractures were the most common injuries affecting 77.1%, 65.6% and 63.9% of the cases, respectively. Conclusion. Blunt chest trauma is a significant problem affecting predominantly males in their forties and it is usually caused by a motor vehicle accident. In case of pneumomediastinum or mediastinal haematoma, the use of 3D reconstructions is advised for diagnosing possible tracheobronchial ruptures and thoracic aorta injuries. Increased resolution of CT scanners yielded a large number of findings that are occult on radiography, especially in the event of lung parenchymal and pleural injuries. However, none imaging modality can replace surgical judgement.

  14. Blunt liver injury with intact ribs under impacts on the abdomen: a biomechanical investigation.

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    Yu Shao

    Full Text Available Abdominal trauma accounts for nearly 20% of all severe traffic injuries and can often result from intentional physical violence, from which blunt liver injury is regarded as the most common result and is associated with a high mortality rate. Liver injury may be caused by a direct impact with a certain velocity and energy on the abdomen, which may result in a lacerated liver by penetration of fractured ribs. However, liver ruptures without rib cage fractures were found in autopsies in a series of cases. All the victims sustained punches on the abdomen by fist. Many studies have been dedicated to determining the mechanism underlying hepatic injury following abdominal trauma, but most have been empirical. The actual process and biomechanism of liver injury induced by blunt impact on the abdomen, especially with intact ribs remained, are still inexhaustive. In order to investigate this, finite element methods and numerical simulation technology were used. A finite element human torso model was developed from high resolution CT data. The model consists of geometrically-detailed liver and rib cage models and simplified models of soft tissues, thoracic and abdominal organs. Then, the torso model was used in simulations in which the right hypochondrium was punched by a fist from the frontal, lateral, and rear directions, and in each direction with several impact velocities. Overall, the results showed that liver rupture was primarily caused by a direct strike of the ribs induced by blunt impact to the abdomen. Among three impact directions, a lateral impact was most likely to cause liver injury with a minimum punch speed of 5 m/s (the momentum was about 2.447 kg.m/s. Liver injuries could occur in isolation and were not accompanied by rib fractures due to different material characteristics and injury tolerance.

  15. An unusual case of a serious blunt injury of the eye

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    Jovanović Miloš

    2009-01-01

    Full Text Available Introduction. Optic nerve avulsion is a serious injury of the eye. The objective of the paper was to present the peculiarity of the eye injury caused by a penetrating orbital wound with foreign body being retained in the orbit. Case report. A 15-year-old boy who sustained injury by chain link is presented. While he was turning the chain round in his hand, the last link broke off, piercing the lower lid, penetrated the left orbital cavity and remained behind the eyeball at the top of orbit. While passing towards the top of the orbit, the foreign body caused a blunt injury of the eyeball and avulsion of the ocular nerve. The accurate localization of the foreign body was verified by X-ray and CT imaging. The foreign body was removed through the entry wound. The eye injury resulted in amaurosis. Conclusion. This injury was one of those that could have been prevented.

  16. Gastrointestinal injuries from blunt abdominal trauma in children ...

    African Journals Online (AJOL)

    Treatment consisted of simple closure of perforations, over sewing of contusions, resection and anastomosis for gangrene and repair with protective stoma for the rectal injury. One patient each developed prolonged ileus, urinary tract infection and chest infection, respectively postoperatively. Mortality was 28%, all of who ...

  17. AAST grade III pancreatic injury following blunt abdominal trauma

    African Journals Online (AJOL)

    bowel injuries.4 Isolated pancreatic trauma with disruption of the major pancreatic duct is rare.3 When the pancreas is injured in isolation, its retroperitoneal position makes diagnosis difficult, with a subsequent risk of delayed recognition due to the lack of clinical signs. The incidence of isolated major duct disruption is.

  18. Blunt cardiac injury: case report of salvaged traumatic right atrial rupture.

    Science.gov (United States)

    Al Ayyan, Muna; Aziz, Tanim; El Sherif, Amgad; Bekdache, Omar

    2015-12-01

    The incidence of cardiac rupture following blunt trauma is rare, occurring in 0.3%-0.5% of all blunt trauma patients. It can be fatal at the trauma scene, and is frequently missed in the emergency room setting. The severity of a cardiac trauma is based on the mechanism and degree of the force applied. The objective of this study was to report the case of a 32-year-old male patient who was involved in a motor vehicle collision and presented to the emergency room with signs of hypovolemic shock. The patient was found to have severe chest trauma associated with massive hemothorax requiring immediate intervention. The patient had an emergent thoracotomy revealing a right atrial injury. Repair of the atrial injury reversed the state of shock. The patient was discharged after 35 days of hospitalization in good condition.

  19. EndoVascular and Hybrid Trauma Management (EVTM) for Blunt Innominate Artery Injury with Ongoing Extravasation

    Energy Technology Data Exchange (ETDEWEB)

    Bilos, Linda, E-mail: linda.bilos@regionorebrolan.se; Pirouzram, Artai; Toivola, Asko; Vidlund, Mårten; Cha, Soon Ok; Hörer, Tal [Örebro University Hospital and Örebro University, Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health (Sweden)

    2017-01-15

    Innominate artery (IA) traumatic injuries are rare but life-threatening, with high mortality and morbidity. Open surgical repair is the treatment of choice but is technically demanding. We describe a case of blunt trauma to the IA with ongoing bleeding, treated successfully by combined (hybrid) endovascular and open surgery. The case demonstrates the immediate usage of modern endovascular and surgical tools as part of endovascular and hybrid trauma management.

  20. Frequency of myocardial injury after blunt chest trauma as evaluated by radionuclide angiography

    Energy Technology Data Exchange (ETDEWEB)

    Sutherland, G.R.; Driedger, A.A.; Holliday, R.L.; Cheung, H.W.; Sibbald, W.J.

    1983-11-01

    Seventy-seven patients who had sustained multisystem trauma, including severe blunt chest injury, were prospectively evaluated to assess the frequency of associated traumatic myocardial injury. Traumatic injury to either the right or left ventricle was defined by the presence of discrete abnormalities of wall motion on electrocardiographically gated cardiac scintigraphy in patients without a clinical history of heart disease. Forty-two patients (55%) (Group 1) had focal abnormalities of wall motion; 27 involved the right ventricle, 7 the left ventricle, 7 were biventricular, and 1 involved only the septum. Both the right and left ventricular ejection fractions were significantly lower (31 +/- 11% and 47 +/- 14%, respectively) than those in the 35 traumatized patients without wall motion abnormalities on scintigraphy (Group 2) (49 +/- 8% and 58 +/- 11%, respectively). Repeat scintigraphic examination in 32 Group 1 patients at a time remote from initial injury showed improvement or resolution of previously defined focal wall motion abnormalities in 27 of 32 patients (84%). The electrocardiogram and serum enzyme tests were insensitive indexes of traumatic myocardial injury when defined by the scintigraphic abnormalities. Thus, severe blunt chest trauma results in a higher frequency of traumatic myocardial injury than heretofore recognized, and frequently involves the anteriorly situated right ventricle.

  1. The Association between Blunt Cardiac Injury and Isolated Sternal Fracture

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    Anahita Dua

    2014-01-01

    Full Text Available The treatment of isolated sternal fractures (ISF throughout the world is heterogeneous. This study aimed to identify the incidence, morbidity, and mortality associated with isolated fractures of the sternum and describe current practice for diagnosis and management of ISF and cardiac injury at a level I trauma center in the UK. A retrospective cohort study of adult patients (>16 years with ISF presenting from 2006 to 2010 was conducted. Eighty-eight patients with ISF were identified. Most patients (88%, 77 were admitted to hospital with 66% (58 of them discharged within 48 hours. Two (2% patients had an ER EKG with abnormality but both resolved to normal sinus rhythm within 6 hours of follow-up. Serum CEs were drawn from 55 (63% patients with only 2 (2% having a rise in serum troponin >0.04; however, in both of these patients troponin quickly normalized. Six (7% patients underwent echocardiograms without significant findings. In all 88 patients with ISF, no cases of clinically significant cardiac injury were identified. Patients presenting with an isolated sternal fracture with no changes on EKG or chest X-ray do not warrant an admission to hospital and may be discharged from the ER.

  2. Prevalence of clinically important traumatic brain injuries in children with minor blunt head trauma and isolated severe injury mechanisms.

    Science.gov (United States)

    Nigrovic, Lise E; Lee, Lois K; Hoyle, John; Stanley, Rachel M; Gorelick, Marc H; Miskin, Michelle; Atabaki, Shireen M; Dayan, Peter S; Holmes, James F; Kuppermann, Nathan

    2012-04-01

    To determine the prevalence of clinically important traumatic brain injuries (TBIs) with severe injury mechanisms in children with minor blunt head trauma but with no other risk factors from the Pediatric Emergency Care Applied Research Network (PECARN) TBI prediction rules (defined as isolated severe injury mechanisms). Secondary analysis of a large prospective observational cohort study. Twenty-five emergency departments participating in the PECARN. Children with minor blunt head trauma and Glasgow Coma Scale scores of at least 14. Treating clinicians completed a structured data form that included injury mechanism (severity categories defined a priori). Clinically important TBIs were defined as intracranial injuries resulting in death, neurosurgical intervention, intubation for more than 24 hours, or hospital admission for at least 2 nights. We investigated the rate of clinically important TBIs in children with either severe injury mechanisms or isolated severe injury mechanisms. Of the 42,412 patients enrolled in the overall study, 42,099 (99%) had injury mechanisms recorded, and their data were included for analysis. Of all study patients, 5869 (14%) had severe injury mechanisms, and 3302 (8%) had isolated severe injury mechanisms. Overall, 367 children had clinically important TBIs (0.9%; 95% CI, 0.8%-1.0%). Of the 1327 children younger than 2 years with isolated severe injury mechanisms, 4 (0.3%; 95% CI, 0.1%-0.8%) had clinically important TBIs, as did 12 of the 1975 children 2 years or older (0.6%; 95% CI, 0.3%-1.1%). Children with isolated severe injury mechanisms are at low risk of clinically important TBI, and many do not require emergent neuroimaging.

  3. Blunt cardiac injury due to trauma associated with snowboarding: a case report.

    Science.gov (United States)

    Yamaji, Fuminori; Okada, Hideshi; Nakajima, Yasuhiro; Suzuki, Kodai; Yoshida, Takahiro; Mizuno, Yosuke; Okamoto, Haruka; Kitagawa, Yuichiro; Tanaka, Taku; Nakano, Shiho; Nachi, Sho; Doi, Tomoaki; Kumada, Keisuke; Yoshida, Shozo; Ishida, Narihiro; Shimabukuro, Katsuya; Ushikoshi, Hiroaki; Toyoda, Izumi; Doi, Kiyoshi; Ogura, Shinji

    2017-03-25

    Cardiac trauma is associated with a much higher mortality rate than injuries to other organ systems, even though cardiac trauma is identified in less than 10% of all trauma admissions. Here we report blunt trauma of the left atrium due to snowboarding trauma. A 45-year-old Asian man collided with a tree while he was snowboarding and drinking. He lost consciousness temporarily. An air ambulance was requested and he was transported to an advanced critical care center. On arrival, a pericardial effusion was detected by a focused assessment with sonography for trauma. His presenting electrocardiogram revealed normal sinus rhythm and complete right bundle branch block. Laboratory findings included a white blood cell count of 13.5 × 10 3 /μl, serum creatine kinase level of 459 IU/l, and creatine kinase-myocardial band level of 185 IU/l. Enhanced computed tomography showed a large pericardial effusion and bleeding from his left adrenal gland. There were no pelvic fractures. A diagnosis of cardiac tamponade due to blunt cardiac injury and left adrenal injury due to blunt trauma was made. Subsequently, emergency thoracic surgery and transcatheter arterial embolization of his left adrenal artery were performed simultaneously. A laceration of the left atrial appendage in the lateral wall of his left ventricle was detected intraoperatively and repaired. His postoperative course progressed favorably, although a pericardial effusion was still detected on chest computed tomography on hospital day 35. His electrocardiogram showed normal sinus rhythm and the complete right bundle branch block pattern changed to a narrow QRS wave pattern. He was discharged on hospital day 40. The present case report illustrates two points: (1) severe injuries resulted from snowboarding, and (2) complete right bundle branch block was caused by blunt cardiac injury. The present report showed blunt trauma of the left atrium with complete right bundle branch block as an electrocardiogram change

  4. Natural history of splenic vascular abnormalities after blunt injury: A Western Trauma Association multicenter trial.

    Science.gov (United States)

    Zarzaur, Ben L; Dunn, Julie A; Leininger, Brian; Lauerman, Margaret; Shanmuganathan, Kathirkamanthan; Kaups, Krista; Zamary, Kirellos; Hartwell, Jennifer L; Bhakta, Ankur; Myers, John; Gordy, Stephanie; Todd, Samuel R; Claridge, Jeffrey A; Teicher, Erik; Sperry, Jason; Privette, Alicia; Allawi, Ahmed; Burlew, Clay Cothren; Maung, Adrian A; Davis, Kimberly A; Cogbill, Thomas; Bonne, Stephanie; Livingston, David H; Coimbra, Raul; Kozar, Rosemary A

    2017-12-01

    Following blunt splenic injury, there is conflicting evidence regarding the natural history and appropriate management of patients with vascular injuries of the spleen such as pseudoaneurysms or blushes. The purpose of this study was to describe the current management and outcomes of patients with pseudoaneurysm or blush. Data were collected on adult (aged ≥18 years) patients with blunt splenic injury and a splenic vascular injury from 17 trauma centers. Demographic, physiologic, radiographic, and injury characteristics were gathered. Management and outcomes were collected. Univariate and multivariable analyses were used to determine factors associated with splenectomy. Two hundred patients with a vascular abnormality on computed tomography scan were enrolled. Of those, 14.5% were managed with early splenectomy. Of the remaining patients, 59% underwent angiography and embolization (ANGIO), and 26.5% were observed. Of those who underwent ANGIO, 5.9% had a repeat ANGIO, and 6.8% had splenectomy. Of those observed, 9.4% had a delayed ANGIO, and 7.6% underwent splenectomy. There were no statistically significant differences between those observed and those who underwent ANGIO. There were 111 computed tomography scans with splenic vascular injuries available for review by an expert trauma radiologist. The concordance between the original classification of the type of vascular abnormality and the expert radiologist's interpretation was 56.3%. Based on expert review, the presence of an actively bleeding vascular injury was associated with a 40.9% risk of splenectomy. This was significantly higher than those with a nonbleeding vascular injury. In this series, the vast majority of patients are managed with ANGIO and usually embolization, whereas splenectomy remains a rare event. However, patients with a bleeding vascular injury of the spleen are at high risk of nonoperative failure, no matter the strategy used for management. This group may warrant closer observation or

  5. Simultaneous "traumatic Gerbode" and aortic rupture due to blunt chest trauma

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    Hector Anninos

    2016-01-01

    Full Text Available The Gerbode defect is characterized by a perimembranous ventricular septal defect between the left ventricle and the right atrium. This intracardiac shunt is a congenital defect but may be iatrogenic after valve surgery or atrioventricular node ablation, may be the result of endocarditis or may be traumatic. It is really rarely encountered as sequelae of non-penetrating heart trauma, and their clinical manifestations may often be unrecognized in the multi-injured patient. However, they are serious complications, and their diagnostic approach is not always feasible. We hereby present a case of a young man with the left ventricle to the right atrium communication after blunt thoracic trauma due to a car accident and concomitant rupture of the thoracic aorta. We present also the case and the ways of treatment according to the international bibliography.

  6. The Accuracy and Applicability of 3D Modeling and Printing Blunt Force Cranial Injuries.

    Science.gov (United States)

    Edwards, Julie; Rogers, Tracy

    2017-08-23

    The purpose of this study was to determine the factors affecting the accuracy of 3D models and 3D prints of cranial blunt force trauma, to evaluate the applicability and limitations of modeling such injuries. Three types of cranial blunt force lesions were documented (hinge, depressed, and comminuted) using three forms of surface scanning (laser, structured light scanner, and photogrammetry) at two different quality settings (standard and high). 3D printed models of the lesions were produced using two different materials (a gypsum-like composite powder called VisiJet ® PXL and an acrylic engineered composite plastic called VisiJet ® M3 in crystal colour). The results of these analyzes indicate the prints in this study exhibit some statistically significant differences from the actual bone lesions, but details of the lesions can be reproduced to within 2 mm accuracy. © 2017 American Academy of Forensic Sciences.

  7. Ruling out intra-abdominal injuries in blunt trauma patients using clinical criteria and abdominal ultrasound

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    Flávia Helena Barbosa Moura

    Full Text Available ABSTRACT Objective: to identify victims of blunt abdominal trauma in which intra-abdominal injuries can be excluded by clinical criteria and by complete abdominal ultrasonography. Methods: retrospective analysis of victims of blunt trauma in which the following clinical variables were analyzed: hemodynamic stability, normal neurologic exam at admission, normal physical exam of the chest at admission, normal abdomen and pelvis physical exam at admission and absence of distracting lesions (Abbreviated Injury Scale >2 at skull, thorax and/or extremities. The ultrasound results were then studied in the group of patients with all clinical variables evaluated. Results: we studied 5536 victims of blunt trauma. Intra-abdominal lesions with AIS>1 were identified in 144 (2.6%; in patients with hemodynamic stability they were present in 86 (2%; in those with hemodynamic stability and normal neurological exam at admission in 50 (1.8%; in patients with hemodynamic stability and normal neurological and chest physical exam at admission, in 39 (1.5%; in those with hemodynamic stability, normal neurological, chest, abdominal and pelvic physical exam at admission, in 12 (0.5%; in patients with hemodynamic stability, normal neurological, chest, abdominal and pelvic physical exam at admission, and absence of distracting lesions, only two (0.1% had intra-abdominal lesions. Among those with all clinical variables, 693 had normal total abdominal ultrasound, and, within this group, there were no identified intra-abdominal lesions. Conclusion: when all clinical criteria and total abdominal ultrasound are associated, it is possible to identify a group of victims of blunt trauma with low chance of significant intra-abdominal lesions.

  8. Identifying severe abdominal injuries during the initial assessment in blunt trauma patients.

    Science.gov (United States)

    Farrath, Samires; Parreira, José Gustavo; Olliari, Camilla Bilac; Silva, Mateus Almeida; Perlingeiro, Jacqueline Arantes Giannini; Soldá, Silvia Cristine; Assef, José Cesar

    2013-01-01

    To evaluate the predictive factors of severe abdominal injuries (SAI) identified in the initial assessment of blunt trauma victims. A retrospective analysis of data from blunt trauma victims older than 13 years undergoing abdominal computed tomography and/or laparotomy was carried out. Serious injuries were considered with an Abbreviated Injury Scale (AIS) greater than or equal to three. Variables were compared between both A (SAI) and B (no SAI). We conducted an initial univariate statistical analysis to identify the variables associated with the presence of SAI. From these we selected those that had p<0.20 and could be evaluated on admission of the patient for multivariate analysis (logistic regression). The sample consisted of 331 cases and 140 (42.3%) patients had abdominal injuries. Of these, 101 (30.5%) had abdominal injury with AIS e" 3 (Group A). In univariate analysis, conditions significantly associated with the SAI (p<0.05): systolic blood pressure (SBP) in the pre-hospital setting (p = 0.019), SBP at admission (p<0.001), heart rate at admission (p = 0.047), altered physical examination of the abdomen (p <0.001) and the presence of pelvic fractures (p = 0.006). The following variables were significantly and independently correlated with the presence of severe abdominal injuries: SBP at admission (p = 0.034), altered abdominal physical examination (p<0.001), lower limb fracture (p<0.044), motorcycle accident as mechanism of injury (p = 0.017) and positive FAST (p <0.001). the variables present at baseline were significantly associated with the presence of SAI: SBP, physical examination, altered abdominal examination, presence of open fractures of the lower limb, motorcycle accident and positive FAST.

  9. Laparoscopy decreases the laparotomy rate for hemodynamically stable patients with blunt hollow viscus and mesenteric injuries.

    Science.gov (United States)

    Lin, Heng-Fu; Chen, Ying-Da; Lin, Keng-Li; Wu, Meng Che; Wu, Cheng Yi; Chen, Shyr-Chyr

    2015-08-01

    The aim of this study was to evaluate the effect of laparoscopy on patients with blunt hollow viscus and mesenteric injuries (BHVMIs). Hemodynamically stable patients with BHVMIs were diagnosed using computed tomography and serial examinations. Patients admitted from July 1, 1999 to June 30, 2006 underwent exploratory laparotomy (group A), and those admitted from January 1, 2007 to December 31, 2013 received laparoscopy (group B). There were 62 patients in group A, and 59 patients in group B. There were no significant differences in demographic characteristics, injury severity score, and injuries requiring surgical intervention between the groups (all, P > .05). Patients in group B had a shorter hospital stay (mean 11.0 vs 17.6 days, P laparoscopy to laparotomy in group B was 8.5%, compared with a 100% laparotomy rate in group A (P Laparoscopy is feasible and safe for hemodynamically stable patients with BHVMIs. Copyright © 2015 Elsevier Inc. All rights reserved.

  10. Rare Case of Large Bowel Injury due to Direct Blunt Trauma to a Preexisting Femoral Hernia

    Directory of Open Access Journals (Sweden)

    C. Tinner

    2017-01-01

    Full Text Available We report a case of an 85-year-old man with a known asymptomatic left femoral hernia who was admitted to the emergency ward a few hours after falling from a bicycle and suffering from blunt trauma of the handlebar to the left inguinal region. The clinical findings and a computed tomography (CT scan detecting free air in the femoral hernia sac suggested bowel perforation. Emergency laparotomy 6 hours after the incident confirmed a tear of the sigmoid colon accompanied by free blood and faeces in the left inguinal region of the abdomen. A segmental sigmoid resection and a primary end-to-end colorectal anastomosis were performed. The postoperative course was complicated by delayed oral feeding, a local infection, and a partial left testicle necrosis that led to secondary resection. The patient was discharged after 32 days of in-hospital care. Three months post trauma, we recorded a restitutio ad integrum. The case exemplifies that blunt trauma to preexisting femoral hernias may cause potentially lethal bowel perforation and that the time interval between time of injury and surgical treatment may be a prognostic factor. CT scans seem most suitable for ruling out bowel perforation. The scarce literature for blunt trauma to hernias is reviewed.

  11. Traumatic ventricular septal defect in a 4-year-old boy after blunt chest injury

    Directory of Open Access Journals (Sweden)

    Yun Mi Kim

    2011-02-01

    Full Text Available Traumatic ventricular septal defect (VSD resulting from blunt chest injury is a very rare event. The mechanisms of traumatic VSD have been of little concern to dateuntil now, but two dominant theories have been described. In one, the rupture occurs due to acute compression of the heart; in the other, it is due to myocardial infarction of the septum. The clinical symptoms and timing of presentation are variable, so appropriate diagnosis can be difficult or delayed. Closure of traumatic VSD has been based on a combination of heart failure symptoms, hemodynamics, and defect size. Here, we present a case of a 4-year-old boy who presented with a traumatic VSD following a car accident. He showed normal cardiac structure at the time of injury, but after 8 days, his repeated echocardiography revealed a VSD. He was successfully treated by surgical closure of the VSD, and has been doing well up to the present. This report suggests that the clinician should pay great close attention to the patients injured by blunt chest trauma, keeping in mind the possibility of cardiac injury.

  12. Long-term follow-up of blunt cerebrovascular injuries: Does time heal all wounds?

    Science.gov (United States)

    Laser, Adriana; Bruns, Brandon R; Kufera, Joseph A; Kim, Andrew I; Feeney, Timothy; Tesoriero, Ronald B; Lauerman, Margaret H; Sliker, Clint W; Scalea, Thomas M; Stein, Deborah M

    2016-12-01

    The short-term natural history of blunt cerebrovascular injuries (BCVIs) has been previously described in the literature, but the purpose of this study was to analyze long-term serial follow-up and lesion progression of BCVI. This is a single institution's retrospective review of a prospectively collected database over four years (2009-2013). All patients with a diagnosis of BCVI by computed tomographic (CT) scan were identified, and injuries were graded based on modified Denver scale. Management followed institutional algorithm: initial whole-body contrast-enhanced CT scan, followed by CT angiography at 24 to 72 hours, 5 to 7 days, 4 to 6 weeks, and 3 months after injury. All follow-up imaging, medication management, and clinical outcomes through 6 months following injury were recorded. There were 379 patients with 509 injuries identified. Three hundred eighty-one injuries were diagnosed as BCVI on first CT (Grade 1 injuries, 126; Grade 2 injuries, 116; Grade 3 injuries, 69; and Grade 4 injuries, 70); 100 "indeterminate" on whole-body CT; 28 injuries were found in patients reimaged only for lesions detected in other vessels. Sixty percent were male, mean (SD) age was 46.5 (19.9) years, 65% were white, and 62% were victims of a motor vehicle crash. Most frequently, Grade 1 injuries were resolved at all subsequent time points. Up to 30% of Grade 2 injuries worsened, but nearly 50% improved or resolved. Forty-six percent of injuries originally not detected were subsequently diagnosed as Grade 3 injuries. Greater than 70% of all imaged Grade 3 and Grade 4 injuries remained unchanged at all subsequent time points. This study revealed that there are many changes in grade throughout the six-month time period, especially the lesions that start out undetectable or indeterminate, which become various grade injuries. Low-grade injuries (Grades 1 and 2) are likely to remain stable and eventually resolve. Higher-grade injuries (Grades 3 and 4) persist, many up to six months

  13. The use of black and white infrared photography for recording blunt force injury.

    Science.gov (United States)

    Bernstein, Mark; Nichols, George; Blair, Jeff

    2013-04-01

    Infrared (IR) wavelengths penetrate skin and can selectively image volumes of subsurface blood. Twenty-eight blunt force injuries on nine decedents were photographed with color and IR film to compare the ability of each to image the injury. Of the 28 injuries, 10 were clinically interpreted as contusions, 4 as abrasions, 10 as abraded contusions, and 4 as erythematous discolorations, nos. Twenty-four of these injuries were incised to determine the presence and extent of subsurface bleeding. It was found that contusion had been clinically missed in five cases, three because they were hidden by abrasion and two because they appeared only as a mild cutaneous erythema. All five cases were detected by IR and verified by incision. Melanin pigmentation contributed to masking of contusion in one case and postmortem lividity confounded interpretation of contusion in one case. In all 14 injuries featuring abrasion as a component, IR de-emphasized or eliminated the visibility of abrasion. A single false negative was reported in which a visible contusion, verified by incision, was not seen with IR. In comparing injury patterns, color and IR renditions were dissimilar in a number of cases reflecting the difference between the manner in which light and IR photography imaged the depth and volume of blood within an injury. In summary, IR imaging of wounds can discover hidden bruises, verify clinical diagnosis of bruises, and augment interpretation of wound patterns. Copyright © 2012 Wiley Periodicals, Inc.

  14. Chylothorax after Blunt Chest Trauma: A Case Report

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    Pawit Sriprasit

    2017-10-01

    Full Text Available Traumatic chylothorax after blunt chest trauma alone is considered rare. Our patient was a 27-year-old female who was in a motorcycle accident and sustained blunt thoracic and traumatic thoracic aortic injuries with T1–T2 vertebral subluxation. She underwent thoracic endovascular aortic repair from T4 to T9 without any thoracic or spinal surgery. On postoperative day 7, the drainage from her left chest turned into a milky- white fluid indicative of chyle leakage. The patient was treated conservatively for 2 weeks and then the chest drain was safely removed. The results show that traumatic chylothorax can be successfully managed with conservative treatment.

  15. A novel decision tree approach based on transcranial Doppler sonography to screen for blunt cervical vascular injuries.

    Science.gov (United States)

    Purvis, Dianna; Aldaghlas, Tayseer; Trickey, Amber W; Rizzo, Anne; Sikdar, Siddhartha

    2013-06-01

    Early detection and treatment of blunt cervical vascular injuries prevent adverse neurologic sequelae. Current screening criteria can miss up to 22% of these injuries. The study objective was to investigate bedside transcranial Doppler sonography for detecting blunt cervical vascular injuries in trauma patients using a novel decision tree approach. This prospective pilot study was conducted at a level I trauma center. Patients undergoing computed tomographic angiography for suspected blunt cervical vascular injuries were studied with transcranial Doppler sonography. Extracranial and intracranial vasculatures were examined with a portable power M-mode transcranial Doppler unit. The middle cerebral artery mean flow velocity, pulsatility index, and their asymmetries were used to quantify flow patterns and develop an injury decision tree screening protocol. Student t tests validated associations between injuries and transcranial Doppler predictive measures. We evaluated 27 trauma patients with 13 injuries. Single vertebral artery injuries were most common (38.5%), followed by single internal carotid artery injuries (30%). Compared to patients without injuries, mean flow velocity asymmetry was higher for single internal carotid artery (P = .003) and single vertebral artery (P = .004) injuries. Similarly, pulsatility index asymmetry was higher in single internal carotid artery (P = .015) and single vertebral artery (P = .042) injuries, whereas the lowest pulsatility index was elevated for bilateral vertebral artery injuries (P = .006). The decision tree yielded 92% specificity, 93% sensitivity, and 93% correct classifications. In this pilot feasibility study, transcranial Doppler measures were significantly associated with the blunt cervical vascular injury status, suggesting that transcranial Doppler sonography might be a viable bedside screening tool for trauma. Patient-specific hemodynamic information from transcranial Doppler assessment has the potential to alter

  16. The efficacy and benefits of transcatheter arterial embolization (TAE) in patients with blunt splenic injury

    International Nuclear Information System (INIS)

    Kwack, Kyu Sung; Kim, Young Ju; Lee, Myung Sub; Kim, Dong Jin; Hong, In Soo

    2000-01-01

    To evaluate the efficacy and benefits of transcatheter arterial embolization (TAE) in patients with blunt splenic injury after blunt abdominal trauma. We retrospectively analyzed the results of transcatheter arterial embolization in 23 patients who suffered splenic injury after blunt abdominal trauma. Fourteen of the patients were male, and 9 were female; 13 were adults, and 10 were children. Transcatheter arterial embolization was performed in patients with hypotension, tachycardia, evidence of hemodynamic instability due, for example, to low levels of Hgb and Hct, or those who needed fluid therapy or blood transfusion. After embolization the patients' progress was monitored by CT scanning, abdominal sonography, or 99m Tc-sulfur colloid scintigraphy. The degree of splenic injury was classified according to the system devised by Mirvis et al.; nine cases were CT grade III, and 14 were grade IV. After demonstrating angiographically the site of contrast leakage, embolization was performed; for this, a coil only was used in 16 cases, gelfoam only in four, and both coil and gelfoam in three. There were three sites of vascular embolization: 16 procedures were performed in the proximal part of the main trunk of the splenic artery, four in a superselected branch of this same artery, and three in both the splenic artery and one of its superselected branches. Of the 23 cases, 18 recovered without splenectomy after embolization, three adult patients died from coexisting conditions (spinal or cerebral injuries, liver cirrhosis, or pelvic bone fracture) or complications (acute renal failure or disseminated intravascular coagulation). Due to co-existing pancreatic and mesenteric vessel injury, two of the adult patients who underwent TAE also underwent delayed surgery; intraoperatively, there was no evidence of splenic rebleeding. In all patients who did not undergo surgery, follow-up observation revealed a decreased volume of hemoperitoneum, increased uptake of radionuclide in

  17. The efficacy and benefits of transcatheter arterial embolization (TAE) in patients with blunt splenic injury

    Energy Technology Data Exchange (ETDEWEB)

    Kwack, Kyu Sung; Kim, Young Ju; Lee, Myung Sub; Kim, Dong Jin; Hong, In Soo [Wonju Christian Hospital, College of Medicine, Yonsei University, Wonju (Korea, Republic of)

    2000-07-01

    To evaluate the efficacy and benefits of transcatheter arterial embolization (TAE) in patients with blunt splenic injury after blunt abdominal trauma. We retrospectively analyzed the results of transcatheter arterial embolization in 23 patients who suffered splenic injury after blunt abdominal trauma. Fourteen of the patients were male, and 9 were female; 13 were adults, and 10 were children. Transcatheter arterial embolization was performed in patients with hypotension, tachycardia, evidence of hemodynamic instability due, for example, to low levels of Hgb and Hct, or those who needed fluid therapy or blood transfusion. After embolization the patients' progress was monitored by CT scanning, abdominal sonography, or {sup 99m}Tc-sulfur colloid scintigraphy. The degree of splenic injury was classified according to the system devised by Mirvis et al.; nine cases were CT grade III, and 14 were grade IV. After demonstrating angiographically the site of contrast leakage, embolization was performed; for this, a coil only was used in 16 cases, gelfoam only in four, and both coil and gelfoam in three. There were three sites of vascular embolization: 16 procedures were performed in the proximal part of the main trunk of the splenic artery, four in a superselected branch of this same artery, and three in both the splenic artery and one of its superselected branches. Of the 23 cases, 18 recovered without splenectomy after embolization, three adult patients died from coexisting conditions (spinal or cerebral injuries, liver cirrhosis, or pelvic bone fracture) or complications (acute renal failure or disseminated intravascular coagulation). Due to co-existing pancreatic and mesenteric vessel injury, two of the adult patients who underwent TAE also underwent delayed surgery; intraoperatively, there was no evidence of splenic rebleeding. In all patients who did not undergo surgery, follow-up observation revealed a decreased volume of hemoperitoneum, increased uptake of

  18. Cardiac magnetic resonance imaging in suspected blunt cardiac injury: A prospective, pilot, cohort study.

    Science.gov (United States)

    Burrell, Aidan Jc; Kaye, David M; Fitzgerald, Mark C; Cooper, David J; Hare, James L; Costello, Benedict T; Taylor, Andrew J

    2017-05-01

    The aim of this study was to evaluate the incidence and severity of blunt cardiac injury (BCI) as determined by cardiac magnetic resonance imaging (CMR), and to compare this to currently used diagnostic methods in severely injured patients. We conducted a prospective, pilot cohort study of 42 major trauma patients from July 2013 to Jan 2015. The cohort underwent CMR within 7 days, enrolling 21 patients with evidence of chest injury and an elevated Troponin I compared to 21 patients without chest injury who acted as controls. Major adverse cardiac events (MACE) including ventricular arrhythmia, unexplained hypotension requiring inotropes, or a requirement for cardiac surgery were recorded. 6/21 (28%) patients with chest injuries had abnormal CMR scans, while all 21 control patients had normal scans. CMR abnormalities included myocardial oedema, regional wall motion abnormalities, and myocardial haemorrhage. The left ventricle was the commonest site of injury (5/6), followed by the right ventricle (2/6) and tricuspid valve (1/6). MACE occurred in 5 patients. Sensitivity and specificity values for CMR at predicting MACE were 60% (15-95) and 81% (54-96), which compared favourably with other tests. In this pilot trial, CMR was found to give detailed anatomic information of myocardial injury in patients with suspected BCI, and may have a role in the diagnosis and management of patients with suspected BCI. Copyright © 2017 Elsevier Ltd. All rights reserved.

  19. Blunt splenic injury: are early adverse events related to trauma, nonoperative management, or surgery?

    Science.gov (United States)

    Frandon, Julien; Rodiere, Mathieu; Arvieux, Catherine; Vendrell, Anne; Boussat, Bastien; Sengel, Christian; Broux, Christophe; Bricault, Ivan; Ferretti, Gilbert; Thony, Frédéric

    2015-01-01

    We aimed to compare clinical outcomes and early adverse events of operative management (OM), nonoperative management (NOM), and NOM with splenic artery embolization (SAE) in blunt splenic injury (BSI) and identify the prognostic factors. Medical records of 136 consecutive patients with BSI admitted to a trauma center from 2005 to 2010 were retrospectively reviewed. Patients were separated into three groups: OM, NOM, and SAE. We focused on associated injuries and early adverse events. Multivariate analysis was performed on 23 prognostic factors to find predictors. The total survival rate was 97.1%, with four deaths all occurred in the OM group. The spleen salvage rate was 91% in NOM and SAE. At least one adverse event was observed in 32.8%, 62%, and 96% of patients in NOM, SAE, and OM groups, respectively (P events: simplified acute physiology score 2 ≥25 for almost all adverse events, age ≥50 years for acute respiratory syndrome, limb fracture for secondary bleeding, thoracic injury for pleural drainage, and at least one associated injury for pseudocyst. Adverse events were not related to the type of BSI management. Patients with BSI present worse outcome and more adverse events in OM, but this is related to the severity of injury. The main predictor of adverse events remains the severity of injury.

  20. Assessment of the TASER XREP blunt impact and penetration injury potential using cadaveric testing.

    Science.gov (United States)

    Lucas, Scott R; McGowan, Joseph C; Lam, Tack C; Yamaguchi, Gary T; Carver, Matthew; Hinz, Andrew

    2013-01-01

    TASER International's extended range electronic projectile (XREP) is intended to be fired from a shotgun, impact a threat, and apply remote neuromuscular incapacitation. This study investigated the corresponding potential of blunt impact injury and penetration. Forty-three XREP rounds were deployed onto two male human cadaver torsos at impact velocities between 70.6 and 95.9 m/sec (232 and 315 ft/sec). In 42 of the 43 shots fired, the XREP did not penetrate the abdominal wall, resulting in superficial wounds only. On one shot, the XREP's nose section separated prematurely in flight, resulting in penetration. No bony fractures were observed with any of the shots. The viscous criterion (VC), blunt criterion (BC), and energy density (E/A) were calculated (all nonpenetrating tests, average ± 1 standard deviation: VC: 1.14 ± 0.94 m/sec, BC: 0.77 ± 0.15, E/A: 22.6 ± 4.15 J/cm(2)) and, despite the lack of injuries, were generally found to be greater than published tolerance values. © 2012 American Academy of Forensic Sciences.

  1. Blunt trauma pancreatic duct injury managed by non-operative technique, a case study and literature review

    Directory of Open Access Journals (Sweden)

    A. Zala

    2015-02-01

    Full Text Available We describe the case of a 15 year old boy who presented with generalised abdominal pain following a seemingly minor collision at weekend soccer. Investigation revealed a grade IV pancreatic injury that was subsequently managed with pancreatic stent insertion by endoscopic retrograde cholangiopancreatography (ERCP and total parenteral nutrition (TPN prior to recommencing low fat diet 10 days post-injury. Keywords: Trauma, Blunt injury, Pancreas, Non-operative

  2. Performance of the 4-way range of motion test for radiographic injuries after blunt elbow trauma.

    Science.gov (United States)

    Vinson, David R; Kann, Gregory S; Gaona, Samuel D; Panacek, Edward A

    2016-02-01

    Acute elbow injuries are common in the acute care setting. A previous study observed that limited active range of motion (ROM) was highly sensitive for radiographic injuries after blunt trauma. Our aim was to validate these findings in patients ≥5 years old with an acute (undergoing plain radiographs of an injured elbow in 3 emergency departments. Before imaging, treating clinicians completed a standardized data collection sheet including mechanism of injury and 4-way ROM findings (full extension, flexion to 90°, full pronation and supination). Radiographic interpretation by a staff radiologist was used to ascertain the presence of fracture or joint effusion. The median age of the 251 patients was 24 years. Ninety-two patients (36.7%) had active 4-way ROM, and 159 patients (63.3%) demonstrated limited ROM. Negative radiographs were present in 152 patients (60.6%), whereas 99 patients (39.4%) had abnormal radiographs: 75 with explicit fractures and 24 with only joint effusions. The 4-way ROM elbow test had a sensitivity of 0.99 (95% confidence interval [CI], 0.94-1.00), specificity of 0.60 (95% CI, 0.52-0.68), positive predictive value of 0.62 (95% CI, 0.54-0.69), and negative predictive value of 0.99 (95% CI, 0.94-1.00). Active 4-way ROM test is 99% sensitive for all radiographic injures following blunt elbow trauma and 100% sensitive for injuries requiring surgical intervention. Caution should be used in relying on this test in the pediatric population until it is validated in a larger cohort. Copyright © 2015 Elsevier Inc. All rights reserved.

  3. Esophageal Foreign Body Causing Direct Aortic Injury

    Directory of Open Access Journals (Sweden)

    ECS Lam

    2003-01-01

    Full Text Available Foreign bodies in the esophagus are uncommon causes of esophageal perforation. Many nonperforating cases are successfully managed by flexible gastroscopy. However, complicated foreign bodies such as those that result in esophageal perforation and vascular injury are best managed surgically. Gastroscopy remains the primary method of diagnosis. A case of a 59-year-old woman who developed retrosternal and intrascapular pain, odynophagia and hematemesis after eating fish is reported. Flexible gastroscopy showed arterial bleeding from the midthoracic esophagus. Computed tomography scan localized a 3 cm fish bone perforating the esophagus with surrounding hematoma. An aortogram did not reveal an actively bleeding aortoesophageal fistula. The fish bone was surgically removed and the patient recovered with no postoperative complications. This case illustrates the importance of early consideration for surgical intervention when confronted with a brisk arterial bleed from the esophagus with suggestive history of foreign body ingestion.

  4. Utility of MRI for cervical spine clearance after blunt traumatic injury: a meta-analysis

    Energy Technology Data Exchange (ETDEWEB)

    Malhotra, Ajay; Wu, Xiao; Kalra, Vivek B.; Liu, Renu; Forman, Howard P. [Yale School of Medicine, Department of Radiology and Biomedical Imaging, Tompkins East 2, 333 Cedar St, Box 208042, New Haven, CT (United States); Nardini, Holly K.G. [Yale University, Research and Education Librarian, Harvey Cushing/John Hay Whitney Medical Library, New Haven, CT (United States); Abbed, Khalid M. [Yale School of Medicine, Minimally Invasive Spine Surgery and Spine Tumor Surgery, New Haven, CT (United States)

    2017-03-15

    To quantify the rate of unstable injuries detected by MRI missed on CT in blunt cervical spine (CS) trauma patients and assess the utility of MRI in CS clearance. We undertook a systematic review of worldwide evidence across five major medical databases and performed a meta-analysis. Studies were included if they reported the number of unstable injuries or gave enough details for inference. Variables assessed included severity, CT/MRI specifications, imaging timing, and outcome/follow-up. Pooled incidences of unstable injury on follow-up weighted by inverse-of-variance among all included and obtunded or alert patients were reported. Of 428 unique citations, 23 proved eligible, with 5,286 patients found, and 16 unstable injuries reported in five studies. The overall pooled incidence is 0.0029 %. Among studies reporting only obtunded patients, the pooled incidence is 0.017 %. In alert patients, the incidence is 0.011 %. All reported positive findings were critically reviewed, and only 11 could be considered truly unstable. There is significant heterogeneity in the literature regarding the use of imaging after a negative CT. The finding rate on MRI for unstable injury is extremely low in obtunded and alert patients. Although MRI is frequently performed, its utility and cost-effectiveness needs further study. (orig.)

  5. Vertebral artery injury associated with blunt cervical spine trauma: a multivariate regression analysis.

    Science.gov (United States)

    Lebl, Darren R; Bono, Christopher M; Velmahos, George; Metkar, Umesh; Nguyen, Joseph; Harris, Mitchel B

    2013-07-15

    Retrospective analysis of prospective registry data. To determine the patient characteristics, risk factors, and fracture patterns associated with vertebral artery injury (VAI) in patients with blunt cervical spine injury. VAI associated with cervical spine trauma has the potential for catastrophical clinical sequelae. The patterns of cervical spine injury and patient characteristics associated with VAI remain to be determined. A retrospective review of prospectively collected data from the American College of Surgeons trauma registries at 3 level-1 trauma centers identified all patients with a cervical spine injury on multidetector computed tomographic scan during a 3-year period (January 1, 2007, to January 1, 2010). Fracture pattern and patient characteristics were recorded. Logistic multivariate regression analysis of independent predictors for VAI and subgroup analysis of neurological events related to VAI was performed. Twenty-one percent of 1204 patients with cervical injuries (n = 253) underwent screening for VAI by multidetector computed tomography angiogram. VAI was diagnosed in 17% (42 of 253), unilateral in 15% (38 of 253), and bilateral in 1.6% (4 of 253) and was associated with a lower Glasgow coma scale (P < 0.001), a higher injury severity score (P < 0.01), and a higher mortality (P < 0.001). VAI was associated with ankylosing spondylitis/diffuse idiopathic skeletal hyperosteosis (crude odds ratio [OR] = 8.04; 95% confidence interval [CI], 1.30-49.68; P = 0.034), and occipitocervical dissociation (P < 0.001) by univariate analysis and fracture displacement into the transverse foramen 1 mm or more (adjusted OR = 3.29; 95% CI, 1.15-9.41; P = 0.026), and basilar skull fracture (adjusted OR = 4.25; 95% CI, 1.25-14.47; P= 0.021), by multivariate regression model. Subgroup analyses of neurological events secondary to VAI occurred in 14% (6 of 42) and the stroke-related mortality rate was 4.8% (2 of 42). Neurological events were associated with male sex (P

  6. Pattern of visceral injuries following blunt abdominal trauma in motor vehicular accidents

    International Nuclear Information System (INIS)

    Khan, J.S.; Iqbal, N.; Gardezi, J.R.

    2006-01-01

    To determine the frequency of various visceral injuries following, high-speed motor vehicle crashes with special reference to frequency of liver injuries, severity and complications. The study included 100 consecutive patients of blunt abdominal trauma. Patients of either gender and age above 12 and below 70 were included in this study. Purposive non-probability sampling was done. Injuries were identified, graded and managed accordingly. The data was then entered into SPSS and descriptive statistical tests were applied. Liver was the most common organ injured (35%), followed by spleen (32 %) and small gut (30 %). In 23 patients, liver was the only organ injured. Most of the liver injuries fell under grade I (42.8%) followed by grade II (28.35%) and grade III (22.85%) and were treated by suture hepatorrhaphy alone in 71.42% cases. The operated cases were mostly complicated by wound infection (33.76%). Overall mortality remained high (12%) and was related to a combination of delays in arriving at a diagnosis due to nonavailability of CT scan and routine use of peritoneal lavage. (author)

  7. Blunt cerebrovascular injury in rugby and other contact sports: case report and review of the literature.

    Science.gov (United States)

    Cuellar, Trajan A; Lottenberg, Lawrence; Moore, Frederick A

    2014-01-01

    Contact sports have long been a part of human existence. The two earliest recorded organized contact games, both of which still exist, include Royal Shrovetide Football played since the 12(th) century in England and Caid played since 1308 AD in Ireland. Rugby is the premier contact sport played throughout the world with the very popular derivative American football being the premier contact sport of the North American continent. American football in the USA has on average 1,205,037 players at the high school and collegiate level per year while rugby in the USA boasts a playing enrollment of 457,983 at all levels. Recent media have highlighted injury in the context of competitive contact sports including their long-term sequelae such as chronic traumatic encephalopathy (CTE) that had previously been underappreciated. Blunt cerebrovascular injury (BCVI) has become a recognized injury pattern for trauma; however, a paucity of data regarding this injury can be found in the sports trauma literature. We present a case of an international level scrum-half playing Rugby Union at club level for a local non-professional team, in which a player sustained a fatal BCVI followed by a discussion of the literature surrounding sport related BCVI.

  8. Management of children with solid organ injuries after blunt torso trauma.

    Science.gov (United States)

    Wisner, David H; Kuppermann, Nathan; Cooper, Arthur; Menaker, Jay; Ehrlich, Peter; Kooistra, Josh; Mahajan, Prashant; Lee, Lois; Cook, Lawrence J; Yen, Kenneth; Lillis, Kathy; Holmes, James F

    2015-08-01

    Management of children with intra-abdominal solid organ injuries has evolved markedly. We describe the current management of children with intra-abdominal solid organ injuries after blunt trauma in a large multicenter network. We performed a planned secondary analysis of a prospective, multicenter observational study of children (trauma. We included children with spleen, liver, or kidney injuries identified by computed tomography, laparotomy/laparoscopy, or autopsy. Outcomes included disposition and interventions (blood transfusion for intra-abdominal hemorrhage, angiography, laparotomy/laparoscopy). We performed subanalyses of children with isolated injuries. A total of 12,044 children were enrolled; 605 (5.0%) had intra-abdominal solid organ injuries. The mean (SD) age was 10.7 (5.1) years, and injured organs included spleen 299 (49.4%), liver 282 (46.6%), and kidney 147 (24.3%). Intraperitoneal fluid was identified on computed tomography in 461 (76%; 95% confidence interval [CI], 73-80%), and isolated solid organ injuries were present in 418 (69%; 95% CI, 65-73%). Treatment included therapeutic laparotomy in 17 (4.1%), angiographic embolization in 6 (1.4%), and blood transfusion in 46 (11%) patients. Laparotomy rates for isolated injury were 11 (5.4%) of 205 (95% CI, 2.7-9.4%) at non-freestanding children's hospitals and 6 (2.8%) of 213 (95% CI, 1.0-6.0%) at freestanding children's hospitals (difference, 2.6%; 95% CI, -7.1% to 12.2%). Dispositions of the 212 children with isolated Grade I or II organ injuries were home in 6 (3%), emergency department observation in 9 (4%), ward in 114 (54%), intensive care unit in 73 (34%), operating suite in 7 (3%), and transferred in 3 (1%) patients. Intensive care unit admission for isolated Grade I or II injuries varied by center from 9% to 73%. Most children with solid organ injuries are managed with observation. Blood transfusion, while uncommon, is the most frequent therapeutic intervention; angiographic embolization and

  9. The comparison of C-proteasome activity in the plasma of children after burn injury, mild head injury and blunt abdominal trauma.

    Science.gov (United States)

    Matuszczak, Ewa; Tylicka, Marzena; Dębek, Wojciech; Hermanowicz, Adam; Ostrowska, Halina

    2015-09-01

    We aimed to evaluate and compare the changes in circulating 20S proteasome activity in the plasma of children suffering from blunt abdominal trauma, thermal injury and mild head injury. The study population comprised 40 patients with burns, 35 children admitted due to mild head injury, and 30 children suffering from blunt abdominal trauma, who were admitted to Pediatric Surgery Department of Medical University of Bialystok Poland, between 2010 and 2014, and their parents gave informed consent, were included into the study. Patients were aged 9 months to 17 years (median=5.73±1.91y). The girls to boys ratio was nearly 1:2 (34 girls and 106 boys). Plasma proteasome activity was assessed using Suc-Leu-Leu-Val-Tyr-AMC peptide substrate, 2-6h, 12-16h, and 48h after the injury. 20 healthy children admitted for planned inguinal hernia repair served as controls. In our series of patients, the C-proteasome activity was much higher 12-16h after burns, than after mild head injuries, or blunt abdominal injuries, and the difference was statistically significant (pmild head injury and blunt abdominal trauma. Therefore detection of 20S proteasome may represent a novel marker of immunological activity and cellular degradation in trauma patients. Copyright © 2015 Medical University of Bialystok. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.

  10. Lack of utility of repeat monitoring of hemoglobin and hematocrit following blunt solid organ injury in children.

    Science.gov (United States)

    Acker, Shannon N; Petrun, Branden; Partrick, David A; Roosevelt, Genie E; Bensard, Denis D

    2015-12-01

    Current management protocols for children with blunt solid organ injury to the liver and spleen call for serial monitoring of the child's hemoglobin and hematocrit every 6, 12, or 24 hours, depending on the injury grade. We hypothesized that children who require emergent intervention in the form of laparotomy, angioembolization, or packed red blood cell (PRBC) transfusion because of bleeding from a solid organ injury will have changes in their vital signs that alert the clinician to the need for intervention, making scheduled laboratory evaluation unnecessary. We performed a retrospective review of all children admitted to either of two pediatric trauma centers following blunt trauma with any grade liver or spleen injury from January 2009 to December 2013. Data evaluated include a need for intervention, indication for intervention, and timing of intervention. A total of 245 children were admitted with blunt liver or spleen injury. Six patients (2.5%) underwent emergent exploratory laparotomy for hypotension a median of 4 hours after injury (range, 2-4 hours), four of who required splenectomy. No child required laparotomy for delayed bleeding from a solid organ injury. One child (0.4%) underwent angioembolization for blunt splenic injury. Forty-one children (16.7%) received a PRBC transfusion during hospitalization, 32 of whom did not undergo laparotomy or angioembolization. Children who underwent an intervention had a lower nadir hematocrit (median, 22.9 vs. 32.8; p hematocrit (median, 35.5 vs. 16 hours; p hemoglobin and hematocrit monitoring (median, 20 vs. 5; p hemoglobin and hematocrit values may not be necessary. Retrospective study with no negative criteria, prognostic study, level III.

  11. AN ANALYSIS ON HOLLOW VISCERAL INJURY AND ITS MANAGEMENT FOLLOWING BLUNT TRAUMA ABDOMEN AT A TERTIARY HEALTHCARE CENTRE

    Directory of Open Access Journals (Sweden)

    Niranjan Sahoo

    2017-10-01

    Full Text Available BACKGROUND Trauma is “the neglected disease of modern developing nations.” Hollow viscous injury following blunt trauma to abdomen is not common. The incidence of hollow viscous injuries following abdominal trauma varies from 2 to 15%. The following study was conducted at Department of General Surgery, MKCG Medical College and Hospital, Berhampur, a tertiary care hospital. MATERIALS AND METHODS All the patients admitted to MKCG Medical College and Hospital, Berhampur, with history of blunt trauma to abdomen were examined carefully. Those patients with symptoms and signs suggestive of visceral injury were identified and subjected to xray chest and abdomen erect view and ultrasound abdomen/CT scan. Those with features of pneumoperitoneum are subjected to laparotomy and treated according to location of perforation. Duration of study was from January 2016 to July 2017. RESULTS This study included people of different age groups from 13 to 65 years. Majority of the patients were men (83.5% and most common mode was found to be road traffic accident (69.6%. Most of the patients injured were young and belonged to earning group (81.44%. Most common viscera injured was ileum (37.85% Most common type of injury encountered in our study was isolated perforation and the common surgical procedure was primary closure. CONCLUSION In cases of polytrauma, blunt abdominal trauma contributes significantly to morbidity and mortality. Both the sexes were affected with a male preponderance. The most common mode of blunt trauma was found to be Road Traffic Accident (RTA. Adequate knowledge regarding suspecting intra-abdominal injuries and timely management at tertiary care centre can definitely bring a marked difference in the prognosis of polytrauma patients with history of blunt trauma to abdomen.

  12. Is It safe? Nonoperative management of blunt splenic injuries in geriatric trauma patients.

    Science.gov (United States)

    Trust, Marc D; Teixeira, Pedro G; Brown, Lawrence H; Ali, Sadia; Coopwood, Ben; Aydelotte, Jayson D; Brown, Carlos V R

    2018-01-01

    Because of increased failure rates of nonoperative management (NOM) of blunt splenic injuries (BSI) in the geriatric population, dogma dictated that this management was unacceptable. Recently, there has been an increased use of this treatment strategy in the geriatric population. However, published data assessing the safety of NOM of BSI in this population is conflicting, and well-powered multicenter data are lacking. We performed a retrospective analysis of data from the National Trauma Data Bank (NTDB) from 2014 and identified young (age Injury Severity Score of 16 or higher was the only independent risk factor associated with failure of NOM in geriatric patients (odds ratio, 2.778; confidence interval, 1.769-4.363; p Injury Severity Score of 16 or higher, Glasgow Coma Scale score of 8 or less, and cardiac disease. However, failure of NOM was not independently associated with mortality (odds ratio, 1.429; confidence interval, 0.776-2.625; p = 0.25). Compared with younger patients, geriatric patients had a higher but comparable rate of failed NOM of BSI, and failure rates are lower than previously reported. Failure of NOM in geriatric patients is not an independent risk factor for mortality. Based on our results, NOM of BSI in geriatric patients is safe. Therapeutic, level IV.

  13. Blunt thoracic trauma and cardiac injury in the athlete: contemporary management.

    Science.gov (United States)

    DE Gregorio, Cesare; Magaudda, Ludovico

    2017-09-29

    Commotion cordis and cardiac injuries are rare events usually following a chest blunt trauma during sports activities. Various aetiologies have been identified to cause electrical (commotion cordis) and/or structural (contusion and further injuries) damage, but high-velocity tools such as baseballs or hockey pucks (also called projectiles) have been chiefly identified. Clinical consequences are challenging, varying from uncomplicated supraventricular arrhythmias to cardiac wall rupture. Ventricular fibrillation is the most remarkable outcome leading to cardiac arrest in some individuals. In this article, up-to-date epidemiological and pathophysiological issues are discussed, along with the most suitable assistance protocols of the injured athlete in the sports arena. Current knowledge about traumatic sports injuries and ensuing cardiovascular sequelae made significant steps forwards than in the past. The majority of athletes (especially the youngest ones) wearing chest protectors are usually preserved from serious outcomes and sudden cardiac death, but further technical effort is encouraged to attain more satisfactory barriers against projectile's impact. Educational campaigns among students, closer team surveillance, implementation of the sports arenas with adequate rescue devices and medical assistance remain mandatory in every sports activity.

  14. Abdominal injuries following bicycle-related blunt abdominal trauma in children.

    Science.gov (United States)

    Klin, Baruch; Efrati, Yigal; Vaiman, Michael; Kozer, Eran; Jeroukhimov, Igor; Abu-Kishk, Ibrahim

    2016-06-01

    The aim of this study was to confirm our clinical impression that intra-abdominal handlebar injuries are progressively increasing in number and severity in the latest years. A retrospective analysis of data concerning 132 patients admitted to our department of pediatric surgery during a 10-year period (between 2003 and 2012), following bicycle-related blunt abdominal trauma, was performed. Patients were divided into two groups: those who fall from their bicycle (N.=43) and those who sustained direct impact from the handlebars (N.=89) and compared. Number of admitted patients due to bike related injury was increased during a 10-year period. The bikes used by 91.6% of the participants were the high quality BMX, with rigid and strong handlebars. The average age for both groups was 10.3 years (4-16 years). Boys were injured more than girls. Thirty patients from both groups sustained severe abdominal visceral injuries, 25 from the handlebar group and 6 from the fall group (P=0.018). The overall average length of hospital stay was 3.04 days, with 36 cases (27.36%) requiring pediatric intensive care unit (PICU) admission (N.=26 of the handlebar group and N.=10 of the fall group, P=0.024). Eight children sustaining handlebar injuries required abdominal surgery compared to only one case for the fall group (P=0.018), when excluding extra-abdominal procedures. Number of pediatric patients admitted due to bike related injury has been gradually increasing. Children who suffer from direct impact of the handlebars are more likely to require abdominal operative intervention and PICU admission than those who fall. Preventive measures are urgently needed in order to defeat this trend.

  15. The use of laparoscopy in the diagnosis and treatment of blunt and penetrating abdominal injuries: 10-year experience at a level 1 trauma center.

    Science.gov (United States)

    Johnson, Jeremy J; Garwe, Tabitha; Raines, Alexander R; Thurman, Joseph B; Carter, Sandra; Bender, Jeffrey S; Albrecht, Roxie M

    2013-03-01

    Diagnostic laparoscopy (DL) has decreased the rate of nontherapeutic laparotomy for patients suffering from penetrating injuries. We evaluated whether DL similarly lowers the rate of nontherapeutic laparotomy for patients with blunt injuries. All patients undergoing DL over a 10-year period (ie, 2001-2010) in a single level 1 trauma center were classified by the mechanism of injury. Demographic and perioperative data were compared using the Student t and Fisher exact tests. There were 131 patients included, 22 of whom sustained blunt injuries. Patients suffering from blunt injuries were more severely injured (Injury Severity Score 18.0 vs 7.3, P = .0001). The most common indication for DL after blunt injury was a computed tomographic scan concerning for bowel injury (59.1%). The rate of nontherapeutic laparotomy for patients sustaining penetrating vs blunt injury was 1.8% and nil, respectively. DL, when coupled with computed tomographic findings, is an effective tool for the initial management of patients with blunt injuries. Copyright © 2013 Elsevier Inc. All rights reserved.

  16. Right hepatic vein injury after blunt abdominal trauma in a 12-year-old boy- case report

    International Nuclear Information System (INIS)

    Roik, D.; Konecka, A.; Brzewski, M.; Marcinski, A.; Kaminski, A.; Piotrowska, A.; Jasinska, A.

    2008-01-01

    Blunt abdominal trauma in children is one of the most frequent causes of hospitalization. We present a rare case of traumatic liver injury. A 12-year-old boy was admitted to the Surgery Department after a bicycle fall and handlebar impact injury to the right infracostal area. At admission he was stable, with no abnormalities except for a subcutaneous hepatoma found in the injured area. Abdominal ultrasound examination revealed free intraperitoneal fluid. Computed tomography (CT) revealed irregular branching laceration of the right superior hepatic segments with extension into the hepatic veins. No active extravasation of contrast material was seen. On the next day, cause of the deterioration of the patient's condition, CT examination was repeated and revealed focal extravasation of contrast material in the portal hilum posterior to the gallbladder. An injury of the right hepatic vein was found on laparotomy. Hepatic vein injury is a rare but very serious complication after blunt liver trauma and it is an indication for surgical treatment. Diagnostic imaging is essential for therapeutic decisions, but its value is sometimes limited.The precise analysis of injury mechanism and localization may be very helpful.CT is currently the modality of choice for the evaluation of blunt liver trauma. If an active bleeding is suspected the delayed scans seem to be recommended. (author)

  17. Cardiopulmonary bypass after severe blunt hepatic injury: management of multi-system blunt trauma in an adolescent.

    Science.gov (United States)

    Streit, Stephanie; Kavarana, Minoo; Scheurer, Mark A; Cina, Robert A

    2013-06-01

    A 16-year-old adolescent male sustained combined injuries to the tricuspid valve and liver. This injury is exceptional due to the mechanism and the circumstances in which it took place: a flying pumpkin thrown from a sport utility vehicle. An echocardiogram demonstrated a flail chordal apparatus associated with the posterior leaflet of the tricuspid valve, creating substrate for severe tricuspid regurgitation with preserved right heart function. He was treated with non-operative management for the liver injury; he remained hemodynamically stable and was discharged home. He underwent successful repair of the tricuspid valve 17 days following the initial injury necessitating systemic anticoagulation and was discharged home two days later. The patient recovered fully without residual valvular pathology or hepatic sequelae. Copyright © 2013 Elsevier Inc. All rights reserved.

  18. New scoring system for intra-abdominal injury diagnosis after blunt trauma

    Directory of Open Access Journals (Sweden)

    Shojaee Majid

    2014-02-01

    Full Text Available 【Abstract】Objective: An accurate scoring system for intra-abdominal injury (IAI based on clinical manifestation and examination may decrease unnecessary CT scans, save time, and reduce healthcare cost. This study is designed to provide a new scoring system for a better diagno- sis of IAI after blunt trauma. Methods: This prospective observational study was performed from April 2011 to October 2012 on patients aged above 18 years and suspected with blunt abdominal trauma (BAT admitted to the emergency department (ED of Imam Hussein Hospital and Shohadaye Hafte Tir Hospital. All patients were assessed and treated based on Advanced Trauma Life Support and ED protocol. Diagnosis was done according to CT scan findings, which was considered as the gold standard. Data were gathered based on patient's history, physical exam, ultrasound and CT scan findings by a general practitioner who was not blind to this study. Chisquare test and logistic regression were done. Factors with significant relationship with CT scan were imported in multivariate regression models, where a coefficient (β was given based on the contribution of each of them. Scoring system was developed based on the obtained total βof each factor. Results: Altogether 261 patients (80.1% male were enrolled (48 cases of IAI. A 24-point blunt abdominal trauma scoring system (BATSS was developed. Patients were divided into three groups including low (score<8, moderate (8≤score<12 and high risk (score≥12. In high risk group immediate laparotomy should be done, moderate group needs further assessments, and low risk group should be kept under observation. Low risk patients did not show positive CT-scans (specificity 100%. Conversely, all high risk patients had positive CT-scan findings (sensitivity 100%. The receiver operating characteristic curve indicated a close relationship between the results of CT scan and BATSS (sensitivity=99.3%. Conclusion: The present scoring system furnishes a

  19. Association between cervical spine and skull-base fractures and blunt cerebrovascular injury

    International Nuclear Information System (INIS)

    Buch, Karen; Nguyen, Thanh; Norbash, Alex; Mian, Asim; Mahoney, Eric; Burke, Peter; Libby, Brandon; Calner, Paul

    2016-01-01

    Blunt cerebrovascular injuries (BCVI) are associated with high morbidity and mortality and can lead to neurological deficits. The established criteria for patients undergoing CT angiography (CTA) for BCVI are broad, and can expose patients to radiation unnecessarily. This study aimed to examine the prevalence of BCVI in patients on CTA and determine presentations associated with the highest rates of BCVI. With IRB approval, patients were selected for CTA screening for BCVI according to a predefined set of criteria at our hospital between 2007 and 2010. Patients were identified from our institution's trauma database. CTAs were retrospectively reviewed for BCVI including vasospasm and dissection. Electronic medical records were reviewed for clinical presentation and hospital course. Of 432 patients, vasospasm (n = 10) and/or dissection (n = 36) were found in 46 patients (10.6 %). BCVI was associated with cervical spine and/or skull-base fracture in 40/46 patients (87 %, P < 0.0001). Significant correlations were seen between dissection and fracture in 31/36 patients (86.2 %, p < 0.0001) and between BCVI and both neurological deficits and fractures (27/44, P < 0.0001). BCVI was significantly associated with cervical and/or skullbase fractures and neurological deficits with coexistent fractures. Patients with these injuries should be prioritized for rapid CTA evaluation for BCVI. (orig.)

  20. Association between cervical spine and skull-base fractures and blunt cerebrovascular injury

    Energy Technology Data Exchange (ETDEWEB)

    Buch, Karen; Nguyen, Thanh; Norbash, Alex; Mian, Asim [Boston University School of Medicine, Department of Radiology, Boston Medical Center, Boston, MA (United States); Mahoney, Eric; Burke, Peter [Boston University School of Medicine, Department of Surgery, Boston Medical Center, Boston, MA (United States); Libby, Brandon; Calner, Paul [Boston University School of Medicine, Department of Emergency Medicine, Boston Medical Center, Boston, MA (United States)

    2016-02-15

    Blunt cerebrovascular injuries (BCVI) are associated with high morbidity and mortality and can lead to neurological deficits. The established criteria for patients undergoing CT angiography (CTA) for BCVI are broad, and can expose patients to radiation unnecessarily. This study aimed to examine the prevalence of BCVI in patients on CTA and determine presentations associated with the highest rates of BCVI. With IRB approval, patients were selected for CTA screening for BCVI according to a predefined set of criteria at our hospital between 2007 and 2010. Patients were identified from our institution's trauma database. CTAs were retrospectively reviewed for BCVI including vasospasm and dissection. Electronic medical records were reviewed for clinical presentation and hospital course. Of 432 patients, vasospasm (n = 10) and/or dissection (n = 36) were found in 46 patients (10.6 %). BCVI was associated with cervical spine and/or skull-base fracture in 40/46 patients (87 %, P < 0.0001). Significant correlations were seen between dissection and fracture in 31/36 patients (86.2 %, p < 0.0001) and between BCVI and both neurological deficits and fractures (27/44, P < 0.0001). BCVI was significantly associated with cervical and/or skullbase fractures and neurological deficits with coexistent fractures. Patients with these injuries should be prioritized for rapid CTA evaluation for BCVI. (orig.)

  1. Management of pediatric blunt splenic injury at a rural trauma center.

    Science.gov (United States)

    Bird, Julio J; Patel, Nirav Y; Mathiason, Michelle A; Schroeppel, Thomas J; D'huyvetter, Cecile J; Cogbill, Thomas H

    2012-10-01

    Patterns for nonoperative management of pediatric blunt splenic injuries (BSIs) vary significantly within and between institutions. The indications for repeated imaging, duration of activity restrictions, as well as the impact of volume and type of trauma center (pediatric vs. adult) on outcomes remain unclear. A retrospective review of all patients younger than 16 years with BSI managed at a rural American College of Surgeons-verified adult Level II trauma center from January 1995 to December 2008 was completed. Patients were identified from the trauma registry by DRG International Classification of Diseases-9th Rev. (865.00-865.09) and management codes (41.5, 41.43, and 41.95). Variables reviewed included demographics, mechanism of injury, Injury Severity Score, grade of splenic injury, degree of hemoperitoneum, presence of arterial phase contrast blush on computed tomography at admission, admission and nadir hemoglobin level, blood transfused, length of stay, disposition, outpatient clinical and radiographic follow-up, interval of return to unrestricted activity, and clinical outcomes. During the 13-year study period, 38 children with BSI were identified. Thirty-seven (97%) were successfully managed nonoperatively. Median grade of splenic injury was 3 (range, 1-5); 73% had moderate-to-large hemoperitoneum. Median Injury Severity Score was 10 (range, 4-34). Three patients with isolated contrast blush on initial computed tomography were successfully managed nonoperatively with no angiographic intervention. One patient failed nonoperative management and underwent successful splenorrhaphy. All patients were discharged home. Thirty-day mortality was zero. Median follow-up duration was 5.5 years, with no late complications identified. Of the patients successfully managed nonoperatively, 92% had their follow-up at our institution; 74% underwent subsequent imaging, and none resulted in intervention or alteration of management plan. Pediatric BSI can be managed in adult

  2. Evaluation of the criteria for angiotomography indications in the diagnosis of carotid and vertebral arterial injury associated with blunt trauma

    Directory of Open Access Journals (Sweden)

    Almerindo Júnior

    2010-06-01

    Full Text Available Abstract Background Blunt carotid and vertebral artery injury (BCVI occur infrequently. The incidence of this type of injury is difficult to determine as many emergency room patients are neurologically asymptomatic. The statistics have not been reported in Brazil. The objectives of the current study were: To evaluate the accuracy of criteria used to recommend angiotomography in the diagnosis of cervical BCVI in 100 patients with blunt cervical trauma in the trauma services section of a Brazilian quaternary care hospital. Methods During a 30-month (2006-2008, all patients admitted to the emergency room of Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo with blunt cervical trauma and potential risk of cervical vessel injury, were subjected to cervical angiotomography to diagnose BCVI. The data analyzed are presented as mean ± standard deviation, and statistical analyses included Chi-square and Fisher's exact tests, and the Mann-Whitney test. Results During the study period 2467 blunt trauma patients were admitted. In 100 patients that met the criteria for inclusion in the study, angiotomography identified 23 with BCVI, including 17 males and six females. The mean patient age was 34.81 ± 14.84 years. Car crash (49% and car-pedestrian accidents (24% were the most frequent causes of injury. Ten patients had internal carotid artery injuries, two patients had common carotid artery injuries, and 11 patients had vertebral artery injuries. Seven patients presented with Degree I arterial injuries, 10 patients presented with Degree II artery injuries, four patients presented with Degree IV artery injuries, one patient presented with a Degree V artery injury, and one patient had a carotid fistula. Seven out of the 23 patients with BCVI (30.4% presented with cervical vertebrae fractures, and 11 out of the 23 patients with BCVI (47.8% presented with facial fractures (LeFort II and III. Conclusions Although there is no consensus

  3. Using a new evidence-based trauma protocol to improve detection and reduce costs in patients with blunt cardiac injury.

    Science.gov (United States)

    Genrich, Ilean; OʼMara, Susan K; Sulo, Suela

    2015-01-01

    Management of blunt cardiac injury is often discussed in trauma literature due to the lack of a "gold standard" for early identification and cost-effective care. The effectiveness of an evidence-based trauma protocol was assessed by comparing patients treated with the new protocol to those managed with prior practice. The data of 80 patients prospectively managed using the new trauma protocol were compared with the medical records of 80 former patients treated according to existing practice. Implementing the new protocol improved detection of abnormal troponin I levels and resulted in cost savings. The length of time inpatients required continuous electrocardiographic monitoring decreased by 4.23 days and echocardiography use dropped by 70%. Implementation of the evidence-based trauma protocol at our facility improved the early identification of patients with blunt cardiac injury and reduced the number of laboratory and diagnostic tests.

  4. Ureteral injury concomitant with kidney injury due to blunt trauma: case report.

    Science.gov (United States)

    Asali, Murad G; Romanowsky, Igor; Kaneti, Jacob

    2010-06-01

    A 27- year old man fell from seven meters high. A CT of abdomen and pelvis with contrast injection showed injury of right kidney, perirenal hematoma, and periureteral extravasation of contrast. Retrograde pyelography confirmed the diagnosis of partial transection of the right upper ureter. Conservative management of the case is discussed. A JJ internal ureteral stent was inserted successfully.

  5. A Rare Entity: Traumatic Thoracic Aortic Injury in a Patient with Aberrant Right Subclavian Artery.

    Science.gov (United States)

    Patel, Hiten Mohanbhai; Banerjee, Shubhabrata; Bulsara, Shahzad; Sahu, Tapish; Sheorain, Virender K; Grover, Tarun; Parakh, Rajiv

    2017-05-01

    Aberrant right subclavian artery is an uncommon entity incidence ranging from 0.5 to 2.5%. Management of thoracic aortic injury in the presence of such anomalies can be a challenge. We present here a case of traumatic aortic injury, which was incidentally found to have an asymptomatic aberrant right subclavian artery. The patient was managed by an endovascular repair of thoracic aortic injury with an endograft and a right carotid to subclavian artery bypass as a hybrid procedure. A 40-year male patient was brought to the emergency in shock with an alleged history of road traffic accident an hour back. After initial resuscitation as per advance trauma life support protocol, imaging revealed thoracic aortic injury with aberrant right subclavian artery with multiple rib and bilateral humerus fracture. After primary stabilization of arm fractures, the patient was shifted to a hybrid operation room. As the aortic injury was within 10 mm of the origin of both subclavian arteries, it was decided to cover the origin of both subclavian arteries and land the endograft distal to the left carotid artery origin. Since there was a right dominant vertebral artery on imaging, right carotid to right subclavian artery bypass was done with expanded polytetrafluoroethylene graft to prevent posterior circulatory stroke along with thoracic endovascular aortic repair to seal the thoracic aortic injury. After endovascular repair of thoracic aortic injury, left subclavian artery perfusion was maintained through left vertebral artery; and hence, revascularization of left subclavian artery was deferred. After management of all fractures, the patient was discharged 3 weeks after the date of admission without any complications. At 6 months follow-up, patient was stable and images showed patent bypass graft and sealed aortic injury. In a trauma setting with multiple injuries, hybrid procedure with a thoracic endograft is associated with low mortality and morbidity; hence, it is the treatment

  6. Early thromboembolic prophylaxis in patients with blunt solid abdominal organ injuries undergoing nonoperative management: is it safe?

    Science.gov (United States)

    Joseph, Bellal; Pandit, Viraj; Harrison, Caitlyn; Lubin, Dafney; Kulvatunyou, Narong; Zangbar, Bardiya; Tang, Andrew; O'Keeffe, Terence; Green, Donald J; Gries, Lynn; Friese, Randall S; Rhee, Peter

    2015-01-01

    The aim of this study was to compare the safety of early (≤48 hours), intermediate (48 to 72 hours), and late (≥72 hours) venous thromboembolism prophylaxis in patients with blunt abdominal solid organ injury managed nonoperatively. We performed a 6-year (2006 to 2011) retrospective review of all trauma patients with blunt abdominal solid organ injuries. Patients were matched using propensity score matching in a 2:1:1 (early:intermediate:late) for age, gender, systolic blood pressure, Glasgow Coma Scale, Injury Severity Score, and type and grade of organs injured. Our primary outcome measures were: hemorrhage complications and need for intervention (operative intervention and/or angioembolization). A total of 116 patients (58 early, 29 intermediate, and 29 late) were included. There were no differences in age (P = .5), Injury Severity Score (P = .6), type (P = .1), and grade of injury of the organ (P = .6) between the 3 groups. There were 67 liver (43.2%), 63 spleen (40.6%), 49 kidney (31.6%), and 24 multiple solid organ (15.4%) injuries. There was no difference in operative intervention (P = .8) and postprophylaxis blood transfusion (P = .3) between the 3 groups. Early enoxaparin-based anticoagulation may be a safe option in trauma patients with blunt solid organ injury. This study showed no significant correlation between early anticoagulation and development of bleeding complications. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. Paediatric Blunt Torso Trauma; Injury mechanisms, patterns and outcomes among children requiring hospitalisation at the Sultan Qaboos University Hospital, Oman

    Directory of Open Access Journals (Sweden)

    Khalid M. Bhatti

    2016-05-01

    Full Text Available Objectives: Trauma is the greatest cause of morbidity and mortality in paediatric/adolescent populations worldwide. This study aimed to describe trauma mechanisms, patterns and outcomes among children with blunt torso trauma admitted to the Sultan Qaboos University Hospital (SQUH in Muscat, Oman. Methods: This retrospective single-centre study involved all children ≤12 years old with blunt torso trauma admitted for paediatric surgical care at SQUH between January 2009 and December 2013. Medical records were analysed to collect demographic and clinical data. Results: A total of 70 children were admitted with blunt torso trauma during the study period, including 39 (55.7% male patients. The mean age was 5.19 ± 2.66 years. Of the cohort, 35 children (50.0% received their injuries after having been hit by cars as pedestrians, while 19 (27.1% were injured by falls, 12 (17.1% during car accidents as passengers and four (5.7% by falling heavy objects. According to computed tomography scans, thoracic injuries were most common (65.7%, followed by abdominal injuries (42.9%. The most commonly involved solid organs were the liver (15.7% and spleen (11.4%. The majority of the patients were managed conservatively (92.9% with a good outcome (74.3%. The mortality rate was 7.1%. Most deaths were due to multisystem involvement. Conclusion: Among children with blunt torso trauma admitted to SQUH, the main mechanism of injury was motor vehicle accidents. As a result, parental education and enforcement of infant car seat/child seat belt laws are recommended. Conservative management was the most successful approach.

  8. Traumatic eye injuries as a result of blunt impact: computational issues

    Science.gov (United States)

    Clemente, C.; Esposito, L.; Bonora, N.; Limido, J.; Lacome, J. L.; Rossi, T.

    2014-05-01

    The detachment or tearing of the retina in the human eye as a result of a collision is a phenomenon that occurs very often. Reliable numerical simulations of eye impact can be very useful tools to understand the physical mechanisms responsible for traumatic eye injuries accompanying blunt impact. The complexity and variability of the physical and mechanical properties of the biological materials, the lack of agreement on their related experimental data as well as the unsuitability of specific numerical codes and models are only some of the difficulties when dealing with this matter. All these challenging issues must be solved to obtain accurate numerical analyses involving dynamic behavior of biological soft tissues. To this purpose, a numerical and experimental investigation of the dynamic response of the eye during an impact event was performed. Numerical simulations were performed with IMPETUS-AFEA, a new general non-linear finite element (FE) software which offers non uniform rational B-splines (NURBS) FE technology for the simulation of large deformation and fracture in materials. IMPETUS code was selected in order to solve hourglass and locking problems typical of nearly incompressible materials like eye tissues. Computational results were compared with the experimental results on fresh enucleated porcine eyes impacted with airsoft pellets.

  9. Thromboembolic Prophylaxis with Heparin in Patients with Blunt Solid Organ Injuries Undergoing Non-operative Treatment.

    Science.gov (United States)

    Khatsilouskaya, Tatsiana; Haltmeier, Tobias; Cathomas, Marionna; Eberle, Barbara; Candinas, Daniel; Schnüriger, Beat

    2017-05-01

    Patients with blunt solid organ injuries (SOI) are at risk for venous thromboembolism (VTE), and VTE prophylaxis is crucial. However, little is known about the safety of early prophylactic administration of heparin in these patients. This is a retrospective study including adult trauma patients with SOI (liver, spleen, kidney) undergoing non-operative management (NOM) from 01/01/2009 to 31/12/2014. Three groups were distinguished: prophylactic heparin (low molecular weight heparin or low-dose unfractionated heparin) ≤72 h after admission ('early heparin group'), >72 h after admission ('late heparin group'), and no heparin ('no heparin group'). Patient and injury characteristics, transfusion requirements, and outcomes (failed NOM, VTE, and mortality) were compared between the three groups. Overall, 179 patients were included; 44.7% in the 'early heparin group,' 34.6% in the 'late heparin group,' and 20.8% in the 'no heparin group.' In the 'late heparin group,' the ISS was significantly higher than in the 'early' and 'no heparin groups' (median 29.0 vs. 17.0 vs. 19.0; p < 0.001). The overall NOM failure rate was 3.9%. Failed NOM was significantly more frequent in the 'no heparin group' compared to the 'early' and 'late heparin groups' (10.8 vs. 3.2 vs. 1.3%; p = 0.043). In the 'early heparin group' 27.5% patients suffered from a high-grade SOI; none of these patients failed NOM. Mortality did not differ significantly. Although not statistically significant, VTE were more frequent in the 'no heparin group' compared to the 'early' and 'late heparin groups' (10.8 vs. 4.8 vs. 1.3%; p = 0.066). In patients with SOI, heparin was administered early in a high percentage of patients and was not associated with an increased NOM failure rate or higher in-hospital mortality.

  10. Screening for blunt cardiac injury: an Eastern Association for the Surgery of Trauma practice management guideline.

    Science.gov (United States)

    Clancy, Keith; Velopulos, Catherine; Bilaniuk, Jaroslaw W; Collier, Bryan; Crowley, William; Kurek, Stanley; Lui, Felix; Nayduch, Donna; Sangosanya, Ayodele; Tucker, Brian; Haut, Elliott R

    2012-11-01

    Diagnosing blunt cardiac injury (BCI) can be difficult. Many patients with mechanism for BCI are admitted to the critical care setting based on associated injuries; however, debate surrounds those patients who are hemodynamically stable and do not otherwise require a higher level of care. To allow safe discharge home or admission to a nonmonitored setting, BCI should be definitively ruled out in those at risk. This Eastern Association for the Surgery of Trauma (EAST) practice management guideline (PMG) updates the original from 1998. English-language citations were queried for BCI from March 1997 through December 2011, using the PubMed Entrez interface. Of 599 articles identified, prospective or retrospective studies examining BCI were selected. Each article was reviewed by two members of the EAST BCI PMG workgroup. Data were collated, and a consensus was obtained for the recommendations. We identified 35 institutional studies evaluating the diagnosis of adult patients with suspected BCI. This PMG has 10 total recommendations, including two Level 2 updates, two upgrades from Level 3 to Level 2, and three new recommendations. Electrocardiogram (ECG) alone is not sufficient to rule out BCI. Based on four studies showing that the addition of troponin I to ECG improved the negative predictive value to 100%, we recommend obtaining an admission ECG and troponin I from all patients in whom BCI is suspected. BCI can be ruled out only if both ECG result and troponin I level are normal, a significant change from the previous guideline. Patients with new ECG changes and/or elevated troponin I should be admitted for monitoring. Echocardiogram is not beneficial as a screening tool for BCI and should be reserved for patients with hypotension and/or arrhythmias. The presence of a sternal fracture alone does not predict BCI. Cardiac computed tomography or magnetic resonance imaging can be used to differentiate acute myocardial infarction from BCI in trauma patients.

  11. Angiographic frequency of blunt cerebrovascular injury in patients with carotid canal or vertebral foramen fractures on multidetector CT

    Energy Technology Data Exchange (ETDEWEB)

    McKinney, Alexander [Department of Radiology, Hennepin County and University of Minnesota-Fairview and Medical Centers, Minneapolis, MN (United States)]. E-mail: mckin022@umn.edu; Ott, Frederick [Department of Radiology, Hennepin County and University of Minnesota-Fairview and Medical Centers, Minneapolis, MN (United States); Short, James [Department of Radiology, Hennepin County and University of Minnesota-Fairview and Medical Centers, Minneapolis, MN (United States); McKinney, Zeke [Department of Radiology, Hennepin County and University of Minnesota-Fairview and Medical Centers, Minneapolis, MN (United States); Truwit, Charles [Department of Radiology, Hennepin County and University of Minnesota-Fairview and Medical Centers, Minneapolis, MN (United States)

    2007-06-15

    Purpose: Blunt carotid injuries (BCI's) and blunt vertebral artery injuries (BVI's), known jointly as BCVI's, are common in 'high risk' patients. The purpose is to evaluate the rate of occurrence of BCI/BVI in patients screened purely by the radiologic criteria of fracture through the carotid canal or vertebral transverse foramina, or significant cervical subluxation, noted by multidetector CT. Methods: Seventy-one patients with 108 catheterized vessels were included over a 13-month interval. The angiographic examinations were prompted by current hospital protocol, solely by the presence of fractures involving/adjacent to the carotid canal, cervical fractures involving/adjacent to the foramen transversarium, or cervical fractures with significant subluxation. The incidence of each grade of blunt injury was calculated after review of the CT scans and catheter angiograms by two neuroradiologists. Results: Two thousand and seventy-three total blunt trauma admissions occurred during the time period, with a BCVI rate of 0.92-1.0% (depending on the reviewer), similar to previous studies. Mean time to catheter angiography was 16.6 h. Of the 71 included patients, there were 11-12 BCI's and 10-12 BVI's, an overall rate of 27-30% of BCVI in the patients with foraminal fractures. Interobserver agreement in reviewing the catheter angiograms was excellent (Kappa 0.795). Of note, three internal carotid pseudoaneurysms resolved spontaneously after anticoagulation or aspirin. Conclusion: This study confirms that there is a high rate of BCVI in the presence of carotid canal or vertebral foramen fractures that are noted by multidetector CT. Utilization of purely radiologic criteria of foraminal involvement may be a significant screening tool in the decision of whether to evaluate these patients acutely by catheter or CT angiography, and for early detection of patients at risk for symptomatology, to initiate prompt, prophylactic treatment.

  12. Lethal now or lethal later: The natural history of Grade 4 blunt cerebrovascular injury.

    Science.gov (United States)

    Lauerman, Margaret H; Feeney, Timothy; Sliker, Clint W; Saksobhavivat, Nitima; Bruns, Brandon R; Laser, Adriana; Tesoriero, Ronald; Brenner, Megan; Scalea, Thomas M; Stein, Deborah M

    2015-06-01

    Grade 4 blunt cerebrovascular injury (BCVI4) has a known, significant rate of stroke. However, little is known about the natural history of BCVI4 and the pathophysiology of subsequent stroke formation. A 4-year review of patients with BCVI4 at the R Adams Cowley Shock Trauma Center was performed. Rates of BCVI4-related stroke, stroke-related mortality, and overall mortality were calculated. The relationship of change in vessel characteristics and BCVI4-related stroke was examined, as was the mechanism of stroke formation. There were 82 BCVI4s identified, with 13 carotid artery (ICA) and 69 vertebral artery BCVI4s. BCVI4-related stroke rate was 2.9% in vertebral artery BCVI4 and 70% in ICA BCVI4 patients surviving to reimaging. Stroke mechanisms included embolic strokes, thrombotic strokes, and combined embolic and thrombotic strokes. Peristroke vessel recanalization and an embolic stroke mechanism were seen in 100% of ICA BCVI4-related strokes developing after admission. BCVI4-related stroke occurred within 10 hours of hospital admission in 67% of the patients with strokes. Contraindications to anticoagulation were present in most patients with BCVI4-related stroke developing after admission. Multiple etiologies of stroke formation exist in BCVI4. Early risk-benefit analysis for initiation of anticoagulation or antiplatelet agents should be performed in all patients with BCVI4, and the use of endovascular vessel occlusion should be considered in those with true contraindications to anticoagulation. However, more aggressive medical therapy may be needed to lessen BCVI4-related stroke development. Prognostic study, level IV; therapeutic study, level V.

  13. Accuracy of the abdominal examination for identifying children with blunt intra-abdominal injuries.

    Science.gov (United States)

    Adelgais, Kathleen M; Kuppermann, Nathan; Kooistra, Joshua; Garcia, Madelyn; Monroe, David J; Mahajan, Prashant; Menaker, Jay; Ehrlich, Peter; Atabaki, Shireen; Page, Kent; Kwok, Maria; Holmes, James F

    2014-12-01

    To determine the accuracy of complaints of abdominal pain and findings of abdominal tenderness for identifying children with intra-abdominal injury (IAI) stratified by Glasgow Coma Scale (GCS) score. This was a prospective, multicenter observational study of children with blunt torso trauma and a GCS score ≥13. We calculated the sensitivity of abdominal findings for IAI with 95% CI stratified by GCS score. We examined the association of isolated abdominal pain or tenderness with IAI and that undergoing acute intervention (therapeutic laparotomy, angiographic embolization, blood transfusion, or ≥2 nights of intravenous fluid therapy). Among the 12 044 patients evaluated, 11 277 (94%) had a GCS score of ≥13 and were included in this analysis. Sensitivity of abdominal pain for IAI was 79% (95% CI, 76%-83%) for patients with a GCS score of 15, 51% (95% CI, 37%-65%) for patients with a GCS score of 14, and 32% (95% CI, 14%-55%) for patients with a GCS score of 13. Sensitivity of abdominal tenderness for IAI also decreased with decreasing GCS score: 79% (95% CI, 75%-82%) for a GCS score of 15, 57% (95% CI, 42%-70%) for a GCS score of 14, and 37% (95% CI, 19%-58%) for a GCS score of 13. Among patients with isolated abdominal pain and/or tenderness, the rate of IAI was 8% (95% CI, 6%-9%) and the rate of IAI undergoing acute intervention was 1% (95% CI, 1%-2%). The sensitivity of abdominal findings for IAI decreases as GCS score decreases. Although abdominal computed tomography is not mandatory, the risk of IAI is sufficiently high that diagnostic evaluation is warranted in children with isolated abdominal pain or tenderness. Copyright © 2014 Elsevier Inc. All rights reserved.

  14. Spinal cord injury after blunt cervical spine trauma: correlation of soft-tissue damage and extension of lesion.

    Science.gov (United States)

    Martínez-Pérez, R; Paredes, I; Cepeda, S; Ramos, A; Castaño-León, A M; García-Fuentes, C; Lobato, R D; Gómez, P A; Lagares, A

    2014-05-01

    In patients with spinal cord injury after blunt trauma, several studies have observed a correlation between neurologic impairment and radiologic findings. Few studies have been performed to correlate spinal cord injury with ligamentous injury. The purpose of this study was to retrospectively evaluate whether ligamentous injury or disk disruption after spinal cord injury correlates with lesion length. We retrospectively reviewed 108 patients diagnosed with traumatic spinal cord injury after cervical trauma between 1990-2011. Plain films, CT, and MR imaging were performed on patients and then reviewed for this study. MR imaging was performed within 96 hours after cervical trauma for all patients. Data regarding ligamentous injury, disk injury, and the extent of the spinal cord injury were collected from an adequate number of MR images. We evaluated anterior longitudinal ligaments, posterior longitudinal ligaments, and the ligamentum flavum. Length of lesion, disk disruption, and ligamentous injury association, as well as the extent of the spinal cord injury were statistically assessed by means of univariate analysis, with the use of nonparametric tests and multivariate analysis along with linear regression. There were significant differences in lesion length on T2-weighted images for anterior longitudinal ligaments, posterior longitudinal ligaments, and ligamentum flavum in the univariate analysis; however, when this was adjusted by age, level of injury, sex, and disruption of the soft tissue evaluated (disk, anterior longitudinal ligaments, posterior longitudinal ligaments, and ligamentum flavum) in a multivariable analysis, only ligamentum flavum showed a statistically significant association with lesion length. Furthermore, the number of ligaments affected had a positive correlation with the extension of the lesion. In cervical spine trauma, a specific pattern of ligamentous injury correlates with the length of the spinal cord lesion in MR imaging studies

  15. Initial experience with the treatment of concomitant aortic pseudoaneurysm and thoracolumbar spinal fracture: Case report

    Directory of Open Access Journals (Sweden)

    Viktor Zsolt Kovari

    2017-12-01

    Full Text Available One blunt abdominal aortic disruption (BAAD and one blunt thoracic aortic injury (BTAI case are presented. Both aortic injuries were combined with spinal fractures. In the BAAD case the aortic pseudoaneurysm manifested just above the lumbar fracture while in the BTAI case the aortic injury appeared several vertebras below the thoracal fracture site, suggesting different mechanisms in the aortic wall damage. In both cases the aortic wall first was sealed, successfully, by endovascularly-placed stents, meaning the risks of open aortic reconstructive surgery could be avoided. The adjacent crucial vessel's preservation, despite the stent covering the left subclavian artery and the left common carotid artery in one of the cases was verified by post-operative computed tomography angiography (CTA examination. In second stage those spinal fractures which were deemed unstable were stabilized by the fixateur interne (a transpedicular screw-rod system. With this treatment sequence we wanted to avoid the unnecessary risk of a possible rupture of the unsealed aortic wall during positioning for the spinal procedure and during the spinal surgery. Both patients recovered from their aortic and spinal injuries.

  16. Proximal splenic artery embolization for blunt splenic injury: clinical, immunologic, and ultrasound-Doppler follow-up.

    Science.gov (United States)

    Bessoud, Bertrand; Duchosal, Michel A; Siegrist, Claire-Anne; Schlegel, Susanna; Doenz, Francesco; Calmes, Jean-Marie; Qanadli, Salah D; Schnyder, Pierre; Denys, Alban

    2007-06-01

    To evaluate the clinical, US (ultrasound)-Doppler and hematologic findings after proximal splenic artery embolization (PSAE) for blunt injury. From August 1998 to February 2003, 37 patients (28 men and 9 women; 20-89 years old, mean 40 years) underwent PSAE for blunt injuries. One patient required secondary splenectomy after PSAE. Early complications were investigated during the hospital stay. Delayed follow-up included review of the outpatient records, telephone interview, consultation, US-Doppler splenic study, Howell-Jolly body search, and serum antibody titer determinations (pneumococcus and Haemophilus influenzae B). No early postprocedural complications were depicted. Ten patients were lost on follow-up. Two patients had a telephone interview that revealed no complication. Twenty-four patients were examined 6 to 63 (mean 26) months after the embolization. No late complication was reported. Splenic measurements were in the normal range: length (53-110 mm; mean, 73), width (49-110 mm; 76), thickness (26-56 mm; 38), volume (61-508 mL; 226), standard ellipsoid formula volume (32-265 mL; 118), corrected volume (29-238 mL; 106), and splenic volumetric index (2.3-18.8; 8.4). The spleen was homogeneous in 23 patients (96%). Intrasplenic vascularization was present and splenic vein was patent in all patients. Howell-Jolly bodies were found in two patients. All patients (24 of 24) evaluated for exposure-driven immunity against Haemophilus Influenza b had sufficient immunity. Seventeen of the 18 patients (94%) evaluated for exposure-driven immunity against pneumococcus had sufficient immunity. Five of the six patients (83%) evaluated for pneumococcus vaccine response had a sufficient response. Proximal splenic artery embolization in blunt splenic injuries is a well-tolerated technique without major long-term impact on the splenic anatomy and immune function.

  17. Blunt abdominal trauma: does the use of a second-generation sonographic contrast agent help to detect solid organ injuries?

    Science.gov (United States)

    Poletti, Pierre-Alexandre; Platon, Alexandra; Becker, Christoph D; Mentha, Gilles; Vermeulen, Bernard; Buhler, Léo H; Terrier, François

    2004-11-01

    The objective of our study was to prospectively evaluate whether a second-generation sonography contrast agent (SonoVue) can improve the conspicuity of solid organ injuries (liver; spleen; or kidney, including adrenal glands) in patients with blunt abdominal trauma. Two hundred ten consecutive hemodynamically stable trauma patients underwent both abdominal sonography and CT at admission. The presence of solid organ injuries and the quality of sonography examinations were recorded. Patients with false-negative sonography findings for solid organ injuries in comparison with CT results underwent control sonography. If a solid organ injury was still undetectable, contrast-enhanced sonography was performed. Findings of admission, control, and contrast-enhanced sonograms were compared with CT results for their ability to depict solid organ injuries. Contrast-enhanced sonography was also performed in patients in whom a vascular injury (pseudoaneurysm) was shown on admission or control CT. CT findings were positive for 88 solid organ injuries in 71 (34%) of the 210 patients. Admission, control, and contrast-enhanced sonograms had a detection rate for solid organ injury of 40% (35/88), 57% (50/88), and 80% (70/88), respectively. The improvement in the detection rate between control and contrast-enhanced sonography was statistically significant (p = 0.001). After exclusion of low-quality examinations, contrast-enhanced sonography still missed 18% of solid organ injuries. Five vascular liver (n = 1) and spleen (n = 4) injuries (pseudoaneurysms) were detected on CT; all were visible on contrast-enhanced sonography. Contrast-enhanced sonography misses a large percentage of solid organ injuries and cannot be recommended to replace CT in the triage of hemodynamically stable trauma patients. However, contrast-enhanced sonography could play a role in the detection of pseudoaneurysms.

  18. The characteristics and pre-hospital management of blunt trauma patients with suspected spinal column injuries: a retrospective observational study.

    Science.gov (United States)

    Oosterwold, J T; Sagel, D C; van Grunsven, P M; Holla, M; de Man-van Ginkel, J; Berben, S

    2017-08-01

    Pre-hospital spinal immobilisation by emergency medical services (EMS) staff is currently the standard of care in cases of suspected spinal column injuries. There is, however, a lack of data on the characteristics of patients who received spinal immobilisation during the pre-hospital phase and on the adverse effects of immobilisation. The objectives of this study were threefold. First, we determined the pre-hospital characteristics of blunt trauma patients with suspected spinal column injuries who were immobilised by EMS staff. Second, we assessed the choices made by EMS staff regarding spinal immobilisation techniques and reasons for immobilisation. Third, we researched the possible adverse effects of immobilisation. A retrospective observational study in a cohort of blunt trauma patients. Data of blunt trauma patients with suspected spinal column injuries were collected from one EMS organisation between January 2008 and January 2013. Coded data and free text notes were analysed. A total of 1082 patients were included in this study. Spinal immobilisation was applied in 96.3 % of the patients based on valid pre-hospital criteria. In 2.1 % of the patients immobilisation was not based on valid criteria. Data of 1.6 % patients were missing. Main reasons for spinal immobilisation were posterior midline spinal tenderness (37.2 % of patients) and painful distracting injuries (13.5 % of patients). Spinal cord injury (SCI) was suspected in 5.7 % of the patients with posterior midline spinal tenderness. A total of 15.8 % patients were immobilised using non-standard methods. The reason for departure from the standard method was explained for 3 % of these patients. Reported adverse effects included pain (n = 10, 0.9 %,); shortness of breath (n = 3, 0.3 %); combativeness or anxiety (n = 6, 0.6 %); and worsening of pain when supine (n = 1, 0.1 %). Spinal immobilisation was applied in 96.3 % of all included patients based on pre-hospital criteria. We found

  19. Clinical prediction rules for identifying adults at very low risk for intra-abdominal injuries after blunt trauma.

    Science.gov (United States)

    Holmes, James F; Wisner, David H; McGahan, John P; Mower, William R; Kuppermann, Nathan

    2009-10-01

    We derive and validate clinical prediction rules to identify adult patients at very low risk for intra-abdominal injuries after blunt torso trauma. We prospectively enrolled adult patients (>or=18 years old) after blunt torso trauma for whom diagnostic testing for intra-abdominal injury was performed. In the derivation phase, we used binary recursive partitioning to create a rule to identify patients with intra-abdominal injury who were undergoing acute intervention (including therapeutic laparotomy or angiographic embolization) and a separate rule for identifying patients with any intra-abdominal injury present. We considered only clinical variables readily available with acceptable interrater reliability. The prediction rules were then prospectively validated in a separate cohort of patients. In the derivation phase, we enrolled 3,435 patients, including 311 (9.1%; 95% confidence interval [CI] 8.1% to 10.1%) with intra-abdominal injury and 109 (35.0%; 95% CI 29.7% to 40.6%) with intra-abdominal injury requiring acute intervention. In the validation study, we enrolled 1,595 patients, including 143 (9.0%; 95% CI 7.6% to 10.5%) with intra-abdominal injury. The derived rule for patients with intra-abdominal injuries who were undergoing acute intervention consisted of hypotension, Glasgow Coma Scale (GCS) score less than 14, costal margin tenderness, abdominal tenderness, hematuria level greater than or equal to 25 red blood cells/high powered field, and hematocrit level less than 30% and identified all 44 patients in the validation phase with intra-abdominal injury who were undergoing acute intervention (sensitivity 44/44, 100%; 95% CI 93.4% to 100%). The derived rule for the presence of any intra-abdominal injury consisted of GCS score less than 14, costal margin tenderness, abdominal tenderness, femur fracture, hematuria level greater than or equal to 25 red blood cells/high powered field, hematocrit level less than 30%, and abnormal chest radiograph result

  20. Blunt injury of the infrarenal inferior vena cava — imaging and ...

    African Journals Online (AJOL)

    Isolated rupture of the infrarenal segment of the inferior vena cava due to blunt trauma is relatively rare. It may be missed clinically and even diagnostic peritoneal lavage may prove negative. The mainstay of diagnosis remains a high degree of clinical suspicion together with sectional imaging. If the patient is ...

  1. Blunt abdominal trauma with handlebar injury: A rare cause of traumatic amputation of the appendix associated with acute appendicitis

    Directory of Open Access Journals (Sweden)

    Amanda Jensen

    2016-04-01

    Full Text Available We describe traumatic appendicitis in a 7-year-old boy who presented after sustaining blunt abdominal trauma to his right lower abdomen secondary to bicycle handlebar injury. With diffuse abdominal pain following injury, he was admitted for observation. Computed axial tomography (CT obtained at an outside hospital demonstrated moderate stranding of the abdomen in the right lower quadrant. The CT was non-contrasted and therefore significant appendiceal distention could not be confirmed. However, there was a calcified structure in the right pelvis with trace amount of free fluid. Patient was observed with conservative management and over the course of 15 h his abdominal pain continued to intensify. With his worsening symptoms, we elected to take him for diagnostic laparoscopy. In the operating room we found an inflamed traumatically amputated appendix with the mesoappendix intact. We therefore proceeded with laparoscopic appendectomy. Pathology demonstrated acute appendicitis with fecalith. It was unclear as to whether the patient's appendicitis and perforation were secondary to fecalith obstruction, his blunt abdominal trauma or if they concurrently caused his appendicitis. Acute appendicitis is a common acute surgical condition in the pediatric population and continues to be a rare and unique cause of operative intervention in the trauma population.

  2. Schematic X-ray diagnostic examination for the acute phase after a blunt thoraco-abdominal injury

    International Nuclear Information System (INIS)

    Kingma, L.M.

    1981-01-01

    The radiodiagnostic examination in the acute phase after a blunt thoracoabdominal injury can be made more reliable by repeating the examination after half an hour. The classical radiodiagnostic examination of the thorax and the abdomen is completed by a detail view of the upper abdomen. This X-ray plays a decisive part in the diagnosis of lesions of the liver, the spleen and both hemi-diafragms. The intravenous urogram is not only important because of the information gained about the condition of the urinary tract, but is also of great value to the management of shock and to regulate the infusion of fluids in the acute phase. One of the most important conclusions from this investigation is that the exclusion of pathology in trauma-patients is just as important as the demonstration of it. By ignoring the indications for urography and the significance of possible haematuria unnecessary loss of time can be avoided. The statistical relevance of the observations is shown in many examples, with the exception of the time-limits imposed in the selection of the patients. It could not be proved that the X-ray scheme is only of more value in the early post traumatic period. There was no correlation found between the passage of time since trauma and the significance of the results of the radiodiagnostic examination. Finally, advice is given about a scheme for the radiodiagnostic examination of patients with a blunt thoraco-abdominal injury, based upon the observations and conclusions in this dissertation. (Auth.)

  3. [Blunt force injuries due to martial arts in children--a diagnostic problem? Delayed diagnosis of an infected hematoma].

    Science.gov (United States)

    Kruppa, C; Goericke, S L; Matheney, T; Ozokyay, L; Schildhauer, T A; Muhr, G; Dudda, M

    2010-10-01

    Blunt force injuries in martial arts occur frequently but isolated hematoma of muscles in the extremities is rare. Even minor trauma of the lower extremities due to throwing techniques in judo and other forms of Asian martial arts can lead to major pathologies. A 9-year-old girl presented with an unclear swelling and soreness of the calf muscle. The patient could not remember an obvious traumatic event. She was admitted 4 days later because of increased swelling, pain and erythema. The parents reported a minor trauma at judo training 1 week ago. Further investigation was performed with MRI and confirmed a massive hematoma much greater than previously shown by sonography. Histologic and microbiologic evaluation demonstrated florid inflammation and proof of Staphylococcus aureus was found intra-operatively. The diagnosis of blunt force injuries due to martial arts is difficult in childhood because often children do not remember a traumatic event. Therefore, it is important to obtain a thorough history from caregivers. Because sonography depends highly on the experience of the investigator MRI is considered to be a better diagnostic modality to diagnose and guide treatment in this age group.

  4. Unexpected traumatic rupture of left atrium mimicking aortic rupture

    Directory of Open Access Journals (Sweden)

    Abdallah K Alameddine

    2014-01-01

    Full Text Available Left atrial (LA rupture is rare following blunt chest injury. We describe a case of blunt LA rupture that was treated surgically. This report is intended to alert practitioners for a need of a close multiple disciplinary collaborations among them for optimal management of patients with this type of trauma; because other non-cardiac injuries involving the head, abdomen, or extremities are considered covariates for in-hospital mortality. As in the present case, the patient eventually died from associated extrathoracic injuries. The diagnosis of LA rupture is by exclusion. However, the initial radiological reading may be misinterpreted, because this injury can easily be mistaking for an aortic rupture. The final reappraisal of the chest imaging studies should be interpreted by a skilled radiologist to avoid misdiagnosis. Subtle radiological features can help distinguish aortic thoracic injury as illustrated in this patient. These factors may be useful to the practicing surgeon in deciding surgical approach.

  5. Risk factors and early outcomes of acute renal injury after thoracic aortic endograft repair for type B aortic dissection

    Directory of Open Access Journals (Sweden)

    Luo S

    2017-08-01

    Full Text Available Songyuan Luo,* Huanyu Ding,* Jianfang Luo, Wei Li, Bing Ning, Yuan Liu, Wenhui Huang, Ling Xue, Ruixin Fan, Jiyan Chen Cardiology Department, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China *These authors contributed equally to this work Background: Thoracic endovascular aortic repair (TEVAR has become an emerging treatment modality for acute type B aortic dissection (TBAD patients in recent years. The risk factors and impacts of acute kidney injury (AKI after percutaneous TEVAR, however, have not been widely established.Methods: We retrospectively studied the clinical records of 305 consecutive patients who admitted to our institution and had TEVAR for TBAD between December 2009 and June 2013. The patients were routinely monitored for their renal functions preoperatively until 7 days after TEVAR. The Kidney Disease Improving Global Guidelines (KDIGO criteria were used for AKI.Results: Of the total 305 consecutive patients, 84 (27.5% developed AKI after TEVAR, comprising 66 (21.6% patients in KDIGO stage 1, 6 (2.0% patients in stage 2 and 12 (3.9% patients in stage 3. From the logistic regression analysis, systolic blood pressure (SBP on admission >140 mmHg (odds ratio [OR], 2.288; 95% CI, 1.319–3.969 and supra-aortic branches graft bypass hybrid surgery (OR, 3.228; 95% CI, 1.526–6.831 were independent risk factors for AKI after TEVAR. Local anesthesia tended to be a protective factor (OR, 0.563; 95% CI, 0.316–1.001. The preoperative renal function, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker or statin administration, volume of contrast agent, range of TBAD and false lumen involving renal artery were not associated with post-operation AKI. The in-hospital mortality and major adverse events were markedly increased with the occurrence of AKI (7.1% vs 0.9%, P=0

  6. Clinical and radiographic indications for aortography in blunt chest trauma.

    Science.gov (United States)

    Kram, H B; Wohlmuth, D A; Appel, P L; Shoemaker, W C

    1987-08-01

    To determine which clinical and radiographic findings are valuable in selecting patients with blunt chest trauma for aortography, we analyzed the medical records and admission chest radiographs of 76 consecutive victims of blunt chest trauma with suspected thoracic aortic rupture during the past 7 years. All patients were evaluated by history, physical examination, chest radiography, and aortography; a total of 70 clinical and radiographic findings were independently assessed in each patient. The following occurred with significantly greater frequency in patients with thoracic aortic rupture than in those without: history of significant hypotension (mean arterial pressure less than 80 mm Hg) (p less than 0.04); the presence of upper extremity hypertension, bilateral lower extremity pulse pulse deficits, or an initial chest tube output greater than 750 ml of blood (p less than 0.05); and greater incidence of myocardial contusions, intra-abdominal injuries, and pelvic fractures compared with patients without thoracic aortic rupture (p less than 0.05). Mediastinal widening (equal to or greater than 8 cm) shown on anteroposterior chest radiography occurred in all patients with thoracic aortic rupture; however, its specificity was only 10.6%. Radiographic signs that were helpful in indicating the presence of thoracic aortic rupture included paratracheal stripe greater than 5 mm, rightward deviation of the nasogastric tube or central venous pressure line, blurring of the aortic knob, and an abnormal or absent paraspinous stripe. Upper rib fractures and mediastinal to thoracic cage width ratios at any level did not increase diagnostic accuracy for thoracic aortic rupture in the present series. Six patients in the series died, two of whom had thoracic aortic rupture.(ABSTRACT TRUNCATED AT 250 WORDS)

  7. When Physics Meets Biology: Low and High Velocity Penetration, Blunt Trauma and Blast Injuries to the Brain

    Directory of Open Access Journals (Sweden)

    Leanne eYoung

    2015-05-01

    Full Text Available The incidence of TBI in the US has reached epidemic proportions with well over 2 million new cases reported each year. TBI can occur in both civilians and warfighters, with head injuries occurring in both combat and non-combat situations from a variety of threats, including ballistic penetration, acceleration, blunt impact, and blast. Most generally, TBI is a condition in which physical loads exceed the capacity of brain tissues to absorb without injury. More specifically, TBI results when sufficient external force is applied to the head and is subsequently converted into stresses that must be absorbed or redirected by protective equipment. If the stresses are not sufficiently absorbed or redirected, they will lead to damage of extracranial soft tissue and the skull. Complex interactions and kinematics of the head, neck and jaw cause strains within the brain tissue, resulting in structural, anatomical damage that is characteristic of the inciting insult. This mechanical trauma then initiates a neuro-chemical cascade that leads to the functional consequences of TBI, such as cognitive impairment. To fully understand the mechanisms by which TBI occurs, it is critically important to understand the effects of the loading environments created by these threats. In the following, a review is made of the pertinent complex loading conditions and how these loads cause injury. Also discussed are injury thresholds and gaps in knowledge, both of which are needed to design improved protective systems.

  8. Recombinant Factor VIIa Reduces Bleeding after Blunt Liver Injury in a Pig Model of Dilutional Coagulopathy under Severe Hypothermia.

    Directory of Open Access Journals (Sweden)

    Henri M H Spronk

    Full Text Available Recombinant factor VIIa (rFVIIa is registered for use in haemophilia with inhibitors and other rare bleeding disorders, but has also been used in various other clinical conditions to terminate life-threatening bleeding. Underlying conditions (e.g. coagulopathy and dosing may affect treatment efficacy. The objective of the present study was to evaluate the impact of increasing doses of rFVIIa on blood loss and coagulation assays in haemodiluted and hypothermic pigs undergoing blunt liver injury.A grade III blunt liver injury was induced in 28 pigs after 70% haemodilution and cooling to 32.6-33.4°C. Ten minutes after trauma, animals randomly received placebo or 90, 180 or 360 μg/kg rFVIIa. Global coagulation parameters, thromboelastometry (TEM and plasma thrombin generation (TG were determined at different time points during the observation period of 120 minutes.Total blood loss was significantly lower following 90 μg/kg rFVIIa (1206 [1138-1470] mL relative to placebo (2677 [2337-3068] mL; p<0.05, with no increased effect with higher dose levels of rFVIIa. Following trauma and haemodilution, coagulation was impaired relative to baseline in both TEM and TG analysis. At 60 and 120 minutes after trauma, TEM variables improved in the rFVIIa-treated animals compared with the placebo group. Similarly, rFVIIa improved coagulation kinetics in TG. As was observed with blood loss, no significant effect between different rFVIIa dose levels was found in TEM or TG. Macro- and microscopic post-mortem examination did not reveal any signs of thromboembolic events.Early administration of 90 μg/kg rFVIIa reduced blood loss in pigs undergoing blunt liver injury even after severe haemodilution and hypothermia, with no further effect of higher dose levels. Coagulation assays showed impaired coagulation in coagulopathic animals, with a dose-independent improvement in animals treated with rFVIIa.

  9. Association of a Guardian's Report of a Child Acting Abnormally With Traumatic Brain Injury After Minor Blunt Head Trauma.

    Science.gov (United States)

    Nishijima, Daniel K; Holmes, James F; Dayan, Peter S; Kuppermann, Nathan

    2015-12-01

    Increased use of computed tomography (CT) in children is concerning owing to the cancer risk from ionizing radiation, particularly in children younger than 2 years. A guardian report that a child is acting abnormally is a risk factor for clinically important traumatic brain injury (ciTBI) and may be a driving factor for CT use in the emergency department. To determine the prevalence of ciTBIs and TBIs in children younger than 2 years with minor blunt head trauma and a guardian report of acting abnormally with (1) no other findings or (2) other concerning findings for TBI. Secondary analysis of a large, prospective, multicenter cohort study that included 43 399 children younger than 18 years with minor blunt head trauma evaluated in 25 emergency departments. The study was conducted on data obtained between June 2004 and September 2006. Data analysis was performed between August 21, 2014, and March 9, 2015. A guardian report that the child was acting abnormally after minor blunt head trauma. The prevalence of ciTBI (defined as death, neurosurgery, intubation for >24 hours, or hospitalization for ≥2 nights in association with TBI on CT imaging) and TBI on CT imaging in children with a guardian report of acting abnormally with (1) no other findings and (2) other concerning findings for TBI. Of 43 399 children in the cohort study, a total of 1297 children had reports of acting abnormally, of whom 411 (31.7%) had this report as their only finding. Reported as percentage (95% CI), 1 of 411 (0.2% [0-1.3%]) had a ciTBI, and 4 TBIs were noted on the CT scans in 185 children who underwent imaging (2.2% [0.6%-5.4%]). In children with reports of acting abnormally and other concerning findings for TBI, 29 of 886 (3.3% [2.2%-4.7%]) had ciTBIs and 66 of 674 (9.8% [7.7%-12.3%]) had TBIs on CT. Clinically important TBIs are very uncommon, and TBIs noted on CT are uncommon in children younger than 2 years with minor blunt head trauma and guardian reports of the child acting

  10. Isolated transverse process fractures of the subaxial cervical spine: a clinically insignificant injury or not?: a prospective, longitudinal analysis in a consecutive high-energy blunt trauma population.

    NARCIS (Netherlands)

    Schotanus, M.; Middendorp, J.J. van; Hosman, A.J.F.

    2010-01-01

    STUDY DESIGN: Prospective single cohort study. OBJECTIVE: To analyze the incidence, associated injuries, treatment outcomes and associated adverse events of isolated transverse process fractures (TPFs) of the subaxial cervical spine in a high-energy blunt trauma population. SUMMARY OF BACKGROUND

  11. Incidence and pattern of cervical spine injury in blunt assault: it is not how they are hit, but how they fall.

    Science.gov (United States)

    Kulvatunyou, Narong; Friese, Randall S; Joseph, Bellal; O'Keeffe, Terence; Wynne, Julie L; Tang, Andrew L; Rhee, Peter

    2012-01-01

    The injury mechanism of blunt cervical spine injury (CSI) involves two forces: (1) an acceleration-deceleration force or change in velocity (delta v) that causes significant head and neck movement, resulting in flexion-extension injury pattern and (2) a direct force to the head or face against an immovable object with force transmitted down the cervical spine. Combining those two forces creates what bioengineers call imparted energy (IE). In blunt assault to the head or face, IE is low; hence, the reported incidence of CSI is low. The goal of our study was to identify the incidence, pattern, and outcome of CSI in blunt assaulted patients. We queried the trauma registry at our Level I trauma center for patients admitted with the diagnosis of blunt assault over a 5-year period (2005-2009). Patients with CSI were identified by International Classification Diagnosis (Ninth Revision) codes of 805, 806, 839, or 952. We only included the patients who received the blow to the head and face. For eligible patients, we extracted data from trauma registry and inpatient chart review, including radiographic reports. A single author (N.K.) reviewed computed tomography (CT) scan of all individuals with CSI. We performed summary and Spearman rank correlation statistical analysis with p value pattern of injury and severity is related to a fall occurring after the assault. Our results should encourage clinicians to find out if patient falls after the assault.

  12. The role of imaging studies in pancreatic injury due to blunt abdominal trauma in children

    Energy Technology Data Exchange (ETDEWEB)

    Bosboom, D. [Department of Radiology, University Medical Center St Radboud, Postbus 9101, Route 667, 6500 HB Nijmegen (Netherlands); Braam, A.W.E. [Department of Pediatric Surgery, University Medical Center St Radboud, Postbus 9101, Route 815, 6500 HB Nijmegen (Netherlands); Blickman, J.G. [Department of Radiology, University Medical Center St Radboud, Postbus 9101, Route 667, 6500 HB Nijmegen (Netherlands); Wijnen, R.M.H. [Department of Pediatric Surgery, University Medical Center St Radboud, Postbus 9101, Route 815, 6500 HB Nijmegen (Netherlands)]. E-mail: R.Wijnen@kchir.umcn.nl

    2006-07-15

    Background: The role imaging studies play in the choice of treatment in traumatic pancreas damage remains unclear. This study was performed to gain insight into the role of radiological studies in children 16 years of age or younger admitted to our hospital with pancreatic damage due to a blunt abdominal trauma. Method: Retrospectively, the radiological as well as patient clinical records were reviewed of all children admitted to our hospital between 1975 and 2003 with a pancreatic lesion due to blunt abdominal trauma. Results: Thirty-four children with ages ranging from 3 to 14 years old were admitted with traumatic pancreas damage. Initially 33 children were treated conservatively for the pancreatic damage and only one had immediate surgery of the pancreas with a Roux-y pancreaticojejunostomy. Five other children had immediate surgery for other reasons. Overall, five children proved to have a pancreas transection on CT scans or during laparotomy. One child had a pancreas hematoma and 28 a pancreas contusion. In total 15 children developed a pseudocyst (44%), nine of which resolved spontaneously while six were treated by intervention. None of the children had residual morbidity, and there were no deaths. Considering the pancreas, the 11 available CT's were re-evaluated by two radiologists independently. Grade 3 pancreas damage (distal transection of the pancreatic duct) was diagnosed in five patients by radiologist A and four patients by radiologist B (80% match); Grade 1 was diagnosed in, respectively six and one patients (15% match). An US was performed on 19 children with 82 follow-up examinations, mostly for follow-up of the pseudocysts. Conclusion: Traumatic pancreas damage is a rare and difficult diagnosis. There is no straightforward answer for diagnostic imaging in blunt abdominal trauma in children. The diagnostic relevance of CT is limited. CT in combination with MRCP may be a better option for exclusion of pancreatic duct lesions.

  13. Chronic Prosopis Glandulosa Treatment Blunts Neutrophil Infiltration and Enhances Muscle Repair after Contusion Injury

    OpenAIRE

    George, Cindy; Smith, Carine; Isaacs, Ashwin; Huisamen, Barbara

    2015-01-01

    The current treatment options for soft tissue injuries remain suboptimal and often result in delayed/incomplete recovery of damaged muscle. The current study aimed to evaluate the effects of oral Prosopis glandulosa treatment on inflammation and regeneration in skeletal muscle after contusion injury, in comparison to a conventional treatment. The gastrocnemius muscle of rats was subjected to mass-drop injury and muscle samples collected after 1-, 3 h, 1- and 7 days post-injury. Rats were tre...

  14. ACR appropriateness criteria blunt chest trauma.

    Science.gov (United States)

    Chung, Jonathan H; Cox, Christian W; Mohammed, Tan-Lucien H; Kirsch, Jacobo; Brown, Kathleen; Dyer, Debra Sue; Ginsburg, Mark E; Heitkamp, Darel E; Kanne, Jeffrey P; Kazerooni, Ella A; Ketai, Loren H; Ravenel, James G; Saleh, Anthony G; Shah, Rakesh D; Steiner, Robert M; Suh, Robert D

    2014-04-01

    Imaging is paramount in the setting of blunt trauma and is now the standard of care at any trauma center. Although anteroposterior radiography has inherent limitations, the ability to acquire a radiograph in the trauma bay with little interruption in clinical survey, monitoring, and treatment, as well as radiography's accepted role in screening for traumatic aortic injury, supports the routine use of chest radiography. Chest CT or CT angiography is the gold-standard routine imaging modality for detecting thoracic injuries caused by blunt trauma. There is disagreement on whether routine chest CT is necessary in all patients with histories of blunt trauma. Ultimately, the frequency and timing of CT chest imaging should be site specific and should depend on the local resources of the trauma center as well as patient status. Ultrasound may be beneficial in the detection of pneumothorax, hemothorax, and pericardial hemorrhage; transesophageal echocardiography is a first-line imaging tool in the setting of suspected cardiac injury. In the blunt trauma setting, MRI and nuclear medicine likely play no role in the acute setting, although these modalities may be helpful as problem-solving tools after initial assessment. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. Copyright © 2014 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  15. A successful treatment for concomitant injury of the coronary artery and tricuspid valve after blunt chest trauma.

    Science.gov (United States)

    Kikuchi, Chizuo; Motohashi, Shinya; Takahashi, Yoshiki; Nakazawa, Satoshi; Kanazawa, Hiroshi

    2015-11-01

    A 63-year-old woman involved in an automobile accident was brought to our hospital with thoracic injury sustained by the impact of her vehicle's steering wheel. Cardiac auscultation revealed a grade III/VI systolic murmur and the electrocardiogram showed ST elevation in leads 2, 3 and aVF. A 2D echocardiogram revealed severe tricuspid regurgitation and a hypokinetic right ventricle. Coronary angiography revealed dissection of the proximal right coronary artery (RCA) with 90 % stenosis. Urgent CABG for the RCA and tricuspid valvuloplasty were performed, as the anterior leaflet of the tricuspid valve had prolapsed as a result of chordal rupture. Blunt thoracic trauma causing both tricuspid insufficiency and coronary artery dissection is a very rare and life-threatening situation. Prompt diagnosis and timely surgery enabled us to save this patient's life.

  16. A Retrospective Observational Study Examining the Effect of Thoracic Epidural and Patient Controlled Analgesia on Short-term Outcomes in Blunt Thoracic Trauma Injuries.

    Science.gov (United States)

    Baker, Edward James; Lee, Geraldine Ann

    2016-01-01

    Effective analgesia in the early stages after any major traumatic event remains pivotal to optimal trauma management. For patients with significant thoracic injuries, this is paramount to ensure ongoing efficient respiratory function. The aim of this study was to investigate the use of analgesic modes in the management of patients with a primary thoracic injury and blunt mechanism of injury. By understanding variables that influence the use of varying analgesic modes and influence the development of pulmonary complications, there should be more uniform evidence-based prescription in the future.This retrospective study considered analgesic use in patients admitted after blunt thoracic injuries at one major trauma center over a 2-year period. Pulmonary complications measured included both infective and ventilator-associated failure. Univariate and multivariate analyses were used to identify patient and injury severity characteristics and their association with respiratory complications.A total of 401 cases were reviewed and analyzed: 159 received Patient Controlled Analgesia (PCA), 32 received PCA and epidural analgesia (EA), 6 received EA alone, and 204 received interval-administered analgesia. There were no significant differences in the rates of complication when compared between analgesic modes. Patients who developed pneumonia had significantly increased number of thoracic fractures and underlying organ injury (P cardiac disease (OR 2.624, P = 0.042) and ICU length of stay (OR: 1.146, P blunt thoracic injuries. However, variables that may influence usage of different analgesic modes and high-risk groups for the development of pneumonia were identified. Further work is warranted to consider the long-term benefits of analgesia in patients post-blunt thoracic injuries.

  17. Death of a 23-year-old man from cardiac conduction system injury through a blunt chest impact after a car accident

    Directory of Open Access Journals (Sweden)

    S. Zerbo

    2014-12-01

    The authors report a case of death due to a cardiac conduction system injury from a blunt chest impact following a car accident. The autopsy showed no external signs of thoracic trauma, no evident rib or sternum fractures. A small sub-endocardial hemorrhage was found in the region of the atrioventricular node. Histological examination revealed an injury of the atrioventricular node and His’ bundle. The cause of the death was attributed to the arrhythmia induced by contusion of the cardiac conduction system.

  18. Efficacy and tolerability of escin/diethylamine salicylate combination gels in patients with blunt injuries of the extremities.

    Science.gov (United States)

    Pabst, H; Segesser, B; Bulitta, M; Wetzel, D; Bertram, S

    2001-08-01

    The aim of this confirmative, monocentre, double-blind, controlled clinical trial was to investigate whether different escin combinations show differences in comparison to placebo with regard to pain reactions in the topical treatment of sports injuries. A total of 126 patients with blunt injuries of the extremities were randomly allocated to four parallel groups: Reparil-Gel N (n = 32), Reparil-Gel (n = 31), Reparil-Sportgel (n = 32) and a placebo gel (n = 31). All patients were evaluated for efficacy (intention to treat) and tolerability. A per-protocol analysis was also carried out, in which 12 of the 126 patients were excluded due to protocol violations. The intention-to-treat and per-protocol analyses produced similar results. The patients had suffered contusions while participating in soccer, hockey, karate, tae-kwon-do, handball, American football, rugby or tennis. The measured variable was the pressure required at the centre of the lesion to elicit the first pain reaction (tenderness reaction) at measuring time 0 (baseline) and then 1, 2, 3, 4, 6 and 24 h after the injury. The primary variable was the area under the curve (AUC) for tenderness over a six-hour period. The mean AUC differed significantly in the four groups (Kruskal-Wallis test p = 0.0001). Then six pairwise comparisons of two treatment groups each were carried out using the Mann-Whitney test. To control the multiple significance level of 5%, the adjusted p-values according to the Holm-Shaffer method were used in these tests. The three active gels were significantly superior to the placebo gel (Mann-Whitney test, p = 0.0004 in each case) in terms of the AUC. There were no significant differences between the active test substances in terms of the primary variable. The intensity of the pain was also measured on a visual analogue scale (VAS). The pain diminished more rapidly with the Reparil gels than with the placebo. The tolerability of all test substances was good. No adverse events were

  19. Chronic Prosopis Glandulosa Treatment Blunts Neutrophil Infiltration and Enhances Muscle Repair after Contusion Injury

    Directory of Open Access Journals (Sweden)

    Cindy George

    2015-01-01

    Full Text Available The current treatment options for soft tissue injuries remain suboptimal and often result in delayed/incomplete recovery of damaged muscle. The current study aimed to evaluate the effects of oral Prosopis glandulosa treatment on inflammation and regeneration in skeletal muscle after contusion injury, in comparison to a conventional treatment. The gastrocnemius muscle of rats was subjected to mass-drop injury and muscle samples collected after 1-, 3 h, 1- and 7 days post-injury. Rats were treated with P. glandulosa (100 mg/kg/day either for 8 weeks prior to injury (up until day 7 post-injury, only post-injury, or with topically applied diclofenac post-injury (0.57 mg/kg. Neutrophil (His48-positive and macrophage (F4/80-positive infiltration was assessed by means of immunohistochemistry. Indicators of muscle satellite cell proliferation (ADAM12 and regeneration (desmin were used to evaluate muscle repair. Chronic P. glandulosa and diclofenac treatment (p < 0.0001 was associated with suppression of the neutrophil response to contusion injury, however only chronic P. glandulosa treatment facilitated more effective muscle recovery (increased ADAM12 (p < 0.05 and desmin (p < 0.001 expression, while diclofenac treatment had inhibitory effects on repair, despite effective inhibition of neutrophil response. Data indicates that P. glandulosa treatment results in more effective muscle repair after contusion.

  20. Chronic Prosopis glandulosa treatment blunts neutrophil infiltration and enhances muscle repair after contusion injury.

    Science.gov (United States)

    George, Cindy; Smith, Carine; Isaacs, Ashwin W; Huisamen, Barbara

    2015-01-23

    The current treatment options for soft tissue injuries remain suboptimal and often result in delayed/incomplete recovery of damaged muscle. The current study aimed to evaluate the effects of oral Prosopis glandulosa treatment on inflammation and regeneration in skeletal muscle after contusion injury, in comparison to a conventional treatment. The gastrocnemius muscle of rats was subjected to mass-drop injury and muscle samples collected after 1-, 3 h, 1- and 7 days post-injury. Rats were treated with P. glandulosa (100 mg/kg/day) either for 8 weeks prior to injury (up until day 7 post-injury), only post-injury, or with topically applied diclofenac post-injury (0.57 mg/kg). Neutrophil (His48-positive) and macrophage (F4/80-positive) infiltration was assessed by means of immunohistochemistry. Indicators of muscle satellite cell proliferation (ADAM12) and regeneration (desmin) were used to evaluate muscle repair. Chronic P. glandulosa and diclofenac treatment (pglandulosa treatment facilitated more effective muscle recovery (increased ADAM12 (pglandulosa treatment results in more effective muscle repair after contusion.

  1. Serum beta-2 microglobulin levels for predicting acute kidney injury complicating aortic valve replacement.

    Science.gov (United States)

    Zaleska-Kociecka, Marta; Skrobisz, Anna; Wojtkowska, Izabela; Grabowski, Maciej; Dabrowski, Maciej; Kusmierski, Krzysztof; Piotrowska, Katarzyna; Imiela, Jacek; Stepinska, Janina

    2017-10-01

    Acute kidney injury complicating both transcatheter and surgical aortic valve replacement is associated with high rates of morbidity and mortality. The aim of this study was to investigate the role of serum beta 2 (β2) microglobulin, cystatin C and neutrophil gelatinase-associated lipocalin levels in detecting periprocedural acute kidney injury. Eighty consecutive patients who were 70 years of age or older and who were having surgical (n = 40) or transcatheter (n = 40) aortic valve replacement were recruited in a prospective study. The biomarkers were tested before the procedure, 6 times afterwards, at discharge and at a 6-month follow-up visit. The baseline β2-microglobulin level was the strongest predictor of acute kidney injury as a complication of transcatheter aortic valve replacement [odds ratio (OR) 5.277, P = 0.009]. Its level 24 h after the procedure reached the largest area under the curve (AUC) of 0.880 (P regression analysis, the levels of β2-microglobulin and cystatin C 24 h after the procedure were significantly associated with acute kidney injury after transcatheter valve replacement (OR 38.15, P = 0.044; OR 1782, P = 0.019, respectively). In the surgical aortic valve replacement group, the highest AUCs belonged to β2-microglobulin and cystatin C at 24 h (AUC = 0.808, P = 0.003 and AUC = 0.854, P = 0.001, respectively). Their higher values were also associated with acute kidney injury (OR 17.2, P = 0.018; OR 965.6, P = 0.02, respectively). A persistent increase in the postoperative levels of β2-microglobulin following acute kidney injury was associated with the progression of chronic kidney disease for 6 months after both transcatheter (OR 6.56, P = 0.030) and surgical (OR 7.67, P = 0.03) aortic valve replacements. Serum β2-microglobulin had the potential to predict acute kidney injury complicating transcatheter valve replacement and to diagnose it as early as 24 h after both the

  2. Isolated blunt severe traumatic brain injury in Bern, Switzerland, and the United States: A matched cohort study.

    Science.gov (United States)

    Haltmeier, Tobias; Schnüriger, Beat; Benjamin, Elizabeth; Brodmann Maeder, Monika; Künzler, Michael; Siboni, Stefano; Inaba, Kenji; Demetriades, Demetrios

    2016-02-01

    The ideal prehospital management of patients with severe traumatic brain injury (TBI) including the impact of endotracheal intubation (ETI) and physicians on scene is unclear. Prehospital management differs substantially in Switzerland and the United States: in Switzerland, there is usually a physician on scene who may provide ETI and other advanced life support procedures, whereas in the United States, prehospital management (including ETI) is performed by paramedics. This is a retrospective cohort-matched study of patients with isolated blunt severe TBI (head Abbreviated Injury Scale [AIS] score, 4-5) and no major extracranial injuries, using Bern University Hospital data from the Swiss PEBITA [Patient-relevant Endpoints after Brain Injury from Traumatic Accidents] (TBI-specific) database and the US National Trauma Data Bank from 2009 to 2010. A 1:4 cohort matching of Bern and US patients was performed. Matching criteria were sex, age (±10 years), exact field Glasgow Coma Scale (GCS) score, exact head AIS score, and injury type (subdural hematoma, epidural hematoma, intraparenchymal hemorrhage, intraventricular hemorrhage, brain edema/swelling, brain stem injury). The matched cohorts were compared with univariable analysis (Fisher's exact test and Mann-Whitney U-test). Matching of the Bern (n = 128) and US (n = 86,375) cohort resulted in 355 matched cases (71 Bern and 284 US patients). Bern patients had significantly longer scene times (median, 23.0 minutes vs. 9.0 minutes, p < 0.001) and more frequent prehospital ETI (31.0% vs. 18.7%, p = 0.034) and air transportation (39.4% vs. 19.4%, p < 0.001). No significant difference in procedures (craniotomy/craniectomy, intracranial pressure monitoring, tracheotomy), intensive care unit and total hospital lengths of stay, ventilator days, and in-hospital mortality (14.1% vs. 15.8%, p = 0.855) was found between the two cohorts. When taking into account the limitation that patient- and injury-related factors, but not in

  3. Traumatic partial avulsion of a single right subclavian artery from the aortic arch and definitive repair.

    Science.gov (United States)

    Kapetanakis, Emmanouil I; Sears-Rogan, Pamela; Young, Richard S; Kanda, Louis T; Ellis, Jennifer L

    2006-01-01

    Blunt injury to the right subclavian artery is a rare complication of severe deceleration trauma often associated with significant morbidity and mortality. We describe an atypical presentation in a patient who sustained a traumatic avulsion of his right subclavian artery arising off the aortic arch. An interposition graft was used to restore the continuity of the artery to the ascending thoracic aorta.

  4. Blunt renal trauma in children: healing of renal injuries and recommendations for imaging follow-up

    International Nuclear Information System (INIS)

    Abdalati, H.; Bulas, D.I.; Sivit, C.J.; Majd, M.; Rushton, H.G.; Eichelberger, M.R.

    1994-01-01

    Initial CT grading of renal injury was correlated with the frequency of complications and the time course of healing in 35 children. All renal contusions (grade 1, 8) and small parenchymal lacerations (grade 2, 8) healed without complications. All lacerations extending to the collecting system (grade 3, 9) resulted in mild to severe loss of renal function with progressive healing over 4 months. One of four segmental infarcts (grade 4 A), and five of six vascular pedicle injuries (grade 4 B) resulted in severe loss of renal function. Complications, including urinoma (2), sepsis (1), hydronephrosis (1), and persistent hypertension (2), were limited to grade 3 and 4 injuries. Our results suggest that mild renal injuries do not require follow-up imaging. Major renal lacerations and vascular pedicle injuries, however, often result in loss of renal function and should be followed up closely due to the risk of delayed complications. Follow-up examinations should continue for 3-4 months until healing is documented. (orig.)

  5. Overview of Nonoperative Blunt Splenic Injury Management with Associated Splenic Artery Pseudoaneurysm.

    Science.gov (United States)

    Morrison, Chet A; Gross, Brian W; Kauffman, Matthew; Rittenhouse, Katelyn J; Rogers, Frederick B

    2017-06-01

    The delayed development of splenic artery pseudoaneurysm (SAP) can complicate the nonoperative management of splenic injuries. We sought to determine the utility of repeat imaging in diagnosing SAP in patients managed nonoperatively without angioembolization. We hypothesized that a significant rate of SAPs would be found in this population on repeat imaging. Patients undergoing nonoperative splenic injury management from January 2011 to June 2015 were queried from the trauma registry. Rates of repeat imaging, angioembolization, readmission, and SAP development were analyzed. Further, subanalyses investigating the incidence of SAP in patients managed nonoperatively without angioembolization were conducted. A total of 133 patients met inclusion criteria. Repeat imaging rate was 40 per cent, angioembolization rate was 26 per cent, and readmission rate was 6 per cent. Within the study population, nine SAPs were found (8/9 in patients with splenic injury grade ≥III). Of these nine SAPs, three (33%) were identified on initial scans and embolized, whereas six (67%) were found on repeat imaging in patients not initially receiving angioembolization. Splenic injuries are typically managed nonoperatively without serious complications. Our results suggest patients with splenic injuries grade ≥III managed nonoperatively without angioembolization should have repeat imaging within 48 hours to rule out the possibility of SAP.

  6. Blunt traumatic diaphragmatic rupture

    Directory of Open Access Journals (Sweden)

    Antonio Carlos Nogueira

    2011-09-01

    Full Text Available Traumatic injury of the diaphragm ranges from 0.6 to 1.2% and rise up to 5%among patients who were victims of blunt trauma and underwent laparotomy.Clinical suspicion associated with radiological assessment contributes to earlydiagnosis. Isolated diaphragmatic injury has a good prognosis. Generallyworse outcomes are associated with other trauma injuries. Bilateral andright diaphragmatic lesions have worse prognosis. Multi detector computed tomography (MDCT scan of the chest and abdomen provides better diagnosticaccuracy using the possibility of image multiplanar reconstruction. Surgicalrepair via laparotomy and/ or thoracotomy in the acute phase of the injury hasa better outcome and avoids chronic complications of diaphragmatic hernia.The authors present the case of a young male patient, victim of blunt abdominaltrauma due to motor vehicle accident with rupture of the diaphragm, spleenand kidney injuries. The diagnosis was made by computed tomography of thethorax and abdomen and was confirmed during laparotomy.

  7. Lung injury following thoracic aortic occlusion: comparison of sevoflurane and propofol anaesthesia.

    Science.gov (United States)

    Annecke, T; Kubitz, J C; Langer, K; Hilberath, J M; Kahr, S; Krombach, F; Bittmann, I; Rehm, M; Kemming, G I; Conzen, P F

    2008-08-01

    Halogenated anaesthetics have been shown to reduce ischaemia-reperfusion injuries in various organs due to pre- and post-conditioning mechanisms. We compared volatile and total intravenous anaesthesia with regard to their effect on remote pulmonary injury after thoracic aortic occlusion and reperfusion. Eighteen pigs were randomized after sternotomy and laparotomy (fentanyl-midazolam anaesthesia) to receive either sevoflurane or propofol in an investigator-blinded fashion. Ninety minutes of thoracic aortic occlusion was induced by a balloon catheter. During reperfusion, a goal-directed resuscitation protocol was performed. After 120 min of reperfusion, the anaesthetic regimen was changed to fentanyl-midazolam again for another 180 min. The oxygenation index and intra-pulmonary shunt fractions were calculated. After 5 h of reperfusion, a bronchoalveolar lavage was performed. The total protein content and lactate dehydrogenase activity were measured in epithelial lining fluid (ELF). Alveolar macrophage oxidative burst was analysed. The wet to dry ratio was calculated and tissue injury was graded using a semi-quantitative score. Ten animals (n=5 for each anaesthetic) without aortic occlusion served as time controls. The oxygenation index decreased and the intra-pulmonary shunt fraction increased significantly in both occlusion groups. There were no significant differences between sevoflurane and propofol with respect to the oxygenation index, ELF composition, morphologic lung damage, wet to dry ratio and alveolar macrophage burst activity. Differences were, however, seen in terms of systemic haemodynamic stability, where catecholamine requirements were less pronounced with sevoflurane. We conclude that the severity of remote lung injury was not different between sevoflurane and propofol anaesthesia in this porcine model of severe lower-body ischaemia and reperfusion injury.

  8. MDCT in blunt intestinal trauma

    Energy Technology Data Exchange (ETDEWEB)

    Romano, Stefania [Department of Diagnostic Imaging, ' A.Cardarelli' Hospital, 80131 Naples (Italy)]. E-mail: stefromano@libero.it; Scaglione, Mariano [Department of Diagnostic Imaging, ' A.Cardarelli' Hospital, 80131 Naples (Italy); Tortora, Giovanni [Department of Diagnostic Imaging, ' A.Cardarelli' Hospital, 80131 Naples (Italy); Martino, Antonio [Trauma Center, ' A.Cardarelli' Hospital, 80131 Naples (Italy); Di Pietto, Francesco [Department of Diagnostic Imaging, ' A.Cardarelli' Hospital, 80131 Naples (Italy); Romano, Luigia [Department of Diagnostic Imaging, ' A.Cardarelli' Hospital, 80131 Naples (Italy); Grassi, Roberto [Department ' Magrassi-Lanzara' , Section of Radiology, Second University of Naples, 80138 Naples (Italy)

    2006-09-15

    Injuries to the small and large intestine from blunt trauma represent a defined clinical entity, often not easy to correctly diagnose in emergency but extremely important for the therapeutic assessment of patients. This article summarizes the MDCT spectrum of findings in intestinal blunt lesions, from functional disorders to hemorrhage and perforation.

  9. MDCT in blunt intestinal trauma

    International Nuclear Information System (INIS)

    Romano, Stefania; Scaglione, Mariano; Tortora, Giovanni; Martino, Antonio; Di Pietto, Francesco; Romano, Luigia; Grassi, Roberto

    2006-01-01

    Injuries to the small and large intestine from blunt trauma represent a defined clinical entity, often not easy to correctly diagnose in emergency but extremely important for the therapeutic assessment of patients. This article summarizes the MDCT spectrum of findings in intestinal blunt lesions, from functional disorders to hemorrhage and perforation

  10. Recent Research in Behind-Armor Blunt Trauma and Traumatic Brain Injury

    Science.gov (United States)

    2014-02-01

    sleep disturbance, vertigo, and anxiety. Most often these symptoms occur immediately after injury and resolve after a few hours or days. Diffuse...by skull deformation and not head motion (i.e., rigid body inertia ), confirming previous computational results (22). Strain developed mainly in the

  11. Predictive factors for early failure of transarterial embolization in blunt hepatic injury patients

    International Nuclear Information System (INIS)

    Lee, Y.-H.; Wu, C.-H.; Wang, L.-J.; Wong, Y.-C.; Chen, H.-W.; Wang, C.-J.; Lin, B.-C.; Hsu, Y.-P.

    2014-01-01

    Aim: To evaluate the early success of transarterial embolization (TAE) in patients with traumatic liver haemorrhage and to determine independent factors for its failure. Materials and methods: From January 2009 to December 2012, TAE was performed in 48 patients for traumatic liver haemorrhage. Their medical charts were reviewed for demographic information, pre-TAE vital signs and laboratory data, injury grade, type of contrast medium extravasation (CME) at CT, angiography findings, and early failure. “Early failure” was defined as the need for repeated TAE or a laparotomy for hepatic haemorrhage within 4 days after TAE. Variables were compared between the early success and early failure groups. Variables with univariate significance were also analysed using multivariate logistic regression for predictors of early failure. Results: Among 48 liver TAE cases, nine (18.8%) were early failures due to liver haemorrhage. Early failure was associated with injury grade (p = 0.039), major liver injury (grades 4 and 5; p = 0.007), multiple CMEs at angiography (p = 0.031), incomplete TAE (p = 0.002), and elevated heart rate (p = 0.026). Incomplete embolization (OR = 8; p = 0.042), and heart rate >110 beats/min (bpm; OR = 8; p = 0.05) were independent factors for early failure of TAE in the group with major liver injuries. Conclusion: Major hepatic injury is an important factor in early failure. Patients with a heart rate >110 bpm and incomplete embolization in the major injury group have an increased rate of early failure. The success rate of proximal TAE was comparable to that of the more time-consuming, superselective, distal TAE. - Highlights: • Early failure of TAE is associated with a higher grade of liver injury. • Incomplete embolization is more likely to suffer early failure of TAE. • A heart rate greater than 110 bpm is more likely to suffer early failure of TAE. • We recommend proximal embolization to prevent early failure of TAE

  12. Emergency management of blunt chest trauma in children: an evidence-based approach.

    Science.gov (United States)

    Pauzé, Denis R; Pauzé, Daniel K

    2013-11-01

    Pediatric trauma is commonly encountered in the emergency department, and trauma to the head, chest, and abdomen may be a source of significant morbidity and mortality. As children have unique thoracic anatomical and physiological properties, they may present with diagnostic challenges that the emergency clinician must be aware of. This review examines the effects of blunt trauma to the pediatric chest, as well as its relevant etiologies and associated mortality. Diagnostic and treatment options for commonly encountered injuries such as pulmonary contusions, rib fractures, and pneumothoraces are examined. Additionally, this review discusses rarely encountered--yet highly lethal--chest wall injuries such as blunt cardiac injuries, commotio cordis, nonaccidental trauma, and aortic injuries.

  13. Vascular injuries after minor blunt upper extremity trauma: pitfalls in the recognition and diagnosis of potential "near miss" injuries

    Directory of Open Access Journals (Sweden)

    Bravman Jonathan T

    2008-11-01

    Full Text Available Abstract Background Low energy trauma to the upper extremity is rarely associated with a significant vascular injury. Due to the low incidence, a high level of suspicion combined with appropriate diagnostic algorithms are mandatory for early recognition and timely management of these potentially detrimental injuries. Methods Review of the pertinent literature, supported by the presentation of two representative "near miss" case examples. Results A major diagnostic pitfall is represented by the insidious presentation of significant upper extremity arterial injuries with intact pulses and normal capillary refill distal to the injury site, due to collateral perfusion. Thus, severe vascular injuries may easily be missed or neglected at the upper extremity, leading to a long-term adverse outcome with the potential need for a surgical amputation. Conclusion The present review article provides an outline of the diagnostic challenges related to these rare vascular injuries and emphasizes the necessity for a high level of suspicion, even in the absence of a significant penetrating or high-velocity trauma mechanism.

  14. Trauma centers with higher rates of angiography have a lesser incidence of splenectomy in the management of blunt splenic injury.

    Science.gov (United States)

    Capecci, Louis M; Jeremitsky, Elan; Smith, R Stephen; Philp, Frances

    2015-10-01

    Nonoperative management (NOM) for blunt splenic injury (BSI) is well-established. Angiography (ANGIO) has been shown to improve success rates with NOM. Protocols for NOM are not standardized and vary widely between centers. We hypothesized that trauma centers that performed ANGIO at a greater rate would demonstrate decreased rates of splenectomy compared with trauma centers that used ANGIO less frequently. A large, multicenter, statewide database (Pennsylvania Trauma Systems Foundation) from 2007 to 2011 was used to generate the study cohort of patients with BSI (age ≥ 13). The cohort was divided into 2 populations based on admission to centers with high (≥13%) or low (Splenectomy rates were then compared between the 2 groups, and multivariable logistic regression for predictors of splenectomy (failed NOM) were also performed. The overall rate of splenectomy in the entire cohort was 21.0% (1,120 of 5,333 BSI patients). The high ANGIO group had a lesser rate of splenectoy compared with the low ANGIO group (19% vs 24%; P splenectomy compared with low ANGIO centers (odds ratio, 0.68; 95% CI 0.58-0.80; P splenectomy rates compared with centers with lesser rate of ANGIO. Inclusion of angiographic protocols for NOM of BSI should be considered strongly. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. Blunt abdominal trauma in adults: role of CT in the diagnosis and management of visceral injuries. Part 1. Liver and spleen

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    Becker, C.D.; Terrier, F. [Department of Radiology, Division of Diagnostic and Interventional Radiology, Geneva University Hospital, Geneva (Switzerland); Mentha, G. [Department of Surgery, Division of Abdominal Surgery, Geneva University Hospital, Geneva (Switzerland)

    1998-05-01

    Computed tomography is now widely used in the initial diagnostic workup of adult trauma victims with suspected intra-abdominal injuries. We review the role of CT in the detection and management of blunt visceral injuries in two parts. In the first part we discuss general aspects of performing CT in the setting of abdominal trauma and the diagnostic findings of intra-abdominal hemorrhage and blunt hepatic and splenic injuries. Hepatic and splenic injuries can be detected by means of CT with a high accuracy. The vast majority of hepatic injuries can be successfully managed conservatively, even when CT demonstrates parenchymal damage of more than three segments and major hemoperitoneum. Delayed complications, e. g., formation of biloma or a false aneurysm, can be readily detected on repeat CT studies, although they are quite uncommon. The outcome of conservative treatment of splenic injuries remains unpredictable because delayed splenic rupture may occur even when initial CT shows only minor parenchymal lesions and little or no intraperitoneal hemorrhage. (orig.) With 11 figs., 5 tabs., 64 refs.

  16. The clinical effectiveness of permissive hypotension in blunt abdominal trauma with hemorrhagic shock but without head or spine injuries or burns: a systematic review

    Directory of Open Access Journals (Sweden)

    Alsawadi A

    2012-05-01

    Full Text Available Abdulrahman AlsawadiColchester Hospital University NHS Foundation Trust, Colchester, Essex, United KingdomBackground: Trauma is a major cause of death and disability. The current trend in trauma management is the rapid administration of fluid as per the Advanced Trauma Life Support guidelines, although there is no evidence to support this and even some to suggest it might be harmful. Some guidelines, protocols, and recommendations have been established for the use of permissive hypotension although there is reluctance concerning its application in blunt injuries.Objectives: The aim of this review is to determine whether there is evidence of the use of permissive hypotension in the management of hemorrhagic shock in blunt trauma patients. This review also aims to search for any reason for the reluctance to apply permissive hypotension in blunt injuries.Methods: This systematic review has followed the steps recommended in the Cochrane Handbook for Systematic Reviews of Interventions. It is also being reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement and checklist. Database searches of MEDLINE, EMBASE, the Centre for Reviews and Dissemination databases and the Cochrane Library were made for eligible studies as well as journal searches. Inclusion criteria included systematic reviews that have similar primary questions to this review and randomized controlled trials where patients with blunt torso injuries and hemorrhagic shock were not excluded. Rapid or early fluid administration was compared with controlled or delayed fluid resuscitation and a significant outcome was obtained.Results: No systematic reviews attempting to answer similar questions were found. Two randomized controlled trials with mixed types of injuries in the included patients found no significant difference between the groups used in each study. Data concerning the question of this review was sought after these papers were

  17. The Head Injury Retrieval Trial (HIRT): a single-centre randomised controlled trial of physician prehospital management of severe blunt head injury compared with management by paramedics only.

    Science.gov (United States)

    Garner, Alan A; Mann, Kristy P; Fearnside, Michael; Poynter, Elwyn; Gebski, Val

    2015-11-01

    Advanced prehospital interventions for severe brain injury remains controversial. No previous randomised trial has been conducted to evaluate additional physician intervention compared with paramedic only care. Participants in this prospective, randomised controlled trial were adult patients with blunt trauma with either a scene GCS score definition), or GCSdefinition). Patients were randomised to either standard ground paramedic treatment or standard treatment plus a physician arriving by helicopter. Patients were evaluated by 30-day mortality and 6-month Glasgow Outcome Scale (GOS) scores. Due to high non-compliance rates, both intention-to-treat and as-treated analyses were preplanned. 375 patients met the original definition, of which 197 was allocated to physician care. Differences in the 6-month GOS scores were not significant on intention-to-treat analysis (OR 1.11, 95% CI 0.74 to 1.66, p=0.62) nor was the 30-day mortality (OR 0.91, 95% CI 0.60 to 1.38, p=0.66). As-treated analysis showed a 16% reduction in 30-day mortality in those receiving additional physician care; 60/195 (29%) versus 81/180 (45%), pdefinition, of which 182 were allocated to physician care. The 6-month GOS scores were not significantly different on intention-to-treat analysis (OR 1.14, 95% CI 0.73 to 1.75, p=0.56) nor was the 30-day mortality (OR 1.05, 95% CI 0.66 to 1.66, p=0.84). As-treated analyses were also not significantly different. This trial suggests a potential mortality reduction in patients with blunt trauma with GCSdefinition only). Confirmatory studies which also address non-compliance issues are needed. NCT00112398. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  18. “Don Juan-Fracture” as a Hint to Aortic Isthmus Rupture

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    Sirilak Suksompong

    2014-01-01

    Full Text Available We report a case of thoracic aortic rupture after blunt trauma in a 23-year-old male patient. The initial investigation found no external injury or bleeding, only a slightly widened mediastinum and a broken left calcaneus. Abdominal lavage was negative, biochemistry was normal, and breathing and oxygenation were not compromised. When changing his position during diagnostics, the patient all of a sudden developed cardiac arrest and typical signs of hypovolemic shock. An immediate sternotomy was done without any further diagnostics on suspicion of aortic isthmus injury. A circular avulsion at the ligamentum arteriosum was found as assumed and repaired under cardiopulmonary bypass. The patient left the hospital for rehabilitation after 12 days in adequate health status. Biodynamics of blunt trauma after high-speed frontal impact and the relationship between calcaneus fracture, called “Don-Juan fracture,” and aortic rupture at the site of ligamentum arteriosum are discussed.

  19. Role of Complement C5 in Experimental Blunt Chest Trauma-Induced Septic Acute Lung Injury (ALI.

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    Miriam Kalbitz

    Full Text Available Severe blunt chest trauma is associated with high mortality. Sepsis represents a serious risk factor for mortality in acute respiratory distress syndrome (ARDS. In septic patients with ARDS complement activation products were found to be elevated in the plasma. In single models like LPS or trauma complement has been studied to some degree, however in clinically highly relevant double hit models such as the one used here little data is available. Here, we hypothesized that absence of C5 is correlated with a decreased inflammatory response in trauma induced septic acute lung injury.12 hrs after DH in mice the local and systemic cytokines and chemokines were quantified by multiplex bead array or ELISA, activated caspase-3 by western blot. Data were analyzed using one-way ANOVA followed by post-hoc Sidak's multiple comparison test (significance, p≤ 0.05.In lung tissue interleukin (IL-6, monocyte chemo attractant protein-1 (MCP-1 and granulocyte-colony stimulating factor (G-CSF was elevated in both C5-/- mice and wildtype littermates (wt, whereas caspase-3 was reduced in lungs after DH in C5-/- mice. Systemically, reduced keratinocyte-derived chemokine (KC levels were observed after DH in C5-/- compared to wt mice. Locally, lung myeloperoxidase (MPO, protein, IL-6, MCP-1 and G-CSF in brochoalveolar lavage fluid (BALF were elevated after DH in C5-/- compared to wt.In the complex but clinically relevant DH model the local and systemic inflammatory immune response features both, C5-dependent and C5-independent characteristics. Activation of caspase-3 in lung tissue after DH was C5-dependent whereas local inflammation in lung tissue was C5-independent.

  20. Failure of nonoperative management of pediatric blunt liver and spleen injuries: A prospective Arizona-Texas-Oklahoma-Memphis-Arkansas Consortium study.

    Science.gov (United States)

    Linnaus, Maria E; Langlais, Crystal S; Garcia, Nilda M; Alder, Adam C; Eubanks, James W; Maxson, R Todd; Letton, Robert W; Ponsky, Todd A; St Peter, Shawn D; Leys, Charles; Bhatia, Amina; Ostlie, Daniel J; Tuggle, David W; Lawson, Karla A; Raines, Alexander R; Notrica, David M

    2017-04-01

    Nonoperative management (NOM) is standard of care for most pediatric blunt liver and spleen injuries (BLSI); only 5% of patients fail NOM in retrospective reports. No prospective studies examine failure of NOM of BLSI in children. The aim of this study was to determine the frequency and clinical characteristics of failure of NOM in pediatric BLSI patients. A prospective observational study was conducted on patients 18 years or younger presenting to any of 10 Level I pediatric trauma centers April 2013 and January 2016 with BLSI on computed tomography. Management of BLSI was based on the Arizona-Texas-Oklahoma-Memphis-Arkansas Consortium pediatric guideline. Failure of NOM was defined as needing laparoscopy or laparotomy. A total of 1008 patients met inclusion; 499 (50%) had liver injury, 410 (41%) spleen injury, and 99 (10%) had both. Most patients were male (n = 624; 62%) with a median age of 10.3 years (interquartile range, 5.9, 14.2). A total of 69 (7%) underwent laparotomy or laparoscopy, but only 34 (3%) underwent surgery for spleen or liver bleeding. Other (nonexclusive) operations were for 21 intestinal injuries; 15 hematoma evacuations, washouts, or drain placements; 9 pancreatic injuries; 5 mesenteric injuries; 3 diaphragm injuries; and 2 bladder injuries. Patients who failed were more likely to receive blood (52 of 69 vs. 162 of 939; p liver or spleen injury. For children failing NOM due to bleeding, the mortality was 24%. Therapeutic study, level II.

  1. Management of severe blunt hepatic injury in the era of computed tomography and transarterial embolization: A systematic review and critical appraisal of the literature.

    Science.gov (United States)

    Melloul, Emmanuel; Denys, Alban; Demartines, Nicolas

    2015-09-01

    During the last decade, the management of blunt hepatic injury has considerably changed. Three options are available as follows: nonoperative management (NOM), transarterial embolization (TAE), and surgery. We aimed to evaluate in a systematic review the current practice and outcomes in the management of Grade III to V blunt hepatic injury. The MEDLINE database was searched using PubMed to identify English-language citations published after 2000 using the key words blunt, hepatic injury, severe, and grade III to V in different combinations. Liver injury was graded according to the American Association for the Surgery of Trauma classification on computed tomography (CT). Primary outcome analyzed was success rate in intention to treat. Critical appraisal of the literature was performed using the validated National Institute for Health and Care Excellence "Quality Assessment for Case Series" system. Twelve articles were selected for critical appraisal (n = 4,946 patients). The median quality score of articles was 4 of 8 (range, 2-6). Overall, the median Injury Severity Score (ISS) at admission was 26 (range, 0.6-75). A median of 66% (range, 0-100%) of patients was managed with NOM, with a success rate of 94% (range, 86-100%). TAE was used in only 3% of cases (range, 0-72%) owing to contrast extravasation on CT with a success rate of 93% (range, 81-100%); however, 9% to 30% of patients required a laparotomy. Thirty-one percent (range, 17-100%) of patients were managed with surgery owing to hemodynamic instability in most cases, with 12% to 28% requiring secondary TAE to control recurrent hepatic bleeding. Mortality was 5% (range, 0-8%) after NOM and 51% (range, 30-68%) after surgery. NOM of Grade III to V blunt hepatic injury is the first treatment option to manage hemodynamically stable patients. TAE and surgery are considered in a highly selective group of patients with contrast extravasation on CT or shock at admission, respectively. Additional standardization of

  2. A systematic review of the need for MRI for the clearance of cervical spine injury in obtunded blunt trauma patients after normal cervical spine CT.

    Science.gov (United States)

    James, Iyore Ao; Moukalled, Ahmad; Yu, Elizabeth; Tulman, David B; Bergese, Sergio D; Jones, Christian D; Stawicki, Stanislaw Pa; Evans, David C

    2014-10-01

    Clearance of cervical spine injury (CSI) in the obtunded or comatose blunt trauma patient remains controversial. In patients with unreliable physical examination and no evidence of CSI on computed tomography (CT), magnetic resonance imaging of the cervical spine (CS-MRI) is the typical follow-up study. There is a growing body of evidence suggesting that CS-MRI is unnecessary with negative findings on a multi-detector CT (MDCT) scan. This review article systematically analyzes current literature to address the controversies surrounding clearance of CSI in obtunded blunt trauma patients. A literature search through MEDLINE database was conducted using all databases on the National Center for Biotechnology Information (NCBI) website (www.ncbi.nlm.nih.gov) for keywords: "cervical spine injury," "obtunded," and "MRI." The search was limited to studies published within the last 10 years and with populations of patients older than 18 years old. Eleven studies were included in the analysis yielding data on 1535 patients. CS-MRI detected abnormalities in 256 patients (16.6%). The abnormalities reported on CS-MRI resulted in prolonged rigid c-collar immobilization in 74 patients (4.9%). Eleven patients (0.7%) had unstable injury detected on CS-MRI alone that required surgical intervention. In the obtunded blunt trauma patient with unreliable clinical examination and a normal CT scan, there is still a role for CS-MRI in detecting clinically significant injuries when MRI resources are available. However, when a reliable clinical exam reveals intact gross motor function, CS-MRI may be unnecessary.

  3. A systematic review of the need for MRI for the clearance of cervical spine injury in obtunded blunt trauma patients after normal cervical spine CT

    Directory of Open Access Journals (Sweden)

    Iyore AO James

    2014-01-01

    Full Text Available Clearance of cervical spine injury (CSI in the obtunded or comatose blunt trauma patient remains controversial. In patients with unreliable physical examination and no evidence of CSI on computed tomography (CT, magnetic resonance imaging of the cervical spine (CS-MRI is the typical follow-up study. There is a growing body of evidence suggesting that CS-MRI is unnecessary with negative findings on a multi-detector CT (MDCT scan. This review article systematically analyzes current literature to address the controversies surrounding clearance of CSI in obtunded blunt trauma patients. A literature search through MEDLINE database was conducted using all databases on the National Center for Biotechnology Information (NCBI website (www.ncbi.nlm.nih.gov for keywords: "cervical spine injury," "obtunded," and "MRI." The search was limited to studies published within the last 10 years and with populations of patients older than 18 years old. Eleven studies were included in the analysis yielding data on 1535 patients. CS-MRI detected abnormalities in 256 patients (16.6%. The abnormalities reported on CS-MRI resulted in prolonged rigid c-collar immobilization in 74 patients (4.9%. Eleven patients (0.7% had unstable injury detected on CS-MRI alone that required surgical intervention. In the obtunded blunt trauma patient with unreliable clinical examination and a normal CT scan, there is still a role for CS-MRI in detecting clinically significant injuries when MRI resources are available. However, when a reliable clinical exam reveals intact gross motor function, CS-MRI may be unnecessary.

  4. Superman play and pediatric blunt abdominal trauma.

    Science.gov (United States)

    Machi, J M; Gyuro, J; Losek, J D

    1996-01-01

    Two pediatric patients with life-threatening intra-abdominal injuries associated with Superman play are presented. The cases illustrate the importance of knowing the mechanism of injury in the assessment of children with blunt abdominal trauma. The diagnostic value of liver enzymes and the controversies surrounding the radiographic assessment of pediatric blunt abdominal trauma are presented.

  5. Five-year experience with the peri-operative goal directed management for surgical repair of traumatic aortic injury in the eastern province, Saudi Arabia

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    Haytham Z Al-Gameel

    2014-01-01

    Full Text Available Context: Traumatic aortic injury (TAI accounts for 1/3 of all trauma victims. Aim: We aimed to investigate the efficacy of the adopted standardized immediate pre-operative and intra-operative hemodynamic goal directed control, anesthetic technique and organs protection on the morbidity and mortality in patients presented with TAI. Settings and Design: An observational retrospective study at a single university teaching hospital. Materials and Methods: Following ethical approval, we recruited the data of 44 patients admitted to the King Fahd Hospital of the University, Al Khobar, Saudi Arabia, with formal confirmation of diagnosis of blunt TAI during a 5-year period from February 2008 to April 2013 from the hospital medical records. Statistical Analysis: descriptive analysis. Results: A total of 44 victims (41 men, median (range age 29 (22-34 years with TAI who underwent surgical repair were recruited. Median (range post-operative chest tube output was 700 (200-1100 ml necessitated transfusion in 5 (11.4% of cases. Post-operative complications included transient renal failure (13.6%, pneumonia (6.8%, acute lung injury/distress syndrome (20.5%, sepsis (4.5%, wound infection (47.7% and air leak (6.8%. No patient developed end stage renal failure or spinal cord injury. Median intensive care unit stay was 6 (4-30 days and in-hospital mortality was 9.1%. Conclusion: We found that the implementation of a standardized early goal directed hemodynamic control for the peri-operative management of patients with TAI reduces the post-operative morbidity and mortality after surgical repair.

  6. Surgical management for the first 48 h following blunt chest trauma: state of the art (excluding vascular injuries).

    Science.gov (United States)

    de Lesquen, Henri; Avaro, Jean-Philippe; Gust, Lucile; Ford, Robert Michael; Beranger, Fabien; Natale, Claudia; Bonnet, Pierre-Mathieu; D'Journo, Xavier-Benoît

    2015-03-01

    This review aims to answer the most common questions in routine surgical practice during the first 48 h of blunt chest trauma (BCT) management. Two authors identified relevant manuscripts published since January 1994 to January 2014. Using preferred reporting items for systematic reviews and meta-analyses statement, they focused on the surgical management of BCT, excluded both child and vascular injuries and selected 80 studies. Tension pneumothorax should be promptly diagnosed and treated by needle decompression closely followed with chest tube insertion (Grade D). All traumatic pneumothoraces are considered for chest tube insertion. However, observation is possible for selected patients with small unilateral pneumothoraces without respiratory disease or need for positive pressure ventilation (Grade C). Symptomatic traumatic haemothoraces or haemothoraces >500 ml should be treated by chest tube insertion (Grade D). Occult pneumothoraces and occult haemothoraces are managed by observation with daily chest X-rays (Grades B and C). Periprocedural antibiotics are used to prevent chest-tube-related infectious complications (Grade B). No sign of life at the initial assessment and cardiopulmonary resuscitation duration >10 min are considered as contraindications of Emergency Department Thoracotomy (Grade C). Damage Control Thoracotomy is performed for either massive air leakage or refractive shock or ongoing bleeding enhanced by chest tube output >1500 ml initially or >200 ml/h for 3 h (Grade D). In the case of haemodynamically stable patients, early video-assisted thoracic surgery is performed for retained haemothoraces (Grade B). Fixation of flail chest can be considered if mechanical ventilation for 48 h is probably required (Grade B). Fixation of sternal fractures is performed for displaced fractures with overlap or comminution, intractable pain or respiratory insufficiency (Grade D). Lung herniation, traumatic diaphragmatic rupture and pericardial rupture are life

  7. Surgical management and outcome of blunt major liver injuries: experience of damage control laparotomy with perihepatic packing in one trauma centre.

    Science.gov (United States)

    Lin, Being-Chuan; Fang, Jen-Feng; Chen, Ray-Jade; Wong, Yon-Cheong; Hsu, Yu-Pao

    2014-01-01

    This retrospective study aimed to assess the clinical experience and outcome of damage control laparotomy with perihepatic packing in the management of blunt major liver injuries. From January 1998 to December 2006, 58 patients of blunt major liver injury, American Association for the Surgery of Trauma-Organ Injury Scale (AAST-OIS) equal or greater than III, were operated with perihepatic packing at our institute. Demographic data, intra-operative findings, operative procedures, adjunctive managements and outcome were reviewed. To determine whether there was statistical difference between the survivor and non-survivor groups, data were compared by using Mann-Whitney U test for continuous variables, either Pearson's chi-square test or with Yates continuity correction for contingency tables, and results were considered statistically significant if plaparotomy, depending on the severity of injuries, all 58 patients underwent various liver-related procedures and perihepatic packing. The more frequent liver-related procedures included debridement hepatectomy (n=21), hepatorrhaphy (n=19), selective hepatic artery ligation (n=11) and 7 patients required post-laparotomy hepatic transarterial embolization. Of the 58 patients, 28 survived and 30 died with a 52% mortality rate. Of the 30 deaths, uncontrolled liver bleeding in 24-h caused 25 deaths and delayed sepsis caused residual 5 deaths. The mortality rate versus OIS was grade III: 30% (6/20), grade IV: 54% (13/24), and grade V: 79% (11/14), respectively. On univariate analysis, the significant predictors of mortality were OIS grade (p=0.019), prolonged initial prothrombin time (PT) (p=0.004), active partial thromboplastin time (APTT) (plaparotomy in these major liver injuries. Copyright © 2013 Elsevier Ltd. All rights reserved.

  8. Case Report: Urgent endovascular treatment of subclavian artery injury after blunt trauma [v1; ref status: indexed, http://f1000r.es/4x8

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    Taka-aki Nakada

    2014-12-01

    Full Text Available Subclavian arterial injury is rare and potentially life-threatening, particularly when it leads to arterial occlusion, causing limb ischemia, retrograde thromboembolization and cerebral infarction within hours after injury. Here we report a blunt trauma case with subclavian arterial injury, upper extremity ischemia, and the need for urgent treatment to salvage the limb and prevent cerebral infarction. A 41-year-old man had a left, open, mid-shaft clavicle fracture and left subclavian artery injury accompanied by a weak pulse in the left radial artery, decreased blood pressure of the left arm compared to the right, and left hand numbness. Urgent debridement and irrigation of the open clavicle fracture was followed by angiography for the subclavian artery injury. The left distal subclavian artery had a segmental dissection with a thrombus. Urgent endovascular treatment using a self-expanding nitinol stent successfully restored the blood flow and blood pressure to the left upper extremity. Endovascular treatment is a viable option for cases of subclavian artery injury where there is a risk of extremity ischemia and cerebral infarction.

  9. Blunt abdominal trauma in adults: role of CT in the diagnosis and management of visceral injuries. Part 2: Gastrointestinal tract and retroperitoneal organs

    Energy Technology Data Exchange (ETDEWEB)

    Becker, C.D.; Terrier, F. [Department of Radiology, Division of Diagnostic and Interventional Radiology, Geneva University Hospital, 24, Rue Micheli-du-Crest, CH-1211 Geneva 14 (Switzerland); Mentha, G. [Department of Surgery, Division of Abdominal Surgery, Geneva University Hospital, 24, Rue Micheli-du-Crest, CH-1211 Geneva 14 (Switzerland); Schmidlin, F. [Department of Surgery, Division of Urology, Geneva University Hospital, 24, Rue Micheli-du-Crest, CH-1211 Geneva 14 (Switzerland)

    1998-06-02

    Computed tomography plays an important role in the detection and management of blunt visceral injuries in adults. Current standard examination techniques enable detection of the majority of perforating or devascularizing bowel injuries, although diagnostic findings are often subtle and meticulous inspection is required. Computed tomography may demonstrate pancreatic contusions and lacerations and help in distinguishing minor traumatic lesions without involvement of the pancreatic duct (organ injury scale, grades I and II) from deep lacerations with ductal involvement (grades III and V). Computed tomography enables distinguishing renal contusions and minor cortical lacerations that can usually be managed conservatively (injuries of grades I-III) from corticomedullary lacerations and injuries of the major renal vessels (grades IV and V) that have a less favorable prognosis and more commonly require surgical repair. In addition, CT is well suited for the detection of active renal hemorrhage and guidance of transcatheter embolization treatment and delineation of preexisting benign or malignant pathologies that may predispose to posttraumatic hemorrhage. The radiologist`s awareness of the diagnostic CT findings of abdominal visceral injuries as well as their clinical and surgical implications are important prerequisites for optimal patient management. (orig.) With 11 figs., 5 tabs., 56 refs.

  10. Hemostasis with emergently modified application of intra‐aortic balloon occlusion in a patient with impending cardiac arrest following blunt proximal thigh amputation

    Science.gov (United States)

    Uchida, Kotaro; Homma, Hiroshi; Yukioka, Tetsuo; Nagai, Noriko; Mishima, Shiro; Ohta, Shoichi

    2014-01-01

    Case A 30‐year‐old woman had her left thigh run over by a train. We tried to compress the left femoral area to control the arterial bleeding, but bleeding continued from the stump and injured soft tissue. The application of a tourniquet bandage also failed because of the limited remaining thigh. She developed impending cardiac arrest. As the left femoral arterial pulsation was still palpable, we inserted an intra‐aortic balloon occlusion catheter percutaneously. The hemorrhage from the stump region decreased rapidly. She was transferred to an operating room to carry out surgical hemostasis, and it was confirmed with deflation of the balloon in the common iliac artery. Outcome There was no complication of the skin or soft tissue at the surgical site caused by impaired circulation, and her consciousness fully recovered. Conclusion We report the successful control of bleeding by the emergently modified application of intra‐aortic balloon occlusion in the left common iliac artery. PMID:29123695

  11. Thromboembolic prophylaxis with low-molecular-weight heparin in patients with blunt solid abdominal organ injuries undergoing nonoperative management: current practice and outcomes.

    Science.gov (United States)

    Eberle, Barbara M; Schnüriger, Beat; Inaba, Kenji; Cestero, Ramon; Kobayashi, Leslie; Barmparas, Galinos; Oliver, Matthew; Demetriades, Demetrios

    2011-01-01

    Low-molecular-weight heparins (LMWHs) are effective in preventing thromboembolic complications after trauma. In the nonoperative management (NOM) of blunt solid abdominal organ injuries, the timing of the administration of LMWH remains controversial because of the unknown risk for bleeding. Retrospective study including patients aged 15 years or older who sustained blunt splenic, liver, and/or kidney injuries from January 2005 to December 2008. Patients were stratified according to the type and severity of organ injuries. NOM failure rates and blood transfusion requirements were compared between patients who got LMWH early (≤3 days), patients who got LMWH late (>3 days), and patients who did not receive LMWH. Overall, 312 (63.8%) patients with solid organ injuries had NOM attempted. There were 154 splenic, 144 liver, and 65 kidney injuries (1.2 organs injured per patient). Forty-one patients (13.2%) received LMWH early, 70 patients (22.4%) received LMWH late, and 201 (64.4%) patients did not receive LMWH. The early LMWH group was less severely injured compared with the late LMWH group. However, the distribution of the risk factors for failure of NOM (high-grade injury, large amount of hemoperitoneum, and contrast extravasation) was similar between the three LMWH groups. Overall, 17 of 312 patients (5.4%) failed NOM (7.8% spleen, 2.1% liver, and 3.1% kidney). All but one failure occurred before LMWH administration. After adjustment for demographic differences, the overall blood transfusion requirements for the early LMWH group was significantly lower when compared with patients with late LMWH administration (3.0±5.3 units vs. 6.4±9.9 units; adjusted p=0.027). Pulmonary embolism and deep venous thrombosis occurred in four patients. The mortality rate for patients with splenic, liver, and kidney injuries was 3.2% and did not differ with LMWH application. In patients with solid abdominal organ injuries undergoing NOM, early use of LMWH does not seem to increase

  12. The selective poly(ADP)ribose-polymerase 1 inhibitor INO1001 reduces spinal cord injury during porcine aortic cross-clamping-induced ischemia/reperfusion injury.

    Science.gov (United States)

    Maier, Christian; Scheuerle, Angelika; Hauser, Balázs; Schelzig, Hubert; Szabó, Csaba; Radermacher, Peter; Kick, Jochen

    2007-05-01

    It is well-established that poly(ADP)ribose-polymerase (PARP) assumes major importance during ischemic brain damage, and the selective PARP-1 inhibitor PJ34 reduced spinal cord damage in murine aortic occlusion-induced ischemia/reperfusion injury. We investigated the effect of the PARP-1 inhibitor INO1001 on aortic-occlusion-related porcine spinal cord injury. Prospective, randomized, controlled experimental study in an animal laboratory. Ten anesthetized, mechanically ventilated, and instrumented pigs. Animals underwent 45 min of thoracic aortic cross-clamping after receiving vehicle (n=5) or intravenous INO1001 (n=5, total dose 4 mg/kg administered both before clamping and during reperfusion). During reperfusion continuous intravenous norepinephrine was incrementally adjusted to maintain blood pressure at or above 80% of the preclamping level. Plasma INO1001 levels were analyzed by HPLC. After 4[Symbol: see text]h of reperfusion spinal cord biopsy samples were analyzed for neuronal damage (hematoxyline-eosine and Nissl staining), expression of the cyclin-dependent kinase inhibitor genes p21 and p27 (immunohistochemistry), and apoptosis (terminal deoxynucleotidyl transferase mediated nick end labeling assay). Plasma INO1001 levels were 0.8-2.3 and 0.30-0.76 mM before and after clamping, respectively. While 3-5% of the spinal cord neurons were irreversibly damaged in the INO1001 animals, the neuronal cell injury was three times higher in the control group. Neither p21 and p27 expression nor apoptosis showed any intergroup difference. The selective PARP-1 inhibitor INO1001 markedly reduced aortic occlusion-induced spinal cord injury. Given the close correlation reported in the literature between morphological damage and impaired spinal cord function, INO1001 may improve spinal cord recovery after thoracic aortic cross-clamping.

  13. Tricuspid Valve Avulsion after Blunt Chest Trauma

    OpenAIRE

    Mehrotra, Deepak; Dalley, Paul; Mahon, Barry

    2012-01-01

    Blunt cardiac trauma causing tricuspid regurgitation is rare and is most often associated with traffic accidents. Falling from a height can also cause such injuries, resulting in hemodynamic compromise and arrhythmias. The signs of traumatic tricuspid regurgitation can appear early or be delayed, depending upon the severity of injury. We present the case of a 68-year-old woman who fell from a height onto rocks during a hike. She sustained blunt cardiac injury with complete tricuspid valve avu...

  14. Weapon identification using antemortem CT with 3D reconstruction, is it always possible?--A report in a case of facial blunt and sharp injuries using an ashtray.

    Science.gov (United States)

    Aromatario, Mariarosaria; Cappelletti, Simone; Bottoni, Edoardo; Fiore, Paola Antonella; Ciallella, Costantino

    2016-01-01

    An interesting case of homicide involving the use of a heavy glass ashtray is described. The victim, a 81-years-old woman, has survived for few days and died in hospital. The external examination of the victim showed extensive blunt and sharp facial injuries and defense injuries on both the hands. The autopsy examination showed numerous tears on the face, as well as multiple fractures of the facial bones. Computer tomography scan, with 3D reconstruction, performed in hospital before death, was used to identify the weapon used for the crime. In recent years new diagnostics tools such as computer tomography has been widely used, especially in cases involving sharp and blunt forces. Computer tomography has proven to be very valuable in analyzing fractures of the cranial teca for forensic purpose, in particular antemortem computer tomography with 3D reconstruction is becoming an important tool in the process of weapon identification, thanks to the possibility to identify and make comparison between the shape of the object used to commit the crime, the injury and the objects found during the investigations. No previous reports on the use of this technique, for the weapon identification process, in cases of isolated facial fractures were described. We report a case in which, despite the correct use of this technique, it was not possible for the forensic pathologist to identify the weapon used to commit the crime. Authors wants to highlight the limits encountered in the use of computer tomography with 3D reconstruction as a tool for weapon identification when facial fractures occurred. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  15. Predictive Value of Aortic Valve Calcification for Periprocedural Myocardial Injury in Patients Undergoing Percutaneous Coronary Intervention.

    Science.gov (United States)

    Shibata, Yohei; Ishii, Hideki; Suzuki, Susumu; Tanaka, Akihito; Tatami, Yosuke; Harata, Shingo; Ota, Tomoyuki; Shimbo, Yusaku; Takayama, Yohei; Kunimura, Ayako; Hirayama, Kenshi; Harada, Kazuhiro; Osugi, Naohiro; Murohara, Toyoaki

    2017-05-01

    Previous studies have shown that aortic valve calcification (AVC) was associated with cardiovascular events and mortality. On the other hand, periprocedural myocardial injury (PMI) in percutaneous coronary intervention (PCI) is a well-known predictor of subsequent mortality and poor clinical outcomes. The purpose of the study was to assess the hypothesis that the presence of AVC could predict PMI in PCI. This study included 370 patients treated with PCI for stable angina pectoris. AVC was defined as bright echoes >1 mm on one or more cusps of the aortic valve on ultrasound cardiography (UCG). PMI was defined as an increase in high-sensitivity troponin T level of >5 times the upper normal limit (>0.070 ng/ml) at 24 hours after PCI. AVC was detected in 45.9% of the patients (n=170). The incidence of PMI was significantly higher in the patients with AVC than in those without AVC (43.5% vs 21.0%, p<0.001). The presence of AVC independently predicted PMI after adjusting for other significant variables (odds ratio 2.26, 95% confidence interval 1.37-3.74, p=0.002). Other predictors were male sex, age, estimated glomerular filtration rate, and total stent length. Furthermore to predict PMI, adding AVC to the established risk factors significantly improved the area under the receiver operating characteristic curves, from 0.68 to 0.72, of the PMI prediction model (p=0.025). The presence of AVC detected in UCG could predict the incidence of PMI.

  16. Association between the seat belt sign and intra-abdominal injuries in children with blunt torso trauma in motor vehicle collisions.

    Science.gov (United States)

    Borgialli, Dominic A; Ellison, Angela M; Ehrlich, Peter; Bonsu, Bema; Menaker, Jay; Wisner, David H; Atabaki, Shireen; Olsen, Cody S; Sokolove, Peter E; Lillis, Kathy; Kuppermann, Nathan; Holmes, James F

    2014-11-01

    The objective was to determine the association between the abdominal seat belt sign and intra-abdominal injuries (IAIs) in children presenting to emergency departments with blunt torso trauma after motor vehicle collisions (MVCs). This was a planned subgroup analysis of prospective data from a multicenter cohort study of children with blunt torso trauma after MVCs. Patient history and physical examination findings were documented before abdominal computed tomography (CT) or laparotomy. Seat belt sign was defined as a continuous area of erythema, ecchymosis, or abrasion across the abdomen secondary to a seat belt restraint. The relative risk (RR) of IAI with 95% confidence intervals (CIs) was calculated for children with seat belt signs compared to those without. The risk of IAI in those patients with seat belt sign who were without abdominal pain or tenderness, and with Glasgow Coma Scale (GCS) scores of 14 or 15, was also calculated. A total of 3,740 children with seat belt sign documentation after blunt torso trauma in MVCs were enrolled; 585 (16%) had seat belt signs. Among the 1,864 children undergoing definitive abdominal testing (CT, laparotomy/laparoscopy, or autopsy), IAIs were more common in patients with seat belt signs than those without (19% vs. 12%; RR = 1.6, 95% CI = 1.3 to 2.1). This difference was primarily due to a greater risk of gastrointestinal injuries (hollow viscous or associated mesentery) in those with seat belt signs (11% vs. 1%; RR = 9.4, 95% CI = 5.4 to 16.4). IAI was diagnosed in 11 of 194 patients (5.7%; 95% CI = 2.9% to 9.9%) with seat belt signs who did not have initial complaints of abdominal pain or tenderness and had GCS scores of 14 or 15. Patients with seat belt signs after MVCs are at greater risk of IAI than those without seat belt signs, predominately due to gastrointestinal injuries. Although IAIs are less common in alert patients with seat belt signs who do not have initial complaints of abdominal pain or tenderness, the

  17. Blunt and Penetrating Cardiac Trauma.

    Science.gov (United States)

    Bellister, Seth A; Dennis, Bradley M; Guillamondegui, Oscar D

    2017-10-01

    Patients with traumatic cardiac injuries can present with wide variability in their severity of illness. The most severe will present in cardiac arrest, whereas the most benign may be altogether asymptomatic; most will fall somewhere in between. Management of cardiac injuries largely depends on mechanism of injury and patient physiology. Understanding the spectrum of injuries and their associated manifestations can help providers react more quickly and initiate potentially life-saving therapies more efficiently when time is critical. This article discusses the workup and management of both blunt and penetrating cardiac injuries. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Blunt hepatic and splenic trauma in children: correlation of a CT injury severity scale with clinical outcome

    International Nuclear Information System (INIS)

    Ruess, L.; Sivit, C.J.; Eichelberger, M.R.; Taylor, G.A.; Bond, S.J.

    1995-01-01

    The purpose of this report is to compare a computed tomography (CT) injury severity scale for hepatic and splenic injury with the following outcome measures: requirement for surgical hemostasis, requirement for blood transfusion and late complications. Sixty-nine children with isolated hepatic injury and 53 with isolated splenic injury were prospectively classified at CT according to extent of parenchymal involvement. Clinical records were reviewed to determine clinical outcome. Ninety-seven children (80%) were managed non-operatively without transfusion. One child with hepatic injury required surgical hemostasis, and 17 (25%) required transfusion of blood. Increasing severity of hepatic injury at CT was associated with progressively greater frequency of transfusion (P = 0.002 by χ 2 -test). One child with splenic injury underwent surgery and eight (15%) required transfusion of blood. Splenic injury grade at CT did not correlate with frequency (P = 0.41 by χ 2 -test) or amount (P = 0.35 by factorial analysis of variance) of transfusion. There was one late complication in the nonsurgical group. A majority of children with hepatic and splenic injury were managed non-operatively without requiring blood transfusion. The severity of injury by CT scan did not correlate with need for surgery. Increasing grade of hepatic injury at CT was associated with increasing frequency of blood transfusion. CT staging was not discriminatory in predicting transfusion requirement in splenic injury. (orig.)

  19. Minimizing variance in Care of Pediatric Blunt Solid Organ Injury through Utilization of a hemodynamic-driven protocol: a multi-institution study.

    Science.gov (United States)

    Cunningham, Aaron J; Lofberg, Katrine M; Krishnaswami, Sanjay; Butler, Marilyn W; Azarow, Kenneth S; Hamilton, Nicholas A; Fialkowski, Elizabeth A; Bilyeu, Pamela; Ohm, Erika; Burns, Erin C; Hendrickson, Margo; Krishnan, Preetha; Gingalewski, Cynthia; Jafri, Mubeen A

    2017-12-01

    An expedited recovery protocol for management of pediatric blunt solid organ injury (spleen, liver, and kidney) was instituted across two Level 1 Trauma Centers, managed by nine pediatric surgeons within three hospital systems. Data were collected for 18months on consecutive patients after protocol implementation. Patient demographics (including grade of injury), surgeon compliance, National Surgical Quality Improvement Program (NSQIP) complications, direct hospital cost, length of stay, time in the ICU, phlebotomy, and re-admission were compared to an 18-month control period immediately preceding study initiation. A total of 106 patients were treated (control=55, protocol=51). Demographics were similar among groups, and compliance was 78%. Hospital stay (4.6 vs. 3.5days, p=0.04), ICU stay (1.9 vs. 1.0days, p=0.02), and total phlebotomy (7.7 vs. 5.3 draws, p=0.007) were significantly less in the protocol group. A decrease in direct hospital costs was also observed ($11,965 vs. $8795, p=0.09). Complication rates (1.8% vs. 3.9%, p=0.86, no deaths) were similar. An expedited, hemodynamic-driven, pediatric solid organ injury protocol is achievable across hospital systems and surgeons. Through implementation we maintained quality while impacting length of stay, ICU utilization, phlebotomy, and cost. Future protocols should work to further limit resource utilization. Retrospective cohort study. Level II. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Blunt Head Trauma and Headache

    Directory of Open Access Journals (Sweden)

    Ana B Chelse

    2015-04-01

    Full Text Available Investigators from New York Presbyterian Morgan Stanley Children’s Hospital examined whether having an isolated headache following minor blunt head trauma was suggestive of traumatic brain injury (TBI among a large cohort of children 2-18 years of age.

  1. Improving the prognostic value of blunt abdominal trauma scoring ...

    African Journals Online (AJOL)

    Purpose Blunt abdominal trauma (BAT) is a frequent reason for hospital admission and a significant cause of death in children older than 2 years of age. Mechanisms causing abdominal injuries are predominantly motor vehicle accidents, falls, and intentional injuries. Blunt trauma accounts for 90% of pediatric injuries.

  2. Lap-belt syndrome: management of aortic intimal dissection in a 7-year-old child with a constellation of injuries

    International Nuclear Information System (INIS)

    Khanna, Paritosh C.; Bulas, Dorothy I.; Rothenbach, Patricia; Guzzetta, Philip C.

    2007-01-01

    We present a case of lap-belt motor vehicle injury in a 7-year-old male who was admitted with abdominal ecchymoses and pain with associated aortic intimal flap, bowel injury, hemoperitoneum, and retroperitoneal hematoma at initial imaging with CT. Most of these findings were confirmed at subsequent laparotomy, and the patient underwent operative repair of bowel injuries. His aortic intimal flap was followed with US and color Doppler imaging during which time he was treated conservatively until there was sonographic evidence of intimal healing. This patient illustrates a multimodality approach to imaging and conservative management. (orig.)

  3. Lap-belt syndrome: management of aortic intimal dissection in a 7-year-old child with a constellation of injuries

    Energy Technology Data Exchange (ETDEWEB)

    Khanna, Paritosh C.; Bulas, Dorothy I. [George Washington University, Diagnostic Imaging and Radiology, Children' s National Medical Center, Washington, DC (United States); Rothenbach, Patricia; Guzzetta, Philip C. [George Washington University, Pediatric Surgery, Children' s National Medical Center, Washington, DC (United States)

    2007-01-15

    We present a case of lap-belt motor vehicle injury in a 7-year-old male who was admitted with abdominal ecchymoses and pain with associated aortic intimal flap, bowel injury, hemoperitoneum, and retroperitoneal hematoma at initial imaging with CT. Most of these findings were confirmed at subsequent laparotomy, and the patient underwent operative repair of bowel injuries. His aortic intimal flap was followed with US and color Doppler imaging during which time he was treated conservatively until there was sonographic evidence of intimal healing. This patient illustrates a multimodality approach to imaging and conservative management. (orig.)

  4. Blunt cardiac rupture in a toddler

    Directory of Open Access Journals (Sweden)

    Peep Talving

    2016-08-01

    Full Text Available Blunt cardiac rupture is typically a fatal injury with overall mortality exceeding 90%. Most of the patients never reach the hospital alive. In pediatric patients, only 0.03% of cases following blunt trauma admissions have a cardiac injury. This report presents a rare survivor of 16-months old toddler injured in a domestic accident suffering a right atrial rupture repaired through a median sternotomy. To the best of our knowledge this is the youngest case reported in the literature.

  5. Comparison of Fatty Acid and Gene Profiles in Skeletal Muscle in Normal and Obese C57BL/6J Mice before and after Blunt Muscle Injury

    Directory of Open Access Journals (Sweden)

    Jens-Uwe Werner

    2018-01-01

    Full Text Available Injury and obesity are two major health burdens affecting millions of people worldwide. Obesity is recognized as a state of chronic inflammation accompanied by various co-morbidities like T2D or cardiovascular diseases. There is increasing evidence that obesity impairs muscle regeneration, which is mainly due to chronic inflammation and to excessive accumulation of lipids in adipose and non-adipose tissue. To compare fatty acid profiles and changes in gene expression at different time points after muscle injury, we used an established drop tower-based model with a defined force input to damage the extensor iliotibialis anticus on the left hind limb of female C57BL/6J mice of normal weight and obese mice. Although most changes in fatty acid content in muscle tissue are diet related, levels of eicosaenoic (normal weight and DHG-linolenic acid (obese in the phospholipid and docosahexaenoic acid (normal weight in the triglyceride fraction are altered after injury. Furthermore, changes in gene transcription were detected in 3829 genes in muscles of normal weight mice, whereas only 287 genes were altered in muscles of obese mice after trauma. Alterations were found within several pathways, among them notch-signaling, insulin-signaling, sonic hedgehog-signaling, apoptosis related pathways, fat metabolism related cholesterol homeostasis, fatty acid biosynthetic process, fatty acid elongation, and acyl-CoA metabolic process. We could show that genes involved in fat metabolism are affected 3 days after trauma induction mostly in normal weight but not in obese mice. The strongest effects were observed in normal weight mice for Alox5ap, the activating protein for leukotriene synthesis, and Apobec1, an enzyme substantial for LDL synthesis. In summary, we show that obesity changes the fat content of skeletal muscle and generally shows a negative impact upon blunt muscle injury on various cellular processes, among them fatty acid related metabolism, notch

  6. Efficacy and tolerability of a new ibuprofen 200mg plaster in patients with acute sports-related traumatic blunt soft tissue injury/contusion.

    Science.gov (United States)

    Predel, Hans-Georg; Giannetti, Bruno; Connolly, Mark P; Lewis, Fraser; Bhatt, Aomesh

    2018-01-01

    Ibuprofen is used for the treatment of non-serious pain. This study assessed the efficacy and safety of a new ibuprofen plaster for the treatment of pain associated with acute sports impact injuries/contusions. In this randomised, double-blind, multi-centre, placebo controlled, parallel group study, adults (n = 130; 18-58 years of age) diagnosed with acute sports-related blunt soft tissue injury/contusion were randomized to receive either ibuprofen 200 mg plaster or placebo plaster. Plasters were administered once daily for five consecutive days. The primary assessment was area under the visual analogue scale (VAS) of pain on movement (POM) over 0 to three days (VAS AUC 0-3d ). Other endpoints included algometry AUC from 0 to three days (AUC 0-3d ) and 0 to five days (AUC 0-5d ), to evaluate improvement of sensitivity at the injured site, and patient and investigator global assessment of efficacy. Safety was monitored throughout the study. The ibuprofen plaster resulted in superior reduction in AUC 0-3d compared with placebo; the Least Squares (LS) mean difference was 662.82 mm*h in favour of the ibuprofen 200mg plaster (P = 0.0011). The greater improvement in VAS AUC of POM was also observed after 12 h, 24 h, and five days of therapy. Tenderness also significantly improved with the ibuprofen plaster compared with placebo; LS mean difference in algometry/tenderness AUC 0-3d was 1.87 N/cm 2 *d and AUC 0-5d was 1.87 N/cm 2 *d (P values ≤0.0004). At all study timepoints, a greater percentage of patients and investigators rated the effectiveness of the ibuprofen 200 mg plaster as good/excellent than the placebo plaster. Treatment-emergent adverse events for the ibuprofen plaster were few (≤1.5%) and were mild in severity. The results of this study indicate 200 mg plaster is effective and safe for the treatment of pain due to acute sports-related traumatic blunt soft tissue injury/contusion in adults.

  7. How Does the Severity of Injury Vary between Motorcycle and Automobile Accident Victims Who Sustain High-Grade Blunt Hepatic and/or Splenic Injuries? Results of a Retrospective Analysis.

    Science.gov (United States)

    Hsieh, Ting-Min; Tsai, Tsung-Cheng; Liu, Yueh-Wei; Hsieh, Ching-Hua

    2016-07-21

    High-grade blunt hepatic and/or splenic injuries (BHSI) remain a great challenge for trauma surgeons. The main aim of this study was to investigate the characteristics, mortality rates, and outcomes of high-grade BHSI in motorcyclists and car occupants hospitalized for treatment of traumatic injuries in a Level I trauma center in southern Taiwan. High-grade BHSI are defined as grade III-VI blunt hepatic injuries and grade III-V blunt splenic injuries. This retrospective study reviewed the data of 101 motorcyclists and 32 car occupants who experienced a high-grade BHSI from 1 January 2011 to 31 December 2013. Two-sided Fisher's exact or Pearson's chi-square tests were used to compare categorical data, unpaired Student's t-test was used to analyze normally distributed continuous data, and Mann-Whitney's U test was used to compare non-normally distributed data. In this study, the majority (76%, 101/133) of high-grade BHSI were due to motorcycle crashes. Car occupants had a significantly higher injury severity score (ISS; 26.8 ± 10.9 vs. 20.7 ± 10.4, respectively, p = 0.005) and organ injured score (OIS; 3.8 ± 1.0 vs. 3.4 ± 0.6, respectively, p = 0.033), as well as a significantly longer hospital length of stay (LOS; 21.2 days vs. 14.6 days, respectively, p = 0.038) than did motorcyclists. Car occupants with high-grade BHSI also had worse clinical presentations than their motorcyclist counterparts, including a significantly higher incidence of hypotension, hyperpnea, tube thoracostomy, blood transfusion >4 units, LOS in intensive care unit >5 days, and complications. However, there were no differences in the percentage of angiography or laparotomy performed or mortality rate between these two groups of patients. This study demonstrated that car occupants with high-grade BHSI were injured more severely, had a higher incidence of worse clinical presentation, had a longer hospital LOS, and had a higher incidence of complications than motorcyclists. The results also

  8. Screening and detection of blunt vertebral artery injury in patients with upper cervical fractures: The role of cervical CT and CT angiography

    Energy Technology Data Exchange (ETDEWEB)

    Payabvash, Seyedmehdi, E-mail: spayab@gmail.com [Department of Radiology, University of Minnesota Medical Center, Minneapolis, MN (United States); McKinney, Alexander M., E-mail: mckinrad@umn.edu [Department of Radiology, Hennepin County Medical Center, 701 Park Avenue, Minneapolis, MN (United States); McKinney, Zeke J., E-mail: zeke.mckinney@hcmed.org [Department of Radiology, Hennepin County Medical Center, 701 Park Avenue, Minneapolis, MN (United States); Palmer, Christopher S., E-mail: palme018@umn.edu [Department of Radiology, Hennepin County Medical Center, 701 Park Avenue, Minneapolis, MN (United States); Truwit, Charles L., E-mail: truwit@umn.edu [Department of Radiology, Hennepin County Medical Center, 701 Park Avenue, Minneapolis, MN (United States)

    2014-03-15

    Objective: To evaluate the clinical utility of nonenhanced CT (NECT)-based screening criteria and CTA in detection of blunt vertebral artery injury (BVAI) in trauma patients with C1 and/or C2 fractures. Methods: We retrospectively reviewed the clinical records of all blunt trauma patients with C1 and/or C2 fractures between 8/2006 and 9/2011. Cervical CTA was prompted by cervical fractures involving/adjacent to a transverse foramen, and/or subluxation on NECT. Two neuroradiologists independently reviewed the CTA studies, and graded the BVAI. Results: 210 patients were included; of these, 124 underwent CTA (21/124 with digital subtraction angiography, DSA), and 2 underwent DSA only. Overall, 30/126 suffered BVAI. Among 21 patients who underwent both CTA and DSA, there was 1 false negative and 1 false positive (both grade 1). There was strong interobserver agreement regarding CTA-based BVAI detection (kappa = 0.93, p < 0.001) and grading (kappa = 0.90, p < 0001). Only 3/30 BVAI patients suffered a posterior circulation stroke; none of the patients who had a negative CTA or were not selected for CTA, based on NECT screening criteria, suffered symptomatic stroke. While C1/C2 comminuted fracture was more common in patients with high grade BVAI (p = 0.039), simultaneous C3–C7 comminuted fracture increased the overall BVAI risk (p = 0.011). Conclusion: CTA reliably detects symptomatic BVAI in patients with upper cervical fractures. Utilization of NECT-based screening criteria such as transverse foraminal involvement or subluxation may be adequate in deciding whether to perform CTA, as no patients who were not selected for CTA suffered a symptomatic stroke. However, CTA may miss lower grade, asymptomatic BVAI.

  9. Low-flow antegrade cerebral perfusion attenuates early renal and intestinal injury during neonatal aortic arch reconstruction.

    Science.gov (United States)

    Algra, Selma O; Schouten, Antonius N J; van Oeveren, Wim; van der Tweel, Ingeborg; Schoof, Paul H; Jansen, Nicolaas J G; Haas, Felix

    2012-12-01

    Deep hypothermic circulatory arrest (DHCA) and antegrade cerebral perfusion (ACP) are 2 cardiopulmonary bypass strategies mainly used in aortic arch reconstructions. It has been suggested that during ACP, abdominal organs are better protected than during DHCA owing to partial perfusion via collaterals. We tested this hypothesis using intraoperative near-infrared spectroscopy (NIRS), lactate measurements, and biomarkers for early abdominal injury in neonates undergoing complex aortic arch repair. Neonates scheduled for aortic arch reconstruction via median sternotomy between 2009 and 2011 were randomized to either DHCA or ACP. During surgery, regional oxygen saturations of the abdomen were monitored using NIRS. Immediately aafter DHCA or ACP, lactate concentrations from the inferior vena cava were compared with those from the arterial cannula. Postoperatively, biomarkers for early abdominal organ injury were measured in urine. Twenty-five neonates were analyzed (DHCA, n = 12; ACP, n = 13). Procedures were performed at 18°C, and ACP flow was set at 35 to 50 mL · kg(-1) · min(-1). Median abdominal NIRS value during DHCA was 31% (IQR, 28%-41%) whereas during ACP it was 56% (IQR, 34%-64%; P intestinal damage (gluthatione s-transferase and intestinal fatty acid binding protein, respectively) were higher in the DHCA group than for the ACP group (P = .03, P = .04, respectively). These results substantiate earlier suggestions that ACP provides more abdominal organ protection than DHCA in neonates undergoing aortic arch reconstruction. Copyright © 2012 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  10. Comparison of Clinician Suspicion Versus a Clinical Prediction Rule in Identifying Children at Risk for Intra-abdominal Injuries After Blunt Torso Trauma.

    Science.gov (United States)

    Mahajan, Prashant; Kuppermann, Nathan; Tunik, Michael; Yen, Kenneth; Atabaki, Shireen M; Lee, Lois K; Ellison, Angela M; Bonsu, Bema K; Olsen, Cody S; Cook, Larry; Kwok, Maria Y; Lillis, Kathleen; Holmes, James F

    2015-09-01

    Emergency department (ED) identification and radiographic evaluation of children with intra-abdominal injuries who need acute intervention can be challenging. To date, it is unclear if a clinical prediction rule is superior to unstructured clinician judgment in identifying these children. The objective of this study was to compare the test characteristics of clinician suspicion with a derived clinical prediction rule to identify children at risk of intra-abdominal injuries undergoing acute intervention following blunt torso trauma. This was a planned subanalysis of a prospective, multicenter observational study of children (trauma conducted in 20 EDs in the Pediatric Emergency Care Applied Research Network (PECARN). Clinicians documented their suspicion for the presence of intra-abdominal injuries needing acute intervention as 50% prior to knowledge of abdominal computed tomography (CT) scanning (if performed). Intra-abdominal injuries undergoing acute intervention were defined by a therapeutic laparotomy, angiographic embolization, blood transfusion for abdominal hemorrhage, or intravenous fluid administration for 2 or more days in those with pancreatic or gastrointestinal injuries. Patients were considered to be positive for clinician suspicion if suspicion was documented as ≥1%. Suspicion ≥ 1% was compared to the presence of any variable in the prediction rule for identifying children with intra-abdominal injuries undergoing acute intervention. Clinicians recorded their suspicion in 11,919 (99%) of 12,044 patients enrolled in the parent study. Intra-abdominal injuries undergoing acute intervention were diagnosed in 203 (2%) patients. Abdominal CT scans were obtained in the ED in 2,302 of the 2,667 (86%, 95% confidence interval [CI] = 85% to 88%) enrolled patients with clinician suspicion ≥1% and in 3,016 of the 9,252 (33%, 95% CI = 32% to 34%) patients with clinician suspicion undergoing acute intervention (197 of 203; 97.0%, 95% CI = 93.7% to 98.9%) was

  11. Rupture of the aorta following road traffic accidents in the United Kingdom 1992-1999. The results of the co-operative crash injury study.

    Science.gov (United States)

    Richens, D; Kotidis, K; Neale, M; Oakley, C; Fails, A

    2003-02-01

    The true incidence and survivability of blunt traumatic aortic rupture following road traffic accidents in the UK is unclear. The objective of this study was to determine the extent of blunt traumatic aortic rupture in the UK after road traffic accidents and the conditions under which it occurs. Data for the study was obtained from the Co-operative Crash Injury Study database. Road traffic accidents that happened between 1992 and 1999 and included in the Co-operative Crash Injury Study database were retrospectively investigated. A total of 8285 vehicles carrying 14,435 occupants were involved in 7067 accidents. There were 132 cases of blunt traumatic aortic rupture, of which the scene survival was 9% and the overall mortality was 98%. Twenty-one percent of all fatalities had blunt traumatic aortic rupture (130/613). Twenty-nine percent were due to frontal impacts and 44% were due to side impacts. Twelve percent of the blunt traumatic aortic rupture cases in frontal vehicle impacts were wearing seat belts and had airbag protection and 19% had no restraint mechanism. The Equivalent Test Speed of the accident vehicles, (where equivalent test speed provides an estimate of the vehicle impact severity and not an estimate of the vehicle speed at the time of the accident), ranged from 30 to 110 km/h in frontal impacts and from 15 to 82 km/h in side impacts. Blunt traumatic aortic rupture carries a high mortality and occurred in 21% of car occupant deaths in this sample of road traffic accidents. Impact scenarios varied but were most common from the side. The use of an airbag or seat belt does not eliminate risk. The injury can occur at low severity impacts particularly in side impact. Copyright 2002 Elsevier Science B.V.

  12. Aortic Dissection

    Science.gov (United States)

    ... Follow a low-salt diet with plenty of fruits, vegetables and whole grains and exercise regularly. Wear a seat belt. This reduces the risk of traumatic injury to your chest area. Work with your doctor. If you have a family history of aortic dissection, a connective tissue disorder or ...

  13. Acute Traumatic Aortic Disruption and Right Aortic Arch: A Fatal Diagnosis

    Directory of Open Access Journals (Sweden)

    Shirvan Salaminia

    2016-09-01

    Full Text Available Acute traumatic aortic disruption occurs after forceful deceleration and usually due to motor accidents. Only 10 % to 15 % reach a treatment facility alive and a highly suspicious state is needed for timely diagnosis. Most time they suffer multiple associated lethal injuries. Asymptomatic and isolated right aortic arch is a rare anomaly of the aorta with a prevalence of 0.5% [3]. Its diagnosis is by radiologic studies. We present this patient to remember that the incidental right aortic arch and disruption may interpreted as the left side mediastinal rotation in radiography and so inadvertently lead to late diagnosis and a futile outcome. A 24-year old man was brought to emergency room following a motor accident. He had Glascow Coma Scale Score: 14-15/15 but with stable vital signs. After primary survey chest radiography, emergency abdominal sonography (eFAST and brain CT scanning were requested. Spiral thoracoabdominal CT was also requested about seven hours after admission and when the patient entered an unstable hemodynamic phase. The primary survey was unremarkable. His chest radiography had left mediastinal rotation, which is opposite to what is seen pathologically in the condition of the traumatic aortic disruption, the right mediastinal rotation. His eFAST and brain CT were normal. The patient remained stable until seven hours after admission when the patient becomes unstable. Massive pleural effusion with aortic disruption and a right aortic arch was seen in thoracoabdominal CT. He transferred to the operation room but arrested during transfer. Massive hemothorax was seen during open cardiac massage. Cardiopulmonary resuscitation was unsuccessful. This may raises that in any blunt trauma patient with highly suspicious history for the great vessel injury, it may be better to consider the spiral chest CT scanning as the primary radiologic test for evaluation of the chest trauma and not waste the time or resources with rely simply on a

  14. Rupture of the left atrial roof due to blunt trauma.

    Science.gov (United States)

    Ryu, Dae Woong; Lee, Sam Youn; Lee, Mi Kyung

    2013-11-01

    Cardiac rupture after blunt trauma is rare and associated with high mortality. The anatomic pattern of blunt cardiac rupture has been demonstrated with the right cardiac chambers more frequently affected than the left. Furthermore, left atrial injury is usually restricted to the atrial appendage and the pulmonary vein-atrial junction. Herein, we report the first case of a 61-year old man with a rupture of the left atrial roof after blunt trauma with minimal thoracic injury.

  15. Rupture of the left atrial roof due to blunt trauma

    OpenAIRE

    Ryu, Dae Woong; Lee, Sam Youn; Lee, Mi Kyung

    2013-01-01

    Cardiac rupture after blunt trauma is rare and associated with high mortality. The anatomic pattern of blunt cardiac rupture has been demonstrated with the right cardiac chambers more frequently affected than the left. Furthermore, left atrial injury is usually restricted to the atrial appendage and the pulmonary vein–atrial junction. Herein, we report the first case of a 61-year old man with a rupture of the left atrial roof after blunt trauma with minimal thoracic injury.

  16. Diagnostic imaging of cervical spine injuries following blunt trauma: A review of the literature and practical guideline

    NARCIS (Netherlands)

    Saltzherr, T. P.; Fung Kon Jin, P. H. P.; Beenen, L. F. M.; Vandertop, W. P.; Goslings, J. C.

    2009-01-01

    - Patients with a (potential) cervical spine injury can be subdivided into low-risk and high-risk patients. - With a detailed history and physical examination the cervical spine of patients in the 'low-risk' group can be 'cleared' without further radiographic examinations. - X-ray imaging (3-view

  17. The characteristics and pre-hospital management of blunt trauma patients with suspected spinal column injuries : a retrospective observational study

    NARCIS (Netherlands)

    Oosterwold, J. T.; Sagel, D. C.; van Grunsven, P. M.; Holla, M.; de Man-van Ginkel, J.; Berben, S.

    Background Pre-hospital spinal immobilisation by emergency medical services (EMS) staff is currently the standard of care in cases of suspected spinal column injuries. There is, however, a lack of data on the characteristics of patients who received spinal immobilisation during the pre-hospital

  18. The characteristics and pre-hospital management of blunt trauma patients with suspected spinal column injuries: a retrospective observational study

    NARCIS (Netherlands)

    Oosterwold, J.T.; Sagel, D.C.; Grunsven, P.M. van; Holla, M.; Man-van Ginkel, J.M. de; Berben, S.A.

    2017-01-01

    BACKGROUND: Pre-hospital spinal immobilisation by emergency medical services (EMS) staff is currently the standard of care in cases of suspected spinal column injuries. There is, however, a lack of data on the characteristics of patients who received spinal immobilisation during the pre-hospital

  19. Appendicitis following blunt abdominal trauma.

    Science.gov (United States)

    Cobb, Travis

    2017-09-01

    Appendicitis is a frequently encountered surgical problem in the Emergency Department (ED). Appendicitis typically results from obstruction of the appendiceal lumen, although trauma has been reported as an infrequent cause of acute appendicitis. Intestinal injury and hollow viscus injury following blunt abdominal trauma are well reported in the literature but traumatic appendicitis is much less common. The pathophysiology is uncertain but likely results from several mechanisms, either in isolation or combination. These include direct compression/crush injury, shearing injury, or from indirect obstruction of the appendiceal lumen by an ileocecal hematoma or traumatic impaction of stool into the appendix. Presentation typically mirrors that of non-traumatic appendicitis with nausea, anorexia, fever, and right lower quadrant abdominal tenderness and/or peritonitis. Evaluation for traumatic appendicitis requires a careful history and physical exam. Imaging with ultrasound or computed tomography is recommended if the history and physical do not reveal an acute surgical indication. Treatment includes intravenous antibiotics and surgical consultation for appendectomy. This case highlights a patient who developed acute appendicitis following blunt trauma to the abdomen sustained during a motor vehicle accident. Appendicitis must be considered as part of the differential diagnosis in any patient who presents to the ED with abdominal pain, including those whose pain begins after sustaining blunt trauma to the abdomen. Because appendicitis following trauma is uncommon, timely diagnosis requires a high index of suspicion. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Value of CT to predict surgically important bowel and/or mesenteric injury in blunt trauma: performance of a preliminary scoring system

    Energy Technology Data Exchange (ETDEWEB)

    Faget, Claire; Taourel, Patrice; Ruyer, Alban; Alili, Chakib; Millet, Ingrid [CHU Lapeyronie, Department of Medical Imaging, Montpellier (France); Charbit, Jonathan [CHU Lapeyronie, Department of Intensive Care and Anesthesiology, Montpellier (France); Molinari, Nicolas [UMR 729 MISTEA, CHU Montpellier, Department of Medical Information and Statistics, Montpellier (France)

    2015-12-15

    To evaluate the performance of a computed tomography (CT) diagnostic score to predict surgical treatment for blunt bowel and/or mesentery injury (BBMI) in consecutive abdominal trauma. This was a retrospective observational study of 805 consecutive abdominal traumas with 556 patients included and screened by an abdominal radiologist blinded to the patient outcome, to evaluate numerous CT findings and calculate their diagnostic performances. These CT findings were compared using univariate and multivariate analysis between patients who had a laparotomy-confirmed BBMI requiring surgical repair, and those without BBMI requiring surgery. A CT score was obtained with an internal bootstrap validation. Fifty-six patients (10.1 %) had BBMI requiring surgery. Nine CT signs were independently associated with BBMI requiring surgery and were used to develop a CT diagnostic score. The AUC of our model was 0.98 (95 % CI 0.96-100), with a ≥5 cut-off. Its diagnostic performance was determined by internal validation: sensitivity 91.1-100 %, specificity 85.7-97.6 %, positive predictive value 41.4-82.3 % and negative predictive value 98.9-100 %. Bowel wall discontinuity and mesenteric pneumoperitoneum had the strongest association with BBMI requiring surgery (OR = 128.9 and 140.5, respectively). We developed a reliable CT scoring system which is easy to implement and highly predictive of BBMI requiring surgery. (orig.)

  1. Timing of blunt force injuries in long bones: the effects of the environment, PMI length and human surrogate model.

    Science.gov (United States)

    Coelho, Luís; Cardoso, Hugo F V

    2013-12-10

    Timing of blunt force trauma in human bone is a critical forensic issue, but there is limited knowledge on how different environmental conditions, the duration of postmortem interval (PMI), different bone types and different animal models influence fracture morphology. This study aims at evaluating the influence of the type of postmortem environment and the duration of the postmortem period on fracture morphology, for distinguishing perimortem from postmortem fractures on different types of long bones from different species. Fresh limb segments from pig and goat were sequentially left to decompose, under 3 different environmental circumstances (surface, buried and submerged), resulting in sets with different PMI lengths (0, 28, 56, 84, 112, 140, 168 and 196 days), which were then fractured. Fractured bones (total=325; pig tibia=110; pig fibula=110; goat metatarsals=105) were classified according to the Fracture Freshness Index (FFI). Climatic data for the experiment location was collected. Statistical analysis included descriptive statistics, correlation analysis between FFI and PMI, Mann-Whitney U tests comparing FFI medians for different PMI's and linear regression analysis using PMI, pluviosity and temperature as predictors for FFI. Surface samples presented increases in FFI with increasing PMI, with positive correlations for all bone types. The same results were observed in submerged samples, except for pig tibia. Median FFI values for surface samples could distinguish bones with PMI=0 days from PMI≥56 days. Buried samples presented no significant correlation between FFI and PMI, and nonsignificant regression models. Regression analysis of surface and submerged samples suggested differences in FFI variation with PMI between bone types, although without statistical significance. Adding climatic data to surface regression models resulted in PMI no longer predicting FFI. When comparing different animal models, linear regressions suggested greater increases in

  2. One-year follow-up and convalescence evaluated by nuclear medicine studies and 24-hour holter electrocardiogram in 11 patients with myocardial injury due to a blunt chest trauma.

    Science.gov (United States)

    Amino, Mari; Yoshioka, Koichiro; Morita, Seiji; Iizuka, Shinichi; Otsuka, Hiroyuki; Yamamoto, Rie; Aoki, Hiromichi; Aizawa, Toru; Ikari, Yuji; Nasu, Seiji; Hatakeyama, Kenji; Iino, Misako; Kodama, Itsuo; Inokuchi, Sadaki; Tanabe, Teruhisa

    2009-05-01

    There are few reports on long-term convalescence with regard to cardiac injury caused by blunt chest trauma. Nuclear medicine study of the heart (NMSH) in the early stages of injury is reportedly superior to detect the correlation between injury and fatal arrhythmia. Therefore, we prospectively performed NMSH and Holter electrocardiogram (ECG) in the early and chronic stages for a cardiac injury patient, and we longitudinally examined the recovery process and the occurrence of fatal arrhythmia. A total of 202 patients with blunt chest trauma were admitted to our hospital between April 2006 and January 2007. Of 65 patients who were diagnosed with cardiac injury by ECG, a myocardial enzyme, or cardiac ultrasonography, 11 were enrolled in this study because they agreed to outpatient visiting for regular examinations for 1 year. NMSH showed positive findings in 6 of the 11 patients in the acute period of cardiac damage without complete recovery. Among the six patients in whom NMSH showed positive findings, Holter ECG indicated an abnormal finding in two patients in the acute period and in four patients in the chronic period, and detected one patient with a nonsustained ventricular tachycardia in the chronic period. Cardiac injuries may exacerbate cardiac functions and lead to fatal arrhythmia during the chronic period. Therefore, evaluating recovery for at least 12 months after myocardial damage is necessary to prevent sudden cardiac death.

  3. Frequency and Effect of Access-Related Vascular Injury and Subsequent Vascular Intervention After Transcatheter Aortic Valve Replacement

    DEFF Research Database (Denmark)

    Dencker, Ditte; Taudorf, Mikkel; Luk, N H Vincent

    2016-01-01

    Vascular access and closure remain a challenge in transcatheter aortic valve replacement (TAVR). This single-center study aimed to report the incidence, predictive factors, and clinical outcomes of access-related vascular injury and subsequent vascular intervention. During a 30-month period, 365...... patients underwent TAVR and 333 patients (94%) were treated by true percutaneous transfemoral approach. Of this latter group, 83 patients (25%) had an access-related vascular injury that was managed by the use of a covered self-expanding stent (n = 49), balloon angioplasty (n = 33), or by surgical...... for access-related vascular intervention. In addition, a high sheath/common femoral artery ratio as measured on preoperative CTA was associated with a higher rate of post-TAVR vascular intervention. The radiation dose, iodine contrast volume, transfusion need, length of hospitalization, and 30-day mortality...

  4. Neutrophil gelatinase-associated lipocalin and acute kidney injury in endovascular aneurysm repair or open aortic repair: a pilot study.

    Science.gov (United States)

    Rampoldi, Benedetta; Tessarolo, Serena; Giubbilini, Paola; Gaia, Paola; Corino, Samantha D; Mazza, Sarah; Rigolini, Roberta; Poli, Marco Dei; Vianello, Elena; Romanelli, Massimiliano M Corsi; Costa, Elena

    2018-02-15

    Acute kidney injury (AKI) occurs frequently after abdominal aortic surgery and there is currently no effective marker able to detect early onset. The aim of this study is to evaluate the ability of neutrophil gelatinase-associated lipocalin (NGAL) to early identify the development of acute renal damage in patients undergoing endovascular aneurysm repair (EVAR) or open aortic repair (OAR). Serial samples of blood and urine were obtained from 25 patients undergoing both EVAR and OAR. Seven male subjects with AKI and 18 subjects with no-AKI (17 males, 1 female) were included in the study. We determined concentrations of serum creatinine (sCr) and urinary, serum and whole blood NGAL (uNGAL, sNGAL, bNGAL) collected at baseline, and after 4 and 18 hours. AKI was defined according to the RIFLE criteria (risk, injury, failure, loss of kidney function, and end-stage kidney disease): increase by 50% in sCr or reduction of at least 25% of estimated glomerular filtration rate (eGFR) from baseline. Seven patients developed AKI in the stage Risk. There was no significant difference in sNGAL concentrations in the AKI group as compared to no-AKI group. However, the uNGAL/uCreatinine ratio and bNGAL concentrations were significantly higher after 18 hours in the AKI group (no-AKI 1.69 (0.91 - 2.47) vs AKI 3.2 (2.08 - 5.92) ng/mg for uNGAL/uCreatinine ratio, P = 0.036; and no-AKI 83 (59 - 131) vs AKI 164 (126 - 263) ng/mL for bNGAL, P = 0.029). Our results suggest that uNGAL, sNGAL and bNGAL, after abdominal aortic surgery, are not suitable as early biomarkers of AKI.

  5. The effects of contrast media volume on acute kidney injury after transcatheter aortic valve replacement: a systematic review and meta-analysis.

    Science.gov (United States)

    Thongprayoon, Charat; Cheungpasitporn, Wisit; Podboy, Alexander J; Gillaspie, Erin A; Greason, Kevin L; Kashani, Kianoush B

    2016-11-01

    The goal of this systematic review was to assess the effects of contrast media volume on transcatheter aortic valve replacement-related acute kidney injury. A literature search was performed using Medline, EMbase, the Cochrane Database of Systematic Reviews, and clinicaltrials.gov from the inception of these databases through December 2015. Studies that reported relative risk, odds ratio, or hazard ratio comparing the risks of acute kidney injury following transcatheter aortic valve replacement in patients who received high contrast media volume were included. Pooled risk ratio (RR) and 95% confidence intervals (95% CI) were calculated using a random-effect, generic inverse variance method. Four cohort studies composed of 891 patients were included in the analyses to assess the risk of acute kidney injury after transcatheter aortic valve replacement in patients who received high contrast media volume. The pooled RR of acute kidney injury after transcatheter aortic valve replacement in patients who received a large volume of contrast media was 1.41 (95% CI, 0.87 to 2.28) compared with low contrast media volume. The meta-analysis was limited to studies using standard acute kidney injury definitions, and the pooled RR of acute kidney injury in patients who received high contrast media volume is 1.12 (95% CI, 0.78 to 1.62). Our meta-analysis shows no significant association between contrast media volume and risk of acute kidney injury after transcatheter aortic valve replacement. © 2016 Chinese Cochrane Center, West China Hospital of Sichuan University and John Wiley & Sons Australia, Ltd.

  6. Impact of Acute Kidney Injury on Short- and Long-term Outcomes After Transcatheter Aortic Valve Implantation.

    Science.gov (United States)

    Nunes Filho, Antonio C B; Katz, Marcelo; Campos, Carlos M; Carvalho, Luiz A; Siqueira, Dimytri A; Tumelero, Rogério T; Portella, Antenor L F; Esteves, Vinícius; Perin, Marco A; Sarmento-Leite, Rogério; Lemos Neto, Pedro A; Tarasoutchi, Flavio; Bezerra, Hiram G; de Brito, Fábio S

    2018-01-18

    Acute kidney injury (AKI) is frequently observed after transcatheter aortic valve implantation (TAVI) and is associated with higher mortality. However, the impact of AKI on long-term outcomes remains controversial. Therefore, we sought to evaluate the impact of AKI on short- and long-term outcomes following TAVI using the Valve Academic Research Consortium 2 criteria. Consecutive patients (n = 794) with severe aortic stenosis who underwent TAVI were included in a multicenter Brazilian registry. Logistic regression analysis was used to identify predictors of AKI. Four-year outcomes were determined as Kaplan-Meier survival curves, and an adjusted landmark analysis was used to test the impact of AKI on mortality among survivors at 12 months. The incidence of AKI after TAVI was 18%. Independent predictors of AKI were age, diabetes mellitus, major or life-threatening bleeding and valve malpositioning. Acute kidney injury was independently associated with higher risk of all-cause death (adjusted HR, 2.8; 95%CI, 2.0-3.9; P cardiovascular mortality (adjusted HR, 2.9; 95%CI, 1.9-4.4; P < .001) over the entire follow-up period. However, when considering only survivors at 12 months, there was no difference in both clinical endpoints (adjusted HR, 1.2; 95%CI, 0.5-2.4; P = .71, and HR, 0.7; 95%CI, 0.2-2.1; P = .57, respectively). Acute kidney injury is a frequent complication after TAVI. Older age, diabetes, major or life-threatening bleeding, and valve malpositioning were independent predictors of AKI. Acute kidney injury is associated with worse short- and long-term outcomes. However, the major impact of AKI on mortality is limited to the first year after TAVI. Copyright © 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  7. Tricuspid valve avulsion after blunt chest trauma.

    Science.gov (United States)

    Mehrotra, Deepak; Dalley, Paul; Mahon, Barry

    2012-01-01

    Blunt cardiac trauma causing tricuspid regurgitation is rare and is most often associated with traffic accidents. Falling from a height can also cause such injuries, resulting in hemodynamic compromise and arrhythmias. The signs of traumatic tricuspid regurgitation can appear early or be delayed, depending upon the severity of injury. We present the case of a 68-year-old woman who fell from a height onto rocks during a hike. She sustained blunt cardiac injury with complete tricuspid valve avulsion, and underwent successful repair. In addition, we review the relevant medical literature.

  8. Tricuspid regurgitation after blunt chest trauma

    Directory of Open Access Journals (Sweden)

    Tone Gabrijelčič

    2013-01-01

    Conclusion: Our data support the fact that an injury of the tricuspid valve due to blunt chest trauma is rare and easily overlooked. Therefore, ultrasound of the heart should be done in all cases of blunt chest trauma. If negative, it should be repeated. Transoesophageal approach is more reliable than the transthoracic one. The gold standard for therapy is a valve repair, which should be done early enough to prevent further morbidity and mortality.

  9. Frequency and Effect of Access-Related Vascular Injury and Subsequent Vascular Intervention After Transcatheter Aortic Valve Replacement.

    Science.gov (United States)

    Dencker, Ditte; Taudorf, Mikkel; Luk, N H Vincent; Nielsen, Michael B; Kofoed, Klaus F; Schroeder, Torben V; Søndergaard, Lars; Lönn, Lars; De Backer, Ole

    2016-10-15

    Vascular access and closure remain a challenge in transcatheter aortic valve replacement (TAVR). This single-center study aimed to report the incidence, predictive factors, and clinical outcomes of access-related vascular injury and subsequent vascular intervention. During a 30-month period, 365 patients underwent TAVR and 333 patients (94%) were treated by true percutaneous transfemoral approach. Of this latter group, 83 patients (25%) had an access-related vascular injury that was managed by the use of a covered self-expanding stent (n = 49), balloon angioplasty (n = 33), or by surgical intervention (n = 1). In 16 patients (5%), the vascular injury was classified as a major vascular complication. Absence of a preprocedural computed tomography angiography (CTA) of the iliofemoral arteries (OR 2.04, p = 0.007) and female gender (OR 2.18, p = 0.004) were independent predictors of the need for access-related vascular intervention. In addition, a high sheath/common femoral artery ratio as measured on preoperative CTA was associated with a higher rate of post-TAVR vascular intervention. The radiation dose, iodine contrast volume, transfusion need, length of hospitalization, and 30-day mortality were not significantly different between patients with versus without access-related vascular intervention. In conclusion, access-related vascular intervention in patients who underwent transfemoral-TAVR is not uncommon. Female gender and a high sheath/common femoral artery ratio are risk factors for access-related vascular injury, whereas preprocedural planning with CTA of the access vessels may reduce the risk of vascular injury. Importantly, most access-related vascular injuries may be treated by percutaneous techniques with similar clinical outcomes to patients without vascular injuries. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. GRAF1 deficiency blunts sarcolemmal injury repair and exacerbates cardiac and skeletal muscle pathology in dystrophin-deficient mice.

    Science.gov (United States)

    Lenhart, Kaitlin C; O'Neill, Thomas J; Cheng, Zhaokang; Dee, Rachel; Demonbreun, Alexis R; Li, Jianbin; Xiao, Xiao; McNally, Elizabeth M; Mack, Christopher P; Taylor, Joan M

    2015-01-01

    The plasma membranes of striated muscle cells are particularly susceptible to rupture as they endure significant mechanical stress and strain during muscle contraction, and studies have shown that defects in membrane repair can contribute to the progression of muscular dystrophy. The synaptotagmin-related protein, dysferlin, has been implicated in mediating rapid membrane repair through its ability to direct intracellular vesicles to sites of membrane injury. However, further work is required to identify the precise molecular mechanisms that govern dysferlin targeting and membrane repair. We previously showed that the bin-amphiphysin-Rvs (BAR)-pleckstrin homology (PH) domain containing Rho-GAP GTPase regulator associated with focal adhesion kinase-1 (GRAF1) was dynamically recruited to the tips of fusing myoblasts wherein it promoted membrane merging by facilitating ferlin-dependent capturing of intracellular vesicles. Because acute membrane repair responses involve similar vesicle trafficking complexes/events and because our prior studies in GRAF1-deficient tadpoles revealed a putative role for GRAF1 in maintaining muscle membrane integrity, we postulated that GRAF1 might also play an important role in facilitating dysferlin-dependent plasma membrane repair. We used an in vitro laser-injury model to test whether GRAF1 was necessary for efficient muscle membrane repair. We also generated dystrophin/GRAF1 doubledeficient mice by breeding mdx mice with GRAF1 hypomorphic mice. Evans blue dye uptake and extensive morphometric analyses were used to assess sarcolemmal integrity and related pathologies in cardiac and skeletal muscles isolated from these mice. Herein, we show that GRAF1 is dynamically recruited to damaged skeletal and cardiac muscle plasma membranes and that GRAF1-depleted muscle cells have reduced membrane healing abilities. Moreover, we show that dystrophin depletion exacerbated muscle damage in GRAF1-deficient mice and that mice with dystrophin/GRAF1

  11. Brief secondhand smoke exposure depresses endothelial progenitor cells activity and endothelial function: sustained vascular injury and blunted nitric oxide production.

    Science.gov (United States)

    Heiss, Christian; Amabile, Nicolas; Lee, Andrew C; Real, Wendy May; Schick, Suzaynn F; Lao, David; Wong, Maelene L; Jahn, Sarah; Angeli, Franca S; Minasi, Petros; Springer, Matthew L; Hammond, S Katharine; Glantz, Stanton A; Grossman, William; Balmes, John R; Yeghiazarians, Yerem

    2008-05-06

    This study sought to analyze the effects of acute secondhand smoke (SHS) exposure on the number and function of endothelial progenitor cells (EPCs) over 24 h. Secondhand smoke increases the risk of vascular disease and is a major public health concern, but the mechanism(s) of action are not fully understood. Healthy nonsmokers (age SEM 30.3 +/- 1.3 years, n = 10) were exposed to 30 min of SHS yielding cotinine levels commonly observed in passive smokers and to smokefree air on 2 separate days. Measurements were taken before exposure (baseline), immediately after (0 h), and at 1 h, 2.5 h, and 24 h after. The EPCs (CD133(+)/KDR(+), CD34(+)/KDR(+)) and endothelial microparticles (EMPs: CD31(+)/CD41(-), CD144(+), CD62e(+)) were determined in blood using flow cytometry. The EPC chemotaxis toward vascular endothelial growth factor was measured. Endothelial function was assessed as flow-mediated dilation (FMD) using ultrasound. Secondhand smoke exposure increased EPCs and plasma vascular endothelial growth factor and completely abolished EPC chemotaxis during 24 h after exposure. Secondhand smoke increased EMPs and decreased FMD. Although FMD returned to baseline at 2.5 h, EMPs and vascular endothelial growth factor levels remained elevated at 24 h, suggesting endothelial activation and injury with functional impairment of the vascular endothelium. Exposure to smokefree air had no effect. Incubation of EPCs from nonexposed subjects with plasma isolated from SHS-exposed subjects in vitro decreased chemotaxis by blockade of vascular endothelial growth factor-stimulated nitric oxide production. Brief exposure to real-world levels of SHS leads to sustained vascular injury characterized by mobilization of dysfunctional EPCs with blocked nitric oxide production. Our results suggest that SHS not only affects the vascular endothelium, but also the function of EPCs.

  12. Chronic baclofen therapy improves the blunted growth hormone response to intravenous arginine in subjects with spinal cord injury.

    Science.gov (United States)

    Bauman, W A; Spungen, A M; Zhong, Y G; Tsitouras, P D

    1994-05-01

    Human GH (hGH) secretion is stimulated by vigorous physical activity, whereas immobilization reduces its release. In paralyzed subjects with spinal cord injury (SCI), it has recently been shown that the release of hGH to provocative stimulation and plasma insulin-like growth factor-I (IGF-I) levels are reduced. The acute administration of baclofen, a gamma-aminobutyric acid derivative, has been shown to stimulate hGH release. The present study investigated the effect of chronic administration of baclofen on the provocative testing of hGH secretion and plasma IGF-I levels. Sixteen subjects with SCI were studied; eight subjects were treated (40-80 mg/day; > 6 months) with baclofen (Bac+), and eight were not (Bac-). Additionally, 8 non-SCI subjects were studied as controls. The groups were matched for gender and age. The subjects were not receiving any medications known to influence hGH secretion. After an overnight fast, arginine hydrochloride (30 g/subject) was infused iv over 30 min, with blood drawn for hormone determinations at baseline and 30, 60, 90, and 120 min. In the Bac- group compared with the Bac+ group, the arginine-stimulated mean plasma hGH levels at 30 and 60 min (P hGH levels (P hGH response between the Bac+ group and the control group. Plasma IGF-I levels may reflect the integrated tissue response to hGH. A significant inverse relationship was present between age and plasma IGF-I levels for the control and Bac+ groups, but not for the Bac- group. The mean plasma IGF-I level was significantly reduced in the Bac- compared with the Bac+ group. No significant differences in mean plasma IGF-I levels were noted between the Bac+ and control groups. SCI is associated with body composition changes and metabolic alterations that may be exacerbated by reduced activity of the hGH-IGF-I axis. Oral chronic baclofen therapy appears to reverse the deleterious effects of paralysis and immobilization on hGH physiology.

  13. Short report Neutrophil gelatinase-associated lipocalcin (NGAL) as a biomarker of dialysis-dependent acute kidney injury following infrarenal aortic surgery

    DEFF Research Database (Denmark)

    Jørgensen, Helene Korvenius; Stæhr, Jannie Bisgaard; Gilsaa, Torben

    2013-01-01

    Background: Acute kidney injury (AKI) is common following abdominal aortic surgery. NGAL might be useful in the early diagnosis of AKI since it responds rapidly to ischaemic damage. Methods: Twenty patients undergoing elective infrarenal aortic surgery. U-NGAL was measured before surgery and 24, 48...... and 72 hours postoperatively. Results: No significant rise in U-NGAL was seen in patients without AKI at any time. All patients who developed dialysisdependent AKI had a significant increase in U-NGAL. Conclusion: U-NGAL did not increase solely in response to the surgical trauma. U-NGAL may be a useful...

  14. [Valvular cardiopathies due to nonpenetrating injury. Apropos of a surgical case of aortic insufficiency].

    Science.gov (United States)

    Protais, E; Simon, J C; Herreman, F; Fouchard, J

    1986-05-01

    One case of traumatic aortic valve regurgitation operated upon is reported, and published cases of cardiac valve regurgitation caused by non-penetrating traumas are reviewed. This study demonstrates the relatively high frequency of traumatic heart diseases and among these, valve lesions. The dynamic disturbance occurs suddenly in a heart that is usually healthy and therefore without adaptation mechanism. This explains why such lesions are poorly tolerated and accounts for some peculiarities of semiology and haemodynamics. Plastic surgery seems to be successful in mitral valve lesions, whereas lesions of the aortic valve are such that valve replacement is required. The same applies to the tricuspid valve. The medico-legal aspects of the subject are mentioned.

  15. In Vivo Effects of Quercetin in Association with Moderate Exercise Training in Improving Streptozotocin-Induced Aortic Tissue Injuries

    Directory of Open Access Journals (Sweden)

    Irina C. Chis

    2015-12-01

    Full Text Available Background: Diabetes mellitus (DM is a chronic endocrine-metabolic disorder associated with endothelial dysfunction. Hyperglycemia, dyslipidemia and abnormal nitric oxide-mediated vasodilatation are the major causal factors in the development of endothelial dysfunction in DM. The prevention of endothelial dysfunction may be a first target against the appearance of atherosclerosis and cardiovascular diseases. We have investigated the synergistic protective effects of quercetin administration and moderate exercise training on thoracic aorta injuries induced by diabetes. Methods: Diabetic rats that performed exercise training were subjected to a swimming training program (1 h/day, 5 days/week, 4 weeks. The diabetic rats received quercetin (30 mg/kg body weight/day for 4 weeks. At the end of the study, the thoracic aorta was isolated and divided into two parts; one part was immersed in 10% formalin for histopathological evaluations and the other was frozen for the assessment of oxidative stress markers (malondialdehyde, MDA and protein carbonyls groups, PC, the activity of antioxidant enzymes (superoxide dismutase, SOD and catalase, CAT, nitrite plus nitrate (NOx production and inducible nitric oxide synthase (iNOS protein expression. Results: Diabetic rats showed significantly increased MDA and PC levels, NOx production and iNOS expression and a reduction of SOD and CAT activity in aortic tissues. A decrease in the levels of oxidative stress markers, NOx production and iNOS expression associated with elevated activity of antioxidant enzymes in the aortic tissue were observed in quercetin-treated diabetic trained rats. Conclusions: These findings suggest that quercetin administration in association with moderate exercise training reduces vascular complications and tissue injuries induced by diabetes in rat aorta by decreasing oxidative stress and restoring NO bioavailability.

  16. The Effect Of Supraphysiologic Blood Pressure on Traumatic Brain Injury and Proximal Tissue Beds During Resuscitative Balloon Occlusion of the Aorta and Variable Aortic Control in a Porcine Model (Sus scrofa) of Polytrauma.

    Science.gov (United States)

    2017-04-27

    Supraphysiologic Blood Pressure On Traumatic Brain Injury And Proximal Tissue Beds During Resuscitative Balloon Occlusion Of The Aorta And Variable Aortic...combined effects of increased proximal mean arterial pressure (pMAP), carotid blood flow (Qcarotid), and intracranial pressure (ICP) from REBOA would...Mandatory) The Effect of REBOA, Partial Aortic Occlusion and Aggressive Blood Transfusion on Traumatic Brain Injury in a Swine Polytrauma Model

  17. The double jeopardy of blunt thoracoabdominal trauma.

    Science.gov (United States)

    Berg, Regan J; Okoye, Obi; Teixeira, Pedro G; Inaba, Kenji; Demetriades, Demetrios

    2012-06-01

    To examine the specific injuries, need for operative intervention, and clinical outcomes of patients with blunt thoracoabdominal trauma. Trauma registry and medical record review. Level I trauma center in Los Angeles, California. All patients with thoracoabdominal injuries from January 1996 to December 2010. Injuries, incidence and type of operative intervention, clinical outcomes, and risk factors for mortality. Blunt thoracoabdominal injury occurred in 1661 patients. Overall, 474 (28.5%) required laparotomy, 31 (1.9%) required thoracotomy (excluding resuscitative thoracotomy), and 1146 (69.0%) required no thoracic or abdominal operation. Overall incidence of intraabdominal solid organ injury was 59.7% and hollow viscus injury, 6.0%. Blunt cardiac trauma occurred in 6.3%; major thoracic vessel injury, in 4.6%; and diaphragmatic trauma, in 6.0%. The majority of solid organ injuries were managed nonoperatively (liver, 83.9%; spleen, 68.3%; and kidney, 91.2%). Excluding patients with severe head trauma, mortality ranged from 4.5% with nonoperative management to 18.1% and 66.7% in those requiring laparotomy and dual cavitary exploration, respectively. Age 55 years or older, Injury Severity Score of 25 or more, Glasgow Coma Scale score of 8 or less, initial hypotension, massive transfusion, and liver, cardiac, or abdominal vascular trauma were all independent risk factors for mortality. Most patients with blunt thoracoabdominal trauma are managed nonoperatively. The need for non-resuscitative thoracotomy or combined thoracoabdominal operation is rare. The abdomen contains the overwhelming majority of injuries requiring operative intervention and should be the initial cavity of exploration in the patient requiring emergent surgery without directive radiologic data.

  18. Haemobilia following blunt liver injury

    African Journals Online (AJOL)

    retrograde cholangiopancreatography (ERCP) and papillotomy were therefore performed, and the biliary drainage resolved. Three days after the endoscopic procedure, the patient had a significant episode of haemobilia, identified by the contents of the pigtail drain. A catheter-directed angiogram was performed. This.

  19. Recurrent Autonomic Dysreflexia due to Chronic Aortic Dissection in an Adult Male with Cervical Spinal Cord Injury

    Directory of Open Access Journals (Sweden)

    Subramanian Vaidyanathan

    2008-01-01

    Full Text Available Autonomic dysreflexia is a hypertensive clinical emergency for persons with spinal cord injury at T-6 level or above. Recurrent autonomic dysreflexia is uncommon in spinal cord injury patients and is usually caused by noxious stimuli that cannot be removed promptly, e.g., somatic pain, abdominal distension. A 61-year-old man, who sustained tetraplegia at C-5 (ASIA-A 38 years ago, was admitted with chest infection. Computerised tomography (CT of the chest showed the ascending aorta to measure 4 cm in anteroposterior diameter; descending thoracic aorta measured 3.5 cm. No dissection was seen. Normal appearances of abdominal aorta were seen. He was treated with noninvasive ventilation, antibiotics, and diuretics. Nineteen days later, when there was sudden deterioration in his clinical condition, CT of the pulmonary angiogram was performed to rule out pulmonary embolism. This showed no pulmonary embolus, but the upper abdominal aorta showed some dissection with thrombosis of the false lumen. Blood pressure was controlled with perindopril 2 mg, once a day, doxazosin 4 mg, twice a day, and furosemide 20 mg, twice a day. Since this patient did not show clinical features of mesenteric or lower limb ischaemia, the vascular surgeon did not recommend subdiaphragmatic aortic replacement.

  20. Traumatic Mitral Valve and Pericardial Injury

    Directory of Open Access Journals (Sweden)

    Nissar Shaikh

    2013-01-01

    Full Text Available Cardiac injury after blunt trauma is common but underreported. Common cardiac trauma after the blunt chest injury (BCI is cardiac contusion; it is very rare to have cardiac valve injury. The mitral valve injury during chest trauma occurs when extreme pressure is applied at early systole during the isovolumic contraction between the closure of the mitral valve and the opening of the aortic valve. Traumatic mitral valve injury can involve valve leaflet, chordae tendineae, or papillary muscles. For the diagnosis of mitral valve injury, a high index of suspicion is required, as in polytrauma patients, other obvious severe injuries will divert the attention of the treating physician. Clinical picture of patients with mitral valve injury may vary from none to cardiogenic shock. The echocardiogram is the main diagnostic modality of mitral valve injuries. Patient’s clinical condition will dictate the timing and type of surgery or medical therapy. We report a case of mitral valve and pericardial injury in a polytrauma patient, successfully treated in our intensive care unit.

  1. Blunt Force Trauma in Veterinary Forensic Pathology.

    Science.gov (United States)

    Ressel, L; Hetzel, U; Ricci, E

    2016-09-01

    Veterinary pathologists commonly encounter lesions of blunt trauma. The development of lesions is affected by the object's mass, velocity, size, shape, and angle of impact and by the plasticity and mobility of the impacted organ. Scrape, impact, and pattern abrasions cause localized epidermal loss and sometimes broken hairs and implanted foreign material. Contusions are best identified after reflecting the skin, and must be differentiated from coagulopathies and livor mortis. Lacerations-traumatic tissue tears-may have irregular margins, bridging by more resilient tissue, deviation of the wound tail, crushed hairs, and unilateral abrasion. Hanging or choking can cause circumferential cervical abrasions, contusions and rupture of hairs, hyoid bone fractures, and congestion of the head. Other special forms of blunt trauma include fractured nails, pressure sores, and dog bites. Ocular blunt trauma causes extraocular and intraocular hemorrhages, proptosis, or retinal detachment. The thoracic viscera are relatively protected from blunt trauma but may develop hemorrhages in intercostal muscles, rib fractures, pulmonary or cardiac contusions or lacerations with subsequent hemothorax, pneumothorax, or cardiac arrhythmia. The abdominal wall is resilient and moveable, yet the liver and spleen are susceptible to traumatic laceration or rupture. Whereas extravasation of blood can occur after death, evidence of vital injury includes leukocyte infiltration, erythrophagocytosis, hemosiderin, reparative lesions of fibroblast proliferation, myocyte regeneration in muscle, and callus formation in bone. Understanding these processes aids in the diagnosis of blunt force trauma including estimation of the age of resulting injuries. © The Author(s) 2016.

  2. Massive expanding hematoma of the chin following blunt trauma

    Directory of Open Access Journals (Sweden)

    K Thanvir Mohamed Niazi

    2016-01-01

    Full Text Available Posttraumatic hematoma of the face is common and usually self-limiting in nature. We report an unusual massive expanding hematoma of the chin within 9 h following a blunt trauma with no associated injuries or fracture.

  3. Transient electrocardiographic abnormalities following blunt chest trauma in a child

    OpenAIRE

    Udink ten Cate, Floris; Heerde, van, Marc; Rammeloo, Lukas; Hruda, Jaroslav

    2008-01-01

    Blunt cardiac injury may occur in patients after suffering nonpenetrating trauma of the chest. It encompasses a wide spectrum of cardiac injury with varied severity and clinical presentation. Electrocardiographic abnormalities are frequently encountered. This article presents a case of a child who presented with complete right bundle branch block on the initial ECG at the emergency department. She suffered blunt chest trauma during a horseback riding accident. She was admitted for cardiac mon...

  4. Recycling and Reinforcing Intimomedial Flap of the Infrarenal Aorta Using Anterior Longitudinal Ligament in Patients With Acute Trauma With Bowel Injuries.

    Science.gov (United States)

    Jovanovic, Milan; Radojkovic, Milan; Djordjevic, Predrag; Rancic, Dejan; Jovanovic, Nemanja; Rancic, Zoran

    2017-10-01

    We present a patient with blunt abdominal trauma with severe acute right limb ischemia and clinical signs of diffuse peritonitis. Computed tomography angiography showed circumferential dissection of the infrarenal aorta with occlusion of the right common iliac artery. We opted for simultaneous abdomen exploration and open repair of injured aorta. Critical weakening of the aortic wall with imminent rupture was identified intraoperatively. Aortotomy cranially from bifurcation showed circumferential intimomedial dissection. The fixation of fragile intimomedial flap of aortic dissection was achieved with reinforcement using an anterior longitudinal ligament. The long aortoiliac arteriotomy was repaired using a great saphenous vein patch. Patient had uneventful postoperative course and was discharged after 7 days. In patients with abdominal polytrauma with peritonitis, and no available endovascular tools, open surgery for circumferential aortic dissection is possible and successful. Described reinforcement of the posterior aortic wall to the anterior longitudinal ligament should be added to the armamentarium of aortic injury treatment.

  5. Cardiogenic shock following blunt chest trauma

    Directory of Open Access Journals (Sweden)

    Rodríguez-González Fayna

    2010-01-01

    Full Text Available Cardiac contusion, usually caused by blunt chest trauma, has been recognized with increased frequency over the past decades. Traffic accidents are the most frequent cause of cardiac contusions resulting from a direct blow to the chest. Other causes of blunt cardiac injury are numerous and include violent fall impacts, interpersonal aggression, explosions, and various types of high-risk sports. Myocardial contusion is difficult to diagnose; clinical presentation varies greatly, ranging from lack of symptoms to cardiogenic shock and arrhythmia. Although death is rare, cardiac contusion can be fatal. We present a case of cardiac contusion due to blunt chest trauma secondary to a fall impact, which manifested as cardiogenic shock.

  6. Aortic dissection

    Science.gov (United States)

    ... made in the chest or abdomen. Endovascular aortic repair. This surgery is done without any major surgical ... needed. If the heart arteries are involved, a coronary bypass is also performed. Outlook ... aneurysm - dissecting; Chest pain - aortic dissection; Thoracic aortic aneurysm - ...

  7. The influence of aortic valve calcification on the risk of periprocedural myocardial injury after elective coronary intervention.

    Science.gov (United States)

    Chen, Zhang-Wei; Yang, Hong-Bo; Chen, Ying-Hua; Qian, Ju-Ying; Shu, Xian-Hong; Ge, Jun-Bo

    2015-10-01

    Aortic valve calcification (AVC) is a common progressive condition that involves several inflammatory and atherosclerotic mediators. However, it is unclear whether the occurrence of periprocedural myocardial injury (PMI) after elective coronary intervention is associated with AVC in stable coronary artery disease (CAD) patients. A total of 530 stable CAD patients who underwent elective coronary intervention were enrolled in this clinical study. High sensitive cardiac troponin T (hs-cTnT) was detected before and after the procedure. PMI was defined as hs-cTnT after coronary intervention higher than 99th percentile upper reference limit (URL). All patients underwent echocardiography to detect the occurrence of AVC. Univariate and multivariate analyses were applied to analyze risk factors of PMI. A total of 210 patients (39.6 %) were diagnosed with PMI after elective coronary intervention. Compared with non-AVC patients (n = 386), AVC patients (n = 144) had higher rate of PMI (64.6 vs. 30.3 %, P AVC had higher Gensini score (39.9 ± 26.6 vs. 34.2 ± 22.1, P AVC patients had increased risk of PMI compared with non-AVC patients. Importantly, even after being adjusted by multivariate analysis, AVC still independently increased the risk of PMI (OR = 3.329, 95 % CI = 2.087-5.308, P AVC significantly increased the risk of PMI after elective coronary intervention. It could be one of the independent predictors for PMI in stable CAD patients.

  8. Ventricular septal defect following blunt chest trauma

    Directory of Open Access Journals (Sweden)

    Lisa Ryan

    2012-01-01

    Full Text Available We present a 32-year-old male with ventricular septal defect (VSD following blunt chest trauma. Traumatic VSD is a rare but potentially life-threatening injury, the severity, course and presentation of which are variable. While the diagnosis of myocardial injury may be challenging, cardiac troponins are useful as a screening and diagnostic test. The proposed pathophysiological mechanisms in the development of traumatic VSD are early mechanical rupture and delayed inflammatory rupture. We conducted a literature review to investigate the pathogenesis, distribution of patterns of presentation, and the associated prognoses in patients with VSD following blunt chest trauma. We found that traumatic VSDs diagnosed within 48 hours were more likely to be severe, require emergency surgery and were associated with a higher mortality. Children with traumatic VSDs had an increased mortality risk. Smaller lesions may be managed conservatively but should be followed up to detect late complications. In both groups elective repair was associated with a good outcome.

  9. Pectus excavatum in blunt chest trauma: a case report

    Directory of Open Access Journals (Sweden)

    Liodakis Emmanouil

    2013-01-01

    Full Text Available Abstract Introduction Blunt cardiac rupture is an exceedingly rare injury. Case presentation We report a case of blunt cardiac trauma in a 43-year-old Caucasian German mother with pectus excavatum who presented after a car accident in which she had been sitting in the front seat holding her two-year-old boy in her arms. The mother was awake and alert during the initial two hours after the accident but then proceeded to hemodynamically collapse. The child did not sustain any severe injuries. Intraoperatively, a combined one-cm laceration of the left atrium and right ventricle was found. Conclusion Patients with pectus excavatum have an increased risk for cardiac rupture after blunt chest trauma because of compression between the sternum and spine. Therefore, patients with pectus excavatum and blunt chest trauma should be admitted to a Level I Trauma Center with a high degree of suspicion.

  10. Left atrial rupture due to blunt thoracic trauma.

    Science.gov (United States)

    Akar, İlker; İnce, İlker; Aslan, Cemal; Çeber, Mehmet; Kaya, İlker

    2015-07-01

    Blunt traumatic cardiac rupture is rare and associated with high mortality. The most popular theory of cardiac rupture after blunt thoracic trauma is rapid deceleration with disruption of the atria from their connections to the vena cava and pulmonary veins. In cases with both massive hemothorax and hemopericardium, injury can usually originate from the heart and/or major vessels. Surgical approach through the median sternotomy can provide convenience to repair the defect. In this article, successful treatment with median sternotomy of a 33-year-old male case with a rupture of the left atrium after blunt thoracic trauma was reported.

  11. Clinical value of different detection methods in blunt ocular trauma

    Directory of Open Access Journals (Sweden)

    Yang Li

    2018-02-01

    Full Text Available Blunt ocular can cause persistent change of eye structure and function, the method of detection which is closely related to eye injury including B-can ultrasonography, UBM, OCT, FFA, scanning laser polarimetry, fundus autofluorescence, each examination with particular emphasis. This paper aims to review the advantages and disadvantages of different inspection methods in order to provide reference for clinical diagnosis and treatment of blunt ocular trauma.

  12. Transient electrocardiographic abnormalities following blunt chest trauma in a child

    NARCIS (Netherlands)

    Udink ten Cate, Floris; Heerde, van Marc; Rammeloo, Lukas; Hruda, Jaroslav

    2008-01-01

    Blunt cardiac injury may occur in patients after suffering nonpenetrating trauma of the chest. It encompasses a wide spectrum of cardiac injury with varied severity and clinical presentation. Electrocardiographic abnormalities are frequently encountered. This article presents a case of a child

  13. Swords with Blunt Edges

    Science.gov (United States)

    Popham, W. James

    2004-01-01

    Many U.S. educators now wonder whether they're teachers or targets. This mentality stems from the specter of their school being sanctioned for failing the state accountability tests mandated under No Child Left Behind (NCLB). According to this author, most of those tests are like blunt-edged swords: They function badly in two directions. While…

  14. Blunt cardiac trauma: lessons learned from the medical examiner.

    Science.gov (United States)

    Teixeira, Pedro G R; Georgiou, Chrysanthos; Inaba, Kenji; Dubose, Joseph; Plurad, David; Chan, Linda S; Toms, Carla; Noguchi, Thomas T; Demetriades, Demetrios

    2009-12-01

    The objective of this study was to analyze autopsy findings after blunt traumatic deaths to identify the incidence of cardiac injuries and describe the patterns of associated injuries. All autopsies performed by the Los Angeles County Forensic Medicine Division for blunt traumatic deaths in 2005 were retrospectively reviewed. Only cases that underwent a full autopsy including internal examination were included in the analysis. The study population was divided into two groups according to the presence or absence of a cardiac injury and compared for differences in baseline characteristics and types of associated injuries. Of the 881 fatal victims of blunt trauma received by the Los Angeles County Forensic Medicine Division, 304 (35%) underwent a full autopsy with internal examination and were included in the analysis. The mean age was 43 years +/- 21 years, patients were more often men (71%) and were intoxicated in 39% of the cases. The most common mechanism was motor vehicle collision (50%), followed by pedestrian struck by auto (37%), and 32% had a cardiac injury. Death at the scene was significantly more common in patients with a cardiac injury (78% vs. 65%, p = 0.02). The right chambers were the most frequently injured (30%, right atrium; 27%, right ventricle). Among the 96 patients with cardiac injuries, 64% had transmural rupture. Multiple chambers were ruptured in 26%, the right atrium in 25%, and the right ventricle in 20% of these patients. Patients with cardiac injuries were significantly more likely to have other associated injuries: thoracic aorta (47% vs. 27%, p = 0.001), hemothorax (81% vs. 59%, p injury (77% vs. 48%, p cardiac injury. Of the 96 patients with a cardiac injury, 78% died at the scene of the crash and 22% died en route or at the hospital. Cardiac injury is a common autopsy finding after blunt traumatic fatalities, with the majority of deaths occurring at the scene. Patients with cardiac injuries are at significantly increased risk for

  15. Immediate Outcomes of Covered Stent Placement for Treatment or Prevention of Aortic Wall Injury Associated With Coarctation of the Aorta (COAST II).

    Science.gov (United States)

    Taggart, Nathaniel W; Minahan, Matthew; Cabalka, Allison K; Cetta, Frank; Usmani, Kudret; Ringel, Richard E

    2016-03-14

    This study aimed to describe the safety and short-term efficacy of the Covered Cheatham-Platinum stent (CCPS) in treating or preventing aortic wall injury (AWI) in patients with coarctation of the aorta (CoA). The COAST II trial (Covered Cheatham-Platinum Stents for Prevention or Treatment of Aortic Wall Injury Associated with Coarctation of the Aorta Trial) is a multicenter, single-arm trial using the CCPS for the treatment and/or prevention of AWI in patients with CoA and pre-existing AWI or increased risk of AWI. Patients were enrolled if they had a history of CoA with pre-existing AWI (Treatment group) or with increased risk of AWI (Prevention group). Pre/post-implant hemodynamics and angiography were reported. A core laboratory performed standardized review of all angiograms. One-month follow-up was reported. A total of 158 patients (male = 65%; median age 19 years) underwent placement of CCPS. Eighty-three patients had pre-existing AWI. The average ascending-to-descending aorta systolic gradient improved from 27 ± 20 mm Hg to 4 ± 6 mm Hg. Complete coverage of pre-existing AWI was achieved in 66 of 71 patients (93%) with AWI who received a single CCPS. Ultimately, complete coverage of AWI was achieved in 76 of 83 patients (92%); 7 patients had minor endoleaks that did not require repeat intervention. Four patients experienced important access site vascular injury. There were no acute AWI, repeat interventions, or deaths. The CCPS can effectively treat and potentially prevent AWI associated with CoA. Access site arterial injury is the most common important complication. Longer-term follow-up is necessary to define mid- and late-term outcomes. Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  16. A strategy to optimize CT use in children with mild blunt head trauma utilizing clinical risk stratification; could we improve CT use in children with mild head injury?

    Science.gov (United States)

    Kocyigit, Ali; Serinken, Mustafa; Ceven, Zumrut; Yılmaz, Atakan; Kaya, Furkan; Hatipoglu, Celile; Yaylacı, Serpil; Karabulut, Nevzat

    2014-01-01

    The purpose of our study was to investigate the impact of clinical risk classification on optimization of the rationale of CT scanning in children with mild blunt head trauma. Exposed effective radiation dose values of CT scanning were also evaluated. Children with isolated pediatric mild head trauma admitted in a single center over a 5-year period (n=3102, >2 years and trauma were significantly different between low (n=10) 1.9% and high (n=90) 29.8% risk groups. Certain predefined signs and symptoms (e.g., vomiting, suspected skull fracture and loss of consciousness) were related significantly with pathologic CT findings attributed to trauma. Estimated mean effective dose values were 3.91±0.38mSv for 2-6 year old (n=557), and 3.33±0.12mSv for 7-16 year old patients (n=349). The pediatric victims of mild head trauma patients within high risk group and those with vomiting, suspected skull fracture and loss of consciousness should undergo head CT scanning. The manufacturer settings on the CT scanners for children should be revised to alleviate untoward radiation exposure. © 2014.

  17. Validation of the sensitivity of the National Emergency X-Radiography Utilization Study (NEXUS Head computed tomographic (CT decision instrument for selective imaging of blunt head injury patients: An observational study.

    Directory of Open Access Journals (Sweden)

    William R Mower

    2017-07-01

    Full Text Available Clinicians, afraid of missing intracranial injuries, liberally obtain computed tomographic (CT head imaging in blunt trauma patients. Prior work suggests that clinical criteria (National Emergency X-Radiography Utilization Study [NEXUS] Head CT decision instrument [DI] can reliably identify patients with important injuries, while excluding injury, and the need for imaging in many patients. Validating this DI requires confirmation of the hypothesis that the lower 95% confidence limit for its sensitivity in detecting serious injury exceeds 99.0%. A secondary goal of the study was to complete an independent validation and comparison of the Canadian and NEXUS Head CT rules among the subgroup of patients meeting the inclusion and exclusion criteria.We conducted a prospective observational study of the NEXUS Head CT DI in 4 hospital emergency departments between April 2006 and December 2015. Implementation of the rule requires that patients satisfy 8 criteria to achieve "low-risk" classification. Patients are excluded from "low-risk" classification and assigned "high-risk" status if they fail to meet 1 or more criteria. We examined the instrument's performance in assigning "high-risk" status to patients requiring neurosurgical intervention among a cohort of 11,770 blunt head injury patients. The NEXUS Head CT DI assigned high-risk status to 420 of 420 patients requiring neurosurgical intervention (sensitivity, 100.0% [95% confidence interval [CI]: 99.1%-100.0%]. The instrument assigned low-risk status to 2,823 of 11,350 patients who did not require neurosurgical intervention (specificity, 24.9% [95% CI: 24.1%-25.7%]. None of the 2,823 low-risk patients required neurosurgical intervention (negative predictive value [NPV], 100.0% [95% CI: 99.9%-100.0%]. The DI assigned high-risk status to 759 of 767 patients with significant intracranial injuries (sensitivity, 99.0% [95% CI: 98.0%-99.6%]. The instrument assigned low-risk status to 2,815 of 11

  18. Sternal fractures and delayed cardiac tamponade due to a severe blunt chest trauma.

    Science.gov (United States)

    Liang, Huai-min; Chen, Qiu-lin; Zhang, Er-yong; Hu, Jia

    2016-04-01

    Sternal fractures caused by blunt chest trauma are associated with an increased incidence of cardiac injury. Reports of the incidence of cardiac injury associated with sternal fracture range from 18% to 62%. Delayed cardiac tamponade is a rare phenomenon that appears days or weeks after injury. Moreover, after nonpenetrating chest trauma, cardiac tamponade is very rare and occurs in less than 1 of 1000. This case describes a patient who had delayed cardiac tamponade 17 days after a severe blunt chest trauma.

  19. Hepatic hydrothorax after blunt chest trauma

    Directory of Open Access Journals (Sweden)

    Shang-Chiung Wang

    2012-08-01

    Full Text Available We report a successful treatment result in a rare case of hepatitis C virus-related cirrhosis, who had sustained hydrothorax after blunt thoracoabdominal trauma. This was a female patient with liver cirrhosis, Child–Turcotte–Pugh class A, without ascites before injury. She sustained blunt thoracoabdominal trauma with a left clavicle fracture dislocation and right rib fractures. There was no hemopneumothorax at initial presentation. However, dyspnea and right pleural effusion developed gradually. We inserted a chest tube to relieve the patient's symptoms, and the daily drainage amount remained consistent. Hepatic hydrothorax was confirmed by the intraperitoneal injection of radioisotope 99mTc-sulfur colloid that demonstrated one-way transdiaphragmatic flow of fluid from the peritoneal cavity to pleural cavities. Finally, the hydrothorax was treated successfully by minocycline-induced pleural symphysis. To the best of our knowledge, this is the first case of hepatic hydrothorax developed after thoracoabdominal trauma.

  20. Factors influencing the injury pattern and injury severity after high speed motor vehicle accident--a retrospective study.

    Science.gov (United States)

    Weninger, Patrick; Hertz, Harald

    2007-10-01

    Motor vehicular accidents (MVA) are the leading cause of death among people under 40 years of age. Despite improvement in car safety and driver awareness of the use of safety devices, fatalities and severe injuries continue to occur. From 1997 to 2004, 13,678 patients after MVA were admitted to our institution. Out of this cohort, 584 (4.3%) patients suffered blunt major trauma defined as Injury Severity Score (ISS) >or=16 and at least one life-threatening injury in one body region. Preclinical data were recorded in 458 patients matching the inclusion criteria. The circumstances of the trauma scene such as weather conditions were analysed as well as technical crash data such as direction of impact, security devices used and type and severity of automobile damage. In a retrospective trial, the influence of preclinical variables on the injury pattern and on injury severity was investigated. 314 (68.6%) patients were male and 144 (31.4%) female. Injury severity (p=0.015) and rate of multiple injuries (p=0.012) were higher in patients after side-impact crashes. If automobiles with SIPS were used, injury severity was significantly reduced in case of side-impact crashes (p=0.003). Patients after frontal impact crashes had a higher rate of severe traumatic brain injury (TBI) compared to the overall cohort (p=0.014). Patients suffering blunt aortic (n=29) dissection were involved in frontal crashes with seat belt use (pIn case of high speed MVA in rural areas the trauma mechanism and the circumstances (i.e., impact direction, automobile deformation) should be considered to identify patients at high risk of severe blunt trauma and multiple injuries.

  1. Multidetector Computer Tomography: Evaluation of Blunt Chest Trauma in Adults

    International Nuclear Information System (INIS)

    Palas, J.; Matos, A.P.; Ramalho, M.; Mascarenhas, V.; Heredia, V.

    2014-01-01

    Imaging plays an essential part of chest trauma care. By definition, the employed imaging technique in the emergency setting should reach the correct diagnosis as fast as possible. In severe chest blunt trauma, multidetector computer tomography (MDCT) has become part of the initial workup, mainly due to its high sensitivity and diagnostic accuracy of the technique for the detection and characterization of thoracic injuries and also due to its wide availability in tertiary care centers. The aim of this paper is to review and illustrate a spectrum of characteristic MDCT findings of blunt traumatic injuries of the chest including the lungs, mediastinum, pleural space, and chest wall.

  2. Multidetector Computer Tomography: Evaluation of Blunt Chest Trauma in Adults

    Directory of Open Access Journals (Sweden)

    João Palas

    2014-01-01

    Full Text Available Imaging plays an essential part of chest trauma care. By definition, the employed imaging technique in the emergency setting should reach the correct diagnosis as fast as possible. In severe chest blunt trauma, multidetector computer tomography (MDCT has become part of the initial workup, mainly due to its high sensitivity and diagnostic accuracy of the technique for the detection and characterization of thoracic injuries and also due to its wide availability in tertiary care centers. The aim of this paper is to review and illustrate a spectrum of characteristic MDCT findings of blunt traumatic injuries of the chest including the lungs, mediastinum, pleural space, and chest wall.

  3. Diabetes mellitus is associated with increased acute kidney injury and 1-year mortality after transcatheter aortic valve replacement: A meta-analysis.

    Science.gov (United States)

    Mina, George S; Gill, Priyanka; Soliman, Demiana; Reddy, Pratap; Dominic, Paari

    2017-09-01

    Diabetes mellitus (DM) is associated with adverse outcomes after surgical aortic valve replacement. However, there are conflicting data on the impact of DM on outcomes of transcatheter aortic valve replacement (TAVR). DM is associated with poor outcomes after different cardiac procedures. Therefore, DM can also be associated with poor outcomes after TAVR. We searched PubMed and Cochrane Central Register of Controlled Trials for studies that evaluated outcomes after TAVR and stratified at least 1 of the studied endpoints by DM status. The primary endpoint was all-cause mortality at 1 year. Secondary endpoints were early (up to 30 days) mortality, acute kidney injury (AKI), cerebrovascular accident (CVA), major bleeding, and major vascular complications. Pooled odds ratio (OR) and 95% confidence interval (CI) were calculated using random effects models. We included 64 studies with a total of 38 686 patients. DM was associated with significantly higher 1-year mortality (OR: 1.14, 95% CI: 1.04-1.26, P = 0.008) and periprocedural AKI (OR: 1.28, 95% CI: 1.08-1.52, P = 0.004). On the other hand, there were no significant differences between diabetics and nondiabetics in early mortality, CVAs, major bleeding, or major vascular complications. DM is associated with increased 1-year mortality and periprocedural AKI in patients undergoing TAVR. The results of this study suggest that DM is a predictor of adverse outcomes in patients undergoing TAVR. © 2017 Wiley Periodicals, Inc.

  4. CT findings in children with blunt trauma in the spleen

    Energy Technology Data Exchange (ETDEWEB)

    Nishiguchi, Hiroyasu; Shimizu, Toshihisa; Ohmura, Makoto; Kawai, Naoki; Tauchi, Hayato; Hayakawa, Masao; Nishio, Yoshinori (Kyoto Second Red Cross Hospital (Japan)); Watanabe, Shinsuke

    1991-09-01

    We evaluated CT findings in 19 children with blunt injuries in the spleen. CT demonstrated laceration of the spleen in 7 children, rupture of the spleen in 7, and splenic hematoma in 5. Leakage of the contrast medium was observed in 3 children, of whom 1 was treated by arterial embolization. Laparotomy was performed in 3 children (15.8%) other than the 3 showing contrast medium leakage; hemostasis by compression was performed in 1 with laceration, and splenectomy in 2 with rupture. Late splenic rupture or abscess did not occur in any child. One child (5.3%) died of complicating injuries. Many of children with blunt splenic injuries can be successfully treated with conservative treatment, and CT scanning is useful for evaluating the degree of splenic injuries and complicating injuries. (author).

  5. The role of non-operative management (NOM) in blunt hepatic trauma

    African Journals Online (AJOL)

    Ayman Zaki Azzam

    2013-01-10

    Jan 10, 2013 ... Results: Blunt trauma was the mechanism of injury in 44 patients (60.2%) including road traffic acci- dents in 42.5%. The peak age was .... mechanism of blunt trauma was road traffic accidents in. 42.5% including drivers ... patients, perihepatic packing in 1 patient, right hepatic artery ligation with formal right ...

  6. Laparoscopic Splenectomy in Hemodynamically Stable Blunt Trauma.

    Science.gov (United States)

    Huang, Gregory S; Chance, Elisha A; Hileman, Barbara M; Emerick, Eric S; Gianetti, Emily A

    2017-01-01

    No criteria define indications for laparoscopic splenectomy in trauma. This investigation compared characteristics of trauma patients and outcomes between laparoscopic and open splenectomies. Patients were identified retrospectively by using ICD-9 codes. Included patients were 18 or older, with a blunt splenic injury from January 1, 2011, through December 31, 2014, and required splenectomy. Excluded patients had penetrating trauma, successful nonoperative management, or successful embolization. Variables included demographics, presenting characteristics, injury severity scores, abdominal abbreviated injury scores, splenic injury grade, surgical indication and approach (open or laparoscopic), surgery length, intra-operative blood loss, transfusions, length of stay, complications, mortality, and discharge disposition. Forty-one patients underwent open splenectomy, and 11 underwent laparoscopic splenectomy. The mean age was 48.7 years, and men comprised the sample majority (36/52). The groups were well matched for age, abdominal injury scores, and admission vital signs. The open group had a significantly lower level of consciousness and more acidosis compared with the laparoscopic group. Most laparoscopic splenectomies were performed after failed nonoperative management or embolization. The indications for open splenectomy were a positive focused assessment with sonography for trauma and computed tomography results. Laparoscopic patients had significantly longer times between presentation and surgery and longer operations, but had significantly less blood loss and fewer transfusions compared with the open group. There were no differences in mortality, length of stay, complications, or discharge dispositions. Laparoscopic splenectomy is useful in patients with blunt trauma in whom conservative management produced no improvement and who do not have other injuries to preclude laparoscopy.

  7. Blunt Splenic Trauma in Children : Are We Too Careful?

    NARCIS (Netherlands)

    De Jong, W. J. J.; Nellensteijn, D. R.; ten Duis, H. J.; Albers, M. J. I. J.; El Moumni, M.; Hulscher, J. B. F.

    Introduction: There has been a shift from operative treatment (OT) to non-operative treatment (NOT) of splenic injury. We evaluated the outcomes of treatment of pediatric patients with blunt splenic trauma in our hospital, with special focus on the outcomes after NOT. Patients and Methods: The data

  8. Hypothermic circulatory arrest for acute traumatic aortic rupture associated with shock.

    Science.gov (United States)

    Kawahito, Koji; Adachi, Hideo

    2011-07-01

    Hypothermic circulatory arrest is considered to be a contraindication in acute traumatic aortic rupture (TAR) because full heparinization and hypothermia may lead to fatal bleeding if concomitant hemorrhagic injuries are present. However, in extremely emergent situations, rapid volume infusion via cardiotomy vacuums and the institution of hypothermic circulatory arrest appears to be the only method for saving patients with uncontrollable bleeding. In this study, we evaluate the feasibility of hypothermic circulatory arrest for treating patients with TAR with hemorrhagic shock. Ten patients (nine men and one woman; mean age, 35 ± 18 years), with acute TAR caused by blunt chest trauma and in a shock state, underwent surgery between 1999 and 2007. All ten patients exhibited rupture of the isthmus, and polytraumatism was frequent. Any life-threatening blood loss from other injuries was surgically treated before aortic surgery. All patients were operated on with standard cardiopulmonary bypass under hypothermic circulatory arrest. All patients received prosthetic graft replacement. The overall hospital mortality was 10.0% (1/10). One patient died of intraabdominal and pulmonary bleeding during surgery, and the other nine were discharged without complications. There was no evidence of any new or increased hemorrhagic complications during heparinization in the nine surviving patients. Mean operation and circulatory arrest times were 305 ± 44 min and 27 ± 7 min, respectively. Hypothermic circulatory arrest is feasible for saving TAR patients with unstable hemodynamics resulting from rupture, provided associated injuries are properly treated in advance.

  9. Multi-detector row computed tomography and blunt chest trauma

    International Nuclear Information System (INIS)

    Scaglione, Mariano; Pinto, Antonio; Pedrosa, Ivan; Sparano, Amelia; Romano, Luigia

    2008-01-01

    Blunt chest trauma is a significant source of morbidity and mortality in industrialized countries. The clinical presentation of trauma patients varies widely from one individual to another and ranges from minor reports of pain to shock. Knowledge of the mechanism of injury, the time of injury, estimates of motor vehicle accident velocity and deceleration, and evidence of associated injury to other systems are all salient features to provide for an adequate assessment of chest trauma. Multi-detector row computed tomography (MDCT) scanning and MDCT-angiography are being used more frequently in the diagnosis of patients with chest trauma. The high sensitivity of MDCT has increased the recognized spectrum of injuries. This new technology can be regarded as an extremely valuable adjunct to physical examination to recognize suspected and unsuspected blunt chest trauma

  10. Blunt adrenal gland trauma in the pediatric population

    Directory of Open Access Journals (Sweden)

    Stylianos Roupakias

    2011-07-01

    Full Text Available A retrospective review of the literature was performed to determine the natural history, prevalence, prognosis and management of adrenal injury associated with blunt abdominal trauma in pediatric population. Blunt adrenal injury in children is uncommon, rarely isolated, and typically present as part of a multi organ trauma. Adrenal hemorrhage is being diagnosed more frequently since the emergence of computed tomography in modern emergency rooms. Obstetric birth trauma during vaginal delivery of a macrosomic fetus may result in neonatal adrenal hemorrhage. In children appear to be an incidental finding that resolves on follow-up imaging. Most of these injuries are self-limited and do not require intervention. The differential diagnosis of an adrenal neoplasm, especially in children with an isolated adrenal hemorrhage, must be considered. The presence of adrenal hemorrhage in the absence of a trauma history should alert to the possibility of pediatric inflicted injury.

  11. Multidetector CT findings of bowel Transection in blunt abdominal trauma

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Hyun Suk; Woo, Ji Young; Hong, Hye Suk; Park, Mee Hyun; Yang, Ik; Lee, Yul; Jung, Ah Young; Hwang, Ji Young [Dept. of Radiology, Hallym University College of Medicine, Kangnam Sacred Heart Hospital, Seoul (Korea, Republic of); Ha, Hong Il [Dept. of Radiology, Hallym University College of Medicine, Hallym University Sacred Heart Hospital, Anyang (Korea, Republic of)

    2013-08-15

    Though a number of CT findings of bowel and mesenteric injuries in blunt abdominal trauma are described in literature, no studies on the specific CT signs of a transected bowel have been published. In the present study we describe the incidence and new CT signs of bowel transection in blunt abdominal trauma. We investigated the incidence of bowel transection in 513 patients admitted for blunt abdominal trauma who underwent multidetector CT (MDCT). The MDCT findings of 8 patients with a surgically proven complete bowel transection were assessed retrospectively. We report novel CT signs that are unique for transection, such as complete cutoff sign (transection of bowel loop), Janus sign (abnormal dual bowel wall enhancement, both increased and decreased), and fecal spillage. The incidence of bowel transection in blunt abdominal trauma was 1.56%. In eight cases of bowel transection, percentage of CT signs unique for bowel transection were as follows: complete cutoff in 8 (100%), Janus sign in 6 (100%, excluding duodenal injury), and fecal spillage in 2 (25%). The combination of complete cutoff and Janus sign were highly specific findings in patients with bowel transection. Complete cut off and Janus sign are the unique CT findings to help detect bowel transection in blunt abdominal trauma and recognition of these findings enables an accurate and prompt diagnosis for emergency laparotomy leading to reduced mortality and morbidity.

  12. Detection of flail tricuspid valve many years after blunt chest trauma.

    Science.gov (United States)

    Gulel, Okan; Demir, Serdar; Gol, Mehmet Kamil

    2008-01-01

    Posttraumatic tricuspid insufficiency is a rare clinical entity that is mostly associated with traffic accidents causing nonpenetrating chest wall injury. Here we report a patient with a flail tricuspid valve detected many years after blunt chest trauma at work place.

  13. Occult Spinal Cord Injury after Blunt Force Trauma in a Patient with Achondroplasia: A Case Report and Review of Trauma Management Strategy.

    Science.gov (United States)

    Huecker, Martin; Harris, Zach; Yazel, Eric

    2017-10-01

    Achondroplastic dwarfism is associated with anatomic abnormalities that can predispose to occult injury and challenges in trauma management. Airway anatomy is problematic due to macrocephaly, midface hypoplasia, and a narrow nasopharynx. Manipulation of the neck is very dangerous due to the high likelihood of preexisting cervicomedullary stenosis. Restrictive lung disease and obstructive sleep apnea may complicate respiratory status. Peripheral and central venous access can be difficult to obtain. Orthopedic and metabolic comorbidities can lead to a prolonged hospital course. A 17-year-old male patient with achondroplasia presented to the Emergency Department after a high-speed motor vehicle collision. Despite a negative computed tomography scan of the cervical spine and absence of neck pain, a magnetic resonance imaging evaluation was obtained due to severe neurologic deficits; it revealed disruption of the anterior longitudinal ligament at C2/3 and spinal cord contusion from C3-C6. The patient had a difficult intubation and prolonged weaning from the ventilator after his operation. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians must maintain preparedness for all patients and situations, no matter how rare. Prior knowledge of key differences in management of the ABCDs (airway, breathing, circulation, neurological deficit) in patients with achondroplasia will reduce morbidity and mortality. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Axillofemoral Bypass Markedly Improved Acute Decompensated Heart Failure and Kidney Injury in a Patient with Severely Calcified Stenosis of Thoracoabdominal Aorta (Atypical Aortic Coarctation).

    Science.gov (United States)

    Ishizuka, Masato; Yamada, Shintaro; Maemura, Sonoko; Yamamoto, Keisuke; Takizawa, Masataka; Uozumi, Hiroki; Minegishi, Sachito; Kobayashi, Jotaro; Ikenouchi, Hiroshi

    2017-10-21

    Atypical aortic coarctation (AAC) has been reported to occur anywhere along the aorta, except for the ascending aorta. The associated symptoms include hypotension in the lower half of the body, secondary hypertension in the upper half of the body, and heart failure. Here we present an 80-year-old Asian woman complaining of progressive exertional dyspnea. She was diagnosed with acute decompensated heart failure and kidney injury due to severely calcified stenosis of the thoracoabdominal aorta, the so called AAC. She received hemodiafiltration, and pulmonary congestion improved in part. Generally, surgical treatments are quite invasive in elderly patients. Endovascular stent graft placement is less invasive, however, fracture and rupture should be considered at severely calcified lesions like this case. Therefore, we selected extra-anatomical axillofemoral bypass. Her recovery after the surgery was remarkable. In a few days, she became free from hemodiafiltration, intravenous diuretics, and oxygen administration. We thought the contributive factors are the increase in kidney blood flow and the correction of afterload mismatch. The decrease in pulse pressure may reflect the reduction in systemic arterial compliance by axillofemoral bypass. The operative mortality of axillofemoral bypass was reported to be acceptable, although the patency of the axillofemoral bypass graft was not high enough. In conclusion, axillofemoral bypass is effective and feasible for elderly patients with acute decompensated heart failure and kidney injury due to AAC.

  15. Blunt Facial Trauma Causing Isolated Optic Nerve Hematoma

    Directory of Open Access Journals (Sweden)

    R. Parab

    2013-01-01

    Full Text Available Traumatic optic neuropathy is an uncommon, yet serious, result of facial trauma. The authors present a novel case of a 59-year-old gentleman who presented with an isolated blunt traumatic left optic nerve hematoma causing vision loss. There were no other injuries or fractures to report. This case highlights the importance of early recognition of this rare injury and reviews the current literature and management of traumatic optic neuropathy.

  16. A Mouse Model of Ischemic Spinal Cord Injury with Delayed Paralysis Caused by Aortic Cross-clamping

    Science.gov (United States)

    Awad, Hamdy; Ankeny, Daniel P.; Guan, Zhen; Wei, Ping; McTigue, Dana M.; Popovich, Phillip G.

    2010-01-01

    Background Spinal cord ischemia and paralysis are devastating perioperative complications that can accompany open or endovascular repair surgery for aortic aneurysms. Here, we report on the development of a new mouse model of spinal cord ischemia with delayed paralysis induced by cross-clamping the descending aorta. Methods Transient aortic occlusion was produced in mice by cross clamping the descending aorta through a lateral thoracotomy. To establish an optimal surgical procedure with limited mortality, variable cross-clamp times and core temperatures were tested between experiments. Results The onset of paresis or paralysis and postsurgical mortality varied as a function of cross-clamp time and core temperature that was maintained during the period of cross-clamp. Using optimal surgical parameters (7.5 min cross-clamp duration @ 33°C core temperature), the onset of paralysis is delayed 24–36 h postreperfusion and > 95% of mice survive through 9 weeks postsurgery. These mice are further stratified into two groups, with 70% (n = 19/27) of mice developing severe hindlimb paralysis and the remaining mice showing mild, though still permanent, behavioral deficits. Conclusion This new model should prove useful as a preclinical tool for screening neuroprotective therapeutics and for defining the basic biological mechanisms that cause delayed paralysis and neurodegeneration after transient spinal cord ischemia. PMID:20808212

  17. Isolated tear in left atrial appendage due to blunt trauma chest: A rare case report

    OpenAIRE

    Salooja, Manpreet S.; Singla, Manender; Srivastava, Anupam; Mukherjee, Kishore C.

    2013-01-01

    Blunt traumatic cardiac rupture is associated with a high mortality rate. Motor vehicle accidents account for most cardiac ruptures, but crush injury is relatively rare. We describe a case of a 72-year-old man who had the left atrial appendage ruptured through blunt trauma due to a fall from scooter. Simple suture repair of the atrial appendage was achieved after clamping the base of the left atrium to control the bleeding. He recovered without complication. Traumatic injury to left atrial ap...

  18. The Risk of Acute Kidney Injury and Its Impact on 30-Day and Long-Term Mortality after Transcatheter Aortic Valve Implantation

    Directory of Open Access Journals (Sweden)

    Katrin Gebauer

    2012-01-01

    Full Text Available Background. Transcatheter aortic valve implantation (TAVI is widely used in high risk patients (pts with aortic stenosis. Underlying chronic kidney disease implicates a high risk of postprocedural acute kidney injury (AKI. We analyzed its occurrence, impact on hospital stay, and mortality. Methods. 150 consecutive pts underwent TAVI in our institution (mean age 81 ± 7 years; logistic EuroSCORE 24 ± 15%. AKI definition was a creatinine rise of 26.5 μmol/L or more within 48 hours postprocedural. Ten patients on chronic hemodialysis were excluded. Results. AKI occurred in 28 pts (20%. Baseline creatinine was higher in AKI pts (126.4 ± 59.2 μmol/L versus 108.7 ± 45.1 μmol/L, P=0.09. Contrast media use was distributed evenly. Both, 30-day mortality (29% versus 7%, P<0.0001 and long-term mortality (43% versus 18%, P<0.0001 were higher; hospital stay was longer in AKI pts (20 ± 12 versus 15 ± 10 days, P=0.03. Predicted renal failure calculated STS Score was similar (8.0 ± 5.0% [AKI] versus 7.1 ± 4.0% [non-AKI], P=0.32 and estimated lower renal failure rates than observed. Conclusion. AKI remains a frequent complication with increased mortality in TAVI pts. Careful identification of risk factors and development of more suitable risk scores are essential.

  19. The Risk of Acute Kidney Injury and Its Impact on 30-Day and Long-Term Mortality after Transcatheter Aortic Valve Implantation

    Science.gov (United States)

    Gebauer, Katrin; Diller, Gerhard-Paul; Kaleschke, Gerrit; Kerckhoff, Gregor; Malyar, Nasser; Meyborg, Matthias; Reinecke, Holger; Baumgartner, Helmut

    2012-01-01

    Background. Transcatheter aortic valve implantation (TAVI) is widely used in high risk patients (pts) with aortic stenosis. Underlying chronic kidney disease implicates a high risk of postprocedural acute kidney injury (AKI). We analyzed its occurrence, impact on hospital stay, and mortality. Methods. 150 consecutive pts underwent TAVI in our institution (mean age 81 ± 7 years; logistic EuroSCORE 24 ± 15%). AKI definition was a creatinine rise of 26.5 μmol/L or more within 48 hours postprocedural. Ten patients on chronic hemodialysis were excluded. Results. AKI occurred in 28 pts (20%). Baseline creatinine was higher in AKI pts (126.4 ± 59.2 μmol/L versus 108.7 ± 45.1 μmol/L, P = 0.09). Contrast media use was distributed evenly. Both, 30-day mortality (29% versus 7%, P < 0.0001) and long-term mortality (43% versus 18%, P < 0.0001) were higher; hospital stay was longer in AKI pts (20 ± 12 versus 15 ± 10 days, P = 0.03). Predicted renal failure calculated STS Score was similar (8.0 ± 5.0% [AKI] versus 7.1 ± 4.0% [non-AKI], P = 0.32) and estimated lower renal failure rates than observed. Conclusion. AKI remains a frequent complication with increased mortality in TAVI pts. Careful identification of risk factors and development of more suitable risk scores are essential. PMID:23365748

  20. [Prognostic factors for in-hospital mortality in patients with acute kidney injury requiring continuous renal replacement therapy undergoing surgery for acute Stanford type A aortic dissection].

    Science.gov (United States)

    Jiao, R; Liu, N

    2017-04-01

    Objective: To evaluate prognostic factors for in-hospital mortality in patients with acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT) undergoing surgery for acute Stanford type A aortic dissection. Methods: Retrospective analysis were conducted for 60 patients diagnosed with AKI requiring CRRT undergoing surgery for acute Stanford type A aortic dissection at Beijing Anzhen Hospital, Capital Medical University from March 2015 to September 2016. There were 43 male and 17 female patients with an mean age of (50±14) years. Demographic characteristics, diagnosis, perioperative periodrelated data, clinical parameters during CRRT were collected to set up a database. The patients were divided into survival group and non-survival group according to in-hospital mortality. The prognostic factors of mortality in-hospital after AKI requiring CRRT were analyzed by multivariate Logistic regression analysis regression. Results: In the 60 adult patients who had received CRRT, 21 patients (35.0%) died. There were significant differences between died and survival patients on proportion of age>60 years (χ(2)=6.851, P =0.003), lactic acid levels at 12-hour after CRRT ( t =-3.631, P =0.004), lactic acid levels at 24 hours after CRRT ( t =-2.986, P =0.032), proportion of body mass index >25 kg/m(2) (χ(2)=5.660, P =0.041), cardiopulmonary bypass time ( t =-2.720, P =0.001). Multivariate Logistic regression analysis revealed that age≥60 years ( OR =16.450, 95% CI: 2.172 to 84.589); high lactic acid levels at 12-hour after CRRT ( OR =1.719, 95% CI: 1.998 to 2.960) and long cardiopulmonary bypass time ( OR =1.028, 95% CI: 1.004 to 1.052) (all P acid levels at 12-hour after CRRT and long cardiopulmonary bypass time were independent prognostic factors of patients with AKI requiring CRRT after aortic surgery. Proper identification and management shall improve the prognosis of patients.

  1. CT of suspected thoracic acute aortic injury in the emergency department: is routine abdominopelvic imaging worth the additional collective radiation dose?

    Science.gov (United States)

    Haji-Momenian, Shawn; Rischall, Jonathan; Okey, Neil; Taffel, Myles; Khati, Nadia; Zeman, Robert

    2017-02-01

    This study aimed to determine the incidence of non-traumatic acute aortic injury (AAI) extending from the chest into the abdomen or pelvis in emergency department (ED) patients with acute aortic syndrome (AAS), to estimate the effective dose of the abdominopelvic portion of these CT exams, and to compare the number needed to screen (NNS) with the collective population radiation dose of imaging those stations. All patients (n = 238) presenting to the ED with AAS between March 2014 and June 2015 who were imaged per CT AAI protocol (noncontrast and contrast-enhanced CT angiography of the chest, abdomen, and pelvis) were retrospectively identified in this IRB-approved HIPAA-compliant study. The Stanford classification for positive cases of AAI was further subclassified based on chest, abdominal, or pelvic involvement. The dose length product (DLP) of each exam was used to estimate the dose of the abdominal and pelvic stations and the collective effective dose for the population. There were five cases of aortic dissection (AD) and two of intramural hematoma (IMH), with an AAI incidence of 2.9/100. Three cases of AAI were confined to the chest. Two cases of AAI were confined to the chest and abdomen, and two cases involved the chest, abdomen, and pelvis. There was only one case of AAI involving the ascending aorta that extended into the abdomen or pelvis. The number needed to screen to identify (a) AAI extending from the chest into the abdomen or pelvis was 59.5 and (b) Stanford A AAI extending into the abdomen or pelvis was 238. The estimated mean effective dose for the abdominopelvic stations were unenhanced abdomen 2.3 mSv, unenhanced pelvis 3.3 mSv, abdominal CTA 2.5 mSv, and pelvic CTA 3.6 mSv. The collective effective doses to the abdomen and pelvis with unenhanced CT and CTA in 59.5 patients and 238 patients were 761.6 and 3046.4 mSv, respectively. While the estimated mean effective dose for imaging of the abdominopelvic stations are low, the collective

  2. Computed tomography and nonoperative treatment for blunt abdominal trauma

    International Nuclear Information System (INIS)

    Watanabe, Shinsuke; Ishi, Takashi; Kamachi, Masahiro; Takahashi, Toshio.

    1990-01-01

    Studies were undertaken to determine if computed tomography (CT) could reliably assist physical examination in the initial assessment of blunt abdominal trauma, and also to examine how various abdominal injuries were managed with the guidance of CT. A total of 255 patients underwent emergency abdominal CT following blunt abdominal trauma over a period of seven years. One hundred and fifty two patients had abnormal CT scans, including 58 hepatic, 36 renal, 25 splenic and 9 pancreatic injuries as well as 67 patients with intra-abdominal hemorrhage and 21 patients with free abdominal air. A comparative study on the detection of pneumoperitoneum revealed CT to be far superior to plain radiography. One hundred and three patients had normal CT scans, all of whom were managed nonoperatively, except for three false-negative cases and two nontherapeutic cases. The patients with injury to the parenchymal organs were given nonoperative treatment if they had stable vital signs and no evidence of associated injuries demanding immediate surgery and the majority of these patients were managed well nonoperatively. CT was thus found to be a useful adjunct in the management of victims of blunt abdominal trauma, since in a rapid and noninvasive fashion, CT accurately defined the extent of parenchymal organ injury and also disclosed any other abdominal injuries. (author)

  3. Effects of a cantaloupe melon extract/wheat gliadin biopolymer during aortic cross-clamping.

    Science.gov (United States)

    Kick, Jochen; Hauser, Balázs; Bracht, Hendrik; Albicini, Maura; Oter, Sükrü; Simon, Florian; Ehrmann, Ulrich; Garrel, Catherine; Sträter, Jörn; Brückner, Uwe B; Leverve, Xavier M; Schelzig, Hubert; Speit, Günter; Radermacher, Peter; Muth, Claus-Martin

    2007-04-01

    We previously reported in healthy volunteers that a cantaloupe melon extract chemically combined with wheat gliadin (melon extract/gliadin) and containing SOD, catalase and residual glutathione peroxidase (GPx), protected against DNA strand-break damage induced by hyperbaric oxygen (HBO), a well-established model of DNA damage resulting from oxidative stress. Aortic cross-clamping is a typical example of ischemia/reperfusion injury-related oxidative stress, and therefore we investigated whether this melon extract/gliadin would also reduce DNA damage after aortic cross-clamping and reperfusion. Prospective, randomized, controlled experimental study. Animal laboratory. 18 anesthetized, mechanically ventilated and instrumented pigs. After 14 days of oral administration of 1250 mg of the melon extract/gliadin (n=9) or vehicle (n=9), animals underwent 30 min of thoracic aortic cross-clamping and 4 h of reperfusion. Before clamping, immediately before declamping, and at 2 and 4 h of reperfusion, we measured blood isoprostane (immunoassay) and malondialdehyde concentrations (fluorimetric thiobarbituric acid test), SOD, catalase and GPx activities (spectrophotometric kits), NO formation (nitrate+nitrite; chemoluminescence), DNA damage in whole blood samples and isolated lymphocytes exposed to hyperbaric oxygen (comet assay). Organ function was also evaluated. Kidney and spinal cord specimen were analysed for apoptosis (TUNEL assay). The melon extract/gliadin blunted the DNA damage, reduced spinal cord apoptosis and attenuated NO release, however, without any effect on lipid peroxidation and organ function. Pre-treatment with the oral melon extract/gliadin may be a therapeutic option to reduce oxidative cell injury affiliated with aortic cross-clamping.

  4. Diagnosing Myocardial Contusion after Blunt Chest Trauma

    Directory of Open Access Journals (Sweden)

    Zahra Alborzi

    2016-10-01

    Full Text Available A myocardial contusion refers to a bruise of the cardiac muscle, the severity of which can vary depending on the severity of the injury and when the injury occurs. It is a major cause of rapid death which happens after blunt chest trauma and should be suspected at triage in the emergency department. We demonstrated that suspected myocardial contusion patients who have normal electrocardiograms (ECGs and biomarker tests can be safely discharged. However, if the test results are abnormal, the next steps should be echocardiography and more advanced measures. Diagnosing myocardial contusion is very difficult because of its nonspecific symptoms. If a myocardial contusion happens, cardiogenic shock or arrhythmia must be anticipated, and the patient must be carefully monitored.

  5. Development of a computer model to predict aortic rupture due to impact loading.

    Science.gov (United States)

    Shah, C S; Yang, K H; Hardy, W; Wang, H K; King, A I

    2001-11-01

    Aortic injuries during blunt thoracic impacts can lead to life threatening hemorrhagic shock and potential exsanguination. Experimental approaches designed to study the mechanism of aortic rupture such as the testing of cadavers is not only expensive and time consuming, but has also been relatively unsuccessful. The objective of this study was to develop a computer model and to use it to predict modes of loading that are most likely to produce aortic ruptures. Previously, a 3D finite element model of the human thorax was developed and validated against data obtained from lateral pendulum tests. The model included a detailed description of the heart, lungs, rib cage, sternum, spine, diaphragm, major blood vessels and intercostal muscles. However, the aorta was modeled as a hollow tube using shell elements with no fluid within, and its material properties were assumed to be linear and isotropic. In this study fluid elements representing blood have been incorporated into the model in order to simulate pressure changes inside the aorta due to impact. The current model was globally validated against experimental data published in the literature for both frontal and lateral pendulum impact tests. Simulations of the validated model for thoracic impacts from a number of directions indicate that the ligamentum arteriosum, subclavian artery, parietal pleura and pressure changes within the aorta are factors that could influence aortic rupture. The model suggests that a right-sided impact to the chest is potentially more hazardous with respect to aortic rupture than any other impact direction simulated in this study. The aortic isthmus was the most likely site of aortic rupture regardless of impact direction. The reader is cautioned that this model could only be validated on a global scale. Validation of the kinematics and dynamics of the aorta at the local level could not be done due to a lack of experimental data. It is hoped that this model will be used to design

  6. James Blunt matuselaulude edetabeli tipus

    Index Scriptorium Estoniae

    2006-01-01

    Bereavement Registeri andmetel Suurbritannias matustel tellitavate laulude edetabelis: James Blunt "Goodbye My Lover", Robbie Williams "Angels", Jennifer Warnes ja Bill Medley "I've Had the Time Of My Life", Elton John "Candle in the Wind", Righteous Brothers "Unchained Melody"

  7. Pediatric blunt splenic trauma: a comprehensive review

    Energy Technology Data Exchange (ETDEWEB)

    Lynn, Karen N.; Werder, Gabriel M.; Callaghan, Rachel M.; Jafri, Zafar H. [William Beaumont Hospital, Department of Diagnostic Radiology, Royal Oak, MI (United States); Sullivan, Ashley N. [St. George' s University School of Medicine, Grenada, West Indies (Grenada); Bloom, David A. [William Beaumont Hospital, Department of Diagnostic Radiology, Royal Oak, MI (United States); William Beaumont Hospital, Section of Pediatric Radiology, Department of Radiology, Royal Oak, MI (United States)

    2009-09-15

    Abdominal trauma is a leading cause of death in children older than 1 year of age. The spleen is the most common organ injured following blunt abdominal trauma. Pediatric trauma patients present unique clinical challenges as compared to adults, including different mechanisms of injury, physiologic responses, and indications for operative versus nonoperative management. Splenic salvage techniques and nonoperative approaches are preferred to splenectomy in order to decrease perioperative risks, transfusion needs, duration/cost of hospitalization, and risk of overwhelming postsplenectomy infection. Early and accurate detection of splenic injury is critical in both adults and children; however, while imaging findings guide management in adults, hemodynamic stability is the primary determinant in pediatric patients. After initial diagnosis, the primary role of imaging in pediatric patients is to determine the level and duration of care. We present a comprehensive literature review regarding the mechanism of injury, imaging, management, and complications of traumatic splenic injury in pediatric patients. Multiple patients are presented with an emphasis on the American Association for the Surgery of Trauma organ injury grading system. Clinical practice guidelines from the American Pediatric Surgical Association are discussed and compared with our experience at a large community hospital, with recommendations for future practice guidelines. (orig.)

  8. [Right ventricular perforation by a rib fragment following blunt thoracic trauma].

    Science.gov (United States)

    Pometlová, J; Pleva, L; Sír, M; Gloger, J; Chmelová, J

    2011-11-01

    Blunt chest trauma produces a variety of injuries. Penetrating cardiac injuries from rib fractures are extremely rare. We report the unusual case of a patient with multiple rib fractures and penetrating cardiac injury from dislocated segment of fractured VIII left rib. We did find eight patients reported in the literature having penetrating cardiac injuries from rib fractures. The clinical finding and the diagnosis of this injuries are discussed.

  9. Utility of MRI for cervical spine clearance in blunt trauma patients after a negative CT.

    Science.gov (United States)

    Malhotra, Ajay; Durand, David; Wu, Xiao; Geng, Bertie; Abbed, Khalid; Nunez, Diego B; Sanelli, Pina

    2018-02-15

    To determine the utility of cervical spine MRI in blunt trauma evaluation for instability after a negative non-contrast cervical spine CT. A review of medical records identified all adult patients with blunt trauma who underwent CT cervical spine followed by MRI within 48 h over a 33-month period. Utility of subsequent MRI was assessed in terms of findings and impact on outcome. A total of 1,271 patients with blunt cervical spine trauma underwent both cervical spine CT and MRI within 48 h; 1,080 patients were included in the study analysis. Sixty-six percent of patients with a CT cervical spine study had a negative study. Of these, the subsequent cervical spine MRI had positive findings in 20.9%; 92.6% had stable ligamentous or osseous injuries, 6.0% had unstable injuries and 1.3% had potentially unstable injuries. For unstable injury, the NPV for CT was 98.5%. In all 712 patients undergoing both CT and MRI, only 1.5% had unstable injuries, and only 0.42% had significant change in management. MRI for blunt trauma evaluation remains not infrequent at our institution. MRI may have utility only in certain patients with persistent abnormal neurological examination. • MRI has limited utility after negative cervical CT in blunt trauma. • MRI is frequently positive for non-specific soft-tissue injury. • Unstable injury missed on CT is infrequent.

  10. Duodenal Transection without Pancreatic Injury following Blunt ...

    African Journals Online (AJOL)

    Tata Memorial Hospital, Dr. E. Borges Road,. Parel, Mumbai ‑ 12, Maharashtra, India. E‑mail: sanketbankar23@gmail.com mobilized. There was complete transection of the third part of the duodenum [Figure 1] with normal pancreas. Edges were freshened and primary anastomosis was done with. 3.0 mersilk in two layers.

  11. Right Atrium Laceration with Pericardial Tamponade: A Rare Presentation of Blunt Cardiac Trauma

    Directory of Open Access Journals (Sweden)

    Hamid Hoseinikhah

    2015-11-01

    Full Text Available Cardiac laceration from blunt thoracic trauma is not a common presentation. The rate of mortality due to this injury is very high since it is not diagnosed and treated immediately. In this study, we present the case of a 65-year-old man with blunt cardiac trauma, causing right atrial rupture and pericardial tamponade. Successful management of this patient was firstly done with initial pericardiocentesis. Then, the patient was immediately transferred to the operating room for tamponade relief and cardiac wall repair. We recommend that cardiac surgeon have  an important suspicious for cardiac involvement in Blunt chest wall trauma

  12. A Clinical Study of Blunt Ocular Trauma in a Tertiary Care Centre

    Directory of Open Access Journals (Sweden)

    Shobha G Pai

    2013-08-01

    Full Text Available Purpose: To analyze blunt eye injuries with respect to mode of injury, sites involved and outcome. Method: This was a retrospective study of 32 patients with blunt ocular trauma from 2010 to 2012 in a tertiary care centre. Patient data, mode and extent of injury, management and outcome was noted and analyzed. Result: The commonest age of presentation was 10-20 years (28.125% and the commonest mode of injury was road traffic accident (28.125%. The most commonly involved structure was conjunctiva (84.375%, followed by lid and adnexa (62.5%. Anterior segment involvement included corneal epithelial defect (7 cases, hyphaema (4 cases, iritis (3 cases and anterior dislocation of lens (1 case. Posterior segment involvement included vitreous haemorrhage (1 case and commotio retinae (2 cases. Conclusion: This study reinforces that blunt trauma can cause any extent of damage to ocular structures and the final visual outcome is dependent on the structures injured.

  13. Dissection of the left main coronary artery after blunt thoracic trauma: Case report and literature review

    Directory of Open Access Journals (Sweden)

    Beilman Greg

    2010-07-01

    Full Text Available Abstract Blunt chest trauma is commonly encountered by surgeons and is rarely associated with cardiac injuries. The incidence of cardiac injury is rare but can be rapidly fatal, requiring prompt recognition and treatment. We review the case of a 37 year-old male who was involved in a head-on motor vehicle collision at highway speed and was found to have an isolated left main coronary artery dissection. We then review the supporting literature for evaluation of blunt cardiac injuries and the treatment options for traumatic coronary dissection.

  14. Use of Chest Computed Tomography in Stable Patients with Blunt Thoracic Trauma: Clinical and Forensic Perspective

    OpenAIRE

    Makbule Ergin

    2011-01-01

    Aim: The aim of this study was to investigate the medical and forensic importance of thorax computed tomography in stable patients with blunt chest trauma. Material and Methods: Fifty patients with blunt chest injury were retrospectively evaluated with chest radiography and thorax computed tomography in the first 24 hours after trauma. Patient demographics, thoracic lesions, management options, and forensic assessment were rewieved. Results: The most common lesion of the study was ri...

  15. The use of angiography in pediatric blunt abdominal trauma patients.

    Science.gov (United States)

    Fenton, Stephen J; Sandoval, Kristin N; Stevens, Austin M; Scaife, Eric R

    2016-08-01

    Angiography is a common treatment used in adults with blunt abdominal trauma and/or severe pelvic fractures. The Committee on Trauma of the American College of Surgeons has recently advocated for this resource to be urgently available at pediatric trauma centers; however, its usefulness in the pediatric setting is unclear. The purpose of this study was to determine the incidence of angiography in the treatment of blunt abdominal trauma among injured children. An analysis was performed using an established public use data set of children (younger than 18 years) treated at 20 participating trauma centers for blunt torso trauma through the Pediatric Emergency Care Applied Research Network. Patients who underwent angiography of the abdomen or pelvis were identified and analyzed. Of the 12,044 children evaluated for blunt abdominal trauma included within the data set, 973 sustained abdominopelvic injuries. Of these, only 26 (3%) underwent angiography. The median age was 14 years, 65% were males, with a mortality rate of 19%. Overall, 29 angiographic procedures were performed: 21 abdominal, 8 pelvic, with 3 patients undergoing both abdominal and pelvic. Eleven patients underwent embolization of a bleeding vessel, all of which were related to the spleen. No hepatic, renal, or pelvic vessels required embolization. The median time to angiography from emergency department evaluation was 7.3 hours. In addition to angiography, 50% also required surgical intervention, of which 31% underwent a laparotomy. Thirty-five percent of these patients required blood product transfusion, and 42% were admitted to the intensive care unit. The emergent use of angiography with embolization is uncommon in pediatric patients with blunt abdominal injuries. The requirement that pediatric trauma centers have access to interventional radiology within 30 minutes may be unnecessary. Epidemiologic study, level III; therapeutic study, level IV.

  16. Blunt Traumatic Cardiac Rupture: Single-Institution Experiences over 14 Years

    Directory of Open Access Journals (Sweden)

    Jeong Hee Yun

    2016-12-01

    Full Text Available Background: Blunt traumatic cardiac rupture is rare. However, such cardiac ruptures carry a high mortality rate. This study reviews our experience treating blunt traumatic cardiac rupture. Methods: This retrospective study included 21 patients who experienced blunt traumatic cardiac rupture from 1999 to 2015. Every patient underwent surgery. Several variables were compared between survivors and fatalities. Results: Sixteen of the 21 patients survived, and 5 (24% died. No instances of intraoperative mortality occurred. The most common cause of injury was a traffic accident (81%. The right atrium was the most common location of injury (43%. Ten of the 21 patients were suspected to have cardiac tamponade. Significant differences were found in preoperative creatine kinase–myocardial band (CK-MB levels (p=0.042 and platelet counts (p= 0.004 between the survivors and fatalities. The patients who died had higher preoperative Glasgow Coma Scale scores (p=0.007, worse Trauma and Injury Severity Scores (p=0.007, and higher Injury Severity Scores (p=0.004 than those who survived. Conclusion: We found that elevated CK-MB levels, a low platelet count, and multi-organ traumatic injury were prognostic factors predicting poor outcomes of blunt cardiac rupture. If a patient with blunt traumatic cardiac rupture has these factors, clinicians should be especially attentive and respond promptly in order to save the patient’s life.

  17. Behind armour blunt trauma--an emerging problem.

    Science.gov (United States)

    Cannon, L

    2001-02-01

    Behind Armour Blunt Trauma (BABT) is the non-penetrating injury resulting from the rapid deformation of armours covering the body. The deformation of the surface of an armour in contact with the body wall arises from the impact of a bullet or other projectile on its front face. The deformation is part of the retardation and energy absorbing process that captures the projectile. In extreme circumstances, the BABT may result in death, even though the projectile has not perforated the armour. An escalation of the available energy of bullets and the desire of armour designers to minimise the weight and bulk of personal armour systems will increase the risk of BABT in military and security forces personnel. In order to develop materials that can be interposed between the armour and the body wall to attenuate the transfer of energy into the body, it is essential that the mechanism of BABT is known. There is a great deal of activity within UK and NATO to unravel the interactions; the mechanism is likely to be a combination of stress (pressure) waves generated by the rapid initial motion of the rear of the armour, and shear deformation to viscera produced by gross deflection of the body wall. Physical and computer model systems are under development to characterise the biophysical processes and provide performance targets for materials to be placed between armours and the body wall in order to attenuate the injuries (trauma attenuating backings-TABs). The patho-physiological consequences of BABT are being clarified by research, but the injuries will have some of the features of blunt chest trauma observed in road traffic accidents and other forms of civilian blunt impact injury. The injuries also have characteristics of primary blast injury. An overview diagnosis and treatment is described.

  18. Outcomes of patients with blunt chest trauma encountered at emergency department and possible risk factors affecting mortality

    OpenAIRE

    Yuan-Ming Tsai; Kuan-Hsun Lin; Tsai-Wang Huang; Chun-Ying Chen; Zhi-Jie Hong; Sheng-Der Hsu

    2017-01-01

    Background: Blunt chest trauma is associated with a high risk of mortality. Respiratory complications may necessitate prolonged ventilation and result in death. The present study aimed to investigate possible signs of trauma and the prognosis of trauma patients with thoracic injuries and identify risk factors for mortality. Patients and Methods: A retrospective study was performed to investigate the clinical characteristics and treatment outcomes of trauma patients with blunt chest injuries ...

  19. Isolated perforation of a duodenal diverticulum following blunt abdominal trauma

    Directory of Open Access Journals (Sweden)

    Metcalfe Matthew

    2010-01-01

    Full Text Available Only 10% of duodenal diverticula are symptomatic. We present the case of a man who fell from a height of 6 ft, landing on his abdomen and presenting 4 h later with severe back pain and a rigid abdomen. At laparotomy, a perforated retroperitoneal duodenal diverticulum was found and repaired with an omental patch. No other injury was noted. Not only is this perforation unusual, but the absence of other injuries sustained during this minor blunt trauma makes this case unique. This case highlights the need for a high index of suspicion when managing patients with back or abdominal pain following minor trauma.

  20. Transcatheter aortic valve replacement

    Science.gov (United States)

    ... gov/ency/article/007684.htm Transcatheter aortic valve replacement To use the sharing features on this page, please enable JavaScript. Transcatheter aortic valve replacement (TAVR) is surgery to replace the aortic valve. ...

  1. Aortic Valve Regurgitation

    Science.gov (United States)

    ... correct direction. These valves include the mitral valve, tricuspid valve, pulmonary valve and aortic valve. Each valve has ... Causes of aortic valve regurgitation include: Congenital heart valve disease. You may have been born with an aortic ...

  2. Blunt traumatic cardiac rupture: therapeutic options and outcomes.

    Science.gov (United States)

    Nan, Yu-Yun; Lu, Ming-Shian; Liu, Kuo-Sheng; Huang, Yao-Kuang; Tsai, Feng-Chun; Chu, Jaw-Ji; Lin, Pyng Jing

    2009-09-01

    Cardiac rupture following blunt thoracic trauma is rarely encountered by clinicians, since it commonly causes death at the scene. With advances in traumatology, blunt cardiac rupture had been increasingly disclosed in various ways. This study reviews our experience of patients with suspected blunt traumatic cardiac rupture and proposes treatment protocols for the same. This is a 5-year retrospective study of trauma patients confirmed with blunt traumatic cardiac rupture admitted to a university-affiliated tertiary trauma referral centre. The following information was collected from the patients: age, sex, mechanism of injury, initial effective diagnostic tool used for diagnosing blunt cardiac rupture, location and size of the cardiac injury, associated injury and injury severity score (ISS), reversed trauma score (RTS), survival probability of trauma and injury severity scoring (TRISS), vital signs and biochemical lab data on arrival at the trauma centre, time elapsed from injury to diagnosis and surgery, surgical details, hospital course and final outcome. The study comprised 8 men and 3 women with a median age of 39 years (range: 24-73 years) and the median follow-up was 5.5 months (range: 1-35 months). The ISS, RTS, and TRISS scores of the patients were 32.18+/-5.7 (range: 25-43), 6.267+/-1.684 (range: 2.628-7.841), and 72.4+/-25.6% (range: 28.6-95.5%), respectively. Cardiac injuries were first detected using focused assessment with sonography for trauma (FAST) in 4 (36.3%) patients, using transthoracic echocardiography in 3 (27.3%) patients, chest CT in 1 (9%) patient, and intra-operatively in 3 (27.3%) patients. The sites of cardiac injury comprised the superior vena cava/right atrium junction (n=4), right atrial auricle (n=1), right ventricle (n=4), left ventricular contusion (n=1), and diffuse endomyocardial dissection over the right and left ventricles (n=1). Notably, 2 had pericardial lacerations presenting as a massive haemothorax, which initially masked

  3. CT scanning of blunt trauma to bowel and mesentery

    International Nuclear Information System (INIS)

    Federle, M.P.; Griffiths, B.G.; Donohue, J.H.; Minagi, H.

    1986-01-01

    In a 6-year period, 1,500 consecutive CT scans were performed for the evaluation of blunt abdominal trauma. The patient population included 25 patients with a preoperative diagnosis of mesenteric or bowel injury. The preoperative diagnosis was proved correct in 23 cases. An additional 12 patients were diagnosed from CT findings as having bowel or mesenteric injuries, but did not undergo laparotomy. Of the patients who underwent operation, bowel wall thickening, intraperitoneal fluid, or both were noted on CT in all cases but one. Less frequently noted CT signs of bowel or mesenteric injury included extraluminal gas (seven cases) and extravasated contrast material (one). Both of these signs were regarded as indications for surgery, as were hematomas in the bowel wall or mesentery when accompanied by substantial amounts of intraperitoneal fluid. The importance of meticulous scanning technique and photography is emphasized. Potential sources of error in the assessment of bowel or mesenteric injuries are described

  4. Complete Rupture of Both Heads of the Biceps Brachii Muscle Belly by Blunt Trauma.

    Science.gov (United States)

    Chen, Herbert W; Chew, Felix S

    2006-01-01

    A young adult male pedestrian was struck by a car and sustained a closed complete rupture of both heads of the biceps brachii muscle belly, among other injuries. Rupture of the biceps brachii muscle belly is a rare injury, and complete muscle belly rupture of both long and short heads from direct blunt force trauma has not been reported outside of military parachutists. We describe the findings on magnetic resonance imaging (MRI) of this injury.

  5. Conservative therapy for missed esophageal perforation after blunt trauma.

    Science.gov (United States)

    Lucas, C E; Splittgerber, F; Ledgerwood, A M

    1986-11-01

    An 80-year-old man was treated, non-operatively, for a distal esophageal perforation, diagnosed nine days after blunt thoracic trauma. Emergency department diagnosis was impeded by absence of mediastinal air; right chest-wall emphysema was thought to result from associated rib fractures. Conservative therapy consisting of nasogastric suction, intravenous antibiotics, right-chest tube drainage of a large communicating empyema cavity, temporary nasotracheal intubation with ventilatory support, total parenteral nutrition, and, finally, nasoduodenal intubation for elemental feeding were employed. This mode of therapy may be best in comparable elderly patients with esophageal perforation that is overlooked during the initial 24 hours after injury. Possibly, routine barium swallow in all patients with chest-wall emphysema and rib fractures would circumvent missed esophageal rupture after blunt trauma.

  6. Bronchial and cardiac ruptures due to blunt trauma.

    Science.gov (United States)

    Misao, Takahiko; Yoshikawa, Takeshi; Aoe, Motoi; Iga, Norichika; Furukawa, Masashi; Suezawa, Takanori; Tago, Mamoru

    2011-03-01

    Tracheobronchial and cardiac injuries following blunt thoracic trauma are uncommon but can be life-threatening. We report a case in which the patient with bronchial and right atrial ruptures due to blunt trauma survived after emergent repairs. An 18-year-old female driver was transported to our hospital after a traffic accident and was hemodynamically stable on arrival. Chest computed tomography revealed cervicomediastinal emphysema and hemopericardium, and fiberoptic bronchoscopy showed a tear in the right main bronchus. She was intubated with a double-lumen endotracheal tube guided by bronchoscopy. A median sternotomy was undertaken, and a laceration of the right atrium was oversewn without the use of cardiopulmonary bypass. After that, right-sided thoracotomy was performed. The tear in the membranous portion of the right main bronchus was repaired with interrupted sutures, and the suture lines were wrapped with a pedicled flap of intercostal muscle.

  7. Early detection of myocardial infarction following blunt chest trauma by computed tomography: a case report.

    Science.gov (United States)

    Lee, Thung-Lip; Hsuan, Chin-Feng; Shih, Chen-Hsiang; Liang, Huai-Wen; Tsai, Hsing-Shan; Tseng, Wei-Kung; Hsu, Kwan-Lih

    2017-02-10

    Blunt cardiac trauma encompasses a wide range of clinical entities, including myocardial contusion, cardiac rupture, valve avulsion, pericardial injuries, arrhythmia, and even myocardial infarction. Acute myocardial infarction due to coronary artery dissection after blunt chest trauma is rare and may be life threatening. Differential diagnosis of acute myocardial infarction from cardiac contusion at this setting is not easy. Here we demonstrated a case of blunt chest trauma, with computed tomography detected myocardium enhancement defect early at emergency department. Under the impression of acute myocardial infarction, emergent coronary angiography revealed left anterior descending artery occlusion. Revascularization was performed and coronary artery dissection was found after thrombus aspiration. Finally, the patient survived after coronary stenting. Perfusion defects of myocardium enhancement on CT after blunt chest trauma can be very helpful to suggest myocardial infarction and facilitate the decision making of emergent procedure. This valuable sign should not be missed during the initial interpretation.

  8. Coronary artery rupture in blunt thoracic trauma: a case report and review of literature.

    Science.gov (United States)

    Abu-Hmeidan, Jareer Heider; Arrowaili, Arief Ismael; Yousef, Raid Said; Alasmari, Sami; Kassim, Yasser M; Aldakhil Allah, Hamad Hamad; Aljenaidel, Abdullah Mohammed; Alabdulqader, Abdullah Abdulmohsen; Alrashed, Muath Hamad; Alkhinjar, Mulfi Ibrahim; Al-Shammari, Nawwaf Rahi

    2016-08-02

    Blunt thoracic trauma can rarely result in coronary artery injury. Blunt trauma can result in occlusion of any of the coronary arteries or can lead to its rupture and bleeding. Traumatic coronary artery occlusion can lead to myocardial infarction, while its rupture and bleeding can result in hemopericardium and cardiac tamponade, and can be rapidly fatal. Survival after coronary artery rupture in blunt thoracic trauma is exceedingly rare. We present a case of a young male who sustained a blunt thoracic trauma in a motor vehicle collision, that resulted in rupture of the left anterior descending (LAD) coronary artery and subsequent cardiac tamponade. Prompt surgical intervention with pericardiotomy and ligation of the artery has resulted in survival of the patient. In cases of traumatic coronary artery rupture, early surgical intervention is crucial to avoid mortality. Ligation of the injured coronary is a viable option in selected cases, and can be the most expeditious option in patients in extremis.

  9. Are routine pelvic radiographs in major pediatric blunt trauma necessary?

    Energy Technology Data Exchange (ETDEWEB)

    Lagisetty, Jyothi [Memorial Hermann Medical Center, Emergency Medicine Department, Houston, TX (United States); Slovis, Thomas [Wayne State University School of Medicine, Department of Radiology, Pediatric Imaging, Children' s Hospital of Michigan, Detroit, MI (United States); Thomas, Ronald [Children' s Hospital of Michigan, Wayne State University of Medicine, Department of Pediatrics, Detroit, MI (United States); Knazik, Stephen; Stankovic, Curt [Wayne State University of Medicine, Division of Emergency Medicine, Children' s Hospital of Michigan, Detroit, MI (United States)

    2012-07-15

    Screening pelvic radiographs to rule out pelvic fractures are routinely used for the initial evaluation of pediatric blunt trauma. Recently, the utility of routine pelvic radiographs in certain subsets of patients with blunt trauma has been questioned. There is a growing amount of evidence that shows the clinical exam is reliable enough to obviate the need for routine screening pelvic radiographs in children. To identify variables that help predict the presence or absence of pelvic fractures in pediatric blunt trauma. We conducted a retrospective study from January 2005 to January 2010 using the trauma registry at a level 1 pediatric trauma center. We analyzed all level 1 and level 2 trauma victims, evaluating history, exam and mechanism of injury for association with the presence or absence of a pelvic fracture. Of 553 level 1 and 2 trauma patients who presented during the study period, 504 were included in the study. Most of these children, 486/504 (96.4%), showed no evidence of a pelvic fracture while 18/504 (3.6%) had a pelvic fracture. No factors were found to be predictive of a pelvic fracture. However, we developed a pelvic fracture screening tool that accurately rules out the presence of a pelvic fracture P = 0.008, NPV 99, sensitivity 96, 8.98 (1.52-52.8). This screening tool combines eight high-risk clinical findings (pelvic tenderness, laceration, ecchymosis, abrasion, GCS <14, positive urinalysis, abdominal pain/tenderness, femur fracture) and five high-risk mechanisms of injury (unrestrained motor vehicle collision [MVC], MVC with ejection, MVC rollover, auto vs. pedestrian, auto vs. bicycle). Pelvic fractures in pediatric major blunt trauma can reliably be ruled out by using our pelvic trauma screening tool. Although no findings accurately identified the presence of a pelvic fracture, the screening tool accurately identified the absence of a fracture, suggesting that pelvic radiographs are not warranted in this subset of patients. (orig.)

  10. The craniocervical junction: embryology, anatomy, biomechanics and imaging in blunt trauma.

    Science.gov (United States)

    Offiah, Curtis Edward; Day, Emily

    2017-02-01

    Imaging of the blunt traumatic injuries to the craniocervical junction can be challenging but central to improving morbidity and mortality related to such injury. The radiologist has a significant part to play in the appropriate management of patients who have suffered injury to this vital junction between the cranium and the spine. Knowledge of the embryology and normal anatomy as well as normal variant appearances avoids inappropriate investigations in these trauma patients. Osseous injury can be subtle while representing important radiological red flags for significant underlying ligamentous injury. An understanding of bony and ligamentous injury patterns can also give some idea of the biomechanics and degree of force required to inflict such trauma. This will assist greatly in predicting risk for other critical injuries related to vital neighbouring structures such as vasculature, brain stem, cranial nerves and spinal cord. The embryology and anatomy of the craniocervical junction will be outlined in this review and the relevant osseous and ligamentous injuries which can arise as a result of blunt trauma to this site described together. Appropriate secondary radiological imaging considerations related to potential complications of such trauma will also be discussed. • The craniocervical junction is a distinct osseo-ligamentous entity with specific functional demands. • Understanding the embryology of the craniocervical junction may prevent erroneous radiological interpretation. • In blunt trauma, the anatomical biomechanical demands of the ligaments warrant consideration. • Dedicated MRI sequences can provide accurate evaluation of ligamentous integrity and injury. • Injury of the craniocervical junction carries risk of blunt traumatic cerebrovascular injury.

  11. Evaluation of three phases computed tomography scan findings in blunt abdominal trauma

    Directory of Open Access Journals (Sweden)

    Mahboub Pouraghaei

    2016-08-01

    Full Text Available Introduction: Blunt abdominal trauma is one of the important types of trauma and causes mortality in patients. Identifying the internal organ damage is necessary to proper management of trauma patients. Computed tomography (CT scan is a powerful non-invasive imaging technique to assess internal organ damages in blunt abdominal trauma. The aim of present study was to evaluate findings of CT scan with contrast in patient with blunt abdominal trauma. Methods: In this descriptive study, 290 patients with blunt abdominal trauma were studied who referred to emergency department of Imam-Reza Hospital of Tabriz University of Medical Sciences in Tabriz, Iran, from June 2014 to June 2015. Abdominal and pelvic CT scan with contrast was done using 1 detector CT scan machine in three phases (arterial phase, portal-venous phase and a delayed phase. Patients’ demographic information, cause of trauma, and CT scan findings were collected. Results: Mean age of patients was 26.3 ± 8.15 years. Male to female ratio was 1 to 0.42. Most common causes of blunt abdominal trauma were traffic accidents in 65.5% of patients, fall from height in 24.1% patients, and fall of heavy objects in 10.4% patients. Among all the patients, 57.6% had a detectable damage based on CT scanning. Based on CT scan findings, most common injuries were spleen injury in 20.0% of patients, liver injury in 18.9% of patients, and kidney injury in 8.9%. Conclusion: Traffic accidents were the most common cause of blunt abdominal trauma. Spleen, liver, and kidney injury were the most common internal organ damages based on CT scan findings.

  12. Aortic valve bypass

    DEFF Research Database (Denmark)

    Lund, Jens T; Jensen, Maiken Brit; Arendrup, Henrik

    2013-01-01

    In aortic valve bypass (AVB) a valve-containing conduit is connecting the apex of the left ventricle to the descending aorta. Candidates are patients with symptomatic aortic valve stenosis rejected for conventional aortic valve replacement (AVR) or transcatheter aortic valve implantation (TAVI). ...

  13. Bicuspid Aortic Valve

    Science.gov (United States)

    2006-08-01

    with tricuspid aortic valves matched for age, gender and grade of valvular disease . These studies suggest that the predisposition for aortic...enlargement in healthy patients with normally functioning BAV when compared to healthy subjects with normally functioning tricuspid aortic valves ...ascending aorta but also in the pulmonary arteries of patients with BAV, compared to that of patients with tricuspid aortic valves . These studies

  14. Nonoperative management for patients with grade IV blunt hepatic trauma

    Directory of Open Access Journals (Sweden)

    Zago Thiago

    2012-08-01

    Full Text Available Abstract Introduction The treatment of complex liver injuries remains a challenge. Nonoperative treatment for such injuries is increasingly being adopted as the initial management strategy. We reviewed our experience, at a University teaching hospital, in the nonoperative management of grade IV liver injuries with the intent to evaluate failure rates; need for angioembolization and blood transfusions; and in-hospital mortality and complications. Methods This is a retrospective analysis conducted at a single large trauma centre in Brazil. All consecutive, hemodynamically stable, blunt trauma patients with grade IV hepatic injury, between 1996 and 2011, were analyzed. Demographics and baseline characteristics were recorded. Failure of nonoperative management was defined by the need for surgical intervention. Need for angioembolization and transfusions, in-hospital death, and complications were also assessed Results Eighteen patients with grade IV hepatic injury treated nonoperatively during the study period were included. The nonoperative treatment failed in only one patient (5.5% who had refractory abdominal pain. However, no missed injuries and/or worsening of bleeding were observed during the operation. None of the patients died nor need angioembolization. No complications directly related to the liver were observed. Unrelated complications to the liver occurred in three patients (16.7%; one patient developed a tracheal stenosis (secondary to tracheal intubation; one had pleural effusion; and one developed an abscess in the pleural cavity. The hospital length of stay was on average 11.56 days. Conclusions In our experience, nonoperative management of grade IV liver injury for stable blunt trauma patients is associated with high success rates without significant complications.

  15. Routine Chest Computed Tomography and Patient Outcome in Blunt Trauma

    Science.gov (United States)

    Moussavi, Nushin; Davoodabadi, Abdol Hossein; Atoof, Fatemeh; Razi, Seyed Ebrahim; Behnampour, Mehdi; Talari, Hamid Reza

    2015-01-01

    Background: Computerized Tomography (CT) scan is gaining more importance in the initial evaluation of patients with multiple trauma, but its effect on the outcome is still unclear. Until now, no prospective randomized trial has been performed to define the role of routine chest CT in patients with blunt trauma. Objectives: In view of the considerable radiation exposure and the high costs of CT scan, the aim of this study was to assess the effects of performing the routine chest CT on the outcome as well as complications in patients with blunt trauma. Patients and Methods: After approval by the ethics board committee, 100 hemodynamically stable patients with high-energy blunt trauma were randomly divided into two groups. For group one (control group), only chest X-ray was requested and further diagnostic work-up was performed by the decision of the trauma team. For group two, a chest X-ray was ordered followed by a chest CT, even if the chest X-ray was normal. Injury severity, total hospitalization time, Intensive Care Unit (ICU) admission time, duration of mechanical ventilation and complications were recorded. Data were evaluated using t-test, Man-Whitney and chi-squared test. Results: No significant differences were found regarding the demographic data such as age, injury severity and Glasgow Coma Scale (GCS). Thirty-eight percent additional findings were seen in chest CT in 26% of the patients of the group undergoing routine chest CT, leading to 8% change in management. The mean of in-hospital stay showed no significant difference in both groups with a P value of 0.098. In addition, the mean ICU stay and ventilation time revealed no significant differences (P values = 0.102 and 0.576, respectively). Mortality rate and complications were similar in both groups. Conclusions: Performing the routine chest CT in high-energy blunt trauma patients (with a mean injury severity of 9), although leading to the diagnosis of some occult injuries, has no impact on the outcome

  16. Hernia Following Blunt Abdominal Trauma

    Directory of Open Access Journals (Sweden)

    N Aghaie

    2009-10-01

    Full Text Available Traumatic abdominal wall hernia is a rare type of hernia, which follows blunt trauma to the abdomen, where disruption of the musculature and fascia occurs with the overlying skin remaining intact. Diagnosis of this problem is very difficult and delayed. Traumatic hernia is often diagnosed during laparatomy or laparascopy, but CT scan also has a role in distinguishing this pathology. Delay in diagnosis is very dangerous and can result in gangrene and necrosis of the organs in the hernia. The case report of a 35 years old man with liftruck blunt trauma is reported. His vital signs were stable. On physical examination, tenderness of RUQ was seen. He underwent Dpl for suspected hemoprotein. Dpl was followed up by laparatomy. Laparatomy revealed that the transverse and ascending colon partially herniated in the abdominal wall defect. The colon was reduced in the abdomen and repair of abdominal hernia was done. The patient was discharged after 5 day. The etiology, pathogenesis and management are discussed.

  17. Blunt indentation of core graphite

    International Nuclear Information System (INIS)

    Hartley, M.; McEnaney, B.

    1996-01-01

    Blunt indentation experiments were carried out on unoxidized and thermally oxidised IM1-24 graphite as a model to simulate local point stresses acting on graphite moderator bricks. Blunt indentation of unoxidized graphite initiates cracks close to the region of maximum tensile stress at the edge of the indentation. Cracks propagate and converge to form a cone of material. Failure is catastrophic, typically forming three pieces of graphite and ejecting the cone referred to above. The failure mode under indentation loading for highly oxidised graphite (weigh loss > 40%) is different from that for the unoxidized graphite. There is no longer a distinct crack path, the indentation is much deeper than in the case of the unoxidized graphite, and there is a region of crushed debris beneath the indentation, producing a crater-like structure. The reduction in the compressive fracture stress, σ cf , under indentation loading with increasing fractional weight loss on oxidation, x, can be fitted to σ cf /σ 0 = exp-[5.2x] where σ 0 is the compressive fracture stress of the unoxidized graphite. This indicates that the effect of thermal oxidation on indentation fracture stress is more severe than the effects of radiolytic oxidation on conventional strengths of nuclear graphites. (author). 8 refs, 12 figs

  18. Quadricuspid Aortic Valve Combined with Moderate Ascending Aortic Dilatation

    Science.gov (United States)

    Uspenskiy, Vladimir E.; Osadchii, Alexei M.; Gordeev, Mikhail L.

    2015-01-01

    The quadricuspid aortic valve is a very uncommon malformation associated with aortic insufficiency, aortic stenosis, endocarditis, and ascending aortic dilatation. We report four cases of this aortic valve malformation. One patient with severe aortic regurgitation and moderate aortic dilatation required aortic valve replacement. Three patients had mild or moderate aortic insufficiency combined with moderate ascending aortic dilatation. These patients were referred to follow-up. The presented cases demonstrate that this aortic valve malformation may not be as rare as it appears and that attention must be paid to any quadricuspid findings during computed tomographic angiography and echocardiography. PMID:27390747

  19. Diagnostic Accuracy of Secondary Ultrasound Exam in Blunt Abdominal Trauma

    International Nuclear Information System (INIS)

    Rajabzadeh Kanafi, Alireza; Giti, Masoumeh; Gharavi, Mohammad Hossein; Alizadeh, Ahmad; Pourghorban, Ramin; Shekarchi, Babak

    2014-01-01

    In stable patients with blunt abdominal trauma, accurate diagnosis of visceral injuries is crucial. To determine whether repeating ultrasound exam will increase the sensitivity of focused abdominal sonography for trauma (FAST) through revealing additional free intraperitoneal fluid in patients with blunt abdominal trauma. We performed a prospective observational study by performing primary and secondary ultrasound exams in blunt abdominal trauma patients. All ultrasound exams were performed by four radiology residents who had the experience of more than 400 FAST exams. Five routine intraperitoneal spaces as well as the interloop space were examined by ultrasound in order to find free fluid. All patients who expired or were transferred to the operating room before the second exam were excluded from the study. All positive ultrasound results were compared with intra-operative and computed tomography (CT) findings and/or the clinical status of the patients. Primary ultrasound was performed in 372 patients; 61 of them did not undergo secondary ultrasound exam; thus, were excluded from the study.Three hundred eleven patients underwent both primary and secondary ultrasound exams. One hundred and two of all patients were evaluated by contrast enhanced CT scan and 31 underwent laparotomy. The sensitivity of ultrasound exam in detecting intraperitoneal fluid significantly increased from 70.7% for the primary exam to 92.7% for the secondary exam. Examining the interloop space significantly improved the sensitivity of ultrasonography in both primary (from 36.6% to 70.7%) and secondary (from 65.9% to 92.7%) exams. Performing a secondary ultrasound exam in stable blunt abdominal trauma patients and adding interloop space scan to the routine FAST exam significantly increases the sensitivity of ultrasound in detecting intraperitoneal free fluid

  20. Emergency department repair of blunt right atrial rupture utilizing cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Samuel P. Carmichael

    2017-12-01

    Full Text Available Blunt cardiac injury (BCI with free wall rupture carries a high risk of pre-hospital death. Cardiopulmonary bypass (CPB has been utilized as a bridge to repair of cardiac lesions in select patients. We present an interesting case of emergency department repair of right atrial rupture with cardiopulmonary bypass.

  1. Successful Kidney and Lung Transplantation From a Deceased Donor With Blunt Abdominal Trauma and Intestinal Perforation

    NARCIS (Netherlands)

    van Smaalen, Tim C.; Krikke, Christina; Haveman, Jan Willem; van Heurn, L. W. Ernest

    2016-01-01

    The number of organ donors is limited by many contraindications for donation and poor quality of potential organ donors. Abdominal infection is a generally accepted contraindication for donation of abdominal organs. We present a 43-year-old man with lethal brain injury, blunt abdominal trauma, and

  2. ORIGINAL ARTICLE FAST as a predictor of clinical outcome in blunt ...

    African Journals Online (AJOL)

    ORIGINAL ARTICLE. Introduction. Peer-reviewed literature demonstrates an increasing trend of support for focused abdominal sonography for trauma (FAST) in the setting of blunt trauma. It is used as the initial screening tool to detect the presence of intra-abdominal free fluid and to indirectly confirm abdominal injury as the ...

  3. Scapular Fractures in Blunt Chest Trauma – Self-Experience Study

    Directory of Open Access Journals (Sweden)

    Tabet A. Al-Sadek

    2016-11-01

    CONCLUSIONS:The study confirms the role of scapular fractures as a marker for the severity of the chest trauma (based on the number of associated thoracic injuries, but doesn’t present scapular fractures as an indicator for high mortality in blunt chest trauma patients.

  4. Accuracy of chest radiography versus chest computed tomography in hemodynamically stable patients with blunt chest trauma

    Directory of Open Access Journals (Sweden)

    Chardoli Mojtaba

    2013-12-01

    Full Text Available 【Abstract】 Objective: Thoracic injuries are respon- sible for 25% of deaths of blunt traumas. Chest X-ray (CXR is the first diagnostic method in patients with blunt trauma. The aim of this study was to detect the accuracy of CXR versus chest computed tomograpgy (CT in hemodynami- cally stable patients with blunt chest trauma. Methods: Study was conducted at the emergency department of Sina Hospital from March 2011 to March 2012. Hemodynamically stable patients with at least 16 years of age who had blunt chest trauma were included. All patients underwent the same diagnostic protocol which consisted of physical examination, CXR and CT scan respectively. Results: Two hundreds patients (84% male and 16% female were included with a mean age of (37.9±13.7 years. Chin J Traumatol 2013;16(6:351-354 Rib fracture was the most common finding of CXR (12.5% and CT scan (25.5%. The sensitivity of CXR for hemothorax, thoracolumbar vertebra fractures and rib fractures were 20%, 49% and 49%, respectively. Pneumothorax, foreign body, emphysema, pulmonary contusion, liver hematoma and ster- num fracture were not diagnosed with CXR alone. Conclusion: Applying CT scan as the first-line diag- nostic modality in hemodynamically stable patients with blunt chest trauma can detect pathologies which may change management and outcome. Key words: Radiography; Thoracic injuries; Tomography, X-ray computed

  5. Intrathoracic Kidney after Blunt Abdominal Trauma: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Fikret Halis

    2015-01-01

    Full Text Available Abdominal trauma is responsible for most genitourinary injuries. The incidence of renal artery injury and intrathoracic kidney is quite low in patients who present with blunt trauma experiencing damage. There are four defined etiologies for intrathoracic kidney, which include real intrathoracic ectopic kidney, eventration of the diaphragm, congenital diaphragmatic herniation, and traumatic diaphragmatic rupture. The traumatic intrathoracic kidney is an extremely rare case. We presented intrathoracic kidney case after traumatic posterior diaphragmatic rupture.

  6. Aortic Annular Enlargement during Aortic Valve Replacement

    Directory of Open Access Journals (Sweden)

    Selman Dumani

    2016-09-01

    Full Text Available In the surgery of aortic valve replacement is always attempted, as much as possible, to implant the larger prosthesis with the mains goals to enhance the potential benefits, to minimise transvalvular gradient, decrease left ventricular size and avoid the phenomenon of patient-prosthesis mismatch. Implantation of an ideal prosthesis often it is not possible, due to a small aortic annulus. A variety of aortic annulus enlargement techniques is reported to avoid patient-prosthesis mismatch. We present the case that has submitted four three times open heart surgery. We used Manouguian technique to enlarge aortic anulus with excellent results during the fourth time of surgery.

  7. Evisceration of the intestine following blunt force impact: Highlighting management

    Directory of Open Access Journals (Sweden)

    Rikki Singal

    2015-01-01

    Full Text Available Aims and objectives: Evisceration of the abdominal parts following traumatic injury with high velocity impact is a rare entity. We are reporting five cases of high velocity injury with different findings. Our objectives are to present the potential clinical impact of injury and requirement of early management. Materials and Methods: The present study was conducted in the Department of Surgery at Maharishi Markandeshwar Institute of Medical Sciences and Research, Maharishi Markandeshwar University, Mullana, from March 2010 to March 2013. A total of 150 cases were admitted, diagnosed with blunt and penetrating abdominal wall injury. We are presenting five cases diagnosed as eviscerated abdominal injury. Ultrasonography (USG and computed tomography was done which helped us in their management. Results: A total of five cases were admitted with evisceration of the abdominal parts. One case presented with a rare finding as the stomach and intestine were lying outside and on surgery, multiple perforations of the small intestine were seen. Ultrasonography and computed tomography (CT helped in the management of the patient. Conclusion: High velocity impact due to road side accidents can lead to severe abdominal organ injury or evisceration of the abdominal parts. It can cause morbidity and mortality, if not treated on time. USG and CT scans are the important diagnostic tools for diagnosing and preventing further complications. We came out with better prognosis as cases were operated on time. We treated the patients successfully without any mortality.

  8. Multidetector CT of blunt cervical spine trauma in adults.

    Science.gov (United States)

    Dreizin, David; Letzing, Michael; Sliker, Clint W; Chokshi, Falgun H; Bodanapally, Uttam; Mirvis, Stuart E; Quencer, Robert M; Munera, Felipe

    2014-01-01

    A number of new developments in cervical spine imaging have transpired since the introduction of 64-section computed tomographic (CT) scanners in 2004. An increasing body of evidence favors the use of multidetector CT as a stand-alone screening test for excluding cervical injuries in polytrauma patients with obtundation. A new grading scale that is based on CT and magnetic resonance (MR) imaging findings, the cervical spine Subaxial Injury Classification and Scoring (SLIC) system, is gaining acceptance among spine surgeons. Radiographic measurements described for the evaluation of craniocervical distraction injuries are now being reevaluated with the use of multidetector CT. Although most patients with blunt trauma are now treated nonsurgically, evolution in the understanding of spinal stability, as well as the development of new surgical techniques and hardware, has driven management strategies that are increasingly favorable toward surgical intervention. It is therefore essential that radiologists recognize findings that distinguish injuries with ligamentous instability or a high likelihood of nonfusion that require surgical stabilization from those that are classically stable and can be treated with a collar or halo vest alone. The purpose of this article is to review the spectrum of cervical spine injuries, from the craniocervical junction through the subaxial spine, and present the most widely used grading systems for each injury type. ©RSNA, 2014.

  9. Surgical repair of rupture of the membranous septum after blunt chest trauma.

    Science.gov (United States)

    Tarmiz, Amine; Lopez, Stéphane; Honton, Ben; Riu, Béatrice

    2011-01-01

    Rupture of the membranous septum is a very rare complication of blunt chest trauma. In this report, we describe a 22-year-old man who sustained multiple blunt trauma injuries during a motor vehicle accident. Rupture of the membranous septum was diagnosed 48 hours after the initial trauma and the defect was closed with Gore-Tex (W.L. Gore & Assoc, Flagstaff, AZ). However, the operation was complicated by complete atrioventricular block requiring implantation of a permanent DDD pacemaker. Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  10. Análise comparativa entre as lesões encontradas em motociclistas envolvidos em acidentes de trânsito e vítimas de outros mecanismos de trauma fechado Comparative analysis of injuries observed in motorcycle riders involved in traffic accidents and victims of other blunt trauma mechanisms

    Directory of Open Access Journals (Sweden)

    José Gustavo Parreira

    2012-02-01

    Full Text Available OBJETIVO: Realizar uma análise comparativa entre as lesões encontradas em motociclistas envolvidos em acidentes de trânsito e vítimas de outros mecanismos de trauma fechado. MÉTODOS: Análise dos protocolos (colhidos prospectivamente dos traumatizados com idade superior a 13 anos, admitidos de 10/06/2008 a 01/09/2009, vítimas de trauma fechado. Foram coletadas informações sobre mecanismo de trauma, dados vitais à admissão, exames complementares, lesões e tratamento. A estratificação da gravidade do trauma e das lesões foi realizada pelo cálculo dos índices de trauma: RTS, escala de coma de Glasgow (ECG, AIS, ISS e TRISS. Comparamos as variáveis entre os motociclistas (grupo A e os demais (grupo B. Consideramos graves as lesões com AIS > 3. Para a análise estatística, utilizamos os testes t de Student, Mann Whitney, qui-quadrado e Fisher, considerando p OBJECTIVE: To conduct a comparative analysis of the lesions found among motorcycle riders involved in traffic accidents and victims of other mechanisms of blunt trauma. METHODS: Analysis of data prospectively collected on protocols for trauma patients older than 13 years, admitted from 06/10/2008 to 09/01/2009, victims of blunt trauma. Data collected included trauma mechanism, vital signs at admission, laboratory tests, injuries, and treatment.Stratification of trauma and lesion severity was performed by calculating the trauma index: Glasgow Coma Scale (GCS, Revised Trauma Score (RTS, Abbreviated Injury Scale (AIS, Injury Severity Score (ISS and TRISS. We compared the variables between motorcycle riders (group A and the others (group B. Severe injuries were considered when AIS > 3. For statistical analysis, we used Student's t, Mann Whitney, chi-square and Fisher's test, with p < 0.05 considered statistically significant. RESULTS: The study included 3,783 blunt trauma victims, aged 14 to 99 years, of which 76.0% were males. The most frequent trauma mechanisms were accidents

  11. Mechanisms and Clinical Management of Ventricular Arrhythmias following Blunt Chest Trauma

    Directory of Open Access Journals (Sweden)

    Daniel H. Wolbrom

    2016-01-01

    Full Text Available Nonpenetrating, blunt chest trauma is a serious medical condition with varied clinical presentations and implications. This can be the result of a dense projectile during competitive and recreational sports but may also include other etiologies such as motor vehicle accidents or traumatic falls. In this setting, the manifestation of ventricular arrhythmias has been observed both acutely and chronically. This is based on two entirely separate mechanisms and etiologies requiring different treatments. Ventricular fibrillation can occur immediately after chest wall injury (commotio cordis and requires rapid defibrillation. Monomorphic ventricular tachycardia can develop in the chronic stage due to underlying structural heart disease long after blunt chest injury. The associated arrhythmogenic tissue may be complex and provides the necessary substrate to form a reentrant VT circuit. Ventricular tachycardia in the absence of overt structural heart disease appears to be focal in nature with rapid termination during ablation. Regardless of the VT mechanism, patients with recurrent episodes, despite antiarrhythmic medication in the chronic stage following blunt chest injury, are likely to require ablation to achieve VT control. This review article will describe the mechanisms, pathophysiology, and treatment of ventricular arrhythmias that occur in both the acute and chronic stages following blunt chest trauma.

  12. Predictors of paediatric injury mortality

    African Journals Online (AJOL)

    from falls, cuts, burns, road crashes, assaults (physical, including sexual), blunt injury, poisoning, drowning and near-drowning, gunshots, human or animal bites and nonspecific causes.3. Each patient was assessed and data on age, sex, social class, cause of injury, site of injury, symptoms and signs, radiological and other ...

  13. Peri-cardiac arrest following blunt bicycle handlebar trauma to the iliac vessels: management of a rare case.

    Science.gov (United States)

    Houston, Emma L; Chandrasekar, Ramasubramanyan

    2012-12-01

    Iliac vessel disruption following blunt trauma is an unusual presentation, particularly in the absence of an orthopaedic injury. We present the unique case of a 14-year-old boy who sustained a blunt bicycle handlebar impalement that resulted in complete transection of the external iliac artery and laceration of the external iliac vein, without a skeletal fracture. The patient deteriorated rapidly, entering hypovolaemic shock and peri-cardiac arrest at anaesthetic induction. Once haemodynamic stability was achieved, the lacerated external iliac vein was used to form an interposition graft to repair the external iliac artery. The rare occurrence and lack of familiarity with this injury, combined with the potential for fatal exsanguination if not swiftly diagnosed makes this case crucial to highlight. Blunt bicycle handlebar injury should carry a high suspicion of severe vascular compromise. If diagnosed this should be rapidly managed with aggressive resuscitation and revascularisation.

  14. Blunt trauma induced splenic blushes are not created equal

    Directory of Open Access Journals (Sweden)

    Burlew Clay

    2012-03-01

    Full Text Available Abstract Background Currently, evidence of contrast extravasation on computed tomography (CT scan is regarded as an indication for intervention in splenic injuries. In our experience, patients transferred from other institutions for angioembolization have often resolved the blush upon repeat imaging at our hospital. We hypothesized that not all splenic blushes require intervention. Methods During a 10-year period, we reviewed all patients transferred with blunt splenic injuries and contrast extravasation on initial postinjury CT scan. Results During the study period, 241 patients were referred for splenic injuries, of whom 16 had a contrast blush on initial CT imaging (88% men, mean age 35 ± 5, mean ISS 26 ± 3. Eight (50% patients were managed without angioembolization or operation. Comparing patients with and without intervention, there was a significant difference in admission heart rate (106 ± 9 vs 83 ± 6 and decline in hematocrit following transfer (5.3 ± 2.0 vs 1.0 ± 0.3, but not in injury grade (3.9 ± 0.2 vs 3.5 ± 0.3, systolic blood pressure (125 ± 10 vs 115 ± 6, or age (38.5 ± 8.2 vs 30.9 ± 4.7. Of the 8 observed patients, 3 underwent repeat imaging immediately upon arrival with resolution of the blush. In the intervention group, 4 patients had ongoing extravasation on repeat imaging, 2 patients underwent empiric embolization, and 2 patients underwent splenectomy for physiologic indications. Conclusions For blunt splenic trauma, evidence of contrast extravasation on initial CT imaging is not an absolute indication for intervention. A period of observation with repeat imaging could avoid costly, invasive interventions and their associated sequelae.

  15. Traumatic Abdominal Wall Hernia After a Blunt Trauma: A Case Report

    Directory of Open Access Journals (Sweden)

    Ersin Dumlu

    2014-06-01

    Full Text Available Traumatic abdominal wall hernia is a rare result of blunt abdominal traumas in adults. Altough the detection of the injuries of the abdominal organs is the priority in blunt traumas, abdominal wall defect may also occur in these patients. These hernias can go undetected due to preservation of the skin overlying the hernia defect. Traumatic abdominal wall hernias can have high morbidity and mortality rates due to incarceration and perforation of tubular hollow organs, especially if there is any delay. The possibility of traumatic hernia should always be considered in cases with serious blunt trauma. Computed Tomography (CT scan examinations should be performed routinely due to their high diagnostic value if trumatic hernia is suspected. In this report, a traumatic abdominal wall hernia patient who was treated by surgery has been presented with the review of the current literature.

  16. Isolated Avulsion of the Common Hepatic Duct from Blunt Abdominal Trauma

    Directory of Open Access Journals (Sweden)

    Victor W. Wong

    2012-01-01

    Full Text Available Isolated extrahepatic biliary tract injury following blunt abdominal trauma is rare. The underlying pathogenic mechanisms remain obscure, but include shear and/or compression forces on the biliary system. Associated morbidity rates are high and largely the result of delays in diagnosis. Imaging modalities commonly employed for diagnosis include ultrasonography, computed tomography, nuclear medicine, and magnetic resonance imaging. Percutaneous and endoscopic techniques have been used both for diagnosis and treatment. Treatment options are dictated by the stability of the patient and the extent of bile duct and concomitant injuries. In this paper, we discuss a case of isolated avulsion of the hepatic duct confluence following blunt trauma that was successfully managed with Roux-en-Y hepaticojejunostomy. To our knowledge, this specific injury pattern has not been previously reported.

  17. The usefulness of physical examination and laboratory data in pediatric patients with blunt abdominal trauma

    International Nuclear Information System (INIS)

    Muramori, Katsumi; Kondo, Tsuyoshi; Zaizen, Yoshio; Tsuno, Shinsuke

    2007-01-01

    To evaluate the usefulness of clinical and laboratory data in pediatric patients with abdominal blunt trauma, the case records of 43 pediatric cases with blunt trauma who were admitted to our hospital were reviewed retrospectively. Among these patients, 23 were determined to have intraabdominal injury. Abdominal physical examination was not statistically identified to be a predictor of intraabdominal injury, however, the hematocrit and serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) values were significantly aberrant in these cases. Furthermore, the mean AST and ALT values in the non-hepatic injury cases were also apt to be higher than those in the no-injury group. These findings suggested that the serum AST and ALT may be possible predictors of intraabdominal injury, not only that restricted to the liver. Additionally, in our cases, abdominal CT examination was more diagnostic than ultrasound examination. Accordingly, in cases of pediatric abdominal blunt trauma with aberrant serum values of the liver transaminases, CT san should be performed electively. (author)

  18. Obesity and increased mortality in blunt trauma.

    Science.gov (United States)

    Choban, P S; Weireter, L J; Maynes, C

    1991-09-01

    To determine the effect of admission body weight on blunt trauma victims, a chart review of all patients greater than 12 years of age admitted to Sentara Norfolk General Hospital between January 1 and July 31, 1987 was undertaken. The charts of 351 patients were reviewed; 184 records contained admission height and weight. These 184 patients made up the study group and age, gender, injuries, Injury Severity Score (ISS), ventilator days (VD), complications, length of stay (LOS), and outcome were noted. Body Mass Index (BMI) (weight (kg)/(height(m))2, was calculated for each patient. The average ISS was 21.87 (range, 1-66) and the average BMI was 25.15 kg/m2 (range, 16-46 kg/m2). The overall mortality for the population was 9%. The population was grouped according to BMI: average (less than 27 kg/m2), overweight (27-31 kg/m2), and severely overweight (greater than 31 kg/m2). The mortality of 5.0% and 8.0% in the average and overweight groups was not different. The severely overweight group had a higher mortality at 42.1% compared with the other two groups (p less than 0.0001). The groups did not differ in age, ISS, LOS, nor VD. Age, BMI, and ISS were subjected to regression analysis. By this method BMI and ISS were independent determinants of outcome (p less than 0.0001). There was an increase in complications, mainly pulmonary problems, in the SO group (p less than 0.05). The three groups were subdivided into survivors and nonsurvivors. The nonsurvivors had a longer average LOS at 26.6 days compared with nonsurvivors in the overweight (5.0 days) or severely overweight (8.62 days) groups (p less than 0.007). The severely group was characterized by a rapid deterioration and demise that was unresponsive to intervention. ISS did not differ among nonsuvivors. Among survivors the severely overweight group had a lower ISS, 9.73. This was different from the overweight group (21.57) and from the average group (20.21) (p less than 0.04).

  19. Blunt traumatic pericardial rupture and cardiac herniation with a penetrating twist: two case reports

    Directory of Open Access Journals (Sweden)

    Galloway Robert

    2009-12-01

    Full Text Available Abstract Background Blunt Traumatic Pericardial Rupture (BTPR with resulting cardiac herniation following chest trauma is an unusual and often fatal condition. Although there has been a multitude of case reports of this condition in past literature, the recurring theme is that of a missed injury. Its occurrence in severe blunt trauma is in the order of 0.4%. It is an injury that frequently results in pre/early hospital death and diagnosis at autopsy, probably owing to a combination of diagnostic difficulties, lack of familiarity and associated polytrauma. Of the patients who survive to hospital attendance, the mortality rate is in the order of 57-64%. Methods We present two survivors of BTPR and cardiac herniation, one with a delayed penetrating cardiac injury secondary to rib fractures. With these two cases and literature review, we hope to provide a greater awareness of this injury Conclusion BTPR and cardiac herniation is a complex and often fatal injury that usually presents under the umbrella of polytrauma. Clinicians must maintain a high index of suspicion for BTPR but, even then, the diagnosis is fraught with difficulty. In blunt chest trauma, patients should be considered high risk for BTPR when presenting with: Cardiovascular instability with no obvious cause Prominent or displaced cardiac silhouette and asymmetrical large volume pneumopericardium Potentially, with increasing awareness of the injury and improved use and availability of imaging modalities, the survival rates will improve and cardiac Herniation could even be considered the 5th H of reversible causes of blunt traumatic PEA arrest.

  20. [External ureteral injuries].

    Science.gov (United States)

    Asali, Murad G; Romanowsky, Igor; Kaneti, Jacob

    2007-09-01

    Traumatic ureteral injuries are quite uncommon. Penetrating and non-blunt trauma are the most common cause of ureteral injuries. Most of the blunt ureteral injuries described in the literature are case reports. Simultaneous bilateral ureteral injury is extremely rare. In homodynamic stable patients imaging studies should be conducted when there is suspicion of urinary tract injury. Abdominal computerized tomography with contrast injection and delayed scans are the gold standard for staging such injuries. Excretory urography may be used when computerized tomography is not feasible. When both of these imaging studies are not diagnostic and there is still a high suspicion of injury, a retrograde pyelography would be the next imaging study option. Partial ureteral transection can be managed with ureteral stent placement. Complete ureteral transection and some grade III injuries should be explored and repaired with debridement, placement of ureteral stent and tension-free anastomosis of healthy ureteral ends with absorbable stitches and omental or peritoneal wrap. The type of anastomosis depends on the height of the ureteral injury and whether the contralateral ureter is existent and with no diseases. A high index of suspicion is needed in diagnosing ureteral injury in patients with blunt or penetrating trauma. Delay in diagnosis or inappropriate treatment would lead to serious immediate and delayed complications, from mild hematoma to abscess, sepsis, strictures, obstructive nephropathy, and renal unit loss.

  1. Criteria for the selective use of chest computed tomography in blunt trauma patients

    International Nuclear Information System (INIS)

    Brink, Monique; Dekker, Helena M.; Kool, Digna R.; Blickman, Johan G.; Deunk, Jaap; Edwards, Michael J.R.; Vugt, Arie B. van; Kuijk, Cornelis van

    2010-01-01

    The purpose of this study was to derive parameters that predict which high-energy blunt trauma patients should undergo computed tomography (CT) for detection of chest injury. This observational study prospectively included consecutive patients (≥16 years old) who underwent multidetector CT of the chest after a high-energy mechanism of blunt trauma in one trauma centre. We included 1,047 patients (median age, 37; 70% male), of whom 508 had chest injuries identified by CT. Using logistic regression, we identified nine predictors of chest injury presence on CT (age ≥55 years, abnormal chest physical examination, altered sensorium, abnormal thoracic spine physical examination, abnormal chest conventional radiography (CR), abnormal thoracic spine CR, abnormal pelvic CR or abdominal ultrasound, base excess <-3 mmol/l and haemoglobin <6 mmol/l). Of 855 patients with ≥1 positive predictors, 484 had injury on CT (95% of all 508 patients with injury). Of all 192 patients with no positive predictor, 24 (13%) had chest injury, of whom 4 (2%) had injuries that were considered clinically relevant. Omission of CT in patients without any positive predictor could reduce imaging frequency by 18%, while most clinically relevant chest injuries remain adequately detected. (orig.)

  2. Flexion/extension cervical spine views in blunt cervical

    Directory of Open Access Journals (Sweden)

    Nasir Sadaf

    2012-06-01

    Full Text Available 【Abstract】Objective: To examine the contribution of flexion and extension radiographs in the evaluation of ligamentous injury in awake adults with acute blunt cervical spine trauma, who show loss of cervical lordosis and neck pain. Methods: All patients who presented to our emer-gency department following blunt trauma were enrolled in this study, except those with schiwora, neurological defi-cits or fracture demonstrated on cross-table cervical spine X-rays, and those who were either obtunded or presented after cervical spine surgery. Adequacy of flexion and exten-sion views was checked by the neurosurgery and radiology team members. All these patients underwent cross-table cervical spine view followed by flexion/extension views based on the loss of lordosis on cross-table imaging and the presence of neck pain. Results: A total of 200 cases were reviewed, of whom 90 (45% underwent repeat X-rays because of either inadequate exposure or limited motion. None of the patients with loss of lordosis on cross-table view had positive flexion and extension views of cervical spine for instability. Conclusions: Our results show that in patients who underwent acute radiographic evaluation of blunt cervical spine trauma, flexion and extension views of the cervical spine are unlikely to yield positive results in the presence of axial neck pain and/or loss of cervical lordosis. We can also hypothesize that performing flexion and extension views will be more useful once the acute neck pain has settled. Key words: X-rays; Cervical vertebrae; Lordosis

  3. Management of blunt pancreatic trauma in children: Review of the National Trauma Data Bank☆,☆☆

    Science.gov (United States)

    Englum, Brian R.; Gulack, Brian C.; Rice, Henry E.; Scarborough, John E.; Adibe, Obinna O.

    2016-01-01

    Purpose This study aims to examine the current management strategies and outcomes after blunt pancreatic trauma in children using a national patient registry. Methods Using the National Trauma Data Bank (NTDB) from 2007–2011, we identified all patients ≤18 years old who suffered blunt pancreatic trauma. Patients were categorized as undergoing nonoperative pancreatic management (no abdominal operation, abdominal operation without pancreatic-specific procedure, or pancreatic drainage alone) or operative pancreatic management (pancreatic resection/repair). Patient characteristics, operative details, clinical outcomes, and factors associated with operative management were examined. Results Of 610,402 pediatric cases in the NTDB, 1653 children (0.3%) had blunt pancreatic injury and 674 had information on specific location of pancreatic injury. Of these 674 cases, 514 (76.3%) underwent nonoperative pancreatic management. The groups were similar in age, gender, and race; however, pancreatic injury grade > 3, moderate to severe injury severity, and bicycle accidents were associated with operative management in multivariable analysis. Children with pancreatic head injuries or GCS motor score undergo pancreatic operation. Overall morbidity and mortality rates were 26.5% and 5.3%, respectively. Most outcomes were similar between treatment groups, including mortality (2.5% vs. 6.7% in operative vs. nonoperative cohorts respectively; p = 0.07). Conclusion Although rare, blunt pancreatic trauma in children continues to be a morbid injury. In the largest analysis of blunt pancreatic trauma in children, we provide data on which to base future prospective studies. Operative management of pancreatic trauma occurs most often in children with distal ductal injuries, suggesting that prospective studies may want to focus on this group. PMID:27577183

  4. Value of Multidetector Computed Tomography in Assessing Blunt Multitrauma Patients

    Energy Technology Data Exchange (ETDEWEB)

    Ahvenjaervi, L.; Mattila, L.; Ojala, R.; Tervonen, O. [Oulu Univ. Hospital (Finland). Dept. of Diagnostic Radiology

    2005-04-01

    Purpose: To find out if multidetector computed tomography (MDCT), using a dedicated trauma protocol, provides sufficient diagnostic information of the injuries of blunt multitrauma patients to enable the planning of treatment for all body compartments. Material and Methods: One-hundred-and-thirty-three patients exposed to high-energy trauma were referred and scanned with the standardized MDCT multitrauma protocol. The imaging protocol consisted of axial scanning of the head and helical scanning of the facial bones, cervical spine, thorax, abdomen, and pelvis. The scanning times were 12 s for the head, 19-21 s for the facial bones and cervical spine (1 mm collimation), and 32-50 s for the thorax, abdomen, and pelvis (2 mm collimation). One-hundred-and-forty milliliters of non-iodinated contrast material (300 mg I/ml) was administered intravenously at 3 ml/s. Results: Ninety-nine of the patients (74%) had at least one finding consistent with trauma. The most frequent findings were in the thorax in 58 patients (44%). Nineteen false-negative findings and two false-positive findings were made. The overall sensitivity of MDCT was 94%, specificity 100%, and accuracy 97%. Conclusion: MDCT is accurate in the assessment of blunt multitrauma patients. The decision to treat the patient can be made on the basis of MDCT with a reasonable level of certainty.

  5. Acute aortic syndromes: current status.

    Science.gov (United States)

    Ridge, Carole A; Litmanovich, Diana E

    2015-05-01

    The term acute aortic syndrome comprises aortic dissection, intramural hematoma, and penetrating atherosclerotic ulcer. The most recent developments in acute aortic syndromes include (1) a change in the mindset that each entity is pathologically distinct, with a shift toward considering the acute aortic syndromes as points along a spectrum of aortic disease, (2) the optimization of aortic imaging quality and radiation dose, and (3) surgical or endovascular management. This review article focuses on how these developments pertain to thoracic radiologists.

  6. Primary metastasizing aortic endothelioma.

    Science.gov (United States)

    Schmid, E; Port, S J; Carroll, R M; Friedman, N B

    1984-10-01

    An instance of malignant endothelioma, primary in the aorta, metastasizing to intestine and bone, is reported. The aortic tumor was successfully resected. The unexpected finding of a large hepatic growth at autopsy raised the possibility that the aortic neoplasm was a metastasis. Histochemical, immunologic, and ultrastructural studies supported the diagnosis of an endothelial neoplasm. Although a number of malignant aortic and large vessel tumors have been reported, only four previous instances appear to be endotheliomatous.

  7. Aortic valve replacement

    DEFF Research Database (Denmark)

    Kapetanakis, Emmanouil I; Athanasiou, Thanos; Mestres, Carlos A

    2008-01-01

    BACKGROUND AND AIMS OF THE STUDY: Prompted by anecdotal evidence and observations by surgeons, an investigation was undertaken into the potential differences in implanted aortic valve prosthesis sizes, during aortic valve replacement (AVR) procedures, between northern and southern European...... assigned to the 'small' aortic size subset. Effective orifice area indices were calculated for all patients to assess the geographic distribution of patient-prosthesis mismatch. Univariable and multivariable logistic regression analyses adjusting for possible confounding variables were performed. RESULTS...

  8. Blunt impact as deterrent: human approach-avoidance behaviors and other stress responses studied within a paintball gaming context

    Science.gov (United States)

    Short, Kenneth R.; Bergen, Michael T.; DeMarco, Robert M.; Chua, Florence B.; Servatius, Richard J.

    2006-05-01

    Blunt impact munitions are often used by civilian law enforcement and in military operations on urban terrain (MOUT) missions to dissuade individuals and groups from approaching valued assets. The use of blunt munitions (rubber-ball or sponge) is predicated on their effectiveness as aversive stimuli; the effectiveness is weighed against the risk of serious injury or death. However, little empirical evidence supports effectiveness. Here, we use a paintball gaming context to study the effects of blunt impact on performance and approach behaviors. Volunteers individually traversed a course in which targets offer the opportunity to gain for accuracy. While completing the targeting task, subjects were bombarded with paintballs, which progressively became more numerous and the impact more intense as the subjects neared goal locations. Initial data suggest that over 30 blunt impacts by paintballs delivered at 280 ft/sec over 30 to 100 ft are insufficient to overcome intrinsic and extrinsic approach motivations or impair targeting or advance performance in an overwhelming majority of subjects. Our apparent ceiling effect was surprising. A sub-comparison of the few subjects who stopped the game before the end with those who did not suggests that personality factors influence the effectiveness of blunt impact as a deterrent. While paintballs differ from traditional blunt impact munitions on a number of physical characteristics, impact that was sufficient to repeatedly bruise volunteers was not an effective deterrent.

  9. Imaging of blunt arterial trauma of the upper extremity in children

    Energy Technology Data Exchange (ETDEWEB)

    Hodina, M.; Gudinchet, F.; Schnyder, P. [Depts. of Diagnostic and Interventional Radiology, University Hospital (CHUV), Lausanne (Switzerland); Reinberg, O. [Dept. of Paediatric Surgery, University Hospital (CHUV), Lausanne (Switzerland)

    2001-08-01

    We report four patients with blunt arterial trauma of the upper limb following unusual mechanisms of injury in two patients (one fell on the handlebars of his bicycle, the second was crushed by a moving lawn mower) and due to bicycle accidents in two further patients. The use of digital subtraction angiography (DSA) in all patients, together with colour Doppler imaging (CDI) in one patient, provided optimum preoperative identification and localisation of the arterial lesions. (orig.)

  10. Blunt bowel and mesenteric trauma: role of clinical signs along with CT findings in patients' management.

    Science.gov (United States)

    Firetto, Maria Cristina; Sala, Francesco; Petrini, Marcello; Lemos, Alessandro A; Canini, Tiberio; Magnone, Stefano; Fornoni, Gianluca; Cortinovis, Ivan; Sironi, Sandro; Biondetti, Pietro R

    2018-04-27

    Bowel and/or mesentery injuries represent the third most common injury among patients with blunt abdominal trauma. Delayed diagnosis increases morbidity and mortality. The aim of our study was to evaluate the role of clinical signs along with CT findings as predictors of early surgical repair. Between March 2014 and February 2017, charts and CT scans of consecutive patients treated for blunt abdominal trauma in two different trauma centers were reread by two experienced radiologists. We included all adult patients who underwent contrast-enhanced CT of the abdomen and pelvis with CT findings of blunt bowel and/or mesenteric injury (BBMI). We divided CT findings into two groups: the first included three highly specific CT signs and the second included six less specific CT signs indicated as "minor CT findings." The presence of abdominal guarding and/or abdominal pain was considered as "clinical signs." Reference standards included surgically proven BBMI and clinical follow-up. Association was evaluated by the chi-square test. A logistic regression model was used to estimate odds ratio (OR) and confidence intervals (CI). Thirty-four (4.1%) out of 831 patients who sustained blunt abdominal trauma had BBMI at CT. Twenty-one out of thirty-four patients (61.8%) underwent surgical repair; the remaining 13 were treated conservatively. Free fluid had a significant statistical association with surgery (p = 0.0044). The presence of three or more minor CT findings was statistically associated with surgery (OR = 8.1; 95% CI, 1.2-53.7). Abdominal guarding along with bowel wall discontinuity and extraluminal air had the highest positive predictive value (100 and 83.3%, respectively). In patients without solid organ injury (SOI), the presence of free fluid along with abdominal guarding and three or more "minor CT findings" is a significant predictor of early surgical repair. The association of bowel wall discontinuity with extraluminal air warrants exploratory laparotomy.

  11. The Use of CT Scan in Hemodynamically Stable Children with Blunt Abdominal Trauma : Look before You Leap

    NARCIS (Netherlands)

    Nellensteijn, David R.; Greuter, Marcel J.; el Moumni, Moustafa; Hulscher, Jan B.

    We set out to determine the diagnostic value of computed tomographic (CT) scans in relation to the radiation dose, tumor incidence, and tumor mortality by radiation for hemodynamically stable pediatric patients with blunt abdominal injury. We focused on the changes in management because of new

  12. Dual-source computed tomography may define cardiac contusion in patients with blunt chest trauma in ED.

    Science.gov (United States)

    Emet, Mucahit; Saritemur, Murat; Altuntas, Bayram; Karaca, Leyla; Sari, Fatih Mehmet; Bilgin, Yasin; Kantarci, Mecit; Aslan, Sahin

    2015-06-01

    We report a 20-year-old woman with blunt chest trauma because of a motor vehicle injury who has traumatic asphyxia and hypotension. The diagnosis of blunt cardiac injury was put by using dual-energy computed tomography in the emergency department because other laboratory and imaging modalities were useless. After hospitalization in intensive care unit, she was treated with supportive and antiedema therapy. The patient was extubated on the fifth day and discharged on the ninth day without any sequel. Coexistence of traumatic asphyxia with blunt cardiac injury is rare. Several imaging techniques such as transthoracic and transesophageal echocardiography, contrast-enhanced multislice thorax computed tomography or initial electrocardiogram, and troponin I levels are used to detect the myocardial damage, but diagnostic capability is low. Dual-energy computed tomography is a promising new technology with the ability of defining blunt cardiac injuries and may have an indication in the emergency setting in patients with hemodynamic instability to rule in traumatic cardiac complications especially when electrocardiogram and transthoracic echocardiography are useless in the emergency department.

  13. Trauma attenuating backing improves protection against behind armor blunt trauma.

    Science.gov (United States)

    Sondén, Anders; Rocksén, David; Riddez, Louis; Davidsson, Johan; Persson, Jonas K; Gryth, Dan; Bursell, Jenny; Arborelius, Ulf P

    2009-12-01

    Body armor is used by military personnel, police officers, and security guards to protect them from fatal gunshot injuries to the thorax. The protection against high-velocity weapons may, however, be insufficient. Complementary trauma attenuating backings (TAB) have been suggested to prevent morbidity and mortality in high-velocity weapon trauma. Twenty-four Swedish landrace pigs, protected by a ceramid/aramid body armor without (n = 12) or with TAB (n = 12) were shot with a standard 7.62-mm assault rifle. Morphologic injuries, cardiorespiratory, and electroencephalogram changes as well as physical parameters were registered. The bullet impact caused a reproducible behind armor blunt trauma (BABT) in both the groups. The TAB significantly decreased size of the lung contusion and prevented hemoptysis. The postimpact apnea, desaturation, hypotension, and rise in pulmonary artery pressure were significantly attenuated in the TAB group. Moreover, TAB reduced transient peak pressures in thorax by 91%. Our results indicate that ordinary body armor should be complemented by a TAB to prevent thoracic injuries when the threat is high-velocity weapons.

  14. Aortic valve surgery - open

    Science.gov (United States)

    ... while you are connected to this machine. This machine does the work of your heart while your heart is stopped. If your aortic valve is too damaged, you will need a new valve. This is called replacement surgery. Your surgeon will remove your aortic valve ...

  15. Imaging in aortic dissection

    International Nuclear Information System (INIS)

    Yu-Qing Liu, M.D.

    1995-01-01

    Aortic dissection (AD) is a catastrophic aortic disease. Imaging techniques play an invaluable role in the diagnostic evaluation and management of patients with AD. Major signs of AD with different imaging modalities are described in this article with a pertinent discussion on guidelines for the optimized approach of imaging study (13 refs.)

  16. Aortic arch malformations

    International Nuclear Information System (INIS)

    Kellenberger, Christian J.

    2010-01-01

    Although anomalies of the aortic arch and its branches are relatively uncommon malformations, they are often associated with congenital heart disease. Isolated lesions may be clinically significant when the airways are compromised by a vascular ring. In this article, the development and imaging appearance of the aortic arch system and its various malformations are reviewed. (orig.)

  17. [Traumatic aortic valve insufficiency].

    Science.gov (United States)

    Nascimento, J; Lemos, C; Marques, A M; Antunes, M J; Gonsalves, A

    1996-02-01

    The traumatic aortic valvular insufficiency (TAVI), through less frequent after a non-penetrating thoracic traumatism, is a serious entity with a very reserved prognosis. So it must be suspected in every patients with signs or symptoms of de novo heart failure post-traumatism. The transthoracic echocardiography and eventually transesophageal echocardiography have a fundamental role in the confirmation of the diagnosis. The clinical picture of traumatic aortic regurgitation is quickly evolutionary and the non efficacy of medical therapy has placed the valvular substitution surgery as the best succeeded treatment. With the advent of the aortic valve repairing surgery some TAVI cases has been submitted to this procedure. Nevertheless, the development of residual aortic regurgitation in these situations, usually requiring later valvular replacement surgery, make the aortic valvuloplasty a controversial surgical technique. The AA describe a recent clinical case of aortic regurgitation after a non-penetrant thoracic traumatism, discussing the aspects connected with physiopathology, diagnosis and therapy. The singularity of this case was based on the fact that the initial clinical diagnosis had been prejudiced by the context of a polytraumatism and there had been a time free of symptoms between the traumatism and the beginning of the symptomatology of left ventricular failure. Even though the identification of the problem allowed an intensive treatment of this serious situation that ended with the replacement of the aortic valve by mechanical aortic prosthesis, with the patient's total recovery.

  18. Diagnosis of an Inguinal Hernia after a Blunt Inguinal Trauma with an Intestinal Perforation

    Directory of Open Access Journals (Sweden)

    Farès Moustafa

    2014-01-01

    Full Text Available Introduction. Inguinal hernias are very common in men. A clinical exam can do the diagnosis easily. But bowel perforation inside an inguinal hernia caused by a directly blunt trauma is rare and can have important consequences. Up to now, there have been a few case reports that described blunt injury to the inguinal area causing traumatic perforation of the bowel in the inguinal hernia. Case Report. We present a case of a 45-year-old Eastern European man with a small perforation of ileal bowels and a peritonitis after direct blunt trauma to the inguinal hernia region, with no inguinal hernia known by the patient, and show how the diagnosis can be difficult. Conclusion. This case shows that external forces, that may seem too trivial to cause intraperitoneal injury, can cause significant injury when applied to a patient with a hernia and shows how a careful examination, with the help of an abdominal CT scan, is important even if the patient do not seem to have an inguinal hernia.

  19. An evidence based blunt trauma protocol

    NARCIS (Netherlands)

    Vugt, R. van; Kool, D.R.; Lubeek, S.F.K.; Dekker, H.M.; Brink, M.; Deunk, J.; Edwards, M.J.R.

    2013-01-01

    OBJECTIVE: Currently CT is rapidly implemented in the evaluation of trauma patients. In anticipation of a large international multicentre trial, this study's aim was to evaluate the clinical feasibility of a new diagnostic protocol, used for the primary radiological evaluation in adult blunt

  20. Tetanus after blunt lawn mower trauma

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    Camilla Normand

    2015-01-01

    Full Text Available A patient presented with tetanus ten days after blunt trauma with a lawn mower. Our case describes the diagnosis and treatment of this patient with an infectious disease commonly seen in the developing world but rarely seen in the developed world.

  1. Bilateral ureteropelvic disruption following blunt abdominal trauma: Case report

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    Kikuchi Hiroko

    2011-07-01

    Full Text Available Abstract Background Ureteral injury occurs in less than 1% of blunt abdominal trauma cases, partly because the ureters are relatively well protected in the retroperitoneum. Bilateral ureteral injury is extremely rare, with only 10 previously reported cases. Diagnosis may be delayed if ureteric injury is not suspected, and delay of 36 hours or longer has been observed in more than 50% of patients with ureteric injury following abdominal trauma, leading to increased morbidity. Case presentation A 29-year-old man was involved in a highway motor vehicle collision and was ejected from the front passenger seat even though wearing a seatbelt. He was in a preshock state at the scene of the accident. An intravenous line and left thoracic drain were inserted, and he was transported to our hospital by helicopter. Whole-body, contrast-enhanced computed tomography (CT scan showed left diaphragmatic disruption, splenic injury, and a grade I injury to the left kidney with a retroperitoneal haematoma. He underwent emergency laparotomy. The left diaphragmatic and splenic injuries were repaired. Although a retroperitoneal haematoma was observed, his renal injury was treated conservatively because the haematoma was not expanding. In the intensive care unit, the patient's haemodynamic state was stable, but there was no urinary output for 9 hours after surgery. Anuresis prompted a review of the abdominal x-ray which had been performed after the contrast-enhanced CT. Leakage of contrast material from the ureteropelvic junctions was detected, and review of the repeat CT scan revealed contrast retention in the perirenal retroperitoneum bilaterally. He underwent cystoscopy and bilateral retrograde pyelography, which showed bilateral complete ureteral disruption, preventing placement of ureteral stents. Diagnostic laparotomy revealed complete disruption of the ureteropelvic junctions bilaterally. Double-J ureteral stents were placed bilaterally and ureteropelvic

  2. Screening for traumatic aortic tear with chest CT

    International Nuclear Information System (INIS)

    Raptopoulos, V.; Sheiman, R.G.; Phillips, D.A.; Davidoff, A.; Silva, W.

    1990-01-01

    This paper determines if chest CT can be used in the screening of traumatic aortic tear, using CT evidence of mediastinal fluid (presumably blood) as a criterion for aortography. Dynamic CT limited to the region of the aortic arch was performed in all patients undergoing abdominal CT because of blunt trauma. Over a period of 2 years, 131 such patients also had thoracic aortograms performed within 123 hours of CT. Traumatic tear of the aorta was identified in 10 patients; all had abnormal CT scans (evidence of fluid), but only eight had abnormal chest radiographs. Of the 121 patients with normal aortograms, 86 had normal and 35 had abnormal CT scans. The chest radiographs were normal in 18 and abnormal in 103. Comparing chest radiography with CT, there was no significant difference in sensitivity (80% vs 100%), but the specificity and accuracy of CT were significantly higher (71% vs 15% and 74% vs 20%, respectively)

  3. Delayed recurrent nerve paralysis following post-traumatic aortic pseudoaneurysm

    Directory of Open Access Journals (Sweden)

    Mesolella Massimo

    2016-01-01

    Full Text Available Blunt trauma to the neck or to the chest are increasingly observed in the emergency clinical practice. They usually follow motor vehicle accidents or may be work or sports related. A wide pattern of clinical presentation can be potentially encountered. We report the uncommon case of a patient who was referred to our observation presenting with hoarseness and disphagia. Twenty days before he had sustained a car accident with trauma to the chest, neck and the mandible. Laryngoscopy showed a left recurrent laryngeal nerve palsy. Further otolaryngo-logical examination showed no other abnormality. At CT and MR imaging a post-traumatic aortic pseudoaneurysm was revealed. The aortic pseudoaneurysm was consequently repaired by implantation of an endovascular stent graft under local anesthesia. The patient was discharged 10 days later. At 30-days follow-up laryngoscopy the left vocal cord palsy was completely resolved.

  4. Aortic ruptures in seat belt wearers.

    Science.gov (United States)

    Arajärvi, E; Santavirta, S; Tolonen, J

    1989-09-01

    Several investigations have indicated that rupture of the thoracic aorta is one of the leading causes of immediate death in victims of road traffic accidents. In Finland in 1983, 92% of front-seat passengers were seat belt wearers on highways and 82% in build-up areas. The mechanisms of rupture of the aorta have been intensively investigated, but the relationship between seat belt wearing and injury mechanisms leading to aortic rupture is still largely unknown. This study comprises 4169 fatally injured victims investigated by the Boards of Traffic Accident Investigation of Insurance Companies during the period 1972 to 1985. Chest injuries were recorded as the main cause of death in 1121 (26.9%) victims, 207 (5.0%) of those victims having worn a seat belt. Aortic ruptures were found at autopsy in 98 victims and the exact information of the location of the aortic tears was available in 68. For a control group, we analyzed 72 randomly chosen unbelted victims who had a fatal aortic rupture in similar accidents. The location of the aortic rupture in unbelted victims was more often in the ascending aorta, especially in drivers, whereas in seat belt wearers the distal descending aorta was statistically more often ruptured, especially in right-front passengers (p less than 0.05). The steering wheel predominated statistically as the part of the car estimated to have caused the injury in unbelted victims (37/72), and some interior part of the car was the most common cause of fatal thoracic impacts in seat belt wearers (48/68) (p less than 0.001). The mechanism of rupture of the aorta in the classic site just distal to the subclavian artery seems to be rapid deceleration, although complex body movements are also responsible in side impact collisions. The main mechanism leading to rupture of the ascending aorta seems to be severe blow to the bony thorax. This also often causes associated thoracic injuries, such as heart rupture and sternal fracture. Injuries in the ascending

  5. Circumferential ascending aortic strain and aortic stenosis.

    Science.gov (United States)

    Teixeira, Rogério; Moreira, Nádia; Baptista, Rui; Barbosa, António; Martins, Rui; Castro, Graça; Providência, Luís

    2013-07-01

    Two-dimensional speckle tracking (2D-ST) echocardiography for the measurement of circumferential ascending thoracic aortic strain (CAAS) in the context of aortic stenosis (AS) is not elucidated. Purpose This study assesses the thoracic ascending aortic deformation using 2D-ST echocardiography in AS patients. Population and methods Forty-five consecutive patients with an aortic valvular area (AVA) ≤0.85 cm(2)/m(2) were included. Regarding aortic deformation, the global peak CAAS was the parameter used, and an average of six segments of arterial wall deformation was calculated. The corrected CAAS was calculated as the global CAAS/pulse pressure (PP). Aortic stiffness (β2) index was assessed according to ln(Ps/Pd)/CAAS. The sample was stratified according to the stroke volume index (SVI) as: Group A (low flow, SVI ≤35 mL/m(2); n = 19) and Group B (normal flow, SVI >35 mL/m(2); n = 26). The mean age was 76.8 ± 10.3 years, 53.3% were male, the mean indexed AVA was 0.43 ± 0.15 cm(2)/m(2), and the mean CAAS was 6.3 ± 3.0%. The CAAS was predicted by SVI (β = 0.31, P < 0.01) and by valvulo-arterial impedance (Zva). The corrected CAAS was correlated with the M-mode guided aortic stiffness index (β1) (r = -0.39, P < 0.01), and was predicted by SVI, Zva, and systemic arterial compliance (β = 0.15, P < 0.01). The β2 index was significantly higher for the low-flow patients (16.1 ± 4.8 vs. 9.8 ± 5.3, P < 0.01), and was predicted by SVI (β -0.58, P < 0.01) and PP (β = 0.17, P < 0.01). Global CAAS was more accurate to predict low flow than Zva, systolic function and systemic vascular resistance. In patients with moderate-to-severe aortic stenosis, SVI and LV afterload-related variables were the most important determinants of 2S-ST global CAAS.

  6. Experimental blunt chest trauma-induced myocardial inflammation and alteration of gap-junction protein connexin 43.

    Directory of Open Access Journals (Sweden)

    Miriam Kalbitz

    Full Text Available Severe blunt chest trauma in humans is associated with high mortality rates. Whereas lung tissue damage and lung inflammation after blunt chest trauma have extensively been investigated, the traumatic and posttraumatic effects on the heart remain poorly understood. Therefore, the purpose of this study was to define cardiac injury patterns in an experimental blunt chest trauma model in rats.Experimental blunt chest trauma was induced by a blast wave in rats, with subsequent analysis of its effects on the heart. The animals were subjected either to a sham or trauma procedure. Systemic markers for cardiac injury were determined after 24 h and 5 days. Postmortem analysis of heart tissue addressed structural injury and inflammation 24 h and 5 days after trauma.Plasma levels of extracellular histones were elevated 24 h and 5 days after blunt chest trauma compared to sham-treated animals. In the heart, up-regulation of interleukin-1β 24 h after trauma and increased myeloperoxidase activity 24 h and 5 days after trauma were accompanied by reduced complement C5a receptor-1 expression 24 h after trauma. Histological analysis revealed extravasation of erythrocytes and immunohistochemical analysis alteration of the pattern of the gap-junction protein connexin 43. Furthermore, a slight reduction of α-actinin and desmin expression in cardiac tissue was found after trauma together with a minor increase in sarcoplasmatic/endoplasmatic reticlulum calcium-ATPase (SERCA expression.The clinically highly relevant rat model of blast wave-induced blunt chest trauma is associated with cardiac inflammation and structural alterations in cardiac tissue.

  7. Experimental blunt chest trauma-induced myocardial inflammation and alteration of gap-junction protein connexin 43.

    Science.gov (United States)

    Kalbitz, Miriam; Amann, Elisa Maria; Bosch, Belinda; Palmer, Annette; Schultze, Anke; Pressmar, Jochen; Weber, Birte; Wepler, Martin; Gebhard, Florian; Schrezenmeier, Hubert; Brenner, Rolf; Huber-Lang, Markus

    2017-01-01

    Severe blunt chest trauma in humans is associated with high mortality rates. Whereas lung tissue damage and lung inflammation after blunt chest trauma have extensively been investigated, the traumatic and posttraumatic effects on the heart remain poorly understood. Therefore, the purpose of this study was to define cardiac injury patterns in an experimental blunt chest trauma model in rats. Experimental blunt chest trauma was induced by a blast wave in rats, with subsequent analysis of its effects on the heart. The animals were subjected either to a sham or trauma procedure. Systemic markers for cardiac injury were determined after 24 h and 5 days. Postmortem analysis of heart tissue addressed structural injury and inflammation 24 h and 5 days after trauma. Plasma levels of extracellular histones were elevated 24 h and 5 days after blunt chest trauma compared to sham-treated animals. In the heart, up-regulation of interleukin-1β 24 h after trauma and increased myeloperoxidase activity 24 h and 5 days after trauma were accompanied by reduced complement C5a receptor-1 expression 24 h after trauma. Histological analysis revealed extravasation of erythrocytes and immunohistochemical analysis alteration of the pattern of the gap-junction protein connexin 43. Furthermore, a slight reduction of α-actinin and desmin expression in cardiac tissue was found after trauma together with a minor increase in sarcoplasmatic/endoplasmatic reticlulum calcium-ATPase (SERCA) expression. The clinically highly relevant rat model of blast wave-induced blunt chest trauma is associated with cardiac inflammation and structural alterations in cardiac tissue.

  8. Imaging of unilateral adrenal hemorrhages in patients after blunt abdominal trauma: Report of two cases

    Directory of Open Access Journals (Sweden)

    Asli Tanrivermis Sayit

    2017-02-01

    Full Text Available Adrenal hemorrhage following blunt abdominal trauma is extremely rare. Most of the lesions are unilateral and right sided. Although often asymptomatic, life-threatening adrenal insufficiency may develop in the bilateral adrenal gland hemorrhage. Isolated adrenal injuries are very rare. They are often associated with other organ injuries. The mortality rates of patients range from 7% to 32%. In this report, we present the computed tomography and magnetic resonance imaging findings of unilateral adrenal hemorrhages in two patients with a history of fall from a height.

  9. Blunt traumatic bronchial transection in a 28-month-old child

    Directory of Open Access Journals (Sweden)

    Sung Mi Hwang

    2014-01-01

    Full Text Available Tracheobronchial injury is uncommon in children, but may result in life-threatening conditions. We present a case of transection of the right intermediate bronchus, right middle lobe bronchus and right lower lobe bronchus in a 28-month-old child with blunt chest injury. The gold standard for diagnosis is tracheobronchoscopy, however, the bronchoscopy may not always be available for little children. For diagnosis in similar cases, a high index of suspicion should be needed based on symptoms, chest X-ray and computed tomography findings. In addition, anesthesiologists should be aware of this dangerous condition and must be fully prepared for rapid and appropriate management during operation.

  10. Evaluation of acute traumatic coagulopathy in dogs and cats following blunt force trauma.

    Science.gov (United States)

    Gottlieb, Dara L; Prittie, Jennifer; Buriko, Yekaterina; Lamb, Kenneth E

    2017-01-01

    To evaluate the presence of acute traumatic coagulopathy (ATC) in dogs and cats following blunt trauma and to relate coagulation variables with injury severity and admission variables. Prospective, single center, observational study from 2013 to 2014. Urban private referral hospital. Eighteen and 19 client-owned dogs and cats, respectively, sustaining blunt trauma within 8 hours of presentation without prior resuscitation; 17 healthy staff and client-owned control cats METHODS: Blood samples were collected upon presentation for measurement of blood gas, lactate, blood glucose, ionized calcium, PCV, total plasma protein, prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen, platelet count, and thromboelastography. ATC was diagnosed in 1 dog and 1 cat on presentation. Hypercoagulability was documented in 4/18 (22%) of dogs and 1/19 (5.3%) of cats. In dogs, prolongation of PT (P = 0.018), aPTT (P = 0.013) and decrease in maximum amplitude (MA) (P = 0.027) were significantly associated with injury severity as measured by the animal trauma triage (ATT) score. In cats, PT, aPTT, MA, and clot strength (G) were not associated with injury severity. In cats, increasing blood glucose and lactate were significantly associated with decreasing MA (P = 0.041, P = 0.031) and G (P = 0.014, P = 0.03). In both dogs (P = 0.002) and cats (P = 0.007), fibrinogen concentration was significantly correlated with G. ATC is rare in minimally injured dogs and cats following blunt trauma. In dogs, ATT score is significantly associated with PT, aPTT, and MA, suggesting an increased risk of ATC in more severely injured animals. ATT score does not appear to predict coagulopathies in cats. Future studies including more severely injured animals are warranted to better characterize coagulation changes associated with blunt trauma. © Veterinary Emergency and Critical Care Society 2016.

  11. Thoracic endovascular aortic repair migration and aortic elongation differentiated using dual reference point analysis.

    Science.gov (United States)

    Alberta, Hillary B; Takayama, Toshio; Panthofer, Annalise; Cambria, Richard P; Farber, Mark A; Jordan, William D; Matsumura, Jon S

    2018-02-01

    We evaluated images of patients undergoing a thoracic endovascular aortic repair procedure using two reference points as a means for differentiating stent graft migration from aortic elongation. Conventional standards define migration of a stent graft as an absolute change in the distance from the distal graft ring to a distal landmark ≥10 mm compared with a baseline measurement. Aortic elongation occurs over time in both healthy individuals and patients with aortic disease. Aortic elongation in patients with stent grafts may result in increased distal thoracic aortic lengths over time. False-positive stent graft migration would be defined when these patients meet the standard definition for migration, even if the stent has not moved in relation to the elongating aorta. This retrospective study evaluated the aortic length of 23 patients treated with the conformable GORE TAG thoracic endoprosthesis (W. L. Gore & Associates, Flagstaff, Ariz) in three clinical trials (dissection, traumatic injury, and aneurysm). Patients who met the standard definition for migration were selected. A standardized protocol was used to measure aortic centerline lengths, including the innominate artery (IA) to the most distal device ring, the IA to the celiac artery (CA), and the distal ring to the CA. Baseline lengths obtained from the first postoperative image were compared with length measurements obtained from the first interval at which they met the standard definition for migration. The conventional standards for migration using a single reference point were compared with the use of dual reference points. Of the 23 patients with endograft changes, 20 were deemed to have aortic elongation rather than true migration. The remaining three patients were deemed to have migration on the basis of the IA to distal ring position compared with the IA to CA length change. The IA to CA interval length change was markedly greater in those with elongation compared with migration (23.8 ± 8.4

  12. Severe blunt thoracic trauma: differences between adults and children in a level I trauma centre.

    Science.gov (United States)

    Skinner, D L; den Hollander, D; Laing, G L; Rodseth, R N; Muckart, D J J

    2015-01-01

    Trauma is a leading cause of death in the developing world. Blunt thoracic trauma represents a major burden of disease in both adults and children. Few studies have investigated the differences between these two patient groups. To compare mechanism of injury, presentation, management and outcome in children and adults with blunt thoracic trauma. Patients were identified from the database of the trauma intensive care unit at Inkosi Albert Luthuli Central Hospital, Durban, South Africa. Demographics and relevant data were extracted from a pre-existing database. Of 415 patients admitted to the unit, 331 (79.7%) were adults and 84 (20.2%) children aged injury severity score (ISS) was similar for both age groups (32 v. 34; p = 0.812). Adults had a higher lactate level at presentation (3.94 v. 2.60 mmol/L; p = 0.001). Of the children, 96.4% were injured in motor vehicle collisions, 75.0% as pedestrians. Compared with adults, children had significantly fewer rib fractures (20.2% v. 42.0%; p blunt cardiac injuries (BCIs) (9.5% v. 23.6%; p = 0.004), but sustained more lung contusions (79.8% v. 65.6%; p = 0.013). Mortality in children was significantly lower than in adults (16.7% v. 27.8%; p = 0.037). Thoracic injuries in children are the result of pedestrian collisions more often than in adults. They suffer fewer rib fractures and BCIs, but more lung contusions. Despite similar ISSs, children have significantly lower mortality than adults. More effort needs to be concentrated on child safety and preventing pedestrian injury.

  13. IDIOPATHIC NEONATAL AORTIC ARCH THROMBOSIS: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Ignazio Lofù

    2014-04-01

    Full Text Available Background: Neonatal aortic arch thrombosis is a rare but life threatening condition. A correct diagnosis and an appropriate therapeutic approach are fundamental to prevent death or severe injuries. Case presentation: we report a case of spontaneous aortic arch thrombosis in a term newborn, who presented with suggestive signs of aortic coarctation immediately after birth. Despite the initiation of anticoagulant therapy, a massive increase in size of thrombus with evidence of coronary involvement was noted. Thrombolytic treatment was performed with thrombus resolution. Death occurred after a few days due to widespread brain haemorrhage. Conclusion: To date, no definitive guidelines have been published for the treatment of neonatal aortic arch thrombosis, and only anecdotal reports are available. A multidisciplinary approach is fundamental in order to evaluate the risk:benefit ratio of proposed medical and surgical interventions. Further studies are needed to improve consensus evidence based guidelines and ensure appropriate approaches to this condition.

  14. Aortic Aneurysm Statistics

    Science.gov (United States)

    ... people with inherited connective tissue disorders, such as Marfan syndrome and Ehlers-Danlos syndrome, get thoracic aortic aneurysms. ... Smoking . Some inherited connective tissue disorders, such as Marfan syndrome and Ehlers-Danlos syndrome, can also increase your ...

  15. Aortic Valve Disease

    Science.gov (United States)

    ... It is then replaced with an artificial valve (prosthesis). There are two valve options for aortic valve ... place, the catheter will be withdrawn from your body through the original access point. Because not all ...

  16. The value of routine follow-up imaging in pediatric blunt liver trauma

    International Nuclear Information System (INIS)

    Navarro, O.; Babyn, P.S.; Pearl, R.H.

    2000-01-01

    Purpose. To evaluate the utility of routine follow-up computed tomography (CT) and/or ultrasound (US) scans in children with blunt hepatic trauma initially managed non-operatively. Materials and methods. Review of the records of 66 children with proven blunt liver injury on initial CT scan, who were initially managed non-operatively during the period January 1991 to December 1996. Follow-up CT and US studies were analyzed and correlated with clinical outcome. Results. Of the 66 children, 30 were not followed with any imaging study, 26 were followed with US only, 7 with CT only and 3 with US and CT. Disappearance of the liver lesion(s) was seen in 25 patients (range: 6 days - 14 months) and decrease in size was noted in 10. In one patient, who developed abdominal and right shoulder pain 10 days after presentation with subsequent hemoglobin drop, CT showed contrast medium extravasation into a hepatic hematoma from portal vein injury that required surgery. Conclusion. Our series suggests that in asymptomatic patients, US and CT follow-up studies do not provide the additional information needed for patient management. Therefore, we believe that in asymptomatic children with blunt hepatic trauma who are clinically stable, routine follow-up imaging studies are of very limited value. (orig.)

  17. Negative predictive value of cardiac troponin for predicting adverse cardiac events following blunt chest trauma.

    Science.gov (United States)

    Guild, Cameron S; deShazo, Matthew; Geraci, Stephen A

    2014-01-01

    Cardiac-specific troponins (Tns) are sensitive and specific markers of myocardial injury that have been shown to be predictive of outcomes in many cardiac and noncardiac conditions. We sought to determine whether normal cardiac Tn concentrations obtained during the first 24 hours following blunt chest trauma would predict good cardiac outcomes. A PubMed/MEDLINE search was performed to identify prospective studies in patients with blunt chest trauma in which serial cardiac TnT or TnI values were measured within 24 hours of admission and clinical outcomes assessed. Ten studies qualified for review. Studies that used the lower reference limit of Tn as the cutoff for cardiac injury showed 100% negative predictive value (NPV) for developing cardiac complications, whereas studies using higher Tn cutoffs showed wider variation in NPV (50%-98%). Cardiac Tn measured within 24 hours using the lower reference limit (LRL) as the cutoff appears to have excellent NPV for clinically significant adverse cardiac events. This could allow for early discharge after a 24-hour observation period in otherwise uncomplicated blunt chest trauma patients and avoid the need for more expensive cardiac imaging and additional resource utilization.

  18. Value of diagnostic and therapeutic laparoscopy for patients with blunt abdominal trauma: A 10-year medical center experience

    Science.gov (United States)

    Chen, Ying-Da; Chen, Shyr-Chyr

    2018-01-01

    Laparoscopy has been used for the diagnosis and treatment for hemodynamically stable patients with penetrating abdominal trauma. This study evaluated whether diagnostic and therapeutic laparoscopy can be used as effectively in select patients with blunt abdominal trauma. All hemodynamically stable patients undergoing operations for blunt abdominal trauma over a 10-year period (2006–2015) at a tertiary medical center were included. Patients undergoing laparotomy were categorized as group A. Patients who underwent laparoscopy were categorized as group B. The clinical outcomes of the 2 groups were compared. There were 139 patients in group A and 126 patients in group B. Group A patients were more severely injured (mean injury severity score of 23.3 vs. 18.9, P .05). Laparoscopy is a feasible and safe tool for the diagnosis and treatment of hemodynamically stable patients with blunt abdominal trauma who require surgery. PMID:29470527

  19. Cardiac Rupture of the Junction of the Right Atrium and Superior Vena Cava in Blunt Thoracic Trauma

    Directory of Open Access Journals (Sweden)

    Chun Sung Byun

    Full Text Available Cardiac rupture following blunt thoracic trauma is rarely encountered, since it commonly causes death at the scene. With advances in critical care, blunt cardiac rupture has been successfully treated with well-organized team approach including an emergency physician, anesthesiologist, and cardiac surgeon. We encountered a patient with blunt cardiac rupture of the junction of the superior vena cava and right atrium that extended 7 cm to the right ventricular junction. The patient was successfully resuscitated after a closed thoracostomy and pericardiocentesis with fluid loading. Cardiac injury was repaired via mid-sternotomy without cardiopulmonary bypass. The patient recovered without complications and was discharged on the 7th day after surgery.

  20. Thoracoabdominal Aortic Aneurysms

    Directory of Open Access Journals (Sweden)

    Ali Azizzadeh

    2008-09-01

    Full Text Available Over the last 50 years, significant progress has been made in the surgical repair of thoracoabdominal aortic aneurysms (TAAA.  Improvements in perioperative care and surgical techniques have resulted in reductions in complication and mortality rates. Adjunctive use of distal aortic perfusion and cerebrospinal fluid drainage has been especially helpful, reducing the incidence of neurological deficits to 2.4%. Current research is aimed at improving organ preservation. This review focuses on the current diagnosis and management of TAAA.

  1. Evaluation of leadership skills during the simulation education course for the initial management of blunt trauma.

    Science.gov (United States)

    Schott, Eric; Brautigam, Robert T; Smola, Jacqueline; Burns, Karyl J

    2012-04-01

    Leadership skills of senior residents, trauma fellows, and a nurse practitioner were assessed during simulation training for the initial management of blunt trauma. This was a pilot, observational study, that in addition to skill development and assessment also sought to determine the need for a dedicated leadership training course for surgical residents. The study evaluated the leadership skills and adherence to Advance Trauma Life Support (ATLS) guidelines of the team leaders during simulation training. The team leaders' performances on criteria regarding prearrival planning, critical actions based on ATLS, injury identification, patient management, and communication were evaluated for each of five blunt-trauma scenarios. Although there was a statistically significant increase in leadership skills for performing ATLS critical actions, P skills for team leadership willbe a worthwhile endeavor at our institution.

  2. Origin of the 44-mm behind-armor blunt trauma standard.

    Science.gov (United States)

    Hanlon, Erin; Gillich, Patrick

    2012-03-01

    A number of armed assaults on public officials occurred in the early 1970s, which prompted the Lightweight Soft Body Armor Program to develop modern, concealable, soft body armor. Methodology needed to be developed to (1) determine the effectiveness of the soft body armor to stop bullet penetration and (2) assess the potential injury from nonpenetrating blunt impacts to the body. Extensive research was performed under the program to develop methodologies to assess soft body armor, including behind-armor blunt trauma (BABT) evaluation. This methodology is still used today, and it has been applied extensively beyond the original intent. However, the origin of this methodology is not well understood by many researchers in the various fields in which it is being applied because the original documentation is difficult to obtain. Therefore, the purpose of this article is to provide a comprehensive review of the BABT to offer researchers information about its history and limitations.

  3. Axillary nerve palsy following blunt trauma to the shoulder region: a clinical and electrophysiological review.

    Science.gov (United States)

    Berry, H; Bril, V

    1982-01-01

    Although the commonest type of axillary nerve palsy occurs following shoulder dislocation on humeral fracture, another form is seen after blunt trauma to the shoulder region without associated fracture or dislocation. The former usually goes on to a full recovery whereas a failure to recover is common in the latter group. In our review of 13 patients with palsy after blunt shoulder trauma, seven patients showed minimal or no recovery of deltoid muscle function and six patients went on to complete or near complete recovery. Serial electromyographic examinations usually revealed the lesion to be in continuity although eventual clinical recovery was not satisfactory in a number of these patients. The mechanism of the palsy appeared to involve a stretch injury and this was confirmed at operation in two patients. Glenohumeral fixation was a troublesome complication which limited recovery of function in four patients. Further details of the type of trauma, clinical and electromyographic examination, assessment and management are discussed. Images PMID:7175526

  4. Case Report - AAST grade III pancreatic injury following blunt ...

    African Journals Online (AJOL)

    Abstract. Isolated pancreatic trauma with major pancreatic duct disruption is a rare finding; it can present with equivocal clinical signs. Serum amylase levels and diagnostic contrast-enhanced computed tomography can facilitate the diagnostic process.

  5. Pediatric aortoiliac injury following blunt abdominal trauma: A case report

    Directory of Open Access Journals (Sweden)

    Edward Daniele

    2017-01-01

    Conclusion: Bovine pericardium is a strong and stable acellular collagenous material with the potential to accelerate endothelialization and tissue regeneration. This remains an interesting field of research as stenosis and pseudo-coarction data have yet to be determined.

  6. Cardiac changes after simulated behind armor blunt trauma or impact of nonlethal kinetic projectile ammunition.

    Science.gov (United States)

    Kunz, Sebastian N; Arborelius, Ulf P; Gryth, Dan; Sonden, Anders; Gustavsson, Jenny; Wangyal, Tashi; Svensson, Leif; Rocksén, David

    2011-11-01

    Cardiac-related injuries caused by blunt chest trauma remain a severe problem. The aim of this study was to investigate pathophysiological changes in the heart that might arise after behind armor blunt trauma or impacts of nonlethal projectiles. Sixteen pigs were shot directly at the sternum with "Sponge Round eXact I Mpact" (nonlethal ammunition; diameter 40 mm and weight 28 g) or hard-plastic ammunition (diameter 65 mm and weight 58 g) to simulate behind armor blunt trauma. To evaluate the influence of the shot location, seven additional pigs where exposed to an oblique heart shot. Physiologic parameters, electrocardiography, echocardiogram, the biochemical marker troponin I (TnI), and myocardial injuries were analyzed. Nonlethal kinetic projectiles (101-108 m/s; 143-163 J) did not cause significant pathophysiological changes. Five of 18 pigs shot with 65-mm plastic projectiles (99-133 m/s; 284-513 J) to the front or side of the thorax died directly after the shot. No major physiologic changes could be observed in surviving animals. Animals shot with an oblique heart shot (99-106 m/s; 284-326 J) demonstrated a small, but significant decrease in saturation. Energy levels over 300 J caused increased TnI and myocardial damages in most of the pigs. This study indicates that nonlethal kinetic projectiles "eXact iMpact" does not cause heart-related damage under the examined conditions. On impact, sudden heart arrest may occur independently from the cardiac's electrical cycle. The cardiac enzyme, TnI, can be used as a reliable diagnostic marker to detect heart tissue damages after blunt chest trauma.

  7. Fatal right coronary artery rupture following blunt chest trauma: detection by postmortem selective coronary angiography.

    Science.gov (United States)

    Inokuchi, Go; Makino, Yohsuke; Motomura, Ayumi; Chiba, Fumiko; Torimitsu, Suguru; Hoshioka, Yumi; Iwase, Hirotaro

    2016-05-01

    Coronary artery injury is a rare complication following blunt chest trauma (BCT), and can be fatal. Here we report findings on postmortem selective coronary angiography of right coronary artery rupture after an assault involving blunt trauma to the chest. A woman in her 60s died after her son stomped on her chest. There were no appreciable signs of injury on external examination, and cause of death could not be determined by postmortem computed tomography (PMCT). Internal findings indicated that an external force had been applied to the anterior chest, as evidenced by subcutaneous hemorrhage and pericardial and cardiac contusions. Postmortem coronary angiography revealed irregularity of the intima and of the fat tissue surrounding the proximal part of the right coronary artery associated with a local filling defect. Histopathological examination suggested coronary rupture with dissection of the tunica media and compression of the lumen cavity. The key points in the present case are that no fatal injuries could be determined on external examination, and the heart and coronary artery injuries were not evident on PMCT. Criminality might be overlooked in such cases, as external investigation at the crime scene would be inadequate and could result in a facile diagnosis of cause of death. This is the first report of coronary artery rupture with dissection that was detected by CT coronary angiography, and provides helpful findings for reaching an appropriate decision both forensically and clinically.

  8. Arch vessel injury: geometrical considerations. Implications for the mechanism of traumatic myocardial infarction II

    Directory of Open Access Journals (Sweden)

    Ismailov Rovshan M

    2006-09-01

    Full Text Available Abstract Background Various types of vascular injury have been reported in the medical literature; the isthmic part of the aorta is at particularly high risk of traumatic rupture. Early diagnosis results in better survival, justifying the search for potential risk factors and diagnostic tests. The aim of this research was to investigate the complex mechanism of blunt injury to the vascular wall with particular focus on the branching region of the vessels. Geometric peculiarities were investigated. Methods Multi-phase equations have been used. The system of equations with certain boundary conditions was solved numerically by applying the finite-difference method with order of approximation equal to 0.0001. Results The degree of curvature (the Dean number is highly informative about the shear stress on the external surface of the vessel. An important function of the blood flow on the external wall is to destroy rouleaux. The viscosity of phase 2 (f2 exceeds, by many times, the viscosity of phase 1 (f1. The major stress created by blood flow is expressed as the shear stress of f2. The volume fraction of rouleaux depends to a greater degree on the concentration of erythrocytes (expressed as the viscosity of the mixture than on the shear stress. The peculiarities of rouleaux formation were assessed and their impact on the local shear stress and, therefore, on the internal wall was determined in relation to the erythrocyte concentration. Conclusion The results of this research take into account certain geometrical peculiarities of the branching part of the vessel. The mathematical model created in this study will improve our understanding of the complex mechanism of blunt injury to the vascular wall and, therefore, conditions such as aortic rupture and traumatic acute myocardial infarction.

  9. Characteristics and time-dependence of cut marks and blunt force fractures on costal cartilages: an experimental study.

    Science.gov (United States)

    Spagnoli, Laura; Amadasi, Alberto; Frustaci, Michela; Mazzarelli, Debora; Porta, Davide; Cattaneo, Cristina

    2016-03-01

    The distinction between cut marks and blunt force injuries on costal cartilages is a crucial issue in the forensic field. Moreover, a correct distinction may further be complicated by decomposition, so the need arises to investigate the distinctive features of lesions on cartilage and their changes over time. This study aimed to assess the stereomicroscopic features of cut marks (performed with six different knives) and blunt fractures (performed with a hammer and by means of manual bending) on 48 fragments of human costal cartilages. Moreover, in order to simulate decomposition, the cut and fractured surfaces were checked with stereomicroscopy and through casts after 1 and 2 days, 1 week, and 1, 2 and 4 months of drying in ambient air. In fresh samples, for single and unique cuts, striations were observed in between 44 and 88% of cases when non-serrated blades were used, and between 77 and 88% for serrated blades; in the case of "repeated" (back and forth movement) cuts, striations were detected in between 56 and 89% of cases for non-serrated blades, and between 66 and 100% for serrated blades. After only 1 week of decomposition the detection rates fell to percentages of between 28 and 39% for serrated blades and between 17 and 33% for non-serrated blades. Blunt force injuries showed non-specific characteristics, which, if properly assessed, may lead to a reliable distinction between different cut marks in fresh samples. The most evident alterations of the structure of the cartilage occurred in the first week of decomposition in ambient air. After one week of drying, the characteristics of cut marks were almost undetectable, thereby making it extremely challenging to distinguish between cut marks, blunt force fractures and taphonomic effects. The study represents a contribution to the correct assessment and distinction of cut marks and blunt force injuries on cartilages, providing a glimpse on the modifications such lesions may undergo with decomposition.

  10. Pathogenetic Basis of Aortopathy and Aortic Valve Disease

    Science.gov (United States)

    2018-02-19

    Aortopathies; Thoracic Aortic Aneurysm; Aortic Valve Disease; Thoracic Aortic Disease; Thoracic Aortic Dissection; Thoracic Aortic Rupture; Ascending Aortic Disease; Descending Aortic Disease; Ascending Aortic Aneurysm; Descending Aortic Aneurysm; Marfan Syndrome; Loeys-Dietz Syndrome; Ehlers-Danlos Syndrome; Shprintzen-Goldberg Syndrome; Turner Syndrome; PHACE Syndrome; Autosomal Recessive Cutis Laxa; Congenital Contractural Arachnodactyly; Arterial Tortuosity Syndrome

  11. Kuula. Kellele ei meeldiks James Blunt? / Mart Juur

    Index Scriptorium Estoniae

    Juur, Mart, 1964-

    2007-01-01

    Heliplaatidest: James Blunt "Back To Bedlam", Enrique Iglesias "Insomniac", Prince "Planet Earth", Garbage "Absolut Garbage", Justice "Cross", Interpol "Our Love To Admire", Rufus Wainwright "Release The Stars"

  12. Ultrasonographic findings in blunt abdominal trauma among Yemeni patients in Sana'a

    International Nuclear Information System (INIS)

    Al Najjar, A. A. H.

    2004-09-01

    A hundred and thirty patients (104 males, and 26 females) with suspected blunt abdominal trauma were admitted to this prospective study at Althawra hospital, Sana'a, Yemen in the period between june and december 2003. Real-time ultrasonography of the abdomen was performed in all patients. Fifty-six patients showed U/S evidence of visceral injury. Fourteen injuries of spleen, 7 had evidence of liver and 8 had renal injuries. Only eight needed a laparatomy because of cardiovascular instability and the laparatomy confirmed the ultrasound findings. The remainder were treated conservatively with good results. It is of interest that there was one ultrasonic sign of fluid in one patient who progressed well on conservative therapy. Ultrasonic signs of visceral laceration or contusion were found in patients who had 2 up to 8 sonic findings. It appears that visceral injury always gives more than two sonic signs. The remaining 33 patients only had intraperitoneal fluid, only one of them had volvulus. It is not possible to state the nature of fluid, whether it is an exudate, transudate, blood or lymph. Diagnostic peritoneal lavage would have been helpful. Seven patients died, most of them due to associated injuries, mainly head injury and cardiovascular collapse, one patient died on table and had retroperitonieal haematoma extending from pelvis to the mesentery of transverse colon and had no abdominal organ injury. The sensitivity of ultrasonography for liver was 87.5% and for spleen 100%. Ultrasonography is sensitive, safe, cost effective and non invasive method for screening patients with blunt abdominal trauma.(Author)

  13. Fatigue crack growth from blunt notches

    International Nuclear Information System (INIS)

    Rhodes, D.

    1982-01-01

    A number of methods have been proposed, by which the formation and early growth of fatigue cracks at blunt notches may be predicted. In this report, four methods are compared - i.e. analysis of the crack tip plastic deformation, the cyclic contour integral, δJ, the strain in a critical volume of material, and the notch root plastic strain range. It is shown that these approaches have fundamental elements in common, and that all are compatable with linear elastic fracture mechanics. Early results from a continuing experimental programme are reported. (orig.) [de

  14. Is behind armour blunt trauma a real threat to users of body armour? A systematic review.

    Science.gov (United States)

    Carr, Debra J; Horsfall, I; Malbon, C

    2016-02-01

    Behind armour blunt trauma (BABT) has been defined as a non-penetrating injury caused by the rapid deformation of body armour. There has been an increasing awareness of BABT as an injury mechanism in both the military and civilian worlds; whether BABT results in serious injuries is debatable. A systematic review of the openly accessible literature was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method to investigate those injuries classified as BABT and their severity. 50 sources were identified that included pertinent information relevant to this systematic review on BABT injuries. Typical injuries reported included skin contusion, laceration and penetration, rib fracture and contusions to lungs, kidneys, spleen and (rarely) the heart. No evidence of fatal injuries due to BABT was identified. Whether BABT can lead to life-threatening injuries when small-arms ammunition impacts body armour components designed to stop that ammunition is debatable. It should be emphasised that other data may be available in government reports that are not openly available. Further research should be considered that investigates developments in body armour, including initiatives that involve reducing burden, and how they affect BABT. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  15. Traumatic ileal perforation in post-traumatic ventral hernia: adding insult to injury

    International Nuclear Information System (INIS)

    Rab, A.Z.U.; Fakir, S.B.; Peethambaran, M.S.

    2007-01-01

    Rupture of abdominal wall with formation of ventral hernia is a rare complication following blunt abdominal trauma. Small intestinal rupture within such a hernial sac, resulting from a subsequent blunt trauma is rarer still. Ventral hernias often go untreated in developing countries because of their seemingly innocuous nature, ignorance and financial constraints. Blunt trauma in patients with hernia warrants a thorough clinical examination along with evaluation for intestinal injury, since even trivial trauma can cause potentially serious intra-peritoneal visceral injury. A case of fatal traumatic ileal perforation in pre-existing post-traumatic ventral hernia (from blunt trauma sustained 10 years earlier) is being reported. (author)

  16. [Aortic arch advancement surgery as treatment for aortic coarctation with hypoplastic aortic arch in children].

    Science.gov (United States)

    Palacios-Macedo-Quenot, Alexis; Urencio, Miguel; Ponce-De-León-Rosales, Sergio; López-Terrazas, Javier; Castañuela-Sánchez, Violeta; March-Mifsut, Almudena; López-Magallón, Alejandro; Pérez-Juárez, Fabiola; Cedillo-Rendón, Irma; Tamariz-Cruz, Orlando

    2012-01-01

    Treatment of aortic coarctation with hypoplastic aortic arch is still a surgical challenge. The aortic arch advancement surgery has shown less re-coarctation frequency. To determine the re-coarctation frequency in patients who underwent aortic arch advancement technique for aortic coarctation with hypoplastic aortic arch and analyze the results. Retrospective and observational study of 38 patients who underwent aortic arch advancement in a third level Institution from 2002 to 2010. Twenty four males and 14 females all with aortic arch Z index diameter of coarctation was O%. With the previously mentioned technique the recoarctation frequency on medium and long term basis was 0%. From the anatomical and functional point of view, we believe this technique offers the best possible results.

  17. Conservative Management of Azygous Vein Rupture in Blunt Thoracic Trauma

    Directory of Open Access Journals (Sweden)

    Cian McDermott

    2012-01-01

    Full Text Available We report a case of successful conservative management of acute traumatic rupture of the azygous vein. A 48-year-old male was involved in a motor vehicle collision. Primary survey revealed acute right intrathoracic haemorrhage. He remained haemodynamically stable with rapid infusion of warmed crystalloid solution and blood. Computed tomographic imaging showed a contained haematoma of the azygous vein. The patient was managed conservatively in the intensive care. Azygous vein laceration resulting from blunt thoracic trauma is a rare condition that carries a universally poor prognosis unless the appropriate treatment is instituted. Clinical features include acute hypovolaemic shock, widened mediastinum on chest radiograph, and a right-sided haemothorax. Haemodynamic collapse necessitates immediate resuscitative thoracotomy. Interest in this injury stems from the severity of the clinical condition, difficulty in diagnosis, the onset of a rapidly deteriorating clinical course all of which can be promptly reversed by timely and appropriate treatment. Although it is a rare cause of intramediastinal haemorrhage, it is proposed that a ruptured azygous vein should be considered in every trauma case causing a right-sided haemothorax or widened mediastinum. All cases described in the literature to date involved operative management. We present a case of successful conservative management of this condition.

  18. The Effect of Sarcopenia on Outcomes in Geriatric Blunt Trauma.

    Science.gov (United States)

    Malekpour, Mahdi; Bridgham, Kelly; Jaap, Kathryn; Erwin, Ryan; Widom, Kenneth; Rapp, Megan; Leonard, Diane; Baro, Susan; Dove, James; Hunsinger, Marie; Blansfield, Joseph; Shabahang, Mohsen; Torres, Denise; Wild, Jeffrey

    2017-11-01

    Elderly patients are at a higher risk of morbidity and mortality after trauma, which is reflected through higher frailty indices. Data collection using existing frailty indices is often not possible because of brain injury, dementia, or inability to communicate with the patient. Sarcopenia is a reliable objective measure for frailty that can be readily assessed in CT imaging. In this study, we aimed to evaluate the effect of sarcopenia on the outcomes of geriatric blunt trauma patients. Left psoas area (LPA) was measured at the level of the third lumbar vertebra on the axial CT images. LPA was normalized for height (LPA mm2/m2) and after stratification by gender, sarcopenia was defined as LPA measurements in the lowest quartile. A total of 1175 patients consisting of 597 males and 578 females were studied. LPAs below 242.6 mm2/m2 in males and below 187.8 mm2/m2 in females were considered to be sarcopenic. We found sarcopenia in 149 males and 145 females. In multivariate analysis, sarcopenia was associated with a higher risk of in-hospital mortality (odds ratio [OR]: 1.61, 95% confidence interval [CI]: 1.01-2.56) and a higher risk of discharge to less favorable destinations (OR: 1.42, 95% CI: 1.05-1.97). Lastly, sarcopenic patients had an increased risk of prolonged hospitalization (hazard ratio: 1.21, 95% CI: 1.04-1.40).

  19. Thyroid gland hemorrhage after blunt neck trauma: case report and review of the literature.

    Science.gov (United States)

    Lemke, Johannes; Schreiber, Markus N; Henne-Bruns, Doris; Cammerer, Gregor; Hillenbrand, Andreas

    2017-11-28

    Thyroid hemorrhage is considered to be an uncommon complication following blunt trauma to the neck. This condition is potentially life-threatening due to airway compression and may therefore require emergency airway management and surgical intervention in some cases. We present the case of a 52-year-old woman who experienced a traumatic thyroid gland rupture (right lobe) with subsequent active arterial bleeding from branches of the inferior thyroid artery. On the same day, the patient presented to our emergency department with a painful swelling of the neck with an inspiratory stridor and hoarseness a few hours after a cycling accident. A right hemithyroidectomy was performed. The postoperative course was uneventful. We identified 33 additional cases published in English literature within the last 30 years, reporting blunt trauma to the neck with hemorrhagic complication of the thyroid gland. We provide a systematic review and particularly consider the aspects of endocrine surgery. The treatment approach for patients with blunt thyroid trauma should be dependent on the extent of the thyroid injury. Patients with tracheal compression, active bleeding and increasing hoarseness/shortness of breath require emergency airway control and often surgical exploration for hemorrhage control followed by resection of the ruptured thyroid. Importantly, in contrast to routine thyroid surgery, no electromyographic endotracheal tube is used during emergency intubation. Exchange of an endotracheal tube should be carefully evaluated due to difficult airway management in this setting. For protection against double-sided recurrent nerve palsy and postoperative hypoparathyroidism, a unilateral approach is preferable whenever possible.

  20. Surgical repair of right atrial wall rupture after blunt chest trauma.

    Science.gov (United States)

    Telich-Tarriba, Jose E; Anaya-Ayala, Javier E; Reardon, Michael J

    2012-01-01

    Right atrial wall rupture after blunt chest trauma is a catastrophic event associated with high mortality rates. We report the case of a 24-year-old woman who was ejected 40 feet during a motor vehicle accident. Upon presentation, she was awake and alert, with a systolic blood pressure of 100 mmHg. Chest computed tomography disclosed a large pericardial effusion; transthoracic echocardiography confirmed this finding and also found right ventricular diastolic collapse. A diagnosis of cardiac tamponade with probable cardiac injury was made; the patient was taken to the operating room, where median sternotomy revealed a 1-cm laceration of the right atrial appendage. This lesion was directly repaired with 4-0 polypropylene suture. Her postoperative course was uneventful, and she continued to recover from injuries to the musculoskeletal system. This case highlights the need for a high degree of suspicion of cardiac injuries after blunt chest trauma. An algorithm is proposed for rapid recognition, diagnosis, and treatment of these lesions.

  1. Value of ultrasound in the evaluation of blunt abdominal trauma

    International Nuclear Information System (INIS)

    Jayanthi, Shri Krishna

    2008-01-01

    Trauma is a major cause of morbidity and mortality in an age group including from teenagers to young adults, in a male dominant proportion, resulting in great economic and social impact. Within the complex of trauma, blunt abdominal trauma (BAT) is frequent event and presents difficulty in the evaluation and management since the clinical examination shows low sensitivity and specificity. The detection of hemo peritoneum is one of the methods of evaluation of possible indirect intra-abdominal injuries, initially using direct diagnostic abdominal paracentesis and posteriorly the diagnostic peritoneal lavage, that despite the effectiveness, have drawbacks such as invasiveness and the inability of hemo peritoneum quantification and the lesion staging, resulting in non-therapeutic laparotomies. Imaging methods provide useful information in the investigation of abdominal injuries, such as conventional and contrast radiology, ultrasound (US) and computed tomography (CT), which is the best effective method, but has its own drawbacks, such as cost, accessibility, use of ionizing radiation and contrast media and the displacement of the patient to the machine. US presents itself as an alternative in the initial evaluation of these patients as noninvasive method, with lack of harmfulness, low cost, fast answer and portability. Nevertheless, this method also has its limitations, as in cases of abdominal injuries without free fluid. This study was conducted in order to establish the performance of the US in this setting, allowing to rationalise the use of CT. For this purpose we studied 163 patients treated in the ER of HC/FMUSP, with the completion of consecutive US and CT. The population fits the usual profile of trauma victims, with 83% male, 56% in the age group between 20 and 39 years and in 73% of cases victims of traffic accidents. They were brought to the service in an average time of 51 minutes, mainly stable and with satisfactory level of consciousness. US took on

  2. Quadricuspid Aortic Valve Combined with Moderate Ascending Aortic Dilatation: A Report of Four Cases.

    Science.gov (United States)

    Uspenskiy, Vladimir E; Osadchii, Alexei M; Gordeev, Mikhail L

    2015-12-01

    The quadricuspid aortic valve is a very uncommon malformation associated with aortic insufficiency, aortic stenosis, endocarditis, and ascending aortic dilatation. We report four cases of this aortic valve malformation. One patient with severe aortic regurgitation and moderate aortic dilatation required aortic valve replacement. Three patients had mild or moderate aortic insufficiency combined with moderate ascending aortic dilatation. These patients were referred to follow-up. The presented cases demonstrate that this aortic valve malformation may not be as rare as it appears and that attention must be paid to any quadricuspid findings during computed tomographic angiography and echocardiography.

  3. Isolated gallbladder perforation following blunt abdominal trauma: A ...

    African Journals Online (AJOL)

    2012-05-12

    May 12, 2012 ... Schachter P, Czerniak A, Shemesh E, Avigad I, Lotan G, Wolfstein I. Isolated gallbladder rupture due to blunt abdominal trauma. HPB Surg. 1989;1:359‑ 62. 2. Bainbridge J, Shaaban H, Kenefick N, Armstrong CP. Delayed presentation of an isolated gallbladder rupture following blunt abdominal trauma: A ...

  4. (PCR) for direct cloning of blunt-end DNA fragments

    African Journals Online (AJOL)

    Administrator

    2011-09-19

    Sep 19, 2011 ... interest by PCR using proof reading DNA polymerase, such as Pfu, KOD and Primerstar, is preferred since the. PCR products with a higher degree of fidelity are required in many investigations. However, traditional blunt-end cloning method for direct cloning of blunt-end PCR products is not efficient since ...

  5. Repair of Isolated Mitral Papillary Muscle Rupture Consequent to Blunt Trauma in a Small Child

    Science.gov (United States)

    Hazan, Eyup; Guzeloglu, Mehmet; Sariosmanoglu, Nejat; Ugurlu, Baran; Keskin, Vehip; Unal, Nurettin

    2009-01-01

    Blunt thoracoabdominal trauma is most often caused by high-velocity motor-vehicle accidents or by falls from a height. The clinical spectrum of cardiac injuries arising from this type of trauma varies from myocardial contusion to valvular rupture. Intracardiac valvular rupture is rarely observed, and few cases have been reported. The youngest of the patients in cases reported to date was 6 years of age. Here we report the case of a 2½year-old child, who sustained mitral valve insufficiency due to isolated rupture of the posterior mitral papillary muscle, which developed after a domestic accident. PMID:19568400

  6. Coronary artery dissection and acute myocardial infarction following blunt chest trauma

    Directory of Open Access Journals (Sweden)

    Tønnessen Theis

    2009-04-01

    Full Text Available Abstract Blunt chest trauma might lead to cardiac injury ranging from simple arrhythmias to lethal conditions such as cardiac rupture. We experienced a case of initially overlooked traumatic coronary artery dissection which resulted in acute myocardial infarction (AMI. A high degree of suspicion is needed to diagnose this condition. Based on our case, we will give an overview of relevant literature on this topic. ECG, echocardiography, coronary angiography and cardiac enzymes are valuable tools in diagnosing this rare condition. The time span from coronary artery occlusion to revascularisation must be short if AMI is to be avoided.

  7. VALIDITY OF PARACENTESIS IN DIAGNOSING BLUNT TRAUMA ABDOMEN

    Directory of Open Access Journals (Sweden)

    Fahad Bin Abdul Majeed

    2017-03-01

    Full Text Available BACKGROUND Blunt abdominal trauma is a common case that comes to an emergency department and it is the most easily missed diagnosis resulting in catastrophic consequences. Delay in diagnosing a case is due to the nonspecific character of the symptoms with which it presents. Clinical signs that could be elicited in blunt trauma abdomen are equally nonspecific. Thus, to avoid delay and save the life of the patient, a doctor has to depend on various investigations to rule out blunt trauma abdomen. The modalities which help include paracentesis, diagnostic peritoneal lavage, Focused Abdominal Sonography for Trauma (FAST and ContrastEnhanced Computed Tomography (CECT. To choose the right investigation for the right patient helps in saving precious lives. Validity of each investigation, availability, condition of the patient are the main points to look into before deciding on the right investigative modality. Paracentesis is the simplest investigation that could be done in emergency department and also at the site of accident to triage the patient. Paracentesis has low sensitivity to detect blunt trauma. FAST is a better investigation with higher validity rates than paracentesis. This study aims to validate paracentesis, which is the simplest and commonest investigation used to identify blunt abdominal trauma. MATERIALS AND METHODS In this study, 106 patients who fulfilled the inclusion and exclusion criteria were followed up by detailed history, clinical examination, paracentesis and FAST to identify blunt abdominal trauma and then compared with a gold standard investigation, which was assigned as CECT for haemodynamically stable patients and laparotomy for haemodynamically unstable patients. Commonest organs injured in blunt trauma and their management was noted. Patients were followed up till discharge or death. Subsequently, the data were compiled using excel sheet and evaluated using tables and charts. RESULTS Paracentesis is found to have a

  8. Sharp compared with blunt fascial incision at cesarean delivery

    DEFF Research Database (Denmark)

    Aabakke, Anna J M; Hare, Kristine J; Krebs, Lone

    2014-01-01

    OBJECTIVE: To compare patient preference for either sharp incision with scissors or blunt manual cleavage of the fascia at cesarean delivery in a randomized controlled trial in which each woman was her own control. STUDY DESIGN: Women undergoing primary cesarean delivery (n=34) were randomized...... to side distribution of sharp or blunt incision of the fascia (sharp right and blunt left or blunt right and sharp left) and followed three months postoperatively. The primary outcome was patient preference for the right or left side of the scar 3 months postoperatively and modeled by polytomous logistic...... difference was found in patient preference with regard to sharp or blunt incision of the fascia, nor was there a significant difference in postoperative pain scores. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov: www.clinicaltrials.org;NCT01297725....

  9. Unoperated aortic aneurysm

    DEFF Research Database (Denmark)

    Perko, M J; Nørgaard, M; Herzog, T M

    1995-01-01

    From 1984 to 1993, 1,053 patients were admitted with aortic aneurysm (AA) and 170 (15%) were not operated on. The most frequent reason for nonoperative management was presumed technical inoperability. Survivals for patients with thoracic, thoracoabdominal, and abdominal AA were comparable. No sig...

  10. Double aortic arch

    Science.gov (United States)

    Surgery can be done to fix double aortic arch. The surgeon ties off the smaller branch and separates it from the larger branch. Then the surgeon closes the ends of the aorta with stitches. This relieves pressure on the esophagus and windpipe.

  11. Bicuspid aortic valve

    Science.gov (United States)

    ... females. A BAV often exists in babies with coarctation of the aorta (narrowing of the aorta). BAV is also seen ... to view the blood vessels of the heart Treatment ... to the heart and into the narrow opening of the aortic valve. A balloon attached to the end of ...

  12. Tissue engineered aortic valve

    OpenAIRE

    Dohmen, P M

    2012-01-01

    Several prostheses are available to replace degenerative diseased aortic valves with unique advantages and disadvantages. Bioprotheses show excellent hemodynamic behavior and low risk of thromboembolic complications, but are limited by tissue deterioration. Mechanical heart valves have extended durability, but permanent anticoagulation is mandatory. Tissue engineering created a new generation heart valve, which overcome limitations of biological and mechanical heart valves due to remodelling,...

  13. Cyclic Mechanical Stretch Up-regulates Hepatoma-Derived Growth Factor Expression in Cultured Rat Aortic Smooth Muscle Cells.

    Science.gov (United States)

    Kao, Ying-Hsien; Chen, Po-Han; Sun, Cheuk-Kwan; Chang, Yo-Chen; Lin, Yu-Chun; Tsai, Ming-Shian; Lee, Po-Huang; Cheng, Cheng-I

    2018-02-21

    Hepatoma-derived growth factor (HDGF) is a potent mitogen for vascular smooth muscle cells (SMCs) during embryogenesis and injury repair of vessel walls. Whether mechanical stimuli modulate HDGF expression remains unknown. This study aimed at investigating whether cyclic mechanical stretch plays a regulatory role in HDGF expression and regenerative cytokine production in aortic SMCs. A SMC cell line was grown on a silicone-based elastomer chamber with extracellular matrix coatings (either type I collagen or fibronectin) and received cyclic and uni-axial mechanical stretches with 10% deformation at frequency 1 Hz. Morphological observation showed that fibronectin coating provided better cell adhesion and spreading and that consecutive 6 hours of cyclic mechanical stretch remarkably induced reorientation and realignment of SMCs. Western blotting detection demonstrated that continuous mechanical stimuli elicited up-regulation of HDGF and PCNA, a cell proliferative marker. Signal kinetic profiling study indicated that cyclic mechanical stretch induced signaling activity in RhoA/ROCK and PI3K/Akt cascades. Kinase inhibition study further showed that blockade of PI3K activity suppressed the stretch-induced TNF-a, whereas RhoA/ROCK inhibition significantly blunted the IL-6 production and HDGF over-expression. Moreover, siRNA-mediated HDGF gene silencing significantly suppressed constitutive expression of IL-6, but not TNF-α, in SMCs. These findings support the role of HDGF in maintaining vascular expression of IL-6, which has been regarded a crucial regenerative factor for acute vascular injury. In conclusion, cyclic mechanical stretch may maintain constitutive expression of HDGF in vascular walls and be regarded an important biophysical regulator in vascular regeneration. ©2018 The Author(s).

  14. Primary nasal tuberculosis following blunt trauma nose

    Directory of Open Access Journals (Sweden)

    Kaushik Saha

    2014-01-01

    Full Text Available Primary nasal tuberculosis is a rare disease with nearly 40 cases reported. Our patient was a young male presented with left sided nasal obstruction, anosmia and occasional epistaxis for last 7 weeks after 6 months of blunt trauma nose. Contrast enhanced computed tomography of the para nasal sinuses showed increased soft-tissue density with contrast enhancement in the left maxillary antrum with extension through left osteomeatal foramen to the left nasal cavity along with further extension through choana to nasopharynx resulting in partial obliteration of the nasopharyngeal airway. Nasal endoscopy revealed a sessile polypoidal pinkish mass arising from the left osteomeatal foramen. Histopathological examination of excisional biopsy of that area showed caseating granuloma. Our patient diagnosed as primary nasal tuberculosis following trauma and treated with anti-tubercular chemotherapy.

  15. Blunted stress reactivity in chronic cannabis users.

    Science.gov (United States)

    Cuttler, Carrie; Spradlin, Alexander; Nusbaum, Amy T; Whitney, Paul; Hinson, John M; McLaughlin, Ryan J

    2017-08-01

    One of the most commonly cited reasons for chronic cannabis use is to cope with stress. Consistent with this, cannabis users have shown reduced emotional arousal and dampened stress reactivity in response to negative imagery. To our knowledge, the present study represents the first to examine the effects of an acute stress manipulation on subjective stress and salivary cortisol in chronic cannabis users compared to non-users. Forty cannabis users and 42 non-users were randomly assigned to complete either the stress or no stress conditions of the Maastricht Acute Stress Test (MAST). The stress condition of the MAST manipulates both physiological (placing hand in ice bath) and psychosocial stress (performing math under conditions of social evaluation). Participants gave baseline subjective stress ratings before, during, and after the stress manipulation. Cortisol was measured from saliva samples obtained before and after the stress manipulation. Further, cannabis cravings and symptoms of withdrawal were measured. Subjective stress ratings and cortisol levels were significantly higher in non-users in the stress condition relative to non-users in the no stress condition. In contrast, cannabis users demonstrated blunted stress reactivity; specifically, they showed no increase in cortisol and a significantly smaller increase in subjective stress ratings. The stress manipulation had no impact on cannabis users' self-reported cravings or withdrawal symptoms. Chronic cannabis use is associated with blunted stress reactivity. Future research is needed to determine whether this helps to confer resiliency or vulnerability to stress-related psychopathology as well as the mechanisms underlying this effect.

  16. Management of high-risk popliteal vascular blunt trauma: clinical experience with 62 cases

    Directory of Open Access Journals (Sweden)

    Ali Pourzand

    2010-07-01

    Full Text Available Ali Pourzand, Bassir A Fakhri, Ramin Azhough, Mohammad Ali Hassanzadeh, Shahryar Hashemzadeh, Amrollah M BayatDepartment of General Surgery, Tabriz University of Medical Sciences, Tabriz, East Azarbaijan Province, IranPurpose: The purpose of this study is to report the clinical and functional outcomes of patients, treated between 2004 and 2009, with high-risk popliteal vascular injuries due to compound fractures about the knee.Patients and methods: A retrospective analysis was conducted of prospectively collected data from Tabriz Medical Trauma Center. Our aim was to perform surgical revascularization as soon as the arterial injury was recognized. The mechanism of injury was blunt in the entire cohort of patients, and all of them had bone fractures about the knee. The treatment of arterial injury included vein graft interposition in 39 (63%, primary anastomosis in 20 (32.3%, and lateral repair in 3 (4.8% patients. The patients were divided into 2 study groups: limb salvage group (group 1 and amputation group (group 2. Subgroup analysis consisted of univariate analysis comparing the 2 groups and multivariate analysis examining the factors associated negatively and positively with the primary endpoint, limb salvage.Results: In the entire cohort of patients, 60 patients (97% were male and 2 were female (3%; the mean age was 34.1 years (16–49 years. The overall amputation rate in this study was 37.1% (23 amputations. Significant (P < 0.05 independent factors associated negatively with limb salvage were combined tibia and fibula fracture, concomitant artery and vein injury, ligation of venous injury, and lack of backflow after Fogarty catheter thrombectomy, while repair of popliteal artery and vein injury, when present, was associated with improved early limb salvage. For 40 patients, we adopt a liberal attitude toward open 4-compartment fasciotomy through both medially and laterally placed incisions.Conclusion: Expeditious recognition of vascular

  17. Impact of Aortic Insufficiency on Ascending Aortic Dilatation and Adverse Aortic Events After Isolated Aortic Valve Replacement in Patients With a Bicuspid Aortic Valve.

    Science.gov (United States)

    Wang, Yongshi; Wu, Boting; Li, Jun; Dong, Lili; Wang, Chunsheng; Shu, Xianhong

    2016-05-01

    Aberrant flow pattern and congenital fragility bestows bicuspid aortic valve (BAV) with a propensity toward ascending aorta dilatation, aneurysm, and dissection. Whether isolated aortic valve replacement (AVR) can prevent further dilatation in BAV ascending aorta and what indicates concurrent aortic intervention in the case of valve operation remain controversial. From June 2006 to January 2009, patients with a BAV who underwent isolated AVR were consecutively included and categorized into aortic insufficiency (BAV-AI, n = 84) and aortic stenosis (n = 112) groups, and another population of patients with a tricuspid aortic valve with aortic insufficiency (n = 149) was also recruited during the same period for comparison of annual aortic dilatation rate and adverse aortic events after isolated AVR. With a median follow-up period of 72 months (interquartile range, 66 to 78 months), ascending aorta dilatation rates were faster in the BAV-AI group than the BAV plus aortic stenosis and tricuspid aortic valve with aortic insufficiency groups (both p regression analysis identified aortic insufficiency (hazard ratio, 3.7; 95% confidence interval, 1.2 to 11.1; p = 0.019) as an independent risk factor for adverse aortic events among patients with BAV in general, whereas preoperative ascending aortic diameter larger than 45 mm (hazard ratio, 13.8; 95% confidence interval, 3.0 to 63.3; p = 0.001) served as a prognostic indicator in the BAV-AI group. An aggressive policy of preventive aortic interventions seemed appropriate in patients with BAV-AI during AVR, and BAV phenotype presenting as either insufficiency or stenosis should be taken into consideration when contemplating optimal surgical strategies for BAV aortopathy. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  18. Wound Ballistics Modeling for Blast Loading Blunt Force Impact and Projectile Penetration.

    Energy Technology Data Exchange (ETDEWEB)

    Taylor, Paul A. [Sandia National Laboratories (SNL-NM), Albuquerque, NM (United States)

    2015-11-01

    Light body armor development for the warfighter is based on trial-and-error testing of prototype designs against ballistic projectiles. Torso armor testing against blast is nonexistent but necessary to protect the heart and lungs. In tests against ballistic projectiles, protective apparel is placed over ballistic clay and the projectiles are fired into the armor/clay target. The clay represents the human torso and its behind-armor, permanent deflection is the principal metric used to assess armor protection. Although this approach provides relative merit assessment of protection, it does not examine the behind-armor blunt trauma to crucial torso organs. We propose a modeling and simulation (M&S) capability for wound injury scenarios to the head, neck, and torso of the warfighter. We will use this toolset to investigate the consequences of, and mitigation against, blast exposure, blunt force impact, and ballistic projectile penetration leading to damage of critical organs comprising the central nervous, cardiovascular, and respiratory systems. We will leverage Sandia codes and our M&S expertise on traumatic brain injury to develop virtual anatomical models of the head, neck, and torso and the simulation methodology to capture the physics of wound mechanics. Specifically, we will investigate virtual wound injuries to the head, neck, and torso without and with protective armor to demonstrate the advantages of performing injury simulations for the development of body armor. The proposed toolset constitutes a significant advance over current methods by providing a virtual simulation capability to investigate wound injury and optimize armor design without the need for extensive field testing.

  19. Blunt splenic trauma: splenectomy increases early infectious complications: a prospective multicenter study.

    Science.gov (United States)

    Demetriades, Demetrios; Scalea, Thomas M; Degiannis, Elias; Barmparas, Galinos; Konstantinidis, Agathoklis; Massahis, John; Inaba, Kenji

    2012-01-01

    The purpose of this study was to evaluate the effect of the method of splenic injury management on early infectious complications. Prospective observational, multicenter study which included all patients with blunt splenic injury surviving at least 72 hours. Epidemiologic and clinical data, grade of splenic injury, method of splenic management, and infectious complications during the initial hospitalization were collected according to a standardized collecting datasheet. Logistic regression analysis was used to identify independent risk factors for infectious complications. During a 22-month period, 269 eligible patients were enrolled in the study. Overall, 105 (39.0%) patients were observed; 48 (17.8%) underwent successful angioembolization, 19 (7.1%) underwent splenorrhaphy, and 97 (36.1%) underwent splenectomy. Multivariate analysis adjusting for age, hypotension on admission, Glasgow Coma Scale, Injury Severity Score, Abbreviated Injury Scale, laparotomy, grade of splenic injury, and associated solid and hollow viscus injuries, showed that splenectomy had a significantly higher incidence of infectious complications than splenic preservation (adjusted odds ratio [95% confidence interval], 9.62 [3.04-30.30]; p < 0.001). A regression model analysis identified splenectomy, hypotension on admission, associated hollow viscus injury, and high Injury Severity Score as independent risk factors for infectious complications. Forward logistic regression analysis, which included only the 176 patients with grades III to V splenic injuries, identified splenectomy as the most significant independent risk factors for infection (adjusted odds ratio [95% confidence interval], 16.67 [3.76-71.43]; p < 0.001). Splenectomy is an independent risk factor for early infectious complications. Splenic-preserving techniques should be considered more liberally.

  20. Computed tomography of aortic wall calcifications in aortic dissection patients.

    Directory of Open Access Journals (Sweden)

    Pim A de Jong

    Full Text Available To investigate the frequency of aortic calcifications at the outer edge of the false lumen and the frequency of fully circular aortic calcifications in a consecutive series of patients with aortic dissection who underwent contrast-enhanced CT.The study population compromised of 69 consecutive subjects aged 60 years and older with a contrast-enhanced CT scan demonstrating an aortic dissection. All CT scans were evaluated for the frequency of aortic calcifications at the outer edge of the false lumen and the frequency of fully circular aortic calcifications by two experienced observers. Between observer reliability was evaluated by using Cohen's Kappa. Differences between groups were tested using unpaired T test and Chi-square test.Presumed media calcifications were observed in 22 (32% patients of 60 years and older and were found more frequently in chronic aortic dissection (N = 12/23, 52% than in acute aortic dissection (N = 10/46, 22%.As the intima has been torn away by the aortic dissection it is highly likely that CT scans can visualize the calcifications in the tunica media of the aorta.

  1. The development of simple survival prediction models for blunt trauma victims treated at Asian emergency centers.

    Science.gov (United States)

    Kimura, Akio; Nakahara, Shinji; Chadbunchachai, Witaya

    2012-02-02

    For real-time assessment of the probability of survival (Ps) of blunt trauma victims at emergency centers, this study aimed to establish regression models for estimating Ps using simplified coefficients. The data of 10,210 blunt trauma patients not missing both the binary outcome data about survival and the data necessary for Ps calculation by The Trauma and Injury Severity Score (TRISS) method were extracted from the Japan Trauma Data Bank (2004-2007) and analyzed. Half (5,113) of the data was allocated to a derivation data set, with the other half (5,097) allocated to a validation data set. The data of 6,407 blunt trauma victims from the trauma registry of Khon Kaen Regional Hospital in Thailand were analyzed for validation. The logistic regression models included age, the Injury Severity Score (ISS), the Glasgow Coma Scale score (GCS), systolic blood pressure (SBP), respiratory rate (RR), and their coded values (cAGE, 0-1; cISS, 0-4; cSBP, 0-4; cGCS, 0-4; cRR, 0-4) as predictor variables. The coefficients were simplified by rounding off after the decimal point or choosing 0.5 if the coefficients varied across 0.5. The area under the receiver-operating characteristic curve (AUROCC) was calculated for each model to measure discriminant ability. A group of formulas (log (Ps/1-Ps) = logit (Ps) = -9 + cISS - cAGE + cSBP + cGCS + cRR/2, where -9 becomes -7 if the predictor variable of cRR or cISS is missing) was developed. Using these formulas, the AUROCCs were between 0.950 and 0.964. When these models were applied to the Khon Kean data, their AUROCCs were greater than 0.91. These equations allow physicians to perform real-time assessments of survival by easy mental calculations at Asian emergency centers, which are overcrowded with blunt injury victims of traffic accidents. © 2012 Kimura et al; licensee BioMed Central Ltd.

  2. The development of simple survival prediction models for blunt trauma victims treated at Asian emergency centers

    Directory of Open Access Journals (Sweden)

    Kimura Akio

    2012-02-01

    Full Text Available Abstract Background For real-time assessment of the probability of survival (Ps of blunt trauma victims at emergency centers, this study aimed to establish regression models for estimating Ps using simplified coefficients. Methods The data of 10,210 blunt trauma patients not missing both the binary outcome data about survival and the data necessary for Ps calculation by The Trauma and Injury Severity Score (TRISS method were extracted from the Japan Trauma Data Bank (2004-2007 and analyzed. Half (5,113 of the data was allocated to a derivation data set, with the other half (5,097 allocated to a validation data set. The data of 6,407 blunt trauma victims from the trauma registry of Khon Kaen Regional Hospital in Thailand were analyzed for validation. The logistic regression models included age, the Injury Severity Score (ISS, the Glasgow Coma Scale score (GCS, systolic blood pressure (SBP, respiratory rate (RR, and their coded values (cAGE, 0-1; cISS, 0-4; cSBP, 0-4; cGCS, 0-4; cRR, 0-4 as predictor variables. The coefficients were simplified by rounding off after the decimal point or choosing 0.5 if the coefficients varied across 0.5. The area under the receiver-operating characteristic curve (AUROCC was calculated for each model to measure discriminant ability. Results A group of formulas (log (Ps/1-Ps = logit (Ps = -9 + cISS - cAGE + cSBP + cGCS + cRR/2, where -9 becomes -7 if the predictor variable of cRR or cISS is missing was developed. Using these formulas, the AUROCCs were between 0.950 and 0.964. When these models were applied to the Khon Kean data, their AUROCCs were greater than 0.91. Conclusion: These equations allow physicians to perform real-time assessments of survival by easy mental calculations at Asian emergency centers, which are overcrowded with blunt injury victims of traffic accidents.

  3. Acute Aortic Arch Perforation During Transcatheter Aortic Valve Replacement in Bicuspid Aortic Stenosis and a Gothic Aortic Arch.

    Science.gov (United States)

    Millan-Iturbe, Oscar; Sawaya, Fadi J; Bieliauskas, Gintautas; Chow, Danny H F; De Backer, Ole; Søndergaard, Lars

    2017-09-01

    Transcatheter aortic valve replacement (TAVR) has evolved from a novel technology to an established therapy for high/intermediate-risk patients with severe symptomatic aortic stenosis (AS). Although TAVR is used to treat bicuspid severe AS, the large randomized trials typically excluded bicuspid AS because of its unique anatomic features. This case report describes an acute aortic perforation during delivery of a transcatheter heart valve to treat a severe bicuspid AS with a "gothic aortic arch"; more careful evaluation of the preprocedural multislice computed tomographic scan would have unveiled a sharply angulated aortic arch. This life-threatening complication was successfully treated by thoracic endovascular aortic repair. Copyright © 2017 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  4. Prognosis for children in cardiac arrest shortly after blunt cranial trauma.

    Science.gov (United States)

    Widdel, Lars; Winston, Ken R

    2010-10-01

    The goal of this investigation is to determine the success rate of aggressive cardiorespiratory resuscitation in children who experience blunt cranial trauma of sufficient magnitude to quickly cause cardiac arrest. The records of all the children who, within a 6-year period, suffered cardiac arrest at the scene of injury, during transport or in the emergency department of a level one pediatric trauma center, as a consequence of blunt cranial trauma, form the basis of this study. One of the 40 children who met the inclusion criteria survived. Their ages ranged from 1 month to 16 years, and all had a Glasgow Coma Score of 3 at the scene of injury. Forty-two percent were passengers in motor vehicles, and 32% were victims of nonaccidental trauma. Eleven of the 17 children in the motor vehicle crash were not properly restrained. Eleven of the unrestrained children plus two who were properly restrained were ejected at the time of impact. The average cardiopulmonary resuscitation time was 36 (2-107) minutes. A sinus rhythm was established in 50% but was not sustained in most. The sole survivor was an 8-year-old boy who was ejected and had asystole at the scene. At discharge, he was walking well but had cranial nerve deficits and learning disability. Survival in 40 consecutive children with documented cardiac arrest caused by blunt cranial trauma was 2.5%. This series, when combined with other published reports, is supportive of the position that aggressive resuscitation is rarely successful after 10 minutes and futile after 20 minutes.

  5. Hypoplasia of the aortic arch

    Directory of Open Access Journals (Sweden)

    Ю. С. Синельников

    2015-10-01

    Full Text Available An aggressive surgical approach to early repair of aortic coarctation and concomitant arch hypoplasia results in considerable improvement of the long-term outcomes of surgical treatment by reducing the number of aortic re-coarctation and arterial hypertension persistence events. At present, there exist some methods of determining the degree of aortic arch hypoplasia, which allow for arch reconstruction planning. Our review focuses on the analysis of modern methods of determination of the aortic arch hypoplasia and the outcomes of surgical treatment of this disease.

  6. Progressive Supranuclear Palsy-like Syndrome After Aortic Aneurysm Repair: A Case Series

    Directory of Open Access Journals (Sweden)

    Sirisha Nandipati

    2013-12-01

    Full Text Available The syndrome of progressive supranuclear palsy‐like syndrome is a rare complication of ascending aortic aneurysm repair. We report two patients with videos and present a table of prior reported cases. To our knowledge there is no previously published video of this syndrome. The suspected mechanism is brainstem injury though neuroimaging is often negative for an associated infarct. We hope our report will increase recognition of this syndrome after aortic surgery, especially in patients with visual complaints.

  7. Whole body perfusion in patients undergoing frozen elephant trunk for type A acute aortic dissections.

    Science.gov (United States)

    Cappabianca, Giangiuseppe; Roscitano, Claudio; Bichi, Samuele; Cricco, Antonio; Parrinello, Matteo; Beghi, Cesare; Albano, Giovanni; Esposito, Giampiero

    2017-03-01

    The Frozen Elephant Trunk (FET) can be adopted in selected type A acute aortic dissections (TAAAD). During FET, a prolonged distal circulatory arrest exposes the spine and visceral organs to potential ischemic injuries. Antegrade distal aortic perfusion (ADAP) could minimize this risk: we describe the technical aspects of the simultaneous use of antegrade cerebral perfusion (ACP) and ADAP achieving a "Whole Body Perfusion" (WBP) during FET.

  8. Cardiovascular magnetic resonance of myocardial infarction after blunt chest trauma: a heartbreaking soccer-shot

    Directory of Open Access Journals (Sweden)

    Fogarassy Peter

    2009-10-01

    Full Text Available Abstract Cardiac injury occasionally occurs as a result of blunt chest trauma. Most cardiac complications in chest trauma are due to myocardial contusion rather than direct damage to the coronary arteries. However, traumatic coronary injury has been reported, and a variety of underlying pathophysiological mechanisms have been proposed. We present a 26 year old patient presenting with an acute coronary syndrome as a consequence of a soccer-shot impact to the chest. CMR showed apical inferior infarction, as well as multiple small septal lesions which were presumed to have resulted from embolization. The culprit lesion was a proximal 75% LAD stenosis with a prominent plaque-rupture and thrombus-formation, and the distal LAD was occluded by thromboembolic material.

  9. Thoracolumbar spine clearance: Clinical examination for patients with distracting injuries.

    Science.gov (United States)

    Cason, Ben; Rostas, Jack; Simmons, Jon; Frotan, Mohammed A; Brevard, Sidney B; Gonzalez, Richard P

    2016-01-01

    The purpose of this study was to prospectively assess the sensitivity of clinical examination to screen for thoracolumbar spine (TLS) injury in awake and alert blunt trauma patients with distracting injuries. From December 2012 to June 2014, all blunt trauma patients older than 13 years were prospectively evaluated as per standard TLS examination protocol at a Level 1 trauma center. Awake and alert patients with Glasgow Coma Scale (GCS) score of 14 or greater underwent clinical examination of the TLS. Clinical examination was performed regardless of distracting injuries. Patients with no complaints of pain or tenderness on examination of the TLS were considered clinically cleared of injury. Patients with distracting injuries, including those clinically cleared and those with complaints of TLS pain or tenderness, underwent computed tomographic scan of the entire TLS. Patients with minor distracting injuries were not considered to have a distracting injury. A total of 950 blunt trauma patients were entered, 530 (56%) of whom had at least one distracting injury. Two hundred nine patients (40%) with distracting injuries had a positive TLS clinical examination result, of whom 50 (25%) were diagnosed with TLS injury. Three hundred twenty-one patients (60%) with distracting injuries were initially clinically cleared, in whom 17 (5%) TLS injuries were diagnosed. There were no missed injuries that required surgical intervention, with only four injuries receiving TLS orthotic bracing. This yielded an overall clinical clearance sensitivity for injury of 75% and sensitivity for clinically significant injury of 89%. In awake and alert blunt trauma patients with distracting injuries, clinical examination is a sensitive screening method for significant TLS injury. Radiologic assessment may be unnecessary for safe clearance of the asymptomatic TLS in patients with distracting injuries. These findings suggest significant potential reduction of both health care cost and patient

  10. Cardiac Injuries: A Review of Multidetector Computed Tomography Findings

    Science.gov (United States)

    Baxi, Ameya Jagdish; Restrepo, Carlos; Mumbower, Amy; McCarthy, Michael; Rashmi, Katre

    2015-01-01

    Trauma is the leading cause of death in United States in the younger population. Cardiac trauma is common following blunt chest injuries and is associated with high morbidity and mortality. This study discusses various multidetector computed tomography (MDCT) findings of cardiac trauma. Cardiac injuries are broadly categorized into the most commonly occurring blunt cardiac injury and the less commonly occurring penetrating injury. Signs and symptoms of cardiac injury can be masked by the associated injuries. Each imaging modality including chest radiographs, echocardiography, magnetic resonance imaging and MDCT has role in evaluating these patients. However, MDCT is noninvasive; universally available and has a high spatial, contrast, and temporal resolution. It is a one stop shop to diagnose and evaluate complications of cardiac injury. MDCT is an imaging modality of choice to evaluate patients with cardiac injuries especially the injuries capable of causing hemodynamic instability. PMID:26839855

  11. Hemorrhage Control for Major Traumatic Vascular Injuries

    Science.gov (United States)

    2016-10-01

    Mechanism of Injury: a. □ Blunt Injury (Select all that apply) □ Fall □ MVC – Motorcycle □ MVC □ Industrial Accident □ MVC – Bicycle □ Struck by...against (assault) □ MVC – Pedestrian □ Bicycle □ Motorcycle □ Other, (Describe):___________ b. □ Penetrating Injury (Select all that apply) □ Gunshot...will be assigned to each eligible subject. A linking log will be kept at each site to track the study ID# with the medical record number of the

  12. Overload blunts baroreflex only in overreached athletes.

    Science.gov (United States)

    Bourdillon, Nicolas; Yazdani, Sasan; Nilchian, Masih; Mariano, Alessio; Vesin, Jean-Marc; Millet, Grégoire P

    2018-01-31

    Heart rate variability (HRV) is commonly used to diagnose overreaching and monitor athletes' responses to training. Baroreflex sensitivity (BRS) is modified by changes in training load and might be another means to detect overreaching. The goal of this study was to assess BRS and HRV changes in two groups of athletes responding either negatively (FOR) or positively (AF) to similar training overload. Fifteen athletes performed 2-week baseline (BSL) training followed by 3-week overload (+45%; OVL) and 2-week recovery (-20%; RCV). HRV, training load and subjective fatigue were measured daily via questionnaires. BRS, salivary cortisol and testosterone, and submaximal exercise and maximal 3-km run performances were measured at the end of each period. Based on their performance change during OVL, 8 athletes were diagnosed as FOR and 7 as AF. Subjective fatigue was increased in FOR athletes during OVL. BRS increased in AF but not in FOR athletes during RCV. At the end of RCV, cortisol and testosterone were higher than BSL in both groups. Three weeks of similar training overload can induce either performance enhancement or overreaching. The changes in submaximal exercise and maximal performances and in subjective fatigue were the fastest-responding parameters that distinguished the two groups of athletes during OVL. Training overload blunted the increase in BRS in FOR only. Most of the differences in BRS were observed during the recovery period. BRS appears to be a more sensitive parameter than HRV for early monitoring of responses to training. Copyright © 2018. Published by Elsevier Ltd.

  13. False negative pericardial Focused Assessment with Sonography for Trauma examination following cardiac rupture from blunt thoracic trauma: a case report.

    Science.gov (United States)

    Baker, Laura; Almadani, Ammar; Ball, Chad G

    2015-07-15

    The Focused Assessment with Sonography for Trauma examination is an invaluable tool in the initial assessment of any injured patient. Although highly sensitive and accurate for identifying hemoperitoneum, occasional false negative results do occur in select scenarios. We present a previously unreported case of survival following blunt cardiac rupture with associated negative pericardial window due to a concurrent pericardial wall laceration. A healthy 46-year-old white woman presented to our level 1 trauma center with hemodynamic instability following a motor vehicle collision. Although her abdominal Focused Assessment with Sonography for Trauma windows were positive for fluid, her pericardial window was negative. After immediate transfer to the operating room in the setting of persistent instability, a subsequent thoracotomy identified a blunt cardiac rupture that was draining into the ipsilateral pleural space via an adjacent tear in the pericardium. The cardiac injury was controlled with digital pressure, resuscitation completed, and then repaired using standard cardiorrhaphy techniques. Following repair of her injuries (left ventricle, left atrial appendage, and liver), her postoperative course was uneventful. Evaluation of the pericardial space using Focused Assessment with Sonography for Trauma is an important component in the initial assessment of the severely injured patient. Even in cases of blunt mechanisms however, clinicians must be wary of occasional false negative pericardial ultrasound evaluations secondary to a concomitant pericardial laceration and subsequent decompression of hemorrhage from the cardiac rupture into the ipsilateral pleural space.

  14. Differential effect of central command on aortic and carotid sinus baroreceptor-heart rate reflexes at the onset of spontaneous, fictive motor activity.

    Science.gov (United States)

    Matsukawa, Kanji; Ishii, Kei; Kadowaki, Akito; Liang, Nan; Ishida, Tomoko

    2012-08-15

    Our laboratory has reported that central command blunts the sensitivity of the aortic baroreceptor-heart rate (HR) reflex at the onset of voluntary static exercise in conscious cats and spontaneous contraction in decerebrate cats. The purpose of this study was to examine whether central command attenuates the sensitivity of the carotid sinus baroreceptor-HR reflex at the onset of spontaneous, fictive motor activity in paralyzed, decerebrate cats. We confirmed that aortic nerve (AN)-stimulation-induced bradycardia was markedly blunted to 26 ± 4.4% of the control (21 ± 1.3 beats/min) at the onset of spontaneous motor activity. Although the baroreflex bradycardia by electrical stimulation of the carotid sinus nerve (CSN) was suppressed (P activity was much weaker (P abdominal aorta was blunted to 36% of the control (36 ± 1.6 beats/min) during spontaneous motor activity, suggesting that central command is able to inhibit the cardiomotor sensitivity of arterial baroreflexes as the net effect. Mechanical stretch of the triceps surae muscle never affected the baroreflex bradycardia elicited by AN or CSN stimulation and by aortic occlusion, suggesting that muscle mechanoreflex did not modify the cardiomotor sensitivity of aortic and carotid sinus baroreflex. Since the inhibitory effect of central command on the carotid baroreflex pathway, associated with spontaneous motor activity, was much weaker compared with the aortic baroreflex pathway, it is concluded that central command does not force a generalized modulation on the whole pathways of arterial baroreflexes but provides selective inhibition for the cardiomotor component of the aortic baroreflex.

  15. Clinical characteristics of external iliac artery branch injury in pelvic trauma.

    Science.gov (United States)

    Tanizaki, Shinsuke; Maeda, Shigenobu; Ishida, Hiroshi; Yamamoto, Toru; Yoshikawa, Jun

    2017-11-01

    The clinical characteristics of an injury of external iliac artery branches in blunt pelvic trauma have not yet been sufficiently studied. We evaluated the relationship between injury characteristics and the presence of an injury to external iliac artery branches in blunt pelvic trauma. A retrospective review of patients admitted with blunt pelvic trauma was conducted over an 11-year period. Charts were reviewed for age, gender, injury characteristics, injury severity score, length of stay in the intensive care unit, transfusion requirements, and fracture pattern. Of 286 blunt pelvic trauma patients, 90 patients (31%) underwent pelvic angiography. Of those patients, 10 (11%) had the injuries of the branches of external iliac artery and 88 (97%) had the injuries of the branches of internal iliac artery. Those patients with external iliac artery branch injuries were significantly associated with hemodynamic instability, when compared to those without external iliac artery branch injuries. There were no significant differences between the patients with and without external iliac artery branch injury with regard to the anatomical characteristics of pelvic trauma. Blunt pelvic trauma with hemodynamic instability may be associated with concomitant external iliac artery branch injury. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Imaging evaluation of blunt renal trauma in children: diagnostic accuracy of intravenous pyelography and ultrasonography

    International Nuclear Information System (INIS)

    Mayor, B.; Gudinchet, F.; Wicky, S.; Reinberg, O.; Schnyder, P.

    1995-01-01

    Forty-six consecutive children with blunt renal injury were evaluated retrospectively to assess the diagnostic accuracy of the different imaging methods, including ultrasonography (US), intravenous pyelography (IVP), and computed tomography (CT), and to determine the optimal radiologic management. Doppler ultrasonography was never performed in an emergency. Classification of the 46 renal injuries was as follows: 25 contusions, 4 lacerations, 11 ruptures, and 6 pedicle injuries. The diagnostic accuracy of IVP (80.8 %) was superior to the diagnostic accuracy of US (41 %) in all types of renal injuries. IVP should be performed as an emergency procedure when macroscopic hematuria is present, or when an isolated renal injury is clinically suspected. Microscopic hematuria alone is no longer an indication to perform IVP. Asymptomatic patients with microscopic hematuria should have US examination and should be observed with performance of serial urine analyses. Multiply injured and hemodynamically stable children should be evaluated by contrast-enhanced CT. Hemodynamically unstable children should undergo immediate exploratory laparotomy, if it is indicated after assessment by imaging. (orig.)

  17. Acute Aortic Arch Perforation During Transcatheter Aortic Valve Replacement in Bicuspid Aortic Stenosis and a Gothic Aortic Arch

    DEFF Research Database (Denmark)

    Millan-Iturbe, Oscar; Sawaya, Fadi J.; Bieliauskas, Gintautas

    2017-01-01

    AS because of its unique anatomic features. This case report describes an acute aortic perforation during delivery of a transcatheter heart valve to treat a severe bicuspid AS with a “gothic aortic arch”; more careful evaluation of the preprocedural multislice computed tomographic scan would have unveiled...

  18. Will Transcatheter Aortic Valve Replacement (TAVR be the Primary Therapy for Aortic Stenosis?

    Directory of Open Access Journals (Sweden)

    Jose F. Condado, MD, MS

    2016-05-01

    Full Text Available Transcatheter aortic valve replacement (TAVR is increasingly used for the treatment of high or very high surgical risk patients with severe aortic stenosis (AS or failing surgical bioprosthesis (valve-in-valve, VIV-TAVR. In TAVR, the collapsed transcatheter heart valve (THV is introduced using the delivery system inserted from the femoral artery (preferred or other alternative accesses (transapical, transaortic, transcarotid, subclavian/transinnominate or transcaval. The delivery system is then advanced until coaxially aligned with the aortic annulus, where the THV is deployed. This procedure can be associated with complications such as access site injury (vascular complication, paravalvar leak, cerebrovascular events and conduction disturbances. However, the rapid acceptance and successes observed with TAVR have been made possible through careful patient selection, preprocedural planning (i.e. MDCT annular sizing, THV technology (i.e. new generation valves, and procedural techniques (i.e. minimalist TF-TAVR and alternative percutaneous access options, as well as a decrease in complications as TAVR experience grows. Though the results or ongoing clinical trials evaluating TAVR in intermediate surgical risk patients are pending, it is likely that TAVR will soon be approved for lower risk patients as well.

  19. Acute Type II Aortic Dissection with Severe Aortic Regurgitation and Chronic Descending Aortic Dissection in Pregnant Patient with Marfan Syndrome.

    Science.gov (United States)

    Lee, Seok-Soo; Jung, Tae-Eun; Lee, Dong Hyup

    2012-12-01

    Aortic dilatation and dissection are severe complications during pregnancy that can be fatal to both the mother and the fetus. The risks of these complications are especially high in pregnant patients with Marfan syndrome; however, incidents of descending aortic dissection are very rare. This case report involves a successful Bentall procedure for and recovery from a rare aortic dissection in a pregnant Marfan patient who developed acute type II aortic dissection with severe aortic regurgitation and chronic descending aortic dissection immediately after Cesarean section. Regular follow-up will be needed to monitor the descending aortic dissection.

  20. Cost-effectiveness of the Cardiac Component of the Focused Assessment of Sonography in Trauma Examination in Blunt Trauma.

    Science.gov (United States)

    Hall, M Kennedy; Omer, Talib; Moore, Chris L; Taylor, R Andrew

    2016-04-01

    Blunt cardiac injury severe enough to require surgical intervention (sBCI) is an exceedingly rare event occurring in approximately 1 out of every 1600 trauma patients. While performing the cardiac component of the Focused Assessment of Sonography in Trauma (cFAST) exam is effective in penetrating trauma, it is unclear whether it is of value in blunt trauma given the low prevalence of sBCI, the imperfect test characteristics of the FAST exam, and the rate of incidental pericardial effusion. The objective was to determine through decision analysis whether performing the cFAST exam is cost-effective in the evaluation of hypotensive and normotensive blunt trauma patients. We created two decision analytic models using commercially available software (TreeAgePro2011) to evaluate the cost-effectiveness of the cFAST in hypotensive (systolic blood pressure blunt trauma patients. Clinical probabilities were obtained from published data. Costs were estimated from Medicare reimbursement and charge data. The willingness-to-pay threshold was $50,000/quality-adjusted life-years (QALYs). Sensitivity analyses were performed over plausible ranges using available literature. In hypotensive patients, for the base case scenario of a 34-year-old with blunt trauma, the cFAST strategy had a cost of $42,882.70 and an effectiveness of 25.3597 QALYs, whereas the no cFAST strategy had a cost of $42,753.52 and an effectiveness of 25.3532 QALYs. The incremental cost-effectiveness ratio (ICER) was $19,918/QALY. For normotensive patients the cFAST strategy had a cost of $18,331.03 and an effectiveness of 23.2817 QALYs, whereas the no cFAST strategy had a cost of $18,207.58 and an effectiveness of 23.2814 QALYs. The ICER was $465,867/QALY. In the sensitivity analyses, age, probability of death from sBCI with prompt treatment, and probability of sBCI were the main drivers of variability in the model outcomes. The cFAST for blunt trauma is cost-effective for hypotensive but not for normotensive

  1. Minimally invasive aortic valve replacement

    DEFF Research Database (Denmark)

    Foghsgaard, Signe; Schmidt, Thomas Andersen; Kjaergard, Henrik K

    2009-01-01

    In this descriptive prospective study, we evaluate the outcomes of surgery in 98 patients who were scheduled to undergo minimally invasive aortic valve replacement. These patients were compared with a group of 50 patients who underwent scheduled aortic valve replacement through a full sternotomy...... operations were completed as mini-sternotomies, 4 died later of noncardiac causes. The aortic cross-clamp and perfusion times were significantly different across all groups (P replacement...... is an excellent operation in selected patients, but its true advantages over conventional ao