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Sample records for blunt head trauma

  1. Blunt Head Trauma and Headache

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    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.

  2. Pseudopancreatitis on computed tomography in a patient with isolated blunt head trauma: a case report

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    Cheng, Ah-Ling; Lang, Eddy S

    2014-01-01

    Introduction Computed tomography is commonly used to exclude occult injuries in patients with trauma, but imaging can reveal findings that are of uncertain etiology or clinical significance. We present a case of unsuspected pancreatic abnormality in a female patient with trauma who sustained an isolated blunt head injury. Case presentation A 25-year-old female Caucasian patient sustained massive blunt and penetrating head trauma, secondary to a large object penetrating through the vehicle win...

  3. 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

  4. Neuroprotective effects of tetracyclines on blunt head trauma: An experimental study on rats

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    Ozhan Merzuk Uckun

    2015-01-01

    Full Text Available Background: Prevention of primary damage caused by head trauma may be avoided with protective measures and techniques which is a public health concern. Experimental and clinical studies about treatment of head trauma were all centered to prevent secondary damage caused by physiopathological changes following primary injury. Neuroprotective features of tetracyclines were the focus of several experimental studies in the last decade. In the present study we aimed to investigate the neuroprotective effects of tetracycline in an experimental model of blunt brain injury in rats. Materials and Methods: 32 male Sprague-Dawley rats were divided into four experimental groups (n = 8. Head trauma was not performed in control group (group 1, craniectomy only. In the second group, head trauma and craniectomy were performed. Intraperitoneal saline was used in addition to trauma and craniectomy for treatment in group 3 whereas intraperitoneal tetracycline and saline were used for treatment in group 4. Results: When histological examinations performed by transmission electron microscopy were evaluated, injury at ultrastructural level was demonstrated to be less pronounced in tetracycline group with decreased lipid peroxidation levels. Conclusion: In accordance with these findings, we conclude that systemic tetracycline administration is effective in reduction of secondary brain damage and brain edema and thus it may be considered as a therapeutic option.

  5. Politraumatizados com trauma craniencefálico grave: importância das lesões abdominais associadas Severe blunt head trauma: the relevance of associated abdominal lesions

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    José Gustavo Parreira

    2001-10-01

    Full Text Available OBJETIVO: Analisar as lesões abdominais dos politraumatizados com trauma craniencefálico (TCE grave. MÉTODO: Realizou-se avaliação retrospectiva dos prontuários das vítimas de TCE no período de 1996 a 1997. Foram selecionados para o estudo os com Escala de Coma de Glasgow (ECG BACKGROUND: The present study was carried out to analyze the abdominal lesions in victims of multiple trauma sustaining severe blunt head trauma. METHODS: We retrospectively reviewed charts and trauma protocols of patients admitted from January 1996 to July 1997, who sustained blunt head trauma and underwent head CT Scan. Those admitted with a Glasgow Coma Score (GCS < 8 were selected for this study. There were 52 patients who fulfilled the inclusion criteria, 44 male and 8 female, with a mean age of 37 years. Demographic data, mechanism of injury, trauma indices (RTS and ISS, diagnostic exams, treatment and evolution were evaluated. We employed the X² test, Student - t test, and Fisher exact test for the statistical analysis. RESULTS: Pedestrian versus auto was the most frequent mechanism of trauma, occurring in 25 cases. The mean RTS and ISS were 5.18 and 27 respectively. None of these patients had the diagnosis of abdominal lesion based only in physical examination. Forty four were assessed with diagnostic peritoneal lavage and 8 with abdominal ultrasound or computed tomography. Eight (15% patients sustained abdominal lesions, including 5 hepatic, 4 splenic and one colonic injury. There were 17 craniotomies and 8 laparotomies (4 non therapeutic. A higher incidence of abdominal lesions was observed in patients sustaining either shock on admission or orthopedic lesions requiring surgical repair. The mortality was 71%. CONCLUSION: Considering the incidence of abdominal lesions and the difficulties for their diagnosis in those patients sustaining severe head trauma, the objective assessment of abdomen by complementary methods is advisable in all cases.

  6. MDCT in blunt intestinal trauma

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    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.

  7. Imaging of blunt chest trauma

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    Wicky, S.; Wintermark, M.; Schnyder, P.; Capasso, P.; Denys, A. [Centre Hospitalier Universitaire Vaudois, Lausanne (Switzerland). Dept. of Radiology

    2000-10-01

    In western European countries most blunt chest traumas are associated with motor vehicle and sport-related accidents. In Switzerland, 39 of 10,000 inhabitants were involved and severely injured in road accidents in 1998. Fifty two percent of them suffered from blunt chest trauma. According to the Swiss Federal Office of Statistics, traumas represented in men the fourth major cause of death (4 %) after cardiovascular disease (38 %), cancer (28 %), and respiratory disease (7 %) in 1998. The outcome of chest trauma patients is determined mainly by the severity of the lesions, the prompt appropriate treatment delivered on the scene of the accident, the time needed to transport the patient to a trauma center, and the immediate recognition of the lesions by a trained emergency team. Other determining factors include age as well as coexisting cardiac, pulmonary, and renal diseases. Our purpose was to review the wide spectrum of pathologies related to blunt chest trauma involving the chest wall, pleura, lungs, trachea and bronchi, aorta, aortic arch vessels, and diaphragm. A particular focus on the diagnostic impact of CT is demonstrated. (orig.)

  8. Major gastroenteric injuries from blunt trauma.

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    Talton, D S; Craig, M H; Hauser, C J; Poole, G V

    1995-01-01

    Hollow visceral injuries are far less common in blunt abdominal trauma than in penetrating abdominal trauma. From 1982 through 1993 we treated 50 patients with 57 major blunt injuries to the gut, defined as perforation, transection, or devascularization. Thirty-two patients (64%) were injured in motor vehicle collisions. Of these, 29 wore no restraints; three were wearing lap belts (none wore lap-shoulder restraints). Mean injury Severity Score (ISS) in patients wearing lap belts was 13.3, compared with 28.6 in the 29 patients who were not using restraint devices (P injuries, followed by devascularization of the small bowel, colorectal injuries, duodenal, and gastric perforations. ISS and mortality rates were lowest in small bowel injuries and higher in the less common colonic and gastroduodenal injuries. Except for those patients with perforations of the small bowel, most patients had associated injuries to the head, chest, or abdominal solid organs that were largely responsible for morbidity and mortality. Injuries to the abdominal hollow viscera are unusual following blunt trauma, but are the result of very high energy truncal trauma, and are associated with multiple additional injuries. Most alert patients had physical findings suggestive of peritoneal irritation, but when diagnostic testing was necessary, peritoneal lavage was superior to computed tomography scanning (false negatives = 6.7% versus 36%, respectively; P < 0.05). A high index of suspicion is necessary to avoid diagnostic delays that can lead to severe complications and death.

  9. Multidetector CT of blunt abdominal trauma.

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    Soto, Jorge A; Anderson, Stephan W

    2012-12-01

    The morbidity, mortality, and economic costs resulting from trauma in general, and blunt abdominal trauma in particular, are substantial. The "panscan" (computed tomographic [CT] examination of the head, neck, chest, abdomen, and pelvis) has become an essential element in the early evaluation and decision-making algorithm for hemodynamically stable patients who sustained abdominal trauma. CT has virtually replaced diagnostic peritoneal lavage for the detection of important injuries. Over the past decade, substantial hardware and software developments in CT technology, especially the introduction and refinement of multidetector scanners, have expanded the versatility of CT for examination of the polytrauma patient in multiple facets: higher spatial resolution, faster image acquisition and reconstruction, and improved patient safety (optimization of radiation delivery methods). In this article, the authors review the elements of multidetector CT technique that are currently relevant for evaluating blunt abdominal trauma and describe the most important CT signs of trauma in the various organs. Because conservative nonsurgical therapy is preferred for all but the most severe injuries affecting the solid viscera, the authors emphasize the CT findings that are indications for direct therapeutic intervention. PMID:23175542

  10. Management of blunt hepatic trauma.

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    Letoublon, C; Amariutei, A; Taton, N; Lacaze, L; Abba, J; Risse, O; Arvieux, C

    2016-08-01

    For the last 20 years, nonoperative management (NOM) of blunt hepatic trauma (BHT) has been the initial policy whenever this is possible (80% of cases), i.e., in all cases where the hemodynamic status does not demand emergency laparotomy. NOM relies upon the coexistence of three highly effective treatment modalities: radiology with contrast-enhanced computerized tomography (CT) and hepatic arterial embolization, intensive care surveillance, and finally delayed surgery (DS). DS is not a failure of NOM management but rather an integral part of the surgical strategy. When imposed by hemodynamic instability, the immediate surgical option has seen its effectiveness transformed by development of the concept of abbreviated (damage control) laparotomy and wide application of the method of perihepatic packing (PHP). The effectiveness of these two conservative and cautious strategies for initial management is evidenced by current experience, but the management of secondary events that may arise with the most severe grades of injury must be both rapid and effective. PMID:27519150

  11. Blunt force trauma to skull with various instruments.

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    Sulaiman, Nur Amirah; Osman, Khairul; Hamzah, Noor Hazfalinda; Amir, Sri Pawita Albakri

    2014-04-01

    Deaths due to blunt force trauma to the head as a result of assault are some of the most common cases encountered by the practicing forensic pathologist. Previous studies have shown inflicting injury to the head region is one of the most effective methods of murder. The important factors that determine severity of trauma include the type of weapon used, type and site of skull fracture, intracranial haemorrhage and severity of brain injury. The aim of this study was to determine the characteristics of blunt force trauma to the skull produced by different instruments. Nine adult monkeys (Macaca fascicularis) skulls were used as models. Commonly found blunt objects comprising of Warrington hammer, hockey stick and open face helmet were used in this study. A machine calibrated force generator was used to hold the blunt object in place and to hit the skulls at forces of 12.5N and 25N. Resultant traumatic effects and fractures (linear, depressed, basilar, comminuted, and distastic) were analyzed according to type of blunt object used; surface area of contact and absolute force (N/cm(2)) delivered. Results showed that all investigated instruments were capable of producing similar injuries. The severity of trauma was not related to the surface area of contact with the blunt objects. However, only high absolute forces produced comminuted fractures. These findings were observational, as the samples were too small for statistical conclusions. PMID:24763233

  12. Head Trauma, First Aid

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    ... rashes clinical tools newsletter | contact Share | Head Trauma, First Aid A A A Head trauma signs and symptoms ... to take care for potential neck/spinal injury. First Aid Guide If you suspect either a serious head ...

  13. Blunt pancreatic trauma. Role of CT

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    Procacci, C. [Dept. of Radiology, Univ. Hospital, Verona (Italy); Graziani, R. [Dept. of Radiology, Univ. Hospital, Verona (Italy); Bicego, E. [Dept. of Radiology, Univ. Hospital, Verona (Italy); Mainardi, P. [Dept. of Radiology, Univ. Hospital, Verona (Italy); Bassi, C. [Dept. of Surgery, Univ. Hospital, Verona (Italy); Bergamo Andreis, I.A. [Dept. of Radiology, Univ. Hospital, Verona (Italy); Valdo, M. [Dept. of Radiology, Univ. Hospital, Verona (Italy); Guarise, A. [Dept. of Radiology, Univ. Hospital, Verona (Italy); Girelli, M. [Dept. of Radiology, Univ. Hospital, Verona (Italy)

    1997-07-01

    Purpose: To define the evolution patterns of blunt pancreatic trauma, and to point out the CT features most significant for the diagnosis. Material and Methods: Ten cases of pancreatic trauma, observed over a period of about 10 years, were analyzed in retrospect. The cases were divided into 3 groups according to the time that had elapsed between trauma and first CT: Early phase (within 72 h: n=3/10); late phase (after 10 days: n=3/10); and following pancreatic drainage (n=4/10). Results: In the early phase, one case showed a blood collection surrounding the pancreatic head and duodenum, and displacing the mesenteric vessels to the left. In the 2 other cases it was possible to demonstrate a tear in the pancreas at the neck, perpendicular to the main pancreatic axis. In the late phase in all 3 cases, one cystic lesion was present at the site of the tear, either surrounding the gland or embedded - more or less deeply - within the parenchyma. One of the lesions subsided spontaneously; the 2 others required surgery. In the postoperative phase, an external fistula was demonstrated in 2 cases following percutaneous drainage of pancreatic cysts; the fistula was fed by a cystic lesion in the pancreatic neck. In the 2 other cases a pseudocyst developed. (orig.).

  14. Cardiac injuries in blunt chest trauma

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    Tobon-Gomez Catalina

    2009-09-01

    Full Text Available Abstract Blunt chest traumas are a clinical challenge, both for diagnosis and treatment. The use of Cardiovascular Magnetic Resonance can play a major role in this setting. We present two cases: a 12-year-old boy and 45-year-old man. Late gadolinium enhancement imaging enabled visualization of myocardial damage resulting from the trauma.

  15. Cardiac injuries in blunt chest trauma

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    Tobon-Gomez Catalina; Huguet Marina; Bijnens Bart H; Frangi Alejandro F; Petit Marius

    2009-01-01

    Abstract Blunt chest traumas are a clinical challenge, both for diagnosis and treatment. The use of Cardiovascular Magnetic Resonance can play a major role in this setting. We present two cases: a 12-year-old boy and 45-year-old man. Late gadolinium enhancement imaging enabled visualization of myocardial damage resulting from the trauma.

  16. Contemporary management of blunt aortic trauma.

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    Dubose, J J; Azizzadeh, A; Estrera, A L; Safi, H J

    2015-10-01

    Blunt thoracic aortic injury (BTAI) remains a common cause of death following blunt mechanisms of trauma. Among patients who survive to reach hospital care, significant advances in diagnosis and treatment afford previously unattainable survival. The Society for Vascular Surgery (SVS) guidelines provide current best-evidence suggestions for treatment of BTAI. However, several key areas of controversy regarding optimal BTAI care remain. These include the refinement of selection criteria, timing for treatment and the need for long-term follow-up data. In addition, the advent of the Aortic Trauma Foundation (ATF) represents an important development in collaborative research in this field. PMID:25868973

  17. Isolated renal pelvis rupture secondary to blunt trauma: Case report

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    Kerem Taken

    2015-01-01

    Conclusion: Renal pelvic injury must be considered in the differential diagnosis of blunt trauma. Surgical intervention may be necessary in some cases. We present a case who underwent surgery due to isolated renal pelvis rupture caused by blunt abdominal trauma.

  18. Cardiogenic shock following blunt chest trauma

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    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.

  19. 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.

  20. Complimentary imaging technologies in blunt ocular trauma

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    Anton M Kolomeyer

    2013-01-01

    Full Text Available We describe complimentary imaging technologies in traumatic chorioretinal injury. Color and fundus autofluorescence (FAF images were obtained with a non-mydriatic retinal camera. Optical coherence tomography (OCT helped obtain detailed images of retinal structure. Microperimetry was used to evaluate the visual function. A 40-year-old man sustained blunt ocular trauma with a stone. Color fundus image showed a large chorioretinal scar in the macula. Software filters allowed detailed illustration of extensive macular fibrosis. A 58-year-old man presented with blunt force trauma with a tennis ball. Color fundus imaging showed a crescentric area of macular choroidal rupture with fibrosis. FAF imaging delineated an area of hypofluorescence greater on fundus imaging. OCT showed chorioretinal atrophy in the macula. Microperimetry delineated an absolute scotoma with no response to maximal stimuli. Fundus imaging with digital filters and FAF illustrated the full extent of chorioretinal injury, while OCT and microperimetry corroborated the structure and function correlations.

  1. CT of blunt chest trauma in children

    International Nuclear Information System (INIS)

    While trauma is still the leading cause of death in the pediatric age range, it is surprising how little the CT appearances of pediatric chest injury have been investigated in the literature. We have reviewed the CT findings of blunt chest trauma in 44 children for whom chest CT examinations were requested to investigate the extent of intrathoracic injury. We noted a propensity for pulmonary contusions to be located posteriorly or posteromedially, and for them to be anatomically nonsegmental and crescentic in shape. This is possibly attributable to the relatively compliant anterior chest wall in children. The CT appearances of other major thoracic injuries are described, including pulmonary lacerations, pneumothoraces, malpositioned chest tubes, mediastinal hematomas, aortic injury, tracheobronchial injury, hemopericardium, and spinal injuries with paraspinal fluid collections. Children demonstrating findings incidental to the actual injury yet important to the subsequent therapy are also presented. We conclude that, in the event of clinically significant blunt chest trauma, the single supine chest examination in the trauma room is insufficient to adequately identify the extent of intrathoracic injury. With the exception of concern for aortic injury for which aortography is indicated, a dynamically enhanced CT scan of the thorax should be performed as clinically significant findings may result in altered therapy. (orig.)

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

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    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

  3. Segmental Renal Infarction due to Blunt Trauma.

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    Alevizopoulos, Aristeidis; Hamilton, Lauren; Stratu, Natalia; Rix, Gerald

    2016-05-01

    Segmental renal infarction is a rare situation which has been reported so far in the form of case reports. It's caused usually by cardiac conditions, such as atrial fibrillation, and systemic diseases (e.g. systemic lupus erythematous). We are presenting a case of a 31 year old healthy male, who sustained a left segmental renal infarction, following a motorbike accident. We report his presentation, management and outcome. We also review the literature in search of the optimal diagnostic and treatment pathway. To our knowledge, this is the first report of segmental renal infarction due to blunt trauma.

  4. CT of blunt hepatic trauma in children

    International Nuclear Information System (INIS)

    CT findings of blunt hepatic trauma were studied in 27 children. Liver injury was classified into 3 types from mild to severe. Liver contusion was observed in 1, liver laceration in 21, and liver rupture in 5. Only 2 patients (7.4%) required surgery, and the others could be managed by conservative therapy. CT, which accurately reveals not only the severity of liver injury but also injuries of other abdominal organs and intraperitoneal bleeding, is important for the diagnosis of liver injury and determination of its treatment. (author)

  5. Pediatric blunt splenic trauma: a comprehensive review

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    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.)

  6. Unrecognized blunt tracheal trauma with massive pneumomediastinum and tension pneumothorax

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    Nanda Shetty; H M Krishna; Elsa Varghese; Subhashree, J; Arushi Gupta

    2011-01-01

    Blunt neck trauma with an associated laryngotracheal injury is rare. We report a patient with blunt neck trauma who came to the emergency room and was sent to ward without realizing the seriousness of the situation. He presented later with respiratory distress and an anesthesiologist was called in for emergency airway management. Airway management in such a situation is described in this report.

  7. Aortic bifurcation tear following blunt trauma in childhood

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    Shlomo Yellinek; Dimitri Gimelrich; Ofer Merin; Petachia Reissman; Marc Arkovitz

    2015-01-01

    Rupture of the abdominal aorta from blunt trauma is rare and aortic biforcation tear is extremely rare. We will present the management of a 2 year old boy who suffered blunt abdominal trauma and was operated in urgent fashion in our institution.

  8. A RETROSPECTIVE STUDY OF BLUNT TRAUMA ABDOMEN

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    Kumawat

    2015-07-01

    Full Text Available BACKGROUND: Blunt abdominal trauma is one of the important components of poly - trauma. It requires suspicion, investigation and proper management in time, to avoid morbidity & mortality. AIM: The aim of this retrospective study spanning 5 years w.e.f. Jan, 2010 to December, 2014 in this tertiary care institute of Geetanjali Medical College & Hospital, Udaipur was to find out BTA patients in RTA, fall from height, and assault like injuries. We studied type of injuries, male - female ratio, age group, urban & rural population involvement & their operative & non - operative management. MATERIAL & METHOD S : The study is based on 273 cases of BTA; managed in this institute from admission, investigation, management & possible follow up. Observations are depicted in different tables. RESULT: Liver is most commonly involved organ followed by spleen, kidney & pancreas respectively. Initially solid organ injuries cases where treated by surgery, but than non - operative management are tried in haemostatically stable patients. Hollow visceral injuries were always managed by laparotomy & repair or resection as and when needed . Mortality occurred in 35 patients out 273 patients because of delay to reach hospital or septicemia, renal failure and shock due to multi organ failure. CONCLUSION: Close supervision with sophisticated infrastructure and quick action significantly reduces mortality.

  9. Isolated duodenal rupture due to blunt abdominal trauma

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    Celik Atilla

    2006-01-01

    Full Text Available Duodenal rupture following blunt abdominal trauma is rare and it usually seen with other abdominal organ injuries. It represents approximately 2% to 20% of patients with blunt abdominal injury and often occurs after blows to the upper abdomen, or abdominal compression from high-riding seat belts. Two cases of blunt duodenal rupture successfully treated surgically, are presented with their preoperative diagnosis and final out comes.

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

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    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.

  11. Unrecognized blunt tracheal trauma with massive pneumomediastinum and tension pneumothorax

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    Nanda Shetty

    2011-01-01

    Full Text Available Blunt neck trauma with an associated laryngotracheal injury is rare. We report a patient with blunt neck trauma who came to the emergency room and was sent to ward without realizing the seriousness of the situation. He presented later with respiratory distress and an anesthesiologist was called in for emergency airway management. Airway management in such a situation is described in this report.

  12. The molecular fingerprint of lung inflammation after blunt chest trauma

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    Ehrnthaller, Christian; Flierl, Michael; Perl, Mario; Denk, Stephanie; Unnewehr, Heike; Ward, Peter A.; Radermacher, Peter; Ignatius, Anita; Gebhard, Florian; Chinnaiyan, Arul; Huber-Lang, Markus

    2015-01-01

    Background After severe blunt chest trauma, the development of an acute lung injury (ALI) is often associated with severe or even lethal complications. Especially in multiple injured patients after blunt chest trauma ALI/ARDS [acute respiratory distress syndrome (ARDS)] is frequent. However, in the initial posttraumatic phase, inflammatory clinical signs are often not apparent and underlying changes in gene-expression profile are unknown. Methods Therefore, inflammation in lung tissue followi...

  13. Bedside Ultrasound in a Case of Blunt Scrotal Trauma

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    Mark Cannis

    2013-03-01

    Full Text Available This case study describes a patient who suffered blunt force trauma to the scrotum. Use of bedsideemergency ultrasound facilitated early diagnosis of a ruptured testicle and allowed for prompturological consultation and timely surgical repair. The utility of bedside emergency ultrasound inthe evaluation of testicular trauma, as well as the outcome of our case, is discussed here.

  14. Pancreatic laceration and portal vein thrombosis in blunt trauma abdomen

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    Rastogi Rajul

    2008-01-01

    Full Text Available Injuries to the pancreas by blunt trauma are uncommon. The association of pancreatic injury with acute portal vein thrombosis secondary to blunt trauma abdomen is furthermore rare. The early diagnosis of the pancreas with injury to the portal vein is challenging and difficult. These injuries are associated with high morbidity and mortality, particularly if the diagnosis is delayed. Accurate and early diagnosis is therefore imperative and computed tomography plays a key role in detection. We present a case of child with a rare combination of pancreatic laceration and acute portal vein thrombosis following a blunt trauma to the abdomen. With extensive literature search we found no such cases has been described previously.

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

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    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.

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

    International Nuclear Information System (INIS)

    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.

  17. CT of blunt trauma to the bowel and mesentery.

    Science.gov (United States)

    Nghiem, H V; Jeffrey, R B; Mindelzun, R E

    1993-01-01

    The high mortality and morbidity rates associated with traumatic rupture of the hollow viscera have been attributed to the clinical difficulty in establishing an early diagnosis. CT has been shown to be accurate for detecting bowel and mesenteric injuries caused by blunt trauma and may be useful in predicting the need for either surgical repair or conservative management. However, many major gastrointestinal injuries have subtle CT findings. In this pictorial essay, we illustrate the broad spectrum of gastrointestinal abnormalities that can be shown by CT in patients with blunt abdominal trauma.

  18. Severe Pulmonary Valve Regurgitation 40 Years After Blunt Chest Trauma.

    Science.gov (United States)

    Fuglsang, Simon; Heiberg, Johan; Hjortdal, Vibeke Elisabeth

    2015-10-01

    Severe pulmonary valve regurgitation caused by a pulmonary valve tear is a rare complication to a blunt chest trauma. In this case report, we present a patient with pulmonary regurgitation originating from a chest trauma 40 years ago. Possible mechanisms are osseous pinch of the pulmonary valve between the anterior chest wall and the vertebral column, and retrograde blowout from severe compression of the lungs. PMID:26434447

  19. Optic Nerve Avulsion after Blunt Trauma

    Directory of Open Access Journals (Sweden)

    Hacı Halil Karabulut

    2014-05-01

    Full Text Available Optic nerve avulsion is an uncommon presentation of ocular trauma with a poor prognosis. It can be seen as complete or partial form due to the form of trauma. We assessed the complete optic nerve avulsion in a 16-year-old female patient complaining of loss of vision in her left eye after a traffic accident. (Turk J Ophthalmol 2014; 44: 249-51

  20. A rare case of blunt thoracoabdominal trauma with small bowel perforation from air bags.

    Science.gov (United States)

    Liverani, A; Pezzatini, M; Conte, S; Mari, F; Milillo, A; Gasparrini, M; Marino, G; Catracchia, V; -Favi, F

    2009-05-01

    Vehicle collisions represent more than 75% of mechanism of blunt abdominal trauma. In spite of the incomparable improvement of car safety devices, recent studies pointed out that the air bags might cause injuries, specially when it is not associated with seatbelt. In fact, some studies pointed out that crash victims using air bags alone have increased injury severity, hospitalisations, thoracoabdominal procedure, and rehabilitation. Some of the most frequently injured organs reported from air bag deployment are the liver (38%), the spleen (23%) and digestive system (17%). Injury of the hollow viscera are far less common. In particular, blunt abdominal trauma resulting in small bowel perforation is an infrequent lesion. These injuries are difficult to diagnose because specific signs are poor and a delay in treatment increases mortality and morbidity of the patients. We describe a case of thoracoabdominal trauma that occurred during a head-on collision after an air bag deployment without seatbelt use.

  1. Traumatic pseudocyst due to blunt trauma: Case report.

    Science.gov (United States)

    Becel, Sinan; Oztok, Beliz; Kurtoglu Celik, Gulhan; Icme, Ferhat; Sener, Alp; Pamukcu Gunaydin, Gul

    2015-09-01

    Damage to lung parenchyma due to blunt thoracic trauma often appears as contusion or hematoma. Cavitary lung lesions or pseudocyst formation due to trauma is a rare phenomenon. In the literature traumatic pseudocysts are also known as pseudocystic hematomas, traumatic lung cavity and traumatic pneumotocel. Traumatic pseudocysts usually have good clinical prognosis, recover spontaneously with supportive treatment and do not require surgery. In this article, we present the case of 52 year old male who was brought to the emergency department after a fall from height and was diagnosed with lung contusions and traumatic cyst. PMID:27239612

  2. Renal Pelvis Injury in Case of Blunt Trauma Abdomen

    Directory of Open Access Journals (Sweden)

    Rajendra B. Nerli

    2015-07-01

    Full Text Available Isolated renal pelvis/upper ureteric injuries are uncommon in a case of blunt abdominal trauma. These injuries are associated with fractures of transverse process of the adjoining vertebrae. We report a case of such a case in a 35 year old male involved in road traffic accident. He underwent exploration and repair of the right UPJ/Upper ureteric injury. This case presented with injury to the transverse processes on the left side, which is unusual.

  3. 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.

  4. Acute aortic and mitral valve regurgitation following blunt chest trauma.

    Science.gov (United States)

    Bernabeu, Eduardo; Mestres, Carlos A; Loma-Osorio, Pablo; Josa, Miguel

    2004-03-01

    Traumatic rupture of intracardiac structures is an uncommon phenomenon although there are a number of reports with regards to rupture of the tricuspid, mitral and aortic valves. We report the case of a 25-year-old patient who presented with acute aortic and mitral valve regurgitation of traumatic origin. Both lesions were seen separated by 2 weeks. Pathophysiology is reviewed. The combination of both aortic and mitral lesions following blunt chest trauma is almost exceptional.

  5. Abusive Head Trauma (Shaken Baby Syndrome)

    Science.gov (United States)

    ... Things to Know About Zika & Pregnancy Abusive Head Trauma (Shaken Baby Syndrome) KidsHealth > For Parents > Abusive Head ... babies tend to cry the most. How These Injuries Happen Abusive head trauma results from injuries caused ...

  6. Diagnostic accuracy of CT scan in abdominal blunt trauma

    Institute of Scientific and Technical Information of China (English)

    Javad Salimi; Khadyjeh Bakhtavar; Mehdi Solimani; Patrcia Khashayar; Ali Pasha Meysamie; Moosa Zargar

    2009-01-01

    Obiective: To evaluate the sensitivity and specificity of CT scan findings in Patients ith blunt abdominal trauma admitted to the university hospital.Methods: All the atients ith blunt abdominal trauma admitted at a tertiary teaching trauma center in Iran between 2005 and 2007 were enrolled in this study.In the absence of any clinical anifestations,he patients underwent a diagnostic CT scan.Laparatomy was performed in those with positive CT results.Others were observed for 48 hours and discharged in case no problem as reported;otherwise they underwent laparatomy.Information on patients'demographic ata,mechanism of trauma,indication for CT scan,CT scan findings,results of laparotomy ere gathered.The sensitivity,specificity and accuracy of the CT-scan images in regard ith the organ injured were calculated.The sensitivity,specificity and accuracy of the T scan were calculated in each case.Results: CT Scan had the highest sensitivity for etecting the injuries to liver (100%) and spleen (86.6%).The specificity of the method or detecting retroperitoneal hematoma (100%) and injuries to kidney (93.5%) was higher han other organs.The accuracy of CT images to detect the injuries to spleen,liver,idney and retroperitoneal hematoma was reported to be 96.1%,94.4%,91.6% and 91.6% espectively.Conclusion: The findings of the present study reveal that CT scan could econsidered as a good choice,especially for patients with blunt abdominal trauma in eaching hospitals where the radiologic academic staff is not present in the hospital in the night shifts.

  7. Imaging of blunt chest trauma; Bildgebung des stumpfen Thoraxtraumas

    Energy Technology Data Exchange (ETDEWEB)

    Prosch, H. [Medizinische Universitaet Wien, Allgemeines Krankenhaus, Univ.-Klinik fuer Radiologie und Nuklearmedizin, Wien (Austria); Negrin, L. [Medizinische Universitaet Wien, Allgemeines Krankenhaus, Univ.-Klinik fuer Unfallchirurgie, Wien (Austria)

    2014-09-15

    Blunt chest trauma is associated with high morbidity and mortality. Consequently, all patients should be evaluated radiologically after blunt chest trauma to allow timely and appropriate treatment. Conventional chest radiographs and computed tomography (CT) are proven modalities with which to evaluate patients after blunt chest trauma. Over the last several years extended focused assessment with sonography for trauma (eFAST) has gained increasing importance for the initial assessment of seriously injured patients. In the acute phase of severely injured patients eFAST examinations are helpful to exclude pneumothorax, hemothorax and hemopericardium. Chest radiographs may also be used to diagnose a pneumothorax or hemothorax; however, the sensitivity is limited and CT is the diagnostic modality of choice to evaluate severely injured patients. (orig.) [German] Stumpfe Thoraxtraumen gehen mit einer hohen Morbiditaet und Mortalitaet einher. Daher sollten Patienten mit Verdacht auf ein stumpfes Thoraxtrauma rasch radiologisch untersucht werden, damit die entsprechenden therapeutischen Schritte zeitgerecht eingeleitet werden koennen. Zur Abklaerung von Patienten nach einem stumpfen Thoraxtrauma sind seit Jahren das konventionelle Lungenroentgen und die Computertomographie bewaehrte Verfahren. In den letzten Jahren hat die fokussierte Ultraschalluntersuchung (eFAST, Extended Focused Assessment with Sonography for Trauma) von schwerverletzten Patienten vermehrt an Bedeutung gewonnen. Durch eine eFAST-Untersuchung kann in der Akutphase rasch geklaert werden, ob bei dem Patienten ein therapiebeduerftiger Pneumothorax, Haematoperikard oder Haematothorax vorliegen. Auch das Lungenroentgen wird zur Diagnose eines Pneumothorax oder Haematothorax eingesetzt, wenngleich seine Sensitivitaet deutlich eingeschraenkt ist. Die CT ist das diagnostische Verfahren der Wahl, um v. a. Patienten mit einem schweren Thoraxtrauma abzuklaeren. (orig.)

  8. [Bronchial rupture in blunt thoracic trauma].

    Science.gov (United States)

    López Espadas, F; Zabalo, M; Encinas, M; Díaz Regañón, G; Pagola, M A; González Fernández, C

    2000-12-01

    In closed chest trauma, bronchial rupture is an unusual but potentially serious complication, with an associated mortality rate of 30%. Recent decades have seen an increase in incidence parallel to greater use of transport. Eighty percent of injuries are located 2.5 cm from the carina. Diagnosis is based on clinical signs, imaging and bronchoscopy. Subcutaneous emphysema and respiratory insufficiency are the most common findings. Images show the presence of pneumothorax, pneumomediastinum or both. Bronchoscopy is the diagnostic method of choice and must be performed early. Treatment consists of reestablishing anatomical continuity of the tracheobronchial tree by surgical repair if the lesion affects more than a third of the circumference and/or pneumothorax is not resolved after two chest drainages. This type of injury should be recognized and treated early, both to restore lung function and to prevent associated complications caused by delay. However, initial findings are seldom specific, requiring the physician to display a high degree of suspicion and explaining why diagnosis often comes late. PMID:11171438

  9. Prehospital response model and time to CT scan in blunt trauma patients; an exploratory analysis of data from the head injury retrieval trial

    OpenAIRE

    Garner, Alan A; Mann, Kristy P.; Poynter, Elwyn; Weatherall, Andrew; Dashey, Susan; Puntis, Michael; Gebski, Val

    2015-01-01

    Background It has been suggested that prehospital care teams that can provide advanced prehospital interventions may decrease the transit time through the ED to CT scan and subsequent surgery. This study is an exploratory analysis of data from the Head Injury Retrieval Trial (HIRT) examining the relationship between prehospital team type and time intervals during the prehospital and ED phases of management. Methods Three prehospital care models were compared; road paramedics, and two physicia...

  10. Distal thoracic oesophageal perforation secondary to blunt trauma: Case report

    Directory of Open Access Journals (Sweden)

    Tandon Ruchi

    2007-03-01

    Full Text Available Abstract Background Traumatic perforation of the distal oesophagus due to blunt trauma is a very rare condition and is still associated with a significant morbidity and mortality. This is further exacerbated by delayed diagnosis and management as symptoms and signs are often masked by or ascribed to more common blunt thoracic injuries. Case report We present a case of a distal oesophageal perforation, secondary to a fall from a third storey window, which was masked by concomitant thoracic injuries and missed on both computed tomography imaging and laparotomy. The delay in his diagnosis significantly worsened the patient's recovery by allowing the development of an overwhelming chest sepsis that contributed to his death. Conclusion Early identification of an intrathoracic oesophageal perforation requires deliberate consideration and is essential to ensure a favorable outcome. Treatment should be individualised taking into account the nature of the oesophageal defect, time elapsed from injury and the patient's general condition.

  11. Isolated Multiple Fragmented Cricoid Fracture Associated with External Blunt Neck Trauma: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Byung Hoon; Hwang, Yoon Joon; Kim, Yong Hoon; Seo, Jung Wook; Cho, Hyeon Je; Kim, Yeon Soo [Inje University School of Medicine, Ilsan Paik Hospital, Goyang (Korea, Republic of)

    2010-08-15

    Blunt laryngeal trauma is a relatively uncommon but possibly life-threatening injury. An isolated cricoid fracture associated with blunt trauma is rare. We report a case of an isolated multiple fragmented cricoid cartilage fracture that developed in a 20-year-old man after a blunt neck trauma that occurred during a baseball game and was diagnosed by 64-slice multidetector computed tomography (MDCT)

  12. 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. PMID:11307682

  13. Blunt pancreatic trauma: experience at a rural referral center.

    Science.gov (United States)

    Timberlake, G A

    1997-03-01

    The objective of this study was to compare mechanism of injury, treatment methods, and outcome of blunt pancreas trauma patients transferred from another hospital to those of patients brought directly from the scene. A retrospective review was conducted of 6078 patients treated at a Level I trauma center from 1/1/90 to 12/31/94. Blunt pancreas injury was found in 39 (0.64%) patients (mean age, 33.2 years). Mechanism of injury included 34 (87%) motor vehicle crashes, 3 (8%) motorcycle crashes, and 2 (5%) other injuries. There were 11 transfer patients (28%), and 28 (72%) admitted directly from the scene. Eighty-two per cent of the motor vehicle crash patients were unrestrained, and 35 per cent had ethanol intoxication. Exploratory laparotomy was performed on 32 (82%); eight (25%) required repair or resection; 22 (69%) had trivial injuries, at most requiring drainage; and two (6.3%) exsanguinated. No patients required Whipple resection or pancreatiocojejunostomy. At operation, an average of 2.5 associated intra-abdominal injuries were found. Overall survival was 35 of 39 (90%). Among the patients brought directly to the trauma center, 93 per cent survived, whereas survival among transferred patients was 82 per cent (chi2 = 0.19; P = 0.66). Blunt pancreatic injuries vary in severity, but radical resection is rarely required. Lack of safety restraint and ethanol use are major risk factors. Despite the high likelihood of associated injuries, survivability is high. No difference in outcome was seen between directly admitted and transferred patients. PMID:9036900

  14. Diagnosis and management of colonic injuries following blunt trauma

    Institute of Scientific and Technical Information of China (English)

    Yi-Xiong Zheng; Li Chen; Si-Feng Tao; Ping Song; Shao-Ming Xu

    2007-01-01

    AIM: To retrospectively evaluate the preoperative diagnostic approaches and management of colonic injuries following blunt abdominal trauma.METHODS: A total of 82 patients with colonic injuries caused by blunt trauma between January 1992 and December 2005 were enrolled. Data were collected on clinical presentation, investigations, diagnostic methods,associated injuries, and operative management. Colonic injury-related mortality and abdominal complications were analyzed.RESULTS: Colonic injuries were caused mainly by motor vehicle accidents. Of the 82 patients, 58 (70.3%) had other associated injuries. Laparotomy was performed within 6 h after injury in 69 cases (84.1%), laparoscopy in 3 because of haemodynamic instability. The most commonly injured site was located in the transverse colon. The mean colon injury scale score was 2.8. The degree of faecal contamination was classified as mild in 18 (22.0%), moderate in 42 (51.2%), severe in 14 (17.1%), and unknown in 8 (9.8%) cases. Sixty-seven patients (81.7%) were treated with primary repair or resection and anastomosis. Faecal stream diversion was performed in 15 cases (18.3%). The overall mortality rate was 6.1%. The incidence of colonic injuryrelated abdominal complications was 20.7%. The only independent predictor of complications was the degree of peritoneal faecal contamination (P = 0.02).CONCLUSION: Colonic injuries following blunt trauma are especially important because of the severity and complexity of associated injuries. A thorough physical examination and a combination of tests can be used to evaluate the indications for laparotomy. One stage management at the time of initial exploration is most often used for colonic injuries.

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

    Directory of Open Access Journals (Sweden)

    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.

  16. CT diagnosis of unsuspected pneumothorax after blunt abdominal trauma

    International Nuclear Information System (INIS)

    Review of abdominal CT scans for evaluation of blunt abdominal trauma yielded 35 cases of pneumothorax, 10 of which had not been diagnosed before CT by clinical examination of plain radiographs. Of the 10 cases initially diagnosed on CT, seven required tube thoracostomy for treatment of the pneumothorax. CT detection of pneumothorax is especially important if mechanical assisted ventilation or general anesthesia is used. Demonstration of pneumothorax requires viewing CT scans of the upper abdomen (lower thorax) at lung windows in addition to the usual soft-tissue windows

  17. Testicular Infarction and Rupture After Blunt Trauma — Use of Diagnostic Ultrasound

    Directory of Open Access Journals (Sweden)

    Alistair Pace

    2004-01-01

    Full Text Available We report the case of a 23-year-old male who suffered localised testicular infarction and rupture following blunt trauma. This pathology is rare after blunt trauma and has not been previously described in literature. The appearance on ultrasound resembled malignancy, necessitating orchidectomy. An overview of the pathology of testicular trauma as well as its management is given with particular emphasis on the use diagnostic ultrasound in testicular trauma.

  18. 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.

  19. Isolated pancreatic injury following blunt abdominal trauma in a child

    Directory of Open Access Journals (Sweden)

    Jain Sandeep

    2007-01-01

    Full Text Available Pancreatic injury following blunt abdominal trauma is rare as compared to other visceral organs. Isolated injury to the pancreas is even more rare. The clinical presentation is subtle resulting in delayed treatment with high morbidity and mortality. A three-year-old female child presented with vomiting 18h following a motor vehicle accident. She was hemodynamically stable with no external signs of injury. Investigations revealed hyperamylasemia and isolated grade III pancreatic injury. Laparotomy with distal pancreatic resection and splenectomy was done. A high degree of clinical suspicion with due consideration to the mechanism of injury is the key to good outcome in these patients. Major ductal injury is the critical issue in the management and a number of therapeutic choices are available specific to the location of the insult.

  20. Pediatric head trauma: the evidence regarding indications for emergent neuroimaging

    International Nuclear Information System (INIS)

    Traumatic brain injury (TBI) is a leading cause of childhood death and disability worldwide. In the United States, childhood head trauma results in approximately 3,000 deaths, 50,000 hospitalizations, and 650,000 emergency department (ED) visits annually. Children presenting to the ED with seemingly minor head trauma account for approximately one-half of children with documented TBIs. Despite the frequency and importance of childhood minor head trauma, there exists no highly accurate, reliable and validated clinical scoring system or prediction rule for assessing risk of TBI among those with minor head trauma. At the same time, use of CT scanning in these children in recent years has increased substantially. The major benefit of CT scanning is early identification (and treatment) of TBIs that might otherwise be missed and result in increased risk of morbidity and mortality. Unnecessary CT imaging, however, exposes the child needlessly to the risk of radiation-induced malignancies. What constitutes appropriate criteria for obtaining CT scans in children after minor blunt head trauma remains controversial. Current evidence to guide clinicians in this regard is limited; however, large studies performed in multi-center research networks have recently been conducted. These studies should provide the foundation of evidence to guide CT decisions by clinicians, help identify TBIs in a timely fashion, and reduce unnecessary radiation exposure. (orig.)

  1. Pediatric head trauma: the evidence regarding indications for emergent neuroimaging

    Energy Technology Data Exchange (ETDEWEB)

    Kuppermann, Nathan [UC Davis Medical Center, Department of Emergency Medicine, Sacramento, CA (United States); University of California, Davis School of Medicine, Departments of Emergency Medicine and Pediatrics, Davis, CA (United States)

    2008-11-15

    Traumatic brain injury (TBI) is a leading cause of childhood death and disability worldwide. In the United States, childhood head trauma results in approximately 3,000 deaths, 50,000 hospitalizations, and 650,000 emergency department (ED) visits annually. Children presenting to the ED with seemingly minor head trauma account for approximately one-half of children with documented TBIs. Despite the frequency and importance of childhood minor head trauma, there exists no highly accurate, reliable and validated clinical scoring system or prediction rule for assessing risk of TBI among those with minor head trauma. At the same time, use of CT scanning in these children in recent years has increased substantially. The major benefit of CT scanning is early identification (and treatment) of TBIs that might otherwise be missed and result in increased risk of morbidity and mortality. Unnecessary CT imaging, however, exposes the child needlessly to the risk of radiation-induced malignancies. What constitutes appropriate criteria for obtaining CT scans in children after minor blunt head trauma remains controversial. Current evidence to guide clinicians in this regard is limited; however, large studies performed in multi-center research networks have recently been conducted. These studies should provide the foundation of evidence to guide CT decisions by clinicians, help identify TBIs in a timely fashion, and reduce unnecessary radiation exposure. (orig.)

  2. Study of Duodenal Rupture Followed by Abdominal Blunt Trauma

    Directory of Open Access Journals (Sweden)

    Mohammad Reza Abdoulhosseini

    2014-01-01

    Full Text Available Duodenal rupture followed by blunt trauma is usually very rare and happens by hit to epigastrium region caused by trauma, accident or sport injuries. Because of unclear signs or no specific signs of rupture, usually diagnosis of rupture is delayed and associated with dangerous or occasionally deathful complications. The patient was a 29-year-old male who three days after accident referred to emergency unit of Shahroud Imam Hossein hospital with severe pain of abdomen, nausea, decrease in level of consciousness and unstable vital signs. After resuscitation, the patient with diagnosis of peritonitis underwent laparotomy. He had transverse and severs rupture that after duodenal reconstruction, a jejunostomy was performed, then a drain was placed at the site of duodenum and pancreas and the patient was sent to ICU. After two days followed by leakage from abdominal drain, the patient underwent laparotomy again. Then after one week, followed by leakage from abdominal drain, the patient underwent laparotomy. One week after last operation, due to general condition improvement, the patient was transferred to surgical ward and jejunostomy feeding was started for him and duodenostomy and jejunostomy were excluded. Then with enough speed, and paying attention to clinical signs & symptoms and with patient's exact examination, it is possible to prevent the waste of time and expense and gain desired results of treatment.

  3. Diagnostic value of pelvic radiography in the initial trauma series in blunt trauma

    Energy Technology Data Exchange (ETDEWEB)

    Their, Micael E.A.; Bensch, Frank V.; Koskinen, Seppo K. [Toeoeloe Trauma Center, Department of Radiology, Helsinki University Central Hospital, Helsinki (Finland); Handolin, Lauri [Toeoeloe Trauma Center, Department of Orthopaedics and Traumatology, Helsinki (Finland); Kiuru, Martti J. [Toeoeloe Trauma Center, Department of Radiology, Helsinki University Central Hospital, Helsinki (Finland); Research Institut of Military Medicine, Helsinki (Finland)

    2005-08-01

    The purpose of the study was to evaluate the diagnostic value of pelvic radiography in the initial trauma series when compared to multidetector CT (MDCT) findings in serious blunt trauma. Inclusion criteria were blunt trauma and pelvic radiography in the initial trauma series, followed by a whole-body MDCT. A total of 1386 patients (874 male, 512 female, age 16-91 years, mean 41 years) met the inclusion criteria. Imaging studies were evaluated retrospectively by anatomical region and classified, when possible, using the Tile classification. Based on MDCT, a total of 629 injuries occurred in 226 (16%) of these 1386 patients. Radiography depicted 405 fractures in these 226 patients, giving an overall sensitivity of 55%. In 24 patients (11%) radiography was false-negatively normal. The sensitivity of radiography was mainly good in the anteroinferior parts of the pelvis, fair in the acetabulum and ileum, and poor in the posterior ring. By MDCT 141 (62%) patients were classified using the Tile classification and by radiography 133 patients (59%) were classified. MDCT and radiography showed the same type of pelvic injury in 72 patients (59%) and the subtype in 17 patients (14%). In 48 patients (40%) the pelvis was shown to be stable by radiography but unstable by MDCT. In conclusion, the sensitivity of pelvic radiography is low, and it is not reliable for determining if the pelvic injury is stable or not. (orig.)

  4. 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.

  5. Surgical Management of Undiagnosed Laceration of Superior Vena Cava Caused by Blunt Trauma.

    Science.gov (United States)

    Bouabdallaoui, Nadia; Debbagh, Hassan; Schoell, Thibaut; Lebreton, Guillaume

    2016-05-01

    Intrapericardial rupture of the superior vena cava resulting from blunt thoracic trauma is a rare and life-threatening condition that has to be ruled out in the presence of signs of cardiac tamponade and a history of blunt thoracic trauma. We report the case of undiagnosed superior vena cava laceration caused by a high-speed road traffic accident in a 25 year-old patient revealed by cardiac tamponade. We highlight the need of urgent surgical exploration in all patients whose condition is unstable in the setting of blunt thoracic trauma regardless of imaging conclusions. PMID:27106431

  6. 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.

  7. 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

  8. COMPARATIVE STUDY OF MULTIDETECTOR COMPUTED TOMOGRAPHY AND ULTRASONOGRAPHY FINDINGS IN BLUNT ABDOMINAL TRAUMA

    Directory of Open Access Journals (Sweden)

    Okram Pusparani Devi

    2016-07-01

    Full Text Available BACKGROUND Blunt abdominal trauma usually has low sensitivity on physical examination and also subtle clinical manifestations. Improved resolution of the ultrasound machines and availability of multiple frequency probes has improved the specificity of ultrasound evaluation in blunt abdominal trauma. Despite this about 50% of the solid organ injuries are missed. Computed tomography has been used with better specificity to evaluate patients with blunt abdominal trauma who are FAST (Focused Assessment with Sonography for Trauma positive as well as indeterminate and clinically suspicious cases of solid organ, hollow viscera, spine and pelvic injury. AIM AND OBJECTIVES The purpose of this study was to determine sensitivity, specificity and diagnostic accuracy of USG and MDCT and compare the efficacy of the two imaging modalities in blunt abdominal trauma. METHOD A prospective observational study of 100 patients was conducted in the Department of Radiodiagnosis, Bharati Hospital, Pune. All patients with blunt abdominal trauma were included. FAST screening was done with ANTARES ACUSON SIEMENS followed by MDCT on 16-Slice Philips Brilliance. Sensitivity, specificity and diagnostic accuracy of USG and CT were determined by comparing with laparotomy findings. RESULTS Although USG was sensitive, specific and accurate in detecting free fluid in abdomen, CT was found better and also superior in detecting solid organ injury in patients with blunt abdominal trauma. CONCLUSION Ultrasound is an efficient modality in the initial evaluation of blunt abdominal trauma. But CT is the superior diagnostic modality and must be performed in symptomatic patient with ultrasound negative report and suboptimal ultrasound examination. CT scan thoroughly scrutinizes entire abdomen including retroperitoneum with additional assessment of thoracic trauma and bony pelvic trauma. Hence, CT increases diagnostic confidence and influences management decision.

  9. Hepatic arterial pseudoaneurysm: a rare complication of blunt abdominal trauma in children

    International Nuclear Information System (INIS)

    We report a child who developed a hepatic artery pseudoaneurysm following blunt hepatic injury. This is a rare complication of hepatic trauma in children. The imaging evaluation and clinical management of hepatic artery pseudoaneurysms are presented. (orig.)

  10. Computed tomography of the chest in blunt thoracic trauma: results of a prospective study

    International Nuclear Information System (INIS)

    Blunt thoracic injuries detected by computed tomography of the chest infrequently require immediate therapy. If immediate therapy is needed, findings will be visible on plain roentgenograms or on clinical exam. Routine Computed Tomography of the chest in blunt trauma is not recommended but may be helpful in selected cases. (N.C.)

  11. Blunt renal trauma in children with pre-existing renal abnormalities.

    Science.gov (United States)

    Dahlstrom, Kelly; Dunoski, Brian; Zerin, Jeffrey Michael

    2015-01-01

    The kidneys are the most commonly injured genitourinary organ in children following blunt abdominal trauma. Though the retroperitoneal location affords the kidneys some protection from the forces experienced in blunt abdominal trauma, the kidneys are at greater risk of injury when a disease process exposes them from their normal shielded location. In such cases, the injuries may appear to be disproportionate in relation to the severity of the trauma history, confusing the imaging findings. Recognition of both the underlying disease process as well as the manifestations of acute trauma is important; therefore, we present a pictorial essay of traumatized kidneys in children with pre-existing renal abnormalities. PMID:25552392

  12. 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.

  13. Imaging of accidental paediatric head trauma

    Energy Technology Data Exchange (ETDEWEB)

    Tang, Phua Hwee [KK Women' s and Children' s Hospital, Department of Diagnostic Imaging, Singapore (Singapore); Lim, Choie Cheio Tchoyoson [National Neuroscience Institute, Department of Neuroradiology, Singapore (Singapore)

    2009-05-15

    Head trauma is the most common form of injury sustained in serious childhood trauma and remains one of the top three causes of death despite improved road planning and safety laws. CT remains the first-line investigation for paediatric head trauma, although MRI may be more sensitive at picking up the full extent of injuries and may be useful for prognosis. Follow-up imaging should be tailored to answer the specific clinical question and to look for possible complications. (orig.)

  14. Imaging of accidental paediatric head trauma

    International Nuclear Information System (INIS)

    Head trauma is the most common form of injury sustained in serious childhood trauma and remains one of the top three causes of death despite improved road planning and safety laws. CT remains the first-line investigation for paediatric head trauma, although MRI may be more sensitive at picking up the full extent of injuries and may be useful for prognosis. Follow-up imaging should be tailored to answer the specific clinical question and to look for possible complications. (orig.)

  15. Open Surgical Bypass for Superficial Femoral Artery Occlusion Caused by Blunt Trauma

    OpenAIRE

    Ikeda, Akihiko; Kudo, Yohei; Maeda, Michihiro; Tochiki, Aito; Ichimura, Haruto; Uesugi, Masafumi; Jikuya, Tomoaki

    2015-01-01

    Blunt vascular trauma of the lower extremities brings about a high amputation rate, because other organ injuries disturb revascularization. We experienced a case of a superficial femoral artery occlusion caused by blunt trauma. The patient also had a femoral bone fracture and a large skin defect with deep muscular injuries of the thigh. We performed a femoropopliteal (FP) bypass using a saphenous vein which was routed through the contaminated wound. Postoperative vacuum-assisted closure thera...

  16. The Houdini effect--an unusual case of blunt abdominal trauma resulting in perforative appendicitis.

    LENUS (Irish Health Repository)

    O'Kelly, F

    2012-03-01

    We present a unique case of perforative appendicitis that occurred in an adult following blunt abdominal trauma. This case represents the first such reported case from Ireland. It also represents a modern practical example of Laplace\\'s theory of the effect of increased pressure on colonic wall tension leading to localized perforation, and serves to highlight not only the importance in preoperative imaging for blunt abdominal trauma, but also the importance of considering appendiceal perforation.

  17. Computed Tomography in the Evaluation of Diaphragmatic Hernia following Blunt Trauma

    OpenAIRE

    Magu, Sarita; Agarwal, Shalini; Singla, Sham

    2012-01-01

    Diagnosis of traumatic diaphragmatic hernia due to blunt abdominal trauma requires a high index of suspicion. This study was conducted to assess the accuracy of multidetector computed tomogram (MDCT) in the diagnosis of traumatic diaphragmatic hernia. All patients with thoracoabdominal blunt trauma with diaphragmatic hernia diagnosed on radiologic evaluation during a 3-year period (i.e., from June 2004 to June 2007) were analyzed. Nineteen patients with diaphragmatic injuries in 117 patients ...

  18. Ocular blunt trauma: loss of sight from an ice hockey injury

    OpenAIRE

    Morris, Daniel S.

    2009-01-01

    A case of ocular blunt trauma is described in which a 17 year old male ice hockey player collided with an opponent during a game. The opponent's stick travelled under the patient's half face visor and struck his left eye causing hyphema, angle recession, lens subluxation, and choroidal rupture over the macula, permanently reducing his vision to counting fingers. Sequelae of ocular blunt trauma are discussed along with methods of injury prevention by addressing players' behaviour and safety eq...

  19. ACR Appropriateness Criteria Head Trauma.

    Science.gov (United States)

    Shetty, Vilaas S; Reis, Martin N; Aulino, Joseph M; Berger, Kevin L; Broder, Joshua; Choudhri, Asim F; Kendi, A Tuba; Kessler, Marcus M; Kirsch, Claudia F; Luttrull, Michael D; Mechtler, Laszlo L; Prall, J Adair; Raksin, Patricia B; Roth, Christopher J; Sharma, Aseem; West, O Clark; Wintermark, Max; Cornelius, Rebecca S; Bykowski, Julie

    2016-06-01

    Neuroimaging plays an important role in the management of head trauma. Several guidelines have been published for identifying which patients can avoid neuroimaging. Noncontrast head CT is the most appropriate initial examination in patients with minor or mild acute closed head injury who require neuroimaging as well as patients with moderate to severe acute closed head injury. In short-term follow-up neuroimaging of acute traumatic brain injury, CT and MRI may have complementary roles. In subacute to chronic traumatic brain injury, MRI is the most appropriate initial examination, though CT may have a complementary role in select circumstances. Advanced neuroimaging techniques are areas of active research but are not considered routine clinical practice at this time. In suspected intracranial vascular injury, CT angiography or venography or MR angiography or venography is the most appropriate imaging study. In suspected posttraumatic cerebrospinal fluid leak, high-resolution noncontrast skull base CT is the most appropriate initial imaging study to identify the source, with cisternography reserved for problem solving. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three 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. PMID:27262056

  20. Mediastinal mature teratoma with rupture into pleural cavity due to blunt trauma.

    Science.gov (United States)

    Miyazawa, Masahisa; Yoshida, Kazuo; Komatsu, Kazunori; Kobayashi, Nobutaka; Haba, Yoshiaki

    2012-03-01

    We report a rare case of mediastinal mature teratoma with rupture due to blunt trauma. A 15-year-old boy had received a strong head-butt in the left upper chest wall and was admitted with the sudden onset of left-sided severe chest pain and dyspnea. Chest computed tomography (CT) scan on admission revealed a heterogeneous mass lesion in the anterior mediastinum. The contrast-enhanced CT scans obtained 2 days after admission showed not only mediastinal mass lesion but also left pleural effusion. On the radiologic finding at 5 months later, the lesion became larger and was thought to be a typical mediastinal mature teratoma. The patient underwent extirpation of the tumor. Microscopically, the tumor was typically composed of adult-type tissues and was confirmed to be mature teratoma.

  1. Bilateral ureteropelvic disruption following blunt abdominal trauma: Case report

    Directory of Open Access Journals (Sweden)

    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. The Effect of Pre-Injury Anti-Platelet Therapy on the Development of Complications in Isolated Blunt Chest Wall Trauma: A Retrospective Study

    OpenAIRE

    Battle, Ceri; Hutchings, Hayley; Bouamra, Omar; Phillip A Evans

    2014-01-01

    Introduction The difficulties in the management of the blunt chest wall trauma patient in the Emergency Department due to the development of late complications are well recognised in the literature. Pre-injury anti-platelet therapy has been previously investigated as a risk factor for poor outcomes following traumatic head injury, but not in the blunt chest wall trauma patient cohort. The aim of this study was to investigate pre-injury anti-platelet therapy as a risk factor for the developmen...

  3. [Isolated left ventricular--right atrial shunt after blunt chest trauma (author's transl)].

    Science.gov (United States)

    Kreuzer, E; Beyer, J

    1978-12-01

    A case of left-ventricular-right-atrial septal defect secundary to blunt chest trauma is described. The etiology of this type of septal defect, e. g. congenital, following aortic and mitral valve replacement, endocarditis and trauma, is discussed. Early defect closure is recommended in the presence of significant shunt volume. PMID:751280

  4. Predicting outcomes after blunt chest wall trauma: development and external validation of a new prognostic model

    OpenAIRE

    Battle, Ceri Elisabeth; Hutchings, Hayley; Lovett, Simon; Bouamra, Omar; Jones, Sally; Sen, Aruni; Gagg, James; Robinson, David; Hartford-Beynon, Jake; Williams, Jeremy; Evans, Adrian

    2014-01-01

    Introduction Blunt chest wall trauma accounts for over 15% of all trauma admissions to Emergency Departments worldwide. Reported mortality rates vary between 4 and 60%. Management of this patient group is challenging as a result of the delayed on-set of complications. The aim of this study was to develop and validate a prognostic model that can be used to assist in the management of blunt chest wall trauma. Methods There were two distinct phases to the overall study; the development and the v...

  5. Liver injury following blunt abdominal trauma: a new mechanism-driven classification

    OpenAIRE

    Slotta, J. E.; Justinger, C.; Kollmar, O; Kollmar, C.; Schäfer, T.; Schilling, M. K.

    2013-01-01

    Purposes The current classifications for blunt liver trauma focus only on the extent of liver injury. However, these scores are independent from the localization of liver injury and mechanism of trauma. Methods The type of liver injury after blunt abdominal trauma was newly classified as type A when it was along the falciform ligament with involvement of segments IVa/b, III, or II, and type B when there was involvement of segments V–VIII. With the use of a prospectively established database, ...

  6. Protocol compliance and time management in blunt trauma resuscitation.

    NARCIS (Netherlands)

    Spanjersberg, W.R.; Bergs, E.A.; Mushkudiani, N.; Klimek, M.; Schipper, I.B.

    2009-01-01

    OBJECTIVES: To study advanced trauma life support (ATLS) protocol adherence prospectively in trauma resuscitation and to analyse time management of daily multidisciplinary trauma resuscitation at a level 1 trauma centre, for both moderately and severely injured patients. PATIENTS AND METHODS: All vi

  7. Accuracy of chest radiography versus chest computed tomography in hemodynamically stable patients with blunt chest trauma

    Institute of Scientific and Technical Information of China (English)

    Mojtaba Chardoli; Toktam Hasan-Ghaliaee; Hesam Akbari; Vafa Rahimi-Movaghar

    2013-01-01

    Objective:Thoracic injuries are responsible 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 hemodynamically stable patients with blunt chest trauma.Methods:Study was conducted at the emergency department of S ina 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.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 sternum fracture were not diagnosed with CXR alone.Conclusion:Applying CT scan as the first-line diagnostic modality in hemodynamically stable patients with blunt chest trauma can detect pathologies which may change management and outcome.

  8. Head trauma in female professional wrestlers

    International Nuclear Information System (INIS)

    The clinical characteristics of head trauma were evaluated in 18 wrestlers belonging to a female professional wrestling organization, 13 regular members and five trainees aged 15-34 years. Medical examinations for head trauma were performed in all wrestlers, and wrestlers treated at our emergency outpatient department were clinically evaluated. In addition, the relationships of head trauma with duration of the wrestling career of 1-16 years (mean 8 years) in the regular members, and less than 1 year in the five trainees, and body mass index (BMI) of 21.0-32.0 in the 16 subjects, excluding two trainees, was evaluated. Chronic symptoms were noted in four of the 18 wrestlers with long wrestling careers (16 years in 1, 13 years in 1, and 5 years in 2). Three wrestlers with symptoms immediately after head trauma showed recurrent retrograde amnesia and had low BMI (21.6, 21.6, and 23.1). Five wrestlers were treated at our emergency outpatient clinic, three required hospitalization and two showed intracranial traumatic changes on computed tomography (acute subdural hematoma in 1 and diffuse brain swelling in 1). Head trauma in female professional wrestlers is associated with longer wrestling career and low BMI. Periodic medical examinations are recommended to monitor for signs of head trauma. (author)

  9. Ultrasonographic findings in blunt abdominal trauma among Yemeni patients in Sana'a

    International Nuclear Information System (INIS)

    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)

  10. [Blunt abdominal trauma.--analysis of 201 cases (author's transl)].

    Science.gov (United States)

    Pannenborg, G; Wolf, O; Voigtsberger, P

    1978-01-01

    201 blunt abdominal traumata treated clinically at the surgical department of the Medical Academy in Erfurt from 1967 to 1976 are reported: No increase of blunt abdominal traumata within the period of the report in spite of considerable growth of trafficdensity and industrialization could be observed.--The percentage of severe secundary injuries remained approximately constant, too.--Intestinal lesions, combined hepatolienal ruptures caused the highest mortality especially in combination with severe craniocerebral lesions. PMID:685552

  11. Neuroimaging differential diagnoses to abusive head trauma

    International Nuclear Information System (INIS)

    Trauma is the most common cause of death in childhood, and abusive head trauma is the most common cause of traumatic death and morbidity in infants younger than 1 year. The main differential diagnosis of abusive head trauma is accidental traumatic brain injury, which is usually witnessed. This paper also discusses more uncommon diagnoses such as congenital and acquired disorders of hemostasis, cerebral arteriovenous malformations and metabolic diseases, all of which are extremely rare. Diagnostic imaging including CT and MRI is very important for the distinction of non-accidental from accidental traumatic injury. (orig.)

  12. Neuroimaging differential diagnoses to abusive head trauma

    Energy Technology Data Exchange (ETDEWEB)

    Girard, Nadine [AP-HM Timone 2, Department of Neuroradiology, Marseille cedex 05 (France); Aix Marseille University, UMR CNRS 7339, Marseille (France); Brunel, Herve; Dory-Lautrec, Philippe [AP-HM Timone 2, Department of Neuroradiology, Marseille cedex 05 (France); Chabrol, Brigitte [AP-HM Timone, Department of Pediatric Neurology, Marseille (France)

    2016-05-15

    Trauma is the most common cause of death in childhood, and abusive head trauma is the most common cause of traumatic death and morbidity in infants younger than 1 year. The main differential diagnosis of abusive head trauma is accidental traumatic brain injury, which is usually witnessed. This paper also discusses more uncommon diagnoses such as congenital and acquired disorders of hemostasis, cerebral arteriovenous malformations and metabolic diseases, all of which are extremely rare. Diagnostic imaging including CT and MRI is very important for the distinction of non-accidental from accidental traumatic injury. (orig.)

  13. GLAUCOMA FOLLOWING BLUNT TRAUMA : AN EPIDEMIOLOGICAL AND CLINICAL STUDY

    Directory of Open Access Journals (Sweden)

    Purvi R

    2014-03-01

    Full Text Available AIMS: To study the demographic profile, clinical picture, treatment modalities and long term follow up of patients suffering from glaucoma developing after blunt trauma. MATERIALS AND METHODS: This was a prospective study over one year in which 75 eyes, newly diagnosed or referred with post traumatic glaucoma to M & J Institute of Ophthalmology were studied. All cases underwent thorough eye examination. Treatment was individualized and instituted. RESULTS: Patients ranged from 1 - 70 years with 32 patients (42.66% below 30 years of age. 61 patients (81.33% were males. 66.65% were students, laborers or housewives, with laborers topping the charts in vulnerability. In 46 cases (61.33%, left eye was affected, while in 29 pts. (38.66% right eye was affected. In 54.66% of cases, trauma was caused by stone, wooden stick or ball. Others included fist, firecracker, iron rod, handle, belt.16% patients presented with IOP in the normal range, 38 (50.66% patients had IOP in the range of 21-30 mm Hg, whereas 16 (21.33% patients had IOP more than 40 mm Hg. Within 1 week of instituting treatment, 41 (54.66% had IOP ≤ 20 mm Hg and only 3 patients had IOP more than 30 mm Hg. However, 70 (93.33% patients had IOP ≤ 20 mm Hg by the end of 6 months and all the patients were in this range after 6 months. On slit lamp examination, corneal edema, traumatic mydriasis and sphincter tears were seen in 32 patients each. 12 patients had hyphema and 19 patients had lens dislocated either into vitreous or into the anterior chamber. Iridodialysis was seen in 5 patients. Other findings included cataract, posterior synechiae, subluxation of lens and tobacco dusting. 57 (76% patients had vision less than 6/60, however after an interval of more than 6 months, 28 (37% patients had vision less than 3/60. The number of patients having vision ≥ 6/12 rose from 5 at initial presentation to 15 in follow-up more than 6 months. Disc changes could be assessed by ophthalmoscopy in 37

  14. 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.

  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. 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.

  17. Surgical Management of Undiagnosed Laceration of Superior Vena Cava Caused by Blunt Trauma

    OpenAIRE

    Bouabdallaoui, Nadia; Debbagh, Hassan; Schoell, Thibaut; Lebreton, Guillaume

    2016-01-01

    International audience Intrapericardial rupture of the superior vena cava resulting from blunt thoracic trauma is a rare and life-threatening condition that has to be ruled out in the presence of signs of cardiac tamponade and a history of blunt thoracic trauma. We report the case of undiagnosed superior vena cava laceration caused by a high-speed road traffic accident in a 25 year-old patient revealed by cardiac tamponade. We highlight the need of urgent surgical exploration in all patien...

  18. Thyroid gland rupture: a rare finding after a blunt neck trauma.

    Science.gov (United States)

    Zawawi, Faisal; Varshney, Rickul; Payne, Richard J; Manoukian, John J

    2013-05-01

    This is a case report of a 13 years old boy with a thyroid rupture secondary to a hockey stick blunt trauma to his neck and a literature review focused on diagnosis and management. There are 14 other cases in the literature, 7 of which required surgical intervention mainly to evacuate a hematoma. The case in this review did not develop any complications. This is the first reported case in the literature of thyroid gland rupture due to a blunt trauma in a child. Patients with thyroid gland rupture should be monitored closely for developing a hematoma or thyroid storm. PMID:23522054

  19. Double ischemic ileal stenosis secondary to mesenteric injury after blunt abdominal trauma

    Institute of Scientific and Technical Information of China (English)

    Valérie Bougard; Claude Avisse; Martine Patey; Denis Germain; Nathalie Levy-Chazal; Jean-Francois Delattre

    2008-01-01

    The authors describe a rare case in which blunt abdominal trauma resulted in mesenteric injury with delayed double ischemic ileal stenosis. Abdominal computed tomography demonstrated stenotic ileal loop with mural thickening. At surgery, a double stenotic bowel loop was found adjacent to a healed defect in the mesentery. Histological examination of the two resected segments showed fibrotic and ischemic lesions within the mesentery. Ischemic intestinal stenosis from mesenteric injury should be considered in the differential diagnosis in patients suffering from intestinal occlusion with a history of blunt abdominal trauma.

  20. The case of the missing testicle: blunt scrotal trauma in the pediatric emergency department.

    Science.gov (United States)

    Pesch, Megan H; Bradin, Stuart

    2014-11-01

    Serious blunt scrotal trauma in the pediatric population is rare and can pose significant danger to the viability of the testes. The following case describes an adolescent boy who presented with a single testis in his scrotum after low-impact perineal trauma, consistent with testicular dislocation. The literature regarding scrotal trauma includes few cases of testicular dislocation from low-impact perineal trauma. Included is a brief review of the most recent data including epidemiology, differential diagnosis, acute management, and complications pertinent to the pediatric emergency clinician.

  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 < 0.05, there were 10 adverse events. A structured simulation program dedicated to developing skills for team leadership willbe a worthwhile endeavor at our institution. PMID:22611722

  2. 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

  3. Divergent adaptive and innate immunological responses are observed in humans following blunt trauma

    OpenAIRE

    Lentsch Alex B; Solomkin Joseph S; Cave Cindy M; Robinson Chad T; Adediran Samuel G; Rasper Alison M; Reid Maria R; Goetzman Holly S; Kasten Kevin R; Johannigman Jay A; Caldwell Charles C

    2010-01-01

    Abstract Background The immune response to trauma has traditionally been modeled to consist of the systemic inflammatory response syndrome (SIRS) followed by the compensatory anti-inflammatory response syndrome (CARS). We investigated these responses in a homogenous cohort of male, severe blunt trauma patients admitted to a University Hospital surgical intensive care unit (SICU). After obtaining consent, peripheral blood was drawn up to 96 hours following injury. The enumeration and functiona...

  4. Cardiovascular magnetic resonance of myocardial infarction after blunt chest trauma: a heartbreaking soccer-shot

    OpenAIRE

    Fogarassy Peter; Maunz Martin; Beck Torsten; Baccouche Hannibal; Beyer Martin

    2009-01-01

    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 i...

  5. Diagnostic accuracy of emergency-performed focused assessment with sonography for trauma (FAST) in blunt abdominal trauma

    Science.gov (United States)

    Ghafouri, Hamed Basir; Zare, Morteza; Bazrafshan, Azam; Modirian, Ehsan; Farahmand, Shervin; Abazarian, Niloofar

    2016-01-01

    Introduction Intra-abdominal hemorrhage due to blunt abdominal trauma is a major cause of trauma-related mortality. Therefore, any action taken for facilitating the diagnosis of intra-abdominal hemorrhage could save the lives of patients more effectively. The aim of this study was to determine the accuracy of focused assessment with sonography for trauma (FAST) performed by emergency physicians. Methods In this cross-sectional study from February 2011 to January 2012 at 7th Tir Hospital in Tehran (Iran), 120 patients with abdominal blunt trauma were chosen and evaluated for abdominal fluid. FAST sonography was performed for all the subjects by emergency residents and radiologists while they were blind to the other tests. Abdominal CTs, which is the gold standard, were done for all of the cases. SPSS 20.0 was used to analyze the results. Results During the study, 120 patients with abdominal blunt trauma were evaluated; the mean age of the patients was 33.0 ± 16.6 and the gender ratio was 3/1 (M/F). The results of FAST sonography by emergency physicians showed free fluid in the abdomen or pelvic spaces in 33 patients (27.5%), but this was not observed by the results of CT scans of six patients; sensitivity and specificity were 93.1 and 93.4%, respectively. As for tests performed by radiology residents, sensitivity was a bit higher (96.5%) with lower specificity (92.3%). Conclusion The results suggested that emergency physicians can use ultrasonography as a safe and reliable method in evaluating blunt abdominal trauma.

  6. Isolated hepatic artery injury in blunt abdominal trauma presenting as upper gastrointestinal bleeding: treatment with transcatheter embolisation.

    Science.gov (United States)

    Taslakian, Bedros; Ghaith, Ola; Al-Kutoubi, Aghiad

    2012-11-15

    Liver injury in blunt abdominal trauma is common. However, not often does blunt trauma cause injury to the anatomical structures of the porta hepatis. Isolated injury of the hepatic artery has been rarely reported in the literature. Such injury may be lethal and requires immediate diagnosis and management. This report describes an unusual case of blunt abdominal trauma resulting in hepatic and gastroduodenal artery dissection, with pseudoaneurysm formation complicated by active upper gastrointestinal bleeding. The injury was managed by transcatheter embolisation. Awareness of this diagnosis should facilitate management of similar trauma cases.

  7. diagnostic imaging of acute head trauma

    International Nuclear Information System (INIS)

    Computed tomography (CT) is the primary modality of choice for imaging patients with acute head trauma. Lesions of the soft tissues and of the bones can be assessed more precisely than with other imaging modalities. With magnetic resonance imaging (MRI) additional information may be gained especially in subacute and chronic posttraumatic conditions. Urgent indication to perform a CT examination depends on the patient's history and on the mechanism of trauma. Imaging interpretation has been performed in the context of typical pathologic effects of trauma and with respect to potential therapy. (author)

  8. Diagnostic accuracy of Focused Abdominal Sonography for Trauma in blunt abdominal trauma patients in a trauma centre of Hong Kong

    Institute of Scientific and Technical Information of China (English)

    Cheung Kent Shek; Wong Hay Tai; Leung Ling Pong; Tsang Tat Chi; Leung Gilberto Ka Kit

    2012-01-01

    Objective: Focused Abdominal Sonography for Trauma (FAST) is widely used for the detection of intraperitoneal free fluids in patients suffering from blunt abdominal trauma (BAT).This study aimed at assessing the diagnostic accuracy of this investigation in a designated trauma centre.Methods: This was a retrospective study of BAT patients over a 6 year period seen in a trauma centre in Hong Kong.FAST findings were compared with laparotomy,abdominal computed tomography or autopsy findings,which served as the gold standard for presence of intrapcritoneal free fluids.The patients who did not have FAST or gold standard confirmatory test performed,had preexisting peritoneal fluid,died at resuscitation or had imcomplete documentation of FAST findings were excluded.The performance of FAST was expressed as sensitivity,specificity,predictive values (PV),likelihood ratios (LR) and accuracy.Results: FAST was performed in 302 patients and 153 of them were included in this analysis.The sensitivity,specificity,positive PV,negative PV,positive LR,negative LR and accuracy for FAST were respectively 50.0 %,97,3%,87.0%,84.6%,18.8,0.5 and 85.0%.FAST was found to be more sensitive in less severely injured patients and more specific in more severely injured patients.Conclusion: FAST is a reliable investigation iu the initial assessment of BAT patients.The diagnostic values of FAST could be affected by the severity of injury and staff training is needed to further enhance its effective use.

  9. Nutrition in Patients with Head Trauma

    Directory of Open Access Journals (Sweden)

    Burcu Totur

    2013-01-01

    Full Text Available The need of energy increases by 40% in patients with a head trauma, when compared to people who are living a normal life. This ratio reaches to 200% in some cases. It is important to give a nutrition support which can satisfy the energy need resulted from the hypermetabolic and hypercatabolic states and that is enough to help to fix the immunologic state and achieve a better result in healing the injury. When oral nutrition is not possible in the patient with a head trauma, their energy need is satisfied through enteral and parenteral nutrition. Though parenteral nutrition had held an important role in feeding patients with head trauma, enteral nutrition is applied much more widely today. Enteral and parenteral nutrition both has their own advantages and disadvantages. In the clinical and laboratory studies that had been held, it was found that enteral nutrition improved the systemic immunity, decreased the incidence of the major infectious complications, decreased the metabolic response to trauma, protected the intestinal mucosa, and protected the ecologic balance of the microflora. In this article, it is investigated through the importance of the feeding in patients with a head trauma and reasons to chose enteral nutrition

  10. [Leber's hereditary optic neuropathy after head trauma: a case report].

    Science.gov (United States)

    Hayashi, Shintaro; Okamoto, Koichi

    2011-10-01

    A previously healthy 34-year-old man sustained multiple skull fractures in a traffic accident. Radiological findings and visual field examination did not detect any abnormality. Shortly after the accident, he noticed blurred vision in both eyes. Six months after the accident, he gradually developed disturbance of visual acuity in the right eye. His best corrected visual acuity (BCVA) was 0.8 OD and 1.2 OS and brain MRI did not show any abnormality, while Humphrey visual field analysis demonstrated right homonymous hemianopsia. Two months after the initial presentation, his BCVA showed 0.1 OD and 0.08 OS. Visual field examination suggested that both right homonymous hemianopsia and left blind spot had become enlarged. Mitochondrial DNA analysis demonstrated G11,778A mutation and a diagnosis of Leber's hereditary optic neuropathy (LHON) was made. A few reports have documented mild acute insult to the head or blunt optic trauma as triggers of optic neuropathy in subjects with LHON. Although, the precise mechanism of LHON following trauma remains unknown, it appears that an acute insult may be sufficient to precipitate neuropathy in the optic nerve already compromised by mitochondrial dysfunction. Asymptomatic carriers should be advised to avoid possible precipitating factors such as head trauma.

  11. Nutrition in Patients with Head Trauma

    OpenAIRE

    Burcu Totur; Meryem Yavuz

    2013-01-01

    The need of energy increases by 40% in patients with a head trauma, when compared to people who are living a normal life. This ratio reaches to 200% in some cases. It is important to give a nutrition support which can satisfy the energy need resulted from the hypermetabolic and hypercatabolic states and that is enough to help to fix the immunologic state and achieve a better result in healing the injury. When oral nutrition is not possible in the patient with a head trauma, their ...

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

    International Nuclear Information System (INIS)

    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)

  13. Duration of antibiotic treatment in surgical infections of the abdomen. Blunt abdominal trauma.

    Science.gov (United States)

    Melcher, G A; Rüedi, T P

    1996-01-01

    Blunt abdominal trauma is associated with a low risk of injury to the microorganism-containing hollow viscera. Therefore, routine pre-operative administration of antibiotics is not necessary. Antibiotics are given intraoperatively, if laparotomy discloses transmural injury of a hollow organ and peritoneal contamination. If intervention is early (injuries should be treated with antibiotics for a maximum of 5 days.

  14. Predictors of successful non-operative management of grade III & IV blunt pancreatic trauma

    Directory of Open Access Journals (Sweden)

    Suman B Koganti

    2016-09-01

    Conclusions: Non-operative measures should be attempted in a select group of grade III&IV blunt pancreatic trauma. In hemodynamically stable patients with a controlled leak walled off as a pseudocyst without associated organ injuries and pancreatic necrosis, NOM has a higher success rate.

  15. Delayed Presentation of Renocolic Fistula at 4 Months after Blunt Abdominal Trauma

    Directory of Open Access Journals (Sweden)

    Sang Don Lee

    2011-01-01

    Full Text Available Causes of previously reported reno-colic fistulas included primary renal and colonic pathologic states involving infectious, malignant or other inflammatory processes. However, reno-colic fistula after renal injury is extremely uncommon. We report an unusual delayed presentation of reno-colic fistula that occurred at 4 months later after blunt abdominal trauma.

  16. Delayed Presentation of Renocolic Fistula at 4 Months after Blunt Abdominal Trauma

    OpenAIRE

    Sang Don Lee; Tae Nam Kim; Hong Koo Ha

    2011-01-01

    Causes of previously reported reno-colic fistulas included primary renal and colonic pathologic states involving infectious, malignant or other inflammatory processes. However, reno-colic fistula after renal injury is extremely uncommon. We report an unusual delayed presentation of reno-colic fistula that occurred at 4 months later after blunt abdominal trauma.

  17. Post-traumatic pulmonary pseudocyst with hemopneumothorax following blunt chest trauma: a case report

    Directory of Open Access Journals (Sweden)

    Fagkrezos Dimitris

    2012-10-01

    Full Text Available Abstract Introduction Post-traumatic pulmonary pseudocyst is an uncommon cavitary lesion of the lung and develops after blunt chest trauma and even more rarely following penetrating injuries. It is generally seen in young adults presenting with cough, chest pain, hemoptysis, and dyspnea. Post-traumatic pulmonary pseudocyst should be included in the differential diagnosis of cavitary pulmonary lesions. We describe the case of a 60-year-old Caucasian Greek woman who sustained traumatic pulmonary pseudocyst with hemopneumothorax due to a blunt chest trauma after a traffic accident. Case presentation After a traffic accident, a 60-year-old Caucasian Greek woman sustained a hemopneumothorax due to a blunt chest trauma. There was evidence of an extensive contusion in the posterior and lateral segments of the right lower lobe, a finding that was attributed to an early sign of a cavitation, and the presence of a thin-walled air cavity was detected on the anterior segment of the right lower lobe in the control computed tomography taken 24 hours after admission. Our patient was treated by catheter aspiration, and the findings of computed tomography evaluation about one month later showed complete resolution of one of the two air-filled cavitary lesions. The second pseudocyst also disappeared completely, as shown by the control computed tomography scan performed six months later. Conclusions Traumatic pulmonary pseudocyst is a rare complication of blunt chest trauma, and computed tomography is a more valuable imaging technique than chest radiograph for early diagnosis.

  18. Thyroid gland rupture after blunt neck trauma: A case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Sebastian Arana-Garza

    2015-01-01

    Conclusions: Although the rarity of this condition, physicians should take in mind the possibility of thyroid injury after blunt neck trauma. Early detection and prompt treatment, can reduce life threatening complications. Management should be individualized to patient’s characteristics and surgeon’s experience.

  19. Ischemic jejunal stenosis and blind loop syndrome after blunt abdominal trauma.

    Science.gov (United States)

    Isaacs, P; Rendall, M; Hoskins, E O; Missen, G A; Sladen, G E

    1987-02-01

    One month after suffering blunt abdominal trauma a patient developed severe steatorrhea and profound weight loss in association with an ischemic distal jejunal stricture and blind loop syndrome. Evidence for a partial mesenteric tear was found at resection of the stricture, which resulted in complete cure.

  20. Pneumoperitoneum in a patient with pneumothorax and blunt neck trauma

    Directory of Open Access Journals (Sweden)

    Suhail Yaqoob Hakim

    2014-01-01

    CONCLUSION: Free air in the abdomen after blunt traumatic neck injury is very rare. If pneumoperitoneum is suspected in the presence of pneumothorax, exploratory laparotomy should be performed to rule out intraabdominal injury. As, there is no consensus for this plan yet, further prospective studies are warrant. Conservative management for pneumoperitoneum in the absence of viscus perforation is still a safe option in carefully selected cases.

  1. Pericardio-diaphragmatic rupture following blunt abdominal trauma: Case report and review of literature

    Science.gov (United States)

    Abou Hussein, Bassem; Khammas, Ali; Kaiyasah, Hadiel; Swaleh, Abeer; Al Rifai, Nazim; Al-Mazrouei, Alya; Badri, Faisal

    2015-01-01

    Introduction Traumatic diaphragmatic rupture (TDR) occurs in 0–5% of patients with major blunt thoraco-abdominal trauma, in most of them on the left side, and an early correct diagnosis is made in less than half of the cases (Meyers and McCabe, 1993; Ball et al., 1982). Presentation of the case We report a case of a forty-eight years old man who had a pericardio-diaphragmatic rupture after a high-velocity blunt abdominal trauma that was diagnosed and treated successfully. Discussion Pericardio-diaphragmatic rupture (PDR) is an uncommon problem that poses a diagnostic challenge to surgeons. The incidence of PDR is between 0.2% and 3.3% of cases with TDR (Sharma, 1999 [3]). Conclusion PDR should be suspected in any patient with high velocity thoraco-abdominal trauma. Early diagnosis is essential and needs a high index of suspicion. Early Management is important in decreasing morbidity and mortality. PMID:26773877

  2. Biomedical Techniques for Post Head Trauma Victims.

    Science.gov (United States)

    Doney, Judith V.

    The nature and effects of head trauma are discussed. Among the most common deficits noted are impaired cognition, difficulties in oral and written communication, sensory problems, and marked personality changes. Suggestions are offered for dealing with each type of deficit, such as using alarm clocks and other tools to remind the individual about…

  3. MULTI - DETECTOR COMPUTED TOMOGRAPHY AND INTRA - OPERATIVE CORRELATION IN BLUNT ABDOMINAL TRAUMA

    Directory of Open Access Journals (Sweden)

    Rakesh

    2014-01-01

    Full Text Available BACKGROUND : With the change in the pace of life fast , faster , fastest being the motto of the present day , the incidence of trauma and the associated mortality and morbidities is on a continuous rise.Imaging plays a very important role in the management of these injuries in deciding which injuries , in trauma the final verdict of organ injury in abdomen is intra - ope rative findings. AIMS : In view of the above said we considered to study to determine diagnostic accuracy of MDCT (Multi - Detector Computed Tomography in detection of intra - abdominal solid organ injury in blunt abdominal trauma and to highlight the importance of MDCT in evaluation of blunt abdominal trauma. METHODS AND MATERIALS : This was a prospective study done between over a period of 2 years from between January 2011 to February 2013 on patients who presented with blun t abdominal trauma after excluding patients who were managed conservatively and normal on imaging , the data we compared had 32 patients and the analysis was as follows. RESULTS : Blunt abdominal trauma was common in males , the male to female ratio was 9:1 , road traffic accident is the most common mode of injury in blunt abdominal trauma with 60% of the patients in this mode of injury , single organ injury is 22 patients (76% spleen is the most commonly injured organ 15(47% patients having splenic injury , wi th grade 3 being the commonest splenic injury 8 out of the 15 patients had splenic injury bowel injury was the second common organ injured in blunt trauma abdomen. In this study computed tomography grading correlated well with intra - operative grading with a PPV of= 95.45 % (95% ci: 84.50 % to 99.31 % Asensitivityof 76.36 % (95% ci: 62.98 % to 86.76 % . CONCLUSION : Computed tomography is an important imaging technique for diagnosis of organ injuries in patients with abdominal trauma. It helps in grading of the type of injury and accordingly deciding the management of patient. It is a highly

  4. Mothers' unresolved trauma blunts amygdala response to infant distress

    Science.gov (United States)

    While the neurobiology of post-traumatic stress disorder has been extensively researched, much less attention has been paid to the neural mechanisms underlying more covert but pervasive types of trauma (e.g., those involving disrupted relationships and insecure attachment). Here, we report on a neur...

  5. INADEQUACY IN DIAGNOSIS OF BLUNT TRAUMA ABDOMEN - CAN ANAESTHESIOLOGIST BE BAFFLED BY CATASTROPHIC INTRAOPERATIVE FINDINGS?

    Directory of Open Access Journals (Sweden)

    Joyanta Kumar

    2015-08-01

    Full Text Available The magnitude of injury inflicted by Blunt trauma abdomen has varied manifestations ranging from minor single - system injury to devastating, multi - system injury .Blunt trauma abdomen alone or in association with polytrauma is a frequent presentation in the emergency department. High index of suspicion and clinical acumen is required during evaluation of blunt abdominal injuries because physical signs and symptoms indicating presence of visceral lesions may poorly correlate with clinical presentation. Diagnostic peritoneal tapping is considered safe initial option with high accuracy but carries possibility of significant false positive and false negative result. Ultrasonography (FAST ha s its own limitations; although CT findings can be conclusive it involves time for analysis and the patient should be cooperative. Blunt trauma abdomen may present with life threatening internal haemorrhage due to visceral or vascular injuries prompting em ergency surgical intervention at odd hours with limited investigations and resources, Pre anaesthetic optimization by maintenance of adequate tissue oxygenation with optimal blood volume replacement and judicious use of inotropes, determine outcome of such emergency procedures. Careful selection of anaesthetic techniques and drugs particularly the inducing agents can be life - saving. Agility of the attending anesthesiologist to handle unforeseen intra operative critical events plays a pivotal role in overall outcome. We are discussing Anaesthetic management of a 23 year old victim of road traffic accident, who sustained blunt trauma abdomen about 24 hrs. Back, was conscious, oriented and ambulatory till the time of shifting to the operating theatre but on exp loration sudden gush of blood from a preoperatively undetected 7 cms long tear of the sub diaphragmatic part of IVC, and lacerated liver almost exsanguinated the patient.

  6. 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.

  7. Non-operative versus operative treatment for blunt pancreatic trauma in children

    DEFF Research Database (Denmark)

    Haugaard, Michael V; Wettergren, André; Hillingsø, Jens Georg;

    2014-01-01

    . Currently, the optimal treatment, of whether to perform operative or non-operative treatment of severe, grade III to V, blunt pancreatic injury in children is unclear. OBJECTIVES: To assess the benefits and harms of operative versus non-operative treatment of blunt pancreatic trauma in children. SEARCH...... or language of publication. DATA COLLECTION AND ANALYSIS: We used relevant search strategies to obtain the titles and abstracts of studies that were relevant for the review. Two review authors independently assessed trial eligibility. MAIN RESULTS: The search found 83 relevant references. We excluded all...

  8. Nonoperative management for major blunt hepatic trauma. A case report.

    Science.gov (United States)

    Mingoli, Andrea; Saracino, Andrea; Brachini, Gioia; Mariotta, Giovanni; Migliori, Emanuele; Silvestri, Vania

    2015-03-16

    Negli ultimi 20 anni il trattamento del trauma epatico chiuso si è modificato radicalmente passando da una gestione quasi costantemente chirurgica ad una non operativa in tutti i casi in cui non vi siano le condizioni di instabilità emodinamica o di variazione nella clinica del paziente traumatizzato. A tutt’oggi però non è raro osservare un approccio a tale condizione clinica seguendo criteri che la Medicina Basata sull’Evidenza dimostra essere superati. Presentiamo in questo lavoro il caso clinico di una donna di 34 anni che subiva un trauma diretto della regione postero-laterale dell’emitorace destro cadendo accidentalmente da una scala. Nonostante la gravità della lesione evidenziata dalla TC (IV grado secondo AAST Liver Injury Scale), si è optato per un trattamento non operativo data la condizione di stabilità emodinamica ottenuta con un primo bolo di cristalloidi. Una complicanza di tipo respiratorio ha complicato il quadro in terza giornata dal trauma richiedendo una toracentesi e dei cicli di ventilazione non invasiva. A 4 anni di distanza dal trauma la paziente sta bene e non lamenta disturbi. La letteratura mostra che il trattamento conservativo viene impiegato oggi in oltre l’85% dei traumi epatici, indipendentemente dall’entità della lesione. Il successo del trattamento conservativo varia nelle diverse casistiche dall’82% al 100% dei casi, e le sue complicanze, quando si verificano (14% dei traumi maggiori) possono spesso essere trattate con procedure di radiologia interventistica, evitando ancora l’intervento chirurgico. Oggi, in assenza di altre lesioni addominali che richiedano l’esplorazione chirurgica, l’indicazione al trattamento operativo è solo l’instabilità emodinamica del paziente che persiste o si ripresenta subito dopo un corretto trattamento rianimatorio iniziale.

  9. 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.

  10. 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.

  11. Tc-99m sulfur colloid scanning in blunt trauma: detection of abdominal bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Bronfman, H.J.; Kunkel, B.K.; Rabin, H.S.

    1981-11-01

    Tc-99m sulfur colloid scintigraphy can detect and locate active lower gastrointestinal bleeding. The same principles apply to the detection and location of active intra-abdominal or pelvic hemorrhage following blunt abdominal trauma. We report two patients with abdominal bleeding who were correctly diagnosed by this method. As part of the routine examination of all patients having Tc-99m sulfur colloid liver-spleen scans for trauma, 500,000-count images should be made of the rest of the abdomen and pelvis.

  12. Tc-99m sulfur colloid scanning in blunt trauma: detection of abdominal bleeding

    International Nuclear Information System (INIS)

    Tc-99m sulfur colloid scintigraphy can detect and locate active lower gastrointestinal bleeding. The same principles apply to the detection and location of active intra-abdominal or pelvic hemorrhage following blunt abdominal trauma. We report two patients with abdominal bleeding who were correctly diagnosed by this method. As part of the routine examination of all patients having Tc-99m sulfur colloid liver-spleen scans for trauma, 500,000-count images should be made of the rest of the abdomen and pelvis

  13. Divergent adaptive and innate immunological responses are observed in humans following blunt trauma

    Directory of Open Access Journals (Sweden)

    Lentsch Alex B

    2010-01-01

    Full Text Available Abstract Background The immune response to trauma has traditionally been modeled to consist of the systemic inflammatory response syndrome (SIRS followed by the compensatory anti-inflammatory response syndrome (CARS. We investigated these responses in a homogenous cohort of male, severe blunt trauma patients admitted to a University Hospital surgical intensive care unit (SICU. After obtaining consent, peripheral blood was drawn up to 96 hours following injury. The enumeration and functionality of both myeloid and lymphocyte cell populations were determined. Results Neutrophil numbers were observed to be elevated in trauma patients as compared to healthy controls. Further, neutrophils isolated from trauma patients had increased raft formation and phospho-Akt. Consistent with this, the neutrophils had increased oxidative burst compared to healthy controls. In direct contrast, blood from trauma patients contained decreased naïve T cell numbers. Upon activation with a T cell specific mitogen, trauma patient T cells produced less IFN-gamma as compared to those from healthy controls. Consistent with these results, upon activation, trauma patient T cells were observed to have decreased T cell receptor mediated signaling. Conclusions These results suggest that following trauma, there are concurrent and divergent immunological responses. These consist of a hyper-inflammatory response by the innate arm of the immune system concurrent with a hypo-inflammatory response by the adaptive arm.

  14. Acute direct inguinal hernia resulting from blunt abdominal trauma: Case Report

    OpenAIRE

    Hipkins Gabrielle; Vedanayagam Maria; Biswas Seema; Leather Andrew

    2010-01-01

    Abstract We report a case of traumatic inguinal hernia following blunt abdominal trauma after a road traffic accident and describe the circumstances and technique of repair. The patient suffered multiple upper limb fractures and developed acute swelling of the right groin and scrotum. CT scan confirmed the acute formation of a traumatic inguinal hernia. Surgical repair was deferred until resolution of the acute swelling and subcutaneous haematoma. The indication for surgery was the potential ...

  15. Successful endoscopic treatment of biliary stricture following mesenteric tear caused by blunt abdominal trauma

    Institute of Scientific and Technical Information of China (English)

    Dong O Kang; Tae Hyo Kim; Seung Suk You; Hyun Ju Min; Hyun Jin Kim; Woon Tae Jung; Ok Jae Lee

    2008-01-01

    Biliary duct injuries are frequently iatrogenic, being associated with surgery for gallbladder stones. However,blunt abdominal trauma such as a motor vehicle crash is a rare cause of extrahepatic biliary stricture. A few reports have been published on biliary strictures treated with endoscopic therapy. In the present study, we describe a suprapancreatic biliary stricture associated with mesenteric tear following road traffic accident.We performed endoscopic stent placement, which was successful in relieving the biliary stricture.

  16. Isolated inferior rectus muscle rupture after blunt orbital trauma

    Science.gov (United States)

    Tomasetti, Patrick; Metzler, Philipp; Jacobsen, Christine

    2013-01-01

    A 44-year-old man was referred to our department with diplopia, periorbital swelling and haematoma of the left eye after orbital trauma due to a punch. During the examination, mild enophthalmos, hypertropia and a total absence of infraduction were observed. An orbital computed tomography (CT) scan demonstrated a left orbital floor blow-out fracture, with caudal herniation of periorbital fat and rectus inferior muscle. Repair was performed under total anaesthesia with placement of a Titan mesh. The following days were marked by the persistence of diplopia without improvement of infraduction. A postoperative, 0.5 mm CT scan highlighted a complete rupture of the inferior rectus muscle, not seen before operation, by a 1.0 mm-sliced CT. In this case, orthoptic therapy was undertaken with good results after 6 months and without need of a second repair. PMID:24963904

  17. Pediatric blunt renal trauma with wide fragments dislocation: successful organ saving management by internal stenting and percutaneous perirenal drain

    Directory of Open Access Journals (Sweden)

    C. Olivieri

    2014-12-01

    Full Text Available Children have an high risk of renal damage as a result of blunt trauma. Conservative management is always recommended for lower grades (I to III but is rather controversial whenever high grade injuries (grade IV and V are concerned. We describe a case of successful conservative management in grade IV renal injury occurred in a 9-years-old girl with blunt trauma.

  18. [Primary radial head arthroplasty in trauma : Complications].

    Science.gov (United States)

    Schmidt-Horlohé, K; Buschbeck, S; Wincheringer, D; Weißenberger, M; Hoffmann, R

    2016-10-01

    Radial head fractures are common injuries in elbow trauma. Non-displaced fractures are best treated conservatively. Simple but displaced fractures require anatomic reduction and fixation, typically using screws. The treatment course for complex fractures with multiple fragments is still being debated, as results are less predictable. Radial head resection is not advised if concomitant injuries of the coronoid process or the collateral ligaments with instability are present. Favorable outcomes following open reduction and fixation using plates were reported recently. However, complication rates are very high. Radial head replacement is a valuable tool in treating complex fractures of the radial head with predominantly good and excellent results. Patients who suffer radial head fractures are typically of a younger age, resulting in high functional demands. Certainly, unspecific and specific complications related to radial head arthroplasty were reported in up to 40 % of cases in an acute fracture setting. This article highlights common complications in radial head arthroplasty and aims to present strategies to avoid them. PMID:27600571

  19. A rare consequence of blunt abdominal trauma: bilateral renal infarction.

    Science.gov (United States)

    Saritas, Ayhan; Kandis, Hayati; Gunes, Harun; Kayikci, Ali; Baltaci, Davut; Buyukkaya, Ramazan; Ozaydinli, Ismet

    2014-05-01

    A 28-year-old man was admitted to the emergency department with lumbar pain owing to a motorbike accident. On clinical examination, abdominal tenderness, pelvic and left cruris pains were present. Erythrocytes, leucocytes and protein was found to be positive in urine analysis. Abdominal computed tomography with intravenous contrast solution showed contrast enhancement in 80% of right kidney, and 30% of left kidney; some intra-abdominal free fluid was also seen. Conservative management was planned for bilateral renal infarction. Urine output was 1.1 L per day. He was discharged on the seventh day of the hospital stay. The patient had not got any problems on the sixth month follow-up. Urine output is a very important parameter for multiple trauma patients. Any decrease in urine output may not be seen inspite of the presence of bilateral renal damage as in the case of the patient, and this situation does not allow ruling out renal injury completely. Hence, emergency physician should still be careful about the risk of renal injury.

  20. Neurodegeneration and Vision Loss after Mild Blunt Trauma in the C57Bl/6 and DBA/2J Mouse.

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    Courtney Bricker-Anthony

    Full Text Available Damage to the eye from blast exposure can occur as a result of the overpressure air-wave (primary injury, flying debris (secondary injury, blunt force trauma (tertiary injury, and/or chemical/thermal burns (quaternary injury. In this study, we investigated damage in the contralateral eye after a blast directed at the ipsilateral eye in the C57Bl/6J and DBA/2J mouse. Assessments of ocular health (gross pathology, electroretinogram recordings, optokinetic tracking, optical coherence tomography and histology were performed at 3, 7, 14 and 28 days post-trauma. Olfactory epithelium and optic nerves were also examined. Anterior pathologies were more common in the DBA/2J than in the C57Bl/6 and could be prevented with non-medicated viscous eye drops. Visual acuity decreased over time in both strains, but was more rapid and severe in the DBA/2J. Retinal cell death was present in approximately 10% of the retina at 7 and 28 days post-blast in both strains. Approximately 60% of the cell death occurred in photoreceptors. Increased oxidative stress and microglial reactivity was detected in both strains, beginning at 3 days post-injury. However, there was no sign of injury to the olfactory epithelium or optic nerve in either strain. Although our model directs an overpressure air-wave at the left eye in a restrained and otherwise protected mouse, retinal damage was detected in the contralateral eye. The lack of damage to the olfactory epithelium and optic nerve, as well as the different timing of cell death as compared to the blast-exposed eye, suggests that the injuries were due to physical contact between the contralateral eye and the housing chamber of the blast device and not propagation of the blast wave through the head. Thus we describe a model of mild blunt eye trauma.

  1. Prevalence of Radiologic Findings in Patients with Blunt Chest Trauma in Isfahan

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    M. Haghighi

    2008-01-01

    Full Text Available Background/Objective: Chest trauma due to its vital organs can be very dangerous and lethal. Our country has the first grade of accidents in the word, so rapid diagnosis and treatment in patients with chest trauma is necessary. One cost benefit and available imaging modality in each Region of our country is X-ray."nCXR interpretation needs to knowledge about prevalence of abnormal Radiologic findings and their accuracy. Therefore, it is necessary to perform a study about the rate of CXR abnormal findings in patients with blunt chest trauma."nPatients and Methods: In this descriptive and prospective study, CXR of patients with blunt chest trauma that admitted in Alzahra and Kashani hospitals studied and percent of vital radiologic findings prevalence determined."nResults: The final results were as below:"n1- Rib FX (18.5% (143, 2- Hemothorax (13.6% (105, 3- Pneumothorax (11.8% (91, 4- Sub cutaneous emphysema (10.2% (79, 5- Lung laceration (8.1% (63, 6- Mediastinal winding (6.4% (50, 7- Clavicular and sternal FX (5.8% (44, 8- Pneumo mediastinum (4.1% (32, 9- spinal FX (3.5% (27, 10- Great vessels injury signs (1.4% (11."nConclusion: According to above results, accurate investigation of CXR, helps physician and radiologist to find any threatened finding, so determination of next step as clinical follow up or spiral CT, angiography or surgery; accordingly.

  2. Venous injury in abusive head trauma

    Energy Technology Data Exchange (ETDEWEB)

    Choudhary, Arabinda K. [Nemours A. I. duPont Hospital for Children, Department of Radiology, Wilmington, DE (United States); Bradford, Ray; Thamburaj, K.; Boal, Danielle K.B. [Hershey Medical Center, Department of Radiology, Hershey, PA (United States); Dias, Mark S. [Hershey Medical Center, Department of Neurosurgery, Hershey, PA (United States)

    2015-11-15

    Abusive head trauma (AHT) is an important cause of serious brain injury in infants and young children who have characteristic clinical and imaging findings that are discordant with the clinical history provided. Recent attention has focused on abnormalities of the cranial venous sinuses and cortical veins, both on MRI and at autopsy. Although many have interpreted these to be secondary to the AHT, some have recently argued that these venous abnormalities represent primary cortical sinus and venous thrombosis that leads secondarily to subdural hemorrhage and secondary brain injury. Direct trauma to the veins and sinuses has been reported at autopsy in AHT, but there has been no systematic study of venous abnormalities in cases of AHT. The purpose of this study was to define the incidence and characteristics of venous and sinus abnormalities in AHT. We included all children <36 months of age who were diagnosed with abusive head trauma between 2001 and 2012 and who had MRI and magnetic resonance (MR) venography as part of their diagnostic workup. We analyzed age, gender and clinical findings. MRI and MR venography were analyzed independently by two neuroradiologists with a focus on abnormalities involving the intracranial veins and venous sinuses. A total of 45 children were included. The median age was 3 months (range 15 days to 31 months) and 28 were boys (62%). Clinical findings included retinal hemorrhage in 71% and extracranial fractures in 55%. CT or MRI demonstrated subdural hemorrhage in 41 (91%); none had subdural effusions. In 31 cases (69%) MR venography demonstrated mass effect on the venous sinuses or cortical draining veins, with either displacement or partial or complete effacement of the venous structures from an adjacent subdural hematoma or brain swelling. We also describe the lollipop sign, which represents direct trauma to the cortical bridging veins and was present in 20/45 (44%) children. Evidence of displacement or compression of cortical veins

  3. Screening US and CT for blunt abdominal trauma: A retrospective study

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    Marco, Giuseppetti Gian [Institute of Radiology, Polytechnic University of Marche Medical School, Umberto I Hospital, Ancona (Italy)]. E-mail: gm.giuseppetti@ao-umbertoprimo.marche.it; Diego, Salera [Institute of Radiology, Polytechnic University of Marche Medical School, Umberto I Hospital, Ancona (Italy); Giulio, Argalia [Institute of Radiology, Polytechnic University of Marche Medical School, Umberto I Hospital, Ancona (Italy); Luca, Salvolini [Institute of Radiology, Polytechnic University of Marche Medical School, Umberto I Hospital, Ancona (Italy)

    2005-10-01

    Objective: To assess the accuracy of screening US and CT in patients with blunt abdominal trauma admitted to the trauma centre of our General Hospital. Materials and method: The abdominal US reports of 864 primary trauma patients (139 with major and 725 with minor injuries) and 162 CT reports of a subgroup of the same subjects (64 with major and 98 with minor injuries) were reviewed and compared to the best available reference standard. The accuracy of screening US was assessed by evaluating its overall ability to distinguish negative from positive cases by showing at least one of the lesions documented by the reference standard and its specific ability to depict all lesions; CT reports were evaluated only for the method's performance in depicting all lesions. Results: Screening US exhibited a satisfactory overall ability to distinguish negative from positive patients (91.5% sensitivity and 97.5% specificity in major trauma patients versus 73.3% sensitivity and 98.1% specificity in the minor trauma group) and a satisfactory specific ability to depict all injuries in major trauma patients. In minor trauma cases sensitivity was satisfactory for free fluid but unsatisfactory for organ injuries. Of the 21/864 false negative reports (5 in patients with major and 16 in cases with minor traumas), only one affected patient management, a major trauma case, by delaying an emergency laparotomy. The performance of CT in detecting each single lesion was predictably excellent in both patient groups. Conclusion: Its satisfactory accuracy for major trauma suggests that US could be employed not only to screen cases for emergency laparotomy but also as an alternative to CT. However, since major traumatic injuries generally carry an imperative indication for CT, especially as regards neurological, thoracic and skeletal evaluation, US should be employed to perform a prompt preliminary examination using a simplified technique in the emergency room simultaneously with resuscitation.

  4. The development of simple survival prediction models for blunt trauma victims treated at Asian emergency centers

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    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.

  5. Investigation of childhood blunt abdominal trauma: A practical approach using ultrasound as the initial diagnostic modality

    International Nuclear Information System (INIS)

    During a 5.5-year retrospective study (1979-84) 170 children with blunt abdominal trauma were investigated with intravenous urography (IVU), ultrasound (US) and scintigraphy. For the investigation of the last 71 children (after 1982) a 4th generation CT scanner was available in the same department. The results of radiologic investigations were compared with clinical outcome in 157 and results at laparotomy in 13 children. During the study period, real time US became the first line screening tool, and was combined with IVU in suspected renal trauma. In spite of permanent accessibility of CT since November 1982, the latter was used only in complex diagnostic problems or in children with multiple injuries (8% of the series). There were no deaths resulting from abdominal trauma. During the study, the incidence of splenectomy and exploratory laparotomy decreased, and no diagnostic peritoneal lavage was performed after 1980. (orig.)

  6. Acute fatal coronary artery dissection following exercise-related blunt chest trauma.

    Science.gov (United States)

    Barbesier, Marie; Boval, Catherine; Desfeux, Jacques; Lebreton, Catherine; Léonetti, Georges; Piercecchi, Marie-Dominique

    2015-01-01

    Coronary artery injury such as acute coronary dissection is an uncommon and potentially life-threatening complication after blunt chest trauma. The authors report an unusual autopsy case of a 43-year-old healthy man who suddenly collapsed after receiving a punch to the chest during the practice of kung fu. The occurrence of the punch was supported by the presence of one recent contusion on the left lateral chest area at the external examination and by areas of hemorrhage next to the left lateral intercostal spaces at the internal examination. The histological examination revealed the presence of an acute dissection of the proximal segment of the left anterior descending coronary artery. Only few cases of coronary artery dissection have been reported due to trauma during sports activities such as rugby and soccer games, but never during the practice of martial arts, sports usually considered as safe and responsible for only minor trauma.

  7. Clinical predictors of abnormal computed tomography scan in minor head trauma in children under 2 years old

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    Sepideh Lotfi Sadigh

    2015-03-01

    Full Text Available Introduction: Minor blunt head trauma is a common reason for children to present to the emergency department (ED. Crania computed tomography (CT is the choice for evaluating children with blunt head trauma in the ED, but few shows abnormal findings. In this study, we aim to evaluate CT findings in children with blunt head trauma and clinical symptoms to identify clinical predictors of abnormal CT scans. Methods: In this prospective study, 218 children under 2 years of age (121 male and 97 female with mean age of 11.24 ± 4.31 months with compliant of minor blunt head trauma visiting the ED between April 2011 and April 2014 were included. Physical examination and clinical symptoms, as well as CT findings and patients’ outcome were evaluated. Results: Physical examinations were normal in 95.9%, and clinical symptoms were present only in 25.7% including vomiting in 16.1%, loss of consciousness (LOC in 8.3%, ear/nose bleeding in 4.1% and seizure in 5.5%. CT scan was requested in 189 cases (86.7% of which, 7.9% were abnormal including linear fracture in 5.3%, subgaleal hematoma in 1.1% and depressed fracture, subcutaneous hematoma and intracranial hemorrhage (ICH each in 0.5%. Among all cases, 89.0% were discharged from ED with no further observation, 6.0% discharged after 48 h observation and 5.0% were hospitalized. There was a significant correlation between abnormal CT findings and having any clinical symptoms, vomiting and Ear/nose bleeding. Conclusion: In children under 2 years old with minor blunt head trauma, most CT scans are unnecessary. Considering clinical symptoms as predictors of abnormal CT scans we can reduce unnecessary ones.

  8. Diagnostic accuracy of a step-up imaging strategy in pediatric patients with blunt abdominal trauma

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    Schuppen, J. van [Department of Radiology, Academic Medical Centre, Amsterdam (Netherlands); Olthof, D.C. [Trauma Unit Department of Surgery, Academic Medical Centre, Amsterdam (Netherlands); Wilde, J.C.H. [Department of Paediatric Surgery, Emma' s Children Hospital/Academic Medical Centre, Amsterdam (Netherlands); Beenen, L.F.M.; Rijn, R.R. van [Department of Radiology, Academic Medical Centre, Amsterdam (Netherlands); Goslings, J.C., E-mail: j.c.goslings@amc.nl [Trauma Unit Department of Surgery, Academic Medical Centre, Amsterdam (Netherlands)

    2014-01-15

    Introduction: Blunt abdominal trauma (BAT) is an important but often unrecognized cause of death in children. Imaging plays a vital role in the early detection of abdominal trauma. The exact role of imaging in the management of BAT in children is still under research. The aim of this study was to assess diagnostic accuracy of a step-up imaging strategy, where the decision to observe or to perform an intervention depends on the vital parameters of the patient, in combination with the presence or absence of free fluid at Focused Assessment with Sonography for Trauma (FAST) and the findings on CT (performed selectively), for pediatric patients presenting to the ED with a blunt abdominal trauma. Methods: Consecutive patients aged ≤16 years admitted between January 2008 and December 2012 to a Dutch level 1 trauma centre were included in this retrospective study. Sensitivity, negative predictive value (NPV) and the negative likelihood ratio (LR−) of the imaging strategy were calculated. Results: The cohort consisted of 122 patients; 66 (54%) patients were discharged home after primary survey, 51 (41%) patients were admitted and observed, 3 (2%) patients underwent transarterial embolization and 2 (2%) patients underwent surgery. Treatment failed in 1 patient, initially selected for observation. The sensitivity of the imaging strategy was 0.833 (0.446–0.990). The NPV and LR− were 0.991 (0.963–1.000) and 0.167 (0.028–0.997), respectively. Conclusion: The step-up imaging strategy that is applied in our academic level 1 trauma centre has a high sensitivity and a high negative predictive value. No clinically relevant injuries were missed without doing unnecessary harm, e.g. radiation or an intervention.

  9. Unenhanced Computed Tomography to Visualize Hollow Viscera and/or Mesenteric Injury After Blunt Abdominal Trauma

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    Yang, Xu-Yang; Wei, Ming-Tian; Jin, Cheng-Wu; Wang, Meng; Wang, Zi-Qiang

    2016-01-01

    Abstract To identify and describe the major features of unenhanced computed tomography (CT) images of blunt hollow viscera and/or mesenteric injury (BHVI/MI) and to determine the value of unenhanced CT in the diagnosis of BHVI/MI. This retrospective study included 151 patients who underwent unenhanced CT before laparotomy for blunt abdominal trauma between January 2011 and December 2013. According to surgical observations, patients were classified as having BHVI/MI (n = 73) or not (n = 78). Sensitivity, specificity, P values, and likelihood ratios were calculated by comparing CT findings between the 2 groups. Six significant CT findings (P < 0.05) for BHVI/MI were identified and their sensitivity and specificity values determined, as follows: bowel wall thickening (39.7%, 96.2%), mesentery thickening (46.6%, 88.5%), mesenteric fat infiltration (12.3%, 98.7%), peritoneal fat infiltration (31.5%, 87.1%), parietal peritoneum thickening (30.1%, 85.9%), and intra- or retro-peritoneal air (34.2%, 96.2%). Unenhanced CT scan was useful as an initial assessment tool for BHVI/MI after blunt abdominal trauma. Six key features on CT were correlated with BHVI/MI. PMID:26945375

  10. Diagnosis of an Inguinal Hernia after a Blunt Inguinal Trauma with an Intestinal Perforation

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    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.

  11. Acute direct inguinal hernia resulting from blunt abdominal trauma: Case Report

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    Hipkins Gabrielle

    2010-06-01

    Full Text Available Abstract We report a case of traumatic inguinal hernia following blunt abdominal trauma after a road traffic accident and describe the circumstances and technique of repair. The patient suffered multiple upper limb fractures and developed acute swelling of the right groin and scrotum. CT scan confirmed the acute formation of a traumatic inguinal hernia. Surgical repair was deferred until resolution of the acute swelling and subcutaneous haematoma. The indication for surgery was the potential for visceral strangulation or ischaemia with the patient describing discomfort on coughing. At surgery there was complete obliteration of the inguinal canal with bowel and omentum lying immediately beneath the attenuated external oblique aponeurosis. A modified prolene mesh hernia repair was performed after reconstructing the inguinal ligament and canal in layers. To our knowledge, this is the first documented case of the formation of an acute direct inguinal hernia caused as a result of blunt abdominal trauma with complete disruption of the inguinal canal. Surgical repair outlines the principles of restoration of normal anatomy in a patient who is physiologically recovered from the acute trauma and whose anatomy is distorted as a result of his injuries.

  12. Pancreatic transection from blunt trauma associated with vascular and biliary lesions: A case report

    Institute of Scientific and Technical Information of China (English)

    Gian Luca Baiocchi; Guido AM Tiberio; Federico Gheza; Marco Gardani; Massimiliano CantO; Nazario Portolani; Stefano Maria Giulini

    2008-01-01

    Major injuries of the pancreas may result in considerable morbidity and mortality when associated with vascular and visceral injuries.In such cases,a right diagnosis and a prompt surgical intervention are necessary to give a chance to the patient.We herein describe a case of blunt abdominal trauma in a 29-year-old man whose pancreatic rupture was associated with hepatic artery,splenic vein and extrahepatic bile duct damage.Immediate surgery was performed after computer tomograghy (CT),the haemorrhagic lesions dictat the emergency transfer to the operating room.Spleno-pancreatic resection was done with reconstruction of the hepatic artery,ligation of the splenic vein and a Roux-en-Y bilio-jejunal diversion.The early post-operative course was complicated by stenosis of the arterial reconstruction,which was treated by endovascular angioplasty followed by percutaneous drainage of symptomatic pseudocyst,rest and antibiotics.Finally,the patient was discharged and was alive without clinical problems at the time when we wrote this case report.The present case underlines the clinical relevance of vascular and visceral injuries associated with pancreatic trauma and the problems arising in the diagnostic evaluation and the surgical strategy of complex multiple visceral and vascular lesions in blunt abdominal trauma.

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

    International Nuclear Information System (INIS)

    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

  14. The role of computed tomography in blunt abdominal trauma in children.

    Science.gov (United States)

    Taylor, G A; Fallat, M E; Potter, B M; Eichelberger, M R

    1988-12-01

    This study was performed in order to test the hypothesis that abdominal computed tomography (CT) can assist in the decision to perform laparotomy in children following blunt trauma to the abdomen. Three hundred forty children with blunt abdominal trauma underwent evaluation with CT. Abdominal injuries were detected in 84 children (25%). These included: 75 injuries to solid viscera in 60 patients (30 splenic, 29 hepatic, 13 renal, and three pancreatic); four injuries to hollow viscera (three small bowel transections, and one rupture of the urinary bladder); and 23 skeletal injuries (21 fractures of the pelvis, and two lumbar spine subluxations). Injury to solid viscera was categorized as minor in 32 (43%), moderate in 18 (24%), or severe in 25 (33%) according to an assessment of the percentage of parenchyma involved. Hemoperitoneum was detected in 42 patients, and characterized as small in 18 (43%), moderate in nine (21%), and large in 15 (36%). CT was useful in establishing the location and extent of injuries, and in detecting the presence of blood or air in the peritoneal cavity. However, the extent of injury to solid viscera detected on CT did not correlate with the need for laparotomy. Of 46 moderate to severe anatomic injuries of the liver, spleen or kidney, only five (9%) required surgical intervention because of persistent bleeding or infection. Although laparotomy occurred more frequently in the presence of a large hemoperitoneum, only 6/24 (25%) with moderate to large hemoperitoneum required surgical exploration. This analysis confirms the usefulness of CT for detection of location and extent of injury in pediatric blunt abdominal trauma.(ABSTRACT TRUNCATED AT 250 WORDS)

  15. Abusive head trauma: two case reports.

    Science.gov (United States)

    Kanık, Ali; İnce, Osman Tolga; Yeşiloğlu, Şehriban; Eliaçık, Kayı; Bakiler, Ali Rahmi

    2015-09-01

    Abusive head trauma is a serious form of child abuse and mostly seen in infants below the age of two years as a result of a strong shaking by the caregiver who aims to stop the infant's crying. Characteristic symptoms include subdural hematomas, encephalopathy, retinal hemorrhages and fractures of the long bones. When physically examined, there are generally no externally visible signs. For this reason, it can be underdiagnosed, if it is not considered in the differential diagnosis. When the information provided from the parents is inconsistent and contradictory with the clinical picture of the patient, this form of abuse must be suspected and retinal hemorrhages should be searched. In this article, two patients who were admitted to our emergency department and diagnosed with physical child abuse are reported. One of these patients had a history of minor head trauma after falling down from the sofa and the other one had a history of breathlessness and loss of consciousness as a result of excessive crying. PMID:26568695

  16. Emergency department evaluation and management of blunt chest and lung trauma (Trauma CME).

    Science.gov (United States)

    Morley, Eric J; Johnson, Scott; Leibner, Evan; Shahid, Jawad

    2016-06-01

    The majority of blunt chest injuries are minor contusions or abrasions; however, life-threatening injuries, including tension pneumothorax, hemothorax, and aortic rupture can occur and must be recognized early. This review focuses on the diagnosis, management, and disposition of patients with blunt injuries to the ribs and lung. Utilization of decision rules for chest x-ray and computed tomography are discussed, along with the emerging role of bedside lung ultrasonography. Management controversies presented include the limitations of needle thoracostomy us¬ing standard needle, chest tube placement, and chest tube size. Finally, a discussion is provided related to airway and ventilation management to assist in the timing and type of interventions needed to maintain oxygenation. PMID:27177417

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

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    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.

  18. Characteristics of Hollow Viscus Injury following Blunt Abdominal Trauma; a Single Centre Experience from Eastern India

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    Nawal Kishore Jha

    2014-10-01

    Full Text Available Objective: To determine the presentation, anatomical distribution, diagnostic method, management and outcome of hollow viscus injury (HVI from blunt abdominal trauma. Methods: This was a retrospective cross-sectional study including patients with blunt abdominal trauma leading to HVI admitted at Rajendra Institute of Medical Sciences, Ranchi, over a period of 4.5 years (January 2009 to July 2014. Data were retrieved from patients’ medical records. Total 173 patients with HVI due to blunt abdominal trauma, who underwent laparotomy at our institute, were reviewed. Data regarding clinical presentation, anatomical distribution, management and outcome were recorded and analysed. Results: Out of 173 patients 87.1% were men and 12.9% were women. Mean age of patients was 29±14.02 years. The most common site of injury was ileum (46.2% followed by jejunum (44.5%. There were 5 gastric perforations (2.9%, 2 (1.15% duodenal, 2 (1.15% colonic, 2 (1.15% sigmoidal and 2 (1.15% rectal injuries. One caecal injury was also recorded. Road traffic accident was the most common mechanism of injury (57.2% followed by fall from height (36.4% and assault (6.4%. Free gas under diaphragm on erect abdomen radiography was seen in 85.5% of cases while preoperative CT Abdomen was done in 11.6% of cases. Treatment consisted of simple closure of the perforation (66.5%, resection and anastomosis (11.0% and stoma (22.5%. Major complication was anastamotic leak which was recorded in 6.4% cases and 15.6% patients developed burst abdomen. Average hospital stay was 13±6 days. Overall mortality rate was 12.7%. Conclusion: Although early recognition of intestinal injuries from blunt abdominal trauma may be difficult in all cases, it is very important due to its tremendous life threatening potential. Age of the patient, anatomical site and time of presentation are probably main prognostic factors.

  19. Characteristics of behind armor blunt trauma produced by bullets with different structural materials: an experimental study

    OpenAIRE

    Ling-qing WANG; Xi-nan LAI; Zhang, Bo; Zheng-lin SU; Huang, Yi-Feng; Wang, Li-Li

    2013-01-01

    Objective To investigate the effect of structural materials of bullets on behind armor blunt trauma (BABT). Methods Ten healthy male Landraces were randomly divided into two groups (5 each): 56 type 7.62-mm rifle bullet group and SS109 5.56-mm rifle bullet group. The kinetic energy of two types of bullets was adjusted to the same level (about 1880J) by the way of grow downwards gunpowder. Then the animals as protected with both grade NIJ Ⅲ ceramic hard armor and grade Ⅱ police soft body armor...

  20. Guillain-Barré syndrome following acute head trauma.

    OpenAIRE

    Duncan, R; Kennedy, P G

    1987-01-01

    A case of classical Guillain-Barré syndrome following acute head trauma is described. The association of Guillain-Barré syndrome with head injury per se is not well recognized, and a possible immunological explanation is proposed.

  1. NON - OPERATIVE MANAGEMENT OF BLUNT HEPATIC AND/OR SPLENIC TRAUMA : A PROSPECTIVE STUDY

    Directory of Open Access Journals (Sweden)

    Ravikar

    2015-03-01

    Full Text Available PURPOSE: The incidence of blunt splenic and hepatic injuries are on a rise not only because of an increase in the overall incidence of Road Traffic Accidents but also due to more liberal use of radiological tests in the work - up of these patients. Spleen and liver are respectively the first and the second most common intra - abdominal organs to be injured in blunt abdominal injury. However, most of these patients can be treated without a formal laparotomy and its associated complications, as long as they remain hemody namically stable. Although few studies have proven the efficacy of conservative management, most of them are retrospective. This prospective study aims to evaluate the efficacy of conservative management of blunt liver and/or splenic injuries. MATERIALS AN D METHODS: Over a 12 - month period, a total of 56 patients with blunt hepatic and/or splenic injury were evaluated prospectively. Fourteen [25%] patients underwent immediate exploration for hemodynamic instability and the rest 42 patients constituted the st udy group. Injury Severity Score [ISS] was used to assess the extent of overall injury. Unstable patients underwent emergent laparotomies, and stable patients had abdominal computed tomography (CT scans to grade the source and severity of their injury. He patic and splenic injuries were graded using AAST grading for solid organ injuries. Those with nonhepatic, nonsplenic operative indications underwent exploration, and the remaining patients were intentionally managed nonoperatively in the trauma intensive care unit. Frequent measurement of vitals and estimation of hemoglobin and hematocrit was done. The outcome was measured in terms of total blood transfused, total duration of hospital stay and complications due to conservative management. RESULTS: A total of 56 patients presented to our ED with blunt abdominal trauma. Fourteen patients had to undergo emergent surgery for hemodynamic stability. The rest 42 were

  2. 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.

  3. [Blunt chest trauma with total rupture of the right main stem bronchus--a case report].

    Science.gov (United States)

    Moerer, O; Heuer, J; Benken, I; Roessler, M; Klockgether-Radke, A

    2004-01-01

    Tracheo-bronchial lesions in blunt chest trauma are rare--the incidence is about 1%--but potentially life-threatening events. Indirect signs such as pneumothorax, pneumomediastinum, subcutaneous emphysema or an insufficient expansion of the lungs after drainage of a pneumothorax are ominous. The fastest and most reliable method to assess the definite diagnosis of tracheo-bronchial lesion is fibre-optic tracheobronchoscopy. Early surgical treatment is mandatory to prevent major pulmonary resection. This case shows that computer tomography might fail to provide the right diagnosis. Independent lung ventilation is an option to protect the bronchial anastomosis during the early postoperative period. Reported here is the case of a young man who sustained a total traumatic rupture of the right main stem bronchus after being thrown from the passenger seat through the windshield of a motor vehicle. When the emergency doctor arrived on the scene, he found the patient with dyspnoea and massive thoracic subcutaneous emphysema. Reduced breath sounds on the left and no breath sounds on the right side led to an immediate placement of two chest tubes and controlled mechanical ventilation. After primary care in a district hospital, the patient was transferred to our university hospital for further treatment of his head injury. On admission, the patient was making breath sounds on both sides and a CT scan showed no clear sign of a tracheo-bronchial lesion. After neurosurgical intervention, the diagnosis of a rupture of the right main stem bronchus was made with delay by fibre-optic bronchoscopy. The patient was intubated with a left-sided double lumen endotracheal tube followed by surgical end-to-end anastomosis of the lesion. The initial postoperative ventilator support consisted of BIPAP-mode ventilation of the left lung, while the right lung was kept open with positive airway pressure. Forty-eight hours later, synchronised independent lung ventilation with two ventilators was

  4. Head kinematics during shaking associated with abusive head trauma.

    Science.gov (United States)

    Lintern, T O; Puhulwelle Gamage, N T; Bloomfield, F H; Kelly, P; Finch, M C; Taberner, A J; Nash, M P; Nielsen, P M F

    2015-09-18

    Abusive head trauma (AHT) is a potentially fatal result of child abuse but the mechanisms of injury are controversial. To address the hypothesis that shaking alone is sufficient to elicit the injuries observed, effective computational and experimental models are necessary. This paper investigates the use of a coupled rigid-body computational modelling framework to reproduce in vivo shaking kinematics in AHT. A sagittal plane OpenSim computational model of a lamb was developed and used to interpret biomechanical data from in vivo shaking experiments. The acceleration of the head during shaking was used to provide in vivo validation of the associated computational model. Results of this study demonstrated that peak accelerations occurred when the head impacted the torso and produced acceleration magnitudes exceeding 200ms(-)(2). The computational model demonstrated good agreement with the experimental measurements and was shown to be able to reproduce the high accelerations that occur during impact. The biomechanical results obtained with the computational model demonstrate the utility of using a coupled rigid-body modelling framework to describe infant head kinematics in AHT. PMID:26256822

  5. Head kinematics during shaking associated with abusive head trauma.

    Science.gov (United States)

    Lintern, T O; Puhulwelle Gamage, N T; Bloomfield, F H; Kelly, P; Finch, M C; Taberner, A J; Nash, M P; Nielsen, P M F

    2015-09-18

    Abusive head trauma (AHT) is a potentially fatal result of child abuse but the mechanisms of injury are controversial. To address the hypothesis that shaking alone is sufficient to elicit the injuries observed, effective computational and experimental models are necessary. This paper investigates the use of a coupled rigid-body computational modelling framework to reproduce in vivo shaking kinematics in AHT. A sagittal plane OpenSim computational model of a lamb was developed and used to interpret biomechanical data from in vivo shaking experiments. The acceleration of the head during shaking was used to provide in vivo validation of the associated computational model. Results of this study demonstrated that peak accelerations occurred when the head impacted the torso and produced acceleration magnitudes exceeding 200ms(-)(2). The computational model demonstrated good agreement with the experimental measurements and was shown to be able to reproduce the high accelerations that occur during impact. The biomechanical results obtained with the computational model demonstrate the utility of using a coupled rigid-body modelling framework to describe infant head kinematics in AHT.

  6. Primary Chest Wall Abscess Mimicking a Breast Tumor That Occurred after Blunt Chest Trauma: A Case Report

    Directory of Open Access Journals (Sweden)

    Yusuke Yamaoka

    2014-01-01

    Full Text Available Primary chest wall abscess occurring after blunt chest trauma is rare. We present the case of a 50-year-old woman who presented with a swelling in her left breast. The patient had experienced blunt chest trauma 2 months back. Needle aspiration revealed pus formation in the patient’s chest. Computed tomography revealed a mass in the lower region of the left mammary gland, with thickening of the parietal pleura and skin and fracture of the fifth rib under the abscess. Following antibiotic administration and irrigation of the affected region, surgical debridement was performed. During surgery, we found that the pectoralis major muscle at the level of the fifth rib was markedly damaged, although the necrotic tissue did not contact the mammary gland. We diagnosed the lesion as a chest wall abscess that occurred in response to blunt chest trauma. Her postoperative course was uneventful. There has been no recurrence for six months after surgery.

  7. The Child Welfare Response to Serious Nonaccidental Head Trauma

    Science.gov (United States)

    Jaudes, Paula Kienberger; Bilaver, Lucy A.

    2004-01-01

    Serious nonaccidental head trauma (NHT) can leave permanent neurological damage in children who survive abuse. This study reports on child welfare's handling of NHT cases compared with cases of physical abuse and head trauma due to neglect with regard to placement in foster care, reunification with family, and safety issues. The results show that…

  8. Association between increased blood interleukin-6 levels on emergency department arrival and prolonged length of intensive care unit stay for blunt trauma

    OpenAIRE

    Taniguchi, Masashi; Nakada, Taka-aki; Shinozaki, Koichiro; Mizushima, Yasuaki; Matsuoka, Tetsuya

    2016-01-01

    Background Systemic immune response to injury plays a key role in the pathophysiological mechanism of blunt trauma. We tested the hypothesis that increased blood interleukin-6 (IL-6) levels of blunt trauma patients on emergency department (ED) arrival are associated with poor clinical outcomes, and investigated the utility of rapid measurement of the blood IL-6 level. Methods We enrolled 208 consecutive trauma patients who were transferred from the scene of an accident to a level I trauma cen...

  9. Isolated Blunt Duodenal Trauma: Delayed Diagnosis and Favorable Outcome with "Quadruple Tube" Decompression

    Directory of Open Access Journals (Sweden)

    Stefano Crippa

    2007-09-01

    Full Text Available Context Isolated blunt duodenal injury is a rare finding associated with high morbidity and significant mortality. The early identification of a duodenal injury is usually difficult, considering the anatomical location of the duodenum and lack of peritoneal signs and diagnostic delay is part of the clinical picture in most cases. Case report A 43-year-old man was admitted to our hospital after a motor vehicle collision. At admission he underwent emergency surgery because of lower extremities fractures. Twelve hours later he started to complain an increasing abdominal pain; blood tests showed serum amylase up to 180 U/L and a CT scan demonstrated a perforation of the third duodenal portion. At laparotomy a Grade III injury of the duodenum was evident. The laceration was sutured and a “quadruple-tube” decompression was performed. The postoperative course was uneventful. One year after surgery he is well without any long-term complication. Conclusion A high degree of suspicion is necessary for early diagnosis of blunt duodenal trauma and CT scan should be performed in case of all significant epigastric trauma. In most cases primary direct repair of duodenal wounds can be safely achieved and duodenal decompression via triple or quadriple tube technique is required to decrease the risk of duodenal fistula.

  10. Asymptomatic diaphragmatic rupture with retroperitoneal opening as a result of blunt trauma

    Directory of Open Access Journals (Sweden)

    Narci Adnan

    2010-01-01

    Full Text Available Blunt traumas of the abdomen and thorax are important clinical problems in pediatric ages. Severity of trauma may not always be compatible with the patients′ clinical situation. A 2-year-old male child was admitted to our emergency clinic as a result of tractor crash accident. Physical examination of the child was normal. The abdominal and thoracic ultrasonography (USG examination performed in the emergency clinic was normal. In thoracic computed tomography (CT scan of the patient, there was irregularity of the right diaphragmatic contour that was described as micro perforation-rupture (the free air was just in the perihepatic and retroperitoneal area, which was not passing through the abdomen. The patient was followed-up for 1 week in the hospital with a diagnosis of retroperitoneal diaphragmatic rupture. It is not appropriate to decide the severity of trauma in childhood on the basis of clinical findings. Although severe trauma and sustaining radiological examinations, the patients′ clinical pictures may be surprisingly normal, as in our patient. In such cases, there may not be any clinical symptom. CT scan examination must be preferred to USG for both primary diagnosis and follow-up of these patients. According to the current literature, there is no reported case with retroperitoneal rupture of the diaphragm.

  11. Treatments for blunt chest trauma and their impact on patient outcomes and health service delivery.

    Science.gov (United States)

    Unsworth, Annalise; Curtis, Kate; Asha, Stephen Edward

    2015-01-01

    Blunt chest trauma is associated with a high risk of morbidity and mortality. Complications in blunt chest trauma develop secondary to rib fractures as a consequence of pain and inadequate ventilation. This literature review aimed to examine clinical interventions in rib fractures and their impact on patient and hospital outcomes. A systematic search strategy, using a structured clinical question and defined search terms, was performed in MEDLINE, EMBASE, CINAHL and the Cochrane Library. The search was limited to studies of adult humans from 1990-March 2014 and yielded 977 articles, which were screened against inclusion/exclusion criteria. A hand search was then performed of the articles that met the eligibility criteria, 40 articles were included in this review. Each article was assessed using a quantitative critiquing guideline. From these articles, interventions were categorised into four main groups: analgesia, surgical fixation, clinical protocols and other interventions. Surgical fixation was effective in patients with flail chest at improving patient outcomes. Epidural analgesia, compared to both patient controlled analgesia and intravenous narcotics in patients with three or more rib fractures improved both hospital and patient outcomes, including pain relief and pulmonary function. Clinical pathways improve outcomes in patients ≥ 65 with rib fractures. The majority of reviewed papers recommended a multi-disciplinary approach including allied health (chest physiotherapy and nutritionist input), nursing, medical (analgesic review) and surgical intervention (stabilisation of flail chest). However there was a paucity of evidence describing methods to implement and evaluate such multidisciplinary interventions. Isolated interventions can be effective in improving patient and health service outcomes for patients with blunt chest injuries, however the literature recommends implementing strategies such as clinical pathways to improve the care and outcomes of

  12. Evaluating clinical abdominal scoring system in predict- ing the necessity of laparotomy in blunt abdominal trauma

    Directory of Open Access Journals (Sweden)

    Erfantalab-Avini Peyman

    2011-06-01

    Full Text Available 【Abstract】 Objectives: Trauma is among the lead- ing causes of death. Medical management of blunt abdomi- nal trauma (BAT relies on judging patients for whom lap- arotomy is mandatory. This study aimed to determine BAT patients’ signs, as well as paraclinical data, and to clarify the accuracy, sensitivity, specificity, positive and negative predictive value of clinical abdominal scoring system (CASS, a new scoring system based on clinical signs, in predicting whether a BAT patient needs laparotomy or not. Methods: Totally 400 patients suspected of BAT that arrived at the emergency department of two university hos- pitals in Tehran from March 20, 2007 to March 19, 2009 were included in this study. They were evaluated for age, sex, type of trauma, systolic blood pressure, Glasgow coma scale (GCS, pulse rate, time of presentation after trauma, abdomi- nal clinical findings, respiratory rate, temperature, hemoglo- bin (Hb concentration, focused abdominal sonography in trauma (FAST and CASS. Results: Our measurements showed that CASS had an accuracy of 94%, sensitivity of 100%, specificity of 88%, positive predictive value of 90% and negative predictive value of 100% in determining the necessity of laparotomy in BAT patients. Moreover, in our analysis, systolic blood pressure, GCS, pulse rate, Hb concentration, time of presen- tation after trauma, abdominal clinical findings and FAST were also shown to be helpful in confirming the need for laparotomy (P<0.05. Conclusion: CASS is a promising scoring system in rapid detection of the need for laparotomy as well as in minimizing auxiliary expense for further evaluation in BAT patients, thus to promote the cost-benefit ratio and accu- racy of diagnosis. Key words: Abdominal injuries; Laparotomy; Patients; Wounds, nonpenetrating

  13. 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

  14. The Use of Ophthalmic Ultrasonography to Identify Retinal Injuries Associated With Abusive Head Trauma.

    Science.gov (United States)

    Riggs, Becky J; Trimboli-Heidler, Carmelina; Spaeder, Michael C; Miller, Marijean M; Dean, Nathan P; Cohen, Joanna S

    2016-05-01

    Abusive head trauma includes any nonaccidental injury inflicted to a child's head and body. It is often characterized by, but not limited to, the repetitive acceleration-deceleration forces with or without blunt head impact. It has a mortality rate of 30%, and 80% of survivors experience permanent neurologic damage. In this case series, we hypothesize that bedside ultrasonography can be useful in the identification of retinal injuries that are consistent with abusive head trauma. Ocular manifestations of abusive head trauma are identified by dilated ophthalmic examination showing retinal hemorrhages that are too numerous to count, multilayered, and extending to the periphery. Traumatic retinoschisis, splitting of the retinal layers with or without blood accumulating in the intervening space, is exclusive for abusive head trauma in infants without a history of significant cerebral crush injury. Direct visualization of intraocular structures is difficult when the eyelids are swollen shut or when dilatation must be delayed. We present a series of 11 patients with brain injuries who underwent ophthalmic point-of-care ultrasonography that revealed traumatic retinoschisis on average 60 hours earlier than direct ophthalmic visualization. Dilated ophthalmic examinations and autopsy reports confirmed retinoschisis and other forms of retinal hemorrhages that were too numerous to count, multilayered, and extending to the periphery in all 11 patients. One patient did not have a dilated ophthalmic examination; however, traumatic retinoschisis and retinal hemorrhages were confirmed on autopsy. Ocular point-of-care ultrasonography is a promising tool to investigate abusive head trauma through the identification of traumatic retinoschisis and retinal hemorrhages when pupillary dilatation and direct ophthalmic examination is delayed.

  15. THE EVOLUTION OF ISOLATED BILATERAL LUNG CONTUSION FROM BLUNT CHEST TRAUMA IN RATS: CELLULAR AND CYTOKINE RESPONSES

    OpenAIRE

    Raghavendran, Krishnan; Davidson, Bruce A.; Woytash, James A.; Helinski, Jadwiga D.; Marschke, Cristi J.; Manderscheid, Patricia A.; Notter, Robert H.; Paul R. Knight

    2005-01-01

    Lung contusion is the leading cause of death from blunt thoracic trauma in adults, but its mechanistic pathophysiology remains unclear. This study uses a recently developed rat model to investigate the evolution of inflammation and injury in isolated lung contusion. Bilateral lung contusion with minimal cardiac trauma was induced in 54 anesthetized rats by dropping a 0.3-kg hollow cylindrical weight onto a precordial shield (impact energy, 2.45 Joules). Arterial oxygenation, pressure-volume (...

  16. Invading of intrauterine contraceptive device into the sigmoid colon through uterine perforation caused by a blunt trauma.

    Science.gov (United States)

    Davoodabadi, Abdoulhossein; Mohammadzadeh, Mahdi; Amirbeigi, Mahdieh; Jazayeri, Hoda

    2015-01-01

    Intrauterine contraceptive device (IUCD) is relatively safe but still with some serious risks. Uterus perforation is rare and would be fatal. A case of Cu-7 IUCD invading into the sigmoid colon through uterine perforation caused by a pelvic blunt trauma was presented. Our case showed that uterus perforation by an IUCD could induce utero-sigmoid fistula which is likely to be missed. Imaging is required when the patients with IUCD present abdominal pain, particularly with a history of trauma. PMID:26764547

  17. Evaluation of the safety of high-frequency chest wall oscillation (HFCWO) therapy in blunt thoracic trauma patients

    OpenAIRE

    Becker Brian; Ney Arthur L; Palmer Cassandra A; Anderson Casandra A; Schaffel Steven D; Quickel Robert R

    2008-01-01

    Abstract Background Airway clearance is frequently needed by patients suffering from blunt chest wall trauma. High Frequency Chest Wall Oscillation (HFCWO) has been shown to be effective in helping to clear secretions from the lungs of patients with cystic fibrosis, bronchiectasis, asthma, primary ciliary dyskinesia, emphysema, COPD, and many others. Chest wall trauma patients are at increased risk for development of pulmonary complications related to airway clearance. These patients frequent...

  18. Blunt Chest Trauma in Mice after Cigarette Smoke-Exposure: Effects of Mechanical Ventilation with 100 % O2

    OpenAIRE

    Wagner, Katja; Gröger, Michael; McCook, Oscar; Scheuerle, Angelika; Asfar, Pierre; Stahl, Bettina; Huber-Lang, Markus; Ignatius, Anita; Jung, Birgit; Duechs, Matthias; Möller, Peter; Georgieff, Michael; Calzia, Enrico; Radermacher, Peter; Wagner, Florian

    2015-01-01

    Cigarette smoking (CS) aggravates post-traumatic acute lung injury and increases ventilator-induced lung injury due to more severe tissue inflammation and apoptosis. Hyper-inflammation after chest trauma is due to the physical damage, the drop in alveolar PO2, and the consecutive hypoxemia and tissue hypoxia. Therefore, we tested the hypotheses that 1) CS exposure prior to blunt chest trauma causes more severe post-traumatic inflammation and thereby aggravates lung injury, and that 2) hyperox...

  19. Efficacy of aprotinin treatment on bilateral blunt chest trauma created in rabbits

    International Nuclear Information System (INIS)

    Objectives: To investigate the effects of aprotinin, on blood gasses, oxidant-antioxidant status, and lung histopathology in an experimental bilateral blunt chest trauma model. Methods: Conducted at the Experimental Animal Laboratory of Meram Medical School at Selcuk University, Konya, Turkey, the study comprised 21 New Zealand female albino rabbits who were divided into three groups. Trauma was applied on the sham and aprotinin groups, which was administered intravenous Aprotinin 20.000 U/kg. Arterial blood samples were obtained from all rabbits at hours 0, 3, 24, and 96. At hour 96 after trauma, all rabbits were sacrificed using the decapitation method, and then blood and lung tissue samples were obtained. Blood nitric oxide, malondialdehyde and blood gas measurements were made. Histopathological changes in the lung were examined with a light microscope. Results: While no positive effect of aprotinin was observed on nitric oxide malondialdehyde and partial pressure of carbon dioxide values, it was seen to have an increasing effect on partial oxygen pressure level. Aprotinin had a partial effect on lung histopathology. Conclusion: Aprotinin was determined to have a positive effect on PO/sub 2/ levels. We could not find any positive effects especially on alveolar haemorrhage. (author)

  20. Damage control surgery in patient with delayed rupture of pseudoaneurysm after blunt abdominal trauma.

    Science.gov (United States)

    Park, Chan Yong; Ju, Jae Kyun; Kim, Jung Chul

    2012-08-01

    Delayed rupture of post-traumatic pseudoaneurysms of the visceral arteries, especially the pancreaticoduodenal artery, is uncommon. Here, we describe a 55-year-old man hemorrhaging from a pseudoaneurysm of the inferior pancreaticoduodenal artery (IPDA). Computed tomography of the abdomen showed active bleeding in the IPDA and large amounts of hemoperitoneum and hemoretroperitoneum. Selective mesenteric angiography showed that the pseudoaneurysm arose from the IPDA, and treatment by angioembolization failed because the involved artery was too tortuous to fit with a catheter. Damage control surgery with surgical ligation and pad packing was successfully performed. The patient had an uncomplicated postoperative course and was discharged 19 days after the operation. To our knowledge, this is the first report of ruptured pseudoaneurysm of an IPDA after blunt abdominal trauma from Korea. PMID:22880189

  1. SURGICAL TREATMENT OF BLUNT CARDIAC TRAUMA IN CHHDREN: REPORT OF 2 CASES AND REVIEW OF LITERATURES

    Institute of Scientific and Technical Information of China (English)

    朱宏斌; 苏肇伉; 丁文祥; 郑景浩

    2005-01-01

    Objective Summarizing the clinical experience of surgical treatment in 2 cases of blunt cardiac trauma and reviewing the relevant literatures. Methods A 6-year-old girl was diagnosed muscular ventricular septal defect and left ventricular aneurysm 2d after automobile accident and underwent ventricular septal defect repair 2 weeks after injury. Another 9-year-old boy was diagnosed severe mitral regurgitation resulted from rupture of posterior papillary muscle 9d after automobile accident and underwent mitral valvuloplasty 2 weeks after injury.Results Heart function of the first patient was in New York Heart Association ( NYHA ) class Ⅰ , echocardiography showed no residual septal defect and the size of left ventricular aneurysm reduced. Heart function of the second patient is in NYHA class Ⅱ, echocardiography showed mild mitral regurgitation. Conclusion Blunt traumatic heart disease occurs either because of heart compression between sternum and the spine and/or because of myocardi-al contusion; A more aggressive strategy with surgical treatment earlier before deterioration of heart function is advocated; Earlier surgical correction of anatomic deformity will achieve a good result and a long time follow-up is necessary.

  2. Blunt cerebrovascular trauma causing vertebral arteryd issection in combination with a laryngeal fracture: a case report

    Directory of Open Access Journals (Sweden)

    Krettek Christian

    2011-08-01

    Full Text Available Abstract Introduction The diagnosis and therapy of blunt cerebrovascular injuries has become a focus since improved imaging technology allows adequate description of the injury. Although it represents a rare injury the long-term complications can be fatal but mostly prevented by adequate treatment. Case presentation A 33-year-old Caucasian man fell down a 7-meter scarp after losing control of his quad bike in a remote area. Since endotracheal intubation was unsuccessfully attempted due to the severe cervical swelling as well as oral bleeding an emergency tracheotomy was performed on scene. He was hemodynamically unstable despite fluid resuscitation and intravenous therapy with vasopressors and was transported by a helicopter to our trauma center. He had a stable fracture of the arch of the seventh cervical vertebra and fractures of the transverse processes of C5-C7 with involvement of the lateral wall of the transverse foramen. An abort of the left vertebral artery signal at the first thoracic vertebrae with massive hemorrhage as well as a laryngeal fracture was also detected. Further imaging showed retrograde filling of the left vertebral artery at C5 distal of the described abort. After stabilization and reconfirmation of intracranial perfusion during the clinical course weaning was started. At the time of discharge, he was aware and was able to move all extremities. Conclusion We report a rare case of a patient with vertebral artery dissection in combination with a laryngeal fracture after blunt trauma. Thorough diagnostic and frequent reassessments are recommended. Most patients can be managed with conservative treatment.

  3. Role of plasma ammonia level in detecting intra-abdominal hemorrhage following blunt abdominal trauma

    Directory of Open Access Journals (Sweden)

    Davood Farsi

    2014-01-01

    Full Text Available Background: Blunt abdominal injury is a leading cause of death in trauma patients. A reliable test predicting intra-abdominal hemorrhage would be a novel method. The study objective was to assess the diagnostic accuracy of plasma ammonia in detection of intra-abdominal bleeding in patients with blunt abdominal trauma (BAT. Materials and Methods: In this observational study, all patients suffering from BAT, referred to our university teaching hospital included. The levels of ammonia were measured at the time of emergency department admission and 1 h after initial treatment. Demographic data, vital signs, and venous blood gas reports were recorded. Findings of contrast-enhanced abdominopelvic computed tomography scan and laparotomy were assumed as a gold standard for abdominal injuries. Results: A total of 104 patients was enrolled in the study. 15 patients (14.4% had intra-abdominal hemorrhage and the mean plasma ammonia level in this group was significantly higher than the other patients on admission time (101.73 ± 5.41 μg/dL vs. 47.36 ± 26.31 μg/dL, P < 0.001. On receiver-operator characteristic curve analysis, in cutoff point of 89 μg/dL, the sensitivity, specificity, positive and negative likelihood ratios were 100% (95% confidence interval [CI], 79.6-100, 93.26% (95% CI, 86-96.8, 14.83 (95% CI, 6.84-32.12, and 0, respectively. Conclusion: The study findings suggest the measurement of ammonia level at the time of admission in the patients with BAT would be a useful test predicting intra-abdominal hemorrhage. Furthermore, decrease in the ammonia level could be a useful marker for monitoring response to treatment in these patients.

  4. Evaluation of Head Trauma Cases in the Emergency Department

    OpenAIRE

    Alim Cokuk; Nalan Kozaci; Mehmet Oguzhan Ay; Ayca Acikalin; Meltem Seviner; Salim Satar

    2013-01-01

    Aim: In this study, we aimed to determine the epidemiological characteristics, morbidity and mortality rates of patients admitted to the emergency department with head trauma. Material and Methods: In this study, ambulatory and hospitalized patients over the age of 18 brought to the Emergency Department because of head trauma between 01.12.2009 - 31.12.2010 were analyzed retrospectively. Patient data were recorded to standard data entry form. SPSS 17.0 package program was used for statistical...

  5. Subclavian artery injury following blunt trauma: A report of three cases

    Directory of Open Access Journals (Sweden)

    Amr Fares

    2012-04-01

    Full Text Available Subclavian artery injuries are rare in blunt chest trauma, constituting just 1-2 percent of all acute vascular injuries. The diagnosis of injury to the subclavian artery is challenging as a good percentage of patients with such vascular injuries have palpable distal pulses, no signs of any external local trauma and associated injuries often divert the attention of treating physicians. Subclavian artery injuries are the second most common injuries to occur to the aortic arch vessels. The mechanism of injury to these vessels varies from deceleration to traction on upper extremity and neck. Angiography is vital in diagnosis and surgical planning of these patients depends on the site and side of the vascular injuries. Early surgical treatment is an important part of management of these patients. Endovascular treatment is of value in a selected subgroup of subclavian artery injury patients. Reported mortality of subclavian artery injuries varies according to haemodynamic status of patient, time of presentation and other associated injuries. A high degree of suspicion is key to diagnosing these vascular injuries. Early appropriate surgical repair of vascular injury, in combination with aggressive treatment of associated injuries, is important for the optimal outcome of these cases. Here we report three cases of subclavian artery injury, which were successfully treated in Hamad General Hospital by vascular surgery and intensive care teams.

  6. CT evaluation of pulmonary parenchymal injury due to blunt chest trauma and its clinical significance

    Energy Technology Data Exchange (ETDEWEB)

    Niimi, Hiroshi (St. Marianna University School of Medicine, Kawasaki, Kanagawa (Japan))

    1990-10-01

    The CT findings of pulmonary parenchymal injury due to blunt chest trauma in 73 patients and their clinical significance were analyzed. CT was obtained within 6 hours after trauma. Findings were analyzed according to the number of injured segments and severity which was classified into three grades. A correlation was also made with arterial blood PaO{sub 2} and thoracic complications. Pulmonary parenchymal injury was identified in multisegmental portions bilaterally in most cases. It was most frequently observed in the posterior portion of the lung such as segment 6. More than 50% of lesions were classified as Grade 1. Pulmonary laceration, defined as patchy density with the cavitary lesion (Grade 3), was noted in 9.2%. There was a good correlation between extent of pulmonary injury and degree of hypoxia. The correlation of pneumothorax was also found with extensive lesion and frequency of Grade 3 lesion. Cases with pulmonary laceration tend to have extensive injury, and be related to the degree of hypoxia. In conclusion, CT evaluation of pulmonary parenchymal injury is valuable not only for morphological evaluation but also for estimation of hypoxia. (author).

  7. Maternal reporting of behaviour following very severe blunt head injury.

    OpenAIRE

    Kinsella, G.; Packer, S.; Olver, J.

    1991-01-01

    Mothers of 40 very severely head injured male subjects rated their son's behaviour on the Current Behaviour Scale and their ratings were compared with mothers' ratings of 40 control male subjects. The scale was able to discriminate the two groups, by utilising two factors--loss of emotional control and loss of motivation. The mothers' level of emotional distress was closely related to their reporting of loss of emotional control in their sons, but reporting of loss of motivation, or lowered a...

  8. Can Brain 'Pacemaker' Improve Lives of Head Trauma Patients?

    Science.gov (United States)

    ... 161109.html Can Brain 'Pacemaker' Improve Lives of Head Trauma Patients? Deep brain stimulation appears to boost function and quality of life, small study finds To use the sharing ... that's implanted from the head, under the skin, through the neck and shoulders ...

  9. 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

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

    Institute of Scientific and Technical Information of China (English)

    LI Hong-wei; CHANG Hong-fa; YU Yong-min; DAI Guo-xin; YIN Zhi-yong

    2012-01-01

    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 formative rationale of blunt head injury will offer easy access to medicolegal expertise on the mode and character of the injury.

  11. Influence of molding pressure on blunt trauma effect and ballistic properties of unidirectional and bidirectional composites based on ultra high molecular weight polyethylene fibers

    OpenAIRE

    Srebrenkoska, Vineta; Dimeski, Dimko; Spaseska, Dijana; Smileski, Rose

    2003-01-01

    The influence of molding pressure on blunt traume effect and ballistic strength of unidirectional and bidirectional composites based on UHMWPE (Ultra Hight Molecular Weight Polyethylene) fibers is investigated. Two types of unidirectional and one type of bidirectional composites molded at 20, 60 and 100 bar were tested on their ballistic strength and their blunt traume depth and area were measured. It was found out that by increasing the molding pressure the blunt trauma effect was decreas...

  12. Invading of intrauterine contraceptive device into the sigmoid colon through uterine perforation caused by a blunt trauma

    Institute of Scientific and Technical Information of China (English)

    Abdoulhossein Davoodabadi; Mahdi Mohammadzadeh; Mahdieh Amirbeigi; Hoda Jazayeri

    2015-01-01

    Intrauterine contraceptive device (IUCD) is relatively safe but still with some serious risks.Uterus perforation is rare and would be fatal.A case of Cu-7 IUCD invading into the sigmoid colon through uterine perforation caused by a pelvic blunt trauma was presented.Our case showed that uterus perforation by an IUCD could induce utero-sigmoid fistula which is likely to be missed.Imaging is required when the patients with IUCD present abdominal pain,particularly with a history of trauma.

  13. Non-operative management of blunt abdominal trauma. Is it safe and feasible in a district general hospital?

    Directory of Open Access Journals (Sweden)

    Giannopoulos George A

    2009-05-01

    Full Text Available Abstract Background To evaluate the feasibility and safety of non-operative management (NOM of blunt abdominal trauma in a district general hospital with middle volume trauma case load. Methods Prospective protocol-driven study including 30 consecutive patients who have been treated in our Department during a 30-month-period. Demographic, medical and trauma characteristics, type of treatment and outcome were examined. Patients were divided in 3 groups: those who underwent immediate laparotomy (OP group, those who had a successful NOM (NOM-S group and those with a NOM failure (NOM-F group. Results NOM was applied in 73.3% (22 patients of all blunt abdominal injuries with a failure rate of 13.6% (3 patients. Injury severity score (ISS, admission hematocrit, hemodynamic status and need for transfusion were significantly different between NOM and OP group. NOM failure occurred mainly in patients with splenic trauma. Conclusion According to our experience, the hemodynamically stable or easily stabilized trauma patient can be admitted in a non-ICU ward with the provision of close monitoring. Splenic injury, especially with multiple-site free intra-abdominal fluid in abdominal computed tomography, carries a high risk for NOM failure. In this series, the main criterion for a laparotomy in a NOM patient was hemodynamic deterioration after a second rapid fluid load.

  14. Diaphragmatic rupture precipitated by intercostal chest tube drainage in a patient of blunt thoraco-abdominal trauma

    Science.gov (United States)

    Mehrotra, Ashok Kumar; Feroz, Asif; Dawar, Sachet; Kumar, Prem; Singh, Anupam; Khublani, Trilok Kumar

    2016-01-01

    Blunt thoraco-abdominal trauma in collision injuries in road traffic accident (RTA) occasionally results in diaphragmatic injury and rupture besides other serious multisystem injuries. These diaphragmatic injuries (DI) frequently go undetected specially when occur on the right side. DI associated with hemothorax need insertion of intercostal tube drainage (ICTD). ICTD has never been reported to precipitate diaphragmatic rupture and hernia. We are reporting such a rare case for the first time in medical literature. PMID:26933316

  15. Imbalance between macrophage migration inhibitory factor and cortisol induces multiple organ dysfunction in patients with blunt trauma

    OpenAIRE

    2011-01-01

    Migration inhibitory factor (MIF) is associated with multiple organ dysfunction syndrome (MODS) in patients with systemic inflammatory response syndrome (SIRS). Our purposes were to determine the serum MIF, cortisol and tumor narcosis factor-α (TNF-α) and to investigate the influences of the balance between the levels of MIF and cortisol in patients with blunt trauma. The cortisol levels were identical between the patients with and without MODS. However, the MIF and TNF-α levels in the patien...

  16. Delayed Presentation of Isolated Complete Pancreatic Transection as a Result of Sport-Related Blunt Trauma to the Abdomen

    Directory of Open Access Journals (Sweden)

    Andrew J. Healey

    2008-01-01

    Full Text Available Introduction: Blunt abdominal trauma is a rare but well-recognized cause of pancreatic transection. A delayed presentation of pancreatic fracture following sport-related blunt trauma with the coexisting diagnostic pitfalls is presented. Case Report: A 17-year-old rugby player was referred to our specialist unit after having been diagnosed with traumatic pancreatic transection, having presented 24 h after a sporting injury. Despite haemodynamic stability, at laparotomy he was found to have a diffuse mesenteric hematoma involving the large and small bowel mesentery, extending down to the sigmoid colon from the splenic flexure, and a large retroperitoneal hematoma arising from the pancreas. The pancreas was completely severed with the superior border of the distal segment remaining attached to the splenic vein that was intact. A distal pancreatectomy with spleen preservation and evacuation of the retroperitoneal hematoma was performed. Discussion/Conclusion: Blunt pancreatic trauma is a serious condition. Diagnosis and treatment may often be delayed, which in turn may drastically increase morbidity and mortality. Diagnostic difficulties apply to both paraclinical and radiological diagnostic methods. A high index of suspicion should be maintained in such cases, with a multi-modality diagnostic approach and prompt surgical intervention as required.

  17. Blunt force impact to the head using a teeball bat: systematic comparison of physical and finite element modeling.

    Science.gov (United States)

    Kettner, Mattias; Ramsthaler, Frank; Potente, Stefan; Bockenheimer, Alexander; Schmidt, Peter H; Schrodt, Michael

    2014-12-01

    Blunt head trauma secondary to violent actions with various weapons is frequently a cause of injury in forensic casework; differing striking tools have varying degrees of injury capacity. The systematic approach used to examine a 19-year-old student who was beaten with a wooden teeball bat will be described. The assailant stopped beating the student when the teeball bat broke into two pieces. The surviving victim sustained bruises and a forehead laceration. The State's Attorney assigned a forensic expert to examine whether the forces exerted on the victim's head (leading to the fracture of the bat) were potentially life threatening (e.g. causing cranial bone fractures). Physical modeling was conducted using a pigskin-covered polyethylene end cap cushioned by cellulose that was connected to a piezoelectric force gauge. Experiments with teeball bats weighing 295-485 g demonstrated that 12-20 kN forces were necessary to cause a comparable bat fracture. In addition to physical testing, a computer-aided simulation was conducted, utilizing a finite-element (FE) method. In the FE approach, after selecting for wood properties, a virtual bat was swung against a hemisphere comprising two layers that represented bone and soft tissue. Employing this model, a 17.6 kN force was calculated, with the highest fracture probability points resembling the fracture patterns of the physically tested bats.

  18. Chest trauma in childhood. Radiological findings

    International Nuclear Information System (INIS)

    Blunt thoracic trauma is frequently associated with further injuries (head and/or blunt abdominal trauma). The prognosis also depends on the concurrent injuries. The initial evaluation of an injured child is based on the chest X-ray and abdominal ultrasound examination. Additional information can be obtained by a CT scan in mediastinal injuries. (orig./MG)

  19. Enhanced emotional reactions in chronic head trauma patients.

    OpenAIRE

    Fordyce, D J; Roueche, J R; Prigatano, G P

    1983-01-01

    The emotional characteristics of head injury patients referred for neuropsychological testing were examined as a function of the time since injury. Patients referred more than 6 months from injury were more emotionally distressed on the MMPI and Katz Adjustment Scale (relatives form) compared to those tested 6 months or earlier. The more chronic head trauma patients were more anxious and depressed, more confused in their thinking, and more socially withdrawn compared to the acute patient grou...

  20. HEAD TRAUMA AND THE RISK OF ALZHEIMERS-DISEASE

    NARCIS (Netherlands)

    VANDUIJN, CM; TANJA, TA; HAAXMA, R; SCHULTE, W; SAAN, RJ; LAMERIS, AJ; ANTONIDESHENDRIKS, G; HOFMAN, A

    1992-01-01

    A population-based case-control study of the association between head trauma and Alzheimer's disease was conducted in the Netherlands from 1980 to 1987. The study comprised 198 patients with clinically diagnosed early onset Alzheimer's disease and 198 age- and sex-matched population controls. Adjust

  1. Head trauma and the risk of Alzheimer's disease

    NARCIS (Netherlands)

    C.M. van Duijn (Cock); T.A. Tanja (Teun); R. Haaxma (Rob); W. Schulte (Wim); R.J. Saan; A.J. Lameris; G. Antonides-Hendriks (Gea); A. Hofman (Albert)

    1992-01-01

    textabstractA population-based case-control study of the association between head trauma and Alzheimer's disease was conducted in the Netherlands from 1980 to 1987. The study comprised 198 patients with clinically diagnosed early onset Alzheimer's disease and 198 age- and sex-matched population cont

  2. Planning for the Vocational Implications of Head Trauma.

    Science.gov (United States)

    Sauer, G. C., Jr.; And Others

    A model using career interest test results and career specific information to formulate vocational recommendations was tested on four head trauma patients who had been involved in car or motorcycle accidents at least 2 years before. As part of a psychological evaluation, patients completed the Self Directed Search (SDS), the Adjective Checklist…

  3. Evaluation of Head Trauma Cases in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Alim Cokuk

    2013-02-01

    Full Text Available Aim: In this study, we aimed to determine the epidemiological characteristics, morbidity and mortality rates of patients admitted to the emergency department with head trauma. Material and Methods: In this study, ambulatory and hospitalized patients over the age of 18 brought to the Emergency Department because of head trauma between 01.12.2009 - 31.12.2010 were analyzed retrospectively. Patient data were recorded to standard data entry form. SPSS 17.0 package program was used for statistical analysis of data. The statistical significance level of all tests was p <0.05. Results: 5200 patients were included in this study. The average age of the patients was 39.97 ± 16.66 years. 4682'si patients (90 % were discharged from the emergency department. The most common reason for admission to the emergency department was falls (41.81 % in the discharged patients. 518 (10 % patients were hospitalized. Gender of these patients was 110 female (21:24% and 408 male (78.76%. 256 patients (48.35% were injured as a result of a traffic accident. 201(38.8% of the cerebral CT were reported as normal and 89 (17.2% of the cerebral CT were reported as traumatic subarachnoid hemorrhage (SAH in hospitalized patients. The fracture of lumbar spine (12 % was detected as an additional pathological disease in patients. 75 patients hospitalized because of head trauma (14.5% had died (1.44 % of all patients. Cervical spine fracture was the most common (14 patients, 18.68 % additional pathology in patients who died. Thoracic trauma was detected as the second most common (13 patients, 17.33 % additional pathology. Conclusion: Most of the patients admitted to the emergency department with head injury had a minor trauma. Patients can be discharged from the emergency department after a thorough physical examination and simple medical intervention. Most of the head injury patients admitted to hospital were male. The most common reason of the patients with head injury admitted to

  4. Significance of magnetic resonance imaging in the diagnosis of vertebral artery injury associated with blunt cervical spine trauma

    International Nuclear Information System (INIS)

    Vertebral artery injury associated with non-penetrating cervical trauma is rare. We report 11 cases of vertebral artery injury diagnosed with magnetic resonance imaging (MRI) after blunt trauma to the cervical spine and discuss about the importance of MRI in the diagnosis of this injury. Seven cases were caused by motor vehicle accidents, three by diving accidents, and one by static compression of the neck. All of the patients had documented cervical spine fractures and dislocations. In three patients, the diagnosis of complete occlusion of the vertebral artery was made on the basis of MRI and digital subtraction angiography (DSA). In the other patients, mural injuries of the vertebral artery were demonstrated with DSA. These 11 patients presented with acute, nonspecific changes in neurological status. Two had infarctions of the cerebellum and brainstem. None were treated with anticoagulants. All of them survived and were discharged to other hospitals for physical and occupational therapy. Although DSA remains the gold standard for diagnosing vertebral artery injuries, MRI is a newer modality for assessing cervical cord injury, and it may be useful for evaluating the presence of vertebral injury after blunt cervical spine trauma. (author)

  5. Evaluation of gastrointestinal injury in blunt abdominal trauma "FAST is not reliable": the role of repeated ultrasonography

    Directory of Open Access Journals (Sweden)

    Mohammadi Afshin

    2012-01-01

    Full Text Available Abstract Background To determine the diagnostic Accuracy of Focused Assessment Sonography for Trauma (FAST and repeated FAST in the patients with blunt abdominal trauma. Methods In this retrospective study we collected the data of all patients from September 2007 to July 2011 with gastrointestinal injury. The intraoperative outcome was compared with FAST technique and the repeated or delayed sonography. Results A total number of 1550 patients with blunt abdominal trauma underwent FAST in a period of 4 years in our hospital. Eighty-eight (5.67% patients were found to have gastrointestinal injury after exploratory laparotomy. Fifty-five (62.5% patients had isolated gastrointestinal injury and 33 (37.5% patients had concomitant injury to the other solid organs. In those with isolated gastrointestinal injury, the sensitivity of FAST was 38.5%. Repeated ultrsonography was performed in 34 patients with false negative initial FAST after 12-24 hours. The sensitivity of repeated ultrasonography in negative initial FAST patients in detection of gastrointestinal injury was 85.2% (95% CI, 68.1%, and 94.4%. Conclusion Repeated sonography after 12 to 24 hours in patients with negative initial FAST but sustain abdominal symptom can facilitated a diagnosis of GI tract injury and can be as effective method instead of Computed tomography in developing country.

  6. 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.

  7. Video-assisted thoracoscopic surgery in the management of penetrating and blunt thoracic trauma

    OpenAIRE

    Milanchi S; Makey I; McKenna R; Margulies D

    2009-01-01

    Background: The role of video-assisted Thoracoscopic Surgery (VATS) is still being defined in the management of thoracic trauma. We report our trauma cases managed by VATS and review the role of VATS in the management of thoracic trauma. Materials and Methods: All the trauma patients who underwent VATS from 2000 to 2007 at Cedars-Sinai Medical Center were retrospectively studied. Results: Twenty-three trauma patients underwent 25 cases of VATS. The most common indication for VATS was reta...

  8. A comparative study of cranial, blunt trauma fractures as seen at medicolegal autopsy and by computed tomography

    DEFF Research Database (Denmark)

    Jacobsen, Christina; Bech, Birthe H; Lynnerup, Niels

    2009-01-01

    for biomechanical trauma analysis by Finite Element Analysis. If CT scan data are to be used for creating individual head models for retrograde trauma analysis in the future we need to ascertain how well cranial fractures are captured by CT scan. The purpose of this study was to compare the diagnostic agreement....... Difficulties remained in the minute diagnosis of hairline fractures. These inconsistencies need to be resolved in order to use CT scan data of victims for individual head modelling and trauma analysis.......BACKGROUND: Computed Tomography (CT) has become a widely used supplement to medico legal autopsies at several forensic institutes. Amongst other things, it has proven to be very valuable in visualising fractures of the cranium. Also CT scan data are being used to create head models...

  9. Retroclival collections associated with abusive head trauma in children

    International Nuclear Information System (INIS)

    Retroclival collections are rare lesions reported almost exclusively in children and strongly associated with trauma. We examine the incidence and imaging characteristics of retroclival collections in young children with abusive head trauma. We conducted a database search to identify children with abusive head trauma ≤3 years of age with brain imaging performed between 2007 and 2013. Clinical data and brain images of 65 children were analyzed. Retroclival collections were identified in 21 of 65 (32%) children. Ten (48%) were subdural, 3 (14%) epidural, 2 (10%) both, and 6 (28%) indeterminate. Only 8 of 21 retroclival collections were identifiable on CT and most were low or intermediate in attenuation. Eighteen of 21 retroclival collections were identifiable on MRI: 3 followed cerebral spinal fluid in signal intensity and 15 were bloody/proteinaceous. Additionally, 2 retroclival collections demonstrated a fluid-fluid level and 2 enhanced in the 5 children who received contrast material. Sagittal T1-weighted images, sagittal fluid-sensitive sequences, and axial FLAIR (fluid-attenuated inversion recovery) images showed the retroclival collections best. Retroclival collections were significantly correlated with supratentorial and posterior fossa subdural hematomas and were not statistically correlated with skull fracture or parenchymal brain injury. Retroclival collections, previously considered rare lesions strongly associated with accidental injury, were commonly identified in this cohort of children with abusive head trauma, suggesting that retroclival collections are an important component of the imaging spectrum in abusive head trauma. Retroclival collections were better demonstrated on MRI than CT, were commonly identified in conjunction with intracranial subdural hematomas, and were not significantly correlated with the severity of brain injury or with skull fractures. (orig.)

  10. Retroclival collections associated with abusive head trauma in children

    Energy Technology Data Exchange (ETDEWEB)

    Silvera, V.M.; Danehy, Amy R.; Carducci, Chiara; Grant, P.E.; Kleinman, Paul K. [Harvard Medical School, Department of Radiology, Boston Children' s Hospital, Boston, MA (United States); Newton, Alice W. [Harvard Medical School, Child Protection Program, Department of Pediatrics, Massachusetts General Hospital, Boston, MA (United States); Stamoulis, Catherine [Harvard Medical School, Department of Radiology, Boston Children' s Hospital, Boston, MA (United States); Harvard Medical School, Department of Neurology, Boston Children' s Hospital, Boston, MA (United States); Wilson, Celeste R. [Harvard Medical School, Division of General Pediatrics, Department of Medicine, Boston Children' s Hospital, Boston, MA (United States)

    2014-12-15

    Retroclival collections are rare lesions reported almost exclusively in children and strongly associated with trauma. We examine the incidence and imaging characteristics of retroclival collections in young children with abusive head trauma. We conducted a database search to identify children with abusive head trauma ≤3 years of age with brain imaging performed between 2007 and 2013. Clinical data and brain images of 65 children were analyzed. Retroclival collections were identified in 21 of 65 (32%) children. Ten (48%) were subdural, 3 (14%) epidural, 2 (10%) both, and 6 (28%) indeterminate. Only 8 of 21 retroclival collections were identifiable on CT and most were low or intermediate in attenuation. Eighteen of 21 retroclival collections were identifiable on MRI: 3 followed cerebral spinal fluid in signal intensity and 15 were bloody/proteinaceous. Additionally, 2 retroclival collections demonstrated a fluid-fluid level and 2 enhanced in the 5 children who received contrast material. Sagittal T1-weighted images, sagittal fluid-sensitive sequences, and axial FLAIR (fluid-attenuated inversion recovery) images showed the retroclival collections best. Retroclival collections were significantly correlated with supratentorial and posterior fossa subdural hematomas and were not statistically correlated with skull fracture or parenchymal brain injury. Retroclival collections, previously considered rare lesions strongly associated with accidental injury, were commonly identified in this cohort of children with abusive head trauma, suggesting that retroclival collections are an important component of the imaging spectrum in abusive head trauma. Retroclival collections were better demonstrated on MRI than CT, were commonly identified in conjunction with intracranial subdural hematomas, and were not significantly correlated with the severity of brain injury or with skull fractures. (orig.)

  11. Cerebral infarction after mild head trauma in children.

    Science.gov (United States)

    Yang, Feng-Hua; Wang, Hua; Zhang, Jun-Mei; Liang, Hong-Yuan

    2013-09-01

    We conducted this retrospective, case record review to determine the risk factors and clinical features associated with cerebral infarction after mild head trauma in children. The median age of the cohort was 2.18 years (range, 6 mo-8 y). Most (26/29) of the patients developed the neurological symptoms and signs within 72 hours after trauma, 51.7% within 30 minutes. The first symptoms included hemiparesis (20), facial paresis (7), and convulsion (7). 86.21% of the lesions lay in basal ganglia region. Pre-existing basal ganglia calcification was identified in 13 as a risk factor.

  12. Characteristics of behind armor blunt trauma produced by bullets with different structural materials: an experimental study

    Directory of Open Access Journals (Sweden)

    Ling-qing WANG

    2013-07-01

    Full Text Available Objective To investigate the effect of structural materials of bullets on behind armor blunt trauma (BABT. Methods Ten healthy male Landraces were randomly divided into two groups (5 each: 56 type 7.62-mm rifle bullet group and SS109 5.56-mm rifle bullet group. The kinetic energy of two types of bullets was adjusted to the same level (about 1880J by the way of grow downwards gunpowder. Then the animals as protected with both grade NIJ Ⅲ ceramic hard armor and grade Ⅱ police soft body armor, were shot at the left midclavicular line of fourth intercostal space (shooting distance was 25m. The damage to the animals was observed. Other 2 healthy male Landraces were selected, and biomechanical sensor was subcutaneously implanted into the soft tissue in precordium and intracalvarium to detect the pressure at the time point of bullet contact under the protection of armor, and the relationship between pressure and damage was analyzed. Results Respiration, heart rate and systolic arterial pressure of animals in two groups were all elevated after injury, but there was no significant difference between the two groups. No obvious change was found on blood oxygen saturation of both groups. Gross anatomy showed the predominant local injury was cardiac and pulmonary contusions. The area of pulmonary hemorrhage of 7.62mm group was 6.00%±3.18%, significantly higher than that of 5.56mm group (3.59%±2.11%, P<0.05. Histopathological examination revealed acute injuries of lung tissues, myocardial tissue and cerebral cortical neurons. The contents of cardiac troponin T (TnT, creatine kinase (CK and creatine kinase-MB (CK-MB isoenzyme were all increased 3 hours after injury, and the rise was higher in 7.62mm group than in 5.56mm group (P<0.05. Biomechanical testing showed the pressure of precordium and intracalvarium was elevated at the moment of bullet contact, and the rise was higher in 7.62mm group than in 5.56mm group (P<0.05. Conclusions

  13. Concussion associated with head trauma in athletes

    Directory of Open Access Journals (Sweden)

    Gabriela Murguía Cánovas

    2013-01-01

    Full Text Available Recently, there has been increased attention to concussions that occur during sports activities, both at school level or amateur and professional level. Concussion is defined as a sudden and transient alteration of consciousness induced by traumatic biomechanical forces transmitted directly or indirectly to the brain. Such injuries most commonly occur in contact sports such as boxing, football, soccer, wrestling, hockey, among others. Concussion should be suspected in any athlete who suffers a head injury, whether or not it is associated to loss of consciousness. These athletes should not return to their sports activities immediately, and a few days of mental and physical leave are recommended in order to ensure full recovery. Repeat head injuries should be avoided, since there is evidence that in some athletes they can lead to chronic traumatic encephalopathy. The present review focuses on the different definitions of concussion, management and long-term consequences. It also contains the Spanish version of the Sport Concussion Assessment Tool 2 (SCAT2.

  14. A blunt chest trauma causing left anterior descending artery dissection and acute myocardial infarction treated by deferred angioplasty

    Directory of Open Access Journals (Sweden)

    Rafid Fayadh Al-Aqeedi

    2011-01-01

    Full Text Available Traumatic coronary artery dissection is an uncommon cause of acute myocardial infarction (AMI. We report a case of blunt chest trauma resulting from a motorcycle collision causing ostial dissection of the left anterior descending (LAD artery in a 31-year-old previously healthy male. The patient also suffered from compound comminuted fractures of the humerus and ulna and severe liver laceration, which hampered both percutaneous and surgical acute revasularization. After a stormy hospital course, a bare metal stent was implanted to seal the LAD artery dissection. The patient was discharged in a stable condition and was followed-up for rehabilitation. This case report underscores the multidisciplinary approach in facing challenges encountered after rare sequelae of chest trauma.

  15. Evaluation of the safety of high-frequency chest wall oscillation (HFCWO therapy in blunt thoracic trauma patients

    Directory of Open Access Journals (Sweden)

    Becker Brian

    2008-10-01

    Full Text Available Abstract Background Airway clearance is frequently needed by patients suffering from blunt chest wall trauma. High Frequency Chest Wall Oscillation (HFCWO has been shown to be effective in helping to clear secretions from the lungs of patients with cystic fibrosis, bronchiectasis, asthma, primary ciliary dyskinesia, emphysema, COPD, and many others. Chest wall trauma patients are at increased risk for development of pulmonary complications related to airway clearance. These patients frequently have chest tubes, drains, catheters, etc. which could become dislodged during HFCWO. This prospective observational study was conducted to determine if HFCWO treatment, as provided by The Vest™ Airway Clearance System (Hill-Rom, Saint Paul, MN, was safe and well tolerated by these patients. Methods Twenty-five blunt thoracic trauma patients were entered into the study. These patients were consented. Each patient was prescribed 2, 15 minute HFCWO treatments per day using The Vest® Airway Clearance System (Hill-Rom, Inc., St Paul, MN. The Vest® system was set to a frequency of 10–12 Hz and a pressure of 2–3 (arbitrary unit. Physiological parameters were measured before, during, and after treatment. Patients were free to refuse or terminate a treatment early for any reason. Results No chest tubes, lines, drains or catheters were dislodged as a result of treatment. One patient with flail chest had a chest tube placed after one treatment due to increasing serous effusion. No treatments were missed and continued without further incident. Post treatment survey showed 76% experienced mild or no pain and more productive cough. Thirty days after discharge there were no deaths or hospital re-admissions. Conclusion This study suggests that HFCWO treatment is safe for trauma patients with lung and chest wall injuries. These findings support further work to demonstrate the airway clearance benefits of HFCWO treatment.

  16. CT detection of occult pneumothorax in head trauma

    International Nuclear Information System (INIS)

    A prospective evaluation for occult pneumothorax was performed in 25 consecutive patients with serious head trauma by combining a limited chest CT examination with the emergency head CT examination. Of 21 pneuomothoraces present in 15 patients, 11 (52%) were found only by chest CT and were not identified clinically or by supine chest radiograph. Because of pending therapeutic measures, chest tubes were placed in nine of the 11 occult pneumothoraces, regardless of the volume. Chest CT proved itself as the most sensitive method for detection of occult pneumothorax, permitting early chest tube placement to prevent transition to a tension pneumothorax during subsequent mechanical ventilation or emergency surgery under general anesthesia

  17. Blunt renal trauma: comparison of contrast-enhanced CT and angiographic findings and the usefulness of transcatheter arterial embolization

    Energy Technology Data Exchange (ETDEWEB)

    Kitase, M.; Mizutani, M.; Tomita, H.; Kono, T.; Sugie, C.; Shibamoto, Y. [Nagoya City University, Nagoya, (Japan). Graduate School of Medical Sciences. Dept. of Radiology

    2007-07-15

    Full text: Background: The purpose of this study was to evaluate the role of contrast-enhanced CT and the usefulness of super selective embolization therapy in the management of arterial damage in patients with severe blunt renal trauma. Patients and Methods: Nine cases of severe renal trauma were evaluated. In all cases, we compared contrast enhanced CT findings with angiographic findings, and performed transcatheter arterial embolization (TAE) in six of them with microcoils and gelatin sponge particles. Morphological changes in the kidney and site of infarction after TAE were evaluated on follow-up CT Chronological changes in blood biochemistry findings after injury, degree of anemia and renal function were investigated. Adverse effects or complications such as duration of hematuria, fever, abdominal pain, renovascular hypertension and abscess formation were also evaluated. Results: The CT finding of extravasation was a reliable sign of active bleeding and useful for determining the indication of TAE. In all cases, bleeding was effectively controlled with super selective embolization. There was minimal procedure-related loss of renal tissue. None of the patients developed abscess, hypertension or other complications. Conclusions: In blunt renal injury, contrast-enhanced CT was useful for diagnosing arterial hemorrhage. Arterial bleeding may produce massive hematoma and TAE was a useful treatment for such cases. By using selective TAE for a bleeding artery, it was possible to minimize renal parenchymal damage, with complications of TAE rarely seen. (author)

  18. Blunt renal trauma: comparison of contrast-enhanced CT and angiographic findings and the usefulness of transcatheter arterial embolization

    International Nuclear Information System (INIS)

    Full text: Background: The purpose of this study was to evaluate the role of contrast-enhanced CT and the usefulness of super selective embolization therapy in the management of arterial damage in patients with severe blunt renal trauma. Patients and Methods: Nine cases of severe renal trauma were evaluated. In all cases, we compared contrast enhanced CT findings with angiographic findings, and performed transcatheter arterial embolization (TAE) in six of them with microcoils and gelatin sponge particles. Morphological changes in the kidney and site of infarction after TAE were evaluated on follow-up CT Chronological changes in blood biochemistry findings after injury, degree of anemia and renal function were investigated. Adverse effects or complications such as duration of hematuria, fever, abdominal pain, renovascular hypertension and abscess formation were also evaluated. Results: The CT finding of extravasation was a reliable sign of active bleeding and useful for determining the indication of TAE. In all cases, bleeding was effectively controlled with super selective embolization. There was minimal procedure-related loss of renal tissue. None of the patients developed abscess, hypertension or other complications. Conclusions: In blunt renal injury, contrast-enhanced CT was useful for diagnosing arterial hemorrhage. Arterial bleeding may produce massive hematoma and TAE was a useful treatment for such cases. By using selective TAE for a bleeding artery, it was possible to minimize renal parenchymal damage, with complications of TAE rarely seen. (author)

  19. Are acute subdural hematomas possible without head trauma?

    Science.gov (United States)

    Garbossa, D; Altieri, R; Specchia, F M Calamo; Agnoletti, A; Pilloni, G; Lanotte, M; Spaziante, R; Ducati, A

    2014-01-01

    Acute subdural hematomas (ASDHs) are rarely reported in the literature. In general, it is due to head trauma, but if the traumatic event is very mild, it is inadequate to explain the ASDH occurrence. Risk factors for the development of spontaneous ASDH include hypertension, vascular abnormalities and deficit of coagulation. We present two cases of ASDH in patients with the coagulation deficit and review of the literature to understand the coagulation factors role and platelet role in the management of ASDHs.

  20. Indications and Overuse of Computed Tomography in Minor Head Trauma

    OpenAIRE

    Zargar Balaye Jame, Sanaz; MAJDZADEH, Reza; AKBARI SARI, Ali; Rashidian, Arash; ARAB, Mohammad; Rahmani, Hojjat

    2014-01-01

    Background: Computed Tomography (CT) is a useful diagnostic technology, particularly in accident and emergency departments. Objectives: To identify a comprehensive list of indications for application of CT in patients with minor head trauma (MHT) and to determine appropriateness of its use on the basis of this list. Materials and Methods: A cross-sectional study was conducted in three Imaging centers in Tehran. A panel of experts developed a list of CT indications for MHT by reviewing documen...

  1. Video-assisted thoracoscopic surgery in the management of penetrating and blunt thoracic trauma

    Directory of Open Access Journals (Sweden)

    Milanchi S

    2009-01-01

    Full Text Available Background: The role of video-assisted Thoracoscopic Surgery (VATS is still being defined in the management of thoracic trauma. We report our trauma cases managed by VATS and review the role of VATS in the management of thoracic trauma. Materials and Methods: All the trauma patients who underwent VATS from 2000 to 2007 at Cedars-Sinai Medical Center were retrospectively studied. Results: Twenty-three trauma patients underwent 25 cases of VATS. The most common indication for VATS was retained haemothorax. Thoracotomy was avoided in 21 patients. VATS failed in two cases. On an average VATS was performed on trauma day seven (range 1-26 and the length of hospital stay was 20 days (range 3-58. There was no mortality. VATS was performed in an emergency (day 1-2, or in the early (day 2-7 or late (after day 7 phases of trauma. Conclusion: VATS can be performed safely for the management of thoracic traumas. VATS can be performed before or after thoracotomy and at any stage of trauma. The use of VATS in trauma has a trimodal distribution (emergent, early, late, each with different indications.

  2. Sword-Like Trauma to the Shoulder with Open Head-Splitting Fracture of the Head

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    Andreas Panagopoulos

    2016-01-01

    Full Text Available Head-splitting fractures occur as a result of violent compression of the head against the glenoid; the head splits and the tuberosities may remain attached to the fragments or split and separate. Isolated humeral head-splitting fractures are rare injuries. Favorable results with osteosynthesis can be difficult to achieve because of the very proximal location of the head fracture and associated poor vascularity. We present a case of a 67-year-old man who sustained a severe, sword-like trauma to his left shoulder after a road traffic accident with associated isolated open Gustilo-Anderson IIIA humeral head-splitting fracture. Bony union was achieved with minimal internal fixation but the clinical outcome deteriorated due to accompanying axillary nerve apraxia. To our knowledge, this type of sword-like injury with associated humeral head-split fracture has not previously been reported.

  3. Sword-Like Trauma to the Shoulder with Open Head-Splitting Fracture of the Head.

    Science.gov (United States)

    Panagopoulos, Andreas; Pantazis, Konstantinos; Iliopoulos, Ilias; Seferlis, Ioannis; Kokkalis, Zinon

    2016-01-01

    Head-splitting fractures occur as a result of violent compression of the head against the glenoid; the head splits and the tuberosities may remain attached to the fragments or split and separate. Isolated humeral head-splitting fractures are rare injuries. Favorable results with osteosynthesis can be difficult to achieve because of the very proximal location of the head fracture and associated poor vascularity. We present a case of a 67-year-old man who sustained a severe, sword-like trauma to his left shoulder after a road traffic accident with associated isolated open Gustilo-Anderson IIIA humeral head-splitting fracture. Bony union was achieved with minimal internal fixation but the clinical outcome deteriorated due to accompanying axillary nerve apraxia. To our knowledge, this type of sword-like injury with associated humeral head-split fracture has not previously been reported. PMID:27478665

  4. Severe cardiac trauma or myocardial ischemia? Pitfalls of polytrauma treatment in patients with ST-elevation after blunt chest trauma

    OpenAIRE

    Orkun Özkurtul; Andreas Höch; Andreas Reske; Carsten Hädrich; Christoph Josten; Jörg Böhme

    2015-01-01

    Introduction: Thoracic injuries are the third most common injuries in polytrauma patients. The mechanism of injury and the clinical presentation are crucially important for adequate emergency treatment. Presentation of case: Here we present a case of a 37-year-old male who was admitted to our level-1 trauma center after motor vehicle accident. The emergency physician on scene presented the patient with a myocardial infarction. During initial clinical trauma assessment the patient developed...

  5. RETROSPECTIVE AND PROSPECTIVE STUDY OF MANAGEMENT AND OUTCOME OF BLUNT ABDOMEN TRAUMA IN TERTIARY HEALTH CENTER IN LAST 5 - YEAR 2009 - 2014

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    Raikwar

    2015-05-01

    Full Text Available AIMS: 1. To study the incidence of various intra - abdominal and extra - abdominal injuries in blunt abdominal trauma in tertiary health care center in five year (2009 - 14 . 2 . To study the relationship between mode of injury , severity of injury and clinical presentation and its outcome , mortality and morbidity. 3 . To study modalities for evaluating the abdomen after blunt abdominal trauma. 4 . To evaluate the major indication for operation in each cases . 5 . To study of outcome , mortality and morbidity . SETTINGS AND DESIGN: This study carried out in the Department of Surgery , MGM Medical College , M.Y. Hospital Indore and Trauma Department , M.Y. Hospital Indore both retrospectively and prospectively in patients with Blunt abdominal trauma over the period of from 2009 to 2014 with co - operation of the staff of Medicolegal section , Central record room and residents looking after the admitted pat ients. MATERIALS AND METHODS: On admission to hospital patient’s name , age , sex , address , registration number and date and time of admission , length of delay in treatment taken noted and mode of trauma also noted. Patient’s presenting complaint , detail his tory and time of trauma noted. RESULTS: During this study total 250 admission were included 170 ( P rospective and 80 ( R etrospective. There were over all 201 males (80.4% and 49 female (19.6%. Mortality was maximum due to RTA 64.52%. Highest number of ca ses (65 in the third decade i.e. 26%. Among these injuries hemoperitoneum was found in 94 cases i.e.37.6%. Small intestine (ileal>jejunal injury 45 cases i.e. , 18% was most common hollow viscous injury. In solid organ injury there was maximum incidence o f liver injury 34 cases. i.e. , 13.6% . CONCLUSION: This study concludes that young males are more prone to trauma and maximum blunt trauma is asso ciated with RTA. Almost half of patients required laparotomy and found injury to liver and small intestine in max cases. Overall

  6. Delayed-onset bilateral abducens paresis after head trauma

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    Pravin Salunke

    2012-01-01

    Full Text Available Bilateral sixth nerve paresis following closed head injury, though rare, is a known entity. However, delayed-onset post-traumatic bilateral abducens paresis is extremely rare. We present two cases. The first patient had onset of bilateral abducens paresis 2 weeks after closed head injury and the second patient after 3 days. The cause in the former was detected to be chronic subdural hematoma and in the latter is speculated to be edema/ischemia due to injury to soft tissue structures housing these nerves. The delayed onset of bilateral abducens paresis following head injury may vary according to the cause. There may be another mechanism of injury apart from direct trauma. Though rare, it needs to be evaluated and may have a treatable cause like elevated intracranial pressure.

  7. Mesenteric thrombosis in patient victim of blunt abdominal trauma Trombose mesentérica em vítima de trauma abdominal fechado

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    Iwan Augusto Collaço

    2008-06-01

    Full Text Available INTRODUCTION: Mesenteric thrombosis related to trauma is an uncommon entity and has poor prognosis when associated to low perfusion and hemorrhagic shock. Usually presents a challenging diagnosis and high mortality rates, despite appropriate treatment. OBJECTIVE: To relate a case of a car accident and blunt abdominal trauma with terminal ileum and right colon necrosis. CASE REPORT: After initial procedures, complementary exams showed ribs and humerus fractures. Computerized tomography evidenced aerial distension in small bowel, gastric stasis and hidro-pneumothorax. Hypotension was observed during clinical observation followed by cardiopulmonary arrest, responding to reanimation. At surgery, it was found extensive necrosis of right colon and terminal ileum, and an ileum-transversostomy was performed with primary anastomosis. During the staying in intensive care unit, oliguria, miosis, convulsion and pulseless electric activity happened with death in three days after hospital admission. CONCLUSION: Although uncommon, mesenteric ischemia with venous thrombosis might be secondary to blunt abdominal trauma and must be considered in a bad abdominal evolution.INTRODUÇÃO: Trombose mesentérica, relacionada à trauma é entidade incomum com pobre prognóstico quando seguida de estados de baixo fluxo e choque hipovolêmico. Geralmente se apresenta com quadro de difícil diagnóstico, mortalidade elevada a despeito de tratamento adequado. OBJETIVO: Apresentar um caso de vítima de atropelamento que evoluiu com necrose de cólon direito e íleo terminal. RELATO DO CASO: Após admissão hospitalar e atendimento inicial, os exames complementares mostraram fratura de costela e úmero. Tomografia computadorizada evidenciou distensão aérea em intestino delgado associada à estase gástrica e hidropneumotórax. O paciente evoluiu com hipotensão durante o período de observação clínica, com parada cardiorespiratória, respondendo à reanimação. Levado

  8. [Thromboprophylaxis in multiple trauma and head injury patients].

    Science.gov (United States)

    Colomina, M J; Mora, L; Ciércoles, E

    2011-12-01

    Venous thromboembolic disease (VTD) is a frequent condition with serious clinical consequences and elevated mortality related to underdiagnosis or undertreatment, especially in patients with multiple trauma. The incidence of VTD in these patients ranges from 5% to 58% and thromboprophylaxis is considered essential for proper management. Traditionally, pelvic and lower extremity fractures, head injury, and prolonged immobilization have been cited as risk factors for VTD; however, how these factors combine with others to predict high risk is still unclear. The best way to approach VTD prophylaxis in multiple trauma patients is currently unclear. Both mechanical and pharmacologic means are available. The main clinical practice guidelines recommend thromboprophylaxis with low-molecular weight heparin, which can be started 48 hours after trauma, unless patients are still bleeding, in which case mechanical compression is recommended in spite of the limited effectiveness of that measure. Compression is maintained until the risk of hemorrhage has diminished. There is insufficient evidence to support routine use of ultrasound imaging or venography. In patients with head injury who are at risk for intracranial bleeding, the use of low-molecular weight heparin should be delayed until risk disappears but mechanical prophylaxis (compression) can be considered according to clinical status.

  9. Vestibular disorders following different types of head and neck trauma

    Science.gov (United States)

    Kolev, Ognyan I.; Sergeeva, Michaela

    2016-01-01

    Summary This review focuses on the published literature on vestibular disorders following different types of head and neck trauma. Current knowledge of the different causes and underlying mechanisms of vestibular disorders, as well as the sites of organic damage, is presented. Non-organic mechanisms are also surveyed. The frequency of occurrence of vestibular symptoms, and of other accompanying subjective complaints, associated with different types of trauma is presented and related to the specific causes. Hypotheses about the pathogenesis of traumatic vestibular disorders are presented, and the knowledge derived from animal experiments is also discussed. We believe this to be a very important topic, since vestibular complaints in traumatic patients often remain undiagnosed or underestimated in clinical practice. This review article aims to suggest directions for additional research and to provide guidance to both the scientific and clinical practice communities. PMID:27358219

  10. Unusual case of life threatening subcutaneous hemorrhage in a blunt trauma patient

    Directory of Open Access Journals (Sweden)

    Ashraf F. Hefny

    2015-01-01

    Conclusion: Bleeding into the subcutaneous plane in closed degloving injury can cause severe hypovolemic shock. It is important for the clinicians managing trauma patients to be aware this serious injury.

  11. Does Splenectomy Protect Against Immune-Mediated Complications in Blunt Trauma Patients?

    OpenAIRE

    Crandall, Marie; Shapiro, Michael B.; West, Michael A.

    2009-01-01

    Activation of the innate immune system results from severe trauma and the resultant systemic inflammatory response is thought to mediate remote organ injury. In animal models, vagal-mediated innate immune responses have been shown to modulate proinflammatory cytokine release in response to trauma or sepsis. In those models, vagal nerve transaction and splenectomy decreased cytokine release and protected against lung injury and mortality. We hypothesized that, if similar mechanisms are active ...

  12. Blunt Chest Trauma in Mice after Cigarette Smoke-Exposure: Effects of Mechanical Ventilation with 100% O2.

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    Katja Wagner

    Full Text Available Cigarette smoking (CS aggravates post-traumatic acute lung injury and increases ventilator-induced lung injury due to more severe tissue inflammation and apoptosis. Hyper-inflammation after chest trauma is due to the physical damage, the drop in alveolar PO2, and the consecutive hypoxemia and tissue hypoxia. Therefore, we tested the hypotheses that 1 CS exposure prior to blunt chest trauma causes more severe post-traumatic inflammation and thereby aggravates lung injury, and that 2 hyperoxia may attenuate this effect. Immediately after blast wave-induced blunt chest trauma, mice (n=32 with or without 3-4 weeks of CS exposure underwent 4 hours of pressure-controlled, thoraco-pulmonary compliance-titrated, lung-protective mechanical ventilation with air or 100% O2. Hemodynamics, lung mechanics, gas exchange, and acid-base status were measured together with blood and tissue cytokine and chemokine concentrations, heme oxygenase-1 (HO-1, activated caspase-3, and hypoxia-inducible factor 1-α (HIF-1α expression, nuclear factor-κB (NF-κB activation, nitrotyrosine formation, purinergic receptor 2X4 (P2XR4 and 2X7 (P2XR7 expression, and histological scoring. CS exposure prior to chest trauma lead to higher pulmonary compliance and lower PaO2 and Horovitz-index, associated with increased tissue IL-18 and blood MCP-1 concentrations, a 2-4-fold higher inflammatory cell infiltration, and more pronounced alveolar membrane thickening. This effect coincided with increased activated caspase-3, nitrotyrosine, P2XR4, and P2XR7 expression, NF-κB activation, and reduced HIF-1α expression. Hyperoxia did not further affect lung mechanics, gas exchange, pulmonary and systemic cytokine and chemokine concentrations, or histological scoring, except for some patchy alveolar edema in CS exposed mice. However, hyperoxia attenuated tissue HIF-1α, nitrotyrosine, P2XR7, and P2XR4 expression, while it increased HO-1 formation in CS exposed mice. Overall, CS exposure

  13. Detection of alveolar epithelial injury by 99mTc-DTPA radioaerosol inhalation lung scan following blunt chest trauma

    International Nuclear Information System (INIS)

    DTPA clearance rate is a reliable index of alveolar epithelial permeability, and is a highly sensitive marker of pulmonary epithelial damage, even of mild degree. In this study, 99mTc-DTPA aerosol inhalation scintigraphy was used to assess the pulmonary epithelial membrane permeability and to investigate the possible application of this permeability value as an indicator of early alveolar or interstitial changes in patients with blunt chest trauma. A total of 26 patients was chest trauma (4 female, 22 male, 31-80 yrs, mean age; 53±13 yrs) who were referred to the emergency department in our hospital participated in this study. Technetium-99m diethylene triamine pentaacetic acid (DTPA) aerosol inhalation scintigraphy was performed on the first and thirtieth days after trauma. Clearance half times (T1/2) were calculated by placing a mono-exponential fit on the curves. Penetration index (PI) was calculated on the first-minute image. On the first day, mean T1/2 value of the whole lung was 63±19 minutes (min), and thirtieth day mean T1/2 value was 67±21 min. On the first day, mean PI values of the lung and 30th day mean PI value were 0.60±0.05, and 0.63 ±0.05, respectively. Significant changes were observed in radioaerosol clearance and penetration indices. Following chest trauma, clearance of 99mTc-DTPA increased owing to breakdown of the alveolar-capillary barrier. This increase in the epithelial permeability of the lung appears to be an early manifestation of lung disease that may lead to efficient therapy in the early phase. (author)

  14. Occult Mediastinal Great Vessel Trauma: The Value of Aortography Performed During Angiographic Screening for Blunt Cervical Vascular Trauma

    International Nuclear Information System (INIS)

    Purpose. To determine the value of aortography in the assessment of occult aortic and great vessel injuries when routinely performed during screening angiography for blunt cerebrovascular injury (BCVI). Methods. One hundred and one consecutive patients who received both aortography and screening four-vessel angiography over 4 years were identified retrospectively. Angiograms for these patients were evaluated, and the incidence of occult mediastinal vascular injury was determined. Results. Of the 101 patients, 6 (6%) had angiographically documented traumatic aortic injuries. Of these 6 patients, one injury (17%) was unsuspected prior to angiography. Four of the 6 (67%) also had BCVI. One additional patient also had an injury to a branch of the subclavian artery. Conclusion. Routine aortography during screening angiography for BCVI is not warranted due to the low incidence (1%) of occult mediastinal arterial injury. However, in the setting of a BCVI screening study and no CT scan of the chest, aortography may be advantageous

  15. Blunt aortic trauma in a patient with the Ehlers–Danlos syndrome type VI

    Science.gov (United States)

    Yung, Marco Yat Hang; Murray, Jennifer; Thompson, Errington C.

    2016-01-01

    A 24-year-old male with the Ehlers–Danlos syndrome (EDS) type VI (ocular scoliotic) who was kicked in the abdomen presented to the emergency room (ER) with abdominal pain. He was found to have a blunt traumatic aortic injury. The patient was treated nonoperatively. He was stable and discharged home on the eighth day. The patient returned to the ER several days later hypotensive and tachycardic. The patient was taken immediately to the operating room, but vascular repair was not possible. The patient expired. We discuss the challenges of taking care of a patient with EDS and offer suggestions that might improve future patient's outcome. PMID:26956239

  16. Blunt aortic trauma in a patient with the Ehlers-Danlos syndrome type VI.

    Science.gov (United States)

    Yung, Marco Yat Hang; Murray, Jennifer; Thompson, Errington C

    2016-01-01

    A 24-year-old male with the Ehlers-Danlos syndrome (EDS) type VI (ocular scoliotic) who was kicked in the abdomen presented to the emergency room (ER) with abdominal pain. He was found to have a blunt traumatic aortic injury. The patient was treated nonoperatively. He was stable and discharged home on the eighth day. The patient returned to the ER several days later hypotensive and tachycardic. The patient was taken immediately to the operating room, but vascular repair was not possible. The patient expired. We discuss the challenges of taking care of a patient with EDS and offer suggestions that might improve future patient's outcome. PMID:26956239

  17. Prior blunt chest trauma may be a cause of single vessel coronary disease; hypothesis and review

    DEFF Research Database (Denmark)

    Bartels, Mette Damkjær; Nielsen, PE; Sleight, P

    2006-01-01

    old, and only 2.5% more than 60 years old. The most common trauma was a road traffic accident, and the LAD was the vessel most often affected. Angiography revealed 12 cases with completely normal vessels, which might be due to spasm or recanalisation; 31 cases showed occlusion but no atherosclerosis...

  18. Vascular changes in the kidney after blunt abdominal trauma in childhood

    International Nuclear Information System (INIS)

    A genuine trauma, which had been overlooked at first, resulted in macrohaematuria. Infusion urography showed an enlarged left kidney with delayed and incomplete visualisation of the renal pelvis. Angiography showed swelling of the left kidney and small arterial ruptures with pseudoaneurysmatic contrast medium deposits in the parenchyma. Three months later, the angiogram showed largely normalised vessels. (orig.)

  19. Histone deactylase gene expression profiles are associated with outcomes in blunt trauma patients

    DEFF Research Database (Denmark)

    Sillesen, Martin; Bambakidis, Ted; Dekker, Simone E;

    2016-01-01

    BACKGROUND: Treatment with histone deacetylase (HDAC) inhibitors, such as valproic acid, increases survival in animal models of trauma and sepsis. Valproic acid is a pan-inhibitor that blocks most of the known HDAC isoforms. Targeting individual HDAC isoforms may increase survival and reduce...

  20. Cerebral Venous Air Embolism due to a Hidden Skull Fracture Secondary to Head Trauma

    Directory of Open Access Journals (Sweden)

    Ai Hosaka

    2015-01-01

    Full Text Available Cerebral venous air embolism is sometimes caused by head trauma. One of the paths of air entry is considered a skull fracture. We report a case of cerebral venous air embolism following head trauma. The patient was a 55-year-old man who fell and hit his head. A head computed tomography (CT scan showed the air in the superior sagittal sinus; however, no skull fractures were detected. Follow-up CT revealed a fracture line in the right temporal bone. Cerebral venous air embolism following head trauma might have occult skull fractures even if CT could not show the skull fractures.

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

    Science.gov (United States)

    Karbach, Michael; Braumueller, Sonja; Kellermann, Philipp; Gebhard, Florian; Huber-Lang, Markus; Perl, Mario

    2016-01-01

    Background 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. Methods 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). Results 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. Conclusions 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. PMID:27437704

  2. Primary Prevention of Pediatric Abusive Head Trauma: A Cost Audit and Cost-Utility Analysis

    Science.gov (United States)

    Friedman, Joshua; Reed, Peter; Sharplin, Peter; Kelly, Patrick

    2012-01-01

    Objectives: To obtain comprehensive, reliable data on the direct cost of pediatric abusive head trauma in New Zealand, and to use this data to evaluate the possible cost-benefit of a national primary prevention program. Methods: A 5 year cohort of infants with abusive head trauma admitted to hospital in Auckland, New Zealand was reviewed. We…

  3. Long-term outcome of abusive head trauma.

    Science.gov (United States)

    Chevignard, Mathilde P; Lind, Katia

    2014-12-01

    Abusive head trauma is a severe inflicted traumatic brain injury, occurring under the age of 2 years, defined by an acute brain injury (mostly subdural or subarachnoidal haemorrhage), where no history or no compatible history with the clinical presentation is given. The mortality rate is estimated at 20-25% and outcome is extremely poor. High rates of impairments are reported in a number of domains, such as delayed psychomotor development; motor deficits (spastic hemiplegia or quadriplegia in 15-64%); epilepsy, often intractable (11-32%); microcephaly with corticosubcortical atrophy (61-100%); visual impairment (18-48%); language disorders (37-64%), and cognitive, behavioral and sleep disorders, including intellectual deficits, agitation, aggression, tantrums, attention deficits, memory, inhibition or initiation deficits (23-59%). Those combined deficits have obvious consequences on academic achievement, with high rates of special education in the long term. Factors associated with worse outcome include demographic factors (lower parental socioeconomic status), initial severe presentation (e.g., presence of a coma, seizures, extent of retinal hemorrhages, presence of an associated cranial fracture, extent of brain lesions, cerebral oedema and atrophy). Given the high risk of severe outcome, long-term comprehensive follow-up should be systematically performed to monitor development, detect any problem and implement timely adequate rehabilitation interventions, special education and/or support when necessary. Interventions should focus on children as well as families, providing help in dealing with the child's impairment and support with psychosocial issues. Unfortunately, follow-up of children with abusive head trauma has repeatedly been reported to be challenging, with very high attrition rates. PMID:25501726

  4. Transplantation after blunt trauma to the liver: a valuable option or just a "waste of organs"?

    Directory of Open Access Journals (Sweden)

    Heuer M

    2010-04-01

    Full Text Available Abstract Objective Liver injury due to trauma is a rare indication for transplantation. The main indications in such cases were uncontrollable bleeding and insufficient hepatic function. Because of poor results, liver transplantation in these patients is occasionally described as "waste of organs", however based on insufficient data. This study aims to report our experience and to critically question the indication of transplantation in these patients. Methods All liver transplantations at our institution were reviewed retrospectively. This covered 1,529 liver transplants between September 1987 and December 2008. Of them, 6 transplants were performed due to motor-vehicle accidents which caused uncontrollable acute liver trauma in 4 patients. The patients' peri-operative course, short- and long-term outcomes were analyzed. Results Five deceased-donor liver transplantations (4 full size, 1 split and 1 living donor (right transplantation were performed. The median GCS score was 9/15; the median MELD score was 15. Postoperative complications were observed in 3 patients, requiring re-operation in 2. After a median (range follow-up of 32.95 (10.3-55.6 months, 2 patients are alive and remain well on immunosuppression. Conclusion Liver transplantation in patients with otherwise surgically uncontrollable acute liver injury can be indicated as a life saving procedure and can be performed successfully in highly selected cases.

  5. A combination of methylprednisolone and quercetin is effective for the treatment of cardiac contusion following blunt chest trauma in rats

    International Nuclear Information System (INIS)

    Cardiac contusion is a potentially fatal complication of blunt chest trauma. The effects of a combination of quercetin and methylprednisolone against trauma-induced cardiac contusion were studied. Thirty-five female Sprague-Dawley rats were divided into five groups (n=7) as follows: sham, cardiac contusion with no therapy, treated with methylprednisolone (30 mg/kg on the first day, and 3 mg/kg on the following days), treated with quercetin (50 mg·kg−1·day−1), and treated with a combination of methylprednisolone and quercetin. Serum troponin I (Tn-I) and tumor necrosis factor-alpha (TNF-α) levels and cardiac histopathological findings were evaluated. Tn-I and TNF-α levels were elevated after contusion (P=0.001 and P=0.001). Seven days later, Tn-I and TNF-α levels decreased in the rats treated with methylprednisolone, quercetin, and the combination of methylprednisolone and quercetin compared to the rats without therapy, but a statistical significance was found only with the combination therapy (P=0.001 and P=0.011, respectively). Histopathological degeneration and necrosis scores were statistically lower in the methylprednisolone and quercetin combination group compared to the group treated only with methylprednisolone (P=0.017 and P=0.007, respectively). However, only degeneration scores were lower in the combination therapy group compared to the group treated only with quercetin (P=0.017). Inducible nitric oxide synthase positivity scores were decreased in all treatment groups compared to the untreated groups (P=0.097, P=0.026, and P=0.004, respectively). We conclude that a combination of quercetin and methylprednisolone can be used for the specific treatment of cardiac contusion

  6. A combination of methylprednisolone and quercetin is effective for the treatment of cardiac contusion following blunt chest trauma in rats

    Energy Technology Data Exchange (ETDEWEB)

    Demir, F. [Department of Pediatric Cardiology, Faculty of Medicine, Dicle University, Diyarbakır (Turkey); Güzel, A. [Department of Pediatrics, Faculty of Medicine, Ondokuz Mayıs University, Samsun (Turkey); Katı, C. [Department of Emergency Medicine, Faculty of Medicine, Ondokuz Mayıs University, Samsun (Turkey); Karadeniz, C. [Pediatric Cardiology Services, Behçet Uz Children' s Hospital, İzmir (Turkey); Akdemir, U. [Department of Emergency Medicine, Faculty of Medicine, Ondokuz Mayıs University, Samsun (Turkey); Okuyucu, A. [Department of Medical Biochemistry, Faculty of Medicine, Ondokuz Mayıs University, Samsun (Turkey); Gacar, A. [Department of Pathology, Faculty of Veterinary Medicine, Ondokuz Mayıs University, Samsun (Turkey); Özdemir, S. [Department of Pediatrics, Faculty of Medicine, Ondokuz Mayıs University, Samsun (Turkey); Güvenç, T. [Department of Pathology, Faculty of Veterinary Medicine, Ondokuz Mayıs University, Samsun (Turkey)

    2014-08-01

    Cardiac contusion is a potentially fatal complication of blunt chest trauma. The effects of a combination of quercetin and methylprednisolone against trauma-induced cardiac contusion were studied. Thirty-five female Sprague-Dawley rats were divided into five groups (n=7) as follows: sham, cardiac contusion with no therapy, treated with methylprednisolone (30 mg/kg on the first day, and 3 mg/kg on the following days), treated with quercetin (50 mg·kg{sup −1}·day{sup −1}), and treated with a combination of methylprednisolone and quercetin. Serum troponin I (Tn-I) and tumor necrosis factor-alpha (TNF-α) levels and cardiac histopathological findings were evaluated. Tn-I and TNF-α levels were elevated after contusion (P=0.001 and P=0.001). Seven days later, Tn-I and TNF-α levels decreased in the rats treated with methylprednisolone, quercetin, and the combination of methylprednisolone and quercetin compared to the rats without therapy, but a statistical significance was found only with the combination therapy (P=0.001 and P=0.011, respectively). Histopathological degeneration and necrosis scores were statistically lower in the methylprednisolone and quercetin combination group compared to the group treated only with methylprednisolone (P=0.017 and P=0.007, respectively). However, only degeneration scores were lower in the combination therapy group compared to the group treated only with quercetin (P=0.017). Inducible nitric oxide synthase positivity scores were decreased in all treatment groups compared to the untreated groups (P=0.097, P=0.026, and P=0.004, respectively). We conclude that a combination of quercetin and methylprednisolone can be used for the specific treatment of cardiac contusion.

  7. Cranial computed tomography scan findings in head trauma patients in Enugu, Nigeria

    OpenAIRE

    Ohaegbulam, Samuel C; Wilfred C Mezue; Chika A Ndubuisi; Erechukwu, Uwadiegwu A.; Ani, Chinenye O.

    2011-01-01

    Background: The choice of radiological investigations in head trauma in Africa is influenced by factors such as cost. Some patients who require computed tomography (CT) scan elsewhere are either managed blindly or do not present for it at the appropriate time. This paper evaluates the CT scan findings as they are obtained in cases of head trauma in a region of Nigeria. Methods: Prospectively recorded data of all head injury patients who presented for CT scan between January 2009 and April 201...

  8. Unusual delayed presentation of head trauma complicating outcome of facial nerve decompression surgery

    OpenAIRE

    Thakur, J S; Shekar, Vidya; Saluja, Manika; Mohindroo, N K

    2013-01-01

    Late presentation of head trauma is rare. A young boy presented with a traumatic facial paralysis after head trauma. A CT scan of the head showed temporal bone fracture without intracranial insult. Facial nerve decompression was performed and paralysis started improving. However, he presented with vertigo and sensorineural hearing loss after 2 months. Clinical examination also showed cerebellar sign. We suspected iatrogenic injury to the cochlea; however, brain MRI showed haemorrhage in the a...

  9. COMPARATIVE ROLE AND EVALUATION OF ULTRASOUND AND MULTISLICE COMPUTED TOMOGRAPHY IN THE GRADING OF HEMOPERITONEUM IN PATIENTS WITH ACUTE BLUNT ABDOMINAL TRAUMA AND ITS CORRELATION WITH THE GRADING OF ORGAN INJURY

    OpenAIRE

    Kunwarpal; Sukhdeep; Thukral; Amandeep; Harmeet; Sonali

    2015-01-01

    AIMS AND OBJECTIVES: 1. To assess the role of Ultrasound (US) and Multislice Computed Tomography (MSCT) in detecting hemoperitoneum in patients with acute blunt abdominal trauma. 2. To study the use of US and MSCT in grading of hemoperitoneum in blunt abdominal trauma patients. 3. To compare the US and MSCT grading of hemoperitoneum with the grading of organ injury. 4. To compare and statistically analyze the spectrum of findings observed in each moda...

  10. Socio-economic outcome after blunt orthopaedic trauma: Implications on injury prevention

    Directory of Open Access Journals (Sweden)

    Zilkens Anna

    2011-05-01

    Full Text Available Abstract Background Several large studies have identified factors associated with long-term outcome after orthopaedic injuries. However, long-term social and economic implications have not been published so far. The aim of this investigation is to study the long-term socio-economic consequences of patients sustaining severe trauma. Methods Patients treated at a level one trauma center were invited for a follow-up (at least 10 years examination. There were 637 patients who responded and were examined. Inclusion criteria included injury severity score (ISS ≥ 16 points, presence of lower and upper extremity fractures, and age between 3 and 60 years. Exclusion criteria included the presence of amputations and paraplegia. The socio-economic outcome was evaluated in three age groups: group I ( 50 years. The following parameters were analyzed using a standardized questionnaire: financial losses, net income losses, pension precaution losses, need for a bank loan, and the decrease in number of friends. Results 510 patients matched all study criteria, and breakdown of groups were as follows: 140 patients in group I, 341 patients in group II, and 29 patients in group III. Financial losses were reported in all age groups (20%-44%. Younger patients (group I were associated with less income losses when compared with other groups (p Conclusions Economic consequences are reported by polytraumatized patients even ten or more years after injury. Financial losses appear to be common in patients between 19 and 50 years. In contrast, social deprivation appears to be most pronounced in the younger age groups. Early socio-economic support and measures of injury prevention should focus on these specific age groups.

  11. Delayed Presentation of a Carotid Artery Dissection Following Blunt Trauma in a Young Adult with Minimal Risk Factors.

    Science.gov (United States)

    Talburt, Jason; Cayton, Steward T; Alwood, Shannon; Musso, Mandi

    2016-01-01

    A 22-year-old woman presented to the emergency department (ED) after suffering injuries as a restrained driver in a head-on motor vehicle accident. Upon presentation to the ED, her Glasgow Coma Score (GCS) was 15. A computed tomography (CT) of the head and neck was negative. She was taken to surgery for orthopedic injuries. Recovery from general anesthesia was somewhat prolonged due to somnolence. Roughly two hours after transfer, her family noticed that she was not moving her left arm. Trauma staff noted she had a new left hemiparesis. She was promptly taken for a repeat head CT which showed a dense area of ischemia in her right cerebral hemisphere, in the distribution of the right middle cerebral artery (MCA). A CT angiogram of the head and neck revealed a large dissection of the right carotid artery below the level of C2-C3, complete occlusion of the right internal carotid artery beginning 2 cm superior to the bifurcation, and developing cerebral edema with subsequent leftward shift. PMID:27159489

  12. Clinical Symptoms of Minor Head Trauma and Abnormal Computed Tomography Scan

    Directory of Open Access Journals (Sweden)

    Maghsoudi

    2015-11-01

    Full Text Available Background Minor head trauma accounts for 70% to 90% of all head traumas. Previous studies stated that minor head traumas were associated with 7% - 20% significant abnormal findings in brain computed tomography (CT-scans. Objectives The aim of this study was to reevaluate clinical criteria of taking brain CT scan in patients who suffered from minor head trauma. Patients and Methods We enrolled 680 patients presented to an academic trauma hospital with minor head trauma in a prospective manner. All participants underwent brain CT scan if they met the inclusion criteria and the results of scans were compared with clinical examination finding. Results Loss of consciousness (GCS drop or amnesia was markedly associated with abnormal brain CT scan (P < 0.05. Interestingly, we found 7 patients with normal clinical examination but significant abnormal brain CT scan. Conclusions According to the results of our study, we recommend that all patients with minor head trauma underwent brain CT scan in order not to miss any life-threatening head injuries.

  13. Injuries of the Portal Vein in Patients With Blunt Abdominal Trauma

    Directory of Open Access Journals (Sweden)

    D. Henne-Bruns

    1993-01-01

    four or more organs. Additionally, in 11.8% of these cases (n = 8 a major vascular injury (portal vein n = 5, vena cava n = 2, mesenteric root n = 1 was found. Injuries to the portal vein were always associated with complete rupture of the pancreas, requiring distal pancreatic resection in four cases and a duodenum preserving resection of the head of the pancreas in one. In two of these patients the portal vein had to be reconstructed with a Goretex prosthetic graft. Mortality was 14.7% for the whole group (n = 68 and 0% for patients with additional portal venous injuries.

  14. Presacral retroperitoneal hematoma after blunt trauma presents with rectal bleeding - A case report

    DEFF Research Database (Denmark)

    Dich, Sanne Jensen; El-Hussuna, Alaa Abdul-Hussein Hmood

    2016-01-01

    INTRODUCTION: We present a case of a presacral hematoma, which penetrated into the rectum resulting in rectal bleeding. This is an unusual presentation of a presacral hematoma. PRESENTATION OF THE CASE: A 76-year-old woman, using warfarin anticoagulant prophylaxis, presented with a rectal bleed t......: Rectal bleed after trauma, in a patient receiving anticoagulant treatment, should raise suspicion of a penetrating hematoma, and such patients should be managed at highly specialized facilities....... in the gastrointestinal tract. In this report the patient's anticoagulant treatment has likely contributed to bleeding and the formation of the hematoma. To our knowledge, this is the first case report of a presacral hematoma acutely penetrating into the rectum and causing lower gastrointestinal bleeding. CONCLUSION......INTRODUCTION: We present a case of a presacral hematoma, which penetrated into the rectum resulting in rectal bleeding. This is an unusual presentation of a presacral hematoma. PRESENTATION OF THE CASE: A 76-year-old woman, using warfarin anticoagulant prophylaxis, presented with a rectal bleed two...

  15. Autopsy Findings of Brainstem in Head Trauma in Comparison with CT Scan Findings in Brain Trauma Ward in Tabriz, Iran

    Directory of Open Access Journals (Sweden)

    Shakeri Bavil Moslem

    2009-10-01

    Full Text Available Computed tomography (CT is now the primary diagnostic method for head trauma because of its ability to demonstrate the nature, extent, sites, and multiplicity of brain injuries. Although there have been numerous reports on the CT findings of most types of intracranial injury, the findings in brainstem injury have not been well described. This study aimed at comparing the autopsy findings of brainstem in head trauma in comparison with CT scan results. Two hundred patients with head trauma, who expired after a period of time of hospitalization, were assessed in a diagnostic value study. Brain stem involvement was determined by autopsy as well as CT scanning of the brain during their hospitalization. The results of the two methods were compared with each other, emphasizing on the type and location of probable lesions in the brain stem. Considering the autopsy as the method of the choice, sensitivity, specificity, positive predictive value (PPV and negative predictive value (NPV of CT scan in brain stem lesions of patients with head trauma were calculated. The effect of primary cause of head trauma, survival time and Glasgow Coma Scale (GCS were evaluated, as well. Brain stem lesions were detected in 39 (19.5% patients in autopsy. However, CT scan revealed brain stem lesions in 23(11.5% cases. The sensitivity, specificity, PPV and NPV of CT scan was 59%, 100%, 100% and 91% respectively. The most common lesions of the brain stem region were as contusion of pons (8.5%, medulla (5% and midbrain (4.5%. There were 6 (3% cases of ponto-medullary junction tearing and 1 (0.5% case of cervico-medullary junction tearing. CT scan is a specific method of evaluating patients with probable brain stem injuries after head trauma, but low sensitivity limits its efficacy. Our results are in conformity with the reports in the literature.

  16. Cerebellar Infarction in Childhood: Delayed-Onset Complication of Mild Head Trauma.

    Science.gov (United States)

    Ilker Oz, Ibrahim; Bozay Oz, Evrim; Şerifoğlu, Ismail; Kaya, Nurullah; Erdem, Oktay

    2016-01-01

    Objective Cerebellar ischemic infarction is a rare complication of minor head trauma. Vertebral artery dissection, vasospasm or systemic hypo perfusion can cause infarct. However, underlying causes of the ischemic infarct cannot be explained in nearly half of cases. The accurate diagnosis is essential to ensure appropriate treatment. Here we report a five yr old boy patient of cerebellar infraction after minor head trauma, admitted to emergency serves of BulentEcevit University, Turkey in 2013. We aimed to remind minor head trauma that causes cerebellar infarction during childhood, and to review the important points of the diagnosis, which should be keep in mind. PMID:27375760

  17. Blunt splenic trauma: Can contrast enhanced sonography be used for the screening of delayed pseudoaneurysms?

    Energy Technology Data Exchange (ETDEWEB)

    Poletti, Pierre-Alexandre, E-mail: Pierre-Alexandre.Poletti@hcuge.ch [Department of Radiology, University Hospital of Geneva, 4 Rue Gabrielle Perret-Gentil, 1211 Geneva 14 (Switzerland); Becker, Christoph D.; Arditi, Daniel; Terraz, Sylvain [Department of Radiology, University Hospital of Geneva, 4 Rue Gabrielle Perret-Gentil, 1211 Geneva 14 (Switzerland); Buchs, Nicolas [Department of Surgery, University Hospital of Geneva, 4 Rue Gabrielle Perret-Gentil, 1211 Geneva 14 (Switzerland); Shanmuganathan, Kathirkamanathan [Department of Diagnostic Radiology and Nuclear Medicine, 22 S. Greene Street, Baltimore, MD 21201 (United States); Platon, Alexandra [Department of Radiology, University Hospital of Geneva, 4 Rue Gabrielle Perret-Gentil, 1211 Geneva 14 (Switzerland)

    2013-11-01

    Purpose: To assess the value of contrast-enhanced sonography (CES) for the detection of delayed post-traumatic splenic pseudo-aneurysms, usually considered an indication for angiographic embolization. Methods: Sixty-three consecutive hemodynamically stable trauma patients in whom admission CT displayed a splenic injury of grade II or higher (AAST classification), without evidence of vascular involvement, were included in the study. CES of the spleen using a second generation contrast agent was systematically performed within 48–72 h after admission, for the detection of a pooling of contrast media suggestive of pseudoaneurysm. Within 6 h after contrast-enhanced sonography, all patients underwent an abdominal CT for control purposes. CES results were compared to CT findings, which were considered the reference standard. This study received approval from the institutional ethical board. Results: CES showed a blush of contrast consistent with a pseudoaneurysm in 6 of the 63 patients. All were confirmed at subsequent control CT. Pooling of contrast was found at CT in 2 patients in whom contrast-enhanced sonography was negative. There was no false positive CES examination for the suspicion of pseudoaneurysms. When compared to CT, the sensitivity, specificity, positive and negative predictive values of CES to suggest a pseudoaneurysms, were 75% (6/8), 100% (55/55), 100% (6/6), and 96% (55/57), respectively. Conclusion: Our data suggest that CES may be useful for the screening of delayed traumatic splenic pseudoaneurysms: if a negative CES does not absolutely rule out a pseudoaneurysm, a positive CES warrants an angiography, without need of control CT.

  18. Blunt splenic trauma: Can contrast enhanced sonography be used for the screening of delayed pseudoaneurysms?

    International Nuclear Information System (INIS)

    Purpose: To assess the value of contrast-enhanced sonography (CES) for the detection of delayed post-traumatic splenic pseudo-aneurysms, usually considered an indication for angiographic embolization. Methods: Sixty-three consecutive hemodynamically stable trauma patients in whom admission CT displayed a splenic injury of grade II or higher (AAST classification), without evidence of vascular involvement, were included in the study. CES of the spleen using a second generation contrast agent was systematically performed within 48–72 h after admission, for the detection of a pooling of contrast media suggestive of pseudoaneurysm. Within 6 h after contrast-enhanced sonography, all patients underwent an abdominal CT for control purposes. CES results were compared to CT findings, which were considered the reference standard. This study received approval from the institutional ethical board. Results: CES showed a blush of contrast consistent with a pseudoaneurysm in 6 of the 63 patients. All were confirmed at subsequent control CT. Pooling of contrast was found at CT in 2 patients in whom contrast-enhanced sonography was negative. There was no false positive CES examination for the suspicion of pseudoaneurysms. When compared to CT, the sensitivity, specificity, positive and negative predictive values of CES to suggest a pseudoaneurysms, were 75% (6/8), 100% (55/55), 100% (6/6), and 96% (55/57), respectively. Conclusion: Our data suggest that CES may be useful for the screening of delayed traumatic splenic pseudoaneurysms: if a negative CES does not absolutely rule out a pseudoaneurysm, a positive CES warrants an angiography, without need of control CT

  19. Susceptibility weighted imaging depicts retinal hemorrhages in abusive head trauma

    International Nuclear Information System (INIS)

    This study aims to evaluate the capability of magnetic resonance imaging (MRI) susceptibility weighted images (SWI) in depicting retinal hemorrhages (RH) in abusive head trauma (AHT) compared to the gold standard dilated fundus exam (DFE). This is a retrospective, single institution, observational study on 28 patients with suspected AHT, who had a DFE and also underwent brain MRI-SWI as part of routine diagnostic protocol. Main outcome measures involved evaluation of patients to determine whether the RH could be identified on standard and high-resolution SWI sequences. Of the 21 subjects with RH on DFE, 13 (62 %) were identified by using a standard SWI sequence performed as part of brain MRI protocols. Of the 15 patients who also underwent an orbits SWI protocol, 12 (80 %) were positive for RH. None of the seven patients without RH on of DFE had RH on either standard or high-resolution SWI. Compared with DFE, the MRI standard protocol showed a sensitivity of 75 % which increased to 83 % for the orbits SWI protocol. Our study suggests the usefulness of a tailored high-resolution orbits protocol to detect RH in AHT. (orig.)

  20. FLAIR images of mild head trauma with transient amnesia

    Energy Technology Data Exchange (ETDEWEB)

    Wakamoto, Hirooki; Miyazaki, Hiromichi; Inaba, Makoto; Ishiyama, Naomi [Hiratsuka City Hospital, Kanagawa (Japan); Kawase, Takeshi

    1998-11-01

    A newly advanced MRI pulse sequence, the FLAIR (fluid-attenuated inversion recovery) imaging, in which a long TE spin echo sequence is used with suppression of the CSF with an inversion pulse, displays the CSF space as a no signal intensity area. We examined 45 cases of mild head trauma with posttraumatic amnesia by FLAIR images and could detect some findings which could not be detected by CT scan and conventional MR images. These findings could be detected in many patients with long posttraumatic amnesia (over 2 hours), but they could not be detected in patients with short posttraumatic amnesia (within 30 mins). These findings existed surrounding lateral ventricles and we classified them into 3 types: type 1 is anterior horn of lateral ventricle, type 2 is the base of frontal lobe, and type 3 is cerebral deep white matter. Some of them were examined again by FLAIR images a month later, and these findings had disappeared. We suspect that these lesions were brain edema or mild contusion without hemorrhage. (author)

  1. End-of-life decisions in abusive head trauma.

    Science.gov (United States)

    Ellingson, Clifford C; Livingston, Jared S; Fanaroff, Jonathan M

    2012-03-01

    Abusive head trauma is a significant and tragic cause of morbidity and mortality in infants and its victims often have a poor prognosis. With such high rates of morbidity and mortality, health care providers and parents are often faced with the decision to continue or discontinue life support for an affected child. Sadly, however, this decision becomes complicated when parents are accused of causing the victim-child's current state. In this situation, if life support is withdrawn, criminal charges for the accused may escalate from assault to murder. This escalation of legal charges creates a conflict of interest for accused parents. As a result, parents have a strong incentive to avoid murder charges by using their parental decision-making rights to keep the child alive, even when treatment is deemed futile or inhumane. In this article, we discuss the legal challenges health care providers may face when parents place their interest above their child's. We also propose solutions that give greater deference to the rights and interest of these critically ill children while still preserving protected parental rights. PMID:22311991

  2. Susceptibility weighted imaging depicts retinal hemorrhages in abusive head trauma

    Energy Technology Data Exchange (ETDEWEB)

    Zuccoli, Giulio [Children' s Hospital of Pittsburgh of UPMC, Department of Pediatric Radiology, Pittsburgh, PA (United States); Children' s Hospital of Pittsburgh of UPMC, Department of Radiology, Pittsburgh, PA (United States); Panigrahy, Ashok; Haldipur, Anshul; Willaman, Dennis [Children' s Hospital of Pittsburgh of UPMC, Department of Pediatric Radiology, Pittsburgh, PA (United States); Squires, Janet; Wolford, Jennifer [Children' s Hospital of Pittsburgh of UPMC, Division of Child Advocacy, Pittsburgh, PA (United States); Sylvester, Christin; Mitchell, Ellen; Lope, Lee Ann [Children' s Hospital of Pittsburgh of UPMC, Eye Center, Pittsburgh, PA (United States); Nischal, Ken K. [Children' s Hospital of Pittsburgh of UPMC, Eye Center, Pittsburgh, PA (United States); Children' s Hospital of Pittsburgh of UPMC, Division of Pediatric Ophthalmology, Strabismus, and Adult Motility, Eye Center, Pittsburgh, PA (United States); Berger, Rachel P. [Children' s Hospital of Pittsburgh of UPMC, Division of Child Advocacy, Pittsburgh, PA (United States); University of Pittsburgh Medical Center, Safar Center for Resuscitation Research, Pittsburgh, PA (United States)

    2013-07-15

    This study aims to evaluate the capability of magnetic resonance imaging (MRI) susceptibility weighted images (SWI) in depicting retinal hemorrhages (RH) in abusive head trauma (AHT) compared to the gold standard dilated fundus exam (DFE). This is a retrospective, single institution, observational study on 28 patients with suspected AHT, who had a DFE and also underwent brain MRI-SWI as part of routine diagnostic protocol. Main outcome measures involved evaluation of patients to determine whether the RH could be identified on standard and high-resolution SWI sequences. Of the 21 subjects with RH on DFE, 13 (62 %) were identified by using a standard SWI sequence performed as part of brain MRI protocols. Of the 15 patients who also underwent an orbits SWI protocol, 12 (80 %) were positive for RH. None of the seven patients without RH on of DFE had RH on either standard or high-resolution SWI. Compared with DFE, the MRI standard protocol showed a sensitivity of 75 % which increased to 83 % for the orbits SWI protocol. Our study suggests the usefulness of a tailored high-resolution orbits protocol to detect RH in AHT. (orig.)

  3. Blunt Abdominal Trauma Patients Are at Very Low Risk for Intra-Abdominal Injury after Emergency Department Observation

    Directory of Open Access Journals (Sweden)

    Jason S Haukoos

    2011-05-01

    Full Text Available Introduction: Patients are commonly admitted to the hospital for observation following blunt abdominal trauma (BAT, despite initially negative emergency department (ED evaluations. With the current use of screening technology, such as computed tomography (CT of the abdomen and pelvis, ultrasound, and laboratory evaluations, it is unclear which patients require observation. The objective of this study was to determine the prevalence of intra-abdominal injury (IAI and death in hemodynamically normal and stable BAT patients with initially negative ED evaluations admitted to an ED observation unit and to define a low-risk subgroup of patients and assess whether they may be discharged without abdominal/pelvic CT or observation. Methods: This was a retrospective cohort study performed at an urban level 1 trauma center and included all BAT patients admitted to an ED observation unit as part of a BAT key clinical pathway. All were observed for at least 8 hours as part of the key clinical pathway, and only minors and pregnant women were excluded. Outcomes included the presence of IAI or death during a 40-month follow-up period. Prior to data collection, low-risk criteria were defined as no intoxication, no hypotension or tachycardia, no abdominal pain or tenderness, no hematuria, and no distracting injury. To be considered low risk, patients needed to meet all low-risk criteria. Results: Of the 1,169 patients included over the 2-year study period, 29% received a CT of the abdomen and pelvis, 6% were admitted to the hospital from the observation unit for further management, 0.4% (95% confidence interval [CI], 0.1%–1% were diagnosed with IAI, and 0% (95% CI, 0%–0.3% died. Patients had a median combined ED and observation length of stay of 9.5 hours. Of the 237 (20% patients who met low-risk criteria, 7% had a CT of the abdomen and pelvis and 0% (95% CI, 0%–1.5% were diagnosed with IAI or died. Conclusion: Most BAT patients who have initially negative

  4. Unenhanced Computed Tomography to Visualize Hollow Viscera and/or Mesenteric Injury After Blunt Abdominal Trauma: A Single-Institution Experience.

    Science.gov (United States)

    Yang, Xu-Yang; Wei, Ming-Tian; Jin, Cheng-Wu; Wang, Meng; Wang, Zi-Qiang

    2016-03-01

    To identify and describe the major features of unenhanced computed tomography (CT) images of blunt hollow viscera and/or mesenteric injury (BHVI/MI) and to determine the value of unenhanced CT in the diagnosis of BHVI/MI. This retrospective study included 151 patients who underwent unenhanced CT before laparotomy for blunt abdominal trauma between January 2011 and December 2013. According to surgical observations, patients were classified as having BHVI/MI (n = 73) or not (n = 78). Sensitivity, specificity, P values, and likelihood ratios were calculated by comparing CT findings between the 2 groups. Six significant CT findings (P < 0.05) for BHVI/MI were identified and their sensitivity and specificity values determined, as follows: bowel wall thickening (39.7%, 96.2%), mesentery thickening (46.6%, 88.5%), mesenteric fat infiltration (12.3%, 98.7%), peritoneal fat infiltration (31.5%, 87.1%), parietal peritoneum thickening (30.1%, 85.9%), and intra- or retro-peritoneal air (34.2%, 96.2%). Unenhanced CT scan was useful as an initial assessment tool for BHVI/MI after blunt abdominal trauma. Six key features on CT were correlated with BHVI/MI.

  5. Fewer U.S. Kids Die from Abusive Head Trauma: CDC

    Science.gov (United States)

    ... https://medlineplus.gov/news/fullstory_159052.html Fewer U.S. Kids Die From Abusive Head Trauma: CDC Parent ... two years of the study, according to the U.S. Centers for Disease Control and Prevention. Experts said ...

  6. Abusive Head Trauma in Young Children: Characteristics and Medical Charges in a Hospitalized Population

    Science.gov (United States)

    Ettaro, L.; Berger, R. P.; Songer, T.

    2004-01-01

    Objective: To describe the presenting characteristics, hospital course, and hospital charges associated with hospital admissions for head trauma in young children at a regional pediatric trauma center, and to examine whether these factors differ among abused and non-abused subjects. Method: Comparative case series study involving a retrospective…

  7. The effect of head trauma on fracture healing: biomechanical testing and finite element analysis

    OpenAIRE

    Ozan, Firat; Hasan YILDIZ; Bora, Osman Arslan; Pekedis, Mahmut; Coskun, Gulnihal Ay; Gore, Oya

    2010-01-01

    Objectives: We aimed to evaluate the effect of head trauma on fracture healing with biomechanical testing, to compare the results obtained from a femur model created by finite element analysis with experimental data, and to develop a finite element model that can be employed in femoral fractures. Methods: Twenty-two Wistar albino rats were randomized into two groups. The control group was subjected to femoral fracture followed by intramedullary fixation, whereas the head trauma group was ...

  8. Imaging abusive head trauma: why use both computed tomography and magnetic resonance imaging?

    International Nuclear Information System (INIS)

    Abusive head trauma is the leading cause of death in child abuse cases. The majority of victims are infants younger than 1 year old, with the average age between 3 and 8 months, although these injuries can be seen in children up to 5 years old. Many victims have a history of previous abuse and the diagnosis is frequently delayed. Neuroimaging is often crucial for establishing the diagnosis of abusive head trauma as it detects occult injury in 37% of cases. Several imaging patterns are considered to be particularly associated with abusive head trauma. The presence of subdural hematoma, especially in multiple locations, such as the interhemispheric region, over the convexity and in the posterior fossa, is significantly associated with abusive head trauma. Although CT is the recommended first-line imaging modality for suspected abusive head trauma, early MRI is increasingly used alongside CT because it provides a better estimation of shear injuries, hypoxic-ischemic insult and the timing of lesions. This article presents a review of the use and clinical indications of the most pertinent neuroimaging modalities for the diagnosis of abusive head trauma, emphasizing the newer and more sensitive techniques that may be useful to better characterize the nature and evolution of the injury. (orig.)

  9. Imaging abusive head trauma: why use both computed tomography and magnetic resonance imaging?

    Energy Technology Data Exchange (ETDEWEB)

    Vazquez, Elida; Delgado, Ignacio; Sanchez-Montanez, Angel [Hospital Universitario Vall d' Hebron, UAB, Pediatric Radiology Department, Barcelona (Spain); Fabrega, Anna [Hospital Universitario Vall d' Hebron, UAB, Department of Pediatrics, Barcelona (Spain); Cano, Paola [Hospital Universitario Vall d' Hebron, UAB, Pediatric Neurosurgery, Barcelona (Spain); Martin, Nieves [Hospital Universitario Vall d' Hebron, UAB, Pediatric Ophthalmology, Barcelona (Spain)

    2014-12-15

    Abusive head trauma is the leading cause of death in child abuse cases. The majority of victims are infants younger than 1 year old, with the average age between 3 and 8 months, although these injuries can be seen in children up to 5 years old. Many victims have a history of previous abuse and the diagnosis is frequently delayed. Neuroimaging is often crucial for establishing the diagnosis of abusive head trauma as it detects occult injury in 37% of cases. Several imaging patterns are considered to be particularly associated with abusive head trauma. The presence of subdural hematoma, especially in multiple locations, such as the interhemispheric region, over the convexity and in the posterior fossa, is significantly associated with abusive head trauma. Although CT is the recommended first-line imaging modality for suspected abusive head trauma, early MRI is increasingly used alongside CT because it provides a better estimation of shear injuries, hypoxic-ischemic insult and the timing of lesions. This article presents a review of the use and clinical indications of the most pertinent neuroimaging modalities for the diagnosis of abusive head trauma, emphasizing the newer and more sensitive techniques that may be useful to better characterize the nature and evolution of the injury. (orig.)

  10. Analysis of the association between periportal low attenuation, as seen on CT, after blunt abdominal trauma, and elevated central venous pressure

    International Nuclear Information System (INIS)

    To assess the causes of periportal low attenuation, as seen on CT, in patients with blunt abdominal trauma. From among 812 patients who underwent abdominal CT after blunt abdominal trauma, we retrospectively analysed the findings in 124 with evidence of periportal low attenuation. Among these, hepatic injury was noted in only 87. The presence or absence, and extent of hepatic injury, and of periportal low attenuation, as seen on CT, were carefully evaluated. In each case, the ratio of the transverse diameter of the inferior vena cava(IVC) to the aorta at the level of the right adrenal gland provided an indirect measurement of central venous pressure ; for control purposes, the ratio was also obtained in 21 non-traumatic patients with no abnormal abdominal CT findings. Of the 87 patients with hepatic injury, 46 showed no periportal low attenuation, and average value of the ratio between the IVC and aorta was 1.16±0.12, while the remaining 41 patients showed periportal low attenuation with a ratio of 1.51±0.21(p<0.05). In the 37 patients with periportal low attenuation but no evidence of concomitant hepatic injury, the average ratio was 1.52±0.25, while in 21 non-traumatic patients it was 1.15±0.16. For resuscitation, all patients had received 0.5-5.0 litre of IV fluid therapy before CT, and at the time of CT, were normotensive. Rapidly elevated central venous pressure following massive IV infusion therapy in patients with blunt abdominal trauma can be one of the causes of periportal low attenuation, as seen on CT

  11. Using 99mTc-DTPA radioaerosol inhalation lung scan as compared with computed tomography to detect lung injury in blunt chest trauma

    International Nuclear Information System (INIS)

    Detection of pulmonary contusion in patients with blunt chest trauma is very important so as to commence therapy immediately to avoid irreversible damage. The purpose of our study was to evaluate the efficacy of technetium-99m diethylene triamine penta-acetic acid (99mTc-DTPA) aerosol inhalation lung scintigraphy in comparison with chest computed tomography (CT) in the diagnosis of pulmonary contusion at acute blunt chest trauma. Twenty-nine patients with isolated blunt chest trauma were referred to the emergency department of our hospital, and nine healthy people participated in this study. Sixteen patients who had pulmonary contusion on CT scans were referred to as group 1, and 13 patients who had normal CT scans as group 2. Nine healthy people comprised a control group. 99mTc-DTPA aerosol inhalation lung scintigraphy was performed on the first day in all patients. The mean half time (T1/2) and penetration index values of 99mTc-DTPA clearance were significantly lower in groups 1 and 2 compared with the control group. Among the three groups, there were no significant differences in arterial blood gas analysis except for PO2. The mean T1/2 value of 99mTc-DTPA clearance did correlate with PO2 values but not with pH, PCO2, or HCO3 values. 99mTc-DTPA radioaerosol inhalation lung imaging may serve as a useful adjunct and supportive method to chest CT scanning for detecting mild pulmonary contusion. (author)

  12. Head trauma as a risk factor for Alzheimer's disease: A collaborative re-analysis of case-control studies

    NARCIS (Netherlands)

    J.A. Mortimer; C.M. van Duijn (Cock); V. Chandra; L. Fratiglioni (Laura); A.B. Graves; A. Heyman; A.F. Jorm; E. Kokmen (Emre); K. Kondo; W.A. Rocca; S.L. Shalat; H. Soininen; A. Hofman (Albert)

    1991-01-01

    textabstractA re-analysis of the data from 11 case-control studies was performed to investigate the association between head trauma and Alzheimer's disease (AD). To increase comparability of studies, exposures were limited to head trauma with loss of consciousness (hereafter referred to as 'head tra

  13. MR imaging observations in head injury and their importance in understanding the pathophysiology of head trauma

    International Nuclear Information System (INIS)

    Forty-five patients were imaged with a General Electric 1.5-T Signa MR imager following significant head injury. Seventeen of them had acute head injury (within 10 days of trauma). In none of the acute cases, despite significant alterations in the level of consciousness, was there diffuse cerebral edema (diffuse high intensity on long repetition time [TR], long echo time [TE] images). CT and MR imaging, in some cases, demonstrated what was interpreted as a diffusely swollen brain with loss of normal sulci. These findings suggest that increased blood volume with concomitant loss of cerebral autoregulation, rather than vasogenic edema, is responsible for the diffusely swollen brain imaged with CT or MR. Treatment based on these MR findings should be aimed at decreasing the cerebral blood volume rather than treating of nonexistent diffuse cerebral edema. In 13 patients with longitudinal MR images, improvement was noted in some patients in initially diagnosed diffuse axonal injury (DAI). The focal regions of high intensity on long TR, long TE representing the DAI reverted to isointensity on subsequent images

  14. Direction of Head Trauma and its Effect on Olfactory Bulb Volume in Post-Traumatic Anosmia

    Directory of Open Access Journals (Sweden)

    S Farshchi

    2012-09-01

    Full Text Available Background: Anosmia is a physical sign in post-traumatic patients, which significantly reduces the quality of life. Anosmia occurs in up to 30% of cases with head trauma. In this study we aimed to compare the Olfactory Bulb Volume (OBV in patients with posttraumatic anosmia in different impact positions and also with healthy individuals to find the relation between the two variables. Methods: Thirty-eight patients with posttraumatic anosmia and 27 healthy individuals with normal olfactory function were recruited in this case-control study performed in Amir Alam Hospital in Tehran, Iran. Variables of age, sex, time of trauma, site of trauma (frontoparietal/occipital, side of trauma, OBV, the results of olfactory identification tests and olfactory threshold were extracted and evaluated. We used non-contrasted 1.5-Tesla coronal brain MRI for the measurement of OBV.Results: There were no significant differences between cases and controls regarding sex and age. Olfactory bulb volume was significantly smaller in cases compared to the controls (P=0.004. Among the case group, OBV was smaller in anterior versus posterior head traumas (P=0.02. OBV was also smaller in ipsilateral rather than the contralateral side of trauma (P=0.01.Conclusion: The direction of trauma had a significant effect on OBV and it was smaller in traumas to the anterior and also ipsilateral sides of the head. It seems that changes in OBV differ due to the direction of head trauma and it can be helpful in predicting the prognosis of posttraumatic anosmia. Further studies are required for more conclusive statements.

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

    Energy Technology Data Exchange (ETDEWEB)

    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. Comparative Effectiveness of Emergency Resuscitative Thoracotomy versus Closed Chest Compressions among Patients with Critical Blunt Trauma: A Nationwide Cohort Study in Japan.

    Directory of Open Access Journals (Sweden)

    Kodai Suzuki

    Full Text Available Although emergency resuscitative thoracotomy is performed as a salvage maneuver for critical blunt trauma patients, evidence supporting superior effectiveness of emergency resuscitative thoracotomy compared to conventional closed-chest compressions remains insufficient. The objective of this study was to investigate whether emergency resuscitative thoracotomy at the emergency department or in the operating room was associated with favourable outcomes after blunt trauma and to compare its effectiveness with that of closed-chest compressions.This was a retrospective nationwide cohort study. Data were obtained from the Japan Trauma Data Bank for the period between 2004 and 2012. The primary and secondary outcomes were patient survival rates 24 h and 28 d after emergency department arrival. Statistical analyses were performed using multivariable generalized mixed-effects regression analysis. We adjusted for the effects of different hospitals by introducing random intercepts in regression analysis to account for the differential quality of emergency resuscitative thoracotomy at hospitals where patients in cardiac arrest were treated. Sensitivity analyses were performed using propensity score matching.In total, 1,377 consecutive, critical blunt trauma patients who received cardiopulmonary resuscitation in the emergency department or operating room were included in the study. Of these patients, 484 (35.1% underwent emergency resuscitative thoracotomy and 893 (64.9% received closed-chest compressions. Compared to closed-chest compressions, emergency resuscitative thoracotomy was associated with lower survival rate 24 h after emergency department arrival (4.5% vs. 17.5%, respectively, P < 0.001 and 28 d after arrival (1.2% vs. 6.0%, respectively, P < 0.001. Multivariable generalized mixed-effects regression analysis with and without a propensity score-matched dataset revealed that the odds ratio for an unfavorable survival rate after 24 h was lower for

  17. Horner's syndrome after blunt cervical and chest trauma: case report Síndrome de Horner após trauma cérvico-torácico fechado: relato de caso

    OpenAIRE

    Wellingson Silva Paiva; Robson Luis Oliveira de Amorim; Wagner Malago Tavares; Eduardo Joaquim Lopes Alho; Brasil Ping Jeng; Eberval Gadelha Figueiredo

    2007-01-01

    Horner‘s syndrome is the triad of miosis, ptosis, and anhidrosis, resulting from disruption of the sympathetic pathways. This article describes an uncommon case of Horner‘s syndrome in a 22-year-old man after blunt trauma to the neck and chest without carotid artery dissection. The patient was brought to the emergency service after motorcycle fall. Neurologic examination revealed a patient presenting the score 15 at Glasgow Coma Scale. The left eyelid was 1-2 mm lower than the right. Carotid ...

  18. The song remains the same although the instruments are changing: complications following selective non-operative management of blunt spleen trauma: a retrospective review of patients at a level I trauma centre from 1996 to 2007

    Directory of Open Access Journals (Sweden)

    Clancy Aisling A

    2012-03-01

    Full Text Available Abstract Background Despite a widespread shift to selective non-operative management (SNOM for blunt splenic trauma, there remains uncertainty regarding the role of adjuncts such as interventional radiological techniques, the need for follow-up imaging, and the incidence of long-term complications. We evaluated the success of SNOM (including splenic artery embolization, SAE for the management of blunt splenic injuries in severely injured patients. Methods Retrospective review (1996-2007 of the Alberta Trauma Registry and health records for blunt splenic trauma patients, aged 18 and older, with injury severity scores of 12 or greater, admitted to the Foothills Medical Centre. Results Among 538 eligible patients, 150 (26% underwent early operative intervention. The proportion of patients managed by SNOM rose from 50 to 78% over the study period, with an overall success rate of SNOM of 87%, while injury acuity remained unchanged over time. Among SNOM failures, 65% underwent surgery within 24 hours of admission. Splenic arterial embolization (SAE was used in only 7% of patients managed non-operatively, although at least 21% of failed SNOM had contrast extravasation potentially amenable to SAE. Among Calgary residents undergoing SNOM, hospital readmission within six months was required in three (2%, all of whom who required emergent intervention (splenectomy 2, SAE 1 and in whom none had post-discharge follow-up imaging. Overall, the use of post-discharge follow-up CT imaging was low following SNOM (10%, and thus no CT images identified occult hemorrhage or pseudoaneurysm. We observed seven cases of delayed splenic rupture in our population which occurred from five days to two months following initial injury. Three of these occurred in the post-discharge period requiring readmission and intervention. Conclusions SNOM was the initial treatment strategy for most patients with blunt splenic trauma with 13% requiring subsequent operative intervention

  19. 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

  20. Scandinavian guidelines for initial management of minor and moderate head trauma in children

    DEFF Research Database (Denmark)

    Astrand, Ramona; Rosenlund, Christina; Undén, Johan

    2015-01-01

    BACKGROUND: The management of minor and moderate head trauma in children differs widely between countries. Presently, there are no existing guidelines for management of these children in Scandinavia. The purpose of this study was to produce new evidence-based guidelines for the initial management....... CONCLUSIONS: We present new evidence and consensus based Scandinavian Neurotrauma Committee guidelines for initial management of minor and moderate head trauma in children. These guidelines should be validated before extensive clinical use and updated within four years due to rapid development of new...

  1. Acute head trauma in children - early application of MRI; Akutes Schaedel-Hirn-Trauma im Kindesalter - fruehzeitiger Einsatz der MRT

    Energy Technology Data Exchange (ETDEWEB)

    Reither, M. [Kinderkrankenhaus Park Schoenfeld, Kassel (Germany). Abt. fuer Bildgebende Diagnostik

    2001-05-01

    The purpose of the study was to evaluate the present diagnostic potential of MRI in early stage head trauma and possibly to replace CT studies in children. FLAIR-techniques consequently applied as 'scout sequences' provided reliable identification of traumatic intra- and extracranial lesions yet during the first measurement in all 24 cases. Follow-up scan confirmed the initial results. The reliability of MRI in acute pediatric head trauma is underlined by the fact that CT scans were no longer necessary within the last three years. Therefore, the imaging algorithm of acute head trauma in children has changed in our institution: medium and high risk patients undergo MRI, in young infants we do US first. HR-CT is reserved for lesions of the visceral cranium. X rays are out. (orig.) [German] Ziel dieser Studie war es, die heutigen technischen Moeglichkeiten der MRT beim akuten Schaedel-Hirn-Trauma (SHT) des Kindes einzusetzen und evtl. ganz auf CTs zu verzichten. Die konsequente Anwendung der FLAIR-Technik als 'Suchsequenz' erlaubte bereits bei der ersten Messung eine sichere Zuordnung intra- und extrakranieller Laesionen in allen 24 Faellen. Kontrolluntersuchungen bestaetigten die Erstbefunde. Die Zuverlaessigkeit der MRT wird auch dadurch unterstrichen, dass wir in den vergangenen 3 Jahren keine CT-Untersuchungen mehr durchfuehrten. Infolgedessen hat sich der Algorithmus bildgebender Verfahren beim SHT des Kindes in unserem Hause geaendert: Bei Patienten mit niedrigem Risiko fuehren wir keine Bildgebung durch. Bei Patienten mit mittlerem und hohem Risiko wird die MRT, bei jungen Saeuglingen zuerst der US eingesetzt. Die HR-CT ist Verletzungen des Gesichtsschaedels vorbehalten. Roentgenaufnahmen fertigen wir nicht mehr an. (orig.)

  2. Preservation of the kidney with delayed diagnosis of traumatic pelvi-ureteric junction disruption secondary to blunt abdominal trauma in children

    Institute of Scientific and Technical Information of China (English)

    LI Ming-lei; LI Ning; SUN Ning; ZHANG Wei-ping; HUANG Cheng-ru; BAI Ji-wu; LIANG Ruo-xin; TIAN Jun; XIE Xiang-hui; SONG Hong-cheng

    2011-01-01

    Background The delayed diagnosis of pelvi-ureteric junction (PUJ) disruption in children following blunt abdominal trauma can result in loss of function of the involved kidney. We examined the potential for kidney preservation and the limits of diagnostic delays. Methods A retrospective review of 17 cases of PUJ disruption at Beijing Children's Hospital from 1993 to 2009 was done with respect to diagnosis, treatment and follow-up. Results The interval from trauma to diagnosis of PUJ disruption was (52±52) days. If one case with nephrectomy was excluded, the interval from trauma to diagnosis was (40±20) days. The average time between injury and first treatment was (49±25) days. Pelvi-ureteric reanastomosis and caliceal ureterostomy were performed separately in 11 and 4patients, respectively. lleal replacement for ureter injuries was finally performed in one patient. Hydronephrosis of the injured kidney was reduced and the function improved in 15 out of 17 patients (88%). Only one patient received nephrectomy and the nephrectomy rate was 5.9%. Conclusion Differential renal function at the PUJ disruption side can be saved and the rate of nephrectomy reduced by appropriate surgery if the time to diagnosis and first treatment is limited to within two months.

  3. Development of skull fracture criterion based on real-world head trauma simulations using finite element head model.

    Science.gov (United States)

    Sahoo, Debasis; Deck, Caroline; Yoganandan, Narayan; Willinger, Rémy

    2016-04-01

    The objective of this study was to enhance an existing finite element (FE) head model with composite modeling and a new constitutive law for the skull. The response of the state-of-the-art FE head model was validated in the time domain using data from 15 temporo-parietal impact experiments, conducted with postmortem human surrogates. The new model predicted skull fractures observed in these tests. Further, 70 well-documented head trauma cases were reconstructed. The 15 experiments and 70 real-world head trauma cases were combined to derive skull fracture injury risk curves. The skull internal energy was found to be the best candidate to predict skull failure based on an in depth statistical analysis of different mechanical parameters (force, skull internal energy), head kinematic-based parameter, the head injury criterion (HIC), and skull fracture correlate (SFC). The proposed tolerance limit for 50% risk of skull fracture was associated with 453mJ of internal energy. Statistical analyses were extended for individual impact locations (frontal, occipital and temporo-parietal) and separate injury risk curves were obtained. The 50% risk of skull fracture for each location: frontal: 481mJ, occipital: 457mJ, temporo-parietal: 456mJ of skull internal energy.

  4. Pediatric minor head trauma: do cranial CT scans change the therapeutic approach?

    Science.gov (United States)

    Andrade, Felipe P; Montoro, Roberto; Oliveira, Renan; Loures, Gabriela; Flessak, Luana; Gross, Roberta; Donnabella, Camille; Puchnick, Andrea; Suzuki, Lisa; Regacini, Rodrigo

    2016-01-01

    OBJECTIVES: 1) To verify clinical signs correlated with appropriate cranial computed tomography scan indications and changes in the therapeutic approach in pediatric minor head trauma scenarios. 2) To estimate the radiation exposure of computed tomography scans with low dose protocols in the context of trauma and the additional associated risk. METHODS: Investigators reviewed the medical records of all children with minor head trauma, which was defined as a Glasgow coma scale ≥13 at the time of admission to the emergency room, who underwent computed tomography scans during the years of 2013 and 2014. A change in the therapeutic approach was defined as a neurosurgical intervention performed within 30 days, hospitalization, >12 hours of observation, or neuro-specialist evaluation. RESULTS: Of the 1006 children evaluated, 101 showed some abnormality on head computed tomography scans, including 49 who were hospitalized, 16 who remained under observation and 36 who were dismissed. No patient underwent neurosurgery. No statistically significant relationship was observed between patient age, time between trauma and admission, or signs/symptoms related to trauma and abnormal imaging results. A statistically significant relationship between abnormal image results and a fall higher than 1.0 meter was observed (p=0.044). The mean effective dose was 2.0 mSv (0.1 to 6.8 mSv), corresponding to an estimated additional cancer risk of 0.05%. CONCLUSION: A computed tomography scan after minor head injury in pediatric patients did not show clinically relevant abnormalities that could lead to neurosurgical indications. Patients who fell more than 1.0 m were more likely to have changes in imaging tests, although these changes did not require neurosurgical intervention; therefore, the use of computed tomography scans may be questioned in this group. The results support the trend of more careful indications for cranial computed tomography scans for children with minor head trauma.

  5. Early seizures and cerebral oedema after trivial head trauma associated with the CACNA1A S218L mutation

    NARCIS (Netherlands)

    Stam, A. H.; Luijckx, G-J; Poll-The, B. T.; Ginjaar, I. B.; Frants, R. R.; Haan, J.; Ferrari, M. D.; Terwindt, G. M.; van den Maagdenberg, A. M. J. M.

    2009-01-01

    Objective: To study the clinical spectrum of CACNA1A S218L mutation carriers with special attention to "early seizures and cerebral oedema after trivial head trauma (ESCEATHT)", a combination of symptoms which resembles the "juvenile head trauma syndrome". Patients and methods: In two patients with

  6. Early seizures and cerebral oedema after trivial head trauma associated with the CACNA1A S218L mutation

    NARCIS (Netherlands)

    A.H. Stam; G.J. Luijckx; B.T. Poll-Thé; I.B. Ginjaar; R.R. Frants; J. Haan; M.D. Ferrari; G.M. Terwindt; A.M.J.M. van den Maagdenberg

    2009-01-01

    OBJECTIVE: To study the clinical spectrum of CACNA1A S218L mutation carriers with special attention to "early seizures and cerebral oedema after trivial head trauma (ESCEATHT)", a combination of symptoms which resembles the "juvenile head trauma syndrome". PATIENTS AND METHODS: In two patients with

  7. Penetrating nontorso trauma: the head and the neck.

    Science.gov (United States)

    Ball, Chad G

    2015-08-01

    Acute penetrating injuries to the head and neck cause considerable anxiety for most clinicians owing to concern for airway control and neurologic injury and to limited clinician experience in most centres. This article discusses an organized approach to the evaluation and initial treatment of penetrating injuries to the head and neck based on regional anatomy and clinical examination. The approach is particularly helpful in the context of ongoing hemorrhage and/or airway compromise.

  8. Derivation and validation of two decision instruments for selective chest CT in blunt trauma: a multicenter prospective observational study (NEXUS Chest CT.

    Directory of Open Access Journals (Sweden)

    Robert M Rodriguez

    2015-10-01

    Full Text Available Unnecessary diagnostic imaging leads to higher costs, longer emergency department stays, and increased patient exposure to ionizing radiation. We sought to prospectively derive and validate two decision instruments (DIs for selective chest computed tomography (CT in adult blunt trauma patients.From September 2011 to May 2014, we prospectively enrolled blunt trauma patients over 14 y of age presenting to eight US, urban level 1 trauma centers in this observational study. During the derivation phase, physicians recorded the presence or absence of 14 clinical criteria before viewing chest imaging results. We determined injury outcomes by CT radiology readings and categorized injuries as major or minor according to an expert-panel-derived clinical classification scheme. We then employed recursive partitioning to derive two DIs: Chest CT-All maximized sensitivity for all injuries, and Chest CT-Major maximized sensitivity for only major thoracic injuries (while increasing specificity. In the validation phase, we employed similar methodology to prospectively test the performance of both DIs. We enrolled 11,477 patients-6,002 patients in the derivation phase and 5,475 patients in the validation phase. The derived Chest CT-All DI consisted of (1 abnormal chest X-ray, (2 rapid deceleration mechanism, (3 distracting injury, (4 chest wall tenderness, (5 sternal tenderness, (6 thoracic spine tenderness, and (7 scapular tenderness. The Chest CT-Major DI had the same criteria without rapid deceleration mechanism. In the validation phase, Chest CT-All had a sensitivity of 99.2% (95% CI 95.4%-100%, a specificity of 20.8% (95% CI 19.2%-22.4%, and a negative predictive value (NPV of 99.8% (95% CI 98.9%-100% for major injury, and a sensitivity of 95.4% (95% CI 93.6%-96.9%, a specificity of 25.5% (95% CI 23.5%-27.5%, and a NPV of 93.9% (95% CI 91.5%-95.8% for either major or minor injury. Chest CT-Major had a sensitivity of 99.2% (95% CI 95.4%-100%, a specificity of

  9. Ruptura isolada da pelve renal secundária ao trauma abdominal contuso Isolated disruption of the renal pelvis by blunt trauma

    Directory of Open Access Journals (Sweden)

    Sizenando Vieira Starling

    2007-06-01

    Full Text Available Blunt rupture of the renal pelvis is a exceedingly rare injury. Hematuria is absent in one-third of cases. Such injuries are usually caused by desacceleration forces. Despite improved imaging techniques, diagnosis of this injuries is frequently delayed. Diagnosis is suggested by the presence of massive medial extravasation of contrast material at excretory urography or computed tomography. Surgical treatment consists in pyeloplasty or pyeloraphy with stent placement (double J or nephrostomy.

  10. Two siblings with progressive, fluctuating hearing loss after head trauma, treated with cochlear implantation.

    NARCIS (Netherlands)

    Wolf, M.J.F. de; Honings, J.; Joosten, F.B.M.; Hoefsloot, L.H.; Mylanus, E.A.M.; Cremers, C.W.R.J.

    2010-01-01

    OBJECTIVE: Description of two siblings with unexplained, progressive, perceptive hearing loss after head trauma. DESIGN: Case report. SUBJECTS: Two siblings aged six and eight years old with bilateral, intermittent but progressive hearing loss. RESULTS: These patients had a c.1172G>A (p.Ser391Asn

  11. Abusive Head Trauma at a Tertiary Care Children's Hospital in Mexico City. A Preliminary Study

    Science.gov (United States)

    Diaz-Olavarrieta, Claudia; Garcia-Pina, Corina A.; Loredo-Abdala, Arturo; Paz, Francisco; Garcia, Sandra G.; Schilmann, Astrid

    2011-01-01

    Objectives: Determine the prevalence, clinical signs and symptoms, and demographic and family characteristics of children attending a tertiary care hospital in Mexico City, Mexico, to illustrate the characteristics of abusive head trauma among this population. Methods: This is a cross-sectional descriptive study of infants and children under 5,…

  12. Perpetrator Accounts in Infant Abusive Head Trauma Brought about by a Shaking Event

    Science.gov (United States)

    Biron, Dean; Shelton, Doug

    2005-01-01

    Objective: To analyze perpetrator and medical evidence collected during investigations of infant abusive head trauma (IAHT), with a view to (a) identifying cases where injuries were induced by shaking in the absence of any impact and (b) documenting the response of infant victims to a violent shaking event. Method: A retrospective study was…

  13. Effects of Feedback and Self-Monitoring on Head Trauma Youths' Conversation Skills.

    Science.gov (United States)

    Gajar, Anna; And Others

    1984-01-01

    The effects of feedback and self-recording on the small group conversational behaviors of two head trauma youths were evaluated. Leisures demonstrated efficacy of both interventions. Performance gains generalized to less structured situations, bringing the clients' level of positive responses into a range established with a social comparison…

  14. Comparison of intracranial computed tomographic (CT) findings in pediatric abusive and accidental head trauma

    International Nuclear Information System (INIS)

    Background. Child abuse specialists rely heavily on diagnostic neuroimaging. Objectives. Study objectives were: (1) to compare the frequencies of six specific intracranial CT abnormalities in accidental and non-accidental pediatric head trauma, and (2) to assess interobserver agreement regarding these CT findings. Materials and methods. Three pediatric radiologists blindly and independently reviewed cranial CT scans of pediatric patients who sustained closed head trauma between 1991 and 1994. All patients were less than 4 years of age. Study cases included thirty-nine (50 %) with non-accidental head trauma and thirty-nine (50 %) with accidental head trauma. Each scan was evaluated for the presence or absence of the following six intracranial findings: (1) interhemispheric falx hemorrhage, (2) subdural hemorrhage, (3) large (non-acute) extra-axial fluid, (4) basal ganglia edema, (5) posterior fossa hemorrhage, and (6) frontal-parietal shearing tear(s). Interobserver agreement was calculated as the percentage of total cases in which all reviewers agreed a specific CT finding was present or absent. Diagnosis required independent agreement by all three pediatric radiologists. The frequencies of these six intracranial CT abnormalities were compared between the two study groups by Chi-square analysis and Fisher's exact test. Results. Interobserver agreement between radiologists was greater than 80 % for all lesions evaluated, with the exception of frontal-parietal shearing tear(s). Interhemispheric falx hemorrhage, subdural hemorrhage, large (non-acute) extra-axial fluid, and basal ganglia edema were discovered significantly more frequently in non-accidental trauma (P ≤.05). Conclusion. Although not specific for child abuse, discovery of these intracranial CT abnormalities in young patients should prompt careful evaluation of family and injury circumstances for indicators of non-accidental trauma. (orig.). With 6 figs., 2 tabs

  15. Effects of Copper, Zinc, and Vitamin Complex (Cernevit®) on Hepatic Healing in Rats Experimentally Subjected to Blunt Hepatic Trauma.

    Science.gov (United States)

    Ayten, Refik; Aygen, Erhan; Cerrahoglu, Yusuf Ziya; Camci, Cemalettin; Ilhan, Yavuz Selim; Girgin, Mustafa; Ilhan, Necip; Ozercan, Ibrahim Hanefi

    2015-12-01

    Solid organ injuries following blunt trauma are frequently encountered. The use of non-operative approach is gradually increasing. Thus, research on the methods that could enhance healing in solid organ injuries is in progress. Agents known to have antioxidant property were used after an experimentally induced blunt hepatic trauma. Thirty-two Wistar albino rats weighing 200 g were dropped from a height of 40 cm on to the right upper abdominal quadrant to produce a grade II-III hepatic injury. Rats were divided into control, Zn-administered, Cu-administered, and vitamin complex-administered groups, with eight rats in each. Aminotransferase (AST), alanine aminotransferase (ALT), and lactate dehydrogenase (LDH) levels were measured in the blood samples. The percentage of cells displaying Ki-67 nuclear staining was estimated. The sections were stained with hematoxylin and eosin and the degree of inflammation in the samples was semi-quantitatively assessed. Treatment with zinc, copper, and Cernevit® caused varying levels of decrease in AST, ALT, and LDH levels compared to the control group. Ki-67 positivity was significantly lower in group I compared with groups II and III (p = 0.002). Ki-67 positivity was significantly higher in group II compared to the other groups (p < 0.05). A marked improvement was observed in inflammation in group II. Copper and zinc treatment decreased inflammation as well as blood levels of AST and ALT, and enhanced the healing of traumatized hepatic tissue. However, Cernevit® reduced only the degree of inflammation. PMID:27011508

  16. 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.)

  17. Computed Tomographic Angiography (CTA) in Vascular Trauma

    OpenAIRE

    M. Tehrai

    2007-01-01

    In the evaluation of trauma patients, computed tomo-graphy and CT angiography (CTA) are powerful non-invasive tools that provide a large amount of informa-tion in so little time that they have virtually replaced plain film radiography and catheter angiography. In our hospital, CTA has replaced catheter angiogra-phy for diagnosing most vascular injuries, resulting from penetrating and blunt trauma to head, neck, thorax, abdomen and extremities. This lecture will cover current imaging protocols...

  18. Prudent care of head trauma in the elderly: a case report

    OpenAIRE

    Ross, Allen GP

    2014-01-01

    Introduction Severe traumatic brain injury is a major public health problem that accounts for one-third of all deaths due to trauma in the United States. This case report illustrates some of the challenges faced by the elderly in accessing essential emergency services for traumatic brain injury. Case presentation A 74-year-old Caucasian man presented with head trauma at his local acute care hospital (level III/IV) in Canada at 2:30 PM. He was triaged at 4:00 PM and was seen by the emergency r...

  19. Is a black eye a useful sign of facial fractures in patients with minor head injuries? A retrospective analysis in a level I trauma centre over 10 years.

    Science.gov (United States)

    Büttner, Michael; Schlittler, Fabian Lukas; Michel, Chantal; Exadaktylos, Aris Konstantinos; Iizuka, Tateyuki

    2014-07-01

    Orbital blunt trauma is common, and the diagnosis of a fracture should be made by computed tomographic (CT) scan. However, this will expose patients to ionising radiation. Our objective was to identify clinical predictors of orbital fracture, in particular the presence of a black eye, to minimise unnecessary exposure to radiation. A 10-year retrospective study was made of the medical records of all patients with minor head trauma who presented with one or two black eyes to our emergency department between May 2000 and April 2010. Each of the patients had a CT scan, was over 16 years old, and had a Glasgow Coma Score (GCS) of 13-15. The primary outcome was whether the black eye was a valuable predictor of a fracture. Accompanying clinical signs were considered as a secondary outcome. A total of 1676 patients (mean (SD) age 51 (22) years) and minor head trauma with either one or two black eyes were included. In 1144 the CT scan showed a fracture of the maxillofacial skeleton, which gave an incidence of 68.3% in whom a black eye was the obvious symptom. Specificity for facial fractures was particularly high for other clinical signs, such as diminished skin sensation (specificity 96.4%), diplopia or occulomotility disorders (89.3%), fracture steps (99.8%), epistaxis (95.5%), subconjunctival haemorrhage (90.4%), and emphysema (99.6%). Sensitivity for the same signs ranged from 10.8% to 22.2%. The most striking fact was that 68.3% of all patients with a black eye had an underlying fracture. We therefore conclude that a CT scan should be recommended for every patient with minor head injury who presents with a black eye.

  20. Multiplanar reconstructed CT images increased depiction of intracranial hemorrhages in pediatric head trauma

    Energy Technology Data Exchange (ETDEWEB)

    Langford, Stacey; Panigrahy, Ashok; Narayanan, Srikala; Hwang, Misun; Fitz, Charles; Flom, Lynda; Lee, Vincent Kyu; Zuccoli, Giulio [Children' s Hospital of Pittsburgh of UPMC, Department of Radiology, Section of Neuroradiology, Pittsburgh, PA (United States)

    2015-12-15

    The benefits of multiplanar reconstructed images (MPR) of unenhanced axial head computed tomography (CT) data have not been established in trauma patients younger than 3 years old, a population in which a reliable history and physical examination may be most difficult. We retrospectively evaluated unenhanced head CTs in pediatric trauma patients to investigate the various benefits of MPR in this age group. A total of 221 unenhanced head CTs performed for any case of head trauma (HT) on children younger than 3 years old were independently reviewed by two radiologists. Studies were reviewed first in the standard axial plane alone and then with the addition of MPR. Reviewers were asked to determine if the MPR affected the ability to make findings of hemorrhage, incidental findings, and artifacts. MPR improved the detection of hemorrhage in 14 cases (6.5 %, p-value < 0.01) and incidental findings in five cases (2.3 %, p-value < 0.05) as well as helped prove artifacts in five cases (2.3 %, p-value < 0.05). Routine use of MPR in HT patients younger than 3 years old has the potential to increase the detection of acute and incidental imaging findings. (orig.)

  1. Diffuse pachymeningeal enhancement on brain MRI: spontaneous intracranial hypotension and head trauma

    International Nuclear Information System (INIS)

    We evaluated the MRI finding of pachymeningeal enhancement in patients with intracranial hypotension and head trauma with particular attention to differential findings and change in follow-up study, and in order to support the knowledge about the pathophysiology of dural enhancement. The findings of enhanced brain MRI of fifteen patients who showed diffuse pachymeningeal enhancement were retrospectively examined. Seven of fifteen patients were finally diagnosed as spontaneous intracranial hypotension (SIH). Eight of fifteen patients had a recent history of head trauma. We analyzed the shape, thickness, continuity and extent of dural enhancement, and the others concerned with positive MR findings. We also analyzed findings suggested displacement of brain parenchyma-displacement of the iter and cerebellar tonsil, and flattening of the anterior aspect of the pons-. Four of seven patients with SIH and four of eight patients with head trauma, underwent follow-up MRI. In the follow-up study, the presence of resolving pachymeningeal enhancement and symptom improvement was investigated. In all cases of SIH, the dura showed diffuse, even 3(1mm thick, global and contiguous enhancement along both cerebral convexities, both tentoria, and the falx. Displacement of the iter was noted in six cases and flattening of the anterior aspect of the pons in five. Displacement of the cerebellar tonsil was noted in one case. Five of seven cases showed small amount of subdural fluid collection. In all cases of head trauma, the dura was enhanced diffusely and asymmetrically, and showed no contiguity. Its distribution was consistent with the locations of traumatic lesions. Displacement of the iter was noted in one case. In four cases of SIH, clinical symptoms had improved, and three showed complete resolution of dural enhancement, in one patient continuously showed partial dural enhancement. Four cases of head trauma showed complete resolution of dural enhancement. Reversible diffuse

  2. Characterization and Comparison of Injuries Caused by Accidental and Non-accidental Blunt Force Trauma in Dogs and Cats.

    Science.gov (United States)

    Intarapanich, Nida P; McCobb, Emily C; Reisman, Robert W; Rozanski, Elizabeth A; Intarapanich, Pichai P

    2016-07-01

    Motor vehicle accidents (MVA) are often difficult to distinguish from non-accidental injury (NAI). This retrospective case-control study compared animals with known MVA trauma against those with known NAI. Medical records of 426 dogs and cats treated after MVA and 50 after NAI were evaluated. Injuries significantly associated with MVA were pelvic fractures, pneumothorax, pulmonary contusion, abrasions, and degloving wounds. Injuries associated with NAI were fractures of the skull, teeth, vertebrae, and ribs, scleral hemorrhage, damage to claws, and evidence of older fractures. Odds ratios are reported for these injuries. MVA rib fractures were found to occur in clusters on one side of the body, with cranial ribs more likely to fracture, while NAI rib fractures were found to occur bilaterally with no cranial-caudal pattern. Establishing evidence-based patterns of injury may help clinicians differentiate causes of trauma and may aid in the documentation and prosecution of animal abuse. PMID:27364279

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

    OpenAIRE

    Bravman Jonathan T; Ipaktchi Kyros; Biffl Walter L; Stahel Philip F

    2008-01-01

    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 th...

  4. Determination of Sensitivity and Specificity of Ultrasonography Compared with CT-Scan in Diagnosis of Free Abdominal Fluid in Patients with Blunt Abdominal Trauma Admitted to Zahedan Khatam-al-anbia H

    Directory of Open Access Journals (Sweden)

    Mohammad Ghasemi Rad

    2010-05-01

    Full Text Available Background/Objective: Nowadays, trauma is the fourth cause of mortality and morbidity in developed countries. Intraabdominal hemorrhage due to blunt abdominal trauma is the major cause of these mortalities. Therefore, every action taken for quick diagnosis of intraabdominal hemorrhage could save the lives of patients more effectively."nPatients and Methods: This cross-sectional study concerns patients with blunt abdominal trauma admitted to the emergency of Khatam-al-anbia Hospital in a one-year period from 1385. Information from ultrasonography and CT scan were registered in a questionnaire and analyzed by statistical software SPSS 14. We used sensitivity, specifity, positive predictive value, negative predictive value and accuracy as statistical tools for comparison."nResuIts: Of the 100 patients surveyed, 20% were female and 80% were male. The most common clinical symptoms in both groups were abdominal pain and then abdominal tenderness. There was significant statistical difference between clinical symptoms from the point view of existing free abdominal fluid and CT-scan report (P =0.017. The sensitivity, specificity, negative predictive value and positive predictive value of ultrasonography in the diagnosis of free abdominal fluid were respectively, 84%, 86%, 91% and 75%, which were respectively, 54%, 90%, 65% and 79% in the diagnosis of intra abdominal damage. "nConclusion: Ultrasonography has sensitivity, specificity and enough accuracy to detect free abdominal fluid in blunt abdominal trauma in comparison with CT-scan in the children's and adult's age group which if combined with abdominal viscera parenchymal abnormalities, these parameters would sensitively increase in the children's age group."nKeywords: CT Scan, Ultrasonography, Abdominal Blunt Trauma, Sensitivity, Specificity

  5. Value of ultrasound in the evaluation of blunt abdominal trauma;O valor da ultra-sonografia na avaliacao do traumatismo abdominal fechado

    Energy Technology Data Exchange (ETDEWEB)

    Jayanthi, Shri Krishna

    2008-07-01

    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

  6. The efficacy of sequential compression devices in multiple trauma patients with severe head injury.

    Science.gov (United States)

    Gersin, K; Grindlinger, G A; Lee, V; Dennis, R C; Wedel, S K; Cachecho, R

    1994-08-01

    Thirty-two multiple trauma patients with severe head injury and a Glasgow Coma Scale (GCS) score of 8 or less were prospectively studied to assess the occurrence of deep venous thrombosis (DVT) and pulmonary embolism (PE). All patients required mechanical ventilation. A sequential compression device (SCD) was used in 14 patients and 18 patients received no prophylaxis for thromboembolism. Bilateral lower extremity technetium venoscans and ventilation/perfusion (V/Q) lung scans were performed within 6 days of admission and every week for 1 month or until the patient developed DVT or PE or was discharged from the SICU. Deep venous thrombosis occurred in two patients (6%) at 16 and 28 days following trauma. Twenty-five patients had normal or low probability V/Q scans. Six had high probability V/Q scans confirmed by pulmonary arteriograms (PAGs) at 12.5 +/- 4 days. Clinical signs of PE were absent in all patients with a positive PAG. There were no differences in age, Injury Severity Score (ISS), GCS Score, APACHE II Score, or Trauma Score between the patients who developed DVT or PE and those who did not. A SCD was used in four of the eight patients with DVT or PE. All but one patient with DVT or PE underwent placement of a vena caval filter. Multiple trauma patients with severe head injury (GCS score < or = 8) are at high risk for thromboembolism. The available means of prevention and diagnosis of DVT or PE in multiple trauma patients with severe head injury are not entirely effective. PMID:8064917

  7. Imaging of head trauma; Bildgebende Diagnostik akuter Schaedel-Hirn-Verletzungen

    Energy Technology Data Exchange (ETDEWEB)

    Wiesmann, M.; Brueckmann, H. [Ludwig-Maximilians-Univ. Muenchen (Germany). Abt. fuer Neuroradiologie

    1998-08-01

    The role of neuroimaging in the acute setting of head trauma is to diagnose the extent of intracranial injury and to identify all lesions which require urgent neurosurgical treatment. Computed tomography (CT) remains the most important victims. Although magnetic resonance imaging (MR) has higher sensitivity to most traumatic lesions than CT, due to the ease and spend of CT, and the fact that sufficent monitoring of critically ill patients during the examination is much easier with CT than with MR, mean that MR is not the imaging modality of choice for the initial diagnostic work-up. Recent MR techniques such as FLAIR or diffusion imaging further improve the sensitivity of MR in head trauma. Conventional angiography is currently indicated only for few suspected vascular lesions (e.g. traumatic arterio-venous fistulas, vascular dissections). (orig.) [Deutsch] In der Akutphase nach einem Schaedel-Hirn-Trauma soll die bildgebende Diagnostik das Ausmass der intrakraniellen Schaedigung zeigen und v.a. die Laesionen sicher erfassen, die eine umgehende kausale Therapie erfordern. Hierzu ist die Computertomographie initial die wichtigste diagnostische Massnahme. Die Magnetresonanztomographie ist der Computertomographie diagnostisch ueberlegen. Aufgrund des hoeheren Zeitbedarfs und der schwierigeren Patientenueberwachung wird sie jedoch nicht primaer in der Akutdiagnostik durchgefuehrt. Neuere Verfahren wie FLAIR oder diffusionsgewichtete Untersuchungstechniken erweitern die diagnostische Aussagefaehigkeit der Magnetresonanztomographie beim Schaedel-Hirn-Trauma. Die digitale Subtraktionsangiographie ist nur noch indiziert bei speziellen Fragestellungen, wie etwa einer Karotis-sinus-cavernosus-Fistel oder einer traumatischen Dissektion der hirnversorgenden Arterien. (orig.)

  8. Abusive head trauma: Differentiation between impact and non-impact cases based on neuroimaging findings and skeletal surveys

    Energy Technology Data Exchange (ETDEWEB)

    Sieswerda-Hoogendoorn, T., E-mail: t.sieswerda@amc.nl [Department of Forensic Medicine, Netherlands Forensic Institute, The Hague (Netherlands); Department of Radiology, Academic Medical Center/Emma Children' s Hospital, Meibergdreef 9, 1105 AZ Amsterdam (Netherlands); Robben, S.G.F., E-mail: s.robben@maastrichtuniversity.nl [Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht (Netherlands); Karst, W.A., E-mail: w.karst@nfi.minvenj.nl [Department of Forensic Medicine, Netherlands Forensic Institute, P.O. Box 24044, 2490 AA The Hague (Netherlands); Moesker, F.M., E-mail: f.moesker@erasmusmc.nl [Faculty of Medicine, Academic Medical Center, Amsterdam (Netherlands); Aalderen, W.M. van, E-mail: w.m.vanaalderen@amc.nl [Department of Paediatrics, Academic Medical Center/Emma Children' s Hospital, Meibergdreef 9, 1105 AZ Amsterdam (Netherlands); Laméris, J.S., E-mail: j.s.lameris@amc.nl [Department of Radiology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam (Netherlands); Rijn, R.R. van, E-mail: r.r.vanrijn@amc.nl [Department of Forensic Medicine, Netherlands Forensic Institute, The Hague (Netherlands); Department of Radiology, Academic Medical Center/Emma Children' s Hospital, Meibergdreef 9, 1105 AZ Amsterdam (Netherlands)

    2014-03-15

    Objectives: To determine whether imaging findings can be used to differentiate between impact and non-impact head trauma in a group of fatal and non-fatal abusive head trauma (AHT) victims. Methods: We included all AHT cases in the Netherlands in the period 2005–2012 for which a forensic report was written for a court of law, and for which imaging was available for reassessment. Neuroradiological and musculoskeletal findings were scored by an experienced paediatric radiologist. Results: We identified 124 AHT cases; data for 104 cases (84%) were available for radiological reassessment. The AHT victims with a skull fracture had fewer hypoxic ischaemic injuries than AHT victims without a skull fracture (p = 0.03), but the relative difference was small (33% vs. 57%). There were no significant differences in neuroradiological and musculoskeletal findings between impact and non-impact head trauma cases if the distinction between impact and non-impact head trauma was based on visible head injuries, as determined by clinical examination, as well as on the presence of skull fractures. Conclusions: Neuroradiological and skeletal findings cannot discriminate between impact and non-impact head trauma in abusive head trauma victims.

  9. MR tomography after head and brain trauma: Comparison with CT, EEG and neurological examination

    Energy Technology Data Exchange (ETDEWEB)

    Dewes, W.; Moskopp, D.; Kurthen, M.; Solymosi, L.; Harder, T.; Kersting, G.

    1989-03-01

    56 patients with head and brain trauma and in coma were studied prospectively by means of MRT, CT, EEG and neurological examination. All patients had initial CT and EEG admission. MRT showed that in our patients morphological return to normal was the exception. Patients with head and brain injuries should be examined by MRT during the course of their illness. The use of special sequences, such as gradient-echo sequences for the diagnosis of haemorrhagic contusions, is indicated. CT should be retained for evaluating bone injury and cerebral damage during the acute stage.

  10. MR tomography after head and brain trauma: Comparison with CT, EEG and neurological examination

    International Nuclear Information System (INIS)

    56 patients with head and brain trauma and in coma were studied prospectively by means of MRT, CT, EEG and neurological examination. All patients had initial CT and EEG admission. MRT showed that in our patients morphological return to normal was the exception. Patients with head and brain injuries should be examined by MRT during the course of their illness. The use of special sequences, such as gradient-echo sequences for the diagnosis of haemorrhagic contusions, is indicated. CT should be retained for evaluating bone injury and cerebral damage during the acute stage. (orig.)

  11. Head injury predictors in sports trauma--a state-of-the-art review.

    Science.gov (United States)

    Fernandes, Fábio A O; de Sousa, Ricardo J Alves

    2015-08-01

    Head injuries occur in a great variety of sports. Many of these have been associated with neurological injuries, affecting the central nervous system. Some examples are motorsports, cycling, skiing, horse riding, mountaineering and most contact sports such as football, ice and field hockey, soccer, lacrosse, etc. The outcome of head impacts in these sports can be very severe. The worst-case scenarios of permanent disability or even death are possibilities. Over recent decades, many In recent decades, a great number of head injury criteria and respective thresholds have been proposed. However, the available information is much dispersed and a consensus has still not been achieved regarding the best injury criteria or even their thresholds. This review paper gives a thorough overview of the work carried out by the scientific community in the field of impact biomechanics about head injuries sustained during sports activity. The main goal is to review the head injury criteria, as well as their thresholds. Several are reviewed, from the predictors based on kinematics to the ones based on human tissue thresholds. In this work, we start to briefly introduce the head injuries and their mechanisms commonly seen as a result of head trauma in sports. Then, we present and summarize the head injury criteria and their respective thresholds. PMID:26238791

  12. Head injury predictors in sports trauma--a state-of-the-art review.

    Science.gov (United States)

    Fernandes, Fábio A O; de Sousa, Ricardo J Alves

    2015-08-01

    Head injuries occur in a great variety of sports. Many of these have been associated with neurological injuries, affecting the central nervous system. Some examples are motorsports, cycling, skiing, horse riding, mountaineering and most contact sports such as football, ice and field hockey, soccer, lacrosse, etc. The outcome of head impacts in these sports can be very severe. The worst-case scenarios of permanent disability or even death are possibilities. Over recent decades, many In recent decades, a great number of head injury criteria and respective thresholds have been proposed. However, the available information is much dispersed and a consensus has still not been achieved regarding the best injury criteria or even their thresholds. This review paper gives a thorough overview of the work carried out by the scientific community in the field of impact biomechanics about head injuries sustained during sports activity. The main goal is to review the head injury criteria, as well as their thresholds. Several are reviewed, from the predictors based on kinematics to the ones based on human tissue thresholds. In this work, we start to briefly introduce the head injuries and their mechanisms commonly seen as a result of head trauma in sports. Then, we present and summarize the head injury criteria and their respective thresholds.

  13. [Cerebral salt wasting syndrome and traumatic vasospasm after head trauma: report of two cases].

    Science.gov (United States)

    Katsuno, Makoto; Kobayashi, Shiro; Yokota, Hiroyuki; Teramoto, Akira

    2009-08-01

    While patients with cerebral salt wasting syndrome and traumatic cerebral arterial spasms have been reported, the underlying pathogenesis of these events remains unclear. We encountered 2 patients with head trauma and cerebral infarction who presented with cerebral salt-wasting syndrome and cerebral arterial spasms. Our findings suggested hypothalamic dysfunction due to venous congestion around the hypothalamus caused cerebral salt wasting syndrome and traumatic cerebral arterial spasms.

  14. Recent advance and current status of management of head trauma in China

    Institute of Scientific and Technical Information of China (English)

    JIANG Ji-yao

    2008-01-01

    @@ It is estimated that more than 1 million Chinese people sustain traumatic brain injury (TBI) annually, nearly 10% of whom are dead and 30% are complicated with physical, cognitive, behavioral and/or psychosocial impairments in China. A lot of experimental researches and clinical trials of head trauma have been made in China recently, which improves the understanding of pathological mechanisms and prognosis of severe traumatic brain injury.

  15. Two siblings with progressive, fluctuating hearing loss after head trauma, treated with cochlear implantation.

    OpenAIRE

    Wolf, M.J.F. de; Honings, J.; Joosten, F. B. M.; Hoefsloot, L.H.; Mylanus, E.A.M.; Cremers, C. W. R. J.

    2010-01-01

    OBJECTIVE: Description of two siblings with unexplained, progressive, perceptive hearing loss after head trauma. DESIGN: Case report. SUBJECTS: Two siblings aged six and eight years old with bilateral, intermittent but progressive hearing loss. RESULTS: These patients had a c.1172G>A (p.Ser391Asn) mutation in the SLC26A4 gene, which has not previously been reported and which caused Pendred or enlarged vestibular aqueduct syndrome. The diagnosis was based on the perceptive hearing loss, com...

  16. Surgical complications secondary to decompressive craniectomy for patients with severe head trauma

    Institute of Scientific and Technical Information of China (English)

    Xiaofeng Yang; Liang Wen

    2016-01-01

    Decompressive craniectomy (DC) is a surgical method for managing highly elevated intracranial increased pressure (ICP) resulted from severe head trauma. This procedure is able to reduce the ICP rapidly and effectively. However, it may lead to kinds of secondary complications, which would cause patient’s severe neurological dysfunction or even death. In this paper, we reviewed the literatures about surgical complications secondary to DC, and tried to bring up suggestions on surgical techniques aiming to prevention and treatment of these complications.

  17. Usefulness of MRI detection of cervical spine and brain injuries in the evaluation of abusive head trauma

    International Nuclear Information System (INIS)

    In the evaluation of children younger than 3 years with intracranial hemorrhage it can be difficult to determine whether the cause of hemorrhage was traumatic, and if so, whether abusive head trauma (AHT) is a possibility. Cervical spine MRI is not a routine part of the nationally recommended imaging workup for children with suspected abusive head trauma. There is increasing evidence that spinal injuries are found at autopsy or MRI in abused children. However the prevalence of cervical spine injuries in children evaluated for abusive head trauma is unknown. We sought to determine both the incidence and the spectrum of cervical spine and brain injuries in children being evaluated for possible abusive head trauma. We also examined the relationship between cervical and brain MRI findings and selected study outcome categories. This study is a 3-year retrospective review of children evaluated for abusive head trauma. Inclusion criteria were: children with head trauma seen at our institution between 2008 and 2010, age younger than 36 months, availability of diagnostic-quality brain and cervical spine MRI, and child abuse team involvement because abusive head trauma was a possibility. A child abuse pediatrician and pediatric radiologists, all with board certification, were involved in data collection, image interpretation and data analysis. Statistical analysis was performed using Stata v12.1. The study included 74 children (43 boys, 31 girls) with a mean age of 164 days (range, 20-679 days). Study outcomes were categorized as: n = 26 children with accidental head trauma, n = 38 with abusive head trauma (n = 18 presumptive AHT, n = 20 suspicious for AHT), and n = 10 with undefined head trauma. We found cervical spine injuries in 27/74 (36%) children. Most cervical spine injuries were ligamentous injuries. One child had intrathecal spinal blood and two had spinal cord edema; all three of these children had ligamentous injury. MRI signs of cervical injury did not show a

  18. Usefulness of MRI detection of cervical spine and brain injuries in the evaluation of abusive head trauma

    Energy Technology Data Exchange (ETDEWEB)

    Kadom, Nadja [Children' s National Medical Center, Department of Diagnostic Imaging and Radiology, Washington, DC (United States); Boston University Medical Center, Boston, MA (United States); Khademian, Zarir; Vezina, Gilbert; Shalaby-Rana, Eglal [Children' s National Medical Center, Department of Diagnostic Imaging and Radiology, Washington, DC (United States); Rice, Amy [Independent Consultant (Biostatistics), Chevy Chase, MD (United States); Hinds, Tanya [Children' s National Medical Center, Child and Adolescent Protection Center, Washington, DC (United States)

    2014-07-15

    In the evaluation of children younger than 3 years with intracranial hemorrhage it can be difficult to determine whether the cause of hemorrhage was traumatic, and if so, whether abusive head trauma (AHT) is a possibility. Cervical spine MRI is not a routine part of the nationally recommended imaging workup for children with suspected abusive head trauma. There is increasing evidence that spinal injuries are found at autopsy or MRI in abused children. However the prevalence of cervical spine injuries in children evaluated for abusive head trauma is unknown. We sought to determine both the incidence and the spectrum of cervical spine and brain injuries in children being evaluated for possible abusive head trauma. We also examined the relationship between cervical and brain MRI findings and selected study outcome categories. This study is a 3-year retrospective review of children evaluated for abusive head trauma. Inclusion criteria were: children with head trauma seen at our institution between 2008 and 2010, age younger than 36 months, availability of diagnostic-quality brain and cervical spine MRI, and child abuse team involvement because abusive head trauma was a possibility. A child abuse pediatrician and pediatric radiologists, all with board certification, were involved in data collection, image interpretation and data analysis. Statistical analysis was performed using Stata v12.1. The study included 74 children (43 boys, 31 girls) with a mean age of 164 days (range, 20-679 days). Study outcomes were categorized as: n = 26 children with accidental head trauma, n = 38 with abusive head trauma (n = 18 presumptive AHT, n = 20 suspicious for AHT), and n = 10 with undefined head trauma. We found cervical spine injuries in 27/74 (36%) children. Most cervical spine injuries were ligamentous injuries. One child had intrathecal spinal blood and two had spinal cord edema; all three of these children had ligamentous injury. MRI signs of cervical injury did not show a

  19. Proximal Versus Distal Splenic Artery Embolisation for Blunt Splenic Trauma: What is the Impact on Splenic Immune Function?

    Energy Technology Data Exchange (ETDEWEB)

    Foley, P. T., E-mail: pfoley@doctors.org.uk [The Canberra Hospital, Department of Medical Imaging (Australia); Kavnoudias, H., E-mail: h.kavnoudias@alfred.org.au [The Alfred Hospital, Radiology Research Unit, Radiology Department (Australia); Cameron, P. U., E-mail: paul.cameron@unimelb.edu.au [The Alfred Hospital, Infectious Diseases Unit (Australia); Czarnecki, C., E-mail: caroline.czarnecki@gmail.com [Royal Melbourne Hospital, Radiology Department (Australia); Paul, E., E-mail: eldho.paul@monash.edu [Monash University, Department of Epidemiology & Preventive Medicine, School of Public Health and Preventive Medicine, Alfred Hospital (Australia); Lyon, S. M., E-mail: lyonsey@optusnet.com.au [Melbourne Endovascular (Australia)

    2015-10-15

    PurposeTo compare the impact of proximal or distal splenic artery embolisation versus that of splenectomy on splenic immune function as measured by IgM memory B cell levels.Materials and MethodsPatients with splenic trauma who were treated by splenic artery embolisation (SAE) were enrolled. After 6 months splenic volume was assessed by CT, and IgM memory B cells in peripheral blood were measured and compared to a local normal reference population and to a post-splenectomy population.ResultsOf the 71 patients who underwent embolisation, 38 underwent proximal embolisation, 11 underwent distal embolisation, 22 patients were excluded, 1 had both proximal and distal embolisation, 5 did not survive and 16 did not return for evaluation. There was a significant difference between splenectomy and proximal or distal embolisation and a trend towards greater preservation of IgM memory B cell number in those with distal embolisation—a difference that could not be attributed to differences in age, grade of injury or residual splenic volume.ConclusionIgM memory B cell levels are significantly higher in those treated with SAE compared to splenectomy. Our data provide evidence that splenic embolisation should reduce immunological complications of spleen trauma and suggest that distal embolisation may maintain better function.

  20. 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.

  1. Proximal Versus Distal Splenic Artery Embolisation for Blunt Splenic Trauma: What is the Impact on Splenic Immune Function?

    International Nuclear Information System (INIS)

    PurposeTo compare the impact of proximal or distal splenic artery embolisation versus that of splenectomy on splenic immune function as measured by IgM memory B cell levels.Materials and MethodsPatients with splenic trauma who were treated by splenic artery embolisation (SAE) were enrolled. After 6 months splenic volume was assessed by CT, and IgM memory B cells in peripheral blood were measured and compared to a local normal reference population and to a post-splenectomy population.ResultsOf the 71 patients who underwent embolisation, 38 underwent proximal embolisation, 11 underwent distal embolisation, 22 patients were excluded, 1 had both proximal and distal embolisation, 5 did not survive and 16 did not return for evaluation. There was a significant difference between splenectomy and proximal or distal embolisation and a trend towards greater preservation of IgM memory B cell number in those with distal embolisation—a difference that could not be attributed to differences in age, grade of injury or residual splenic volume.ConclusionIgM memory B cell levels are significantly higher in those treated with SAE compared to splenectomy. Our data provide evidence that splenic embolisation should reduce immunological complications of spleen trauma and suggest that distal embolisation may maintain better function

  2. Management of Temporal Bone Trauma

    OpenAIRE

    Patel, Alpen; Groppo, Eli

    2010-01-01

    The temporal bones are paired structures located on the lateral aspects of the skull and contribute to the skull base. Trauma is usually the result of blunt head injury and can result in damage to the brain and meninges, the middle and internal ear, and the facial nerve. Complications can include intracranial hemorrhage, cerebral contusion, CSF leak and meningitis, hearing loss, vertigo, and facial paralysis. To prevent these complications, diagnosis followed by appropriate medical and surgic...

  3. Characteristics of associated craniofacial trauma in patients with head injuries: An experience with 100 cases

    Directory of Open Access Journals (Sweden)

    Rajendra Prasad

    2009-01-01

    Full Text Available Background: Facial fractures and concomitant cranial injuries carry the significant potential for mortality and neurological morbidity mainly in young adults. Aims and Objectives: To analyze the characteristics of head injuries and associated facial injuries, the management options and outcome following cranio-facial trauma. Methods: This retrospective review was performed at Justice K. S. Hegde Charitable Hospital, and associated A. B. Shetty Memorial Institute of Dental sciences, Deralakatte, Mangalore. Following Ethical Committee approval, hospital charts and radiographs of 100 consecutive patients of cranio-facial trauma managed at the Department of Oral and Maxillofacial Surgery and Neurosurgery between January 2004 and December 2004 were reviewed. Results: Majority of the patients were in the 2nd to 4th decade (79% with a male to female ratio of -8.09:1. Road traffic accidents were the common cause of craniofacial trauma in present study (54% followed by fall from height (30%. Loss of consciousness was the most common clinical symptom (62% followed by headache (33%. Zygoma was the most commonly fractured facial bone 48.2% (alone 21.2%, in combination 27.2%. Majority of patients had mild head injury and managed conservatively in present series. Causes of surgical intervention for intracranial lesions were compound depressed fracture, contusion and intracranial hematoma. Operative indications for facial fractures were displaced facial bone fractures. Major causes of mortality were associated systemic injuries. Conclusion: Adult males are the most common victims in craniofacial trauma, and road traffic accidents were responsible for the majority. Most of the patients sustained mild head injuries and were managed conservatively. Open reduction and internal fixation with miniplates was used for displaced facial bone fractures.

  4. Early diagnosis of intrahepatic biliary injury by DIC-CT, complicating the non-operative management of blunt liver trauma

    International Nuclear Information System (INIS)

    Of the patients with a blunt liver injury who were admitted to our hospital over a period of 2 years and 5 months, the subjects enrolled in the present study were 15 patients diagnosed with CT as having liver injury, and who underwent drip infusion cholangiography (DIC)-CT intended to diagnose intrahepatic biliary injury (IHBI) in its early stages. These 15 patients included 11 with a type IIIb injury and 4 with a type Ib injury. All of 5 patients with the type IIIb injury who underwent transcatheter arterial embolization (TAE) were found to have some signs of IHBI on DIC-CT. Of these patients, 2 were found to have extrahepatic leakage and underwent local drainage; 1 also underwent ENBD and was discharged. Three patients were not found to have extrahepatic leakage even though they were found to have signs of HIBI; the 3 underwent conservative therapy with no other care and had a satisfactory course. In 6 patients with a type IIIb injury and without TAE, only 1 patient was found to have IHBI, but without extrahepatic leakage. Comparison of two groups, with or without TAE, in type IIIb injury, the former had a higher Injury Severity Score (ISS) and higher incidence of IHBI on DIC-CT. No TAE was needed and no sign of IHBI was found in type Ib injury patients. DIC-CT may, in cases of severe liver injury that might require TAE, help to diagnose IHBI in its early stages. Our strategy, namely performing an early examination and drainage when the extrahepatic biliary leakage is found, seemed to be adequate. (author)

  5. Re-estimation of acute subdural hematoma in children caused by trivial household head trauma

    International Nuclear Information System (INIS)

    The objective of this study was to identify characteristics of acute subdural hematoma in children caused by a trivial household head trauma from a modem neurosurgical and medicolegal standpoint. We performed a retrospective study of 25 children younger than 48 months hospitalized for acute subdural hematoma from December 1, 1993, through February 28, 2003. Inclusion criteria were as follows: acute subdural hematoma caused by trivial household trauma and a history of trauma corroborated by a caretaker, absence of physical injuries consistent with child abuse, fundoscopic examinations performed by a pediatric ophthalmologist, absence of fractures on general bone survey, and child abuse ruled out by long-term follow-up (more than 5 years). Twenty-one of the patients were boys, and 4 were girls. The patients ranged in age from 6 to 17 months, with an average age of 8.5 months. In 17 of 25 patients trauma had been caused by falls to the floor while standing with support or while sitting. Most of the patients were admitted to the hospital because of generalized convulsions or seizures that had developed soon after a trivial household trauma. Fifteen of the 25 (60%) patients had retinal or preretinal hemorrhage and 9 patients had bilateral retinal hemorrhage. Computed tomography showed fluid-type acute subdural hematomas at the frontal convexity or in the interhemispheric fissure in 18 of 25 (72%) patients. Fourteen of 25 (56%) patients had pre-existing external hydrocephalus (enlargements of the subarachnoid space). The long-term outcomes included normal mental development (IQ≥80) in 18 cases, mild mental retardation (IQ<80) in 7 cases, and epilepsy in 3 cases. Acute subdural hematoma in children caused by trivial household trauma is a clinical entity distinct from acute subdural hematoma caused by child abuse or shaken-baby syndrome. (author)

  6. Clinical value of MSCT in blunt renal trauma%MSCT在钝性肾创伤中的临床应用价值

    Institute of Scientific and Technical Information of China (English)

    文峰; 赵振国; 顾强; 唐小彬

    2013-01-01

    目的 探讨多层螺旋CT(multislice spiral computed tomography,MSCT)在钝性肾创伤( blunt renal trauma,BRT)的临床价值.方法 回顾分析56例经临床手术病理证实的BRT患者资料,所有患者均行MSCT平扫及增强检查,分别就平扫、增强、增强联合后处理等3种方法对是否肾脏创伤进行双盲读片,并按美国创伤外科协会(AAST)肾创伤分级标准进行分级阅片.3种方法对损伤的检出率运用行乘列表的Pearson χ2检验.MSCT平扫和增强对肾损伤的AAST分级,运用Fisher确切概率法χ2检验.结果 本组MSCT征象对BRT的阳性影像表现的检出率为51.8%(29/56).3种方法对BRT的阳性影像检出率无显著性差异(P=0.095).MSCT平扫与增强在BRT属Ⅳ级,卡方检验显示有显著性差异(P=0.040),其他级别的BRT 2种检查方法之间无显著性差异(P>0.05).结论 MSCT能对钝性肾创伤损伤做出准确诊断,增强扫描能提高BRT的AAST分级的准确性,对临床治疗方案的选择有重要价值.%Objective To investigate the clinical value of multi-slice spiral computed tomography (MSCT) in the blunt renal trauma (BRT). Methods 56 kidneys with clinical proved BRT were retrospectively analyzed. All patients were underwent plain and enhanced MSCT scan in whole abdomen. Two experienced radiologists blinded to the clinical diagnosis, reached a consensus diagnosis from the MSCT findings by three ways of plain , enhanced and enhance connected the post-processing MSCT images. The detection rate of BRT was compared with others by using Pearson chi-square test. The grade of BRT according to the American Association for the Surgery of Trauma (AAST) renal injury scale was judged by radiologists. The BRT AAST grade with plain and enhanced MSCT was analyzed by Fisher probabilities chi-square test. Results The diagnostic detection rate of BRT with MSCT was 51. 8% (29/56) in our study. The detection rate of BRT by three ways was no significant (P = 0. 095). The chi

  7. Acute Subdural Hematoma in Infants with Abusive Head Trauma: A Literature Review.

    Science.gov (United States)

    Karibe, Hiroshi; Kameyama, Motonobu; Hayashi, Toshiaki; Narisawa, Ayumi; Tominaga, Teiji

    2016-05-15

    The number of cases with child abuse is increasing in Japan, and abusive head trauma (AHT) is a major cause of death in abused children. Child abuse has been recognized by the late 19th century, and widely accepted as battered child syndrome in the middle of the 20th century. As terms, there had been considerable mechanistic controversies between shaken-baby and -impact syndrome until the beginning of the 21st century. In recent years, AHT has been utilized as a less mechanistic term. Most of the characteristics of AHT in Japan have been similar to those in the United States as follows: infant is the most common victim, acute subdural hematoma (SDH) is the most common intracranial lesion, and retinal hemorrhage is often complicated. On the other hand, several characteristics have been different as follows: mother is the most common perpetrators, impact is a more common mechanism of trauma than shaking, and external trauma is more common reflecting the existence of impact. Since AHT as well as child abuse is a social pathological phenomenon influenced by victims, perpetrators, socioeconomic circumstances, and so on, various aspects of AHT as well as child abuse can be changed with times. Actually, a recent paper suggests such changes in infants with acute SDH due to AHT. In this review article, AHT, abusive infantile acute SDH in particular, are reviewed from the aspect of neurosurgical perspectives, including its mechanisms of trauma, biomechanics, clinical features, management, and prognosis, to update the trend in Japan. PMID:26960448

  8. The Role of Prothrombotic Factors in the Ocular Manifestations of Abusive and Non-Abusive Head Trauma: A Feasibility Study

    Science.gov (United States)

    Yu, Anna; Stephens, Derek; Feldman, Brian M.; Parkin, Patricia C.; Kahr, Walter H. A.; Brandao, Leonardo R.; Shouldice, Michelle; Levin, Alex V.

    2012-01-01

    Objectives: Retinal hemorrhage is a cardinal manifestation of abusive head injury. Thrombophilia is relatively common in the general population and in adults can be associated with retinal hemorrhage. The specificity of retinal hemorrhage for abusive head trauma in the presence of prothrombotic factors, in particular following non-abusive head…

  9. Severe lung contusion and death after high-velocity behind-armor blunt trauma: relation to protection level.

    Science.gov (United States)

    Gryth, Dan; Rocksén, David; Persson, Jonas K E; Arborelius, Ulf P; Drobin, Dan; Bursell, Jenny; Olsson, Lars-Gunnar; Kjellström, Thomas B

    2007-10-01

    The most-used safety recommendation for protective vests is that the impact should not cause more than a 44-mm impression in plasticine. The aim of this study was to investigate whether this criterion was sufficient if the vest was exposed to a high-velocity projectile. We tested the hypothesis with pigs divided into a 40-mm group (n = 10) and a 34-mm group (n = 8) protected by a vest allowing a 40-mm or 34-mm impression in plasticine, respectively. Five (50%) of 10 animals in the 40-mm group and 2 (25%) of 8 in the 34-mm group died due to the trauma. We observed severe lung hematoma, impaired circulation, desaturation, and electroencephalogram changes. These effects were more aggravated in the 40-mm group compared to the 34-mm group. Based on our results, the overall judgment is that the safety criterion of 44-mm impression is insufficient when a vest is exposed to a high-velocity projectile. PMID:17985777

  10. Correlation of CT Scan Findings with the Level of Consciousness in Acute Head Trauma

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    A. R. Moghaddas

    2005-06-01

    Full Text Available Background/ Objective: The purpose of this study was to determine CT scan findings in acute craniocerebral trauma and the relation between these findings and the level of consciousness. Patients and Methods: In this retrospective study, 800 pati ents with acute (less than 24 hours craniocerebral trauma were studied over a period of three years. The patients’ level of consciousness (GCS were determined and a brain CT scan without contrast agent was performed. A third generation General Electrics ( GE CT scanner was utilized and 10-mm and 5-mm sections were obtained for the supratento rial and infratentorial parts, respectively. Results: From 800 patients studied, 641 (80.1% were males and 159 (19.9% were females. The peak age was 25 and the mean age was 26.80 ±18.30. The most common mechanism of head trauma was motor vehicle accidents (60.1%.80. M ild head injury was seen in 75% of patients,while 14% and 5.25% had moderate and severe head injuries, respectively. In 14.1%, the CT scan was normal. The most common lesions were as follows: epidural hematoma (EDH 27.1%, subdural hematoma (SDH 13.3%, subarachnoid hemorrhage (SAH 11.4%, contusion 32.9% and pneumocephalus 12.1%. Intracranial hemorrhage, IVH and subdural hygroma were seen in less than 10 percent of patients. The presence of mixed lesions and midline shift regardless of the background lesions were related to statistically significant decreases in GCS. Conclusion: As one of the leading causes of mortality in Iran, craniocerebral trauma needs more considration, This is true especially for road accidents, which are the main cause of multiple traumas. In lower levels of consciousness, one should consider more complicated lesions and probable surgical inter vention. The presence of mixed lesions and midline shift regardless of the underlying le sion on CT scan were accompan ied by lower GCS, which may be due to major energy transmission and diff use brain tissue damage and compression of the

  11. Criteria for applying imaging diagnosis and initial management for pediatric head trauma

    International Nuclear Information System (INIS)

    It may be difficult to perform CT for pediatric head trauma because of body movement and radiation exposure. Imaging application criteria were established, in which patients diagnosed as less likely to have an intracranial lesion meeting the criteria were not indicated for imaging and subjected to course observation at home, and this policy was explained to the parents. When consent was obtained, patients were followed up at home, and we checked on the condition by making a phone call 4-8 hours after injury. The patients were 103 infants aged 15 years or younger brought to the emergency medical care center of our hospital between May and August 2008. Imaging was basically indicated for cases of traffic accidents, falls from a high level, those brought in by ambulance, referred cases, and cases with disturbance of consciousness, neurologically abnormal findings, vomiting on examination, and trauma requiring X-ray examination in addition to that for the head. However, apart from these cases, imaging was not required. Imaging was not necessary for 94% of infant cases. The parents were convinced by the explanation and selected course observation at home in 94% of cases for which imaging was judged as unnecessary. None of the patients required re-examination based on the conditions reported in phone calls to homes. Imaging diagnosis for pediatric head trauma is not always necessary, and its application should be decided on after consultation. When no imaging is performed, this should be fully explained at the initial treatment before selecting course observation at home. Checking on the child's condition by making a phone call several hours after injury is useful for both patients and physicians. (author)

  12. Comparing the Antiemetic Effects of Ondansetron and Metoclopramide in Patients with Minor Head Trauma

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    Majid Zamani

    2014-09-01

    Full Text Available Introduction: Nausea and vomiting are the most common complications after minor head trauma that increases the risk of intracranial pressure rising. Therefore, the present study was aimed to compare the antiemetic effects of metoclopramide and ondansetron in the treatment of post-traumatic nausea and vomiting. Methods: The study was a controlled, randomized, double blind clinical trial, which was conducted in the first 6 months of 2014 in emergency department Al-Zahra and Kashani Hospitals in Isfahan, Iran. The patients with minor head trauma associated with nausea and vomiting were randomly divided into 2 groups: treatment with metoclopramide (10mg/2ml, slow injection and treatment with ondansetron (4mg/2ml, slow injection. The comparison between the 2 groups was done regarding antiemetic efficacy and side effects using SPSS 21 statistical software. Results: 120 patients with minor head trauma were distributed and studied into two groups of 60 patients (mean age 35.6±14.1 years; 50.0% male. Administration of both ondansetron and metoclopramide significantly reduced the severity of nausea (P<0.001. Changes in the severity of nausea in both groups before and after the treatment revealed that nausea had been decreased significantly in both groups (P < 0.001. The incidence of fatigue (p=0.44, headache (p=0.58 and dystonia (p=0.06 had no significant difference in the two groups but the incidence of drowsiness and anxiety in the metoclopramide group was significantly higher (P < 0.001. Conclusion: The present study indicated that the treatment effectiveness of ondansetron and metoclopramide are similar. However, incidence of drowsiness and anxiety in the metoclopramide was considerably higher. Since these complications can have adverse effects on the treatment of patients with brain injury, it is suggested that it may be better to use ondansetron in these patients.

  13. Chronic Traumatic Encephalopathy: A Potential Late Effect of Sport-Related Concussive and Subconcussive Head Trauma1

    OpenAIRE

    Gavett, Brandon E; Stern, Robert A; McKee, Ann C.

    2011-01-01

    Chronic traumatic encephalopathy (CTE) is a form of neurodegeneration that is believed to result from repeated head injuries. Originally termed dementia pugilistica due to its association with boxing, the neuropathology of CTE was first described by Corsellis in 1973 in a case series of 15 retired boxers. CTE has recently been found to occur following other causes of repeated head trauma, suggesting that any repeated blows to the head, such as those that occur due to American football, hockey...

  14. Acute Subdural Hematoma in Infants with Abusive Head Trauma: A Literature Review

    OpenAIRE

    KARIBE, Hiroshi; KAMEYAMA, Motonobu; Hayashi, Toshiaki; NARISAWA, Ayumi; Tominaga, Teiji

    2016-01-01

    The number of cases with child abuse is increasing in Japan, and abusive head trauma (AHT) is a major cause of death in abused children. Child abuse has been recognized by the late 19th century, and widely accepted as battered child syndrome in the middle of the 20th century. As terms, there had been considerable mechanistic controversies between shaken-baby and -impact syndrome until the beginning of the 21st century. In recent years, AHT has been utilized as a less mechanistic term. Most of...

  15. The evaluation of the role of ultrasonography and ultrasound-guided aspiration as an initial screening test in blunt abdominal trauma

    International Nuclear Information System (INIS)

    The role of ultrasonography (US) as an initial screening test was evaluated in 3000 consecutive cases of blunt abdominal trauma (BAT). Seventy-three were positive for free fluid collection or organ injury. US-guided aspiration was used to rule out the hollow visceral injury in those referred to nonsurgical therapy. Sixty patients underwent laparotomy. These included 53 clinically unstable patients, three stable patients with positive US-guided aspiration for bile or intestinal contents and four who deteriorated upon conservative treatment. The remaining patients with US negative for fluid had some evidence of abdominal injury on clinical examination. Ultrasonoraphy complemented the clinical examination. Both the sensitivity and specificity of US for the detection of free fluid were 100%. The overall sensitivity was 92% in spleen injuries, 88% in liver injuries and 100% in kidney injuries, with positive predictive value of 96%, 100% and 100% and a specificity of 97%, 100% and 100% respectively. Retrospective correlation of US with laparotomy findings regarding free fluid showed that 50-100 mL of free fluid was minimal, 100-500 mL significant. Thirteen patients completed conservative treatment with an uneventful course in hospital. Both the US findings and the clinical condition of the patient should be considered in decision-making in BAT. Unnecessary laparotomies can be avoided when the major bleeding site is not in the abdomen and such patients can be safely observed after excluding the hollow visceral injury by US-guided aspiration. US, being rapid to perform, sensitive and easily repeatable, is quite useful as an initial screening test in BAT patients. (author)

  16. 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.

  17. An optimized computed tomography protocol for metallic gunshot head trauma in a seal model.

    Science.gov (United States)

    Fraga-Manteiga, Eduardo; Shaw, Darren J; Dennison, Sophie; Brownlow, Andrew; Schwarz, Tobias

    2014-01-01

    Computed tomography (CT) is commonly used to assess animals with head trauma. However, strongly attenuating objects such as metallic gunshot cause artifacts that may make accurate localization of shrapnel pieces difficult. The purpose of this study was to develop an optimized CT protocol for minimizing metal artifacts in an animal model of gunshot head trauma. A cadaver head of a stranded Gray seal (Halichoerus grypus) was shot post-mortem with a 0.223-inch caliber rifle. The head was frozen, thawed, and scanned using a multislice CT scanner and protocols with varying acquisition and reconstruction parameters. Scans were acquired with and without use of the scanner's proprietary Extended CT Scale (ECTS) mode and beam hardening reduction (Posterior Fossa Optimization [PFO]) filter. Window/level display settings were also varied. For each protocol and each of five selected metallic shrapnel pieces, a single observer measured combined metal halo artifact and shrapnel area using a hand-traced region of interest. The number of hypo- and hyper-attenuating streak artifacts was also recorded. Measurements were repeated for three different reading sessions. Metal CT artifacts were minimized with a high-frequency image reconstruction algorithm and a wide window setting. Further artifact reduction was achieved with a proprietary ECTS raw data reconstruction technique and a very wide window. This enabled a more confident evaluation of surrounding bone. On the other hand, these techniques are unfortunately not effective under conditions of soft tissue evaluation. Increasing tube voltage and use of a proprietary PFO filter did not yield a significant reduction in metal artifacts. PMID:25184173

  18. Comparative study of earthquake-related and non-earthquake-related head traumas using multidetector computed tomography

    Directory of Open Access Journals (Sweden)

    Zhi-gang Chu

    2011-01-01

    Full Text Available OBJECTIVE: The features of earthquake-related head injuries may be different from those of injuries obtained in daily life because of differences in circumstances. We aim to compare the features of head traumas caused by the Sichuan earthquake with those of other common head traumas using multidetector computed tomography. METHODS: In total, 221 patients with earthquake-related head traumas (the earthquake group and 221 patients with other common head traumas (the non-earthquake group were enrolled in our study, and their computed tomographic findings were compared. We focused the differences between fractures and intracranial injuries and the relationships between extracranial and intracranial injuries. RESULTS: More earthquake-related cases had only extracranial soft tissue injuries (50.7% vs. 26.2%, RR=1.9, and fewer cases had intracranial injuries (17.2% vs. 50.7%, RR = 0.3 compared with the non-earthquake group. For patients with fractures and intracranial injuries, there were fewer cases with craniocerebral injuries in the earthquake group (60.6% vs. 77.9%, RR = 0.8, and the earthquake-injured patients had fewer fractures and intracranial injuries overall (1.5 + 0.9 vs. 2.5 +1.8; 1.3 + 0.5 vs. 2.1 + 1.1. Compared with the non-earthquake group, the incidences of soft tissue injuries and cranial fractures combined with intracranial injuries in the earthquake group were significantly lower (9.8% vs. 43.7%, RR = 0.2; 35.1% vs. 82.2%, RR = 0.4. CONCLUSION: As depicted with computed tomography, the severity of earthquake-related head traumas in survivors was milder, and isolated extracranial injuries were more common in earthquake-related head traumas than in non-earthquake-related injuries, which may have been the result of different injury causes, mechanisms and settings.

  19. Horner's syndrome after blunt cervical and chest trauma: case report Síndrome de Horner após trauma cérvico-torácico fechado: relato de caso

    Directory of Open Access Journals (Sweden)

    Wellingson Silva Paiva

    2007-12-01

    Full Text Available Horner‘s syndrome is the triad of miosis, ptosis, and anhidrosis, resulting from disruption of the sympathetic pathways. This article describes an uncommon case of Horner‘s syndrome in a 22-year-old man after blunt trauma to the neck and chest without carotid artery dissection. The patient was brought to the emergency service after motorcycle fall. Neurologic examination revealed a patient presenting the score 15 at Glasgow Coma Scale. The left eyelid was 1-2 mm lower than the right. Carotid Doppler and angiotomography were undertaken and revealed no abnormalities of the carotid artery. CT disclosed a mediastinal hematoma extending to the left apex, compressing the left sympathetic chain. The understanding of this clinical entity may help the surgeon to make a better differential diagnosis in trauma patients in whom prompt diagnosis is critical to stablish the correct treatment.A síndrome de Horner compreende a tríade de miose, ptose e anidrose, resultado de lesão em algum ponto das vias simpáticas. O referido estudo apresenta um caso da referida síndrome em um jovem de 22 anos vitima de queda de moto, com escoriações no tórax e no pescoço, sem dissecção carotídea. Ao exame neurológico, encontrava-se com 15 pontos na Escala de Coma de Glasgow, com miose à esquerda e ptose palpebral ipsilateral. Realizado Doppler de carótidas e angiotomografia dos vasos cérvico-cranianos não sendo evidenciadas anormalidades. A tomografia de tórax mostrou um hematoma no ápice pulmonar esquerdo, comprimindo a cadeia simpática ipsilateral. O conhecimento desta entidade clínica pode ajudar o cirurgião a fazer um diagnóstico diferencial adequado nos pacientes vítimas de traumas, nos quais o diagnóstico correto e eficaz pode ser fundamental para a definição da conduta a ser tomada.

  20. Cancer-related trauma, stigma and growth: the 'lived' experience of head and neck cancer.

    Science.gov (United States)

    Threader, J; McCormack, L

    2016-01-01

    Head and neck cancer is associated with multiple layers of distress including stigma. Stigma attraction or devalued social identity is twofold: (1) it is a cancer associated with lifestyle risk factors and (2) treatment often results in confronting facial disfigurement. Subjective interpretations from nine head and neck cancer patients were analysed using Interpretative Phenomenological Analysis. An overarching superordinate theme--Distress, Stigma and Psychological Growth--encompassed four subordinate themes. Two themes captured the expressed trauma and terror as a result of diagnosis and treatment, and two the redefining of self despite stigma through meaning making. Distress was interpreted as a catalyst for awakening new life interpretations and combined with social support to facilitate two distinct pathways of growth: (1) psychological growth without support; (2) psychological and relational growth with support. Previously unfelt empathetic understanding and altruism for others with cancer emerged from the impact of stigma on 'self'. Acceptance allowed a new sense of identity that recognised cancer-related traumatic distress as integral to growth for these participants. The present study offers a unique insight into cancer-related trauma and stigma and the potential to redefine a more accepting, empathic and altruistic 'self' for psychological growth. Implications are discussed. PMID:25899673

  1. Chest trauma in children: A local experience

    International Nuclear Information System (INIS)

    Chest trauma in childhood is relatively uncommon in clinical practice andhas been the subject of few reports in literature. This study was undertakento examine our experience in dealing with chest trauma in children. This wasa retrospective study of 74 children who sustained chest trauma and werereferred to King Fahd Hospital in Medina over a two-year period. The age,cause of injury, severity of injury, associated extrathoracic injuries,treatment and outcome were analyzed. The median age of patients was nineyears. Fifty-nine of them (80%) sustained blunt trauma in 62% of thechildren, gun shot wounds were seen in five and stab wounds in 10 children.Head injury was the most common injury associated with thoracic trauma andwas seen in 14 patients (19%) and associated intra-abdominal injuries wereseen in nine patients. Chest x-ray of the blunt trauma patients revealedfractured ribs in 24 children, pneumothorax in six, hemothorax in four,hemoneumothorax in three, and pulmonary contusions in 22 patients. Fifty onepercent of children were managed conservatively, 37% required tubethoracostomy, 8% were mechanically ventilated and 4% underwent thoractomy.The prevalence of chest trauma in children due to road traffic accidents ishigh in Saudi Arabia. Head injury is thought to be the most common associatedextrathoracic injuries, however, most of these patients can be managedconservatively. (author)

  2. Early insulin resistance in severe trauma without head injury as outcome predictor? A prospective, monocentric pilot study

    Directory of Open Access Journals (Sweden)

    Bonizzoli Manuela

    2012-10-01

    Full Text Available Abstract Background Hyperglycemia following major trauma is a well know phenomenon related to stress-induced systemic reaction. Reports on glucose level management in patients with head trauma have been published, but the development of insulin resistance in trauma patients without head injury has not been extensively studied. The aim of this study was therefore to investigate the prognostic role of acute insulin-resistance, assessed by the HOMA model, in patients with severe trauma without head injury. Methods All patients consecutively admitted to the Intensive Care Unit (ICU of a tertiary referral center (Careggi Teaching Hospital, Florence, IT for major trauma without head injury (Jan-Dec 2010 were enrolled. Patients with a previous diagnosis of diabetes mellitus requiring insulin therapy or metabolism alteration were excluded from the analysis. Patients were divided into “insulin resistant” and “non-insulin resistant” based on the Homeostasis Model Assessment index (HOMA IR. Results are expressed as medians. Results Out of 175 trauma patients admitted to the ICU during the study period, a total of 54 patients without head trauma were considered for the study, 37 of whom met the inclusion criteria. In total, 23 patients (62.2% resulted insulin resistant, whereas 14 patients (37.8% were non-insulin resistant. Groups were comparable in demographic, clinical/laboratory characteristics, and severity of injury. Insulin resistant patients had a significantly higher BMI (P=0.0416, C-reactive protein (P=0.0265, and leukocytes count (0.0301, compared to non-insulin resistant patients. Also ICU length of stay was longer in insulin resistant patients (P=0.0381. Conclusions Our data suggest that admission insulin resistance might be used as an early outcome predictor.

  3. MRI findings in acute stage after head trauma and intellectual outcome

    Energy Technology Data Exchange (ETDEWEB)

    Yamazaki, Shingo; Hashimoto, Kunio; Yatsushige, Hiroshi; Kubota, Yoshihiro; Tabata, Hitoshi [Tsuchiura Kyodo General Hospital, Ibaraki (Japan)

    1998-12-01

    Disturbance of mental function, as a sequela of head trauma, occurred not only after severe head injury, but after mild to moderate head injury. Although initial Glasgow Coma Scale (GCS) score and its chronological change have been shown as good predictive indices of functional outcome in severely head injured patients, a useful predictive index has not been established in cases with mild to moderate head injury. In this study, MRI and CT image findings of acute stage in 17 head injured cases with initial GCS score 9 or more were analyzed and compared with intellectual outcome. MRI findings which suggest diffuse axonal injury (DAI findings) were seen in 7 out of 17, focal cerebral contusion of eloquent area in 6, and lesions of medial temporal lobe in 9. Medial temporal lobe lesions (MTL) were demonstrated as hyperintensity area in proton density weighted image (PDWI) within 3 days and in T2 weighted image more than 7 days after injury, and were not seen in CT or T1WI in most cases. All cases with MTL of dominant side failed in returning to pre-injury work or position. Comparison with MRI findings and WAIS-R 3 months after injury showed statistically significant correlation of MTL with impaired IQ, although DAI findings could not have significant correlation with poor functional coutcome. Etiology of MTL might be primary brain damage caused by collision of temporal lobe against basal dura or shearing force, rather than secondary changes following ischemia or deafferentation. These results suggest the importance of MRI examination (PDWI) to disclose post-traumatic changes and to predict intellectual outcome. (author)

  4. Radiographic evaluation of hepatic trauma

    International Nuclear Information System (INIS)

    The incidence of significant abdominal trauma continues to rise and accounts currently for approximately 10 percent of the annual 130,000 trauma-related deaths in the United States. Over 60 percent of patients are from 10 to 40 years of age, with a striking predominance of males. Children are mostly victims of blunt trauma, while some large reviews of liver trauma in adults show a prevalence of penetrating injuries. Injury to the liver is second only to the spleen in incidence of intraperitoneal injuries. Morbidity and mortality from hepatic trauma are related to the mechanism and extent of injury. Penetrating injuries generally have a lower mortality, about 5 percent, especially if they are due to stab wounds or low velocity gunshot wounds. Shotgun and high velocity gunshot wounds may cause massive fragmentation of the liver and are associated with proportionately greater mortality. The mortality from blunt trauma is from 15 to 45 percent in many large series. Death from isolated liver injury is uncommon, but is usually due to uncontrolled hemorrhage. Injury to other abdominal organs is associated in many cases, as are injuries to the head, chest, and limbs. The extraabdominal injuries are frequently more apparent clinically, but may mask potentially life-threatening abdominal visceral injuries

  5. Tratamento das lesões de aorta nos traumatismos torácicos fechados Management of aortic lesions in blunt chest trauma

    Directory of Open Access Journals (Sweden)

    Boulanger Mioto Neto

    2005-09-01

    Full Text Available OBJETIVO: Rever a casuística, etiologia, lesões associadas, tipos de tratamento e evolução das lesões da aorta por trauma torácico fechado. MÉTODOS: Estudo retrospectivo em prontuário dos pacientes atendidos no Pronto-Socorro do Hospital das Clínicas da Universidade de São Paulo e tratados pelo Grupo de Cirurgia Vascular de janeiro de 2001 a junho de 2004. Foram analisados 10 pacientes, todos do sexo masculino, sendo sete com técnica endovascular e três com técnica operatória aberta. RESULTADOS: Quanto à localização, foram observadas oito lesões da aorta descendente junto ao istmo, uma lesão da aorta descendente na transição tóraco-abdominal e uma dissecção traumática da aorta. O intervalo de tempo para o tratamento cirúrgico foi, em média, de 10,62 ± 3,45 horas para os que receberam tratamento endoluminal e 28 ± 32,39 para os operados de forma convencional. Já o período de internação total variou de 9 a 180 dias (média de 23,33 ± 6,66 dias para os tratados com endoprótese e 42,55 ± 52,7 para os operados de forma convencional. Foram utilizadas uma endoprótese Excluder®, uma Apolo® e cinco Talent®. Dos pacientes operados, dois utilizaram bomba átrio femoral. Ocorreram dois óbitos, um entre os operados de forma convencional e um entre os operados com endopróteses. CONCLUSÕES: As lesões da aorta em casos de trauma torácico fechado são pouco freqüentes e geralmente associadas a um grande número de lesões associadas. O diagnóstico precoce e preciso é fundamental para a evolução do paciente. A correção com endopróteses nos pacientes estáveis do ponto de vista hemodinâmico apresenta-se como solução eficaz.OBJECTIVE: To review the population, etiology, associated injuries, types of treatment, and evolution of aortic injuries due to blunt chest trauma. METHODS: Retrospective study of medical charts of patients admitted to the Emergency Department at Hospital das Clínicas of Universidade de S

  6. Hyperbaric oxygen plus naloxone in the treatment of severe head trauma%高压氧、纳络酮治疗重型脑外伤

    Institute of Scientific and Technical Information of China (English)

    张香菊; 王强; 王湘渝; 郑世钢; 谭聪; 晏莉娜; 陈广鑫

    2002-01-01

    Background:Secondary head injury following severe head trauma is a main factor affecting prognosis,treatment for which is an effective measure in improving prognosis.It is indicated that hyperbaric oxygen can facilitate recovery of injured nerve cells.

  7. Radiology of trauma to kidney and lower urinary tract

    International Nuclear Information System (INIS)

    The contents are trauma to kidney, imaging of kidney trauma, management of renal trauma, delayed complications, trauma to the lower urinary tract, trauma to urinary bladder, radiologic diagnosis, ethiology of blunt bladder injury, urethal injury (6 refs.)

  8. Alcohol consumption, helmet use and head trauma in cycling collisions in Germany.

    Science.gov (United States)

    Orsi, Chiara; Ferraro, Ottavia E; Montomoli, Cristina; Otte, Dietmar; Morandi, Anna

    2014-04-01

    Cycling, being easy, inexpensive and healthy, is becoming one of the most popular means of transport. Cyclists, however, are among the most vulnerable road users in traffic collisions. The aims of this study were to establish which cyclist and cycling accident characteristics are associated with alcohol consumption and helmet use in Germany and to identify risk factors related to head trauma sustained in cycling accidents. The source used for the present analysis was the database of the German in-depth accident study (GIDAS). All cyclists who had been involved in a road accident between 2000 and 2010 and submitted to an alcohol test were selected. Logistic regression analyses were carried out to evaluate various aspects: alcohol consumption, helmet use, head trauma, and cyclist/accident characteristics. Female riders were less likely to have consumed alcohol (OR=0.23, 95% CI: 0.08-0.66); cyclists who did not wear a helmet were more likely to have consumed alcohol (OR=2.41, 95% CI: 1.08-5.38); cyclists who were not responsible for the collision were less likely to have consumed alcohol than those who were partially responsible for the accident (OR=0.22, 95% CI: 0.08-0.61). Cyclists involved in collisions with another vehicle, motorised or not, had a lower risk of suffering a head injury compared with those involved in single-vehicle accidents (OR=0.27, 95% CI: 0.12-0.62, and OR=0.08, 95% CI: 0.03-0.22, respectively). The prevention or limiting of alcohol consumption among cyclists and the corresponding testing of cyclists must be improved. Training initiatives on helmet protection should be encouraged. PMID:24448470

  9. Alcohol consumption, helmet use and head trauma in cycling collisions in Germany.

    Science.gov (United States)

    Orsi, Chiara; Ferraro, Ottavia E; Montomoli, Cristina; Otte, Dietmar; Morandi, Anna

    2014-04-01

    Cycling, being easy, inexpensive and healthy, is becoming one of the most popular means of transport. Cyclists, however, are among the most vulnerable road users in traffic collisions. The aims of this study were to establish which cyclist and cycling accident characteristics are associated with alcohol consumption and helmet use in Germany and to identify risk factors related to head trauma sustained in cycling accidents. The source used for the present analysis was the database of the German in-depth accident study (GIDAS). All cyclists who had been involved in a road accident between 2000 and 2010 and submitted to an alcohol test were selected. Logistic regression analyses were carried out to evaluate various aspects: alcohol consumption, helmet use, head trauma, and cyclist/accident characteristics. Female riders were less likely to have consumed alcohol (OR=0.23, 95% CI: 0.08-0.66); cyclists who did not wear a helmet were more likely to have consumed alcohol (OR=2.41, 95% CI: 1.08-5.38); cyclists who were not responsible for the collision were less likely to have consumed alcohol than those who were partially responsible for the accident (OR=0.22, 95% CI: 0.08-0.61). Cyclists involved in collisions with another vehicle, motorised or not, had a lower risk of suffering a head injury compared with those involved in single-vehicle accidents (OR=0.27, 95% CI: 0.12-0.62, and OR=0.08, 95% CI: 0.03-0.22, respectively). The prevention or limiting of alcohol consumption among cyclists and the corresponding testing of cyclists must be improved. Training initiatives on helmet protection should be encouraged.

  10. Role of brain CT scan in the diagnosis of patients with minor head injury in trauma emergency center

    Directory of Open Access Journals (Sweden)

    Ali Mousavi Jafarabad

    2014-07-01

    Full Text Available Currently, a large burden of hospital admissions is related to minor head trauma and its related imaging studies. One of the challenging issues for emergency physicians is brain computed tomography scan. Sensible use of computed tomography studies could minimize unnecessary radiation exposure and resource use. On the other hand, it can result in delayed or missed early treatment of intracranial injury. The aim of this review is to evaluate and summarize the costs and benefits of using diagnostic measurements in minor head trauma with particular focus on computed tomography scan and the advances and limitations of available guidelines. We studied different issues related to the current approach to minor head trauma in emergency departments. Altogether, it seems using brain computed tomography scan in the setting of emergency is a cost-effective method for the selected patients with minor head injury. However, concerning considerable costs of caring for patients with head injury and high sensitivity of brain computed tomography in terms of minor head injury, it seems reasonable to use brain computed tomography scan for a wider range of patients with minor head injury.

  11. Development of a screening MRI for infants at risk for abusive head trauma

    Energy Technology Data Exchange (ETDEWEB)

    Flom, Lynda; Panigrahy, Ashok [Children' s Hospital of Pittsburgh of UPMC, Department of Radiology, Pittsburgh, PA (United States); Fromkin, Janet [University of Pittsburgh, Department of Pediatrics, Children' s Hospital of Pittsburgh of UPMC, Pittsburgh, PA (United States); Tyler-Kabara, Elizabeth [University of Pittsburgh, Department of Neurosurgery, Children' s Hospital of Pittsburgh of UPMC, McGowan Institute for Regenerative Medicine, Pittsburgh, PA (United States); Berger, Rachel P. [University of Pittsburgh, Department of Pediatrics, Children' s Hospital of Pittsburgh of UPMC, Pittsburgh, PA (United States); University of Pittsburgh, Safar Center for Resuscitation Research, Pittsburgh, PA (United States)

    2016-04-15

    Abusive head trauma (AHT) is an important cause of morbidity in infants. Identifying which well-appearing infants are at risk for AHT and need neuroimaging is challenging, and concern about radiation exposure limits the use of head CT. Availability of an MRI protocol that is highly sensitive for intracranial hemorrhage would allow for AHT screening of well-appearing infants without exposing them to radiation. To develop a screening MRI protocol to identify intracranial hemorrhage in well-appearing infants at risk for AHT. Infants enrolled in a parent study of well-appearing infants at increased risk for AHT were eligible for the current study if they underwent both head CT and conventional brain MRI. A derivation cohort of nine infants with AHT was used to identify sequences that provided the highest sensitivity for intracranial hemorrhage. A validation cohort of 78 infants including both controls with normal neuroimaging and cases with AHT was used to evaluate the accuracy of the selected sequences. Three pulse sequences - axial T2, axial gradient recalled echo (GRE) and coronal T1-W inversion recovery - were 100% sensitive for intracranial hemorrhage in the derivation cohort. The same sequences were 100% sensitive (25/25) and 83% specific (44/53) for intracranial hemorrhage in the validation cohort. A screening MRI protocol including axial T2, axial GRE and coronal T1-W inversion recovery sequences is highly sensitive for intracranial hemorrhage and may be useful as a screening tool to differentiate well-appearing infants at risk for AHT who should undergo head CT from those who can safely be discharged without head CT. Additional research is needed to evaluate the feasibility of this approach in clinical practice. (orig.)

  12. Development of a screening MRI for infants at risk for abusive head trauma

    International Nuclear Information System (INIS)

    Abusive head trauma (AHT) is an important cause of morbidity in infants. Identifying which well-appearing infants are at risk for AHT and need neuroimaging is challenging, and concern about radiation exposure limits the use of head CT. Availability of an MRI protocol that is highly sensitive for intracranial hemorrhage would allow for AHT screening of well-appearing infants without exposing them to radiation. To develop a screening MRI protocol to identify intracranial hemorrhage in well-appearing infants at risk for AHT. Infants enrolled in a parent study of well-appearing infants at increased risk for AHT were eligible for the current study if they underwent both head CT and conventional brain MRI. A derivation cohort of nine infants with AHT was used to identify sequences that provided the highest sensitivity for intracranial hemorrhage. A validation cohort of 78 infants including both controls with normal neuroimaging and cases with AHT was used to evaluate the accuracy of the selected sequences. Three pulse sequences - axial T2, axial gradient recalled echo (GRE) and coronal T1-W inversion recovery - were 100% sensitive for intracranial hemorrhage in the derivation cohort. The same sequences were 100% sensitive (25/25) and 83% specific (44/53) for intracranial hemorrhage in the validation cohort. A screening MRI protocol including axial T2, axial GRE and coronal T1-W inversion recovery sequences is highly sensitive for intracranial hemorrhage and may be useful as a screening tool to differentiate well-appearing infants at risk for AHT who should undergo head CT from those who can safely be discharged without head CT. Additional research is needed to evaluate the feasibility of this approach in clinical practice. (orig.)

  13. Blunt abdominal trauma in sports.

    Science.gov (United States)

    Rifat, Sami F; Gilvydis, Rimas P

    2003-04-01

    Abdominal injuries are rare in sports, but when they do occur it is important that the physician recognize the warning signs of potentially life-threatening injury to the liver, spleen, or hollow abdominal viscera. Though the sports medicine physician may not always provide definitive treatment of many of these conditions, he or she should be familiar with the preferred diagnostic modalities and latest treatment options. This information is not only essential to appropriately participate in treatment decisions, but is also important in order to make return-to-play determinations.

  14. Identifying Characteristics in Abusive Head Trauma: A Single-Institution Experience.

    Science.gov (United States)

    Westrick, Ashly C; Moore, Marjorie; Monk, Steve; Greeno, Amber; Shannon, Chevis

    2015-01-01

    Abusive head trauma (AHT) is a significant cause of childhood morbidity and mortality. The purpose of this study was to better understand the trends centered on AHT patients treated at Vanderbilt Children's Hospital. A retrospective study of 139 children undergoing treatment and management for traumatic brain injury due to abuse between January 2006 and April 2013 at Vanderbilt Children's Hospital was conducted. Caucasian males made up 61% and the youngest sibling represented 86.3% of our cohort. The median age was 5 months with injuries occurring during summertime and on weekdays, 31 and 63%, respectively. Seventy-nine percent were diagnosed with subdural hematomas, and 42% had a Glasgow Coma Scale (GCS) of 8 or less. A total of 25 patients, median age 8.6 months, died during our study period. The results of this study describe the AHT population at Vanderbilt Children's Hospital. Future studies should prospectively assess this population to better understand social factors involved in AHT. PMID:26068322

  15. Dating the abusive head trauma episode and perpetrator statements: key points for imaging

    Energy Technology Data Exchange (ETDEWEB)

    Adamsbaum, Catherine; Morel, Baptiste [AP-HP, CHU Bicetre, Service d' Imagerie Pediatrique, Paris (France); Ducot, Beatrice [Universite Paris Sud, Faculte de Medecine, Le Kremlin Bicetre (France); INSERM CESP U 1018, Paris (France); Antoni, Guillemette [Universite Paris Sud, Faculte de Medecine, Le Kremlin Bicetre (France); Rey-Salmon, Caroline [AP-HP, CHU Hotel Dieu, Unite Medico-Judiciaire, Paris (France)

    2014-12-15

    Shaken baby syndrome/abusive head trauma is a leading cause of morbidity and mortality in infants. The presence of a diffuse subdural hematoma without evidence of accident is a key diagnostic clue. The hematoma is typically attributed to rupture of the cerebral bridging veins due to violent shaking, with or without impact. Dating the incident, however, remains controversial. The aim of this article is to review the most reliable features used for dating the incident, based on both legal statements by perpetrators and medical documentation. The key points are: 1) The high (yet likely underestimated) frequency of repeated shaking is around 50%, 2) Children do not behave normally immediately after shaking, and the time of onset of even mild symptoms appears to be the best clue for dating the incident and 3) Brain imaging provides strong indicators of ''age-different'' injuries but the ranges for dating the causal event are wide. The density pattern in a single subdural hematoma location provides no reliable clues for assessing repeated violence. Only the finding of different density in two distant subdural hematomas argues in favor of ''age-different'' injuries, i.e. repeated violence. MRI is difficult to interpret in terms of dating subdural hemorrhages and must be analyzed in conjunction with CT. Most importantly, all of the child's previous clinical and radiological data must be carefully studied and correlated to provide accurate information on the date and repetition of the trauma. (orig.)

  16. Dating the abusive head trauma episode and perpetrator statements: key points for imaging

    International Nuclear Information System (INIS)

    Shaken baby syndrome/abusive head trauma is a leading cause of morbidity and mortality in infants. The presence of a diffuse subdural hematoma without evidence of accident is a key diagnostic clue. The hematoma is typically attributed to rupture of the cerebral bridging veins due to violent shaking, with or without impact. Dating the incident, however, remains controversial. The aim of this article is to review the most reliable features used for dating the incident, based on both legal statements by perpetrators and medical documentation. The key points are: 1) The high (yet likely underestimated) frequency of repeated shaking is around 50%, 2) Children do not behave normally immediately after shaking, and the time of onset of even mild symptoms appears to be the best clue for dating the incident and 3) Brain imaging provides strong indicators of ''age-different'' injuries but the ranges for dating the causal event are wide. The density pattern in a single subdural hematoma location provides no reliable clues for assessing repeated violence. Only the finding of different density in two distant subdural hematomas argues in favor of ''age-different'' injuries, i.e. repeated violence. MRI is difficult to interpret in terms of dating subdural hemorrhages and must be analyzed in conjunction with CT. Most importantly, all of the child's previous clinical and radiological data must be carefully studied and correlated to provide accurate information on the date and repetition of the trauma. (orig.)

  17. New Phenomenon of Abnormal Auditory Perception Associated with Emotional and Head Trauma: Pathological Confirmation by SPECT Scan

    Science.gov (United States)

    Stephane, Massoud; Hill, Thomas; Matthew, Elizabeth; Folstein, Marshal

    2004-01-01

    We report the case of an immigrant who suffered from death threats and head trauma while a prisoner of war in Kuwait. Two months later, he began to hear conversations that had taken place previously. These perceptions occurred spontaneously or were induced by the patient's effortful concentration. The single photon emission computerized tomography…

  18. Facial trauma

    Science.gov (United States)

    Maxillofacial injury; Midface trauma; Facial injury; LeFort injuries ... Kellman RM. Maxillofacial trauma. In: Flint PW, Haughey BH, Lund LJ, et al, eds. Cummings Otolaryngology: Head & Neck Surgery . 6th ed. Philadelphia, PA: ...

  19. The role of computed tomography in blunt hepatic injury

    International Nuclear Information System (INIS)

    Computed tomography (CT) images and medical records of 283 patients with blunt abdominal trauma were reviewed. There were 67 patients with hepatic injury. Liver was the most frequently injured organ in blunt abdominal trauma. Most hepatic injuries occurred in the right lobe of the liver. Of the 67 patients with hepatic injury, 60 patients had associated other injuries. There was a high incidence of associated lung injuries (35.8 %). Of importance is the high incidence of associated head injuries (22.4 %), because, in some patients such as those with concomitant head trauma, abdominal symptom is not obvious. The associated hemoperitoneum were correlated with the mode of therapy used in each case (operative vs. nonoperative). 32 patients with hepatic injury but no hemoperitoneum were managed nonoperatively. 9 patients with hepatic injury and little hemoperitoneum were also managed conservatively. 22 patients with high density hemoperitoneum were surgically treated. By combining information on the clinical state of the patient and CT finding, therapy of hepatic injury can be individualized and the incidence of nontherapeutic laparotomies decreased. (author)

  20. Imaging of spinal injury in abusive head trauma: a retrospective study

    Energy Technology Data Exchange (ETDEWEB)

    Choudhary, Arabinda K. [Nemours A.I. DuPont Children Hospital, Department of Radiology, Wilmington, DE (United States); Ishak, Ramsay; Zacharia, Thomas T. [Hershey Medical Center, Department of Radiology, Hershey, PA (United States); Dias, Mark S. [Hershey Medical Center, Department of Neurosurgery, Hershey, PA (United States)

    2014-09-15

    Spinal imaging has been a neglected part of abusive head trauma (AHT) imaging. As most of the radiographs and CT spine are negative in AHT in infants, the cervical spine is assumed to be normal. There is increasing evidence in the role of injury to brainstem and cervical cord in the pathogenesis of AHT. In addition, in courts of law, there is fierce debate about AHT, its mimics and other disparate nontraumatic diagnoses explaining the neuroradiological and skeletal findings. However, this discussion ignores the evidence and significance of spinal injury. We sought to study the cervical spine in an AHT cohort to understand the true prevalence of spinal injuries in AHT and contrast it with cohorts of accidental and nontraumatic groups to give the clinicians a robust diagnostic tool in evaluating AHT. The purpose of this study is to compare the relative incidence of spinal ligamentous and soft-tissue abnormalities on spinal MRI among three groups of children ages < 48 months: (1) those with AHT, (2) those with accidental trauma, and (3) those with nontraumatic conditions. This comparative study included 183 children who underwent spine MRI: 67 with AHT, 46 with accidental trauma and a clinical suspicion of spinal injury, and 70 with nontraumatic conditions. Clinical and radiographic findings were collected in all cases and were analyzed retrospectively to identify MRI evidence of traumatic spinal injuries. The incidence of spinal injuries among the three groups was compared. The incidence of spinal ligamentous injuries was calculated for those with and without radiographic evidence of hypoxic-ischemic encephalopathy. All comparisons were performed using Fisher exact test with P < 0.05 considered statistically significant. Cervical spine ligamentous injuries (predominantly the nuchal, atlanto-occipital and atlanto-axial ligaments) were present in 78% of the AHT group, 46% of the accidental trauma group and 1% of the nontraumatic group; all of these differences were

  1. Progressive Epidural Hematoma in Patients with Head Trauma: Incidence, Outcome, and Risk Factors

    Directory of Open Access Journals (Sweden)

    Hao Chen

    2012-01-01

    Full Text Available Progressive epidural hematoma (PEDH after head injury is often observed on serial computerized tomography (CT scans. Recent advances in imaging modalities and treatment might affect its incidence and outcome. In this study, PEDH was observed in 9.2% of 412 head trauma patients in whom two CT scans were obtained within 24 hours of injury, and in a majority of cases, it developed within 3 days after injury. In multivariate logistic regression, patient gender, age, Glasgow Coma Scale (GCS score at admission, and skull fracture were not associated with PEDH, whereas hypotension (odds ratio (OR 0.38, 95% confidence interval (CI 0.17–0.84, time interval of the first CT scanning (OR 0.42, 95% CI 0.19–0.83, coagulopathy (OR 0.36, 95% CI 0.15–0.85, or decompressive craniectomy (DC (OR 0.46, 95% CI 0.21–0.97 was independently associated with an increased risk of PEDH. The 3-month postinjury outcome was similar in patients with PEDH and patients without PEDH (χ2=0.07, P=0.86. In conclusion, epidural hematoma has a greater tendency to progress early after injury, often in dramatic and rapid fashion. Recognition of this important treatable cause of secondary brain injury and the associated risk factors may help identify the group at risk and tailor management of patients with TBI.

  2. Unilateral hypoxic-ischemic injury in young children from abusive head trauma, lacking craniocervical vascular dissection or cord injury

    International Nuclear Information System (INIS)

    Abusive head trauma (AHT) in young children usually has a severe outcome when associated with hypoxic-ischemic encephalopathy (HIE), which is best characterized by MRI in the acute or subacute phase utilizing diffusion-weighted imaging (DWI). HIE in this setting has been hypothesized to result from stretching of the spinal cord, brainstem, or vasculature. To provide clinical correlation in patients with unilateral HIE and to postulate a mechanism in the setting of suspected AHT. IRB approval was obtained. Over a 5-year period, the medical records and images were reviewed of the 53 children ≤3 years of age who presented with acute head trauma according to the hospital registry. The children were subselected in order to determine how many suffered either HIE or AHT, and to detect those with unilateral HIE. In 11 of the 53 children, the etiology of the head trauma was highly suspicious for abuse. In 38 the head trauma was accidental and in 4 the trauma was of unknown etiology and at the time of this report was unresolved legally. Of the 53, 4 suffered HIE confirmed by CT or MRI. In three of these four with HIE the trauma was considered highly suspicious for AHT. Two of these three were the only patients with unilateral HIE, and both (7 months and 14 months of age) presented with early subacute phase HIE seen on DW MRI (range 4-7 days) and are described in detail with clinical correlation. The third child with AHT and HIE had bilateral findings. In the fourth patient the HIE was bilateral and was considered accidental. The work-up for both patients with unilateral HIE included head CT, craniocervical MRI, and craniocervical MR angiography (MRA). In both, there was mostly unilateral, deep white matter restricted diffusion, with subdural hematomas that were small compared to the extent of hypoxic-ischemic insult, and no skull fracture. Craniocervical MRA and axial thin-section fat-saturation images were negative for dissection, brainstem, or cord injury. Legal

  3. Unilateral hypoxic-ischemic injury in young children from abusive head trauma, lacking craniocervical vascular dissection or cord injury

    Energy Technology Data Exchange (ETDEWEB)

    McKinney, Alexander M.; Thompson, Linda R.; Truwit, Charles L.; Velders, Scott; Karagulle, Ayse; Kiragu, Andrew [University of Minnesota Medical School, Department of Radiology, Hennepin County Medical Center, Minneapolis, MN (United States)

    2008-02-15

    Abusive head trauma (AHT) in young children usually has a severe outcome when associated with hypoxic-ischemic encephalopathy (HIE), which is best characterized by MRI in the acute or subacute phase utilizing diffusion-weighted imaging (DWI). HIE in this setting has been hypothesized to result from stretching of the spinal cord, brainstem, or vasculature. To provide clinical correlation in patients with unilateral HIE and to postulate a mechanism in the setting of suspected AHT. IRB approval was obtained. Over a 5-year period, the medical records and images were reviewed of the 53 children {<=}3 years of age who presented with acute head trauma according to the hospital registry. The children were subselected in order to determine how many suffered either HIE or AHT, and to detect those with unilateral HIE. In 11 of the 53 children, the etiology of the head trauma was highly suspicious for abuse. In 38 the head trauma was accidental and in 4 the trauma was of unknown etiology and at the time of this report was unresolved legally. Of the 53, 4 suffered HIE confirmed by CT or MRI. In three of these four with HIE the trauma was considered highly suspicious for AHT. Two of these three were the only patients with unilateral HIE, and both (7 months and 14 months of age) presented with early subacute phase HIE seen on DW MRI (range 4-7 days) and are described in detail with clinical correlation. The third child with AHT and HIE had bilateral findings. In the fourth patient the HIE was bilateral and was considered accidental. The work-up for both patients with unilateral HIE included head CT, craniocervical MRI, and craniocervical MR angiography (MRA). In both, there was mostly unilateral, deep white matter restricted diffusion, with subdural hematomas that were small compared to the extent of hypoxic-ischemic insult, and no skull fracture. Craniocervical MRA and axial thin-section fat-saturation images were negative for dissection, brainstem, or cord injury. Legal

  4. The impact of helmets on motorcycle head trauma at a tertiary hospital in Jamaica

    Directory of Open Access Journals (Sweden)

    Meeks-Aitken Nicole

    2009-08-01

    Full Text Available Abstract Background Although the Jamaica road traffic act mandates motorcycle riders to wear approved helmets, opponents suggest that the local road conditions obviate any benefits from helmet use that have been proven in Developed countries. They suggest that the narrow, winding, poorly surfaced, congested local highways do not allow motorcyclists to sustain high velocity travel. The accidents then tend to occur at lower speeds and are accompanied by less severe injuries. This study was carried out to determine the impact of helmet use on traumatic brain injuries from motorcycle collisions in patients admitted to a tertiary referral hospital in Jamaica. Methods A prospectively collected trauma registry maintained by the Department of Surgery at the University Hospital of the West Indies in Jamaica was accessed to identify all motorcycle collision victims from January 2000 to January 2007. The therapeutic outcomes of traumatic brain injuries were compared between helmeted and un-helmeted riders. The data was analyzed using SPSS Version 12. Results Of 293 motorcycle collision victims, 143 sustained brain injuries. There were 9 females (6.3% with an average age of 23 +/- 7.3 years and 134 males (93.7% at an average age of 33.4 +/- 11.2 years (mean +/- SD. Only 49 (34.3% patients wore a helmet at the time of a collision. Helmet use at the time of a collision significantly reduced the severity of head injuries (28.6% vs 46.8%, P = 0.028 and the likelihood of sustaining intra-cranial lesions (26.5% vs 44.7%, P = 0.03 from head injuries. Conclusion Wearing a helmet at the time of a motorcycle collision reduces the severity of head injuries. However, the prevalence of helmet use at the time of a collision is unacceptably low.

  5. Trauma in pregnancy

    Directory of Open Access Journals (Sweden)

    A Rudra

    2007-01-01

    Full Text Available Trauma is the most common non-obstetrical cause of death in pregnant women. Pregnancy must always be suspected in any female trauma patient of childbearing age until proved otherwise. Unique changes in anatomy and physiology that takes place during pregnancy alter the pathophysiology and location of maternal injuries in pregnancy, which may be significantly different from the non-pregnant state. Trauma from road traffic accidents, falls and domestic violence are the most common causes of abdominal blunt trauma. As pregnancy progresses, the change of accidental injury increases. Head and neck injuries, respiratory failure, and hypovolemic shock constitute the most frequent causes of trauma related maternal death in pregnancy. Even the pregnant woman with minor injuries should be carefully observed. Initial management is directed at resuscitation and stabilization of the mother that takes precedence over that of the fetus, unless vital signs cannot be maintained and perimortem cesarean section decided upon. Fetal monitoring should be maintained after satisfactory resuscitation and stabilization of the mother. Preventive measures include proper seat belt use and identifying and counseling victims of suspected domestic violence.

  6. National Trauma Database (NTrD)--improving trauma care: first year report.

    Science.gov (United States)

    Sabariah, F J; Ramesh, N; Mahathar, A W

    2008-09-01

    The first Malaysian National Trauma Database was launched in May 2006 with five tertiary referral centres to determine the fundamental data on major trauma, subsequently to evaluate the major trauma management and to come up with guidelines for improved trauma care. A prospective study, using standardized and validated questionnaires, was carried out from May 2006 till April 2007 for all cases admitted and referred to the participating hospitals. During the one year period, 123,916 trauma patients were registered, of which 933 (0.75%) were classified as major trauma. Patients with blunt injury made up for 83.9% of cases and RTA accounted for 72.6% of injuries with 64.9% involving motorcyclist and pillion rider. 42.8% had severe head injury with an admission Glasgow Coma Scale (GCS) of 3-8 and the Revised Trauma Score (RTS) of 5-6 were recorded in 28.8% of patients. The distribution of Injury Severity Score (ISS) showed that 42.9% of cases were in the range of 16-24. Only 1.9% and 6.3% of the patients were reviewed by the Emergency Physician and Surgeon respectively. Patients with admission systolic blood pressure of less than 90 mmHg had a death rate of 54.6%. Patients with severe head injury (GCS report has successfully demonstrated its significance in giving essential data on major trauma in Malaysia, however further expansion of the study may reflect more comprehensive trauma database in this country.

  7. Value of emergency bedside ultrasound in diagnosis of blunt abdominal trauma%急诊床旁超声在腹部脏器闭合性损伤诊断中的应用价值

    Institute of Scientific and Technical Information of China (English)

    张惠萍; 刘燕; 尹毅

    2010-01-01

    目的 探讨急诊床旁超声检查对腹部闭合性损伤的诊断应用价值.方法 应用便携式超声仪对184例外伤患者行急诊床旁超声检查,观察腹部脏器声像图有无异常改变,并重视观察腹腔内有无游离液体及气体.结果 超声诊断总符合率91.8%(169/184),其中单脏器损伤156例,符合率95.5%(149/156),多脏器损伤28例,符合率71.4%(20/28),漏诊21例,误诊3例,漏、误诊率13%(24/184).手术治疗119例;保守治疗65例,经CT、MRI检查及临床保守治疗证实.结论 急诊床旁超声检查对腹部闭合性损伤的诊断符合率高,为临床提供迅速、可靠的诊断信息.%Objective To discuss the value of emergency bedside ultrasound in diagnose of blunt abdominal injury. Methods Portable ultrasound was used in 184 patients with blunt abdominal trauma in emergency department. The abnormal changes of the sound and image of the abdomen were observed,paying equal attention to free intraperitoneal fluid and gas. Results The emergency bedside ultrasound identified 169 (91.8%) patients with blunt abdominal injury, of whom 149 patients (95.5%) with single-organ injury and 20 patients (71.4%) with multi-organ injury. There were 21 patients missed diagnosis and three misdiagnosed, with rate of missed diagnosis and misdiagnosis of 13%. Surgical treatment was performed in 119 patients and conservative treatment in 65, which were proved by CT/MRI examination or clinic conservative treatment. Conclusion Emergency bedside ultrasound can provide fast and credible diagnostic information for blunt abdominal trauma, with high diagnosis accordance rate.

  8. Creutzfeldt-Jakob disease masked by head trauma and features of Wilson's disease.

    Science.gov (United States)

    Scontrini, Alessandra; Di Bonaventura, Carlo; Fiorelli, Marco; Tiple, Dorina; Colaizzo, Elisa; Ladogana, Anna; Parchi, Piero; Pocchiari, Maurizio

    2015-04-01

    Creutzfeldt-Jakob disease (CJD) is a fatal neurodegenerative disorder typically characterized by progressive dementia associated with myoclonus, cerebellar and other focal neurological signs. Electroencephalogram, brain MRI and cerebrospinal fluid (CSF) analyses are helpful diagnostic tools, but diagnosis in patients with atypical presenting neurological signs is often difficult to make. A 55-year-old woman developed disorientation, drowsiness and focal motor signs after a traumatic brain injury due to an accidental fall. In two weeks, her symptoms worsened in spite of a brain MRI showed an improvement of traumatic lesions, but the presence of bilateral hyperintensity in the basal nuclei was suggestive of a metabolic or prion encephalopathy. The high 24-h urinary copper level and reduction of ceruloplasmin initially supported the diagnosis of Wilson's disease, but the absence of Kayser-Fleischer rings, and the positivity of 14-3-3 protein test and elevated tau concentrations in the CSF oriented toward a diagnosis of CJD. She died 5 months after the onset, and the postmortem examination of the brain revealed immunochemical features of CJD. This case exemplifies the difficulty of a timely diagnosis when rapid progressive dementia is masked by concomitant factors (i.e., head trauma) and neurological signs are associated with unclear laboratory findings.

  9. Simulation of the Impact of Programs for Prevention and Screening of Pediatric Abusive Head Trauma.

    Science.gov (United States)

    Bailhache, Marion; Bénard, Antoine; Salmi, Louis-Rachid

    2016-07-15

    Primary prevention programs of pediatric abusive head trauma (PAHT) exist and early screening is proposed, but negative effects of mislabeling parents as abusers, an important issue, are not well documented. The aim of our study was to simulate the possible impact of programs for the primary prevention and screening of PAHT. We developed Markov models that simulate the life histories of PAHT with no intervention, with primary prevention program only, with screening program, and with both programs in a hypothetical cohort of 800,000 newborns in a high-income country. Screening program would be addressed to all families until children are 2 years old, during repeated consultations. Potential side effects for parents being mislabeled as abusers were supposed to increase the probability of PAHT and decrease participation in screening. Time horizon was 2 years with cycles of 15 days. Outcomes were number of deaths and abused children avoided. Uncertainty was specified with probability distributions. After 2 years, the median number of deaths avoided through primary prevention would vary from 6 (95% confidence interval [CI] 2-11) to 28 (95% CI 6-51) per 100,000 newborns. Screening could prevent up to 6 (95% CI 0-29) or cause up to 66 (95% CI 0-361) deaths per 100,000 children born alive. The impact of both programs was uncertain. Our model confirmed the potential benefits of primary prevention and documented the uncertainty associated with screening of PAHT. PMID:26566679

  10. Association between linear skull fractures and intracranial hemorrhage in children with minor head trauma

    Energy Technology Data Exchange (ETDEWEB)

    Erlichman, David B.; Blumfield, Einat; Weiss, Amanda [Jacobi Medical Center, Department of Pediatric Radiology, Albert Einstein College of Medicine, Bronx, NY (United States); Rajpathak, Swapnil [Albert Einstein College of Medicine, Department of Epidemiology and Population Health, Bronx, NY (United States)

    2010-08-15

    To determine whether skull fractures can be used to associate intracranial hemorrhage with minor head trauma (MHT). We conducted a retrospective study evaluating the association between linear skull fractures and intracranial hemorrhage among children with MHT. Furthermore, we evaluated the significance of small intracranial hemorrhages by assessing the need for neurosurgical interventions. The case group included 114 children with a diagnosis of a linear skull fracture and the control group included 125 children without the diagnosis. We conducted multivariable logistic regression analyses to estimate the odds ratio (OR) between linear skull fractures and intracranial bleeding. Among the cases, 29 of 114 (25%) children were diagnosed with an intracranial hemorrhage on CT, compared to only 14 of 125 (11%) among the controls. The multivariable OR for intracranial hemorrhages comparing cases and controls adjusted for age and gender was 2.17 (95% confidence interval [CI]: 1.01, 4.68). All the intracranial hemorrhages were small (3.8 {+-} 2.3 mm) and none of them required any neurosurgical intervention. The presence of a linear skull fracture is an independent risk factor for intracranial hemorrhage. However, all the intracranial hemorrhages associated with the skull fractures were small and did not require any neurosurgical interventions. (orig.)

  11. [Pulse synchronous bruit, swollen eye, diplopia, exophthalmos, chemosis and diplopia three weeks after a head trauma].

    Science.gov (United States)

    Tabakovic, S; Nigg, Christel; Landau, K; Zerkiebel, N

    2010-11-01

    Traumatic carotid-cavernous sinus fistulas represent an uncommon complication of a head trauma. The consequences of a delayed diagnosis are progressive ocular complications such as visual loss, extraocular muscle palsy, progressive proptosis, conjuctival chemosis, retinal vein occlusion and secondary glaucoma. Moreover, severe epistaxis, intracerebral and subarachnoidal hemorrhage may occur. We present a patient who developed a carotid-cavernous sinus fistula within three weeks after a craniocerebral injury. Despite initial exclusion of an arteriovenous fistula using duplex sonography, angiography later demonstrated the carotid-cavernous sinus fistula that was successfully occluded be means of catheter intervention. The patient's symptomatology consisting of pulse synchronous bruit, red, swollen and painful eye, diplopia, chemosis, pulsating exophthalmos, ocular hypertension and progressive visual loss allowed various differential diagnoses. Apart from inflammatory, mechanical, autoimmune, vascular and tumorous disorders, a traumatic cause was highly probable considering the patient's history of craniocerebral injury. A rapid elimination of such a fistula is necessary in order to prevent long-term damage. However it is important to consider the possible complications due to the intervention, in our case the risk of a hyperperfusion syndrome with a consecutive cerebral hemorrhage.

  12. Risk factors associated with retinal hemorrhage in suspected abusive head trauma

    Science.gov (United States)

    Burkhart, Zachary N.; Thurber, Clinton J.; Chuang, Alice Z.; Kumar, Kartik S.; Davis, Garvin H.; Kellaway, Judianne

    2015-01-01

    Purpose To determine risk factors associated with retinal hemorrhage (RH) in pediatric abusive head trauma (AHT) suspects. Methods Records of children aged 0–3 years hospitalized for suspected AHT from January 2007 to November 2011 were retrospectively reviewed in this case–control study. Children were classified into case and control groups based on RH presence. Medical history, presenting symptoms, reasons, and characteristics of injury were recorded. Logistic regression analysis was performed to identify risk factors. Results A total of 168 children (104 males) were included. Of these, 103 were classified as cases and 65 as controls. The mean age (with standard deviation) was 9.3 ± 8.3 months (range, 1 day-36 months). Of the 103 cases, 22 (21%) had subretinal hemorrhage, 9 (9%) had retinoschisis, and 1 (1%) had vitreous hemorrhage. Children presenting with lethargy or altered mental status (P children with skull or nonskull fracture without intracranial hemorrhage did not have RH (P < 0.0001 both categories). Conclusions Retinal hemorrhages were almost never found in the absence of intracranial hemorrhage and not found in the setting of fracture without intracranial hemorrhage. PMID:25828822

  13. Risk of Delayed Intracerebral Hemorrhage in Anticoagulated Patients after Minor Head Trauma: The Role of Repeat Cranial Computed Tomography

    Science.gov (United States)

    Swap, Clifford; Sidell, Margo; Ogaz, Raquel; Sharp, Adam

    2016-01-01

    Context: Patients receiving anticoagulant medications who experience minor head injury are at increased risk of an intracerebral hemorrhage (ICH) developing, even after an initial computed tomography (CT) scan of the brain yields normal findings. Conflicting evidence exists regarding the frequency at which delayed bleeding occurs. Objective: To identify the frequency of delayed traumatic ICH in patients receiving warfarin or clopidogrel. Design: We performed a retrospective observational study of adult trauma encounters for anticoagulated patients undergoing head CT at 1 of 13 Kaiser Permanente Southern California Emergency Departments (EDs) between 2007 and 2011. Encounters were identified using structured data from electronic health and administrative records, and then records were individually reviewed for validation of results. Main Outcome Measures: The primary outcome measure was ICH within 60 days of an ED visit with a normal head CT result. Results: Our sample included 443 (260 clopidogrel and 183 warfarin) eligible ED encounters with normal findings of initial head CT. Overall, 11 patients (2.5%, 95% confidence interval [CI] = 1.4%–4.4%) had a delayed ICH, and events occurred at similar rates between the clopidogrel group (6/260, 2.3%, CI 1.1%–5.0%) and warfarin group (5/183, 2.7%, CI 1.2%–6.2%). Conclusion: Trauma patients in the ED who are receiving warfarin or clopidogrel have approximately a 2.5% risk of delayed ICH after an initial normal finding on a head CT. PMID:26901269

  14. Neck Flexion Induces Larger Deformation of the Brain Than Extension at a Rotational Acceleration, Closed Head Trauma

    Directory of Open Access Journals (Sweden)

    Hans-Arne Hansson

    2014-01-01

    Full Text Available A closed head trauma induces incompletely characterized temporary movement and deformation of the brain, contributing to the primary traumatic brain injury. We used the pressure patterns recorded with light-operated miniature sensors in anaesthetized adult rabbits exposed to a sagittal plane rotational acceleration of the head, lasting 1 ms, as a measure of brain deformation. Two exposure levels were used and scaled to correspond to force levels reported to cause mild and moderate diffuse injury in an adult man, respectively. Flexion induced transient, strong, extended, and predominantly negative pressures while extension generated a short positive pressure peak followed by a minor negative peak. Low level flexion caused as strong, extended negative pressures as did high level extension. Time differences were demonstrated between the deformation of the cerebrum, brainstem, and cerebellum. Available X-ray and MRI techniques do not have as high time resolution as pressure recordings in demonstrating complex, sequential compression and stretching of the brain during a trauma. The exposure to flexion caused more protracted and extensive deformation of the brain than extension, in agreement with a published histopathological report. The severity and extent of the brain deformation generated at a head trauma thus related to the direction at equal force.

  15. Traumatic bilateral carotid artery dissection following severe blunt trauma: a case report on the difficulties in diagnosis and therapy of an often overlooked life-threatening injury

    OpenAIRE

    Crönlein, Moritz; Sandmann, Gunther H.; Beirer, Marc; Wunderlich, Silke; Biberthaler, Peter; Huber-Wagner, Stefan

    2015-01-01

    Background Traumatic carotid artery dissections are very rare, often overlooked and life-threatening injuries. Diagnosis and treatment are difficult especially in multiple injured patients. Case presentation We report on a 28-year-old female major trauma patient (injury severity score, ISS 50) who was involved in a motor vehicle accident. She was primarily transferred to a level II trauma center. After initial assessment and operative management, an anisocoria was diagnosed on the intensive c...

  16. Mortality Factors in Geriatric Blunt Trauma Patients: Creation of a Highly Predictive Statistical Model for Mortality Using 50,765 Consecutive Elderly Trauma Admissions from the National Sample Project

    OpenAIRE

    Hranjec, Tjasa; Sawyer, Robert G; Young, Jeffrey S.; Swenson, Brian R.; CALLAND, JAMES F.

    2012-01-01

    Elderly patients are at high risk for mortality after injury. We hypothesized that trauma benchmarking efforts would benefit from development of a geriatric-specific model for risk-adjusted analyses of trauma center outcomes. A total of 57,973 records of elderly patients (age older than 65 years), which met our selection criteria, were submitted to the National Trauma Database and included within the National Sample Project between 2003 and 2006. These cases were used to construct a multivari...

  17. Lacunar stroke in a teenager after minor head trauma: case report and literature review.

    Science.gov (United States)

    Zwank, Michael D; Dummer, Benjamin W; Danielson, Levi T; Haake, Bret C

    2014-09-01

    Ischemic strokes in children and young adults are fortunately rare. Contrasted with adult ischemic strokes, pediatric stroke etiologies vary greatly and are often unknown. Childhood lacunar strokes and trauma-induced strokes represent particularly uncommon subsets and have been reported infrequently in the literature. It is unique to find a combination of the 2-a lacunar stroke induced by trauma. Underreporting of these trauma-induced ischemic strokes could be responsible for perpetuating the lack of recognition. Here we present a lacunar stroke in a young woman associated with a water sport accident and explore relevant literature encircling deep brain ischemia coinciding with trauma.

  18. Characteristics and Trends of Hospitalized Pediatric Abuse Head Trauma in Wuhan, China: 2002–2011

    Directory of Open Access Journals (Sweden)

    Xin Xia

    2012-11-01

    Full Text Available This study investigated characteristics and trends of hospitalized abuse-related traumatic brain injuries (TBI treated at a large pediatric medical center in Wuhan, China during the past 10 years. De-identified hospital discharge data for patients 0–4 years old hospitalized at the Wuhan Medical Care Center for Women and Children were analyzed, and ICD-10 codes were used to identify cases of TBI. Medical notes provided by doctors in the medical record were used to identify TBI cases in which suspected child abuse was the cause. From 2002 to 2011, 3,061 pediatric TBI patients were hospitalized and 4.6% (140 of these cases were suspected child abuse-related. The majority of suspected child abuse cases involved children younger than 1 year of age (68.6% and usually affected males (63.6%. Children with non-Abusive Head Trauma (AHT were more likely to have full recovery outcome (68.4%, 95% CI: 66.6%–70.0% than children with suspected AHT (44.3%, 95% CI: 36.1%–52.5%. The proportion of all childhood TBI attributable to abuse did not appear to have increased in the 10-year period at this medical center. This is the first comprehensive study highlighting the important role of suspected child abuse in causing TBIs among Chinese children. Child abuse as a major cause of TBIs among infants in China should be studied further, and there should be greater awareness of this important social and medical problem in China.

  19. Extended follow-up of neurological, cognitive, behavioral and academic outcomes after severe abusive head trauma.

    Science.gov (United States)

    Lind, Katia; Toure, Hanna; Brugel, Dominique; Meyer, Philippe; Laurent-Vannier, Anne; Chevignard, Mathilde

    2016-01-01

    Studies about long-term outcome following abusive head trauma (AHT) are scarce. The aims of this study were to report long-term neurological, cognitive, behavioral and academic outcomes, ongoing treatments and/or rehabilitation, several years after AHT diagnosis, and factors associated with outcome. In this retrospective study, all patients admitted to a single rehabilitation unit following AHT between 1996 and 2005, with subsequent follow-up exceeding 3 years, were included. Medical files were reviewed and a medical interview was performed with parents on the phone when possible. The primary outcome measure was the Glasgow Outcome Scale (GOS). Forty-seven children (out of 66) met the inclusion criteria (mean age at injury 5.7 months; SD=3.2). After a median length of follow-up of 8 years (range 3.7-12), only seven children (15%) had "good outcome" (normal life - GOS I) and 19 children (40%) presented with severe neurological impairment (GOS III and IV). Children sustained epilepsy (38%), motor deficits (45%), visual deficit (45%), sleep disorders (17%), language abnormalities (49%), attention deficits (79%) and behavioral disorders (53%). Most children (83%) had ongoing rehabilitation. Only 30% followed a normal curriculum, whereas 30% required special education services. Children with better overall outcome (GOS I and II) had significantly higher educated mothers than those with worse outcomes (GOS III and IV): graduation from high school 59% and 21% respectively (p=0.006). This study highlights the high rate of severe sequelae and health care needs several years post-AHT, and emphasizes the need for extended follow-up of medical, cognitive and academic outcomes. PMID:26299396

  20. Experience on treatment of 200 cases with blunt abdominal trauma by integrated Chinese and western medicine%闭合性腹部创伤200例中西医诊疗体会

    Institute of Scientific and Technical Information of China (English)

    兰文贤

    2014-01-01

    目的:观察200例闭合性腹部损伤患者的中西医疗效。全面系统的体格检查。腹腔穿刺应作为常规首选的检查手段。腹部闭合创伤的治疗应遵循的原则是分秒必争、争取时机;细致探查、避免遗漏;遵循原则、处理果断;积极正确处理合并伤。闭合性腹部创伤术后功能恢复,早期可灌注以补益气血,逐癖通腑为治则的固脱清腑汤。%Objective: To observe the traditional Chinese and Western medical treatment effect of 200 cases of closed abdominal injury. A comprehensive system of physical examination. Abdominal paracentesis should be used as the preferred means of conventional check. Treatment of closed abdominal trauma should abide by the principle of count every minute and second, strive for the opportunity;detailed exploration, avoid missing; follow the principles, processes decisively; positive and correct treatment of associated injury. Functional recovery after blunt abdominal trauma, early reperfusion by replenishing qi and blood, by addiction Tongfu to treat solid De Qing Fu decoction.

  1. Delayed post-traumatic spinal cord infarction in an adult after minor head and neck trauma: a case report

    Directory of Open Access Journals (Sweden)

    Bartanusz Viktor

    2012-09-01

    Full Text Available Abstract Introduction Delayed post-traumatic spinal cord infarction is a devastating complication described in children. In adults, spinal cord ischemia after cardiovascular interventions, scoliosis correction, or profound hypotension has been reported in the literature. However, delayed spinal cord infarction after minor head trauma has not been described yet. Case presentation We report the case of a 45-year-old Hispanic man who had a minor head trauma. He was admitted to our hospital because of paresthesias in his hands and neck pain. A radiological workup showed cervical spinal canal stenosis and chronic cervical spondylotic myelopathy. Twelve hours after admission, our patient became unresponsive and, despite full resuscitation efforts, died. The autopsy revealed spinal cord necrosis involving the entire cervical spinal cord and upper thoracic region. Conclusions This case illustrates the extreme fragility of spinal cord hemodynamics in patients with chronic cervical spinal canal stenosis, in which any further perturbations, such as cervical hyperflexion related to a minor head injury, can have catastrophic consequences. Furthermore, the delayed onset of spinal cord infarction in this case shows that meticulous maintenance of blood pressure in the acute post-traumatic period is of paramount importance, even in patients with minimal post-traumatic symptoms.

  2. Indicadores clínicos e pré-hospitalares de sobrevivência no trauma fechado: uma análise multivariada Indicadores clínicos y prehospitalarios de supervivencia al trauma cerrado: un análisis multivariado Clinical and prehospital survival indicators in blunt trauma: a multivariate analysis

    Directory of Open Access Journals (Sweden)

    Marisa Aparecida Amaro Malvestio

    2010-06-01

    protector en todos los períodos. Los resultados sugieren que la magnitud de la hipoxemia y la inestabilidad hemodinámica debida a la hemorragia influyeron de manera significativa en la muerte temprana y tardía en este grupo de víctimas.The aim of the study was to identify the clinical and prehospital indicators associated to the survival of blunt trauma victims. The Kaplan Meier survival analysis and the Cox proportional hazards model were used to analyze the association of 33 variables to early and late death, proposing multivariate models. The final models until 48 hours post-trauma showed high rates of risk promoted by abdominal injuries, Injury Severity Score > 25, advanced respiratory procedures and prehospital chest compressions. In the model up to 7 days, a systolic blood pressure in accident site lower than 75mmHg was associated with increased risk of death, and if absent it was associated with higher risk of death after 7 days. The prehospital volume replacement showed a protective effect in all periods. Results suggest that the magnitude of hypoxemia and hemodynamic instability due to bleeding had a significant influence on early and late death in this group of victims.

  3. Medical, social and societal issues in infants with abusive head trauma.

    LENUS (Irish Health Repository)

    Koe, S

    2010-04-01

    Abusive head trauma (AHT) is the leading cause of death from traumatic brain injury in under 2 year olds. AHT presents with acute encephalopathy, subdural hemorrhages and retinal hemorrhages occurring in the context of an inappropriate or inconsistent history. We retrospectively analyzed, over a 10 year period, admissions and transfers to our hospital with suspected AHT to assess patterns of presentation, presenting symptoms, investigations, subsequent confirmation, social work input and both neurological and social outcomes. We analyzed all suspected AHT infants and children looking for the time of presentation, presenting symptoms, caregivers concerns prior to presentation, a family profile including stressors, investigations (in particular neuroradiology and ophthalmology assessments), treatment in hospital, length of stay in hospital, social work involvement, subsequent discharge, neurological outcome and subsequent social work follow up. Data was collected from the hospital HIPE system, RIS (radiology reports system) and records from the social work department from a period October 1998 to January 2009 inclusive. Of 22 patients with confirmed AHT, ages seizures and irritability followed by vomiting, poor feeding, a bulging fontanelle and lethargy. The father was the sole minder in 5 cases. There was a delayed history in 4 cases. One had multiple visits to his GP. All cases had subdural hemorrhages proven by either CT or MRI scans and retinal hemorrhages diagnosed by ophthalmology. One infant presented with a torn frenulum. Four had suspicious bruising. All had normal coagulation profiles, skeletal surveys and extensive metabolic tests. Hospital stays ranged from 1 to 124 days (the median was 28 days and mean 33 days). Ten (45%) infants required ventilatory support. Sixteen infants had social work involvement within 4 days of admission (7 of these were interviewed immediately). Outcomes after case conferences were that 6 returned home with parents, 9 were

  4. A Comparative Study of SPECT, q-EEG and CT in Patients with Mild, Acute Head Trauma

    International Nuclear Information System (INIS)

    Functional cerebral impairments have been verified objectively by brain SPECT and q-EEG (quantitative electroencephalography). Microcerebral circulatory defects without anatomical changes cannot be detected by the brain CT or MRI. Brain SPECT using 99mTc-HMPAO (Hexamethyl propyleneamine oxime) as a key radioisotope may be accepted as the useful method for identifying functional cerebral impairments. We studied 25 patients with mild head trauma to define whether the SPECT was helpful in detecting cerebral impairment. The SPECT was positive in 23 patients out of 25, q-EEG positive in 16 patients and brain CT was positive in 3 cases. SPECT and q-EEG were more sensitive than CT. SPECT would be more useful method than brain CT to investigate cerebral function after head injury

  5. 急诊超声检查在腹部闭合性损伤诊断中的应用价值%Value of Emergency Ultrasonography in Diagnosis of Blunt Abdominal Trauma

    Institute of Scientific and Technical Information of China (English)

    吴隽; 李毅; 徐俊; 陈旭东; 赖会君

    2016-01-01

    Objective:To explore the value of emergency ultrasonography in diagnosis of bluntabdominal injury. Methods:Emergency ultrasonography was used in102 patients with blunt abdominal traumain emergency department. The abnormal changes of the sound and image of the abdomen were observed,paying equal attention to free intraperitoneal fluid and gas. Results: All patients were proved by CT examinationor surgical operation.The emergency ultrasonography identified 87(85.3%)patients with blunt abdominal injury,of whom 93 patients with solid organ injury and 9 patients with hollow organ injury.The accordance rate of diagnosis in the solid organs was significantly higher than that in the hollow organs (89.2% vs 44.4%,P<0.01). Conclusion: Emergency ultrasonographycan show high diagnosis accordance rate in abdominal solid organ injury after blunt abdominal trauma. Thus ,it is of great value in clinical application.%目的:探讨急诊超声检查在腹部闭合性损伤诊断中的应用价值。方法:对我院102例腹部闭合性损伤患者进行急诊超声检查,观察腹部脏器声像图有无异常改变,并重视观察腹腔内有无游离液体及气体。结果:所有患者均经CT检查或手术证实,超声诊断总体符合率85.3%(87/102),其中实质性脏器损伤93例,空腔脏器损伤9例,实质性脏器损伤诊断符合率明显高于空腔脏器损伤(89.2% vs44.4%,P<0.01)。结论:对腹部闭合性损伤尤其是实质性脏器损伤,急诊超声检查诊断符合率高,具有较好的临床应用价值。

  6. COMPARATIVE ROLE AND EVALUATION OF ULTRASOUND AND MULTISLICE COMPUTED TOMOGRAPHY IN THE GRADING OF HEMOPERITONEUM IN PATIENTS WITH ACUTE BLUNT ABDOMINAL TRAUMA AND ITS CORRELATION WITH THE GRADING OF ORGAN INJURY

    Directory of Open Access Journals (Sweden)

    Kunwarpal

    2015-06-01

    Full Text Available AIMS AND OBJECTIVES: 1. To assess the role of Ultrasound (US and Multislice Computed Tomography (MSCT in detecting hemoperitoneum in patients with acute blunt abdominal trauma. 2. To study the use of US and MSCT in grading of hemoperitoneum in blunt abdominal trauma patients. 3. To compare the US and MSCT grading of hemoperitoneum with the grading of organ injury. 4. To compare and statistically analyze the spectrum of findings observed in each modality. MATERIAL AND METHODS: The study was conducted at advanced diagnostics and institute of imaging , Amritsar. The study comprised of 50 patients who were stable enough to undergo both US and CT scans.US was preceded by MSCT in most of the patients and the time gap between the imaging modalities was less than 1 hour to make the study comparable. TECHNIQUES ADOPTED : 1. US was performed on Versa plus (Siemens and Xario (Toshiba with Cardiac , 3.5 - 5 Mhz - Convex and 5 - 7.5 Mhz - Line ar probes. Particular attention was paid to the amount of free fluid in the abdomen and pelvis. 2. MSCT was performed with MSCT Volume Zoom (Siemens Forchheim Germany AG. 500 - 1000cc of water orally or through nasogastric tube was given 15 - 20 minutes before the study , followed by 120cc I/V contrast at the rate of 2 - 3ml/second using power injector. Parameters used: Single breath hold ; A. 165 mAs . B. 120 kvp . C. Scan delay - 40 seconds . D. Collimation - 4x2.5mm . E. Pitch - 5mm . Following findings were observed : a. Presence of peritoneal fluid. B. Any tear or hematoma in the solid abdominal organs like spleen and liver. C. Status of hollow viscera like small bowel , large bowel and urinary bladder. Hemoperitoneum was scored on both US and MSCT. Visceral injuries were graded according to O.I.S grading system. Score was correlated with the underlying organ injury and the management of the patient. US scoring (Table A and MSCT quantification of hemoperitoneum was done. (Table B Location of hemoperitoneum . A

  7. The usefulness of diffusion tensor imaging in detection of diffuse axonal injury in a patient with head trauma

    Institute of Scientific and Technical Information of China (English)

    Hyeok Gyu Kwon; Sung Ho Jang

    2012-01-01

    Diffuse axonal injury is the predominant mechanism of injuries in patients with traumatic brain injury. Neither conventional brain computed tomography nor magnetic resonance imaging has shown sufficient sensitivity in the diagnosis of diffuse axonal injury. In the current study, we attempted to demonstrate the usefulness of diffusion tensor imaging in the detection of lesion sites of diffuse axonal injury in a patient with head trauma who had been misdiagnosed as having a stroke. A 44-year-old man fell from a height of about 2 m. Brain magnetic resonance imaging (32 months after onset) showed leukomalactic lesions in the isthmus of the corpus callosum and the left temporal lobe. He presented with mild quadriparesis, intentional tremor of both hands, and trunkal ataxia. From diffusion tensor imaging results of 33 months after traumatic brain injury onset, we found diffuse axonal injury in the right corticospinal tract (centrum semiovale, pons), both fornices (columns and crus), and both inferior cerebellar peduncles (cerebellar portions). We think that diffusion tensor imaging could be a useful tool in the detection of lesion sites of diffuse axonal injuryin patients with head trauma.

  8. 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.

  9. Abdominal trauma

    International Nuclear Information System (INIS)

    Abdominal injury is an important cause of morbidity and mortality in childhood. Ten percent of trauma-related deaths are due to abdominal injury. Thousands of children are involved in auto accidents annually; many suffer severe internal injury. Child abuse is a second less frequent but equally serious cause of internal abdominal injury. The descriptions of McCort and Eisenstein and their associates in the 1960s first brought to attention the frequency and severity of visceral injury as important manifestations of the child abuse syndrome. Blunt abdominal trauma often causes multiple injuries; in the past, many children have been subjected to exploratory surgery to evaluate the extent of possible hidden injury. Since the advent of noninvasive radiologic imaging techniques including radionuclide scans and ultrasound and, especially, computed tomography (CT), the radiologist has been better able to assess (accurately) the extent of abdominal injury and thus allow conservative therapy in many cases. Penetrating abdominal trauma occurs following gunshot wounds, stabbing, and other similar injury. This is fortunately, a relatively uncommon occurrence in most pediatric centers and will not be discussed specifically here, although many principles of blunt trauma diagnosis are valid for evaluation of penetrating abdominal trauma. If there is any question that a wound has extended intraperitonelly, a sinogram with water-soluble contrast material allows quick, accurate diagnosis. The presence of large amounts of free intraperitoneal gas suggests penetrating injury to the colon or other gas-containing viscus and is generally considered an indication for surgery

  10. Experience in the surgical treatment of 16 cases of cardiac rupture caused by blunt chest trauma%闭合性胸部外伤致心脏破裂16例

    Institute of Scientific and Technical Information of China (English)

    李晓峰; 马建欣; 刘建伟; 雷威

    2012-01-01

    Objective To retrospectively analyze the experience in the treatment of cardiac rupture caused by blunt chest trauma and to explore the approaches and methods to improve patient survival.Methods From 2004 to 2010,16 cases of closed chest trauma caused by cardiac rupture,who were treated in our hospital,were treated by heart repair using median sternotomy incision approach.Results Except for 1 patient occurred cardiac arrest before the establishment of CPB,who was failed for cardiopulmonary resuscitation after surgical repair,the remaining 15 patients were all successfully treated.Conclusion The diagnosis of cardiac rupture should be made as soon as possible once it occurs.Timely and decisive rescue and emergency surgery should be given.Heart repair can greatly improve the patient's survival.%目的 探讨闭合性胸部外伤致心脏破裂的手术抢救入路与方法.方法 2004年1月至2010年12月我院抢救闭合性胸部外伤致心脏破裂患者16例,均采用胸骨正中切口行心脏破裂修补术,分析其效果.结果 除1例在体外循环建立前出现心跳停止、手术修补后心肺复苏失败外,余15例全部救治成功.结论 闭合性胸部外伤致心脏破裂应及时果断进行抢救和急诊手术,心脏破裂修补术可以提高患者的存活率.

  11. Correção de aneurisma do tronco braquiocefálico, 10 anos após traumatismo torácico fechado Correction of an innominate artery aneurysm, 10 years after a blunt chest trauma

    Directory of Open Access Journals (Sweden)

    José Almeida Lopes

    2012-03-01

    Full Text Available Aneurismas do tronco braquiocefálico são extremamente raros. Os autores apresentam o caso clínico de um doente de 22 anos de idade, com antecedente de atropelamento de alta energia há cerca de 10 anos por motociclo, com traumatismo toraco-abdominal anterior, em quem foi acidentalmente descoberto um aneurisma do tronco braquiocefálico com 52mm. Para a exclusão do referido aneurisma o doente foi submetido com sucesso à construção de um bypass aorta ascendente-carotídio-subclávio com prótese bifurcada de Dacron® (14x7mm, com abordagem por esternotomia mediana, cervical e supra-clavicular. É feita uma revisão da literatura, sendo descritas e discutidas as características clínicas, o tratamento cirúrgico e o mecanismo de traumatismo torácico sobre o tronco braquiocefálico.Innominate artery aneurysms are extremely rare. The authors present a case report of a 22-year-old patient, in whom was accidently discovered an innominate artery aneurysm of 52 mm, 10 years after a blunt thoraco-abdominal trauma caused by a high energy running over by a motorcycle. For the exclusion of the aneurysm, the patient was successfully submitted to the construction of an ascending aorta-carotid-subclavian bypass with bifurcated Dacron® graft (14x7mm, by means of a median sternotomy, right cervical and supra-clavicular approaches. Review of the literature, clinical features, surgical treatment and chest trauma mechanisms over the innominate artery are described and discussed.

  12. 损伤控制外科在闭合性胰腺创伤中的应用%Damage control surgery for pancreatic injuries after blunt abdominal trauma

    Institute of Scientific and Technical Information of China (English)

    赵振国; 李幼生; 王剑; 李刚; 王凯; 胥子玮; 郑磊; 李宁; 黎介寿

    2012-01-01

    Objective To summarize the management of pancreatic injuries after blunt abdominal trauma.Methods The clinical data of 42 patients with blunt pancreatic injury admitted from January 2001to December 2010 was analyzed retrospectively.There were 38 male and 4 female patients,aging from 13 to 65 ycars with a mean of 31 years.The organ injury scaling of Committee of the American Association for the Surgery of Trauma (AAST grade):grade Ⅰ in 3 patients,grade Ⅱ in 12 patients,grade Ⅲ in 9 patients,grade Ⅳ in 13 patients and grade Ⅴ in 5 patients.The mean injury severity score was 27 ± 21.Patients above AAST grade Ⅱ underwent peritoneal drainage and "three neostomy" (gastrostomy,jejunostomy and gallbladder) according to damage control theory.Results Thirty-eight patients got abdominal CT scanning with a positive rate of 79.9% (30/38).Forty patients underwent surgical procedures,and 2 patients with non-operative management.The surgical procedures include peritoneal drainage and "three neostomy" in 32patients,pancreas suture or pancreatic tail resection in 6 patients,pancreatoduodenectomy or caudal pancreaticojejunostomy in 2 patients.Forty patients (95.2%) survived,2 patients (4.8% ) died and 16patients (38.1% ) had complications such as pancreatic fistula,pulmonary infection.Conclusions Abdominal CT scanning will benefit the preoperative diagnosis of blunt pancreatic trauma. Although the survival rate of patients with blunt pancreatic trauma might be improved by using the damage control surgery,the management of damage control surgery also needs to be modified because of the high rate of complications.%目的 总结闭合性胰腺创伤的外科治疗经验.方法 回顾性分析2001年1月至2010年12月收治的42例闭合性胰腺创伤患者的临床资料.其中男性38例,女性4例;年龄13~65岁,平均年龄31岁.根据美国创伤外科协会脏器损伤委员会(AAST)的器官损伤分级:Ⅰ级3例,Ⅱ级12例,Ⅲ级9例,Ⅳ级13

  13. Mortality Factors in Geriatric Blunt Trauma Patients: Creation of a Highly Predictive Statistical Model for Mortality Using 50,765 Consecutive Elderly Trauma Admissions from the National Sample Project

    Science.gov (United States)

    HRANJEC, TJASA; SAWYER, ROBERT G.; YOUNG, JEFFREY S.; SWENSON, BRIAN R.; CALLAND, JAMES F.

    2013-01-01

    Elderly patients are at high risk for mortality after injury. We hypothesized that trauma benchmarking efforts would benefit from development of a geriatric-specific model for risk-adjusted analyses of trauma center outcomes. A total of 57,973 records of elderly patients (age older than 65 years), which met our selection criteria, were submitted to the National Trauma Database and included within the National Sample Project between 2003 and 2006. These cases were used to construct a multivariable logistic regression model, which was compared with the American College of Surgeons Committee on Trauma’s Trauma Quality Improvement Project’s (TQIP) existing model. Additional spline regression analyses were performed to further objectively quantify the physiologic differences between geriatric patients and their younger counterparts. The geriatric-specific and TQIP mortality models shared several covariates: age, Injury Severity Score, motor component of the Glasgow Coma Scale, and systolic blood pressure. Our model additionally used temperature and the presence of mechanical ventilation. Our geriatric-specific regression mode generated a superior c-statistic as compared with the TQIP approximation (0.85 vs 0.77; P = 0.048). Spline analyses demonstrated that elderly patients appear to be less likely to tolerate relative hypotension with higher observed mortality at initial systolic blood pressures of 90 to 130 mmHg. Although the TQIP model includes a single age component, these data suggest that each variable needs to be adjusted for age to more accurately predict mortality in the elderly. Clearly, a separate geriatric model for predicting outcomes is not only warranted, but necessary. PMID:23265126

  14. Hyperglycemia in pediatric head trauma patients: a cross-sectional study Hiperglicemia em pacientes pediátricos com traumatismo craniencefálico: estudo de corte transversal

    Directory of Open Access Journals (Sweden)

    José Roberto Tude Melo

    2009-09-01

    Full Text Available OBJECTIVE: To verify the prevalence of acute hyperglycemia in children with head trauma stratified by the Glasgow coma scale (GCS. METHOD: A prospective cross-sectional study carried out with information from medical records of pediatric patients presenting with head injury in the emergency room of a referral emergency hospital during a one year period. We considered the cut-off value of 150 mg/dL to define hyperglycemia. RESULTS: A total of 340 children were included and 60 (17.6% had admission hyperglycemia. Hyperglycemia was present in 9% of mild head trauma cases; 30.4% of those with moderate head trauma and 49% of severe head trauma. We observed that among children with higher blood glucose levels, 85% had abnormal findings on cranial computed tomography scans. CONCLUSION: Hyperglycemia was more prevalent in patients with severe head trauma (GCS OBJETIVO: Verificar a prevalência de hiperglicemia aguda em crianças vítimas de trauma craniencefálico, de acordo com a escala de coma de Glasgow (GCS. MÉTODO: Estudo prospectivo, de corte transversal realizado por meio do acompanhamento de prontuários médicos de pacientes na faixa etária pediátrica admitidos na unidade de urgência de um hospital de referência vítimas de traumatismo craniencefálico, durante um ano. Consideramos o valor de corte em 150 mg/dL para definição de hiperglicemia. RESULTADOS: 340 crianças foram incluídas no estudo e 60 (17,6% apresentaram hiperglicemia na admissão. Hiperglicemia esteve presente em 9% dos casos de trauma craniano leve, 30,4% daqueles com trauma craniano moderado e em 49% dos pacientes com trauma craniano grave. Verificamos que, entre as crianças com níveis elevados de glicemia, 85% apresentavam alterações radiológicas verificadas na tomografia computadorizada do crânio. CONCLUSÃO: A hiperglicemia foi mais prevalente em pacientes com traumatismo craniano grave (GCS <8, assim como naqueles com alterações identificadas na tomografia

  15. 高压氧综合治疗中、重度颅脑外伤68例%Effect of hyperbaric oxygen in the treatment of moderate and severe head trauma in 68 cases

    Institute of Scientific and Technical Information of China (English)

    周宏图; 王建宏; 袁建国; 张雪春

    2003-01-01

    @@ INTRODUCTION Neurotrophic drugs,resting treatment,and proper physical therapy are generally suggested for rehabilitation after head trauma.In recent years,hyperbaric oxygen a new,safe and effective therapy had been used for rehabilitation following head trauma,which is safe,and effective.

  16. [First manic episode in the elderly--consider a subdural haematoma due to head trauma as cause].

    Science.gov (United States)

    Marijnissen, Radboud M; Bakker, Miranda; Stek, Max L

    2010-01-01

    A manic episode in old age presents a diagnostic challenge to the clinician due to the different symptomatology often difficult to distinguish from delirium, dementia, agitated depression and psychosis. To complicate matters further, a first episode of mania in later life is very often based on underlying physical and cerebral pathology ('secondary mania'). Many causes of 'secondary mania', including neurological, systemic or endocrine diseases, infections, intoxications, apnoea, post-thoracic surgery and vitamin B12 deficiency have been described to date, but there have been no reports on subdural haematomas in this context. However, the elderly are more prone to subdural haematomas following head trauma than younger patients. We present two case reports of older patients with a first manic episode in later life probably caused by subdural haematomas. A first episode of mania in later life always requires thorough assessment of the patient to determine physical and cerebral pathology. PMID:20456795

  17. Imaging of bridging vein thrombosis in infants with abusive head trauma: the ''Tadpole Sign''

    Energy Technology Data Exchange (ETDEWEB)

    Hahnemann, Maria L.; Kinner, Sonja; Schweiger, Bernd [University Hospital Essen, Institute of Diagnostic and Interventional Radiology and Neuroradiology, Essen (Germany); Bajanowski, Thomas [University Hospital Essen, Institute of Legal Medicine, Essen (Germany); Karger, Bernd; Pfeiffer, Heidi; Wittschieber, Daniel [University Hospital Muenster, Institute of Legal Medicine, Muenster (Germany)

    2014-10-03

    Abusive head trauma (AHT) in infants is usually diagnosed using a multi-disciplinary approach by investigating the circumstances and identifying morphological indicators, for example, subdural hematomas (SDHs), subdural hygromas (SDHys), retinal haemorrhages and encephalopathy. The present morphological study investigates the incidence, radiological characteristics and non-radiological co-factors of bridging vein thrombosis (BVT) in infants with AHT. From 2002 to 2013, computed tomography (CT) and magnetic resonance imaging (MRI) material of 628 infants aged 0-2 years were analysed retrospectively. If available, medicolegal expert opinions were additionally considered. Cases with SDHs and/or SDHys were identified and systematically evaluated as to the presence and characteristics of BVT. SDHs and/or SDHys were present in 29 of the 81 cases exhibiting morphological abnormalities in the initial CT. Among these, 11 cases (40 %) had BVT (mean age = 5.0 months). BVT could be best depicted in the T1-weighted spin echo and T2*/susceptibility-weighted MRI. In one case, BVT could be depicted indirectly using time-of-flight MR venography. The predominant (73 %) BVT shape was found to be tadpole-like (''Tadpole Sign''). In the absence of appropriate accidental trauma, BVT appears to be a strong indicator of AHT. Therefore, the BVT/Tadpole Sign represents compelling cause to search for other signs of AHT. (orig.)

  18. Cranioplasty of large cranial defect at an early stage after decompressive craniectomy performed for severe head trauma.

    Science.gov (United States)

    Liang, Wen; Xiaofeng, Yang; Weiguo, Liu; Gang, Shen; Xuesheng, Zheng; Fei, Cao; Gu, Li

    2007-05-01

    Large cranial defects resulting from decompressive craniectomy performed for refractory intracranial hypertension after head trauma is one of the indications for cranioplasty, and this procedure is commonly performed 3 months after craniectomy. However, the large cranial defect would lead to the kinds of complications early during the phase of these patients' recovery, which would go against rehabilitation. This study retrospectively reviewed 23 patients undergoing early cranioplasty (5-8 weeks after craniectomy) in the last 4 years with a detailed choice of patients, outcome of complications after head trauma and large craniectomy, as well as assessment of prognosis. The early outcome (1 month later) revealed most of the patients who had conscious disturbance before the cranioplasty recovered their consciousness and presented an improved neurologic function. The long-dated prognosis (18 months later) revealed that 17 patients were good (independent patients) in this series (74%), whereas four patients survived with a severe disability (17%) and two remained in a vegetative state (9%). No dead patients or intracranial infection after the procedure were found in this study. Most patients' complications were relieved after the cranioplasty with improvements of symptoms or image of computed tomography scan. In conclusion, we consider that with the appropriate choice of patients and materials, early cranioplasty for large cranial defects after decompressive craniectomy would be safe and helpful for the improvement of patients' neurologic function and prognosis. To our knowledge, this series may be the first detailed report in English about early cranioplasty after decompressive craniectomy. We are going to perform prospective and retrospective contrastive studies to further confirm the effects of this procedure on the patients with large cranial defects after decompressive craniectomy. PMID:17538313

  19. Identification with School and Head Trauma: Parental Perceptions on Students' Experiences

    Science.gov (United States)

    Jones, BreAnna; Robinson, Lindsay; Larwin, Karen H.

    2015-01-01

    In the United States 40% of all traumatic brain injuries (TBI) are in children under the age 14. This means a portion of the school age population is exposed to head injury every year. The effect this injury and experience can have on a child varies, but it is important for educators, counselors, and family to understand the psychosocial…

  20. Assessment of Factors Resulting in Abuse Evaluations in Young Children with Minor Head Trauma

    Science.gov (United States)

    Anderst, James D.

    2008-01-01

    Objective: The primary objective was to determine which of the examined factors prompted physicians to initiate a further abuse evaluation in young children with minor head injury. The recording of important historical elements in the charts of these patients was also evaluated. Methods: Charts of 349 children less than 3 years of age with minor…

  1. Factors predicting early outcome in patients admitted at emergency department with severe head trauma

    Institute of Scientific and Technical Information of China (English)

    Rejeb Belfekih Imen; Chakroun Olfa; Chtara Kamilia; Boujelbene Meriam; Ksibi Hichem; Chaari Adel; Bahloul Mabrouk; Rekik Noureddine

    2015-01-01

    Objective:To determine predictive factors of early mortality among severe traumatic brain injury in emergency department. Methods: This study is based on a retrospective analysis of 198 admitted in emergency depatment with severe head injury (Glasgow coma scale score≤8) of an university hospital (Sfax, Tunisia). Basic demographic, clinical, biological and radiological data were recorded on admission and during emergency department stay. Results: Forty two patients were died. Univariate analysis showed that the presence of shock, cardiac arrest, bilateral mydriasis, high value of injury severity score and low value of Glasgow coma scale were associated with mortality. Moreover, meningeal hemorrhage, cerebral and subdural haematoma were associated with poorer outcome. Multivariate analysis showed that factors associated with a poor prognosis were cardiac arrest cerebral and the presence of cerebral haematoma. Conclusions: Improving pre-hospital care and ovoid futile resuscitation to given priority in resource allocation and urgent CT scan of the head to look for operable mass lesions as early detection should improve the prognosis of severe head injury at emergency department.

  2. Computed tomography following paediatric head injury. Computertomographische Verlaufskontrollen nach Schaedel-Hirn-Trauma im Kindesalter

    Energy Technology Data Exchange (ETDEWEB)

    Dietrich, U. (Klinikum Essen (Germany, F.R.). Roentgendiagnostisches Zentralinstitut); Lins, E.; Rembrink, K. (Duesseldorf Univ. (Germany, F.R.). Neurochirurgische Klinik)

    1989-08-01

    38 children with moderate and severe head injuries had CT follow-ups. On initial scans combined lesions dominated over diffuse (diffuse swelling, subarachnoid haemorrhage) and focal lesions (focal swelling, contusions). Contusion showed up until the 6th day after the accident. Two cases of focal lesions could be demonstrated only after intravenous contrast. Up to 40% of the children developed hypodense extracerebral accumulations. Long-term CT follow-ups showed ventricular (84%) and sulcal enlargement (63%) as well as hypodense parenchymal lesions (50%). Combined and diffuse lesions showed a correlation of initial scans and long-term follow-up which could not be demonstrated in case of focal lesions. (orig.).

  3. Sonography of scrotal trauma

    Directory of Open Access Journals (Sweden)

    Meka Srinivasa Rao

    2012-01-01

    Full Text Available The purpose of this article is to depict the spectrum of scrotal injuries in blunt trauma. Scrotal injuries are not very common and are mostly due to blunt trauma from direct injury, sports injuries or motor vehicle accidents. To minimize complications and ensure testicular salvage, rapid and accurate diagnosis is necessary. High-resolution USG is the investigation of choice, as it is readily available, accurate and has been seen to improve outcomes. An understanding of and familiarity with the sonographic appearance of scrotal injuries on the part of the radiologist/sonographer is therefore of key importance.

  4. Validation of CRASH Model in Prediction of 14-day Mortality and 6-month Unfavorable Outcome of Head Trauma Patients

    Science.gov (United States)

    Hashemi, Behrooz; Amanat, Mahnaz; Baratloo, Alireza; Forouzanfar, Mohammad Mehdi; Rahmati, Farhad; Motamedi, Maryam; Safari, Saeed

    2016-01-01

    Introduction: To date, many prognostic models have been proposed to predict the outcome of patients with traumatic brain injuries. External validation of these models in different populations is of great importance for their generalization. The present study was designed, aiming to determine the value of CRASH prognostic model in prediction of 14-day mortality (14-DM) and 6-month unfavorable outcome (6-MUO) of patients with traumatic brain injury. Methods: In the present prospective diagnostic test study, calibration and discrimination of CRASH model were evaluated in head trauma patients referred to the emergency department. Variables required for calculating CRASH expected risks (ER), and observed 14-DM and 6-MUO were gathered. Then ER of 14-DM and 6-MUO were calculated. The patients were followed for 6 months and their 14-DM and 6-MUO were recorded. Finally, the correlation of CRASH ER and the observed outcome of the patients was evaluated. The data were analyzed using STATA version 11.0. Results: In this study, 323 patients with the mean age of 34.0 ± 19.4 years were evaluated (87.3% male). Calibration of the basic and CT models in prediction of 14-day and 6-month outcome were in the desirable range (P < 0.05). Area under the curve in the basic model for prediction of 14-DM and 6-MUO were 0.92 (95% CI: 0.89-0.96) and 0.92 (95% CI: 0.90-0.95), respectively. In addition, area under the curve in the CT model for prediction of 14-DM and 6-MUO were 0.93 (95% CI: 0.91-0.97) and 0.93 (95% CI: 0.91-0.96), respectively. There was no significant difference between the discriminations of the two models in prediction of 14-DM (p = 0.11) and 6-MUO (p = 0.1). Conclusion: The results of the present study showed that CRASH prediction model has proper discrimination and calibration in predicting 14-DM and 6-MUO of head trauma patients. Since there was no difference between the values of the basic and CT models, using the basic model is recommended to simplify the risk

  5. The spectrum of agricultural trauma.

    Science.gov (United States)

    Cogbill, T H; Busch, H M

    1985-01-01

    During the past 6 years, 375 patients were hospitalized with injuries resulting from farm accidents. The mechanism of injury was farm animal in 135 patients (36%), tractor in 89 (24%), corn picker or auger in 57 (15%), power take-off in 29 (8%), other farm machinery in 50 (13%), and miscellaneous in 15 (4%). Injury severity score (ISS) of 25 or greater was calculated for 29 individuals (8%). Eleven groups of surgical subspecialists performed 539 procedures. Eight patients (2.1%) died as a result of their injuries. All eight deaths occurred after tractor accidents secondary to pelvic fractures, head and spinal cord injury, or blunt chest trauma. Thirty-nine patients (10%) were left with serious permanent disability. Unnecessary morbidity and mortality in many cases were attributed to excessive prehospital care times within a largely rural area. Better prevention by farmer education and the initiation of mandatory safety devices on agricultural equipment may lower the incidence of farm accidents. Major agricultural trauma is frequent and diverse and is optimally managed in a regional trauma center. PMID:4093573

  6. 川芎嗪干预钝性肺挫伤急性期大鼠肺组织细胞的凋亡*%Ligustrazine prevents lung cell apoptosis in the acute stage of pulmonary contusion induced by blunt chest trauma

    Institute of Scientific and Technical Information of China (English)

    曹晨; 邓应忠; 郑明安; 刘芳; 孟庆涛

    2013-01-01

      背景:急性胸部撞击后所致的肺挫伤(钝性肺挫伤)常引起呼吸功能异常和继发性炎性反应,并参与全身炎性反应综合征和多器官功能障碍综合征,其发病原因及致病机制亟待明确。目的:观察胸部撞击所致钝性肺挫伤急性期细胞凋亡的变化及其川芎嗪对其的影响。方法:健康雄性 SD 大鼠随机分为正常对照组、模型组、川芎嗪治疗组,后两组制备胸部撞击伤模型,川芎嗪治疗组建模后立即腹腔注射川芎嗪80 mg/kg 1次。在创伤发生后1,2,3 h 观察肺组织病理形态学及细胞凋亡的改变、检测肺水肿程度和肺血管通透性改变,免疫组织化学检测肺组织 Bcl-2、Bax和 Caspase-3的表达及血液中肿瘤坏死因子α水平变化。结果与结论:模型组肿瘤坏死因子α水平在创伤后1 h 即显著增加,创伤后2 h 及3 h 间急剧增加(P <0.05);创伤后2 h 及3 h 肺组织细胞凋亡指数及肺组织损伤程度显著增高(均 P <0.05);肺血管通透性及肺水肿程度增加(P <0.05);Caspase-3表达显著增高(P <0.05),Bcl-2/Bax 比值显著降低(P <0.05)。川芎嗪治疗组在相应时间点相对于模型组肿瘤坏死因子α水平显著降低(P <0.05),肺组织内细胞凋亡指数及肺组织损伤程度降低(P <0.05),肺血管通透性及肺水肿程度减轻(P <0.05);Caspase-3表达下降(P <0.05),Bcl-2/Bax 比值增加(P <0.01)。结果提示,川芎嗪可通过抑制肿瘤坏死因子α表达,下调 Caspase-3的表达并提高 Bcl-2/Bax 的比值,以降低胸部撞击所致肺组织急性期的异常凋亡并减轻胸部撞击所致急性期肺挫伤。%BACKGROUND: Pulmonary contusion induced by blunt chest trauma can result in respiratory dysfunction and secondary inflammatory reaction, which can take part in the occurrence of systemic inflammatory response syndrome and multiple-organ dysfunction syndrome. However, the reason and mechanism

  7. [Adrenal injury in blunt abdominal trauma].

    Science.gov (United States)

    Abakumov, M M; Smoliar, A N; Barmina, T G; Boĭko, A V; Shalimova, I G

    2009-01-01

    10 patients with adrenal damage were observed during 2.5 years. It amounted 0.93% of all patients with closed abdominal injuries. The right adrenal gland was traumatized in all cases evidently due to it's compression between right lobe of liver and vertebral column. Adrenal damage is observed quite often in combination with injuries of right liver lobe, right kidney and retroperitoneal hematoma formation. 5 patients underwent laparotomy on account of intra-abdominal bleeding, but adrenal damage was never revealed. Ultrasound and tomographic semiotics of adrenal damage was worked out, which allowed ascertaining diagnosis in 80% on application of ultrasound study and in 100% at computer tomography. Injury of one adrenal gland was not accompanied by adrenal failure and did not require hormonal replacement therapy.

  8. A response to Mimics of child abuse: Can choking explain abusive head trauma? [35 (2015) 33-37].

    Science.gov (United States)

    Galaznik, John G

    2016-04-01

    In the recently published article in this journal, "Mimics of Child Abuse: Can Choking Explain Abusive Head Trauma?",(1) the author chose to revisit a discussion prompted by a case report from 5 years ago which was inappropriate in his opinion. He went further to suggest that bringing an unvalidated mechanism of injury into the legal setting "obstructs justice", is a "further victimization of the child", and is a "travesty of justice".(1) Given the "Shaken Baby Syndrome: Rotational Cranial Injuries" has always been only an unvalidated hypothesis lacking experimental confirmation, the exploring of alternative injury mechanisms should be entirely appropriate. In 2010, the post publication discussion ended with a challenge to the American Academy of Pediatrics Committee on Child Abuse and Neglect (AAP COCAN) to either support the pure shaking mechanism with quality EBMS or eliminate any positive support for it from any official policy statement until the exact nature of each injury that pure abusive shaking has the potential to cause is clearly defined and supported with quality experimental research.(4) Since this is an area of acknowledged controversy by the AAP, it is appropriate to examine the evidence based experimental literature that has emerged over the last five years that is relevant to the abusive shaking hypothesis and the hypothesis of any primary brain-lethal hypoxic event leading to the findings of retinal hemorrhages, extra-axial bleeding, and brain injury when an infant presents to medical attention after an Acute/Apparent Life Threatening Event. In that light, this review was undertaken. PMID:26828828

  9. The epidemiology of renal trauma

    OpenAIRE

    Voelzke, Bryan B.; Leddy, Laura

    2014-01-01

    Introduction Nonoperative and minimally invasive management techniques for both blunt and penetrating renal trauma have become standard of care over the past decades. We sought to examine the modern epidemiology of renal trauma over the past decade. Methods A systematic review of PubMed from the past decade was conducted to examine adult and pediatric renal trauma. A total of 605 articles were identified. Of these, 15 adult and 5 pediatric articles met our a priori search criteria. Results Th...

  10. 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.

  11. Fatores prognósticos relacionados à falha do tratamento não-operatório de lesões esplênicas no trauma abdominal fechado Prognostic factors related to non surgical treatment failure of splenic injuries in the abdominal blunt trauma

    Directory of Open Access Journals (Sweden)

    Fábio Henrique de Carvalho

    2009-04-01

    Full Text Available OBJETIVO: Identificar fatores prognósticos relacionados com a falha do tratamento não-operatório (TNO de lesões esplênicas no trauma abdominal fechado. MÉTODOS: Análise prospectiva de 56 pacientes adultos submetidos à TNO e divididos em um grupo de sucesso e outro de falha, que foi definida como necessidade de laparotomia por qualquer indicação. As lesões foram diagnosticadas por tomografia computadorizada e classificadas de acordo com os critérios da AAST (American Association for Surgery of Trauma. Os parâmetros estudados foram: na admissão - pressão arterial sistólica, frequências cardíaca e respiratória, nível de consciência (Escala de Glasgow e RTS (Revised Trauma Score; durante a hospitalização - presença de lesões associadas, transfusão sanguínea e parâmetros hematológicos, tempo de internação e ISS (Injury Severity Score. RESULTADOS: As falhas do TNO (19,6% foram devidas à dor abdominal (45,4%, instabilidade hemodinâmica (36,4%, queda do volume globular associada a hematoma esplênico (9,1% e abscesso esplênico (9,1%. Não foram observadas diferenças entre os grupos de sucesso e de falha nos dados na admissão. A taxa de falha de acordo com o grau da lesão esplênica foi 0% nos graus I e II agrupados; 17,5% nos graus III e IV agrupados e 80% no grau V (p = 0,0008. O uso de hemoderivados foi maior e mais frequente no grupo de falha (p=0,05. As relação do ISS (Injury Severity Score com as taxas de falha foram 0% nos pacientes com ISS = 8; 15,9% nos com ISS entre 9 e 25, e 50% nos com ISS = 26 (p = 0,05. Não houve mortalidade e nem lesões de vísceras ocas despercebidas. CONCLUSÃO: O Injury Severity Score e grau da lesão esplênica relacionaram-se com a falha do tratamento não-operatório.OBJECTIVE: Identify prognostic factors related to treatment failure of blunt splenic injuries managed by non surgical treatment (NST. METHODS: Fifty six adult patients submitted to NST were prospectively studied

  12. Infarto do miocárdio causado por lesão arterial coronariana após trauma torácico fechado Infarto de miocardio causado por lesión arterial coronaria post traumatismo torácico cerrado Myocardial infarction caused by coronary artery injury after a blunt chest trauma

    Directory of Open Access Journals (Sweden)

    Márcio Silva Miguel Lima

    2009-07-01

    Full Text Available Relatamos o caso de um indivíduo do sexo masculino de 29 anos de idade, vítima de um acidente de carro no qual sofreu trauma torácico fechado, evoluindo com insuficiência cardíaca congestiva. O paciente apresentava boa saúde previamente, sem sintomas de doença cardiovascular. Na avaliação inicial, o eletrocardiograma mostrou ondas Q nas derivações precordiais e o ecocardiograma mostrou disfunção ventricular esquerda importante. A angiografia coronária mostrou uma lesão na artéria coronária descendente anterior esquerda (ADE, com acinesia da parede anterior na ventriculografia com contraste. A tomografia computadorizada por emissão de fóton único (SPECT com Tálio-201 não mostrou viabilidade. O paciente foi mantido em tratamento clínico com boa evolução.Relatamos el caso de un individuo del sexo masculino, de 29 años de edad, víctima de accidente automovilístico en el cual sufrió traumatismo torácico cerrado, evolucionando con insuficiencia cardíaca congestiva. El paciente presentaba buena salud previamente, sin síntomas de enfermedad cardiovascular. En la evaluación inicial, el electrocardiograma mostró ondas Q en las derivaciones precordiales y el ecocardiograma mostró disfunción ventricular izquierda importante. La angiografía coronaria mostró una lesión en la arteria coronaria descendente anterior izquierda (ADI, con acinesia de la pared anterior en la ventriculografía de contraste. La tomografía computada por emisión de fotón único (SPECT con Talio-201 no mostró viabilidad. El paciente fue mantenido en tratamiento clínico con buena evolución.We report the case of a 29-year-old man, victim of a car accident, who suffered a severe blunt chest trauma, with evolving congestive heart failure. He had previously had a good overall health status, with no symptoms of cardiovascular disease. At the initial assessment, the electrocardiogram showed Q waves in the precordial leads and the echocardiogram

  13. 轻微头部外伤后头部CT扫描对神经外科手术的预测%After Minor Head Trauma Head CT Scan Predict for Neurosurgery

    Institute of Scientific and Technical Information of China (English)

    许俊华

    2015-01-01

    Objective: There continues to be an ongoing debate regarding the utility of Head CT scans in patients with a normal Glasgow Coma Scale (GCS) after minor head injury.The objective of this study is to determine patient and injury characteristics that predict a positive head CT scan or need for a Neurosurgical Procedure (NSP) among patients with blunt head injury and a normal GCS. Methods:Retrospective analysis of adult patients with a history of blunt head injury and a normal GCS,the primary outcomes were a positive head CT scan or a NSP.Multivariate logistic regression controlling for patient and injury characteristics was used to determine predictors of each outcome.Results:Total of 835 patients,250 (29.9%) had a positive head CT scan and 38 (9.9%)underwent a NSP.Older patients and patients with a history of fall (as compared to a motor vehicle crash) were more likely to have a positive finding on a head CT scan.Male patients,and those who presented with a fall were more likely to have a NSP.Conclusion:Older age,male gender,and mechanism of injury are significant predictors of a positive finding on head CT scans and the need for neurosurgical procedures.This study highlights patient and injury specific characteristics that may help in identifying patients with supposedly minor head injury who will benefit from a head CT scan.%目的:本研究的目的是确定钝性颅脑损伤及正常格拉斯哥昏迷评分(GCS)患者采用头部CT扫描预测采取神经手术操作(Neurosurgical Procedure,NSP)的必要。方法:回顾分析钝性颅脑损伤成人患者的临床资料,主要结局为阳性头部CT扫描或NSP。采用多变量回归分析分析损伤特征确定预测因素。结果:835例患者中,250例(29.9%)头部CT阳性,38例(9.9%)经历NSP。年龄更大及跌倒史患者(与效能事故比较)CT阳性的可能性更大。男性跌倒患者更可能经历NSP。结论:年龄较大,男性的性别、损伤的机制

  14. Green turtle head trauma with intracerebral hemorrhage: image diagnosis and treatment Traumatismo craniano com hemorragia intracerebral em tartaruga verde: diagnóstico por imagem e tratamento

    Directory of Open Access Journals (Sweden)

    Daphne Wrobel Goldberg

    2010-11-01

    Full Text Available Sea turtles are threatened to the point of extinction. The major goal of rehabilitating injured individuals is to eventually reintroduce them back into their habitat. Sea turtles are vulnerable to anthropogenic effects, and impact traumas are a common cause of death among these animals. Carapace and skull fractures are usually related to vessel collisions or propeller impacts. However, intentional traumas inflicted by humans are also considered as a potential threat. The purpose of this article is to describe the diagnosis and rehabilitation procedures of a juvenile green turtle (Chelonia mydas after severe head trauma with brain hemorrhage. The data presented here can be used as a reference for future cases of head trauma in chelonians.Tartarugas marinhas são animais ameaçados de extinção. Por isso, o principal objetivo em reabilitar indivíduos feridos é posteriormente reintroduzi-los em seu habitat. Quelônios marinhos apresentam grande vulnerabilidade a efeitos antropogênicos, e a ocorrência de traumatismos impactantes constituem uma importante causa de óbitos entre esses animais. Fraturas de carapaça e crânio estão normalmente associadas a colisões por embarcações. No entanto, lesões intencionais provocadas por humanos também podem ser consideradas ameaças em potencial. O objetivo deste estudo é descrever o diagnóstico e a reabilitação de um indivíduo jovem de tartaruga verde (C. mydas após traumatismo craniano severo com hemorragia cerebral. Os dados apresentados poderão ser utilizados como referências para casos futuros de traumatismos afetando a região da cabeça de quelônios.

  15. External air compression: A rare cause of blunt esophageal injury, managed by a stent

    Directory of Open Access Journals (Sweden)

    Mohammed Muneer

    2014-01-01

    CONCLUSION: High index of suspicion is needed for early diagnosis of esophageal perforation after blunt trauma. Appropriate drainage, antibiotic and temporary endoscopic esophageal stenting may be an optimal approach in selected patients, especially with delayed diagnosis.

  16. CLINICAL STUDY AND MANAGEMENT OF BLUNT INJURY ABDOMEN PERTAINING TO SOLID ORGANS

    Directory of Open Access Journals (Sweden)

    Katta Srinivasa

    2015-09-01

    Full Text Available Blunt Abdominal trauma is one of the most common causes among injuries caused mainly due to road traffic accidents. 1 The rapid increase in number of motor vehicles and its aftermath has caused rapid increase in number of victims to blunt abdominal trauma. Motor vehicle accidents account for 75 to 80% of blunt abdominal trauma. 2 Blunt injury of abdomen is also a result of fall from height, assault with blunt objects, industrial mishaps, sport injuries, bomb blast and fall from riding bicycle. 2 In view of increasing number of vehicles and consequently road traffic accidents, this topic is chosen to study the cases of blunt abdominal trauma with reference to the patients presenting at Govt. General Hospital, attached to Guntur Medical College, Guntur. OBJECTIVES: The objectives of the study are: 1. To evaluate the impact of blunt abdominal trauma on solid viscera. 2. To evaluate etiology and various modes of presentation. 3. To evaluate various available investigations for the detection of solid organ injuries. 4. To evaluate various modalities of treatment available with aim to reduce the mortality and morbidity. 5. To evaluate common complications of solid organ injury in blunt trauma abdomen. MATERIALS AND METHODS: Patients admitted in Government General Hospital, Guntur, from November 2012 to October 2014 and studied 50 cases. This is a prospective study conducted over 2 years. RESULTS: Male patients were commonly affected (80%, Peak age group being 21 – 30 years (48%. The commonest mode of injury was road traffic accident (58%. The common organ injured was spleen (54% followed by liver. 70% of the patients were treated by surgery, 30% conservatively. The mortality in this study was 14%. CONCLUSIONS : Blunt injury abdomen forms considerable load and health care system, most common age group is youngsters in road traffic accidents , so efforts should be made to formulate and execute road traffic regulations. Well established trauma care

  17. Trauma in pregnancy.

    Science.gov (United States)

    Oxford, Corrina M; Ludmir, Jonathan

    2009-12-01

    In the United States, trauma is the leading nonobstetric cause of maternal death. The principal causes of trauma in pregnancy include motor vehicle accidents, falls, assaults, homicides, domestic violence, and penetrating wounds. The managing team evaluating and coordinating the care of the pregnant trauma patient should be multidisciplinary so that it is able to understand the physiologic changes in pregnancy. Blunt trauma to the abdomen increases the risk of placental abruption. Evaluation of the pregnant trauma patient requires a primary and secondary survey with emphasis on airway, breathing, circulation, and disability. The use of imaging studies, invasive hemodynamics, critical care medications, and surgery, if necessary, should be individualized and guided by a coordinating team effort to improve maternal and fetal conditions. A clear understanding of gestational age and fetal viability should be documented in the record. PMID:20393413

  18. 腹部闭合伤致儿童胰腺外伤的诊治探讨%Pancreatic injury in children with blunt abdominal trauma: a report of 14 cases

    Institute of Scientific and Technical Information of China (English)

    李长春; 王珊; 李晓庆; 章均; 欧阳军

    2009-01-01

    Objective To evaluate the management of pancreatic injury in pediatric blunt abdominal trauma.Methods Fourteen children with closed pancreatic injury from January 1999 to May 2008 were reviewed.Results There were 11 boys and 3 of girls (M:F = 3.7:1).Five injuries were a result of bicycle handlebar injury,4 were from vehicle-related accidents,3 from direct blow and 2 from fall.The clinical presentations of pancreatic injury were abdominal pain,tenderness,leukocytosis,hy-peramylasemia and fever.The laboratory findings associated with pancreatic injury were elevated serum amylase level in 10 (71.5%) and leukocytosis in all cases.No correlation was found between leukocyte level,amylase value and the severity of pancreas injury.Repeated amylase values and CT scans were useful in detecting pancreatic injuries.CT scan was obtained in 11(78.6%) patients and was diagnostic in 6 (54.5%).Two of four children with negative CT scan finding had pancreatic injuries confirmed by exploratory laparotomy.Ultrasound scan was performed in 12 (85.7%) patients and was positive for pancreatic injury in 8 (66.7%).One child had emergency endoscopic retrograde cholangiopancreaticography (ERCP).Nine children were treated conservatively.This included six with minor pancreas injuries,one with proximal pancreatic duct injury,and two with duct injuries that were missed at admission.Five children were operated.The procedures included exploratory laparoto-mies and external drainage of pseudocysts.Four children had external drainage of pseudocysts.Conclusions The diagnosis of pancreatic injury was confirmed by hyperamylasemia,CT evaluation and ultrasound scan,and laparotomy.Initial serum amylase level and leukocytosis do not correlate with the severity of pancreatic injury.The majority of pancreatic injuries can be managed non-operatively.The non-operative management of proximal pancreatic duct injury allows the formation pseudocyst which could be subsequently drained.Distal duct injuries are best

  19. Primary study on median nerve stimulation therapy in improving the level of consciousness of patients in coma caused by head traumas

    International Nuclear Information System (INIS)

    Objective: To investigate the therapeutic effect of median nerve stimulation in improving the level of consciousness of patients in coma caused by severe head traumas and the possible mechanism of its hastening awakening from coma. Methods: 30 unconscious patients with severe brain traumas were randomly assigned to the treated group (n=15) and the control group (n=15). The patients in the control group were treated routinely. Besides routine therapy the patients in the treated group were treated with median nerve electrical stimulation. As the treated group were treated with initial stimulation, SPECT brain perfusion imaging was performed before and after 30 minutes' median nerve electrical stimulation under the same condition. The changes of the regional cerebral blood flow (rCBF) of lesion spot of brain were compared and analysed with visual method and semi-quantitative method in BFCK% mathematical model. A week after stimulation authors assess the therapeutic effect in the two groups with GCS scores. Results: The patients in the treated group's rCBF of the lesion spot increased significantly after stimulation. A week later the patients in the treated group had improved by average of 4.8 on the GCS in contrast to 2.0 on the GCS in the control group which showed that the GCS scores of the two groups had significant difference (P<0.05). Conclusion: The median nerve electrical stimulation can improve the level of consciousness of patients in coma caused by severe head traumas. The increase of rCBF of lesion spot of brain can be one of mechanisms of its hastening awakening from coma

  20. Skull radiographs and computed tomography scans in children and adolescents with mild head trauma Radiografia simples e tomografia computadorizada do crânio em crianças e adolescentes vítimas de traumatismo craniano leve

    Directory of Open Access Journals (Sweden)

    José Roberto Tude Melo

    2008-01-01

    Full Text Available OBJECTIVE: To identify which pediatric patients with mild head trauma are candidates for skull radiographs or cranial computed tomography (CCT scans. METHOD: Patients with mild head trauma aged from 0 to 19 years presenting to the Emergency Department of a trauma centre from Salvador City, Brazil, between May 2007 and May 2008. RESULTS: A total of 1888 mild head trauma patients were admitted; mean age was 7.4 (±5.5 years. A total of 1956 skull radiographs and 734 CCT scans were performed. About 44.4% patients with Glasgow coma score (GCS 13 and 55.4% with GCS 14 had abnormal CCT scans. In patients with multiple traumas, 16% had abnormal findings on CCT scans. CONCLUSION: We strongly recommend routine CCT studies to patients with GCS of 13 and 14 or to multiple trauma victims, independently of score. Routine screening skull radiographs were not useful in the evaluation of mild head trauma patients in this study.OBJETIVO: Identificar quais os pacientes na faixa pediátrica com trauma craniencefálico leve são candidatos para a realização de radiografia simples ou tomografia computadorizada do crânio (TCC. MÉTODO: Pacientes com trauma craniano leve, entre 0 e 19 anos, admitidos em um centro de referência em traumatologia, na cidade do Salvador, Brasil, entre maio 2007 e maio 2008. RESULTADOS: Foram atendidos 1888 pacientes com trauma craniano leve, com idade média de 7,4 (±5,5 anos. Um total de 1956 radiografias simples e 734 TCC foram realizadas. Em 44,4% dos pacientes com escala de coma de Glasgow (GCS 13 e 55.4% com GCS 14, tiveram TCC com achados anormais. Em pacientes com múltiplos traumas, 16% possuíam alterações na TCC. CONCLUSÃO: Recomendamos TCC em pacientes com GCS 13 e 14 ou naqueles com traumas múltiplos, independente do GCS. Radiografias simples do crânio como rotina, não foram identificadas como úteis, no presente estudo.

  1. [Minor head trauma - trivial matter or sirious diagnostic and therapeutic problem? The role of Infrascanner in the diagnostic process].

    Science.gov (United States)

    Lewartowska-Nyga, Dorota; Skotnicka-Klonowicz, Grażyna

    2016-01-01

    Head injuries in children, especially minor head injuries, still constitute a important diagnostic and therapeutic problem. Despite progress in medical sciences, there is no definition of minor head injury or standards of the management of children with a minor head injury. In consequence, the diagnostic procedure in the child who does not show any signs of central nervous system damage as a result of head injury is individual and depends on the experience and knowledge of the aid provider and as well as procedures established in a given ward. Therefore, a problem which requires to be urgently solved is to determine the justification and indications for imaging investigations (justification for skull X-ray, performance indications for carrying out computed tomography of the head) as well as indications for inpatient observation in such cases. The study presents currently existing definitions and proposals for the management of children presenting with a minor head injury. On the basis of own investigation we would stress that there is an opportunity to use in the initial diagnostics of head injuries in children, a modern non-invasive method already available in Poland, utilising the near-infrared NIR technology in order to detect intracranial haemorrhages by means of the Infrascanner. PMID:27442697

  2. [Minor head trauma - trivial matter or sirious diagnostic and therapeutic problem? The role of Infrascanner in the diagnostic process].

    Science.gov (United States)

    Lewartowska-Nyga, Dorota; Skotnicka-Klonowicz, Grażyna

    2016-01-01

    Head injuries in children, especially minor head injuries, still constitute a important diagnostic and therapeutic problem. Despite progress in medical sciences, there is no definition of minor head injury or standards of the management of children with a minor head injury. In consequence, the diagnostic procedure in the child who does not show any signs of central nervous system damage as a result of head injury is individual and depends on the experience and knowledge of the aid provider and as well as procedures established in a given ward. Therefore, a problem which requires to be urgently solved is to determine the justification and indications for imaging investigations (justification for skull X-ray, performance indications for carrying out computed tomography of the head) as well as indications for inpatient observation in such cases. The study presents currently existing definitions and proposals for the management of children presenting with a minor head injury. On the basis of own investigation we would stress that there is an opportunity to use in the initial diagnostics of head injuries in children, a modern non-invasive method already available in Poland, utilising the near-infrared NIR technology in order to detect intracranial haemorrhages by means of the Infrascanner.

  3. Simultaneous multisystem surgery: An important capability for the civilian trauma hospital.

    Science.gov (United States)

    Moore, Justin M; Thomas, Piers A W; Gruen, Russell L; Chan, Patrick; Rosenfled, Jeffrey V

    2016-09-01

    Head injury commonly presents in association with torso or limb injuries, especially in blunt trauma mechanisms. Stopping life-threatening thoraco-abdominal hemorrhage and preventing secondary brain injury are time critical priorities. Although simultaneous operative management by multiple teams has been common practice in the recent wars in Iraq and Afghanistan, simultaneous surgery is rare in most civilian settings. Nevertheless, situations arise whereby simultaneous craniotomy and chest or abdominal surgery is necessary to prevent mortality or reduce severe morbidity. We discuss two recent cases at our level one trauma centre, the challenges that surgeons and the operating room staff face and propose that with appropriate planning this surgical capability can be integrated into the systems of contemporary advanced trauma units. PMID:27359088

  4. Comparison of PCT, CRP, D-Dimer, Lactate, TNF-α, IL-1β, IL-6 and lL-10 in Development of Systemic Inflammatory Response Syndrome and Sepsis on Patients with Isolated Head Trauma and Polytrauma

    OpenAIRE

    Emine Dağlı; Ali Aydın Altunkan; Handan Birbiçer; Gülhan Orekeci Temel

    2012-01-01

    Objective: In this study, it was aimed to compare the relationship between Glasgow Coma Scale (GKS), ISS values, PCT, CRP, D-Dimer, laktat, TNF-α, IL-1β, IL-6, IL-10 in patients with polytrauma and isolated head trauma in conjunction with SIRS and sepsis. Material and Method: Total of 68 patients (32 polytrauma, 36 isolated head trauma) aged between 18-65 years were enrolled in the study. For 7 days of follow up, the biochemical parameters were analysed on the days 0, 1, 3, 5, 7 and the IS...

  5. 中国颅脑创伤数据库:短期预后因素分析%Chinese Head Trauma Data Bank: factors of short-term prognosis

    Institute of Scientific and Technical Information of China (English)

    惠纪元; 龚如; 梁玉敏; 高国一; 包映晖; 江基尧

    2014-01-01

    Objective To set up Chinese Head Trauma Data Bank and analyze the factors which may be related to the prognosis of patient with acute head trauma.Methods 11 937 cases with acute head trauma were enrolled Chinese Head Trauma Data Bank from 47 hospitals from December 2008 to December 2012,and all causes including gender,age,causes of trauma,GCS,ICP and cerebral herniation were analyzed to prognosis of patients.Results All factors were significantly related to the mortality and morbidity of patients except the gender.Conclusions Chinese Head Trauma Data Bank is established and offers the evidence of current status of head trauma in China,which provides the evidence for improving the outcome of patients with head trauma.%目的 建立我国颅脑创伤资料库,并分析影响急性颅脑创伤患者预后的相关因素.方法 2008年12月至2012年12月47家医院11 937例急性颅脑创伤患者资料,分析患者的性别、年龄、致伤原因、GCS评分、ICP和脑疝对患者病死率及不良预后率(死亡、植物生存、重残)的影响.结果 除男性与女性病死率无明显统计学差异外,患者年龄、致伤原因、GCS评分和颅内压值与病死率和预后不良率均有明显统计学差异.结论 我国颅脑创伤资料库的建立为客观了解我国颅脑创伤治疗现状、提高我国颅脑创伤救治水平提供了客观依据.

  6. CT scan findings in mild head trauma: a series of 2,000 patients Achados tomográficos no trauma cranioencefálico leve: análise de 2000 casos

    Directory of Open Access Journals (Sweden)

    Kelly C. Bordignon

    2002-06-01

    Full Text Available The present study describes the cranial computed tomography (CT scan findings of 2,000 cases of mild head trauma (HT in Curitiba, Southern Brazil. The mean age of the entire series was 30.8 ±19 years. The overall male to female ratio was 2:1. The most common causes of head injury were interpersonal aggression (17.9%, falls (17.4%, automobile accidents (16.2%, falls to the ground (13.1% and pedestrian injuries (13 %. Alcohol intoxication was associated with HT in 158 cases (7.9%. A normal CT scan was seen in 60.75% (1215 and an abnormal CT scan in 39.25% (785 of patients. Out of 785 abnormal CT scan, 518(65.9% lesions were related to HT. The most common CT scan HT related findings were: soft tissue swelling (8.9 %, skull fractures (4.3 %, intracranial and subgaleal hematomas (3.4% and 2.4 %, brain swelling (2 % and brain contusion (1.2%. Out of 785 abnormal CT scans, 267 (34.1% lesions were not related to head trauma. Incidental CT scan findings included brain atrophy (5.9%, one calcification (5.2% several calcifications (2.4% (probably neurocysticercosis in most cases, ischemic infarct (1.9% and leukoaraiosis (1.3%. These findings showed the importance of CT scan examination in mild head injuries. Further studies to identify mild HT patients at higher risk of significant brain injury are warranted in order to optimize its use.São descritos os achados de tomografia computadorizada craniana (TC de 2000 casos de trauma cranio-encefálico (TCE leve em Curitiba, Paraná. A idade média de toda série de pacientes foi 30,8 ± 19 anos. A razão homem/mulher foi 2:1. A causas mais comuns de TCE foram agressão interpessoal (17,9%, quedas de nível (17,4%, acidentes automobilísticos (16,2%, queda ao solo (13,1% e atropelamento (13%. Intoxicação por álcool foi um importante fator associado ao TCE e esteve presente em 158 casos (7,9% de 2000 pacientes. Uma TC normal ocorreu em 60,75% (1215 e uma TC anormal em 39,25% (785 dos pacientes. Das 785 TC

  7. Influência da fisioterapia respiratória na pressão intracraniana em pacientes com traumatismo craniencefálico grave Influence of the respiratory physioterapy on intracranial pressure in severe head trauma patients

    Directory of Open Access Journals (Sweden)

    Rosana A. Thiesen

    2005-03-01

    Full Text Available OBJETIVO: Estudar a influência das manobras de fisioterapia respiratória na pressão intracraniana (PIC dos pacientes com trauma craniencefálico grave. MÉTODO: Trinta e cinco pacientes com trauma craniencefálico grave foram incluídos no estudo, sendo divididos em três grupos: com PIC OBJECTIVE: To evaluate influence of the respiratory physiotherapy on intracranial pressure (ICP in patients with severe head trauma. METHOD: Thirty five patients with severe head trauma were included in the study.The patients were divided into three groups: ICP 0-10, 11-20 and 21-30 mmHg. The following variables were measured: ICP and mean arterial pressure. Cerebral perfusion pressure was calculated as the difference between mean arterial and intracranial pressure. RESULTS: Endotracheal aspiration increased ICP in all patients. The mean arterial pressure didn't change and cerebral perfusion pressure decreased, but remaning normal value. CONCLUSION: Respiratory physiotherapy maneuvers can be safely applied in patients with severe head trauma with ICP below 30 mmHg. More attention should be taken during endotracheal aspiration .

  8. Comparison of PCT, CRP, D-Dimer, Lactate, TNF-α, IL-1β, IL-6 and lL-10 in Development of Systemic Inflammatory Response Syndrome and Sepsis on Patients with Isolated Head Trauma and Polytrauma

    Directory of Open Access Journals (Sweden)

    Emine Dağlı

    2012-12-01

    Full Text Available Objective: In this study, it was aimed to compare the relationship between Glasgow Coma Scale (GKS, ISS values, PCT, CRP, D-Dimer, laktat, TNF-α, IL-1β, IL-6, IL-10 in patients with polytrauma and isolated head trauma in conjunction with SIRS and sepsis. Material and Method: Total of 68 patients (32 polytrauma, 36 isolated head trauma aged between 18-65 years were enrolled in the study. For 7 days of follow up, the biochemical parameters were analysed on the days 0, 1, 3, 5, 7 and the ISS, GCS score and growth rates of SIRS and sepsis were recorded. Results: It was demonstrated that for patients with isolated head trauma, SIRS (80.6%, sepsis (38.9% and mortality values (71.4% were higher and there is a statistically important linear and inverse relationship between ISS and GCS values (p<0.05. During sepsis and SIRS phases, CRP elevated in both groups, whereas PCT only in the polytrauma group. D-Dimer values were investigated high in both groups, but atypically decreased on day 3 in isolated head trauma group. Lactate, TNF-α and, IL-1β were within reference values, IL-6 and IL-10 values were elevated in both groups but were higher in the polytrauma group. Conclusion: Although multiple variations were detected in serum markers of pro-inflamatory and acute phase proteins, we thought that these are inadequate in predicting mortality and complications such as SIRS and sepsis.

  9. 枪弹射击致防弹衣后长白猪远达脑组织损伤特点及其机制%Characteristics and mechanism of behind armour blunt trauma in Landrace brain

    Institute of Scientific and Technical Information of China (English)

    苏正林; 许民辉; 赖西南; 张波; 黄艺峰; 王丽丽

    2011-01-01

    Objective To study the characteristics of behind armor blunt trauma extending to the brain and to investigate the biomechanics mechanism of the remote injury. Methods Eighteen male Landraces were randomly divided into a sham injury group (n =4) , a bullet velocity 910 m/s group (re =6), a 740 m/s group (n =4) and a S90 m/s group (n =4). The injury model was anesthetized Landrace in right lateral position and wrapped in a two-layer bullet-proof vest. The outer layer was ceramic hard armor with NIJ Ⅲ protection grade. The inner layer was police grade II ultra-high molecular polyethylene soft body armor. Caliber 5. 8 mm ballistic guns were fired at 25 m range and three different projectile velocities, aimed at the left midclavicular line 4, 5 intercostal (heart window). Air bomb shooting was applied to sham injury group. EEG, ECG, invasive arterial blood pressure, heart rate and respiratory changes before and after injury were continuously monitored. Plasma was collected at 1, 2 and 3 h before and after injury to detect markers of brain injury. Lumbar puncture was taken at 3 h before and after injury to test specific brain injury protein in cerebrospinal fluid. In 3 h after injury the animals were deep anesthetized and bled to death. Their brain blocks were collected for toluidine blue staining and electron microscopy. The other 4 Landrace pigs were used for biomechanical testing. On the basis of the above model pressure sensors were placed in the subcutaneous layer of precordium at the point of impact, pericardial cavity, left chest, left common carotid artery and cranial cavity. Acceleration sensors and force sensors were placed in the sixth rib at precordial midclavicular line. When the target was hit, each parts biomechanical parameters and duration were recorded and analyzed. Results In the 3 groups of different speed, spectrum intensity of low-frequency EEG Delta and Theta wave within 2 minutes after injury was significantly lower than that before injury (P

  10. Clinical Study on Ocular Trauma in Children

    Institute of Scientific and Technical Information of China (English)

    Zicai Huang; Hongni Li; Yixia Huang; Zhongxia Zhou

    2002-01-01

    Purpose: To investigate the clinical characteristics of ocular trauma in children and put forward the major treatment and prevention of ocular trauma in children.Methods: To analyze the clinical data by 77 eyes in 77 cases of ocular trauma in children from April 1999 to February 2002. Results: The male and female were in the ratio of 2.21: 1. Right eye ocular traumas were more than left ones. Ocular penetrating trauma was 83.12% and blunt trauma 12.99%. 41 cases (53.25%) were injured by themselves while 33 cases by others. 90.91% patients came from the countryside.Conclusion: The rate of blindness of children with ocular trauma could be reduced by prompt treatment. The study indicated that ocular trauma preventive publicity should be faced in the countryside in order to improve the understanding of the severity of ocular trauma and treat it as a social problem.

  11. Renal Trauma: Case Reports and Overview

    OpenAIRE

    Tait, Campbell D.; Somani, B. K.

    2012-01-01

    Introduction. Renal trauma patients are largely managed conservatively but on occasion have to be embolised or taken to theatre for definitive surgical management, usually in the form of emergency nephrectomy. Review. We present an overview of renal trauma as illustrated by three interesting cases of blunt renal trauma who presented in quick succession of each other to the Emergency Department. The first case—a 48-year-old-female passenger in a road traffic accident—was treated with life-savi...

  12. Outcome of patients with traumatic head injury in infants: An institutional experience at level 1 trauma center

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    Gaurang Vaghani

    2013-01-01

    Full Text Available Background: Traumatic head injury is a common cause of mortality and acquired disability in infants and children. However, patterns and outcome of head injury in infants are different from other age groups. Aims and Objectives: Aim of our study was to find out epidemiological factors, characteristics of injury, and outcome in infants with traumatic brain injury. Materials and Methods: This is a retrospective study from March 2009 through Feb 2012, at JPNATC, AIIMS, New Delhi. The clinical records of all patients, admitted with head injury were evaluated. Twenty-nine infants with traumatic brain injury were followed up and outcome was analyzed. Results: Twenty-nine infants with traumatic brain injury were included in the study. Of these 17 (59% were boys and 12 (41% were girls. Fall from height was recorded in 27 (93% patients and road traffic accident was the mode of injury in 2 (7%. Mild head injury (GCS 14-15 was found in 18 (62% patients, moderate in 4 (14% patients (GCS 9-13, severe (GCS 3-8 in 7 (24% patients. SDH was the most common injury in 8 (27% patients. Out of these 4 (14% were immediately operated, 25 (86% were managed conservatively. Overall mortality was 11% (3 patients. Glasgow Outcome Scale was 5 in 20 (69% patients and 3 (10.3% patients each had GOS 3 or 4. Conclusion: Infants suffered significant brain injury due to fall. Traumatic brain injury in infants generally carries good outcome. Severe head injury was observed to be a predictor of poor outcome.

  13. External validation of the New Orleans Criteria (NOC), the Canadian CT Head Rule (CCHR) and the National Emergency X-Radiography Utilization Study II (NEXUS II) for CT scanning in pediatric patients with minor head injury in a non-trauma center

    International Nuclear Information System (INIS)

    Head CT scans are considered the imaging modality of choice to screen patients with head trauma for neurocranial injuries; however, widespread CT imaging is not recommended and much research has been conducted to establish objective clinical predictors of intracranial injury (ICI) in order to optimize the use of neuroimaging in children with minor head trauma. To evaluate whether a strict application of the New Orleans Criteria (NOC), Canadian CT Head Rule (CCHR) and National Emergency X-Radiography Utilization Study II (NEXUS II) in pediatric patients with head trauma presenting to a non-trauma center (level II) could reduce the number of cranial CT scans performed without missing clinically significant ICI. We conducted an IRB-approved retrospective analysis of pediatric patients with head trauma who received a cranial CT scan between Jan. 1, 2001, and Sept. 1, 2008, and identified which patients would have required a scan based on the criteria of the above listed decision instruments. We then determined the sensitivities, specificities and negative predictive values of these aids. In our cohort of 2,101 patients, 92 (4.4%) had positive head CT findings. The sensitivities for the NOC, CCHR and NEXUS II were 96.7% (95%CI 93.1-100), 65.2% (95%CI 55.5-74.9) and 78.3% (95%CI 69.9-86.7), respectively, and their negative predictive values were 98.7%, 97.6% and 97.2%, respectively. In contrast, the specificities for these aids were 11.2% (95%CI 9.8-12.6), 64.2% (95%CI 62.1-66.3) and 34.2% (95%CI 32.1-36.3), respectively. Therefore, in our population it would have been possible to scan at least 10.9% fewer patients. The number of cranial CT scans conducted in our pediatric cohort with head trauma would have been reduced had any of the three clinical decision aids been applied. Therefore, we recommend that further validation and adoption of pediatric head CT decision aids in non-trauma centers be considered to ultimately increase patient safety while reducing medical

  14. Research status of otolaryngology head and neck trauma and the expectation of digital treatment%耳鼻咽喉头颈战创伤研究现状及数字化救治展望

    Institute of Scientific and Technical Information of China (English)

    陈继川

    2013-01-01

    Because of the special anatomical and physiological characteristics ,otolaryngology head and neck trauma is frequently found in multiply injured patients .Otolaryngology head and neck trauma may cause permanent derangement of functions ,destroy of facial appearance,and social psychological dysfunction ,which is different from injuries in other regions.But otolaryngology head and neck trauma is characterized by pain ,bleeding,and dysfunc-tion,similar to other regions.Based on the feature and research direction of the modern trauma rescue work ,apply-ing digital technology in treatment of otolaryngology head and neck trauma is the development direction in this field .%耳鼻咽喉头颈位于浅表处,解剖位置特殊,防护薄弱,无论平时战时,易受创伤,遭受创伤后,不仅对生理功能产生破坏,威胁生命,且常因头面部形貌的损毁而导致社会心理障碍。耳鼻咽喉头颈部战创伤根据各种因素不同,其临床表现各异,但具有疼痛、出血、功能障碍等共同点,而根据现代战伤救治工作的特点和研究方向,应用数字化高新技术来加强对耳鼻咽喉头颈部创伤救治方法和策略的研究正是这一领域的发展方向。

  15. Clinical experience of ocular trauma with metallic arrow-headed foreign bodies%眼部弓箭射伤诊治的体会

    Institute of Scientific and Technical Information of China (English)

    林育华

    2011-01-01

    Objective To discuss surgical treatments of patients with orbital foreign bodies. Methods We analyzed 7 cases(7 eyes) of eye injury with arrow-head foreign body.The huge foreign body (arrows)was extracted after soft tissue separation was done or the removal of arrows was together with enucleation. Results Arrows were completely removed in all the patients. No sight-threatening to patients if there was no eyeball injury. The sight was lost in patients with eyeball rupture. Craniocerebral trauma and neurological complications occurred on the basis of the depth of the arrows in the patients' eyes. Conclusion It is rare that arrows are orbital foreign bodies,which should be removed timely by surgery. Computer tomography (CT) examination should done before the operation. The method of operation depends on the eye injury positions and the accompanied eyeball double perforation and craniocerebral trauma.%目的 探讨眼部弓箭射伤的手术治疗方法.方法 7例(7眼)眼部弓箭伤进行分析.7例眼部巨大异物(箭)分别采用分离软组织后拔出和眼球摘除同时拔出异物(箭).结果 7例均完整取出弓箭异物,不伤及眼球者视力完好,眼球破裂者视力丧失,伴颅脑损伤者有神经并发症.结论 眼部弓箭射伤是罕见的眼部巨大异物,需及时手术取出,术前行CT检查,手术的方式根据箭伤及的部位和是否伴有眼球贯通和颅脑伤.

  16. Chest trauma experience over eleven-year period at al-mouassat university teaching hospital-Damascus: a retrospective review of 888 cases

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    Al-Koudmani Ibrahim

    2012-04-01

    Full Text Available Abstract Background Thoracic trauma is one of the leading causes of morbidity and mortality in developing countries. In this study, we present our 11-year experience in the management and clinical outcome of 888 chest trauma cases as a result of blunt and penetrating injuries in our university hospital in Damascus, Syria. Methods We reviewed files of 888 consequent cases of chest trauma between January 2000 and January 2011. The mean age of our patients was 31 ± 17 years mostly males with blunt injuries. Patients were evaluated and compared according to age, gender, etiology of trauma, thoracic and extra-thoracic injuries, complications, and mortality. Results The leading cause of the trauma was violence (41% followed by traffic accidents (33%. Pneumothorax (51%, Hemothorax (38%, rib fractures (34%, and lung contusion (15% were the most common types of injury. Associated injuries were documented in 36% of patients (extremities 19%, abdomen 13%, head 8%. A minority of the patients required thoracotomy (5.7%, and tube thoracostomy (56% was sufficient to manage the majority of cases. Mean hospital LOS was 4.5 ± 4.6 days. The overall mortoality rate was 1.8%, and morbidity (n = 78, 8.7%. Conclusions New traffic laws (including seat belt enforcement reduced incidence and severity of chest trauma in Syria. Violence was the most common cause of chest trauma rather than road traffic accidents in this series, this necessitates epidemiologic or multi-institutional studies to know to which degree violence contributes to chest trauma in Syria. The number of fractured ribs can be used as simple indicator of the severity of trauma. And we believe that significant neurotrauma, traffic accidents, hemodynamic status and GCS upon arrival, ICU admission, ventilator use, and complication of therapy are predictors of dismal prognosis.

  17. Trauma Kimia

    OpenAIRE

    Lubis, Rodiah Rahmawaty

    2015-01-01

    Mata merupakan organ yang keberadaannya berhubungan langsung dengan lingkungan luar sehingga sering menyebabkan mata terkena dampak dari posisi anatominya tersebut. Mata sering terpapar dengan keadaan lingkungan sekitar seperti udara, debu, benda asing dan suatu trauma yang dapat langsung mengenai mata. Trauma pada mata meliputi trauma tumpul, trauma tajam, trauma kimia, dan trauma radiasi. Rodiah Rahmawaty Lubis

  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

    2016-11-01

    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. PMID:27054650

  19. 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.

  20. Operative treatment of hepatic trauma in Vachira Phuket Hospital.

    Science.gov (United States)

    Vatanaprasan, Thanong

    2005-03-01

    Descriptive study of an 8-year period, 211 patients with hepatic trauma were studied retrospectively. Most of the patients were male (81.5%). Patients mainly affected were in the third decade of life (46.9%) with an age range of 2 to 65 years old (Mean 26.1 +/- 9.8). Fifty four percent resulted from blunt and 46.4% from penetrating injuries. The most common cause of injuries was motorcycle accidents (41.2%). The injuries were graded by the hepatic injury scale (grades I to VI). There were 22 (10.4%), 62 (29.4%), 70 (33.2%), 27 (12.8%), 28 (13.3%) and 2 (0.9%) patients with grade I, II, III, IV, V and VI hepatic injuries, respectively. Forty seven percent of patients were in shock when they first arrived at the emergency room. One hundred and sixty five patients (78.2%) had 375 associated injuries. Seventy three percent of patients had low grade hepatic injuries (grades I to III), the remainder (27%) had high grade hepatic injuries (grades IV to VI). Operative treatment of hepatic injuries varied according to degree of injury. Low grade hepatic injuries amenable to relatively simple operative treatment. Nineteen deaths (12.3%) occurring in this group were attributed to the commonly encountered associated injuries inside and outside the abdomen, which were more frequently seen after blunt trauma (89.5%). High-grade hepatic injuries required major techniques. Thirty four of these patients died (59.6%), death was related to the injury itself (91.2%), which were more frequently seen after blunt trauma (85%). During operation, suture ligature of the bleeding point, or hepatorrhaphy stopped the bleeding in most circumstances. Perihepatic packing was a useful procedure when termination of the operation was considered necessary in order to prevent the development of hypothermia, acidosis and coagulopathy. Perihepatic packing was used for treatment of 73% of high grade hepatic injuries and yielded 65.5% survival rate. The results were 59 patients had complication (morbidity

  1. [Bilateral Dislocation Fracture of the Humeral Head (Right AO 11C3.3; Left AO 11A1.3) without Direct Trauma Due to First Clinical Manifestation of Seizure - a Case Report and Review of the Literature].

    Science.gov (United States)

    Ploeger, M M; Pennekamp, P H; Müller, M C; Kabir, K; Burger, C; Wirtz, D C; Schmolders, J

    2015-12-01

    The incidence of fractures among epileptics is frequent and mostly occurs by direct trauma due to falls caused by seizures. The risk of fractures is estimated to be 50 % higher in epileptics than in the general population. Most of the fractures affect the proximal femora and the hip joint. Dorsal shoulder dislocations occur frequently in epileptics. If they occur bilaterally, this is pathognomonic for seizuring. Besides this, shoulder dislocation and bilateral dislocation fractures of the humeral head, however, are far more rare even among epileptics but pathognomonic for seizure. In this case report we present a female patient with bilateral dislocation fracture of the humeral head due to first clinical manifestation of a tonic-clonic seizure without direct trauma.

  2. Imaging in spinal trauma

    Energy Technology Data Exchange (ETDEWEB)

    Goethem, J.W.M. van [Universitair Ziekenhuis Antwerpen, University of Antwerp, Belgium, Department of Radiology, Edegem (Belgium); Algemeen Ziekenhuis Maria Middelares, Department of Radiology, Sint-Niklaas (Belgium); Maes, Menno; Oezsarlak, Oezkan; Hauwe, Luc van den; Parizel, Paul M. [Universitair Ziekenhuis Antwerpen, University of Antwerp, Belgium, Department of Radiology, Edegem (Belgium)

    2005-03-01

    Because it may cause paralysis, injury to the spine is one of the most feared traumas, and spinal cord injury is a major cause of disability. In the USA approximately 10,000 traumatic cervical spine fractures and 4000 traumatic thoracolumbar fractures are diagnosed each year. Although the number of individuals sustaining paralysis is far less than those with moderate or severe brain injury, the socioeconomic costs are significant. Since most of the spinal trauma patients survive their injuries, almost one out of 1000 inhabitants in the USA are currently being cared for partial or complete paralysis. Little controversy exists regarding the need for accurate and emergent imaging assessment of the traumatized spine in order to evaluate spinal stability and integrity of neural elements. Because clinicians fear missing occult spine injuries, they obtain radiographs for nearly all patients who present with blunt trauma. We are influenced on one side by fear of litigation and the possible devastating medical, psychologic and financial consequences of cervical spine injury, and on the other side by pressure to reduce health care costs. A set of clinical and/or anamnestic criteria, however, can be very useful in identifying patients who have an extremely low probability of injury and who consequently have no need for imaging studies. Multidetector (or multislice) computed tomography (MDCT) is the preferred primary imaging modality in blunt spinal trauma patients who do need imaging. Not only is CT more accurate in diagnosing spinal injury, it also reduces imaging time and patient manipulation. Evidence-based research has established that MDCT improves patient outcome and saves money in comparison to plain film. This review discusses the use, advantages and disadvantages of the different imaging techniques used in spinal trauma patients and the criteria used in selecting patients who do not need imaging. Finally an overview of different types of spinal injuries is given

  3. Imaging in spinal trauma

    International Nuclear Information System (INIS)

    Because it may cause paralysis, injury to the spine is one of the most feared traumas, and spinal cord injury is a major cause of disability. In the USA approximately 10,000 traumatic cervical spine fractures and 4000 traumatic thoracolumbar fractures are diagnosed each year. Although the number of individuals sustaining paralysis is far less than those with moderate or severe brain injury, the socioeconomic costs are significant. Since most of the spinal trauma patients survive their injuries, almost one out of 1000 inhabitants in the USA are currently being cared for partial or complete paralysis. Little controversy exists regarding the need for accurate and emergent imaging assessment of the traumatized spine in order to evaluate spinal stability and integrity of neural elements. Because clinicians fear missing occult spine injuries, they obtain radiographs for nearly all patients who present with blunt trauma. We are influenced on one side by fear of litigation and the possible devastating medical, psychologic and financial consequences of cervical spine injury, and on the other side by pressure to reduce health care costs. A set of clinical and/or anamnestic criteria, however, can be very useful in identifying patients who have an extremely low probability of injury and who consequently have no need for imaging studies. Multidetector (or multislice) computed tomography (MDCT) is the preferred primary imaging modality in blunt spinal trauma patients who do need imaging. Not only is CT more accurate in diagnosing spinal injury, it also reduces imaging time and patient manipulation. Evidence-based research has established that MDCT improves patient outcome and saves money in comparison to plain film. This review discusses the use, advantages and disadvantages of the different imaging techniques used in spinal trauma patients and the criteria used in selecting patients who do not need imaging. Finally an overview of different types of spinal injuries is given

  4. 头部外伤所致旋转性斜视药物治疗的体会%The experience of medication for the patients with cyclotropia strabismus caused by head trauma

    Institute of Scientific and Technical Information of China (English)

    温佶俐

    2016-01-01

    目的 探讨头部外伤所致旋转性斜视的临床特点及药物治疗的效果.方法 通过5例临床典型病例的观察,探讨头部外伤所致的旋转性斜视的特点及治疗结果.结果 头部外伤所致旋转性斜视治疗上可进行药物保守治疗和手术治疗,本组5例病例均经药物保守治疗6个月后基本恢复正常双眼视功能,避免了手术.结论 头部外伤所致旋转性斜视,因病情复杂,临床上容易被误诊,应加强诊断认识.部分病例经药物保守治疗6个月后可以治愈.%Objective To investigate the clinical manifestations,curative effectiveness and prognosis among patients with the cyclotropia strabismus caused by head trauma.Methods Through the clinical examination and treatment of 5 typical cases of cyclotropia caused by head trauma,the clinical signs and the result of treatment were investigated.Results Cyclotropia caused by head trauma may be treated with medical conservative treatment or surgical treatment.The binocular visual function of the 5 cases returned to normal state after the medicine treatment for 6 months,and the surgery was avoided.Conclusion Cyclotropia strabismus caused by head trauma is easy to be misdiagnosed because of the complex of the disease.The diagnosis knowledge should be strengthened.Some cases can be cured by medicine conservative treatment for 6 months.

  5. Temporal bone trauma and complications: computed tomography findings

    Energy Technology Data Exchange (ETDEWEB)

    Costa, Ana Maria Doffemond; Gaiotti, Juliana Oggioni; Couto, Caroline Laurita Batista; Gomes, Natalia Delage; Diniz, Renata Lopes Furletti Caldeira; Motta, Emilia Guerra Pinto Coelho, E-mail: anadoffemond@yahoo.com.br [Hospital Mater Dei, Belo Horizonte, MG (Brazil). Unit of Radiology and Imaging Diagnosis

    2013-03-15

    Most temporal bone fractures result from high-energy blunt head trauma, and are frequently related to other skull fractures or to polytrauma. Fractures and displacements of ossicular chain in the middle ear represent some of the main complications of temporal bone injury, and hence they will be more deeply approached in the present article. Other types of injuries include labyrinthine fractures, dural fistula, facial nerve paralysis and extension into the carotid canal. Computed tomography plays a fundamental role in the initial evaluation of polytrauma patients, as it can help to identify important structural injuries that may lead to severe complications such as sensorineural hearing loss, conductive hearing loss, dizziness and balance dysfunction, perilymphatic fistulas, facial nerve paralysis, vascular injury and others. (author)

  6. 大骨瓣开颅减压术治疗重型颅脑损伤的疗效观察%Curative observation on large bone craniotomy decompression in severe head trauma

    Institute of Scientific and Technical Information of China (English)

    刘新社; 黄和雪; 李峰

    2010-01-01

    目的 探讨重型颅脑损伤采用大骨瓣开颅减压术的疗效.方法 回顾性分析我院2007年6月-2009年7月收治的52例重型颅脑损伤患者的临床资料,所有患者均采用大骨瓣开颅减压术治疗.结果 52例患者中恢复良好33例,中残5例,重残3例,植物生存4例,死亡8例,治愈率63.4%.结论 重型颅脑损伤采用大骨瓣开颅减压术疗效明显.%Objective To obseve the efficacy of large bone craniotomy decompression in severe head trauma. Method Retrospective analysis of our hospital from June 2007 to July 2009 was carried out in 52 admitted patients with severe head trauma by collecting clinical data, all patients with large bone craniotomy decompression in the treatment. Results It was revealed that 33 patients recovered well, 5 patients revealed moderate disability, 3 patients severe disability, 4 patients plant survival, 8 patients dead. And that the total cure rate was 63.4%. Conclusion Large bone craniotomy decompression has marked effects on severe head trauma.

  7. Percutaneous artherial embolization in the treatment of liver trauma

    International Nuclear Information System (INIS)

    Percutaneous arterial embolization in the treatment of liver trauma. Liver trauma requires emergency therapy. Because it is highly vascular and because of its location, the hemostasis is difficult to achieve. The main causes of death associated to liver trauma are due to prolonged hipovolemia. The current forms of surgical treatment of liver wounds are associated with a high morbidity rate. In some hepatic injuries, hemorrage is so massive that operative control of bleeding is necessary, bu t in most cases, particularly in blunt trauma, an angiographic approach with diagnosis and embolotherapy is preferable. Six patients with blunt or perforating hepatic trauma were managed with percutaneous arterial embolization. Hemostasis was achieved immediately in all of them withoyt recurrence. Surgical intervention with additional trauma was thus avoided, decreasing the morbidity rate. The percutaneous arterial embolization presents an efficient alternative in the management of hemorrage due to liver trauma, being particularly useful in the poor risk patient. (author)

  8. Marijuana May Blunt Bone Health

    Science.gov (United States)

    ... page: https://medlineplus.gov/news/fullstory_161575.html Marijuana May Blunt Bone Health Study finds heavy users ... 19, 2016 WEDNESDAY, Oct. 19, 2016 (HealthDay News) -- Marijuana may be bad to the bone, a new ...

  9. 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"

  10. Isolated blunt chest injury leads to transient activation of circulating neutrophils

    OpenAIRE

    Visser, T.; Hietbrink, F.; Groeneveld, K. M.; Koenderman, L; Leenen, L.P.H.

    2010-01-01

    Introduction The acute respiratory distress syndrome (ARDS) is a severe and frequently seen complication in multi-trauma patients. ARDS is caused by an excessive innate immune response with a clear role for neutrophils. As ARDS is more frequently seen in trauma patients with chest injury, we investigated the influence of chest injury on the systemic neutrophil response and the development of ARDS. Materials and methods Thirteen patients with isolated blunt chest injury [abbreviated injury sco...

  11. Application of emergency nursing procedure in early rescuing the patients with severe head trauma%急救护理流程在重型颅脑创伤早期救治中的应用

    Institute of Scientific and Technical Information of China (English)

    林青

    2014-01-01

    目的:探讨急救护理流程在急诊重度颅脑损伤患者早期救治中的应用效果。方法对48例急诊重度颅脑损伤患者的早期救治与护理过程进行回顾性研究分析。结果48例患者应用急救护理流程进行抢救护理后,成功45例,死亡1例,放弃2例,抢救成功率93.75%。结论对重度颅脑损伤患者早期应用急救护理流程,可有效提高抢救成功率,提升医患满意度。%Objective To discuss the clinical effects of early rescue of severe head trauma. Methods Clinical nursing procedures and nursing of 48 severe trauma patients were retrospectively analyzed.Results After emergency nursing and rescue,there were 45 patients with successful rescue,1 patient died and 2 patients gave up,with success rate 93.75%.Conclusions Applica-tion of emergency nursing procedure in rescuing the patients with severe head trauma can not only improve the success rate of rescuing patients but also enhance satisfaction of patients.

  12. When Physics Meets Biology: Low and High-Velocity Penetration, Blunt Impact, and Blast Injuries to the Brain

    Science.gov (United States)

    Young, Leanne; Rule, Gregory T.; Bocchieri, Robert T.; Walilko, Timothy J.; Burns, Jennie M.; Ling, Geoffrey

    2015-01-01

    The incidence of traumatic brain injuries (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. PMID:25999910

  13. Splenic injury diagnosis & splenic salvage after trauma

    NARCIS (Netherlands)

    D.C. Olthof

    2014-01-01

    Non-operative management (NOM) has replaced surgery as the treatment of choice for hemodynamically stable patients with splenic injury after trauma. The growing use of NOM for blunt abdominal organ injury has been made possible by the progress in the quality and availability of the multidetector CT

  14. Analysis of 133 patients with severe blunt liver injury

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    Objective: To investigate the treatment and causes of death aboutsevere blunt liver injury.Methods: The data of 133 patients with severe blunt liver injury (Grade Ⅲ to Grade Ⅴ) were analyzed retrospectively. All the patients except 2 underwent operations. Different types of surgical procedures were adopted according to the severity of liver injury.Results: Operations were the major method to treat hepatic injury. The total mortality rate was 21.0% in this study. The mortality rates of Grade Ⅲ, Grade Ⅳ and Grade Ⅴ of liver injuries were 11.3%, 24.4% and 69.2%, respectively.Conclusions: Packing treatment plays an important role in the treatment of hepatic injury. The mortality rate is related closely to the severity of hepatic injury, multiple trauma, shock and disturbance of blood coagulation.

  15. Trauma in elderly patients evaluated in a hospital emergency department in Konya, Turkey: a retrospective study

    Directory of Open Access Journals (Sweden)

    Kara H

    2013-12-01

    Full Text Available Hasan Kara,1 Aysegul Bayir,1 Ahmet Ak,1 Murat Akinci,1 Necmettin Tufekci,1 Selim Degirmenci,1 Melih Azap21Department of Emergency Medicine, Selçuk University, Konya, Turkey; 2Department of Emergency Medicine, Konya Numune Hospital, Konya, TurkeyPurpose: Trauma is a common cause of admission to the hospital emergency department. The purpose of this study was to evaluate the cause of admission, clinical characteristics, and outcomes of patients aged ≥65 years admitted to an emergency department in Turkey because of blunt trauma.Materials and methods: Medical records were retrospectively reviewed for 568 patients (314 women and 254 men aged ≥65 years who were admitted to an emergency department of a tertiary care hospital.Results: Trauma was caused by low-energy fall in 379 patients (67%, traffic accident in 79 patients (14%, high-energy fall in 69 patients (12%, and other causes in 41 patients (7%. The most frequent sites of injury were the lower extremity, thorax, upper extremity, and head. The femur was the most frequent fracture site. After evaluation in the emergency department, 377 patients (66% were hospitalized. There were 31 patients (5% who died. Risk of hospitalization after trauma was significantly associated with trauma to the lower extremity, thorax, and spine; fractures of the femur and rib; and intracranial injury.Conclusion: Emergency department admission after trauma in patients aged $65 years is common after low-energy falls, and most injuries occur to the extremities. It is important to focus on prevention of falls to decrease the frequency of trauma in the elderly.Keywords: fall, femur, fracture, injury

  16. 颅脑外伤术后头部固定装置的研制%Research and Development of a Head Fixation Device for Post-Operative Patients with Cranio-Cerebral Trauma

    Institute of Scientific and Technical Information of China (English)

    王学建

    2015-01-01

    针对颅脑外伤术(尤其是枕部手术)后头部切口不易保护、包扎易松动、易致切口污染等问题,本文研制了一款神经外科头部固定装置,该装置主要由头部包扎部分及可拆卸保护装置等结构构成,具有包扎牢固、舒适、切口保护等功能,可解决头部外伤术后包扎的问题。临床实际应用证实其具有省时、方便、实用、舒适等效果,值得临床推广。%In view of the issues occurring after cranio-cerebral trauma surgeries, especially occipital surgeries, including difficulty in incision protection, loose dressing, and incision pollution, a kind of neurosurgery head ifxation device was researched and developed, which mainly consisted of the head bandage and removable protection structure. With the functions of steady and comfortable bandage as well as incision protection, the device was intended to solve the problem of incision protection after head trauma surgeries. Clinical application proved its time-saving, easy-to-use, practical and comfortable features, deserving wider clinical promotion.

  17. CTA 在头颈部创伤性异物中的诊断价值%The Diagnostical Value of CTA for Foreign Bodies in Head and Neck Trauma

    Institute of Scientific and Technical Information of China (English)

    王强; 洪居陆

    2013-01-01

      目的:探讨 CTA 在头颈部创伤性异物中的诊断价值。材料和方法:搜集创伤性异物行头颈部 CTA 检查病例5例,均有完整的手术资料,分析其诊断价值。结果:5例 CTA 清晰显示异物位置及血管关系,无血管损伤。1例术前发现异物周围软组织肿胀伴出血,其余4例软组织散在积气。术中异物取出顺利,均无大出血,3例局部少许渗血。异物均为金属,2例斑片状,1例新月形,1例铁丝状,1例刀状。结论:CTA 在头颈部创伤性异物中的诊断价值明确,能提供异物与血管关系及血管损伤信息,指导临床手术。%  Objective: To investigate the diagnostically value of CTA for foreign bodies in the head and neck trauma. Materials and Methods: 5 cases who underwent CTA with foreign bodies in head and neck trauma and all proved by operation, were retrospectively analyzed the diagnostically value. Results: 5 cases were clearly displayed the location of foreign bodies and the connection with vas, without blood vessel trauma. 1 case was found that parenchyma was swelled with bleeding around the foreign body. The rest 4 cases were found that parenchyma was accumulated the gas. 5 cases foreign bodies extraction were triumphant without massive hemorrhage. However, 3 cases were little bleeding around. The 5 foreign bodies all were metal. 2 cases were speckle, 1 case was lunular, 1 case was wiriness, and 1 case was cult rated. Conclusion: The CTA has a significant value to diagnose foreign bodies in head and neck trauma. It can give surgeons very important information about the connection foreign bodies with vas and blood vessel trauma to guide operation.

  18. Trauma renal Renal trauma

    Directory of Open Access Journals (Sweden)

    Gerson Alves Pereira Júnior

    1999-02-01

    Full Text Available Apresentamos uma revisão sobre trauma renal, com ênfase na avaliação radiológica, particularmente com o uso da tomografia computadorizada, que tem se tornado o exame de eleição, ao invés da urografia excretora e arteriografia. O sucesso no tratamento conservador dos pacientes com trauma renal depende de um acurado estadiamento da extensão da lesão, classificado de acordo com a Organ Injury Scaling do Colégio Americano de Cirurgiões. O tratamento conservador não-operatório é seguro e consiste de observação contínua, repouso no leito, hidratação endovenosa adequada e antibioti- coterapia profilática, evitando-se uma exploração cirúrgica desnecessária e possível perda renal. As indicações para exploração cirúrgica imediata são abdome agudo, rápida queda do hematócrito ou lesões associadas determinadas na avaliação radiológica. Quando indicada, a exploração renal após controle vascular prévio é segura, permitindo cuidadosa inspeção do rim e sua reconstrução com sucesso, reduzindo a probabilidade de nefrectomia.We present a revision of the renal trauma with emphasis in the radiographic evaluation, particularly CT scan that it has largely replaced the excretory urogram and arteriogram in the diagnostic worh-up and management of the patient with renal trauma. The successful management of renal injuries depends upon the accurate assessment of their extent in agreement with Organ Injury Scaling classification. The conservative therapy managed by careful continuous observation, bed rest, appropriate fluid ressuscitation and prophylactic antibiotic coverage after radiographic staging for severely injured kidneys can yield favorable results and save patients from unnecessary exploration and possible renal loss. The indications for immediate exploratory laparotomy were acute abdomen, rapidly dropping hematocrit or associated injuries as determinated from radiologic evaluation. When indicated, renal exploration

  19. Chest wall, lung, and pleural space trauma.

    Science.gov (United States)

    Miller, Lisa A

    2006-03-01

    Chest radiographs frequently underestimate the severity and extent of chest trauma and, in some cases, fail to detect the presence of injury. CT is more sensitive than chest radiography in the detection of pulmonary, pleural, and osseous abnormalities in the patient who has chest trauma. With the advent of multidetector CT (MDCT), high-quality multiplanar reformations are obtained easily and add to the diagnostic capabilities of MDCT. This article reviews the radiographic and CT findings of chest wall, pleural, and pulmonary injuries that are seen in the patient who has experienced blunt thoracic trauma.

  20. Effect of clinical medicine in lung infection caused by severe head trauma in infensive care unit%重症监护室重型颅脑损伤致肺部感染的临床用药分析

    Institute of Scientific and Technical Information of China (English)

    罗志建

    2015-01-01

    Objective:To investigate the clinical condition of pulmonary infection caused by severe head trauma infensive care unit, and observe its clinical manifestations and drug effects. Methods:The clinical diagnosis and treatment data of 110 cases with pulmonary infection caused by severe head trauma were retrospectively analyzed. Results:The incidence of pulmonary infection caused by severe head trauma was high. Eighty-eight strains of gram-negative bacteria(73. 3%),26 strains of gram-positive bacteria(21. 7%) and 6 strains of fungi (5. 0%) were found. The sensitivities of imipenem and vancomycin were the highest. All patients were alleviated after treatment. Conclusions:The gram-negative bacteria in pulmonary infection caused by severe head trauma infensive care unit is the major pathogenic bacteria. The patient is multiple drug resistance,the use of antibiotics should be strictly control.%目的::了解重症监护室( ICU)重型颅脑损伤致肺部感染的发生情况、临床表现及用药效果。方法:对110例ICU重型颅脑损伤出现肺部感染患者的临床诊治资料进行回顾性分析。结果:ICU重型颅脑损伤出现肺部感染的发生率较高,病原菌中革兰阴性菌88株,占73.3%,革兰阳性菌26株,占21.7%,真菌6株,占5.0%。革兰阴性菌和阳性菌分别以铜绿假单胞杆菌和金黄色葡萄球菌检出率最高,分别对头胞哌酮和万古霉素的敏感率最高。经治疗,所有病例均得到缓解。结论:ICU重型颅脑损伤致肺部感染的致病菌以革兰阴性菌为主,且多重耐药情况严重,须严格控制抗生素的使用。

  1. A case of malignant fibrous histiocytoma of the head after trauma and radiation therapy%脑部恶性纤维组织细胞瘤1例报道

    Institute of Scientific and Technical Information of China (English)

    S. Mourgela; A. Sakellaropoulos; K. Kirgiannis; A. Spanos

    2009-01-01

    Malignant fibrous histiocytoma (MFH) firstly described as "malignant fibrous xanthoma" by O'Brien and Stout in 1964, is the most common soft tissue sarcoma of late adult life. Uncertain histogenesis and numerous subtypes make MFH a rather controversial entity. MFH only rare arises from structures of the head and neck. When it does, it most often originates in facial structures, particularly the maxilla. This report details a case of a patient with malignant fibrous histiocytoma presenting clinically as a right-sided large indurated frontoparietal mass, three months after head trauma and eight years after radiation therapy for brain lymphoma located in the right frontal and parietal lobes. Radical excision was a surgical challenge because of the extensiveness of the lesion.

  2. Physical Trauma as an Etiological Agent in Mental Retardation.

    Science.gov (United States)

    Angle, Carol R., Ed.; Bering, Edgar A., Jr., Ed.

    The conference on Physical Trauma as a Cause of Mental Retardation dealt with two major areas of etiological concern - postnatal and perinatal trauma. Following two introductory statements on the problem of and issues related to mental retardation (MR) after early trauma to the brain, five papers on the epidemiology of head trauma cover…

  3. Vascular Injury in Orthopedic Trauma.

    Science.gov (United States)

    Mavrogenis, Andreas F; Panagopoulos, George N; Kokkalis, Zinon T; Koulouvaris, Panayiotis; Megaloikonomos, Panayiotis D; Igoumenou, Vasilios; Mantas, George; Moulakakis, Konstantinos G; Sfyroeras, George S; Lazaris, Andreas; Soucacos, Panayotis N

    2016-07-01

    Vascular injury in orthopedic trauma is challenging. The risk to life and limb can be high, and clinical signs initially can be subtle. Recognition and management should be a critical skill for every orthopedic surgeon. There are 5 types of vascular injury: intimal injury (flaps, disruptions, or subintimal/intramural hematomas), complete wall defects with pseudoaneurysms or hemorrhage, complete transections with hemorrhage or occlusion, arteriovenous fistulas, and spasm. Intimal defects and subintimal hematomas with possible secondary occlusion are most commonly associated with blunt trauma, whereas wall defects, complete transections, and arteriovenous fistulas usually occur with penetrating trauma. Spasm can occur after either blunt or penetrating trauma to an extremity and is more common in young patients. Clinical presentation of vascular injury may not be straightforward. Physical examination can be misleading or initially unimpressive; a normal pulse examination may be present in 5% to 15% of patients with vascular injury. Detection and treatment of vascular injuries should take place within the context of the overall resuscitation of the patient according to the established principles of the Advanced Trauma Life Support (ATLS) protocols. Advances in the field, made mostly during times of war, have made limb salvage the rule rather than the exception. Teamwork, familiarity with the often subtle signs of vascular injuries, a high index of suspicion, effective communication, appropriate use of imaging modalities, sound knowledge of relevant technique, and sequence of surgical repairs are among the essential factors that will lead to a successful outcome. This article provides a comprehensive literature review on a subject that generates significant controversy and confusion among clinicians involved in the care of trauma patients. [Orthopedics. 2016; 39(4):249-259.]. PMID:27322172

  4. Temporal bone trauma and the role of multidetector CT in the emergency department.

    Science.gov (United States)

    Zayas, Julio O; Feliciano, Yara Z; Hadley, Celene R; Gomez, Angel A; Vidal, Jorge A

    2011-10-01

    The temporal bone anatomy is complex, with many critical structures in close association with one another. The temporal bone region comprises cranial nerves V, VI, VII, and VIII; vascular structures such as the internal carotid and middle meningeal arteries; sigmoid sinus; jugular bulb; and sensorineural and membranous structures of the inner ear. Most temporal bone fractures are a result of high-energy blunt head trauma. Multidetector computed tomography (CT) plays a fundamental role in the initial evaluation of patients with polytrauma in the emergency department. Multidetector CT may help identify important structural injuries that may have devastating complications such as sensorineural hearing loss, conductive hearing loss, dizziness and balance dysfunction, perilymphatic fistulas, cerebrospinal fluid leaks, facial nerve paralysis, and vascular injury. Although classifying temporal bone fractures helps physicians understand and predict trauma-associated complications and guide treatment, identifying injury to critical structures is more important for guiding management and determining prognosis than is simply classifying temporal bone fractures into a general category. Many temporal bone fractures and complications may be readily identified and characterized at routine cervical, maxillofacial, and head multidetector CT performed in patients with polytrauma, without the need for dedicated temporal bone multidetector CT. Dedicated temporal bone multidetector CT should be considered when there is a high degree of suspicion for temporal bone fractures and no fractures are identified at head, cervical, or maxillofacial CT. PMID:21997992

  5. Trauma is danger

    Directory of Open Access Journals (Sweden)

    Porterfield Nancy

    2011-06-01

    Full Text Available Abstract Background Trauma is one of the leading causes of death in young adult patients. Many pre-clinical and clinical studies attempt to investigate the immunological pathways involved, however the true mediators remain to be elucidated. Herein, we attempt to describe the immunologic response to systemic trauma in the context of the Danger model. Data Sources A literature search using PubMed was used to identify pertinent articles describing the Danger model in relation to trauma. Conclusions Our knowledge of Danger signals in relation to traumatic injury is still limited. Danger/alarmin signals are the most proximal molecules in the immune response that have many possibilities for effector function in the innate and acquired immune systems. Having a full understanding of these molecules and their pathways would give us the ability to intervene at such an early stage and may prove to be more effective in blunting the post-injury inflammatory response unlike previously failed cytokine experiments.

  6. 视神经减压术对颅脑损伤合并视神经损伤视力康复的意义%The significance of decompression of optic nerve in the rehabilitation of traumatic optic nerve following head trauma

    Institute of Scientific and Technical Information of China (English)

    邱建武; 宋振全; 林军

    2002-01-01

    Objective To investigate the significance of decompression of optic nerve in the rehabilitation of traumatic optic neuropathy following head trauma.Method Surgical treatment was performed on 16 patients suffered from traumatic neuropathy following head trauma.Fragments ,hematoma,necrotic brain tissue resulting from fracture of orbital bone were removed and frontal and orbital fracture or malposition corrected by craniotomy through valve of frontal bone in 15 patients.Optic canal was probed and sheath of optic nerve was cut open for decompression of optic nerve.Frontotemporal wound was made in 1 case with superior orbital fissure syndrome and decompression of optic canal and abrasion of superior orbital fissure were performed through outer side of orbital point.Result Surgical treatment was effective in 12 cases(75% ),exophthalmus in 2 cases was corrected.Conclusion Decompression of optic nerve through frontal bone or frontotemporal is effective in enhancing visual acuity in patients with traumatic optic neuropathy following head trauma.

  7. Systemic trauma.

    Science.gov (United States)

    Goldsmith, Rachel E; Martin, Christina Gamache; Smith, Carly Parnitzke

    2014-01-01

    Substantial theoretical, empirical, and clinical work examines trauma as it relates to individual victims and perpetrators. As trauma professionals, it is necessary to acknowledge facets of institutions, cultures, and communities that contribute to trauma and subsequent outcomes. Systemic trauma-contextual features of environments and institutions that give rise to trauma, maintain it, and impact posttraumatic responses-provides a framework for considering the full range of traumatic phenomena. The current issue of the Journal of Trauma & Dissociation is composed of articles that incorporate systemic approaches to trauma. This perspective extends conceptualizations of trauma to consider the influence of environments such as schools and universities, churches and other religious institutions, the military, workplace settings, hospitals, jails, and prisons; agencies and systems such as police, foster care, immigration, federal assistance, disaster management, and the media; conflicts involving war, torture, terrorism, and refugees; dynamics of racism, sexism, discrimination, bullying, and homophobia; and issues pertaining to conceptualizations, measurement, methodology, teaching, and intervention. Although it may be challenging to expand psychological and psychiatric paradigms of trauma, a systemic trauma perspective is necessary on both scientific and ethical grounds. Furthermore, a systemic trauma perspective reflects current approaches in the fields of global health, nursing, social work, and human rights. Empirical investigations and intervention science informed by this paradigm have the potential to advance scientific inquiry, lower the incidence of a broader range of traumatic experiences, and help to alleviate personal and societal suffering.

  8. Systemic trauma.

    Science.gov (United States)

    Goldsmith, Rachel E; Martin, Christina Gamache; Smith, Carly Parnitzke

    2014-01-01

    Substantial theoretical, empirical, and clinical work examines trauma as it relates to individual victims and perpetrators. As trauma professionals, it is necessary to acknowledge facets of institutions, cultures, and communities that contribute to trauma and subsequent outcomes. Systemic trauma-contextual features of environments and institutions that give rise to trauma, maintain it, and impact posttraumatic responses-provides a framework for considering the full range of traumatic phenomena. The current issue of the Journal of Trauma & Dissociation is composed of articles that incorporate systemic approaches to trauma. This perspective extends conceptualizations of trauma to consider the influence of environments such as schools and universities, churches and other religious institutions, the military, workplace settings, hospitals, jails, and prisons; agencies and systems such as police, foster care, immigration, federal assistance, disaster management, and the media; conflicts involving war, torture, terrorism, and refugees; dynamics of racism, sexism, discrimination, bullying, and homophobia; and issues pertaining to conceptualizations, measurement, methodology, teaching, and intervention. Although it may be challenging to expand psychological and psychiatric paradigms of trauma, a systemic trauma perspective is necessary on both scientific and ethical grounds. Furthermore, a systemic trauma perspective reflects current approaches in the fields of global health, nursing, social work, and human rights. Empirical investigations and intervention science informed by this paradigm have the potential to advance scientific inquiry, lower the incidence of a broader range of traumatic experiences, and help to alleviate personal and societal suffering. PMID:24617751

  9. Subtle Radiological Features of Splenic Avulsion following Abdominal Trauma

    Directory of Open Access Journals (Sweden)

    S. A. Rehim

    2010-01-01

    Full Text Available Splenic trauma in children following blunt abdominal injury is usually treated by nonoperative management (NOM. Splenectomy following abdominal trauma is rare in children. NOM is successful as in the majority of instances the injury to the spleen is contained within its capsule or a localised haematoma. Rarely, the spleen may suffer from an avulsion injury that causes severe uncontrollable bleeding and necessitates an emergency laparotomy and splenectomy. We report two cases of children requiring splenectomy following severe blunt abdominal injury. In both instances emergency laparotomy was undertaken for uncontrollable bleeding despite resuscitation. The operating team was unaware of the precise source of bleeding preoperatively. Retrospective review of the computed tomography (CT scans revealed subtle radiological features that indicate splenic avulsion. We wish to highlight these radiological features of splenic avulsion as they can help to focus management decisions regarding the need/timing for a laparotomy following blunt abdominal trauma in children.

  10. Simplified pancreatoduodenectomy for complex blunt pancreaticoduodenal injury

    Institute of Scientific and Technical Information of China (English)

    FENG Xin-fu; FAN Wei; SHI Cheng-xian; LI Jun-hua; LIU Jun; LIU Zhen-hua

    2013-01-01

    A 34-year-old man admitted to our department with complex blunt pancreaticoduodenal injury after a car accident.The wall of the first,second,and third portions of the duodenum was extensively lacerated,and the pancreas was longitudinally transected along the superior mesenteric vein-portal vein trunk.The pancreatic head and the uncinate process were devitalized and the distal common bile duct and the proximal main pancreatic duct were completely detached from the Vater ampulla.The length of the stump of distal common bile located at the cut surface of remnant pancreas was approximately 0.6 cm.A simplified Kausch-Whipple's procedure was performed after debridement of the devitalized pancreatic head and resection of the damaged duodenum in which the stump of distal common bile duct and the pancreatic remnant were embedded into the jejunal loop.Postoperative wound abscess appeared that eventually recovered by conservative treatment.During 16 months follow-up the patient has been stable and healthy.A simplified pancreaticoduodenectomy is a safe alternative for the Whipple procedure in managing complex pancreaticoduodenal injury in a hemodynamically stable patient.

  11. Non-operative management of adult blunt splenic injuries

    Institute of Scientific and Technical Information of China (English)

    YANG Jun; GAO Jin-mou; Jean-Claude Baste

    2006-01-01

    Objective: To investigate the indication of nonoperative management of adult blunt splenic injuries.Methods: A retrospective review was performed on all adult patients (age > 15 years ) with blunt splenic injuries admitted to the department of vascular surgery of Pellegrin hospital in France from 1999 to 2003. We managed splenic injuries non-operatively in all appropriate patients without regard to age.Results: During the 4 years, 54 consecutive adult patients with blunt splenic injuries were treated in the hospital. A total of 27 patients with stable hemodynamic status were treated non-operatively at first, of which 2 patients were failed to non-operative treatment. The successful percentage of non-operative management was 92.6 %. In the 54 patients, 7 of 8 patients older than 55 years were treated with non-operative management. Two cases developing postoperatively subphrenic infection were healed by proper treatment. In the series, there was no death.Conclusions: Non-operative management of low-grade splenic injuries can be accomplished with an acceptable low-failure rate. If the clinical and laboratory parameters difficult for surgeons to make decisions, they can depend on Resciniti' s CT (computed tomography)scoring system to select a subset of adults with splenic trauma who are excellent candidates for a trial of nonoperative management. The patients older than 55 years are not absolutely inhibited to receive non-operative management.

  12. A resposta metabólica ao trauma cranioencefálico é autolimitada? Análise das proteínas de fase aguda e glicemia Is the metabolic response self-limited in head trauma? Analysis of acute phase proteins and glycemia

    Directory of Open Access Journals (Sweden)

    ARTHUR O. SCHELP

    1998-12-01

    Full Text Available Nos últimos anos tem havido referências à limitação da resposta metabólica nas duas primeiras semanas após trauma cranioencefálico (TCE. Foi feita proposta de estudo a partir de experimento clínico em pacientes com trauma encefálico grave, que foram avaliados por volta de 7 dias após a lesão (M1. A segunda avaliação ocorreu 4 dias após (M2, e a terceira 3 a 4 dias após (M3. Em um período de 2 anos, foram selecionados 28 pacientes do sexo masculino, com trauma encefálico grave, escala de gravidade de Glasgow entre 4 e 6. Dentre os 28 pacientes, 6 completaram o estudo proposto. Os pacientes foram acompanhados clinicamente durante toda a fase do experimento. Em cada um dos momentos de análise, foram feitas análises da excreção nitrogenada e proteínas de fase aguda. Da mesma forma foram feitas determinações da glicemia plasmática, N-amínico e triglicerídeos. Os resultados do estudo demonstraram não haver modificações no balanço nitrogenado, normalização da proteína-C-reativa e redução relativa da glicemia ao final do experimento. Os autores tecem considerações sobre os possíveis mecanismos envolvidos na modulação da resposta metabólica e concluem que o hipermetabolismo, a basear-se na análise da glicemia e das proteínas de fase aguda, não persiste além do 13° dia do período de recuperação pós-trauma. São feitas sugestões de estudos futuros que possam elucidar os mecanismos envolvidos na normalização do hipercatabolismo e hipermetabolismo observados nas duas primeiras semanas após TCE.There are many reports supporting a self-limitation mechanism involved with hypermetabolic response after severe cranial injury. It was proposed a study with severe head injury patients, in three stages of the evolution. The first 7 days after admission (moment 1- M1, the second three days latter (M2 and the last 7 days after the first (M3. Among male patients with severe head injury, attended between January 1992

  13. CRANIOROFACIAL TRAUMA - RADIODIAGNOSIS

    Directory of Open Access Journals (Sweden)

    Zambrano JCR

    2013-09-01

    Full Text Available Clinical examination of Craniorofacial injuries are often limited in patients with trauma to the head and neck region due to obscuration by overlying edema, hematoma, hemorrhage, and soft-tissue injury. Craniorofacial injuries require accurate and prompt diagnosis for management. For Proper clinical examination and treatment plan, high resolution radiographs are always essential which will indirectly contribute to render a good medical care to the patients.

  14. Geriatric Trauma.

    Science.gov (United States)

    Reske-Nielsen, Casper; Medzon, Ron

    2016-08-01

    Within the next 15 years, 1 in 5 Americans will be over age 65. $34 billion will be spent yearly on trauma care of this age group. This section covers situations in trauma unique to the geriatric population, who are often under-triaged and have significant injuries underestimated. Topics covered include age-related pathophysiological changes, underlying existing medical conditions and certain daily medications that increase the risk of serious injury in elderly trauma patients. Diagnostic evaluation of this group requires liberal testing, imaging, and a multidisciplinary team approach. Topics germane to geriatric trauma including hypothermia, elder abuse, and depression and suicide are also covered. PMID:27475011

  15. Systemic inflammation after trauma.

    Science.gov (United States)

    Lenz, Andreas; Franklin, Glen A; Cheadle, William G

    2007-12-01

    Trauma is still one of the main reasons for death among the population worldwide. Mortality occurring early after injury is due to "first hits", including severe organ injury, hypoxia, hypovolaemia or head trauma. Massive injury leads to activation of the immune system and the early inflammatory immune response after trauma has been defined as systemic inflammatory response syndrome (SIRS). "Second hits" such as infections, ischaemia/reperfusion or operations can further augment the pro-inflammatory immune response and have been correlated with the high morbidity and mortality in the latter times after trauma. SIRS can lead to tissue destruction in organs not originally affected by the initial trauma with subsequent development of multi-organ dysfunction (MOD). The initial pro-inflammatory response is followed by an anti-inflammatory response and can result in immune suppression with high risk of infection and sepsis. Trauma causes activation of nearly all components of the immune system. It activates the neuroendocrine system and local tissue destruction and accumulation of toxic byproducts of metabolic respiration leads to release of mediators. Extensive tissue injury may result in spillover of these mediators into the peripheral bloodstream to further maintain and augment the pro-inflammatory response. Hormones like ACTH, corticosteroids and catecholamines as well as cytokines, chemokines and alarmins play important roles in the initiation and persistence of the pro-inflammatory response after severe injury. The purpose of this review is therefore to describe the immunological events after trauma and to introduce important mediators and pathways of the inflammatory immune response.

  16. 重型颅脑外伤灌注CT结果与脑灌注压的相关性%Correlation of brain perfusion computed tomography results and cerebral perfusion pressure in patients with severe head trauma

    Institute of Scientific and Technical Information of China (English)

    徐裕; 冯东侠; 高恒; 那汉荣; 徐伟东; 周新民

    2012-01-01

    目的 探讨重型颅脑外伤患者灌注CF结果与脑灌注压监测结果的相关性.方法 50例重型颅脑外伤患者分为两组:T组28例,C组22例,人院时头颅CT平扫有明显异常.在行灌注CT时,同时监测平均动脉压(MAP)及颅内压(ICP),计算脑灌注压(CPP).应用直线回归分析灌注CT参数[局部脑血容量(rCBV)、局部脑血流(rCBF)和平均通过时间(MTT)]与CPP的相关性.结果 根据灌注CT结果,T组分为两个亚组:T1组,16例,灌注CT结果与CPP呈弱相关;T2组,12例,两者存在强相关.T1、T2和C组间的灌注CT参数均有明显差异.T1组的rCBF为(18.8±8.0)cm3·100g1·min-2,明显低于T2组的(60.2±21.3)cm3·100g1·min-1和C组的(48.3±11.0)CM3·100g1·min-1(P<0.01).T1、T2组灌注CT参数与相应CPP值之间均显著相关(P<0.01).结论 灌注CT结合ICP监测能提供有价值的评估脑血管自动调节功能是否完好的信息,有助于指导治疗.%Objective To investigate the correlation of brain perfusion computed tomography (CT) results and cerebral perfusion pressure (CPP) in patients with severe head trauma. Methods Perfusion CT results of 50 patients with head trauma were analyzed , who were divided into two groups of T(28 cases, severe head trauma with abnormal CT findings during admission) and C(22 cases,head trauma with normal CT findings during admission). The patients underwent perfusion CT and MAP and ICP were measured at the same time, by which CPP was calculated. The correlation between perfusion CT results [regional cerebral blood volume (rCBV), regional cerebral blood flow (rCBF) and MTT] and corresponding CPP was analyzed using linear regression analysis. Results According to perfusion CT results, group T was divided into two subgroups of Tl (16 cases, characterized by a weak correlation between the perfusion-CT results and the corresponding CPP values) and T2(12 cases,characterized by a strong correlation between the perfusion-CT results and the corresponding

  17. 8. Book Review: ‘Broken Bones: Anthropological Analysis of Blunt Force Trauma’ 2 nd edition, 2014

    Directory of Open Access Journals (Sweden)

    R. Gaur

    2014-04-01

    Full Text Available 'Broken Bones: Anthropological Analysis of Blunt Force Trauma' 2nd edition, 2014. Editors: Vicki L. Wedel and Alison Galloway; Publisher: Charles C. Thomas, Illinois. pp 479 + xxiii ISBN: 978-0-398-08768-5 (Hard ISBN: 978-0-398-08769-2 (eBook

  18. Management of liver trauma.

    LENUS (Irish Health Repository)

    Badger, S A

    2012-02-01

    BACKGROUND: Blunt and penetrating liver trauma is common and often presents major diagnostic and management problems. METHODS: A literature review was undertaken to determine the current consensus on investigation and management strategies. RESULTS: The liver is the most frequently injured organ following abdominal trauma. Immediate assessment with ultrasound has replaced diagnostic peritoneal lavage in the resuscitation room, but computerised tomography remains the gold standard investigation. Nonoperative management is preferred in stable patients but laparotomy is indicated in unstable patients. Damage control techniques such as perihepatic packing, hepatotomy plus direct suture, and resectional debridement are recommended. Major complex surgical procedures such as anatomical resection or atriocaval shunting are now thought to be redundant in the emergency setting. Packing is also recommended for the inexperienced surgeon to allow control and stabilisation prior to transfer to a tertiary centre. Interventional radiological techniques are becoming more widely used, particularly in patients who are being managed nonoperatively or have been stabilised by perihepatic packing. CONCLUSIONS: Management of liver injuries has evolved significantly throughout the last two decades. In the absence of other abdominal injuries, operative management can usually be avoided. Patients with more complex injuries or subsequent complications should be transferred to a specialist centre to optimise final outcome.

  19. Hypotensive Resuscitation among Trauma Patients

    Science.gov (United States)

    Carrick, Matthew M.; Leonard, Jan; Slone, Denetta S.; Mains, Charles W.

    2016-01-01

    Hemorrhagic shock is a principal cause of death among trauma patients within the first 24 hours after injury. Optimal fluid resuscitation strategies have been examined for nearly a century, more recently with several randomized controlled trials. Hypotensive resuscitation, also called permissive hypotension, is a resuscitation strategy that uses limited fluids and blood products during the early stages of treatment for hemorrhagic shock. A lower-than-normal blood pressure is maintained until operative control of the bleeding can occur. The randomized controlled trials examining restricted fluid resuscitation have demonstrated that aggressive fluid resuscitation in the prehospital and hospital setting leads to more complications than hypotensive resuscitation, with disparate findings on the survival benefit. Since the populations studied in each randomized controlled trial are slightly different, as is the timing of intervention and targeted vitals, there is still a need for a large, multicenter trial that can examine the benefit of hypotensive resuscitation in both blunt and penetrating trauma patients. PMID:27595109

  20. Effect of skull flexural properties on brain response during dynamic head loading - biomed 2013.

    Science.gov (United States)

    Harrigan, T P; Roberts, J C; Ward, E E; Carneal, C M; Merkle, A C

    2013-01-01

    The skull-brain complex is typically modeled as an integrated structure, similar to a fluid-filled shell. Under dynamic loads, the interaction of the skull and the underlying brain, cerebrospinal fluid, and other tissue produces the pressure and strain histories that are the basis for many theories meant to describe the genesis of traumatic brain injury. In addition, local bone strains are of interest for predicting skull fracture in blunt trauma. However, the role of skull flexure in the intracranial pressure response to blunt trauma is complex. Since the relative time scales for pressure and flexural wave transmission across the skull are not easily separated, it is difficult to separate out the relative roles of the mechanical components in this system. This study uses a finite element model of the head, which is validated for pressure transmission to the brain, to assess the influence of skull table flexural stiffness on pressure in the brain and on strain within the skull. In a Human Head Finite Element Model, the skull component was modified by attaching shell elements to the inner and outer surfaces of the existing solid elements that modeled the skull. The shell elements were given the properties of bone, and the existing solid elements were decreased so that the overall stiffness along the surface of the skull was unchanged, but the skull table bending stiffness increased by a factor of 2.4. Blunt impact loads were applied to the frontal bone centrally, using LS-Dyna. The intracranial pressure predictions and the strain predictions in the skull were compared for models with and without surface shell elements, showing that the pressures in the mid-anterior and mid-posterior of the brain were very similar, but the strains in the skull under the loads and adjacent to the loads were decreased 15% with stiffer flexural properties. Pressure equilibration to nearly hydrostatic distributions occurred, indicating that the important frequency components for typical

  1. Posterior compartment syndrome associated with clopidogrel therapy following trivial trauma

    OpenAIRE

    Byrne, A‐M; Kearns, S. R.; Kelly, E P

    2006-01-01

    Haematomata caused by blunt trauma may potentially induce a compartment syndrome by raising intra‐compartmental pressure. We report a case of acute posterior compartment syndrome following minimal trauma to the leg of an elderly patient on the antiplatelet agent clopidogrel. This case highlights the high index of clinical suspicion required to detect compartment syndrome in those on long term antiplatelet therapy and prompt surgical decompression is recommended.

  2. [Severe hepatic trauma. Initial non-operative treatment. A case report].

    Science.gov (United States)

    Christophe, M; Le Treut, Y P; Thomas, P; Pol, B; Escoffier, J M; Ottomani, A; Bricot, R

    1990-05-26

    The emergency surgical treatment of severe hepatic traumas still carries a high mortality risk. We report a case of severe blunt trauma of the liver managed without surgery under CT guidance. This attitude--which does not exclude surgery as a later resort--requires haemodynamic stability of the patient, close monitoring in a surgical intensive care unit and repeated CT scans. PMID:2141153

  3. Should blunt segmental vascular renal injuries be considered an AAST grade 4 renal injury?

    Science.gov (United States)

    Malaeb, Bahaa; Figler, Brad; Wessells, Hunter; Voelzke, Bryan B.

    2013-01-01

    Background Renal segmental vascular injury (SVI) following blunt abdominal trauma is not part of the original AAST renal injury grading system. Recent recommendations support classifying SVI as an AAST grade 4 injury. Our primary aim was to compare outcomes following blunt renal SVI and blunt renal collecting system lacerations (CSL). We hypothesize that renal SVI fare well with conservative management alone and should be relegated a less severe renal AAST grade. Methods We retrospectively identified patients with SVI and G4 CSL admitted to a Level 1 trauma center between 2003–2010. Penetrating trauma was excluded. Need for surgical intervention, length of stay, kidney salvage (>25% renal preservation on renography 6–12 weeks after injury), and delayed complication rates were compared between the SVI and CSL injuries. Statistical analysis utilized chi squared, Fisher exact, and t-test. Results 56 patients with SVI and 88 patients with G4 CSL sustained blunt trauma. Age, injury severity score, and length of stay were similar for the two groups. Five patients in each group died of concomitant, non-renal injuries. In the G4 CSL group, 15 patients underwent major interventions and 32 patients underwent minor interventions. Only one patient in the SVI group underwent a major intervention. The renal salvage rate was 85.7% following SVI versus 62.5% following CSL (p=0.107). Conclusions Overall surgical interventions are significantly lower among the SVI cohort than G4 CSL cohort. Further analysis using a larger cohort of patients is recommended before revising the current renal grading system. Adding SVI as a grade 4 injury could potentially increase the heterogeneity of grade 4 injuries and decrease the ability of the AAST renal injury grading system to predict outcomes, such as nephrectomy rate. Level of Evidence IV (retrospective, cohort study) PMID:24458054

  4. Cortical necrosis secondary to trauma in a child: contrast-enhanced ultrasound comparable to magnetic resonance imaging

    International Nuclear Information System (INIS)

    Cortical necrosis is an uncommon cause of renal impairment and is rarely a consequence of blunt abdominal trauma. We present a case of unilateral traumatic acute cortical necrosis in a child demonstrated on contrast-enhanced US with confirmation on MRI. Contrast-enhanced US provides a rapid, accurate evaluation of renal parenchyma abnormalities in blunt abdominal trauma in children without exposure to ionising radiation or the risk of sedation. (orig.)

  5. Risk of symptomatic heterotopic ossification following plate osteosynthesis in multiple trauma patients: an analysis in a level-1 trauma centre

    Directory of Open Access Journals (Sweden)

    Pape Hans-Christoph

    2009-10-01

    Full Text Available Abstract Background Symptomatic heterotopic ossification (HO in multiple trauma patients may lead to follow up surgery, furthermore the long-term outcome can be restricted. Knowledge of the effect of surgical treatment on formation of symptomatic heterotopic ossification in polytrauma is sparse. Therefore, we test the effects of surgical treatment (plate osteosynthesis or intramedullary nailing on the formation of heterotopic ossification in the multiple trauma patient. Methods We retrospectively analysed prospectively documented data of blunt multiple trauma patients with long bone fractures which were treated at our level-1 trauma centre between 1997 and 2005. Patients were distributed to 2 groups: Patients treated by intramedullary nails (group IMN or plate osteosynthesis (group PLATE were compared. The expression and extension of symptomatic heterotopic ossifications on 3-6 months follow-up x-rays in antero-posterior (ap and lateral views were classified radiologically and the maximum expansion was measured in millimeter (mm. Additionally, ventilation time, prophylactic medication like indomethacine and incidence and correlation of head injuries were analysed. Results 101 patients were included in our study, 79 men and 22 women. The fractures were treated by intramedullary nails (group IMN n = 50 or plate osteosynthesis (group PLATE n = 51. Significantly higher radiologic ossification classes were detected in group PLATE (2.9 ± 1.3 as compared to IMN (2.2 ± 1.1; p = 0.013. HO size in mm ap and lateral showed a tendency towards larger HOs in the PLATE group. Additionally PLATE group showed a higher rate of articular fractures (63% vs. 28% in IMN while IMN demonstrated a higher rate of diaphyseal fractures (72% vs. 37% in PLATE; p = 0.003. Ventilation time, indomethacine and incidence of head injuries showed no significant difference between groups. Conclusion Fracture care with plate osteosynthesis in polytrauma patients is associated with

  6. Research on the drag reduction performance induced by the counterflowing jet for waverider with variable blunt radii

    Science.gov (United States)

    Li, Shi-bin; Wang, Zhen-guo; Barakos, George N.; Huang, Wei; Steijl, Rene

    2016-10-01

    Waverider will endure the huge aero-heating in the hypersonic flow, thus, it need be blunt for the leading edge. However, the aerodynamic performance will decrease for the blunt waverider because of the drag hoik. How to improve the aerodynamic performance and reduce the drag and aero-heating is very important. The variable blunt radii method will improve the aerodynamic performance, however, the huge aero-heating and bow shock wave at the head is still serious. In the current study, opposing jet is used in the waverider with variable blunt radii to improve its performance. The three-dimensional coupled implicit Reynolds-averaged Navier-Stokes(RANS) equation and the two equation SST k-ω turbulence model have been utilized to obtain the flow field properties. The numerical method has been validated against the available experimental data in the open literature. The obtained results show that the L/D will drop 7-8% when R changes from 2 to 8. The lift coefficient will increase, and the drag coefficient almost keeps the same when the variable blunt radii method is adopted, and the L/D will increase. The variable blunt radii method is very useful to improve the whole characteristics of blunt waverider and the L/D can improve 3%. The combination of the variable blunt radii method and opposing jet is a novel way to improve the whole performance of blunt waverider, and L/D can improve 4-5%. The aperture as a novel way of opposing jet is suitable for blunt waverider and also useful to improve the aerodynamic and aerothermodynamic characteristics of waverider in the hypersonic flow. There is the optimal P0in/P0 that can make the detached shock wave reattach the lower surface again so that the blunt waverider can get the better aerodynamic performance.

  7. Profile of care given to patients with blunt chest injuries within the first 48 hours

    Directory of Open Access Journals (Sweden)

    E Nyangena

    2000-09-01

    Full Text Available This study was conducted in the trauma unit of a large academic hospital in Johannesburg, South Africa. The study aimed at describing the nature of care that patients with blunt chest injuries received during the first 48 hours after injury. A descriptive survey was chosen using retrospective and prospective record review to obtain data. The sample comprised 60 records of patients who were admitted to the hospital due to blunt chest injuries between January 1997 and June 1998. Descriptive statistics were used to present and analyse data. The study showed that: (i Blunt chest trauma victims received a thorough initial assessment and care. No missed injuries were identified on subsequent assessment; (ii More than half of the patients spent over one hour in the accident/emergency department before admission to the trauma ward or intensive care unit (ICU; (iii Motor vehicle accidents (MVA were the commonest cause of injury while pedestrian vehicle accidents (PVA were often fatal; (iv Nurses are good providers of care but poor in prescribing and documenting care; (v Pain assessment and psychosocial care was often neglected; (vi Less than half the patients developed complications during the first 48 hours; pain and pneumonia being the most common complications encountered.

  8. A decade of civilian vascular trauma in Kosovo

    Directory of Open Access Journals (Sweden)

    Jaha Luan

    2012-07-01

    Full Text Available Abstract Purpose We sought to analyze the results of arterial injury management in a busy metropolitan vascular unit and risk factors associated with mortality and morbidity. Patients and methods We analyzed 120 patient with arterial injury treated between year 2000 and 2010 at the University Clinical Center of Kosovo. Seven of these years were prospective and three retrospective study. Results The mechanism of arterial injury was stabbing 46.66%, gunshot wounds in 31.66%, blunt in 13.33%, and landmine in 8.33%. The most frequently injured vessel was the superficial femoral artery (25%, followed by the brachial artery (20.9%, crural arteries (13.1%, forearm arteries (14.3%, iliac arteries (7.5%, abdominal aorta (3.3%, common femoral artery (3.3% and popliteal artery (3.3%. Associated injuries including bone, nerve and remote injury (affecting the head, chest, or abdomen were present in 24.2% of patients. The decision to operate was made based on the presence of “hard signs” of vascular trauma. Arterial reconstruction was performed in 90.8% of patients, 5.8% of patients underwent primary amputation and 3.2% died on the operation table. Overall survival rate was 95.8%. Conclusion Injuries to the arteries are associated with significant mortality and morbidity. Mechanism of injury (blunt, gunshot, landmine or stub, hemodynamic stability at the admission, localization of injury, time from injury to flow restitution, associated injuries to the structures in the region and remote organs are critical factors influencing outcome.

  9. Trauma Africa

    Directory of Open Access Journals (Sweden)

    Victor Y. Kong

    2013-11-01

    Full Text Available “Major Trauma. Dr. Kong, please come to the Trauma Unit immediately. Dr. Kong, please come to the Trauma Unit immediately.” Even though I have been working at Edendale Hospital as a trauma registrar for over a year, whenever I hear this announcement over the hospital intercom system, my heart beats just a little faster than normal. When I first arrived at Edendale my colleagues told me that the adrenaline rush I would experience after being called out to attend a new emergency would decrease over time, and indeed they were right. However, it is also true to say that on some occasions more than others, it is still felt more strongly than ever.

  10. Epidemiological evaluation of hepatic trauma victims undergoing surgery

    Directory of Open Access Journals (Sweden)

    Mitre Kalil

    2016-02-01

    Full Text Available Objective : to evaluate the epidemiological variables and diagnostic and therapeutic modalities related to hepatic trauma patients undergoing laparotomy in a public referral hospital in the metropolitan region of Vitória-ES. Methods : we conducted a retrospective study, reviewing charts of trauma patients with liver injuries, whether isolated or in association with other organs, who underwent exploratory laparotomy, from January 2011 to December 2013. Results : We studied 392 patients, 107 of these with liver injury. The male: female ratio was 6.6 : 1 and the mean age was 30.12 years. Penetrating liver trauma occurred in 78.5% of patients, mostly with firearms. Associated injuries occurred in 86% of cases and intra-abdominal injuries were more common in penetrating trauma (p <0.01. The most commonly used operative technique was hepatorrhaphy and damage control surgery was applied in 6.5% of patients. The average amounts of blood products used were 6.07 units of packed red blood cells and 3.01 units of fresh frozen plasma. The incidence of postoperative complications was 29.9%, the most frequent being infectious, including pneumonia, peritonitis and intra-abdominal abscess. The survival rate of patients suffering from blunt trauma was 60%, and penetrating trauma, 87.5% (p <0.05. Conclusion : despite technological advances in diagnosis and treatment, mortality rates in liver trauma remain high, especially in patients suffering from blunt trauma in relation to penetrating one.

  11. The clinical implications of heterotopic ossification in patients treated with radial head replacement for trauma: A case series and review of the literature.

    Science.gov (United States)

    Bowman, Seth H; Barfield, William R; Slone, Harris S; Shealy, Gerald J; Walton, Zeke J

    2016-12-01

    Radial head arthroplasty (RHA) is an acceptable treatment for comminuted radial head fractures (RHF). Fourteen patients with no postop HO prophylaxis were treated with RHA for comminuted RHF. A 50% incidence in HO was seen following RHA with a statistically increased risk (p ≤ 0.05) of reoperation compared to those without HO. Decreased ROM was seen on the affected side (p ≤ 0.05); patients without HO showed no statistical difference (p ≥ 0.05) in ROM or grip strength. HO following RHA increases patient risk for reoperation and decreases ROM. We recommend HO prophylaxis with NSAIDs and/or radiotherapy if no direct patient contraindications are found. PMID:27408502

  12. Imaging of penetrating injuries of the head and neck:current practice at a level I trauma center in the United States.

    Science.gov (United States)

    Saito, Naoko; Hito, Rania; Burke, Peter A; Sakai, Osamu

    2014-01-01

    Penetrating neck injuries are commonly related to stab wounds and gunshot wounds in the United States. The injuries are classified by penetration site in terms of the three anatomical zones of the neck. Based on this zonal classification system, penetrating injuries to the head and neck have traditionally been evaluated by conventional angiography and/or surgical exploration. In recent years, multidetector-row computed tomography (CT) angiography has significantly improved detectability of vascular injuries and extravascular injuries in the setting of penetrating injuries. CT angiography is a fast and minimally invasive imaging modality to evaluate penetrating injuries of the head and neck for stable patients. The spectrum of penetrating neck injuries includes vascular injury (extravasation, pseudoaneurysm, dissection, occlusion, and arteriovenous fistula), aerodigestive injury (esophageal and tracheal injuries), salivary gland injury, neurologic injury (spinal canal and cerebral injuries), and osseous injury, all of which can be evaluated using CT angiography. Familiarity with the complications and imaging characteristics of penetrating injuries of the head and neck is essential for accurate diagnosis and optimal treatment.

  13. Age-related differences in mechanism, cause, and location of trauma deaths

    DEFF Research Database (Denmark)

    Meisler, Rikke; Thomsen, Annemarie Bondegaard; Theilade, Peter;

    2011-01-01

    BACKGROUND: Trauma death has traditionally been described as primarily occurring in young men exposed to penetrating trauma or road traffic accidents. The epidemiology of trauma fatalities in Europe may change as a result of the increasing proportion of elderly patients. The goal of this study...... was to describe age-related differences in trauma type, mechanism, cause and location of death in a well-defined European region. METHODS: We prospectively registered all trauma patients and severe burn patients in eastern Denmark over 12 consecutive months. We analyzed all trauma fatalities in our region...... regarding the trauma type, mechanism, cause and location of death. RESULTS: A total of 2923 patients were registered, of which 292 (9.9%) died within 30 days. Mortality increased with age, with a mortality of 46.1% in patients older than 80 years old. Blunt trauma was the most frequent trauma type at all...

  14. Age-related differences in mechanism, cause, and location of trauma deaths

    DEFF Research Database (Denmark)

    Meisler, Rikke; Thomsen, Annemarie Bondegaard; Theilade, Peter;

    2011-01-01

    was to describe age-related differences in trauma type, mechanism, cause and location of death in a well-defined European region. METHODS: We prospectively registered all trauma patients and severe burn patients in eastern Denmark over 12 consecutive months. We analyzed all trauma fatalities in our region......BACKGROUND: Trauma death has traditionally been described as primarily occurring in young men exposed to penetrating trauma or road traffic accidents. The epidemiology of trauma fatalities in Europe may change as a result of the increasing proportion of elderly patients. The goal of this study...... regarding the trauma type, mechanism, cause and location of death. RESULTS: A total of 2923 patients were registered, of which 292 (9.9%) died within 30 days. Mortality increased with age, with a mortality of 46.1% in patients older than 80 years old. Blunt trauma was the most frequent trauma type at all...

  15. Liver Hydatid Cyst Rupture Into the Peritoneal Cavity After Abdominal Trauma: Case Report and Literature Review

    OpenAIRE

    Yilmaz, Mehmet; Akbulut, Sami; Kahraman, Aysegul; Yilmaz, Sezai

    2012-01-01

    The aim of this study was to review the literature regarding the rupture of hydatid cysts into the abdominal cavity after trauma. We present both a new case of hydatid cyst rupture that occurred after blunt abdominal trauma and a literature review of studies published in the English language about hydatid cyst rupture after trauma; studies were accessed from PubMed, Google Scholar, EBSCO, EMBASE, and MEDLINE databases. We identified 22 articles published between 2000 and 2011 about hydatid cy...

  16. Comparison of the new injury severity score and the injury severity score in multiple trauma patients

    Institute of Scientific and Technical Information of China (English)

    ZHAO Xiao-gang; MA Yue-feng; ZHANG Mao; GAN Jian-xin; XU Shao-wen; JIANG Guan-yu

    2008-01-01

    Objective: To assess whether these characteristics of less misclassification and greater area under receiver opera-tor characteristic (ROC) curve of the new injury severity score (NISS) are better than the injury severity score (ISS) as applying it to our multiple trauma patients registered into the emergency intensive care unit (EICU). Methods: This was a retrospective review of registry data from 2 286 multiple trauma patients consecutively reg-istered into the EICU from January 1,1997 to December 31, 2006 in the Second Affiliated Hospital, Medical School of Zhejiang University in China. Comparisons between ISS and NISS were made using misclassification rates, ROC curve analysis, and the H-L statistics by univariate and mul-tivariate logistic progression model. Results: Among the 2 286 patients, 176 (7.7%) were excluded because of deaths on arrival or patients less than 16 years of age. The study population therefore comprised 2 110 patients. Mean EICU length of stay (LOS) was 7.8 days±2.4 days. Compared with the blunt injury group, the penetrating injury group had a higher percentage of male, lower mean EICU LOS and age. The most frequently injured body regions were extremities and head/neck, followed by thorax, face and abdomen in the blunt injury group; whereas, thorax and abdomen were more frequently seen in the pen-etrating injury group. The minimum misclassification rate for NISS was slightly less than ISS in all groups (4.01% versus 4.49%). However, NISS had more tendency to misclassify in the penetrating injury group. This, we noted, was attributed mainly to a higher false-positive rate (21.04% versus 15.55% for ISS, t=-3.310, P<0.001), resulting in an over-all misclassification rate of 23.57% for NISS versus 18.79% for ISS (t=3.290, P<0.001). In the whole sample, NISS pre-sented equivalent discrimination (area under ROC curve:NISS=0.938 versus ISS=0.943). The H-L statistics showed poorer calibration (48.64 versus 32.11, t=3.305, P<0.001) in the

  17. Basal ganglia stroke due to mild head trauma in pediatric age - clinical and therapeutic management: a case report and 10 year literature review

    Directory of Open Access Journals (Sweden)

    Salvati Maurizio

    2011-01-01

    Full Text Available Abstract Ischemia of the basal ganglia as an immediate consequence of minor head injury in children is rare ( Young patients should be closely monitored and treated conservatively with osmotic diuretics to reduce perilesional edema. At the same time, however, it is very important to exclude, by means of instrumental and laboratory studies, conditions that could favour the onset of ischemia, including emboligen heart disease, thrombophilia and acute traumatic arterial dissections. Generally speaking, the prognosis in these cases is good. The authors describe their experience treating a 10-month old baby girl, with a left lenticular nucleus ischemia and report a literature review.

  18. Carcinoma of the duodenum after trauma, radiotherapy and chemotherapy.

    Science.gov (United States)

    Bayens, Y C; Wiggers, T; Meerwaldt, J H; Vroom, T M; Van Geel, A N

    1991-10-01

    The case history is reported of a patient with a carcinoma of the duodenum 30 years after blunt abdominal trauma at the site of the 'scar' in the duodenum. Thirteen years after the trauma the patient was treated with chemotherapy and abdominal irradiation for a relapse of Hodgkin's disease. At follow-up, 25 months after the operation, he had no local recurrence of Hodgkin's disease or duodenal cancer. The possible relation between the cancer and the abdominal trauma, chemotherapy and abdominal irradiation is discussed.

  19. Closed head injury in rats: histopathological aspects in an experimental weight drop model Trauma craniano fechado em ratos: aspectos histopatológicos em um modelo experimental de queda de peso

    Directory of Open Access Journals (Sweden)

    Danilo dos Santos Silva

    2012-04-01

    Full Text Available PURPOSE: To study histopathological findings due to a model of closed head injury by weight loss in rats. METHODS: A platform was used to induce closed cranial lesion controlled by weight loss with a known and predefined energy. 25 male Wistar rats (Rattus novergicus albinus were divided in five equal groups which received different cranial impact energy levels: G1, G2, G3 and G4 with 0.234J, 0.5J, 0.762J and 1J respectively and G5 (Sham. Under the effect of analgesia, the brain of each group was collected and prepared for histopathological analysis by conventional optic microscopy. RESULTS: It was observed greater number of injured neurons in animals of group 4, however neuronal death also could be noticed in animals of group 5. Intraparenchymal hemorrhages were more frequent in animals of group 4 and the cytotoxic brain swelling and vascular congestion were more intense in this group CONCLUSION: The histopathological analysis of these findings allowed to observe typical cranial trauma alterations and these keep close relation with impact energy.OBJETIVO: Investigar as alterações histopatológicas produzidas por um modelo de trauma craniano fechado por queda de peso em ratos. MÉTODOS: Utilizando uma plataforma para produção de lesão craniana fechada controlada por queda de peso com energia pré-definida e conhecida, 25 ratos Wistar machos (Rattus norvegicus albinus foram divididos em cinco grupos iguais que receberam níveis diferentes de energia de impacto craniano: G1, G2, G3 e G4 com 0,234J, 0,5J, 0,762J e 1J respectivamente e G5 (Sham. Sob analgesia, cada grupo teve seus encéfalos coletados e processados para análise histopatológica por microscopia óptica convencional. RESULTADOS: Houve maior número de neurônios lesados em animais do grupo 4, mas morte neuronal também pôde ser constatada nos animais do grupo 5. Hemorragias parenquimatosas foram mais frequentes nos animais do grupo 4 e o inchaço cerebral citotóxico e congest

  20. Paediatric trauma care

    Directory of Open Access Journals (Sweden)

    Sebastian van As A

    2010-01-01

    Full Text Available Background: Childhood trauma has become a major cause of mortality and morbidity, disability and socio-economic burden and it is expected by the World Health Organization (WHO that by 2020 it will be the number 1 disease globally. The WHO and UNICEF have published their third World Report on Child Injury Prevention in December 2008. Materials and Methods: A systematic review was performed on the history and magnitude of paediatric trauma worldwide. Additionally exciting developments and new trends were assessed and summarized. Results: Paediatric trauma is a growing field of clinical expertise. New developments include total body digital imaging of children presenting with polytrauma; targeted management of head injuries; conservative management of abdominal injuries in children and diagnostic laparoscopy, including the laparoscopic management of complications following the conservative management of solid organ injuries. Conclusion: Paediatric trauma has long been neglected by the medical profession. In order to deal with it appropriately, it makes sense to adopt the public health approach, requiring that we view child injuries similarly to any other disease or health problem. The greatest gain in our clinical practice with dealing with child injuries will result from a strong focus on primary (preventing the injury, secondary (dealing with the injury in the most efficient manner as well as tertiary prevention (making sure that children treated for trauma will be appropriately reintegrated within our society. By actively promoting child safety we will not only achieve a most welcome reduction in medical cost and disability, but also the ever-so-much desired decline of avoidable childhood misery and suffering.