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Sample records for neck trauma part

  1. Traumatismos penetrantes de cuello Neck penetrating traumas

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    Luis Sarra; Jorge Carbajo; Alejandro Da Silva; Julio Bitar; Marina Mariotti

    2007-01-01

    Presentamos los resultados de un protocolo de exploración selectiva para traumatismos penetrantes de cuello en un hospital público municipal. Tratamos 46 pacientes desde julio de 1990 hasta julio de 2005 con el protocolo siguiente: atención inicial según normas de apoyo vital en el trauma (‘Advanced Trauma Life Support Protocol’ [ATLS]); clasificación topográfica (de Roon); clasificación según modalidad del traumatismo; clasificación en niveles de gravedad (de 1 a 4); exploración ...

  2. Traumatismos penetrantes de cuello Neck penetrating traumas

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    Luis Sarra

    2007-03-01

    Full Text Available Presentamos los resultados de un protocolo de exploración selectiva para traumatismos penetrantes de cuello en un hospital público municipal. Tratamos 46 pacientes desde julio de 1990 hasta julio de 2005 con el protocolo siguiente: atención inicial según normas de apoyo vital en el trauma (‘Advanced Trauma Life Support Protocol’ [ATLS]; clasificación topográfica (de Roon; clasificación según modalidad del traumatismo; clasificación en niveles de gravedad (de 1 a 4; exploración inmediata en heridas transfixiantes, hemorragia externa, hematoma, asfixia, estridor laríngeo, enfisema subcutáneo, aerorragia, hemoptisis o hemorragia intratorácica. En zona I consideramos un abordaje combinado; en zona I y III o cuando existió compromiso neurológico realizamos una ecografía Doppler color o angiografía preoperatoria. En los pacientes estables adoptamos una conducta expectante, indicamos radiografía de columna cervical perfil, hospitalización, tránsito faringoesofágico, endoscopias, etc. En presencia de lesión ósea o compromiso neurológico, indicamos tomografía computadorizada o resonancia magnética. Obtuvimos resultados similares a los protocolos que exploran todas las lesiones de zona II, con un bajo porcentaje de cervicotomías no terapéuticas

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

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    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)

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

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    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.

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

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    Arana-Garza, Sebastian; Juarez-Parra, Marco; Monterrubio-Rodríguez, Jeronimo; Cedillo-Alemán, Enrique; Orozco-Agüet, David; Zamudio-Vázquez, Zaire; Garza-Jasso, Tanya

    2015-01-01

    Introduction Soft tissue injuries are relatively common after blunt neck trauma, because of its complex anatomy, many vital structures can be compromised. Isolated trauma to the thyroid is highly uncommon and there are few cases reported in the literature. Presentation of case A 19 year-old female patient with no known pathologies who sustained direct blunt trauma to the right frontal half of the neck after falling down from a stair case. She arrived at the ER with moderate neck swelling and pain. There were no visible hematomas and no respiratory compromise was noted. Contrast enhanced CT-scan showed rupture and hematoma of the right thyroid lobe; she underwent surgical exploration with hemi thyroidectomy and recovered uneventfully. Discussion Despite soft tissue injuries are relatively common after blunt neck trauma, isolated thyroid gland injury is extremely rare and is present in about 1–2% of the cases and in most of the cases there is an underlining pathology within the gland. Most patients arrived at the emergency room hemodynamically stable, presenting neck swelling, pain, respiratory distress, dysphagia and hoarseness. Diagnosis strategy should be focused to rule out respiratory or vascular compromise. Surgical exploration remains the most common treatment strategy. 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. PMID:26001363

  6. [A case report of metal penetrating trauma in maxillo-facial, neck and chest].

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    Sheng, Guomin; Mo, Zhiyang; Gao, Dongwang

    2015-03-01

    A 21 years old male patient was admitted with a complex trauma of metal penetrating wound in maxillo facial region,neck and chest because of a high falling accident one hour ago. General examination:the vital signs were stable. Specialized examination: metal foreign body penetrated from the front wall of the axilla ,passing left clavicle superficies, through the middle of neck into the posterior pharyngeal wall, then piercing out from the superciliary arch lateral. The patient had apparent tenderness in the right arch,right zygomatic bone and the front of right maxilla. the degree of mouth was about 1. 8cm. X-ray showed the foreign body: from left armpit to right temporal part. The admission diagnosis was : 1. metal penetrating wound in maxillo-facial,neck and chest; 2. right zygomatic maxillary and zygomatic arch fractures. Treatment: the foreign body was removed smoothly through the concurrent operation, and by scendary operation of open reduction and internal fixation of fractures, the finally result of patient was good.

  7. Value of computed tomographic angiography in neck and extremity pediatric vascular trauma.

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    Hogan, Anthony R; Lineen, Edward B; Perez, Eduardo A; Neville, Holly L; Thompson, William R; Sola, Juan E

    2009-06-01

    We sought to define the sensitivity and specificity of computed tomographic angiography (CTA) in pediatric vascular injuries. All neck and extremity CTAs performed in pediatric patients at a level 1 trauma center were reviewed from 2001 to 2007. Overall, 78 patients were identified with an average age of 15.0 +/- 4.0 (0-18 years). Males outnumbered females 3.6:1. CTA was performed for 41 penetrating and 37 blunt traumas. Most penetrating injuries were due to missile wounds (71%) or stab wounds (17%). Eleven major vascular injuries resulted from penetrating trauma. For penetrating trauma, CTA was 100% sensitive and 93% specific. CTA for penetrating trauma had a positive predictive value (PPV) of 85% and negative predictive value (NPV) of 100%. Most blunt injuries were due to motor vehicle accidents (57%), followed by pedestrian hit by car (27%). Eight major vascular injuries resulted from blunt trauma. For blunt trauma, CTA was 88% sensitive and 100% specific. CTA for blunt trauma had a PPV of 100% and an NPV of 97%. The accuracy for penetrating and blunt trauma was 95% and 97%, respectively. CTA is highly sensitive, specific, and accurate for pediatric neck and extremity vascular trauma.

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

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    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.

  9. Vertebral artery dissection due to indirect neck trauma : an underrecognised entity.

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    Prabhakar S

    2001-10-01

    Full Text Available Vertebral artery dissection is an important cause of brain stem stroke, especially in the young. Dissections of carotid and vertebral arteries in neck account for about 20% of strokes in young compared with 2.5% in the elderly. Three patients of vertebral artery dissection related to indirect neck trauma are described. The first patient developed the symptoms while dancing, the second after a trivial fall and the third while he was on a dental chair. None of them had a direct severe neck trauma or concomitant risk factor like hypertension, connective tissue disease or migraine. Clinical symptomatology was similar in all the patients and included occipito-nuchal pain, headache and brain stem dysfunction chiefly in the posterior inferior cerebellar artery (PICA territory. One of the patients also had associated ischaemic myelopathy. MRA and DSA confirmed dissection in all with a predominant steno-occlusive picture. Cases of so called trivial neck movement/torsion related dissection have been described previously but have not received any major importance. Usually classified as ′spontaneous′ or ′traumatic′, there is a possible ambiguity in literature about appropriate terminology. We emphasise that a history of such subtle precipitating events be taken while diagnosing young patients with brain stem strokes, to recognise this clinical entity. Although mechanisms are not absolutely clear, yet there seems to be an important relationship between arterial dissection and neck movements or minor trauma.

  10. Diagnostic performance of CT angiography in neck vessel trauma: systematic review and meta-analysis.

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    Morales-Uribe, Carlos; Ramírez, Ana; Suarez-Poveda, Tatiana; Ortiz, Margarita; Sanabria, Alvaro

    2016-10-01

    This study was conducted in order to define the diagnostic performance of CT angiography for vascular injuries compared with angiography in patients with neck trauma. CT angiography is the cornerstone of diagnosis for hemodynamically stable patients with wounds suspicious of vascular trauma in the limbs, chest, or abdomen. Available evidence for the use of CT angiography in neck vascular trauma comes from small case series and few randomized controlled trials, and high-quality information does not exist regarding its performance. A protocol using the recommendations of the Cochrane Collaboration was designed. A systematic search of diagnostic studies without limits on language or time was carried out to December 2014. Studies including patients with neck trauma with retrospective or prospective data collection that assessed CT angiography compared with other methods were selected. Methodological quality was assessed using the QUADAS-2 tool. A hierarchical model ROC curve and a bivariate random effects model were used for the pooled analysis. Sixteen studies were selected and reviewed, and nine studies with 693 patients were included in this review. The overall sensitivity was 97 % (95 % CI 0.77-1.00; I (2) = 65.7 % (41.4-90.0)), while the overall specificity was 99 % (95 % CI 0.93-1.00; I (2) = 0). The hierarchic ROC curve showed an area under the curve of 0.99. Publication bias was not identified in this study. CT angiography can be stated as the gold standard for diagnosing vascular injuries in hemodynamically stable patients with neck trauma.

  11. Neck ligament strength is decreased following whiplash trauma

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    Rubin Wolfgang

    2006-12-01

    Full Text Available Abstract Background Previous clinical studies have documented successful neck pain relief in whiplash patients using nerve block and radiofrequency ablation of facet joint afferents, including capsular ligament nerves. No previous study has documented injuries to the neck ligaments as determined by altered dynamic mechanical properties due to whiplash. The goal of the present study was to determine the dynamic mechanical properties of whiplash-exposed human cervical spine ligaments. Additionally, the present data were compared to previously reported control data. The ligaments included the anterior and posterior longitudinal, capsular, and interspinous and supraspinous ligaments, middle-third disc, and ligamentum flavum. Methods A total of 98 bone-ligament-bone specimens (C2–C3 to C7-T1 were prepared from six cervical spines following 3.5, 5, 6.5, and 8 g rear impacts and pre- and post-impact flexibility testing. The specimens were elongated to failure at a peak rate of 725 (SD 95 mm/s. Failure force, elongation, and energy absorbed, as well as stiffness were determined. The mechanical properties were statistically compared among ligaments, and to the control data (significance level: P Results For all whiplash-exposed ligaments, the average failure elongation exceeded the average physiological elongation. The highest average failure force of 204.6 N was observed in the ligamentum flavum, significantly greater than in middle-third disc and interspinous and supraspinous ligaments. The highest average failure elongation of 4.9 mm was observed in the interspinous and supraspinous ligaments, significantly greater than in the anterior longitudinal ligament, middle-third disc, and ligamentum flavum. The average energy absorbed ranged from 0.04 J by the middle-third disc to 0.44 J by the capsular ligament. The ligamentum flavum was the stiffest ligament, while the interspinous and supraspinous ligaments were most flexible. The whiplash

  12. Airway Management of Two Patients with Penetrating Neck Trauma

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    P Bhattacharya

    2009-01-01

    Full Text Available Direct trauma to the airway is a rare injury which can lead to disastrous consequences due to compounding effect of bleeding, aspiration of blood, airway obstruction and severe sympathetic stimulation. Here we are presenting two cases of open tracheal injury in two adult males following assault with sharp weapon. Two different techniques of securing the airways were employed depending upon the severity and urgency of the situation. In the first case, orotracheal intubation helped the surgeon to repair airway around the endotracheal tube whereas in the second patient this stenting effect was absent as he was intubated through the distal cut-end of trachea in the face of airway emergency.

  13. Clinical importance of the "seat belt sign" in blunt trauma to the neck.

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    DiPerna, Costanzo A; Rowe, Vincent L; Terramani, Thomas T; Salim, Ali; Hood, Douglas B; Velmahos, George C; Weaver, Fred A

    2002-05-01

    Currently a carotid duplex scan is the initial screening modality routinely used to evaluate occult extracranial carotid artery injuries secondary to blunt neck trauma. The objective of this study was to investigate the role of carotid artery duplex scanning in patients who suffered blunt trauma to the neck with a "seat belt sign." The medical records of 131 consecutive patients who sustained blunt trauma to the neck from a motor vehicle accident were reviewed. Patients with the cervical seat belt sign underwent a complete physical examination and carotid duplex scan in an accredited vascular laboratory. An intimal flap with severe carotid artery stenosis was found in one of 131 patients (0.76%). This patient has multiple injuries to the face, head, chest, lateralizing neurological signs, and a Glasgow Coma Scale score of 8. In an era of cost containment, resource consumption should target appropriate populations. A cervical seat belt sign should not serve as a sole indicator for evaluation of the carotid artery in the absence of other pertinent signs or symptoms.

  14. Endovascular treatment of intramural hematoma of internal carotid artery after blunt trauma of neck inflicted with the seatbelt.

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    Stanisic, M; Winckiewicz, M; Juszkat, R; Gabriel, M; Jawien, A; Staniszewski, R

    2009-08-01

    Blunt trauma of the neck caused by a seatbelt may cause dissection with intramural hematoma of the internal carotid artery. The following case report discusses the differential diagnosis and the potential of endovascular treatment of symptomatic intramural hematoma of the internal carotid artery.

  15. Management of traumatic vascular injuries to the neck: a 7-year experience at a Level I trauma center.

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    Simmons, Jon D; Ahmed, Naveed; Donnellan, Kimberly A; Schmieg, Robert E; Porter, John M; Mitchell, Marc E

    2012-03-01

    Injury to the carotid artery results in significant mortality and morbidity. The general consensus is to repair all injuries to the common and internal carotid arteries. Ligation is usually reserved for neurologic or hemodynamic instability. We report our experience at a Level I trauma center with vascular injuries to the neck. Retrospective chart review of all patients with vascular injuries in the neck resulting from either blunt or penetrating trauma treated at a Level I trauma center between January 2000 and February 2007. Demographics and outcomes were collected from a chart review. Twenty-five patients with vascular injuries to the neck were identified. There were 13 carotid artery injuries (CAI), five internal jugular vein (IJV) injuries, and 13 external jugular vein (EJV) injuries. Of the carotid artery injuries, six (50%) underwent operative repair (4 primary repairs and 2 bypasses), five (38%) were managed nonoperatively, and one was treated using endovascular techniques. No patient had a postoperative decrease in Glasgow Coma Scale score. There were five isolated IJV injuries (3 primary repair and 2 ligations). Four of the venous injuries (all internal jugular veins) were repaired and the remaining 13 were ligated. Vascular injuries to the neck have significant mortality and morbidity. Treatment of these injuries must be individualized. All CAI in noncomatose patients should be repaired if hemodynamically stable. All IJV injuries should be repaired but may be ligated if hemodynamically unstable. All EJV injuries can be ligated without reservation regardless of neurological status.

  16. An audit of penetrating neck injuries in a South African trauma service.

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    Madsen, A S; Laing, G L; Bruce, J L; Oosthuizen, G V; Clarke, D L

    2016-01-01

    This study reviews and validates the practice of selective non-operative management (SNOM) of penetrating neck injury (PNI) in a South African trauma service and reviews the impact new imaging modalities have had on the management of this injury. This study was performed within the Pietermaritzburg Metropolitan Trauma Service, in the city of Pietermaritzburg, Kwazulu-Natal, South Africa. A prospectively maintained trauma registry was retrospectively interrogated. All patients with PNI treated over a 46-month period were included within the study. A total of 510 patients were included in the study. There were 452 stab wounds (SW) and 58 gunshot wounds (GSW). A total of 202 (40%) patients sustained isolated PNI, the remaining 308 (60%) patients sustained trauma to at least one additional anatomical region. An airway injury was identified in 29 (6%) patients; a pharyngo-oesophageal injury in 41 (8%) patients and a vascular injury in 86 (17%) patients. Associated injuries included three penetrating cardiac injuries (PCI) and 146 patients with haemo-pneumothoraces. Of the total cohort, 387 patients (76%) underwent CT Angiography (CTA), of which 70 (18%) demonstrated a vascular injury. Formal catheter directed angiogram (CDA) was performed on 16 patients with positive CTA but confirmed injury in only half of these patients. Of 212 patients (42%) who underwent water-soluble contrast swallow (WS-swallow), an injury was demonstrated in 29 (14%) cases. A total of 401 (79%) patients were successfully managed conservatively for PNI and 109 (21%) surgically or by endovascular intervention. Only five (1.2%) patients failed a trial of SNOM and required surgery. The in-hospital mortality rate was 2%. No deaths could be attributed to a failure of SNOM. SNOM of PNI is a safe and appropriate management strategy. The conservative management of isolated pharyngeal injuries is well supported by our findings but the role of conservative treatment of oesophageal injuries needs to be

  17. Nontraumatic head and neck injuries: a clinical approach. Part 2.

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    Brea Álvarez, B; Esteban García, L; Tuñón Gómez, M; Cepeda Ibarra, Y

    Nontraumatic emergencies of the head and neck represent a challenge in the field of neuroradiology for two reasons. As explained in the first part of this update, these entities affect an area where the thorax joins the cranial cavity and can thus compromise both structures; second, they are uncommon, so they are not well known. Maintaining the same approach as in the first part, focusing on the clinical presentations in the emergency department rather than on the anatomic regions affected, we will study the entities that present with two patterns: those that present with a combination of cervical numbness, dysphagia, and dyspnea and those that present with acute sensory deficits. In the latter group, we will specifically focus on visual deficits, because this is the most common symptom that calls for urgent imaging studies. Copyright © 2017 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

  18. Vascular Injuries to the Neck After Penetrating Trauma: Diagnostic Performance of 40- and 64-MDCT Angiography.

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    Bodanapally, Uttam K; Dreizin, David; Sliker, Clint W; Boscak, Alexis R; Reddy, Ramachandra P

    2015-10-01

    The purposes of this study were to assess the diagnostic performance of 40- and 64-MDCT angiography with digital subtraction angiography as the reference standard in the detection of arterial injuries in patients at high risk after penetrating neck trauma and to perform a separate analysis of injuries to the external carotid artery. In a retrospective evaluation of 53 sets of angiograms from 51 patients with penetrating neck injury, three reviewers unaware of the digital subtraction angiographic findings reviewed the CT angiographic (CTA) images to discern the presence or absence of arterial injuries. Sensitivity and specificity of CTA were calculated per injury, and a separate analysis of external carotid artery injuries was performed. Sensitivity of CTA for detecting arterial injuries ranged from 75.7% (95% CI, 62.3-86.9%) to 82.2% (95% CI, 69.5-92.1%). Specificity ranged from 96.4% (95% CI, 94.0-98.4%) to 98.4% (95% CI, 96.0-100%). CTA was highly sensitive for detection of the subgroup of injuries involving the large-caliber vessels that contribute to cerebral circulation. These sensitivities ranged from 92.8% (95% CI, 66-98.8%) to 100% (95% CI, 76.6-100%) for internal carotid artery injuries and from 88.9% (95% CI, 65.2-98.3%) to 94.4% (95% CI, 72.6-99.0%) for vertebral artery injuries. In contrast, sensitivity of CTA was limited for external carotid artery injuries, ranging from 63.4% (95% CI, 45.5-79.5%) to 70.0% (95% CI, 52.0-85.0%). CTA can be used for initial evaluation and may help guide management decisions if an external carotid artery injury is detected. Negative findings should not preclude close clinical follow-up, repeat CTA evaluation, or, in the presence of high suspicion of arterial injury due to clinical findings or wound trajectory, evaluation with digital subtraction angiography.

  19. CT angiography - head and neck

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    ... often on the face or scalp Swallowing problems Stroke Transient ischemic attack (TIA) Weakness in one part of your body CTA of the neck may also be done: After trauma to the neck to look for damage to blood vessels For planning before carotid artery ...

  20. Head, Face, and Neck Injuries During Operation Iraqi Freedom II: Results From the US Navy and Marine Corps Combat Trauma Registry

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    2006-01-12

    injuries at Navy–Marine Corps military medical treatment facilities (MTFs). Examples of Navy–Marine Corps MTFs include battalion aids stations (ie...incident details, injuries , treatment , and outcomes is collected by the patient’s medical provider(s) in the form of a clinical record. Clinical...and mouth; and neck injuries included trauma to cervical area and cervical spine. Head, Face, and Neck Injuries During OIF-II 7 Descriptive

  1. Undetected hangman's fracture in a patient referred for physical therapy for the treatment of neck pain following trauma.

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    Ross, Michael D; Cheeks, John M

    2008-01-01

    This case report describes a patient referred for physical therapy treatment of neck pain who had an underlying hangman's fracture that precluded physical therapy intervention. This case involved a 61-year-old man who had a sudden onset of neck pain after a motor vehicle accident 8 weeks before his initial physical therapy visit. Conventional radiographs of his cervical spine taken on the day of the accident did not reveal any abnormalities. Based on the findings at his initial physical therapy visit, the physical therapist ordered conventional radiographs of the cervical spine to rule out the possibility of an undetected fracture. The radiographs revealed bilateral C2 pars interarticularis defects consistent with a hangman's fracture. The patient was referred to a neurosurgeon for immediate review. Based on a normal neurological examination, a relatively low level of pain, and the results of radiographic flexion and extension views of the cervical spine (which revealed no evidence of instability), the neurosurgeon recommended that the patient continue with nonsurgical management. In patients with neck pain caused by trauma, physical therapists should be alert for the presence of cervical spine fractures. Even if the initial radiographs are negative for a fracture, additional diagnostic imaging may be necessary for a small number of patients, because they may have undetected injuries that would necessitate medical referral and preclude physical therapy intervention.

  2. A comparative audit of gunshot wounds and stab wounds to the neck in a South African metropolitan trauma service

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    Madsen, AS; Laing, GL; Bruce, JL

    2016-01-01

    Introduction The aim of this comparative study of gunshot wounds (GSWs) and stab wounds (SWs) to the neck was to quantify the impact of the mechanism of injury on the outcome and management of penetrating neck injury (PNI). Methods A prospective trauma registry was interrogated retrospectively. Data were analysed pertaining to demographics and injury severity score (ISS), physiology on presentation, anatomical site of wounds and injuries sustained, investigations, management, outcome and complications. Results There were 452 SW and 58 GSW cases over the 46 months of the study. Patients with GSWs were more likely to have extracervical injuries than those with SWs (69% vs 63%). The incidence of a ‘significant cervical injury’ was almost twice as high in the GSW cohort (55% vs 31%). For patients with transcervical GSWs, this increased to 80%. The mean ISS was 17 for GSW and 11 for SW patients. Those in the GSW cohort presented with threatened airways and a requirement for an emergency airway three times as often as patients with SWs (24% vs 7% and 14% vs 5% respectively). The incidence among GSW and SW patients respectively was 5% and 6% for airway injuries, 12% and 8% for injuries to the digestive tract, 21% and 16% for vascular injuries, 59% and 10% for associated cervical injuries, 36% and 14% for maxillofacial injuries, 16% and 9% for injuries to the head, and 35% and 45% for injuries to the chest. In the GSW group, 91% underwent computed tomography angiography (CTA), with 23% of these being positive for a vascular injury. For SWs, 74% of patients underwent CTA, with 17% positive for a vascular injury. Slightly more patients with GSWs required operative intervention than those with SWs (29% vs 26%). Conclusions Patients with GSWs to the neck have a worse outcome than those with injuries secondary to SWs. However, the proportion of neck injuries actually requiring direct surgical intervention is not increased and most cases with PNI secondary to GSWs can be

  3. A comparative audit of gunshot wounds and stab wounds to the neck in a South African metropolitan trauma service.

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    Madsen, A S; Laing, G L; Bruce, J L; Clarke, D L

    2016-09-01

    Introduction The aim of this comparative study of gunshot wounds (GSWs) and stab wounds (SWs) to the neck was to quantify the impact of the mechanism of injury on the outcome and management of penetrating neck injury (PNI). Methods A prospective trauma registry was interrogated retrospectively. Data were analysed pertaining to demographics and injury severity score (ISS), physiology on presentation, anatomical site of wounds and injuries sustained, investigations, management, outcome and complications. Results There were 452 SW and 58 GSW cases over the 46 months of the study. Patients with GSWs were more likely to have extracervical injuries than those with SWs (69% vs 63%). The incidence of a 'significant cervical injury' was almost twice as high in the GSW cohort (55% vs 31%). For patients with transcervical GSWs, this increased to 80%. The mean ISS was 17 for GSW and 11 for SW patients. Those in the GSW cohort presented with threatened airways and a requirement for an emergency airway three times as often as patients with SWs (24% vs 7% and 14% vs 5% respectively). The incidence among GSW and SW patients respectively was 5% and 6% for airway injuries, 12% and 8% for injuries to the digestive tract, 21% and 16% for vascular injuries, 59% and 10% for associated cervical injuries, 36% and 14% for maxillofacial injuries, 16% and 9% for injuries to the head, and 35% and 45% for injuries to the chest. In the GSW group, 91% underwent computed tomography angiography (CTA), with 23% of these being positive for a vascular injury. For SWs, 74% of patients underwent CTA, with 17% positive for a vascular injury. Slightly more patients with GSWs required operative intervention than those with SWs (29% vs 26%). Conclusions Patients with GSWs to the neck have a worse outcome than those with injuries secondary to SWs. However, the proportion of neck injuries actually requiring direct surgical intervention is not increased and most cases with PNI secondary to GSWs can be managed

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

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    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.

  5. Trauma.

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    Cobb, A B

    1991-03-01

    The need for planning and development of statewide trauma prevention and trauma service systems is or should be a high priority--if one sets priorities on criteria that address important factors such as cost to benefits in reduction of life years lost and reduction of disability and costs of long-term rehab services, etc. Prevention of injury and first class trauma care will lessen our heavy human burdens (loss of life and disability) and reduce our long-term outlays for rehabilitation, etc. Obviously our first line of intervention should be prevention--all educational, regulatory and automatic protectors (seat belts, gun restrictions, air bags) that will lower injury rates. A state trauma system must be planned for the larger universe than individual institutions or communities. We must educate our public that the only practical way to provide services for major trauma is through regionalized systems that they somehow must help support. The recent emphasis on making the health services industry a "competitive market" has discouraged public interest and support for regionalized health systems. Our best chances for funding such systems are probably through user fees, sin taxes and surcharges on fines, etc. We need the elements or principles of a plan and present it to the public and to their representatives in the courthouses, city halls and state capital of our state. We need to generate public discussion and understanding on the problem, the potential for saving lives and preventing disability. To do any less would mean our failure to meet our duties as health professionals and public health officials.

  6. Internal Fixation of Femoral Neck Fractures : Treatment and effects

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    S.M. Zielinski (Stephanie)

    2015-01-01

    markdownabstract__Abstract__ This thesis consists of three parts. Part 1 described aspects of the organization of trauma related trials. Part 2 analyzed the uniformity of current femoral neck fracture treatment and adherence to the Dutch guideline on hip fracture treatment. The implications of

  7. The Joint Facial and Invasive Neck Trauma (J-FAINT) Project, Iraq and Afghanistan 2003-2011

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    2013-01-01

    immediate vs delayed exploration of penetrating neck wounds was also developed through experience in OIF.10 These practices are now the standard...Facial nerve 35 0.14 Optic nerve 27 0.10 Nerve 14 0.05 Total 25,834 Abbreviation: TMJ, temporomandibular joint. Figure 1. Soft tissue injuries. TMJ... temporomandibular joint. Figure 2. Facial fractures. Feldt et al 405 at BROOKE ARMY MEDICAL CENTER on December 23, 2014oto.sagepub.comDownloaded from

  8. Advanced trauma life support (ATLS) and facial trauma: can one size fit all? Part 2: ATLS, maxillofacial injuries and airway management dilemmas.

    Science.gov (United States)

    Perry, M; Morris, C

    2008-04-01

    Maxillofacial trauma poses an obvious threat to the patient's airway, which may not be immediately evident. In the multiply injured patient, the co-existence of actual or potential injuries elsewhere may complicate airway management, notably in the presence of full spinal immobilization. Following high-velocity trauma, injuries to the cervical spine must be assumed to be present. They also need to be ruled out in an appropriate and timely manner, as patients may wish to sit up. Assessment and management of the airway in maxillofacial trauma can be difficult, requiring a senior anaesthetist or other individual appropriately trained in emergency airway care. A number of management options may exist to protect the airway, each with advantages and drawbacks. Agitation and vomiting can occur unexpectedly and need to be managed safely with due consideration to the spine. Oral and maxillofacial surgeons need to be aware of these dilemmas and their early warning signs, and be skilled in emergency surgical airway procedures, especially if involved as part of the trauma team. Prolonged immobilization is associated with significant morbidity and mortality. A number of protocols currently exist for 'clearing' the spine. Imaging now plays a greater role, especially in the obtunded, unconscious or intubated patient, and this is discussed.

  9. 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.

  10. 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。

  11. Epidemiology of work related neck and upper limb problems: psychosocial and personal risk factors (part I) and effective interventions from a bio behavioural perspective (part II).

    Science.gov (United States)

    Bongers, P M; Ijmker, S; van den Heuvel, S; Blatter, B M

    2006-09-01

    Work related neck and upper limb symptoms have a multi-factorial origin. Possible risk factors are of a physical, psychosocial or personal origin. These factors can reinforce each other and their influence can also be mediated by cultural or societal factors. Initially, most research on neck and upper limb symptoms focused on work-related physical exposure. Nowadays, psychosocial work characteristics are recognized as important risk factors. Various models have been developed to offer frameworks for possible pathways, but their empirical support is still not conclusive. In part I of this paper an overview is presented of the results of recent epidemiological studies on work related psychosocial and personal risk factors for neck and upper limb symptoms. In addition, the interplay between these factors and the possible intermediate role of an individuals work style in this process is explored. In contrast to previous reviews, it is now possible to base the conclusions on the effect of work related psychosocial factors on neck and upper limb symptoms on quite a few longitudinal studies. These studies show that high work demands or little control at work are often related to these symptoms. However, this relationship is neither very strong nor very specific. Perceived stress is studied in not as many studies but more consistently related to neck and upper limb symptoms. This also applies to general distress or other pain (co-morbidity). Job dissatisfaction does not contribute to neck and upper limb symptoms. Too little research on personal characteristics is available to draw any conclusions. It is plausible that behavioural aspects, such as work style, are of importance in the etiology of work related upper limb symptoms. However, studies concerning these factors are promising but too scarce to draw conclusions. Future studies should address these behavioural aspects. In part II, the recent studies on the effectiveness of preventive measures for work related neck and

  12. Subjective safety and self-confidence in prehospital trauma care and learning progress after trauma-courses: part of the prospective longitudinal mixed-methods EPPTC-trial.

    Science.gov (United States)

    Häske, David; Beckers, Stefan K; Hofmann, Marzellus; Lefering, Rolf; Grützner, Paul A; Stöckle, Ulrich; Papathanassiou, Vassilios; Münzberg, Matthias

    2017-08-14

    Prehospital trauma care is stressful and requires multi-professional teamwork. A decrease in the number of accident victims ultimately affects the routine and skills and underlines the importance of effective training. Standardized courses, like PHTLS, are established for health care professionals to improve the prehospital care of trauma patients. The aim of the study was to investigate the subjective safety in prehospital trauma care and learning progress by paramedics in a longitudinal analysis. This was a prospective intervention trial and part of the mixed-method longitudinal EPPTC-trial, evaluating subjective and objective changes among participants and real patient care as a result of PHTLS courses. Participants were evaluated with pre/post questionnaires as well as one year after the course. We included 236 datasets. In the pre/post comparison, an increased performance could be observed in nearly all cases. The result shows that the expectations of the participants of the course were fully met even after one year (p = 0.002). The subjective safety in trauma care is significantly better even one year after the course (p < 0.001). Regression analysis showed that (ABCDE)-structure is decisive (p = 0.036) as well as safety in rare and common skills (both p < 0.001). Most skills are also rated better after one year. Knowledge and specific safety are assessed as worse after one year. The courses meet the expectations of the participants and increase the subjective safety in the prehospital care of trauma patients. ABCDE-structure and safety in skills are crucial. In the short term, both safety in skills and knowledge can be increased, but the courses do not have the power to maintain knowledge and specific subjective safety issues over a year. German Clinical Trials Register, ID DRKS00004713 , registered 14. February 2014.

  13. Distant metastases from head and neck squamous cell carcinoma. Part III. Treatment

    NARCIS (Netherlands)

    Haigentz, Missak; Hartl, Dana M.; Silver, Carl E.; Langendijk, Johannes A.; Strojan, Primoz; Paleri, Vinidh; de Bree, Remco; Machiels, Jean-Pascal; Hamoir, Marc; Rinaldo, Alessandra; Paccagnella, Daniela; Shaha, Ashok R.; Takes, Robert P.; Ferlito, Alfio

    2012-01-01

    Distant metastases from head and neck squamous cell carcinoma (HNSCC), though rare at initial presentation, remain an important manifestation of cancer recurrence and mortality. Although generally considered incurable with a dismal prognosis despite palliative therapy, highly selected patients with

  14. Saving Lives on the Battlefield (Part II) - One Year Later: A Joint Theater Trauma System and Joint Trauma System Review of Prehospital Trauma Care in Combined Joint Operations Area-Afghanistan (CJOA-A)

    Science.gov (United States)

    2015-01-01

    medical and dental treatment facili- ties. Likewise, though not excluding medical care in the prehospital battlefield environment, none of the...authorized to carry IV/IM ketorolac in trauma but not TCCC Guideline analgesia . Saving Lives on the Battlefield (Part II) 41 35. Add IV saline lock and IV... dental technician became a PA and deployed straight out of IPAP and is the sole provider in an isolated FOB. He admits his inadequacies for combat

  15. Nontraumatic head and neck emergencies: a clinical approach. Part 1: cervicofacial swelling, dysphagia, and dyspnea.

    Science.gov (United States)

    Brea Álvarez, B; Tuñón Gómez, M; Esteban García, L; García Hidalgo, C Y; Ruiz Peralbo, R M

    2016-01-01

    Nontraumatic emergencies of the head and neck represent a challenge in the field of neuroradiology for two reasons: first, they affect an area where the thorax joins the cranial cavity and can thus compromise both structures; second, they are uncommon, so they are not well known. Various publications focus on nontraumatic emergencies of the head and neck from the viewpoints of anatomic location or of particular diseases. However, these are not the most helpful viewpoints for dealing with patients in the emergency department, who present with particular signs and symptoms. We propose an analysis starting from the four most common clinical presentations of patients who come to the emergency department for nontraumatic head and neck emergencies: cervical swelling, dysphagia, dyspnea, and loss of vision. Starting from these entities, we develop an approach to the radiologic management and diagnosis of these patients. Copyright © 2016 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

  16. Cerebrovascular trauma

    Energy Technology Data Exchange (ETDEWEB)

    Krings, Timo [Hopital de Bicetre, Service de Neuroradiologie Diagnostique et Therapeutique, Paris (France); University Hospital Aachen, Department of Neuroradiology, Aachen (Germany); University Hospital, University of Technology, Aachen (DE), Departments of Neuroradiology and Neurosurgery, Aachen (Germany); Univ. of Technology, Aachen (Germany) Dept. of Neurosurgery; Geibprasert, Sasikhan [Hopital de Bicetre, Service de Neuroradiologie Diagnostique et Therapeutique, Paris (France); Ramathibodi Hospital Bangkok, Department of Radiology, Bangkok (Thailand); Lasjaunias, Pierre L. [Hopital de Bicetre, Service de Neuroradiologie Diagnostique et Therapeutique, Paris (France)

    2008-08-15

    Vascular injury of the head and neck region is a rare and often life-threatening complication of head or neck trauma and is due to two major pathomechanisms: penetrating or blunt trauma. Both the arterial and the venous site of the CNS vasculature can be involved, the latter one being often overlooked. Concerning arterial lesions, depending on how many layers of the arterial vessel are affected and on the spatial relationship to adjacent structures, dissections, false aneurysms or arteriovenous fistulae may develop. On the venous side, dural tears, compressive effects on pial veins and a deranged clotting system may lead to delayed venous thrombosis. In this review we describe clinical and imaging findings, as well as diagnostic and treatment strategies in these lesions. (orig.)

  17. 危及生命的重症颈部外伤的诊治体会%The management of life-threatening neck trauma

    Institute of Scientific and Technical Information of China (English)

    吴静; 刘业海; 吴开乐; 赵益; 童步升; 高潮兵; 李亦凡; 王杨

    2014-01-01

    目的:探讨危及生命的重症颈部外伤有效的诊治方法。方法回顾性分析我科2005年1月~2010年1月间收住入院的各种颈部外伤病例资料,对危及生命的重症颈部外伤的18例诊治过程及预后情况进行回顾性分析。此类病例,首先根据具体病情进行急救,再根据颈部外伤的具体情况进行不同的处理,急救方法主要包括紧急止血、抗休克治疗、气管切开术、重要脏器合并伤的处理。结果18例颈部外伤中入院前伴有出血性休克症状者7例,同时伴有出血性休克症状和喉梗阻者或开放性喉气管贯通损伤者6例,伴有喉梗阻者3例,伴有气胸或血气胸者2例。本组病例皆急救成功,其中9例行气管切开术,随诊6个月~5年,3例拔管困难,其中1例气管套管上方肉芽组织增生,肉芽切除术后2周拔管;1例胸段气管轻度狭窄,随访半年无堵管后无呼吸困难后予以拔管;1例声门下狭窄,保留气管套管。2例声音嘶哑好转不明显,其中1例喉返神经损伤行修复后声带运动部分恢复,1例因杓区损伤未完全康复。所有患者均无气管食管瘘、咽瘘。结论迅速而准确判断颈部外伤的临床特点,及时采取不同的急救措施和具体有效的颈部探查修复术是治疗重症颈部外伤、防止术后并发症的安全有效方法。%Objective To investigate the effective management of life-threatening neck trauma. Methods We retrospectively analyzed on 18 cases of life-threatening neck trauma inpatients of our hospital from 2005 to 2010. To severe cases, took first-aid firstly according to the specific condition, then adopted approriate treatments to individual condition. Emergency methods mainly include these aspects, firstly, treating for shock to patients who accompanied by shock symptoms. Secondly, stopping bleeding to massive active bleeding. At the same time ,the airway must be secured immediately

  18. PHTLS ® (Prehospital Trauma Life Support) provider courses in Germany - who takes part and what do participants think about prehospital trauma care training?

    Science.gov (United States)

    Frank, Christian B; Wölfl, Christoph G; Hogan, Aidan; Suda, Arnold J; Gühring, Thorsten; Gliwitzky, Bernhard; Münzberg, Matthias

    2014-01-01

    The goal of this study was to examine PHTLS Provider courses in Germany and to proof the assumption that formation of physicians and paramedics in prehospital trauma care can be optimized. PHTLS participants were asked to fill out standardized questionnaires during their course preparation and directly after the course. There were some open questions regarding their professional background and closed questions concerning PHTLS itself. Further questions were to be answered on an analog scale in order to quantify subjective impressions of confidence, knowledge and also to describe individual levels of education and training. 247 questionnaires could be analyzed. Physicians noted significant (p PHTLS (p = 0.005), didn't benefit as much as the rest (p = 0.004) and stated more often, that the course was of less value for their daily work (p = 0.03). After the course confidence increased remarkably and reached higher rates than before the course (p PHTLS both groups showed similar ratings concerning the course concept indicating that PHTLS could equalize some training deficits and help to gain confidence and assurance in prehospital trauma situations. 90% of the paramedics and 100% of the physicians would recommend PHTLS. Physicians and especially anesthetists revised their opinions with regard to providing PHTLS at Medical School after having taken part in a PHTLS course. The evaluation of PHTLS courses in Germany indicates the necessity for special prehospital trauma care training. Paramedics and physicians criticize deficits in their professional training, which can be compensated by PHTLS. With respect to relevant items like confidence and knowledge PHTLS leads to a statistically significant increase in ratings on a visual analogue scale. PHTLS should be integrated into the curriculum at Medical School.

  19. PHTLS ® (Prehospital Trauma Life Support) provider courses in Germany – who takes part and what do participants think about prehospital trauma care training?

    Science.gov (United States)

    2014-01-01

    Background The goal of this study was to examine PHTLS Provider courses in Germany and to proof the assumption that formation of physicians and paramedics in prehospital trauma care can be optimized. Methods PHTLS participants were asked to fill out standardized questionnaires during their course preparation and directly after the course. There were some open questions regarding their professional background and closed questions concerning PHTLS itself. Further questions were to be answered on an analog scale in order to quantify subjective impressions of confidence, knowledge and also to describe individual levels of education and training. Results 247 questionnaires could be analyzed. Physicians noted significant (p PHTLS (p = 0.005), didn’t benefit as much as the rest (p = 0.004) and stated more often, that the course was of less value for their daily work (p = 0.03). After the course confidence increased remarkably and reached higher rates than before the course (p PHTLS both groups showed similar ratings concerning the course concept indicating that PHTLS could equalize some training deficits and help to gain confidence and assurance in prehospital trauma situations. 90% of the paramedics and 100% of the physicians would recommend PHTLS. Physicians and especially anesthetists revised their opinions with regard to providing PHTLS at Medical School after having taken part in a PHTLS course. Conclusion The evaluation of PHTLS courses in Germany indicates the necessity for special prehospital trauma care training. Paramedics and physicians criticize deficits in their professional training, which can be compensated by PHTLS. With respect to relevant items like confidence and knowledge PHTLS leads to a statistically significant increase in ratings on a visual analogue scale. PHTLS should be integrated into the curriculum at Medical School. PMID:25050135

  20. Playing the Part: Hungarian Boy Scouts and the Performance of Trauma in Interwar Hungary

    Directory of Open Access Journals (Sweden)

    Steven Jobbitt

    2011-01-01

    Full Text Available In 1920, the historic Kingdom of Hungary was dismembered according to the dictates of the Treaty of Trianon. Resulting in the loss of two-thirds of the nation’s pre-World War I territory, and one-third of its prewar population, Trianon has long stood as a symbol for Hungarian suffering and trauma in the twentieth century. Historians of modern Hungary have given much consideration to Trianon, with serious attention being paid to what some have called the Trianon syndrome, or the Trianon trauma. Arguing that interwar Hungarian culture and politics need to be understood in light of the menacing psychological shadow cast by Trianon, a number of historians have suggested that the people of Hungary were traumatized spontaneously and universally by the dismemberment of the nation and the suffering that followed. This paper argues that, though this may indeed have been the case on a raw emotional level, careful consideration needs to be given to the overlapping political and pedagogical functions of the Trianon trauma, especially as this trauma found expression in repeated public “performances” of the Trianon tragedy. Focusing on the revisionist performances of Hungarian boy scouts between the wars, and in particular on the personal papers of the Hungarian geographer and boy scout leader Ferenc Fodor, this paper draws a direct link between trauma and performance in the interwar period, and argues that, though trauma was indeed central to Hungarian cultural politics, it functioned as much as a pedagogical strategy as it did a psychological reality.

  1. Trauma-Informed Part C Early Intervention: A Vision, A Challenge, A New Reality

    Science.gov (United States)

    Gilkerson, Linda; Graham, Mimi; Harris, Deborah; Oser, Cindy; Clarke, Jane; Hairston-Fuller, Tody C.; Lertora, Jessica

    2013-01-01

    Federal directives require that any child less than 3 years old with a substantiated case of abuse be referred to the early intervention (EI) system. This article details the need and presents a vision for a trauma-informed EI system. The authors describe two exemplary program models which implement this vision and recommend steps which the field…

  2. Trauma-Informed Part C Early Intervention: A Vision, A Challenge, A New Reality

    Science.gov (United States)

    Gilkerson, Linda; Graham, Mimi; Harris, Deborah; Oser, Cindy; Clarke, Jane; Hairston-Fuller, Tody C.; Lertora, Jessica

    2013-01-01

    Federal directives require that any child less than 3 years old with a substantiated case of abuse be referred to the early intervention (EI) system. This article details the need and presents a vision for a trauma-informed EI system. The authors describe two exemplary program models which implement this vision and recommend steps which the field…

  3. External injuries to the neck after free fall from great height.

    Science.gov (United States)

    Plattner, Thomas; Kopp, Andrea; Bolliger, Stephan; Zollinger, Ulrich

    2004-12-01

    Falls from great height are suicidal in most cases. Any antecedent trauma that would indicate an involvement of a third party should, however, be excluded in each case. Herein lies the difficulty in such cases since injuries prior to the fall which could be of criminal nature may be masked by the impact injuries. Injuries on unexposed parts of the body should always raise the suspicion of an involvement of a third party. This applies especially for neck injuries. By a retrospective analysis of 132 cases of falls from great height, the authors conclude, however, that neck injuries may occur after free fall from great height on a flat surface without antecedent trauma.

  4. The role of dental implants in the management of dento-alveolar trauma. Part 2.

    Science.gov (United States)

    Gamble, Eugene; Shahdad, Shakeel

    2015-01-01

    Patients who suffer dento-alveolar trauma present a unique challenge for the dentist. There are numerous options to consider when attempting to restore the dentition. This article reviews the role of dental implants and how thorough planning and execution of such treatment could result in an optimal outcome. Clinical Relevance: Knowledge of the role of dental implants and factors imperative for a successful treatment outcome will assist the clinician in achieving optimal restorative results.

  5. Clinical indications for digital imaging in dento-alveolar trauma. Part 1: traumatic injuries.

    Science.gov (United States)

    Cohenca, Nestor; Simon, James H; Roges, Ramon; Morag, Yoav; Malfaz, Jose Maria

    2007-04-01

    Traumatized teeth present a clinical challenge with regard to their diagnosis, treatment plan, and prognosis. Recent developments in imaging systems have enabled clinicians to visualize structural changes effectively. Computed tomography, magnetic resonance imaging and cone beam computed tomography are among the most commonly used systems for dental and maxillofacial surgery. The purpose of this review is to describe the advantages and disadvantages of each technique and the clinical application for dento-alveolar trauma. Three clinical cases are described to illustrate the potential use of the NewTom 3G for diagnosis and treatment plan of dento-alveolar traumatic injuries.

  6. Soft tissue hematoma of the neck due to thyroid rupture with unusual mechanism

    Directory of Open Access Journals (Sweden)

    Kohei Tsukahara

    2016-01-01

    Conclusion: Although hemorrhage from the thyroid gland without blunt trauma is rare, emergency physicians should regard possible thyroid gland rupture in patients with swelling of the neck or acute respiratory failure after direct/indirect trauma to the neck. Observation or operative management for limited or expanding hematoma are appropriately based on fundamental neck trauma principles.

  7. 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.

  8. Clinical indications for digital imaging in dento-alveolar trauma. Part 2: root resorption.

    Science.gov (United States)

    Cohenca, Nestor; Simon, James H; Mathur, Aeshna; Malfaz, Jose Maria

    2007-04-01

    Common complications of dento-alveolar trauma are pulp necrosis, pulp canal obliteration, periapical pathosis and root resorption. Different types of root resorption have been identified with traumatic injuries. Repair-related (surface), infection-related (inflammatory), ankylosis-related (osseous replacement) or extraradicular invasive cervical resorption are among the most common. Recent developments in imaging systems have enabled clinicians to visualize structural changes effectively. The diagnosis and three-dimensional imaging assessment of the resorption is important in order to determine the treatment complexity and expected outcome based on the location and extension of the root defect. This article discusses and illustrates the clinical application of cone beam computed tomography for diagnosis and treatment plan of root resorption. Four clinical cases are presented to illustrate the potential use of the NewTom 3G for root resorption.

  9. Epidemiology of work related neck and upper limb problems: Psychosocial and personal risk factors (Part I) and effective interventions from a bio behavioural perspective (Part II)

    NARCIS (Netherlands)

    Bongers, P.M.; IJmker, S.; Heuvel, S. van den; Blatter, B.M.

    2006-01-01

    Work related neck and upper limb symptoms have a multi-factorial origin. Possible risk factors are of a physical, psychosocial or personal origin. These factors can reinforce each other and their influence can also be mediated by cultural or societal factors. Initially, most research on neck and upp

  10. Epidemiology of work related neck and upper limb problems: Psychosocial and personal risk factors (Part I) and effective interventions from a bio behavioural perspective (Part II)

    NARCIS (Netherlands)

    Bongers, P.M.; IJmker, S.; Heuvel, S. van den; Blatter, B.M.

    2006-01-01

    Work related neck and upper limb symptoms have a multi-factorial origin. Possible risk factors are of a physical, psychosocial or personal origin. These factors can reinforce each other and their influence can also be mediated by cultural or societal factors. Initially, most research on neck and

  11. Results of triple muscle (sartorius, tensor fascia latae and part of gluteus medius pedicle bone grafting in neglected femoral neck fracture in physiologically active patients

    Directory of Open Access Journals (Sweden)

    Pankaj Kumar Mishra

    2014-01-01

    Full Text Available Background: Femoral neck fractures are notorious for complications like avascular necrosis and nonunion. In developing countries, various factors such as illiteracy, low socioeconomic status, ignorance are responsible for the delay in surgery. Neglected fracture neck femur always poses a formidable challenge. The purpose of this study was to evaluate the results of triple muscle pedicle bone grafting using sartorius, tensor fasciae latae and part of gluteus medius in neglected femoral neck fracture. Materials and Methods: This is a retrospective study with medical record of 50 patients, who were operated by open reduction, internal fixation along with muscle pedicle bone grafting by the anterior approach. After open reduction, two to three cancellous screws (6.5 mm were used for internal fixation in all cases. A bony chunk of the whole anterior superior iliac spine of 1 cm thickness, 1 cm width and 4.5 cm length, taken from the iliac crest comprised of muscle pedicle of sartorius, tensor fascia latae and part of gluteus medius. Then the graft with all three muscles mobilized and put in the trough made over the anterior or anterosuperior aspect of the femoral head. The graft was fixed with one or two 4.5 mm self-tapping cortical screw in anterior to posterior direction. Results: 14 patients were lost to followup. The results were based on 36 patients. We observed that in our series, there was union in 34, out of 36 (94.4% patients. All patients were within the age group of 15-51 years (average 38 years with displaced neglected femoral neck fracture of ≥30 days. Mean time taken for full clinicoradiological union was 14 weeks (range-10-24 weeks. Conclusion: Triple muscle pedicle bone grafting gives satisfactory results for neglected femoral neck fracture in physiologically active patients.

  12. Does applying the Canadian Cervical Spine rule reduce cervical spine radiography rates in alert patients with blunt trauma to the neck? A retrospective analysis

    Directory of Open Access Journals (Sweden)

    Yesupalan Rajam

    2008-06-01

    Full Text Available Abstract Background A cautious outlook towards neck injuries has been the norm to avoid missing cervical spine injuries. Consequently there has been an increased use of cervical spine radiography. The Canadian Cervical Spine rule was proposed to reduce unnecessary use of cervical spine radiography in alert and stable patients. Our aim was to see whether applying the Canadian Cervical Spine rule reduced the need for cervical spine radiography without missing significant cervical spine injuries. Methods This was a retrospective study conducted in 2 hospitals. 114 alert and stable patients who had cervical spine radiographs for suspected neck injuries were included in the study. Data on patient demographics, high risk & low risk factors as per the Canadian Cervical Spine rule and cervical spine radiography results were collected and analysed. Results 28 patients were included in the high risk category according to the Canadian Cervical Spine rule. 86 patients fell into the low risk category. If the Canadian Cervical Spine rule was applied, there would have been a significant reduction in cervical spine radiographs as 86/114 patients (75.4% would not have needed cervical spine radiograph. 2/114 patients who had significant cervical spine injuries would have been identified when the Canadian Cervical Spine rule was applied. Conclusion Applying the Canadian Cervical Spine rule for neck injuries in alert and stable patients would have reduced the use of cervical spine radiographs without missing out significant cervical spine injuries. This relates to reduction in radiation exposure to patients and health care costs.

  13. PHTLS ® (Prehospital Trauma Life Support) provider courses in Germany – who takes part and what do participants think about prehospital trauma care training?

    OpenAIRE

    Frank, Christian B; Wölfl, Christoph G; Hogan, Aidan; Suda, Arnold J.; Gühring, Thorsten; Gliwitzky, Bernhard; Münzberg, Matthias

    2014-01-01

    Background The goal of this study was to examine PHTLS Provider courses in Germany and to proof the assumption that formation of physicians and paramedics in prehospital trauma care can be optimized. Methods PHTLS participants were asked to fill out standardized questionnaires during their course preparation and directly after the course. There were some open questions regarding their professional background and closed questions concerning PHTLS itself. Further questions were to be answered o...

  14. PHTLS ® (Prehospital Trauma Life Support) provider courses in Germany – who takes part and what do participants think about prehospital trauma care training?

    OpenAIRE

    Frank, Christian B; Christoph G Wölfl; Hogan, Aidan; Suda, Arnold J.; Gühring, Thorsten; Gliwitzky, Bernhard; Münzberg, Matthias

    2014-01-01

    Background The goal of this study was to examine PHTLS Provider courses in Germany and to proof the assumption that formation of physicians and paramedics in prehospital trauma care can be optimized. Methods PHTLS participants were asked to fill out standardized questionnaires during their course preparation and directly after the course. There were some open questions regarding their professional background and closed questions concerning PHTLS itself. Further questions were to be answered o...

  15. Blunt pancreatic trauma in children.

    Science.gov (United States)

    Klin, Baruch; Abu-Kishk, Ibrahim; Jeroukhimov, Igor; Efrati, Yigal; Kozer, Eran; Broide, Efrat; Brachman, Yuri; Copel, Laurian; Scapa, Eitan; Eshel, Gideon; Lotan, Gad

    2011-07-01

    To report our experience with blunt pancreatic trauma in pediatric patients and evaluate several various management strategies. Ten children admitted over the last 10 years with pancreatic blunt trauma were included in the present series. The average time from injury to hospital admission was 2.4 days. All injuries resulted from accidents: bicycle handlebar injuries (5), being kicked by a horse (2), falls from a height (2), and injury sustained during closure of an electric gate (1). Additional systemic and abdominal injuries were recorded in 7 patients. The amylase levels at the time of patient admission were normal in 3 patients, mildly raised in 4 patients, and elevated in 3 patients. Abdominal computed tomography was performed in 10 patients, ultrasonography in 5, and endoscopic retrograde cholangiopancreatography (ERCP) in 4. Pancreatic injuries comprised 4 grade I, 3 grade II, and 3 grade III injuries. Grade I and II injuries were successfully managed by conservative treatment. The 3 children with grade III trauma and pancreatic ductal injury in the neck (1), body (1), and tail (1) of the gland were surgically treated, having an uneventful postoperative stay of 8-14 days and no complications during the 1-year follow-up period. The present study supports early ERCP as an essential part of the initial patient evaluation when pancreatic transection is highly suspected.

  16. Ossifying fibromyxoid tumour (of soft parts) of the head and neck: a clinicopathological and immunohistochemical study of nine cases.

    Science.gov (United States)

    Williams, S B; Ellis, G L; Meis, J M; Heffner, D K

    1993-01-01

    Ossifying fibromyxoid tumour (OFT) is a recently described, mesenchymal neoplasm originally defined as a borderline or low-grade malignant lesion. Prior reports of OFT characterize it as a slow growing lesion with a propensity to occur in both the upper and lower extremities. Most OFTs have occurred within the deep subcutis or skeletal muscle. We report nine cases which arose in the head and neck region. Six of the nine tumours were classified as ossifying variants of OFT while two were non-ossifying variants that lacked a discernable shell of lamellar bone. One tumour was classified as a malignant OFT. Seven lesions occurred in a subcutaneous site while two lesions occurred intraorally beneath the gingival and palatal mucosa. The OFTs occurred in six men and three women (age range of 29-75 years). The tumours had histological features compatible with previously described OFTs and consisted of lobulated nests of small, cytologically bland round cells (with the exception of one malignant OFT), with a myxoid to hyalinized stroma and were surrounded in part by dense fibrous connective tissue. Six cases had an incomplete rim of lamellar bone with occasional perpendicularly oriented spicules of bone. Five lesions were immunostained. S-100 protein, neuron specific enolase, and Leu-7 were found in three out of five tumours. Glial fibrillary acidic protein, smooth muscle actin (SMA), and muscle specific actin (MSA) were detected in two out of five lesions, although staining for SMA and MSA was weak in reactivity. Staining for vimentin was strongly positive in all five cases tested. The tumours were not reactive with antibodies directed against cytokeratin, epithelial membrane antigen or neurofilament protein. Follow-up information, available in eight cases, revealed multiple local recurrences in the one tumour believed to be a malignant OFT. The histogenesis of these tumours is uncertain, although the preponderance of evidence suggests a Schwann cell origin.

  17. Dental traumas during the military service.

    Science.gov (United States)

    Immonen, Matti; Anttonen, Vuokko; Patinen, Pertti; Kainulainen, Marco-Juhan; Päkkilä, Jari; Tjäderhane, Leo; Oikarinen, Kyösti

    2014-06-01

    Dental traumas are most frequent during the first three decades of life and more frequent among males than females. Approximately 80% (n = 28 000) of the male age cohort performs military service annually in Finland. As little is known of dental, head, and neck traumas during the military service, our aim was to study the etiology, number and occurrence of traumas of the Finnish conscripts during one calendar year. Our hypothesis was that above-mentioned traumas comprise a remarkable proportion of military accidents. The data comprised of all the Finnish conscripts' trauma cases in the year 2009 (mean age 20.1 years, SD 1.1). The frequency, mechanism, and time of the incidences were analyzed. Of the total 1432 trauma cases, 303 (23%) involved head, neck, or dentition. The occurrence rate of dental traumas was 6.5 cases/1000 persons/year. Dental traumas comprised 14.3% of all traumas. The most common mechanism for dental traumas was a blow-type force. First 4 months of the service and winter time were periods of increased risk of dental traumas. Two-thirds of the dental traumas, one-third of the body traumas and a quarter of the head and neck traumas occurred during military field exercises. Most dental traumas required a visit to a military dental clinic and also needed follow-up care. Head, neck, and dental injuries are common during the military service in Finland. Prevention of dental traumas and need for first aid dental skills of the personnel should be emphasized. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  18. A comparative study of oral health amongst trisomy 21 children living in Riyadh, Saudi Arabia: Part 1 caries, malocclusion, trauma

    Directory of Open Access Journals (Sweden)

    M. AlSarheed

    2015-10-01

    Conclusions: While there was no significant difference in the incidence of caries between children with and without T21, practitioners should be aware of the disparities in malocclusion and trauma in this vulnerable population.

  19. Biogeometry of femoral neck for implant placement

    Directory of Open Access Journals (Sweden)

    Patwa J

    2006-01-01

    Full Text Available Background : Treatment of fracture neck femur with three cannulated cancellous screws in an apex proximal configuration is practised in many parts of the world. Methods : Dimensions of femoral neck at the middle of transcervical neck using CT scan (live neck and vernier caliper (dry cadeveric neck in 20 subjects respectively were measured. Results : Inferior half of the neck is narrower than superior half. Conclusion : Biogeometry of the neck of femur does not accomodate two inferior screws and thus fixation of fracture neck femur with three canulated cancellous screws in an apex distal configuration is recommended.

  20. Ultrasonography in trauma

    DEFF Research Database (Denmark)

    Weile, Jesper; Nielsen, Klaus; Primdahl, Stine C

    2017-01-01

    BACKGROUND: The Focused Assessment with Sonography in Trauma (FAST) protocol is considered beneficial in emergent evaluation of trauma patients with blunt or penetrating injury and has become integrated into the Advanced Trauma Life Support (ATLS) protocol. No guidelines exist as to the use...... of ultrasonography in trauma in Denmark. We aimed to determine the current use of ultrasonography for assessing trauma patients in Denmark. METHODS: We conducted a nation-wide cross-sectional investigation of ultrasonography usage in trauma care. The first phase consisted of an Internet-based investigation....... Twenty-one (95.5%) of the guidelines included and recommended FAST as part of trauma assessment. The recommended person to perform the examination was the radiologist in n = 11 (50.0%), the surgeon in n = 6 (27.3%), the anesthesiologist in n = 1 (4.5%), and unspecified in n = 3 (13.6%) facilities. FAST...

  1. Cytological evaluation and prediction of progression of acute erosive ulcered lesions of upper parts of gastrointestinal tract in acute and early periods of cerebrospinal trauma

    Directory of Open Access Journals (Sweden)

    Norkin I.A.

    2010-09-01

    Full Text Available 80 cytological preparations derived by fibrogastroduodenoscopy from 20 patients with cerebrospinal trauma at cervical part level served as the research subject. Dynamics of the progression of acute erosive ulcered lesions of mucous membrane of the upper parts of the gastrointestinal tract was studied on the basis of the cytological analyses of mucous membrane biopsy materials. In the course of our work we used endoscopic (fibrogastroduodenoscopy and cytological research methods. Cytological analyses of mucous membrane biopsy materials were carried out on the 7th, 14th, 21st and 28th day. Biopsy material cellular composition was evaluated on the grounds of the calculation of neutrophilic leukocytes and epithelial cells with the use of an immersion objective. In so doing we registered neutrophilic leukocyte number for 100 cells and determined neutrophilic and epithelial index. Monitoring of neutrophilic leukocyte number enables to determine presence or absence of inflammatory changes in stomach mucous membrane and duodenum in different periods of cerebrospinal trauma

  2. Management of radiation therapy-induced mucositis in head and neck cancer patients. Part II: supportive treatments

    Directory of Open Access Journals (Sweden)

    Wei Cheong Ngeow

    2011-12-01

    Full Text Available Oropharyngeal mucositis is the acute inflammatory and ulcerative reaction of the oral mucosa following radiation therapy to the head and neck region. It is such a common problem that nearly all head and neck cancer patients develop some degree of mucositis. This complication is usually transient in nature but it also represents an important clinical problem as it is a painful, debilitating, dose-dependent side effect for which there is no widely acceptable prophylaxis or effective treatment. As several authoritative groups have recently either undertaken systematic reviews or issued guidelines on the management of mucositis, it is the aim of this review instead, to provide an overview of all the remedies and pharmaceutical agents available, as well as highlighting to researchers the gaps that need to be filled.

  3. Neck Pain

    Science.gov (United States)

    ... antidepressants for pain relief. Therapy Physical therapy. A physical therapist can teach you correct posture, alignment and neck- ... therapy, under supervision of a medical professional and physical therapist, may provide relief of some neck pain, especially ...

  4. 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.

  5. Oral toxicity management in head and neck cancer patients treated with chemotherapy and radiation: Xerostomia and trismus (Part 2). Literature review and consensus statement.

    Science.gov (United States)

    Buglione, Michela; Cavagnini, Roberta; Di Rosario, Federico; Maddalo, Marta; Vassalli, Lucia; Grisanti, Salvatore; Salgarello, Stefano; Orlandi, Ester; Bossi, Paolo; Majorana, Alessandra; Gastaldi, Giorgio; Berruti, Alfredo; Trippa, Fabio; Nicolai, Pietro; Barasch, Andrei; Russi, Elvio G; Raber-Durlacher, Judith; Murphy, Barbara; Magrini, Stefano M

    2016-06-01

    Radiotherapy alone or in combination with chemotherapy and/or surgery is a well-known radical treatment for head and neck cancer patients. Nevertheless acute side effects (such as moist desquamation, skin erythema, loss of taste, mucositis etc.) and in particular late toxicities (osteoradionecrosis, xerostomia, trismus, radiation caries etc.) are often debilitating and underestimated. A multidisciplinary group of head and neck cancer specialists from Italy met in Milan with the aim of reaching a consensus on a clinical definition and management of these toxicities. The Delphi Appropriateness method was used for this consensus and external experts evaluated the conclusions. The paper contains 20 clusters of statements about the clinical definition and management of stomatological issues that reached consensus, and offers a review of the literature about these topics. The review was split into two parts: the first part dealt with dental pathologies and osteo-radionecrosis (10 clusters of statements), whereas this second part deals with trismus and xerostomia (10 clusters of statements). Copyright © 2016. Published by Elsevier Ireland Ltd.

  6. Head and neck position sense.

    Science.gov (United States)

    Armstrong, Bridget; McNair, Peter; Taylor, Denise

    2008-01-01

    Traumatic minor cervical strains are common place in high-impact sports (e.g. tackling) and premature degenerative changes have been documented in sports people exposed to recurrent impact trauma (e.g. scrummaging in rugby) or repetitive forces (e.g. Formula 1 racing drivers, jockeys). While proprioceptive exercises have been an integral part of rehabilitation of injuries in the lower limb, they have not featured as prominently in the treatment of cervical injuries. However, head and neck position sense (HNPS) testing and re-training may have relevance in the management of minor sports-related neck injuries, and play a role in reducing the incidence of ongoing pain and problems with function. For efficacious programmes to be developed and tested, fundamental principles associated with proprioception in the cervical spine should be considered. Hence, this article highlights the importance of anatomical structures in the cervical spine responsible for position sense, and how their interaction with the CNS affects our ability to plan and execute effective purposeful movements. This article includes a review of studies examining position sense in subjects with and without pathology and describes the effects of rehabilitation programmes that have sought to improve position sense. In respect to the receptors providing proprioceptive information for the CNS, the high densities and complex arrays of spindles found in cervical muscles suggest that these receptors play a key role. There is some evidence suggesting that ensemble encoding of discharge patterns from muscle spindles is relayed to the CNS and that a pattern recognition system is used to establish joint position and movement. Sensory information from neck proprioceptive receptors is processed in tandem with information from the vestibular system. There are extensive anatomical connections between neck proprioceptive inputs and vestibular inputs. If positional information from the vestibular system is inaccurate or

  7. Neck pain

    OpenAIRE

    2002-01-01

    Non-specific neck pain has a postural or mechanical basis, and affects about two thirds of people at some stage, especially in middle age. Acute neck pain resolves within days or weeks, but becomes chronic in about 10% of people.Whiplash injuries follow sudden acceleration–deceleration of the neck, such as in road traffic or sporting accidents. Up to 40% of people continue to report symptoms 15 years after the accident.

  8. 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

  9. 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.

  10. THE EFFECT OF PREEMPTIVE GABAPENTIN ON POSTOPERATIVE PAIN AND OPIOID REQUIREMENT FOLLOWING SURGERIES IN THE ANTERIOR PART OF THE NECK

    Directory of Open Access Journals (Sweden)

    Nikhil

    2016-05-01

    Full Text Available BACKGROUND Acute postoperative pain has resulted in physiological and psychological disturbances. In spite of the spectacular advances in pain relief during surgery, relief of pain in the postoperative period still remains a problem. Here, we decided to study the effect of pre-emptive oral gabapentin on postoperative pain and opioid requirement. AIMS To evaluate the effect of pre-emptive gabapentin on postoperative pain and opioid requirement following surgeries in the neck area. To observe for the change in heart rate and blood pressure following surgery for 24 hrs. post-operatively. To observe for the incidence of nausea and vomiting. MATERIALS AND METHODS The patients selected for elective surgical procedures were randomly allocated into two groups, a control Group C and a gabapentin Group G of 30 members each. Patients in Group C received B-complex capsule orally as placebo 2 hours prior to surgery and those in Group B received gabapentin 300 mg orally 2 hours before surgery. After surgery, pain scores were assessed by a blinded person using visual analogue scale hourly for first 24 hours. Pethidine 1 mg/kg slow IV was given if pain score was 4 or more. Also adverse effects in the form of nausea and vomiting were documented. Statistical analysis of all the quantitative data was done by using the ‘Student’s unpaired t-test’ (e.g.: Mean Age, Vas Scores, Heart Rate, Systolic Blood Pressure, Diastolic Blood Pressure. Statistical analysis of all the qualitative data was done by using Chi ( 2 square test (e.g.: Gender, Nausea, Vomiting. Inter-group comparison of pethidine requirement was done using Mann-Whitney ‘u’ test (Z. RESULTS Patients in the gabapentin group had significantly lower VAS scores at all-time intervals of 0-6, 7-12, 13-18, 19-24 hours than those in the control group and it was statistically significant. Total pethidine requirement after surgery in the first 24 hours in the gabapentin group was (47±23.51 when

  11. Neck lump

    Science.gov (United States)

    ... the neck lump treated. When to Contact a Medical Professional Call your health care provider if you have an abnormal neck swelling or ... to Expect at Your Office Visit The health care provider will take your medical history and do a physical exam. You may ...

  12. A comparative study of oral health amongst trisomy 21 children living in Riyadh, Saudi Arabia: Part 1 caries, malocclusion, trauma

    OpenAIRE

    Alsarheed, M

    2015-01-01

    Background: Trisomy 21 (T21) is a genetic disorder stemming from a chromosomal abnormality and characterized by general and mental retardation. Depending on the population, T21 is known to affect 1 in every 600–2000 live births. The current literature provides a mixed view on the oral health status of T21 individuals. Aim: To establish the prevalence of dental caries, malocclusion, and trauma amongst children with T21 compared with non-T21 children in Riyadh, Saudi Arabia. Methods: This...

  13. 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.

  14. Stress hormones and post-traumatic stress disorder in civilian trauma victims: a longitudinal study. Part II: the adrenergic response.

    Science.gov (United States)

    Videlock, Elizabeth J; Peleg, Tamar; Segman, Ronen; Yehuda, Rachel; Pitman, Roger K; Shalev, Arieh Y

    2008-05-01

    The aim of the study was to prospectively evaluate the association between the occurrence of post-traumatic stress disorder (PTSD) and the adrenergic response to the traumatic event, and additionally, to explore the link between PTSD and the initial norepinephrine:cortisol ratio. Plasma levels and urinary excretion of norepinephrine (NE) were measured in 155 survivors of traumatic events during their admission to a general hospital emergency room (ER) and at 10 d, 1 month and 5 months later. Symptoms of peri-traumatic dissociation, PTSD and depression were assessed in each follow-up session. The Clinician-Administered PTSD Scale (CAPS) conferred a diagnosis of PTSD at 5 months. Trauma survivors with (n=31) and without (n=124) PTSD had similar levels of plasma NE, urinary NE excretion, and NE:cortisol ratio in the ER. Plasma NE levels were lower in subjects with PTSD at 10 d, 1 month, and 5 months. There was a weak but significant positive correlation between plasma levels of NE in the ER and concurrent heart rate, and a negative correlation between NE in the ER and dissociation symptoms. Peripheral levels of NE, shortly after traumatic events, are poor risk indicators of subsequent PTSD among civilian trauma victims. Simplified biological models may not properly capture the complex aetiology of PTSD.

  15. Ear trauma.

    Science.gov (United States)

    Eagles, Kylee; Fralich, Laura; Stevenson, J Herbert

    2013-04-01

    Understanding basic ear anatomy and function allows an examiner to quickly and accurately identify at-risk structures in patients with head and ear trauma. External ear trauma (ie, hematoma or laceration) should be promptly treated with appropriate injury-specific techniques. Tympanic membrane injuries have multiple mechanisms and can often be conservatively treated. Temporal bone fractures are a common cause of ear trauma and can be life threatening. Facial nerve injuries and hearing loss can occur in ear trauma.

  16. Incidence of blunt craniocervical artery injuries: use of whole-body computed tomography trauma imaging with adapted computed tomography angiography.

    Science.gov (United States)

    Fleck, Steffen K; Langner, Soenke; Baldauf, Joerg; Kirsch, Michael; Kohlmann, Thomas; Schroeder, Henry W S

    2011-09-01

    The incidence of traumatic craniocervical artery dissection varies in published trauma series. To determine the frequency of traumatic craniocervical artery injury in polytrauma patients by using standardized whole-body trauma computed tomography with adapted computed tomography angiography of the craniocervical vessels. A total of 718 consecutive patients requiring whole-body trauma computed tomography (16-row multislice) because of the mechanism of their injury patterns and an Injury Severity Scale score greater than 16 were analyzed prospectively. After a cranial scan, computed tomography angiography of the craniocervical vessels with 40 mL of iodinated contrast agent was performed using bolus tracking. The overall incidence of blunt carotid and vertebral injuries (BCVIs) in the screened population was 1.7%. BCVIs were observed in 27.3% of patients with detected isolated cervical spine injuries and in 3.9% of patients with isolated cranial fractures with or without intracranial hemorrhage, whereas 5.3% of patients with combined cervical and cranial lesions were associated with BCVIs. In addition, 0.4% of BCVIs occurred in patients without evidence of head or neck trauma. Whole-body trauma computed tomography with an adapted scanning protocol for the craniocervical vessels is a fast, safe, and feasible method for detecting vascular injuries. It allows prompt further treatment if necessary. Computed tomography angiography could be a part of a broad screening protocol for craniocervical vessels in documented injuries of the head and neck and in trauma mechanisms influencing the craniocervical region as well.

  17. Ultrasound in trauma.

    Science.gov (United States)

    Rippey, James C R; Royse, Alistair G

    2009-09-01

    Point-of-care ultrasound is well suited for use in the emergency setting for assessment of the trauma patient. Currently, portable ultrasound machines with high-resolution imaging capability allow trauma patients to be imaged in the pre-hospital setting, emergency departments and operating theatres. In major trauma, ultrasound is used to diagnose life-threatening conditions and to prioritise and guide appropriate interventions. Assessment of the basic haemodynamic state is a very important part of ultrasound use in trauma, but is discussed in more detail elsewhere. Focussed assessment with sonography for Trauma (FAST) rapidly assesses for haemoperitoneum and haemopericardium, and the Extended FAST examination (EFAST) explores for haemothorax, pneumothorax and intravascular filling status. In regional trauma, ultrasound can be used to detect fractures, many vascular injuries, musculoskeletal injuries, testicular injuries and can assess foetal viability in pregnant trauma patients. Ultrasound can also be used at the bedside to guide procedures in trauma, including nerve blocks and vascular access. Importantly, these examinations are being performed by the treating physician in real time, allowing for immediate changes to management of the patient. Controversy remains in determining the best training to ensure competence in this user-dependent imaging modality.

  18. Urogenital trauma: imaging upper GU trauma

    Energy Technology Data Exchange (ETDEWEB)

    Goldman, Stanford M. E-mail: Stanford.M.Goldman@uth.tmc.edu; Sandler, Carl M

    2004-04-01

    Objectives: This article will define the current controversies and concepts in the classification, clinical presentation, imaging approaches and management of upper urinary tract trauma. Materials and methods, results: This review will include the experience of the authors in the field of renal trauma over a 32-year period. Current thinking accepts the view that significant renal trauma is generally present when there is gross hematuria, signs of shock, or other clinical signs of severe injury. In most patients, suspected renal injury will be evaluated as a part of the overall assessment of the patient for suspected intraperitoneal injury. The authors will stress some exceptions to the rule. Conclusions: Most trauma experts now advocate conservative management, unless the patient is unstable or a renal vascular thrombosis or avulsion is suspected. Similarly, penetrating trauma to the kidney in and of itself no longer requires mandatory surgery. In the United States, computed tomography (CT), especially spiral CT, is considered the best diagnostic study, if available. Intravenous pyelography (IVP) is adequate if this is the only imaging modality available and if no concomitant injuries to the abdominal structure are suspected. Ultrasound, although strongly advocated in some countries, can lead to some significant false negatives. The diagnosis and management of unusual problems such as the traumatic AV fistula, the patient with an absent kidney or injury to the congenitally abnormal kidney, the serendipitous renal tumor in a patient with trauma, or serious bleeding after an apparent minor injury (i.e., spontaneous hemorrhage) are also reviewed in this article.

  19. 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.

  20. [Trauma and psychosis--part 1. On the association of early childhood maltreatment in clinical populations with psychotic disorders].

    Science.gov (United States)

    Kapfhammer, Hans-Peter

    2012-01-01

    A comprehensive literature stresses a high percentage of severe childhood maltreatment in the history of many psychotically ill patients treated in mental health services. Early childhood abuse seems to be associated among other things with a more severe clinical state, a more chronic course of illness and a more unfavourable psychosocial adaptation. In order not to jump to unwarranted causal conclusions, several conceptual und methodological problems have to be clarified before. From a conceptual perspective psychotic disorders diagnosed according to conventional criteria define only a minor subgroup within a much broader psychosis continuum in general population. Early childhood abuse has to be differentiated according to type, severity, timing, and context. The rates of early childhood abuse are high in general population. The methods of measurement of psychotic symptoms on the one side, of early trauma on the other side have to be critically evaluated. There is an empirically well founded association of childhood maltreatment and psychological and psychosomatic morbidity during adult years in general. In order to establish a potential conditional link also to psychotic disorders, clinical populations have to be compared to adequate control groups at least. A systematic literature search shows a very small number of studies including control groups at all. These studies underline that early childhood abuse may be significantly associated to the risk of psychosis indeed. The conditional role of early childhood abuse, however, has to be investigated only within a multifactorial biopsychosocial model of psychotic illness.

  1. Chronic neck pain : An epidemiological, psychological and SPECT study with emphasis on whiplash-associated disorders

    OpenAIRE

    2006-01-01

    Chronic neck pain, a common cause of disability, seems to be the result of several interacting mechanisms. In addition to degenerative and inflammatory changes and trauma, psychological and psychosocial factors are also involved. One common type of trauma associated with chronic neck pain is whiplash injury; this sometimes results in whiplash-associated disorder (WAD), a controversial condition with largely unknown pathogenetic mechanisms. We studied the prevalence of chronic neck pain of tra...

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

    Directory of Open Access Journals (Sweden)

    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.

  3. Neck dissection - discharge

    Science.gov (United States)

    Radical neck dissection - discharge; Modified radical neck dissection - discharge; Selective neck dissection - discharge ... 659-665. Robbins KT, Samant S, Ronen O. Neck dissection. In: Flint PW, Haughey BH, Lund V, et ...

  4. Trauma Fact Sheet

    Science.gov (United States)

    ... Home > Science Education > Physical Trauma Fact Sheet Physical Trauma Fact Sheet Tagline (Optional) Middle/Main Content Area ... of physical trauma. Credit: iStock. What is physical trauma? Physical trauma is a serious injury to the ...

  5. CT diagnosis of interfascial space infections in maxillofacial and neck part%颌面部颈部筋膜间隙感染的 CT 诊断

    Institute of Scientific and Technical Information of China (English)

    王镇; 邹真; 杨君

    2015-01-01

    OBJECTIVE To investigate nosocomial infections of interfascial space in maxillofacial and neck part and diagnostic significance of multi - slice spiral CT to provide reference for clinical diagnosis and treatment . METHODS Totally 52 patients with interfascial space infections in maxillofacial and neck part admitted and treated in the hospital during Jul .2009 to Mar .2014 were enrolled and their drainage pus after operation was collected for bacterial culture and simultaneously anaerobic culture .The performance of multi‐slice spiral CT diagnosis and the spread ways were observed .The software SPSS19 .0 was used for data analysis .RESULTS The 52 cases of patients with nosocomial infections had 59 strains of pathogens cultured from the specimens with pathogens ranking the top three including 13 strains of K lebsiella pneumoniae accounting for 22 .03% ,16 strains of Streptococcus pyogenes accounting for 27 .11% ,and 8 strains of Streptococcus anginosus accounting for 13 .56% .Multi‐slice spiral CT diagnosed that the 52 patients were infected with cellulitis or abscess .CT of abscess showed abscess wall ring enhancement ,with low density of vomicae .CT of cellular inflammation showed thickening and swelling of the affected muscles with fuzzy boundaries and the skin of affected parts had edema and thickness and the fat in fascial space disappeared .The 52 patients with interfascial space infection included 27 patients with masseteric space infection ,12 patients with mouth floor space infection ,10 patients with infection of carotid space abscess ,and 3 patients with space infection around tonsil .CONCLUSION Multi‐slice spiral CT has high accuracy for diagnosis of interfascial space infection in maxillofacial and neck part ,and the diagnostic CT can display spread ways ,which has important clinical value .%目的:探讨颌面部颈部筋膜间隙医院感染及多层螺旋 CT诊断意义,为临床诊断治疗提供参考。方法选择2009年7月-2014年3

  6. [Chest trauma].

    Science.gov (United States)

    Freixinet Gilart, Jorge; Ramírez Gil, María Elena; Gallardo Valera, Gregorio; Moreno Casado, Paula

    2011-01-01

    Chest trauma is a frequent problem arising from lesions caused by domestic and occupational activities and especially road traffic accidents. These injuries can be analyzed from distinct points of view, ranging from consideration of the most severe injuries, especially in the context of multiple trauma, to the specific characteristics of blunt and open trauma. In the present article, these injuries are discussed according to the involvement of the various thoracic structures. Rib fractures are the most frequent chest injuries and their diagnosis and treatment is straightforward, although these injuries can be severe if more than three ribs are affected and when there is major associated morbidity. Lung contusion is the most common visceral lesion. These injuries are usually found in severe chest trauma and are often associated with other thoracic and intrathoracic lesions. Treatment is based on general support measures. Pleural complications, such as hemothorax and pneumothorax, are also frequent. Their diagnosis is also straightforward and treatment is based on pleural drainage. This article also analyzes other complex situations, notably airway trauma, which is usually very severe in blunt chest trauma and less severe and even suitable for conservative treatment in iatrogenic injury due to tracheal intubation. Rupture of the diaphragm usually causes a diaphragmatic hernia. Treatment is always surgical. Myocardial contusions should be suspected in anterior chest trauma and in sternal fractures. Treatment is conservative. Other chest injuries, such as those of the great thoracic and esophageal vessels, are less frequent but are especially severe.

  7. Reasonable application of antibiotic prophylaxis in maxillofacial trauma: Literature review

    Directory of Open Access Journals (Sweden)

    Afshin Yadegari Naeeni

    2016-07-01

    Full Text Available Background and Aims: Despite advances in trauma management, treatment of the consequent infections has remained a major challenge. Antibiotic prophylaxis has been widely applied to reduce such infections. Although bacteria are present in most body parts, severe infections after treatment are less frequent in the head and neck of healthy individuals. The aim of the present study was to review the reasonable application of antibiotic prophylaxis in maxillofacial trauma. Materials and Methods: In this review article, PubMed and Google Scholar databases were searched for studies on antibiotic prophylaxis in maxillofacial trauma published during 2000-2014. Conclusion: Antibiotics were not prescribed for tears and small clean wounds in the face and mouth. However, prophylaxis was applied for extensive mouth injuries which involved the facial skin. In case of maxillofacial fractures, 24-hour administration of antibiotics sufficed for compound fractures of the mandible and other parts of the face. Antibiotics were not required in other types of fractures. Prophylaxis should be applied over short pre- or post-operative periods based on the severity and complexity of maxillofacial fractures and their relations with intra- and extraoral environments. Apparently, more detailed studies are warranted to further clarify the subject.

  8. 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.

  9. TRAUMA SURGERY

    African Journals Online (AJOL)

    utilisation of multiple resources, including blood products, anaesthetic ... surgical management of AVC injuries in the trauma centre at ... Sciences Human Research Ethics Committee. ..... Karinos N, Hayes PM, Nicol AJ, Kahn D. Avoiding futile.

  10. Digital subtraction angiography in head and neck radiology

    Energy Technology Data Exchange (ETDEWEB)

    Carmody, R.F.; Seeger, J.F.; Smith, R.L.; Horsley, W.W.; Miller, R.W.

    1984-07-01

    Intravenous digital subtraction angiography (IVDSA) was used to evaluate 44 patients with suspected otolaryngologic abnormalities. Sixteen had IVDSA for pulsatile tinnitus or suspected glomus tumor of the petrous bone. Nine patients were evaluated because of pulsatile neck masses, and 12 others had suspected tumors of the neck, face, and paranasal sinuses. Seven had IVDSA following head and neck trauma. The technique of examination is described. The current indications of IVDSA in head and neck radiology are discussed. It is concluded that IVDSA is a suitable substitute for conventional angiography for many otolaryngologic conditions and, because of its safety, can be used more liberally.

  11. TO COMPARE THE EFFECTS OF DEEP NECK FLEXORS STRENGHTNING EXERCISE AND McKENZIE NECK EXERCISE IN SUBJECTS WITH FORWARD NECK POSTURE: A RANDOMISED CLINICAL TRIAL

    Directory of Open Access Journals (Sweden)

    Vijay Kage

    2016-04-01

    Full Text Available Background: Forward Neck Posture also called as Protracted neck, is one in which the head is positioned anteriorly and the normal anterior cervical convexity is increased with the apex of the lordotic cervical curve at a considerable distance from the LOG in comparison with optimal posture.Nowadays texting may play a significant role in forward neck posture. According to Wellness Centre “It is the repetition of forward head movements combined with poor ergonomic postures and/or trauma that causes the body to adapt to forward head posture. Purpose: To compare effects of deep flexor strengthening exercises and McKenzie neck exercises in subjects with forward neck posture. Materials and Methods: 30 Subjects clinically diagnosed with FNP meeting the inclusion criteria were randomly assigned into three groups. Group A received McKenzie neck exercises, Group B received Deep Neck Flexor Strengthening Exercises and both the groups commonly went for pectoralis minor stretching respectively for once daily for a total of 6 sessions. Results: The results suggested that all the outcome measure i.e Forward Neck Posture, flexibility of pectoralis minor and CROM values showed significant differences among both the groups. Conclusion: The present study concluded that the comparison of McKenzie neck Exercises and Deep Neck Flexor Strengthening Exercises revealed no statistically significant differences, However each group showed improvement in cervical range of motion and forward neck posture with increase in the pectoralis minor flexibility.

  12. 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.

  13. A preliminary report on the efficacy of a dynamic jaw opening device (dynasplint trismus system) as part of the multimodal treatment of trismus in patients with head and neck cancer.

    Science.gov (United States)

    Stubblefield, Michael D; Manfield, Laura; Riedel, Elyn R

    2010-08-01

    To examine the effectiveness of a dynamic jaw opening device as part of a multimodal treatment strategy for trismus in patients with head and neck cancer. Retrospective cohort study. Tertiary care cancer center. Patients with head and neck cancer and trismus (N=20). All patients underwent assessment by a board-certified physiatrist and were referred to physical therapy for delivery of the DTS and instructed to progress use of the DTS to 30 minutes 3 times a day. Additional modalities for the treatment of trismus including pain medications and botulinum toxin injections were prescribed as clinically indicated. Change in maximal interincisal distance (MID) as documented in the medical record. The use of the DTS as part of multimodal therapy including physical therapy, pain medications, and botulinum toxin injections as deemed clinically appropriate resulted in an overall improvement of the MID from 16.5mm to 23.5mm (Ptrismus associated with head and neck cancer and its treatment. Further investigation is needed to determine the relative efficacy of the treatment modalities available for trismus including physical therapy and other jaw stretching devices.

  14. Low-level laser therapy/photobiomodulation in the management of side effects of chemoradiation therapy in head and neck cancer: part 2 : proposed applications and treatment protocols

    NARCIS (Netherlands)

    Zecha, J.A.E.M.; Raber-Durlacher, J.E.; Nair, R.G.; Epstein, J.B.; Elad, S.; Hamblin, M.R.; Barasch, A.; Migliorati, C.A.; Milstein, D.M.J.; Genot, M.T.; Lansaat, L.; van der Brink, R.; Arnabat-Dominguez, J.; van der Molen, L.; Jacobi, I.; van Diessen, J.; de Lange, J.; Smeele, L.E.; Schubert, M.M.; Bensadoun, R.J.

    2016-01-01

    Purpose There is a large body of evidence supporting the efficacy of low-level laser therapy (LLLT), more recently termed photobiomodulation (PBM) for the management of oral mucositis (OM) in patients undergoing radiotherapy for head and neck cancer (HNC). Recent advances in PBM technology, together

  15. Low-level laser therapy/photobiomodulation in the management of side effects of chemoradiation therapy in head and neck cancer: part 2 : proposed applications and treatment protocols

    NARCIS (Netherlands)

    Zecha, J.A.E.M.; Raber-Durlacher, J.E.; Nair, R.G.; Epstein, J.B.; Elad, S.; Hamblin, M.R.; Barasch, A.; Migliorati, C.A.; Milstein, D.M.J.; Genot, M.T.; Lansaat, L.; van der Brink, R.; Arnabat-Dominguez, J.; van der Molen, L.; Jacobi, I.; van Diessen, J.; de Lange, J.; Smeele, L.E.; Schubert, M.M.; Bensadoun, R.J.

    2016-01-01

    Purpose There is a large body of evidence supporting the efficacy of low-level laser therapy (LLLT), more recently termed photobiomodulation (PBM) for the management of oral mucositis (OM) in patients undergoing radiotherapy for head and neck cancer (HNC). Recent advances in PBM technology, together

  16. Neck Injuries and Disorders

    Science.gov (United States)

    ... or upper arms. Muscle strain or tension often causes neck pain. The problem is usually overuse, such as from ... or accidents, including car accidents, are another common cause of neck pain. Whiplash, a soft tissue injury to the neck, ...

  17. Dento-alveolar and maxillofacial injuries: a 5-year multi-center study. Part 1: general vs facial and dental trauma.

    Science.gov (United States)

    Lin, Shaul; Levin, Liran; Goldman, Sharon; Peleg, Kobi

    2008-02-01

    Maxillofacial injuries are a significant cause of morbidity and demand meticulously planned treatment. The aim of this present multi-center study was to evaluate the occurrence of dento-alveolar and maxillofacial injuries over a 5-year period. A retrospective cohort study of data from the Israel Trauma Registry was conducted for the years 2000-2004. The registry includes all trauma patients admitted and hospitalized due to an injury. Of the 111,010 hospitalized trauma patients, 5886 (5.3%) were diagnosed with maxillofacial or dental injuries. The main causes of injuries for hospitalized trauma patients were falls (48.1%) and motor vehicle accidents (25.2%), while the major causes of facial and dental injuries were vehicle accidents (39.6%, 56.8%, respectively) and falls (32.1%, 26.7%, respectively). High-risk age groups for dental and facial trauma were 10-18 years and 19-28 years, respectively, while for other trauma, ages for the greatest risk ranged from 0 to 9 years and over 59 years. Males were injured two to three times more frequently than females. A better understanding of the etiology of maxillofacial and dental injuries and identifying the high-risk groups should lead to appropriate prevention programs and treatment methods.

  18. Trauma care systems in India - An overview

    Directory of Open Access Journals (Sweden)

    Joshipura M

    2004-01-01

    Full Text Available Trauma-care systems in India are at a nascent stage of development. Industrialized cities, rural towns and villages coexist, with variety of health care facilities and almost complete lack of organized trauma care. There is gross disparity between trauma services available in various parts of the country. Rural India has inefficient services for trauma care, due to the varied topography, financial constraints and lack of appropriate health infrastructure. There is no national lead agency to coordinate various components of a trauma system. No mechanism for accreditation of trauma centres and professionals exists. Education in trauma life-support skills has only recently become available. A nationwide survey encompassing various facilities has demonstrated significant deficiencies in current trauma systems. Although injury is a major public-health problem, the government, medical fraternity and the society are yet to recognize it as a growing challenge.

  19. Trauma care in India: current scenario.

    Science.gov (United States)

    Joshipura, M K

    2008-08-01

    Trauma-care systems in India are at a nascent stage of development. Industrialized cities, rural towns, and villages coexist with a variety of health care facilities and an almost complete lack of organized trauma care. There is gross disparity between trauma services available in various parts of the country. Rural India has inefficient services for trauma care, due to the varied topography, financial constraints, and lack of appropriate health infrastructure. There is no national lead agency to coordinate various components of a trauma system. No mechanism for accreditation of trauma centers and professionals exists. Education in trauma life-support skills has only recently become available. A nationwide survey encompassing various facilities has documented significant deficiencies in current trauma systems. Some initiatives on improving prehospital systems have been seen recently. Although injury is a major public-health problem, the government, medical fraternity, and the society are yet to recognize it as a significant public health challenge.

  20. Children and Facial Trauma

    Science.gov (United States)

    ... an ENT Doctor Near You Children and Facial Trauma Children and Facial Trauma Patient Health Information News ... staff at newsroom@entnet.org . What is facial trauma? The term facial trauma means any injury to ...

  1. Ballistic trauma

    Directory of Open Access Journals (Sweden)

    Parvathi Devi Munishwar

    2016-01-01

    Full Text Available Gunshot injuries are rather serious but uncommon type of trauma in India. Radiologists can contribute substantially in the evaluation and treatment of patients with gunshot wounds. Foreign bodies that enter a patient as a result of trauma are contaminated and produce a range of symptoms. Oral and maxillofacial gunshot injuries are usually fatal due to close proximity with vital structures. Here, we report a case in which radiographic evidence of foreign bodies in the right orofacial region exposed a history of a gunshot injury. The patient did not have any major complaints except for reduced mouth opening. These foreign bodies were clinically silent for approximately 12 years.

  2. Penetrating wounds of the head and neck.

    Science.gov (United States)

    Jahrsdoerfer, R A; Johns, M E; Cantrell, R W

    1979-12-01

    Wounding capability of bullets is primarily releated to velocity. Bullet mass and shape, and specific gravity of body tissues being struck by the missile, are lesser factors. Seventy cases of penetrating wounds of the head and neck were treated during a six-year period. Vascular injuries were more common with neck wounds, while face and head injuries (extracranial) were similar to maxillofacial trauma. It is recognized that hemorrhage at the base of the skull is difficult to treat, and contemporary training in temporal bone and base of skull surgery is mandatory for the critical management of these wounds.

  3. Trauma Theory

    DEFF Research Database (Denmark)

    Pedersen, Bodil Maria

    There are two main trends in psychological approaches to human suffering related to what we term trauma. Although they have their respective limitations both approaches may help us explore and alleviate human suffering. One trend, primarily using concepts like traumatic events and traumatisation...

  4. Trauma Ultrasound.

    Science.gov (United States)

    Wongwaisayawan, Sirote; Suwannanon, Ruedeekorn; Prachanukool, Thidathit; Sricharoen, Pungkava; Saksobhavivat, Nitima; Kaewlai, Rathachai

    2015-10-01

    Ultrasound plays a pivotal role in the evaluation of acute trauma patients through the use of multi-site scanning encompassing abdominal, cardiothoracic, vascular and skeletal scans. In a high-speed polytrauma setting, because exsanguinations are the primary cause of trauma morbidity and mortality, ultrasound is used for quick and accurate detection of hemorrhages in the pericardial, pleural, and peritoneal cavities during the primary Advanced Trauma Life Support (ATLS) survey. Volume status can be assessed non-invasively with ultrasound of the inferior vena cava (IVC), which is a useful tool in the initial phase and follow-up evaluations. Pneumothorax can also be quickly detected with ultrasound. During the secondary survey and in patients sustaining low-speed or localized trauma, ultrasound can be used to help detect abdominal organ injuries. This is particularly helpful in patients in whom hemoperitoneum is not identified on an initial scan because findings of organ injuries will expedite the next test, often computed tomography (CT). Moreover, ultrasound can assist in detection of fractures easily obscured on radiography, such as rib and sternal fractures.

  5. Psychological Care, Patient Education, Orthotics, Ergonomics and Prevention Strategies for Neck Pain: An Systematic Overview Update as Part of the ICON§ Project

    Science.gov (United States)

    Gross, Anita R.; Kaplan, Faith; Huang, Stacey; Khan, Mahweesh; Santaguida, P. Lina; Carlesso, Lisa C.; MacDermid, Joy C.; Walton, David M.; Kenardy, Justin; Söderlund, Anne; Verhagen, Arianne; Hartvigsen, Jan

    2013-01-01

    Objectives: To conduct an overview on psychological interventions, orthoses, patient education, ergonomics, and 1⁰/2⁰ neck pain prevention for adults with acute-chronic neck pain. Search Strategy: Computerized databases and grey literature were searched (2006-2012). Selection Criteria: Systematic reviews of randomized controlled trials (RCTs) on pain, function/disability, global perceived effect, quality-of-life and patient satisfaction were retrieved. Data Collection & Analysis: Two independent authors selected articles, assessed risk of bias using AMSTAR tool and extracted data. The GRADE tool was used to evaluate the body of evidence and an external panel to provide critical review. Main Results: We retrieved 30 reviews (5-9 AMSTAR score) reporting on 75 RCTs with the following moderate GRADE evidence. For acute whiplash associated disorder (WAD), an education video in emergency rooms (1RCT, 405participants] favoured pain reduction at long-term follow-up thus helping 1 in 23 people [Standard Mean Difference: -0.44(95%CI: -0.66 to -0.23)). Use of a soft collar (2RCTs, 1278participants) was not beneficial in the long-term. For chronic neck pain, a mind-body intervention (2RCTs, 1 meta-analysis, 191participants) improved short-term pain/function in 1 of 4 or 6 participants. In workers, 2-minutes of daily scapula-thoracic endurance training (1RCT, 127participants) over 10 weeks was beneficial in 1 of 4 participants. A number of psychosocial interventions, workplace interventions, collar use and self-management educational strategies were not beneficial. Reviewers' Conclusions: Moderate evidence exists for quantifying beneficial and non-beneficial effects of a limited number of interventions for acute WAD and chronic neck pain. Larger trials with more rigorous controls need to target promising interventions PMID:24133554

  6. Ultrasound examination of the head and neck

    NARCIS (Netherlands)

    R.J. Baatenburg de Jong (Robert Jan); R.J. Rongen (Robert Jan)

    1990-01-01

    textabstractStructure of this thesis Part I deals with basic bio-physics and bio-effects of clinical ultrasound of the head and neck. Furthermore, the ultrasound anatomy of the head and neck is described and illustrated. In addition, the technique of ultrasound guided fine needle aspiration biopsy (

  7. Is informed consent effective in trauma patients?

    Science.gov (United States)

    Bhangu, A; Hood, E; Datta, A; Mangaleshkar, S

    2008-11-01

    Informed consent in the modern era is a common and important topic both for the well-informed patient and to prevent unnecessary litigation. However, the effectiveness of informed consent in trauma patients is an under-researched area. This paper aims to assess the differences in patient recall of the consent process and desire for information by performing a comparative analysis between orthopaedic trauma and elective patients. Information from 41 consecutive elective operations and 40 consecutive trauma operations was collected on the first post-operative day. 100% of elective patients and 90% of trauma patients knew what operation they had received (p = 0.06). Overall recall of complications was poor, but was significantly lower in trauma patients compared with elective patients (62% vs 22%, p<0.001). 30% of trauma patients desired more information about their operation compared to 12% of elective patients (p = 0.049), although only 35% of trauma patients wanted written as well as verbal explanations, compared to 85% of elective patients p<0.001). Overall 100% of elective and 90% of trauma patients were happy with the consent process (p = 0.06). Subset analysis of neck of femur compared to other trauma patients showed that the above factors were not significantly different between the two groups. Recall of complications in the trauma patients is significantly lower than in elective patients, although both groups scored poorly overall. Repeated verbal explanations should be reinforced with the option of additional information leaflets for trauma operations. Further research into the usefulness of DVDs for commonly performed operations is warranted, although official internet resources may be more cost-effective.

  8. Experimental Injury Biomechanics of the Pediatric Neck

    Science.gov (United States)

    Nightingale, Roger W.; Luck, Jason F.

    Motor vehicle related crashes rank as the most common cause of spinal related injuries in the pediatric population (Platzer et al. 2007; Brown et al. 2001; Kokoska et al. 2001; Eleraky et al. 2000; Hamilton and Myles 1992a; Bonadio 1993; Babcock 1975). Pediatric spinal related trauma accounts for between 1 and 12 % of all spinal related injuries (Hamilton and Myles 1992a; Hadley et al. 1988; Aufdermaur 1974). Cervical spine trauma in children accounts for approximately 2 % of all cervical spinal injuries (Henrys et al. 1977). Approximately 1-2 % of all children admitted for traumatic injury are related to injuries to the cervical spine (Platzer et al. 2007; Brown et al. 2001; Kokoska et al. 2001; Orenstein et al. 1994; Rachesky et al. 1987). Overall, pediatric neck injury rates are significantly lower than adult rates; however, the neck injury rate in children between the ages of 11 and 15 years approaches the adult rate of 18.8 per 100,000 (McGrory et al 1993; Myers and Winkelstein 1995). For children less than 11 years of age, neck injuries are relatively rare (1.2 per 100,000), but have particularly devastating consequences (McGrory et al. 1993). The overall mortality rate amongst victims of pediatric spinal trauma is approximately 16-41 % but considerably higher for the youngest ages (Platzer et al. 2007; Brown et al. 2001; Kokoska et al. 2001; Eleraky et al. 2000; Givens et al. 1996; Orenstein et al. 1994; Hamilton and Myles 1992b).

  9. Dentoalveolar trauma.

    Science.gov (United States)

    Olynik, Christopher R; Gray, Austin; Sinada, Ghassan G

    2013-10-01

    Dentoalveolar injuries are an important and common component of craniomaxillofacial trauma. The dentition serves as a vertical buttress of the face and fractures to this area may result in malalignment of facial subunits. Furthermore, the dentition is succedaneous with 3 phases-primary dentition, mixed dentition, and permanent dentition-mandating different treatment protocols. This article is written for nondental providers to diagnose and treat dentoalveolar injuries.

  10. Suspension trauma; Le traumatisme de suspension

    Energy Technology Data Exchange (ETDEWEB)

    Trudel, S. [Le Centre de sante et de services sociaux du rocher Perce, Chandler, PQ (Canada)

    2010-07-01

    This presentation discussed the precautions that should be taken to avoid falls from wind turbines or transmission towers. Suspension trauma was explained by a medical doctor in terms of physiology and the body's normal circulation and the elements that disturb normal physiology when in suspension. The trauma occurs following a fall, which carries the risk of 1or more disorders, such as massive hemorrhage, high cardiac pulse, and constriction of blood vessels. Nausea, vertigo, cardiac arrhythmia and sweating occur 15 to 20 minutes following the fall. The presentation emphasized the importance of having qualified personnel at the site and wearing proper harnesses and equipment that supports the neck. figs.

  11. Retained crossbow bolt after penetrating facial trauma.

    Science.gov (United States)

    Shah, Manan U; Sridhara, Shankar K; Wolf, Jeffrey S; Ambro, Bryan T

    2016-01-01

    We present an unusual case of a retained crossbow bolt in the maxillofacial area of a 31-year-old man. While crossbow injuries are rare, this case is of interest because otolaryngologists are often faced with treating retained foreign objects after penetrating facial trauma. These cases are difficult to manage because of the complexity and variety of injuries that can occur during both the initial trauma and the removal. We focus on the management of the bolt's removal and provide a brief discussion of the relevant literature on crossbow injuries to the head and neck.

  12. Head and neck mycetoma: the mycetoma research centre experience.

    Science.gov (United States)

    Fahal, Ahmed; Mahgoub, El Sheikh; El Hassan, Ahmed Mohamed; Jacoub, Angom Osman; Hassan, Doaa

    2015-03-01

    Mycetoma is a unique neglected tropical disease which is endemic in what is known as the "mycetoma belt". The disease has many devastating impacts on patients and communities in endemic area and is characterised by massive deformity, destruction and disability. Mycetoma is commonly seen in the foot and hand and less frequent in other parts of the body. Mycetoma of the head and neck is a rarity and is associated with high morbidity and even mortality if not treated early. In this communication we report on 49 patients with head and neck mycetoma followed up at the Mycetoma Research Centre in Khartoum. Most of the reported patients had actinomycetoma and the majority were young adult males from mycetoma endemic areas in the Sudan. Most of them were students, farmers and workers. Prior to presentation the majority had long disease duration and the cause was multifactorial. Advanced disease with massive lesion, deformity and disability was the common presentation. There was no obvious history of local trauma, familial tendency or other predisposing factor identified in this group of patients. MRI and CT scan were the most accurate diagnostic tools to determine the disease extent. The treatment outcome was rather poor and characterised by low cure rate, poor outcome and high follows-up dropout. Such a gloomy outcome calls for structured and objective health education programs.

  13. Head and neck mycetoma: the mycetoma research centre experience.

    Directory of Open Access Journals (Sweden)

    Ahmed Fahal

    2015-03-01

    Full Text Available Mycetoma is a unique neglected tropical disease which is endemic in what is known as the "mycetoma belt". The disease has many devastating impacts on patients and communities in endemic area and is characterised by massive deformity, destruction and disability. Mycetoma is commonly seen in the foot and hand and less frequent in other parts of the body. Mycetoma of the head and neck is a rarity and is associated with high morbidity and even mortality if not treated early. In this communication we report on 49 patients with head and neck mycetoma followed up at the Mycetoma Research Centre in Khartoum. Most of the reported patients had actinomycetoma and the majority were young adult males from mycetoma endemic areas in the Sudan. Most of them were students, farmers and workers. Prior to presentation the majority had long disease duration and the cause was multifactorial. Advanced disease with massive lesion, deformity and disability was the common presentation. There was no obvious history of local trauma, familial tendency or other predisposing factor identified in this group of patients. MRI and CT scan were the most accurate diagnostic tools to determine the disease extent. The treatment outcome was rather poor and characterised by low cure rate, poor outcome and high follows-up dropout. Such a gloomy outcome calls for structured and objective health education programs.

  14. Bilateral impacted femoral neck fracture in a renal disease patient

    Directory of Open Access Journals (Sweden)

    Pramod Devkota

    2013-01-01

    Full Text Available Spontaneous bilateral femoral neck facture in a renal disease patient is not common. We report a case of 47-year-old female patient with chronic renal failure and on regular hemodialysis for the past 5 years who sustained bilateral impacted femoral neck fracture without history of trauma and injury and refused any surgical intervention. The patient was mobilised on wheel chair one year after the fractures. The cause of the fracture and the literature review of the bilateral femoral neck fracture in renal disease are discussed.

  15. [Isolated hyoid bone fracture due to blunt trauma: case report].

    Science.gov (United States)

    Erdoğan, Mehmet Ozgür; Koşargelir, Mehmet; Yorulmaz, Rasim; Meriç, Kaan; Erdoğan, Barış

    2013-05-01

    Fractures of the hyoid bone are very rare. Diagnosis of hyoid fracture is difficult and can be made only with a strong degree of suspicion. We report a case of isolated hyoid bone fracture due to blunt trauma to the neck. A 26-year-old woman was admitted to emergency department for motor vehicle accident. She complained of dysphagia and anterior neck discomfort. Physical examination showed hyperemia and tenderness of neck. A tomographic scan of neck was performed. The findings demonstrated hyoid fracture. Patient was observed with medical therapy for 24 hours and discharged with recommendation of outpatient control.Emergency physician has to be aware of the possibility of hyoid fractures in blunt traumas. Patients with hyoid fracture should be observed for 24 hours. Generally, medical treatment is satisfactory in isolated hyoid fractures.

  16. Minor trauma triggering cervicofacial necrotizing fasciitis from odontogenic abscess

    Directory of Open Access Journals (Sweden)

    Jain Shraddha

    2008-01-01

    Full Text Available Necrotizing fasciitis (NF of the face and neck is a very rare complication of dental infection. Otolaryngologists and dentists should be familiar with this condition because of its similarity to odontogenic deep neck space infection in the initial stages, its rapid spread, and its life-threatening potential. Trauma has been reported to be an important predisposing factor for NF of the face. In this paper, we describe the presentation and treatment of a 62-year-old man who developed NF of the face and neck following bilateral odontogenic deep neck space abscesses. The disease progressed rapidly, with necrosis of the skin, after the patient inflicted minor trauma in the form of application of heated medicinal leaves. The organism isolated in culture from pus was Acinetobacter sp . The comorbid conditions in our patient were anemia and chronic alcoholism. The patient was managed by immediate and repeated extensive debridements and split-skin grafting.

  17. Minor trauma triggering cervicofacial necrotizing fasciitis from odontogenic abscess.

    Science.gov (United States)

    Jain, Shraddha; Nagpure, Prakash S; Singh, Roohie; Garg, Deepika

    2008-07-01

    Necrotizing fasciitis (NF) of the face and neck is a very rare complication of dental infection. Otolaryngologists and dentists should be familiar with this condition because of its similarity to odontogenic deep neck space infection in the initial stages, its rapid spread, and its life-threatening potential. Trauma has been reported to be an important predisposing factor for NF of the face. In this paper, we describe the presentation and treatment of a 62-year-old man who developed NF of the face and neck following bilateral odontogenic deep neck space abscesses. The disease progressed rapidly, with necrosis of the skin, after the patient inflicted minor trauma in the form of application of heated medicinal leaves. The organism isolated in culture from pus was Acinetobacter sp. The comorbid conditions in our patient were anemia and chronic alcoholism. The patient was managed by immediate and repeated extensive debridements and split-skin grafting.

  18. Videolaparoscopia no trauma abdominal

    Directory of Open Access Journals (Sweden)

    Átila Varela Velho

    Full Text Available A videolaparoscopia (VL vem contribuindo de forma crescente, para diagnóstico e terapêutica de várias afecções cirúrgicas abdominais, introduzindo profundas mudanças na cirurgia contemporânea. Esse avanço incorporou-se também às urgências traumáticas, fazendo parte da avaliação diagnóstica e, às vezes, da terapêutica do trauma abdominal. Os autores apresentam uma revisão concisa da literatura sobre a VL no trauma, atualizando o tema e discutindo os aspectos mais relevantes das indicações, limitações e complicações do método.

  19. Trauma Theory

    DEFF Research Database (Denmark)

    Pedersen, Bodil Maria

    There are two main trends in psychological approaches to human suffering related to what we term trauma. Although they have their respective limitations both approaches may help us explore and alleviate human suffering. One trend, primarily using concepts like traumatic events and traumatisation...... and situated meanings and practices related to suffering and resilience connected to ‘traumatic’ events. This presentation is based on a large qualitative research project. Inspired by this study it will explore the possibilities of developing the theoretical understanding of personal meanings of violent and...

  20. The influence of psychosocial factors on recovery following acute whiplash trauma.

    Science.gov (United States)

    Carstensen, Tina Birgitte Wisbech

    2012-12-01

    Persistent pain and disability after whiplash trauma has become an increasingly significant problem in many industrialized countries entailing comprehensive individual as well as social costs. The dissertation includes two areas of research within whiplash trauma. The first part contains two empirical articles focusing on risk factors for poor recovery. The second part contains a systematic review and an empirical article and concerns the influence of coping strategies on recovery with a special emphasis on possible gender differences. All empirical articles in the dissertation are based on self-reported questionnaire data on a patient cohort of whiplash-exposed. Patients are consecutively included in the study within the first ten days of collision recruited from emergency departments and general practitioners in four counties in Denmark from April 2001 to June 2003. One of the empirical articles in the dissertation is supplemented with data from a social register of transfer benefits on the patient cohort as well as on a matched register control cohort in the general population. In this dissertation we wish to answer the following questions: 1) Do self-reported pre-collision health-related and socio-demographic factors affect self-reported work capability and neck pain one year after acute whiplash trauma? 2) Do transfer benefits before the accident predict negative change in future health-related provisional situation and future neck pain? 3) Do persons with acute whiplash trauma experience more negative change in future health-related provisional situation compared to a matched register control group? 4) Does research in the use of coping strategies after whiplash trauma show that these predict poor restitution and is there any research on gender differences in the use of coping strategies in whiplash-exposed? 5) Do gender and coping strategies interact in the prediction of future neck pain following acute whiplash trauma? Self-reported unspecified pain, female

  1. Neck x-ray

    Science.gov (United States)

    X-ray - neck; Cervical spine x-ray; Lateral neck x-ray ... There is low radiation exposure. X-rays are monitored so that the lowest amount of radiation is used to produce the image. Pregnant women and ...

  2. Chronic neck pain. An epidemiological, psychological and SPECT study with emphasis on whiplash-associated disorders.

    Science.gov (United States)

    Guez, Michel

    2006-02-01

    Chronic neck pain, a common cause of disability, seems to be the result of several interacting mechanisms. In addition to degenerative and inflammatory changes and trauma, psychological and psychosocial factors are also involved. One common type of trauma associated with chronic neck pain is whiplash injury; this sometimes results in whiplash-associated disorder (WAD), a controversial condition with largely unknown pathogenetic mechanisms. We studied the prevalence of chronic neck pain of traumatic and non-traumatic origin and compared the prevalence of, sociodemographic data, self-perceived health, workload and chronic low-back pain in these groups. In a ready-made questionnaire (MONICA study), we added questions about cervical spine and low-back complaints. 6,000 (72%) completed a self-administered questionnaire. 43% reported neck pain: 48% of women and 38% of men. Women of working age had more neck pain than retired women, a phenomenon not seen in men. 19% of the studied population suffered from chronic neck pain and it was more frequent in women. A history of neck trauma was common in those with chronic neck pain. Those with a history of neck trauma perceived their health worse and were more often on sick-leave. About 50% of those with traumatic and non-traumatic chronic neck pain also had chronic low-back pain. We assessed the subjective and objective neuropsychological functioning in 42 patients with chronic neck pain, 21 with a whiplash trauma, and 21 without previous neck trauma. Despite cognitive complaints, the WAD patients had normal neuropsychological functioning, but the WAD group especially had deviant MMPI results-indicating impaired coping ability and somatization. WAD patients had no alterations in cerebral blood-flow pattern, as measured by rCBF-SPECT and SPM analysis, compared to healthy controls. This contrasts with the non-traumatic group with chronic neck pain, which showed marked blood-flow changes. The blood-flow changes in the non

  3. Evaluation of geriatric patients with trauma scores after motor vehicle trauma.

    Science.gov (United States)

    Cevik, Yunsur; Doğan, Nurettin Özgür; Daş, Murat; Karakayali, Onur; Delice, Orhan; Kavalci, Cemil

    2013-10-01

    The aim of this study was to investigate the factors affecting in-hospital mortality among geriatric trauma patients who presented to the emergency department (ED) following a motor vehicle collision. A retrospective cohort study was carried out in a high-volume tertiary care facility in the central Anatolian Region. Clinical data were extracted from hospital databases for all eligible geriatric patients (either driver, passenger or pedestrian) with entries dated between January 1, 2007, and December 31, 2009. Multivariate logistic regression analysis was used to assess the in-hospital mortality effects of variables including demographic characteristics, trauma mechanisms, injured body parts and various trauma scores. There were 395 geriatric motor vehicle trauma presentations to the ED during the 3-year period. Of these patients, 371 (93.9%) survived, and 24 (6.1%) died in the ED, operating room or intensive care unit. The multivariate logistic regression model included the following variables: heart failure, cranial trauma, abdominal trauma, thoracic trauma, pelvic trauma, Glasgow Coma Score and Injury Severity Score (ISS). These variables were chosen because univariate analysis indicated that they were potential predictors of mortality. The multivariate logistic regression showed that the presence of heart failure (OR: 20.2), cranial trauma (OR: 3.6), abdominal trauma (OR: 26.9), pelvic trauma (OR: 9.9) and ISS (OR: 1.2) were predictors of in-hospital mortality in the study population. In our study, heart failure, cranial trauma, abdominal trauma, pelvic trauma, and ISS were found to be the most important predictors of in-hospital mortality among geriatric motor vehicle trauma patients. © 2013.

  4. Trauma during pregnancy.

    Science.gov (United States)

    Tweddale, Carla J

    2006-01-01

    Trauma is the leading nonobstetrical cause of maternal death. The effect of trauma on the pregnant woman and unborn fetus can be devastating. The major causes of maternal injury are blunt trauma, penetrating trauma, burns, falls, and assaults. There are specific changes associated with pregnancy that are important for the clinician to consider when providing care to these patients. Initial management of traumatic injuries during pregnancy is essential for maternal and fetal well-being. This review outlines common causes of maternal trauma, the initial assessment of the pregnant trauma patient, and ongoing care for the pregnant trauma patient and unborn fetus.

  5. Neck injuries in young pediatric homicide victims.

    Science.gov (United States)

    Brennan, Laura K; Rubin, David; Christian, Cindy W; Duhaime, Ann-Christine; Mirchandani, Haresh G; Rorke-Adams, Lucy B

    2009-03-01

    In this study, the authors estimate the prevalence of injuries to the soft tissue of the neck, cervical vertebrae, and cervical spinal cord among victims of abusive head trauma to better understand these injuries and their relationship to other pathophysiological findings commonly found in children with fatal abusive head trauma. The population included all homicide victims 2 years of age and younger from the city of Philadelphia, Pennyslvania, who underwent a comprehensive postmortem examination at the Office of the Medical Examiner between 1995 and 2003. A retrospective review of all available postmortem records was performed, and data regarding numerous pathological findings, as well as the patient's clinical history and demographic information, were abstracted. Data were described using means and standard deviations for continuous variables, and frequency and ranges for categorical variables. Chi-square analyses were used to test for the association of neck injuries with different types of brain injury. The sample included 52 children, 41 (79%) of whom died of abusive head trauma. Of these, 29 (71%) had primary cervical cord injuries: in 21 there were parenchymal injuries, in 24 meningeal hemorrhages, and in 16, nerve root avulsion/dorsal root ganglion hemorrhage were evident. Six children with abusive head trauma had no evidence of an impact to the head, and all 6 had primary cervical spinal cord injury (SCI). No child had a spinal fracture. Six of 29 children (21%) with primary cervical SCIs had soft-tissue (ligamentous or muscular) injuries to the neck, and 14 (48%) had brainstem injuries. There was a significant association of primary cervical SCI with cerebral edema (p = 0.036) but not with hypoxia-ischemia, infarction, or herniation. Cervical SCI is a frequent but not universal finding in young children with fatal abusive head trauma. In the present study, parenchymal and/or root injury usually occurred without evidence of muscular or ligamentous damage

  6. Ecological salivary cortisol analysis (Part 2): Relative impact of trauma history, posttraumatic stress, comorbidity, chronic stress, and known confounds on hormone levels

    Science.gov (United States)

    King, Anthony; Leichtman, Jennifer; Abelson, James; Liberzon, Israel; Seng, Julia S.

    2011-01-01

    Background Although bio-psycho-social health research is an ideal, samples adequate for complex modeling require biomarker specimens from hundreds of participants. Ecological sampling departs from laboratory study norms, with implications for analysis. Objective This paper compares salivary cortisol levels and effect sizes of ‘focal’ psychiatric factors, such as trauma history, posttraumatic stress diagnosis, comorbidity, and chronic stress, and ‘nuisance’ factors, including endocrine disorders, medications, physiological factors, such as gestational age, and smoking, to inform ecological study designs. Study Design This is a descriptive analysis of ecologically collected cortisol specimens, assayed in an on-going perinatal psychobiological study, addressing methodological considerations. Results Focal and nuisance factors are often interdependent with similar effect sizes. Careful specimen deletion decisions and model specification are needed to achieve the hoped-for external validity while maintaining internal validity. Conclusions Results of multivariate models support the validity and usefulness of an ecological approach to incorporating biomarkers in health research. PMID:21665772

  7. [Quality of initial trauma care in paediatrics].

    Science.gov (United States)

    Ibáñez Pradas, Vicente; Pérez Montejano, Rut

    2017-04-18

    Trauma care in Spain is not provided in specific centres, which means that health professionals have limited contact to trauma patients. After the setting up of a training program in paediatric trauma, the aim of this study was to evaluate the quality of the initial care provided to these patients before they were admitted to the paediatric intensive care unit (PICU) of a third level hospital (trauma centre), as an indirect measurement of the increase in the number of health professionals trained in trauma. Two cohorts of PICU admissions were reviewed, the first one during the four years immediately before the training courses started (Group 1, period 2001-2004), and the second one during the 4 years (Group 2, period 2012-2015) after nearly 500 professionals were trained. A record was made of the injury mechanism, attending professional, Glasgow coma score (GCS), and paediatric trauma score (PTS). Initial care quality was assessed using five indicators: use of cervical collar, vascular access, orotracheal intubation if GCS ≤ 8, gastric decompression if PTS≤8, and number of actions carried out from the initial four recommended (neck control, provide oxygen, get vascular access, provide IV fluids). Compliance was compared between the 2 periods. A P<.05 was considered statistically significant. A total of 218 patient records were analysed, 105 in Group 1, and 113 in Group 2. The groups showed differences both in injury mechanism and in initial care team. A shift in injury mechanism pattern was observed, with a decrease in car accidents (28% vs 6%; P<.0001). Patients attended to in low complexity hospitals increased from 29.4% to 51.9% (P=.008), and their severity decreased when assessed using the GCS ≤ 8 (29.8% vs 13.5%; P=.004), or PTS≤8 (48.5% vs 29.7%; P=.005). As regards quality indicators, only the use of neck collar improved its compliance (17.3% to 32.7%; P=.01). Patients who received no action in the initial care remained unchanged (19% vs 11%%; P=.15

  8. Gênero e trauma Gender and trauma

    Directory of Open Access Journals (Sweden)

    Gláucio Ary Dillon Soares

    2005-04-01

    Full Text Available As conseqüências sociais e psicológicas da violência urbana sobre os parentes e amigos de pessoas vitimadas por mortes violentas (homicídio, suicídio ou acidentes são analisadas à luz das diferenças de gênero. A literatura especializada nesta área propõe que mulheres e homens vivenciam experiências traumáticas de forma peculiar. Porém, os traumas típicos são diferentes em cada gênero, deixando em aberto a questão sobre quanto das diferenças entre as respostas se devem a gênero e quanto se devem ao tipo de trauma. Testamos a hipótese de que as mulheres são mais suscetíveis à desordem de estresse pós-trauma (DEPT numa situação traumática comum, usando dados qualitativos e quantitativos. Comparamos os sintomas do trauma e as percepções sobre o significado da perda de seus entes queridos. A amostra, de 425 mulheres (62% e 265 homens (38%, foi retirada de uma lista de parentes de pessoas que sofreram morte violenta na cidade do Rio de Janeiro. Incluímos trinta relatos de parentes e amigos próximos das vítimas diretas. Os resultados revelaram que 54% das mulheres e 41% dos homens tiveram o cotidiano alterado depois da morte de um parente/amigo. Há diferenças estatisticamente significativas nos problemas de saúde e na diversão. Essa área foi a mais afetada, atingindo metade dos entrevistados. Uma variável intimamente correlacionada com os sintomas da DEPT é o contato com o corpo: controlando a extensão do contato (fez o reconhecimento do corpo; viu, mas não reconheceu e nem viu nem reconheceu. Em cada uma dessas categorias, as mulheres foram mais afetadas do que os homens. O artigo conclui que as mulheres sentem mais as perdas do que os homens, mas que parte das diferenças não são internas aos gêneros, mas externas a eles, dependendo das interações e dos contatos pessoais.The social and psychological consequences endured by friends and relatives of people victimized by violent death (homicide, suicide or

  9. Fatal Vertebral Artery Injury in Penetrating Cervical Spine Trauma

    Directory of Open Access Journals (Sweden)

    Chadi Tannoury

    2015-01-01

    Full Text Available Study Design. This case illustrates complications to a vertebral artery injury (VAI resulting from penetrating cervical spine trauma. Objectives. To discuss the management of both VAI and cervical spine trauma after penetrating gunshot wound to the neck. Summary of Background Data. Vertebral artery injury following cervical spine trauma is infrequent, and a unilateral VAI often occurs without neurologic sequela. Nevertheless, devastating complications of stroke and death do occur. Methods. A gunshot wound to the neck resulted in a C6 vertebral body fracture and C5–C7 transverse foramina fractures. Neck CT angiogram identified a left vertebral artery occlusion. A cerebral angiography confirmed occlusion of the left extracranial vertebral artery and patency of the remaining cerebrovascular system. Following anterior cervical corpectomy and stabilization, brainstem infarction occurred and resulted in death. Results. A fatal outcome resulted from vertebral artery thrombus propagation with occlusion of the basilar artery triggering basilar ischemia and subsequent brainstem and cerebellar infarction. Conclusions. Vertebral artery injury secondary to cervical spine trauma can lead to potentially devastating neurologic sequela. Early surgical stabilization, along with anticoagulation therapy, contributes towards managing the combination of injuries. Unfortunately, despite efforts, a poor outcome is sometimes inevitable when cervical spine trauma is coupled with a VAI.

  10. Forgotten triangles of neck.

    Science.gov (United States)

    Singh, Manpreet; Vashistha, Arpit; Chaudhary, Manoj; Kaur, Gagandeep

    2016-01-01

    The purpose of this manuscript is to add some more information in the present scientific literature on these nearly forgotten triangles of surgical importance. The neck is an area that lends itself to anatomical geometry, such as triangles. Many triangles of the neck have been described, and some are well-known, yet, some have been nearly forgotten, i.e., Lesser's triangle, Farabeuf triangle, Pirogoff's triangle, and Beclard's triangle. From the anatomic and surgical point of view, the neck is an amazingly interesting place. It is like a connection where crucial functional units meet and pass. Added surgical landmarks are always helpful to the surgeon while dealing with the neck. Described triangles of neck in this article are always reliable and constant landmarks for head and neck surgeons.

  11. Nodular Fasciitis of Neck in Childhood.

    Directory of Open Access Journals (Sweden)

    Saurabh Varshney

    2013-01-01

    Full Text Available Nodular fasciitis, is a benign, pseudo sarcomatous proliferative lesion of the soft tissue, which is frequently misinterpreted as sarcoma, both clinically and microscopically. It is a reactive lesion composed of fibroblasts/myofibroblasts and most commonly found in extremities and trunk. NF has been described in the head and neck region in 10-20% of cases. Many pathologists do not consider NF in the differential diagnosis of soft tissue masses arising in the Head neck region. NF that occurs in otherwise healthy individuals usually presents with a history of rapid growth, and is commonly found in the upper extremities and on the chest and trunk. The importance of otolaryngologists being aware of the existence of this entity in this area of the body is stressed. It has a confirmed perfectly benign clinical course, and simple excision, as tissue-sparing as possible, is the treatment of choice. A case of NF over the neck in a 05-year-old female not associated with trauma who presented with a localized mass over her left neck is presented.

  12. Head and Neck

    DEFF Research Database (Denmark)

    Højgaard, Liselotte; Berthelsen, Anne Kiil; Loft, Annika

    2014-01-01

    Positron emission tomography (PET)/computed tomography with FDG of the head and neck region is mainly used for the diagnosis of head and neck cancer, for staging, treatment evaluation, relapse, and planning of surgery and radio therapy. This article is a practical guide of imaging techniques......, including a detailed protocol for FDG PET in head and neck imaging, physiologic findings, and pitfalls in selected case stories....

  13. Do whiplash patients differ from other patients with non-specific neck pain regarding pain, function or prognosis?

    Science.gov (United States)

    Verhagen, Arianne P; Lewis, Martyn; Schellingerhout, Jasper M; Heymans, Martijn W; Dziedzic, Krysia; de Vet, Henrica C W; Koes, Bart W

    2011-10-01

    We evaluated whether patients with self-reported whiplash differed in perceived pain, functional limitation and prognosis from patients with other painful neck complaints. Data from three Dutch trials and an English trial were used all evaluating conservative treatment in neck pain patients in primary care. All patients had non-specific neck pain. Information on any trauma or injury came from self-report at baseline. We compared frequencies of baseline variables and outcome at short-term and long term for whiplash and non-trauma neck pain patients separately. The total study population consisted of 804 neck pain patients. Of these patients 133 reported (16.5%) that an injury was the cause of their neck pain. In all trials there were 17-18% more male patients in the whiplash group. At follow-up pain decreased between 12 and 28%, function 10%, and 25-50% of patients recovered in all trials. Post-treatment improvements in pain, function and recovery were comparable between whiplash and non-trauma patients. We also found no different prognostic factors between whiplash and non-trauma patients. Overall we found in a population with mild to moderate pain no clinically relevant differences between patients with self-reported whiplash and patients with other painful neck complaints. The findings suggest that whiplash patients with mild to moderate pain should not be considered a specific subgroup of patients with non-specific neck pain.

  14. Appendicitis following blunt abdominal trauma.

    Science.gov (United States)

    Cobb, Travis

    2017-09-01

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

  15. Blunt laryngeal trauma secondary to sporting injuries.

    Science.gov (United States)

    Mendis, D; Anderson, J A

    2017-08-01

    Laryngeal injury after blunt trauma is uncommon, but can cause catastrophic airway obstruction and significant morbidity in voice and airway function. This paper aims to discuss a case series of sports-related blunt laryngeal trauma patients and describe the results of a thorough literature review. Retrospective case-based analysis of laryngeal trauma referrals over six years to a tertiary laryngology centre. Twenty-eight patients were identified; 13 (46 per cent) sustained sports-related trauma. Most were young males, presenting with dysphonia, some with airway compromise (62 per cent). Nine patients were diagnosed with a laryngeal fracture. Four patients were managed conservatively and nine underwent surgery. Post-treatment, the majority of patients achieved good voice outcomes (83 per cent) and all had normal airway function. Sports-related neck trauma can cause significant injury to the laryngeal framework and endolaryngeal soft tissues, and most cases require surgical intervention. Clinical presentation may be subtle; a systematic approach along with a high index of suspicion is essential, as early diagnosis and treatment have been reported to improve airway and voice outcome.

  16. Head and Neck Cancer Treatment

    Science.gov (United States)

    ... Professions Site Index A-Z Head and Neck Cancer Treatment Head and neck cancer overview What are my ... and neck cancer. For updated information on new cancer treatments that are available, you should discuss these issues ...

  17. Blunt pancreatic trauma. Role of CT

    Energy Technology Data Exchange (ETDEWEB)

    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.).

  18. Suspension Trauma / Orthostatic Intolerance

    Science.gov (United States)

    ... of Science and Technology Assessment Printer Friendly Version Suspension Trauma/Orthostatic Intolerance Safety and Health Information Bulletin ... information about the hazards of orthostatic intolerance and suspension trauma when using fall arrest systems. This bulletin: ...

  19. About Military Sexual Trauma

    Medline Plus

    Full Text Available ... total__ Find out why Close About Military Sexual Trauma Veterans Health Administration Loading... Unsubscribe from Veterans Health ... 10 VA HSR&D Investigator Insights: Military Sexual Trauma - Duration: 3:27. Veterans Health Administration 898 views ...

  20. Trauma resuscitation time.

    NARCIS (Netherlands)

    Olden, G.D.J. van; Vugt, A.B. van; Biert, J.; Goris, R.J.A.

    2003-01-01

    Documenting the timing and organisation of trauma resuscitation can be utilised to assess performance standards, and to ensure a high quality of trauma resuscitation procedures. Since there is no European literature available on trauma resuscitation time (TRT) in the emergency room, the aim of this

  1. Trauma Facts for Educators

    Science.gov (United States)

    National Child Traumatic Stress Network, 2008

    2008-01-01

    This paper offers facts which can help educators deal with children undergoing trauma. These include: (1) One out of every 4 children attending school has been exposed to a traumatic event that can affect learning and/or behavior; (2) Trauma can impact school performance; (3) Trauma can impair learning; (4) Traumatized children may experience…

  2. Trauma resuscitation time.

    NARCIS (Netherlands)

    Olden, G.D.J. van; Vugt, A.B. van; Biert, J.; Goris, R.J.A.

    2003-01-01

    Documenting the timing and organisation of trauma resuscitation can be utilised to assess performance standards, and to ensure a high quality of trauma resuscitation procedures. Since there is no European literature available on trauma resuscitation time (TRT) in the emergency room, the aim of this

  3. The relationship between childhood exposure to trauma and intermittent explosive disorder.

    Science.gov (United States)

    Nickerson, Angela; Aderka, Idan M; Bryant, Richard A; Hofmann, Stefan G

    2012-05-15

    There has been a paucity of research linking intermittent explosive disorder (IED) to trauma and posttraumatic stress responses, despite evidence that trauma is strongly associated with anger reactions. The present study investigated the relationship between IED and a number of trauma-related factors, including trauma dosage, timing of first trauma, and posttraumatic stress disorder (PTSD). Participants were 4844 trauma-exposed and 731 non trauma-exposed adults who took part in the National Comorbidity Survey-Replication (NCS-R). Findings indicated that IED was associated with greater trauma exposure, PTSD and generalized anxiety disorder (GAD) diagnosis, and first exposure to traumatic events in childhood. Exploratory analyses investigating the link between IED and age at first trauma exposure across trauma types suggested that IED is related to childhood exposure to interpersonal traumatic events. These findings are discussed in the context of developmental trauma and cycles of violence models.

  4. Morbidity of the neck after head and neck cancer therapy

    NARCIS (Netherlands)

    van Wilgen, C.P.; Dijkstra, P.U.; van der Laan, B.F.; Plukker, J.T.; Roodenburg, J.L.

    2004-01-01

    Background. Studies on morbidity of the neck after head and neck cancer therapy are scarcely described. Methods. Patients who underwent surgery, including neck dissection, with and without radiation therapy at least 1 year before the study were asked to participate. We assessed neck pain, loss of se

  5. Morbidity of the neck after head and neck cancer therapy

    NARCIS (Netherlands)

    van Wilgen, C.P.; Dijkstra, P.U.; van der Laan, B.F.; Plukker, J.T.; Roodenburg, J.L.

    Background. Studies on morbidity of the neck after head and neck cancer therapy are scarcely described. Methods. Patients who underwent surgery, including neck dissection, with and without radiation therapy at least 1 year before the study were asked to participate. We assessed neck pain, loss of

  6. Trauma Collaborative Care Intervention: Effect on Surgeon Confidence in Managing Psychosocial Complications After Orthopaedic Trauma.

    Science.gov (United States)

    Wegener, Stephen T; Carroll, Eben A; Gary, Joshua L; McKinley, Todd O; OʼToole, Robert V; Sietsema, Debra L; Castillo, Renan C; Frey, Katherine P; Scharfstein, Daniel O; Huang, Yanjie; Collins, Susan C J; MacKenzie, Ellen J

    2017-08-01

    The impact of the Trauma Collaborative Care (TCC) program on surgeon confidence in managing the psychosocial sequelae of orthopaedic trauma was evaluated as part of a larger prospective, multisite, cluster clinical trial. We compared confidence and perceived resource availability among surgeons practicing in trauma centers that implemented the TCC program with orthopaedic trauma surgeons in similar trauma centers that did not implement the TCC. Prospective cohort design. Level-I trauma centers. Attending surgeons and fellows (N = 95 Pre and N = 82 Post). Self-report 10-item measure of surgeon confidence in managing psychosocial issues associated with trauma and perceived availability of support resources. Analyses, performed on the entire sample and repeated on the subset of 52 surgeons who responded to the survey at both times points, found surgeons at intervention sites experienced a significantly greater positive improvement (P < 0.05) in their (1) belief that they have strategies to help orthopaedic trauma patients change their psychosocial situation; (2) confidence in making appropriate referrals for orthopaedic trauma patients with psychosocial problems; and (3) belief that they have access to information to guide the management of psychosocial issues related to recovery. Initial data suggest that the establishment of the TCC program can improve surgeons' perceived availability of resources and their confidence in managing the psychosocial sequelae after injury. Further studies will be required to determine if this translates into beneficial patient effects. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

  7. Citation classics in trauma.

    Science.gov (United States)

    Ollerton, Joanne Emma; Sugrue, Michael

    2005-02-01

    The evolution of trauma may be analyzed by review of articles most frequently cited by scientific articles worldwide. This study identified the "trauma classics" by reviewing the most-cited articles ever published in The Journal of Trauma. The Science Citation Index of the Institute for Scientific Information was searched for the 50 most-cited articles in The Journal of Trauma. Of the 12,672 articles published since 1961, 80 were cited over 100 times and 17 over 200 times. The most-cited article was by Baker, a hallmark publication on injury scoring published in 1974. Feeding postinjury, bacterial translocation, and multiple organ failure were common themes. Overall, 32% involved gastrointestinal topics and 18% involved injury scoring, with institutions in the United States publishing 80% of the articles. This study identified the trauma classics from the last 42 years of The Journal of Trauma. Citation analysis has recognized limitations but gives a fascinating insight into the evolution of trauma care.

  8. Clinical decision making associated with an undetected odontoid fracture in an older individual referred to physical therapy for the treatment of neck pain

    National Research Council Canada - National Science Library

    Ross, Michael D; Cheeks, John M

    2008-01-01

    Resident's case problem. The purpose of this paper is to provide the examination of and decision-making process for a patient referred to physical therapy for the treatment of neck pain following trauma...

  9. Trauma in patients with temporomandibular disorders: frequency and treatment outcome.

    Science.gov (United States)

    De Boever, J A; Keersmaekers, K

    1996-02-01

    Controversy exists on the aetiological importance and the effect of jaw macrotrauma (fractures excluded) on the occurrence of temporomandibular joint disorders (TMD). The purpose of this study was to assess the incidence of jaw injury in TMD patients and to compare the severity of the symptoms, the clinical characteristics and the treatment outcome in TMD patients with or without a history of trauma to the head and neck region directly linked to the onset of symptoms. The study sample included 400 consecutive TMD clinical patients. In 24.5% of patients the onset of the pain and dysfunction could be linked directly to the trauma, mainly whiplash accidents. No significant differences could be found between the two groups in daily recurrent headache, dizziness, neck pain, joint crepitation and pain in the joints. Maximal mouth opening was less than 20 mm in 14.3% of patients with a history of trauma and in 4.1% of those without such a history. According to the Helkimo dysfunction index (DI), more trauma than non-trauma TMD patients belonged to the severe dysfunction groups (DI 4 and 5) at first examination. The outcome of a conservative treatment procedure (counselling, occlusal splint, physiotherapy, occasionally occlusal therapy and non-steroidal anti-inflammation drugs was not different between the two groups at the 1 year evaluation. The degree of maximal opening was similar: less than 20 mm in 3.7% and 2.2% in trauma and non-trauma patients respectively. Forty percent and 41% respectively were symptom free or had DI = 1. The results suggest that external trauma to the joint or to the jaw in general is an important initiating factor in the aetiology of TMD but also that the prognosis is favourable.

  10. Multidisciplinary treatment of the neck

    NARCIS (Netherlands)

    de Bree, Remco; Langendijk, Johannes A.; Leemans, C. R.

    2016-01-01

    Since lymph node metastases are one of the most important prognostic factors, treatment of the neck is challenging. In clinically N0 neck, (super)selective neck dissection is indicated, whereas a more extensive neck dissection with preservation of important structures is performed in N2-N3 disease.

  11. Frontiers in Head and Neck Trauma: Clinical and Biomechanical.

    Science.gov (United States)

    2007-11-02

    the frontal, parietal and occipital bones that form the bulk of the convexity on top . The lateral aspect of the sphenoid bone meets the temporal bone...Bones The facial bones consist of fourteen bones: two nasal, two superior maxillary , two lachrymal, two malar, two palate, two inferior turbinate...vomer and inferior maxillary bones. These bones form the housing for most of the sensory structures of the human, including sight, smell and taste

  12. Melanoma - neck (image)

    Science.gov (United States)

    This melanoma on the neck is variously colored with a very darkly pigmented area found centrally. It has irregular ... be larger than 0.5 cm. Prognosis in melanoma is best defined by its depth on resection.

  13. Art and trauma.

    Science.gov (United States)

    Laub, D; Podell, D

    1995-10-01

    The authors of this paper attempt to show that 'the art of trauma', because of its indirect, unaestheticised and dialogic nature, may be the only possible medium for effective representations of trauma. The real witnessing presence created in the art of trauma can act as an antidote to the annihilation of the internal 'other' that occurs in the traumatic experience and to the resulting absence, which both constitutes the core of trauma and precludes its representation. Important elements of the art of trauma are illustrated using the work of Paul Celan, Anselm Kiefer, Claude Lanzmann, Art Spiegelman, and Anne-Marie Levine and texts by Aharon Appelfeld. Examining more closely what Holocaust survivors say in their testimonies, the authors contend that survival itself should be considered as a type of art of trauma when it is made possible by a creative comprehension of reality analogous to that which characterises more conventional forms of the art of trauma. The authors proceed to explore both the possible limits to the extent that trauma may be represented and the continuous struggle involved in attempting to 'know' trauma. They also discuss how art dealing with trauma may circumscribe a double locus: one of witnessing as well as one of emptiness or execution.

  14. Minor trauma triggering cervicofacial necrotizing fasciitis from odontogenic abscess

    OpenAIRE

    Jain Shraddha; Nagpure Prakash; Singh Roohie; Garg Deepika

    2008-01-01

    Necrotizing fasciitis (NF) of the face and neck is a very rare complication of dental infection. Otolaryngologists and dentists should be familiar with this condition because of its similarity to odontogenic deep neck space infection in the initial stages, its rapid spread, and its life-threatening potential. Trauma has been reported to be an important predisposing factor for NF of the face. In this paper, we describe the presentation and treatment of a 62-year-old man who developed NF of the...

  15. Head and neck teratomas

    OpenAIRE

    Shah, Ajaz; Latoo, Suhail; Ahmed, Irshad; Malik, Altaf H

    2009-01-01

    Teratomas are complex lesions composed of diverse tissues from all 3 germinal cell layers and may exhibit variable levels of maturity. Head and neck teratomas are most commonly cervical with the oropharynx (epignathus) being the second commonest location. In this article, clinical presentation, behaviour and associated significance of head and neck teratomas have been highlightened. Because of their obscure origin, bizarre microscopic appearance, unpredictable behaviour and often dramatic cli...

  16. Key performance indicators in British military trauma.

    Science.gov (United States)

    Stannard, Adam; Tai, Nigel R; Bowley, Douglas M; Midwinter, Mark; Hodgetts, Tim J

    2008-08-01

    Key performance indicators (KPI) are tools for assessing process and outcome in systems of health care provision and are an essential component in performance improvement. Although KPI have been used in British military trauma for 10 years, they remain poorly defined and are derived from civilian metrics that do not adjust for the realities of field trauma care. Our aim was to modify current trauma KPI to ensure they more faithfully reflect both the military setting and contemporary evidence in order to both aid accurate calibration of the performance of the British Defence Medical Services and act as a driver for performance improvement. A workshop was convened that was attended by senior, experienced doctors and nurses from all disciplines of trauma care in the British military. "Speciality-specific" KPI were developed by interest groups using evidence-based data where available and collective experience where this was lacking. In a final discussion these were streamlined into 60 KPI covering each phase of trauma management. The introduction of these KPI sets a number of important benchmarks by which British military trauma can be measured. As part of a performance improvement programme, these will allow closer monitoring of our performance and assist efforts to develop, train, and resource British military trauma providers.

  17. EPIDEMOLOGY OF TRAUMA GLOBALY

    Directory of Open Access Journals (Sweden)

    Nur Yuniarti

    2013-10-01

    Full Text Available Normal 0 false false false EN-US X-NONE X-NONE MicrosoftInternetExplorer4 This study describes the epidemiology of trauma globaly. Trauma can cause death, burden of disease and economic losses. Traffic accidents are the most common cause of injury in the whole world. Riskesdes 2007, the proportion of the highest injury of Yogyakarta, experienced by adult age group, higher in male, the high levels of injury increasing the proportion of respondents. Found in the work as an employee, in the upper midle economic level. Lower limb (leg is part most affected by injuries. Based on the types of injuries classified as serious in a row that a head injury. Traffic accidents are often caused by four factors: road user, drivers, pedestrian, and vehicle. Because the victim of traffic accident is quite high and high health costs incurred. By him that there are three phases of stage traffic accident prevention, the prevention of the pre-crash phase, the phase of the accident, when the accident occur, to minimize the injuries. /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;}

  18. Management of duodenal trauma

    Institute of Scientific and Technical Information of China (English)

    CHEN Guo-qing; YANG Hua

    2011-01-01

    Duodenal trauma is uncommon but nowadays seen more and more frequently due to the increased automobile accidents and violent events. The management of duodenal trauma can be complicated, especially when massive injury to the pancreatic-duodenal-biliary complex occurs simultaneously. Even the patients receive surgeries in time, multiple postoperative complications and high mortality are common. To know and manage duodenal trauma better, we searched the recent related literature in PubMed by the keywords of duodenal trauma, therapy, diagnosis and abdomen. It shows that because the diagnosis and management are complicated and the mortality is high,duodenal trauma should be treated in time and tactfully.And application of new technology can help improve the management. In this review, we discussed the incidence,diagnosis, management, and complications as well as mortality of duodenal trauma.

  19. Dental Trauma Guide

    DEFF Research Database (Denmark)

    Andreasen, Jens Ove; Lauridsen, Eva; Gerds, Thomas Alexander

    2012-01-01

    Diagnosis and treatment for traumatic dental injuries are very complex owing to the multiple trauma entities represented by six luxation types and nine fracture types affecting both the primary and the permanent dentition. When it is further considered that fracture and luxation injuries are often...... combined, the result is that more than 100 trauma scenarios exist, when the two dentitions are combined. Each of these trauma scenarios has a specific treatment demand and prospect for healing. With such a complexity in diagnosis and treatment, it is obvious that even experienced practitioners may have...... problems in selecting proper treatment for some of these trauma types. To remedy this situation, an Internet-based knowledge base consisting of 4000 dental trauma cases with long-term follow up is now available to the public and the professions on the Internet using the address http://www.DentalTrauma...

  20. Compromised quality of life in adult patients who have received a radiation dose towards the basal part of the brain. A case-control study in long-term survivors from cancer in the head and neck region

    Directory of Open Access Journals (Sweden)

    Löfdahl Elisabet

    2012-10-01

    Full Text Available Abstract Background Adult patients with hypothalamic-pituitary disorders have compromised quality of life (QoL. Whether this is due to their endocrine consequences (hypopituitarism, their underlying hypothalamic-pituitary disorder or both is still under debate. The aim of this trial was to measure quality of life (QoL in long-term cancer survivors who have received a radiation dose to the basal part of the brain and the pituitary. Methods Consecutive patients (n=101 treated for oropharyngeal or epipharyngeal cancer with radiotherapy followed free of cancer for a period of 4 to10 years were identified. Fifteen patients (median age 56 years with no concomitant illness and no hypopituitarism after careful endocrine evaluation were included in a case-control study with matched healthy controls. Doses to the hypothalamic-pituitary region were calculated. QoL was assessed using the Symptom check list (SCL-90, Nottingham Health Profile (NHP, and Psychological Well Being (PGWB questionnaires. Level of physical activity was assessed using the Baecke questionnaire. Results The median accumulated dose was 1.9 Gy (1.5–2.2 Gy to the hypothalamus and 2.4 Gy (1.8–3.3 Gy to the pituitary gland in patients with oropharyngeal cancer and 6.0–9.3 Gy and 33.5–46.1 Gy, respectively in patients with epipharyngeal cancer (n=2. The patients showed significantly more anxiety and depressiveness, and lower vitality, than their matched controls. Conclusion In a group of long time survivors of head and neck cancer who hade received a low radiation dose to the hypothalamic-pituitary region and who had no endocrine consequences of disease or its treatment QoL was compromised as compared with well matched healthy controls.

  1. Cisplatin, 5-fluorouracil, and cetuximab (PFE) with or without cilengitide in recurrent/metastatic squamous cell carcinoma of the head and neck: results of the randomized phase I/II ADVANTAGE trial (phase II part).

    Science.gov (United States)

    Vermorken, J B; Peyrade, F; Krauss, J; Mesía, R; Remenar, E; Gauler, T C; Keilholz, U; Delord, J P; Schafhausen, P; Erfán, J; Brümmendorf, T H; Iglesias, L; Bethe, U; Hicking, C; Clement, P M

    2014-03-01

    Recurrent and/or metastatic squamous cell carcinoma of the head and neck (R/M-SCCHN) overexpresses αvβ5 integrin. Cilengitide selectively inhibits αvβ3 and αvβ5 integrins and is investigated as a treatment strategy. The phase I/II study ADVANTAGE evaluated cilengitide combined with cisplatin, 5-fluorouracil, and cetuximab (PFE) in R/M-SCCHN. The phase II part reported here was an open-label, randomized, controlled trial investigating progression-free survival (PFS). Patients received up to six cycles of PFE alone or combined with cilengitide 2000 mg once (CIL1W) or twice (CIL2W) weekly. Thereafter, patients received maintenance therapy (cilengitide arms: cilengitide plus cetuximab; PFE-alone arm: cetuximab only) until disease progression or unacceptable toxicity. One hundred and eighty-two patients were treated. Median PFS per investigator read was similar for CIL1W + PFE, CIL2W + PFE, and PFE alone (6.4, 5.6, and 5.7 months, respectively). Accordingly, median overall survival and objective response rates were not improved with cilengitide (12.4 months/47%, 10.6 months/27%, and 11.6 months/36%, respectively). No clinically meaningful safety differences were observed between groups. None of the tested biomarkers (expression of integrins, CD31, Ki-67, vascular endothelial growth factor receptor 2, vascular endothelial-cadherin, type IV collagen, epidermal growth factor receptor, or p16 for human papillomavirus) were predictive of outcome. Neither of the cilengitide-containing regimens demonstrated a PFS benefit over PFE alone in R/M-SCCHN patients.

  2. Head and neck cancers masquerading as deep neck abscesses.

    Science.gov (United States)

    Soon, Sue Rene; Kanagalingam, Jeevendra; Johari, Shirish; Yuen, Heng Wai

    2012-12-01

    Deep neck space abscesses are common otolaryngological emergencies, and prompt incision and drainage is the treatment of choice. Head and neck cancers often present with cervical metastases that may become secondarily infected. Clinical presentation is similar to a deep neck abscess. Surgical drainage of such collections has implications on subsequent treatment. In this case series, we describe six cases with this unusual presentation that were subsequently found to have a head and neck malignancy, and where three patients had their abscesses treated surgically. We aim to raise awareness of this unusual presentation of a head and neck carcinoma, and to avoid a potential pitfall in the management of deep neck abscess.

  3. [Unilateral atypical neck pain in Eagle syndrome].

    Science.gov (United States)

    Lonka, Matilde Mia; Schousboe, Lars Peter

    2012-04-30

    This article is an introduction to Eagle syndrome as a differential diagnosis in patients with lateral neck pain, a symptom, which is often difficult to diagnose and where the accepted treatment covers a variety of forms. This was the case for a 51 year-old man with lateral neck pain and a crunchy sensation/sound when he turned his head. After years of pain, the right examination and a computed tomography finally suggested Eagle syndrome. The patient had severe symptoms and was treated with an operation by which part of the ossificated stylohyoid ligament was removed. The operation relieved him of all his symptoms.

  4. Trauma e temporalidade

    Directory of Open Access Journals (Sweden)

    Ana Maria Rudge

    Full Text Available O trauma tem sido abordado na literatura psicanalítica especialmente como um trauma infantil de natureza sexual. A neurose traumática é tomada como modelo para a circunscrição de uma acepção de trauma que não se confunde com o trauma estrutural eficaz na constituição do psiquismo, e cuja sintomatologia não pode ser diretamente remetida à experiência infantil de natureza sexual.

  5. About Military Sexual Trauma

    Medline Plus

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  6. About Military Sexual Trauma

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  7. About Military Sexual Trauma

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  8. [Scrotal trauma: management strategy].

    Science.gov (United States)

    Culty, T; Ravery, V

    2006-04-01

    Scrotal traumas are rare. Most are blunt traumas caused by a direct blow on the scrotum. The testicle is projected against the pubic arch. Early surgical investigation has considerably improved the prognosis of testicular trauma, and reduced orchidectomy rate. ULtrasonography has also improved the management of scrotal trauma. But there is a controversy about accuracy of ultrasonography in predicting presence or absence of testicular disruption. ULtrasonography should not challenge the dogma regarding systematic surgical investigation of hematocele and enlarged scrotum. Long term outcomes (testicular atrophy, infertility) may be more frequent as previously thought and should be detected.

  9. Prevalence of whiplash trauma in TMD patients: a systematic review.

    Science.gov (United States)

    Häggman-Henrikson, B; Rezvani, M; List, T

    2014-01-01

    The purpose of this systematic review was to describe the prevalence of whiplash trauma in patients with temporomandibular disorders (TMDs) and to describe clinical signs and symptoms in comorbid TMD/whiplash compared with TMD localised to the facial region. A systematic literature search of the PubMed, Cochrane Library and Bandolier databases was carried out for articles published from 1 January 1966 to 31 December 2012. The systematic search identified 129 articles. After the initial screening of abstracts, 32 articles were reviewed in full text applying inclusion and exclusion criteria. Six studies on the prevalence of neck trauma in patients with TMD met the inclusion criteria and were included in the review. Two of the authors evaluated the methodological quality of the included studies. The reported prevalence of whiplash trauma ranged from 8·4% to 70% (median 35%) in TMD populations, compared with 1·7-13% in the non-TMD control groups. Compared with patients with TMD localised to the facial region, TMD patients with a history of whiplash trauma reported more TMD symptoms, such as limited jaw opening and more TMD pain, and also more headaches and stress symptoms. In conclusion, the prevalence of whiplash trauma is higher in patients with TMD compared with non-TMD controls. Furthermore, patients with comorbid TMD/whiplash present with more jaw pain and more severe jaw dysfunction compared with TMD patients without a history of head-neck trauma. These results suggest that whiplash trauma might be an initiating and/or aggravating factor as well as a comorbid condition for TMD.

  10. Physical examination and arteriography in patients with penetrating zone II neck wounds.

    Science.gov (United States)

    Beitsch, P; Weigelt, J A; Flynn, E; Easley, S

    1994-06-01

    To review the management of patients with penetrating zone II neck wounds to discern the value of physical examination and proximity arteriography for predicting arterial injury. A retrospective chart review of 178 patients treated for penetrating wounds to the neck. A level I trauma facility in Dallas, Tex. All patients seen from 1987 to 1991 with platysma penetration in zone II of the neck. Physical examination, arteriography, and surgical exploration were used to identify patients with arterial injuries in the neck after penetrating trauma. To identify the presence or absence of an arterial injury. Negative findings on physical examination ruled out an arterial injury in 99% of all patients. Patients with any sign of arterial injury had a 26% incidence of arterial injury confirmed at operation. Of 71 arteriograms in patients without signs or symptoms of arterial injury, only one had an arterial injury requiring operative intervention. Findings on physical examination are good predictors of arterial injury in patients with penetrating neck wounds and can exclude injury in over 99% of patients. Arteriography is a sensitive test but has a very low yield (1.4%). These findings question whether the current practice of mandatory neck exploration or proximity arteriography is necessary for patients without signs or symptoms of injury who have penetrating wounds of the neck.

  11. Pediatric Neck Mass

    Directory of Open Access Journals (Sweden)

    Guilherme Machado de Carvalho

    2015-11-01

    Full Text Available Introduction  Neck masses include a wide variety of diagnostic possibilities, with more than 60 etiologies that depend on clinical aspects such as age, location and time of disease progression. The interview and physical examination guide research that cross the neck masses in pediatric patients in 3 groups: infectious / inflammatory, and neoplastic embryonic remnants. The aim of this study was to present a protocol for evaluation of neck masses in the pediatric age group, based on a review of literature on the subject and experience of this service. Materials and Methods Survey of literature data from PubMed / Medline, Google Scholar and Scopus Database without language restriction, since 1980 sources, with the MeSH term "Pediatric neck mass".  Results Prepared flowchart guidelines to be followed according with diagnostic suspicions. Patients were divided into 3 groups according to the initial clinical manifestations and according to etiological hypotheses formulated recommend evaluations protocols.  Conclusion The standardization of the evaluation of neck masses in children proves valuable and can help in the differential diagnosis of different etiologies involved.

  12. Advances in forefoot trauma.

    Science.gov (United States)

    Clements, J Randolph; Schopf, Robert

    2013-07-01

    Forefoot traumas, particularly involving the metatarsals, are commonly occurring injuries. There have been several advances in management of these injuries. These advances include updates in operative technique, internal fixation options, plating constructs, and external fixation. In addition, the advances of soft tissue management have improved outcomes. This article outlines these injuries and provides an update on techniques, principles, and understanding of managing forefoot trauma.

  13. Treating childhood trauma.

    Science.gov (United States)

    Terr, Lenore C

    2013-01-01

    This review begins with the question "What is childhood trauma?" Diagnosis is discussed next, and then the article focuses on treatment, using 3 basic principles-abreaction, context, and correction. Treatment modalities and complications are discussed, with case vignettes presented throughout to illustrate. Suggestions are provided for the psychiatrist to manage countertransference as trauma therapy proceeds.

  14. Virtual Trauma Team

    NARCIS (Netherlands)

    Jones, Valerie M.; Bults, Richard G.A.

    2001-01-01

    The clinical motivation for Virtual Trauma Team is to improve quality of care in trauma care in the vital first "golden hour" where correct intervention can greatly improve likely health outcome. The motivation for Virtual Homecare Team is to improve quality of life and independence for patients by

  15. Malakoplakia of the neck.

    Science.gov (United States)

    Schmerber, Sebastien; Lantuejoul, Sylvie; Lavieille, Jean-Pierre; Reyt, Emile

    2003-11-01

    Malakoplakia that presents in the head and neck is very rare. We describe a 76-year-old man who presented with an inflammatory mass in the lateral aspect of the neck that clinically mimicked a tumoral expansion and was consistent with a cervical malakoplakia. To our knowledge, this is the second case reported with manifestations of this chronic inflammatory disease localized in the neck. Malakoplakia is a rare granulomatous disease that most frequently involves the genitourinary tract and occurs in an immunodeficient host. The symptoms are nonspecific and the diagnosis is based on the histologic findings. In the present case, the biopsy specimen of the cervical mass revealed a collection of numerous von Hansemann cells containing Michaelis-Gutmann bodies, which are pathognomonic of malakoplakia. Bacteriologic analysis identified Escherichia coli. The evolution was favorable after surgical excision and prolonged antibiotic therapy with fluoroquinolones.

  16. Trauma-induced coagulopathy.

    Science.gov (United States)

    Katrancha, Elizabeth D; Gonzalez, Luis S

    2014-08-01

    Coagulopathy is the inability of blood to coagulate normally; in trauma patients, it is a multifactorial and complex process. Seriously injured trauma patients experience coagulopathies during the acute injury phase. Risk factors for trauma-induced coagulopathy include hypothermia, metabolic acidosis, hypoperfusion, hemodilution, and fluid replacement. In addition to the coagulopathy induced by trauma, many patients may also be taking medications that interfere with hemostasis. Therefore, medication-induced coagulopathy also is a concern. Traditional laboratory-based methods of assessing coagulation are being supported or even replaced by point-of-care tests. The evidence-based management of trauma-induced coagulopathy should address hypothermia, fluid resuscitation, blood components administration, and, if needed, medications to reverse identified coagulation disorders.

  17. Dental Trauma Guide

    DEFF Research Database (Denmark)

    Andreasen, Jens Ove; Lauridsen, Eva Fejerskov; Christensen, Søren Steno Ahrensburg

    2012-01-01

    Diagnose and treatment of traumatic dental injuries is very complex due to the multiple trauma entities represented by 6 lunation types and 9 fracture types affecting both the primary and the permanent dentition. When it is further considered that fracture and lunation injuries are often combined......, the result is, that more than 100 trauma scenario exist when the two dentitions are combined. Each of these trauma scenarios have a specific treatment demand and prospect for healing. With such a complexity in diagnose and treatment it is obvious that even experienced practitioners may have problems may have...... problems in selecting proper treatment for some of these trauma types. To remedy this situation, an internet based knowledge base consisting of 4000 dental trauma cases with long term follow up is now available to the public and professionals, on the internet using the address www...

  18. Haemostatic resuscitation in trauma

    DEFF Research Database (Denmark)

    Stensballe, Jakob; Ostrowski, Sisse Rye; Johansson, Par I.

    2016-01-01

    PURPOSE OF REVIEW: To discuss the recent developments in and evolvement of next generation haemostatic resuscitation in bleeding trauma. RECENT FINDINGS: Mortality from major trauma is a worldwide problem, and massive haemorrhage remains a major cause of potentially preventable deaths. Development...... of coagulopathy further increases trauma mortality emphasizing that coagulopathy is a key target in the phase of bleeding. The pathophysiology of coagulopathy in trauma reflects at least three distinct mechanisms that may be present isolated or coexist: acute traumatic coagulopathy, coagulopathy associated...... with the lethal triad, and consumptive coagulopathy. The concepts of 'damage control surgery' and 'damage control resuscitation' have been developed to ensure early control of bleeding and coagulopathy to improve outcome in bleeding trauma. Haemostatic resuscitation aims at controlling coagulopathy and consists...

  19. Trauma: the seductive hypothesis.

    Science.gov (United States)

    Reisner, Steven

    2003-01-01

    In much of contemporary culture, "trauma" signifies not so much terrible experience as a particular context for understanding and responding to a terrible experience. In therapy, in the media, and in international interventions, the traumatized are seen not simply as people who suffer and so are deserving of concern and aid; they are seen also as people who suffer for us, who are given special dispensation. They are treated with awe if they tell a certain kind of trauma story, and are ignored or vilified if they tell another. Trauma has become not simply a story of pain and its treatment, but a host of sub-stories involving the commodification of altruism, the justification of violence and revenge, the entry point into "true experience," and the place where voyeurism and witnessing intersect. Trauma is today the stuff not only of suffering but of fantasy. Historically, trauma theory and treatment have shown a tension, exemplified in the writings of Freud and Janet, between those who view trauma as formative and those who view it as exceptional. The latter view, that trauma confers exceptional status deserving of special privilege, has gained ground in recent years and has helped to shape the way charitable dollars are distributed, how the traumatized are presented in the media, how governments justify and carry out international responses to trauma, and how therapists attend to their traumatized patients. This response to trauma reflects an underlying, unarticulated belief system derived from narcissism; indeed, trauma has increasingly become the venue, in society and in treatment, where narcissism is permitted to prevail.

  20. Head and Neck Cancer Treatment

    Science.gov (United States)

    ... oncologist will listen to the history of your problem and perform a physical examination. Consultations with other members of the head and neck team, such as the head and neck surgeon, pathologist, ...

  1. Mass Casualty Response of a Modern Deployed Head and Neck Surgical Team

    Science.gov (United States)

    2010-07-01

    tures (maxilla, mandible, frontal sinus), and miscellaneous injuries such as a parotid duct injury. Based on review of the operative log, 6 patients...trained to consider subtle head and neck injuries such as facial nerve or parotid duct transection. The flexibility to operate alongside other trauma

  2. Strategies for Teaching about Trauma to Graduate Social Work Students

    Science.gov (United States)

    Gilin, Barbara; Kauffman, Stephen

    2015-01-01

    Actual exposure to the details of trauma within the classroom setting is considered to be a necessary part of preparation for social work practice with traumatized clients. This article reviews the reasons why it is important for faculty to understand students' possible reactions to exposure to trauma content. One factor believed to increase the…

  3. Strategies for Teaching about Trauma to Graduate Social Work Students

    Science.gov (United States)

    Gilin, Barbara; Kauffman, Stephen

    2015-01-01

    Actual exposure to the details of trauma within the classroom setting is considered to be a necessary part of preparation for social work practice with traumatized clients. This article reviews the reasons why it is important for faculty to understand students' possible reactions to exposure to trauma content. One factor believed to increase the…

  4. Short report of an unusual ballistic trauma

    Science.gov (United States)

    Inchingolo, Francesco; Tatullo, Marco; Marrelli, Massimo; Inchingolo, Alessio D.; Pinto, Giorgia; Inchingolo, Angelo M.; Dipalma, Gianna

    2011-01-01

    INTRODUCTION Portable firearms have a relevant medico-legal interest, being a major cause of injury. Bullet entry wounds generally have a particular appearance, including contusion, skin introflection, and simple or excoriated ecchymosis. The skin wound is typically a hole with frayed margins, whose diameter is smaller than that of the bullet. PRESENTATION OF CASE We report the case of a 19-year-old man with ballistic trauma. Examination of the patient's lesions indicated that the bullet had entered from the left mandibular parasymphysis, creating a small hole without the typical bullet wipe and blackening. Subsequently, the bullet seemed to have fractured the left chin region immediately below the lower alveolar process, and it finally stopped in the submandibular area in the suprahyoid region of the neck. DISCUSSION This case is peculiar because the distinctive features of a firearm injury were absent; the lack of bleeding and edema made the case difficult to interpret without additional diagnostic investigations. CONCLUSION Ballistic trauma can manifest in different ways; therefore, internal trauma should be suspected even in the absence of clear external signs. This case report shows how an unusual bullet entry hole can mask quite serious injuries. PMID:22096751

  5. Developmental biomechanics of neck musculature.

    Science.gov (United States)

    Lavallee, Amy V; Ching, Randal P; Nuckley, David J

    2013-02-01

    Neck mechanics is central to head injury prevention since it is the musculoskeletal neck, which dictates the position and movement of the head. In the US, traumatic injury is the leading cause of death for children; however prevention is hampered by the lack of data concerning the mechanics of the immature head-and-neck. Thus, the objective of this study was to quantify neck muscle strength and endurance across the maturation spectrum and correlate these with head-and-neck anthropometry. A factorial study was performed on 91 human subjects measuring head-and-neck anthropometry and neck strength and endurance in three bending directions (flexion, extension, and lateral) as a function of age (6-23 years). Using a custom device, neck maximum voluntary contraction (MVC) force was measured in triplicate. Next, neck muscle endurance (sustained effort) was measured as the subjects' ability to maintain 70% of peak force over 30s. Linear regression of peak force and endurance as a function of age revealed each direction to significantly (pNeck muscle strength, similar between young males and females, becomes disparate in adolescence and adulthood with males exhibiting greater strength. Bending direction differences were also found with extension strength being the greatest regardless of age and sex. Furthermore, neck circumference appears predictive of neck strength and endurance in children. Together, these relationships may facilitate improved design of injury prevention interventions.

  6. Lipoblastoma of the neck

    DEFF Research Database (Denmark)

    Lorenzen, Jacob C; Godballe, Christian; Kerndrup, Gitte B

    2005-01-01

    with lipoblastomatous tumours in the neck is presented. A 6-year-old boy with complains of stridorous respiration and significant reduction in physical capacity was referred to the ENT Department, Odense University Hospital, Denmark. He was treated with total surgical resection of a soft and slowly growing tumour...

  7. Lower cervical spine loading in frontal sled tests using inverse dynamics: potential applications for lower neck injury criteria.

    Science.gov (United States)

    Pintar, Frank A; Yoganandan, Narayan; Maiman, Dennis J

    2010-11-01

    Lower cervical spine injuries are more common in survivors of motor vehicle crashes sustaining neck trauma. Injury criteria are determined using upper neck loads in dummies although a lower neck load cell exists. Due to a paucity of lower neck data from post mortem human subject (PMHS) studies, this research was designed to determine the head-neck biomechanics with a focus on lower neck metrics and injuries. Sixteen frontal impact tests were conducted using five belted PMHS. Instrumentation consisted of a pyramid shaped nine accelerometer package on the head, tri-axial accelerometer on T1, and uniaxial accelerometer on the sled. Three-dimensional kinematics of the head-neck complex were obtained using a 20- camera high-speed motion analysis system. Testing sequence was: low (3.6 m/s), medium (6.9 m/s), repeat low, and high (15.8 m/s) velocities. Trauma evaluations were made between tests. Testing was terminated upon confirmation of injuries. Autopsy was conducted, and geometric and inertial properties of the head were determined. Using inverse dynamics, upper and lower neck loads were determined, along with head and T1 kinematics. Lower cervical injuries occurred in four specimens during the loading phase and were attributed to the flexion mechanism. Peak upper and lower neck loading magnitudes and head-neck and T1 kinematics are given for each test. Sagittal plane head center of gravity and T1 kinematic data along with upper and lower neck forces and moments, hitherto not reported in literature, may be used to determine the biofidelity responses of frontal impact dummies and establish lower neck injury criteria.

  8. Demographic and clinical profile of trauma patients: a fourth-level institution, Medellín, 2005-2008

    Directory of Open Access Journals (Sweden)

    Alejandra Valencia V

    2010-11-01

    Full Text Available Objective: to describe the demographic and clinical behavior of trauma inpatients admitted in an institution of fourth level of complexity between 2005 and 2008. Methodology: descriptive and retrospective study based on information from patients admitted to the emergency room and to stay hospitalized. Frequencies and percentages for both demographic and clinical variables were estimated. Finally, a simple random sampling was conducted to estimate the trauma and injury severity score (triss. Results: during this period a total amount of 165736 inpatients were admitted; 57382 of them were admitted for trauma (35% of the total. The male gender and the 20-29 years of age groups were the most affected by trauma. The predominant cause of admission was traffic accidents followed by other types of accidents (falls, burns, drowning. 6721 patients were hospitalized, 278 of which died while the general mortality rate was 4,1. The most affected body part in those patients was the body limbs (42% and trauma to the head and neck (19%. In order to estimate the triss, a total amount of 347 patients we analyzed. The estimated triss scored more than 49 for 3,17% of the patients studied, the average was 7,507 rts, the systolic blood pressure and the respiratory rate showed an average of 121,948 mmHg and 18,659 minutes respectively, and according to the Glasgow coma scale, 30 patients scored less than or equal to 8. The total amount of expected deaths was 17 patients and the total amount of observed deaths was 19. Finally, the triss calculated was 1.097. Conclusion: the iss becomes a good indicator of the severity of trauma patients. It was feasible to estimate the triss by using the rts and age. The mortality slightly observed turned out to be higher than expected indicating that the quality of care provided to trauma patients in this institution of the fourth level can be maintained or improved inasmuch as there were approximately two deaths more than expected.

  9. Endovascular treatment of iatrogenic penetrating trauma of the carotid artery: case report

    Directory of Open Access Journals (Sweden)

    Eduardo Lichtenfels

    2014-04-01

    Full Text Available Carotid trauma demands early diagnosis and treatment. Open repair may be technically challenging if the trauma is at the base of the neck. We present a case of iatrogenic penetrating carotid trauma caused by insertion of a hemodialysis catheter. Treatment was accomplished by placement of a covered stent-graft in the common carotid artery, covering the puncture site. This case suggests that placement of a covered stent-graft is a good option for treatment of iatrogenic injury to the carotid artery.

  10. Effectiveness of a tailored neck training program on neck strength, movement, and fatigue in under-19 male rugby players: a randomized controlled pilot study.

    Science.gov (United States)

    Barrett, Matthew D; McLoughlin, Terence F; Gallagher, Kieran R; Gatherer, Don; Parratt, Michael Tr; Perera, Jonathan R; Briggs, Tim Wr

    2015-01-01

    To investigate the effect of a tailored neck muscle conditioning program on neck muscle strength, neck muscle fatigue, and range of neck movement in 16-18-year-old male rugby players. Thirty-four male rugby players were divided into forward and back playing positions and randomized within these groups. Seventeen players were randomly assigned to each group. The test group was given a tailored 6-week exercise regime based on their baseline measurements to be performed three times a week in addition to their normal training and playing. The control group trained and played as normal. The outcome measures used were cervical spine range of movement, neck strength, and neck muscle fatigability. There were no clinically relevant statistically significant differences between the two groups. Trends identified between the two groups suggest that a tailored neck exercise program increases neck strength, particularly neck extension, and increases resistance to fatigue, as well as influencing right- and left-sided neck muscle balance. A reduction in range of movement was also demonstrated in the test group. There was a great deal of variability in range of movement and strength within this age group. No previously undiagnosed neck conditions were detected, and there were no adverse events reported. This study has shown that neck strength, range of movement, and susceptibility of the neck muscles to fatigue can be influenced using a focused neck training regime. It forms an important basis for a larger, multicenter study to ensure the neck is given due attention in rugby training and receives the same focus of conditioning as other parts of the body.

  11. Closed lung trauma.

    Science.gov (United States)

    Feden, Jeffrey P

    2013-04-01

    Pulmonary injuries from blunt thoracic trauma are seen regularly with high-energy mechanisms but described less frequently in association with sports. Pneumothorax, hemothorax, pneumomediastinum, and pulmonary contusion are uncommon with athletic participation and often follow a benign clinical course. Life-threatening complications may arise, and athletes with chest trauma deserve close attention. Appropriate diagnosis is suggested by history and physical examination; conventional chest radiography is preferred as the initial imaging study but has limitations. Use of CT for trauma has improved diagnostic sensitivity for occult injury, although this may not alter management or outcomes. Return to play is guided by resolution of symptoms and radiographic findings.

  12. Trauma Induced Coagulopathy

    DEFF Research Database (Denmark)

    Genét, Gustav Folmer; Johansson, Per; Meyer, Martin Abild Stengaard

    2013-01-01

    It remains debated whether traumatic brain injury (TBI) induces a different coagulopathy compared to non-TBI. This study investigated traditional coagulation tests, biomarkers of coagulopathy and endothelial damage in trauma patients with and without TBI. Blood from 80 adult trauma patients were...... sampled (median of 68 min (IQR 48-88) post-injury) upon admission to our trauma centre. Plasma/serum were retrospectively analysed for biomarkers reflecting sympathoadrenal activation (adrenaline, noradrenaline), coagulation activation/inhibition and fibrinolysis (protein C, activated protein C, tissue...

  13. Cost-utility analysis of prehospital spine immobilization recommendations for penetrating trauma.

    Science.gov (United States)

    Garcia, Arturo; Liu, Terrence H; Victorino, Gregory P

    2014-02-01

    The American College of Surgeons' Committee on Trauma's recent prehospital trauma life support recommendations against prehospital spine immobilization (PHSI) after penetrating trauma are based on a low incidence of unstable spine injuries after penetrating injuries. However, given the chronic and costly nature of devastating spine injuries, the cost-utility of PHSI is unclear. Our hypothesis was that the cost-utility of PHSI in penetrating trauma precludes routine use of this prevention strategy. A Markov model based cost-utility analysis was performed from a society perspective of a hypothetical cohort of 20-year-old males presenting with penetrating trauma and transported to a US hospital. The analysis compared PHSI with observation alone. The probabilities of spine injuries, costs (US 2010 dollars), and utility of the two groups were derived from published studies and public data. Incremental effectiveness was measured in quality-adjusted life-years. Subset analyses of isolated head and neck injuries as well as sensitivity analyses were performed to assess the strength of the recommendations. Only 0.2% of penetrating trauma produced unstable spine injury, and only 7.4% of the patients with unstable spine injury who underwent spine stabilization had neurologic improvement. The total lifetime per-patient cost was $930,446 for the PHSI group versus $929,883 for the nonimmobilization group, with no difference in overall quality-adjusted life-years. Subset analysis demonstrated that PHSI for patients with isolated head or neck injuries provided equivocal benefit over nonimmobilization. PHSI was not cost-effective for patients with torso or extremity penetrating trauma. Despite increased incidence of unstable spine injures produced by penetrating head or neck injuries, the cost-benefit of PHSI in these patients is equivocal, and further studies may be needed before omitting PHSI in patients with penetrating head and neck injuries. Economic and value-based evaluation

  14. Developmental biomechanics of neck musculature

    OpenAIRE

    Lavallee, Amy V.; Ching, Randal P.; Nuckley, David J.

    2012-01-01

    Neck mechanics is central to head injury prevention since it is the musculoskeletal neck, which dictates the position and movement of the head. In the US, traumatic injury is the leading cause of death for children; however prevention is hampered by the lack of data concerning the mechanics of the immature head-and-neck. Thus, the objective of this study was to quantify neck muscle strength and endurance across the maturation spectrum and correlate these with head-and-neck anthropometry. A fa...

  15. Trauma no idoso Trauma in the elderly

    Directory of Open Access Journals (Sweden)

    JOSÉ ANTONIO GOMES DE SOUZA

    2002-03-01

    Full Text Available O crescimento populacional de idosos, associado a uma forma de vida mais saudável e mais ativa, deixa este grupo de pessoas mais exposto ao risco de acidentes. Em alguns países, o trauma do idoso responde por uma elevada taxa de mortalidade, a qual se apresenta de forma desproporcionalmente maior do que a observada entre a população de adultos jovens. Tal fato acarreta um grande consumo de recursos financeiros destinados à assistência da saúde e um elevado custo social. As características fisiológicas próprias do idoso, assim como a presença freqüente de doenças associadas, faz com que estes pacientes se comportem diferentemente e de forma mais complexa do que os demais grupos etários. Estas particularidades fazem com que o atendimento ao idoso vítima de trauma se faça de forma diferenciada. A presente revisão aborda aspectos da epidemiologia, da prevenção, da fisiologia, do atendimento e da reabilitação do idoso vítima de trauma.The populational growth of the elderly, associated to a healthier and more active life, make this group of people more exposed to accidents. In some countries, trauma in the elderly is responsible for a high mortality rate, desproportionately higher than in the adults. This fact consumes a great portion of health care resources and implies in a high social cost. The distinct physiologic characteristics of the elderly and the frequent presence of associated diseases make that these patients behave diferently and in a more complex way than patients of other ages. These particularities make that health care to the elderly victims of trauma have to be different. The present revision is about aspects of epidemiology, prevention, physiology, health care and reabilitation of the elderly victims of trauma.

  16. From trauma victim to terrorist: redefining superheroes in Post-9/11 Hollywood

    NARCIS (Netherlands)

    Hassler-Forest, D.; Berninger, M.; Ecke, J.; Haberkorn, G.

    2010-01-01

    In this paper I use trauma theory to identify and discuss post-9/11 film adaptation of graphic novels as trauma narratives. I argue, for example, that since the first major recognition of the graphic novel as a legitimate form of literature in the late 1980s, trauma has played an important part in t

  17. Quality in Trauma Care : Improving the Discharge Procedure of Patients by Means of Lean Six Sigma

    NARCIS (Netherlands)

    Niemeijer, Gerard C.; Trip, Albert; Ahaus, Kees T. B.; Does, Ronald J. M. M.; Wendt, Klaus W.

    2010-01-01

    Background: The University Medical Center Groningen is a level I trauma center in the northern part of the Netherlands. Sixty-three percent of all the patients admitted at the Trauma Nursing Department (TND) are acute patients who are admitted directly after trauma. In 2006 and 2007, the University

  18. Burden of maxillofacial trauma at level 1 trauma center.

    Science.gov (United States)

    Kaul, Ruchi Pathak; Sagar, Sushma; Singhal, Maneesh; Kumar, Abhishek; Jaipuria, Jiten; Misra, Mahesh

    2014-06-01

    major etiologic factor of maxillofacial injuries in our setting and the young adult males were the main victims. Henceforth, establishment of regionalized, efficient, and focused trauma centers in various parts of the country particularly for acute trauma should be emphasized. Also, the laws regarding the precautions such as seat belts, speed limits, and traffic rules must be observed strictly to reduce the incidence of RTA.

  19. Anaesthesia for trauma patients

    African Journals Online (AJOL)

    ... hypothermia. E. Figure 1: Advance Trauma Life Support® management priorities ... should determine their own algorithm, based on available skills and resources. ... the fastest onset (30 seconds) and shortest duration of action. Therefore ...

  20. Tailbone trauma - aftercare

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/patientinstructions/000573.htm Tailbone trauma - aftercare To use the sharing features on this ... fractured one of these bones. More about Your Injury Most tailbone injuries lead to bruising and pain. ...

  1. Paediatric trauma care

    African Journals Online (AJOL)

    In this review, paediatric trauma care will be considered primarily for ... to technology increases, injury becomes a major source of childhood ..... reached include the nursing profession, workers in industry, ... New York: Freeman, 1984. 21.

  2. Military Sexual Trauma

    Science.gov (United States)

    ... VHA Forms & Publications Quality & Safety Quality of Care Ethics VA/DOD Clinical Practice Guidelines Hospital ... Trauma Overview Programs & Services Articles & Fact Sheets Other Resources Help with VA Services ...

  3. Platelet aggregation following trauma

    DEFF Research Database (Denmark)

    Windeløv, Nis A; Sørensen, Anne M; Perner, Anders

    2014-01-01

    We aimed to elucidate platelet function in trauma patients, as it is pivotal for hemostasis yet remains scarcely investigated in this population. We conducted a prospective observational study of platelet aggregation capacity in 213 adult trauma patients on admission to an emergency department (ED......). Inclusion criteria were trauma team activation and arterial cannula insertion on arrival. Blood samples were analyzed by multiple electrode aggregometry initiated by thrombin receptor agonist peptide 6 (TRAP) or collagen using a Multiplate device. Blood was sampled median 65 min after injury; median injury...... severity score (ISS) was 17; 14 (7%) patients received 10 or more units of red blood cells in the ED (massive transfusion); 24 (11%) patients died within 28 days of trauma: 17 due to cerebral injuries, four due to exsanguination, and three from other causes. No significant association was found between...

  4. Acute coagulopathy of trauma

    DEFF Research Database (Denmark)

    Johansson, P I; Ostrowski, S R

    2010-01-01

    Acute coagulopathy of trauma predicts a poor clinical outcome. Tissue trauma activates the sympathoadrenal system resulting in high circulating levels of catecholamines that influence hemostasis dose-dependently through immediate effects on the two major compartments of hemostasis, i.......e., the circulating blood and the vascular endothelium. There appears to be a dose-dependency with regards to injury severity and the hemostatic response to trauma evaluated in whole blood by viscoelastic assays like thrombelastography (TEG), changing from normal to hypercoagulable, to hypocoagulable and finally......, is an evolutionary developed response that counterbalances the injury and catecholamine induced endothelial activation and damage. Given this, the rise in circulating catecholamines in trauma patients may favor a switch from hyper- to hypocoagulability in the blood to keep the progressively more procoagulant...

  5. Childhood trauma in bipolar disorder

    OpenAIRE

    Watson, Stuart; Gallagher, Peter; Dougall, Dominic; Porter, Richard; Moncrieff, Joanna; Ferrier, I Nicol; Young, Allan H.

    2014-01-01

    Objective: There has been little investigation of early trauma in bipolar disorder despite evidence that stress impacts on the course of this illness. We aimed to compare the rates of childhood trauma in adults with bipolar disorder to a healthy control group, and to investigate the impact of childhood trauma on the clinical course of bipolar disorder. Methods: Retrospective assessment of childhood trauma was conducted using the Childhood Trauma Questionnaire (CTQ) in 60 outpatients with bipo...

  6. Childhood trauma in bipolar disorder.

    OpenAIRE

    Watson, S; Gallagher, P.; Dougall, D.; Porter, R.; Moncrieff, J; Ferrier, I N; Young, A.H.

    2014-01-01

    Objective:There has been little investigation of early trauma in bipolar disorder despite evidence that stress impacts on the course of this illness. We aimed to compare the rates of childhood trauma in adults with bipolar disorder to a healthy control group, and to investigate the impact of childhood trauma on the clinical course of bipolar disorder.Methods:Retrospective assessment of childhood trauma was conducted using the Childhood Trauma Questionnaire (CTQ) in 60 outpatients with bipolar...

  7. Linear abdominal trauma.

    Science.gov (United States)

    Danto, L A; Wolfman, E F

    1976-03-01

    Three cases of blunt abdominal trauma are presented to exemplify the mechanism of trauma and the problems of diagnosis associated with any linear blow to the abdomen. The mechanisms of visceral injury are reviewed, and special attention is directed to the abdominal wall injury that can be present in these patients. This injury has special implications in directing the operative approach and repair. An unusual aortic occlusion is described which is peculiar to this type of injury.

  8. Quality of trauma care and trauma registries.

    Science.gov (United States)

    Pino Sánchez, F I; Ballesteros Sanz, M A; Cordero Lorenzana, L; Guerrero López, F

    2015-03-01

    Traumatic disease is a major public health concern. Monitoring the quality of services provided is essential for the maintenance and improvement thereof. Assessing and monitoring the quality of care in trauma patient through quality indicators would allow identifying opportunities for improvement whose implementation would improve outcomes in hospital mortality, functional outcomes and quality of life of survivors. Many quality indicators have been used in this condition, although very few ones have a solid level of scientific evidence to recommend their routine use. The information contained in the trauma registries, spread around the world in recent decades, is essential to know the current health care reality, identify opportunities for improvement and contribute to the clinical and epidemiological research. Copyright © 2014 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

  9. Cervical Muscle Dysfunction in Chronic Whiplash-Associated Disorder Grade 2: The Relevance of the Trauma

    NARCIS (Netherlands)

    Nederhand, Marc J.; Hermens, Hermie J.; IJzerman, Maarten J.; Turk, Dennis C.; Zilvold, Gerrit

    2002-01-01

    Study Design. Surface electromyography measurements of the upper trapezius muscles were performed in patients with a chronic whiplash-associated disorder Grade 2 and those with nonspecific neck pain. Objective. To determine the etiologic relation between acceleration–deceleration trauma and the pre

  10. Airway management in trauma

    Directory of Open Access Journals (Sweden)

    Rao B

    2004-01-01

    Full Text Available Airway Management for the victims of major trauma is the first priority in the care of the trauma victim and is a core skill in emergency medicine and critical care. Endotracheal intubation remains the gold standard for trauma airway management. Airway management in trauma patients is not just the capability to insert an oral/nasal airway or endotracheal tube beyond the vocal cords. The five components integral to modern, sophisticated airway management in trauma patients include equipment, pharmacologic adjuncts, manual techniques, physical circumstances, and patient profile. A trauma patient may require airway management in a variety of physical circumstances. Whereas, the commonly used airway management algorithms may not suffice in all these situations, the construction of a truly complete decision tree is also virtually impossible. There is consensus that it is not the intervention per se but rather the conditions, skills, and performance that might be the possible variables that affect outcome. Paramedics have only limited experience and on-the-job skills for invasive airway management. Difficult airway management is best left for the experienced physicians to handle.

  11. Airway management in trauma.

    Science.gov (United States)

    Langeron, O; Birenbaum, A; Amour, J

    2009-05-01

    Maintenance of a patent and prevention of aspiration are essential for the management of the trauma patient, that requires experienced physicians in airway control techniques. Difficulties of the airway control in the trauma setting are increased by the vital failures, the risk of aspiration, the potential cervical spine injury, the combative patient, and the obvious risk of difficult tracheal intubation related to specific injury related to the trauma. Endotracheal intubation remains the gold standard in trauma patient airway management and should be performed via the oral route with a rapid sequence induction and a manual in-line stabilization maneuver, to decrease the risks previously mentioned. Different techniques to control the airway in trauma patients are presented: improvement of the laryngoscopic vision, lighted stylet tracheal intubation, retrograde technique for orotracheal intubation, the laryngeal mask and the intubating laryngeal mask airways, the combitube and cricothyroidotomy. Management of the airway in trauma patients requires regular training in these techniques and the knowledge of complementary techniques allowing tracheal intubation or oxygenation to overcome difficult intubation and to prevent major complications as hypoxemia and aspiration.

  12. Hypothyroidism after Radiotherapy of Locally Advanced Head and Neck Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jeong Eun; Eun; Kim, Jae Chul; Park, In Kyu [Kyungpook National Yonsei University School of Medicine, Daegu (Korea, Republic of); Yea, Ji Woon [Dongguk University Gyeongju Hospital, Gyeongju (Korea, Republic of)

    2010-11-15

    The aim of the present study was to retrospectively evaluate the incidence of hypothyroidism in locally advanced head and neck cancer patients who received radiotherapy (RT) either with or without neck dissection. From January 2000 to December 2005, 115 patients with locally advanced head and neck cancer and who received definitive RT or postoperative RT including standard anterior low-neck field were recruited to be part of this study. Nineteen patients had undergone ipsilateral neck dissection, whereas, 18 patients underwent bilateral neck dissection, and 78 patients were received RT alone. Patients' ages ranged from 28 to 85 years (median, 59 years) and there were a total of 73 male and 42 female patients. The primary tumor sites were the oral cavity, oropharynx, hypopharynx, larynx, and other sites in 18, 40, 28, 22 and 7 patients, respectively. Radiation dose to the thyroid gland ranged from 44 Gy to 66 Gy with a median dose of 50 Gy. Follow-up time ranged from 2 to 91 months, with a median of 29 months. The 1- and 3- year incidence of hypothyroidism was 28.7% (33 patients) and 33.0% (38 patients), respectively. The median time to detection of hypothyroidism was 8.5 months (range, 0 to 36 months). A univariate analysis revealed that neck node dissection was a risk factor for hypothyroidism (p=0.037). However, no factor was statistically significant from the results of a multivariate analysis. Patients treated for advanced head and neck cancer with radiotherapy with or without neck dissection will develop hypothyroidism. It is important to check the thyroid function periodically in these patients especially with the risk factor of neck node dissection.

  13. Bouncing back - trauma and the HPA-axis in healthy adults

    Directory of Open Access Journals (Sweden)

    Ellen Renée Klaassens

    2010-12-01

    Full Text Available Dysregulation of the hypothalamic–pituitary–adrenal (HPA-axis is thought to underlie stress-related psychiatric disorders such as posttraumatic stress disorder (PTSD. Some studies have reported HPA-axis dysregulation in trauma-exposed (TE adults in the absence of psychiatric morbidity. In this dissertation we set out to unravel part of the mechanism that underlies the complex relations between trauma exposure, stress regulation, and psychopathology. Mentally healthy TE subjects were compared with non-trauma-exposed (NE healthy controls. To distinguish between the potential effects of childhood trauma and adulthood trauma, we included women exposed to childhood trauma as well as men who were exposed to trauma during adulthood. Basal HPA-axis functioning was assessed with salivary cortisol samples. HPA-axis reactivity was assessed with the dexamethasone/corticotropin-releasing hormone (Dex/CRH test. The results show that childhood trauma exposure is associated with an attenuated cortisol response after the Dex/CRH challenge test in women. In contrast, trauma exposure during adulthood was not associated with alterations in HPA-axis regulation after the Dex/CRH test. Neither childhood trauma nor adulthood trauma were associated with basal HPA-axis functioning. Childhood trauma rather than adulthood trauma may chronically affect HPA-axis functioning. Since the association between adulthood trauma and resilience to psychopathology cannot be explained by HPA-axis functioning alone, other factors must play a role.

  14. Flexion/extension cervical spine views in blunt cervical trauma

    Institute of Scientific and Technical Information of China (English)

    Sadaf Nasir; Manzar Hussain; Roomi Mahmud

    2012-01-01

    Objective: To examine the contribution of flexion and extension radiographs in the evaluation of ligamentous injury in awake adults with acute blunt cervical spine trauma,who show loss of cervical lordosis and neck pain.Methods: All patients who presented to our emergency department following blunt trauma were enrolled in this study,except those with schiwora,neurological deficits or fracture demonstrated on cross-table cervical spine X-rays,and those who were either obtunded or presented after cervical spine surgery.Adequacy of flexion and extension views was checked by the neurosurgery and radiology team members.All these patients underwent cross-table cervical spine view followed by flexion/extension views based on the loss of lordosis on cross-table imaging and the presence of neck pain.Results: A total of 200 cases were reviewed,of whom 90 (45%) underwent repeat X-rays because of either inadequate exposure or limited motion.None of the patients with loss of lordosis on cross-table view had positive flexion and extension views of cervical spine for instability.Conclusions: Our results show that in patients who underwent acute radiographic evaluation of blunt cervical spine trauma,flexion and extension views of the cervical spine are unlikely to yield positive results in the presence of axial neck pain and/or loss of cervical lordosis.We can also hypothesize that performing flexion and extension views will be more useful once the acute neck pain has settled.

  15. Pain management in trauma: A review study

    Directory of Open Access Journals (Sweden)

    Alireza Ahmadi

    2016-07-01

    Full Text Available Background: Pain in trauma has a role similar to the double-edged sword. On the one hand, pain is a good indicator to determine the severity and type of injury. On the other hand, pain can induce sever complications and it may lead to further deterioration of the patient. Therefore, knowing how to manage pain in trauma patients is an important part of systemic approach in trauma. The aim of this manuscript is to provide information about pain management in trauma in the Emergency Room settings. Method: In this review we searched among electronic and manual documents covering a 15-yr period between 2000 and 2016. Our electronic search included Pub Med, Google scholar, Web of Science, and Cochrane databases. We looked for articles in English and in peer-reviewed journals using the following keywords: acute pain management, trauma, emergency room and injury. Results: More than 3200 documents were identified. After screening based on the study inclusion criteria, 560 studies that had direct linkage to the study aim were considered for evaluation based World Health Organization (WHO pain ladder chart. Conclusion: To provide adequate pain management in trauma patients require: adequate assessment of age-specific pharmacologic pain management; identification of adequate analgesic to relieve moderate to severe pain; cognizance of serious adverse effects of pain medications and weighting medications against their benefits, and regularly reassessing patients and reevaluating their pain management regimen. Patient-centered trauma care will also require having knowledge of barriers to pain management and discussing them with the patient and his/her family to identify solutions.

  16. 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.

  17. Aorta Balloon Occlusion in Trauma: Three Cases Demonstrating Multidisciplinary Approach Already on Patient’s Arrival to the Emergency Room

    Energy Technology Data Exchange (ETDEWEB)

    Hörer, Tal M., E-mail: tal.horer@orebroll.se [Örebro University, Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital (Sweden); Hebron, Dan [Hillel Yaffe Medical Center, Department of Radiology (Israel); Swaid, Forat [Bnai-Zion Medical Center, Department of General Surgery (Israel); Korin, Alexander [Hillel Yaffe Medical Center, Trauma Unit (Israel); Galili, Offer [Hillel Yaffe Medical Center, Department of Vascular Surgery (Israel); Alfici, Ricardo [Hillel Yaffe Medical Center, Surgical Division (Israel); Kessel, Boris [Hillel Yaffe Medical Center, Trauma Unit (Israel)

    2016-02-15

    PurposeTo describe the usage of aortic balloon occlusion (ABO), based on a multidisciplinary approach in severe trauma patients, emphasizing the role of the interventional radiologist in primary trauma care.MethodsWe briefly discuss the relevant literature, the technical aspects of ABO in trauma, and a multidisciplinary approach to the bleeding trauma patient. We describe three severely injured trauma patients for whom ABO was part of initial trauma management.ResultsThree severely injured multi-trauma patients were treated by ABO as a bridge to surgery and embolization. The procedures were performed by an interventional radiologist in the early stages of trauma management.ConclusionsThe interventional radiologist and the multidisciplinary team approach can be activated already on severe trauma patient arrival. ABO usage and other endovascular methods are becoming more widely spread, and can be used early in trauma management, without delay, thus justifying the early activation of this multidisciplinary approach.

  18. Relationship between neck disability and mandibular range of motion.

    Science.gov (United States)

    Packer, Amanda Carine; Dibai-Filho, Almir Vieira; de Souza Costa, Ana Cláudia; dos Santos Berni, Kelly Cristina; Rodrigues-Bigaton, Delaine

    2014-01-01

    There is a close interaction between the mandibular and cervical systems due to the existing neurological and biomechanical communications. This study aimed to evaluate the relationship between neck disability and mandibular range of motion (ROM). Fifty-two women aged between 18 and 40 years were recruited and allocated to four groups using two outcome measures: the Neck Disability Index (NDI) and the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD): Group I (n=13), healthy volunteers; Group II (n=13), volunteers with TMD and neck disability; Group III (n=13), volunteers with TMD and without neck disability; and Group IV (n=13), volunteers with neck disability and without TMD. Mandibular ROM was evaluated as part of the RDC/TMD clinical examination. Statistical analysis involved one-way ANOVA followed by Tukey's test for comparisons between groups. Spearman's correlation coefficients were calculated to determined correlations among the variables. Significant differences were found in the mandibular ROM of functional opening in the comparisons between Groups I and III (p=0.009) and between Groups III and IV (p=0.024). No significant association was found between mandibular ROM and the NDI score (p > 0.05). Based on the methodology employed, there is no association between mandibular ROM and neck disability in university women. In this sense, clinical interventions focusing on the flexibility of the temporomandibular joint does not have repercussions on the neck disability and vice versa.

  19. Epidemiology of severe trauma.

    Science.gov (United States)

    Alberdi, F; García, I; Atutxa, L; Zabarte, M

    2014-12-01

    Major injury is the sixth leading cause of death worldwide. Among those under 35 years of age, it is the leading cause of death and disability. Traffic accidents alone are the main cause, fundamentally in low- and middle-income countries. Patients over 65 years of age are an increasingly affected group. For similar levels of injury, these patients have twice the mortality rate of young individuals, due to the existence of important comorbidities and associated treatments, and are more likely to die of medical complications late during hospital admission. No worldwide, standardized definitions exist for documenting, reporting and comparing data on severely injured trauma patients. The most common trauma scores are the Abbreviated Injury Scale (AIS), the Injury Severity Score (ISS) and the Trauma and Injury severity Score (TRISS). Documenting the burden of injury also requires evaluation of the impact of post-trauma impairments, disabilities and handicaps. Trauma epidemiology helps define health service and research priorities, contributes to identify disadvantaged groups, and also facilitates the elaboration of comparable measures for outcome predictions.

  20. Ultrasonography in ocular trauma.

    Science.gov (United States)

    Dastevska-Djosevska, Emilija

    2013-01-01

    Ultrasonography is a non-invasive, simple and effective diagnostic method which enables visualization and evaluation of intraocular injury degree in cloudy eye media. The basic aim of this investigation was to find out the frequency of various types of ocular injuries using ultrasonography and to make an analysis of their frequency in relation to gender and age. This retrospective study included 182 patients hospitalized at the Clinic of Ophthalmology in Skopje due to mechanical eye trauma. The patients underwent ultrasonography on the Alcon Ultrascan Imagining System apparatus and Sonomed EZ Scan AB 5500+. B scan technique was used primarily, while the A scan had a positive and correlative role. Ocular trauma was more present in males (85.2%) compared to females (14.8%). 49.5% of the patients had open, and 50.5% had closed globe injuries. The most represented age group in ocular injuries was the age ranged from 51 to 60 years. There was no significant difference between the type of mechanical injury and the age (Chi-Squares=5.52 p=0.47895025). Ultrasonography showed that the most frequent pathologic result, both in open and closed globe injuries, was vitreous hemorrhage. Ultrasonography has an irreplaceable role in the clinical evaluation and management of ocular trauma. It showed that the most frequent finding in ocular trauma was vitreous haemorrhage, and the male gender was more frequently exposed to ocular trauma.

  1. Kinematics of a Head-Neck Model Simulating Whiplash

    Science.gov (United States)

    Colicchia, Giuseppe; Zollman, Dean; Wiesner, Hartmut; Sen, Ahmet Ilhan

    2008-02-01

    A whiplash event is a relative motion between the head and torso that occurs in rear-end automobile collisions. In particular, the large inertia of the head results in a horizontal translation relative to the thorax. This paper describes a simulation of the motion of the head and neck during a rear-end (whiplash) collision. A head-neck model that qualitatively undergoes the same forces acting in whiplash and shows the same behavior is used to analyze the kinematics of both the head and the cervical spine and the resulting neck loads. The rapid acceleration during a whiplash event causes the extension and flexion of the cervical spine, which in turn can cause dislocated vertebrae, torn ligaments, intervertebral disc herniation, and other trauma that appear to be the likely causes of subsequent painful headache or neck pain symptoms. Thus, whiplash provides a connection between the dynamics of the human body and physics. Its treatment can enliven the usual teaching in kinematics, and both theoretical and experimental approaches provide an interesting biological context to teach introductory principles of mechanics.

  2. Pictorial essay: Vascular interventions in extra cranial head and neck

    Directory of Open Access Journals (Sweden)

    Suyash S Kulkarni

    2012-01-01

    Full Text Available Medicine is an ever changing field and interventional radiology (IR procedures are becoming increasingly popular because of high efficacy and its minimally invasive nature of the procedure. Management of disease processes in the extra cranial head and neck (ECHN has always been a challenge due to the complex anatomy of the region. Cross sectional imaging of the ECHN has grown and evolved tremendously and occupies a pivotal and integral position in the clinical management of variety of head and neck pathologies. Advances in angiographic technologies including flat panel detector systems, biplane, and 3-dimensional rotational angiography have consolidated and expanded the role of IR in the management of various ECHN pathologies. The ECHN is at cross roads between the origins of great vessels and the cerebral vasculature. Thorough knowledge of functional and technical aspects of neuroangiography is essential before embarking on head and neck vascular interventions. The vessels of the head and neck can be involved by infectious and inflammatory conditions, get irradiated during radiotherapy and injured due to trauma or iatrogenic cause. The ECHN is also a common site for various hypervascular neoplasms and vascular malformations, which can be treated with endovascular and percutaneous embolization. This pictorial essay provides a review of variety of ECHN pathologies which were managed by various IR procedures using different approaches.

  3. Noninvasive analysis of human neck muscle function

    Science.gov (United States)

    Conley, M. S.; Meyer, R. A.; Bloomberg, J. J.; Feeback, D. L.; Dudley, G. A.

    1995-01-01

    STUDY DESIGN. Muscle use evoked by exercise was determined by quantifying shifts in signal relaxation times of T2-weighted magnetic resonance images. Images were collected at rest and after exercise at each of two intensities (moderate and intense) for each of four head movements: 1) extension, 2) flexion, 3) rotation, and 4) lateral flexion. OBJECTIVE. This study examined the intensity and pattern of neck muscle use evoked by various movements of the head. The results will help elucidate the pathophysiology, and thus methods for treating disorders of the cervical musculoskeletal system. SUMMARY OF BACKGROUND DATA. Exercise-induced contrast shifts in T2 has been shown to indicate muscle use during the activity. The noninvasive nature of magnetic resonance imaging appears to make it an ideal approach for studying the function of the complex neuromuscular system of the neck. METHODS. The extent of T2 increase was examined to gauge how intensely nine different neck muscles or muscle pairs were used in seven subjects. The absolute and relative cross-sectional area of muscle showing a shift in signal relaxation was assessed to infer the pattern of use among and within individual neck muscles or muscle pairs. RESULTS. Signal relaxation increased with exercise intensity for each head movement. The absolute and relative cross-sectional area of muscle showing a shift in signal relaxation also increased with exercise load. Neck muscles or muscle pairs extensively used to perform each head movement were: extension--semispinalis capitis and cervicis and splenius capitis; flexion--sternocleidomastoid and longus capitis and colli; rotation--splenius capitis, levator scapulae, scalenus, semispinalis capitis ipsilateral to the rotation, and sternocleidomastoid contralateral; and lateral flexion--sternocleidomastoid CONCLUSION. The results of this study, in part, agree with the purported functions of neck muscles derived from anatomic location. This also was true for the few

  4. A finite element study on the mechanical response of the head-neck interface of hip implants under realistic forces and moments of daily activities: Part 1, level walking.

    Science.gov (United States)

    Farhoudi, Hamidreza; Fallahnezhad, Khosro; Oskouei, Reza H; Taylor, Mark

    2017-08-12

    This paper investigates the mechanical response of a modular head-neck interface of hip joint implants under realistic loads of level walking. The realistic loads of the walking activity consist of three dimensional gait forces and the associated frictional moments. These forces and moments were extracted for a 32mm metal-on-metal bearing couple. A previously reported geometry of a modular CoCr/CoCr head-neck interface with a proximal contact was used for this investigation. An explicit finite element analysis was performed to investigate the interface mechanical responses. To study the level of contribution and also the effect of superposition of the load components, three different scenarios of loading were studied: gait forces only, frictional moments only, and combined gait forces and frictional moments. Stress field, micro-motions, shear stresses and fretting work at the contacting nodes of the interface were analysed. Gait forces only were found to significantly influence the mechanical environment of the head-neck interface by temporarily extending the contacting area (8.43% of initially non-contacting surface nodes temporarily came into contact), and therefore changing the stress field and resultant micro-motions during the gait cycle. The frictional moments only did not cause considerable changes in the mechanical response of the interface (only 0.27% of the non-contacting surface nodes temporarily came into contact). However, when superposed with the gait forces, the mechanical response of the interface, particularly micro-motions and fretting work, changed compared to the forces only case. The normal contact stresses and micro-motions obtained from this realistic load-controlled study were typically in the range of 0-275MPa and 0-38µm, respectively. These ranges were found comparable to previous experimental displacement-controlled pin/cylinder-on-disk fretting corrosion studies. Copyright © 2017 Elsevier Ltd. All rights reserved.

  5. When should magnetic resonance imaging be considered with neck pain?

    Science.gov (United States)

    Howard, Patricia Kunz; Shapiro, Susan E

    2012-01-01

    Review of recent evidence with translation to practice for the advanced practice nurse role is presented using a case study module for "Cervical Spine Magnetic Resonance Imaging in Alert, Neurologically Intact Trauma Patients With Persistent Midline Tenderness and Negative Computed Tomography Results." The study was designed to identify factors predictive of clinically significant spinal injury in neurologically intact trauma patients with persistent midline cervical tenderness, despite negative computed tomography and plain film findings. The authors reported a lack of guidelines to help emergency care providers identify which of these patients should undergo magnetic resonance imaging studies. The authors highlight the need to develop a clinical prediction rule, or clinical decision rule, to help providers caring for patients such as those with persistent neck pain. The implications and clinical relevance of these findings for advanced practice nurses are discussed highlighting best evidence.

  6. Neck pain in different cephalalgias

    OpenAIRE

    E. A. Chechet; G. R. Tabeeva

    2014-01-01

    The paper reviews the literature related to the investigations of neck pain (cervicalgia) in patients with headache (cephalalgia). Neck pain is second to lower back pain as a reason for considerable socioeconomic damage to society. The prevalence of cervicalgia in the population ranges from 5.9 to 38%; the annual incidence is 10.4–21.3%; 14.2 to 71% of people report to have neck pain at some time in their lifetime. Neck pain is concurrent with cephalalgia in 70% of cases. In patients with cer...

  7. Trauma care system in Iran

    Institute of Scientific and Technical Information of China (English)

    Moussa Zargar; Sarah Ganji; Mahmoud Khodabandeh; Shahab Abdollahi Far; Morteza Abdollahi; Mohammad Reza Zarei; Seyed Mohammad Reza Kalantar Motamedi; Mojgan Karbakhsh; Seyed Mohammad Ghodsi; Vafa Rahimi-Movaghar; Farzad Panahi; Soheil Saadat; Ali Khaji; Seyed Mahdi Davachi

    2011-01-01

    Objective: The high burden of injuries in Iran necessitates the establishment of a comprehensive trauma care system. The purpose of this paper is to describe the current status of trauma system regarding the components and function. Methods: The current status of trauma system in all components of a trauma system was described through expert panels and semi-structured interviews with trauma specialists and policy makers.Results: Currently, various organizations are involved in prevention, management and rehabilitation of injuries,but an integrative system approach to trauma is rather deficient. There has been ongoing progress in areas of public education through media, traffic regulation reinforcement,hospital care and prehospital services. Meanwhile, there are gaps regarding financing, legislations and education of high risk groups. The issues on education and training standards of the front line medical team and continuing education and evaluation are yet to be addressed. Trauma registry has been piloted in some provinces, but as it needs the well-developed infrastructure (regarding staff, maintenance,financial resources), it is not yet established in our system of trauma care.Conclusions: It seems that one of the problems with trauma care in Iran is lack of coordination among trauma system organizations. Although the clinical management of trauma patients has improved in our country in the recent decade, decreasing the burden of injuries necessitates an organized approach to prevention and management of trauma in the context of a trauma system.

  8. Mucormycosis in trauma patients.

    Science.gov (United States)

    Cocanour, C S; Miller-Crotchett, P; Reed, R L; Johnson, P C; Fischer, R P

    1992-01-01

    Cutaneous mucormycosis is a rare but often fatal infection in trauma patients. We retrospectively reviewed a 9-year experience with mucormycosis among injured patients. Eleven patients had biopsy- or culture-proven mucormycosis. Nine patients were victims of blunt trauma, two patients had burns measuring greater than 50% TBSA. No patient was at increased risk because of underlying disease or immunosuppression prior to injury. All 11 patients had open wounds on admission. Four patients died of mucormycosis. All nonsurvivors had phycomycotic gangrenous cellulitis of the head, the trunk, or both. In contrast, survivors had involvement of only the extremities. Because of underlying disease, contaminating wounds, antibiotic use, or immunocompromise secondary to shock and sepsis, trauma patients are at risk of developing mucormycosis. To successfully treat mucormycosis, diagnosis must be prompt and accompanied by aggressive debridement and parenteral administration of amphotericin B.

  9. Transfusion practices in trauma

    Directory of Open Access Journals (Sweden)

    V Trichur Ramakrishnan

    2014-01-01

    Full Text Available Resuscitation of a severely traumatised patient with the administration of crystalloids, or colloids along with blood products is a common transfusion practice in trauma patients. The determination of this review article is to update on current transfusion practices in trauma. A search of PubMed, Google Scholar, and bibliographies of published studies were conducted using a combination of key-words. Recent articles addressing the transfusion practises in trauma from 2000 to 2014 were identified and reviewed. Trauma induced consumption and dilution of clotting factors, acidosis and hypothermia in a severely injured patient commonly causes trauma-induced coagulopathy. Early infusion of blood products and early control of bleeding decreases trauma-induced coagulopathy. Hypothermia and dilutional coagulopathy are associated with infusion of large volumes of crystalloids. Hence, the predominant focus is on damage control resuscitation, which is a combination of permissive hypotension, haemorrhage control and haemostatic resuscitation. Massive transfusion protocols improve survival in severely injured patients. Early recognition that the patient will need massive blood transfusion will limit the use of crystalloids. Initially during resuscitation, fresh frozen plasma, packed red blood cells (PRBCs and platelets should be transfused in the ratio of 1:1:1 in severely injured patients. Fresh whole blood can be an alternative in patients who need a transfusion of 1:1:1 thawed plasma, PRBCs and platelets. Close monitoring of bleeding and point of care coagulation tests are employed, to allow goal-directed plasma, PRBCs and platelets transfusions, in order to decrease the risk of transfusion-related acute lung injury.

  10. Trauma-Focused CBT for Youth Who Experience Ongoing Traumas

    Science.gov (United States)

    Cohen, Judith A.; Mannarino, Anthony P.; Murray, Laura K.

    2011-01-01

    Many youth experience ongoing trauma exposure, such as domestic or community violence. Clinicians often ask whether evidence-based treatments containing exposure components to reduce learned fear responses to historical trauma are appropriate for these youth. Essentially the question is, if youth are desensitized to their trauma experiences, will…

  11. Trauma-Focused CBT for Youth Who Experience Ongoing Traumas

    Science.gov (United States)

    Cohen, Judith A.; Mannarino, Anthony P.; Murray, Laura K.

    2011-01-01

    Many youth experience ongoing trauma exposure, such as domestic or community violence. Clinicians often ask whether evidence-based treatments containing exposure components to reduce learned fear responses to historical trauma are appropriate for these youth. Essentially the question is, if youth are desensitized to their trauma experiences, will…

  12. Trauma in the elderly caused by traffic accident: integrative review

    Directory of Open Access Journals (Sweden)

    Ana Maria Ribeiro dos Santos

    2015-02-01

    Full Text Available OBJECTIVE To describe the scientific knowledge produced about trauma in the elderly caused by traffic accidents in healthcare area studies. METHODS Integrative review of studies from 2003 to 2013 searched in LILACS, SciELO, PubMed and CINHAL databases. We used combination of the descriptors injuries, wounds and accidents, in English, Portuguese and Spanish languages. RESULTS 32 studies were selected. In the thematic analysis, three categories emerged: epidemiological data from traffic accidents involving elderly; traffic accidents with elderly pedestrians; and trauma care in the elderly. We observed increased incidence of trauma in most countries and pedestrians represented a large part of the victims. Among these, the elderly are the most vulnerable group. CONCLUSION Studies showed that trauma care in the elderly need protocols and professionals with training in gerontology specialized in trauma care services.

  13. Onycholysis due to trauma

    Directory of Open Access Journals (Sweden)

    Patricia Chang

    2014-04-01

    Full Text Available Female patient, 35 years old who came to the private office due to discoloration of her left thumbnail and little pain since 1 month ago. Clinical examination shows nail disease on her left thumbnail with onycholysis and dyschromia, dermatoscopy showed white-yellowish discoloration (Fig. 1A, B. The rest of the clinical examination was normal. Patient use to using acrylic nails since 2 years ago and denied some trauma at the nail. The diagnosis of onycholysis due to trauma was done and recommended her not to use acrylic nail, maintain the nail short and avoid wetness.

  14. Trauma cardiaco cerrado

    OpenAIRE

    Camilo Alvarado; Fernando Vargas; Fernando Guzmán; Alejandro Zárate; Correa, José L.; Alejandro Ramírez; Diana M. Quintero; Erika M. Ramírez

    2016-01-01

    El trauma cardiaco constituye una de las primeras causas de mortalidad en la población general. Requiere alto índice de sospecha en trauma cerrado severo, mecanismo de desaceleración y en presencia de signos indirectos como: equimosis, huella del volante o del cinturón en el tórax anterior. Las lesiones incluyen: conmoción cardiaca, ruptura cardiaca, lesión cardiaca indirecta como la trombosis coronaria aguda, lesión aórtica, lesión del pericardio y herniación cardiaca. Entre las manifestacio...

  15. Eye trauma in boxing.

    Science.gov (United States)

    Corrales, Gustavo; Curreri, Anthony

    2009-10-01

    In boxing, along with a few other sports, trauma is inherent to the nature of the sport; therefore it is considered a high-risk sport for ocular injuries. The long-term morbidity of ocular injuries suffered by boxers is difficult to estimate due to the lack of structured long-term follow-up of these athletes. Complications of blunt ocular trauma may develop years after the athlete has retired from the ring and is no longer considered to be at risk for boxing-related injuries. This article describes the wide range of eye injuries a boxer can sustain, and their immediate and long-term clinical management.

  16. Interventional radiology neck procedures.

    Science.gov (United States)

    Zabala Landa, R M; Korta Gómez, I; Del Cura Rodríguez, J L

    2016-05-01

    Ultrasonography has become extremely useful in the evaluation of masses in the head and neck. It enables us to determine the anatomic location of the masses as well as the characteristics of the tissues that compose them, thus making it possible to orient the differential diagnosis toward inflammatory, neoplastic, congenital, traumatic, or vascular lesions, although it is necessary to use computed tomography or magnetic resonance imaging to determine the complete extension of certain lesions. The growing range of interventional procedures, mostly guided by ultrasonography, now includes biopsies, drainages, infiltrations, sclerosing treatments, and tumor ablation.

  17. Aggressive Fibromatosis in Neck.

    Directory of Open Access Journals (Sweden)

    Namita Kabdwal

    2013-01-01

    Full Text Available Aggressive fibromatosis (AF is a locally aggressive infiltrative low-grade benign tumor that accounts for approximately less than 3% of all soft tissue tumors. In the head and neck region this tumor tends to be more aggressive and associated with significant morbidity. Aggressive surgery is a viable management option and may be successfully used as a single modality treatment, or in combination with radiotherapy. We report a rare case of AF in a 38 year old female, who presented with a painless mass over the left supraclavicular fossa, extending inferiorly into the thoracic inlet, which was excised successfully in toto with the help of cardiothoracic vascular surgeon (CTVS.

  18. Imaging of head and neck venous malformations

    Energy Technology Data Exchange (ETDEWEB)

    Flis, Christine M.; Connor, Stephen E. [King' s College Hospital, Neuroradiology Department, London (United Kingdom)

    2005-10-01

    Venous malformations (VMs) are non proliferative lesions that consist of dysplastic venous channels. The aim of imaging is to characterise the lesion and define its anatomic extent. We will describe the plain film, ultrasound (US) (including colour and duplex Doppler), computed tomography (CT), magnetic resonance imaging (MRI), conventional angiographic and direct phlebographic appearances of venous malformations. They will be illustrated at a number of head and neck locations, including orbit, oral cavity, superficial and deep facial space, supraglottic and intramuscular. An understanding of the classification of such vascular anomalies is required to define the correct therapeutic procedure to employ. Image-guided sclerotherapy alone or in combination with surgery is now the first line treatment option in many cases of head and neck venous malformations, so the radiologist is now an integral part of the multidisciplinary management team. (orig.)

  19. We need to include bystander first aid in trauma research.

    Science.gov (United States)

    Bakke, Håkon Kvåle; Wisborg, Torben

    2017-03-23

    The chain of trauma survival is a concept that originated in the area of out-of-hospital cardiac arrest (OHCA) and was adapted to the treatment of trauma. In out-of-hospital cardiac arrest research into bystander first aid has resulted in improved outcome. Whereas, in trauma research the first link of the chain of survival is almost ignored. In OHCA, cardiopulmonary resuscitation (CPR) from bystanders has been subject of a vast amount of research, as well as measures and programs to raise the rate of bystander CPR to cardiac arrest victims. These efforts have resulted in improved survival. The research effort has been well grounded in the research community, as demonstrated by its natural inclusion in the uniform reporting template (Utstein) for the treatment of OHCA. In trauma the bystander may contribute by providing an open airway, staunch bleedings, or prevent hypothermia. In trauma however, while the chain of survival has been adopted along with it distinct links, including bystander first aid, the consensus-based uniform reporting template for trauma (the Utstein template) does not include the bystander first aid efforts. There is extremely little research on what first aid measures bystanders provide to trauma victims, and on what impact such measures have on outcome. An important step to improve research on bystander first aid in trauma would be to include this as part of the uniform reporting template for trauma CONCLUSION: The lack of research on bystander first aid makes the first link in the trauma chain of survival the weakest link. We, the trauma research community, should either improve our research and knowledge in this area, or remove the link from the chain of survival.

  20. Physical workload on neck and shoulder muscles during military helicopter flight - a need for exercise training?

    OpenAIRE

    Murray, Mike; Lange, Britt; Chreiteh, Shadi Samir; Olsen, Henrik Baare; Søgaard, Karen; Sjøgaard, Gisela

    2013-01-01

    Introduction Work-related neck/shoulder pain is a common complaint among military helicopter pilots and crew members. The flight helmet and additional Night Vision Goggles (NVG) place a considerable load on the cervical spine. The aim of this study was to quantify the physical workload on neck/shoulder muscles to assess possible overload that may call for exercise training to improve capacity and prevent neck pain. Methods Nine pilots and nine crew members from the Royal Danish Air Force part...

  1. Deep Neck Fibromatosis After Diskectomy and Cervical Fusion: Case Series and Review of the Literature.

    Science.gov (United States)

    Lacayo, Eduardo A; Glastonbury, Christine M; Hoang, Jenny K; Magliocca, Kelly R; Hill, Kenneth L; Hudgins, Patricia A

    2016-05-01

    The objective of our study was to report head and neck deep fibromatosis as part of the differential diagnosis of a firm painful neck mass after cervical fusion and diskectomy. Although they are rare tumors, fibromatosis tumors or desmoid tumors should be considered in a patient with a painful neck mass; a history of cervical spine surgery; and MRI findings showing a large, avidly enhancing, heterogeneous mass adjacent to surgical hardware that is hyperintense on T2-weighted imaging.

  2. Trauma social y memoria colectiva

    Directory of Open Access Journals (Sweden)

    Margarita Iglesias Saldaña

    2009-04-01

    Full Text Available El trauma social y la memoria colectiva, o memorias colectivas están de la mano en la América latina post-dictatorial. Desde fines de los años ochenta, se fueron destituyendo las dictaduras latinoamericanas, la mayoría sobre bases de consensos entre las fuerzas dictatoriales y los negociadores políticos de corrientes democráticas. La fuerza de los movimientos sociales sirvió de puente para las negociaciones, pero no logró estar del todo en las transacciones hacia los procesos de transición. Si así hubiera sido, la justicia y la verdad hubieran tenido un lugar privilegiado en los procesos denominados de "transición a las democracias" en distintos países del cono sur latinoamericano. La memoria colectiva ligada al trauma social tendrá varios componentes que abarcan también la memoria individual, incluyendo los espacios de la experiencia, propia y ajena. Este artículo pretende bucear en las interacciones entre ambos ámbitos de la memoria y sus conexiones con el tiempo presente.__________ABSTRACT:Social trauma and collective memory or collective memories are linked to the post-dictatorial Latin America. Since the late eighties, Latin American dictatorships were progressively dismissing, the majority on the basis of consensus between the dictatorial forces and the political mediators of the democratic part. The strength of social movements formed the bridge to negotiations, but could not entirely participate in the transactions to the transition process. If it would have been so, justice and truth would have had a special place in the process called "transition to democracy" in several Latin American Southern Cone countries. The collective memory linked to social trauma will have several components that also include individual memory, including personal and collective spaces of experience. This article aims to analyze the interactions between the two areas of memory and its connections to the present time.

  3. Tranexamic Acid (TXA) in Trauma Patients: Barriers to Use among Trauma Surgeons and Emergency Physicians

    Science.gov (United States)

    2017-01-01

    Objective. Tranexamic Acid (TXA) is currently the only drug with prospective clinical evidence supporting its use in bleeding trauma patients. We sought to better understand the barriers preventing its use and elicit suggestions to further its use in trauma patients in the state of Maryland. Methods. This is a cross-sectional study. Results. The overall response rate was 38%. Half of all participants reported being familiar with the CRASH-2 trial and MATTERs study. Half reported being aware of TXA as part of their institution's massive transfusion protocol. The majority of participants felt that TXA would have a significant positive impact on the survival of trauma patients. A majority also felt that the use of TXA would increase if its administration was the responsibility of both trauma surgeons and emergency physicians. Conclusion. Only half of responders reported being aware of TXA as being part of their institution's massive transfusion protocol. Lack of awareness of the clinical data supporting its use is a major barrier. However, most trauma providers and emergency physicians do have a favorable view of TXA and support its incorporation into massive transfusion protocols. We believe that more studies of this kind on both state and national level are needed.

  4. Emergency Department Management of Trauma

    DEFF Research Database (Denmark)

    MacKenzie, Colin; Lippert, Freddy

    1999-01-01

    Initial assessment and management of severely injured patients may occur in a specialized area of an emergency department or in a specialized area of a trauma center. The time from injury until definitive management is of essence for survival of life-threatening trauma. The initial care delivered...... injured patients after these patients reach a hospital emergency department or a trauma center....

  5. Trauma and the endocrine system.

    Science.gov (United States)

    Mesquita, Joana; Varela, Ana; Medina, José Luís

    2010-12-01

    The endocrine system may be the target of different types of trauma with varied consequences. The present article discusses trauma of the hypothalamic-pituitary axes, adrenal glands, gonads, and pancreas. In addition to changes in circulating hormone levels due to direct injury to these structures, there may be an endocrine response in the context of the stress caused by the trauma.

  6. Emergency Department Management of Trauma

    DEFF Research Database (Denmark)

    MacKenzie, Colin; Lippert, Freddy

    1999-01-01

    Initial assessment and management of severely injured patients may occur in a specialized area of an emergency department or in a specialized area of a trauma center. The time from injury until definitive management is of essence for survival of life-threatening trauma. The initial care delivered...... injured patients after these patients reach a hospital emergency department or a trauma center....

  7. Scoring systems of severity in patients with multiple trauma.

    Science.gov (United States)

    Rapsang, Amy Grace; Shyam, Devajit Chowlek

    2015-04-01

    Trauma is a major cause of morbidity and mortality; hence severity scales are important adjuncts to trauma care in order to characterize the nature and extent of injury. Trauma scoring models can assist with triage and help in evaluation and prediction of prognosis in order to organise and improve trauma systems. Given the wide variety of scoring instruments available to assess the injured patient, it is imperative that the choice of the severity score accurately match the application. Even though trauma scores are not the key elements of trauma treatment, they are however, an essential part of improvement in triage decisions and in identifying patients with unexpected outcomes. This article provides the reader with a compendium of trauma severity scales along with their predicted death rate calculation, which can be adopted in order to improve decision making, trauma care, research and in comparative analyses in quality assessment. Copyright © 2013 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  8. Neck dissection: then and now.

    NARCIS (Netherlands)

    Ferlito, A.; Rinaldo, A.; Silver, C.E.; Shah, J.P.; Suarez, C.; Medina, J.E.; Kowalski, L.P.; Johnson, J.T.; Strome, M.; Rodrigo, J.P.; Werner, J.A.; Takes, R.P.; Towpik, E.; Robbins, K.T.; Leemans, C.R.; Herranz, J.; Gavilan, J.; Shaha, A.R.; Wei, W.I.

    2006-01-01

    The significance of metastatic disease in the lymph nodes of the neck as a critical independent prognostic factor in head and neck cancer has long been appreciated. Although 19th century surgeons attempted to remove involved cervical lymph nodes at the time of resection of the primary cancer, a syst

  9. Post trauma abdominal cocoon.

    Science.gov (United States)

    Kaur, Supreet; Doley, Rudra Prasad; Chabbhra, Mohinish; Kapoor, Rajeev; Wig, Jaidev

    2015-01-01

    Abdominal cocoon or sclerosing peritonitis refers to a rare cause of intestinal obstruction due to formation of a membrane encasing the bowel. We report a case of abdominal cocoon post blunt trauma abdomen. The patient presented with a history of subacute intestinal obstruction and a mobile abdomen lump. Abdominal cocoon was diagnosed on computed tomography. He underwent adhesiolysis with excision of membrane.

  10. Early Childhood Trauma

    Science.gov (United States)

    National Child Traumatic Stress Network, 2010

    2010-01-01

    Early childhood trauma generally refers to the traumatic experiences that occur to children aged 0-6. Because infants' and young children's reactions may be different from older children's, and because they may not be able to verbalize their reactions to threatening or dangerous events, many people assume that young age protects children from the…

  11. The Ocular Trauma Score

    Directory of Open Access Journals (Sweden)

    Robert Scott

    2016-01-01

    Full Text Available Relatively junior doctors or allied health workers, with little or no training in ophthalmology, are often tasked with the recognition and initial management of eye trauma. In these situations, the lack of clear instructions and guidance to support decision making has been a key challenge, which has been compounded by the inconsistent terminologies used to describe eye injuries.

  12. Penetrating abdominal trauma

    African Journals Online (AJOL)

    Enrique

    inal trauma (PAT) in our area, and to try to identify a pattern of organ-specific injury ... laparotomy due to persistent abdominal pain, after a period of observation of about .... in the ini- tial assessment who turned out to be free of visceral injuries.

  13. Traumatismos oculares Ocular traumas

    Directory of Open Access Journals (Sweden)

    Gelen Welch Ruiz

    2007-12-01

    Full Text Available Se realizó un estudio descriptivo de tipo retrospectivo longitudinal cuyo universo estuvo constituido por 72 ojos de 72 pacientes con traumatismos oculares mecánicos que fueron hospitalizados en el Hospital Militar Central “Dr. Carlos J. Finlay” desde enero de 1999 hasta enero de 2005. Para el análisis estadístico de la información se utilizó el programa automatizado SPSS versión 11.5 en el cual también se conformó la base de datos y se realizaron los cálculos de acuerdo con el tipo de variable analizada. Se utilizaron medidas de resumen, tendencia central y asociación estadística con un nivel de significación de p A retrospective longitudinal and descriptive study was carried out in 72 eyes from 72 patients with mechanical occular traumas, who had been hospitalized in “Dr. Carlos J. Finlay” Military Hospital from December 1999 to January 2005. For the statistical data analysis, an automated program (SPSS 11.5 version was used to create the database and estimations were made according to the variable types. Summary measures, central tendency measures and statistical association with significance level equal to p < 0.05 were employed. Males prevailed (95.8%, the average age was 30.26 years with a minimum rate of 17 years and maximum rate of 82 years. The most frequent mechanisms of trauma were aggressions (23. 6% and injures from secondary projectiles (13.9%. The anterior segment traumas were more frequent (61, 1% than posterior segment traumas (6.94%. Both segments of the eyeball were affected in 39, 1% of eyes which evinced the worst visual acuity. The most common associated injures were hyphema (54, 2% and vitreous hemorrhage (16.6%. Closed trauma (contusions were more common and most of the eyes had better final visual acuity (45, 2% with vision range of 0.6-1.0 and 26.2% with vision range of 0.59-0.1. On the other hand, eyes affected by open trauma (simple wound, contusion-wound, wound with intraocular foreign body and

  14. Emotion regulation difficulties in trauma survivors: the role of trauma type and PTSD symptom severity

    NARCIS (Netherlands)

    Ehring, T.; Quack, D.

    2010-01-01

    Two different hypotheses regarding the relationship between emotion regulation and PTSD are described in the literature. First, it has been suggested that emotion regulation difficulties are part of the complex sequelae of early-onset chronic interpersonal trauma and less common following late-onset

  15. The trauma report nurse: a trauma triage process improvement project.

    Science.gov (United States)

    Jelinek, Lisa; Fahje, Carol; Immermann, Carol; Elsbernd, Terri

    2014-09-01

    Accurate trauma triage is imperative to facilitate appropriate resource mobilization for severely injured trauma patients. A critical window of opportunity exists to prevent secondary injury or death. Timely assessment with a multidisciplinary trauma team is essential to facilitate rapid diagnosis and treatment. However, consistent and accurate trauma triage proved daunting at our institution, resulting in instances of undertriage. A process improvement strategy aimed at improving trauma triage accuracy was implemented. An innovative role, the trauma report nurse (TRN), was created and became the trauma nurse expert. The TRN was responsible for assigning a trauma triage level to all incoming adult and pediatric trauma patients. In parallel, improvements were made to the prehospital report format, increasing standardization and clarifying hand-off verbiage. Undertriage rates dropped from 14% to 4.8%. Qualitative data demonstrated acceptance and support of the TRN role among physicians, nurses and nursing and ancillary staff. Designating trauma triage to an ED registered nurse proved to reduce undertriage rates. By providing staff education, infrastructure improvements, and leadership support, the role continues to thrive, resulting in improved care for severely injured trauma patients. Copyright © 2014 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

  16. ASSESSMENT OF RELATIONSHIP BETWEEN NECK SHAFT ANGLE AND NECK LENGTH WITH INTEREPICONDYLAR DISTANCE IN FEMUR

    Directory of Open Access Journals (Sweden)

    Ishita Ghosh

    2015-12-01

    Full Text Available Background: Femur is the longest and strongest bone of the body. It transmits body weight from hip bone to tibia in standing position. Femoral neck is a constricted part connecting head with shaft at an angle of about 125°-known as angle of inclination or neck shaft angle (NSA; this facilitates the movement of hip joint enabling the limb to swing clear of pelvis. Abnormal femoral neck angle (FNA may be associated with various clinical problems ranging from harmless in toeing gait in childhood to disabling osteoarthritis in adults. The current study attempted to find out if a co-relation exists between those parameters and other clinically measurable variables like inter-epicondylar distance or distance between greater trochanter to lateral epicondyle. This may help to predict the risk of fracture neck femur without any risk of radiation exposure and proper prophylactic measures can be undertaken (Vit-D, calcium to decrease risk of fracture. Results: Measurements were taken in dry femora mostly in East Indian population. Variables that were measured in 158 dry femora (85 femora from left side and 73 from the right side are: - a Neck shaft angle of femur, b Neck length of femur, c Neck circumference of femur, d Inter-epicondylar distance of femur, e Distance between lateral epicondyle and greater trochanter of femur. No significant difference was found between the right and left sided femoral groups regarding any of the study variables. From the analysis it was revealed that no positive or negative correlation exists between the study variables. Therefore, it is not possible to predict the value of one or more of them from the magnitude of the other variable(s. Conclusions: Our study attempted to find out if it was possible to predict the risk of fracture neck femur by simple clinical procedure without exposing the subjects to radiation hazards associated with a radiological imaging. A screening test and subsequent prophylactic measures could

  17. Neck pain causes respiratory dysfunction.

    Science.gov (United States)

    Kapreli, Eleni; Vourazanis, Evangelos; Strimpakos, Nikolaos

    2008-01-01

    This paper describes a presumptive mechanism for the development of changes in respiratory function due to chronic neck pain. The patient with neck pain presents a number of factors that could constitute a predisposition of leading to a respiratory dysfunction: (a) the decreased strength of deep neck flexors and extensors, (b) the hyperactivity and increased fatigability of superficial neck flexors, (c) the limitation of range of motion, (d) the decrease in proprioception and disturbances in neuromuscular control, (e) the existence of pain and (f) the psychosocial influence of dysfunction. The possible connection of neck pain and respiratory function could have a great impact on various clinical aspects notably patient assessment, rehabilitation and pharmacological prescription.

  18. 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

  19. Surgical trainees and trauma emergencies.

    Science.gov (United States)

    Wybaillie, E; Broos, P L O

    2010-01-01

    An accident and emergency (A&E) training has been suggested as an essential part of the basic surgical training. The A&E curriculum should be divided into three sections: a critical curriculum, a core curriculum and a comprehensive curriculum. For instance, the critical curriculum contains topics that provide the opportunity to translate the ABCDE principles of trauma management into practice. Furthermore, a post in the A&E department provides the surgical trainee with significant exposure to the management of the polytrauma patient and to the management of other acute general surgical, urological and orthopaedic conditions. By presenting better educational programs and by reducing the non-medical tasks a trainee has to deal with, the education of surgical trainees during A&E attachment can be improved.

  20. Role of ENT Surgeon in Managing Battle Trauma During Deployment.

    Science.gov (United States)

    Rajguru, Renu

    2013-01-01

    With technological improvements in body armour and increasing use of improvised explosive devices, it is the injuries to head, face and neck are the cause for maximum fatalities as military personnel are surviving wounds that would have otherwise been fatal. The priorities of battlefield surgical treatment are to save life, eyesight and limbs and then to give the best functional and aesthetic outcome for other wounds. Modern day battlefields pose unique demands on the deployed surgical teams and management of head and neck wounds demands multispecialty approach. Optimal result will depend on teamwork of head and neck trauma management team, which should also include otolaryngologist. Data collected by various deployed HFN surgical teams is studied and quoted in the article to give factual figures. Otorhinolaryngology becomes a crucial sub-speciality in the care of the injured and military otorhinolaryngologists need to be trained and deployed accordingly. The otolaryngologist's clinical knowledge base and surgical domain allows the ENT surgeon to uniquely contribute in response to mass casualty incident. Military planners need to recognize the felt need and respond by deploying teams of specialist head and neck surgeons which should also include otorhinolaryngologists.

  1. "C3, 4, 5 Keeps the Diaphragm Alive." Is phrenic nerve palsy part of the pathophysiological mechanism in strangulation and hanging? Should diaphragm paralysis be excluded in survived cases?: A review of the literature.

    Science.gov (United States)

    Davies, Susan J

    2010-03-01

    The phrenic nerve arises in the neck. It is formed from C3, C4, and C5 nerve fibers and descends along the anterior surface of the scalenus anterior muscle before entering the thorax to supply motor and sensory input to the diaphragm. Its anatomic location in the neck leaves the nerve vulnerable to traumatic injury. Phrenic nerve injury can arise as a result of transection, stretching or compression of the nerve, and may result in paralysis of the diaphragm. Consequences of diaphragm paralysis include respiratory compromise, gastrointestinal obstruction, and cardiac arrhythmias. There may be serious morbidity and onset of symptoms may be delayed. Cases of diaphragm paralysis occurring as a consequence of neck trauma are documented in the literature. In some cases, the forces involved are relatively minor and include whiplash injury, occurring in minor motor vehicle collisions, chiropractic manipulation, and compression of neck structures, including a case involving external neck compression by industrial machinery. It is concluded that phrenic nerve palsy might be part of the pathophysiological mechanism in strangulation and hanging, and clinical investigation to exclude diaphragm paralysis in survived cases should be considered.

  2. Minor Trauma Causing Stroke in a Young Athlete

    Directory of Open Access Journals (Sweden)

    Vineet Gupta

    2015-01-01

    Full Text Available A 17-year-old Caucasian male presented with sudden dizziness, ataxia, vertigo, and clumsiness lasting for a couple of hours. He had a subtle trauma during a wrestling match 2 days prior to the presentation. A CT Angiogram (CTA and MRI showed left vertebral artery dissection (VAD. The patient was treated with anticoagulation with heparin drip in the ICU. The patient was discharged home on the third day on Lovenox-warfarin bridging. This case underscores the importance of considering VAD as a differential diagnosis in patients with sports-related symptoms especially in activities entailing hyperextension or hyperrotation of neck. Due to a varied latent period, often minor underlying trauma, and subtle presentation, a low index of suspicion is warranted in timely diagnosis and treatment of VAD. Considering recent evidence in treatment modality, either antiplatelet therapy or anticoagulation may be used for treatment of VAD.

  3. Evaluating trauma center structural performance: The experience of a Canadian provincial trauma system

    Directory of Open Access Journals (Sweden)

    Lynne Moore

    2013-01-01

    Full Text Available Background: Indicators of structure, process, and outcome are required to evaluate the performance of trauma centers to improve the quality and efficiency of care. While periodic external accreditation visits are part of most trauma systems, a quantitative indicator of structural performance has yet to be proposed. The objective of this study was to develop and validate a trauma center structural performance indicator using accreditation report data. Materials and Methods: Analyses were based on accreditation reports completed during on-site visits in the Quebec trauma system (1994-2005. Qualitative report data was retrospectively transposed onto an evaluation grid and the weighted average of grid items was used to quantify performance. The indicator of structural performance was evaluated in terms of test-retest reliability (kappa statistic, discrimination between centers (coefficient of variation, content validity (correlation with accreditation decision, designation level, and patient volume and forecasting (correlation between visits performed in 1994-1999 and 1998-2005. Results: Kappa statistics were >0.8 for 66 of the 73 (90% grid items. Mean structural performance score over 59 trauma centers was 47.4 (95% CI: 43.6-51.1. Two centers were flagged as outliers and the coefficient of variation was 31.2% (95% CI: 25.5% to 37.6%, showing good discrimination. Correlation coefficients of associations with accreditation decision, designation level, and volume were all statistically significant (r = 0.61, -0.40, and 0.24, respectively. No correlation was observed over time (r = 0.03. Conclusion: This study demonstrates the feasibility of quantifying trauma center structural performance using accreditation reports. The proposed performance indicator shows good test-retest reliability, between-center discrimination, and construct validity. The observed variability in structural performance across centers and over-time underlines the importance of

  4. A DIALECTICAL PERSPECTIVE OF TRAUMA PROCESSING

    Directory of Open Access Journals (Sweden)

    Brurit Laub

    2014-03-01

    Full Text Available This article presents a dialectical perspective, which attempts to elucidate the integrative components of trauma processing in therapy. It is proposed that the inherent movement toward greater integration is an expanding dialectical movement. It is conceived as a spiral resulting from the synergy of two dialectical movements. The horizontal line moves between the opposite aspects of the individual (thesis vs. antithesis toward a synthesis. The vertical line moves upward via whole/part shifts toward greater integration, or downward toward disintegration and fragmentation. It is proposed that the complementary processes of differentiation and linking are the building blocks of the integrative/dialectical movement. Differentiation relates to the separation of parts and linking relates to their connection. The role of differentiation and linking in three basic interacting systems of trauma work is discussed. It is proposed that the dialectical principles are applicable to various therapeutic approaches and clinical vignettes are included to illustrate.

  5. [Factors related to perineal trauma in normal births in nulliparous].

    Science.gov (United States)

    Scarabotto, Leila Barreto; Riesco, Maria Luiza Gonzalez

    2006-09-01

    Many studies have been undertaken with the purpose of contributing towards the prevention of perineal trauma in normal birth. The objective of this study was to relate height of the perineum, duration of the second stage of labor, variation of the position of the head detaching, kind of effort, presence of the umbilical cord around the babies' neck, birth weight and vulva's ardor to urinate with the occurrence of perineal laceration. The study was undertaken in 2003 at the Normal Birth Center of the Amparo Maternal, with a sample consisting of 67 women in labor without previous vaginal births. The results demonstrated that there were no significant statistical differences between the variables verified.

  6. Trauma care system in Iran

    Directory of Open Access Journals (Sweden)

    Zargar Moussa

    2011-06-01

    Full Text Available 【Abstract】Objective: The high burden of injuries in Iran necessitates the establishment of a comprehensive trauma care system. The purpose of this paper is to de- scribe the current status of trauma system regarding the components and function. Methods: The current status of trauma system in all components of a trauma system was described through ex- pert panels and semi-structured interviews with trauma spe- cialists and policy makers. Results: Currently, various organizations are involved in prevention, management and rehabilitation of injuries, but an integrative system approach to trauma is rather deficient. There has been ongoing progress in areas of pub- lic education through media, traffic regulation reinforcement, hospital care and prehospital services. Meanwhile, there are gaps regarding financing, legislations and education of high risk groups. The issues on education and training stan- dards of the front line medical team and continuing educa- tion and evaluation are yet to be addressed. Trauma regis- try has been piloted in some provinces, but as it needs the well-developed infrastructure (regarding staff, maintenance, financial resources, it is not yet established in our system of trauma care. Conclusions: It seems that one of the problems with trauma care in Iran is lack of coordination among trauma system organizations. Although the clinical management of trauma patients has improved in our country in the recent decade, decreasing the burden of injuries necessitates an organized approach to prevention and management of trauma in the context of a trauma system. Key words: Emergency medical services; Trauma centers; Wounds and injuries

  7. Treatment of the femoral neck peudoarthrosis in childhood: Case report

    Directory of Open Access Journals (Sweden)

    Vukašinović Zoran

    2013-01-01

    Full Text Available Introduction. Femoral neck fractures in children and adolescents are rare. However, their complications are frequent - avascular necrosis, femoral neck pseudoarthrosis, premature physeal closure with consequent growth disturbance and coxa vara deformity. Case Outline. A 9.5­year­old boy was injured in a car accident, and femoral neck fracture was diagnosed. Prior to admission at our hospital he was surgically treated several times. He was admitted at our hospital eight months following the accident. On the X­ray transcervical pseudoarthrosis of the femoral neck was found, as well as coxa vara deformity and metaphyseal avascular necrosis. He was operated at our hospital; all previously placed ostefixation material was removed, valgus osteotomy of 30 degrees was done as well as additional local osteoplasty using the commercial osteoindactive agent (Osteovit®. Postoperatively, we applied skin traction, bed rest and physical therapy. At the final follow­up, the patient was recovered completely. He is now painless, the legs are of equal length, range of movements in the left hip is full, life activity is normal. The X­ray shows that the femoral neck pseudoarthrosis is fully healed. Conclusion. This case is presented in order to encourage other colleagues to challenge the problematic situation such as this one. Also, we would like to remind them what one should think about and what should be taken into consideration in the primary treatment of femoral neck fractures in children. Valgus femoral osteotomy, as a part of the primary treatment of femoral neck fracture in children (identically as in the adults can prevent the occurrence of femoral neck pseudoarthrosis.

  8. A different trauma, a different fracture

    Directory of Open Access Journals (Sweden)

    Ü. Kaldırım

    2013-12-01

    Discussion and conclusion: The epiphyses and the apophyses are the weakest part of all the skeletal system. In these regions, avulsion fractures may occur with sudden and severe spasm of the muscles. Avulsion fractures of SIAS are mostly treated conservatively unless there is more than 2 cm fragment separated and non-union case in which case surgery is recommended. This type of injuries can be easily overlooked or misdiagnosed due to history of trauma free. It may also effects

  9. ['Advanced trauma life support' in Netherlands].

    Science.gov (United States)

    van Vugt, A B

    2000-10-28

    Introduction of the principles of advanced trauma life support (ATLS) in the management of accident victims has been in progress in the Netherlands since 1995. The main ATLS principles are that the aid giver treats the most dangerous disorder first and does no further damage. After assessment and, if necessary, treatment of the airways, the respiration, the circulation and any craniocerebral injury, an exploratory examination is carried out. Physicians receive theoretical and practical instructions in this form of management during an intensive two-day course, counselled by a coordinating organization in the USA. Most of those attending are interns in general surgery, traumatology and orthopaedics, gatekeeper doctors of emergency rooms and army medical officers. The standardized way of thinking improves the communication and understanding between the various disciplines involved in trauma care, in part because there exist comparable programmes for ambulance care and emergency care. Other measures improving the quality of trauma care are regionalization of the trauma care, medical helicopter teams and evaluation of the effects of ATLS as an operating procedure.

  10. Imaging of the head and neck. 2. rev. and enl. ed

    Energy Technology Data Exchange (ETDEWEB)

    Mafee, M.F.; Valvassori, G.E. [University of Illinois, Chicago, IL (United States); Becker, M. [Geneva University Hospital (Switzerland)

    2004-07-01

    Remarkable advances in medical diagnostic imaging have been made during the past three decades. The development of new imaging techniques and continuous improvements in the display of digital images have opened new horizons in the study of head and neck anatomy and pathology. The American Society of Head and Neck Radiology (ASHNR) and its European and Asiatic counterparts evolved because of the emerging awareness of the roles that head and neck radiologists play in the diagnosis and management of head and neck, base of the skull, neuro-ophthalmologic and neuro-otologic diseases. This edition continues the tradition of excellence set by the first edition of Valvassori's Head and Neck Imaging (which was also the first textbook in head and neck radiology), and provides a comprehensive review of the most pertinent and up-to-date knowledge in the field of head and neck imaging. The content of this edition has been organized into 12 chapters according to anatomic regions. It now includes new material on the temporomandibular joint, the lacrimal drainage system, dental scanning, fibro-osseous and cartilaginous lesions of the head and neck, MRI sialography, MR interventional technique, and thyroid and parathyroid glands. All chapters have been expanded to address new developments in the field and to stress the importance of imaging anatomy, pathologic correlation, and pertinent clinical data. For each anatomic region, the embryology and anatomy are introduced, followed by congenital and developmental disorders, inflammatory processes, benign and malignant neoplastic diseases, trauma, and postoperative changes. The detailed reference lists in each chapter include key references and are as recent as possible. Care has been taken to include exquisitely reproduced illustrations that provide the maximum of pertinent information. It is our hope that this textbook will be useful to students and physicians in the fields of radiology, otolaryngology, neurootology, rhinology

  11. Airway management in trauma

    Directory of Open Access Journals (Sweden)

    Rashid M Khan

    2011-01-01

    Full Text Available Trauma has assumed epidemic proportion. 10% of global road accident deaths occur in India. Hypoxia and airway mismanagement are known to contribute up to 34% of pre-hospital deaths in these patients. A high degree of suspicion for actual or impending airway obstruction should be assumed in all trauma patients. Objective signs of airway compromise include agitation, obtundation, cyanosis, abnormal breath sound and deviated trachea. If time permits, one should carry out a brief airway assessment prior to undertaking definitive airway management in these patients. Simple techniques for establishing and maintaining airway patency include jaw thrust maneuver and/or use of oro- and nas-opharyngeal airways. All attempts must be made to perform definitive airway management whenever airway is compromised that is not amenable to simple strategies. The selection of airway device and route- oral or -nasal, for tracheal intubation should be based on nature of patient injury, experience and skill level.

  12. Trauma-affected refugees

    DEFF Research Database (Denmark)

    Sonne, Charlotte Kærgaard

    2016-01-01

    Introduction and aim: There is a lack of evidence for evaluating which types of treatment approaches are the most efficient for trauma-affected refugees, especially when it comes to pharmacological treatment. Additionally, only a very few studies have been published on predictors of treatment...... outcomes for this patient group. This omission in evidence constitutes a problem for patients and clinicians as well as for society. Accordingly, this PhD thesis aims to generate new knowledge on pharmacological treatment and predictors of treatment outcome for trauma-affected refugees in order to optimise...... treatment outcome for this patient group. Methods: This thesis includes four papers based on two studies – a literature review and a randomised trial called PTF3: The aim of the literature review was to provide an overview of the existing literature on the pharmacological treatment of refugees with PTSD and...

  13. Post trauma abdominal cocoon

    Directory of Open Access Journals (Sweden)

    Supreet Kaur

    2015-01-01

    Full Text Available Abdominal cocoon or sclerosing peritonitis refers to a rare cause of intestinal obstruction due to formation of a membrane encasing the bowel. We report a case of abdominal cocoon post blunt trauma abdomen. The patient presented with a history of subacute intestinal obstruction and a mobile abdomen lump. Abdominal cocoon was diagnosed on computed tomography. He underwent adhesiolysis with excision of membrane.

  14. Substance Abuse and Trauma.

    Science.gov (United States)

    Simmons, Shannon; Suárez, Liza

    2016-10-01

    There is a strong, bidirectional link between substance abuse and traumatic experiences. Teens with cooccurring substance use disorders (SUDs) and posttraumatic stress disorder (PTSD) have significant functional and psychosocial impairment. Common neurobiological foundations point to the reinforcing cycle of trauma symptoms, substance withdrawal, and substance use. Treatment of teens with these issues should include a systemic and integrated approach to both the SUD and the PTSD.

  15. Calcinosis cutis following trauma.

    Science.gov (United States)

    Larralde, Margarita; Giachetti, Ana; Cáceres, María Rodríguez; Rodríguez, Marcela; Casas, José

    2005-01-01

    We report an 8-year-old boy who developed dystrophic calcinosis cutis that occurred following trauma. Multiple abrasions were observed in the inguinal folds after a soccer game. Subsequently, multiple papules with soft centers and white particles appeared in the same area. A biopsy specimen showed calcinosis cutis with transepidermal elimination of calcium. The causes of the underlying tissue damage associated with dystrophic calcinosis are discussed.

  16. A pain in the neck-Imaging in neck sepsis

    Energy Technology Data Exchange (ETDEWEB)

    Lyle, N.J., E-mail: nickylyle@doctors.org.uk [Department of Diagnostic Imaging, Southampton General Hospital, Southampton (United Kingdom); Rutherford, E.E.; Batty, V.B. [Department of Diagnostic Imaging, Southampton General Hospital, Southampton (United Kingdom)

    2011-09-15

    Deep neck infection has a high morbidity and mortality and the extent of infection is often difficult to estimate clinically. The complex anatomy and the communication between neck spaces means that infection can spread along fascial planes leading to life-threatening complications such as airway compromise, vascular erosion/thrombosis, neural dysfunction, and ultimately descending necrotizing mediastinitis. Imaging has an important role to play in identifying the extent of infection and the presence of complications.

  17. Imaging of laryngeal trauma

    Energy Technology Data Exchange (ETDEWEB)

    Becker, Minerva, E-mail: Minerva.Becker@hcuge.ch [Department of Radiology, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14 (Switzerland); Leuchter, Igor, E-mail: Igor.Leuchter@hcuge.ch [Department of Otorhinolaryngology and Cervico-facial Surgery, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14 (Switzerland); Platon, Alexandra, E-mail: Alexandra.Platon@hcuge.ch [Department of Radiology, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14 (Switzerland); Becker, Christoph D., E-mail: Christoph.Becker@hcuge.ch [Department of Radiology, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14 (Switzerland); Dulguerov, Pavel, E-mail: Pavel.Dulguerov@hcuge.ch [Department of Otorhinolaryngology and Cervico-facial Surgery, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14 (Switzerland); Varoquaux, Arthur, E-mail: Arthur.Varoquaux@hcuge.ch [Department of Radiology, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14 (Switzerland)

    2014-01-15

    External laryngeal trauma is a rare but potentially life-threatening situation in the acutely injured patient. Trauma mechanism and magnitude, maximum focus of the applied force, and patient related factors, such as age and ossification of the laryngeal cartilages influence the spectrum of observed injuries. Their correct diagnosis and prompt management are paramount in order to avoid patient death or long-term impairment of breathing, swallowing and speaking. The current review provides a comprehensive approach to the radiologic interpretation of imaging studies performed in patients with suspected laryngeal injury. It describes the key anatomic structures that are relevant in laryngeal trauma and discusses the clinical role of multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) in the acute emergency situation. The added value of two-dimensional multiplanar reconstructions (2D MPR), three-dimensional volume rendering (3D VR) and virtual endoscopy (VE) for the non-invasive evaluation of laryngeal injuries and for treatment planning is discussed. The clinical presentation, biomechanics of injury, diagnostic pitfalls and pearls, common and uncommon findings are reviewed with emphasis of fracture patterns, involvement of laryngeal joints, intra- and extralaryngeal soft tissue injuries, and complications seen in the acute emergency situation. The radiologic appearance of common and less common long-term sequelae, as well as treatment options are equally addressed.

  18. Imaging of laryngeal trauma.

    Science.gov (United States)

    Becker, Minerva; Leuchter, Igor; Platon, Alexandra; Becker, Christoph D; Dulguerov, Pavel; Varoquaux, Arthur

    2014-01-01

    External laryngeal trauma is a rare but potentially life-threatening situation in the acutely injured patient. Trauma mechanism and magnitude, maximum focus of the applied force, and patient related factors, such as age and ossification of the laryngeal cartilages influence the spectrum of observed injuries. Their correct diagnosis and prompt management are paramount in order to avoid patient death or long-term impairment of breathing, swallowing and speaking. The current review provides a comprehensive approach to the radiologic interpretation of imaging studies performed in patients with suspected laryngeal injury. It describes the key anatomic structures that are relevant in laryngeal trauma and discusses the clinical role of multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) in the acute emergency situation. The added value of two-dimensional multiplanar reconstructions (2D MPR), three-dimensional volume rendering (3D VR) and virtual endoscopy (VE) for the non-invasive evaluation of laryngeal injuries and for treatment planning is discussed. The clinical presentation, biomechanics of injury, diagnostic pitfalls and pearls, common and uncommon findings are reviewed with emphasis of fracture patterns, involvement of laryngeal joints, intra- and extralaryngeal soft tissue injuries, and complications seen in the acute emergency situation. The radiologic appearance of common and less common long-term sequelae, as well as treatment options are equally addressed. Copyright © 2013 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

  19. Fluid resuscitation in trauma

    Directory of Open Access Journals (Sweden)

    Rudra A

    2006-01-01

    Full Text Available Appropriate fluid replacement is an essential component of trauma fluid resuscitation. Once hemorrhage is controlled, restoration of normovolemia is a priority. In the presence of uncontrolled haemorrhage, aggressive fluid management may be harmful. The crystalloid-colloid debate continues but existing clinical practice is more likely to reflect local biases rather than evidence based medicine. Colloids vary substantially in their pharmacology and pharmacokinetics,and the experimental finding based on one colloid cannot be extrapolated reliably to another. In the initial stages of trauma resuscitation the precise fluid used is probably not important as long as an appropriate volume is given. Later, when the microcirculation is ′leaky′, there may be some advantages to high or medium weight colloids such as hydroxyethyl starch. Hypertonic saline solutions may have some benefit in patients with head injuries. A number of hemoglobin solutions are under development, but one of the most promising of these has been withdrawn recently. It is highly likely that at least one of these solutions will eventually become routine therapy for trauma patient resuscitation. In the meantime, contrary to traditional teaching, recent data suggest that restrictive strategy of red cell transfusion may improve outcome in some critically ill patients.

  20. Rethinking historical trauma.

    Science.gov (United States)

    Kirmayer, Laurence J; Gone, Joseph P; Moses, Joshua

    2014-06-01

    Recent years have seen the rise of historical trauma as a construct to describe the impact of colonization, cultural suppression, and historical oppression of Indigenous peoples in North America (e.g., Native Americans in the United States, Aboriginal peoples in Canada). The discourses of psychiatry and psychology contribute to the conflation of disparate forms of violence by emphasizing presumptively universal aspects of trauma response. Many proponents of this construct have made explicit analogies to the Holocaust as a way to understand the transgenerational effects of genocide. However, the social, cultural, and psychological contexts of the Holocaust and of post-colonial Indigenous "survivance" differ in many striking ways. Indeed, the comparison suggests that the persistent suffering of Indigenous peoples in the Americas reflects not so much past trauma as ongoing structural violence. The comparative study of genocide and other forms of massive, organized violence can do much to illuminate both common mechanisms and distinctive features, and trace the looping effects from political processes to individual experience and back again. The ethics and pragmatics of individual and collective healing, restitution, resilience, and recovery can be understood in terms of the self-vindicating loops between politics, structural violence, public discourse, and embodied experience. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  1. Chylopericardium with symptoms of tamponade on the grounds of extensive neck vein thrombosis

    Science.gov (United States)

    Nardini, Marco; Katsogridakis, Emmanuel; Migliore, Marcello; Dunning, Joel

    2017-01-01

    Chylopericardium is a recognized complication of thoracic trauma, surgery or malignancy. Idiopathic or primary presentations, however, are rarely encountered in clinical practice. The severity of its presentation varies from the complete absence of symptoms to cardiac tamponade. We present the case of a 23-year-old woman with chylopericardium and extensive neck vein thrombosis that was managed surgically with a pericardial window. PMID:28122899

  2. Perforating oesophageal carcinoma presenting as necrotizing fasciitis of the neck.

    Science.gov (United States)

    Francque, S M; Van Laer, C; Struyf, N; Vermeulen, P; Corthouts, B; Jorens, P G

    2001-10-01

    A patient with a history of schizophrenia was admitted to our hospital in an already severe stage of necrotizing fasciitis of the neck, complicated with mediastinitis and gangrene. Later on, he also developed a vena cava superior syndrome and sepsis. In the few cases and small series described in the literature, necrotizing fasciitis of the neck is usually associated with surgery or trauma. Less frequently, an orodental or pharyngeal infection, often innocuous, is the underlying cause. None of these causes could be identified in our patient. Initially, on computer-assisted tomography (CT) scan, a tracheal rupture was suspected, but this diagnosis could not be confirmed on bronchoscopic examination. On gastroscopy, a stenotic oesophageal segment was discovered. Biopsy of this segment showed a poorly differentiated squamous cell carcinoma. The patient died in sepsis. Autopsy confirmed the presence of a large proximal oesophageal tumour with perforation. As far as we know, no case of a necrotizing fasciitis of the neck caused by perforation of a formerly unknown oesophageal carcinoma has been reported. Even mediastinitis, with or without gangrene, is rarely associated with oesophageal cancer, and in the few cases reported it is always due to fistulization after surgery.

  3. Head, Neck, and Oral Cancer

    Science.gov (United States)

    ... a bright light and a mirror: Remove any dentures Look and feel inside the lips and the ... Early treatment may well be the key to complete recovery. Head, Neck & Oral Cancer Facts The information ...

  4. Spontaneous emphysema of the neck.

    Science.gov (United States)

    El-Ghazali, A M

    1983-04-01

    A case of spontaneous emphysema in the neck in a 17-year-old male was reported. Pathogenesis and management are discussed. Although it is a benign and self-limiting condition, it may carry a potential for serious complications.

  5. [The Ulm trauma track : Trauma care and research as focal points for medical students].

    Science.gov (United States)

    Huber-Lang, M; Radermacher, P; Palmer, A; Geiler, S; Grab, C; Wachter, U; Georgieff, M; Gebhard, F; Öchsner, W

    2017-03-01

    As part of the expansion of the site-specific education profile of the medical curriculum MED@ULM of the University of Ulm, a new track "trauma care and trauma research" was established in the winter semester 2012/2013. The acceptance of the track was evaluated during the winter semester 2013/2014. The 6-semester track extends the existing curriculum by offering subjects in trauma management and trauma research to students of human medicine. A central aim of the track is to promote medical professional competence, expertise in emergency care and competence in trauma-related scientific work and research. Central learning contents could be intensified in newly established emergency simulation training. Additionally, participating students have to perform a doctoral thesis on an obligatory trauma-related experimental subject. A first analysis study focusing on the learning style of the participating students (n = 17) and a control group consisting of members of the same semester (n = 20) was performed using the Kolb learning style inventory. In a validated evaluation in the winter semesters 2013/2014 and 2014/2015, the students were asked about their expectations and experience with the track, criticisms, suggestions and satisfaction with the study conditions. The data were analyzed using descriptive statistics. The analysis of the students' preferred learning styles revealed no differences between track students and the control group. Most of the students considered the track as a form of personal further education. The students had high expectations of practical skills with relevance to the clinical daily routine, learning scientific methods and preparing their thesis. The track students were more critical with regard to the study conditions than the control group students, although the track students of the third semester still judged their studies to be more interesting than the track students of the first semester and the control group. With the

  6. Neck pain in different cephalalgias

    Directory of Open Access Journals (Sweden)

    E. A. Chechet

    2014-01-01

    Full Text Available The paper reviews the literature related to the investigations of neck pain (cervicalgia in patients with headache (cephalalgia. Neck pain is second to lower back pain as a reason for considerable socioeconomic damage to society. The prevalence of cervicalgia in the population ranges from 5.9 to 38%; the annual incidence is 10.4–21.3%; 14.2 to 71% of people report to have neck pain at some time in their lifetime. Neck pain is concurrent with cephalalgia in 70% of cases. In patients with cervicalgia, the prevalence of headache is 20–40% higher than in those with musculoskeletal pain at another site. Neck pain is as a major risk factor for migraine and tension headache (TH. Neck pain in TH progresses with the increased intensity, frequency, and strength of headache. There is a direct relationship of the quality of life worsening associated withcervicalgia to the frequency of migraine attacks and the risk of its chronization. Neck pain is noted in cervicogenic headache belonging to secondary headaches. The identification of mixed headache in a patient with cervicalgia allows the prescription of a treatment option that may be effective in relieving both headache and neck pain. The paper discusses the causes and pathogenesis of cervicalgia in patients with headache, examination methods, and main approaches to drug and nondrug therapies in relation to the leading pathophysiological mechanism, as well as new possibilities for the effective and safe relief of pain syndrome in this category of patients. Nonsteroidal anti-inflammatory drugs, myorelaxants,and their combination are observed to be effective in treating patients with cervicalgia and cephalalgia.

  7. Childhood trauma and compulsive buying.

    Science.gov (United States)

    Sansone, Randy A; Chang, Joy; Jewell, Bryan; Rock, Rachel

    2013-02-01

    Childhood trauma has been empirically associated with various types of self-regulatory difficulties in adulthood. However, according to the extant literature, no study has examined relationships between various types of childhood trauma and compulsive buying behavior in adulthood. Using a self-report survey methodology in a cross-sectional consecutive sample of 370 obstetrics/gynecology patients, we examined five types of childhood trauma before the age of 12 years (i.e. witnessing violence, physical neglect, emotional abuse, physical abuse, sexual abuse) in relationship to compulsive buying as assessed by the Compulsive Buying Scale (CBS). All forms of trauma demonstrated statistically significant correlations with the CBS. Using a linear regression analysis, both witnessing violence and emotional abuse significantly contributed to CBS scores. Further analyses indicated that race did not moderate the relationship between childhood trauma and compulsive buying. Findings indicate that various forms of childhood trauma are correlated with compulsive buying behavior, particularly witnessing violence and emotional abuse.

  8. Trauma Systems. An Era of Development

    NARCIS (Netherlands)

    Lansink, K.W.W.

    2017-01-01

    The introduction of an inclusive trauma system in the Netherlands during last decade of the past century, has led to an improvement in Dutch trauma care. Eleven trauma regions were formed nationwide each surrounding a level I trauma center. All hospitals in a trauma region were assigned levels I, II

  9. Trauma Studies: prospettive e problemi

    Directory of Open Access Journals (Sweden)

    Rachele Branchini

    2013-12-01

    Full Text Available The trauma paradigm pervades contemporary life. In newspapers, on television, on the web, even in ordinary conversation, experiences of every kind (both figurative and positive ones are described as “traumatic”. Thus the very meaning of the term is often overturned. This article seeks to reshape the limits of the concept of trauma by tracing its evolution from the psychological debate of the early nineteenth century to the recent setting up of the specific discipline of Trauma Studies.

  10. [Resolution of a neck chylous fistula with oral diet treatment].

    Science.gov (United States)

    Cánovas, B; Morlán, M A; Familiar, C; Sastre, J; Marco, A; López, J

    2005-01-01

    Chylous fistula after neck dissection is a well-described complication. This pHatology can lead to serious respiratory and nutritional complications. Therapeutical options for chylous fistula remains controversial. On last reviews, there are an agreement on the conservative management. Within of this management, low long-chain triglycerides fat diet is an essential part.

  11. Novel insights into the interplay between ventral neck muscles in individuals with whiplash-associated disorders.

    Science.gov (United States)

    Peterson, Gunnel; Nilsson, David; Trygg, Johan; Falla, Deborah; Dedering, Åsa; Wallman, Thorne; Peolsson, Anneli

    2015-10-16

    Chronic whiplash-associated disorder (WAD) is common after whiplash injury, with considerable personal, social, and economic burden. Despite decades of research, factors responsible for continuing pain and disability are largely unknown, and diagnostic tools are lacking. Here, we report a novel model of mechanical ventral neck muscle function recorded from non-invasive, real-time, ultrasound measurements. We calculated the deformation area and deformation rate in 23 individuals with persistent WAD and compared them to 23 sex- and age-matched controls. Multivariate statistics were used to analyse interactions between ventral neck muscles, revealing different interplay between muscles in individuals with WAD and healthy controls. Although the cause and effect relation cannot be established from this data, for the first time, we reveal a novel method capable of detecting different neck muscle interplay in people with WAD. This non-invasive method stands to make a major breakthrough in the assessment and diagnosis of people following a whiplash trauma.

  12. Sick Leave within 5 Years of Whiplash Trauma Predicts Recovery: A Prospective Cohort and Register-Based Study.

    Directory of Open Access Journals (Sweden)

    Tina Birgitte Wisbech Carstensen

    Full Text Available 10-22% of individuals sustaining whiplash trauma develop persistent symptoms resulting in reduced working ability and decreased quality of life, but it is poorly understood why some people do not recover. Various collision and post-collision risk factors have been studied, but little is known about pre-collision risk factors. In particular, the impact of sickness and socioeconomic factors before the collision on recovery is sparsely explored. The aim of this study was to examine if welfare payments received within five years pre-collision predict neck pain and negative change in provisional situation one year post-collision.719 individuals with acute whiplash trauma consecutively recruited from emergency departments or primary care after car accidents in Denmark completed questionnaires on socio-demographic and health factors immediately after the collision. After 12 months, a visual analogue scale on neck pain intensity was completed. 3595 matched controls in the general population were sampled, and national public register data on social benefits and any other welfare payments were obtained for participants with acute whiplash trauma and controls from five years pre-collision to 15 months after. Participants with acute whiplash trauma who had received sickness benefit for more than 12 weeks pre-collision had increased odds for negative change in future provisional situation (Odds Ratio (OR (95% Confidence Interval (CI = 3.8 (2.1;7.1 and future neck pain (OR (95%CI = 3.3 (1.8;6.3, controlling for other known risk factors. Participants with acute whiplash trauma had weaker attachment to labour market (more weeks of sick leave (χ2(2 = 36.7, p < 0.001 and unemployment (χ2(2 = 12.5, p = 0.002 pre-collision compared with controls. Experiencing a whiplash trauma raised the odds for future negative change in provisional situation (OR (95%CI = 3.1 (2.3;4.4 compared with controls.Sick leave before the collision strongly predicted prolonged recovery

  13. Current experience with computed tomographic cystography and blunt trauma.

    Science.gov (United States)

    Deck, A J; Shaves, S; Talner, L; Porter, J R

    2001-12-01

    We present our experience with computed tomographic (CT) cystography for the diagnosis of bladder rupture in patients with blunt abdominal and pelvic trauma and compare the results of CT cystography to operative exploration. We identified all blunt trauma patients diagnosed with bladder rupture from January 1992 to September 1998. We also reviewed the radiology computerized information system (RIS) for all CT cystograms performed for the evaluation of blunt trauma during the same time period. The medical records and pertinent radiographs of the patients with bladder rupture who underwent CT cystography as part of their admission evaluation were reviewed. Operative findings were compared to radiographic findings. Altogether, 316 patients had CT cystograms as part of an initial evaluation for blunt trauma. Of these patients, 44 had an ultimate diagnosis of bladder rupture; 42 patients had CT cystograms indicating bladder rupture. A total of 28 patients underwent formal bladder exploration; 23 (82%) had operative findings that exactly (i.e., presence and type of rupture) matched the CT cystogram interpretation. The overall sensitivity and specificity of CT cystography for detection of bladder rupture were 95% and 100%, respectively. For intraperitoneal rupture, the sensitivity and specificity were 78% and 99%, respectively. CT cystography provides an expedient evaluation for bladder rupture caused by blunt trauma and has an accuracy comparable to that reported for plain film cystography. We recommend CT cystography over plain film cystography for patients undergoing CT evaluation for other blunt trauma-related injuries.

  14. Extrasensory Perception Experiences and Childhood Trauma: A Rorschach Investigation.

    Science.gov (United States)

    Scimeca, Giuseppe; Bruno, Antonio; Pandolfo, Gianluca; La Ciura, Giulia; Zoccali, Rocco A; Muscatello, Maria R A

    2015-11-01

    This study investigated whether people who report recurrent extrasensory perception (ESP) experiences (telepathy, clairvoyance, and precognition) have suffered more traumatic experiences and traumatic intrusions. Thirty-one nonclinical participants reporting recurrent ESP experiences were compared with a nonclinical sample of 31 individuals who did not report recurrent ESP phenomena. Past traumatic experiences were assessed via a self-report measure of trauma history (Childhood Trauma Questionnaire); traumatic intrusions were assessed via a performance-based personality measure (Rorschach Traumatic Content Index). Participants also completed the Anomalous Experience Inventory, the Minnesota Multiphasic Personality Inventory-2, the Dissociative Experience Scale, and the Revised Paranormal Belief Scale. The ESP group reported higher levels of emotional abuse, sexual abuse, emotional neglect, physical neglect, and traumatic intrusions. The association between ESP experiences and trauma was partly mediated by the effects of dissociation and emotional distress. Implications for health professionals are discussed. Results also showed the reliability of the twofold method of assessment of trauma.

  15. Blunt adrenal gland trauma in the pediatric population.

    Science.gov (United States)

    Roupakias, Stylianos; Papoutsakis, Marinos; Mitsakou, Paraskevi

    2011-07-01

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

  16. Correlation between Trunk Posture and Neck Reposition Sense among Subjects with Forward Head Neck Postures

    OpenAIRE

    Han Suk Lee; Hyung Kuk Chung; Sun Wook Park

    2015-01-01

    Objective. To assess the correlation of abnormal trunk postures and reposition sense of subjects with forward head neck posture (FHP). Methods. In all, postures of 41 subjects were evaluated and the FHP and trunk posture including shoulder, scapular level, pelvic side, and anterior tilting degrees were analyzed. We used the head repositioning accuracy (HRA) test to evaluate neck position senses of neck flexion, neck extension, neck right and left side flexion, and neck right and left rotation...

  17. Spinal trauma: first aid from cross-sectional imaging; Trauma der Wirbelsaeule: erste Hilfe durch Schnittbildverfahren

    Energy Technology Data Exchange (ETDEWEB)

    Schueller, G.; Schueller-Weidekamm, C. [Emergency Radiology Schueller, Neerach (Switzerland)

    2014-09-15

    The diagnosis of the traumatized spine is one of the key issues for trauma radiologists. The cross-sectional imaging procedures, computed tomography (CT) and magnetic resonance imaging (MRI) are the essential methods in spinal trauma radiology. These modalities are of great help in accurately assessing injury patterns and extent and in providing indications of patient outcome. In contrast to cross-sectional imaging, radiography has a role in the evaluation of minor spinal trauma only. It is generally accepted that trauma radiologists do not use typical classifications to evaluate the spine partly because such an ideal classification system does not yet exist. Not least because of this classification difficulty, eponyms and synonyms are widely used to describe traumatology of the spine as a high level of specific information is included in these various terms. The members of the trauma team should be aware of the strengths and limitations of the methods used in the assessment of the spine. This article provides a brief outline of fundamental knowledge about the diagnosis of spinal trauma. (orig.) [German] Die Beurteilung der verletzten Wirbelsaeule nimmt fuer Traumaradiologen eine zentrale Stellung ein. Die Schnittbildverfahren CT und MRT sind ihre wesentlichen Arbeitsmethoden. Sie helfen dabei, schnell und mit hoher Zuverlaessigkeit Aussagen ueber Art und Ausmass von Verletzungen zu treffen sowie Hinweise auf die Prognose der Patienten zu geben. Die Projektionsradiographie hat ihre Bedeutung lediglich in der Diagnostik des Bagatelltraumas und ist in ihrer Aussagekraft auch dort nicht unumstritten. Traumaradiologen bedienen sich nicht ausschliesslich typischer Klassifikationen des Wirbelsaeulentraumas, z. T. auch deshalb, da es die ideale Klassifikation aus heutiger Sicht nicht gibt. Vielmehr ist es wichtig, auch ueber Eponyme und Synonyme Bescheid zu wissen, da sie ein hohes Mass an spezifischen Informationen der spinalen Verletzungen verinnerlichen. Alle

  18. An investigation to determine the association between neck pain and upper limb disability for patients with non-specific neck pain: a secondary analysis.

    Science.gov (United States)

    McLean, Sionnadh Mairi; Moffett, Jennifer Klaber; Sharp, Donald Macfie; Gardiner, Eric

    2011-10-01

    This study investigated the relationship between neck pain and upper limb disability in patients with non-specific neck pain (n = 151) recruited from physiotherapy departments in the United Kingdom. Baseline neck pain/disability was measured using the Northwick Park Neck Pain Questionnaire (NPQ). Baseline upper limb disability was measured using the Disabilities of Arm, Shoulder, Hand questionnaire (DASH). A range of baseline psychosocial variables were measured as potential confounding variables. Pairwise analysis revealed a positive correlation between NPQ score and DASH score (Pearsons' r = 0.799, p pain self efficacy (PSE) scores (B = -0.489) {R(2) = 0.713; n = 100, p neck pain/disability also report severe upper limb disability. The relationship between neck pain/disability and upper limb disability was mediated by PSE. Clinically, the presence of severe neck pain or low PSE should direct clinicians towards an assessment of upper limb function. In these cases upper limb disability may need to be addressed as part of the neck management process.

  19. Changes in head and neck position affect elbow joint position sense.

    Science.gov (United States)

    Knox, Joanna J; Hodges, Paul W

    2005-08-01

    Changes in the position of the head and neck have been shown to introduce a systematic deviation in the end-point error of an upper limb pointing task. Although previous authors have attributed this to alteration of perceived target location, no studies have explored the effect of changes in head and neck position on the perception of limb position. This study investigated whether changes in head and neck position affect a specific component of movement performance, that is, the accuracy of joint position sense (JPS) at the elbow. Elbow JPS was tested with the neck in four positions: neutral, flexion, rotation and combined flexion/rotation. A target angle was presented passively with the neck in neutral, after a rest period; this angle was reproduced actively with the head and neck in one of the test positions. The potential effects of distraction from head movement were controlled for by performing a movement control in which the head and neck were in neutral for the presentation and reproduction of the target angle, but moved into flexion during the rest period. The absolute and variable joint position errors (JPE) were greater when the target angle was reproduced with the neck in the flexion, rotation, and combined flexion/rotation than when the head and neck were in neutral. This study suggests that the reduced accuracy previously seen in pointing tasks with changes in head position may be partly because of errors in the interpretation of arm position.

  20. Effectiveness of a tailored neck training program on neck strength, movement, and fatigue in under-19 male rugby players: a randomized controlled pilot study

    Directory of Open Access Journals (Sweden)

    Barrett MD

    2015-05-01

    Full Text Available Matthew D Barrett,1 Terence F McLoughlin,2 Kieran R Gallagher,1 Don Gatherer,3 Michael TR Parratt,1 Jonathan R Perera,1 Tim WR Briggs1 1Royal National Orthopaedic Hospital, Stanmore, Middlesex, United Kingdom; 2Royal Liverpool University Hospital, Liverpool, Mersey Deanery, United Kingdom; 3The Gatherer Partnership, Aylesbury, United Kingdom Purpose: To investigate the effect of a tailored neck muscle conditioning program on neck muscle strength, neck muscle fatigue, and range of neck movement in 16–18-year-old male rugby players. Materials and methods: Thirty-four male rugby players were divided into forward and back playing positions and randomized within these groups. Seventeen players were randomly assigned to each group. The test group was given a tailored 6-week exercise regime based on their baseline measurements to be performed three times a week in addition to their normal training and playing. The control group trained and played as normal. The outcome measures used were cervical spine range of movement, neck strength, and neck muscle fatigability. Results: There were no clinically relevant statistically significant differences between the two groups. Trends identified between the two groups suggest that a tailored neck exercise program increases neck strength, particularly neck extension, and increases resistance to fatigue, as well as influencing right- and left-sided neck muscle balance. A reduction in range of movement was also demonstrated in the test group. There was a great deal of variability in range of movement and strength within this age group. No previously undiagnosed neck conditions were detected, and there were no adverse events reported. Conclusion: This study has shown that neck strength, range of movement, and susceptibility of the neck muscles to fatigue can be influenced using a focused neck training regime. It forms an important basis for a larger, multicenter study to ensure the neck is given due attention in

  1. Trauma and posttraumatic stress disorder in Japan: Results from the World Mental Health Japan Survey

    OpenAIRE

    Kawakami, Norito; Tsuchiya, Masao; Umeda, Maki; Koenen,Karestan C; Kessler, Ronald C.

    2014-01-01

    The purpose of the study was to report the prevalence of trauma exposure and PTSD, conditional risk of PTSD associated with each trauma exposure in the community population in Japan. An interview survey was conducted of a random sample of adult residents in 11 communities of Japan. Among 4134 respondents (response rate, 55%), data from those who completed the part 2 interview (n = 1682) were analyzed with a weight for this subsample. Lifetime experiences of 27 trauma events and PTSD were asse...

  2. A Civilian/Military Trauma Institute: National Trauma Coordinating Center

    Science.gov (United States)

    2012-10-01

    Rehabilitation Physical therapy/ rehabilitation evaluation Fracture femur OR tibia OR pelvis AND not in ICU 25. Evaluation Abdominal CT scans during...Trauma, ICU , education, research, training, analysis, practice 15. SUBJECT TERMS 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF ABSTRACT...POC encompassed all aspects of trauma care, including initial evaluation, resuscitation, oper- ative care, critical care, rehabilitation , and injury

  3. Trauma-Focused CBT for Youth with Complex Trauma

    Science.gov (United States)

    Cohen, Judith A.; Mannarino, Anthony P.; Kliethermes, Matthew; Murray, Laura A.

    2012-01-01

    Objectives: Many youth develop complex trauma, which includes regulation problems in the domains of affect, attachment, behavior, biology, cognition, and perception. Therapists often request strategies for using evidence-based treatments (EBTs) for this population. This article describes practical strategies for applying Trauma-Focused Cognitive…

  4. Trauma-Focused CBT for Youth with Complex Trauma

    Science.gov (United States)

    Cohen, Judith A.; Mannarino, Anthony P.; Kliethermes, Matthew; Murray, Laura A.

    2012-01-01

    Objectives: Many youth develop complex trauma, which includes regulation problems in the domains of affect, attachment, behavior, biology, cognition, and perception. Therapists often request strategies for using evidence-based treatments (EBTs) for this population. This article describes practical strategies for applying Trauma-Focused Cognitive…

  5. Psychosocial factors in trauma patients : studies on trauma recurrence and trauma recovery

    OpenAIRE

    Ponzer, Sari

    1999-01-01

    The present studies aimed to highlight the influence of psychosocial and psychiatric factors on trauma recurrence and trauma recovery. A subgroup of trauma patients, 820 victims of firearm injuries, were compared to an age- and sex-matched control group in a retrospective register study. The results showed that firearm victims were characterised by high mortality, morbidity and antisocial traits independent of the intention of the gunshot. Hospitalisation due to injuries as ...

  6. Healing the Trauma of Sethe:A Psychological Study on Toni Morrison’s Beloved

    Institute of Scientific and Technical Information of China (English)

    ZHAO Xiang-yu

    2015-01-01

    Beloved is one of Toni Morrison’s most famous novels and attracts much attention from the public.This essay aims to ana⁃lyze the healing process of Sethe’s trauma from the perspective of psychological analysis. There are four parts. First, it introduces the plot of the story and the theory. The second part analyzes the forming of Sethe’s trauma and the third part discusses the healing process. The last part reaches the conclusion. By analyzing Sethe’s trauma from psychoanalysis, this paper aims to help these black people to reconstruct their identity and achieve renascence.

  7. Facial nerve palsy due to birth trauma

    Science.gov (United States)

    Seventh cranial nerve palsy due to birth trauma; Facial palsy - birth trauma; Facial palsy - neonate; Facial palsy - infant ... this condition. Some factors that can cause birth trauma (injury) include: Large baby size (may be seen ...

  8. Trauma as Pathogenesis of a Plantar Forefoot Fibrolipoma: First Case and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Juliana S. P. Vasconcelos

    2013-01-01

    Full Text Available Lipomas and their variants are benign soft-tissue tumors that occur at any age and most frequently on the upper back and neck, shoulder, and abdomen. The foot is a relatively uncommon site for soft-tissue neoplasia and the etiology is not usually related to trauma. We describe a case of a pedunculated fibrolipoma of the forefoot that originated from a cut wound at the Atlantic Ocean. A brief review of the literature is also given.

  9. Are trauma patients better off in a trauma ICU?

    Directory of Open Access Journals (Sweden)

    Duane Therese

    2008-01-01

    Full Text Available There is very little data on the value of specialized intensive care unit (ICU care in the literature. To determine if specialize ICU care for the trauma patient improved outcomes in this patient population. Level I Trauma Center Compared outcomes of trauma patients treated in a surgical trauma ICU (STICU to those treated in non- trauma ICUs (non-STICU. Retrospective review of trauma registry data. Statistical Analysis: Wilcoxon Rank Test , Fischer′s Exact test, logistic regression. There were 1146 STICU patients compared to 1475 non-STICU. In all ISS groups there were more penetrating trauma patients in the STICU (32.54% STICU vs. 18.15% non-STICU, P < 0.0001 (ISS< 15, (21.03% STICU vs. 12.98% non-STICU, P =0.0074 (ISS between 15-25, and (19.42% STICU vs. 11.35% non-STICU, P =0.0026 (ISS> 25. All groups had similar lengths of stay. The blunt trauma patients were sicker in the STICU (20.8 ISS ± 12.2 STICU vs. 19.7 ISS ± 11.9 non-STICU, P =0.03 yet had similar outcomes to the non-STICU group. Logistic regression identified penetrating trauma and not ICU location as a predictor of mortality. Sicker STICU patients do as well as less injured non-STICU patients. Severely injured patients should be preferentially treated in a STICU where they are better equipped to care for the complex multi-trauma patient. All patients, regardless of location, do well when their management is guided by a surgical critical care team.

  10. Therapeutic modalities in the management of nonspecific neck pain.

    Science.gov (United States)

    Swenson, Rand S

    2003-08-01

    This article has surveyed several therapeutic modalities, including physical modalities, thermal modalities, electrical modalities, exercise therapy, behavioral therapy, education, and laser therapy. Of these, exercise, mobilization, and manipulation have the greatest support in the literature, whereas thermal treatments (including therapeutic ultrasound), and electrical therapies (including TENS) have little evidence of effectiveness and no evidence for more than a transient benefit. There is a need for well-controlled studies of educational programs and behavioral interventions specifically for patients with chronic neck pain, particularly because these interventions are often employed as part of a multimodal treatment program. Low-power laser treatment and magnetic therapy require some well-controlled studies before they can be recommended to neck pain patients or discarded as worthless interventions. Cervical traction and soft collars seem to be generally ineffective for nonspecific neck pain.

  11. Larynx Trauma and Hyoid Bone Fracture after Bite Injury in Dog: Case Report

    Science.gov (United States)

    Manchi, George; Brunnberg, Mathias M.; Shahid, Muhammad; Al Aiyan, Ahmad; Brunnberg, Leo; Stein, Silke

    2016-01-01

    An 8-year-old male Jack Russell crossbreed dog was admitted to our hospital with dyspnea and shock following a dog-bite injury on the ventral neck. Radiographs revealed subcutaneous emphysema and bilateral thyrohyoid bone fractures. Intraoperatively, rupture of both sternohyoid muscles, both hyoepiglotticus muscles, both thyrohyoid muscles, and a partial cranial rupture of the superficial sphincter colli muscle were detected. Part of the epiglottis was detached from the thyroid cartilage. The patient’s severed muscles and torn epiglottis were reattached using a simple interrupted suture pattern. Hyoepiglotticus muscles could not be identified. The bilateral thyrohyoid bone fractures were repaired with intraosseous wire suture. A temporary tracheostomy tube and an esophageal feeding tube were placed postoperatively. The dog was discharged after 8 days, re-examined at 2 and 6 months and laryngeal and pharyngeal function were evaluated as normal. To the authors’ knowledge, this is the first report of a dog that presented with laryngeal trauma with hyoid bone fracture and acute dyspnea that underwent surgical treatment resulting in an acceptable outcome. PMID:27579303

  12. Larynx trauma and hyoid bone fracture after bite injury in dog: case report

    Directory of Open Access Journals (Sweden)

    George Manchi

    2016-08-01

    Full Text Available An 8-year-old male Jack Russell crossbreed dog was admitted to our hospital with dyspnoea and shock following a dog-bite injury on the ventral neck. Radiographs revealed subcutaneous emphysema and bilateral thyrohyoid bone fractures. Intra-operatively, rupture of both sternohyoid muscles, both hyoepiglotticus muscles, both thyrohyoid muscles and a partial cranial rupture of the superficial sphincter colli muscle were detected. Part of the epiglottis was detached from the thyroid cartilage. The patient’s severed muscles and torn epiglottis were reattached using a simple interrupted suture pattern. Hyoepiglotticus muscles could not be identified. The bilateral thyrohyoid bone fractures were repaired with intraosseous wire suture. A temporary tracheostomy tube and an esophageal feeding tube were placed postoperatively. The dog was discharged after 8 days, re-examined at 2 and 6 months and laryngeal and pharyngeal function were evaluated as normal. To the authors’ knowledge, this is the first report of a dog that presented with laryngeal trauma with hyoid bone fracture and acute dyspnea who underwent surgical treatment resulting in an acceptable outcome.

  13. 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.

  14. 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.

  15. Assessment of a Comprehensive Anti-Aging Neck Cream.

    Science.gov (United States)

    Saxena, Subhash J; Duque, Deysi; Schirripa, Michael J

    2015-09-01

    With many effective anti-aging solutions for the face, consumer focus is now turning to other parts of the body including the delicate skin on the neck. This study investigates the effect of a new neck cream on the appearance of texture, fine lines and wrinkles, laxity, and hydration. 85 adult females ages 35-65 with Fitzpatrick skin types I through IV applied the test neck cream twice daily for a 3-month study period. Screening was conducted at Baseline, 2, 30, 60, and 90 days via a virtual trial. Subjects rated satisfaction in each of 4 anti-aging categories including hydration, texture, appearance of wrinkles, and appearance of laxity as well as three product attributes including application, feel, and smell. Improvement was statistically significant for all measured categories (hydration, texture, appearance of wrinkles, and appearance of laxity) with 94% of study subjects noting improvement in one or more of the measured categories. Further, the quantity of "Satisfied" and "Highly Satisfied" assessments increased 8-fold from baseline with a 94x increase in the quantity of "Highly Satisfied" assessments. The results demonstrate the product's rapid and continuing ability to improve the self-perceived signs of aging in the neck area including improvement in skin texture on the neck and a reduction in the appearance of wrinkles and laxity along the jawline. Future studies are recommended to determine the primary action mechanisms and to assess the degree of improvement by blinded physician assessment.

  16. Novel insights in elbow trauma

    NARCIS (Netherlands)

    Claessen, F.M.A.P.

    2016-01-01

    Musculoskeletal trauma is among the ten most common causes for loss of healthy life years (disability adjusted life years) in Western Countries. Nine percent of all musculoskeletal trauma is related to the elbow; in athletes the prevalence is 11 percent. Approximately 80 percent of patients that had

  17. Prehospital fluid resuscitation in trauma

    NARCIS (Netherlands)

    Raum, M. R.; Waydhas, C.

    2009-01-01

    The indications for and type and amount of fluid resuscitation for trauma patients in the field remains highly controversial. There is unanimity, however, that trauma victims may suffer from acute blood loss. In addition to stopping the bleeding fluid resuscitation is the second mainstay in shock th

  18. Novel insights in elbow trauma

    NARCIS (Netherlands)

    Claessen, F.M.A.P.

    2016-01-01

    Musculoskeletal trauma is among the ten most common causes for loss of healthy life years (disability adjusted life years) in Western Countries. Nine percent of all musculoskeletal trauma is related to the elbow; in athletes the prevalence is 11 percent. Approximately 80 percent of patients that had

  19. Clinical management of abdominal trauma

    Institute of Scientific and Technical Information of China (English)

    FANG Guo-en; LUO Tian-hang; DU Cheng-hui; BI Jian-wei; XUE Xu-chao; WEI Guo; WENG Zhao-zhang; MA Li-ye; HUA Ji-de

    2008-01-01

    Objective: To improve the prognosis of patients with abdominal trauma. Methods: Between January 1993 and December 2005, 415 patients were enrolled in this research. The patients consisted of 347 males and 68 females with mean age of 36 years ranging from 3-82 years. All abdominal traumas consisted of closed traumas 360 cases, 86.7% and open traumas 55 cases, 13.3%. Results: Atotal of 407 cases 98.1% were fully recovered from trauma and the other 8 cases 1.9% died of multiple injuries. The mean injury severity score ISS of all patients was 22 while the mean ISS of the patients who died in hospital was 42. Postoperative complications were seen in 9 patients such as infection of incisional wounds 6 cases, pancreatic fistula 2 cases and intestinal fistula 1 case. All these postoperative complications were cured by the conservative treatment. Conclusion: Careful case history inquisition and physical examination are the basic methods to diagnose abdomi- nal trauma. Focused abdominal ultrasonography is always the initial imaging examination because it is non-invasive and can be performed repeatedly with high accuracy. The doctors should consider the severity of local injuries and the general status of patients during the assessment of abdominal trauma. The principle of treatment is to save lives at first, then to cure the injuries. Unnecessary laparotomy should be avoided to reduce additional surgical trauma.

  20. Sexual Trauma, Spirituality, and Psychopathology

    Science.gov (United States)

    Krejci, Mark J.; Thompson, Kevin M.; Simonich, Heather; Crosby, Ross D.; Donaldson, Mary Ann; Wonderlich, Stephen A.; Mitchell, James E.

    2004-01-01

    This study assessed the association between spirituality and psychopathology in a group of sexual abuse victims and controls with a focus on whether spirituality moderated the association between sexual trauma and psychopathology. Seventy-one sexual trauma victims were compared to 25 control subjects on spiritual well-being, the Eating Disorder…

  1. Altered motor control patterns in whiplash and chronic neck pain

    Directory of Open Access Journals (Sweden)

    Vasseljen Ottar

    2008-06-01

    history of neck trauma, nor to current pain, but more likely due to long-lasting pain. No group differences were found for kinaesthetic sense.

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

    Directory of Open Access Journals (Sweden)

    João Palas

    2014-01-01

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

  3. Multidetector computer tomography: evaluation of blunt chest trauma in adults.

    Science.gov (United States)

    Palas, João; Matos, António P; Mascarenhas, Vasco; Herédia, Vasco; Ramalho, Miguel

    2014-01-01

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

  4. A rare and lethal case of right common carotid pseudoaneurysm following whiplash trauma.

    Science.gov (United States)

    Pomara, Cristoforo; Bello, Stefania; Serinelli, Serenella; Fineschi, Vittorio

    2015-03-01

    Whiplash trauma from a car crash is one of the most common causes of neck injury, resulting in pain and dysfunction. We report on an unusual case of post-whiplash pseudoaneurysm of the right common carotid artery, which led to acute massive hemorrhage and death days after the initial trauma. A post-mortem computed tomography angiography showed rupture of the pseudoaneurysm of the right common carotid artery with the contrast agent leaking out into the mouth. The subsequent autopsy confirmed a large hemorrhagic clot extending to the right side of the neck and mediastinum. A rupture of the right wall of the oropharynx was identified with massive bronchial hemoaspiration. The case demonstrates a rare but lethal clinical entity, and is important in providing a better understanding of the potentially fatal consequences of minor trauma, such as whiplash injury, and its physiopathological mechanisms. Thus, changing symptoms after a whiplash injury should be carefully evaluated since they can be related to the underlying severe consequences of a rapid hyperextension-hyperflexion of the neck, as in the reported case.

  5. Maternal mortality due to trauma.

    Science.gov (United States)

    Romero, Vivian Carolina; Pearlman, Mark

    2012-02-01

    Maternal mortality is an important indicator of adequacy of health care in our society. Improvements in the obstetric care system as well as advances in technology have contributed to reduction in maternal mortality rates. Trauma complicates up to 7% of all pregnancies and has emerged as the leading cause of maternal mortality, becoming a significant concern for the public health system. Maternal mortality secondary to trauma can often be prevented by coordinated medical care, but it is essential that caregivers recognize the unique situation of providing simultaneous care to 2 patients who have a complex physiologic relationship. Optimal management of the pregnant trauma victim requires a multidisciplinary team, where the obstetrician plays a central role. This review focuses on the incidence of maternal mortality due to trauma, the mechanisms involved in traumatic injury, the important anatomic and physiologic changes that may predispose to mortality due to trauma, and finally, preventive strategies that may decrease the incidence of traumatic maternal death.

  6. Vascular trauma in Western Australia: a comparison of two study periods over 15 years.

    Science.gov (United States)

    Friend, Jikol; Rao, Sudhakar; Sieunarine, Kishore; Woodroof, Paul

    2016-03-01

    Royal Perth Hospital (RPH) has become Western Australia's only designated adult major trauma facility since a previous study of vascular trauma was conducted in 2001 at the same facility. The aim of this study is to identify changes in vascular trauma patterns over the two study periods and compare these changes with international literature. All individuals presenting to RPH between January 2000 and December 2010 with vascular injury were identified from a prospective trauma database for this descriptive study. Injuries were classified using the Abbreviated Injury Score (AIS). The incidence of vascular trauma as a percentage of total trauma increased over the two study periods. The current 10-year study included 45 164 patients on the trauma database, of which 1205 patients (2.6%) sustained 1335 vascular injuries, an increase from 1% in the previous 5-year study at the same facility. Males aged 20-29 years were more frequently injured. Blunt trauma occurred more frequently than penetrating. The extremities, particularly the upper limbs were most commonly injured. The most common causes of injury for each region were as follows; motorbike crash (MBC), motor vehicle crash (MVC) and stabbing (neck, thorax and abdomen), MBC and MVC (lower limb) and piercing injuries (upper limb). Injury Severity Score (ISS) and mortality 43% (32 of 75) were highest for thoracic injuries, particularly thoracic aorta injury. Mortality rate has decreased. Vascular injuries in Western Australia are increasing. MVC are the most common cause of life threatening injury. Road safety interventions targeting young males are likely to reduce trauma. © 2013 Royal Australasian College of Surgeons.

  7. Association of neck pain, disability and neck pain during maximal effort with neck muscle strength and range of movement in women with chronic non-specific neck pain.

    Science.gov (United States)

    Ylinen, Jari; Takala, Esa-Pekka; Kautiainen, Hannu; Nykänen, Matti; Häkkinen, Arja; Pohjolainen, Timo; Karppi, Sirkka-Liisa; Airaksinen, Olavi

    2004-10-01

    Several studies have reported lower neck muscle strength in patients with chronic neck pain compared to healthy controls. The aim of the present study was to evaluate the association between the severity of neck pain and disability with neck strength and range of movement in women suffering from chronic neck pain. One hundred and seventy-nine female office workers with chronic neck pain were selected to the study. The outcome was assessed by the self-rating questionnaires on neck pain (visual analogue scale, Vernon's disability index, Neck pain and disability index) and by measures of the passive range of movement (ROM) and maximal isometric neck muscle strength. No statistically significant correlation was found between perceived neck pain and the disability indices and the maximal isometric neck strength and ROM measures. However, the pain values reported during the strength tests were inversely correlated with the results of strength tests (r=-0.24 to -0.46), showing that pain was associated with decreased force production. About two-thirds of the patients felt pain during test efforts. Pain may prevent full effort during strength tests and hence the production of maximal force. Thus in patients with chronic neck pain the results do not always describe true maximal strength, but rather the patients' ability to bear strain, which may be considerably influenced by their painful condition. The results of the present study suggest that rehabilitation in cases of chronic neck pain should aim at raising tolerance to mechanical strain.

  8. Trauma patient outcome after the Prehospital Trauma Life Support program.

    Science.gov (United States)

    Ali, J; Adam, R U; Gana, T J; Williams, J I

    1997-06-01

    We have previously demonstrated a significant improvement in trauma patient outcome after the Advanced Trauma Life Support (ATLS) program in Trinidad and Tobago. In January of 1992, a Prehospital Trauma Life Support (PHTLS) program was also instituted. This study assessed trauma patient outcome after the PHTLS program. Morbidity (length of stay and degree of disability), mortality, injury severity score, mechanism of injury, age, and sex among all adult trauma patients transported by ambulance to the major trauma hospital were assessed between July of 1990 to December of 1991 (pre-PHTLS, n = 332) and January of 1994 to June of 1995 (post-PHTLS, n = 350). Age, sex distribution, percentage blunt injury, and injury severity score were similar for both groups. Mortality pre-PHTLS (15.7%) was greater than post-PHTLS (10.6%). Length of stay and disability were statistically significantly decreased post-PHTLS. Age, injury severity score, and mechanism of injury were positively correlated with mortality in both periods. The previously reported post-ATLS mortality was similar to the pre-PHTLS mortality. Post-PHTLS mortality and morbidity were significantly decreased, suggesting a positive impact of the PHTLS program on trauma patient outcome.

  9. Essential Trauma Care: strengthening trauma systems round the world.

    Science.gov (United States)

    Joshipura, Manjul; Mock, Charles; Goosen, Jacques; Peden, Margie

    2004-09-01

    Injury has become a major cause of death and disability world-wide. Systematic approaches to its prevention and treatment are needed. In terms of treatment, there are many low-cost improvements that could be made particularly in low- and middle-income countries to strengthen their trauma systems. These can be formalised under "Essential Trauma Care" programme, similar to other global programmes for major public health problems. World Health Organisation (WHO), leading the initiative in this direction, convened a meeting at Geneva in June 2002, involving Injuries and Violence Prevention Department of the WHO, the Working Group for Essential Trauma Care of the International Association for Trauma and Surgical Intensive Care (IATSIC), representatives of other organisations and trauma care clinicians representing Africa, Asia, and Latin America. The meeting developed a preliminary list of Essential Trauma Care services and a model template for the skills and equipment needed to assure them. It is intended to be used to assist individual countries in planning their own trauma care services.

  10. 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.)

  11. 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

  12. Trauma cardiaco cerrado

    Directory of Open Access Journals (Sweden)

    Camilo Alvarado

    2016-01-01

    Full Text Available El trauma cardiaco constituye una de las primeras causas de mortalidad en la población general. Requiere alto índice de sospecha en trauma cerrado severo, mecanismo de desaceleración y en presencia de signos indirectos como: equimosis, huella del volante o del cinturón en el tórax anterior. Las lesiones incluyen: conmoción cardiaca, ruptura cardiaca, lesión cardiaca indirecta como la trombosis coronaria aguda, lesión aórtica, lesión del pericardio y herniación cardiaca. Entre las manifestaciones clínicas están: la angina refractaria a nitratos, el dolor pleurítico, la hipotensión arterial, la taquicardia, la ingurgitación yugular que aumenta con la inspiración, el galope por tercer ruido, el frote pericárdico, los soplos de reciente aparición, los estertores crepitantes por edema pulmonar. El electrocardiograma es el primer eslabón en el algoritmo diagnóstico con hallazgos como: la taquicardia sinusal, los complejos ventriculares prematuros, la fibrilación auricular, el bloqueo de rama derecha y los bloqueos auriculoventriculares. La radiografía de tórax ayuda a descartar lesiones adicionales óseas y pulmonares. La troponina I tiene un valor predictivo negativo del 93% para el trauma cardiaco, otras enzimas como la creatina quinasa total y la creatina quinasa fracción MB son menos específicas. El ecocardiograma está indicado en caso de hipotensión persistente, electrocardiograma con alteraciones o falla cardiaca aguda. El tratamiento incluye la estabilización inicial y un manejo específico de las lesiones. Entre las complicaciones se incluyen: el taponamiento cardiaco, la contusión miocárdica, el síndrome coronario agudo, las arritmias cardíacas y la lesión aórtica. El pronóstico se determina en mayor medida por los signos vitales al ingreso y la presencia de paro cardiaco durante el abordaje inicial.

  13. Suitable time of treating maxillofacial trauma caused by traffic accident in general hospitals

    Institute of Scientific and Technical Information of China (English)

    桑修文; 赵宏伟; 等

    1999-01-01

    Objective To explore sutitable time of treating maxillofacial trauma caused by traffic accident in general hospitals to decrease adverse effect caused by delayed therapy.Methods:In recent 10 years we have treated 154 cases of maxillofacial trauma by traffic accidents and their data were analyzed.Results:Early surgical therapy could be done in maxillofacial soft tissue trauma.The therapy of returning occlusion relation or temporary fixing was performed in bone fracture before porosis.Conclusions:For maxilloficial trauman and trauman of other parts caused by traffic accidents.early treatment should be done in order to decrease dysfunction and deformity caused by maxillofacial trauma.

  14. Deep space infections of neck.

    Science.gov (United States)

    Kaluskar, S; Bajaj, P; Bane, P

    2007-03-01

    A retrospective study was performed on fourteen cases of deep cervical space infections in the neck admitted for diagnosis and treatment to the ENT Department, during a period of seven years from 1989-1997. Of the fourteen, four patients had Ludwig's angina and of the fourteen, one had a very serious complication resulting in death. Early diagnosis and adequate treatment were of paramount importance. The role of tracheostomy and management of airway in deep cervical space infections of the neck is discussed to gether with bacteriology, antibiotic treatment and surgical management.

  15. FKBP5 as a possible moderator of the psychosis-inducing effects of childhood trauma

    NARCIS (Netherlands)

    Collip, Dina; Myin-Germeys, Inez; Wichers, Marieke; Jacobs, Nele; Derom, Catherine; Thiery, Evert; Lataster, Tineke; Simons, Claudia; Delespaul, Philippe; Marcelis, Machteld; van Os, Jim; van Winkel, Ruud

    Background FK506 binding protein 5 (FKBP5) has repeatedly been shown to be a critical determinant of post-traumatic stress disorder (PTSD) and depression following childhood trauma. Aims To examine the role of FKBP5 trauma interactions in the partly stress-related psychosis phenotype. Method In 401

  16. FKBP5 as a possible moderator of the psychosis-inducing effects of childhood trauma

    NARCIS (Netherlands)

    Collip, Dina; Myin-Germeys, Inez; Wichers, Marieke; Jacobs, Nele; Derom, Catherine; Thiery, Evert; Lataster, Tineke; Simons, Claudia; Delespaul, Philippe; Marcelis, Machteld; van Os, Jim; van Winkel, Ruud

    2013-01-01

    Background FK506 binding protein 5 (FKBP5) has repeatedly been shown to be a critical determinant of post-traumatic stress disorder (PTSD) and depression following childhood trauma. Aims To examine the role of FKBP5 trauma interactions in the partly stress-related psychosis phenotype. Method In 401

  17. The evaluation and intervention of psychological trauma of the fire fighters took part in WENCHUAN earthquake post-disaster relief%对参加汶川地震救援的消防战士心理创伤的评估与干预

    Institute of Scientific and Technical Information of China (English)

    赵长江; 黎雪松; 谢国军; 容倩华; 伍丽华

    2010-01-01

    Objective To assessment the mental health status and the effects of implementation of psychological intervention on the maintenance of health, treatment and prevention of secondary psychological trauma of the fire fighters take part in post-disaster relief. Methods 33 fire fighters who took part in postdisaster relief was set as Study Group, and then randomly selected 33 fire fighters who did not take part in post-disaster relief as the control group. The Study Group used collective, group and one-to-one psychological counseling for psychological intervention. Six months later, evaluate the psychological condition of the study group. Results After psychological intervention, the fire fighters who took part in post-disaster relief feel better than before, emotional stability, and flashback symptoms disappeared; the experience of anxiety and fear rapid alleviated. Psychological intervention can assist them in passing through the psychological trauma, reducing the adverse effects of post-disaster psychological stimulate factors and protect and enhance the mental health level of fire fighters. Conclusion Early psychological intervention for fire fighters psychological problems and psychological trauma occurred in the course of relief has a significant effect. psychological intervention can help the fire fighters proventing the secondary psychological traumas.%目的 了解参加灾后救援的消防战士的心理健康状况和实施心理干预对维护健康、治疗与防范二级心理创伤的效果.方法 将33名参加灾后救援的消防战士设为研究组,再随机抽取33名未参加救援的消防战士设为对照驵,对研究组采用集体心理辅导、小组心理辅导和一对一心理辅导进行心理干预;半年后对研究组重新进行心理评估.结果 参加救援消防战士心理干预感受良好,情绪减低、闪回症状基本消失,焦虑、恐惧体验等迅速缓解,心理干预能够帮助他们渡过心理创伤,减少灾后

  18. Gravidade do trauma avaliada na fase pré-hospitalar Trauma severity assessment in prehospital setting

    Directory of Open Access Journals (Sweden)

    I.Y. Whitaker

    1998-06-01

    . RESULTS: Prehospital attendance was carried out in 81.31% until 40 minutes. Non-fatal victims (83.96% had 12 and 11 TSm scores while 53.96% of the fatal victims had 0, 1 and 2 scores. External surface (30.25% and head/neck (20.98% were most injured areas and 63.63% fatal victims with Injury Severity Score (ISS > or = 16 died within first 24 hours. Comparing the fatal victims TSm and ISS scores verified that 81.20% victims with TSm score between 0 and 11 had major trauma (ISS > or = 16. CONCLUSION: Strong trends were also found out in that fatal victims with low TSm scores showed relations to the high ISS scores.

  19. Orthopedic trauma in pregnancy.

    Science.gov (United States)

    Desai, Pratik; Suk, Michael

    2007-11-01

    Trauma sustained during pregnancy can trigger uncertainty and anxiety for patient and orthopedic surgeon alike. In particular, orthopedic-related injuries raise concerns about preoperative, intraoperative, and postoperative care. In this article, we review common concerns about radiation exposure, leukemia, pain management, anticoagulation, and anesthesia. One finding is that radiation risk is minimal when obtaining x-rays for operative planning, provided that the cumulative dose is within 5 rad. We also address safety concerns about patient positioning and staff radiation exposure. In addition, we found that most anesthetics used in pregnancy are category C (ie, safe). Perioperative opioid use for pain management is recommended with little risk. Regarding anticoagulation, low-molecular-weight heparin and fondaparinux are the safest choices. Last, pregnancy is not a contraindication to operative management of pelvic and acetabular fractures.

  20. [Minor craniocerebral trauma].

    Science.gov (United States)

    Scharplatz, D; Zimmermann, H

    2002-09-04

    Mild craniocerebral injury or mild traumatic brain injury (MTBI) predominates, occurring with an 80% frequency. A 1997 publication by the American Academy of Neurology clearly defines MTBI as a transient alteration of mental status, without any neurological deficit, that may or may not involve loss of consciousness or amnesia. On the Glasgow Coma Scale (GCS), mild craniocerebral injury corresponds to a score of 14 and 15. The GCS must be taken immediately. Advanced trauma life support follows primary survey methodology and ABCDE protocol. The prognosis in MTBI is significantly worse when the patient suffers from intercurrent hypotension and hypoxia. In smaller hospitals, 24-hour monitoring is imperative. Wherever computerized tomography (CT) is available, a CT examination is broadly indicated. There is no knowledge of any adverse effects on patients whose GCS worsened when the CT revealed normal findings.

  1. Predicting significant torso trauma.

    Science.gov (United States)

    Nirula, Ram; Talmor, Daniel; Brasel, Karen

    2005-07-01

    Identification of motor vehicle crash (MVC) characteristics associated with thoracoabdominal injury would advance the development of automatic crash notification systems (ACNS) by improving triage and response times. Our objective was to determine the relationships between MVC characteristics and thoracoabdominal trauma to develop a torso injury probability model. Drivers involved in crashes from 1993 to 2001 within the National Automotive Sampling System were reviewed. Relationships between torso injury and MVC characteristics were assessed using multivariate logistic regression. Receiver operating characteristic curves were used to compare the model to current ACNS models. There were a total of 56,466 drivers. Age, ejection, braking, avoidance, velocity, restraints, passenger-side impact, rollover, and vehicle weight and type were associated with injury (p < 0.05). The area under the receiver operating characteristic curve (83.9) was significantly greater than current ACNS models. We have developed a thoracoabdominal injury probability model that may improve patient triage when used with ACNS.

  2. Lightweight Trauma Module - LTM

    Science.gov (United States)

    Hatfield, Thomas

    2008-01-01

    Current patient movement items (PMI) supporting the military's Critical Care Air Transport Team (CCATT) mission as well as the Crew Health Care System for space (CHeCS) have significant limitations: size, weight, battery duration, and dated clinical technology. The LTM is a small, 20 lb., system integrating diagnostic and therapeutic clinical capabilities along with onboard data management, communication services and automated care algorithms to meet new Aeromedical Evacuation requirements. The Lightweight Trauma Module is an Impact Instrumentation, Inc. project with strong Industry, DoD, NASA, and Academia partnerships aimed at developing the next generation of smart and rugged critical care tools for hazardous environments ranging from the battlefield to space exploration. The LTM is a combination ventilator/critical care monitor/therapeutic system with integrated automatic control systems. Additional capabilities are provided with small external modules.

  3. AN APPROACH TO THE NECK MASS

    African Journals Online (AJOL)

    Enrique

    The neck mass is often surrounded by mystique — in arriving at a diagnosis as ... and Neck Surgery at. Groote Schuur ... picious features include lymph nodes ..... Blood investigations can often exclude ... after treatment with antibiotics, referral.

  4. Neck Circumference and Cardio- Metabolic Syndrome

    OpenAIRE

    Kumar, Nagendran Vijaya; Ismail, Mohammed H.; P, Mahesha; M, Girish; Tripathy, Monica

    2014-01-01

    Background: Only few studies about neck circumference (NC) as a measure of cardio metabolic syndrome available from India. Study was conducted to establish an association between neck circumference and cardio metabolic syndrome.

  5. Unusual origin and potentially hazardous course of the major blood vessels in neck – A clinically relevant rare case

    Directory of Open Access Journals (Sweden)

    Rastogi R

    2010-04-01

    Full Text Available We present a rare case of aberrant left brachiocephalic vein and brachiocephalic artery, which crosses the trachea in the neck obliquely and closely related to lower border of thyroid gland. If not noticed while performing open or percutaneous dilatational tracheostomy or other neck surgeries, trauma to these vessel and subsequent hemorrhage can occur and may be fatal. Vascular compression of the airway causing obstructive symptoms can also occur due to this anomaly. In this report the case is presented along with its clinical significance.

  6. [Penetrating injuries in the face and neck region. Diagnosis and treatment].

    Science.gov (United States)

    Maier, H; Tisch, M; Lorenz, K J; Danz, B; Schramm, A

    2011-08-01

    Penetrating head and neck injuries often present with vascular lesions and airway compromise and may be life-threatening. Thus controlling bleeding and airway stabilisation take priority in emergency treatment. High-velocity projectiles, fragmentations from improvised explosive devices (IEDs) and shrapnel can cause severe tissue injury, representing a challenge for the head and neck surgeon. Since several organ structures, such as the eyes, midface, pharynx, larynx, trachea, esophagus, nerves, vessels and vertebral spine can be injured at the same time, patients should be referred to a specialized trauma center for interdisciplinary treatment following emergency treatment. High-speed ballistic injuries were once confined to the battle field and have been uncommon in Europe since World War II. For this reason, experience among civilian head and neck surgeons is at present limited. With the increased incidence of terrorism and the use of IEDs as the preferred weapon in terrorism it has become important for civilian head and neck surgeons to understand the role of ballistic injuries in mass casualty events. The present paper discusses current viewpoints in the diagnosis and treatment of penetrating head and neck injuries.

  7. Relationship between Neutrophil-to-Lymphocyte Ratio and Prognosis in Patients with Deep Neck Space Infection

    Directory of Open Access Journals (Sweden)

    Engin Şengül

    2016-03-01

    Full Text Available Objective: The aim of this study was to demonstrate if there is any relation between the neutrophil-to-lym­phocyte ratio and prognosis in patients with deep neck space infections Methods: One hundred eight patients who were interned and treated due to deep neck infection in department of otolaryngology between January 2010 and January 2015 were analyzed. Demographics, clini­cal data, complications and treatment results of patients were evaluated. Pediatric patients between the age of 0 and 14, the patients who had only peritonsillary abscess, infection secondary to trauma were excluded from study. During follow-up and treatment duration the patients with deep neck infections were divided into two groups ac­cording to whether they had any complication (group 1 or not (group 2. Results: Fourteen (13% patients with deep neck in­fections had life-threatening complications whereas 94 (87% did not have any complication during follow-up and treatment duration. The mean neutrophil-to-lymphocyte ratio in patients with complications was significantly high­er than the patients without any complications (p0.05. Conclusion: This study showed that the neutrophil-to-lymphocyte ratio can be used as a cheap, easily obtained and predictive prognostic factor in patients with deep neck infections.

  8. Head and Neck Soft Tissue Sarcoma

    OpenAIRE

    Aljabab, A. S.; Nason, R. W.; Kazi, R; Pathak, K. A.

    2011-01-01

    Sarcomas are malignant neoplasms originating from mesodermal tissues and constitute less than 1% of body’s tumors, including those of the head and neck region. 5–15% of adult sarcomas are in the head and neck region (20% from bones and cartilages and 80% in soft tissues). Commonly encountered sarcomas in the head and neck region are - osteosarcoma, rhabdomyosarcoma, malignant fibrous histiocytoma, fibrosarcoma and angiosarcoma. This article reviews the available literature on head and neck sa...

  9. EAU Guidelines on Urethral Trauma.

    Science.gov (United States)

    Martínez-Piñeiro, Luis; Djakovic, Nenad; Plas, Eugen; Mor, Yoram; Santucci, Richard A; Serafetinidis, Efraim; Turkeri, Levent N; Hohenfellner, Markus

    2010-05-01

    These guidelines were prepared on behalf of the European Association of Urology (EAU) to assist urologists in the management of traumatic urethral injuries. To determine the optimal evaluation and management of urethral injuries by review of the world's literature on the subject. A working group of experts on Urological Trauma was convened to review and summarize the literature concerning the diagnosis and treatment of genitourinary trauma, including urethral trauma. The Urological Trauma guidelines have been based on a review of the literature identified using on-line searches of MEDLINE and other source documents published before 2009. A critical assessment of the findings was made, not involving a formal appraisal of the data. There were few high-powered, randomized, controlled trials in this area and considerable available data was provided by retrospective studies. The Working Group recognizes this limitation. The full text of these guidelines is available through the EAU Central Office and the EAU website (www.uroweb.org). This article comprises the abridged version of a section of the Urological Trauma guidelines. Updated and critically reviewed Guidelines on Urethral Trauma are presented. The aim of these guidelines is to provide support to the practicing urologist since urethral injuries carry substantial morbidity. The diversity of urethral injuries, associated injuries, the timing and availability of treatment options as well as their relative rarity contribute to the controversies in the management of urethral trauma. Copyright © 2010 European Association of Urology. Published by Elsevier B.V. All rights reserved.

  10. Trauma and the development of borderline personality disorder.

    Science.gov (United States)

    van der Kolk, B A; Hostetler, A; Herron, N; Fisler, R E

    1994-12-01

    Prolonged and severe trauma, particularly trauma that occurs early in the life cycle, tends to result in a chronic inability to modulate emotions. When this occurs, people can mobilize a range of behaviors that are best understood as attempts at self-soothing. Some of these attempts include clinging and indiscriminate relationships with others in which old traumas are re-enacted over time, as well as more self-directed behaviors such as self-mutilation, eating disorders, and substance abuse. Usually, these behaviors will coexist. Patients with complicated trauma histories often repetitively attempt suicide or engage in chronic self-destructive behavior, and need to address issues of childhood trauma, neglect, and abandonment, both in the past and as re-experienced in current relationships. When treating these patients, therapists must anticipate that painful affects related to interpersonal safety, anger, and emotional needs may give rise to dissociative episodes, which may, in turn, be accompanied by increased self-destructive behavior. The therapy must clarify how current stresses are experienced as a return of past traumas and how small disruptions in present relationships are seen as a repetition of prior abandonment. As part of this, it is essential that the therapist provide validation and support, and avoid participating in a re-enactment of the trauma. Fear needs to be tamed in order for people to be able to think and be conscious of current needs. This bodily response of fear can be mitigated by safety of attachments, security of meaning schemes, and by a body whose reactions to environmental stress can be predicted and controlled. One of the great mysteries of the processing of traumatic experience is that as long as the trauma is experienced as speechless terror, the body continues to keep score and react to conditioned stimuli as a return of the trauma. When the mind is able to create symbolic representations of these past experiences, however, there

  11. X-Ray Exam: Neck (For Parents)

    Science.gov (United States)

    ... Old Feeding Your 1- to 2-Year-Old X-Ray Exam: Neck KidsHealth > For Parents > X-Ray Exam: Neck A A A What's in ... español Radiografía: cuello What It Is A neck X-ray is a safe and painless test that ...

  12. Planned Neck Dissection Following Radiation Treatment for Head and Neck Malignancy

    Directory of Open Access Journals (Sweden)

    J. F. Dautremont

    2012-01-01

    Full Text Available Introduction. Optimal therapy for patients with metastatic neck disease remains controversial. Neck dissection following radiotherapy has traditionally been used to improve locoregional control. Methods. A retrospective review of 28 patients with node-positive head and neck malignancy treated with planned neck dissection following radiotherapy between January 2002 and December 2005 was performed to assess treatment outcomes. Results. Median interval to neck dissection was 9.6 weeks with a median number of 21 + 9 lymph nodes per specimen. Ten of 31 (32% neck dissection specimens demonstrated evidence of residual carcinoma. Overall survival at two years was 85%; five-year overall survival was 65%. Concurrent chemotherapy did not impact the presence of residual neck disease. Conclusion. Based on the frequency of residual malignancy in the neck of patients treated with primary radiotherapy, a planned, postradiotherapy neck dissection should be strongly advocated for all patients with advanced-stage neck disease.

  13. Dental Trauma. A Case Report

    Directory of Open Access Journals (Sweden)

    Alain Soto Ugalde

    2015-06-01

    Full Text Available Dental traumas in children are common; therefore the dentist should be trained to solve them. This paper presents the diagnosis, treatment and outcome of a child with a 12 mm overjet, mouth breathing habit and bilabial incompetence who suffered a severe trauma to tooth number 11, causing its mobility. A splint was applied to the affected tooth and subsequently, a root canal filling was performed, all with a satisfactory outcome. Although these traumas are common, the presentation of this case is important due to its use in the teaching context.

  14. Interventional radiology for paediatric trauma

    Energy Technology Data Exchange (ETDEWEB)

    Sidhu, Manrita K. [Everett Clinic, AIC, Seattle Radiologists, Seattle, WA (United States); University of Washington School of Medicine, Radiology Department, Children' s Hospital and Regional Medical Center, Seattle, WA (United States); Hogan, Mark J. [The Ohio State University, Section of Vascular and Interventional Radiology, Nationwide Children' s Hospital, Columbus, OH (United States); Shaw, Dennis W.W. [University of Washington School of Medicine, Radiology Department, Children' s Hospital and Regional Medical Center, Seattle, WA (United States); Burdick, Thomas [University of Washington School of Medicine, Interventional Radiology, Harborview Medical Center, Seattle, WA (United States)

    2009-05-15

    Paediatric interventional radiology plays a cornerstone role in the management of paediatric trauma. In the acute setting, interventional radiology techniques allow minimally invasive control of haemorrhage or re-establishment of blood flow. Percutaneous stenting and drainage can allow disruptions in urinary or biliary systems to heal without the need for further surgery. Interventional radiology techniques also have a significant role in treating delayed complications of trauma, including embolization of arterial pseudoaneurysms and pulmonary embolism prophylaxis in individuals immobilized due to the trauma or its operative treatment. (orig.)

  15. Habitat preferences and conservation threats to Black-necked Cranes wintering in Bhutan.

    Science.gov (United States)

    Namgay, Rinchen; Wangchuk, Sangay

    2016-01-01

    Black-necked Crane (Grus nigricollis) is a vulnerable Red list species whose populations are declining. However, little is known about Black-necked Cranes' habitat requirements or the causes of their population decline. We identified Black-necked Cranes' winter roost and foraging preferences of Black-necked Cranes in Bhutan during the winter of 2013-2014. Black-necked Cranes' roosts were recorded using Garmin GPSmap 60CSx, while foraging preferences and threats to the birds were identified based on a survey of household heads (n = 107) residing within a 3 km radius of roost sites. We grouped the threats identified by the communities into four major categories, viz. biological, social, political and natural threats based on the relevance. Of the four major threats, communities residing within the roosting and foraging habitat of the Black-necked Crane reported biological threat as major. Biological threats as reported by communities include loss of habitat, food shortage and competition from other animals. We recommend the present roosting areas be designated as part of the conservation areas for Black-necked Crane wintering in Bumthang district. In addition to preserving these areas, government should also encourage farming in foraging habitats of Black-necked Crane, because they mainly feed on barley, wheat, paddy, potatoes and buckwheat, besides roots, tubers and insects in the wetlands.

  16. Protocol for Shoulder function training reducing musculoskeletal pain in shoulder and neck: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Mortensen Ole S

    2011-01-01

    Full Text Available Abstract Background Neck and shoulder complaints are common among employees in sedentary occupations characterized by intensive computer use. Such musculoskeletal pain - which is often associated with restricted range of motion and loss of muscle strength - is one of the most common conditions treated by physical therapists. The exact mechanism of neck pain is rarely revealed by clinical examination and the treatment has varied from passive rest to active treatments. Active treatments have often been divided into either training of the painful area or the surrounding musculature avoiding direct training of the painful area. Our study investigates the effect of the latter approach. Methods/Design A randomized controlled trial of 10 weeks duration is currently being conducted. Employed office workers with severe neck-shoulder pain are randomized to 3 × 20 min shoulder function training with training supervision or to a reference group receiving advice to stay physically active. Shoulder function training primarily focuses on the serratus anterior and lower trapezius muscle with only minimal activation the upper trapezius. An announcement was sent to the administrative section of the university including jobs characterized by intensive computer work. The first 100 positive replies entered the study. Among these inclusion criteria were pain intensity in the neck/shoulder of at least 3 on a 0-9 scale. Exclusion criteria were cardiovascular disease, trauma, hypertension, or serious chronic disease. Before and after the intervention period the participants replied to a questionnaire about musculoskeletal disorders and work disability, and underwent a standardized clinical examination of the neck and shoulder girdle. Further, on a weekly basis the participants log pain intensity of the neck and shoulder during the previous week. The primary outcome measure is pain in the neck and shoulders at week 10 based on the weekly pain registration and results

  17. Intrathoracic lipoma masquerading as subclavian artery trauma.

    LENUS (Irish Health Repository)

    Munro, P T

    2012-02-03

    A 58 year old man was admitted to the accident and emergency department following an industrial accident in which he sustained a three part fracture dislocation of his right humerus. Chest radiography revealed a large mass in the right upper hemithorax and, when the patient became hypotensive, an emergency thoracotomy was performed. The mass was found to be a massive intrathoracic lipoma. This case shows how preexisting intrathoracic lesions may be mistaken for subclavian or great vessel trauma following violent shoulder girdle injury. The differential diagnosis of traumatic and non-traumatic intrathoracic mass lesions in chest radiography should be considered carefully.

  18. Fatal subarachnoid hemorrhage associated with internal carotid artery dissection resulting from whiplash trauma.

    Science.gov (United States)

    Uhrenholt, Lars; Freeman, Michael D; Webb, Alexandra L; Pedersen, Michael; Boel, Lene Warner Thorup

    2015-12-01

    Spinal injury following inertial loading of the head and neck (whiplash) is a common sequel of low speed traffic crashes. A variety of non-musculoskeletal injuries have been described in association with injury to the spine following whiplash trauma, including traumatic brain injury, vestibular derangement, and cranial nerve injury, among others. Vascular injuries in the head and neck have, however, only rarely been described. We present the case of a middle-aged male who sustained an ultimately fatal injury that resulted from injury to the internal carotid artery (ICA) and intracerebral vascular structures following a hard braking maneuver, with no direct head- or neck contact with the vehicular interior. Based on this unusual mechanism of injury we reviewed hospital data from the United States nationwide inpatient database (NIS) to assess the frequency of similar injuries reportedly resulting from traffic crashes. The post-mortem examination revealed a left internal carotid artery dissection associated with subarachnoid hemorrhage (SAH). Based on the close temporal association, the absent prior history, and the plausibility of the injury mechanism, the injury was attributed to the braking maneuver. An analysis of NIS data demonstrated that the prevalence of subarachnoid hemorrhage is significantly higher when there is a traumatic etiology, and higher yet when the trauma is a traffic crash (odds ratio 3.3 and 4.3, respectively). The presented case, together with the hospital inpatient data analysis, indicate that although SAH in combination with ICA dissection is relatively rare, it is substantially more probable following a traffic crash. In a clinical or forensic setting the inference that magnitude of a trauma was low should not serve as a basis for either excluding a cervical artery dissection from a differential diagnosis, or for excluding the trauma as a cause of a diagnosed dissection. This case report illustrates a rare fatal outcome of inertial load to

  19. Secondary Trauma in Children and School Personnel

    Science.gov (United States)

    Motta, Robert W.

    2012-01-01

    A review of childhood secondary trauma is presented. Secondary trauma involves the transfer and acquisition of negative affective and dysfunctional cognitive states due to prolonged and extended contact with others, such as family members, who have been traumatized. As such, secondary trauma refers to a spread of trauma reactions from the victim…

  20. Secondary Trauma in Children and School Personnel

    Science.gov (United States)

    Motta, Robert W.

    2012-01-01

    A review of childhood secondary trauma is presented. Secondary trauma involves the transfer and acquisition of negative affective and dysfunctional cognitive states due to prolonged and extended contact with others, such as family members, who have been traumatized. As such, secondary trauma refers to a spread of trauma reactions from the victim…

  1. Integrated media presentation in multidisciplinary head and neck oncology meetings.

    Science.gov (United States)

    Simo, Ricard; Morgan, Peter; Jeannon, Jean-Pierre; Odell, Edward; Harrison, John; Almeida, Bernice; McGurk, Mark; Lyons, Andrew; Hussain, Karim; Gleeson, Michael; O'Connell, Mary; Calman, Frances; Ng, Roy; Roblin, Paul; Connor, Steve; Fenlon, Michael; Burke, Mary; Chandra, Ashish; Herbert, Amanda; Patt, Sarah; Steward-Bagley, Lizzie; Donnelly, Rachael; Freeman, Lesley; Twinn, Claire; Mason, Carolyn

    2009-02-01

    Multidisciplinary meetings (MDMs) are an essential part of the management of head and neck cancer. Practice care guidance set up by the British Association of Head and Neck Oncologists has recommended that MDMs should have appropriate projection equipment for computer-generated images so that all members of group have access to the same information. The aim of this paper is to review our experience with the integrated visual presentation of head and neck oncology patients and to demonstrate its advantages over conventional approaches. Digital photographs are taken of patients and of their index tumour at presentation or at the time of diagnostic endoscopy. All relevant pre-treatment digitised images from tumour sites and radiological images and histological slides are incorporated into a single presentation using Microsoft PowerPoint software. During the past 2 years, on-line radiological scans have also become accessible for the meeting to aid treatment planning. Subsequently, all peri-operative pictures and post-surgical macroscopic and microscopic histopathological images are added to each patient's presentation, which is then hyperlinked into the agenda. The Guy's and St Thomas' Head and Neck Cancer Centre treats over 400 patients a year, and since 2002, all new cancer diagnoses have been discussed in the weekly MDM as described above. A total of 1,638 presentations have been incorporated in a centralized database that is updated in the event of recurrence, further primary tumours or other clinical developments. Satisfactory documentation and staging of head and neck tumours must include a verbal description, accurate measurement, diagrammatic representation, photographic recording and appropriate radiological imaging. Integrated presentation at MDM collates all relevant findings for clinical management decisions on patients with head and neck cancer. This approach is also an extremely valuable adjunct to long-term clinical monitoring.

  2. The prevalence and impact of trauma history in eating disorder patients

    Directory of Open Access Journals (Sweden)

    Klas Backholm

    2013-11-01

    Full Text Available Background: Early experiences of traumatic events (TEs may be associated with subsequent eating disturbance. However, few studies have investigated overall exposure and trauma-type frequency in various types of eating disorders (EDs. Objective: This study aimed to investigate the prevalence and type of TEs in a nationally representative sample of Swedish ED patients. Method: Data from a database (Stepwise for specialized ED care were used. Trauma history was assessed as a part of the routine, initial assessment. Participants over the age of 18 with a diagnosed DSM-IV ED were included (N=4,524. Results: The number of patients having experienced at least one TE was 843 (18.6%, and 204 (24.2% reported at least one additional trauma. Sexual trauma was the most common form of TE (6.3%. There was no difference in overall traumatic exposure or in type of experienced trauma between the ED diagnostic subgroups (AN, BN, EDNOS, and BED. Overall traumatic exposure was linked to self-reported severity of ED symptoms, more secondary psychosocial impairment, psychiatric comorbidity, and negative self-image. Conclusions: Trauma history in ED patients merits attention. Results are partly in line with and partly in contrast to previous research. Measurement of trauma history has varied substantially in research on EDs, and this study adds to the indistinct literature on trauma history in ED.

  3. Imaging of cervicothoracic junction trauma

    Directory of Open Access Journals (Sweden)

    Wongwaisayawan S

    2013-01-01

    Full Text Available Sirote Wongwaisayawan,1 Ruedeekorn Suwannanon,2 Rathachai Kaewlai11Department of Radiology, Ramathibodi Hospital and Mahidol University, Bangkok, Thailand; 2Department of Radiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, ThailandAbstract: Cervicothoracic junction trauma is an important cause of morbidity and mortality in trauma patients. Imaging has played an important role in identifying injuries and guiding appropriate, timely therapy. Computed tomography is currently a method of choice for diagnosing cervicothoracic junction trauma, in which the pattern of injuries often suggests possible mechanisms and potential injuries. In this article, the authors describe and illustrate common and uncommon injuries that can occur in the cervicothoracic junction.Keywords: cervicothoracic junction, cervical spine, trauma, imaging, radiology

  4. Epidemiology of acute wrist trauma

    DEFF Research Database (Denmark)

    Larsen, C F; Lauritsen, Jens

    1993-01-01

    Epidemiological data on wrist injuries in a population can be used for planning by applying them to criteria for care and thus deriving estimates of provisions for care according to currently desirable standards. In a 1-year study all patients > or = 15 years with acute wrist trauma and treated...... in the emergency room were examined according to an algorithm until a diagnosis was established. The overall incidence of wrist trauma was 69 per 10,000 inhabitants per year. Incidence of wrist trauma requiring x-ray examination was 58 per 10,000 per year. The incidence of distal radius fractures was 27 per 10...... using data from a population-based study. A completeness rate of 0.56 (95% confidence interval: 0.31-0.78) was found. An x-ray had been taken for all patients reporting a fracture thus justifying the use of fractures as an incidence measure when comparing groups of patients with wrist trauma....

  5. Epidemiology of acute wrist trauma

    DEFF Research Database (Denmark)

    Larsen, C F; Lauritsen, Jens

    1993-01-01

    Epidemiological data on wrist injuries in a population can be used for planning by applying them to criteria for care and thus deriving estimates of provisions for care according to currently desirable standards. In a 1-year study all patients > or = 15 years with acute wrist trauma and treated...... in the emergency room were examined according to an algorithm until a diagnosis was established. The overall incidence of wrist trauma was 69 per 10,000 inhabitants per year. Incidence of wrist trauma requiring x-ray examination was 58 per 10,000 per year. The incidence of distal radius fractures was 27 per 10...... using data from a population-based study. A completeness rate of 0.56 (95% confidence interval: 0.31-0.78) was found. An x-ray had been taken for all patients reporting a fracture thus justifying the use of fractures as an incidence measure when comparing groups of patients with wrist trauma....

  6. Hemostatic resuscitation with plasma and platelets in trauma

    DEFF Research Database (Denmark)

    Johansson, Pär I; Oliveri, Roberto S; Ostrowski, Sisse R

    2012-01-01

    in an immediate and sustained manner as part of an early massive transfusion protocol has been introduced. The aim of the present review was to investigate the potential effect on survival of proactive administration of plasma and/or platelets (PLT) in trauma patients with massive bleeding....

  7. Developing Self-Care Practices in a Trauma Treatment Course

    Science.gov (United States)

    Shannon, Patricia J.; Simmelink-McCleary, Jennifer; Im, Hyojin; Becher, Emily; Crook-Lyon, Rachel E.

    2014-01-01

    This article describes the development of self-care practices of social work students who were part of a larger study of students' experiences in a graduate course on the treatment of trauma. Consensual qualitative research methods were used to analyze 17 participant journals submitted at 4 times during the course. Findings indicated that…

  8. Cost effectiveness in trauma care.

    Science.gov (United States)

    Elliott, D C; Rodriguez, A

    1996-02-01

    The above discussion brings together a vast body of data that together proclaim with fervent clarity: Traumatic injuries are expensive. The expense is paid in productive lives lost, in permanent disability, in pain and suffering, and in health care resources consumed. As local and regional trauma systems struggle for development and survival, competition for the health care dollar casts in the additional necessity of providing the service of trauma care with maximum efficiency. Despite the variety of cost-efficiency measures described above, a majority of trauma centers continue to operate "in the red." Such cannot continue indefinitely. Fiscal responsibility dictates that health care institutions must balance budgets in order to maintain operations. Four primary strategies for cost containment appear from the above discussion: 1. Improve reimbursement rates from trauma patients. 2. Increase outside funding from government sources. 3. Improve cost efficiency of diagnostic and therapeutic procedures used in trauma patient management. 4. Increase efforts aimed at primary prevention of intentional and unintentional injuries. In the final analysis, most authors agree that the last strategy offers the best hope. As stated in their article, "The Economic Impact of Injuries," Harlan and colleagues conclude that "the most effective medical and cost reduction strategy would be prevention." The same article goes on to detail how greater funding for research into optimal prevention modalities could reap societal and economic benefits far beyond the value of the initial outlay. Yet such research funding continues to be inadequate. For every dollar spent on medical care of cancer patients, nine cents is directed to research. For every dollar spent on trauma care, less than a penny is spent on research. Until the public recognizes the terrible toll trauma extracts in lives, livelihood, and money wasted and until it realizes the pre-eminent importance of prevention, care of the

  9. Spinal trauma. An imaging approach

    Energy Technology Data Exchange (ETDEWEB)

    Cassar-Pullicino, V.N. [The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire (United Kingdom). Dept. of Radiology; Imhof, H. [University and General Hospital Vienna (Austria). Dept. of Radiodiagnostics

    2006-07-01

    The diagnosis of trauma to the spine - where the slightest oversight may have catastrophic results - requires a thorough grasp of the spectrum of resultant pathology as well as the imaging modalities used in making an accurate diagnosis. In Spinal Trauma, the internationally renowned team of experts provides a comprehensive, cutting-edge exposition of the current vital role of imaging in the diagnosis and treatment of injuries to the axial skeleton. Beginning with a valuable clinical perspective of spinal trauma, the book offers the reader a unique overview of the biomechanics underlying the pathology of cervical trauma. Acute trauma topics include: - Optimization of imaging modalities - Malalignment - signs and significance - Vertebral fractures - detection and implications - Classification of thoraco-lumbar fractures - rationale and relevance - Neurovascular injury. Distilling decades of clinical and teaching expertise, the contributors further discuss the current role of imaging in special focus topics, which include: - The pediatric spine - Sports injuries - The rigid spine - Trauma in the elderly - Vertebral collapse, benign and malignant - Spinal trauma therapy - Vertebral fractures and osteoporosis - Neuropathic spine. All throughout the book, the focus is on understanding the injury, and its implications and complications, through 'an imaging approach'. Lavishly illustrated with hundreds of superb MR images and CT scans, and clear full-color drawings, the authors conclude with a look into the future, defining clinical trends and research directions. Spinal Trauma - with its broad scope, practical imaging approach, and current focus - is designed to enhance confidence and accuracy, making it essential reading for clinicians and radiologists at all levels. (orig.)

  10. Trauma ocular y politrauma Ocular trauma and multitrauma

    Directory of Open Access Journals (Sweden)

    Dunia Cruz Izquierdo

    2012-01-01

    Full Text Available Se realizó una revisión sobre el trauma ocular y su manejo en pacientes politraumatizados. Entre las causas más frecuentes de trauma ocular se encuentran los accidentes domésticos, laborales, juegos, actividades recreativas y deportivas. Involucran en un alto por ciento a niños y jóvenes, y predomina el sexo masculino en casi todos los trabajos revisados. No solo en Cuba sino en el mundo, el trauma ocular es fuente importante de ceguera unilateral o bilateral. Se presenta un breve compendio de los términos y definiciones actuales que son utilizados para el manejo del trauma ocular, su clasificación y la ventaja que ofrece aplicar el Puntaje del Trauma Ocular, OTS (Ocular Trauma Score, para el pronóstico de la agudeza visual final de acuerdo a los hallazgos clínicos encontrados en la evaluación inicial. Se hace referencia a los pacientes con politrauma y los aspectos a tener en cuenta por el oftalmólogo para tomar conducta cuando estos presentan heridas penetrantes o perforantes y tienen compromiso vital. En estos casos se hace necesaria la colaboración urgente de múltiples especialistas para primero mantener al paciente con vida y luego disminuir las complicaciones que repercuten en su pronóstico visual.A review was made on the ocular trauma and its management in multitrauma patients. The most common causes comprise domestic and occupational accidents, games, recreational and sport activities. It involves more frequently a high percentage of young people, with male prevalence in almost all the reviewed papers. Ocular trauma is an important source of unilateral or bilateral blindness not only in Cuba but worldwide as well. A brief summary of the current terms and definitions used to manage ocular trauma, their classification and the advantage of the Ocular Trauma Score (OTS to know the possible final visual acuity, according to the clinical findings at the emergency room, were presented. Reference was also made to the multitrauma

  11. Jugular neck dissection for NO neck supraglottic carcinoma

    Directory of Open Access Journals (Sweden)

    Petrović Željko

    2004-01-01

    Full Text Available Appropriate management of patients with supraglottic laryngeal carcinoma and negative findings in the neck is still controversial. A prospective and retrospective study comprised 193 patients who were treated primary surgically between 1976 and 1993. They all had clinically and ultrasound negative findings on the neck (NO. Supraglottic carcinomas usually spread regionally. Metastases develop in the jugular group, between level II-IV. The incidence of metastases has been reported to vary from 12 to 62.5%. The size and localization of the primary tumor, its histological grade, genotype of the malignant cells, imunological and other elucidated factors can all affect the incidence of regional spread. AIM Aim of this study was to specify the incidence of occult cervical metastases; to analyze the distribution of occult metastases related to tumor localization; to specify the distribution of occult metastases related to local spread; to analyze the distribution of occult metastases according to localization in the neck. RESULTS All patients had primary surgery of primary tumor and bilateral jugular, selective neck dissection at the level II-IV with histological examination of removed lymphoid tissue. Out of 193 patients, metastatic deposits were detected in 35(18%. Occult metastases were found in patients with carcinoma of the epilarynx in 19% (14/72 of cases, and in 17% (21/121 patients with carcinoma of the supraglottis excluding the epilarynx. This difference in frequency is not statistically significant. The incidence of occult metastases in epilaryngeal tumors did not depend on the degree of local spread. Even relatively small tumors (T1 and T2 yielded occult metastases in 33% (5/15, and 24% (6/25 of patients, respectively. In patients with T1 tumors localized at the supraglottis, excluding the epilarinx, occult metastases were not found. In the supragiottis excluding the epilarynx increased local spread was associated an increase of occult

  12. [Spinal accessory nerve and lymphatic neck dissection].

    Science.gov (United States)

    Pinsolle, V; Michelet, V; Majoufre, C; Caix, P; Siberchicot, F; Pinsolle, J

    1997-09-01

    Radical neck dissection was the golden standard of treatment for cervical nodes in head and neck tumors. From the seventies, the preservation of the spinal accessory nerve has become increasingly popular in order to improve the functional result of the neck dissections. The aim of this study was to assess the degree of functional disability associated with each type of neck dissection and the value of anatomical references for dissection of the spinal accessory nerve. One hundred twenty seven patients were evaluated 1 month and 1 year after radical, functional or supraomohyoid neck dissection with a questionnaire and a physical examination. Anatomical measurements of the spinal accessory nerve were performed in 20 patients. We found considerable or severe shoulder dysfunction in 7%, 34% and 51% respectively of patients in whom supraomohyoid, functional and radical neck dissections were performed. Furthermore 49% of patients having undergone a radical neck dissection had little or no symptoms. Sacrifice of the spinal accessory nerve in radical neck dissection may lead to shoulder dysfunction. A functional disability may also be associated, although in a less extent, with any neck dissection in which the spinal accessory nerve is dissected and placed in traction. There is a large variation in the degree of functional disability and pain in patients with similar neck dissections. The course of the spinal accessory nerve in the neck makes it particularly vulnerable to injury during the dissection near the sternocleidomastoid muscle and in the posterior cervical triangle.

  13. Renal Trauma: The Rugby Factor

    Science.gov (United States)

    Freeman, Catherine M.; Kelly, Michael E.; Nason, Gregory J.; McGuire, Barry B.; Kilcoyne, Aoife; Ryan, John; Lennon, Gerald; Galvin, David; Quinlan, David; Mulvin, David

    2015-01-01

    Introduction Renal trauma accounts for 5% of all trauma cases. Rare mechanisms of injuries including sports participation are increasingly common. Rugby-related trauma poses a conundrum for physicians and players due to the absence of clear guidelines and a paucity of evidence. Our series highlights traumatic rugby-related renal injuries in our institution, and emphasize the need for international guidelines on management. Methods A retrospective review of all abdominal traumas between January 2006 and April 2013, specifically assessing for renal related trauma that were secondary to rugby injuries was performed. All patients' demographics, computerized tomography results, hematological and biochemical results and subsequent management were recorded. Results Five male patients presented with rugby-related injuries. Mean age was 21 years old. All patients were hemodynamically stable and managed conservatively in acute setting. One patient was detected to have an unknown pre-existing atrophic kidney that had been subsequently injured, and was booked for an elective nephrectomy an 8-week interval. Conclusion Rugby-related trauma has generated essential attention. This paper serves to highlight this type of injury and the need for defined guidelines on role of imaging and international consensus on timing of return to contact sport, in both professional and amateur settings. PMID:26889132

  14. EAU guidelines on iatrogenic trauma.

    Science.gov (United States)

    Summerton, Duncan J; Kitrey, Noam D; Lumen, Nicolaas; Serafetinidis, Efraim; Djakovic, Nenad

    2012-10-01

    The European Association of Urology (EAU) Trauma Guidelines Panel presents an updated iatrogenic trauma section of their guidelines. Iatrogenic injuries are known complications of surgery to the urinary tract. Timely and adequate intervention is key to their management. To assess the optimal evaluation and management of iatrogenic injuries and present an update of the iatrogenic section of the EAU Trauma Guidelines. A systematic search of the literature was conducted, consulting Medline and the Cochrane Register of Systematic reviews. No time limitations were applied, although the focus was on more recent publications. The expert panel developed statements and recommendations. Statements were rated according to their level of evidence, and recommendations received a grade following a rating system modified from the Oxford Centre for Evidence-based Medicine. Currently, only limited high-powered studies are available addressing iatrogenic injuries. Because the reporting of complications or sequelae of interventions is now increasingly becoming a standard requirement, this situation will likely change in the future. This section of the trauma guidelines presents an updated overview of the treatment of iatrogenic trauma that will be incorporated in the trauma guidelines available at the EAU Web site (http://www. uroweb.org/guidelines/online-guidelines/). Copyright © 2012 European Association of Urology. Published by Elsevier B.V. All rights reserved.

  15. Trauma of the midface

    Directory of Open Access Journals (Sweden)

    Kühnel, Thomas S.

    2015-12-01

    Full Text Available Fractures of the midface pose a serious medical problem as for their complexity, frequency and their socio-economic impact. Interdisciplinary approaches and up-to-date diagnostic and surgical techniques provide favorable results in the majority of cases though. Traffic accidents are the leading cause and male adults in their thirties are affected most often. Treatment algorithms for nasal bone fractures, maxillary and zygomatic fractures are widely agreed upon whereas trauma to the frontal sinus and the orbital apex are matter of current debate. Advances in endoscopic surgery and limitations of evidence based gain of knowledge are matters that are focused on in the corresponding chapter. As for the fractures of the frontal sinus a strong tendency towards minimized approaches can be seen. Obliteration and cranialization seem to decrease in numbers. Some critical remarks in terms of high dose methylprednisolone therapy for traumatic optic nerve injury seem to be appropriate. Intraoperative cone beam radiographs and preshaped titanium mesh implants for orbital reconstruction are new techniques and essential aspects in midface traumatology. Fractures of the anterior skull base with cerebrospinal fluid leaks show very promising results in endonasal endoscopic repair.

  16. Trauma of the midface

    Science.gov (United States)

    Kühnel, Thomas S.; Reichert, Torsten E.

    2015-01-01

    Fractures of the midface pose a serious medical problem as for their complexity, frequency and their socio-economic impact. Interdisciplinary approaches and up-to-date diagnostic and surgical techniques provide favorable results in the majority of cases though. Traffic accidents are the leading cause and male adults in their thirties are affected most often. Treatment algorithms for nasal bone fractures, maxillary and zygomatic fractures are widely agreed upon whereas trauma to the frontal sinus and the orbital apex are matter of current debate. Advances in endoscopic surgery and limitations of evidence based gain of knowledge are matters that are focused on in the corresponding chapter. As for the fractures of the frontal sinus a strong tendency towards minimized approaches can be seen. Obliteration and cranialization seem to decrease in numbers. Some critical remarks in terms of high dose methylprednisolone therapy for traumatic optic nerve injury seem to be appropriate. Intraoperative cone beam radiographs and preshaped titanium mesh implants for orbital reconstruction are new techniques and essential aspects in midface traumatology. Fractures of the anterior skull base with cerebrospinal fluid leaks show very promising results in endonasal endoscopic repair. PMID:26770280

  17. Review of a single contemporary femoral neck fracture fixation method in young patients.

    LENUS (Irish Health Repository)

    Henari, Shwan

    2011-03-01

    An intracapsular femoral neck fracture in a young patient is a rare and difficult injury to manage. The occurrence of complications following fixation is multifactorial. Initial displacement and timing and accuracy of reduction are the key factors affecting outcome. The severities of the trauma to the hip and the impact of the intracapsular hematoma also play a role, the importance of which remains poorly understood. The purpose of this study was to evaluate the high incidence of femoral neck fractures treated in our institution over a 7-month period, to record the long-term outcome of these patients, all of whom were treated with contemporary methods of internal fixation, and to highlight the reasons for this injury being termed an "orthopedic emergency" and its differences from the same injury in the elderly population. We performed a retrospective analysis of 12 cases of intracapsular femur neck fracture in patients younger than 50 years treated over 7 months in a regional trauma center. All patients underwent satisfactory reduction and fixation. Nine of the 12 patients had a good outcome at a mean follow-up of 29 months. One patient developed a nonunion of the femoral head requiring total hip arthroplasty, one developed avascular necrosis of the femoral head, and one developed partial avascular necrosis. This compares favorably with other studies.

  18. Leadership and Teamwork in Trauma and Resuscitation.

    Science.gov (United States)

    Ford, Kelsey; Menchine, Michael; Burner, Elizabeth; Arora, Sanjay; Inaba, Kenji; Demetriades, Demetrios; Yersin, Bertrand

    2016-09-01

    Leadership skills are described by the American College of Surgeons' Advanced Trauma Life Support (ATLS) course as necessary to provide care for patients during resuscitations. However, leadership is a complex concept, and the tools used to assess the quality of leadership are poorly described, inadequately validated, and infrequently used. Despite its importance, dedicated leadership education is rarely part of physician training programs. The goals of this investigation were the following: 1. Describe how leadership and leadership style affect patient care; 2. Describe how effective leadership is measured; and 3. Describe how to train future physician leaders. We searched the PubMed database using the keywords "leadership" and then either "trauma" or "resuscitation" as title search terms, and an expert in emergency medicine and trauma then identified prospective observational and randomized controlled studies measuring leadership and teamwork quality. Study results were categorized as follows: 1) how leadership affects patient care; 2) which tools are available to measure leadership; and 3) methods to train physicians to become better leaders. We included 16 relevant studies in this review. Overall, these studies showed that strong leadership improves processes of care in trauma resuscitation including speed and completion of the primary and secondary surveys. The optimal style and structure of leadership are influenced by patient characteristics and team composition. Directive leadership is most effective when Injury Severity Score (ISS) is high or teams are inexperienced, while empowering leadership is most effective when ISS is low or teams more experienced. Many scales were employed to measure leadership. The Leader Behavior Description Questionnaire (LBDQ) was the only scale used in more than one study. Seven studies described methods for training leaders. Leadership training programs included didactic teaching followed by simulations. Although programs

  19. Clinical Study of Tuina for Stiff Neck

    Institute of Scientific and Technical Information of China (English)

    吴耀持; 张峻峰; 汪崇淼; 王健雄; 张沈煜

    2009-01-01

    Objective: To observe the clinical effect of Tuina for stiffneck. Methods: All of 216 cases with stiff neck were randomly allocated into a tuina group (110 cases) and a control group (106 cases). The patients in the tuina group were treated with "Three Parts, Four Points,Five Manipulation" tuina therapy, while those in the control group were treated with pucturing Wailaogong (Ex-UE 8), Houxi (SI 3), Jianjing (GB 21) and Ashi points in the affected side,Once a day, and 3 times constitute one treatment course. The effect was observed after 2-course treatments. Result: The effective rate in the tuina group and the control group was 93.64% and 83.02%, respectively, and there was statistical difference between the two groups (P < 0.05).Conclusion: The tuina therapy of "Three Parts, Four Points, Five Manipulations" is better than simple acupuncture therapy in treating stiff neck.%目的:观察推拿治疗落枕的临床疗效.方法:将216例落枕患者随机分为推拿组110例和对照组106例,推拿组用"三部四穴五法"推拿法治疗,对照组针刺患侧外劳宫、后溪、肩井和阿是穴.每日1次,3次为1个疗程;治疗2个疗程后观察疗效. 结果:推拿组有效率为93.64%,对照组为83.02%,两者比较有统计学意义(P<0.05)结论:"三部四穴五法"推拿法治疗落枕明显优于单纯针刺疗法.

  20. Neck muscle function in violinists/violists with and without neck pain.

    Science.gov (United States)

    Steinmetz, Anke; Claus, Andrew; Hodges, Paul W; Jull, Gwendolen A

    2016-04-01

    Neck pain is associated with changes in neuromuscular control of cervical muscles. Violin and viola playing requires good function of the flexor muscles to stabilize the instrument. This study investigated the flexor muscle behaviour in violin/viola players with and without neck pain using the craniocervical flexion test (CCFT). In total, 12 violin/viola players with neck pain, 21 violin/viola players without neck pain in the preceding 12 weeks and 21 pain-free non-musicians were included. Activity of the sternocleidomastoid muscles (SCM) was measured with surface electromyography (EMG) during the CCFT. Violin/viola players with neck pain displayed greater normalised SCM EMG amplitudes during CCFT than the pain-free musicians and non-musicians (P neck pain in violinists/violists is associated with altered behaviour of the superficial neck flexor muscles consistent with neck pain, despite the specific use of the deep and superficial neck flexors during violin playing.

  1. [EMDR: method of psychotherapy for the treatment of trauma].

    Science.gov (United States)

    Havelka, Judit

    2010-01-01

    Eye Movement Desensitization and Reprocessing (EMDR) is a method of psychotherapy that has been extensively researched for the treatment of trauma. The current treatment guidelines of the American Psychiatric Association and the International Society for Traumatic Stress Studies designate EMDR as an effective treatment for PTSD.In this article the author writes about the history of this "breakthrough therapy" and describes EMDR as a standardized protocol. In the second part describes trauma recovery where she uses EMDR in treating post-traumatic stress disorder in a case study about a 25 year old woman, who has been a rubbery survivor.

  2. Radiologic findings of thoracic trauma

    Directory of Open Access Journals (Sweden)

    Akgul Ozmen C

    2017-08-01

    Full Text Available Cihan Akgul Ozmen,1 Serdar Onat,2 Delal Aycicek3 1Department of Radiology, 2Department of Chest Surgery, Dicle University School of Medicine, Diyarbakir, 3Radiology Unit, Siirt State Hospital, Siirt, Turkey Introduction: Chest trauma may be blunt or penetrating and the chest is the third most common trauma region. It is a significant cause of mortality. Multidetector computed tomography (MDCT has been an increasingly used method to evaluate chest trauma because of its high success in detecting tissue and organ injuries. Herein, we aimed to present MDCT findings in patients with blunt and penetrating chest trauma admitted to our department. Methods: A total of 240 patients admitted to the emergency department of our hospital between April 2012 and July 2013 with a diagnosis of chest trauma who underwent MDCT evaluations were included. Most of the patients were male (83.3% and victims of a blunt chest trauma. The images were analyzed with respect to the presence of fractures of bony structures, hemothorax, pneumothorax, mediastinal organ injury, and pulmonary and vascular injuries. Results: MDCT images of the 240 patients yielded a prevalence of 41.7% rib fractures, 11.2% scapular fractures, and 7.5% clavicle fractures. The prevalence of thoracic vertebral fracture was 13.8% and that of sternal fracture was 3.8%. The prevalence of hemothorax, pneumothorax, pneumomediastinum, and subcutaneous emphysema was 34.6%, 62.1%, 9.6%, and 35.4%, respectively. The prevalence of rib, clavicle, and thoracic vertebral fractures and pulmonary contusion was higher in the blunt trauma group, whereas the prevalence of hemothorax, subcutaneous emphysema, diaphragmatic injury, and other vascular lacerations was significantly higher in the penetrating trauma group than in the blunt trauma group (p<0.05. Conclusion: MDCT images may yield a high prevalence of fracture of bony structures, soft tissue lacerations, and vascular lesions, which should be well understood by

  3. Use of intubating laryngeal mask airway in a morbidly obese patient with chest trauma in an emergency setting

    Directory of Open Access Journals (Sweden)

    Tripat Bindra

    2011-01-01

    Full Text Available A morbidly obese male who sustained blunt trauma chest with bilateral pneumothorax was referred to the intensive care unit for management of his condition. Problems encountered in managing the patient were gradually increasing hypoxemia (chest trauma with multiple rib fractures with lung contusions and difficult mask ventilation and intubation (morbid obesity, heavy jaw, short and thick neck. We performed awake endotracheal intubation using an intubating laryngeal mask airway (ILMA size 4 and provided mechanical ventilation to the patient. This report suggests that ILMA can be very useful in the management of difficult airway outside the operating room and can help in preventing adverse events in an emergency setting.

  4. 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.

  5. Warfare facial trauma: who will treat?

    Science.gov (United States)

    Holmes, D K

    1996-09-01

    Most of the facial trauma in the United States is treated in trauma centers in large urban or university medical centers, with limited trauma care taking place in our military medical treatment facilities. In many cases, active duty facial trauma surgeons may lack the current experience necessary for the optimal care of facial wounds of our inquired military personnel in the early stages of the conflict. Consequently, the skills of the reservist trauma surgeons who staff our civilian trauma centers and who care for facial trauma victims daily will be critical in caring for our wounded. These "trauma-current" reservists may act as a cadre of practiced surgeons to aid those with less experience. A plan for refresher training of active duty facial trauma surgeons is presented.

  6. Social work with trauma survivors: collaboration with interpreters.

    Science.gov (United States)

    Berthold, S Megan; Fischman, Yael

    2014-04-01

    Scant attention has been given to the emotional plight, lack of training, and stressful working conditions of interpreters serving survivors of severe human-perpetrated trauma from different parts of the world. This article addresses the critical need for effective collaboration between social workers and interpreters when the provider and survivor do not speak the same language. The careful selection of interpreters; the training, support, and promotion of self-care of interpreters; the training needs for social workers related to their work with interpreters; and the impact of secondary trauma and organizational support on the work of social workers and interpreters are explored. Proposed curriculum components for training interpreters and the importance of therapy and ongoing supervision for interpreters are highlighted. It is essential to prepare interpreters and social workers for the various challenges they will face in their collaborative efforts to serve survivors of severe human-perpetrated trauma, and organizational support is vital to the success of this work.

  7. 'Ready-access' CT imaging for an orthopaedic trauma clinic.

    LENUS (Irish Health Repository)

    Cawley, D

    2011-03-01

    \\'Ready-Access\\' to CT imaging facilities in Orthopaedic Trauma Clinics is not a standard facility. This facility has been available at the regional trauma unit, in Merlin Park Hospital, Galway for the past four years. We reviewed the use of this facility over a 2-year period when 100 patients had CT scans as part of their trauma clinic assessment. The rate of CT scan per clinic was 0.6. The mean waiting time for a CT scan was 30 minutes. 20 (20%) new fractures were confirmed, 33 (33%) fractures were out-ruled, 25 (25%) fractures demonstrated additional information and 8 (8%) had additional fractures. 20 (20%) patients were discharged and 12 (12%) patients were admitted as a result of the CT scan. It adds little time and cost to CT scanning lists.

  8. [Assessment of an educational maze for major trauma care teaching].

    Science.gov (United States)

    Cuisinier, A; Schilte, C; Declety, P; Baudrant, M; Picard, J; Berger, K; Bouzat, P; Gay, S; Falcon, D; Bosson, J-L; Payen, J-F; Albaladejo, P

    2012-11-01

    Assess efficacy, satisfaction and usefulness of an educational maze based on posters and audioguide for major trauma care teaching to medical students. The educational maze consists of posters with audio comments recorded in an audioguide. This tool was part of a larger educational program including medical simulation. Prospective, interventional, observational, monocentric study. STUDENT: Medical student of Grenoble University Hospital, in the four last years of medical school, following a training course in anesthesia, emergency medical services and intensive care units. Forty essentials key messages for major trauma management were included in 10 posters and audioguides. A first assessment with short opened answers was handed to the students at the end of the educational maze to assess their memorization. A second assessment with simple choice answers regarding satisfaction and usefulness of this new educational tool was realized at the end of the entire program. One hundred and eighty-four medical students attending the major trauma program were included in this study. On the first test, 75% of essential knowledge on major trauma management was memorized by more than 50% of the medical students. On the second test, 94% of medical students had a high satisfaction level of this educational maze. An educational maze based on posters and audioguides seems to be an efficient, useful tool for teaching essential knowledge on major trauma management to medical students. Copyright © 2012. Published by Elsevier SAS.

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

    Science.gov (United States)

    Kim, Sohye; Fonagy, Peter; Allen, Jon; Strathearn, Lane

    2014-01-01

    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 neurobiological study documenting that mothers' attachment-related trauma, when unresolved, undermines her optimal brain response to her infant's distress. We examined the amygdala blood oxygenation level-dependent response in 42 first-time mothers as they underwent functional magnetic resonance imaging scanning, viewing happy- and sad-face images of their own infant, along with those of a matched unknown infant. Whereas mothers with no trauma demonstrated greater amygdala responses to the sad faces of their own infant as compared to their happy faces, mothers who were classified as having unresolved trauma in the Adult Attachment Interview (Dynamic Maturational Model) displayed blunted amygdala responses when cued by their own infants' sadness as compared to happiness. Unknown infant faces did not elicit differential amygdala responses between the mother groups. The blunting of the amygdala response in traumatized mothers is discussed as a neural indication of mothers' possible disengagement from infant distress, which may be part of a process linking maternal unresolved trauma and disrupted maternal caregiving.

  10. The study of psychic trauma.

    Science.gov (United States)

    Bacciagaluppi, Marco

    2011-01-01

    This article starts from the DSM definition of psychic trauma. A central source in this field is the 1992 book by Judith Herman. One line of investigation is the sexual abuse of women and children. In an early phase, both Janet and Freud described dissociation as a reaction to trauma. In 1897, Freud disputed the reality of sexual trauma, a position countered later by Ferenczi. In a later phase, this subject was investigated by the American feminist movement. Studies of physical abuse are then described, followed by mental abuse and neglect. Another line of investigation is combat neurosis. The two lines converged in the definition of PTSD and its incorporation into the DSM in 1980. The views on trauma of John Bowlby and Alice Miller are also discussed. The integration of the relational model in psychoanalysis with the trauma literature is presented. The most recent advances are located in neurobiology. The discussion makes a preliminary investigation of the remote causes of war and sexual violence.

  11. Trauma, attachment, and intimate relationships.

    Science.gov (United States)

    Zurbriggen, Eileen L; Gobin, Robyn L; Kaehler, Laura A

    2012-01-01

    Intimate relationships can both affect and be affected by trauma and its sequelae. This special issue highlights research on trauma, attachment, and intimate relationships. Several themes emerged. One theme is the exploration of the associations between a history of trauma and relational variables, with an emphasis on models using these variables as mediators. Given the significance of secure attachment for healthy relationships, it is not surprising that attachment emerges as another theme of this issue. Moreover, a key component of relationships is trust, and so a further theme of this issue is betrayal trauma (J. J. Freyd, 1996 ). As the work included in this special issue makes clear, intimate relationships of all types are important for the psychological health of those exposed to traumatic events. In order to best help trauma survivors and those close to them, it is imperative that research exploring these issues be presented to research communities, clinical practitioners, and the public in general. This special issue serves as one step toward that objective.

  12. Post-trauma ratings of pre-collision pain and psychological distress predict poor outcome following acute whiplash trauma: a 12-month follow-up study

    DEFF Research Database (Denmark)

    Carstensen, Tina B W; Frostholm, Lisbeth; Oernboel, Eva

    2008-01-01

    identified by multiple logistic regression analysis. Factors associated with affected work capacity at the 12-month follow-up were pre-collision unspecified pain condition (OR=2.4, p=0.002) and socio-demographic characteristics: female gender, low educational level, unemployment and blue collar worker...... with poor recovery and high accumulation of pre-collision psychological distress is associated with considerable neck pain at follow-up. However, no conclusions on causality can be drawn. Personal characteristics before the collision are important for recovery and attention to pre-collision characteristics...... may contribute to the prevention of poor recovery after acute whiplash trauma....

  13. "Heading" and neck injuries in soccer: a review of biomechanics and potential long-term effects.

    Science.gov (United States)

    Mehnert, Michael J; Agesen, Thomas; Malanga, Gerard A

    2005-10-01

    Although soccer has a lower injury rate than does American football, injuries to the head and neck do occur. Indeed, soccer is classified as a contact sport. The potential for cervical injuries from the maneuver known as "heading" are of particular concern. This review provides a synopsis of soccer-related head and neck injuries, an overview of the biomechanics of trauma, and a rational approach to evaluating patients. This review was conducted to assess and evaluate existing literature on the biomechanics of the act of heading in soccer and the potential for acute and long-term injury to the head and neck. The resulting work is based on literature searches of the PubMed and Medline databases, textbook reviews, and bibliographies of articles and textbooks obtained during the search. Findings from several studies were summarized and critiqued. Biomechanics, anatomy, pathophysiology, and their relation to the act of heading in soccer were also synthesized into the discussion. Relevant studies of athletes in other sports where activity can affect the neck and head in a manner similar to heading were also considered. The act of heading in soccer involves the athlete's entire body, and studies have used electromyography to define the activity of neck musculature during heading. The majority of head and neck injuries in soccer occur secondary to impacts other than those that occur during heading, however, rare case reports of serious injury exist. Degenerative bony changes in the cervical spine of soccer players have been noted in a few studies, but the connection with heading is not well established. Data from research in other sports, particularly American football and rugby, suggest a predisposition to degenerative disease of the neck secondary to axial loading mechanisms; the exact relevance of these studies to heading and soccer is unclear. The complex biomechanics of heading in soccer are not completely defined, especially with regard to long-term effects on the

  14. Oncologic safety of cervical nerve preservation in neck dissection for head and neck cancer.

    Science.gov (United States)

    Honda, Keigo; Asato, Ryo; Tsuji, Jun; Miyazaki, Masakazu; Kada, Shinpei; Tsujimura, Takashi; Kataoka, Michiko

    2017-09-01

    Although the functional merits of preserving cervical nerves in neck dissection for head and neck cancer have been reported, the oncologic safety has not yet been determined. Therefore, the purpose of this study was to evaluate the safety of cervical nerve preservation. A retrospective chart review was performed on patients with head and neck cancer who had been treated by neck dissection between 2009 and 2014 at Kyoto Medical Center. Management of cervical nerves and clinical results were analyzed. A total of 335 sides of neck dissection had been performed in 222 patients. Cervical nerves were preserved in 175 neck sides and resected in 160 sides. The 5-year overall survival (OS) rate calculated by the Kaplan-Meier method was 71%. The 5-year neck control rate was 95% in cervical nerve preserved sides and 89% in cervical nerve resected sides. Preserving cervical nerves in neck dissection is oncologically safe in selected cases. © 2017 Wiley Periodicals, Inc.

  15. Increased neck muscle activity and impaired balance among females with whiplash-related chronic neck pain

    DEFF Research Database (Denmark)

    Juul-Kristensen, Birgit; Clausen, Brian; Ris Hansen, Inge

    2013-01-01

    To investigate neck muscle activity and postural control in patients with whiplash-associated disorder compared with healthy controls.......To investigate neck muscle activity and postural control in patients with whiplash-associated disorder compared with healthy controls....

  16. Vascular Shunts in Civilian Trauma

    Science.gov (United States)

    Abou Ali, Adham N.; Salem, Karim M.; Alarcon, Louis H.; Bauza, Graciela; Pikoulis, Emmanuel; Chaer, Rabih A.; Avgerinos, Efthymios D.

    2017-01-01

    Experience with temporary intravascular shunts (TIVS) for vessel injury comes from the military sector and while the indications might be clear in geographically isolated and under resourced war zones, this may be an uncommon scenario in civilian trauma. Data supporting TIVS use in civilian trauma have been extrapolated from the military literature where it demonstrated improved life and limb salvage. Few non-comparative studies from the civilian literature have also revealed similar favorable outcomes. Still, TIVS placement in civilian vascular injuries is uncommon and by some debatable given the absence of clear indications for placement, the potential for TIVS-related complications, the widespread resources for immediate and definitive vascular repair, and the need for curtailing costs and optimizing resources. This article reviews the current evidence and the role of TIVS in contemporary civilian trauma management. PMID:28775985

  17. Pancreatic trauma: A concise review

    Science.gov (United States)

    Debi, Uma; Kaur, Ravinder; Prasad, Kaushal Kishor; Sinha, Saroj Kant; Sinha, Anindita; Singh, Kartar

    2013-01-01

    Traumatic injury to the pancreas is rare and difficult to diagnose. In contrast, traumatic injuries to the liver, spleen and kidney are common and are usually identified with ease by imaging modalities. Pancreatic injuries are usually subtle to identify by different diagnostic imaging modalities, and these injuries are often overlooked in cases with extensive multiorgan trauma. The most evident findings of pancreatic injury are post-traumatic pancreatitis with blood, edema, and soft tissue infiltration of the anterior pararenal space. The alterations of post-traumatic pancreatitis may not be visualized within several hours following trauma as they are time dependent. Delayed diagnoses of traumatic pancreatic injuries are associated with high morbidity and mortality. Imaging plays an important role in diagnosis of pancreatic injuries because early recognition of the disruption of the main pancreatic duct is important. We reviewed our experience with the use of various imaging modalities for diagnosis of blunt pancreatic trauma. PMID:24379625

  18. Management of Acute Skin Trauma

    Institute of Scientific and Technical Information of China (English)

    Joel W. Beam

    2010-01-01

    @@ Acute skin trauma (ie, abrasions, avulsions, blisters, incisions, lacerations, and punctures) is common among individuals involved in work, recreational, and athletic activities. Appropriate management of these wounds is important to promote healing and lessen the risk of cross-contamination and infection. Wound management techniques have undergone significant changes in the past 40 years but many clinicians continue to manage acute skin trauma with long-established, traditional techniques (ie, use of hydrogen peroxide, adhesive strips/patches, sterile gauze, or no dressing) that can delay healing and increase the risk of infection. The purpose of this review is to discuss evidence-based cleansing, debridement, and dressing techniques for the management of acute skin trauma.

  19. Treatment strategy for hepatic trauma

    Institute of Scientific and Technical Information of China (English)

    Wu-Yong Yu; Qu-Jin Li; Jian-Ping Gong

    2016-01-01

    Liver is one of the organs with the highest injury rate,and in recent decades,the guidelines for the treatment of liver trauma have changed considerably.Now,there is a growing consensus that the most important step is diagnosis and depending upon the degree of severity,non-operative therapy is the main treatment method for hepatic trauma if conditions permit.For serious hepatic trauma patients such as those with hemodynamic instability,they should be operated upon as soon as possible.Regardless of the surgical options,doctors should control damage to patients and try to prevent complications.New therapies such as hepatic artery embolization and liver transplantation have been more and more used for the treatment of serious hepatic damage in clinics.

  20. Speciation of Black-necked Crane

    Institute of Scientific and Technical Information of China (English)

    2002-01-01

    Based on the concepts of species and speciation,the speciation of Black-necked Grane(Grus nigricollis) was discussed using bio-geographic principles and some evidences suggest that Black-necked Grane had a close relationship with Red-crowned Crane(Grus japonensis).The Qinghai-Tibetan Plateau uplift may be the most important factor in allopatric speciation for Black-necked Crane.

  1. Fusobacterial head and neck infections in children.

    Science.gov (United States)

    Brook, Itzhak

    2015-07-01

    Fusobacterium species are increasingly recognized as a cause of head and neck infections in children. These infections include acute and chronic otitis, sinusitis, mastoiditis, and tonsillitis; peritonsillar and retropharyngeal abscesses; Lemierre syndrome; post-anginal cervical lymphadenitis; and periodontitis. They can also be involved in brain abscess and bacteremia associated with head and neck infections. This review describes the clinical spectrum of head and neck fusobacterial infection in children and their management. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  2. 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.].

  3. Exposure to childhood traumas ups the odds of giving birth to daughters.

    Science.gov (United States)

    Kaitz, Marsha; Rokem, Ann Marie; Mankuta, David; Davidov, Maayan; Faraone, Stephen V

    2014-04-01

    This study examined the likelihood of giving birth to a daughter as a function of women's exposure to four categories of stressors: childhood trauma, adult trauma, chronic stressors, and recent (adverse) life events. Hypothesis 1 stated that exposure to recent life events (near conception) and to childhood traumas would increase women's chances of having a girl baby. Hypothesis 2 stated that the relationship between stress and gender outcome is mediated by persistent posttraumatic stress disorder (PTSD) symptoms. The final sample was comprised of 225 women. The design was prospective observational. At first contact, women were retained if they were 3.0 for women who had been exposed to more than two such events. PTSD symptoms (partially) mediated the relationship between childhood trauma and infant gender. Findings suggest that women's exposure to childhood trauma contributes to the determination of the sex ratio at birth and that PTSD symptoms are part of the cause.

  4. Complicaciones en el trauma raquimedular

    OpenAIRE

    M. López(Universidad Complutense, Madrid, Spain)

    2013-01-01

    El trauma raquimedular es un enfermedad que afecta principalmente a adultos jóvenes y suele resultar en muerte o discapacidad con sus complicaciones implícitas. Las personas con trauma raquimedular presentan complicaciones multisistemicas según el tipo y nivel de lesión, además, su aparición depende del manejo médico y terapéutico temprano. Entre las complicaciones más comunes se encuentran las respiratorias, cardiovasculares (hipotensión ortostatica, disrreflexia autonómica y trombosis venos...

  5. Male genital trauma in sports.

    Science.gov (United States)

    Hunter, Stanley R; Lishnak, Timothy S; Powers, Andria M; Lisle, David K

    2013-04-01

    Male genital trauma is a rare but potentially serious sports injury. Although such an injury can occur by many different mechanisms, including falls, collisions, straddle injuries, kicks, and equipment malfunction, the clinical presentation is typically homogeneous, characterized by pain and swelling. Almost all sports-related male genital injury comes from blunt force trauma, with involvement of scrotal structures far more common than penile structures. Most injuries can be treated conservatively, but catastrophic testicular injury must first be ruled out. Despite being relatively uncommon compared with other sports injuries, more than half of all testicular injuries are sustained during sports.

  6. Migraine and neck pain: Mechanisms of comorbidity

    Directory of Open Access Journals (Sweden)

    A. S. Zenkevich

    2016-01-01

    Full Text Available Neck pain and migraine are common diseases. Neck pain seldom occurs in a patient with migraine. However, the relationship between migraine and neck pain has been inadequately investigated.Objective: to analyze neck pain in patients with migraine to determine possible comorbidity mechanisms of these diseases.Patients and methods. The investigation enrolled 63 patients with chronic migraine (CM and 40 with episodic migraine (EM diagnosed in accordance with the International Classification of Headache Disorders, 3rd edition (ICHD-3. Winking reflex (WR and nociceptive flexion reflex (NFR were examined to evaluate the function of antinociceptive systems.Results. In the patients with CM, neck pain was more common than in those with EM (53.03% versus 14.02%; and panful tenderness, sensitivity, and tension of neck muscles were more marked. There was also a significant reduction in WR and NFR thresholds. Neck pain was noted to be an integral component of the pathogenesis of CM in a large number of patients with this condition. The authors proposed several pathophysiological mechanisms of a relationship between migraine and neck pain. Neck muscles and craniovertebral junction areas serve as a source for the arrival of nociceptive pain pulses in the central nervous system (peripheral sensitization, promoting pain chronization. Muscle dysfunction in this area may be, in turn, a reflection of central sensitization and impaired descending pain control.

  7. [Update on current care guidelines. Neck pain].

    Science.gov (United States)

    2009-01-01

    Neck pain is very common. Age, female gender, obesity, and several physical and psychological work related factors increase the risk while physical activity appears to decrease it. Non-specific neck pain is most common but serious or specific illness must be ruled out and neural compression identified. Patients are encouraged to remain active and improve their ergonomics. Acute neck pain often disappears without any special treatment. Paracetamol is the primary pain medication. Multidisciplinary treatment is recommended if disabling pain has lasted for two months, and intensive muscle exercises in chronic neck pain. Progressive muscle weakness and myelopathy indicate a surgical assessment.

  8. Endoscopic resection of the inflamed bicipitoradial bursa extended around the radial neck

    Science.gov (United States)

    Lui, Tun Hing

    2013-01-01

    The bicipitoradial bursa lies at the insertion of the biceps tendon on the radial tuberosity. It is an unusual site for chronic bursitis and most often, results from repetitive mechanical trauma or overuse. Other causes include tuberculosis, immunological complications of the rheumatological disease, for example, psoriatic arthropathy, rheumatoid arthritis and synovial chondromatosis. Unlike ganglion cyst arising from the elbow joint, resection of the bursa through the elbow arthroscopy is not possible as the bursa is not communicated with the joint. We reported a patient with rheumatoid arthritis presenting with bicipitoradial bursitis extended around the radial neck which was successfully resected endoscopically. PMID:23704464

  9. Sexual Trauma: Women Veterans Health Care

    Science.gov (United States)

    ... ZIP code here Enter ZIP code here Health Awareness Campaigns: Sexual Trauma Sexual Trauma Women Veterans Health ... abuse drugs or alcohol or engage in risky sexual behavior. In some cases, anger and stress stemming from ...

  10. Abusive Head Trauma (Shaken Baby Syndrome)

    Science.gov (United States)

    ... Your 1- to 2-Year-Old 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 ...

  11. Cultural Trauma and Life Stories / Ene Kõresaar

    Index Scriptorium Estoniae

    Kõresaar, Ene

    2007-01-01

    Aili Aarelaid-Tarti 15-aastase uuringu tulemused raamatus "Cultural Trauma and Life Stories", Hesinki, Kikimora Publications, 2006. Uuritud on kolme suurt rahvusgruppi 1940-test tingitud trauma kontekstis: eestlased kodumaal, eestlased eksiilis ja venekeelne rahvusgrupp Eestis postsovetlikus diskursuses

  12. THE DEADLY DOZEN OF CHEST TRAUMA

    African Journals Online (AJOL)

    Enrique

    Severe chest injuries are responsible for 25% of all trauma deaths, and in a ... mechanical compression of the trachea, laryngeal trauma such as thyroid or cricoid ... Unit Head at Chris Hani .... mechanical ventilation to 'internally splint' the ...

  13. Cultural Trauma and Life Stories / Ene Kõresaar

    Index Scriptorium Estoniae

    Kõresaar, Ene

    2007-01-01

    Aili Aarelaid-Tarti 15-aastase uuringu tulemused raamatus "Cultural Trauma and Life Stories", Hesinki, Kikimora Publications, 2006. Uuritud on kolme suurt rahvusgruppi 1940-test tingitud trauma kontekstis: eestlased kodumaal, eestlased eksiilis ja venekeelne rahvusgrupp Eestis postsovetlikus diskursuses

  14. Seatbelt sign as an indication for four-vessel computed tomography angiogram of the neck to diagnose blunt carotid artery and other cervical vascular injuries.

    Science.gov (United States)

    Dhillon, Ramandeep Singh; Barrios, Cristobal; Lau, Cecilia; Pham, Jacqueline; Bernal, Nicole; Kong, Allen; Lekawa, Michael; Dolich, Matthew

    2013-10-01

    Computed tomography angiography (CTA) of the neck has become the most common modality for diagnosing blunt carotid artery injury (BCAI). The protocol at our institution includes CTA on trauma patients with a seatbelt sign. The purpose of this study is to evaluate whether a solitary seatbelt sign is an indication for CTA of the neck to diagnose BCAI. We conducted a retrospective review of patients from 2000 to 2010 who received CTAs as a result of a seatbelt sign performed at our Level I trauma center. Four hundred eighteen patients received CTAs based on the presence of a seatbelt sign. Two hundred twenty-six had skeletal injuries, obvious soft tissue injuries, and/or positive findings on imaging, including 11 positive vascular findings with two BCAIs found. Patients with noncarotid vascular injuries on CTA had a higher Injury Severity Score than patients with solitary seatbelt signs (11.4 ± 7.6 vs 3.4 ± 4.2, P injuries and/or positive findings on standard trauma imaging. This suggests that a protocol for CTA of the neck for patients with a seatbelt sign can be reserved for those with associated injuries on physical examination and/or findings on standard trauma imaging.

  15. Detecting relevant changes and responsiveness of Neck Pain and Disability Scale and Neck Disability Index

    NARCIS (Netherlands)

    Reneman, Michiel F.; Geertzen, Jan H. B.; Jorritsma, Wim; Knol-de Vries, Grietje; Dijkstra, Pieter U.

    2012-01-01

    To investigate relevant change on the Neck Pain and Disability Scale (NPAD) and Neck Disability Index (NDI) and which questionnaire is the most responsive in patients with non-specific chronic neck pain (CNP). Seventy-six patients with non-specific CNP in an outpatient tertiary rehabilitation settin

  16. Trauma, forgiveness and the witnessing dance: making public spaces intimate.

    Science.gov (United States)

    Gobodo-Madikizela, Pumla

    2008-04-01

    In this paper I explore the concept of forgiveness as a response to gross human rights violations. I present a conceptual examination of the effects of massive trauma in relation to what I refer to as the 'unfinished business' of trauma. Using a psychoanalytic framework, I consider the process of 'bearing witness' about trauma and examine how this process opens up the possibility of reciprocal expressions of empathy between victim and perpetrator. I then argue that, in this context of trauma testimony and witnessing, empathy is essential for the development of remorse on the part of perpetrators, and of forgiveness on the part of victims. Using a case study from South Africa's Truth and Reconciliation Commission (TRC) I clarify the relationship between empathy and forgiveness, and show how the restorative model of the TRC can open up an ethical space and create the possibility of transformation for victims, perpetrators and bystanders. In my conclusion I suggest that forgiveness in politics is the only action that holds promise for the repair of brokenness in post-conflict societies, particularly if, as in South Africa, victims have to live together with perpetrators and beneficiaries in the same country.

  17. Vascular trauma: selected historical reflections from the western world

    Institute of Scientific and Technical Information of China (English)

    Norman M. Rich; Patricia L. McKay; David R. Welling; Todd E. Rasmussen

    2011-01-01

    In the spirit of international exchanges of knowledge with colleagues from all over the world, who are interested in the care and treatment of vascular trauma,we offer selected historical reflections from the westem world on vascular trauma. Whereas there are a number of key individuals and a variety of events that are important to us in our writing, we know essentially nothing about what is written by other cultures and, particularly, the Chinese. It is well recognized around the world that Chinese surgeons are among the first to be highly successful in re-plantation of severed extremities, repairing both injured arteries and veins. Also, we recognize that there are contributions in other parts of the world, which are not well known to us collectively. Contributions from the Arabic speaking part of the world come to mind because there is periodic brief reference. We offer our perspective hoping that there will be one or more Chinese surgeons who will offer us the benefit of sharing their perspective on important historical contributions to the managing of vascular trauma outside of the western world, and, particularly, the English speaking literature. Once again, we encourage our colleagues in the Arabic speaking world to provide us with their perspective of the development and management of vascular trauma.

  18. Prevalence of interpersonal trauma exposure and trauma-related disorders in severe mental illness

    NARCIS (Netherlands)

    Mauritz, M.W.; Goossens, P.J.J.; Draijer, N.; Achterberg, T. van

    2013-01-01

    BACKGROUND: Interpersonal trauma exposure and trauma-related disorders in people with severe mental illness (SMI) are often not recognized in clinical practice. OBJECTIVE: To substantiate the prevalence of interpersonal trauma exposure and trauma-related disorders in people with SMI. METHODS: We con

  19. Prevalence of interpersonal trauma exposure and trauma-related disorders in severe mental illness

    NARCIS (Netherlands)

    Mauritz, M.W.; Goossens, P.J.J.; Draijer, N.; Achterberg, T. van

    2013-01-01

    BACKGROUND: Interpersonal trauma exposure and trauma-related disorders in people with severe mental illness (SMI) are often not recognized in clinical practice. OBJECTIVE: To substantiate the prevalence of interpersonal trauma exposure and trauma-related disorders in people with SMI. METHODS: We

  20. External Validation of the Emergency Trauma Score for Early Prediction of Mortality in Trauma Patients

    NARCIS (Netherlands)

    Joosse, Pieter; de Jong, Willem-Jan J.; Wendt, Klaus W.; Schep, Niels W.; Goslings, J. Carel; Reitsma, J.

    Objectives: The Emergency Trauma Score has been developed for early estimation of mortality risk in adult trauma patients with an Injury Severity Score of 16 or higher. Emergency Trauma Score combines four early predictors available at the trauma resuscitation room: age, Glasgow Coma Scale, base

  1. External Validation of the Emergency Trauma Score for Early Prediction of Mortality in Trauma Patients

    NARCIS (Netherlands)

    Joosse, Pieter; de Jong, Willem-Jan J.; Wendt, Klaus W.; Schep, Niels W.; Goslings, J. Carel; Reitsma, J.

    2014-01-01

    Objectives: The Emergency Trauma Score has been developed for early estimation of mortality risk in adult trauma patients with an Injury Severity Score of 16 or higher. Emergency Trauma Score combines four early predictors available at the trauma resuscitation room: age, Glasgow Coma Scale, base exc

  2. Witnessing Trauma:A Reading of A Pale of Hills Based on Trauma Theory

    Institute of Scientific and Technical Information of China (English)

    王肖

    2016-01-01

    This thesis tries to interpret A Pale View of Hills based on trauma theory, and to have a detailed analysis from the aspects of trauma experience and memory and recovery from trauma in order to illustrate the connotations behind trauma and how to get healed and regain new hope for the future.

  3. Leadership and Teamwork in Trauma and Resuscitation

    Directory of Open Access Journals (Sweden)

    Michael Menchine

    2016-09-01

    Full Text Available Introduction: Leadership skills are described by the American College of Surgeons’ Advanced Trauma Life Support (ATLS course as necessary to provide care for patients during resuscitations. However, leadership is a complex concept, and the tools used to assess the quality of leadership are poorly described, inadequately validated, and infrequently used. Despite its importance, dedicated leadership education is rarely part of physician training programs. The goals of this investigation were the following: 1. Describe how leadership and leadership style affect patient care; 2. Describe how effective leadership is measured; and 3. Describe how to train future physician leaders.  Methods: We searched the PubMed database using the keywords “leadership” and then either “trauma” or “resuscitation” as title search terms, and an expert in emergency medicine and trauma then identified prospective observational and randomized controlled studies measuring leadership and teamwork quality. Study results were categorized as follows: 1 how leadership affects patient care; 2 which tools are available to measure leadership; and 3 methods to train physicians to become better leaders. Results: We included 16 relevant studies in this review. Overall, these studies showed that strong leadership improves processes of care in trauma resuscitation including speed and completion of the primary and secondary surveys. The optimal style and structure of leadership are influenced by patient characteristics and team composition. Directive leadership is most effective when Injury Severity Score (ISS is high or teams are inexperienced, while empowering leadership is most effective when ISS is low or teams more experienced. Many scales were employed to measure leadership. The Leader Behavior Description Questionnaire (LBDQ was the only scale used in more than one study. Seven studies described methods for training leaders. Leadership training programs

  4. Leadership and Teamwork in Trauma and Resuscitation

    Science.gov (United States)

    Ford, Kelsey; Menchine, Michael; Burner, Elizabeth; Arora, Sanjay; Inaba, Kenji; Demetriades, Demetrios; Yersin, Bertrand

    2016-01-01

    Introduction Leadership skills are described by the American College of Surgeons’ Advanced Trauma Life Support (ATLS) course as necessary to provide care for patients during resuscitations. However, leadership is a complex concept, and the tools used to assess the quality of leadership are poorly described, inadequately validated, and infrequently used. Despite its importance, dedicated leadership education is rarely part of physician training programs. The goals of this investigation were the following: 1. Describe how leadership and leadership style affect patient care; 2. Describe how effective leadership is measured; and 3. Describe how to train future physician leaders. Methods We searched the PubMed database using the keywords “leadership” and then either “trauma” or “resuscitation” as title search terms, and an expert in emergency medicine and trauma then identified prospective observational and randomized controlled studies measuring leadership and teamwork quality. Study results were categorized as follows: 1) how leadership affects patient care; 2) which tools are available to measure leadership; and 3) methods to train physicians to become better leaders. Results We included 16 relevant studies in this review. Overall, these studies showed that strong leadership improves processes of care in trauma resuscitation including speed and completion of the primary and secondary surveys. The optimal style and structure of leadership are influenced by patient characteristics and team composition. Directive leadership is most effective when Injury Severity Score (ISS) is high or teams are inexperienced, while empowering leadership is most effective when ISS is low or teams more experienced. Many scales were employed to measure leadership. The Leader Behavior Description Questionnaire (LBDQ) was the only scale used in more than one study. Seven studies described methods for training leaders. Leadership training programs included didactic teaching

  5. Conflict nightmares and trauma in Aceh.

    Science.gov (United States)

    Grayman, Jesse Hession; Good, Mary-Jo Delvecchio; Good, Byron J

    2009-06-01

    In both the Acehnese and Indonesian languages, there is no single lexical term for "nightmare." And yet findings from a large field research project in Aceh that examined post traumatic experience during Aceh's nearly 30-year rebellion against the Indonesian state and current mental distress revealed a rich variety of dream narratives that connect directly and indirectly to respondents' past traumatic experiences. The results reported below suggest that even in a society that has a very different cultural ideology about dreams, where "nightmares" as such are not considered dreams but rather the work of mischievous spirits called jin, they are still a significant part of the trauma process. We argue that it is productive to distinguish between terrifying and repetitive dreams that recreate the traumatic moment and the more ordinary varieties of dreams that Acehnese reported to their interviewers. Nightmares that refer back to conflict events do not appear as an elaborated feature of trauma as the condition is understood by people in Aceh, but when asked further about their dreams, respondents who reported symptoms suggestive of PTSD were more likely to report PTSD-like dreams, memory intrusions that repeat the political violence of the past.

  6. The role of interventional radiology in trauma

    Institute of Scientific and Technical Information of China (English)

    Douglas M. Coldwell

    2007-01-01

    @@ Introduction Interventional Radiology has evolved into a specialty having enormous input into the care of the traumatized patient. In all hospitals, regardless of size, the Interventional Radiologist must consider their relationships with the trauma service in order to quickly and efficiently render aid to the trauma victim. Such consideration should take place in the light of day as it seems that most trauma occurs in the middle of the night or another inconvenient time. The watchwords of trauma IR are speed and efficiency.

  7. Lymphangioma of Oral Mucosa After Chronic Trauma: A Case Report

    Directory of Open Access Journals (Sweden)

    Seval Doğruk Kaçar

    2013-09-01

    Full Text Available Lymphangiomas are vascular malformations, known as benign tumors of lymphatic vessels. They are most commonly located in head and neck region whereas oral cavity lesions are rare. The clinical appearance is either clear fluid and blood filled thin walled blisters or smooth flesh-colored papules or nodules varying in size. The condition does not regress itself. Dilated lymphatic vessels lined with endothelium of varying wall thickness is seen on histopathology. Surgical excision, electrocautery, cryosurgery, radiotherapy, injection of sclerosing agent, CO2 and argon laser are used in treatment and recurrence is common. As a developmental defect lymphangiomas are frequently seen at birth or early childhood period, whereas acquired lymphangioma or lymphangiectasias are structurally and histologically not different from lymphangioma. This condition develops in a previously normal lymphatic vessels and is described following chronic infections as tuberculosis, radiotherapy, cheloid, tumors and recurrent trauma. Thirty six year old female patient with vesicular papules of 9 months history underwent to cryosurgery after the biopsy is compatible with lymphangioma. The lesions are thought to be related to chronic trauma due to deficiency of lower central incisor and dental treatment is offered to patient.

  8. Decolonizing Trauma Theory : Retrospect and Prospects

    NARCIS (Netherlands)

    Visser, Irene

    2015-01-01

    Decolonizing trauma theory has been a major project in postcolonial literary scholarship ever since its first sustained engagements with trauma theory. Since then, trauma theory and postcolonial literary studies have been uneasy bedfellows, and the time has now come to take stock of what remains in

  9. Helpers in Distress: Preventing Secondary Trauma

    Science.gov (United States)

    Whitfield, Natasha; Kanter, Deborah

    2014-01-01

    Those in close contact with trauma survivors are themselves at risk for trauma (e.g., Bride, 2007; Figley, 1995). Family, friends, and professionals who bear witness to the emotional retelling and re-enacting of traumatic events can experience what is called "secondary trauma" (Elwood, Mott, Lohr, & Galovski, 2011). The literature…

  10. Decolonizing Trauma Theory : Retrospect and Prospects

    NARCIS (Netherlands)

    Visser, Irene

    2015-01-01

    Decolonizing trauma theory has been a major project in postcolonial literary scholarship ever since its first sustained engagements with trauma theory. Since then, trauma theory and postcolonial literary studies have been uneasy bedfellows, and the time has now come to take stock of what remains in

  11. Addressing Trauma in Substance Abuse Treatment

    Science.gov (United States)

    Giordano, Amanda L.; Prosek, Elizabeth A.; Stamman, Julia; Callahan, Molly M.; Loseu, Sahar; Bevly, Cynthia M.; Cross, Kaitlin; Woehler, Elliott S.; Calzada, Richard-Michael R.; Chadwell, Katie

    2016-01-01

    Trauma is prevalent among clients with substance abuse issues, yet addictions counselors' training in trauma approaches is limited. The purpose of the current article is to provide pertinent information regarding trauma treatment including the use of assessments, empirically supported clinical approaches, self-help groups and the risk of vicarious…

  12. Helpers in Distress: Preventing Secondary Trauma

    Science.gov (United States)

    Whitfield, Natasha; Kanter, Deborah

    2014-01-01

    Those in close contact with trauma survivors are themselves at risk for trauma (e.g., Bride, 2007; Figley, 1995). Family, friends, and professionals who bear witness to the emotional retelling and re-enacting of traumatic events can experience what is called "secondary trauma" (Elwood, Mott, Lohr, & Galovski, 2011). The literature…

  13. Triage and mortality in 2875 consecutive trauma patients

    DEFF Research Database (Denmark)

    Meisler, Rikke; Thomsen, A B; Abildstrøm, H

    2010-01-01

    Most studies on trauma and trauma systems have been conducted in the United States. We aimed to describe the factors predicting mortality in European trauma patients, with focus on triage.......Most studies on trauma and trauma systems have been conducted in the United States. We aimed to describe the factors predicting mortality in European trauma patients, with focus on triage....

  14. [Interdisciplinary treatment of severely injured patients in the trauma resuscitation room].

    Science.gov (United States)

    Wurmb, Thomas; Müller, Thorben; Jansen, Hendrik; Ruchholtz, Steffen; Roewer, Norbert; Kühne, Christian A

    2010-06-01

    The trauma resuscitation room in emergency departments is an important link between preclinical treatment and clinical management of patients with multiple trauma. For the trauma team (Trauma Surgery, Anaesthesiology, Radiology) to respond adequately, a high degree of training and standardisation is required. With arrival of the patient, the trauma team starts with priority orientated resuscitation. After life-threatening problems have been resolved, the diagnostic work is started with plain films of the chest and the pelvis and FAST. Additional plain films are made depending on further suspected injuries. Reassessment of the patient is done and necessary emergency interventions are performed before the patient is transferred to the radiology department for organ focused computed tomography. CT has gained importance in the early diagnostic phase of trauma care. The development of Multislice Helical Computed Tomography (MSCT) has led to substantial refinement in the diagnostic work-up. For many institutions it has become an essential part of the imaging of the traumatized patient. Delayed and insufficient medical interventions have a high impact on negative patient outcome. Anticipating and dealing with critical situations might reduce preventable errors in the treatment process and can be achieved by implementation of an algorithm-based structured workflow. In that context some elements of quality management are well established in clinical practice. In the presented paper we describe the effort that needs to be done to provide optimal care for multiple trauma patients after admission to a designed trauma centre.

  15. American Academy of Otolaryngology--Head and Neck Surgery

    Science.gov (United States)

    ... Neck Mass in Adults is now available in Otolaryngology–Head and Neck Surgery. The guideline addresses the ... Interested in systematic review training? SAGE, publisher of Otolaryngology—Head and Neck Surgery , will offer three grants ...

  16. Psychological trauma after the Great East Japan Earthquake.

    Science.gov (United States)

    Matsumoto, Kazunori; Sakuma, Atsushi; Ueda, Ikki; Nagao, Ayami; Takahashi, Yoko

    2016-08-01

    The Great East Japan Earthquake (GEJE) struck the northeastern part of Japan on 11 March 2011 and triggered a devastating tsunami, causing widespread destruction along the coast of northeastern Japan. The tsunami also led to an accident at the Fukushima Daiichi nuclear power plant. Incidents occurring in such major disasters are known to lead to psychological trauma. This paper has summarized English-language documentation regarding GEJE-related psychological trauma or post-traumatic stress disorder (PTSD). Research thus far has reported the possibility of higher probable PTSD prevalence among residents of the GEJE areas than in the average Japanese population during normal times. At the very least, many people have experienced trauma symptoms at self-recognition levels 1 year or longer after the disaster. It appears that the percentage of persons with high PTSD risk was higher in regions with radiation-related impacts than in regions where the main damage was caused by the earthquake and tsunami. Results have not been limited to showing relations between severe exposure to a traumatic event and PTSD symptoms but also show that a variety of factors, including social factors, has been shown to interact with PTSD symptoms. The fact that Japanese society as a whole united against the trauma of the GEJE may have worked to minimize the effects of trauma. To grasp a full picture of the effects of psychological trauma due to the GEJE, further surveys and research are necessary. It will be necessary to continue engagements related to these problems and issues into the future.

  17. Probiotics for severe trauma patients

    OpenAIRE

    Rijkers, Ger T

    2011-01-01

    Probiotics are live micro-organisms with a health promoting effect. Because of their immunomodulating capacity as well as improvement of gut barrier function, probiotics have the capacity to prevent infectious complications in a variety of clinical settings. Now selected probiotics show potential for improving the clinical outcome of severe trauma patients.

  18. The Trauma-Sensitive Teacher

    Science.gov (United States)

    Craig, Susan E.

    2016-01-01

    According to the National Center for Mental Health Promotion and Youth Violence Prevention, about one quarter of children in the United States will witness or experience a traumatic event before the age of four. In this article, Susan E. Craig explains how these early trauma histories prime a child's brain to expect certain experiences,…

  19. MDCT in blunt intestinal trauma

    Energy Technology Data Exchange (ETDEWEB)

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

    2006-09-15

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

  20. Bilateral acetabular fracture without trauma

    OpenAIRE

    De Rosa, M. A.; G. Maccauro; D’Arienzo, M.

    1999-01-01

     In the absence of trauma fracture of the acetabulum is an extremely rare injury. We describe a 70 year old man who spontaneously developed fractures in both acetabulae due to bony insufficiency. It was successfully treated by bilateral total hip replacement.

  1. Blunt Head Trauma and Headache

    Directory of Open Access Journals (Sweden)

    Ana B Chelse

    2015-04-01

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

  2. Transforming Cultural Trauma into Resilience

    Science.gov (United States)

    Brokenleg, Martin

    2012-01-01

    One of the biggest challenges facing Aboriginal populations increasingly is being called "intergenerational trauma." Restoring the cultural heritage is a central theme in the book, "Reclaiming Youth at Risk." That work describes the Circle of Courage model for positive development which blends Native child and youth care…

  3. Transforming Cultural Trauma into Resilience

    Science.gov (United States)

    Brokenleg, Martin

    2012-01-01

    One of the biggest challenges facing Aboriginal populations increasingly is being called "intergenerational trauma." Restoring the cultural heritage is a central theme in the book, "Reclaiming Youth at Risk." That work describes the Circle of Courage model for positive development which blends Native child and youth care philosophy with research…

  4. Transforming Cultural Trauma into Resilience

    Science.gov (United States)

    Brokenleg, Martin

    2012-01-01

    One of the biggest challenges facing Aboriginal populations increasingly is being called "intergenerational trauma." Restoring the cultural heritage is a central theme in the book, "Reclaiming Youth at Risk." That work describes the Circle of Courage model for positive development which blends Native child and youth care…

  5. Orofacial trauma in rural India: A clinical study.

    Science.gov (United States)

    Malik, Sunita; Singh, Gurdarshan; Kaur, Gagandeep; Yadav, Sunil; Mittal, Hitesh C

    2017-08-01

    Orofacial trauma is becoming a leading medical problem worldwide. Most of the studies pertaining to orofacial trauma have been done in urban areas but very little scientific literature is available for rural areas. A prospective medical institute-based study of orofacial injury patients was carried out from May 2013 to April 2016 (36 Months). Data regarding incidence, age and sex distribution, causes, types and site of injury, treatment modalities and trauma associated complications were collected and analysed. A total of 784 patients were studied. Males outnumbered females by a ratio of 2.9:1. Age range was 9 months-75 years with the peak incidence in the age-group of 18-34 years. Most injuries were caused by road-side accidents (72.7%), followed by assault and falls in 11.6% and 8% respectively. Soft tissue injuries and mandibular fractures were the most common type of injuries. Head/neck (50.29%) and limb injuries (27.2%) were the most prevalent associated injuries. Surgical debridement and soft tissue suturing was the most common emergency procedure. Closed reduction was performed in 61% of patients and open reduction and internal fixation in 30% of cases and 9% were managed conservatively. Complications occurred in 6.88% of patients, mainly due to infection and malocclusion. The mean duration of hospital stay was (10.12 ± 6.24) days. This study highlights the importance of department of dental surgery along with other disciplinaries in the management of orofacial injuries. Road-side accident remains the major etiological factor of orofacial injuries in our setting. Copyright © 2017 Daping Hospital and the Research Institute of Surgery of the Third Military Medical University. Production and hosting by Elsevier B.V. All rights reserved.

  6. Trauma Center Staffing, Infrastructure, and Patient Characteristics that Influence Trauma Center Need

    Science.gov (United States)

    Faul, Mark; Sasser, Scott M.; Lairet, Julio; Mould-Millman, Nee-Kofi; Sugerman, David

    2015-01-01

    Introduction The most effective use of trauma center resources helps reduce morbidity and mortality, while saving costs. Identifying critical infrastructure characteristics, patient characteristics and staffing components of a trauma center associated with the proportion of patients needing major trauma care will help planners create better systems for patient care. Methods We used the 2009 National Trauma Data Bank-Research Dataset to determine the proportion of critically injured patients requiring the resources of a trauma center within each Level I–IV trauma center (n=443). The outcome variable was defined as the portion of treated patients who were critically injured. We defined the need for critical trauma resources and interventions (“trauma center need”) as death prior to hospital discharge, admission to the intensive care unit, or admission to the operating room from the emergency department as a result of acute traumatic injury. Generalized Linear Modeling (GLM) was used to determine how hospital infrastructure, staffing Levels, and patient characteristics contributed to trauma center need. Results Nonprofit Level I and II trauma centers were significantly associated with higher levels of trauma center need. Trauma centers that had a higher percentage of transferred patients or a lower percentage of insured patients were associated with a higher proportion of trauma center need. Hospital infrastructure characteristics, such as bed capacity and intensive care unit capacity, were not associated with trauma center need. A GLM for Level III and IV trauma centers showed that the number of trauma surgeons on staff was associated with trauma center need. Conclusion Because the proportion of trauma center need is predominantly influenced by hospital type, transfer frequency, and insurance status, it is important for administrators to consider patient population characteristics of the catchment area when planning the construction of new trauma centers or

  7. Trauma Center Staffing, Infrastructure, and Patient Characteristics that Influence Trauma Center Need

    Directory of Open Access Journals (Sweden)

    Faul, Mark

    2014-11-01

    Full Text Available Introduction: The most effective use of trauma center resources helps reduce morbidity and mortality, while saving costs. Identifying critical infrastructure characteristics, patient characteristics and staffing components of a trauma center associated with the proportion of patients needing major trauma care will help planners create better systems for patient care.   Methods: We used the 2009 National Trauma Data Bank-Research Dataset to determine the proportion of critically injured patients requiring the resources of a trauma center within each Level I-IV trauma center (n=443. The outcome variable was defined as the portion of treated patients who were critically injured. We defined the need for critical trauma resources and interventions (“trauma center need” as death prior to hospital discharge, admission to the intensive care unit, or admission to the operating room from the emergency department as a result of acute traumatic injury. Generalized Linear Modeling (GLM was used to determine how hospital infrastructure, staffing Levels, and patient characteristics contributed to trauma center need.     Results: Nonprofit Level I and II trauma centers were significantly associated with higher levels of trauma center need. Trauma centers that had a higher percentage of transferred patients or a lower percentage of insured patients were associated with a higher proportion of trauma center need.  Hospital infrastructure characteristics, such as bed capacity and intensive care unit capacity, were not associated with trauma center need. A GLM for Level III and IV trauma centers showed that the number of trauma surgeons on staff was associated with trauma center need. Conclusion: Because the proportion of trauma center need is predominantly influenced by hospital type, transfer frequency, and insurance status, it is important for administrators to consider patient population characteristics of the catchment area when planning the

  8. Non-specific neck pain in preadolescent to adolescent populations

    OpenAIRE

    2014-01-01

    Neck pain is a common health problem globally. In addition to individual suffering, it causes a huge burden on societies. Some evidence suggests that neck pain in adolescence predicts frequent neck symptoms also in adulthood. A steady increase in prevalence of frequent and persistent neck pain among Finnish adolescents was observed in the 1990s, which might predict an increasing amount of adults with chronic neck pain in the near future. Thus, better understanding neck pain in children and ad...

  9. Preventing head and neck injury.

    Science.gov (United States)

    McIntosh, A S; McCrory, P

    2005-06-01

    A wide range of head and neck injury risks are present in sport, including catastrophic injury. The literature since 1980 on prevention of head and neck injury in sport was reviewed, focusing on catastrophic and brain injury and identifying the range of injury prevention methods in use. There have been few formal evaluations of injury prevention methods. Approaches that are considered, or have been proven, to be successful in preventing injury include: modification of the baseball; implementation of helmet standards in ice hockey and American football and increased wearing rates; use of full faceguards in ice hockey; changes in rules associated with body contact; implementation of rules to reduce the impact forces in rugby scrums. Helmets and other devices have been shown to reduce the risk of severe head and facial injury, but current designs appear to make little difference to rates of concussion. Research methods involving epidemiological, medical, and human factors are required in combination with biomechanical and technological approaches to reduce further injury risks in sport.

  10. Reabilitação visual com lentes de contato após trauma ocular Visual rehabilitation with contact lenses after ocular trauma

    Directory of Open Access Journals (Sweden)

    Adamo Lui Netto

    2008-12-01

    Full Text Available Trauma ocular é causa importante de baixa de acuidade visual em todos os países do mundo. A integridade do bulbo ocular é primordial para recuperação visual nesses pacientes. Acidentes domésticos, automobilísticos, esportivos, além de queimaduras químicas e térmicas são as principais causas de trauma em nosso meio. O uso de lentes de contato é indicado para a reabilitação visual em casos de astigmatismos regulares ou irregulares de córnea, anisometropias, afacias, opacidades paracentrais superficiais ou profundas na córnea decorrentes do trauma ocular. As lentes de contato podem ser utilizadas no pós-trauma com finalidade terapêutica ou para correção visual. As lentes mais utilizadas para correção visual pós-trauma são as lentes de contato rígidas gás permeáveis, com alto coeficiente de permeabilidade. As lentes de contato gelatinosas podem ser usadas imediatamente após o trauma ocular com finalidade terapêutica e mais tardiamente para correção óptica em afacias e anisometropias traumáticas. A lente de contato é parte importante no tratamento tardio do trauma ocular, propiciando melhora significativa da acuidade visual na maioria dos casos.Ocular trauma is an important cause of visual acuity loss worldwide. Visual recovery is related to anatomical integrity. The main causes of trauma are domestic and automobilist accidents, sports practice and chemical or thermic burns. Contact lens is indicated for visual rehabilitation in cases of corneal regular and irregular astigmatisms, anisometropic and aphakic patients and in cases of deep or superficial corneal opacities that do not affect the visual axis. Contact lens can be used in the post- trauma period for therapeutic and optical purposes. Rigid gas permeable contact lens, with a high permeability index, is the most used for optical purpose. Soft contact lens can be used immediately after trauma as therapy or later for optical correction in aphakic and

  11. Initial conformation of kinesin's neck linker

    CERN Document Server

    Geng, Yi-Zhao; Liu, Shu-Xia; Yan, Shiwei

    2013-01-01

    How ATP binding initiates the docking process of kinesin's neck linker is a key question in understanding kinesin mechanism. It is believed that the formation of an extra turn structure by the first three amino acids of neck linker (LYS325, THR326, ILE327 in 2KIN) is crucial for initiating the docking process. But the initial conformation of neck linker (specially the three amino acids of the extra turn) and the neck linker docking initiation mechanism remain unclear. By using molecular dynamics method, we investigate the initial conformation of kinesin's neck linker in the docking process. We find that, in the initial state of NL docking process, NL still has interactions with {\\beta}0 and forms a conformation similar to the "cover-neck bundle" structure proposed by Hwang et al. [Structure 2008, 16(1): 62-71]. From this initial structure, the docking of the "cover-neck bundle" structure can be achieved. The motor head provides a forward force on the initial cover-neck bundle structure through ATP-induced rot...

  12. Evaluation of head and neck postures

    NARCIS (Netherlands)

    Delleman, N.J.

    2000-01-01

    This paper describes the literature and two experiments on the evaluation of head and neck postures. It is concluded that health and safety professiona1s and ergonomists during posture evaluation should consider neck flexion/extension (head vs. trunk), besides the traditionally used inclination of t

  13. Acute Neck Pain in General Practice

    NARCIS (Netherlands)

    C.J. Vos (Kees)

    2006-01-01

    textabstractWe performed a prospective cohort study with one-year follow-up of patients with acute neck pain in general practice. Patients above 18 years of age consulting their GP for non-specific acute neck pain lasting no longer than six weeks were invited to participate. Self-administered quest

  14. Nodal yield in selective neck dissection

    DEFF Research Database (Denmark)

    Norling, Rikke; Therkildsen, Marianne H; Bradley, Patrick J

    2013-01-01

    The total lymph node yield in neck dissection is highly variable and depends on anatomical, surgical and pathological parameters. A minimum yield of six lymph nodes for a selective neck dissection (SND) as recommended in guidelines lies in the lower range of the reported clinical nodal yields...

  15. Evaluation of head and neck postures

    NARCIS (Netherlands)

    Delleman, N.J.

    2000-01-01

    This paper describes the literature and two experiments on the evaluation of head and neck postures. It is concluded that health and safety professiona1s and ergonomists during posture evaluation should consider neck flexion/extension (head vs. trunk), besides the traditionally used inclination of

  16. Inter-vertebral flexibility of the ostrich neck: implications for estimating sauropod neck flexibility.

    Directory of Open Access Journals (Sweden)

    Matthew J Cobley

    Full Text Available The flexibility and posture of the neck in sauropod dinosaurs has long been contentious. Improved constraints on sauropod neck function will have major implications for what we know of their foraging strategies, ecology and overall biology. Several hypotheses have been proposed, based primarily on osteological data, suggesting different degrees of neck flexibility. This study attempts to assess the effects of reconstructed soft tissues on sauropod neck flexibility through systematic removal of muscle groups and measures of flexibility of the neck in a living analogue, the ostrich (Struthio camelus. The possible effect of cartilage on flexibility is also examined, as this was previously overlooked in osteological estimates of sauropod neck function. These comparisons show that soft tissues are likely to have limited the flexibility of the neck beyond the limits suggested by osteology alone. In addition, the inferred presence of cartilage, and varying the inter-vertebral spacing within the synovial capsule, also affect neck flexibility. One hypothesis proposed that flexibility is constrained by requiring a minimum overlap between successive zygapophyses equivalent to 50% of zygapophyseal articular surface length (ONP50. This assumption is tested by comparing the maximum flexibility of the articulated cervical column in ONP50 and the flexibility of the complete neck with all tissues intact. It is found that this model does not adequately convey the pattern of flexibility in the ostrich neck, suggesting that the ONP50 model may not be useful in determining neck function if considered in isolation from myological and other soft tissue data.

  17. The family of the trauma victim.

    Science.gov (United States)

    Solursh, D S

    1990-03-01

    Emergency room and trauma unit work offers unique challenges to the nurse, both professionally and personally. One of these challenges is understanding and dealing with the behavior of victims' families. Some of the factors that impact on the behavior of families include (1) the sudden and unpredictable nature of trauma; (2) the nature of the relationship of the specific family member and the trauma victim; (3) the issues of responsibility, anger, and guilt; (4) religious beliefs; and (5) trauma sequelae. The development of organ and tissue donor programs and of psychotraumatology as ways to help ease the plight of trauma victims' families are also discussed.

  18. Nonpathologizing trauma interventions in abnormal psychology courses.

    Science.gov (United States)

    Hoover, Stephanie M; Luchner, Andrew F; Pickett, Rachel F

    2016-01-01

    Because abnormal psychology courses presuppose a focus on pathological human functioning, nonpathologizing interventions within these classes are particularly powerful and can reach survivors, bystanders, and perpetrators. Interventions are needed to improve the social response to trauma on college campuses. By applying psychodynamic and feminist multicultural theory, instructors can deliver nonpathologizing interventions about trauma and trauma response within these classes. We recommend class-based interventions with the following aims: (a) intentionally using nonpathologizing language, (b) normalizing trauma responses, (c) subjectively defining trauma, (d) challenging secondary victimization, and (e) questioning the delineation of abnormal and normal. The recommendations promote implications for instructor self-reflection, therapy interventions, and future research.

  19. Endovascular Treatment of Infrarenal Abdominal Aortic Aneurysm with Short and Angulated Neck in High-Risk Patient

    Directory of Open Access Journals (Sweden)

    Stylianos Koutsias

    2013-01-01

    Full Text Available Endovascular treatment of abdominal aortic aneurysms (AAA is an established alternative to open repair. However lifelong surveillance is still required to monitor endograft function and signal the need for secondary interventions (Hobo and Buth 2006. Aortic morphology, especially related to the proximal neck, often complicates the procedure or increases the risk for late device-related complications (Hobo et al. 2007 and Chisci et al. 2009. The definition of a short and angulated neck is based on length (60° (Hobo et al. 2007 and Chisci et al. 2009. A challenging neck also offers difficulties during open repairs (OR, necessitating extensive dissection with juxta- or suprarenal aortic cross-clamping. Patients with extensive aneurysmal disease typically have more comorbidities and may not tolerate extensive surgical trauma (Sarac et al. 2002. It is, therefore, unclear whether aneurysms with a challenging proximal neck should be offered EVAR or OR (Cox et al. 2006, Choke et al. 2006, Robbins et al. 2005, Sternbergh III et al. 2002, Dillavou et al. 2003, and Greenberg et al. 2003. In our case the insertion of a thoracic endograft followed by the placement of a bifurcated aortic endograft for the treatment of a very short and severely angulated neck proved to be feasible offering acceptable duration of aneurysm exclusion. This adds up to our armamentarium in the treatment of high-risk patients, and it should be considered in emergency cases when the fenestrated and branched endografts are not available.

  20. Public knowledge of head and neck cancer.

    LENUS (Irish Health Repository)

    O'Connor, T E

    2010-04-01

    Studies show 60% of patients with newly diagnosed Head & Neck Squamous Cell Cancer in Ireland, present with advanced disease. A poor level of knowledge and awareness among the public of Head & Neck Cancer, is an important consideration in the often delayed presentation for medical attention in many of these cases. Our study surveyed 200 members of the public to assess their knowledge and awareness of Head & Neck Cancer. One hundred and forty (70%) of respondents had never encountered the term "Head & Neck Cancer". One hundred and forty six (73%) failed to identify excessive alcohol consumption as a risk factor. Less than 100 (50%) would have concern about persisting hoarseness or a prolonged oral ulcer. An urgent need exists to raise awareness of Head & Neck Cancer among the public in Ireland.

  1. Advanced Trauma Life Support. ABCDE from a radiological point of view.

    Science.gov (United States)

    Kool, Digna R; Blickman, Johan G

    2007-07-01

    Accidents are the primary cause of death in patients aged 45 years or younger. In many countries, Advanced Trauma Life Support(R) (ATLS) is the foundation on which trauma care is based. We will summarize the principles and the radiological aspects of the ATLS, and we will discuss discrepancies with day to day practice and the radiological literature. Because the ATLS is neither thorough nor up-to-date concerning several parts of radiology in trauma, it should not be adopted without serious attention to defining the indications and limitations pertaining to diagnostic imaging.

  2. Advanced Trauma Life Support®. ABCDE from a radiological point of view

    OpenAIRE

    2007-01-01

    Accidents are the primary cause of death in patients aged 45 years or younger. In many countries, Advanced Trauma Life Support® (ATLS®) is the foundation on which trauma care is based. We will summarize the principles and the radiological aspects of the ATLS®, and we will discuss discrepancies with day to day practice and the radiological literature. Because the ATLS® is neither thorough nor up-to-date concerning several parts of radiology in trauma, it should not be adopted without serious a...

  3. The effect of brain injury on the inflammatory response following severe trauma.

    Science.gov (United States)

    Lustenberger, T; Kern, M; Relja, B; Wutzler, S; Störmann, P; Marzi, I

    2016-03-01

    The inflammatory response is an important part of the pathophysiology of severe injury and, in particular, of severe traumatic brain injury (TBI). This study evaluates the inflammatory course following major trauma and focuses on the effect of severe TBI on inflammatory markers. This was a retrospective analysis of prospectively collected data in 123 severely injured (ISS ≥16) trauma patients. The study cohort was divided into patients with isolated TBI (Head AIS ≥3, all other AIS trauma. Significant correlations between admission IL-6 values and the development of MOF, sepsis and the neurological outcome were found in patients with TBI. Copyright © 2015 Elsevier GmbH. All rights reserved.

  4. [Standardised primary care of multiple trauma patients. Prehospital Trauma Life Support und Advanced Trauma Life Support].

    Science.gov (United States)

    Wölfl, C G; Gliwitzky, B; Wentzensen, A

    2009-10-01

    Standardised management improves treatment results in seriously injured patients. For conditions like stroke or acute coronary syndrome (ACS) there are set treatment pathways which have been established for prehospital and primary hospital care. The treatment of critical trauma patients, however, follows varying procedures in both the prehospital and primary hospital phases. From an analysis of the trauma register of the German Society for Trauma Surgery (DGU), we know that a seriously injured patient remains on the road for 70 min on average before transferral to hospital. This requires improvement. With the 2003 introduction of the ATLS programme in Germany, the initial clinical phase could be improved upon simply by means of standardised training. PHTLS und ATLS complement one another. PHTLS und ATLS represent training concepts which teach standardised, priority-based prehospital and hospital trauma management. The aim is to make an initial rapid and accurate assessment of the patient's condition, thereby identifying the"critical" patient. The concepts also make priority-based treatment possible and facilitate decision-making as to whether patients can receive further on-the-spot treatment or whether immediate transport is necessary. The procedure is identical in the shock room. The primary consideration is to prevent secondary damage, not to lose track of time and to ensure consistent quality of care. The courses teach systematic knowledge, techniques, skills and conduct in diagnosis and therapy. The courses are oriented to all medical specialities associated with trauma care. With the support of the German Society for Trauma Surgery (DGU) and the German Society for Anesthesiology and Intensive Medicine (DGAI), the German Professional Organisation of Rescue Services (DBRD) has adopted the PHTLS course system on licence from the National Association of Emergency Medical Technicians (NAEMT) and the American College of Surgeons (ACS) and has been offering it in

  5. International benchmarking of tertiary trauma centers: productivity and throughput approach

    Directory of Open Access Journals (Sweden)

    Matthes Gerrit

    2011-08-01

    were the most comparable parts of trauma care between the hospitals. The study also showed that the international benchmarking approach could be used to reveal bottlenecks in system-level policies and practices.

  6. Trauma, posttraumatic stress disorder and psychosis: etiopathogenic and nosological implications

    Directory of Open Access Journals (Sweden)

    Álvaro Frías Ibáñez

    2014-03-01

    Full Text Available Background and Objectives: The relationship between trauma, post-traumatic stress disorder (PTSD, and psychosis has promoted heterogeneous research lines, in both etiopathogenic and nosological areas. The main aim of this review is to provide a systematic framework that encompasses this theoretical gap in the literature. Methods: A literature research was carried out through PubMed and PsycINFO between 1980 and May 2013. One hundred and thirteen articles were recruited. A first part of this review describes the role of trauma in the development of psychosis. The second part focuses on research about PTSD and psychosis. Results: Longitudinal and cross-sectional studies with clinical and community samples confirm that childhood trauma (CT is a vulnerability factor for schizophrenia and psychotic-like symptoms in adulthood. More empirical research is needed in order to assess the role of trauma as precipitant of acute psychosis. There is also preliminary evidence with cross-sectional samples that suggests that PTSD and psychosis are a risk factor for each other, with studies about post-psychotic PTSD (PP-PTSD being outstanding. Finally, results from different comparative research studies postulate a subtype of PTSD with psychotic features (PTSD-SP. Conclusions: The role of trauma in psychosis is more conclusive as predispositional rather than as trigger factor. Nosological status of acute psychoses remains a focus of controversy unresolved. The association between PTSD and psychosis is complex, requiring more prospective research in order to determine causal relationships between these pathologies. Also, research in nosological status of PTSD-SP must encourage more comparative studies not limited to neurobiological variables.

  7. Short Term Effects of Mobilization Techniques on Neck Pain and Deep Neck Flexor Muscle Endurance in Patients with Mechanical Chronic Neck Pain

    OpenAIRE

    Kılınç, Hasan Erkan; Harput, Gülcan; Baltacı, Gül; İnce, Deniz İnal

    2014-01-01

    Objectives: The aim of the study was to investigate short term effects of cervical and scapular mobilization techniques on neck pain and deep cervical muscles endurance in chronical mechanical neck pain patients. Methods: 22 chronical mechanic neck pain patients four male 18 female (mean age: mean±sd 35.59± 15.85) were included. Before treatment, neck pain level (visual analog scale) and deep neck flexor muscles endurance (in supine position with digital chronometer) of all patients were eval...

  8. History of the Dental Trauma Guide.

    Science.gov (United States)

    Andreasen, Jens Ove; Ahrensburg, Søren Steno

    2012-10-01

    The history of the Dental Trauma Guide dates back to 1965, where guidelines were developed for trauma records and treatment of various trauma entities at the Department of Oral and Maxillofacial Surgery at the University Hospital in Copenhagen. In 1972, a unique possibility came up at the Serum Institute in Copenhagen to test various dental trauma procedures in monkeys, which served as kidney donors in the polio vaccine production. Over the years, 40 000 dental trauma patients were treated at the Trauma Centre according to established guidelines, and 4000 of these have been enrolled in long-term follow-up of various trauma entities. This has resulted in 79 clinical studies, and 64 studies in monkeys have examined the effect of various treatment procedures and the aetiology of most healing complications.

  9. History of the Dental Trauma Guide

    DEFF Research Database (Denmark)

    Andreasen, Jens Ove; Christensen, Søren Steno Ahrensburg

    2012-01-01

    The history of the Dental Trauma Guide dates back to 1965, where guidelines were developed for trauma records and treatment of various trauma entities at the Department of Oral and Maxillofacial Surgery at the University Hospital in Copenhagen. In 1972, a unique possibility came up at the Serum...... Institute in Copenhagen to test various dental trauma procedures in monkeys, which served as kidney donors in the polio vaccine production. Over the years, 40 000 dental trauma patients were treated at the Trauma Centre according to established guidelines, and 4000 of these have been enrolled in long......-term follow-up of various trauma entities. This has resulted in 79 clinical studies, and 64 studies in monkeys have examined the effect of various treatment procedures and the aetiology of most healing complications....

  10. Morbidity associated with golf-related injuries among children: findings from a pediatric trauma center.

    Science.gov (United States)

    Vitale, Melissa A; Mertz, Kristen J; Gaines, Barbara; Zuckerbraun, Noel S

    2011-01-01

    To describe injuries due to golf-related activities among pediatric patients requiring hospital admission. We conducted a retrospective analysis of all sports-related injuries from 2000 to 2006 using a level 1 trauma center database. Of 1005 children admitted with sports-related injuries, 60 (6%) had golf-related injuries. The mean injury severity score was significantly higher for golf-related injuries (11.0) than that for all other sports-related injuries (6.8). Most golf-related injuries occurred in children younger than 12 years (80%), at home (48%), and by a strike from a club (57%) and resulted in trauma to the head or neck (68%). Golf-related injuries, although an infrequent cause of sports-related injuries, have the potential to result in severe injuries, especially in younger children. Preventive efforts should target use of golf clubs by younger children in the home setting.

  11. Delayed presentation of carotid artery dissection following major orthopaedic trauma resulting in dense hemiparesis.

    LENUS (Irish Health Repository)

    Edmundson, S P

    2012-01-31

    We report a 30-year-old patient who was involved in a high-velocity road traffic accident and developed a left-sided hemiparesis, which was noted in the post-operative period following bilateral femoral intramedullary nailing. CT scanning of the brain revealed infarcts in the right frontal and parietal lobes in the distribution of the right middle cerebral artery. CT angiography showed occlusion of the right internal carotid artery consistent with internal carotid artery dissection. He was anticoagulated and nine months later was able to walk independently. An awareness of this injury is needed to diagnose blunt trauma to the internal carotid artery. Even in the absence of obvious neck trauma, carotid artery dissection should be suspected in patients with a neurological deficit in the peri-operative period.

  12. Diffuse Subcutaneous Emphysema and Pneumomediastinum Secondary to a Minor Blunt Chest Trauma

    Directory of Open Access Journals (Sweden)

    Maximilian Andreas Storz

    2017-01-01

    Full Text Available Full medical evaluation is paramount for all trauma patients. Minor traumas are often overlooked, as they are thought to bear low injury potential. In this case report, we describe the case of a 48-year-old man presenting to our Emergency Department with mild to moderate right-sided shoulder and scapular pain following a fall from his own height ten days previously. Clinical and paraclinical investigations (CT revealed diffuse right shoulder pain, with crepitations on palpation of the neck, right shoulder, and right lateral chest wall. Computed tomography (CT demonstrated right-sided costal fractures (ribs 7 to 9, with diffuse subcutaneous emphysema and pneumomediastinum due to laceration of the visceral and parietal pleura and the adjacent lung parenchyma. In addition, a small ipsilateral pneumothorax was found. Surprisingly, the clinical status was only minimally affected by mild to moderate pain and minor functional impairment.

  13. CERN’s firefighters hone their trauma response skills

    CERN Document Server

    Anaïs Schaeffer

    2016-01-01

    Seven CERN firefighters have been trained in how to treat trauma victims. This training forms part of the Fire Brigade’s efforts to acquire specialist knowledge.   The fifteen trainees who took the PHTLS course at CERN, with the instructor team. On 23 and 24 May, the CERN Fire Brigade welcomed five instructors from Life Support France, an association that offers training in pre-hospital emergency treatment, to provide a course on Pre-Hospital Trauma Life Support (PHTLS). Fifteen “trainees” – seven CERN firefighters and eight rescue and healthcare professionals from outside the Organization (nurses, paramedics and firefighters) – took part in the course, at the end of which they were awarded an official PHTLS certificate, valid for four years. Of course, the whole PHTLS programme cannot be covered in just two days, so several months of additional work were required in advance of the course, particularly to acquire the necessary theoretical knowledg...

  14. A Civilian/Military Trauma Institute: National Trauma Coordinating Center

    Science.gov (United States)

    2015-12-01

    update trauma research subject areas based upon the basis of impact on survival or care of patients, existing funding, and funding availability...Lastly, this is a retrospective post hoc analysis and therefore the data is not powered to prevent a type 2 error. Based on our data, we found no...Scale Attitude and Willingness Items Table 1 – Demographics of the Study Population Table 2 – Univariate Analysis of AVERT Attitude and EFIC

  15. Trauma care systems in Spain.

    Science.gov (United States)

    Queipo de Llano, E; Mantero Ruiz, A; Sanchez Vicioso, P; Bosca Crespo, A; Carpintero Avellaneda, J L; de la Torre Prado, M V

    2003-09-01

    Trauma care systems in Spain are provided by the Nacional Health Service in a decentralized way by the seventeen autonomous communities whose process of decentralization was completed in January 2002. Its organisation is similar in all of them. Public sector companies of sanitary emergencies look after the health of citizens in relation to medical and trauma emergencies with a wide range of up to date resources both technical and human. In the following piece there is a description of the emergency response teams divided into ground and air that are responsible for the on site care of the patients in coordination with other public services. They also elaborate the prehospital clinical history that is going to be a valuable piece of information for the teams that receive the patient in the Emergency Hospital Unit (EHU). From 1980 to 1996 the mortality rate per 10.000 vehicles and the deaths per 1.000 accidents dropped significantly: in 1980 6.4 and 96.19% and in 1996, 2.8 and 64.06% respectively. In the intrahospital organisation there are two differentiated areas to receive trauma patients the casualty department and the EHU. In the EHU the severe and multiple injured patients are treated by the emergency hospital doctors; first in the triage or resuscitation areas and after when stabilised they are passed too the observation area or to the Intensive Care Unit (ICU) and from there the EHU or ICU doctors call the appropriate specialists. There is a close collaboration and coordination between the orthopaedic surgeon the EHU doctors and the other specialists surgeons in order to comply with treatment prioritization protocols. Once the patient has been transferred an entire process of assistance continuity is developed based on interdisciplinary teams formed in the hospital from the services areas involved in trauma assistance and usually coordinated by the ICU doctors. There is also mentioned the assistance registry of trauma patients, the ICU professional training

  16. Outcome after vascular trauma in a deployed military trauma system.

    Science.gov (United States)

    Stannard, A; Brown, K; Benson, C; Clasper, J; Midwinter, M; Tai, N R

    2011-02-01

    Military injuries to named blood vessels are complex limb- and life-threatening wounds that pose significant difficulties in prehospital and surgical management. The aim of this study was to provide a comprehensive description of the epidemiology, treatment and outcome of vascular injury among service personnel deployed on operations in Afghanistan and Iraq. Data from the British Joint Theatre Trauma Registry were combined with hospital records to review all cases of vascular trauma in deployed service personnel over a 5-year interval ending in January 2008. Of 1203 injured service personnel, 110 sustained injuries to named vessels; 66 of them died before any surgical intervention. All 25 patients who sustained an injury to a named vessel in the abdomen or thorax died; 24 did not survive to undergo surgery and one casualty in extremis underwent a thoracotomy, but died. Six of 17 patients with cervical vascular injuries survived to surgical intervention; two died after surgery. Of 76 patients with extremity vascular injuries, 37 survived to surgery with one postoperative death. Interventions on 38 limbs included 19 damage control procedures (15 primary amputations, 4 vessel ligations) and 19 definitive limb revascularization procedures (11 interposition vein grafts, 8 direct repairs), four of which failed necessitating three amputations. In operable patients with extremity injury, amputation or ligation is often required for damage control and preservation of life. Favourable limb salvage rates are achievable in casualties able to withstand revascularization. Despite marked progress in contemporary battlefield trauma care, torso vascular injury is usually not amenable to surgical intervention.

  17. Pediatric vs adult vascular trauma: a National Trauma Databank review.

    Science.gov (United States)

    Barmparas, Galinos; Inaba, Kenji; Talving, Peep; David, Jean-Stephane; Lam, Lydia; Plurad, David; Green, Donald; Demetriades, Demetrios

    2010-07-01

    The purpose of this study was to examine nationwide data on vascular injuries in children and to compare pediatric and adult patients with respect to the incidence, injury mechanisms, and outcomes. This is a National Trauma Databank analysis based on dataset version 7.0 (spanning a 5-year period ending December 2006). Pediatric patients under the age of 16 with at least one reported diagnosis of a vascular injury were compared to the adult cohort aged 16 and greater with a vascular injury. During the study period, of 251,787 injured patients younger than 16 years, 1138 (0.6%) had a vascular injury. The incidence in patients 16 years or older was significantly higher, at 1.6% (P vascular patients, pediatric patients had a significantly lower Injury Severity Score (16.8 +/- 14.9 vs 26.3 +/- 16.7, P vascular injuries (adjusted odds ratio, 0.60; 95% CI, 0.45-0.79; P vascular injuries. Vascular trauma in the pediatric population is uncommon, occurring in only 0.6% of all pediatric trauma patients. Although less frequent than adults, a significant proportion was due to penetrating injury. Vessels of the upper extremity were the most commonly injured and were associated with low mortality. Injuries of the thoracic aorta are rare. Overall, pediatric patients had an improved adjusted mortality when compared to adults. Copyright 2010 Elsevier Inc. All rights reserved.

  18. Acute neck pain in the ED: Consider longus colli calcific tendinitis vs meningitis.

    Science.gov (United States)

    Patel, Tyag K; Weis, James C

    2017-06-01

    Presented here is a rare cause of severe neck pain - acute longus colli calcific tendinitis - in a 54year old man who presented to the emergency department. The neck pain is due to inflammation caused by calcium hydroxyapatite crystal deposition in the tendons on the longus colli muscles. This is non-infectious. The gold standard for diagnosis is a CT neck which best shows the calcifications in the anterior vertebral column of C1-C4, where the tendons of these muscles insert bilaterally. Longus colli calcific tendinitis is not life-threatening and patients will make a full recovery after treatment with NSAIDs. However, this condition is often confused with life-threatening conditions such as infection (meningitis or retropharyngeal abscess), intracranial hemorrhage, trauma, herniation of cervical discs, or malignancy (Estimable et al. (2015) [1]). Symptoms associated with calcific tendinitis of the longus colli muscle are non-specific and include mild fever, moderate-severe headache, neck pain, and drastically reduced range of motion of the neck. More specific symptoms are the presence of dysphagia and odynophagia. Lab findings usually are significant for mild leukocytosis, and elevated ESR and CRP. Awareness of this condition by E.D. physicians can avoid unnecessary invasive interventions, increased costs, and delays that result from incorrect diagnosis and treatment. This is a unique case in which a patient who was afebrile with a normal ESR was worked up for meningitis and an intracranial process, and also empirically treated for meningitis before finally being diagnosed with acute calcific tendinitis of the longus colli muscle in the E.D. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Ingestion and Pharyngeal Trauma Causing Secondary Retropharyngeal Abscess in Five Adult Patients

    Directory of Open Access Journals (Sweden)

    Sudhir B. Sharma

    2012-01-01

    Full Text Available Retropharyngeal abscess most commonly occurs in children. When present in adults the clinical features may not be typical, and associated immunosuppression or local trauma can be part of the presentation. We present a case series of five adult patients who developed foreign body ingestion trauma associated retropharyngeal abscess. The unusual pearls of each case, along with their outcomes, are discussed. Pertinent information for the emergency medicine physician regarding retropharyngeal abscess is presented as well.

  20. The Focused Assessment With Sonography For Trauma (FAST) Examination And Pelvic Trauma: Indications And Limitations.

    Science.gov (United States)

    Shaukat, Nadia Maria; Copeli, Nikolai; Desai, Poonam

    2016-03-01

    Pelvic trauma accounts for only 3% of all skeletal injuries but may have mortality as high as 45% in cases of severe trauma. Significant high-grade-mechanism trauma to the pelvis must always take the abdomen into consideration for evaluation. The focused assessment with sonography for trauma (FAST) examination has been shown to be a valuable tool in assessing the unstable trauma patient with blunt abdominal injury, though its diagnostic utility is much less well-defined than in primary pelvic trauma. This systematic review explores the utility and limitations of the FAST examination in patients with blunt pelvic trauma and discusses the timing for the examination during the trauma survey. Newer techniques for emergency department management of the unstable trauma patient are also addressed.

  1. The role of trauma on temporomandibular joint ankylosis and mandibular growth retardation: an experimental study.

    Science.gov (United States)

    Oztan, Hasan Yucel; Ulusal, Betul Gozel; Aytemiz, Cemal

    2004-03-01

    The purpose of this pilot study was to analyze the role of different types of trauma in the formation of temporomandibular joint ankylosis. The specific aim was to explore the physical and histological effects of trauma on temporomandibular joint and mandibular growth. Fifty-five growing white male guinea pigs were used for the study. Initially, cadaveric studies were performed (n = 1) to assess the topographic anatomy of the temporomandibular joint region. Animals were then assigned to pilot (n = 4), experimental (n = 40), and control (n = 10) groups. The pilot group was used to assess the technical feasibility of creating various trauma types and endurance of the animals to the surgery. Four types of trauma were carried out in the experimental group: A) intra-articular hematoma (n = 10), B) mechanical damage to the articular surface (n = 10), C) fracture of the condyle neck (n = 10), and D) excision of the condyle head (n = 10). Each trauma group was further divided into two subgroups. Procedures were performed unilaterally or bilaterally in the subgroups. In the control group, no procedure was performed. Subjects were examined after a 2-month follow-up period. The development and anatomical structure of the mandible were evaluated, and histopathological assessment of the temporomandibular joint was carried out in each group. The results revealed that hyaline cartilage of the condylar head had an important role in the development of the mandible and traumas targeting this site may cause ankylosis, growth retardation, and resultant facial malformations. Hence, mechanical damage to the articular surface (B1, B2) and resection of the condylar head (D1, D2) almost always resulted in ankylosis. Intra-articular hematoma alone (A1, A2) was established not be a causative factor for ankylosis formation, however.

  2. A proposed algorithm for multimodal liver trauma management from a surgical trauma audit in a western European trauma center.

    Science.gov (United States)

    Di Saverio, S; Sibilio, A; Coniglio, C; Bianchi, E; Biscardi, A; Villani, S; Gordini, G; Tugnoli, G

    2014-11-01

    Management of liver trauma is challenging and may vary widely given the heterogeneity of liver injuries' anatomical configuration, the hemodynamic status, the settings and resources available. Perhaps the use of non-operative management (NOM) may have potential drawbacks and the role of damage control surgery (DCS) and angioembolization represents a major evolving concept.1 Most severe liver trauma in polytrauma patients accounts for a significant morbidity and mortality. Major liver trauma with extensive parenchymal injury and uncontrollable bleeding is therefore a challenge for the trauma team. However a safe and effective surgical hemostasis and a carefully planned multidisciplinary approach can improve the outcome of severe liver trauma. The technique of perihepatic packing, according to DCS approach, is often required to achieve fast, early and effective control of hemorrhage in the highest grades of liver trauma and in unstable patients. A systematic and standardized technique of perihepatic packing may contribute to improve hemostatic efficacy and overall outcomes if wisely combined in a stepwise "sandwich" multimodal approach. DCS philosophy evolved alongside with damage control resuscitation (DCR) in the management of trauma patients, requiring close interaction between surgery and resuscitation. Therefore, as a result of a combined surgical and critical care clinical audit activity in our western European trauma center, a practical algorithm for multimodal sequential management of liver trauma has been developed based on a historical cohort of 253 liver trauma patients and subsequently validated on a prospective cohort of 135 patients in the period 2010-2013.

  3. Profile of thoracic trauma victims submitted to chest drainage.

    Science.gov (United States)

    Broska, Cesar Augusto; Botelho, Adriane Barbosa; Linhares, André DE Castro; DE-Oliveria, Mariana Santos; Veronese, Gabriela; Naufel, Carlos Roberto; Batista, Lislaine Cruz; Diogo, Maria Angélica Kurpel

    2017-01-01

    . Os atendimentos geralmente ocorreram à noite sem predomínio entre mecanismo aberto ou fechado e/ou em relação ao sexo ou idade. A maioria dos pacientes com trauma torácico que necessitaram de drenagem teve diagnóstico feito por anamnese e exame físico (41,1%) e foram drenados no pronto socorro (80,8%). Grande parte dos pacientes (66,2%) teve outra lesão associada, na maioria alguma víscera abdominal. Complicações estiveram presentes em 16,6% (81 pacientes), a maior parte por erro de posicionamento do dreno (9,2%). O tempo médio de internamento foi 15 dias e de drenagem, 8,1 dias, sem diferença estatística entre trauma aberto e fechado. O desfecho clínico envolveu alta na maioria dos casos. o perfil dos pacientes com trauma torácico é o de homens jovens, atendidos durante a noite, com alguma outra lesão associada. Apesar do diagnóstico e do tratamento serem feitos de modo rápido e, na maior parte das vezes, sem a necessidade de exames complexos, o tempo de drenagem, internamento e complicações foram mais alto do que na literatura, o que pode ser explicado pela drenagem no próprio pronto-socorro e pela presença de outras lesões associadas.

  4. Predictive Factors of Dependency in Activities of Daily Living Following Limb Trauma in the Elderly

    Directory of Open Access Journals (Sweden)

    Safa

    2016-04-01

    Full Text Available Background Traumatic injuries in the elderly often lead to permanent disabilities and long-term treatments that can adversely influence their activities of daily of living (ADL. The effect on ADL is an important outcome in elderly trauma. Objectives The present study was designed to evaluate the predictive factors of dependency in ADL following limb trauma in elderly referred to Shahid Beheshti Hospital, Kashan, Iran, in 2013. Patients and Methods This descriptive study was conducted on 200 traumatic patients admitted to the trauma emergency ward of Shahid Beheshti hospital in 2013. The questionnaire used in this study had three parts: demographic data, information related to trauma, and an independence scale of ADL (ISADL. The ISADL was completed in the emergency ward to declare pre-traumatic status; it was also completed one and three months after trauma. Statistical analysis was conducted by the t-test and analysis of variance (ANOVA. The repeated measure was used to study the trend of the ISADL and other demographic variables. The multiple regression analysis was also used to declare the predictive variables related to the ISADL. Results The study population consisted of 81 males (40.5% and 119 females (59.5%. The participants’ average age was 70.57 ± 9.05 years. In total, 80.5% of the elderly were completely independent in ADL before trauma; this decreased to 13.5% one month after trauma. The repeated measure analysis showed a significant improvement in the ISADL three months after trauma. Gender, age, and education had significant interaction with the ISADL. The multiple regression analysis showed that type of trauma and location of injured organ had predictive values related to the ISADL, one and three months after trauma. The place and cause of trauma, and having surgery showed a significant relationship with the ISADL three months after trauma. Conclusions Many factors, such as gender, age, education, type of trauma, and location of

  5. Anaphylaxis from intravascular rupture of Hydatid disease following liver trauma

    Directory of Open Access Journals (Sweden)

    Paul J Marriott

    2010-09-01

    Full Text Available Cystic Echinococcosis also known as cystic hydatid disease is a parasitic infection endemic in many parts of the world. Humans are accidental intermediate hosts with cysts most commonly developing in the liver. This case describes a rare presentation of hydatid disease following trauma to the liver. Intraparenchymal cyst rupture led to haemodynamic instability with release of the parasites protoscolices into hepatic venules producing severe life threatening anaphylaxis.

  6. A curious metaphor. Engaging with trauma: an analytical perspective.

    Science.gov (United States)

    Waldron, Sharn

    2010-02-01

    This paper explores the metaphor of in vitro fertilization in respect to those parts of the individual 'frozen' through early trauma. It describes the conditions necessary for the reintroduction of the frozen 'embryo' in the therapeutic relationship through use of an extended example. The role of the analytic relationship and the analyst's countertransference are highlighted within the context of implications for the process of therapy.

  7. Oral health: treatment of dental trauma and pain.

    Science.gov (United States)

    Martonffy, Andrea Ildiko

    2015-01-01

    Dental trauma is common among adults and children. As children become mobile, they frequently experience trauma to their primary teeth because of falls. Injuries to permanent teeth are common results of falls, motor vehicle accidents, sports injuries, and violence. Trauma can affect the tooth enamel, dentin, pulp, root, periodontal ligament, gum, or alveolar bone. Avulsions are characterized by complete displacement of the tooth from the socket. Avulsed primary teeth should not be replanted because replantation is associated with a risk of damage to the developing permanent tooth. Avulsed permanent teeth are considered a dental emergency and should be replanted by the first individual capable of doing so. If immediate replantation is not possible, the tooth should be stored in cold animal or human milk; it also can be stored in the mouth, adjacent to the buccal mucosa, if the patient is capable of doing so. Water should be avoided as a storage medium because it impedes healing of the periodontal ligament, but storage in water is superior to dry storage. Intruded teeth (ie, pushed into the jaw) may need immediate extraction, depending on their orientation. All patients with dental trauma should follow up promptly with a dentist. Patients presenting with chronic dental pain without an obvious treatable etiology will benefit from ongoing support from their family physicians. Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.

  8. Maxillofacial intervention in trauma patients aged 60 years and older

    Directory of Open Access Journals (Sweden)

    Subhashraj K

    2008-01-01

    Full Text Available The purpose of this study was to evaluate the incidence of trauma victims of age 60 years and older who required maxillofacial intervention. The study analyses the pattern of injuries and the various factors that predict the treatment plan of these patients. A retrospective study was carried out in 1820 trauma patients who reported to the Sri. Ramachandra Dental College and Hospital and required maxillofacial intervention, over a period of 5 years (October 2000 and September 2005. Of the total trauma victims, 185 patients were found to be aged 60 years more. In the majority of the patients, the injury was due to road traffic accidents (79.4%. Males (72.4% sustained more injuries than females (27.6%. Soft tissue injuries were seen in 49.1% of the patients, while 14% had mandibular fractures. People in their early 60s were injured more often than their older counterparts. The findings of this study highlight the present situation with regard to maxillofacial trauma in patients aged 60 years and older and its management in this part of the country.

  9. An Overview of Systematic Reviews on Prognostic Factors in Neck Pain: Results from the International Collaboration on Neck Pain (ICON) Project

    DEFF Research Database (Denmark)

    Walton, David M; Carroll, Linda J; Kasch, Helge;

    2013-01-01

    of transition to chronic or persistent problems. As a field of research, prognosis in neck pain has stimulated several empirical primary research papers, and a number of systematic reviews. As part of the International Consensus on Neck (ICON) project, we sought to establish the general state of knowledge...... in the area through a structured, systematic review of systematic reviews (overview). An exhaustive search strategy was created and employed to identify the 13 systematic reviews (SRs) that served as the primary data sources for this overview. A decision algorithm for data synthesis, which incorporated...

  10. Associations between neck musculoskeletal complaints and work related factors among public service computer workers in Kaunas

    Directory of Open Access Journals (Sweden)

    Gintaré Kaliniene

    2013-10-01

    Full Text Available Objectives:Information technologies have been developing very rapidly, also in the case of occupational activities. Epidemiological studies have shown that employees, who work with computers, are more likely to complain of musculoskeletal disorders (MSD. The aim of this study was to evaluate associations between neck MSD and individual and work related factors. Materials and Methods: The investigation which consisted of two parts - a questionnaire study (using Nordic Musculoskeletal questionnaire and Copenhagen Psychosocial Questionnaire and a direct observation (to evaluate ergonomic work environment using RULA method was carried out in three randomly selected public sector companies of Kaunas. The study population consisted of 513 public service office workers. Results: The survey showed that neck MSDs were very common in the investigated population. The prevalence rate amounted to 65.7%. According to our survey neck MSDs were significantly associated with older age, bigger work experience, high quantitative and cognitive job demands, working for longer than 2 h without taking a break as well as with higher ergonomic risk score. The fully adjusted model working for longer than 2 h without taking a break had the strongest associations with neck complaints. Conclusion: It was confirmed, that neck MSDs were significantly associated with individual factors as well as conditions of work, therefore, preventive acions against neck complaints should be oriented at psychosocial and ergonomic work environment as well as at individual factors.

  11. Bracing the trunk and neck in young adults leads to a more aged-like gait.

    Science.gov (United States)

    Russell, Daniel M; Kelleran, Kyle J; Morrison, Steven

    2016-09-01

    Older individuals typically walk at slower speeds, with shorter step lengths, greater step widths and spend a larger proportion of the gait cycle in double stance. Changes in neck and trunk mobility may underlie some of the changes in walking seen with increasing age. Consequently, this study was designed to assess whether externally increasing trunk/neck stiffness in young adults leads to similar changes in gait pattern observed with aging. Twelve young adults (20-29 years), sixteen old adults (60-69 years) and fifteen older adults (70-79 years) walked across a 20' pressure sensitive GAITRite© instrumented walkway at their preferred speed. The young adults also walked under three bracing conditions: (1) Neck braced, (2) Trunk braced, and (3) Neck and Trunk braced. The results revealed that the old and older age groups walked significantly slower, with a shorter step length and with a narrower base of support (p'syoung adults. In young adults, combined neck and trunk bracing led to reduced walking speed, shorter step length, wider base of support and a larger proportion of the gait cycle spent in double stance (p'sadults remained less than fully braced young adults (p'syoung individuals leads to systematic gait changes similar to aging. Consequently, age-related changes in mobility of the neck and torso may in part contribute to the decrements in walking seen for older adults.

  12. MALLASEZIA FOLLICULITIS ON THE NECK

    Directory of Open Access Journals (Sweden)

    Brzeziński Piotr

    2010-10-01

    Full Text Available Folliculitis caused by Malassezia spp. classified as yeasts in our climate (Poland is fairly rare disease . MF is most commonly found on the chest, back, upper arms, and less frequently on the face. Permanent symptom is persistent itching. The favorable external conditions, which are largely due to high temperature and humidity, and endogenous factors, such as immunosuppression, there is a lipophilic yeast multiplication in the hair follicles. The aim of this article is presentation of the patient with Malassezia Folliculitis on the neck. Patient age 33 with 1- to 2-mm monomorphic papules and pustules on chest. Skin lesions accompanied by itching. In the treatment used topical: ketoconazole containing shampoo, 1% clindamycin cream, 0,5% hydrocortisonum cream, fluconazole 400 mg once p.o.

  13. Neck pain: causes, diagnosis, treatment

    Directory of Open Access Journals (Sweden)

    Aleksey Ivanovich Isaikin

    2011-01-01

    Full Text Available Neck pain is frequently encountered in clinical practice. In most cases, it is unassociated with a serious problem and ends with complete recovery. Nonspecific (mechanical, axial pain is most common; posttraumatic pain associated with whiplash injury is less frequently encountered; compression (radicular and myelopathic syndromes are much less frequent. Analysis of complaints and medical histories and neuroorthopedic and neurological examinations allow one to define the major source of pain. Additional studies are indicated in cases of suspected serious pathology, ineffective standard medical therapy, elective manual therapy or neurosurgery. Paracetamol, nonsteroidal anti-inflammatory agents, and myelorelaxants are the drugs of choice in treating acute pain. If these are ineffective, blocks with local anesthetics and glucocorticoids, including diprospan, are used. Early activation and manual therapy are effective. Psychotherapy, therapeutic exercises, manual therapy, and the use of antidepressants and anticonvulsants are indicated for chronic pain. Surgical treatment has limited indications.

  14. Carotid Artery Management in Head and Neck Surgery

    Directory of Open Access Journals (Sweden)

    Murat Haluk Özkul

    2014-06-01

    Full Text Available Prevention and management of intraoperative and postoperative bleeding are of a great importance in performing successful head and neck surgery. Since the carotid artery is the major source of cerebral vascular supply, the management of carotid artery diseases including replacement, when needed, necessitates special knowledge and skill as well as experience. Delayed postoperative hemorrhage usually comes from carotid artery due to increasing frequency of radiotherapy treatment of head and neck cancers nowadays. This is the most catastrophic complication of the head and neck surgery. Carotid resection can be planned as part of surgical treatment or salvage. Carotid resection is performed mostly to salvage patients when radiotherapy and chemotherapy are ineffective and less for carotid invasion caused by either direct extension of a malign tumor originating from the nasopharynx and oropharynx or extracapsular invasion of advanced jugular node metastasis. The purpose of this presentation was to enlighten the readers about carotid artery problems and management emphasizing the importance of preoperative evaluation. (The Me­di­cal Bul­le­tin of Ha­se­ki 2014; 52: 71-4

  15. Correlation between Trunk Posture and Neck Reposition Sense among Subjects with Forward Head Neck Postures

    Directory of Open Access Journals (Sweden)

    Han Suk Lee

    2015-01-01

    Full Text Available Objective. To assess the correlation of abnormal trunk postures and reposition sense of subjects with forward head neck posture (FHP. Methods. In all, postures of 41 subjects were evaluated and the FHP and trunk posture including shoulder, scapular level, pelvic side, and anterior tilting degrees were analyzed. We used the head repositioning accuracy (HRA test to evaluate neck position senses of neck flexion, neck extension, neck right and left side flexion, and neck right and left rotation and calculated the root mean square error in trials for each subject. Spearman’s rank correlation coefficients and regression analysis were used to assess the degree of correlation between the trunk posture and HRA value, and a significance level of α = 0.05 was considered. Results. There were significant correlations between the HRA value of right side neck flexion and pelvic side tilt angle (p<0.05. If pelvic side tilting angle increases by 1 degree, right side neck flexion increased by 0.76 degrees (p=0.026. However, there were no significant correlations between other neck motions and trunk postures. Conclusion. Verifying pelvic postures should be prioritized when movement is limited due to the vitiation of the proprioceptive sense of neck caused by FHP.

  16. Pediatric thoracic trauma: Current trends.

    Science.gov (United States)

    Pearson, Erik G; Fitzgerald, Caitlin A; Santore, Matthew T

    2017-02-01

    Pediatric thoracic trauma is relatively uncommon but results in disproportionately high levels of morbidity and mortality when compared with other traumatic injuries. These injuries are often more devastating due to differences in children׳s anatomy and physiology relative to adult patients. A high index of suspicion is of utmost importance at the time of presentation because many significant thoracic injuries will have no external signs of injury. With proper recognition and management of these injuries, there is an associated improved long-term outcome. This article reviews the current literature and discusses the initial evaluation, current management practices, and future directions in pediatric thoracic trauma. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Emergency Department Management of Trauma

    DEFF Research Database (Denmark)

    MacKenzie, Colin; Lippert, Freddy

    1999-01-01

    Initial assessment and management of severely injured patients may occur in a specialized area of an emergency department or in a specialized area of a trauma center. The time from injury until definitive management is of essence for survival of life-threatening trauma. The initial care delivered...... strongly influences patient morbidity and mortality. Prolonged transport times or inadequate prehospital care increases the requirement for early rapid restoration of tissue perfusion and reversal of physiologic disturbances on patient arrival. On the other hand, in urban areas, rapid emergency medical...... services (EMS) response times and advanced prehospital care increase the number of critically injured patients surviving sufficiently long to reach a hospital “in extremis.” Both scenarios provide challenges in the management of traumatized patients. This article addresses the management of severely...

  18. Bipolar Disorder and Childhood Trauma

    Directory of Open Access Journals (Sweden)

    Evrim Erten

    2015-06-01

    Full Text Available Bipolar disorder is a chronic disorder in which irregular course of depressive, mania or mixed episodes or a complete recovery between episodes can be observed. The studies about the effects of traumatic events on bipolar disorder showed that they had significant and long-term effects on the symptoms of the disorder. Psychosocial stress might change the neurobiology of bipolar disorder over time. The studies revealed that the traumatic events could influence not only the onset of the disorder but also the course of the disorder and in these patients the rate of suicide attempt and comorbid substance abuse might increase. Bipolar patients who had childhood trauma had an earlier onset, higher number of episodes and comorbid disorders. In this review, the relationship between childhood trauma and bipolar disorder is reviewed. [Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry 2015; 7(2: 157-165

  19. Giant sialocele following facial trauma

    OpenAIRE

    Medeiros Júnior,Rui; Rocha Neto,Alípio Miguel da; Queiroz, Isaac Vieira; Cauby,Antônio de Figueiredo; Gueiros,Luiz Alcino Monteiro; Leão,Jair Carneiro

    2012-01-01

    Injuries in the parotid and masseter region can cause serious impairment secondary to damage of important anatomical structures. Sialocele is observed as facial swelling associated with parotid duct rupture due to trauma. The aim of this paper is to report a case of a giant traumatic sialocele in the parotid gland, secondary to a knife lesion in a 40-year-old woman. Conservative measures could not promote clinical resolution and a surgical intervention for the placement of a vacuum drain was ...

  20. Current Epidemiology of Genitourinary Trauma

    Science.gov (United States)

    McGeady, James B.; Breyer, Benjamin N.

    2013-01-01

    Synopsis This article reviews recent publications evaluating the current epidemiology of urologic trauma. It begins by providing a brief explanation of databases that have been recently used to study this patient population, then proceeds to discuss each genitourinary organ individually, discussing the most relevant and up to date information published for each one. The conclusion of the article briefly discusses possible future research and development areas pertaining to the topic. PMID:23905930