1/12. Treatment of traumatic cyclodialysis with vitrectomy, cryotherapy, and gas endotamponade.An aphakic patient with severe chronic hypotony had an alternative treatment of a traumatic cyclodialysis cleft: a 3-port pars plana vitrectomy, cryotherapy of the cleft, and fluid-gas exchange with subsequent supine positioning. The therapeutic principle was mechanical apposition of the detached ciliary muscle to the scleral spur by the gas bubble and scar induction by cryotherapy. intraocular pressure increased to within normal ranges, and visual acuity improved over a 15 month follow-up.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/12. Dorsal compartment syndrome of the upper arm. A case report.A rare case of posttraumatic dorsal compartment syndrome of the upper arm is reported. This case was diagnosed by measuring the intracompartmental pressure. The patient was administered local anesthesia and immediately underwent surgery. The result was successful.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
3/12. Laryngeal crepitus: an aid to diagnosis in non-fatal strangulation.Examination of victims exposed to strangulation is well known in clinical forensic medicine. Not all cases show the objective signs to be found at the examination, e.g. petechial haemorrhages in the eyes and face as well as bruises and abrasions on the neck. In cases without objective signs especially, examination of the laryngeal crepitus might be an aid to diagnosis in strangulation. Laryngeal crepitus is felt by the examiner when the larynx is moved from side to side with a slight posterior pressure. When absent, it is a clinical sign of a mass in the retrolaryngeal space or hypopharynx, probably due to a laryngeal trauma. This paper describes three cases of strangulation where the clinical examinations showed a temporary absence of laryngeal crepitus.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
4/12. Delayed presentation of acute compartment syndrome after contusion of the thigh.Acute compartment syndrome has been described as a result of thigh contusion in several contact sports, and emergent fasciotomy has routinely been recommended. However, recent data suggest that thigh contusions in athletes presenting with isolated elevation of compartment pressures in the absence of neurovascular deficits may be treated expectantly. We describe a case of anterior thigh contusion, which initially presented with isolated compartmental hypertension without neurovascular symptoms. Under nonoperative treatment the patient developed delayed acute compartment syndrome from persistent muscular hemorrhage ten days after the initial trauma, requiring operative treatment. This case demonstrates that expanding hematoma formation may result in delayed increase of intramuscular pressures and compromise of myoneural perfusion in patients with severe thigh contusions. Early evacuation of the hematoma may help to prevent late development of compartment syndrome and reduce the risk for long-term complications.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
5/12. Aortic dissection and rupture presenting as suprasternal bruising and neck swelling.BACKGROUND: a 76-year-old man presented with transient loss of consciousness associated with swelling of the neck, bruising in the suprasternal notch and an absent left carotid pulse. blood pressure was equal in both arms and chest x-ray was normal, but computed tomography of the neck and thorax showed dissection and rupture of the thoracic aorta with extensive intra-mediastinal bleeding. OUTCOME: surgical intervention was inappropriate in this situation and the patient died within 4 hours of presentation. CONCLUSION: syncope is a common presentation to hospital in older people and its cause may be difficult to elucidate, particularly if the patient is unable to provide a reliable history. syncope without pain is a rare presentation of aortic dissection and the occurrence of anterior chest wall bruising has not been described previously. pulse deficits and abnormal chest x-ray findings are often cited as indicative of aortic dissection but are rare manifestations and their absence should not be used to exclude this diagnosis.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
6/12. Raised intracranial pressure presenting with spontaneous periorbital bruising: two case reports.The venous drainage of the orbit is known to be via the ophthalmic and vortex veins which communicate with the cavernous sinus. We describe two patients with raised intracranial pressure presenting with periorbital bruising. In one patient dural venous sinus thrombosis was demonstrated and it is suspected that the cause of the raised intracranial pressure may have been the same in the second. We suggest that the abrupt rise of pressure in the cerebral venous system was transmitted via the cavernous sinus to the orbital venous system.- - - - - - - - - - ranking = 7keywords = pressure (Clic here for more details about this article) |
7/12. An autopsy case of heart rupture from a scooter accident with 3 riders.A 15-year-old male died of cardiac rupture due to blunt chest trauma from a traffic accident involving a low-speed scooter carrying 3 people and a head-on collision with a tree. The victim was sitting on the footrest of the scooter. It was concluded that the victim was compressed between the handlebar of the scooter and the other 2 passengers, causing cardiac ruptures via bidirectional compression and intravascular hydrostatic pressure. The victim may have served as a cushion for the other 2 passengers, who were not thrown from the scooter and sustained only minor injuries.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
8/12. Early recovery from post-traumatic acute respiratory distress syndrome.BACKGROUND: To present and discuss the rationale and possible benefits of timely alveolar recruitment in early post-traumatic acute respiratory distress syndrome. methods: A 17-year-old patient who had sustained blunt thoracic trauma presented with severe hypoxaemia on admission and whole body computed tomography showed pulmonary contusion and substantial bilateral atelectasis. Oxygenation and lung mechanics did not improve with low tidal volume ventilation using high positive end-expiratory pressures (PEEPs). Therefore we applied an alveolar recruitment manoeuvre 7 h after admission. After alveolar recruitment, PEEP was titrated to the lowest level which prevented alveolar derecruitment. RESULTS: Oxygenation and lung compliance improved rapidly and aeration of the entire lung was confirmed by computed tomography 27 h after the recruitment manoeuvre. The patient recovered completely and was discharged after 17 days. CONCLUSION: Although robust evidence is still lacking, several lines of evidence suggest potential benefits of timely alveolar recruitment. patients with early post-traumatic respiratory failure seem to most readily respond to alveolar recruitment manoeuvres and could thus benefit from the gain in functional lung volume and oxygenation. Moreover the probability of ventilator associated complications may be reduced.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
9/12. Bruising: a useful physical sign in ruptured knee joint.The clinical distinction of a ruptured knee joint or popliteal cyst from a deep venous thrombosis is important in the planning of treatment, particularly to avoid anticoagulant therapy. Bruising, which may be severe, may occur when inappropriate anticoagulants are administered. It is less well recognised that spontaneous bruising may occur with a ruptured knee joint even when anticoagulant therapy has not been given. A case is presented which demonstrates this useful physical sign and shows also the value of the patient's history in eliciting the diagnosis. The bruising extended to the foot, its gravitational and propulsive advance being halted by the pressure of footwear. This appearance has not been emphasised in the rheumatology literature.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
10/12. Combined use of HFPPV with low-rate ventilation in traumatic respiratory insufficiency.Two patients with chest injuries, flail chest and respiratory failure were mechanically ventilated by a system composed of 2 Bennett respirators and an independent source of gas. This system provides high-frequency positive pressure ventilation (HFPPV), low-frequency conventional mechanical ventilation (LFCMV) and high inspiratory flow of fresh gas (HIF), through the independent source. This system made use of the advantages of HFPPV and also solved the problem of possible CO2 retention. Using this system we could ventilate the patients while they were fully conscious and cooperative, thus eliminating the need for sedatives and muscle relaxants. time of mechanical ventilation was shortened since the internal pneumatic fixation was very good and made it possible for the fractured ribs to unite rapidly. Restoration of spontaneous breathing was immediate after disconnection from the ventilator. We suggest this method as another mode of ventilation for patients with flail chest and respiratory failure.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
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