1/354. Laparoscopic drainage of an intramural duodenal hematoma.A 21-year-old man was admitted with vomiting and abdominal pain 3 days after sustaining blunt abdominal trauma by being tackled in a game of American football. A diagnosis of intramural hematoma of the duodenum was made using computed tomography and upper gastrointestinal tract contrast radiography. The hematoma caused obstructive jaundice by compressing the common bile duct. The contents of the hematoma were laparoscopically drained. A small perforation was then found in the duodenal wall. The patient underwent laparotomy and repair of the injury. Laparoscopic surgery can be used as definitive therapy in this type of abdominal trauma.- - - - - - - - - - ranking = 1keywords = abdominal pain, pain (Clic here for more details about this article) |
2/354. Ruptured hemidiaphragm after bilateral lung transplantation.A case of right hemidiaphragm rupture and abdominal herniation into the thorax occurring during the immediate post-operative course of double-lung transplantation is reported. This complication has not been reported previously. We examine the possible aetiology and suggest that the direct cause could be an increase in intra-abdominal pressure during chest physiotherapy.- - - - - - - - - - ranking = 1.1907786547569keywords = chest (Clic here for more details about this article) |
3/354. Isolated longitudinal rupture of the posterior tracheal wall following blunt neck trauma.The authors report 3 female children (4, 5 and 12 years old) who suffered an isolated rupture of the posterior tracheal wall (membranous part) following a minimal blunt trauma of the neck. Such tracheal ruptures often cause a mediastinal and a cutaneous thoraco-cervical emphysema, and can also be combined with a pneumothorax. The following diagnostic steps are necessary: X-ray and CT of the chest, tracheo-bronchoscopy and esophagoscopy. The most important examination is the tracheo-bronchoscopy to visualize especially the posterior wall of the trachea. Proper treatment of an isolated rupture of the posterior tracheal wall requires knowledge about the injury mechanisms. The decision concerning conservative treatment or a surgical intervention is discussed. In our 3 patients we chose the conservative approach for the following reasons: 1) The lesions of the posterior tracheal wall were relatively small (1 cm, 1.5 cm, 3 cm) and showed a good adaptation of the wound margins. 2) No cases showed an associated injury of the esophageal wall. All of our patients had an uneventful recovery, the lesion healed within 10 to 14 days, and follow-up showed no late complications.- - - - - - - - - - ranking = 1.1907786547569keywords = chest (Clic here for more details about this article) |
4/354. Polyester fibre prosthetic anterior cruciate ligament implant rupture: necrosis of ingrown connective tissue.AIMS: To describe the histopathological and microanalytical features in seven cases of ruptured Apex(R) polyester (Terylene(R)) fibre anterior cruciate ligament prosthesis. methods AND RESULTS: Transmitted and polarized light microscopy was performed in all cases; one case was investigated by immunohistochemistry, transmission electron microscopy and scanning electron microscopy, with backscatter and X-ray detectors for elemental microanalysis. For comparison we also studied synovial biopsy material and unused polyester fibres. In the excised ligaments there was much ingrowth of fibrous tissue accompanying a florid giant cell reaction to the individual intact polyester fibres throughout the ligaments. phagocytosis of particles of prosthesis-derived material was demonstrated and a striking finding was of necrosis of the ingrown connective tissue in the central portions of the ligaments. Hyalinized areas and 'neoligament growth' were less striking. A consistent finding in the polyester fibres was of small particles containing antimony, used as a catalyst in the manufacturing process. CONCLUSIONS: The pattern of reaction to the prosthetic material and the presence of necrosis differ from previous descriptions in animal and human explants of this and other prosthesis types. The mechanical effect of the necrosis is unlikely to be of significance with this ligament, which is load-bearing ab initio.- - - - - - - - - - ranking = 0.0091629978409087keywords = back (Clic here for more details about this article) |
5/354. Multivascular trauma on an adolescent. Perioperative management.Penetrating vascular injury, in particular at the neck, is a life-threatening trauma not only of the nature and the anatomic proximity of cardiovascular, aerodigestive, glandular and neurologic system but also of the development of early and late complications. The following case report describes our experience with a penetrating wound patient, who was admitted to our emergencies twelve hours after the accident. The only demonstrable objective signs included a large hematoma at the right-side of the neck and distended mediastinum on the chest X-ray. As the patient was cardiovascularly unstable he was immediately transported to the theater without any angiography. The mandatory operative exploration was initially unsuccessful and a median sternotomy with a standard cardiopulmonary bypass and deep hypothermia circulatory arrest was established to restore all the vascular lesions. Actually, the patient was in critical condition with a rupture of the right internal jugular vein, a large pseudoaneurysm of the innominate artery and an avulsion of the ascending aorta with the suspicion of a cardiac tamponade. The postoperative period lasted two full months, while complications appeared. The substantial message from this multivascular trauma is the early diagnosis of the life-threatening complications as exsanguinations, ventricular fibrillation and the ability to minimize postoperative complications, which will impair the normal functional life of the patient.- - - - - - - - - - ranking = 1.1907786547569keywords = chest (Clic here for more details about this article) |
6/354. A case of ruptured mesenchymal chondrosarcoma of the pancreas.A 25-year-old woman who underwent surgical removal of a right frontal meningeal mesenchymal chondrosarcoma in 1980 manifested abdominal pain and progressive anemia after a traffic accident in April 1997. CT disclosed a well-enhanced solid mass 2.5 cm in diameter with internal calcific deposits at the tail of the pancreas and a surrounding hematoma of 5.5 cm in diameter. Surgical resection revealed a ruptured metastatic mesenchymal chondrosarcoma of the pancreas.- - - - - - - - - - ranking = 1keywords = abdominal pain, pain (Clic here for more details about this article) |
7/354. Massive ovarian haemorrhage complicating oral anticoagulation in the antiphospholipid syndrome: a report of three cases.We report three cases of severe haemorrhagic rupture of luteal ovarian cyst requiring surgical haemostasis in young women treated with long-term oral anticoagulation for antiphospholipid syndrome (APS) who used no contraception. At the time of bleeding, the international normalized ratios were 3.78, 4.24, and 7.11. Anticoagulation was resumed post-operatively, in association with antigonadotropic progestins to induce ovulatory suppression. A systematic use of these progestins should probably be discussed in young women receiving long-term warfarin for APS. Ovarian haemorrhage must be considered when such patients develop acute abdominal pain.- - - - - - - - - - ranking = 1keywords = abdominal pain, pain (Clic here for more details about this article) |
8/354. Treatment of delayed partial bronchial rupture with expandable metallic stent.Traumatic bronchial rupture is a rare entity. The severity of the trauma often causes lethal injury to other thoracic organs. The incidence in patients with blunt chest trauma admitted to the hospital ranges from 1.5% to 3%. As a rule, early diagnosis and surgical treatment are important to facilitate successful repair of the disruption. We describe an unusual case of bronchial rupture which was diagnosed 15 days after blunt chest trauma and was treated by bronchial stenting. The success of this case involving the left main bronchial rupture provides a feasible alternative to the repair of partial airway disruption and greatly reduces the morbidity.- - - - - - - - - - ranking = 2.3815573095139keywords = chest (Clic here for more details about this article) |
9/354. Paralabral cyst: an unusual cause of quadrilateral space syndrome.A paralabral cyst arising from a detached inferior glenoid labral tear was shown by magnetic resonance imaging (MRI) to dissect into the quadrilateral space, resulting in a compressive neuropathy of the axillary nerve. Three consecutive MRI examinations were performed over a 5-year period in a 47-year-old man with a long history of worsening shoulder pain. The MRI examinations revealed a slowly enlarging paralabral cyst extending into the quadrilateral space with progressive atrophy of the teres minor muscle.- - - - - - - - - - ranking = 0.45681611663015keywords = pain (Clic here for more details about this article) |
10/354. Broken arrow: a complication of meniscal repair.A case is reported in which a biodegradable arrow, used for arthroscopic meniscal repair, broke and migrated from the back to the front of the knee. Further surgery was necessary to remove the broken fragment. The concept of this sort of repair device is appealing as it may overcome some of the difficulties of suture repair techniques for posterior meniscal tears. However, surgeons should be aware that such devices can break and that the fragment may migrate. Questions over the shearing and bending strength, and the fixation of these devices should be addressed.- - - - - - - - - - ranking = 0.0091629978409087keywords = back (Clic here for more details about this article) |
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