1/21. Blunt chest trauma: case report.Care of patients with blunt cardiac trauma is challenging for bedside nurses because of the potentially elusive and subtle nature of clinical findings associated with such trauma. An understanding of the forces exerted during the trauma episode will assist nurses in the assessment and search for hidden injuries. A high index of suspicion and continued cautious assessment and attention to subtle changes in the patient's physical condition are essential. Keen attention to changes in the patient's vital signs, cardiac output, ECG findings, pulses, and fluid volume status alert nurses to potential injuries associated with blunt cardiac trauma ranging from myocardial contusion to cardiac tamponade, aortic tears, and cardiac rupture. survival of patients with blunt cardiac trauma depends on early intervention.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/21. Facial fractures and related injuries: a ten-year retrospective analysis.A retrospective analysis of 828 patients with significant midface or mandibular fractures was undertaken to illustrate the multisystem nature of traumatic injuries associated with fracture of the facial skeleton, covering the period from 1985 to 1994. Special emphasis was placed on determining associated injuries sustained as well as epidemiological information. The experience presented differs from other large series in the literature in that the predominant mechanism of injury is motor vehicle accidents (67%) rather than assaults. Of the patients reviewed, 89% sustained significant associated injuries. Closed head trauma with documented loss of consciousness was noted most frequently (40%), followed by extremity fractures (33%), thoracic trauma (29%), and traumatic brain injuries (25%). Only 11% of patients sustained facial fractures without concomitant injury.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/21. bronchogenic cyst masquerading as a chronic post-traumatic pseudoaneurysm of the aortic isthmus.The serious nature of false aneurysms that develop in the aortic isthmus after blunt chest trauma is well known. The authors describe the case of a 33-year-old woman who presented with symptoms of chronic post-traumatic pseudoaneurysm of the aorta 3 months after blunt chest trauma. Radiologic investigations could not substantiate an aortic disruption. A bronchogenic cyst masquerading as a false aneurysm of the aorta was identified at thoracotomy. Bronchogenic cysts are one of the most common causes of primary mid-mediastinal masses and should be considered as potential causes of mid-mediastinal enlargement. However, this consideration should not delay urgent surgery if vascular damage cannot be ruled out.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/21. A suicidal death by explosives.A 23-year-old man committed suicide by detonating an explosive substance clutched to his abdomen. The face was singed, the hands were lacerated and the chest and the upper part of abdomen were badly mutilated. The death was due to the destruction of several vital organs. The injuries had a directional nature. Only the consideration of all the facts of the case in relation to the situation, nature, distribution and extent of wounds and the preceding medical and social history allowed a reconstruction of the circumstances.- - - - - - - - - - ranking = 2keywords = nature (Clic here for more details about this article) |
5/21. Stabbing chest pain: a case of intermittent diaphragmatic herniation.A case of traumatic diaphragmatic herniation is described in which gross mediastinal shift was caused by a combination of the herniated abdominal organs, purulent exudate, and air. This complex presentation might best be described as a case of gastrocolopyopneumothorax, diagnosis of which was further complicated by the intermittent nature of the herniation.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/21. phrenic nerve injury after blunt trauma.phrenic nerve injury resulting from blunt trauma is unusual and may closely mimic diaphragmatic rupture. diagnosis remains difficult and is often delayed. A prompt diagnosis requires a high index of suspicion. We describe one patient with phrenic nerve injury in whom the diagnosis was made late at the time of injury. Radiograph, ultrasonography, and computed tomography were helpful in the diagnosis. Video-assisted thoracic surgery was performed on our patient for diagnostic purposes. Left phrenic nerve injury and pericardial injury were found. Diaphragmatic plication was performed through a miniature left posterolateral thoracotomy. This case was presented to show the unusual nature of phrenic nerve injury.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/21. Posttraumatic active bleeding of mediastinal mixed vascular malformation: a case report.A case of an actively bleeding mediastinal mass in a 4-year-old boy who sustained multitrauma is described. A computed tomography (CT) scan of the chest upon admission demonstrated a mediastinal mass, which enlarged significantly as seen by repeat CT scan at 3 days with a concomitant drop in serum hemoglobin levels. The lesion was excised, and pathological examination established the diagnosis of a lymphatic-venous malformation containing bloody fluid. Lymphatic-venous malformations are rare vascular malformations and are usually found in the head and neck and less commonly at other sites. Spontaneous bleeding is a known complication, and there are few reports describing posttraumatic hemorrhage. Our case is the first description in the English medical literature of a posttraumatic bleeding mediastinal mixed vascular malformation and includes sequential CT scans illustrating the dynamic nature of hemorrhage.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/21. Automatic rifle injuries: suicide by eight bullets. Report of an unusual case and a literature review.A 25-year-old man committed suicide by shooting himself with eight bullets fired from a military rifle set on automatic. This rifle has two firing modes: an automatic mode and a self-loading, single-shot mode. Using this case as an example, some important aspects of firearm injuries are discussed with special emphasis on those points that are relevant to automatic military rifles and most applicable to forensic pathology practice. Some of the pathologic features of firearm wounds are reviewed and the role of the pathologist is discussed. Lastly, the most important points that help the pathologist to determine the type or nature of a firearm death--that is, whether it is an accident, homicide, or a suicide--are discussed. Classically, the number of the firearm wounds is used to differentiate suicide from homicide. As in the case reported here, however, when an automatic rifle or a military rifle set on automatic is used, the number of wounds is not a reliable indicator of the type of death.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/21. Nail-gun suicide.Two cases are reported of young men who committed suicide using a nail gun. One shot himself through the heart and left lung. The other shot himself in the head. No cases of completed suicide by nail gun have previously been reported in the English literature. These cases are reported because of their uncommon nature and because they represent a potentially fatal use of a relatively common industrial implement.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
10/21. Restrictive pulmonary dysfunction caused by the grafted chest and abdominal burn.We report on the effect of the excised and grafted chest and abdominal burn on lung function. Six consecutive patients with 3 degree burns to the entire chest and abdomen (72 /- 10% total body surface area 3 degree burns) were studied. A severe restrictive lung dysfunction due to the noncompliant nature of the excised and grafted chest and abdominal wound was identified; this was most evident when inspiratory pressure (IP) was even modestly impaired with general anesthetics. Measured vital capacity (VC) was 12 to 14 ml/kg at 6 to 8 wk postburn, in the absence of any significant parenchymal injury. The measured VC was identical to the tidal volume (VT) used during the extended period of mechanical ventilatory support. Dynamic compliance (or characteristic) (Cdyn) decreased dramatically from 35 /- 8 to 15 /- 9 ml/cm H2O when the positive pressure VT was increased by as little as 100 ml above prior VT settings, indicating the noncompliant nature of the combined chest and abdominal excised and grafted burn. Major cardiopulmonary complications developed in the first two patients after onset of the restrictive process when general anesthesia was used for grafting procedures (n = 8) and the limits of chest wall excursion were unrecognized. patients received only continuous positive airway pressure preoperatively. A modest but significant decrease in IP from -45 /- 8 to -33 /- 5 cm H2O and 30% decrease in spontaneous VT were noted in the early postoperative period. These changes, however, resulted in a dramatic decrease in pulmonary function leading to hypercarbia, PCO2 greater than 50 torr.(ABSTRACT TRUNCATED AT 250 WORDS)- - - - - - - - - - ranking = 2keywords = nature (Clic here for more details about this article) |
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