1/282. The changes in human spinal sympathetic preganglionic neurons after spinal cord injury.We have applied conventional histochemical, immunocytochemical and morphometric techniques to study the changes within the human spinal sympathetic preganglionic neurons (SPNs) after spinal cord injury. SPNs are localized within the intermediolateral nucleus (IML) of the lateral horn at the thoraco-lumbar level of the spinal cord and are the major contributors to central cardiovascular control. SPNs in different thoracic segments in the normal spinal cord were similar in soma size. SPNs in the IML were also identified using immunoreactivity to choline acetyltransferase. Soma area of SPNs was 400.7 15 microm2 and 409.9 /-22 microm2 at the upper thoracic (T3) and middle thoracic (T7) segments, respectively. In the spinal cord obtained from a person who survived for 2 weeks following a spinal cord injury at T5, we found a significant decrease in soma area of the SPNs in the segments below the site of injury: soma area of SPNs at T8 was 272.9 /-11 microm2. At T1 the soma area was 418 /-19 microm2. In the spinal cord obtained from a person who survived 23 years after cord injury at T3, the soma area of SPNs above (T1) and below (T7) the site of injury was similar (416.2 /-19 and 425.0 /-20 microm2 respectively). The findings demonstrate that the SPNs in spinal segments caudal to the level of the lesion undergo a significant decrease of their size 2 weeks after spinal cord injury resulting in complete transection of the spinal cord. The impaired cardiovascular control after spinal cord injury may be accounted for, in part, by the described changes of the SPNs. The SPNs in spinal segments caudal to the injury were of normal size in the case studied 23 years after the injury, suggesting that the atrophy observed at 2 weeks is transient. More studies are necessary to establish the precise time course of these morphological changes in the spinal preganglionic neurons.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
2/282. pulmonary artery bullet injury following thoracic gunshot wound.Thoracic trauma occurs frequently but seldom requires surgery (10-20%, [1]). The mortality rate for gunshot wound of the chest varies from 14.3 to 36.8% [2]. We report, herein an example of bullet injury to the pulmonary artery (PA) following a thoracic gunshot wound. This patient had previous history of coronary surgery. Absolute and relative indications for exploratory thoracotomy in emergency will be reviewed.- - - - - - - - - - ranking = 9.54043642209keywords = chest (Clic here for more details about this article) |
3/282. pressure-controlled inverse-ratio synchronised independent lung ventilation for a blast wound to the chest.Massive unilateral pulmonary injury poses a severe ventilatory problem. We used pressure-controlled, inverse-ratio, independent lung ventilation for a shotgun injury. Two synchronised Siemens Servo 900C ventilators were connected to a double lumen endotracheal tube. Arterial pO2 tripled in 15 minutes, and the patient remained on SILV for 36 hours.- - - - - - - - - - ranking = 38.16174568836keywords = chest (Clic here for more details about this article) |
4/282. arthroplasty after war injuries to major joints.From 1992 to 1995, replacement of the joint with an endoprosthesis after serious wounding and major destruction of joint elements was performed in 10 soldiers. arthroplasty was performed on five knees, three hips, and two shoulders. The age range of the wounded soldiers was 22 to 55 years (mean, 37.7 years). Six soldiers suffered explosive injuries, and 4 were injured by gunfire. time elapsed from the moment of wounding to the time of total joint replacement was 9 to 42 months. We decided on arthroplasty as the preferred treatment because of the presence of strong contractures and very painful movement. In 8 patients, the results of the treatment, based on a follow-up time of 36 to 48 months, were good. In 2 patients, early septic arthritis developed after arthroplasty of the knee with concomitant loosening of the endoprosthesis. staphylococcus aureus was detected in both patients. In those 2 patients, therefore, arthrodesis of the knee with external fixation was performed.- - - - - - - - - - ranking = 0.66315140316087keywords = pain (Clic here for more details about this article) |
5/282. Fourteen shots for a suicide.A 56-year-old man is discovered unconscious in a pool of blood in the kitchen of his house. According to findings, the man used a 22 long Rifle to fire 14 shots at his thorax with trajectories going from front to back, from right to left and on a nearly horizontal level. All the projectiles got into the left front side of his thorax and came out just under the back of his left armpit. One of them then got through his left arm and fractured his left humerus. According to the findings made on the premises and the position of the bloodstains, we think that man put his rifle against the wall, resting on a pipe. He fired, unloading two clips into his thorax. He had to handle the bolt of the rifle before each shot. To reload, he took the bullets which were on the nearby table on which blood marks can be seen. When reloading at a certain moment, he sat down in his armchair and when he wanted to stand up, he leaned on the armrests, on which blood marks can be seen. The last bullet was probably the one which went through his left arm, preventing him from keeping on shooting. His death, caused by a hypovolemical shock, was obviously very slow.- - - - - - - - - - ranking = 2.9398425575386keywords = back (Clic here for more details about this article) |
6/282. Civilian gunshot wounds to the head with brain stem localization. A case report.The authors present a case of a patient wounded to the head and back by civilian firearm projectiles. The case peculiarity is that only one bullet reached the brain stem level causing significant neurological deficits. The final clinical picture is comparable to the "caudal pontine tegmentum syndrome". The authors describe both the bullet path and the intracranial localization taking into account ballistic details. The problems associated with prognosis, diagnosis, and treatment for gunshot wounds are discussed. In addition, the authors explain the main intracranial lesions and their mechanisms, the role of investigation, and the protocol of medical and surgical treatment. Lastly, a systematic approach for treating these types of gunshot wounds is outlined.- - - - - - - - - - ranking = 1.4699212787693keywords = back (Clic here for more details about this article) |
7/282. Five-year study on the injury of the great thoracic vessels after penetrating chest injury.In the cases of penetrating injury of the heart and the great thoracic vessels, 80% of the patients die before reaching the hospital care, nevertheless patients with sufficient vital functions can be rescued. Between 01. 01. 1994 and 31. 12. 1998 four patients were operated for penetrating injuries of the great vessels in the 2nd Department of Surgery, University Medical School of Debrecen. The left subclavian vein, arcus aortae and the pulmonary artery (2 cases) were injured. In this study authors report a detailed case operated for gunshot injury of the pulmonary artery. On the base of the situation of the projectile on X-ray picture and on the base of the entrance wound of the projectile on the skin we supposed the injury of the great thoracic vessels and we performed an urgent operation. After thoracotomy we found haemopericardium, bleeding wounds on the anterior and posterior haemorrhagic wall of the left pulmonary artery. We found the projectile inside the wall of the bronchus impacted. The bleeding wounds were finger-tamponaded and sutured. On the tenth postoperative day the patient was discharged from our clinic without complaint. The surgical approach to specific thoracic great vessels is also described.- - - - - - - - - - ranking = 38.16174568836keywords = chest (Clic here for more details about this article) |
8/282. Arthroscopic removal of bullet fragments from the subtalar joint.A case of arthroscopic removal of a bullet fragment from the subtalar joint and the calcaneus is presented. The bullet fragments impinged on the fibula, limiting eversion and causing pain. The fragments were removed both arthroscopically and through open incision. The patient noted complete relief of pain and improved range of motion within 1 week, and complete recovery soon thereafter.- - - - - - - - - - ranking = 1.3263028063217keywords = pain (Clic here for more details about this article) |
9/282. eye injuries associated with paintball guns.AIMS: This study identifies the various types of ocular injuries sustained after blunt trauma with a paintball fired from a paintball gun. methods: We report two patients who sustained injury to an eye after being shot with a paintball and review similar cases presented in the world literature. The type of injury sustained and the final visual acuity obtained after a paintball hit to the eye are examined. RESULTS: The two boys presented were hit in the eye with a paintball resulting in lens subluxation, hyphema formation, and angle recession. cataract extraction was required in both cases. One boy also had an optic neuropathy and a choroidal rupture. A review of the literature reveals a variety of injuries occur after a paintball hit to the eye. In some of the cases, the damage to the eye has led to loss of vision and at times loss of the eye. CONCLUSIONS: Paintball guns can cause devastating ocular injuries. Wearing protective eye and face gear during this game is essential. We recommend that an anti-fog face mask with a one-piece polycarbonate eye shield be worn by those participating in paintball games.- - - - - - - - - - ranking = 7.2946654347695keywords = pain (Clic here for more details about this article) |
10/282. Ureteric obstruction by shotgun pellet "pellet colic".Acute renal colic from retained missiles is an unusual and interesting delayed complication of missile injuries to the abdomen. It must be considered in patients who present with symptoms of renal colic following gunshot and shotgun wounds with retained missiles. We report a case of acute ureteral obstruction secondary to a migrating intraluminal projectile 3 days after a shotgun wound to the back.- - - - - - - - - - ranking = 1.4699212787693keywords = back (Clic here for more details about this article) |
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