11/254. Cruciate paralysis, hypothesis for injury and recovery.STUDY DESIGN: Case report and review of the literature. OBJECTIVES: Discuss a case of cruciate paralysis, a review of the literature and the hypotheses regarding the pathogenesis and recovery in spinal cord injuries that cause disproportionate weakness of the upper extremities. SETTING: Thomas Jefferson University Hospital, philadelphia, PA, USA. methods: Case report. RESULTS: A case of cruciate paralysis is presented involving a 59-year-old female who experienced a gunshot wound to the face. Initial motor exams revealed mild lower limb weakness and absent upper limb function with an upper limb modified American Spinal Injury association motor score of 0/50 (a modified impairment scale using half point muscle grades). Spinal imaging revealed fractures of the C1 anterior ring and the odontoid process, both associated with multiple bullet fragments. No spinal surgery was performed and she was placed in halo fixation. By 3 weeks she had regained enough upper limb function to manipulate large objects with her left hand and move her right hand. At that time, her upper limb asia score was 16/50. By 5 weeks, her upper limb modified asia motor score had improved to 31.5/50 and she began manipulating feeding utensils, writing legibly, and brushing her teeth with her left hand. CONCLUSIONS: In this case report we present a patient's motor and functional recovery. We also discuss the hypothesis that the acute central cord syndrome and cruciate paralysis are a likely result of similar pathologic mechanisms and that good functional outcome resulted from an initially disabling trauma.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
12/254. lead poisoning after gunshot wound.CONTEXT: Despite the absence of symptoms in the majority of patients carrying lead bullet fragments in their bodies, there needs to be an awareness of the possible signs and symptoms of lead intoxication when bullets are lodged in large joints like knees, hips and shoulders. Such patients merit closer follow-up, and even surgical procedure for removing the fragments. OBJECTIVE: To describe a patient who developed clinical lead intoxication several years after a gunshot wound. DESIGN: Case report. CASE REPORT: A single white 23-year-old male, regular job as a bricklayer, with a history of chronic alcohol abuse, showed up at the emergency department complaining of abdominal pain with colic, weakness, vomiting and diarrhea with black feces. All the symptoms had a duration of two to three weeks, and had been recurrent for the last two years, with calming during interval periods of two to three weeks. Abdominal radiograms showed a bullet lodged in the left hip, with a neat bursogram of the whole synovial capsule. A course of chelating treatment using calcium versenate (EDTACaNa2) intravenously was started. After the chelation therapy the patient had recurrence of his symptoms and a radical solution for the chronic mobilization of lead was considered. A hip arthroplasty procedure was performed, leading to complete substitution of the left hip.- - - - - - - - - - ranking = 0.10064208700485keywords = abdominal pain (Clic here for more details about this article) |
13/254. lead poisoning from a retained bullet: a case report and review.A 47-year-old man with a prior gunshot wound presented with arthritis, constipation, abdominal pain, and weight loss. Arthrocentesis did not reveal the cause of the arthritic complaints, but lead poisoning was suspected and confirmed. We present this case along with a short review of the literature pertaining to this often overlooked and reversible cause of lead poisoning.- - - - - - - - - - ranking = 0.10064208700485keywords = abdominal pain (Clic here for more details about this article) |
14/254. Gunshot wound to the head with full recovery.A 28-year-old man was shot in the back of the head at close range by a robber who then locked him in a room assuming that he was dead. The man was discovered 2 days later. The entrance wound of the bullet was in the left occipital region and it passed into the periphery of the right temporal lobe, where it lodged. The man was transferred to a rehabilitation centre 3 weeks later in relatively good health with only slight general EEG changes. The mild clinical course in this case is attributable to two major factors: firstly, no important brain structures were injured, and secondly, the kinetic energy of the silver-tip hollow-point bullet was probably rather low. Three years after the incident, the man still has slight sensory disturbances in the fingers of the left hand and left-sided homonymous hemianopia. He is now working again at his old profession (managing director) and the projectile is still lodged in the right temporal lobe.- - - - - - - - - - ranking = 0.16678991803363keywords = back (Clic here for more details about this article) |
15/254. limb salvage of lower-extremity wounds using free gracilis muscle reconstruction.An extensive series reviewing the benefits and drawbacks of use of the gracilis muscle in lower-extremity trauma has not previously been collected. In this series of 50 patients, the use of microvascular free transfer of the gracilis muscle for lower-extremity salvage in acute traumatic wounds and posttraumatic chronic wounds is reviewed. In addition, the wound size, injury patterns, problems, and results unique to the use of the gracilis as a donor muscle for lower-extremity reconstruction are identified. In a 7-year period from 1991 to 1998, 50 patients underwent lower-extremity reconstruction using microvascular free gracilis transfer at the University of maryland shock Trauma Center, Johns Hopkins Hospital, and Johns Hopkins Bayview Medical Center. There were 22 patients who underwent reconstruction for coverage of acute lower-extremity traumatic soft-tissue defects associated with open fractures. The majority of patients were victims of high-energy injuries with 91 percent involving motor vehicle or motorcycle accidents, gunshot wounds, or pedestrians struck by vehicles. Ninety-one percent of the injuries were Gustilo type IIIb tibial fractures and 9 percent were Gustilo type IIIc. The mean soft-tissue defect size was 92.2 cm2. Successful limb salvage was achieved in 95 percent of patients. Twenty-eight patients with previous Gustilo type IIIb tibia-fibula fractures presented with posttraumatic chronic wounds characterized by osteomyelitis or deep soft-tissue infection. Successful free-tissue transfer was accomplished in 26 of 28 patients (93 percent). All but one of the patients in this group who underwent successful limb salvage (26 of 27, or 96 percent) are now free of infection. Use of the gracilis muscle as a free-tissue transfer has been shown to be a reliable and predictable tool in lower-extremity reconstruction, with a flap success and limb salvage rate comparable to those in other large studies.- - - - - - - - - - ranking = 0.16678991803363keywords = back (Clic here for more details about this article) |
16/254. hemoptysis secondary to pulmonary pseudoaneurysm 30 years after a gunshot wound.A 49-year-old man presented with intermittent hemoptysis from a traumatic pulmonary artery pseudoaneurysm 30 years following a thoracic gunshot wound. The patient was asymptomatic for 28.5 years, when he began experiencing recurrent hemoptysis, chest pain, and a cough. A left lower lobe mass on chest x-ray film was investigated with contrast-enhanced computed tomography and pulmonary angiogram confirming a 1.5-cm pseudoaneurysm. Intraluminal coil embolization was attempted, but a left lower lobectomy was ultimately necessary to treat persistent hemoptysis.- - - - - - - - - - ranking = 2.7545883743735keywords = chest (Clic here for more details about this article) |
17/254. Elective removal of an intramyocardial bullet.A 26-year-old man had a gunshot wound in the right posterolateral aspect of the chest. A chest radiograph showed the bullet in the region of the cardiac silhouette. The patient was hemodynamically stable and had no complaints of dyspnea or abdominal pain. echocardiography and computed tomography identified the bullet in the wall of the right ventricle. The surgical management of the injury is discussed in detail.- - - - - - - - - - ranking = 2.8552304613783keywords = chest, abdominal pain (Clic here for more details about this article) |
18/254. Assessment of shooting distance on the basis of bloodstain analysis and histological examinations.A 28-year-old man was shot using a pump-gun. The main question to be resolved was whether the biological stain pattern on the suspect's trousers, and in particular the bloodstains, can provide evidence to assess the shooting distance between the suspect and the position of the victim's body. The biological stain pattern (i.e. bloodstains and brain tissue) showed backspatters from the shot entrance wound on the back of the head, while the victim was lying face down and the suspect was standing close behind his head.- - - - - - - - - - ranking = 0.33357983606725keywords = back (Clic here for more details about this article) |
19/254. Delayed pulmonary hemorrhage 17 years after gunshot wound to the chest.A 45-year-old male returned 17 years after a gunshot wound to the chest with intermittent hemoptysis that progressed to frank pulmonary hemorrhage. The complications of retained intrathoracic foreign bodies are briefly reviewed.- - - - - - - - - - ranking = 6.8864709359337keywords = chest (Clic here for more details about this article) |
20/254. carcinoid tumor mistaken for persistent neurogenic bowel symptoms in a patient with paraplegia: a case report.neurogenic bowel in spinal cord injury (SCI) can present with constipation and diarrhea as ongoing problems. Usually, these manifestations are adequately controlled with modification in the bowel program. When these symptoms persist, other causes should be considered. This case report describes a jejunal carcinoid tumor with colonic extension that was diagnosed in a paraplegic patient with persistent constipation and diarrhea. A 39-year-old man sustained a T1 paraplegia with neurogenic bowel and bladder dysfunction from a gunshot wound. His bowels were initially managed adequately with digital disimpaction. Over the next 8 years, he had intermittent constipation that was managed with the addition of various suppositories. He then developed progressively worsening constipation, and other gastrointestinal (GI) symptoms. Although his symptoms initially resolved with medical management, the constipation worsened. Upper endoscopy revealed a submucosal bulge in the duodenal bulb. A month later, gallstones were found on renal ultrasound performed to evaluate recurrent urinary tract infections. He underwent cholecystectomy, but his GI symptoms persisted over the next several months. Repeat upper endoscopy subsequently revealed an ulcerated tumor at the duodenojejunal flexure. An upper-GI scan with small bowel follow through showed a proximal jejunal mass. The patient underwent laparotomy with resection of the mass. Final pathologic diagnosis was malignant carcinoid tumor. This case shows the importance of entertaining other clinical entities in patients with SCI when constipation and diarrhea persist despite adequate management.- - - - - - - - - - ranking = 0.33333333333333keywords = upper (Clic here for more details about this article) |
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