1/831. Delayed hemorrhage after nonoperative management of blunt hepatic trauma in children: a rare but significant event.PURPOSE: Nonoperative management of blunt hepatic injury (BHI) has become widely accepted in hemodynamically stable children without ongoing transfusion requirements. However, late hemorrhage, especially after discharge from the hospital can be devastating. The authors report the occurrence of serious late hemorrhage and the sentinel signs and symptoms in children at risk for this complication. methods: Nonoperative management of hemodynamically stable children included computed tomography (CT) evaluation on admission and hospitalization with bed rest for 7 days, regardless of injury grade. Activity was restricted for 3 months after discharge. Hepatic injuries were classified according to grade, amount of hemoperitoneum, and periportal hypoattenuation. RESULTS: Over 5 years, nonoperative management was successful in 74 of 75 children. One child returned to the hospital 3 days after discharge with recurrent hemorrhage necessitating surgical control. review of the CT findings demonstrated that he was the only child with severe liver injury in all four classifications. A second child, initially treated at an outside hospital, presented 10 days after injury with ongoing bleeding and died despite surgical intervention. Only the two children with delayed bleeding had persistent right abdominal and shoulder discomfort in the week after BHI. CONCLUSIONS: Our findings support nonoperative management of BHI. However, late hemorrhage heralded by persistence of right abdominal and shoulder pain may occur in children with severe hepatic trauma and high injury severity scores in multiple classifications.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
2/831. Hypobaric ocular trauma from a Popper.We have observed 3 cases of ocular trauma in children that were caused by an atypical, hypobaric mechanism induced by a toy called a Popper. When we initially notified the united states consumer product safety Commission in 1990, Poppers disappeared from store shelves. We are concerned that this potentially harmful toy is making a comeback in 1998 (Smilemakers Inc, Spartanburg, SC; June-July 1998 catalog, p. 57). In 1990, packaged poppers cautioned against applying to face or skin; we are not sure that such warnings accompany current Poppers.- - - - - - - - - - ranking = 0.13066650230998keywords = back (Clic here for more details about this article) |
3/831. Coronary dissection and myocardial infarction following blunt chest trauma.myocardial infarction (MI) following blunt chest trauma is rarely diagnosed because the ensuing cardiac pain is commonly attributed to contused myocardium or the traumatic injuries in the local chest wall. There are only scattered reports on the coronary pathology associated with MI secondary to blunt chest trauma. Because differentiation of the pathology is difficult but important, we report here three cases of acute anterior MI secondary to coronary dissection following blunt chest trauma. Coronary dissection was demonstrated by coronary angiography. Two of the patients had intimal tears at the proximal left anterior descending artery (LAD) with normal flow, and the other patient had nearly total occlusion of the LAD associated with filling defects probably caused by an intracoronary thrombus. All three patients received conservative treatment without major complications and remained free from angina or heart failure throughout a 5-year follow-up period. In order to exclude associated MI in cases of blunt chest trauma, electrocardiography is necessary, and coronary angiography may be indicated to demonstrate coronary arterial pathology. dissection of the coronary artery with subsequent thrombus formation is one of the possible pathophysiologic mechanisms of MI following blunt chest trauma.- - - - - - - - - - ranking = 552.2862611944keywords = chest, pain (Clic here for more details about this article) |
4/831. The diagnosis of subcapsular hematoma of the liver by scintigraphy.The diagnosis of subcapsular hematoma of the liver following blunt abdominal trauma has assumed clinical importance with recent reports of improved mortality with conservative management. There is increasing use of hepatic scintigraphy in evaluation of upper abdominal trauma. Two recently observed cases are used to illustrate the typical findings in this entity.- - - - - - - - - - ranking = 0.24951076332661keywords = upper (Clic here for more details about this article) |
5/831. Aortobronchial fistula after coarctation repair and blunt chest trauma.A 34-year-old man had development of an aortobronchial fistula 17 years after patch aortoplasty for correction of aortic coarctation and 5 years after blunt chest trauma, an unusual combination of predisposing factors. The clinical presentation, characterized by dysphonia and recurrent hemoptysis, and the surgical findings suggested the posttraumatic origin of the fistula, which was successfully managed by aortic resection and graft interposition under simple aortic cross-clamping, associated with partial pulmonary lobectomy. When hemoptysis occurs in a patient with a history of an aortic thoracic procedure, the presence of an aortobronchial fistula should be suspected. early diagnosis offers the only possibility of recovery through a lifesaving surgical procedure.- - - - - - - - - - ranking = 275.6431305972keywords = chest (Clic here for more details about this article) |
6/831. 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 = 3.8982948951915keywords = abdominal pain, pain, upper (Clic here for more details about this article) |
7/831. Isolated fracture of the ventricular septum after blunt chest trauma.Isolated rupture of of the ventricular septum after blunt chest trauma is a very rare traumatic affection. A 21-year-old man was admitted to our hospital because of blunt chest trauma and a forearm fracture. Initial echocardiography did not show any intracardiac or extracardiac pathologic lesions, but 12 hours later this examination was repeated because of the onset of a holosystolic murmur. An unusual traumatic rupture of the ventricular septum was demonstrated. The hemodynamically stable condition of the patient allowed surgical repair to be performed 3 months later.- - - - - - - - - - ranking = 330.77175671664keywords = chest (Clic here for more details about this article) |
8/831. Traumatic aortic rupture: delayed presentation with a normal chest radiograph.Traumatic aortic injury is a potentially fatal complication of blunt trauma. patients with this entity may have a constellation of signs and symptoms and frequently have other significant injuries. The diagnosis is often suspected through abnormalities on the presenting chest radiograph. Delay in diagnosis results in increased morbidity and mortality. This report details the delayed presentation of an ambulatory patient with traumatic aortic rupture and a normal chest radiograph.- - - - - - - - - - ranking = 330.77175671664keywords = chest (Clic here for more details about this article) |
9/831. Blunt trauma-induced bilateral chylothorax.This report describes the case of a man who presented in a delayed manner after blunt trauma with bilateral chylothoraces, a rare result of trauma. He presented with shortness of breath and chest pain. A diagnostic workup resulted in the determination of traumatic chylothorax. His course in the hospital identified a disruption at a level of the 5th thoracic vertebra. No surgical ligation was required because his leak spontaneously sealed after conservative measures. The anatomy, physiology, mechanisms, and management of this injury are discussed.- - - - - - - - - - ranking = 56.12862611944keywords = chest, pain (Clic here for more details about this article) |
10/831. Acute carpal tunnel syndrome from thrombosed persistent median artery.We report a case of acute carpal tunnel syndrome from thrombosis of a persistent median artery caused by blunt trauma. The sudden onset of numbness in the median nerve distribution with pain in the fingers in a young adult may provide clues to the diagnosis.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
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