1/2520. 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 = injury, trauma (Clic here for more details about this article) |
2/2520. splenic rupture as a complication of P. falciparum malaria after residence in the tropics. Report of two cases.splenic rupture is an uncommon complication of malaria, which requires urgent medical investigation, close follow-up and adequate treatment. Until present, this complication was reported more often in P. vivax infections than in infections with other species. Rupture can happen spontaneously or as a result of trauma, which may be minor and unnoticed. The diagnosis is made by physical examination, ultrasound and CT-scan. Especially in malaria endemic areas the management of splenic rupture in malaria should be focused on splenic preservation. We describe two cases of splenic rupture during a P. falciparum infection, both requiring finally splenectomy.- - - - - - - - - - ranking = 0.051096253558141keywords = trauma (Clic here for more details about this article) |
3/2520. Painful incarcerated hernia following a rugby union lineout.Discussion related to hernias in sport usually involves the diagnosis and treatment of chronic musculotendinous groin disruption. A case of acute trauma in an incarcerated inguinal hernia, occurring in a rugby union player during a lineout, is presented. The injury arose as a result of a change in the laws of the game.- - - - - - - - - - ranking = 0.2keywords = injury, trauma (Clic here for more details about this article) |
4/2520. Post-traumatic thrombosis of a segmental branch of the inferior mesenteric vein.We report the case of man with post-traumatic thrombosis in a segmental branch of the inferior mesenteric vein with secondary venous congestion and ischemia of the sigmoid colon. We discuss the current imaging modalities for diagnosing venous thrombosis and their relative significance.- - - - - - - - - - ranking = 0.25548126779071keywords = trauma (Clic here for more details about this article) |
5/2520. Duodenal perforation following blunt abdominal trauma: case report.A case of severe duodenal injury in a 20-year-old female due to blunt abdominal trauma secondary to road traffic accident is presented. The difficulty and hence delay in making a diagnosis of duodenal injury is discussed.- - - - - - - - - - ranking = 0.55328876067442keywords = injury, trauma (Clic here for more details about this article) |
6/2520. Delayed presentation of traumatic arterial vasospasm.Traumatic arterial vasospasm with no surrounding anatomic damage is a rare finding. Delayed presentation of arterial vasospasm several days from the inciting event is also rare. However, when the diagnosis of arterial vasospasm is considered, evaluation and treatment must be initiated promptly to avoid prolonged ischemia to the extremity. We present an 11-year-old female who presented with a delayed presentation of arterial vasospasm, and also review the literature.- - - - - - - - - - ranking = 0.20438501423257keywords = trauma (Clic here for more details about this article) |
7/2520. 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 = 0.25548126779071keywords = trauma (Clic here for more details about this article) |
8/2520. Pericardial drainage prior to operation contributes to surgical repair of traumatic cardiac injury.We report on two cases of successful surgical repair of cardiac injury: one involving a left ventricular stab injury and the other a blunt rupture of the right atrium. Each patient underwent emergency surgical repair, the former via left anterolateral thoracotomy and the latter via median sternotomy, following pericardial drainage tube insertion from the subxiphoid area. The operative approach was chosen according to the color of drained blood, i.e., arterial bleeding indicated left anterolateral thoracotomy, while venous bleeding indicated median sternotomy. We conclude that pericardial drainage via the subxiphoid approach prior to induction of anesthesia is an easy and useful technique to perform, not only to release cardiac tamponade but to determine the operative approach in patients suffering from cardiac tamponade following cardiac injury.- - - - - - - - - - ranking = 1.2467112393256keywords = injury, trauma (Clic here for more details about this article) |
9/2520. 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 = 0.51096253558141keywords = trauma (Clic here for more details about this article) |
10/2520. Bilateral vertebral artery occlusion following cervical spine trauma--case report.A 41-year-old female presented with a rare case of bilateral vertebral artery occlusion following C5-6 cervical spine subluxation after a fall of 30 feet. Digital subtraction angiography showed occlusion of the bilateral vertebral arteries. Unlocking of the facet joint, posterior wiring with iliac crest grafting, and anterior fusion were performed. The patient died on the 3rd day after the operation. This type of injury has a grim prognosis with less than a third of the patients achieving a good outcome.- - - - - - - - - - ranking = 0.35328876067442keywords = injury, trauma (Clic here for more details about this article) |
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