1/40. death due to concussion and alcohol.We encountered 5 deaths following blunt trauma to the face and head in which the injuries were predominantly soft tissue in nature with absence of skull fractures, intracranial bleeding, or detectable injury to the brain. All individuals were intoxicated, with blood ethanol levels ranging from 0.22 to 0.33 g/dl. We feel that in these deaths, ethanol augmentation of the effects of concussive brain injury, with resultant posttraumatic apnea, was the mechanism of death.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/40. Giant duodenal diverticulum: presentation by blunt trauma.Most duodenal diverticula are asymptomatic, small (i.e., less than 5 cm in greatest dimension), acquired, extraluminal, and false. The only report of a massive or giant duodenal diverticulum (i.e., 10 cm or more), in the current literature, included severe nocturnal diarrhea. The present case report is the incidental finding of a massive duodenal diverticulum in a 34-year-old male trauma victim. The insidious nature of this case and the patient's age suggest a congenital etiology. We believe this is the first report of such a case.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/40. Traumatic adrenal injury in children.BACKGROUND: Multiple organ injury in children is an increasingly frequent phenomenon in the modern emergency room. Adrenal hemorrhage associated with this type of trauma has received little attention in the past. OBJECTIVES: Using computed tomography, we sought to determine the rate and nature of adrenal gland injury in children following blunt abdominal trauma due to motor vehicular accident. methods: A total of 121 children with blunt abdominal trauma were examined and total body CT was performed in cases of multi-organ trauma or severe neurological injury. RESULTS: Of all the children who presented with blunt abdominal trauma over a 51 month period, 6 (4.95%) had adrenal hemorrhage. In all cases only the right adrenal gland was affected. Coincidental injury to the chest and other abdominal organs was noted in 66.7% and 50% of patients, respectively. CONCLUSIONS: Traumatic adrenal injury in the pediatric population may be more common than previously suspected. Widespread application of the more sophisticated imaging modalities available today will improve the detection of damage to the smaller organs in major collision injuries and will help in directing attention to the mechanism of trauma.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/40. 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) |
5/40. Cricketing injuries in children: from the trivial to the severe.AIM: To describe the nature of acute cricketing injuries in children presenting to the emergency department of a tertiary level children's hospital. Two cases of severe injuries during a cricket game are reported. METHOD: A retrospective review of presentations to the emergency department from 1993 to April 1998. RESULTS: Sixty cases of cricketing injuries were reviewed. Injuries to the head, hands and forearms were most common. Most injuries were caused by being hit by a ball. A high proportion of cases required operative intervention. length of stay in hospital was only overnight in most cases. The two case reports highlight unusual but severe injuries that caused significant morbidity to the patients involved. CONCLUSION: Although cricket is, by and large, a safe sport, this report will raise awareness of the variety of injuries that can be suffered by children playing the game.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/40. Arthroscopic treatment for traumatic hip dislocation with avulsion fracture of the ligamentum teres.Traumatic hip dislocation in children is a rare condition. Immediate closed reduction is a treatment of choice, but when incongruent reduction results, it can be due to interposition and requires open arthrotomy. We present a previously unreported technique of arthroscopic treatment that was used successfully for traumatic hip dislocation in a 10-year-old girl with impingement of the avulsed ligamentum teres. arthroscopy was effective in confirming the exact nature of the interposition material and excising the fragment with minimal invasion.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/40. Traumatic diaphragmatic hernias: a report of 26 cases.Traumatic diaphragmatic hernias, when diagnosed many years after the traumatic event, are observed in about 10% of diaphragmatic injuries. Due to coexisting injuries and the silent nature of diaphragmatic injuries, the diagnosis is easily missed or difficult. The medical records of 26 patients, who were treated for diaphragmatic hernias during the last 20 years, were analysed retrospectively. The patients were divided into acute phase and late-presenting groups, in whom emergency surgery and elective intervention were performed respectively. Chest radiography was diagnostic in 34.6% (n = 9) of patients. 92.3% of the hernias were on the left side, while the most common herniated organs were the stomach (31.8%) and the colon (27.2%). Coexisting injuries were recorded in 38.4% (n = 10) of the patients. Primary repair was predominantly used (92.3%). The hospitalisation period was longer in the late-presenting group (24.1 /- 18.8 vs. 14.3 /- 7.7 days). Two deaths occurred in the late-presenting group. Diaphragmatic hernia should be suspected in all blunt abdominal trauma patients. Prompt surgical repair is the treatment of choice in all traumatic diaphragmatic hernias.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/40. Lateral impact injury. A source of occult hip pathology.arthroscopy has helped greatly in understanding the nature of many intra-articular disorders of the hip. It also has provided a better understanding of the pathomechanics and natural progression. This knowledge has aided in improving interpretative clinical skills and investigative techniques. Isolated traumatic chondral injury can occur as a result of impact loading over the greater trochanter. There seems to be a particular propensity for this injury in young physically fit adult males apt to incur this type of blow as a consequence of sport or activity. Initially, this injury may appear innocuous with variable dysfunction. When present, arthroscopy can reliably discern the pathology and often result in significant symptomatic improvement. The long-term consequences of these lesions are still concerning. Although symptomatic improvement from arthroscopic intervention is encouraging, for some cases the long-term influence may only be the knowledge provided for counseling the patient. Nonetheless, arthroscopy can be valuable in both the assessment and management of chondral injuries.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/40. Vascular surgery of the upper limb: the first year of a new vascular service.Upper limb vascular reconstruction represents a small part of the vascular surgical workload (5%). The aim of this study was to assess the incidence of upper limb vascular reconstruction in a Regional Hospital. During the first year of a new vascular surgical service in Waterford Regional Hospital, upper limb vascular problems were prospectively analysed. Upper limb vascular reconstruction comprised seven of the total 92 major vascular procedures performed. Three cases were emergencies and four elective. There was one case of penetrating injury, two injuries due to blunt trauma, three patients with thoracic outlet syndrome (TOS) and one chronic ischaemia. The male:female ratio was 4:3 and the mean age was 42 years. Six of the cases were arterial in nature only, and one was both venous and arterial. Two of the cases were associated with upper limb fractures and multiple trauma. Three patients had interposition reversed cephalic vein grafting. One patient had an embolectomy and endarterectomy. Procedures for TOS included excision of a cervical rib in two patients (one bilateral) and scalenectomy alone in one patient. Of these, one patient also had thrombolysis and thrombectomy of the axillary and brachial artery. All of the patients made a good functional recovery and all arteries remained patent but the patient with the brachial plexus injury is awaiting repair abroad. Upper limb vascular problems form a small but significant part (8%) of the workload. Many cases present as emergencies and maybe associated with multiple trauma. This emphasises the need for an emergency vascular surgery service in all trauma units.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
10/40. Early-onset liver abscess after blunt liver trauma: report of a case.A 23-year-old male patient underwent nonoperative management for his blunt liver trauma as he was hemodynamically stable without any signs of peritonitis initially after injury. A fever of 39.5 degrees C and severe right upper quadrant abdominal pain developed on the second day, and an abdominal computed tomography (CT) scan showed the formation of a gas-containing liver abscess in the traumatized liver. An emergency laparotomy revealed a foul-smelling liver abscess at the traumatized site, which was finally disclosed to be the result of a clostridium species infection. A liver abscess is a rare complication following the nonoperative management of liver injury, and such an occurrence is even more rare within 1 day after injury. A clostridium species infection is responsible for the fulminant progressing nature of the disease because the devitalized, ischemic liver parenchyma is ideal for such growth, and this is the first time that a such condition has been shown by CT images. Close observation with a high degree of suspicion is required for the successful treatment of such abscesses.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
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