1/26. Unilateral exophthalmos caused by traumatic vertebral artery to vertebral and jugular vein fistula: problems in diagnosis and management.skull base venous fistulas are rare. A 15-year-old boy was stabbed in the left side of his neck, just below the mastoid process. Two years later, he presented with a protruded and pulsating left eye with red sclera. A soft murmur was audible all over his head and neck. angiography revealed an arteriovenous fistula between the third portion of the vertebral artery (V3) and the vertebral venous plexus, as well as the ipsilateral jugular vein (VVJF). The fistula recruited several arterial feeders and rising the venous pressure along the outflow system of the skull base had led to unilateral exophthalmos.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/26. Lung isolation for the prevention of air embolism in penetrating lung trauma. A case report.PURPOSE: To illustrate a new airway and ventilatory management strategy for patients with unilateral penetrating lung injury. Emphasis is placed on avoiding positive pressure ventilation (PPV)-induced systemic air/gas embolism (SAE) through traumatic bronchiole-pulmonary venous fistulas. CLINICAL FEATURES: A 14-yr-old male, stabbed in the left chest, presented with hypovolemia, left hemopneumothorax, an equivocal acute abdomen, and no cardiac or neurological injury. In view of the risk of SAE, we did not ventilate the left lung until any fistulas, if present, had been excised. After pre-oxygenation, general anesthesia was induced and a left-sided double-lumen tube (DLT) was placed to allow right-lung ventilation. bronchoscopy was performed. The surgeons performed a thorascopic wedge resection of the lacerated lingula. Upon completion of the repair, two-lung ventilation was instituted while the ECG, pulse oximetry, PETCO2, and blood pressure were monitored. Peak inflation pressure was increased slowly and was well tolerated up to 50 cm H2O. The patient's intravascular status was maintained normal. CONCLUSION: patients with lung trauma are at risk of developing SAE when their lungs are ventilated with PPV. In a unilateral case, expectant non-ventilation of the injured lung until after repair is recommended.- - - - - - - - - - ranking = 3keywords = pressure (Clic here for more details about this article) |
3/26. Endovascular repair of occluded subclavian arteries following penetrating trauma.PURPOSE: To describe the endovascular repair of 2 subclavian arteries occluded due to penetrating trauma. case reports: Two male patients were admitted with zone-I neck stab wounds. Both were hemodynamically stable and had absent pulses in the ipsilateral upper limb with decreased Doppler pressures. There were no signs of critical ischemia or active bleeding. On arteriography, complete occlusion of the second segment of the left subclavian arteries in both patients was demonstrated. Stent-graft repair and embolectomy under local anesthesia were successfully performed. No procedure-related complications occurred, and both patients were discharged after 2 days. At 1-year follow-up, stent-graft patency was demonstrated in both patients. CONCLUSIONS: Endovascular repair is a feasible and safe option in the management of occluded subclavian arteries due to penetrating trauma. This may represent another indication for stent-grafting in the expanding role of this technique.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
4/26. Successful resuscitation by emergency room thoracotomy in a patient in agonal state with hemorrhagic shock resulting from penetrating cardiac injury.A 23-year-old male patient, who was stabbed in the left chest at the fourth intercostal space leaving a 4-cm wound, was in agonal state with blood pressure of 0/0 kPa when admitted. The patient underwent emergency room thoractomy on stretcher through the left fourth intercostal anterior lateral incision 16 min after injury. The exploration revealed 2 500 ml blood in the plural cavity, 4-cm wound in the pericardium, 2-cm wound in the right ventricle of the heart without asystole, and 5-cm wound in the left upper lobe of the lung. Within 4 min the wound in the heart was sutured with the pericardium as the backing. The patient was discharged with full recovery 8 d after injury.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
5/26. The abdominal compartment syndrome as a consequence of penetrating heart injury.The abdominal compartment syndrome results from gradual increase of intra-abdominal pressure and affects many bodily systems. It is usually associated with abdominal trauma or surgery. We report the first case of this syndrome developing after a penetrating wound to the chest and heart.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
6/26. Orbital porencephalic cyst following penetrating orbitocranial trauma.In a 10-year-old boy an orbitocranial penetrating wound produced by an umbrella tip caused an orbital roof bone fragment to penetrate up to the anterior part of the third ventricle behind the left foramen of Monro. Hemorrhages and encephalomalacia developed along the trajectory of the fragment and subsequently a porencephalic cyst was formed at this site. Six months after the trauma, increased pressure developed in the left ventricular system due to obstructive hydrocephalus and consequently the porencephalic cyst herniated into the orbit through the orbital roof fracture, producing intermittent diplopia, left exophthalmos, and palpebral swelling. A ventriculo-peritoneal shunt led to shrinkage of the orbital cyst content and resolution of the symptoms.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
7/26. Congestive heart failure due to traumatic arteriovenous fistula--two case reports.Arteriovenous fistulas are abnormal connections between the high-pressure and high-resistance arterial system and the venous system with opposite features. Due to its lower resistance, the blood preferentially flows via the fistula rather than through the capillary bed. The amount of shunt flow depends on its size and proximity to the heart. Due to the increase in circulating volume, progressive dilation develops in the whole vascular system proximal to the shunt. cardiomegaly and venous distention may return to normal after surgical repair of this vascular abnormality. Two cases are presented of heart failure due to traumatic arteriovenous fistula, one of which was between the right renal artery and inferior vena cava and the other between the left renal artery and renal vein.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
8/26. Employing vasopressin as an adjunct vasopressor in uncontrolled traumatic hemorrhagic shock. Three cases and a brief analysis of the literature.Resuscitation of patients in hemorrhagic shock remains one of the most challenging aspects of trauma care. We showed in experimental studies that vasopressin, but not fluid resuscitation, enabled short-term and long-term survival in a porcine model of uncontrolled hemorrhagic shock after penetrating liver trauma. In this case report, we present two cases with temporarily successful cardiopulmonary resuscitation (CPR) using vasopressin and catecholamines in uncontrolled hemorrhagic shock with subsequent cardiac arrest that was refractory to catecholamines and fluid replacement. In a third patient, an infusion of vasopressin was started before cardiac arrest occurred; in this case, we were able to stabilize blood pressure thus allowing further therapy. The patient underwent multiple surgical procedures, developed multi-organ failure, but was finally discharged from the critical care unit without neurological damage.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
9/26. Non-infective subcutaneous emphysema of the hand secondary to a minor webspace injury.subcutaneous emphysema in the hand is commonly associated with infection or high-pressure injection injuries, with other non-infectious causes being reported as rarities in the literature. We describe an unusual case of minor injury to the first webspace resulting in significant subcutaneous emphysema.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
10/26. Prevention of pressure-induced skin ischemia and impending skin penetration in a displaced clavicle fracture.This article presents a quick and effective method using adhesive tapes to prevent ischemia or penetration of the skin in clavicle fractures.- - - - - - - - - - ranking = 4keywords = pressure (Clic here for more details about this article) |
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