11/579. Civilian versus military trauma dogma: who do you trust?Combat trauma differs from its peacetime counterpart by involving a different spectrum of injuries, occurring in austere environments, dealing with mass casualties, and embodying inherent treatment delays. Thus, civilian trauma practices may be inappropriate in certain combat settings. A review of historical as well as current vivilian and military data is presented for four trauma topics (military antishock trousers, wound debridement, colon wounds, fluid resuscitation) in which civilian and military principles have clashed. The following recommendations are made. (1) Military antishock trousers are still useful in a combat setting. (2) Soft-tissue wound management should be directed by the wound rather than by the weapon. (3) Cautious avoidance of colostomy may be indicated in certain wartime colon wounds. (4) The majority of combat casualties require early vigorous fluid resuscitation. When civilian trauma experience challenges military dogma, it must be carefully considered before being applied to a combat setting.- - - - - - - - - - ranking = 1keywords = trauma (Clic here for more details about this article) |
12/579. Post traumatic rupture of the right main bronchus: a rare clinical entity?Tracheobronchial disruption is an uncommon injury usually associated with severe blunt thoracic trauma and rarely occurs in isolation. We report a case of isolated rupture of the right main bronchus occurring after a crush injury without an associated pneumothorax. Difficulties in the diagnosis of this condition are briefly discussed and an algorithm of management presented.- - - - - - - - - - ranking = 25.698684507808keywords = injury, trauma (Clic here for more details about this article) |
13/579. Two cases of chromobacterium violaceum infection after injury in a subtropical region.chromobacterium violaceum is a gram-negative rod and is isolated from soil and water in tropical and subtropical regions. The species have pigmented and nonpigmented colony types. Infections caused by nonpigmented strains are rare. We report on two cases of infection caused by both pigmented and nonpigmented strains of C. violaceum. Two 24-year-old korea Airline stewardesses were admitted to Inha University Hospital, Inchon, South korea, on 9 August 1997, 3 days after an airplane accident in guam. Both had multiple lacerations on exposed parts of their bodies. There was swelling, tenderness, and pus discharge. The wounds contained many small fragments of stones and weeds. A pigmented strain was isolated from the left hand and a nonpigmented strain was isolated from the left knee of one patient. For the other patient only a nonpigmented strain was isolated from a foot wound. The nonpigmented colonies from the left-knee and the left-foot wounds did not produce any pigment even after an extended period of incubation. The biochemical characteristics were the same for each strain except for oxidase and indole reactions. The pigmented strain was oxidase negative and indole positive, whereas the nonpigmented strains were oxidase positive and indole negative. The patients were successfully treated by debridement and with appropriate antibiotics.- - - - - - - - - - ranking = 50.253468797781keywords = injury, laceration (Clic here for more details about this article) |
14/579. Non-traumatic acute rhabdomyolysis.A boy developed sudden severe generalized muscle stiffness, bulbar weakness and passed dark coloured urine. Laboratory tests revealed marked elevation of creatinine kinase(CK) levels and myoglobinuria. Histopathology of quadriceps muscle showed features of acute rhabdomyolysis. Patient made complete clinical recovery over a period of three weeks and CK returned to normal level. The possible aetiologies of non-traumatic rhabdomyolysis are discussed and the relevant literature reviewed.- - - - - - - - - - ranking = 0.625keywords = trauma (Clic here for more details about this article) |
15/579. vacuum-assisted closure in the treatment of degloving injuries.Degloving injuries range from the occult, easily missed injury to obvious massive tissue damage. The serious nature of these wounds is exacerbated by mismanagement. It is generally accepted that the degloved tissue should be excised, defatted, fenestrated, and reapplied as a full-thickness skin graft. Dressings are required that provide gentle, evenly distributed pressure and avoid shear stress to the newly grafted skin. Numerous types of dressings have been devised but all are cumbersome and time-consuming. We have found the vacuum-Assisted Closure device to be a rapid, effective, and easy-to-use alternative to traditional methods. The authors examine their experience using a vacuum-assisted closure device to treat nine degloving injuries in 5 patients and discuss the important aspects in using this technique.- - - - - - - - - - ranking = 12.536842253904keywords = injury (Clic here for more details about this article) |
16/579. Arterial embolization in the treatment of post-traumatic priapism.priapism is a prolonged penile erection not associated with sexual arousal. Two types of priapism have been described: the more common one is the "veno-occlusive" priapism and can be frequently observed as the consequence of an intracavernosal injection of vaso-active drugs for the treatment of erectile dysfunction. The less common type of priapism is known as "high flow" priapism and usually follows perineal or direct penile trauma. The clinical presentation in case of high flow priapism is quite typical: hystory of recent penile or perineal trauma followed, by the onset of a painless, incomplete and constant erection of the penis. A color-flow Doppler sonogram should be performed as first diagnostic step: this examination allows to identify the presence of patent cavernous arteries and prominent venous drainage with focal area of high flow turbulence along the pathway of one or both the cavernous arteries. An arterial blood sample taken from the corpora will confirm the diagnosis. At first, conservative therapeutical attempts can be suggested, with mechanical external compression of the perineum, the use of ice packs, corporeal aspiration and irrigation with saline. Besides, intracorporeal administration of alpha-agonists and methylene blue should be performed. Unfortunately, these conservative measures often result unsuccessful, and more invasive approaches must be considered. The radiological superselective transcatheter embolization of the proximal artery supplying arterial-lacunar fistula should be the present treatment of choice in these cases of high-flow priapism refractory to conservative and medical treatments. The first successful management of high flow priapism by selective arterial embolization was reported by Wear and coworkers in 1977. Autologous clots and gelatine sponge have been extensively used and become very popular as the embolic agent. More recently, platinum microcoils have been proposed with the aim to achieve more precise and selective embolization. In our single-case-experience on the treatment of high flow priapism by arterial embolization, we used the recently introduced tungsten microcoils. At the time of the follow-up, 2 months later, patient reported satisfactory intercourse with an approximately 75% of penile rigidity. By comparison with microsurgical ligature of the damaged vessel, selective embolization is, at least theoretically, a less invasive procedure, particularly with reference to the trauma caused to the erectile tissue. High-flow priapism is a fairly rare urological pathology which does not require immediate and emergency treatment (as is the case, instead, with venous-occlusive priapism), since the risk of post-ischaemic fibrosis is excluded thanks to the fact that oxygen is supplied to the cavernous tissue. Once the diagnosis has been established with certainty, therefore, the specialist has the necessary time at disposal to arrange for the most appropriate therapeutic steps. When, as is frequently the case, conservative measures prove ineffective, the current treatment of choice for cases of fistula of the cavernous artery would appear to be superselective embolization of the artery, provided same can be performed at specialized centres and by experienced personnel.- - - - - - - - - - ranking = 0.875keywords = trauma (Clic here for more details about this article) |
17/579. Delayed splenic rupture in a haemophiliac.We report an unusual case of post-traumatic delayed rupture of the spleen occurring in a 38-year-old man with haemophilia A. The time interval between injury and splenic rupture was at least 2 weeks. Although a rare event, the possibility of splenic rupture should always be considered in the differential diagnosis in patients with a bleeding disorder and abdominal pain, even when the patient does not initially give a history of abdominal injury. Radiological imaging, including ultrasound examination, is of great value in establishing the diagnosis. This case report includes a brief review of other similar cases.- - - - - - - - - - ranking = 25.198684507808keywords = injury, trauma (Clic here for more details about this article) |
18/579. Catastrophic antiphospholipid syndrome triggered by trauma.We describe the first case of catastrophic antiphospholipid syndrome triggered by trauma. In contrast to reports that emphasize the devastating nature of the syndrome, our patient's course is less dramatic and more elusive. A possible pathophysiological explanation to the association of antiphospholipid syndrome and trauma is discussed.- - - - - - - - - - ranking = 0.75keywords = trauma (Clic here for more details about this article) |
19/579. Traumatically induced inclusion cyst secondary to shoe impingement: report of three cases.Three cases of traumatically induced inclusion cyst affecting the dorsal aspect of the first metatarsophalangeal joint are presented. Though each case was unique, the clinical presentation was similar with patients relating discrete callus formation with a central sinus overlying an enlarging mass. In all cases, the lesion site involved the dorsal first metatarsophalangeal joint and specifically corresponded to the throatline of "pump" shoes that these patients commonly wore. Predisposing factors in these cases appeared to be forefoot equinus deformity with extensus contractor of the extensor hallucis longus tendon and use of pump shoes with a constricting throatline. The authors describe a surgical approach for treatment of this condition, which addresses underlying etiologies of inclusion cyst formation. pathology was consistent with traumatically induced inclusion cyst. Though inclusion cysts are common in the foot, rarely is the dorsum of the foot involved, and this article, to the authors' knowledge, is the first to be reported in the podiatric literature.- - - - - - - - - - ranking = 0.25keywords = trauma (Clic here for more details about this article) |
20/579. abdominal pain in children.Chronic vague abdominal pain is an extremely common complaint in children over 5 years, with a peak incidence in the 8 to 10 year group. In over 90 per cent of the cases no serious underlying organic disease will be discovered. Most disease states can be ruled out by a careful history, a meticulous physical examination, and a few simple laboratory tests such as urinalysis, sedimentation rate, hemoglobin, white blood count determination, and examination of a blood smear. If organic disease is present there are often clues in the history and the examination. The kidney is often the culprit--an intravenous pyelogram should be done if disease is suspected. barium enema is the next most valuable test. Duodenal ulcers and abdominal epilepsy are rare and are over-diagnosed. If no organic cause is found, the parents must be convinced that the pain is real, and that "functional" does not mean "imaginary." This is best explained by comparing with "headache"--the headache resulting from stress and tension hurts every bit as much as the headache caused by a brain tumor or other intracranial pathology. Having convinced the patient and his parents that no serious disease exists, no further investigation should be carried out unless new signs or symptoms appear. The child must be returned to full activity immediately.- - - - - - - - - - ranking = 0.0064328692322174keywords = brain (Clic here for more details about this article) |
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