1/29. 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 = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/29. Unilateral osseous bridging between the arches of atlas and axis after trauma.STUDY DESIGN: This is a case report. OBJECTIVE: To present a case of osseous bridging between C1 and C2 of posttraumatic origin and with an associated closed head injury and to discuss its pathogenesis and clinical outcome after surgical resection. SUMMARY OF BACKGROUND DATA: Heterotopic ossifications of posttraumatic origin in the spine are rare. To the authors' knowledge, no cases have been reported of spontaneous bony bridging between C1 and C2 with a posttraumatic origin. methods: Heterotopic ossifications were detected when pain and limited axial rotation (left/right 10 degrees/0 degree/20 degrees) were persistent, despite intensive physical therapy. Because heterotopic ossifications were ankylosing C1 and C2, the decision was to resect the osseous bridge in combination with a careful mobilization of the cervical spine. Functional computed tomography was performed for analysis of the postoperative results. RESULTS: Four months after surgery, clinical examination showed asymptomatic increased axial rotation. Functional computed tomography indicated that left C1-C2 axial rotation was reduced, possibly related to impingement caused by residual bony spurs. Pathologic changes in the surrounding soft tissue may be another important factor in the persistent limitation of rotation. CONCLUSIONS: Osseous bridging between C1 and C2 may be considered when persistent pain and limited axial rotation are observed after trauma. Operative resection, together with careful intraoperative and postoperative mobilization, may be the treatment of choice.- - - - - - - - - - ranking = 0.092339597711763keywords = physical (Clic here for more details about this article) |
3/29. Perforation of the colon after blunt trauma.Blunt rupture of the colon follows a direct blow to the abdomen. Physical findings suggesting peritoneal irritation are usually present early in the postinjury period and lead to further evaluation and operation. In unresponsive patients, physical findings may be masked, diagnosis delayed, and outcome compromised. Perioperative antibiotics and early celiotomy with complete intra-abdominal exploration and primary repair of the colon injury usually provide excellent results.- - - - - - - - - - ranking = 0.092339597711763keywords = physical (Clic here for more details about this article) |
4/29. Handlebar hernia: ultrasonography-aided diagnosis.Traumatic hernia resulting from blunt impalement of the abdominal wall, known as "handlebar hernia," is seldom addressed in the surgical literature, with only 28 previously reported cases. We describe our experience with this rare traumatic hernia diagnosed by physical examination and confirmed by ultrasonography. Published reports suggest handlebar hernia's potential for serious underlying injury and the diagnostic importance of computed tomographic scanning. The case presented here demonstrates the value of bedside ultrasonography in diagnosis confirmation and surgical planning for this condition.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
5/29. Multiple gastric ruptures caused by blunt abdominal trauma: report of a case.We report a rare case of four separate gastric ruptures resulting from blunt abdominal trauma that were successfully repaired by primary closure. A 22-year-old man injured in a motorcycle accident was admitted to our hospital where physical and radiological examinations confirmed the need for abdominal exploration. laparotomy revealed four full-thickness lacerations in the anterior wall of the stomach. The lacerations were repaired primarily by a two-layer closure. The patient recovered gradually, and was discharged on hospital day 41, since when he has remained well. Although there has been no previous report of as many gastric lacerations following blunt abdominal trauma, surgeons should be aware of the possibility of multiple ruptures, which can be managed by simple closures.- - - - - - - - - - ranking = 0.092339597711763keywords = physical (Clic here for more details about this article) |
6/29. Management of traumatic abdominal wall hernia.Traumatic abdominal wall hernia (TAWH) can occur after blunt trauma and can be classified into low- or high-energy injuries. Low energy injuries occur after impact on a small blunt object. High-energy injuries are sustained during motor vehicle accidents or automobile versus pedestrian accidents. We present six cases of high-energy TAWH cases that were treated at our trauma center. All patients presented with varying degrees of abdominal tenderness with either abdominal skin ecchymosis or abrasions, which made physical examination difficult. CT scan confirmed the hernia in each patient. All six patients had associated injuries that required open repair. The abdominal wall defects were repaired primarily. Three patients (50%) in our series developed a postoperative wound infection or abscess. review of the literature on low-energy TAWH shows no associated abdominal injuries. In conclusion distinction between low- and high-energy injury is imperative in the management of TAWH. Hernias following low-energy injuries can be repaired after local exploration through an incision overlying the defect. TAWHs following high-energy trauma should undergo exploratory laparotomy through a midline incision. The defect should be repaired primarily and prosthetics avoided because of the high incidence of postoperative infection.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
7/29. Late presentation of small bowel obstruction following blunt abdominal trauma.BACKGROUND: Motor vehicle accidents have increasingly become a major cause of serious blunt abdominal and chest injury, the pattern and mechanism of which has changed in recent years largely due to seatbelt legislation. AIM: A case of blunt abdominal and chest trauma is reported which resulted in a mesenteric tear--the small bowel subsequently herniated through and strangulated. CONCLUSION: This case highlights the need for clinical suspicion, serial physical examination and early surgery in the management of these injuries.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
8/29. Unexplained, elevated maternal serum alpha-fetoprotein suggesting blunt abdominal trauma in pregnancy. A case report.BACKGROUND: Physical findings of abdominal trauma in pregnancy are often minimal or absent in spite of the poor outcome. CASE: A healthy, 28-year-old, Caucasian woman, gravida 3, para 2, underwent amniocentesis due to unexplained elevated maternal serum alpha-fetoprotein. The fluid was dark brown, evidence of an old intrauterine hemorrhage. Two weeks prior to blood sampling the patient experienced blunt abdominal trauma. In the emergency room no abnormal signs were found on physical examination. CONCLUSION: Abdominal trauma in pregnancy should be suspected in the case of elevated maternal serum alpha-fetoprotein and dark brown amniotic fluid.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
9/29. Mechanical trauma as a cause of late complications: after AneuRx Stent Graft repair of abdominal aortic aneurysms.We present a series of 4 patients in whom mechanical trauma was identified as a factor in the development of late complications after AneuRx Stent Graft placement for repair of abdominal aortic aneurysms. In all 4 patients, Type I or III endoleaks (and pseudoaneurysms in 2 patients) were discovered several months after abdominal aortic aneurysm repair with the AneuRx device. Two patients had sustained blunt abdominal trauma in a car accident one had suffered a traumatic fall, and another had been participating in vigorous rowing activity. In all patients, the trauma had occurred several months before the diagnosis of endoleak or pseudoaneurysm (or both) was established. In all patients, follow-up computed tomographic scans identified the complications. In conclusion, blunt mechanical injury is an unrecognized factor contributing to the late failure of endovascular stent grafts. Vigorous physical activity may also contribute to graft disruption or to the separation of modular components.- - - - - - - - - - ranking = 0.092339597711763keywords = physical (Clic here for more details about this article) |
10/29. High output heart failure 8 months after an acquired arteriovenous fistula.Congestive heart failure (CHF) due to hyperkinetic states can occur in systemic diseases and in arteriovenous fistulas. An 18 year old Turkish male patient complaining of dyspnea and palpitations, who had suffered a stab wound to his abdomen eight months earlier, was admitted to our clinic. auscultation revealed a systolodiastolic murmur over the entire abdomen. Chest x-rays demonstrated significant cardiomegaly. echocardiography revealed biatrial enlargement and significant mitral and tricuspid regurgitation accompanied by dilatation of the inferior vena cava. Right heart catheterization showed increased oxygen saturation at the inferior vena cava. A diagnosis of an aortocaval fistula was made by aortography. The symptoms subsided and valvular regurgitations ceased alter surgical correction. This rare case demonstrates the significance of routine physical examination and history of the patient.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
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