1/16. Tentative injuries to exposed skin in a homicide case.A 28-year-old man stabbed both his wife and his 3-year-old son to death, before unsuccessfully attempting to commit suicide. The incident occurred against a background of marital conflict. The child's body exhibited six tentative wounds to the skin in the area of the heart, with no corresponding defects in the overlying clothing, a pattern normally seen only in suicide. Their presence can be explained by the fact that this can be considered an extended suicide, the father's motivation for the killing being comparable to that for true suicide. However, wounds of this nature can be produced in such cases only if the victim is severely limited in his ability to defend himself, here due to the superior physical strength of the father.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/16. risperidone in the treatment of acute stress disorder in physically traumatized in-patients.Although symptoms of acute stress disorder or PTSD in the aftermath of physical trauma may be a reason for psychiatric referral, little has been written on the management of patients in this context. We report the possible benefit of risperidone, an atypical antipsychotic, in 4 cases where flashbacks were reported in patients hospitalized for the treatment of physical trauma.- - - - - - - - - - ranking = 6keywords = physical (Clic here for more details about this article) |
3/16. A biomechanical reconstruction of a wound caused by a glass shard--a case report.During the course of a criminal trial, an investigating pathologist is commonly asked how much force was required to produce an injury. This subjective opinion is based on the pathologist's previous experience of dealing with wounds inflicted with similar weapons. However, in the case of stab wounds inflicted by broken glass, it is unlikely that two glass fragments would be physically similar. In the case studied, two theories were examined: that a wound resulted from a thrown glass fragment or that it had been caused as a stab injury by the glass held in the bare hand. The investigation involved quantifying the energy required for human tissue penetration, comparison of sharpness, a biomechanical analysis of throwing actions and testing of the hypothesis that if the glass shard were used as a stabbing implement it would result in a cut to the hand.The investigation utilised a scientific methodology that reduced the need for speculative (though informed) opinion from the pathologist by producing quantitative results.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/16. Facio-cervical transfixion by a metallic rod: a case report.foreign bodies penetrating into the neck may cause extensive neurovascular and aerodigestive tract injuries. Facio-cervical transfixion by a metallic rod without such injuries is very rare. The patient presented in this article reported to our center 5 hours after the road traffic accident with impacted hollow metallic rod traversing through the tongue, pharynx, and neck after causing fracture to maxilla. Exploration under general anesthesia after tracheostomy resulted in an uneventful extraction of the metallic rod. Postoperatively, the patient recovered completely and had no neurologic deficits. [editorial comment: This case report demonstrates an approach to an extremely difficult and potentially dangerous clinical problem. The authors decision to forego angiography is based on physical examination with evidence of palpable flow in the superficial temporal artery.]- - - - - - - - - - ranking = 3.2420640365686keywords = physical examination, physical (Clic here for more details about this article) |
5/16. Laryngotracheal transection in blunt trauma of the neck.Laryngotracheal injuries are relatively rare following blunt trauma to the neck and chest but results in a high degree of morbidity and mortality. Complete disruption of the trachea is extremely rare and a systematic approach is needed for early diagnosis and management. The symptoms and physical signs do not necessarily correlate with the severity of injury as was observed in the presented cases here. An early diagnosis and surgical exploration is a must for a reasonably favourable outcome.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/16. Presentation of a previously asymptomatic Chiari I malformation by a flexion injury to the neck.Flexion injury and/or whiplash injury to the neck in car accidents are usually trivial injuries with no serious neurological deficits. Our intention was to point out the importance to proceed with diagnostic procedures if neurological deficits do occur in order to reveal the true cause of the deficit. The paper presents the case of a 35-year-old woman who sustained a flexion injury to the neck. A relatively trivial injury to the neck promoted a progressive neurological deterioration. The standard diagnostic procedures (x-ray, computed tomography scan) were normal. Further diagnostics with magnetic resonance imaging was required to reveal an underlying Chiari I malformation. Finally, the operative decompression of the craniocervical junction was performed. Following the surgical treatment, the patient's clinical symptoms regressed. One year after her discharge, she remains in good physical condition. To our knowledge, this case is the first report of the manifestation of Chiari I malformation in the adult as a result of a flexion or whiplash injury of the neck. This unusual case suggests that in a trivial flexion injury to the neck sustained in a car accident, which presents with serious neurological dysfunction, and where the standard diagnostic procedures are normal, the possibility of underlying congenital abnormality, such as Chiari I malformation should be considered.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/16. Gunshot wounds to the neck.Gunshot wounds to the neck are diagnostically and therapeutically challenging cases. We report such a case with vascular and neurologic injuries and describe the therapeutic options. Initial treatment is aimed at hemodynamic stabilization. Zone II neck injuries are managed selectively, and physical examination alone may dictate emergency surgical exploration. spinal cord injury must be suspected and assessed clinically, as well as by computed tomography and angiography. Deteriorating or stable neurologic status and cord compression by bullet or bone fragments require surgical decompression. Improving neurologic status may be managed conservatively. In gunshot wounds to the neck, treatment should be individualized and multidisciplinary.- - - - - - - - - - ranking = 3.2420640365686keywords = physical examination, physical (Clic here for more details about this article) |
8/16. A clinical guide to surface-EMG-assisted stretching as an adjunct to chronic musculoskeletal pain rehabilitation.Therapeutic stretching is a vital component of chronic musculoskeletal pain rehabilitation for increasing range of motion and counteracting the effects of physical deconditioning. Surface EMG biofeedback is currently being used to facilitate movement and to maximize effective stretching with patients in an interdisciplinary chronic pain rehabilitation program for disabled workers. A clinical protocol with case examples is presented.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
9/16. Free split-cutaneous perforator flaps procured using a three-dimensional harvest technique for the reconstruction of postburn contracture defects.With recent advances in free-tissue transfer, microsurgical techniques have been used more frequently for the reconstruction of postburn contracture defects. Traditional methods, including full-thickness skin grafts and local flaps, often result in a good outcome; however, multiple operative procedures, long periods of splinting, and physical rehabilitation are often required. Free split-cutaneous perforator flaps, consisting of one large cutaneous paddle with two perforating vessels split into two separate skin regions, were used for two kinds of postburn contractures: rectangular and spatially separate defects. From September of 2000 to October of 2002, seven patients underwent this method of reconstruction at Chang Gung Memorial Hospital in taiwan. A three-dimensional flap harvest method, in which the skin paddle is circumferentially elevated early in the harvest, was used. Postburn scar contractures had resulted from flame burns in six cases and an electric burn in one case. The reconstructive regions included the neck in two patients, the breast in one patient, and the hand in four patients. There were six male patients and one female patient, with a mean age of 34.8 years (range, 25 to 49 years). The size of the excised scar ranged from 120 cm2 to 308 cm2 (mean, 162.3 cm2). The size of the unsplit flaps ranged from 144 cm2 to 337.5 cm2 (mean, 192.1 cm2). The average time for flap harvest using this three-dimensional harvest technique was 39.1 minutes. The average total operative time was 4.3 hours. The average total hospital stay was 7.3 days (range, 6 to 11 days). All flaps survived without major complications. The donor site was closed primarily in all cases. At a mean follow-up time of 9 months, the functional and aesthetic outcomes showed significant improvement as compared with the preoperative condition. In this study, a new method of flap harvest using a three-dimensional technique is introduced, and its application in the reconstruction of postburn contractures is evaluated.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
10/16. Anesthetic management of neck trauma.In a retrospective review of one year's experience in the management of neck trauma, 88 cases comprising 42 gunshot wounds, 29 stab or slash injuries, and 17 injuries by blunt trauma were reviewed. Multiple injuries were noted in all groups, but a higher percentage was found in the blunt trauma series. Anesthetic management is reviewed, and emphasis is placed on careful evaluation of the patient's airway, using physical and roentgenographic examination to plan adequate airway management.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
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