1/21. 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 = 1keywords = physical (Clic here for more details about this article) |
2/21. 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 = physical (Clic here for more details about this article) |
3/21. Homicidal commotio cordis in two children.This paper's objective is to describe two cases of fatal commotio cordis resulting from the deliberate striking of children's chests by adults with their fists. These deaths involve two male children, ages 3 years and 14 months. The clinical histories, events in the households prior to the deaths, behaviors of the children, autopsy findings, and investigation results are all similar. In both cases, fatal blows were delivered to the anterior chest with a closed fist. Both children collapsed immediately, unable to be resuscitated. Confessions were obtained in both cases by investigators soon after the children's deaths. Autopsies showed chest contusions in only one child, presumably due to knuckle impact. The cardiac rhythms noted by paramedics were ventricular fibrillation and asystole. Due to the lack of physical findings, an immediate and thorough investigation is critical. An accurate history of events preceding death must be obtained.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/21. Traumatic asphyxia complicated by unwitnessed cardiac arrest.We report a case of traumatic asphyxia complicated by unwitnessed cardiac arrest in which the patient has made a good, functional recovery. Traumatic asphyxia is an uncommon clinical syndrome usually occurring after chest compression. Associated physical findings include subconjunctival hemorrhage and purple-blue neck and face discoloration. These facial changes can mimic those seen with massive closed head injury; however, cerebral injury after traumatic asphyxia usually occurs due to cerebral hypoxia. When such features are observed, the diagnosis of traumatic asphyxia should be considered. Prompt treatment with attention to the reestablishment of oxygenation and perfusion may result in good outcomes.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/21. Myocardial contusion presented as acute myocardial infarction after chest trauma.A 46-year-old male patient developed an acute myocardial infarction and congestive heart failure following blunt chest trauma. Electrocardiogram (ECG) revealed acute anterior myocardial infarction. echocardiography showed akinesis of interventricular septum, dyskinesis in apical anterior wall, and severe impairment of left ventricular overall systolic function. coronary angiography revealed normal coronary arteries. The patient followed a low-intensity physical medicine rehabilitation program. Follow-up was without new complications or deterioration of congestive heart failure. Five months later the patient presented with fulminant acute pulmonary edema and cardiogenic shock. cardiopulmonary resuscitation was unsuccessful.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/21. Periaortic contrast medium extravasation on chest CT in traumatic aortic injury: a sign for immediate thoracotomy.Traumatic aortic injury (TAI) after blunt chest trauma is potentially a lethal condition. The injury must be diagnosed promptly and accurately. Evaluation for traumatic aortic injury begins with an assessment of mechanism of injury, a physical examination and chest radiography. In recent years, chest computed tomography (CT) has been advocated as a better screening tool to detect TAI but there is still controversial over the confirmatory diagnostic value of CT. For hemodynamically unstable patients in whom chest CT had shown direct sign of aortic injury and with periaortic contrast medium extravasation, we advocate that these patients should be operated on immediately without aortogram to avoid unnecessary delay. Herein, we describe a case of TAI with direct signs and periaortic contrast extravasation and discuss if chest CT can substitute an aortogram as a diagnostic tool when direct signs of TAI are revealed.- - - - - - - - - - ranking = 5.7502373218169keywords = physical examination, physical (Clic here for more details about this article) |
7/21. Purtscher retinopathy in the battered child syndrome.Purtscher retinopathy is a hemorrhagic angiopathy that occurs after sudden compression of the thorax. Virtually all reported cases have been in adults who have decreased visual acuity, retinal hemorrhages and exudates, and no other neurological signs. By contrast, in infants, hemorrhagic retinopathy is rarely benign, and generally is considered to indicate intracranial hemorrhage, usually an acute subdural hematoma. Two battered infants had seizures and associated chest injury. There were retinal hemorrhages and exudates, unaccompanied by clinically important intracranial hemorrhage. At follow-up, the hemorrhagic retinopathy had resolved without sequelae; development was normal, and seizures had not recurred. Purtscher retinopathy thus should be added both to the differential diagnosis of hemorrhagic retinopathy in infancy and to the list of physical signs suggesting child abuse.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/21. An unusual suicide by stabbing: a case report.A 50-year old cobbler, employed in a paramilitary unit, was found dead in a pool of blood in his shop inside the unit line in the morning. He had multiple stab wounds on his chest and was alleged to have committed suicide by repeated self-stabbing on the chest with a sharp iron chisel, which was found clenched in his right hand by the investigating officer. Fifteen wounds were communicating with the chest cavity, injuring the vital anatomical structures. The individual, according to the unit personnel, was not suffering from any physical or mental disorder and was not on any medication.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
9/21. Dehiscence of a valved conduit in the ascending aorta following low-velocity blunt chest trauma: case report.We report a case of a 56-year old man presenting with dehiscence of a valved conduit in the ascending aorta following low-velocity blunt thoracic trauma. The patient had a history of a Bentall procedure in 1994. Two weeks before referral to our hospital, the patient fell during a bicycle ride and hit the handlebars of the bicycle with his chest. During the days following the accident, the patient developed progressively worsening fatigue, shortness of breath, and intolerance for even minor physical effort. The presence of an enlarged ascending aorta surrounding the implanted valved graft was confirmed, and the patient was referred to our department for surgical repair, after which the patient had an uneventful recovery and was discharged home on postoperative day 12.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
10/21. sports-related pneumothorax in children.pneumothorax after blunt chest trauma in the absence of rib fractures is uncommon and has only rarely been reported as a result of sporting activity. Presentation may vary from an apparently normal physical examination in the presence of a small pneumothorax to hemodynamic compromise in the presence of a tension pneumothorax. High fitness levels in athletes may result in failure to recognize symptoms and delay diagnosis, potentially increasing morbidity. It is imperative for the emergency physician to exclude pneumothorax in children who present with chest pain after blunt chest trauma from sports injury. We report our experience with and the management of 3 patients with pneumothoraces.- - - - - - - - - - ranking = 5.7502373218169keywords = physical examination, physical (Clic here for more details about this article) |
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