1/65. Fatal neck injuries caused by blank cartridges.We report three cases where fatal neck injuries were caused by blanks from starting pistols. The weapons were loaded with blank cartridges or tear gas cartridges. Neither live ammunition nor any form of projectile was used. All three cases involved a contact discharge. The gas pressure caused by firing the weapons created extensive wound cavities in all three cases. Each victim died from blood loss as a result of ruptured cervical vessels; there were no air embolisms. In one case, a man shot himself eight times with two different starting pistols, and the wounds could be matched to each gun by the muzzle imprint marks on the neck.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/65. Double layered autogenous vein graft patch reconstruction of the common carotid-internal jugular fistula caused by gunshot wound.Hereby we present a case with a common carotid-internal jugular fistula caused by gunshot wound. The patient was a 32-year old male who had an entrance hole of a bullet on his right anterior cervical area, at the C4 level with a hematoma surrounding it. The exit hole could be detected at the sublingual area. By palpation a thrill and on auscultation a souffle was noted. Neither crepitation, nor any neurologic deficit or any symptom of Horner's syndrome was present. The emergency digital subtraction angiography (DSA) showed a fistulisation to internal jugular vein (IJV) approximately 0.5 cm below the common carotid artery (CCA) bifurcation level. During the operation a hematoma and a false aneurysm was observed on the CCA. Also, proximally to the bifurcation, a communication of CCA with IJV was noted. The wall of the JJV was rather thinned and the size of the vessel had considerably enlarged. Following the evacuation of the hematoma and debridement, the integration of the artery was achieved by placing a double layered autogenous vein graft patch over the 0.5 x 1.5 cm defect. The 0.3 x 1.5 cm defect laterally over the IJV was primarily sutured. The patient was discharged on the fifth day. The control DSA taken on the twelfth day showed a perfect integration of the vessels. We considered the case noticeable due to its rather rare incidence and the double layered autogen vein patch graft reconstruction.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
3/65. Five-year study on the injury of the great thoracic vessels after penetrating chest injury.In the cases of penetrating injury of the heart and the great thoracic vessels, 80% of the patients die before reaching the hospital care, nevertheless patients with sufficient vital functions can be rescued. Between 01. 01. 1994 and 31. 12. 1998 four patients were operated for penetrating injuries of the great vessels in the 2nd Department of Surgery, University Medical School of Debrecen. The left subclavian vein, arcus aortae and the pulmonary artery (2 cases) were injured. In this study authors report a detailed case operated for gunshot injury of the pulmonary artery. On the base of the situation of the projectile on X-ray picture and on the base of the entrance wound of the projectile on the skin we supposed the injury of the great thoracic vessels and we performed an urgent operation. After thoracotomy we found haemopericardium, bleeding wounds on the anterior and posterior haemorrhagic wall of the left pulmonary artery. We found the projectile inside the wall of the bronchus impacted. The bleeding wounds were finger-tamponaded and sutured. On the tenth postoperative day the patient was discharged from our clinic without complaint. The surgical approach to specific thoracic great vessels is also described.- - - - - - - - - - ranking = 8keywords = vessel (Clic here for more details about this article) |
4/65. Successful free flap transfer and salvage in sickle cell trait.The presence of sickle cell haemoglobin is generally regarded as a contraindication to free tissue transfer. We present the case of a 42-year-old male with sickle cell trait who had free transfer of a latissimus dorsi flap to cover a gunshot wound to his thigh. His initial haemoglobin S was 36%. Early flap failure from venous thrombosis was successfully salvaged by re-anastomosis to alternative vessels.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/65. Primary and secondary microvascular reconstruction of the upper extremity.Tissue defects of the upper extremity may result from trauma, tumor resection, infection, and congenital malformation. Restoration of anatomy and functional integrity may require microsurgical free flap transfer for coverage of bones, nerves, blood vessels, or tendons. Microsurgical tissue transfer also may be required prior to secondary reconstruction, such as tendon transfers or nerve or bone grafts. This article addresses indications for upper extremity reconstruction using microsurgical tissue transfer flap selection and strategies including primary and secondary reconstruction.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/65. Experiences with intraluminal occlusion with the Fogarty catheter in the treatment of carotid-cavernous sinus fistulas and other lesions at the base of the skull.Indications for the occlusion of the extradural portions of the carotid and vertebral arteries with the Fogarty catheter are demonstrated in 5 cases of traumatic carotid-cavernous sinus fistulas, in 1 case of an extradural carotid aneurysm originating from the anterior portion of the carotid siphon, in 1 case of traumatic carotid-jugular vein fistula and vertebral artery aneurysm with a-v shunt at the level of the atlas, and in 2 cases of large tumours of the base of the skull extending into the cavernous sinus. The limitation of the method is shown in one case where the catheter could not be passed through a "high" kink of the carotid artery. "Low" kinking, at the typical site above the bifurcation, can be overcome by mobilization and stretching of the vessel while introducing the catheter.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/65. Blood lead concentration after a shotgun accident.In an accidental shooting, a man in his late forties was hit in his left shoulder region by about 60 lead pellets from a shotgun. He had injuries to the vessels, the clavicle, muscles, and nerves, with total paralysis of the left arm due to axonal injury. After several surgical revisions and temporary cover with split skin, reconstructive surgery was carried out 54 days after the accident. The brachial plexus was swollen, but the continuity of the nerve trunks was not broken (no neuroma present). We determined the blood lead (BPb) concentration during a follow-up period of 12 months. The BPb concentration increased considerably during the first months. Although 30 lead pellets were removed during the reconstructive surgery, the BPb concentration continued to rise, and reached a peak of 62 microg/dL (3.0 micromol/L) on day 81. Thereafter it started to decline. Twelve months after the accident, BPb had leveled off at about 30 microg/dL. At that time, muscle and sensory functions had partially recovered. The BPb concentration exceeded 30 microg/dL for 9 months, which may have influenced the recovery rate of nerve function. Subjects with a large number of lead pellets or fragments embedded in the body after shooting accidents should be followed for many years by regular determinations of BPb. To obtain a more stable basis for risk assessment, the BPb concentrations should be corrected for variations in the subject's hemoglobin concentration or erythrocyte volume fraction.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
8/65. An unusual case of birdshot embolism.There are numerous cases of arterial and venous bullet embolism to the heart. An unusual case of birdshot embolus to the right ventricle from the femoral vein caused diagnostic confusion. Distant migration of the foreign bodies via blood vessels has to be taken into consideration after gunshot wounds.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
9/65. Evolution of descending optic atrophy. A case report.Fundus changes following severe trauma to the intracranial optic nerve were followed by means of serial fundus photography. The eye was completely blind. Little change was seen during the first 4 weeks. The retinal nerve fibre layer disappeared gradually during weeks 4 to 8. At the same time the retinal vessels turned narrow, and vascular pseudo-sheathing appeared close to the optic disc.Disc pallor was not maximal until the 12th week, when the peripapillary retina also had acquired a mottled appearance.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
10/65. Delayed presentation of bilateral popliteal artery injury.We describe a patient who developed serious vascular complications following gunshot wounds to both popliteal fossae. There was minimal evidence of vascular injury on presentation to hospital, in particular ankle systolic pressures were normal. Five days following the initial injuries he was found to have a false aneurysm of the popliteal artery in his right leg and an arteriovenous fistula affecting the popliteal vessels of his left leg. The roles of arteriography and Doppler pressure studies in assessment of possible peripheral vascular injury following penetrating trauma are discussed. It is emphasised that a high index of suspicion and careful clinical review is essential if vascular injuries and their complications are not to be missed.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
| | Next -> |