To analyse management and outcomes of carotid artery CA injuries. Retrospective study of the patients in the combat operations in Chechnya and in peacetime A total of 46 patients with missile 27 and stab 19 wounds, who had common and internal CA injury , underwent an open surgery. Temporary shunts TSs were placed in eight patients with more severe injuries. Retrospective analysis of patients' data. CA ligation and CA repair were performed in 9 and 37 patients, respectively. TS use does not result in a decreased mortality rate or neurologic deficit reduction in patients with severe injuries.
Published by Elsevier Ltd. All rights reserved.
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The role of diagnostic VATS in penetrating thoracic injuries. In order to make a correct diagnosis, reduce the number of missed injuries , chronic sequelae and late mortality we propose performing surgical exploration of all patients with a penetrating injury of the pleural cavity. Methods patients who sustained thoracic trauma were admitted to our hospital between and Of these, 16 patients had penetrating injuries : thirteen were surgically explored by means of Video Assisted Thoracic Surgery VATS, and 3 with thoracotomy due to hemodynamic instability or suspected lesion of the heart or great vessels.
Results In the 13 patients who underwent VATS, 5 injuries to the diaphragm, 3 lesions to an intercostal artery, and 1 lesion to the diaphragmatic artery were detected. In 12 of these patients a laceration of the pulmonary parenchyma was also present. A conversion to thoracotomy was necessary due to a broad laceration of the diaphragm and due to hemostasis of an intercostal artery.
In all but one case, which was later converted, diagnostic imaging missed the diagnosis of laceration of the diaphragm. There was no intra- or postoperative mortality, and average hospital stay was five days. Conclusion VATS is a safe and effective way to diagnose and manage penetrating thoracic injuries , and its extensive use leads to a reduction in the number of missed, potentially fatal lesions as well as in chronic sequelae.
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In attemption to determine the place of primary repair in management of colon injuries , an open, non randomized clinical study was performed. Prospective PR group of 34 patients was managed using one stage repair non-selectively: two stage procedures were performed in 3 cases of advanced peritonitis and multi-segmental lacerations with impaired circulation of colon.
In RS group 36 patients were managed by primary repair and in PR group, 31 were managed by primary repair. The latent time was shorter in PR group. Associated injuries to other body regions and abdominal organs were similar in both groups. PR groups were similar. Comparison of attempted and successful primary repairs justifies the more liberal use of primary repair in early management of colon injuries.
In this study, the factors that effect the morbidity and mortality in patients with penetrating colonic injuries were evaluated. Fourty-two patients 37 males, 5 females; mean age 30,1; range 14 to 63 years with penetrating colonic trauma were evaluated according to age, gender, type of penetrating trauma, location and severity of the colonic injury , associated injury , interval between the trauma and the definitive operation, hemodynamic status, blood transfusion requirement, fecal contamination, surgical procedure, postoperative complication and mortality.
The mean Colon Injury Severity Score was 2,1. It was found that morbidity rates were increased in patients with ATI score higher than 25, and mortality rates were increased in patients presenting shock at admission, with the amount of intraabdominal blood more than mL, and who needed three or more units of blood transfusion.
The primary repair of the penetrating colon trauma can be performed confidently in the hemodynamically stable patients with ATI score less than Selective observational management of penetrating neck injury in The most appropriate management of penetrating neck injury PNI remains controversial. This study was conducted to determine the accuracy and safety of physical examination as the basis of selective observational management of PNI at our institution. The study was conducted between and Laparoscopic repair of penetrating injury of the diaphragm: an In this study we review our experience in using laparoscopy as a diagnostic and therapeutic tool in dealing with penetrating diaphragmatic injuries due to stab wounds and look at the feasibility of using this procedure in other similar institutions.
Thirty patients, all of whom were males years of age, presented to the Nonoperative management of penetrating kidney injuries : a prospective audit. The role of nonoperative management for penetrating kidney injuries is unknown. Therefore, we review the management and outcome of penetrating kidney injuries at a center with a high incidence of penetrating trauma. These data were analyzed for demographics, injury mechanism, perioperative management, nephrectomy rate and nonoperative success.
Patients presenting with hematuria and with an acute abdomen underwent a single shot excretory urogram. Those presenting with hematuria without an indication for laparotomy underwent computerized tomography with contrast material. A total of 92 patients presented with hematuria following penetrating abdominal trauma. There were 75 Of the patients 84 were men and the median age was 26 years range 14 to There were 50 stab wounds and 42 gunshot renal injuries. Imaging modalities included computerized tomography in 60 cases and single shot excretory urography in There were 9 patients brought directly to the operating room without further imaging.
A total of 47 patients with 49 proven renal injuries were treated nonoperatively. In this group 4 patients presented with delayed hematuria, of whom 1 had a normal angiogram and 3 underwent successful angioembolization of arteriovenous fistula 2 and false aneurysm 1. All nonoperatively managed renal injuries were successfully treated without surgery.
There were 18 nephrectomies performed for uncontrollable bleeding 11 , hilar injuries 2 and shattered kidney 3. Post-nephrectomy complications included 1 infected renal bed hematoma requiring percutaneous drainage.
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Of the injuries found at laparotomy 12 were not explored, 2 were drained and 5 were treated with. Penetrating cardiac injury by wire thrown from a lawn mower. The first successful surgically treated case of penetrating heart injury , specifically the right ventricle, caused by a fragment of coat hanger wire thrown by a lawn mower, is reported. Though traumatic heart injuries are rare, this case represents accurate surgical management and judgment, especially in the preoperative phase which resulted in early operating and excellent postoperative results.
It is our feeling that if the patient can be transferred safely to the operating room the mortality rate is considerably lowered; however, emergency room thoracotomy, which will undoubtedly result in a greater survival rate from these spectacular injuries , should be performed in the emergency center if cardiac activity ceases or the patient's condition deteriorates considerably. Lightning strike victims are rarely presented at an emergency department.
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Burns are often the primary focus. This case report describes the improvised explosive device like- injury to the thorax due to lightning strike and its treatment, which has not been described prior in kerauno medicine. Penetrating injury due to blast from lightning strike is extremely rare. These "shrapnel" injuries should however be ruled out in all patients struck by lightning. Published by Mosby, Inc. Full Text Available After a bombing attack, patients were brought into hospital suffering from a combination of injuries caused by the blast, penetrating injuries and burns which as a case of polytrauma.
In penetrating thoracoabdominal injuries due to bombing possibility of cardiac injury should be kept in mind. Penetrating cardiac injuries in children are rare but has a high mortality and morbidity. In some cases there may be difficulty in diagnosis of penetrating cardiac injury. In this case we want to share the diagnosis, treatment and follow-up processes of penetrating cardiac and hepatic injury with burns of a politrauma child due to bombing.
Towards these findings, we questioned the patient again and we found that, 40 years ago, a broken part of the shaving razor had injured his eye. We suggest that kind of patient shold be followed up to prevent late complications of penetrating injury. Full Text Available There have been very few reports of swordfish attacks on humans and none have resulted in death.
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Although there are no reports of unprovoked attacks on humans, swordfish can be very dangerous when provoked and they can jump and use their swords to pierce their target. We describe here an unusual case of death that resulted from intracranial penetrating injury caused by a swordfish.
Penetrating cardiac injuries in blunt chest wall trauma. The present photocase illustrates the possible mechanism of direct cardiac injuries from broken sharp jagged fractured ends of ribs in blunt force trauma to the chest in run over traffic mishaps. We propose that the projecting fractured ends of the ribs penetrate the underlying thoracic organs due to the transient phenomenon of deformation of chest cavity under pressure in run over traffic mishaps.
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Assessment and outcome of penetrating gastrointestinal warfare injuries. The abdominal viscera are among the most vulnerable organs of the body to penetrating trauma. Proper management of such trauma in war victims at the first-line hospital where these victims are first seen is of paramount importance. We reviewed medical records of war victims suffering small bowel and colorectal injuries treated at first, second and third-line hospitals during the Iraq-Iran War to assess surgical outcomes. The medical records of Iranian war victims suffering penetrating gastrointestinal GI injuries treated at first, second and third-line tertiary hospitals, a total of 19 centres, were reviewed.
Laparotomy had been performed at the 1st line hospitals for all patients who had an acute abdomen, whose wounds violated the peritoneum or whose abdominal radiographs showed air or shrapnel in the abdominal cavity. Stable patients were transferred from first-line to second-line or from second line to tertiary hospitals postoperatively. The treatments, complications and patient outcomes were documented and analyzed.
There were patients; , and victims underwent laparotomy for GI injuries at first, second and third-line hospitals respectively. The small intestine and colon respectively were the most prevalent abdominal organs damaged. Those first treated for GI injuries at front-line hospitals victims had more serious conditions and could not be transferred prior to surgery and presented a higher prevalence of complications and mortality.