RESUMEN
Electrical injuries are not uncommon, and electrical shock-induced cardiac damage can be life-threatening. We present the case of a young patient who suffered from acute myocardial damage due to an occupational electric shock. Myocardial damage was assessed by very early (day 4) and repeated (up to month 18) MRI. Clinical management and patient risk estimation in such a setting are challenging because data on similar non-lethal cases and practice recommendations are scarce in the literature.
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Traumatismos por Electricidad , Humanos , Traumatismos por Electricidad/complicaciones , Traumatismos por Electricidad/diagnóstico por imagen , Imagen por Resonancia MagnéticaRESUMEN
OBJECTIVE: To develop the algorithm for correction of defects following high-voltage electrical trauma with revascularized autografts, to assess the incidence and risk factors of postoperative complications. MATERIAL AND METHODS: Surgical interventions were performed in 16 men. Autografts were selected considering localization of defect and preoperative ultrasound data on perfusion of donor and recipient areas. We applied a sample with temporary compression of the vessels and ultrasound scanning of arteries and veins (a small-sized Doppler sound indicator of blood flow velocity - MINIDOP, BIOSS). RESULTS: Nine patients underwent microsurgical transplantation of revascularized flaps. Six patients with electrical trauma of the upper extremities underwent transplantation of free skin autografts and transposition of flexor and extensor muscles of the fingers in various combinations. In 1 patient, simultaneous microsurgical graft transplantation and plasty with local tissues were carried out. Microsurgical transplantation of thoracodorsal flap was performed in 2 patients with maxillofacial defect (with preliminary deepidermization of the flap in one case). In 3 patients with traumatic amputation of the penis, 2 patients underwent phalloplasty with a thoracodorsal flap and prefabrication of a radial forearm graft at the first stage. At the next stage, urethroplasty with a prefabricated radial forearm graft was performed. In 1 patient, closure of the penis defect was carried out using scrotal flaps. CONCLUSION: An integrated surgical approach, the use of free revascularized autografts and adequate postoperative management ensure high-quality aesthetic and functional restoration, improvement of the quality of life and social adaptation of patients with defects and deformations following high-voltage electrical injury.
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Traumatismos por Electricidad/cirugía , Procedimientos de Cirugía Plástica , Colgajos Quirúrgicos , Quemaduras por Electricidad/diagnóstico por imagen , Quemaduras por Electricidad/cirugía , Traumatismos por Electricidad/diagnóstico por imagen , Humanos , Incidencia , Masculino , Microcirculación , Microcirugia , Calidad de Vida , Procedimientos de Cirugía Plástica/efectos adversos , Factores de Riesgo , Trasplante de Piel/métodos , Colgajos Quirúrgicos/irrigación sanguínea , Colgajos Quirúrgicos/trasplante , Trasplante Autólogo , Resultado del Tratamiento , Ultrasonografía Doppler , Heridas y Lesiones/diagnóstico por imagen , Heridas y Lesiones/cirugíaRESUMEN
BACKGROUND: We imaged the corticospinal tract (CST) and corticoreticular pathway (CRP) using diffusion tensor tractography (DTT) to evaluate the cause of muscle weakness in a patient who was exposed to high-voltage electricity. CASE PRESENTATION: A 39-year-old man presented with quadriparesis after high-voltage electrical shock from power lines while working about 5.8 years ago. The electrical current entered through the left hand and exited through the occipital area of the head. The degree of weakness on bilateral upper and lower extremities was 3-4 on the Medical Research Council strength scale. Diffusion tensor imaging (DTI) was performed 5.8 years after onset. The CST and CRP were depicted by placing two regions of interest for each neural tract on the two-dimensional fractional anisotropy color map. DTT of the DTI scan showed that the bilateral CST and CRP were thinned compared to those of the healthy control subject. On the nerve conduction test, abnormal findings suggesting peripheral nerve lesion were not observed. Therefore, injury of bilateral CST and CRP seems to have contributed to our patient's weakness after the electrical shock. CONCLUSION: Depiction of neural tracts in the brain using DTT can assist in the accurate and detailed evaluation of the cause of neural deficit after electrical injury.
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Imagen de Difusión Tensora/métodos , Traumatismos por Electricidad/diagnóstico por imagen , Tractos Piramidales/lesiones , Adulto , Anisotropía , Mano , Humanos , Masculino , Debilidad Muscular/etiología , Tractos Piramidales/patologíaAsunto(s)
Quemaduras por Electricidad/diagnóstico por imagen , Lesión Pulmonar/diagnóstico por imagen , Adulto , Quemaduras por Electricidad/terapia , Traumatismos por Electricidad/diagnóstico por imagen , Traumatismos por Electricidad/terapia , Oxigenación por Membrana Extracorpórea , Fasciotomía , Traumatismos de los Pies/terapia , Traumatismos de la Mano/terapia , Humanos , Masculino , Radiografía Torácica , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: This study aimed to investigate the applications of intelligent 256-slice computed tomography (iCT) perfusion imaging in high-voltage electrical injuries (HVEIs). METHODS: 256-slice iCT was used to perform perfusion scanning for 48 patients with HVEI to detect the perfusion parameters. RESULTS: The blood flow (BF) and peak enhancement intensity (PEI) values of the plane lower than the amputation level of the diseased side (ALD) were smaller than those of the corresponding healthy side (P<0.05); therefore, the differences were statistically significant. The BF value of the plane beyond the ALD was bigger than that of the ALD (t=2.99 and P=0.042); therefore, the difference was statistically significant. The BF, PEI, and blood volume values of the plane below the ALD were smaller than those of the ALD (P<0.05); therefore, the differences were statistically significant. CONCLUSIONS: The technique of 256-slice iCT perfusion imaging could provide richer and more comprehensive imaging data for the clinical treatment of HVEIs, thus exhibiting its benefit in reducing the disability of patients with HVEIs. (Disaster Med Public Health Preparedness. 2018;12:478-485).
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Traumatismos por Electricidad/diagnóstico , Extremidades/lesiones , Recuperación del Miembro/métodos , Tomografía Computarizada Espiral/métodos , Preescolar , Traumatismos por Electricidad/diagnóstico por imagen , Traumatismos por Electricidad/terapia , Extremidades/fisiopatología , Humanos , Recuperación del Miembro/efectos adversos , Masculino , Persona de Mediana Edad , Imagen de Perfusión/métodosRESUMEN
Lenticular changes are often seen following electrical injury. We report an unusual case of electrical injury with late spontaneous posterior dislocation of lens nucleus with intact anterior capsule with ruptured posterior capsule in the right eye and anterior subcapsular cataract in the left eye. The right eye was managed with pars plana vitrectomy with cortical matter removal with multipiece intraocular lens insertion in ciliary sulcus. This report adds posterior capsular rupture and posterior dislocation of lens to the usual ocular complications of electrical injury.
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Traumatismos por Electricidad/diagnóstico , Cápsula del Cristalino/lesiones , Diagnóstico Diferencial , Traumatismos por Electricidad/complicaciones , Traumatismos por Electricidad/diagnóstico por imagen , Traumatismos por Electricidad/cirugía , Humanos , Masculino , Persona de Mediana Edad , Rotura Espontánea/complicaciones , Rotura Espontánea/diagnóstico , Rotura Espontánea/diagnóstico por imagen , Rotura Espontánea/cirugía , Trastornos de la Visión/etiología , VitrectomíaRESUMEN
A 12-year-old boy presented with best-corrected visual acuity (BCVA) of 6/9 in both eyes following an episode of electric shock. Optical coherence tomography (OCT) showed disruption of the ellipsoid zone as well as retinal pigment epithelium (RPE) layer. Fundus autofluorescence (FAF) showed increased central hypoautofluorescence in both eyes. At 3-month follow-up, BCVA improved to 6/6 with OCT showing spontaneous resolution of maculopathy in both eyes with reorganized RPE layer and ellipsoid zone. To the best of our knowledge, this is the first case of bilateral electric shock maculopathy (ESM) with spontaneous anatomical as well as functional recovery. Ophthalmologists must be aware of various forms of ESM. OCT and FAF must be done in patients presenting with defective vision and history of electric shock for the diagnostic as well as prognostic evaluation.
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Traumatismos por Electricidad/fisiopatología , Lesiones Oculares/fisiopatología , Enfermedades de la Retina/fisiopatología , Epitelio Pigmentado de la Retina/fisiopatología , Niño , Traumatismos por Electricidad/diagnóstico por imagen , Lesiones Oculares/diagnóstico por imagen , Humanos , Masculino , Remisión Espontánea , Retina/fisiopatología , Enfermedades de la Retina/diagnóstico por imagen , Epitelio Pigmentado de la Retina/diagnóstico por imagen , Tomografía de Coherencia Óptica , Agudeza Visual/fisiologíaRESUMEN
PURPOSE: Electrical injury to the central nervous system may lead to neurologic compromise via pleiotropic mechanisms. It may cause current-related, thermal or nonthermal damage followed by secondary mechanisms. METHODS: We herein report a case of a 20-year old man, who experienced a low-voltage electric injury due to an occupational accident. RESULTS: Magnetic resonance imaging (MRI) one week after the insult allowed differentiation of pathophysiologic features including thermal, nonthermal and hypoxic cerebral lesions. CONCLUSION: The capability of MRI assessing a variety of lesions for diagnostic and potentially prognostic reasons is presented.
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Lesiones Encefálicas/diagnóstico por imagen , Traumatismos por Electricidad/diagnóstico por imagen , Hipoxia Encefálica/diagnóstico por imagen , Traumatismos Ocupacionales/diagnóstico por imagen , Humanos , Imagen por Resonancia Magnética , Masculino , Tomografía Computarizada Multidetector , Tomografía Computarizada por Rayos X , Adulto JovenRESUMEN
In forensic practice, determination of electrocution as a cause of death usually depends on the conventional histological examination of electrical mark in the body skin, but the limitation of this method includes subjective bias by different forensic pathologists, especially for identifying suspicious electrical mark. The aim of our work is to introduce Fourier transform infrared (FTIR) spectroscopy in combination with chemometrics as a complementary tool for providing an relatively objective diagnosis. The results of principle component analysis (PCA) showed that there were significant differences of protein structural profile between electrical mark and normal skin in terms of α-helix, antiparallel ß-sheet and ß-sheet content. Then a partial least square (PLS) model was established based on this spectral dataset and used to discriminate electrical mark from normal skin areas in independent tissue sections as revealed by color-coded digital maps, making the visualization of electrical injury more intuitively. Our pilot study demonstrates the potential of FTIR spectroscopy as a complementary tool for diagnosis of electrical mark.
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Quemaduras por Electricidad/diagnóstico por imagen , Traumatismos por Electricidad/diagnóstico por imagen , Traumatismos de la Mano/diagnóstico por imagen , Piel/lesiones , Espectroscopía Infrarroja por Transformada de Fourier/métodos , Quemaduras por Electricidad/etiología , Quemaduras por Electricidad/metabolismo , Quemaduras por Electricidad/patología , Traumatismos por Electricidad/diagnóstico , Traumatismos por Electricidad/patología , Traumatismos de la Mano/etiología , Traumatismos de la Mano/metabolismo , Traumatismos de la Mano/patología , Humanos , Análisis de los Mínimos Cuadrados , Adhesión en Parafina , Proyectos Piloto , Análisis de Componente Principal , Estructura Secundaria de Proteína , Piel/diagnóstico por imagen , Piel/patologíaRESUMEN
Contact with high- or low-voltage electricity can cause injury. Low-voltage damage is more common and widespread, although there is little information on it in the literature. Exposure to an electrical current can effect every organ system in the body. The degree of damage is related to many factors, including the duration of exposure, type of current, and nature of the affected tissue. An unusual low-voltage electrical injury with a serious pulmonary lesion is presented, including the clinical intervention and imaging findings. We present a 20-year-old male electrician who sustained direct electrical damage to the pulmonary parenchyma, with no signs of chest wall damage, when exposed to a 380 V shock while working. Imaging demonstrated an electrical burn of the posterior right lower lobe. This case demonstrates that a low-voltage electric current can cause lung damage. A timely diagnosis is required for treatment.
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Lesión Pulmonar Aguda/diagnóstico por imagen , Traumatismos por Electricidad/diagnóstico por imagen , Lesión Pulmonar Aguda/etiología , Humanos , Masculino , Adulto JovenRESUMEN
PURPOSE: To verify the following phenomenon in vivo using quantitative magnetic resonance imaging (MRI). Neuronal compression may occur following brain injuries in the cortex and hippocampus. As well being characterized by previous histological studies in rats, the majority of these neurons undergo hyperacute recovery rather than apoptotic death. MATERIALS AND METHODS: Twenty male Wistar rats were assigned into injured or sham-injured groups (n = 10). The injured group underwent an electric trauma model to provoke compacted neuron formation. A T1 map was acquired prior to the injury and 10 T1 maps were acquired consecutively over a period of 2.5 hours after the injury, using a 3.0T scanner. Voxelwise statistical analyses were performed between timepoints. To enable comparison with the histological appearance of the compacted neurons, silver staining was performed on a sham-injured rat and five injured rats, 10, 40, 90, 150, and 300 minutes after the injury. RESULTS: A significant (corrected P < 0.05) increase in average T1 from the preinjury (895.24 msec) to the first postinjury timepoint (T1 = 951.37 msec) was followed by a significant (corrected P < 0.05) decrease (return) up to the last postinjury timepoint (T1 = 913.16 msec) in the voxels of the cortex and hippocampus. No significant (corrected P < 0.05) change in T1 was found in the sham-injured group. CONCLUSION: The spatial and temporal linkages between the MRI T1 changes and the histological findings suggest that neuronal compaction and recovery is associated with T1 alterations. MRI therefore offers the possibility of in vivo investigations of neuronal compaction and recovery. J. MAGN. RESON. IMAGING 2016;44:814-822.
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Lesiones Encefálicas/diagnóstico por imagen , Lesiones Encefálicas/patología , Traumatismos por Electricidad/diagnóstico por imagen , Traumatismos por Electricidad/patología , Imagen por Resonancia Magnética/métodos , Síndromes de Compresión Nerviosa/diagnóstico por imagen , Síndromes de Compresión Nerviosa/patología , Animales , Masculino , Ratas , Ratas Wistar , Recuperación de la Función , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
The case of a 77-year-old man admitted for suspected epileptic seizure is reported. Patient history showed implantation of a single-chamber implantable cardioverter-defibrillator (ICD) after cardiac arrest in 2007 with replacement in 2012 due to battery depletion; the patient reported no previous syncope, unconsciousness or seizures. Interrogation records of the ICD showed five ventricular tachyarrhythmia episodes that corresponded to the "seizure". Further examination revealed incorrect position of the RV-lead. Diagnosis was a provoked epileptic seizure due to undersensing of ventricular tachycardia because of improper ICD lead implantation in the coronary sinus. Treatment consisted of implantation of a new device with an additional ICD lead into the right ventricle.
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Desfibriladores Implantables/efectos adversos , Errores Diagnósticos/efectos adversos , Traumatismos por Electricidad/diagnóstico por imagen , Traumatismos por Electricidad/etiología , Epilepsia/diagnóstico , Epilepsia/etiología , Anciano , Remoción de Dispositivos , Traumatismos por Electricidad/prevención & control , Epilepsia/prevención & control , Falla de Equipo , Humanos , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/prevención & controlRESUMEN
PURPOSE: Documentation of forensic radiological observations in postmortem imaging of electrical injuries is not common yet and is less prevalent compared to other forms of burn injuries. However, electrical injuries have high morbidity and mortality. The objective of this case report was the visualization and evaluation of unique electrocution-related injuries by postmortem contrast and non-contrast enhanced imaging compared to a forensic autopsy. METHODS: Forensic imaging included whole-body postmortem computed tomography (PMCT), PMCT-angiography (PMCTA), postmortem magnetic resonance tomography (PMMR), and PMMR-angiography (PMMRA). Initial external inspection and subsequent autopsy were performed. RESULTS: Imaging results revealed intestinal mucosal pathologies, particularly of the gastric vascular integrity and remarkable rhabdomyolysis of the striated muscles of the extremities. Furthermore, PMCT and PMCTA revealed a hepatic lesion with perihepatic free fluid. The results from external inspection and autopsy correlated to the well-known pathologies of electrocution in the course of a high-voltage incident. CONCLUSION: Postmortem imaging visualized electrocution-related injuries and aided substantially in the medico-legal investigation. These findings, particularly of the rhabdomyolysis in magnetic resonance tomography, may support the future image interpretation of cases with electrical injuries-in the living and the deceased.
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Diagnóstico por Imagen , Traumatismos por Electricidad/diagnóstico por imagen , Traumatismos por Electricidad/patología , Imagen de Cuerpo Entero , Adulto , Intoxicación Alcohólica/complicaciones , Resultado Fatal , Patologia Forense , Humanos , Imagenología Tridimensional , Masculino , Radiografía , Rabdomiólisis/patologíaAsunto(s)
Desfibriladores Implantables/efectos adversos , Traumatismos por Electricidad/diagnóstico por imagen , Traumatismos por Electricidad/etiología , Electrodos Implantados/efectos adversos , Falla de Equipo , Migración de Cuerpo Extraño/diagnóstico por imagen , Migración de Cuerpo Extraño/etiología , Remoción de Dispositivos , Diagnóstico Diferencial , Traumatismos por Electricidad/prevención & control , Migración de Cuerpo Extraño/cirugía , Humanos , Masculino , Persona de Mediana Edad , Radiografía , SíndromeRESUMEN
The performance of bilateral supraclavicular brachial plexus nerve blocks is controversial. We present the challenging case of a 29-year-old male who suffered bilateral high-voltage electrocution injuries to the upper extremities, resulting in severe tissue damage, sensory and motor deficits, and wounds in both axillae. This injury necessitated bilateral below-elbow amputations. His postoperative course was complicated by pain refractory to intravenous narcotics. The decision was made to attempt bilateral supraclavicular brachial plexus blocks. Our concerns with this approach included the risks of pneumothorax and respiratory failure due to phrenic nerve block. Initial attempts at brachial plexus blockade using nerve stimulation were unsuccessful; therefore, ultrasound guidance was employed. With vigilant monitoring in an intensive care unit setting, we were able to safely perform bilateral continuous supraclavicular brachial plexus nerve blocks with an excellent analgesic response and no noted complications.
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Amputación Quirúrgica , Bloqueo del Plexo Braquial/métodos , Traumatismos por Electricidad , Nervio Frénico , Extremidad Superior , Adulto , Traumatismos por Electricidad/diagnóstico por imagen , Traumatismos por Electricidad/fisiopatología , Traumatismos por Electricidad/cirugía , Humanos , Masculino , Dolor Postoperatorio/diagnóstico por imagen , Dolor Postoperatorio/fisiopatología , Dolor Postoperatorio/terapia , Nervio Frénico/diagnóstico por imagen , Nervio Frénico/fisiopatología , Extremidad Superior/diagnóstico por imagen , Extremidad Superior/lesiones , Extremidad Superior/inervaciónAsunto(s)
Traumatismos por Electricidad/complicaciones , Enfermedades del Sistema Nervioso Periférico/etiología , Luxación del Hombro/etiología , Adulto , Traumatismos por Electricidad/diagnóstico por imagen , Electromiografía , Humanos , Imagen por Resonancia Magnética , Masculino , Conducción Nerviosa , Examen Neurológico , Enfermedades del Sistema Nervioso Periférico/diagnóstico por imagen , Enfermedades del Sistema Nervioso Periférico/terapia , Modalidades de Fisioterapia , Radiografía , Escápula , Hombro , Luxación del Hombro/diagnóstico por imagen , Luxación del Hombro/terapiaRESUMEN
Several animal studies have shown that the TASER X26 (TASER International, Scottsdale, Ariz) conducted electrical weapon can electrically capture the myocardium when discharged on the thorax. These results have not been reproduced in human echocardiographic studies. A primary limitation of those human studies is that the TASER device was connected by taping the wires into conductive gel on the skin surface of the thorax. This study overcomes those limitations. In this study, a training instructor discharged a TASER X26 into the chests of 10 subjects from a distance of 7 ft so that a 5-second discharge could be administered through the probes as in field exposures. Limited echocardiography was performed before, during, and after discharge. In agreement with 2 prior studies by these authors, the TASER X26 did not electrically capture the human myocardium when used with probe deployment. These data are contrary to animal studies in which capture occurred.
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Arritmias Cardíacas/diagnóstico , Ecocardiografía , Traumatismos por Electricidad/complicaciones , Armas , Adulto , Arritmias Cardíacas/diagnóstico por imagen , Arritmias Cardíacas/etiología , Traumatismos por Electricidad/diagnóstico por imagen , Femenino , Humanos , Aplicación de la Ley , Masculino , Persona de Mediana Edad , Estudios Prospectivos , TóraxAsunto(s)
Traumatismos por Electricidad/sangre , Traumatismos por Electricidad/diagnóstico por imagen , Disfunción Ventricular Izquierda/sangre , Disfunción Ventricular Izquierda/diagnóstico por imagen , Catecolaminas/sangre , Ecocardiografía/métodos , Traumatismos por Electricidad/complicaciones , Humanos , Troponina I/sangre , Disfunción Ventricular Izquierda/etiologíaRESUMEN
Heart injury due to electric shock is currently diagnosed based on electrocardiogram (ECG) changes or elevated levels of myocardial enzymes or both. However, the rate at which ECG detects abnormalities is very low; thus, the estimated rate of the diagnosis of myocardial damage due to electric shock is lower than the actual rate. The method of nuclear medicine study of the heart is superior with regard to evaluating transient ischemia, such as angina pectoris, in patients whose ECG and myocardial enzyme levels are normal. Therefore, we attempted to diagnose transient myocardial damage in electric shock patients by using nuclear medicine study of the heart.
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Creatina Quinasa/sangre , Traumatismos por Electricidad/diagnóstico por imagen , Electrocardiografía , Lesiones Cardíacas/diagnóstico por imagen , Miocardio/enzimología , Accidentes de Trabajo , Adulto , Ecocardiografía , Traumatismos por Electricidad/enzimología , Metabolismo Energético/fisiología , Estudios de Seguimiento , Corazón/inervación , Lesiones Cardíacas/enzimología , Humanos , Masculino , Isquemia Miocárdica/diagnóstico por imagen , Miocardio/metabolismo , Cintigrafía , Valores de Referencia , Sistema Nervioso Simpático/diagnóstico por imagenRESUMEN
OBJECTIVE: There has been limited study regarding the effects of high-voltage electrical injury on left ventricular (LV) function, as well as the clinical utility of using cardiac troponin I (cTnI) to assess such injuries. We investigated changes in LV function by using two-dimensional speckle tracking imaging, and we also studied the clinical utility of cTnI for predicting myocardial damage in survivors of high-voltage electrical injury. DESIGN: Prospective clinical study. SETTING: Burn care unit and echocardiography laboratory of a university hospital. PATIENTS: Twenty male patients surviving a high-voltage electrical injury. INTERVENTIONS: From July 2006 to October 2007, 20 patients suffering from high-voltage electrical injury were prospectively evaluated. A serial echocardiogram was obtained from each patient on hospital days 1, 3, and 7. Serum cTnI levels were drawn at baseline and every 6 hours for the first 24 hours. All parameters of the study patients were compared with age-, sex-, and body mass index-matched healthy controls. MEASUREMENTS AND MAIN RESULTS: On the day of admission and during follow-up, there were no significant differences in LV dimension, stroke volume index, LV fractional shortening, LV ejection fraction, or peak systolic strain as compared with the controls. In contrast to the peak systolic strain, the peak systolic strain rate was significantly increased at baseline and during follow-up for the patient group. There were no significant differences in LV systolic function parameters between the two groups according to the level of cTnI. CONCLUSION: The current study demonstrates that LV dysfunction after high-voltage electrical injury is uncommon, and that the serum cTnI level does not seem to be a useful diagnostic test for predicting impairment of LV contractility in patients who did not experience cardiac arrest or fatal arrhythmia.