Cervical spine injury in dismounted improvised explosive device trauma.

BACKGROUND: The injury pattern from improvised explosive device (IED) trauma is different if the target is in a vehicle (mounted) or on foot (dismounted). Combat and civilian first response protocols require the placement of a cervical collar on all victims of a blast injury. METHODS: We searched the Joint Theatre Trauma Registry (JTTR) and the Role 3 Hospital, Kandahar Airfield (KAF) database from Mar. 1, 2008, to May 31, 2011. We collected data on cervical fracture; head injury; traumatic amputation; initial blood pressure, pulse, injury severity score (ISS), Glasgow Coma Scale (GCS) score and base excess; and patient demographic information. RESULTS: The concordance rate between JTTR and KAF databases was 98%. Of the 15 693 admissions in JTTR, 326 patients with dismounted IED injuries were located. The rate of cervical collar prehospital placement was 7.6%. Cervical fractures were found in 19 (5.8%) dismounted IED victims, but only 4 (1.2%) were considered radiographically unstable. None of these 19 patients had prehospital placement of a collar. Patients with cervical spine fractures were more severely injured than those without (ISS 18.2 v. 13.4; GCS 10.1 v. 12.5). Patients with head injuries had significantly higher risk of cervical spine injury than those with no head injury recorded (13.6% v. 3.9%). No differences in frequency of cervical spine injury were found between patients who had associated traumatic amputations and those who did not (5.4% v. 6.0%). CONCLUSION: Dismounted IED is a mechanism of injury associated with a low risk for cervical spine trauma. A selective protocol for cervical collar placement on victims of dismounted IED blasts is possible and may be more amenable to combat situations.

CONTEXTE: Le type de blessures infligées par un engin explosif improvisé (EEI) est différent selon que la cible se trouve à l'intérieur d'un véhicule ou qu'elle circule à pied. Les protocoles de première intervention en zone de combat et auprès des populations civiles prévoient la pose d'un collet cervical chez toutes les victimes d'une blessure causée par une explosion. MÉTHODES: Nous avons interrogé le JTTR (Joint Theatre Trauma Registry ­ Registre des traumatismes liés au théâtre des opérations conjointes) et la base de données de l'hôpital de Rôle 3 de la base aérienne de Kandahar (BAK) entre le 1er mars 2008 et le 31 mai 2011. Nous avons recueilli des données sur les fractures cervicales, les traumatismes crâniens, les amputations post-traumatiques, la tension artérielle initiale, le pouls, l'indice de gravité des traumatismes (IGT), le score à l'échelle de Glasgow (SG) et l'excès de base (gazométrie), de même que les caractéristiques démographiques des patients. RÉSULTANTS: Le taux de concordance entre les bases de données du JTTR et de la BAK était de 98 %. Parmi les 15 693 admissions au JTTR, on a recensé 326 patients victimes de blessures causées par un EEI qui circulaient à pied. Le taux de pose de collet cervical préhospitalisation était de 7,6 %. Des fractures cervicales ont été observées chez 19 (5,8 %) des victimes d'EEI qui circulaient à pied, mais seulement 4 (1,2 %) étaient considérées radiographiquement instables. Aucun de ces 19 patients n'avait reçu de collet cervical avant l'hospitalisation. Les patients atteints d'une fracture cervicale étaient plus gravement blessés que les autres (IGT 18,2 c. 13,4; SG 10,1 c. 12,5). Les patients victimes d'un traumatisme crânien étaient exposés à un risque significativement plus élevé de traumatisme cervical comparativement aux patients qui n'avaient pas de traumatisme crânien (13,6 % c. 3,9 %). On n'a observé aucune différence dans la fréquence des traumatismes cervicaux selon que les patients avaient ou non subi une amputation post-traumatique associée (5,4 % c. 6,0 %). CONCLUSION: Les blessures causées par un EEI chez une personne qui circule à pied sont associées à un risque faible de traumatisme cervical. Il serait possible d'adopter un protocole sélectif de pose de collet cervical chez les victimes d'EEI qui circulent à pied, ce qui pourrait être mieux adapté aux situations de combat.

Surgical management of adult-onset cystic hygroma in the axilla.

INTRODUCTION: Lymphatic malformations are commonly recognized as relatively benign congenital masses affecting infants and children in the perinatal period. In children, these masses are most commonly found in the neck, and are occasionally seen in other areas of the body. PRESENTATION OF CASE: A 58-year-old man presented with an acute axillary swelling measuring approximately 20cm in length, 12cm in AP width, and 7cm in depth. Biopsy and cytology analysis demonstrated this mass to be a cystic hygroma of adult-onset. DISCUSSION: Given its multi-loculated nature and size, it was surgically excised and one year later the patient is without evidence of recurrence. CONCLUSION: As the incidence of adult-onset cystic hygroma is rare, the nature and reporting of their management is limited. This case report contributes to the body of literature which serves to elucidate the optimal management of this perinatal condition in adults.

Contemporary comparison of surgical and interventional arteriography management of blunt renal injury.

PURPOSE: High-grade renal injuries have traditionally been treated operatively. Alternatively, embolotherapy is used to control hemorrhage, but there are few studies that validate this practice after renal injury. Embolotherapy may offer an effective and safe means to arrest hemorrhage after high-grade blunt renal injury. MATERIALS AND METHODS: Retrospective analysis was performed of high-grade renal injury (grade III or higher). Patients who were initially treated with arteriography were compared with those who underwent surgery. Statistical analysis was performed with Wilcoxon rank-sum and χ(2) tests. RESULTS: Sixty-nine patients were identified, 28 of whom had contrast agent extravasation on computed tomography (CT). Of these 69 patients, 17 underwent operation and 20 underwent arteriography. The surgical cohort had a higher injury severity score (39.6 vs 24.2; P < .01), but there was no difference in renal injury grade (P = .9). The arteriography cohort received significantly more contrast medium (P < .001). Contrast agent extravasation was confirmed angiographically in six of 12 patients who had this finding on CT, and embolotherapy controlled bleeding in all six. No significant difference was noted in transfusion need, recurrent hemorrhage, creatinine level at discharge, glomerular filtration rate, or length of stay (P > .4 for each endpoint). There was a trend toward a longer stay in the intensive care unit in the surgical cohort and a higher likelihood of discharge to home in the arteriography group (P = .08 for each endpoint). CONCLUSIONS: Embolotherapy offers a safe means to diagnose and arrest hemorrhage after renal injury. The additional contrast agent needed for imaging does not increase the incidence of nephropathy irrespective of renal injury grade.