Caracterización de adolescentes lesionados por armas blancas en región tóraco-abdominal / Adolescents' characterization injured by steels in tóraco-abdominal region

Introducción: El trauma intencional por arma blanca, que ocasiona lesiones potencialmente fatales, constituye una de las causas de atención médica frecuente en el Servicio de Urgencias. Objetivo: Caracterizar a adolescentes con lesiones por armas blancas en región tóraco-abdominal. Métodos: Se realizó un estudio observacional, descriptivo, de corte transversal en 94 pacientes con lesiones tóraco-abdominales por arma blanca ingresados en el Hospital Pediátrico Juan Manuel Márquez en el período comprendido desde enero del 2016 hasta diciembre del 2020. Las variables estudiadas fueron: edad, sexo, tipo de heridas y localización, lesiones ocasionadas, procedimientos quirúrgicos realizados, complicaciones y casuística según los años estudiados. Resultados: El sexo masculino fue el más frecuente (92,6 por ciento) y las edades entre 15 y 18 años (87,2 por ciento). Predominaron las heridas de tipo no penetrantes (60,7 por ciento) y la localización torácica (59,8 por ciento). En las lesiones penetrantes predominó el neumotórax abierto (31 por ciento). Los procedimientos quirúrgicos más realizados fueron la sutura de herida traumática (100 por ciento) y la pleurostomía (44,8 por ciento). Entre las complicaciones presentadas prevalecieron la neumonía (35,2 por ciento) y la infección de la herida traumática (17,6 por ciento). El 2019 fue el año con mayor número de casos (25,5 por ciento). Conclusiones: Los adolescentes con lesiones tóraco-abdominales por arma blanca se caracterizan, en general, por ser varones entre 15 y 18 años. Las heridas de tipo no penetrante en tórax constituyen la lesión fundamental y la sutura de heridas es el procedimiento quirúrgico más empleado. La complicación más frecuente es la neumonía(AU)

Introduction: Intentional stab wound trauma, which causes potentially fatal injuries, is one of the causes for frequent medical attention in the emergency department. Objective: To characterize adolescents with stab wounds in the thoracoabdominal region. Methods: An observational, descriptive and cross-sectional study was conducted in 94 patients with thoracoabdominal stab wounds admitted to Hospital Pediátrico Juan Manuel Márquez from January 2016 to December 2020. The variables studied were age, sex, wound type and location, caused injuries, performed surgical procedures, complications and casuistry according to the studied years. Results: The male sex was the most frequent (92.6 percent), together with ages between 15 and 18 years (87.2 percent). Nonpenetrating injuries (60.7 percent) and the thoracic location (59.8 percent) predominated. Among penetrating injuries, open pneumothorax (31 percent) dominated. The most frequently performed surgical procedures were traumatic wound suturing (100 percent) and pleurostomy (44.8 percent). Among the complications, pneumonia (35.2 percent) and traumatic wound infection (17.6 percent) prevailed. 2019 was the year with the highest number of cases (25.5 percent). Conclusions: Adolescents with thoracoabdominal stab wounds were generally characterized as males at ages between 15 and 18 years. Nonpenetrating thoracic wounds are the main injuries and wound suturing is the most frequently used surgical procedure. The most frequent complication is pneumonia(AU)

Rising incidence of interpersonal violence in Pennsylvania during COVID-19 stay-at home order.

BACKGROUND: The coronavirus disease 2019 pandemic and associated policies have had important downstream consequences for individuals, communities, and the healthcare system, and they appear to have been accompanied by rising interpersonal violence. The objective of this study was to evaluate the incidence of injuries owing to interpersonal violence after implementation of a statewide stay-at-home order in Pennsylvania in March 2020. METHODS: Using the Pennsylvania Trauma Outcome Study registry, we conducted a retrospective cohort study of patients with gunshot wounds, stab wounds, and blunt assault-related injuries attributable to interpersonal violence treated at Pennsylvania trauma centers from March 16 to July 31 of 2018, 2019, and 2020. RESULTS: There were fewer total trauma admissions in 2020 (17,489) vs 2018 (19,290) and 2019 (19,561). Gunshot wounds increased in 2020 to 737 vs 647 for 2019 and 565 for 2018 (P = .028), whereas blunt assault injuries decreased (P = .03). In all time periods, interpersonal violence primarily impacted urban counties. African American men were predominantly affected by gunshot wounds and stab wounds, whereas Caucasian men were predominantly affected by blunt assault injuries. There were more patients with substance abuse disorders and positive drug screens during coronavirus disease than in comparison periods: (stab wound population 52.3% vs 33.9% vs 45.9%, coronavirus disease era vs 2018 vs 2019, respectively P = .0001), (blunt assault injury population 41.4% vs 33.1% vs 33.5%, coronavirus disease era vs 2018 vs 2019, respectively P < .0001). There was no correlation between the incidence of interpersonal violence and coronavirus disease 2019 rates at the county level. CONCLUSION: The implementation of a stay-at-home order was accompanied by rising incidence of gunshot and stab wound injuries in Pennsylvania. Preparedness for future resurgences of coronavirus disease 2019 and other pandemics calls for plans to address injury prevention, recidivism, and access to mental health and substance abuse prevention services.

Injuries Sustained During Incarceration Among Prisoners.

BACKGROUND: The U.S. prison population has increased substantially in recent years, and violent injury is common among prisoners. We sought to describe injury patterns and other characteristics of prisoners who presented to a trauma center after injury. Because penetrating trauma from an improvised weapon (e.g., shank) is frequent, we also sought to compare characteristics and outcomes of prisoners and non-prisoners who sustained an anterior abdominal stab or shank wound (AASW). METHODS: We analyzed injured adult prisoners who presented to a Level 1 trauma center between February, 2011, and April, 2017. We described characteristics of the injured prisoners and their hospitalizations. We compared prisoners who sustained an AASW to a random sample of non-prisoners with the same mechanism of injury using the chi-square test, Student's t-test, and logistic and Poisson regression. RESULTS: Of 14,461 hospitalized injured adults, 299 (2.0%) were injured while incarcerated. 185 (62%) encounters involved interpersonal violence and 36 prisoners (12%) presented with self-inflicted injuries. 98 (33%) had a psychiatric disorder. Among 33 prisoners and 66 non-prisoners who sustained an AASW, prisoners were less likely to have undergone a laparotomy [14/33 (42%) vs 44/66 (67%); RR 0.64 (95% CI 0.41-0.98)] or sustained an injury requiring operative intervention [2/33 (6%) vs 23/66 (35%); RR 0.17 (95% CI 0.04-0.69)]. CONCLUSIONS: Many injured prisoners have psychiatric illness, are involved in interpersonal violence, or harm themselves. Among hospitalized patients, abdominal stab/shank wounds sustained in prison are less likely to result in significant injuries or operative intervention than similar wounds in non-prisoners.

Glass table tops: An unusual source of lethal domestic injury.

A 42-year-old woman who fell through a glass tabletop had her lower back pierced by a long shard of glass. She rapidly exsanguinated. At autopsy, a single penetrating wound was present in her left lower back, with complete transection of her left kidney and a 3.5 L haematoperitoneum. Death was due to exsanguination following accidental transection of the left kidney by a penetrating glass injury of the lower back. Glass-topped tables are a well-recognised source of injury in a domestic setting There are far more non-lethal than lethal injuries, many of which involve children. Quite long shards may remain undetected in wounds for considerable amounts of time. Non-tempered glass is a particular risk for breakage. Glass-topped tables should not be used as substitutes for chairs, particularly in overweight or obese individuals.

Crossbow injuries: A case report with experimental reconstruction study and a systematic review of literature.

In modern times crossbow - a ranged weapon diffused during Middle Ages - is increasing its popularity in recreational hunting and sports; crossbow bolts have a great penetration capacity, despite their low initial velocity. Great concerns emerge when considering that notwithstanding crossbow is a potentially lethal distance weapon, it is easy to obtain without having to undertake any tests on the buyer's mental or physical health. Although rare, crossbow injuries can be challenging for the forensic pathologist due to great similarities with other wounds pattern (gunshots wounds or injury due to sharp force). Especially when the arrow is removed from its original position or the body is decomposed, identification of the weapon can be difficult. According to forensic literature, suicides, homicides and non-lethal injuries by crossbow have been reported up to the present day. We followed the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) indications in the identification and selection of studies and reviewed a series of cases of both fatal and non-fatal crossbow injuries, according to the manner of death (homicide, suicide, accidental). The casuistic part of this paper deals with an attempted murder of a 21-year old man: a case of non-lethal crossbow injury of the thorax in which an interdisciplinary approach, involving forensic inspection, ballistic and radiology tests, led to solve the case.

Are Self-Inflicted Stab Wounds Less Severe Than Assaults? Analysis of Injury and Severity by Intent.

BACKGROUND: Although there is evidence that self-inflicted abdominal stab wounds are less severe than those from assault, it is unclear if this is true in other anatomic regions. This study compares severity and injury pattern between self-inflicted stab wounds (SISWs) and wounds from assault (ASW). MATERIALS AND METHODS: Stab wounds from our level I trauma registry from 2013 to 2018 were reviewed. Data included age, gender, self-inflicted versus assault, psychiatric or substance use history, anatomic location, operative intervention, injury severity, length of stay, and outcomes. RESULTS: Over the study period, 1390 patients were identified. History of psychiatric diagnoses or previous suicide attempts was more frequent in SISWs (47% versus 6.5%, P < 0.01; 35% versus 0.4%, P < 0.01). SISWs had a higher incidence of wounds to the neck and abdomen (44% versus 11%, P < 0.01; and 34% versus 26%, P = 0.02). Overall, injuries from ASW had a higher injury severity score, but more procedures were performed on SISWs (46% versus 34%, P < 0.01). SISWs to the neck were more likely to undergo procedures (26% versus 15%, P = 0.04). Median hospital charges were higher in patients with SISWs ($58.6 K versus $39.4 K, P < 0.01). CONCLUSIONS: SISWs have a distinct pattern of injuries, more commonly to the neck and abdomen, when compared with injuries resulting from ASW. The patients with SISWs have a higher rate of procedures, longer length of stay, and higher hospital charges despite low injury severity overall.

Unusual attempted suicide or covered attempted homicide? A neck stabbing case report and review of literature.

A medico-legal consult is frequently required in a clinical context in order to assess the eventual compatibility of specific wounds with a self- or hetero-infliction. Accordingly, the case of a 52-year-old man with a single, penetrating stab wound of the neck, reported as self-inflicted, is here presented. The forensic aspects, taken into account in order to determine the self- or hetero-infliction nature of the wound, are further discussed and compared to cases described in the literature.

Self-inflicted neck wounds under influence of lysergic acid diethylamide: A case report and literature review.

RATIONALE: Lysergic acid diethylamide (LSD) is a highly potent psychedelic drug derived from ergot alkaloids. The available literature data derived from controlled studies or usage in a medical setting seem reassuring; however the literature contains very rare cases of fatal self-inflicted injuries associated with LSD exposure. The behavioral disorder that created the conditions conducive to death is a maladaptive or irrational response to the psychiatric manifestations induced by the substance. PATIENT CONCERN: Here, we report the case of a 26-year-old man found dead with large neck wounds in a locked house. No medical history other than recreational use of alcohol and narcotics was reported as well as any history of psychotic disease. The entirety of the other investigations carried out did not demonstrate the presence of a third party at the place of death and a dropper bottle containing LSD was found near the body. DIAGNOSIS: We report the first case of fatal self-inflicted neck wounds with a cutting instrument in the context of acute exposure to LSD in a patient with no psychiatric history and without suicidal symptoms at the time of the self-aggressive act. INTERVENTION AND OUTCOMES: In the present work, we used a validated method using liquid chromatography coupled with mass spectrometry for simultaneous quantification of LSD and its metabolites (O-H-LSD and Nor-LSD) in whole blood and urine samples. LSD and O-H-LSD were respectively found at 1460 and 182 pg/mL in blood. In the urine, the concentrations of LSD, nor-LSD, O-H-LSD were, respectively, 3670, 201, and 4890 ng/L. LESSONS: This observation is particularly relevant in view of the resurgence of interest in the therapeutic use of LSD, notwithstanding the fact that the literature has not demonstrated a link between suicidal risk and acute or chronic exposure to LSD.

Traumatismo torácico por arma blanca / Thoracic trauma by a bladed weapon

Resumen Objetivos Describir las características, índices de gravedad de traumatismo (IGT), morbilidad, mortalidad y factores asociados a mortalidad en pacientes hospitalizados por traumatismo torácico por arma blanca (TTAB). Materiales y Método Estudio analítico transversal. Período enero de 1981 a diciembre de 2017. Revisión base de datos prospectiva, protocolos quirúrgicos, fichas clínicas. Se describe y compara las características de los TTAB. Se calculó IGT: Injury Severity Score (ISS), Revised Trauma Score ( RTS-T) y Trauma Injury Severity Score (TRISS). Resultados Total 4.163 pacientes hospitalizados por TT, 2.286 hospitalizados por TTAB. Hombres: 2.131 (93,2%), edad promedio 27,8 ± 10,7 años, TTAB aislado 2.035 (89,0%), asociado a lesiones extratorácicas 251 (11,0%) y de éstos 124 (5,5%) se consideraron politraumatismos. Mecanismos principales del traumatismo: agresión 2.246 (98,3%) y autoagresión 22 (1,0%). Lesiones y hallazgos torácicos más frecuentes: neumotórax 1.473 (64,4%), hemotórax 1.408 (61,6%), enfisema subcutáneo 485 (21,2%). Tratamiento definitivo: pleurotomía 1.378 (60,3%), cirugía torácica 537 (23,5%) y tratamiento médico 370 (16,2%). Hospitalización promedio 6,2 ± 6,5 días, IGT: ISS promedio 10,9 ± 7,2, RTS-T promedio 11,6 ± 1,4 y TRISS promedio 3,6. Morbilidad: 318 (13,9%). Mortalidad: 32 (1,4%). Conclusión Los TTAB ocurren frecuentemente en hombres jóvenes por agresión. La mayoría se puede tratar con pleurotomía exclusiva.

Aim Our objectives are to describe and correlate the clinical characteristics, trauma severity indexes (TSI) and morbidity and mortality in patients hospitalized for thoracic trauma by a bladed weapon (TTBW). Materials and Method Transversal analytic study. Period January-1981 to December-2017. Prospective database review, surgical protocols, clinical files. The characteristics of the TTBW are described and compared. Injury Severity Score (ISS), Revised Trauma Score (RTS-T) and Trauma Injury Severity Score (TRISS) were calculated. Results Total of 4,163 patients hospitalized for TT, 2,286 hospitalized for TTBW. Men: 2,131 (93.2%), average age 27.8 ± 10.7 years, isolated TTBW 2,035 (89.0%), associated with extra thoracic injuries 251 (11.0%) and of these 124 (5.5%) were considered polytrauma. Main mechanisms of trauma: Aggression 2,246 (98.3%) and self-aggression 22 (1.0%). Most frequent injuries and thoracic findings: pneumothorax 1,473 (64.4%), hemothorax 1,408 (61.6%), subcutaneous emphysema 485 (21.2%). Definitive treatment: Pleurotomy 1,378 (60.3%), thoracic surgery 537 (23.5%) and medical treatment 370 (16.2%). Average hospital stay: 6.2 ± 6.5 days. ISS average 10.9 ± 7.2, RTS-T average 11.6 ± 1.4 and TRISS average 3.6. Morbidity: 318 (13.9%). Mortality: 32 (1.4%). Discussion TTBW are frequent in our environment, unlike on an international level. Conclusions TTBW frequently occur in young male patients due to aggression. The majority can be treated with exclusive pleurotomy.

[Stingray injury: A case in French Polynesia]. / Piqûre de raie pastenague : un cas en Polynésie française.

INTRODUCTION: Stingray injuries occur when people inadvertently step on these fish. Penetration of the barb results in puncture and/or laceration wounds and lesions related to the venom. PATIENTS AND METHODS: We report the case of a 76-year-old woman in French Polynesia who was stung on her right ankle by a stingray. She initially had a hypertensive episode with encephalopathy and a haemorrhagic wound due to an indwelling fragment of the barb. Necrosis due to the poison required medical-surgical management with debridement, which yielded a favourable outcome. DISCUSSION: Stingray injuries are rare and not well-known by doctors. They can be serious due to injury by the barb and to venom poisoning, leading to enzymatic tissue destruction, ischaemia and intense pain. The initial treatment consists in immersion in hot water, as the venom is thermolabile; antibiotics and surgery may be necessary, depending on the condition of the wound.

Increased risk of head injury in pediatric patients with attention deficit hyperactivity disorder.

OBJECTIVE: The prevalence of attention deficit hyperactivity disorder (ADHD) in the general pediatric population is 7%, whereas the prevalence in trauma is unknown. We hypothesized pediatric patients with ADHD would have a higher risk of involvement in a mechanism of injury (MOI) requiring constant attention to surroundings, such as a bicycle collision. METHODS: The Pediatric Trauma Quality Improvement Program (2014-2016) was queried for patients with ADHD. Patients, less than 16 years of age, with ADHD were compared to those without ADHD. RESULTS: The prevalence of ADHD was 2.5% (2,866). ADHD patients had higher risk for bicycle collision (odds ratio [OR], 1.85; 95% confidence interval [CI], 1.59-2.15; p < .001). ADHD bicyclists were less likely to wear a helmet (9.4% vs. 18.2%, p = .003) and had a higher rate of traumatic brain injury (TBI; 55.6% vs. 39.7%, p < .001), compared to non-ADHD bicyclists. CONCLUSIONS: Pediatric ADHD patients have a 60% higher risk of being involved in a bicycle collision. ADHD patients that are involved in a bicycle collision are less likely to wear a helmet with a higher rate of TBI. Increased public awareness, education, and supervision may help reduce risk of bicycle collisions and TBI in this population.

Assessment of cases with sharp and penetrating object injuries.

BACKGROUND: Sharp and penetrating object injuries (SPOIs) are seen frequently in forensic medicine practice. In this study, we aimed to retrospectively investigate cases with SPOIs. MATERIALS AND METHODS: This study investigated the charts of patients treated at Adiyaman University Education and Research Hospital between January 1, 2013, and December 31, 2017. A total of 934 inpatients with sharp object injuries were included in the study. Data were assessed using a suitable computer-aided package program. Cases were examined in terms of age, gender, injury body site, suicide or homicide, radiologic findings, presence of vital danger, and severity of injury. RESULTS: In this study, we examined the charts for 934 inpatients with stab wounds. It was stated that 124 (13.27%) of those injured were female and 810 (86.63%) male; the average age of the injured persons was 29.8 ± 18.2 years. It was found that 214 (22.91%) people were exposed to vital danger and that 720 (77.09%) suffered from soft tissue injuries (penetrating skin and muscle injuries). Also, 69.27% of the cases (n = 647) involved people less than 35 years of age. CONCLUSION: Considering that stab injuries are more frequent in the lower age groups, we believe that such injuries could be reduced by increasing training programs for young people.

Diagrama de Ishikawa: causas e soluções da infecção ao HIV adquirida por profissionais de enfermagem através de materiais perfurocortantes / Ishikawa Diagram: causes and solutions of HIV infection in nursing professionals due to sharps use / Diagrama de Ishikawa: causas y soluciones de la infección al vih adquirida por profesionales de enfermado a través de materiales perfurocortantes

Objective: The study's goal has been to analyze, through the Ishikawa Diagram, the causes and solutions of HIV infection in nursing professionals due to sharps handling. Methods: It is a literature review based on the Construction of the Ishikawa Diagram, which was carried out in May 2017 in the PubMed and Virtual Health Library databases. Results: The following are the main causes of HIV infection through sharps: work overload, perception of frail risk, careless use of needles, lack of training. Regarding the solutions: adequate post-exposure management, implementing and monitoring compliance with biosafety standards, improving the notification of accidents with sharps. Conclusion: There is a need to alerting managers towards intervening in the factors that might trigger accidents with sharp materials by the nursing team

Objetivo: Analisar por meio do Diagrama de Ishikawa as causas e soluções da infecção ao HIV adquirida por profissionais de enfermagem no manuseio de materiais perfurocortantes. Métodos: Revisão da literatura baseada na Construção do Diagrama de Ishikawa, realizado em maio de 2017 nas bases de dados Pubmed e Biblioteca Virtual de Saúde. Resultados: Dentre as causas da infecção ao HIV através de perfurocortantes: sobrecarga de trabalho, percepção de risco fragilizada, utilização descuidada de agulhas, ausência de treinamento. Quanto às soluções: gestão pós exposição adequada, implementar e fiscalizar o cumprimento das normas de biossegurança, aprimorar a notificação de acidentes com materiais perfurocortantes. Conclusão: Destaca-se a necessidade de sensibilizar gestores para intervir nos fatores que podem desencadear acidentes com materiais perfurocortantes pela equipe de enfermagem

Objetivo: Analizar por medio del Diagrama de Ishikawa las causas y soluciones de la infección al VIH adquirida por profesionales de enfermería en el manejo de materiales punzocortantes. Métodos: Revisión de la literatura basada en la construcción del diagrama de Ishikawa, realizado en mayo de 2017 en las bases de datos Pubmed y Biblioteca Virtual de Salud.Resultados: Entre las causas de la infección por el VIH a través de punzocortantes: sobrecarga de trabajo, percepción de riesgo fragilizada, utilización descuidada de agujas, ausencia de entrenamiento. En cuanto a las soluciones: gestión post exposición adecuada, implementar y fiscalizar el cumplimiento de las normas de bioseguridad, mejorar la notificación de accidentes con materiales punzocortantes. Conclusión: Se destaca la necesidad de sensibilizar a los gestores para intervenir en los factores que pueden desencadenar accidentes con materiales punzocortantes por el equipo de enfermería

Abdominal trauma: experience of 4961 cases in Western Mexico.

INTRODUCTION: Trauma is a leading cause of morbimortality in the world. Intraabdominal compartment is the third most affected anatomical region and bleeding from this origin is difficult to identify, therefore the importance to predict possible lesions to the abdominal cavity. OBJECTIVE: To describe and analyze the sociodemographic profile and injuries found in patients with abdominal trauma in a western hospital in Mexico. METHOD: Consecutive patients included in the local registry GDL-SHOT were analyzed. RESULTS: From 4961 patients, 91.4% were men, with a mean age of 28.7 years. Regarding the mechanism of trauma, 39.7% were stab wounds, 33% blunt abdominal trauma and 27.3% gunshots. The most affected organs were: small bowel (20.9%), liver (18.2%), and colon (14.2%). The mean hospital stay was 6.95 days with a mortality of 6.74%. CONCLUSION: In Mexico, abdominal trauma represents an important cause of morbidity and mortality, especially in young patients. We found an important amount of penetrating trauma.

INTRODUCCIÓN: El trauma es una de las principales causas de morbimortalidad en el mundo. El abdomen es, en frecuencia, la tercera región anatómica más afectada, y el compartimento intraabdominal es un sitio de hemorragia difícil de identificar, por lo que cobra importancia el conocimiento de las posibles lesiones tras un traumatismo. OBJETIVOS: Describir y analizar el perfil sociodemográfico y las lesiones encontradas en pacientes con trauma abdominal en un hospital de referencia del occidente de México. MÉTODO: Se seleccionaron para su análisis los pacientes incluidos en el registro hospitalario local GDL-SHOT. RESULTADOS: De 4961 pacientes, el 91.4% fueron hombres, con un promedio de edad de 28.7 años. Respecto al mecanismo, el 39.7% correspondió a arma blanca, el 33% a trauma cerrado y el 27.3% a arma de fuego. Los órganos más afectados fueron el intestino delgado (20.9%), el hígado (18.2%) y el colon (14.2%). La estancia hospitalaria promedio fue de 6.95 días, con una mortalidad del 6.74%. CONCLUSIONES: En México, el trauma abdominal representa una causa importante de morbimortalidad, en especial en pacientes jóvenes, y predomina el mecanismo penetrante; el manejo más común es no conservador. La frecuencia de lesiones encontradas es discordante con la literatura de otros países y predominan las de vísceras huecas, probablemente por la diferencia en los mecanismos implicados.

Portopulmonary Hypertension: A Complex Case Derived from Multiple Penetrating Trauma-Induced Mesenteric Arteriovenous Fistulae.

Portopulmonary hypertension (PoPH) is a well-recognized complication of portal hypertension. This study reports a case of PoPH that was secondarily caused by post-traumatic mesenteric arteriovenous fistula. A 38-year-old man with a history of knife stabbing wounds in the abdomen in 2003 was admitted to the hospital with exertional shortness of breath and a mechanic murmur over the umbilical region. Computed tomography indicated signs of PoPH and mesenteric arteriovenous fistula. Percutaneous catheter-directed embolization was first performed but failed. Subsequently, the patient was successfully treated with fistula resection and partial enterectomy. The patient had been postoperatively followed regularly, and chief symptoms had been alleviated significantly and pulmonary pressure had successfully decreased to normal range. We believe that this is the first case of PoPH caused by mesenteric arteriovenous fistula.

Aggression Using a Knife or Other Sharp Instruments and Oral-Maxillofacial Trauma: Incidence, Risk Factors, and Epidemiologic Trends.

PURPOSE: The aim of the present study was to characterize the profile of victims of interpersonal physical violence (IPV) caused by a knife or other sharp instrument, identify the factors associated with maxillofacial trauma, and examine the incidence of maxillofacial trauma over time. PATIENTS AND METHODS: In a retrospective cohort study, we evaluated 569 medicolegal and social records of IPV victims by knife or other sharp instruments treated at a forensic medicine and dentistry center in Brazil during a 4-year consecutive period. The variables investigated were related to the sociodemographic characteristics of the victims, circumstances of the aggression, and trauma patterns. Descriptive and multivariate statistics through Poisson regression and trend analysis with the creation of polynomial regression models were used. RESULTS: The cumulative incidence of oral-maxillofacial trauma was 19.3%. The mean age of the victims was 31.29 ± 13.82 years. Cases of trauma affecting more than one region of the face prevailed (45.5%). Based on the final Poisson regression model, unemployed people were more likely to exhibit maxillofacial trauma (relative risk [RR] 1.86; 95% confidence interval [CI] 1.03-3.35; P = .039). In addition, individuals were more likely to experience maxillofacial trauma on Wednesdays (RR 1.85; 95% CI 1.01-3.37; P = .045). The trend analysis revealed a significant increase in oral-maxillofacial injuries over time (P < .05). CONCLUSIONS: The incidence of oral-maxillofacial trauma was high, and the main factors associated with trauma were the victim's employment status and day of occurrence. Future studies will focus on assessing the effect of maxillofacial trauma on the quality of life and well-being of violence victims.

Soft tissue infections from fish spike wounds: normal commensal bacteria are more common than marine pathogens.

BACKGROUND: A fish spike injury can be sustained by anyone handling fish; during fishing, meal preparation or in retail. Case reports of fish spikes inoculating victims with virulent marine-specific pathogens and causing systemic illness led us to question whether empirical treatment of these injuries with amoxicillin and clavulanic acid is adequate. METHODS: This 2-year prospective observational study was conducted at Middlemore Hospital, Auckland, New Zealand. Wound swabs and tissue samples belonging to patients presenting to the Department of Plastic and Reconstructive Surgery with an upper limb fish spike injury were sent to the laboratory (n = 60). A series of stains and cultures were performed to look specifically for marine bacteria not typically isolated in other soft tissue injuries. Patient demographic data and injury details were collected. RESULTS: Of the patients with adequate microbiology samples, 12% (6/50) grew clinically relevant bacteria resistant to amoxicillin and clavulanic acid. These included methicillin-resistant Staphylococcus aureus (8%, 4/50), Enterobacter cloacae (2%, 1/50) and an anaerobic sporing bacillus (2%, 1/50). Only one patient grew a true marine-specific bacteria, Photobacterium damselae, which was susceptible to amoxicillin and clavulanic acid. CONCLUSION: The authors concluded that amoxicillin and clavulanic acid is an adequate first-line antibiotic for fish spike injuries but that flucloxacillin may be more appropriate given most bacteria were from patients' own skin flora. The authors suggest that clinicians consider the presence of resistant marine-specific bacteria in cases where there is sepsis or inadequate response to initial therapy.

Endovascular Treatment of Penetrating Injury to the Vertebral Artery by a Stab Wound: Case Report and Literature Review.

BACKGROUND: We describe a unique case of a patient with penetration of the cervical region by a stab wound, who required emergency care for the controlled removal of the knife and for vertebral artery trauma (VAT) treatment. Although rare, VAT causes high morbidity and mortality. METHODS: A patient admitted for emergency care was diagnosed with traumatic complete section of the vertebral artery by a knife and underwent removal of the knife under radioscopic supervision and vertebral artery embolization with coils. RESULTS: The knife was removed successfully, the bleeding was controlled, and the patient did not present any sequelae. CONCLUSIONS: In the authors' experience, a patient in an emergent state due to VAT can be treated effectively and quickly with proximal embolization.