A Review of "Options in Management of Trauma to the Esophagus" (1982) "Submitted for the Literary Festschrift in Honor of J. David Richardson, MD".

This article is an update of a paper which Dave Richardson and I published in 1982, and serves as both an update of management of esophageal injuries and as a lasting tribute to my mentor and hero J. David Richardson.

Troubles in Tuva: Patterns of perimortem trauma in a nomadic community from Southern Siberia (second to fourth c. CE).

OBJECTIVES: Warfare is assumed to be one of the defining cultural characteristics of steppe nomads in Eastern Eurasia. For the first-centuries CE, a period of political turmoil in Northern China and Southern Siberia, relatively few data are, however, available about the degree and variability of violence in these communities. Here, we provide new data on violence among steppe nomads during the first-centuries CE by analyzing the type, anatomical distribution, and demographic distribution of perimortem trauma at Tunnug1 (Tuva, Southern Siberia-second to fourth c. CE). MATERIALS AND METHODS: Perimortem traumas were assessed on 87 individuals representing both sexes and different age classes. The timing of the lesions was assessed based on morphological criteria, including the absence and presence of bone reactive processes and the relative plasticity of the bone at the moment of impact. The distribution by age, sex, and anatomical location of trauma was analyzed by means of logistic models, Fisher's exact tests, and 3D visualizations. RESULTS: A total of 130 perimortem traumas, including chop marks, slice marks, penetrating lesions, and blunt traumas were identified on 22 individuals. Chop marks were mostly at the level of the skull and vertebrae and were likely caused by bladed weapons. Slice marks were found on the cervical vertebrae and cranium and may be the result of throat slitting and scalping by means of smaller bladed implements. Traumas were more frequent in males, and their presence is not correlated with age. DISCUSSION: This study adds new data to the few available regarding violence among steppe nomadic cultures and provides new insights about the effects of political instability on the life of the people inhabiting Eastern Eurasia during the early centuries CE.

The botulinum toxin legend of Reinhard Heydrich's death: The end of "Himmler's brain".

The high-ranking German Nazi Reinhard Heydrich (1904-1942) was one of the main organizers of the mass murder of Jews during the Second World War. He died on June 4, 1942, in Prague after having been wounded in Operation Anthropoid planned by the British intelligence services. Since the 1970s and 1980s, Heydrich's death has been frequently presented in British, American, and French literature as the consequence of a bacteriologic attack. Botulinum toxin would have been used in the grenades or ammunition. We discuss the botulinum toxin hypothesis using the now declassified British archives of Operation Anthropoid and of the chemical and bacteriologic warfare centers to assess this hypothesis.

The provisional matrix: setting the stage for tissue repair outcomes.

Since its conceptualization in the 1980s, the provisional matrix has often been characterized as a simple fibrin-containing scaffold for wound healing that supports the nascent blood clot and is functionally distinct from the basement membrane. However subsequent advances have shown that this matrix is far from passive, with distinct compositional differences as the wound matures, and providing an active role for wound remodeling. Here we review the stages of this matrix, provide an update on the state of our understanding of provisional matrix, and present some of the outstanding issues related to the provisional matrix, its components, and their assembly and use in vivo.

The effects of World War I upon French ophthalmology.

Among the health emergency of World War 1, the one relating to the visual organs injuries is one of the most serious. The use of weapons of new type (grenades, shells, shrapnel) that produce chips that are projected on faces, brings the number of soldiers eye injured to an already impressive quantity at the end of the first year of conflict. This emergency is completely unexpected and it is particularly serious because this kind of trauma was extremely disabling. This situation cause a reaction by French ophthalmologists who start working to improve the organization of assistance, to administer effective treatments and surgery, and even on some issues beyond the medical field (legislation, assistance for war blinds). This article presents the main issues that French ophthalmologists have had to confront with during the Great War and, through this, to question the impact of the First World War on the development of ophthalmology as a medical specialty.

[The injured of the summer of 1914 and their stories]. / Les blessés de l'été 14 et le roman.

The situation of the French Military Health Service was particularly precarious at the beginning of the Great War. Contemporary novelists wished to expose the lies of propaganda and described without any complacency the disorganisation, the improvisation and the mistakes of the first weeks of the conflict. In this context they show the initiatives taken by civilians, especially the ladies from the aristocracy, to help the wounded. From the battlefield to the hospitals they describe the stations of the cross of the soldiers, those hoping for "la bonne blessure" and those who end up being amputated when alternatives could have been possible.

Medical aspects of the Battle of Waterloo: the battle.

The Duke of Wellington's polyglot army assembled for the Waterloo campaign was hastily aggregated and the Army Medical Department was somewhat short of staff and not entirely of the calibre of the department serving latterly in the Peninsular campaigns. The casualty rates during the battles of this campaign were high and the regimental and hospital staff struggled with the large number of casualties. Lack of stretcher bearers and transport were significant problems, which were compounded by the high density of the casualties. Three quarters of the surviving wounded rejoined their units.

Goldie Brangman Remembers the Operation to Save Dr King.

In September 1958 the Rev Dr Martin Luther King Jr was stabbed and nearly assassinated. Surgeons at Harlem Hospital in New York City removed a 17.8-cm (7-in)-long letter opener from Dr King's chest. Certified Registered Nurse Anesthetist Goldie Brangman remembers this event because she participated in Dr King's anesthetic. This article correlates Brangman's memories with published accounts of the event. It also places the event within the context of the modern civil rights movement that Dr King led.

The First World War and its influence on the development of orthopaedic surgery.

By December 1914, overwhelming numbers of soldiers with infected musculoskeletal wounds had filled hospitals in France and Britain. Frequently initial management had been inadequate. In 1915, patients with orthopaedic wounds were segregated for the first time when Robert Jones established an experimental orthopaedic unit in Alder Hey Hospital, Liverpool. In 1916 he opened the first of 17 orthopaedic centres in Britain to surgically treat and rehabilitate patients. Henry Gray from Aberdeen emerged as the leading authority in the management of acute musculoskeletal wounds in casualty clearing stations in France and Flanders. Gray had particular expertise in dealing with compound fractures of the femur for which he documented an 80% mortality rate in 1914-15.

Physical training, with especial reference to the training of convalescents.

Lieutenant-Colonel Netterville Barron, MVO RAMC, identified that although there was a moral and practical reason for providing training for convalescents, there lacked the scientific knowledge and structure to deliver it correctly. He should perhaps be considered the pioneer of rehabilitation within the military, with this paper providing the embryonic foundation from which the present DMRP has evolved. There is now very good science to support physical training and the delivery of rehabilitation, which now begins at the earliest time possible in the intensive care unit. From there, a robust structure of rehabilitation supports the patient back to duty or to the point of discharge. What has not altered is the seemingly never-ending debate about the provision of continued support (or lack of) after soldiers are finally discharged. Despite this fact, it is highly likely that Lt. Col Barron would be very satisfied with how far "physical training, with especial reference to the training of convalescent" has progressed.

Do we really need new medical information about the Turin Shroud?

Image processing of the Turin Shroud (TS) shows that the Man represented in it has undergone an under glenoidal dislocation of the humerus on the right side and lowering of the shoulder, and has a flattened hand and enophthalmos; conditions that have not been described before, despite several studies on the subject. These injuries indicate that the Man suffered a violent blunt trauma to the neck, chest and shoulder from behind, causing neuromuscular damage and lesions of the entire brachial plexus. The posture of the left claw-hand is indicative of an injury of the lower brachial plexus, as is the crossing of the hands on the pubis, not above the pubis as it would normally be, and are related to traction of the limbs as a result of the nailing to the patibulum. The disappearance of the thumbprints is because of entrainment of the flexor pollicis longus tendons while the nails were driven through the wrists. The blunt chest trauma, which resulted in the body falling forwards, was the direct cause of a lung contusion and haemothorax, confirmed by the post-mortem leakage of clots and serum from the chest caused by the stabbing with the spear, and was a likely cause of cardiac contusion. All the evidence is in favour of the hypothesis that the TS Man is Jesus of Nazareth.

Revisiting the harem conspiracy and death of Ramesses III: anthropological, forensic, radiological, and genetic study.

OBJECTIVE: To investigate the true character of the harem conspiracy described in the Judicial Papyrus of Turin and determine whether Ramesses III was indeed killed. DESIGN: Anthropological, forensic, radiological, and genetic study of the mummies of Ramesses III and unknown man E, found together and taken from the 20th dynasty of ancient Egypt (circa 1190-1070 BC). RESULTS: Computed tomography scans revealed a deep cut in Ramesses III's throat, probably made by a sharp knife. During the mummification process, a Horus eye amulet was inserted in the wound for healing purposes, and the neck was covered by a collar of thick linen layers. Forensic examination of unknown man E showed compressed skin folds around his neck and a thoracic inflation. Unknown man E also had an unusual mummification procedure. According to genetic analyses, both mummies had identical haplotypes of the Y chromosome and a common male lineage. CONCLUSIONS: This study suggests that Ramesses III was murdered during the harem conspiracy by the cutting of his throat. Unknown man E is a possible candidate as Ramesses III's son Pentawere.

Russian war surgery in 1812: 200 years since Russia's war triumph.

Specific wounds inflicted on soldiers and officers of the Russian Army by French firearms and cold weapon and wound treatment by Russian surgeons during 1812 Napoleon's invasion (better known in Russia as the Patriotic War of 1812) are discussed. An inference is made that the then surgical treatment was not only administered at a high level but was also versatile and efficient and thus could make a certain contribution to the victory of the Russian arms.

Suturing of penetrating wounds to the heart in the nineteenth century: the beginnings of heart surgery.

The beginnings of cardiac surgery go back to the 19th century. This article describes the history of the first attempts to operate on the heart. In 1882, Dr Block from Danzig, and in 1895, Simplicio Del Vecchio, published reports of animal experiments showing that the suturing of heart wounds is possible. After unsuccessful attempts by Axel Cappelen in Norway and Guido Farina in Italy, it was Ludwig Rehn of Germany who first sutured a laceration of the right ventricle of a human heart. Shortly afterward, Antonio Parrozzani successfully sutured a stab wound of the left ventricle. Following cardiac surgery back to its very beginnings, it is striking that the first attempts in the 19th century to repair the injured heart were regarded with great skepticism, and that heart suturing only slowly became an established method of treatment. Once the concept of cardiac surgery had become accepted, however, many kinds of operations were developed, paving the way for an explosion in the number of cardiac operations, as we well know, in the century that followed.

An historical context of modern principles in the management of intracranial injury from projectiles.

The contemporary management of projectile head injuries owes much to the lessons neurosurgeons have distilled from their experiences in war. Through early investigation and an increasingly detailed account of wartime clinical experience, neurosurgeons--including the field's early giants--began to gain a greater understanding not only of intracranial missile pathophysiology but also of appropriate management. In this paper, the authors trace the development of the principles of managing intracranial projectile injury from the Crimean War in the 19th century through the Vietnam War to provide a context that frames a summary of today's core management principles.

Historia de las heridas penetrantes de abdomen / History of penetrating abdominal wounds

A lo largo de la historia la conducta habitual frente a las heridas penetrantes de abdomen fue la de no intervenirlas quirúrgicamente y, con suerte, algunos no morían. Los antiguos hindúes, que desarrollaron una asombrosa cirugía, intentaron con éxito cerrar las víscerasabdominales extruidas con decapitadas cabezas de hormigas gigantes, en un arte que pocos cientos de años después se perdió. Celso, el gran romano del siglo I, nos ha dejado la minuciosa descripción de un tratamientointervencionista y poco más sucedió hasta la Edad Media, cuando Roger de Salerno comenzó a suturar vísceras sobre un trozo de madera de saúco. Ugo Borgognoni, Lanfranco y Henri deMondeville, con atrevidas suturas, llevaron la cirugía abdominal medieval hasta el cenit hacia fines del siglo XIV.Más allá de algunas excepciones, operar en lugar de esperar debió aguardar a lasoperaciones pioneras de ûentre muchosû Lucien Baudens, Marion Sims, William Mac Cormac, Eugène Chauvel, Félix Léjars y de un cometa en el cielo siberiano, la cirujana y princesa rusaVera Gedroits. La Gran Guerra terminó con las discusiones y, a partir de 1915, explorar fue la consigna en todas las heridas penetrantes de abdomen. En Uruguay, la tesis de Justo Duarte sobre el tema nos ilustra acerca del conservadurismo imperante en el país hasta por lo menos 1892. Siete años después, Luis Pedro Lenguas, Alfredo Navarro y Gerardo Arrizabalaga se pronunciaron ya definitivamente a favor de operar. Manuel B. Nieto, José Iraola, Domingo Prat, Eduardo Blanco Acevedo y Velarde Pérez Fontana, a comienzos del siglo XX, fueron algunas de las sobresalientes figuras quirúrgicasde la nueva generación, que, con trabajo y genio, sentaron las bases de la moderna cirugía abdominal de urgencia en Uruguay...

Throughout history, penetrating abdominal wounds were usually not managed through surgery, and out of luck, a few patients did not die. Ancient Hindus who excelled at sugery, successfully tried to close extruded abdominal internal organs with the heads of giant ants, an art that was lost a few centuries later. Celso, the great Roman if the 1st Century, provided uswith a detailed description of an interventionist treatment and not much happened until the Middle Ages, whenRoger of Salerno started sewing internal organs on a small elderberry board. The brave sutures of Ugo Borgognoni,Lanfranco and Henri de Mondeville led Medieval abdominal surgery to is zenith towards the end of the XIV century.Except for a few exceptions, managing wounds through surgery instead of waiting only came true with the pioneer surgeries by Lucien Baudens, Marion Sims, William Mac Cormac, Eugène Chauvel, Félix Léjars and the outstanding Vera Gedrotis, a Russian surgeon and Princess who standed out in the Siberian reality, û among others. The debate came to an end with the great WWI, and as from 1915 exploration was the standard for all penetrating abdominal wounds. In Uruguay, Justo DuarteÆs thesis on this issue illustrates the approach that ruled the country until at least 1892. Seven years after, Luis Pedro Lenguas, AlfredoNavarro and Gerardo Arrizabalaga admitted the convenience of operating such patients. In the early XX century, Manuel B. Nieto, José Iraola, Domingo Prat, Eduardo Blanco Acevedo and Velarde Pérez Fontana were some of the outstanding surgeons of the new generation who, thanks to their hard work and talent, provided the grounds for modern emergency abdominalsurgery in Uruguay...

Historicamente nos casos de feridas penetrantes de abdômen a conduta mais freqüente era não realizar umaintervenção cirúrgica, e em poucos casos os pacientes não morriam. Os antigos hindus, que desenvolveram umatécnica cirúrgica muito avançada, fechavam as vísceras abdominais com cabeças de formigas gigantes, uma arteque foi perdida alguns séculos depois. Celso, o grande romano do século I, deixou uma descrição minuciosa de um tratamento cirúrgico. Pouca coisa mais aconteceu até a Idade Médica quando Roger de Salerno começou a suturar vísceras sobre um pedaço de madeira de sabugueiro. Ugo Borgognoni, Lanfranco eHenri de Mondeville, com suturas atrevidas, fizeram com que a cirurgia abdominal medieval chegasse ao seu ponto mais alto no final do século XIV.Com poucas exceções, a decisão de operar ao invés de aguardar teve que esperar pelas operações pioneiras de,entre muitos outros, Lucien Baudens, Marion Sims, William Mac Cormac, Eugène Chauvel, Félix Léjars e deuma estrela solitária dos céus siberianos a cirurgiã e princesa russa Vera Gedroits. A I Guerra Mundial colocou fim às discussões e a partir de 1915 explorar é a palavra de ordem nos casos de feridas penetrantes de abdômen.No Uruguai, a tese de Justo Duarte sobre o tema nos ilustra sobre o conservadorismo imperante no país atépelo menos 1892. Sete anos depois, Luis Pedro Lenguas, Alfredo Navarro e Gerardo Arrizabalaga declararam serdefinitivamente favoráveis à realização de cirurgia. No começo do século XX Manuel B. Nieto, José Iraola, Domingo Prat, Eduardo Blanco Acevedo e Velarde Pérez Fontana foram algumas das figuras destacadas da nova geração de cirurgiões, que com trabalho e gênio, estabeleceram as bases da moderna cirurgia abdominal de urgência no Uruguai..