Clinical characteristics and associated factors of posttraumatic epilepsy after traumatic brain injury in children: A retrospective case-control study.

BACKGROUND: Traumatic brain injury (TBI) affects approximately 69 million individuals annually, often resulting in well-documented complications such as epilepsy. Although numerous studies have been performed on posttraumatic epilepsy (PTE) in adults over the past decade, research on chronic consequences of TBI in children remains limited. Herein, we retrospectively assessed children who had experienced moderate to severe TBI to determine their clinical characteristics and identify associated factors associated with the development of PTE in the pediatric population. METHODS: The study population comprised children aged 0-18 years who had experienced moderate to severe TBI and underwent treatment at the Children's Hospital of Chongqing Medical University between 2011 and 2021. They were categorized into two groups: the PTE group, comprising individuals diagnosed with PTE within a one-year follow-up period, and the nPTE group, consisting of those who did not develop PTE during the same timeframe. The primary objective was to investigate the clinical characteristics and identify related associated factors. The relationship between various clinical factors and the incidence of PTE was assessed through univariate and multivariate logistic regression. RESULTS: A total of 132 patients were assessed. Most participants were male (65%) and the age distribution skewed towards younger children, with a median age of 41.0 months (interquartile range: 45.3). Upon their last clinical visit, 64 children (49%) were diagnosed with PTE. Notably, the first posttraumatic seizure predominantly occurred within the first week following the traumatic event. Further analyses revealed that increasing injury severity, as indicated by a lower Glasgow Coma Scale (GCS) score (odds ratio [OR]: 0.78, 95% confidence interval [CI]: 0.54-1.12, p= 0.018), a contusion load ≥3 (OR: 8.1, 95% CI: 2.3-28.9, p= 0.001), immediate posttraumatic seizures (IPTS) (OR: 8.9, 95% CI: 2.5-31.2, p < 0.001), and early posttraumatic seizures (EPTS) (OR: 54, 95% CI: 11-276, p < 0.001), were all significantly associated with a higher risk of developing PTE. CONCLUSION: This study highlights that the onset of PTE was associated with the markers of injury severity or PTS and identified GCS scores, contusion loads of ≥3, IPTS, and EPTS as independent associated factors significantly associated with the development of PTE.

[Complications after conservative vs. operative treatment of severe thoracic trauma]. / Komplikationen nach operativer vs. konservativer Versorgung des schweren Thoraxtraumas.

BACKGROUND: Thoracic trauma is a frequent injury in the routine treatment of injured patients. Due to the increasing demographic changes a further increase is to be expected, especially after low-energy trauma. OBJECTIVE: Expected complications after conservative vs. operative treatment of various injury patterns of thoracic trauma. MATERIAL AND METHODS: Evaluation of a selective literature search regarding possible complications after thoracic trauma and formulation of instructions for action as expert recommendations. CONCLUSION: Both conservative and operative treatment of thoracic trauma have their specific complications, which have to be known to the treating physician. Lung contusions are often underestimated in the initial radiological diagnostics but often lead to relevant problems during the further course of treatment. After conservative treatment of rib fractures persistent pain, functional limitations or even relevant deformities due to secondary dislocation, can remain. There is a significant risk of overlooking or underestimating relevant injuries during the initial diagnostics which then leads to secondary complications. By far the most frequent risk of surgical treatment is an incorrect positioning of chest tubes. Overall, postoperative infections after chest trauma are relatively rare.

Timing matters: Early versus late rib fixation in patients with multiple rib fractures and pulmonary contusion.

BACKGROUND: Recent literature has shown that surgical stabilization of rib fractures benefits patients with rib fractures accompanied by pulmonary contusion; however, the impact of timing on surgical stabilization of rib fractures in this patient population remains unexplored. We aimed to compare early versus late surgical stabilization of rib fractures in patients with traumatic rib fractures and concurrent pulmonary contusion. METHODS: We selected all adult patients with isolated blunt chest trauma, multiple rib fractures, and pulmonary contusion undergoing early (<72 hours) versus late surgical stabilization of rib fractures (≥72 hours) using the American College of Surgeons Trauma Quality Improvement Program 2016 to 2020. Propensity score matching was performed to adjust for patient, injury, and hospital characteristics. Our outcomes were hospital length of stay, acute respiratory distress syndrome, unplanned intubation, ventilator days, unplanned intensive care unit admission, intensive care unit length of stay, tracheostomy rates, and mortality. We then performed sub-group analyses for patients with major or minor pulmonary contusion. RESULTS: We included 2,839 patients, of whom 1,520 (53.5%) underwent early surgical stabilization of rib fractures. After propensity score matching, 1,096 well-balanced pairs were formed. Early surgical stabilization of rib fractures was associated with a decrease in hospital length of stay (9 vs 13 days; P < .001), decreased intensive care unit length of stay (5 vs 7 days; P < .001), and lower rates of unplanned intubation (7.4% vs 11.4%; P = .001), unplanned intensive care unit admission (4.2% vs 105%, P < .001), and tracheostomy (8.4% vs 12.4%; P = .002). Similar results were also found in the subgroup analyses for patients with major or minor pulmonary contusion. CONCLUSION: These findings suggest that in patients with multiple rib fractures and pulmonary contusion, the early implementation of surgical stabilization of rib fractures could be beneficial regardless of the severity of pulmonary contusion.

Earthquake-related isolated blunt thoracic trauma patients: A special population study in the emergency department.

OBJECTIVE: The objective of this study is to compare patients with severe and mild blunt thoracic trauma, who survived an earthquake and presented to the emergency department (ED), in order to identify factors influencing the severity of trauma in earthquake-related thoracic injuries. METHODS: This retrospective, cross-sectional, observational comparative study included patients with isolated thoracic injuries due to the February 6th Kahramanmaras earthquake. The patients were categorized into severe and mild groups based on chest trauma scoring (CTS), and their characteristics were compared. RESULTS: The study included 53 patients, with 43 (88.1%) classified as having mild thoracic trauma and 10 (18.9%) classified as having severe thoracic trauma. There was no significant difference in the duration of entrapment between the groups (p = 0.824). The incidence of hemothorax, pneumothorax, rib fractures, and pneumomediastinum did not differ significantly between the two groups (p > 0.05). However, severe thoracic trauma was associated with a higher rate of lung contusion compared to the mild group (p = 0.045). The severe group exhibited significantly higher median scores for lung contusion, rib fractures, and total CTS compared to the mild group (p < 0.001). The mortality rate was significantly higher in the severe group (40%, n = 4) compared to the mild group (2.3%, n = 1) (p = 0.003). CONCLUSION: The duration of entrapment did not significantly affect the severity of thoracic injuries in earthquake-related blunt thoracic trauma. However, lung contusion was found to be a more prominent feature in these injuries compared to other clinical conditions such as hemothorax and pneumothorax. These findings highlight the distinct clinical implications of earthquake-related thoracic trauma and may have implications for management strategies in these cases.

Hérnia diafragmática à direita por trauma contuso: uma revisão bibliográfica / Right diaphragmatic hernia due to blunt trauma: a literature review

As hérnias diafragmáticas são decorrentes principalmente de traumas contusos e são mais comuns à esquerda. Essa menor frequência à direita é explicada pela contenção e proteção do fígado ao hemidiafragma homolateral. Entretanto, apesar de as lesões à esquerda serem mais frequentes, aquelas situadas à direita associam-se a lesões mais graves e resultam em mais instabilidade hemodinâmica, o que gera elevada mortalidade no momento do trauma. Além disso, a hérnia diafragmática direita, pode permanecer assintomática por longo tempo, favorecendo a aparecimento de complicações como isquemia e ruptura das vísceras herniadas dentro do tórax. Assim é fundamental um diagnóstico precoce, a fim de se realizar o tratamento cirúrgico, uma vez que o diafragma não cicatriza espontaneamente. (AU)

The diaphragmatic hernias are mainly due to blunt trauma and are more common on the left. This lower frequency on the right side is explained by liver protection of the ipsilateral hemidiaphragm. However, despite the injuries are more frequent on the left, those situated on the right are associated with more severe injuries and result in more hemodynamic instability, which leads to high mortality at the time of trauma. Furthermore, the right diaphragmatic hernia can remain asymptomatic for long time, favoring the onset of complications such as ischemia and rupture of the herniated organs inside the chest. Therefore early diagnosis is fundamental in order to perform surgical treatment, since the diaphragm does not heal spontaneously. (AU)

Hernia diafragmática traumática: presentación de un caso / Traumatic diaphragmatic hernia: presentation of a case

La hernia diafragmática traumática constituye un problema poco frecuente para el cirujano general, necesitándose un elevado índice de sospecha para su diagnóstico, especialmente en los pacientes portadores de un trauma cerrado. Se presenta un paciente masculino de 40 años de edad, portador de una hernia diafragmática traumática formada por estómago y epiplón mayor, secundaria a un trauma toroco-abdominal en accidente automovilístico, en el que se práctica video toracoscopía izquierda, que permite realizar el diagnóstico correcto. Se exponen los datos clínicos del paciente, su manejo, tratamiento quirúrgico efectuado y su posterior evolución...(AU)

Traumatic diaphragmatic hernia is a little frequent problem for the general surgeon, needing a high level of suspicion for the diagnosis, especially in patients carrying a closed trauma. We present the case of a male, 40-years-old patient, with a traumatic diaphragmatic hernia formed by stomach and greater omentum, secondary to a thoraco-abdominal trauma in automobile accident. A left video thoracoscopy allows arriving to the correct diagnosis. We expose the clinical data of the patient, his management, the surgical treatment applied and his subsequent evolution...(AU)

Hernia diafragmática traumática: presentación de un caso / Traumatic diaphragmatic hernia: presentation of a case

La hernia diafragmática traumática constituye un problema poco frecuente para el cirujano general, necesitándose un elevado índice de sospecha para su diagnóstico, especialmente en los pacientes portadores de un trauma cerrado. Se presenta un paciente masculino de 40 años de edad, portador de una hernia diafragmática traumática formada por estómago y epiplón mayor, secundaria a un trauma toroco-abdominal en accidente automovilístico, en el que se práctica video toracoscopía izquierda, que permite realizar el diagnóstico correcto. Se exponen los datos clínicos del paciente, su manejo, tratamiento quirúrgico efectuado y su posterior evolución...

Traumatic diaphragmatic hernia is a little frequent problem for the general surgeon, needing a high level of suspicion for the diagnosis, especially in patients carrying a closed trauma. We present the case of a male, 40-years-old patient, with a traumatic diaphragmatic hernia formed by stomach and greater omentum, secondary to a thoraco-abdominal trauma in automobile accident. A left video thoracoscopy allows arriving to the correct diagnosis. We expose the clinical data of the patient, his management, the surgical treatment applied and his subsequent evolution...

Paraplejia por contusión lumbar / Paraplegia due to low back strain

Un traumatismo dorsal, en una columna afectada por espondilitis anquilosante (EA), debe tratarse inicialmente por defecto como una fractura y el paciente se considerará potencialmente inestable hasta que se normalicen todas las pruebas complementarias. Se expone un caso de contusión lumbar en un paciente con historia conocida de EA, que sufre un deterioro neurológico tardío y paraplejia de miembros inferiores. En este artículo queremos enfatizar el manejo inicial y las complicaciones derivadas de la enfermedad, que todo médico en la puerta de urgencias debe conocer (AU)

Dorsal injury in a spine affected by ankylosing spondylitis (AS) must be treated initially by default as a fracture and the patient will be considered potentially unstable until all supplemental investigations show normal results. We report a case of low back strain in a patient with known history of AS, suffering late neurological impairment and paraplegia of the lower limbs. This article intends to highlight the initial management and complications resulting of the disease that any physician at the emergency room should know (AU)

Hematomas pulmonares secundarios a contusión pulmonar / No disponible

No disponible

Forensic medical assessment in post-trauma retinal detachment / 法医学杂志

OBJECTIVE@#To analyze risk factors associated with post-traumatic retinal detachment and to identify the cause-effect relationship between retinal detachment and blunt ocular trauma in forensic medical assessment.@*METHODS@#112 cases of forensic medical examination on post -traumatic retinal detachment were retrospectively analyzed.@*RESULTS@#A variety of retinal abnormalities were found in these cases, including tearing of the ora serrata retinae (4.28%), macular perforation (12.50%), small (<90 degrees) nonmacular retinal perforation (56.25%), larger (>90 degrees) retinal perforation (5.00%), and tractive retinal detachment without perforation (11.6%). Proliferative vitreoretinopathy (PVR) was found in 45 eyes examined. In most cases, retinal detachment occurred between 1 week to 2 months after blunt ocular trauma (61.60%), with 83.93% accompanied with severe myopia (>-3.00D) and 52.67% accompanied with vitreous floaters. Of all cases, 41.07% were directly and 52.68% were indirectly resulted from blunt ocular trauma, and the rest (6.25%) showed no association with blunt ocular trauma. CONCLUSION Many risk factors may result in retinal detachment including blunt ocular trauma and other causes. Accurate assessment of the relationship between blunt ocular trauma and retinal detachment is an important part of forensic examination.

Aneurisma en el segmento palma de la arteria cubital / No disponible

Presentamos un paciente joven con aneurisma en el segmento palmar de la arteria cubital, secundario a traumatismos contusos repetidos, asociado con su actividad laboral. El paciente fue tratado exitosamente mediante escisión del aneurisma sin reconstrucción arterial, actualmente asintomático, en seguimiento hace 6 meses. Realizamos una revisión de la fisiopatología, manifestaciones clínicas, métodos diagnósticos y el tratamiento quirúrgico de la enfermedad aneurismática en la arteria cubital (AU)

A Young patient with an aneurysm in the palmar segment of the ulnar artery, secondary to repetitive blunt trauma, associated with his laboral a ctivity, is presented. The patient underwent a successful aneurysmectome y without revascularization, he was asymptomatic during a six-month follow-up. A review of the pathophysiology, clinical manifestations, diagnostic methods and surgical management of the ulnar artery aneurysm, was done (AU)

Rabdomiolisis tras actividad física extenuante. A propósito de un caso / Rhabdomyolysis after strenuous physical exercise. A case report

Se presenta un caso de rabdomiolisis no complicada en un varón tras detención policial y estancia en comisaría durante 4 días. El detenido refirió malos tratos policiales consistentes en contusiones menores y exposición a actividad física extenuante. Se analizan las causas de rabdomiolisis descritas en la literatura médica y el curso natural de la enfermedad en los casos traumáticos. Se comprueba la posible relación entre ambos hechos: rabdomiolisis no complicada y mal trato físico. Se sugiere la posibilidad de introducir el estudio de mioglobina y enzimas musculares en sangre y orina como parte de los protocolos de diagnóstico de malos tratos físicos

It´s reported a case of not complicated Rhabdomyolysis in a young man after having been detained in a police station for 4 days. The detainee claimed to have been subject of an ill-treatment consistent in a forced exposure to strenuous physical exercise. After having considered main causes of rhabdomyolysis and natural course of the syndrome in similar cases it is suggested a relation between both facts: uncomplicated rhabdomyolysis and ill-treatment. Myoglobine and muscle enzymes can also be analyzed in blood and urine as a part of the protocols for the diagnosis of physical ill-treatment

Transfusión en la cirugía intracraneal / Transfusion in intracraneal surgery

Fundamentos: Analizar la transfusión en los pacientes de cirugía intracraneal a partir de los datos del Conjunto Mínimo Básico de Datos del paciente. Métodos: Informes de alta de los pacientes intervenidos durante 1996, codificados según la Clasificación Internacional de Enfermedades (CIE-9-MC), evaluando: edad, sexo, los códigos de diagnósticos, de procedimientos, incluidas las transfusiones, y los códigos de las intervenciones quirúrgicas. Resultados: Fueron operados 203 pacientes, de los que se transfundieron 19 (9.4 por ciento). El mayor riesgo de transfusión ocurre en los pacientes con fractura de cráneo (18.5 por ciento), hemorragias intracraneales (12.1 por ciento) y tumoraciones benignas (10.3 por ciento). Mediante análisis univariante, se detecta una asociación estadísticamente significativa de la transfusión con el diagnóstico (p: 0.049), número de diagnósticos codificados (p: 0.049) y de técnicas quirúrgicas codificadas (p: 0.018), posibles indicadores indirectos de la severidad clínica y quirúrgica. Sin embargo mediante el análisis multivariante de regresión logística no se detectó ninguna asociación ajustada de las variables estudiadas con el riesgo de transfusión. Conclusiones: 1º Aunque no hemos podido encontrar un modelo predictor del riesgo de transfusión, este es mayor en los pacientes con fractura de cráneo, hemorragias intracraneales y tumores benignos. 2º Es coste-efectivo el poder monitorizar las transfusiones a partir de los datos administrativos del hospital, dada su fácil disponibilidad y los beneficios del análisis de los mismos. 3º Son necesarios ulteriores estudios para intentar definir con exactitud el subgrupo de los pacientes con mayor riesgo a priori de ser transfundido en la cirugía intracraneal (AU)

Traumatismo renal contuso en niños 56 casos: evolución hacia el tratamiento conservador / Renal contusous trauma in children 56 cases: evolution to preservation treatment

El presente trabajo pretende poner de manifiesto la evolución hacia la adopción de conductas terapéuticas cada vez más conservadoras frente a las lesiones renales secundarias a traumatismos contusos. De enero de 1989 a marzo de 1996 ingresaron 56 pacientes con traumatismo renal: 52 contusos y 4 penetrantes que no se analizaron. 36 varones y 20 niñas cuyas edades oscilan entre los 3 y 14 años. En 3 casos hubo asociación con lesión esplénica y en 2 laceración hepática. La evaluación lesional se realizó mediante ecografía, TAC, Orografía y arteriografía. La conducta terapéutica adoptada en cada caso, estuvo en función del grado de lesión al ingreso, así como de la situación clínica y heinodinárnica del paciente. Se requirió cirugía inmediata en 3 pacientes con traumatismo G' 111 de Hodges y en forma diferida en 7 pacientes con traumatismo G' 11. De estos 7, 5 fueron realizadas en los primeros 4 arios de este estudio. En ninguno de ellos se realizó nefrectomía total. De acuerdo a nuestra experiencia y a la hora de decidir el trataniiento adecuado del traumatismo renal contuso del niño, somos partidarios de la adopción de conductas conservadoras. Una adecuada y precisa valoración clínico-imagenológica permite conseguir resultados para salvar un riñón con la mínima morbilidad

Traumatismos vasculares / Vascular trauma

El trauma vascular sigue siendo una entidad trascendente en el ámbito de la cirugía. El presente artículo intenta actualizar logros recientes en este campo e incluirlos en una exposición global coherente. Se exponen aspectos generales del desarrollo histórico de la cirugía vascular, se señalan los diversos mecanismos que pueden ocasionar esta patología y se intenta normar sobre la terminología en ella involucrada. Se describen los caracteres semiológicos más relevantes de los traumatismos vasculares, se indican los recursos de laboratorio necesarios y se expone la técnica quirúrgica que debe emplearse en estas lesiones

Insuficiencia respiratoria y traumatismo torácico / Respiratory failure and thoracic trauma

Se presentan dos casos de traumatismo cerrado de tórax en politraumatizados con contusión pulmonar, insuficiencia respiratoria importante y escaso compromiso parietal. Se enfatiza la importancia de la contusión pulmonar como causa de la insuficiencia respiratoria, en detrimento del movimiento paradojal parietal, en los casos de tórax móvil. En los casos de contusión pulmonar en traumatismos torácicos puros o politraumatizados, se señala la importancia, para la decisión terapeútica, la predicción pronóstica y la evaluación de resultados, de los siguientes índices: a) Condición al ingreso; b) Trauma score (TS); c) Injury severity score (ISS); d) Dosis de severidad lesional (LD50); e) Cociente arterio/alveolar de oxígeno (A/ApO2); f) Escala de gravedad; g) Lesiones agregadas. Un tratamiento médico minucioso basado en la correcta analgesia, la eliminación de secreciones y una kinesioterapia y fisioterapia cuidadosas permiten tratar muchos casos de contusión pulmonar, con o sin tórax móvil, sin necesidad de recurrir a la asistencia respiratoria mecánica, como en los dos casos presentados. Cuando ésta se requiere es para reemplazar temporariamente la función del parénquima pulmonar lesionado y no para estabilizar neumáticamente la pared, acortando el tiempo de asistencia respiratoria mecánica y disminuyendo las complicaciones asociadas a la misma (AU)

Contusión ocular en el niño asociada con hipema: estudio de 200 pacientes / Ocular contusion in the child associated with hyphea: study of 200 patients

Se realiza un estudio de 200 historias clínicas de niños ingresados en el Servicio de Oftalmología Pediátrica del Hospital Provincial Docente "V. I Lenin", en el período de agosto de 1981 hasta agosto de 1986. Se analizan variables como edad, sexo, tiempo de evolución del trauma, cantidad de sangre en mm, tiempo de reabsorción de la misma, lesiones asociadas, complicaciones, secuelas, entre otras. Se realizan conclusiones