RESUMO
Introduction: Penetrating cardiac injuries are emergencies that require prompt surgical management. Most of these injuries are caused by gunshots or stab wounds however the incidence of nail-gun injuries is rising due to their availability and widespread use. Cardiac injuries caused by nail-guns are often self-inflicted. These injuries almost always require operative management with a sternotomy or thoracotomy. Case report: This case report describes a 47-year-old male with two self-inflicted nail-gun wounds to the chest. He presented in a stable condition and subsequently underwent an emergency sternotomy to repair a penetrating cardiac injury. We highlight our diagnostic and operative approach to this injury and present a contemporary narrative review of similar cases. Conclusion: Almost all cases of penetrating trauma caused by nail-gun injuries require urgent surgery. Some cases require the use of cardiopulmonary bypass. In this case, the use of the Medtronic® urchin apical suction device, usually reserved for off pump cardiac surgery, facilitated exposure and repair of the lateral wall of the left ventricle.
RESUMO
Traumatic tricuspid valve injury is rare, accounting for 0.02% of traumatic injuries. The majority of cases result from blunt force trauma to the chest, however penetrating injuries have been documented in literature. Patients' can be in the full spectrum of disease, from asymptomatic to cardiogenic shock. Indications for surgery include right heart failure or evidence of right heart volume overload in the setting of significant tricuspid regurgitation. Early surgical repair is warranted to preserve right ventricular function. Surgery also needs to be planned in conjunction with the patients' other injuries. In some cases, it may be beneficial for surgery to be delayed whilst the patient is closely observed, in order for the patient to recover from concomitant injuries. We report two cases of tricuspid regurgitation in the context of blunt trauma, and our approach to the management of these patients.
RESUMO
AIM: To investigate the ability of White Cell Count (WCC), Neutrophil count & C-Reactive Protein (CRP) levels at admission to predict length of stay (LOS) in patients with uncomplicated diverticulitis. METHOD: This study was performed as a retrospective review of all patients admitted with CT proven uncomplicated diverticulitis over a one-year period. WCC, Neutrophils and CRP levels where recorded at admission. Uniform discharge criteria where used and length of stay measured. A correlation analysis was performed between the inflammatory markers and LOS. RESULTS: A total of 84 admissions with uncomplicated diverticulitis was included in this study. Average LOS 3.06 (range 1-7 days). On Romaadmission average CRP was 55 (1-276), WCC 11.5 (4.5-35.6) and Neutrophils 8.37 (2.3-18.9). Peak inflammatory values were also measured with mean peak CRP 93.5 (3-325), WCC 11.6 (5.1-35.6) and neutrophils 8.47 (2.3-18.9). Inflammatory markers were correlated to LOS. Multivariate analysis and Fit Plots showed no correlation between any of the inflammatory markers and LOS. Using a modified Hinchey classification 8 patients were Hinchey 0, 60 Hinchey Ia and 16 Hinchey Ib. Hinchey classification was associated with longer LOS (Hinchey 0 mean LOS 2.63 days, Hinchey Ia 2.71 days, Hinchey Ib 4.4 days). CONCLUSION: There was a high degree of variation in the inflammatory markers at admission, as well as the peak level of these inflammatory markers during the patients stay. The extent to which these markers were raised did not correlate with the patients' length of stay. As such, the use of inflammatory markers has limited prognostic value in patients with uncomplicated diverticulitis.
