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1.
BMC Surg ; 21(1): 142, 2021 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-33740945

RESUMO

BACKGROUND: We present here our experience with surgical management of traumatic diaphragmatic hernia, trying to find out the era impact of different periods on the outcome and risk factors of mortality. METHODS: A series of 63 patients with traumatic diaphragmatic hernia were referred to us and operated on during March, 1990-August, 2017. The patient records were reviewed and statistically analyzed to demonstrate injury characteristics and to find out optimal treatment strategy, risk factors of death as well as the difference between two periods (1990-2005, 2005-2017) divided by introduction of computed tomography at our institution. RESULTS: The overall mean age was 31.2 ± 16.3 years old with a female to male ratio of 11/52. The mechanism was penetrating trauma in 19 cases (30.2%), and blunt trauma in 44 cases (69.9%). Two thirds of the patients in the second group (2005-2017) yet none in the first group (1990-2005) underwent computed tomography. Ten patients (15.9%), of which 8 in the first and the other 2 in the second group (p = .042), had late diagnoses. The most commonly used incision was a thoracotomy (n = 43, 89.6%). There was no statistical difference in etiology or mortality between the two periods. Univariate analysis showed survivors were younger, and had lesser injury severity scores (ISS) and lower American Association for the Surgery of Trauma (AAST) grade than non-survivors. By multivariate logistic regression analysis, increased age (odds ratio, 1.275; p = .013) and greater ISS (OR, 1.174; p = .028) were risk factors of death in all patients. CONCLUSIONS: High-definition computed tomography has significantly improved the preoperative diagnosis rate. The transthoracic approach could be used in selected cases with traumatic diaphragmatic hernia with good outcomes. Patients with greater ISS and advanced ages are at a higher risk of death.


Assuntos
Hérnia Diafragmática Traumática , Ferimentos não Penetrantes , Ferimentos Penetrantes , Adolescente , Adulto , Feminino , Hérnia Diafragmática Traumática/mortalidade , Hérnia Diafragmática Traumática/cirurgia , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Resultado do Tratamento , Ferimentos não Penetrantes/mortalidade , Ferimentos não Penetrantes/cirurgia , Ferimentos Penetrantes/mortalidade , Ferimentos Penetrantes/cirurgia , Adulto Jovem
2.
J Spec Oper Med ; 21(1): 106-108, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33721316

RESUMO

Pneumatic nail guns are hand-held tools used in industrial and construction settings. Nail guns cause the most trauma with hospitalization among construction workers. To our knowledge, we report for the first time a case of pneumomediastinum from a nail gun injury to the hand. Our patient was a 40-year-old male construction worker who shot a nail gun into his hand. He became acutely dyspneic and was found to have a pneumomediastinum due to air insufflation. He later underwent tube thoracostomy and intubation. To our knowledge, this is the first report of pneumomediastinum from a nail gun injury to the hand.


Assuntos
Armas de Fogo , Enfisema Mediastínico , Ferimentos Penetrantes , Acidentes de Trabalho , Adulto , Materiais de Construção , Humanos , Masculino , Enfisema Mediastínico/etiologia , Ferimentos Penetrantes/etiologia , Ferimentos Penetrantes/cirurgia
3.
Medicine (Baltimore) ; 100(10): e24981, 2021 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-33725868

RESUMO

RATIONALE: Necrotizing fasciitis (NF) is a rapidly progressing bacterial soft tissue infection with a high mortality rate. It is characterized by significant soft tissue destruction with associated sepsis. The mainstay of treatment is coverage with appropriate broad-spectrum antibiotic therapy and emergent surgical debridement. PATIENT CONCERNS: A previously healthy 66-year-old female presented with a deep laceration to her right, posterior calf with subsequent contamination with lake water. After the wound was irrigated and closed, the patient developed NF. DIAGNOSIS: Laceration of the right lower extremity complicated by NF secondary to Aeromonas sobria. INTERVENTIONS: The patient underwent emergent surgical debridements with intravenous broad-spectrum antibiotics and negative pressure wound therapy. The lower extremity was reconstructed with split-thickness skin grafts. OUTCOMES: The patient's initial penetrating trauma was closed in the emergency room, and the patient was discharged home with antibiotics. She returned the next day with unstable vitals and was admitted to the intensive care unit. Her condition continued to deteriorate, and she underwent serial surgical debridements. Her condition improved and was discharged home after 13 days in the hospital. LESSONS LEARNED: Close monitoring for NF is important for tissue infections sustained in aquatic environments. Timely identification and surgical management of NF increases overall survival.


Assuntos
Aeromonas/isolamento & purificação , Antibacterianos/administração & dosagem , Desbridamento , Fasciite Necrosante/microbiologia , Infecções por Bactérias Gram-Negativas/microbiologia , Ferimentos Penetrantes/complicações , Idoso , Fasciite Necrosante/diagnóstico , Fasciite Necrosante/terapia , Feminino , Infecções por Bactérias Gram-Negativas/diagnóstico , Infecções por Bactérias Gram-Negativas/terapia , Humanos , Lagos/microbiologia , Perna (Membro) , Transplante de Pele , Resultado do Tratamento , Ferimentos Penetrantes/microbiologia , Ferimentos Penetrantes/cirurgia
4.
Am Surg ; 87(2): 183-187, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33522267

RESUMO

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.


Assuntos
Esôfago/lesões , Esôfago/cirurgia , História do Século XX , Humanos , Kentucky , Ferimentos não Penetrantes/diagnóstico , Ferimentos não Penetrantes/história , Ferimentos não Penetrantes/cirurgia , Ferimentos Penetrantes/diagnóstico , Ferimentos Penetrantes/história , Ferimentos Penetrantes/cirurgia
5.
J Surg Res ; 257: 101-106, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32818778

RESUMO

BACKGROUND: Penetrating traumatic brain injury (pTBI) is the most lethal form of TBI, with mortality rates as high as 90%. This high mortality rate leads many providers to feel that the treatment of pTBI is futile. Contrary to this point of view, several studies have shown that victims of pTBI who present with a Glasgow Coma Scale (GCS) ≥6 have a reasonable chance of a meaningful outcome. This study sought to investigate outcomes of pTBI patients based on GCS score who underwent neurosurgical intervention (craniotomy or craniectomy) and compare them with patients who did not undergo surgical intervention. MATERIALS AND METHODS: The study represents a secondary analysis of the data that were collected from 2006 to 2016 from 17 institutions as part of a multi-center study, investigating clinical outcomes for adult patients sustaining pTBI and surviving >72 h. Patients were divided into those with GCS 3-5 and those with GCS ≥6. Within these groups, patients were stratified by whether they received surgical intervention, compared with standard non-surgical care. Patient level data (age and gender), clinical data (Injury Severity Score and Abbreviated Injury Score), GCS on admission, post-op infection rates, and outcomes data (mortality, length of stay [LOS], intensive care unit LOS) were collected. Both groups were compared using independent sample t-test or chi-squared test. RESULTS: Seven hundred twenty patients with pTBI were identified over 11 y, out of which 336 (46.7%) underwent surgery. The mean Injury Severity Score and Abbreviated Injury Score on admission were higher in the surgical intervention group than their non-surgical counterpart in patients with a GCS ≥6 (P < 0.0001). Patients with GCS of 3-5 with surgical intervention demonstrated a higher survival rate than non-surgical patients (P < 0.0001). In the GCS ≥6 group, surgical intervention did not impact near-term mortality. Intensive care unit LOS was significantly longer in the surgical intervention group in patients with GCS ≥ 6 (P < 0.0001) and GCS of 3-5 (P < 0.0001), as was total hospital LOS (P < 0.0001). Patients with a GCS 3-5 and ≥6 who underwent surgical intervention were more likely to develop a central nervous system infection (P = 0.016; P = 0.017). CONCLUSIONS: Surgical intervention in pTBI patients with GCS 3-5 results in improved mortality but comes at a cost of increased resource utilization in the form of longer LOS and higher infection rate. On the other hand, in patients with GCS ≥6, surgery does not provide significant benefits in patient survival. Future prospective studies providing insight as to the impact of surgery on the resource utilization and quality of survival would be beneficial in determining the need for surgical intervention in this population.


Assuntos
Lesões Encefálicas Traumáticas/cirurgia , Lesões Encefálicas Traumáticas/terapia , Ferimentos Penetrantes/cirurgia , Ferimentos Penetrantes/terapia , Adulto , Lesões Encefálicas Traumáticas/mortalidade , Craniotomia , Feminino , Escala de Coma de Glasgow , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento , Adulto Jovem
6.
J Surg Res ; 257: 69-78, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32818786

RESUMO

BACKGROUND: Despite improvements in operative techniques, major abdominal complications (MACs) continue to occur after penetrating abdominal trauma (PAT). This study aimed to evaluate the burden of MAC after PAT. METHODS: The (2012-2015) National Readmission Database was queried for all adult (age ≥18 y) trauma patients with penetrating injuries who underwent exploratory laparotomy and were readmitted within 6 mo of index hospitalization discharge. Patients were stratified by firearm injuries (FIs) and stab injuries (SIs). Primary outcomes were rates of MAC: intra-abdominal abscesses (IAAs), superficial surgical site infection (SSI), and fascial dehiscence within 6 mo after discharge. Secondary outcomes were both nonabdominal complications and mortality, postdischarge, and 6-mo readmission. Regression analysis was performed. RESULTS: A total of 4473 patients (FI, 2326; SI, 2147) were included in the study; the mean age was 32 ± 14 y, the Injury Severity Score was 19 (15-25), and 23% underwent damage control laparotomy (DCL). The rate of MAC within 6 mo was 22% (IAA 19%, SSI 7%, and fascial dehiscence 4%). Patients with FIs had a higher rate of IAA (27% versus 10%; P < 0.01), SSI (11% versus 3%; P < 0.01), fascial dehiscence (5% versus 3%; P = 0.03), nonabdominal complications (54% versus 24%; P < 0.01), and postdischarge mortality (8% versus 6%; P < 0.01) compared with patients with SIs . On regression analysis, DCL (P < 0.01), large bowel perforation (P < 0.01), biliary-pancreatic injury (P < 0.01), hepatic injury (P < 0.01), and blood transfusion (P = 0.02) were predictors of MAC. CONCLUSIONS: MAC developed in one in five patients after PAT. FIs have a higher potential for hollow viscus injury and peritoneal contamination, and are more predictive of MAC and nonabdominal complications, especially after DCL. LEVEL OF EVIDENCE: Level III Prognostic.


Assuntos
Abdome/cirurgia , Traumatismos Abdominais/cirurgia , Laparotomia , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Ferimentos Penetrantes/cirurgia , Abscesso Abdominal/epidemiologia , Traumatismos Abdominais/complicações , Traumatismos Abdominais/mortalidade , Adolescente , Adulto , Feminino , Humanos , Escala de Gravidade do Ferimento , Laparotomia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Deiscência da Ferida Operatória/epidemiologia , Infecção da Ferida Cirúrgica/epidemiologia , Ferimentos por Arma de Fogo/complicações , Ferimentos por Arma de Fogo/cirurgia , Ferimentos Penetrantes/complicações , Ferimentos Penetrantes/mortalidade , Ferimentos Perfurantes/complicações , Ferimentos Perfurantes/cirurgia , Adulto Jovem
7.
Am J Surg ; 221(1): 21-24, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32546370

RESUMO

BACKGROUND: Penetrating injury independently predicts the need for surgeon presence (NSP) upon arrival. Penetrating injury is often used as a trauma triage indicator, however, it includes a wide range of specific mechanisms of injury. We sought to compare firearm-related and non-firearm related pediatric penetrating injuries with respect to NSP, ISS and mortality. METHODS: Patients <18 from the 2016 National Trauma Quality Improvement Program Database were included. Penetrating injury was identified and grouped using ICD-10 mechanism codes into firearm and non-firearm related injury. NSP, ISS, and mortality were compared between the two groups. RESULTS: A total of 1715 (4.2%) patients with penetrating injury were; 832 firearm-related and 883 non-firearm. No deaths occurred among the non-firearm group compared to 94 (11.3%) among firearm-related patients. Among non-firearm patients, 22.7% had a NSP indicator compared to 51.2% of patients injured by a firearm. CONCLUSION: There is a significantly higher proportion of severe injury and mortality with firearm penetrating injury when compared to non-firearm pediatric penetrating injury. Consideration should be given to dividing it into firearm and non-firearm penetrating injury.


Assuntos
Ferimentos por Arma de Fogo/classificação , Ferimentos por Arma de Fogo/cirurgia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Classificação Internacional de Doenças , Masculino , Estudos Retrospectivos , Ferimentos Penetrantes/classificação , Ferimentos Penetrantes/cirurgia
9.
Niger J Clin Pract ; 23(9): 1221-1228, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32913160

RESUMO

Background: : Vascular injuries are commonly seen in both emergency services and forensic medicine practise. They are often life-threatening, with high morbidity and mortality rates. Aims: This study aimed to retrospectively evaluate extremity vascular injuries and the associated treatment approaches. Methods: After obtaining approval from the ethics committee of the university, those patients admitted to the emergency department of Adiyaman between 1 February 2013 and 31 August 2018 were included in this study. The patients' data were obtained through the electronic records system, and the cases were evaluated according to the age, gender and cause of injury, including blunt force trauma injuries (accidents, traffic accidents, crush injuries and occupational accidents) and penetrating injuries (stabbing, gunshot wounds, suicide attempts and assaults). Additionally, the injuries were evaluated based on the extremity, according to the anatomical location and whether the injury was life-threatening. Results: This study included 76 patients with extremity vascular injuries; 65 were males (85.52%), 11 were females (14.48%) and their average age was 33.24 ± 15.85 years. Forty-five (59.2%) of the patients had upper extremity vascular injuries, and 31 (40.3%) had lower extremity vascular injuries. In addition to arterial injuries, 26 (34.21%) of the patients had venous injuries and 22 (28.94%) had nerve injuries. Nine of these patients had neurological deficits due to their nerve injuries. All of the patients were revascularized within 3-5 hours, and none of the patients required amputations. Conclusion: The primary goals in extremity vessel injury cases are to prevent mortality, especially after major vascular injuries, and save the extremity from amputation. With a fast, effective and multi-disciplinary approach, an accurate diagnosis and effective surgical intervention can prevent morbidity and mortality as well as reduce the rate of undesirable complications.


Assuntos
Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/lesões , Procedimentos Cirúrgicos Vasculares/métodos , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/cirurgia , Ferimentos Penetrantes/diagnóstico por imagem , Acidentes de Trânsito , Adolescente , Adulto , Artérias/diagnóstico por imagem , Artérias/lesões , Angiografia por Tomografia Computadorizada , Extremidades , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Ferimentos por Arma de Fogo/complicações , Ferimentos por Arma de Fogo/epidemiologia , Ferimentos por Arma de Fogo/cirurgia , Ferimentos não Penetrantes/complicações , Ferimentos não Penetrantes/epidemiologia , Ferimentos Penetrantes/epidemiologia , Ferimentos Penetrantes/cirurgia , Adulto Jovem
10.
Chirurgia (Bucur) ; 115(4): 530-536, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32876028

RESUMO

The enlarged number of powerful vehicles in our country led to an increased speed of travel and hence the high number of traffic accidents with severe consequences, even death. Along with polytrauma caused by occupational accidents, these types of traumas require complex and often multidisciplinary surgical therapy against the clock, which places the surgeon in front of situations that are not found in the everyday practice. Injuries involving damage to the thoracic-phreno-abdominal region fall into this specific category that we have chosen to discuss in the present work. We will further present three clinical cases of patients with thoraco-phreno-abdominal injuries produced by different mechanisms. A work-accident wound produced by an angle grinder, causing left thoracoabdominal injuries; a polytrauma caused by a road accident, with a thoraco-phreno abdominal wound produced by a piece of wood that penetrated obliquely through the right thorax, in the 5th and 6th intercostal spaces, crossed the right lower lung lobe, the diaphragm, the 7th liver segment, and stopped in the right posterior costal grid, and a polytrauma following a fall from a height, with a torn diaphragm and mesentery.


Assuntos
Traumatismos Abdominais/cirurgia , Traumatismo Múltiplo/cirurgia , Traumatismos Torácicos/cirurgia , Ferimentos Penetrantes/cirurgia , Traumatismos Abdominais/complicações , Acidentes por Quedas , Acidentes de Trânsito , Humanos , Traumatismo Múltiplo/complicações , Traumatismos Ocupacionais/complicações , Traumatismos Ocupacionais/cirurgia , Traumatismos Torácicos/complicações , Resultado do Tratamento , Ferimentos Penetrantes/complicações
11.
Vasc Endovascular Surg ; 54(8): 692-696, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32787694

RESUMO

OBJECTIVES: Penetrating abdominal aortic injury (PAAI) is a highly acute injury requiring prompt surgical management. When compared to surgeons at level-II trauma centers, surgeons at level-I trauma centers are more likely to take in-house call, and may more often be available within 15 minutes of patient arrival. Thus, we hypothesized that level-I trauma centers would have a lower mortality rate than level-II trauma centers in patients with PAAI. METHODS: We queried the Trauma Quality Improvement Program database for patients with PAAI, and compared patients treated at American College of Surgeons (ACS)-verified level-I centers to those treated at ACS level-II centers. RESULTS: PAAI was identified in 292 patients treated at level-I centers and 86 patients treated at level-II centers. Patients treated at the 2 center types had similar median age, injury severity scores and prevalence of diabetes, hypertension, and smoking (p > 0.05). There was no difference in the frequency of additional intra-abdominal vascular injuries (p > 0.05). Median time to hemorrhage control (level-I: 40.8 vs level-II: 49.2 minutes, p = 0.21) was similar between hospitals at the 2 trauma center levels. We found no difference in the total hospital length of stay or post-operative complications (p > 0.05). When controlling for covariates, we found no difference in the risk of mortality between ACS verified level-I and level-II trauma centers (OR:1.01, CI:0.28-2.64, p = 0.99). CONCLUSION: Though the majority of PAAIs are treated at level-I trauma centers, we found no difference in the time to hemorrhage control, or the risk of mortality in those treated at level-I centers when compared to those treated at level-II trauma centers. This finding reinforces the ACS-verification process, which strives to achieve similar outcomes between level-I and level-II centers.


Assuntos
Traumatismos Abdominais/cirurgia , Aorta Abdominal/cirurgia , Certificação/normas , Técnicas Hemostáticas/normas , Centros de Traumatologia/normas , Procedimentos Cirúrgicos Vasculares/normas , Lesões do Sistema Vascular/cirurgia , Ferimentos Penetrantes/cirurgia , Traumatismos Abdominais/diagnóstico por imagem , Traumatismos Abdominais/mortalidade , Adolescente , Adulto , Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/lesões , Bases de Dados Factuais , Feminino , Técnicas Hemostáticas/efeitos adversos , Técnicas Hemostáticas/mortalidade , Mortalidade Hospitalar , Humanos , Tempo de Internação , Masculino , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/terapia , Indicadores de Qualidade em Assistência à Saúde/normas , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Procedimentos Cirúrgicos Vasculares/mortalidade , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/mortalidade , Ferimentos Penetrantes/diagnóstico por imagem , Ferimentos Penetrantes/mortalidade , Adulto Jovem
12.
Rev. chil. obstet. ginecol. (En línea) ; 85(4): 371-375, ago. 2020. graf
Artigo em Espanhol | LILACS | ID: biblio-1138634

RESUMO

RESUMEN Las lesiones del tracto genital femenino tras relaciones sexuales son un problema frecuente en las urgencias de ginecología, pero poco estudiado salvo su aspecto médico-legal. Su incidencia es desconocida ya que muchas mujeres no llegan a consultar por miedo o pudor. El reconocimiento precoz de estas lesiones y su correcto tratamiento puede evitar la parición de secuelas que acompañarán a nuestra paciente durante el resto de su vida. Presentamos el caso de una paciente de 18 años con un desgarro perineal con mucosa vaginal íntegra tras su primera relación sexual.


ABSTRACT Injuries to the female genital tract after sexual intercourse are a frequent problem in gynecological emergencies, but little studied except for their medico-legal aspect. Its incidence is unknown since many women do not go to their specialist out of fear or embarrassment. Early recognition of these injuries and their correct treatment may prevent the appearance of sequelae that will accompany our patient for the rest of her life. We present the case of an 18-year-old patient with a perineal tear with intact vaginal mucosa after her first sexual intercourse.


Assuntos
Humanos , Feminino , Adolescente , Vagina/lesões , Ferimentos Penetrantes/etiologia , Coito , Vagina/cirurgia , Doenças Vaginais/cirurgia , Doenças Vaginais/etiologia , Ferimentos Penetrantes/cirurgia , Ferimentos Penetrantes/diagnóstico , Fatores de Risco , Lacerações , Membrana Mucosa/cirurgia , Membrana Mucosa/lesões
13.
Am Surg ; 86(5): 493-498, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32684037

RESUMO

BACKGROUND: Isolated diaphragm injury (IDI) occurs in up to 30% of penetrating left thoracoabdominal injuries. Laparoscopic abdominal procedures have demonstrated improved outcome including decreased postoperative pain and length of stay (LOS) compared to open surgery. However, there is a paucity of data on this topic for penetrating IDI. The aim of this study was to examine the prevalence and outcome of laparoscopic diaphragmatic repair versus open diaphragmatic repair (LDR vs ODR) of IDI. METHODS: The Trauma Quality Improvement Program (2010-2016) was queried for patients with IDI who underwent ODR versus LDR. A bivariate analysis using Pearson chi-square and Mann-Whitney test was performed to determine LOS among the two groups. RESULTS: From 2039 diaphragm injuries, 368 patients had IDI; 281 patients (76.4%) underwent ODR and 87 (23.6%) underwent LDR. Compared to LDR, the ODR patients were older (median, 31 vs 25 years, P < .001) and had a higher injury severity score (mean, 11.2 vs 9.6, P = .03) but had similar rates of intensive care unit LOS, unplanned return to the operating room, ventilator days, and complications (P > .05). Patients undergoing ODR had a longer LOS (5 vs 4 days, P = .01), compared to LDR. There were no deaths in either group. CONCLUSIONS: Trauma patients presenting with IDI undergoing ODR had a longer hospital LOS compared to patients undergoing LDR with no difference in complications or mortality. Therefore, we recommend when possible an LDR should be employed to decrease hospital LOS. Further research is needed to examine other benefits of laparoscopy such as postoperative pain, incisional hernia, and wound-related complications.


Assuntos
Diafragma/lesões , Diafragma/cirurgia , Laparoscopia , Tempo de Internação/estatística & dados numéricos , Ferimentos Penetrantes/cirurgia , Adulto , Feminino , Humanos , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
15.
No Shinkei Geka ; 48(7): 607-613, 2020 Jul.
Artigo em Japonês | MEDLINE | ID: mdl-32694230

RESUMO

Herein, we report a rare case of penetrating transorbital cavernous sinus injury caused by a bamboo stick, treated by craniotomy in a hybrid operating room. A 63-year-old gardener presented at our hospital with right upper orbital injury after falling on a bamboo basket. Neurological examination revealed right II, III, IV, and VI cranial nerve palsies. CT and MRI revealed a right transorbital penetrating injury by a small sharp wooden foreign body, extending from the orbit to the cavernous sinus via the superior orbital fissure. Preoperative digital subtraction angiography revealed partial occlusion of the right cavernous sinus by the foreign body and no internal carotid artery(ICA)injury. There was a nine-day waiting period after the injury because the patient was on dual antiplatelet therapy for ischemic heart disease. Subsequently, the bamboo stick was completely removed through the right fronto-temporo-orbito-zygomatic approach in a hybrid operating room. To treat the potential massive hemorrhage, a five-French balloon catheter was inserted in the right ICA at its origin via the right transfemoral approach before the craniotomy. The bamboo stick was completely removed with minor hemorrhage in the cavernous sinus; this was controlled using hemostatic materials. The postoperative course was uneventful. The patient was discharged with blindness and total ophthalmoplegia in the right eye but he was able to return to his prior job. This is the first report of such a treatment of a transorbital penetrating injury in a hybrid operating room.


Assuntos
Seio Cavernoso/cirurgia , Ferimentos Penetrantes/cirurgia , Craniotomia , Humanos , Masculino , Pessoa de Meia-Idade , Salas Cirúrgicas , Órbita/cirurgia
16.
BMC Surg ; 20(1): 134, 2020 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-32539857

RESUMO

BACKGROUND: Penetrating thoracic injuries are uncommon in childhood. Massive penetrating injury due to impalement is even more rare and has scarcely been reported. It has a dramatic clinical presentation and is often fatal, depending on the organs injured. CASE PRESENTATION: Two boys presented with an unusual mechanism of injury. They fell from a height to be impaled by a large stick. Appropriate emergency medical service was not available and surgery was delayed by more than 24 h after the accident. Both children were labelled "lucky" as they survived the injury without any significant sequelae. CONCLUSION: We discuss two new cases of pediatric thoracic impalement and perform the first literature review on the subject. Emphasis should be given to the initial care which comprises avoiding premature removal, rapid transport, resuscitation, anti-tetanus and antibiotics. All reported cases had a favorable outcome, even those managed within the constraints of low-income countries.


Assuntos
Traumatismos Torácicos/cirurgia , Ferimentos Penetrantes/cirurgia , Criança , Humanos , Masculino , Ressuscitação , Sobreviventes
17.
World Neurosurg ; 141: 402-405, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32561491

RESUMO

BACKGROUND: Nonmissile penetrating injuries to the craniocervical junction caused by a glass fragment are rare, and a standard management strategy has not been established. CASE DESCRIPTION: A 75-year-old Japanese man was brought into our emergency department after receiving a left retroauricular stab wound by broken glass fragments. After spinal immobilization, a computed tomography (CT) scan revealed glass fragments penetrating at the right craniocervical junction to the interatlantooccipital subarachnoid space. CT angiography showed that both vertebral arteries were not injured. Magnetic resonance imaging demonstrated that the glass fragments did not penetrate the cervical cord or medulla oblongata. These glass fragments were removed via a midline incision from the external occipital protuberance to the C7 and with laminectomy without suboccipital craniectomy. Five of the glass fragments were found and removed in total. The dural defect was patched with a free fascia autograft. His postoperative course was uneventful. Postoperative CT angiography showed that both vertebral arteries were intact and the glass fragments had been removed completely. CONCLUSIONS: CT graphical diagnosis is useful for the management of penetrating craniocervical junction trauma, and it should be considered in the evaluation of patients who have suffered craniocervical penetrating injury even in the absence of major wounds or bleeding. Spinal immobilization of patients with craniocervical penetrating injuries is crucial to avoid not only secondary neurologic damage but also secondary critical vascular damage. Incomplete or inadequate assessment of craniocervical stab wounds results in unexpected hazards that are preventable.


Assuntos
Articulação Atlantoccipital/lesões , Infecções por Coronavirus , Vidro , Pandemias , Pneumonia Viral , Espaço Subaracnóideo/lesões , Traumatismos do Sistema Nervoso/complicações , Traumatismos do Sistema Nervoso/cirurgia , Idoso , Articulação Atlantoccipital/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Espaço Subaracnóideo/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Traumatismos do Sistema Nervoso/diagnóstico por imagem , Ferimentos Penetrantes/complicações , Ferimentos Penetrantes/cirurgia , Ferimentos Perfurantes/terapia
19.
Ann Vasc Surg ; 69: 146-157, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32502675

RESUMO

BACKGROUND: Brachial artery injuries are rare. The objectives of the study are to report our experience and identify predictors of outcome. The hypothesis of the study is that maintaining ischemic times less than six hours results in improved outcomes. METHODS: This is a retrospective 118-month study. The outcome measure is total operative time from admission to restoration of blood flow, and outcomes are survival and limb salvage. Statistical analyses used in the study are univariate and multivariate stepwise logistic regression. RESULTS: There were 124 patients with 131 brachial artery injuries. Mechanism of injury (MOI) included the following: penetrating: 108 (87%) and blunt: 16 (13%). Operative management included the following: 77 (62%) reverse saphenous vein interposition grafts, 37 (29.8%) end-to-end anastomosis, and 4 (3.2%) ligation. Fasciotomies were performed in 23 (19.2%) patients. Outcomes of the study were as follows: 120 patients survived and the overall survival rate was 96.8%, adjusted survival rate excluding intraoperative deaths was 100%, overall limb salvage/amputation rate was 95.1%/4.9%, and adjusted limb salvage/amputation rates excluding intraoperative deaths were 98.3%/1.67%. Univariate analysis showed the mean ischemic times for survivors as 5 ± 3.1 hrs (300 ± 186 min) versus ischemic times for non survivors as 3 ± 2.2 hrs (180 ± 132 min) (P = 0.017); Injury Severity Score (ISS) (P = 0.002); and estimated blood loss (EBL) (P = 0.024). Logistic regression identified independent predictors of outcome for survival: MOI: penetrating [P = 0.015, RR - 4.29, 95% CI: 1.49-12.36]; Glasgow Coma Score < 7 [P < 0.001, RR - 21.71, 95% CI: 9.37-50.32]; ISS > 15 [P < 0.005, RR - 4.98, 95% CI: 1.68-14.73]; and patients not requiring ED thoracotomy [P = 0.009, RR - 7.48, 95% CI: 2.58-21.69]. CONCLUSIONS: Brachial artery injuries are rare. For patients not requiring ED thoracotomy, Glasgow Coma Score, ISS, and EBL predicted survival. The adjusted limb salvage rate was 98.3%. Patients with brachial artery injuries die from associated injuries, experiencing less ischemic times than survivors who are able to undergo repairs.


Assuntos
Artéria Braquial/cirurgia , Veia Safena/transplante , Lesões do Sistema Vascular/cirurgia , Ferimentos não Penetrantes/cirurgia , Ferimentos Penetrantes/cirurgia , Adolescente , Adulto , Amputação , Anastomose Cirúrgica , Artéria Braquial/diagnóstico por imagem , Artéria Braquial/lesões , Feminino , Humanos , Ligadura , Salvamento de Membro , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos Penetrantes/diagnóstico por imagem , Adulto Jovem
20.
Ulus Travma Acil Cerrahi Derg ; 26(3): 469-474, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32436965

RESUMO

BACKGROUND: Diaphragmatic injuries, which can be seen after penetrating thoracic traumas, have some difficulties in diagnosis. Undiagnosed small diaphragmatic lacerations may lead to serious health problems. This study aims to evaluate the role of VATS (Video Assisted Thoracoscopic Surgery) in the diagnosis and treatment of diaphragmatic injuries after penetrating thoracic traumas. METHODS: Among 268 penetrating thoracic trauma patients, we retrospectively evaluated a total of 22 patients performed VATS due to suspected diaphragmatic injury in our department between June 2008 and June 2018. RESULTS: Twenty (91%) patients were male, and two (9%) patients were female with a mean age of 28.01±6.4 (18-42) years. In 11 (50%) patients, VATS was performed on the right side and the others on the left side according to the penetrating area of trauma. In 10 (45%) patients, diaphragmatic laceration was detected and was repaired. In six cases (27%) in which diaphragmatic laceration detected with VATS, preoperative traumatic pathologies were detected radiologically. The missed injury rate was 18%. VATS had a specificity, sensitivity, positive predictive value and negative predictive value of 75%, 71.5%, 60% and 83.3%, respectively. There was no significant statistical difference between types of penetrating trauma, ages and gender of cases (p>0.05). No complication was detected during the mean follow up period of 36.2±9.3 (range 9-62) months. CONCLUSION: Our opinion is that VATS is important and feasible in hemodynamically stable patients with suspected isolated diaphragmatic laceration after penetrating thoracic trauma that cannot be determined by radiologically.


Assuntos
Traumatismos Abdominais , Diafragma , Traumatismos Torácicos , Cirurgia Torácica Vídeoassistida , Ferimentos Penetrantes , Traumatismos Abdominais/diagnóstico , Traumatismos Abdominais/cirurgia , Adolescente , Adulto , Diafragma/diagnóstico por imagem , Diafragma/lesões , Diafragma/cirurgia , Feminino , Humanos , Masculino , Traumatismos Torácicos/diagnóstico , Traumatismos Torácicos/cirurgia , Ferimentos Penetrantes/diagnóstico , Ferimentos Penetrantes/cirurgia , Adulto Jovem
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