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1.
J Med Case Rep ; 13(1): 172, 2019 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-31164170

RESUMO

BACKGROUND: Aspergillus terreus, a saprophytic fungus, is recognized as an emerging pathogen in various infections in humans. However, bone and joint involvement is uncommon. To the best of our knowledge, only seven cases of spondylodiscitis caused by Aspergillus terreus have been reported previously in humans. We report a case of a patient with Aspergillus terreus spondylodiscitis following an abdominal stab wound. CASE PRESENTATION: A 74-year-old Japanese man with no particular medical history fell from a ladder and sustained a left abdominal stab wound from an L-shaped metal peg. Computed tomography showed the trace of the L-shaped metal peg from the left abdomen to the left rib and left kidney. The scan also showed an anterolateral bone avulsion of the left side of the T12 vertebral body, as well as fractures of the L1 left transverse process and the left 10th-12th ribs. He was hospitalized and treated with conservative therapy for 6 weeks. He was readmitted to the hospital with complaints of sudden back pain, numbness of both legs, and inability to walk 13 weeks after the fall. Magnetic resonance imaging findings were typical of spondylodiscitis. Gadolinium-enhanced T1-weighted magnetic resonance imaging indicated increased signal intensity at T11-T12 vertebral bodies and severe cord compression and epidural abscess at T11-T12 associated with infiltration of soft paravertebral tissues. On the seventh day after admission, he underwent partial laminectomy at T11 and posterior fusion at T9 to L2. The result of his blood culture was negative, but Aspergillus terreus was isolated from the material of T11-T12 intervertebral disc and vertebral bodies. His Aspergillus antigen was positive in a blood examination. Histological examination showed chronic suppurative osteomyelitis. On the 35th day after admission, he underwent anterior fusion at T11 and T12 with a rib bone graft. For 5 months, voriconazole was administered, and he wore a rigid corset. Posterior partial laminectomy at T11 and anterior fusion at T11 and T12 resulted in a good clinical course. The patient's neurological dysfunction was completely recovered, and his back pain disappeared. Two years after the operation, computed tomography was performed and showed bone fusion at T11 and T12. Magnetic resonance imaging revealed no evidence of increased signal intensity at T11-T12 vertebral bodies and severe cord compression and epidural abscess at T11-T12. CONCLUSIONS: To our knowledge, this is the first report of spondylodiscitis caused by Aspergillus terreus after an abdominal penetrating injury. The histological finding of chronic suppurative osteomyelitis and the radiological findings strongly suggested direct inoculation of Aspergillus terreus.


Assuntos
Traumatismos Abdominais/diagnóstico por imagem , Aspergilose/diagnóstico por imagem , Discite/diagnóstico por imagem , Abscesso Epidural/diagnóstico por imagem , Osteomielite/diagnóstico por imagem , Ferimentos Perfurantes/diagnóstico por imagem , Traumatismos Abdominais/complicações , Acidentes por Quedas , Idoso , Antifúngicos/uso terapêutico , Aspergilose/etiologia , Aspergilose/terapia , Discite/etiologia , Discite/terapia , Abscesso Epidural/etiologia , Abscesso Epidural/terapia , Fratura Avulsão/complicações , Fratura Avulsão/diagnóstico por imagem , Humanos , Laminectomia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/lesões , Imagem por Ressonância Magnética , Masculino , Osteomielite/etiologia , Osteomielite/terapia , Fraturas das Costelas/complicações , Fraturas das Costelas/diagnóstico por imagem , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/terapia , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/lesões , Voriconazol/uso terapêutico , Ferimentos Perfurantes/complicações
2.
World Neurosurg ; 129: 295-297, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31229754

RESUMO

BACKGROUND: Direct penetrating trauma to the spinal cord as a result of stabbing is rare. The vertebral column is strongly suited to protecting the vital neural structures underneath, especially in the midline. CASE DESCRIPTION: A 25-year-old woman experienced a direct stabbing injury to her spinal cord, through the midline structures, resulting in bilateral dorsal column injury. She remained intact with regard to motor function despite bilateral sensory and proprioception loss. CONCLUSIONS: Owing to the strength of the protective elements of the osseous structures surrounding the spinal cord, direct stabbing injuries usually result in incomplete neurologic deficits. This is generally manifested as a Brown-Sequard syndrome because of the midline ligamentous structures and spinous processes deflecting injuries laterally. Our patient experienced a direct midline puncture, resulting in a unique case of bilateral dorsal column injury. These injuries are generally treated conservatively, in the absence of a retained foreign body. Spinal cord stabbing injuries are a rare entity with interesting clinical and anatomic correlations.


Assuntos
Distúrbios Somatossensoriais/etiologia , Traumatismos da Medula Espinal/complicações , Ferimentos Perfurantes/complicações , Adulto , Vértebras Cervicais , Feminino , Humanos , Distúrbios Somatossensoriais/patologia , Traumatismos da Medula Espinal/patologia , Ferimentos Perfurantes/patologia
3.
Ann Vasc Surg ; 60: 479.e5-479.e9, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31195105

RESUMO

We report a case of an 18-year-old woman who developed a delayed pseudoaneurysm of the right anterior tibial artery (ATA), 14 days after a knife accidental trauma. The patient was admitted to our emergency department for acute onset of pain in the right limb after a domestic trauma. At a physical examination, the limb was tense and tender, with a pulsatile mass in the anterior compartment. Femoral, popliteal, and distal pulses were palpable on both limbs. Duplex ultrasound scan (DUS) and computed tomography angiography showed the presence of an ATA pseudoaneurysm. An urgent endovascular treatment was performed under local anesthesia via percutaneous access. Pseudoaneurysm was excluded implanting 2 coronary covered balloon-expandable stents (BeGraft; Bentley Innomed GmbH, Hechingen, Germany). Postoperative course was uneventful and the patient was discharged on the second postoperative day under dual antiplatelet therapy. One- and 13-month scheduled follow-up visits and DUS revealed the presence of a normal pedal pulse, complete pseudoaneurysm exclusion, and patency of the stent grafts and the entire ATA with triphasic waveforms. In conclusion, endovascular treatment of an ATA pseudoaneurysm seems to be a feasible option. Further experience with this technique is needed to validate its safety and long-term patency, especially in young and healthy subjects.


Assuntos
Falso Aneurisma/terapia , Angioplastia com Balão , Artérias da Tíbia/lesões , Lesões do Sistema Vascular/terapia , Ferimentos Perfurantes/complicações , Adolescente , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Angioplastia com Balão/instrumentação , Feminino , Humanos , Stents , Artérias da Tíbia/diagnóstico por imagem , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/etiologia , Ferimentos Perfurantes/diagnóstico
4.
BMJ Case Rep ; 12(4)2019 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-31040138

RESUMO

We present two children treated with endovascular techniques to gain proximal arterial control of the internal carotid and vertebral artery prior to removal of penetrating objects from the skull base. Both siblings (8-month-old and 22-month-old boys) were injured by different sharp objects (knife and scissor) by a guardian. They were transported to the emergency room where vascular control, including coil embolisation and internal carotid balloon occlusion, was performed in the neuroendovascular suite for safe removal of penetrating objects. Both minors recovered and were discharged home without any focal neurological deficits. In two children with scissor and knife stab with intracranial penetration, endovascular technique allowed safe removal of objects and ensured proximal arterial control was maintained to control for possible extravasation of blood on removal from the skull base.


Assuntos
Oclusão com Balão , Artéria Carótida Interna/diagnóstico por imagem , Corpos Estranhos/cirurgia , Artéria Vertebral/diagnóstico por imagem , Ferimentos Perfurantes/cirurgia , Oclusão com Balão/métodos , Artéria Carótida Interna/cirurgia , Angiografia Cerebral , Vítimas de Crime , Embolização Terapêutica , Procedimentos Endovasculares , Corpos Estranhos/diagnóstico por imagem , Humanos , Lactente , Masculino , Procedimentos Neurocirúrgicos , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares , Artéria Vertebral/cirurgia , Ferimentos Perfurantes/complicações , Ferimentos Perfurantes/diagnóstico por imagem , Ferimentos Perfurantes/fisiopatologia
5.
World Neurosurg ; 127: 237-240, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30965173

RESUMO

BACKGROUND: We describe endovascular coil embolization of the internal carotid artery before removing a retained knife blade partially occluding the lacerum segment of the internal carotid artery. CASE DESCRIPTION: A 21-year-old male presented to the emergency department with a retained transcranial knife after sustaining a stab to the left temporal scalp. He was hemodynamically stable and neurologically intact on presentation. Computed tomography angiography followed by digital subtraction angiography revealed narrowing of the lacerum segment of the left internal carotid artery by the tip of the knife blade with adequate blood flow from the contralateral internal carotid artery. Embolization and occlusion of the internal carotid artery proximal and distal to the knife tip were performed. The patient was transferred to the neurosurgical operating room for extraction of the knife. A repeat left carotid artery angiogram post knife extraction showed no displacement of the coils and no extravasation of contrast. Follow-up imaging confirmed a good outcome. CONCLUSIONS: A staged approach of digital subtraction angiography and endovascular therapy followed by surgical treatment is a safe and effective management strategy for patients presenting with a retained transcranial knife and suspected vascular injury.


Assuntos
Artéria Carótida Interna/cirurgia , Procedimentos Endovasculares , Corpos Estranhos/cirurgia , Traumatismos Cranianos Penetrantes/cirurgia , Ferimentos Perfurantes/cirurgia , Artéria Carótida Interna/diagnóstico por imagem , Corpos Estranhos/diagnóstico por imagem , Corpos Estranhos/etiologia , Traumatismos Cranianos Penetrantes/complicações , Traumatismos Cranianos Penetrantes/diagnóstico por imagem , Humanos , Masculino , Ferimentos Perfurantes/complicações , Ferimentos Perfurantes/diagnóstico por imagem , Adulto Jovem
8.
Injury ; 50(1): 156-159, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30146368

RESUMO

INTRODUCTION: Organ evisceration following abdominal stab wound (SW) is currently considered as an absolute indication for mandatory laparotomy due to the high incidence of associated intra-abdominal injuries, but literature describing the spectrum of organ injury encountered is limited. MATERIALS AND METHODS: We reviewed our experience of 301 consecutive patients who were subjected to mandatory laparotomy over an eight-year period at a major trauma centre in South Africa. RESULTS: Of the 301 patients with organ evisceration, 92% were male (mean age: 28 years). Ninety per cent (270/301) of the laparotomies were positive (85% (229/270) therapeutic, 15% (41/270) non-therapeutic). The frequencies of eviscerated organs were small bowel (70%), large bowel (26%), and stomach 3%. Three (1%) patients had combined evisceration of more than one of the above organs. The most commonly injured organs were small bowel and large bowel. The mean length of hospital stay was nine days. Seven patients required intensive care admission. The morbidity rate was 21% and mortality was 2%. CONCLUSIONS: The spectrum of injury associated with abdominal SW with organ evisceration is similar to smaller published series. Multiple organ injuries are common. The most commonly eviscerated organs were small bowel, large bowel and stomach, while the most commonly injured organs were small bowel and large bowel.


Assuntos
Traumatismos Abdominais/cirurgia , Laparotomia , Tempo de Internação/estatística & dados numéricos , Centros de Traumatologia , Vísceras/patologia , Ferimentos Perfurantes/complicações , Adulto , Feminino , Humanos , Incidência , Masculino , Estudos Retrospectivos , África do Sul/epidemiologia , Resultado do Tratamento , Vísceras/cirurgia , Ferimentos Perfurantes/cirurgia , Adulto Jovem
10.
Am J Emerg Med ; 37(2): 377.e5-377.e6, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30413368

RESUMO

Thoracostomy tube placement is one of the more common procedures performed in the Emergency Department, most commonly for treatment of pneumothorax or hemothorax but occasionally for drainage of empyema or pleural effusion. Thoracostomy may be a life-saving procedure with a wide range of complication rates reported, ranging from 19.4-37%, most commonly extrathoracic placement. Most recent meta-analyses showed a relatively stable complication rate of 19% over the past three decades with the vast majority being benign in nature. We present a case with the rare complication of thoracostomy in which of a small-caliber thoracostomy tube was placed in the left ventricle. Although thoracotomy was performed to remove the catheter, the patient remained virtually asymptomatic and had an uneventful course.


Assuntos
Tubos Torácicos/efeitos adversos , Ventrículos do Coração/lesões , Toracostomia/efeitos adversos , Toracostomia/instrumentação , Adulto , Remoção de Dispositivo , Serviço Hospitalar de Emergência , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/cirurgia , Humanos , Masculino , Pneumotórax/diagnóstico por imagem , Pneumotórax/etiologia , Pneumotórax/terapia , Radiografia , Toracotomia , Tomografia Computadorizada por Raios X , Ferimentos Perfurantes/complicações , Ferimentos Perfurantes/diagnóstico por imagem , Ferimentos Perfurantes/terapia
14.
BMJ Case Rep ; 20182018 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-30115720

RESUMO

A 27-year-old man presented to a major trauma centre with two posterolateral thoracic stab injuries over the right scapula and thoracoabdominal junction. He was tachycardic and hypotensive with a chest X-ray revealing a large right-sided tension haemothorax, requiring insertion of two intercostal chest drains. A subsequent CT scan demonstrated a grade 4 right kidney laceration with active back bleeding from a renal artery branch, through a right diaphragmatic defect, into the pleural cavity. Embolisation of the feeding renal vessel controlled the bleeding and avoided the need for a nephrectomy. The patient required subsequent video-assisted thoracoscopic evacuation of the haemothorax and diaphragmatic repair, confirming that there was no associated lung or major vessel injury. A ureteric stent was ultimately inserted to manage a persistent urinary leak. This case highlights a rare cause for a common traumatic presentation and the need for a multidisciplinary approach in effective management of complex, multiorgan trauma.


Assuntos
Hemotórax/etiologia , Rim/lesões , Artéria Renal/lesões , Ferimentos Perfurantes/complicações , Adulto , Transfusão de Sangue , Drenagem , Embolização Terapêutica , Hemotórax/diagnóstico por imagem , Hemotórax/terapia , Humanos , Lacerações/complicações , Masculino , Traumatismos Torácicos/complicações , Traumatismos Torácicos/terapia , Tomografia Computadorizada por Raios X
15.
Am J Forensic Med Pathol ; 39(4): 367-369, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30161033

RESUMO

Fatalities due to stabbings are usually caused by large blood vessels or organs injuries resulting in hemorrhagic shock. Vagal inhibition from a stab to the neck is an undeniably exceptional event, infrequently described in the literature. In our case report, we describe one such fatality.The body of a deceased 38-year-old man was found near a public garden. According to a bystander, the victim had been assaulted by 2 individuals, sustaining a stab wound to the neck with a broken glass bottle. At the autopsy, there was a large, inverted L-shaped cut wound in the left cervical region, measuring approximately 4.5 × 3 cm. The carotid artery and the jugular vein, as well as their main branches, were uninjured. The trachea and bronchi contained no exudate or blood. There was a hematoma near the trunk of the vagus nerve and its branches.The cause of death was attributed to the deep stab wound to the neck via vasovagal inhibition and parasympathetic nervous system stimulation.


Assuntos
Bloqueio Atrioventricular/etiologia , Lesões do Pescoço/complicações , Traumatismos do Nervo Vago/complicações , Ferimentos Perfurantes/complicações , Adulto , Homicídio , Humanos , Masculino , Sistema Nervoso Parassimpático/fisiopatologia , Traumatismos do Nervo Vago/fisiopatologia
16.
A A Pract ; 11(11): 312-314, 2018 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-29894346

RESUMO

We present an approach to airway management in a patient with machete injuries culminating in near-complete cricotracheal transection, in addition to a gunshot wound to the neck. Initial airway was established by direct intubation through the cricotracheal wound. Once the airway was secured, a bronchoscopy-guided orotracheal intubation was performed with simultaneous retraction of the cricotracheal airway to optimize the surgical field. This case offers insight into a rarely performed approach to airway management. Furthermore, our case report demonstrates that, in select airway injuries, performing through-the-wound intubation engenders a multitude of benefits.


Assuntos
Cartilagem Cricoide/lesões , Intubação Intratraqueal/métodos , Ferimentos por Arma de Fogo/complicações , Ferimentos Perfurantes/complicações , Adulto , Manuseio das Vias Aéreas , Broncoscopia , Humanos , Masculino , Resultado do Tratamento , Ferimentos por Arma de Fogo/cirurgia , Ferimentos Perfurantes/cirurgia
17.
J Trauma Nurs ; 25(3): 205-206, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29742636

RESUMO

This case study presents the inadvertent catheterization of a traumatic hemopneumothorax. A 22-year-old man sustained multiple stab wounds, including the left chest with a resultant hemopneumothorax. Upon arrival at a Level 1 trauma center, an ipsilateral subclavian central catheter was placed, blood was freely aspirated, and because of the patient's critical status, immediately utilized for resuscitation prior to line verification by radiography. A short time later, the catheter was felt to be malpositioned, most likely in the left intrathoracic space, and removed. The patient subsequently recovered and was discharged home 3 days later.


Assuntos
Cateterismo Venoso Central/efeitos adversos , Hemopneumotórax/terapia , Traumatismos Torácicos/terapia , Ferimentos Perfurantes/complicações , Adulto , Reanimação Cardiopulmonar/métodos , Cateterismo Venoso Central/métodos , Remoção de Dispositivo , Escala de Coma de Glasgow , Hemopneumotórax/diagnóstico por imagem , Hemopneumotórax/etiologia , Humanos , Escala de Gravidade do Ferimento , Masculino , Alta do Paciente , Radiografia Torácica/métodos , Medição de Risco , Traumatismos Torácicos/diagnóstico por imagem , Traumatismos Torácicos/etiologia , Cirurgia Torácica Vídeoassistida/métodos , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Ferimentos Perfurantes/diagnóstico por imagem , Ferimentos Perfurantes/terapia
18.
BMJ Case Rep ; 20182018 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-29764819

RESUMO

A 19-year-old man with a stab injury to the lower back presented with no focal neurology or haemodynamic instability. He complained of a headache that was improved by lying flat and underwent imaging to look for damage to local structures. He was found to have air in his intraspinal space. Initially this case was managed conservatively; however, 2 weeks after discharge, he presented with cerebrospinal fluid leak from his wound. This was managed with neurosurgical intervention and watertight closure of fascia. There were no further complications.


Assuntos
Vazamento de Líquido Cefalorraquidiano/etiologia , Dura-Máter/lesões , Ferimentos Perfurantes/complicações , Drenagem , Cefaleia/etiologia , Humanos , Região Lombossacral , Imagem por Ressonância Magnética , Masculino , Canal Vertebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Ferimentos Perfurantes/diagnóstico por imagem , Ferimentos Perfurantes/cirurgia , Adulto Jovem
20.
Forensic Sci Med Pathol ; 14(3): 406-409, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29644530

RESUMO

Pseudoaneurysms arise from a disruption of arterial wall continuity and are most commonly related to a penetrating trauma, an arterial wall inflammation or iatrogenic causes. They differ from real aneurysms due to a lack of one or more layers of the arterial wall. The frequency of peripheral artery pseudoaneurysms in the upper extremities is less than in the lower extremities and its most common cause is a gunshot or a stab wound. The risk of a rupture is higher than in true aneurysms due to a lack of wall layers, therefore requiring surgical treatment in most cases. Here we describe an unusual case of an 8-year-old girl who presented to the emergency department complaining of swelling and pain in her left distal forearm. One month before admission she experienced a penetrating trauma in the same area due to a self inflicted stab wound. After clinical and duplex ultrasonography evaluation the tumefaction proved to be a posttraumatic pseudoaneurysm of the left radial artery.


Assuntos
Falso Aneurisma/diagnóstico por imagem , Artéria Radial/diagnóstico por imagem , Artéria Radial/lesões , Ferimentos Perfurantes/complicações , Falso Aneurisma/etiologia , Criança , Feminino , Humanos , Comportamento Autodestrutivo/complicações , Ultrassonografia Doppler
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