Missed gastric injuries in blunt abdominal trauma case report with review of literature

Hollow viscus injuries of the digestive tract are an uncommon occurrence in blunt abdominal trauma. We report a 39-year-old male who was hit by a vehicle as a pedestrian and admitted to the Sultan Qaboos University Hospital, Muscat, Oman, in 2015. He underwent an exploratory laparotomy which revealed injuries to the distal stomach, liver and descending colon. Postoperatively, the patient was febrile, tachycardic and hypotensive. Abdominal examination revealed distention and tenderness. The next day, a repeat laparotomy identified a gastric injury which had not been diagnosed during the initial laparotomy. Although the defect was repaired, the patient subsequently died as a result of multiorgan failure. Missed gastric injuries are rare and are associated with a grave prognosis, particularly for trauma patients. Delays in diagnosis, in addition to associated injuries, contribute to a high mortality rate

Use of prophylactic inferior vena cava filters in trauma

Venous thromboembolisms, specifically pulmonary embolisms [PEs], represent a significant burden on healthcare systems worldwide, particularly within the setting of trauma. According to the literature, PEs are the most common cause of in-hospital death; however, this condition can be prevented with a variety of prophylactic and therapeutic measures. This article aimed to examine current evidence on the use, indications for prophylaxis, outcomes and complications of prophylactic inferior vena cava filters in trauma patients

Doppler tissue imaging: a new approach to myocardial assessment in infants of diabetic mothers and correlation to maternal diabetic controls

The study included 30 newborn infants born to diabetic mothers in the Obstetrics Department and admitted to the Neonatal Care Unit in Tanta University Hospital. Their gestational age ranged from 31-40 weeks [mean 37.7 +/- 2.13] and birth weight 2.5-5.7 kg [mean 3.61 +/- 0.7 kg]. Ten healthy newborn infants of matched gestational age and sex, born to non-diabetic mothers were included as controls. The aims of the present study were: 1] to define cardiac morphology particularly septal hypertrophy with conventional echocardiography, 2] to use Doppler Tissue Imaging [TDI] echocardiography to detect early cardiomyopathic changes in infants of diabetic mothers, 3] to correlate these data to the parameters of glycemic control of maternal diabetes and 4] to follow up cases with affected myocardium so that their prognosis is determined. Full history and thorough clinical evaluation were done. Laboratory investigations included: cord blood glucose, cord blood insulin, cord blood C-peptide and fetal glycosylated hemoglobin [Hb F1c] as well as maternal glycosylated hemoglobin [Hb A1c]. Cardiac evaluation was done using conventional M-mode, 2-D, and Doppler transmitral flow velocities as well as by TDI to assess cardiac diastolic function. Septal myocardial hypertrophy was detected in 46.66% of the studied cases. Diastolic dysfunction was found in 33.3% by conventional transmitral Doppler flow studies and in 66.6% by TDI. None of the detected myocardial abnormalities were significantly correlated to parameters of maternal diabetes control such as maternal Hb A1c, cord blood insulin, cord blood C-peptide or cord blood Hb F1c. In cases of myocardial hypertrophy or diastolic dysfunction echo-Doppler and DTI studies were repeated till disappearance of myocardial abnormalities. Macrosomia was detected in 20% of the studied cases and did not correlate significantly to maternal diabetes control parameters nor to the myocardial abnormalities. There was no sign of outflow tract obstruction or myocardial systolic dysfunction in any of our studied cases, and myocardial hypertrophy or diastolic dysfunction resolved within 6 months of follow up. We conclude that macrosomia and non-obstructive cardiomyopathy are transient phenomena that still occur in IDM irrespective to the metabolic control of maternal glycemia and it is possible that other factors contribute to such manifestations. The new technique TDI could detect more cases of myocardial diastolic dysfunction in IDM than conventional echo Doppler method and it could be used for early detection and follow up of myocardial abnormalities in IDM

effect of valproate monotherapy on hepatic and hemostatic functions in epileptic children: value of L-carnitine supplementation

The study included 15 epileptic children without previous hepatic or hemostatic defects [10 males and 5 females] aging 2 to 14 years selected from the outpatients attending the Pediatric Neurology Clinic of the Pediatric Department of Tanta University Hospital. We excluded patients receiving other medications which affect hepatic or platelet function, fifteen healthy children of matched age and sex served as controls. History, clinical examination and the following investigations were done for all of the cases: EEG, complete blood count, total serum proteins, albumin, bilirubin, ammonia, and alanine aminotransferase [ALT]. Hemostatic studies included bleeding time [BT], clotting time [CT], prothrombin time [PT], activated partial thromhopiastin time [PTT], serum fibrinogen, protein C, von Willebrand factor antigen, platelet count and platelet aggregation. All of the hepatic and hemostatic parameters were done before, and 9 weeks after commencement of antiepileptic therapy with valproate [VPA]. Serum valproate level was measured after establishment of therapy and showed a good complience to treatment. L-carnitine was measured before and after valproate therapy then oral L-carnitine was supplemented in a dose of 100 mg/kg/day for two weeks in all of the studied cases. The studied hepatic and hemostatic function parameters mentioned above were repeated again after L-carnitine supplementation. Valproate therapy was associated with a significant decrease in serum L-carnitine with impairment of hepatic functions [manifested by a significant increase in serum bilirubin, ammonia and ALT]. Following oral administration of L-carnitine there was a significant decrease in serum bilirubin and ALT, Hemostatic disturbances were also observed after valproate therapy in the studied cases [manifested by a significant increase in BT, CT, PT and PTT, with a significant decrease in serum fibrinogen, serum protein C, platelet count and platelet aggregation], VPA therapy or L-carnitine administration did not significantly affect Von Willebrand factor. Most of the studied hemostatic parameters improved significantly in response to oral L-carnitine. None of our studied cases showed life threatening or Reye-like hepatotoxicity. We conclude that within the usual therapeutic serum levels of VPA, it could be associated with L-carnitine deficiency and hepatic synthetic dysfunction as well as decreased number and function of platelets. Most of these abnormalities could be reversed by co-administration of L-carnitine. The latter might be recommended in epileptic children on VPA therapy particularly those with abnormal liver or platelet functions and those at risk for hepatotoxicity