NO ZONE APPROACH FOR MANAGEMENT OF PENETRATING NECK INJURIES-A CASE SERIES

Purpose: The assessment and management of penetrating trauma to the neck has traditionally centered on the anatomical zone based classication over the previous four decades has evolved considerably towards "NO ZONE APPROACH" a more selective option. The purpose of this study was to assess the effectiveness of the “NO ZONE APPROACH” in penetrating neck injuries. Case series of 6 patients with penetrating neck Materials And Methods: injuries admitted in department of general surgery in government Kilpauk medical college and government Royapettah hospital, Chennai. All 6 cases have been analyzed for this descriptive study during a period of 1 year. No specic exclusion criteria applied. All 6 patients survived. 1 patient had nerve injury and external carotid artery injury. 2 patients had Results: tracheal injuries for which tracheostomy was done. 1 patient had avulsed a part of thyroid gland. 1 patient developed cerebrovascular accident post operatively.3 patients had primary repair& neck exploration avoided in those 3 patients by application of NO ZONE APPROACH. Penetrating neck injuries are complex injuries with no single denitive Conclusion: approach. Surgical intervention is mandatory for unstable patients but rapid swift clinical and logical reasoning helps in determining the outcome of the patient. The 'no zone approach' to penetrating neck trauma is a selective approach with superior patient outcomes in comparison with traditional method of zones of neck injuries in which zone 2 and zone 3 warrants denitive exploration. No zone approach mandates thorough clinical examination. Penetrating neck injuries classied as having hard signs based on the no zone approach may be correlated with internal organ injuries of the neck.

Lesiones mortales por armas traumáticas: reporte de caso / Fatal injuries due to traumatic weapons: Case report

Introducción. Las armas de energía cinética son diseñadas para generar lesiones dolorosas y superficiales. Sin embargo, las lesiones asociadas causan confusión al ser abordadas como heridas por proyectil de arma de fuego, convirtiendo el enfoque y el manejo correcto en un desafío. El caso presentado describe un paciente herido en el cuello por arma traumática con el objetivo de analizar factores que permitan identificar este tipo de heridas y sus implicaciones en el manejo. Caso clínico. Paciente masculino de 31 años que ingresó con intubación orotraqueal, remitido de una institución de nivel 2, con herida por aparente proyectil de arma de fuego con trayectoria transcervical. Se encontró hemodinámicamente estable, pero con dificultad para la valoración clínica, por lo que se realizaron exámenes complementarios que descartaron lesión aerodigestiva. La tomografía de cuello reportó proyectil alojado en musculatura paravertebral izquierda, descartando trayectoria transcervical. Discusión. El comportamiento de las lesiones asociadas a los proyectiles de armas depende de varios factores, como el tipo de material del proyectil, su velocidad y las propiedades del tejido impactado. Se presentó un caso en que inicialmente se sospechaba una lesión transcervical, pero con la evaluación se identificó el proyectil cinético en la musculatura paravertebral. Conclusión. En el abordaje de un paciente con sospecha de herida por proyectil de arma de fuego se debe considerar ante todo la respuesta clínica y la correlación del supuesto vector del proyectil con las lesiones sospechadas. La evaluación imagenológica permite identificar oportunamente los proyectiles y evitar procedimientos o terapias innecesarias que forman parte del manejo convencional del paciente con trauma penetrante

Introduction. Kinetic energy weapons are designed to produce superficial and painful injuries. Nevertheless, the approach of these patients in the emergency department can be confusing as they can be managed as gunshot wounds. This case describes a patient with an injury in the neck caused by kinetic energy gun. In addition, we analyzed factors that might identify these wounds and their implications in the management. Clinical case. A 31-year-old male patient who presented to the emergency department referred from a second level hospital with gunshot wound with suspected trans-cervical trajectory. They performed orotracheal intubation and transferred to our institution. Due to the patient ́s hemodynamic stability and impossibility for clinical evaluation, test and radiology tests were performed. These ruled out any aero-digestive injuries. The CT-scan reported a bullet hosted in the left paravertebral muscles, ruling out a trans-cervical trajectory. Discussion. Several factors contribute to the injuries produced by kinetic energy weapons. The injury patterns may vary according to the bullet material, muzzle velocity and impacted tissue characteristics. In this case, an initial trans-cervical injury was suspected and due to clinical evaluation we identified the bullet hosted in the paravertebral muscles. Conclusion. In the approach of a patient with suspicion of gunshot wound, as surgical team we must consider clinical manifestations and the correlation of the vector with suspected injuries. Evaluation of diagnostic imaging allows the identification of traumatic bullets, avoiding unnecessary procedures in the conventional management of patients with penetrating trauma

Effect of strength training on neck injuries prevention in martial arts athletes / Efeito do treinamento de força sobre a prevenção de lesões no pescoço em atletas de artes marciais / Efecto del entrenamiento de fuerza en la prevención de lesiones en el cuello en atletas de artes marciales

ABSTRACT Introduction: As competitive martial arts develop rapidly, technical difficulty and training intensity continues increasing, neck injuries in athletes have also increased proportionally, attracting the attention of researchers. Localized strength training is used for rehabilitation, but there is no research related to prevention in athletes. Objective: Explore the neck strength training effect on neck injury prevention in martial arts athletes. Methods: 68 (34 male) volunteers attended the experiment randomly divided into control and experimental groups. Traditional training activities were practiced in the control group, while a strength training protocol was added in the experimental group. Indices of change in pain, motor quality, and neck disability index were compared. Results: After the test, the number of neck injuries in the control group was 23, compared to five in the experimental group; there is a significant difference. There was a significant reduction of injuries in the experimental group (P=0.05); one year later, the VAS score of the experimental group remained significantly lower than the same pre-experiment or control group. The neck dysfunction score of the experimental group was still significantly lower than the pre-experimental and control group; there was no statistically significant difference between the control group and the experimental group before the experiment. Conclusion: The adequate periodic neck strength training formulation has a significant preventive effect on neck injuries in martial arts athletes. Evidence Level II; Therapeutic Studies - Investigating the result.

RESUMO Introdução: Com o rápido desenvolvimento das artes marciais competitivas, a dificuldade técnica e a intensidade do treinamento continuam a aumentar, as lesões no pescoço dos atletas também têm aumentado proporcionalmente, atraindo a atenção dos pesquisadores. Treinamentos de força localizados são utilizados para reabilitação, porém não há pesquisas relacionadas à prevenção nos esportistas. Objetivo: Explorar o efeito do treinamento de força no pescoço na prevenção de lesões no pescoço de atletas de artes marciais. Métodos: 68 (34 homens) voluntários, divididos aleatoriamente em grupo controle e experimental, participaram do experimento. Enquanto o grupo controle praticava as atividades tradicionais de treinamento, no grupo controle foi adicionado um protocolo de treinamento de força. Foram comparados os índices de variação na dor e na qualidade motora. O índice de incapacidade do pescoço também foi comparado. Resultados: Após o teste, o número de lesões no pescoço no grupo controle foi de 23, comparado com os cinco do grupo experimental; há uma diferença significativa. Houve redução significativa das lesões no grupo experimental(P=0,05); um ano depois, o escore VAS do grupo experimental continuou significativamente menor que o mesmo grupo pré-experimento ou controle. O escore do de disfunção do pescoço do grupo experimental ainda foi significativamente menor que o grupo pré-experimental e controle; não houve diferença estatisticamente significativa entre o grupo controle e o grupo experimental antes do experimento. Conclusão: A formulação do treinamento periódico adequado de força no pescoço tem um efeito preventivo significativo sobre lesões no pescoço em atletas de artes marciais. Nível de evidência II; Estudos Terapêuticos - Investigação de Resultados.

RESUMEN Introducción: Con el rápido desarrollo de las artes marciales de competición, la dificultad técnica y la intensidad del entrenamiento siguen aumentando, las lesiones cervicales en los atletas también han aumentado proporcionalmente, lo que ha atraído la atención de los investigadores. El entrenamiento de fuerza localizado se utiliza para la rehabilitación, pero no hay investigaciones relacionadas con la prevención en los deportistas. Objetivo: Explorar el efecto del entrenamiento de la fuerza del cuello en la prevención de lesiones del cuello en atletas de artes marciales. Métodos: Participaron en el experimento 68 voluntarios (34 hombres), divididos aleatoriamente en el grupo de control y en el experimental. Mientras que el grupo de control practicó actividades de entrenamiento tradicionales, en el grupo de control se añadió un protocolo de entrenamiento de fuerza. Se compararon los índices de variación del dolor y de calidad motriz. También se comparó el índice de discapacidad del cuello. Resultados: Después de la prueba, el número de lesiones en el cuello en el grupo de control fue de 23 en comparación con cinco en el grupo experimental; hay una diferencia significativa. Hubo una reducción significativa de las lesiones en el grupo experimental (P=0,05); un año después, la puntuación VAS del grupo experimental seguía siendo significativamente inferior a la del mismo grupo antes del experimento o del grupo de control. La puntuación de la disfunción del cuello del grupo experimental seguía siendo significativamente más baja que la del grupo preexperimental y la del grupo de control; no había diferencias estadísticamente significativas entre el grupo de control y el grupo experimental antes del experimento. Conclusión: La formulación de un entrenamiento periódico adecuado de la fuerza del cuello tiene un efecto preventivo significativo sobre las lesiones del cuello en los atletas de artes marciales. Nivel de evidencia II; Estudios terapéuticos - Investigación de resultados.

Estudio clínico y morfológica de las lesiones cervicales de alto grado. Hospital General Docente Abel SantamaríaCuadrado, 2019-2021 / Clinical and morphological study of high-grade cervical lesions. Abel Santamaría Cuadrado General Teaching Hospital, 2019-2021

RESUMEN Introducción: la neoplasia intraepitelial cervical es una lesión donde parte del espesor del epitelio está sustituido por células con atipias. Objetivo: caracterizar clínico y morfológicamente las lesiones cervicales de alto grado, en las pacientes del Hospital "Abel Santamaría Cuadrado", en el 2019 - 2021. Métodos: se realizó un estudio observacional, descriptivo y transversal. El universo estuvo representado por 472 pacientes que se les realizó histerectomía, conización o amputación cervical, la muestra coincide de manera intencional. Se empleó la prueba de dependencia u homogeneidad de proporciones para datos cualitativos y cuantitativos, y el Chi Cuadrado. Resultados: existió un predominio de pacientes con color de la piel blanca y las edades más frecuentes fueron entre 15 y 29 años de edad. De acuerdo a los resultados colposcópicos y edad, existió una preponderancia de las pruebas Schiller negativo y dentro de las positivo, el grupo más frecuente fue entre 40-49 años. En cuanto a la clasificación histológica, fueron más frecuentes las lesiones Cervicales de Alto Grado NICII, en la mayoría de los grupos de edades. Dado el grado de compromiso de los bordes en una conización, existe una superioridad de los bordes libres. Los más frecuentes fueron la infección por el virus del Papiloma Humano, y la edad temprana de la primera relación sexual. Conclusiones: el diagnóstico precoz y el adecuado control de los factores de riesgo constituyen las herramientas necesarias para la disminución de la mortalidad atribuibles al cáncer cérvico-uterino.

ABSTRACT Introduction: cervical intraepithelial neoplasia is a lesion where part of the thickness of the epithelium is replaced by cells with atypia. Objective: to clinically and morphologically characterize high-grade cervical lesions in patients at the "Abel SantamaríaCuadrado" Hospital in 2019 - 2021. Methods: an observational, descriptive and cross-sectional study was conducted. The universe was represented by 472 patients who underwent hysterectomy, conization or cervical amputation, matching the sample intentionally. The test of dependence or homogeneity of proportions was used for qualitative and quantitative data, as well as the Chi-square test. Results: there was a predominance of patients with white skin color and the most frequent ages were between 15 and 29 years old. According to colposcopic findings and age, there was a preponderance of negative Schiller tests and within the positive ones, the most frequent group was between 40-49 years old. In terms of histological classification, High Grade CIN II cervical lesions were more frequent in most age groups. Given the degree of edge involvement in a conization, there is a superiority of free edges. The most frequent were infection by the Human Papilloma Virus, and early age of first sexual intercourse. Conclusions: early diagnosis and adequate control of risk factors are the necessary tools to reduce mortality attributable to cervical-uterine cancer.

Lesión laringotraqueal secundaria a traumatismo cerrado de cuello / Laryngotracheal injury secondary to blunt neck trauma

Resumen Los traumatismos contusos en la tráquea pueden provocar un compromiso agudo de las vías respiratorias, con implicaciones poten cialmente mortales. Representan el 5-10% de todos los casos traumatológicos, y se acompañan de una mortalidad de aproximadamente el 1-7%, siendo necesario su diagnóstico y manejo precoz. Los órganos frecuentemente lesionados son: estructuras vasculares, en un 20%, y se estima que el tracto aéreo y digestivo se encuentran comprometidos en un 10% de los casos.

Abstract Blunt trauma to the trachea can cause acute airway involvement, with life-threatening implications. They represent 5-10% of all trauma cases, and are accompanied by a mortality of approximately 1-7%, requiring early diagnosis and management. The organs frequently injured are: vascular structures, in 20%, and it is estimated that the air and digestive tracts are compromised in 10% of cases.

Damage control in penetrating carotid artery trauma: changing a 100-year paradigm / Control de daños en el trauma penetrante de la arteria carótida: cambiando un paradigma de 100 años

Abstract Carotid artery trauma carries a high risk of neurological sequelae and death. Surgical management of these injuries has been controversial because it entails deciding between repair or ligation of the vessel, for which there is still no true consensus either way. This article proposes a new management strategy for carotid artery injuries based on the principles of damage control surgery which include endovascular and/or traditional open repair techniques. The decision to operate immediately or to perform further imaging studies will depend on the patient's hemodynamic status. If the patient presents with massive bleeding, an expanding neck hematoma or refractory hypovolemic shock, urgent surgical intervention is indicated. An altered mental status upon arrival is a potentially poor prognosis marker and should be taken into account in the therapeutic decision-making. We describe a step-by-step algorithmic approach to these injuries, including open and endovascular techniques. In addition, conservative non-operative management has also been included as a potentially viable strategy in selected patients, which avoids unnecessary surgery in many cases.

Resumen El trauma de la arteria carótida tiene una alta probabilidad de muerte y de secuelas neurológicas. El manejo quirúrgico es objeto de controversia porque se tiene que decidir entre reparar la arteria carótida o ligarla, para lo cual aún no existe un consenso. El objetivo de este artículo es proponer una nueva estrategia de manejo para el trauma de la arteria carótida con los principios de la cirugía de control de daños y el uso de técnicas como el reparo endovascular o el manejo conservador. La decisión de operar el paciente inmediatamente o realizar estudios imagenológicos dependerá del estado hemodinámico del paciente. Si el paciente presenta sangrado masivo, hematoma expansivo o choque hipovolémico refractario, una intervención quirúrgica urgente esta indicada. Un déficit del estado neurológico al ingreso es un marcador de mal pronóstico en estos casos e influye en la toma de decisiones. Se describe el paso a paso del reparo vascular abierto y se incluye las estrategias de manejo tanto endovasculares como abiertas. Adicionalmente, el manejo conservador también ha sido incluido como una estrategia viable en pacientes seleccionados, evitando cirugías innecesarias.

Damage control of laryngotracheal trauma: the golden day / Control de daños del trauma laringotraqueal: todo en 24 horas

Abstract Laryngotracheal trauma is rare but potentially life-threatening as it implies a high risk of compromising airway patency. A consensus on damage control management for laryngotracheal trauma is presented in this article. Tracheal injuries require a primary repair. In the setting of massive destruction, the airway patency must be assured, local hemostasis and control measures should be performed, and definitive management must be deferred. On the other hand, management of laryngeal trauma should be conservative, primary repair should be chosen only if minimal disruption, otherwise, management should be delayed. Definitive management must be carried out, if possible, in the first 24 hours by a multidisciplinary team conformed by trauma and emergency surgery, head and neck surgery, otorhinolaryngology, and chest surgery. Conservative management is proposed as the damage control strategy in laryngotracheal trauma.

Resumen El trauma laringotraqueal es poco frecuente, pero con alto riesgo de comprometer la permeabilidad la vía aérea. El presente artículo presenta el consenso de manejo de control de daños del trauma laringotraqueal. En el manejo de las lesiones de tráquea se debe realizar un reparo primario; y en los casos con una destrucción masiva se debe asegurar la vía aérea, realizar hemostasia local, medidas de control y diferir el manejo definitivo. El manejo del trauma laríngeo debe ser conservador y diferir su manejo, a menos que la lesión sea mínima y se puede optar por un reparo primario. El manejo definitivo se debe realizar durante las primeras 24 hora por un equipo multidisciplinario de los servicios de cirugía de trauma y emergencias, cirugía de cabeza y cuello, otorrinolaringología, y cirugía de tórax. Se propone optar por la estrategia de control de daños en el trauma laringotraqueal.

Disnea por rotura espontánea traqueal en ancianos / Dyspnea due to spontaneous tracheal rupture in the elderly

Tracheal rupture is an infrequent complication with high morbidity and mortality, of multifactorial etiology, being orotracheal intubation its main cause. Spontaneous tracheal rupture usually occurs after severe coughing and/or vomiting over a weakened trachea. The diagnosis is non-specific, based on highly suggestive signs and symptoms such as subcutaneous emphysema, pneumomediastinum and respiratory distress, and its confirmation requires the performance of a bronchoscopy. The location and extent of the rupture determines the clinic. This implies the importance of an early diagnosis to avoid a poor prognosis. We present the case of an elderly male patient with a spontaneous tracheal rupture without apparent cause

La rotura traqueal es una complicación infrecuente de etiología multifactorial, con una elevada morbimortalidad, la intubación orotraqueal es su principal causa. La rotura traqueal espontánea suele producirse luego de toser o presentar vómitos intensos, sobre una tráquea debilitada. El diagnóstico es inespecífico, se basa en signos y síntomas altamente sugestivos como enfisema subcutáneo, neumomediastínico y dificultad respiratoria y su confirmación exige la realización de una broncoscopia. La localización y extensión de la rotura determinan la clínica. Esto implica la importancia del diagnóstico precoz para evitar un pronóstico infausto. Se presenta el caso de un paciente varón, de edad avanzada. con una rotura espontánea traqueal sin causa aparente

Neck Injuries by Traffic Accidents: Diagnosis and Treatment (review) / 中国康复理论与实践

Neck injuries caused by traffic accidents increase by years, timely and effective treatment can greatly reduce the mortality rate. This paper summarized the characteristics, image features, evoked potential detection and serum markers detection of neck injury caused by traffic accidents. Then, the condition of injuries was comprehensively considered and analyzed, and the priorities were correctly judged. The injuries were classified and treated. It is conducive for the attending doctors to carry out precise individualized first aid and surgical treatment for the patients, in order to save lives to the maximum extent, reduce disabilities, and prevent and treat post traumatic stress disorders.

Unusual Suicide with Chainsaw: An Autopsy Case Report / 대한법의학회지

In autopsy practice, we encounter case of suicide or murder using various methods or tools. Damage caused by tools such as a knife or hammer is commonly encountered, but a case of damage using a chainsaw is not commonly encountered. We present an autopsy case of a suicide due to neck injury using a chainsaw. A 56-year-old man was found dead with a neck injury and a chainsaw below him. Soft tissue of the neck, thyroid cartilage, trachea, carotid vessels, cervical vertebrae, and cervical spinal cord were found to be cleaved, and a cogwheel-shaped pattern was observed in the injured area.

Perfil das vítimas de suicídio necropsiadas no núcleo de medicina e odontologia legal de João Pessoa ­ PB ­ Brasil / Profile of necropsied victims in the nucleus of forensic medicine and dentistry of Joao Pessoa ­ PB ­ Brazil

Introdução: A incidência de suicídio vem crescendo no Brasil e no mundo, apresentando-se como problema de saúde pública. Objetivo: Traçar o perfil das vítimas de suicídio da cidade de João Pessoa/PB ­ Brasil. Material e Métodos: Estudo transversal, descritivo e de abordagem quantitativa por meio da avaliação de dados presentes nas Declarações de Óbito de vítimas de suicídio nos anos 2015 e 2016 emitidas pelo Núcleo de Medicina e Odontologia Legal da cidade de João Pessoa/PB ­ Brasil. Os dados foram fornecidos pela Vigilância Epidemiológica da Secretaria Municipal de João Pessoa. As variáveis estudadas foram sexo, idade, escolaridade, estado civil, ocupação, local do suicídio, se houve atendimento médico e causa básica da morte (de acordo com a Classificação Internacional de Doenças ­ CID-10). Procedeu-se a análise estatística descritiva e inferencial, adotando nível de significância de 5,0%. Resultados: 105 pessoas morreram vítimas de suicídio, com prevalência do sexo masculino (75,2%), entre 20 e 39 anos (41,9%), sendo a residência (73,3%) o local de eleição para a prática suicida. Quanto à forma, o enforcamento foi mais comum entre homens (57,1% e p=0,006) e a autointoxicação e o enforcamento (10,5% e p=0,006) entre mulheres. Não houve diferença estatisticamente significante quando o sexo foi relacionado ao estado civil (p=0,381), escolaridade (p=0,051) e ocupação (p=0,628). Conclusão: O perfil das vítimas de suicídio em João Pessoa nos anos de 2015 e 2016 foi de homens, adultos, solteiros, com baixa escolaridade, profissão relacionada à agricultura, ocorrendo, em sua maioria, na residência, por enforcamento (homens) e enforcamento e autointoxicação (mulheres)

Introduction: Suicide has been increasing in Brazil and worldwide, presenting itself as a public health problem. Objective: Outline the suicide victims profile in the city of João Pessoa/PB, Brazil. Material and Methods: Cross-sectional, descriptive and quantitative-approach study, through the evaluation of data presented in the Death Certificates of suicide victims in the years 2015 and 2016 issued by Nucleus of Forensic Medicine and Dentistry of João Pessoa city/PB ­ Brazil. The data were provided by the Epidemiological Surveillance of the Municipal Secretariat of João Pessoa. The variables studied were sex, age, schooling, marital status, occupation, place of suicide, if there was medical attention and basic cause of death, according to the International Classification of Diseases (ICD-10). Descriptive and inferential statistical analysis were used, with a significance level of 5.0%. Results: 105 people died of suicide, showing prevalence of males (75.2%), between 20 and 39 years (41.9%), and residence as being the place of choice for suicidal practice (73.3%). Regarding the method, hanging was more common among men (57.1% and p = 0.006) and autointoxication and hanging (10.5% and p = 0.006) among women. There was no statistically significant difference when genre was related to marital status (p = 0.381), schooling (p = 0.051) and occupation (p = 0.628). Conclusion: The suicide victims profile in the city of Joao Pessoa in the years 2015 and 2016 was man, adult, single, with low schooling, agriculture-related profession, mostly occurring in the residence, by hanging (men) and hanging and autointoxication (women)

Firearm Injuries of Head and Neck: Our Experience

Background: Injuries inflicted on head & neck  are of different types. It could be either blunt injury, sharp penetrating injury or gunshot injury. Multiple cranial nerve injury, airway injury, injury to bone and soft tissues are common outcome of such injury Methods: This study was a retrospective undertaken in the Department of ENT, JNMC, AMU over a period of five years from January 2000 to June 2005. In our present study we have exclusively dealt with firearm injuries inflicted on head & neck area and those patients who survived and were treated in our medical college. We studied ten cases of firearm injury. We had discarded all those cases of head & neck firearm assault who were brought dead. Results:  The study was conducted in the Department of ENT, JNMC over a period of five years. The age of presentation ranged from 15yrs-50 yrs. The male & female ratio was of 4:1. Most of the patients belonged either to areas east of Aligarh or Aligarh itself. Conclusion: The firearm injuries are now more common because of the development of sophisticated ammunition, intolerance and hatred. Timely intervention if given saves lifes of many patients. Team management and sound facilities are significant in the management of firearm injuries

Colgajo supraclavicular de perforantes: reporte de dos casos / Supraclavicular flap of perforants: two case report

La reconstrucción posterior a la resección de tumores en la cabeza y el cuello es un reto para la cirugía reconstructiva. El colgajo supraclavicular es un excelente recurso quirúrgico por su fácil disección, poca morbilidad y adecuada extensión. En el presente artículo presentamos 2 casos de reconstrucción exitosa con esta alternativa.

Reconstruction after resection of lesions in the head and neck are a challenge for reconstructive surgery. The supraclavicular flap is an excellent surgical alternative because it´s easy dissection, low morbidity and adequate extension. In this work, we present two cases of successful reconstruction with this flap.

Differences of Neck Injury Risks for Different Dummies During Arrested Landing / 医用生物力学

Objective To compare the differences of neck injury risks for different mummies during arrested landing on naval vessels. Methods Based on the established dynamic model of dummy-belt-seat systems and mechanical model of head-neck, with the acceleration curve at seat base during typical arrested landing reported in the literature as the input, numerical simulation was conducted to test the validity of the model, and the axial force, shear force， bending moment of typical joints in dummy neck during arrested landing were obtained. Results The injury index Nkm of 95 percentile dummy was higher than that of 5 percentile dummy. The injury index Nij of the dummy’s upper and lower cervical spine was smaller than 0.2, meanwhile the Nkm was around 0.65. Conclusions During arrested landing, human neck was much easier to get hurt due to the shear force. The research findings can provide data support for evaluating neck injury risks of pilots with different sizes during typical arrested landing process.

Manejo del trauma penetrante de cuello en dos hospitales de Bogotá, Colombia / Management of penetrating neck trauma at two hospitals in Bogotá, Colombia

Introducción. El manejo del trauma penetrante de cuello en pacientes estables, según la zona de Monson lesionada, orienta la solicitud de pruebas diagnósticas para identificar lesiones vasculares, de las vías aéreas y del tubo digestivo. Materiales y métodos. Se trata de un estudio observacional, descriptivo y retrospectivo. Se incluyeron pacientes de 15 años o más con trauma penetrante de cuello, que consultaron a los dos hospitales de la Sociedad de Cirugía de Bogotá en un periodo de cinco a seis años. Se recolectó la información demográfica, clínica y de las pruebas diagnósticas practicadas, para determinar su utilidad. Las variables cualitativas se describieron con frecuencias relativas y absolutas, y las cuantitativas, con medias y desviaciones estándar. Resultados. Inicialmente, se incluyeron 148 pacientes, de los cuales 133 fueron catalogados como estables durante la valoración primaria, con un promedio de edad de 33,04 años (desviación estándar, DE=12,9); la mayoría (88,7 %) eran hombres. La mediana de la estancia hospitalaria fue de dos días (rango intercuartílico, RIQ=1-4 días). En la mayoría (117; 87,9 %) de los casos, la herida fue causada con arma cortopunzante. En casi todas las pruebas diagnósticas, se reportaron pocos hallazgos anormales, a excepción de la angiotomografía (angio-TC) que se practicó en 59 pacientes y demostró 43 resultados anormales. Se decidió tratamiento quirúrgico en siete pacientes catalogados como estables al ingreso y, en 14, por resultados anormales de las pruebas diagnósticas. Se presentaron cinco fallecimientos. Conclusión. El examen físico, la observación clínica y la angio-TC son suficientes para identificar lesiones vasculares, de la vía aérea o del tubo digestivo en los pacientes con trauma penetrante de cuello, en hospitales que no son considerados como especializados en trauma

Introduction: Management of penetrating neck trauma in stable patients according to the affected Monson zone directs the diagnostic tests to identify vascular, airway and digestive tract lesions. Materials and methods: A retrospective descriptive observational study was conducted. We included 15 year-old or older patients with penetrating neck trauma that consulted at the two hospitals of the Sociedad de Cirugía in Bogotá, Colombia, during a 5 to 6 year period. Demographic and clinical information was collected, as well as the results of the diagnostic tests applied in order to determine their utility. Qualitative variables were described with relative and absolute frequencies and quantitative variables with median and standard deviations. Results: 148 patients were enrolled initially, of which 133 were classified as stable during the primary assessment, with an average age of 33.04 years (SD: 12.9), the majority being men (88.7%). The median hospital stay was 2 days (IQR=1-4 days). The most frequent wound mechanism was a sharp bladed weapon in 117 cases (87.9%). A low proportion of abnormal findings were reported in the diagnostic tests, except for angiography CT which was performed in 59 patients with 43 with abnormal findings. Surgical management was defined for 7 patients classified as stable at admission and for 14 patients after abnormal findings found in the diagnostic tests. Five deaths were registered. Conclusion: Physical examination, clinical observation and angiography CT are sufficient to identify vascular, airway and digestive lesions in patients with penetrating neck trauma at hospitals that are not considered specialized in trauma

Reconstrucción traqueal bajo oxigenación con membrana para circulación extracorpórea para el manejo de una lesión traumática: reporte de caso y revisión bibliográfica / Tracheal reconstruction under oxygenation with membrane extracorporeal circulation for the management of a traumatic lesion: case report and literature

Introducción. El traumatismo traqueal es una condición poco frecuente que puede ser ocasionada por traumas abiertos, cerrados o iatrogénicos; su presentación clínica es variable y el diagnóstico suele ser clínico, apoyándose en la radiografía de tórax, la tomografía cérvico-torácica y la fibrobroncoscopia. Su manejo representa todo un reto médico y quirúrgico, y se requieren múltiples herramientas para su adecuado tratamiento. La terapia con oxigenación con membrana para circulación extracorpórea ha sido ampliamente utilizada en el manejo de pacientes con falla respiratoria aguda, en los cuales los métodos convencionales de asistencia respiratoria mecánica no son suficientes para garantizar una adecuada oxigenación. Caso clínico. Se presenta el caso de una paciente con una lesión traqueal iatrogénica reparada quirúrgicamente, bajo asistencia con oxigenación con membrana para circulación extracorpórea, para garantizar la oxigenación tisular y la adecuada recuperación y supervivencia de la paciente. Conclusiones. La terapia con oxigenación con membrana para circulación extracorpórea es una excelente alternativa para el manejo quirúrgico de las lesiones traqueales complejas que amenazan la vida del paciente, ya que permite brindar un soporte vital y un adecuado intercambio gaseoso durante el procedimiento

ntroduction: Tracheal trauma is a rare condition that can be caused by open, closed, or iatrogenic trauma; its clinical presentation is variable and the diagnosis is usually clinical, supported by chest X-ray, thoracic CT and bronchoscopy. Its management represents a medical and surgical challenge, requiring multiple tools for the proper treatment of this entity. Extracorporeal membrane oxygenation therapy has been widely used in the management of patients with acute ventilatory failure in whom conventional methods of mechanical ventilation are insufficient to ensure adequate oxygenation of the patient. Case report: We present the case of a patient with a surgically repaired iatrogenic tracheal lesion conducted with extracorporeal membrane oxygenation to maintain tissue oxygenation and assure recuperation and survival. Conclusions: Extracorporeal membrane oxygenation therapy is an excellent alternative for the surgical management of complex tracheal lesions that threaten the patient's life, allowing vital support and adequate gas exchange during the procedure

Current Status of Forensic Identification for Blunt Injuries of Internal Carotid Arterial System / 法医学杂志

Internal carotid arterial system is the main source of blood supply in brain. In forensic identi-fication practice, blunt injures of internal carotid arterial system usually cause complications such as throm-bus, aneurysm and arteriovenous fistula, etc. The deaths following delayed cerebral infarction or intracra-nial haemorrhage are not rare. At present, literature of deaths caused by blunt injuries of internal carotid arterial system mainly consist of case reports in China. This paper reviews related literature and case re-ports at home and abroad, and summarizes forensic medical features and identification method of the deaths caused by such injuries. The results show that blunt injures of internal carotid arterial system are related to the direct or indirect force on head and neck, which can result in exceed physiological range traction of head and neck, incision following basicranial fracture, etc. Such injuries are common in the cases as mechanical asphyxia, cervical manipulation, traffic accident and fall, etc. The artery should be examined carefully, and the relationship among injury, disease and death should be analysed correctly when no cause of infarction and hemorrhage was found in routine examination of such cases in forensic pratice. Because of the difficulty for exposing the artery completely in autopsy, angiography can be used to infer the location when necessary for improving the scientificity and reliability of the appraisal conclusion.

Trauma cervical penetrante / Penetrating neck trauma

Aim: The aim of this study is to report the surgical outcomes in a series of patients undergoing to exploratory cervicotomy by penetrating neck trauma (PNT) in emergency department of Barros Luco-Trudeau Hospital (BLTH), between 2003 and 2013, in terms of postoperative morbidity (POM). Matherial and methods: Retrospective case series of patient undergoing exploratory cervicotomy in emergency department of BLTH, between 2003 and 2013. The outcome variable was development of POM. Other variables were age, sex, etiology and kind of injury, hemodynamic status at admission, surgical time, distribution of injuries by anatomic areas, need for re operation and intra and post operative mortality. Descriptive statistics were used. Results: During the study period, 59 exploratory cervicotomies were performed to patients with PNT, with an average age of 32,5 years old. 89,8 percent of patients were male. The POM was 33,4 percent, being the most frequent the neurological ones. The most frequent etiology was the stab with 83 percent. 66 percent of patients were hemodynamically unstable at admission. Mean operative time was 107 minutes. The most injured area was the area II. Conclusion: The PNT is a little prevalent disease. The outcomes of our study are consistent with those reported in the literature.

Objetivo: El objetivo de este estudio es comunicar los resultados quirúrgicos observados en una serie de pacientes sometidos a cervicotomía exploradora por trauma cervical penetrante (TCP) en el Servicio de Urgencias del Hospital Barros Luco-Trudeau (HBLT), entre los años 2003 y 2013, en términos de morbilidad postoperatoria (MPO). Material y método: Serie de casos retrospectiva de pacientes sometidos a cervicotomía exploradora en el servicio de urgencia del HBLT, entre el año 2003 y 2013. La variable resultado fue desarrollo de MPO. Otras variables fueron: edad, sexo, etiología y tipo de lesión, estado hemodinámico al ingreso, tiempo quirúrgico, distribución de la lesión según zona anatómica, necesidad de re operación y mortalidad intra y post operatoria. Se utilizó estadística descriptiva. Resultados: En el período en estudio, se realizaron 59 cervicotomías a pacientes con TCP, con un promedio de edad de 32,5 años, de los cuales el 89,8 por ciento era de sexo masculino. La MPO fue de 33,4 por ciento, siendo las más frecuentes las de tipo neurológico. La etiología más recurrente fue el arma blanca con 83 por ciento. El 66 por ciento de los pacientes se encontraban hemodinámicamente inestables al momento del ingreso. El tiempo quirúrgico promedio fue de 107 min. La zona más lesionada fue la zona II. Conclusión: El TCP es una entidad poco prevalente. Los resultados obtenidos en nuestra serie son coincidentes con lo reportado en la literatura.

Evaluation of the use of tomography in penetrating neck trauma / Avaliação da utilização da tomografia computadorizada no trauma cervical penetrante

ABSTRACTObjective:the study has the intention of evaluate the accuracy of computed tomography for the diagnosis of cervical lesions on penetrating neck trauma and also identify the most frequent mechanisms of trauma. Most injured structures, determine the age range and the most prevalent sex.Methods: observational descriptive retrospective study executed by the systematic retrospective review of medical records of all patients victims of penetrating neck trauma that went through surgery and CT scans, admitted into Hospital do Trabalhador, between January 2009 and December 2013.Results:the final sample was of 30 patients, 96.7% of the male sex, the median age was of 28 years old. Most patients suffered injuries by gun (56.7%) and 33,3% suffered stab wounds. The most stricken area of the neck was Zone II (77.8%) and the left side (55.2%). Regarding the structures injured, the CT showed 6.7% lesions on airways but the surgery showed 40% of damaged, with a value of p=0.002. As to damages of the esophagus and pharynx the CT detected 10% of lesions, while surgery found 30% of lesions, therefore with a significant value of p=0.013. As for the analysis the CT showed reliable. As for the analysis of vascular damage, the CT showed to be, in most cases, reliable to the findings during the surgical act.Conclusion:besides the great use of CT for the diagnosis of penetrating neck injuries we can say that this is an exam with low accuracy for the diagnosis of lesions of aerodigestive tract, therefore it is important a clinical correlation for a good diagnosis.as for the vascular lesions and of other structures, the CT had high sensibility and specificity, thus a good exam to be used in overall.

RESUMOObjetivo:avaliar a acurácia da tomografia computadorizada no diagnóstico de lesões do trauma cervical penetrante.Métodos:estudo retrospectivo descritivo observacional realizado através da revisão de prontuários de todos os pacientes vítimas de trauma cervical penetrante que foram operados e submetidos à tomografia computadorizada no pré-operatório.Resultados:a amostra final compreendeu 30 pacientes, sendo 96,7% do sexo masculino e a mediana de idade foi 28 anos. A maioria dos pacientes sofreu ferimento por arma de fogo (FAF) em 56,7% dos casos e 33,3% foram ferimentos por arma branca (FAB). A zona do pescoço mais acometido foi a zona II (77,8%) e no lado esquerdo (55,2%). Em relação às estruturas lesadas, a tomografia computadorizada (TC) mostrou 6,7% de lesões em vias aéreas e durante a operação encontrou-se 40% de alterações (p=0,002). A tomografia computadorizada detectou 10% de leões do esôfago e faringe, durante a operação encontrou-se 30% de lesões (p=0,013). Já, para análise de danos vasculares, a TC se mostrou, na maioria dos casos, fidedigna aos achados durante o procedimento operatório.Conclusão:apesar do grande uso da tomografia computadorizada no diagnóstico de lesões cervicais penetrantes, pode-se afirmar que este é um exame com baixa acurácia no diagnóstico de lesões de trato aerodigestivo, sendo importante uma correlação clínica para um bom diagnóstico. Já para lesões vasculares e de outras estruturas, a TC apresentou alto grau de sensibilidade e especificidade, sendo assim um bom exame a ser utilizado nesses casos.

Domestic Violence Against Children and Adolescents: Prevalence of Physical Injuries in a Southern Brazilian Metropolis

Violence against children and adolescents is a public health issue worldwide that threatens physical and mental wellbeing and causes irreparable harm. Reports on this violence are an essential way to prevent it and to protect the children and adolescents. Thus, the objective of the present study was to evaluate the prevalence of physical injuries that occur in domestic environments and reported to the Child and Adolescent Protection Network. This retrospective study was conducted at the Epidemiology Center of the Municipality of Curitiba. A total of 10,483 reports for the years 2010 (5,112) and 2011 (5,371) were analyzed and from them were selected reports of physical injuries that occurred in the family environment. The children and adolescents were 0-17 years old, comprising 322 cases of physical abuse within the family in 2010. Out of these, 57.1% were male and 42.9% were female, and 58% (187) presented head and neck injuries. There were 342 reports in 2011, 49% were male and 51% were female; head and neck injuries corresponded to 65% (222) of the reported cases. The prevalence of injuries increased by 6% and head and neck injury increased by 19% between 2010 and 2011. It may be concluded that physical abuse is associated with a high prevalence of head and neck injury, which is easily observed by the health and education professionals. Notification organs should be created in Brazilian hospitals and health centers, which is essential to conduct epidemiological surveillance and appropriate policies.

A violência contra crianças e adolescentes é um grave problema mundial e de saúde pública, que ameaça o bem estar físico e mental, deixando sequelas irreparáveis. A notificação desta violência permite sua prevenção e proteção das crianças e adolescentes. Assim, o objetivo desse estudo foi avaliar a prevalência de lesões na região de cabeça e pescoço contra crianças e adolescentes, bem como caracterizar o tipo das lesões, o agressor e unidades notificadoras. Essa pesquisa retrospectiva foi realizada no Centro de Epidemiologia da Prefeitura Municipal de Curitiba. Um total de 10.483 notificações dos anos de 2010 (5.112) e 2011 (5.371) foi analisado, para compor a amostra das lesões físicas ocorridas no ambiente intrafamiliar, na faixa etária de 0 a 17 anos de idade. Em 2010, a frequência de abuso físico intrafamiliar foi de 322 casos. Destas, 57,1% eram do sexo masculino e 42,9% do sexo feminino, e 58% (187) delas tiveram lesões em cabeça e pescoço. No ano de 2011 foram 342 notificações, sendo que 49% eram do sexo masculino e 51% do sexo feminino e as lesões em cabeça e pescoço corresponderam a 65% (222) dos casos notificados. Houve aumento na prevalência de 6% das lesões físicas e 19% das lesões na região de cabeça e pescoço, do ano de 2010 para 2011. Conclui-se que é alta a prevalência de lesões na região de cabeça e pescoço, áreas facilmente observadas pelo profissional de saúde e da educação. A criação de órgãos notificadores em hospitais e unidades de saúde é fundamental para a vigilância epidemiológica e para definição de políticas adequadas.