Multi detector computed tomography imaging in penetrating injuries

Background: Penetrating injuries forms an important component of surgical emergencies. Penetrating trauma typically involves the violation of the body by a gunshot wound (GSW) or stab wound. Emergency laparotomy is the accepted management in patients with a penetrating injury who are not hemodynamically stable. However, selective non-operative management has been shown to decrease the rate of unnecessary surgery. Plain radiographs and FAST are useful for initial assessment of these patients. Multi detector CT is an indispensable tool in the evaluation of patients who are stable and are candidates for conservative treatment.Methods: A cross sectional observational study was carried out on 40 patients admitted with penetrating injury to the trauma centre of PGIMER and Dr RML hospital. Of the 40 patients, 14 were taken for emergency laparotomy. In 26 cases, MDCT was done to evaluate for solid organ, hollow organ and vascular injuries.Results: The mean age of patients was 38 years, with male to female ratio of 5:1. Stab injury was the commonest type of injury, followed by gunshot wounds. Liver was the commonest solid organ involved, followed by kidneys and spleen. Other organs involved were diaphragm, small bowel and colon.Conclusions: Penetrating injuries can be life-threatening, making prompt diagnosis essential. Recognizing key abnormalities on MDCT ensures patients are triaged appropriately. Multi-detector CT is thus widely used to evaluate penetrating injuries in stable patients.

The Uncharted Danger of Living in the Tropics: A Needlefish Impalement of the Sigmoid Colon

@#Penetrating injury to the abdominal viscera is not uncommon unless when it is caused by marine life. We present a 39-year-old fisherman from a tropical country who had sustained a penetrating injury from a stab wound to the abdomen due to needlefish impalement. He sustained a small perforation of the sigmoid colon during exploratory laparotomy and primary repair was done. Although this incident is rare, there are cases involving seawater activities either for leisure, sport or diving for fishing. We highlight this rare incident and discuss the management plan.

Procedure for early corneal basement membrane repair and regeneration in corneal penetrating injury in rabbits / 中华实验眼科杂志

Objective To describe the procedure for early corneal epithelial basement membrane (EBM) repair and regeneration in rabbits with corneal penetrating injury.Methods Forty-two New Zealand white rabbits were divided into modeling 1-,3-,5-,7-,14-,21-,and 30-day groups using a random number table method,with 6 rabbits in each group;the right eyes were selected as the experimental eyes.Another 6 New Zealand white rabbits without any treatment were taken as the normal control group.A 2.0-mm trephine was used to ablate a full-thickness button of the central corneal tissue of each rabbit.The corneas were observed by slit lamp biomicroscopy at the respective time points after the trephined injury.Corneal epithelial fluorescein staining was used to evaluate re-epithelialization with Image J software and haze grading was evaluated with the Fantes classification.Hematoxylin-eosin staining was used to observe the healing process of the cornea.Transmission electron microscopy was conducted to assess the regeneration of the EBM and the reconstruction of the cornea.The study protocol was approved by the Ethics Committee of Guangxi Medical University (No.201811031).The use and care of the experimental animals complied with the Statement for the Use of Animals in Ophthalmic and Vision Research.Results The corneal epithelial fluorescein areas in modeling 1-,3-,5-,7-,and 14-day group were (4.00±0.10),(3.11±0.10),(2.00±0.06),(0.90±0.04) and (0.67 ± 0.03)mm2,respectively,with a significant difference among them (F =3 398.88,P ＜ 0.01).With the increasing of time after modeling,the corneal epithelium fluorescein area was gradually reduced,showing significant differences between any two groups (all at P＜0.05),and the staining was disappeared at 21 and 30 days after modeling.The corneal haze grades were 3.44±0.53,0.67±0.25,1.33±0.50,2.11±0.60,2.44±0.53,3.22±0.44 and 3.78±0.44 in modeling 1-,3-,5-,7-,14-,21-,and 30-day group,respectively.The corneal opacity score gradually decreased during 1-5 days after modeling and gradually increased during 5-30 days after modeling,with a significant difference among them (F =51.182,P＜0.01).Hematoxylin-eosin staining revealed that a fibrin clot formed in the wound area,and a single layer of epithelium covered the area at initial 3 days after modeling,and a large number of fibroblasts and some extracellular matrix were found at 5 days after modeling.At 21 and 30 days after modeling,the collagen fibers were tightly arranged in the anterior stroma.Transmission electron microscopy showed that the wound was filled with irregular collagen fibers and myofibroblasts.The stroma was remodeled at 21 days after modeling,and defective regeneration of the EBM was detected at 21 and 30 days after modeling.Conclusions Corneal fibrosis initiates after corneal penetrating injury in rabbits and gradually aggravates,the EBM regenerates defectively.

Procedure for early corneal basement membrane repair and regeneration in corneal penetrating injury in rabbits / 中华实验眼科杂志

Objective@#To describe the procedure for early corneal epithelial basement membrane(EBM) repair and regeneration in rabbits with corneal penetrating injury.@*Methods@#Forty-two New Zealand white rabbits were divided into modeling 1-, 3-, 5-, 7-, 14-, 21-, and 30-day groups using a random number table method, with 6 rabbits in each group; the right eyes were selected as the experimental eyes.Another 6 New Zealand white rabbits without any treatment were taken as the normal control group.A 2.0-mm trephine was used to ablate a full-thickness button of the central corneal tissue of each rabbit.The corneas were observed by slit lamp biomicroscopy at the respective time points after the trephined injury.Corneal epithelial fluorescein staining was used to evaluate re-epithelialization with Image J software and haze grading was evaluated with the Fantes classification.Hematoxylin-eosin staining was used to observe the healing process of the cornea.Transmission electron microscopy was conducted to assess the regeneration of the EBM and the reconstruction of the cornea.The study protocol was approved by the Ethics Committee of Guangxi Medical University (No.201811031). The use and care of the experimental animals complied with the Statement for the Use of Animals in Ophthalmic and Vision Research.@*Results@#The corneal epithelial fluorescein areas in modeling 1-, 3-, 5-, 7-, and 14-day group were (4.00±0.10), (3.11±0.10), (2.00±0.06), (0.90±0.04) and (0.67±0.03)mm2, respectively, with a significant difference among them (F=3 398.88, P<0.01). With the increasing of time after modeling, the corneal epithelium fluorescein area was gradually reduced, showing significant differences between any two groups (all at P<0.05), and the staining was disappeared at 21 and 30 days after modeling.The corneal haze grades were 3.44±0.53, 0.67±0.25, 1.33±0.50, 2.11±0.60, 2.44±0.53, 3.22±0.44 and 3.78±0.44 in modeling 1-, 3-, 5-, 7-, 14-, 21-, and 30-day group, respectively. The corneal opacity score gradually decreased during 1-5 days after modeling and gradually increased during 5-30 days after modeling, with a significant difference among them (F=51.182, P<0.01). Hematoxylin-eosin staining revealed that a fibrin clot formed in the wound area, and a single layer of epithelium covered the area at initial 3 days after modeling, and a large number of fibroblasts and some extracellular matrix were found at 5 days after modeling.At 21 and 30 days after modeling, the collagen fibers were tightly arranged in the anterior stroma.Transmission electron microscopy showed that the wound was filled with irregular collagen fibers and myofibroblasts.The stroma was remodeled at 21 days after modeling, and defective regeneration of the EBM was detected at 21 and 30 days after modeling.@*Conclusions@#Corneal fibrosis initiates after corneal penetrating injury in rabbits and gradually aggravates, the EBM regenerates defectively.

El trauma ocular en la infancia / Ocular trauma in childhood

RESUMEN Objetivo: Determinar los resultados de la aplicación del ocular trauma score como herramienta de pronóstico visual en traumatismos. Métodos: Se realizó un estudio descriptivo longitudinal retrospectivo en el Servicio de Oftalmología del Hospital Pediátrico Provincial Docente "Eduardo Agramonte Piña", desde enero del año 2011 a enero de 2016. El universo estuvo conformado por 438 pacientes quienes recibieron ingreso hospitalario, y la muestra quedó conformada por 357 ojos de 356 pacientes con el diagnóstico de trauma ocular. Se analizaron las siguientes variables: etiología al ingreso, edad, sexo, topografía y tipo de lesión, evento traumático, agente causal, agudeza visual inicial según tipo de lesión y el pronóstico visual según el ocular trauma score. Resultados: El 81,3 por ciento de los pacientes ingresados presentaron etiología traumática; 64,6 por ciento fueron varones, con predominio del grupo de edad entre 5 y 9 años. Hubo una preponderancia de los traumas cerrados. Los accidentes recreativos fueron los más predominantes; los palos y las piedras resultaron el agente causal más frecuente y la agudeza visual final fue superior a la inicial. Conclusiones: La etiología traumática constituye la primera causa de ingreso en el Servicio de Oftalmología, donde se observa predominio de los pacientes entre 5 y 9 años, fundamentalmente del sexo masculino. Los traumas del globo ocular cerrado predominan sobre los del globo ocular abierto. Estos últimos presentan mayor afectación de la agudeza visual. El accidente recreativo y doméstico es más frecuente, así como los palos y las piedras como agentes causales. La mejoría de la agudeza visual fue significativa en este estudio, lo que se correspondió con la predicción sugerida por el ocular trauma score(AU)

ABSTRACT Objective: To determine the results of the application of the ocular trauma score as a tool for visual prognosis in traumatisms. Methods: Descriptive, longitudinal and retrospective study was carried out. The universe consisted of 438 patients who received hospital admission and the sample consisted of 357 eyes of 356 patients with the diagnosis of ocular trauma at admission. Different variables were analyzed: etiology at admission, age, sex, topography and type of injury, traumatic event, causal agent, initial visual acuity according to type of injury and visual prognosis according to ocular trauma score. Results: 81,3 percent of the patients admitted had traumatic etiology, 64.6 percent were males with predominance of the group aged between 5 and 9 years. There was a preponderance of closed traumas. The sticks and stones were the most frequent causal agent and the final visual acuity was superior to the initial one. Conclusions: The traumatic etiology is the first cause of admission in the Ophthalmology Service, where predominance is observed between 5 to 9 years, mainly of the male sex. The traumas to closed ocular globe predominate over those of open ocular globe presenting these last greater affectation of the visual acuity. The recreational and domestic accident is more frequent, as well as the sticks and stones as causal agents. The improvement in visual acuity is significant, corresponding with the prediction suggested by ocular trauma score(AU)

Two Cases of Pediatric Pneumolabyrinth with Traumatic Tympanic Membrane Perforation after Penetrating Injury / 대한평형의학회지

Pneumolabyrinth is an uncommon condition in which air is present in the vestibule or cochlear. It is rarely found, even in otic capsule violating fractures or in transverse fracture of the temporal bone. So far, there is no consensus on management of pneumolabyrinth. We describe 2 new cases of pneumolabyrinth by penetrating injury with traumatic tympanic membrane perforation. They presented whirling vertigo with moderate conductive hearing loss. Temporal bone computed tomography clearly demonstrated the presence of air in the vestibule and cochlear.

Fleck-like deposits and swept source optical coherence tomography characteristics in a case of confirmed ocular chalcosis

A 36-year-old male presented with history of injury in the left eye 3 years back with a copper wire. Examination revealed the presence of typical sunflower cataract with golden yellow deposits over the anterior lens capsule with dull glow and old vitreous hemorrhage. Non-contrast computerized tomography revealed retained intraocular foreign body in the pars plana region. The patient underwent phacoemulsification with intraocular lens implantation followed by pars plana vitrectomy and foreign body removal. Intraoperatively, fleck-like deposits were noted on the retinal surface in a circinate manner around the fovea and also over mid-peripheral retina. Postoperative swept source optical coherence tomography (SS-OCT) was performed to document the location of deposits and their characteristics. Limited literature exists regarding SS-OCT characteristics of ocular chalcosis.

A Prospective Study Of Laryngotracheal Trauma And It‘S Management

BACKGROUND: Traumatic injuries of the larynx are diverse, uncommon, and potentially life threatening. Laryngotracheal trauma can be oadly divided into External trauma , which can be blunt or penetrating trauma , and internal trauma , which can be iatrogenic , thermal , caustic and foreign body injuries .external trauma which can be blunt trauma caused by motor vehicle accidents , suicidal or homicidal strangulation and penetrating trauma caused by suicidal or homicidal cut throat injuries . Iatrogenic injuries are most common cause of internal trauma . If not adequately treated these injuries lead to significant morbidity such as dysphonia , airway stenosis , aspiration and sometimes may lead to death . Laryngotracheal trauma is often associated with concomitant cervical or intracranial trauma or with multisystem poly trauma . External laryngeal trauma is rare. It has a population incidence of 1 in 137,000 in adults and accounts for 0.5% of trauma admissions in children. Incidence of postintubation laryngotracheal stenosis requiring surgical correction is 1 in 204,000 in adults and 4.9 in 100,000 in children.Laryngeal webs , intubation granulomas , laryngeal injuries while intubation , inhalational and ingestion injuries are very rare in incidence 1 . MATERIALS AND METHODS: 20 patients who presented with external and internal laryngotracheal trauma to casualty department in Government general hospital, Kakinada, Andhra Pradesh state , during the period between June 2015 to September 2017. A detailed history was taken with emphasis on trauma.Clinical features were noted and patients were appropriately investigated . RESULTS: The age of patients in present study varied from 12-70 years . Majority of patients are present in 26-40 years age group (55%) . Among the 20 cases in our study 13 cases were males (65%) and 7 cases were females (35%). In our study of 20 patients 14 patients sustained injuries due to external trauma(70%) and 6 patients presented with internal trauma of larynx(30%) due to prolonged intubation . In our study 6 of the 20 patients presented with laryngeal stenosis due to prolonged intubation among them 3 patients presented with subglottic stenosis 2 with glottic stenosis and 1 tracheal stenosis. Amongst them 9 of 14 patients were due to penetrating neck injuries(64.3%) and 5 of 14 are due to blunt neck trauma (35.7%) . 7 of 9 patients knife infected wounds and 2 due to motor vehicle accident. 2 of 5 patients in blunt trauma are due to hanging 2 are due to strangulation and one is due to bullgore injury. Most commonly presented with pain (70%) , dyspnoea (50%) , hoarseness (45%) . stridor was present mostly in laryngeal stenosis patients. The present study 15 of 20 patients airway was initially managed with the help of tracheostomy in 3 of 20 patients with intubation and 2 patients were under observation. There was a recurrence in one case of subglottic stenosis and endoscopic laser exicision was done again .In further followup there was no recurrence. CONCLUSION: In conclusion, we believe that the management of injuries to the larynx and trachea can be individualized based on the clinical presentation and mechanism of injury. Early diagnosis and stratification of treatment based on the initial history, physical findings has improved outcomes. Our goal remains preservation of life with restoration of a normal airway and voice. Patients with blunt injuries can often be managed conservatively with close monitoring in the intensive care unit. Penetrating injuries will often have associated injuries or airway compromise that will mandate operative exploration.

Trauma ocular a globo abierto asociado a cuerpo extraño intraocular vegetal / Ocular trauma to an open eyeball associated with a vegetable intraocular foreign body

Introducción: El trauma ocular es una causa importante de morbilidad oftalmológica en el mundo, con implicaciones socio-económicas importantes para el paciente y sus familiares, pues ocurre generalmente en adultos jóvenes, con una buena agudeza visual al inicio del evento traumático y que se verá comprometida según la severidad del trauma, las estructuras oculares que afecte y las complicaciones que puedan aparecer; de ahí que la pérdida de la visión sea una de las minusvalías más temidas. Presentación del caso: Paciente con alteraciones anatómicas y funcionales producidas por un trauma ocular a globo abierto penetrante zona 3, y presencia de cuerpo extraño intraocular vegetal, donde se logró un diagnóstico precoz y conducta quirúrgica oportuna obteniendo resultados visuales excelentes. Conclusiones: El trauma ocular a globo abierto penetrante zona III con cuerpo extraño intraocular vegetal, a pesar de su difícil manejo, permite alcanzar buenos resultados visuales. Esto depende del diagnóstico precoz, y una conducta pertinente basándose en criterios actuales del BETT Y del OTS(AU)

Introduction: Ocular trauma is a fundamental cause for ophthalmological morbidity worldwide, with important socio-economic implications for the patient and their relatives, since it usually occurs in young adults, with good visual acuity at the beginning of the traumatic event and which will be seen compromised based on trauma seriousness, the affected ocular structures and the complications that may appear; hence, vision loss is one of the most feared handicaps. Case presentation: Patient with anatomical and functional alterations produced by an ocular trauma in open penetrating globe zone III, and the presence of a vegetal intraocular foreign body, where an early diagnosis and timely surgical behavior were achieved, obtaining excellent visual results. Conclusions: Ocular trauma in open penetrating globe zone III with vegetal intraocular foreign body, in spite of its difficult management, allows to achieve good visual results. Based on current criteria, this depends on early diagnosis and relevant behavior based on current criteria(AU)

Clinical characteristics and prevention of ocular penetrating injuries in children / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To analyze the clinical features of children ocular penetrating trauma,and hope to effectively assist to prevent pediatric ocular trauma METHODS: The data of 145 cases (145 eyes) with ocular penetrating trauma,hospitalized in Xijing Hospital from January 2012 to December 2016,were collected and retrospectively analyzed.All the data of injury factors and environment,age and gender of patients,lesions,treatment and prognosis were detailed studied.RESULTS: In all the 145 pediatric patients with ocular penetrating trauma,accounted for 8.5% of all the ocular trauma patients,there were 95 cases of male,and 50 of female.Penetrating injuries mainly occurred in age of 3-9.The main injuries of ocular perforating in children were scissors,and sharp objects of wooden and iron.The wound was often located in the cornea or the anterior sclera.Traumatic cataract,vitreous hemorrhage and endophthalmitis were the common complications.The visual acuity was severely damaged,and 90 cases (62.1%) of the children recovered better than 0.1 after effective treatment.CONCLUSION: The visual function of pediatric p0atients was seriously threatened after penetrating injuries.However,the damage of vision and the rate of blindness can be reduced effectively after timely and correct diagnosis and treatment.It is the most important that active and effective prevention in keep children away from penetrating injuries.

Treatment of large irregular rabbit corneal penetrating injury with fibrin glue / 中华实验眼科杂志

Background Suture stitching is currently the standard treatment for corneal penetrating injuries.The shortcomings of suture stitching have led to the exploration of non-sutured surgical methods.Tissue adhesive is a promising non-suture replacement procedure.Objective This study was to observe the effect of fibrin glue on large irregular rabbit corneal penetrating injury.Methods Eighteen pure white healthy rabbits were randomly divided into suture group and adhesive group.A total length of 6-mm non-self-sealing corneal penetrating injury in nonpupillary-area of the right eye formed with a 15° corneal puncture knife was repaired with fibrin glue plus temporary suture and therapeutic corneal contact lens (9 eyes) or with 3 to 5 interrupted 10-0 nylon sutures (9 eyes) with the fellow eyes acted as the internal controls respectively.Operative time was compared between the two groups.Clinic observation was performed with slit lamp microscope.Animals were humanely sacrificed for histologic examination at week 1,3,and 8 to evaluate wound healing.Results The average operation time was (3.48±0.48) minutes in the adhesive group,which was significantly lower than that in the suture group ([7.77 ± 1.30] minutes) (t =9.28,P＜ 0.01).The postoperative slit lamp microscope observation indicated corneal wounds were quickly and regularly healed in the glued corneas compared with the stitched ones.The histologic examination revealed that glued corneas had regular healing,mild inflammation,and no corneal neovascularization,while sutured corneas showed irregular fibrin arrays,a large number of inflammatory cells and macrophages infiltration around the suture,heavy inflammatory response.Neovascularization was found at week 3 postoperatively.Conclusions Fibrin glue combined with temporary suture and therapeutic corneal contact lens is an effective treatment in sealing large irregular corneal wounds with considerable advantages over traditional sutures,ircluding simplified operative technique,short surgery time,less postoperative irritation,mild inflammation,more regular wound healing,short healing time,and no corneal neovascularization.

Wooden stick penetration from the perineal region up to the thorax / 世界急诊医学杂志（英文）

@#BACKGROUND: Penetrating injuries of the perineum are rare but very dangerous. Since the genitourinary and colorectal organs may be injured, how to evaluate surgical management of the injury is very important. METHODS: The present report presents a case of penetrating injury of the perineum by a wooden stick when the patient fell on the upright wooden stick from a tree. The three feet long stick entered the perineal region just left lateral to the anal opening. Upon reaching the thoracic cavity, it broke and only a foot stick was left in the subcutaneous plane. These injuries are potentially serious with risk of damage to multiple organs. Exploratory laprotomy was done, and bladder injury was repaired. The entry wound and the track of stick was thoroughly washed and allowed for secondary intention healing. RESULTS: The post operative period was uneventful and the patient recovered fully. CONCLUSION: Meticulous evaluation and surgical management of perineal injuries are the key to prevent devastating complications.

Ferimento transfixante em criança: relato de caso clínico / Transfixing injury in a child: a case report

Ferimentos penetrantes em região de cabeça e pescoço podem ter morbidade e mortalidade significativos. avaliação rápida e adequadas condições de tratamento iniciais, especialmente no que se refereà estabilidade das vias aéreas e controle vascular, são fundamentais no correto manejo dessas lesões. O presente artigo se constitui em de um relato de caso em criança após acidente transfixante em pescoço e face, buscando trazer uma revisão de literatura sobre o assunto e as diretrizes atuais de tratamento para esse tipo de lesão.

Penetrating injuries to the neck and head can have significant morbidity and mortality. Rapid assessment and prompt management of life threatening conditions especially airway and vascular control is essential in early management. The following article it is a case report of a child after accident transfixing neck and face, seeking to bring a literature review on the subject and the current guidelines for treating this type of injury.

Traumatismo encefalocraneano fetal por vía penetrante transvaginal / Transvaginal penetrating fetal head injury

Los traumatismos encefalocraneanos in útero son extremadamente raros y suelen ser consecuencia de lesiones penetrantes a través de la pared torácica o abdominal, que alcanzan la cavidad uterina. Los originados a través de la vagina se han comunicado excepcionalmente. Se presenta el caso de un feto que padeció traumatismo encefalocraneano penetrante, con fractura de la bóveda craneal y hemorragia intraventricular tras la introducción violenta de un objeto contundente a través de la vagina por parte de su madre. La ruptura traumática de las membranas ovulares desencadenó el trabajo de parto pretérmino. Tras el nacimiento, se realizó tratamiento quirúrgico de la fractura deprimida y desbridamiento de la herida; sin embargo, el paciente falleció cuatro semanas más tarde a causa de sepsis neonatal. El tratamiento de estos casos no solo deber ser dirigido a la corrección de las lesiones traumáticas primarias sino también a la prevención de las complicaciones infecciosas.

In utero head traumas are extremely rare and are usually caused by penetrating injuries in the thoracic or abdominal wall that affect the uterine cavity. Transvaginal fetal head injuries have been reported in exceptional cases. This is a case-report of a fetus affected by penetrating head trauma with skull fracture and intra-ventricular hemorrhage after his mother's self-insertion of a blunt object, violently through the vagina. Trauma disrupted the integrity of intrauterine membranes and precipitated preterm labor. After birth, there was a debridement of the scalp and surgical management of the fracture was performed; nevertheless, the patient died four weeks later, due to neonatal sepsis. Management of these wounds must not only be focused on repairing the primary wound, but on preventing the infectious complications.

Incidentally Discovered a Self-Inflicted a Nail in the Brain of Schizophrenia Patient

The self-infliction of foreign bodies into the brain represents rare a clinical phenomenon that has been reported primarily in cases involving accidents and suicide attempts. However, various motivations for self-injurious behaviors as well as suicide attempts have been reported, especially in patients with psychotic illnesses. A 47-year-old man with a history of schizophrenia presented to our hospital due to the presence of a nail on his plain skull X-ray. He diagnosed paranoid type of schizophrenia about 17 years earlier, and his psychiatric symptoms were well controlled by medication. Interestingly, he was not aware of the presence of the nail in his brain and showed no neurological deficits. In the course of detailed history taking, we discovered that the nail was driven into his brain during a hallucinatory experience that had occurred more than 10 years earlier. Because we believed that removing the nail from his brain would be more dangerous than maintaining the status quo, the nail was not removed. This is a very rare case of a self-inflicted injury involving inserting a nail into the brain under the influence of hallucinations. The absence of adverse effects or neurological symptoms/signs related to the presence of a foreign metallic body in the brain for over 10 years is exceptional.

Clinical Analysis of Patients with Abdomen or Neck-penetrating Trauma

PURPOSE: Recently, the change to a more complex social structure has led to an increased frequency of traumas due to violence, accident and so on. In addition, the severity of the traumas and the frequency of penetrating injuries have also increased. Traumas to cervical and abdominal areas, what are commonly seen by general surgeons, can have mild to fatal consequences because in these areas, various organs that are vital to sustaining life are located. The exact location and characteristics of the injury are vital to treating patients with the trauma to these areas. Thus, with this background in mind, we studied, compared, and analyzed clinical manifestations of patients who were admitted to Wonju Christian hospital for penetrating injuries inflicted by themselves or others. METHODS: We selected and performed a retrospective study of 64 patients who had been admitted to Wonju Christian Hospital from January 2005 to December 2009 and who had cervical or abdominal penetrating injuries clearly inflicted by themselves or others. RESULTS: There were 51 male (79.7%) and 13 female (20.3%) patients, and the number of male patients was more dominant in this study, having a sex ratio of 3.9 to 1. The range of ages was between 20 and 86 years, and mean age was 43.2 years. There were 5 self-inflicted cervical injuries, and 19 self-inflicted abdominal injuries, making the total number of self-inflicted injury 24. Cervical and abdominal injuries caused by others were found in 11 and 29 patients, respectively. The most common area involved in self-inflicted injuries to the abdomen was the epigastric area, nine cases, and the right-side zone II was the most commonly involved area. On the other hand, in injuries inflicted by others, the left upper quadrant of the abdomen was the most common site of the injury, 14 cases. In the neck, the left-side zone II was the most injured site. In cases of self-inflicted neck injury, jugular vein damage and cervical muscle damage without deep organ injury were observed in two cases each, making them the most common. In cases with abdominal injuries, seven cases had limited abdominal wall injury, making it the most common injury. The most common deep organ injury was small bowel wounds, five cases. In patients with injuries caused by others, six had cervical muscle damage, making it the most common injury found in that area. In the abdomen, small bowel injury was found to be the most common injury, being evidenced in 13 cases. In self-inflicted injuries, a statistical analysis discovered that the total duration of admission and the number of patients admitted to the intensive care unit were significantly shorter and smaller, retrospectively, than in the patient group that had injuries caused by others. No statistically significant difference was found when the injury sequels were compared between the self-inflicted-injury and the injury-inflicted-by-others groups. CONCLUSION: This study revealed that, in self-inflicted abdominal injuries, injuries limited to the abdominal wall were found to be the most common, and in injuries to the cervical area inflicted by others, injuries restricted to the cervical muscle were found to be the most common. As a whole, the total duration of admission and the ICU admission time were significantly shorter in cases of self-inflicted injury. Especially, in cases of self inflicted injuries, abdominal injuries generally had a limited degree of injury. Thus, in our consideration, accurate injury assessment and an ideal treatment plan are necessary to treat these patients, and minimally invasive equipment, such as laparoscope, should be used. Also, further studies that persistently utilize aggressive surgical observations, such as abdominal ultrasound and computed tomography, for patients with penetrating injuries are needed.

Fetal Head Injury due to Penetrating Abdominal Stab Wound in a 31 Weeks Pregnant Woman / 대한주산의학회잡지

Penetrating trauma in a fetus is uncommon but may cause potentially life-threatening injuries. We experienced a case of preterm infant who delivered by C-section and showed two deep laceration wounds on face, facial nerve palsy, skull fracture and intracranial hemorrhage due to penetrating injury of an abdominal stab wound in a 31 weeks pregnant woman.

Successful management of asymptomatic penetrating carotid artery injury.

A 30-year-old male sustained a gunshot wound (GSW) in zone II of the left side of his neck. Initially, an inlet wound had an active bleeding which stopped later. When he arrived at our hospital, his vital signs had stabilized and the examination showed no abnormality in the aerodigestive tract and normal focal signs of hemispheric function. There was only a positive sign in paresthesia at the lateral aspect of his left shoulder and upper arm. He had undergone several investigations and then, was treated successfully by repairing his left carotid artery with a reversed saphenous vein graft. To our knowledge, this is a rare case of asymptomatic penetrating carotid artery injury. In this paper, we also reviewed literatures discussing about investigations and controversial issues in the management of a zone II penetrating neck injury.

Clinical management of non-missile penetrating brain injury and intracranial foreign body / 中国基层医药

Objective To study the clinical management of non-missile penetrating brain injury and intracranial foreign body.Methods Retrospectively analyzed 5 cases of non-missile penetrating brain injury and intracranial foreign body,and reviewed relative literature.Results Eady surgical management for all 5 cases,4 cases were cured except hemiparesis in 1 case.There were not active bleeding during surgical treatment,and there were not intracranial infection,epilepsy and cerebrospinal fluid leakage in post-operation in all 5 cases.Conclusions The surgical plan is rely on skull X-rays and brain CT scan.To keep the penetrating object in situ posttrauma,early surgical intervention,remove the penetrating object and prevent secondary brain injury may provide a better outcome.