Efficacy of Omental Implantation of Autologous Splenic Segments after Splenectomy for Traumatic Rupture / 中国医科大学学报

Objective To evaluate the feasibility and efficacy of autologous splenic segment implantation after splenectomy for traumatic rupture. Methods This study included 42 patients with traumatic splenic rupture who were treated between July 2014 and August 2016 at the Affiliated Central Hospital of Shenyang Medical College. The patients were divided into an observation group (n = 23) and a control group (n = 19). Informed consent was provided by the patient or family members. The control group underwent routine splenectomy, and the observation group underwent implantation of autologous spleen segments after splenectomy. Results The operative time in the observation group was significantly longer than in the control group (P < 0.05). The intraoperative blood loss,time to postoperative return to oral feeding,and length of hospital stay were not statistically different (P > 0.05). The rate of postoperative wound infections in the observation group was significantly lower than in the control group (P < 0.05). All spleen segments developed well in the observation group. At 30 postoperative days,platelets were increased in both groups,but the level in the observation group was significantly lower than in the control group (P < 0.05). IgG,IgM,and IgA levels were significantly higher in the observation group than in the control group at 28 postoperative days (P < 0.01). CD3+ and CD4+/CD8+ levels were significantly higher in the observation group than in the control group at 14 and 28 postoperative days (P < 0.01). Conclusion Implantation of autologous spleen segments after splenectomy for trauma could be feasible and effective.

Ruptura traumática de la arteria vertebral por herida penetrante en el cuello / Traumatic rupture of the vertebral artery caused by penetrating neck injury

Introducción: la exanguinación es una entidad clínica dramática que requiere rapidez de pensamiento y acción para obtener buenos resultados.Presentación del caso: se reporta el caso de un paciente de 13 años que sufrió accidente automovilístico y fue atendido en el Hospital Pediátrico Eliseo Noel Camaño , de la provincia de Matanzas, Cuba. El niño llegó con múltiples traumas en miembros superiores e inferiores, y una herida penetrante en el cuello que requirió tratamiento quirúrgico inmediato para controlar hemorragia. Se necesitó un acceso multidisciplinario de intensivistas, anestesiólogos, cirujanos pediátricos, neurocirujanos y cirujanos vasculares, porque la cuantía del sangrado y la localización de la lesión hicieron sospechar una afección traumática de la arteria vertebral. El niño sobrevivió a la lesión exanguinante, y actualmente se encuentra en proceso de recuperación.Conclusiones: la lesión penetrante del cuello puede provocar ruptura traumática de la arteria vertebral, entidad infrecuente que requiere alta sospecha diagnóstica para lograr éxito en su tratamiento. Consideramos vital la visión multidisciplinaria, en la que deben prevalecer maniobras seguras, rápidas y eficientes(AU)

Introduction: exsanguination is a dramatic clinical condition that requires quick analysis and action to achieve good results.Case report: this is a 13 years/old patient who suffered a car accident and was seen at Eliseo Noel Camano pediatric hospital in Matanzas province, Cuba. The teenager had many upper and lower limb traumas and a penetrating neck injury that required immediate surgery to control hemorrhage. It was necessary to involve intensive care experts, anesthesiologists, pediatric surgeons, neurosurgeons, and vascular surgeons because the amount of bleeding and the location of injury aroused the suspicion of traumatic damage of the vertebral artery. The teenager managed to survive from the exsanguinating injury and is currently in his recovery process.Conclusions: the penetrating neck injury may cause traumatic rupture of the vertebral artery, an uncommon condition that requires great diagnostic suspicion in order to succeed in treatment. It is vital to have a multidisciplinary vision in which safe, rapid and effective procedures should prevail(AU)

A comparative study on the effect of interventional embolization and surgical treatment for traumatic splenic rupture / 实用放射学杂志

Objective To investigate the value of emergency interventional embolization in the treatment of traumatic splenic rupture.Methods Clinical data of 45 patients with traumatic splenic rupture in our hospital were analyzed retrospectively.Selective splenic artery embolization (embolization group) was performed in 29 patients guided by DSA,and surgical resection or repair operation (operation group) was performed in 16 patients.Results Data of two groups were compared:①For operation time and length of hospital stay,the intervention group was significantly better than the operation group (P0.05);④Compared with the operation group,patients in the intervention group had less long-term complications,and did not require long-term anticoagulation therapy.Conclusion Interventional embolization in the treatment of traumatic splenic rupture is safe and effective, and has less postoperative complications.The interventional embolization improves spleen preservation rate and improved the life quality.

Clinical significance of creatine kinase and creatine kinase isoenzyme in patients with traumatic rupture in early stage / 中国综合临床

Objective To investigate creatine kinase (CK) and creatine kinase isoenzyme (CK-MB) changes of patients with traumatic rupture in the early stage.Methods Eighty-six patients with traumatic rupture who were treated in the Fourth Hospital Affiliated to China Medical University were enrolled to rupture group(rupture.group) and 40 cases of patients with abdominal trauma but non-rupture were admitted to abdominal trauma group.Another 40 healthy volunteers were enrolled to healthy control group.The myocardial enzymes were detected at before operation (T0),2 h after operation(T1),12 h after operation(T2),24 h after operation (T3),3 d after operation(T4) and 7 d after operation(T5).Results The contents of CK and CK-MB in rupture group,abdominal trauma group and control group were (573.4 ± 168.6) U/L and (30.4 ± 15.3) U/L,(59.3 ± 37.5) U/L and (7.6 ± 4.8) U/L,(30.7 ± 16.2) U/L and (5.6 ± 1.4) U/L respectively.There was significant difference among three group (F =295.696,90.109 ; P ＜ 0.001).SNK test showed that the contents of CK and CK-MB in rupture group were higher than that in abdominal trauma group or control group(P ＜ 0.05),and there was no significant difference between abdominal trauma group and control group(P ＞0.05).The contents of CK and CK-MB levels in rupture group at T1,T2,T3,T4 and T5 were (668.2 ±215.4),(589.3 ± 187.6),(551.2 ±202.8),(214.9 ± 194.5),(134.2 ± 118.3) U/L and (36.8 ± 17.5),(29.3 ± 16.4),(27.9 ± 17.3),(15.6 ± 9.7),(10.1 ± 4.4) U/L respectively,which were all higher than that in abdominal trauma group (CK:(67.5 ±41.8),(43.5 ±24.7),(34.2 ± 17.6),(33.4 ±16.5),(32.2 ±17.1) U/L;CK-MB:(8.1 ±5.2),(7.5 ±4.3),(7.1 ±3.9),(6.7 ±2.5),(6.1 ± 1.9)U/L),and the differences were statistically significant(P ＜ 0.05).At T0,T1 and T3 time point,the content of CK-MB of patients with Ⅲ and Ⅳ stage in rupture group were (37.9 ± 15.2),(42.8 ± 16.9),(33.2 ± 17.2),(29.7 ± 16.6) U/L respectively,higher than that in patients with Ⅰ and Ⅱ stage ((26.5 ± 17.3),(31.2 ±18.2),(25.3±15.7),(23.2±18.4) U/L;P ＜0.05).Conclusion The CK and CK-MB levels of patients with traumatic rupture appear elevated at early stage.Meanwhile,the changes of CK-MB are positively correlated with the rupture injury classification,which indicated that myocardial injury may appear in early stage of patients with traumatic rupture.It should be concerned myocardial enzymes changes in patients as early as possible.

Tratamiento endovascular de transecciones agudas de la aorta descendente / Endovascular treatment of acute traumatic aortic rupture

Background: Traumatic rupture of the thoracic aorta as a result from high-speed deceleration injury is associated with a mortality rate of 80 percent to 90 percent at the scene of the accident. Survivors usually have life-threatening injuries to other organ systems. Standard open repair is associated with a high penoperative morbidity and mortality. Endografting offers a less invasive alternative to open surgical repair. Aim: To evaluate results of endovascular management of acute traumatic descending thoracic aortic ruptures. Methods: Between August 2002 and March 2010, patients treated for this trauma were reviewed. Results: 16 patients (fourteen males mean age 42.7 +/- 15.8 years, range 24-74) underwent endovascular treatment of an acute aortic rupture. Associated traumas in fifteen patients were: severe brain (7), spleen (4), liver (1), kidney (3) and large bone (9) injuries. Motor vehicle accidents caused 13 of the injuries and fall from height 3. Rupture was diagnosed with admission CT sean and confirmed by intraoperative angiogram. Patients were treated with thoracic aortic endograft, in 11 cases the left subclavian artery was covered with no need for further revascularization. Technical success was 100 percent, no procedure-related mortality or paraplegia was observed. One patient died 5 days after the procedure due to severe associated injuries. During a mean follow-up of 30.8 months (range 1-80), no deaths, complications or need for further interventions presented. Conclusion: Endovascular treatment of acute traumatic aortic isthmic rupture is encouraging and compares favorably to open surgical approach with low morbidity and mortality rates.

Los accidentes por desaceleración súbita se asocian a transección de la aorta torácica, falleciendo 85-90 por ciento de ellos en el sitio del suceso. Los que sobreviven presentan habitualmente politraumatismo asociado grave, teniendo la reparación quirúrgica convencional de la aorta una alta morbimortalidad. La reparación endovascular es una alternativa menos invasiva y de menor morbi-mortalidad. Objetivo: Analizar los resultados de la reparación endovascular de transecciones agudas de la aorta torácica. Pacientes y Métodos: Se revisan los antecedentes de los pacientes tratados entre agosto de 2002 y marzo de 2010. Resultados: Tratamos 16 pacientes (14 hombres, 42,7 +/- 15,8 años, extremos 24-74) con transección traumática aguda de aorta torácica descendente. Quince presentaban lesiones asociadas: traumatismo encéfalo-craneano (7), fractura de huesos largos (9), laceración esplénica (4), hepática (1), renal (3). La causa del accidente fue vehicular en 13 casos y caída de altura en 3. El diagnóstico fue realizado mediante tomograña axial computada al ingreso y luego angiograña en la sala de operaciones. El tratamiento consistió en la cobertura de la zona de transección mediante el implante de una endoprótesis, siendo necesario cubrir la arteria subclavia izquierda en 11 casos, sin requerir revascularización de la extremidad. El éxito técnico fue 100 por ciento, no hubo mortalidad relacionada al procedimiento. No hubo paraplejia. Un paciente de 60 años fallece al 5to día por lesiones asociadas graves. En el seguimiento alejado a 30,8 meses (1-80) no ha habido complicaciones ni reintervenciones. Conclusión: La cirugía endovascular es una alternativa eficaz y con baja morbimortalidad para el tratamiento de transecciones de la aorta torácica.

Traumatic Carotid Cavernous Fistula Caused by Intradural Aneurysm Rupture: A Case Report / 신경중재치료의학

Traumatic carotid carvenous fistula (CCF) associated with cerebral aneurysm is a rare condition. Early detection of the traumatic cerebral aneurysm (TCA) before traumatic CCF occlusion is difficult, largely because of steal phenomenon of the fistula, masking by complex venous drains and a nearby parent artery, and a latent period of the TCA. In addition, traumatic CCF caused by a combined aneurysm rupture is an extremely rare condition. It is a dangerous condition in which treatment should be performed immediately or even on an emergency basis. A 31-year-old man developed traumatic CCF after traffic accident. Cerebral angiography revealed a direct CCF communicated with an intradural aneurysm on the origin of right posterior communicating artery (PcomA). Successful transarterial coil embolization was achieved after consecutive two trials.

Clinical application of orthotopic spleen-preserved operati on characterized of taking advantage of collateral circulation / 中国综合临床

Objective To explore the feasibility of orthotopic spleen-p re served operation characterized of taking advantage of collateral circulation.Methods 12 cases with severe injuries of the spleen and its pedicle underwent splenic pedicel ligation and irregular subtotal splenectomy.R esults All patients had good operative and postoperative results and no postoperative complications.Ultrasonography and CT scanning showed that the remn ant of spleen had no infarct and secondary hemorrhage.Conclusion Orthotopic spleen-preserved operation using collateral circulation is useful i n treating severe traumatic rupture of spleen accomplied by destruction of sple nic pedicles.

Clinical Study of Indirect Traumatic Rupture of the Choroid

Indirect traumatic rupture of the choroid is a common sequela of contusion of the globe. Choroid is more prone to rupture than the other ocular coats because of the greater toughness of the sclera and the greater elasticity of the retina. Initially, a choroidal rupture may be obscured by a subretinal hemorrhage caused by tearing of the choriocapillaris. Later, after the blood has resorbed, a white curvilinear streak concentric to the optic disc is seen. Ophthalmoscopically, detection may be difficult, and fluorescein angiography may be required to reveal the presence or true extent of the choroidal rupture. The authors evaluated the clinical course of 34 cases of indirect rupture of the choroid at Department of Ophthalmology, Pusan Paik Hospital Inje University from January, 1984 to April, 1988. The results were as follows: 1. The sex distribution revealed 28 male(82.4%) and 6 female(17.6%) but there was no significant difference in the laterality of affected eye. 2. The most prevalent age group was the twenties(35.3%). 3. The most common site of choroidal rupture was found in T group, which was the worst group in the final visual acuity.

Complete Traumatic Rupture of Female Urethra

Four cases of complete traumatic rupture of female urethra were reviewed. Herein the incidence, etiology and treatment modalities of complete rupture of female urethra are discussed to propose guidelines for the proper management of these unusual injuries. I recommend the following: Through the retropubic approach in children, a primary realignment with either surgery or an interlocking Foley catheterization should be performed as in the delayed retropubic urethroplasty when primary realignment was not accomplished. Transvaginal repair is considered choice approach for the urethro-vaginal laceration due to other than pelvic fracture in adults.