A case report of a transorbital penetrating intracranial injury from a motorcycle side mirror metal bar

Objective@#To present a case of transorbital penetrating intracranial injury successfully managed using a stepwise multispecialty approach.@*Methods@#This is a case report.@*Results@#A 26-year-old male presented with a motorcycle side-mirror metal bar impaled into his right orbit. He had a Glasgow Coma Scale (GCS) score of 12. Computed tomography (CT) imaging revealed the metal bar’s trajectory from the right lateral canthus, traversing the superior orbital wall and frontal lobe, resulting in contusion, intracranial hemorrhages and multiple orbital and facial fractures. Despite the severity of the injury, the right globe was found to be intact during intraoperative exploration. The transorbital approach was employed for safe removal of the penetrating object, followed by repair of full-thickness eyelid laceration and transections of the lateral and medial canthi. Subsequently, the Neurosurgery service conducted a right pterional craniotomy, debridement, and duraplasty. Upon discharge, the visual acuity on the right eye was 20/50.@*Conclusion@#Transorbital penetrating intracranial injuries are rare and result in vision loss and life-threatening complications. A transorbital approach in removing a penetrating foreign body can be adopted when injury to cerebral tissues is imminent. Individualizing the management and employing a multispecialty approach can lead to favorable outcomes.

Trauma penetrante de arteria vertebral. Del control de daños a lo endovascular

Introducción: El trauma penetrante de la arteria vertebral es extremadamente infrecuente. Objetivo: Aportar evidencia clínica mediante la revisión de una serie de casos. Materiales y Método: Se analizan cuatro casos de trauma penetrante con compromiso de la arteria vertebral entre los años 2020 y 2021, manejados en la unidad de trauma y urgencias del Complejo Asistencial Dr. Sótero del Río. Resultados: Se presentan cuatro casos clínicos relatando su proceso diagnóstico y manejo. Discusión: La evidencia de compromiso traumático de arteria vertebral es escasa. Reconocer su compleja anatomía y variada clínica resultan trascendentales para su adecuado manejo. Ante sospecha de este tipo de lesión, la angiografía por tomografía computada es el estudio de elección cuando se presentan hemodinámicamente estables. El abanico de opciones terapéuticas incluyen: observación, terapia antitrombótica o con antiagregantes, terapia endovascular o cirugía abierta. Conclusión: El trauma penetrante de arteria vertebral es una condición infrecuente, sin embargo, su diagnóstico y manejo deben ser conocidos por el cirujano.

Introduction: Traumatic involvement of the vertebral artery is extremely rare and difficult to diagnose. Objective: To provide clinical evidence by reviewing a case series. Materials and Method: We analyze four cases of penetrating trauma with involvement of the vertebral artery between 2020 and 2021, managed in the trauma and emergency unit of the Dr. Sótero del Río Care Complex. Results: Four clinical cases are presented describing diagnosis and management process. Discussion: There is little evidence of traumatic involvement of the vertebral artery. Recognizing its complex anatomy and varied clinic are transcendental for its proper management. When this type of lesion is suspected, computed tomography angiography is the choice study when hemodynamically stable. The range of therapeutic options include observation, antithrombotic or antiplatelet therapy, endovascular therapy or open surgery. Conclusion: Penetrating trauma of the vertebral artery is an uncommon condition, however, its diagnosis and management should be known to the surgeon.

Enfoque terapéutico en el trauma penetrante de esófago cervical / Therapeutic Approach in the Penetrating Cervical Esophageal Trauma

Introducción: Las perforaciones del esófago cervical por traumas externos son lesiones raras asociadas con una morbilidad significativa. Los mecanismos primarios son los traumatismos penetrantes por heridas de bala, cerca del 80 por ciento de los casos, seguidas de las heridas con armas cortopunzantes en el 15 al 20 por ciento. Objetivo: Describir los criterios actuales sobre la conducta y enfoque terapéutico ante el trauma penetrante de esófago cervical. Métodos: Se realizó revisión descriptiva narrativa, de fuentes primarias y secundarias que abordaron el tema durante el primer semestre del año 2021. Los criterios de selección de los artículos a examinar fueron determinados, entre otros, por el objetivo de la actual revisión. Desarrollo: El estándar diagnóstico para estas lesiones, en ausencia de inestabilidad hemodinámica, se basó en estudios como el esofagograma, la endoscopia y la tomografía. La reparación primaria con o sin reforzamiento fue la opción más utilizada, aunque las condiciones locales y tipo de lesión en esófago cervical marcan en gran medida el proceder a realizar. Conclusiones: Las lesiones traumáticas del esófago cervical son raras pero muy mórbidas. El tratamiento depende de la ubicación de la perforación y cualquier lesión concurrente. La mayoría de los casos son susceptibles de reparación primaria con refuerzo de colgajo. Otros principios del tratamiento incluyen el drenaje adecuado alrededor de la reparación, la descompresión del esófago y el estómago (mediante sonda nasogástrica o sonda de gastrostomía) y nutrición enteral distal (yeyunostomía de alimentación). El cirujano ha de ser incisivo en los esfuerzos por descubrir la lesión de forma temprana y manejarla adecuadamente(AU)

Introduction: Cervical esophageal perforations for external trauma are rare injuries associated with a significant morbidity. The primary mechanisms are penetrating trauma for gunshot wounds, accounting for about 80 percent of cases, followed by sharp weapon injuries, accounting for 15 percent to 20 percent. Objective: To describe the current criteria on the behavior and therapeutic approach to cervical esophageal penetrating trauma. Methods: A descriptive narrative review was carried out of primary and secondary sources that addressed the subject during the first semester of the year 2021. The selection criteria of the articles to be examined were determined, among others, by the objective of the current review. Development: The standard diagnosis for these lesions, in the absence of hemodynamic instability, was based on studies such as esophagogram, endoscopy and tomography. Primary repair with or without reinforcement was the most commonly used option, although local conditions and type of lesion in cervical esophagus largely mark the procedure to be performed. Conclusions: Traumatic cervical esophageal injuries are rare but very morbid. Their treatment depends on the location of the perforation and any concurrent injury. Most cases are amenable to primary repair with flap reinforcement. Other principles of treatment include adequate drainage around the repair, decompression of the esophagus and stomach (by nasogastric tube or gastrostomy tube), as well as distal enteral nutrition (feeding jejunostomy). The surgeon must be incisive in efforts to discover the injury early and manage it appropriately(AU)

Analysis of 74 Open Globe Injuries Requiring Vitreo-Retinal Intervention and Its Correlation with Ocular Trauma Score

Aim: Retrospective study of 74 eyes with open globe injuries requiring V-R Intervention & its correlation with ocular trauma score.Results: Commonest cause of injury: Hammer-chisel/stone in 32.43% (24) & Thorn/wooden stick 27% (20). Average age-30.5yrs. Average interval between trauma & intervention was -10.04days (4hrs – 52days).Discussion: Delay of presentation to ophthalmologist has lot of significance,high incidence of endophthalmitis & retinal detachment compared to other studies. Surgical outcome shows lower incidence of NO Light Perception & Significant reduction in number of cases with </=HM. Patients had better prognosis & visual outcome, higher incidence of 1/200- 20/50; 35.14% cases with >20/200. 60% of our cases had traumatic cataract, visual acuity may be underestimated in traumatic cataract. Faulty Projection of rays probably would be better criteria than RAPD. Extension of wound beyond pars plana, and aniridia (6.7%) are important risk factor.Conclusion: Modification of raw points is recommended in OTS criteria in Indian scenario.

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.

Penetrating Scrotal Injury: Two Unusual Case Reports in Children and Brief Review of Literature

Introduction:Scrotal trauma is a rare surgical emergency that accounts for less than 1% of all traumatic injuries. They are more prevalent in 15-40 years age group. Blunt scrotal trauma contributes to about 80% of all scrotal injuries whilst penetrating scrotal injuries constitute the remaining 20%. Penetrating scrotal injuries are however, more rare in children but can result from bicycle handlebars, falls with impalement, and animal bites. Case Reports: We did a retrospective review of our records over a 7-year period for penetrating scrotal injuries and report two (2) cases involving 13-year old and 14-year old males who sustained injuries from a tree branch and an iron rod respectively after falling from heights. Discussion:Penetrating scrotal trauma can present with complex injury patterns involving the testes and other surrounding structures, and all invariably need urgent scrotal exploration Consequently, both of our cases had immediate surgical exploration with conservative debridement of non-viable tissue and surprisingly both were spared any testicular injury. Conclusion:Penetrating scrotal trauma may spare the testis and the scrotal contents despite the gravity of the injury.

Implementation of a new Single-Pass Whole-Body Computed Tomography Protocol: Is it safe, effective and efficient in patients with severe trauma? / Implementación de un nuevo protocolo de Tomografía Computarizada Corporal Total de un solo pase: ¿Es seguro, efectivo y eficiente en pacientes con trauma severo?

Abstract Purpose: The objective of this study was to evaluate the implementation of a new single-pass whole-body computed tomography Protocol in the management of patients with severe trauma. Methods: This was a descriptive evaluation of polytrauma patients who underwent whole-body computed tomography. Patients were divided into three groups: 1. Blunt trauma hemodynamically stable 2. Blunt trauma hemodynamically unstable and 3. Penetrating trauma. Demographics, whole-body computed tomography parameters and outcome variables were evaluated. Results: Were included 263 patients. Median injury severity score was 22 (IQR: 16-22). Time between arrival to the emergency department and completing the whole-body computed tomography was under 30 minutes in most patients [Group 1: 28 minutes (IQR: 14-55), Group 2: 29 minutes (IQR: 16-57), and Group 3: 31 minutes (IQR: 13-50; p= 0.96)]. 172 patients (65.4%) underwent non-operative management. The calculated and the real survival rates did not vary among the groups either [Group 1: TRISS 86.4% vs. real survival rate 85% (p= 0.69); Group 2: TRISS 69% vs. real survival rate 74% (p= 0.25); Group 3: TRISS 93% vs. real survival rate 87% (p= 0.07)]. Conclusion: This new single-pass whole-body computed tomography protocol was safe, effective and efficient to decide whether the patient with severe trauma requires a surgical intervention independently of the mechanism of injury or the hemodynamic stability of the patient. Its use could also potentially reduce the rate of unnecessary surgical interventions of patients with severe trauma including those with penetrating trauma.

Resumen Introducción: El objetivo de este estudio fue evaluar la implementación de un nuevo protocolo de tomografía computarizada corporal total para el manejo de pacientes con trauma severo. Métodos: Este estudio es una evaluación descriptiva de pacientes que recibieron tomografía computarizada corporal total. Los pacientes fueron divididos en 3 grupos: 1. Trauma cerrado hemodinámicamente estables, 2. Trauma cerrado hemodinámicamente inestables y 3. Trauma penetrante. Se evaluaron las características demográficas, parámetros relacionados con la técnica y los desenlaces de los pacientes. Resultados: Se incluyeron 263 pacientes. La mediana del puntaje de severidad de la lesión fue 22 (RIQ: 16-22). El tiempo entre el ingreso a urgencias y completar la tomografía corporal total fue menor a 30 minutos en la mayoría de pacientes [Grupo 1: 28 minutos (RIQ: 14-55), Grupo 2: 29 minutos (RIQ: 16-57), y Grupo 3: 31 minutos (RIQ: 13-50; p= 0.96). 172 pacientes (65.4%) recibieron manejo no operatorio. Las tasas de supervivencia calculadas y reales no difirieron entre ninguno de los grupos [Grupo 1: TRISS 86.4% vs. Tasa real de supervivencia 85% (p= 0.69); Grupo 2: TRISS 69% vs. Tasa real de supervivencia 74% (p= 0.25); Grupo 3: TRISS 93% vs. Tasa real de supervivencia 87% (p= 0.07)]. Conclusión: Este nuevo protocolo de tomografía corporal total de un solo pase fue seguro, efectivo y eficiente para definir si los pacientes con trauma severo requieren o no una intervención quirúrgica. Su uso podría reducir la tasa de intervenciones quirúrgicas innecesarias en estos pacientes incluyendo los que se presentan con trauma penetrante.

Adrenal gland injury due to gunshot / 中华创伤杂志(英文版)

Adrenal gland trauma is a rare phenomenon, due to the small size and retroperitoneal location of the organ. The majority of adrenal gland trauma is due to blunt force injury and is only rarely encountered due to the penetrating mechanisms. A 20-year-old male sustained a gunshot wound to the left abdomen. Upon exploration, he was found to have a through and through injury to the left adrenal gland, among other injuries. Injury to the adrenal gland due to penetrating trauma is exceptionally rare. The principles of management are to control bleeding from the gland with debridement and hemostasis rather than attempt to resect the entire organ. The management of a penetrating injury to the adrenal gland is straightforward and should not be a contributor to a patient's morbidity or mortality.

The role of laparoscopy in patients with abdominal trauma

Background: Use of laparoscopy in penetrating trauma has been well established; however, its application in blunt trauma is gaining popularity as a useful diagnostic tool to avoid unnecessary laparotomies where there is diagnostic dilemma. Even though recent case reports seem to suggest that these patients can be managed using laparoscopy, the practice is not yet wildly adopted.Methods: All adult patients who presented with abdominal trauma laparoscopic surgery was considered in patients who were deemed fit for the same in the Department of General Surgery, MMIMSR, Mullana, Ambala during a period of 18 months starting from January 1st 2015 to June 30th 2016. Data was analysed using descriptive statistics.Results: A total of 53 patients with either blunt or penetrating abdominal trauma that required surgery were included in the study. Exploratory laparotomy was performed in 45 patients (84.91%) and laparoscopy was performed in 8 patients (15.09%). Overall mesenteric injury (45.28%) was the most common intra-abdominal injury noted. The most common organ involved in blunt trauma was the spleen (68.97%). The mean operating time of laparoscopy was lesser by 57 minutes as compared to exploratory laparotomy. The use of laparoscopy avoided negative and non-therapeutic laparotomy in 2 patients (25%). Therapeutic laparoscopy was performed in 3 patients with repair of bowel and mesenteric injuries. There was no documented procedure‑related morbidity and mortality.Conclusions: The positive outcomes from the study suggest that laparoscopy can be safe and feasible in both diagnostic and therapeutic interventions in carefully selected blunt abdominal trauma patients.

Diagnosis And Treatment Of Esophagic Trauma In A Reference Hospital.

Background. Penetrating lesions of the esophagus are more common than blunt injuries. The bullet wound (75%) is the main cause of these. In traumatic injuries, primary surgical repair is the standard of treatment. Methods. Observational, Descriptive, cross-sectional, retrospective analysis of patients with esophageal trauma during January 2017 to December 2018. Results.There were 4 male patients, average of hospital stay 37.4 days. The mechanism of injury was: 2 due to injury with a puncturing instrument, 1 due to a gunshot wound (HPAF) and another injury due to perforation with a foreign body. Surgical treatment was: 3 of 4 patients underwent esophageal rafa and one of them had a trachea rafa with a sternocleidomastoid ap. The complications were esophageal stula and tracheal stula. Conclusions.These types of injuries are potentially fatal if there is a delay in diagnosis and treatment.

Unusual Presentation of a Penetrating Aortic Arch Injury

A 27-year-old man was admitted with a penetrating injury at the mid-manubrium. Computed tomographic (CT) angiography showed a filling defect in the aortic arch. This was evaluated as a sign of injury and the patient underwent an emergency operation. No active bleeding or clot was found in the mediastinum during the operation. The laceration point was between the innominate and the left carotid artery posteriorly. The injury was approached using hypothermic circulatory arrest. Aortotomy and exploration showed a 2-cm-long full-thickness aortic injury with an overlying clot. A filling defect on angiography as a sign of a penetrating arch injury has never been reported previously, but was the main pathological finding on CT angiography in our case. The aorta is a high-pressure system and injuries to it should be treated aggressively.

Análisis comprensivo de los traumatismos torácios penetrantes atendidos en Hospital Padre Hurtado de Santiago / Penetrating chest trauma

Objectives: Penetrating chest trauma (PCT) is a life threatening condition that challenges emergency surgeons daily. The aim of this study is to make an epidemiological characterization of these patients, and secondarily analyze their treatment and outcome. Methods: A retrospective analysis of a series of consecutive patients experiencing PCT who presented at our hospital, was performed from 1st May 2009 to 30th April 2013. Results: Of 274 consecutive patients who presented to the emergency department (ED) with PCT, 257 (94 percent) were male and 17 (6 percent) were female. The median age was 26 (range 15-66) years. Stab wounds (SW) accounted for 185 (68 percent) of the injuries, and 80 (29 percent) suffered from gunshot wounds (GSW). As first treatment, chest tube drainage was performed in 229 (84 percent) patients, emergent thoracotomy in 21 (8 percent) and observation, in 13 (5 percent). 26 (9 percent) patients died: 21 (81 percent) from GSW and 4 (15 percent) with SW P<0.0001; 20 (77 percent) had heart or thoracic great vessels involvement. Thoracic complications occurred in 30 (12 percent) patients. There was no mortality associated with thoracic complications. The median hospital stay was 4 days. Conclusions: PCT is frequent in our hospital compared with historical series. The majority of the patients who died had cardiac or thoracic great vessels involvement due to GSW. Therefore, healthcare improvements are needed to reduce mortality in this group of patients.

Objetivos: Los traumatismos torácicos penetrantes (TTP) son graves y desafían diariamente a los cirujanos de urgencia. El objetivo de este estudio es realizar una caracterización epidemiológica de los pacientes con TTP, y como objetivo secundario analizar el tratamiento efectuado y su evolución. Métodos: Se realizó un estudio retrospectivo de los pacientes atendidos en el Hospital Padre Hurtado de Santiago que presentaron un TTP desde el 1 de mayo de 2009 hasta el 30 de abril de 2013. Resultados: 274 pacientes que se consultaron al servicio de urgencia con un TTP, 257 (94 por ciento) eran hombres y 17 (6 por ciento) eran mujeres. La mediana de edad fue 26 (15-66) años. Lesiones por arma blanca 185 (68 por ciento), y 80 (29 por ciento) fueron por arma de fuego. Como primer tratamiento la pleurostomía fue realizada en 229 (84 por ciento) pacientes. La toracotomía de emergencia fue realizada en 21 (8 por ciento) pacientes. No se realizó tratamiento y solo observación en 13 (5 por ciento) de los casos. 26 (9 por ciento) de los pacientes murieron, 21 (81 por ciento) fueron consecuencia de lesiones por arma de fuego y 4 (15 por ciento) por arma blanca P<0,0001, 20 (77 por ciento) tenían lesiones cardíacas o de grandes vasos torácicos. 30 (12 por ciento) pacientes presentaron complicaciones torácicas. No hubo mortalidad asociada a complicaciones torácicas. La mediana de días de hospitalización fue 4. Conclusiones: El TTP es frecuente en nuestro hospital comparado con series históricas. La mayoría de los pacientes fallecidos presentaban TTP por arma de fuego con lesiones cardíacas o de grandes vasos torácicos. Se precisan mejoras asistenciales en este grupo para disminuir su mortalidad.

Duodenal Perforation Caused by an Inferior Vena Cava Filter

The inferior vena cava (IVC) filter is known as an effective and safe method for preventing fatal pulmonary thromboembolism in patients with deep vein thrombosis. Usually, the remaining IVC filters are asymptomatic and do not cause clinical problems. We report a case of duodenal perforation caused by a remaining IVC filter.

Trauma de abdomen / Abdominal trauma

El trauma abdominal representa un gran desafío para el cirujano que trabaja en los Servicios de Urgencia. El objetivo de este artículo es discutir los mecanismos de producción, así como los diferentes métodos diagnósticos que nos ayuden a tomar la mejor decisión terapéutica. Didácticamente se separa el estudio según el mecanismo de producción del trauma, ya que su utilidad es variable. Posteriormente se esboza el tratamiento y se entrega un algoritmo para facilitar decisiones.

Abdominal trauma is a major challenge for surgeons working in emergency services. The aim of this paper is to discuss the mechanisms of production and the different diagnostic methods to help us make the best therapeutic decision. Therefore for better assessment, the study is divided according to the mechanism that produces the trauma, since its usefulness is variable. Later, the treatment is planned and an algorithm is given to facilitate the decisions.

Penetrating Injury of Cervical Trachea: Two Case Reports

Penetrating neck trauma involving tracheobronchial tree is potentially fatal, especially in cases of gunshot injury, which are rare in Korea. A 28-year-old male presenting with an air-leaking gunshot wound in the left supraclavicular area and a 39-year-old female with a full depth penetrating laceration in her chest wall and a pin-point sized cervical wound on the midline below the cricoid cartilage presented with common symptoms of dyspnea and subcutaneous emphysema, and radiologic findings of pneumomediastinum, bilateral pneumothorax and hemothorax, which are key findings suggesting potential major airway injury. Urgent bronchosopic evalution was performed to confirm the suspected diagnosis of tracheobronchial injury, as well as the extent and the level of injury. To exclude associated injury of esophagus and major vascular structures prior to surgical exploration, esophagography and angiography had been carefully planned based on the principles, but were only performed for the second case. Through a low collar incision extending to an mid-thoracotomy incision, the damaged segment of tracheal rings of cervical trachea was resected out and an end-to-end anastomosis was performed for both cases. Extubation was done on the first postoperative day and the chin-to-chest sutures done to minimize the tension at the suture line were maintained until postoperative day 7. Both cases with penetrating injury of cervical trachea regardless of the mechanism of injury were successfully treated by early diagnosis and prompt surgical exploration.

Penetrating Injury of Cervical Trachea: Two Case Reports

Penetrating neck trauma involving tracheobronchial tree is potentially fatal, especially in cases of gunshot injury, which are rare in Korea. A 28-year-old male presenting with an air-leaking gunshot wound in the left supraclavicular area and a 39-year-old female with a full depth penetrating laceration in her chest wall and a pin-point sized cervical wound on the midline below the cricoid cartilage presented with common symptoms of dyspnea and subcutaneous emphysema, and radiologic findings of pneumomediastinum, bilateral pneumothorax and hemothorax, which are key findings suggesting potential major airway injury. Urgent bronchosopic evalution was performed to confirm the suspected diagnosis of tracheobronchial injury, as well as the extent and the level of injury. To exclude associated injury of esophagus and major vascular structures prior to surgical exploration, esophagography and angiography had been carefully planned based on the principles, but were only performed for the second case. Through a low collar incision extending to an mid-thoracotomy incision, the damaged segment of tracheal rings of cervical trachea was resected out and an end-to-end anastomosis was performed for both cases. Extubation was done on the first postoperative day and the chin-to-chest sutures done to minimize the tension at the suture line were maintained until postoperative day 7. Both cases with penetrating injury of cervical trachea regardless of the mechanism of injury were successfully treated by early diagnosis and prompt surgical exploration.

Trauma: the burden of a preventable problem / Trauma: la carga de un problema evitable

Trauma is a leading cause of morbidity and mortality in developing countries and we reviewed the demographics and cost of trauma in a Jamaican population. This is a retrospective, descriptive analytical study of all trauma patients aged 25 to 29years who presented to the University Hospital of the West Indies (UHWI) during the study period, January 2001 to December 2005. Data were extracted from the Trauma Registry and analysed. Seven hundred and fifteen patients were included in the specified age group over the fiveyear period. The median age of the patients was 27 years and the median hospital stay was 3 days. There was a 4:1 ratio of males to females and 49.7% of injuries were caused by penetrating wounds. Motor vehicle accidents occurred in 22.4% of cases. Head injuries occurred in 13.6% of cases, long bone fractures in 16.5% and internal injury to chest or abdominal organs in 15.9% of cases. Craniotomy or thoracotomy was undertaken in 4% of cases, Open Reduction Internal Fixation (ORIF) or bone immobilization in 11% and laparotomy in 8% of cases. The mean injury severity scores (ISS) was 4 while 5% of patients had ISS greater than 15. More than 60% of patients underwent diagnostic Xrays, 8% had abdominal imaging (CT scan or ultrasound) and 9.5% underwent head CT scan. The inhospital mortality was 4.2%. The median hospital bill charged was US$320.00 and the median amount paid by the patients was US$50.00. At the start of the new millennium, penetrating trauma accounted for almost 50% of cases at UHWI with the majority of costs associated with traumacare being state funded.

El trauma es una de las causas principales de morbosidad y mortalidad en los países en vías dedesarrollo. Aquí examinamos la demografía y el costo de los traumas en una población jamaicana. Éste es un estudio retrospectivo, analíticodescriptivo de todos los pacientes traumados de 25 a 29 años de edad que acudieron al Hospital Universitario de West Indies (UHWI) durante el periodo del estudio, a saber, de enero del 2001 a diciembre del 2005. Se extrajeron y analizaron los datos del Registro de Traumas. Setecientos quince pacientes fueron incluidos en el grupo etario especificado en el período de cinco años. La edad mediana de los pacientes fue de 27 años y la mediana de la estadía hospitalaria fue de 3 días. Hubo una proporción 4:1 de varones a hembras, y el 49.7% de lesiones fueron causadas por heridas penetrantes. Los accidentes automovilísticos ocuparon el 22.4% de casos. Las lesiones de cabeza ocurrieron en el 13.6% de casos; las fracturas de huesos largos en el 16.5%; las lesiones interiores del pecho y los órganos abdominales en el 15.9% de los casos. Se requirió craniotomía o toracotomía en el 4% de casos, reducción abierta y fijación interna (ORIF) o la inmovilización de huesos en el 11% de los casos, y laparotomía en el 8% de los casos. El promedio de la puntuación de la severidad de la lesión o puntuación ISS fue 4, mientras que el 5% de pacientes tuvo un ISS mayor de 15. Más del 60% de los pacientes recibieron examen diagnóstico mediante rayos x; el 8% recibió examen abdominal mediante imágenes (TC scan o ultrasonido) y al 9.5% se le practicó un TAC de la cabeza. La mortalidad intrahospitalaria fue de 4.2%. La mediana de la cuenta a pagar por gastos hospitalarios fue $320.00 USD y la mediana de la cantidad pagada por los pacientes fue $50.00 USD. En el comienzo del nuevo milenio, el trauma penetrante representaba casi el 50% de los casos atendidos en HUWI, con respecto a lo cual cabe señalar que la mayor parte de los costos asociados con la atención a traumas, están subvencionados por el Estado.

Trachea, Esophagus, and Spinal Cord Injury Caused by Stab Wound: A case report / 대한흉부외과학회지

Simultaneous occurrence of the trachea, esophagus, and spinal cord injuries due to stabbing is rare. The incidence is decreasing, but early diagnosis and surgical treatment is important because it can be life-threatening. We present one case of simultaneous trachea, esophagus, and spinal cord injury caused by self-stabbing complicated with paraplegia.

Management of Vascular Injuries to the Extremities after Trauma / 대한흉부외과학회지

BACKGROUND: Vascular injuries to the extremities are potentially devastating and they can lead to limb loss and mortality if they are not appropriately managed. The vascular trauma caused by traffic and industrial accidents has recently increased according to the developing industry and transport system in Korea. Early recognition and treatment of these injuries are mandatory to achieve satisfactory outcomes. MATERIAL AND METHOD: We retrospective reviewed 43 patients with vascular injuries that were due to blunt and penetrating trauma and they underwent emergency operations from January of 1998 to December of 2006. RESULT: There were 38 men and 5 women patients with a mean age of 42.0+/-16.8 years (range: 17~77). The cause of vascular injuries were 28 traffic accidents (65%), 6 industrial accidents (14%), 6 glass injuries (14%) and 3 knife injuries (7%). The average time from admission to the operating room was 319.0+/-482.2 minutes (range: 27~2,400 minutes). The average time from admission to discharge was 53.1+/-56.0 days (range: 2~265 days). The anatomic injuries included the femoral artery in 16 cases (37%), the popliteal artery in 8 cases (19%), the brachial artery in 8 cases (19%), and the subclavian and axillary arteries in 7 cases (16%). The associated injuries were 23 bone fractures (53%), 18 muscle injuries (42%) 5 nerve injuries (12%) and 11 vein injuries (26%). The operation methods were 20 end to end anastomoses (46%), 16 interposition grafts (36%), 2 repairs with using patches (5%) and 5 others (12%). The number of amputations and cases of mortality were 3 cases (7%) and 4 cases (9%), respectively. CONCLUSION: Minimizing ischemia is an important factor for maximizing salvage of extremities. Prompt diagnosis and treatment can reduce the amputation and mortality rates.

Epidemiology of ocular trauma in Tehran, Iran: A retrospective survey of 959 cases / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To review the characteristics, complications, and epidemiology of perforating eye injury treated at a referral eye centre in Tehran, over one year, ·METHODS: The medical records of 959 patients hospitalized in Farabi Eye Hospital, Tehran, Iran, due to ocular trauma in 2002 were studied. Information recorded included demographic information (age, sex, and occupation), offending agent, type of trauma, initial visual acuity, location where trauma occurred, accompanying signs and symptoms, and types of treatment provided. ·RESULTS: Mean age of patients was (22.6±16.4) years with a peak age of 21-25 years in males and under 5 years in females. The ratio of male to female was 4.2:1.62.4% of patients had penetrating trauma, 33.9% had blunt trauma, and 3.7% had mixed or chemical trauma. Metallic agents were the most common cause of penetrating ocular trauma, while stone was the most common blunt counterpart. Foreign bodies were observed in 23.4% of cases. Cornea was the most com-mon site of rupture (46.7%). ·CONCLUSION: Based on this study, penetrating trauma is more common than blunt trauma. Younger individuals are more prone to ocular trauma. Cornea is the most common site of injury.