El verdadero origen histórico del trauma cardíaco penetrante / The true historical origin of penetrating cardiac trauma

Introducción. Los traumatismos cardíacos son lesiones graves y con elevado índice de letalidad, aspecto que influye en el interés mostrado por los lectores cada vez que aparecen reportados en publicaciones científicas. En ocasiones existe cierto grado de incongruencia a la hora de establecer el origen histórico de sucesos o eventos ocurridos y relacionados con la historia de la medicina. En el caso del trauma cardíaco penetrante han sido descritos diversos orígenes en algunos de los artículos científicos publicados, lo cual puede generar un grado de duda en los lectores. Métodos. Se realizó una revisión de la literatura, médica y no médica, para buscar información que ayudara a esclarecer el verdadero origen histórico de esta entidad. Resultados. El trauma cardíaco penetrante fue descrito por primera vez en la obra griega titulada La Ilíada, escrita por Homero en el siglo VIII A.C., y no en El papiro quirúrgico de Edwin Smith, como varios autores mencionan. Conclusiones. De todos los eventos de trauma cardíaco penetrante descritos, el más irrefutable es el narrado en el canto XIII, donde se cuenta la muerte de Alcátoo, producto de una herida cardíaca ocasionada por una lanza arrojada por Idomeneo durante una batalla

Introduction. Cardiac traumatic injuries are serious injuries with a high lethality rate, an aspect that influences the interest shown by readers each time they appear reported in scientific publications. Sometimes there is a certain degree of inconsistency when it comes to establishing the historical origin of occurrences or events related to the history of medicine. In the case of penetrating cardiac trauma, different origins have been described in some of the published scientific articles, which may generate a degree of doubt in the readers. Methods. A review of the medical and non-medical literature was carried out to seek information that would help to clarify the true historical origin of this entity. Results. Penetrating cardiac trauma was first described in a Greek work entitled The Iliad, written by Homer in the 8th century B.C., and not in The Surgical Papyrus of Edwin Smith as several authors mention. Conclusions. Of all the events of penetrating cardiac trauma described, the most irrefutable is the one narrated in canto XIII, where it recounts the death of Alcathous product of a cardiac wound caused by a spear thrown by Idomeneo during a battle.

Lesión cardíaca por arma blanca inadvertida durante la evaluación inicial en el servicio de emergencia / Missed cardiac stab injury during initial evaluation in the Emergency Department

Introducción. La incidencia reportada de traumatismo cardíaco es baja y su grado de resolución es variable, dependiendo de la causa, el mecanismo de la lesión, el lugar donde ocurra y las características del sistema sanitario. Su incidencia ha aumentado recientemente debido al incremento de los accidentes de tránsito y la violencia, predominando los traumatismos penetrantes asociados a heridas por armas cortopunzantes y de fuego. Los traumatismos cardíacos se acompañan de un alto grado de letalidad. Caso clínico. Mujer de 35 años que consultó a emergencia por trauma torácico penetrante ocasionado por arma blanca y fue intervenida de urgencia por derrame pleural izquierdo, sin mejoría hemodinámica. Fue reevaluada detectándose derrame pericárdico con taponamiento cardíaco, ocasionado por lesión cardíaca. Fue tratada quirúrgicamente con resultados satisfactorios. Resultados. Las manifestaciones clínicas en los traumatismos penetrantes generalmente son graves y fatales, pero en algunos casos puede no comprometer tanto la hemodinamia del paciente. Para consolidar el diagnóstico clínico pueden realizarse variados estudios, siendo la ecografía FAST extendida uno de los más recomendados por su elevada sensibilidad y especificidad. Dependiendo del adelanto tecnológico del centro hospitalario y la estabilidad hemodinámica del paciente, el tratamiento quirúrgico es el más indicado. Conclusión. El conocimiento del trauma cardíaco penetrante resulta de gran importancia, no solo para el médico del servicio de emergencia sino también para el médico general. Un diagnóstico rápido y acertado, unido a un manejo adecuado, pueden ser decisivos para salvar la vida del paciente.

Introduction. The reported incidence of cardiac trauma is low and its degree of resolution is variable depending on the cause, the mechanism of injury, the place where it occurs and the characteristics of the health care system. Their incidence has currently increased due to the increase in traffic accidents and violence, with a predominance of penetrating trauma associated with stab wounds and firearms. Cardiac trauma is accompanied by a high degree of lethality. Clinical case. A 35-year-old female patient, evaluated in the emergency room for penetrating thoracic trauma caused by stab wound. She underwent emergency intervention due to left pleural effusion, but without hemodynamic improvement. She was reevaluated and pericardial effusion with cardiac tamponade caused by cardiac injury was detected. She was treated surgically with satisfactory results. Results.The clinical manifestations generally described in penetrating cardiac trauma are severe and fatal, but in some cases and due to the characteristics of the injury caused, the patient's hemodynamics may not be so compromised. To consolidate the clinical diagnosis, several complementary studies can be performed, with FAST ultrasound being one of the most recommended due to its high sensitivity and specificity. Surgical treatment is still the most indicated, depending on the technological progress of the hospital and the hemodynamic stability of the patient. Conclusions.Knowledge of penetrating cardiac trauma is of great importance, not only for the emergency department physician but also for the general practitioner. A quick and accurate diagnosis, together with adequate management can be decisive in saving the patient's life.

Descemet's membrane endothelial keratoplasty for primary graft failure after penetrating keratoplasty / Transplante endotelial de membrana de Descemet para falência primária após transplante penetrante

ABSTRACT Primary graft failure (PGF) is a known complication following penetrating keratoplasty (PKP). The usual approach to treat this complication is to repeat a penetrating keratoplasty. Here, we report a case of Descemet's membrane endothelial keratoplasty (DMEK) for the treatment of PGF after PKP. A patient that underwent PKP, developed PGF with persistent graft edema and very poor visual acuity despite aggressive steroid use and a proof anti-viral treatment. Three months after the initial surgery, a DMEK was performed under the PKP graft. There was progressive early corneal clearing and, by the end of the first month, the patient already had no corneal edema. Uncorrected visual acuity (UCVA) improved to 20/40 and best corrected visual acuity (BCVA) to 20/20. DMEK may be an alternative to a second PKP for the treatment of PGF. This technique is a less invasive option when compared to the standard PKP procedure.

RESUMO A falência primária do enxerto é uma complicação conhecida que pode ocorrer após o transplante penetrante de córnea. O tratamento usual dessa complicação é com um novo transplante penetrante. Apresentamos um caso em que foi usado o transplante endotelial de membrana de Descemet (DMEK - do inglês Descemet membrane endo-thelial keratoplasty) para o tratamento da falência primária após o transplante penetrante. Uma paciente submetida a transplante penetrante evoluiu com falência primária do enxerto a despeito do uso intenso de corticoide tópico e uma prova terapêutica de antivirais. Três meses após a cirurgia inicial, foi optado pela realização do transplante endotelial de membrana de Descemet sob o transplante penetrante. Houve um clareamento precoce e progressivo do enxerto com melhora importante da visão. Após um mês, a visão sem correção era de 20/40 melhorando para 20/20 com refração. O transplante endotelial de membrana de Descemet pode ser uma alternativa a um novo transplante penetrante como tratamento da falência primária.

Wet bio-amniotic membrane plugging combined with transplantation in the treatment of small corneal perforations

ABSTRACT Purpose: Wet bio-amniotic membrane plugging combined with transplantation is a novel option that combined amniotic membrane plugging with amniotic membrane transplantation for the treatment of small corneal perforations. This study aimed to evaluate the efficacy of wet bio-amniotic membrane plugging in the treatment of small corneal perforations and compared it with that of the penetrating keratoplasty procedure. Methods: Forty patients (41 eyes) with small corneal perforations <3 mm in diameter treated at our hospital between July 2018 and January 2021 were retrospectively included. Among them, 21 eyes were treated with wet bio-amniotic membrane plugging (wet bio-amniotic membrane plugging group), and 20 eyes were treated with penetrating keratoplasty procedure (penetrating keratoplasty procedure group). The best-corrected visual acuity, anterior chamber formation, corneal thickness, primary disease control, postoperative complications, and graft survival rate were assessed. Results: No significant difference in baseline characteristics was found between the wet bio-amniotic membrane plugging and penetrating keratoplasty procedure groups (p>0.05). The postoperative control rates of primary diseases in the wet bio-amniotic membrane plugging and penetrating keratoplasty procedure groups were 95.2% and 90.0%, respectively (p=0.481). Visual acuity was improved 6 months after the operation in the wet bio-amniotic membrane plugging group and was improved at postoperative 1 month in the penetrating keratoplasty procedure group. The formation time of the anterior chamber in the wet bio-amniotic membrane plugging group was significantly shorter than that in the penetrating keratoplasty procedure group (p=0.023). The corneal thickness of the two groups significantly increased 12 months after the operation; however, the degree of thickening in the penetrating keratoplasty procedure group was higher than that in the wet bio-amniotic membrane plugging group (p<0.001). During the follow-up, postoperative complications were not different between the two groups (p>0.999). Conclusion: The results suggest that wet bio-amniotic membrane plugging is effective and safe in the treatment of small corneal perforations. Thus, it can be used as an emergency treatment alternative to penetrating keratoplasty procedure for small corneal perforations.

Deep anterior lamellar keratoplasty and penetrating keratoplasty in macular corneal dystrophy: comparison of visual and topographic outcomes and complications

ABSTRACT Purposes: This study aims to assess and compare the postoperative visual and topographic outcomes, complications, and graft survival rates following deep anterior lamellar keratoplasty and penetrating keratoplasty in patients with macular corneal dystrophy. Methods: In this study we enrolled 59 patients (23 male; and 36 female) with macular corneal dystrophy comprising 81 eyes. Out of these, 64 eyes underwent penetrating keratoplasty, while 17 eyes underwent deep anterior lamellar keratoplasty. The two groups were analyzed and compared based on best-corrected visual acuity, corneal tomography parameters, pachymetry, complication rates, and graft survival rates. Results: After 12 months, 70.6% of the patients who underwent deep anterior lamellar keratoplasty (DALK) and 75% of those who had penetrating keratoplasty (PK) achieved a best-corrected visual acuity of 20/40 or better (p=0.712). Following surgery, DALK group showed lower front Kmean (p=0.037), and Q values (p<0.01) compared to the PK group. Postoperative interface opacity was observed in seven eyes (41.2%) in the DALK group. Other topography values and other complications (graft rejection, graft failure, cataract, glaucoma, microbial keratitis, optic atrophy) did not show significant differences between the two groups. The need for regrafting was 9.4% and 11.8% in the PK and DALK groups, respectively (p=0.769). Graft survival rates were 87.5% and 88.2% for PK and DALK; respectively (p=0.88 by Log-rank test). Conclusion: Both PK and DALK are equally effective in treating macular corneal dystrophy, showing similar visual, topographic, and survival outcomes. Although interface opacity occurs more frequently after DALK the visual results were comparable in both groups. Therefore, DALK emerges as a viable surgical choice for patients with macular corneal dystrophy without Descemet membrane involvement is absent.

Cataract surgery following penetrating keratoplasty in children

Background: Following penetrating keratoplasty, cataract surgery warrants certain modifications to ensure maximum survival of the graft. Purpose: To emphasize the intraoperative challenges and surgical manipulations to be followed. Synopsis: The surgeon makes a superior sclerocorneal tunnel avoiding the graft host junction. Dispersive viscoelastic is used. Continuous curvilinear capsulorhexis is done. Cataractous lens aspirated with a low flow rate. The intraocular lens is placed in the bag. Superior peripheral iridectomy and primary posterior capsulorhexis are done. The wound closed with two interrupted 10�nylon sutures. Graft host junction integrity is maintained. Highlights: Ensure 1. Good intraoperative corneal visibility, 2. Avoid graft host junction for main port incision 3. Generous dispersive viscoelastic use/soft shell technique to protect the corneal endothelium, 4. Avoid phaco energy in case of soft cataracts/low phaco energy and flow rates, 5. Phaco probe to be meticulously oriented away from corneal endothelium, 6. Primary posterior capsulorhexis to be done as in any pediatric cataract surgery, 7. Make sure of the graft host junction integrity at the end of the surgery, 8. Restrict to a single port whenever possible.

Deep anterior lamellar keratoplasty versus penetrating keratoplasty: comparison of clinical outcomes in contralateral eyes / Ceratoplastia lamelar anterior profunda versus ceratoplastia penetrante: comparação dos resultados clínicos em olhos contralaterais

ABSTRACT Purpose: This study aimed to compare the clinical outcomes following deep anterior lamellar keratoplasty and penetrating keratoplasty in contralateral eyes of the same patients. Methods: In this retrospective, comparative case series, clinical outcome data included best-corrected visual acuity, refractive spherical equivalent, refractive astigmatism, endothelial cell density, endothelial cell loss, central corneal thickness, and intraocular pressure, which were evaluated at 6, 12, 24, and 36 months after deep anterior lamellar keratoplasty and penetrating keratoplasty. Additionally, complications were assessed. Results: Fifty-two eyes (26 patients) were included, of which 19 patients had keratoconus, 6 had stromal dystrophy, and 1 had post-laser-assisted in situ keratomileusis ectasia. The mean follow-up was 44.1 ± 10.5 months in the deep anterior lamellar keratoplasty Group and 47.9 ± 11.9 months in the penetrating keratoplasty Group. No significant differences were observed in the mean best-corrected visual acuity, refractive spherical equivalent, refractive astigmatism, and central corneal thickness between the deep anterior lamellar keratoplasty and penetrating keratoplasty Groups during follow-up. The endothelial cell density was significantly higher in the deep anterior lamellar keratoplasty Group than in the penetrating keratoplasty Group at 24 and 36 months postoperatively (p=0.022 and 0.013, respectively). Endothelial cell loss was significantly lower in the deep anterior lamellar keratoplasty Group than in the penetrating keratoplasty Group at 24 and 36 months postoperatively (p=0.025 and 0.001, respectively). Intraocular pressure was significantly lower in the deep anterior lamellar keratoplasty Group than in the penetrating keratoplasty Grroup at 6 months postoperatively (p=0.015). Microperforation occurred in 4 eyes (15%) during deep anterior lamellar keratoplasty surgery; however, penetrating keratoplasty was not required. No endothelial rejection occurred in the penetrating keratoplasty Group during follow-up. Conclusions: Over the 3-year follow-up, endothelial cell loss and intraocular pressure in the deep anterior lamellar keratoplasty Group were significantly lower than those in the penetrating keratoplasty Group, while visual and refractive results were similar.

RESUMO Objetivo: Este estudo teve como objetivo comparar os resultados clínicos após ceratoplastia lamelar anterior profunda e ceratoplastia penetrante nos olhos contralaterais dos mesmos pacientes. Métodos: Nesta série de casos comparativa e retrospectiva, avaliaram-se os seguintes dados de resultados clínicos: melhor acuidade visual corrigida, equivalente esférico refrativo, astigmatismo refrativo, densidade de células endoteliais, perda de células endoteliais, espessura central da córnea e pressão intraocular. Esses dados foram avaliados aos 6, 12, 24 e 36 meses após ceratoplastia lamelar anterior profunda e ceratoplastia penetrante. Também foram avaliadas as complicações. Resultados: Foram incluídos 52 olhos (26 pacientes), sendo que 19 pacientes apresentavam ceratocone, 6 apresentavam distrofia estromal e 1 apresentava ectasia após ceratomileuse in situ assistida por laser. O tempo médio de acompanhamento foi de 44,1 ± 10,5 meses no grupo da ceratoplastia lamelar anterior profunda e 47,9 ± 11,9 meses no grupo da ceratoplastia penetrante. Nenhuma diferença significativa foi observada nas médias da melhor acuidade visual corrigida, equivalente esférico refrativo, astigmatismo refrativo e espessura central da córnea entre os grupos da ceratoplastia lamelar anterior profunda e da ceratoplastia penetrante durante o acompanhamento. A densidade de células endoteliais foi significativamente maior no grupo da ceratoplastia lamelar anterior profunda que no grupo da ceratoplastia penetrante aos 24 e 36 meses de pós-operatório (p=0,022 e 0,013, respectivamente). A perda de células endoteliais foi significativamente menor no grupo da ceratoplastia lamelar anterior profunda que no grupo da ceratoplastia penetrante aos 24 e 36 meses de pós-operatório (p=0,025 e 0,001, respectivamente). A pressão intraocular foi significativamente menor no grupo da ceratoplastia lamelar anterior profunda que no grupo da ceratoplastia penetrante aos 6 meses de pós-operatório (p=0,015). Ocorreu microperfuração em 4 olhos (15%) durante a cirurgia de ceratoplastia lamelar anterior profunda; entretanto, a ceratoplastia penetrante não foi necessária. Não ocorreu nenhuma rejeição endotelial no grupo da ceratoplastia penetrante durante o período de acompanhamento. Conclusões: Durante o acompanhamento de 3 anos, a perda de células endoteliais e a pressão intraocular foram significativamente menores no grupo da ceratoplastia lamelar anterior profunda que no grupo da ceratoplastia penetrante, mas os resultados visuais e refrativos foram semelhantes.

A long-term clinical outcome of Hoffmann pocket four-point scleral fixated intraocular lens implantation combined with penetrating keratoplasty – A single corneal surgeon’s report

Purpose: To analyze retrospectively the outcomes of Hoffmann pocket scleral fixated intraocular lens implantation combined with penetrating keratoplasty at a tertiary institute by a single corneal surgeon. Methods: Forty?two eyes of 42 patients, aged between 11 and 84 years, had a mean follow?up of 2 ± 2.216 years. Overall, five (11.9%) had congenital and 37 had acquired pathology, 15 were pseudophakic, 23 were aphakic, and four were phakic. The commonest indication was trauma in 19 (45.2%), and 21 had previous multiple surgeries including five retinal procedures. Results: The grafts were clear in 20 (47.6%), they failed in 20, three had acute rejection, three were ectatic, two had infection, one had persistent edema, and one had endophthalmitis. The mean log of minimum angle of resolution (logMAR) best corrected visual acuity was 1.902 pre?op, 1.802 at the final follow?up, and 0.52 after excluding preexisting retinal pathologies. At the last follow?up, the vision improved in 18 (42.9%), maintained in 6, and worsened in 18, and three needed more than ?5.00 D and seven needed more than ?3.00 D cylinder correction. Five had glaucoma preoperatively, 10 developed the condition postoperatively, six needed cyclodestructive procedure, and three had valve surgery. Conclusion: Advantages of this surgery are avoidance of additional sections to insert the lens, direct positioning of the lens in the posterior chamber, rotational stability of the lens from four?point fixation, and untouched conjunctiva over the scleral pockets. The fact that 20 had clear grafts and 18 visually improved, though two needed lens removal and one developed retinal detachment postsurgery is encouraging. More cases with longer follow?ups will help understand the technique better

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.

Trauma abdominal en pacientes del Hospital Universitario General Calixto García / Abdominal Trauma in patients at Hospital Universitario General Calixto García

Introducción: El trauma abdominal se considera un problema de salud significativo, debido a que su cinemática ocasiona lesiones tanto anatómicas como funcionales de los órganos del abdomen. Objetivo: Caracterizar el trauma abdominal en un grupo de pacientes lesionados del Hospital Universitario General Calixto García. Métodos: Se realizó un estudio observacional, descriptivo, prospectivo, de corte transversal en los pacientes con trauma abdominal atendidos en el Servicio de Cirugía General desde enero de 2017 hasta diciembre de 2019. La muestra fue de 879 pacientes. Resultados: Existió un mayor número de pacientes con trauma abdominal en el grupo etario de 19-29 años, con una prevalencia del sexo masculino. Predominaron los accidentes de tránsito como la principal causa de trauma abdominal con el 52 por ciento. Prevalecieron las lesiones sobre órganos macizos, con mayor frecuencia en el hígado con un 33 por ciento. El tratamiento que con mayor asiduidad se empleó fue el quirúrgico, lo que representa el 83 por ciento con respecto al manejo conservador. Conclusiones: Por su ubicación y funcionalidad, las lesiones asociadas a trauma abdominal se convierten en un factor que representa gran riesgo para la vida del paciente. Los accidentes de tránsito continúan estando dentro de las primeras causas de trauma abdominal. Aunque la conducta conservadora ha ganado adeptos, existe un predominio en el tratamiento quirúrgico apoyado fundamentalmente en la sintomatología de los pacientes y en los medios diagnósticos(AU)

Introduction: Abdominal trauma is considered a significant health problem due to the fact that its kinematics causes both anatomical and functional injuries to the abdominal organs. Objective: To characterize abdominal trauma in a group of injured patients from Hospital Universitario General Calixto García. Methods: An observational, descriptive, prospective and cross-sectional study was conducted in patients with abdominal trauma attended at the general surgery service from January 2017 to December 2019. The sample was 879 patients. Results: There was a higher number of patients with abdominal trauma within the age group 19-29 years, with a prevalence of the male sex. Road traffic accidents predominated as the main cause of abdominal trauma, accounting for 52 percent. Injuries to solid organs prevailed, most frequently to the liver, accounting for 33 percent. The most frequently used treatment was surgical, which represents 83 percent with reference to conservative management. Conclusions: Due to their location and functionality, injuries associated with abdominal trauma become a factor that represents a great risk for the patient's life. Road traffic accidents continue to be among the first causes of abdominal trauma. Although the conservative approach has gained followers, there is a predominance of surgical treatment supported mainly by the patients' symptomatology and diagnostic means(AU)

Outcomes of therapeutic penetrating keratoplasty in Pythium insidiosum keratitis managed with a combination of antibiotics

Purpose: To describe the clinical outcomes of therapeutic penetrating keratoplasty (TPK) in patients with Pythium insidiosum keratitis following treatment with anti?pythium therapy (APT) consisting of linezolid and azithromycin. Methods: A retrospective review of medical records from May 2016 to December 2019 of patients with P. insidiosum keratitis was carried out. Patients who were treated with APT for a minimum of 2 weeks and then subsequently underwent TPK were included in the study. Data on demographic characteristics, clinical features, microbiology characteristics, and intraoperative details, postoperative outcomes were documented. Results: A total of 238 cases of Pythium keratitis were seen during the study period and 50 cases that satisfied the inclusion criteria were included. The median of the geometric mean of the infiltrate was 5.6 mm (IQR 4.0–7.2 mm). The patients received topical APT for a median of 35 days (IQR 25–56) prior to surgery. The most common indication of TPK was worsening keratitis (41/50, 82%). No recurrence of infection was observed. An anatomically stable globe was noted in 49/50 eyes (98%). The median graft survival rate was 2.4 months. A clear graft was present in 10 eyes (20%) with a final median visual acuity of 20/125 after a median follow?up period of 18.4 months (IQR 11–26 months). Graft size of less than 10 mm [OR: 5.824 (CI:1.292?41.6), P = 0.02] was found to be significantly associated with a clear graft. Conclusion: Performing TPK following the administration of APT has good anatomical outcomes. A smaller graft of <10 mm was associated with a higher chance of graft survival

Urrets-Zavalia Syndrome after Penetrating Keratoplasty: A Case Report

Urrets-Zavalia syndrome is a dreaded complication of anterior segment surgery and the most common in patients undergoing corneal transplantation. Avoiding the prescription of mydriatic eye drops during the postoperative period is the mainstay of its therapy, which focuses on prevention. One month after having keratoplasty in the left eye, a 42-year-old man presented with Urrets-Zavalia syndrome and ocular hypertonia at 35 mmgh. Medical and surgical management were required in this situation.The purpose of our presentation is to describe a real-world instance of Urrets-Zavalia syndrome.

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

Corneal Perforation associated with "Silent Brain Syndrome" / Perfuração corneana associada à "síndrome do cérebro silencioso"

ABSTRACT This case report describes the clinical characteristics and ophthalmic management of a patient who developed corneal perforation due to severe enophthalmos consistent with "silent brain syndrome." A 27-year-old man with a history of congenital hydrocephalus and ventriculoperitoneal shunt was referred with complaints of "sinking of the eyeballs" and progressively decreasing vision in the left eye. Examination revealed severe bilateral enophthalmos in addition to superonasal corneal perforation with iris prolapse in the left eye. The patient underwent therapeutic keratoplasty the next day. Orbital reconstruction with costochondral graft and shunt revision of the intracranial hypotension were performed the next month to prevent further progression.

RESUMO Este relato de caso descreve as características clínicas e o manejo cirúrgico de um paciente que teve perfuração da córnea devido à enoftalmia grave consistente com a "síndrome do cérebro silencioso". Um homem de 27 anos com história de hidrocefalia congênita e derivação ventrículo-peritoneal foi encaminhado com queixas de "afundamento dos globos oculares" e diminuição progressiva da visão no olho esquerdo. O exame revelou enoftalmo bilateral importante, além de perfuração superonasal da córnea com prolapso iriano no olho esquerdo. A paciente foi submetida à ceratoplastia terapêutica no dia seguinte. Foi realizado no mês seguinte a reconstrução da órbita com enxerto costocondral e revisão do shunt para evitar progressão e piora do caso.

Impact of pandemic COVID-19 lockdown on penetrating keratoplasty patients

Purpose: To study the impact of the COVID?19 lockdown on the regular follow?up of keratoplasty patients. Methods: This retrospective interventional case series included 30 patients who had immunological corneal endothelial rejection out of 190 patients who came for post?PKP follow?up between September 15, 2019, and September 30, 2020. The demographics, primary diagnosis, surgical technique, time of presentation, recovery of graft, associated ocular problems, and visual acuity at 1 month were analyzed. Forward stepwise (likelihood ratio) binary logistic regression was used to find significant variables. Results: The study population had 19 males (63.33%) and 11 females (36.67%). The mean age of the study group was 42.83 ± 18.89 (8–80) years. Of 30 patients, 19 (63.3%) presented before and 11 (36.7%) after the COVID?19 lockdown. Overall, 23 (77%) showed a reversal of graft rejection. Logistic regression showed that preoperative indications, large?sized grafts, and deep corneal vascularization were significant risk factors for non?resolution of graft rejection. It was noted that patients who presented to the hospital late had poor recovery (P = 0.002). The delay in the presentation was a significant risk factor for non?resolution of graft rejection (P < 0.01). Z?test for proportions revealed that the difference in the non?resolution of rejection on immediate or delayed treatment in patients presenting during lockdown (P = 0.002) was significant. Conclusion: This article is to highlight the impact of the COVID?19 lockdown on graft rejection recovery of PKP patients due to delays in follow?up. Early treatment helps in the recovery of graft transparency and the reversal of immunological graft rejection. Also, primary diagnosis, deep vascularization, and large?sized grafts were significant risk factors for non?resolution of graft rejection.

Removal of Foreign Body in the Rafe Pterigomandibular: Case Report / Remoção de Corpo Estranho Alojado na Rafe Pterigomandibular: Relato de Caso

Introduction: Penetrating lesions in the oral cavity, caused by foreign bodies, is an event of significant clinical relevance and presents itself as an important etiological factor, especially in pediatric patients. Several objects are related to this type of trauma, such as knife blades, nails, pencils, wood, firearm projectile, and glass, among others. Case Report: This report describes a case of removal of a pencil lodged in the left pterygomandibular raphe of a pediatric patient, as well as all the conduct adopted by the team of surgeons. Discussion: Pterygomandibular raphe has an intimate relationship with noble structures, and injuries by penetrating instruments in this region can result in important clinical repercussions. Due to this, it is necessary to have an efficient clinical-anamnesis examination, with adequate analysis of the affected structures, in order to provide a fast and effective treatment. Conclusion: For this, it is essential to have qualified professionals, adequate equipment available, and the proper management of the victim.

Introdução: As lesões penetrantes em cavidade oral, ocasionadas por corpos estranhos, é um evento de relevância clínica significativa e se apresenta como um importante fator etiológico, principalmente, em pacientes pediátricos. Diversos objetos estão relacionados a esse tipo de trauma, como lâmina de faca, prego, lápis, madeira, projétil de arma de fogo, vidro, entre outros. Relato de Caso: Este relato descreve um caso de remoção de um lápis alojado na rafe pterigomandibular esquerda de um paciente pediátrico, assim como toda a conduta adotada pela equipe de cirurgiões. Discussão: A rafe pterigomandibular possui uma íntima relação com estruturas nobres e as lesões por instrumentos penetrantes nessa região podem acarretar uma repercussão clínica importante. Devido a isso, se faz necessário, um exame clínico-anamnese eficiente, com análise adequada das estruturas acometidas, para assim fornecer um tratamento rápido e eficaz. Conclusão: Para isso, é fundamental profissionais qualificados, equipamentos adequados disponíveis e o manejo adequado da vítima.

A nomogram based on CT enterography signs for prediction of intestinal penetrating lesions in patients with Crohn disease / 中华放射学杂志

Objective:To explore the value of a nomogram model based on the CT enterography (CTE) signs for prediction of intestinal penetrating lesions in patients with Crohn disease (CD).Methods:The clinical and CTE data of CD patients who underwent at least two CTE examinations from January 2010 to June 2020 in the First Affiliated Hospital of Sun Yat-sen University were retrospectively collected. A total of 112 patients were enrolled, and according to whether there was intestinal wall penetration in the last CTE observation were divided into non-penetration group (84 cases) and penetration group (28 cases). First, the clinical and CTE data for the first examination was analyzed by using univariate and multivariate Cox proportional hazards regression to screen out high-risk factors that could effectively predict intestinal wall penetrating lesions in CD patients and established a nomogram model. Then the change trend of CTE data (ΔCTE) between the first and last clinical and CTE signs was analyzed by using univariate and multivariate Cox proportional hazards regression, and built a nomogram model to sort out ΔCTE that may accompany the development of penetrating lesions in CD patients. The Harrell concordance index was used to evaluate the discriminative ability of the nomogram model.Results:In the first time clinical and CTE signs, multivariate Cox proportional hazards regression results showed that numbers of diseased bowel segments (HR=0.686, 95%CI 0.475-0.991, P=0.045) and the shortest diameter of the largest lymph node (HR=0.751, 95%CI 0.593-0.949, P=0.017) were independent protection factors for penetrating lesions, and rough bowel wall surface (HR=5.626, 95%CI 2.466-12.839, P<0.001) was an independent risk factor for penetrating lesions. The specificity and sensitivity of the nomogram model to predict non-penetration lesions were 82.1% and 59.5% respectively, and the Harrell concordance index was 0.810 (95%CI 0.732-0.888). In the ΔCTE signs, multivariate Cox proportional hazards regression showed that Δrough bowel wall surface (always rough bowel wall surface HR=12.344, 95%CI 2.042-74.625, P=0.006; slide bowel wall surface becomes rough bowel wall surface HR=28.720, 95%CI 4.580-180.112, P<0.001) and Δthe shortest diameter of the largest lymph node (HR=1.534, 95%CI 1.091-2.157, P=0.014) were independent risk factors for penetrating lesions. The specificity and sensitivity of the nomogram model were 89.3% and 79.2% respectively, and the Harrell concordance index was 0.876 (95%CI 0.818-0.934). Conclusion:The nomogram based on CTE signs of numbers of diseased bowel segments, the shortest diameter of the largest lymph node and rough bowel wall surface and ΔCTE can effectively predict the intestinal wall penetrating lesions of CD patients.

Research progress in characteristics and field surgical treatment of craniocerebral war injury in foreign armies / 中华创伤杂志

Craniocerebral war injury, mainly caused by weaponry equipment and wartime conditions during warfare, are characterized by high difficulty in treatment and evacuation as well as high mortality rate. The field surgical treatment of craniocerebral war injury is not only related to injury characteristics, but also to factors such as war scale, combat style, combat area and weapon power. In recent years, there have been few comprehensive reports on the characteristics and field surgical treatment of craniocerebral war injury in China. Therefore, the authors reviewed the research progress in the characteristics and field surgical treatment of craniocerebral war injuries in foreign armies since 2001, with the aim to provide a reference for relevant basic researches and war injury treatment in China.

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.

Exploring the ability of TAT, a cell-penetrating peptide, to deliver proteins in a non-fused form / 药学学报

Accumulating evidence has shown that the cell-penetrating peptide TAT can be applied to deliver different types of drug molecules, including nucleic acids, proteins and small molecule drugs. Usually TAT delivers cargoes on the basis of their covalent bonds or non-covalent interactions. However, there are few reports on the delivery of proteins by TAT in a non-covalent manner, and no quantitative comparisons have been made on the protein delivery ability of TAT in fusion and non-fusion manners. In order to explore the ability of TAT to deliver proteins in non-fusion manner, here we used fluorescence microscopy and flow cytometry to investigate the ability of TAT to deliver enhanced green fluorescent protein (EGFP) into non-small cell lung cancer cells A549 in a non-fusion manner. It was found that TAT could deliver EGFP into A549 cells, and its delivery ability was positively correlated with its concentration. In addition, the fusion protein TAT-EGFP was overexpressed and purified, and its permeability across cell membrane was also investigated. In this paper, based on quantitative comparison, we found that the delivery of EGFP by TAT in fusion manner is significantly efficient than that of TAT in non-fusion manner. This is the report that TAT can deliver EGFP in a non-fusion manner. Although its delivery efficiency remains to be improved as compared with the fusion manner, the non-fusion manner has shown incomparable advantages in ease of operation, suggesting that it is also a candidate for delivery strategy in the future.