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1.
Rev. bras. cir. cardiovasc ; 35(6): 1017-1019, Nov.-Dec. 2020. tab, graf
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1144003

ABSTRACT

Abstract Case Presentation: A case of a 49-year-old patient, male, victim of stab wound, developing belatedly cardiac tamponade and hemodynamic stability was reported. The patient underwent a pericardial window with drainage of pericardial effusion of blackened aspect; however, without visualization of the cardiac lesion, enlargement of the incision by median sternotomy was opted for. A hematoma was spotted at the left ventricle with epicardial lesion and a patch of pericardium was made with 3-0 polypropylene. The patient developed acute pulmonary edema and atrial fibrillation, which improved after the intensive care unit clinical management, with hospital discharge in the 7th postoperative day.


Subject(s)
Humans , Male , Middle Aged , Pericardial Effusion/surgery , Pericardial Effusion/etiology , Pericardial Effusion/diagnostic imaging , Cardiac Tamponade/surgery , Cardiac Tamponade/etiology , Cardiac Tamponade/diagnostic imaging , Wounds, Penetrating , Wounds, Stab/surgery , Wounds, Stab/complications , Sternotomy
3.
Rev. cir. (Impr.) ; 72(2): 137-143, abr. 2020. tab
Article in Spanish | LILACS | ID: biblio-1092905

ABSTRACT

Resumen Objetivos Describir las características, índices de gravedad de traumatismo (IGT), morbilidad, mortalidad y factores asociados a mortalidad en pacientes hospitalizados por traumatismo torácico por arma blanca (TTAB). Materiales y Método Estudio analítico transversal. Período enero de 1981 a diciembre de 2017. Revisión base de datos prospectiva, protocolos quirúrgicos, fichas clínicas. Se describe y compara las características de los TTAB. Se calculó IGT: Injury Severity Score (ISS), Revised Trauma Score ( RTS-T) y Trauma Injury Severity Score (TRISS). Resultados Total 4.163 pacientes hospitalizados por TT, 2.286 hospitalizados por TTAB. Hombres: 2.131 (93,2%), edad promedio 27,8 ± 10,7 años, TTAB aislado 2.035 (89,0%), asociado a lesiones extratorácicas 251 (11,0%) y de éstos 124 (5,5%) se consideraron politraumatismos. Mecanismos principales del traumatismo: agresión 2.246 (98,3%) y autoagresión 22 (1,0%). Lesiones y hallazgos torácicos más frecuentes: neumotórax 1.473 (64,4%), hemotórax 1.408 (61,6%), enfisema subcutáneo 485 (21,2%). Tratamiento definitivo: pleurotomía 1.378 (60,3%), cirugía torácica 537 (23,5%) y tratamiento médico 370 (16,2%). Hospitalización promedio 6,2 ± 6,5 días, IGT: ISS promedio 10,9 ± 7,2, RTS-T promedio 11,6 ± 1,4 y TRISS promedio 3,6. Morbilidad: 318 (13,9%). Mortalidad: 32 (1,4%). Conclusión Los TTAB ocurren frecuentemente en hombres jóvenes por agresión. La mayoría se puede tratar con pleurotomía exclusiva.


Aim Our objectives are to describe and correlate the clinical characteristics, trauma severity indexes (TSI) and morbidity and mortality in patients hospitalized for thoracic trauma by a bladed weapon (TTBW). Materials and Method Transversal analytic study. Period January-1981 to December-2017. Prospective database review, surgical protocols, clinical files. The characteristics of the TTBW are described and compared. Injury Severity Score (ISS), Revised Trauma Score (RTS-T) and Trauma Injury Severity Score (TRISS) were calculated. Results Total of 4,163 patients hospitalized for TT, 2,286 hospitalized for TTBW. Men: 2,131 (93.2%), average age 27.8 ± 10.7 years, isolated TTBW 2,035 (89.0%), associated with extra thoracic injuries 251 (11.0%) and of these 124 (5.5%) were considered polytrauma. Main mechanisms of trauma: Aggression 2,246 (98.3%) and self-aggression 22 (1.0%). Most frequent injuries and thoracic findings: pneumothorax 1,473 (64.4%), hemothorax 1,408 (61.6%), subcutaneous emphysema 485 (21.2%). Definitive treatment: Pleurotomy 1,378 (60.3%), thoracic surgery 537 (23.5%) and medical treatment 370 (16.2%). Average hospital stay: 6.2 ± 6.5 days. ISS average 10.9 ± 7.2, RTS-T average 11.6 ± 1.4 and TRISS average 3.6. Morbidity: 318 (13.9%). Mortality: 32 (1.4%). Discussion TTBW are frequent in our environment, unlike on an international level. Conclusions TTBW frequently occur in young male patients due to aggression. The majority can be treated with exclusive pleurotomy.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Thoracic Injuries/mortality , Thoracic Injuries/epidemiology , Wounds, Stab/mortality , Wounds, Stab/epidemiology , Thoracic Injuries/surgery , Thoracic Injuries/complications , Wounds, Stab/surgery , Wounds, Stab/etiology , Chile/epidemiology , Retrospective Studies
4.
Rev. cir. (Impr.) ; 72(1): 43-47, feb. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1092889

ABSTRACT

Resumen Introducción Por su ubicación retroperitoneal, las lesiones de vena cava (LVC) son infrecuentes, presentándose en el contexto de un paciente con múltiples lesiones intraabdominales y en estado crítico. Objetivo Describir la experiencia de pacientes politraumatizados con LVC sometidos a resolución quirúrgica en Hospital Dr. Sotero del Río. Materiales y Método Análisis retrospectivo de 36 pacientes politraumatizados que dentro de la intervención quirúrgica se evidenció LVC en un período comprendido entre el 2010 y 2017. Resultados La serie estuvo compuesta por 36 pacientes, con LVC. El 88,8% son hombres, en el 97,2% el mecanismo de trauma es penetrante. Dentro de los niveles anatómicos vasculares más frecuentemente lesionados está la cava infrarrenal (41,6%), suprarrenal (25%), yuxtarrenal (22,2%) y la retrohepática e intratorácica (5,5% cada una). Las estructuras lesionadas asociadas más frecuentes fueron intestino delgado (38,8%), otros vasos de gran calibre (36,1%) y riñón (30,5%). Dentro del tipo de resolución quirúrgica, al 15,6% se realizó ligadura de vena cava y al 83,3% rafia simple. En 33,3% fue necesaria una toracotomía para el control vascular, siendo 2 de estas toracotomías resucitadoras. La media de hospitalización fue de 19,8 días. La mortalidad fue de 33,3%. Conclusiones De acuerdo a lo presentado, la alta mortalidad de LVC se encontró en el grupo de pacientes con inestabilidad hemodinámica y número de lesiones asociadas, en especial si involucran otros grandes vasos. Los esfuerzos para optimizar la supervivencia se deberían dirigir al traslado rápido prehospitalario y al entrenamiento de los cirujanos que enfrentan este tipo de lesiones.


Introduction For its retroperitoneal location, vena cava injuries are infrequent, however, occurring to a patient with multiple intra-abdominal injuries and in critical condition. Aim To describe the experience of polytraumatized patients with VCI who underwent surgical resolution in the Dr. Sotero del Rio hospital. Materials and Method Retrospective analysis of 36 polytraumatized patients that showed VCI during the surgical intervention within 2010 and 2017. Results The series was composed of 36 VCI patients. 88.8% are men, in 97.2% the mechanism of trauma is penetrating. Within the vascular anatomical levels, the most frequently injured are the infra-renal cava (41.6%) suprarenal (25%), yuxta-renal (22.2%) retro-hepatic and intrathoracic (5.5% each). The most frequent associated injured structures were the small intestine (38.8%) other vessels of large caliber (36.1%) and kidney (30.5%). In relation to the type of surgical resolution, 15.6% had a vena cava ligature and 83.3% simple raffia. In 33.3%, a thoracotomy was required for vascular control, two of them were resuscitative procedures. The average of hospitalization was 19.8 days. The mortality was 33.3%. Conclusions According to what presented, the high mortality of VCI was found in the group of patients with hemodynamic instability and the number of associated injuries; specially if other large vessels are involved. To optimize the survival, the efforts should be focused on a fast prehospital transfer and the training for surgeons who face this type of injury.


Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Vena Cava, Inferior/surgery , Vena Cava, Inferior/injuries , Abdominal Injuries/complications , Time Factors , Wounds, Gunshot/surgery , Wounds, Penetrating/surgery , Wounds, Stab/surgery , Chile , Treatment Outcome , Abdominal Injuries/surgery , Abdominal Injuries/mortality
5.
Prensa méd. argent ; 105(11): 783-785, dic2019. fig
Article in Spanish | LILACS, BINACIS | ID: biblio-1049774

ABSTRACT

Background: It is widely established that the extraction of impaled objects should be carried out under direct vision. In the case of stable patients, endoscopic vision can be used as an alternative. Clinical Case: A 70-year-old male is admitted for a 5-hour impaled precordial stab wound. Evolution valued according to ATLS standards. Clinically and hemodynamically compensated patient. On physical examination: left pulmonary hypoventilation, subcutaneous emphysema, no jugular engorgement. Control of vital signs: TA: 110 / 70mmHg, FC: 70min, FR: 20min, Sat02: 97%. Complementary studies: ECO FAST: no pericardial fluid. Rx thorax: mild left pneumothorax heme. Chest CT: Puncture object of 18 cm in the left lung of AP and medial to the lateral path, hematoma of the angle, and hemopneumothorax grade I. Surgery: Patient in dorsal recumbency, under ARM with selective intubation. An incision in 5th left intercostal space, middle axillary line. 10mm trocar placement, 30 ° optics introduction. After discarding the commitment of the pericardium, active bleeding, and observing that the end of the weapon was going through the end of the angle, the weapon is removed under endoscopic vision. Clot washing/aspiration. Verification of hemostasis, absence of air leakage and pulmonary expansion. Drainage with 28 French tubes. Evolution: Derived from UTI extubated. CT scan thorax 72 h post: small intraparenchymal hematoma left, expanded lung. Minimum serohematic debit. Pleural tube and definitive discharge are removed on the 4th post-surgical day. Discussion: The literature suggests in the urgency, the removal of impaled objects under direct vision of the compromised structures. However, in stable patients, the previous study with CT should be unavoidable. Video-thoracoscopy in these wounded can avoid open surgery, but the procedure must be performed in trauma reference centers, with the appropriate means and by a trained surgical team willing to perform an emergency thoracotomy


Subject(s)
Male , Aged , Wounds, Stab/surgery , Chest Pain/surgery , Thoracotomy , Laparoscopy , Thoracic Surgery, Video-Assisted , Vital Signs
6.
Rev. chil. cir ; 70(4): 362-366, ago. 2018. ilus
Article in Spanish | LILACS | ID: biblio-959397

ABSTRACT

Objetivo: Presentar un caso clínico y discutir el manejo del trauma de arteria axilar y revisar la literatura actual. Caso Clínico: se presenta el caso de un paciente con lesión de arteria axilar, que es traído en shock hipovolémico al Servicio de Emergencias de nuestro hospital. En pabellón, se aprecia sección incompleta de la segunda porción de la arteria axilar. Se controla y repara con anastomosis primaria término-terminal. En su posoperatorio evoluciona de forma satisfactoria. Discusión: El manejo del trauma vascular debe ser metódico y multidisciplinario. Los signos duros de trauma vascular son indicación de exploración quirúrgica inmediata. Los pacientes con signos blandos pueden complementarse con imágenes. En una sección incompleta de arteria axilar, la anastomosis término-terminal ha mostrado buenos resultados. Conclusiones: las lesiones de arteria axilar en el contexto de traumas son infrecuentes. Su manejo necesita de un alto índice de sospecha, un enfoque multidisciplinario y un acceso quirúrgico adecuado al contexto.


Objective: To present a clinical case and discuss the management of axillary artery trauma and to review current literature. Clinical case: Male patient with axillary artery injury, who is brought in hypovolemic shock to the Emergency Department. Surgical findings demonstrated an incomplete section of the second portion of the axillary artery which was repaired with primary end-to-end anastomosis. Postoperatively, the patient evolves without pain and is discharged. Discussion: The management of vascular trauma should be methodical and multidisciplinary. Hard signs of vascular trauma mandate immediate surgical exploration. Patients with soft signs may need further evaluation with images. In an incomplete section of the axillary artery the end-to-end anastomosis has shown good results. Conclusions: Axillary artery lesions in the context of trauma are infrequent. Its management requires a high index of suspicion, a multidisciplinary approach and adequate surgical access.


Subject(s)
Humans , Male , Adult , Axillary Artery/surgery , Axillary Artery/injuries , Vascular Surgical Procedures/methods , Wounds, Stab/surgery , Blood Vessels/injuries , Anastomosis, Surgical/methods
8.
Rev. cuba. cir ; 53(4): 402-407, ilus
Article in Spanish | LILACS | ID: lil-751786

ABSTRACT

Introducción: el objetivo de este trabajo es presentar un caso de empalamiento a través de la región inguinal. Las heridas por empalamiento son infrecuentes y, en ocasiones, de extrema gravedad, necesitan de una actuación rápida del personal médico de urgencias y del cirujano. Caso clínico: se presenta el caso de un varón de 40 años que sufrió un accidente laboral con empalamiento de un hierro de ferralla a través de la región inguinal derecha, el cuerpo extraño penetró en la cavidad abdominal. Se expone ampliamente el caso clínico, así como los procedimientos realizados en el diagnóstico y el tratamiento de este tipo de lesiones. Conclusiones: las heridas por empalamiento son infrecuentes y suponen un reto para el personal médico que atiende al afectado desde el primer momento, tanto por lo complejas que pueden ser, como por la necesidad de una actuación rápida, sin poder conocer a priori, en muchas de las situaciones, la extensión verdadera de las lesiones, que se evidenciará durante el posible acto operatorio(AU)


Introduction: the objective of this paper was to present a case of impalement through the inguinal region. The impalement injuries are infrequent and sometimes extremely serious. These injuries require prompt action of the emergency medical personnel and surgeon. Clinical case: a forty-year old man, who had an occupational accident resulting in impalement of an iron rebar through the right inguinal region and penetrating abdominal cavity. The clinical case and the procedures performed in the diagnosis and treatment of these injuries were presented in detail. Conclusions: The impalement injuries are rare and represent a challenge to the medical staff that treat the patient from the very beginning, because they can be very complex and require fast action and treatment. In many cases, the real dimension and severity of lesions at first is unknown and can only be assessed during surgery(AU)


Subject(s)
Humans , Male , Adult , Abdominal Injuries/diagnosis , Accidents, Occupational , Emergencies , Inguinal Canal/injuries , Wounds, Stab/surgery , Abdominal Injuries/therapy
9.
Rev. Col. Bras. Cir ; 41(1): 75-79, Jan-Feb/2014.
Article in English | LILACS | ID: lil-707272

ABSTRACT

The meeting of the Publication "Evidence Based Telemedicine - Trauma and Emergency Surgery" (TBE-CiTE), through literature review, selected three recent articles on the treatment of victims stab wounds to the abdominal wall. The first study looked at the role of computed tomography (CT) in the treatment of patients with stab wounds to the abdominal wall. The second examined the use of laparoscopy over serial physical examinations to evaluate patients in need of laparotomy. The third did a review of surgical exploration of the abdominal wound, use of diagnostic peritoneal lavage and CT for the early identification of significant lesions and the best time for intervention. There was consensus to laparotomy in the presence of hemodynamic instability or signs of peritonitis, or evisceration. The wound should be explored under local anesthesia and if there is no injury to the aponeurosis the patient can be discharged. In the presence of penetration into the abdominal cavity, serial abdominal examinations are safe without CT. Laparoscopy is well indicated when there is doubt about any intracavitary lesion, in centers experienced in this method.


A reunião de Revista "Telemedicina Baseada em Evidências - Cirurgia do Trauma e Emergência" (TBE-CiTE) através de revisão da literatura selecionou três artigos recentes sobre o tratamento do paciente vítima de agressão por arma branca na parede abdominal. O primeiro trabalho observou o papel da tomografia computadorizada (TC) no tratamento do paciente com agressão por arma branca na parede abdominal. O segundo analisou o uso da laparoscopia diagnóstica em detrimento do exame físico seriado para avaliar os pacientes com necessidade de laparotomia terapêutica. O terceiro fez uma avaliação da exploração cirúrgica do ferimento abdominal, uso do lavado peritoneal diagnóstico e TC na identificação precoce de lesões significativas e o melhor momento para intervenção. Houve consenso para a indicação de laparotomia na presença de instabilidade hemodinâmica, ou sinais de peritonite, ou evisceração. O ferimento deve ser explorado sob anestesia local e se não houver lesão da aponeurose o doente pode receber alta. Na presença de penetração na cavidade abdominal, o exame seriado do abdome é seguro, sem a necessidade de TC. A laparoscopia está bem indicada quando existe dúvida de lesão intracavitária em centros com experiência nesse método.


Subject(s)
Humans , Abdominal Injuries/surgery , Abdominal Wall/surgery , Wounds, Stab/surgery , Laparoscopy , Laparotomy , Practice Guidelines as Topic
10.
Rev. cuba. cir ; 52(1): 55-62, ene.-mar. 2013.
Article in Spanish | LILACS | ID: lil-672130

ABSTRACT

Los traumatismos torácicos graves (TT), ya sean abiertos o cerrados, pueden ocurrir secundarios a lesiones por arma de fuego, arma blanca, accidentes de tránsito, caídas de altura o compresiones torácicas por aplastamientos, entre otros y se han transformado en una causa importante de morbilidad y mortalidad, pero son las lesiones vasculares directamente responsables de un 20 a un 25 por ciento del total de las muertes, causadas por estos traumatismos. La mayoría de los afectados por estas lesiones son personas jóvenes previamente sanas, fundamentalmente del sexo masculino. Se presenta un caso clínico de un paciente de 38 años de edad, con antecedentes de salud previos, que durante una riña, sufrió una herida en la región posterior del hemitórax derecho, por debajo del borde inferior de la escápula, penetrante en la cavidad torácica, ocasionada por un objeto corto punzante de fabricación artesanal, cuyo pedazo quedó dentro de esta cavidad, lo cual provocó una lesión de alrededor de 3 cm de longitud, aproximadamente a nivel de la aorta descendente torácica. El paciente fue intervenido quirúrgicamente de manera urgente, y se logró suturar la lesión vascular con éxito, proceder que casi nunca es posible debido al alto índice de mortalidad de este tipo de lesiones, pues la mayoría de las personas fallecen antes de su llegada a un centro especializado de salud(AU)


Severe thoracic traumatisms, either open or close, may occur secondary to injuries caused by firearms, knifes, traffic accidents, falls from height or thoracic compression due to crushing, among others. They have become an important cause of mortality and morbidity but they are vascular injuries directly responsible for 20 to 25 percent of the total number of deaths caused by this type of traumatism. Most of the injuries occurred in healthy young people, mainly men. This is the case of a 38 years-old patient with a history of health problems, who in a street fight, suffered an injury in the posterior region of the right hemithorax, below the lower rim of the scapula. It was a penetrating wound in the thoracic cavity caused by a short sharpened object; a piece of this object was trapped into the cavity and caused a 3 cm long injury, at the level of the thoracic descending aorta. The patient was operated on in an emergency situation and the vascular injury was successfully sutured, a procedure that barely has positive results due to the high mortality rate of this type of injuries. Most of the affected people die before arriving to the specialized health center(AU)


Subject(s)
Humans , Male , Adult , Thoracic Injuries/surgery , Wounds, Stab/surgery , Aortic Rupture/surgery , Thoracotomy/methods
11.
J. vasc. bras ; 12(1): 75-80, jan.-mar. 2013. ilus
Article in Portuguese | LILACS | ID: lil-670393

ABSTRACT

As fístulas aortocavais são entidades raras e de etiologia variada. Uma minoria é consequente a eventos pós-traumáticos. As manifestações clínicas, nesses casos, podem ser agudas ou tardias. As tardias manifestam-se dias, semanas ou anos após o trauma, principalmente como quadro de insuficiência cardíaca congestiva. O tratamento de tais fístulas pode ser realizado através do reparo direto por cirurgia aberta ou através da abordagem endovascular. Relatamos o caso de um paciente do sexo masculino, de 53 anos que apresentou, 27 anos após um ferimento por arma branca abdominal, sinais importantes de insuficiência cardíaca congestiva, manifestada como palpitações e dispneia, fibrilação atrial paroxística, além de pressão arterial divergente e sopro em epigástrio. A angiotomografia confirmou o diagnóstico de fístula aortocaval e procedeu-se ao tratamento endovascular para o selamento da fístula. O paciente, segundo acompanhamento após três meses, apresentou evolução satisfatória, com melhora significante do quadro e controle adequado da insuficiência cardíaca congestiva.


Aortocaval fistulas are rare entities with different etiologies. A minority of them are consequent to post-traumatic events. The clinic in these cases may be acute or delayed. The later manifest themselves days, weeks or years after the trauma mainly as congestive heart failure. Its treatment can be done by open surgery or endovascular approach. The present case it is a 53 year old man who presented, 27 years after a stab wound in the abdomen, important signs of congestive heart failure, manifested as palpitations and dyspnea, paroxysmal atrial fibrillation, besides of dissenting blood pressure and bruit in the epigastrium. Angiotomography confirmed the diagnosis of aorto-caval fistula and proceeded to endovascular treatment for fistula repair. The patient, according with control after three months, showed a satisfactory outcome, with significant improvement of the condition and appropriate control of heart failure.


Subject(s)
Humans , Male , Middle Aged , Wounds, Stab/surgery , Arteriovenous Fistula/surgery , Endovascular Procedures/rehabilitation , Angiography , Aorta, Abdominal , Dissection , Tomography, X-Ray Computed
12.
Rev. Col. Bras. Cir ; 36(6): 482-486, nov.-dez. 2009. ilus
Article in Portuguese | LILACS | ID: lil-539545

ABSTRACT

OBJETIVO: Analisar os pacientes submetidos à toracotomia para o tratamento de traumatismo torácico. MÉTODOS: Estudo retrospectivo por meio da análise de prontuários nos dois principais hospitais de referência para trauma em adultos desta cidade, por um período de cinco anos, interessando dados epidemiológicos, agente causal, indicações, tipo de incisão, classificação do escore anatômico do trauma, fatores prognósticos e a mortalidade. RESULTADOS: Foi analisado neste estudo 124 pacientes submetidos à toracotomia com idade média de 28 anos, tendo como o agente causal mais incidente a arma branca (68 por cento dos casos). A principal indicação da toracotomia foi hemotórax maciço com 50,7 por cento dos casos, seguido de choque cardiogênico ou hipovolêmico com 48,4 por cento. Ocorreram 28 óbitos (20,6 por cento), sendo que os pacientes com lesões de veia cava (cinco pacientes) e aorta (dois pacientes) tiveram uma mortalidade de 100 por cento. Observou-se uma maior mortalidade em pacientes com escore anatômico do trauma superior a 14 (p=0,004) e maior quantidade de sangue transfundido (p=0,090). CONCLUSÃO: O perfil do paciente que foi vítima de traumatismo torácico e submetido à toracotomia exploradora é o seguinte: jovem, do sexo masculino e vítima de trauma por arma branca. Os fatores que mais contribuíram para o êxito letal foram o elevado escore anatômico do trauma e a associação com lesões vasculares importantes, como da artéria aorta e veia cava.


OBJECTIVE: To analyze patients who underwent thoracotomy for the treatment of chest trauma in the City of Manaus. METHODS: We performed a retrospective study through analyzed records in the two main reference hospitals for trauma adults in this city during a period of 5 years. We considered for this study the epidemiological data, causal agent, type of incision, anatomical classification score of trauma, prognostic factors and mortality. RESULTS: We analyzed 124 patients who underwent thoracotomy with a mean age of 28 years. Stab wounds were the most common casual agent (68 percent). The main indication for thoracotomy was massive hemothorax with 50.7 percent of cases, followed by cardiogenic or hypovolemic shock with 48.4 percent. There were 28 deaths (20.6 percent). Patients with vena cava injuries (5 patients) and aorta lesions (2 patients) had 100 percent mortality rate. There was a higher mortality in patients with major index of trauma (p = 0004), and largest quantity of blood transfused (p = 0090). CONCLUSION: Thoracic trauma patients submitted to exploratory thoracotomy were young, males and victims of stab wound trauma. The most contributing death factors were the lethal anatomical score, more than 15 points, and the association with major vascular lesions, as the aorta and vena cava.


Subject(s)
Adult , Female , Humans , Male , Thoracic Injuries/surgery , Thoracotomy , Brazil/epidemiology , Chi-Square Distribution , Hemothorax/etiology , Hemothorax/surgery , Retrospective Studies , Shock, Cardiogenic/etiology , Shock, Cardiogenic/surgery , Trauma Severity Indices , Thoracic Injuries/complications , Thoracic Injuries/mortality , Wounds, Stab/complications , Wounds, Stab/surgery
13.
Cir. & cir ; 77(5): 365-368, sept.-oct. 2009. tab
Article in Spanish | LILACS | ID: lil-566473

ABSTRACT

Introducción: El colon es el segundo órgano más frecuentemente lesionado en las heridas por trauma penetrante de abdomen. En México, las lesiones por arma blanca o de fuego van en aumento. Nuestro objetivo fue evaluar el principal manejo para las lesiones traumáticas de colon. Material y métodos: Estudio retrospectivo y aleatorizado de 178 pacientes con trauma abdominal y lesiones de colon, en un lapso de cinco años (enero de 2003 a junio de 2008) en el Hospital General de Balbuena. Se comparó el uso del cierre primario y cirugía derivativa con colostomía. Se analizó sexo, grupo de edad, tipo de herida, grado de lesión y mortalidad. Resultados: De 178 pacientes, 156 fueron hombres (87.6 %) y 22 mujeres (12.4 %). El grupo de edad con mayor afección fue el de 21 a 30 años; 74 pacientes (41.6 %) presentaron heridas por instrumento punzocortante y 104 pacientes (58.4 %) heridas por arma de fuego. El principal manejo fue mediante cierre primario: 92 casos (51.7 %) versus 86 (48.3 %) para cirugía derivativa; sin embargo, en las heridas por arma de fuego el principal manejo fue la colostomía (67 casos). La mortalidad fue de 17 casos (9.55 %) debido a causas diversas como lesiones a múltiples órganos de manera asociada. Conclusiones: En las lesiones colónicas debe individualizarse el tratamiento, según la etiopatogenia, grado de lesión y lesiones asociadas.


BACKGROUND: Colon trauma is frequent and its prevalence is difficult to establish because of the different factors that intervene in its origin. In Mexico, traumatic colon injuries, albeit stab wounds or gunshot wounds, are on the rise. Our objective was to evaluate the most appropriate management for traumatic colon injuries. METHODS: We conducted a retrospective study of 178 case files of patients with abdominal trauma and colon lesions during a 5-year period from January 2003 to June 2008 from the General Hospital of Balbuena, Mexico City. The study compared the use of primary closure vs. colostomy, analyzing variables such as sex, age, type of wound, severity of lesion and mortality. RESULTS: There were a total of 178 patients; 156 were male (87.6%) and 22 were female (12.4%). The most affected age group was between 21 and 30 years; 74 patients (41.6%) had stab wounds and 104 patients (58.4%) had gunshot wounds. Management consisted mainly of primary closure in 92 cases (51.7%) vs. colostomy in 86 patients (48.3%). However, 64% of gunshot wounds were treated with colostomy. Reported mortality was 9.55% and this was due to different factors such as multiple organ injury. CONCLUSIONS: Treatment of traumatic colon injury should be case specific, taking into account the mechanism of the lesion, its severity and associated injuries.


Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Colon/surgery , Colostomy/statistics & numerical data , Wounds, Stab/surgery , Wounds, Gunshot/surgery , Wound Infection/epidemiology , Digestive System Surgical Procedures/statistics & numerical data , Abdominal Injuries/surgery , Shock/etiology , Shock/therapy , Colon/injuries , Colostomy/adverse effects , Colostomy , Postoperative Complications/prevention & control , Wounds, Stab/epidemiology , Wounds, Gunshot/epidemiology , Surgical Wound Infection/epidemiology , Wound Infection/drug therapy , Mexico/epidemiology , Digestive System Surgical Procedures/adverse effects , Digestive System Surgical Procedures , Retrospective Studies , Suture Techniques , Multiple Trauma/epidemiology , Multiple Trauma/surgery , Abdominal Injuries/epidemiology , Viscera/injuries , Young Adult
15.
Cir. & cir ; 76(1): 95-98, ene.-feb. 2008. graf
Article in Spanish | LILACS | ID: lil-568172

ABSTRACT

BACKGROUND: Uncontrolled bleeding leads to 40-86% of preventable deaths due to trauma. Use of NovoSeven (rFVIIa) in trauma is promising, although data supporting its utilization are limited. CASE REPORT: We report the case of a patient who sustained a penetrating grade V cardiac injury (AAST-OIS) and presented postoperative massive coagulopathic bleeding arrested by the administration of platelet pools and NovoSeven. DISCUSSION: This report represents our initial experience and the very first case of successful use of NovoSeven for the treatment of traumatic coagulopathic hemorrhage at the Central Military Hospital in Mexico City. A further prospective trial justifying its use in our institution is warranted.


Subject(s)
Humans , Male , Adult , Factor VIIa/therapeutic use , Wounds, Stab/complications , Hemorrhage/drug therapy , Heart Injuries/complications , Blood Component Transfusion , Combined Modality Therapy , Drainage , Emergencies , Wounds, Stab/surgery , Hemorrhage/etiology , Hemorrhage/surgery , Alcoholic Intoxication/complications , Recombinant Proteins/therapeutic use , Thoracotomy , Multiple Trauma/surgery , Abdominal Injuries/surgery , Heart Injuries/surgery
16.
LJM-Libyan Journal of Medicine. 2008; 3 (1): 52-53
in English | IMEMR | ID: emr-146625

ABSTRACT

This report describes a case of cortical blindness that followed successful surgical repair of two stab wounds in the heart in a 29-year old Libyan man. The patient presented in a state of pre cardiac arrest [shock and low cardiac output status], following multiple chest stab wounds. Chest tube was immediately inserted. Surgery was urgently performed suturing the two wounds; in the root of the aorta and in the left ventricle, and haemostasis was secured. Cardiac arrest was successfully prevented. The patient recovered smoothly, but 24 hours later he declared total blindness. Ophtalmic and neurological examinations and investigations that included fundoscopy, Electroencephalograms [EEGs] and Computed Tomography Scans revealed no abnormalities, apart from absence of alpha waves in the EEGs. We diagnosed the case as cortical blindness and continued caring for the patient conservatively. Three days later, the patient regained his vision gradually and was discharged on the 7[th] postoperative day without any remarks


Subject(s)
Humans , Male , Heart Arrest/surgery , Wounds, Stab/surgery , Resuscitation , Heart Injuries/surgery , Heart Ventricles/injuries , Hypoxia, Brain , Coronary Angiography , Electroencephalography
17.
Cuad. cir ; 22(1): 11-17, 2008. ilus, tab
Article in Spanish | LILACS | ID: lil-518986

ABSTRACT

El trauma penetrante cervical de zona II, zona comprendida entre el cartílago cricoides y el ángulo de la mandíbula, que presenta signos de compromiso de una estructura vital, requiere exploración quirúrgica inmediata. La principal controversia, se genera sobre el manejo de lesiones de zona II en pacientes hemodinámicamente estables y sin signos que indiquen daño de estructura vital evidente. Existen 2 conductas: exploración quirúrgica de todas las lesiones que atraviesen el músculo platisma o, tratamiento selectivo que implicaría el examen clínico complementado con estudio por imágenes y endoscópicos que descarten lesiones de resorte quirúrgico. El objetivo de este artículo es presentar una serie de casos de trauma penetrante cervical de zona II en la Unidad de Emergencia del Hospital Clínico Regional de Valdivia entre los años 2002 y 2008 y realizar una breve revisión del tema. Se presentan 7 pacientes de sexo masculino que ingresaron con diagnostico de herida penetrante cervical de zona II, entre 16 y 75 años. De éstos, 4 pacientes sufrieron lesiones por arma blanca, 2 por arma de fuego y I por trauma accidental sobre un cerco. Destaca la presencia de signos duros en los casos de esta serie: 4 pacientes con hematoma expansivo o grande, 2 con aire saliendo por la herida, 1 con disfagia y 1 con ausencia de pulso carotídeo. Se exploraron todos los pacientes. La estadía post-operatoria promedio fue de 8 días y no existieron complicaciones post-operatorias ni fallecidos. La incidencia de este tipo de lesiones en nuestro medio es baja pero de elevada gravedad, por lo que es importante identificar a los pacientes que tienen indicación quirúrgica inmediata de los que Se puede realizar un manejo conservador con el apoyo de métodos de estudio complementarios.


Subject(s)
Humans , Male , Adolescent , Adult , Middle Aged , Wounds, Penetrating/surgery , Neck Injuries/surgery , Chile/epidemiology , Wounds, Stab/surgery , Wounds, Gunshot/surgery , Length of Stay , Retrospective Studies
18.
Cir. & cir ; 74(6): 425-429, nov.-dic. 2006. tab, ilus
Article in Spanish | LILACS | ID: lil-571243

ABSTRACT

Introducción: la rotura traumática del diafragma es una lesión infrecuente que aparece en politraumatismos o agresiones. Predomina en los varones entre 20 y 50 años de edad, siendo los accidentes de tráfico la principal causa en Europa. El diagnóstico preoperatorio requiere alto nivel de sospecha junto con las adecuadas exploraciones radiológicas. El retraso diagnóstico se asocia con elevada morbilidad y mortalidad, constituyendo la intervención quirúrgica inmediata un factor determinante para el éxito en el tratamiento de estos pacientes. El objetivo de este informe fue analizar la incidencia y epidemiología de la rotura traumática del diafragma en nuestro medio, y exponer nuestros resultados en el diagnóstico y tratamiento de esta lesión. Material y métodos: presentamos siete casos correspondientes al periodo 1999-2005 y analizamos el motivo de ingreso, la clínica, las formas de diagnóstico, las lesiones asociadas, el tratamiento y la evolución. Conclusiones: el diagnóstico de rotura diafragmática es difícil debido a su baja frecuencia y a su sintomatología variable, no obstante, debe ser considerado en todo paciente politraumatizado. La tomografía helicoidal es la exploración radiológica de elección y la vía de abordaje más adecuada es la laparotomía media.


BACKGROUND: Traumatic diaphragmatic rupture is an infrequent lesion usually found in polytrauma cases or after violent attacks. Patients are usually males between 20 and 50 years old, and car accidents are the main causes in Europe. Preoperative diagnosis must be based on a high level of suspicion and appropriate radiological explorations. Diagnostic delay is associated with high morbidity and mortality and early surgical treatment is required for successful management. We undertook this study to analyze the epidemiology of diaphragmatic rupture and to report our results in the diagnosis and treatment of this injury. METHODS: We present seven cases from 1999 through 2005. We analyzed the reasons for admission, signs and symptoms, diagnostic approach, associated lesions, treatment and course. CONCLUSION: Diagnosis of diaphragmatic rupture is difficult due to changeable symptomatology; nevertheless, it must be considered in all polytraumatized patients. Computerized tomography is the radiological exploration of choice and the most suitable surgical approach is laparotomy.


Subject(s)
Humans , Male , Adult , Middle Aged , Diaphragm/injuries , Accidents, Traffic , Abdominal Pain/etiology , Chest Pain/etiology , Wounds, Stab/diagnosis , Wounds, Stab/surgery , Liver/injuries , Fractures, Bone/complications , Hemothorax/etiology , Hernia, Diaphragmatic, Traumatic/etiology , Hernia, Diaphragmatic, Traumatic/surgery , Incidence , Laparotomy , Retrospective Studies , Rupture , Splenic Rupture/complications , Splenic Rupture/surgery , Thoracotomy , Tomography, X-Ray Computed , Multiple Trauma/complications
19.
ACM arq. catarin. med ; 35(2): 63-67, abr.-jun. 2006. tab, graf
Article in Portuguese | LILACS | ID: lil-445526

ABSTRACT

Objetivo: Traçar o perfil epidemiológico dos pacientes vítimas de ferimentos provocados pelo uso de arma branca atendidos no Hospital Florianópolis, em Florianópolis, Santa Catarina. Métodos: Avaliou-se os prontuários e fichas de atendimento dos pacientes que deram entrada na emergência do Hospital Florianópolis no período de 1° de janeiro de 1999 a 31 de dezembro de 2004, tendo como causa ferimentos por arma branca, e os dados encontrados transpostos para um protocolo pré-estabelecido. Resultados: encontramos 263 registros, sendo a maioria vítimas jovens, média de idade de 29,29 anos, com predomínio de homens (85,17%), procedente de Florianópolis (62,73%), bairro Monte Cristo (17,57%), profissionais economicamente ativos (76,68%). O principal instrumento utilizado foi a faca (50,95%), ocasionando ferimento único (67,68%) em membro superior (37,38%). Conclusões: a maioria das vítimas são jovens, do sexo masculino, provenientes de Florianópolis, do bairro Monte Cristo, com ferimento único em membro superior ocasionado por faca...


Subject(s)
Humans , Male , Female , Adult , Wounds, Stab/surgery , Health Profile , Wounds, Stab , Emergencies , Medical Records , Retrospective Studies
20.
Medical Principles and Practice. 2006; 15 (1): 80-82
in English | IMEMR | ID: emr-79515

ABSTRACT

To report a case of penetrating cardiac injury with patients survival. A 23-year-old man stabbed with a knife to the epigastric area just below the right costal margin was brought to the Emergency Room, AI-Adan Hospital, Kuwait, in a state of shock. Aggressive resuscitation was performed, chest X-ray showed no evidence of hemo- or pneumothorax. Exploratory laparotomy was performed revealing a severely congested liver, with no intraperitoneal hemorrhage to explain his being in a state of shock. Left thoracotomy revealed pericardial tamponade with perforation in the right ventricle and hemorrhage. A mattress suture was used to control bleeding from the right ventricle. Postoperative echography revealed a tear in the interventricular septum and papillary muscle. Open-heart surgery was performed to repair the injured tissues. The patient made an uneventful recovery. This report shows that patients with penetrating cardiac injuries and detectable vital signs on arrival at the hospital can be salvaged by prompt surgical intervention.


Subject(s)
Humans , Male , Emergency Medical Services , Violence , Wounds, Stab/surgery
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