Patient survival and limb salvage after shark attack with major vascular injury: A case report / 中华创伤杂志(英文版)

Shark attacks are rare unique pathological processes. Some of them represent devastating injuries with a high morbidity and significant mortality. Related published articles are limited. The increased human interaction within the environment of sharks is the cause of rising incidence of such attacks. This study reported a case of level 4 shark injuries (shark-induced trauma scale) in a 33-year-old male patient, who presented with an extensive injury of the right lower limb with the characteristic features of shark bite. At admission the patient was in a state of shock with profuse bleeding that was controlled by tourniquet. The patient was resuscitated according to the advanced trauma life support. Clinical examination showed hard signs of vascular injury with absent pedal pulse, associated neurological deficits and severance at the knee joint. Prompt vascular intervention after resuscitation was performed to manage the major vascular injuries, together with proper washout and debridement of all the necrotic tissues under strong antibiotic coverage to prevent infection. After that, the patient underwent sequenced plastic, orthopedic, and neurological interventions. Strict follow-up was conducted, which showed that the patient was saved and achieved a functioning limb. This study aims to highlight the management of level 4 shark injuries, which are considered serious and challenging with a high fatality rate and a great risk of amputation due to the associated major vascular injuries. Immediate well organized management plan is crucial. Prompt resuscitation and surgical intervention by a highly-skilled medical team are required to improve the chance of patient survival and limb salvage.

Subacute sclerosing panencephalitis in a child

Subacute sclerosing panencephalitis [SSPE] is a progressive neurological disease affecting children and adolescents. The etiology is proven to be due to measles virus which causes persistent central nervous system infection. SSPE is classified under the category of progressive myoclonic epilepsy syndromes. This group of disorders characterized by progressive dementia, cognitive decline and myoclonic epilepsy are frequently resistant to anti epileptic medications. Although SSPE has generally a poor prognosis, several studies showed variable response to antiviral therapy and Interferon Alpha resulting into stabilization of the disease. In the era of measles vaccination program the incidence of the disease dropped dramatically in USA[1]. We are reporting as far as we believe the first child discovered to have SSPE in the Kingdom of Bahrain. The child presented to the pediatric neurology department with new onset seizures and progressive decline in her school performance. Examination and further investigation proved that the child was suffering from SSPE

plastic syringe minifixator for phalangeal fractures

Aminifixator, made of the barrel of a plastic hypodermic syringe as a crossbar and K wires as pins, was used to treat 32 phalangeal fractures in 27 patients. The average age was 31.5 years. Union occurred in 30 fractures, in which the total active range of motion [TAM] was good in 25, fair in 3 and poor in 2 fractures. Two fractures developed nonunion, 2 had 10 degree ulnar angulations, 1 had 10 degree anterior angulation, 5 showed pin tract infection, 2 had aseptic loosening of one K wire and one case developed reflex sympathetic dystrophy. In conclusion, the method is simple, affordable and well tolerated by patients. The fixation is stable allowing early joint motion and soft tissue care and the materials are always available

Kuntscher nail plus lnterfragmentary screws fixation for comminuted mid-shaft femoral fractures

Twenty-nine patients with unilateral mid-shaft femoral fractures with single butterfly fragments were treated by intramedullary Kuntscher nail and lnterfragmentary screws fixation at Tanta University Hospitalfrom July 1999 to July 2003. Eighteen [62%] were males and 11 [38%] were females. Their age ranged between 19 to 53 years with a mean of 34 years. One lnterfragmentary screw was used in 13 cases [45%] while two were used in 16 cases [55%]. Twenty-seven fractures [93.1%] united within 12 to 24 weeks with an average of 16 weeks. Satisfactory functional results were obtained in 26 patients [90%], and unsatisfactory in 3 patients [10%]. Complications met with this method of fixation were infected nonunion in 1 patient [3.4%], aseptic nonunion with nail breakage in 1 patient [3 .4%], nail bending plus gluteal bursitis in one patient [3.4%], and bursitis alone in 2 patients [6.9%]. This method of fixation is reliable for mid-shaft femoral fracture with a single butterfly fragment. It is- less costly with no need for special equipment's and no X-ray exposure