Penetrating neck trauma: review of 192 cases

The neck region contains a high density of vital organ structures within a relatively small and unprotected anatomic region, making it one of the most vulnerable areas of the body for all types of injuries. In this article, we studied penetrating neck trauma cases in Alzahra Hospital over a 10-year period. In this retrospective, descriptive, analytical study, penetrating neck trauma cases admitted to Alzahra Hospital between April 2000 and April 2010 were analyzed for epidemiology, mechanism of trauma, zone of trauma, therapeutic method, injuries to other organs, complications, and mortality. Among 192 penetrating neck injuries, the mean age at the time of injury was 25.08 +/- 15.02 years. Of these cases, 96.4% occurred in men. The most common mechanisms of trauma was stab wounds [85.93%]. In 56.3% of penetrating neck injuries, zone 2 was involved. Neck exploration was positive in 84.4% of cases, and 52.1% of patients underwent surgery. Vascular exploration was the most common cause of surgery [67.2% of patients]. The most common surgical intervention was vein ligation [50.8% of cases]. In 11.98% of cases, another organ injury occurred simultaneously, and chest injury was the most common coexisting problem [65.2%]. Complications were reported in 9.3% of patients, and the need for intubation was the most common complication [5.2% of patients]. Mortality rate was 1.5%. According to the findings of this study, the most common cause of penetrating neck injuries was stab wounds, and the majority of patients were young men, therefore, preventive measures should be implemented. Because of fatal complications associated with neck injuries, we recommend early neck exploration in unstable cases or when injuries are deeper than the platysma

role of early upper gastrointestinal endoscopy [less than 24 hours and after] in the management of corrosive ingestion in adults

Upper gastrointestinal [UGI] endoscopy is the most reliable modality for evaluating patients with caustic injury of GI tract; however there is an ongoing debate on its optimal timing. 100 adult patients with definite diagnosis of injury due to corrosive ingestion on direct laryngoscopy were evaluated in Tabriz Emam Khomeini Hospital during a 15-month period. The patients with signs and symptoms indicating a serious internal injury were operated immediately. In other patients, endoscopy was employed and according to timing, patients categorized in two groups; early [<24 h] and late endoscopy [>24 h]. Inhospital condition of the two groups was compared. 62 females and 38 males [25.51 +/- 9.25 y/o] were recruited. Alkaline materials were used in majority of cases [83%]. Eight percent of the patients were operated immediately. Early endoscopy was employed in 37% of patients and 55% underwent late endoscopy. Endoscopy results were normal in 11%, grade I in 36%, grade II in 22%, grade III in 11% and grade IV lesion in 12% of the patients. There was no significant difference between the two groups regarding the need of operation, gap between admission and operation, need of ICU admit and its duration and inhospital morbidity and mortality. However, operation gap and ICU admit were apparently better in early endoscopy group and morbidity was lower in late endoscopy group. Early and late endoscopy did not significantly affect inhospital condition of adult patients with corrosive ingestion. However, early endoscopy was apparently along with better results

Evalution of validity of Alvarado scoring system for diagnosis of acute appendicitis

Hemorrhagic shock and resuscitation is welt known to result in myocardiat dysfunction and injury. Stimulation of the Na[+]-H[+] exchanger plays an important role in the pathway of myocardial injury. The purpose of the present study was to examine the protective effects of blocking the cardiac Na[+]-H[+] exchange, using 100mM ethyl-isopropyl amiloride [EIPA], a specific Na[+]- ft exchanger blocker, on myocardial contractile function on ex vivo resuscitation of isolated rat heart following one hour of hemorrhagic shock. Sprague- Dawley rats-were assigned to-hemorrhage, hemorrhage + EIPA, sham hemorrhage and sham hemorrhage + EIPA groups. Rats were hemorrhaged for one hour. Hearts were harvested and ex vivo treated and resuscitated by perfused in the Langendorff System. Myocardial function was determined. The results showed that inhibition of the Na[+]-H[+] exchanger using EIPA improved the post-resuscitation myocardial contractile function. Blocking the Na[+]-H[+] exchanger using 100mM EIPA following 60 minutes of hemorrhagic shock improved myocardial function