Proper Management for Morbid Iatrogenic Retroperitoneal Barium Insufflation

A barium enema is a diagnostic and therapeutic procedure commonly used for colon and rectum problems. Rectal perforation with extensive intra- and/or extraperitoneal spillage of barium is a devastating complication of a barium enema that leads to a significant increase in patient mortality. Due to the low number of reported cases in recent scientific literature and the lack of experience with the management of these cases, we would like to present our treatment approach to a rare case of retroperitoneal contamination with barium, followed by its intraperitoneal involvement during a diagnostic barium enema. Our experience with long-term management of the patient and the good outcome will be depicted in this paper.

Ectopic major transplantation for salvage of upper and lower extremity amputations / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>Ectopic tissue transplantation is not a new idea. Godina and his colleagues pioneered this method in the 1980s. This method is a last resort method of preserving an amputated body part, which consists of banking the amputated segment in an ectopic area and returning it to its native place at a later date. In this article we present our experience with this demanding procedure.</p><p><b>METHODS</b>Debridement was the mainstay of this procedure. The stump and amputated part are carefully debrided and the stump was either closed primarily or covered by a flap. The amputated part was transplanted to one of several banking sites in the body and at a later date it will be transferred to its native site in an elective setting.</p><p><b>RESULTS</b>Seven patients meeting the set criteria for ectopic transplantation were enrolled in this study. The overall success rate was about 70%, lower than expected but these are cases of severe crush injury. Although the functional recovery of these patients are very low, all of the successful cases except one could find a job as a janitor or light manual worker. No patient could return to his previous job.</p><p><b>CONCLUSION</b>Ectopic transplantation of body parts is an accepted method of treatment of severely crushed extremity or finger injuries. In our country an amputee has very little chance of finding a job instead a disabled person can. In addition in Iran cultures amputation is seen as punishment of either the God or the society, so it is not well accepted and many patients persist on saving the limb even with no functional recovery. None of our successful cases could return to his previous occupation but almost all of them could find a job as janitors or light manual workers.</p>

Management of treadmill hand injuries using soft tissue distraction

In the modern day cities, home treadmill usage is increasing. Toddlers are prone to a special injury by the treadmill, during workout the toddler tries to get on the belt and the roller action pulls the fingers under the belt and get caught between the belt and a ; metal rod under the machine and the belt scrapes the fingers. If untreated some of these injuries will lead to flexion contracture. The usual treatment is release of contracture and skin grafting, however, graft discoloration and recurrence of contracture are the complications of this method and the patients usually seek treatment for the brown discoloration of the grafts at a later age. In this study we assess the results of Z-plasty in combination with soft tissue distraction without skin grafting with long term usage of splint as an alternative treatment for these patients. In this retrograde descriptive cross-sectional study, we evaluated the patients presented with treadmill hand injuries between the years 2006 and 2011. Demographic data including age and sex in addition to other information including location of trauma, severity of trauma, time elapsed between the trauma and treatment, type of treatment including wound care and surgical method and treatment outcomes were assessed. A total of 8 patients [3 girls and 5 boys] following finger treadmill injury were assessed. 15 fingers in 7 patients had volar injury. The middle finger was the most commonly injured finger. In all patients a minimum of 2 fingers were injured and in just l patient 3 fingers were injured. In long-term follow-up all the patients had acceptable volar skin and complete ROM of the fingers. Due to discoloration of the skin graft and recurrence of contracture following skin graft as the sole treatment for the injury, application of Z-plasty with soft tissue distraction and long term splints seems to be a proper alternative treatment for these patients

Impact of morphine dependency on secondary intention wound healing in rat

Wound healing has always been among important and crucial subjects in medicine. Morphine dependency has also been a social and health problem in the Middle East. This study was aimed to investigate the effects of morphine dependency on pro-inflammatory and fibroblast cell recruitment, as well as reepithelialization and the revascularization processes involved in secondary intention wound healing in rats. A full-thickness wound [2×2 cm in diameters] was created on the dorsum of two groups of rats, a control group and a second group consisted of morphine dependent rats. During the first 14 days of post wounding the wound was excised consecutively at priorly planned days with peripheral margins of normal skin. The specimens were evaluated by two pathologists, who were blind to the study design, and the cellular population, re-epithelialization and revascularization were reported by them. Histological examination of the wound tissue showed evidence of increased population of fibroblasts and a plateau or decreased recruitment of macrophage and neutrophile cells. In the dependent group re-epithelialization was observed to be enhanced significantly in comparison to the control group while having an inhibitory effect on revascularization. The present study demonstrates that morphine dependency enhances re-epithelialization as well as tissue recruitment of fibroblasts; thereby probably enhancing secondary intention wound healing

[Treatment of upper limb deformities using soft tissue distraction: an introduction to pentagonal frame]

Soft tissue distraction is an increasingly accepted treatment method in hand surgery which can be applied as a method of contracture release from elbow to proximal phalangeal joints. Common methods have been shown that contracture release alone is not enough and leads to recurrence after a while. Currently, joint and soft tissue distraction and holding them in a proper position in which physiotherapy can be done is the most accepted method. Herein we present a technique named "pentagonal frame" for soft tissue distraction which can help us in reaching the desired outcome. As a result of novelty of this technique and lack of enough data regarding its outcome, we would like to report its treatment results in this article. In this case series study, we report 33 patients that presented with soft tissue contracture in their hands. In this method, a thin 1-1.5 mm Kirschner wire was passed horizontally at the proximal head of the distal phalanx and bent like a frame around the finger, forming a pentagonal shape for anchorage and allowing limb traction without damage to pulp and soft tissues. Two forms of traction were performed: static [with a wire exerting pressure] or dynamic [using a rubber band to adjust the tension]. The wire or rubber band may be temporarily freed to commence active and passive physiotherapy. We maintained the frame for 3-6 weeks which played the role of night splint within final weeks. SPSS V.16 was used for data analysis. In this study, 33 patients [23 male, 10 female] with a mean age of 20.91 years [SD=13.05] were evaluated. The patients underwent surgery for a mean of 3 times. After the surgery and removing the frame, patients were followed up every 6 months for a maximum of 5 years. The difference between flexion contracture in PIP, before and after the surgery was statistically significant [65.15 +/- 37.44 vs. 7 +/- 4.74, p<0.001]. Except for one case of pin infection that was treated using antibiotic administration and its removal, no other major complications were encountered during the follow-up period [3-5 years]. The pentagonal frame with its effective traction on soft tissues and ligaments and additional physiotherapy may be used as an effective treatment for soft tissue adhesions. Moreover, it provides traction to the fingers and even the hand without complications on distal phalanx and joints and allows concurrent physiotherapy