Trauma abdominal contuso por golpe con manubrio de bicicleta: evaluación y tratamiento / Blunt abdominal trauma due to handlebar injury

INTRODUCCIÓN: Los accidentes en bicicleta son una causa frecuente de trauma abdominal contuso en pediatría. En Chile no existen publicaciones científicas que traten sobre las lesiones abdominales por manubrio de bicicleta, su presentación y manejo. OBJETIVO: Describir tres casos clínicos de trauma abdominal contuso provocados por manubrio de bicicleta en niños, ilustrar las distintas lesiones observadas, sus formas de presentación y manejo. CASOS CLÍNICOS: 1) Paciente masculino, 11 años, consulta tras golpe con manubrio de bicicleta en epigastrio; en la Tomografía Computada (TC) de abdomen y pelvis se describió neumoretroperitoneo. Se realizó laparotomía exploradora, reparándose una perforación duodenal. 2) Paciente masculino, 14 años, consulta tras golpe en el hipocondrio izquierdo con el manubrio de la bicicleta; en la TC se evidenció fractura esplénica con múltiples laceraciones. Por la presencia de sangrado activo se trató con angioembolización, lográndose resolución de la lesión y viabilidad del órgano luego de 6 semanas de seguimiento. 3) Paciente masculino, 9 años, ingresó tras sufrir golpe con manubrio de bicicleta en el hipocondrio derecho. En TC se observó una laceración hepática, que fue manejada de forma expectante, con resolución de la lesión luego de 8 semanas de seguimiento. Todos los pacientes tuvieron una evolución favorable. CONCLUSIÓN: El trauma abdominal contuso por golpe con manubrio de bicicleta puede ser potencialmente grave en pacientes pediátricos, pudiendo afectar órganos sólidos y vísceras huecas. El manejo no quirúrgico cada vez es más utilizado, logrando altas tasas de éxito en pacientes estables. Los pacientes inestables o en los que se sospeche perforación de víscera hueca, requerirán cirugía como primera aproximación.

INTRODUCTION: Bicycle accidents are a frequent cause of blunt abdominal trauma in children. In Chile, there are no scientific articles about such accidents, their presentation and management. OBJECTIVE: The aim of this study is to describe three cases of blunt abdominal trauma due to handlebar injury in children, in order to illustrate the different kinds of lesions, their presentation, and management. CLINICAL CASES: 1) 11-year-old boy presented to Emergency Department (ED) after falling on a bi cycle handlebar, hitting his epigastric region. A CT scan showed signs of duodenal perforation. A la parotomy was performed and the duodenal perforation repaired. 2) 14-year-old boy seen at ED after a bicycle accident in which the handlebar hit him in the abdomen area. A CT scan showed a splenic injury with multiple lacerations and active bleeding that was treated with angioembolization. After 6 weeks of follow-up, he presented resolution of the lesion and viability of the spleen. 3) 9-year-old boy admitted due to a hit with the bicycle handlebar on the abdomen area. A CT scan showed a he patic injury that was managed with non-surgical procedures, achieving resolution of the lesion after 8 weeks of follow-up. CONCLUSION: Blunt abdominal trauma caused by handlebar can be potentially serious in pediatric patients, since it may affect solid and hollow abdominal viscera. Non-surgical ma nagement is becoming more used for stable patients, achieving high success rates. Unstable patients or those with suspicion of hollow viscera perforation will require surgery as first approach.

Traumatismo torácico contuso / Blunt Thoracic Trauma

INTRODUCCIÓN: El traumatismo torácico (TT) es una causa importante de morbilidad y mortalidad, presente en el 25-50% de la mortalidad por traumatismo. El TT contuso (TTC) es el tipo más frecuente de TT según las diferentes publicaciones internacionales. OBJETIVO: Nuestros objetivos son describir las características, tratamientos, morbilidad y mortalidad en pacientes hospitalizados por TTC en nuestra institución. MATERIAL Y MÉTODOS: Estudio descriptivo transversal desde enero-1981 a diciembre-2017. Revisión de una base de datos prospectiva, protocolos quirúrgicos y fichas clínicas. Se describen y comparan las características de los TTC. Se calcularon índices de gravedad de traumatismo (IGT): Injury Severity Score (ISS), Revised Trauma Score (RTS-T), Trauma Injury Severity Score (TRISS). RESULTADOS: Total 4.163 pacientes hospitalizados por TT, 1.719 (41,3%) TTC. Hombres 1.327 (77,2%), edad promedio 46,7±18,8 años. Se consideró TT aislado 966 (56,2%), asociado a lesiones extratorácicas 753 (43,8%) y de estos 508 (29,6%) eran politraumatizados. Mecanismo: Accidente de tránsito 838 (48,7%), caída de altura 279 (16,2%). Lesiones y hallazgos torácicos: fractura costal 1.294 (75,3%), neumotórax 752 (43,1%). Tratamiento: médico 874 (50,8%), pleurotomía 704 (41%) y cirugía torácica 141 (8,2%). Período de hospitalización 9,2 ± 9,5 días. Según IGT: ISS promedio 14,1 ± 11,1, RTS-Tpromedio 11,5 ± 1,5, TRISS promedio 6,6. Morbilidad en 297 (17,3%), mortalidad en 68 (4%). DISCUSIÓN: La causa principal de los TTC fue el accidente de tránsito. La fractura costal correspondió a la lesión torácica más frecuente. La mayoría requirió solo tratamiento médico. La mortalidad fue menor a la esperada según IGT.

BACKGROUND: Thoracic trauma (TT) is a major cause of morbimortality, involved in 25-50% of trauma deaths. Internationally, blunt thoracic trauma (BTT) is the most frequent type of TT. OBJECTIVE: Our objectives are to describe the clinical characteristics, treatments, morbidity and mortality in patients hospitalized by blunt thoracic trauma (BTT) in our institution. MATERIAL AND METHODS: Cross-sectional descriptive study from january-1981 to december-2017. Prospective database review, surgical protocols and clinical files. The characteristics of the BTT are described and compared. The following trauma severity indices (TSI) were calculated: Injury Severity Score (ISS), Revised Trauma Score (RTS-T) and Trauma Injury Severity Score (TRISS). RESULTS: 4,163 patients were hospitalized because of TT, 1.719 (41.3%) of them with BTT. 1,327 (77.2%)patients were men, average age 46.7 ± 18.8 years-old. We considered isolated TT 966 (56.2%), associated with extrathoracic lesions 753 (43,8%) and 508 (29.6%)with polytraumatism. Mechanism: Traffic accident 838 (48.7%), fall down from a height 279 (16.2%). Lesions and intrathoracic findings: rib fracture 1.294 (75.3%), pneumothorax 752 (43.7%). Treatment: Medical 876 (50.8%), pleurotomy 704 (41%) and thoracic surgery 141 (8.2%). Average hospitalized period 9.2 ± 9.5 days. According to TSI: ISS average 14.1 ± 11.1, RTS-T average 11.5 ± 1.5, TRISS average 6.6. Morbidity in 297 (17.3%), mortality in 68 (4%). DISCUSSION: The TTC was mainly attributed to the traffic accident. Rib fracture was the most common chest injury. The majority of patients required only medical treatment. Mortality was lower than expected according to TSI.

Relação entre o mecanismo de trauma e lesões diagnosticadas em vítimas de trauma fechado / Trauma mechanism predicts the frequency and the severity of injuries in blunt trauma patients

RESUMO Objetivo: analisar a correlação do mecanismo de trauma com a frequência e a gravidade das lesões. Métodos: análise retrospectiva das informações do registro de trauma em período de 15 meses. O mecanismo de trauma foi classificado em seis tipos: ocupantes de veículo de quadro rodas envolvidos em acidente de tráfego (AUTO), pedestres vítimas de atropelamento (ATRO), motociclistas vítimas de acidentes de tráfego (MOTO), vítimas de quedas de altura (QUED), vítimas de agressão física com instrumentos contundentes (AGRE) e vítimas de queda do mesmo nível (QMN). Resultados: o mecanismo de trauma foi classificado em 3639 casos, sendo 337 (9,3%) AUTO, 855 (23,5%) ATRO, 924 (25,4%) MOTO, 455 (12,5%) QUED, 424 (11,7%) AGRE e 644 (17,7%) QMN. Houve diferença significativa na comparação entre os grupos das médias dos índices do Revised Trauma Score (RTS), do Injury Severity Score (ISS) e da Abbreviated Injury Scale (AIS) do segmento cefálico, torácico, abdominal e extremidades (p<0,05). Lesões graves em segmento cefálico foram mais frequentes nas vítimas de ATRO, seguidos de AGRE e QUED (p<0,001). Lesões graves em tórax foram mais frequentes em AUTO, seguidos de QUED e ATRO (p<0,001). As lesões abdominais foram menos frequentes nas vítimas de QMN (p=0,004). Lesões graves em extremidades foram mais frequentes em ATRO, seguidos de MOTO e QUED (p<0,001). Conclusão: com a análise do mecanismo de trauma é possível prever a frequência e a gravidade das lesões em vítimas de trauma fechado.

ABSTRACT Objective: to study the correlation of trauma mechanism with frequency and severity of injuries in blunt trauma patients. Methods: retrospective analysis of trauma registry in a 15-month period was carried out. Trauma mechanism was classified into six types: occupants of four-wheeled vehicles involved in road traffic accidents (AUTO), pedestrians struck by road vehicles (PED), motorcyclists involved in road traffic accidents (MOTO), falls from height (FALL), physical assault with blunt instruments (ASSA) and falls on same level (FSL). Injuries with AIS>2 were considered severe. One-way ANOVA, Students t and Chi-square tests were used for statistical analysis, considering p<0.05 significant. Results: trauma mechanism was classified by group for 3639 cases, comprising 337 (9.3%) AUTO, 855 (23.5%) PED, 924 (25.4%) MOTO, 455 (12.5%) FALL, 424 (11.7%) ASSA and 644 (17.7%) FSL. There was significant difference among groups when comparing the Revised Trauma Score (RTS), the Injury Severity Score (ISS) and the Abbreviated Injury Scale (AIS) of the head, thorax, abdomen and extremities (p<0.001). Severe injuries in the head and in the extremities were more frequent in PED patients (p<0.001). Severe injuries to the chest were more frequent in AUTO (p<0.001). Abdominal injuries were less frequent in FSL (p=0.004). Complex fractures of the pelvis and spine were more frequent in FALL (p<0.001). Lethality was greater in PED, followed by FALL and AUTO (p<0.001). Conclusion: trauma mechanism analysis predicted frequency and severity of injuries in blunt trauma patients.

Traumatic wound dehiscence after corneal keratoplasty / Deiscência de sutura pós-trauma ocular em olhos submetidos a transplante de córnea

ABSTRACTPurpose:To assess patient characteristics, risk factors, outcomes, and the treatment of wound dehiscence (WD) in patients after corneal keratoplasty.Methods:Retrospective chart review of 11 eyes of 11 patients with corneal grafts who underwent repair of WD from January 1, 2004 to December 31, 2012 at Hospital Oftalmologico de Brasilia.Results:Eight (72.7%) patients were men and three were women. Six (54.5%) patients had deep anterior lamellar keratoplasty (DALK) and 5 had penetrating keratoplasty. The mean age at trauma was 31.1 years. The mean time from corneal keratoplasty to WD was 12.82 months (range, 3-33 months). The mean best-corrected visual acuity of patients before trauma was 20/60 (0.48 logMAR) and after final treatment was 20/160 (0.90 logMAR) (P=0.15). In one case, visual acuity decreased to no light perception because of retinal detachment and phthisis bulbi. Accidental blunt trauma and fall were the most common causes of WD.Conclusion:Patients who undergo corneal keratoplasty have a life-long risk of WD. The full-thickness rupture at the graft-host junction in our study suggests that the junction remains vulnerable, even following DALK, and can rupture with trauma. In our series, depending upon the severity of the trauma, postkeratoplastic WD can be associated with a good visual prognosis.

RESUMOObjetivo:Avaliar as características, os fatores de risco, resultados, e tratamento de pacientes que apresentaram deiscência traumática de sutura após transplante de córnea.Métodos:Estudo retrospectivo em que foram avaliados 11 olhos de 11 pacientes submetidos a transplante de córnea e que desenvolveram deiscência de sutura entre janeiro de 2004 e dezembro de 2012 no Hospital Oftalmológico de Brasília.Resultados:Oito (72,7%) pacientes eram homens e três mulheres. Seis (54,5%) pacientes foram submetidos a ceratoplastia lamelar anterior profunda (DALK) e 5 pacientes a ceratoplastia penetrante (PK). A média de idade dos pacientes no momento do trauma era de 31,1 anos. O tempo médio entre o transplante de córnea e a deiscência de sutura foi de 12,82 meses (variando de 3 a 33 meses). A melhor acuidade visual corrigida (AVCC) doa pacientes antes do trauma era de 20/60 (0,48 logMAR), e após o trauma era de 20/160 (0,90 logMAR) (P=0,15). Em um caso, a acuidade visual reduziu para sem percepção luminosa devido a descolamento de retina e posterior atrofia bulbar. O trauma ocular acidental e a queda da própria altura foram as principais causas de deiscência de sutura nos olhos transplantados.Conclusão:Pacientes previamente submetidos a transplante de córnea apresentam um risco prolongado de deiscência de sutura. A ruptura completa na junção doador-receptor no nosso estudo sugere que mesmo após um DALK a junção permanece vulnerável e pode romper com o trauma. Na nossa série, dependendo da severidade do trauma, a deiscência pós-ceratoplastia pode estar associada a um bom prognóstico visual.

Comparative analysis between identified injuries of victims of fall from height and other mechanisms of closed trauma / Análise comparativa entre as lesões identificadas em vítimas de queda de altura e de outros mecanismos de trauma fechado

OBJECTIVE: To analyze the lesions diagnosed in victims of falls, comparing them with those diagnosed in other mechanisms of blunt trauma. METHODS: We conducted a retrospective study of trauma protocol charts (prospectively collected) from 2008 to 2010, including victims of trauma over 13 years of age admitted to the emergency room. The severity of injuries was stratified by the Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS). Variables were compared between the group of victims of falls from height (Group 1) and the other victims of blunt trauma (Group 2). We used the Student t, chi-square and Fisher tests for comparison between groups, considering the value of p <0.05 as significant. RESULTS: The series comprised 4,532 cases of blunt trauma, of which 555 (12.2%) were victims of falls from height. Severe lesions (AISe"3) were observed in the extremities (17.5%), in the cephalic segment (8.4%), chest (5.5%) and the abdomen (2.9%). Victims of Group 1 had significantly higher mean age, AIS in extremities / pelvis, AIS in the thoracic segment and ISS (p <0.05). The group 1 had significantly (p <0.05) higher incidence of tracheal intubation on admission, pneumothorax, hemothorax, rib fractures, chest drainage, spinal trauma, pelvic fractures, complex pelvic fractures and fractures to the upper limbs. CONCLUSION: Victims of fall from height had greater anatomic injury severity, greater frequency and severity of lesions in the thoracic segment and extremities. .

OBJETIVO: analisar as lesões diagnosticadas nas vítimas de queda de altura, comparando-as com as diagnosticadas em outros mecanismos de trauma fechado. MÉTODOS: estudo retrospectivo dos protocolos de trauma (coletados prospectivamente) de 2008 a 2010, incluindo as vítimas de trauma fechado com idade superior a 13 anos, admitidas na sala de emergência. A gravidade das lesões foi estratificada pelo Abbreviated Injury Scale (AIS) e Injury Severity Score (ISS). As variáveis foram comparadas entre o grupo de vítimas de quedas de altura (Grupo 1) e as demais vítimas de trauma fechado (Grupo 2). Empregamos os testes t de Student, qui-quadrado e Fisher para a comparação entre os grupos, considerando o valor de p<0,05 como significativo. RESULTADOS: foram analisados 4532 casos de trauma fechado, sendo que 555 (12,2%) foram vítimas de quedas de altura. As lesões graves (AISe"3) foram observadas em extremidades (17,5%), em segmento cefálico (8,4%), torácico (5,5%) e em abdome (2,9%). As vítimas do grupo 1 apresentaram, significativamente (p<0,05), maior média etária, de AIS em extremidades/pelve, de AIS em segmento torácico e de ISS. O grupo 1 também apresentou, significativamente (p<0,05), maior frequência de intubação orotraqueal na admissão, pneumotórax, hemotórax, fraturas de costelas, drenagem de tórax, trauma raquimedular, fraturas de pelve, fraturas complexas de pelve e de fraturas em membros superiores. CONCLUSÃO: As vítimas de queda de altura apresentaram maior gravidade anatômica do trauma, maior frequência e gravidade de lesões em segmento torácico e em extremidades. .

Comparative analysis between identified injuries of victims of fall from height and other mechanisms of closed trauma / Análise comparativa dos fatores preditivos de morte em vítimas de trauma fechado com fraturas pélvicas

OBJECTIVE: to identify predictors of death in blunt trauma patients sustaining pelvic fractures and, posteriorly, compare them to a previously reported series from the same center. METHOD: Retrospective analysis of trauma registry data, including blunt trauma patients older than 14 y.o. sustaining pelvic fractures admitted from 2008 to 2010. Patients were assigned into group 1 (dead) or 2 (survivors). We used Student's t, qui square and Fisher's tests for statistical analysis, considering p<0.05 as significant. Posteriorly, we compared predictors of death between both periods. RESULTS: Seventy-nine cases were included. Mean RTS, ISS and TRISS were, respectively, 6.44 + 2.22, 28.0 + 15.2 e 0.74 + 0.33. Nineteen patients died (24,0%). Main cause of death was hemorrhage (42,1%). Group 1 was characterized by (p<0.05) lower systolic blood pressure and Glasgow coma scale means on admission, higher heart rate, head AIS, extremity AIS and ISS means, as well as, higher frequency of severe head injuries and complex pelvic fractures. Comparing both periods, we notice that the anatomic and physiologic severity of injury increased (RTS and ISS means). Furthermore, there was a decrease in the impact of associated thoracic and abdominal injuries on the prognosis and an association of lethality with the presence of complex pelvic fractures. CONCLUSION: There were significant changes in the predictors of death between these two periods. The impact of thoracic and abdominal associated injures decreased while the importance of severe retroperitoneal hemorrhage increased. There was also an increase in trauma severity, which accounted for high lethality. .

OBJETIVO: analisar os fatores preditivos de morte nas vítimas de trauma fechado com fraturas pélvicas. MÉTODOS: análise retrospectiva dos dados de registro de trauma, incluindo as vítimas trauma fechado com fraturas de pelve e idade superior a 14 anos. Os que faleceram formaram o grupo 1 e, os sobreviventes, o grupo 2. Utilizamos os testes t de Student, Fisher e Qui-quadrado para a análise estatística, considerando p<0,05 como significativo. Posteriormente comparamos os fatores preditivos de morte entre os períodos estudados. RESULTADOS: Foram incluídos 79 doentes. As médias do RTS, ISS e TRISS foram, respectivamente, 6,44 + 2,22; 28,0 + 15,2 e 0,74 + 0,33. Houve 19 óbitos (24%). A causa principal foi o choque hemorrágico (42,1%). Os que morreram apresentaram, significativamente (p<0,05), menor média de pressão arterial sistólica e escala de Glasgow à admissão, maior média de frequência cardíaca à admissão, AIS segmento cefálico, AIS em extremidades e ISS, como também, maior frequência de lesões graves em segmento cefálico e de fraturas complexas de pelve. O período mais recente se caracterizou por maior gravidade anatômica e fisiológica da amostra, como também, diminuição do impacto das lesões associadas (tórax e abdome) sobre a letalidade. Ao contrário do observado anteriormente, houve relação significativa entre a complexidade da fratura de pelve e letalidade. CONCLUSÃO: Houve diferença significativa entre os dois períodos, representada por aumento na gravidade da amostra e maior impacto da hemorragia retroperitoneal como causa de morte. .

Fundus autofluorescence in blunt ocular trauma / Autofluorescência do fundo de olho no trauma ocular contuso

Purpose: To describe the findings of fundus autofluorescence (FAF) imaging in patients with blunt ocular trauma. Methods: In this non-interventional retrospective study, we reviewed medical records and imaging examination results. The data analyzed included gender, age, laterality, trauma etiology, time between trauma and imaging, visual acuity, changes in the retinal periphery, fundus examination results, and FAF imaging findings. FAF imaging was performed using a Topcon TRC-50DX Retinal Camera (Tokyo, Japan). Results: Eight eyes from 8 patients were studied. The mean age was 27.6 years (range, 19-43 years). Men (n=7) were more frequently affected by blunt ocular trauma than women (n=1). Physical aggression was the most common trauma etiology (n=3), followed by accidents with fireworks (n=2). Other causes were car accidents (n=1), occupational trauma caused by a grinder (n=1), or being hit by a stone (n=1). Visual acuity ranged from 20/80 to light perception. Traumatic pigment epitheliopathy (TPE) was identified in 5 cases, choroidal rupture in 3 cases, subretinal hemorrhage in 3 cases, and Purtscher's retinopathy in 1 case. Hypoautofluorescence was observed in cases of choroidal rupture, recent subretinal hemorrhage, and intraretinal hemorrhage, and in two cases of TPE. Hyperautofluorescence was observed in cases of old subretinal hemorrhage and at the edge of the lesion in two cases of choroidal rupture. Mild hyperautofluorescence was observed in the posterior pole in Purtscher's retinopathy. Three cases of TPE exhibited hypoautofluorescence with diffuse hyperautofluorescent areas. Conclusion: FAF imaging is a non-invasive method for assessing changes in the posterior segment of the eye resulting from blunt ocular trauma. Furthermore, this technique provides valuable information. We described the findings of FAF imaging in cases of TPE, choroidal rupture, subretinal hemorrhage, and Purtscher's retinopathy. .

Objetivo: Descrever os achados do exame de autofluorescência do fundo de olho (AFF) em pacientes vítimas de trauma ocular contuso. Métodos: Estudo retrospectivo, não intervencionista, realizado através da revisão de prontuários e exames de imagem. Os dados analisados foram: sexo, idade, lateralidade, etiologia do trauma, tempo decorrente entre o trauma e a realização do exame, acuidade visual, alterações na periferia da retina, diagnóstico fundoscópico e achados ao exame de AFF (realizada no aparelho Topcon TRC-50DX Retinal Camera). Resultados: Oito olhos de 8 pacientes foram estudados. A idade média foi de 27,6 anos (de 19 a 43 anos), o sexo masculino (n=7) foi mais acometido do que o feminino (n=1), agressão física foi a etiologia mais comum do trauma (n=3), seguido de acidente com fogos de artifício (n=2). Outras causas foram acidente automobilístico (n=1), trauma ocupacional com lixadeira (n=1) e pedrada (n=1). A acuidade visual variou de 20/80 a percepção luminosa. Epiteliopatia pigmentar traumática (EPT ) foi identificada em 5 casos, rotura de coroide em 3, hemorragia subretiniana em 3 e retinopatia de Purtscher em 1 caso. Hipoautofluorescência foi observada nos casos de rotura de coroide, hemorragia subretiniana recente, hemorragia intrarretiniana e em 2 casos de EPT. Hiperautofluorescência foi visualizada nos casos de hemorragia subretiniana em degradação, na borda de 2 casos de roturas de coroide e discretamente no polo posterior na retinopatia de Purtcher. Três casos de EPT apresentaram hipoautofluorescência com pontos hiperautofluorescentes difusos. Conclusão: O exame de AFF permite avaliar as alterações do segmento posterior do olho decorrentes do trauma ocular contuso de forma não invasiva, somando informações valiosas. Foram descritos achados do exame ...

Analysis of homicidal deaths in and around Bastar region of Chhattisgarh.

FREEDOM FROM VIOLENCE, not necessarily proportional with development in some basic capabilities like nutrition, longevity and literacy which positively related to economic growth. So, dealing with violence in society is intrinsically a matter of public interest. In present study 79 cases of homicidal deaths due to different mechanical injuries was studied in two year period from 1/1/2009 to 31/12/2010. The incidence of homicidal death was 9.13% during this period. Males affected more in comparison to females. Majority of cases were fall in 21-40 yrs. of age comprising 50 cases (63.28%).Injuries by blunt weapons commonly observed in 30 cases (37.97%) which followed by injuries by sharp weapons 19 cases (24.05%). Totally 329 sharp injuries observed in comparison to 152 blunt injuries. Incidences were prevalent at dense forest area 26 cases (32.91%), in married persons 55 cases (69.62%), in between 6 pm to 12 midnight 24 cases (30.37%) and revenge was main motive 23 cases (29.11%).

Blunt injuries of chest: A medicolegal analysis.

Chest injuries are always a great challenge for medical professionals as two of the vital organs, which are present there, very often involved & damaged causing excessive bleeding and death. These injuries are usually caused by blunt forces or sharp penetrating weapons. Here in this paper 60 cases of chest injuries by blunt forces are studied for their epidemiological, medicolegal and clinico-pathological aspects. Most of them are adult/ middle aged male between 20-50years of age, hit or run over by heavy vehicles in road traffic accidents. Lungs are lacerated in almost all the cases and internal haemorrhage & shock is the prime cause of death. Heart, aorta & other organs were also involved in substantial number of cases. Though majority of them died within two hours, either on the spot or in the way to the hospital, an attempt is also made to correlate the prognosis & the nature of injuries.

Victim profile and pattern of thoraco-abdominal injuries sustained in fatal road traffic accidents.

The present research aims to highlight the pattern of thoraco-abdominal injuries sustained by the victims of fatal road traffic accidents (RTA) in Manipal, South India. The study is an autopsy based observation of thoraco-abdominal injuries in victims of fatal road traffic accidents during 1999 – 2003. Road traffic accidents accounted for most of the injury related deaths (77%) during the study period. A male preponderance (86%) was observed with a male-female ratio of 6:1. Individuals in the age group of 21 to 50 years formed the most vulnerable (83%) group. External thoracic injuries were more common than internal thoracic injuries in the thoracic region. In the abdominal region, internal injuries were more common than external injuries. Lungs (61%) and kidneys (23%) were the most commonly involved organs in the thoracic and abdominal regions respectively. Majority of the victims were two wheeler occupants (35%) followed by pedestrians (23%). The study indicates the pattern of thoraco-abdominal injuries sustained along with the trend of road traffic accidents in the region.

Trauma do pâncreas: fatores preditivos de morbidade e mortalidade relacionados a índices de trauma / Trauma of pancreas: predictor's factors of morbidity and mortality related to trauma index

Contexto: Embora incomuns, lesões traumáticas do pâncreas estão associadas a significativos níveis de complicações e mortalidade. OBJETIVO: Definir os fatores preditivos de morbidade e mortalidade em pacientes vítimas de trauma pancreático. MÉTODO: Foram estudados 131 pacientes atendidos pela Disciplina de Cirurgia do Trauma no Hospital de Clínicas da Universidade Estadual de Campinas, SP, no período entre janeiro de 1994 a dezembro de 2007, com seus parâmetros epidemiológicos, fisiológicos e anatômicos, sendo comparados e analisados aos fatores preditivos de evolução, com estudo estatístico. Resultados: Trauma penetrante, com predomínio de ferimentos por projétil de arma de fogo ocorreu em 64 por cento dos casos. A maioria, 91,6 por cento, era do sexo masculino e a idade média de 29,8anos. A morbidade global foi de 64,9 por cento, com 29 por cento de complicações diretamente relacionadas ao pâncreas, como fístulas e sangramento. A mortalidade foi de 27,5 por cento, principalmente em decorrência de choque hipovolêmico e falência de múltiplos órgãos e sistemas. Houve maior morbidade e mortalidade em pacientes com lesões complexas (graus IV e V) do pâncreas quando comparadas com lesões menos graves (graus I e II), porém a morbidade e mortalidade neste grupo não foram desprezíveis, devido a valores alterados de escore de trauma revisado ("revised trauma score"), valores elevados de índice de gravidade da lesão ("injury severity score") e "abdominal trauma index". Conclusões: Valores alterados de "revised trauma score", pressão arterial sistólica menor que 90 mm Hg, valor de "injury severity score" menor ou igual a 15 e valor de "abdominal trauma index" maior ou igual a 25 são fatores relacionados a aumento da morbidade. Valores anormais de "revised trauma score", valores de "injury severity score" e "abdominal trauma index" superiores a 25, pressão arterial sistólica inferior a 90 mm Hg são fatores preditivos de aumento de mortalidade...

Context: Although relatively uncommon, traumatic pancreatic injury is associated with significant morbidity and mortality. OBJECTIVE: To define the predictors' factors of increase in the morbidity and mortality in patients with pancreatic trauma. METHOD: In this casuistic 131 patients were studied, since January 1994 through December 2007, with theirs epidemiological, physiological and anatomic parameters compared and the analysis of the predictive values for the occurrence of bad evolution, with an appropriate statistical study. Results: Penetrating trauma occurred in 64 percent and blunt trauma in 36 percent, and 91.6 percent was male. The mean age was 29,8 years. The global morbidity in this series was 64.9 percent with 29 percent prevalence of pancreas related complications, such as pancreatic fistula and bleeding occurrence. The overall mortality was 27.5 percent and occurred by hemorrhagic shock and multiple organs and system failed. CONCLUSIONS: Higher morbidity and mortality was related with complex injuries of the pancreas (grade IV and V), but morbidity and mortality in the group of injuries grade I and II are not minimal in patients with changed values of revised trauma score and high values of injury severity score and abdominal trauma index. Systolic blood pressure lower 90 mm Hg, changed values of revised trauma score index, values of injury severity score higher 15 and values of abdominal trauma index higher 25 are predictive factors of morbidity. Changed values of revised trauma score, values of injury severity score or abdominal trauma index higher 25, systolic blood pressure are predictive factors of mortality in patients with pancreatic trauma. Low values of TRISS are predictive of higher morbidity and mortality, but high values of TRISS are not predictives of satisfactory evolution.

Scheimpflug imaging of pediatric posterior capsule rupture.

We report a case of an 11-year-old boy who presented two days after blunt trauma to the left eye with a slingshot. On examination his best corrected visual acuity (BCVA) was 20/20 in the right eye and 20/400 in the left eye. Slit-lamp examination of the left eye revealed a Vossius ring, traumatic cataract, traumatic posterior capsule tear (PCT). The contour of the posterior capsule bulge corresponded to the edges of the PCT. Rotating Scheimpflug imaging (Pentacam 70700:Oculus, Wetzlar Germany) confirmed the traumatic cataract in the region of the PCT visualized as increased lens density at the cortex-vitreous interface. The extent of the PCT in the greatest and least dimensions was documented before and after intraocular lens (IOL) implantation. Intra-operatively, the PCT was evident and phaco-emulsification with an IOL implant was performed. Postoperatively, his BCVA improved to 20/20 in the left eye with a well-centered in-the-bag IOL as found on slit-lamp and Scheimpflug images.

A postmortem study of blunt cardiac injuries.

35 cases of blunt cardiac trauma following vehicular accidents brought for autopsy to the morgue of Regional Institute of Medical Sciences, Imphal have been studied to find out types of cardiac injuries, their association with sternal and rib fractures, mechanism of causation, risk factors, etc. It was observed that 48.57% of the cases with blunt cardiac trauma had associated sternal and rib fractures. Maximum number (60%) of the cardiac rupture was seen in run-over cases. 40% of the cases had injury to the right ventricle. All the injuries were located on the anterior surface of the heart. In one (2.86%) case, laceration of the right atrium without any external injury of the chest region was observed. In assessing blunt cardiac trauma victims in vehicular accidents, knowledge about the commonest sites, types and degrees of injuries as has been highlighted in the present study will be of great help in a timely intervention.

Laceration of the heart without significant external injury: A case report.

In a case of vehicular accident the heart was found lacerated, when there were only some scratch abasions on the chest externally without fracture of the ribs or sternum. This case is reported to highlight the possiblitity of a serious fatal internal injury without significant external injury in the chest.

Manejo de las heridas del tórax no penetrantes a cavidad torácica / Management of no penetrating thoracic wounds to the thoracic cavity

me revisó las historias clínicas de 102 pacientes con herida de tórax no penetrante a cavidad torácica hospitalizados en el Hospital Nacional Cayetano Heredia(Lima,Perú) en un período de 10 años. La mayoría de ellos fueron varones (95.1 por ciento), con heridas punzopenetrantes (76.5 por ciento), entre 11 y 30 años de edad (76.1 por ciento) y que sufrieron agresión (90.2 por ciento). Las manifestaciones clínicas más frecuentes fueron dolor torácico (n=92) y disnea (n=17). Los hallazgos físicos más frecuentes al arribo del hospital fueron taquipnea (n=51) y disminución del murmullo vesicular (n=20). Las lesiones extratorácicas asociadas más frecuentes fueron las de tejidos blandos (n=34). El manejo fue conservador en casi la totalidad de los casos. Ningún paciente fue sometido a toracotomía pero se colocó innecesariamente tubo de toracostomía a 4 pacientes. Se realizó también 4 laparotomía y una exploración axilar. el tiempo promedio de hospitalización fue 2.28 días (excluyendo a pacientes que fueron a cirugía mayor). Sólo 5 pacientes presentaron complicaciones. Ningún paciente falleció y todos fueron dados de alta en buenas condiciones. Finalmente, se subraya la importancia de la radiografía de tórax y se señalan algunas pautas para optimizar el manejo de estos pacientes desde su arribo al hospital

Rectal injuries.

Rectal injuries were often caused by penetrating injuries and usually occurred in male patients. The results of treatment related to many factors. These factors include the mechanisms of injury, the time from wounding to treatment, the severity of associated injuries, and the operative procedures. The important therapeutic procedures are colostomies, presacral drainage, and rectal irrigation. The type of colostomy and repair of the rectal defect played little significant role concerning the outcome of the patients.

Trauma hepatico durante un periodo de 10 anos: analisis de 1675 casos / Liver trauma during a 10 years period: analysis of 1675 cases

Se hace un analisis retrospectivo de las historias clinicas de 1675 pacientes con trauma hepatico que ingresaron al Servicio de Policlinica del Hospital Universitario San Vicente de Paul, entre 1970 y 1980. El dano hepatico fue causado por arma cortopunzante en 1097 casos (65%) por bala en 412 casos (25%) y por accidente de transito en 134 casos (8%). En 1578 pacientes (94%) la lesion hepatica fue reparada con sutura y/o drenaje. La lobectomia hepatica se realizo en 97 pacientes (6%). La morbilidad fue del 15% siendo mas alta para el trauma penetrante por arma blanca (55%) y la mortalidad global fue de 6.9% correspondiendo el rubro mas alto a trauma cerrado (23%). Las lesiones asociadas multiples fueron mas comunes en el trauma por arma cortopunzante, siendo estos pacientes los que ingresaron en shock, recibiendo el mayor numero de transfusiones y con una estadia larga en el hospital. La fistula biliar externa se manifesto en 11 pacientes (0.6%) y la hemobilia en 4 casos (0.2%). La coledocostomia se realizo en 9 pacientes (0.5%). Las derivaciones ("shunt") intracava fueron aplicadas en 14 pacientes con trauma masivo hepatico, o compromiso vascular yuxtahepatico, logrando sobrevivir 6 pacientes