Papel de distintas técnicas de imagen para identificar y localizar cuerpos extraños intraoculares relacionados con trauma ocular abierto: reporte de tres casos y revisión de la literatura / The role of various imaging techniques in identifying and locating intraocular foreign bodies related to open-globe injury: three case reports and literature review

ANTECEDENTES La ubicación precisa de un cuerpo extraño intraocular es crucial para el manejo de pacientes con trauma ocular abierto. La tomografía computarizada se usa habitualmente para detectar su ubicación en el segmento posterior. Reportamos tres casos con diferentes cuerpos extraños intraoculares en el segmento posterior, que fueron localizados con precisión mediante la tomografía computarizada y ecografía modo B. PRESENTACIÖN DEL CASO Presentamos tres casos con diferentes mecanismos de trauma, tipos de cuerpo extraño intraocular, síntomas clínicos y pronóstico visual. La tomografía computarizada determinó la ubicación exacta de todos los cuerpos extraños intraoculares en el segmento posterior. El ultrasonido modo B se realizó en un paciente con un cuerpo extraño intraocular no metálico. El primer caso tuvo una lesión ocular perforante con un cuerpo extraño intraorbitario; el caso dos y el caso tres presentaron diferentes tipos de cuerpos extraños intraoculares con pronóstico diferente. El manejo y el pronóstico fue distinto en todos los casos; todos se manejaron con éxito. La ubicación exacta de los cuerpos extraños intraoculares utilizando las diferentes modalidades de diagnóstico es importante en estos pacientes. Estos casos sirven como recordatorio de que el uso adecuado de las pruebas de imagen es indispensable en el contexto de un cuerpo extraño intraocular relacionado con trauma ocular abierto. CONCLUSIÓN Las diferentes técnicas de imágenes son muy importantes para la detección de un cuerpo extraño intraocular. La tomografía computarizada es una de las modalidades de imagen más simple y efectiva para la localización de cuerpos extraños intraoculares relacionadas con trauma ocular abierto.

BACKGROUND: Determining the precise location of intraocular foreign bodies is crucial for the management of patients with open-globe injury. Computed tomography is the most common method for detecting intraocular foreign bodies in the posterior segment. In this article, we describe three cases of open-globe injury with different types of intraocular foreign bodies in the posterior segment that were accurately located using computed tomography scans and B-scan ultrasonography. CASE PRESENTATION: Each of the three cases of open-globe injury described in this report had different types of ocular trauma, clinical symptoms, and intraocular foreign bodies. Computed tomography scans showed the exact location of the intraocular foreign bodies in the posterior segment in two of the three cases. A B-scan ultrasound was used to determine the location of a non-metallic intraocular foreign body in the third case. All three patients had intraocular foreign bodies, and one of them had an additional orbital foreign body. Case 1 had a perforating eye injury with the additional intraorbital foreign body; Cases 2 and Case 3 had different types of intraocular foreign bodies and prognoses. Various treatment approaches were used, ranging from observation to surgery, depending on the location of the intraocular foreign bodies, and all cases were successfully managed. These three cases show that proper use of various types of imaging tests is indispensable in the context of an intraocular foreign body related to open-globe injury. CONCLUSION: Imaging techniques are crucial for the detection of an intraocular foreign body, and computed tomography is one of the simplest and most useful, especially in cases of open-globe injury.

Penetrating colonic injuries in wartime; our experiences in Al Yarmouk Teaching Hospital, Baghdad

Penetrating trauma is the commonest cause of surgical admissions in Baghdad following invasion to Iraq 2003. In this study, the factors that affect the morbidity and mortality in patients with penetrating colonic injuries were evaluated. Eighty six [86] patients [74 males, 12 females; age range 7 to 60 years] with penetrating colonic trauma, most of them of high velocity injuries were evaluated according to age, gender, type of penetration, trauma location and severity of colonic injury, associated injury, interval between the trauma and definitive operation, hemodynamic status, blood transfusion requirement, fecal contamination, surgical procedure, postoperative complication and mortality. The mechanisms of injuries were bullets injury in 66 [76.74%] patients, blast injury [shell] in 18 [ 20.93%] and stab injury in 2 [2.3%] patients. Injuries were evaluated according to TRISS and PATI [penetrating abdominal trauma index]. Multiple organs injuries found in 68 [79%] patients, wherease only the large bowels injured in 18 [21%] patients. Primary repair was performed in 36 [42%] of the 86 patients, and colostomy was performed in 50[58%] patients. From those with primary closure [36 patients], PATI was over 25 in 10 patients and below 25 in 26 patients. 15 patients had resection segment [destructive injuries, primary anastomosis], 7 patients had more than 25% of colonic wall injuries, and 10 had less than 25%. Symptoms of shock were present in 66 patients at admission, mortality rate was 6.97%. These results suggest that the use of primary closure should be expanded in penetrating colon trauma and that, even with moderate and severe degrees of colon injury, primary closure provides an outcome equivalent to that provided by colostomy. The primary repair of the penetrating colon trauma can be performed confidently in patients with PATI suggests that is should be included along with other injury severity indices in trauma data bases

Blast injury of the ears: the experience from Yala Hospital, Southern Thailand.

OBJECTIVE: To report acute and subacute consequences of blast injury to the ear from terrorists' bombings experienced from Yala Provincial Hospital, Southern Thailand STUDY DESIGN: Retrospective chart review was done on 54 patients who suffered otologic injuries from bombing attacks in Yala Province from January to May 2005. Only 33 patients who had complete otologic and audiologic examination with a 3-month follow-up were studied. MATERIAL AND METHOD: The ear symptoms, the size of tympanic membrane perforation, degree of hearing loss at first examination within 30 days after injuries were recorded. After a 3-month follow-up, the rate of spontaneous healing, rate of operation needed and long-term complications including hearing loss were analyzed. RESULTS: The two most common initial symptoms were hearing loss (72.73%) and tinnitus (66.67%). Tympanic membrane perforations were encountered in 31 ears of 22 out of 33 patients. Spontaneous healing occurred in 23 ears (74.19%) with the highest incidence in small perforations (size < 50%). All healings occurred within 8 weeks. Tympanoplasty was done on the rest, except one patient. Eight patients (24.24%) had sensorineural hearing loss without tympanic membrane perforation. They still have sensorineural hearing loss, which is rather mild and typically affects in high tone with five of this group having normal hearing in speech range. Eleven patients from the tympanic membrane perforation group still have mixed hearing loss, which were also mostly mild. CONCLUSION: Patients with aural symptoms after a blast injury need thorough otologic and audiological examination. The spontaneous healing of tympanic membrane perforation from explosive injury was relatively high (74.19%) after an 8-week follow-up, only 8/31 ears required surgical repair. At 3-months follow-up, more than two-thirds of the patients still had residual hearing loss, which was rather mild and affected mainly in high tone.

Treatment of intractable tinnitus due to acoustic trauma in war injury patients

To evaluate the value of intravenous lidocaine as a diagnostic tool and oral carbamazepine as treatment modality, we performed a double-blind, randomized, controlled trial on more than 100 patients with tinnitus who were referred to a special tinnitus clinic from 1990-1992. The selected subjects were from two equal groups, civilian patients [C.P.] and war-injury patients [W.I.P.] who suffered from intractable tinnitus after acoustic trauma. Our results revealed approximately 60% effectiveness of this mode of therapy, whereas false-positive response to normal saline [control] was 13% for C.P. and 26% for W.I.P