Complicated Abdominal Seat Belt Injuries in Children

Background: The proper use of security accessories in cars has resulted in the reduction of morbidity and mortality both in adults and children. Improper use of abdominal seat belt is associated in some cases with severe abdominal injuries. Objectives: Investigation of the treatment outcomes of children who suffered complicated abdominal seat belt injuries between 1998 and 2013. Methods: We present five cases of children aged 6-14 years, who suffered complicated abdominal injuries due to improper use of the seat belt. Abdominal injuries included injuries to the liver, spleen, small bowel (duodenum, jejunum, and ileum), colon and aorta, mesenterial bleeding, retroperitoneal bleeding, bowel obstruction and pelvic fractures. Results: Three children were operated on within a few hours of admission due to peritoneal irritation, hemodynamic instability after fluid resuscitation, bowel injuries including perforation and bowel ischemia. Two children who were hemodynamically stable, were operated on after few days. One of them had a diagnosis of aortic injury and the other, bowel obstruction. The first child was treated in two stages: i. repair of duodenal rupture, and ii. repair of the aortic injury by using interposition Gore-Tex graft. For the child with bowel obstruction, segmental resection and primary anastomosis were performed. The operation and postoperative periods for all children were uneventful, and all five children are healthy today. Conclusion: 1) The abdominal seat belt should always be used in conjunction with the chest seat belt. 2) An abdominal seat belt sign should always raise the possibility of complicated abdominal injuries. 3) Gastrointestinal tract injuries are common in this setting. 4) Aortic injury is rare; however, it can easily be missed initially. 5) Abdominal aortic trauma is associated with duodenal injuries in almost all cases.

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Motor Vehicle Accident Trauma and Restraint Usage Patterns in Children Less Than 4 Years of Age

PEDIATRICS ◽

10.1542/peds.76.3.382 ◽

1985 ◽

Vol 76 (3) ◽

pp. 382-386

Author(s):

Phyllis F. Agran ◽

Debora E. Dunkle ◽

Diane G. Winn

Keyword(s):

Motor Vehicle ◽

Motor Vehicle Accident ◽

Seat Belt ◽

Vehicle Interior ◽

Use Patterns ◽

Vehicle Accident ◽

Restraint Use ◽

Usage Patterns ◽

Improper Use ◽

Safety Seat

In a sample of children less than 4 years of age, treated in an emergency room after a motor vehicle accident, 22% were restrained in a child safety seat (improper and proper), 12% were restrained by a vehicle seat belt, and 70% were unrestrained. Trauma and injury patterns related to the various restraint use patterns are described. Most children in safety seats and seat-belted children, if injured, sustained minor contusions, abrasions, or lacerations. Injury among properly restrained children in safety seats was primarily the result of unavoidable mechanisms (eg, flying glass, intrusion). Improper use contributed to injury among safety-seat-restrained children, primarily by allowing the child to hit against the vehicle interior. Seat-belted children also were injured, primarily by hitting against the vehicle interior. Although some of the restrained children were seriously injured, in general, restrained children tended to sustain less serious and fewer injuries than the unrestrained children.

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Multimodality Surgical Approach in Management of Laryngotracheal Stenosis

Case Reports in Otolaryngology ◽

10.1155/2018/4583726 ◽

2018 ◽

Vol 2018 ◽

pp. 1-11

Author(s):

Ashfaque Ansari ◽

Annju Thomas

Keyword(s):

Primary Anastomosis ◽

Delayed Diagnosis ◽

Subglottic Stenosis ◽

Long Term Results ◽

Laryngotracheal Stenosis ◽

Surgical Anastomosis ◽

Suture Tension ◽

Multiple Treatments ◽

Almost All

Introduction. Postintubation laryngotracheal stenosis requires a precise diagnosis and an experienced operator in both endoscopic and surgical treatment. This report presents surgically treated cases of laryngotracheal stenosis secondary to long-term intubation/tracheostomy with review of the literature. Materials and Methods. In this retrospective study, we present 5 cases (a 23-year-old male, 13-year-old male, 22-year-old male, 19-year-old male, and 33-year-old female) of postintubation/tracheostomy laryngotracheal (glottic/subglottic) stenosis in the years 2016 and 2017. Each patient was managed differently. Intubation characteristics, localization of stenosis, surgical technique and material, postoperative complications, and survival of patients were recorded. Results. The site of stenosis was in the subglottis in 4 patients and glottis in 1 patient. The mean length of the stenosis was greater in the postintubation group. Postintubation stenosis had a mean duration of intubation of 6.8 days, compared to 206.25 days of cannulation following tracheostomies. Each patient underwent an average of 2 procedures during their treatment course. One patient underwent open surgical anastomosis because of recurrent subglottic stenosis after multiple treatments. Phonation improved immediately in almost all except in the patient who underwent only endoscopic dilatation. Discussion. The reasons for laryngeal stenosis and its delayed diagnosis have been reviewed from the literature. Suture tension should be appropriate, and placement of the suture knot outside the trachea minimizes formation of granulation tissue. The published reports suggest that resection by endoscopy with laser and open technique resection and primary anastomosis are the best treatment modality so far as the long-term results are concerned. Conclusion. Resection of stenotic segment by open surgical anastomosis and laser-assisted resection is a safe option for the treatment of subglottic stenosis following intubation without the need for repeated dilation. Endoscopic dilation can be reserved for unfit patients.

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Association Between the Seat Belt Sign and Intra‐abdominal Injuries in Children With Blunt Torso Trauma in Motor Vehicle Collisions

Academic Emergency Medicine ◽

10.1111/acem.12506 ◽

2014 ◽

Vol 21 (11) ◽

pp. 1240-1248 ◽

Cited By ~ 25

Author(s):

Dominic A. Borgialli ◽

Angela M. Ellison ◽

Peter Ehrlich ◽

Bema Bonsu ◽

Jay Menaker ◽

...

Keyword(s):

Motor Vehicle ◽

Seat Belt ◽

Motor Vehicle Collisions ◽

Abdominal Injuries ◽

Vehicle Collisions ◽

Torso Trauma

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Alexander and the Iranians

The Journal of Hellenic Studies ◽

10.2307/630729 ◽

1980 ◽

Vol 100 ◽

pp. 1-21 ◽

Cited By ~ 20

Author(s):

A. B. Bosworth

Keyword(s):

Second World War ◽

Source Analysis ◽

World War ◽

Historical Evidence ◽

Living Together ◽

The One ◽

Polar Opposite ◽

Almost All ◽

Two Stages ◽

Second World

The last two decades have seen a welcome erosion of traditional dogmas of Alexander scholarship, and a number of hallowed theories, raised on a cushion of metaphysical speculation above the mundane historical evidence, have succumbed to attacks based on rigorous logic and source analysis. The brotherhood of man as a vision of Alexander is dead, as is (one hopes) the idea that all Alexander sources can be divided into sheep and goats, the one based on extracts from the archives and the other mere rhetorical fantasy. One notable theory, however, still flourishes and has indeed been described as one of the few certainties among Alexander's aims. This is the so-called policy of fusion. As so often, the idea and terminology go back to J. G. Droysen, who hailed Alexander's marriage to Rhoxane as a symbol of the fusion (Verschmelzung) of Europe and Asia, which (he claimed) the king recognised as the consequence of his victory. At Susa the fusion of east and west was complete and Alexander, as interpreted by Droysen, saw in that fusion the guarantee of the strength and stability of his empire. Once enunciated, Droysen's formulation passed down the mainstream of German historiography, to Kaerst, Wilcken, Berve and Schachermeyr, and has penetrated to almost all arteries of Alexander scholarship. Like the figure of Alexander himself the theory is flexible and capable of strange metamorphoses. In the hands of Tarn it developed into the idea of all subjects, Greek and barbarian, living together in unity and concord in a universal empire of peace. The polar opposite is an essay of Helmut Berve, written in the heady days before the Second World War, in which he claimed that Alexander, with commendable respect for Aryan supremacy, planned a blending of the Macedonian and Persian peoples, so that the two racially related (!)Herrenvölkerwould lord it over the rest of the world empire. On Berve's interpretation the policy had two stages. Alexander first recognised the merits of the Iranian peoples and placed them alongside the Macedonians in his court and army hierarchy. Next came the ‘Blutvermischung’, the integration of the two peoples by marriage.

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Click it: do not risk it: lap seat belt causing extensive abdominal injuries

ANZ Journal of Surgery ◽

10.1111/ans.13009 ◽

2015 ◽

Vol 87 (10) ◽

pp. 845-846

Author(s):

Amelie Maurel ◽

Ian Gollow ◽

Parshotam Gera

Keyword(s):

Seat Belt ◽

Abdominal Injuries

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Psychological readiness for distance learning in a pandemic of pedagogical university students

World of Science Pedagogy and psychology ◽

10.15862/22psmn121 ◽

2021 ◽

Vol 9 (1) ◽

Author(s):

Svetlana Volodina ◽

Lyudmila Korneva

Keyword(s):

Distance Learning ◽

Student Teachers ◽

Emotional State ◽

Negative Impact ◽

Educational Process ◽

Future Teachers ◽

State Pedagogical ◽

Students First ◽

Almost All ◽

Two Stages

The article presents data from an empirical study of the psychological readiness of first-third-year students of the Moscow State Pedagogical University for distance learning in a pandemic. The authors considered such indicators of the mental state of future teachers as emotional tone and mental stress, and also determined the index of their life satisfaction in new learning conditions. This article presents a comparative analysis of the emotional state of students, studied at two stages: in April 2020, when students first completely switched to the distance learning format, and in October 2020, when they returned to this format amid the growing new wave of the pandemic. The results of the first stage of the study revealed that abrupt changes in the conditions of the educational process, namely, its transfer to distance learning, as well as technical difficulties with equipment and the speed of the Internet, had a negative impact on the emotional state of many students. The data of the second stage of the study showed that most of the future teachers have adapted to distance learning and do not experience high psycho-emotional stress in the educational process. This is in particular evidenced by such facts as an increase in the number of students participating in classes with the camera turned on, in contrast to the first stage of distance learning, when almost all students in lectures and practical classes experienced problems associated with the "camera effect". In general, student teachers have become much more active in learning activities than in the first months of transition to online learning.

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248 Rectus flap for repair of Strangulated Obturator Hernia

British Journal of Surgery ◽

10.1093/bjs/znab259.278 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

N Angamuthu ◽

S Alagaratnam ◽

M Varcada ◽

R D'Souza

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Primary Anastomosis ◽

Muscle Flap ◽

Rectus Muscle ◽

Obturator Hernia ◽

Suture Repair ◽

Primary Suture ◽

Large Defect

Abstract Introduction Obturator hernia (OH) is a rare abdominal wall hernia which commonly presents as small bowel obstruction. Surgical options include suture repair or use of autologous tissue or a mesh repair when primary suture repair is not feasible. We describe a case involving the use of the rectus abdominus muscle to repair a large OH. Case report An 81-year-old female presented with three days of abdominal distension and vomiting. A computerised tomography scan confirmed small bowel obstruction due to an obstructed left OH. At laparotomy, a short segment of non-viable distal ileum was reduced from the sac and resected with a primary anastomosis. The obturator defect was not amenable for suture approximation and due to concerns of possible mesh infection, the ipsilateral rectus muscle belly was mobilised from the anterior sheath, routed extra-peritoneally to plug the defect without tension. The muscle was anchored with prolene sutures to the cooper’s ligament, pectineus muscle and the fascia overlying the inner surface of inferior pubic ramus. Four months post-operatively, she has made an excellent recovery with no concerns currently. Conclusions In OH with a large defect precluding primary suture repair, a range of options have been described (use of autogenous peritoneal fold, pectineus muscle, round ligament, ovary, uterine fundus, omental and mesh plugs, and biological mesh). We believe, to plug and cover the defect, rectus muscle flap is a viable option giving a tension free robust repair, especially in patients with gangrenous bowel and local contamination.

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Chance Fracture in Three Brothers

JBNC - JORNAL BRASILEIRO DE NEUROCIRURGIA ◽

10.22290/jbnc.v24i4.1457 ◽

2018 ◽

Vol 24 (4) ◽

pp. 322-326

Author(s):

Lucidio Duarte De Souza Filho ◽

Geraldo Vitor Cardoso Bicalho ◽

Bernardo Drummond ◽

Rafael Stein Rosseto ◽

Rodrigo Moreira Faleiro ◽

...

Keyword(s):

Fracture Mechanism ◽

Motor Vehicle ◽

Pediatric Population ◽

Seat Belt ◽

Seat Belts ◽

Abdominal Injuries ◽

Chance Fracture ◽

Belo Horizonte ◽

Type Of Injury ◽

Type Of Fracture

Chance fracture, suggestive of a flexion-distraction mechanism, is an uncommon type of injury in the pediatric population. Its occurrence, with associated intra-abdomimal lesions, has increased with the widespread use of seat belts. Since this type of fracture presents subtle variations on common image examinations, its diagnosis may be delayed increasing the probability of subsequent neurologic deficits. In this paper we report the case of three siblings, victims of a motor vehicle head-on collision,either presenting seat belt fracture or Chance fracture. They were treated in the Hospital João XXIII, Belo Horizonte. The case reported reinforces the hypothesis describing the fracture mechanism and associated intra-abdominal injuries.

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Is There a Relationship Between Smoking and Stricture Recurrence After the Urethroplasty? a Systematic Review and Meta-Analysis

10.21203/rs.2.23580/v1 ◽

2020 ◽

Author(s):

Yu-cheng Ma ◽

Menghua Wang ◽

Zhong-Yu Jian ◽

Hong Li ◽

Kunjie Wang

Keyword(s):

Primary Anastomosis ◽

Meta Analysis ◽

Univariate Analysis ◽

Current Evidence ◽

Significant Heterogeneity ◽

Buccal Mucosa Graft ◽

Quitting Smoking ◽

Newcastle Ottawa Scale ◽

Stricture Recurrence ◽

Two Stages

Abstract Background Some retrospective studies have noted that smoking is a possible risk factor for recurrence of restenosis after urethroplasty, but not all of them are consistent. Therefore a meta-analysis is needed. Method Pubmed, Web of Science, Embase, Cochrane databases were searched with key words: “urethroplasty”, “buccal mucosa graft urethroplasty”, “oral mucosa graft urethroplasty”, “excision and primary anastomosis urethroplasty”, “urethral stricture recurrence” until Jan 30, 2020. The quality of included studies was assessed by Newcastle-Ottawa Scale (NOS) system. Hazard ratio (HR), odds ratio (OR), relative risk (RR) with 95% confidence interval (CI) were extracted or re-calculated from included studies. Meta-analysis was performed with Stata 15.0 based on univariate and multivariate data separately. Sensitivity analysis was performed to test stability of meta-analysis. I 2 was calculated to evaluate heterogeneity. Publication biases were assessed by egger’s and begg’s tests. Funnel plots of univariate analysis and multivariate analysis were also offered. Results 12 studies with 3443 patients were involved into this meta-analysis. The analysis results of two stages were consistent. In the univariate meta-analysis stage, 9 studies with 2279 patients were pooled and the result indicated that smoking might promote stricture recurrence (RR=1.46, 95%CI: 1.11-1.93, P=0.008). In the multivariate meta-analysis stage, based on adjusted estimate, 7 studies with 2074 patients were pooled and the result indicated that smoking might promote stricture recurrence (RR=1.39, 95%CI: 1.04-1.85, P=0.026). There was no significant heterogeneity in both univariate and multivariate stage. Conclusion This meta-analysis of current evidence indicates that smoking may prompt stricture recurrence after the urethroplasty. Quitting smoking may be a good option for patients undergoing urethroplasty surgery.

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Diagnosis and treatment of acute bowel obstruction

Kazan medical journal ◽

10.17816/kmj2188 ◽

2013 ◽

Vol 94 (3) ◽

pp. 377-381

Author(s):

A M Khadjibaev ◽

N A Khadjimukhamedova ◽

F A Khadjibaev

Keyword(s):

Small Bowel ◽

Bowel Obstruction ◽

Large Bowel ◽

Bowel Resection ◽

Primary Anastomosis ◽

Local Treatment ◽

Small Bowel Resection ◽

Large Bowel Obstruction ◽

Segmental Resection ◽

Diagnosis And Treatment

Aim. To improve treatment outcomes in patients with acute bowel obstruction. Methods. 1479 patients with bowel obstruction (75.7% - small bowel obstruction, 24.3% - large bowel obstruction) were examined. Patients were treated according to the local treatment protocol, 1003 (68%) patients underwent surgery. Results. The following procedures were performed at the stage of bowel obstruction diagnosis and treatment: conventional adhesiolysis was performed in 425 cases, laparoscopic adhesiolysis - in 425 cases, small bowel resection with further anastomosis - in 151 cases, small bowel resection with ileostomy - in 15 cases, phytobezoar fragmenting - in 56 cases, enterotomy and phytobezoar removal - in 2 cases. In patients with large bowel obstruction the following procedures were performed: large bowel segmental resection with further anastomosis - in 38 cases, large bowel segmental resection with colostomy - in 38 cases, large bowel partial resection with colostomy - in 54 cases, right hemicolectomy with primary anastomosis - in 43 cases, left hemicolectomy with primary anastomosis - in 58 cases, manual intussusception reduction - in 65 cases, side anastomosis - in 31 cases. In 69 cases of bowel obstruction primary anastomosis was performed using the metal ring frame. Conclusion. To reduce the rate of complications, the need for the surgery should be diagnosed as soon as possible, coagulopathies should be compensated, and surgery tactics should be defined, including the primary anastomosis formation.

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