scholarly journals Unpredictable Outcome of Large Traumatic Oesophageal Injury: An Experience and Challenges

2021 ◽  
Author(s):  
Mahaveer Singh Rodha ◽  
Satya Prakash Meena ◽  
Subhash Chandra Soni ◽  
Pawan Kumar Garg ◽  
Althea Vency Cardoz
Keyword(s):  
Traffic Accidents ◽  
Road Traffic ◽  
Thoracoscopic Surgery ◽  
Delayed Diagnosis ◽  
Oesophageal Perforation ◽  
Feeding Jejunostomy ◽  
Oesophageal Injury ◽  
Life Threatening ◽  
Thoracic Oesophagus

Oesophageal injury following blunt or penetrating injury due to road traffic accidents is a rare cause of morbidity and mortality. The outcome of delayed diagnosis of oesophageal injury is mostly life threatening conditions. A 23-year-old female presented with respiratory distress, fever, chest pain and facial deformity, following road traffic accident 15 days back. After evaluation, the patient was diagnosed with septicaemia due to large thoracic oesophageal perforation with left pyothorax. The patient was managed by Video Assisted Thoracoscopic Surgery (VATS) decortication with feeding jejunostomy followed by diversion cervical oesophagostomy. The patient was planned for oesophageal reconstructive surgery electively in follow-up period. After six weeks in the follow-up period, surprisingly large thoracic oesophagus perforation and cervical oesophagostomy was healed spontaneously which was confirmed by gastrograffin study. Spontaneous closure of large thoracic oesophageal perforation is the rare outcome of this injury.

scholarly journals P014: Incidental findings in trauma whole-body CT scans: a systematic review

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S69-S69
Author(s):  
V. Tsang ◽  
K. Bao ◽  
J. Taylor
Keyword(s):  
Systematic Review ◽  
Incidental Findings ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Subsequent Treatment ◽  
Whole Body ◽  
Trauma Patients ◽  
Patient Demographics ◽  
Study Results

Introduction: Whole-body computed tomography scans (WBCT) are a mainstay in the work-up of polytrauma or multiple trauma patients in the emergency department. While incredibly useful for identifying traumatic injuries, WBCTs also reveal incidental findings in patients, some of which require further diagnostic testing and subsequent treatment. Although the presence of incidental findings in WBCTs have been well documented, there has been no systematic review conducted to organize and interpret findings, determine IF prevalence, and document strategies for best management. Methods: A systematic review was conducted using MEDLINE, PUBMED, and EMBASE. Specific journals and reference lists were hand-mined, and Google Scholar was used to find any additional papers. Data synthesis was performed to gather information on patient demographics, prevalence and type of incidental findings (IFs), and follow-up management was collected. All documents were independently assessed by the two reviewers for inclusion and any disagreements were resolved by consensus. Results: 1231 study results were identified, 59 abstracts, and 12 included in final review. A mean of 53.9% of patients had at least one IF identified, 31.5% had major findings, and 68.5% had minor findings. A mean of 2.7 IFs per patient was reported for articles that included number of total IFs. The mean age of patients included in the studies were 44 years old with IFs more common in older patients and men with more IFs than women. IFs were most commonly found in the abdominal/pelvic region followed by kidneys. Frequency of follow-up documentation was poor. The most common reported mechanisms of injury for patients included in the study were MVA and road traffic accidents (60.0%) followed by falls from >3m (23.2%). Conclusion: Although there is good documentation on the mechanism of injury, patient demographics, and type of IF, follow-up for IFs following acute trauma admission lacks documentation and follow-up and is an identified issue in patient management. There is great need for systematic protocols to address management of IFs in polytrauma patients.

scholarly journals Titanium Clamps for a Simple Low-Profile Autologous Osteosynthesis in the Reconstruction of Posttraumatic Craniofacial Convexital Skeletal Disruption

2017 ◽  
Vol 10 (1) ◽  
pp. 29-34 ◽  
Author(s):  
AmosOlufemi Adeleye ◽  
ToluyemiAdefolarin Malomo
Keyword(s):  
Traffic Accidents ◽  
Road Traffic ◽  
Low Cost ◽  
Low Resource ◽  
Low Profile ◽  
The Aesthetic ◽  
Craniofacial Defects ◽  
Profile Technique ◽  
Prospective Database

Attempts at reconstruction of posttraumatic craniofacial defects (PTCDs) can be a challenge in low-resource practice areas of the world where the needed biomaterials are logistically beyond reach. A simple low-profile technique of autologous osteosynthesis for PTCD using the titanium clamps is presented in this report. In addition, a 6-year prospective database on a consecutive cohort of patients who underwent this procedure was analyzed for clinical, functional, and aesthetic outcomes, both in-hospital and at midterm follow-up. The clinical data of 18 patients, all males, mean age 31.3 years (standard deviation, 9.7), were analyzed. Road traffic accidents (RTAs) were the cause of trauma in 14 of 18 patients (78%) and motorcycle crash, none helmeted, in 10 of the 18 patients (71% of RTAs). Out of 18 cases, 17 were open fractures; 89% suffered mild head injury, and associated brain injury on CT scan included pneumocephalus in 6 (5 of them significant); acute extradural hematoma in 4 and subdural in 2, and brain contusions in 9. The surgery was successful in all the cases: operative time <3 hours in 10 cases (56%), the in-hospital outcome was good in 95%. The median follow-up time was 24 months, in 6 of the 18 cases for ≥36 months. There was no case of surgical site infection in the perioperative or the follow-up period to date. The aesthetic outcome was also acceptable. This surgical technique for the reconstruction of PTCD appears effectual. Although its low cost makes it very attractive therein, it appears to be actually also recommendable even outside the low-resource developing countries.

scholarly journals Primary care pediatricians’ interest in diagnostic error reduction

Diagnosis ◽  
2016 ◽  
Vol 3 (2) ◽  
pp. 65-69 ◽  
Author(s):  
Michael L. Rinke ◽  
Hardeep Singh ◽  
Sarah Ruberman ◽  
Jason Adelman ◽  
Steven J. Choi ◽  
...  
Keyword(s):  
Delayed Diagnosis ◽  
Diagnostic Errors ◽  
Diagnostic Error ◽  
Error Reduction ◽  
Self Report ◽  
Abnormal Laboratory ◽  
Electronic Survey ◽  
Laboratory Values ◽  
Life Threatening

Abstract: Diagnostic errors causing harm in children are understudied, resulting in a knowledge gap regarding pediatricians’ interest in reducing their incidence.: Electronic survey of general pediatricians focusing on diagnostic error incidence, errors they were interested in trying to improve, and errors reduced by their electronic health record (EHR).: Of 300 contacted pediatricians, 77 (26%) responded, 58 (19%) served ambulatory patients, and 48 (16%) completed the entire questionnaire. Of these 48, 17 (35%) reported making a diagnostic error at least monthly, and 16 (33%) reported making a diagnostic error resulting in an adverse event at least annually. Pediatricians were “most” interested in “trying to improve” missed diagnosis of hypertension (17%), delayed diagnosis due to missed subspecialty referral (15%), and errors associated with delayed follow-up of abnormal laboratory values (13%). Among the 44 pediatricians with an EHR, 16 (36%) said it reduced the likelihood of missing obesity and 14 (32%) said it reduced the likelihood of missing hypertension. Also, 15 (34%) said it helped avoid delays in follow-up of abnormal laboratory values. A third (36%) reported no help in diagnostic error reduction from their EHR.: Pediatricians self-report an appreciable number of diagnostic errors and were most interested in preventing high frequency, non-life-threatening errors. There exists a need to leverage EHRs to support error reduction efforts.

scholarly journals Laryngeal Trauma

2021 ◽  
Vol 29 (1) ◽  
pp. 86-93
Author(s):  
Gurbax Singh ◽  
Sumit Prinja ◽  
Suchina Parmar ◽  
Garima Bansal ◽  
Simmi Jindal
Keyword(s):  
Traffic Accidents ◽  
Surgical Intervention ◽  
Road Traffic ◽  
Penetrating Trauma ◽  
Laryngeal Trauma ◽  
Presenting Symptoms ◽  
Laryngeal Injury ◽  
Life Threatening ◽  
Term Basis ◽  
Specific Factors

Introduction Laryngeal trauma can be an immediately life-threatening entity.  Failure to recognize such injuries and delay in securing the airway may have fatal results. Early diagnosis and accurate evaluation with proper treatment is vital. Materials and Methods Fifteen patients with laryngotracheal injuries were analyzed prospectively. The outcome was assessed both in terms of voice and airway, on short term and long term basis. Result Commonest cause of injury was suicidal followed by road traffic accidents and strangulation. The main presenting symptoms and signs were stridor, hoarseness, haemoptysis and odynophagia. Five patients suffered penetrating trauma and ten patient sustained blunt trauma. Sites of laryngeal injury included; hyoid bone fracture, mixed soft tissue and cartilaginous injuries, thyrohyoid membrane and cricothyroid membrane injuries. Eleven patients presented within 24 hours of the injury. Outcome (airway and voice) was good in ten patients whereas it was poor in three patients. Poor results were seen in patients who had delayed surgical intervention. Conclusion Early surgical intervention is recommended for   traumatic laryngeal injuries to ensure a good outcome; which further depends upon patient’s condition, injury and treatment-specific factors.

scholarly journals Association of aspartate aminotransferase in statin-induced rhabdomyolysis

2017 ◽  
Vol 9 (4) ◽  
pp. 316 ◽  
Author(s):  
Xu Cong Ruan ◽  
Lian Leng Low ◽  
Yu Heng Kwan
Keyword(s):  
Regression Model ◽  
Clinical Diagnosis ◽  
Aspartate Aminotransferase ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Delayed Diagnosis ◽  
Acute Care Hospital ◽  
Care Hospital ◽  
Inclusion Criteria ◽  
Aspartate Transferase

ABSTRACT INTRODUCTION The risk of rhabdomyolysis in the general population is elevated by the increased prevalence of statin use. As the presentation of rhabdomyolysis is varied, there is a risk of delayed diagnosis leading to patient complications and increased healthcare costs. Creatine kinase (CK) alone is not sufficiently predictive for risk stratification. Beyond serum CK, other biomarkers such as transaminases may be used as surrogates to evaluate rhabdomyolysis severity and predict complication risks. AIM To assess if other biomarkers are associated with peak CK and severity of rhabdomyolysis to aid in clinical diagnosis of rhabdomyolysis. METHODS A retrospective study was conducted at an acute care hospital from 2008 to 2011. Inclusion criteria were: (1) patients diagnosed with statin-induced rhabdomyolysis; and (2) peak CK levels of ≥1000 IU/L. Patients with post-operational rhabdomyolysis, acute myocardial infarction and who had suffered from road traffic accidents were excluded. A total of 24,332 patients were screened, and 78 patients fulfilled our inclusion criteria. RESULTS Aspartate aminotransferase (AST) was found to be positively associated with peak CK levels in the multivariable linear regression model after adjusting for alanine aminotransferase (ALT) levels (P = 0.002; β = 83.18). Aspartate aminotransferase was found to be associated with severity of rhabdomyolysis in the multivariable logistics regression model after adjusting for ALT levels (P = 0.015; OR = 1.01). DISCUSSION Aspartate transferase is associated with raised peak CK levels and severity of rhabdomyolysis. Clinicians may consider ordering AST to aid in the clinical diagnosis of rhabdomyolysis.

A Differential Approach to the Choice of Treatment of Facial Bone Fractures in the Children

10.12737/3564 ◽  
2014 ◽  
Vol 8 (1) ◽  
pp. 1-5
Author(s):  
Тихонов ◽  
E. Tikhonov ◽  
Харитонов ◽  
D. Kharitonov ◽  
Гаршина ◽  
...  
Keyword(s):  
High Speed ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Bone Fractures ◽  
Facial Bone ◽  
Differential Approach ◽  
Fractures In Children ◽  
Choice Of Treatment ◽  
Post Traumatic

The choice of treatment of facial bone fractures in the early age remains a challenge for dentists and maxillofacial surgeons due to the peculiarities of child organism. The purpose of this study was to develop a differential approach to the choice of treatment of children´s facial bone fractures taking into account the age of a child, location of injury and possible complications. This paper presents the analysis of current epidemiological situation regarding to facial bone fractures in children in Voronezh city and Voronezh region. It is shown that the most common injuries is a fall from a height of its own growth, i.e. low-trauma; at the same time the number of high-speed traumas, such as road-traffic accidents, high falls, has decreased. The analysis was carried out 58 cases of facial bone fractures in a group of children from 1 month to 16 years being treated in Maxillofacial Department of Voronezh Regional Pediatric Hospital №2. The developed model of differential choice of treatment of facial bone fractures in children allows to choosing the method taking into account a child age, location of injury and severity, as well as possible consequences of surgery. The clinical monitoring has proved the efficacy of the model which gives an opportunity to decrease post-traumatic complications associated with growth and occlusion deformations as well as complications of inflammatory genesis. It was convincingly shown the need for follow-up care of children with facial fracture that the doctor-orthodontist should continue. The presented data of this study about correlation between surgical and conservative treatment of facial bone fractures in children coincide with the worldwide statistics showing the current tendency to a wide application of mini-invasive methods of fractures fragments immobilization.

scholarly journals Patterns and Severity of Injuries in Patients Following Road Traffic Accidents – A Medicolegal Aspects

2020 ◽  
Vol 2 (1) ◽  
pp. 13-17
Author(s):  
Archana Chaudhary ◽  
Harihar Wasti
Keyword(s):  
Traffic Accidents ◽  
Analytical Study ◽  
Road Traffic ◽  
Tertiary Care ◽  
Fracture Dislocation ◽  
Common Finding ◽  
Age Group ◽  
Road Traffic Accidents ◽  
Tertiary Care Centre ◽  
Life Threatening

 Background and purpose: Road traffic accident (RTA) is the major cause of the morbidity and mortality throughout the world and the incidence is still very high in developed and developing countries. With the objective to see the pattern and severity of the injury following RTA from the medico legal point of view, this study was design in a tertiary care centre at far eastern part of Nepal. Material and method: This is a prospective analytical study with non- probability consecutive sampling of road traffic accidents cases presented in the emergency department during period of 6 months. Type of study: Prospective Analytical study.  Result: There were total 210 cases of road traffic accidents with mean age of 31.8 (SD 15.7) years where majority were at 20-29 years of age group and males were the majority. Majority of the cases had injuries to the extremities followed by head. Grievous injury and life threatening injuries were also a common finding in this study. Conclusion: Road traffic accidents are more common among male, bike/scooter rider and 22-29 years of age group. Majority of the injury were fracture/dislocation of extremities and intracranial injuries. As per the medicolegal aspect, grievous and life threatening injuries were common findings among patients with road traffic accidents.

The aetiology of posterior glenohumeral dislocations and occurrence of associated injuries

2019 ◽  
Vol 101-B (1) ◽  
pp. 15-21 ◽  
Author(s):  
M. J. Kelly ◽  
A. E. Holton ◽  
A. J. Cassar-Gheiti ◽  
S. A. Hanna ◽  
J. F. Quinlan ◽  
...  
Keyword(s):  
Traffic Accidents ◽  
Web Of Science ◽  
Road Traffic ◽  
Glenohumeral Joint ◽  
Delayed Diagnosis ◽  
Associated Injuries ◽  
Inclusion Criteria ◽  
Posterior Shoulder ◽  
Male Patients ◽  
Insight Into

AimsThe glenohumeral joint is the most frequently dislocated articulation, but possibly due to the lower prevalence of posterior shoulder dislocations, approximately 50% to 79% of posterior glenohumeral dislocations are missed at initial presentation. The aim of this study was to systematically evaluate the most recent evidence involving the aetiology of posterior glenohumeral dislocations, as well as the diagnosis and treatment.Materials and MethodsA systematic search was conducted using PubMed (MEDLINE), Web of Science, Embase, and Cochrane (January 1997 to September 2017), with references from articles also evaluated. Studies reporting patients who experienced an acute posterior glenohumeral joint subluxation and/or dislocation, as well as the aetiology of posterior glenohumeral dislocations, were included.ResultsA total of 54 studies met the inclusion criteria. In total, 182 patients were included in this analysis; study sizes ranged from one to 66 patients, with a mean age of 44.2 years (sd 13.7). There was a higher proportion of male patients. In all, 216 shoulders were included with 148 unilateral injuries and 34 bilateral. Seizures were implicated in 38% of patients (n = 69), with falls, road traffic accidents, electric shock, and iatrogenic reasons also described. Time to diagnosis varied across studies from immediate up to a delay of 25 years. Multiple associated injuries are described.ConclusionThis review provides an up-to-date insight into the aetiology of posterior shoulder dislocations. Our results showed that seizures were most commonly implicated. Overall, reduction was achieved via open means in the majority of shoulders. We also found that delayed diagnosis is common.

scholarly journals Evaluation of Clinical Outcome in Traumatic Facial Nerve Paralysis

2021 ◽  
Author(s):  
Abhijit Shankar ◽  
Shibu George ◽  
Satheesh Somaraj
Keyword(s):  
Clinical Outcome ◽  
Facial Nerve ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Objective Evaluation ◽  
Facial Nerve Paralysis ◽  
Temporal Bone Fracture ◽  
Nerve Paralysis ◽  
Tertiary Center

Abstract Introduction The facial nerve is the most commonly paralyzed nerve in the human body, resulting in far-reaching functional, aesthetic and emotional concerns to the patient. Objective Evaluation of the clinical outcome of 47 patients with traumatic facial nerve paralyses, with respect to clinical recovery and audiological sequelae. Methods A descriptive longitudinal study was conducted over 24 months between January 2017 and December 2018 at a tertiary center with detailed clinical, topodiagnostic, audiometric and radiological evaluation and regular follow-up after discharge. Results Road traffic accidents constituted 82.98% of the trauma cases, out of which 76.60% were found to be under the influence of alcohol.Delayed facial paralysis was observed in 76.60% cases. Temporal bone fracture was reported in 89.36%, with otic capsule (OC) sparing fractures forming 91.49% of the cases. Topologically, the injury was mostly at the suprachordal region around the second genu. The majority of the patients (65%) attained full recovery of facial nerve function with conservative medical management. Audiometrically, 77.27% of the patients had hearing loss at the time of presentation, of which 64.71% were conductive in nature; 51.22% attained normal hearing at follow-up visits. Conclusion Early initiation of steroid therapy, concurrent eye care and physiotherapy are the cornerstones in the management of traumatic facial nerve paralysis.

scholarly journals Penetrating neck injury with consequential thoracic complications managed with use of video-assisted thoracoscopic surgery: A case report

2020 ◽  
Vol 77 (3) ◽  
pp. 330-334
Author(s):  
Natasa Vesovic ◽  
Aleksandar Ristanovic ◽  
Vlado Cvijanovic ◽  
Dejan Stojkovic ◽  
Nebojsa Maric ◽  
...  
Keyword(s):  
Case Report ◽  
Thoracoscopic Surgery ◽  
Left Lung ◽  
Thoracic Wall ◽  
Cervical Region ◽  
Anatomical Structures ◽  
Penetrating Neck Injury ◽  
Life Threatening ◽  
Invasive Method

Introduction. Penetrating injuries of the neck are potentially life-threatening conditions. They can cause injuries of larynx, trachea, esophagus and major blood vessels in this area. Case report. The patient was a 28-year-old male who was stabbed with broken glass penetrating the front side of the base of his neck. The patient had dyspnea and the wound was inflicted the night before admission to hospital. An otorhinolaryngologist found a stab wound in the region of the left basis of the neck. The wound was 2 cm long with no signs of bleeding and deep injuries of the anatomical structures of the neck. However, since left hemopneumothorax was clinically and radiologically apparent, drainage of the thorax was performed upon admission to the intensive care unit. Initially, 400 mL of hemorrhagic effusion was evacuated. However, 24 hours later the patient became hemodynamically unstable. It was an indication for videoassisted thoracoscopy (VATS). Therefore, VATS was used as a diagnostic method in order to determine the nature of the injury. Intraoperatively, we treated a laceration of pleuropulmonary adhesion which was continuously bleeding from the apex of the thoracic cavity. As a result, adequate surgical hemostasis was achieved. Furthermore, during the three-week postoperative period, thoracic tubes were placed due to the prolonged air leakage. A thoracic tube was placed laterally along with another one which was placed in intercostal space higher. After total reexpansion of the left lung, thoracic tubes were extracted, and the patient was discharged. Conclusion. Nowadays, VATS has become a highly important ultimate treatment of thoracic trauma. This minimally invasive method allows us to verify injury type and localization, to resolve it and further to follow-up evaluation of pathological changes in the lungs, pericardium, mediastinum, pleura and thoracic wall. In the case of stab wounds in the cervical region, any injuries of the lungs and pleura must be taken into consideration.

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