Cervical trauma: Epidemiological, Diagnostic and Therapeutic aspects at the Adolphe SICE General Hospital in Pointe-Noire

Introduction: Cervical spine injuries are relatively rare, and caused by external sharp and vulnating agents. They can be potentially serious and life-threatening. The aim of this work was to describe the epidemiological, clinical and therapeutic aspects. Patients and Method: This was a descriptive, retrospective, cross-sectional study of the records of patients with neck trauma from January 1, 2005 to December 31, 2018, conducted in the ENT and Cervico-Facial Surgery Department of the Adolphe SICE Hospital in Pointe-Noire (Congo-Brazzaville). Results: The study included 30 patients from a total of 107 cases of cervicofacial trauma. The average annual incidence of cervical trauma was 2 cases per year, with a predominance of males, including 25 males (83.3%) and 5 females (16.6%), i.e. a sex ratio of 5:1. The average age was 34.4 years with extremes of 17 to 70 years. 50% of our patients were single. The circumstances of occurrence were represented by knives (83% of cases), followed by road traffic injuries (13%) and firearms (3%). Sharp objects were the most common cause of injury (83%). The mechanism of injury was a section in 87% and a contusion in 13%. Neck pain was the main symptom in 100% of cases. The wound represented 87% of the physical examination, followed by edema and hemorrhage in 33% and 20% respectively. The trauma was isolated in 80% of cases and in a context of polytrauma in 4%. Exploratory and reparative cervicotomy was the most common surgical procedure, 87%, followed by tracheotomy, 27%. The evolution was simple, in spite of the parietal suppuration noted in 10% of the cases. Conclusion: Despite their rarity, cervical trauma remains a worrying surgical emergency in our work context. These traumas are the prerogative of young adult males in connection with external vulnating agents with high traumatic risk. Keywords: Trauma ; penetrating wound; Neck; Cervicotomy

Fungal endophthalmitis

The question of the pathogenesis and development of fungal endophthalmitis is an urgent research topic Purpose. Evaluation of the clinical effectiveness of treatment of patients with fungal endophthalmitis over the past 5 years using the developed surgical technology. Material and methods. In the period 2016-2021, 5 patients with fungal endophthalmitis were treated. With the fungal etiology of endophthalmitis, one patient was after a penetrating wound, 4-after corneal microtraumas with the development of keratouveitis (all after using contact lenses). Surgical treatment included taking intraocular material for examination, performing vitrectomy in the maximum possible volume, tamponade of the vitreal cavity with perfluorodecalin (for 5-14 days) and intravitreal administration of amphotericin B in 10 mcg in 0.1 ml. Results. As a result of treatment of fungal endophthalmitis, it was possible to preserve the eye as an organ in 3 patients (60%), to preserve visual functions in 1 patient (20%). Conclusion. Fungal endophthalmitis is a severe pathology of the visual organ. The prognosis for the preservation of visual functions is unfavorable, the preservation of the eye is doubtful. Key words: fungal endophthalmitis, vitrectomy, perfluorodecalin, amphotericin B.

Thoracoabdominal impalement injury during pregnancy

Trauma has emerged as the leading cause of death during pregnancy. Penetrating abdominal trauma in pregnancy requires a rigorous clinical evaluation to establish a complete assessment of obstetric and non-obstetric lesions. In the case of major trauma, treatment is essentially carried out in a trauma centre with a multidisciplinary team to improve maternal and fetal prognosis. This is a case of a 20-year-old primigravid woman, 33 weeks and 4 days age of gestation, who was admitted for impaled foreign body. She was brought to the emergency department for a penetrating wound of the chest and abdomen after being accidentally impaled by a metre-long, inch-thick steel rod. Emergency laparotomy, caesarean section and thoracotomy were performed. The aim of this report is to discuss the assessment, management and role of the multidisciplinary team in the management of a pregnant trauma patient.

Results of treatment of penetrating wounds of the eyeball

Actuality. Trauma of the organ of vision still has been one of the most frequent causes of disability due to visual disorders leading to blindness, which determines the high socio-economic significance of this problem. In the structure of eye trauma, penetrating wounds make up from 67 to 84%. Timely and fully performed primary surgical treatment in combination with modern vitreoretinal surgery, according to indications, allows preserving the eyeball and even obtaining good functional results. Purpose. The aim of this work is to analyze the structure and outcomes of penetrating eye injuries in patients treated at the N.A. Semashko for 2015-2020. Material and methods. We carried out a retrospective analysis of the medical records of patients with penetrating wounds for 2015-2020. For five years in the regional clinical hospital named after N.A. Semashko, Ryazan, 142 patients aged 19 to 82 were hospitalized. Results. In the first hours after admission primary surgical debridement was done to 100% of patients. Also all patients were immediately started systemic and local detoxification and antibiotic therapy. Against the background of the treatment, the inflammatory process was arrested in 95.8% of patients, the average hospital stay was 6.8±2.5 days. An improvement in visual functions was observed in 52.1% of cases (74 eyes), visual acuity remained the same in 47 eyes (33.1%), and deterioration, up to complete loss of vision, in 21 eyes (14.8%). Conclusion. The results of the treatment of penetrating wounds depend both on the time and amount of care provided, and on the patient's age, the presence of complications and concomitant diseases, on the localization of the inlet, on the depth of penetration of a foreign body, and on many other factors. Key words: penetrating wound, vitrectomy, phacoemulsification, intraocular foreign body.

THE USE OF X-RAY ENDOVASCULAR METHODS OF DIAGNOSIS AND TREATMENT IN A PATIENT WITH POSTTRAUMATIC HEMOBILIA DUE TO PENETRATING WOUND OF THE ABDOMINAL CAVITY. OUR OWN EXPERIENCE

Background. Hemobilia is the excretion of blood alongside with bile through intra- and extrahepatic bile ducts. Despite the use of new methods of diagnosis and treatment, the mortality rate from hemobilia remains high (20-40%). Objective. To demonstrate a clinical case and some methods of diagnosis and treatment of a patient with hemobilia. Material and methods. The article presents our own clinical observation of a patient with a penetrating knife wound of the abdominal cavity with liver injury complicated by hemobilia. Two-stage treatment was performed including upper midline laparotomy, cholecystectomy, and biliary tract sanitation with external drainage of the common bile duct according to Pikovsky in combination with angioembolization of the damaged artery of the 4th liver segment. Results. The analysis of the clinical case shows X-ray endovascular methods to be one of the promising ways of increasing surgical management efficiency of traumatic hemobilia. Conclusions. This observation shows the possibility of developing hemobilia without signs of intra-abdominal bleeding in penetrating abdominal wounds with liver injury. The use of X-ray endovascular diagnostic methods can improve treatment outcomes of patients with hemobilia of traumatic origin.

Deep anterior lamellar keratoplasty for corneal penetrating wounds

Purpose: To report our surgical experience of deep anterior lamellar keratoplasty (DALK) performed in eyes with scarring resulting from a corneal penetrating wound without tissue loss. Methods: Case series of three eyes of three patients that underwent DALK for poor vision due to a scar resulting from a previous corneal penetrating wound. Surgery was performed at least 1 year after the initial injury. Manual dissection technique was used in all cases. Preoperative and postoperative best correct visual acuity (BCVA), postoperative residual bed thickness, and postoperative endothelial cell count (ECC) were evaluated. Results: Preoperative BCVA ranged from 1.3 to 1.0 LogMAR. Two eyes were pseudophakic and one eye had a traumatic cataract. Manual DALK was successfully accomplished in all three cases. The mean residual recipient bed thickness was 103 µm (range 68–130 µm). The mean endothelial cell loss at the 6th month of follow-up was 6% (range 3%–11%) with a further 1% decrease at 4 years. One of the patients underwent cataract surgery and limbal relaxing incisions 1 year after DALK having a total endothelial cell loss of 4.8% at 2 years of follow-up. BCVA at 2 years of follow-up was 0.1 LogMAR (range 0.22–0.0 LogMAR). No episode of rejection was recorded, and all grafts remained clear at last follow-up (5 years, range 4–6 years). Conclusions: Manual DALK should be considered in cases of corneal scars in optical zone resulting from penetrating wound.

Glass table tops: An unusual source of lethal domestic injury

A 42-year-old woman who fell through a glass tabletop had her lower back pierced by a long shard of glass. She rapidly exsanguinated. At autopsy, a single penetrating wound was present in her left lower back, with complete transection of her left kidney and a 3.5 L haematoperitoneum. Death was due to exsanguination following accidental transection of the left kidney by a penetrating glass injury of the lower back. Glass-topped tables are a well-recognised source of injury in a domestic setting There are far more non-lethal than lethal injuries, many of which involve children. Quite long shards may remain undetected in wounds for considerable amounts of time. Non-tempered glass is a particular risk for breakage. Glass-topped tables should not be used as substitutes for chairs, particularly in overweight or obese individuals.

Soft palatal wound associated with dental avulsion: an exceptional consequence of a bovine horn blow in children

Introduction: Palatal wounds in children as a result of a bovine horn blow have rarely been observed in adults and almost never in children. They are serious and can lead to fatal complications. Dental injuries by bovine horn are also rare. Observation: This study presents the unpublished case of an 11-year-old child who developed a soft palate penetrating wound associated with traumatic loss of the lower incisors as a result of a bovine horn blow. The surgical outcomes were positive. Comment: This type of childly bovine trauma is common in rural African agricultural areas. Dental trauma probably served as a mitigator to the soft palate trauma thus avoiding an associated injury of the hard palate and a contusion of the internal carotid artery. Although, there is a consensus among practitioners on leaving palate wounds to heal spontaneously, we chose a debridement and a suture because of the severity of the wound and the potential risk of turning into an oral-nasal fistula. Conclusion: The potential severity of palate and dental damage from bovine horns should lead to dehorning of cattle for better protection of children in rural agriculture.

Deep Penetrating Kerosene Exposure in the Hand Mimicking Deep Space Infection

In this case report, we review the clinical course of an adolescent who sustained a low-velocity, low-pressure, penetrating wound to the midpalmar aspect of the hand with a kerosene containing thermometer. The exposure led to a clinical picture of an acute midpalmar abscess within 24 hours. Despite irrigation and debridement of frank purulent material, cultures and pathology remained negative for infection. This case highlights that kerosene exposure, although rare, can mimic an acute infection with intraoperative findings consistent with sterile purulence. Hand surgeons must be aware of the effects of deep soft tissue exposure with hydrocarbons, such as kerosene and petrol, and should have a low threshold to take the patient to the operating room for thorough irrigation and debridement of the offending substance.

Laparoscopy and Penetrating Abdominal Trauma: A Systematic Review

This article aims to evaluate the effectiveness and use of laparoscopy in penetrating abdominal trauma, thus providing a better definition of the role of laparoscopic approach in patients with PAD. A systematic review was performed by searching indexed articles in the Virtual Health Library and the Medical Literature Analysis and Retrieval System Online database (MEDLINE / PubMed), in which analysis after final analysis included 07 articles. In this study we identified seven articles that evaluated the use and contributions of the laparoscopic approach in patients with TAP, in which it was identified that the use as a diagnostic approach is widely used due to its benefits and safety. Regarding its therapeutic approach it was determined that in the largest of the studies there is indication, usefulness, reliability and accuracy of its use, however, for better results is essential experience of the surgical team in laparoscopic technique.Keywords: Abdominal trauma; Laparoscopy and Penetrating Trauma; Abdominal injury; Laparoscopy; Penetrating wound.