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https://www.readbyqxmd.com/read/28290970/severe-systemic-lead-toxicity-resulting-from-extra-articular-retained-shrapnel-presenting-as-jaundice-and-hepatitis-a-case-report-and-review-of-the-literature
#1
Ian A Grasso, Matthew R Blattner, Tyler Short, John W Downs
INTRODUCTION: Despite greater than 60,000 nonfatal firearm injuries per year in the United States, retained shrapnel is a relatively rare cause of systemic lead toxicity with less than 100 cases reported in the medical literature since 1867. While intra-articular retained shrapnel as a cause of lead toxicity is well-described, extra-articular fragments are less well known to cause symptomatic disease. CASE REPORT: A 31-year-old man initially presented with abdominal pain, constipation, jaundice, and elevated liver transaminases approximately 3 weeks after suffering a left lower extremity injury during athletic activity...
March 2017: Military Medicine
https://www.readbyqxmd.com/read/28248124/-multiple-firearm-injury-caused-with-a%C3%A2-blank-pistol
#2
Eva Nevická, Rastislav Rozboril, Boris Ťažký, Ivan Závodný, Martin Zdarílek, Jozef Šidlo
The authors present a case of a complex suicide of a 60-year-old woman found dead on her bed. A blank pistol Umarex caliber 9-mm, several blank cartridges and a lot of drug packages were discovered near the body. The woman suffered from a psychiatric depression. There were three gunshot wounds on the body: in the right temporal region, on the palatum of the mouth and on the left chest wall. The gunshot wounds in the right temporal region and in the mouth had central circle defects with the margins of stellate or star-like appearance and blackening...
2017: Soudní Lékarství
https://www.readbyqxmd.com/read/28245668/first-human-experience-with-autologous-schwann-cells-to-supplement-sciatic-nerve-repair-report-of-2-cases-with-long-term-follow-up
#3
Zachary C Gersey, S Shelby Burks, Kim D Anderson, Marine Dididze, Aisha Khan, W Dalton Dietrich, Allan D Levi
OBJECTIVE Long-segment injuries to large peripheral nerves present a challenge to surgeons because insufficient donor tissue limits repair. Multiple supplemental approaches have been investigated, including the use of Schwann cells (SCs). The authors present the first 2 cases using autologous SCs to supplement a peripheral nerve graft repair in humans with long-term follow-up data. METHODS Two patients were enrolled in an FDA-approved trial to assess the safety of using expanded populations of autologous SCs to supplement the repair of long-segment injuries to the sciatic nerve...
March 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/28240620/infection-rates-and-treatment-of-low-velocity-extremity-gunshot-injuries
#4
Mai P Nguyen, Jonathan C Savakus, Jeffrey A O'Donnell, Nicholas F Prayson, Michael S Reich, Joseph F Golob, Amy A McDonald, John J Como, Heather A Vallier
OBJECTIVES: To determine the rates of infection in low-energy gunshot wounds (GSWs) to the extremity. DESIGN: Retrospective review. SETTING: Level I trauma center. PATIENTS/PARTICIPANTS: Patients (N=140) with at least 90-day follow-up for extremity-only low-energy GSW injuries from 2010-2014 were retrospectively reviewed. Treatment was recorded, including type and duration of antibiotics and details of non-operative and operative management...
February 23, 2017: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/28110378/belfast-limb-arterial-and-skeletal-trauma-blast-the-evolution-of-punishment-shooting-in-northern-ireland
#5
REVIEW
M Lau, S McCain, R Baker, D W Harkin
INTRODUCTION: Northern Ireland has developed significant experience in specific punishment injuries due to its unique civil unrest. Simple gunshot wound (GSW) injuries have begun to evolve into more complex injuries. CASE PRESENTATION: We describe three cases of young male victims who suffered from GSW injuries-from a single GSW injury to multiple GSW injuries involving all four limbs; the phenomenon of Belfast Limb Arterial and Skeletal Trauma. We describe the management of these injuries, with a review of current literature...
January 21, 2017: Irish Journal of Medical Science
https://www.readbyqxmd.com/read/28099379/systemic-intraoperative-anticoagulation-during-arterial-injury-repair-implications-for-patency-and-bleeding
#6
Zoё Maher, Brian Frank, Noelle Saillant, Anna Goldenberg, Elizabeth Dauer, Joshua P Hazelton, Andrea Lubitz, Huaqing Zhao, Jeremy W Cannon, Mark J Seamon
BACKGROUND: The role of systemic intraoperative anticoagulation (SIAC) during surgical repair of major arterial injuries is controversial. Any potential improvement in arterial patency must be weighed against the risk of hemorrhage in these critically injured patients. We hypothesized that SIAC would increase arterial patency without increasing bleeding complications. METHODS: We conducted a multi-institution, retrospective cohort study of trauma patients with major vascular injury from 2005 to 2013 in three Level I centers...
April 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/27920844/popliteal-artery-embolism-of-bullet-after-abdominal-gunshot-wound
#7
Junjian Huang, Vivek Pandey, Rohan Shah, Vivek Yedavalli, Anand Joshi, Roger Stimpson, Mark Keldahl, Loren Zuiderveld
Bullet embolism to the peripheral arterial system is a rare phenomenon which frequently results in misdiagnosis due to lack of early symptoms. Embolisms can go to either arterial or venous systems with common sites of injury including the left ventricle, pulmonary vein, thoracic and abdominal aorta and peripheral arteries. Herein we present a case of a 19 year old patient with multiple gunshot wounds to the torso with a bullet embolism to the left popliteal artery necessitating embolectomy. This subsequently led to diagnosis and repair of an abdominal aortic psuedoaneurysm not clearly evident on initial imaging...
December 2016: Radiology case reports
https://www.readbyqxmd.com/read/27858523/laparoscopic-assisted-approach-for-penetrating-abdominal-trauma-an-underutilized-technique
#8
Modise Z Koto, Oleh Y Matsevych, Colleen Aldous
INTRODUCTION: Diagnostic laparoscopy is well accepted in the management of penetrating abdominal trauma (PAT). Therapeutic laparoscopy, on the other hand, remains controversial. In patients with multiple hollow viscera injuries, laparoscopy is usually converted to laparotomy. We aim at describing the laparoscopic-assisted technique in the management of patients with PAT. Using our experience with laparoscopy, we tailored the technique to the setting of PAT. METHODS: The laparoscopic-assisted approach (LAA) was adapted to a trauma setting and prospectively evaluated...
November 18, 2016: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
https://www.readbyqxmd.com/read/27833712/partially-thrombosed-internal-maxillary-pseudoaneurysm-after-gunshot-wound
#9
Menachem Gold
A 29-year-old man arrived in our emergency department after being shot on the face. Computed tomography (CT) revealed multiple facial bone fractures along the bullet trajectory. On day 10 of admission, CT angiogram of the neck revealed a partially thrombosed pseudoaneurysm in the parapharyngeal fat pad. The pseudoaneurysm was successfully treated with coil embolization. This report discusses diagnosis and treatment of a partially thrombosed internal maxillary artery pseudoaneurysm. Although digital subtraction angiography is the gold standard for pseudoaneurysm diagnosis, CT angiography may provide complimentary information, as seen in this case...
November 2016: Craniomaxillofacial Trauma & Reconstruction
https://www.readbyqxmd.com/read/27798535/urinary-biomarkers-are-associated-with-severity-and-mechanism-of-injury
#10
Jud C Janak, Ian J Stewart, Jonathan A Sosnov, Jeffrey T Howard, Edward D Siew, Mallory M Chan, Nancy Wickersham, T Alp Ikizler, Kevin K Chung
Combat-related blast trauma results in massive tissue injury and tends to involve multiple systems. Further, an acute measure of injury severity based on underlying biological mechanisms may be important for the triage and treatment of these types of patients. We hypothesized that urinary biomarkers (UBs) would reflect severity of injury and that they would be elevated for blast injuries compared with gunshot wounds (GSW) in a cohort of combat casualties. We also postulated that UBs would be higher in patients with burns compared with patients with non-burn trauma in a civilian cohort...
May 2017: Shock
https://www.readbyqxmd.com/read/27742157/sentinel-events-preceding-youth-firearm-violence-an-investigation-of-administrative-data-in-delaware
#11
Steven A Sumner, Matthew J Maenner, Christina M Socias, James A Mercy, Paul Silverman, Sandra P Medinilla, Steven S Martin, Likang Xu, Susan D Hillis
INTRODUCTION: Accurately identifying youth at highest risk of firearm violence involvement could permit delivery of focused, comprehensive prevention services. This study explored whether readily available city and state administrative data covering life events before youth firearm violence could elucidate patterns preceding such violence. METHODS: Four hundred twenty-one individuals arrested for homicide, attempted homicide, aggravated assault, or robbery with a firearm committed in Wilmington, Delaware, from January 1, 2009 to May 21, 2014, were matched 1:3 to 1,259 Wilmington resident controls on birth year and sex...
September 8, 2016: American Journal of Preventive Medicine
https://www.readbyqxmd.com/read/27734452/a-case-of-prehospital-traumatic-arrest-in-a-us-special-operations-soldier-care-from-point-of-injury-to-full-recovery
#12
Myles R McKenzie, Ernest W Parrish, Ethan A Miles, James C Spradling, Lanny F Littlejohn, Mark D Quinlan, George A Barbee, David R King
During an assault on an extremely remote target, a US Special Operations Soldier sustained multiple gunshot and fragmentation wounds to the thorax, resulting in a traumatic arrest and subsequent survival. His care, including care under fire, tactical field care, tactical evacuation care, and Role III, IV, and V care, is presented. The case is used to illustrate the complex dynamics of Special Operations care on the modern battlefield and the exceptional outcomes possible when evidence-based medicine is taken to the warfighter with effective, farforward, expeditionary medical-force projection...
2016: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
https://www.readbyqxmd.com/read/27727041/oculocardiac-reflex-as-a-result-of-intraorbital-trauma
#13
Joel M Fahling, L Kendall McKenzie
BACKGROUND: The oculocardiac reflex is a decrease in heart rate caused by ocular compression or traction upon the extraocular musculature. Multiple instances of this phenomenon have been described in anesthesia, trauma, craniofacial, and ophthalmology literature, but there is a sparsity of documentation in the emergency medicine literature. CASE REPORT: We describe the observation and management of the oculocardiac reflex in a 26-year-old man with retrobulbar hematoma and intraocular trauma caused by a self-inflicted gunshot wound...
April 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27723646/surgical-correction-of-severe-enophthalmos-caused-by-bullet-injury
#14
S M Balaji
Ballistic injuries of oral and maxillofacial region are usually fatal due to close propinquity with the vital structures. The severity of injury depends on the caliber of the weapon used and distance from which the patient is shot. The preliminary care of facial ballistic wounds strictly adheres to the basics of trauma resuscitation. Early and appropriate surgical management has proved to be influential on the final outcome and esthetic result. Treatment of facial gunshot wounds should be planned and carried out carefully to avoid esthetic complications...
July 2016: Indian Journal of Dental Research: Official Publication of Indian Society for Dental Research
https://www.readbyqxmd.com/read/27671737/is-early-appropriate-care-of-axial-and-femoral-fractures-appropriate-in-multiply-injured-elderly-trauma-patients
#15
M S Reich, A J Dolenc, T A Moore, H A Vallier
BACKGROUND: Previous work established resuscitation parameters that minimize complications with early fracture management. This Early Appropriate Care (EAC) protocol was applied to patients with advanced age to determine if they require unique parameters to mitigate complications. METHODS: Between October 2010 and March 2013, 376 consecutive skeletally mature patients with unstable fractures of the pelvis, acetabulum, thoracolumbar spine, and/or proximal or diaphyseal femur fractures were treated at a level I trauma center and were prospectively studied...
September 26, 2016: Journal of Orthopaedic Surgery and Research
https://www.readbyqxmd.com/read/27648655/useful-method-for-intraoperative-monitoring-of-facial-nerve-in-a-scarred-bed
#16
Bilge Kagan Aysal, Abdulkerim Yapici, Yalcin Bayram, Fatih Zor
Facial nerve is the main cranial nerve for the innervation of facial expression muscles. Main trunk of facial nerve passes approximately 1 to 2 cm deep to tragal pointer. In some patients, where a patient has multiple operations, fibrosis due to previous operations may change the natural anatomy and direction of the branches of facial nerve. A 22-year-old male patient had 2 operations for mandibular reconstruction after gunshot wound. During the second operation, there was a possible injury to the marginal mandibular nerve and a nerve stimulator was used intraoperatively to monitor the nerve at the tragal pointer because the excitability of the distal segments remains intact for 24 to 48 hours after nerve injuries...
October 2016: Journal of Craniofacial Surgery
https://www.readbyqxmd.com/read/27578384/reconstruction-and-rehabilitation-of-short-range-gunshot-injury-to-lower-part-of-face-a-systematic-approach-of-three-cases
#17
Ashutosh Vatsyayan, Apurba-Kumar Adhyapok, Subhas-Chandra Debnath, Kapil Malik
Gunshot injuries are always known to cause severe morbidity and mortality when head and neck are involved. They vary in morbidity, which can occur in civilian surroundings. The wound largely depends on the type of weapon, mass and velocity of the bullet, and the distance from where it has been shot. Close-range gunshot wounds in the head and neck region can result in devastating aesthetic and functional impairment. The complexity in facial skeletal anatomy cause multiple medical and surgical challenges to an operating surgeon, demanding elaborate soft and hard tissue reconstruction...
August 1, 2016: Chinese Journal of Traumatology, Zhonghua Chuang Shang za Zhi
https://www.readbyqxmd.com/read/27553197/penetrating-thoracic-trauma-patients-with-gross-physiological-derangement-a-responsibility-for-the-general-surgeon-in-the-absence-of-trauma-or-cardiothoracic-surgeon
#18
Dietrich Doll, Markus Eichler, Pantelis Vassiliu, Kenneth Boffard, Tim Pohlemann, Elias Degiannis
BACKGROUND: Penetrating trauma is becoming increasingly common in parts of the world where previously it was rare. At the same time, general surgeons and surgical trainees are becoming more specialized, and less comfortable operating within areas beyond their zone of specialization. OBJECTIVE: The purpose of this manuscript is to assess the technical difficulties encountered in operating on patients who have sustained penetrating trauma, and to prove to general surgeons that the technical skills and techniques required are no different to those required for abdominal surgery, and do not require additional dexterity...
January 2017: World Journal of Surgery
https://www.readbyqxmd.com/read/27552704/evaluation-of-trauma-patterns-in-blast-injuries-using-multiple-correspondence-analysis
#19
Marie Christine Dussault, Martin Smith, Ian Hanson
Anthropology features little in published literature about blast injuries. Contributions through case studies and experimental research are beginning to expand our understanding of the effect these injuries have on the human skeleton. This study examines blast injury and gunshot related fractures through multiple correspondence analysis (MCA) with the aim of establishing injury patterns between the two types of trauma. Using a sample of 491 individuals from Bosnia, MCA is employed to identify which body regions differentiate between blast or gunshot related fractures...
October 2016: Forensic Science International
https://www.readbyqxmd.com/read/27493261/scintigraphic-diagnosis-of-intrathoracic-splenic-implants-masquerading-as-malignancy
#20
Paul D Rodrigue, Asif A Fakhri, Jin T Lim
After significant trauma to the spleen, small viable splenic fragments may exist in the peritoneal cavity or, less commonly, in the thorax. Thus, the appearance of splenules within the thorax on CT images can easily be mistaken for malignancy and lead to unnecessary intervention. Here, we present a case of multiple pulmonary masses that initially were presumed to be malignancy, leading to CT-guided biopsy, but were eventually confirmed to be thoracic splenules through (99m)Tc-labeled sulfur colloid scintigraphy...
December 2016: Journal of Nuclear Medicine Technology
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