Management and outcome of severe head injuries in the Trent region 1985-90.
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In a five year period, 39 children (29 boys, 10 girls) aged 2 months to 13 years (mean 7.8 years) were studied who had suffered a major head injury (29 road traffic accidents, six falls, and four non-accidental injury). The injury had been assessed clinically and by cranial computed tomography or cranial ultrasound (in a single baby of 2 months). Initial Glasgow coma scores for all subjects ranged from 3-11 (mean 5.5), intact survivors 5-11 (7.4), minor handicap 4-11 (6.1), major handicap 3-6 (4.3), fatalities 3-6 (4.1). All were treated with sedation, paralysis, hyperventilation (arterial carbon dioxide tension 3.0-3.5 kPa), intracranial pressure monitoring and moderate body surface hypothermia to 32 degrees C. Nine children died and 30 survived (nine intact, 13 minor disability, and eight major disability). The worst cerebral perfusion pressure was over 40 mm Hg in all but one survivor, and less than 40 mm Hg in seven of nine fatalities. Severe hypocapnia both in the first 24 hours and overall was correlated with poor outcomes (dead or major disability), as were bilateral contusions or diffuse axonal injury. (+info)
Injuries to Scottish farmers while tagging and clipping cattle: a cross-sectional survey.
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BACKGROUND: Anecdotal reports suggested that farmers were sustaining significant injuries while ear tagging newborn calves or clipping cattle prior to slaughter. AIMS: This national survey was designed for determining the incidence and nature of self-reported injuries to farmers that were sustained while tagging calves and clipping cattle. METHODS: A cross-sectional, anonymous, postal questionnaire survey was sent to all members of the National Farmers Union of Scotland with beef or dairy cattle (n = 4495). RESULTS: In total, 2439 (54%) usable questionnaires were received and 1341 injuries were reported by 591 (24%) respondents. Tagging-related injuries were reported by 297 (12%) respondents. The most commonly described injury was bruising, but lacerations (3%) and fractures (3%) also occurred. Fifty-eight (20%) individuals lost time from work, with a median of 3 days [interquartile range (IQR) = 2-7 days]. Four hundred and eighteen (17%) respondents reported clipping-related injuries. The most common injury was bruising, but lacerations (6%) and fractures (7%) also occurred. Ninety-five (23%) individuals lost time from work, with a median of 4 days (IQR = 2-14 days). Tagging injuries more commonly affected lower limbs and the trunk, while clipping injuries affected the upper limbs. Tagging injuries were associated with working alone, in an open field and with a vehicle nearby, while clipping injuries were associated with working alone, with beef cattle and with younger age. Both types of injury were associated with injuries from livestock in other circumstances. CONCLUSIONS: Tagging calves and clipping cattle prior to slaughter are associated with a significant risk of injury, which may be severe, necessitating treatment and time lost from work. Policy makers, safety advisers and the farming community should reconsider whether these procedures are necessary and whether current guidelines should be modified in order to improve safety. (+info)
The practical application of reflectance spectrophotometry for the demonstration of haemoglobin and its degradation in bruises.
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AIMS: To develop a non-invasive method to demonstrate the presence of haemoglobin and its degradation products in bruises in live human subjects for the purposes of objectively assisting in the determination of the age of a bruise. METHODS: The cuvette holder unit of a Cary 100 Bio UV-Visible Spectrophotometer was replaced with the manufacture's fibre optic cable and optical reflectance probe. The probe was placed on the skin surface. The absorption spectrum from 780 to 380 nm was collected and transformed into the first derivative. Calculation of the first derivative permits absorption attributed to haemoglobin degradation (primarily to bilirubin, but also haemosiderin) to be separated from absorption by haemoglobin. First derivative and colorimetry values, expressed as CIEL*a*b data, were derived from scans of 50 bruises. RESULTS: The fibre optic cable and probe allowed the spectrophotometer to collect reproducible absorption spectra of bruises in the skin of living subjects. A bruise at three days has greater negative first derivative values at 480 and 490 nm than does a fresh bruise, indicating the local degradation of haemoglobin. Correlation between the first derivative and the CIEL*a*b "b" values in a series of bruises indicates that the yellow colour in a bruise is proportional to the amount of local haemoglobin breakdown. CONCLUSION: The ability to demonstrate the presence of haemoglobin and measure its degradation in bruises in living human subjects by a non-invasive method has not been described previously, and may be of use in the objective ageing of bruises for forensic purposes. (+info)
Pathophysiology and management of the flail chest.
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Flail chest occurs when a series of adjacent ribs are fractured in at least 2 places, anteriorly and posteriorly. This section of the chest wall becomes unstable and it moves inwards during spontaneous inspiration. The physiological impact of a flail chest depends on multiple factors, including the size of the flail segment, the intrathoracic pressure generated during spontaneous ventilation, and the associated damage to the lung and chest wall. Treatment varies with the severity of the physiologic impairment attributable to the flail segment itself. Immediate surgical fixation may decrease morbidity, but conservative treatment with positive pressure ventilation is preferred when multiple injuries to the intrathoracic organs are present. (+info)
Raised intracranial pressure presenting with spontaneous periorbital bruising: two case reports.
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The venous drainage of the orbit is known to be via the ophthalmic and vortex veins which communicate with the cavernous sinus. We describe two patients with raised intracranial pressure presenting with periorbital bruising. In one patient dural venous sinus thrombosis was demonstrated and it is suspected that the cause of the raised intracranial pressure may have been the same in the second. We suggest that the abrupt rise of pressure in the cerebral venous system was transmitted via the cavernous sinus to the orbital venous system. (+info)
Cutaneous angiosarcoma presenting as an unusual facial bruise.
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Angiosarcoma is a rare vascular tumour accounting for 2% of soft tissue sarcomas, which together represent less than 1% of all cancers. Although well described in specialist literature, it is unusual in general medical practice. We describe a case in which the initial appearance as a bruise gave rise to diagnostic uncertainty and delay. (+info)
The Football Association medical research programme: an audit of injuries in academy youth football.
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OBJECTIVES: To undertake a prospective epidemiological study of the injuries sustained in English youth academy football over two competitive seasons. METHODS: Player injuries were annotated by medical staff at 38 English football club youth academies. A specific injury audit questionnaire was used together with a weekly return form that documented each club's current injury status. RESULTS: A total of 3805 injuries were reported over two complete seasons (June to May) with an average injury rate of 0.40 per player per season. The mean (SD) number of days absent for each injury was 21.9 (33.63), with an average of 2.31 (3.66) games missed per injury. The total amount of time absent through injury equated to about 6% of the player's development time. Players in the higher age groups (17-19 years) were more likely to receive an injury than those in the younger age groups (9-16 years). Injury incidence varied throughout the season, with training injuries peaking in January (p<0.05) and competition injuries peaking in October (p<0.05). Competition injuries accounted for 50.4% of the total, with 36% of these occurring in the last third of each half. Strains (31%) and sprains (20%) were the main injury types, predominantly affecting the lower limb, with a similar proportion of injuries affecting the thigh (19%), ankle (19%), and knee (18%). Growth related conditions, including Sever's disease and Osgood-Schlatter's disease, accounted for 5% of total injuries, peaking in the under 13 age group for Osgood-Schlatter's disease and the under 11 age group for Sever's disease. The rate of re-injury of exactly the same anatomical structure was 3%. CONCLUSIONS: Footballers are at high risk of injury and there is a need to investigate ways of reducing this risk. Injury incidence at academy level is approximately half that of the professional game. Academy players probably have much less exposure to injury than their full time counterparts. Areas that warrant further attention include the link between musculoskeletal development and the onset of youth related conditions such as Sever's disease and Osgood-Schlatter's disease, the significant number of non-contact injuries that occur in academy football, and the increased rates of injury during preseason training and after the mid season break. This study has highlighted the nature and severity of injuries that occur at academy level, and the third part of the audit process now needs to be undertaken: the implementation of strategies to reduce the number of injuries encountered at this level. (+info)
Traumatic humeral articular cartilage shear (THACS) lesion in a professional rugby player: a case report.
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A 20 year old male professional rugby player was seen at the clinic for evaluation of shoulder pain after rugby play. Magnetic resonance imaging showed extensive subchondral bone bruising of the humeral head with defect of the articular cartilage. Arthroscopy showed that the inferior half of the humeral head had extensive articular cartilage loss with nearly 70% of the inferior head having lost its cartilage. Sports medicine doctors should be aware that the shoulder joint in young competitive athletes playing contact sports may be exposed to greater risk of this kind of injury. (+info)