(1/1062) Painful incarcerated hernia following a rugby union lineout.
Discussion related to hernias in sport usually involves the diagnosis and treatment of chronic musculotendinous groin disruption. A case of acute trauma in an incarcerated inguinal hernia, occurring in a rugby union player during a lineout, is presented. The injury arose as a result of a change in the laws of the game. (+info)
(2/1062) Use of ultrasonography in the patient with acute renal trauma.
The purpose of this study was to assess the use of emergent ultrasonographic examination in acute traumatic renal injuries. Over a 3 year period, prospective data of all patients who had an emergency ultrasonogram were recorded. Thirty-two patients with 37 renal injuries were studied retrospectively to identify in how many patients the sonogram detected free fluid or a renal parenchymal abnormality. Free fluid in the abdomen was identified in 19 of 32 patients (59%). However, 12 of these 19 patients had concomitant injury, such as splenic rupture requiring splenectomy, severe liver lacerations, or bowel lacerations requiring repair, that were possible causes of the free fluid. Eliminating these patients, only seven of 20 patients with isolated renal injuries had free fluid in the abdomen (35%), whereas 13 of 20 patients (65%) had no evidence of free fluid. All seven patients with free fluid had moderate or severe renal injuries. Renal parenchymal abnormalities were identified on ultrasonograms in eight of 37 (22%) of injured kidneys. The abnormalities were detected more commonly in cases of severe injury (60%). In conclusion, acute injuries of the kidney from blunt abdominal trauma often are associated with significant splenic, hepatic, or bowel trauma. Isolated renal injuries frequently occur without the presence of free fluid in the abdomen. Furthermore, the ultrasonogram of the kidney often is normal with acute renal injuries, but it is more likely to be abnormal with severe (grade II or greater) renal injuries. Sonography may be used in the triage of patients with blunt abdominal trauma and possible renal injury. However, a negative ultrasonogram does not exclude renal injury, and, depending on clinical and laboratory findings, other imaging procedures such as computed tomography should be performed. (+info)
(3/1062) Bilateral vertebral artery occlusion following cervical spine trauma--case report.
A 41-year-old female presented with a rare case of bilateral vertebral artery occlusion following C5-6 cervical spine subluxation after a fall of 30 feet. Digital subtraction angiography showed occlusion of the bilateral vertebral arteries. Unlocking of the facet joint, posterior wiring with iliac crest grafting, and anterior fusion were performed. The patient died on the 3rd day after the operation. This type of injury has a grim prognosis with less than a third of the patients achieving a good outcome. (+info)
(4/1062) Factors associated with the poor final visual outcome after traumatic hyphema.
In order to determine the factors related to the worse final visual outcome following nonperforating traumatic hyphema, the clinical characteristics of 18 patients with visual outcome of 0.1 or worse were compared with those of 166 patients with visual outcome of 0.15 or better. The presence of posterior segment injuries such as macula edema, retinal hemorrhage, epiretinal membrane, and choroidal rupture were significant factors of a poor final visual outcome (P < 0.01). The presence of anterior segment injuries such as corneal blood staining, traumatic mydriasis, iridodialysis, cataract, and lens subluxation had significant predictive factors on a poor final visual outcome and the concurrent posterior segment injuries were more frequent in these patients. Initial visual acuity of 0.1 or worse, glaucoma, vitreous hemorrhage, and eyelid laceration were also significant associations of a poor final visual outcome (P < 0.05). Patients with initially larger hyphema (grade I or more vs microscopic) and older age group (16 years or more vs 15 years or less) tended to have poor final visual acuities. Rebleeding was not associated with significant deterioration in visual prognosis. We conclude that the posterior segment injuries seem to be directly related to a poor visual outcome rather than the occurrence of secondary hemorrhage. (+info)
(5/1062) Evaluating methods for estimating premorbid intellectual ability in closed head injury.
OBJECTIVES: The present study examines the utility of three measures of premorbid intellectual functioning in closed head injury, the National adult reading test (NART), the Cambridge contextual reading test (CCRT), and the spot the word test (STW). METHODS: In the first experiment, a group of 25 patients with closed head injury were compared with 50 healthy controls and 20 orthopaedic trauma controls. In the second experiment, the strength of correlation between the premorbid measures and current intellectual level were assessed in 114 healthy adults. RESULTS: The head injured group performed significantly more poorly than both control groups on measures of current intellectual ability. However, no significant differences emerged between the groups on any of the premorbid measures. In the large control sample, both the NART and the CCRT accounted for about 50% of the variance in current verbal intelligence. However, by contrast, the STW only accounted for 29% of the variability in verbal intelligence. Adding demographic variables to the prediction of current intellectual level increased the amount of variance explained to 60% for the NART, 62% for the CCRT, but only 41% for the STW. CONCLUSION: The results provide supportive evidence for the use of the CCRT and NART in estimating premorbid intellectual functioning in patients who have sustained closed head injuries, but suggest caution when employing the STW. (+info)
(6/1062) Traumatic wound rupture after penetrating keratoplasty in Africa.
AIM: To investigate risk factors, visual outcome, and graft survival for traumatic wound rupture after penetrating keratoplasty. METHODS: A retrospective analysis of 336 patients who underwent penetrating keratoplasty from 1988 to 1995. RESULTS: 19 patients (5.7%) suffered traumatic postoperative wound rupture requiring surgical repair. They were younger (mean age 16.6 years, 95% CI 13.2-20.6) and more frequently keratoconic (p = 0.01) than other patients (mean age 28.9 years, 95% CI 26.-31.0). Mean postoperative follow up was 37.7 (SD 22.9) months and 24.5 (18.9) months for the rupture and non-rupture patients. Mean interval between keratoplasty and rupture was 18 (21) weeks. The lens was damaged and removed in 37% of ruptured eyes. For keratoconics, the probability of graft survival at 5 years was lower (p = 0.03) in the ruptured eyes (75%) than in the non-ruptured eyes (90%). Endothelial failure was a more common (p <0.05) cause of graft opacification in ruptured grafts than in intact grafts. Of the ruptured eyes, 53% achieved a final corrected acuity of at least 6/18 and 63% achieved at least 6/60 compared with 48% and 71% of the intact eyes respectively (both p >0.1). The proportion of keratoconic eyes which achieved at least 6/60 was lower (p = 0.02) in the ruptured eyes (67%) than the non-ruptured eyes (87%). Eyes with wound ruptures of 5 clock hours or greater were less likely (p <0.05) to achieve an acuity of 6/18 and were more likely (p <0.05) to have an associated lens injury. CONCLUSIONS: Graft rupture is relatively common in African practice, particularly in young keratoconics. Visual outcome and graft survival are not significantly worse than for other grafted eyes, but are significantly worse than for other grafted keratoconic eyes. (+info)
(7/1062) Pseudoaneurysm of the vertebral artery.
Pseudoaneurysms of the vertebral artery are rare. Their treatment depends on the location, size, cause, and coexisting injuries. The surgical management of a 22-year-old man who had a large pseudoaneurysm in the 1st portion of the right vertebral artery is described, and an additional 144 cases from the medical literature are briefly reviewed. (+info)
(8/1062) Receptor subtype mediating the adrenergic sensitivity of pain behavior and ectopic discharges in neuropathic Lewis rats.
Receptor subtype mediating the adrenergic sensitivity of pain behavior and ectopic discharges in neuropathic Lewis rats. We attempted to identify the subtype of alpha-adrenergic receptor (alpha-AR) that is responsible for the sympathetic (adrenergic) dependency of neuropathic pain in the segmental spinal injury (SSI) model in the Lewis strain of rat. This model was chosen because our previous study showed that pain behaviors in this condition are particularly sensitive to systemic injection of phentolamine (PTL), a general alpha-AR blocker. We examined the effects of specific alpha1- and alpha2-AR blockers on 1) behavioral signs of mechanical allodynia, 2) ectopic discharges recorded in the in vivo condition, and 3) ectopic discharges recorded in an in vitro setup. One week after tight ligation of the L5 and L6 spinal nerves, mechanical thresholds of the paw for foot withdrawals were drastically lowered; we interpreted this change as a sign of mechanical allodynia. Signs of mechanical allodynia were significantly relieved by a systemic injection of PTL (a mixed alpha1- and alpha2-AR antagonist) or terazosin (TRZ, an alpha1-AR antagonist) but not by various alpha2-AR antagonists (idazoxan, rauwolscine, or yohimbine), suggesting that the alpha1-AR is in part the mediator of the signs of mechanical allodynia. Ongoing ectopic discharges were recorded from injured afferents in fascicles of the L5 dorsal root of the neuropathic rat with an in vivo recording setup. Ongoing discharge rate was significantly reduced after intraperitoneal injection of PTL or TRZ but not by idazoxan. In addition, by using an in vitro recording setup, spontaneous activity was recorded from teased dorsal root fibers in a segment in which the spinal nerve was previously ligated. Application of epinephrine to the perfusion bath enhanced ongoing discharges. This evoked activity was blocked by pretreatment with TRZ but not with idazoxan. This study demonstrated that both behavioral signs of mechanical allodynia and ectopic discharges of injured afferents in the Lewis neuropathic rat are in part mediated by mechanisms involving alpha1-ARs. These results suggest that the sympathetic dependency of neuropathic pain in the Lewis strain of the rat is mediated by the alpha1 subtype of AR. (+info)