Reflex nature of the cardiorespiratory response to primary thoracic blast injury in the anaesthetised rat.
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Blast injuries represent a problem for civilian and military populations. Primary thoracic blast injury causes a triad of bradycardia, hypotension and apnoea. The objective of this study was to investigate the reflex nature of this response and its modulation by vagotomy or administration of atropine. The study was conducted on terminally anaesthetised (alphadolone/alphaxalone, 18-24 mg x kg x h(-1), I.V.) male Wistar rats randomly allocated to the groups indicated below. Blast injuries were produced with compressed air while sham blast involved the sound of a blast only. Primary blast injury to the thorax resulted in a bradycardia (measured as an increase in the interval between beats, or heart period (HP) to 489 +/- 37 ms from 133 +/- 3 ms with a latency of onset of 4.3 +/- 0.3 s, mean +/- S.E.M.), hypotension (fall in mean arterial blood pressure (MBP) from 128.1 +/- 3.7 mmHg to 34.8 +/- 4.1 mmHg, latency of onset 2.0 +/- 0.1 s) and apnoea lasting 28.3 +/- 2.3 s. Sham blast had no effect. The bradycardia and apnoea following thoracic blast were abolished by cervical vagotomy while the hypotension was attenuated. Atropine (0.3 mg x kg(-1), I.V.) caused a significant reduction in the bradycardia (HP increasing from 124 +/- 3 ms to 142 +/- 4 ms) but did not modulate either the hypotension or apnoea. It is concluded that a reflex involving the vagus nerve mediates the bradycardia, apnoea and a component of the hypotension associated with thoracic blast. The pattern of this response is similar to effects that follow stimulation of the pulmonary afferent C-fibres. (+info)
Battle casualities.
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Eighty casualities, mainly due to explosive devices, sustained over a period of 3 1/2 months by the armed forces of the Sultan of Oman in counterinsurgency operations are analysed and their management by a British field surgical team is described. Of the 73 who reached the surgical centre alive, 56 per cent had suffered major injuries, yet all but 2 survived, giving an overall survival rate of 88.75 per cent (71/80). The effects of first aid and rapid evacuation on survival and their influence on the surgical work load and on the facilities required for treatment are assessed, together with their relevance to the planning of military and civilian accident services. (+info)
The Tower of London bomb explosion.
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After the detonation of a bomb in the Tower of London 37 people were brought to St. Bartholomew's Hospital. The explosion caused numerous severe injuries of a type rarely seen in peacetime. (+info)
Report on injuries sustained by patients treated at the Birmingham General Hospital following the recent bomb explosions.
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As a result of recent bomb explosions a total of 82 patients were treated at the Birmingham General Hospital, 61 with minor injuries. Bomb injuries may be divided into three main groups due to the blast effect (such as blast lung and ruptured tympanic membranes), the flash (such as burns to the exposed part of the body), and shrapnel (which may cause a wide variety of injuries). The amount of warning of such explosions is usually minimal, and so the prepared accident schemes of most hospitals are inappropriate. If the disaster occurs outside normal working hours much responsibility initially falls on the resident staff. This report gives some idea of the type of injuries they are likely to see. (+info)
Minimal fixation in the treatment of open hand and foot bone fractures caused by explosive devices: case series.
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AIM: To evaluate minimal fixation method with Kirschner's wires in the treatment of open fractures of the hand and foot short bones, caused by explosive devices. METHOD: There were 270 wounded persons with open fractures of hand and foot short bones, who were surgically treated at the Department of Surgery at the Osijek University Hospital. The stabilization of an unstable open fracture was performed with intramedullary positioned Kirschner's wires. In a few cases, satisfactory stabilization was achieved with Kirschner's wires positioned percutaneously alongside the wound and perpendicularly through the fracture. In the rest of the wounded, plaster immobilization was sufficient after surgical treatment and fracture reposition. RESULTS: Among 270 persons with 412 open hand and foot bone fractures, 49% had fracture only in the feet, 27% only in the hands, and 24% in both hands and feet. Unstable short bone fractures were found in 56 patients (21%). Such fractures were stabilized with Kirschner's wires (n=71). In 58 patients (21%) partial hand and foot amputations had to be performed. Reconstructive operations to improve pseudarthrosis after minimal osteosynthesis were performed on 5 short bones (7%). Osteitis was found on four short bones (6%) after minimal osteosynthesis. CONCLUSION: Minimal osteosynthesis with Kirschner's wires is a reliable and adequate method of the treatment of open unstable short bone fractures caused by explosive devices. (+info)
Tympanoplasty after war blast lesions of the eardrum: retrospective study.
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AIM: To establish whether hearing loss after eardrum blast injury could be recovered by tympanoplasty performed immediately after injury and what material is the most suitable for eardrum closure. METHODS: Tympanoplasty was performed in 119 (a total of 181 injuries) out of 651 patients examined for blast injury of the ear between 1991 and 2000. The study included a total of 106 patients who underwent tympanoplasty: 51 patients with unilateral and 55 with bilateral blast eardrum rupture (a total of 161 injuries). Three different materials were used for eardrum rupture closure: temporal fascia in 81, perichondrium in 61, and heterograft in 19 cases. Injuries were divided in 4 groups, according to the time elapsed between the injury and tympanoplasty (0-20, 21-60, 61-180, and 181 days and more). Otomicroscopic finding, audiometry, and tympanometry were used for definitive evaluation of tympanoplasty outcome. RESULTS: Eardrum rupture was successfully closed with temporal fascia in 91%, perichondrium in 92%, and heterograft in 89% of the cases (p=0.429). There were no statistically significant differences in either values of postoperative air- bone gap (p=0.210) or in eardrum perforation closure rate (p=0.951) with respect to the time period between the injury and tympanoplasty. Also, there was no correlation between the postoperative air-bone gap and the number of days elapsed between the rupture and tympanoplasty (r=-0.037, p=0.641). CONCLUSION: Small ruptures of the eardrum should be left to heal spontaneously. The patients with subtotal and total rupture and rupture that did not heal spontaneously in three months should undergo tympanoplasty. Temporal fascia, perichondrium from tragus, and heterograft are equally acceptable materials for eardrum closure after blast injury. (+info)
Vasodilator and vitamins in therapy of sensorineural hearing loss following war-related blast injury: retrospective study.
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AIM: To establish whether a better recovery of the sensorineural hearing loss can be achieved by systemic administration of a vasodilator and vitamins in a saline infusion immediately after a blast injury. METHODS: Retrospective analysis included 134 patients with pure sensorineural hearing loss after blast injury (a total of 192 injuries), who were treated between 1991 and 1995. A group of 82 patients (119 injuries) was treated with 250 mL infusion of saline containing vitamins and pentoxifylin, whereas the other group (52 patients or 73 injuries) did not receive any therapy. RESULTS: The patients who received infusion therapy with vitamins and pentoxifylin showed no better hearing recovery than the patients who did not receive any therapy. There was no statistically significant difference between the groups in the average values of the sensorineural hearing recovery (p=0.315). CONCLUSION: Therapy with vitamins and pentoxifylin does not improve recovery of sensorineural hearing loss caused by blast injuries of the internal ear. (+info)
Treating traumatic tattoo by micro-incision.
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OBJECTIVE: To design a micro-incision operation for treating traumatic tattoo. METHODS: With an 11-gauge blade, a micro-incision was made on each side of the small tattoo spot and the tattoo skin was removed. For a longer tattoo particle, a longer incision was needed. The skin incision was sutured with 6-0 silk. For a complex tattoo, dermabrasion could be used first to remove the superficial one so as to expose the deep one which was removed in the same way as mentioned above. When there was a large number of tattoo particles, many operations were needed. RESULTS: Fourteen patients were treated by this method with good to excellent result. CONCLUSION: Micro-incision for treating traumatic tattoo is an effective method. (+info)