1/157. diabetes insipidus caused by craniofacial trauma.A patient is presented with diabetes insipidus secondary to craniofacial trauma. diabetes insipidus can occur in any patient within ten days of craniofacial trauma. Even the masked disease in the unconscious patient can be diagnosed by observation of intake and output, urinary specific gravities, and appropriate chemical studies. The disease can recur following operative reduction of facial fractures. diabetes insipidus can be successfully treated by intramuscular Pitressin and appropriate fluid intake.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
2/157. Post-traumatic pituitary apoplexy--two case reports.A 60-year-old female and a 66-year-old male presented with post-traumatic pituitary apoplexy associated with clinically asymptomatic pituitary macroadenoma manifesting as severe visual disturbance that had not developed immediately after the head injury. Skull radiography showed a unilateral linear occipital fracture. magnetic resonance imaging revealed pituitary tumor with dumbbell-shaped suprasellar extension and fresh intratumoral hemorrhage. Transsphenoidal surgery was performed in the first patient, and the visual disturbance subsided. decompressive craniectomy was performed in the second patient to treat brain contusion and part of the tumor was removed to decompress the optic nerves. The mechanism of post-traumatic pituitary apoplexy may occur as follows. The intrasellar part of the tumor is fixed by the bony structure forming the sella, and the suprasellar part is free to move, so a rotational force acting on the occipital region on one side will create a shearing strain between the intra- and suprasellar part of the tumor, resulting in pituitary apoplexy. Recovery of visual function, no matter how severely impaired, can be expected if an emergency operation is performed to decompress the optic nerves. Transsphenoidal surgery is the most advantageous procedure, as even partial removal of the tumor may be adequate to decompress the optic nerves in the acute stage. Staged transsphenoidal surgery is indicated to achieve total removal later.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
3/157. An unidentified substance.AT 5.00 am one Friday morning a 19-year-old woman was brought into the Accident & Emergency (A&E) department following a head on collision with a van. The young woman had sustained severe head injuries, along with a fractured pelvis and a ruptured spleen. Following resuscitative surgery, the patient was taken to the intensive care unit, where she remained unconscious following her head injury. Two patients from the van were admitted to A&E with minor injuries, and were discharged home mid-morning. When staff checked the woman's belongings and listed them in a property book, they discovered white powder in a small twist of white paper, which amounted to about the size of a pea. Staff present listed the substance in the property book and then locked it in the cd cupboard. Six hours later, following discussion with senior staff, two nurses disposed of the substance by flushing it down the toilet and recorded their actions with a witness signature from a senior nurse and pharmacist. Was this the best course of action from the viewpoint of the seriously injured patient and the other two involved in the van? What opinion would a police officer have?- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
4/157. Bilateral reflex fracture of the coronoid process of the mandible. A case report.Bilateral fractures of the coronoid process of the mandible occurred following a blow to the left temporal region in an assault. There was no evidence of direct trauma and the zygoma and other facial bones were intact. The probable cause was acute reflex contraction of the temporalis muscles leading to bilateral stress coronoid fractures. Conservative management was followed by complete resolution of symptoms.- - - - - - - - - - ranking = 6keywords = fracture (Clic here for more details about this article) |
5/157. adult growing skull fracture mimicking a skull tumor.Growing skull fractures (GSF) are rare in adults. We report the case of an adult who was found to have a GSF 50 years after head trauma. This case highlights the need to consider GSFs in the differential diagnosis of adults with intradiploic skull lesions.- - - - - - - - - - ranking = 5keywords = fracture (Clic here for more details about this article) |
6/157. Selective laser sintering: application of a rapid prototyping method in craniomaxillofacial reconstructive surgery.Advances in technology have benefited the medical world in many ways and a new generation of computed tomography (CT) scanners and three-dimensional (3-D) model making rapid prototyping systems (RPS) have taken craniofacial surgical planning and management to new heights. With the development of new rapid prototyping systems and the improvements in CT scan technology, such as the helical scanner, biomedical modelling has improved considerably and accurate 3-D models can now be fabricated to allow surgeons to visualise and physically handle a 3-D model on which simulation surgery can be performed. The principle behind this technology is to first acquire digital data (CT scan data) which is then imported to the RPS to fabricate fine layers or cuts of the model which are gradually built up to form the 3-D models. Either liquid resin or nylon powder or special paper may be used to make these models using the various RPS available today. Selective laser sintering (SLS), which employs a CO2 laser beam to solidify special nylon powder and build up the model in layers is described in this case report, where a 23-year old Chinese female with panfacial fracture and a skull defect benefited from SLS biomodelling in the preoperative workup.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
7/157. Horner'sy syndrome and its significance in the management of head and neck trauma.The history, mechanism and aetiology of Horner'sy syndrome is presented and the pharmacology of the pupil is discussed. The case reported is a rare combination of Horner's syndrome in a patient who sustained bilateral fractures of the mandible and a chest injury. It is emphasised that the miotic changes in Horner's syndrome, in combination with head injuries can lead to confusion in diagnosis and the potential anaesthetic hazards and their influence on the management of the facial injury are outlined.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
8/157. Sevoflurane mask anesthesia for urgent tracheostomy in an uncooperative trauma patient with a difficult airway.PURPOSE: Proper care of the trauma patient often includes tracheal intubation to insure adequate ventilation and oxygenation, protect the airway from aspiration, and facilitate surgery. airway management can be particularly complex when there are facial bone fractures, head injury and cervical spine instability. CLINICAL FEATURES: A 29-yr-old intoxicated woman suffered a motor vehicle accident. Injuries consisted of multiple abrasions to her head, forehead, and face, right temporal lobe hemorrhage, and complex mandibular fractures with displacement. mouth opening was <10 mm. blood pressure was 106/71 mm Hg, pulse 109, respirations 18, temperature 37.3 degrees C, SpO2 100%. Chest and pelvic radiographs were normal and the there was increased anterior angulation of C4-C5 on the cervical spine film. Drug screen was positive for cocaine and alcohol. The initial plan was to perform awake tracheostomy with local anesthesia. However, the patient was uncooperative despite sedation and infiltration of local anesthesia. Sevoflurane, 1%, inspired in oxygen 100%, was administered via face mask. The concentration of sevoflurane was gradually increased to 4%, and loss of consciousness occurred within one minute. The patient breathed spontaneously and required gentle chin lift and jaw thrust. A cuffed tracheostomy tube was surgically inserted without complication. Blood gas showed pH 7.40, PCO2 35 mm Hg, PO2 396 mm Hg, hematocrit 33.6%. Diagnostic peritoneal lavage was negative. Pulmonary aspiration did not occur. Oxygenation and ventilation were maintained throughout the procedure. CONCLUSION: Continuous mask ventilation with sevoflurane is an appropriate technique when confronted with an uncooperative trauma patient with a difficult airway.- - - - - - - - - - ranking = 2keywords = fracture (Clic here for more details about this article) |
9/157. The organized subdural blood clot in forensic case work - a case report.The medico-legal assessment of a subdural haematoma (recent or organized) usually requires some information regarding its cause. Quite often, especially in the absence of a known history of trauma, minor head injuries, which are no longer verifiable, are simply assumed to be the most likely causes. Considering the fact that a subdural haematoma could also be non-traumatic, e.g. in haemorrhagic disorders, cardiac conditions with persistent passive hyperaemia, true inflammatory and degenerative processes of the dura, etc., the medico-legal implication of a possible head injury would require the exclusion of such non-traumatic conditions capable of causing subdural bleeding. In this respect, the case of a 92-year-old man, who suffered from cerebral sclerosis with occasional episodes of confusion and agitation, is briefly discussed. He was reported to have fallen from his bed, was hospitalized and died 2 days later. A head injury was suspected. At autopsy, no skull fractures and no obvious bruises were discovered. Fresh bilateral temporal subdural haematomas were found. These appeared consistent with a suspected head injury sustained as a result of a fall. Fairly large partly organized adherent subdural clots in the parieto-occipital region completely remote from and unconnected with the fresh bitemporal haematomas were also found. Based on the gross pathology and the histology, an attempt is made to assess the possible cause of the organized clots. Some of the findings indicated a possible non-traumatic origin, a consideration which is likely to affect the forensic implications.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
10/157. Infantile head injury, with special reference to the development of chronic subdural hematoma.An infantile head injury has unique features in that infants are totally helpless and dependent on their parents, and biomechanical characteristics of the skull and brain are very different from those of other age groups. The authors reviewed a total of 16 infant head injury patients under 12 months of age who were treated in our hospital from 1989 to 1997. Birth head injury was excluded. The most common age group was 3-5 months. Early seizures were noted in 7 cases, and motor weakness in 6. Three patients with acute intracranial hematoma and another 3 with depressed skull fracture were operated on soon after admission. Chronic subdural hematomas (SDHs) developed in 3 infants. Initial CT scans showed a small amount of SDH that needed no emergency operation. Resolution of the acute SDH and development of subdural hygroma appeared on follow-up CT scans within 2 weeks of injury. Two of these infants developed early seizures. Chronic SDH was diagnosed on the 68th and 111th days after the injuries were sustained, respectively. The third patient was the subject of close follow-up with special attention to the evolution of chronic SDH in view of our experience in the previous 2 cases, and was found to have developed chronic SDH on the 90th day after injury. All chronic SDH patients were successively treated by subduro-peritoneal shunting. In conclusion, the evolution of chronic SDH from acute SDH is relatively common following infantile head injury. Infants with head injuries, especially if they are associated with acute SDH and early development of subdural hygroma, should be carefully followed up with special attention to the possible development of chronic SDH- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
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