1/80. incidence of intracranial bullet fragment migration.Migration of retained bullets or bullet fragments may present as a complication of gunshot wounds to the head. This phenomenon has been reported in cases of abscess formation or retained copper fragments. Management of such migratory fragments is controversial. The purpose of this study is to determine the incidence of fragment migration in a population of neurosurgical patients treated for gunshot wounds to the head. Two-hundred and thirteen cases treated at Detroit Receiving Hospital between 1985 and 1987 were reviewed. Each patient treated had initial and one week follow-up imaging studies. Nine cases of documented migratory intracranial bullet fragments were identified. Thus, the incidence in this population is 4.2%. The fragments in eight cases were composed of copper, and in the remaining case, lead. No case was associated with an abscess. Fragments in the anterior fossa were found to migrate towards the sella turcica, while those of the middle fossa and posterior hemispheres migrate towards the confluence of sinuses (Torcula Herophili). Fragment migration was documented as early as 36 h post-injury. Based on this study, we recommend serial imaging studies to look for migrating bullet fragments and surgical removal aided by intra-operative ultrasound to localize the fragment when possible.- - - - - - - - - - ranking = 1keywords = gunshot, wound (Clic here for more details about this article) |
2/80. Late traumatic intraocular lens extrusion after penetrating keratoplasty.BACKGROUND: Penetrating keratoplasty places a patient at risk for wound rupture from blunt trauma because the graft-host interface remains weakened for years after the surgery. Violent environments, contact sports, and strenuous activity put patients with compromised corneal structural integrity at high risk of traumatic injury. CASE REPORT: This case report presents a 42-year-old penetrating keratoplasty patient with a history of homelessness, polysubstance abuse, and domestic violence. This patient experienced a ruptured globe at the graft-host junction secondary to a direct blow by a fist, which extruded the intraocular lens from the eye. After emergency wound closure, the graft continued to degrade until bullous keratopathy developed. With little visual recovery potential for this graft, a Gunderson conjunctival flap procedure was implemented to decrease chronic ocular pain. CONCLUSIONS: After penetrating keratoplasty, patients should be periodically reminded of the susceptibility of the graft wound to injury from high-risk activity and violence. Constant use of protective eyewear should be recommended to corneal transplant recipients.- - - - - - - - - - ranking = 0.038768795942227keywords = wound (Clic here for more details about this article) |
3/80. Cruciate paralysis, hypothesis for injury and recovery.STUDY DESIGN: Case report and review of the literature. OBJECTIVES: Discuss a case of cruciate paralysis, a review of the literature and the hypotheses regarding the pathogenesis and recovery in spinal cord injuries that cause disproportionate weakness of the upper extremities. SETTING: Thomas Jefferson University Hospital, philadelphia, PA, USA. methods: Case report. RESULTS: A case of cruciate paralysis is presented involving a 59-year-old female who experienced a gunshot wound to the face. Initial motor exams revealed mild lower limb weakness and absent upper limb function with an upper limb modified American Spinal Injury association motor score of 0/50 (a modified impairment scale using half point muscle grades). Spinal imaging revealed fractures of the C1 anterior ring and the odontoid process, both associated with multiple bullet fragments. No spinal surgery was performed and she was placed in halo fixation. By 3 weeks she had regained enough upper limb function to manipulate large objects with her left hand and move her right hand. At that time, her upper limb asia score was 16/50. By 5 weeks, her upper limb modified asia motor score had improved to 31.5/50 and she began manipulating feeding utensils, writing legibly, and brushing her teeth with her left hand. CONCLUSIONS: In this case report we present a patient's motor and functional recovery. We also discuss the hypothesis that the acute central cord syndrome and cruciate paralysis are a likely result of similar pathologic mechanisms and that good functional outcome resulted from an initially disabling trauma.- - - - - - - - - - ranking = 0.5keywords = gunshot, wound (Clic here for more details about this article) |
4/80. Use of a magnet to retrieve a broken scalpel blade.The retrieval of metallic foreign bodies, such as screws, drill bits, needles, and scalpel blades, from the surgical wound during orthopaedic surgery is often a time-consuming procedure. The extra time and dissection may result in increased morbidity. We report a case during a hip arthroplasty in which a broken surgical blade could not be located with surgical dissection even with the aid of an image intensifier. The broken blade finally was retrieved with the introduction of a magnet.- - - - - - - - - - ranking = 0.012922931980742keywords = wound (Clic here for more details about this article) |
5/80. Repositioning a subluxated sutured intraocular lens in a vitrectomized eye.A simple, effective technique for repositioning a subluxated intraocular lens (IOL) in a vitrectomized eye is reported. A 49-year-old man who had previous pars plana vitrectomy and transscleral suture fixation of a posterior chamber (PC) IOL had lens subluxation caused by slippage of the haptic from a fixation suture. The IOL was dangling in the liquefied vitreous, preventing direct visualization of the displaced haptic. The displaced haptic was directly grasped from the opposite side with an intraocular forceps through a limbal wound and resutured to the sclera. Because only the end-grip intraocular forceps was required, this technique provides anterior segment surgeons an alternative technique of repositioning scleral-fixated PC IOLs.- - - - - - - - - - ranking = 0.012922931980742keywords = wound (Clic here for more details about this article) |
6/80. Cranio-orbital missile wound and bullet migration. Case report.An unusual case of craniocerebral missile injury, with orbital roof perforation and spontaneous bullet migration into the maxillary sinus, is reported. emergency treatment consisted in wide craniectomy around the bullet entry point, blood and foreign bodies debridement. Subsequent procedures were necessary for abscess evacuation, transmaxillary bullet removal and later cranial vault reconstruction. Challenging aspects were the treatment of the infectious complications, following cerebrospinal fluid fistula through the wound, and the onset of post-traumatic epilepsy, scarcely responsive to common antiepileptic drugs. The treatment of the abscess by combined systemic and intracavitary antibiotic therapy and of the chronic seizures by progressive adjustment with new protocols of antiepileptic drugs under EEG and brain mapping revealed successful.- - - - - - - - - - ranking = 0.064614659903712keywords = wound (Clic here for more details about this article) |
7/80. Transfemoral extraction of an intracardiac bullet embolus.Missiles may reach the heart via direct penetration of the thoracic cavity or indirectly by means of the venous circulation. Often the hemodynamic stability of the patient dictates the approach that is used not only to retrieve the projectile but also to repair associated life-threatening injuries. The case of a 40-year-old man with an intracardiac missile after a gunshot wound to the right gluteal area is presented along with the transfemoral technique used to recover an intracardiac projectile. This approach may be used instead of thoracotomy for missile extraction in stable patients.- - - - - - - - - - ranking = 0.5keywords = gunshot, wound (Clic here for more details about this article) |
8/80. Delayed presentation of right ventricular bullet embolus.Venous bullet embolism to the heart is a rare complication of penetrating gunshot trauma. There are little data regarding long-term follow-up of missiles retained in the right ventricle. We report a rare case of right ventricular bullet embolus following a left-sided thoracic gunshot wound. The patient presented with delayed onset of cardiac irritability symptoms 4 years after injury.- - - - - - - - - - ranking = 0.98707706801926keywords = gunshot, wound (Clic here for more details about this article) |
9/80. Spontaneous migration of a bullet in the cerebellum--case report.A 15-year-old boy presented with a gunshot wound in the left cerebellar hemisphere. He was confused and left cerebellar signs were noted. The patient underwent the first surgery for debridement of the entry wound in the left parietal region and second surgery to remove the bullet. However, the bullet could not be located via a left unilateral suboccipital craniectomy in the park bench position, because it had migrated to the opposite side due to the effects of gravity in just a few hours. skull radiography obtained just before the third surgery showed that the bullet had returned to the left side, and it was removed easily via the previous craniectomy in the sitting position. The clinical course suggests that in removing a bullet, skull radiography or computed tomography should be obtained just before surgery, or even intraoperatively, and that those findings should be the basis for the surgical procedure and operative position.- - - - - - - - - - ranking = 0.51292293198074keywords = gunshot, wound (Clic here for more details about this article) |
10/80. Migrating foreign body in the tracheobronchial tree: an unusual case of firework penetrating neck injury.Firework injuries can manifest themselves in many different ways; usually as an explosive or burn injury. This case describes an unusual presentation of a firework penetrating injury resulting in a sharp coiled metal foreign body travelling through a small entry wound in the neck and subsequently lodging itself in the tracheobronchial tree. A foreign body such as this can potentially travel a considerable distance through the soft tissues and end up in an unsuspecting distant site. There must, therefore, be a high index of suspicion with the appropriate radiological investigations for appropriate management of such cases.- - - - - - - - - - ranking = 0.012922931980742keywords = wound (Clic here for more details about this article) |
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