1/666. The use of magnetic resonance imaging in the diagnosis of triceps tendon ruptures.Triceps tendon rupture is a rare injury. Three cases are presented with a brief review of the literature. Additionally, the use of magnetic resonance imaging to facilitate the diagnosis of triceps tendon rupture is described for the first time in the English literature. Each of the three patients has done well with a Mersilene tape repair of the triceps tendon.- - - - - - - - - - ranking = 1keywords = injury (Clic here for more details about this article) |
2/666. Old total rupture of the adductor longus muscle. A report of seven cases.Seven cases of old total rupture of the adductor longus muscle are described. Five patients were referred with the suspicion of a soft tissue tumour. Six patients reported an adequate trauma when thoroughly questioned; four of them had sustained the injury while playing soccer; the seventh patient could not recall any trauma. The diagnosis of this lesion is discussed.- - - - - - - - - - ranking = 1keywords = injury (Clic here for more details about this article) |
3/666. Traumatic liver rupture in pregnancy.Two pregnant women, 1 in the second trimester and 1 in the third trimester, sustained blunt liver trauma as unrestrained drivers in motor vehicle accidents. One patient had an overt injury that was apparent on computerized tomography and underwent surgical exploration when nonreassuring fetal monitoring occurred. The second patient, discharged after 23 hours of normal observation, returned a day later with overt intra-abdominal hemorrhage from an obvious liver laceration.- - - - - - - - - - ranking = 1keywords = injury (Clic here for more details about this article) |
4/666. Laparoscopic drainage of an intramural duodenal hematoma.A 21-year-old man was admitted with vomiting and abdominal pain 3 days after sustaining blunt abdominal trauma by being tackled in a game of American football. A diagnosis of intramural hematoma of the duodenum was made using computed tomography and upper gastrointestinal tract contrast radiography. The hematoma caused obstructive jaundice by compressing the common bile duct. The contents of the hematoma were laparoscopically drained. A small perforation was then found in the duodenal wall. The patient underwent laparotomy and repair of the injury. Laparoscopic surgery can be used as definitive therapy in this type of abdominal trauma.- - - - - - - - - - ranking = 1keywords = injury (Clic here for more details about this article) |
5/666. Ultrasonic assistance in the diagnosis of hand flexor tendon injuries.In contrast to routine flexor tendon injuries, flexor tendon ruptures following blunt injury or re-ruptures following repair can be difficult to diagnose. The authors investigated the efficacy of using ultrasound to assist in the diagnosis. From 1996 to 1997, 8 patients underwent evaluation of the flexor tendons using an ATL HDI-3000 ultrasound machine with a high-resolution, 5 to 9-MHz hockey stick linear probe. Dynamic evaluation was performed in real time, simulating clinical symptoms. Six patients underwent surgical exploration. Sonographic diagnosis and intraoperative findings were correlated. Ultrasound was used to diagnose 3 patients with ruptured flexor digitorum profundus tendons. Mechanisms of injury included forceful extension, penetrating injury, and delayed rupture 3 weeks after tendon repair. Subsequent surgical exploration confirmed the ruptures and location of the stumps. Five patients had intact flexor tendons by ultrasound after forceful extension, penetrating injury, phalangeal fracture, crush injury, and unknown etiology. In 3 patients who underwent surgery for tenolysis, scar release, or arthrodesis, the flexor tendons were found to be intact, as predicted by ultrasound. The authors found ultrasound to be accurate in diagnosing the integrity of flexor tendons and in localizing the ruptured ends. They conclude that ultrasound is helpful in evaluating equivocal flexor tendon injuries.- - - - - - - - - - ranking = 5keywords = injury (Clic here for more details about this article) |
6/666. Post traumatic rupture of the right main bronchus: a rare clinical entity?Tracheobronchial disruption is an uncommon injury usually associated with severe blunt thoracic trauma and rarely occurs in isolation. We report a case of isolated rupture of the right main bronchus occurring after a crush injury without an associated pneumothorax. Difficulties in the diagnosis of this condition are briefly discussed and an algorithm of management presented.- - - - - - - - - - ranking = 2keywords = injury (Clic here for more details about this article) |
7/666. Ruptured hemidiaphragm after bilateral lung transplantation.A case of right hemidiaphragm rupture and abdominal herniation into the thorax occurring during the immediate post-operative course of double-lung transplantation is reported. This complication has not been reported previously. We examine the possible aetiology and suggest that the direct cause could be an increase in intra-abdominal pressure during chest physiotherapy.- - - - - - - - - - ranking = 0.020493330570657keywords = chest (Clic here for more details about this article) |
8/666. Isolated longitudinal rupture of the posterior tracheal wall following blunt neck trauma.The authors report 3 female children (4, 5 and 12 years old) who suffered an isolated rupture of the posterior tracheal wall (membranous part) following a minimal blunt trauma of the neck. Such tracheal ruptures often cause a mediastinal and a cutaneous thoraco-cervical emphysema, and can also be combined with a pneumothorax. The following diagnostic steps are necessary: X-ray and CT of the chest, tracheo-bronchoscopy and esophagoscopy. The most important examination is the tracheo-bronchoscopy to visualize especially the posterior wall of the trachea. Proper treatment of an isolated rupture of the posterior tracheal wall requires knowledge about the injury mechanisms. The decision concerning conservative treatment or a surgical intervention is discussed. In our 3 patients we chose the conservative approach for the following reasons: 1) The lesions of the posterior tracheal wall were relatively small (1 cm, 1.5 cm, 3 cm) and showed a good adaptation of the wound margins. 2) No cases showed an associated injury of the esophageal wall. All of our patients had an uneventful recovery, the lesion healed within 10 to 14 days, and follow-up showed no late complications.- - - - - - - - - - ranking = 2.0204933305707keywords = injury, chest (Clic here for more details about this article) |
9/666. Blunt cardiac rupture: the utility of emergency department ultrasound.BACKGROUND: rupture of the heart is usually a fatal injury in patients sustaining blunt trauma. Those arriving in the emergency department alive can be saved with prompt diagnosis and treatment. methods: We describe the cases of 4 consecutive patients with rupture of the free cardiac wall whom we treated at Grady Hospital. Two had a tear of the right ventricle, 1 had a tear of the right atrium, and 1 had two tears of the left atrium. All patients were involved in motor vehicle accidents. The diagnosis was made by ultrasound in 3 patients and during exploratory surgical intervention in the other. All tears were repaired primarily without the aid of cardiopulmonary bypass. RESULTS: Three of the patients survived, and 1 died. CONCLUSIONS: Rarely are patients with rupture of the free cardiac wall seen in an emergency department. The improvements in the prehospital care and the transportation may result in an increase in the numbers of such patients. physicians treating patients with blunt trauma must suspect the presence of cardiac rupture. Immediate use of ultrasonography will establish the diagnosis and prompt repair of the injury may improve overall survival.- - - - - - - - - - ranking = 2keywords = injury (Clic here for more details about this article) |
10/666. Ocular explosion during cataract surgery: a clinical, histopathological, experimental, and biophysical study.INTRODUCTION: An increasing number of cases are being recognized in which a peribulbar anesthetic for cataract surgery has been inadvertently injected directly into the globe under high pressure until the globe ruptures or explodes. We reviewed the records of 6 such cases (one of which was reported previously by us), and one additional case has been reported in the literature. Surprisingly, 2 of these 7 cases went unrecognized at the time, and the surgeons proceeded with the cataract operation; all of the patients ultimately developed severe visual loss and/or loss of the eye. OBJECTIVES: To reproduce this eye explosion in a live anesthetized rabbit model and to perform a clinical, histopathological, experimental, biophysical, and mathematical analysis of this injury. methods: Eyes of live anesthetized rabbits were ruptured by means of the injection of saline directly into the globe under high pressure. The clinical and pathological findings of the ruptured human and animal eyes were documented photographically and/or histopathologically. An experimental, biophysical, and mathematical analysis of the pressures and forces required to rupture the globe via direct injection using human cadavers, human eye-bank eyes, and classic physics and ophthalmic formulas was performed. The laws of Bernoulli, LaPlace, Friedenwald, and Pascal were applied to the theoretical and experimental models of this phenomenon. RESULTS: The clinical and pathological findings of scleral rupture, retinal detachment, vitreous hemorrhage, and lens extrusion were observed. In the exploded human and rabbit eyes, the scleral ruptures appeared at the equator, the limbal area, or the posterior pole. In 2 of the 7 human eyes, the anterior segments appeared entirely normal despite the rupture, and cataract surgery was completed; surgery was canceled in the other 4 cases. In 4 of the 5 injected and ruptured rabbit eyes, the anterior segments appeared essentially normal. The experiments with human eye-bank eyes and the theoretical analyses of this entity show that the pressure required to produce such an injury is much more easily obtained with a 3- or 5-mL syringe than with a syringe 10 mL or larger. CONCLUSIONS: Explosion of an eyeball during the injection of anesthesia for ocular surgery is a devastating injury that may go unrecognized. The probability of an ocular explosion can be minimized by careful use of a syringe 10 mL or larger with a blunt needle, by discontinuing the injection if resistance is met, and by inspecting the globe prior to ocular massage or placement of a Honan balloon. When ocular explosion occurs, immediate referral to and intervention by a vitreoretinal surgeon is optimal. Practicing ophthalmologists should be aware of this blinding but preventable complication of ocular surgery.- - - - - - - - - - ranking = 3keywords = injury (Clic here for more details about this article) |
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