1/15. otitis externa sicca/fibrotising external otitis (FEO) as a complication of sjogren's syndrome.sjogren's syndrome (SS) is a condition characterized by sicca symptoms and by autoimmune features. We describe two SS patients with otitis externa fibroticans/sicca. One of these 2 patients developed a lesion of the tympanic membrane making it necessary to perform a tympantomy and meatoplasty. Our findings suggest firstly that the epithelial cell-mediated secretion of lamellar bodies and the production of the permeability barrier are defective in SS. Secondly, local moisturing and/or topical corticosteroid treatment in SS patients with sicca symptoms in the auditory canal could help to avoid reconstructive surgical treatment.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
2/15. Prehospital rounds. The quick stop.The coroner's post-mortem examination revealed a tom aorta. This case illustrates that although a patient may appear stable, a major catastrophic event may nonetheless be taking place. How many times have we responded to MVAs similar to the one described here and seen those involved deny injuries? We carry a higher suspicion of aortic injury after someone has been ejected from a vehicle or involved in a high-speed crash. That's not always the case, however, and understanding how internal organs respond to high-speed impacts is crucial. Damage to the aorta may result after a sudden deceleration injury of any type: a fall, vehicle crash or violence. The most common forms of traumatic aortic injury occur where the aorta is "tethered" in place: at its intersection with the heart and at its distal portion just beneath the left subclavian artery near the ligamenta arteriosum. Approximately 80% of patients with aortic injury die at the scene. The injury may be hidden in the other 20%, but they have the potential to rapidly deteriorate and die. Those who survive typically are at a trauma center and are cared for by providers who have a suspicion of the injury. A high index of suspicion should be maintained on all rapid-deceleration injuries and with patients who experience chest pain, dyspnea, a difference in pressure between the upper and lower extremities, and paralysis. paralysis can occur when aortic injury cuts off blood supply [table: see text] to the spinal cord. The spinal cord obtains its blood supply from arteries coming directly off the aorta, and a torn aorta can shear off these vessels, leaving the spinal cord to infarct and the patient to lose all distal function. When a victim sustains a sudden-deceleration injury to the chest, signs of aortic injury should be sought. It is imperative to maintain a high index of suspicion throughout patient care and be aware that although a patient may appear to be quite stable, the reality might be otherwise, and rapid transport to a trauma center will be necessary to save their life.- - - - - - - - - - ranking = 54.675255237792keywords = ligament (Clic here for more details about this article) |
3/15. Persistent inner ear injury after diving.OBJECTIVE: The purpose of this multiple case report was to discuss the occurrence and cause of sudden sensorineural hearing loss after diving. STUDY DESIGN: The study design was a retrospective case review. SETTING: The study was conducted at an academic tertiary referral center. patients: In this multiple case report, two teenagers with unilateral sudden sensorineural hearing loss after diving, one from a starting block and one from a 1-m board, while performing school swimsports were included. INTERVENTION: The patients underwent diagnostic tympanotomy with sealing of the round and oval window membranes and a vasoactive rheologic therapy combined with corticosteroid treatment. MAIN OUTCOME MEASURES: The average pure-tone bone-conduction thresholds were calculated. The appearance of nystagmus, vertigo, and tinnitus was analyzed. RESULTS: Both patients experienced unilateral sudden deafness after performing a headfirst pike-type dive into a swimming pool. None of the patients contacted with the bottom of the pool. In one patient, a rupture of the round window was found intraoperatively. In the other patient, no rupture of the round or oval window was seen intraoperatively. In spite of sealing of the round window and application of vasoactive rheologic therapy, hearing did not improve significantly in either of the patients. CONCLUSION: rupture of the round window may occur after diving even if the dive is performed from a low height into the water and the bottom of the pool is not contacted. Besides direct contusion to the external ear and barotrauma, other causes such as whiplash mechanism have to be considered.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
4/15. Extracorporeal life support for posttraumatic acute respiratory distress syndrome at a children's medical center.BACKGROUND: Primary traumatic injury was considered previously a contraindication for institution of extracorporeal life support because of high risk for persistent or new bleeding. Published experience in adults suggests that extracorporeal membrane oxygenation (ECMO) can successfully support trauma victims with pulmonary failure. The authors reviewed their experience with the use of ECMO in pediatric and adult trauma patients with acute respiratory distress syndrome (ARDS) at a children's medical center. methods: ECMO Center records from 1991 through 2001 (76 children, 8 adults) were reviewed to identify all patients with a primary or secondary ICD-9 diagnostic code of posttraumatic ARDS in addition to documented trauma. RESULTS: Five children and 3 adults with traumatic injury and ARDS received ECMO support. Seven patients were injured in motor vehicle collisions; one patient suffered a gunshot wound to the chest. Patient ages ranged from 21 months to 29 years (pediatric median, 4 years; range, 21 months to 18 years). Four patients had pre-ECMO laparotomies, including 3 who required splenectomy. Four patients had liver lacerations, 3 had pulmonary contusions, and 1 had a renal contusion. Median ventilation before ECMO was 6 days (range, 2 to 10). Seven of 8 patients were placed on venovenous (VV) ECMO. Seven patients had significant bleeding on ECMO. patients were treated with blood product replacement, epsilon-aminocaproic acid (EACA), and aprotinin infusions. Surgical intervention was not required for bleeding. Six patients received hemofiltration. Median time on ECMO was 653 hours (range, 190 to 921 hours). Six of 8 patients overall survived (75%). Four of 5 pediatric patients survived. CONCLUSIONS: Children and adults with severe posttraumatic ARDS can be treated successfully on VV extracorporeal support. hemorrhage occurs frequently but is manageable.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
5/15. Traumatic lumbosacral dislocation: report of two cases.STUDY DESIGN: A retrospective study of 2 patients with traumatic lumbosacral dislocation. OBJECTIVES: To discuss the difficulty in making diagnosis and the effect of surgical treatment. SUMMARY OF BACKGROUND DATA: Traumatic lumbosacral dislocation is an uncommon injury, which creates diagnostic difficulty and is typically managed by open reduction internal fixation of the lumbosacral spine. methods: Medical notes and imaging of the 2 patients were reviewed. RESULTS: Both patients were engaged in high-energy accidents and had concomitant injuries. Patient 1 was initially misdiagnosed as having L5 lytic spondylolisthesis and was treated with a lumbar corset. She developed progressive low back and left leg pain. Eleven months after the accident, a bilateral lumbosacral dislocation with right S1 superior facet fracture, disc rupture, posterior soft tissue disruption, and a resultant Grade 4 L5-S1 traumatic spondylolisthesis was identified. She underwent open reduction, followed by a staged anteroposterior spinal arthrodesis using instrumentation with excellent results. Patient 2 sustained a unilateral L5-S1 facet dislocation without neurologic deficit, which reduced spontaneously. The evaluation demonstrated a grossly disturbed posterior ligamentous complex adjacent to the lumbosacral articulation. A combined anteroposterior spinal fusion with instrumentation was performed with favorable outcome. CONCLUSION: Meticulous clinical examination and careful imaging assessment, including CT and MRI, assist an early diagnosis in cases of lumbosacral dislocation. Open reduction and circumferential bony fusion restore segmental stability and painless function.- - - - - - - - - - ranking = 54.675255237792keywords = ligament (Clic here for more details about this article) |
6/15. Neurologic deterioration secondary to unrecognized spinal instability following trauma--a multicenter study.STUDY DESIGN: A retrospective study was undertaken that evaluated the medical records and imaging studies of a subset of patients with spinal injury from large level I trauma centers. OBJECTIVE: To characterize patients with spinal injuries who had neurologic deterioration due to unrecognized instability. SUMMARY OF BACKGROUND DATA: Controversy exists regarding the most appropriate imaging studies required to "clear" the spine in patients suspected of having a spinal column injury. Although most bony and/or ligamentous spine injuries are detected early, an occasional patient has an occult injury, which is not detected, and a potentially straightforward problem becomes a neurologic catastrophe. methods: The study was designed as a retrospective review of patients who had neurologic deterioration as a direct result of an unrecognized fracture, subluxation, or soft tissue injury of the cervical, thoracic, or lumbar spine from 8 level I trauma centers. Demographics, injury information, and neurologic outcome were collected. The etiology and incidence of the missed injury were determined. RESULTS: A total of 24 patients were identified who were treated or referred to 1 of the participating trauma centers and had an adverse neurologic outcome as a result of the missed injury. The average age of the patients was 50 years (range 18-92), and average delay in diagnosis was 19.8 days. radiculopathy developed in 5 patients, 16 had spinal cord injuries, and 3 patients died as a result of their neurologic injury. The most common reason for the missed injury was insufficient imaging studies (58.3%), while only 33.3% were a result of misread radiographs or 8.3% poor quality radiographs. The incidence of missed injuries resulting in neurologic injury in patients with spine fractures or strains was 0.21%, and the incidence as a percentage of all trauma patients evaluated was 0.025%. CONCLUSIONS: This multicenter study establishes that missed spinal injuries resulting in a neurologic deficit continue to occur in major trauma centers despite the presence of experienced personnel and sophisticated imaging techniques. Older age, high impact accidents, and patients with insufficient imaging are at highest risk.- - - - - - - - - - ranking = 54.675255237792keywords = ligament (Clic here for more details about this article) |
7/15. Pediatric extracorporeal membrane oxygenation in posttraumatic respiratory failure.The leading cause of death in the pediatric population in the united states is trauma. A retrospective review of patients treated with extracorporeal membrane oxygenation (ECMO) for traumatic respiratory failure was performed. Eight children were treated at the Ochsner Medical Foundation and additional data on six children were available from the National Registry. Six children developed respiratory failure as a result of blunt trauma and eight as a result of near drowning. Standard venoarterial ECMO was used with a circuit very similar to that used in neonatal ECMO. Vascular access was via the common carotid artery and the internal jugular vein. Ventilatory support was weaned to minimal settings during ECMO. Central hyperalimentation and systemic antibiotics were used in all of the cases. Four of six children survived in the blunt trauma group; three of eight children survived in the near drowning group. Although significant conclusions cannot be drawn from a small group of patients the average pre-ECMO PO2 for survivors was 87 mm Hg, whereas for nonsurvivors the average PO2 was only 46 mm Hg. Ventilatory support for both groups was not remarkably different, and the average PCO2 was lower in the nonsurvivor group. The cause of death in this group of patients is usually multisystem organ failure. In the four patients treated at Ochsner who did not survive, all had positive blood cultures and presumed systemic sepsis. ECMO has been demonstrated to be very successful in neonatal respiratory failure. Predicting mortality and morbidity in pediatric respiratory failure has been more difficult.(ABSTRACT TRUNCATED AT 250 WORDS)- - - - - - - - - - ranking = 5keywords = membrane (Clic here for more details about this article) |
8/15. Incomplete avulsion of the femoral attachment of the posterior cruciate ligament with an osteochondral fragment in a twelve-year-old boy.Isolated avulsion of the posterior cruciate ligament from the femoral attachment of the knee as a hyperextension injury is rare. We saw a young child with an incomplete avulsion of the posterior cruciate ligament that occurred after a blow to the anterior tibial surface of a flexed knee; the child revealed a lack of knee extension due to a pinch of the osteochondral fragment connected to the anterior band of the posterior cruciate ligament in the knee joint. Arthroscopic extirpation of a fragment was undertaken.- - - - - - - - - - ranking = 382.72678666454keywords = ligament (Clic here for more details about this article) |
9/15. Entrapment of the C2 root and ganglion by the atlanto-epistrophic ligament: clinical syndrome and surgical anatomy.Two cases of progressive, occipital lancinating pain and dysesthesias associated with a sensory deficit of the C2 dermatome are presented. Symptoms were relieved, and C2 sensory function restored by releasing a hypertrophied atlanto-epistrophic ligament entrapping the C2 root and ganglion. The normal anatomy and abnormal surgical findings are described. C2 entrapment by the atlanto-epistrophic ligament is discussed in reference to other C2 lesions causing occipital pain. We conclude that some patients whose progressive occipital pain is accompanied by a C2 sensory deficit are suffering from entrapment of the C2 root and ganglion amenable to surgical decompression.- - - - - - - - - - ranking = 328.05153142675keywords = ligament (Clic here for more details about this article) |
10/15. Differential diagnosis of malignant hyperthermia: a case report.A 17-year-old male received general anesthesia for repair of a torn right knee anterior cruciate ligament. The medical history revealed manic-depressive psychosis, treated with lithium carbonate and sertraline hydrochloride, and asthma for which the patient occasionally used an albuterol inhaler. Induction with propofol, isoflurane, nitrous oxide, and oxygen was uneventful. anesthesia was maintained by isoflurane, nitrous oxide, and oxygen. During the first 90 minutes after induction, a persistent mild elevation in end-tidal carbon dioxide was noted, and several possible causes for this elevation were subsequently ruled out. A diagnosis of malignant hyperthermia was made when the patient exhibited tachycardia and a temperature increase, although some discussion remained regarding the possibility of neuroleptic malignant syndrome. The patient was treated successfully using a malignant hyperthermia protocol. malignant hyperthermia may prove fatal if effective treatment is delayed. Favorable outcome and patient prognosis rely on astute vigilance, accurate diagnosis, and swift, appropriate treatment.- - - - - - - - - - ranking = 54.675255237792keywords = ligament (Clic here for more details about this article) |
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