1/26. Retroperitoneal abscess and bacteremia due to mycoplasma hominis in a polytraumatized man.We report a case of a retroperitoneal abscess due to mycoplasma hominis in a young polytraumatized man who developed septicemia under treatment with rifampin and flucloxacillin. M. hominis was recovered from blood cultures as well as from the abscess near the left iliac spine. After 10 days of therapy with clindamycin the patient improved, and intraoperatively taken swabs were culture negative but still positive by PCR.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
2/26. Physical injury as a provoking factor in three patients with scleroderma.A 51-year-old female developed linear-like scleroderma in the left thigh following a linear wound caused by a car accident. 27 years later she also developed a typical diffuse cutaneous systemic sclerosis with extensive skin involvement and bibasilar pulmonary fibrosis. The second case is a 39-year-old female who had a history of Raynaud's phenomenon since early childhood. She developed a morphea following a burning injury of the left thigh. 17 years later she also developed a typical limited cutaneous systemic sclerosis with sclerodactyly, skin ulcers and subcutaneous calcinosis. The third case is a 43-year-old female who developed a typical morphea of the right elbow around the site of a previous local corticosteroid injection. The two remarkable points of these 3 cases are the possible role of physical injury in the provocation of localized scleroderma and in the first 2 cases the unusual later development of a systemic form of scleroderma.- - - - - - - - - - ranking = 2keywords = near (Clic here for more details about this article) |
3/26. Hindbrain stroke in children caused by extracranial vertebral artery trauma.Hindbrain transient ischemic attacks (TIAs) culminating in posterior circulation stroke are described in five children. Atlanto-axial subluxation and angiographical documentation of C1 to C2 level arterial pathology are documented in one patient. Four additional patients with nearly identical clinical presentations, posterior fossa TIAs, stroke and basilar angiographical pathology are reviewed. A mechanical traumatic etiology is suggested. Unexplained transient repeated brain stem and/or cerebellar sympotomatology may be due to extracranial vetebral artery stenosis or occlusion by atlanto-axial instability. After appropriate documentation, stabilization may prevent further TIAs or strokes.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
4/26. diving-related fatalities caused by underwater explosions: a report of two cases.The authors report two cases of diving-related water blast with fatal outcome resulting from nearby underwater explosions. water blast with fatal outcome almost exclusively occurs in wars at sea. Underwater explosions are extremely rare in diving because of the limited exposure. Forensic findings in both cases reported included expected injuries to gas-filled organs such as the middle ear, lungs, and intestine; some rarely described injuries such as rupture of the liver, spleen, and kidneys; and also some lesions that were not found in a search of the literature: rupture of the heart and contusion of the hypophysis. Injuries caused by fatal underwater explosions should be carefully evaluated in forensic medicine to provide data that may support a criminal investigation.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
5/26. light aircraft crash--a case analysis of injuries.BACKGROUND: As air travel increases and the number of commercial and non-commercial flights rises, so does the number of aircraft accidents. The improved safety standards of the aviation industry result in a growing number of survivors of aircraft crashes, but there are no management guidelines for the treatment of these survivors. OBJECTIVES: To present our experience in treating five survivors of a light aircraft crash that occurred in August 1995 near Jerusalem. RESULTS: All five survivors sustained vertebral column injuries, which was the only injury in most of the survivors. We discuss the mechanism of injury. CONCLUSIONS: Investigation of injuries' pattern in survivors of aircraft crash is important for establishing management protocols in trauma centers.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
6/26. 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 = 1keywords = near (Clic here for more details about this article) |
7/26. In-flight transfusion of packed red blood cells on a combat search and rescue mission: a case report from operation enduring freedom.Injuries on the battlefield can occur far from the nearest medical treatment facility. This is especially likely for downed pilots and special operations personnel. Some of these injuries lead to significant blood loss requiring transfusion. We present two cases of injured coalition force members during Operation Enduring freedom that illustrate the potential need for a transfusion capability at the site of injury to prevent death. Consideration should be given to augmenting transfusion capabilities in military environments with predictably long evacuation times.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
8/26. A pedicle-lengthening technique for free latissimus dorsi muscle flaps: the "Y-V-I" principle.This article describes a pedicle-lengthening procedure (the Y-V-I principle) that reverts a Y-shaped vascular structure into an I-shaped vascular structure, and its application to the latissimus dorsi muscle. If the Y-shaped vascular structure is divided proximal to the branching point and ligated, it becomes a V-shaped vascular structure. To obtain a linear I-shaped vascular structure, the V is opened, and the length of the vascular pedicle will become equal to the combined length of both limbs of the V. This report indicates that the latissimus dorsi flap may be transferred based on the circumflex scapular artery or the serratus branch.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
9/26. Comparative alcohol concentrations in blood and vitreous fluid with illustrative case studies.The toxicology Bureau of the new mexico Department of health performs drug and alcohol testing on approximately 2800 medical examiner cases each year across the entire state. Although blood is usually the preferred specimen for alcohol analysis, the importance of multiple specimen analysis in alcohol-related death investigation is well understood. Quantitative alcohol determination in a variety of postmortem specimens may provide important interpretive information. In a total of 322 consecutive cases, blood and vitreous alcohol concentrations were compared. No alcohol was detected in either specimen in only 27 of the cases. In the remaining 295 investigations, alcohol was detected in the vitreous fluid, blood, or both. Analysis of the data and presentation of case studies reinforce the need for multiple specimen analysis in alcohol-related death investigation. Postmortem blood and vitreous alcohol concentrations were compared in a series of 295 alcohol-positive cases. The vitreous alcohol concentration (VAC) exceeded the blood alcohol concentration (BAC) in 209 cases (71%). Blood alcohol concentrations exceeded vitreous concentrations in 81 cases (27%), and the concentrations were equivalent in 5 cases (2%). For the purpose of this study, samples that were negative in both specimens were excluded. In casework where the VAC > BAC, linear regression analysis indicated an R2 value of 0.958 (n = 209) and a VAC approximately 16% higher than the BAC. The VAC/BAC ratio was more variable at lower BACs (< 0.1 g/100 mL). The source of blood for this data set was predominantly femoral (n = 203), followed by heart (n = 5) and pleural cavity (n = 1). Although VAC/BAC ratios were more consistent at concentrations of 0.1 g/100 mL and above, the overall ratio ranged from 1.01 to 2.20. Of the 81 cases where BAC > VAC, a total of 24 cases indicated no vitreous alcohol. The range of blood alcohol concentrations among these cases was widely variable (0.01 to 0.30 g/100 mL). Unlike the VAC/BAC data set which consisted of 97% femoral blood, the source of blood in the BAC > VAC data set was slightly more variable. Of the 81 cases where BAC > VAC the blood source consisted of femoral (n = 68), heart (n = 8), pleural cavity (n = 2), carotid (n = 1), jugular (n = 1), and chest blood (n = 1). All analyses were conducted using dual-column gas chromatography with flame-ionization detection (GC-FID) with a reporting limit of 0.01 g/100 mL ethanol in postmortem samples. A series of case studies are used to demonstrate postmortem interpretive issues and the benefits associated with multiple specimen analysis. Cases include postmortem production of ethanol, rapid or unexpected death during the absorptive phase, and site-dependent differences following traumatic injury. Actual case studies involving other volatile organic compounds are also presented including isopropanol and acetone from endogenous and exogenous sources. Many of these cases studies highlight the difficulty associated with postmortem alcohol interpretation in the absence of multiple specimens or adequate case history.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
10/26. Diverse applications of negative pressure wound therapy: a multiple case report.The purpose of this retrospective case report was to describe the results of negative pressure wound therapy (NP WT) in the treatment of wounds of various size, location and etiology in four patients. The effects of NP WT were assessed in the following patients. 1) A 68-year-old male diagnosed with cellulitis presenting with two open wounds on the left foot; 2) a 60-year-old male diagnosed with Type II diabetes mellitus presenting with a full thickness wound on the plantar surface of the right foot; 3) a 64-year-old male diagnosed with necrotizing fasciitis, diabetes mellitus, and Crohn's disease presenting with a left gluteal wound; and 4) a 47-year-old obese female diagnosed with necrotizing fasciitis presenting with a wound of the right groin and buttock. All wounds were debrided of devitalized tissue and contained nearly 100% granulation tissue prior to NPWT treatment. NPWT was applied three times per week, each application lasting 48 hrs, followed by dressing change, cleaning of the wound bed and continued debridement as required. Treatment duration, varying from 4-9 weeks, corresponded to the patient's length of stay at the sub-acute rehabilitation facility, and pressure settings ranged from 100 to 200 mmHg. Measurements of wound length, width, depth and appearance were recorded once a week. Follow-up was conducted 6-18 months post treatment to assess self-reported wound status. NPWT resulted in reductions of wound length, width, and depth, with the greatest reduction in each case being wound depth. Reduction in wound depth ranged from 75-100% (100% being complete wound closure), with four of the five wounds exceeding 90%. Reduction in wound length ranged from 32-100%, with three wounds exceeding 80%, and reduction in wound width ranged from 35-100%, with three wounds exceeding 80%. Three wounds closed completely either during therapy or soon (2-4 weeks) thereafter, and two wounds were reduced in size sufficiently for treatment via skin grafts. NPWT, applied to wounds of diverse size, location, and etiology, resulted in reductions in wound length, width, and depth in four patient cases, with the greatest influence of reducing wound depth.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
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