1/70. hypoglossal nerve injury as a complication of anterior surgery to the upper cervical spine.Injury to the hypoglossal nerve is a recognised complication after soft tissue surgery in the upper part of the anterior aspect of the neck, e.g. branchial cyst or carotid body tumour excision. However, this complication has been rarely reported following surgery of the upper cervical spine. We report the case of a 35-year-old woman with tuberculosis of C2-3. She underwent corpectomy and fusion from C2 to C5 using iliac crest bone graft, through a left anterior oblique incision. She developed hypoglossal nerve palsy in the immediate postoperative period, with dysphagia and dysarthria. It was thought to be due to traction neurapraxia with possible spontaneous recovery. At 18 months' follow-up, she had a solid fusion and tuberculosis was controlled. The hypoglossal palsy persisted, although with minimal functional disability. The only other reported case of hypoglossal lesion after anterior cervical spine surgery in the literature also failed to recover. It is concluded that hypoglossal nerve palsy following anterior cervical spine surgery is unlikely to recover spontaneously and it should be carefully identified.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
2/70. Arterial embolization in the treatment of post-traumatic priapism.priapism is a prolonged penile erection not associated with sexual arousal. Two types of priapism have been described: the more common one is the "veno-occlusive" priapism and can be frequently observed as the consequence of an intracavernosal injection of vaso-active drugs for the treatment of erectile dysfunction. The less common type of priapism is known as "high flow" priapism and usually follows perineal or direct penile trauma. The clinical presentation in case of high flow priapism is quite typical: hystory of recent penile or perineal trauma followed, by the onset of a painless, incomplete and constant erection of the penis. A color-flow Doppler sonogram should be performed as first diagnostic step: this examination allows to identify the presence of patent cavernous arteries and prominent venous drainage with focal area of high flow turbulence along the pathway of one or both the cavernous arteries. An arterial blood sample taken from the corpora will confirm the diagnosis. At first, conservative therapeutical attempts can be suggested, with mechanical external compression of the perineum, the use of ice packs, corporeal aspiration and irrigation with saline. Besides, intracorporeal administration of alpha-agonists and methylene blue should be performed. Unfortunately, these conservative measures often result unsuccessful, and more invasive approaches must be considered. The radiological superselective transcatheter embolization of the proximal artery supplying arterial-lacunar fistula should be the present treatment of choice in these cases of high-flow priapism refractory to conservative and medical treatments. The first successful management of high flow priapism by selective arterial embolization was reported by Wear and coworkers in 1977. Autologous clots and gelatine sponge have been extensively used and become very popular as the embolic agent. More recently, platinum microcoils have been proposed with the aim to achieve more precise and selective embolization. In our single-case-experience on the treatment of high flow priapism by arterial embolization, we used the recently introduced tungsten microcoils. At the time of the follow-up, 2 months later, patient reported satisfactory intercourse with an approximately 75% of penile rigidity. By comparison with microsurgical ligature of the damaged vessel, selective embolization is, at least theoretically, a less invasive procedure, particularly with reference to the trauma caused to the erectile tissue. High-flow priapism is a fairly rare urological pathology which does not require immediate and emergency treatment (as is the case, instead, with venous-occlusive priapism), since the risk of post-ischaemic fibrosis is excluded thanks to the fact that oxygen is supplied to the cavernous tissue. Once the diagnosis has been established with certainty, therefore, the specialist has the necessary time at disposal to arrange for the most appropriate therapeutic steps. When, as is frequently the case, conservative measures prove ineffective, the current treatment of choice for cases of fistula of the cavernous artery would appear to be superselective embolization of the artery, provided same can be performed at specialized centres and by experienced personnel.- - - - - - - - - - ranking = 0.0095717326166228keywords = compression (Clic here for more details about this article) |
3/70. Lumbosacral nerve root avulsion: report of a case and review of the literature.The 14th myelographically demonstrated case of lumbosacral nerve root avulsion is presented with a summary of the previously reported cases. In most cases lumbosacral nerve root avulsion is associated with pelvic fractures and sacroiliac dislocation, which cause a stretching force to be applied to the nerves of the lumbar and sacral plexuses, and in turn to the nerve roots intradurally. This force causes nerve root avulsion in the intradural course of the nerve root. The myelographic defect is a pseudomeningocele or diverticulum-like outpouching created by the tearing of the arachnoid covering of the nerve roots. myelography clearly indicates nerve root avulsion and surgical exploration is not indicated.- - - - - - - - - - ranking = 15.975351993434keywords = nerve root, avulsion, nerve, root (Clic here for more details about this article) |
4/70. Congenital insensitivity to pain with anhidrosis. Report of a case and review of the literature.In a previous paper published in this journal, we reported two cases of "Congenital Sensory Neuropathy with Anhidrosis" with reference to the orthopedic complications (Theodorou et al., 1985). We now present a new typical case, under the currently used term: "Congenital Insensitivity to pain with Anhidrosis" (CIPA) and a brief review of the literature on the incidence, etiology and problems arising in various systems. CIPA is an autosomal recessive form of sensory neuropathy manifesting with typical clinical features. Universal insensitivity to pain, anhidrosis or hypohidrosis, bouts of hyperpyrexia from very young age, self inflicted injuries, defective or absent lacrimation and mental retardation are specific diagnostic findings. Orthopedic, maxillofacial, dermatological and ophthalmologic complications are common. counseling of the family and school personnel for the prevention of injuries is necessary. early diagnosis is very important for the prevention and treatment of various complications. The etiology and pathogenesis of the condition is still unclear. The recent detection of a new gene, which encodes a receptor tyrosine kinase for nerve growth factor and lately of a specific point mutation associated with the gene inactivation11, may open new ways for the study and management of this disabling condition.- - - - - - - - - - ranking = 0.14285714285714keywords = nerve (Clic here for more details about this article) |
5/70. A traumatic asphyxia in a child.PURPOSE: Traumatic asphyxia in a child is rare and the pathophysiology is different from that occurring in an adult. We report a case of traumatic asphyxia in a child who recovered without specific treatment, even though chest and abdominal compression was severe. CLINICAL FEATURES: A three-year-old boy (14.2 kg) was run over by the rear wheel of a Jeep. He was under the tire for about three minutes and then was transferred to our hospital. When he arrived, he was lethargic with glasgow coma scale of E3V4M6 (coma score of 13). He was cyanotic in his face and had a tire mark from the left shoulder to the right abdomen, petechiae on the head, face, conjunctiva and chest, oral bleeding, and facial edema. serum concentrations of liver enzymes were increased and microhematuria was detected. However, no injuries were seen in the brain, eye, chest, or abdomen. cyanosis disappeared in a few hours. Facial and thoracic petechiae disappeared in three days and that of the conjunctiva in five days. He was discharged from hospital on the 13th day without any disturbances. CONCLUSION: We present a three-year-old boy with traumatic asphyxia. He had no complications although he received severe thoraco-abdominal compression by a Jeep.- - - - - - - - - - ranking = 0.019143465233246keywords = compression (Clic here for more details about this article) |
6/70. Elastic adhesive dressing treatment of bleeding wounds in trauma victims.Conventional methods for hemorrhage control in the trauma patient fall short of providing a full solution for the life-threatening bleeding injury. The tourniquet is limited specifically to injuries of the distal limbs. Local pressure or tight bandaging with military bandages is cumbersome and often insufficient. Therefore, we sought a superior method to stop bleeding in emergency situations. Our objective is report and description of our experience with this method. Since 1992 our trauma team repeatedly encountered multiple trauma victims presenting with bleeding wounds. We achieved hemorrhage control by means of an adhesive elastic bandage applied directly over a collection of 4 x 4 gauze pads placed on the wound surface. The roll is then wrapped around the body surface, over the bleeding site, until sufficient pressure is reached to terminate ongoing hemorrhage. Three typical cases are described in detail. Adhesive elastic dressing compression was successful in fully controlling bleeding without compromise of distal blood flow. Our method corresponded to the demand for an immediate, effective and lasting form of hemorrhage control without complications. Furthermore, this technique proved successful even over body surfaces normally recognized as difficult to compress. We experienced equal favorable success while working during transit by either ambulance or helicopter transportation. We find our preliminary experience using elastic adhesive dressing for bleeding control encouraging and suggest that this may substitute existing practices as the selected treatment when indicated. This method is presently underrecognized for this purpose. Development of a single unit bandage may further enhance success in the future.- - - - - - - - - - ranking = 0.0095717326166228keywords = compression (Clic here for more details about this article) |
7/70. Brief therapy of civil war-related trauma: a case study.The incidence of posttraumatic stress disorder is widespread among refugees who have been exposed to violence or torture. Many families struggle with side effects of this condition, such as recurrent nightmares, flashbacks, emotional detachment, and difficulty trusting people. Some unwittingly become involved in a pattern of alcoholism, family violence, and somatic illness that is rooted in traumatization. Service providers must often struggle with overwhelmed clients whose multiple needs make long-term therapy impractical. Thus, brief treatment appears to be especially well suited to this population. This article describes a case study using short-term psychotherapy (10 to 20 sessions) that aims to restore refugees who are in reasonable emotional health to their premorbid level of functioning. A 4-stage treatment process involving specific tools is described, and the case study is used as an illustration. Contraindications for time-limited therapy are also outlined.- - - - - - - - - - ranking = 0.040611383696274keywords = root (Clic here for more details about this article) |
8/70. High-pressure water jet injuries: a surgical emergency.Injuries from high-pressure jet devices are surgical emergencies characterised by small entry wounds with extensive internal damage. Three factors are involved in these injuries. Physical injury can include local soft tissue disruption and vascular and nerve damage; chemical properties of the injectate can exacerbate compressive vascular injuries with increased oedema and inflammation; water-jet injuries can be contaminated by virulent organisms and foreign matter which can lead to unusual infections. Management is usually similar to that for injuries caused by high-velocity missiles, and involves aggressive debridement, irrigation and decompression followed by careful monitoring, and appropriate antibiotic therapy.- - - - - - - - - - ranking = 0.15242887547377keywords = nerve, compression (Clic here for more details about this article) |
9/70. Traumatic lesions of the bilateral middle meningeal arteries--case report.A 44-year-old man presented with traumatic injuries of the bilateral middle meningeal arteries after a traffic accident. Neurological examination found left visual impairment due to left optic nerve injury. Computed tomography demonstrated a small amount of left epidural hemorrhage and bilateral skull fractures. Left external carotid angiography revealed a pseudoaneurysm of the left middle meningeal artery at the sphenoid ridge. Right external carotid angiography demonstrated a dural arteriovenous fistula fed by the right middle meningeal artery colocated with the right frontal convexity fracture. Transarterial embolization of the left middle meningeal artery pseudoaneurysm with four fibered platinum coils and transarterial embolization of the right dural arteriovenous fistula with poly(2-hydroxyethyl methacrylate-co-methyl methacrylate) were performed, resulting in complete obliteration of both lesions. Angiographic cure was obtained and the postoperative course was uneventful.- - - - - - - - - - ranking = 0.14285714285714keywords = nerve (Clic here for more details about this article) |
10/70. Driver and front seat passenger fatalities associated with air bag deployment. Part 1: A Canadian study.Real world motor vehicle collision research of injuries due to deployment of "first-generation" air bags has been conducted by Transport canada since 1993. Fifty-three fatal crashes (36 frontal impacts; 17 side collisions) involving 48 drivers and 10 right front passengers were reviewed. In the Canadian data, air bag deployment in five of nine low severity frontal crashes (delta-V (deltaV) < 25 km/h or 15 mph) was linked to five deaths, four of whom were autopsied (four adults with craniocervical (basal skull and C2 fracture with brainstem avulsion; "closed head injury"--no autopsy) or chest trauma (aortic or pulmonary artery tears); one child with atlanto-occipital dislocation). An occupant who is close ("out-of-position") to the air bag at the time of deployment is at risk for injury. In 27 high severity frontal impacts, unusual (e.g., pulmonary "blast" hemorrhage in one autopsied case) or isolated potentially survivable injuries (e.g., clinically documented ruptured right atrium; probable flail chest observed during the autopsy on a decomposed body) localized to the head, neck or chest in three possibly out-of-position drivers pointed to the deployed air bag as a source of injury. In one of 17 side collisions an out-of-position driver sustained a radiographically confirmed C1-C2 dislocation in a minimally intruded vehicle.- - - - - - - - - - ranking = 0.22028974428639keywords = avulsion (Clic here for more details about this article) |
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