Cases reported "Contusions"

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11/20. Secondary infection of post-traumatic pulmonary cavitary lesions in adolescents and young adults: role of computed tomography and operative debridement and drainage.

    Secondary infection of post-traumatic cavitary lung lesions is unusual. This report describes the clinical course of four patients who sustained severe blunt chest trauma and developed pulmonary pseudocysts that became foci for systemic sepsis. All four patients were adolescents or young adults. Hemophilus species and aerobic Gram-negative rods were the predominant pathogens recovered. Computed tomography of the chest was instrumental in establishing the diagnosis in each case. Despite appropriate antibiotic therapy, all four patients remained septic for weeks. One of the patients died as a result of this infectious process. One patient underwent successful operative debridement and drainage of the involved lung and pleural space. Because infected traumatic pseudocysts may not respond like typical lung abscesses to appropriate antibiotic management, early exploratory thoracotomy should be considered in those patients with prolonged fever and pulmonary deterioration.
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ranking = 1
keywords = operative
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12/20. Emergency surgery in patients with post-traumatic myocardial contusion.

    Little information concerning the prognostic and functional significance of post-traumatic myocardial contusion appears to exist. During a 10-month period, 19 patients with major blunt thoracic trauma were diagnosed as having myocardial contusion using clinical findings, serial ECG and CPK-MB isoenzyme determinations, and biventricular radionuclide angiocardiography (RA). All patients had associated thoracic and extrathoracic injuries. ECG and RA were useful and complementary tests, detecting abnormalities in 90% and 47% of patients, respectively. Only one patient had an abnormally elevated CPK-MB. All patients required operative treatment for associated injuries, 15 (79%) on the day of admission. Eleven patients required perioperative cardiac inotropic support and one needed IABP. No late complications were attributable to the cardiac contusions per se; no patients died. Emergency surgery for associated injuries in patients with myocardial contusion can be safely performed using hemodynamic monitoring to guide cardiac inotropic support measures. Myocardial contusion does not constitute an absolute contraindication to necessary operations in polytraumatized patients.
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ranking = 0.4
keywords = operative
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13/20. Intraperitoneal hepatic bile duct fistula following blunt abdominal contusion.

    Injuries to intrahepatic biliary ducts rarely cause severe clinical manifestations in context with blunt abdominal trauma. A case with mild symptoms and signs, but slowly developing bile peritonitis due to posttraumatic intraperitoneal hepatic bile duct fistula is described here. A young girl sustained a blunt contusion on the right lower thoracoabdominal region by the handle bar of a bike. A week after the accident ultrasonography revealed fluid under the liver. The patient showed no signs of peritonitis but had occasional shoulder pain. At laparotomy 200 ml of biliary fluid was drained from the subphrenic space, and excoriation was observed on the upper surface of the liver. A second operation was necessary due to continuous bile leakage via the drain in the subphrenic space and a bile-fistula was demonstrated by contrast x-ray examination. A local resection of the liver was performed and the intrahepatic bile duct fistula closed by a ligature. The postoperative course was then uneventful and the patient was symptomfree on examination six months after the accident.
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ranking = 0.2
keywords = operative
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14/20. Combined use of HFPPV with low-rate ventilation in traumatic respiratory insufficiency.

    Two patients with chest injuries, flail chest and respiratory failure were mechanically ventilated by a system composed of 2 Bennett respirators and an independent source of gas. This system provides high-frequency positive pressure ventilation (HFPPV), low-frequency conventional mechanical ventilation (LFCMV) and high inspiratory flow of fresh gas (HIF), through the independent source. This system made use of the advantages of HFPPV and also solved the problem of possible CO2 retention. Using this system we could ventilate the patients while they were fully conscious and cooperative, thus eliminating the need for sedatives and muscle relaxants. time of mechanical ventilation was shortened since the internal pneumatic fixation was very good and made it possible for the fractured ribs to unite rapidly. Restoration of spontaneous breathing was immediate after disconnection from the ventilator. We suggest this method as another mode of ventilation for patients with flail chest and respiratory failure.
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ranking = 0.2
keywords = operative
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15/20. Carriers of factor vii deficiency are not always asymptomatic.

    Seven children, referred because of bleeding symptoms, proved to be heterozygotes for factor vii deficiency. Abnormal bruising was the commonest symptom (6/7), followed by postoperative bleeding (4/7). One case had recurrent epistaxis. Results on the patients and their families are presented. prothrombin times were prolonged by 2-3 s and factor VII assays ranged from 25 to 55% (mean 38%). The cases are reported because they bled excessively: yet it is usually stated that carriers for factor vii deficiency are symptom-free. One case of homozygous factor vii deficiency is also described: the parents (who are heterozygotes) were symptom-free.
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ranking = 0.2
keywords = operative
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16/20. Post-traumatic spinal epidural hematoma.

    Five patients with vertebral fracture and spinal epidural hematoma (SEH) are described. Another 58-year-old man developed a post-traumatic SEH without bony damage. From the literature, 38 patients (31 male, 4 female, and 3 unknown) were collected. Ankylosing spondylitis or rheumatoid arthritis was noted in 9 of 12 subjects between 50 and 75 years of age. Two groups of patients were identified: Group 1--16 patients with spinal fracture (aged 23 to 63 years), and Group 2--22 patients without spinal fracture (the age was less than 18 years in 12 subjects). In Group 2, a coagulation defect or spinal epidural vascular malformation resulted in a SEH in 6 patients. The preoperative myelopathy was complete in 3 patients each from Group 1 (23.1%) and Group 2 (16.7%). Of the 31 patients operated upon, 9 of the 13 from Group 1 (69.3%) and 6 of the 18 from Group 2 (33.3%) underwent laminectomy within 1 week after the onset of symptoms. Postoperative neurological return was observed in 38.5% (5 of 13) and 88.9% (16 of 18) of these two groups of patients, respectively. Post-traumatic SEHs, predominant in the male population, are often associated with vertebral disease in elderly patients. In the very young patient, there is usually no fracture/dislocation of the spine. A predisposing lesion may be present when spinal fracture is not evident. The prognosis after surgical intervention is better in patients without spinal fracture than in those with vertebral damage, probably because of less contusion to the spinal cord and the presence of very young subjects in the former group of patients.
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ranking = 0.4
keywords = operative
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17/20. Cervical spinal subdural hematoma.

    We report a case of intraspinal subdural hematoma following trauma - a rare entity - with a review of the literature. The location of the hematoma in the cervical spine as described in this report is even more uncommon and was reported only once before. The pathophysiology of this entity is discussed, and the myelographic features are emphasized to facilitate the preoperative diagnosis.
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ranking = 0.2
keywords = operative
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18/20. myositis ossificans of the upper arm.

    myositis ossificans is a benign condition resulting from severe muscular contusion manifested by heterotrophic bone formation. The process is common in the anterior thigh but the literature dealing with myositis ossificans in the upper arm is limited. Ten cases of the condition in the upper arm were seen in our practice. All 10 were the result of football injuries and exhibited one or more of the triad of local pain, a hard palpable mass in the muscle, and a flexion contracture of the elbow. Seven of the cases (70%) were asymptomatic or signficantly improved in less than 3 months with conservative nonoperative management. Three patients (30%) underwent surgery because the painful mass persisted. In two (66%) of the surgically managed cases, there was clinical and radiographic evidence of recurrence postoperatively in spite of delaying excision until radiographic parameters of maturation were present.
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ranking = 0.4
keywords = operative
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19/20. Tracheobronchial disruption: postoperative management with jet ventilation to minimize airway pressures.

    The case of a 17-year-old male victim of blunt trauma with complex tracheobronchial injury identified by flexible bronchoscopy is discussed. The paper also describes the surgical treatment used and good results obtained.
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ranking = 0.8
keywords = operative
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20/20. Intermediate-degree blunt renal trauma.

    One hundred four cases of blunt renal trauma have been reviewed and analyzed, yielding 71 minor, 13 major, and 20 intermediate-degree injuries. Of the latter group, urinary extravasation (60%) and parenchymal laceration (100%) appear to be the dominant features exhibited by conventional radiographic maneuvers, neither of which suggest a de novo need for operation or interference with spontaneous resolution. nephrectomy (9) and heminephrectomy (2) may often have been performed unnecessarily in this group, since nine such patients managed either nonoperatively (7), or undergoing negligible operative procedures (2) responded with total functional and anatomic restoration. Arteriography is endoresed as an important contributor of information encouraging conficdence in the conservative management of such cases.
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ranking = 0.4
keywords = operative
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