Cases reported "Wounds, Gunshot"

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11/631. Severe jaundice in a gunshot casualty due to the coexistence of Dubin-Johnson and glucose-6-phosphate dehydrogenase deficiency.

    We report an unusual case of a 21-year-old man who was shot in his abdomen in the course of a robbery. He was previously diagnosed as glucose-6-phosphate dehydrogenase deficient. Mild icterus was noticed on admission to the emergency room. Exploratory laparotomy revealed a perforated ileal loop that was resected, and because the liver color was greenish black, a liver biopsy was performed during the operation. After operation the patient went through a severe icteric state that resolved spontaneously within a few days. Urinary coproporphyrin levels, along with compatible liver biopsy, confirmed the diagnosis of Dubin-Johnson disease. Severe hyperbilirubinemia after an abdominal injury is uncommon and is usually due to either a biliary duct injury or iatrogenic injury. This case presents an unusual cause of severe postoperative jaundice due to the rare coexistence of two inherited disorders.
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12/631. Frey syndrome: treatment with temporoparietal fascia flap interposition.

    There is a 10% to 48% reported incidence of clinically significant gustatory sweating after parotid surgery or injury. Various medical and surgical treatments have been used in the attempt to treat this socially embarrassing condition. These treatments are not always effective and often have unwanted risks and adverse effects. They also do not address the post-parotidectomy defect. Prevention of Frey syndrome and correction of the postoperative contour deformity after parotidectomy have recently been achieved by interposition of temporoparietal fascia flap between the parotid gland and the cheek skin flap at the time of parotidectomy. This article presents the first report (to our knowledge) of an established case of Frey syndrome being treated with temporoparietal fascia flap interposition.
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13/631. Five-year study on the injury of the great thoracic vessels after penetrating chest injury.

    In the cases of penetrating injury of the heart and the great thoracic vessels, 80% of the patients die before reaching the hospital care, nevertheless patients with sufficient vital functions can be rescued. Between 01. 01. 1994 and 31. 12. 1998 four patients were operated for penetrating injuries of the great vessels in the 2nd Department of Surgery, University Medical School of Debrecen. The left subclavian vein, arcus aortae and the pulmonary artery (2 cases) were injured. In this study authors report a detailed case operated for gunshot injury of the pulmonary artery. On the base of the situation of the projectile on X-ray picture and on the base of the entrance wound of the projectile on the skin we supposed the injury of the great thoracic vessels and we performed an urgent operation. After thoracotomy we found haemopericardium, bleeding wounds on the anterior and posterior haemorrhagic wall of the left pulmonary artery. We found the projectile inside the wall of the bronchus impacted. The bleeding wounds were finger-tamponaded and sutured. On the tenth postoperative day the patient was discharged from our clinic without complaint. The surgical approach to specific thoracic great vessels is also described.
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14/631. incidence of intracranial bullet fragment migration.

    Migration of retained bullets or bullet fragments may present as a complication of gunshot wounds to the head. This phenomenon has been reported in cases of abscess formation or retained copper fragments. Management of such migratory fragments is controversial. The purpose of this study is to determine the incidence of fragment migration in a population of neurosurgical patients treated for gunshot wounds to the head. Two-hundred and thirteen cases treated at Detroit Receiving Hospital between 1985 and 1987 were reviewed. Each patient treated had initial and one week follow-up imaging studies. Nine cases of documented migratory intracranial bullet fragments were identified. Thus, the incidence in this population is 4.2%. The fragments in eight cases were composed of copper, and in the remaining case, lead. No case was associated with an abscess. Fragments in the anterior fossa were found to migrate towards the sella turcica, while those of the middle fossa and posterior hemispheres migrate towards the confluence of sinuses (Torcula Herophili). Fragment migration was documented as early as 36 h post-injury. Based on this study, we recommend serial imaging studies to look for migrating bullet fragments and surgical removal aided by intra-operative ultrasound to localize the fragment when possible.
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15/631. Digital nerve repair by autogenous vein graft in high-velocity gunshot wounds.

    Gunshot wounds to the hands are high-energy injuries that cause widespread tissue damage, including to the nerves. Great difficulty is encountered in later reconstruction with nerve grafting of gaps in these destructive and scarred wounds. We present our experience with three patients with digital nerve repair by autogenous vein graft performed at an early stage in this type of injury. Based on our experience and that of others, this simple and rapid technique suggests a high rate of satisfactory results. It also avoids extensive and destructive late dissection and the morbidity associated with other late reconstructive procedures.
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keywords = injury, nerve
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16/631. Pseudoaneurysm of the internal carotid artery after shrapnel injury in World war II: demonstration by CT angiography with 3D MIP reconstruction.

    A case of pseudoaneurysm of the left internal carotid artery (ICA) after shrapnel injury is demonstrated by intra-arterial digital subtraction angiography (DSA) and computed tomography angiography (CTA) with subtraction technique. Although the pseudoaneurysm was well demonstrated by intra-arterial DSA, CTA was the only modality to demonstrate the three-dimensional shape of the perfused part of pseudoaneurysm and the aneurysmal neck, which affected the therapeutic strategy. The CTA technique is useful in the assessment of large pseudoaneurysms and for therapeutic planning.
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17/631. Non-free osteoplasty of the mandible in maxillofacial gunshot wounds: mandibular reconstruction by compression-osteodistraction.

    We have treated 33 young men with medium to large (3-8 cm) bony and soft tissue defects of the lower third of the face caused by gunshot wounds. After debridement, collapsing the proximal segments for primary approximation of soft and hard tissues and a closed osteotomy of a small fragment of mandible, we used an original compression-distraction device, designed in 1982 and tested during 1983 (analogous devices were absent at that time) to reposition the mandible and cause callus to form (during distraction) between the fragment and to use the remaining stumps of bone to fill in the defect. The soft tissues were repaired at the same time. Twenty-eight of the patients presented within a few hours of injury, and the remaining five had old injuries. The only complications were in the group with old injuries where four patients developed abscesses that required drainage, but these did not interfere with the process of osteogenesis. All 33 patients had good functional and aesthetic results within 3-4.5 months. The method allows a bloodless minimally traumatic procedure which can be carried out in one stage. The results compare very favourably with the classic methods of the treatment of mandibular gunshot injuries.
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18/631. Traumatic pseudoaneurysm of the abdominal aorta.

    A traumatic pseudoaneurysm of the abdominal aorta is a rare entity, occurring as the result of a missed aortic lesion at the time of the initial injury. Therefore, clinical suspicion and careful abdominal exploration at first laparotomy is mandatory to prevent aortic pseudoaneurysm formation and its risk of delayed rupture. We present a case of successful surgical treatment of a suprarenal aortic false aneurysm, presenting 4 weeks after a life-threatening gunshot wound in a 13-year-old child.
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19/631. Central venous injuries of the subclavian-jugular and innominate-caval confluences.

    Injuries to the central venous system can result from penetrating trauma or iatrogenic causes. Injuries to major venous confluences can be particularly problematic, because the clavicle and sternum seriously limit exposure of the injury site. We report our institution's experience with central venous injuries of the subclavian-jugular and innominate-caval venous confluences. Significant injuries of the subclavian-jugular venous confluence frequently result from penetrating trauma, while injuries to the innominate-caval confluence are usually catheter-related. Median sternotomy provides adequate exposure of the innominate-caval confluence, while exposure of the subclavian-jugular venous confluence requires extension of the median sternotomy incision into the neck and resection of the clavicle. The literature is reviewed.
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20/631. eye injuries associated with paintball guns.

    AIMS: This study identifies the various types of ocular injuries sustained after blunt trauma with a paintball fired from a paintball gun. methods: We report two patients who sustained injury to an eye after being shot with a paintball and review similar cases presented in the world literature. The type of injury sustained and the final visual acuity obtained after a paintball hit to the eye are examined. RESULTS: The two boys presented were hit in the eye with a paintball resulting in lens subluxation, hyphema formation, and angle recession. cataract extraction was required in both cases. One boy also had an optic neuropathy and a choroidal rupture. A review of the literature reveals a variety of injuries occur after a paintball hit to the eye. In some of the cases, the damage to the eye has led to loss of vision and at times loss of the eye. CONCLUSIONS: Paintball guns can cause devastating ocular injuries. Wearing protective eye and face gear during this game is essential. We recommend that an anti-fog face mask with a one-piece polycarbonate eye shield be worn by those participating in paintball games.
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