Cases reported "Wounds, Penetrating"

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1/134. Thoracoscopic retrieval of foreign body after penetrating chest injury: report of two cases.

    Video-assisted thoracic surgery has proved to be valuable in many settings in thoracic surgery. The use of video-assisted thoracic surgery in trauma has recently rapidly increased. It is useful in acute or delayed management of patients with blunt and penetrating chest trauma. It is safe for removal of clotted hemothorax, treatment of thoracic empyema, treatment of persistent pneumothorax, treatment of chylothorax, and for diagnosis of diaphragmatic injury. We report two cases using thoracoscopy to remove intrathoracic metal fragments and avert the need for thoracotomy. In the first patient, a metal fragment injury was sustained via a penetrating wound from the supraclavicular notch to the right upper lung. The metal fragment was retrieved and the lung was repaired thoracoscopically using conventional suturing techniques. A second patient sustained a broken pin injury to the left upper mediastinum via a low neck wound. The pin was successfully removed under videothoracoscopy. Both patients recovered uneventfully and had shortened hospital stays. We feel that thoracoscopy offers a therapeutic as well as diagnostic benefit in stable patients with penetrating chest trauma.
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2/134. A case of stapler pin in the root canal--extending beyond the apex.

    There have been several reports describing the placement, by patients, of foreign objects into exposed pulp chambers and canals. In the present case, a 13-year-old patient reported with complaints of pain and a history of inserting a foreign object into the root canal of the left central incisor. On examination the foreign body was found to be a stapler pin which was projecting 5 millimeters from the apical foramen. foreign bodies discovered from the root canal have varied from radiolucent objects like wooden tooth picks or tooth brush bristles to radioopaque materials like paper pins, needles, pencil leads etc. In the present case, despite our best efforts, the patient did not agree to undergo any treatment except for the extraction of the left central incisor.
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3/134. Unusual parotid gland foreign body.

    A foreign body in the parotid gland whether from the oral cavity or through the skin is extremely uncommon. A case is described of the tip of a golden-colored pencil accidentally piercing the deep lobe after a fall. Emergency surgical removal was performed, and the diagnosis of the foreign body was quite easy. In contrast, determination of the location in the gland had to be done by a microscope, with fluoroscopy during the operation and was quite difficult. During removal, great attention was paid to avoiding facial nerve injury. This was done by identifying the facial trunk at the pointer using a microscope. The dissolved material including copper and zinc metal powder, paste, and clay, was found in the deep lobe associated with the surrounding abscess. Although these materials are assumed to be harmless to human tissues, the complete and immediate removal is to prevent salivary fistule resulting from inflammation.
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4/134. Craniofacial ballpoint pen injury: endoscopic management.

    Penetrating facial injuries are not infrequent. There have been isolated case reports of unusual penetrating craniofacial trauma. We describe an unusual case of a 22-month-old child who suffered an external orbital injury from a ballpoint pen that penetrated the orbit, lamina papyracea, posterior ethmoid sinuses, and sphenoid sinus. Endoscopic sinus surgery was performed to extract the ballpoint pen nib after localization with computed tomography. Careful pediatric endoscopic sinus surgery techniques permitted safe foreign body extraction with minimal morbidity.
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5/134. A hypothesis to explain the occurence of inner myometrial laceration causing massive postpartum hemorrhage.

    BACKGROUND: Inner myometrial lacerations were found in three patients who developed uncontrollable postpartum massive bleeding despite the usual treatment for uterine atony. Because all the patients suffered from hemorrhage shock and their medical status deteriorated, their uteri were surgically removed to stop bleeding. After removal, one of them died. postpartum hemorrhage was caused by inner myometrial laceration. We hypothesized a cause of inner myometrial laceration, using the three resected uteri, an assumed model of the uterine body, and 34 women. methods: The subjects were 37 women, of whom three were patients with inner myometrial laceration, 23 were women without inner myometrial laceration who underwent cesarean section, and 11 were women in the first stage of labor. The three resected uteri were examined both macroscopically and microscopically. We measured the thickness of the wall of the uterine muscle at the widest point of the uterine corpus and the thickness of the myometrial wall at a transverse section of the uterine cervix, as well as the radius of the inner lumen at the widest point of the uterus in 23 women during cesarean section. We also measured the thickness of the myometrial wall at the widest point of the uterine corpus in 11 women at the end of the first stage of labor during ultrasonic examination. The data were then used to estimate the stress on the uterine muscle. RESULTS: The stress on the uterine cervix was stronger than that on the uterine corpus during labor. When the stress on the uterine muscle is stronger than a specific value, inner myometrial lacerations develop on the right and/or left side of the uterine cervix. These lacerations may involve large vessels. CONCLUSIONS: We have discovered another cause of postpartum hemorrhage which we have named inner myometrial laceration. These lacerations appeared to result from a strong stress on the uterine cervix caused by an abnormal rise in intrauterine pressure during labor.
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6/134. A foreign body in the spinal canal. A case report.

    An 18-year-old man who presented with weakness in his lower limbs, had an upper motor neurone lesion at the D12-L1 level. At laminectomy two stone-like objects were found which proved to be bundles of tiny pieces of wood. They are thought to have entered the cord through an abdominal penetrating injury sustained six years previously.
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7/134. Glossopharyngeal neuralgia following foreign body impaction in the neck.

    Glossopharyngeal neuralgia is rare, typically idiopathic and treated with carbamazepine. Surgery to decompress or transect the glossopharyngeal nerve root may be performed if conservative management fails. We present a case following trauma to the neck with foreign body impaction. To our knowledge this is the first case of glossopharyngeal neuralgia due to neck trauma.
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8/134. Left internal mammary artery graft perforation repair using polytetrafluoroethylene-covered stents.

    The increase in the use of the left internal mammary artery (LIMA) as graft of choice to the left anterior descending coronary artery for conventional and minimally invasive coronary artery bypass surgery has led to an increased incidence of LIMA pathologic lesions early after surgery. The lesion, commonly located in the body of the LIMA graft, is usually caused by mechanical injury during harvesting of the vessel. In this context, percutaneous intervention with stent implantation can be complicated by vessel rupture, which usually requires emergency surgical repair. We describe two cases of stent implantation in newly placed LIMA grafts complicated by vessel rupture, which were successfully repaired using polytetrafluoroethylene-covered stents.
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9/134. Suicides by sharp force: typical and atypical features.

    A total of 65 consecutive cases of suicide by sharp force were investigated by evaluating the autopsy and prosecution department records. Suicides constituted 17% of all fatalities from sharp force autopsied between 1967 and 1996. Young males and persons with a psychiatric history predominated among the persons who chose this "hard" method of suicide. The most common implements used were knives (62%) and razor blades (15%). Cutting injuries in isolation were present in 26, stab injuries in isolation in 24 and a combination of both in 15 fatalities. The number of injuries per case varied from 1 to 37 but 1/3 showed one injury. More than 85% of the cutting injuries were located at the wrist, elbow crease or neck whereas 79% of the stab injuries involved the ventral aspect of the trunk. Perforation of clothing was present in 16 (52%) out of 31 stab injuries to the trunk. Injuries to more than one body region were observed in 34 (52%) cases. Tentative marks were present in 50 (77%) fatalities and the number varied from 1 to 60 per case. Superficial incisions of the fingers were found in 15% with razor blades constituting the weapon in half of these cases. Deviations from these typical patterns occurred not infrequently. The utter determination of the victim to carry it through or the use of unusual weapons resulted in a few bizarre cases which are outlined briefly.
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10/134. Impalement injuries involving the spinal canal.

    Two cases of impalement injury involving the spinal canal are presented. In the first patient septic bacteria were carried into the spinal canal along the track of the impaling rod. This patient died of sepsis. In the second patient a steel rod penetrated the patient's trunk on the right side, traversing his body obliquely, impaling the L1 vertebral body and coming to lie in the left retroperitoneal space. This injury was not complicated by infection and the patient recovered without any neurological deficit. The principles of managing these injuries and factors influencing their outcomes are discussed.
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