Cases reported "Wounds, Penetrating"

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1/586. Plastic injection injury of the hand.

    A unique case of injection of plastic material into the hand is reported. Treatment was simple because the molten plastic solidified, separated readily from the surrounding tissues and could be withdrawn without fragmentation. There was no evidence of serious damage to the surrounding tissues by the plastic before it has cooled and set. The mechanism of the injury is explained and the need for simple safety precautions is noted.
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2/586. Bone cyst of a fishy origin: from an old catfish spine puncture wound to the foot.

    A rare first metatarsal unicameral-type bone cyst with a deceptive radiographic appearance and size and an unusual pathological etiology was identified in a female patient. This eccentric cyst was observed only postoperatively by radiograph. review of the patient's history documented a foot injury from a catfish spine as the etiology of this chronically inflamed cyst.
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3/586. Some missile injuries due to civil unrest in northern ireland.

    Some missile injuries are reviewed after nearly 8 years of continuous warfare. A feature of many of these injuries is the early admission to hospital which has had a profound effect on the survival rate and the recovery period. Some examples are given of injuries inflicted by rubber bullets. The effects of wounding by low and high velocity missiles are described and examples given. An injury caused by a missile incorporated in a bomb is also shown.
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4/586. Technique of removal of an impacted sharp object in a penetrating head injury using the lever principle.

    Penetrating head injuries can be difficult to manage as the extensive surgery which may be required can result in severe morbidity and mortality in some patients. A conservative surgical approach with a "pull and see" policy was adopted successfully in a described case. Extraction can be achieved by using the mechanical advantage of the lever principle. By this method while removing the object any movements of sharp edges which will cause secondary damage can be reduced to a minimum.
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5/586. Isolated intrathoracic injury with air bag use.

    The restrained (air bag and seatbelt) driver of a vehicle involved in a high-speed motor-vehicle accident sustained a tear of the thoracic aorta with no signs of external injury. air bag deployment may mask significant internal injury, and a high index of suspicion is warranted in such situations.
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6/586. Transorbital-transpetrosal penetrating cerebellar injury--case report.

    A 4-year-old boy presented with a transorbital-transpetrosal penetrating head injury after a butter knife had penetrated the left orbit. The knife tip reached the posterior fossa after penetrating the petrous bone. Wide craniotomy and the pterional, subtemporal, and lateral suboccipital approaches were performed for safe removal of the object. The patient was discharged with left-sided blindness, complete left ophthalmoplegia, and hypesthesia of the left face. Early angiography is recommended to identify vascular injury which could result in fatal intracranial hemorrhage.
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7/586. A new hazard for windsurfers: needlefish impalement.

    Marine-related injuries and envenomations are common to the coastal physician. Needlefish injuries, which occur almost exclusively in the Indo-Pacific region, have not previously been reported along the Atlantic seaboard. This case report describes a penetrating injury to the lower extremity from a needlefish. Treatment is guided by general resuscitative procedures as well as antibiotic therapy directed against infections unique to the marine environment.
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8/586. Transorbital penetrating injury of the paranasal sinuses.

    Penetrating injuries of the paranasal sinuses due to foreign bodies are rare, especially as a result of a traffic accident. Here we report a patient with a ballpoint pen lodged in his left eye following a traffic accident. The pen extended from the medial aspect of the left orbit, through the left ethmoid sinus and the nasal septum, to the right sphenoid sinus. We removed the pen uneventfully using endoscopic sinus surgery. There are no similar reports in the English literature and we therefore present this case because of its rarity.
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9/586. Physical activity following fatal injury from sharp pointed weapons.

    Cases of suicide from sharp pointed weapons (n = 12) witnessed by one or more persons are reported with regard to the potential for physical activity. One case each involved the ulnar artery, the great saphenous vein and the periphery of the lung and liver and the physical activity following these injuries lasted for several hours. In one case, the left carotid and vertebral arteries were transected and the physical activity lasted for approximately 10 s. An extraordinary case involved a protracted incapacitation due to heart tamponade from a small myocardial injury caused by a cannula. In the remaining seven cases, a stab wound to the heart was present. With regard to the physical activity, a long-term group (2-10 min, n = 4) can be differentiated from a short-term group (approximately 10 s, n = 2) and one case of immediate incapacitation. The size of the myocardial perforation was 7-10 mm in length in the long-term group compared to 1.4-2 cm in the short-term group. So small perforations of the heart or incisions of the carotid artery offer a potential for considerable physical activity. Large perforations of the heart or a transection of the carotid and vertebral arteries can result in short-term activity.
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10/586. Selective motor hyperreinnervation by using contralateral C-7 motor rootlets in the reconstruction of an avulsion injury of the brachial plexus. Case report.

    brachial plexus avulsion injuries are a clinical challenge. In recent experimental studies the authors have demonstrated the high degree of muscle reinnervation attained when a C-4 motor rootlet was directly connected to the musculocutaneous nerve. This degree of reinnervation was attributed to the good chance that a muscle fiber can be reinnervated by a motor fiber when the number of regenerating motor neurons is increased and when competitive sensory fibers are excluded from the process. The authors present the first clinical case in which this phenomenon has been observed. This 26-year-old man, who was involved in an automobile accident, presented with an upper brachial plexus avulsion, for which he underwent operation 4 months later. The axillary and suprascapular nerves were directly surgically connected to the motor rootlets of the C-7 contralateral root by using two cables of sural nerve graft. Two years postsurgery, the patient was able to perform shoulder abduction of 120 degrees and hold an 800-g weight at 90 degrees. These results are encouraging, and in selected patients motor rootlet transfer might prove to be a useful surgical strategy.
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