Cases reported "Wounds, Penetrating"

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1/158. 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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ranking = 1
keywords = operative
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2/158. A surgical method for treating anterior skull base injuries.

    skull base surgery was performed on 18 patients with anterior skull base injuries. The operative technique consisted of opening the operative field in the anterior skull base via a coronal incision and a frontal craniotomy, debridement of the anterior skull base including the injured dura mater, performing drainage from the anterior skull base to the nasal cavity by ethmoidectomy, and reconstructing the resulting dural and anterior skull base defect using bilateral temporal musculo-pericranial flaps and a bone graft. Seventeen of the 18 patients recovered without any complications, although epidural abscesses in the anterior skull base had been present in four patients at the time of the operation. Only one patient developed an epidural abscess in the anterior skull base after the operation. None of the patients developed any other complications including meningitis, recurrent liquorrhoea or cerebral herniation. Satisfactory aesthetic results were achieved in 16 of the 18 patients. In one patient, uneven deformity of the forehead, which was caused by the partial sequestration of the frontal bone due to postoperative infection, was observed. In another patient, a depressed deformity of the forehead, which was caused by the partial loss of the frontalis muscle following the use of the frontal musculo-pericranial flap instead of a temporal musculo-pericranial flap, was observed. Anterior skull base reconstruction using bilateral temporal musculo-pericranial flaps provides excellent results in terms of patient recovery and aesthetics.
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ranking = 3
keywords = operative
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3/158. Central venous access: accidental arterial puncture in a patient with right-sided aortic arch.

    OBJECTIVE: To describe an unusual case of accidental insertion of a central line into an anomalous right-sided aortic arch. DESIGN: Case report, clinical. SETTINGS: Community hospital, university-affiliated. CONCLUSIONS: Intraoperative radioscopy, chest radiographs, and pressure transducer monitoring usually allow for the prompt recognition of the accidental insertion of venous catheters into the arterial system. However, in the presence of a right-sided aortic arch, a central line could be erroneously inserted into the arterial system and the radiologic findings can give the false impression of a correct placement in the superior vena cava.
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ranking = 1
keywords = operative
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4/158. Penetrating intracranial wooden object: case report and review of CT morphology, complications, and management.

    BACKGROUND: Penetrating intracranial wooden fragments after vehicular accidents are uncommon. The CT morphology, complications, and management in such cases are quite variable. CASE REPORT: A 27-year-old male was seen with a "twig" from a tree embedded firmly just below the right medial canthus after a motorcycle accident. Diagnosis of intracranial penetrating wooden object was made on CT scanning. The wooden stick, which had splintered into two, was extricated through a craniotomy in two operative sessions. However the patient succumbed to septicemia and meningitis on the twelfth day after the accident. CONCLUSIONS: The need for prompt extrication of these objects and the causes of high mortality in this condition are discussed. The importance of imaging the intracranial compartment in injuries involving the periorbital region is emphasized.
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ranking = 1
keywords = operative
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5/158. Multivascular trauma on an adolescent. Perioperative management.

    Penetrating vascular injury, in particular at the neck, is a life-threatening trauma not only of the nature and the anatomic proximity of cardiovascular, aerodigestive, glandular and neurologic system but also of the development of early and late complications. The following case report describes our experience with a penetrating wound patient, who was admitted to our emergencies twelve hours after the accident. The only demonstrable objective signs included a large hematoma at the right-side of the neck and distended mediastinum on the chest X-ray. As the patient was cardiovascularly unstable he was immediately transported to the theater without any angiography. The mandatory operative exploration was initially unsuccessful and a median sternotomy with a standard cardiopulmonary bypass and deep hypothermia circulatory arrest was established to restore all the vascular lesions. Actually, the patient was in critical condition with a rupture of the right internal jugular vein, a large pseudoaneurysm of the innominate artery and an avulsion of the ascending aorta with the suspicion of a cardiac tamponade. The postoperative period lasted two full months, while complications appeared. The substantial message from this multivascular trauma is the early diagnosis of the life-threatening complications as exsanguinations, ventricular fibrillation and the ability to minimize postoperative complications, which will impair the normal functional life of the patient.
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ranking = 7
keywords = operative
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6/158. Transoral missile removal from the anterior C1 region following transpharyngeal missile wound.

    We present a successful treatment result in a rare case of low velocity missile transpharyngeal wound to the upper cervical area in a 33-year-old man. There are very few reports concerning related cases, with some disagreement regarding their treatment. The retained missile was successfully removed from the anterior region of the C1 vertebra through a transoral-transpharyngeal approach using the explosive transpharyngeal wound sustained. Neurological status and spine stability were not affected due to the missile's low velocity. The early soft-tissue debridement, missile removal, pharyngeal closure without wound drainage and broad-spectrum antibiotic coverage resulted in an uneventful postoperative course and good long-term outcome. Early surgery is important to prevent complications in such cases. However, the prophylactic tracheostomy, wound drainage and applying of a nasogastric tube could be left to the surgeon's judgment based on the individual patient's respiratory status, intraoperative findings and wound contamination/colonization.
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ranking = 2
keywords = operative
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7/158. Perforation of the right ventricular free wall by an active fixation transvenous cardioverter defibrillator lead.

    A 58-year-old patient with dilated cardiomyopathy underwent implantable cardioverter defibrillator (ICD) implantation. The postoperative course was complicated by perforation of the right ventricular free wall by the active fixation transvenous ICD lead. The type of ICD lead and the type of organic heart disease are apparently important risk factors for perforation.
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ranking = 1
keywords = operative
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8/158. The arrow-head which went through the brain.

    An 18-year old man was admitted into hospital being fully conscious, with a thirteen centimetre long metal arrow-head entirely lodged intracranially, having entered through the right orbit. Pre- and post-operative neurological condition, treatment and investigations are described. The arrow-head was removed through a partial occipital craniectomy without any major haemorrhage. The patient not only survived the operation, but was also discharged in an astonishing improved neurological condition.
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ranking = 1
keywords = operative
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9/158. life-threatening nail gun injuries.

    The use of pneumatic and explosive cartridge-activated nail guns is common in the construction industry. The ease and speed of nailing these tools afford enhance productivity at the cost of increased potential for traumatic injury. Although extremity injuries are most common, life-threatening injuries to the head, neck, chest, or abdomen and pelvis may occur. During a 20-month period, eight potentially life-threatening nail gun injuries were admitted to a Level I trauma center, including injuries to the brain, eye, neck, heart, lung, and femoral artery. Mechanism of injury included nail ricochet, nail gun misuse due to inadequate training, and successful suicide. Nail guns have significant potential for causing severe debilitating injury and death. These findings indicate a need for improved safety features and user education. The various types of nail guns, their ballistic potential, and techniques for operative management are discussed.
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ranking = 1
keywords = operative
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10/158. Giant retinal tears resulting from eye gouging in rugby football.

    A 29 year old myopic man sustained two separate giant retinal tears in his right eye following deliberate eye gouging during a rugby tackle. These were successfully repaired by vitrectomy and intraocular silicone oil injection. Although the postoperative course was complicated by pupil block glaucoma, he regained corrected visual acuity of 6/5 after oil removal. This injury highlights the potentially sight threatening nature of this type of rugby injury and the importance of early referral for specialist treatment.
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ranking = 1
keywords = operative
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