Cases reported "Wounds and Injuries"

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1/8. Trauma, sepsis, and disseminated intravascular coagulation.

    disseminated intravascular coagulation (DIC) was first observed clinically in a case of sepsis following severe trauma. It was postulated that the observed clotting defect and bleeding were due to the using up of clotting factors in an episode of intravascular clotting. It was also postulated that the multiple organ failure observed was due to obstruction of the microcirculation of the organs by microclots. Evidence for this process was worked out in many animal studies. It was then postulated that if these microclots could be lysed before organ necrosis was produced, organ failure could be prevented. This prevention was shown to be possible in animals. It was then tried in humans using plasminogen activators, and the approach was found to be effective. Using a low dose of plasminogen activator over a 24-hour period caused no changes in the coagulation profile or bleeding.
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2/8. Mole gun--an unusual firearm, a case note.

    There are different kinds of types of firearms used worldwide and of different origin. This case note evaluates the mole gun, which cannot be found in the literature. This simple gun, which is usually used in the fields against moles, was used in an apartment as a trap against burglars. This instrument manufactured to be used as a trap against detrimental animals, and not to be used as a firearm, can create dangerous situations, if used for different purposes.
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3/8. The latency between traumatic axonal injury and the onset of amyotrophic lateral sclerosis in young adult men.

    Traumatic axonal injury-induced apoptotic motor neuron cell death in neonatal rats is an established animal model used to study potential therapeutic agents in amyotrophic lateral sclerosis (ALS). In an analogous manner, trauma causing motor neuron axonal injury (which included focal neuropathy, plexopathy, and radiculopathy) preceded the onset of ALS in nine young adult men (age range, 28-43 years). The latency between the traumatic axonal injury and the onset of ALS symptoms in these patients ranged from 5 to 42 months (mean, 14.6 months).
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4/8. immobilization dystonia.

    The mechanisms underlying dystonia after injury are unclear. pain has been implicated as an important factor. We report four patients who exhibited segmental dystonia following removal of a cast, only two of whom experienced pain during casting. Recent work implicates the cerebral cortex as an important site of neural plasticity underlying the development of dystonia. Cortical changes may be induced by peripheral stimuli that are repetitive, spatially and temporally proximate, stereotyped, and attended. immobilization by casting may meet these requirements if there is sufficiently persistent sensation of the immobilized limb to assure that it is regularly attended. The fact that all of our patients were immobilized but only two experienced pain during casting suggests that pain is not necessary and immobilization alone may be sufficient for the development of segmental dystonia after peripheral injury, consistent with the implications of animal studies.
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5/8. Injuries caused by pigs in papua new guinea.

    Pigs are intelligent animals that can be formidable adversaries to humans because of their sharp tusks and their ability to attack swiftly. Domestic and feral pigs have an important role in the ecology of village life in melanesia. A six-year review of all injuries that were caused by pigs that were referred from the villages in Milne Bay Province, papua new guinea, to the Provincial Hospital was completed. Some of the injuries that were seen among the 20 patients who were studied included: three penetrating abdominal injuries with prolapse and strangulation of the intestine; a "sucking" chest wound; bilateral pneumothoraces; two infected open fractures of the radius and the ulna; a perforating injury of the knee with septic arthritis; a hand injury with laceration of multiple tendons; an arterial injury of the wrist; injury of a tibial nerve with foot drop; and a severe scrotal injury with exposure of the testicles. Most injuries resulted from the hunting of feral pigs. Adult male hunters who used dogs and carried only one spear were injured most frequently. Wounds from injuries by pigs are deep, often involve multiple critical structures, and are grossly contaminated. resuscitation requires the administration of fluid and often blood. Treatment includes irrigation, debridement and closure of the wound. The principles of managing such injuries, the prevention of injuries, the ecology of pigs and humans, human infections originating from pigs, and safer methods of hunting pigs are discussed.
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6/8. Trauma and multiple sclerosis. An hypothesis.

    An obligatory event in the pathogenesis of the multiple sclerosis plaque appears to be an increase in the permeability of the blood-brain barrier. Neuropathological observations of the brain of persons suffering from concussion after relatively minor head injury, as well as of animals subjected to experimental brain injury, have shown that alterations of the blood-brain barrier constitute a common result of such trauma. It is postulated that the alterations of the blood-brain barrier secondary to trauma of the brain or spinal cord of patients with already established multiple sclerosis may result in an exacerbation or recurrence of a previously symptomatic plaque, in the appearance of symptoms from a silent lesion, or in the formation of a new plaque in such an area of selected vulnerability. In other persons injury to the nervous system may cause the development of multiple sclerosis plaques in the previously damaged areas when the disease has its onset after the trauma. There is no evidence to support the idea that trauma ever causes multiple sclerosis.
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7/8. Nondomestic mammalian bites.

    life-threatening injuries resulting from wild animal bites are always treated first. Local wound management varies, depending on the type of wound and its location, but scrupulous cleansing and copious irrigation are mandatory. tetanus prophylaxis and rabies prophylaxis are provided according to accepted guidelines. antibiotic prophylaxis is not routinely necessary but is advisable for wounds of the hands or joints and for wounds in immunocompromised individuals.
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8/8. Trauma, axonal injury, and amyotrophic lateral sclerosis: a clinical correlate of a neuropharmacologic model.

    Axonal injury induces cell death in selectively vulnerable motor neurons of immature animals. This extensively studied animal model of trauma-induced motor neuron death is being used to develop the theoretical basis for the therapeutic use of neurotrophic factors to "rescue" dying neurons in amyotrophic lateral sclerosis, Parkinson's disease, and Alzheimer's disease. Antecedent trauma has been implicated as a precipitating factor for amyotrophic lateral sclerosis in susceptible individuals. The animal model of trauma-induced motor neuron death provides support for the concept that motor neurons in individuals susceptible to amyotrophic lateral sclerosis may be selectively vulnerable to trauma producing axonal injury. The case histories of six young adult men who developed amyotrophic lateral sclerosis after trauma with axonal injury are presented.
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