Cases reported "Wounds and Injuries"

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11/34. Bilateral traumatic neuroma of the anterior cervical nerve root: case report.

    STUDY DESIGN: Case report. OBJECTIVES: A rare case of anterior cervical second root traumatic neuroma with no history of trauma is reported, and possible etiology is discussed. SUMMARY OF BACKGROUND DATA: Traumatic neuroma is the reactive, nonneoplastic proliferation in the injured nerve. Several atypical locations of traumatic neuroma have been reported. To date, only 4 cervical traumatic neuroma cases with no history of trauma have been reported, and, to our knowledge, there is no case of bilateral cervical traumatic neuroma published in the literature. methods: A patient with a history of neck and left upper extremity pain, who had hypoesthesia in left C2 dermatome on neurologic examination is presented. A left C2-C3 hemilaminectomy and tumor extirpation were performed. RESULTS: A histopathologic study revealed features of a typical traumatic neuroma. The patient had no deficits on her postoperative neurologic examination, and her neck and left arm pain improved. The unusual location of this lesion and possible etiology of such a traumatic neuroma are discussed. CONCLUSIONS: A rare case of anterior bilateral cervical second root traumatic neuroma with no history of trauma is reported. An unnoticed history of trauma may play an etiologic role in the development of these lesions.
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keywords = neck
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12/34. Mechanical injury of the subthalamic area during stereotactic surgery followed by improvement of trunk, neck, and face tremor--case report--.

    A 50-year-old man had undergone right nucleus ventrointermedius (Vim) thalamotomy 1 year previously, resulting in the disappearance of left hand tremor. However, he presented with right distal and proximal tremor including the axial trunk, neck, and head. deep brain stimulation (DBS) of the left Vim for these symptoms was unsuccessful. Attempts were made to stimulate the left Vim, nucleus ventralis lateralis, and subthalamic nucleus (STN), but no significant improvement was obtained after repeat surgery. However, subsequent improvement of the symptoms including proximal tremor was very marked even without DBS stimulation. Brain magnetic resonance imaging demonstrated lesion and edema in the posteromedial area of the STN. Mechanical injury of the area caused by the surgical procedures may have contributed to the improvement in his persistent symptoms.
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keywords = neck
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13/34. Retrograde intraventricular hemorrhage caused by a traumatic sacral pseudomeningocele in the presence of spina bifida occulta. Case report.

    The authors present the case of a large, posttraumatic sacral pseudomeningocele in the presence of spina bifida occulta. A pseudomeningocele in the sacral region is associated with trauma and with marfan syndrome, but only one occurrence has been reported in association with spinal dysraphism. Trauma resulted in bleeding into the pseudomeningocele and retrograde passage of blood and fat into the ventricles. An oculomotor nerve palsy subsequently developed in the patient. The authors suspected a subarachnoid hemorrhage caused by a posterior communicating artery aneurysm, although this hypothesis was refuted on further investigation. The pseudomeningocele was drained by direct exposure of the neck and opening of the sac. Postoperatively, communicating hydrocephalus developed and the patient underwent ventriculoperitoneal shunt placement, resulting in resolution of the cranial nerve palsies. This first report of intradural bleeding from direct trauma to a pseudomeningocele illustrates the rare phenomenon of retrograde passage of blood from the sacral region to the brain. It also illustrates a possible but unlikely differential diagnosis of intraventricular blood and fat.
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keywords = neck
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14/34. Clothesline injury mechanism associated with all-terrain vehicle use by children.

    OBJECTIVES: Clothesline injury to the face and neck is a unique mechanism of injury seen in children and adolescents on all-terrain vehicles (ATVs). The purpose of this study was to describe this serious and avoidable injury pattern. methods: A search was made of the trauma registry at a major pediatric referral hospital for the years 1998 to 2003 to find cases of clothesline injury associated with ATV use. The data were deidentified and compiled by the research group. The study was deemed exempt by the local institutional review board. RESULTS: Seven cases of neck and/or facial injury were found associated with a child or adolescent on an ATV striking a wire fence or clothesline. All patients were white, including 5 boys and 2 girls. The mean age was 8 years (range, 2-14 years). In most cases (5/7), the child was driving across a field when the wire fence was struck. All patients had significant neck and/or facial lacerations, and 5 of 7 patients were taken to the operating room for wound closure. One patient had functional impairment, and all had lasting disfigurement. The mean initial hospital charges were US22,843 dollars. CONCLUSIONS: Clothesline injury to the neck and face associated with ATV use in children and adolescents is a unique and serious injury mechanism. Because all of these injuries in our series occurred in young children or adolescents who were driving or riding on the front of the ATV, it emphasizes the recommendation that children and young adolescents should not ride or drive ATVs.
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keywords = neck
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15/34. Prediction and prevention of fistulae after major head and neck surgery: a preliminary report.

    A method of checking the integrity of mucosal repair after head and neck surgery using wound amylase levels is described. A low wound amylase concentration allows early resumption of oral intake; an increasing amylase concentration is a strong predictor of subsequent wound breakdown and fistula formation. A regimen has been developed which has prevented fistulae from developing in the small number of patients studied thus far.
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ranking = 2.5
keywords = neck
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16/34. Multiple microvascular transplants: a preliminary report of simultaneous versus sequential reconstruction.

    We review a 10-year experience with multiple microvascular transplants (MMTs) performed on 94 patients undergoing reconstruction of complex extremity and head and neck wounds. One hundred ninety-eight flaps were performed with an overall success rate of 95%. patients were classified into two groups: Group I comprised 38 patients who received simultaneous MMTs (76 total flaps); two flaps were transplanted in the initial operative procedure. Group II consisted of 56 patients undergoing reconstruction with sequentially transplanted MMTs (122 total flaps). The success rates of the two groups were not statistically different (97% vs. 93.4%). Complications were similar in both groups, although sequential reconstruction of lower extremity wounds had a higher frequency of complications and flap failures than the simultaneous method. patients receiving simultaneous MMTs required more emergent reexplorations, but salvage rates were high (87.5%), particularly in upper extremity reconstructions. We suggest that simultaneous MMTs are a reliable, cost-effective method of reconstructing complex injuries. They reduce patient morbidity by eliminating second hospitalizations and reoperations without increased complications or flap failure.
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keywords = neck
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17/34. brown-sequard syndrome associated with posttraumatic cervical epidural hematoma: case report and review of the literature.

    Post-traumatic cervical epidural hematoma is an uncommon entity. A case is presented in which such a lesion developed after chiropractic manipulation of the neck. The patient presented with a brown-sequard syndrome, which has only rarely been reported in association with cervical epidural hematoma. The correct diagnosis was obtained by computed tomographic scanning. Surgical evacuation of the hematoma was followed by full recovery.
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keywords = neck
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18/34. Angiosarcoma of the carotid artery: a case report.

    Angiosarcomas are rare tumors, particularly in the head and neck region. A case report of an angiosarcoma arising in the internal carotid artery is described; such an occurrence has not previously been reported. The etiology, pathology, and treatment of this unusual tumor are discussed.
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keywords = neck
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19/34. Kaposi's sarcoma occurring in a dermatome previously involved by herpes zoster.

    A 31-year-old black man with a history of intravenous drug abuse developed a mass in his neck, a biopsy of which revealed Kaposi's sarcoma. The patient underwent radiation therapy, and the mass diminished in size. Approximately 2 months later the patient developed a herpes zoster infection in the left T3 distribution. The vesicular eruption resolved, but postherpetic neuralgia remained. Two months after the herpes zoster infection, the patient developed many small nodules in the area of the prior vesicular eruption. biopsy revealed these nodules to be Kaposi's sarcoma. At this time no other cutaneous lesions were present. We believe that these nodules represent the occurrence of the Koebner phenomenon in a patient with Kaposi's sarcoma and the acquired immunodeficiency syndrome.
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keywords = neck
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20/34. Pneumomediastinum on a surgical service.

    mediastinal emphysema results from multiple etiologies and is associated with a variety of underlying disease entities. Twenty five patients with pneumomediastinum treated on a surgical service over a 6 year period were reviewed. The cause of the mediastinal emphysema was related to trauma in seven patients, attempted central venous access in four patients, cardiopulmonary resuscitation in four patients and some type of valsalva maneuver in ten patients. Besides the mediastinal emphysema, air may dissect into the peritoneal cavity, the pericardium, and the subcutaneous tissues within the neck and chest wall. Treatment of the mediastinal emphysema, per se, is expectant; success or failure is determined by treatment of the associated underlying problems. Deaths occurred in three patients after cardiopulmonary resuscitation and in one patient after crushing chest injury. One patient with an associated hydrothorax was found to have a perforated distal esophagus which was treated by emergency fundoplication. When associated diseases are absent and there is no evidence of pleural effusion or hydrothorax, no special diagnostic tests are indicated. Sequential chest x-rays are used to follow the pneumomediastinum through resolution, which usually occurs within 72 hours.
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