Absence Of Traumatic Injury Research Articles

Spontaneous pneumomediastinum: A comprehensive review of diagnosis and management.

Pneumomediastinum is a rare condition defined by the presence of air in the mediastinum. In the absence of traumatic injury, iatrogenic injury, or clear etiology, it is called spontaneous pneumomediastinum (SPM). Spontaneous pneumomediastinum most commonly occurs in younger individuals and has a self-limiting course with a good outcome. The purpose of the present manuscript is to systematically review the existing literature on SPM evaluation and management for updated clinical understanding of this condition. A literature search was conducted of publications about SPM on MEDLINE/PubMed and Google Scholar by identifying all the articles with key search terms "pneumomediastinum" and "spontaneous pneumomediastinum". Inclusion criteria were case series published in English between 1980 and 2023. In total, 24 case series were selected and reviewed to determine presenting symptoms, clinical signs and predisposing factors associated with spontaneous pneumomediastinum. Most patients were male; the average age at diagnosis was 26.3 years. The most common presenting symptoms were chest pain and dyspnea. The most common exam finding was subcutaneous emphysema, in 35.4% of patients. Only 5.9% had the classic Hamman's sign. Risk factors include history of asthma, history of smoking, and recent physical activity. This manuscript presents an extensive review of relevant literature highlighting the diagnosis and essential management of spontaneous pneumomediastinum.

MANIFESTATIONS OF HYPERPARATHYROIDISM IN JUVENILE WHOOPING CRANES (GRUS AMERICANA).

Juvenile whooping cranes (Grus americana) raised for wild release were found to have an increased incidence of rib fractures at fledging in 2017 compared with the previous 16 years. Serum analysis showed 30-day-old juveniles in 2017 (n = 12) had significantly lower 25-hydroxyvitamin D3 and significantly higher parathyroid hormone concentrations than juveniles in 2010 (n = 6) with no history of rib fractures. Increased serum parathyroid hormone concentrations in the 2017 juveniles persisted to fledging age. Review of dietary and environmental management revealed that juveniles in 2017 were provided a commercial diet with a lower, and perhaps suboptimal, calcium:phosphorus ratio and experienced reduced time outdoors in the first month after hatch, presumably resulting in less ultraviolet B radiation exposure. Mild hyperparathyroidism in precocial whooping cranes may result when dietary constraints and/or outdoor access is compromised and manifest as rib fractures in the absence of traumatic injury.

Atraumatic painless compartment syndrome

Acute compartment syndrome is a time-sensitive diagnosis and surgical emergency because it poses a threat to life and the limbs. It is defined by Matsen et al (Surg Gynecol Obstet. 1978;147(6):943–949) as "a condition in which increased pressure within a limited space compromises the circulation and function of the tissues within that space." The most common cause of compartment syndrome is traumatic injury. A variety of other conditions such as vascular injuries, bleeding disorders, thrombosis, fasciitis, gas gangrene, rhabdomyolysis, prolonged limb compression, cellulitis, and nephrotic syndrome may also cause compartment syndrome. Patients who are elderly, have preexisting nerve damage, or have psychopathology may have an atypical presentation. This case highlights the first report of a 75-year-old woman who developed painless bilateral compartment syndrome in the absence of traumatic injury.

An evaluation of the use of whole-body computed tomography in trauma patients at a United Kingdom trauma centre

We sought to identify the impact of whole-body computed tomography (WBCT) on working and suspected diagnoses in Emergency Department (ED) trauma patients and to determine the rate of WBCT scans with no detectable traumatic injuries. We performed a retrospective database analysis of all trauma patients who underwent WBCT in 2009, comparing pretest suspicion of specific injury to WBCT findings, looking for the rates of unexpected findings and the absence of traumatic injury in WBCT studies. Our results showed that of the 179 patients who underwent WBCT, no traumatic injury reported in 17 patients while 162 patients demonstrated pathology (47 confirming previously suspected or diagnosed injury and 115 with previously unexpected injury). Overall, WBCT results differed from clinical findings in 130 (72.6%) patients, a statistically significant difference (P<0.0001). In conclusion, WBCT identifies previously unexpected injuries in almost 66% of ED trauma patients, supporting its continued use in the initial assessment of trauma patients.

Cervical Spinal Cord, Root, and Bony Spine Injuries

The aim of this study was to characterize cervical cord, root, and bony spine claims in the American Society of Anesthesiologists Closed Claims database to formulate hypotheses regarding mechanisms of injury. All general anesthesia claims (1970-2007) in the Closed Claims database were searched to identify cervical injuries. Three independent teams, each consisting of an anesthesiologist and neurosurgeon, used a standardized review form to extract data from claim summaries and judge probable contributors to injury. Cervical injury claims (n = 48; mean ± SD age 47 ± 15 yr; 73% male) comprised less than 1% of all general anesthesia claims. When compared with other general anesthesia claims (19%), cervical injury claims were more often permanent and disabling (69%; P < 0.001). In addition, cord injuries (n = 37) were more severe than root and/or bony spine injuries (n = 10; P < 0.001), typically resulting in quadriplegia. Although anatomic abnormalities (e.g., cervical stenosis) were often present, cord injuries usually occurred in the absence of traumatic injury (81%) or cervical spine instability (76%). Cord injury occurred with cervical spine (65%) and noncervical spine (35%) procedures. Twenty-four percent of cord injuries were associated with the sitting position. Probable contributors to cord injury included anatomic abnormalities (81%), direct surgical complications (24% [38%, cervical spine procedures]), preprocedural symptomatic cord injury (19%), intraoperative head/neck position (19%), and airway management (11%). Most cervical cord injuries occurred in the absence of traumatic injury, instability, and airway difficulties. Cervical spine procedures and/or sitting procedures appear to predominate. In the absence of instability, cervical spondylosis was the most common factor associated with cord injury.

New Perioperative Cervical Injury

New Perioperative Cervical Injury

Incarcerated spontaneous transdiaphragmatic intercostal hernia

IntroductionProlapse of abdominal viscera into the thoracic subcutis through the chest wall is known as transdiaphragmatic intercostal hernia (TIH). Herein, we present the first case of spontaneous TIH presenting as a thoracoabdominal emergency. Presentation of caseA 78-year-old male presented with acute left thoracoabdominal pain following a sudden bulge at the left posterolateral chest wall corresponding to a partially reducible soft tissue mass with ecchymosis at the overlying skin. Paroxysmal cough during the last four days was also reported along with a prolonged daily application of a special tight abdominal belt that used while milking sheep. CT-scan of the abdomen showed intrathoracic proptosis of the splenic flexure through a defect of the left hemidiaphragm and subcutaneous prolapse of the herniated colon through the 7th intercostal space. On laparotomy, the herniated colon showed signs of ischemic necrosis leading to segmental colectomy followed by repair of the diaphragmatic defect. DiscussionThe clinical diagnosis of spontaneous TIH demands very high index of suspicion and thorough patient's history. In this case the daily elevation of the intraabdominal pressure due to an abdominal milking belt might have caused gradual slimming and loosening of the diaphragm and the intercostals muscles rendering them vulnerable to sudden increases of the thoracoabdominal pressure due to violent coughing. Such a hypothesis is reasonable in the absence of traumatic injury in this patient. ConclusionSpontaneous TIH should be suspected in patients presenting with a sudden palpable chest wall bulge and associated thoracoabdominal symptoms in the absence of preceding injury.

Aumento de tamaño muscular secundario a metástasis de adenocarcinoma gástrico no conocido

Objective To present a case of rare manifestation of metastases as multiple muscular masses. Clinical case A 52 year old male with gastric ulcer as the only history of interest went to traumatology service referring to progressive pain in the left buttock with associated mass effect when walking. Results Imaging tests detected a multiple muscle mass. The biopsies showed signet ring gastric adenocarcinoma metastases. Conclusion The insidious presentation of muscular symptoms in the absence of traumatic injury, should be suspected and the possibility of a tumour assessed.

Increase in muscle mass secondary to metastasis of an unknown gastric adenocarcinoma

Objective To present a case of rare manifestation of metastases as multiple muscular masses. Clinical case A 52 year old male with gastric ulcer as the only history of interest went to traumatology service referring to progressive pain in the left buttock with associated mass effect when walking. Results Imaging tests detected a multiple muscle mass. The biopsies showed signet ring gastric adenocarcinoma metastases. Conclusion The insidious presentation of muscular symptoms in the absence of traumatic injury, should be suspected and the possibility of a tumour assessed.

Anterior Spinal Cord Syndrome After Initiation of Treatment with Atenolol

Anterior spinal cord syndrome is a rare condition with a variety of precipitating factors. Patients typically complain of weakness or paralysis of the extremities, often accompanied by pain, but frequently without a history of trauma. A 48-year-old man presented to the emergency department complaining of neck pain and inability to move his legs in the absence of trauma. Several hours prior he had seen his private physician and was given a dose of atenolol for elevated blood pressure. He had not previously been on medications for hypertension. His neurological examination revealed bilateral paralysis of the lower extremities. In the upper extremities he had weakness and sensory loss at the level of C6. Rectal tone was decreased and without sensation. Cervical and thoracic spine magnetic resonance imaging showed spondylotic disc disease, with disc herniation at C6-7 causing severe spinal canal stenosis. Despite i.v. methylprednisolone, pressors, and a prolonged intensive care unit course, the patient was discharged 5 weeks later with continued neurological deficits. Anterior spinal cord syndrome results from compression of the anterior spinal artery and often occurs in the absence of traumatic injury. The recognition, management, and prognosis of this condition are discussed.