Development Of Fatal Complications Research Articles

Morphological state of lungs of rats under the influence of Vipera berus berus venom

About 5.4 million snake bite cases are registered worldwide every year. About half of them cause 81,000-138,000 deaths or disabled 400,000 people. Despite this, this problem is neglected in many countries in Asia, Africa and Latin America. It is believed that death from snakebites is associated with poverty since the lack of proper access to medical facilities in such sections of the population causes the development of fatal complications. The purpose of the study is to study the morphological state of rats' lungs under exposure to Vipera berus berus venom. Experimental studies were carried out on white, non-linear male rats. Animals were conditionally divided into control and experimental groups, ten individuals each. Experimental rats were injected intraperitoneally with a semi-lethal dose (LD50) (1.576 mg/g-1) of Vipera berus berus venom in a physiological solution. Animals of the control group were injected intraperitoneally with only a physiological solution. Rats were removed from the experiment 24 hours after exposure to the poison and anaesthetized by cervical dislocation. Lung tissue samples were taken for microscopic examination. Fixation of the material and preparation of paraffin blocks were carried out according to generally accepted methods. Staining of histological preparations of the lungs was carried out with hematoxylin and eosin, according to Masson, and the PAS+"Hale" reaction was carried out according to the Mowry method. Histological preparations were studied using an SEO SСAN light microscope. The toxic effect of Vipera berus berus venom caused significant changes in the vascular, stromal and parenchymal components, which was confirmed by histological, histochemical and morphometric data. In the lungs of experimental animals, the vascular bed is primarily restructured, forming coagulopathies and thrombosis. The development of DIC syndrome and haemorrhages accompanies an increase in the permeability of the vessel wall. Inflammatory phenomena are found in the bronchi and respiratory departments' walls. There is a remodelling of the respiratory department components, with the formation of significant areas of dis- and atelectasis and zones of emphysema, which is confirmed morphometrically.

Модифицированный эндоваскулярный стент-графт у пациента с расслаивающей аневризмой грудной аорты. Клинический случай

Increasement in the diameter of the thoracic aorta ≥ 50% of the norm of 40 mm in men and 34 mm in women (99 percentile) is considered to be an aneurysmal expansion. The risk of rupture is proportional to the size of the aneurysm and is associated with the development of fatal complications. Diagnosis is usually verified by computed tomographic angiography (CTA), magnetic resonance angiography (MRA), or transesophageal echocardiogram. Treatment consists of endovascular stent graft placement or open surgery in combination with optimal medical therapy. The article presents the experience of treating a patient with a dissecting aneurysm of the thoracic aorta type IIIB according to DeBakey using a stent graft modified by a doctor “on table” by forming a fenestration modeled after the anatomy of the left subclavian artery orifice. The aim of the work was to evaluate the short-term and medium-term results and prognosis of treatment using the technique of endovascular prosthesis with a modified graft. Such modifications on the table or in situ make it possible to model the prosthesis according to the variant of the anatomy of a particular patient, which allows optimizing the apposition of the prosthesis, eliminating additional stages of complex surgical treatment, reducing the undesirable effects of standard approaches, including preliminary endovascular occlusion of the left subclavian artery and/or the formation of a carotid-subclavian shunt, reduce the time of stationary observation. The use of the described technique will reduce the radicalness of surgical treatment of patients with dissecting aneurysms and increase economic efficiency. This technique is a promising direction in the development of endovascular and surgery and requires further study to assess long-term results and prognosis in a large number of patients.

Difficulties in the differential diagnosis of intestinal tuberculosis and Crohn‘s disease

The differential diagnosis of intestinal tuberculosis and Crohn’s disease is a difficult task for most specialists due to their high similarity in clinical manifestations, instrumental diagnosis and histological pattern.The aim: to consider the clinical and diagnostic features of intestinal tuberculosis and Crohn’s disease, to show the role of various methods of their diagnosis (CT of the abdominal cavity, CT-enterography, colonoscopy with biopsy).A clinical example shows a case illustrating the difficulties of diagnosing intestinal tuberculosis, initially diagnosed as Crohn’s disease. The features of the course, complex diagnosis and treatment of intestinal tuberculosis and its complications during immunosuppression are demonstrated. At the first stage of treatment, the patient’s data related to CT of the chest organs, colonoscopy and histological examination of biopsy samples were incorrectly interpreted. As a result, a wrong diagnosis of Crohn’s disease was made, and immunosuppressive therapy was prescribed that provoked a generalization of the existing tuberculosis process. Subsequently, repeated surgical interventions were performed for complications of intestinal tuberculosis – perforation of tuberculous ulcers, peritonitis. Based on the analysis of the literature data and our own observation, it is shown that granulomatous inflammation in the study of intestinal biopsies doesn’t always allow us to make a clear diagnosis, first of all, there are intestinal tuberculosis and Crohn’s disease in the differential diagnostic series. The use of histobacterioscopy according to Ziehl – Neelsen, the study of fecal matter by luminescent microscopy, as well as molecular genetic methods for detecting DNA MTB allow us to verify the diagnosis. If Crohn’s disease is misdiagnosed as intestinal tuberculosis, then the prescribed anti-tuberculosis therapy can cause harm and lead to a delay in the underlying disease treatment. The reverse misdiagnosis is potentially more dangerous: if tuberculosis is misdiagnosed as Crohn’s disease, then the appointment of immunosuppressive therapy can lead to the generalization of tuberculosis and the development of fatal complications.

Thiamine deficiency after sleeve gastrectomy

The prevalence of morbid obesity has risen to global epidemic proportions. Bariatric surgery has been proven to be a safe and effective treatment for obesity with weight reduction, resolution of obesity-related co-morbidities, improved quality of life and an increased life expectancy. Sleeve gastrectomy (SG) is the most commonly performed bariatric procedure worldwide. Obesity is associated with micronutrient deficiencies that results in the high prevalence of deficient vitamins status prior to bariatric surgery. After bariatric surgery, these micronutrient and vitamins deficiencies increase or occur de novo, and they may be threatening when left unattended. This presented clinical case demonstrates the clinical features of thiamine deficiency as well as the principles of laboratory and instrumental diagnostics. Electromyo­graphy is an informative method for diagnostic of muscle weakness. The lower serum thiamine level, neurological symptoms and electromyography results are the most important for the diagnosis of thiamine deficiency. Pathogenetic treatment can improve the patient’s condition in a short period of time. Although the SG is a purely restrictive procedure with no malabsorptive component, microelement or vitamin deficiency can occur in patients after procedure. The presented clinical case demonstrates the importance of timely thorough diagnosis and correct treatment of thiamine deficiency in patients after SG. Thus, patients after the LRS in deficiency of vitamin B1 may cause the development of neurological comp­lica­tions of varying severity, in particular dysmetabolic polyneuropathy. This condition is reversed and administration of an adequate and timely substitution therapy in patients with thiamine insufficiency allows be avoided the development of fatal complications.

Results of treatment of myocardial infarction with ST-segment elevation using early and delayed coronary interventions in different age groups

The aim of the study was to assess the treatment results in patients with anterior STEMI using primary PCI in different patient age groups, including those at late hospitalization, taking into account the initial mortality risk (MR). The study included 804 patients with anterior STEMI, aged 28 to 91 years, who were admitted to N. V. Sklifosovsky Research Institute for Emergency Medicine in the period from 2008 to 2017: 583 of them had the primary PCI performed either within the first 12 hours from the disease onset (311 patients) or at late hospitalization: after 12–72 hours (272 patients); and 221 patients treated without PCI. The distribution of patients by age: under 65 years old, 65–75 years old, and over 75 years old was 340, 139, and 104 in the PCI group, and 126, 47, and 48 in the group without PCI, respectively. In 26 death cases after PCI and in 39 of died without interventions, the state of the coronary bed, the affected area, and the immediate cause of death were determined. We have found that in the absence of reperfusion therapy (RT) in STEMI, the initially high baseline MR assessed by TIMI Risk Score corresponds to high mortality. It affects people of predominantly elderly and, especially, senile age, who more often have a proximal lesion of the main coronary arteries, which causes an extensive area of infarction with the development of fatal complications. The use of primary PCIs, including those at late hospitalization, prevents the progression of acute heart failure, the formation of LV aneurysms, and reduces the deaths rate. In different periods of time, the mortality rate with the use of primary PCI, including the delayed ones, fluctuates; it can rise with a significantly increasing number of the hospitalized at senile age. An increase in mortality is associated with complications, including those arising during procedures in severe multivessel coronary artery disease, which is more common in this patient population. Achieving angiographic success even in the absence of ECG signs of reperfusion can significantly reduce mortality in all age groups. High MR is an optimal indication for using delayed procedures. An urgent use of primary PCIs, including those at late hospitalization, allows the optimization of the STEMI treatment, and the achievement of the maximum reduction in mortality.

Intraorbital Abscess: A Rare Cause of Orbit Compression

Introduction: Intraorbital abscess is a rare complication of rhinosinusitis that affects most commonly the pediatric population. It is thought to be caused by direct extension or venous spread of infections from contiguous sites and can lead to life-threatening complications, like permanent visual loss and cerebral abscesses. Objectives: Intraorbital abscess is a rare condition that requires prompt diagnosis and treatment to avoid serious complications. Our objectives are to provide an overview of this rare disease process and its management including our successful treatment experience. Case Description: We present a 2 case report of a 13-year-old pediatric male and a 66-year-old male with history of chronic sinusitis who presented with a right intraorbital abscess successfully treated with external drainage with decompression of the orbit. Conclusion: When intraorbital abscess is encountered, a high index of suspicion is needed to allow prompt and accurate diagnosis for this infrequent condition. Timely surgical drainage of the abscess is needed to prevent the development of fatal complications.

OBESITY EFFECT ON THE COURSE OF ABDOMINAL TRAUMA

The aim was to determine the role of obesity in the development of fatal complications and deaths in victims with abdominal trauma. Materials and methods: The study was conducted on the basis of the Department of Polytrauma at the Municipal Health Care Institution of Kharkiv City Council ”O.I. Meshchaninov City Clinical Hospital of Ambulance and Emergency Care”. The authors have analyzed the case histories of 240 patients with abdominal trauma depending on the presence of obesity, which was determined by BMI (body mass index) and/or waist circumference (WC). Results: Complications were found in 93 (38.8%) victims, 34 (14.2%) victims died. It was found that the overall incidence of complications, respiratory and hemocoagulation complications, the incidence of multiple organ failure (MOF) and mortality significantly increased in obese victims. Determination of obesity by the value of the BMI during hospitalization was possible in 41.7% of victims. The identification of WC turned out to be no less informative, but more accessible. Conclusions: Obesity increases the incidence of complications and mortality in victims of abdominal trauma, and is a marker of a negative prognosis. Traditional assessment of BMI during hospitalization in most victims with abdominal trauma is not possible due to the severity of the condition and/or the presence of combined injuries. A good alternative to determining obesity in victims with abdominal trauma is a WC (more than 88 cm in women and more than 102 cm in men).

Multiple ruptures of major vessels and womb in a parturient woman with Ehlers-Danlos syndrome

Presented herein is a clinical case report demonstrating uncontrolled development of fatal complications in a young parturient woman with vascular Ehlers-Danlos syndrome. The disease had not been known previously. In the third period of natural term delivery we revealed a complete linear vertical uterine rupture with a clinical picture of haemorrhagic shock. After hysterectomy we encountered sequential ruptures of the iliac veins, arteries, abdominal portion of the aorta and inferior vena cava. Attempts at restoring the integrity of vessels followed by ligation thereof, terminating in cutting of vascular walls, with the appearance of new sources of bleeding. The diagnosis was later on verified by the findings of autopsy and genetic typing.

Şanlıurfa’nın Halfeti ilçesindeki akut gastroenteritli çocuklarda rotavirüs ve adenovirüs sıklığı

Background/Aim: Enteric viruses (rotavirus, adenovirus, norovirus, etc.) have been reported as the most common cause of non-bacterial acute gastroenteritis. Rotavirus can cause severe fluid and electrolyte imbalance and the development of fatal complications during the course of the disease if not diagnosed and treated early. The aim of study was to evaluate the frequency, epidemiological characteristics, clinical and laboratory data of rotavirus and enteric adenovirus agents in children presenting with diarrhea. Material and Method: The records of patients with diarrhea between ages of 0-12 who applied to Halfeti State Hospital between July 2017 and July 2019 and diagnosed with acute gastroenteritis and whose rotavirus and enteric adenovirus tests (examined by immunochromatographic methods) were requested were evaluated retrospectively. The frequency of rotavirus and adenovirus gastroenteritis, demographic data, clinical status, laboratory findings of these patients; age groups, gender and seasonal distribution were examined. SPSS 25.0 package program was used for statistical analysis. Results: 640 patients were included in the study. The median age of the patients was 22 months and 57% were male. Rotavirus was detected in 40% of the patients and adenovirus was found in 10.2% of the patients. It was found that the hospitalization rates of children with positive rotavirus were higher than other groups. The children with rotavirus are mostly in winter; children with adenovirus mostly in spring; rotavirus and adenovirus negative children were admitted to the emergency department mostly during the summer months. Conclusion: Viral agents constitute an important part of acute gastroenteritis in our region. It was found that stool examinations were important in the diagnosis of rotavirus and adenovirus gastroenteritis causing high mortality and morbidity. We think that unnecessary antibiotic use will decrease with appropriate treatment and the incidence of the disease and hospitalization cost burden will decrease with increasing rotavirus vaccination rates for Turkey.

Predictors of Hospital Mortality in Patients with Atrial Fibrillation and Stroke

Atrial fibrillation is one of the most common cardiac arrhythmias; it accounts for about a third of all hospital admissions for cardiac arrhythmias. Currently, there is a tendency of aging of the population and an increase in overall life expectancy, which will further lead to an increase in the number of patients with atrial fibrillation.Usually atrial fibrillation is associated with a number of symptoms such as palpitations, interruptions, shortness of breath, pain in the heart area, fatigue, dizziness and syncopal states, but at the same time the course of both paroxysmal and permanent atrial fibrillation may not be accompanied by obvious symptoms or a noticeable decrease in quality life. Such asymptomatic atrial fibrillation is usually diagnosed by chance during an examination and can be considered a clinical finding. According to a number of studies, every third to fifth patient with atrial fibrillation was asymptomatic, and in a recently completed study in patients with paroxysmal atrial fibrillation, more than 50% of all episodes of arrhythmia were asymptomatic. When newly diagnosed atrial fibrillation, the asymptomatic form may occur in 83.2% of cases [1].The purpose of the research is on the basis of studying the clinical features of the course of atrial fibrillation, determine the effect of asymptomatic arrhythmia on the development of fatal complications and patient survival in various forms of atrial fibrillation and develop a therapeutic strategy for managing patients with asymptomatic atrial fibrillation for the first time.

To the Analysis of Correlations Between Clinical Manifestations, Postmortem Pathomorphological and Biochemical Changes in Patients with Polytrauma

The aim of this work was to establish the relationship between the clinical course of polytrauma in persons who died in medical organizations in a relatively remote posttraumatic period with pathomorphological changes in internal organs and postmortal biochemical shifts. Material and methods. The article presents the results of the analysis of 140 cases of death affected with mechanical trauma in the second and third periods of traumatic disease, including the studying of documented material (original medical card hospital patient, expert archival documents), personal conduct expert studies, holding tanatogenesis analysis, evaluation of results of autopsy, postmortem histological and biochemical studies and their comparison with the clinical data described in the medical records. Results. According to the results of the study, it was found that regardless of the terms of hospitalization in the post-traumatic period exceeding 3 days, the results of various “posthumous” studies (the corpse, its organs, tissues and fluids) actually reflect the final traumatic disease of the corresponding period of hospitalization, are not strictly specific, so often do not allow to speak about a specific nosological unit that led to the development of fatal complications. More such studies provide an opportunity to confirm or deny the presence of the described clinical complications premortal period, to determine the tanatogenesis (mechanism of death) and its compliance with the “picture” of dying. Therefore, information from medical documentation about the clinical course of polytrauma, its manifestations and complications, confirmed by in vivo laboratory methods of research and methods of radiation diagnosis, with their proper expert evaluation, are of fundamental diagnostic importance for the scientifically grounded and objective establishment of the main (original) cause of death, developed tanatogenetically significant complications and their relationship with the injury.

Complications with rotavirus: A single center experiences.

Rotavirus is an important morbidity and mortality agent among previously healthy infants. Rotavirus gastroenteritis (RG) causes severe fluid and electrolyte imbalance and development of fatal complications during course of the disease, if untreated. Although there are few case reports in the literature regarding septicemia after RG, it is one of the most important complications of the disease. The main reason of septicemia is unknown but it can be associated with severe consequences such as septic shock, endocarditis, and even death. If complications are taken into consideration on the course of disease, morbidity and mortality can be reduced. Herein, we evaluated the clinical characteristics, incidence and types of the complications during RG in this retrospective study. We evaluated a total of 276 patients (164 male, 112 female) diagnosed with RG between January 2006 and February 2013 at the department of Pediatric Infectious Disease. Male to female ratio was 1.5 and the median age at admission was 12 months (1-102 months). None of the patients had a history of Rotavirus immunization. While overall complication rate was 44.2%, the most common complication related RG was electrolyte imbalance and the second common complication was septicemia (32.6% and 6.5%, respectively). Klebsiella, E. coli and Candida species were the most common isolated microorganisms from the blood cultures. Rotavirus gastroenteritis is still an important cause of morbidity in children which can cause serious complications such as sepsis. Lack of rotavirus vaccine in our national immunization program might contribute to the related complications and prolonged hospitalization, health care expenses and family work loss, as well.

Modern opportunities for optimising the treatment of patients with coronary heart disease and arterial hypertension: role of zofenopril

The wide prevalence (82%) of coronary heart disease (CHD) in combination with arterial hypertension (AH), as well as its initiating role in the development of fatal complications, such as myocardial infarction (MI) or heart failure, emphasise the need for the choice of optimal ACE inhibitors with organ-protective characteristics. This paper presents a literature review on the effectiveness of a SH-containing ACE inhibitor zofenopril in patients with CHD and AH, in terms of its anti-anginal and antihypertensive activity. The authors summarise the results of the international SMILE studies which included patients after acute MI. It was demonstrated that zofenopril therapy is associated with reduced combined incidence of cardiovascular death or cardiovascular hospitalisation, and is also safe in the acute post-MI period. In patients with preserved left ventricular function, zofenopril reduced the incidence of angina attacks and arrhythmias of coronary genesis, as well as improved exercise capacity. A clinical case of zofenopril therapy, as a part of a complex treatment regimen, is also presented.

Ochronosis masquerading as pigmented villonodular synovitis: a case report

Alkaptonuria is an autosomal recessive disorder of tyrosine metabolism with a Mendelian pattern of inheritance. We present a unique, clinically asymptomatic case of ochronosis, first diagnosed on histopathological examination. This case is presented for its rarity. The knowledge of the histopathological changes would help to clinch the diagnosis even when it is not suspected clinically or radiologically, as in our case. An early and appropriate diagnosis would direct conservative therapy rather than major surgeries and would also help in preventing the development of fatal complications.

Immunohistochemical Study of Scrub Typhus: A Report of Two Cases

Scrub typhus is a zoonotic disease caused by Orientia tsutsugamushi, which is transmitted by chiggers. The target cells of this rickettsia are poorly defined in humans. Immunohistochemical staining of tissue sections of patients with scrub typhus is helpful in investigating the target cells of this rickettsia in different organs. We studied two autopsy specimens by immunohistochemical staining using a specific antibody against O. tsutsugamushi. Rickettsiae were located in endothelial cells in all of the organs evaluated, namely heart, lung, brain, kidney, appendix and skin, within cardiac muscle cells and renal tubular epithelial cells, and in macrophages located in the lymph node, liver and spleen. In conclusion, O. tsutsugamushi may disseminate into multiple organs through endothelial cells and macrophages, resulting in the development of fatal complications.

Proteolytic inactivation of plasma C1- inhibitor in sepsis.

Activation of both the complement system and the contact system of intrinsic coagulation is implicated in the pathophysiology of sepsis. Because C1 inhibitor (C1-Inh) regulates the activation of both cascade systems, we studied the characteristics of plasma C1-Inh in 48 patients with severe sepsis on admission to the Intensive Care Unit at the Free University of Amsterdam. The ratio between the level of functional and antigenic C1-Inh (functional index) was significantly reduced in the patients with sepsis compared with healthy volunteers (P = 0.004). The assessment of modified (cleaved), inactive C1-Inh (iC1-Inh), and complexed forms of C1-Inh (nonfunctional C1-Inh species) revealed that the reduced functional index was mainly due to the presence of iC1-Inh. On SDS-PAGE, iC1-Inh species migrated with a lower apparent molecular weight (Mr 98,000, 91,000, and 86,000) than native C1-Inh (Mr 110,000). Elevated iC1-Inh levels (greater than or equal to 0.13 microM) were found in 81% of all patients, sometimes up to 1.6 microM. Levels of iC1-Inh on admission appeared to be of prognostic value: iC1-Inh was higher in 27 patients who died than in 21 patients who survived (P = 0.003). The mortality in 15 patients with iC1-Inh levels up to 0.2 microM was 27%, but in 12 patients with plasma iC1-Inh exceeding 0.44 microM, the mortality was 83%. The overall mortality in the patients with sepsis was 56%. We propose that the cleavage of C1-Inh in patients with sepsis reflects processes that play a major role in the development of fatal complications during sepsis.

後頭蓋窩破裂脳動脈瘤に対する急性期手術の検討

During the past four years, we have treated 29 patients with ruptured posterior circulation aneurysms. To investigate the outcome of this treatment we divided the patients into three groups; an early surgery group, a delayed surgery group, and a no aneurysmal surgery group. Half of these patients were in very poor condition at admission; so only five patients underwent delayed operation. We operated on 10 patients in the acute stage within 72 hours after the last subarachnoid hemorrhage. The outcome for this early surgery group, evaluated on the Glasgow Outcome Scale, was very excellent compared with the other two groups. After the aneurysmal operation we were able to carry out aggressive antispasm treatment, such as hemodilution, induced hypertension and antiplatelet therapy; therefore, the post-operative course in the early surgery group was better. Factors influencing poor prognosis of patients with ruptured cerebral aneurysms are mainly rebleeding and vasospasm. Particularly in the early stage, prevention of rebleeding is thought to be very important. At present it is controversial whether early or delayed operation is more beneficial for ruptured cerebral aneurysms. However, management of delayed operation is very complicated, and the opportunity to operate may be lost with the development of fatal complications. So we strongly believe that, based on this study, early operation is necessary to improve prognosis, even for patients with ruptured posterior circulation aneurysms.

Elevated plasma levels of the anaphylatoxins C3a and C4a are associated with a fatal outcome in sepsis

purpose and patients and methods: Both complement and contact system of coagulation have been implicated in the pathophysiology of sepsis. We therefore measured levels of the complement activation products C 1 C 1 -inhibitor complexes and C3a in serial plasma samples (obtained every six hours) from 48 patients with clinically suspected sepsis, and related these levels to the clinical outcome. C4a was also measured in samples obtained on admission. results: C3a levels were elevated in 47 patients at least once during the observation period. These levels appeared to be considerably higher in patients who died than in patients who survived. This difference was found for the levels on admission (p = 0.0003), as well as for the highest (p = 0.0010) and the lowest (p <0.0001) levels encountered in each patient. The mortality in patients with plasma C3a levels of 13 nmol/liter or less on admission (27 patients) was 33 percent, compared with 86 percent in patients with levels of 14 nmol/liter or more. Patients with septic shock had significantly higher C3a levels than normotensive patients (p values between 0.046 and 0.004). No significant differences in C3a were found between patients who had respiratory distress syndrome and those who did not. C4a levels in plasma samples obtained on admission were elevated in 43 patients. These levels correlated very significantly with C3a levels (p <0.0001), and showed similar associations with a fatal outcome. C 1 C 1 -inhibitor complexes were elevated in 23 patients at least once during the observation period. These patients had significantly higher levels of C4a and C3a than patients with normal amounts of C 1 |C 1 -inhibitor complexes. Patients who died had higher levels of C 1 |C 1 -inhibitor complexes than patients who survived. However, this difference was not significant. conclusion: On the basis of our results, we propose that activation of the complement system via the classical pathway is involved in the development of fatal complications in sepsis.

False Aneurysm of the Aorta Following Penetrating Trauma

LONG-TERM survival with a false aneurysm of the aorta following penetrating trauma is a unique occurrence. Death from rapid exsanguination or cardiac tamponade is the immediate result in over 80% of stab and missile wounds to the aorta, and there is an additional 30% mortality during the first 24 hours in the group of initial survivors. 1 Only the development of a false aneurysm or arteriovenous fistula permits long-term survivals. The following example of false aortic aneurysm secondary to penetrating trauma was unusual in its development and location, had a long asymptomatic period before development of fatal complications, and emphasizes the need to follow well founded dicta of management. Report of Case A 13-year-old boy was stabbed in the left lumbar region on Feb 14, 1962. The embedded knife blade was 6 inches in length and was easily removed. Upon removal there was brisk bleeding which subsided spontaneously. He did