Horn Injury Research Articles

Inguinal hernia resulting from bull horn injury

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Halofuginone- and Chitosan-Coated Amnion Membranes Demonstrate Improved Abdominal Adhesion Prevention

Our objective was to determine whether coating the amniotic membrane with halofuginone, a type 1 collagen synthase inhibitor, with or without the hemostasis-inducing substance chitosan, reduced the number and severity of adhesions in the rat uterine horn injury model. Sixty retired breeder Sprague-Dawley rats underwent midline laparotomy and a zone of ischemia was created in the left uterine horn of each animal. Rats were randomized to one of six treatment groups: (1) untreated control, (2) oxidized regenerated cellulose (Interceed®) (ORC), (3) plain amnion, (4) amnion coated on both sides with 0.5% solution of halofuginone (HAH), (5) amnion coated on one side with 0.5% halofuginone and on the other side with chitosan (CAH), or (6) amnion coated on both sides with chitosan (CAC). The zone of ischemia in each left uterine horn was wrapped in each treatment. Rats were sacrificed 2 weeks after laparotomy, and adhesions were counted and scored for severity. Data were analyzed using Chi square and a p <0.05 was considered significant. Our results showed that there were no differences in the percentage of animals with adhesions in the untreated, ORC, plain amnion, or CAC groups. No adhesions formed in any animal in the HAH group and only 14% of the animals developed adhesions to the uterine horn in the CAH group (p < 0.05). The percentage of animals with moderate and severe adhesions did not differ between untreated controls and the ORC groups, but were significantly reduced in all four of the amnion groups: plain amnion, HAH, CAH, and CAC (p < 0.05). Amnion coated with halofuginone alone or in combination with chitosan reduced the percentage of animals with adhesions, as well as the percentage of animals with moderate and severe adhesions compared to untreated controls and the ORC group in the rat uterine horn injury model. Amnion alone or coated with chitosan reduced the percentage of rats with moderate and severe adhesions, but not the percentage of rats with adhesions of any type compared to both untreated controls and the ORC group in the rat uterine horn injury model.

A Prospective Study of Penetrating Abdominal Trauma at the University of Calabar Teaching Hospital, Calabar, Southern Nigeria.

Abdominal injuries are on the increase in both developed and developing countries. The frequency of penetrating abdominal trauma (PAT) varies across the globe because it relates to industrialization, the weapons available, and the presence of military conflicts. This study sought to evaluate the current pattern and outcome of managementof PAT in Calabar, which is undergoing rapid urbanization, and with a focus on tourism. Patients admitted to the University of Calabar Teaching Hospital, Calabar with PAT from February 2005 to January 2008 were prospectively studied. Seventy-nine patients presented with abdominal trauma, among which 39 (49%) were PAT. There were 37 males and two females, whose ages ranged from 5 to 54 years (mean 27.8 years). Stab wound (18; 46.1%) was the commonest injury, while gunshot wound (15; 38.5%) ranked second. Others were road traffic accident (two patients), fall, cow horn injury, shrapnel, and criminal abortion (a patient each). The commonest injury was evisceration of the omentum and small intestine, which occurred in 13 (36%) patients. Five (14%) patients suffered small intestinal perforations, while three (8%) had liver, splenic and colonic injuries, respectively. Others were rectal injury (four patients), mesenteric injury and perforated stomach (two patients each), and a patient with diaphragmatic injury. The outcome was fatal in two (5%) patients. Penetrating abdominal trauma is on the increase in Calabar. The pattern of injury revealed areas which, when effectively contained, will lead to an improvement in the safety of our environment.

Nonobstetric lower genital tract injuries in rural India

Objective To study the impact of nonobstetric genital tract injury (NOGTI) in rural India. Methods A prospective observational study of 52 consecutive women admitted with NOGTIs caused by voluntary coitus or accidental injury. Details of the causes of trauma, clinical presentations, and management were recorded. Results A total of 17 women (32.7%) presented with coital trauma, while 35 women (67.3%) sustained noncoital injuries: bicycle/automobile accidents (10); fall from height (7); cattle horn injury (7); straddle-type trauma (6); leech bites (3); and vaginal foreign bodies (2). Most women had multiple injuries; 15 women developed vulvar hematomas and 3 had anorectal lacerations. Management included immediate resuscitation along with primary repair of injuries, evacuation of vulvar hematomas, and removal of vaginal foreign bodies. Fifteen women (28.8%) required blood transfusions; none of the women died. Conclusions Severe hemorrhage caused by NOGTIs is potentially fatal in rural settings if treatment is delayed. Prompt resuscitation, early referral, and appropriate surgical intervention can avert both morbidity and mortality.

Complication following primary repair of a penetrating bull horn injury to the trachea

A 22-year-old male patient was admitted to the casualty with a bull horn injury in the lower zone of the neck in the midline. The patient was conscious and distressed but hemodynamically stable. Local examination revealed a lacerated wound. He underwent emergency primary repair of the wound under halothane anesthesia; intubation was done keeping in readiness all preparations for difficult airway management. Postoperatively, elective controlled ventilation was performed with continuous infusion of muscle relaxant. After approximately 8 hours of controlled ventilation, the syringe pump failed; this initially went unnoticed and made the patient cough and buck on the tube. Infusion was restarted after a bolus dose of vecuronium bromide intravenously but, meanwhile, the patient developed subcutaneous emphysema in the neck. He was immediately transferred to the operating room, where exploration of the surgical site revealed dehiscence of the tracheal wound; this had led to the subcutaneous emphysema. Repair of the tracheal wound dehiscence was not possible due to both lack of space and lack of tissue for apposition. Hence, a tracheostomy tube was inserted through the tracheal wound and the patient was transferred to the intensive care unit for elective controlled ventilation. The patient was weaned off the ventilator within 24 h and transferred to the surgical ward on spontaneous ventilation with the tracheostomy tube in situ. The size of the patient's tracheostomy tube was reduced gradually by the serial exchange method. The wound ultimately healed with minimal scarring.

Herida penetrante orbitaria por asta de toro

Bull horn injuries are severe lesions with a high risk of bacterial contamination, and are common in countries where people are fond of bullfighting and related spectacles. A 19-year-old man was referred with a penetrating wound in the superior left eyelid produced by a bull horn and resulting in a fracture of the orbital roof and a fat hernia. Prophylactic antibiotics and tetanus toxoid were administered and surgical reconstruction of the wound performed. Orbital cellulitis did develop, but this responded to systemic antibiotic therapy within a few days. Successful treatment of this type of lesion requires early diagnosis, meticulous surgical exploration and appropriate use of prophylactic antibiotics and tetanus toxoid.

Crosslinked hyaluronan hydrogels containing mitomycin C reduce postoperative abdominal adhesions

To evaluate the efficacy of crosslinked hyaluronan (HA) hydrogels that contained covalently-bound mitomycin C (MMC) in reducing postoperative adhesions in a rat uterine horn model. Two independent parameters were investigated: [1] the quantity of MMC in preformed crosslinked hydrogel films and [2] the efficacy of intraperitoneal injection of in situ crosslinkable solutions. University animal research facility. Female Wistar rats. Injuries (3 x 10 mm) were made to contacting serosal surfaces of the medial uterine wall musculature in female rats. Two treatment protocols were used. In the first, sterile crosslinked HA films that contained different MMC loadings (0, 0.5%, and 2%) were applied to two injured uterine horns; control animals received no films. In the second protocol, MMC-loaded crosslinked HA gels that contained different MMC loadings (0.31%, 0.625%, and 1.25%) were spread on the site of uterine horn injury (1 mL); then, an additional 4 mL of the same formulation was injected into the peritoneal cavity after abdominal closure. Control animals were injected with 5 mL of buffer only. Extent of postoperative adhesions between uterine horns and with surrounding tissues and organs. Mitomycin C-loaded crosslinked HA films and in situ crosslinked gels were more effective in reducing postoperative adhesion formation than were buffer controls or crosslinked HA films without MMC. Mitomycin C-loaded crosslinked HA films and gels reduced formation of postoperative intraperitoneal adhesions.

Une discipline atypique : la chirurgie taurine. À propos de deux observations

Many of bullfighters had been seriously injured, even sometimes killed during the fight in the bullring (around 300 deads since the beginning of the 20th century). There is no comparison between bullfight's traumas and civil or war traumas, so only specialized medicine doctors and surgeons can be involved for practising. Surgery of bullfighting is a single speciality. The bullfight's surgeon in safekeeping will operate immediately in the bullfight place's infirmary and will aim at reducing the deep effect of horn injury. In this work, authors point out the bullfight pathology's complexity and its surgical treatment by presenting two original cases.

Phospholipids reduce adhesion formation in the rabbit uterine horn model

Objective: To access the ability of intraperitoneal phospholipids to reduce adhesions in a standardized model for gynecologic operations. Design: A randomized, experimental, blinded study using the double uterine horn model. Setting: Academic animal research laboratory. Animal(s): Thirty-three Chinchilla rabbits. Intervention(s): Phospholipids or Ringer’s lactate were intraperitoneally administered after bilateral uterine horn injury. Main Outcome Measure(s): After 10 days, adhesions were evaluated concerning area and strength as well as scores describing tenacity and degree. Result(s): Phospholipids (median 102.1 mm 2) significantly reduce adhesion areas in comparison to surgical controls (median 392.2 mm 2) and Ringer group (median 323.8 mm 2). Scores reflecting severity and degree of adhesions support this finding. Conclusion(s): These results prove the efficacy of phospholipids in the double uterine horn model. Future clinical studies are recommended.

Causes of mortality in wild captive ruminants of Maharajbag Zoo, Nagpur

The most common cause of mortality in Chital and Nilgai was found to be hemorrhagic shock due to traumatic injuries (8). Chital and Nilgai (1 each) had dislocation of vertebral column and three animals were found to have wounds or several injuries. One male Chital succumbed to death due to fracture of femur and shock during shifting operation, whereas, horn injury of thorax and abdomen due to infighting during rutting season was noticed in two male Chitals. Acharjyo and Rao (1987) reported 18.59 per cent deaths in captive wild ruminants due to traumatic injuries (85 out of 457). The workers attributed the traumatic injuries to capture operations for management/ disposal/transfer from one enclosure to the other, interand intra species fighting and fighting during rutting season. Paikne et al. (1990) also opined that fractures are common during rutting season. Deaths due to traumatic injuries and shock in seven males and one female in the present investigation supports the view of the earlier workers.

Prevention of postoperative adhesion formation in rat uterine horn model by nimesulide: a selective COX-2 inhibitor.

Pelvic surgery is one of the main causes of intraperitoneal (i.p.) adhesions that create various medical problems including pelvic pain, bowel obstructions and female infertility. A rat model was used to investigate the efficacy of nimesulide, a selective cyclooxygenase-2 inhibitor, in the prevention of adhesion formation. Fifty Wistar-Albino rats underwent bilateral uterine horn injury with a unipolar cautery. Study groups were as follows: (i) control group, no adjuvant therapy; (ii) i.p. Ringer's lactate group, 2 ml Ringer's lactate solution was instilled i.p.; (iii) i.p. Ringer's lactate plus nimesulide group, 1 ml Ringer's lactate plus 1 ml nimesulide (0.5 mg/ml) were given i.p.; (iv) intramuscular (i.m.) nimesulide group, 1 ml i.m. nimesulide (0.5 mg/ml) was given preoperatively for 5 days; and (v) i.p. nimesulide group, 1 ml nimesulide (0.5 mg/ml) was instilled i.p. At the end of the study all animals were killed, and a standard adhesion scoring system was applied by a blinded examiner. The mean adhesion extent in study groups was as follows: 1.33 +/- 0.76 in control group, 1.40 +/- 0.90 in i.p. Ringer's lactate group, 0.75 +/- 0.70 in i.p. Ringer's lactate plus nimesulide group, 0.25 +/- 0.44 in i.m. nimesulide group and 0.31 +/- 0.70 in i.p. nimesulide group. The mean +/- SD adhesion severities of control, i.p. Ringer's lactate, i.p. Ringer's lactate plus nimesulide, i.m. nimesulide, and i.p. nimesulide groups were 0.58 +/- 0.35, 0.30 +/- 0.41, 0.27 +/- 0.3, 0.12 +/- 0.28 and 0.15 +/- 0.35 respectively. The lowest adhesions were found in the groups treated with nimesulide i.m. and nimesulide i.p. ( P < 0.05). This study showed that preoperative i.m. or postoperative i.p. administration of nimesulide to the site of injury reduced the formation of postoperative adhesions in a rat uterine horn model.

Chronic, Selective Forebrain Responses to Excitotoxic Dorsal Horn Injury

Intraspinal injection of the AMPA/metabotropic receptor agonist quisqualic acid (QUIS) results in excitotoxic injury which develops pathological characteristics similar to those associated with ischemic and traumatic spinal cord injury (SCI) (R. P. Yezierski et al., 1998, Pain 75: 141–155; R. P. Yezierski et al., 1993, J. Neurotrauma 10: 445–456). Since spinal injury can lead to partial or complete deafferentation of ascending supraspinal structures, it is likely that secondary to the disruption of spinal pathways these regions could undergo significant reorganization. Recently, T. J. Morrow et al. (Pain 75: 355–365) showed that autoradiographic estimates of regional cerebral blood flow (rCBF) can be used to simultaneously identify alterations in the activation of multiple forebrain structures responsive to noxious formalin stimulation. Accordingly, we examined whether excitotoxic SCI produced alterations in the activation of supraspinal structures using rCBF as a marker of neuronal activity. Twenty-four to 41 days after unilateral injection of QUIS into the T12 to L3 spinal segments, we found significant increases in the activation of 7 of 22 supraspinal structures examined. As compared to controls, unstimulated SCI rats exhibited a significant bilateral increase in rCBF within the arcuate nucleus (ARC), the hindlimb region of S1 cortex (HL), parietal cortex (PAR), and the thalamic posterior (PO), ventral lateral (VL), ventral posterior lateral (VPL), and ventral posterior medial (VPM) nuclei. All structures showing significantly altered rCBF are associated with the processing of somatosensory information. These changes constitute remote responses to injury and suggest that widespread functional changes occur within cortical and subcortical regions following injury to the spinal cord.

EYE INJURIES CAUSED BY COW HORNS

Purpose: To assess ocular injuries caused by cow horns; to investigate clinical findings, treatment, and visual outcome in a population of dairy farmers; and to propose possible preventive measures. Methods: A retrospective review was conducted to identify patients seen over a 45-month period with cow horn-inflicted eye injuries. Eleven patients were identified and their charts reviewed for demographics, mechanism of injury, initial and final visual acuity, surgeries performed, and anatomic outcome. Results: The mean age of the patients was 64 years. Seven patients had open-globe injuries with vitreous hemorrhage. In five cases, pars plana vitrectomy was performed. Final best-corrected visual acuity was≤ hand motion in five patients, between 20/160 and 20/80 in three patients, and better than 20/32 in three patients. Conclusion: The majority of the cow horn injuries studied caused severe permanent impairment of vision. Owing to the blunt nature of the horns, a significant amount of energy is imparted into the eye. To prevent these injuries, coagulation of the horns should be performed 2 weeks after a calf's birth or farmers should be advised to wear safety glasses.

Reduction of Postsurgical Adhesion Formation in the Rabbit Uterine Horn Model with Use of Hyaluronate/ Carboxymethylcellulose Gel

Objective: To assess the efficacy of a bioabsorbable gel for reducing primary postoperative adhesions. Design: A randomized, prospective, blinded study. Setting: Academic research environment. Animals: Forty-one New Zealand rabbits. Intervention(s): A chemically modified hyaluronate and carboxymethylcellulose (HA/CMC) gel formulation was applied to a bilateral uterine horn injury. Postoperative adhesions were assessed at a second-look laparoscopy. Main Outcome Measure(s): The uterine horn model was shown to be adhesiogenic, with 29 (70%) of 42 untreated uterine horns found to have adhesions. After gel treatment, 22 (55%) of 40 uterine horns were free of adhesions compared with 12 (30%) of 42 controls. Result(s): Animals treated with HA/CMC gel had significantly reduced postsurgical adhesion scores when compared with controls. Conclusion(s): Treatment of injured uterine horn with HA/CMC gel resulted in a significant reduction in postoperative surgical adhesions.

A pilot study of cyclosporine for the prevention of postsurgical adhesion formation in rats

OBJECTIVE: Our purpose was to evaluate the efficacy of cyclosporine in preventing primary postsurgical adhesions in the rat model. STUDY DESIGN: Thirty-two Sprague-Dawley rats underwent unilateral uterine horn injury with a combination of unipolar and bipolar cautery. Sixteen of the rats were randomized to the treatment group and received preoperative and daily cyclosporine dosing (10 mg/kg) by gavage for 14 days. At the end of the study all animals were killed, and a standard adhesion scoring system was applied by a blinded examiner. RESULTS: Adhesions were present in 75% of rats in both groups. Treatment did not affect the total adhesion score. CONCLUSION: Cyclosporine does not appear promising as a means to decrease postsurgical adhesion formation.

Behavioral and autonomic correlates of the tactile evoked allodynia produced by spinal glycine inhibition: effects of modulatory receptor systems and excitatory amino acid antagonists

Intrathecal administration of glycine (strychnine) or GABA (bicuculline) but not opioid (naloxone), adrenergic (phentolamine) or serotonin (methysergide) receptor antagonists resulted in a dose-dependent organized agitation response to light tactile stimulation. This effect was maximally evoked by oscillating but not continuous stimulation applied to a dermatome corresponding to the levels of spinal cord acted upon by the intrathecal antagonist. Similar results were observed in chloralose-urethane anesthetized rats in which tactile stimulation evoked hypertensive responses following local tactile stimuli. The effects were only mildly depressed by even high doses of spinal morphine or DADL and not at all by ST-91 or baclofen. In contrast, intrathecal injections of glutamate receptor antagonists resulted in a dose-dependent depression of the strychnine evoked hyperesthesia with the ordering of activity being MK.-801, AP-5, kynurenic acid, SKF10047 and ketamine. At doses below those which produced motor dysfunction, however, these agents had no effects on the hot-plate response latency. These data emphasize that low threshold afferent input is likely subject to an ongoing modulation, the loss of which results in a miscoding of the afferent stimulus yielding a pain relevant message. The lack of effect of agents having a powerful effect on somatic pain stimuli and the converse effects of glutamate receptor antagonists on the strychnine hyperesthesia at doses which do not affect the somatic pain response indicate discriminable processing systems, the characteristics of which resemble the clinical phenomenon observed in patients suffering from sensory dysesthesia following central and peripheral horn injury.

Reduction of postoperative pelvic adhesions in the rabbit with Gore-Tex surgical membrane

Gore-Tex (W.L. Gore and Associates, Inc., Flagstaff, AZ) surgical membrane (SM), a nonreactive expanded polytetrafluoroethylene (PTFE), was used in 24 mature New Zealand rabbits (2200 to 3000 gm) to cover 2-cm2 ischemic defects in the pelvic sidewall peritoneum to reduce adhesion formation in a rabbit pelvic sidewall/uterine horn injury model. SM was randomly assigned to cover one defect; the opposite defect remained uncovered, each animal serving as its own control. Rabbits were sacrificed 3 weeks later, and adhesions between uterine horn and pelvic sidewall or SM were scored for extent (0 to 4), type (0 to 4), and tenacity (0 to 3). Injury sites were removed en bloc for histologic study. The mean (+/- standard deviation [SD]) adhesion score for SM-covered lesions (4.3 +/- 1.8) was significantly lower than for controls (9.1 +/- 2.5) (P less than 0.001; Wilcoxon Signed Rank test). By histology, none of 24 SM-covered lesions demonstrated adhesions to the membrane itself, whereas 19 of the 24 control lesions showed dense adhesions to the injury site (P less than 0.001; chi-square test). By both gross and microscopic assessment, SM was nonadherent to the underlying sidewall defect in 100% of cases. In conclusion, Gore-Tex surgical membrane is an effective barrier for reducing primary adhesions in this pelvic injury model and offers promise for adhesion reduction in human pelvic surgery.

Bull horn injury: a clinical study

Seventy-three cases of bull horn injury from a predominantly rural population around Allahabad were admitted to our unit between 1966 and 1975. Injury to the deep viscera is uncommon and the possible explanations of this pattern of injury are discussed. The abdomen was the commonest site of injury with prolapse of loops of small intestine in 60 per cent of cases. Management differs from other penetrating abdominal wounds and simple cleansing and careful examination of the bowel is sufficient in those injuries with prolapse of the intestine.

SPONTANEOUS LUXATION OF THE EYEBALL

There is little to be found in ordinary textbooks on ophthalmology on the subject of spontaneous luxation of the eyeball. Some confusion has resulted because of the use of the synonymous terms dislocation and The word avulsion, while in no sense a synonym of these two words, when applied to the eyeball does describe a condition which may result from the same type of injury that can cause luxation. Berens1mentioned luxation as being due to injury. Fuchs2and others mentioned instances of luxation of the eye which occurs traumatically in certain barbarous tribes in which gouging of the eyes in fights and brawls is practiced. A cow horn injury has been known to luxate a human eyeball, the horn acting as a lever and the orbital margin as a fulcrum. One old report (DeWecker, cited by Parsons3) was of a pugilist who snatched his eye