Injection Injury Research Articles

High-Pressure Injection Injuries of the Hand: A Report of Three Cases Presenting With Acute Compartment Syndrome

High-Pressure Injection Injuries of the Hand: A Report of Three Cases Presenting With Acute Compartment Syndrome

Peripheral Nerve Injury After Deoxycholic Acid (ATX-101) Injection in an Experimental Rat Model.

Deoxycholic acid (ATX-101) is a drug administered by subcutaneous injection for local fat reduction. However, ATX-101 treatment has been reported to cause marginal mandibular nerve injury with noticeable functional deficits when targeting submental fat. As a cytolytic agent with some selectivity for adipocytes, ATX-101 may damage the lipid-rich myelin surrounding peripheral nerves. This study seeks to characterize the nerve injection injury from ATX-101 in an experimental rat model. Using a rat sciatic nerve injection model, intrafascicular and extrafascicular injections of deoxycholic acid (ATX-101) were compared to lidocaine (positive control) and saline (negative control). Nerves were harvested at a 2-week endpoint for histomorphometric analysis. Cross-sectional area of nerve injury was significantly increased by ATX-101 injection at 75±15% with intrafascicular ATX-101 (p<0.001), 41±21% with extrafascicular ATX-101 (p<0.01), and 38±20% with positive control lidocaine (p<0.01) compared to 7±13% with negative control saline. Demyelinating injury was a significant mechanism of injury in the affected nerve fibers compared to uninjured nerve fibers (p<0.04), but there was no difference in axon-to-myelin area ratio between the lidocaine and ATX-101 cohorts. After two weeks, Wallerian degeneration was evident with only small regenerating nerve fibers present in the ATX-101-injured groups compared to saline (2.54±0.26um vs 5.03±0.44um, p<0.001) in average width. Deoxycholic acid (ATX-101) is capable of extensive nerve injury in rats. The mechanism of action for ATX-101 does not preferentially target myelin more than other common neurotoxic agents. Appropriate knowledge of surgical anatomy and injection technique is necessary for any practitioners providing ATX-101 injections.

Oxidative modification of miR-30c promotes cardiac fibroblast proliferation via CDKN2C mismatch

The response of cardiac fibroblast proliferation to detrimental stimuli is one of the main pathological factors causing heart remodeling. Reactive oxygen species (ROS) mediate the proliferation of cardiac fibroblasts. However, the exact molecular mechanism remains unclear. In vivo, we examined the oxidative modification of miRNAs with miRNA immunoprecipitation with O8G in animal models of cardiac fibrosis induced by Ang II injection or ischemia‒reperfusion injury. Furthermore, in vitro, we constructed oxidation-modified miR-30c and investigated its effects on the proliferation of cardiac fibroblasts. Additionally, luciferase reporter assays were used to identify the target of oxidized miR-30c. We found that miR-30c oxidation was modified by Ang II and PDGF treatment and mediated by excess ROS. We demonstrated that oxidative modification of G to O8G occurred at positions 4 and 5 of the 5′ end of miR-30c (4,5-oxo-miR-30c), and this modification promoted cardiac fibroblast proliferation. Furthermore, CDKN2C is a negative regulator of cardiac fibroblast proliferation. 4,5-oxo-miR-30c misrecognizes CDKN2C mRNA, resulting in a reduction in protein expression. Oxidized miR-30c promotes cardiac fibroblast proliferation by mismatch mRNA of CDKN2C.

Surgical treatment of high-pressure injection injuries of the hand caused by using paint guns: a report of three serial cases

The incidence of high-pressure injection injuries is increasing with the development of industry and use of injectors. Although high-pressure injection injuries are relatively rare, they commonly lead to complications such as skin necrosis, infection, and amputation. Moreover, the initial presentation is prone to be underestimated because of the small entry point at the patient’s first encounter in emergency care. A prompt surgical intervention is required, with appropriate and rapid initial treatments, including broad-spectrum antibiotics and tetanus toxoid. The surgical treatment involves wide debridement for foreign material removal and subsequent reconstruction. In this case report, we present three cases we encountered and the ensuing complications. All three patients who received the same treatments are discussed in detail.

High-Pressure Injection Injuries of the Hand in Community and Industrial Settings: Incidence and Trends.

High-pressure injection injuries to the hand have been reported in both the community and industrial setting with varying levels of severity. However, there are little epidemiologic data regarding the prevalence of pressure-injection injuries. The purpose of this study is thus to describe trends in emergency department (ED) encounters associated with pressure injection injuries, thereby informing potential investments in research and education for these injuries. The National Electronic Injury Surveillance System (NEISS), a nationally representative database of all ED encounters, was queried for all high-pressure injection injuries from 2012 to 2021. Patient demographic and injury data were collected and analyzed to describe trends in incidence, patient demographics, and sequelae of hand injury associated with an ED encounter for a pressure injection-related injury. There were an estimated 15 307 (95% confidence interval: 15 051-15 562) high-pressure injection hand injuries from 2012 to 2021. Injuries were more frequent on weekends with the highest incidence on Sundays (18.9%) and Saturdays (18.0%) and during late spring and summer months (58.6%), with peak incidence occurring in May (16.8%). High-pressure paint injuries demonstrated a significantly higher rate of infection (23.7% of injuries) than pressure washer injuries (3.7%); however, pressure washer injuries were much more common overall (90% vs 10%). High-pressure injection injuries to the hand and upper extremity represent a particularly concerning injury mechanism. Prompt recognition and proper management are crucial for improving outcomes. People that utilize pressure washers for household projects should be aware of the risks associated with these machines and utilize proper safety techniques.

Is Bipolar Dorsal Root Ganglion Pulsed Radiofrequency Effective in the Treatment of Postinjection Sciatic Nerve Neuropathy: Case Report

BACKGROUND: Nerve injury is a common complication of intramuscular (im) injection and the sciatic nerve (SN) is the most frequently affected nerve. Pain management in neuropathic pain due to sciatic injury is challenging. CASE REPORT: A 66-year-old man admitted with neuropathic pain in his right leg. The pain commenced 6 years ago after an im injection into the right hip. CONCLUSIONS: Interventional treatment methods are not favored in the treatment of SN neuropathy subsequent to injection injury. However, bipolar pulsed radiofrequency treatment to L4-L5-S1 dorsal root ganglia may be an effective intervention in intractable sciatic neuropathy. KEY WORDS: Sciatic nerve, neuropathic pain, bipolar, pulsed radiofrequency, case report

Comparison of Ultrasound Contrast between H2O2-Responsive Nanoparticles and Microbubble Contrast According to Muscle Injury in Rat Models.

Ultrasound contrast agents are clinically used for diagnosis of internal organs, but ultrasound contrast agents are rarely applied clinically in musculoskeletal disorders. Our study aims to comparatively analyze the differences between ultrasonographic images through peri-injury injection of the clinically used microbubble and researched nanoparticle contrast agents in various muscular injury models. To compare contrast-enhanced images in different muscle injury models, we prepared groups of rats with sham, laceration, punch, contusion, and toxin injection injuries. We measured H2O2 levels using the Amplex Red assay by extracting tissue from the damaged area. As comparative contrast agents, SonoVue®, a commercially available microbubble contrast agent, and poly(vanillinoxalte) (PVO) nanoparticles, which are H2O2-responsive nanoparticles, were used. The difference in contrast between the two contrast agents was recorded as an ultrasound movie, and J-image software 1.53p was used to quantify and analyze the maximum and minimum echogenicity values of the images after contrast enhancement. In the Amplex red assay for the highest H2O2 level in each muscle injury model, the maximum level showed 24 h after the modeling. In the sham rats, PVO injection showed no increased echogenicity except at the needle insertion site, but SonoVue® injection showed increased echo signal throughout the injected muscle immediately after injection. One day after the preparation of the lesion, PVO and SonoVue® were injected into the lesion site and ultrasound was performed on the lesion site. After the injection of PVO nanoparticles, contrast enhancement was observed at the lesion site immediately. SonoVue® injections, on the other hand, showed a widespread pattern of echo signals and an increase in echo retention only at the lesion site over time, but this was not clear. There were statistically significant differences between the highest and lowest echogenicity in PVO and SonoVue® contrast-enhanced images in all models. Contrast enhancement lasted more than 3 h in the PVO injection, but disappeared within 3 h in the SonoVue® injection. PVO nanoparticles showed the possibility of physiologic contrast by CO2 generated by conjugation with H2O2 generated by muscle injuries, and SonoVue® injection observed the possibility of microbubble contrast as a contrast agent with a pooling effect that lasts longer on the lesion. Further research is needed to investigate the use of various ultrasound contrast agents, including nanoparticles, in musculoskeletal disorders, as well as the potential for further utilities of microbubble contrast agents.

Late Results of Early End-to-End Repair in Sciatic Nerve Injuries.

Mechanisms of sciatic nerve injury include gunshot injury, sharps injury, injection injury, contusion, femoral fracture injury, and iatrogenic injury due to fracture surgery. Regardless of the type of injury, patients undergoing sciatic nerve repair have poor motor and sensory outcomes. In this study, we compared the late outcomes of a group of patients in whom the author performed an early end-to-end anastomosis for sciatic nerve sharps injury and another group of patients with a similar injury who were not operated on but left to natural history. The sciatic nerve, comprising two primary divisions with distinct muscle innervations, was subject to separate examinations. Group 1 (n=10, study group) underwent tibial division anastomosis, while Group 2 (n=12, control group) received no surgical intervention involving the tibial division. Similarly, Group 3 (n=11, study group) underwent peroneal division anastomosis, while Group 4 (n=14, control group) encompassed subgroups that did not undergo peroneal division surgery. In Group 1, the rate of gain in plantar flexion muscle strength was significantly higher (p < 0.05) compared to Group 2. Furthermore, the sensory examination gain level ratio within the tibial domain was significantly greater (p < 0.05) in Group 1 than in Group 2. Additionally, Group 1 exhibited a significantly higher rate (p < 0.05) of detection of regeneration and reinnervation findings in electromyography (EMG) compared to Group 2. When evaluating the long-term outcomes following early end-to-end anastomoses of the sciatic nerve, it becomes evident that while significant improvements are observed when compared to individuals without anastomosis, the positive impact of surgical interventions on motor and sensory gains in daily life remains limited. Nevertheless, we contend that early surgical intervention holds potential advantages in terms of patient management.

Effectiveness of dorsal perforator flap of cross-finger proper digital artery in treatment of high-pressure injection injuries of the finger

To investigate the effectiveness of dorsal perforator flap of cross-finger proper digital artery in the treatment of finger soft tissue defect caused by high-pressure injection injury. Between July 2011 and June 2020, 14 cases of finger soft tissue defect caused by high-pressure injection injury were repaired with dorsal perforator flap of cross-finger proper digital artery. All patients were male, with a mean age of 36 years (range, 22-56 years). The defects were located on the index finger in 8 cases, middle finger in 4 cases, and ring finger in 2 cases. The causes of injury include 8 cases of emulsion paint injection, 4 cases of oil paint injection, and 2 cases of cement injection. The time from injury to debridement was 2-8 hours, with a mean time of 4.5 hours. The soft tissue defects sized from 4.0 cm×1.2 cm to 6.0 cm×2.0 cm. The flaps sized from 4.5 cm×1.5 cm to 6.5 cm×2.5 cm. The donor site of the flap was repaired with skin graft. The pedicle was cut off at 3 weeks after operation, and followed by functional exercise. All flaps and skin grafts at donor sites survived, and the wounds healed by first intention. Twelve patients were followed-up 16-38 months (mean, 22.6 months). The texture and appearance of all flaps were satisfactory. The color and texture of the flaps were similar to those of the surrounding tissues. The two-point discrimination of the flap was 10-12 mm, with a mean of 11.5 mm. There were different degrees of cold intolerance at the end of the affected fingers. At last follow-up, the finger function was evaluated according to the Upper Extremity Functional Evaluation Standard set up by Hand Surgery Branch of Chinese Medical Association, 3 cases were excellent, 8 cases were good, and 1 case was poor. The dorsal perforator flap of cross-finger proper digital artery can effectively repair finger soft tissue defect caused by high-pressure injection injury. The operation was simple, and the appearance and function of the finger recover well.

Insulin injection and changing injury trends

Learn how increasing rates of diabetes have impacted sharps injuries.

Grease-gun injury of the orbit: two cases report and literature review

BackgroundThe grease-guns injury is an uncommon injury to the orbit. We present the twelfth and thirteenth cases of grease-gun injury to the orbit to be reported in the English language literature since 1964. Here we discus and review the presentation, investigation, and treatment of this unusual trauma.Case presentationCase 1 was a 29-year-old man who presented 1 day after a grease-gun injury of the left orbit with severe pain, marked periorbital swelling, and proptosis. Computed tomography (CT) revealed penetration of grease into his left orbit. Following surgical removal, proptosis decreased. The limitation of extraocular movement and loss of visual acuity to finger count was discovered after the initial surgery. Motility gradually returned. Visual acuity recovered after phacoemulsification, capsular tension ring and intraocular lens implantation for traumatic cataract and subluxation. Case 2 was a 6-year-old boy who was referred 2 months after a grease-gun injury for worsening swelling with sinus, necrosis and slight ptosis of the upper left eyelids. This is a case of orbital chronic inflammation from grease-gun injuries masquerading as orbital cellulitis. The imaging findings of CT and magnetic resonance imaging (MRI) are not typical. Surgical exploration and debridement was inevitable and actually relieved the symptoms.ConclusionsGrease-gun injuries can damage the orbit in different degrees. Careful history inquiry and taking is important to establish the diagnosis. Imaging examinations using CT or MRI are helpful to determine depth of trauma and foreign bodies in the orbit at diagnosis. We suggest that surgical exploration and debridement is a key step in the management.

7-Ketocholesterol Promotes Retinal Pigment Epithelium Senescence and Fibrosis of Choroidal Neovascularization via IQGAP1 Phosphorylation-Dependent Signaling.

Accumulation of 7-ketocholesterol (7KC) occurs in age-related macular degeneration (AMD) and was found previously to promote fibrosis, an untreatable cause of vision loss, partly through induction of endothelial-mesenchymal transition. To address the hypothesis that 7KC causes mesenchymal transition of retinal pigment epithelial cells (RPE), we exposed human primary RPE (hRPE) to 7KC or a control. 7KC-treated hRPE did not manifest increased mesenchymal markers, but instead maintained RPE-specific proteins and exhibited signs of senescence with increased serine phosphorylation of histone H3, serine/threonine phosphorylation of mammalian target of rapamycin (p-mTOR), p16 and p21, β-galactosidase labeling, and reduced LaminB1, suggesting senescence. The cells also developed senescence-associated secretory phenotype (SASP) determined by increased IL-1β, IL-6, and VEGF through mTOR-mediated NF-κB signaling, and reduced barrier integrity that was restored by the mTOR inhibitor, rapamycin. 7KC-induced p21, VEGF, and IL-1β were inhibited by an inhibitor of protein kinase C. The kinase regulates IQGAP1 serine phosphorylation. Furthermore, after 7KC injection and laser-induced injury, mice with an IQGAP1 serine 1441-point mutation had significantly reduced fibrosis compared to littermate control mice. Our results provide evidence that age-related accumulation of 7KC in drusen mediates senescence and SASP in RPE, and IQGAP1 serine phosphorylation is important in causing fibrosis in AMD.

Validation of a Specific Phobia Questionnaire by University Students in Malaysia

Specific phobia is a subcategory of anxiety disorders that remains poor understanding due to inadequate screening tools. This study aimed to develop and validate a new Specific Phobia Questionnaire (SPQ). This SPQ was developed based on literature reviews and inputs from related experts for content validity. The SPQ questionnaire consisted of 14 items and after content validity and face validity testing procedure, 12 items were chosen for the final questionnaire. The questionnaire was then distributed via Google form to university students in Klang Valley. A total of 267 students participated in this study with 70.8% were female with mean age of 23.28 (Standard deviation of 4.98) years. Validity analysis using exploratory factor analysis from the final study indicated that the Kaiser-Meyer-Olkin value was 0.77 and extracted three domains; animals, blood injection injury and situational-environment. Reliability analysis showed that Cronbach’s α values were 0.84, 0.86, 0.78 and 0.72 for the total items, animal, blood injection injury and situational-environment domains, respectively. The newly developed SPQ showed good reliability and validity for evaluating specific phobia.

High-pressure injection hand injury: What lies beneath?

High-pressure injection injuries are true emergencies that require prompt treatment to avoid devastating complications. This article describes the presentation and management of these injuries and provides clear and concise recommendations for intervention by the ED clinician.

An uncommon case of high-pressure paint gun injury to the orbit with multimodality evaluation and literature review.

High-pressure paint injection injury to the orbit is a rare type of orbital trauma. We present an unfortunate case of high-pressure paint injury to the right orbit of a young patient. High-pressure injection injury presents with a unique injury mechanism and resultant deep tissue damage. The superficial appearance of the entry site injury is deceiving; therefore, a thorough evaluation is necessary. Debridement is usually required if foreign body material is present. Antibiotics and steroids are commonly used in such cases.

High-pressure injection injury to the hand - a case report

High-pressure injection injury to the hand - a case report

Management of Hand Injuries: a Six-year Experience from Komfo Anokye Teaching Hospital, Kumasi, Ghana

Background: Hand injuries can ruin patients’ ability to work with their hands. This could lead to depression and social isolation. It is imperative that hand injuries be reconstructed to as near normal as possible.Patients and Method: A prospective study was undertaken from January 2005 to December 2010 at the Komfo Anokye Teaching Hospital, Kumasi, Ghana to document the pattern of hand injuries, and the outcome of management. The patients were evaluated clinically. Wound debridement was done; the defects were repaired using reconstructive techniques matched to the type of injury.Result: Ninety-five patients (71 males) were treated. Male: female ratio was about 3:1. Their ages ranged from 2 to 60 years with mean (± SD) of 29.5 (± 12.9). Of the 102 hands injured, 52 were right. The right was the dominant hand in 65%. Both dominant and nondominant hands were injured equally. 5% of the injuries were isolated; 95% were combined. The distribution of mechanisms of injuries was as follows: avulsion, sustained through road traffic accidents (37%), crush injuries (25. 3%), sharp injuries (including spaghetti wrists) (19%) machine mangling (11%), burns (8.4%), blunt injuries (15%), human bites (2.1%), snake bite (1.1%), gunshot (4.2%), and injection injuries (2.1%). Patients’ occupations were: farmers 23%, mechanics (20%), traders (11%), factory workers (5%), followed by 2% each of teachers, electricians and civil servants, and 1% each of drivers and pastors; 5% were unemployed. Ofthe remainder, 16 % were children and 11% students. Surgical procedures performed were groin flap (30%), exploration and repair (24%), skin grafting (21%), debridement alone (13%) cross finger flap (7%). decompression of carpal tunnel,(3%) and terminalisation(2%)Conclusion: Severe hand injuries requiring reconstructive surgery were sustained through road traffic accidents Farmers, traders, mechanics and children are at risk of severe combined hand injuries.

High-Pressure Injection Injury to the Hand With Resulting Pneumomediastinum: A Case Report

BackgroundHigh-pressure injection injury is an uncommon but potentially limb-threatening presentation that in many cases should be treated as a surgical emergency. Case ReportWe present a 46-year-old patient with a high-pressure injection injury from SCUBA equipment who developed pneumomediastinum. Why Should an Emergency Physician Be Aware of This?High-pressure injection injuries are rare and may have significant morbidity. Injection injuries from air are uncommon, may be managed differently than injection with other materials, and may be associated with unique complications.

High-Pressure Injection Injury to the Hand - A Case Report.

Hand, orthopedics, x-ray, high-pressure injection injury.

Forensic Examination of Six Homicide Injection Cases.

To retrospectively analyze homicide cases of death after injection and provide reference for forensic identification. Six homicide cases of death after injection which were investigated by the Criminal Investigation Team of Shanghai Public Security Bureau were collected and analyzed, including case situation, scene investigation, autopsy and other materials. The 6 cases were premeditated crimes, 5 cases took place in private spaces, and 5 cases involved the victims approached by suspects' decoy. There were no obvious abnormalities at the scene of the 6 cases. In 6 cases, the victim's body surface injury was mild or no, lividity color was abnormal, and the needlestick injury showed different manifestations from conventional medical measures. Death after injection is a highly concealed crime and easy to be ignored. For the suspected injection injury found in autopsy, it is necessary to carefully examine, identify and analyze, be alert to the situation of injecting poison (drug) and do a good job in evidence fixation and material extraction.