Nontraumatic Conditions Research Articles

A CASE OF ACUTE RENAL FAILURE CAUSED BY ACUTE EXERTIONAL RHABDOMYOLYSIS

Rhabdomyolysis may often be associated with myoglobinuria and acute renal failure. Known responsible factors include crush syndromes due to severe trauma or nontraumatic conditions such as infections, myopathies, alcohol, drug intoxication and hard exercise. We reported a case of acute renal failure developed by rhabdomyolysis and myoglobinuria occurring after hard exercise. Laboratory findings on admission revealed elevated serum CPK, LDH, transaminase, BUN and creatinine levels. Furthermore, a markedly increased serum myoglobin levels as high as 4, 800ng/ml was noted. After hemodyalysis for 18th days, the patient could be well toward diuretic phase, resulting in an uneventful recovery.

Role of external cardiac compression in truncal trauma.

External cardiac compression (ECC) was originally developed for patients with nontraumatic cardiac conditions, but it is now used for a wide variety of emergency conditions. As an integral part of cardiopulmonary resuscitation (CPR), ECC coupled with forced pulmonary ventilation may NOT be applicable to cases of cardiac arrest following penetrating and blunt thoracic and abdominal trauma. Review of 100 patients with penetrating or blunt truncal trauma who received CPR and ECC more than 3 minutes prehospital revealed NO survivors despite continued aggressive resuscitative efforts in 49 of the patients upon arrival at a trauma center. Major cardiovascular disruption was found at thoracotomy or autopsy in all patients. In another 12 patients receiving forced ventilation and prehospital ECC, air embolism to the coronary arteries was the cause of death. CPR by paramedics, physicians, nurses, or lay persons does not appear to be of value in patients who have sustained cardiac arrest from truncal trauma.

Futility of skull radiography for nontraumatic conditions

Indications for post-traumatic skull radiographs have been well publicized, and "high-yield" criteria have been established. Such criteria have not been established for patients without trauma. We report a review of 157 consecutive skull series taken for nontraumatic conditions. Skull radiography was found to be extremely "low yield" in the evaluation of the nontraumatized patient--only 4.5% of the films showed significant abnormalities related to the patient's diagnosis. Moreover, regardless of radiographic results, skull films had little impact on further diagnostic workup or on patient management. Our results suggest that more stringent criteria should be considered in ordering skull radiographs for nontraumatic indications.

Changes due to trauma in the fat plane overlying the supinator muscle: a radiologic sign.

Aradiolucent fat plane may be recognized parallel to the ventral aspect of the proximal one third of the radius in virtually all normal lateral radiographs of the elbow. Alterations are seen in trauma or inflammatory disease processes. Recognition of widening, blurring, and ventral displacement is often useful in interpretation. It has been found to be particularly helpful in subtle fractures of the.head and neck of the radius. Anatomic Observations A twenty-three year old male fell on his outstretched hand (Case I). The lateral view of the opposite normal elbow, Figure 1, A, illustrates a well defined radiolucent line (arrowheads). It arises from the elbow joint and runs distally in a gentle ventral curve parallel to the proximal third of the radius. In contrast, the usual distortion associated with radial head and neck fracture is demonstrated in Figure 1, B with the fat line widened, blurred, and ventrally displaced. Figure 1, C is an oblique view, obtained because of the soft-tissue findings, which illustrates a fissure fracture of the radial head which was not evident in the frontal film. The location of the fat line was established by anatomic dissection of the cadaver elbow joint in which the fat plane was observed radiologically in the true lateral projection prior to the dissection. The immediate posterior relations of the fat plane are the supinator muscle and the proximal end of the radius. The principal anterior relations are the pronator teres and the brachioradialis muscles. In the majority of adults, the fat plane lies within one cm from the ventral margin of the radius. In patients with very muscular arms, this distance may range up to 1.3 cm. The variation between two normal sides is usually only 1 to 2 mm, whereas the difference noted with a fracture is invariably much greater. Radiologic Observations Two hundred and fifty consecutive cases of elbow trauma were reviewed. During the period of study a lateral film of the opposite normal elbow was obtained for comparison. The records of an additional 50 adult patients with nontraumatic conditions, principally arthritides and infections of the elbow joint, were also reviewed. Fifty pediatric cases of elbow injury from Winnipeg Children's Hospital and Montreal Children's Hospital were also assessed in a similar manner. Radial head and neck fractures constitute the group of greatest interest because this type of fracture may be overlooked in the initial radiologic assessment. In all radial head and neck fractures observed, supinator fat plane changes were present. Another constant feature was the radiologic sign of elbow joint effusion. Several fractures were not initially recognized by experienced radiologists due to subtle fracture lines and the absence of displacement of the fragments. However, because of both supinator fat plane changes and joint effusion, oblique films were obtained and established a radial head and/or neck fracture.

The shin splint syndrome: Medical aspects and differential diagnosis

The shin splint syndrome is a definite clinical entity authoritatively defined and distinct from other nontraumatic conditions causing pain in the lower leg after exertion. The clinical characteristics and differential diagnosis are presented.

Attendances for a New Complaint at Casualty Department of two Childrens?? Hospitals in London

In his study of a casualty department in a hospital, Fry1 summarised his report as follows: 'The present-day casualty department has no specific function and runs as a general practice. It is misused to a considerable extent both by the public and by their doctors.' A similar view was expressed in a report2 of a study conducted by the Nuffield Provincial Hospitals Trust. A medical correspondent,3 reporting on a survey in a children's hospital, sets out to answer an initial question: 'Are hospital casualty departments and resident hospital medical staff being misused by the public and by some practitioners?' The report4 of the Sub-committee of the Standing Medical Advisory Committee of the Central Health Services Council entitled 'Accident and Emergency Services' (1962), has drawn similar conclusions and recommends that the use of the title 'Casualty' should be abandoned and called 'accident and emergency service', and that other provision should be made for minor non-traumatic conditions. Early in November 1962 a pilot study was undertaken in the casualty department of a children's hospital over a period of two weeks. The main purpose was to ascertain the use made of the service by patients attending for the first time for a new complaint. The findings confirmed to some extent what had been found in other studies conducted in

The Practitioners Library of Medicine and Surgery. Volume IV: Non-traumatic Surgery.

In this complete system of medicine and surgery, nontraumatic surgical conditions have been separated from the traumatic. Hence this volume is concerned with lesions of the skin and subcutaneous tissues, tumors, diseases of the breast, surgery of the neck, diseases of the thyroid gland, surgery of the brain and spinal cord and of the peripheral nervous system, surgery of the heart, the blood vessels and the chest, also of the gastro-intestinal tract as a whole, the lymphatics, the spleen, hernia, bones and joints, the urinary tract and the genitalia. There are some hundreds of illustrations which have been well chosen. The vast amount of material included in the book makes it almost an outline rather than an extended consideration of any single subject. Nevertheless it provides much immediate practical information, especially for general practitioners, who may be considered primarily users of a book of this character. There are extensive considerations

Spinal cord compression: Tumors and allied non-traumatic conditions

Tumors of the spinal cord, if diagnosed and removed early in their development, can be permanently cured. Any condition which produces compression of the spinal cord may simulate tumors of the spinal cord. In order to correlate more fully the relation of clinical, surgical, and pathologic aspects of compression of the spinal cord, material gathered from cases reported at The Mayo Clinic from 1912 to 1929 has been analyzed. In view of the difficulty in nomenclature of tumors of the spinal cord, the terminology was confined to an accepted classification, and the microscopic examination was made by means of frozen sections stained with hematoxylin and eosin. Of 312 cases analyzed, 223 tumors were found which did not involve the spinal cord except by compression; these were classified as extramedullary, and were divided again into 156 intradural and 67 extradural tumors. There were also 89 tumors which involved the spinal cord and were classified as intramedullary. Included in the group of 67 cases of extradural tumors compressing the spinal cord were lesions arising from bone, intervertebral disks, extradural fat, spinal nerves, and blood vessels, as well as unsuspected metastatic malignant lesions. A preoperative diagnosis of bony extradural lesion may often be made by roentgenologic examination; likewise, it is possible to make a presumptive diagnosis of metastatic malignant lesion when the primary lesion can be determined. The intradural extramedullary series of tumors comprised the largest group, and fortunately carried the most favorable prognosis. These lesions take their origin from the fibroblastic structures of the meninges and the vessels of the meninges, or they are projected into the subarachnoid space from without the dura or from within the spinal cord. The 2 types of tumor predominating are the endothelioma, or meningeal fibroblastoma, and the neurofibroma. In this series, about half of the intradural extramedullary tumors proved to be endotheliomas, and about a third were neurofibromas. In analyzing the intramedullary lesions, 89 cases were reviewed. Tissue was available in only 62 cases. Tumors arising from the cord and comprising the group of gliomas predominated, but also benign encapsulated tumors which were capable of complete removal were found. In a number of cases in which tissue was not removed, palliative relief was obtained by means of decompression, coincidental with laminectomy. In view of the fact that laminectomy can be performed with minimal risk, exploration can be carried out in many atypical cases of compression of the spinal cord for palliative as well as for diagnostic purposes. In a very high percentage of cases of compression of the spinal cord, a differential diagnosis between inflammatory and neoplastic lesions can be ascertained preoperatively by means of roentgenologic examination, complete neurologic study including examination of the cerebrospinal fluid, and the use of lipiodol when indicated. But the exact pathologic nature of the underlying cause of compression is rather difficult to determine, and this pathologic analysis furnishes evidence of the multiplicity of lesions that can be encountered at operation.

Observations on Fat Embolism.

Fat embolism, occuring as the result of trauma to fat depots, can be demonstrated clinically and experimentally. Trauma is usually considered the sole cause. However, fat embolism has been found in many non-traumatic conditions. Dogs will survive aseptic injections of cotton-seed oil in amounts per kilo body weight that are twice the amount of fat per kilo body weight in the marrow of the human femur.It is obvious, therefore, that there must be some other etiology than trauma for some cases of fat embolism. The most logical other source for fat embolism is, of course, the normal plasma emulsion of fat.Experiments are reported showing that certain artificial emulsions can be broken down by the addition of necrotic muscle extract, peptone and histamine, besides other substances. This breakdown varies in speed and degree inversely with the fineness of the emulsion. It has not been demonstrated in the physiological plasma emulsion of a digestive lipemia.However, the well-known destruction of this emulsion by ...

An account of the improved modes of working hard wood, cast-iron, brass, &c. into shape; practised by Mr. John Ford, Engineer

To determine the range of the Pediatric Outcomes Collection Instrument (PODCI) scores for children with a wide variety of congenital upper limb differences and to examine the scoring effect of the patient’s surgical history, family history, severity of involvement, and syndromic associations.We reviewed the PODCI scores for 109 patients, aged 2–18 years, treated for nontraumatic upper extremity conditions. Charts were reviewed for sex, age, extent of limb involvement, laterality, family history, surgical history, and syndrome association. All patients were classified based on the Oberg, Manske, Tonkin classification with general categories of malformation, deformation, or dysplasia.Of 109 patients, 80 (73%) had a malformation, 12 (11%) had a deformation, and 17 (16%) had a dysplasia. The cohort as a whole had a happiness PODCI score that was similar to the normal population, yet a lower (worse) PODCI score for upper extremity and global function. Patients with a dysplasia had a higher upper extremity function scores than those with malformations or deformations, but they had similar happiness and global function scores. Complete upper limb involvement and lower extremity involvement statistically lowered the PODCI score within our study cohort, whereas a positive family history and syndromic association increased PODCI scores.This study showed that there was a similar level of perceived happiness between children/adolescents with congenital upper extremity conditions compared with the normal pediatric population based on PODCI scores. In contrast, the perceived upper extremity and global function was significantly decreased in patients with congenital differences compared with normal individuals. This investigation also revealed that the extent of upper extremity involvement, lower extremity involvement, family history, and syndromic association may affect PODCI scores as independent variables and should be taken into consideration in studies of upper extremity congenital anomalies.Prognostic IV.