Severe Lacerations Research Articles

Anastomosis lacrimal sac conjunctival sac in severe laceration of lacrimal canaliculus

To investigate the clinical effect of anastomosis lacrimal sac conjunctival sac in the treatment of severe laceration of lacrimal canaliculus. A total of 19 cases (19 eyes) with laceration of lacrimal canaliculus underwent anastomosis lacrimal sac conjunctival sac.All the patients were followed up for 3 to 24 months postoperatively. Among all the 19 patients (19 eyes), 14 cases were cured,3 cases wre markedly improved and 2 cases had no effect,and the effect rate was 89.47%. Anastomosis lacrimal sac conjunctival sac is an effective surgical technique in the management of severe laceration of lacrimal canaliculus.

Severe facial laceration and zygomatic fracture accompanied by traumatic lens luxation: a case report

Severe facial laceration and zygomatic fracture accompanied by traumatic lens luxation: a case report

Traumatic hemipelvectomy in children: report on 2 survivors with urological involvement

Traumatic hemipelvectomy through the sacroiliac joint is a devastating injury, mainly because of motor vehicle accidents. Recent improvements in prehospital trauma care have increased the chances of survival for victims. Besides amputation of the lower limb, associated complications usually involve digestive and urological systems. We report on 2 pediatric patients from 2 different European countries. Patient 1 A 9-year-old boy suffered uprooting of his left lower limb, laceration of the rectum and anal sphincter, as well as an injury to distal urethra with partial loss of cavernous bodies. Initial management included a colostomy and an essay of contention by means of a polypropylene prosthesis that had to be removed in the following months. After several attempts at urethral reconstruction, he underwent a Mitrofanoff derivation. Patient 2 An 18-month-old girl lost her left lower limb and suffered severe lacerations of bladder and rectum. Among other measures, management included a colostomy, a skin graft, and 2 attempts at reconstruction of her bladder neck, including a modified Casale procedure (cecum and ileocecal appendix were in a high position that made a Mitrofanoff derivation impossible) and a Malone procedure. To the authors' knowledge, she would be the youngest reported survivor of this kind of injury.

87: Vaginal Injuries After Consensual Versus Nonconsenual Sexual Intercourse In a Community-Based Population

87: Vaginal Injuries After Consensual Versus Nonconsenual Sexual Intercourse In a Community-Based Population

Spatula-assisted deliveries: a large cohort of 1065 cases

Objective To analyze neonatal and maternal complications of operative vaginal delivery using spatulas. Study design We conducted a retrospective observational study of 1065 consecutive spatula-assisted deliveries at Nice University Hospital from 2003 through 2006, excluding stillbirths and breech deliveries. After univariate analysis, we performed logistic regression analysis to assess risk factors for severe perineal injuries and vaginal lacerations. Results The success rate was 98.2%. Vaginal tears occurred in 23.7% of patients. The rate of third and fourth degree perineal injuries was 6.2%. No severe neonatal complication directly related to extraction was noted. Nulliparity, shoulder dystocia and absence of episiotomy were independently associated with an elevated risk of anal sphincter damage. Nulliparity and absence of episiotomy were significantly and independently associated with an increased incidence of vaginal tears. Conclusion Rates of perineal injuries, failure and neonatal complications observed with spatulas were similar to those reported in the literature with other instruments for operative vaginal delivery.

Risques néonataux et périnéaux liés à l’apprentissage des spatules

To examine the acute neonatal and maternal perineal morbidity due to resident training on spatulas assisted deliveries. We conducted a retrospective observational study of succesful spatulas-assisted deliveries at Nice University Hospital between January2003 and December2006. We performed univariate analysis and logistic regression to assess risk of severe perineal injuries, vaginal laceration and newborn hospitalization according to operator status, controlling for confounders. Among 1004 deliveries, 86.4% were performed by residents. No significant difference was found on incidence of severe perineal tears between the 872 extractions performed by residents and the 132 performed by an attending physician (6.9% versus 7.9% p=0.706; OR=0.86 IC95% [0.41-1.81]), but extraction performed by young residents were associated to more severe perineal tears than those performed by senior residents (8.0% versus 4.5% p=0.035; OR=2.10 IC95% [1.16-3.77]). There was no difference between groups concerning newborn morbidity and hospitalisation in special care units (6.4% versus 9.8% p=0.149; OR=1.49 IC95% [0.73-304]). According to our data, training of resident do not increase the incidence of severe perineal injuries, neonatal complications and hospitalisation linked to spatulas assisted delivery.

UNIVERSITY LAB ACCIDENT UNDER INVESTIGATION

A RECENT ACCIDENT in a chemistry department laboratory at Texas Tech University will be investigated by the Chemical Safety & Hazard Investigation Board (CSB), Chairman John Bresland announced on Jan. 19. The investigation at the Lubbock, Texas, university will be CSB’s first examination of an accident in an academic research lab. One student, Preston Brown, 29, was seriously injured in the Jan. 7 accident and remains in critical condition, according to Eric Finley, a spokesman with University Medical Center in Lubbock. Brown is being treated in the hospital’s burn center, where he has been since the accident. Initially, press accounts said two students were injured; however, university officials say only one was hurt. Brown received severe burns and lacerations to his face and hands when a mixture of nickel hydrazine perchlorate exploded during the afternoon accident in Texas Tech’s chemistry building, according to a police report. University officials told CSB the accident involved the ...

Surgical Repair of Severe Flipper Lacerations in a Loggerhead, Caretta caretta, and a Kemp's Ridley, Lepidochelys kempii, Sea Turtle

A loggerhead, Caretta caretta, and a Kemp's ridley, Lepidochelys kempii, sea turtle were presented to the North Carolina State University, College of Veterinary Medicine for evaluation of distal flipper injuries. The goal for both animals at presentation was to preserve limb function and avoid complete amputation. A severe full-thickness flipper laceration was successfully reapposed in the first case, and a rotational flap was used to cover exposed tissue in the second case. Limb function was improved and complete amputations were avoided in both turtles.

Perineal Outcome after Restrictive use of Episiotomy in Primi-gravidas

Episiotomy is a common obstetrical practice that is believed to prevent severe lacerations. Principles of evidence based medicine raises questions on the utility of routine episiotomy. A prospective observational study was conducted in primi gravidas coming to Tansen Mission Hospital for delivery who were not offered episiotomy sticking to the protocol of restrictive use of episiotomy and the subsequent perineal tear was evaluated in terms of its length, degree and complications. Risk factors associated with significant degrees of perineal tear was investigated. The episiotomy rate during the time of study was only 22%. Among those included in the study, 16.2% of women had intact perineum and majority of women (43.2%) had first degree of tear. Only one (1.4%) had third degree tear without any long term complications. Having a baby weighing 2.5 kg increases the mean tear length significantly (P = 0.019) and increases the risk of having second or third degree of tear by almost two times (Relative Risk = 1.95). No clinically significant complications were observed in any of the women after the delivery. This study provides some evidence that the principle of restrictive use of episiotomy with a total episiotomy rate being around 20% can be carried out successfully even in an under-resourced setting of our country.

Use of uterine fundal pressure maneuver at vaginal delivery and risk of severe perineal laceration

Matsuo et al. [1] published a very interesting, retrospective cohort study about the use of uterine fundal pressure maneuver at vaginal delivery and the risk of severe perineal laceration. A total of 661 vaginal deliveries were evaluated, in 39 (5.9%) of these cases fundal pressure maneuver was applied. The authors concluded the use of uterine fundal pressure during the second stage of labor increased the risk of severe perineal laceration, defined as a third- or fourth degree perineal tear. The risk of severe perineal laceration was 28.1% in the group that received fundal pressure versus 3.7% in the non-fundal pressure group, odds ratio 7.81 (95% CI 3.33–18.3) and P < 0.001. Even adjusted for previously described confounders like, primiparity, length of labor, episiotomy and vacuum extraction there was a significant higher rate of severe laceration in the fundal pressure group [1, 2]. We compliment the authors for publishing these interesting data, since fundal pressure is frequently used during second stage as reported by Kline-Kaye et al. [3] but unfortunately seems to be underreported in medical literature. Merhi and Awonuga [4] concluded in their sceptical reappraisal that the role of fundal pressure is understudied and remains controversial in the management of the second stage of labor, and caution should be exercised using this maneuver until it’s proven to be safe and effective. An interesting review published by Berghella et al. recommends against routinely providing fundal pressure in the termination of the second stage of labor. They conclude there are no significant better outcomes studied in women who received fundal pressure, while these women were less satisfied with the second stage of labor. The authors state the use of obstetric interventions should be studied and associated with the highest risk of safety and effectiveness, with avoidance of less safe and less effective interventions [5, 6]. Although the study by Matsuo et al. is the first to determine the risk for severe perineal laceration associated with the use of fundal pressure, we feel there are some concerns about the interpretation of these data. As already stated by the authors, the study is limited to the lack of information about the indication of fundal pressure, the number and the duration of the maneuver, and the position of the fetal presenting part. In our opinion the indication of fundal pressure is important for the interpretation of the data. When fundal pressure is performed due to prolonged second stage fetal presentation plays an important role in the risk of severe perineal laceration. As described by Pearl et al. [7], deliveries with the fetal occiput in posterior position had a significant higher incidence of severe perineal laceration than presentation with the occiput in anterior position. Unfortunately the study by Matsuo et al. was unable to obtain information about the presentation. On the contrary, when fundal pressure is used to accelerate second stage due to fetal distress with a normal fetal presentation, the risk of severe perineal laceration would probably be less when compared to abnormal presentation and prolonged second stage. A total of nine severe perineal lacerations in the fundal pressure group of 39 women seems to be a rate of severe perineal laceration of 23.1% in contrary to the 28.1% as described by the authors. Although the authors clearly demonstrate that in the synergistic effects of episiotomy, vacuum extraction and fundal pressure, fundal pressure indeed seems to increase the risk of severe perineal laceration, we should know why these deliveries were instrumental deliveries to fully understand these results. Api et al. [8] recently published a randomized controlled trial about the role of fundal pressure on the duration of the second stage of labor. This study randomized a total of 197 women between fundal pressure concomitant with each uterine contraction and normal pushing during second stage, without a medical indication. The authors concluded that fundal pressure was ineffective in shortening the second stage of labor, with no adverse outcomes of mother or child. There was no significant difference in severe perineal laceration between both groups. However, there seemed to be a trend towards a shorter second stage in a subgroup of nulliparous women. It would be interesting to compare the outcome of the study of Matsuo et al. comparing nulliparous women only. The association described between a larger maternal body weight gain during pregnancy and the use fundal pressure maneuver of 11.16 ± 0.4 versus 10.05 ± 0.16 kg in the non-fundal pressure group seems to be a statistically significance without clinical relevance [1]. The contribution of the trial by Matsuo et al. is important for further studies regarding fundal pressure related to the rate of adverse events. Documentation of fundal pressure when applied with clear indication seems to be the first step towards insight in the obstetrical practice of fundal pressure.

Morbidité maternofœtale immédiate de l’accouchement assisté par spatules de Thierry chez la primipare. À propos d’une série prospective continue de 195 extractions

Objectives To investigate the immediate fetal-maternal morbidity related to Thierry's spatula for first instrumental vaginal delivery. Patients and methods We conducted a prospective observational study in Toulouse university hospital, including primiparas who vaginally delivered a live singleton cephalic infant > 36 WG, between December 2005 and June 2006. Instrumental deliveries were performed using short spatulas in all cases. Outcome measures were: perineal complications (episiotomy, laceration and associated lesions, urinary retention, pain at H48), neonatal morbidity (cutaneous injuries, neonatal transfer, cord pH, Apgar score). Instrumental deliveries were compared with spontaneous vaginal deliveries (SVD). Results Six hundred and eight primiparas were included, distributed in 195 extractions (32%) and 413 SVD (68%). Spatulas allowed fetal extraction in all cases. Main differences between the two groups were: length of labour, occiput posterior position (12.8% for spatulas vs 1.7% for SVD; p < 0.0001), episiotomy rate (97.9% vs 51.3%; p < 0.0001), severe perineal lacerations (3.6% vs 0.2%; p = 0.0007), post-partum morbidity (pain, hematoma, and urinary retention). No case of early severe neonatal complication was related to the use of the spatulas. Discussion and conclusions Perineal complications (severe lacerations) associated with spatulas are increased with regard to SVD, but comparable to that reported with forceps. The main disadvantage is the high frequency of episiotomy, which should not be systematic. Neonatal morbidity is reduced. Comparative studies (spatulas vs. other procedures) are needed to confirm these data, but spatulas remain a multipurpose instrument which should continue to be taught.

Transverse Sinus Thrombosis After Internal Jugular Vein Ligation

Background: Cerebral vein and dural sinus thrombosis is a rare condition with a wide range of causes and a highly variable presentation. It can lead to significant morbidity, but scant literature is available describing diagnosis and treatment when this occurs after ligation of the internal jugular vein. Objectives: To discuss potential risk factors for cerebral vein and dural sinus thrombosis after ligation of the internal jugular vein, and present current options for diagnosis and treatment. Case Report: A 23-year-old male construction worker was brought to the Emergency Department by Emergency Medical Services after sustaining a severe neck laceration from a hand-held grinder. He was treated with ligation of the left internal jugular vein, but subsequently developed severe headaches and symptoms of increased intracranial pressure. A magnetic resonance venogram of the head revealed a left transverse sinus thrombosis requiring treatment with anticoagulation. The placement of a lumboperitoneal shunt was ultimately needed for relief of his symptoms. Conclusions: Early diagnosis and aggressive therapeutic interventions are critical to prevent further morbidity in patients who develop cerebral vein and dural sinus thrombosis after ligation of the internal jugular vein.

Rabbits Die of Cat Bites, So Why the Fuss?

It is common for small birds and mammals injured by cats to be presented to rehabilitators. Many of these injured animals die as a result of the cat bites, either because of the severe punctures and lacerations, or because of infection transmitted by bacteria from the cat’s mouth. This case highlights the importance of a rehabilitator paying close attention and acting on what may seem like an a familiar case of a rabbit dying from a cat bite, when actually a zoonotic disease caused the death. The article closes with reminders for rehabilitators such as collecting the rescuer’s contact information, using safe handling protocols, and not assuming an obvious problem described by the rescuer is the primary consideration.

Catastrophic Complication of Stent Perforation in a Uremic Patient with Acute Myocardial Infarction

Catheter-induced coronary artery dissection is a rare but devastating complication of coronary angiography and percutaneous coronary intervention (PCI). Complications during PCI include coronary artery dissection, intramural hematoma, coronary artery perforation, and occlusion of branch vessels. Stent perforation is more unusual and potentially fatal. Here, we report a 68-year-old uremic woman who underwent primary PCI for her acute myocardial infarction. Unfortunately, dissection of the left proximal coronary artery by a guide catheter, followed by stent implantation, resulted in stent perforation through the middle left coronary artery and severe laceration of the left coronary orifice. Cardiogenic shock leading to cardiac arrest occurred. Emergency coronary artery bypass grafting and aortomy for left coronary orifice repair were conducted. The patient's postoperative course was uneventful, and she was discharged 15 days after surgery. From the successful outcome in this patient, we speculate that both better selection of patients and lesions for angioplasty and surgical standby may prove to be life-saving and effectively decrease subsequent mortality for patients experiencing devastating complications during PCI.

Advanced age is a risk factor for higher grade perineal lacerations during delivery in nulliparous women

To identify risk factors for the development of severe perineal lacerations and to give recommendations for their prevention in nulliparous women. A retrospective case-control analysis of deliveries at our University Hospital was performed. Multiparae, Caesarean sections, twin pregnancies, fetal breech position and preterm deliveries were excluded. Univariate and multivariate step forward regression analyses were performed; correlations between contributors were further analyzed by Spearman Rank Correlation. Differences between the degree of lacerations and maternal age were further analyzed with Friedman ANOVA followed by Dunn's Multiple Comparison Test. A total of 2,967 deliveries fitted our inclusion criteria, 50 (1.7%) mothers had higher-grade lacerations. Mediolateral and median episiotomy, advanced maternal age, vaginal operative delivery, higher fetal birth weight and abnormal cephalic presentation were associated with severe lacerations. Advanced maternal age plays an important role in the development of anal sphincter tears in nulliparous women. Episiotomy and operative vaginal deliveries should be restrictively performed when possible. To identify further preventive approaches in patients with accumulated risk factors prospective randomized studies are needed.

Extraperitoneal bladder rupture with severe lacerations of the urogenital diaphragm: a case report

BackgroundA 65-year woman injured by automobile had an open-book type pelvic fracture and extraperitoneal bladder rupture.Case presentationNon-surgical management was selected because of suspected minor leakage. A follow-up CT cystography on day 21 showed a large urinoma. In the sagittal reconstruction CT images, the bladder was displaced downwards. Surgery was performed. Surgical findings showed that the bladder neck and the urethra were not anchored because of a laceration in the urogenital diaphragm. The bladder base had descended to the inferior margin of the pubic bone and a laceration of about 3 cm was found in the anterior surface of the bladder neck. The laceration was sutured, and the wall of the urinoma was extensively resected. The postoperative course was uneventful.ConclusionAn extraperitoneal bladder rupture associated with a severe laceration in the urogenital diaphragm will be indicated for surgery when the bladder is not anchored and healing is prevented. Sagittal reconstruction CT cystography was effective for this diagnosis.

Desfecho da gravidez nas jovens adolescentes

to compare delivery and pregnancy follow-up among adolescent and non-adolescent pregnant women whose delivery occurred in a tertiary hospital from Região de Lisboa (Portugal). retrospective study with 10,656 deliveries. Pregnancy follow-up, delivery type, need of episiotomy and severe lacerations, Apgar index at the fifth minute and the delivery weight have been evaluated. The pregnant women were divided into two groups, over and under 20 years old. The group with women under 20 was further subdivided in pregnant women under or over 16. The chi2 test has been used for statistical analysis. adolescents presented worse follow-up: first appointment after 12 weeks (46.4 versus 26.3%) and less than four appointments (8.1 versus 3.1%), less dystocia (21.5 versus 35.1%), less caesarian sections (10.6 versus 20.7%), and lower need for inducing labor (16.5 versus 26.5%). There was no significant difference concerning gestational age at delivery and ratio of low weight newborns. Among adolescents, the ones under 16 had more low weight newborns (12 versus 7.4%) and more deliveries between 34 and 37 weeks (10.8 versus 4.2%). in a hospital attending adolescents with social and psychological support, the fact of them having had a worse follow-up in the pre-natal phase, their performance has not been worse. Nevertheless, special attention might be given to pregnant women under 16.

Techniques of Peripheral Nerve Repair

Nerve injuries extend from simple nerve compression lesions to complete nerve injuries and severe lacerations of the nerve trunks. A specific problem is brachial plexus injuries where nerve roots can be ruptured, or even avulsed from the spinal cord, by traction. An early and correct diagnosis of a nerve injury is important. A thorough knowledge of the anatomy of the peripheral nerve trunk as well as of basic neurobiological alterations in neurons and Schwann cells induced by the injury are crucial for the surgeon in making adequate decisions on how to repair and reconstruct nerves. The technique of peripheral nerve repair includes four important steps (preparation of nerve end, approximation, coaptation and maintenance). Nerves are usually repaired primarily with sutures applied in the different tissue components, but various tubes are available. Nerve grafts and nerve transfers are alternatives when the injury induces a nerve defect. Timing of nerve repair is essential. An early repair is preferable since it is advantageous for neurobiological reasons. Postoperative rehabilitation, utilising the patients' own coping strategies, with evaluation of outcome are additional important steps in treatment of peripheral nerve injuries. in the rehabilitation phase adequate handling of pain, allodynia and cold intolerance are emphasised.

Change in Morphology and Oxytocin Receptor Expression in the Uterine Blood Vessels during the Involution Process

Background: The histological changes in uterine blood vessels during pregnancy have been well investigated, but there have been few reports focusing on the changes in blood vessels during the involution process, especially within the first 24 h. We observed the process of uterine involution, focusing on the vessels of the resected uterus. Methods: Paraffin-embedded uterine samples from 15 patients who underwent hysterectomy because of severe cervical laceration and uterine rupture were examined. The time between delivery and hysterectomy ranged from 15 min to 456 h. The specimens were stained with hematoxylin-eosin, elastica-van Gieson and an antioxytocin receptor antibody. Results: Changes in the uterine vessels varied substantially based on their location. The intima in arteries of the endometrial side thickened within 5 h after delivery. On the serosal side, phlebosclerosis was demonstrated 6 weeks postpartum. Immunoreactivity for the oxytocin receptor (OTR) appeared in the muscular medias of arteries 5 h after delivery although it was not expressed before this period. Conclusion: Remodeling of uterine vessels involved thickening of the arterial intima and OTR expression in vessel walls during the first 5 h postpartum; the parameters normalized within 6 weeks. However, phlebosclerosis persisted for a long time on the serosal side.

Unusually extensive head trauma in a hydraulic elevator accident: Post-mortem MSCT findings, autopsy results and scene reconstruction

Accidental or intentional falls from a height are a form of blunt trauma and occur frequently in forensic medicine. Reports describing elevator accidents as a small subcategory of falls from heights are rare in the medical literature and no report on injury patterns or scene reconstruction of such an accident was found. A case of an accident in a hydraulic elevator with a man falling 3m was examined using post-mortem multi-slice computed tomography (MSCT) and autopsy. The man suffered an unusually extensive trauma and died at the scene. Post-mortem MSCT examination showed a comminute fracture of the skull, the right femur and the first lumbar vertebra. Severe lacerations of the brain with epidural, subdural and subarachnoidal haemorrhages over both hemispheres were diagnosed. Autopsy confirmed these findings. To reconstruct the accident we used radiological and autopsy results as well as findings at the scene.