Severe Traumatic Lesions Research Articles

Severe traumatic lesions in the Late Neolithic cattle from the site of At‐Vršac, Serbia

AbstractThis paper aims to assess the etiology and differential diagnosis of severe pathological lesions in wild and domestic cattle from the Late Neolithic site of At‐Vršac in the northeast part of the present‐day Serbia. Excavations of this multilayered site revealed the remains of a Late Neolithic settlement belonging to the Vinča culture network of the Central Balkans. An aurochs metacarpal bone, two domestic cattle fragments of fused ulna and radius and of tibia, all with massive bone proliferations were recovered during the archaeological excavations in 1976. Paleopathological study was undertaken using an interdisciplinary approach, including AMS dating, radiography, computed tomography (CT), and histopathology. The results show severe oblique healed fracture with secondary pronounced bone reaction in the aurochs metacarpal bone and in the domestic cattle ulna–radius, while traumatic alteration infected with disseminated osteomyelitis was found in the domestic cattle tibia. These pathologies of wild and domestic cattle are discussed to reveal the level of environmental and human influence on the origin and development of the lesions in the Late Neolithic cattle.

The legal challenges to the diagnosis of shaken baby syndrome or how to counter 12 common fake news.

The shaken baby syndrome (SBS) is a common cause of severe traumatic lesions in infants. Although well established for almost five decades, SBS and its diagnosis are becoming more and more aggressively challenged in courts. These challenges feed on the scientific debate and controversies regarding the pathophysiology and the differential diagnoses, scientific uncertainty being readily exploited by specialized barristers. In the present review, we analyze the most common challenges to the concept of SBS and its diagnosis, as well as the scientific evidence available to counter these challenges, the differential diagnoses, and how SBS can be diagnosed with confidence. We found that the pathophysiology of SBS is well documented, with stereotyped descriptions by perpetrators, in good correlation with experimental studies and computer models. SBS is a well-defined clinico-pathological entity with a characteristic constellation of lesions; with a rigorous evaluation protocol, its diagnosis can be made rapidly and with excellent accuracy beyond a reasonable doubt. It is important that medical experts master an extensive knowledge regarding the pathophysiology of the lesions of SBS, in particular infantile subdural hematomas, as well as other CSF-related conditions. This emphasizes the role that pediatric neurosurgeons should play in the clinical and medicolegal management of these patients.

Giving Nature a Second Chance: Minimally Invasive Management of a Maxillary Central Incisor with a Severe Traumatic Lesion

The decision to save or extract a natural tooth which has been compromised is one of the dilemmas of dental practitioners, as well as the patients. Although there was a considerable effort to save the natural teeth in the past, with the introduction of osseointegrated implants, there is a tendency to extract the compromised teeth and replace them with implant-supported prosthesis. In this article, this important clinical decision is investigated, and a successful restoration of a traumatized anterior tooth is presented.

Peripheral Nerve Imaging - from a Neurological Perspective for Surgeons

Nerve ultrasound is a fairly new non-invasive method to visualise peripheral nerves and to detect peripheral nerve lesions. This technique can depict nerve compression syndromes and their aetiologies as well as fascicular torsions. It is also suitable for sonographically guided nerve interventions and for intraoperative navigation. The main advantage of nerve ultrasound is its capability for early diagnosis of severe traumatic nerve lesions that require immediate surgery. Neurologists further use this method to aid the diagnosis of different kinds of polyneuropathies. Within this review we introduce nerve ultrasound to surgeons from a neurological perspective. We focus on different peripheral nerve disorders that might need surgical interventions. Nerve ultrasound will lay the grounds to bring together different expertise in medicine and thus to establish interdisciplinary excellence centres for the understanding, diagnosis and treatment of diseases of the peripheral nervous system.

Product Development of a Bio-Composite Medical Device

The paper presents a development methodology for a new bio-composite medical device used in extensive anatomical reconstructions. Current surgical techniques and devices include auto transplant, surgical meshes or even acellular devices. Due to the high degree of reconstruction and large amount of exposed tissue, the surgeries tend to have high re-intervention rates, leading to severe complications and even death. A functional approach is proposed to develop an improved medical device for the treatment of these severe traumatic lesions. A six step methodology is presented, validating the first three with the development of several concepts. The general need is accurately identified using the APTE instrument and a FAST diagram is constructed for one product existence stage. Nine concepts are generated using the proposed methodology and three were preliminarily kept for development. Further research will be undertaken for manufacturing and testing of the final selected concept.

Diosgenin Glucoside Protects against Spinal Cord Injury by Regulating Autophagy and Alleviating Apoptosis.

Spinal cord injury (SCI) is a severe traumatic lesion of central nervous system (CNS) with only a limited number of restorative therapeutic options. Diosgenin glucoside (DG), a major bioactive ingredient of Trillium tschonoskii Max., possesses neuroprotective effects through its antioxidant and anti-apoptotic functions. In this study, we investigated the therapeutic benefit and underlying mechanisms of DG treatment in SCI. We found that in Sprague-Dawley rats with traumatic SCI, the expressions of autophagy marker Light Chain 3 (LC3) and Beclin1 were decreased with concomitant accumulation of autophagy substrate protein p62 and ubiquitinated proteins, indicating an impaired autophagic activity. DG treatment, however, significantly attenuated p62 expression and upregulated the Rheb/mTOR signaling pathway (evidenced as Ras homolog enriched in brain) due to the downregulation of miR-155-3p. We also observed significantly less tissue injury and edema in the DG-treated group, leading to appreciable functional recovery compared to that of the control group. Overall, the observed neuroprotection afforded by DG treatment warrants further investigation on its therapeutic potential in SCI.

Immediate reduction under general anesthesia and combined anterior and posterior fusion in the treatment of distraction-flexion injury in the lower cervical spine

BackgroundDistraction-flexion of the lower cervical spine is a severe traumatic lesion, frequently resulting in paralysis. The optimal surgical treatment is controversial. It has been a challenge for orthopedic surgeons to manage distraction-flexion injury in the lower cervical spine while avoiding the risk of iatrogenic damage. Thus, safer strategies need to be designed and adopted.This study aimed to evaluate the clinical efficacy of immediate reduction under general anesthesia and combined anterior and posterior fusion in the treatment of distraction-flexion injury in the lower cervical spine.MethodsTwenty-four subjects of traumatic lower cervical spinal distraction-flexion were retrospectively analyzed from January 2010 to December 2013. Traffic accident was the primary cause of injury, with patients presenting with dislocated segments in C4–5 (n = 8), C5–6 (n = 10), and C6–7 (n = 6). Sixteen patients had unilateral facet dislocation and eight had bilateral facet dislocation. Spinal injuries were classified according to the American Spinal Injury Association (ASIA) impairment scale (2000 edition amended), with four cases of grade A, four cases of grade B, ten cases of grade C, four cases of grade D, and two cases of grade E. On admission, all patients underwent immediate reduction under general anesthesia and combined anterior and posterior fusion. The mean follow-up time was 3.5 years.ResultsAll operations were completed successfully, with no major complications. Postoperative X-rays showed satisfactory height for the cervical intervertebral space and recovery of the vertebral sequence. Bone fusion was completed within 4 to 6 months after surgery. Surgery also significantly improved neurological function in all patients.ConclusionImmediate reduction under general anesthesia and combined anterior and posterior fusion can be used to successfully treat distraction-flexion injury in the lower cervical spine, obtaining completed decompression, safe spinal re-alignment, and excellent immediate postoperative stability.

Clinical Study on Cerebellar Contusion:A Report on 9 Cases and Literature Review

We report 9 cases of cerebellar contusion from April 2011 to September 2014 at our department. Frequency, clinicoradiological findings, mechanism of injury, treatments, and outcomes were retrospectively analyzed. Of 239 head injury cases admitted to our department during the same period, 9(3.8%)were diagnosed as cerebellar contusion. Among these 9 cases, 7 were men, and 2 were women. The patient age ranged from 12 to 83 years with a mean age of 64.7 years. The mechanism of injury was traffic accident in one patient, and fall in 8. All cases were associated with direct head trauma to the occiput, and radiographic studies showed occipital bone fracture in 8 cases. Six cases were managed conservatively. Three cases underwent suboccipital craniectomies and clot evacuations. Glasgow Outcome Scale(GOS)score at discharge were Good Recovery(GR)in 2, Moderate Disability(MD)in 2, Severe Disability(SD)in 3, Vegetative State(VS)in 1, and Dead(D)in 1. GOS scores in surgically treated cases were GR in 1, SD in 1, and VS in 1. Supratentorial severe traumatic lesions were concomitant with poor prognosis. Coup injury was a significant cause of cerebellar contusion. External decompression and clot evacuation were useful in patients who suffered severe cerebellar contusion;however, concomitant supratentorial lesions influenced the prognosis.

Immediate Reduction Under General Anesthesia and Single-staged Anteroposterior Spinal Reconstruction for Fracture-Dislocation of Lower Cervical Spine

Fracture-dislocation of the lower cervical spine is a severe traumatic lesion, most frequently resulting in tetraplegia. Treatment is usually painful and time consuming. This retrospective study evaluated the clinical curative effect of immediate reduction under general anesthesia and single-staged anteroposterior spinal reconstruction for fracture-dislocation of the lower cervical spine. Twelve cases of traumatic lower cervical spinal fracture-dislocation were retrospectively analyzed from January 2006 to December 2011. The injury level was C4/C5 in 4, C5/C6 in 5, and C6/C7 in 3 patients. The spinal cord function grades according to the American Spinal Injury Association impairment scale (2000 edition amended) before operation were as follows: grade A in 2 cases, grade B in 2 cases, grade C in 5 cases, grade D in 2 cases, and grade E in 1 case. On admission, all patients underwent immediate reduction under general anesthesia and single-staged anteroposterior spinal reconstruction by circumferential fixation/fusion. The spinal cord function grades according to American Spinal Injury Association after operation were as follows: grade A in 1 case, grade B in 1 case, grade C in 3 cases, grade D in 3 cases, and grade E in 4 cases. All 12 patients showed evidence of stability at the instrumented level on the final follow-up examination (mean follow-up, 3.7 y). Immediate reduction under general anesthesia followed by a single-stage combined anteroposterior spinal reconstruction is a safe and reliable way of treating patients with lower cervical spine fracture-dislocations.

Grey seal (Halichoerus grypus) predation on harbour seals (Phoca vitulina) on the island of Helgoland, Germany

The prey spectrum of grey seals has to date been described as largely consisting of different fish, cephalopod and shrimp species. On the German island of Helgoland Düne, where harbour seals (Phoca vitulina) and grey seals (Halichoerus grypus) co-occur, a young male grey seal was observed in 2013 and again in 2014 preying upon young harbour seals. A harbour seal carcass with severe traumatic lesions was retrieved and post-mortem examinations were performed. In the following weeks several carcasses showing similar lesions were found. Sightings of grey seals assumed to be preying on harbour porpoises have increased around the North Sea.Increased competition as well as individualised behaviour could explain the increased number of observations, but former cases of abnormal lesions of marine mammals attributed to for example predation by sharks or mechanical processes should be revisited with regard to the emerging knowledge.

Changes in sports injuries incidence over time in world-class road cyclists.

This is a descriptive epidemiologic survey on all traumatic and overuse injuries which occurred in 2 groups of male elite road cyclists based on retrospective clinical interviews and physical examinations. The historical group consisted of 65 professional road cyclists surveyed from 1983 to 1995. The contemporary group included 65 elite racers still active and reporting injuries from 2003 to 2009. Injury/cyclist ratio was 1.32 in the historical group and 2.13 in those still active. Traumatic injuries increased from 39.5% (historical) to 53.9% (contemporary) (p<0.05). Severe traumatic lesions decreased from 49.9% in the historical group to 10.5% in the contemporary group (p<0.01). Patellofemoral pain decreased from 28.8% (historical) to 6.1% (contemporary) (p<0.01). Muscle injuries substantially increased from 13.4% to 44.9% (p<0.01). In the historical racers, the rates of risk for traumatic injury were 0.104 per year per cyclist, and 0.003 per 1 000 km of training and competition. These figures increased to 0.287 and 0.009 respectively in the contemporary group. In summary, contemporary professional road cyclists are exposed to double the risk of traumatic injuries than those competing in the 80s and early 90s. However, these lesions have less severity. Overuse injuries had a completely different clinical pattern, with the currently active cyclist exhibiting more muscle injuries and less tendinous lesions.

Organization of Medical Care to Children with Road Traffic Injury in the Rostov Region

Objective: to analyze the efficiency of the Rostov Region’s medical care service for children with severe traumatic injuries due to road traffic accidents. Results. It has been established that the service meets the generally accepted stepwise principles and has a multilevel network of hospitals, which allows the earliest performance of the required volume of medical care in relation to the pattern and severity of lesions. It has been shown that 58.3% of the children with severe traumatic lesions are primarily admitted to the central district hospitals and emergency care ones that are aimed at rendering medical aid to the adult population. Thus, medical care is delivered to the above contingent by non-pediatric surgical and resuscitative-anesthetic services. Conclusion. By keeping in mind the specific features of the emergency medical system existing in the region, the authors propose its further development, by organizing interregional centers on the basis of a number of central regional hospitals for the treatment of children with traumatic lesions (among other things, by allocating pediatric beds in the intensive care units). The stepwise solution of this problem is currently being done in the Rostov Region in two main directions: 1) organization by developing a round-the-clock advisory subdivision (with an exiting sanitary aviation team) on the basis of – the regional children’s clinical hospital and 2) methodical maintenance of multidisciplinary h°spitals in delivering medical care to different age-groups children. Key words: road traffic accidents, emergency medical service, children, traumatic lesions.

Ultrasound diagnosis following blunt abdominal injury in childhood

In blunt abdominal trauma in childhood, sonography should be the primary method for diagnostic imaging. This simple and non-invasive investigation can be readily performed even in cases with severe traumatic organ lesions. In cases not requiring immediate surgery the method can be used for monitoring and follow-up. Other diagnostic procedures such as IVP, CT, abdominal plain x-ray, angiography, scintigraphy do not become superfluous but should be used according to the clinical and sonographic findings.

Gas Exchange and Mechanical Properties of the Lung in Miners with Severe Concomitant Injury

Objective: to study the specific features of pulmonary gas exchange and mechanical properties in various manifestations of respiratory failure in miners with severe concomitant injury, who have a service length of 10 years or more, in order to optimize respiratory support. Subjects and methods. Pulmonary gas exchange and mechanical properties were studied over time in the presence of respiratory failure (acute lung injury/acute respiratory distress syndrome) in 34 miners and 36 victims (a control group) with severe concomitant injury who had no underground service length. Both groups were matched in age, severity and nature of traumatic lesions and surgical interventions. Pulmonary gas exchange and mechanical properties were evaluated by the following indices: oxygen fraction in an inspired gas mixture; hemoglobin saturation and partial arterial blood oxygen and carbon dioxide tension with the alveolar-arterial gradient being calculated by the oxygen level; oxygenation index; intrapulmonary shunting; statistical compliance and airways resistance. Results. The studies demonstrated that the miners, as compared with the controls, had more pronounced gas exchange changes within 5—7 post-traumatic days; later on (days 7—9) the above differences were undetectable. Impaired pulmonary mechanical properties in the miners persisted throughout the study while in the control group, their recovery started just on day 3. The course of respiratory failure in the miners was attributable to the baseline external respiratory function. Their respiratory support was performed during 14.5±1.4 days versus 9.5±1.9 days in the controls. In the miners, the mean bed-days at an intensive care unit were 18.5±2.2 whereas in the controls those were 12.3±2.1. Conclusion. More significant impairments of pulmonary gas exchange and mechanical properties are seen in the miners due to the background changes in external respiratory function in the development of respiratory function after severe concomitant traumatic lesions than in the victims without underground service length, which causes an increase in the duration of respiratory support and intensive care.

Acute traumatic aortic rupture: A comparison of surgical and stent-graft repair

The study's objective was to comparatively evaluate surgery and stent-graft repair of acute or subacute traumatic aortic rupture. A total of 76 patients (14-76 years old; mean, 37 years; male/female ratio, 63/11) with a traumatic aortic injury were admitted to our hospital between 1981 and 2003. Six patients died within 1 to 9 days of another associated severe traumatic lesion. The 70 remaining patients were divided according to the type of rupture repair. In group 1, 35 patients were treated surgically: 28 with immediate repair and 7 with delayed repair (average time interval 66 days, 5-257 days). In group 2, 29 patients were treated with stent grafting of the aortic isthmus. In group 3, 6 patients with minor aortic lesions were treated medically with a close follow-up. In the 28 patients treated surgically in the emergency department, the mortality and paraplegia rates were 21% and 7%, respectively. No death or paraplegia was observed in the group with delayed surgical repair. With stent grafting, complete exclusion of the pseudoaneurysmal sac was observed in all patients. Except for 1 iliac rupture treated during the same procedure, there was no major morbidity or mortality during the mean follow-up of 46 months (13-90 months). No major complication was observed in group 3. In stable rupture of the aorta, initial conservative treatment is safe and allows management of the major associated lesions. Stent grafting of the aortic isthmus is a valuable therapeutic alternative to surgical repair, especially in patients considered high risk for conventional thoracotomy.

Immediate open anterior reduction and antero-posterior fixation/fusion for bilateral cervical locked facets

Bilateral cervical locked facets is a severe traumatic lesion, most frequently resulting in tetraplegia. The common treatment strategy has been an attempt of awake, closed reduction, adding general anesthesia, muscle relaxation and manual traction in difficult cases. In cases of failed closed reduction, open reduction has most commonly been performed by a posterior approach. Patients in the current series have been managed by immediate open anterior reduction and circumferential fixation/fusion. The technique is described and its potential advantages are discussed. Five consecutive patients with traumatic bilateral cervical locked facets are reported. The injury level was C4/5 in one and C5/6 in four patients. Four patients had initial tetraplegia, one patient was neurogically intact. All patients underwent immediate open anterior reduction by interbody distraction and gentle manual traction, followed by circumferential fixation/fusion. Mean follow-up was 15 months. Immediate anterior open reduction was rapidly and reliably achieved in all five patients. No surgical complication occurred. All patients showed fusion at the three-month follow-up. All four tetraplegic patients regained at least one functional root level, but remained tetraplegic. Immediate open anterior reduction of bilateral cervical locked facets and combined antero-posterior fixation/fusion was safe and reliable. This treatment strategy avoids time loss and patient discomfort from attempted closed reduction by traction, obviates the need for external immobilization, and results in an excellent fusion rate.

MSP007 Phenotypic and molecular characterization of Brucella strains isolated from marine mammals of the german North Sea

The prey spectrum of grey seals has to date been described as largely consisting of different fish, cephalopod and shrimp species. On the German island of Helgoland Düne, where harbour seals (Phoca vitulina) and grey seals (Halichoerus grypus) co-occur, a young male grey seal was observed in 2013 and again in 2014 preying upon young harbour seals. A harbour seal carcass with severe traumatic lesions was retrieved and post-mortem examinations were performed. In the following weeks several carcasses showing similar lesions were found. Sightings of grey seals assumed to be preying on harbour porpoises have increased around the North Sea.Increased competition as well as individualised behaviour could explain the increased number of observations, but former cases of abnormal lesions of marine mammals attributed to for example predation by sharks or mechanical processes should be revisited with regard to the emerging knowledge.

Recovery of locomotion following transplantation of monoaminergic neurons in the spinal cord of paraplegic rats.

Severe traumatic lesions of the spinal cord yield a permanent deficit of motricity in adult mammals and specifically a loss of locomotor activity of hindlimbs when the lesion is located at the lower thoracic level. To restore this function, we have developed a paradigm of transplantation in rats based on a transection model of the spinal cord and the subsequent injection at the sublesional level of a suspension of embryonic brainstem monoaminergic neurons which play a key role in the modulation of locomotion. A genuine locomotion was characterized in transplanted animals by electromyographic and electroneurographic recordings. This correlated with a specific reinnervation pattern of targets, where typical synapses were found, and with the normalization of biochemical parameters.

Airway management in cranio-maxillofacial surgery

Condylar or subcondylar fractures are severe traumatic lesions of the temporomandibular joint (TMJ) but the damage to the intracapsular soft tissues is not fully defined. In this study, twelve joints in ten patients with condylar and subcondylar fractures of the TMJ between two and twelve days after injury, were examined by magnetic resonance imaging to evaluate the damage to the intracapsular soft tissues in the acute phase. The joint capsule and the retrodiscal tissue were both swollen and showed increased signal intensity. Tears were recognized in the capsule of the eight joints and in the retrodiscal tissue of six joints. All discs were displaced in an anteromedial direction along with the fractured condylar fragments, but tear (rupture) was not recognized. In all cases, high signal intensity was seen in the joint spaces, and haemarthrosis was recognized in six joints during open reduction surgery.

Magnetic resonance images in patients with acute traumatic injury of the temporomandibular joint: a preliminary report

Condylar or subcondylar fractures are severe traumatic lesions of the temporomandibular joint (TMJ) but the damage to the intracapsular soft tissues is not fully defined. In this study, twelve joints in ten patients with condylar and subcondylar fractures of the TMJ between two and twelve days after injury, were examined by magnetic resonance imaging to evaluate the damage to the intracapsular soft tissues in the acute phase. The joint capsule and the retrodiscal tissue were both swollen and showed increased signal intensity. Tears were recognized in the capsule of the eight joints and in the retrodiscal tissue of six joints. All discs were displaced in an anteromedial direction along with the fractured condylar fragments, but tear (rupture) was not recognized. In all cases, high signal intensity was seen in the joint spaces, and haemarthrosis was recognized in six joints during open reduction surgery.