Context Of Trauma Research Articles

L’épaule du sportif

The practice of sport can be a source of shoulder pain, the pathologies encountered varying according to the type of sport, the level and intensity of the practice, the age of the athlete and the traumatic context or not. In a traumatic context, in an athlete under 35 year old, rotator cuff injuries are less common than fractures, instability, acromioclavicular lesions, or neurological lesions (motor sports). In the older patient, lesions of the rotator cuff are the most frequent. In a micro-traumatic context, the pathologies encountered (rotator cuff, canal syndromes) are linked to repetitive gestures in armed and throwing sports (Tennis, Handball, Volley Ball, Javelin or even Baseball) or to technical errors. It is in this context that we will encounter rotator cuff lesions, even in young athletes. Their frequencies increase with intensity and the number of year of practice.

Trauma in Context

Trauma in Context

The Influence of Event and Reaction Context on Clinicians’ Disorder Diagnoses

Clinicians’ judgments about clients can be influenced by the causal context (e.g., life events) preceding behavioral symptoms. However, it is unclear whether this influence extends to diagnosis judgments. In diagnosing Posttraumatic Stress Disorder (PTSD), traumatic event context must be present, and severe immediate reaction context was formerly required for many years. In a vignette study, we systematically examined whether event and reaction severity influence clinicians’ open-ended diagnoses of PTSD behaviors, Major Depressive Disorder (MDD) behaviors, and nondisordered behaviors. Clinicians made more diagnoses of PTSD for all three types of behaviors (PTSD, MDD, distressed) given a traumatic event than a mildly stressful event but simultaneously found the behaviors to be less abnormal. We found no evidence that reaction context influenced diagnoses. Future directions and the role of causal context in clinical diagnosis are discussed.

Représentation tridimensionnelle originale d’un cas de métopisme associé à une agénésie unilatérale complète du sinus frontal gauche : intérêt clinique et revue de la littérature

Metopism (complete persistence of the metopic suture in adults) is a rare but not exceptional variation of the calvaria. Hypoplasia or aplasia of the frontal sinus may be associated without evident correlation. Nevertheless, a misdiagnosis of these variations may have clinical consequences, especially in a traumatic context. The aim of this paper was to report a case of metopism associated with a unilateral aplasia of the left frontal sinus, originally illustrated with 3D image fusion volume rendering reconstructions.

Intractable epistaxis: which arteries are responsible? An angiographic study.

Epistaxis constitutes a significant proportion of the Otolaryngologist's emergency workload. Optimal management differs in relation to the anatomic origin of the bleeding. The outcome of our study was to determine which artery(ies) could be considered as the cause of severe bleeding in the context of severe epistaxis. Fifty-five procedures of embolization preceded by angiography were reviewed. Medical records of interventionally treated patients were analysed for demographics, medical history, risk factors and clinical data. Angiographic findings were also assessed for active contrast extravasation (blush), vascular abnormality and embolised artery. Previous angiography showed an active contrast extravasation in only 20 procedures. The most common bleeding source was the sphenopalatine artery (SPA) followed by anterior ethmoïdal artery (AEA) and facial artery. Majority of multiple or bilateral extravasations occured in patients with systemic factors. A better understanding of the potential bleeding source might help and limit the risk of treatment failures. Our study confirms that the SPA is the most common cause of severe bleeding. We also emphasise the role of the AEA not only in traumatic context. Others arteries are rarely involved except in patients with comorbidities or frequent recurrences.

A Subhepatic Calcified Cyst

Question: A 68-year-old woman, asymptomatic, with no medical history, underwent an abdominal computed tomography scan in a traumatic context. An enhanced series (Figure A) revealed a 4-cm cystic mass with tissue and calcified rim components located under the left liver (Figure A, arrow) inside the ligamentum teres. The lesion was supplied by a left hepatic artery branch. The frontal view showed the mass drainage into the left external iliac vein through a long pedicle (the umbilicus vein connected to the left inferior epigastric vein) (v). A laparoscopic resection of this mass was performed because of the risk of spontaneous hemorrhage linked to the dense tumoral vasculature and the lack of formal histologic diagnosis. During the procedure, the surgeon observed a cystic mass attached to ligamentum teres between the liver and the umbilicus. At pathologic examination (Figure B), a well-circumscribed largely cystic mass, with a fibrous and calcified shell and hemorrhagic modifications (arrow) was observed. Histologically (Figure C), the fibrous wall contained many large vessels and a small cellular area (star). This area consisted of small nests of moderate-sized monotonous clear cells with normochromatic ovoid nuclei. There was no nuclear atypia and no mitosis. The tumor exhibited an elaborate network of small capillaries. Tumor cells expressed the melanocytic marker HMB45 and smooth muscular actin. What is your diagnosis? Look on page 489 for the answer and see the Gastroenterology website (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and images in GI. PEComas are tumors derived from epithelioid perivascular cells that typically coexpress smooth muscle and melanocytic markers. The family of PEComas includes angiomyolipoma, clear cell “sugar” tumor, and lymphangioleiomyomatosis. Some of these tumors may be associated with tuberous sclerosis complex. PEComas of the ligamentum teres (also called in this location “clear cell myomelanocytic tumors”) are rare, but the ligamentum teres location is the most classic in children. Thirteen cases have been reported in the literature, within or in the immediate vicinity of falciform ligament/ligamentum teres.1Folpe A.L. Goodman Z.D. Ishak K.G. et al.Clear cell myomelanocytic tumor of the falciform ligament/ligamentum teres: a novel member of the perivascular epithelioid clear cell family of tumors with a predilection for children and young adults.Am J Surg Pathol. 2000; 24: 1239-1246Crossref PubMed Scopus (201) Google Scholar, 2Folpe A.L. Mentzel T. Lehr H.A. et al.Perivascular epithelioid cell neoplasms of soft tissue and gynecologic origin.Am J Surg Pathol. 2005; 29: 1558-1575Crossref PubMed Scopus (679) Google Scholar, 3Alaggio R. Cecchetto G. Martignoni G. et al.Malignant perivascular epithelioid cell tumor in children: description of a case and review of literature.J Pediatr Surg. 2012; 47: 31-40Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar There was a marked female predominance with a mean age of 20 years (range, 3-54), a mean size of 8 cm (range, 5-20), and a significant risk of metastasis (3 of 13 cases). Many of the lesions were calcified and had hemorrhagic and cystic alterations. In the absence of established malignancy criteria, PEComas must be considered to have an uncertain malignant potential, requiring surgical resection and long-term monitoring. A mass of the ligamentum teres should always lead to consider the diagnosis of PEComa, even in adults, and even with cystic presentation. Moreover, most frequently, other tumors of the ligamentum teres are malignant (local extension of hepatocellular carcinoma, metastatic adenocarcinoma of gastrointestinal or gynecological origin). The patient was free of disease at 6 months follow-up.

Surgical treatment in children missed Monteggia lesions at Bhuj, Kutch, Gujarat: a retrospective study

<p class="abstract"><strong>Background:</strong> The treatment of an unrecognized Monteggia lesion continues to pose a therapeutic challenge, as evidenced by the variety of surgical techniques described. Moreover, there are high complication and redislocation rates following surgery. This report concerns a surgical technique to reduce a chronic dislocation of the radial head utilizing an ulnar osteotomy and internal fixation<span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> Present study was performed at department of orthopedics, Gujarat Adani institute of medical science, Bhuj, Kutch, Gujarat. Ethical clearance was taken from the institutional ethics board and informed consent was obtained from all the participants. Between July 2015 and September 2016 six children presented in a traumatic context with chronic dislocation of the radial head and malunion of the ulna. Patient mean age was 6.5 (range 4–8) years, and the mean interval between injury and surgical procedure was 17 (range 1–49) months. Surgery consisted of an ulnar osteotomy with angulation and lengthening, bone grafting at the osteotomy site, and internal fixation. Open reduction of the radial head, repair or reconstruction of the annular ligament or temporary fixation of the radial head with a transarticular wire was not undertaken. Cast immobilization with the forearm in neutral rotation was maintained for 4-6 weeks.<strong></strong></p><p class="abstract"><strong>Results:</strong> There was one case of nonunion. At an average follow-up of 3 (range 1.5–4.4) years, all patients had regained painless function of the forearm, good range of elbow and forearm motion, and maintenance of the radial head reduction<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> Both angulation and elongation of the ulna are required to allow for reduction of the radial head. We do not see any indication for procedures directed at the radio-capitellar joint<span lang="EN-IN">.</span></p>

Beneficial effects of chronic oxytocin administration and social co-housing in a rodent model of post-traumatic stress disorder.

Post-traumatic stress disorder (PTSD) is in part due to a deficit in memory consolidation and extinction. Oxytocin (OXT) has anxiolytic effects and promotes prosocial behaviors in both rodents and humans, and evidence suggests that it plays a role in memory consolidation. We studied the effects of administered OXT and social co-housing in a rodent model of PTSD. Acute OXT yielded a short-term increase in the recall of the traumatic memory if administered immediately after trauma. Low doses of OXT delivered chronically had a cumulating anxiolytic effect that became apparent after 4 days and persisted. Repeated injections of OXT after short re-exposures to the trauma apparatus yielded a long-term reduction in anxiety. Co-housing with naive nonshocked animals decreased the memory of the traumatic context compared with single-housed animals. In the long term, these animals showed less thigmotaxis and increased interest in novel objects, and a low OXT plasma level. Co-housed PTSD animals showed an increase in risk-taking behavior. These results suggest beneficial effects of OXT if administered chronically through increases in memory consolidation after re-exposure to a safe trauma context. We also show differences between the benefits of social co-housing with naive rats and co-housing with other shocked animals on trauma-induced long-term anxiety.

Reconstruction de la veine cave inférieure pour traumatisme

Post traumatic inferior vena cava (IVC) thrombosis is a rare and not well described entity with nonspecific clinical presentation. It remains a therapeutic challenge in traumatic context because of haemorrhagic risk due to anticoagulation.We report a case of IVC thrombosis in an 18 year-old man who presented with liver injury following a traffic crash. The thrombosis was incidentally diagnosed on admission by computed tomography. The patient was managed conservatively without anticoagulation initially considering the increasing haemorrhagic risk. IVC filter placing was not possible because of the unusual localization of the thrombus. Unfractionated heparin was started on the third day after CT scan control showing stability of hepatic lesions with occurrence of a pulmonary embolism. The final outcome was good.The management of post traumatic IVC thrombosis is not well described. Medical approach consists in conservative management with anticoagulation which requires the absence of active bleeding lesions. Surgical treatment is commonly based on thrombectomy under extracorporeal circulation. Interventional vascular techniques have become an important alternative approach for the treatment of many vessel lesions. Their main advantages are the relative ease and speed with which they can be performed.Post traumatic IVC thrombosis is a rare condition. Its management is not well defined. Early anticoagulation should be discussed on a case-by-case basis. Other alternatives such IVC filter or surgical thrombectomy may be used when the bleeding risk is increased. The most serious risk is pulmonary embolism. Outcome can be favorable even with non surgical approaches.

The contribution of MRI in the management of slowly progressive nontraumatic spinal cord compression

Les compressions médullaires lentes sont dues au développement dans le canal médullaire d’une lésion expansive. C’est une pathologie très fréquente dont le diagnostic est essentiellement clinique. L’imagerie par résonnance magnétique occupe une place incontournable dans le diagnostic de localisation et la recherche étiologique. En Europe l’étiologie tumorale est prépondérante. Le but de cette étude était de décrire les aspects IRM des compressions médullaires lentes et de déterminer le profil étiologique. Il s’agit d’une étude rétrospective portant sur 97 observations colligées au service de radiologie du CHUN de Fann sur une période de 30 mois (du 08/03/10 au 29/09/12). On été inclus dans l’étude, tous les patients adressés pour un tableau de compression médullaire lente survenu dans un contexte non traumatique. L’âge moyen des patients était de 42,6 ans avec des extrêmes compris entre 04 mois et 85 ans. Nous avons étudié la topographie des lésions (étage rachidien, compartiments canalaires) leur rehaussement et les critères d’orientation étiologique. Le protocole d’examen permettait la réalisation de séquence pondérées T1 sans avec injection de gado, T2, STIR et T2 DRIVE centrées sur les niveaux lésionnels ou les zones suspectes. L’IRM a permis de préciser le siège exact et l’étendue des lésions. L’atteinte du rachis dorsal représentait 42% des cas, suivi du rachis cervical avec 32% des cas. Les atteintes lombo-sacrées et pluri-étagées représentaient respectivement 18% et 08% des cas. Les lésions extradurales représentaient 87% des cas, suivi des lésions intradurales extramédullaires avec 08% des cas et des lésions intramédullaires dans 05% des cas. La particularité du profil étiologique de notre étude est la prédominance des épidurites infectieuses et la fréquence relative des épidurites métastatiques comparée aux séries occidentales. L’IRM vertébro-médullaire occupe une place capitale dans le diagnostic positif, topographique et étiologique des compressions médullaires.

Prospective study about activity of emergency unit in the Department of Ophthalmology (Nancy, University Hospital, France)

PurposeOphthalmological emergencies are common. Actually, access to care is difficult because of the low medical demography. The Department of Ophthalmology (Nancy, University Hospital, France) created a unit devoted to emergency in 2012.MethodsWe conducted a cross sectional study to describe this activity. All consecutive patients seen in the unit were included from February to April 2012 and from October to December 2014. We used a standardized evaluation (age, sex, access to care, geographic origin, symptoms, diagnosis, treatment, patient outcome). Every physician considered the real nature of the emergency.Results1496 patients were included during the first period (series 1) and 1116 during the second (series 2). The most common patient was a 45 years old man (55.3% and 56.3%). Many patients came by themselves without medical advice (40.1% and 58.4%). Principal symptoms were redness (31.5% and 24.8%), pain (28.5% and 25.0%), visual loss (22.6% and 17.7%), and irritation (20.6% and 17.8%). Traumatic context was frequent (about 25.0% of patients).The most prevalent diagnosis concerned the cornea. Serious infectious condition and vascular diseases were rare. 5.0% of patients were hospitalized and 6.0% received surgical treatment. 62.7% of them benefited only one consultation in emergency. They did not need another clinical control. 62.1–63.1% of consultations were qualified as real emergency.ConclusionsActually, the management of ophthalmic emergencies is a real public health problem. It is important to train emergency physicians and general practitioners, to address wisely to the specialist. Structures such as our unit seem to be an effective way to access care.

Regional cerebral glucose metabolism differentiates danger- and non-danger-based traumas in post-traumatic stress disorder.

Post-traumatic stress disorder (PTSD) is presumably the result of life threats and conditioned fear. However, the neurobiology of fear fails to explain the impact of traumas that do not entail threats. Neuronal function, assessed as glucose metabolism with (18)fluoro-deoxyglucose positron emission tomography, was contrasted in active duty, treatment-seeking US Army Soldiers with PTSD endorsing either danger- (n = 19) or non-danger-based (n = 26) traumas, and was compared with soldiers without PTSD (Combat Controls, n = 26) and Civilian Controls (n = 24). Prior meta-analyses of regions associated with fear or trauma script imagery in PTSD were used to compare glucose metabolism across groups. Danger-based traumas were associated with higher metabolism in the right amygdala than the control groups, while non-danger-based traumas associated with heightened precuneus metabolism relative to the danger group. In the danger group, PTSD severity was associated with higher metabolism in precuneus and dorsal anterior cingulate and lower metabolism in left amygdala (R(2 )= 0.61). In the non-danger group, PTSD symptom severity was associated with higher precuneus metabolism and lower right amygdala metabolism (R(2 )= 0.64). These findings suggest a biological basis to consider subtyping PTSD according to the nature of the traumatic context.

Risk and Resilience Factors in Families Under Ongoing Terror Along the Life Cycle

Families of unarmed civilians who live in warzones at political conflict areas are at risk of exposure to traumatic ongoing terrorism (OGT). This paper focuses on families living at the political conflict area by the border of the Gaza Strip at southwestern Israel, who have experienced OGT of missile fire for a decade and a half. Case examples illustrate the nuances and details of traumatic events, such as massive bombing, life threatening situations, evacuation, threat to and loss of life of family members and close friends, and their implications on the family system along life span. Members of these families are at risk of posttraumatic reactions and maladaptive system functioning in relation to the traumatic context of their specific life cycle stage. However, some families have shown potential for developing resilience, related to three main dimensions: belief system, organizational patterns, and communication channels. The objective of the present paper is to shed light, by evidence of families exposed to OGT, on risk and resilience factors affecting a family’s ability to overcome trauma throughout the lifecycle.

The stigma of surrender: German prisoners, British captors, and manhood in the Great War and beyond

Recent scholarship on the history of masculinity has struggled with a difficult question: how did men form ideals of manhood in the traumatic context of total war? While scholars like George Mosse have studied how medical and political authorities in the nineteenth and twentieth centuries defined images of manhood, the more complex, often contradictory self-conceptions of ordinary soldiers coping with the physical and psychological stresses of combat have remained more elusive. Hegemonic images of manhood in the age of total war featured the “martial masculinity” of steel-nerved, emotionally controlled heroes willing to die for the nation. But this ideal was challenged as many men had to incorporate a “softer side” of nurturing and compassion to survive the destructive effects of modern industrialized war. In The Stigma of Surrender, Brian Feltman (Georgia Southern Univ.) investigates the understudied experiences of German POWs from 1914 to 1920. He analyzes the psychological and emotional universe of men enduring the emasculating conditions of capture and imprisonment. In a military culture prizing the glory of heroic death as the ultimate expression of manhood, they suffered the stigma of falling short of prescribed gender roles. Feltman argues that these POWs underwent a crisis of identity and had to re-establish themselves as “real men” who served their country even while imprisoned. To this end, they cultivated a camp culture of resistance and redemption in a new kind of battle against their captors. This gave them a much needed higher purpose beyond the crushing routine of daily life in British prisoner camps. The author seeks to expand our understanding of manhood in war by revealing how men negotiated and changed prevailing images of masculinity in a specific context of trauma and defeat. Inspired by new perspectives on the history of emotions, Feltman uses POW voices to clarify the effects of their humiliation, depression, and separation. Drawing on over a thousand letters in various German archives and samples from camp newspapers, capture reports, and unpublished memoirs, he offers fascinating glimpses into the everyday lives and emotions of men who were made to feel like failures and even traitors to their families and their nation. Chapter 1, “Between Victory and Death,” concerns the immediate effects of surrender on a German soldier’s sense of self: “If going to war confirmed an individual’s manhood, the act of battlefield surrender challenged a soldier’s masculine identity and cast doubt upon his commitment to Germany’s national struggle” (13). Of the more than 997,000 German soldiers captured during the Great War, about 325,000 fell into British captivity. German military authorities often portrayed surrendering sol-

Detection of diffuse axonal injury in forensic pathology

Abstract: Even if βAPP remains the gold standard in identifying diffuse axonal injuries, other histological, ultrastructure, histochemical, or immunohistochemical markers may aid the diagnosis and may better characterize this traumatic brain pathology. Moreover, associated changes, including neuronal body changes, the presence of microglial clusters, and so on, when identified in a traumatic context, should suggest at least the need of using specific markers for identification of DAIs. The purpose of this article is to present the main microscopy techniques used in forensic practice to detect diffuse axonal injury. Key Words: diffuse axonal injury, beta-APP, ubiquitin, forensic pathology. 1) (a) MD, National Institute of Legal Medicine, Bucharest, Romania; (b) Lecturer, “Carol Davila” University of Medicine and Pharmacy, Dept of Legal Medicine and Bioethics, Bucharest, Romania *Corresponding author: Sos. Vitan Barzesti 9, 042122, Sector 4 Bucharest, Romania, Tel. +40-723-791072, Email: soraer@gmail.com, sorin.hostiuc@legmed.ro2) Lecturer, MD, Research Center for Microscopic Morphology and Immunology, Department of Morphology, University of Medicine and Pharmacy of Craiova, Craiova, Romania3) (a) MD, Floreasca Clinical Emergency Hospital, Bucharest, Romania, (b) Assist.Prof., “Carol Davila” University of Medicine and Pharmacy, Dept of Surgery, Bucharest, Romania4) Prof, “Carol Davila” University of Medicine and Pharmacy, Dept of Physiology, Bucharest, Romania5) (a) MD, National Institute of Legal Medicine, Bucharest, Romania; (b) Lecturer, “Carol Davila” University of Medicine and Pharmacy, Dept of Pathology, Bucharest, Romania

Trauma in Context: Narrative Themes on Responses of Trauma Survivors in South Africa

In this paper, the researchers investigate trauma survivors’ understanding of causes of illness and the treatment choice. The study was conducted in the rural communities of the Vhembe District in ...

Trauma in Context: Narrative Themes on Responses of Trauma Survivors in South Africa

In this paper, the researchers investigate trauma survivors’ understanding of causes of illness and the treatment choice. The study was conducted in the rural communities of the Vhembe District in ...

The Effect of Glucose on Hippocampal-Dependent Contextual Fear Conditioning

The metabolic challenge of trauma disrupts hippocampal functioning, which is necessary for processing the complex co-occurring elements comprising the traumatic context. Poor contextual memory of trauma may subsequently contribute to intrusive memories and overgeneralization of fear. Glucose consumption following trauma may be a means to protect hippocampal functioning and contextual fear learning. This study experimentally examined the effect of glucose on hippocampal-dependent contextual learning versus cued fear learning in humans. Forty-two male participants underwent cued conditioning with an unconditional stimulus (US) (shock) paired with a discrete conditional stimulus (geometric shape) and context conditioning (requiring hippocampal processing) with a US unpredictably paired with a background context (picture of room). Participants were then blindly randomized to consume either a 25 g glucose or sweet-tasting placebo drink and returned for a test phase 24 hours later. Measures included acoustic startle response, US expectancy, blood glucose levels, and arousal ratings. The glucose group showed superior retention of hippocampal-dependent contextual learning at test relative to the placebo group, as demonstrated by acoustic startle response and US expectancy ratings. Glucose and placebo groups did not differ on any measure of cued fear learning at test. This study provides experimental evidence that in mildly stressed humans postconditioning glucose consumption improves retention of hippocampal-dependent contextual learning but not cued learning. Ultimately, glucose consumption following trauma may be a means of improving learning about the traumatic context, thereby preventing subsequent development of symptoms of posttraumatic stress.

Pathologie discale de l’enfant et l’adolescent

Disc pathology, although it is rare concern, should be suspected in children and adolescents in case of back pain. Unlike in the adult population where degenerative lesions dominate the disk pathology, malformative, infectious, inflammatory and traumatic process are an important part of pathologies affecting this structure in children. The intervertebral disc is closely linked to the endplates and areas adjacent vertebral growth impairment frequently associated with these structures (interconnected vascular networks in spondylitis, fracture ring adolescent…). The gold standard exam for diagnostic is MRI that will analyze with more accuracy these anatomical structures. In case of spinal pain in children, this clinical assessment should be asked routinely if greater pain at 3months, no traumatic context, nerve root pain, neurological deficit, spinal inflammatory signs or back contracture.

Facial nerve: From anatomy to pathology

The facial nerve (CN VII) emerges from the facial nerve nucleus in the pons. It is accompanied by CN VIII along its cisternal pathway, as well as at the internal auditory meatus. Its petrous pathway includes a labyrinthine segment, a horizontal tympanic segment and a vertical mastoid segment until the stylomastoid foramen. It then continues to the parotid gland. Pontine impairment is usually associated with other neurological symptoms. Lesions of the cerebellopontine angle (most often meningioma and schwannoma) initially result in impairment of CN VIII. The impairment of CN VII takes second place. Peripheral impairment (outside of a traumatic context) is most often due to Bell's palsy.