Traumatic Origin Research Articles

Mucosal necrosis of the palate after embolization for labial arterioveinous malformation

Objective: Cervico-facial arteriovenous malformations (AVMs) are complex and rare vascular lesions, and present in 0.1% of the population. Of traumatic or congenital origin, they are characterized by variable growth, and their complications can be disfiguring and potentially fatal. The treatment of choice is embolization followed by surgery if necessary. The main complications are recurrence and postoperative bleeding.
 Case report: We report the rare case of a 59-year-old female patient who underwent embolization of a right upper labial and jugal AVM, followed by complete necrosis of the right hemi-palatal mucosa associated with dental mobility and pain. Follow-up at 6 months showed complete reepithelialisation of the palate.
 Conclusions: Soft tissue necrosis after AVM embolization is a rare event and is more commonly described after embolization for epistaxis. The evolution is generally favourable within a few weeks. 

Q&A: Rating Costochondritis

Q&A: Rating Costochondritis

ПРИМЕНЕНИЕ РЕНТГЕНЭНДОВАСКУЛЯРНЫХ МЕТОДОВ ДИАГНОСТИКИ И ЛЕЧЕНИЯ У ПАЦИЕНТА С ПОСТТРАВМАТИЧЕСКОЙ ГЕМОБИЛИЕЙ ПРИ ПРОНИКАЮЩЕМ РАНЕНИИ БРЮШНОЙ ПОЛОСТИ. СОБСТВЕННЫЙ ОПЫТ

Background. Hemobilia is the excretion of blood alongside with bile through intra- and extrahepatic bile ducts. Despite the use of new methods of diagnosis and treatment, the mortality rate from hemobilia remains high (20-40%). Objective. To demonstrate a clinical case and some methods of diagnosis and treatment of a patient with hemobilia. Material and methods. The article presents our own clinical observation of a patient with a penetrating knife wound of the abdominal cavity with liver injury complicated by hemobilia. Two-stage treatment was performed including upper midline laparotomy, cholecystectomy, and biliary tract sanitation with external drainage of the common bile duct according to Pikovsky in combination with angioembolization of the damaged artery of the 4th liver segment. Results. The analysis of the clinical case shows X-ray endovascular methods to be one of the promising ways of increasing surgical management efficiency of traumatic hemobilia. Conclusions. This observation shows the possibility of developing hemobilia without signs of intra-abdominal bleeding in penetrating abdominal wounds with liver injury. The use of X-ray endovascular diagnostic methods can improve treatment outcomes of patients with hemobilia of traumatic origin.

Reduction of missed thoracic findings in emergency whole-body computed tomography using artificial intelligence assistance.

Radiology reporting of emergency whole-body computed tomography (CT) scans is time-critical and therefore involves a significant risk of pathology under-detection. We hypothesize a relevant number of initially missed secondary thoracic findings that would have been detected by an artificial intelligence (AI) software platform including several pathology-specific AI algorithms. This retrospective proof-of-concept-study consecutively included 105 shock-room whole-body CT scans. Image data was analyzed by platform-bundled AI-algorithms, findings were reviewed by radiology experts and compared with the original radiologist's reports. We focused on secondary thoracic findings, such as cardiomegaly, coronary artery plaques, lung lesions, aortic aneurysms and vertebral fractures. We identified a relevant number of initially missed findings, with their quantification based on 105 analyzed CT scans as follows: up to 25 patients (23.8%) with cardiomegaly or borderline heart size, 17 patients (16.2%) with coronary plaques, 34 patients (32.4%) with aortic ectasia, 2 patients (1.9%) with lung lesions classified as "recommended to control" and 13 initially missed vertebral fractures (two with an acute traumatic origin). A high number of false positive or non-relevant AI-based findings remain problematic especially regarding lung lesions and vertebral fractures. We consider AI to be a promising approach to reduce the number of missed findings in clinical settings with a necessary time-critical radiological reporting. Nevertheless, algorithm improvement is necessary focusing on a reduction of "false positive" findings and on algorithm features assessing the finding relevance, e.g., fracture age or lung lesion malignancy.

Ungulomycosis of cattle: etiological factors and pathogenetic mechanisms

Mycotic diseases, ie those caused by microscopic fungi, are widespread among animals. As for cattle, at present ungulomycosis has become the most widespread, in which keratolytic fungi affect the hooves of animals, causing complications such as deformities, pododermatitis, lesions of the hoof bone. Ungulomycosis (from the Latin ungula – hoof, Gr. Mykes – fungus) – a disease of the hooves, which are caused by microscopic fungi that have keratolytic properties. In most cases of ungulomycosis, its complications are most often registered, and not the disease itself, which does not allow to carry out effective preventive measures and treatment of animals in a timely manner. That is why the purpose of the work was to study and concretization the main factor of the disease and the contributing conditions for the disease. For this purpose the basic and additional clinical methods of research were used, including microscopy of the destroyed horn and sowing on nutrient media to determine the species content of microscopic fungi. The research was carried out in the farms of the western regions of Ukraine on cows of Black-Spotted and Holstein breeds in the stall period with tethered animals. It is found that the pathogenic action of microscopic fungi-keratomycetes on the hooves of cattle is carried out in the presence of favorable conditions of external and internal nature, primarily insufficient housing conditions and poor feeding. In particular, for osteodystrophy due to ungulomycosis, the destruction of the hoof's horn is accelerated, which complicates the pathological process. For purulent subdermatitis of traumatic origin, microscopic fungi-keratomycetes act as an additional or contributing factor to the disease. Further research will focus on the development of effective treatments and measures to prevent ungulomycosis.

Bilateral delayed traumatic diaphragmatic injury

ABSTRACTA 47-year-old patient presented at our emergency department with acute epigastric pain. A thoracic X-ray showed a partially intrathoracic stomach as well as bowel left sided. A following computed tomography scan diagnosed a diaphragmatic hernia. In the patient’s history, 20 years ago a serious car accident was reported as the presumable traumatic origin. Intraoperatively, the diaphragmatic hernia was repaired with a direct suture and mesh augmentation. The rest of the abdomen was clear. In a thoracic X-ray following chest tube removal, herniated small bowel appeared intrathoracally on the right. Relaparotomy showed an extensive diaphragmatic hernia with parts of the liver, small bowel and colon in the right thoracic cavity. Only a partial direct repair was possible, an inlay mesh repair was performed. The further recovery was uneventful.Bilateral delayed traumatic diaphragmatic hernias are extremely rare, but with a suggestive trauma history thorough intraoperative exploration of the contralateral side should be evaluated.

Differential diagnosis of flaccid palsy of the upper extremities in children first months after birth (Literature review)

This article analyzes the literature related to flaccid paresis and paralysis of the upper extremities in children during the first months of life. This pathology is a heterogeneous group of diseases with different etiopathogenesis. There are various courses of flaccid paresis and paralysis of the upper extremities in children: damage to the spinal cord, brachial plexus, peripheral nervous system to the level of the brachial plexus, and isolated damage to peripheral nerves. According to the time of occurrence, flaccid paresis and paralysis can be divided into three groups: antenatal, intranatal, and postnatal pathology.
 The main mechanism of occurrence of this pathology is intranatal trauma. More rare causes of flaccid paresis and paralysis of the upper extremities are antenatal conditions of dysplastic and traumatic origin, postnatal damage to the peripheral nervous system due to trauma or infection. Congenital contractures of the upper extremities combined with flaccid paralysis are connected with genetically determined diseases of the lower motor neurons and congenital myopathies, intrauterine injuries of the brachial plexus peripheral nerves. This article discusses the issues of topical and differential diagnosis of this pathology, the clinical picture suitable for each period of the childs life, and the prognosis of the disease. This research will be useful not only for neurologists, but also for specialists of related specialties: orthopedists, physiotherapists, and neonatologists for making correct the diagnosis, providing adequate treatment, and predicting its results.

Temporal trends in neurologically intact survival after paediatric bystander-witnessed out-of-hospital cardiac arrest: A nationwide population-based observational study

AimTrends in neurologically intact survival after paediatric out-of-hospital cardiac arrest (OHCA) remain unclear. In the present study, we aimed to determine trends in 1-month neurologically intact survival after paediatric OHCA over time. MethodsWe reviewed the data of 5461 children (aged < 18 years) who experienced bystander-witnessed OHCA and were included in the nationwide Japanese registry from 2005 to 2017. Patients were divided into three groups according to study period: 2005–2010, 2011–2015, and 2016–2017. We analysed the trends in 1-month neurologically intact survival rates over time. ResultsThe risk-adjusted odds of 1-month neurologically intact survival (odds ratio, 1.86; 95% confidence interval, 1.41–2.44) were significantly improved by 2016–2017 compared with baseline. Similar improvements in 1-month neurologically intact survival rates were observed with both standard bystander cardiopulmonary resuscitation (CPR) with rescue breaths and chest compression-only bystander CPR (P for trend < 0.05 and < 0.001, respectively). In the subgroup analyses by aetiology, the 1-month neurologically intact survival rate in patients with OHCA of non-traumatic origin significantly increased from 11.8%–15.1% to 19.7% (P for trend < 0.001) but not in those with OHCA of traumatic origin (from 4.9% to 3.4% to 4.1%; P for trend = 0.29). ConclusionThe 1-month neurologically intact survival rate significantly increased from 2005 to 2017 in Japanese children with bystander-witnessed OHCA, regardless of bystander CPR type; This increase was noted in patients with OHCA of non-traumatic origin but not in those with OHCA of traumatic origin.

Osteochondral fragmentation of the palmarolateral/plantarolateral aspect of the distal phalanx in four horses: A novel location

Four horses presenting for lameness were diagnosed with unilateral osteochondral fragmentation (OCF) of the palmarolateral/plantarolateral aspect of the distal phalanx within the distal interphalangeal joint (DIPJ). Histological evaluation of one case supported a diagnosis of osteochondritis dissecans (OCD), with patient age and history from two cases suggesting a traumatic origin. Lesion appearance on conventional radiography, computed tomography (CT), nuclear scintigraphy and magnetic resonance imaging (MRI) are described. Fragmentation was best identified on dorsal 65° proximal-palmaro/plantarodistal oblique (D65°PrPDiO/D65°PrPlDiO) and dorsal 65° proximal-palmaro/plantarodistal lateral oblique (D65°Pr45°L-PDiMO/D65°Pr45°L-PlDiMO) radiographic projections of the foot, but articular pathology appeared more severe on cross-sectional imaging modalities. In all cases, lameness was refractory to conservative management. Arthroscopic evaluation of the DIPJ was performed in three horses, although the lesion was inaccessible in two. In one horse, access to the lesion was possible due to increased joint laxity, presumably due to concurrent soft tissue injury. One horse was euthanased after failed conservative management, one was pasture sound following palmar digital neurectomy 12 months after initial presentation, one returned to racing and one was lost to follow-up. Osteochondral fragmentation at this location has not previously been described, treatment options are limited and the prognosis appears to be poor.

The Health and Welfare of Rabbits as Indicated by Post-Mortem Findings at the Slaughterhouse.

Simple SummaryVeterinary inspection at the slaughterhouse plays an important role in the surveillance system for animal health and welfare. The study focused on the quantification and identification of pathological findings in rabbits slaughtered at the slaughterhouses in the Czech Republic in the period from 2010 to 2019. The ratio of the number of pathological findings to the total number of rabbits slaughtered was 0.0214, i.e., for every hundred rabbits, 2.14 findings were made documenting the impairment of health and/or welfare to an extent leading to pathological changes detected during the post-mortem inspection of the rabbits at the slaughterhouse. The pathological findings that occurred most often were those on the limbs (0.84%), trunk (0.71%), kidneys (0.17%), and liver (0.05%), along with generalized changes (0.37%). The results show that findings on the limbs and trunk were dominated by findings of traumatic origin. Findings in the kidneys and liver were most often of a chronic nature. Findings of abscesses were most frequent among generalized findings.The aim of the study was to assess post-mortem findings according to their localization and the nature of damage and to assess the standard of health and welfare of farmed rabbits on the basis of these findings. A total of 40,206 pathological findings were recorded in 1,876,929 rabbits slaughtered at slaughterhouses in the Czech Republic in the period from 2010 to 2019. Pathological findings on the limbs (0.84%), the trunk (0.71%), the kidneys (0.17%), and the liver (0.05%), along with generalized changes (0.37%), occurred most frequently. Findings of traumatic origin dominated among findings on the limbs and trunk, which indicates the inappropriate housing and handling rabbits on farms and during transport. Findings in the kidneys and liver were most often of a chronic nature having an evident correlation with the diet of intensively fed rabbits, with shortcomings in the diet having an impact on the parenchyma with chronic manifestations in the liver and kidneys. Among the generalized findings, multiple abscesses, which were probably associated with the infection of injuries occurring during fattening, and emaciation resulting from current husbandry practices, leading to insufficient feed intake or the development of disease in some individuals, predominated.

Acute corneal hydrops of presumed traumatic origin: An uncontrolled case series (three horses)

SummaryThis case series describes acute corneal hydrops in three young horses. Due to similarities in the clinical appearance and progression of the disease with that which is reported in humans and cats with acute corneal hydrops, traumatic Descemet’s membrane rupture was suspected to be the underlying aetiology in these equine cases. The horses presented with acute severe corneal oedema with intrastromal bullae formation and anterior bulging of the corneal contour. Focal posterior corneal changes were also seen in two of three cases. Mild anterior uveitis was also present. Other causes of corneal oedema (e.g. glaucoma) were ruled out based on presentation and clinical examination. Treatment approaches were medical and included various combinations of prophylactic topical antimicrobial therapy in case of secondary corneal ulceration, anti‐inflammatory therapy for uveitis, targeted oedema therapy with topical hypertonic saline and corneal cross‐linking, and placement of a temporary partial tarsorrhaphy for corneal tamponade. The outcome was excellent in all cases, with rapid resolution of the ocular changes. Acute corneal hydrops of presumed traumatic Descemet’s membrane rupture origin should be considered in cases of young horses presenting with acute corneal oedema. However, further studies are warranted to better characterise the disease and to try to confirm the suspected aetiology.

Traumatic Blepharitis Including Cutanous Changes with a Clinical Appearance of Immune-Mediated Disease

Abstract A four-year-old intact male Labrador retriever was presented with acute onset of ulcerative lesions around both eyes, on the mucocutaneous junctions around the muzzle and nares, and on the lateral aspects of paw pads. All lesions were symmetrical and well demarcated. The rest of ocular and systemic examination was unremarkable. The onset of lesions was acute and coincided with an episode of intense hunting in switchgrass. Similar lesions were present in another dog used in the same hunting trip. The clinical presentation was suggestive of a possible immune-mediated skin disease. However, the patient responded to systemic antibiotic treatment with full recovery without recurrence upon cessation of therapy. Traumatic origin should be included into differential diagnosis of mucocutaneous ulcerative lesions presenting as a possible immune-mediated skin disease.

The effectiveness of community neurorehabilitation for persons with an acquired brain injury: protocol for a systematic review

Background: Acquired brain injury (ABI) refers to any type of brain damage after birth. ABI from either traumatic or non-traumatic origin is a leading cause of death and long-term disability globally. The impact of an ABI can be cognitive and/ or physical, greatly affecting their ability to function independently. With a lack of specialist inpatient rehabilitation facilities and services many of these survivors reside within the community either alone, with family or in residential facilities. Up-to-date evidence is required to indicate which forms of community rehabilitation are most effective in improving cognitive and physical outcomes for survivors. This systematic review aims to explore the clinical effectiveness of community neuro-rehabilitation services for persons living with an ABI. Methods: A systematic review of relevant electronic databases will be undertaken to identify eligible published randomised controlled trials. The PRISMA statement will be used to guide the systematic review. From running the initial search, we aim to submit the paper for publishing within 6 months. This process will be completed using Covidence software. Two reviewers will independently screen the search results and select studies using pre-defined selection criteria, extract data from and assess risk of bias for selected studies. Discussion: This systematic review will aim to explore the clinical effectiveness of community neuro-rehabilitation services for persons with an ABI. It plans to review and synthesize the current best available evidence base. A goal of this study is to positively inform ongoing service development within a quality framework. Systematic review registration: PROSPERO CRD42020148604 (26/02/2020)

Detecting subgroups in social participation among individuals living with spinal cord injury: a longitudinal analysis of community survey data.

Longitudinal community survey. To determine subgroups in social participation of individuals living with spinal cord injury (SCI). Community. Data were collected in 2012 and 2017 as part of the community survey of the Swiss Spinal Cord Injury cohort. Participation was assessed using the 33-item Utrecht Scale of Evaluation of Rehabilitation-Participation evaluating frequency of, restrictions in and satisfaction with productive, leisure, and social activities. Linear mixed-effects model trees were used to distinguish subgroups in participation associated with sociodemographic and lesion characteristics. In all, 3079 observations were used for the analysis, of which 1549 originated from Survey 2012, 1530 from Survey 2017, and 761 from both surveys. Participants were mostly male (2012: 71.5%; 2017: 71.2%), aged on average 50 years (2012: 52.3; 2017: 56.5), with an incomplete paraplegia (2012: 37.5%; 2017: 41.8%) of traumatic origin (2012: 84.7%; 2017: 79.3%). There was limited within-person variation in participation over the 5-year period. Participation varied with age, SCI severity, education, financial strain, number of self-reported health conditions (SHCs), and disability pension level. Among modifiable parameters, the number of SHCs and disability pension level emerged as the most frequent partitioning variables, while education was most informative for participation in productive, leisure, and social activities. Long-term rehabilitation management and clinical practice should target people most prone to decreased participation in major life domains. Our study indicates that the alleviation of SHCs, engagement in further education, or adjusting disability pension level are promising areas to improve participation of persons living with SCI.

Avaliação por ressonância magnética das lesões intramedulares: o que podemos encontrar? - Parte 1. Lesões neoplásicas, vasculares, metabólicas e traumáticas

Diseases involving the spinal cord include a heterogeneous group of abnormalities, including those of inflammatory, infectious, neoplastic, vascular, metabolic, and traumatic origin. Making the clinical differentiation between different entities is often difficult, magnetic resonance imaging being the diagnostic method of choice. Although the neuroimaging findings are not pathognomonic, many are quite suggestive, and the radiologist can assist in the diagnosis and, consequently, in the therapeutic guidance. In this first part of our article, the objective is to review the magnetic resonance imaging findings of the main neoplastic, vascular, metabolic, and traumatic spinal cord injuries.

Avaliação por ressonância magnética das lesões intramedulares: o que podemos encontrar? - Parte 2. Lesões inflamatórias e infecciosas

Diseases involving the spinal cord include a heterogeneous group of abnormalities, including those of inflammatory, infectious, neoplastic, vascular, metabolic, and traumatic origin. Making the clinical differentiation between different entities is often difficult, magnetic resonance imaging being the diagnostic method of choice. Although the neuroimaging findings are not pathognomonic, many are quite suggestive, and the radiologist can assist in the diagnosis and, consequently, in the therapeutic guidance. In this second part of our article, the objective is to review the magnetic resonance imaging findings of the main inflammatory and infectious spinal cord injuries.

Drowning in submerged cars caused by traffic accidents.

Traffic accidents are among the most common causes of death. A small proportion of drownings are associated with traffic accidents. The roads in the Eastern Black Sea Region, where the study was conducted are fairly close to the seas, rivers, and ponds. This study aims to evaluate the cases who underwent autopsies after the traffic accident between 2009 and 2016 and who were found to have died as a result of drowning. A retrospective examination was made of the autopsy reports in the period 2009-2016. As a result of the examination of forensic reports, from a total of 7124 autopsies performed in our center between 2009 and 2016, 41 (0.57%) were seen to be due to death in a traffic accident that resulted in drowning. Of the vehicles involved in the ac-cidents, 30 (73.2%) were retrieved from a river/stream, 7 (17.1%) from a lake, and 4 (9.7%) from the sea. In all 39 cases, the primary cause of death was determined as asphyxia related to drowning. Other reasons affecting death were traumatic intracranial bleeding in 7 (17.1%) cases, medulla spinalis injury in 4 (9.7%), and pulmonary injury in 2 (4.9%). It was determined in the study that the typical autopsy results of trauma and drowning after a traffic accident could coexist. Drowning alone could be the cause of death, even though there was a traumatic origin such as a traffic accident in such cases. It was revealed that chemical and microscopic examinations should be handled together with crime scene results and eyewitness statements in addition to traumatic results during the examination phase.

Photobiomodulation therapy in the treatment of a palatal ulcer

Oral mucosa is the most common site for ulcers, and severely painful ulcers of traumatic origin prompt the patient to visit an oral physician to seek necessary treatment. Currently, numerous topical analgesics and anti-inflammatory medications are prescribed to reduce pain and accelerate healing. An alternative to this is low-level laser therapy which is a drug-free and noninvasive therapy and has shown potential results in treatment of oral ulcers. In this paper, we report a case of a patient with palatal ulcer which was successfully treated using a 660-nm (red) laser.

Three-year outcomes of alcohol delamination of corneal epithelium for recurrent corneal erosions of traumatic etiology.

Purpose:Alcohol delamination of the corneal epithelium (ADCE) is a therapeutic option for patients with recurrent corneal erosion (RCE) who do not respond to nonsurgical management of lubricants and extended wear contact lens. The aim of the study is to report on three-year efficacy and safety of ADCE for RCE of traumatic etiology.Methods:This is a retrospective review of consecutive patients who underwent ADCE for traumatic RCE in a local hospital between January 2010 and January 2020. The outcomes at a 3-year follow-up review are included. Nonsurgical therapy used; intra- and postoperative complications were recorded. ADCE was only offered to those who remained symptomatic despite maximum topical lubrications and/or extended wear contact lens. Success was defined as the absence of recurrence of corneal erosion.Results:Twenty-six eyes of 26 patients with RCE caused by trauma underwent ADCE. The mean age of patients was 39 years. The follow-up period was a minimum of 36 months. Three eyes (11.5%) had recurrence of corneal erosion after ADCE at the 3-year follow-up. Recurrence was noted at months 2, 23, and 36 postoperatively in these patients. All patients reported significant improvement in symptoms associated with recurrent erosion. Ten eyes (38.5%) stopped all topical lubricants postoperatively. No intra- or postoperative complications were noted in our study.Conclusion:This study documents the long-term safety and efficacy of alcohol delamination of corneal epithelium at 3 years for patients with RCE of traumatic origin.

Complicaciones pulmonares en pacientes con ventilación mecánica en un departamento de urgencias

Objective: To analyze pulmonary complications in patients with mechanical ventilation who are in the observation area of ​​the Emergency Department of the High Specialty Hospital Dr. Gustavo A. Rovirosa Pérez. Materials and method: A quantitative, descriptive, cross-sectional study was conducted to describe pulmonary complications associated with mechanical ventilation in patients admitted to the observation area of ​​the Emergency Department of the Regional Hospital of High Specialty Dr. Gustavo A. Rovirosa Pérez, from March 2016 to March 2018. The study consisted of 36 cases, of a review of 200 cases, according to the inclusion and exclusion criteria. Results: It was identified that 52.78% of the patients presented complications associated with possible pneumonia, 33.33% presented complications associated with probable pneumonia, in 13.89% of the patients, there were no complications secondary to an infectious condition associated with mechanical ventilation. 50% of the causes of mechanical ventilation requirement were of traumatic origin, 30.56% in relation to respiratory pathology, 16.67% in relation to neurological pathology and 2.78% in cardiovascular pathology. In relation to the severity using the APACHE II scale, the predicted mortality was lower than that observed, for a cut-off point of 20 points, prevailing as the most frequent causes of mortality in ventilated patients of respiratory etiology. The APACHE II score showed an intermediate positive predictive value and an intermediate negative predictive value. Conclusions: It was concluded that the requirement of mechanical ventilation is greater in relation to causes of traumatic origin, in comparison to causes of respiratory origin as reported in the reviewed publications. It was concluded that an APACHE II result ≥20 points corresponds to a much higher mortality. Likewise, it is concluded that the APACHE II system has a high sensitivity and low specificity to determine its diagnostic efficacy, which is comparable in multiple international studies.