Inferior vena cava injury after blunt trauma: Case report

Introductioninferior vena cava IVC injury is rare with lethal outcomes, the clinical signs depends on the location and associated injuries, andt he treatment might be endovascular, surgical.Clinical caseA 25 years with no medical history was admitted to the emergency department after a car accident. After intubation and hemodynamic stabilization, the computerized tomography CT scan showed hepatic laceration with a rupture of the IVC in the retro-hepatic portion, he was admitted to the operation room for damage control laparotomy; the patient died 12 h after the operation despite appropriate management.ConclusionIVC are rare and lethal, the CT scan remains the gold standard and the evolution of endovascular techniques decreased the mortality rate.     

Primary anastomosis for complete bulbar urethral rupture with rectal laceration caused by straddle injury: A case report

IntroductionThe initial management of urethral trauma remains disputed, and there are several suitable techniques, including delayed repair and suprapubic urinary diversion as well as primary endoscopic or open alignments. The treatment choice used depends on the rupture’s location and length as well as the accompanying trauma.Case presentationA 33-year-old male patient was referred to the department of emergency, with the chief complaint of inability to void experienced 1 day before being admitted, after falling from a height of approximately three meters. There was a laceration to the perineum 3 cm long to the rectum, with no active bleeding. After the incident, the patient could not void, but the lower abdomen was not painful. Upon retrograde urethrography examination, contrast extravasation of the bulbous urethra was seen through the anorectal laceration. Immediate debridement and repair for the anorectal wound, then primary anastomosis for the bulbous urethra, was performed.DiscussionThe likelihood of an injury to the anterior urethra increases with certain clinical features, including blood in the urethral meatus, palpable bladder distention, and a butterfly appearance on the perineum. Immediate exploration and reconstruction of the urethra is recommended in urethral traumas associated with penile fractures and non-life-threatening penetrating injuries. Furthermore, small lacerations are repaired primarily, while total ruptures are treated with anastomosis.ConclusionProper identification and management of urethral rupture determines the outcome. Initial urethral trauma management is disputed; however, a bulbous urethra rupture with anorectal lacerations can be treated safely and effectively with primary anastomosis.     

Complete urethral injury in the penile fracture: a case report and literature review

Penile fracture is described as a traumatic rupture of the tunica albuginea caused by blunt injury to the erect penis. It usually occurs as a single rupture of the tunica albuginea in one of two corpora cavernosa; a rupture with urethral injury is an extremely rare condition. Although its diagnosis is usually clinical, ultrasound plays an important role in confirming diagnosis and identifying the site of the injury. Here, we presented a case of penile fracture with complete urethral injury. A 43-year-old male was admitted to the hospital because of trauma to the genital and dysuria following sexual intercourse. After admission, the patient was diagnosed with double penile fracture and complete urethral injury after the physical and B-ultrasound examinations. Emergency surgery to remove the hematoma and repair the urethra was performed. The patient recovered smoothly and was discharged on the third day after operation. After two months’ follow-up, the patient urinated smoothly and achieved an adequate erection without other complications. In this case, consistent with previous studies, emergency surgery for penile fracture is necessary and can preserve the urethral function and sexual function. In addition, there are two lesions in tunica albuginea in this case, so careful search for the penile shaft during the surgery is important to avoid the missed injuries. This report provides evidence of an uncommon and underreported clinical case.     

Morel-Lavallée lesion diagnosed 25 years after blunt trauma

IntroductionMorel-Lavallée lesions are closed degloving injuries in which the skin and subcutaneous tissues separate from the underlying fascia secondary to a shearing force. These injuries are uncommon and can be misdiagnosed in acute settings. If treated incorrectly, they can recur, causing complications requiring multiple surgical interventions. Therefore, it is important to discuss the clinical presentation and imaging characteristics in order to improve their diagnosis and management.Presentation of caseThis is the case of a 44-year-old male patient with a Morel-Lavallée lesion of the left thigh that presented 25 years after trauma. He was successfully treated with open surgical excision. The patient underwent multiple surgical interventions before the lesion was accurately diagnosed and treated.DiscussionMorel-Lavallée injuries can lead to chronic symptoms, such as pain and swelling, affecting the patient’s quality of life. Treatment options include minimally invasive procedures, such as compression bandages or percutaneous drainage. However, if diagnosed late, a fibrotic capsule can form, which may require surgical excision. Our patient was diagnosed more than 20 years after the trauma. Earlier noninvasive treatment options were unsuccessful.ConclusionThe patient was treated with open surgical excision of the chronic lesion. There was no report of any recurrence up to 10 months after surgery. Such lesion treatments should be guided based on the chronicity of the injury and the patient’s symptoms. To the best of our knowledge, this is the first case with such delayed presentation.     

藤黄酸通过YAP信号通路发挥对高糖诱导的内皮损伤的保护作用

目的 探讨藤黄酸在高糖诱导的内皮损伤中的保护作用及可能的作用机制。方法 人脐静脉内皮细胞（HUVEC）分5组,对照组给与低糖培养基培养,模型组和藤黄酸低剂量组、中剂量组和高剂量组均给与40mmol/L葡萄糖培养基培养,藤黄酸各给药组分别给与0.2μM、0.4μM、0.8μM藤黄酸处理,MTT检测各组细胞活力,流式细胞术检测各组凋亡,WB检测凋亡蛋白Cl-cas-3和Cl-cas-9表达,收集各组细胞上清液,检测氧化应激指标:ROS、MDA、NO以及粘附分子ICAM-1、VCAM-1水平,WB检测YAP信号通路蛋白总YAP（t-YAP）蛋白和细胞核中YAP（n-YAP）蛋白表达量。在藤黄酸处理基础上,在HUVEC细胞中过表达YAP,MTT检测细胞活力,WB检测t-YAP和n-YAP蛋白表达。结果 与对照组比较,模型组及各给药组HUVEC细胞活性明显降低、凋亡率显著增加,凋亡蛋白Cl-cas-3和Cl-cas-9表达增加,细胞中ROS、MDA水平增加,NO水平降低,ICAM-1、VCAM-1水平增加,t-YAP和n-YAP蛋白表达增加（P<0.05）,与模型组比较,藤黄酸各剂量组细胞活力显著增加、凋亡率显著降低,凋亡蛋白Cl-cas-3和Cl-cas-9表达降低,细胞中ROS、MDA水平降低,NO水平升高,ICAM-1、VCAM-1水平降低,t-YAP和n-YAP蛋白表达降低,差异均有统计学意义（P<0.05）。藤黄酸+YAP组细胞活性显著低于藤黄酸组（P<0.05）,t-YAP和n-YAP蛋白显著高于藤黄酸组（P<0.05）。结论 藤黄酸可以抑制高糖诱导的HUVEC凋亡,增强细胞活力,减轻氧化应激损伤和细胞粘附,对高糖诱导的内皮损伤发挥保护作用,机制可能与抑制YAP信号通路激活有关。     

车祸致颅脑损伤患者家属心理健康状况与社会支持相关性研究

目的 了解车祸致颅脑损伤患者家属的心理健康状况和社会支持状况,探讨其相关性。方法 采用自编一般资料调查表、症状自评量表（SCL - 90）和社会支持量表（SSRS）,对225名到精神专科医院就诊的车祸致颅脑损伤患者家属进行问卷调查。结果 车祸致颅脑损伤患家属的SCL - 90总分为（178.45±82.56）分, SCL - 90总分、阳性项目数和9个因子分均显著高于肿瘤患者家属和全国常模(P＜0.05)。社会支持总分为（38.52±8.23）分,社会支持水平与家属的心理健康状况呈显著的负相关（r = - 0.416, P＜0.05）。多元线性回归分析显示,社会支持总分可以负向预测家属的心理健康状况（β = - 0.399,P＜0.05）。结论 车祸致颅脑损伤患者家属的心理问题发生率较高,应从个人、家庭和社会层面为家属提供社会支持资源。     

观察脊柱脊髓损伤不同时间段手术的术后神经功能恢复情况

目的对脊髓损伤患者不同时间段尽早急诊手术的术后神经功能康复情况进行观察。方法选取35例脊柱脊髓损伤并进行创伤外科急诊手术治疗患者的临床资料,进行统计并分析比较其不同时间段进行手术,术后的神经功能康复情况。结果 35例患者术后神经功能恢复均较术前明显好转,8小时手术的患者神经功能康复较8小时的患者好,越早进行手术的患者神经功能康复越好,所有患者术后的脊髓功能ASIA评分(针刺觉评分、轻触觉评分、运动评分)均较术前提高,且时间越早手术的术后ASIA评分提高值就越高,与术前、不同时间段之间比较P0.05,差异具有统计学意义。结论对于脊髓损伤的患者需加快其院外及院内的抢救,以最大限度降低患者的损伤,提高其术后神经功能康复力。     

颅脑外伤后局部脑组织中P物质和生长抑素的表达及意义

本文旨在分子水平探讨人脑外伤后神经肽的变化,为脑外伤后病理生理变化机制提供理论依据。采用免疫组织化学技术和多功能真彩色病理图像分析系统(CMIAS)对31例脑外伤患者局部脑损伤区和12例无脑损伤猝死患者相同脑区神经细胞中P物质(SP),生长抑素(SS)的表达进行了检测。结果得出脑伤患者局部伤区及周围神经细胞中SP、SS表达较尸检对照组明显减少并具时程特点。但与伤情及预后无显著关系。本实验表明SP、SS在颅脑损伤的病理生理过程中起了重要作用。