Penetrating orbital trauma by stiletto causing complex cranial neuropathies

Penetrating orbital injuries pose a serious threat to vision, ocular motility, and in some cases, life. Long, sharp stiletto objects may penetrate deeply, causing catastrophic damage to orbital structures, despite seemingly trivial entry wounds. The authors present two cases of penetrating orbital injuries by stiletto objects, both entering via small eyelid wounds. Traumatic optic neuropathy occurred in both cases, and was treated with corticosteroids, however the globes escaped direct injury. Injuries to the IIIrd and VIth cranial nerves were also observed. Deep orbital injuries must be excluded in patients presenting with small eyelid wounds caused by sharp penetrating objects.     

The Epidemiology and Diagnosis of Penetrating Eye Injuries

It is estimated that there are 3.1 penetrating eye injuries per 100,000 person-years in the United States. OBJECTIVES: To evaluate the epidemiology of penetrating eye injuries and to identify physical examination findings that facilitate the diagnosis and ophthalmologic referral of patients with these injuries. METHODS: This was a retrospective chart review of emergency department patients with penetrating eye injuries seen for evaluation from July 1987 to January 1999. The setting was a tertiary referral, university hospital. Three hundred eighty-four patients with 390 penetrating eye injuries were enrolled; 56% were transferred from outlying hospitals. RESULTS: Penetrating eye injuries were seen almost three times per month. Eighty percent of the injuries occurred in males, and the mean age was 29 years. Twenty-five percent of the patients had used alcohol in the period immediately preceding the injury. Final visual outcome was 28% with enucleation, "no light perception" (NLP) in 10%, light perception to 20/200 in 24%, and light perception of 20/200 or better in 38%. Poor visual outcome was associated with poor initial visual acuity, alcohol use, and delayed presentation (p = 0.036, 0.025, 0.036, respectively). Gun-related injuries caused 33% and motor vehicle crashes (MVCs) caused 21% of the worst outcomes (enucleation or NLP). In MVCs where seat belt use was reported, 71% of injured patients were unrestrained. The most common initial physical findings were hyphema (76%), abnormality of the pupil or uvea (94%), and initial visual acuity worse than 20/200 (77%). All patients had at least one of these findings. Complications occurred in 25% of cases, most commonly traumatic cataract or infection. Complications occurred more commonly in those patients transferred than in those presenting directly (p = 0.002). CONCLUSIONS: Penetrating eye injuries are relatively common, occur predominantly in young males, and often result in poor visual outcome in the affected eye. Motor vehicle crashes, alcohol use, and fire-arm use are associated with more severe injuries.     

Volar Plate Injuries of the Proximal Interphalangeal Joint

The proximal interphalangeal joint (PIPJ) is the articulating joint between the proximal and middle phalanges of the fingers. Hyperextension injuries to the PIPJ of the finger are one of the most common injuries of the hand. Volar plate injuries (VPIs) of the PIPJ typically occur as a result of forced hyperextension, sometimes with a degree of axial loading. As such, VPIs are a distinct possibility to consider in all hyperextension finger injuries. Recognition of the signs and symptoms of the different types of VPI encountered will assist in accurate diagnosis, thus ensuring that the treatment provided is optimal. This clinical feature provides an overview on the assessment, diagnosis, and treatment of “closed” VPIs of the PIPJ.     

严重腹部多发伤38例临床分析

目的：通过总结严重腹部多发伤的诊治经验，以进一步提高其救治水平。方法：回顾性分析2005年1月至2007年12月收治的38例严重腹部多发伤患者的临床资料。结果：38例均采用手术治疗，术中死亡2例，术后死亡1例,原因为失血性休克和多器官功能障碍综合征。结论：结合病史、体检、腹腔穿刺、腹部彩超、CT、X线检查等可提高诊断率．为腹部外伤治疗提供可靠依据。尽早行确定性手术治疗、快速有效止血、术中探查避免遗漏脏器损伤、正确处理合并伤是减少并发症、降低死亡率的主要措施。     

Needlestick and sharps injuries among Turkish nursing students: A cross‐sectional study

Irmak Z, Baybuga MS. International Journal of Nursing Practice 2011; 17 : 151–157 Needlestick and sharps injuries among Turkish nursing students: A cross‐sectional study This cross‐sectional study was performed to investigate the prevalence of and other factors associated with needlestick and sharps injuries (NSIs) among nursing students in Turkey. A total of 60 (19.4%) nursing students reported NSIs during the past 1 year. The most common item causing injury was from a syringe needle (54.0%). Among nursing students, giving intravenous/intramuscular injections (60.0%) was the most common cause of NSIs. In total, 31.7% were not using gloves when injured. A total of 68.3% of NSIs were said to have gone unreported in any official report. A total of 43.5% of the nursing students had not received the hepatitis B vaccine. Finally, no single sociodemographic variables were shown to be significant as a risk factor for needlestick and sharps injury during logistic regression analysis. To decrease NSIs among nursing students, an education programme related to NSIs and standard precautions must be provided and immunized against hepatitis B before beginning clinical practice.     

腹部创伤1076例临床分析

【目的】提高腹部创伤及合并伤的早期诊断和手术治疗水平。【方法】回顾分析2001年1月至2008年12月收治的严重腹部创伤1076例的临床资料。其中闭合伤893例（83．0％）,开放伤183例（17．0％）;手术治疗969例;腹内主要脏器损伤依次是脾、肝、胃、小肠、肾、结肠等。【结果】全组存活1040例（96．7％）,入院时血压为零被抢救成功114例,因手术并发症再次手术17例;死亡36例（3．3％）,多死于失血性休克。【结论】在严重腹部创伤时,耗时的诊断程序是不允许的,只有当病人血流动力学稳定时才可作必要的检查以避免遗漏多脏器伤;同时应积极手术,手术止血被认为是最根本的抗休克措施;多脏器损伤处理坚持“保全生命第一,保全器官第二”的手术原则。     

个体化健康教育应用于手部肌腱损伤患者的临床效果观察

目的探讨个体化健康教育应用于手部肌腱损伤患者的临床效果。方法选取我科2010年4月~2012年3月收治的49例手部肌腱损伤患者设为对照组,开展常规健康教育;2012年4月~2014年3月收治的50例手部肌腱损伤患者设为研究组,开展个体化健康教育。记录两组干预前后手功能恢复状况、疼痛程度以及行为认知水平,并进行比较。结果研究组手功能恢复优良率达90.0%,对照组手功能恢复优良率达61.2%,两组比较有显著性差异(P0.05)。两组干预前疼痛程度比较无显著性差异(P0.05);研究组干预后的疼痛程度明显低于对照组,两组比较有显著性差异(P0.05)。两组干预前SCL-90各维度评分比较无显著性差异(P0.05);研究组干预后SCL-90各维度评分低于对照组,两组比较有显著性差异(P0.05)。结论个体化健康教育模式应用于手部肌腱损伤患者,能有效促进受损肌腱功能恢复,并减轻患者疼痛程度及临床症状,取得较为满意的临床效果。     

手部创伤软组织挛缩畸形修复的探讨

【目的】探讨手部创伤后所致畸形、功能障碍的手术修复及功能重建方法。【方法】对创伤后手部畸形、功能障碍患者137例（164只手）进行手术整复。采用切除瘢痕、松解粘连、肌腱转位、肌腱移植或肌腱“Z”形延长、虎口重建、皮瓣或皮片移植。并在术后采取康复措施。【结果】手术后手的畸形得以矫正，生活自理能力恢复，诸手的分指、对掌、对指及握捏功能恢复，手指均整复以功能位，外形改善明显。采用TAM标准评定优良率85％。【结论】手部畸形伴功能障碍应手术治疗，根据畸形病因和程度采取不同的术式，辅以术后康复治疗，可以较好的矫正畸形、恢复患手的外观和功能。     

Machine learning to predict sports-related concussion recovery using clinical data

ObjectivesSport-related concussions (SRCs) are a concern for high school athletes. Understanding factors contributing to SRC recovery time may improve clinical management. However, the complexity of the many clinical measures of concussion data precludes many traditional methods. This study aimed to answer the question, what is the utility of modeling clinical concussion data using machine-learning algorithms for predicting SRC recovery time and protracted recovery?MethodsThis was a retrospective case series of participants aged 8 to 18 years with a diagnosis of SRC. A 6-part measure was administered to assess pre-injury risk factors, initial injury severity, and post-concussion symptoms, including the Vestibular Ocular Motor Screening (VOMS) measure, King-Devick Test and C3 Logix Trails Test data. These measures were used to predict recovery time (days from injury to full medical clearance) and binary protracted recovery (recovery time > 21 days) according to several sex-stratified machine-learning models. The ability of the models to discriminate protracted recovery was compared to a human-driven model according to the area under the receiver operating characteristic curve (AUC).ResultsFor 293 males (mean age 14.0 years) and 362 females (mean age 13.7 years), the median (interquartile range) time to recover from an SRC was 26 (18–39) and 21 (14–31) days, respectively. Among 9 machine-learning models trained, the gradient boosting on decision-tree algorithms achieved the best performance to predict recovery time and protracted recovery in males and females. The models’ performance improved when VOMS data were used in conjunction with the King-Devick Test and C3 Logix Trails Test data. For males and females, the AUC was 0.84 and 0.78 versus 0.74 and 0.73, respectively, for statistical models for predicting protracted recovery.ConclusionsMachine-learning models were able to manage the complexity of the vestibular-ocular motor system data. These results demonstrate the clinical utility of machine-learning models to inform prognostic evaluation for SRC recovery time and protracted recovery.     

改良法插入结肠透析管对减少婴儿直肠肛门损伤的临床观察

结肠透析后行药物保留灌肠是我院对婴儿结肠炎常用的治疗方法。结肠透析是通过治疗机在结肠腔内建立有效的透析治疗系统,利用结肠自身潜在的吸收和排泄功能,清除肠腔内和肠黏膜上的有害代谢产物和毒素,从而达到清洁肠道的作用。     

手外伤后功能障碍４９例分析

手是人类劳动的器官,具有独特的结构与功能,损伤的机会也最多,占外科急依总数的２０％以上,占骨科急症的４０％［１］。手部解剖精细,损伤后如果治疗不当,易出现功能障碍,甚至畸形,严重影响劳动与生活质量,现就１a内笔所接触的４９例患,手外伤所出现的不同程度功能障碍情况,对其原因作一下分析。     

放射性脑损伤大鼠早期血脑屏障的改变

目的研究大鼠受到全脑照射后早期血脑屏障(BBB)的改变。方法建立清醒状态下大鼠放射性脑损伤模型,采用4MeV电子线作30Gy的单次全脑照射。120只SD大鼠随机分为照射组和假照射组,分别于照射前即刻、照射后6h、1d、1周和1月时记录磁共振成像(MRI)T1加权、T2加权的信号强度及其增强率,测定脑组织中伊文思蓝(EB)含量,免疫组化分析海马区神经细胞血管内皮生长因子(VEGF)的表达,并观察病理形态学的改变。结果照射组照射后T1加权的信号强度降低,T2加权的信号强度和信号强度的增强率升高,脑组织EB含量在照射后6h、1周和1月时及照射后6h VEGF表达较假照射组升高(P<0.05或0.01)。结论放射性脑损伤后早期,VEGF表达上调,BBB通透性增加,导致早期放射性脑损伤的发生。     

伸展分离型颈椎损伤的诊断和治疗

目的 探讨伸展分离型颈椎损伤的诊断与治疗方法.方法 回顾性分析2000-2005年浙江大学医学院附属第二医院收治的56例伸展分离型颈椎损伤患者的临床表现和影像学资料,采取前路椎间盘切除或椎体次全切除、植骨内固定术治疗.结果 48例患者获得随访,随访时间6～17个月,平均11个月.9例完全性脊髓损伤患者术后5例有感觉功能改善,39例不完全性脊髓损伤患者术后13例完全恢复,其余均有不同程度改善.6例陈旧性损伤患者术后颈部疼痛消失,4例神经功能获得改善.结论 MRI是确诊伸展分离型颈椎损伤的最佳手段,早期前路椎间盘切除植骨内固定使颈椎获得稳定、促进神经功能恢复,是治疗伸展分离型颈椎损伤的理想方法.     

Do Football Helmets Reduce Acceleration of Impact in Blunt Head Injuries?

Several recent studies suggest that acceleration of the head at impact during sporting activities may have a detrimental effect on cognitive function. Reducing acceleration of impact in these sports could reduce neurologic sequelae. OBJECTIVE: To measure the effectiveness of a regulation football helmet to reduce acceleration of impact for both low- and moderate-force impacts. METHODS: An experimental paired study design was used. Male volunteers between 16 and 30 years of age headed soccer balls traveling approximately 35 miles per hour bareheaded and with a helmet. An intraoral accelerometer worn inside a plastic mouthpiece measured acceleration of the head. The helmet also had an accelerometer placed inside the padding. For more forceful impacts, cadaver heads, both with and without helmets, were instrumented with intraoral (IO) and intracranial (IC) accelerometers and struck with a pendulum device. Simultaneous IO and IC accelerations were measured and compared between helmeted and unhelmeted cadaver heads. The main outcome was mean peak acceleration of the head and/or brain associated with low- and moderate-force impacts with and without protective headgear. RESULTS: Mean peak Gs, measured by the mouthpiece accelerometer, were significantly reduced when the participants heading soccer balls were wearing a helmet (7.7 Gs with vs 19.2 Gs without, p = 0.01). Wearing a helmet also significantly lowered the peak Gs measured intraorally and intracranially in cadavers subjected to moderate-force pendulum impacts: 28.7 Gs with vs 62.6 Gs without, p < 0.001; and 56.4 Gs with vs 81.6 Gs without, p < 0.001, respectively. CONCLUSIONS: A regulation football helmet substantially reduced the peak Gs associated with "heading" a soccer ball traveling at moderately high velocities. A helmet was also effective in reducing the peak acceleration both intraorally and intracranially for impacts significantly more forceful than heading a soccer ball.