Pancreaticoduodenectomy for pancreatic trauma. A case report

Pancreatic trauma is uncommon and severe, combined pancreaticoduodenal injuries are rare. Different surgical techniques for the management of these injuries have been used. In this article a case of severe pancreaticoduodenal injury which required pancreaticoduodenectomy is reported. This case is unusual because there was no history of trauma, the serum amylase level and abdominal radiograph were normal and the abdominal findings on admission to hospital were minimal. A system of grading pancreatic trauma in terms of severity is advocated and the management of pancreaticoduodenal injuries is discussed.     

A rare case of classic biphasic pulmonary blastoma

Biphasic pulmonary blastomas are rare tumors that together with pulmonary carcinosarcomas comprise less than 2 per cent of all lung neoplasms. They can be defined as tumors that are composed of an admixture of immature mesenchyme and epithelium and that recapitulate morphologically the embryonal structure of the lung. First described in 1945 by Barnett and Barnard, their existence is well documented although their occurrence is rare. We present a case of a 40-year-old Hispanic female that presented with a 2-month history of retrosternal and midepigastric pain. A GI etiology was initially treated unsuccessfully with antireflux medications. A chest radiograph showed a 4.6-cm mass in the right upper lobe of the lung, and computed tomography showed right apical bullous formation with no lymphadenopathy. Bronchoscopy revealed no endobronchial lesions, and biopsy was nondiagnostic. The histopathologic and immunophenotypic analysis of a right upper lobectomy specimen was diagnostic of classic biphasic pulmonary blastoma. The rarity of these tumors makes easy identification difficult. Immunohistochemical analysis must be used to arrive at the proper diagnosis. It is imperative that there be good communication between the surgeon and pathologist and that institutions have access to facilities with the ability of identifying these complex tumors.     

Supination and inversion trauma of the ankle joint--experimental study of the value of arthrography

Arthrographic results obtained from the upper ankle bone are presented on the basis of anatomic specimens. They are considered as providing experimental evidence to practice related criteria for assessment of arthrography.     

Subarachnoid-pleural fistula due to blunt chest trauma. A case report

Subarachnoid pleural fistula (SPF) due to blunt chest trauma is rare. When SPF isn't associated with any neurological deficits, its clinical diagnosis is possible only with high degree of suspicion. Presentation symptoms include dyspnea and respiratory distress caused by the collection of cerebral-spinal fluid in the pleural cavity. Computed tomography scan after myelography is helpful in confirming the site of the fistula. Possible dangerous complications are infections or pneumoencephalus. Some cases resolved spontaneously after bed rest or pleural drainage alone, while others required surgical repair. We report a case of spontaneous closure after pleural drainage and a brief period of mechanical ventilation.     

Supination Deformity of the Forefoot

Supination deformity of the forefoot is rare. Observations of eleven cases and the production of the deformity in rabbits suggest that loss of function of the peroneus longus muscle in combination with the effect of a strong tibialis anterior muscle is decisive for the appearance of the deformity. Primary conditions causing deformity were: spina bifida, talipes equinovarus, poliomyelitis, trauma and muscular dystrophy. Treatment by wedge resection of the first cuneiform and the first metatarsal hones and transfer of the tibialis anterior tendon was successful. Operations for supination deformity were carried out in nine cases.     

Three-dimensional computerized tomography in trauma surgery. A case presentation]

Three-dimensional images of bone structures can easily be reconstructed from computed tomography data. The technique and the advantages of contemplating reconstructions of bone defects in different directions are described. A special software programme allows to combine all data which are given by the standard CT. The slice diameter is two millimetres. The reconstruction shows bone surfaces in all required views. In traumatic and orthopaedic surgery 3-D-CT is useful in the analysis, detection and preoperative planning of comminuted bone injuries of the spine, pelvis, knee, shoulder and the calcaneus. With this technique it is possible to see the bone in its topographic constellation, to observe fractures in unusual directions and to identify fragments from each other. The surgeon gets a lot of additional information which is helpful to decide on the incision, the reduction and the fixation of fragments. Undesirable effects during operation are reduced, which leads to a more accurate treatment and subsequent better results.     

Pelvic displacement of a cardiac pacemaker following trauma. A case report.

The rate migration of an implanted cardiac pacemaker from the subrectus area anterior to the peritoneum to the pelvis following a motor vehicle accident is reported. Discovery of dislodgement was made by observing a marked increase of pacemaker impulse amplitude in the three standard limb leads as measured on an oscilloscope.     

Isolated coronary artery rupture following blunt chest trauma. A case report

In connection with blunt chest trauma, a 44-year-old man sustained isolated rupture of the right coronary artery. The lesion, which is extremely rare, was overlooked as there was no haemopericardium. The patient died. Since early surgical repair is essential, the possibility of coronary artery lesion must be kept in mind in all cases of severe thoracic trauma.     

Sigmoid colon injury due to blunt abdominal trauma. A case report

We present a case of sigmoid colon injury after blunt abdominal trauma. The patient was submitted to sigmoid resection with primary end-to-end colo-colic anastomosis. He died 22 days after operation with septic shock and acute respiratory failure. Post-mortem examination showed left lung generalized pneumonia with no signs of intra-abdominal pathology; colo-colic anastomosis was intact. We reviewed the literature about the management of this rare trauma.     

Ventricular septal defect due to blunt chest trauma. A case report

Blunt chest trauma may cause cardiac trauma, this possibility often being overlooked. Various anatomical structures may be affected. A case of ventricular septal defect due to blunt chest trauma is described and the relevant literature is reviewed.