1086 Consecutive injuries caused by glass

A prospective study of 1086 consecutive injuries caused by glass showed that the mean age of the patients was 15 years and there was a 7: 3 male to female ratio. The home (35 per cent), public places (31.3 per cent) and places of work (21.1 per cent) were the main locations where these accidents occurred. Although most of the injuries were mild, 3 case histories illustrate that some of them were extremely serious, 4.6 per cent of patients requiring immediate admission to hospital. Extrapolation of the figures indicates that approximately 210 000 people attend hospital each year in England and Wales for treatment of an injury caused by glass. The annual cost to the National Health Service is about £7 500 000 but the full financial implications of these injuries in terms of compensation and insurance payments must be much greater. Suggestions are made of ways to reduce the incidence of these injuries from road traffic accidents and accidents with plate glass and glass containers.     

Social and psychological determinants of recovery from industrial injuries

Social and psychological determinants of the time taken to return to work were investigated in a sample of male manual workers referred to an accident clinic with mostly minor industrial injuries. Patients who showed a rapid recovery relative to the severity of their injuries were more often married, had greater job satisfaction, were less likely to be receiving an income supplement from their employers, and blamed themselves more for their accidents. The findings also indicated that a poor recovery rate could be expected when the accident was due to some environmental fault or failure, and the implications for studies of compensation are discussed.     

Early mobilization in the treatment of shin injuries.

The treatment of shin injuries requiring skin grafting by a method which included early mobilization is described.     

Late outcome of patients with Braunwald-Cutter mitral valve replacement

Eighty patients who underwent mitral valve replacement (MVR) with Braunwald-Cutter prostheses (54, single valve replacement; 26, multiple valve replacement) between December, 1972, and September, 1975, are discussed. The period of follow-up ranged from 72 to 120 months with a mean of 84.6 months. For the hospital survivors, actuarial survival at ten years was 73 +/- 6.7% for patients with MVR alone and 30 +/- 17.5% for those with multiple valve replacement. The linearized rate of embolic complications in patients with MVR was 3.2% per year and in patients with multiple valve replacement, 1.5% per year. These low rates of embolism allow a favorable comparison of the Braunwald-Cutter valve with other mechanical prostheses. There was no evidence of serious poppet wear or poppet escape after ten years of the valve in the mitral and tricuspid positions. Thus, elective replacement of the Braunwald-Cutter valve from the atrioventricular position because of this potential problem is not considered necessary. In the aortic position, escape of the poppet from the valve has occurred as late as 101 months. The overall morbidity for the group was high. Only 34% of the patients having MVR and 12% of those with multiple valve replacement are expected to be alive and to remain free from any major complication ten years after operation.     

Traumatic injuries of the pancreas

Traumatic injuries of the pancreas have evolved from an uncommon encounter of even wartime wounds to a relatively common injury of today's civilian strife. A review of 448 patients sustaining pancreatic trauma demonstrated that the pancreatic injury alone contributes little to immediate or late mortality but is frequently a source of postoperative morbidity. Complications of pancreatic injury comprise almost half of those observed after trauma in such patients, but for the most part are self-limited and easily cared for. Survival among patients sustaining pancreatic injury depends mainly upon the degree of success with which the multiple associated injuries can be managed.     

Biatrial myxoma associated with mitral valve lesion

Biatrial myxomas are extremely rare. By 1983, only eight successful removals of such tumors had been reported. We describe another such patient, who also had involvement of the mitral valve. Diagnostic aspects of echocardiography and a simple operative technique for the en bloc removal of both tumors are discussed.     

Clinical Durability of the Pericardial Xenograft Valve: Ten Years' Experience with Mitral Replacement

Data from 366 patients with mitral valve replacement (250 single and 116 multiple) who received pericardial xenografts between 1971 and 1981 were analyzed. Cumulative duration of follow-up was 1,151 patient-years, with a maximum duration of 10.7 years. Actuarial survival at 11 years is 71.6 ± 14.2%. Pericardial valve failure occurred in 7 patients (0.6 episodes per 100 patient-years). Actuarial freedom from valve failure at 11 years is 90.4 ± 9.1% for the entire series. Although 275 (75.1%) patients were in chronic atrial fibrillation, anticoagulants were not used in any patient beyond the first 6 postoperative weeks. The incidence of emboli was 0.6% per year. Six episodes occurred following single mitral valve replacement and 1 after multiple valve replacement (5 early and 2 late). The actuarial freedom from embolism is 96.4 ± 1.5% at 6 and 11 years postoperatively. Valve thrombosis has not been encountered.This analysis has shown a low incidence of valve dysfunction and a very low risk of embolic complications without long-term anticoagulation. The pericardial xenograft is a safe substitute for the mitral valve, with predictable behavior during the first decade of follow-up.     

Long-Term Sequential Hemodynamic Evaluation of Right Ventricular Outflow Tract Reconstruction Using a Valve Mechanism

From May, 1972, to May, 1978, right ventricular outflow tract reconstruction was performed in 20 patients with congenital heart disease. A monocusp patch constructed entirely of glutaraldehyde-stabilized calf pericardium, was employed in 19 patients, and a composite conduit consisting of a three-cusp pericardial xenograft valve in a Dacron tube was used in 1 patient.There were 2 hospital deaths (10%) and no late deaths. The follow-up ranged from 5 to 75 months (mean, 55.7 ± 4.6 months; total, 1,002 patient months). Eleven patients had completed 5 years of follow-up at the time of writing.Hemodynamic studies were performed in 10 patients at an average of 40 months after operation and the right ventricle-pulmonary artery systolic gradient was 9.3 ± 1.7 mm Hg. This was not significantly different in 6 patients who had a second postoperative catheterization at 51.8 ± 2.0 months following operation. Angiography showed fully mobile, thin valve cusps.These results compare well with those reported with other types of conduits, particularly with reference to relief of obstruction.     

Indications for Early Thoracotomy in the Management of Chest Trauma

Trauma to the thorax represents a significant portion of injuries seen in an inner-city emergency room. Although most of these patients may be successfully managed without thoracotomy, a certain percentage require operative intervention either immediately or within several hours.The records of more than 380 patients with major chest trauma seen in recent years have been reviewed. Three hundred twenty-one of these patients (84%) required only good supportive measures such as correction of hypovolemia, temporary ventilatory support, tube thoracostomy, and careful observation. Forty-four additional patients (12%) required immediate operation following preliminary resuscitative treatment. Indications included hemorrhage, cardiac tamponade, injury to a great vessel, and rupture of the diaphragm. There were 10 deaths in this group. In 15 other individuals (4%) delayed operation was undertaken following careful reappraisal of initial injuries by continued examination, monitoring of vital signs, and appropriate roentgenographic and laboratory studies. Indications for delayed operation included continued or recurrent bleeding, widening of the mediastinum, hemoptysis, and recurrent hemothorax. There was only 1 death in this group.Thus, although it may be clear which patients require immediate operation, only careful and continuous monitoring can identify those who initially appear to be in stable condition but eventually will require exploration.     

Serial C-reactive Protein Measurements in Infective Complications Following Cardiac Operation: Evaluation and Use in Monitoring Response to Therapy

Serum C-reactive protein (CRP) was studied serially in 100 patients who underwent cardiac operation and in another 17 patients in whom serious infections including prosthetic valve endocarditis developed in the early postoperative period. Eleven patients with late onset of prosthetic valve endocarditis and infective endocarditis were also investigated. The assay method used was radial immunodiffusion. Patients without postoperative infective complications showed a rapid increase in CRP levels, which reached a peak within 72 hours after operation followed by a progressive decline. The differences between the CRP levels in infected and uninfected patients were significant (p < 0.01). Serial measurements were of prognostic value in evaluating the response to chemotherapy and in predicting the outcome of the disease.     

Comparative Study of Cefamandole versus Ampicillin plus Cloxacillin: Prophylactic Antibiotics in Cardiac Surgery

A randomized, prospective study of the efficacy of cefamandole naftate versus a combination of ampicillin and cloxacillin was undertaken in 109 adult patients operated on in Leeds during 1979. Sixty patients underwent valve replacement, and 49 had either aortocoronary bypass grafts or other forms of open-heart operation. The two groups matched well in age, sex, and type of operation. One gram of either antibiotic was given intravenously during the induction of anesthesia and every 6 hours thereafter for 48 hours. Two additional grams of antibiotic were placed in the prime of the heart-lung machine.The overall rate of infection was 7.5% for the entire series, with 1.7% for the group given cefamandole and 13.7% for the group given ampicillin plus cloxacillin (p < 0.05). The only patient with infection in the former group (1.7%) had sternal wound involvement. Major sternal wound infection occurred in 3 (5.9%) patients in the latter group. All wound infections were caused by Staphylococcus aureus. In 2 of these patients (ampicillin plus cloxacillin group) the infection proceeded to endocarditis. Urinary and respiratory tract infections occurred in 1.9% and 5.9%, respectively, of patients given ampicillin plus cloxacillin. The duration of hospital stay was shorter in the cefamandole group. The results of this study demonstrated that cefamandole confers effective prophylaxis in cardiac operations.     

An expedient shunt for the small internal carotid artery

A simple and readily available device was used as a shunt during carotid endarterectomy in four cases in which difficulty in inserting a conventional shunt into the internal carotid artery was encountered. It was also used preferentially in one case of external carotid endarterectomy. No apparent injuries occurred in conjunction with its use, and in none of the four patients did neurologic complications develop. For those who wish to use a shunt in all cases of carotid endarterectomy, this device provides an expedient means of shunting in cases in which difficulty in inserting a conventional shunt is encountered.     

Hiatus hernia with and without esophageal stricture. Experience with the Belsey Mark IV repair

The aims of surgical treatment for hiatus hernia are elimination of gastroesophageal reflux and relief of symptoms. Sixty-one consecutive adult patients who underwent hernia repair by the Belsey Mark IV technique have been reviewed symptomatically and roentgenographically. Judged by strict roentgenographic criteria, 2 patient groups were identified. Hernia repair gave good results in 34 of the 43 patients without severe periesophagitis and esophageal shortening. Symptoms were relieved in 39 of this group. However, in 17 patients with severe transmural and periesophageal disease, only 4 had a good roentgenographic result, although 9 had symptom relief.Eleven patients in the overall series had an esophageal stricture. Prevention of reflux in these patients has been shown to result in stricture resolution.     

Urinary protein profiles after burn injury

A study of the change of urinary protein excretion has been made in 26 patients followed from the time of admission to time of discharge from the Yorkshire Regional Burn Centre (7–200 days). Total protein, IgG and albumin (as indicators of glomerular function) and al-microglobulin, β2-microglobulin, retinol binding protein and N-acetyl-β-d-glucosaminidase (as indicators of proximal tubular function) as well as the patterns on SDS polyacrylamide gel electrophoresis were examined. Patients were divided into three groups according to their urinary protein profiles. The first group was 3 patients who showed little or no evidence of proteinuria; the second group consisted of 7 patients who showed a mild and transient tubular proteinuria, all of whom recovered normal function within one week. The third group, 16 patients, developed moderate to severe proteinuria usually started as a mixed pattern of glomerular and tubular proteinuria, characterized by the excretion of a high level of total protein. After a few days, this pattern changed to a typical tubular proteinuria and. the latter could last for as long as 200 days; in some of these patients a secondary increase of low molecular weight protein excretion occurred either due to a latent renal complication or induced by the administration of aminoglycosides. There is a close correlation between the intensity and patterns of the proteinuria and the severity and clinical progress of the burn.     

Gaps in access to comprehensive rehabilitation following traumatic injuries in children: A nationwide examination

IntroductionAcute rehabilitation following traumatic injuries is associated with improved functional recovery. Access is often limited to patients at the time of hospital discharge. This phenomenon remains less well described in children, who may have more to benefit with rehabilitation posttrauma. This study aims to determine factors influencing access to rehabilitation among children with traumatic injuries utilizing a nationally representative sample.MethodsThe Kids Inpatient Database (2000–2012) was queried for trauma patients. The outcome measure of interest was discharge with rehabilitative services [acute rehabilitation facilities or home healthcare (HHC)]. Patients that did not survive and those that did not meet hospital admission criteria were excluded. Multivariable models adjusted for age, race/ethnicity, gender, insurance-status, income, injury severity score, year, children's hospital designation, hospital-volume, teaching status, location, and geographical region.ResultsA total of 811,941 records were included. These were predominantly male (65.9%) with an average age of 11.6 (± 6.7) years. 4.2% were discharged to rehabilitation facilities, and 3.9% were discharged with HHC. African-American and Hispanic patients were less likely to be placed/have access to rehabilitation facilities (p < 0.001). Similarly, uninsured patients were less likely to receive these services postdischarge (p < 0.05). However, patients with government insurance, those in the highest income-quartile, those treated at children's hospitals, and those treated at teaching and urban hospitals were more likely to be placed/have access to rehabilitation services.ConclusionRace/ethnicity and insurance status are associated with disparities in access to postdischarge rehabilitation in pediatric trauma patients. Moreover, treatment at designated children's, teaching and urban hospitals better-facilitates discharge planning with rehabilitative services.     

Hand injuries as an indicator of other associated severe injuries

The purpose of this study was to investigate the incidence of disabling or life-threatening injuries in patients with hand injuries. Retrospective data were collected from a level 1 trauma center registry. A total of 472 patients with hand injuries were admitted to the trauma unit between January 2000 and March 2004. Forty-four per cent of patients with hand injuries had life-threatening injuries. Fifty-one per cent of them had motor vehicle crash-related injuries. Motorcycle crashes were the next most common cause followed by explosions, falls, gunshots, machinery, stabs, bites, crushes, and so on. Frequency of associated injuries was as follows: head injuries, 31 per cent, including skull fractures, 22 per cent; spine injuries, 18 per cent, including spine fractures 18 per cent; chest injuries, 36 per cent, including rib fractures, 15 per cent; and abdominal injuries, 13 per cent. The authors focused on the incidence of disabling or life-threatening injuries in patients with hand injuries. Motor vehicle crashes were most common cause of hand injuries. The most common organs to be injured were chest and head. The most common head injury was skull fracture. Other injuries in decreasing order were spine and rib fractures. These data may be helpful in assessing ambulatory patients in the emergency room, in those hand injuries maybe indicative of other simultaneous life-threatening or disabling injuries.     

Extremities--indications and techniques for treatment of extremity vascular injuries

Traumatic vascular injuries involving the extremity are rare and penetrating trauma accounts for the majority of such injuries. The remaining arterial injuries are as a result of either blunt or iatrogenic injuries. The rapid detection, localisation and characterisation of vascular injuries in patients who have a traumatic extremity injury is essential for the effective management and treatment of such injuries. This review will discuss the expanding role of multi-detector computed tomography angiography in diagnosing vascular injuries and its implications on conventional diagnostic angiography. The roles of other non-invasive imaging modalities are reviewed. The presentation and types of vascular injuries in blunt and penetrating injuries are discussed. While surgery remains the gold standard in the management of vascular extremity injuries it has significant morbidity rates. Endovascular techniques are increasingly being used for the treatment of vascular traumatic injuries and various techniques including balloon occlusion, embolisation and stent/stent graft placement are discussed.     

Pediatric spinal injuries– current concepts

Spinal injuries in children contribute to the highest mortality and morbidity among all pediatric injuries. Fortunately, these injuries are a rare clinical entity but pose a difficulty in diagnosis due to challenges in neurological evaluation of a child and varied radiological presentation. Anatomical and biomechanical aspects of developing musculoskeletal system, relative plasticity of the pediatric spine make children vulnerable to spine injuries. Though motor vehicle collisions are common, children also suffer non-accidental trauma, falls and sports injuries. More chances of cervical spine involvement, higher susceptibility of spinal cord to tensile forces and associated multisystem injuries result in devastating consequences in children compared to adults. Injuries like SCIWORA, vertebral apophyseal injuries, birth-related spinal cord injuries are more specific injuries in pediatric age group. A vigilant clinical, neurological and radiological evaluation is mandatory in all children with suspected spinal injuries. Normal radiological features like ossification centers, pseudosubluxation and physiological vertebral wedging should be carefully noted as they could be misinterpreted as injuries. While CT scans help in better understanding of the fracture pattern, Magnetic Resonance Imaging in children is beneficial especially in detecting SCIWORA and other soft tissue injuries. Management principles of these pediatric spinal injuries are similar to adults. Literature evidences support conservative management in injuries like SCIWORA, unless there is an ongoing spinal cord compression. As in adults, the role of high dose methylprednisolone is still controversial in pediatric spinal cord injuries. Stable spinal injuries can be managed conservatively using orthosis or halo. Instrumentation by both anterior and posterior techniques has been described, but it is challenging due to smaller anatomy and poor implant purchase. In addition to pedicle screw instrumentation, wiring techniques are very beneficial especially in younger children.     

Head Injuries and Facial Injuries in Ice Hockey

AbstractBackground and Purpose: Despite a decreasing tendency of head and facial injuries in ice hockey the number of these injuries still seems to be too high. The purpose of this prospective investigation was to study the mechanism of facial and eye injuries as well as the role of protective equipment and revised rules.Methods: A prospective epidemiologic analysis of ice hockey-related injuries in the two highest-ranking Swiss Ice Hockey Leagues—League A (NLA) and B (NLB)—was performed by the Swiss Medical Committee during the two seasons 1996 and 1997.Results: A total of 392 injuries occurred during games or practice. Head injuries and facial injuries made up 26% of these injuries. Most of these injuries were classified as minor injuries. All eye injuries occurred in players either not wearing visors at all or wearing the visor incorrectly. Most injuries were caused by the illegal use of sticks.Conclusion: Most head injuries and facial injuries could be prevented by wearing helmet and visor correctly and by playing the game according to the rules.