Vascular trauma

The incidence and type of vascular injury differs in different geographical locations. Blunt and iatrogenic injuries are the two commonest causes of vascular trauma in most European countries including the UK. However, in the USA, most vascular injuries are the result of stab or gunshot wounds. Vascular injuries are associated with high morbidity and mortality. They require a clear concept of the management and timely intervention in order to avoid early and late complications. This article outlines the basic principles in the management of vascular trauma.     

Radial nerve injury during double plating of a displaced intercondylar fracture

Double-plate fixation is a popular treatment method for intercondylar humeral fractures. Ulnar nerve complications are emphasized, but radial nerve complications are rarely mentioned. We present a case of iatrogenic radial nerve palsy following open reduction and double plating of a supracondylar/intercondylar fracture of the humerus. Before surgery, only a sensory deficit in the radial nerve territory was present, but after surgery, there was a complete motor deficit of the wrist and finger extensors. On exploration, a segment of nerve was found crushed within the reduced lateral condyle fracture site, with a screw from the posteroradial plate going through the nerve. Although rare, radial nerve injury can occur with posteriorly displaced supracondylar/intercondylar humerus fractures. When preoperative signs of radial nerve injury are present, we recommend that the radial nerve be identified and protected during double-plate fixation.     

Overdiagnosis and overtreatment of low back pain: Long-term effects

Low back pain and subsequent disability remain a concern in terms of both cost and impact upon industry let alone the adverse effects on the patients involved. The causes of low back pain remain elusive. There has been extensive focus on the intervertebral disc with treatment ranging from passive modalities to multiple surgery. Current experience suggests that misinformation, inadequate patient examination, medication abuse, over use of passive modalities, focus on pain rather than function and excessive reliance on radiological imaging and specialist referrals are contributing factors. Indeed, one is drawn to the conclusion that low back disability may well be an iatrogenic disorder in many cases.     

Transmural migration of an intracavernous carotid detachable balloon used to control surgically induced haemorrhage

We report a case in which a balloon detached in the carotid siphon for control of iatrogenic bleeding migrated to the oesophagus. We discuss the pathophysiology. Received: 22 September 1997 Accepted: 11 November 1997     

Magnetic resonance imaging may be an asset to diagnose and classify fluoroquinolone-associated Achilles tendinitis

Summary— The aim of this study was to document the accuracy of magnetic resonance imaging (MRI) during fluoroquinolone- associated Achilles tendinitis. Fourteen Achilles tendons were examined by MRI (T1 and T2 or T2*-weighted sequences) in nine patients with typical tendinopathy (13 cases of tendinitis and 1 rupture) during fluoroquinolone therapy. Tendinous involvement was classified according to the prominence of intra- or peritendinous changes. The most typical feature was the presence of intratendinous changes, longitudinal or transversal, detected on T1 or T2-weighted sequences. Peritendinitis was most visible in two cases and nodular involvement in three cases. It was concluded that MRI appears a helpful and accurate method in identifying and classifying such iatrogenic tendinitis. In addition, MRI indicates orthopedic management when detecting risk of rupture.     

Céphalées quotidiennes chroniques

Résumé  Les céphalées quotidiennes chroniques sont souvent méconnues des médecins bien qu'une partie notable de la population en souffre (2 à 5% de la population). Le plus souvent, il s'agit de migraineux dont la maladie s'est dégradée à l'occasion de perturbations psychologiques en relation avec la personnalité des patients et/ou les circonstances de la vie. Dans la plupart des cas, on note également l'utilisation abusive des antalgiques. Le sevrage de ceux-ci, un traitement prophylactique englobant les différents facteurs permettent d'améliorer considérablement ces malades.

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Summary  Daily chronic headaches are often unknown by physicians, although a quite important part of the population suffers because of it (from 2 to 5% of the population). The most frequent situation concerns migrainers whose disease was aggravated on the occasion of psychological disturbance connected with the personality and life of the patients. Most of the time, an abusive use of antalgics is noticed. A wearning of them, and a prophylactic treatment, including these different factors can considerably ameliorate the state of these patients.

     

医源性血管内异物的外科处理

报告 4例医源性血管内异物的手术处理方法 ,4例均获成功     

论医源性损伤的基本法律问题对平抑医疗纠纷之对策的探析(上)

对医源性损伤的基本法律问题所论述的实体问题是如何界定医源性损伤?以及关于医源性损伤后果的法律认定、医源性损伤的民事责任主体--法人责任和个人责任、医源性损伤后果的归责原则、医源性损伤引发的医疗纠纷可供选择的解决途径等的分析.医源性损伤是一个客观的现象,应站在公允的立场上,客观、冷静地观察和分析,并给它一个中性的表述,以求得出较为合理的观点.究其根本,通过探讨,我们希望能为平抑医患冲突和在一定的范围内建立成熟、理性的医患关系奠定基础.     

神经外科重症监护治疗病房获得性肺部感染分析

目的:了解重症监护治疗病房(ICU)获得性肺部感染的流行病学及细菌耐药情况.方法:回顾性分析近3年ICU颅脑疾病患者痰培养检出的致病菌菌株及其耐药性.结果:154株获得性肺部感染中,G-菌109株(70.8%),G+菌45株(29.2%).以铜绿假单孢菌及肠道杆菌为主.G-菌对亚胺培南的敏感性最高.结论:ICU颅脑疾病患者获得性肺部感染发生率较高,致病菌仍以G-菌为主,但G+菌逐渐增加;早期、定期进行痰培养和药敏试验可及时发现致病菌、指导选用抗生素.     

Iatrogenic left internal mammary artery-coronary vein anastomosis treated with covered stent deployment via retrograde percutaneous coronary sinus approach.

OBJECTIVES: Percutaneous treatment of acquired coronary fistula with covered stent BACKGROUND: Acquired aorto-coronary fistulae (ACF) is a rare complication of coronary artery bypass graft (CABG) surgery. Surgical repair has been generally recommended, but percutaneous techniques have also been described; coils were used primarily in smaller fistula while double umbrella or vascular occlusion devices were used in larger ones. To the best of our knowledge the use of coronary covered stent has never been reported. A 73-year-old man underwent CABG in November 2004 for unstable angina and left internal mammary artery (LIMA) was anastomosed to left anterior descending (LAD) coronary artery. Three months later he underwent a control angiogram to check for the reappearance of effort angina, which demonstrated an inadvertent LIMA-great cardiac vein (GCV) anastomosis. After discussions, an attempt to close the ACF with implantation of a covered stent was performed. METHODS: Using a percutaneous right internal jugular vein approach, coronary sinus was selectively cannulated and a 0.014-in. coronary guide wire was advanced selectively to the GCV, then a covered stent was deployed across the anastomotic site, obtaining the immediate occlusion of the ACF. RESULTS: No contrast medium flowed into the distal part of the GCV at the reinjection of the coronary sinus and a selective injection into LIMA showed the absence of flow through LIMA, confirming the occlusion of the anastomotic site. CONCLUSIONS: We have demonstrated successful occlusion of an iatrogenic ACF by using percutaneous stenting of GCV with covered stent via coronary sinus approach, which seems to be technically less demanding, safer, and time sparing.