An intraoral stent to improve examination of swallowing in a case involving gunshot wound to the face

A custom intraoral stent to facilitate oral bolus transport without external drooling and aspiration during radiographic examination of dysphagia in a patient with severely compromised swallowing mechanism due to self-inflicted gun-shot wound to the face is described. This hollow stent, which conforms to the contour of the intraoral space, allows passage of contrast medium during videofluoroscopic modified barium swallow tests resulting in consistent successful swallowing. Severe extraoral leakage (drooling), aspiration, and coughing occurred when the modified barium test was performed without this device.     

Experimental study on vasoactive intestinal peptide—like immunoreactivity in plasma and brain in high—velocity missile injuries of extremity

Experimental high-velocity missile injuries were produced on both hind legs of 15 dogs.It was found that the concentration of vasoactive intestinal peptide-like immunoreactivity(VIP-LI)significantly elevated in both plasma and brain at the early stage after injuries.However,thechanges of VIP-LI concentration in the plasma and brain did not coincide with each other.The re-sults suggest that VIP-LI may participate in the post-traumatic general reaction.The significanceand machanism of the elevation of cerebral VIP-LI level after a severe non-cerebral trauma remainto be clarified.     

Traumatic transient klüver-bucy syndrome

A case of transient Klüver-Bucy syndrome after a gunshot wound through the head is presented. We have found no other case of posttraumatic Klüver-Bucy syndrome described in the literature. The original criteria for the syndrome are reviewed and compared with findings in previously reported human cases.     

Intramedullary spinal cord metastasis

Intramedullary spinal cord metastases are rarely the presenting manifestation of a previously undiagnosed neoplasms. We report such a case in which a subacutely progressive motor and sensory spinal cord syndrome was the initial problem. The differential diagnosis and the difficulties in distinguishing intramedullary from extramedullary mass lesions are discussed. The special features of tumors of the lung and their predilection for metastasis to the central nervous system are considered.     

The role of maxillofacial radiologists in gunshot injuries: a hypothesized missile trajectory in two case reports

Gunshot injuries are an emerging form of trauma that oral radiologists increasingly have to deal with. There are two main types of gunshot injuries: high-velocity and low-velocity bullet injuries. The outcome of high-velocity gunshot injury is usually fatal; however, a non-fatal low-velocity injury to the maxillofacial region is more likely to be encountered by the oral and maxillofacial radiologist. It is therefore important to up-to-date knowledge of ballistic science and its implications in the field of maxillofacial radiology. The ability of oral and maxillofacial radiologists to predict the missile trajectory will aid the assessment and localization of the damage caused by the bullet and its splinters. Predicting the missile trajectory may also be of help to law enforcement agencies and forensic scientists in determining the type of firearm used and direction of fire. This article, which examines two cases, attempts to highlight to the oral radiologist this emerging form of trauma and its implications.     

高原高寒战时环境肢体枪弹伤后电解质代谢的动物实验研究

目的 探讨高原高寒环境下平战时肢体枪弹伤后血浆电解质代谢的特点.方法 将24头实验猪随机分为高原战时致伤组(GZ)、高原平时致伤组(GP)和平原平时致伤组(PP),每组8头.分别于伤前、伤后30分钟、2、6、12小时、1、2、3、5、7、10、14天采静脉血测定钾、钠、氯和钙、镁、磷的含量.结果 伤后平原平时组和高原平...     

Nonoperative management of pelvic gunshot wounds

Background

The nonoperative management (NOM) of abdominal gunshot injuries is gradually becoming the standard of care. Patients with pelvic gunshot injuries constitute a subgroup of patients at high risk of visceral injury. The aim of this study was to assess the feasibility and safety of the selective NOM of pelvic gunshot injuries.

Patients and methods

This prospective study was performed from April 1, 2004, to November 30, 2008. Patients with pelvic gunshot injuries underwent laparotomy for peritonitis, hemodynamic instability, rectal bleeding, and urologic injuries. Patients with benign abdominal findings with hematuria underwent computed tomography scanning with intravenous contrast. Stable patients with no tenderness or minimal tenderness confined to the wound or wound tract underwent serial abdominal examination. Outcome parameters included need for delayed laparotomy, complications, length of hospital stay, and survival.

Results

During the 54-month study period, 239 patients with pelvic gunshot injuries were treated. One hundred seventy-six (73.6%) patients underwent immediate laparotomy, whereas 63 (26.4%) were selected for NOM. The nontherapeutic laparotomy rate was 4.5% in the former group, and no patient required delayed laparotomy in the latter group. Also, 3 patients with minor extraperitoneal bladder injuries were successfully managed nonoperatively. Associated injuries included mostly fractures to the bony pelvis including the iliac blade (19), pubic ramii (3), and acetabulum (3). The mean hospital stay was 2.2 (range 1–8) days in the nonoperative group of patients. There were no deaths.

Conclusions

Selective NOM of pelvic gunshot injuries is a feasible, safe, and effective alternative to routine laparotomy.     

不同种类高速投射物颌面损伤特点的实验研究

选用７．６２ｍｍ,５．５６ｍｍ弹丸,射速为１３００－１４００ｍ／ｓ的１．０３ｇ钢球和１．０ｇ钢球和１．０ｇ炮弹破片分别致伤肥皂靶、离体猪头和活体犬下颌骨区,观察４种高速投资射物致伤时的瞬时空脸形态和颌面伤情切取犬面部伤道周围肌组织行光镜、透射电观察,发现在同种类高速投射物致作形成不同的瞬时空腔,颌面部致伤时有着没的损伤特点。文中对凳面部的创伤弹道学特点和不同种类高速投射物颌面损伤特点的差异进行了讨     

胸部枪伤瞬时及早期心血管效应的实验研究

目的　探讨胸部枪伤瞬时及早期心血管效应及其机制。　方法　 30只家兔随机平均分为A :胸部贯穿伤组 (模型组 )、B :预扎肋间动脉致伤组、C :人工气胸后致伤组、D :预扎肋间动脉 人工气胸后致伤组、E :胸壁切线伤组。分别用 5 .5 6mm小口径步枪致伤 ,连续监测动脉压、心率、静脉压、心电图、左室内压等。　结果　A组伤前血压峰值为 ( 14.80± 1.2 9)kPa ( 1kPa =7.5mmHg) ,枪伤瞬间血压即刻呈单波峰升高 ,达伤前的 ( 1.5 8± 0 .0 8)倍 ,而后迅速降低至伤前水平以下 ,10s下降到最低点 ,30s开始回升 ,1min后回升至伤前的 ( 0 .80± 0 .0 7)倍 ,并逐渐稳定。静脉压瞬时升高后随即下降 ,左室内压和心率出现瞬时下降、而后逐渐恢复 ,B组和C组变化幅度较小。D组和E组仅枪击瞬间有短暂变化。　结论　胸部枪伤瞬间动、静脉压升高 ,而左室内压无变化 ,为枪弹冲击波直接引起。伤后数秒内血压下降 ,心动过缓 ,心肌受抑制和左室内压下降 ,而中心静脉压尚正常 ,提示与迷走反射有关。模型组于伤后 2h血压再度下降 ,则可能与胸内失血和肺损伤有关 ,缺氧也造成了心肌收缩力下降。预扎肋间动脉及临时造成人工气胸防止肺实质损伤 ,可减轻枪伤早期的心血管功能障碍。