Fatal thromboembolic complications following assault in a subject with an abdominal aortic aneurysm

A 62-year-old male with no significant medical history developed thromboembolic complications in the lower limbs shortly after an assault which involved punching and kicking to the trunk. Laparotomy revealed intra-abdominal injuries and an abdominal aortic aneurysm. Death from multi-organ failure and sepsis occurred 9 days post-injury. The discussion concentrates on blunt force trauma to the abdominal aorta, specifically on causation, mechanisms of injury and complications.     

Specific selection of osteosynthetic material in the treatment of thoracic or lumbar spinal injuries by the posterior approach

Summary The authors report 165 cases of thoraco-lumbar lesions with neurological dysfunction. All the patient were operated. They analyze the neurological and mechanical results and indicate the use of different osteosynthesis apparatus according to the type and level of lesions.Harrington's rods seem to give more precise repositioning while Roy Camille's plates give more stability. When the posterior wall of the spinal canal is intact, Kempf's compression rods can be used.Thoraxic spine injuries seem to be an indication for Harrington's rods, while lumbar injuries seem to call for Camille's plates.     

老年与青壮年脑挫裂伤组织NGF的表达差异及意义

目的 研究衰老对脑挫裂伤组织神经生长因子（NGF）基因表达的影响,进一步探讨老年颅脑损伤病人神经功能缺失程度较重的分子生物学机制.方法 收集重型颅脑损伤开颅手术中的脑挫裂伤组织,应用免疫组化和医学数码图像分析技术,观察老年组（≥60岁）和青壮年组（19～59岁）病人脑损伤后3～9 h脑挫裂伤组织NGF蛋白的表达差异.结果 脑损伤后NGF在老年和青壮年脑挫裂伤组织中的表达均明显增强;老年组脑挫裂伤组织中的NGF蛋白表达显著性低于青壮年组（P＜0.05）.结论 老年人脑挫裂伤后NGF表达水平下降明显,提示其受损神经元的修复和生存能力降低,这可能是老年颅脑损伤病人恢复不良的重要原因之一.     

Subakute Verlegung der Atemwege infolge eines retropharyngealen H?matoms nach Halstrauma

Mechanical airway obstruction secondary to retropharyngeal bleeding is rare. In most cases such a complication is described after head and neck trauma. Complicating factors include anticoagulant therapy, tumour, aneurysm, infection or major cervical spine injury. A precise initial diagnosis is necessary to avoid a life-threatening situation. Lateral X-ray and computed tomography is essential for safe management. Treatment depends upon size of the haematoma as well as the clinical course of the patient. Smaller haematomas may be observed. Lager haematomas and those that fail to reabsorb should undergo drainage.      

September 11th related stress and trauma in New Yorkers

Exposure to trauma and stress has been linked with poor health, while forgiveness appears to be positively associated with health outcomes. The current study investigates whether traits such as forgiveness and ruminative tendencies predict levels of trauma and stress experienced by New York City residents on the 1‐year anniversary of the September 11th terrorist attack. Seventy‐one students and staff members (57 females, 14 males) of a graduate school in New York City were administered the Impact of Events Scale, the Perceived Stress Scale, and questionnaires designed for the purpose of this study to measure ruminative tendencies and forgiveness on September 11, 2002. Rumination predicted levels of trauma (p < 0.05) and perceived stress (p < 0.01). Lower levels of forgiveness predicted perceived stress (p < 0.05), but not trauma. Rumination mediated the relationship between forgiveness and perceived stress. These findings suggest that individuals with higher levels of rumination have an elevated risk of experiencing trauma and stress‐related symptoms following a traumatic event. Forgiveness is associated with lower levels of stress, but not trauma, perhaps because trauma is an extreme form of stress. Forgiveness appears to serve as a buffer against stress more so in individuals with low levels of rumination than in individuals with high levels of rumination. Copyright © 2005 John Wiley & Sons, Ltd.     

Complex urethral disruptions: In pursuit of a successful reconstruction

OBJECTIVES: We analyzed the methods and outcomes of urethroplasty in men with complex urethral disruptions. METHODS: The medical records of 40 men with complex urethral disruptions were analyzed. Surgical methods were individualized according to stricture location, severity and length of the stricture, bladder neck characteristics and presence of complicating factors. Patients were divided into four groups based on the above characteristics. RESULTS: End-to-end urethroplasty performed in six patients with short bulbar strictures (<3 cm) was successful in all. Elaborated perineal repair was performed in 10 patients with intermediate (3-6 cm) strictures with or without complicating factors. Elaborated perineal repair with urethral substitution was performed in nine patients with long segment stricture (>6 cm). Abdominal transpubic repair was successfully applied to patients with rectourethral fistula or lacerated bladder neck. Success rate of anastomotic urethroplasty was 95% while over all success rate was 85%. CONCLUSION: Guidelines for urethral reconstruction of complex urethral disruptions are predicated on stricture length, location, bladder neck characteristics and associated complicating factors. End-to-end urethroplasty with stricture excision is highly reliable for short strictures for which previous operative repair have failed. Elaborated perineal repair is extremely versatile for intermediate and longer strictures with associated complicating factors. Abdominal transpubic urethroplasty is effective for patients with rectourethral fistula or lacerated bladder neck.     

Effects of Ethanol in an Experimental Model of Combined Traumatic Brain Injury and Hemorrhagic Shock

Objectives: Given that clinical and laboratory studies suggest that ethanol and hemorrhagic shock (HS) potentiate traumatic brain injury (TBI), the authors studied the effects of ethanol in a model of combined TBI and HS.
Methods: A controlled porcine model of combined TBI and HS was evaluated for the effect of ethanol on survival time, hemodynamic function, and cerebral tissue perfusion. Anesthetized swine (17–24 kg) were instrumented, splenectomized, and subjected to fluid percussion TBI with concurrent 25-mL/kg graded hemorrhage over 30 minutes. Two groups were studied: control ( n = 11) and ethanol ( n = 11). Ethanol, 3.5 g/kg intragastric, was given 100 minutes prior to TBI/HS. Systemic and cerebral physiologic and metabolic parameters were monitored for 2 hours without resuscitation. Regional cerebral blood flow (rCBF) and renal blood flow were measured with dye-labeled microspheres. Data were analyzed with 2-sample t-test and repeated-measures ANOVA.
Results: Ethanol levels at the time of injury were 162 ± 68 mg/dL. Average TBI was 2.65 ± 0.35 atm. Survival time was significantly shorter in the ethanol group (60 ± 27 min vs 94 ± 28 min, p = 0.011). The ethanol group had significantly lower mean arterial pressure, cerebral perfusion pressure, and cerebral venous
O₂ saturation in the postinjury period. Cerebral O₂ extraction ratios and cerebral venous lactate levels were significantly higher in the ethanol group. A trend toward lower postinjury rCBF in all brain regions was observed in the ethanol group.
Conclusion: In this TBI/HS model, ethanol administration decreased survival time, impaired the hemodynamic response, and worsened measures of cerebral tissue perfusion.     

Chemical traumatization of adult mouse olfactory epithelium in situ stimulates growth and differentiation of olfactory neurons in vitro

This study demonstrates that ZnSO₄ induced chemical trauma results in an in situ regeneration of the olfactory epithelium which, when maintained in vitro, provides an enriched population of olfactory neurons. Therefore, the ability of the olfactory epithelium to respond to chemical trauma with increased mitotic activity can be used to increase growth of neurons in culture. Tissue obtained from normal or vehicle-treated adult mice produced few olfactory neurons, when maintained in culture, compared to cultures established from tissue following an in situ ZnSO₄ trauma. Maximal neuronal yields were obtained in cultures established from tissue that was removed 4–6 days following chemical trauma. The morphological appearance and the presence of cell specific intermediate filament proteins were used to classify the cell types in these olfactory epithelial cultures. Single cells and aggregates of cells which were immunopositive for keratin, but immunonegative for neurofilament protein and GFAP, were identified as epithelioid. Flattened polygonal cells immunopositive for GFAP were identified as glia. A small population of flattened cells was immunonegative for all of the antibodies used in this study. Cells that had processes were immunonegative for GFAP and keratin. Some were immunopositive for 200 kDa and 160 kDa neurofilament proteins but immunonegative for the 68 kDa neurofilament protein. A few of these cells showed positive immunoreactivity with the olfactory marker protein (OMP) antibody and most likely represented the most mature olfactory neurons in the cultures. This trauma-induced culture model using olfactory tissue from adult mice can serve as a source of CNS neurons for comparison with cultured embryonic neurons.     

Anesthesia for trauma

Trauma is the leading cause of death for persons aged 1 to 38 years. Successful management is facilitated by prehospital endotracheal intubation, transport to regional trauma centers, rapid resuscitation by an on-site team of trained physicians, timely operative intervention, and provision of care by well-prepared anesthesiologists familiar with the potential complications typical of traumatized patients. No particular anesthetic agent or technique is ideal. Causes for intraoperative hypotension include hypovolemia, hemopneumothorax, pericardial tamponade, an intracranial mass, acidosis, and hypothermia. The anesthesiologist should play an active role in all phases of trauma management, including provision of postoperative intensive care and pain relief.