According to literature data, there are no distinct guidelines regarding the proper diagnostic and therapeutic management of traumatic carotid artery dissection (TCAD). Although most of cases evaluated in research studies refer to spontaneous carotid artery dissection, traumatic cases demand special considerations as far as diagnosis and treatment are concerned. Although both types of dissection share some common characteristics, a patient with TCAD usually presents with several concomitant injuries as well as a higher bleeding risk, thus complicating decision making in such patients. Therefore, aim of this review is to present available data regarding epidemiology, clinical presentation, diagnostics and treatment strategy in cases with TCAD in order to produce useful conclusions for everyday clinical practice.
Carotid Arteries* ; Decision Making ; Diagnosis ; Epidemiology ; Hemorrhage ; Humans ; Wounds, Nonpenetrating

Three cases who were successfully treated for cardiac injuries by open thoracotomy were reported. The range of the ages of the patients was 3rd decade. Two of the 3 were males with blunt injuries by motor vehicle accident and one was male with stab wound by knife. In the case of blunt injuries, the right atrium was involved in one case and the right and left atrium were involved in the other. The site of stab wound was the right atrium. There were two cases with the pre-operative diagnosis of cardiac injuries and they were blunt injuries. The case of stab wound was not diagnosed pre-operatively. All cases were treated with open thoracotomy-one posterolateral thoracotomy, one median sternotomy and one Clam shell incision. All of them had an uneventfull post-operative course.
Bivalvia ; Diagnosis ; Heart Atria ; Humans ; Male ; Motor Vehicles ; Sternotomy ; Thoracotomy ; Wounds, Nonpenetrating ; Wounds, Stab

In order to summarize the clinical diagnosis and treatment methods for 42 cases of multiple injuries with pancreatic injury, a retrospective analysis on 42 cases of multiple injuries with pancreatic injury from January 1990 to January 2006 was carried out in our hospital. Most cases were associated with hemopneumothorax and rib fractures (52.3%), shock (50%), multiple fractures (47.6%), and severe brain injury (26.1%). In 42 cases, one case died of severe hemorrhagic shock, and the remaining 41 cases (97.6%) were cured (including 40 cases receiving surgical operation and one case receiving the conservative treatment). Postoperative complications occurred in 16 cases (21 cases/times): pancreatic fistula (5 cases/times) and incisional wound infection (5 cases/times), intra-abdominal infection (3 cases/times), stress ulcer (3 cases/times), pleural effusion (3 cases/times), pulmonary infection (one case) and wound dehiscence (1 case). The principle therapy of multiple injuries with pancreatic injury is to rescue life, followed by active treatment to prevent injuries which giving rise to the abnormal respiratory and circulatory functions, management of cerebral hernia and other injuries which endangers life at last, and the pancreatic injury to increase the survival rate and survival quality.
Abdominal Injuries/*diagnosis ; Abdominal Injuries/*therapy ; Accidents, Traffic ; Emergency Medicine/methods ; Multiple Trauma ; Pancreas/*injuries ; Retrospective Studies ; Treatment Outcome ; Wound Healing ; Wounds, Nonpenetrating/diagnosis ; Wounds, Nonpenetrating/therapy

Humans ; Thoracic Injuries ; complications ; pathology ; Trauma Severity Indices ; Wounds, Nonpenetrating ; diagnosis ; etiology ; therapy

PURPOSE: This study was performed to examine if CT classification of renal blunt injury could aid in expectation of hemodynamic stability and clinical decision of whether to intervene surgically. MATERIALS AND METHODS: Over a 80-month period between July 1987 and March 1994, 41 patients were admitted to our hospital with the diagnosis of renal blunt injury. The renal blunt injuries were classified on Fedede's three-point scale CT classification methods :grade I, contusion, intrarenal hematoma, segmental infarction, and small subcapsular hematoma;grade II, complete or incomplete laceration, large subcapsular hematoma, and renal fracture;grade Ill, shattered kidney and renal pedicle injury. Hemodynamic stability, treatment method and clinical outcome of the patients with different CT grade were analyzed retrospectively. RESULTS: All 34 patients with grade I or II CT findings were hemodynamically stable and were successfully managed with conservative method. Among 7 patients with grade III CT findings, 6 patients were hemodynamically unstable. Out of the 6, One patient with grade IIIb or renal pedicle injury was expired before surgical intervention due to ischemic shock. Four patients were intervened surgically with one failure to thrive. The remaining one patient refused to be intervened surgically, and was discharged against medical advice. Only one out of 7 patients was hemodynamically stable and was managed conservatively. CONCLUSION: The patients with grade I or II CT findings are prone to be hemodynamically stable and to be managed with conservative method. But the patients with grade III CT findings are more likely to be hemodynamically unstable. Therefore patients with grade III CT findings should be closely monitored and be pre- pared for the possibility of immediate surgical intervention
Classification* ; Contusions ; Diagnosis ; Failure to Thrive ; Hematoma ; Hemodynamics ; Humans ; Infarction ; Kidney ; Lacerations ; Retrospective Studies ; Shock ; Wounds, Nonpenetrating

OBJECTIVETo summarize the experience on diagnosis and treatment of blunt duodenal injuries, and thus to improve the therapeutic skills.

METHODSClinical data of 34 cases of blunt duodenal injuries admitted to our hospital from 1990 to 2006 were retrospectively analyzed.

RESULTSAmong them, 28 cases were cured, 20 cases presented with complications, and 6 cases died. The causes of death were: duodenal or pancreatic fistula in 2 cases, intra-and retroperitoneal infection complicating septicopyemia in 2, disseminated intravascular coagulation in 1 and multiple organ failure in 1.

CONCLUSIONSMisdiagnosis and missed diagnosis predispose to happen for blunt duodenal injuries. Early recognition and surgical intervention are critical to a successful rescue.

Adolescent ; Adult ; Aged ; Duodenum ; injuries ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Wounds, Nonpenetrating ; diagnosis ; surgery

Pseudoaneurysm of the superficial temporal artery is very rare and can potentially be a critical cause of facial masses. Most pseudoaneurysms form as a result of blunt trauma and present as painless, pulsatile tumors that may be associated with neuropathic findings and enlarged size. They can be accurately diagnosed through physical examination alone. The treatment of choice is surgical ligation and resection. We present a case of traumatic pseudoaneurysm of the superficial temporal artery caused by blunt injury and discuss pertinent diagnosis and treatment option.
Aneurysm, False* ; Diagnosis ; Facial Injuries ; Ligation ; Physical Examination ; Temporal Arteries* ; Wounds, Nonpenetrating

Blunt traumatic tracheobronchial injury is rare, but can be potentially life-threatening. It accounts for only 0.5%-2% of all trauma cases. Patients may present with non-specific signs and symptoms, requiring a high index of suspicion with accurate diagnosis and prompt treatment. A 26-year-old female was brought into the emergency department after sustained a blunt trauma to the chest from a high impact motor vehicle accident. She presented with signs of respiratory distress and extensive subcutaneous emphysema from the chest up to the neck. Her airway was secured and chest drain was inserted for right sided pneumothorax. CT of the neck and thorax revealed a collapsed right middle lung lobe with a massive pneumothorax, raising the suspicion of a right middle lobe bronchus injury. Diagnosis was confirmed by bronchoscopy. In view of the difficulty in maintaining her ventilation and persistent pneumothorax with a massive air leak, immediate right thoracotomy via posterolateral approach was performed. The right middle lobar bronchus tear was repaired. There were no intra- or post-operative complications. She made an uneventful recovery. She was asymptomatic at her first month follow-up. A repeated chest X-ray showed expanded lungs. Details of the case including clinical presentation, imaging and management were discussed with an emphasis on the early uses of bronchoscopy in case of suspected blunt traumatic tracheobronchial injury. A review of the current literature of tracheobronchial injury management was presented.
Humans ; Female ; Adult ; Pneumothorax/surgery* ; Bronchi/injuries* ; Wounds, Nonpenetrating/diagnosis* ; Bronchoscopy ; Trachea/injuries*

Adult ; Crohn Disease ; complications ; Female ; Gastrointestinal Hemorrhage ; diagnosis ; etiology ; Hemoperitoneum ; diagnosis ; etiology ; Humans ; Wounds, Nonpenetrating ; diagnosis ; etiology

OBJECTIVEFocused Abdominal Sono-graphy for Trauma (FAST) is widely used for the detection of intraperitoneal free fluids in patients suffering from blunt abdominal trauma (BAT). This study aimed at assessing the diagnostic accuracy of this investigation in a designated trauma centre.

METHODSThis was a retrospective study of BAT patients over a 6 year period seen in a trauma centre in Hong Kong. FAST findings were compared with laparotomy, abdominal computed tomography or autopsy findings, which served as the gold standard for presence of intraperitoneal free fluids. The patients who did not have FAST or gold standard confirmatory test performed, had preexisting peritoneal fluid, died at resuscitation or had imcomplete documentation of FAST findings were excluded. The performance of FAST was expressed as sensitivity, specificity, predictive values (PV), likelihood ratios (LR) and accuracy.

RESULTSFAST was performed in 302 patients and 153 of them were included in this analysis. The sensitivity, specificity, positive PV, negative PV, positive LR, negative LR and accuracy for FAST were respectively 50.0%, 97.3%, 87.0%, 84.6%, 18.8, 0.5 and 85.0%. FAST was found to be more sensitive in less severely injured patients and more specific in more severely injured patients.

CONCLUSIONFAST is a reliable investigation in the initial assessment of BAT patients. The diagnostic values of FAST could be affected by the severity of injury and staff training is needed to further enhance its effective use. Key words: Laparotomy; Autopsy; Tomography, X-ray computed; Tomography, spiral computed; Ultrasonography.

Abdominal Injuries ; diagnosis ; Hong Kong ; Humans ; Retrospective Studies ; Tomography, X-Ray Computed ; Trauma Centers ; Wounds, Nonpenetrating ; diagnosis