Traumatic sternomanubrial dislocation with associated bilateral internal mammary artery occlusion.
Explore the source record for details and available documents.
Adult↗
Biomedical subjects
Riyad Karmy-Jones
Publications and source records attributed to Riyad Karmy-Jones.
Delayed surgical management of a traumatic aortic arch injury.
We report successful management of a blunt traumatic injury to the aortic arch with intentionally delayed surgical repair. The aorta was repaired after the stabilization of other, potentially fatal, traumatic injuries.
Accidents, Traffic↗
Pericarditis after trauma resulting in delayed cardiac tamponade.
Pericarditis complicating cardiac trauma and resulting in tamponade is uncommon. Possible causes include an autoimmune reaction or an inflammatory response to blood entering the pericardium. We present two patients, one with effusive and one with constrictive pericarditis occurring within 2 weeks of a penetrating trauma close to but not directly involving the heart. These cases illustrate the importance of clinical suspicion and aggressive management in the diagnosis and management of such patients.
Adult↗
Limb loss following lower extremity arterial trauma: what can be done proactively?
We performed a retrospective review of patients admitted to two Level I trauma centres over a 15-year period with arterial injuries (excluding primary amputations). Preoperative factors analysed included mechanism of injury, site and type of arterial and venous injury and repair, time to operating room, initial blood pressure, evidence of ipsilateral limb fracture and/or extensive tissue damage, status of preoperative pulses and angiographic data. One hundred and fifty-one arterial injuries were treated (80 penetrating). Overall mortality was 10 (6.6%) and limb loss 16 (10.6%). Only two factors that might possibly be modified by specific interventions were noted. The incidence of limb loss was higher in patients who developed compartment syndrome (41% versus 7% without, P=0.003) and in those who did not receive intra- or immediately postoperative anticoagulation (15% without versus 3% with, P=0.02). Unfortunately, no factor was found that reliably predicted the risk of compartment syndrome. In addition, patients who did not receive peri-operative anticoagulation were more severely injured than those that did were. Despite this, there were no bleeding complications associated with anticoagulation. These findings suggest that the primary interventions that may improve limb salvage include liberal use of fasciotomy (recognising that any patient may require this) as well as early use of anticoagulation.
Adolescent↗
Treatment of acute thoracic aortic injury with commercially available abdominal aortic stent-grafts.
Traumatic rupture of the thoracic aorta is a common cause of death after vehicle collisions. Associated injuries are common, and patients with lung injury, cardiac contusion, abdominal bleeding, and head injury comprise a group at high risk for conventional surgical or medical therapy. In this particular population, existing commercially available stent-grafts may provide a life-saving repair option. The Ancure and AneuRx stent-grafts, designed for abdominal aortic aneurysm application, were successfully placed in three patients. Accommodation for the short length of the delivery device was achieved by retroperitoneal iliac artery access. All patients had follow-up computed tomography (CT) without evidence of endoleak and were doing well with respect to their chest trauma after 5-9 months of follow-up.
Accidents, Traffic↗
Potentially life-saving role for temporary endovascular balloon occlusion in atypical mediastinal hematoma.
Explore the source record for details and available documents.
Adult↗
The impact of positive pressure ventilation on the diagnosis of traumatic diaphragmatic injury.
Initial chest radiography (CXR) has been noted to have limited diagnostic sensitivity to detect acute diaphragmatic injury (ADI). A further confounding variable may be intubation and positive pressure ventilation which may prevent herniation of abdominal organs until weaning is achieved. We sought to determine the impact of positive pressure ventilation on the sensitivity of the initial CXR to identify ADI as well as to document the incidence of late herniation occurring as positive pressure ventilation is weaned. A retrospective chart review of 166 patients over an 8-year period in whom diagnosis of ADI was made on the same admission was performed. Etiology was penetrating trauma in 91 (55%). Eighty-five (51%) patients were intubated and ventilated with positive pressure before the initial chest radiograph. Diagnosis was made within 24 hours in 144 (87%) cases. The ability to correctly identify ADI by CXR was affected by whether or not the patient was intubated (intubated 12% vs nonintubated 27%; P = 0.001), side (right 10% vs left 27%; p = 0.04), and injury size (> 5 cm 81% vs < or = 5 cm 3%, P = 0.02). Late diagnosis was made in 22 cases: eight during surgery, six because of persistent radiographic abnormalities, and six when high levels of ventilator support were decreased with subsequent herniation of stomach above the diaphragm. Two cases were described at autopsy. Diaphragmatic injuries cannot be excluded if patients are intubated. Late diagnosis can be facilitated if chest radiographs are reviewed in sequence as ventilator support is decreased.
Diaphragm↗
Chronic traumatic and congenital diaphragmatic hernias: presentation and surgical management.
BACKGROUND: The diagnosis of chronic diaphragmatic hernias, whether due to congenital defects or trauma, may be difficult to make and may rely on clinical suspicion in the setting of persistent nondiagnostic radiographic findings. Repair is indicated to avoid catastrophic cardiopulmonary compromise and/or incarceration of abdominal organs. STUDY OBJECTIVES: To review the varied presentations and treatment of chronic diaphragmatic hernia. DESIGN: Retrospective review. SETTING: University of Washington and Harborview Medical Center, Seattle, Washington. PATIENTS: Between 1997 and 2001, nine patients presented with chronic diaphragmatic hernia (two congenital cases, seven post-traumatic cases). Four cases involved the right diaphragm. The following clinical features were noted: asymptomatic, chest radiograph showing bowel herniation (n=1); chest wall mass (n=1); asymptomatic with the chest radiograph showing marked elevation of hemidiaphragm (n=1); dyspnea with the chest radiograph showing marked elevation of hemidiaphragm (n=1); diarrhea and heartburn (n=1); generalized gastrointestinal upset (n=1); recurrent pneumonia (n=2); recurring effusions (n=4); and dyspnea on exertion (n=5). INTERVENTIONS: Diagnosis was confirmed by chest radiograph in two patients, chest computed tomography scan in one patient, barium studies in three patients and thoracoscopy in three patients. All hernias were repaired via thoracotomy, and two hernias were repaired with artificial patch. CONCLUSIONS: Patients with chronic diaphragmatic hernias present with a variety of symptoms and radiographic findings. When radiology or symptoms suggest bowel involvement, barium studies are appropriate. In other cases, chest computed tomography scans and/or thoracoscopy are useful. Repair is accomplished through the ipsilateral chest, with primary repair of the diaphragm preferred over patch repair.
Adolescent↗
Hemothorax complicating bronchial artery aneurysm.
An elderly patient presented with spontaneous hemothorax. Workup identified a right-sided bronchial aneurysm as the source, which was successfully embolized. Bronchial aneurysms can be managed by interventional techniques, although the choice of approach depends upon the clinical and anatomical settings.
Aged↗