[REHABILITATION AFTER PERIPHERAL NERVE INJURIES].
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Lack of caution, insufficient knowledge of anatomy, overrating of one's own abilities and operations which are carried out without restricting blood circulation and without sufficient anaesthesia are the most frequent causes of iatrogenic nerve injuries. On the one hand, the faulty treatment of pre-existing nerve injuries will be discussed; on the other hand, nerve injuries resulting from surgery will be considered.
The level of global small arms violence is enormous and the scale of human suffering it causes is immense, although poorly counted. It causes at least hundreds of thousands of deaths and more than a million injuries each year, as well as permanent physical and psychological damage, destruction of families, lost productivity, and diversion of resources from basic health services. Research is required on three basic issues, as follows: health effects of weapons; the contributing factors and causes, including behavioral issues; and impacts of interventions and their cost-effectiveness. Policies and programs designed to reduce the human and social impacts of small arms should make use of public health knowledge and analysis of risk factors as a means of bringing increased focus and effectiveness to their objectives. At its international conference on small arms, gun violence, and injury, "Aiming for Prevention" in Helsinki in September 2001, International Physicians for the Prevention of Nuclear War called on health professionals as well as scientists, activists, humanitarian and development workers to contribute to an effective confrontation of the small arms pandemic.
Twenty eight patients who had subclavian, axillary, and brachial artery injuries were studied. Sixteen (57%) sustained blunt trauma and 12 (43%) sustained penetrating trauma. Motor cycle accidents were the most common cause of injuries (43%). Twenty patients (71.4%) were transferred from other hospitals. Nine patients (32%) were in shock on arrival. All patients had radial pulse abnormalities (3 decreased, 25 absent) of the affected limbs. Eighteen patients (64%) had associated injuries to other parts of the body. Eighteen patients (64%) also had associated nerve injuries, 7 of them had complete brachial plexus injuries from motor cycle accidents. Twelve patients (43%) had preoperative angiography. Twelve patients (43%) had brachial, 10 (35.7%) had axillary, 2 (7%) had axillary-subclavian, and 4 (14%) had subclavian artery injuries. Eight patients (28.6%) had concomitant venous injuries. Resection of the injured artery and reversed saphenous vein graft were performed in 23 patients (82%). The remaining had resection and end to end anastomosis in 3 patients (10.7%), lateral repair in 2 patients (7%), and ligation in 1 patient (3.6%). Concomitant venous repairs were performed in 5 patients. Fasciotomies were performed in 2 patients (7%). Excellent results of vascular repairs were obtained in all patients. Long-term disability occurred in patients who had associated nerve injuries. Avulsion injury of the brachial plexus usually resulted in severe impairment of limb function.
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Primum non nocere. Hippocrates included this admonition in Epidemics, Book I, Second Constitution, to do good or "to do no harm." However, even the most conscientious health care provider will encounter unexpected and serious adverse medical events. This discussion focuses on one relatively common, often perplexing, and usually unexplained perioperative complication: ulnar neuropathy. Perioperative ulnar neuropathy has received increased scientific attention because it accounts for one third of all nerve injury claims in the American Society of Anesthesiologists (ASA) Closed Claims Study database. In addition, these injuries may result in chronic pain or paresthesia, employment disability, catastrophic economic damages, and malpractice litigation. We will explore the current understanding of perioperative ulnar nerve dysfunction by summarizing the relevant scientific literature and information within the ASA closed-claims database, describing the epidemiologic features of perioperative nerve injuries, discussing relevant clinical investigations and recommendations for safe arm positioning during anesthesia, and reviewing the medico-legal issues inevitably intertwined with this topic, particularly the doctrine of res ipsa loquitur.
OBJECTIVE: To develop prevention and treatment modalities for eye injuries, ophthalmologists require epidemiological data on the various types of eye injuries. This study sought to define eye injury patterns in the U.S. armed forces. METHOD: Data on patterns of eye injury in the armed forces were obtained through voluntary reporting by U.S. military ophthalmologists throughout the world. The reporting format was standardized with the U.S. Eye Injury Registry initial and follow-up report forms. The data were analyzed for significant injury patterns. RESULTS: Data on 112 patients were submitted, representing a broad range of the military population. Data on a total of 96 patients with a 6-month follow-up were analyzed in this study. Immediately after injury, 43% of the patients were noted to have poor vision (worse than 20/200). After treatment, only 20% were noted to have poor vision. Patients lost an average of 21.6 days of work after a severe eye injury. CONCLUSION: An eye injury is a traumatic and potentially debilitating event. The loss of visual acuity can be drastic, resulting in an extensive recovery period.
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