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At least 415 records · Page 23Linked to original sources
PubMed2006

Foley catheter balloon tamponade for life-threatening hemorrhage in penetrating neck trauma.

BACKGROUND: Foley catheter (FC) balloon tamponade is a well-recognized technique employed to arrest hemorrhage from penetrating wounds. The aim of this study was to review our experience with this technique in penetrating neck wounds and to propose a management algorithm for patients with successful FC tamponade. METHODS: A retrospective chart review (July 2004-June 2005 inclusive) was performed of patients identified from a prospectively collected penetrating neck injury computer database in whom FC balloon tamponade was used. The units' policy for penetrating neck injuries is one of selective nonoperative management. All patients with successful FC tamponade underwent angiography. A venous injury was diagnosed if angiography was normal. Ancillary tests were performed as indicated. Removal of the FC was performed in the OR. RESULTS: During the study period, 220 patients with penetrating neck injuries were admitted to our unit. Foley catheter balloon tamponade was used in 18 patients and was successful in 17 patients. Angiography was positive in 3 patients, all of whom underwent surgery. The FC was successfully removed in 13 patients at a mean of 72 (range 48-96) hours. One patient bled after removal of the catheter, mandating emergency surgery. CONCLUSION: Foley catheter balloon tamponade remains a useful adjunct in the management of selective patients with penetrating, bleeding neck wounds.

Adult↗
PubMed1990

Neck dissection injury of a brachial plexus anatomical variant.

We describe an unusual brachial plexus anatomical variant that renders it vulnerable to injury in radical or modified neck dissection. It is represented by a looping redundant course of the most cephalad cervical division contribution to the brachial plexus. Unless recognized during development of the inferior surgical plane by blunt dissection techniques, injury to this portion of the brachial plexus may occur. An awareness of this infrequent variation in brachial plexus anatomy should be maintained.

Aged↗
PubMed1998

Acute treatment of whiplash neck sprain injuries. A randomized trial of treatment during the first 14 days after a car accident.

STUDY DESIGN: A single-blinded, randomized treatment study with a follow-up period of 6 months. OBJECTIVE: To study the long-term consequences of whiplash neck sprain injuries in patients treated with two different regimes during the first 14 days after the car accident. Patients in the first group were encouraged to act as usual, i.e., continue to engage in their normal, pre-injury activities; that group was compared with another group of patients who were given time off from work and who were immobilized using a soft neck collar. The end point of the comparison was the evaluation of subjective symptoms 6 months after the accident. SUMMARY OF BACKGROUND DATA: Few randomized treatment studies have been performed to evaluate the clinical outcome for patients with neck sprain. METHOD: Patients who participated in the study were recruited from the Emergency Clinic at the University Hospital in Trondheim, Norway. The study group included 201 patients (47% of the study group) with neck sprain that resulted from a car accident. Neck and shoulder movements and subjective symptoms, which were assessed using several different measurements, were assessed during the follow-up period. RESULTS: There was a significant reduction of symptoms from the time of intake to 24 weeks after the treatment period in both groups. There was a significantly better outcome for the act-as-usual group in terms of subjective symptoms, including pain localization, pain during daily activities, neck stiffness, memory, and concentration, and in terms of visual analog scale measurements of neck pain and headache. CONCLUSIONS: The outcome was better for patients who were encouraged to continue engaging in their normal, pre-injury activities as usual than for patients who took sick leave from work and who were immobilized during the first 14 days after the neck sprain injury.

Accidents, Traffic↗
PubMed2002

Intracartilaginous haemorrhagic lesions in strangulation?

This case control study was designed to investigate if laryngeal haemorrhages occur in cases of strangulation and whether these lesions are specific to strangulation. In the study 30 larynges from victims of fatal strangulation were examined (7 cases of manual strangulation, 12 cases of ligature strangulation, 11 cases of combined manual and ligature strangulation). The control group comprised 40 cases of death without any neck injuries and another group consisted of 5 cases of death caused by trauma with findings of non-strangulation neck injuries. In all the groups, only four solitary haemorrhages (two cases, one control, one non-strangulation neck injury) were observed that did not occur in the proximity of areas of blood accumulation. The results of our investigation suggest that histological evidence of blood accumulation or of haemorrhages in thyroid cartilage is not a reliable criterion to distinguish between haemorrhagic lesions due to strangulation and other types of blood accumulation or artefacts.

Adolescent↗
PubMedDate not supplied

The inappropriateness of helmet drop tests in assessing neck protection in head-first impacts.

Protecting the cervical spine in situations of axial compressive loading is indeed complex. Results from a number of crash simulations suggest that the mechanisms of head impact causing brain damage and those causing neck injury are different. The idea that neck injuries can be predicted from results of helmet drop tests or that the helmet is capable of providing protection to the cervical spine is unsupported. In head-first collisions causing axial compressive loading, the cushioning properties of the helmet alone would dictate the maximum force on the neck if both the head and neck were rigid. Since the head and neck are not rigid and appear to be as stiff or less stiff than the helmet, the cushioning influence of the helmet is minimized, so the forces experienced by the neck are dictated largely by its own properties. The helmet does not have a large influence. To be effective, the helmet would have to be much less stiff than it is at present and would have to maintain this low stiffness under very large loads. These conditions would be difficult to achieve without making the helmet disproportionately larger than it is now.

Athletic Injuries↗
PubMed1987

[Local vital reaction following injuries of the neck].

Sixty-one cases of hemorrhaging of the laryngeal muscles are reported among 86 deaths due to compression of the neck (strangulation by ligature and/or with the hands, blunt force); the results of histological examinations of these cases (laryngeal muscles; hemorrhaging of the cervical muscles and tongue in numerous cases) are discussed, as well as 55 comparative cases (natural, violent death) with regard to vital changes from the hemorrhaging aspect. Although sanguineous infiltration of the laryngeal muscles can occur after death (prone position), it differs macroscopically and in some cases also microscopically from the vital type: extensive bleeding on the inside of the larynx or dorsally above the larynx (PCA muscle), possible combined with histologically detectable ruptures of muscle cells, must be viewed as the result of laryngeal compression suffered when still alive. No clear-cut evidence of emigration or infiltration of leukocytes was found in the cases of immediately fatal strangulation, but there was occasional evidence (6 cases) when protracted maltreatment had taken place. Although there was no clear correlation with age, sex, type of impact, cause of death, or amount of laryngeal bleeding, in 25 of the 61 cases leukocytes were sometimes detectable in enormous amounts within the extravasation; the ratio exceeded that to be expected from the composition of the blood. Findings of this nature have also been made in cases of vital bleeding in other violent or natural deaths; they are not a cell reaction in the proper sense but, when distinctly marked, a vital event--at least in the laryngeal region. These findings can support the assumption of the amount of hemorrhaging in deaths in which the survival time was inadequate for a leukocyte emigration. In 20 cases such findings were combined with localized leucocytosis, which is regarded as an early vital reaction.

Asphyxia↗
PubMed2001

Subtle fatal manual neck compression.

A critical analysis of the postmortem diagnostic criteria for asphyxia leads to a difficulty that has significant implications for the forensic pathologist. The difficulty is that there are no universally recognized pathognomic signs of asphyxia, but pathologists frequently make this diagnosis based on observations that individually have indeterminate significance but combined together, in the appropriate context, have diagnostic value. This leads to the question: if asphyxia has no recognizable signs at autopsy how are we able to diagnose this entity in the latter circumstances? This problem can be solved by defining the minimally adequate diagnostic criteria for compressive neck injury. These criteria are potentially well-defined but currently lacking, in part, due to incomplete morphological characterization of the injuries that frequently occur in strangulation. The problem is especially challenging because the signs of strangulation form a spectrum of degree from minimal to marked and there is no consensus as to the minimal number and nature of lesions that is required to make the diagnosis of strangulation. In the present review of lesions that are commonly encountered in strangulation, intracartilaginous laryngeal haemorrhages and laryngeal cartilage microfractures are considered to have unrecognized diagnostic value, and these lesions are described in detail. A triad of haemorrhages (subepithelial laryngeal haemorrhage, intralaryngeal muscular haemorrhage, and intracartilaginous laryngeal haemorrhage) is discussed in the context of developing a definition of strangulation based on morphological criteria in the absence of overt mechanical injuries to the neck. Although definitive criteria for cases with minimal findings are still lacking, several lesions have putative diagnostic value.

Adult↗
PubMed2005

Concussion in professional football: biomechanics of the striking player--part 8.

OBJECTIVE: Concussive impacts in professional football were simulated in laboratory tests to determine the collision mechanics resulting in injury to the struck player and the biomechanics of the striking players, who were not concussed or neck-injured in the tackle. METHODS: Twenty-seven helmet-to-helmet collisions were reconstructed in laboratory tests using Hybrid III dummies. The head impact velocity, direction, and kinematics matched game video. Translational and rotational head accelerations and six-axis upper neck loads and moments were used to evaluate how the striking player delivered the concussive blow. The neck injury criterion, Nij, was calculated to assess neck injury risks in the striking player. RESULTS: The time-averaged impact force reached 6372 +/- 2486 N at 7.2 milliseconds because of 46.8 +/- 21.7 g head acceleration and 3624 +/- 1729 N neck compression force in the striking player. Fifty-seven percent of the load was contributed by neck compression. The striking players had their heads down and lined up the impact axis through their necks and torsos. This allowed momentum transfer with minimal neck bending and increased the effective mass of the striking player to 1.67 times that of the struck player at peak load. The impact caused 94.3 +/- 27.5 g head acceleration in the concussed players and 67.9 +/- 14.5 g without concussion (t = 2.06, df = 25, P = 0.025). The striking player's Nij was greater than tolerance in 9 of 27 cases by exceeding the 4000 N neck compression limit. For these cases, the average neck compression force was 6631 +/- 977 N (range, 5210-8194 N). Nij was 1.25 +/- 0.16 for eight cases above the tolerance Nij = 1.0. CONCLUSION: In the NFL, striking players line up their heads, necks, and torsos to deliver maximum force to the other player in helmet-to-helmet impacts. The concussive force is from acceleration of the striking player's head and torso load through the neck. Even though neck responses exceeded tolerances, no striking player experienced neck injury or concussion. A head-up stance at impact would reduce the torso inertial load in the collision and the risk of concussion in the struck player.

Biomechanical Phenomena↗
PubMed1975

Soft tissue injuries of the neck.

Soft tissue injuries of the neck are a frequent and important cause of disability and as such deserve close attention and concern. Patient management following this injury should not be left to the therapist but instead should be controlled closely by the physician to promote rapid recovery and avoid psychosomatic problems. Despite all methods of treatment there are patients who continue to complain of neck symptoms and others who develop degenerative disk changes in the years after injury.

Accidents, Traffic↗
PubMed2005

CT angiography in penetrating neck trauma reduces the need for operative neck exploration.

The evaluation of penetrating neck injury has evolved dramatically from mandatory operative exploration of Zone II injuries that penetrate the platysma to selective management based on physical examination and adjunctive studies. More recently, CT angiography has emerged as an efficient, noninvasive method of evaluating penetrating neck injury. We retrospectively reviewed our experience over 10 years with the management of penetrating neck injury. One hundred thirty cases were reviewed with 34 undergoing CT angiogram (Group CTA) and 96 with no CT angiogram (Group nCTA). Group CTA had significantly fewer neck explorations, 1 (3%) versus 32 (33%), P < 0.001. Negative explorations were significantly higher in nCTA as well, with a rate of 22 per cent versus 0 in CTA (P < 0.01). The use of angiogram and esophagram was also significantly lower in CTA versus nCTA (P = 0.02 and P = 0.04). Of the 34 patients in CTA, 4 (12%) also underwent angiography and 4 (12%) received a contrast esophagram. Of the 64 patients in nCTA who did not undergo a neck exploration, 19 (29%) underwent angiography, and 17 (26%) received a contrast esophagram. The use of CT angiogram increased over time with a concomitant decrease in the rate of neck explorations.

Adolescent↗
PubMed2002

Biomedical engineering analysis of glass impact injuries.

This article outlines the history, development, and safety aspects of glass and its use in motor vehicles. It traces the manufacture and describes the characteristics of laminated and tempered glass. It further compares the differences in injuries caused by impact with laminated and tempered glass. The development, use, and results of high penetration resistance (HPR) laminated glass for windshields are examined. Head and neck injuries from impact with glass and glazing structures are delineated. Results of studies with laminated and tempered glass are presented. The probability and severity of injuries occurring secondary to partial or full ejection of vehicle occupants are discussed, and the differences between the performance of laminated and tempered glass are highlighted. Current research to quantify head and neck injury parameters caused by glass impact during rollover is described. The biomechanics of head and neck injury assessment and the development of injury prediction parameters and reference values, respectively, are reviewed.

Accidents, Traffic↗
PubMed1993

[A case report of acute death caused by hyperextension injury of neck].

We report an autopsy case of acute death from an upper cervical spinal cord injury caused by hyperextension of the neck. A 59-year-old drunken man who had been suffering from cervical spondylosis was slapped in the face, fell flat on his face, and remained as such for 4 hours. The victim was carried to a hospital, he had already been dead on arrival. Although he received an intensive care, he remained unconscious for 12 hours until a cardiac arrest. The findings of an autopsy were as follows: Externally, excoriation on the forehead and the left eyebrow and slight subcutaneous hemorrhage in the dorsum of the nose were observed. The intervertebral disk and the anterior longitudinal ligament between the 5th and 6th cervical vertebrae were severed, and a lot of bleeding in the region of the injuries was observed. The 6th cervical spinous process was fractured in the direction to a major axis. A part of the posterior root filaments was torned and the bleeding points could be seen on the front of the 6th cervical spinal cord. In the cross section of the 6th cervical spinal cord, the typical hemorrhagic necrosis could be recognized surrounding the central canal, whereas the similar finding was observed at the second cervical spinal cord. On the histopathological examinations, in C2, C5-C6 regions marked ischemic changes and hemorrhagic necrosis could be observed. From these post-mortem results, we diagnosed that the victim died from an upper spinal cord damage due to a stretching consequence of the hyperextentional injury.

Autopsy↗
PubMed2006

[Injuries of the neck: wartime and peacetime experiences].

INTRODUCTION: There are many diagnostic and therapeutic dilemmas as well as variations in the treatment of neck trauma. AIM: Our own experiences offer a protocol of treatment for neck trauma. PATIENTS AND METHODS: During the 1991-2003 period, 139 patients with neck trauma were treated at Dr. Josip Bencević General Hospital in Slavonski Brod, 95 with war injuries and 44 with peacetime injuries. RESULTS: Immediate neck exploration was done in 115 patients, and 62 (54%) followed-up based on diagnostic procedure was positive without surgical treatment. DISCUSSION: Currently, there are two approaches in the treatment of neck trauma: exploration of neck injuries deeper than platysma, and selective approach when neck exploration is done depending on clinical status and diagnosis. CONCLUSION: The authors emphasize immediate exploration of penetrating neck injuries as decisive in surgical treatment, irrespective of peacetime or war trauma. Neck injuries should be treated by the principles of definitive treatment.

Croatia↗
PubMed2004

Endurance during chewing in whiplash-associated disorders and TMD.

We have previously shown an association between neck injury and disturbed jaw function. This study tested the hypothesis of a relationship between neck injury and impaired endurance during chewing. Fifty patients with whiplash-associated disorders (WAD) were compared with 50 temporomandibular disorders (TMD) patients and 50 healthy subjects. Endurance was evaluated during unilateral chewing of gum for 5 min when participants reported fatigue and pain. Whereas all healthy subjects completed the task, 1/4 of the TMD and a majority of the WAD patients discontinued the task. A majority of the WAD patients also reported fatigue and pain. These findings suggest an association between neck injury and reduced functional capacity of the jaw motor system. From the results, we propose that routine examination of WAD patients should include jaw function and that an endurance test as described in this study could also be a useful tool for non-dental professionals.

Adolescent↗