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Fawaz R, Fouet M, Brenot G, Bertani A, Lamblin A, Delmas JM. Ethical Issues Regarding Neurosurgical Management of Penetrating Brain Injury in the French Armed Forces. Mil Med 2024; 189:e919-e922. [PMID: 37856219 DOI: 10.1093/milmed/usad396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 06/20/2023] [Accepted: 09/25/2023] [Indexed: 10/21/2023] Open
Abstract
Combat penetrating brain injury (PBI) differs significantly from PBI in civilian environments. Differences include technical factors such as the weapons involved, strained resource environments, and limited medical materials and human resources available. Ethical issues regarding the management of PBI in military settings may occur. This case study examines the case of a 20-year-old member of the French Armed Forces that suffered a penetrating brain injury in a combat situation. The four-quadrant method along with the four principles of medical ethics (respect for autonomy, beneficence, nonmaleficence, and justice) was used to analyze this case and to apply ethics to the practice of military medicine. Nowadays, we possess the medical and surgical resources as well as the aeromedical evacuation capability to save the life of a soldier with a penetrating craniocerebral wound. Nonetheless, the functional outcome of this type of wound places military doctors in an ethical dilemma. The line of conduct and clinical protocol established by the French Medical Health Service is to manage all PBIs when the patient's life can be saved and to provide all available financial and social support for the rehabilitation of patients and their family.
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Affiliation(s)
- Rayan Fawaz
- Department of Neurosurgery, Percy Military Teaching Hospital, Clamart Cedex 92140, France
| | - Mathilde Fouet
- Department of Neurosurgery, Percy Military Teaching Hospital, Clamart Cedex 92140, France
| | - Godefroi Brenot
- Department of Urology, Bégin Military Teaching Hospital, Saint Mandé Cedex 94160, France
| | - Antoine Bertani
- Department of Orthopedics, Edouard Herriot Hospital, Lyon Cedex 69003, France
| | - Antoine Lamblin
- Department of Anesthesiology and Reanimation, Edouard Herriot Hospital, Lyon Cedex 69003, France
| | - Jean-Marc Delmas
- Department of Neurosurgery, Percy Military Teaching Hospital, Clamart Cedex 92140, France
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Zhong C, Lu W, Xie W, Jiao W. A prediction model of risk factors of poor wound healing after craniocerebral surgery. Pak J Med Sci 2023; 39:1835-1839. [PMID: 37936752 PMCID: PMC10626108 DOI: 10.12669/pjms.39.6.7963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 04/04/2023] [Accepted: 07/18/2023] [Indexed: 11/09/2023] Open
Abstract
Objective To explore the independent risk factors of poor wound healing after craniocerebral surgery, and to generate a risk prediction model. Methods A single-center retrospective observational analysis of 160 patients who underwent craniocerebral surgery in The 904th Hospital of the Joint Logistics Support Force of the PLA from February 2018 to February 2021 was carried out. Patients were divided into Group-A (n=70) and Group-B (n=90) according to postoperative wound healing outcome. Logistic regression was used to analyze the independent risk factors, and a nomogram prediction model was constructed using R software. The receiver operating characteristic (ROC) curve was used to test the predictive ability of the model, and the fitting effect was verified by Hosmer Lemeshow. Results The duration of operation, surgical site infection, diabetes mellitus, and the time of intubation in Group-B were significantly lower than Group-A (P<0.05). Serum albumin (ALB) and hemoglobin (HGB) in Group-B were significantly higher than those in Group-A (P<0.05). Logistic regression analysis showed that long operation duration, surgical site infection, duration of drainage tube, ALB <35g/L, and abnormal HGB were independent risk factors for poor wound healing (P<0.05). The area under the ROC curve (AUC) predicted by the model was 0.932, 95%CI (0.862~1.000). The Hosmer-Lemeshow goodness of fit test showed that the expected probability calculated by the model matched the actual probability (P>0.05). Conclusions Long operation duration, surgical site infection, duration of drainage tube, ALB <35g/L, and abnormal HGB were risk factors for poor wound healing. The nomograph model based on these factors showed good discrimination, calibration, and clinical effectiveness in predicting poor wound healing.
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Affiliation(s)
- Chunlian Zhong
- Chunlian Zhong, Department of Neurosurgery, The 904th Hospital of the Joint Logistics Support Force of the PLA, Wuxi 214000, Jiangsu Province, P.R. China
| | - Wei Lu
- Wei Lu, Department of Neurosurgery, The 904th Hospital of the Joint Logistics Support Force of the PLA, Wuxi 214000, Jiangsu Province, P.R. China
| | - Wenzhong Xie
- Wenzhong Xie, Department of Neurosurgery, The 904th Hospital of the Joint Logistics Support Force of the PLA, Wuxi 214000, Jiangsu Province, P.R. China
| | - Wei Jiao
- Wei Jiao, Department of Neurosurgery, The 904th Hospital of the Joint Logistics Support Force of the PLA, Wuxi 214000, Jiangsu Province, P.R. China
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Meister MR, Boulter JH, Yabes JM, Sercy E, Shaikh F, Yokoi H, Stewart L, Scanlon MM, Shields MM, Kim A, Tribble DR, Bartanusz V, Dengler BA. Epidemiology of cranial infections in battlefield-related penetrating and open cranial injuries. J Trauma Acute Care Surg 2023; 95:S72-S78. [PMID: 37246289 PMCID: PMC10389625 DOI: 10.1097/ta.0000000000004018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/03/2023] [Accepted: 04/07/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND Penetrating brain injuries are a potentially lethal injury associated with substantial morbidity and mortality. We examined characteristics and outcomes among military personnel who sustained battlefield-related open and penetrating cranial injuries during military conflicts in Iraq and Afghanistan. METHODS Military personnel wounded during deployment (2009-2014) were included if they sustained an open or penetrating cranial injury and were admitted to participating hospitals in the United States. Injury characteristics, treatment course, neurosurgical interventions, antibiotic use, and infection profiles were examined. RESULTS The study population included 106 wounded personnel, of whom 12 (11.3%) had an intracranial infection. Posttrauma prophylactic antibiotics were prescribed in more than 98% of patients. Patients who developed central nervous system (CNS) infections were more likely to have undergone a ventriculostomy ( p = 0.003), had a ventriculostomy in place for a longer period (17 vs. 11 days; p = 0.007), had more neurosurgical procedures ( p < 0.001), and have lower presenting Glasgow Coma Scale ( p = 0.01) and higher Sequential Organ Failure Assessment scores ( p = 0.018). Time to diagnosis of CNS infection was a median of 12 days postinjury (interquartile range, 7-22 days) with differences in timing by injury severity (critical head injury had median of 6 days, while maximal [currently untreatable] head injury had a median of 13.5 days), presence of other injury profiles in addition to head/face/neck (median, 22 days), and the presence of other infections in addition to CNS infections (median, 13.5 days). The overall length of hospitalization was a median of 50 days, and two patients died. CONCLUSION Approximately 11% of wounded military personnel with open and penetrating cranial injuries developed CNS infections. These patients were more critically injured (e.g., lower Glasgow Coma Scale and higher Sequential Organ Failure Assessment scores) and required more invasive neurosurgical procedures. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level IV.
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Outcomes Following Penetrating Brain Injuries in Military Settings: A Systematic Review and Meta-Analysis. World Neurosurg 2022; 166:39-48. [PMID: 35870782 DOI: 10.1016/j.wneu.2022.07.062] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE While neurosurgeons are experienced in treating penetrating brain injuries (PBIs) in civilian settings, much less is known about management and outcomes of PBIs in military settings. METHODS A systematic review was performed according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Data extracted included surgical management, age, gender, location/type of injury, initial Glasgow Coma Scale (GCS) score, and outcomes. The primary outcomes were last reported Glasgow Outcome Score (GOS) and mortality. The secondary outcomes included central nervous system infections, seizures, and cerebrospinal fluid leak/fistula. Odds ratios (ORs) with corresponding 95% confidence intervals (CIs) were used for outcome analysis. RESULTS Twelve studies with 1738 patients treated for PBIs in military settings were included. The weighted mean age was 27.8 years, 86.7% were male, and 64.3% underwent neurosurgical intervention. Most patients (64.3%) presented with a GCS score >8, while 31.0% presented in a coma (GCS score <8). Over a median last follow-up time of 9 months, 68.6% achieved a favorable (GOS = 4-5) outcome and 34.2% achieved a poor (GCS score = 1-3) outcome. The overall mortality was 18.0%. A meta-analysis was performed using 5 of 12 studies to evaluate the effect of the presenting GCS score on primary outcomes. Patients with an initial GCS score <8 had statistically significant lower odds of a favorable (GOS = 4-5) outcome (OR: 0.03; 95% CI: 0.00-0.19; P: 0.000) and higher odds of mortality (OR: 28.46; 95% CI: 8.62-94; P: 0.000) than patients with an initial GCS score >8. The pooled rates of central nervous system infection, seizures, and cerebrospinal fluid leak/fistula were 13.8%, 13.2%, and 5.4%, respectively. CONCLUSIONS In this first systematic review and meta-analysis of outcomes following combat-related PBIs, a GCS score >8 at presentation was found to be an important predictor of a favorable GOS and decreased mortality.
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Birk H, Demand A, Kandregula S, Notarianni C, Meram A, Kosty J. Wound vacuum-assisted closure as a bridge therapy in the treatment of infected cranial gunshot wound in a pediatric patient: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2022; 3:CASE21489. [PMID: 36130545 PMCID: PMC9379617 DOI: 10.3171/case21489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 12/16/2021] [Indexed: 12/02/2022]
Abstract
BACKGROUND The authors reported the first pediatric case of a craniocerebral gunshot injury successfully treated with a wound vacuum-assisted closure (VAC) device after dehiscence and infection of the initial cranial wound. OBSERVATIONS A 17-year-old boy suffered several gunshots to the left hemisphere, resulting in significant damage to the scalp, calvaria, and brain. Emergency hemicraniectomy was performed, with reconstruction of a complicated scalp wound performed at the initial surgery. The scalp was devitalized and ultimately dehisced, resulting in a cranial infection. It was treated first with a repeated attempt at primary closure, which failed because of persistent devitalized tissue, and was then treated with aggressive debridement followed by placement of a wound VAC device over the exposed brain as a bridge therapy to reconstruction. This procedure was deemed necessary given the active infection. LESSONS The patient received delayed reconstruction with a free split-thickness skin graft and made a remarkable recovery, with cranioplasty performed 6 months later. The authors reviewed the literature on wound VAC use in cranial wound treatment and proposed it as a legitimate bridge therapy to definitive reconstruction in the setting of dirty wounds, active infection, or even hemodynamically unstable patients.
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Affiliation(s)
| | | | | | | | - Andrew Meram
- Oral and Maxillofacial Surgery, Louisiana State University Health Shreveport School of Medicine, Shreveport, Louisiana
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Yengo-Kahn AM, Patel PD, Kelly PD, Wolfson DI, Dawoud F, Ahluwalia R, Bonfield CM, Guillamondegui OD. The value of simplicity: externally validating the Baylor cranial gunshot wound prognosis score. J Neurosurg 2021; 135:1560-1568. [PMID: 33690151 PMCID: PMC8426419 DOI: 10.3171/2020.9.jns201891] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 09/08/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Gunshot wounds to the head (GSWH) are devastating injuries with a grim prognosis. Several prognostic scores have been created to estimate mortality and functional outcome, including the so-called Baylor score, an uncomplicated scoring method based on bullet trajectory, patient age, and neurological status on admission. This study aimed to validate the Baylor score within a temporally, institutionally, and geographically distinct patient population. METHODS Data were obtained from the trauma registry at a level I trauma center in the southeastern US. Patients with a GSWH in which dural penetration occurred were identified from data collected between January 1, 2009, and June 30, 2019. Patient demographics, medical history, bullet trajectory, intent of GSWH (e.g., suicide), admission vital signs, Glasgow Coma Scale score, pupillary response, laboratory studies, and imaging reports were collected. The Baylor score was calculated directly by using its clinical components. The ability of the Baylor score to predict mortality and good functional outcome (Glasgow Outcome Scale score 4 or 5) was assessed using the receiver operating characteristic curve and the area under the curve (AUC) as a measure of performance. RESULTS A total of 297 patients met inclusion criteria (mean age 38.0 [SD 15.7] years, 73.4% White, 85.2% male). A total of 205 (69.0%) patients died, whereas 69 (23.2%) patients had good functional outcome. Overall, the Baylor score showed excellent discrimination of mortality (AUC = 0.88) and good functional outcome (AUC = 0.90). Baylor scores of 3-5 underestimated mortality. Baylor scores of 0, 1, and 2 underestimated good functional outcome. CONCLUSIONS The Baylor score is an accurate and easy-to-use prognostic scoring tool that demonstrated relatively stable performance in a distinct cohort between 2009 and 2019. In the current era of trauma management, providers may continue to use the score at the point of admission to guide family counseling and to direct investment of healthcare resources.
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Affiliation(s)
- Aaron M. Yengo-Kahn
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville
| | | | - Patrick D. Kelly
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville
| | | | - Fakhry Dawoud
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville
- Quillen College of Medicine, East Tennessee State University, Mountain Home, Tennessee
| | - Ranbir Ahluwalia
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville
- College of Medicine, Florida State University, Tallahassee, Florida
| | | | - Oscar D. Guillamondegui
- Division of Trauma, Emergency Surgery, and Critical Care, Vanderbilt University Medical Center, Nashville, Tennessee
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Kelly PD, Patel PD, Yengo-Kahn AM, Wolfson DI, Dawoud F, Ahluwalia R, Guillamondegui OD, Bonfield CM. Incorporating conditional survival into prognostication for gunshot wounds to the head. J Neurosurg 2021; 135:1550-1559. [PMID: 33690152 PMCID: PMC8426440 DOI: 10.3171/2020.9.jns202723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 09/08/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Several scores estimate the prognosis for gunshot wounds to the head (GSWH) at the point of hospital admission. However, prognosis may change over the course of the hospital stay. This study measures the accuracy of the Baylor score among patients who have already survived the acute phase of hospitalization and generates conditional outcome curves for the duration of hospital stay for patients with GSWH. METHODS Patients in whom GSWH with dural penetration occurred between January 2009 and June 2019 were identified from a trauma registry at a level I trauma center in the southeastern US. The Baylor score was calculated using component variables. Conditional overall survival and good functional outcome (Glasgow Outcome Scale score of 4 or 5) curves were generated. The accuracy of the Baylor score in predicting mortality and functional outcome among acute-phase survivors (survival > 48 hours) was assessed using receiver operating characteristic curves and the area under the curve (AUC). RESULTS A total of 297 patients were included (mean age 38.0 [SD 15.7] years, 73.4% White, 85.2% male), and 129 patients survived the initial 48 hours of admission. These acute-phase survivors had a decreased mortality rate of 32.6% (n = 42) compared to 68.4% (n = 203) for all patients, and an increased rate of good functional outcome (48.1%; n = 62) compared to the rate for all patients (23.2%; n = 69). Among acute-phase survivors, the Baylor score accurately predicted mortality (AUC = 0.807) and functional outcome (AUC = 0.837). However, the Baylor score generally overestimated true mortality rates and underestimated good functional outcome. Additionally, hospital day 18 represented an inflection point of decreasing probability of good functional outcome. CONCLUSIONS During admission for GSWH, surviving beyond the acute phase of 48 hours doubles the rates of survival and good functional outcome. The Baylor score maintains reasonable accuracy in predicting these outcomes for acute-phase survivors, but generally overestimates mortality and underestimates good functional outcome. Future prognostic models should incorporate conditional survival to improve the accuracy of prognostication after the acute phase.
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Affiliation(s)
- Patrick D. Kelly
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville
| | | | - Aaron M. Yengo-Kahn
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville
| | | | - Fakhry Dawoud
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville
- Quillen College of Medicine, East Tennessee State University, Mountain Home, Tennessee
| | - Ranbir Ahluwalia
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville
- College of Medicine, Florida State University, Tallahassee, Florida
| | - Oscar D. Guillamondegui
- Division of Trauma, Emergency Surgery, and Critical Care, Vanderbilt University Medical Center, Nashville, Tennessee
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Mudekereza PS, Murhula GB, Kachungunu C, Mudekereza A, Cikomola F, Mubenga LEM, Balungwe PB, Budema PM, Molima C, Mugabo EN, Lekuya HM. Factors associated with hospital outcomes of patients with penetrating craniocerebral injuries in armed conflict areas of the Democratic Republic of the Congo: a retrospective series. BMC Emerg Med 2021; 21:109. [PMID: 34600474 PMCID: PMC8487558 DOI: 10.1186/s12873-021-00504-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 09/21/2021] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Penetrating craniocerebral injuries (PCCI) are types of open head injuries caused by sharp objects or missiles, resulting in communication between the cranial cavity and the external environment. This condition is deemed to be more prevalent in armed conflict regions where both civilians and military are frequently assaulted on the head, but paradoxically their hospital outcomes are under-reported. We aimed to identify factors associated with poor hospital outcomes of patients with PCCI. METHODS This was a retrospective series of patients admitted at the Regional Hospital of Bukavu, DRC, from 2010 to 2020. We retrieved medical records of patients with PCCI operated in the surgical departments. A multivariate logistic regression model was performed to find associations between patients' admission clinico-radiological parameters and hospital outcomes. Poor outcome was defined as a Glasgow Outcomes Score below 4. RESULTS The prevalence of PCCI was 9.1% (91/858 cases) among admitted TBI patients. More than one-third (36.2%) of patients were admitted with GCS < 13, and 40.6% of them were unstable hemodynamic. Hemiplegia was found in 23.1% on admission. Eight patients had an intracerebral hemorrhage. Among the 69 operated patients, complications, mainly infectious, occurred in half (50.7%) of patients. Poor hospital outcomes were observed in 30.4% and associated with an admission GCS < 13, hemodynamic instability, intracerebral hemorrhage, and hemiplegia (p < 0.05). CONCLUSION The hospital poor outcomes are observed when patients present with hemodynamic instability, an admission GCS < 13, intracerebral hemorrhage, and hemiplegia. There is a need for optimizing the initial care of patients with PCCI in armed conflict regions.
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Affiliation(s)
- Paterne Safari Mudekereza
- Faculté de Médecine, Université Catholique de Bukavu, Bukavu, Democratic Republic of the Congo
- Hôpital Provincial Général de Référence de Bukavu, Bukavu, Democratic Republic of the Congo
- Société Congolaise de Neurochirurgie (SCNC), Kinshasa, Democratic Republic of the Congo
| | | | - Charles Kachungunu
- Société Congolaise de Neurochirurgie (SCNC), Kinshasa, Democratic Republic of the Congo
| | - Amani Mudekereza
- Hôpital Provincial Général de Référence de Bukavu, Bukavu, Democratic Republic of the Congo
| | - Fabrice Cikomola
- Faculté de Médecine, Université Catholique de Bukavu, Bukavu, Democratic Republic of the Congo
- Hôpital Provincial Général de Référence de Bukavu, Bukavu, Democratic Republic of the Congo
| | - Leon-Emmanuel Mukengeshai Mubenga
- Faculté de Médecine, Université Catholique de Bukavu, Bukavu, Democratic Republic of the Congo
- Hôpital Provincial Général de Référence de Bukavu, Bukavu, Democratic Republic of the Congo
| | - Patrick Birindwa Balungwe
- Faculté de Médecine, Université Catholique de Bukavu, Bukavu, Democratic Republic of the Congo
- Hôpital Provincial Général de Référence de Bukavu, Bukavu, Democratic Republic of the Congo
| | - Paul Munguakonkwa Budema
- Faculté de Médecine, Université Catholique de Bukavu, Bukavu, Democratic Republic of the Congo
- Hôpital Provincial Général de Référence de Bukavu, Bukavu, Democratic Republic of the Congo
| | - Christian Molima
- Ecole Régionale de Santé Publique, Université Catholique de Bukavu, Bukavu, Democratic Republic of the Congo
| | - Erick Namegabe Mugabo
- Hôpital Provincial Général de Référence de Bukavu, Bukavu, Democratic Republic of the Congo
| | - Hervé Monka Lekuya
- Société Congolaise de Neurochirurgie (SCNC), Kinshasa, Democratic Republic of the Congo
- Department of Surgery, CHS, Makerere University, P.O. Box 7072, Kampala, Uganda
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Unintentional penetrating brain injuries caused by air rifles in teenagers: Two case report. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Carbon Nanomaterials in the Treatment of Infectious Bone Defects and Wound Scars after Wushu Fractures. J CHEM-NY 2020. [DOI: 10.1155/2020/2094273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Although modern antibiotics and surgical technology have made great progress, when using carbon nanomaterials to treat bone marrow-induced inflammation after martial arts fractures, how to simultaneously repair bone defects and control wound infections is the current focus of orthopedics research. This paper uses electrospinning technology to develop a carbon nanomaterial based on PLA, HA-g-PLA, and vancomycin. The surface morphology, biocompatibility, drug release, and osteogenesis of carbon nanomaterials are studied, selecting animal models to verify its effect in the treatment of osteomyelitis with bone defects and provide new ideas and new methods for the treatment of bone defects complicated by osteomyelitis infection. In this paper, carbon nanofibers containing doxycycline, a small molecule protease inhibitor, were prepared by simple blending. Encapsulation of carbon nanofibers can control the slow release of doxycycline and improve the effect of doxycycline in treating chronic wounds. This article uses two methods to prepare different types of osteomyelitis models and compare them. After injecting saline or bacterial solution, the two groups were sealed with bone wax and the incision was closed; the blank group did not do any treatment. Within 30 days after surgery, the appearance of the left hind limb wound and general signs of infection were closely monitored, body temperature was measured, and blood was collected from the ear veins of experimental animals to analyze the changes in C-reactive protein (CRP) and procalcitonin levels (PCT); X-ray, CT imaging, and histological observation were performed on 14 and 28 days. Studies have shown that when the drug loading of doxycycline increases from 10% to 15%, this is related to the change in properties of the polylactic acid fiber membrane from hydrophobic to hydrophilic caused by the increase in doxycycline drug loading.
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Sertbaş İ, Karatay M. The effect of the delay between injury and surgery on mortality, morbidity, and complications in craniospinal gunshot wounding. TRAUMA-ENGLAND 2020. [DOI: 10.1177/1460408619864238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction The effect of the surgical approach and the duration between the trauma and surgery on the complications, morbidity, and mortality in cranial and spinal penetrating gunshot injuries are investigated. Methods Evaluation of 63 patients from the Libyan civil war who were referred to the İstanbul Yeni Yüzyıl University Gaziosmanpaşa Hospital neurosurgery clinic for the treatment and surgery between 2015 and 2017. Results Complications such as meningitis, superficial infection, and abscess developed in 31% of the patients who underwent surgery within the initial 24 h, 58% of the patients who underwent surgery between 24 and 72 h and in all patients who underwent surgery after 72 h. While an improvement was seen in all 14 patients who had preoperative paresis and underwent surgery within 24 h or between 24 and 72 h, only one of the six patients who had paresis and underwent surgery after 72 h improved. One of the patients who underwent surgery within 24 h, three of those who underwent surgery between 24 and 72 h, and four of those who underwent surgery after 72 h died. Conclusion The complications, morbidity, and mortality increase with a prolonged duration between the injury and surgery after craniospinal gunshot wounding.
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Affiliation(s)
- İdris Sertbaş
- Department of Neurosurgery, Medical School, Yeniyüzyıl University, Istanbul, Turkey
| | - Mete Karatay
- Department of Neurosurgery, Medical School, Yeniyüzyıl University, Istanbul, Turkey
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Bullet fragments spontaneously migrating in opposite directions after a cardiac arrest treated with extracorporeal cardiopulmonary resuscitation following a gunshot wound to the head: A case report. Trauma Case Rep 2020; 28:100330. [PMID: 32671176 PMCID: PMC7338624 DOI: 10.1016/j.tcr.2020.100330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2020] [Indexed: 11/23/2022] Open
Abstract
Gunshot injuries to the head are associated with a poor neurological prognosis, have a high risk of mortality, and make the return of spontaneous breathing and circulation after cardiopulmonary arrest difficult. Bullets or bullet fragments can cause penetrating injuries to the brain tissue and sometimes remain in the skull, potentially migrating within the skull. Herein, we describe a rare patient who achieved a return of spontaneous circulation after cardiopulmonary (ROSC) arrest caused by a gunshot wound, following extracorporeal cardiopulmonary resuscitation. After ROSC, repeated computed tomography (CT) identified spontaneously migrating bullets/fragments in the right hemisphere and the metal fragment was excreted from the skull, while another fragment had moved from the left temporal to the occipital fossa. The patient died on the 15th day of hospitalization. The present case had a rare clinical course, suggesting that ROSC may be achieved under adequate respiratory and circulation management in cases of cardiac arrest with a head injury. The scans showed differing movements of the bullet fragments at each lesion, which was difficult to predict from the first CT scan. When surgical treatment is required to remove bullet fragments remaining in the skull (due to lead poisoning, or infection, among others), it may be useful to be aware that fragments may move in various directions, even out of the skull. Furthermore, we recognized the usefulness of CT scanning for detecting the location of the foreign body in cases of gunshot injury to the head.
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Letter. Neurosurgery 2020; 86:E575-E578. [DOI: 10.1093/neuros/nyz571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 12/07/2019] [Indexed: 11/14/2022] Open
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Letter to the Editor Regarding "Traumatic Brain Injury Caused by Missile Wounds in the North of Palestine: A Single Institution's Experience with 520 Consecutive Civilian Patients". World Neurosurg 2019; 130:587. [PMID: 31581406 DOI: 10.1016/j.wneu.2019.07.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 07/05/2019] [Indexed: 11/24/2022]
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Kim HR, Go SJ, Sul YH, Ye JB, Lee JY, Choi JH, Choi SM, Kim Y, Yoon SY. Experience of Penetrating Gunshot Wound on Head in Korea. JOURNAL OF TRAUMA AND INJURY 2018. [DOI: 10.20408/jti.2018.31.2.82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Hong Rye Kim
- Departments of Neurosurgery, Chungbuk National University Hospital, Cheongju, Korea
| | - Seung Je Go
- Departments of Trauma Surgery, Chungbuk National University Hospital, Cheongju, Korea
| | - Young Hoon Sul
- Departments of Trauma Surgery, Chungbuk National University Hospital, Cheongju, Korea
| | - Jin Bong Ye
- Departments of Trauma Surgery, Chungbuk National University Hospital, Cheongju, Korea
| | - Jin Young Lee
- Departments of Trauma Surgery, Chungbuk National University Hospital, Cheongju, Korea
| | - Jung Hee Choi
- Departments of Anesthesiology, Chungbuk National University Hospital, Cheongju, Korea
| | - Seoung Myoung Choi
- Departments of Orthopedic Surgery, Chungbuk National University Hospital, Cheongju, Korea
| | - Yook Kim
- Departments of Radiology, and Chungbuk National University Hospital, Cheongju, Korea
| | - Su Young Yoon
- Departments of Thoracic Surgery, Chungbuk National University Hospital, Cheongju, Korea
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Hazama A, Ripa V, Kwon CS, Abouelleil M, Hall W, Chin L. Full Recovery After a Bihemispheric Gunshot Wound to the Head: Case Report, Clinical Management, and Literature Review. World Neurosurg 2018; 117:309-314. [PMID: 29959075 DOI: 10.1016/j.wneu.2018.06.132] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 06/14/2018] [Accepted: 06/15/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Nearly 33,600 people die each year in the United States as a result of gunshot wounds (GSWs). Penetrating craniocerebral GSWs are often fatal with a nearly 70% death rate at the scene of the trauma. Overall combined mortality rate for patients who die at the scene or at the hospital is almost 91%. Poor outcome is associated with initial low Glasgow Coma Scale score and bihemispheric and transventricular gunshot trajectory. We summarize current understanding in management, prognostic factors, and survival outcomes in patients with a penetrating GSWs to the head. We report a patient with return to full function despite bihemispheric, multilobar involvement. Full function is defined here as ability to return to previous work and perform activities of daily living. CASE DESCRIPTION A 33-year-old man sustained a GSW to the head under unknown circumstances. On initial presentation, he had a Glasgow Coma Scale score of 15. He was verbalizing and communicating but was amnestic for the event. From a left frontal entry wound, the bullet traversed both frontal lobes of the brain reaching the right frontal-parietal junction. Physical examination and vital signs were normal. Appropriate surgical and medical management resulted in complete recovery. CONCLUSIONS Craniocerebral GSWs have a high mortality rate and usually require aggressive management. Evaluation of most GSWs requires appropriate imaging studies followed by proactive treatment against infection, seizure, and increased intracranial pressure. Surgical intervention is often necessary and ranges from local wound débridement to craniectomy, decompression, and wound exploration.
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Affiliation(s)
- Ali Hazama
- Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, New York, USA.
| | | | - Churl-Su Kwon
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Walter Hall
- Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Lawrence Chin
- Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, New York, USA
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Kong VY, Weale RD, Sartorius B, Bruce JL, Laing GL, Clarke DL. Routine cervical spine immobilisation is unnecessary in patients with isolated cerebral gunshot wounds: A South African experience. Emerg Med Australas 2018; 30:773-776. [PMID: 29693313 DOI: 10.1111/1742-6723.12985] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 02/01/2018] [Accepted: 03/04/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Routine immobilisation of the cervical spine in trauma has been a long established practice. Very little is known in regard to its appropriateness in the specific setting of isolated traumatic brain injury secondary to gunshot wounds (GSWs). METHODS A retrospective study was conducted over a 5 year period (January 2010 to December 2014) at the Pietermaritzburg Metropolitan Trauma Service, Pietermaritzburg, South Africa in order to determine the actual incidence of concomitant cervical spine injury (CSI) in the setting of isolated cerebral GSWs. RESULTS During the 5 year study period, 102 patients were included. Ninety-two per cent (94/102) were male and the mean age was 29 years. Ninety-eight per cent of the injuries were secondary to low velocity GSWs. Twenty-seven (26%) patients had cervical collar placed by the Emergency Medical Service. The remaining 75 patients had their cervical collar placed in the resuscitation room. Fifty-five (54%) patients had a Glasgow Coma Scale (GCS) of 15 and underwent plain radiography, all of which were normal. Clearance of cervical spine based on normal radiography combined with clinical assessment was achieved in all 55 (100%) patients. The remaining 47 patients whose GCS was <15 all underwent a computed tomography (CT) scan of their cervical spine and brain. All 47 CT scans of the cervical spine were normal and there was no detectable bone or soft tissue injury noted. CONCLUSION Patients who sustain an isolated low velocity cerebral GSW are highly unlikely to have concomitant CSI. Routine cervical spine immobilisation is unnecessary, and efforts should be directed at management strategies aiming to prevent secondary brain injury. Further studies are required to address the issue in the setting of high velocity GSWs.
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Affiliation(s)
- Victor Y Kong
- Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
| | - Ross D Weale
- Department of Surgery, Wessex Deanery, Wessex, UK
| | - Benn Sartorius
- Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
| | - John L Bruce
- Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
| | - Grant L Laing
- Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
| | - Damian L Clarke
- Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu-Natal, Durban, South Africa.,Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa
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Rodrigues LL, Costa ST, Rossi AC, Daruge Júnior E, Prado FB, Freire AR. Computational simulation of projectile injuries to human parietal bone using finite element analysis. AUST J FORENSIC SCI 2018. [DOI: 10.1080/00450618.2017.1416173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Larissa Lopes Rodrigues
- Department of Social Odontology, Legal Odontology Division, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Sarah Teixeira Costa
- Department of Morphology, Anatomy Division, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Ana Cláudia Rossi
- Department of Morphology, Anatomy Division, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Eduardo Daruge Júnior
- Department of Social Odontology, Legal Odontology Division, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Felippe Bevilacqua Prado
- Department of Morphology, Anatomy Division, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Alexandre Rodrigues Freire
- Department of Morphology, Anatomy Division, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
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