Incidence of epidural hematoma, infection, and neurologic injury in obstetric patients with epidural analgesia/anesthesia

Of the 4 million annual births in the United States, 2.4 million involve epidural analgesia. Serious adverse events are rare but are important in young women. Robust estimates for the risk of harm are not available. Data for superficial and deep infections, hematoma, and transient and permanent neurologic injury were obtained from studies reporting adverse events with obstetric epidural analgesia, and incidence presented as individual risk for a woman, number of events per million women, and percentage incidence. A total of 1.37 million women received an epidural for childbirth, reported in 27 articles. Most information (85% of women) was in larger (> 10,000 women) studies published after 1990, with risk estimates as follows: epidural hematoma, 1 in 168,000; deep epidural infection, 1 in 145,000; persistent neurologic injury, 1 in 240,000; and transient neurologic injury, 1 in 6,700. Earlier and smaller studies produced significantly higher risk estimates for transient neurologic injury plus injury of unknown duration.

Death or neurologic injury after tonsillectomy in children with a focus on obstructive sleep apnea: houston, we have a problem!

BACKGROUND

Obesity is epidemic in the United States and with it comes an increased incidence of obstructive sleep apnea (OSA). Evidence regarding opioid sensitivity as well as recent descriptions of deaths after tonsillectomy prompted a survey of all members of the Society for Pediatric Anesthesia regarding adverse events in children undergoing tonsillectomy.

METHODS

An electronic survey was sent to 2377 members of the Society for Pediatric Anesthesia. Additionally, data from the American Society of Anesthesiologists Closed Claims Project were obtained. Adverse events during or after tonsillectomy with or without adenoidectomy in children were included. Children at risk for OSA were identified as either having a positive history for OSA or a post hoc application of the American Society of Anesthesiologists OSA practice guidelines. These children were compared with all other children by Fisher exact test for proportions and t test for continuous variables.

RESULTS

A total of 129 cases were identified from the 731 replies to the survey, with 92 meeting inclusion criteria for having adequate data. Another 19 cases with adequate data were identified from the 45 from the American Society of Anesthesiologists Closed Claims Project. A total of 111 cases were included in the final analysis. Death and permanent neurologic injury occurred in 86 (77%) cases and were reported in the operating room, postanesthesia care unit, on the ward, and at home. Sixty-three (57%) children fulfilled American Society of Anesthesiologists criteria to be at risk for OSA. Children categorized as at risk for OSA were more likely than other children to be obese and to have comorbidities (P < 0.0001). A larger proportion of at risk children had the event attributed to apnea (P = 0.016), whereas all others had a larger proportion of events attributed to hemorrhage (P = 0.006).

CONCLUSIONS

Deaths or neurologic injury after tonsillectomy due to apparent apnea in children suggest that at least 16 children could have been rescued had respiratory monitoring been continued throughout first- and second-stage recovery, as well as on the ward during the first postoperative night. A validated pediatric-specific risk assessment scoring system is needed to assist with identifying children at risk for OSA who are not appropriate to be cared for on an outpatient basis.

Median, ulnar, and combined median-ulnar nerve injuries: functional outcome and return to productivity

BACKGROUND

Forearm and wrist injuries are a common cause of morbidity and are often associated with suboptimal recovery of hand function. This study describes and compares outcome after median, ulnar, or combined median-ulnar nerve injuries.

METHODS

Three hundred thirteen wrist and forearm nerve injuries operated on between 1980 and 1997 in a large university hospital were reviewed in relation to complications, return to work, and sensor and motor recovery. Of these 313 patients, 220 (age range, 5-73 years) met the inclusion criteria.

RESULTS

Motor recovery, progress of sensory reinnervation, and number of severed structures were related to the type of injury (p < 0.05). Multiple linear regression analysis revealed a relation between the appearance of sensory reinnervation and motor recovery (beta = 0.02; 95% confidence interval, 0.01-0.04; p = 0.01). A probability of 24% of work loss, after a mean follow-up of 17.7 months, was found. Poor sensory and motor recovery were associated with work disability (odds ratio [OR], 2.9; p = 0.002; and OR, 2.9; p = 0.007, respectively). No relationship was found between type of injury and return to work (p = 0.47). Level of injury (OR, 2.6; p = 0.01), type of work (OR, 3.1; p = 0.002), number of complications (p < 0.001), and hand-therapy (OR, 0.24; p = 0.001) were found to influence return to work.

CONCLUSION

It may be concluded that peripheral nerve injuries at the forearm level can result in substantial functional loss and have major social consequences. This study identified factors influencing return to work that can be used to optimize postoperative treatment strategy.

Prevalence of saphenous nerve injury after autogenous hamstring harvest: an anatomic and clinical study of sartorial branch injury

PURPOSE

Injury to the sartorial (terminal) branch of the saphenous nerve (SBSN) has received little attention in the literature, despite its anatomic proximity to the hamstring tendons during autogenous harvesting. This study aims to define the prevalence of saphenous nerve injury after anterior cruciate ligament (ACL) reconstruction with autogenous hamstrings and define clinically relevant anatomy that may contribute to nerve injury.

METHODS

Surveys regarding the presence and duration of sensory changes in the infrapatellar branch of the saphenous nerve (IPBSN) and SBSN were retrospectively sent to 164 patients who had undergone arthroscopically assisted ACL reconstruction with hamstring autograft over a 4-year period. Eleven cadavers were then dissected to identify the relation of the saphenous nerve to the hamstring tendons and accessory insertions.

RESULTS

Postoperative sensory disturbance was present in 74% of patients surveyed. Concomitant injuries to both the SBSN and IPBSN occurred in 32% of patients, whereas isolated paresthesias in the SBSN and IPBSN distribution affected 23% and 19%, respectively. The saphenous nerve was intimately associated with the gracilis for 4.6 cm in the distal thigh, from 7.2 cm (range, 6.4 to 9.3 cm) to 11.8 cm (range, 7 to 13.2 cm) proximal to its insertion. Accessory hamstring insertions were present distal to the point where the sartorial branch became extrafascial.

CONCLUSIONS

The SBSN is at higher risk of injury during hamstring ACL reconstruction than has been previously reported. The saphenous nerve is intimately involved with the gracilis tendon for a portion of its course in the distal thigh, likely predisposing it to damage during passage of the tendon stripper.

LEVEL OF EVIDENCE

Level IV.

The impact of neurotrauma on society: an international perspective

Neurotrauma, in many countries and particularly in the younger age group kills more people than AIDS or cancer but unlike these diseases the causes are known and it is preventable. The costs to communities in terms of suffering and economics are enormous. The common causes are road traffic accidents, falls and violence. Neurotrauma affects particularly the developing world where it consumes already over stretched health resources. In the developed world steps to reduce the incidence of neurotrauma and to treat the victims have had some effect nevertheless it stills remains an endemic problem which does not receive the public awareness or the political support it deserves. For the victims there is general agreement on the principles of clinical management but often difficulties in applying early and effective care in countries with the greatest need because of shortage of facilities and expertise. To reduce the overall burden of neurotrauma demands actions which extend from the political to basic patient care. There have been remarkable advances in the understanding of acute brain and spinal cord injury and encouraging possibilities for effective neuroprotection, repair and regeneration but in the broader context prevention of neurotrauma is the urgent imperative. In this endeavour the neuroscientist has knowledge which informs and encourages policy makers to take the steps necessary to reduce injury. These steps require political will and community support for hard decisions which impact on the way people conduct their daily lives. The WHO predicts that unless there are changes in present policies and if there are no additional road safety countermeasures put in place, there will be a major increase in road traffic fatalities over the next 20 years and beyond (World Health Organisation. (2004). www.who.int).

Catastrophic pediatric sports injuries

The high school sports of wrestling, gymnastics, ice hockey, baseball, track, and cheerleading should receive closer attention to prevent injury. Safer equipment and sport-specific conditioning should be provided and injuries strictly monitored. Greater attention must also be paid to swimming and diving techniques, and continued observation is needed for heat stroke and heat intolerance in sports such as football, wrestling, basketball, track and field, and cross-country. An increased awareness of commotio cordis in sports other than baseball should include ice hockey, football, track field events, and lacrosse. American football because of the sheer numbers and associated catastrophic injury potential must continue to be monitored at the highest medical levels!

Iatrogenic nerve injury in a national no-fault compensation scheme: an observational cohort study

BACKGROUND

Iatrogenic nerve injury causes distress and disability, and often leads to litigation. The scale and profile of these injuries has only be estimated from published case reports/series and analyses of medicolegal claims.

AIM

  To determine the current spectrum of iatrogenic nerve injury in New Zealand by analysing treatment injury claims accepted by a national no-fault compensation scheme.

METHODS

The Accident Compensation Corporation (ACC) provides national no-fault personal accident insurance cover, which extends to patients who have sustained a treatment injury from a registered healthcare professional. Nerve injury claims identified from 5227 treatment injury claims accepted by the ACC in 2009 were analysed.

RESULTS

From 327 claims, 292 (89.3%) documenting 313 iatrogenic nerve injuries contained sufficient information for analysis. Of these, 211 (67.4%) occurred in 11 surgical specialties, particularly orthopaedics and general surgery; the remainder involved phlebotomy services, anaesthesia and various medical specialties. The commonest causes of injury were malpositioning (n = 40), venepuncture (n = 26), intravenous cannulation (n = 21) and hip arthroplasty (n = 21). Most commonly injured were the median nerve and nerve roots (n = 32 each), brachial plexus (n = 26), and the ulnar nerve (n = 25). At least 34 (11.6%) patients were referred for surgical management of their nerve injury.

CONCLUSIONS

Iatrogenic nerve injuries are not rare and occur in almost all branches of medicine, with malpositioning under general anaesthesia and venepuncture as leading causes. Some of these injuries are probably unavoidable, but greater awareness of which nerves are at risk and in what context should facilitate the development and/or wider implementation of preventive strategies.

Traumatic fractures as a result of falls in children and adolescents: A retrospective observational study

The aim of this study is to investigate the incidence and pattern of traumatic fractures (TFs) as a result of falls in a population of children and adolescents (≤18 years old) in China.This was a cross-sectional study. We retrospectively reviewed 1412 patients who were children and adolescents with TFs as a result of falls admitted to our university-affiliated hospitals in China from 2001 to 2010. Etiologies included high fall (height ≥2) and low fall (height <2 m). The incidence and pattern were summarized with respect to different age groups, year of admission, etiologies, genders, and the neurological function.This study enrolled 1054 males (74.6%) and 358 females (25.4%) aged 10.8 ± 4.7 years. The etiologies were low fall (1059, 75.0%) and high fall (353, 25.0%). There were 2073 fractures in total and 92 patients (6.5%) presented with multiple fractures. The most common fracture sites were upper extremity fractures in 814 patients (57.6%) and lower extremity fractures in 383 patients (27.1%), followed by craniofacial fractures in 233 patients (16.5%). A total of 231 (16.4%) patients suffered a nerve injury. The frequencies of early and late complications/associated injuries were 19.5% (n = 275) and 9.2% (n = 130). The frequencies of emergency admission, nerve injury, spinal fracture, lower extremity fractures, craniofacial fracture, sternum and rib fracture, and early complications/ASOIs were significantly larger in high fall than low fall (all P <.001, respectively). The frequencies of medical insurance rate (P = .042) and upper extremity fractures (P <.001) were significantly larger in low fall than high fall. The frequencies of spinal fracture (P = .039), lower extremity fractures (P = .048), and craniofacial fracture (P = .041) were significantly larger in female than the male patients. The frequency of upper extremity fractures (P <.001) and the mean age (P <.001) was significantly larger in male than female patients. The frequencies of emergency admission, high fall, spinal fracture, and craniofacial fracture were significantly larger in patients with nerve injury than other patients without nerve injury (all P <.001, respectively).Low falls and upper extremity fractures were the most common etiologies and sites, respectively. High fall, spinal fracture and craniofacial fracture were risk factors for nerve injury. Therefore, we should focus on patients who were caused by high fall and presented with spinal and craniofacial fracture to determine the presence of a nerve injury so that we can provide early, timely diagnosis and targeted treatment to children.

Impaired motor function in patients with psychogenic pseudoseizures

PURPOSE

To evaluate motor speed and grip strength in patients with well-documented psychogenic pseudoseizures.

METHODS

We analyzed manual motor speed and grip strength in a group of 40 patients with confirmed psychogenic pseudoseizures (without evidence of concomitant epilepsy) and a group of 40 normal controls matched for handedness and gender, and of comparable age. The two groups were compared with respect to manual motor performance with the dominant hand, nondominant hand, and asymmetry between the dominant and nondominant hands. For the patient sample, we reviewed the neurologic history.

RESULTS

Patients with pseudoseizures performed more poorly than controls with both dominant and nondominant hands. In addition, pseudoseizure patients failed to demonstrate the dominant-hand advantage observed in the normal control subjects on both tasks. The patient group had a high incidence of head trauma and other antecedent neurologic risk factors, and the proportion of left-handers was 3 times higher than expected.

CONCLUSIONS

Bilaterally reduced motor speed and grip strength, reduced intermanual performance asymmetry, the high percentage of left-handers, and historical evidence of antecedent insults to the brain indicate that frontal lobe impairment may be common in patients with psychogenic pseudoseizures.

Pain syndromes after missile-caused peripheral nerve lesions: part 2--treatment

OBJECTIVE

To analyze treatment procedures and treatment outcomes of painful missile-caused nerve injuries and factors influencing the outcome.

METHODS

The study included 326 patients with clinically significant pain syndromes, including complex regional pain syndrome Type II, deafferentation pain, reinnervation pain, and neuralgic pain. Treatment modalities included drug therapy, nerve surgery, sympatholysis, and dorsal root entry zone operation. Pain intensity was assessed before and after the treatment using a visual analog scale, and treatment outcome was defined as successful (pain relief >70%), fair (pain relief between 50 and 69%), or poor (pain relief <50%). The outcome was compared between different pain syndromes and different treatment modalities.

RESULTS

A successful outcome was achieved in 28.6% of patients with deafferentation pain, in 76.9% of patients with complex regional pain syndrome Type II, and in 87.9 to 100% of patients with other pain syndromes (P = 0.002). Each type of pain syndrome required a specific treatment algorithm, but average pain relief was similar for all definitive treatment modalities (range, 81-88%; P > 0.05). Ten factors were found to significantly influence the treatment outcome, but only three factors were independent predictors of a successful outcome: type of pain syndrome (P < 0.001), severity of nerve injury (P < 0.001), and absence of pain paroxysms (P = 0.03).

CONCLUSION

The treatment outcome of painful nerve injury depends on several factors, including the type of pain syndrome, severance of nerve injury, and absence of pain paroxysms. Drug therapy (carbamazepine, amitriptyline, or gabapentin) should be recommended, at least as a part of treatment, for patients with reinnervation pain, deafferentation pain, and complex regional pain syndrome Type II. Nerve surgery should be recommended for patients with posttraumatic neuralgia, either as the first treatment choice (acute nerve compression or intraneural foreign particles) or after unsuccessful pharmacological treatment (other causes of neuralgic pain).

Pediatric neurotrauma in Kathmandu, Nepal: implications for injury management and control

OBJECTS

There is a scarcity of data regarding childhood neurological injuries in developing countries such as Nepal. The epidemiology of acute pediatric neurotrauma in Kathmandu was studied to assess the implications of these data for injury prevention programs.

METHODS

The clinical records of patients <or=18 years who presented to Tribhuvan University Teaching Hospital between April 1, 2001 and April 1, 2004 with acute neurological trauma and were subsequently admitted to hospital were retrospectively reviewed. A standard proforma was used to collect information on patient demographics, the nature and etiology of the injuries, their acute management, and outcomes.

CONCLUSIONS

Four hundred sixteen injured children were admitted to hospital, and the charts for 352 (85%) were available for review. Spinal injuries were relatively rare (4%) compared to head injuries (96%). Falls were the most common cause of injuries (61%). It took significantly longer (p<0.001) for children injured in rural Nepal (62%) to obtain neurosurgical care (30.1 h) than those injured within Kathmandu (7.1 h). A Glasgow Outcome Score of 5 was obtained for 96%, 76%, and 22% of patients with mild, moderate, or severe head injuries, respectively. Besides efforts to improve prehospital transport and acute management of these injuries, preventive measures that are applicable to the Nepalese scenario are urgently needed. Interventions should focus on health education programs directed at parents and children and upgrading of road safety measures. Neurological injuries must also be viewed in the context of the broader social issues in Nepal that contribute to injury.

Pain syndromes after missile-caused peripheral nerve lesions: part 1--clinical characteristics

OBJECTIVE

To report on the clinical characteristics of pain and factors influencing pain intensity in patients with missile-caused nerve injuries.

METHODS

The prospective study included 326 patients with clinically significant pain syndromes including complex regional pain syndrome Type II, deafferentation pain, reinnervation pain, and neuralgic pain. Diagnostic procedures were analyzed, factors influencing the pain intensity were identified, and the patients' characteristics, pain characteristics, and other clinical symptoms and signs were compared between different types of pain syndromes.

RESULTS

The rate of painful injuries ranged from 17.3 to 22.9% for mixed nerves and from 2.6 to 4.6% for motor nerves. Peripheral nerve block and sympathetic block were useful and safe adjuvant diagnostic procedures, obtaining pain relief in 66.7% of patients with neuralgic pain and in 90.1% of patients with complex regional pain syndrome Type II. Pain started 2.6 days after injury in patients with complex regional pain syndrome Type II and 11.9 days after injury in patients with painful nerve adhesions (analysis of variance, P < 0.001). Permanent pain was more frequent (79.1%) than paroxysmal pain, superficial pain was more frequent (55.2%) than deep pain, and burning pain was the most frequent pain descriptor (43.6%). Ten factors were found to significantly influence the pain intensity (binary logistic analysis), including three independent predictors (multivariate analysis): type of pain syndrome (P < 0.001), multiple nerve damage in the injury site (P = 0.022), and onset of pain in the first two days after injury (P = 0.031).

CONCLUSION

Pain syndromes after missile-caused nerve injury differ significantly regarding time of pain onset, pain characteristics, and other symptoms and signs. The type of pain syndrome, multiple nerve damage, and early onset of pain are independent predictors of initial pain intensity. Although medical history and physical examination are the main diagnostic keys, nerve exploration preceded by a nerve block and sympathetic block are safe and useful adjuvant diagnostic procedures.

Nerve injuries due to obstetric trauma

The incidence of nerve injuries among 32,637 deliveries over a period of ten years was 1.81/1000. Brachial plexus injury (1/1000) and facial nerve injury (0.74/1000) accounted for 98% of nerve injuries. Both the right and left side were involved equally. Bilateral nerve injury was not seen. Lack of antenatal care, macrosomia, abnormal presentations, and operative vaginal deliveries significantly increased the risk of nerve injuries. These babies had significantly higher incidence of meconium stained liquor and intrapartum asphyxia. Parity of the mother, gestational age and sex of the baby did not have significant role in the causation of nerve injuries. Injuries to brachial plexus and facial nerve were seen even in babies born by caesarean section, when it was performed for obstructed labour caused by cephalo-pelvic disproportion and abnormal presentations. Three babies with injuries expired and forty-three could be followed up for varying periods. None of the babies had residual defects. Detection of cephalopelvic disproportion and abnormal lie in the third trimester and their appropriate management would decrease the incidence of obstetric palsies to a significant extent.

Shoulder dystocia related fetal neurological injuries: the predisposing roles of forceps and ventouse extractions

On the basis of 333 documented cases of permanent perinatal neurological damage, associated with arrest of the shoulders at birth, the authors conducted a retrospective study in order to evaluate the predisposing role, if any, of the utilization of extraction instruments. The investigation revealed that 35% of all injuries occurred in neonates delivered by forceps, ventouse or sequential ventouse-forceps procedures. This frequency was several-fold higher than the prevailing instrument use in the practices of American obstetricians during the same years. A high rate of forceps and ventouse extractions was demonstrable in all birth weight categories. Average weight and moderately large for gestational age fetuses underwent instrumental extractions more often than grossly macrosomic ones. This circumstance indicates that forceps and ventouse are independent risk factors, unrelated to fetal size. Their use entailed central nervous system injuries significantly more often than did spontaneous deliveries. The findings suggest that extraction procedures may be as important as macrosomia among the factors that lead to neurological damage in the child in connection with shoulder dystocia. Because they augment the intrinsic dangers of excessive fetal size exponentially, the authors consider their use in case of > or =4,000 g estimated fetal weight inadvisable. Sequential forceps-ventouse utilization further doubles the risks and is, therefore, to be avoided in all circumstances.

Sideswipe injuries to the elbow in Western Australia

OBJECTIVE

To examine the conditions leading to sideswipe injury of the upper limb in motor vehicle accidents and to highlight the severity of these injuries.

DESIGN AND SETTING

Prospective study of upper-limb sideswipe injuries in patients admitted to Royal Perth Hospital, Western Australia, between August 2003 and January 2005.

PARTICIPANTS

Eleven patients sustaining sideswipe injuries to the upper limb.

MAIN OUTCOME MEASURES

Accident pattern, type of injury, surgical management, complications, and functional and employment implications.

RESULTS

Ten patients required open reduction and internal fixation for open fractures of the humerus, ulna and radius, and nine underwent additional surgical procedures including nerve, artery and tendon repair, and free flaps and split-skin grafting. The injury severity scores ranged from 9 to 25. The severity of injuries led to extensive functional deficits in eight patients, affecting employment prospects in seven.

CONCLUSION

Appropriate educational programs, legislation and improvements in traffic conditions, especially in rural areas, as well as changes in current car design, could contribute to preventing these devastating and complex injuries.

Traumatic fractures resulting from collisions in children and adolescents: A retrospective observational study

To investigate the incidence and pattern of child and adolescent (≤18 years old) traumatic fractures (TFs) as a result of collisions.We retrospectively reviewed 270 child and adolescent patients (228 males and 42 females aged 12.8 ± 5.1 years old) with TFs as a result of collisions admitted to our university-affiliated hospitals from 2001 to 2010. The incidence and patterns were summarized with respect to different age groups, sex, etiology, and whether the patient presented with nerve injury.The most common etiologies were struck by object (105, 38.9%) and wounded by person (74, 27.4%). The most common fracture sites were upper limb fractures (126, 46.7%) and craniofacial fractures (82, 30.4%). A total of 65 (24.1%) patients suffered a nerve injury. The frequency of early and late complications/associated injuries was 35.6% (n = 96) and 8.5% (n = 23), respectively. The mean age (P = .001) and frequency of wounded by person (P = .038) was significantly larger in male than in female patients. The frequency of earthquake injury (P < .001) and lower limb fractures (P = .002) was significantly larger in females than in male patients. The frequency of upper limb fracture was significantly higher in the wounded by machine group (83.3%) than in the other groups (all P < .05). The frequency of lower limb fractures was significantly higher in the earthquake injury group (64.7%) than in the other groups (all P < .05). The frequency of craniofacial fracture was significantly higher in the wounded by person group (54.1%) than in the other groups (all P < .05). The emergency admission rate (P = .047), frequency of wounded by person (P < .001), craniofacial fracture (P < .001), and early complications/associated injuries (P < .001) were significantly larger in patients with nerve injury than in other patients.Struck by object and upper limb fractures were the most common etiology and site, respectively. Wounded by person and craniofacial fractures were risk factors for nerve injury. Therefore, we should pay more attention to patients wounded by person, presenting with craniofacial fracture, to find whether there is nerve injury.

Cargo areas of pickup trucks: an avoidable mechanism for neurological injuries in children

OBJECT

Falls from pickup truck cargo areas represent a unique mode of injury in children and adolescents. The goal of this study was to identify the neurological spectrum of injuries resulting from children riding in the back of pickup trucks.

METHODS

The authors undertook a retrospective review of the University of New Mexico Hospital trauma registry of data compiled over a 7-year period. Their goal was to identify instances in which a fall or ejection from a pickup truck cargo area was the mechanism of injury. The charts of pediatric patients (< or = 16 years of age) with neurological injuries were reviewed and analyzed. Seventy-three pediatric patients with injuries related to riding in the cargo areas of trucks were identified, of which 53 children (73%) had sustained neurological injuries. Among these 53 children, 64% sustained isolated head injuries, 15% isolated spine injuries, 9.4% combined spine and head injuries, 2% combined peripheral nerve, spine, and head injuries, 4% isolated peripheral nerve injuries, and 5.6% concussive events. In 53.4% of patients with neurological injuries the results of computed tomography (CT) examination were abnormal. In 36% of patients with Glasgow Coma Scale (GCS) scores of 14 to 15 there was evidence of intracranial hemorrhage on head CT scans. Injury Severity Scores were similar in the patients who were ejected and those who fell from cargo areas, but patients who were ejected had a lower mean GCS score than those who suffered falls (GCS score 12.5 and 14.3, respectively).

CONCLUSIONS

Falls or ejections from pickup truck cargo areas result in a relatively high incidence of traumatic head, spine, and peripheral nerve injury. Head CT scanning should therefore be considered in pediatric patients with this mechanism of injury. Cargo area occupancy poses an unacceptable risk of injury and should be avoided.

An audit of traumatic nerve injury

The impact of trauma in the Irish healthcare setting is considerable. We present the results of a retrospective assessment of referrals to a Neurophysiology department for suspected traumatic nerve injury. A broad range of traumatic neuropathies was demonstrated on testing, from numerous causes. We demonstrate an increased liklihood of traumatic nerve injury after fracture / dislocation (p = 0.007). Our series demonstrates the need for clinicians to be aware of the possibility of nerve injury post trauma, especially after bony injury.

[Investigation of epidemiology of neurotrauma in the Republic of Guinea]

The paper focuses on analysis of incidence of neurotrauma in economically underdeveloped country such as Republic of Guinea. It is found that leading etiology of central nervous system injuries are road accidents and indoor traumatism. Investigation of system of medical care revealed its poor condition and severe defects which prevent practical application of evidence-based recommendations for management of traumatic brain injury in underdeveloped countries including Republic of Guinea. Development of multiplanar strategy of control of neurotrauma is required which can be achieved only in case of massive governmental and international aid.

[Neurosurgery]

Of the patients admitted to our center, 14.44% (26 patients) required evaluation by the Neurosurgery Department. Of these, 29.63% (7 patients) required surgery within 8 hours and 7.69% within the following 48 hours. During the days after the attack, neurological symptoms developed in hospitalized patients.

[Prevention and control strategies of common post-operative complications of microwave ablation in situ in treatment of bone tumors]

OBJECTIVE

To analyze the common post-operative complications of microwave ablation in situ in the treatment of bone tumors and the prevention and control strategies.

METHODS

Between March 2009 and July 2012, 73 cases of bone tumors were treated with microwave ablation in situ, of which 54 cases met the inclusion criteria. There were 31 males and 23 females with a median age of 27 years (range, 9-74 years), including 37 malignant tumors and 17 benign tumors. In 49 primary bone tumors, 17 cases were in stage 3, 13 in stage IIA, and 19 in stage IIB according to Enneking grading system. The postoperative complications, managements, and outcomes in patients were analyzed.

RESULTS

After operation, 54 patients were followed up 12-40 months (mean, 24 months). Seven kinds of complications occurred in 21 patients (38.9%) with 3 cases suffered from more than one, including pathologic fracture in 4 cases (7.4%), deep infection in 2 cases (3.7%), nerve injury in 7 cases (13.0%), deep vein thrombosis of the lower extremity in 1 case (1.9%), medial collateral ligament heat injury of the knee in 1 case (1.9%), hematoma in 2 cases (3.7%), and fat liquefaction of incision and flap necrosis in 8 cases (14.8%).

CONCLUSION

Pathologic fracture is the primary complication which results in a second surgery. Deep infection is the main complication that often leads to failure of the limb salvage. Nerve injury and poor wound healing are the most common complications. Good control of microwave temperature is the key to successful operation, and the related preventive strategies could reduce complications.

Prevalence and distribution of peripheral nerve injuries in victims of Bam earthquake

INTRODUCTION

In the early morning of Friday 25th Dec. 2003, the ancient and historical city of Bam in Southern East of Iran was vibrated by a big and horrible earthquake for 6.4 degree of Richter. About 30,000 people were died and about 30,000 victims and injured persons were the initial results of the earthquake. Almost all of the buildings were destroyed and all the people became houseless. In this study, 156 patients with peripheral nerve lesion (PNL) were assessed for their injuries.

MATERIALS AND METHODS

In a cross sectional study since the second week after the quake until 6 months later, we examined 506 patients with the symptoms and signs of motor/sensory and performed the Electrodiagnostic study for all of the patients who had obvious or suspected lesion of peripheral nerves. There were 156 patients (31.2%) afflicted with peripheral nerve lesion. We performed NCS/EMG for upper limb and face at least 2 weeks and for lower limb, at least 3 weeks after injury in 156 of the victims that had PNL.

FINDINGS

Of 156 patients, 75 (48%) were female and 81 (52%) were male. The average of age was 29.2 +/- 12.9 years, about 87.2% were between 15 to 50 yrs old. The frequency of injuries was 88 nerves, 53 neural plexuses and 5 cauda equina lesions. The most frequent injured nerve was sciatic nerve (24.8%) and the next was Radial nerve (15.5%) and the less frequent nerve was axillary which observed just in 1 patient. 21.6% of patients had the brachial plexus and/or lumbosacral plexus injuries. There were more involvements in lower limbs comparing upper limbs and face (p < 0.01).

CONCLUSION

Peripheral nerve injury is one of the most frequent injuries in earthquake victims. These lesions may cause temporary or lifelong disabilities in patients. In this study, the more frequent involvement of sciatic and radial nerve seems to be related to their anatomic location and also the position of victims when earthquake happened and the involvement of brachial and lumbosacral plexus could be due to inappropriate evacuation of the victims from the loads and also due to incorrect transportation.

[Multiple sclerosis: etiology, epidemiology, some questions of pathogenicity]

In the article the questions of ways of development of the dissipated sclerosis, as nosologies, are affected from the group of autoimmune diseases. Examined etiology, epidedemiologiya, separate links of pathogeny of the dissipated sclerosis. The analysis of multifaktors of his origin is conducted, with the detailed study of internal and external factors, marked on the important role of inherited predisposition, infectious and klimato-geograficheskogo factors in genesis of the dissipated sclerosis.

[Neurological and abdominal lesional associations in polytrauma]

Polytraumatisms have always been a concern in human history, their number increasing especially during wars. Their forecast depends on many factors, starting from means of transportation, first aid's promptitude, technical endowment which evolved a lot within the years. Amongst the thoracal-abdominal, the cranial-cerebral and vertebral-medullary injuries, the cranial-cerebral and the abdominal injuries are the most severe ones. We hereby present the evaluation scales according to various criteria (seriousness, prognosis, clinical valutation). In the case of abdominal and neurosurgical injuries the symptomatology can be modified by addition or defalcation, which may cause diagnostic errors with consequences upon morbidity and mortality.

MATERIAL AND METHOD

We hereby present a study accomplished within three departments: Piatra Neamţ Emergency Hospital, Piatra Neamţ Coronary Office and Iaşi Neurosurgery Clinic, and we find the injury associations in polytrauma cases.

RESULTS

We notice a prevalence of the male sex, of the country people, of traffic accidents, of the active age 20-60 years old. The association within abdominal trauma and neurological injuries is of 16.97% in Iaşi Neurosurgery Clinic. After being solved, the neurological injuries are sent to surgery departments, for solution or surveillance.

CONCLUSION

In order to optimize the medical assistance for traumatized persons we hereby recommend a polytrauma centre establishment.