The task for the medical profession is to diagnose, to treat, to evaluate results of the management and to deliver information about the management to those who are responsible for the regional planning of head injury care and preventive work. The impact of CT scanning on diagnoses and distribution on ...

The 10th revision of ICD (International Classification of Diseases and Injuries, WHO) is now being prepared. Before its codifying starts the contents must be revised to fulfil the requirements of modern clinical medicine. A modified diagnostic severity graded classification on the part of head injuries Chapter XVII is suggested here. ...

Some guidelines for standardization of management charts for head injured patients are exemplified. The acute head injury record--"admission chart"--needs special attention to facilitate continuous management of each patient. The "observation chart" shows traditionally more similarity in the different clinics. The diagnostic terminology and diagnostic classification during management and at discharge ...

Discrepancies between athletes' ratings of the seriousness and disruptive impact of an athletic injury and ratings by one experienced Sports Medicine Trainer were examined for 30 male and 13 female athletes undergoing treatment at a Sports Medicine Clinic. Overestimation of the seriousness or disruptive impact of the injury was significantly ...

The Taser is an electrical law enforcement and self-defense weapon that is being used with increasing frequency. The weapon is described and its effects and ballistic and electrical considerations are reviewed. Clinical aspects of Taser injury, including weapon-fired barb injury, barb removal methods, injury secondary to electrical current, ventricular fibrillation, ...

Corpus cavernosum rupture or fracture of the penis is an unusual injury caused by blunt trauma. There are few cases reported in the literature and controversy regarding initial conservative versus operative management exists. This experience adds 17 cases and suggests that optimal management be determined by demonstrating the presence or ...

The authors describe the management system at their statewide pediatric trauma centre. The system includes nonoperative management of liver and splenic injuries, allowing more aggressive treatment of head injuries. The large volume of injuries treated, combined with weekly morbidity and mortality conferences and the establishment of a registry that records ...

The urologist, when operating transabdominally, may unexpectedly encounter a cystic or solid mass in the liver, a dilated gallbladder or a gallbladder containing stones, or a mass in the pancreas, or may inadvertently injure the duodenum or spleen when mobilizing these organs for a nephrectomy or adrenalectomy. Discussed are some ...

On the basis of experience at the Ottawa Civic Hospital over the past 10 years, a classification of and protocol for the management of human bite injuries of the hand are presented. Early exploration of such wounds under local anesthesia improves the outcome by facilitating adequate cleansing of the wound ...

Identification of the mechanism of injury is the hallmark of dislocation management. If the mechanism can be established by history, anatomic disruptions can be logically explained and identified. Conversely, the injury pattern clinically may help deduce the mechanism. Once the mechanism is established, either historically or clinically, relocation maneuvers can ...

The pathogenesis and management of hypoxic-ischemic encephalopathy in the term infant is reviewed. Specifically, the potential significance of a variety of factors on the pathogenesis of brain injury is discussed including changes in cerebral blood flow, brain swelling, carbohydrate status, alterations in ion homeostasis, and synaptic activity. Management is reviewed ...

The strides made in the last decade, such as contributions of Noyes and colleagues (secondary restraints), and Cabaud and coworkers (augmentation), Arnoczky and associates (microvascularity), and Peterson (elimination of the cross-body block), are enormous. An appreciation of the mechanics and pathology of the acute ACL injury is essential in the ...

Unilateral keratitis developed in a 31-year-old man following superficial corneal injury with vegetable foreign material. The corneal inflammation progressed to perforation and endophthalmitis. Nocardia asteroides was eventually identified in an aspirate from the anterior chamber. Aggressive medical and surgical treatment resulted in salvage of the globe and a visual acuity ...

Wilderness trauma consists of common injuries diagnosed and treated in the least desirable environment. Improvisation is a key factor in wilderness medicine. The article discusses management of fractures; dislocations; and trauma to the head, neck, spine, abdomen, and chest. The physician accompanying an expedition should plan in advance for the ...

The urological management of 1126 consecutive patients treated at the Mersey Regional Spinal Injuries Centre between 1947 and 1983 is reviewed. It is concluded that when urodynamics is included in the urological investigative profile, in addition to clinical, biochemical, intravenous urographic and cystourethrographic assessments, then treatment failure is less likely.

Most shoulder injuries in the athlete can be managed nonoperatively; prior to any management, however, they require careful evaluation for accurate diagnosis. Once the diagnosis has been made, few of these injuries will actually require surgery and most will obtain an excellent result with full return to function. Several specific ...

Maternal intrapartum neurologic injuries are infrequently reported in modern obstetric practice. Two cases are presented and methods of evaluating the level of injury to differentiate this syndrome from peroneal nerve palsies are suggested. The long-term prognosis of lumbosacral plexus injuries encountered during labor and delivery appears to be favorable. Nonetheless, ...

While most residua of thoracic trauma are obvious, tracheal stenosis, aneurysm of the aortic arch and diaphragmatic hernia are easily overlooked. They may be asymptomatic and may go undetected until the occurrence of life-threatening consequences. Therefore, these three conditions must be thought of and ruled out during the management and ...

Injuries secondary to sporting activities have increased significantly in the past decade. Traditional treatment programs for these maladies have frequently failed to meet the physiological expectations of the athlete. Forced rest or immobilization result in predictable musculoskeletal atrophy with impaired function. Furthermore, the rehabilitation process has commonly focused on the ...

Soft tissue contractures resulting from spasticity are a frequent sequella of traumatic head injuries. This article identifies rationale for the use of serial casting to manage these deformities, provides guidelines for cast fabrication and application, and reports the results of lower extremity casting on 42 head-injured adults at Rancho Los ...

The Landers-Foulks temporary operating keratoprosthesis was used in the treatment of a severe double perforating injury involving both the cornea and retina in a 12-year-old boy. The use of the keratoprosthesis permitted surgical intervention at the optimal time for successful treatment of the retina and vitreous, providing the patient with ...

Two hundred and fifteen mountaineering accidents occurred in the Sierra Nevada over a 5-year period in climbers on Class V routes. Patients were evaluated for: climbing preparation and training, first aid experience, altitude acclimatization, age, anatomical site of injuries, and cause of the injury. Consideration as to evacuation procedure was ...

Two cases of impalement injuries seen at the Maryland Institute of Emergency Medical Services Systems are presented. A short literature review and recommendations for management including employment of an incision connecting entry and exit sites but avoiding essential structures, plus antibiotics and standard techniques for management of penetrating trauma are ...

Facial trauma may result in damage to the structures of the mouth, both by direct insult and by hindering access for routine oral health and hygiene measures. Successful management must include consideration of the stomatognathic system. The four major areas of consideration are dentoalveolar response to the forces of trauma ...

Orthopaedic specialists and family physicians practicing in skiing communities are faced with unavoidable, stringent, and expanding legal responsibilities to properly manage ski trauma. Their legal obligations apply to each component of clinical case management: (1) diagnosis; (2) treatment; and (3) rehabilitation. Neither medically nor legally is any one aspect less ...

The surgical management of colon injuries in civilian practice requires individualization. Primary repair, either by debridement and suture or resection and anastomosis, is a safe method of management in selected cases and results in a shorter hospital stay, less morbidity and a complication rate that is no higher. In this ...

The role of interventional radiology in the management and diagnosis of frostbite injury in 18 patients at the West Side VA Medical Center is presented. Conservative treatment and the use of intra-arterial long acting vasodilators, such as reserpine, are emphasized, even in patients referred 48 to 72 hours after the ...

Five cases of duodenal injuries were treated in our hospital between January 1, 1975 and June 18, 1979. They belonged to the Class II and early Class III of duodenal injuries. They were treated with simple closure of the perforation in a single or double layer with external drainage. Only ...

Blunt trauma to the neck requires a systematic analysis of the laryngotrachea, the esophagus and the cervical spine in addition to general trauma considerations. Acute airway decompensation is best managed by tracheotomy, although if the situation permits, an orderly physical examination including indirect laryngoscopy and selected roentgenographic studies will yield ...

Soft tissue ankle injuries, particularly lateral ligament sprains, cause considerable disability and loss of time from activities. These injuries are commonly and frequently treated by physical therapists. Controversy exists over the efficacy of various methods for the nonoperative management of these injuries. A comprehensive program for the management of the ...

Microsurgical revascularization has proved to be a useful method in managing the ring avulsion injury where both neurovascular bundles are damaged with only partial skin avulsion. Representative cases are used to illustrate guidelines for a practical classification for helping to decide the optimal method of treatment of acute ring avulsion ...

Sports injuries involving the eye are common and potentially endangering to the ocular tissue and vision. The evaluation of such injuries and diagnosing any resultant damage requires a careful, systematic approach by the practicing optometrist. This article details such a systematic approach to the ocular sports injury and discuseses diagnostic ...

Heart and thoracic vascular injuries account for 1% to 4% of trauma, but the potential for mortality and morbidity makes preanesthetic evaluation important. A rational management plan initiated from the time the patient is first seen in the emergency room will guide anesthetic management. Our review of 65 patients with ...

A systematic evaluation of the hand, looking for functional or structural damage to each of its six tissue components, is the first step in managing the acute hand problem. We review the diagnostic and therapeutic decisions that are necessary to start treatment, and especially to avoid the pitfalls and oversights ...

In a retrospective review of one year's experience in the management of neck trauma, 88 cases comprising 42 gunshot wounds, 29 stab or slash injuries, and 17 injuries by blunt trauma were reviewed. Multiple injuries were noted in all groups, but a higher percentage was found in the blunt trauma ...

Among the most common injuries encountered by the 700,000 active sport scuba divers in the United States are sinus and otitic barotrauma. The management of these injuries and the identification of high-risk patients during their required pretraining physical examination are discussed.

Mounting evidence supports efforts to preserve splenic function. This evidence indicates (1) that the problem of postsplenectomy sepsis warrants splenic preservation whenever possible, and (2) that the spleen, as a whole or in part, and its function, can be preserved in cirmustances which formerly seemed to necessitate removal of the ...

The controversy of long standing in the management of cervical cord and spine injury in the acute stage ranges from an attitude of neurosurgical nihilism on the one hand, to indiscriminate, incompetent and routine "explorative" or "diagnostic" laminectomies on the other. Judicious neurosurgical management in the acute stage tends to ...

The principles and guidelines in the management of penetrating ocular injury are detailed. In the absence of definitive clinical trial or an experimental model, the rationale for pars plana vitrectomy has been presented. In addition, our recommendations as to the appropriate role and timing of pars plana vitrectomy are included.

Critical emergency cases of chest trauma are of three types: those caused by blunt trauma, thoracoabdominal injuries and penetrating injuries. The author describes the management of the most commonly encountered lesions in each of these three categories. All lesions resulting from chest trauma should be considered as a critical emergency ...

Some characteristics are described for detrusor-sphincter dyssynergia and the dyssynergic response in spinal injury patients with complete lesions. The urodynamic evaluation and clinical problems are analyzed in 53 patients to identify the importance of early recognition of sphincter dyssynergia. Cystomanometric and urethral profile pressures vary from 30 to 150 cm. ...

Improvements in surgical capabilities in the management of malignancies about the ear and parotid gland, increasing vehicular and interpersonal trauma, and greater concern with cosmetic factors by the public at large, have led to increasing need for the surgeon's ability to manage injuries to the facial nerve. Several important anatomic, ...

The management of soft tissue injuries of the face is best approached in an organized manner. The goal is early functional and cosmetic rehabilitation. The steps to be undertaken should be: initial evaluation, planning, repair and follow-up. Thorough cleansing with minimal debridement, use of fine suture material and early suture ...

With the extended indications for abdominal and pelvic radiation therapy, administered at higher dosage levels, an increased incidence of radiation injury to the intestine can be anticipated. Increased efforts are urgently needed to develop innovative methods in the detection, prevention, and management of radiation-induced intestinal injury. Fifty cases of radiation ...

Most bullets which enter the body usually exit or lodge within the soft tissues having traveled in a straight line. Management of such patients is usually a simple matter of repairing the injuries incurred during the passage of the bullet. Emphasis must be placed on the initial management of the ...

One hundred and thirty-one cases of penetrating injuries of the chest were reviewed prospectively. A policy of conservative management is advocated, based on the intercostal drainage of moderate or large collections of fluid and/or air. The site of the intercostal drain is not an important factor in the management.

We have been using monoplane and biplane wedge osteotomies in the management of fifth metatarsal head lesions and have revised the procedure presented by Sgarlato, Subotnick and Gerbert in that we have been utilizing distal diaphyseal dorsiflexory adductory wedge osteotomies as well as proximal diaphyseal dorsiflexory adductory wedge osteotomies. We ...

Several principles in treating the injured hand are poorly understood. This paper outlines basic management of hand injuries and details care of some poorly treated cases frequently seen on referral.

Ureteral injuries may cause infection, fistula, and even death. By revealing abnormalities, preoperative pyelography warns the surgeon of hazards to be anticipated. Injury found during operation is managed by reimplantation, reanastomosis, or ureterostomy in situ, while deliberate ligature is avoided. Postoperative ureteral fistula is treated by reimplantation, although occasionally a ...

Infrared thermography contributes to the care of insensitive limbs. The inflammatory response of near damaged or damaged tissue presents areas of increased heat on the surface which can be detected and followed. Thermography was found to be a valuable aid to the established management methods used for insensitivity problems including ...