Low-velocity gunshot wounds to extremities

Several therapeutic modalities in the management of low-velocity gunshot wounds to extremities were investigated. Local excision of wound margins, irrigation, and primary or delayed primary closure without the use of the operating room or prophylactic antibiotics produced results which were comparable to those obtained with a more aggressive surgical protocol.     

Secondary hemorrhage following trauma to the bones and soft tissues of the extremities

An analysis of 16 cases of secondary hemorrhages in injuries of bones and soft tissues of the extremities is presented. The secondary hemorrhages occurred within the period from 16 hours to 27 days after the trauma. Angiographic study is a valuable adjunct for establishing the correct diagnosis. Arrosion of large arterial trunks was the adjunct for establishing the correct diagnosis. Arrosion of large arterial trunks was the basic cause of the secondary hemorrhage. In the prophylaxis of the latter a special importance is attached to a wide wound dissection in primary surgical treatment and to secure hemostasis, especially in the body portions having multilayer musculature.     

Prenatal gunshot perforation of the colon

Digitoxin plasma levels were determined in the dog by radioimmunoassy after i.v. infusion of this cardenolide in toxic amounts (388 +/- 13 mug/kg). Plasma values found immediately after the administration of this dose were 588.5 +/- 91 ng/ml and attained very low levels (10 ng/ml) 96 h later. The dominant half-life of digitoxin in the dog was found to be 49.6 +/- 6.5 h, but this value was attained only in the final part of our study. The results found are compared with previous data and controversial aspects are discussed.     

Vascular syndromes of the extremities

MOTIVATION: Optimal sequence alignment based on the Smith-Waterman algorithm is usually too computationally demanding to be practical for searching large sequence databases. Heuristic programs like FASTA and BLAST have been developed which run much faster, but at the expense of sensitivity. RESULTS: In an effort to approximate the sensitivity of an optimal alignment algorithm, a new algorithm has been devised for the computation of a gapped alignment of two sequences. After scanning for high-scoring words and extensions of these to form fragments of similarity, the algorithm uses dynamic programming to build an accurate alignment based on the fragments initially identified. The algorithm has been implemented in a program called SALSA and the performance has been evaluated on a set of test sequences. The sensitivity was found to be close to the Smith-Waterman algorithm, while the speed was similar to FASTA (ktup = 2). AVAILABILITY: Searches can be performed from the SALSA homepage at http://dna.uio.no/salsa/ using a wide range of databases. Source code and precompiled executables are also available. CONTACT: torbjorn.rognes@labmed.uio.no     

Arterial injuries of the extremities

Fifty-eight patients with arterial injuries of the extremities were treated during the past 8 years. Fifty-one had acute injuries and seven had nonacute injuries. Blunt trauma or shotgun wounds caused 74% of the injuries, and 55% were associated with skeletal trauma. All the acute injuries endangered the limb; the average ischemic time was 8.5 hours. Brachial, popliteal, and superficial femoral arterial injuries were seen most frequently. Repair was accomplished with autogenous saphenous vein grafts in 47% and end-to-end anastomosis in 41%. Six patients died, four due to injuries of other organs. The most alarming complication of arterial repair was secondary hemorrhage which occurred in three patients and was caused by local infection. Six patients (13.3% required amputations; the highest number (three) after injuries of the popliteal artery. The injuries leading to amputations had associated prolonged ischemia, severity of injury, and associated venous, soft tissue, and skeletal injury. The nonacute injuries were in the form of false aneurysms, pulsating hematomas, AV fistula, and delayed bleeding. These were easily managed without any significant complication.     

Nerve compression syndromes of the extremities

An analogue of human melanin-concentrating hormone (MCH) suitable for radioiodination was designed in which Tyr13 and Val19 of the natural peptide were replaced by phenylalanyl and tyrosyl residues: [Phe13, Tyr19]-MCH. The peptide was synthesized by the continuous-flow solid-phase methodology using Fmoc-strategy and polyhipe PA 500 and PEG-PS resins. The linear MCH peptides with either acetamidomethyl-protected or free cysteinyl residues were purified to homogeneity and cyclized by iodine oxidation, yielding the final product with the correct molecular weight of 2434.61. Radioiodination of the C-terminal tyrosine was carried out enzymatically using solid-phase bound glucose oxidase/lactoperoxidase, followed by purification on a reversed-phase mini-column and by high-pressure liquid chromatography. The resulting [125I]-[Phe13, Tyr19]-MCH tracer was the first radiolabelled MCH peptide suitable for radioreceptor assay: saturation binding analysis using mouse G4F-7 melanoma cells demonstrated the presence of 1090 MCH receptors per cell. The dissociation constant (KD) was 1.18 x 10(-10) M, indicating high-affinity MCH receptors on these cells. MCH receptors were also found in other cell lines such as mouse B16-F1 and G4F and human RE melanoma cells as well as in PC12 and COS-7 cells. Competition binding analyses with a number of other peptides such as alpha-MSH, neuropeptide Y, substance P and pituitary adenylate cyclase activating peptide, demonstrated that the binding to the MCH receptor is specific. Atrial natriuretic factor was found to be a weak competitor of MCH, indicating topological similarities between MCH and ANF when interacting with MCH receptors.     

The classification of gunshot wound-induced pseudarthroses

On the basis of clinico-roentgenological and special investigations of 153 patients the authors have developed a working classification of false joints and indicators of osteogenic activity allowing indications for using more adequate methods of treatment to be elaborated. False joints with sequesters were treated by resection of ends of fragments and apparatus compression. Consolidation of false joints of the bone regenerate was reached by fast fixation of fragments by the apparatus with microdistraction and following compression.     

Vascular injuries to the extremities

The treatment of vascular trauma is a challenging and increasingly successful endeavor. Improvement in patency rates and limb salvage have occurred through advances in diagnostic methods, materials for vessel replacement and techniques of repair. Several principals have evolved. An aggressive diagnostic approach is indicated with early arteriography in all suspicious injuries. Distal blood flow should be established as soon as possible. Associated venous injuries should be repaired if possible. Unstable orthopedic injuries shoud be stabilized conservatively with minimal internal wire fixation of fragments and the use of traction. Fasciotomy should be used in treatment of any injury involving prolonged ischemia of distal tissues.     

War injuries to the extremities

AIM: The authors present their own experience in the treatment of war injuries to the extremities during the war in Croatia and in Bosnia and Herzegovina. METHOD: From November 1991 until April 1994, 186 patients with war injuries to the extremities were treated. Treatment began with first aid offered at the battlefield, followed by transport of patients to war hospitals, and transfer of the most severe cases to the rear hospital (Split University Hospital). RESULTS: Isolated injuries to the extremities were present in 155 patients (83%), 38% of them with injuries to soft tissues of the extremities and 62% with both soft-tissue injuries and bone fractures. Associated minor injuries to the other parts of the body were present in 31 patients (17%). Amputation of the extremity was performed on 22.5% of the patients. All fractures were treated by external fixation, whereas soft-tissue lesions were managed by debridement and excision of the damaged tissue, with compulsory antibiotic and antitetanic therapy. The rates of mortality and infection were 0.5 and 6.4%, respectively. CONCLUSION: Our experience emphasizes the importance of field hospitals in timely and adequate treatment of war wounds to the extremities. Treatment of the wound by a trained professional within 2 hours after wounding saved many lives and extremities. The patients were only rarely referred to the rear hospital.     

Fatal air embolism following gunshot wound of the lung

Air embolism following penetrating lung trauma has been reported infrequently and its existence is questioned. A death resulting from air embolism following a high-velocity gunshot wound is presented. Appropriate treatment and preventive measures are discussed.     

Diagnosis of lymphostatic edema of the extremities

The diagnosis of lymphedema and its combination forms can be established with the aid of basic diagnostic measures (patient's medical history, inspection, palpation). Imaging techniques are indicated only when clinical examination falls to provide an unequivocal diagnosis, or when an accurate functional and morphological status of the disorder is required, for example in early stages of lymphedema and combination forms such as phlebolymphedema or lipolymphedema, etc. At present, the use of ultrasound, CT or MRI is of little value in the diagnosis of lymphedema of the extremities.