ObjectivesThe aim of this study was to explore possible long-term negative health effects of injuries sustained by modern weaponry.SettingThe study was conducted in Gaza’s main hospital, Al-Shifa Hospital.ParticipantsDuring the last 10 to 15 years, thousands of civilian Palestinians in Gaza have survived numerous military incursions, but with war-related traumatic injuries caused by explosive weapons. It is unclear to which extent the injuries sustained by such modern weaponry may increase survivors’ risks of negative long-term health effects and serious illness. We have reported mechanisms and severity of injury, demographics and psychosocial status among 254 Palestinian patients in Gaza with war-related extremity amputations. Among the same amputees, subgroups of patients presented a variety of alarming symptoms and findings. 94 patients received further diagnostic clinical exploration, radiology imaging and clinical chemistry laboratory tests at the main clinical centre in Gaza, the Al-Shifa Hospital.ResultsNine out of ten of the referred patients were young (median 31.5 years) males (88/94, 92.6%). Ultrasound imaging revealed that 19 of 90 patients (20%) had fatty liver infiltration, 3 patients had lung nodules and 10 patients had lung atelectasis on chest CT. Twelve had remaining shrapnel(s) in the chest, five patients had shrapnel(s) in the abdomen and one in the scrotum. We found shrapnel(s) in the amputation stumps of 26 patient’s amputated limbs, while 8 patients had shrapnel in the non-amputated limb. Three patients had liver lesions. Nineteen patients had elevated liver enzymes, 32 patients had elevated erythrocyte sedimentation rate and 12 were anaemic. Two patients tested positive for hepatitis C virus and three were positive for hepatitis B virus (HBV). One of the 19 patients with fatty liver tested positive for HBV. Two of the patients with fatty liver infiltration had elevated glycatedhaemoglobin levels and confirmed diabetes mellitus type II.ConclusionNearly half (44, 8%) had remaining metal fragments from explosives of unknown composition harboured in various parts of their bodies. All patients identified with lesions and nodules are being followed up locally. As of now, we cannot anticipate the long-term health consequences of living with metal residuals from modern explosive weapons embedded in body organs and tissue.
Background: Blunt abdominal trauma is seen with increasing frequency in emergency rooms and is continuous to be associated with significant morbidity and mortality. Intra-abdominal injuries following blunt trauma are of great medico-legal importance to forensic experts. Aim:The study aimed to investigate the contribution of non-invasively and rapidly obtained clinical presentation and biochemical parameters in the early diagnosis of intra-abdominal (IA) injuries in blunt trauma patients, then develop a scoring system and investigate its clinical applicability as pre-test to determine whether abdominal CT should be performed during the diagnosis or not. This may help to decrease number of malpractice claims due to medical negligence. Methods and results: A prospective study was conducted on 30 adult patients with blunt abdominal trauma presented to Emergency department (ED) of Ain shams university hospitals (ASUHS). Patients were classified into two groups: group 1: adult patients with blunt abdominal trauma with normal CT abdomen. Group 2: adult patients with blunt abdominal trauma with abnormal CT abdomen. For every patient, demographic, trauma, and clinical data were collected. Laboratory parameters measured included blood hemoglobin level, liver enzymes, kidney function tests, pancreatic enzymes and finally CT abdomen was done. The mean age for the adult patients with blunt abdominal trauma was 34 ± 11 years. Male to female ratio was 2:1 with no significant importance. There was no significant difference between both groups of the study as regards aetiology and delay time of trauma and the most common cause of BAT was motor car accidents that compromised (36.7%) of all patients. There was no significant difference between both groups of study as regards abdominal symptoms and signs. Regarding vital signs, incidence of patients with high pulse rate per minute more than 100 bpm and high respiratory rate more than 20 brpm were highly significant in group II than group I. There was no significant difference between both groups regarding blood pressure. As regards the conscious level, there was significant difference between both groups of study. Hemoglobin level was significantly lower group II than group I with cutoff point level equal to or less than 9.8gm/dl. AST, ALT, urea, creatinine, amylase and lipase levels showed no significant difference between both groups. According to CT, the spleen was the most injured organ in blunt abdominal trauma patients (43.8%) followed by the liver 4 cases (25%). Conclusion: A scoring system could be done by the sum of points obtained from each parameter (Hb level, pulse rate, respiratory rate, and conscious level). The score points range from (0-4). It was found that the patients with score (0-2) were mainly with normal CT abdomen. On the other hand, patients with score (1-4) were mainly with positive CT findings. So, this scoring system can be used for the early prediction of the presence of IAIs in BAT patients and as a pretest for the need of CT. Recommendations: Blood hem...
Dear Editor:Laparoscopic colectomy is increasingly accepted as the standard of care in the elective setting for both benign and malignant colorectal diseases. The most recent National Bowel Cancer Audit reported an uptake of just over 40 %. The use of laparoscopy in colorectal resection for cancer has been recommended by the National Institute for Healthcare and Clinical Excellence (NICE), provided it is performed by appropriately trained surgeons.Many randomised prospective studies have demonstrated the short-term benefits of laparoscopic over open colectomy for elective surgery. These include short recovery periods, early regaining of bowel function and short hospital stay, with comparable morbidity, mortality and recurrence rates [1][2][3].The role of laparoscopy for emergency colorectal resection and its potential benefits remain controversial. The available studies in the literature compare the outcomes of emergency laparoscopic procedures with emergency open procedures. To the best of our knowledge, there have been no publications comparing outcomes of emergency with elective laparoscopic colectomy.We conducted a study is to examine the use of minimally invasive laparoscopic techniques in carefully selected emergency colorectal procedures and to assess its safety and feasibility when compared with elective surgery, and to assess the outcome when compared with emergency open colectomy. This is a retrospective study of a prospectively collected database. Research ethics committee approval was waived. A literature search was performed to assess the current evidence in laparoscopic emergency colectomy. The entire Ovid database was searched with the keywords Blaparoscopic^, Bcolectomy^and Bemergency^, and these were combined with the set operator BAND^. The search was completed on 19 June 2015. Thirty-one results were found and screened. Papers that were case series, case-control, cohort or randomised controlled trials of the use of emergency laparoscopic colectomy in adults were included. Fourteen papers did not meet the inclusion criteria and 9 were duplicates. All patients who underwent emergency laparoscopic colectomy, performed by one surgeon in a single district general hospital, between 2008 and 2014 were identified. Emergency open colectomy data was collected retrospectively by searching the theatre electronic coding system for the terms Bcolectomyâ nd/or BHartmann's^. The selection criteria for emergency laparoscopic surgery were a stable patient, being fit for laparoscopic procedure and the availability of experienced surgical and nursing staff. Patients with marked small-bowel dilatation or severe sepsis were excluded. Patients who underwent laparoscopic appendicectomy and laparoscopic stoma were excluded from the database. Emergency colectomy included both lifethreatening cases, booked on the emergency list as soon as possible, and urgent surgery which was defined as needed to occur before discharge of the patient.Data collected included age, gender, body mass index (BMI), American Society of Anesthe...
Percutaneous nephrolithotripsy (PNL) is a safe and effective treatment modality for the management of renal stones. This technique is associated with high success rates and few complications. The most important complication is hemorrhage. Delayed hemorrhage following PNL is rare complication and usually occurs due to development of the pseudoaneurysm or Arteriovenous fistula which can be successfully managed with arterial embolization. Here we are reporting a case of delayed post-PNL bleeding that occurred in a 41-year-old male operated on for renal stone. Multi Detector Computed Tomography scan revealed a presence of the pseudoaneurysm and Arteriovenous fistula in the inferior segmental branch of the left renal artery, which was successfully managed with amplatzer vascular plug.
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