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Background: Aortoenteric fistula (AEF) is a rare diagnosis that is often considered only in older patients with histories of abdominal aortic aneurysm., Objectives: To remind emergency physicians that traumatic injury and repair put patients at risk for formation of AEF., Case Report: We discuss the case of a 25-year-old man who developed an aortoduodenal fistula weeks after a stab wound to the abdomen. AEF can occur anywhere along the gastrointestinal tract and can therefore present as either upper or lower tract bleeding. The expected triad of pain, pulsatile mass, and gastrointestinal bleeding is unfortunately rarely present, making diagnosis difficult. Patients often present with a self-limited herald bleed that precedes the fatal exsanguination by hours to days. Diagnosing the fistula at the time of the herald bleed can be difficult but lifesaving. Imaging studies are often misleading and only delay definitive operative treatment. Even with prompt diagnosis and treatment, mortality is high; without repair, it is 100%., Conclusion: This case highlights the importance of suspecting and quickly recognizing AEF based on history and physical examination alone. After extensive preoperative imaging to confirm the diagnosis, this patient nearly died in the operating room as surgeons took down adhesions trying to reach the fistula to repair it., (Copyright © 2013 Elsevier Inc. All rights reserved.)

We report 2 cases of subcutaneous emphysema after stab wounds of the first interdigital space. The first diagnosis of a gas gangrene was not confirmed. We hypothese an air incorporation caused by a bellows mechanism. An escape of the air may not be possible due to an one-way valve mechanism. The aim of this report is to describe criteria to distinguish benign emphysema from emphysema caused by infection., (© Georg Thieme Verlag KG Stuttgart · New York.)

We report a case of an 80-year-old woman with an acute carpal tunnel syndrome. This was based on an acute episode of chondrocalcinoses and accompagnied by a prolaps of the median nerve into a gap of the forearm fascia as result of a cut injury in childhood., (© Georg Thieme Verlag KG Stuttgart · New York.)

Extensor indicis (EI) transfer is the commonest tendon transfer to restore thumb extension after loss of extensor pollicis longus (EPL) function. Rarely are there clinical situations when EI is not available as a donor motor and alternative techniques have to be employed. I report a successful reconstruction of thumb extension using Extensor digiti minimi (EDM) in an adult male patient in whom EI and Abductor pollicis longus (APL) were not available as donor motors. A literature review reveals that this is the first report of such a transfer in an adult; only one previous EDM transfer has been reported for thumb extension on a child in 2011., (Copyright © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

We describe an unusual case of delayed cardiac tamponade that led to death 9 days after a penetrating stab wound. The injury consisted of a longitudinal tear in the LAD coronary artery, with an occlusive thrombus and the rupture of the coronary wall into a pseudo-aneurysmatic peri-coronary hematoma. As imaging evidence of pericardial effusion and ischemic electrocardiographic changes were lacking, the diagnosis was only made during post-mortem examination., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Study Design: A single case is presented of a spontaneously resolving epidural arteriovenous fistula caused by a stab wound., Objective: To demonstrate a unique case of a spontaneously resolving epidural arteriovenous fistula caused by a stab wound, as well as to present a brief review of pathology., Summary of Background Data: Spinal epidural arteriovenous fistulas (SEAVF) are high-flow vascular malformations characterized by an arteriovenous shunt involving the internal vertebral venous plexus (IVVP). SEAVFs can present with intramedullary, subarachnoid or epidural hemorrhages, spinal cord or nerve root compression, and progressive myelopathy secondary to medullary venous hypertension. The type of venous drainage (intradural, extradural, or mixed) strongly influences the mode of presentation. Spontaneous resolution of a spinal vascular malformation is a well-documented yet rare phenomenon., Methods: Angiographical and magnetic resonance images of the lesion were obtained pre- and post spontaneous resolution. A brief review of the topic is also presented., Results: Our observation identifies stabbing as an unusual mechanism for the formation of a SEAVF, and offers an angiographically documented example of complete spontaneous resolution of this type of vascular malformation. SEAVFs of traumatic origin have been previously reported, but we believe that our observation represents the first documentation of such a lesion being caused by stabbing with subsequent spontaneous resolution., Conclusion: Spinal epidural arteriovenous fistulas (SEAVFs) are increasingly diagnosed vascular malformations with the potential to inflict serious neurological damage if not recognized and treated in time. Spontaneous resolution of a spinal vascular malformation is a well-documented yet rare phenomenon. Our observation identifies stabbing as an unusual mechanism for the formation of a SEAVF, and offers an example of complete spontaneous resolution of this type of vascular malformation.

The objective of the present study was to elucidate the peculiarities of the assessment of harm to human health from maxillofacial and neck injuries accompanied by the infectious process. The case report described in this paper demonstrates that the unfavourable outcome of an injury is not infrequently attributable to the inadequacy and drawbacks of the existing schemes for the provision of medical aid. However, the health status of the victim depends on the life-threatening character of the primary injury and its naturally developing infectious complications.

We present the case of a 20-year-old man who was stabbed in the left chest and was diagnosed with a large pericardial effusion by focused emergency department (ED) ultrasonography. After placement of a left chest tube for presumed tension pneumothorax, the pericardial effusion had resolved. The patient's postinjury course was complicated by pericarditis and recurrent tamponade, which required repeated pericardiocentesis for management. This case illustrates the role of focused ED ultrasonography for diagnosis of pericardial effusion in penetrating trauma and the potential for delayed pericardial effusion and tamponade in such patients. Although the pathophysiology of delayed pericardial effusion is unclear, autoimmune postpericardiotomy syndrome has been proposed as the cause of this rare condition. Our case underscores the importance of close monitoring of patients with known or suspected pericardial injuries due to their potential for the development of life-threatening complications.

Cardiac tamponade is life-threatening, slow or rapid compression of the heart due to the pericardial accumulation of fluid, pus, blood, clots or gas, as a result of effusion, trauma or rupture of the heart. Penetrating injuries of the chest are most commonly the result of stab wounds and are often associated with a range of potentially life-threatening injuries. It must be treated by pericardial drainage as soon as possible. Sometimes the injury resulting in life-threatening conditions may be so small that it could be missed in the first instance. We present a case report in which the deceased was stabbed by Bodkin at road side. As the wound was so minute, it was not appreciated and time was lost in getting treatment, resulting in loss of a precious life.

Brown-Séquard plus syndrome (BSPS) or incomplete spinal cord injuries from stab injury have been widely reported. However, only four detailed cases of pure Brown-Séquard syndrome (BSS) from stab injury have been previously reported. Here we present the case of an 18-year-old man who sustained a penetrating knife stab injury to the right side of his back resulting in a pure Brown-Séquard syndrome with left lower extremity hemiplegia. Imaging revealed right-sided soft tissue and ligamentous damage traveling in a right-to-left fashion as well as left-sided T2-weighted MRI cord signal change at the level of T9. Given concern for a cerebrospinal fluid leak (CSF) leak, the patient was taken for wound exploration, irrigation, laminectomy, dural closure and lumbar drain placement. At three years follow up, the patient was almost full strength. This is the first case in the literature demonstrating radiographic and correlative intraoperative imaging of a hemisection of the spinal cord resulting in a pure Brown-Séquard syndrome.

We describe here a young adult patient with penetrating neck injuries (PNI) with an Rh negative blood type and discuss the perioperative anaesthetic management of single-stage surgical exploration under general anaesthesia and extracorporeal circulation in this patient. The patient had zone II PNI and he was in a haemodynamically progressive unstable state, and the knife penetrated the left internal jugular vein, superior thyroid artery and recurrent laryngeal nerve; the trachea and the oesophagus were swelling at a rapid rate. Eight weeks after operation, the patient was discharged from the hospital without any complications.

Background: Traumatic thoracobiliary fistula is a rare but serious complication. A series of thoracobiliary fistulas secondary to penetrating trauma and analysis of trends in management are presented., Methods: We retrospectively reviewed all patients with traumatic thoracobiliary fistula, treated from April 2008 to February 2010. There were 5 patients: 4 suffered gunshot wounds and 1 was stabbed. The mean injury severity score was 22., Results: Initial treatment was insertion of a chest tube in all cases. One patient underwent damage-control surgery and hepatic packing, and 3 were managed with laparotomy, a perihepatic closed drain, and suture of the diaphragm. Two patients developed bronchobiliary fistulas and 3 had pleurobiliary fistulas. Diagnostic procedures involved determination of bilirubin in pleural effusion, computed tomography, magnetic resonance cholangiography, hepatobiliary iminodiacetic scans, and endoscopic retrograde cholangiography. Definitive treatment included sphincterotomy and stenting in 4 cases, pulmonary decortication in 5, fistulectomy in 2, hepatic suture in 2, perihepatic closed drain placement in 4, and suture of the diaphragm in 4., Conclusions: Traumatic thoracobiliary fistulas are complex lesions. A multidisciplinary approach is required for a timely and successful outcome. Endoscopic retrograde cholangiography is very useful as the initial procedure to confirm the diagnosis and also for treatment.

A 39-year-old fisherman is reported who was dragged into the water from a boat after he became entangled in fishing line. His death was attributed to salt water drowning. At autopsy the cause of death was confirmed and the mechanism of the lethal event elucidated. Specifically, a large fish hook attached to line was embedded in his right wrist. The hook had passed beneath flexor tendons and had firmly attached him to fishing line that was being dropped from the vessel. There were no other significant injuries or underlying diseases present. This case demonstrates another rare situation in the commercial fishing industry that may result in a victim being dragged from a boat and drowned., (Copyright © 2012 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.)

Background: Penetrating spinal cord injuries (SCIs) are an uncommon injury and not reported very frequently. SCIs cause sensory, motor and genitourinary system problems or a combination of sensorimotor dysfunctions. These are among the most debilitating kinds of disorders and negatively affect quality of life, not only for the patient, but also for their family members. Therefore, the present study aims to evaluate complete or incomplete SCIs and the course of the injury and the prognosis for SCIs caused by stab wounds., Methods: This case-series design study was performed on 57 patients attending the emergency department of Taleqani Trauma Center (Kermanshah, Iran) due to SCIs caused by violent encounters involving sharp objects such as a knife, dagger, whittle and Bowie-knife between 1999 and 2011. An assessment of sensory and motor functions was performed as part of the neurological examination on admission, and during the treatment, using the Frankel Classification grading system, and the results were recorded., Results: The average age of patients was 27 years (SD= 7.9, Range=17 to 46 years). The results of the study showed a proportion of cervical, thoracic and lumbar injuries of 23 (40%), 24 (42%) and 10 (18%), respectively. There was no case of cerebrospinal fluid leakage (CSF) or infection at the wound site in the subjects. Regarding the extent of the SCI, the combined neurological assessment showed that several patients (43%) had a complete SCI with no sensory and motor functions in the sacral segments and the segments below the site of injury. In 32 patients (57%) incomplete injuries were observed; i.e. they showed only some degrees of sensory-motor functions that were below the neurological level., Conclusions: Both complete and incomplete SCIs are of great importance because the prognosis of SCI is directly associated with the location and extent of injury. It should be considered that partial recovery from SCIs is possible in few cases of complete injuries. Therefore, all the patients should be treated carefully and seriously.

A 31-year-old woman was admitted to the emergency department with a stab wound to the heart. She was initially stable but rapidly developed hypotension. While the operating room and staff were in preparation, she underwent pericardiocentesis. She was then rushed to the operating room by the general surgical trauma team, who performed a bilateral anterior thoracotomy to control the bleeding. In the recovery room, the patient was still hypotensive, so cardiothoracic surgery was consulted. An echocardiogram revealed severe hypokinesis of both ventricles. The cardiothoracic surgeons returned her to the operating room and discovered that the anterior pericardium had been completely removed by the trauma team. This had caused the posterior pericardium to form a "bowstring" that almost totally obstructed pulmonary venous return and restricted right ventricular outflow of blood, inducing right-sided heart failure. This pericardial string also strangulated the left atrium posteriorly, forming 2 compartments. We repositioned the patient's heart and implanted ventricular assist devices bilaterally to provide temporary circulatory support. The patient made a good recovery. We suggest that bilateral assist device placement can be beneficial in the recovery of a stunned but otherwise normal heart.

Background: Traumatic ventricular septal defect (VSD) occurs in approximately 5% of blunt or penetrating cardiac injuries and can result in rare complications., Objectives: To report the serious complication of stroke after a traumatic VSD., Case Report: A 27-year-old man with no previous medical history presented to the Emergency Department with aphasia and right hemiparesis after a stab wound to the chest. He underwent emergent evacuation of a pericardial effusion and repair of a right ventricular wall perforation. Head computed tomography revealed left middle cerebral artery infarct. Post-operatively, he was noted to have a cardiac murmur, and echocardiogram revealed a VSD. The VSD was surgically repaired without complication., Conclusion: Stroke can complicate traumatic VSDs., (Published by Elsevier Inc.)

Visceral arterial aneurysm and pseudoaneurysm are uncommon forms of vascular disease that have a significant potential for rupture or erosion into an adjacent viscera, resulting in life-threatening hemorrhage. Pseudoaneurysms related to the superior mesenteric artery are a recognized complication of trauma to the vessel, and successful treatment with stenting has been previously described. Percutaneous techniques offer an alternative form of therapy, and the number of reported cases treated with embolization has been rising steadily. We present the case of a 26-year-old patient with a large pseudoaneurysm of the superior mesenteric artery complicated with obstructive jaundice.

Study Design: Case report., Objective: To demonstrate the utility of diffusion tensor imaging and tractography in two patients with Brown-Sequard syndrome after penetrating cervical cord injury., Setting: Milwaukee, WI, USA., Methods: Two patients, who presented with features of Brown-Sequard syndrome after sustaining stab wounds to the neck, underwent DTI and tractography of the cervical cord within a week of the injury. DTI metrics were measured within the left and right hemicord around the level of injury. Diffusion tensor tractography was performed to visualize the site of injury and injured fiber tracts., Results: Axial fractional anisotropy maps at the site of injury showed unilateral damage to the cord structure, and FA was significantly reduced within the injured hemicord in both patients. Tractography allowed for visualization of the injured fiber tracts around the level of injury. Both DTI metrics and tractography showed an asymmetry that corresponded to the neurological deficits exhibited by the patients., Conclusion: This report illustrates the utility of DTI and DTT in delineating regions of cord injury in two patients with traumatic Brown-Sequard syndrome. Our results indicate that DTI provides clinically relevant information that supplements conventional MR imaging for patients with acute SCI.

Objective: Ventricular septal defects resulting from post-traumatic cardiac injury are very rare. Percutaneous closure has emerged as a method for treating this disorder. We wish to report our experience in three patients who underwent percutaneous closure of a post-traumatic ventricular septal defect with a patent ductus arteriosus occluder., Methods: We treated three patients with post-traumatic ventricular septal defects caused by stab wounds with knives. After the heart wound was repaired, patient examinations revealed ventricular septal defects with pulmonary/systemic flow ratios (Qp/Qs) of over 1.7. The post-traumatic ventricular septal defects were closed percutaneously with a patent ductus arteriosus occluder (Lifetech Scientific (Shenzhen) Co., LTD, Guangdong, China) utilizing standard techniques., Results: Post-operative transthoracic echocardiography revealed no residual left-to-right shunt and indicated normal ventricular function. In addition, 320-slice computerized tomography showed that the occluder was well placed and exhibited normal morphology., Conclusion: Our experiences indicate that closure of a post-traumatic ventricular septal defect using a patent ductus arteriosus occluder is feasible, safe, and effective.

Three persons became victims of a serial knife stabbing in a fight. Three months later, one of the victims presented with acute hepatitis. On the fifth day of his admission to the hospital, another victim of this serial stabbing presented to our clinic with acute hepatitis B infection. The patients told that the first victim stabbed in this fight was their relative and he was a carrier of hepatitis B virus for a long time. They said that the carier of hepatitis B was stabbed first and then, with the same knife, the first and second patients were stabbed, respectively. After 8 months, the index case (first victim) was admitted to our clinic with elevation of liver enzymes. HBsAg and HBeAg were positive. HBV DNA was 2 × 10 (9) copy/mL. Histopathologic examination of liver biopsy showed chronic hepatitis with histologic activity index of 6/18 and grade I fibrosis., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Penetrating trauma has increased in developed and urban environments. Pulmonary artery injury is rare, but can be associated with significant morbidity. We report a case of delayed cardiac arrest following a stab injury to the chest. The patient had active great vessel bleeding and required extensive surgical intervention. Clinicians should have a high index of suspicion for life-threatening thoracic injuries following a stab injury to the chest, despite initial clinical stability or negative baseline radiological findings., (Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Axillary artery pseudoaneurysms are rare. We report on a 30-year-old patient with a 6.5-cm post-traumatic pseudoaneurysm of the left axillary artery two months after a knife stab wound of the shoulder. The patient showed axillary fullness and signs of severe brachial plexus compression. A surgical repair was undertaken. The aneurysm was excluded and a saphenous vein interposition was performed. The early and late postoperative periods were uneventful. This is probably not only the largest axillary artery pseudoaneurysm ever reported, but also the first secondary to a stab wound.

Objectives: Poorly standardized, the management of high pressure injections (HPI) is frequently too late and inadequate, some teams reporting up to 50% of amputations. HPI causes inoculation of toxic particles in depth, particularly difficult to remove surgically. The persistence of this foreign material maintains local inflammation and increases the risk of infection. The objective of this article is to validate the benefit of a systematic "second look" at 48-72 hours in HPI., Methods: We conducted a retrospective study from 2006 to 2010, of patients who had a HPI into the hand. All patients had initial debridement surgery and a "second look" was systematically performed at 48-72 hours., Results: During this period, six patients were treated for a HPI of paint (n=4) or oil (n=2). The time between the accident and surgery was 12.4 hours (2-24). Four patients had good functional outcome with no disabling sequelae. We performed two amputations. At six months, five patients returned to work., Conclusions: Early management determines the prognosis of the HPI. Extended debridement within six hours showed a better functional outcome than later treatment. Performing a systematic "second look" allows further washing/debridement and gives the possibility to be more conservative during the initial procedure. This second debridement allows excision of the newly formed necrosis and to evacuate the remaining toxic residues. Finally, patients reported good functional outcome., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Pseudoaneurysms of the neck arteries are rare lesions usually traumatic and less frequently infectious in origin. They are often described as case reports. We describe here an unusual occurrence of pseudoaneurysms in the common carotid and vertebral artery in a four-year-old child victim of a stab wound in the neck treated by parent artery occlusion of the vertebral and common carotid arteries.

Background: Many of the patients with thoraco-abdominal stab wound remain asymptomatic; in this regard, previous studies reported that 7-48% of asymptomatic patients had diaphragm injury (DI). Thoracoscopy or multidetector computed tomography (MDCT) scan is the best method to detect DI. We aimed to evaluate the role of CT scan with intrapleural contrast to rule out DI in stable thoraco-abdominal stab wounds., Method: In a prospective study, we evaluated all haemodynamically stable patients with thoraco-abdominal stab wound, from October 2009 to 2010. Exclusion criteria included patients who needed emergency thoracotomy or laparotomy, those who were haemodynamically unstable and those with blunt trauma or gunshot injury. In the CT-scan department, 500 cc of diluted meglumine diatrozate was transfused into the pleural space via a chest tube and the CT scan was performed from the dome of the diaphragm to the pelvic cavity. In the second step, all patients were taken for thoracoscopy within 24h after admission. The CT-scan slide was considered positive if one of the following signs was found: (1) the diaphragm was obviously injured as seen in CT-scan slides and (2) contrast agent was seen in the peritoneal cavity. Sensitivity and specificity were calculated for CT scan and thoracoscopy., Results: Four out of 40 patients had DI according to thoracoscopy. CT scan with intrapleural contrast predicted diaphragmatic injury correctly in all four patients. Considering thoracoscopy as the gold-standard method, the CT scan had two false-positive cases. The sensitivity of the intrapleural-contrast CT scan was 100% and its specificity was 94.4%., Conclusion: Our study showed that CT scan with intrapleural contrast can be an acceptable approach to rule out DI and limit the use of thoracoscopy for final diagnosis and repair of DI in cases with suspicious or positive CT-scan results, especially in trauma centres with high load of trauma patients and little accessible equipment., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

We report a 52-year-old woman presenting with stab wounds on her back and upper extremities. A knife retained in her chest wall was not discovered in the emergency department. This case reminds us that an obvious foreign body can be missed even after obtaining a detailed history, complete physical examination and plain film. Particularly, a retained foreign body increases the risk of infection and may cause further internal organ injury. We suggest that patients undergo computed tomography (CT) scanning whenever a penetrating wound cannot be explored adequately or the trauma surgeons are unable to perform detailed examinations on the injured patients. The CT images could delineate the course and severity of the penetrating injury, and decrease the risk of a retained foreign body.

The authors present the case of a patient with an abdominal puncture wound who developed, in two weeks, perforation of the colon with an unrecognized foreign body in the abdominal cavity.

Pneumothorax is a known complication of spontaneous or traumatic chest events. Trauma is the most common cause of pneumothorax all over the world. The majority of penetrating pneumothoraces are due to stab wound in Iran. The unilateral pneumothorax commonly is due to chest stab wound but it can be caused by neck stab wound, too. Ipsilateral pneumothorax is an uncommon complication of neck stab wound in zone I. We reported a rare case of bilateral pneumothoraces due to usual unilateral neck stab wound.

The superior vena cava syndrome represents the set of signs and symptoms resulting from obstruction of superior vena cava. The syndrome has as main causes malignant tumors such as bronchogenic carcinoma, lymphoma and mediastinal metastases. Lung cancer accounts for 80% of cases, mediastinal lymphomas by 15% and 5% correspond to other causes. This case report aims to present an unusual case of this syndrome, which occurred in a male patient after penetrating wound in the chest, which developed a pseudoaneurysm of the aortic arch and superior vena cava syndrome.

Study Design: Case report and literature review., Objective: To report the case of a young patient who sustained a penetrating wound with a knife tip retained in his cervical vertebrae and to review the literature., Summary of Background Data: Stab wound with foreign body retained, associated with spinal cord injury and vertebral artery injury, is not commonly reported. The timing and approach of surgical intervention are still controversial., Methods: A 17-year-old boy with a wound in the neck presented with diminishing feeling and dysfunction of the left leg and arm. Radiographs demonstrated a foreign body at the C4 level, and possible spinal cord and vertebral artery injuries were detected by computed tomography. Digital subtracted angiography showed a small lateral opening of the injured artery, which was successfully embolized. The knife tip was removed from the original wound without severe cerebrospinal fluid leakage or bleeding,, Results: The patient achieved immediate improvement after the operation., Conclusion: Cases of simultaneous spinal cord injury and vertebral artery injury in which the foreign body is retained are uncommonly reported. Digital subtracted angiography is necessary for cervical penetrating wounds and surgical approach should be individualized.

Aims and Objectives: To study the pattern of death caused by penetrating weapons. This is a prospective autopsy study of 254 cases over 8 years (1995 - 2002), Subjects and Methods: A retrospective analysis of all the medico-legal autopsies performed by the authors on bodies in which the circumstances of death suggested the use of penetrating weapons over a period of 8 years was carried out by the authors., Results: A total of 254 bodies that died during close combat, communal clashes, militant attacks and armed banditry of penetrating weapons were recorded. The youngest was 2 years old male while the oldest was 75 years old male. The highest death toll occurred between the ages of 20-49 years 197(77.6% cases) with a peak at the age group 20 - 29 years 75(29.5%) cases. There were 218(85.8%) males and 36 (14.2%) females giving a male to female ratio of 6:1. The most common cause of penetrating death was gunshot missiles 136(53.5%), while the most common anatomic site of the wound was the chest wall 85(33.5%). Instant death occurred in 179(70.5%) cases and haemorrhagic shock caused the death of 229(90.2%) cases, while the brain was the most common organ lacerated 61(24.0%)., Conclusion: Penetrating wounds were commonly sustained in close combats, during communal clashes, militant and armed robbery attacks, and youth restiveness in the Niger Delta region of Nigeria. Guns which are prohibited by law and other sharp and pointed instruments were freely used. The condition is preventable by enforcing stringent laws, but it resulted into a lot of mortalities.

Introduction: Spinal stab wound injuries are quite rare and only few patients have been reported on the basis of MRI scan., Methods: A 25-year-old man was stabbed at C1/2 and had an incomplete Brown-Sequard syndrome. He underwent surgical exploration because of CSF leakage on the fourth day., Results: After a follow-up period of 32 months, he was left with a remaining loss of the proprioception of the right foot. We show detailed CT and MR images with the focus on the lesions of the dura and myelon and compared them with intraoperative images. In addition, we contrast our findings with a review of literature published over the last three decades., Conclusion: MRI gives the most detailed view of soft tissue lesions in SSWs and is in accordance with our intraoperative findings.

A five year-old girl was admitted to hospital following an accidental stab wound to the chest, inflicted by a knife placed in a dishwasher's cutlery tray. Investigations revealed a traumatic ventricular septum defect of the heart, with a pericardial effusion. Since the patient remained haemodynamically stable, surgical intervention was considered unnecessary. At the first follow-up, an echocardiogram showed no visible pericardial effusion. At ten month follow-up, she showed initial symptoms of cardiac failure, and a renewed echocardiogram revealed a new pericardial effusion. It is important to perform long-term follow-up on patients with traumatic chest wounds.

The annual incidence of traumatic spinal cord injury worldwide is estimated to be 35 patients per million. Nonmissile penetrating spinal injuries most commonly occur in the thoracic region, and the majority has neurologic deficits on admission. The management of patients who lack neurologic deficits is controversial due to the risk of neurologic status alteration intraoperatively. However, failure to intervene increases the risk of infection, delayed onset of neurologic deficits, and worsening functional outcome.A 17-year-old boy presented with an intradural T7-T8 knife penetration injury to the spinal cord with no neurologic deficit. Rapid surgical intervention was critical because the knife was lodged between the 2 hemispheres of the spinal cord. The patient was intubated in the lateral position, transferred to the prone position on a Jackson table, and underwent surgical decompression with laminectomy 1 level above and below the injury site, removal of the knife blade in the original path of trajectory, and repair of the dural tear with a collagen matrix. The patient sustained no neurologic sequelae from the penetrating knife injury. He was able to ambulate at discharge and had no complications. To our knowledge, this is the only report of a patient with intradural spinal cord penetration by a foreign object (knife blade) presenting with a normal neurologic preoperative examination that persisted throughout the course of postoperative care., (Copyright 2012, SLACK Incorporated.)

We present a case of a maxillary fungus ball caused by retained foreign bodies for 25 years. The patient sustained a stab wound in the left face 25 years ago. The patient had no symptoms and complications of a foreign body, until the patient went to the hospital. The fungus ball and foreign bodies were removed via an endoscopic and Caldwell-Luc approach. We suggest the need for careful inspection and radiologic studies to localize occult foreign bodies in the sinonasal cavity or facial soft tissues after facial trauma.