Silicone oil migrating into the conjunctival space and orbit after surgery for an eye-penetrating injury:A case report

BACKGROUND We report a case of eye-penetrating injury in which a massive silicone oil migration into the patient’s subconjunctival space and orbit occurred after vitrectomy.CASE SUMMARY A 30-year-old male patient sought medical attention at Ganzhou People’s Hospital after experiencing pain and vision loss in his left eye due to a nail wound on December 9,2023.Diagnosis of penetrating injury caused by magnetic foreign body retention in the left eye and hospitalization for treatment.On December 9,2023,pars plana vitrectomy was performed on the left eye for intraocular foreign body removal,abnormal crystal extraction,retinal photocoagulation.Owing to the discovery of retinal detachment at the posterior pole during surgery,silicone oil was injected to fill the vitreous body,following which upper conjunctival bubble-like swelling was observed.Postoperative orbital computed tomography(CT)review indicated migration of silicone oil to the subconjunctival space and orbit through a self-permeable outlet.On December 18,2023,the patient sought treatment at the First Affiliated Hospital of Nanchang University,China.The patient presented with a pronounced foreign body sensation following left eye surgery.On December 20,2023,the foreign body was removed from the left eye frame and an intraocular examination was conducted.The posterior scleral tear had closed,leading to termination of the surgical procedure following supplementary laser treatment around the tear.The patient reported a significant reduction in ocular surface symptoms just one day after surgery.Furthermore,a notable decrease in the migration of silicone oil was observed in orbital CT scans.CONCLUSION The timing of silicone oil injection for an eye-penetrating injury should be carefully evaluated to avoid the possibility of silicone oil migration.

Comparison of the effects of intravitreal bevacizumab and dexamethasone in experimental posterior penetrating eye injury

AIM： To compare the effects of intravitreal anti-vascular endothelial growth factor（VEGF） and dexamethasone in an experimental rabbit model of posterior penetrating ocular injury.METHODS： Thirty white New Zealand rabbits were included in the study. A posterior penetrating ocular injury was performed at the superotemporal quadrant. They were randomly divided into three groups. The rabbits in group 1 received intravitreal dexamethasone, in group 2 they received intravitreal bevacizumab and those in group 3 received intravitreal physiological saline solution in both eyes. All eyes were examined ophthalmologically on the 1^st, 3^rd, 7^th, 14^th and 28^th days following the injury and the clinical findings were scored. On the day 28, the eyes were enucleated, evaluated and scored macroscopically, histopathologically and scanning electron microscopically.RESULTS： The median clinical score on the 14 th and 28 th days and the median macroscopic score of the dexamethasone group was significantly better than that of control（P=0.004, 0.018）. Dexamethasone group was also better than that of bevacizumab group but the differences did not reach statistical significance. Retinal detachment rate was 8.3%, 16.6% and 12.5% in the dexamethasone group, bevacizumab group and control group, respectively（P=0.476）. More extensive fibrocelluler proliferations were observed in controls compared with dexamethasone and bevacizumab groups. But these differences did not reach the statistical significance（P=0.538）. In scanning electron microscopy all groups showed fibreous stalk and dense collagen fibrils in vitreous. CONCLUSION： This study shows that intravitreal injection of both dexamethasone and bevacizumab may reduce the intraocular fibrous proliferation after an experimental posterior penetrating ocular injury in rabbits.

Acute penetrating injury of the spinal cord by a wooden spike with delayed surgery:a case report

Rarely,penetrating injuries to the spinal cord result from wooden objects,creating unique challenges to mitigate neurological injury and high rates of infection and foreign body reactions.We report a man who sustained a penetrating cervical spinal cord injury from a sharpened stick.While initially tetraparetic,he rapidly recovered function.The risks of neurological deterioration during surgical removal made the patient reluctant to consent to surgery despite the impalement of the spinal cord.A repeat MRI on day 3 showed an extension of edema indicating progressive inflammation.On the 7~(th)day after injury,fever and paresthesias occurred with a large increase in serum inflammatory indicators,and the patient agreed to undergo surgical removal of the wooden object.We discuss the management nuances related to wood,the longitudinal evolution of MRI findings,infection risk,surgical risk mitigation and technique,an inflammatory marker profile,long-term recovery,and the surprisingly minimal neurological deficits associated with low-velocity midline spinal cord injuries.The patient had an excellent clinical outcome.The main lessons are that a wooden penetrating central nervous system injury has a high risk for infection,and that surgical removal from the spinal cord should be performed soon after injury and under direct visualization.

Frontal penetrating arrow injury:A case report

BACKGROUND Penetrating arrow injuries of the head and neck are exceedingly rare in pediatric patients.This pathology has high morbidity and mortality because of the presence of vital organs,the airway,and large vessels.Therefore,the treatment and removal of an arrow is a challenge that requires multidisciplinary management.CASE SUMMARY A 13-year-old boy was brought to the emergency room after an arrow injury to the frontal region.The arrowhead was lodged in the oropharynx.Imaging studies showed a lesion of the paranasal sinuses without compromising vital structures.The arrow was successfully removed by retrograde nasoendoscopy without complications,and the patient was discharged.CONCLUSION Although rare,maxillofacial arrow injuries have high morbidity and mortality and require multidisciplinary management to preserve function and aesthetics.

Intentional Penetrating Craniocerebral Injury Caused by a Nail: Clinical Presentation and Management of Three Cases

The authors report on their experience in the medical and surgical management of three cases of penetrating craniocerebral injuries caused by a nail. In all three cases, it was an aggression. Two of the three patients were male. The cranial locations affected were respectively left parietal, right temporal and right frontal. The Glasgow coma score (GCS) was between 9 and 13. None of the patients had a motor deficit. A plain skull radiographs was performed for each patient. All patients underwent surgery and all received antibiotic therapy and tetanus vaccination. In two cases, post-operative outcome was simple. Recovery was complete without sequelae. The patient with a GCS of 9 died the day after surgery.

Epidemiology and risk factors for sports-and recreation-related eye injury:a multicenter prospective observational study

AIM:To identify the epidemiologic characteristics of sportsand recreation-related eye injuries in a large metropolitan city and investigate risk factors associated with visual impairment.METHODS:We performed a multicenter prospective observational study on patients using the regional eye injury registry data.This study included patients with sportsand recreation-related eye injury in four tertiary teaching hospitals in Daegu,Republic of Korea,from August 2016 to July 2018.The primary outcome was visual impairment at the first hospital visit.Distributions of sex,age,place,and causative materials were analyzed according to causative activities.To examine the association between causative activities and visual impairment,a Logistic regression analysis was used.RESULTS:Of the 349 sports-and recreation-related eye injuries,soccer was the most common causative activity,with 21.8%(n=76).Sports-and recreation-related eye injuries occurred mainly in teenagers,individuals in their 20 s,and men.Badminton and soccer were significantly associated with visual impairment at the first hospital visit compared with combat sports[(adjusted odds ratio(AOR),5.18;95%confidence interval(CI),1.67-16.09 for badminton and AOR,3.87;95%CI,1.36-10.99 for soccer].CONCLUSION:Intervention efforts such as deployment of protective eyewear in sports facilities and schools and promotion of wearing protective eyewear during these activities in teenagers and individuals in their 20 s are mandatory.

Novel rodent models of penetrating traumatic brain injury

A penetrating traumatic brain injury（pTBI）occurs when an object impacts the head with sufficient energy to penetrate skin,cranial bone and meninges to inflict injury directly to the brain parenchyma.This type of injury is particularly common in areas plagued by armed conflicts or gun-related violence.

GFAP expression in the optic nerve and increased Н2S generation in the integration centers of the rainbow trout（Oncorhynchus mykiss） brain after unilateral eye injury

Hydrogen sulfide(H2S)is considered as a protective factor against cardiovascular disorders.However,there are few reports on the effects of H2S in the central nervous system during stress or injury.Previous studies on goldfish have shown that astrocytic response occurs in the damaged and contralateral optic nerves.Glial fibrillary acidic protein(GFAP)concentration in the optic nerves of rainbow trout has not been measured previously.This study further characterized the astrocytic response in the optic nerve and the brain of a rainbow trout(Oncorhynchus mykiss)after unilateral eye injury and estimated the amount of H2S-producing enzyme cystathionineβ-synthase(CBS)in the brain of the rainbow trout.Within 1 week after unilateral eye injury,a protein band corresponding to a molecular weight of 50 kDa was identified in the ipsi-and contralateral optic nerves of the rainbow trout.The concentration of GFAP in the injured optic nerve increased compared to the protein concentration on the contralateral side.The results of a quantitative analysis of GFAP+cell distribution in the contralateral optic nerve showed the largest number of GFAP+cells and fibers in the optic nerve head.In the damaged optic nerve,patterns of GFAP+cell migration and large GFAP+bipolar activated astrocytes were detected at 1 week after unilateral eye injury.The study of H2S-producing system after unilateral eye injury in the rainbow trout was conducted using enzyme-linked immunosorbent assay,western blot analysis,and immunohistochemistry of polyclonal antibodies again st CBS in the integrative centers of the brain:telencephalon,optic tectum,and cerebellum.Enzyme-linked immunosorbent assay results showed a 1.7-fold increase in CBS expression in the rainbow trout brain at 1 week after unilateral eye injury compared with that in intact animals.In the ventricular and subventricular regions of the rainbow trout telencephalon,CBS+radial glia and neuroepithelial cells were identified.After unilateral eye injury,the number of CBS+neuroepithelial cells in the pallial and subpallial periventricular regions of the telencephalon increased.In the optic tectum,unilateral eye injury led to an increase in CBS expression in radial glial cells;simultaneously,the number of CBS+neuroepithelial cells decreased in intact animals.In the cerebellum of the rainbow trout,neuroglial interrelationships were revealed,where H2S was released,apparently,from astrocyte-like cells.The organization of H2S-producing cell complexes suggests that,the amount of glutamate produced in the rainbow trout cerebellum and its reuptake was controlled by astrocyte-like cells,reducing its excitotoxicity.In the dorsal matrix zone and granular eminences of the rainbow trout cerebellum,CBS was expressed in neuroepithelial cells.After unilateral eye injury,the level of CBS activity increased in all parts of the cerebellum.An increase in the number of H2S-producing cells was a response to oxidative stress after unilateral eye injury,and the overproduction of H2S in the cerebellum occurred to neutralize reactive oxygen species,providing the cells of the rainbow trout cerebellum with a protective effect.A structural reorganization in the dorsal matrix zone,associated with the appearance of an additional CBS+apical zone,and a decrease in the enzyme activity in the dorsal matrix zone,was revealed in the zones of constitutive neurogenesis.All experiments were approved by the Commission on Biomedical Ethics,A.V.Zhirmunsky National Scientific Center of Marine Biology(NSCMB),Far Eastern Branch,Russian Academy of Science(FEB RAS)(approval No.1)on July 31,2019.

Retinal injury following intravitreal injection of a dexamethasone implant in a vitrectomized eye

Lee SM, Jung JW, Park SW, Lee JE, Byon IS. Retinal injury following intravitreal injection of a dexamethasone implant in a vitrectomized eye. Int J Ophthalmo12017; 10（6）： 1019-1020

About an Observation of a Child Penetrating Brain Injury by Knife

Background: Reported cases of knife injuries to the head in children are rare. Here we describe a case of pediatric penetrating brain injury by knife (PPBIK) and review literature. The patient’s parents were informed that non-identifying information from the case would be submitted for publication, and they provided consent. Case Presentation: A 3-year-old boy presented to our emergency department with a knife penetrating the front of his head during play. Neurologic examination was normal. Radiograph in lateral view demonstrated a metallic knife entering frontal bone. Computed tomography (CT) scan showed small hemorrhage around the foreign body recognized, accompanied by small pneumocephalus. The knife was surgically removed and the dura was closed. He was discharged home after the surgery with normal neurological status. Conclusion: Only four cases of PPBIK have been reported in the literature. The adequate management of these types of injuries requires a correct neuroradiological evaluation.

Transorbital nonmissile penetrating brain injury: Report of two cases

BACKGROUND Penetrating brain injury(PBI) is an uncommon emergency in neurosurgery, and transorbital PBI is a rare type of PBI. Reasonable surgical planning and careful postoperative management can improve the prognosis of patients CASE SUMMARY The first case is a 68-year-old male patient who was admitted to the hospital because a branch punctured his brain through the orbit for approximately 9 h after he unexpectedly fell while walking. After admission, the patient underwent emergency surgical treatment and postoperative anti-infection treatment. The patient was able to follow instructions at a 4-mo follow-up review. The other case is a 46-year-old male patient who was admitted to the hospital due to an intraorbital foreign body caused by a car accident, after which the patient was unconscious for approximately 6 h. After admission, the patient underwent emergency surgical treatment and postoperative anti-infection treatment. The patient could correctly answer questions at a 3-mo follow-up review.CONCLUSION Transorbital PBI is a rare and acute disease. Early diagnosis, surgical intervention, and application of intravenous antibiotics can improve the prognosis and quality of life of patients.

Penetrating efficiency of supramolecular hydrogel eye drops:Electrostatic interaction surpasses ligand-receptor interaction

The low drug bioavailability of eye drops challenges the therapy of ocular disorders with high efficacy.One of solutions is to extend the corneal retention and enhance the penetration of drug into cornea.Here we synthesize two fluorophore-conjugated peptide based analogs rich in positive charges(i.e.,NBDFFKK)and with a specific ligand(i.e.,NBD-FFRGD),respectively,to visualize their performances in vitro and in vivo.The peptides both can self-assemble into supramolecular hydrogels with the microstructure of nanofibers.The in vitro experiments exhibit that two peptides are both uniformly distributed in cytoplasm,and the intracellular amount of peptide rich in positive charges is significantly larger than that of peptide with a specific ligand.The living corneal fluorescence shows that two peptides enter the corneal stroma within 15 min,and the peptide rich in positive charges is accumulated more extensively throughout the entire cornea,revealing that the supramolecular hydrogel eye drops penetrate the cornea more efficiently via electrostatic interaction than that via ligand-receptor interaction.This work,as a comparative study of supramolecular hydrogel eye drops on penetrating efficiency,indicates a possible direction for the design of eye drops with efficient corneal penetration.

Abscess rate of patients with penetrating abdominal injury in Zaria

Background: Penetrating abdominal injury occurs when a foreign object pierces the skin. The morbidity and mortality associated with penetrating abdominal trauma is related to the intra-abdominal complications. This study is, therefore, intended to determine the abscess rate resulting from penetrating abdominal trauma in Ahmadu Bello University Teaching Hospital Zaria. Method: A 6-year (January 2006-December 2011) retrospective study of penetrating abdominal trauma emphasizing on the rate of development of intra-abdominal abscess. Information was obtained from patients’ case notes, operating room log books and surgical audit data. Information extracted included cases of penetrating abdominal trauma, intra-operative findings and cases of intra-abdominal abscesses. Results: A total of 39 cases of penetrating abdominal trauma were treated within this period of six years. 3 (7.7%) were treated in 2006, 6 (15.4%) in 2007, 3 (7.7%) in 2008 and 11 (28.2%) in 2009, 8 (20.5%) in 2010, 9 (23.1%) in 2011. 26 (66.7%) were adult while 13 (33.3%) were paediatric cases. The male were 37 (94.9%) and the female were 2 (5.1%), with a sex ratio of 18.5:1 (male to female). The age range was 5 -60 years (39.92 mean). The commonest cause of injury was road traffic accident. At exploration, 13 (33.3%) had organ injury only, 17 (43.6%) suffer from both organ injury and intra-peritoneal emorrhage, 9 (23.1%) had retroperitoneal haemorrhage only. The intra-abdominal abscess rate of penetrating abdominal injury in Zaria was found to be 2.6%. Conclusion: Contamination from either foreign object or organ injury is found to increase the risk of post-operative intra-abdominal abscess. In this center, the abscess rate of penetrating abdominal trauma is comparatively low.

Hospitalized eye injury in a Chinese urban population:a 7-year retrospective analysis

AIMTo present the epidemiology, cause of injury, ocular status and final visual acuity after management of severe ocular trauma required hospitalization during 7 years in a representative urban Chinese population.

Anesthetic Management of a Rare Penetrating Traumatic Brain Injury Caused by a Pickaxe: A Case Report

Penetrating traumatic brain injuries (TBI) are frequent neurosurgical emergencies, associated with a high mortality rate and we almost no previous report on a penetrating pickaxe TBI. Herein, we report and discuss the anesthetic challenges encountered in the surgical extraction a pickaxe from a patient with TBI. We present the case of a 34-year-old man who with a penetrating pickaxe TBI at his left temporal region, signs of raised intracranial pressure and normal vital signs. Anesthetic management began within 3 hours of admission and consisted of general anesthesia and rapid sequence intubation. Surgical extraction of a 14 cm long wing of the pickaxe was achieved with good hemostatic control. His postoperative course was marked by complete blindness of the right eye till one year of follow-up. The authors highlight the need of a prompt multidisciplinary management with close perioperative monitoring of haemostatic control and signs of raised intracranial pressure as key factors for a favourable postoperative outcome.

A Rare Case of Fish Bone Penetrating Injury to Radius Causing Osteitis and Non-Healing Sinus

Penetrating injury to radius or any other bone by fish bone is a rare kind of injury. Commonly metallic sharp objects, bullets, sharpnels, glass particles, hard wooden pieces are the causes of penetrating injury to bones. Radio-opaque objects are easy to detect and thus retrieval is relatively simpler than the radiolucent objects. Non-biological foreign bodies do not incite any reaction in the host bone whereas biological foreign bodies of either plant or animal origin cause hypersensitivity reaction. Osteitis along with excessive formation of new bones may be presented as a part of host reaction to the foreign body. We are presenting here an interesting case of a fisherman boy who sustained penetrating injury to radius by fish bone resulting in osteitis and a chronic non-healing sinus with watery discharge.

Autologous tenon capsule packing to treat posterior exit wound of penetrating injury: A case report

BACKGROUND This study reports a case of autologous tenon capsule packing to treat the posterior exit wound of penetrating injury.CASE SUMMARY To treat a 58-year-old male patient with penetrating eyeball injury caused by an iron sheet,we used autologous tenon capsule packing.Two months after removal of the silicone oil,the corrected visual acuity was 0.3,the retina was flat,the tenon capsule graft was in place,the posterior wound closed well,and the intraocular pressure was 15.8 mmHg.CONCLUSION Autologous tenon capsule packing to treat the posterior exit wound of penetrating injury is safe and effective.

Chest, pericardium, abdomen, and thigh penetrating injury by a steel rebar: A case report

BACKGROUND Combined penetrating trauma involving the chest, pericardium, abdomen, and thigh is rare and lethal. It is difficult to quickly rescue patients with penetrating injuries from long steel bars.CASE SUMMARY A previously healthy 56-year-old male worker presented with a length of rebar that penetrated the chest-abdomen-pelvic cavity and was palpable on the anterior side of the neck and thigh. On radiological imaging, the left chest wall-left chest cavity-mediastinum-abdominal cavity-right groin area-right thigh demonstrated a strip-like density shadow, about 1.5 cm thick, with the heart, stomach wall, and part of the intestine involved. There was a left-sided pleural effusion, left lung compression of about 50%-60%, and a small amount of left pleural effusion/blood accumulation;possible perforation of hollow organs;and double multiple ribs fractures on the side. An emergency green channel was opened to provide a rescue process for smooth and timely diagnostic and treatment to save the patient's life. The patient was followed at 4 mo after discharge and showed good recovery.CONCLUSION For pre-hospital emergency treatment in locations that are not fully prepared for surgery, we do not recommend cutting the steel bars outside the body. We advocate pulling out foreign bodies intact to reduce secondary injuries.

Orchard Sports Injury and Illness Classification System (OSIICS) Version 15

Background:Sports medicine(injury and illnesses)requires distinct coding systems because the International Classification of Diseases is insuf-ficient for sports medicine coding.The Orchard Sports Injury and Illness Classification System(OSIICS)is one of two sports medicine coding systems recommended by the International Olympic Committee.Regular updates of coding systems are required.Methods:For Version 15,updates for mental health conditions in athletes,sports cardiology,concussion sub-types,infectious diseases,and skin and eye conditions were considered particularly important.Results:Recommended codes were added from a recent International Olympic Committee consensus statement on mental health conditions in athletes.Two landmark sports cardiology papers were used to update a more comprehensive list of sports cardiology codes.Rugby union protocols on head injury assessment were used to create additional concussion codes.Conclusion:It is planned that OSIICS Version 15 will be translated into multiple new languages in a timely fashion to facilitate international accessibility.The large number of recently published sport-specific and discipline-specific consensus statements on athlete surveillance warrant regular updating of OSIICS.