In recent years, there has been a steady increase in injuries all over the world. Man-made and natural disasters, local military conflicts, transport and industrial accidents in 50-60% of cases of all injuries lead to combined and multiple injuries to organs and systems of the human body, and, as a result, to high sanitary losses in the first hours and days [1,2,5,13,19,21]. This article discusses intestinal injuries in combined abdominal trauma.
A few states, notably California, are experiencing large increases in the number and cost of disability settlements under workers' compensation. Claims of cumulative injury for coronary heart disease, hypertension, stroke, cancer and neuropsychiatric problems have all been interpreted as compensable under workers' compensation, even when these conditions are clearly related to the aging process. Legal precedents for such claims are building rapidly throughout the country. The resultant costs may lead to the demise of the workers' compensation system. The situation in California is discussed in detail including the legal aspects, cumulative injury claims by type of disease and age of claimants, legal costs to the individual and the employer, and the economic outlook for the workers' compensation insurance system.
In the past 20 years, there has been an increase in the incidence of head injuries caused by gunshot wounds. Penetrating brain injury is a traumatic brain injury caused by high-velocity projectiles or low-velocity sharp objects. A wound in which the projectile breaches the cranium but does not exit is referred as a penetrating wound, and an injury in which the projectile passes entirely through the head, leaving both entrance and exit wounds, is referred to as a perforating wound. A large number of these patients who survive their initial wounding will nevertheless expire shortly after admission to the hospital. Until the introduction of aseptic surgery in the last quarter of the nineteenth century, penetrating missile injuries of the brain were almost universally fatal. We have learned a great deal about gunshot wounds and their management from military experience gained during times of war, when a large number of firearm-related casualties are treated in a short period of time. Newly designed protective body armor has reduced the incidence of penetrating brain injuries significantly. Many of the victims in the vicinity of a cased explosive or an improvised explosive device will incur injuries by fragments. Blast injury is a common mechanism of traumatic brain injury among soldiers serving in war zone. Each war has had different lessons to teach. World War I for example, proved the efficacy of vigorous surgical intervention. During World War II, the importance of initial dural repair and antibiotic medication was first, debated, then acknowledged, and finally, universally accepted. The incidence of blast-induced traumatic brain injury has increased substantially in recent military conflicts. Blast-induced neurotrauma is the term given to describe an injury to the brain that occurs after exposure to a blast. Resent conflict has exposed military personnel to sophisticated explosive devices generating blast overpressure that results in secondary cellular and molecular insults to the brain parenchyma akin to diffuse brain injury. In soldiers with varying amounts of body armor, the pattern is quite different. What had previously been fatal penetrating brain injuries now become treatable brain injuries as a consequence of secondary damping of energy by the helmet. Traumatic brain injury is not prevented by a protective helmet. High- and low-frequency blast waves disrupt the blood-brain barrier and produce massive brain swelling in a very short time, thereby necessitating urgent decompressive craniectomy, and when low in energy, such blast waves may result in cytoskeletal and diffuse axonal injury that leads to neurodegeneration. Penetrating traumatic brain injury is typically identified and treated immediately mild traumatic brain injury may be missed, particularly in the presence of other more obvious injuries. In recent years there has been an apparent paradigm shift of scientific interest in long-term effects of mild traumatic brain injury and its contribution to posttraumatic stress disorder. The introduction of Guidelines for the Management of Penetrating Brain Injury has revolutionized the medical and surgical management of penetrating brain injury during the last decade. There has been a paradigm shift toward a less aggressive debridement of deep seated fragments and a more aggressive antibiotics prophylaxis in an effort to improve outcomes.
Informed by coherence theory, it is contended that the narratives used in legal injury cases possess a universal set of particular characteristics & that these characteristics are found within the genre of melodrama. An overview of the melodramatic genre is presented, highlighting the various character types & motifs prevalent in such works & reviewing literary critical accounts of the function of melodrama. Similarities between melodramas & legal injury narratives are illuminated, including (1) the existence of a fundamental plot in which a benevolent & inherently good plaintiff/protagonist is wronged by a malicious & blameworthy defendant/antagonist; (2) the unilateral assertion of blame for the injury; (3) the presence of certain stock characters who fulfill stereotypical roles; (4) the attribution of certain characteristics like weakness & passivity to the plaintiff/protagonist; (5) the gendering & racializing of both principal parties/characters; (6) the articulation of the plaintiff/protagonist's virtue; & (7) the expression of positive emotions toward the plaintiff/protagonist. Future directions for research are offered. 41 References. J. W. Parker
There is an increasing incidence of military traumatic brain injury (TBI), and similar injuries are seen in civilians in war zones or terrorist incidents. Indeed, blast-induced mild TBI has been referred to as the signature injury of the conflicts in Iraq and Afghanistan. Assessment involves schemes that are common in civilcian practice but, in common with civilian TBI, takes little account of information available from modern imaging (particularly diffusion tensor magnetic resonance imaging) and emerging biomarkers. The efficient logistics of clinical care delivery in the field may have a role in optimizing outcome. Clinical care has much in common with civilian TBI, but intracranial pressure monitoring is not always available, and protocols need to be modified to take account of this. In addition, severe early oedema has led to increasing use of decompressive craniectomy, and blast TBI may be associated with a higher incidence of vasospasm and pseudoaneurysm formation. Visual and/or auditory deficits are common, and there is a significant risk of post-traumatic epilepsy. TBI is rarely an isolated finding in this setting, and persistent post-concussive symptoms are commonly associated with post-traumatic stress disorder and chronic pain, a constellation of findings that has been called the polytrauma clinical triad.
These recommendations on the use of bicycle helmets are the first in a series of Injury-Control Recommendations that are designed for state and local health departments or other organizations for use in planning injury control programs. Each publication in the series of Injury-Control Recommendations will provide information for program planners to use when implementing injury control interventions. These guidelines were developed for state and local agencies and organizations that are planning programs to prevent head injuries among bicyclists through the use of bicycle helmets. The guidelines contain information on the magnitude and extent of the problem of bicycle-related head injuries and the potential impact of increased helmet use; the characteristics of helmets, including biomechanical characteristics, helmet standards, and performance in actual crash conditions; barriers that impede increased helmet use; and approaches to increasing the use of bicycle helmets within the community. In addition, bicycle helmet legislation and community educational campaigns are evaluated ; Introduction -- Background -- Bicycle helmets and the prevention of head injury -- Increasing the use of bicycle helmets -- Recommendations -- Appendix A: Bicycle helmet legislation -- Appendix B: Organizations that provide information on bicycle helmet -- Campaigns -- Appendix C: Components of a community-based bicycle helmet -- campaign. ; February 17, 1995. ; The following CDC staff members prepared this report: Robert D. Brewer, Mary Ann Fenley, Pamela I. Protzel, Jeffrey J. Sacks, Timothy N. Thornton, Nancy Dean Nowak, Benjamin Moore, James Belloni, National Center for Injury Prevention and Control. ; Includes bibliographical references (p. 10-12).
