J Trauma
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We report a case of complete cricotracheal transection with wide separation of the ends, a rare injury. Because of the good general and respiratory condition of the patient on admission, the pathognomonic signs of laryngeal injury were not noticed, causing an unnecessary delay in treatment. Deteriorating respiratory status with progressing cervical subcutaneous emphysema brought up the diagnosis of laryngotracheal injury. Treatment was immediate and included tracheotomy and primary end-to-end anastomosis.
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Esophageal injury resulting from a gunshot wound of the chest is unusual. Even more rare is intraluminal movement of the bullet through the gut, which we found described only twice previously. The perforation was demonstrated by esophagram and confirmed by thoracotomy.
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The "lung in shock" syndrome is a constellation of early morphologic changes in the lung within 1 hour after polytrauma as indicated by human lung biopsies. A hypovolemic-traumatic (soft-tissue trauma together with bone fractures) baboon model with reinfusion was established to study these morphologic and associated pathophysiologic events. This model was developed in order to test the efficacy of therapeutic modalities in future studies. ⋯ The fluid accumulation occurred in spite of careful control of pulmonary artery pressures during the study. More striking histologic findings were significant cellular infiltration of lung tissue, especially by leukocytes, showing evidence of degranulation. This baboon study, similar to studies undertaken in canines, shows that the hypovolemic (hemorrhagic) shock in association with trauma (fracture, soft-tissue trauma) causes ultrastructural morphologic changes that may precede potentially life-threatening functional changes in the lung.