Journal of Trauma & Treatment

Introduction: Trauma is the most common cause of mortality among the age group 1-45 years, causing loss of productive days more than other notorious diseases, such as cardiovascular diseases and malignancies. This study was conducted to describe the frequency and pattern of intra-abdominal injuries in patients with blunt abdominal trauma.

Method: This was an observational study on blunt abdominal injury, which was conducted in surgical unit III, of Jinnah Post-Graduate Medical centre, Karachi. Study included a total of 50 cases of blunt abdominal trauma (data including from July, 2012 to November, 2012). These cases were above the age of 12 years and of both sexes, who came to Accident and Emergency department.

Results: Study included 41 (82%) male and 9 (18%) female patients with ratio of 5.4:1 respectively. There were 15 (30%) patients who suffered from hepatic injuries. Thirteen patients (26%) had splenic injuries. Intestine (from stomach to anal canal) was injured in 11 patients (22%), five patients were with injured small intestine, 2 with stomach and duodenum and rest of the 4 with large gut injuries. Pancreas was injured in 2(4%) patients. Mesenteric tear was found in 3 (6%) patients and 2 (4%) had ruptured diaphragm. Five patients (10%) had retroperitoneal hemotoma. Renal injury was recorded in 3 (6%) patients and 2 patients had urinary bladder injuries.

Conclusion: No abdominal organ is safe from injury. Solid organs are injured more in blunt abdominal trauma. In this study, liver is the organ most commonly injured in blunt abdominal trauma followed by spleen, gut, retroperitoneal hematoma and other organs.

The positive psychology movement has given us new ways to conceptualize behavior. However, little research has been conducted examining the benefits of promoting the development of positive characteristics such as gratitude and love as part of treatment. To address this gap, the present article describes the implementation of a group therapy program grounded in Contemplative Discovery Pathway Theory (CDPT). The innovative program, “The Family”, focuses on the discovery process to resocialize a sample of community members from the Bahamas. We conclude with a case vignette and recommendations for future research directions.

Introduction: Although it is commonly stated that the brain “floats” in the cerebrospinal fluid (CSF), the brain is actually suspended in the CSF-fluid-filled subarachnoid space by trabeculae. Subarachnoid trabaculae are sheets or columns of collagen-reinforced material that stretch between the arachnoid and pia membranes. They can be seen with light microscopes but they are too thin to be seen by ultrasound.

Study: A literature study of the physiology of the subarachnoid space was undertaken. There was a period of interest in trabecular structure in the 1970s, involving electron microscopy. Transmission electron microscopy enabled cell types, and collagen fibre layout, to be determined. The development of scanning electron microscopy techniques allowed the viewing of three dimensional form. Early in mammalian embryo development, a layer of ground substance (gel filled-mesenchyme) advances from the future cervical region into the join between the ectoderm and the neuroepithelium of the telencephalon. It acts as a pia-arachnoid space holder. Randomly spaced fluid-filled “holes” then appear in the gel. These enlarge into randomly spaced and sized, fluid filled, cavities. As the cavities enlarge the remaining mesenchyme elements between them get forced to congregate in the remaining tissue. It appears that when cavities meet, the mesenchyme material lining the two cavities resists further advance leaving, thin walls of mesenchyme which are the origin of trabeculae. The random nature of the original “holes” remains characteristic of trabecular structure thereafter.

Conclusions: The mature subarachnoid space is filled with an ultrasonically invisible “cobweb” of collagen reinforced sheets and cords linking the Arachnoid and Pia Maters. Trabeculae have no coherent structure, they are the result of random removal of tissue, not the generation of new structures.

We present a 12 year old girl who developed pyrexia and a widespread rash following 5 weeks of right shoulder pain. No initial source for sepsis was found. She was diagnosed with right scapula osteomyelitis following plain radiographs and Magnetic Resonance Imaging (MRI). No collection was demonstrated. Despite five days of intravenous antibiotics, she became haemodynamically compromised. She was taken to theatre and her scapula was trephined. Whilst no gross collection was drained, post-operatively she improved rapidly and was discharged home on intravenous (IV) antibiotics.

Two counseling theories, Trauma-Focused Cognitive Behavioral Therapy and Adlerian Therapy are examined for their effectiveness as an integrative model in the treatment of patients who have experienced trauma. The integrative theoretical model is examined and conceptualized in the treatment of individuals, couples and families who have experienced traumatic situations.

Background: Vulnerability of depression has often been linked with enhanced right hemispheric asymmetry. However, other emotional states such as stress and anxiety have also been found to be associated with greater activity of the right hemisphere. Since, anxiety disorders are the most commonly reported co-morbidity in depression; it would be interesting to examine the role of co-morbid anxiety in determining the pattern of hemispheric asymmetry in depression. In the view of this, the present study investigated the influence of co-occurring anxiety on the observed pattern of hemispheric asymmetry in depression in processing of emotional information.

Method: Twenty-nine right handed sub-clinically depressed individuals and matched controls were assessed for their level of anxiety (trait and free-floating) and perceptual asymmetry in processing of emotional information. Three emotional tasks for assessing perceptual asymmetry were used- Chimeric face test, facial emotion discrimination task and judgment of emotional valence of positive and negative emotional words.

Results: The analysis of the obtained data revealed that the depressed individuals showed increased left visual field (right hemispheric) bias in processing of facial emotional stimuli and no asymmetry was reported in processing of emotional words when the co-occurring anxiety was not controlled. Further, the findings of ANCOVA revealed that the observed enhanced right hemispheric asymmetry in depression for processing of emotional information is not influenced by the co-existing level of trait anxiety. But contrary to it, the neurotic (free-floating) anxiety played a minimal role as evident by reduction in the observed magnitude of right hemispheric asymmetry in depressed group after statistically controlling its effect.

Conclusion: The findings indicated that anxiety does not have any significant influence on the observed pattern of hemispheric asymmetry in depression and further, the findings are discussed under the light of several theoretical observations of role of co-morbid anxiety in the pattern of hemispheric asymmetry in depression.

Traumatic stress can alter allostatis and therefore mediate the development of psychological disorders. Recent evidence from molecular studies has shown that telomere length - a measure of cellular aging - is strongly influenced by a broad spectrum of stress. Telomere erosion might be accelerated by traumatic stress, and traumatic stress has shown to be associated with the risk of developing chronic diseases like cancer, cardiovascular diseases and immunologic conditions. Aim: The biological pathways between psychological stress and psychological disorders or physiological diseases are widely unknown. Some experimental studies in animal models and longitudinal studies in humans have investigated the transgenerational consequences of psychological stress on telomere length biology. Telomere length inheritance might provide an additional molecular mechanism for the germ line transmission of environmentally induced phenotypic change and might offer a new biological framework for the multifactorial path etiology underlying stress-related disorders. Procedure: Starting from the well-established allostatic load model, this article reviews theoretical and empirical work from animal models and humans in the field of telomere biology in association with traumatic stress, childhood trauma and post-traumatic stress disorders. Further it reviews recent approaches on telomere length inheritance, and combines these findings with transgenerational research of post-traumatic stress disorder biology. Conclusion: A better understanding of the transgenerational mechanisms underlying common diseases might ultimately help disease prevention of stress related disorders in subsequent generations.

Penetrating scrotal trauma is an uncommon injury that is often secondary to civilian or combat violence. Much of the literature on the topic is from case reports, small retrospective series from civilian trauma centers, and reports from combat zones. In this manuscript, a case report involving self-inflicted penetrating scrotal trauma from our institution is presented. Following the case report, accepted management strategies and recent literature on the topic of penetrating scrotal trauma are reviewed. Briefly, current management strategies for penetrating scrotal injuries involve initial resuscitation and stabilization of the patient, followed by operative exploration, with the primary operative goals of hemostasis, debridement, and testicular salvage. Recent case series of penetrating scrotal trauma have shown rates of testicular salvage that vary between institutions, mechanism of injury, and setting (civilian vs military/combat).