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    ABSTRACT: The worldwide escalation in the volume of suicide terrorist bombing attacks warrants special attention to the specific pattern of injury associated with such attacks. The goal of this study was to characterize thoracic injuries inflicted by terrorist-related explosions and compare pattern of injury to penetrating and blunt thoracic trauma. Prospectively collected database of patients with chest injury who were admitted to Hadassah Hospital Level I trauma centre, in Jerusalem, Israel, from October 2000 to December 2005. Patients were divided into three groups according to the mechanism of injury: terrorist explosions (n = 55), gunshot wounds (GSW; n = 78), and blunt trauma (n = 747). There were many female victims after suicide bombing attacks (49.1%) compared with GSW (21.8%) and blunt trauma (24.6%; p = 0.009). The number of body regions injured was significantly higher in the terror group compared with the GSW and blunt groups (median, 4, 2, and 3, respectively, p < 0.0001). The pattern of chest injury after suicide bombing attacks was caused by a unique combination of the effects of the blast wave and penetrating shrapnel. More than half (52.7%) of the terror victims suffered from lung contusion and 25 (45.5%) required tube thoracostomy. Five patients (9.1%) underwent thoracotomy for lung lacerations (n = 3), injury to great vessels (n = 2), cardiac lacerations (n = 1), and esophageal injury (n = 1). Penetrating shrapnel was the mechanism of injury in all these cases. Injury inflicted by terrorist bombings causes a unique pattern of thoracic wounds. Victims are exposed to a combination of lung injury caused by the blast wave and penetrating injury caused by metallic objects.
    The Journal of trauma 11/2010; 69(5):1022-8; discussion 1028-9. DOI:10.1097/TA.0b013e3181f35c71 · 2.96 Impact Factor
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    ABSTRACT: Blast injury is uncommon, and remains poorly understood by most clinicians outside regions of active warfare. Primary blast injury (PBI) results from the interaction of the blast wave with the body, and typically affects gas-containing organs such as the ear, lungs and gastrointestinal tract. This review investigates the mechanisms and injuries sustained to the abdomen following blast exposure. MEDLINE was searched using the keywords 'primary blast injury', 'abdominal blast' and 'abdominal blast injury' to identify English language reports of abdominal PBI. Clinical reports providing sufficient data were used to calculate the incidence of abdominal PBI in hospitalized survivors of air blast, and in open- and enclosed-space detonations. Sixty-one articles were identified that primarily reported clinical or experimental abdominal PBI. Nine clinical reports provided sufficient data to calculate an incidence of abdominal PBI; 31 (3·0 per cent) of 1040 hospitalized survivors of air blast suffered abdominal PBI, the incidence ranging from 1·3 to 33 per cent. The incidence for open- and enclosed-space detonations was 5·6 and 6·7 per cent respectively. The terminal ileum and caecum were the most commonly affected organs. Surgical management of abdominal PBI is similar to that of abdominal trauma of other causes. Abdominal PBI is uncommon but has the potential for significant mortality and morbidity, which may present many days after blast exposure. It is commoner after blast in enclosed spaces and under water.
    British Journal of Surgery 02/2011; 98(2):168-79. DOI:10.1002/bjs.7268 · 5.21 Impact Factor
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    ABSTRACT: The management of patients who have sustained blast injuries poses an important challenge for military healthcare professionals. Current military operations are generating large numbers of casualties and modern military healthcare facilities are increasingly using CT scanning to facilitate their management. This small case series serves to draw attention to a rare (or possibly under-reported) phenomenon after blast injury. We report two patients exposed to blast who had pneumoperitoneum identified by CT scan but who did not have abdominal visceral injury or ballistic peritoneal violation. The use of cross-sectional imaging is leading to the recognition of otherwise occult injury. Military practitioners should be aware of this injury pattern when using CT to help select patients for conservative management after abdominal blast injury.
    Journal of the Royal Army Medical Corps 12/2013; 159(4):312-3. DOI:10.1136/jramc-2013-000066 · 0.81 Impact Factor