mehdi pakravesh

In the few past decades, the world has experienced numerous terrorist attacks.

We sought to review the mechanisms and patterns of injuries in terrorist attacks; the main goal being better management of victims of these attacks.

In current narrative review; electronic databases (PubMed, Wiley, EMBASE, ISI Web of Knowledge, and Scopus) were searched seeking relevant publications between 2000-2018. The keywords used when searching for articles included: violence, terrorism, disasters, trauma, trauma centers, war, mass casualties, wounds, and injuries. Searching, screening, and assessment of records were done separately by two authors; disagreements were resolved by discussion with a third reviewer.

Nine studies were found to be eligible for inclusion in this study. The most common device-related terrorist attacks were explosives and bombs. More than half of the victims suffered minor injured and could be treated promptly. The most common causes of mortality were head injuries, airway burns, and internal bleeding. The secondary and tertiary results of terrorist attacks were head and neck injuries. Pulmonary injuries were also common injuries in terrorist-attack victims. The most significant cause for emergency treatment was airway burns. The head, neck, pelvis, and hand were the most commonly exposed body areas. Limb amputation is a major result of complications and mortality. The mortality rate of victims that referred to a hospital was low; most deaths occurred at the scene of the attack. Aging victims, children, and women were most influenced by terrorist attacks. Immediate examination, long-term follow-up, and advanced therapeutics and psychological therapy are necessary.

Differences in the severity and type of injuries among victims of terrorist attacks depend upon the various causes of blast injuries, the power of the explosion, the open or enclosed location setting, the destruction of structures, and the interval between cases and the explosion. The current results showed that head and lung injuries are major causes of mortality in victims of terrorism. Appropriate emergency medical services and early management could increase patient survival rates and reduce complications.

Neuroendocrine tumors are classified as rare tumors that are mostly seen in lung or gastrointestinal tract and can cause many specific sign and symptoms such as flushing, diarrhea, heart failure, tachcardia, emesis and bronchoconstriction. In this case, the tumor is located in gallbladder with classic presentations.

A 59 year-old female attended to our clinic with nausea and vomiting, heartburn, weight loss and flushing. The patient’s ultrasound showed a hypo echo and heterogenic mass (24×36 mm) in the anterior wall of gallbladder which continued to the common hepatic duct and the CT scan reported a 40×21 mm mass like lesion in porto-hepatic area with pressure effect on distal of gallbladder and cystic duct suspicious for lymphadenopathy. The postoperative pathological findings were compatible with typical perineural carcinoid tumor.

Carcinoid or neuroendocrine (NETs) tumors are a type of slow growing tumors that are typically originated from several places of the body and usually begin in gastrointestinal (GI) tract or lung. Carcinoid tumor is a rare GI tract disease which consists about 1% of GI tract tumors. The NETs of gallbladder are very rare. This is necessary for surgeons to consider rare types in order to conduct proper management for this condition.