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vascular surgery; general surgery; trauma

Sharon Edwards, Jason Smith
Trauma is a leading cause of death and disability worldwide, in civilian environments and on the battlefield. Trauma-induced haemorrhage is the principal cause of potentially preventable death, which is generally attributable to a combination of vascular injury and coagulopathy. Survival rates following severe traumatic injury have increased due to advanced trauma management initiatives and treatment protocols, influenced by lessons learned from recent conflicts in Iraq and Afghanistan. The use of tourniquets and intraosseous needles, early blood and blood product transfusion, administration of tranexamic acid in pre-hospital settings, and consultant-led damage control resuscitation incorporating damage control surgery have all played their part...
October 6, 2016: Emergency Nurse: the Journal of the RCN Accident and Emergency Nursing Association
Joseph D Forrester, Thomas G Weiser, Paul Maggio, Timothy Browder, Lakshika Tennakoon, David Spain, Kristan Staudenmayer
BACKGROUND: Trauma patients with vascular injuries have historically been within a general surgeon's operative ability. Changes in training and decline in operative trauma have decreased trainees' exposure to these injuries. We sought to determine how frequently vascular procedures are performed at US trauma centers to quantify the need for general surgeons trained to manage vascular injuries. METHODS: We conducted a retrospective analysis of the National Trauma Data Base (NTDB) from 2012 compared with 2002...
September 2016: Journal of Surgical Research
Y E Chee, S E Liu, M G Irwin
Management of acute coagulopathy and blood loss during major vascular procedures poses a significant haemostatic challenge to anaesthetists. The acute coagulopathy is multifactorial in origin with tissue injury and hypotension as the precipitating factors, followed by dilution, hypothermia, acidemia, hyperfibrinolysis and systemic inflammatory response, all acting as a self-perpetuating spiral of events. The problem is confounded by the high prevalence of antithrombotic agent use in these patients and intraoperative heparin administration...
September 2016: British Journal of Anaesthesia
Iulian Daniel Vîlcioiu, Dragoş George Zamfirescu, Ioan Cristescu, Andrei Ursache, Şerban Arghir Popescu, Cosmin Antoniu Creangă, Ioan Lascăr
Giant cell tumor of bone (GCTB) represents one of the commonest bone tumors encountered by an orthopedic surgeon. The giant-cell tumor is generally classified as benign but the fast growing rhythm and the aggressive soft-tissue invasion may in some cases demonstrate a malign potential of the tumor. We present the case of an aggressive giant cell tumor in a young patient that was first diagnosed in our emergency department with a fracture of the distal femur after a low energy trauma. With further examinations, we discovered that the tumor was invading the both femoral condyles and was vascularized by three major arterial pedicles...
2016: Romanian Journal of Morphology and Embryology, Revue Roumaine de Morphologie et Embryologie
U S Dadhwal, N Pathak
Severe traumatic injury is a public health care problem; with injuries accounting for 12% of the global mortality. Continued improvement in the survival of severely injured trauma patients is a paramount goal. Bailout/damage control surgery following trauma has developed as a major advance in surgical practice in the last twenty years. The principles of damage control surgery defied the traditional surgical teaching of definitive operative intervention and were slow to be adopted. Currently, damage control surgery has been successfully utilized to manage traumatic thoracic, abdominal, extremity, and peripheral vascular injuries...
October 2010: Medical Journal, Armed Forces India
Richard A Sidwell, Hayden L Smith, James P Halsey, Matthew J McFarlane
OBJECTIVE: To investigate the level of ionizing radiation exposure among surgical residents and to evaluate resident knowledge, attitudes, and practices regarding exposures. DESIGN: An observational study was conducted using radiation exposure data for surgical residents who wore film badge dosimeters. A cross-sectional survey was electronically administered at the end of the year, examining resident knowledge, attitudes, and practices concerning radiation exposures...
June 2, 2016: Journal of Surgical Education
Aimee K Gardner, Daniel J Scott
BACKGROUND: Although the reciprocity hypothesis (that trainees have a tendency to modify evaluations based on the grades they receive from instructors) has been documented in other fields, very little work has examined this phenomenon in the surgical residency environment. The purpose of this study was to investigate the extent to which lenient-grading faculty receive higher evaluations from surgery residents. METHODS: Evaluation data from 2 consecutive academic years were collected retrospectively at a large university-based General Surgery residency program...
May 17, 2016: Journal of Surgical Education
A Fochtmann, H Binder, G Rettl, J Starlinger, O Aszmann, K Sarahrudi, S Hajdu
INTRODUCTION: Third degree open fractures and traumatic sub-/total amputations of the upper extremity represent severe injuries and are associated with a high rate of functional impairment of the affected extremity. More than 20 years ago, the Mangled Extremity Severity Score (MESS) was introduced to predict amputation following severe lower extremity trauma. However, there have been few studies evaluating MESS in connection with the mangled upper limb. MATERIAL AND METHODS: A retrospective medical chart review was performed of all patients diagnosed with the aforementioned fractures of the upper extremity treated at the Department of trauma surgery (level I trauma center) and the Clinical division of plastic and reconstructive surgery at the general hospital of Vienna between 1994 and 2014...
October 2016: Orthopaedics & Traumatology, Surgery & Research: OTSR
Gianluca Costa, Paolo Ruscelli, Genoveffa Balducci, Francesco Buccoliero, Laura Lorenzon, Barbara Frezza, Piero Chirletti, Franco Stagnitti, Stefano Miniello, Francesco Stella
BACKGROUND: Intestinal obstructions/pseudo-obstruction of the small/large bowel are frequent conditions but their management could be challenging. Moreover, a general agreement in this field is currently lacking, thus SICUT Society designed a consensus study aimed to define their optimal workout. METHODS: The Delphi methodology was used to reach consensus among 47 Italian surgical experts in two study rounds. Consensus was defined as an agreement of 75.0% or greater...
2016: Annali Italiani di Chirurgia
Sherif Shalaby, Jeffrey Indes, Benison Keung, Christopher H Gottschalk, Duarte Machado, Amar Patel, Daphne Robakis, Elan D Louis
BACKGROUND: Public awareness of and attitude toward disease is an important issue for patients. Public awareness of essential tremor (ET) has never been studied. METHODS: We administered a 10-min, 31-item questionnaire to 250 consecutive enrollees. These included three samples carefully chosen to have a potential range of awareness of ET: 100 individuals ascertained from a vascular disease clinic, 100 individuals from a general neurology clinic, and 50 Parkinson's disease (PD) patients...
2016: Frontiers in Neurology
Mehmet İlhan, Ali Fuat Kaan Gök, Gizem Öner, Kayıhan Günay, Cemalettin Ertekin
INTRODUCTION: Penetrating thoracic trauma management represents a major problem for emergency department staff. In these cases, we reported a patient, who can be deemed very lucky, because of both the trauma mechanism and the provided first aid at scene. PRESENTATION OF CASE: A 30-year-old man was transported to the emergency surgery outpatient clinic after being stabbed from his back. A knife entered thorax from the dorsal region paravertebrally between two scapulae...
2016: International Journal of Surgery Case Reports
Rasikh Maqsood, Alia Rasikh, Tariq Abbasi, Irfan Shukr
BACKGROUND: As a front line state in war against terror, Pakistan has been a victim of terrorism, for the last many years & Baluchistan has been the hub of all such terror activities. The objective of this study was to determine the incidence and type of injuries in mass casualties in terrorist activities in Baluchistan. METHODS: The study was done by the review of the record of all patients of terrorist attacks who were admitted in Combined Military Hospital (CMH) Quetta from 27th Aug 2012 to 31st Jul 2015...
October 2015: Journal of Ayub Medical College, Abbottabad: JAMC
Huan Yan, Steven Maximus, Matthew Koopmann, Jessica Keeley, Brian Smith, Christian de Virgilio, Dennis Y Kim
BACKGROUND: Vascular injuries may be challenging, particularly for surgeons who have not received formal vascular surgery fellowship training. Lack of experience and improper technique can result in significant complications. The objective of this study was to examine changes in resident experience with operative vascular trauma over time. METHODS: A retrospective review was performed using Accreditation Council for Graduate Medical Education (ACGME) case logs of general surgery residents graduating between 2004 and 2014 at 2 academic, university-affiliated institutions associated with level 1 trauma centers...
May 2016: Annals of Vascular Surgery
Anthony J Carden, Edgardo S Salcedo, David E Leshikar, Garth H Utter, Machelle D Wilson, Joseph M Galante
BACKGROUND: Current general surgery residents have limited exposure to open trauma operative cases. Simulation supplements variable rotation volume and provides experience with critical but rarely performed procedures. Open simulation classically focuses on static models with anatomic accuracy but lacks practicality when hemorrhage control is the lifesaving maneuver. We sought to evaluate whether training on a dynamic simulator, while much less expensive than training on a static cadaver, might be at least as effective in training surgery residents to expeditiously place temporary vascular shunts (TVSs)...
May 2016: Journal of Trauma and Acute Care Surgery
L Kobayashi, R Coimbra
Planned re-laparotomy or damage control laparotomy (DCL), first described by Dr. Harlan Stone in 1983, has become a widely utilized technique in a broad range of patients and operative situations. Studies have validated the use of DCL by demonstrating decreased mortality and morbidity in trauma, general surgery and abdominal vascular catastrophes. Indications for planned re-laparotomy include severe physiologic derangements, coagulopathy, concern for bowel ischemia, and abdominal compartment syndrome. The immunology of DCL patients is not well described in humans, but promising animal studies suggest a benefit from the open abdomen (OA) and several human trials on this subject are currently underway...
April 2014: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Christian Hierholzer, Volker Bühren, Alexander Woltmann
Spinal injuries occurring in polytrauma patients are caused by high impact trauma. Due to high velocity mechanism, trauma of the vertebral column may be accompanied by injuries of adjacent body cavities such as thorax, abdomen, and pelvis. Neurologic examination is mandatory and has to be documented preferably using the ASIA/IMSOP-classification. Clinical symptoms may point towards spinal injury. However, absence of clinical symptoms is not sufficient to rule out spinal injuries. Two diagnostic pathways may be followed to assess the spine: (1) Conventional X-ray diagnostics of the entire spine followed by selective CT scanning of suspected lesions and CT scanning of the upper cervical spine region C0-C3 in unconscious patients...
October 2007: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
K Koca, T Ege, M Kurklu, S Ekinci, S Bilgic
OBJECTIVE: Humerus shaft fractures are frequent injuries in orthopedic practice and generally occurs with direct and indirect traumas. While the most of these fractures can be managed with conservative methods, in some situations surgery is needed. The aim of this study is to define a different mechanism and treatment result of  humerus spiral fractures with medial butterfly fragment (AO-12-B1). PATIENTS AND METHODS: Between 2010 and 2013, 11 patients who had undergone surgery for spiral humerus shaft fracture with medial large butterfly fragment (AO type 12-B1) resulting from a motor vehicle accident were enrolled to the study...
December 2015: European Review for Medical and Pharmacological Sciences
Sirichai Kamnerdnakta, Nuttorn Boochangkool
BACKGROUND: Microvascular free flap operation has become the preferred reconstructive technique at many medical centers to cover complex defects from tumor ablative surgery or trauma and for reconstructive procedure such as functioning muscle transfer. There are many clinical reports about free tissue transfer since the beginning of microvascular technique in the early 1960s. The overall success rate is about 90 to 98% but there may be postoperative complications. OBJECTIVE: Retrospectively analyze outcome and complications of consecutive series of microvascular free flap procedures, and compare with series published by other center...
October 2015: Journal of the Medical Association of Thailand, Chotmaihet Thangphaet
Manikandan Patchayappan, Sangara Narayanan Narayanasamy, Nagarajan Duraisamy
OBJECTIVE: To analyze mesh fixation with minimum sutures and postoperative complications. STUDY DESIGN: Prospective study. PLACE AND DURATION OF STUDY: Department of General Surgery, Thanjavur Medical College and Hospital, Tamil Nadu, from July 2010 to June 2012. MATERIALS AND METHODS: All inguinal hernia patients, who fulfilled the sample selection criteria, were admitted and planned for surgery. The prolene mesh is fashioned as in Lichtenstein's repair, placed and fixed only by three prolene stitches...
October 2015: Avicenna Journal of Medicine
Giuseppe Solarino, Angela Notarnicola, Giuseppe Maccagnano, Andrea Piazzolla, Biagio Moretti
Irreducible posterolateral dislocations of the knee are rare lesions, generally caused by high-energy trauma inducing rotational stress and a posterior and lateral displacement of the tibia. In these conditions, the interposition of abundant soft tissue inside the enlarged medial joint space prevents spontaneous reduction or non-surgical treatment by manipulation of the dislocation. Surgical treatment is therefore compulsory. We report the clinical case of a woman who suffered a subluxation of the knee while jogging...
April 2015: Joints
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