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Gastrointestinal Trauma

Rani Berry, James Han, Mohit Girotra, James H Tabibian
Hemobilia refers to bleeding from and/or into the biliary tract and is an uncommon cause of gastrointestinal hemorrhage. Hemobilia has been documented since the 1600s, but due to its relative rarity, it has only been more critically examined in recent decades. Most cases of hemobilia are iatrogenic and caused by procedures involving the liver, pancreas, bile ducts, and/or the hepatopancreatobiliary vasculature, with trauma and malignancy representing the two other major causes. A classic triad of right upper quadrant pain, jaundice, and overt upper gastrointestinal bleeding has been described, but this is present in only 25-30% of patients with hemobilia...
2018: Gastroenterology Research and Practice
Shang-Li Tsai, Chi-Chun Lin, Cheng-Yu Lin, Chang Keng-Wei, Cheng-Yu Chien
Patients presenting to the emergency department with hypothermia are rare and often require prompt diagnosis and management. Myxedema coma, which may cause severe hypothermia, is a true endocrine emergency requiring early and appropriate treatment. We report on a 47-year-old woman with a history of hyperthyroidism who underwent thyroidectomy 5 years previously, with no regular medication or examinations. She presented to the emergency department with a 1-month history of progressive dyspnea associated with general weakness...
August 15, 2018: Journal of International Medical Research
Paul M Reynolds, Rob MacLaren
STUDY OBJECTIVE: As recent studies have challenged the efficacy of stress ulcer prophylaxis (SUP) in the critically ill patient, the objective of this study was to evaluate the efficacy of SUP with proton pump inhibitors (PPIs) or histamine2 receptor antagonists (H2 RAs) against placebo, control, no therapy, or enteral nutrition alone in critically ill adults. DESIGN: Meta-analysis with trial sequential analysis (TSA) of 34 randomized controlled trials. PATIENTS: A total of 3220 critically ill adults who received PPIs or H2 RAs versus placebo, control, no therapy, or enteral nutrition...
August 13, 2018: Pharmacotherapy
Kevin M Izquierdo, Ece Unal, John H Marks
Over the past 30 years, colorectal surgery has evolved to include minimally invasive surgical techniques. Minimally invasive surgery is associated with reduced postoperative pain, reduced wound complications, earlier return of bowel function, and possibly shorter length of hospital stay. These benefits have been attributed to a reduction in operative trauma compared to open surgery. The need to extract the specimen in colorectal operations through a "mini-laparotomy" can negate many of the advantages of minimally invasive surgery...
2018: Clinical and Experimental Gastroenterology
Hariprasath Prakash, Anup Kumar Ghosh, Shivaprakash Mandya Rudramurthy, Pankaj Singh, Immaculata Xess, Jayanthi Savio, Umabala Pamidimukkala, Joseph Jillwin, Subhash Varma, Ashim Das, Naresh K Panda, Surjit Singh, Amanjit Bal, Arunaloke Chakrabarti
Mucormycosis due to Mucorales is reported at large numbers in uncontrolled diabetics across India, but systematic multicenter epidemiological study has not been published yet. The present prospective study was conducted at four major tertiary care centers of India (two in north and two in south India) during 2013-2015 to compare the epidemiology, treatment strategies and outcome of mucormycosis between the two regions. Molecular techniques were employed to confirm the identity of the isolates or to identify the agent in biopsy samples...
August 1, 2018: Medical Mycology: Official Publication of the International Society for Human and Animal Mycology
Ryan C Burke, Erin L Simon, Brian Keaton, Laura Kukral, Nicholas J Jouriles
OBJECTIVE: Compare clinical characteristics for adult visits to freestanding emergency departments (FEDs) and a hospital-based ED (HBED). METHODS: Electronic health records were collected on adult ED visits from 7/1/14 to 6/30/15 from three FEDs and one level 1 trauma tertiary care HBED. RESULTS: There were 55,909 HBED visits; 44,108 FED visits. The FED population was slightly more female (61% vs 57%), younger (48 vs 46 years), white (86% vs 60%), and employed (67% vs 49%)...
June 30, 2018: American Journal of Emergency Medicine
Fatma Eti Aslan, Sennur Kula Şahin, Selda Secginli, Semra Bülbüloğlu
OBJECTIVES: The aim of this study was to investigate patient satisfaction with nursing practices regarding postoperative pain management. METHODS: A systematic review of the literature published between 2005 and 2015 was conducted, comprising a search of 7 databases: ScienceDirect, Turkish Medline, PsycINFO, Ovid, Prequest, Google Scholar, and the ULAKBIM Turkish Medical Database. Five articles were identified as eligible for review. The methodological quality of the studies was assessed using the Turkish version of the Joanna Briggs Institute-Meta Analysis of Statistics Assessment and Review Instrument (JBI -MAStARI) Critical Appraisal Checklist...
July 2018: Aǧrı: Ağrı (Algoloji) Derneği'nin Yayın Organıdır, the Journal of the Turkish Society of Algology
S Di Saverio, E Segalini, A Birindelli, S Todero, M Podda, A Rizzuto, G Tugnoli, A Biondi
BACKGROUND: Ideal surgical treatment for acute duodenal injuries should offer a definitive treatment, with low morbidity and mortality. It should be simple and easily reproducible by acute care surgeons in an emergency. Duodenal injury, due to major perforated or bleeding peptic ulcers or iatrogenic/traumatic perforation, represents a surgical challenge, with high morbidity and mortality. The aim was to review definitive surgery with pancreas-sparing, ampulla-preserving duodenectomy for these patients...
July 19, 2018: British Journal of Surgery
Timothy T Pham, Grant H Skrepnek, Christopher Bond, Thomas Alfieri, Terry J Cothran, Shellie L Keast
BACKGROUND: Medicaid members are predisposed to unintentional prescription opioid overdose. However, little is known about their individual risk factors. OBJECTIVES: To describe demographic and clinical characteristics, medical utilization, opioid use, concurrent use of benzodiazepines, risk factors, and substances involved in death for Oklahoma's Medicaid members who died of unintentional prescription opioid poisoning. SUBJECTS: Decedents who were Medicaid eligible in Oklahoma during the year of death, had an opioid recorded in cause of death, and had ≥1 opioid prescription claim between January 1, 2011 and June 30, 2016 were cases...
August 2018: Medical Care
Patrick M Ketter, Jieh-Juen Yu, M Neal Guentzel, Holly C May, Rishein Gupta, Mark Eppinger, Karl E Klose, J Seshu, James P Chambers, Andrew P Cap, Bernard P Arulanandam
Multidrug-resistant Acinetobacter baumannii is among the most common causes of infectious complications associated with combat-related trauma in military personnel serving overseas. However, little is currently known about its pathogenesis. While the gastrointestinal (GI) tract has been found to be a major reservoir for A. baumannii , as well as to potentially contribute to development of multidrug resistance, no studies have addressed the mechanisms involved in gut colonization. In this study, we address this critical gap in knowledge by first assessing the interaction between secretory IgA (SIgA), the principal humoral immune defense on mucosal surfaces, and the A...
July 10, 2018: MBio
Temesgen Firomsa, Muluwork Teferra, Amezene Tadesse
Background: Pediatric surgical emergency condition is a broad spectrum of surgical pathologies/disorders occurring in pediatric age group requiring proper emergency surgical care as the only option of management to salvage life, avoid/minimize disability or palliation. The objective of this study is to analyze the pattern and outcome of pediatric surgical emergencies managed at Tikur Anbesa Hospital and the factors associated with outcome. Methods: Retrospective analysis of medical records of patients was conducted to assess the pattern, outcome and factors associated with outcome of pediatric surgical emergencies admitted and managed at Tikur Anbesa Specialized Hospital, from January 1, 2015 to December 31, 2015...
May 2018: Ethiopian Journal of Health Sciences
Massimo Pieraccini, Susanna Guerrini, Edoardo Laiolo, Alessio Puliti, Giandomenico Roviello, Leonardo Misuraca, Genni Spargi, Ugo Limbruno, Mauro Breggia, Morando Grechi
PURPOSE: The aim of this study is to assess the feasibility of aspiration mechanical thrombectomy in patients with massive and submassive pulmonary embolism (PE) and contraindications to thrombolysis. MATERIALS AND METHODS: Eighteen patients presenting massive (8/18) or submassive (10/18) PE were prospectively enrolled between October 2016 and November 2017. All the patients enrolled had contraindications to thrombolysis (haemorrhagic stroke n = 1, ischaemic stroke in the preceding 6 months n = 7, central nervous system damage or neoplasms n = 1, recent major trauma/surgery/head injury in the preceding 3 weeks n = 5, gastrointestinal bleeding within the last month n = 4)...
July 6, 2018: Cardiovascular and Interventional Radiology
Seung Hwan Lee, Jin Young Lee, Tae Hwa Hong, Bo Ok Kim, Yeon Ju Lee, Jae Gil Lee
BACKGROUND: Plasma cholesterol acts as a negative acute phase reactant. Total cholesterol decreases after surgery and in various pathological conditions, including trauma, sepsis, burns, and liver dysfunction. This study aimed to determine whether hypocholesterolemia after emergency gastrointestinal (GI) surgery is associated with in-hospital mortality in patients with diffuse peritonitis. METHODS: The medical records of 926 critically ill patients who had undergone emergency GI surgery for diffuse peritonitis, between January 2007 and December 2015, were retrospectively analyzed...
2018: PloS One
Gustavo Gonçalves Arliani, Paulo Henrique Schmidt Lara, André Pedrinelli, Benno Ejnisman, Luiz Marcelo Bastos Leite, Moises Cohen
Objective: Several studies have already described the main injuries to soccer players during FIFA World Cup events; however, little is known about the main reasons spectators require medical assistance during these matches. The aim of this study is to assess the number of cases and main reasons spectators required medical assistance during the 2014 World Cup matches in Brazil. Methods: Data were collected from spectators who received medical assistance on all game days, and factors related to the assistance provided were analyzed...
January 2018: Acta Ortopedica Brasileira
Talma Rosenthal
Among migrants who arrived in the USA and Europe, communicable diseases such as dermatologic, gastrointestinal, and respiratory infections are frequent; non-communicable diseases including chronic diseases such as hypertension and diabetes, and vaccine-preventable diseases are also prevalent. Refugees are often not up to date on routine immunizations and screenings for chronic diseases and cancer. In addition, many immigrants have trauma-related mental health problems, which are often not addressed by the healthcare systems where they reside...
July 3, 2018: Current Hypertension Reports
Susannah E Nicholson, Lora T Watts, David M Burmeister, Daniel Merrill, Shannon Scroggins, Yi Zou, Zhao Lai, Ramesh Grandhi, Aaron M Lewis, Larry M Newton, Brian J Eastridge, Martin G Schwacha
The microbiome is defined as the collective genomes of the microbes (composed of bacteria, bacteriophage, fungi, protozoa and viruses) that colonize the human body, and alterations have been associated with a number of disease states. Changes in gut commensals can influence the neurologic system via the brain-gut axis, and systemic insults such as trauma or traumatic brain injury (TBI) may alter the gut microbiome. The objective of this study was to evaluate the gut microbiome in a pre-clinical TBI cortical impact model...
June 26, 2018: Shock
Mathieu Carron, Nicolas Emeyriat, Jacques Levraut, Nicolas Blondeau
BACKGROUND: Navigations on cruise ships are rising and tend to spread to remote areas like polar regions. Our aim was to assess the prevalence of pathologies encountered on a cruise ship navigating in remote areas including Polar Seas. MATERIALS AND METHODS: A prospective observational, descriptive and cross-sectional study was conducted aboard a cruise ship with an overall capacity of 200-264 passengers and 140 crewmembers, sailing in remote areas as the Arctic Ocean and the Antarctic Peninsula over a period of 205 days...
2018: International Maritime Health
Alexander Makatsariya, Lyudmila Radetskaya, Viktoriya Bitsadze, Jamilya Khizroeva, Nadin Khamani, Natalya Makatsariya
BACKGROUND: Mesenchymal dysplasias or inherited connective tissue diseases are the group of diseases with deficiency of various components of connective tissue. Connective tissue disorders can affect different organs: skeleton, sight organ, skin, lungs, heart. But the most dangerous is vascular wall insufficiency leading to high risk of hemorrhage, especially during pregnancy and delivery due to hemodynamic and hormonal effects on the walls of the modified vessels Aim: to evaluate the risk of complications during the pregnancy and delivery in patients with mesenchymal dysplasias...
June 24, 2018: Journal of Maternal-fetal & Neonatal Medicine
Thekla F Vrolijk-Bosschaart, Sonja N Brilleslijper-Kater, Marc A Benninga, Ramón J L Lindauer, Arianne H Teeuw
Recognizing child sexual abuse (CSA) in children is difficult, as there can be many hurdles in the assessment of alleged CSA. With this paper, we try to improve the recognition of CSA by discussing: (1) the difficulties regarding this matter and (2) the diagnostic evaluation of alleged CSA, combining both practical clinical recommendations based on recent research. Children are restrained to disclose CSA due to various reasons, such as fears, shame, and linguistic or verbal limitations. Associations between CSA and urogenital or gastrointestinal symptoms, internalizing and externalizing behavioral problems, post-traumatic stress symptoms, and atypical sexual behavior in children have been reported...
June 25, 2018: European Journal of Pediatrics
Melanie R Hoehn, Natasha Z Hansraj, Amelia M Pasley, Megan Brenner, Samantha R Cox, Jason D Pasley, Jose J Diaz, Thomas Scalea
BACKGROUND: Hemorrhagic shock is the second leading cause of death in blunt trauma and a significant cause of mortality in non-trauma patients. The increased use of resuscitative endovascular balloon occlusion of the aorta (REBOA) as a bridge to definitive control for massive hemorrhage has provided promising results in the trauma population. We describe an extension of this procedure to our hemodynamically unstable non-trauma patients. METHODS: This is a retrospective review of patients requiring REBOA for end stage non-traumatic abdominal hemorrhage from our tertiary care facility...
June 19, 2018: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
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