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Gastrointestinal Trauma

Andrew Davies, Wei Sheng Pang, Timothy Fowler, Ffion Dewi, Thomas Wright
Preoperative fasting is necessary to reduce the risk of regurgitation of gastric contents and pulmonary aspiration in patients undergoing general anaesthetic and procedural sedation. Excessive fasting is associated with metabolic, cardiovascular and gastrointestinal complications and patient discomfort. We aimed to reduce the fasting time for patients on the plastic surgery trauma list. Adult inpatients awaiting surgery were asked to complete a preoperative assessment sheet. Questions included the length of preoperative fasting, clarity of instructions and wellness scores...
2018: BMJ Open Quality
Brian W Powers, Jiali Yan, Jingsan Zhu, Kristin A Linn, Sachin H Jain, Jennifer L Kowalski, Amol S Navathe
BACKGROUND: There is a growing focus on improving the quality and value of health care delivery for high-cost patients. Compared to fee-for-service Medicare, less is known about the clinical composition of high-cost Medicare Advantage populations. OBJECTIVE: To describe a high-cost Medicare Advantage population and identify clinically and operationally significant subgroups of patients. DESIGN: We used a density-based clustering algorithm to group high-cost patients (top 10% of spending) according to 161 distinct demographic, clinical, and claims-based variables...
December 3, 2018: Journal of General Internal Medicine
Farrukh R Virani, Travis Peery, Orlyn Rivas, Jeffrey Tomasek, Ravin Huerta, Charles E Wade, Jenny Lee, John B Holcomb, Karen Uray
BACKGROUND: Although feeding intolerance is a common complication in trauma patients, the incidence, development, and effects are poorly understood. METHODS: We performed a retrospective study in which trauma patients were classified as having feeding intolerance based on time to reach feeding goal. Subsequently, we sorted patients by gastric residual volumes (GRVs) or symptoms of slowed gastrointestinal motility. RESULTS: One-third of trauma patients experienced delayed time to reach feeding goal after diet initiation...
December 3, 2018: JPEN. Journal of Parenteral and Enteral Nutrition
Elise Springer, S Barron Frazier, Donald H Arnold, Adam A Vukovic
BACKGROUND: Computed tomography (CT) is frequently used to identify intra-abdominal injuries in children with blunt abdominal trauma (BAT). The Pediatric Emergency Care Applied Research Network (PECARN) proposed a prediction rule to identify children with BAT who are at very low risk for clinically-important intra-abdominal injuries (CIIAI) in whom CT can be avoided. OBJECTIVE: To determine the sensitivity of this prediction rule in identifying patients at very low risk for CIIAI in our pediatric trauma registry...
November 23, 2018: American Journal of Emergency Medicine
Abhishek Chaturvedi, Prabhakar Rajiah, Alexender Croake, Sachin Saboo, Apeksha Chaturvedi
Thoracic hernias are characterised by either protrusion of the thoracic contents outside their normal anatomical confines or extension of the abdominal contents within the thorax. Thoracic hernias can be either congenital or acquired in aetiology. They can occur at the level of the thoracic inlet, chest wall or diaphragm. Thoracic hernias can be symptomatic or fortuitously discovered on imaging obtained for other indications. Complications of thoracic hernias include incarceration, trauma and strangulation with necrosis...
November 27, 2018: Insights Into Imaging
Chih-Yuan Fu, Francesco Bajani, Caroline Butler, Stanley Welsh, Thomas Messer, Matthew Kaminsky, Frederick Starr, Andrew Dennis, Victoria Schlanser, Justin Mis, Stathis Poulakidas, Faran Bokhari
BACKGROUND: Morbid obesity is usually accompanied by both subcutaneous and visceral fat accumulation. Fat can mimic an air bag, absorbing the force of a collision. We hypothesized that morbid obesity is mechanically protective for hollow viscus organs in blunt abdominal trauma (BAT). METHODS: The National Trauma Data Bank (NTDB) was queried for BAT patients from 2013 to 2015. We looked at the rate of gastrointestinal (GI) tract injuries in all BAT patients with different BMIs...
November 26, 2018: World Journal of Surgery
Eun-Jae Chung
The current treatments for esophageal diseases, such as carcinomas, trauma or congenital malformations, require surgical intervention and esophageal reconstruction using redundant parts of the gastrointestinal tract. However, the use of gastrointestinal segments can cause various surgical morbidities and mortality because additional abdominal surgery may be required at the expense of other anatomic structures. Therefore, tissue engineering using various biomaterial or cell sources has emerged as an alternative strategy of biomimicking the native esophageal tissue that could be implanted as an artificial graft...
2018: Advances in Experimental Medicine and Biology
Caroline Rometsch-Ogioun El Sount, Jana Katharina Denkinger, Petra Windthorst, Christoph Nikendei, David Kindermann, Viola Renner, Johanna Ringwald, Sara Brucker, Virginia M Tran, Stephan Zipfel, Florian Junne
Introduction: A large number of refugees suffer from mental disorders such as post-traumatic stress disorder (PTSD). In the context of a special quota project, 1100 Yazidi women from Northern Iraq who had suffered extreme violence by the so-called Islamic State (IS) were brought to Germany to receive specialized treatment. This study aims to investigate the psychological burden and trauma-related symptoms of these female IS-victims from the perspectives of their care providers. Material and methods: Care providers with various professional backgrounds ( N = 96) were asked to complete a self-developed questionnaire on a Likert-type scale ranging from 1 (very low) to 7 (very high) analyzing the psychological burden and trauma-related symptoms of the IS-traumatized women since their arrival in Germany...
2018: Frontiers in Psychiatry
Shafat Khatoon, Aijaz Ahmed, Shazia Yousaf
BACKGROUND: Iron deficiency anaemia (IDA) is common in Pakistani population and an important cause of morbidity. Celiac disease (CD) is an important contributor and its diagnosis is frequently missed especially if present in atypical/non-diarrhoeal form. Non-responders to iron replacement therapy typically raises suspicion of celiac disease as underlying cause. Aim of this study is to determine the frequency of CD in patients with IDA.. METHODS: A cross sectional study was conducted at tertiary health care centre Islamabad from 12th March to 12th September 2016...
July 2018: Journal of Ayub Medical College, Abbottabad: JAMC
N T M L Fragnan, A L N Tolentino, G B Borba, A C Oliveira, J A Simões, S M U Palma, R N Constantino-Silva, A S Grumach
Hereditary angioedema (HAE) is a rare autosomal dominant disease due to C1 esterase inhibitor deficiency (C1-INH). The disease is characterized by subcutaneous and submucosal edema in the absence of urticaria due to the accumulation of bradykinin. This descriptive study aimed to evaluate the clinical characteristics of patients with a confirmed diagnosis of HAE referred to our Outpatient Clinic between December 2009 and November 2017. Fifty-one patients (38 F, 13 M) with a mean age of 32 years (range: 7-70 y) were included...
November 14, 2018: Brazilian Journal of Medical and Biological Research, Revista Brasileira de Pesquisas Médicas e Biológicas
I Monsellato, A Morello, G Argenio, M C Canepa, L M Lenti, F Priora
Spontaneous urinary bladder perforation is a very rare disease. The main cause of urinary perforation, indeed, is a damage to the urinary bladder wall by blunt or penetrating trauma. There are only few idiopathic spontaneous rupture of urinary bladder (ISRUB) cases reported in the literature. Pre-operative diagnosis is very difficult due to similar symptoms, laboratory and imaging findings of a gastrointestinal perforation that is usually excluded intraoperatively. Herein we report a case of a 91-year-old man presented to the emergency department with a spontaneous bladder perforation mimicking an ileal perforation...
September 2018: Il Giornale di Chirurgia
M Abu Hishmeh, P Srivastava, Q Lougheide, M Srinivasan, S Murthy
Introduction: Hemothorax is usually related to chest or iatrogenic trauma from procedures such as central lines and thoracentesis. Spontaneous hemothorax is defined as pleural fluid hematocrit greater than 50% of serum hematocrit in absence of natural or iatrogenic trauma affecting the lung or pleural space. Coagulopathy secondary to anticoagulant use has been associated with spontaneous hemothorax. We present a case of spontaneous hemothorax in a patient taking apixaban for venous thromboembolism disease...
2018: Case Reports in Pulmonology
Chuhua Fu, Ning Wang, Bo Chen, Pingli Wang, Huayun Chen, Wangwang Liu, Lijun Liu
OBJECTIVE: To date, no standard surgical procedure has been proven effective for intracerebral haemorrhage, particularly deep haematomas. This retrospective study evaluated the effectiveness and safety of endoscopic surgery, minimally invasive puncture and drainage, and craniotomy for treating moderate basal ganglia intracerebral haemorrhage. METHODS: A total of 177 patients with basal ganglia intracerebral haemorrhage were divided into 3 groups based on the therapeutic intervention as follows: endoscopic surgery group (n=61), minimally invasive puncture and drainage group (n=60), and craniotomy group (n=56)...
November 4, 2018: World Neurosurgery
Alessandra Morano, Luigi Iannone, Caterina Palleria, Martina Fanella, Anna Teresa Giallonardo, Giovambattista De Sarro, Emilio Russo, Carlo Di Bonaventura
Antiepileptic drugs (AEDs) are administered orally for chronic use. Parenteral formulations might be necessary when the oral route is not feasible (e.g. an impairment of consciousness, trauma, dysphagia, gastrointestinal illness) or for treatment of seizure emergencies. At present, few intravenous (IV) formulations are available on the market. Areas covered: The purpose of this review is to summarize the pharmacological characteristics and clinical applications of IV medications that have been recently introduced to the armamentarium of epilepsy therapy or are currently being developed...
November 7, 2018: Expert Opinion on Pharmacotherapy
Joyce Li, Genie Roosevelt, Kerry McCabe, Jane Preotle, Faria Pereira, James K Takayesu, Michael Monuteaux, Richard G Bachur
Objective: While emergency medicine (EM) physicians treat the majority of pediatric EM (PEM) patients in the United States, little is known about their PEM experience during training. The primary objective was to characterize the pediatric case exposure and compare to established EM residency training curricula among EM residents across five U.S. residency programs. Methods: We performed a multicenter medical record review of all pediatric patients (aged < 18 years) seen by the 2015 graduating resident physicians at five U...
October 2018: AEM education and training
Nora Sommer, Beat Schnüriger, Daniel Candinas, Tobias Haltmeier
BACKGROUND: Massive bleeding is a major cause of death both in trauma and non-trauma patients. In trauma patients, the implementation of massive transfusion protocols (MTP) led to improved outcomes. However, the majority of patients with massive bleeding are non-trauma patients. OBJECTIVES: To assess if the implementation MTP in non-trauma patients with massive bleeding leads to improved survival. DATA SOURCES: National Library of Medicine's Medline database (PubMed)...
October 29, 2018: Journal of Trauma and Acute Care Surgery
Artur Fedorowski
Postural Orthostatic Tachycardia Syndrome (POTS) is a variant of cardiovascular autonomic disorder characterised by an excessive heart rate increase on standing and orthostatic intolerance. POTS affects younger individuals 15-45 years old with a distinct female predominance (≈80%). The prevalence ranges between 0.2 and 1.0% in developed countries. The onset of POTS is typically precipitated by immunological stressors such as viral infection, vaccination, trauma, pregnancy, surgery or psychosocial stress. The most common complaints are dizziness, weakness, rapid heartbeat and palpitation on standing...
October 29, 2018: Journal of Internal Medicine
I Monsellato, A Morello, G Argenio, M C Canepa, L M Lenti, F Priora
Spontaneous urinary bladder perforation is a very rare disease. The main cause of urinary perforation, indeed, is a damage to the urinary bladder wall by blunt or penetrating trauma. There are only few idiopathic spontaneous rupture of urinary bladder (ISRUB) cases reported in the literature. Pre-operative diagnosis is very difficult due to similar symptoms, laboratory and imaging findings of a gastrointestinal perforation that is usually excluded intraoperatively. Herein we report a case of a 91-year-old man presented to the emergency department with a spontaneous bladder perforation mimicking an ileal perforation...
September 2018: Il Giornale di Chirurgia
Alana Costa Borges, Marcelo de Sousa Cury, Gilberto F de Carvalho, Stella Maria Torres Furlani
Introduction: Intramural hematomas of the gastrointestinal tract are uncommom, usually located in the esophagus or duodenum, with idiophatic or secondary causes. We present a very rare case of gastric intramural hematoma caused by an unpublished etiology, with literature review. Case presentation: An elderly woman suffered acute thoracic aorta dissection followed by gastric intramural hematoma, diagnosed through endoscopy and computed tomography angiography. The treatment included endovascular aortic repair and conservative management...
December 2018: Annals of Medicine and Surgery
Milena Armacki, Anna Katharina Trugenberger, Ann K Ellwanger, Tim Eiseler, Christiane Schwerdt, Lucas Bettac, Dominik Langgartner, Ninel Azoitei, Rebecca Halbgebauer, Rüdiger Groß, Tabea Barth, André Lechel, Benjamin M Walter, Johann M Kraus, Christoph Wiegreffe, Johannes Grimm, Annika Scheffold, Marlon R Schneider, Kenneth Peuker, Sebastian Zeißig, Stefan Britsch, Stefan Rose-John, Sabine Vettorazzi, Eckhart Wolf, Andrea Tannapfel, Konrad Steinestel, Stefan O Reber, Paul Walther, Hans A Kestler, Peter Radermacher, Thomas Fe Barth, Markus Huber-Lang, Alexander Kleger, Thomas Seufferlein
Dysregulated intestinal epithelial apoptosis initiates gut injury, alters the intestinal barrier, and can facilitate bacterial translocation leading to a systemic inflammatory response syndrome (SIRS) and/or multi-organ dysfunction syndrome (MODS). A variety of gastrointestinal disorders, including inflammatory bowel disease, have been linked to intestinal apoptosis. Similarly, intestinal hyperpermeability and gut failure occur in critically ill patients, putting the gut at the center of SIRS pathology. Regulation of apoptosis and immune-modulatory functions have been ascribed to Thirty-eight-negative kinase 1 (TNK1), whose activity is regulated merely by expression...
November 1, 2018: Journal of Clinical Investigation
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