Politrauma

It has been two decades since Maggiore Hospital Trauma Center started its formal activity focused on improving and developing Trauma management and Surgery of Trauma. Whilst evaluating the results of the last year, we can not avoid to look behind at the beginning, comparing the actual activity with the settings we have started from, in 1989. Before this date in our hospital all the Emergency and Trauma Surgery was managed by General Surgeons. However since 1989 few surgeons and ICU anaesthetists started to focus their training and activity on management of Trauma...

Infections caused by bacteria of genus Acinetobacter pose a significant health care challenge worldwide. Information on molecular epidemiological investigation of outbreaks caused by Acinetobacter species in Kosova is lacking. The present investigation was carried out to enlight molecular epidemiology of Acinetobacter baumannii in the Central Intensive Care Unit (CICU) of a University hospital in Kosova using pulse field gel electrophoresis (PFGE). During March - July 2006, A. baumannii was isolated from 30 patients, of whom 22 were infected and 8 were colonised...

INTRODUCTION: Coverage of soft tissue defects in the lower leg is often made by use of free flap, also because of the improving of anaesthesiology techniques in the last decades. However, there are disadvantages in the use of free flaps like the need for a remote donor site, increased operative time, use of a major vessel to the leg, and microsurgical skills. Besides these, trauma in the lower limb are often cause of damage for a major vessels of the leg, so the use of free flaps in these patients may be related to an higher incidence of complications; also associated pathologies, like diabetes and vascular pathology, can increase the incidence of complications when a free flap is utilized...

Politrauma is combination of the most complicated injuries caused by very strong forces. We present treatment of politraumatized patient who has injured his abdomen, with clinical and ultrasonic sings of bleeding-liver rupture, fractured pelvis and both arms and legs. All necessary diagnostic procedures have been performed and treatment team has been formed. After one year of psycical therapy, the patient can independently walk.

BACKGROUND: The consequences of low incidence of penetrating injuries in Europe and of the increasing in nonoperative management of blunt trauma are a decrease in surgeons' confidence for managing traumatic injuries. The Corso Teorico Pratico di Chirurgia del Politrauma was developed as model for teaching operative trauma techniques. The aim of this retrospective study is to evaluate the effectiveness of the course and compare it with other similar courses. METHOD: The Corso Teorico Pratico di Chirurgia del Politrauma is a two day course and consists of lecture on trauma topics and porcine operative experience...

The management of trauma patients has become a very relevant issue and one of the major challenges in the western countries. In the assessment of politrauma patients, since the last 2 decades, radiological imaging methods have been increasingly used in order to provide a quick and thorough survey of craniocerebral, cervical, abdominal, pelvic and limb traumatic injuries. Among imaging methods, conventional radiographs (CR) have precise but limited indications. In most European hospitals, UltraSonography (US) represents the method of choice for patients referred following blunt abdominal trauma, whereas multislice computed tomography (MSCT) remains a second-line method of investigation, although it provides a fully comprehensive assessment of their injuries and allows for their categorization according to the severity of traumatic injuries...

BACKGROUND: The consequence of the low rate of penetrating injuries in Europe and the increase in non-operative management of blunt trauma is a decrease in surgeons' confidence in managing traumatic injuries has led to the need for new didactic tools. The aim of this retrospective study was to present the Corso di Chirurgia del Politrauma (Trauma Surgery Course), developed as a model for teaching operative trauma techniques, and assess its efficacy. METHOD: the two-day course consisted of theoretical lectures and practical experience on large-sized swine...

Authors present a seven years retrospective study on 85 cases of severe brain injuries (SBI) in children (GCS </= 8) treated in the Pediatric and ICU Departments of the Clinic Hospital "Bagdasar-Arseni" Bucharest, Romania. The relationship between ICP, GCS on admission, the CT-scan/MRI alteration and the outcome evaluated by the Glasgow Outcome Scale (GOS) were studied in order to highlight the most important factors to improve prognosis. An overall mortality of 25.9% was found in this series. Authors concluded that the ICP values at admission >/= 20 mmHg, the Diffuse Axonal Injury (DAI) on MRI and the GCS on admission are factors of prognosis in SBI in children...

OBJECTIVES: To present objectively the therapeutic aspects for the management of child victim of trauma.METHODS: The most relevant articles about the management of acute trauma were selected.RESULTS: Children possess great potential for recovery after a trauma, however, inappropriate resuscitation is the major cause of death preventable.Care in the opening and maintenance of the airways, adequate input of fluid to the child victim of politrauma or burns as well as prompt diagnosis and effective management to internal bleeding has improved prognosis and can reduce mortality considerably...

A 41 year old man with a history of politrauma presented with a nodular mass of the left false vocal cord, associated with progressive dysphonia, dyspnoea, and dysphagia. A computed tomography scan of the neck region showed a rounded and circumscribed mass without infiltration of the surrounding tissues. Histological investigation of the nodule revealed the presence of fibroelastic cartilaginous tissue, surrounded by a thin rim of fibrous tissue, with rare hypercellular areas, occasional binucleated cells, slight hyperchromasia, and an irregular nuclear profile...

We reviewed the autopsy records of 1872 cases of death because of politrauma, gunshot wounds and suicidal hanging. The analysis included causes and frequency of cervical spine fractures, their most common localisation, architecture of bone destruction and their influence on cervical cord. The most common cause of cervical spine injury was motor vehicle accidents. We examined 82 specimens with traumatic fractures of cervical spine obtained from accident victims. About half of the injuries occurred in upper cervical spine...

In the retrospective work it is treatment 100 patients, wounderers, RVI, from war with leasies of peripheral nerve upper and lower extremitates. It is used uniformal approach in diagnostic, therapy, and principles of evaluate of degree of invalidity. At all is done control of place and model of wounding, first aid, further surgery, neurologically and physically treatment. It is done inspection in operative and reoperative operations on leasiesed nerven. From 100 patients it was 96 men and only 6 women. All of them are experienced politrauma, all of them have status of RVI, with evaluate which gave Institute for evaluation of working ability in Sarajevo and Mostar, and decision of invalidity gave Ministry of war affairs FBIH...

To evaluate our experience in chest trauma we review the records of the patients admitted for chest trauma to our service between December 1994 and April 2000. There were 126 patients (113 males, 89.7%), with an age range of 7 to 96 years (mean 35.3). The most frequent cause of chest injury were traffic accidents 48 cases (38%) and 73 cases (57.9%) were victims of blunt trauma. In 36 cases there was a politrauma. Hemo and/or pneumothorax represented the most common thoracic injury (85.7%). Rib fractures were present in 47 cases (36...

Comparative estimation of the state severity in 427 injured persons with polytrauma according to B[symbol: see text]X-M[symbol: see text] (OP)--C[symbol: see text]6, ISS, PTS scales was done. The lack of their efficacy was established. The method of the polytrauma severity estimation, concerning the injuries mutual aggravation syndrome as the main pathogenetic cause, was proposed. Six criteria, determined with the help of factor analysis, are estimated: the injured anatomic parts quantity, the anatomic injury severity index, the level of consciousness, systolic arterial pressure, age of the injured person, the period before the onset of the antishock therapy conduction...

Four patients with traumatic dislocation of the knee has been treated with olecranization of the patella. Mean age was 44.4 years (range 27-75 years). Three of them were politrauma patients, but none had popliteal artery injury or peroneal nerve palsy. Olecranization of the patella was performed on the day of injury. Results were assessed according to the Marshall scale. Three results were rated excellent and good with near normal knee function. In one case result was rated fair since despite stable knee and full range of motion pain persisted and marked vascular changes, not related to the injury were present...

We investigated survival of patients with out-of-hospital cardiac arrest in Ljubljana according to the 'Utstein' style. Ljubljana consists of urban, suburban and semi-rural communities which encompass an area of 1615 km2 with 397306 residents. The area is served by a single response emergency medical system and local family practitioners. Between January 1, 1995 and December 31, 1997 cardiac arrest was confirmed in 966 patients. Cardiopulmonary resuscitation was attempted in 454 patients (47%). Collapse of presumed cardiac etiology (337 patients) was either bystander-witnessed (89%), un-witnessed (9%) or EMS personnel-witnessed (2%)...

A series of 112 patients with posttraumatic osteomyelitis has been reviewed. Analysis of the management revealed, that malpractice contributed to the onset of osteomyelitis in many cases. Since politrauma patients with extensive bone and soft tissue injury are prone to infection errors in management of these patients lead to serious complications. Neglecting of primary immobilization of the open fracture in politrauma patients, incorrect methods of fracture fixation or technical errors at surgery, erroneous soft tissue injury management (complete closure of the wound, neglecting compartment syndrome) and disregarding local antibiotics are among most frequently committed errors...

Data base for assessment of results of treatment of politrauma patients is presented. It was created on the basis of Abbreviated Injury Scale, Injury Severity Score and Revised Trauma Score. Examination was supplemented with TRISS method inclusive of graphic assessment PRE-CHART and statistic Z and M. The software was created on the basis of Excel 7.0 and Windows 95.

OBJECTIVE: To find a predictive model for short time mortality and survival of haemodinamically instable patients. DESIGN: Prospective study on two consecutive series of critically ill patients admitted to ICU. SUBJECTS: 115 critically ill patients, subdivided in two series of 83 (47 survivors and 36 non survivors after 20 days from admission) and 32 patients (19 survivors and 13 non survivors), respectively. INTERVENTIONTS: All the patients have been monitored with a Swan-Ganz catheter...

The Authors, on the ground of the data of the experience of the Reanimation and Intensive Care Department (Palermo University), emphasize that the patients admitted in these units are "high risk patients" for thrombosis and embolism diseases for the invasive techniques used, for stillness, shock and politrauma. The Authors recommend an adequate prophilaxis also if often very difficult and emphasize that using Urokynase and Calcium-Heparin recovers the illness of thrombo-embolic complications also if prognosis remain non modified in the pulmonary general form...