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Long-term outcomes in trauma patients

Mariana Fortunata Donadon, Rocio Martin-Santos, Flávia de Lima Osório
Studies have shown that traumatic experiences may affect hormonal systems mediated by the hypothalamic-pituitary-adrenal (HPA) axis and the oxytocinergic system. This effect is the result of long-term impairments in hypothalamic structures and negative feedback mechanisms within the HPA axis, structures that mediate the response to stress. This deregulation reduces the production and release of cortisol and oxytocin (OXT), which may alter stress responses and lead to increased vulnerability to impairments from stressful experiences...
2018: Frontiers in Pharmacology
Conghui Zhang, Yang Liu
BACKGROUND: Thoracolumbar fractures is a frequent injury occurring in spinal trauma. Outcomes and complications between combined pedicle screw fixation at the fracture vertebrae (AFV) and conventional method cross the fracture vertebrae (CFV) are still controversial. Thus, this study aimed to evaluate differences in outcome variables between these two operative methods. MATERIALS AND METHODS: PubMed, Web of Science, Cochrane Library, EMBASE and CNKI were searched with the terms "thoracolumbar fractures", "posterior", "pedicle screw fixation", and "clinical trial" from Jan 1980 to July 2017...
March 10, 2018: International Journal of Surgery
Jonathan P Rehfuss, Kenneth M DeSart, Jared M Rozowsky, Kerri A O'Malley, Lyle L Moldawer, Henry V Baker, Yaqun Wang, Rongling Wu, Peter R Nelson, Scott A Berceli
BACKGROUND: Despite being the definitive treatment for lower extremity peripheral arterial disease, vein bypass grafts fail in half of all cases. Early repair mechanisms after implantation, governed largely by the immune environment, contribute significantly to long-term outcomes. The current study investigates the early response patterns of circulating monocytes as a determinant of graft outcome. METHODS: In 48 patients undergoing infrainguinal vein bypass grafting, the transcriptomes of circulating monocytes were analyzed preoperatively and at 1, 7, and 28 days post-operation...
March 2018: Circ Genom Precis Med
Konstantinos Tigkiropoulos, Fragiska Sigala, Diamantis I Tsilimigras, Demetrios Moris, Konstantinos Filis, Nikolaos Melas, Dimitrios Karamanos, Christos Kontogiannis, Ioannis Lazaridis, Nikolaos Saratzis
BACKGROUND: Blunt thoracic aortic injury (BTAI) is the second most common cause of death in trauma patients. Nowadays, thoracic endovascular aortic repair (TEVAR) has become the treatment of choice due to lower rates of mortality, paraplegia and stroke. However, concerns have been raised whether graft implantation is related to the development of hypertension in the postoperative period. OBJECTIVES: To report short- and long-term outcomes of patients undergoing TEVAR for BTAIs at a tertiary hospital as well as investigate post-implant hypertension...
March 7, 2018: Annals of Vascular Surgery
David Boulate, Dominique Fabre, Nathaniel B Langer, Elie Fadel
Surgical strategy and long-term outcomes of patients with rupture of the ascending aorta, aortic arch and supra-aortic vessels following blunt thoracic trauma have been rarely reported. We reviewed our institutional experience between 1995 and 2016. We identified 2 patients with an innominate artery ruptures, 2 with an aortic arch ruptures and 1 with an ascending aorta rupture; all were induced by the posterior displacement of the anterior chest wall. All patients underwent open surgical repair. Cardiopulmonary bypass with antegrade cerebral perfusion was required in 2 cases...
March 5, 2018: Interactive Cardiovascular and Thoracic Surgery
E Anitua, L Piñas, V Escuer-Artero, R S Fernández, M H Alkhraisat
Oral lichen planus is associated with the Koebner phenomenon, and trauma may exacerbate oral lesions. Short dental implants, as alternatives to bony augmentation, would reduce the number of interventions and their morbidity. However, we know of no studies that have analysed the long-term outcomes of short implants in patients with oral lichen planus. We have therefore designed a retrospective study of such patients treated with short implants (≤8.5mm long), with survival of implants as the main outcome. The secondary outcomes were marginal bone loss and the development of complications...
March 1, 2018: British Journal of Oral & Maxillofacial Surgery
Shelley Wiechman, Michael A Hoyt, David R Patterson
OBJECTIVE: To determine the importance of preburn adjustment, injury related variables and selection of coping style on various outcome measures using a biopsychosocial model. DESIGN: Longitudinal. SETTING: Outpatient burn clinics. PARTICIPANTS: A total of 231 burn survivors participated in this study as part of a larger burn model system study of 645 patients with major burn injuries. INTERVENTIONS: N/A/...
March 1, 2018: Archives of Physical Medicine and Rehabilitation
Dirk H Alander, Shari Cui
Percutaneous pedicle screw fixation has evolved as a useful tool in the management of spinal trauma. As a minimally invasive approach, it provides the stability of open instrumentation while limiting blood loss, avoiding excessive muscle/soft-tissue insult, and improving postoperative pain and mobilization. Muscle-dilating techniques also preserve greater paraspinal muscle volume and strength compared with open midline approaches. In patients with spinal trauma, the use of percutaneous instrumentation and indirect reduction can theoretically preserve the fracture hematoma and its osteogenic inflammatory factors...
March 1, 2018: Journal of the American Academy of Orthopaedic Surgeons
Guoxin Li, Xinhua Chen, Jiang Yu, Hao Liu
Laparoscopic surgery has its unique minimally invasive advantages, however, taking the complex and difficult D2 lymph node dissection for advanced gastric cancer into consideration, laparoscopic gastrectomy was only applied in the treatment of early gastric cancer at its preliminary stage. With the development of more than a decade, many multicenter clinical data have confirmed the safety, feasibility and effectiveness of laparoscopic radical gastrectomy for early gastric cancer. Based on high-quality evidence-based medicine evidence, laparoscopic gastrectomy has been recommended as an optional treatment for stage I( gastric cancer by the Japanese Gastric Cancer Treatment Guidelines 2014(ver...
February 25, 2018: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
Fenglin Liu, Xinyu Qin
Many retrospective and cohort studies have shown that laparoscopic total gastrectomy(LTG) has advantages of less trauma, quicker recovery and better incision than open total gastrectomy, and is not inferior to laparotomy in safety and the short- and long-term outcomes, so it has been widely applied. However there is still a lack of high level evidence-based basis. At present, several prospective multicenter clinical studies are being carried out in China, Japan and South Korea which have high incidence of gastric cancer to demonstrate the safety and feasibility of LTG and evaluate its long-term outcomes as well...
February 25, 2018: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
Hang Joo Cho, Tae Hwa Hong, Maru Kim
Population aging is associated with increasing numbers of geriatric trauma patients, and various studies have evaluated their short-term outcomes, assessment, and treatment. However, there is insufficient information regarding their long-term outcomes. This study evaluated the physical and nutritional statuses of geriatric patients after trauma-related hospitalization.Data regarding physical and nutritional status were obtained from the Korean National Health and Nutrition Examination Survey VI (2013-2015)...
March 2018: Medicine (Baltimore)
Stephanie A Mason, Avery B Nathens, James P Byrne, Christina Diong, Robert A Fowler, Paul J Karanicolas, Rahim Moineddin, Marc G Jeschke
OBJECTIVE: To estimate long-term mortality following major burn injury compared with matched controls. SUMMARY BACKGROUND DATA: The effect of sustaining a major burn injury on long-term life expectancy is poorly understood. METHODS: Using health administrative data, all adults who survived to discharge after major burn injury between 2003 and 2013 were matched to between 1 and 5 uninjured controls on age, sex, and the extent of both physical and psychological comorbidity...
February 27, 2018: Annals of Surgery
Maria Ceja-Rodriguez, Augustus Realyvasquez, Joseph Galante, William C Pevec, Misty Humphries
OBJECTIVE: Intravascular ultrasound (IVUS) has been recommended as an adjunct to thoracic endovascular aortic repair (TEVAR) as Computed Tomography (CT) in injured patients may inaccurately determine the true aortic diameter. We hypothesize that CT and IVUS offer discordant measurements of aortic diameter in trauma patients, and that each modality may result in different graft size estimates for TEVAR. METHODS: Patients treated by TEVAR for blunt aortic injury from June 2011 to 2016 were reviewed...
February 23, 2018: Annals of Vascular Surgery
Matteo Chiapasco, Paolo Casentini
The rehabilitation of partially or totally edentulous patients with implant-supported prostheses has become routine, with excellent long-term outcome. A proper implant position is mandatory to achieve good functional and esthetic outcome and may require an adequate amount of alveolar bone and surrounding soft tissue. When this is lacking because of atrophy, sequelae of periodontal disease, traumas or congenital malformations, increased bone volume and/or keratinized mucosa can be obtained by guided bone regeneration, bone-grafting techniques and alveolar bone expansion...
February 25, 2018: Periodontology 2000
Stephen S Humble, Laura D Wilson, Li Wang, Drew A Long, Miya A Smith, Jonathan C Siktberg, Mina F Mirhoseini, Aashim Bhatia, Sumit Pruthi, Matthew A Day, Susanne Muehlschlegel, Mayur B Patel
BACKGROUND: Determine the prognostic impact of MRI-defined DAI after TBI on functional outcomes, quality of life, and 3-year mortality. METHODS: This retrospective single center cohort included adult trauma patients (age>17y) admitted from 2006-2012 with TBI. Inclusion criteria were positive head CT with brain MRI within 2 weeks of admission. Exclusion criteria included penetrating TBI or prior neurologic condition. Separate ordinal logistic models assessed DAI's prognostic value for following scores: 1)hospital-discharge Functional Independence Measure (FIM); 2)long-term Glasgow Outcome Scale-Extended (GOSE); and 3)long-term Quality of Life after Brain Injury-Overall Scale (QOLIBRI-OS)...
February 17, 2018: Journal of Trauma and Acute Care Surgery
Marvin Ernesto García Reyes, Gabriela Gonçalves Martins, Valentín Fernández Valenzuela, José Manuel Domínguez González, Jordi Maeso Lebrun, Sergi Bellmunt Montoya
INTRODUCTION: The acute aortic arch angle and narrow aortic diameter in young patients may lead to bird-beak configuration and excessive oversizing of the stent-graft in TEVAR for blunt traumatic thoracic aortic injury. Little is known about the association of these factors and complications in long-term follow-up. We evaluated the long-term outcomes in terms of complications, reinterventions and survival, focusing on the effects of bird-beak configuration and oversizing. METHODS: This prospective cohort study included patients who underwent TEVAR for blunt traumatic thoracic aortic injury in our department between October 1999 and January 2015...
February 15, 2018: Annals of Vascular Surgery
Stefan Heschl, Ben Meadley, Emily Andrew, Warwick Butt, Stephen Bernard, Karen Smith
INTRODUCTION: Prehospital airway management of the paediatric patient with traumatic brain injury (TBI) is controversial. Endotracheal intubation of children in the field requires specific skills and has potential benefits but also carries potentially serious complications. We aimed to compare mortality and functional outcomes after six months between children with TBI who either underwent prehospital rapid sequence intubation (RSI) by trained Intensive Care paramedics (ICP) or received no intubation...
February 12, 2018: Injury
Margaret Lauerman, Olga Kolesnik, Habeeba Park, Laura S Buchanan, William Chiu, Ronald B Tesoriero, Deborah Stein, Thomas Scalea, Sharon Henry
Necrotizing soft tissue infection of the perineum, or Fournier's gangrene (FG), is a morbid and mortal diagnosis. Despite the severity of FG, the optimal definitive wound closure strategy is unknown, as are long-term wound outcomes. A retrospective review was performed over a 3-year period at a single trauma center. Patients were managed according to our institutional approach focusing on primary wound closure and secondary intention healing in residual wounds. Overall 168 patients were included. Complete primary wound closure was accomplished in 39...
January 1, 2018: American Surgeon
Ashley P Marek, Jean Dominique Morancy, Jeffrey G Chipman, Rachel M Nygaard, Robert M Roach, Michele M Loor
The incidence of thoracolumbar spine fractures in blunt trauma is 4 to 5 per cent. These fractures may lead to neurologic injury, chronic back pain, and disability. Most studies from United States trauma centers focus on neurologic sequelae and/or compare treatment modalities. However, most patients with spine fractures do not have a neurologic deficit. Our primary objective was to determine the long-term outcome of traumatic thoracolumbar spine fractures, specifically addressing quality of life, chronic pain, and employment using a validated patient outcome survey...
January 1, 2018: American Surgeon
Zeynep Selen Karalok, Birce Dilge Taskin, Zeynep Ozturk, Esra Gurkas, Tuba Bulut Koc, Alev Guven
OBJECTIVE: The objectives of this study were to evaluate the demographic and clinical characteristics, causes, treatment patterns, outcome, and recurrence of childhood peripheral facial palsy. METHODS: We performed a retrospective study of 144 peripheral facial palsy patients, under 18 years old in a tertiary care pediatric hospital. Medical charts were reviewed to analyze the age, gender, side of facial nerve paralysis, family history, cause, grading by the House-Brackmann Facial Nerve Grading Scale (HBS), results of diagnostic tests, therapies, outcomes, and recurrence...
February 9, 2018: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
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