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Acute surgical trauma

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https://www.readbyqxmd.com/read/28437224/structure-process-and-culture-of-intensive-care-units-treating-patients-with-severe-traumatic-brain-injury-survey-of-centers-participating-in-the-american-college-of-surgeons-trauma-quality-improvement-program
#1
Aziz S Alali, Victroia McCredie, Todd G Mainprize, David Gomez, Avery B Nathens
Outcome after severe traumatic brain injury (TBI) differs substantially between hospitals. Explaining this variation begins with understanding the differences in structures and processes of care, particularly at intensive care units (ICUs) where acute TBI care takes place. We invited trauma medical directors (TMDs) from 187 centers participating in the American College of Surgeons Trauma Quality Improvement Program to complete a survey. The survey domains included ICU model, type, availability of specialized units, staff, training programs, standard protocols and order sets, approach to withdrawal of life support, and perceived level of neurosurgeons' engagement in the ICU management of TBI...
February 15, 2017: Journal of Neurotrauma
https://www.readbyqxmd.com/read/28433042/-alarmins-and-surgical-injury
#2
J Máca, M Peteja
Surgical intervention is an inseparable part of the management of serious surgical disease. However, surgery also presents a potential risk related to the so-called surgical injury causing immune response. When dysregulated the immune activation is able to cause local complications (i.e. wound dehiscence, impaired healing). Systemic decompartmentization of the immunologic disturbance can negatively influence long-term outcomes (i.e. hospital length of stay, mortality). Due to aseptic conditions in the operating room, such an immune activation is almost always of sterile nature...
2017: Rozhledy V Chirurgii: Měsíčník Československé Chirurgické Společnosti
https://www.readbyqxmd.com/read/28427944/creating-a-global-acute-care-surgery-fellowship-to-meet-international-need
#3
Amina I Merchant, Camila B Walters, Julie Valenzuela, Kelly A McQueen, Addison K May
INTRODUCTION: Existing Acute Care Surgery (ACS) fellowships are positioned to develop well-trained surgeons with specific skills to facilitate improvements in care delivery in Global ACS. Many resident and fellowship programs offer clinical electives that expose trainees to operative experiences, exposing trainees to the needs in resource-challenged settings. However, most lack a focus on long-term development and research designed to enhance the country's local skills, capability, and capacity...
April 17, 2017: Journal of Surgical Education
https://www.readbyqxmd.com/read/28426557/loop-ileostomy-vs-total-colectomy-as-surgical-treatment-for-clostridium-difficile-associated-disease-an-eastern-association-for-the-surgery-of-trauma-multicenter-trial
#4
Paula Ferrada, Rachael Callcut, Martin D Zielinski, Brandon Bruns, Daniel Dante Yeh, Tanya L Zakrison, Jonathan P Meizoso, Babak Sarani, Richard D Catalano, Peter Kim, Valerie Plant, Amelia Pasley, Linda A Dultz, Asad J Choudhry, Elliott R Haut
OBJECTIVES: The mortality of patients with Clostridum Dificile Associated Disease (CDAD) requiring surgery continues to be very high. Loop ileostomy (LI) was introduced as an alternative procedure to total colectomy (TC) for CDAD by a single center study. To date, no reproducible results have been published. The objective of this study is to compare these two procedures in a multicentric approach to help the surgeon decide what procedure is best suited for the patient in need. METHODS: This was a retrospective multicenter study conducted under the sponsorship of the Eastern Association for the Surgery of Trauma (EAST)...
April 20, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28417279/tackers-versus-glue-mesh-fixation-an-objective-assessment-of-postoperative-acute-and-chronic-pain-using-inflammatory-markers
#5
W Liew, Y Y Wai, N R Kosai, H S Gendeh
PURPOSE: Laparoscopic hernioplasty has become a popular choice for inguinal hernia repair since its advent in 1990s. Postoperative pain is an undesirable clinical outcome impairing daily activity of 22.5% of patients. The aim of this study is to evaluate postoperative acute and chronic pain via inflammatory markers as an objective assessment following tacks or glue mesh fixation in TEP repair. METHODS: Sixty-six (66) patients with unilateral uncomplicated inguinal hernia were randomized into 34 patients in the tacker and 32 patients in cyanoacrylate glue mesh fixation in TEP repair...
April 17, 2017: Hernia: the Journal of Hernias and Abdominal Wall Surgery
https://www.readbyqxmd.com/read/28410599/the-role-of-vitamin-c-in-the-treatment-of-pain-new-insights
#6
REVIEW
Anitra C Carr, Cate McCall
The vitamin C deficiency disease scurvy is characterised by musculoskeletal pain and recent epidemiological evidence has indicated an association between suboptimal vitamin C status and spinal pain. Furthermore, accumulating evidence indicates that vitamin C administration can exhibit analgesic properties in some clinical conditions. The prevalence of hypovitaminosis C and vitamin C deficiency is high in various patient groups, such as surgical/trauma, infectious diseases and cancer patients. A number of recent clinical studies have shown that vitamin C administration to patients with chronic regional pain syndrome decreases their symptoms...
April 14, 2017: Journal of Translational Medicine
https://www.readbyqxmd.com/read/28403868/the-use-of-viscoelastic-haemostatic-assays-in-goal-directing-treatment-with-allogeneic-blood-products-a-systematic-review-and-meta-analysis
#7
REVIEW
Mathilde Fahrendorff, Roberto S Oliveri, Pär I Johansson
BACKGROUND: Management of the critically bleeding patient can be encountered in many medical and surgical settings. Common for these patients is a high risk of dying from exsanguination secondary to developing coagulopathy. The purpose of this meta-analysis was to systematically review and assess randomised controlled trials (RCTs) performed on patients in acute need for blood transfusions due to bleeding to evaluate the effect of viscoelastic haemostatic assay (VHA) guidance on bleeding, transfusion requirements and mortality...
April 13, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28403322/serum-concentrations-of-brain-derived-neurotrophic-factor-in-patients-diagnosed-with-gender-dysphoria-undergoing-sex-reassignment-surgery
#8
Maiko A Schneider, Tahiana Andreazza, Anna Martha V Fontanari, Angelo B Costa, Dhiordan C da Silva, Bianca W de Aguiar, Raffael Massuda, Mariana Pedrini, Clarissa S Gama, Karine Schwarz, Marcia Kauer-Sant'Anna, Maria Ines R Lobato
Introduction: Transsexualism (ICD-10) is a condition characterized by a strong and persistent dissociation with one's assigned gender. Sex reassignment surgery (SRS) and hormone therapy provide a means of allowing transsexual individuals to feel more congruent with their gender and have played a major role in treatment over the past 70 years. Brain-derived neurotrophic factor (BDNF) appears to play a key role in recovery from acute surgical trauma and environmentally mediated vulnerability to psychopathology...
January 2017: Trends in Psychiatry and Psychotherapy
https://www.readbyqxmd.com/read/28400216/high-mortality-rates-after-both-open-surgical-and-endovascular-thoracic-aortic-interventions-in-patients-with-end-stage-renal-disease
#9
Nathan L Liang, Theodore H Yuo, Georges E Al-Khoury, Eric S Hager, Michel S Makaroun, Michael J Singh
BACKGROUND: Morbidity and mortality have improved with the evolution of endovascular techniques (thoracic endovascular aortic repair [TEVAR]) for thoracic aortic disease, but results after aortic intervention in patients with end-stage renal disease (ESRD) remain unclear. The objective of this study was to evaluate outcomes of open and endovascular descending thoracic aortic repair in dialysis-dependent patients. METHODS: We identified 352 patients with ESRD on dialysis undergoing open repair (n = 136) or TEVAR (n = 216) of the thoracic aorta from 2005 to 2008 using the United States Renal Data System database...
April 8, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28377245/postoperative-non-pathological-fever-after-spinal-surgery-incidence-and-risk-factor-analysis
#10
Junghan Seo, Jin Hoon Park, Eun Hee Song, Young-Seok Lee, Sang Ku Jung, Sang Ryong Jeon, Seung Chul Rhim, Sung Woo Roh
BACKGROUND: Although there are many postoperative febrile causes, surgical site infection has always been considered as one of the major causes, but it should be excluded; we encountered many patients who showed delayed postoperative fever that was not related to wound infection after spinal surgery. We aimed to determine the incidence of delayed postoperative fever and its characteristics after spinal surgery, and to analyze the causal factors. METHODS: A total of 250 patients who underwent any type of spinal surgery were analyzed...
April 1, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28374712/-external-pancreatic-fistulas-management
#11
E V Stepan, A S Ermolov, M L Rogal', Yu S Teterin
The main principles of treatment of external postoperative pancreatic fistulas are viewed in the article. Pancreatic trauma was the reason of pancreatic fistula in 38.7% of the cases, operations because of acute pancreatitis - in 25.8%, and pancreatic pseudocyst drainage - in 35.5%. 93 patients recovered after the treatment. Complex conservative treatment of EPF allowed to close fistulas in 74.2% of the patients with normal patency of the main pancreatic duct (MPD). The usage of octreotide 600-900 mcg daily for at least 5 days to decrease pancreatic secretion was an important part of the conservative treatment...
2017: Khirurgiia
https://www.readbyqxmd.com/read/28370979/cohort-study-on-emergency-general-surgery-patients-and-an-observation-unit
#12
Marilla Dickfos, Hany Ibrahim, Andrew Evans, Robert Franz
BACKGROUND: Medium-sized, non-trauma hospitals experience many of the same difficulties as tertiary centres do when it comes to managing emergency general surgery patients. However, acute surgical units are not a financially viable option in these hospitals. To improve the care of emergency general surgery patients at one such hospital, a Rapid Assessment Medical Surgical (RAMS) unit was developed to decrease the time to review and increase the efficiency in caring for these patients...
March 30, 2017: ANZ Journal of Surgery
https://www.readbyqxmd.com/read/28367388/delayed-recognition-of-thoracic-and-lumbar-vertebral-compression-fractures-in-minor-accident-cases
#13
Jesse Hatgis, Michelle Granville, Robert E Jacobson
Osteoporotic vertebral compression fractures (VCFs) in the elderly are commonly diagnosed after a minor fall or trauma; however, the majority of these patients have either been previously evaluated for osteoporosis or are already under some form of medical treatment for osteoporosis at the time of the fall. Although accidents are a known cause of VCFs, these fractures are too often undiagnosed. In reviewing a group of patients seen after minor falls or automobile accidents who were complaining of general spine pain, we found a smaller subgroup with previously undiagnosed VCFs...
February 23, 2017: Curēus
https://www.readbyqxmd.com/read/28361365/acute-non-traumatic-idiopathic-spinal-subdural-hematoma-radiographic-findings-and-surgical-results-with-a-literature-review
#14
Kazuyoshi Kobayashi, Shiro Imagama, Kei Ando, Yoshihiro Nishida, Naoki Ishiguro
PURPOSE: Intraspinal hematoma is a serious condition, and early diagnosis is necessary to permit emergency treatment. Among such hematomas, non-traumatic spinal subdural hematoma is a rare occurrence. We have experienced three patients with surgically proven subdural spinal hematoma, and here we report these cases with a review of their clinical and imaging characteristics. METHODS: All three cases were idiopathic with no history of disease, no coagulopathy, and no trauma...
March 30, 2017: European Spine Journal
https://www.readbyqxmd.com/read/28345069/an-uncommon-case-mimicking-cervical-trauma-os-odontoideum
#15
Idiris Altun, Kasim Zafer Yuksel
Os odontoideum is a separate odontoid process from the body of the axis. It is the most common anomaly of the odontoid process. Patients with this condition can be asymptomatic or present with a wide range of neurological dysfunctions. It may cause cervical instability, atlantoaxial dislocation and myelopathy. This anomaly can mimic Type I and II odontoid fractures. There is a role for conservative treatment of an asymptomatic incidentally found, radiologically stable and non-compressive os odontoideum. However, surgical treatment has a definitive role in symptomatic cases...
March 2017: Turkish Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28340927/resuscitative-endovascular-balloon-occlusion-of-the-aorta-for-control-of-noncompressible-truncal-hemorrhage-in-the-abdomen-and-pelvis
#16
Laura J Moore, Clay D Martin, John A Harvin, Charles E Wade, John B Holcomb
BACKGROUND: Noncompressible truncal hemorrhage is a leading cause of potentially preventable death in trauma and acute care surgery patients. These patients are at high risk of exsanguination before potentially life-saving surgical intervention may be performed. Temporary aortic occlusion is an effective means of augmenting systolic blood pressure and perfusion of the heart and brain in these patients. Aortic occlusion temporarily controls distal bleeding until permanent hemostasis can be achieved...
December 2016: American Journal of Surgery
https://www.readbyqxmd.com/read/28339769/incidence-and-potential-risk-factors-for-hospital-acquired-pneumonia-in-an-emergency-department-of-surgery
#17
Marie Stenlund, Rune Sjödahl, R N Pia Yngman-Uhlin
Objective: Hospital-acquired pneumonia (HAP) is associated with high mortality and is the second most common nosocomial infection. The aim of this study was to calculate the incidence and to identify potential risk factors for HAP in an emergency ward for surgical patients admitted because of acute abdomen or trauma. Design: A structured review of medical records was conducted. Patients diagnosed with pneumonia >48 h after admittance, were compared with a randomly chosen age-matched reference group...
February 23, 2017: International Journal for Quality in Health Care
https://www.readbyqxmd.com/read/28328684/eastern-association-for-the-surgery-of-trauma-society-of-trauma-nurses-advanced-practitioner-position-paper-optimizing-the-integration-of-advanced-practitioners-in-trauma-and-critical-care
#18
Jonathan Messing, Jasmine Garces-King, Dennis Taylor, Jonathan Van Horn, Babak Sarani, A Britton Christmas
Nurse Practitioners and Physician Assistants, collectively known as advanced practitioners (APs), enhance the provision of care for the acutely injured patient. Despite their prevalence, institutions employ, train, and utilize these providers with significant variability. The Eastern Association for the Surgery of Trauma (EAST), the Society of Trauma Nurses (STN), and the American Association of Surgical Physicians Assistants (AASPA) acknowledge the value of APs and support their utilization in the management of injured and critically ill patients...
March 21, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28327940/the-nationwide-burden-of-neurological-conditions-requiring-emergency-neurosurgery
#19
Rafael De la Garza Ramos, C Rory Goodwin, Jonathan Nakhla, Rani Nasser, Reza Yassari, Eugene S Flamm, Ali Bydon, Geoffrey Colby, Daniel M Sciubba
BACKGROUND: Neurosurgical emergencies are an important cause of disability and mortality. OBJECTIVE: To examine the nationwide burden of neurological conditions requiring emergency neurosurgery. METHODS: The Nationwide Inpatient Sample database (2002-2011) was queried to identify adult patients with a primary discharge diagnosis of a neurosurgical condition who were admitted urgently/emergently or through a trauma center and underwent surgical intervention within 2 days of admission...
March 10, 2017: Neurosurgery
https://www.readbyqxmd.com/read/28325461/neurocritical-care-of-acute-subdural-hemorrhage
#20
REVIEW
Fawaz Al-Mufti, Stephan A Mayer
Although urgent surgical hematoma evacuation is necessary for most patients with subdural hematoma (SDH), well-orchestrated, evidenced-based, multidisciplinary, postoperative critical care is essential to achieve the best possible outcome. Acute SDH complicates approximately 11% of mild to moderate traumatic brain injuries (TBIs) that require hospitalization, and approximately 20% of severe TBIs. Acute SDH usually is related to a clear traumatic event, but in some cases can occur spontaneously. Management of SDH in the setting of TBI typically conforms to the Advanced Trauma Life Support protocol with airway taking priority, and management breathing and circulation occurring in parallel rather than sequence...
April 2017: Neurosurgery Clinics of North America
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