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Trauma, emergency surgery

Olfa Chakroun-Walha, Amal Samet, Mouna Jerbi, Abdennour Nasri, Aziza Talbi, Hassen Kanoun, Basma Souissi, Kamilia Chtara, Mounir Bouaziz, Hichem Ksibi, Noureddine Rekik
INTRODUCTION: Tranexamic acid (TXA) is one of the debated therapies in the management of traumatic brain injury (TBI). We conducted this study to evaluate the benefits of TXA in TBI on the mortality and its safety in these patients. METHODS: This was a prospective randomized open-label trial including all patients, aged at 18 years or older, hospitalized in the emergency room during a 13-month period, for TBI. After the realization of the body CT scan, the patients were included if they had intracranial bleeding, and were then randomized according to their medical file number to receive or not the TXA...
June 19, 2018: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
David Dreizin, Arthur J Nam, Jeffrey Hirsch, Mark P Bernstein
This article reviews the conceptual framework, available evidence, and practical considerations pertaining to nascent and emerging advances in patient-centered CT-imaging and CT-guided surgery for maxillofacial trauma. These include cinematic rendering-a novel method for advanced 3D visualization, incorporation of quantitative CT imaging into the assessment of orbital fractures, low-dose CT imaging protocols made possible with contemporary scanners and reconstruction techniques, the rapidly growing use of cone-beam CT, virtual fracture reduction with design software for surgical pre-planning, the use of 3D printing for fabricating models and implants, and new avenues in CT-guided computer-aided surgery...
June 20, 2018: Emergency Radiology
Koin Lon Shum, Yuyang Tan
Pneumocephalus, the presence of air within the cranium, commonly suggests a breach in the meningeal layer or an intracranial infection by a gas-producing organism. Trauma is the most common cause of pneumocephalus, followed by cranial surgery. Other causes include infection and intracranial neoplasm. An 87-year-old man was conveyed to the emergency department after being found to be drowsy by his helper. He was noted to have a new onset right-sided hemiparesis. Past medical history was significant for hypertension, stage 5 chronic kidney disease, cerebrovascular accident, pacemaker insertion for sick sinus syndrome, transurethral resection of the prostate for benign prostatic hyperplasia, and pulmonary tuberculosis...
April 14, 2018: Curēus
Ibrahim Afifi, Sheraz Abayazeed, Ayman El-Menyar, Husham Abdelrahman, Ruben Peralta, Hassan Al-Thani
BACKGROUND: We aimed to review liver injury experience in a level 1 trauma center; namely clinical presentation, grading, management approach and clinical outcomes. METHODS: It is a retrospective analysis to include all blunt liver injury patients who were admitted at the Level 1 trauma center over a 3-year period. Data were compared and analyzed based on the liver injury grades and management approaches. RESULTS: Blunt liver injury accounted for 38% of the total blunt abdominal trauma cases with a mean age of 31 ± 13 years...
June 19, 2018: BMC Surgery
Brittany L Murphy, Matthew C Hernandez, Nimesh D Naik, Amy E Glasgow, Victor Y Kong, Damian L Clarke, Humza Y Saleem, Jennifer M Racz, Elizabeth B Habermann, Martin D Zielinski
BACKGROUND: The American Association for the Surgery of Trauma (AAST) developed emergency general surgery (EGS) grading systems for multiple diseases to standardize classification of disease severity. The grading system for breast infections has not been validated. We aimed to validate the AAST breast infection grading system. METHODS: Multi-institutional retrospective review of all adult patients with a breast infection diagnosis at Mayo Clinic Rochester 1/2015-10/2015 and Pietermaritzburg South African Hospital 1/2010-4/2016 was performed...
August 2018: Journal of Surgical Research
Sanjit R Konda, Ariana Lott, Hesham Saleh, Jordan Gales, Kenneth A Egol
OBJECTIVES: Determine if a novel inpatient mortality risk assessment tool designed to be calculated in the emergency department (ED) setting can risk stratify patient reported functional outcomes and mortality at one year. DESIGN: Prospective cohort SETTING:: Academic level one trauma center PATIENTS:: 685 patients >55 years old who were orthopaedic surgery consults or trauma surgery consults in the ED between 10/1/2014 and 9/30/2015. INTERVENTION: Calculation of validated trauma triage score (STTGMA) using each patient's demographics, injury severity, and functional status MAIN OUTCOME MEASUREMENTS:: mortality, EQ-5D questionnaire, and percent return to baseline function since their hospitalization at one-year post hospitalization...
June 4, 2018: Journal of Orthopaedic Trauma
Carlos G Landaeta-Quinones, Nicole Hernandez, Najy K Zarroug
Computer-assisted surgery (CAS) has evolved over time from its earliest introduction with utility in the Neurosurgical field. Within the past twenty years, optical navigation systems have emerged and developed into a great tool for the fields of dentistry and craniomaxillofacial surgery (CMF). Currently, CAS is useful for orthognathic and temporomandibular joint surgery, facial trauma, maxillomandibular reconstruction, implantology, and restorative dentistry. This article describes the indications of CAS in dentistry, with large emphasis on CMF...
July 2018: Dental Clinics of North America
Luca Napolitano, Mathew Waku, Gustavo Maggi, Franco Ciarelli
Cystic intestinal pneumatosis (CIP) is the presence of gas bubbles inside the wall of the intestine. In literature it has been reported to be associated with a variety of clinical conditions such as: superior mesenteric ischemia, intestinal perforation, bowel necrosis, infections which can cause mucosal alterations and therefore increasing its permeability, necrotizing enterocolitis in babies, trauma, intestinal obstruction, autoimmune and pulmonary pathologies. Its presence is usually documented by radiological techniques such as abdominal X-ray, CT scan and endoscopy and are usually characterized by the typical pattern of gas bubbles in the wall of the intestine...
March 19, 2018: Annali Italiani di Chirurgia
Ansar P P, Ayyappan S, Vikash Mahajan
Laparoscopic procedures to treat endometrial cancer are currently emerging. At present, we have evidence to do laparoscopic oncologic resections for endometrial cancer as proven by many prospective studies from abroad such as LAP2 by GOG. So, we have decided to assess the safety and feasibility of such a study in our population with the following as our primary objectives: (1) to study whether laparoscopy is better compared to open approach in terms of duration of hospital stay, perioperative morbidity and early recovery from surgical trauma and (2) to study whether the laparoscopic approach is noninferior to the open approach in terms of number of lymph nodes harvested in lymphadenectomy and rate of conversion to open surgery...
June 2018: Indian Journal of Surgical Oncology
Craig I Coleman, Alexander G G Turpie, Thomas J Bunz, Jan Beyer-Westendorf
A paucity of real-world data evaluating rivaroxaban in provoked venous thromboembolism (VTE) exists. We assessed the effectiveness and safety of rivaroxaban versus warfarin in provoked VTE patients treated in routine practice. Using MarketScan claims data from 1/2012 to 12/2016, we identified adults who had ≥ 1 primary hospitalization/emergency department discharge diagnosis code for VTE (index event) and a provoking factor, received rivaroxaban or warfarin as their first outpatient oral anticoagulant within 30-days of the index event and had ≥ 12-month of insurance coverage prior the index VTE...
June 7, 2018: Journal of Thrombosis and Thrombolysis
Florent Femy, Arnaud Follin, Philippe Juvin, Anne-Laure Feral-Pierssens
OBJECTIVE: On 13 November 2015, Paris was the target of multiple terrorist attacks responsible for a massive influx of casualties in emergency departments (EDs). Because of the activation of a local crisis plan and the arrival of extra staff, our capacities increased markedly. Our aim was to analyze whether our center, in this challenging context, efficiently managed this massive influx of patients. PATIENTS AND METHODS: We carried out a monocentric retrospective study...
June 5, 2018: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
Janosch Dahmen, Marko Brade, Christian Gerach, Martin Glombitza, Jan Schmitz, Simon Zeitter, Eva Steinhausen
BACKGROUND: The European Resuscitation Council guidelines for resuscitation in patients with traumatic cardiac arrest recommend the immediate treatment of all reversible causes, if necessary even prior to continuous chest compression. In the case of cardiac tamponade immediate emergency thoracotomy should also be considered. OBJECTIVE: The authors report the case of a 23-year-old male patient with multiple injuries including blunt thoracic trauma, which caused a witnessed cardiac arrest...
June 5, 2018: Der Unfallchirurg
Mohd H Abdul-Aziz, Elicia Driver, Jeffrey Lipman, Jason A Roberts
Some special patient populations (e.g. critically ill, burns, haematological malignancy, post-major surgery, post-major trauma) have characteristics that lead to higher rates of failure and mortality associated with infection. Choice of effective antibiotics and optimised doses are challenging in these patients that are commonly infected by multi-drug resistant pathogens Areas covered: A review of the importance of diagnosis and the place of newer microbiological methods (e.g. whole genome sequencing) to ensure rapid transition from empiric to directed antibiotic therapy is provided...
June 4, 2018: Expert Opinion on Drug Metabolism & Toxicology
Matthew K Edwards, Christopher S Kuppler, Chasen A Croft, Hannah M Eason-Bates
Complete small bowel obstruction (SBO) is a common surgical emergency often resulting from adhesive bands that form following iatrogenic peritoneal injury. Rarely, adhesive SBO may arise without previous intra-abdominal surgery through other modes of peritoneal trauma. We present the case of a male evaluated in the emergency department for a closed-loop small bowel obstruction due to an adhesive band that likely formed after blunt abdominal trauma over two decades earlier. We review the epidemiology, pathophysiology, and treatment options for similar cases of adhesive SBO...
February 2018: Clinical practice and cases in emergency medicine
Masato Murata, Makoto Aoki, Shuichi Hagiwara, Masao Sekihara, Takayuki Kohri, Kei Shibuya, Norimasa Koike, Dai Miyazaki, Kiyohiro Oshima
An 85-year-old female suffered pelvic fracture, multiple rib fractures, right hemopneumothorax, and blunt abdominal aortic injury in a traffic accident. After transfer to our hospital, transcatheter arterial embolization (TAE) was performed immediately for hemorrhage from the bilateral internal iliac arteries. Enhanced computed tomography (CT) after TAE showed an increase of hematoma and extravasation at the bifurcation of the abdominal aorta. Therefore, emergency abdominal endovascular aortic repair was performed on the same day...
2018: Open Medicine (Warsaw, Poland)
Konstantin Mitev, Dashurie Neziri, Emil Stoicovski, Zan Mitrev
BACKGROUND: The healthcare system in developing countries is limited; particularly, medical specialties such as emergency and trauma medicine are underdeveloped. Consequently, trauma injuries sustained in traffic accidents result in chronic morbidity more often than similar cases in developed countries. Multiple rib fractures induce significant patient morbidity. Current international guidelines recommend a multidisciplinary, surgery-based treatment approach to achieve optimal clinical benefit...
May 29, 2018: Journal of Medical Case Reports
Kristin DeGirolamo, Karan D'Souza, Sameer Apte, Chad G Ball, Christopher Armstrong, Artan Reso, Sandy Widder, Sarah Mueller, Lawrence M Gillman, Ravinder Singh, Rahima Nenshi, Kosar Khwaja, Samuel Minor, Chris de Gara, S Morad Hameed
BACKGROUND: Emergency general surgery (EGS) services are gaining popularity in Canada as systems-based approaches to surgical emergencies. Despite the high volume, acuity and complexity of the patient populations served by EGS services, little has been reported about the services' structure, processes, case-mix or outcomes. This study begins a national surveillance effort to define and advance surgical quality in an important and diverse surgical population. METHODS: A national cross-sectional study of EGS services was conducted during a 24-hour period in January 2017 at 14 hospitals across 7 Canadian provinces recruited through the Canadian Association of General Surgeons Acute Care Committee...
June 1, 2018: Canadian Journal of Surgery. Journal Canadien de Chirurgie
Brad T Hyatt, James M Saucedo
Many conditions presenting to the hand surgeon are amenable to a bedside procedure rather than a formal operating room setting. With proper patient, room, and surgeon preparation, bedside procedures can provide an efficient and effective treatment for infection, trauma, and foreign bodies. Key differences from the operating room environment include patient expectations, analgesia, room setup, instrumentation, and surgical technique. This article provides a detailed primer for performing bedside procedures in the emergency department, outpatient clinic, and inpatient hospital room...
May 22, 2018: Journal of Hand Surgery
Jing-Yao Ma, Xin Zhang, Xiao-Feng Li, Le-Jian He, Ning Ma, Yun-Yun Wei, Run-Hui Wu, Fang-Yun Wang
Thrombotic storm (TS) is a rare disease, especially with thrombus in the heart of pediatric patient. We present a case of a 4-year-old boy, who was diagnosed with TS during his first hospitalization due to lower extremity deep venous thrombosis, pulmonary embolism, and thrombosis of the inferior vena cava, cerebral, left internal jugular, portal, renal, and iliac veins. He was eventually prescribed with rivaroxaban to control thrombosis after 30 days of successive use of low-molecular-weight heparin, unfractionated heparin, and warfarin, which were demonstrating little effect on preventing thrombosis, and the patient was intolerant to argatroban...
January 2018: International Journal of Immunopathology and Pharmacology
Simone Gurlit, Henriette Möllmann
BACKGROUND: As more aged patients are surgically treated in hospitals without specialized geriatric care, patients at risk for perioperative complications must be identified and treatment must be adapted. The aim was the use of the Identification of Seniors at Risk (ISAR) as a screening tool for the identification of high-risk patients, who need specialized perioperative care. The study presented investigated the use of ISAR screening not only as recommended in the emergency room but also in validation tests as a new option in elective surgery...
May 23, 2018: Zeitschrift Für Gerontologie und Geriatrie
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