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https://www.readbyqxmd.com/read/29035926/damage-control-surgery-current-state-and-future-directions
#1
Daniel Benz, Zsolt J Balogh
PURPOSE OF REVIEW: Damage control surgery (DCS) represents a staged surgical approach to the treatment of critically injured trauma patients. Originally described in the context of hepatic trauma and postinjury-induced coagulopathy, the indications for DCS have expanded to the management of extra abdominal trauma and to the management of nontraumatic acute abdominal emergencies. Despite being an accepted treatment algorithm, DCS is based on a limited evidence with current concerns of the variability in practice indications, rates and adverse outcomes in poorly selected patient cohorts...
October 14, 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29022780/primary-urethral-reconstruction-results-in-penile-fracture
#2
R Barros, Mis Silva, V Antonucci, L Schulze, L Koifman, L A Favorito
Objective This study assessed primary urethral reconstruction results in patients with a penile fracture. Materials and methods Between January 2005 and April 2016, patients who underwent primary urethral reconstruction due to penile fracture were called for a follow-up. Epidemiological and clinical presentation data and operative findings were reviewed retrospectively. Partial urethral lesions were primarily treated with interrupted absorbable sutures over urethral catheter. In cases of complete urethral lesion, tension-free end-to-end anastomosis was performed...
September 15, 2017: Annals of the Royal College of Surgeons of England
https://www.readbyqxmd.com/read/29019639/spine-conditions-cervical-spine-conditions
#3
Marc A Childress
There are a variety of causes of neck pain, including trauma and degenerative changes. The history of onset helps to direct evaluation, including the need for imaging or ancillary testing. Patterns of pain, weakness, and other specific physical examination findings also aid in diagnosis. Management of most soft tissue injuries involves early mobilization, whereas fractures are managed based on patterns of instability. Acute spinal cord injury requires emergent care, to include possible decompressive surgery...
October 2017: FP Essentials
https://www.readbyqxmd.com/read/29017862/emergency-repair-of-upper-extremity-large-soft-tissue-and-vascular-injuries-with-flow-through-anterolateral-thigh-free-flaps
#4
Yi Zhan, Guo Fu, Xiang Zhou, Bo He, Li-Wei Yan, Qing-Tang Zhu, Li-Qiang Gu, Xiao-Lin Liu, Jian Qi
BACKGROUND/OBJECTIVES: Complex extremity trauma commonly involves both soft tissue and vascular injuries. Traditional two-stage surgical repair may delay rehabilitation and functional recovery, as well as increase the risk of infections. We report a single-stage reconstructive surgical method that repairs soft tissue defects and vascular injuries with flow-through free flaps to improve functional outcomes. METHODS: Between March 2010 and December 2016 in our hospital, 5 patients with severe upper extremity trauma received single-stage reconstructive surgery, in which a flow-through anterolateral thigh free flap was applied to repair soft tissue defects and vascular injuries simultaneously...
October 7, 2017: International Journal of Surgery
https://www.readbyqxmd.com/read/28993355/bilateral-fungal-keratitis-with-ring-infiltrates-a-rare-scenario
#5
Manthan Hasmukhbhai Chaniyara, Amar Pujari, Jayanand Urkude, Namrata Sharma
A 12-year-old boy presented to the emergency department with chief complaints of pain, redness, discharge and diminution of vision in both eyes over the previous 20 days. There was no history of preceding trauma, contact lens use, any eye drop usage or ocular surgery. Systemic history was not significant. Presenting uncorrected visual acuity in his right eye was counting fingers at 1 m and 20/200 in the left eye, with accurate projection of rays in both eyes. Slit lamp biomicroscopy showed the presence of bilateral diffuse conjunctival congestion, corneal ring infiltrates and epithelial defect with corneal oedema...
October 9, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28985882/economic-evaluations-of-comprehensive-geriatric-assessment-in-surgical-patients-a-systematic-review
#6
Gilgamesh Eamer, Bianka Saravana-Bawan, Brenden van der Westhuizen, Thane Chambers, Arto Ohinmaa, Rachel G Khadaroo
BACKGROUND: Seniors presenting with surgical disease face increased risk of postoperative morbidity and mortality and have increased treatment costs. Comprehensive Geriatric Assessment (CGA) is proposed to reduce morbidity, mortality, and the cost after surgery. METHODS: A systematic review of CGA in emergency surgical patients was conducted. The primary outcome was cost-effectiveness; secondary outcomes were length of stay, return of function, and mortality. Inclusion and exclusion criteria were predefined...
October 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/28985861/differences-in-rural-and-urban-outcomes-a-national-inspection-of-emergency-general-surgery-patients
#7
Muhammad Ali Chaudhary, Adil A Shah, Cheryl K Zogg, Navin Changoor, Grace Chao, Stephanie Nitzschke, Joaquim M Havens, Adil H Haider
BACKGROUND: About 19% of the United States population lives in rural areas and is served by only 10% of the physician workforce. If this misdistribution represents a shortage of available surgeons, it is possible that outcomes for rural patients may suffer. The objective of this study was to explore differences in outcomes for emergency general surgery (EGS) conditions between rural and urban hospitals using a nationally representative sample. METHODS: Data from the 2007-2011 National Inpatient Sample were queried for adult patients (≥18 years) with a primary diagnosis consistent with an EGS condition, as defined by the American Association for the Surgery of Trauma...
October 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/28985811/ocular-injury-in-orbital-fractures-at-a-level-i-trauma-center
#8
Michael Ross, Christian El-Haddad, Jean Deschênes
OBJECTIVE: To determine the acuity of ophthalmology referral for orbital fractures. METHODS: This is a retrospective chart review of 73 cases of orbital fractures over a 1-year period at a level I trauma centre. All consultations including those for orbital fractures were included in the study. The age and sex of the patient, date and time of initial emergency room (ER) arrival, date and time of input of the ophthalmology consultation, date and time the patient actually saw ophthalmology, reasons for consultation, location of examination, mechanism, and ocular findings at initial and follow-up examination, and any orbital surgery performed were recorded...
October 2017: Canadian Journal of Ophthalmology. Journal Canadien D'ophtalmologie
https://www.readbyqxmd.com/read/28979986/geographic-diffusion-and-implementation-of-acute-care-surgery-an-uneven-solution-to-the-national-emergency-general-surgery-crisis
#9
Jasmine A Khubchandani, Angela M Ingraham, Vijaya T Daniel, Didem Ayturk, Catarina I Kiefe, Heena P Santry
Importance: Owing to lack of adequate emergency care infrastructure and decline in general surgery workforce, the United States faces a crisis in access to emergency general surgery (EGS) care. Acute care surgery (ACS), an organized system of trauma, general surgery, and critical care, is a proposed solution; however, ACS diffusion remains poorly understood. Objective: To investigate geographic diffusion of ACS models of care and characterize the communities in which ACS implementation is lagging...
October 4, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28974353/growth-curves-for-intracranial-volume-in-normal-asian-children-fortify-management-of-craniosynostosis
#10
Hideaki Kamochi, Ataru Sunaga, Daekwan Chi, Rintaro Asahi, Shiho Nakagawa, Masanori Mori, Hirokazu Uda, Shunji Sarukawa, Yasushi Sugawara, Kotaro Yoshimura
BACKGROUND: Although the charting of normal intracranial volume (ICV) is fundamental for managing craniosynostosis, Asian norms in this regard are unknown. The purpose of this study was to establish a growth curve for ICVs in a large series of normal Asian children, providing reference values to guide corrective surgery. METHODS: A total of 124 normal children (male, 63; female, 61) and 41 children diagnosed with craniosynostoses were analyzed. Patients aged 0-8 years presenting to the emergency room and subjected to computed tomography (CT) for head trauma served as the reference cohort...
September 21, 2017: Journal of Cranio-maxillo-facial Surgery
https://www.readbyqxmd.com/read/28966812/mild-hemophilia-a-presaged-by-recurrent-postoperative-hemorrhagic-complications-in-an-elderly-patient
#11
Hajime Ono, Taigen Sase, Hiroshi Takasuna, Yuichiro Tanaka
BACKGROUND: Mild hemophilia without spontaneous bleeding can remain undiagnosed for a lifetime. However, intracranial hemorrhage is one of the most serious complications for patients with hemophilia. In addition, hemorrhagic complications after emergency surgery tend to arise from coagulopathy. CASE DESCRIPTION: An 80-year-old man was admitted with left hemiparesis and disturbed consciousness. He had no history of trauma, fever, or drug and alcohol intake. Computed tomography imaging upon admission disclosed a hemispheric subdural hematoma with a midline shift...
2017: Surgical Neurology International
https://www.readbyqxmd.com/read/28965301/minimal-trauma-ankle-fractures-predominate-during-pregnancy-a-17-year-retrospective-study
#12
Madhuni Herath, Phillip Wong, Anne Trinh, Carolyn A Allan, Euan M Wallace, Peter R Ebeling, Peter J Fuller, Frances Milat
This study assessed all fractures occurring in pregnancy at a tertiary referral centre over a 17-year period. Most fractures were due to minimal trauma, and those involving the ankle were the most common. Women tended to fracture during their second and third trimesters and most required surgical intervention during pregnancy. PURPOSE: To characterise fractures in pregnancy over a 17-year period at a tertiary referral health service. METHODS: Medical records at the Monash Health in Australia were examined from 2000-2016 for fractures in pregnancy using the birthing outcome system database and the tenth revision of the International Statistical Classification of Diseases and Related Health Problems coding...
September 30, 2017: Archives of Osteoporosis
https://www.readbyqxmd.com/read/28962566/-i-stayed-with-my-illness-a-grounded-theory-study-of-health-seeking-behaviour-and-treatment-pathways-of-patients-with-obstetric-fistula-in-kenya
#13
Anne M Khisa, Grace M Omoni, Isaac K Nyamongo, Rachel F Spitzer
BACKGROUND: Obstetric fistula classic symptoms of faecal and urinary incontinence cause women to live with social stigma, isolation, psychological trauma and lose their source of livelihoods. There is a paucity of studies on the health seeking behaviour trajectories of women with fistula illness although women live with the illness for decades before surgery. We set out to establish the complete picture of women's health seeking behaviour using qualitative research. We sought to answer the question: what patterns of health seeking do women with obstetric fistula display in their quest for healing? METHODS: We used grounded theory methodology to analyse data from narratives of women during inpatient stay after fistula surgery in 3 hospitals in Kenya...
September 29, 2017: BMC Women's Health
https://www.readbyqxmd.com/read/28958272/inclusion-of-the-acute-care-surgeon-in-the-difficult-airway-protocol-a-nine-year-experience
#14
Seong K Lee, Andrew A Rosenthal, Dafney L Davare, Chauniqua Kiffin, Rafael Sanchez, Michael Hurtado, Eddy H Carrillo
An emergency surgical airway is a lifesaving intervention required in the event of airway loss or respiratory failure when conventional endotracheal intubation cannot be performed. The Acute Care Surgery/Trauma Service is a critical component in the angioedema/difficult airway protocol at our institution. We conducted a retrospective review (2007-2016) to analyze the role our service has in managing patients requiring an emergency surgical airway. Cases were analyzed for preexisting conditions, hospital location of procedure, techniques, complications, and mortality...
September 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28956316/anesthetic-implications-of-recreational-drug-use
#15
Pierre Beaulieu
PURPOSE: As the use of recreational drugs increases, the likelihood of an anesthesiologist perioperatively encountering patients using or addicted to these drugs will also increase. PRINCIPAL FINDINGS: Addicted patients may present for anesthetic care in a variety of circumstances in everyday elective surgeries or in acute or life-saving situations, such as emergency Cesarean delivery or trauma surgery. Therefore, it is important for anesthesiologists to know about the most common illicit drugs being used, their clinical presentation and side effects, and the anesthetic options that are beneficial or detrimental to these patients...
September 27, 2017: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
https://www.readbyqxmd.com/read/28953551/the-survival-benefit-of-a-novel-trauma-workflow-that-includes-immediate-whole-body-computed-tomography-surgery-and-interventional-radiology-all-in-one-trauma-resuscitation-room-a-retrospective-historical-control-study
#16
Takahiro Kinoshita, Kazuma Yamakawa, Hiroki Matsuda, Yoshiaki Yoshikawa, Daiki Wada, Toshimitsu Hamasaki, Kota Ono, Yasushi Nakamori, Satoshi Fujimi
OBJECTIVE: The aim of this study was to evaluate the impact of a novel trauma workflow, using an interventional radiology (IVR)-computed tomography (CT) system in severe trauma. BACKGROUND: In August 2011, we installed an IVR-CT system in our trauma resuscitation room. We named it the Hybrid emergency room (ER), as it enabled us to perform all examinations and treatments required for trauma in a single place. METHODS: This retrospective historical control study conducted in Japan included consecutive severe (injury severity score ≥16) blunt trauma patients...
September 26, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28948335/damage-control-surgery-for-non-traumatic-abdominal-emergencies
#17
Edouard Girard, Julio Abba, Bastien Boussat, Bertrand Trilling, Adrian Mancini, Pierre Bouzat, Christian Létoublon, Mircea Chirica, Catherine Arvieux
BACKGROUND: Damage control surgery (DCS) was a major paradigm change in the management of critically ill trauma patients and has gradually expanded in the general surgery arena, but data in this setting are still scarce. The study aim was to evaluate outcomes of DCS in patients with general surgery emergencies. METHODS: Between 2005 and 2015, 164 patients (104 men, age 66) underwent DCS for non-traumatic abdominal emergencies. The decision to perform DCS was triggered by the presence of at least one trauma DCS criterion: hypotension (<70 mmHg), hypothermia (<35 °C), acidosis (pH < 7...
September 25, 2017: World Journal of Surgery
https://www.readbyqxmd.com/read/28948295/routine-versus-selective-chest-and-abdominopelvic-ct-scan-in-conscious-blunt-trauma-patients-a-randomized-controlled-study
#18
N Moussavi, H Ghani, A Davoodabadi, F Atoof, A Moravveji, S Saidfar, H Talari
PURPOSE: CT-scan is increasingly used in blunt trauma, but the real impact on patient outcome is still unclear. This study was conducted to assess the effect of performing routine (versus selective) chest and abdominopelvic CT-scan on patient admission time and outcome in blunt trauma. METHODS: Conscious and hemodynamically stable high-energy trauma patients were included (n = 140). Routine chest and abdominopelvic CT-scan was requested in addition to the conventional radiography and ultrasound for the intervention group and selective CT-scan according to clinical presentation was done for the control group...
September 25, 2017: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
https://www.readbyqxmd.com/read/28947402/etiological-clinical-and-therapeutic-aspects-of-acute-generalized-peritonitis-in-n-djamena-chad
#19
O Choua, M M Ali, M Kaboro, K M Moussa, M Anour
Our aim was to define the epidemiological profile of acute generalized peritonitis in N'Djamena, Chad. This retrospective study, conducted in the general surgery department of the National Reference General Hospital, examined the files of 492 patients who underwent surgery for acute generalized peritonitis from June 2007 to December 2012. Epidemiological, clinical, paraclinical, and therapeutic characteristics were described. Acute generalized peritonitis accounted for 35.2 % of all visceral surgical emergencies...
August 1, 2017: Médecine et Santé Tropicales
https://www.readbyqxmd.com/read/28942415/confusion-and-abdominal-symptoms-following-a-rugby-tackle
#20
Demetris Ioannides, Madeleine Davies, Stefan Kluzek
A 19-year-old man was sent to the emergency department following a pitch-side assessment for suspected concussion, unexplained upper abdominal tenderness and vomiting, following a high-impact tackle during a rugby match. A Focussed Assessment with Sonography for Trauma (FAST) scan performed in the emergency department suggested intra-abdominal free fluid, and subsequent head and abdominal CT imaging showed no intracranial lesion but confirmed a significant haemoperitoneum due to large splenic tear and bleeding...
September 23, 2017: BMJ Case Reports
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