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https://www.readbyqxmd.com/read/29224654/evaluation-and-management-of-blunt-solid-organ-trauma
#1
Jonathan G Martin, Jay Shah, Craig Robinson, Sean Dariushnia
Trauma is a leading cause of death in patients under the age of 45 and generally associated with a high kinetic energy event such as a motor vehicle accident or fall from extreme elevations. Blunt trauma can affect every organ system and major vascular structure with potentially devastating effect. When we consider abdominal solid organ injury from blunt trauma, we usually think of the liver, spleen, and kidneys. However, all of the abdominal organs, including the pancreas and adrenal glands, may be involved...
December 2017: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/29221814/use-of-interventional-radiology-as-initial-hemorrhage-control-to-improve-outcomes-for-potentially-lethal-multiple-blunt-injuries
#2
Hiroyuki Otsuka, Toshiki Sato, Keiji Sakurai, Hiromichi Aoki, Takeshi Yamagiwa, Shinichi Iizuka, Sadaki Inokuchi
INTRODUCTION: Recently, trauma management has been markedly improved with interventional radiology (IVR) and damage-control strategies. However, the indications for its use in hemodynamically unstable patients with severe trauma remains unclear. In some cases, IVR may be more effective than surgery for damage-control hemostasis; however, performing IVR in life-threatening trauma settings is challenging. To address this, we practiced and evaluated a trauma-management system with emergency physicians who trained for both severe trauma management, and techniques of surgery and IVR...
December 6, 2017: Injury
https://www.readbyqxmd.com/read/29208274/hemostatic-porous-sponges-of-cross-linked-hyaluronic-acid-cationized-dextran-by-one-self-foaming-process
#3
Jia-Ying Liu, Yang Li, Yang Hu, Gang Cheng, Enyi Ye, Chuanan Shen, Fu-Jian Xu
Effective hemostatic materials are very important for treating trauma cases. Natural polysaccharides have been particularly appealing in the development of new hemostatic materials due to their unique functions in human bodies. In this work, different polysaccharide-based hemostatic porous sponges (SHDP or SHDQ) of cross-linked hyaluronic acid (HA)/cationized dextran were readily prepared by the self-foaming process of HA and poly((2-dimethyl amino)-ethyl methacrylate)-grafted dextran (Dex-PDM) or partially-quaternized Dex-PDM in the presence of sodium trimetaphosphate crosslinkers...
February 1, 2018: Materials Science & Engineering. C, Materials for Biological Applications
https://www.readbyqxmd.com/read/29205995/volume-and-health-outcomes-evidence-from-systematic-reviews-and-from-evaluation-of-italian-hospital-data
#4
Laura Amato, Danilo Fusco, Anna Acampora, Katia Bontempi, Alessandro Cesare Rosa, Paola Colais, Fabio Cruciani, Mariangela D'Ovidio, Francesca Mataloni, Silvia Minozzi, Zuzana Mitrova, Luigi Pinnarelli, Rosella Saulle, Salvatore Soldati, Chiara Sorge, Simona Vecchi, Martina Ventura, Marina Davoli
BACKGROUND Improving quality and effectiveness of healthcare is one of the priorities of health policies. Hospital or physician volume represents a measurable variable with an impact on effectiveness of healthcare. An Italian law calls for the definition of «qualitative, structural, technological, and quantitative standards of hospital care». There is a need for an evaluation of the available scientific evidence in order to identify qualitative, structural, technological, and quantitative standards of hospital care, including the volume of care above or below which the public and private hospitals may be accredited (or not) to provide specific healthcare interventions...
September 2017: Epidemiologia e Prevenzione
https://www.readbyqxmd.com/read/29205984/liver-trauma-in-a-young-woman
#5
Tuure Saarinen, Heikki Mäkisalo
A young woman fell off a horse, leaving her right flank contused by a hoof. This resulted in a severe liver trauma that seemed to require surgical treatment. After fluid resuscitation and five units of red blood cells the patient's status, however, stabilized upon entering the operating room. The operation was avoided, but intensive care follow-up was continued for six days. The patient made a complete recovery. Conservative treatment of liver trauma is successful in 90% of mild and almost 70% in severe traumas...
2017: Duodecim; Lääketieteellinen Aikakauskirja
https://www.readbyqxmd.com/read/29204871/bone-marrow-mesenchymal-stem-cells-combat-lipopolysaccharide-induced-sepsis-in-rats-via-amendment-of-p38-mapk-signaling-cascade
#6
Omnia S Zaki, Marwa M Safar, Afaf A Ain-Shoka, Laila A Rashed
Sepsis is a systemic inflammatory disorder which often occurs during extremely stressful conditions such as trauma, burn, shock, and infection. This study investigated the curative effects of bone marrow-derived mesenchymal stem cells (BM-MSCs) against hepatic, renal, and pulmonary responses caused by a single administration of lipopolysaccharide (LPS) (10 mg/kg, i.p) in rats. Treatment with BM-MSCs (5 × 105 in 0.1 ml PBS, i.p.) 3 h after LPS antagonized the LPS-induced increment of the liver enzymes (ALT, AST) and kidney functions (BUN, sCr)...
December 4, 2017: Inflammation
https://www.readbyqxmd.com/read/29201808/management-of-traumatic-liver-and-bile-duct-laceration
#7
Charu Tiwari, Hemanshi Shah, Mukta Waghmare, Kiran Khedkar, Pankaj Dwivedi
Posttraumatic major bile leak in children is uncommon, with few cases reported in the literature. These injuries are seen in high-grade liver trauma and are difficult to diagnose and manage. We describe a 7-year-old boy with grade IV hepatic trauma and bile leak following blunt abdominal trauma. The leak was successfully managed by percutaneous drainage and endoscopic retrograde cholangiopancreatography (ERCP) stenting of the injured hepatic duct. How to cite this article: Tiwari C, Shah H, Waghmare M, Khedkar K, Dwivedi P...
July 2017: Euroasian journal of hepato-gastroenterology
https://www.readbyqxmd.com/read/29194321/variability-in-management-of-blunt-liver-trauma-and-contribution-of-level-of-acs-cot-verification-status-on-mortality
#8
Christopher J Tignanelli, Bellal Joseph, Jill L Jakubus, Gaby A Iskander, Lena M Napolitano, Mark R Hemmila
BACKGROUND: Patients who sustain blunt liver trauma and are treated at an ACS-COT verified level 1 trauma center have an overall lower risk of mortality compared with patients admitted to a level 2 trauma center. However, elements contributing to these differences are unknown. We hypothesize that practice variation exists between trauma centers in management of blunt liver injury. Our objective is to identify practice variations and their effect on clinical outcomes. METHODS: Data from a statewide collaborative quality initiative for trauma was utilized...
December 1, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29183519/abdominal-trauma-revisited
#9
REVIEW
David V Feliciano
Although abdominal trauma has been described since antiquity, formal laparotomies for trauma were not performed until the 1800s. Even with the introduction of general anesthesia in the United States during the years 1842 to 1846, laparotomies for abdominal trauma were not performed during the Civil War. The first laparotomy for an abdominal gunshot wound in the United States was finally performed in New York City in 1884. An aggressive operative approach to all forms of abdominal trauma till the establishment of formal trauma centers (where data were analyzed) resulted in extraordinarily high rates of nontherapeutic laparotomies from the 1880s to the 1960s...
November 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/29180179/preoperative-thrombelastography-maximum-amplitude-predicts-massive-transfusion-in-liver-transplantation
#10
Peter J Lawson, Hunter B Moore, Ernest E Moore, Gregory R Stettler, Thomas J Pshak, Igal Kam, Christopher C Silliman, Trevor L Nydam
BACKGROUND: Massive transfusion (MT) is frequently required during liver transplantation. Risk stratification of transplant patients at risk for MT is an appealing concept but remains poorly developed. Thrombelastography (TEG) has recently been shown to reduce mortality when used for trauma resuscitation. We hypothesize that preoperative TEG can be used to risk stratify patients for MT. MATERIAL AND METHODS: Liver transplant patients had blood drawn before surgical incision and assayed via TEG...
December 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/29168170/platelets-derived-from-fresh-and-cold-stored-whole-blood-participate-in-clot-formation-in-rats-with-acute-traumatic-coagulopathy
#11
Xiaowu Wu, Daniel N Darlington, Robbie K Montgomery, Bin Liu, Jeffrey D Keesee, Michael R Scherer, Avi Benov, Jacob Chen, Andrew P Cap
The in vitro haemostatic functions of fresh whole blood (FWB) are well preserved after cold storage. This study aimed to determine whether platelets derived from FWB and stored whole blood (SWB) contribute to clot formation in tissue injury after transfusion into coagulopathic rats with polytrauma/haemorrhage (T/H). The rats were resuscitated 1 h after trauma with FWB or SWB collected from green fluorescence protein (GFP) transgenic rats. After transfusion, a liver incision was made and the tissue was collected 10 min after injury to identify GFP(+) platelets by immunohistochemistry...
November 22, 2017: British Journal of Haematology
https://www.readbyqxmd.com/read/29167946/beaver-tail-liver
#12
REVIEW
Mehmet Haydar Atalar, Kayhan Karakus
Also known as the sliver of liver, beaver tail liver is an anatomic variation of the liver where its left lobe extends laterally to contact and enclose the spleen. Hepatic parenchyma is normal. It may be difficult to distinguish the two organs from each other when both have equal echogenicity or density in ultrasonography and computed tomography. Therefore, it may mimic a splenic trauma or a perisplenic hemorrhage or subcapsular hematoma within the splenic parenchyma.
November 22, 2017: Abdominal Radiology
https://www.readbyqxmd.com/read/29161213/laparoscopic-management-of-penetrating-thoracoabdominal-trauma
#13
Megan C Prunty, Siddharth Kudav, Jacob A Quick
BACKGROUND: Traumatic thoracoabdominal injuries can involve multiple organs and multiple cavities, which increases the complexity of surgical management. Traditionally, these injuries required laparotomy and thoracotomy. However, minimally invasive intervention may be reasonable for stable patients. MATERIALS AND METHODS: We present a case of a thoracoabdominal gunshot wound resulting in multiorgan, multicavity injury to the lung, diaphragm, and liver. We performed hepatorrhaphy and diaphragm repair, and addressed a retained hemothorax through a transabdominal laparoscopic approach...
November 21, 2017: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
https://www.readbyqxmd.com/read/29156155/leukotriene-b4-indicates-lung-injury-and-on-going-inflammatory-changes-after-severe-trauma-in-a-porcine-long-term-model
#14
Philipp Störmann, Birgit Auner, Lukas Schimunek, Rafael Serve, Klemens Horst, Tim-P Simon, Roman Pfeifer, Kernt Köhler, Frank Hildebrand, Sebastian Wutzler, Hans-Christoph Pape, Ingo Marzi, Borna Relja
BACKGROUND: Recognizing patients at risk for pulmonary complications (PC) is of high clinical relevance. Migration of polymorphonuclear leukocytes (PMN) to inflammatory sites plays an important role in PC, and is tightly regulated by specific chemokines including interleukin (IL)-8 and other mediators such as leukotriene (LT)B4. Previously, we have reported that LTB4 indicated early patients at risk for PC after trauma. Here, the relevance of LTB4 to indicating lung integrity in a newly established long-term porcine severe trauma model (polytrauma, PT) was explored...
December 2017: Prostaglandins, Leukotrienes, and Essential Fatty Acids
https://www.readbyqxmd.com/read/29150779/perioperative-transesophageal-echocardiography-for-non-cardiac-surgery
#15
REVIEW
Ashraf Fayad, Sasha K Shillcutt
PURPOSE: The use of transesophageal echocardiography (TEE) has evolved to include patients undergoing high-risk non-cardiac procedures and patients with significant cardiac disease undergoing non-cardiac surgery. Implementation of basic TEE education in training programs has increased across a broad spectrum of procedures in the perioperative arena. This paper describes the use of perioperative TEE in non-cardiac surgery and provides an overview of the basic TEE examination. PRINCIPAL FINDINGS: Perioperative TEE is used to monitor hemodynamic parameters in non-cardiac procedures where there is a high risk of hemodynamic instability...
November 17, 2017: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
https://www.readbyqxmd.com/read/29149974/liver-transplantation-with-old-grafts-a-ten-year-experience
#16
S Roullet, M Defaye, A Quinart, J-P Adam, L Chiche, C Laurent, M Neau-Cransac
BACKGROUND: The persistent scarcity of donors has prompted liver transplantation teams to find solutions for increasing graft availability. We report our experience of liver transplantations performed with grafts from older donors, specifically over 70 and 80 years old. PATIENTS AND METHODS: We analyzed our prospectively maintained single-center database from January 1, 2005, to December 31, 2014, with 380 liver transplantations performed in 354 patients. Six groups were composed according to donor age: <40 (n = 84), 40 to 49 (n = 67), from 50 to 59 (n = 62), from 60 to 69 (n = 76), from 70 to 79 (n = 64), and ≥80 years (n = 27)...
November 2017: Transplantation Proceedings
https://www.readbyqxmd.com/read/29145467/adenosine-lidocaine-and-mg2-alm-fluid-therapy-attenuates-systemic-inflammation-platelet-dysfunction-and-coagulopathy-after-non-compressible-truncal-hemorrhage
#17
Hayley Letson, Geoffrey Dobson
BACKGROUND: Systemic inflammation and coagulopathy are major drivers of injury progression following hemorrhagic trauma. Our aim was to examine the effect of small-volume 3% NaCl adenosine, lidocaine and Mg2+ (ALM) bolus and 0.9% NaCl/ALM 'drip' on inflammation and coagulation in a rat model of hemorrhagic shock. METHODS: Sprague-Dawley rats (429±4 g) were randomly assigned to: 1) shams, 2) no-treatment, 3) saline-controls, 4) ALM-therapy, and 5) Hextend®. Hemorrhage was induced in anesthetized-ventilated animals by liver resection (60% left lateral lobe and 50% medial lobe)...
2017: PloS One
https://www.readbyqxmd.com/read/29131053/an-experimental-study-to-measure-the-mechanical-properties-of-the-human-liver
#18
Alireza Karimi, Ahmad Shojaei
BACKGROUND: Since the liver is one of the most important organs of the body that can be injured during trauma, that is, during accidents like car crashes, understanding its mechanical properties is of great interest. Experimental data is needed to address the mechanical properties of the liver to be used for a variety of applications, such as the numerical simulations for medical purposes, including the virtual reality simulators, trauma research, diagnosis objectives, as well as injury biomechanics...
October 31, 2017: Digestive Diseases
https://www.readbyqxmd.com/read/29125848/early-decreased-tlr2-expression-on-monocytes-is-associated-with-their-reduced-phagocytic-activity-and-impaired-maturation-in-a-porcine-polytrauma-model
#19
Lukas Schimunek, Rafael Serve, Michel P J Teuben, Philipp Störmann, Birgit Auner, Mathias Woschek, Roman Pfeifer, Klemens Horst, Tim-P Simon, Miriam Kalbitz, Ramona Sturm, Hans-C Pape, Frank Hildebrand, Ingo Marzi, Borna Relja
In their post-traumatic course, trauma patients suffering from multiple injuries have a high risk for immune dysregulation, which may contribute to post-injury complications and late mortality. Monocytes as specific effector cells of the innate immunity play a crucial role in inflammation. Using their Pattern Recognition Receptors (PRRs), notably Toll-Like Receptors (TLR), the monocytes recognize pathogens and/or pathogen-associated molecular patterns (PAMPs) and organize their clearance. TLR2 is the major receptor for particles of gram-positive bacteria, and initiates their phagocytosis...
2017: PloS One
https://www.readbyqxmd.com/read/29123547/quercetin-pretreatment-attenuates-hepatic-ischemia-reperfusion-induced-apoptosis-and-autophagy-by-inhibiting-erk-nf-%C3%AE%C2%BAb-pathway
#20
Liwei Wu, Qinghui Zhang, Weiqi Dai, Sainan Li, Jiao Feng, Jingjing Li, Tong Liu, Shizan Xu, Wenwen Wang, Xiya Lu, Qiang Yu, Kan Chen, Yujing Xia, Jie Lu, Yingqun Zhou, Xiaoming Fan, Chuanyong Guo
Background: Hepatic ischemia reperfusion (IR) injury is a common phenomenon in transplantation or trauma. The aim of the present study was to determine the protective effect of quercetin (QE) on hepatic IR injury via the ERK/NF-κB pathway. Methods: Mice were randomized into the sham, IR, QE100 + IR, and QE200 + IR groups. Quercetin was administered intragastrically daily at two doses (100 mg/kg and 200 mg/kg) for 5 days prior to IR injury. The expression levels of liver enzymes, inflammatory cytokines, and other marker proteins were determined at 2, 8, and 24 hours after IR...
2017: Gastroenterology Research and Practice
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