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https://www.readbyqxmd.com/read/28803513/mechanisms-of-unexpected-death-and-autopsy-findings-in-friedreich-ataxia
#1
Roger W Byard, John D Gilbert
A 36-year-old woman with a clinical history of Friedreich ataxia and hypertrophic cardiomyopathy was found unexpectedly dead at her home. The heart showed asymmetric left ventricular hypertrophy, with an interventricular septal thickness of 20-25 mm (the remainder of the left ventricular wall measured 15 mm). Histologically, both ventricles had irregular areas of marked myocyte hypertrophy with associated interstitial fibrosis and focal myofibre disarray. There was neuronal loss within the dentate nucleus of the cerebellum, with vacuolation and axonal loss in the dorsal columns and spinocerebellar tracts of the upper cervical spinal cord...
January 1, 2017: Medicine, Science, and the Law
https://www.readbyqxmd.com/read/28803441/thermoregulation-disorders-of-central-origin-how-to-diagnose-and-treat
#2
Marta Zawadzka, Marta Szmuda, Maria Mazurkiewicz-Bełdzińska
Fever is a common symptom in the Intensive Care Unit. At least half of febrile episodes are caused by infection. Excluding infectious etiology and other non-infectious causes of fever, especially in patients with central nervous system (CNS) disorders, attention should be paid to disturbances of thermoregulatory centre. In particular, subarachnoid haemorrhage, cerebral trauma, along with ischaemic or haemorrhagic stroke are strongly associated with the development of central fever. Proper, speedy diagnosis of the cause of fever makes it possible to implement preventive measures against the harmful effects of hyperthermia on the CNS and to avoid the consequences of inappropriate treatment...
2017: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/28801837/blunt-injuries-related-to-equestrian-sports-results-from-an-international-prospective-trauma-database-analysis
#3
Christian D Weber, Anthony R Nguyen, Rolf Lefering, Martijn Hofman, Frank Hildebrand, Hans-Christoph Pape
INTRODUCTION: The objective of this study was to investigate the nature, management, and outcome of major injuries related to equestrian sports and to define the at-risk groups for serious and life-threatening injuries. METHODS: We analyzed demographic, pre-hospital, clinical, and outcome data from an international population-based prospective trauma database (TraumaRegister DGU®). Patients with major injuries (Injury Severity Score [ISS] ≥9 points) related to equestrian sports activities were included (January 1, 1993, to December 31, 2012)...
August 11, 2017: International Orthopaedics
https://www.readbyqxmd.com/read/28799276/mode-of-delivery-for-singleton-extreme-preterm-breech-fetuses-a-10%C3%A2-year-retrospective-review-from-a-single-tertiary-obstetric-centre
#4
Frances Hills, Mandy Way, Renuka Sekar
BACKGROUND: Preterm breech delivery is associated with a higher perinatal mortality rate compared with preterm vertex delivery, and some studies suggest caesarean section leads to lower mortality rates. Few studies include infants delivered less than 26 weeks gestation, and where included, results are often not stratified by gestational age. There is also a lack of consistent reporting on neonatal and maternal morbidity outcome measures. AIMS: To determine if mode of delivery for singleton extreme preterm breech fetuses is associated with a difference in perinatal mortality, neonatal and maternal morbidity...
August 11, 2017: Australian & New Zealand Journal of Obstetrics & Gynaecology
https://www.readbyqxmd.com/read/28797555/to-log-roll-or-not-to-log-roll-that-is-the-question-a-review-of-the-use-of-the-log-roll-for-patients-with-pelvic-fractures
#5
REVIEW
Inês Filipa da Cunha Rodrigues
Pelvic fractures are one of the most serious injuries in polytrauma - massive haemorrhage is a major complication and the leading cause of death. The assessment and early management of these injuries in the Emergency Department (ED) focuses on the recognition of haemodynamic instability and should follow Advanced Trauma Life Support (ATLS) guidelines. The log-roll technique, although an accepted practice in trauma care, has been reported to be inadvisable when a pelvic fracture is suspected. This paper, which includes a case study, briefly explains the pathophysiology and initial management of pelvic fractures...
May 10, 2017: International Journal of Orthopaedic and Trauma Nursing
https://www.readbyqxmd.com/read/28793885/prognostic-factors-in-endovascular-treated-pelvic-haemorrhage-after-blunt-trauma
#6
Rafael Rehwald, Elisabeth Schönherr, Johannes Petersen, Hans-Christian Jeske, Anna Fialkovska, Anna Katharina Luger, Astrid Ellen Grams, Alexander Loizides, Werner Jaschke, Bernhard Glodny
BACKGROUND: Angioembolization is the method of choice for treating haemorrhage after blunt pelvic trauma. The aim of this study was to determine technical factors related to endovascular procedures which might be related to patient outcome. METHODS: This retrospective study included 112 consecutive patients (40 women and 72 men; mean age 57.2 ± 20.0). RESULTS: There were age peaks at 43 and at 77 years. Patients over 65 years had mainly "low-energy" trauma; younger patients were more likely to have polytraumas...
August 9, 2017: BMC Surgery
https://www.readbyqxmd.com/read/28790101/splenic-rupture-following-synchronised-direct-current-cardioversion
#7
Nicholas Kaufman, David Ferraro
Atraumatic rupture of the normal spleen is a rare entity. Often, a triggering factor or minor physical event can be ascribed as the aetiology for rupture, including coughing, vomiting or minor medical procedures not involving the spleen. A 65-year-old man who was hospitalised for eosinophilic pneumonia developed haemodynamically unstable atrial flutter that necessitated urgent synchronised direct current cardioversion (DCCV). Two hours after successful cardioversion, he developed signs of an acute abdomen with free intraperitoneal fluid identified on bedside ultrasonography...
August 7, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28778037/comparison-of-midwife-led-care-and-obstetrician-led-care-on-maternal-and-neonatal-outcomes-in-singapore-a-retrospective-cohort-study
#8
Shi Tian Voon, Julie Tay Suan Lay, Wilson Tam Wai San, Shefaly Shorey, Serena Koh Siew Lin
OBJECTIVES: to examine the maternal and neonatal outcomes of low-risk women receiving midwife-led care and obstetrician-led care. DESIGN, SETTING,&PARTICIPANTS: a retrospective cohort study design was used. Data were collected from a large tertiary maternity hospital in Singapore. This involved a medical record review of 368 women who had singleton, normal to low-risk, term pregnancy, and received midwife-led care and obstetrician-led care between 2013 to 2014. MEASUREMENTS: a data extraction tool was used to solicit information on the outcome measures, including duration of labour, mode of delivery, episiotomy, and 5-minutes Apgar score (<7)...
July 18, 2017: Midwifery
https://www.readbyqxmd.com/read/28756471/the-research-agenda-for-trauma-critical-care
#9
REVIEW
Karim Asehnoune, Zsolt Balogh, Giuseppe Citerio, Andre Cap, Timothy Billiar, Nino Stocchetti, Mitchell J Cohen, Paolo Pelosi, Nicola Curry, Christine Gaarder, Russell Gruen, John Holcomb, Beverley J Hunt, Nicole P Juffermans, Mark Maegele, Mark Midwinter, Frederick A Moore, Michael O'Dwyer, Jean-François Pittet, Herbert Schöchl, Martin Schreiber, Philip C Spinella, Simon Stanworth, Robert Winfield, Karim Brohi
In this research agenda on the acute and critical care management of trauma patients, we concentrate on the major factors leading to death, namely haemorrhage and traumatic brain injury (TBI). In haemostasis biology, the results of randomised controlled trials have led to the therapeutic focus moving away from the augmentation of coagulation factors (such as recombinant factor VIIa) and towards fibrinogen supplementation and administration of antifibrinolytics such as tranexamic acid. Novel diagnostic techniques need to be evaluated to determine whether an individualised precision approach is superior to current empirical practice...
July 29, 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28750794/mediastinal-injury-is-the-strongest-predictor-of-mortality-in-mounted-blast-amongst-uk-deployed-forces
#10
A Phillip Pearce, Anthony M J Bull, Jonathon C Clasper
BACKGROUND: Blast injury has been the most common cause of morbidity and mortality encountered by UK forces during recent conflicts. Injuries sustained by blast are categorised by the injuring component of the explosion and depend upon physical surroundings. Previous work has established that head injuries and intra cavity haemorrhage are the major causes of death following exposure to under body (mounted) blast but has yet to explore the precise nature of these torso injuries nor the effect of particular injuries upon survival...
July 19, 2017: Injury
https://www.readbyqxmd.com/read/28738295/does-the-effect-of-one-day-simulation-team-training-in-obstetric-emergencies-decline-within-one-year-a-post-hoc-analysis-of-a-multicentre-cluster-randomised-controlled-trial
#11
J van de Ven, A F Fransen, E Schuit, P J van Runnard Heimel, B W Mol, S G Oei
Does the effect of one-day simulation team training in obstetric emergencies decline within one year? A post-hoc analysis of a multicentre cluster randomised controlled trial. J van de Ven, AF Fransen, E Schuit, PJ van Runnard Heimel, BW Mol, SG Oei OBJECTIVE: To investigate whether the effect of a one-day simulation-based obstetric team training on patient outcome changes over time. STUDY DESIGN: Post-hoc analysis of a multicentre, open, randomised controlled trial that evaluated team training in obstetrics (TOSTI study)...
July 14, 2017: European Journal of Obstetrics, Gynecology, and Reproductive Biology
https://www.readbyqxmd.com/read/28724601/focused-assessment-with-sonography-for-trauma-fast-identifies-liver-injury-following-cardiopulmonary-resuscitation
#12
Hiroshi Nashiki, Yoshiharu Miyate, Yousuke Terui, Masayuki Otani
Liver trauma is a recognised rare complication of cardiopulmonary resuscitation (CPR) and may be difficult to detect. We report a case of intraperitoneal haemorrhage due to liver injury following CPR in a 50-year-old man admitted to the intensive care unit. The haemorrhage was diagnosed with focused assessment with sonography for trauma (FAST). FAST can rapidly and easily diagnose liver injury. FAST is recommended for excluding haemoperitoneum in patients who are haemodynamically unstable after resuscitation...
July 19, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28716775/acute-rehabilitation-after-resuscitative-endovascular-balloon-occlusion-of-the-aorta-reboa-in-major-trauma
#13
Jessica Anne Rich, Julia Coleman, Camille Devaux, Karen Hoffman
We report a 23-year-old woman admitted post cyclist versus heavy goods vehicle accident in December 2014. This was the second case the life-saving procedure, that is, resuscitative endovascular balloon occlusion of the aorta (REBOA) was performed on at the roadside. This advanced procedure was performed due to the extensive haemorrhage from this patient's complex pelvic fracture . As a result of REBOA, the patient consequently lost her left lower limb and underwent a variety of complex pelvic and lower limb surgeries...
July 17, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28700414/evaluation-of-gut-blood-barrier-gbb-dysfunction-in-various-models-of-trauma-haemorrhagic-shock-and-burn-injury
#14
Lisa Wrba, Annette Palmer, Christian Karl Braun, Markus Huber-Lang
Dysfunction of the gut-blood barrier (GBB) plays a pivotal role in various diseases, including trauma, haemorrhagic shock (HS) and burn injury, as well as inflammatory bowel diseases (IBD). Whereas GBB disruption significantly contributes to IBD, the exact extent and consequences of GBB failure and its reliable determination in the clinical course following trauma remain rather unclear. A compromised GBB function seems to contribute to remote organ injury after trauma by generation of inflammatory mediators and biologically active lymph, which in turn augments the inflammatory response...
July 12, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28698750/the-relationship-between-risk-factors-of-head-trauma-with-ct-scan-findings-in-children-with-minor-head-trauma-admitted-to-hospital
#15
Babak Masoumi, Farhad Heydari, Hamidreza Hatamabadi, Reza Azizkhani, Zahra Yoosefian, Majid Zamani
BACKGROUND: In emergency medicine for determining the intracranial injury (ICI) in children with head trauma, usually brain CT scan is performed. Since brain CT scan, especially in children, has some disadvantages, it is better to find a procedure which could help to choose only the children with real head trauma injury for brain CT scan. AIMS: The aim of this study is to find such procedure. This study was descriptive, analytic and non-interventional. METHODS: We reviewed the archived files of children with head trauma injuries referred to the emergency department of Imam Hossein Hospital within two years...
June 15, 2017: Open Access Macedonian Journal of Medical Sciences
https://www.readbyqxmd.com/read/28692445/normal-cerebral-vascular-pulsations-in-humans-changes-with-age-and-implications-for-microvascular-disease
#16
Mi O Kim, Yan Li, Fangfei Wei, Jiguang Wang, Michael F O'Rourke, Audrey Adji, Alberto P Avolio
BACKGROUND: Cerebral syndromes in older humans, secondary stroke in younger persons following trauma, and sickle cell anaemia in children, are linked by unexplained microvascular damage and high cerebral pressure or flow pulsations. The aim of this study was to characterize age-related pressure and flow waveforms patterns entering the brain, to explain these in terms of disturbed physiological function, and to consider clinical implications. METHOD: Blood flow velocity waves were measured in four cerebral vascular territories by transcranial Doppler of 1020 apparently normal patients (497 men, 21-78 years)...
July 7, 2017: Journal of Hypertension
https://www.readbyqxmd.com/read/28692173/perinatal-and-maternal-morbidity-and-mortality-among-term-singletons-following-midcavity-operative-vaginal-delivery-versus-caesarean-delivery
#17
Giulia M Muraca, Amanda Skoll, Sarka Lisonkova, Yasser Sabr, Rollin Brant, Geoffrey W Cundiff, K S Joseph
OBJECTIVE: To quantify severe perinatal and maternal morbidity/mortality associated with midcavity operative vaginal delivery compared with caesarean delivery. DESIGN: Population-based, retrospective cohort study. SETTING: British Columbia, Canada. POPULATION: Term, singleton deliveries (2004-2014) by attempted midcavity operative vaginal delivery or caesarean delivery in the second stage of labour, stratified by indication for operative delivery (n=10,901 deliveries; 5,057 indicated for dystocia, 5,844 for fetal distress)...
July 10, 2017: BJOG: An International Journal of Obstetrics and Gynaecology
https://www.readbyqxmd.com/read/28688890/any-changes-in-recent-massive-transfusion-practices-in-a-tertiary-level-institution
#18
Romi Sinha, David Roxby
BACKGROUND & OBJECTIVES: A previous review of transfusion practices in our institution between 1998 and 2008 showed a trend of high ratios of red cells (RC) to plasma (FFP) and platelets to RC towards the later years of review period. The aim of the study was to further evaluate transfusion practices in the form of blood product usage and outcomes following massive transfusion (MT) METHODS: All adult patients with critical bleeding who received a MT (defined as ≥10 units of RC in 24h) in 2008 and between January 2010 and December 2014 were identified...
June 8, 2017: Transfusion and Apheresis Science
https://www.readbyqxmd.com/read/28684079/a-comparison-of-base-deficit-and-vital-signs-in-the-early-assessment-of-patients-with-penetrating-trauma-in-a-high-burden-setting
#19
Mark Peter Dunham, Benn Sartorius, Grant Llewellyn Laing, John Lambert Bruce, Damian Luiz Clarke
INTRODUCTION: An assessment of physiological status is a key step in the early assessment of trauma patients with implications for triage, investigation and management. This has traditionally been done using vital signs. Previous work from large European trauma datasets has suggested that base deficit (BD) predicts clinically important outcomes better than vital signs (VS). A BD derived classification of haemorrhagic shock appeared superior to one based on VS derived from ATLS criteria in a population of predominantly blunt trauma patients...
June 20, 2017: Injury
https://www.readbyqxmd.com/read/28681229/late-reconstruction-of-severe-open-book-deformities-of-the-pelvis-tips-and-tricks
#20
Christian Fang, Hatem Alabdulrahman, Roman Pfeifer, Ivan S Tarkin, Hans-Christoph Pape
BACKGROUND: The primary goal of treatment for open book pelvic injuries after high-energy trauma is to control haemorrhage and to close the pelvic ring anatomically. Less commonly, patients may present late with malunion or non-union. METHODS: We reviewed five operatively treated patients with delayed severe open book deformities who had a diastasis of more than 6 cm. We describe the pre-operative workup, surgical strategy and challenges experienced. They specifically include: extensive scar and contracture formation, malunion, urogenital prolapse and difficult reduction of vertical shear element...
July 5, 2017: International Orthopaedics
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