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https://www.readbyqxmd.com/read/28542848/change-of-transfusion-and-treatment-paradigm-in-major-trauma-patients
#1
P Stein, A Kaserer, K Sprengel, G A Wanner, B Seifert, O M Theusinger, D R Spahn
Trauma promotes trauma-induced coagulopathy, which requires urgent treatment with fixed-ratio transfusions of red blood cells, fresh frozen plasma and platelet concentrates, or goal-directed administration of coagulation factors based on viscoelastic testing. This retrospective observational study compared two time periods before (2005-2007) and after (2012-2014) the implementation of changes in trauma management protocols which included: use of goal-directed coagulation management; admission of patients to designated trauma centres; whole-body computed tomography scanning on admission; damage control surgery; permissive hypotension; restrictive fluid resuscitation; and administration of tranexamic acid...
May 23, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28541578/disrupted-development-and-integrity-of-frontal-white-matter-in-patients-treated-for-pediatric-medulloblastoma
#2
John O Glass, Robert J Ogg, Jung W Hyun, Julie H Harreld, Jane E Schreiber, Yimei Li, Amar J Gajjar, Wilburn E Reddick
Background.: Treatment of pediatric medulloblastoma is associated with known neurocognitive deficits that we hypothesize are caused by microstructural damage to frontal white matter (WM). Methods.: Longitudinal MRI examinations were collected from baseline (after surgery but before therapy) to 36 months in 146 patients and at 3 time points in 72 controls. Regional analyses of frontal WM volume and diffusion tensor imaging metrics were performed and verified with tract-based spatial statistics...
May 25, 2017: Neuro-oncology
https://www.readbyqxmd.com/read/28537413/two-stage-surgical-treatment-of-inferior-vena-cava-traumatic-rupture-including-urgent-transport-to-a-specialized-unit
#3
J Kristek, P Hromádka, M Konarik, J Froněk
Inferior vena cava injury as well as major liver injury remains a formidable treatment challenge. The most imminent danger is life-threatening bleeding. In this report, we present a case of polytrauma (Injury Severity Score 35) with arupture of the juxtahepatic inferior vena cava which was successfully treated using two-stage approach. The first part of the treatment consisted of damage control laparotomy at a level I trauma center. After stabilization, the patient was air-transported to receive the definitive treatment at a tertiary care facility experienced in hepatopancreatobiliary and transplantation surgery...
2017: Rozhledy V Chirurgii: Měsíčník Československé Chirurgické Společnosti
https://www.readbyqxmd.com/read/28535877/contemporary-management-of-maxillofacial-ballistic-trauma
#4
REVIEW
J Breeze, D Tong, A Gibbons
Ballistic maxillofacial trauma in the UK is fortunately relatively rare, and generally involves low velocity handguns and shotguns. Civilian terrorist events have, however, shown that all maxillofacial surgeons need to understand how to treat injuries from improvised explosive devices. Maxillofacial surgeons in the UK have also been responsible for the management of soldiers evacuated from Iraq and Afghanistan, and in this review we describe the newer types of treatment that have evolved from these conflicts, particularly that of damage-control maxillofacial surgery...
May 20, 2017: British Journal of Oral & Maxillofacial Surgery
https://www.readbyqxmd.com/read/28535749/analysis-of-change-in-gait-in-the-ovine-stifle-normal-injured-and-anterior-cruciate-ligament-reconstructed
#5
B J Heard, J E Beveridge, M Atarod, E J O'Brien, C Rolian, C B Frank, D A Hart, N G Shrive
BACKGROUND: Many patients who undergo anterior cruciate ligament (ACL) reconstructive surgery develop post-traumatic osteoarthritis (PTOA). ACL reconstructive surgery may not fully restore pre-injury joint biomechanics, thereby resulting in further joint damage and contributing to the development of PTOA. In an ovine model of idealized ACL reconstruction (ACL-R), it has been shown that signs of PTOA develop within surgical joints by 20 weeks post-surgery. The aim of the present study was to investigate whether altered kinematics contribute to early PTOA development within ACL-R joints of the ovine injury model by comparing the gait of these surgical animals to the gait of a stable normal control group, and an unstable injury group in which the ACL and medial collateral ligament (MCL) had been transected...
May 23, 2017: BMC Musculoskeletal Disorders
https://www.readbyqxmd.com/read/28530772/characteristics-of-the-injuries-of-syrian-refugees-sustained-during-the-civil-war
#6
Betül Kocamer Şimşek, Mehmet Dokur, Erdal Uysal, Necdet Çalıker, Oruç Numan Gökçe, İbrahim Kürşat Deniz, Murat Uğur, Murat Geyik, Mehmet Kaya, Güner Dağlı
BACKGROUND: During a war, many civilians are severely injured by firearms, bombs, and shrapnel. The triage of war injuries involves difficult and complicated processes requiring surgical procedures and patient monitoring in the Intensive Care Unit (ICU) of hospitals. In this study, we examine the demographic, traumatic, and critical care characteristics of cases injured during the civil war in Syria and requiring emergency surgery. METHODS: Electronic data of the traumatic, surgical, and ICU monitoring features of 707 patients admitted to Kilis Public Hospital between March 2012 and January 2013 were analyzed retrospectively RESULTS: Most of the patients reported having been injured due to firearms (83...
May 2017: Ulusal Travma Ve Acil Cerrahi Dergisi, Turkish Journal of Trauma & Emergency Surgery: TJTES
https://www.readbyqxmd.com/read/28525410/sm22-a-plasma-biomarker-for-human-transmural-intestinal-ischemia
#7
Dirk H S M Schellekens, Kostan W Reisinger, Kaatje Lenaerts, M'hamed Hadfoune, Steven W Olde Damink, Wim A Buurman, Cornelis H C Dejong, Joep P M Derikx
OBJECTIVE: To evaluate the diagnostic potential of smooth muscle protein of 22 kDa (SM22) as plasma biomarker for the detection of transmural intestinal ischemia. BACKGROUND: Acute mesenteric ischemia is an abdominal emergency requiring rapid diagnosis and treatment. Especially, detection of transmural damage is imperative because it mandates emergency surgery. Since early clinical and radiological signs are nonspecific, there is an urgent need for accurate biomarkers...
May 18, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28520463/a-preclinical-assessment-of-early-continuous-passive-motion-and-treadmill-therapeutic-exercises-for-generating-chondroprotective-effects-after-anterior-cruciate-ligament-rupture
#8
Nai-Jen Chang, Kuan-Wei Lee, Chih-Jou Chu, Ming-You Shie, Pei-Hsi Chou, Chih-Chan Lin, Peir-In Liang
BACKGROUND: Anterior cruciate ligament (ACL) injury is a well-known risk factor for the development of posttraumatic osteoarthritis (PTOA). However, whether using continuous passive motion (CPM) with or without additional treadmill exercise (TRE) in early ACL injury might provide chondroprotective effects and further decrease the risk of PTOA has yet to be determined. HYPOTHESIS: CPM may offer an enhanced chondroprotective effect, but TRE may attenuate that effect due to the mechanical stress on the joint and inflammatory cytokines in the joint...
May 1, 2017: American Journal of Sports Medicine
https://www.readbyqxmd.com/read/28516217/prenatal-surgery-for-myelomeningocele-review-of-the-literature-and-future-directions
#9
Gregory G Heuer, Julie S Moldenhauer, N Scott Adzick
Open spina bifida or myelomeningocele (MMC) is one of the most common serious congenital malformations. Historically, this condition has been treated with closure of the MMC defect shortly after birth. The goal of postnatal closure is to cover the exposed spinal cord and prevent infection. However, postnatal surgery does not reverse or prevent the neurologic injury seen in MMC, reverse hindbrain herniation, or prevent hydrocephalus. The neurologic defects result from primary incomplete neurulation and secondary chronic prenatal damage to the exposed neural elements through mechanical and chemical trauma...
May 17, 2017: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
https://www.readbyqxmd.com/read/28516202/-plastic-reconstruction-of-radiation-injuries
#10
P M Vogt, T R Mett, C Henkenberens, C Radtke, R Ipaktchi
In addition to surgical and drug therapy, radiotherapy (or radiation therapy) is one of the three mainstays of modern oncological therapy regimes. It uses ionizing radiation to control tumors by damaging the DNA of cancerous tissue leading to cellular death. Although advances have been made in recent years resulting in a reduced dosage to the surrounding tissues, radiation injuries and tissue-related side effects cannot be completely avoided. Knowledge of the pathophysiology, treatment modalities and interdisciplinary treatment approaches are essential for effective therapy whilst limiting side effects...
May 17, 2017: Der Chirurg; Zeitschrift Für Alle Gebiete der Operativen Medizen
https://www.readbyqxmd.com/read/28515057/delaying-acl-reconstruction-and-treating-with-exercise-therapy-alone-may-alter-prognostic-factors-for-5-year-outcome-an-exploratory-analysis-of-the-kanon-trial
#11
Stephanie R Filbay, Ewa M Roos, Richard B Frobell, Frank Roemer, Jonas Ranstam, L Stefan Lohmander
AIM: Identify injury-related, patient-reported and treatment-related prognostic factors for 5-year outcomes in acutely ACL-ruptured individuals managed with early reconstruction plus exercise therapy, exercise therapy plus delayed reconstruction or exercise therapy alone. METHODS: Exploratory analysis of the Knee Anterior Cruciate Ligament, Nonsurgical versus Surgical Treatment (KANON) trial (ISRCTN84752559). Relationships between prognostic factors (baseline cartilage, meniscus and osteochondral damage, baseline extension deficit, baseline patient-reported outcomes, number of rehabilitation visits, graft/contralateral ACL rupture, non-ACL surgery and ACL treatment strategy) and 5-year Knee Injury and Osteoarthritis Outcome Score (KOOS) pain, symptoms, sport/recreation and quality of life (QOL) scores were explored using multivariable linear regression...
May 17, 2017: British Journal of Sports Medicine
https://www.readbyqxmd.com/read/28512431/variable-ventilation-improved-respiratory-system-mechanics-and-ameliorated-pulmonary-damage-in-a-rat-model-of-lung-ischemia-reperfusion
#12
André Soluri-Martins, Lillian Moraes, Raquel S Santos, Cintia L Santos, Robert Huhle, Vera L Capelozzi, Paolo Pelosi, Pedro L Silva, Marcelo Gama de Abreu, Patricia R M Rocco
Lung ischemia-reperfusion injury remains a major complication after lung transplantation. Variable ventilation (VV) has been shown to improve respiratory function and reduce pulmonary histological damage compared to protective volume-controlled ventilation (VCV) in different models of lung injury induced by endotoxin, surfactant depletion by saline lavage, and hydrochloric acid. However, no study has compared the biological impact of VV vs. VCV in lung ischemia-reperfusion injury, which has a complex pathophysiology different from that of other experimental models...
2017: Frontiers in Physiology
https://www.readbyqxmd.com/read/28512392/utility-of-glissonean-pedicle-transection-for-surgical-treatment-of-severe-liver-trauma
#13
Satoshi Koizumi, Kenta Katsumata, Tatsunori Ono, Kouhei Segami, Hiroyuki Hoshino, Masafumi Katayama, Shinjiro Kobayashi, Junichi Matsumoto, Shigeki Fujitani, Yasuhiko Taira, Takehito Otsubo
The most common initial strategy for treatment of severe liver trauma is damage control in which hemostasis is achieved by perihepatic gauze packing and/or vascular embolization. However, we encounter patients in whom this strategy alone is not adequate. We have applied the principles of Glissonean pedicle transection, a technique that was originally devised to ensure safe and quick performance of planned hepatectomy for liver cancer, to 3 cases of severe liver trauma. We performed Glissonean pedicle ligation during damage control surgery in 2 patients and Glissonean pedicle transection during the definitive surgery in 1 patient...
January 2017: Case Reports in Gastroenterology
https://www.readbyqxmd.com/read/28510805/interventional-radiology-in-iatrogenic-ureteral-leaks-case-series-and-literature-review
#14
Claudia Trombatore, Giuseppe Giordano, Vincenzo Magnano San Lio
Iatrogenic ureteral injuries are a dramatic complication in medical practice. Nowadays there are no universal guidelines for their management. The aim of our study was to evaluate the feasibility of the percutaneous treatment in restoring ureteral integrity in 19 patients that came to our attention. In each case retrograde stenting failed and patients were candidates for re-surgery. Our strategy consists of two phases. The first step is the nephrostomy that allows an external urinary diversion putting dry the damaged ureteral segment...
May 16, 2017: La Radiologia Medica
https://www.readbyqxmd.com/read/28509526/paraoxonases-and-psoriasis-negative-imbalance-of-anti-oxidant-endogenous-mechanisms
#15
Maria Schiattarella, Giuseppina Caiazzo, Roberta DI Caprio, Serena Lembo, Annunziata Raimondo, Fabio Ayala, Nicola Balato, Giuseppe Monfrecola, Giuliana Fortunato, Anna Balato
BACKGROUNG: Numerous reports have shown that psoriasis patients are more exposed to lipoprotein peroxidation and to a decrease in the activity of paraoxonase (PON)1, an anti-oxidant and anti-inflammatory enzyme. Thus, it has been suggested that malfunction of the anti-oxidant system and an increased production of reactive oxygen species drive immune inflammatory events, that result in progressive skin cell damage in patients with psoriasis. The PON protein family, including PON1, PON2 and PON3, is one of the most important endogenous defense mechanisms against oxidative stress...
May 16, 2017: Giornale Italiano di Dermatologia e Venereologia: Organo Ufficiale, Società Italiana di Dermatologia e Sifilografia
https://www.readbyqxmd.com/read/28507468/paradoxical-effect-of-minocycline-on-established-neuropathic-pain-in-rat
#16
Malek Zarei, Masoumeh Sabetkasaei, Taraneh Moini-Zanjani
Neuropathic pain occurs after peripheral nerve damage, inflammation or infection. In this situation, microglial cells become activated and play a key role in producing pain. Minocycline (microglia inhibitor), was reported to reduce pain when used preventively. However, it seems that, when used after nerve injury, results in its pain reducing effects are different. In this regard, to assess the pain reducing differences of minocycline, neuropathic pain was induced by the ligation of the sciatic nerve in the rat which is recognized as chronic constriction injury (CCI) and minocycline was administered before and after sciatic nerve injury...
2017: EXCLI journal
https://www.readbyqxmd.com/read/28504995/remote-ischemic-preconditioning-decreases-oxidative-lung-damage-after-pulmonary-lobectomy-a-single-center-randomized-double-blind-controlled-trial
#17
José García-de-la-Asunción, Laura Bruno, Jaume Perez-Griera, Genaro Galan, Alfonso Morcillo, Richard Wins, Eva García-Del-Olmo, Ricardo Guijarro, Benjamín Sarriá, Francisco Martí, Marina Soro, Francisco Javier Belda
BACKGROUND: During lobectomy in patients with lung cancer, the operated lung is often -collapsed and hypoperfused. Ischemia/reperfusion injury may then occur when the lung is -re-expanded. We hypothesized that remote ischemic preconditioning (RIPC) would decrease oxidative lung damage and improve gas exchange in the postoperative period. METHODS: We conducted a single-center, randomized, double-blind trial in patients with nonsmall cell lung cancer undergoing elective lung lobectomy...
May 11, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28504624/-damage-control-surgery-in-patients-with-abdominal-sepsis
#18
Nikolaj Nerup, Karen Oline Larsen Langballe, Michael P Achiam, Lars B Svendsen
Damage control surgery (DCS) and resuscitation has improved the survival of trauma patients with decompensated physiology. In recent years, the principles of DCS have been used in the treatment of patients with abdominal sepsis, despite the fact that only a minimum of evidence exists. The aim is to optimize the physiology prior to definitive surgery. This implies a primary decontaminating surgical procedure with temporary abdominal closure without restoration of the intestinal continuity and avoidance of stoma formation in order to reduce time in the operating theatre...
May 8, 2017: Ugeskrift for Laeger
https://www.readbyqxmd.com/read/28502073/early-impact-of-abdominal-compartment-syndrome-on-liver-kidney-and-lung-damage-in-a-rodent-model
#19
Ricardo Lima, Pedro L Silva, Vera L Capelozzi, Mariana G Oliveira, Maria Cristina E Santana, Fernanda F Cruz, Paolo Pelosi, Alberto Schanaider, Manu L N G Malbrain, Patricia R M Rocco
BACKGROUND: Abdominal compartment syndrome (ACS) sometimes occurs in critically ill patients following damage control surgery. The purpose of the present study was to develop a model of ACS and to evaluate its pathologic impact on liver, kidney, and lung morphology. METHODS: Twenty Wistar rats (mass 300-350 g) were randomly divided into four groups: 1) intra-abdominal hypertension (IAH): a laparotomy was performed and the abdomen packed with cotton until an intra-abdominal pressure (IAP) of 15 mm Hg was reached; 2) hypovolemia (HYPO): blood was withdrawn until a mean arterial pressure ~60 mm Hg was reached; 3) IAH + HYPO (to resemble clinical ACS); and 4) sham surgery...
May 14, 2017: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/28501719/colliding-jets-provide-depth-control-for-water-jetting-in-bone-tissue
#20
S den Dunnen, J Dankelman, G M Kerkhoffs, G Tuijthof
In orthopaedic surgery, water jet drilling provides several advantages over classic drilling with rigid drilling bits, such as the always sharp cut, absence of thermal damage and increased manoeuvrability. Previous research showed that the heterogeneity of bone tissue can cause variation in drilling depth whilst water jet drilling. To improve control over the drilling depth, a new method is tested consisting of two water jets that collide directly below the bone surface. The expected working principle is that after collision the jets will disintegrate, with the result of eliminating the destructive power of the coherent jets and leaving the bone tissue underneath the focal point intact...
May 6, 2017: Journal of the Mechanical Behavior of Biomedical Materials
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