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https://www.readbyqxmd.com/read/29352754/providing-ethical-healthcare-in-resource-poor-environments
#1
Kenneth V Iserson
The ethics of providing health care in resource-poor environments is a complex topic. It implies two related questions: What can we do with the resources on hand? Of all the things we can do, which ones should we do? "Resource-poor" (i.e., resource-challenged, resource-constrained) environments are situations in which clinicians, organizations, or healthcare systems have the knowledge and skills, but not the means, to carry out highly effective and beneficial interventions. Determinants of a population's health often rely less on disease and injury management than on recognizing and meeting their basic needs...
January 19, 2018: HEC Forum: An Interdisciplinary Journal on Hospitals' Ethical and Legal Issues
https://www.readbyqxmd.com/read/29352361/the-modified-ravitch-approach-for-the-management-of-severe-anterior-flail-chest-with-bilateral-sternochondral-dislocations-a-case-report
#2
Gabriel Estremera, Ellen Chieko Omi, Eduardo Smith-Singares
The management of flail chest continues to evolve as scientific evidence and surgical experience accumulates. Flail chest injuries that span the sternum present a rare and complicated injury pattern that can be challenging to manage both medically and surgically. Our patient is a 69-year-old involved in a high-speed motor vehicle crash with respiratory failure secondary to an anterior flail chest. Tomographic examination confirmed a sternal fracture with bilateral sternochondral dislocations and multiple rib fractures...
January 19, 2018: Surgical Case Reports
https://www.readbyqxmd.com/read/29351939/retroperitoneal-bile-leak-after-laparoscopic-cholecystectomy
#3
Dee Zhen Lim, Enoch Wong, Sayed Hassen, Yahya Al-Habbal
Bile duct injury (BDI) is a well-recognised complication of laparoscopic cholecystectomy (LC). Following a BDI, bile usually leaks into the peritoneal space and causes biliary peritonitis. This manifests as non-specific abdominal pain and fever occurring several days after the surgery. It can be managed by laparoscopic washout with or without bile duct repair. We present a rare case of retroperitoneal bile leak post-LC. The mechanism of injury here was likely partial avulsion from excessive traction of the cystic duct during intraoperative cholangiogram...
January 18, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29351927/bet-2-is-early-chemical-thromboprophylaxis-safe-in-patients-with-blunt-trauma-solid-organ-injury-soi-undergoing-non-operative-management-nom
#4
Craig Ferguson, Jonathan Lewin
A short cut review was carried out to establish whether chemical thromboprophylaxis was a safe early intervention in patients with solid organ injury that is being managed non-operatively. Eight papers presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. It is concluded that there is inadequate evidence assessing safety of low molecular weight heparin (LMWH) within 24 hours of trauma...
February 2018: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29351922/activation-of-constitutive-androstane-receptor-ameliorates-renal-ischemia-reperfusion-induced-liver-and-kidney-injury
#5
You-Jin Choi, Dong Zhou, Anne Barbosa, Yongdong Niu, Xiudong Guan, Meishu Xu, Songrong Ren, Thomas Nolin, Yiuhua Liu, Wen Xie
Acute kidney injury (AKI) is associate with high mortality. Despite the evidence of AKI-induced distant organ injury, a relationship between AKI and liver injury has not been clearly established. The goal of this study is to investigate whether renal ischemia-reperfusion (IR) can affect liver pathophysiology. We showed that renal IR in mice induced fatty liver and compromised liver function through the down-regulation of constitutive androstane receptor (CAR; -90.4%) and inhibition of hepatic very low-density lipoprotein-triglyceride (VLDL-TG) secretion (-28...
January 19, 2018: Molecular Pharmacology
https://www.readbyqxmd.com/read/29351705/percutaneous-endoscopic-rendezvous-procedure-for-the-management-of-bile-duct-injuries-after-cholecystectomy-short-and-long-term-outcomes
#6
Anne Marthe Schreuder, Klaske A C Booij, Philip R de Reuver, Otto M van Delden, Krijn P van Lienden, Marc G Besselink, Olivier R Busch, Dirk J Gouma, Erik A J Rauws, Thomas M van Gulik
BACKGROUND:  Bile duct injury (BDI) remains a daunting complication of laparoscopic cholecystectomy. In patients with complex BDI, a percutaneous-endoscopic rendezvous procedure may be required to establish bile duct continuity. The aim of this study was to assess short- and long-term outcomes of the rendezvous procedure. METHODS:  All consecutive patients with BDI referred to our tertiary referral center between 1995 and 2016 were analyzed. A rendezvous procedure was performed when endoscopic or radiologic intervention failed, and when deemed feasible by a dedicated multidisciplinary team including hepatopancreaticobiliary surgeons, gastrointestinal endoscopists, and interventional radiologists...
January 19, 2018: Endoscopy
https://www.readbyqxmd.com/read/29351182/the-management-of-partial-zone-ii-intrasynovial-flexor-tendon-lacerations-a-literature-review-of-biomechanics-clinical-outcomes-and-complications
#7
Kyle D Lineberry, Shirley Shue, Kyle J Chepla
BACKGROUND: Penetrating trauma or lacerations within zone II of the flexor sheath may result in partial tendon injury. The proper management of this injury is controversial; the literature contains differing indications for surgical treatment and post-operative rehabilitation. METHODS: A literature review of the Cochrane, Medline and Pubmed databases was performed using the following search criteria: partial, flexor, tendon, laceration. All English language studies that evaluated biomechanical strength, complications, and outcomes after partial tendon injury in human and animal studies were included and reviewed by two of the authors...
January 12, 2018: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/29351135/angiography-and-embolization-in-the-management-of-bleeding-pelvic-fractures
#8
Rahul Vaidya, Jacob Waldron, Alesha Scott, Kerellos Nasr
The use, timing, and priority of angioembolization in the management of bleeding pelvic fractures remain ambiguous. The most common vessels for angioembolization are, in decreasing order, the internal iliac artery and its branches, the superior gluteal artery, the obturator artery, and the internal pudendal artery. Technical success rates for this treatment option range from 74% to 100%. The fracture patterns most commonly requiring angioembolization are the Young and Burgess lateral compression and anterior-posterior compression types and Tile type C...
January 18, 2018: Journal of the American Academy of Orthopaedic Surgeons
https://www.readbyqxmd.com/read/29350771/recombinant-relaxin-protects-liver-transplants-from-ischemia-damage-via-hepatocyte-glucocorticoid-receptor-from-bench-to-bedside
#9
Shoichi Kageyama, Kojiro Nakamura, Takehiro Fujii, Bibo Ke, Rebecca A Sosa, Elaine F Reed, Nakul Datta, Ali Zarrinpar, Ronald W Busuttil, Jerzy W Kupiec-Weglinski
Hepatic ischemia-reperfusion injury (IRI) represents a major risk factor of early graft dysfunction and acute/chronic rejection as well as a key obstacle to expanding the donor pool in orthotopic liver transplantation (OLT). Although glucocorticoid receptor (GR) signaling may enhance cytoprotective programs, clinical use of glucocorticoid is limited due to adverse effects, while clinical relevance of GR-facilitated cytoprotection in OLT remains unknown. We aimed to evaluate the significance of hepatic GR in clinical OLT and verify the impact of recombinant human relaxin (rhRLX), which may function as GR agonist in tissue/disease-specific manner...
January 19, 2018: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
https://www.readbyqxmd.com/read/29350376/an-unexpected-long-term-complication-of-genital-burn-in-a-child-secondary-cryptorchidism
#10
Mustafa Öksüz, Hasan Deliağa, Adem Topkara, Ömer Faruk Koçak
Genital and perineal burns are rare and challenging injuries with serious long-term complications. Involvement of the testes is a sign of severity. There is limited knowledge in the literature about the management of complications and testes involvement in genital and perineal burns. In this report, we present the case of an 8-year-old boy with secondary cryptorchidism due to burn contracture who was treated by increasing the scrotal volume by Z-plasties, skin graft, and orchidopexy.
January 2018: Ulusal Travma Ve Acil Cerrahi Dergisi, Turkish Journal of Trauma & Emergency Surgery: TJTES
https://www.readbyqxmd.com/read/29350373/pediatric-dural-venous-sinus-thrombosis-following-closed-head-injury-an-easily-overlooked-diagnosis-with-devastating-consequences
#11
Joe M Das, Rashmi Sapkota, Binjura Shrestha
Dural venous sinus thrombosis (DVST) is an uncommon finding after traumatic brain injury. The diagnosis can often be initially missed, particularly if not associated with an overlying fracture. Pediatric DVST following closed head injury and without an overlying fracture is very rare, with only 20 cases reported in the literature to date. Here we present the case of a 19-month-old boy who presented with a history of trivial fall and an episode of fever. On presentation, the pediatric Glasgow Coma Scale (pGCS) score was E3V4M6, and initial brain computed tomography (CT) was normal...
January 2018: Ulusal Travma Ve Acil Cerrahi Dergisi, Turkish Journal of Trauma & Emergency Surgery: TJTES
https://www.readbyqxmd.com/read/29350370/operative-and-non-operative-management-of-children-with-abdominal-gunshot-injuries
#12
Mehmet Şerif Arslan, Hikmet Zeytun, Serkan Arslan, Erol Basuguy, Mehmet Hanifi Okur, Bahattin Aydoğdu, Cemil Göya, İbrahim Uygun, Selçuk Otçu
BACKGROUND: Non-operative management (NOM) is a standard treatment method for solid organ injuries worldwide. There is no consensus on the management of gunshot wounds (GSW) because of the higher frequency of hollow viscus injuries (HVI) and the unpredictable depth of tissue damage produced by kinetic energy transfer during retardation of the bullet. Here we aimed to reevaluate indications for surgery and NOM based on our pediatric patients with abdominal GSW. METHODS: We performed a retrospective analysis of patients evaluated and treated for abdominal GSW at University of Dicle between January 2010 and October 2016...
January 2018: Ulusal Travma Ve Acil Cerrahi Dergisi, Turkish Journal of Trauma & Emergency Surgery: TJTES
https://www.readbyqxmd.com/read/29350362/which-common-test-should-be-used-to-assess-spleen-autotransplant-effect
#13
Ehsan Soltani, Mohsen Aliakbarian, Kamran Ghaffarzadegan
BACKGROUND: Historically, total splenectomy was the only choice of treatment for traumatic splenic injuries. However, nonoperative management and spleen-preserving surgical techniques are preferred in modern medicine. In some situations in which the surgeon has to perform splenectomy, spleen autotransplant may preserve the splenic function. Selecting the best method for evaluating the splenic autotransplant effect has been debated for several years. In this study, we compared three common tests in evaluating the implanted spleen function...
January 2018: Ulusal Travma Ve Acil Cerrahi Dergisi, Turkish Journal of Trauma & Emergency Surgery: TJTES
https://www.readbyqxmd.com/read/29349487/lay-first-responder-training-in-eastern-uganda-leveraging-transportation-infrastructure-to-build-an-effective-prehospital-emergency-care-training-program
#14
Peter G Delaney, Richard Bamuleke, Yang Jae Lee
BACKGROUND: Though road traffic injuries (RTIs) are a major cause of mortality in East Africa, few countries have emergency medical services. The aim was to create a sustainable and efficient prehospital lay first responder program, creating a system with lay first responders spread through the 53 motorcycle taxi stages of Iganga Municipality. METHODS: One hundred and fifty-four motorcycle taxi riders were taught a first aid curriculum in partnership with a local Red Cross first aid trainer and provided with a first aid kit following WHO guidelines for basic first aid...
January 18, 2018: World Journal of Surgery
https://www.readbyqxmd.com/read/29349405/pseudoaneurysm-of-the-external-iliac-artery-is-a-rare-late-complication-after-total-hip-arthroplasty
#15
Shinji Fukuhara, Sachiko Kanki, Masahiro Daimon, Ryo Shimada, Hideki Ozawa, Takahiro Katsumata
Vascular injury as a delayed complication of total hip arthroplasty (THA) is rare. We present a case of pseudoaneurysm of the external iliac artery due to chronic irritation from a prominent bone spicule occurring 2 years after revision THA. We successfully managed the patient with open repair, and there has been no sign of recurrence in the 2 years since the previous surgery. This report suggests that patients who have undergone THA should be followed up carefully and assessed for vascular injuries even after a substantial time...
September 2017: Journal of Vascular Surgery Cases and Innovative Techniques
https://www.readbyqxmd.com/read/29349397/femoral-artery-embolization-of-a-thoracic-stray-bullet
#16
Tanous Aoun, Fikani Amine, Khabbaz Ziad
Arterial bullet embolization after a thoracic gunshot wound represents a diagnostic and therapeutic challenge. The absence of an apparent exit wound should alert the clinician. Cardiac bullet injuries are mostly fatal. However, in some cases, patients may remain stable, and conservative management can be an acceptable strategy. We present a case report of a 7.62- × 39-mm thoracic stray bullet that embolized to the femoral artery.
September 2017: Journal of Vascular Surgery Cases and Innovative Techniques
https://www.readbyqxmd.com/read/29349052/malar-relocation-with-reverse-l-osteotomy-and-autogenous-bone-graft
#17
Se Hoon Yoon, Euicheol Jeong, Jee Hyeok Chung
The zygomaticomaxillary complex (ZMC) functions as a buttress for the face and is the cornerstone to a person's aesthetic appearance, by both setting the midfacial width and providing prominence to the cheek. Malar deficiency is often acquired by blunt injury incurred in a traumatic accident, resulting in ZMC fracture. A 48-year-old male patient presented a right ZMC fracture after contusion injury by a baseball. He only received conservative management and later he suffered discomfort during mouth opening at the moment of mastication, due to trismus involving the temporomandibular joint...
December 2017: Archives of Craniofacial Surgery
https://www.readbyqxmd.com/read/29349018/open-4-compartment-fasciotomy-for-chronic-exertional-compartment-syndrome-of-the-leg
#18
Amos Z Dai, Michael Zacchilli, Neha Jejurikar, Hien Pham, Laith Jazrawi
Chronic exertional compartment syndrome (CECS) is a significant source of lower extremity pain and morbidity in the athletic population. Although endoscopic techniques have been introduced, open fasciotomy remains the mainstay of surgical treatment because of the paucity of evidence in support of an endoscopic approach. The literature on surgical management of CECS is mixed, and overall success rates are modest at best. Optimizing surgical technique, including prevention of neurovascular injury and wound complications, can make a significant impact on the clinical outcome...
December 2017: Arthroscopy Techniques
https://www.readbyqxmd.com/read/29348919/thoracic-stent-graft-placement-for-repair-of-iatrogenic-aortic-injury-secondary-to-sheath-placement-during-pacemaker-insertion
#19
Jared T Feyko, Kelsey Musgrove, Cara Lyle, Alexandre d'Audiffret
We describe the inadvertent cannulation of the proximal descending thoracic aortic stent with a five French sheath during attempted pacemaker placement in an 88- year-old male. The injury was managed successfully by the percutaneous placement of a thoracic aortic stent graft with good outcome. Our case highlights the feasibility of managing this uncommon injury with this technique.
2018: SAGE Open Medical Case Reports
https://www.readbyqxmd.com/read/29347982/emergency-department-hyperoxia-is-associated-with-increased-mortality-in-mechanically-ventilated-patients-a-cohort-study
#20
David Page, Enyo Ablordeppey, Brian T Wessman, Nicholas M Mohr, Stephen Trzeciak, Marin H Kollef, Brian W Roberts, Brian M Fuller
BACKGROUND: Providing supplemental oxygen is fundamental in the management of mechanically ventilated patients. Increasing amounts of data show worse clinical outcomes associated with hyperoxia. However, these previous data in the critically ill have not focused on outcomes associated with brief hyperoxia exposure immediately after endotracheal intubation. Therefore, the objectives of this study were to evaluate the impact of isolated early hyperoxia exposure in the emergency department (ED) on clinical outcomes among mechanically ventilated patients with subsequent normoxia in the intensive care unit (ICU)...
January 18, 2018: Critical Care: the Official Journal of the Critical Care Forum
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