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Sample records for abdominal trauma index

  1. Appendicitis following blunt abdominal trauma.

    PubMed

    Ramesh, G; Ho, P W; Ng, K L; Jegan, T

    2002-03-01

    A young boy presented with history of abdominal trauma. History and initial clinical findings suggested a soft tissue injury. Due to increasing abdominal pain and fever, we proceeded with an exploratory laparotomy with a diagnosis of intra-abdominal injury, at which we found a perforated appendix. Appendicitis following blunt abdominal trauma needs high index of suspicion. PMID:14569731

  2. Surgical site infection in abdominal trauma patients: risk prediction and performance of the NNIS and SENIC indexes

    PubMed Central

    Morales, Carlos H.; Escobar, Rene M.; Villegas, Maria I.; Castaño, Andrés; Trujillo, Juliana

    2011-01-01

    Background The National Nosocomial Infections Surveillance (NNIS) and Efficacy of Nosocomial Infection Control (SENIC) indexes are designed to develop control strategies and to reduce morbidity and mortality rates resulting from infections in surgical patients. We sought to assess the application of these indexes in patients under-going surgery for abdominal trauma and to develop an alternative model to predict surgical site infections (SSIs). Methods We conducted a prospective cohort study between November 2000 and March 2002. The main outcome measure was SSIs. We evaluated the variables included in the NNIS and SENIC indexes and some preoperative, intraoperative and postoperative variables that could be risk factors related to the development of SSIs. We performed multivariate analyses using a forward logistic regression method. Finally, we assessed infection risk prediction, comparing the estimated probabilities with actual occurrence using the areas under the receiver operating characteristic (ROC) curves. Results Overall, 614 patients underwent an exploratory laparotomy. Of these, 85 (13.8%) experienced deep incisional and organ/intra-abdominal SSIs. The independent variables associated with this complication were an Abdominal Trauma Index score greater than 24, abdominal contamination and admission to the intensive care unit. We proposed a model for predicting deep incisional and organ/intra-abdominal SSIs using these variables (alternative model). The areas under the ROC curves were compared using the estimated probabilities for this alternative model and for the NNIS and SENIC scores. The analysis revealed a greater area under the ROC curve for the alternative model. The NNIS and SENIC scores did not perform as well as the alternative model in patients with abdominal trauma. Conclusion The NNIS and SENIC indexes were inferior to the proposed alternative model for predicting SSIs in patients undergoing surgery for abdominal trauma. PMID:21251428

  3. Abdominal trauma by ostrich

    PubMed Central

    Usurelu, Sergiu; Bettencourt, Vanessa; Melo, Gina

    2015-01-01

    Introduction Ostriches typically avoid humans in the wild, since they correctly assess humans as potential predators, and, if approached, often run away. However, ostriches may turn aggressive rather than run when threatened, especially when cornered, and may also attack when they feel the need to defend their offspring or territories. Presentation of case A 71-year-old male patient presented with intra abdominal injury sustained from being kicked in the abdominal wall by an ostrich. During laparotomy, were found free peritoneal effusion and perforation of the small intestine. Discussion The clinical history and physical examination are extremely important for diagnostic and therapeutic decision making. CT-scan is the most accurate exam for making diagnosis. Surgery is the treatment of choice, and is always indicated when there is injury to the hollow viscera. In general it is possible to suture the defect. Conclusion In cases of blunt abdominal trauma by animals is necessary to have a low threshold of suspicion for acute abdomen. PMID:25685344

  4. Blunt abdominal trauma in children.

    PubMed

    Tepas, J J

    1993-06-01

    The growing popularity of nonoperative treatment of children with splenic injuries has seduced some physicians into a false sense of security regarding care of the injured child. Although it has been established that hemodynamically stable children with splenic, hepatic, and even renal injuries can safely be treated "expectantly," this concept cannot be applied indiscriminately. Accurate diagnosis and effective care of the child with blunt abdominal trauma is an exercise of clinical precision that demands attention to detail and thorough evaluation. This review addresses this process in light of recent advances in diagnostic imaging and in consideration of recent reports analyzing different protocols for therapeutic decision making. PMID:8374651

  5. Modified Multivisceral Transplant After Acute Abdominal Trauma.

    PubMed

    Nikeghbalian, Saman; Alaa Eldin, Ahmed; Aliakbarian, Mohsen; Kazemi, Kourosh; Shamsaeefar, Alireza; Gholami, Siavash; Malekhosseini, Seyed Ali

    2016-04-01

    A 50-year-old man sustained blunt abdominal trauma in a motor vehicle accident. He underwent exploratory laparotomy on the day of trauma, and severe bleeding from the base of the small bowel mesentery was controlled by mass ligation and through-and-through suturing. After transfer to our center, repeat exploratory laparotomy showed ischemic small intestine, ischemic right colon, and severe pancreatic trauma. The severely injured organs were excised including the entire small bowel, pancreas, spleen, stomach, and right hemicolon. The next day, a modified multivisceral transplant was performed including stomach, pancreaticoduodenal complex, and small bowel transplant. Postoperative complications included an intra-abdominal collection that was drained percutaneously with ultrasonographic guidance and severe rejection that was treated with anti-thymocyte globulin. In summary, for select patients who have severe abdominal trauma may be treated with acute multivisceral transplant. PMID:24918875

  6. [Abdominal aorta injury secondary to closed trauma].

    PubMed

    Frizza, J I; Fainstein, D; Lasdica, S; Ontivero, M; Mele, J I; Vilariño, E

    2007-04-01

    Traumatic injury of the abdominal aorta with total interruption of blood flow is uncommon. When there is total obstruction of the artery, the clinical picture is dramatic. The most frequent mechanism is compression due to the safety belt during a car accident. The patients have absent femoral and distal pulses, associated to neuropathy in the lower limbs. We present a case of abdominal aorta injury secondary to closed trauma and review the causes, presentation forms and management of the injury. PMID:17439771

  7. Abdominal trauma: never underestimate it.

    PubMed

    Bodhit, Aakash N; Bhagra, Anjali; Stead, Latha Ganti

    2011-01-01

    Introduction. We present a case of a sports injury. The initial presentation and clinical examination belied serious intra-abdominal injuries. Case Presentation. A 16-year-old male patient came to emergency department after a sports-related blunt abdominal injury. Though on clinical examination the injury did not seem to be serious, FAST revealed an obscured splenorenal window. The CT scan revealed a large left renal laceration and a splenic laceration that were managed with Cook coil embolization. Patient remained tachycardic though and had to undergo splenectomy, left nephrectomy, and a repair of left diaphragmatic rent. Patient had no complication and had normal renal function at 6-month followup. Conclusion. The case report indicates that management of blunt intra-abdominal injury is complicated and there is a role for minimally invasive procedures in management of certain patients. A great deal of caution is required in monitoring these patients, and surgical intervention is inevitable in deteriorating patients. PMID:23326699

  8. [Blunt abdominal trauma caused by child abuse].

    PubMed

    Gonzalez, R; Heiss, W H; Rauh, W

    1987-10-01

    We report about 3 boys under 4 years of age with abdominal blunt trauma following child abuse admitted to our clinic with different diagnoses. Common were fresh or older haematomas, burn wounds, for which the parents had no plausible explanation. The children had no skeletal or intracranial lesions, but they developed abdominal pain, which became worse in the absence of the parents. X-ray and the clinical course lead us to laparatomy. In all cases we found lesions of the intestines, especially near the duodenojejunal flexure, hepatoduodenal ligament, root of the mesentery, mesocolon and retroperitoneum, in one case a pancrease rupture. All these lesions were caused by child abuse. We want to point out the problem in the diagnosis of battered child syndrome, especially of the abdominal blunt trauma. PMID:3683408

  9. Ureteral wound caused by blunt abdominal trauma.

    PubMed

    Gunnarsson, Ulf; Lewenhaupt, Arvid; Heuman, Rolf

    2003-01-01

    A man fell on icy ground whilst walking to an outdoor toilet. An initial CT scan with intravenous contrast medium was negative. As the man experienced increasing pain a plain abdominal radiograph was performed 2 h later and revealed extravasation of contrast medium emanating from a ureteral injury. This case underlines the possibility that important injuries may not be visible on the initial CT scan that is often used in trauma diagnostics. PMID:12745753

  10. A historical review of penetrating abdominal trauma.

    PubMed

    Blank-Reid, Cynthia

    2006-09-01

    The course of history changed because of the deaths of these two men. Although the world doesn't remember Chester Allan Arthur (JAG's Vice President), Theodore Roosevelt became one of our most popular presidents. Neither president's injuries were life-threatening, but they died of postoperative complications. The technology and treatment used for penetrating abdominal trauma have changed tremendously over the past 100 years. Both presidents would survive if they sustained their injuries today. PMID:16962459

  11. [Videoendosurgical diagnosis and treatment of abdominal injuries in combined trauma].

    PubMed

    Sitnikov, V N; Cherkasov, M F; Litvinov, B I; Sarkisian, V A; Turbin, M V

    2006-01-01

    Experience with videolaparoscopy in 1332 patients with combined abdominal trauma is analyzed. The original method of diagnosis of traumatic abdominal multitraumas in shock patients was proposed and patented. Diagnostic and treatment algorithm for hemoperitoneum in patients with abdominal multitrauma based on USE or CT data on liquid in the abdominal cavity has been developed. Videolaparoscopy helped to avoid open surgery in 73.3% patients with dominating abdominal trauma. PMID:16883252

  12. Splenic injury after blunt abdominal trauma during a soccer (football) game.

    PubMed

    Padlipsky, Patricia S; Brindis, Seth; Young, Kelly D

    2014-10-01

    The spleen is the most commonly injured abdominal organ in children who sustain blunt abdominal trauma, and pediatric splenic injury may result from minor mechanisms of injury, including sports participation. We present 2 cases of splenic injury in soccer goalies because of blunt abdominal trauma sustained during game play. Although abdominal organ injuries are uncommon in soccer, emergency medicine and primary care physicians must be aware of the possibility. A high index of suspicion and careful physical examination are key in making the diagnosis. PMID:25275352

  13. Laparotomy for blunt abdominal trauma-some uncommon indications

    PubMed Central

    Dharap, Satish B.; Noronha, Jarin; Kumar, Vineet

    2016-01-01

    Trauma laparotomy after blunt abdominal trauma is conventionally indicated for patients with features of hemodynamic instability and peritonitis to achieve control of hemorrhage and control of spillage. In addition, surgery is clearly indicated for the repair of posttraumatic diaphragmatic injury with herniation. Some other indications for laparotomy have been presented and discussed. Five patients with blunt abdominal injury who underwent laparotomy for nonroutine indications have been presented. These patients were hemodynamically stable and had no overt signs of peritonitis. Three patients had solid organ (spleen, kidney) infarction due to posttraumatic occlusion of the blood supply. One patient had mesenteric tear with internal herniation of bowel loops causing intestinal obstruction. One patient underwent surgery for traumatic abdominal wall hernia. In addition to standard indications for surgery in blunt abdominal trauma, laparotomy may be needed for vascular thrombosis of end arteries supplying solid organs, internal or external herniation through a mesenteric tear or anterior abdominal wall musculature, respectively. PMID:26957824

  14. Bowel and mesenteric injuries from blunt abdominal trauma: a review.

    PubMed

    Iaselli, Francesco; Mazzei, Maria Antonietta; Firetto, Cristina; D'Elia, Domenico; Squitieri, Nevada Cioffi; Biondetti, Pietro Raimondo; Danza, Francesco Maria; Scaglione, Mariano

    2015-01-01

    The bowel and the mesentery represent the third most frequently involved structures in blunt abdominal trauma after the liver and the spleen. Clinical assessment alone in patients with suspected intestinal and/or mesenteric injury from blunt abdominal trauma is associated with unacceptable diagnostic delays. Multi-detector computed tomography, thanks to its high spatial, time and contrast resolutions, allows a prompt identification and proper classification of such conditions. The radiologist, in fact, is asked not only to identify the signs of trauma but also to provide an indication of their clinical significance, suggesting the chance of conservative treatment in the cases of mild and moderate, non-complicated or self-limiting injuries and focusing on life-threatening conditions which may benefit from immediate surgical or interventional procedures. Specific and non-specific CT signs of bowel and mesenteric injuries from blunt abdominal trauma are reviewed in this paper. PMID:25572542

  15. Isolated Complete Jejunal Transection After Blunt Abdominal Trauma: CT Imaging

    PubMed Central

    Mehta, Chetan; Patel, Juhi; Parmar, Gautami

    2016-01-01

    Abdominal injury following road traffic accident is less common, compared to the extremities, head and chest. Bowel may get injured following blunt abdominal trauma, but perforation and complete transection is rare. Initial clinical examination may be unreliable, as signs of bowel injury may take some time to develop. Imaging plays a crucial role in the early and accurate diagnosis of bowel injuries. We report a case of 21-year-old male, who presented with severe abdominal pain, following a road traffic accident. Chest X-Ray was normal and abdominal ultrasound revealed intra-peritoneal free fluid with internal echoes. Contrast enhanced CT scan showed pneumoperitoneum and intraperitoneal free fluid with disruption in continuity of proximal jejunum along with signs of shock bowel and bowel ischemia. This report highlights the role of CT imaging in the prompt diagnosis of bowel transection following blunt abdominal trauma. PMID:27134965

  16. Pericardio-diaphragmatic rupture following blunt abdominal trauma: Case report and review of literature

    PubMed Central

    Abou Hussein, Bassem; Khammas, Ali; Kaiyasah, Hadiel; Swaleh, Abeer; Al Rifai, Nazim; Al-Mazrouei, Alya; Badri, Faisal

    2015-01-01

    Introduction Traumatic diaphragmatic rupture (TDR) occurs in 0–5% of patients with major blunt thoraco-abdominal trauma, in most of them on the left side, and an early correct diagnosis is made in less than half of the cases (Meyers and McCabe, 1993; Ball et al., 1982). Presentation of the case We report a case of a forty-eight years old man who had a pericardio-diaphragmatic rupture after a high-velocity blunt abdominal trauma that was diagnosed and treated successfully. Discussion Pericardio-diaphragmatic rupture (PDR) is an uncommon problem that poses a diagnostic challenge to surgeons. The incidence of PDR is between 0.2% and 3.3% of cases with TDR (Sharma, 1999 [3]). Conclusion PDR should be suspected in any patient with high velocity thoraco-abdominal trauma. Early diagnosis is essential and needs a high index of suspicion. Early Management is important in decreasing morbidity and mortality. PMID:26773877

  17. Pancreatic Injury in Blunt Abdominal Trauma

    PubMed Central

    Hasanovic, Jasmin; Agic, Mirha; Rifatbegovic, Zijah; Mehmedovic, Zlatan; Jakubovic-Cickusic, Amra

    2015-01-01

    Introduction: Pancreatic injuries are not common after blunt and penetrating trauma, but can be challenging to diagnose and manage. Case report: Twenty-three year old man, injured during a fall from a motorcycle two days earlier, was admitted to Department of Surgery, University Clinical Centre Tuzla because of suspicion of pancreatic trauma. Immediately after hospitalization, patient underwent laboratory and radiological tests that revealed the existence of pancreatic trauma, so we opted for urgent surgical treatment. Surgery and early postoperative course were normal and the patient was discharged on the ninth postoperative day. Conclusion: Proper diagnosis and well-selected surgical treatment significantly increases the chances for recovery of these patients. PMID:26005266

  18. Diagnostic imaging of blunt abdominal trauma in pediatric patients.

    PubMed

    Miele, Vittorio; Piccolo, Claudia Lucia; Trinci, Margherita; Galluzzo, Michele; Ianniello, Stefania; Brunese, Luca

    2016-05-01

    Trauma is a leading cause of morbidity and mortality in childhood, and blunt trauma accounts for 80-90 % of abdominal injuries. The mechanism of trauma is quite similar to that of the adults, but there are important physiologic differences between children and adults in this field, such as the smaller blood vessels and the high vasoconstrictive response, leading to the spreading of a non-operative management. The early imaging of children undergoing a low-energy trauma can be performed by CEUS, a valuable diagnostic tool to demonstrate solid organ injuries with almost the same sensitivity of CT scans; nevertheless, as for as urinary tract injuries, MDCT remains still the technique of choice, because of its high sensitivity and accuracy, helping to discriminate between an intra-peritoneal form a retroperitoneal urinary leakage, requiring two different managements. The liver is the most common organ injured in blunt abdominal trauma followed by the spleen. Renal, pancreatic, and bowel injuries are quite rare. In this review we present various imaging findings of blunt abdominal trauma in children. PMID:27075018

  19. Epidemiology of Abusive Abdominal Trauma Hospitalizations in United States Children

    ERIC Educational Resources Information Center

    Lane, Wendy Gwirtzman; Dubowitz, Howard; Langenberg, Patricia; Dischinger, Patricia

    2012-01-01

    Objectives: (1) To estimate the incidence of abusive abdominal trauma (AAT) hospitalizations among US children age 0-9 years. (2) To identify demographic characteristics of children at highest risk for AAT. Design: Secondary data analysis of a cross-sectional, national hospitalization database. Setting: Hospitalization data from the 2003 and 2006…

  20. Epidemiology of Abusive Abdominal Trauma Hospitalizations in United States Children

    ERIC Educational Resources Information Center

    Lane, Wendy Gwirtzman; Dubowitz, Howard; Langenberg, Patricia; Dischinger, Patricia

    2012-01-01

    Objectives: (1) To estimate the incidence of abusive abdominal trauma (AAT) hospitalizations among US children age 0-9 years. (2) To identify demographic characteristics of children at highest risk for AAT. Design: Secondary data analysis of a cross-sectional, national hospitalization database. Setting: Hospitalization data from the 2003 and 2006

  1. Mechanical small bowel obstruction following a blunt abdominal trauma: A case report

    PubMed Central

    Zirak-Schmidt, Samira; El-Hussuna, Alaa

    2015-01-01

    Introduction Intestinal obstruction following abdominal trauma has previously been described. However, in most reported cases pathological finding was intestinal stenosis. Presentation of the case A 51-year-old male was admitted after a motor vehicle accident. Initial focused abdominal sonogram for trauma and enhanced computerized tomography were normal, however there was a fracture of the tibia. Three days later, he complained of abdominal pain, constipation, and vomiting. An exploratory laparotomy showed bleeding from the omentum and mechanical small bowel obstruction due to a fibrous band. Discussion The patient had prior abdominal surgery, but clinical and radiological findings indicate that the impact of the motor vehicle accident initiated his condition either by causing rotation of a bowel segment around the fibrous band, or by formation of a fibrous band secondary to minimal bleeding from the omentum. Conclusion High index of suspicion of intestinal obstruction is mandatory in trauma patients presenting with complaints of abdominal pain, vomiting, and constipation despite uneventful CT scan. PMID:26566436

  2. Abdominal Trauma in Durban, South Africa: Factors Influencing Outcome

    PubMed Central

    Mnguni, M.N.; Muckart, D.J.J.; Madiba, T.E.

    2012-01-01

    Abdominal injury as a result of both blunt and penetrating trauma has an appreciable mortality rate from hemorrhage and sepsis. In this article, we present our experience with the management of abdominal trauma in Durban and investigate factors that influence outcome. We performed a prospective study of patients with abdominal trauma in one surgical ward at King Edward VIII Hospital in Durban over a period of 7 years, from 1998 through 2004. Demographic details, cause of injury, delay before surgery, clinical presentation, findings at surgery, management and outcome were documented. There were 488 patients with abdominal trauma with a mean age of 29.2 ± 10.7 years. There were 440 penetrating injuries (240 firearm wounds; 200 stab wounds) and 48 blunt injuries. The mean delay before surgery was 11.7 ± 16.4 hours, and 55 patients (11%) presented in shock. Four hundred and forty patients underwent laparotomy, and 48 were managed nonoperatively. The Injury Severity Score was 11.1 ± 6.7, and the New Injury Severity Score was 17.1 ± 11.1. One hundred and thirty-seven patients (28%) were admitted to the intensive care unit (ICU), with a mean ICU stay of 3.6 ± 5.5 days. One hundred and thirty-two patients developed complications (28%), and 52 (11%) died. Shock, acidosis, increased transfusion requirements, number of organs injured, and injury severity were all associated with higher mortality. Delay before surgery had no influence on outcome. Hospital stay was 9.2 ± 10.8 days. The majority of abdominal injuries in our environment are due to firearms. Physiological instability, mechanism of injury, severity of injury, and the number of organs injured influence outcome. PMID:23102083

  3. Single-antibiotic use for penetrating abdominal trauma.

    PubMed

    Nelson, R M; Benitez, P R; Newell, M A; Wilson, R F

    1986-02-01

    A prospective randomized study compared the use of moxalactam disodium vs clindamycin phosphate and tobramycin sulfate for treatment of 190 patients with penetrating abdominal trauma. Twenty-seven patients were disqualified because of early death or failure to follow the protocol. The patients in each group were comparable regarding the cause and severity of injury. No significant difference was seen in the incidence of intra-abdominal infection between the moxalactam-treated group (13%) and the clindamycin- and tobramycin-treated group (9%). The intra-abdominal infection rate in patients with colon injuries (21%) was significantly increased when compared with the patients without colon injuries (6%), but the antibiotic regimen did not significantly change the infection rate. No evidence of bleeding problems from moxalactam were noted. Changes in prothrombin and partial thromboplastin times appeared to be related to shock rather than the use of moxalactam. The most severe coagulopathies occurred prior to moxalactam therapy and were seen only in those patients who had shock requiring 10 or more units of blood. Moxalactam is as effective as combination (clindamycin and tobramycin) antimicrobial therapy in patients with penetrating abdominal trauma. PMID:3947216

  4. Outcomes for Children Hospitalized With Abusive Versus Noninflicted Abdominal Trauma

    PubMed Central

    Lotwin, Irwin; Dubowitz, Howard; Langenberg, Patricia; Dischinger, Patricia

    2011-01-01

    BACKGROUND: Abusive abdominal trauma (AAT) is the second leading cause of child abuse mortality. Previous outcome studies have been limited to data from trauma centers. OBJECTIVES: The goals of this study were (1) to examine mortality, length of hospitalization, and hospital charges among a national sample of children hospitalized for AAT; and (2) to compare these outcomes with children with noninflicted abdominal trauma. METHODS: Hospitalization data for children aged 0 to 9 years were obtained from the 2003 and 2006 Kids' Inpatient Database. Cases were identified using International Classification of Diseases, Ninth Revision, Clinical Modification and external cause of injury codes. Multivariable regression analyses were used to compare outcomes of children with AAT versus those with noninflicted injury. RESULTS: Children with AAT were younger, and more often insured by Medicaid. Among children surviving to discharge, those with AAT had longer hospitalizations (adjusted mean [95% confidence interval (CI)] length of stay: 7.9 (6.6–9.3) vs 6.4 (6.1–6.7) days, P < .01) and higher charges (adjusted mean [95% CI] costs: $24 343 [$20 952–$28 567] vs $19 341 [$18 770–$20 131]; P < .01). Among children aged 1 to 9 years, those with AAT had higher mortality (adjusted rate [95% CI]: 9.2% [5.0%–16.1%] vs 2.7% [2.2%–3.2%], P < .01). There was no significant difference in mortality for children aged younger than 1 year. CONCLUSIONS: Children hospitalized for AAT generally had poorer short-term outcomes compared with children with noninflicted abdominal trauma. Studies to explain these differences are needed. In addition, efforts to prevent these injuries and to assist families at risk should be supported. PMID:21555490

  5. Contrast enhanced ultrasound (CEUS) in blunt abdominal trauma

    PubMed Central

    2013-01-01

    In the assessment of polytrauma patient, an accurate diagnostic study protocol with high sensitivity and specificity is necessary. Computed Tomography (CT) is the standard reference in the emergency for evaluating the patients with abdominal trauma. Ultrasonography (US) has a high sensitivity in detecting free fluid in the peritoneum, but it does not show as much sensitivity for traumatic parenchymal lesions. The use of Contrast-Enhanced Ultrasound (CEUS) improves the accuracy of the method in the diagnosis and assessment of the extent of parenchymal lesions. Although the CEUS is not feasible as a method of first level in the diagnosis and management of the polytrauma patient, it can be used in the follow-up of traumatic injuries of abdominal parenchymal organs (liver, spleen and kidneys), especially in young people or children. PMID:23902930

  6. Contrast-enhanced ultrasound (CEUS) in blunt abdominal trauma.

    PubMed

    Miele, Vittorio; Piccolo, Claudia Lucia; Galluzzo, Michele; Ianniello, Stefania; Sessa, Barbara; Trinci, Margherita

    2016-05-01

    Baseline ultrasound is essential in the early assessment of patients with a huge haemoperitoneum undergoing an immediate abdominal surgery; nevertheless, even with a highly experienced operator, it is not sufficient to exclude parenchymal injuries. More recently, a new ultrasound technique using second generation contrast agents, named contrast-enhanced ultrasound (CEUS) has been developed. This technique allows all the vascular phase to be performed in real time, increasing ultrasound capability to detect parenchymal injuries, enhancing some qualitative findings, such as lesion extension, margins and its relationship with capsule and vessels. CEUS has been demonstrated to be almost as sensitive as contrast-enhanced CT in the detection of traumatic injuries in patients with low-energy isolated abdominal trauma, with levels of sensitivity and specificity up to 95%. Several studies demonstrated its ability to detect lesions occurring in the liver, spleen, pancreas and kidneys and also to recognize active bleeding as hyperechoic bands appearing as round or oval spots of variable size. Its role seems to be really relevant in paediatric patients, thus avoiding a routine exposure to ionizing radiation. Nevertheless, CEUS is strongly operator dependent, and it has some limitations, such as the cost of contrast media, lack of panoramicity, the difficulty to explore some deep regions and the poor ability to detect injuries to the urinary tract. On the other hand, it is timesaving, and it has several advantages, such as its portability, the safety of contrast agent, the lack to ionizing radiation exposure and therefore its repeatability, which allows follow-up of those traumas managed conservatively, especially in cases of fertile females and paediatric patients. PMID:26607647

  7. Left External Iliac and Common Femoral Artery Occlusion Following Blunt Abdominal Trauma without Associated Bone Injury

    PubMed Central

    Byun, Chun Sung; Park, Il Hwan; Do, Hye-jin; Bae, Keum Seok; Oh, Joong Hwan

    2015-01-01

    Blunt abdominal trauma may cause peripheral vascular injuries. However, blunt abdominal trauma rarely results in injuries to the external iliac and common femoral arteries, which often stem from regional bone fractures. Here, we present the case of a patient who had experienced trauma in the lower abdominal and groin area three months before presenting to the hospital, but these injuries did not involve bone fractures and had been managed conservatively. The patient came to the hospital because of left lower leg claudication that gradually became severe. Computed tomography angiography confirmed total occlusion of the external iliac and common femoral arteries. The patient underwent femorofemoral bypass grafting and was discharged uneventfully. PMID:26078931

  8. Diagnosis of abdominal abscesses in patients with major trauma: the use of computed tomography

    SciTech Connect

    Whitley, N.O.; Shatney, C.H.

    1983-04-01

    The usefulness of computed tomography (CT) in diagnosing abdominal abscesses was evaluated prospectively in 69 septic patients who had suffered massive trauma. For the 82 abdominal CT scans obtained, the accuracy rate was 84%, the sensitivity was 92%, and the specificity was 79%. With the use of abdominal CT, 32 patients were spared a ''blind'' laparotomy in the search for the focus of infection. It is concluded that CT is of significant value in the diagnosis of abdominal abscess in the septic trauma patient.

  9. Frequency, causes and pattern of abdominal trauma: A 4-year descriptive analysis

    PubMed Central

    Arumugam, Suresh; Al-Hassani, Ammar; El-Menyar, Ayman; Abdelrahman, Husham; Parchani, Ashok; Peralta, Ruben; Zarour, Ahmad; Al-Thani, Hassan

    2015-01-01

    Background: The incidence of abdominal trauma is still underreported from the Arab Middle-East. We aimed to evaluate the incidence, causes, clinical presentation, and outcome of the abdominal trauma patients in a newly established trauma center. Materials and Methods: A retrospective analysis was conducted at the only level I trauma center in Qatar for the patients admitted with abdominal trauma (2008-2011). Patients demographics, mechanism of injury, pattern of organ injuries, associated extra-abdominal injuries, Injury Severity Score (ISS), Abbreviated Injury Scale, complications, length of Intensive Care Unit, and hospital stay, and mortality were reviewed. Results: A total of 6888 trauma patients were admitted to the hospital, of which 1036 (15%) had abdominal trauma. The mean age was 30.6 ± 13 years and the majority was males (93%). Road traffic accidents (61%) were the most frequent mechanism of injury followed by fall from height (25%) and fall of heavy object (7%). The mean ISS was 17.9 ± 10. Liver (36%), spleen (32%) and kidney (18%) were most common injured organs. The common associated extra-abdominal injuries included chest (35%), musculoskeletal (32%), and head injury (24%). Wound infection (3.8%), pneumonia (3%), and urinary tract infection (1.4%) were the frequently observed complications. The overall mortality was 8.3% and late mortality was observed in 2.3% cases mainly due to severe head injury and sepsis. The predictors of mortality were head injury, ISS, need for blood transfusion, and serum lactate. Conclusion: Abdominal trauma is a frequent diagnosis in multiple trauma and the presence of extra-abdominal injuries and sepsis has a significant impact on the outcome. PMID:26604524

  10. Seat Belt Use and its Effect on Abdominal Trauma: A National Trauma Databank Study.

    PubMed

    Nash, Nick A; Okoye, Obi; Albuz, Ozgur; Vogt, Kelly N; Karamanos, Efstathios; Inaba, Kenji; Demetriades, Demetrios

    2016-02-01

    We sought to use the National Trauma Databank to determine the demographics, injury distribution, associated abdominal injuries, and outcomes of those patients who are restrained versus unrestrained. All victims of motor vehicle collisions (MVCs) were identified from the National Trauma Databank and stratified into subpopulations depending on the use of seat belts. A total of 150,161 MVC victims were included in this study, 72,394 (48%) were belted. Young, male passengers were the least likely to be wearing a seat belt. Restrained victims were less likely to have severe injury as measured by Injury Severity Score and Abbreviated Injury Score. Restrained victims were also less likely to suffer solid organ injuries (9.7% vs 12%, P < 0.001), but more likely to have hollow viscous injuries (1.9% vs 1.3%, P < 0.001). The hospital and intensive care unit length of stay were significantly shorter in belted victims with adjusted mean difference: -1.36 (-1.45, -1.27) and -0.96 (-1.02, -0.90), respectively. Seat belt use was associated with a significantly lower crude mortality than unrestrained victims (1.9% vs 3.3%, P < 0.001), and after adjusting for differences in age, gender, position in vehicle, and deployment of air bags, the protective effect remained (adjusted odds ratio for mortality 0.50, 95% confidence interval 0.47, 0.54). In conclusion, MVC victims wearing seat belts have a significant reduction in the severity of injuries in all body areas, lower mortality, a shorter hospital stay, and decreased length of stay in the intensive care unit. The nature of abdominal injuries, however, was significantly different, with a higher incidence of hollow viscous injury in those wearing seat belts. PMID:26874135

  11. Management and outcome of abdominal shotgun wounds. Trauma score and the role of exploratory laparotomy.

    PubMed Central

    Cairns, B A; Oller, D W; Meyer, A A; Napolitano, L M; Rutledge, R; Baker, C C

    1995-01-01

    OBJECTIVE: The management and outcome of 138 abdominal shotgun wounds were examined over a 5-year period. SUMMARY BACKGROUND DATA: It has been proposed that exploratory laparotomy may be unnecessary and even overused in a subset of patients with abdominal shotgun wounds. METHODS: Data on shotgun wound patients from October 1987 through March 1992 from a statewide trauma registry were examined. Patients with abdominal shotgun wounds were identified and compared with patients with nonabdominal shotgun wounds. RESULTS: Of 516 shotgun wound patients, 138 (26.7%) had abdominal wounds and 88 (63.8%) had exploratory laparotomies. Abdominal shotgun wounds resulted in significantly longer number of intensive care unit days (4.3 vs. 2.5, p < 0.05), a greater number of blood units transfused (7.8 vs. 2.4, p < 0.05), and a higher mortality (15.9% vs. 4.8%, p < 0.05) when compared with nonabdominal shotgun wounds. When stratified for trauma score, the mortality for abdominal shotgun wounds always was significantly greater than for nonabdominal shotgun wounds. All abdominal shotgun wound patients with trauma scores less than ten died. The negative laparotomy rate for abdominal shotgun wound patients with normal trauma scores was 9.4%. No patient with a negative laparotomy died. CONCLUSION: Abdominal shotgun wounds are a particularly lethal subset of shotgun wounds. Although some abdominal shotgun wound patients can be managed without laparotomy, the morbidity and mortality for these injuries are substantial, even in patients with normal trauma score. Clinical judgment is an excellent predictor of the need for laparotomy. PMID:7717780

  12. False-positive focused abdominal sonography in trauma in a hypotensive child: case report.

    PubMed

    Imamedjian, Isabelle; Baird, Robert; Dubrovsky, Alexander Sasha

    2015-06-01

    We report a case of a false-positive focused abdominal sonography in trauma (FAST) examination in a persistently hypotensive pediatric trauma patient, performed 12 hours after the trauma, suspected to be caused by massive fluid resuscitation leading to ascites. While a positive FAST in a hypotensive trauma patient usually indicates hemoperitoneum, this case illustrates that the timing of the FAST examination relative to the injury, as well as clinical evolution including the volume of fluid resuscitation, need to be considered when interpreting the results of serial and/or late FAST examinations. PMID:26035503

  13. Delayed presentation of a sigmoid colon injury following blunt abdominal trauma: a case report

    PubMed Central

    2012-01-01

    Introduction The low incidence of colon injury due to blunt abdominal trauma and the lack of a definitive diagnostic method for the same can lead to delays in diagnosis and treatment, subsequently resulting in high morbidity and mortality. Case presentation A 66-year-old woman with sigmoid colon injury was admitted to our emergency department after sustaining blunt abdominal trauma. Her physical examination findings and laboratory results led to a decision to perform a laparotomy; exploration revealed a sigmoid colon injury that was treated by sigmoid loop colostomy. Conclusions Surgical abdominal exploration revealed gross fecal contamination and a perforation site. Intra-abdominal irrigation and a sigmoid loop colostomy were performed. Our patient was discharged on post-operative day six without any problems. Closure of the sigmoid loop colostomy was performed three months after the initial surgery. PMID:22905731

  14. Computed tomography (CT) of bowel and mesenteric injury in blunt abdominal trauma: a pictorial essay.

    PubMed

    Hassan, Radhiana; Abd Aziz, Azian; Mohamed, Siti Kamariah Che

    2012-08-01

    Computed tomography (CT) is currently the diagnostic modality of choice in the evaluation of clinically stable patients with blunt abdominal trauma, including the assessment of blunt bowel and mesenteric injuries. CT signs of bowel and/or mesenteric injuries are bowel wall defect, free air, oral contrast material extravasation, extravasation of contrast material from mesenteric vessels, mesenteric vascular beading, abrupt termination of mesenteric vessels, focal bowel wall thickening, mesenteric fat stranding, mesenteric haematoma and intraperitoneal or retroperitoneal fluid. This pictorial essay illustrates CT features of bowel and/or mesenteric injuries in patients with blunt abdominal trauma. Pitfalls in interpretation of images are emphasized in proven cases. PMID:23082464

  15. Intrathoracic Kidney after Blunt Abdominal Trauma: A Case Report and Review of the Literature

    PubMed Central

    Halis, Fikret; Amasyali, Akin Soner; Yucak, Aysel; Yildiz, Turan; Gokce, Ahmet

    2015-01-01

    Abdominal trauma is responsible for most genitourinary injuries. The incidence of renal artery injury and intrathoracic kidney is quite low in patients who present with blunt trauma experiencing damage. There are four defined etiologies for intrathoracic kidney, which include real intrathoracic ectopic kidney, eventration of the diaphragm, congenital diaphragmatic herniation, and traumatic diaphragmatic rupture. The traumatic intrathoracic kidney is an extremely rare case. We presented intrathoracic kidney case after traumatic posterior diaphragmatic rupture. PMID:26881170

  16. Intra-abdominal injury following blunt trauma becomes clinically apparent within 9 hours

    PubMed Central

    Jones, Edward L.; Stovall, Robert T.; Jones, Teresa S.; Bensard, Denis D.; Burlew, Clay Cothren; Johnson, Jeffrey L.; Jurkovich, Gregory Jerry; Barnett, Carlton C.; Pieracci, Frederic M.; Biffl, Walter L.; Moore, Ernest E.

    2014-01-01

    Background The diagnosis of blunt abdominal trauma can be challenging and resource intensive. Observation with serial clinical assessments plays a major role in the evaluation of these patients, but the time required for intra-abdominal injury to become clinically apparent is unknown. The purpose of this study was to determine the amount of time required for an intra-abdominal injury to become clinically apparent after blunt abdominal trauma via physical examination or commonly followed clinical values. Methods A retrospective review of patients who sustained blunt trauma resulting in intra-abdominal injury between June 2010 and June 2012 at a Level 1 academic trauma center was performed. Patient demographics, injuries, and the amount of time from emergency department admission to sign or symptom development and subsequent diagnosis were recorded. All diagnoses were made by computed tomography or at the time of surgery. Patient transfers from other hospitals were excluded. Results Of 3,574 blunt trauma patients admitted to the hospital, 285 (8%) experienced intra-abdominal injuries. The mean (SD) age was 36(17) years, the majority were male (194 patients, 68%) and the mean (SD) Injury Severity Score (ISS) was 21 (14). The mean (SD) time from admission to diagnosis via computed tomography or surgery was 74 (55) minutes. Eighty patients (28%) required either surgery (78 patients, 17%) or radiographic embolization (2 patients, 0.7%) for their injury. All patients who required intervention demonstrated a sign or symptom of their intra-abdominal injury within 60 minutes of arrival, although two patients were intervened upon in a delayed fashion. All patients with a blunt intra-abdominal injury manifested a clinical sign or symptom of their intra-abdominal injury, resulting in their diagnosis within 8 hours 25 minutes of arrival to the hospital. Conclusion All diagnosed intra-abdominal injuries from blunt trauma manifested clinical signs or symptoms that could prompt imaging or intervention, leading to their diagnosis within 8 hours 25 minutes of arrival to the hospital. All patients who required an intervention for their injury manifested a sign or symptom of their injury within 60 minutes of arrival. Level of Evidence Therapeutic study, level IV Epidemiologic study, level III. PMID:24662866

  17. [Interest in several surgeries for serious abdominal trauma].

    PubMed

    Chosidow, D; Lesurtel, M; Sauvat, F; Paugam, C; Johanet, H; Marmuse, J P; Benhamou, G

    2000-01-01

    Abbreviated laparotomy and planned reoperation(s) is a new concept in severely injured patients with multivisceral failure by hemorrhagic shock, coagulopathy and hypothermia. The aim of an abbreviated laparotomy is to control hemorrhage, prevent digestive contamination and close the abdominal wall without tension. After a delay for reanimation during 24 to 96 hours, discovery of unknown lesions and anatomic reconstruction will be possible through planned reoperation in better conditions. Emergency reoperation for hemorrhage and abdominal hyperpression severely worsens prognosis. PMID:10921187

  18. Delayed Presentation of Renocolic Fistula at 4 Months after Blunt Abdominal Trauma

    PubMed Central

    Lee, Sang Don; Kim, Tae Nam; Ha, Hong Koo

    2011-01-01

    Causes of previously reported reno-colic fistulas included primary renal and colonic pathologic states involving infectious, malignant or other inflammatory processes. However, reno-colic fistula after renal injury is extremely uncommon. We report an unusual delayed presentation of reno-colic fistula that occurred at 4 months later after blunt abdominal trauma. PMID:21423539

  19. Ureteral rupture after blunt abdominal trauma in a child with unknown horseshoe kidney.

    PubMed

    Mariotto, Arianna; Zampieri, Nicola; Cecchetto, Mariangela; Camoglio, Francesco Saverio

    2015-01-01

    More than 90% of renal injuries in children result from blunt abdominal trauma. A 10-year-old female had a blunt abdominal trauma with macro-hematuria. The computed tomography scan revealed the presence of a horseshoe kidney and a 3rd grade renal lesion and contrast leakage from the right ureter. The ureteral rupture was confirmed by cystoscopy and ascendant pyelography and than a double J-stent was implanted. The stent was removed one month later. Non-surgical management has become the standard of care for both ureteral and renal lesions in children. Non-surgical treatment is a safe procedure for renal trauma with ureteral rupture in children. PMID:26429120

  20. The Accuracy of Urinalysis in Predicting Intra-Abdominal Injury Following Blunt Traumas

    PubMed Central

    Sabzghabaei, Anita; Shojaee, Majid; Safari, Saeed; Hatamabadi, Hamid Reza; Shirvani, Reza

    2016-01-01

    Introduction: In cases of blunt abdominal traumas, predicting the possible intra-abdominal injuries is still a challenge for the physicians involved with these patients. Therefore, this study was designed, to evaluate the accuracy of urinalysis in predicting intra-abdominal injuries. Methods: Patients aged 15 to 65 years with blunt abdominal trauma who were admitted to emergency departments were enrolled. Abdominopelvic computed tomography (CT) scan with intravenous contrast and urinalysis were requested for all the included patients. Demographic data, trauma mechanism, the results of urinalysis, and the results of abdominopelvic CT scan were gathered. Finally, the correlation between the results of abdominopelvic CT scan, and urinalysis was determined. Urinalysis was considered positive in case of at least one positive value in gross appearance, blood in dipstick, or red blood cell count. Results: 325 patients with blunt abdominal trauma were admitted to the emergency departments (83% male with the mean age of 32.63±17.48 years). Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios of urinalysis, were 77.9% (95% CI: 69.6-84.4), 58.5% (95% CI: 51.2-65.5), 56% (95% CI: 48.5-63.3), 79.6% (95% CI: 71.8-85.7), 1.27% (95% CI: 1.30-1.57), and 0.25% (95% CI: 0.18-0.36), respectively. Conclusion: The diagnostic value of urinalysis in prediction of blunt traumatic intra-abdominal injuries is low and it seems that it should be considered as an adjuvant diagnostic tool, in conjunction with other sources such as clinical findings and imaging. PMID:26862543

  1. Computed tomography-defined abdominal adiposity is associated with acute kidney injury in critically ill trauma patients

    PubMed Central

    Shashaty, Michael G. S.; Kalkan, Esra; Bellamy, Scarlett L.; Reilly, John P.; Holena, Daniel N.; Cummins, Kathleen; Lanken, Paul N.; Feldman, Harold I.; Reilly, Muredach P.; Udupa, Jayaram K.; Christie, Jason D.

    2014-01-01

    Objective Higher body mass index (BMI) is associated with increased risk of acute kidney injury (AKI) after major trauma. Since BMI is non-specific, reflecting lean, fluid, and adipose mass, we evaluated the use of computed tomography (CT) to determine if abdominal adiposity underlies the BMI-AKI association. Design Prospective cohort study. Setting Level I Trauma Center of a university hospital. Patients Patients older than 13 years with an Injury Severity Score ≥16 admitted to the trauma intensive care unit were followed for development of AKI over five days. Those with isolated severe head injury or on chronic dialysis were excluded. Interventions None Measurements and Main Results Clinical, anthropometric, and demographic variables were collected prospectively. CT images at the level of the L4-5 intervertebral disc space were extracted from the medical record and used by two operators to quantitate visceral and subcutaneous adipose tissue (VAT and SAT, respectively) areas. AKI was defined by Acute Kidney Injury Network (AKIN) creatinine and dialysis criteria. Of 400 subjects, 327 (81.8%) had CT scans suitable for analysis: 264/285 (92.6%) blunt trauma subjects, 63/115 (54.8%) penetrating trauma subjects. VAT and SAT areas were highly correlated between operators (ICC>0.999, p<0.001 for each) and within operator (ICC>0.999, p<0.001 for each). In multivariable analysis, the standardized risk of AKI was 15.1% (95% CI 10.6%,19.6%), 18.1% (14%,22.2%), and 23.1% (18.3%,27.9%) at the 25th, 50th, and 75th percentiles of VAT area, respectively (p=0.001), with similar findings when using SAT area as the adiposity measure. Conclusions Quantitation of abdominal adiposity using CT scans obtained for clinical reasons is feasible and highly reliable in critically ill trauma patients. Abdominal adiposity is independently associated with AKI in this population, confirming that excess adipose tissue contributes to the BMI-AKI association. Further studies of the potential mechanisms linking adiposity with AKI are warranted. PMID:24776609

  2. Traumatic rupture of a Meckel’s diverticulum due to blunt abdominal trauma in a soccer game: A case report

    PubMed Central

    Tummers, W.S.; van der Vorst, J.R.; Swank, D.J.

    2015-01-01

    Introduction a Meckel’s diverticulum is one of the most common congenital anomalies of the digestive tract. The reported lifetime complication rate is 4%, mostly due to hemorrhage, obstruction, perforation or inflammation. A symptomatic Meckel’s diverticulum due to rupture after blunt abdominal trauma is very rare. We believe this case report is the first reporting a rupture of a Meckel’s diverticulum after a low velocity blunt abdominal trauma and outlining the importance of a thorough and complete examination of the patient after blunt abdominal trauma. Presentation of case a 17-year-old male presented with abdominal pain after blunt abdominal trauma during a soccer game. Physical examination showed signs of peritonitis in all quadrants of the abdomen. During admission the patient deteriorated with decreasing blood pressure and raising pulse rate. A CT-scan showed free abdominal fluid. Our patient was scheduled for an emergent laparotomy where a perforated Meckel’s diverticulum with fecal spill was found. A segmental ileal resection was performed. Post-operative, patient developed a pneumonia and also intra-abdominal abscesses treated with percutaneous drainage. After an admission period of 17-days the patient was discharged. Conclusion perforation of a Meckel’s diverticulum is rarely suspected as a cause of acute deterioration following blunt abdominal trauma. This case shows the importance of awareness of this kind of injury especially in male patients. PMID:26701844

  3. [Tactics of "damage control" in the injured persons with severe combined trauma of abdominal organs].

    PubMed

    Boĭko, V V; Zamiatin, P N; Peev, S B; Nakonechnyĭ, E V; Miroshnichenko, Iu I

    2014-12-01

    In the clinic in 2000 - 2013 yrs of 42 injured persons with severe combined trauma of abdominal organs were treated, in 18 of them the method of a multi-staged treatment (damage control) with a short-term operative intervention on the first stage was applied, what permitted to lower postoperative lethality by 22.3%, and rate of purulent-septic complications--by 18.1%. PMID:25842874

  4. [Abbreviated laparotomy for treatment of severe abdominal trauma: use in austere settings].

    PubMed

    Balandraud, P; Biance, N; Peycru, T; Savoie, P H; Avaro, J P; Tardat, E; Pourrière, M; Cador, L

    2007-10-01

    Abbreviated laparotomy is a recent technique for management of patients with severe abdominal trauma. It is based on a unified approach taking into account the overall extent of injury and the victim's physiologic potential to respond to hemorrhage. It is the first step in a multi-modal strategy. The second step is the critical care phase. The third step consists of "second-look" laparotomy that should ideally be performed on an elective basis within 48 hours and is aimed at definitive treatment of lesions. The goal of abbreviated laparotomy is damage control using temporary quick-fix procedures limited to conspicuous lesions and rapid hemostasis and/or viscerostasis procedures so that the patient can survive the acute critical period. Tension-free closure of the abdominal wall, if necessary using laparostomy, is essential to avoid abdominal compartment syndrome. With reported survival rates of about 50% in Europe and the United States, this simple life-saving technique that requires limited resources should be introduced in Africa where severe abdominal trauma often involves young patients. PMID:18225739

  5. Abdominal compartment syndrome in trauma patients: New insights for predicting outcomes

    PubMed Central

    Shaheen, Aisha W.; Crandall, Marie L.; Nicolson, Norman G.; Smith-Singares, Eduardo; Merlotti, Gary J.; Jalundhwala, Yash; Issa, Nabil M.

    2016-01-01

    Context: Abdominal compartment syndrome (ACS) is associated with high morbidity and mortality among trauma patients. Several clinical and laboratory findings have been suggested as markers for ACS, and these may point to different types of ACS and complications. Aims: This study aims to identify the strength of association of clinical and laboratory variables with specific adverse outcomes in trauma patients with ACS. Settings and Design: A 5-year retrospective chart review was conducted at three Level I Trauma Centers in the City of Chicago, IL, USA. Subjects and Methods: A complete set of demographic, pre-, intra- and post-operative variables were collected from 28 patient charts. Statistical Analysis: Pearson's correlation coefficient was used to determine the strength of association between 29 studied variables and eight end outcomes. Results: Thirty-day mortality was associated strongly with the finding of an initial intra-abdominal pressure >20 mmHg and moderately with blunt injury mechanism. A lactic acid >5 mmol/L on admission was moderately associated with increased blood transfusion requirements and with acute renal failure during the hospitalization. Developing ACS within 48 h of admission was moderately associated with increased length of stay in the Intensive Care Unit (ICU), more ventilator days, and longer hospital stay. Initial operative intervention lasting more than 2 h was moderately associated with risk of developing multi-organ failure. Hemoglobin level <10 g/dL on admission, ongoing mechanical ventilation, and ICU stay >7 days were moderately associated with a disposition to long-term support facility. Conclusions: Clinical and lab variables can predict specific adverse outcomes in trauma patients with ACS. These findings may be used to guide patient management, improve resource utilization, and build capacity within trauma centers. PMID:27162436

  6. A tumoral mass (local recurrence of renal cell carcinoma) causing massive intraabdominal bleeding after blunt abdominal trauma

    PubMed Central

    Yıldız, İhsan; Koca, Yavuz Savaş; Okur, Koray; Barut, İbrahim

    2016-01-01

    Background Solid organ injury after abdominal trauma is a common condition, however, injury of the local recurrent tumoral masses following abdominal trauma is rare. The injuries and bleeding in recurrent tumors tend to be highly serious since they are more fragile. The bleedings caused by renal cell carcinomas and by the traumatic laceration of their recurrence commonly occur in the retroperitoneum. In this report, we present a 55-year-old female patient who underwent emergency surgery due to intraabdominal bleeding and bleeding was from the recurrence of a renal cell carcinomas. Presentation of case The 55-year-old female patient was admitted to the emergency service with intraabdominal bleeding. Physical examination revealed tenderness in the right lower quadrant, particularly in the traumatic area. Ultrasonography and computed tomography revealed diffuse intraabdominal fluid and a ruptured bleeding mass was excised. Pathological analysis indicated that the mass was isolated local recurrence of renal cell carcinoma. Discussion Solid organ injury caused by blunt abdominal trauma may be accompanied by tumoral laceration; however, minor bleeding may occur in cases with blunt trauma, coexistence of blunt abdominal trauma with local recurrence and massive bleeding is extremely rare. Control of bleeding is more challenging in tumoral tissues compared to normal tissues. The bleeding intraabdominal area rather than the retroperitoneal area, and this condition was attributed to the peritoneal tear caused by the trauma. Conclusion Local recurrent tumoral masses may be the source of the intraabdominal massive bleeding after blunt trauma. PMID:26812671

  7. Screening for Occult Abdominal Trauma in Children with Suspected Physical Abuse

    PubMed Central

    Lane, Wendy Gwirtzman; Dubowitz, Howard; Langenberg, Patricia

    2010-01-01

    Background Abusive abdominal trauma may be difficult to diagnose, and even serious abdominal injury may be missed. Screening for occult abdominal trauma (OAT) has been recommended by child abuse experts. However, it is unclear how often screening occurs, and what factors are associated with screening. Objectives (1) To determine the prevalence of OAT in a sample of children with suspected physical abuse. (2) To assess the frequency of OAT screening. (3) To assess factors associated with screening. Patients and Methods Charts of children evaluated for abusive injury were identified via a search of hospital discharge codes. Identified charts were reviewed to determine whether OAT screening occurred. Data were collected regarding results of screening tests, abusive injuries identified, family demographics, and characteristics of the emergency department visit. Results Screening occurred in 51 of 244 eligible children (20%). Positive screens were identified in 41% of those screened, and 9% of the total sample. 5% of children aged 12–23 months had OAT identified by imaging studies. Screening occurred more often in children presenting with probable abusive head trauma [OR=20.4, 95% CI (3.6–114.6), p<0..01] compared to those presenting with other injuries. Subspecialty consultation from the Child Protection Team [OR=8.5, 95% CI (3.5–20.7), p<0.01] and other subspecialists [OR=24.3, 95% CI (7.1–83.3), p<0.01] also increased the likelihood that OAT screening would occur. Conclusions Our findings support OAT screening with liver and pancreatic enzymes for physically abused children. This study also supports the importance of subspecialty input, especially that of a Child Protection Team. Although many identified injuries may not require treatment, their role in confirming, or demonstrating increased severity of maltreatment can play a critical role in protecting children. PMID:19933726

  8. Characteristics of Hollow Viscus Injury following Blunt Abdominal Trauma; a Single Centre Experience from Eastern India

    PubMed Central

    Jha, Nawal Kishore; Yadav, Sanjay Kumar; Sharma, Rajshekhar; Sinha, Dipendra Kumar; Kumar, Sandip; Kerketta, Marshal Daud; Sinha, Mini; Anand, Abhinav; Gandhi, Anjana; Ranjan, Satish Kumar; Yadav, Jitin

    2014-01-01

    Objective: To determine the presentation, anatomical distribution, diagnostic method, management and outcome of hollow viscus injury (HVI) from blunt abdominal trauma. Methods: This  was  a  retrospective  cross-ecnal  study  including  patients  with  blunt  abdominal  trauma leading to HVI admitted at Rajendra Institute of Medical Sciences, Ranchi, over a period of 4.5 years (January 2009 to July 2014). Data were retrieved from patients’ medical records. Total 173 patients with HVI due to blunt abdominal trauma, who underwent laparotomy at our institute, were reviewed. Data regarding clinical presentation, anatomical distribution, management and outcome were recorded and analysed. Results: Out of 173 patients 87.1% were men and 12.9% were women. Mean age of patients was 29±14.02 years. The most common site of injury was ileum (46.2%) followed by jejunum (44.5%). There were 5 gastric perforations (2.9%), 2 (1.15%) duodenal, 2 (1.15%) colonic, 2 (1.15%) sigmoidal and 2 (1.15%) rectal injuries. One caecal injury was also recorded. Road traffic accident was the most common mechanism of injury (57.2%) followed by fall from height (36.4%) and assault (6.4%). Free gas under diaphragm on erect abdomen radiography was seen in 85.5% of cases while preoperative CT Abdomen was done in 11.6% of cases. Treatment consisted of simple closure of the perforation (66.5%), resection and anastomosis (11.0%) and stoma (22.5%). Major complication was anastamotic leak which was recorded in 6.4% cases and 15.6% patients developed burst abdomen. Average hospital stay was 13±6 days. Overall mortality rate was 12.7%. Conclusion: Although early recognition of intestinal injuries from blunt abdominal trauma may be difficult in all cases, it is very important due to its tremendous life threatening potential. Age of the patient, anatomical site and time of presentation are probably main prognostic factors.

  9. Delayed small bowel perforation following blunt abdominal trauma: A case report and review of the literature.

    PubMed

    Hamidian Jahromi, Alireza; Johnson, Lester; Youssef, Asser M

    2016-04-01

    We report a case of delayed presentation of a small bowel perforation following blunt abdominal trauma (BAT). An initial computed tomography (CT) scan revealed that the patient (a 32-year-old man) had a mesenteric hematoma, which was managed conservatively. Four weeks later, he returned to the hospital complaining of abdominal pain. A CT scan of the abdomen showed a thickened loop of the small bowel adjacent to the mesenteric hematoma at the level of the ileum. He was discharged home, but re-presented with acute abdomen 6 weeks post-trauma. An exploratory laparotomy was performed, which showed a perforated thickened loop of the ileum forming a phlegmon in the lower abdomen. In the English medical literature, only eight other reports of delayed post-traumatic presentation of ileal/jejunal perforation following BAT have been reported. We propose that post-traumatic intestinal perforation be considered in the differential diagnosis even in patients who experience a delayed small bowel perforation following BAT. PMID:27016786

  10. Unenhanced Computed Tomography to Visualize Hollow Viscera and/or Mesenteric Injury After Blunt Abdominal Trauma

    PubMed Central

    Yang, Xu-Yang; Wei, Ming-Tian; Jin, Cheng-Wu; Wang, Meng; Wang, Zi-Qiang

    2016-01-01

    Abstract To identify and describe the major features of unenhanced computed tomography (CT) images of blunt hollow viscera and/or mesenteric injury (BHVI/MI) and to determine the value of unenhanced CT in the diagnosis of BHVI/MI. This retrospective study included 151 patients who underwent unenhanced CT before laparotomy for blunt abdominal trauma between January 2011 and December 2013. According to surgical observations, patients were classified as having BHVI/MI (n = 73) or not (n = 78). Sensitivity, specificity, P values, and likelihood ratios were calculated by comparing CT findings between the 2 groups. Six significant CT findings (P < 0.05) for BHVI/MI were identified and their sensitivity and specificity values determined, as follows: bowel wall thickening (39.7%, 96.2%), mesentery thickening (46.6%, 88.5%), mesenteric fat infiltration (12.3%, 98.7%), peritoneal fat infiltration (31.5%, 87.1%), parietal peritoneum thickening (30.1%, 85.9%), and intra- or retro-peritoneal air (34.2%, 96.2%). Unenhanced CT scan was useful as an initial assessment tool for BHVI/MI after blunt abdominal trauma. Six key features on CT were correlated with BHVI/MI. PMID:26945375

  11. Combined Abdominal and Spine Injuries after High Energy Flexion-Distraction Trauma.

    PubMed

    Woltmann, Alexander; Beisse, Rudolph; Eckardt, Henrik; Potulski, Michael; Bühren, Volker

    2007-10-01

    Combined abdominal (AT) and spine (ST) trauma in the multiply traumatized patient (MT) requires optimal clinical management. At the Traumacenter Murnau, Germany all multiply injured patients (injury severity score ≥ 16) are registered in a large prospective database (DGU-Tramaregister). From 1 January 2002 until 31 December 2004, 731 multiply injured patients (ISS ≥ 16) were admitted to the Trauma Center Murnau. In this population, ST was diagnosed in 287 patients (39%), AT was diagnosed in 100 patients (14%), and in 35 patients (5%) a combined ST and AT was observed. The most frequent injury mechanism in patients with a combined ST and AT was high-energy flexion-distraction trauma caused by motor vehicle accident with seat belt fastened passengers, bicycle accident, and fall from great height. In the cohort group of 35 patients, 29 required either abdominal or spinal operation. In 23 patients the AT and in 18 patients the ST necessitated operation. In 14 patients both the AT and ST called for surgery. The AT was predominately treated with splenectomies, resections and suturing of the intestine. The ST resulted in 14 posterior and four postponed anterior stabilizations of the thoracolumbar and four anterior fusions of the cervical spine. Mean age of these patients was 37 years in comparison to 47 years in the control group (MT without combined AT and ST). ISS of patients with combined AT and ST was 38 points compared to 26 points in the control group, and mortality was 7% in the combined group compared to 14% in the control group. The present study documents that damage control principles applied to patients sustaining the complex combination of AT and ST can result in low mortality rates despite the severity of this injury. PMID:26814933

  12. Abdominal wall hernia and aortic injury secondary to blunt trauma: Case report and review of the literature

    PubMed Central

    Ballard, David H.; Kaskas, Nadine M.; Hamidian Jahromi, Alireza; Skweres, Justin; Youssef, Asser M.

    2014-01-01

    INTRODUCTION Traumatic abdominal wall hernia (TAWH) and traumatic abdominal aortic injury (TAAI) are two uncommon complications secondary to blunt trauma. In both TAWH and TAAI, reported cases are often associated with poly-trauma. TAWH may be initially missed if more pressing issues are identified during the patient's primary survey. TAAI may be an incidental finding on imaging or, if severe, a cause of an acute abdomen and hemodynamic abnormality. PRESENTATION OF CASE A 54-year-old white male suffered a TAWH and TAAI (pseudoaneurysm) due to severe blunt trauma. TAWH was apparent on physical exam and the TAAI was suspected on computed tomography (CT). The patient's TAWH was managed with a series of abdominal explorations and the TAAI was repaired with endovascular stenting. DISCUSSION TAWH and TAAI are commonly due to severe blunt trauma from motor vehicle collisions. Diagnosis is made through physical exam, imaging studies, or surgical exploration. A variety of surgical techniques achieve technical success. CONCLUSION The patient with blunt trauma to the abdomen is at risk for TAWH and TAAI, which are often associated with other injuries. Investigations should include thorough clinical exam through secondary survey and radiologic imaging in the hemodynamically normal patient. PMID:25437685

  13. The application of a trauma index to assess injury severity and prognosis in hospitalized patients with acute trauma

    PubMed Central

    Ruan, Hailin; Ge, Wenhan; Li, Bing; Zhu, Yuanqun; Yang, Fan

    2015-01-01

    Objective: The aim of this study was to determine the application value of a trauma index (TI) to assess condition and likelihood of death in hospitalized patients with acute trauma (AT). Methods: Trauma index scores and injury severity scores (ISS) were assessed in 1,802 randomly selected cases of AT-hospitalized patients. The receiver operating characteristic (ROC) curve was used to compare the clinical values of TI and ISS values to predict outcomes in AT-hospitalized patients. Results: The area under the ROC curve for TI scores was 0.896 (95% CI [0.881, 0.909]), while for ISS, it was 0.792 (95% CI [0.773, 0.811]). This difference was not statistically significant (z = 3.236, P = 0.001). Potentially critical disease conditions in AT-hospitalized patients were best identified when TI scores were ≥ 16 points and ISS values were ≥ 22 points. Conclusions: Trauma Index scores exhibited a higher resolution for outcome prediction in AT-hospitalized patients compared to ISS values. The implementation of this scale was simple, reliable, easy to learn, and could quickly identify disease, which is vital for early detection and treatment of critical trauma patients. PMID:26770541

  14. A case of thoracic splenosis in a post-splenectomy patient following abdominal trauma: Hello Howell-Jolly.

    PubMed

    Viviers, Petrus J

    2014-08-01

    Seeding of splenic tissue to extra-abdominal sites is a relatively infrequent consequence of open abdominal trauma. Immunological function of these small foci of ectopic splenic tissue is unknown and their use in determining the splenic function may be limited. In this case report, a patient is described who had previously undergone an emergency splenectomy. The absence of Howell-Jolly bodies on the blood smear in a patient who had previously undergone surgical splenectomy raised the suspicion of splenosis. The immunological features as well as non-invasive evaluation of these ill-defined splenic tissue sites are discussed. PMID:25988041

  15. Diaphragmatic rupture precipitated by intercostal chest tube drainage in a patient of blunt thoraco-abdominal trauma

    PubMed Central

    Mehrotra, Ashok Kumar; Feroz, Asif; Dawar, Sachet; Kumar, Prem; Singh, Anupam; Khublani, Trilok Kumar

    2016-01-01

    Blunt thoraco-abdominal trauma in collision injuries in road traffic accident (RTA) occasionally results in diaphragmatic injury and rupture besides other serious multisystem injuries. These diaphragmatic injuries (DI) frequently go undetected specially when occur on the right side. DI associated with hemothorax need insertion of intercostal tube drainage (ICTD). ICTD has never been reported to precipitate diaphragmatic rupture and hernia. We are reporting such a rare case for the first time in medical literature. PMID:26933316

  16. [Elderly victims of trauma: preexisting conditions, medications taken at home and indexes of trauma].

    PubMed

    Degani, Gláucia Costa; Pereira Júnior, Gerson Alves; Rodrigues, Rosalina Aparecida Partezani; Luchesi, Bruna Moretti; Marques, Sueli

    2014-01-01

    The objective was to identify the sociodemographic profile of the elderly victims of trauma, to characterize preexisting conditions and medications taken at home, and to calculate indices of trauma and clinical outcomes. This is a retrospective and exploratory analysis from a database of a general hospital between 2008 and 2010. There were studied 131 elderly, mean age 69.9 years, 73.3% male, 55.1% married, 54.7% retired, 65.6% had preexisting conditions and 48.9% used drugs at home. There was a representative number of falls (31.3%), followed by running over (28.2%), with the head/neck region being the most affected (59.5%). Moderate trauma prevailed (44.3%), with conditions of survival after the event (80.2%). There was an association between mechanism of trauma and preexisting disease (p=0.01) and between mechanism of trauma and sex (p=0.03). The knowledge of the variables involved with the elderly victims of trauma enables healthcare professionals to plan preventive measures aimed at improving the assistance. PMID:25517670

  17. [Emergency ultrasound for blunt abdominal trauma--meta-analysis update 2003].

    PubMed

    Stengel, D; Bauwens, K; Porzsolt, F; Rademacher, G; Mutze, S; Ekkernkamp, A

    2003-12-01

    Emergency ultrasound has established itself as a key procedure of primary diagnostic work-up for blunt abdominal and multiple trauma. However, in a systematic review published in 2001 ultrasonography turned out to provide an unexpectedly low sensitivity. We conducted an update of this analysis to investigate if test characteristics will be maintained including recent studies. Prospective trials published between January 1957 and January 2003 were identified using the Medline/Oldmedline, Embase and Cochrane Controlled Trials Register databases. The searching strategy comprised a manual search as well as a search along the world-wide web. Qualitative rating was carried out by two investigators using criteria proposed by the Centre for Evidence-Based Medicine, Oxford. We investigated a composite endpoint (i. e., free fluid and/or organ laceration) as well as the single criteria organ injury and free intraabdominal fluid collections. After calculation of two-by-two-tables, Summary Receiver Operating Characteristics (SROC) and Q* values were determined together with their 95% confidence intervals. The Q* value was proposed as the point of intersection where sensitivity equals specificity. In addition, a random effects model was employed to compute common positive and negative likelihood ratios (LR). By assessing the title and/or abstract, 349 of 957 papers contained potentially valid information for the purpose of this review. A total of 67 studies were deemed eligible, nine of which had to be excluded from meta-analysis because of dual publication. This left 58 trials allocating 16,361 subjects for statistical analysis. Despite a trend towards improved study designs observed during the past decade, the included trials were of average methodological quality. Two-thirds of all investigations fulfilled two or less of the six possible quality criteria. The diagnostic reference standard was applied independently in only 40% of all protocols. With regard to the composite endpoint and the sonographic depiction of free fluid, the Q* value was estimated at 0.91, whereas Q* equaled 0.90 for the detection of organ injury. Q* values subsequently decreased with improving study quality and fell clearly below 0.80 in methodologically proper studies. Accounting for a negative LR of 0.23 (composite endpoint) and an assumed prevalence of 35% of intraabdominal injury, a post-test probability of 11% will remain in case of a negative sonogram. In pediatric trauma, ultrasound showed even worse test characteristics (negative LR = 0.43). Thus, in case of a 35% prevalence, the post-test probability has to estimated at 19%. Emergency ultrasound provides high specificity but insufficient sensitivity to reliably rule out intraabdominal injury. PMID:14750064

  18. A prospective study of 91 patients undergoing both computed tomography and peritoneal lavage following blunt abdominal trauma.

    PubMed

    Fabian, T C; Mangiante, E C; White, T J; Patterson, C R; Boldreghini, S; Britt, L G

    1986-07-01

    Recent reports comparing computed tomography of the abdomen (CTA) and diagnostic peritoneal lavage (DPL) following trauma have been contradictory. A 10-month prospective study was conducted at our trauma center comparing both methods. Criteria for entry into the study included suspected blunt abdominal trauma without indication for immediate laparotomy, with either equivocal abdominal examination, diminished sensorium, or neurologic deficit. Ninety-one patients meeting these criteria underwent CTA followed by DPL. CTA was performed using both oral and intravenous contrast; DPL was performed by the open technique with RBC greater than 100,000 mm3 or WBC greater than 500 mm3 as criteria for a positive examination. CTA was interpreted initially by available radiology staff and residents and retrospectively reviewed by an experienced tomographer blind to DPL and surgical results. Twenty patients in whom either test was positive underwent laparotomy; all others were admitted for observation and/or extra-abdominal surgery. Laparotomy revealed 26 organs injured in the 20 patients explored at admission; none of the observed patients required delayed laparotomy. The results of CTA and DPL were compared to the findings at laparotomy or the clinical course of those not explored. The sensitivity, specificity, and accuracy for initial CTA were 60%, 100%, and 91%; for review CTA 85%, 100%, and 97%; for DPL 90%, 100%, and 98%. We conclude that: even with experienced examiners, CTA offers no diagnostic advantage over DPL in blunt trauma; because of relative costs, we do not recommend the routine application of CTA; CTA is a reliable alternative when circumstances prevent the performance of DPL. PMID:3723635

  19. [Characteristics of duodenal ruptures depending on topographical and anatomical properties of this organ and circumstances of blunt abdominal trauma].

    PubMed

    Pigolkin, Iu I; Dubrovin, I A; Chirkov, R N; Dubrovina, I A; Khachaturian, B S; Mosoian, A S; Dallakian, V F

    2013-01-01

    We have studied specific morphological properties of duodenal rupture depending on the topographic and anatomical features of this organ and circumstances of blunt abdominal trauma suffered in a car crash (with the victim found in the passenger compartment or involved in an automobile-pedestrian accident) and a railway crash (a train-pedestrian accident) or resulting from a blunt-force trauma, a fall from height, a fall on the stomach, and traumatic compression of the body. We took into consideration the anatomical peculiarities of the duodenal rupture, such as its circular, horseshoe, and loop-like shape. The study has demonstrated that the frequency of duodenal injury associated with a blunt abdominal trauma shows a stronger dependence on the topographical and anatomical peculiarities of duodenum than on the circumstances of the case. Specifically, the circular duodenum and especially its descending portion are more readily subjected to the damage than the organs of a different shape. The position of the break with respect to the duodenal axis is an important diagnostic signs allowing to clarify circumstances of the blunt injury. Transverse ruptures are typical of strong impacts associated with the short-term interaction between the damaging object and the affected part of the body whereas longitudinal ruptures more commonly occur as a result the long-term traumatic impact. Bile imbibition of paraduodenal and peripancreatic retroperitoneal adipose tissue may be used as an additional diagnostic sign of duodenal rupture. PMID:24428049

  20. Development of a composite trauma exposure risk index.

    PubMed

    Liu, Honghu; Prause, Nicole; Wyatt, Gail E; Williams, John K; Chin, Dorothy; Davis, Teri; Loeb, Tamra; Marchand, Erica; Zhang, Muyu; Myers, Hector F

    2015-09-01

    The high burden of exposure to chronic life adversities and trauma is quite prevalent, but assessment of this risk burden is uncommon in primary care settings. This calls for a brief, multiple dimensional mental health risk screening tool in primary care settings. We aimed to develop such a screening tool named the University of California, Los Angeles (UCLA) Life Adversities Screener (LADS). Using pooled data across 4 studies from the UCLA Center for Culture, Trauma, and Mental Health Disparities, 5 domains of mental health risk including perceived discrimination, sexual abuse histories, family adversity, intimate partner violence, and trauma histories, were identified. Regression models for depression (Centers for Epidemiology Studies Depression Scale) and posttraumatic stress disorder (Posttraumatic Diagnostic Scale), controlling for demographic factors, were fitted to develop a weighted continuous scale score for the UCLA LADS. Confirmatory factor analysis supported the 5-domain structure, while item response theory endorsed the inclusion of each item. Receiver operating characteristic analysis indicated that the score was predictive for classifying subjects as reaching clinical threshold criteria for either depression (Beck Depression Inventory-II ≥ 14 or Patient Health Questionnaire-9 ≥ 10) or anxiety (Patient Health Questionnaire-13 ≥10). An optimal cut of 0.33 is suggested based on maximizing sensitivity and specificity of the LADS score, identifying patients at high risk for mental health problems. Given its predictive utility and ease of administration, the UCLA LADS could be useful as a screener to identify racial minority individuals in primary care settings who have a high trauma burden, needing more extensive evaluation. PMID:25984638

  1. [Effect of the infusion therapy on enzymatic factor of antioxidant defense in severe combined trauma of the abdominal organs in experiment].

    PubMed

    Kryliuk, V O; Hudyma, A A; Ivanov, V I

    2013-05-01

    The influence of the infusion therapy on enzymatic link of antioxidant defense in the small bowel tissue in severe combined trauma of abdominal cavity organs was studied. The best indices of survival in 24 h and changes of the superoxiddysmutase and catalase activity in animals, to whom preparation HAES-LX5% was prescribed. PMID:23888816

  2. Pneumobilia After Penetrating Trauma Abdominal Wall with no Injury to the Biliary Tree- A Case Report.

    PubMed

    Sandhu, Sartaj Singh; Sampley, Sunil K; Chhabra, Kapil

    2013-06-01

    Pneumobilia denotes an abnormal connection between the gastrointestinal and the biliary tracts. In the absence of surgically created anastomosis between the bowel and the bile duct, the common causes for pneumobilia are gallstone obstruction, endoscopic interventions or emphysematous cholecystitis. We present the case of a young male with traumatic pneumobilia with gastric perforation and a tear in the mesentery of the small gut following penetrating trauma in the form of stab in the abdomen. PMID:24426638

  3. Isolated Meckel’s diverticulum perforation as a sequel to blunt abdominal trauma: a case report

    PubMed Central

    2014-01-01

    Introduction Meckel’s diverticulum is the commonest congenital abnormality of the gastrointestinal tract. Its infrequent occurrence is mirrored by the paucity of large series of data on it in the literature. Hemorrhage, obstruction and inflammation are the three main categories of complications resulting from Meckel’s diverticulum. Perforation of Meckel’s diverticulum following blunt abdominal injury is very rare indeed. We present what we believe to be the first case to be published from Africa. Case presentation A 29-year-old Nigerian Igbo man presented with progressively worsening abdominal pain following a road traffic accident. He was a front-seat passenger traveling without a seat belt. On physical examination his abdomen was distended with guarding and rigidity. A provisional diagnosis of peritonitis secondary to perforation of intestinal viscus was made. Our patient had an emergency laparotomy, where a perforated Meckel’s diverticulum was discovered. A segmental resection of his ileum and reanastomosis were done. He had postoperative surgical site infection, but was asymptomatic for three months of follow-up. Conclusion Perforation of Meckel’s diverticulum is rarely suspected as a cause of peritonitis following blunt abdominal injury. This case indicates the need to be aware of the possibility to limit morbidity associated with delayed management of such a perforation. PMID:24693872

  4. Trauma

    MedlinePlus

    ... to function and less scarring. Continued testing of experimental approaches will bring new treatments, leading to further declines in death rates from traumatic injuries and reduced severity of complications. What kinds of trauma research does the National Institute of General Medical Sciences ( ...

  5. Combined Intrathoracic and Subcutaneous Splenosis Discovered 51 Years after Abdominal Trauma

    PubMed Central

    Gleason, James Benjamin; Hadeh, Anas; Diacovo, Maria Julia; Schroeder, Jonathan Ryan

    2015-01-01

    Splenosis is a rare condition that results from the autotransplantation of splenic parenchyma into unexpected locations such as the abdomen or subcutaneous tissue. In the presence of coexisting injury to the diaphragm intrathoracic transplantation can occur emerging as single or multiple pleural-based masses. This occurs after traumatic rupture of the spleen and is usually asymptomatic, only to be discovered incidentally on routine thoracic or abdominal imaging. To our knowledge this is the third documented case of combined intrathoracic and subcutaneous splenosis found in English literature. This occurred in a 71-year-old male involved in a motor vehicle accident at age 19 requiring urgent splenectomy. He has a significant cigarette smoking history and was referred to our hospital for further evaluation of an abnormality seen on shoulder X-ray. PMID:26236530

  6. Asian women have greater abdominal and visceral adiposity than Caucasian women with similar body mass index

    PubMed Central

    Lim, U; Ernst, T; Buchthal, S D; Latch, M; Albright, C L; Wilkens, L R; Kolonel, L N; Murphy, S P; Chang, L; Novotny, R; Le Marchand, L

    2011-01-01

    Background: In the Multiethnic Cohort Study, Japanese Americans (JA) have lower mean body mass index (BMI) compared with Caucasians, but show a higher waist-to-hip ratio at similar BMI values and a greater risk of diabetes and obesity-associated cancers. Objective: We investigated the abdominal, visceral and hepatic fat distribution in these Asian and Caucasian Americans. Design: A cross-sectional sample of 60 female cohort participants (30 JA and 30 Caucasians), of ages 60–65 years and BMIs 18.5–40 kg m−2, underwent anthropometric measurements and a whole-body dual energy X-ray absorptiometry (DXA) scan: a subset of 48 women also had abdominal magnetic resonance imaging (MRI). Results: By design, JA women had similar BMIs (mean 26.5 kg m−2) to Caucasian women (27.1 kg m−2). JA women were found to have a significantly smaller hip circumference (96.9 vs 103.6 cm; P=0.007) but not a significantly lower DXA total fat mass (25.5 vs 28.8 kg; P=0.16). After adjusting for age and DXA total fat mass, JA women had a greater waist-to-hip ratio (0.97 vs 0.89; P<0.0001), DXA trunk fat (15.4 vs 13.9 kg; P=0.0004) and MRI % abdominal visceral fat (23.9 vs 18.5% P=0.01) and a lower DXA leg fat mass (8.2 vs 10.0 kg; P=<.0001). Their MRI % subcutaneous fat (33.4 vs 30.2% P=0.21) and % liver fat (5.8 vs 3.8% P=0.06) did not significantly differ from that of Caucasian women. Conclusions: Our findings build on limited past evidence, suggesting that Asian women carry greater abdominal and visceral fat when compared with Caucasian women with similar overall adiposity. This may contribute to their elevated metabolic risk for obesity-related diseases. PMID:23449381

  7. [Immunological aspects in spleen ruptures surgery due to closed abdominal trauma].

    PubMed

    Khripun, A I; Alimov, A N; Priamikov, A D; Alimov, V A

    2015-01-01

    The remote results of immunity investigation in 30 patients after organ-preserving surgery and in 30 patients after splenectomy forspleen rupture are presented in the article. Indexes of cellular and humoral immunity were normal and life quality did not differ from that in healthy individuals after organ-preserving operations with splenic artery ligation. Splenectomy leads to deterioration of life quality and disorders in cellular immunity including decrease of T-helpers/inductors cells (CD4), immunoregulatory index (CD3/CD4) and general number of T-lymphocytes (CD3) in some cases on background of compensatory increase of normal killers (CD16). It was observed significant decrease of IgG and IgM levels. Values of IgA and cytokines IL-1, IL-2, IL-6 and TNF remained normal. Level of immunosuppression is reduced due to development of splenosis. PMID:26031956

  8. The association between body mass index and abdominal aortic aneurysm growth: a systematic review.

    PubMed

    Takagi, Hisato; Umemoto, Takuya

    2016-04-01

    Diabetes, a state of relative insulin resistance, is negatively associated with both the presence and growth abdominal aortic aneurysms (AAA), which could suggest a protective role of obesity against AAA presence or growth. A recent meta-analysis demonstrated a trend toward a positive, though statistically non-significant, association between body mass index (BMI) and the presence of AAA. With respect to the association between obesity and AAA growth, however, the evidence had been very limited. To determine whether obesity (or BMI) is associated with AAA growth, we reviewed currently available studies with a systematic literature search. Our comprehensive search identified seven eligible studies reporting the association of BMI and AAA growth rates, which included data on a total of 3,768 AAA patients. All seven identified studies demonstrated no association between BMI and AAA growth. Despite a trend toward a positive association between BMI and AAA presence, the reason why BMI is not associated with AAA growth (suggested in the present review) is unclear. A discrepancy between associated comorbidities (coronary artery disease, peripheral artery disease, and chronic obstructive pulmonary disease) and AAA presence and between the same comorbidities and AAA growth, however, could be identified. Further investigations are required to elucidate why BMI is not associated with AAA growth despite the trend for a positive association with AAA presence. PMID:27058797

  9. Unenhanced Computed Tomography to Visualize Hollow Viscera and/or Mesenteric Injury After Blunt Abdominal Trauma: A Single-Institution Experience.

    PubMed

    Yang, Xu-Yang; Wei, Ming-Tian; Jin, Cheng-Wu; Wang, Meng; Wang, Zi-Qiang

    2016-03-01

    To identify and describe the major features of unenhanced computed tomography (CT) images of blunt hollow viscera and/or mesenteric injury (BHVI/MI) and to determine the value of unenhanced CT in the diagnosis of BHVI/MI.This retrospective study included 151 patients who underwent unenhanced CT before laparotomy for blunt abdominal trauma between January 2011 and December 2013. According to surgical observations, patients were classified as having BHVI/MI (n = 73) or not (n = 78). Sensitivity, specificity, P values, and likelihood ratios were calculated by comparing CT findings between the 2 groups.Six significant CT findings (P < 0.05) for BHVI/MI were identified and their sensitivity and specificity values determined, as follows: bowel wall thickening (39.7%, 96.2%), mesentery thickening (46.6%, 88.5%), mesenteric fat infiltration (12.3%, 98.7%), peritoneal fat infiltration (31.5%, 87.1%), parietal peritoneum thickening (30.1%, 85.9%), and intra- or retro-peritoneal air (34.2%, 96.2%).Unenhanced CT scan was useful as an initial assessment tool for BHVI/MI after blunt abdominal trauma. Six key features on CT were correlated with BHVI/MI. PMID:26945375

  10. Risk Stratification of Patients with Peripheral Arterial Disease and Abdominal Aortic Aneurysm Using Aortic Augmentation Index

    PubMed Central

    Beckmann, Marianne; Husmann, Marc

    2015-01-01

    Background Central augmentation index (cAIx) is an indicator for vascular stiffness. Obstructive and aneurysmatic vascular disease can affect pulse wave propagation and reflection, causing changes in central aortic pressures. Aim To assess and compare cAIx in patients with peripheral arterial disease (PAD) and / or abdominal aortic aneurysm (AAA). Methods cAIx was assessed by radial applanation tonometry (Sphygmocor) in a total of 184 patients at a tertiary referral centre. Patients were grouped as having PAD only, AAA only, or both AAA and PAD. Differences in cAIx measurements between the three patient groups were tested by non-parametric tests and stepwise multivariate linear regression analysis to investigate associations with obstructive or aneurysmatic patterns of vascular disease. Results In the study sample of 184 patients, 130 had PAD only, 20 had AAA only, and 34 patients had both AAA and PAD. Mean cAIx (%) was 30.5 8.2 across all patients. It was significantly higher in females (35.2 6.1, n = 55) than males (28.4 8.2, n = 129), and significantly higher in patients over 80 years of age (34.4 6.9, n = 22) than in those under 80 years (30.0 8.2, n = 162). Intergroup comparison revealed a significant difference in cAIx between the three patient groups (AAA: 27.3 9.5; PAD: 31.4 7.8; AAA & PAD: 28.8 8.5). cAIx was significantly lower in patients with AAA, higher in patients with both AAA and PAD, and highest in patients with PAD only (beta = 0.21, p = 0.006). Conclusion Non-invasive assessment of arterial stiffness in high-risk patients indicates that cAIx differs according to the pattern of vascular disease. Measurements revealed significantly higher cAIx values for patients with obstructive peripheral arterial disease than for patients with aneurysmatic disease. PMID:26452151

  11. Nuclear cardiac ejection fraction and cardiac index in abdominal aortic surgery

    SciTech Connect

    Fiser, W.P.; Thompson, B.W.; Thompson, A.R.; Eason, C.; Read, R.C.

    1983-11-01

    Since atherosclerotic heart disease results in more than half of the perioperative deaths that follow abdominal aortic surgery, a prospective protocol was designed for preoperative evaluation and intraoperative hemodynamic monitoring. Twenty men who were prepared to undergo elective operation for aortoiliac occlusive disease (12 patients) and abdominal aortic aneurysm (eight patients) were evaluated with a cardiac scan and right heart catheterization. The night prior to operation, each patient received volume loading with crystalloid based upon ventricular performance curves. At the time of the operation, all patients were anesthetized with narcotics and nitrous oxide, and hemodynamic parameters were recorded throughout the operation. Aortic crossclamping resulted in a marked depression in CI in all patients. CI remained depressed after unclamping in the majority of patients. There were two perioperative deaths, both from myocardial infarction or failure. Both patients had ejection fractions less than 30% and initial CIs less than 2 L/M2, while the survivors' mean ejection fraction was 63% +/- 1 and their mean CI was 3.2 L/M2 +/- 0.6. The authors conclude that preoperative evaluation of ejection fraction can select those patients at a high risk of cardiac death from abdominal aortic operation. These patients should receive intensive preoperative monitoring with enhancement of ventricular performance.

  12. Urethral Trauma

    MedlinePlus

    ... tissues and result in swelling, inflammation, infection and abdominal pain. Urethral trauma can also cause the inability to ... scrotum and perineum may also occur, along with pain in the affected ... an appropriate evaluation (including X-rays) can be performed. In any ...

  13. Effect of Body Mass Index and Intra-Abdominal Fat Measured by Computed Tomography on the Risk of Bowel Symptoms

    PubMed Central

    Nagata, Naoyoshi; Sakamoto, Kayo; Arai, Tomohiro; Niikura, Ryota; Shimbo, Takuro; Shinozaki, Masafumi; Ihana, Noriko; Sekine, Katsunori; Okubo, Hidetaka; Watanabe, Kazuhiro; Sakurai, Toshiyuki; Yokoi, Chizu; Yanase, Mikio; Akiyama, Junichi; Uemura, Naomi; Noda, Mitsuhiko

    2015-01-01

    Background This study aims to investigate the association between body mass index (BMI) or intra-abdominal fat measured by computed tomography (CT) and bowel symptoms. Method A cohort of 958 Japanese adults who underwent colonoscopy and CT and completed questionnaires after excluding colorectal diseases was analyzed. Six symptoms (constipation, diarrhea, loose stools, hard stools, fecal urgency, and incomplete evacuation) using a 7-point Likert scale were evaluated between baseline and second questionnaire for test-retest reliability. Associations between BMI, visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and symptom score were analyzed by a rank-ordered logistic model, adjusting for age, sex, smoking, and alcohol consumption, hypertension, diabetes mellitus, and dyslipidemia. Results Some bowel symptom scores were significantly (p<0.05) different between the age groups, sexes, smoking, and alcohol consumption. In multivariate analysis, constipation was associated with low BMI (p<0.01), low VAT area (p = 0.01), and low SAT area (p<0.01). Moreover, hard stools was associated with low BMI (p<0.01) and low SAT area (p<0.01). The remaining symptoms were not significantly associated with BMI or intra-abdominal fat. Test-retest reliability of bowel symptom scores with a mean duration of 7.5 months was good (mean kappa, 0.672). Conclusions Both low BMI and low abdominal fat accumulation appears to be useful indicators of increased risk for constipation and hard stools. The long-term test-retest reliability of symptom score suggests that bowel symptoms relevant to BMI or visceral fat remain consistent over several months. PMID:25906052

  14. Abdominal exploration - series (image)

    MedlinePlus

    ... surgical exploration of the abdomen, also called an exploratory laparotomy, may be recommended when there is abdominal ... blunt trauma"). Diseases that may be discovered by exploratory laparotomy include: inflammation of the appendix (acute appendicitis) ...

  15. Frequency and severity approaches to indexing exposure to trauma: the Critical Incident History Questionnaire for police officers.

    PubMed

    Weiss, Daniel S; Brunet, Alain; Best, Suzanne R; Metzler, Thomas J; Liberman, Akiva; Pole, Nnamdi; Fagan, Jeffrey A; Marmar, Charles R

    2010-12-01

    The Critical Incident History Questionnaire indexes cumulative exposure to traumatic incidents in police by examining incident frequency and rated severity. In over 700 officers, event severity was negatively correlated (r(s) = -.61) with frequency of exposure. Cumulative exposure indices that varied emphasis on frequency and severity-using both nomothetic and idiographic methods-all showed satisfactory psychometric properties and similar correlates. All indices were only modestly related to posttraumatic stress disorder (PTSD) symptoms. Ratings of incident severity were not influenced by whether officers had ever experienced the incident. Because no index summarizing cumulative exposure to trauma had superior validity, our findings suggest that precision is not increased if frequency is weighted by severity. PMID:21171134

  16. Right diaphragmatic injury and lacerated liver during a penetrating abdominal trauma: case report and brief literature review

    PubMed Central

    2014-01-01

    Introduction Diaphragmatic injuries are rare consequences of thoracoabdominal trauma and they often occur in association with multiorgan injuries. The diaphragm is a difficult anatomical structure to study with common imaging instruments due to its physiological movement. Thus, diaphragmatic injuries can often be misunderstood and diagnosed only during surgical procedures. Diagnostic delay results in a high rate of mortality. Methods We report the management of a clinical case of a 45-old man who came to our observation with a stab wound in the right upper abdomen. The type or length of the knife used as it was extracted from the victim after the fight. CT imaging demonstrated a right hemothorax without pulmonary lesions and parenchymal laceration of the liver with active bleeding. It is observed hemoperitoneum and subdiaphragmatic air in the abdomen, as a bowel perforation. A complete blood count check revealed a decrease in hemoglobin (7mg/dl), and therefore it was decided to perform surgery in midline laparotomy. Conclusion In countries with a low incidence of inter-personal violence, stab wound diaphragmatic injury is particularly rare, in particular involving the right hemidiaphragm. Diaphragmatic injury may be underestimated due to the presence of concomitant lesions of other organs, to a state of shock and respiratory failure, and to the difficulty of identifying diaphragmatic injuries in the absence of high sensitivity and specific diagnostic instruments. Diagnostic delay causes high mortality with these traumas with insidious symptoms. A diaphragmatic injury should be suspected in the presence of a clinical picture which includes hemothorax, hemoperitoneum, anemia and the presence of subdiaphragmatic air in the abdomen. PMID:24817907

  17. Abdominal Adipose Tissue was Associated with Glomerular Hyperfiltration among Non- Diabetic and Normotensive Adults with a Normal Body Mass Index

    PubMed Central

    Cho, Belong; Park, Jin Ho; Choi, Ho Chun; Lee, Cheol Min; Oh, Seung Won; Kwon, Hyuktae; Heo, Nam Ju

    2015-01-01

    Glomerular hyperfiltration is recognized as an early marker of progressive kidney dysfunction in the obese population. This study aimed to identify the relationship between glomerular hyperfiltration and body fat distribution measured by computed tomography (CT) in healthy Korean adults. The study population included individuals aged 20–64 years who went a routine health check-up including an abdominal CT scan. We selected 4,378 individuals without diabetes and hypertension. Glomerular filtration rate was estimated using the CKD-EPI equation, and glomerular hyperfiltration was defined as the highest quintile of glomerular filtration rate. Abdominal adipose tissue areas were measured at the level of the umbilicus using a 16-detector CT scanner, and the cross-sectional area was calculated using Rapidia 2.8 CT software. The prevalence of glomerular hyperfiltration increased significantly according to the subcutaneous adipose tissue area in men (OR = 1.74 (1.16–2.61), P for trend 0.016, for the comparisons of lowest vs. highest quartile) and visceral adipose tissue area in women (OR = 2.34 (1.46–3.75), P for trend < 0.001) in multivariate analysis. After stratification by body mass index (normal < 23 kg/m2, overweight ≥ 23 kg/m2), male subjects with greater subcutaneous adipose tissue, even those in the normal BMI group, had a higher prevalence of glomerular hyperfiltration (OR = 2.11 (1.17–3.80), P for trend = 0.009). Among women, the significance of visceral adipose tissue area on glomerular hyperfiltration resulted from the normal BMI group (OR = 2.14 (1.31–3.49), P for trend = 0.002). After menopause, the odds ratio of the association of glomerular hyperfiltration with subcutaneous abdominal adipose tissue increased (OR = 2.96 (1.21–7.25), P for trend = 0.013). Subcutaneous adipose tissue areas and visceral adipose tissue areas are positively associated with glomerular hyperfiltration in healthy Korean adult men and women, respectively. In post-menopausal women, visceral adipose tissue area shows significant positive association with glomerular hyperfiltration as in men. PMID:26495973

  18. Computed tomography in trauma

    SciTech Connect

    Toombs, B.D.; Sandler, C.M.

    1987-01-01

    This book begins with a chapter dealing with the epidemiology and mechanisms of trauma. Trauma accounts for more lives lost in the United States than cancer and heart disease. The fact that 30%-40% of trauma-related deaths are caused by improper or delayed diagnoses or treatment emphasizes the importance of rapid and accurate methods to establish a diagnosis. Acute thoracic, abdominal, and pelvic trauma and their complications are discussed. A chapter on high-resolution CT of spinal and facial trauma and the role of three-dimensional reconstruction images is presented.

  19. Development and Initial Validation of the Satisfaction and Recovery Index (SRI) for Measurement of Recovery from Musculoskeletal Trauma

    PubMed Central

    Walton, David M; MacDermid, Joy C; Pulickal, Mathew; Rollack, Amber; Veitch, Jennifer

    2014-01-01

    Background: There is a need for a generic patient-reported outcome (PRO) that is patient-centric and offers sound properties for measuring the process and state of recovery from musculoskeletal trauma. This study describes the construction and initial validation of a new tool for this purpose. Methods: A prototype tool was constructed through input of academic and clinical experts and patient representatives. After evaluation of individual items, a 9-item Satisfaction and Recovery Index (SRI) was subject to psychometric evaluation drawn from classical test theory. Subjects were recruited through online and clinical populations, from those reporting pain or disability from musculoskeletal trauma. The full sample (N = 129) completed the prototype tool and a corresponding region-specific disability measure. A subsample (N = 46) also completed the Short-Form 12 version 2 (SF12vs). Of that, a second subsample (N = 29) repeated all measures 3 months later. Results: A single factor ‘health-related satisfaction’ was extracted that explained 71.1% of scale variance, Cronbach’s alpha = 0.95. A priori hypotheses for cross-sectional correlations with region-specific disability measures and the generic Short-form 12 component scores were supported. The SRI tool was equally responsive to change, and able to discriminate between recovered/non-recovered subjects, at a level similar to that of the region-specific measures and generally better than the SF-12 subscales. Conclusion: The new SRI tool, as a measure of health-related satisfaction, shows promise in this initial evaluation of its properties. It is generic, patient-centered, and shows overall measurement properties similar to that of region-specific measures while allowing the potential benefit of comparison between clinical conditions. Despite early promising results, additional properties need to be explored before the tool can be endorsed for routine clinical use. PMID:25320652

  20. Glycemic index predicts individual glucose responses after self-selected breakfasts in free-living, abdominally obese adults.

    PubMed

    Kochan, Angela M; Wolever, Thomas M S; Chetty, V Tony; Anand, Sonia S; Gerstein, Hertzel C; Sharma, Arya M

    2012-01-01

    The degree to which an individual's glycemic response to a meal is determined by the glycemic index (GI) and other components of the meal remains unclear, especially when meals are not consumed in a highly controlled research setting. To address this question, we analyzed data collected during the run-in period of a clinical trial. Free-living, nondiabetic adults (n = 57) aged 53.9 ± 9.8 y (mean ± SD) with a BMI of 33.9 ± 5.3 kg/m(2) and waist circumference of 109 ± 11 cm underwent a 75-g oral glucose tolerance test (OGTT) and, on a separate day, wore a continuous glucose-monitoring system (CGMS) for 24 h during which time they recorded all foods consumed. The protein, fat, and available carbohydrate (avCHO) content and GI of the breakfast meals were calculated from the food records and the incremental areas under the glycemic response curves (iAUC) for 2 h after breakfast (iAUC(breakfast)) were calculated from CGMS data. Values for iAUC(breakfast), avCHO, fat, fiber, and BMI were normalized by log-transformation. The ability of participant characteristics and breakfast composition to predict individual iAUC(breakfast) responses was determined using step-wise multiple linear regression. A total of 56% of the variation in iAUC(breakfast) was explained by GI (30%; P < 0.001), iAUC after the OGTT (11%; P < 0.001), avCHO (11%; P < 0.001), and waist circumference (3%; P = 0.049); the effects of fat, protein, dietary fiber, age, sex, and BMI were not significant. We concluded that, in free-living, abdominally obese adults, GI is a significant determinant of individual glycemic responses elicited by self-selected breakfast meals. In this study, GI was a more important determinant of glycemic response than carbohydrate intake. PMID:22090469

  1. Epidural ropivacaine with dexmedetomidine reduces propofol requirement based on bispectral index in patients undergoing lower extremity and abdominal surgeries

    PubMed Central

    Joy, Renu; Pujari, Vinayak Seenappa; Chadalawada, Mohan V. R.; Cheruvathoor, Ajish Varghese; Bevinguddaiah, Yatish; Sheshagiri, Nirmal

    2016-01-01

    Background and Aim: To assess the amount of propofol required for induction based on bispectral index (BIS) after administering epidural anesthesia with ropivacaine alone and ropivacaine with dexmedetomidine in patients undergoing lower extremities and abdominal surgeries. Subjects and Methods: A double-blinded randomized clinical trial was carried out in 60 patients over a period of 2 years in a tertiary care hospital. American Society of Anaesthesiologists I or II in age group 18–65 years were included in the study. Group R received epidural anesthesia with ropivacaine alone, and Group D received ropivacaine and dexmedetomidine. General anesthesia was induced with propofol under BIS monitoring after 15 min. Onset of sensory and motor block, time for loss of consciousness and total amount of propofol used during induction to achieve the BIS value < 55 were recorded. Student's t-test and Chi-square test were used to find the significance of study parameters. Results: Time of onset of sensory block (Group R 11.30 ± 1.64/Group D 8.27 ± 0.83 min), motor block (Group R 14.16 ± 1.33/Group D 12.63 ± 1.22 min), time for loss of consciousness (Group R 90.57 ± 11.05/Group D 73.67 ± 16.34 s), and total amount of propofol (Group R 129.83 ± 22.38/Group D 92.13 ± 12.93 s) were reduced in Group D which was statistically significant with P < 0.001. Conclusion: Epidural ropivacaine with dexmedetomidine significantly reduces the total propofol dose required for induction of anesthesia. Also, it decreases the onset time of sensory and motor block and provides good hemodynamic stability. PMID:26957689

  2. A case of abdominal trauma

    PubMed Central

    Stephens, Georgina C.; Claydon, Matthew H.

    2015-01-01

    Multiple injuries resulting from the use of nail guns have been described in the literature; however, to date there has been no report of a nail gun injury to the abdomen. We describe the case of a 30-year-old male tradesperson who suffered a penetrating nail gun injury to the epigastrium, resulting in multiple injuries to the bowel and an inferior vena caval injury with massive haemorrhage. This case demonstrates the wide range of injuries capable of being inflicted by a single penetrating injury, and emphasizes the need for proper training and safety measures in the use of nail guns. PMID:25687444

  3. The impact of first time mother’s body mass index or excessive weight gain in pregnancy on genital tract trauma at birth

    PubMed Central

    Gallagher, Kelly; Migliaccio, Laura; Rogers, Rebecca G; Leeman, Lawrence; Hervey, Elizabeth; Qualls, Clifford

    2013-01-01

    Objective To explore the impact of body mass index BMI or pregnancy weight gain on the presence, site and severity of genital tract trauma at childbirth in nulliparous women. Methods The present study is a sub-analysis of a prospective cohort of healthy nulliparous women recruited during pregnancy and followed through birth. Weight gain during pregnancy and pre-pregnancy BMI were recorded. At birth, women underwent detailed mapping of genital tract trauma. For analyses, women were dichotomized into obese(BMI ≥30) versus non obese(BMI <30) at baseline as well as into those who gained weight as recommended by the Institute of Medicine (IOM) and those who gained more than the recommended amount to determine the impact of obesity or excessive weight gain on rates of genital tract trauma. Results Data from 445 women were available for analysis. Presence and severity of genital tract trauma did not vary between obese and non-obese women (P = NS). Likewise women who gained more than the IOM recommended weight did not have a higher incidence of perineal lacerations (53% vs 51% with perineal lacerations, P= .61). Obese women were more likely to gain in excess of the IOM guidelines during pregnancy (75% vs 50% excessive weight gain, obese vs non-obese women, P<0.001). Conclusion A woman’s BMI or excessive weight gain in pregnancy did not influence her risk of genital tract trauma at birth. PMID:24588877

  4. Abdominal Adhesions

    MedlinePlus

    ... tissue that can form between abdominal tissues and organs. [ Top ] What is the abdominal cavity? The abdominal cavity is the internal area of ... tissues and organs. Abdominal adhesions cause tissues and organs in the abdominal cavity to stick together. Abdominal surgery is the most ...

  5. Abdominal Adhesions

    MedlinePlus

    ... body moves. However, abdominal adhesions cause tissues and organs in the abdominal cavity to stick together. What is the abdominal cavity? ... tissues and organs. Abdominal adhesions cause tissues and organs in the abdominal cavity to stick together. • Abdominal surgery is the most ...

  6. Traumatic abdominal wall hernia in two adults: a case series

    PubMed Central

    2009-01-01

    Introduction Traumatic hernia of the abdominal wall is a rare entity. A large proportion of reported cases are in children with a particular type of injury, i.e. from a handlebar injury. In adults, the presentation can vary substantially and the diagnosis is difficult. We present two cases in adults, with widely varying presentations and management. Case presentations A 40-year-old woman from rural north India presented with a low-velocity blunt injury to the lower abdomen. She was attacked by a bull. She had a clinically evident abdominal fascial disruption with intact skin, and was hemodynamically stable. An emergency mesh repair of the defect was performed, and she recovered well. A 38-year-old man from rural north India presented with blunt trauma to the abdomen following a motor vehicle accident. He was stable, with a central abdominal parietal wall swelling and bruising. A computed tomography scan revealed herniation of bowel loops in the area with minor intra-abdominal injuries. A laparotomy, resection-anastomosis of the ischemic bowel, and primary repair of the defect was performed and he recovered well. Conclusion Following blunt abdominal trauma, particularly high-velocity injuries, a high index of suspicion must be reserved for parietal wall swellings, as missed hernias in this setting have a high risk of strangulation. Computed tomography is the best aid to diagnosis. Management of each case needs to be individualized. PMID:19830187

  7. Anthropometry of height, weight, arm, wrist, abdominal circumference and body mass index, for Bolivian adolescents 12 to 18 years: Bolivian adolescent percentile values from the MESA study.

    PubMed

    Baya Botti, A; Prez-Cueto, F J A; Vasquez Monllor, P A; Kolsteren, P W

    2009-01-01

    Anthropometry is important as clinical tool for individual follow-up as well as for planning and health policy-making at population level. Recent references of Bolivian Adolescents are not available. The aim of this cross sectional study was to provide age and sex specific centile values and charts of Body Mass Index, height, weight, arm, wrist and abdominal circumference from Bolivian Adolescents. Data from the MEtabolic Syndrome in Adolescents (MESA) study was used. Thirty-two Bolivian clusters from urban and rural areas were selected randomly considering population proportions, 3445 school going adolescents, 12 to 18 y, 45% males; 55% females underwent anthropometric evaluation by trained personnel using standardized protocols for all interviews and examinations. Weight, height, wrist, arm and abdominal circumference data were collected. Body Mass Index was calculated. Smoothed age- and gender specific 3rd, 5th, 10th, 25th, 50th, 75th, 85th, 90th, 95th and 97th Bolivian adolescent percentiles(BAP) and Charts(BAC) where derived using LMS regression. Percentile-based reference data for the antropometrics of for Bolivian Adolescents are presented for the first time. PMID:19721903

  8. Abdominal Compartment Hypertension and Abdominal Compartment Syndrome.

    PubMed

    Maluso, Patrick; Olson, Jody; Sarani, Babak

    2016-04-01

    Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are rare but potentially morbid diagnoses. Clinical index of suspicion for these disorders should be raised following massive resuscitation, abdominal wall reconstruction/injury, and in those with space-occupying disorders in the abdomen. Gold standard for diagnosis involves measurement of bladder pressure, with a pressure greater than 12 mm Hg being consistent with IAH and greater than 25 mm Hg being consistent with ACS. Decompressive laparotomy is definitive therapy but paracentesis can be equally therapeutic in properly selected patients. Left untreated, ACS can lead to multisystem organ failure and death. PMID:27016163

  9. Association of body mass index, sagittal abdominal diameter and waist-hip ratio with cardiometabolic risk factors and adipocytokines in Arab children and adolescents

    PubMed Central

    2012-01-01

    Background Sagittal abdominal diameter (SAD) is a novel anthropometric measure hypothesized to be a surrogate measure of visceral abdominal obesity in adults. This study aims to determine whether SAD is superior to other anthropometric measures such as body mass index (BMI) and waist to hip ratio (WHR) in terms of association to cardiometabolic risk and circulating adipocytokine concentrations in a cohort of Saudi children and adolescents. Methods A total of 948 (495 boys and 453 girls) apparently healthy children with varying BMI, aged 10–17 years, were included in this cross sectional study. Fasting glucose, lipid profile, leptin, adiponectin, resistin, insulin, TNF-α and aPAI-1 were measured in serum and HOMA-IR was calculated. MetS components were defined according to the International Diabetes Federation (IDF) criteria. Results BMI was superior to SAD as well as WHR, and had the highest number of significant associations to MetS components and adipocytokines even after adjustment for age and gender, including blood pressure, lipids, glucose and leptin. Conclusion In conclusion, while SAD is significantly associated with components of MetS among children and adolescents, it is not superior to BMI. The use of SAD therefore may not be practical for use in the pediatric clinical setting. Follow-up studies are needed to determine whether SAD has clinical significance in terms of harder outcomes such as predicting diabetes mellitus or cardiovascular diseases. PMID:22871266

  10. Computed tomography in the evaluation of trauma

    SciTech Connect

    Federle, M.P.; Brant-Zawadzki, M.

    1982-01-01

    This book is intended to be the current standard for computed tomography in the evaluation of trauma. It summarizes two years of experience at San Francisco General Hospital. The book is organized into seven chapters, covering head, maxillofacial, laryngeal, spinal, chest, abdominal, acetabular, and pelvic trauma. Extremity trauma is not discussed.

  11. Abdominal pain

    MedlinePlus

    Stomach pain; Pain - abdomen; Belly ache; Abdominal cramps; Bellyache; Stomachache ... bad abdominal pain if you have gas or stomach cramps due to viral gastroenteritis . However, life-threatening ...

  12. The clinical effectiveness of permissive hypotension in blunt abdominal trauma with hemorrhagic shock but without head or spine injuries or burns: a systematic review

    PubMed Central

    Alsawadi, Abdulrahman

    2012-01-01

    Background Trauma is a major cause of death and disability. The current trend in trauma management is the rapid administration of fluid as per the Advanced Trauma Life Support guidelines, although there is no evidence to support this and even some to suggest it might be harmful. Some guidelines, protocols, and recommendations have been established for the use of permissive hypotension although there is reluctance concerning its application in blunt injuries. Objectives The aim of this review is to determine whether there is evidence of the use of permissive hypotension in the management of hemorrhagic shock in blunt trauma patients. This review also aims to search for any reason for the reluctance to apply permissive hypotension in blunt injuries. Methods This systematic review has followed the steps recommended in the Cochrane Handbook for Systematic Reviews of Interventions. It is also being reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement and checklist. Database searches of MEDLINE, EMBASE, the Centre for Reviews and Dissemination databases and the Cochrane Library were made for eligible studies as well as journal searches. Inclusion criteria included systematic reviews that have similar primary questions to this review and randomized controlled trials where patients with blunt torso injuries and hemorrhagic shock were not excluded. Rapid or early fluid administration was compared with controlled or delayed fluid resuscitation and a significant outcome was obtained. Results No systematic reviews attempting to answer similar questions were found. Two randomized controlled trials with mixed types of injuries in the included patients found no significant difference between the groups used in each study. Data concerning the question of this review was sought after these papers were appraised. Conclusion The limited available data are not conclusive. However, the supportive theoretical concept and laboratory evidence do not show any reason for treating blunt injuries differently from other traumatic injuries. Moreover, permissive hypotension is being used for some nontraumatic causes of hemorrhagic shock and in theater. Therefore, this should encourage interested researchers to continue clinical work in this important field.

  13. Ultrasound-Derived Abdominal Muscle Thickness Better Detects Metabolic Syndrome Risk in Obese Patients than Skeletal Muscle Index Measured by Dual-Energy X-Ray Absorptiometry

    PubMed Central

    Ido, Ayumi; Nakayama, Yuki; Ishii, Kojiro; Iemitsu, Motoyuki; Sato, Koji; Fujimoto, Masahiro; Kurihara, Toshiyuki; Hamaoka, Takafumi; Satoh-Asahara, Noriko; Sanada, Kiyoshi

    2015-01-01

    Sarcopenia has never been diagnosed based on site-specific muscle loss, and little is known about the relationship between site-specific muscle loss and metabolic syndrome (MetS) risk factors. To this end, this cross-sectional study aimed to investigate the relationship between site-specific muscle size and MetS risk factors. Subjects were 38 obese men and women aged 40–82 years. Total body fat and lean body mass were assessed by whole-body dual-energy X-ray absorptiometry (DXA) scan. Muscle thickness (MTH) was measured using B-mode ultrasound scanning in six body regions. Subjects were classified into general obesity (GO) and sarcopenic obesity (SO) groups using the threshold values of one standard deviation below the sex-specific means of either MTH or skeletal muscle index (SMI) measured by DXA. MetS risk score was acquired by standardizing and summing the following continuously distributed variables: visceral fat area, mean blood pressure, HbA1c, and serum triglyceride / high density lipoprotein cholesterol, to obtain the Z-score. Multiple regression analysis revealed that the MetS risk score was independently associated with abdominal MTH in all subjects, but not with MTH in other muscle regions, including the thigh. Although HbA1c and the number of MetS risk factors in the SO group were significantly higher than those in the GO group, there were no significant differences between GO and SO groups as defined by SMI. Ultrasound-derived abdominal MTH would allow a better assessment of sarcopenia in obese patients and can be used as an alternative to the conventionally-used SMI measured by DXA. PMID:26700167

  14. Body Mass Index Is a Marker of Nutrition Preparation Sufficiency Before Surgery for Crohn's Disease From the Perspective of Intra-Abdominal Septic Complications

    PubMed Central

    Zhang, Min; Gao, Xiang; Chen, Yuanhan; Zhi, Min; Chen, Huangwei; Tang, Jian; Su, Minli; Yao, Jiayin; Yang, Qingfan; Chen, Junrong; Hu, Pinjin; Liu, Huanliang

    2015-01-01

    Abstract Poor preoperative nutritional status for individuals with Crohn's disease (CD) is associated with intra-abdominal septic complications (IASCs). The present study aimed to investigate the association of the common nutrition indices serum albumin and body mass index (BMI) with IASCs. Sixty-four CD patients who had received elective intestinal operations were retrospectively investigated. Among these patients, 32 had received individualized fortified nutrition support. IASCs occurred in 7 patients (10.9%). Compared with non-IASC patients, IASC patients had a lower BMI (17.6 ± 2.7 vs 15.6 ± 1.3 kg/m2, P = 0.048). The area under the receiver operating characteristic curve according to the BMI-based IASC prediction was 0.772 (95% confidence interval [CI], 0.601–0.944; P = 0.020) with an optimum diagnostic cutoff value of 16.2 kg/m2. A BMI < 16.2 kg/m2 significantly increased the risk of developing an IASC (odds ratio [OR], 10.286; 95% CI, 1.158–91.386). Even after correction with the simplified CD activity index (CDAI), a low BMI level remained associated with IASCs (OR, 7.650; 95% CI, 0.808–72.427; P = 0.076). Serum albumin was not associated with IASCs. Although the fortified nutrition support group had an albumin level comparable to the control group, this group had a higher simplified CDAI score, a lower BMI level, and a comparable incidence rate of IASCs. Thus, BMI more accurately reflects the basic preoperative nutritional status of CD patients than serum albumin. BMI can aid in guiding preoperative nutrition support and judging the appropriate operation time for CD. PMID:26334908

  15. Abdominal Assessment.

    PubMed

    Fritz, Deborah; Weilitz, Pamela Becker

    2016-03-01

    Abdominal pain is one of the most common complaints by patients, and assessment of abdominal pain and associated symptoms can be challenging for home healthcare providers. Reasons for abdominal pain are related to inflammation, organ distention, and ischemia. The history and physical examination are important to narrow the source of acute or chronic problems, identify immediate interventions, and when necessary, facilitate emergency department care. PMID:26925941

  16. The Focused Assessment With Sonography For Trauma (FAST) Examination And Pelvic Trauma: Indications And Limitations.

    PubMed

    Shaukat, Nadia Maria; Copeli, Nikolai; Desai, Poonam

    2016-03-01

    Pelvic trauma accounts for only 3% of all skeletal injuries but may have mortality as high as 45% in cases of severe trauma. Significant high-grade-mechanism trauma to the pelvis must always take the abdomen into consideration for evaluation. The focused assessment with sonography for trauma (FAST) examination has been shown to be a valuable tool in assessing the unstable trauma patient with blunt abdominal injury, though its diagnostic utility is much less well-defined than in primary pelvic trauma. This systematic review explores the utility and limitations of the FAST examination in patients with blunt pelvic trauma and discusses the timing for the examination during the trauma survey. Newer techniques for emergency department management of the unstable trauma patient are also addressed. PMID:26881977

  17. Facial trauma

    MedlinePlus

    Kellman RM. Maxillofacial trauma. In: Flint PW, Haughey BH, Lund LJ, et al, eds. Cummings Otolaryngology: Head & Neck Surgery . 6th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 23. Mayersak RJ. Facial trauma. In: Marx JA, Hockberger RS, ...

  18. Abdominal sounds

    MedlinePlus

    ... blood flow. For example, blood clots can cause mesenteric artery occlusion . Mechanical bowel obstruction is caused by ... abdominal distention ? Do you have excessive or absent gas (flatus) ? Have you noticed any bleeding from the ...

  19. Trauma in pregnancy: a systematic approach.

    PubMed

    Mirza, Fadi G; Devine, Patricia C; Gaddipati, Sreedhar

    2010-08-01

    Trauma in pregnancy remains one of the major contributors to maternal and fetal morbidity and mortality. Potential complications include maternal injury or death, shock, internal hemorrhage, intrauterine fetal demise, direct fetal injury, abruptio placentae, and uterine rupture. The leading causes of obstetric trauma are motor vehicle accidents, falls, assaults, and gunshots, and ensuing injuries are classified as blunt abdominal trauma, pelvic fractures, or penetrating trauma. Many of the assessment and management aspects of obstetric trauma are unique to pregnancy, although initial evaluation and resuscitation should always be maternally directed. Once maternal stability is established, vigilant evaluation of fetal well-being becomes warranted. Continuous fetal heart monitoring, ultrasonography, computed tomography, open peritoneal lavage, and/or exploratory laparotomy may be indicated in a case of obstetric trauma. In view of the significant impact of trauma on the pregnant woman and her fetus, preventive strategies are paramount. PMID:20198552

  20. Do Patients with Penetrating Abdominal Stab Wounds Require Laparotomy?

    PubMed Central

    Sanei, Behnam; Mahmoudieh, Mohsen; Talebzadeh, Hamid; Shahabi Shahmiri, Shahab; Aghaei, Zahra

    2013-01-01

    Background The optimal management of hemodynamically stable asymptomatic patients with anterior abdominal stab wounds (AASWs) remains controversial. The goal is to identify and treat injuries in a safe cost-effective manner. Common evaluation strategies are local wound exploration (LWE), diagnostic peritoneal lavage (DPL), serial clinical assessment (SCAs) and computed tomography (CT) imaging. Making a decision about the right time to operate on a patient with a penetrating abdominal stab wound, especially those who have visceral evisceration, is a continuing challenge. Objectives Until the year 2010, our strategy was emergency laparotomy in patients with penetrating anterior fascia and those with visceral evisceration. This survey was conducted towards evaluating the results of emergency laparotomy. So, better management can be done in patients with penetrating abdominal stab wounds. Patients and Methods This retrospective cross-sectional study was performed on patients with abdominal penetrating trauma who referred to Al- Zahra hospital in Isfahan, Iran from October 2000 to October 2010. It should be noted that patients with abdominal blunt trauma, patients under 14 years old, those with lateral abdomen penetrating trauma and patients who had unstable hemodynamic status were excluded from the study. Medical records of patients were reviewed and demographic and clinical data were collected for all patients including: age, sex, mechanism of trauma and the results of LWE and laparotomy. Data were analyzed with PASW v.20 software. All data were expressed as mean ± SD. The distribution of nominal variables was compared using the Chi-squared test. Also, diagnostic index for LWE were calculated. A two-sided P value less than 0.05 was considered to be statistically significant. Results During the 10 year period of the study, 1100 consecutive patients with stab wounds were admitted to Al-Zahra hospital Isfahan, Iran. In total, about 150 cases had penetrating traumas in the anterior abdomen area. Sixty-three (42%) patients were operated immediately due to shock, visceral evisceration or aspiration of blood via a nasogastric tube on admission. Organ injury was seen in 78% of patients with visceral evisceration. Among these 87 cases, 29 patients’ (33.3%) anterior fascia was not penetrated in LWE. So, they were observed for several hours and discharged from the hospital without surgery. While for the remaining 58 patients (66.6%), whose LWE detected penetration of anterior abdominal fascia, laparotomy was performed which showed visceral injuries in 11 (18%) cases. Conclusions All in all, 82 percent of laparotomies in patients with penetrated anterior abdominal fascia without visceral evisceration, who had no signs of peritoneal irritation, were negative. So, we recommended further evaluation in these patients. However, visceral evisceration is an indication for exploratory laparotomy, since in our study; the majority of patients had organ damages. PMID:24396785

  1. Systemic trauma.

    PubMed

    Goldsmith, Rachel E; Martin, Christina Gamache; Smith, Carly Parnitzke

    2014-01-01

    Substantial theoretical, empirical, and clinical work examines trauma as it relates to individual victims and perpetrators. As trauma professionals, it is necessary to acknowledge facets of institutions, cultures, and communities that contribute to trauma and subsequent outcomes. Systemic trauma-contextual features of environments and institutions that give rise to trauma, maintain it, and impact posttraumatic responses-provides a framework for considering the full range of traumatic phenomena. The current issue of the Journal of Trauma & Dissociation is composed of articles that incorporate systemic approaches to trauma. This perspective extends conceptualizations of trauma to consider the influence of environments such as schools and universities, churches and other religious institutions, the military, workplace settings, hospitals, jails, and prisons; agencies and systems such as police, foster care, immigration, federal assistance, disaster management, and the media; conflicts involving war, torture, terrorism, and refugees; dynamics of racism, sexism, discrimination, bullying, and homophobia; and issues pertaining to conceptualizations, measurement, methodology, teaching, and intervention. Although it may be challenging to expand psychological and psychiatric paradigms of trauma, a systemic trauma perspective is necessary on both scientific and ethical grounds. Furthermore, a systemic trauma perspective reflects current approaches in the fields of global health, nursing, social work, and human rights. Empirical investigations and intervention science informed by this paradigm have the potential to advance scientific inquiry, lower the incidence of a broader range of traumatic experiences, and help to alleviate personal and societal suffering. PMID:24617751

  2. Blunt injury of the abdominal aorta: a review.

    PubMed

    Roth, S M; Wheeler, J R; Gregory, R T; Gayle, R G; Parent, F N; Demasi, R; Riblet, J; Weireter, L J; Britt, L D

    1997-04-01

    Injury to the abdominal aorta after blunt trauma occurs much less frequently than injury to the thoracic aorta. Although presentations vary, common themes continue to emerge with each patient. Within a 6-month period, our trauma unit diagnosed and treated two cases of blunt abdominal aortic trauma. Both patients were restrained passengers in motor vehicle crashes with resultant abdominal aortic injuries and demonstrated some of the most common associated injuries. Our two cases bring the number found in the literature to 62 and demonstrate the need for rapid recognition and treatment of this potentially lethal injury. This article is a comprehensive review of the management of abdominal aortic injury from blunt trauma. PMID:9137272

  3. Paediatric Blunt Torso Trauma

    PubMed Central

    Bhatti, Khalid M.; Taqi, Kadhim M.; Al-Harthy, Ahmed Z. S.; Hamid, Rana S.; Al-Balushi, Zainab N.; Sankhla, Dilip K.; Al-Qadhi, Hani A.

    2016-01-01

    Objectives: Trauma is the greatest cause of morbidity and mortality in paediatric/adolescent populations worldwide. This study aimed to describe trauma mechanisms, patterns and outcomes among children with blunt torso trauma admitted to the Sultan Qaboos University Hospital (SQUH) in Muscat, Oman. Methods: This retrospective single-centre study involved all children ≤12 years old with blunt torso trauma admitted for paediatric surgical care at SQUH between January 2009 and December 2013. Medical records were analysed to collect demographic and clinical data. Results: A total of 70 children were admitted with blunt torso trauma during the study period, including 39 (55.7%) male patients. The mean age was 5.19 ± 2.66 years. Of the cohort, 35 children (50.0%) received their injuries after having been hit by cars as pedestrians, while 19 (27.1%) were injured by falls, 12 (17.1%) during car accidents as passengers and four (5.7%) by falling heavy objects. According to computed tomography scans, thoracic injuries were most common (65.7%), followed by abdominal injuries (42.9%). The most commonly involved solid organs were the liver (15.7%) and spleen (11.4%). The majority of the patients were managed conservatively (92.9%) with a good outcome (74.3%). The mortality rate was 7.1%. Most deaths were due to multisystem involvement. Conclusion: Among children with blunt torso trauma admitted to SQUH, the main mechanism of injury was motor vehicle accidents. As a result, parental education and enforcement of infant car seat/child seat belt laws are recommended. Conservative management was the most successful approach. PMID:27226913

  4. Reconstruction after pancreatic trauma by pancreaticogastrostomy

    PubMed Central

    Martín, Gonzalo Martín; Morillas, Patricia Jiménez; Pino, José C. Rodríguez; Canis, José M. Morón; Argenté, Francesc X. González

    2015-01-01

    Introduction Pancreatic lesions are very infrequent after closed abdominal trauma (5% of cases) with a complication rate that affects 30–40% of patients, and a mortality rate that can reach 39%. In our experience, closed abdominal traumatisms occurring at typical popular horse-riding festivals in our region constitute a high risk of pancreatic trauma. The purpose of the present paper is to raise awareness about our experience in the diagnosis and treatment of pancreatic lesions secondary to closed abdominal traumatism. Presentation of case We present the clinical cases of two young patients who, after suffering blunt abdominal trauma secondary to the impact of a horse during the celebration of typical horse-riding festival, were diagnosed with pancreatic trauma type III. The treatment was surgical in both cases and consisted in performing a pancreaticogastric anastomosis with preservation of the distal pancreas and spleen. The postoperative period was uneventful and, at present, both patients are asymptomatic. Discussion Signs and symptoms caused by pancreatic lesion are unspecific and difficult to objectify. With some limitations CT is the imaging test of choice for diagnosis and staging in the acute phase. The Wirsung section is indication for surgical treatment. The most extended surgical procedure in these cases is the resection of pancreatic body, tail, and spleen. Conclusion The identification of a pancreatic injury after closed abdominal trauma requires a high suspicion based on the injury mechanism. A safer option may be the distal pancreatic preservation with pancreaticogastric anastomosis in grade III lesions with healthy pancreatic tissue. PMID:25744560

  5. Abdominal thrusts

    MedlinePlus

    ... call 911 . If the person loses consciousness, start CPR . If you are not comfortable performing abdominal thrusts, ... American Red Cross. First Aid/CPR/AED Participant's Manual. 2nd ... Red Cross; 2014. Berg RA, Hemphill R, Abella BS, et al. Part 5: ...

  6. Abdominal cocoon.

    PubMed

    Katz, Christian B S; Diggory, Robert T; Samee, Abdus

    2014-01-01

    Intestinal obstruction secondary to cocoon formation is not common. We report a case of a patient who had presented with abdominal pain and distension accompanied by vomiting. Investigations, laparotomy and histology together revealed primary peritoneal carcinoma as the cause of the patient's symptoms. PMID:24682136

  7. Abdominal cocoon

    PubMed Central

    Katz, Christian B S; Diggory, Robert T; Samee, Abdus

    2014-01-01

    Intestinal obstruction secondary to cocoon formation is not common. We report a case of a patient who had presented with abdominal pain and distension accompanied by vomiting. Investigations, laparotomy and histology together revealed primary peritoneal carcinoma as the cause of the patient's symptoms. PMID:24682136

  8. Intestinal injury mechanisms after blunt abdominal impact.

    PubMed

    Cripps, N P; Cooper, G J

    1997-03-01

    Intestinal injury is frequent after non-penetrating abdominal trauma, particularly after modern, high-energy transfer impacts. Under these circumstances, delay in the diagnosis of perforation is a major contributor to morbidity and mortality. This study establishes patterns of intestinal injury after blunt trauma by non-penetrating projectiles and examines relationships between injury distribution and abdominal wall motion. Projectile impacts of variable momentum were produced in 31 anaesthetised pigs to cause abdominal wall motion of varying magnitude and velocity. No small bowel injury was observed at initial impact velocity of less than 40 m/s despite gross abdominal compression. At higher velocity, injury to the small bowel was frequent, irrespective of the degree of abdominal compression (P = 0.00044). Large bowel injury was observed at all impact velocities and at all degrees of abdominal compression. This study confirms the potential for intestinal injury in high velocity, low momentum impacts which do not greatly compress the abdominal cavity and demonstrates apparent differences in injury mechanisms for the small bowel and colon. Familiarity with injury mechanisms may reduce delays in the diagnosis of intestinal perforation in both military and civilian situations. PMID:9135238

  9. Trauma team.

    PubMed

    Tiel Groenestege-Kreb, D; van Maarseveen, O; Leenen, L

    2014-08-01

    The introduction of trauma teams has improved patient outcome independently. The aim of establishing a trauma team is to ensure the early mobilization and involvement of more experienced medical staff and thereby to improve patient outcome. The team approach allows for distribution of the several tasks in assessment and resuscitation of the patient in a 'horizontal approach', which may lead to a reduction in time from injury to critical interventions and thus have a direct bearing on the patient's ultimate outcome. A trauma team leader or supervisor, who coordinates the resuscitation and ensures adherence to guidelines, should lead the trauma team. There is a major national and international variety in trauma team composition, however crucial are a surgeon, an Emergency Medicine physician or both and anaesthetist. Advanced Trauma Life Support training, simulation-based training, and video review have all improved patient outcome and trauma team performance. Developments in the radiology, such as the use of computed tomography scanning in the emergency room and the endovascular treatment of bleeding foci, have changed treatment algorithms in selected patients. These developments and new insights in shock management may have a future impact on patient management and trauma team composition. PMID:24980423

  10. Abdominal injuries in communal crises: The Jos experience

    PubMed Central

    Ojo, Emmanuel Olorundare; Ozoilo, Kenneth N.; Sule, Augustine Z.; Ugwu, Benjamin T.; Misauno, Michael A.; Ismaila, Bashiru O.; Peter, Solomon D.; Adejumo, Adeyinka A.

    2016-01-01

    Background: Abdominal injuries contribute significantly to battlefield trauma morbidity and mortality. This study sought to determine the incidence, demographics, clinical features, spectrum, severity, management, and outcome of abdominal trauma during a civilian conflict. Materials and Methods: A prospective analysis of patients treated for abdominal trauma during the Jos civil crises between December 2010 and May 2012 at the Jos University Teaching Hospital. Results: A total of 109 victims of communal conflicts with abdominal injuries were managed during the study period with 89 (81.7%) males and 20 (18.3%) females representing about 12.2% of the total 897 combat related injuries. The peak age incidence was between 21 and 40 years (range: 3–71 years). The most frequently injured intra-abdominal organs were the small intestine 69 (63.3%), colon 48 (44%), and liver 41 (37.6%). Forty-four (40.4%) patients had extra-abdominal injuries involving the chest in 17 (15.6%), musculoskeletal 12 (11%), and the head in 9 (8.3%). The most prevalent weapon injuries were gunshot 76 (69.7%), explosives 12 (11%), stab injuries 11 (10.1%), and blunt abdominal trauma 10 (9.2%). The injury severity score varied from 8 to 52 (mean: 20.8) with a fatality rate of 11 (10.1%) and morbidity rate of 29 (26.6%). Presence of irreversible shock, 3 or more injured intra-abdominal organs, severe head injuries, and delayed presentation were the main factors associated with mortality. Conclusion: Abdominal trauma is major life-threatening injuries during conflicts. Substantial mortality occurred with loss of nearly one in every 10 hospitalized victims despite aggressive emergency room resuscitation. The resources expenditure, propensity for death and expediency of timing reinforce the need for early access to the wounded in a concerted trauma care systems. PMID:26957819

  11. Hope Thinking and Past Trauma Mediate the Relationships of Body Mass Index with Perceived Mental Health Treatment Need and Mental Health Treatment Use

    PubMed Central

    Hendricks, Andrea N.; Dhurandhar, Emily J.; Fontaine, Kevin R.; Hendricks, Peter S.

    2015-01-01

    Greater body mass is associated with a greater risk of mental health conditions and more frequent mental health treatment use. However, factors that might influence perceived mental health treatment need and mental health treatment use among those of greater weight, including hope thinking, trauma history, and perceived mental health treatment stigma, are not well understood. Objective To determine if hope thinking, trauma history, and/or perceived mental health treatment stigma mediate the relationships of BMI with perceived mental health treatment need and mental health treatment use. Method Primary care clinic patients in the Midwest United States (N = 196; BMI range = 18.5 to 47, mean = 29.26 ± 6.61, median = 27.90) were recruited to complete a battery of self-report measures that assessed perceived mental health treatment need, mental health treatment use, hope thinking (Trait Hope Scale), trauma history (a single-item traumatic event history screen from the posttraumatic stress disorder module of the Structured Clinical Interview for DSM-IV), and perceived mental health treatment stigma (Stigma Scale for Receiving Psychological Help). Results Reduced hope thinking and a greater incidence of past trauma accounted for greater perceived mental health treatment need and greater mental health treatment use among those of greater BMI. BMI was not related to perceived unmet mental health treatment need. Conclusion Increased perceived mental health treatment need and mental health treatment use among those of greater BMI may be explained by lower hope thinking and a greater incidence of trauma in this population. Heavier patients may benefit from interventions designed to augment hope and address traumatic histories. PMID:25556357

  12. Abdominal Aortic Aneurysms: Treatments

    MedlinePlus

    ... information Membership Directory (SIR login) Interventional Radiology Abdominal Aortic Aneurysms Interventional Radiologists Treat Abdominal Aneurysms Nonsurgically Interventional radiologists ...

  13. Planned reoperation for severe trauma.

    PubMed Central

    Hirshberg, A; Mattox, K L

    1995-01-01

    OBJECTIVE: The authors review the physiologic basis, indications, techniques, and results of the planned reoperation approach to severe trauma. SUMMARY BACKGROUND DATA: Multivisceral trauma and exsanguinating hemorrhage lead to hypothermia, coagulopathy, and acidosis. Formal resections and reconstructions in these unstable patients often result in irreversible physiologic insult. A new surgical strategy addresses these physiologic concerns by staged control and repair of the injuries. METHOD: The authors review the literature. RESULTS: Indications for planned reoperation include avoidance of irreversible physiologic insult and inability to obtain direct hemostasis or formal abdominal closure. The three phases of the strategy include initial control, stabilization, and delayed reconstruction. Various techniques are used to obtain rapid temporary control of bleeding and hollow visceral spillage. Hypothermia, coagulopathy, and the abdominal compartment syndrome are major postoperative concerns. Definitive repair of the injuries is undertaken after stabilization. CONCLUSION: Planned reoperation offers a simple and effective alternative to the traditional surgical management of complex or multiple injuries in critically wounded patients. PMID:7618965

  14. [Abdominal pain].

    PubMed

    Beer, D; Bettschart, V

    2001-01-01

    The doctor on duty conducting home visits is frequently asked to care for patients with non-traumatic severe abdominal pain. For this reason, visiting doctors should be able to recognize tell-tale alarm signs, evaluate ailments that call for surgical referral to--particularly those that require emergency surgery--and, if necessary, perform simple paraclinical exams at the patient's bedside. In the case of intense abdominal pain requiring a rapid and effective "analgesia", the doctor should be able to administer an opiate, without of the surgical unit impairing the judgement. When hospitalisation or referral for surgery is not necessary, a re-evaluation at 12 to 36 hours later should be offered. PMID:11234707

  15. [Abdominal splenosis: an often underdiagnosed entity].

    PubMed

    Vercher-Conejero, J L; Bello-Arqués, P; Pelegrí-Martínez, L; Hervás-Benito, I; Loaiza-Góngora, J L; Falgas-Lacueva, M; Ruiz-Llorca, C; Pérez-Velasco, R; Mateo-Navarro, A

    2011-01-01

    Splenosis is defined as the heterotopic autotransplantation of splenic tissue because of a ruptured spleen due to trauma or surgery. It is a benign and incidental finding, although imaging tests may sometimes orient toward malignancy simulating renal tumors, abdominal lymphomas, endometriosis, among other. We report the case of a 42-year old male in whom a MRI was performed after a study due to abdominal pain. Multiple enlarged lymph nodes were observed in the abdomen, suggestive of lymphoproliferative disease. As an important background, splenectomy was carried out due to abdominal trauma at age 9. After several studies, it was decided to perform a (99m)Tc-labeled heat-damaged red blood cell scintigraphy that showed multiple pathological deposits distributed throughout the abdomen, and even the pelvis, being consistent with splenosis. PMID:20570413

  16. Renal Trauma: The Rugby Factor

    PubMed Central

    Freeman, Catherine M.; Kelly, Michael E.; Nason, Gregory J.; McGuire, Barry B.; Kilcoyne, Aoife; Ryan, John; Lennon, Gerald; Galvin, David; Quinlan, David; Mulvin, David

    2015-01-01

    Introduction Renal trauma accounts for 5% of all trauma cases. Rare mechanisms of injuries including sports participation are increasingly common. Rugby-related trauma poses a conundrum for physicians and players due to the absence of clear guidelines and a paucity of evidence. Our series highlights traumatic rugby-related renal injuries in our institution, and emphasize the need for international guidelines on management. Methods A retrospective review of all abdominal traumas between January 2006 and April 2013, specifically assessing for renal related trauma that were secondary to rugby injuries was performed. All patients' demographics, computerized tomography results, hematological and biochemical results and subsequent management were recorded. Results Five male patients presented with rugby-related injuries. Mean age was 21 years old. All patients were hemodynamically stable and managed conservatively in acute setting. One patient was detected to have an unknown pre-existing atrophic kidney that had been subsequently injured, and was booked for an elective nephrectomy an 8-week interval. Conclusion Rugby-related trauma has generated essential attention. This paper serves to highlight this type of injury and the need for defined guidelines on role of imaging and international consensus on timing of return to contact sport, in both professional and amateur settings. PMID:26889132

  17. [Ocular trauma. Blunt ocular trauma].

    PubMed

    Saleh, M

    2012-06-01

    Ocular traumas represent a major public health problem with poorly understood ramifications at both the individual and community levels. Any of the ocular structures can be damaged in the case of closed globe injury. These lesions, often multiple, may appear immediately or in a delayed fashion. Classifications have been developed recently in order to better inform the patient of the visual prognosis. However, significant efforts are still needed, on the one hand, to assess and develop new therapies, and on the other hand, to implement effective policies to prevent ocular trauma. PMID:22463853

  18. Blunt thoracic trauma. Analysis of 515 patients.

    PubMed Central

    Shorr, R M; Crittenden, M; Indeck, M; Hartunian, S L; Rodriguez, A

    1987-01-01

    A retrospective analysis of 515 cases of blunt chest trauma is presented. The overall thoracic morbidity rate was 36% and mortality rate was 15.5%. Atelectasis was the most common complication. Severe chest trauma can be present in the absence of rib or other thoracic bony fractures. Emergency thoracotomies for resuscitation of the patient with blunt chest trauma with absent vital signs proved unsuccessful in 39 of 39 patients. A high index of suspicion for blunt chest injury occurring in blunt trauma, coupled with an aggressive diagnostic and therapeutic approach, remains the cornerstone of treatment to minimize the morbidity and mortality of such injuries. PMID:3606246

  19. Comparison of quality control for trauma management between Western and Eastern European trauma center

    PubMed Central

    Calderale, Stefano Massimiliano; Sandru, Raluca; Tugnoli, Gregorio; Di Saverio, Salomone; Beuran, Mircea; Ribaldi, Sergio; Coletti, Massimo; Gambale, Giorgio; Paun, Sorin; Russo, Livio; Baldoni, Franco

    2008-01-01

    Background Quality control of trauma care is essential to define the effectiveness of trauma center and trauma system. To identify the troublesome issues of the system is the first step for validation of the focused customized solutions. This is a comparative study of two level I trauma centers in Italy and Romania and it has been designed to give an overview of the entire trauma care program adopted in these two countries. This study was aimed to use the results as the basis for recommending and planning changes in the two trauma systems for a better trauma care. Methods We retrospectively reviewed a total of 182 major trauma patients treated in the two hospitals included in the study, between January and June 2002. Every case was analyzed according to the recommended minimal audit filters for trauma quality assurance by The American College of Surgeons Committee on Trauma (ACSCOT). Results Satisfactory yields have been reached in both centers for the management of head and abdominal trauma, airway management, Emergency Department length of stay and early diagnosis and treatment. The main significant differences between the two centers were in the patients' transfers, the leadership of trauma team and the patients' outcome. The main concerns have been in the surgical treatment of fractures, the outcome and the lacking of documentation. Conclusion The analyzed hospitals are classified as Level I trauma center and are within the group of the highest quality level centers in their own countries. Nevertheless, both of them experience major lacks and for few audit filters do not reach the mmum standard requirements of ACS Audit Filters. The differences between the western and the eastern European center were slight. The parameters not reaching the minimum requirements are probably occurring even more often in suburban settings. PMID:19019230

  20. Reconstruction option of abdominal wounds with large tissue defects

    PubMed Central

    2014-01-01

    Background Abdominal wall defects result from trauma, abdominal wall tumors, necrotizing infections or complications of previous abdominal surgeries. Apart from cosmetics, abdominal wall defects have strong negative functional impact on the patients. Many different techniques exist for abdominal wall repair. Most problematic and troublesome are defects, where major part of abdominal wall had to be resected and tissue for transfer or reconstruction is absent. Case presentation Authors of the article present operative technique, in which reconstruction of abdominal wall was managed by composite polypropylene mesh with absorbable collagen film, creation of granulation tissue with use of NPWT (negative pressure wound therapy), and subsequent split skin grafting. Three patients with massive abdominal wall defect were successfully managed and abdominal wall reconstruction was performed by mentioned technique. Functional and cosmetic effect is acceptable and patients have good postoperative quality of life. Conclusions Patients with giant abdominal defects can benefit from described technique. It serves as the only option, with which abdominal wall is fully reconstructed without need for the secondary intervention. PMID:25103782

  1. Avalanche trauma.

    PubMed

    Grossman, M D; Saffle, J R; Thomas, F; Tremper, B

    1989-12-01

    Medical aspects of avalanche accidents have apparently not been studied in the American literature. Records from the Utah Avalanche Forecasting Center (UAFC) for the period 1982-1987 were reviewed and compared with similar data from Europe and Canada. One hundred forty-five avalanches involving 188 individuals were reported to the UAFC. Ninety-one (48%) people were caught, of whom 21 required medical attention. Twelve of the 91 died (13%) and nine were injured (10%). Eleven of 12 nonsurvivors and four of nine survivors were completely buried. Evidence of major blunt trauma was present in nine of ten nonsurvivors and all nine survivors. Asphyxia and blunt trauma were the most common causes of death; hypothermia appeared to have played only a minor role. These findings were similar to results obtained in Europe and Canada. PMID:2593202

  2. Penetrating trauma

    PubMed Central

    Kuhajda, Ivan; Zarogoulidis, Konstantinos; Kougioumtzi, Ioanna; Huang, Haidong; Li, Qiang; Dryllis, Georgios; Kioumis, Ioannis; Pitsiou, Georgia; Machairiotis, Nikolaos; Katsikogiannis, Nikolaos; Papaiwannou, Antonis; Lampaki, Sofia; Zaric, Bojan; Branislav, Perin; Dervelegas, Konstantinos; Porpodis, Konstantinos

    2014-01-01

    Pneumothorax occurs when air enters the pleural space. Currently there is increasing incidence of road traffic accidents, increasing awareness of healthcare leading to more advanced diagnostic procedures, and increasing number of admissions in intensive care units are responsible for traumatic (non iatrogenic and iatrogenic) pneumothorax. Pneumothorax has a clinical spectrum from asymptomatic patient to life-threatening situations. Diagnosis is usually made by clinical examination and imaging techniques. In our current work we focus on the treatment of penetrating trauma. PMID:25337403

  3. Computed tomography of pancreatic trauma

    SciTech Connect

    Jeffrey, R.B. Jr.; Federle, M.P.; Crass, R.A.

    1983-05-01

    In a review of over 300 CT scans of abdominal trauma, we encountered 13 patients with surgically proved pancreatic injuries. CT correctly diagnosed pancreatic fractures, contusions, or posttraumatic pseudocysts in 11 of these patients. There were two false positive and two false negative diagnoses. The CT diagnosis of pancreatic trauma may be difficult in selected patients who are scanned soon after injury. Acutely, the actual plane of a pancreatic fracture may be difficult to identify with CT, and the peripancreatic soft-tissue changes of traumatic pancreatitis are often subtle. Eight of 11 correctly diagnosed pancreatic injuries showed thickening of the left anterior renal fascia on CT scans. This sign should prompt a critical evaluation of the pancreas of the traumatized patient.

  4. Clinicopathological Profile of Childhood Primary Abdominal Tumours in Kashmir.

    PubMed

    Khan, Parwez Sajad; Akhter, Zahida; Majeed, Showkat; Wani, Mohd Yousuf; Hayat, Humera

    2015-12-01

    Primary abdominal tumours attract considerable notice because of their serious prognosis, high cost of treatment and the emotional and psychological trauma. Abdominal tumours can present with pain, vomiting, constipation or less commonly intestinal obstruction. The presentation of cancer in children mimic those of childhood conditions like infections particularly viral infections, urinary tract infections, gastro-oesophageal reflux, malnutrition, constipation, lymphadnenitis, glomerulonephritis and congenital urinary tract anomalies. PMID:26730026

  5. Diaphragmatic herniation after penetrating trauma.

    PubMed

    Degiannis, E; Levy, R D; Sofianos, C; Potokar, T; Florizoone, M G; Saadia, R

    1996-01-01

    A study was made of 45 patients with diaphragmatic herniation after penetrating trauma. In 29 the diagnosis was established during the first admission (early presentation) and in 16 during a subsequent admission (delayed presentation). The mortality rate in the early presentation group was 3 per cent compared with 25 per cent in the delayed presentation group. The presence of gangrenous or perforated abdominal viscus in the chest cavity was the single most common and severe aggravating factor. The need for diagnosis of diaphragmatic herniation during the initial admission is emphasized. As isolated diaphragmatic injuries provide few helpful clinical features to aid diagnosis, appropriate investigations and good follow-up are of paramount importance in preventing late herniation of intra-abdominal viscera through a penetrating diaphragmatic injury. PMID:8653376

  6. Abdominal tuberculosis of the gastrointestinal tract: Revisited

    PubMed Central

    Debi, Uma; Ravisankar, Vasudevan; Prasad, Kaushal Kishor; Sinha, Saroj Kant; Sharma, Arun Kumar

    2014-01-01

    Abdominal tuberculosis is an increasingly common disease that poses diagnostic challenge, as the nonspecific features of the disease which may lead to diagnostic delays and development of complications. This condition is regarded as a great mimicker of other abdominal pathology. A high index of suspicion is an important factor in early diagnosis. Abdominal involvement may occur in the gastrointestinal tract, peritoneum, lymphnodes or solid viscera. Various investigative methods have been used to aid in the diagnosis of abdominal tuberculosis. Early diagnosis and initiation of antituberculous therapy and surgical treatment are essential to prevent morbidity and mortality. Most of the patients respond very well to standard antitubercular therapy and surgery is required only in a minority of cases. Imaging plays an important role in diagnosis of abdominal tuberculosis because early recognition of this condition is important. We reviewed our experience with the findings on various imaging modalities for diagnosis of this potentially treatable disease. PMID:25356043

  7. Intraabdominal Challenges Affecting Abdominal Wall Reconstruction

    PubMed Central

    Moffett, Jennifer Movassaghi; Gedalia, Uri; Xue, Amy Shengnan; Heller, Lior

    2012-01-01

    Abdominal wall defects may arise from trauma, infection, and prior abdominal surgeries, such as tumor resections. Although ideally reconstruction should be accomplished as soon as possible to restore the integrity and function of the abdominal wall, it is not always a viable option. A successful reconstruction must take into consideration the local environment of the defect, as well as the global condition of the patient. Therefore, it is imperative that a multidisciplinary team be involved to optimize the patient's care, particularly when a defect is complicated by a wound infection, an abscess, a fistula, or a neoplasm. Our goal in this article is to explore the challenges evoked by each of these special situations, and review the necessary steps for successful management. PMID:23372452

  8. ABCs of scoring systems for pediatric trauma.

    PubMed

    Furnival, R A; Schunk, J E

    1999-06-01

    This review presents an overview of scoring systems used in pediatric and adult trauma. Triage scoring systems, using readily available physical examination, physiologic, and/or mechanism of injury parameters, are used to determine appropriate prehospital referral patterns. The Trauma Score, Revised Trauma Score, Circulation/Respiration/Abdomen/Motor/Speech Scale, Prehospital Index, and Trauma Triage Rule were reviewed. Injury scoring systems based upon anatomic descriptions of all identified injuries, are retrospectively used to analyze trauma populations. The Abbreviated Injury Scale, Injury Severity Score, Modified Injury Severity Score, Organ Injury Scaling, and Anatomic Profile were discussed. The two trauma outcome analysis systems presented, TRISS and ASCOT, allow for reproducible quantification of trauma severity, and survival comparison between trauma populations. Many of these triage, injury severity, and outcome analysis systems were developed with patient survival as the major outcome variable. Although subsequent studies may have found them to have some predictive value for measures of trauma morbidity, these scoring systems do not specifically address long-term risk of impairment, and therefore overlook one of the most crucial elements of pediatric trauma care. The last 2 decades have seen considerable development of scoring systems and analysis methods applicable to the trauma patient. As presented, this trend includes both the elaboration of increasingly simple, field-oriented triage tools, and more complex mathematical techniques for trauma outcome analysis. Although not all systems were designed specifically with the pediatric patient in mind, validation or modification of these systems for the pediatric patient will likely occur in the future. It is anticipated that this field will continue to evolve with greater mathematical sophistication; a baseline familiarity of the early stages of this evolution may be of benefit to those caring for the pediatric trauma patient. PMID:10389962

  9. Modified Opsite Sandwich for Temporary Abdominal Closure: A Non-Traumatic Experience

    PubMed Central

    Wilde, JM; Loudon, MA

    2007-01-01

    INTRODUCTION Laparostomy techniques have advanced since the advent of damage control surgery for the critically injured patient. Numerous methods of temporary abdominal closure (TAC) are described in the literature with most reports focusing on trauma. We describe a modified technique for TAC and report its use in a series of critically ill non-trauma patients. PATIENTS AND METHODS Eleven patients under the care of one consultant underwent TAC over a 36-month period. A standardised technique was used in all cases and this is described. Severity of illness at the time of the first laparotomy was assessed using the Portsmouth variant of the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (P-POSSUM). RESULTS Nineteen TACs were performed in 11 patients with a variety of serious surgical conditions. In-hospital mortality was zero despite seven of the patients having an individual P-POSSUM predicted mortality in excess of 50%. The laparostomy dressing proved simple in construction, facilitated nursing care and was well-tolerated in the critical care environment. All patients underwent definitive fascial closure during the index admission. CONCLUSIONS Laparostomy is a useful technique outwith the context of trauma. We have demonstrated the utility of the modified Opsite sandwich vacuum pack for TAC in a series of critically ill patients with a universally favourable outcome. This small study suggests that selective use of TAC may reduce surgical mortality. PMID:17316524

  10. Abdominal aortic aneurysm

    MedlinePlus

    ... blood to the abdomen, pelvis, and legs. An abdominal aortic aneurysm occurs when an area of the aorta becomes ... High blood pressure Male gender Genetic factors An abdominal aortic aneurysm is most often seen in males over age ...

  11. Abdominal wall surgery

    MedlinePlus

    ... tummy tuck. It can range from a simple mini-tummy tuck to more extensive surgery. Abdominal wall ... abdomen. Your abdominal muscles may be tightened also. Mini abdominoplasty is performed when there are areas of ...

  12. Specific Trauma Subtypes Improve the Predictive Validity of the Harvard Trauma Questionnaire in Iraqi Refugees

    PubMed Central

    Arnetz, Bengt B.; Broadbridge, Carissa L.; Jamil, Hikmet; Lumley, Mark A.; Pole, Nnamdi; Barkho, Evone; Fakhouri, Monty; Talia, Yousif Rofa; Arnetz, Judith E.

    2014-01-01

    Background Trauma exposure contributes to poor mental health among refugees, and exposure often is measured using a cumulative index of items from the Harvard Trauma Questionnaire (HTQ). Few studies, however, have asked whether trauma subtypes derived from the HTQ could be superior to this cumulative index in predicting mental health outcomes. Methods A community sample of recently arrived Iraqi refugees (N = 298) completed the HTQ and measures of posttraumatic stress disorder (PTSD) and depression symptoms. Results Principal components analysis of HTQ items revealed a 5-component subtype model of trauma that accounted for more item variance than a 1-component solution. These trauma subtypes also accounted for more variance in PTSD and depression symptoms (12% and 10%, respectively) than did the cumulative trauma index (7% and 3%, respectively). Discussion Trauma subtypes provided more information than cumulative trauma in the prediction of negative mental health outcomes. Therefore, use of these subtypes may enhance the utility of the HTQ when assessing at-risk populations. PMID:24549491

  13. Scroto-abdominal impalement injury in a skateboard rider.

    PubMed

    Carragher, A M; Sulaiman, S K; Panesar, K J

    1990-01-01

    The injuries sustained by skateboard riders vary from minor cuts and abrasions to fractures. This report describes a unique injury sustained by a young skateboard rider who was impaled on a metal rod. Literature review of over 1,254 skateboard injuries did not reveal any other instances of penetrating abdominal trauma. PMID:2212559

  14. Abdominal Circulatory Interactions.

    PubMed

    Dagar, Gaurav; Taneja, Amit; Nanchal, Rahul S

    2016-04-01

    The abdominal compartment is separated from the thoracic compartment by the diaphragm. Under normal circumstances, a large portion of the venous return crosses the splanchnic and nonsplanchnic abdominal regions before entering the thorax and the right side of the heart. Mechanical ventilation may affect abdominal venous return independent of its interactions at the thoracic level. Changes in pressure in the intra-abdominal compartment may have important implications for organ function within the thorax, particularly if there is a sustained rise in intra-abdominal pressure. It is important to understand the consequences of abdominal pressure changes on respiratory and circulatory physiology. This article elucidates important abdominal-respiratory-circulatory interactions and their clinical effects. PMID:27016167

  15. [Mesenteric trauma: management in austere environments].

    PubMed

    Peycru, T; Biance, N; Avaro, J P; Savoie, P H; Tardat, E; Balandraud, P

    2006-04-01

    Mesenteric trauma, i.e., injuries located in the bowel or organs supplied by the superior mesenteric artery, can be life-threatening. The incidence of these lesions is low. Most occur as result of blunt and penetrating abdominal trauma due mainly to gunshot wounds or road accidents. Management of these serious injuries can be challenging in the military field hospitals. The major problem in austere environment is the unavailabiity of computerized axial and other tools gene rally used for diagnosis. As an alternative to tomography diagnostic peritoneal lavage can be used with a high sensitivity for the detection of mesenteric trauma. The second difficulty is technical. General surgeons without vasular training or supplies must prepared to suspect and reonstuct lesions of the superior mesenteric available resources. PMID:16775948

  16. Isolated Blunt Duodenal Trauma: Simple Repair, Low Mortality.

    PubMed

    Siboni, Stefano; Benjamin, Elizabeth; Haltmeier, Tobias; Inaba, Kenji; Demetriades, Demetrios

    2015-10-01

    Optimal surgical management of traumatic duodenal injury (DI) remains controversial. The National Trauma Data Bank was queried for all blunt trauma patients with DI. Patients with isolated injury were identified by excluding chest and head Abbreviated Injury Score > 3 and nonduodenal intra-abdominal Organ Injury Scale ? 3. Demographics, OIS, and operative intervention were collected. Outcomes included mortality and hospital length of stay (HLOS). During the study period, 3,456,098 blunt trauma patients were entered into the National Trauma Data Bank, 388,137 of which had abdominal trauma. Overall, 1.0 per cent patients with abdominal trauma had DI with isolated DI in only 0.6 per cent (n = 2220). The majority of isolated DI was low grade with only 158 patients sustaining severe injury and overall mortality was 5.2 per cent. Overall 743 patients were operated, of which 353 (47.5%) patients underwent duodenal operation, 280 (37.7%) had primary repair (PR), and 68 (9.2%) had gastroenterostomy (GE). Patients with PR had similar mortality to those with GE (6.6% vs 4.5%, P = 0.777); however, HLOS was shorter (median 11 days, vs 18 days, P < 0.001). In only OIS 4 and 5 injuries, PR was also associated with shorter HLOS (P = 0.004) and similar mortality (P = 1.000) when compared with GE. Isolated DI after blunt abdominal trauma is rare. In severe injuries, PR is associated with a shorter HLOS without effecting mortality when compared with GE. PMID:26463289

  17. A Traumatic Abdominal Wall Hernia Repair: A Laparoscopic Approach

    PubMed Central

    Wilson, Kenneth L.; Rosser, James C.

    2012-01-01

    Background: Traumatic abdominal wall hernias from blunt trauma usually occur as a consequence of motor vehicle collisions where the force is tangential, sudden, and severe. Although rare, these hernias can go undetected due to preservation of the skin overlying the hernia defect. Open repairs can be challenging and unsuccessful due to avulsion of muscle directly from the iliac crest, with or without bone loss. A laparoscopic approach to traumatic abdominal wall hernia can aid in the delineation of the hernia and allow for a safe and effective repair. Case Description: A 36-year-old female was admitted to our Level 1 trauma center with a traumatic abdominal wall hernia located in the right flank near the iliac crest after being involved in a high-impact motor vehicle collision. Computed tomography and magnetic resonance imaging of the abdomen revealed the presence of an abdominal wall defect that was unapparent on physical examination. The traumatic abdominal wall hernia in the right flank was successfully repaired laparoscopically. One-year follow-up has shown no sign of recurrence. Discussion: A traumatic abdominal wall hernia rarely presents following blunt trauma, but should be suspected following a high-impact motor vehicle collision. Frequently, repair is complicated by the need to have fixation of mesh to bony landmarks (eg, iliac crest). In spite of this challenge, the laparoscopic approach with tension-free mesh repair of a traumatic abdominal wall hernia can be accomplished successfully using an approach similar to that taken for laparoscopic inguinal hernia repair. PMID:23477181

  18. Practical Approaches to Definitive Reconstruction of Complex Abdominal Wall Defects.

    PubMed

    Latifi, Rifat

    2016-04-01

    With advances in abdominal surgery and the management of major trauma, complex abdominal wall defects have become the new surgical disease, and the need for abdominal wall reconstruction has increased dramatically. Subsequently, how to reconstruct these large defects has become a new surgical question. While most surgeons use native abdominal wall whenever possible, evidence suggests that synthetic or biologic mesh needs to be added to large ventral hernia repairs. One particular group of patients who exemplify "complex" are those with contaminated wounds, enterocutaneous fistulas, enteroatmospheric fistulas, and/or stoma(s), where synthetic mesh is to be avoided if at all possible. Most recently, biologic mesh has become the new standard in high-risk patients with contaminated and dirty-infected wounds. While biologic mesh is the most common tissue engineered used in this field of surgery, level I evidence is needed on its indication and long-term outcomes. Various techniques for reconstructing the abdominal wall have been described, however the long-term outcomes for most of these studies, are rarely reported. In this article, I outline current practical approaches to perioperative management and definitive abdominal reconstruction in patients with complex abdominal wall defects, with or without fistulas, as well as those who have lost abdominal domain. PMID:26585951

  19. Distribution of emergency operations and trauma in a Swedish hospital: need for reorganisation of acute surgical care?

    PubMed Central

    2012-01-01

    Background Subspecialisation within general surgery has today reached further than ever. However, on-call time, an unchanged need for broad surgical skills are required to meet the demands of acute surgical disease and trauma. The introduction of a new subspecialty in North America that deals solely with acute care surgery and trauma is an attempt to offer properly trained surgeons also during on-call time. To find out whether such a subspecialty could be helpful in Sweden we analyzed our workload for emergency surgery and trauma. Methods Linköping University Hospital serves a population of 257 000. Data from 2010 for all patients, diagnoses, times and types of operations, surgeons involved, duration of stay, types of injury and deaths regarding emergency procedures were extracted from a prospectively-collected database and analyzed. Results There were 2362 admissions, 1559 emergency interventions; 835 were mainly abdominal operations, and 724 diagnostic or therapeutic endoscopies. Of the 1559 emergency interventions, 641 (41.1%) were made outside office hours, and of 453 minor or intermediate procedures (including appendicectomy, cholecystectomy, or proctological procedures) 276 (60.9%) were done during the evenings or at night. Two hundred and fifty-four patients were admitted with trauma and 29 (11.4%) required operation, of whom general surgeons operated on eight (3.1%). Thirteen consultants and 11 senior registrars were involved in 138 bowel resections and 164 cholecystectomies chosen as index operations for standard emergency surgery. The median (range) number of such operations done by each consultant was 6 (3–17) and 6 (1–22). Corresponding figures for senior registrars were 7 (0–11) and 8 (1–39). Conclusion There was an uneven distribution of exposure to acute surgical problems and trauma among general surgeons. Some were exposed to only a few standard emergency interventions and most surgeons did not operate on a single patient with trauma. Further centralization of trauma care, long-term positions at units for emergency surgery and trauma, and subspecialisation in the fields of emergency surgery and trauma, might be options to solve problems of low volumes. PMID:22985447

  20. [Hepatic artery pseudoaneurysm following blunt abdominal injury].

    PubMed

    Kargl, S; Breitwieser, J; Gitter, R; Pumberger, W

    2012-12-01

    Posttraumatic hepatic artery pseudoaneurysms are a rare but life-threatening complication of blunt abdominal trauma with liver damage. We report the case of a child who developed a pseudoaneurysm of the right hepatic artery after a bicycle accident with central liver rupture. After an episode of hemodynamically relevant hemobilia due to delayed bleeding, the asymptomatic pseudoaneurysm was diagnosed coincidentally by ultrasound. Because of the progression in size angiographic coiling was performed and led to thrombotic occlusion of the pseudoaneurysm. After a symptom-free period of 1 month the child required surgery because of acute cholecystitis. PMID:22699314

  1. Factors associated with abdominal obesity in children

    PubMed Central

    Melzer, Matheus Ribeiro Theodósio Fernandes; Magrini, Isabella Mastrangi; Domene, Semíramis Martins Álvares; Martins, Paula Andrea

    2015-01-01

    Objective: To identify the association of dietary, socioeconomic factors, sedentary behaviors and maternal nutritional status with abdominal obesity in children. Methods: A cross-sectional study with household-based survey, in 36 randomly selected census tracts in the city of Santos, SP. 357 families were interviewed and questionnaires and anthropometric measurements were applied in mothers and their 3-10 years-old children. Assessment of abdominal obesity was made by maternal and child's waist circumference measurement; for classification used cut-off points proposed by World Health Organization (1998) and Taylor et al. (2000) were applied. The association between variables was performed by multiple logistic regression analysis. Results: 30.5% of children had abdominal obesity. Associations with children's and maternal nutritional status and high socioeconomic status were shown in the univariate analysis. In the regression model, children's body mass index for age (OR=93.7; 95%CI 39.3-223.3), female gender (OR=4.1; 95%CI 1.8-9.3) and maternal abdominal obesity (OR=2.7; 95%CI 1.2-6.0) were significantly associated with children's abdominal obesity, regardless of the socioeconomic status. Conclusions: Abdominal obesity in children seems to be associated with maternal nutritional status, other indicators of their own nutritional status and female gender. Intervention programs for control of childhood obesity and prevention of metabolic syndrome should consider the interaction of the nutritional status of mothers and their children. PMID:26298655

  2. Recurrent Abdominal Pain

    ERIC Educational Resources Information Center

    Banez, Gerard A.; Gallagher, Heather M.

    2006-01-01

    The purpose of this article is to provide an empirically informed but clinically oriented overview of behavioral treatment of recurrent abdominal pain. The epidemiology and scope of recurrent abdominal pain are presented. Referral process and procedures are discussed, and standardized approaches to assessment are summarized. Treatment protocols…

  3. [Abdominal pregnancy, institutional experience].

    PubMed

    Bonfante Ramírez, E; Bolaños Ancona, R; Simón Pereyra, L; Juárez García, L; García-Benitez, C Q

    1998-07-01

    Abdominal pregnancy is a rare entity, which has been classified as primary or secondary by Studiford criteria. A retrospective study, between January 1989 and December 1994, realized at Instituto Nacional de Perinatología, found 35,080 pregnancies, from which 149 happened to be ectopic, and 6 of them were abdominal. All patients belonged to a low income society class, age between 24 and 35 years, and average of gestations in 2.6. Gestational age varied from 15 weeks to 32.2 weeks having only one delivery at term with satisfactory postnatal evolution. One patient had a recurrent abdominal pregnancy, with genital Tb as a conditional factor. Time of hospitalization varied from 4 to 5 days, and no further patient complications were reported. Fetal loss was estimated in 83.4%. Abdominal pregnancy is often the sequence of a tubarian ectopic pregnancy an when present, it has a very high maternal mortality reported in world literature, not found in this study. The stated frequency of abdominal pregnancy is from 1 of each 3372, up to 1 in every 10,200 deliveries, reporting in the study 1 abdominal pregnancy in 5846 deliveries. The study had two characteristic entities one, the recurrence and two, the delivery at term of one newborn. Abdominal pregnancy accounts for 4% of all ectopic pregnancies. Clinical findings in abdominal pregnancies are pain, transvaginal bleeding and amenorrea, being the cardinal signs of ectopic pregnancy. PMID:9737070

  4. Open abdomen in trauma patients: a double-edged sword.

    PubMed

    Huang, Yu-Hua; Li, You-Sheng

    2016-01-01

    The use of open abdomen (OA) as a technique in the treatment of exsanguinating trauma patients was first described in the mid-19(th) century. Since the 1980s, OA has become a relatively new and increasingly common strategy to manage massive trauma and abdominal catastrophes. OA has been proven to help reduce the mortality of trauma. Nevertheless, the OA method may be associated with terrible and devastating complications such as enteroatmospheric fistula (EAF). As a result, OA should not be overused, and attention should be given to critical care as well as special management. The temporary abdominal closure (TAC) technique after abbreviated laparotomy was used to improve wound healing and facilitate final fascial closure of OA. Negative pressure therapy (NPT) is the most commonly used TAC method. PMID:27042329

  5. Spleen preserving distal pancreatectomy in an isolated blunt pancreatic trauma

    PubMed Central

    Fonseca, Alexandre Zanchenko; Jr, Marcelo Augusto Fontenelle Ribeiro; Contrucci, Orlando; Pompeo, Alexandre; Orsetti, Adriana; Neto, Herico Arsie

    2011-01-01

    Blunt isolated pancreatic trauma is uncommon, accounting for 1%-4% of high impact abdominal injuries. In addition, its diagnosis can be difficult; physical signs may be poor and laboratory findings nonspecific, resulting in delayed treatment. Preserving the spleen during distal pancreatectomy (DP) is controversial. One of the spleens functions regards immunity; complications following splenectomy include leukocytosis, thrombocytosis, overwhelming post splenectomy sepsis and some degree of immunodeficiency. This is why many authors favor its preservation. We describe a case of a young man with an isolated pancreatic trauma due to a blunt abdominal trauma with a delayed presentation who was treated with spleen-preserving DP and we discuss the value of this procedure with reference to the literature. PMID:22007283

  6. Abusive head trauma: past, present, and future.

    PubMed

    Narang, Sandeep; Clarke, Jennifer

    2014-12-01

    Abusive head trauma has a robust and interesting scientific history. Recently, the American Academy of Pediatrics has endorsed a change in terminology to a term that is more general in describing the vast array of abusive mechanisms that can result in pediatric head injury. Simply defined, abusive head trauma is "child physical abuse that results in injury to the head or brain." Abusive head trauma is a relatively common cause of childhood neurotrauma, with an estimated incidence of 16 to 33 cases per 100,000 children per year in the first 2 years of life. Clinical findings are variable; AHT should be considered in all children with neurologic signs and symptoms, especially if no or only mild trauma is described. Subdural and retinal hemorrhages are the most common findings. The current best evidence-based literature has identified some features--apnea and severe retinal hemorrhages--that reliably discriminate abusive from accidental injury. Longitudinal studies of outcomes in abusive head trauma patients demonstrate that approximately one-third of the children are severely disabled, one third of them are moderately disabled, and one third have no or only mild symptoms. Abusive head trauma cases are complex cases that require a rigorous, multidisciplinary team approach. The clinician can establish this diagnosis with confidence if he/she maintains a high index of suspicion for the diagnosis, has knowledge of the signs, symptoms, and risk factors of abusive head trauma, and reasonably excludes other etiologies on the differential diagnosis. PMID:25316728

  7. Military Sexual Trauma

    MedlinePlus

    Military Sexual Trauma What is military sexual trauma (MST)? Military sexual trauma, or MST, is the term used by VA to refer to experiences of sexual assault ... that a Veteran experienced during his or her military service. The definition used by the VA comes ...

  8. Trauma Facts for Educators

    ERIC Educational Resources Information Center

    National Child Traumatic Stress Network, 2008

    2008-01-01

    This paper offers facts which can help educators deal with children undergoing trauma. These include: (1) One out of every 4 children attending school has been exposed to a traumatic event that can affect learning and/or behavior; (2) Trauma can impact school performance; (3) Trauma can impair learning; (4) Traumatized children may experience…

  9. Helping Youth Overcome Trauma

    ERIC Educational Resources Information Center

    Chambers, Jamie C.

    2005-01-01

    The effects of trauma can roll on unchecked like a spirit of death. In its path are strewn its once vibrant victims. Human bonds are rent asunder by the disgrace of trauma. These are the youngsters who have been verbally bashed, physically battered, sexually assaulted, and spiritually exploited. Other traumas of childhood neglect include: (1)…

  10. Pathology of trauma.

    PubMed

    Valsamis, M P

    1994-01-01

    The major unifying concept of the effect of trauma on the central nervous system is the application of force to the brain. The mode of delivery of energy and its dissipation result in the varying pathologic manifestations of hemorrhage, contusions, or tears. Topics discussed in this article include inner cerebral trauma, gunshot wounds, contusions and lacerations, hemorrhages, fractures, and spinal cord trauma. PMID:8124090

  11. Skeletal muscle glutathione after surgical trauma.

    PubMed Central

    Luo, J L; Hammarqvist, F; Andersson, K; Wernerman, J

    1996-01-01

    OBJECTIVE: The authors investigate the effect of surgical trauma on skeletal muscle concentrations of glutathione in patients undergoing selective abdominal surgery. SUMMARY BACKGROUND DATA: The posttraumatic state is accompanied by characteristic changes in the pattern of free amino acids and a decline of protein synthesis in human skeletal muscle. Glutathione has multiple metabolic functions that are involved in cellular homeostasis. It is unknown how surgical trauma affects the glutathione metabolism of skeletal muscle in surgical patients. METHODS: Eight patients undergoing elective abdominal surgery were investigated. Percutaneous muscle biopsies and blood samples were taken before operation and at 6, 24, and 48 hours after operation. The concentrations of glutathione were determined in muscle tissue, plasma, and whole blood, as well as the concentrations of the related amino acids in muscle and plasma. RESULTS: In skeletal muscle, the levels of both reduced and total glutathione decreased by 40% (p<0.01) at 24 hours and remained low at 48 hours after operation compared with the preoperative values. The glutathione concentration in plasma was 20% lower after operation compared with the concentration before operation (p<0.05). There were no changes at the whole blood levels of glutathione. Tissue glutamate and glutamine decreased significantly after operation (p<0.001), whereas intracellular cysteine and glycine remained unchanged. CONCLUSIONS: Skeletal muscle glutathione deficiency occurs after surgical trauma. This may lead to an increase in the susceptibility to intracellular oxidative injury. PMID:8633921

  12. LIVER TRANSPLANTATION AFTER SEVERE HEPATIC TRAUMA: CURRENT INDICATIONS AND RESULTS

    PubMed Central

    RIBEIRO-JR, Marcelo Augusto Fontenelle; MEDRADO, Melina Botelho; ROSA, Otto Mauro; SILVA, Ana Júlia de Deus; FONTANA, Mariana Prado; CRUVINEL-NETO, José; FONSECA, Alexandre Zanchenko

    2015-01-01

    Background : The liver is the most injured organ in abdominal trauma. Currently, the treatment in most cases is non-operative, but surgery may be necessary in severe abdominal trauma with blunt liver damage, especially those that cause uncontrollable bleeding. Despite the damage control approaches in order to achieve hemodynamic stability, many patients develop hypovolemic shock, acute liver failure, multiple organ failure and death. In this context, liver transplantation appears as the lifesaving last resource Aim : Analyze the use of liver transplantation as a treatment option for severe liver trauma. Methods : Were reviewed 14 articles in the PubMed, Medline and Lilacs databases, selected between 2008-2014 and 10 for this study. Results : Were identified 46 cases undergoing liver transplant after liver trauma; the main trauma mechanism was closed/blunt abdominal trauma in 83%, and severe trauma (>grade IV) in 81 %. The transplant can be done, in this context, performing one-stage procedure (damaged organ removed with immediate transplantation), used in 72% of cases. When the two-stage approach is performed, end-to-side temporary portacaval shunt is provided, until new organ becomes available to be transplanted. If two different periods are considered - from 1980 to 2000 and from 2000 to 2014 - the survival rate increased significantly, from 48% to 76%, while the mortality decreased from 52% to 24%. Conclusion : Despite with quite restricted indications, liver transplantation in hepatic injury is a therapeutic modality viable and feasible today, and can be used in cases when other therapeutic modalities in short and long term, do not provide the patient survival chances. PMID:26734803

  13. Abdominal ultrasound (image)

    MedlinePlus

    Abdominal ultrasound is a scanning technique used to image the interior of the abdomen. Like the X-ray, MRI, ... it has its place as a diagnostic tool. Ultrasound scans use high frequency sound waves to produce ...

  14. Abdominal x-ray

    MedlinePlus

    An abdominal x-ray is an imaging test to look at organs and structures in the abdomen. Organs include the spleen, stomach, and intestines. When the test is done to look at the bladder and kidney structures, ...

  15. Athletic injuries of the lateral abdominal wall: review of anatomy and MR imaging appearance.

    PubMed

    Stensby, J Derek; Baker, Jonathan C; Fox, Michael G

    2016-02-01

    The lateral abdominal wall is comprised of three muscles, each with a different function and orientation. The transversus abdominus, internal oblique, and external oblique muscles span the abdominal cavity between the iliocostalis lumborum and quadratus lumborum posteriorly and the rectus abdominis anteriorly. The lateral abdominal wall is bound superiorly by the lower ribs and costal cartilages and inferiorly by the iliac crest and inguinal ligament. The lateral abdominal wall may be acutely or chronically injured in a variety of athletic endeavors, with occasional acute injuries in the setting of high-energy trauma such as motor vehicle collisions. Injuries to the lateral abdominal wall may result in lumbar hernia formation, unique for its high incarceration rate, and also Spigelian hernias. This article will review the anatomy, the magnetic resonance (MR) imaging approach, and the features and complications of lateral abdominal wall injuries. PMID:26450606

  16. Anal avulsion caused by abdominal crush injury.

    PubMed

    Terrosu, G; Rossetto, A; Kocjancic, E; Rossitti, P; Bresadola, V

    2011-12-01

    We report the case of a pelvic and lower abdomen crushing trauma in 37-year-old male patient. The patient had an open lumbar wound, laceration of the psoas muscle, pelvic fracture, a ruptured urogenital diaphragm, and extensive urogenital lacerations. An emergency laparotomy was performed with debridment, urethral reconstruction, and osteosynthesis of the pubic bone. The mobilization of the patient revealed a deep gap, about 8 × 8 cm, in the perineum, with the anus and rectum displaced from their original site. Anal reimplantation was performed, suturing the median raphe, inserting two pelvic drainage tubes, and fashioning a loop transverse colostomy. Closed rectal traumas account for only 4-11% of all rectal traumas. Crushing of the pelvis causes a sudden reduction in its anteroposterior diameter and a corresponding increase in its latero-lateral diameter, together with an abrupt rise in intra-abdominal pressure. The anus is pushed out of the perineal plane due to the divarication of the levator muscles. As suggested in the literature, the standard treatment is wound debridement with immediate or deferred repair, fashioning a diversion colostomy, and repair of the rectum, wherever possible. PMID:21556880

  17. Cerebral palsy after maternal trauma in pregnancy.

    PubMed

    Hayes, B; Ryan, S; Stephenson, J B P; King, M D

    2007-09-01

    Ten children (six males, four females) with spastic (n=9) and mixed spastic-dyskinetic (n=1) cerebral palsy were born at term to mothers who earlier in the pregnancy had been involved in accidents without suffering overt abdominal injury, placental abruption, or premature onset of labour. At follow-up (at ages 2-24y), Gross Motor Function Classification System levels were II (n=7) and V (n=3). Cognitive level was normal in five patients, while learning disability was mild to moderate in two and severe in three. Magnetic resonance imaging of the brain in all children, assessed blind to the dates of maternal trauma in pregnancy, showed lesions consistent with prenatal vascular insult at the time of the trauma. Feasible mechanisms of brain injury include reduced placental blood flow and/or placental embolization. PMID:17718828

  18. Blunt abdominal injury with rupture of giant hepatic cavernous hemangioma and laceration of the spleen.

    PubMed

    Kang, Lung-Yun; Huang, Fong-Dee; Liu, Yuan-Yuarn

    2015-02-01

    A 41-year-old woman with blunt abdominal trauma due to a motor vehicle accident presented to our emergency department. The patient had a history of a giant hepatic cavernous hemangioma. Emergency exploratory laparotomy was performed for suspected intra-abdominal bleeding with abdominal compartment syndrome, and more than 4 liters of blood and blood clots were removed. An active bleeding laceration (5 cm) of a hepatic cavernous hemangioma was detected in segment III of the liver. The bleeding was controlled by sutures, Teflon patches and tamponade. The abdomen was closed temporarily using the vacuum-assisted method. Because of the presence of persistent fresh blood through abdominal drainage at a rate of >1 L/h, splenectomy was performed to control the bleeding again by sutures and Teflon patches. Finally, the abdomen was closed using a biologic mesh. The patient was discharged home 30 days after trauma. Bleeding of trauma-caused hepatic hemangioma is rare, but splenic injury due to blunt abdominal trauma is common. An in-depth investigation is necessary to avoid second intervention. PMID:25655300

  19. Childhood trauma and psychosis.

    PubMed

    Dvir, Yael; Denietolis, Brian; Frazier, Jean A

    2013-10-01

    Childhood trauma is a common occurrence and has been associated with psychosis and suggested as a risk factor leading to psychosis and schizophrenia in adulthood. This article introduces the scope of the problem and discusses the evidence for causal relationships between childhood adversities and increased risk for psychosis. The relationship between specific types of trauma and their association with specific psychotic symptoms is described, as well as the manifestations of co-occurring trauma effects and psychosis in adolescents. Clinical presentations and the use of diagnostic instruments, diagnostic comorbidities, and evidence-based psychotherapeutic interventions to treat effects of trauma in youth with psychotic illnesses are discussed. PMID:24012077

  20. Ventilation in chest trauma

    PubMed Central

    Richter, Torsten; Ragaller, Maximilian

    2011-01-01

    Chest trauma is one important factor for total morbidity and mortality in traumatized emergency patients. The complexity of injury in trauma patients makes it challenging to provide an optimal oxygenation while protecting the lung from further ventilator-induced injury to it. On the other hand, lung trauma needs to be treated on an individual basis, depending on the magnitude, location and type of lung or chest injury. Several aspects of ventilatory management in emergency patients are summarized herein and may give the clinician an overview of the treatment possibilities for chest trauma victims. PMID:21769213

  1. Caring for Trauma Survivors.

    PubMed

    Antai-Otong, Deborah

    2016-06-01

    Although trauma exposure is common, few people develop acute and chronic psychiatric disorders. Those who develop posttraumatic stress disorder likely have coexisting psychiatric and physical disorders. Psychiatric nurses must be knowledgeable about trauma responses, implement evidence-based approaches to conduct assessments, and create safe environments for patients. Most researchers assert that trauma-focused cognitive-behavioral approaches demonstrate the most efficacious treatment outcomes. Integrated approaches, offer promising treatment options. This article provides an overview of clinical factors necessary to help the trauma survivor begin the process of healing and recovery and attain an optimal level of functioning. PMID:27229285

  2. Assessment of trauma patients.

    PubMed

    Parker, M; Magnusson, C

    2016-05-01

    Trauma is a major contributor to global mortality and morbidity with a notable difference between low income countries (LIC) and high to moderate income countries (HMIC). The modality of trauma differs globally; however, the most notable cause is pedestrian vs. vehicle and road traffic collision respectively. It is imperative that patients who have sustained a traumatic injury are managed in an appropriate and timely manner. Part 1 of the article will address the aetiology and demographic distribution of trauma globally and part 2 of the article will provide information about structured assessment and management of trauma patients. PMID:26655681

  3. Renal trauma imaging: Diagnosis and management. A pictorial review

    PubMed Central

    Szmigielski, Wojciech; Kumar, Rajendra; Al Hilli, Shatha; Ismail, Mostafa

    2013-01-01

    Summary Background The purpose of this review is to illustrate and discuss the spectrum of imaging findings, particularly computed tomography (CT), of blunt and penetrating renal trauma, based on our own materials, according to the American Association for Surgery of Trauma (AAST) renal injury grading scale. The article also indicates the conditions in which interventional radiology procedures can be applied for the management of renal trauma. Material/Method Cases for this pictorial review were selected from the imaging material collected at the Radiology Department of Hamad Medical Corporation during a 14-year period from 1999 to 2012. The material includes 176 cases (164 males and 12 females) with confirmed blunt or penetrating renal trauma. Following abdominal trauma, all patients had a CT examination performed on admission to the hospital and/or during hospitalization. The most representative and illustrative cases of renal trauma were reviewed according to CT findings and were categorized according to the AAST grading system. Discusion The review describes a spectrum of imaging presentations with special emphasis on the 5 grades of renal injury on a CT according to the AAST scale. The most representative cases were illustrated and discussed with indications of possible interventional radiology treatment. Two groups of patients not included in the AAST grading system were presented separately: those with preexisting renal abnormalities and those with sustained iatrogenic renal injury. Conclusions Proper application of renal trauma grading scale is essential for selecting the patients for conservative treatment, surgery or interventional radiology procedure. PMID:24505221

  4. Diagnostic peritoneal lavage in evaluating acute abdominal pain.

    PubMed

    Barbee, C L; Gilsdorf, R B

    1975-06-01

    A study was performed to determine the value of peritoneal lavage in the acute abdomen not related to trauma. Lavage was performed in 33 patients in the evaluation of abdominal pain of sufficient degree to warrant consideration for surgical intervention. Peritoneal lavage was truly positive or truly negative in 64% of the cases. It showed false negative results in 28% and false positive results in 8%. The lavage was most accurate in the evaluation of appendicitis, colonic disease, and intra abdominal bleeding. It was highly inaccurate in the evaluation of cholecystitis and peptic ulcer disease. It was concluded that the peritoneal lavage can be a useful adjunct in the evaluation of patients with abdominal pain and should be considered in difficult diagnostic problems but not routinely employed. PMID:1138636

  5. Abdominal actinomycosis with multiple myeloma: A case report

    PubMed Central

    ERCOLAK, VEHBI; PAYDAS, SEMRA; ERGIN, MELEK; ATES, BERNA T.; DUMAN, BERNA B.; GUNALDI, MERAL; AFSAR, CIGDEM U.

    2014-01-01

    Actinomycosis is a chronic suppurative infection, for which immune suppression is a predisposing factor. In unusual cases, this disease may present as an abdominal wall involvement simulating a soft tissue tumor as seen in the present case. The presented patient had no signs of trauma or surgical approach and the pathology was considered to be a primary abdominal wall actinomycosis. Preoperative diagnosis is difficult due to the nonspecific nature of clinical presentation, radiographic and laboratory findings. Surgery combined with antibiotic treatment is a curative approach for this relatively rare infection. Surgeons must be aware of this disease in order to ensure correct diagnosis and to prevent performing any unnecessary procedures. The present study describes a case of abdominal actinomycosis with multiple myeloma, together with a review of important points related to this disease. PMID:25202429

  6. Laparoscopy in trauma: An overview of complications and related topics

    PubMed Central

    Kindel, Tammy; Latchana, Nicholas; Swaroop, Mamta; Chaudhry, Umer I; Noria, Sabrena F; Choron, Rachel L; Seamon, Mark J; Lin, Maggie J; Mao, Melissa; Cipolla, James; El Chaar, Maher; Scantling, Dane; Martin, Niels D; Evans, David C; Papadimos, Thomas J; Stawicki, Stanislaw P

    2015-01-01

    The introduction of laparoscopy has provided trauma surgeons with a valuable diagnostic and, at times, therapeutic option. The minimally invasive nature of laparoscopic surgery, combined with potentially quicker postoperative recovery, simplified wound care, as well as a growing number of viable intraoperative therapeutic modalities, presents an attractive alternative for many traumatologists when managing hemodynamically stable patients with selected penetrating and blunt traumatic abdominal injuries. At the same time, laparoscopy has its own unique complication profile. This article provides an overview of potential complications associated with diagnostic and therapeutic laparoscopy in trauma, focusing on practical aspects of identification and management of laparoscopy-related adverse events. PMID:26557490

  7. Pediatric trauma: differences in pathophysiology, injury patterns and treatment compared with adult trauma.

    PubMed Central

    Kissoon, N; Dreyer, J; Walia, M

    1990-01-01

    Although multiple trauma remains the leading cause of death among children, fewer resources and less attention have been directed to treatment of the injured child than to treatment of the injured adult. Insufficient training of medical personnel and hence lack of expertise in the management of injured children are factors contributing to disability and death in such children. Although the principles of resuscitation of injured children are similar to those for adults, appreciation of the differences in cardiorespiratory variables, airway anatomy, response to blood loss, thermoregulation and equipment required is essential for successful initial resuscitation. Cerebral, abdominal and thoracic injuries account for most of the disability and death among injured children. Cerebral damage may be due to secondary injuries to the brain and is potentially preventable. The need to preserve the spleen in children complicates the management of abdominal trauma. Although children usually have large cardiorespiratory reserves, they are likely to need airway control and ventilation with thoracic injuries. The psychologic effect of trauma may pose long-term problems and needs close follow-up. PMID:2403481

  8. [Abdominal actinomycosis: four cases].

    PubMed

    Ghannouchi Jaafoura, N; Kaabia, N; Khalifa, M; Ben Jazia, I; Hachfi, W; Braham, A; Letaief, A; Bahri, F

    2008-12-01

    The abdominal actinomycosis (AA) is a rare and often unrecognised suppurative chronic illness. It is caused by an anaerobic Gram positive bacteria, Actinomyces israelii. Abdominal actinomycosis is responsible for pseudotumoral syndrome often leading, to a large and mutilating surgery whereas a prolonged treatment by antibiotics would have permitted to cure the disease. The diagnosis is obtained generally from anatomopathologic exam. We report four cases of abdominal actinomycosis being revealed by a pseudotumoral syndrome. The diagnosis was only made after surgery. In spite of an active treatment by antibiotics during several months, two of our patients had a relapse of the infectious process. These four observations confirm the diagnostic and therapeutic difficulties previously reported by other authors. PMID:19180833

  9. Complications and risk factors for mortality in penetrating abdominal firearm injuries: analysis of 120 cases

    PubMed Central

    Iflazoglu, Nidal; Ureyen, Orhan; Oner, Osman Z; Tusat, Mustafa; Akcal, Mehmet A

    2015-01-01

    Due to the high kinetic energy, of bullets and explosive gun particles, their paths through the abdomen (permanent cavity effect), and the blast effect (temporary cavity effect), firearm injuries (FAI) can produce damage not only in the organ they enter, but in the surrounding tissues as well. Since they change route after entering the body they may cause organ damage in locations other than those at the path of entry. For example, as a result of the crushing onto bone tissues, bullet particles or broken bone fragments may cause further damage outside of the path of travel, For these reasons it is very difficult to predict the possible complications from the size of the actual injury in patients with penetrating abdominal firearm injuries. The factors affecting the mortality and morbidity from firearm injuries have been evaluated in various studies. Insufficient blood transfusion, long duration of time until presenting to a hospital and the presence of colon injuries are common factors that cause the high complication rates and mortality. A total of 120 cases injured in the civil war at Turkey’s southern neighbouring countries were admitted to our hospital and evaluated in terms of: development of complications and factors affecting mortality; age, gender, time of presentation to the hospital, number of injured organs, the type of injuring weapon, the entrance site of the bullet, the presence of accompanying chest trauma, the amount of administered blood, the penetrating abdominal trauma index (PATI) and the injury severity score (ISS) scores were determined and evaluated retrospectively. The most significant factors for the development of complications and mortality include: accompanying clinical shock, high number of injured organs, numerous blood transfusions administered and accompanying thoracic trauma. It has also been observed that the PATI and ISS scoring systems can be used in predicting the complication and mortality rates in firearm injuries. Consequently, reducing the mortality and complication rates from firearm injuries is still a serious problem. Despite all of these efforts, there is still a need to determine the optimum treatment strategy to achieve this end goal. PMID:26131219

  10. Complications and risk factors for mortality in penetrating abdominal firearm injuries: analysis of 120 cases.

    PubMed

    Iflazoglu, Nidal; Ureyen, Orhan; Oner, Osman Z; Tusat, Mustafa; Akcal, Mehmet A

    2015-01-01

    Due to the high kinetic energy, of bullets and explosive gun particles, their paths through the abdomen (permanent cavity effect), and the blast effect (temporary cavity effect), firearm injuries (FAI) can produce damage not only in the organ they enter, but in the surrounding tissues as well. Since they change route after entering the body they may cause organ damage in locations other than those at the path of entry. For example, as a result of the crushing onto bone tissues, bullet particles or broken bone fragments may cause further damage outside of the path of travel, For these reasons it is very difficult to predict the possible complications from the size of the actual injury in patients with penetrating abdominal firearm injuries. The factors affecting the mortality and morbidity from firearm injuries have been evaluated in various studies. Insufficient blood transfusion, long duration of time until presenting to a hospital and the presence of colon injuries are common factors that cause the high complication rates and mortality. A total of 120 cases injured in the civil war at Turkey's southern neighbouring countries were admitted to our hospital and evaluated in terms of: development of complications and factors affecting mortality; age, gender, time of presentation to the hospital, number of injured organs, the type of injuring weapon, the entrance site of the bullet, the presence of accompanying chest trauma, the amount of administered blood, the penetrating abdominal trauma index (PATI) and the injury severity score (ISS) scores were determined and evaluated retrospectively. The most significant factors for the development of complications and mortality include: accompanying clinical shock, high number of injured organs, numerous blood transfusions administered and accompanying thoracic trauma. It has also been observed that the PATI and ISS scoring systems can be used in predicting the complication and mortality rates in firearm injuries. Consequently, reducing the mortality and complication rates from firearm injuries is still a serious problem. Despite all of these efforts, there is still a need to determine the optimum treatment strategy to achieve this end goal. PMID:26131219

  11. Major trauma guidance.

    PubMed

    2016-03-01

    The National Audit Office states that immediate treatment for major trauma, which comprises serious and multiple injuries that are often life threatening, accounts for up to 400,000 of health expenditure and up to 3.7 billion in lost economic output every year. There is also significant emotional impact on patients and their families during the trauma and rehabilitation phases. PMID:26948204

  12. Orthodontic procedures after trauma.

    PubMed

    Fields, Henry W; Christensen, John R

    2013-03-01

    This review considers oral trauma and its relationship to orthodontics with respect to prevention and primary, secondary, and tertiary care. The level of evidence is not high in regard to this topic, but recommendable approaches to trauma at each stage are discussed on the basis of available literature and published guidelines. Simplified biomechanics are presented to aid treatment. PMID:23439050

  13. Thromboprophylaxis for trauma patients

    PubMed Central

    Lozano, Luis Manuel Barrera; Perel, Pablo; Ker, Katharine; Cirocchi, Roberto; Farinella, Eriberto; Morales, Carlos Hernando

    2014-01-01

    This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effects of thromboprophylaxis in trauma patients on mortality and incidence of DVT and PE. To compare the effects of different thromboprophylaxis interventions and their relative effects according to the type of trauma. PMID:25267908

  14. Abdominal Vascular Catastrophes.

    PubMed

    Singh, Manpreet; Koyfman, Alex; Martinez, Joseph P

    2016-05-01

    Abdominal vascular catastrophes are among the most challenging and time sensitive for emergency practitioners to recognize. Mesenteric ischemia remains a highly lethal entity for which the history and physical examination can be misleading. Laboratory tests are often unhelpful, and appropriate imaging must be quickly obtained. A multidisciplinary approach is required to have a positive impact on mortality rates. Ruptured abdominal aortic aneurysm likewise may present in a cryptic fashion. A specific type of ruptured aneurysm, the aortoenteric fistula, often masquerades as the more common routine gastrointestinal bleed. The astute clinician recognizes that this is a more lethal variant of gastrointestinal hemorrhage. PMID:27133247

  15. Thoracic trauma in horses.

    PubMed

    Hassel, Diana M

    2007-05-01

    Thoracic trauma represents an important cause of morbidity in mortality after injury in human beings and animals. After any form of suspected chest wall trauma, initial emergency management should include assurance of a patent airway and adequate ventilation, along with treatment for shock if present. As with any open wound, tetanus prophylaxis should be instituted. Types of trauma to the thoracic region of the horse include pectoral and axillary lacerations, penetrating chest wounds, flail chest, fractures of the ribs, blunt thoracic trauma, and several potential sequelae that include pneumothorax, pneumomediastinum, hemothorax, pleuritis, fistulae of the sternum or ribs, and diaphragmatic hernia. Emergency management of these various forms of thoracic trauma is discussed. PMID:17379110

  16. Trauma: the seductive hypothesis.

    PubMed

    Reisner, Steven

    2003-01-01

    In much of contemporary culture, "trauma" signifies not so much terrible experience as a particular context for understanding and responding to a terrible experience. In therapy, in the media, and in international interventions, the traumatized are seen not simply as people who suffer and so are deserving of concern and aid; they are seen also as people who suffer for us, who are given special dispensation. They are treated with awe if they tell a certain kind of trauma story, and are ignored or vilified if they tell another. Trauma has become not simply a story of pain and its treatment, but a host of sub-stories involving the commodification of altruism, the justification of violence and revenge, the entry point into "true experience," and the place where voyeurism and witnessing intersect. Trauma is today the stuff not only of suffering but of fantasy. Historically, trauma theory and treatment have shown a tension, exemplified in the writings of Freud and Janet, between those who view trauma as formative and those who view it as exceptional. The latter view, that trauma confers exceptional status deserving of special privilege, has gained ground in recent years and has helped to shape the way charitable dollars are distributed, how the traumatized are presented in the media, how governments justify and carry out international responses to trauma, and how therapists attend to their traumatized patients. This response to trauma reflects an underlying, unarticulated belief system derived from narcissism; indeed, trauma has increasingly become the venue, in society and in treatment, where narcissism is permitted to prevail. PMID:12866751

  17. Duodenal injuries due to trauma: Review of the literature.

    PubMed

    García Santos, Esther; Soto Sánchez, Ana; Verde, Juan M; Marini, Corrado P; Asensio, Juan A; Petrone, Patrizio

    2015-02-01

    Duodenal injuries constitute a challenge to the Trauma Surgeon, mainly due to their retroperitoneal location. When identified, they present associated with other abdominal injuries. Consequently, they have an increased morbidity and mortality. At best estimates, duodenal lesions occur in 4.3% of all patients with abdominal injuries, ranging from 3.7% to 5%, and because of their anatomical proximity to other organs, they are rarely an isolated injury. The aim of this paper is to present a concise description of the anatomy, diagnosis, surgical management and treatment of complications of duodenal trauma, and an analysis of complications and mortality rates of duodenal injuries based on a 46-year review of the literature. PMID:25443151

  18. Intra-abdominal sepsis.

    PubMed

    Holliday, R L

    1976-01-01

    Intra-abdominal sepsis remains one of the major challenges to the surgeon. With a proper appreciation of the bacteriology and pathophysiology involved and an awareness of new diagnostic and therapeutic modalities, hopefully, mortality and morbidity rates can be reduced. PMID:1048948

  19. Screening for Abdominal Aortic Aneurysm

    MedlinePlus

    Understanding Task Force Recommendations Screening for Abdominal Aortic Aneurysm The U.S. Preventive Services Task Force (Task Force) has issued a final recommendation statement on Screening for Abdominal Aortic Aneurysm. This final recommendation ...

  20. JAMA Patient Page: Abdominal Hernia

    MedlinePlus

    ... The Journal of the American Medical Association Abdominal Hernia Common abdominal hernias A HERNIA DEVELOPS WHEN A WEAKNESS THAT FORMS IN THE ... through it. Among the most common are umbilical hernias that occur at the navel and inguinal hernias ...

  1. Pattern of ocular trauma.

    PubMed

    Hossain, M M; Mohiuddin, A A; Akhanda, A H; Hossain, M I; Islam, M F; Akonjee, A R; Ali, M

    2011-07-01

    This prospective observational study was conducted in the department of Ophthalmology Mymensingh Medical College Hospital during the period of November, 2009 to October, 2010. Two hundred & fifty (250) patients of both sexes and all ages with ocular trauma were selected randomly for this study. A detailed history of patients, duration of trauma, relation of trauma with work, visual status prior to injury, any surgery prior to injury & patients were alcoholic or not were taken. Male patients were 190(76%) and female patients were 60(24%). Majority of patients were 11-20 years group (39.2%). Most of patients (40%) attended into hospital within 60 hours of ocular trauma. Accidental occupational trauma were more common (51.2%) and assault injury were less common (12.8%). Greater number of ocular trauma was caused by sharp objects (59.2%) and less number of ocular trauma was caused by chemical injuries (2.4%). Open globe injuries were more common (62%) than closed globe injury (38%). Visual acuity on admission between 6/60 to PL comprises highest number (64%) and also on discharge between 6/60 to PL comprises highest number of cases (50%). Most of the patients came from poor socioeconomic group (60%). PMID:21804497

  2. Renal Pelvis Injury in Case of Blunt Trauma Abdomen

    PubMed Central

    Nerli, Rajendra B.; Patil, Amey; Devaraju, Shishir; Hiremath, Murigendra B.

    2015-01-01

    Isolated renal pelvis/upper ureteric injuries are uncommon in a case of blunt abdominal trauma. These injuries are associated with fractures of transverse process of the adjoining vertebrae. We report a case of such a case in a 35 year old male involved in road traffic accident. He underwent exploration and repair of the right UPJ/Upper ureteric injury. This case presented with injury to the transverse processes on the left side, which is unusual. PMID:26793520

  3. Mathematics and Medical Indexes: A Life-Saving Connection.

    ERIC Educational Resources Information Center

    Crouse, Richard J.; Sloyer, Clifford W.

    1993-01-01

    In cases of trauma, medical indexes are used by paramedics to report the condition of the patient to the hospital. Presents a scenario in which students act as paramedics at the scene of an earthquake and use the index called capillary refill to report the severity of the trauma and predict probable survival. (MDH)

  4. Trauma and Mobile Radiography

    SciTech Connect

    Drafke, M.W.

    1989-01-01

    Trauma and Mobile Radiography focuses on the radiography of trauma patients and of patients confined to bed. This book offers students a foundation in the skills they need to produce quality radiograms without causing additional injury or pain to the patient. Features of this new book include: coverage of the basics of radiography and patient care, including monitoring of heavily sedated, immobile, and accident patients. Information on the injuries associated with certain types of accidents, and methods for dealing with these problems. Detailed explanation of the positioning of each anatomical area. A Quick Reference Card with information on evaluating, monitoring and radiographing trauma patients.

  5. Diagnosis of urinary leak following abdominal total hysterectomy using renal scintigraphy.

    PubMed

    Lantsberg, S; Rachinsky, I; Boguslavsky, L; Piura, B

    2000-07-01

    Surgical trauma to the urinary system is a relatively rare complication following gynecological surgery. A case of urinary leak from rupture of the bladder following abdominal hysterectomy was diagnosed by Tc-99m-DTPA renal scintigraphy and confirmed by direct radio-isotopic cystography. Renal scintigraphic techniques should be very helpful in early diagnosis of surgical damage to the urinary tract. PMID:10817871

  6. Urinary bladder herniation through a caudoventral abdominal wall defect in a mature cat

    PubMed Central

    Neville-Towle, Jack; Sakals, Sherisse

    2015-01-01

    A 16-year-old spayed female domestic shorthair cat with no history of trauma was presented to the Western College of Veterinary Medicine for assessment of urinary incontinence. Diagnostic investigation revealed herniation of the urinary bladder through a caudoventral abdominal wall defect. Clinical signs resolved after surgical reduction of the bladder. PMID:26347198

  7. Abdominal wall Actinomyces abscess associated with an intrauterine device. A case report.

    PubMed

    Pearlman, M; Frantz, A C; Floyd, W S; Faro, S

    1991-05-01

    An abdominal wall Actinomyces abscess occurred in a woman with an intrauterine device. Contributing factors were local trauma, spread from surrounding colonized body sites and symbiotic growth of other anaerobes. The diagnosis was based on the histologic finding of the sulfur granule. Special studies may be needed to distinguish this condition from other, similar ones (Nocardia, botryomycosis). PMID:1829483

  8. Forgetting trauma stimuli.

    PubMed

    DePrince, Anne P; Freyd, Jennifer J

    2004-07-01

    Previous work reported in this journal suggested that the cognitive capacities of high dissociators are impaired under conditions of focused (selective) attention, but not under conditions of divided attention, compared with the cognitive capacities of low dissociators. Using a directed-forgetting paradigm, the current study demonstrated that under divided-attention demands, high dissociators have impaired memory for words associated with trauma (e.g., incest) but not for neutral words, as compared with low dissociators. In addition, high dissociators reported significantly more trauma history and significantly more betrayal trauma (abuse by a caregiver) than low dissociators. These results are consistent with the proposal that dissociation may aid individuals with histories of betrayal traumas to keep threatening information out of awareness. PMID:15200634

  9. Imaging in orbital trauma

    PubMed Central

    Lin, Ken Y.; Ngai, Philip; Echegoyen, Julio C.; Tao, Jeremiah P.

    2012-01-01

    Orbital trauma is one of the most common reasons for ophthalmology specialty consultation in the emergency department setting. We survey the literature from 1990 to present to describe the role of computed tomography (CT), magnetic resonance imaging (MRI) and their associated angiography in some of the most commonly encountered orbital trauma conditions. CT orbit can often detect certain types of foreign bodies, lens dislocation, ruptured globe, choroidal or retinal detachments, or cavernous sinus thrombosis and thus complement a bedside ophthalmic exam that can sometimes be limited in the setting of trauma. CT remains the workhorse for acute orbital trauma owing to its rapidity and ability to delineate bony abnormalities; however MRI remains an important modality in special circumstances such as soft tissue assessment or with organic foreign bodies. PMID:23961028

  10. Men and Sexual Trauma

    MedlinePlus

    ... Public » Violence and Abuse » Men and Sexual Trauma PTSD: National Center for PTSD Menu Menu PTSD PTSD Home For the Public ... bottom of the page. Share this page Search PTSD Site Choose Section Enter Term and Search Advanced ...

  11. Common Reactions After Trauma

    MedlinePlus

    ... Center for PTSD » Public » Common Reactions After Trauma PTSD: National Center for PTSD Menu Menu PTSD PTSD Home For the Public ... bottom of the page. Share this page Search PTSD Site Choose Section Enter Term and Search Advanced ...

  12. Head Trauma, First Aid

    MedlinePlus

    ... or all parts of the head: the scalp, skull, brain, spinal fluid, and blood vessels. Head trauma ... or both. External injuries can cause a fractured skull. An internal injury, such as the brain hitting ...

  13. Trauma program development.

    PubMed

    Althausen, Peter L

    2014-07-01

    The development of a strong trauma program is clearly one of the most important facets of successful business development. Several recent publications have demonstrated that well run trauma services can generate significant profits for both the hospital and the surgeons involved. There are many aspects to this task that require constant attention and insight. Top notch patient care, efficiency, and cost-effective resource utilization are all important components that must be addressed while providing adequate physician compensation within the bounds of hospital financial constraints and the encompassing legal issues. Each situation is different but many of the components are universal. This chapter addresses all aspects of trauma program development to provide the graduating fellow with the tools to create a new trauma program or improve an existing program in order to provide the best patient care while optimizing financial reward and improving care efficiency. PMID:24918830

  14. Imaging of Abusive Trauma.

    PubMed

    Shekdar, Karuna

    2016-06-01

    "Shaken baby syndrome" is a term often used by the physicians and public to describe abusive trauma inflicted on infants and young children. Advances in the understanding of the mechanisms and the associated clinical spectrum of injury has lead us to modify our terminology and address it as "abusive trauma" (AT). Pediatric abusive head trauma is defined as an injury to the skull or intracranial contents of an infant or a young child (< 5 y age) due to inflicted blunt impact and/or violent shaking. This chapter focuses on the imaging aspects of childhood abusive trauma along with a brief description of the mechanism and pathophysiology of abusive injury. The diagnosis of AT is not always obvious, and abusive injuries in many infants may remain unrecognized. Pediatricians should be cognizant of AT since pediatricians play a crucial role in the diagnosis, management and prevention of AT. PMID:26882906

  15. Abusive head trauma.

    PubMed

    Chiesa, Antonia; Duhaime, Ann-Christine

    2009-04-01

    Child physical abuse that results in injury to the head or brain has been described using many terms, including battered child syndrome, whiplash injuries, shaken infant or shaken impact syndrome, and nonmechanistic terms such as abusive head trauma or nonaccidental trauma. These injuries sustained by child abuse victims are discussed in detail in this article, including information about diagnosis, management and outcomes. The use of forensics, the use imaging studies, and associated injuries are also detailed. PMID:19358918

  16. The Abdominal Circulatory Pump

    PubMed Central

    Aliverti, Andrea; Bovio, Dario; Fullin, Irene; Dellacà, Raffaele L.; Lo Mauro, Antonella; Pedotti, Antonio; Macklem, Peter T.

    2009-01-01

    Blood in the splanchnic vasculature can be transferred to the extremities. We quantified such blood shifts in normal subjects by measuring trunk volume by optoelectronic plethysmography, simultaneously with changes in body volume by whole body plethysmography during contractions of the diaphragm and abdominal muscles. Trunk volume changes with blood shifts, but body volume does not so that the blood volume shifted between trunk and extremities (Vbs) is the difference between changes in trunk and body volume. This is so because both trunk and body volume change identically with breathing and gas expansion or compression. During tidal breathing Vbs was 50–75 ml with an ejection fraction of 4–6% and an output of 750–1500 ml/min. Step increases in abdominal pressure resulted in rapid emptying presumably from the liver with a time constant of 0.61±0.1SE sec. followed by slower flow from non-hepatic viscera. The filling time constant was 0.57±0.09SE sec. Splanchnic emptying shifted up to 650 ml blood. With emptying, the increased hepatic vein flow increases the blood pressure at its entry into the inferior vena cava (IVC) and abolishes the pressure gradient producing flow between the femoral vein and the IVC inducing blood pooling in the legs. The findings are important for exercise because the larger the Vbs the greater the perfusion of locomotor muscles. During asystolic cardiac arrest we calculate that appropriate timing of abdominal compression could produce an output of 6 L/min. so that the abdominal circulatory pump might act as an auxiliary heart. PMID:19440240

  17. Trauma and multiple sclerosis.

    PubMed

    Kurland, L T

    1994-01-01

    The belief that trauma may precede or exacerbate multiple sclerosis (MS) has come primarily from anecdotal reports and case series that provide no rates and no basis for critical comparison. Each year in the United States, approximately 10,000 persons develop MS. A high proportion of the estimated 250,000 prevalence cases have one or more exacerbations, whereas one-third (or 83,000,000 persons in the United States) suffer a memorable injury; therefore, when trauma precedes MS onset or exacerbation, coincidence, as well as causal association, must be considered. For many patients, MS disability may have precipitated an injury, rather than follow one. Two major prospective cohort studies of MS indicate that physical trauma is not responsible for onset or exacerbation. A prospective cohort of patients with MS followed for eight years at the University of Arizona has failed to demonstrate an association between physical trauma and exacerbation. At the Mayo Clinic, cohorts identified in the Olmsted County, Minnesota population with MS, head injury (819), and lumbar disk surgery (942) demonstrated no correlation between onset or exacerbation of MS. Thus, on the basis of credible epidemiological studies, and particularly the studies of cohorts with MS and with trauma, there is no indication that either onset or exacerbation of MS is the result of physical trauma. PMID:8017887

  18. [Major thoracic trauma--sternal trauma].

    PubMed

    Dominioni, Lorenzo; Berizzi, Fabio; Imperatori, Andrea; Rovera, Francesca; Carcano, Giulio

    2005-01-01

    From 1999 to 2003, 101 patients (M/F = 83/18, mean age = 46 +/- 18 y) with thoracic trauma have been admitted to the Center for Thoracic Surgery in Varese. Over 50% of pts. with major thoracic trauma were treated by chest tube drainage; however, surgery was necessary just in 16/101 pts.; 29 pts. were admitted to ICU; deaths were 3/101. The Authors recorded 23/101 sternal fractures. Routine blood test, chest radiography and EKG were performed in all patients; in case of abnormal EKG, echocardiography was performed; in case of widened mediastinum, chest CT was mandatory. 13/23 pts. showed associated injuries, 12 pts. a non-aligned sternal fracture, 7 pts. mediastinal hematoma. Simple observation in hospital was indicated in 15/23 pts. with sternal fractures; chest tubes were positioned in 3 pts. (hemopneumothorax) and one patient was surgically treated because of painful sternal pseudoarthrosis (2 months after trauma). Admission in ICU was necessary in 3 pts. with non-aligned sternal fracture, mediastinal hematoma and associated injuries. No patient with sternal fracture died. PMID:16355852

  19. Multidetector computed tomography in the evaluation of pediatric acute abdominal pain in the emergency department.

    PubMed

    Lin, Wei-Ching; Lin, Chien-Heng

    2016-06-01

    The accurate diagnosis of pediatric acute abdominal pain is one of the most challenging tasks in the emergency department (ED) due to its unclear clinical presentation and non-specific findings in physical examinations, laboratory data, and plain radiographs. The objective of this study was to evaluate the impact of abdominal multidetector computed tomography (MDCT) performed in the ED on pediatric patients presenting with acute abdominal pain. A retrospective chart review of children aged <18 years with acute abdominal pain who visited the emergency department and underwent MDCT between September 2004 and June 2007 was conducted. Patients with a history of trauma were excluded. A total of 156 patients with acute abdominal pain (85 males and 71 females, age 1-17 years; mean age 10.9 ± 4.6 years) who underwent abdominal MDCT in the pediatric ED during this 3-year period were enrolled in the study. One hundred and eighteen patients with suspected appendicitis underwent abdominal MDCT. Sixty four (54.2%) of them had appendicitis, which was proven by histopathology. The sensitivity of abdominal MDCT for appendicitis was found to be 98.5% and the specificity was 84.9%. In this study, the other two common causes of nontraumatic abdominal emergencies were gastrointestinal tract (GI) infections and ovarian cysts. The most common etiology of abdominal pain in children that requires imaging with abdominal MDCT is appendicitis. MDCT has become a preferred and invaluable imaging modality in evaluating uncertain cases of pediatric acute abdominal pain in ED, in particular for suspected appendicitis, neoplasms, and gastrointestinal abnormalities. PMID:27154197

  20. Endoscopic single-port “components separation technique” for postoperative abdominal reconstruction

    PubMed Central

    Rulli, Francesco; Villa, Massimo; Tucci, Gianfranco

    2012-01-01

    BACKGROUND: In 1990, Ramirez introduced a new procedure to close abdominal wall hernia (AWH), called “components separation technique (CST)”. Thanks to endoscopy, surgical repair possibilities have risen, reducing the operative trauma and preserving vascular and neuronal anatomical structures. This report aims to describe a single port endoscopic approach for CST to repair the abdominal wall of a patient undergoing surgery for abdominal aneurysm and already subject to placement of a mesh for AWH. METHODS: We performed endoscopic-assisted CST, using a single-port access with a gasless technique. CONCLUSION: CST is a useful procedure to close large abdominal wall incisional hernia avoiding the use of mesh, notably under contamination, when prosthetic material use is contraindicated. The endoscopic-assisted CST produces same results than the conventional open separation technique and also minimised tissue trauma that ensures blood supply and prevents postoperative wounds complications. The described single port method was found to be safe and effective to close large midline abdominal hernias when a primary open or laparoscopic closure is not feasible or when patients have been previously treated with abdominal meshes. PMID:22623830

  1. Standard Dosing of Enoxaparin for Venous Thromboembolism Prophylaxis Is Not Sufficient for Most Patients Within a Trauma Intensive Care Unit.

    PubMed

    Rostas, Jack W; Brevard, Sidney B; Ahmed, Naveed; Allen, John; Thacker, Derek; Replogle, William H; Gonzalez, Richard P; Frotan, Amin M; Simmons, Jon D

    2015-09-01

    Recent reports confirm that the standard dose of enoxaparin in obese patients is often subtherapeutic, leading to a higher incidence of venous thromboembolism. All patients receiving subcutaneous enoxaparin 30 mg twice a day (b.i.d.) for venous thromboembolism prophylaxis were prospectively enrolled in this study. Trough antiXa levels were obtained and any level less than 0.1 IU/mL was considered subtherapeutic and the final dosage requirement was recorded. Body mass index (BMI), abdominal wall thickness, and fluid balance were collected. Thirty-four patients were prospectively enrolled in the study, 14 (50%) of which had a BMI >30. Sixty-five per cent of obese patients were initially nontherapeutic, compared with 53 per cent of the nonobese (P = 0.73). However, elevated BMI (P < 0.05) and abdominal wall thickness (P < 0.05) correlated to an increased final dose required to attain an anti Xa ≥0.1 when not initially therapeutic, whereas fluid balance demonstrated no correlation (P = 0.232). Subcutaneous enoxaparin dosing of 30 mg b.i.d. is not sufficient for the majority adult trauma patients in the intensive care unit, regardless of BMI. When enoxaparin 30 mg b.i.d. is initially subtherapeutic, obese patients may require a larger dose necessary to achieve necessary anticoagulation. PMID:26350667

  2. Epidemiology of severe trauma.

    PubMed

    Alberdi, F; García, I; Atutxa, L; Zabarte, M

    2014-12-01

    Major injury is the sixth leading cause of death worldwide. Among those under 35 years of age, it is the leading cause of death and disability. Traffic accidents alone are the main cause, fundamentally in low- and middle-income countries. Patients over 65 years of age are an increasingly affected group. For similar levels of injury, these patients have twice the mortality rate of young individuals, due to the existence of important comorbidities and associated treatments, and are more likely to die of medical complications late during hospital admission. No worldwide, standardized definitions exist for documenting, reporting and comparing data on severely injured trauma patients. The most common trauma scores are the Abbreviated Injury Scale (AIS), the Injury Severity Score (ISS) and the Trauma and Injury severity Score (TRISS). Documenting the burden of injury also requires evaluation of the impact of post-trauma impairments, disabilities and handicaps. Trauma epidemiology helps define health service and research priorities, contributes to identify disadvantaged groups, and also facilitates the elaboration of comparable measures for outcome predictions. PMID:25241267

  3. Male genital trauma

    SciTech Connect

    Jordan, G.H.; Gilbert, D.A.

    1988-07-01

    We have attempted to discuss genital trauma in relatively broad terms. In most cases, patients present with relatively minimal trauma. However, because of the complexity of the structures involved, minimal trauma can lead to significant disability later on. The process of erection requires correct functioning of the arterial, neurologic, and venous systems coupled with intact erectile bodies. The penis is composed of structures that are compliant and distensible to the limits of their compliance. These structures therefore tumesce in equal proportion to each other, allowing for straight erection. Relatively minimal trauma can upset this balance of elasticity, leading to disabling chordee. Likewise, relatively minimal injuries to the vascular erectile structures can lead to significantly disabling spongiofibrosis. The urethra is a conduit of paramount importance. Whereas the development of stricture is generally related to the nature of the trauma, the extent of stricture and of attendant complications is clearly a function of the immediate management. Overzealous debridement can greatly complicate subsequent reconstruction. A delicate balance between aggressive initial management and maximal preservation of viable structures must be achieved. 38 references.

  4. Abdominal imaging: An introduction

    SciTech Connect

    Frick, M.P.; Feinberg, S.B.

    1986-01-01

    This nine-chapter book gives an overview of the integrated approach to abdominal imaging. Chapter 1 provides an introduction to the physics used in medical imaging; chapter 2 is on the selection of imaging modalities. These are followed by four chapters that deal, respectively, with plain radiography, computed tomographic scanning, sonography, and nuclear imaging, as applied to the abdomen. Two chapters then cover contrast material-enhanced studies of the gastrointestinal (GI) tract: one focusing on technical considerations; the other, on radiologic study of disease processes. The final chapter is a brief account of different interventional procedures.

  5. Abdominal Superficial Subcutaneous Fat

    PubMed Central

    Golan, Rachel; Shelef, Ilan; Rudich, Assaf; Gepner, Yftach; Shemesh, Elad; Chassidim, Yoash; Harman-Boehm, Ilana; Henkin, Yaakov; Schwarzfuchs, Dan; Ben Avraham, Sivan; Witkow, Shula; Liberty, Idit F.; Tangi-Rosental, Osnat; Sarusi, Benjamin; Stampfer, Meir J.; Shai, Iris

    2012-01-01

    OBJECTIVE Unlike visceral adipose tissue (VAT), the association between subcutaneous adipose tissue (SAT) and obesity-related morbidity is controversial. In patients with type 2 diabetes, we assessed whether this variability can be explained by a putative favorable, distinct association between abdominal superficial SAT (SSAT) (absolute amount or its proportion) and cardiometabolic parameters. RESEARCH DESIGN AND METHODS We performed abdominal magnetic resonance imaging (MRI) in 73 patients with diabetes (mean age 58 years, 83% were men) and cross-sectionally analyzed fat distribution at S1-L5, L5-L4, and L3-L2 levels. Patients completed food frequency questionnaires, and subgroups had 24-h ambulatory blood pressure monitoring and 24-h ambulatory electrocardiography. RESULTS Women had higher %SSAT (37 vs. 23% in men; P < 0.001) despite a similar mean waist circumference. Fasting plasma glucose (P = 0.046) and HbA1c (P = 0.006) were both lower with increased tertile of absolute SSAT. In regression models adjusted for age, waist circumference, and classes of medical treatments used in this patient population, increased %SSAT was significantly associated with decreased HbA1c (β = −0.317; P = 0.013), decreased daytime ambulatory blood pressure (β = −0.426; P = 0.008), and increased HDL cholesterol (β = 0.257; P = 0.042). In contrast, increased percent of deep SAT (DSAT) was associated with increased HbA1c (β = 0.266; P = 0.040) and poorer heart rate variability parameters (P = 0.030). Although total fat and energy intake were not correlated with fat tissue distribution, increased intake of trans fat tended to be associated with total SAT (r = 0.228; P = 0.05) and DSAT (r = 0.20; P = 0.093), but not with SSAT. CONCLUSIONS Abdominal SAT is composed of two subdepots that associate differently with cardiometabolic parameters. Higher absolute and relative distribution of fat in abdominal SSAT may signify beneficial cardiometabolic effects in patients with type 2 diabetes. PMID:22344612

  6. Functional abdominal bloating.

    PubMed

    Sullivan, S N

    1994-07-01

    Ten to 25% of healthy persons have bloating at some time or other. It is very common in those with the irritable bowel syndrome, constipation, or anorexia nervosa. Although the cause of functional bloating remains unknown, old explanations such as a low diaphragm, exaggerated lumbar lordosis, and psychiatric problems have been disproved. New suggestions on its etiology include recent weight gain, weak abdominal muscles, and retained fluid in loops of small intestine. No treatment is of proven benefit, but treatment by weight loss, exercise, and prokinetics should be studied. PMID:7930428

  7. Recurrent abdominal pain.

    PubMed

    Stickler, G B; Murphy, D B

    1979-05-01

    A long-term follow-up study (minimum of five years) of 161 children with recurrent abdominal pain disclosed that three had organic disease and that was missed--inflammatory bowel disease. Anorexia nervosa developed in one patient. Three fourths of the patients recovered from the initial symptom; most recovered within a few weeks; but some patients continued to have complaints for a number of years. Approximately 20% of patients underwent additional surgical or medical treatments of doubtful necessity. In 18% of patients, other psychosomatic symptoms developed. PMID:433872

  8. Lower Abdominal Pain.

    PubMed

    Carlberg, David J; Lee, Stephen D; Dubin, Jeffrey S

    2016-05-01

    Although most frequently presenting with lower abdominal pain, appendicitis, colitis, and diverticulitis can cause pain throughout the abdomen and can cause peritoneal and retroperitoneal symptoms. Evaluation and management of lower intestinal disease requires a nuanced approach by the emergency physician, sometimes requiring computed tomography, ultrasonography, MRI, layered imaging, shared decision making, serial examination, and/or close follow-up. Once a presumed or confirmed diagnosis is made, appropriate treatment is initiated, and may include surgery, antibiotics, and/or steroids. Appendicitis patients should be admitted. Diverticulitis and inflammatory bowel disease can frequently be managed on an outpatient basis, but may require admission and surgical consultation. PMID:27133242

  9. Is diagnostic peritoneal lavage for blunt trauma obsolete?

    PubMed

    Hawkins, M L; Bailey, R L; Carraway, R P

    1990-02-01

    Diagnostic peritoneal lavage was 97 percent accurate, with a 2 percent false positive rate and a 1 percent false negative rate in this series of 414 patients. The ease, safety, and accuracy of diagnostic peritoneal lavage justify its continued use in evaluating these patients. Recent studies show computerized tomography (CT) can be highly accurate in detecting intra-abdominal injuries after blunt trauma. We reviewed our experience with diagnostic peritoneal lavage (DPL) to evaluate whether the accuracy, safety, speed, and cost justified its continued use. Four hundred fifteen DPLs were performed on 414 patients from February 1, 1983, through December 31, 1987. All DPLs were done by the open technique. The lavage was considered grossly positive if 10 cc gross blood were aspirated. If there were greater than 100,000 red blood cells (RBC)/mm3, greater than 500 white blood cells (WBC)/mm3, elevated amylase or bilirubin, or bacteria or vegetable fibers the lavage was microscopically positive. There were no cases with elevated bilirubin, amylase, or presence of bacteria. All four cases with "rare vegetable fibers" were false positive. Six DPLs were for penetrating trauma to the lower chest or back. There were 291 negative lavages, including five false negatives (1%), and 124 positive DPLs, including seven false positives (2%), resulting in a crude accuracy of 97 percent. Three of the five false negative lavages had a ruptured diaphragm as the only intra-abdominal injury. There was one minor complication. DPL was usually performed in the trauma resuscitation room during the secondary survey. At our institution, the total fees for DPL are +185 less than the fees for CT. DPL is accurate, rapid, safe, and avoids the disruption of patient care that results in the radiology suite. DPL remains our procedure of choice for evaluating blunt abdominal trauma in the adult. PMID:2306058

  10. RECOGNITION AND MANAGEMENT OF ABDOMINAL INJURIES AT ATHLETIC EVENTS

    PubMed Central

    Smith, Danny

    2012-01-01

    Most athletic events present potential for abdominal trauma for their participants. The responsibility of the “most medical” professional at the event is to have the knowledge to recognize, treat, and properly manage these injuries. As these injuries are very different in nature from orthopedic injuries, the dangers presented are also very different, and can include outcomes as serious as organ failure and death. Because of these differing risks, many professionals are uneasy about proper treatment, especially on the sidelines. However, with a few key points about mechanism of injury, monitoring changes in vital signs, and careful assessment of presenting symptoms, most abdominal injuries can be properly managed on the sidelines. Level of Evidence: 5 PMID:22893864

  11. Penetrating injuries of the abdominal inferior vena cava.

    PubMed Central

    Degiannis, E.; Velmahos, G. C.; Levy, R. D.; Souter, I.; Benn, C. A.; Saadia, R.

    1996-01-01

    This is a retrospective study of 74 patients with penetrating injuries of the abdominal inferior vena cava; the cause of injury was gunshot in 91% and stabbing in 9%. Of the patients, 77% underwent lateral venorrhaphy, 5% underwent infrarenal ligation of the inferior vena cava (IVC), and 18% died perioperatively before any caval repair could be carried out. There was an overall perioperative mortality of 39%. Persistent shock, the site of the venous injury, particularly in the retrohepatic position, and the number of associated vascular injuries were directly related to mortality. Irrespective of the improvements in resuscitation and the various operative methods available, penetrating trauma of the abdominal IVC remains a life-threatening injury. PMID:8943628

  12. Assuring optimal trauma care: the role of trauma centre accreditation

    PubMed Central

    Simons, Richard; Kirkpatrick, Andrew

    2002-01-01

    Optimal care of the injured patient requires the delivery of appropriate, definitive care shortly after injury. Over the last 30 to 40 years, civilian trauma systems and trauma centres have been developed in the United States based on experience gained in military conflicts, particularly in Korea and Vietnam. A similar process is evolving in Canada. National trauma committees in the US and Canada have defined optimal resources to meet the goal of rapid, appropriate care in trauma centres. They have introduced programs (verification or accreditation) to externally audit trauma centre performance based on these guidelines. It is generally accepted that implementing trauma systems results in decreased preventable death and improved survival after trauma. What is less clear is the degree to which each facet of trauma system development contributes to this improvement. The relative importance of national performance guidelines and trauma centre audit as integral steps toward improved outcomes following injury are reviewed. Current Trauma Association of Canada guidelines for trauma centres are presented and the process of trauma centre accreditation is discussed. PMID:12174987

  13. Trauma-focused CBT for youth who experience ongoing traumas.

    PubMed

    Cohen, Judith A; Mannarino, Anthony P; Murray, Laura K

    2011-08-01

    Many youth experience ongoing trauma exposure, such as domestic or community violence. Clinicians often ask whether evidence-based treatments containing exposure components to reduce learned fear responses to historical trauma are appropriate for these youth. Essentially the question is, if youth are desensitized to their trauma experiences, will this in some way impair their responding to current or ongoing trauma? The paper addresses practical strategies for implementing one evidence-based treatment, Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) for youth with ongoing traumas. Collaboration with local therapists and families participating in TF-CBT community and international programs elucidated effective strategies for applying TF-CBT with these youth. These strategies included: (1) enhancing safety early in treatment; (2) effectively engaging parents who experience personal ongoing trauma; and (3) during the trauma narrative and processing component focusing on (a) increasing parental awareness and acceptance of the extent of the youths' ongoing trauma experiences; (b) addressing youths' maladaptive cognitions about ongoing traumas; and (c) helping youth differentiate between real danger and generalized trauma reminders. Case examples illustrate how to use these strategies in diverse clinical situations. Through these strategies TF-CBT clinicians can effectively improve outcomes for youth experiencing ongoing traumas. PMID:21855140

  14. Trauma-Focused CBT for Youth Who Experience Ongoing Traumas

    ERIC Educational Resources Information Center

    Cohen, Judith A.; Mannarino, Anthony P.; Murray, Laura K.

    2011-01-01

    Many youth experience ongoing trauma exposure, such as domestic or community violence. Clinicians often ask whether evidence-based treatments containing exposure components to reduce learned fear responses to historical trauma are appropriate for these youth. Essentially the question is, if youth are desensitized to their trauma experiences, will…

  15. Trauma-Focused CBT for Youth who Experience Ongoing Traumas

    PubMed Central

    Cohen, Judith A.; Mannarino, Anthony P.; Murray, Laura A.

    2011-01-01

    Many youth experience ongoing trauma exposure, such as domestic or community violence. Clinicians often ask whether evidence-based treatments containing exposure components to reduce learned fear responses to historical trauma are appropriate for these youth. Essentially the question is, if youth are desensitized to their trauma experiences, will this in some way impair their responding to current or ongoing trauma? The paper addresses practical strategies for implementing one evidence-based treatment, Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) for youth with ongoing traumas. Collaboration with local therapists and families participating in TF-CBT community and international programs elucidated effective strategies for applying TF-CBT with these youth. These strategies included: 1) enhancing safety early in treatment; 2) effectively engaging parents who experience personal ongoing trauma; and 3) during the trauma narrative and processing component focusing on a) increasing parental awareness and acceptance of the extent of the youths’ ongoing trauma experiences; b) addressing youths’ maladaptive cognitions about ongoing traumas; and c) helping youth differentiate between real danger and generalized trauma reminders. Case examples illustrate how to use these strategies in diverse clinical situations. Through these strategies TF-CBT clinicians can effectively improve outcomes for youth experiencing ongoing traumas. PMID:21855140

  16. [Pathophysiology of abdominal pain].

    PubMed

    Curatolo, Michele

    2011-08-01

    Abdominal pain can be induced by stimulation of visceral nociceptors. Activation of nociceptors usually requires previous sensitization by pathological events, such as inflammation, ischemia or acidosis. Although abdominal pain can obviously be caused by pathology of a visceral structure, clinicians frequently observe that such a pathology explains only part of the pain complaints. Occasionally, there is lack of objective signs of visceral lesions. There is clear evidence that pain states are associated with profound changes of the central processing of the sensory input. The main consequences of such alterations for patients are twofold: 1) a central sensitization, i.e. an increased excitability of the central nervous system; 2) an alteration of the endogenous pain modulation, which under normal conditions inhibits the processing of nociceptive signals in the central nervous system. Both phenomena lead to a spread of pain to other body regions and an amplification of the pain perception. The interactions between visceral pathology and alterations of the central pain processes represent an at least partial explanation for the discrepancy between objective signs of peripheral lesions and severity of the symptoms. Today, both central hypersensitivity and alteration in endogenous pain modulation can be measured in clinical practice. This information can be used to provide the patients with an explanatory model for their pain. Furthermore, first data suggest that alterations in central pain processing may represent negative prognostic factors. A better understanding of the individual pathophysiology may allow in the future the development of individual therapeutic strategies. PMID:21796591

  17. Post-operative Abdominal Wall Mucormycosis-a Case Series.

    PubMed

    Nain, Prabhdeep Singh; Matta, Harish; Singh, Kuldip; Chhina, Deepinder; Trehan, Munish; Batta, Nishant

    2015-12-01

    Mucormycosis is caused by saprophtytic fungi which cause acute invasive zygomycosis. It clinically presents with necrosis, and on histopathology, acute and chronic infiltrates are seen. It rarely infects a healthy host, but is devastating in an immunocompromised host. We studied five cases with post-operative abdominal wall mucormycosis, three females and two males. Three patients were post-operative while the other two had mucormycosis following trauma and infection was found in sutured wound. All were initially diagnosed as cases of necrotizing fasciitis. Two patients eventually survived after intensive medical therapy and extensive debridements. PMID:26730004

  18. Neurotrauma and trauma systems.

    PubMed

    Pitts, L H

    1995-08-01

    Optimal trauma care, including that for head and spinal cord injury, requires system organization and adoption throughout the United States and the world. Neurosurgeons play an essential role in system design and development in addition to treating neurotrauma patients. Areas of neurosurgical involvement include defining prehospital triage and treatment guidelines, emergency department evaluation and therapy, operative management, and active involvement in the critical care and acute hospital settings. Collaboration among all members of the trauma team is essential to ensure the best possible outcome for patients with traumatic injuries. PMID:7496766

  19. Advances in prehospital trauma care

    PubMed Central

    Williamson, Kelvin; Ramesh, Ramaiah; Grabinsky, Andreas

    2011-01-01

    Prehospital trauma care developed over the last decades parallel in many countries. Most of the prehospital emergency medical systems relied on input or experiences from military medicine and were often modeled after the existing military procedures. Some systems were initially developed with the trauma patient in mind, while other systems were tailored for medical, especially cardiovascular, emergencies. The key components to successful prehospital trauma care are the well-known ABCs of trauma care: Airway, Breathing, Circulation. Establishing and securing the airway, ventilation, fluid resuscitation, and in addition, the quick transport to the best-suited trauma center represent the pillars of trauma care in the field. While ABC in trauma care has neither been challenged nor changed, new techniques, tools and procedures have been developed to make it easier for the prehospital provider to achieve these goals in the prehospital setting and thus improve the outcome of trauma patients. PMID:22096773

  20. A rare case of blunt thoracoabdominal trauma with small bowel perforation from air bags.

    PubMed

    Liverani, A; Pezzatini, M; Conte, S; Mari, F; Milillo, A; Gasparrini, M; Marino, G; Catracchia, V; -Favi, F

    2009-05-01

    Vehicle collisions represent more than 75% of mechanism of blunt abdominal trauma. In spite of the incomparable improvement of car safety devices, recent studies pointed out that the air bags might cause injuries, specially when it is not associated with seatbelt. In fact, some studies pointed out that crash victims using air bags alone have increased injury severity, hospitalisations, thoracoabdominal procedure, and rehabilitation. Some of the most frequently injured organs reported from air bag deployment are the liver (38%), the spleen (23%) and digestive system (17%). Injury of the hollow viscera are far less common. In particular, blunt abdominal trauma resulting in small bowel perforation is an infrequent lesion. These injuries are difficult to diagnose because specific signs are poor and a delay in treatment increases mortality and morbidity of the patients. We describe a case of thoracoabdominal trauma that occurred during a head-on collision after an air bag deployment without seatbelt use. PMID:19505417

  1. Trauma mechanisms and injuries associated with go-karting.

    PubMed

    Eker, Hasan H; Van Lieshout, Esther M M; Den Hartog, Dennis; Schipper, Inger B

    2010-01-01

    Annually, approximately 600 patients seek medical attention after go-kart accidents in the Netherlands. A large variability in injury patterns can be encountered. Knowledge of the trauma mechanisms of go-kart accidents and insight into the associated injuries is limited and requires improvement. Such additional knowledge may lead to customized trauma protocols for patients with a high index of suspicion on go-kart injuries. Research into trauma mechanisms may also lead to implementation of improved or additional safety measures for go-karting, involving both the go-karts itself as well as prerequisites to the go-kart tracks and qualifications for the drivers. The main trauma mechanisms involved in go-kart accidents, and three cases to illustrate the variety of injuries are described in the current manuscript. PMID:20361000

  2. Trauma Mechanisms and Injuries Associated with Go-Karting

    PubMed Central

    Eker, Hasan H.; Van Lieshout, Esther M.M.; Den Hartog, Dennis; Schipper, Inger B.

    2010-01-01

    Annually, approximately 600 patients seek medical attention after go-kart accidents in the Netherlands. A large variability in injury patterns can be encountered. Knowledge of the trauma mechanisms of go-kart accidents and insight into the associated injuries is limited and requires improvement. Such additional knowledge may lead to customized trauma protocols for patients with a high index of suspicion on go-kart injuries. Research into trauma mechanisms may also lead to implementation of improved or additional safety measures for go-karting, involving both the go-karts itself as well as prerequisites to the go-kart tracks and qualifications for the drivers. The main trauma mechanisms involved in go-kart accidents, and three cases to illustrate the variety of injuries are described in the current manuscript. PMID:20361000

  3. Extrasensory Perception Experiences and Childhood Trauma: A Rorschach Investigation.

    PubMed

    Scimeca, Giuseppe; Bruno, Antonio; Pandolfo, Gianluca; La Ciura, Giulia; Zoccali, Rocco A; Muscatello, Maria R A

    2015-11-01

    This study investigated whether people who report recurrent extrasensory perception (ESP) experiences (telepathy, clairvoyance, and precognition) have suffered more traumatic experiences and traumatic intrusions. Thirty-one nonclinical participants reporting recurrent ESP experiences were compared with a nonclinical sample of 31 individuals who did not report recurrent ESP phenomena. Past traumatic experiences were assessed via a self-report measure of trauma history (Childhood Trauma Questionnaire); traumatic intrusions were assessed via a performance-based personality measure (Rorschach Traumatic Content Index). Participants also completed the Anomalous Experience Inventory, the Minnesota Multiphasic Personality Inventory-2, the Dissociative Experience Scale, and the Revised Paranormal Belief Scale. The ESP group reported higher levels of emotional abuse, sexual abuse, emotional neglect, physical neglect, and traumatic intrusions. The association between ESP experiences and trauma was partly mediated by the effects of dissociation and emotional distress. Implications for health professionals are discussed. Results also showed the reliability of the twofold method of assessment of trauma. PMID:26488918

  4. Trauma Induced Myocardial Infarction

    PubMed Central

    Lolay, Georges A.; Abdel-Latef, Ahmed K.

    2016-01-01

    Chest Trauma in athletes is a common health problem. However, myocardial infarction secondary to coronary dissection in the setting of blunt chest trauma is extremely rare. We report a case of acute inferior wall myocardial infarction following blunt chest trauma. A 32-year-old male with no relevant medical problems was transferred to our medical center for retrosternal chest pain after being elbowed in the chest during a soccer game. Few seconds later, he started experiencing sharp retrosternal chest pain that was severe to that point where he called the emergency medical service. Upon arrival to the Trauma department patient was still complaining of chest pain. ECG demonstrated ST segment elevation in the inferior leads with reciprocal changes in the lateral leads all consistent with active ischemia. After rolling out Aortic dissection, patient was loaded with ASA, ticagerlor, heparin and was emergently taken to the cardiac catheterization lab. Coronary angiography demonstrated 100% thrombotic occlusion in the distal right coronary artery with TIMI 0 flow distally. After thrombus aspiration, a focal dissection was noted on the angiogram that was successfully stented. Two days after admission patient was discharged home. Echocardiography prior to discharge showed inferior wall akinesis, normal right ventricular systolic function and normal overall ejection fraction. PMID:26490501

  5. [Multiple trauma and burns].

    PubMed

    Carsin, H; Dutertre, G; Le Bever, H; Ainaud, P; Le Rveill, R; Rives, J M

    1995-01-01

    In peace time, burn injury combined with traumatic, chemical or radioactive casualties is rarely encountered and often unrecognized; during disasters, burn injury is unlikely the only trauma. The authors try to bring out the main pathophysiological, diagnostic and therapeutic characteristics of changes induced by combined lesions on burn injury and vice-versa. PMID:7671090

  6. Pediatric spinal trauma.

    PubMed

    Huisman, Thierry A G M; Wagner, Matthias W; Bosemani, Thangamadhan; Tekes, Aylin; Poretti, Andrea

    2015-01-01

    Pediatric spinal trauma is unique. The developing pediatric spinal column and spinal cord deal with direct impact and indirect acceleration/deceleration or shear forces very different compared to adult patients. In addition children are exposed to different kind of traumas. Moreover, each age group has its unique patterns of injury. Familiarity with the normal developing spinal anatomy and kind of traumas is essential to correctly diagnose injury. Various imaging modalities can be used. Ultrasound is limited to the neonatal time period; plain radiography and computer tomography are typically used in the acute work-up and give highly detailed information about the osseous lesions. Magnetic resonance imaging is more sensitive for disco-ligamentous and spinal cord injuries. Depending on the clinical presentation and timing of trauma the various imaging modalities will be employed. In the current review article, a summary of the epidemiology and distribution of posttraumatic lesions is discussed in the context of the normal anatomical variations due to progressing development of the child. PMID:25512255

  7. Early Childhood Trauma

    ERIC Educational Resources Information Center

    National Child Traumatic Stress Network, 2010

    2010-01-01

    Early childhood trauma generally refers to the traumatic experiences that occur to children aged 0-6. Because infants' and young children's reactions may be different from older children's, and because they may not be able to verbalize their reactions to threatening or dangerous events, many people assume that young age protects children from the…

  8. Structured Sensory Trauma Interventions

    ERIC Educational Resources Information Center

    Steele, William; Kuban, Caelan

    2010-01-01

    This article features the National Institute of Trauma and Loss in Children (TLC), a program that has demonstrated via field testing, exploratory research, time series studies, and evidence-based research studies that its Structured Sensory Intervention for Traumatized Children, Adolescents, and Parents (SITCAP[R]) produces statistically

  9. Structured Sensory Trauma Interventions

    ERIC Educational Resources Information Center

    Steele, William; Kuban, Caelan

    2010-01-01

    This article features the National Institute of Trauma and Loss in Children (TLC), a program that has demonstrated via field testing, exploratory research, time series studies, and evidence-based research studies that its Structured Sensory Intervention for Traumatized Children, Adolescents, and Parents (SITCAP[R]) produces statistically…

  10. Case scenario - thoracic trauma.

    PubMed

    Michelet, P; Boussen, S

    2013-01-01

    Among trauma patients, blunt chest trauma remains a major cause of morbidity and mortality. We report the case of an 85-year old patient under new oral anticoagulant implicated in a multiple-vehicle accident. The patient presented a complex thoracic trauma involving multiple rib fractures, flail chest, hemothorax and lung contusions. All the thoracic lesions were situated at the left side. Despite the absence of neurological lesion and hemodynamic instability, the patient required the admission in our intensive care unit related to the worsening of a respiratory distress. This respiratory distress resulted from the association of the thoracic injuries with related hypoxemia and a high level of pain. The management of this case included the reversal of the anticoagulant therapy, use of non-invasive ventilation, the placement of a paravertebral block and the surgical fixation of the flail chest. We provide a discussion of the risk/benefit balance for all the medical and surgical strategies used in this case as the interest of chest ultrasonography in thoracic trauma situations. PMID:23916516

  11. Trauma induced myocardial infarction.

    PubMed

    Lolay, Georges A; Abdel-Latif, Ahmed K

    2016-01-15

    Chest Trauma in athletes is a common health problem. However, myocardial infarction secondary to coronary dissection in the setting of blunt chest trauma is extremely rare. We report a case of acute inferior wall myocardial infarction following blunt chest trauma. A 32-year-old male with no relevant medical problems was transferred to our medical center for retrosternal chest pain after being elbowed in the chest during a soccer game. Few seconds later, he started experiencing sharp retrosternal chest pain that was severe to that point where he called the emergency medical service. Upon arrival to the trauma department patient was still complaining of chest pain. ECG demonstrated ST segment elevation in the inferior leads with reciprocal changes in the lateral leads all consistent with active ischemia. After rolling out aortic dissection, patient was loaded with ASA, ticagerlor, heparin and was emergently taken to the cardiac catheterization lab. Coronary angiography demonstrated 100% thrombotic occlusion in the distal right coronary artery with TIMI 0 flow distally. After thrombus aspiration, a focal dissection was noted on the angiogram that was successfully stented. Two days after admission patient was discharged home. Echocardiography prior to discharge showed inferior wall akinesis, normal right ventricular systolic function and normal overall ejection fraction. PMID:26490501

  12. How I Manage Abdominal Injuries.

    ERIC Educational Resources Information Center

    Haycock, Christine E.

    1986-01-01

    In sports, abdominal injuries occur most frequently in cycling, horseback riding, and skiing. Most involve children, not adults. Any athlete sustaining a severe blow to the abdomen should be examined. Guidelines are provided for recognizing and treating injuries to the abdominal muscles, kidneys, spleen, and liver. (Author/MT)

  13. Abdominal aortic aneurysm repair - open

    MedlinePlus

    Open abdominal aortic aneurysm repair is surgery to fix a widened part in your aorta. This is called an aneurysm. The ... Open surgery to repair an abdominal aortic aneurysm is sometimes ... is bleeding inside your body from the aneurysm. You may have an ...

  14. The influence of injury severity on complication rates after primary closure or colostomy for penetrating colon trauma.

    PubMed Central

    Nelken, N; Lewis, F

    1989-01-01

    The management of penetrating colon injury has been frequently debated in the literature, yet few reports have evaluated primary closure versus diverting colostomy in similarly injured patients. Diverting colostomy is the standard of care when mucosal penetration is present, but primary closure in civilian practice has generally had excellent results, although it has been restricted to less severely injured patients. Because the degree of injury may influence choice of treatment in modern practice, various indices of injury severity have been proposed for assessment of patients with penetrating colon trauma. As yet, however, there has been no cross-comparison of repair type versus injury severity. A retrospective study 76 patients who sustained penetrating colon trauma between January 1, 1979 and December 31, 1985 and who survived for at least 24 hours was conducted. Different preferences among attending surgeons and a more aggressive approach to the use of primary closure during the years of study led to an essentially random use of primary closure and diverting colostomy for moderate levels of colon injury, with mandatory colostomy reserved for the most serious injuries. Primary closure was performed in 37 patients (three having resection and anastomosis), and colostomy was performed in 39 patients. Severity of injury was evaluated by the Injury Severity Score (ISS), Penetrating Abdominal Trauma Index (PATI), and the Flint Colon Injury Score. Complications and outcome were evaluated as a function of severity of injury, and primary closure and colostomy were compared. Demographic profiles of the two groups did not differ regarding age, sex, mechanism of injury, shock, or delay between injury and operation. The mortality rate was 2.6% for each group. Major morbidity, including septic complications, occurred in 11% of the patients of the primary closure group and in 49% of those of the colostomy group. When PATI was less than 25, the Flint score was less than or equal to 2, or when the ISS was less than 25, primary closure resulted in fewer complications than did colostomy. Of the injury severity indices examined, the PATI most reliably predicted complications and specifically identified patients who whose outcome would be good with primary repair. These results suggest that the use of primary closure should be expanded in civilian penetrating colon trauma and that, even with moderate degrees of colon injury, primary closure provides an outcome equivalent to that provided by colostomy. In addition, the predictive value of the PATI suggests that it should be included along with other injury severity indices in trauma data bases. Images Fig. 3. Fig. 4. PMID:2930290

  15. CT of abdominal tuberculosis

    SciTech Connect

    Epstein, B.M.; Mann, J.H.

    1982-11-01

    Intraabdominal tuberculosis (TB) presents with a wide variety of clinical and radiologic features. Besides the reported computed tomographic (CT) finding of high-density ascites in tuberculous peritonitis, this report describes additional CT features highly suggestive of abdominal tuberculosis in eight cases: (1) irregular soft-tissue densities in the omental area; (2) low-density masses surrounded by thick solid rims; (3) a disorganized appearance of soft-tissue densities, fluid, and bowel loops forming a poorly defined mass; (4) low-density lymph nodes with a multilocular appearance after intravenous contrast administration; and (5) possibly high-density ascites. The differential diagnosis of these features include lymphoma, various forms of peritonitis, peritoneal carcinomatosis, and peritoneal mesothelioma. It is important that the CT features of intraabdominal tuberculosis be recognized in order that laparotomy be avoided and less invasive procedures (e.g., laparoscopy, biopsy, or a trial of antituberculous therapy) be instituted.

  16. The Role of Trauma Type in the Risk for Insomnia

    PubMed Central

    Hall Brown, Tyish S.; Akeeb, Ameenat; Mellman, Thomas A.

    2015-01-01

    Objective: Insomnia is common following exposure to trauma and can occur independently or as a feature of posttraumatic stress disorder (PTSD). However, there is limited research identifying risk factors associated with the development of insomnia following exposure to a traumatic event. The goal of this study was to evaluate the role of specific trauma types in the risk for insomnia in a community sample of urban African Americans young adults. Methods: A sample of 554 nonclinical, urban, young adult African Americans was recruited for a larger study from which 465 participants were utilized for this study based on their completion of all study self-report measures. Participants were initially screened by phone to determine whether they provisionally met study criteria. Once selected, participants underwent informed consent and then completed a battery of self-report measures that included the Life Events Checklist, the PTSD Checklist, the Insomnia Severity Index, and the Fear of Sleep Index. Results: Of the seven trauma categories that were endorsed by at least 20% of the sample, results from logistic regression models indicated that sexual trauma, physical assault, accidents, natural disasters, and sudden violent death predicted insomnia independent of sex. However, PTSD symptom severity and nocturnal fears differentially influenced the relationship between trauma type and risk for insomnia. Conclusions: Exposure to specific types of trauma increases the odds of insomnia twofold to threefold. Additionally, PTSD symptom severity and nocturnal fears contribute differentially to the relationship between trauma exposure and insomnia suggesting the possibility of multiple underlying pathways. Citation: Hall Brown TS, Akeeb A, Mellman TA. The role of trauma type in the risk for insomnia. J Clin Sleep Med 2015;11(7):735–739. PMID:25766711

  17. Trauma-Induced Coagulopathy

    PubMed Central

    Pittet, Jean-Francois; Pierce, Bert

    2014-01-01

    Trauma is the leading cause of death among people under the age of 44. Hemorrhage is a major contributor to deaths related to trauma in the first 48 h. Accordingly, the management of these patients is a time-sensitive and critical affair that anesthesiologists responsible for surgical resuscitation will face. Coagulopathy associated with trauma exists in one-third of all severely injured patients upon presentation to the hospital. Trauma patients presenting with coagulopathy have significantly higher mortality. This trauma-induced coagulopathy (TIC) must be managed adroitly in the resuscitation of these patients. Recent advancements in our understanding of TIC have led to new protocols and therapy guidelines. Anesthesiologists must be aware of these to effectively manage this form of shock. TIC driven by a combination of endogenous biological processes, as well as iatrogenic causes, can ultimately lead to the lethal triad of hypothermia, acidemia, and coagulopathy. Providers should understand how to promptly diagnose TIC and be aware of the early indicators of massive transfusion. The use of common laboratory studies and patient vital signs serve as our current guide, but the importance of each is still under debate. Thromboelastography is a tool used often in the diagnosis of TIC and can be used to guide blood product transfusion. Certain pharmaceutical strategies and non-transfusion strategies also exist, which aid in the management of hemorrhagic shock. Damage control surgery, rewarming, tranexamic acid, and 1:1:1 transfusion protocols are promising methods used to treat the critically wounded. Though protocols have been developed, controversies still exist on the optimal resuscitation strategy. PMID:25587242

  18. Invading of intrauterine contraceptive device into the sigmoid colon through uterine perforation caused by a blunt trauma.

    PubMed

    Davoodabadi, Abdoulhossein; Mohammadzadeh, Mahdi; Amirbeigi, Mahdieh; Jazayeri, Hoda

    2015-08-01

    Intrauterine contraceptive device (IUCD) is relatively safe but still with some serious risks. Uterus perforation is rare and would be fatal. A case of Cu-7 IUCD invading into the sigmoid colon through uterine perforation caused by a pelvic blunt trauma was presented. Our case showed that uterus perforation by an IUCD could induce utero-sigmoid fistula which is likely to be missed. Imaging is required when the patients with IUCD present abdominal pain, particularly with a history of trauma. PMID:26764547

  19. Trauma and Chinese heroin users.

    PubMed

    Sun, An-Pyng; Chen, Yi-Ching; Marsiglia, Flavio

    2016-01-01

    This qualitative study explores the traumas of Chinese heroin users. The results showed that the Chinese experience traumas during (childhood, later in life but prior to heroin-use onset, and throughout their heroin-use career. Themes related to the traumas include the historical economic transition, the value of family orientation, an emphasis on scholarly pursuits, the shame orientation, and a scarcity of resources conducive to recovery. This article provides a framework to understand the traumas experienced by Chinese people and offers insights on how macrofactors may impact the trauma and its treatment in different societies. PMID:26421948

  20. Antithrombin in the treatment of burn trauma.

    PubMed

    Kowal-Vern, Areta; Orkin, Bruce A

    2016-02-01

    Antithrombin (AT) is a natural anticoagulant with anti-inflammatory properties that has demonstrated value in sepsis, disseminated intravascular coagulation and in burn and inhalation injury. With high doses, AT may decrease blood loss during eschar excision, reducing blood transfusion requirements. There are no human randomized, placebo-controlled studies, which have tested the true benefit of this agent in these conditions. Two main forms of AT are either plasma-derived AT (phAT) and recombinant AT (rhAT). Major ovine studies in burn and smoke inhalation injury have utilized rhAT. There have been no studies which have either translated the basic rhAT research in burn trauma, or determined the tolerance and pharmacokinetics of rhAT concentrate infusions in burn patients. Advantages of rhAT infusions are no risk of blood borne diseases and lower cost. However, the majority of human burn patient studies have been conducted utilizing phAT. Recent Japanese clinical trials have started using phAT in abdominal sepsis successfully. This review examines the properties of both phAT and rhAT, and analyzes studies in which they have been utilized. We believe that it is time to embark on a randomized placebo-controlled multi-center trial to establish the role of AT in both civilian and military patients with burn trauma. PMID:26855890

  1. Antithrombin in the treatment of burn trauma

    PubMed Central

    Kowal-Vern, Areta; Orkin, Bruce A

    2016-01-01

    Antithrombin (AT) is a natural anticoagulant with anti-inflammatory properties that has demonstrated value in sepsis, disseminated intravascular coagulation and in burn and inhalation injury. With high doses, AT may decrease blood loss during eschar excision, reducing blood transfusion requirements. There are no human randomized, placebo-controlled studies, which have tested the true benefit of this agent in these conditions. Two main forms of AT are either plasma-derived AT (phAT) and recombinant AT (rhAT). Major ovine studies in burn and smoke inhalation injury have utilized rhAT. There have been no studies which have either translated the basic rhAT research in burn trauma, or determined the tolerance and pharmacokinetics of rhAT concentrate infusions in burn patients. Advantages of rhAT infusions are no risk of blood borne diseases and lower cost. However, the majority of human burn patient studies have been conducted utilizing phAT. Recent Japanese clinical trials have started using phAT in abdominal sepsis successfully. This review examines the properties of both phAT and rhAT, and analyzes studies in which they have been utilized. We believe that it is time to embark on a randomized placebo-controlled multi-center trial to establish the role of AT in both civilian and military patients with burn trauma. PMID:26855890

  2. Chest trauma in a developing country.

    PubMed Central

    Anyanwu, C. H.; Swarup, A. S.

    1981-01-01

    In a developing country with inadequate clinical facilities a conservative method of management of a major clinical problem is often the only rational approach. This policy was adopted in the management of 145 patients with chest trauma in a teaching hospital in Nigeria. Automobile accidents were the cause of the thoracic injuries in 73.1% of the patients; 71.7% of the patients were managed as in-patients. The management of the patients was essentially aimed at correction of hypovolaemia, tube drainage of pleural collections, and relief of pain by intercostal nerve block. Major operative procedures were adopted in 11 cases (7.6%) for persistent haemothorax or for pyothorax, ruptured diaphragm, ruptured abdominal viscus, and subdural haematona. No operative reduction of rib fractures was performed and only 1 of the 12 patients with flail chest was mechanically ventilated. The hospital mortality was 9.7% and, despite a high rate of default at follow-up attendances, no late death or serious complication was recorded. Th aspects peculiar to chest trauma in Nigeria are discussed. PMID:7247266

  3. The effect of different types of abdominal binders on intra-abdominal pressure

    PubMed Central

    Zhang, Hua-Yu; Liu, Dong; Tang, Hao; Sun, Shi-Jin; Ai, Shan-Mu; Yang, Wen-Qun; Jiang, Dong-Po; Zhang, Lian-Yang

    2016-01-01

    Objectives: To investigate the effect of non-elastic/elastic abdominal binders on intra-vesical pressure (IVP), physiological functions, and clinical outcomes in laparotomy patients at the perioperative stage. Methods: This prospective study was conducted from May to October 2014 at the Trauma Surgery Department, Daping Hospital, Chongqing, China. Laparotomy patients were randomly divided into non-elastic abdominal binder group (28 patients), and elastic abdominal binder group (29 patients). Binders were applied for 14 days following the operation, or until discharge. Demographic information, Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation II (APACHE-II) scores (prior to the operation, on the first day after operation, the day IVP measurement was stopped, and one day before discharge), and outcomes were recorded. The IVP was measured before the operation to postoperative day 7. Results: There were no significant differences in the demographic information, outcomes, SOFA or APACHE-II scores between the 2 groups. Initial out-of-bed mobilization occurred earlier in the elastic binder group (3.2 ± 2.0 versus 5.0 ± 3.7 days, p=0.028). A greater increase in IVP was observed in the non-elastic binder group than in the elastic binder group (2.9 ± 1.1 versus 1.1 ± 0.7 mm Hg, p=0.000). Conclusion: Elastic binders have relatively little effect on IVP and are more helpful at promoting postoperative recovery than non-elastic binders. Therefore, elastic binders are more suitable for clinical use. PMID:26739977

  4. Abdominal actinomycosis presenting as appendicitis: two case reports and review

    PubMed Central

    Liu, Ken; Joseph, David; Lai, Ken; Kench, James; Ngu, Meng Chong

    2016-01-01

    Abdominal actinomycosis (AA) is a rare infection caused by filamentous Gram-positive anaerobic bacteria Actinomyces. We report two cases of adults with AA who initially presented with clinical and radiological features of appendicitis. Both patients underwent appendicectomy with histopathology diagnostic for actinomycosis of the appendix and subsequently completed prolonged courses of oral penicillin. AA is a rare differential diagnosis for appendicitis and should be considered especially in patients with a chronic, indolent course and nonspecific abdominal symptoms. A high index of suspicion may avoid unnecessary surgery, as treatment with prolonged antibiotic therapy is very effective. PMID:27147718

  5. Abdominal actinomycosis presenting as appendicitis: two case reports and review.

    PubMed

    Liu, Ken; Joseph, David; Lai, Ken; Kench, James; Ngu, Meng Chong

    2016-01-01

    Abdominal actinomycosis (AA) is a rare infection caused by filamentous Gram-positive anaerobic bacteria Actinomyces. We report two cases of adults with AA who initially presented with clinical and radiological features of appendicitis. Both patients underwent appendicectomy with histopathology diagnostic for actinomycosis of the appendix and subsequently completed prolonged courses of oral penicillin. AA is a rare differential diagnosis for appendicitis and should be considered especially in patients with a chronic, indolent course and nonspecific abdominal symptoms. A high index of suspicion may avoid unnecessary surgery, as treatment with prolonged antibiotic therapy is very effective. PMID:27147718

  6. Abdominal aortic aneurysm demonstrated on renal scintigraphy.

    PubMed

    Phisitkul, Sorot; Brian, Susan; Rakvit, Ariwan; Jenkins, Leigh A; Bohannon, W Todd; Harris, Jennifer; Tsikouris, James; Silva, Michael B; Meyerrose, Gary E

    2003-08-01

    A 74-year-old hypertensive woman presented with abdominal discomfort and a pulsatile abdominal mass. Anterior abdominal angiography during cardiac blood pool, and renal scintigraphic imaging demonstrated a large abdominal aortic aneurysm. 1, 2 Before endovascular repair with an aortoiliac endograft, the abdominal aneurysm measured 7.5 x 7.0 cm on abdominal computed tomography. This study demonstrates that a suspected abdominal aortic aneurysm can be confirmed using the addition of anterior abdominal imaging with normal posterior imaging at the time of renal scintigraphy. PMID:12897671

  7. Traumatic disruption of the abdominal wall: lap-belt injuries in children.

    PubMed

    Moremen, Jacob R; Nakayama, Don K; Ashley, Dennis W; Astin, Matthew; Nolan, Tracy L

    2013-04-01

    Traumatic abdominal wall hernia (TAWH) from high speed mechanism is a unique finding in adult trauma, and exceedingly rare in pediatrics. The majority of reports are of low-speed "handlebar" hernias associated with direct injury by bicycle handlebars. We report a series of three pediatric patients in motor vehicle collisions (MVC) who experienced TAWH by lap-belt and associated intra-abdominal injuries necessitating immediate operative intervention. Different operative approaches were used in each case to manage the varying types of disruptions. This adds to the pediatric literature the largest series of its kind. PMID:23583160

  8. Experimental mechanical characterization of abdominal organs: liver, kidney & spleen.

    PubMed

    Umale, Sagar; Deck, Caroline; Bourdet, Nicolas; Dhumane, Parag; Soler, Luc; Marescaux, Jacques; Willinger, Remy

    2013-01-01

    Abdominal organs are the most vulnerable body parts during vehicle trauma, leading to high mortality rate due to acute injuries of liver, kidney, spleen and other abdominal organs. Accurate mechanical properties and FE models of these organs are required for simulating the traumas, so that better designing of the accident environment can be done and the organs can be protected from severe damage. Also from biomedical aspect, accurate mechanical properties of organs are required for better designing of surgical tools and virtual surgery environments. In this study porcine liver, kidney and spleen tissues are studied in vitro and hyper-elastic material laws are provided for each. 12 porcine kidneys are used to perform 40 elongation tests on renal capsule and 60 compression tests on renal cortex, 5 porcine livers are used to perform 45 static compression tests on liver parenchyma and 5 porcine spleens are used to carry out 20 compression tests. All the tests are carried out at a static speed of 0.05 mm/s. A comparative analysis of all the results is done with the literature and though the results are of same order of magnitude, a slight dissonance is observed for the renal capsule. It is also observed that the spleen is the least stiff organ in the abdomen whereas the kidney is the stiffest. The results of this study would be essential to develop the FE models of liver, kidney and spleen which can be further used for impact biomechanical and biomedical applications. PMID:23127642

  9. Acute incarcerated external abdominal hernia

    PubMed Central

    Yang, Xue-Fei

    2014-01-01

    External abdominal hernia occurs when abdominal organs or tissues leave their normal anatomic site and protrude outside the skin through the congenital or acquired weakness, defects or holes on the abdominal wall, including inguinal hernia, umbilical hernia, femoral hernia and so on. Acute incarcerated hernia is a common surgical emergency. With advances in minimally invasive devices and techniques, the diagnosis and treatment have witnessed major changes, such as the use of laparoscopic surgery in some cases to achieve minimally invasive treatment. However, strict adherence to the indications and contraindications is still required. PMID:25489584

  10. [Blunt trauma with bullet-proof vests. Skin lesions are no reliable predictor of injury severity].

    PubMed

    Doll, D; Illert, B; Bohrer, S; Richter, C; Woelfl, C

    2009-04-01

    It is well known that so-called bullet-proof vests offer protection against a wide range of penetrating trauma, but their protection against blunt trauma is less well understood. Fast projectiles may result in hematomas and contusions behind the armour. We report a traffic accident involving a young soldier wearing a ballistic protection vest resulting in a right thoracoabdominal blunt trauma leading to a confined liver compression rupture. As nearly no skin marks were detectable, we point out that every emergency department surgeon should be very suspicious if a patient wore a ballistic vest at the time of the accident--there may be no skin marks despite severe intra-abdominal trauma. Our patient recovered following hypotensive ICU treatment, thrombocyte mobilization, and factor VIIa substitution. PMID:18854963

  11. Imaging of laryngeal trauma.

    PubMed

    Becker, Minerva; Leuchter, Igor; Platon, Alexandra; Becker, Christoph D; Dulguerov, Pavel; Varoquaux, Arthur

    2014-01-01

    External laryngeal trauma is a rare but potentially life-threatening situation in the acutely injured patient. Trauma mechanism and magnitude, maximum focus of the applied force, and patient related factors, such as age and ossification of the laryngeal cartilages influence the spectrum of observed injuries. Their correct diagnosis and prompt management are paramount in order to avoid patient death or long-term impairment of breathing, swallowing and speaking. The current review provides a comprehensive approach to the radiologic interpretation of imaging studies performed in patients with suspected laryngeal injury. It describes the key anatomic structures that are relevant in laryngeal trauma and discusses the clinical role of multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) in the acute emergency situation. The added value of two-dimensional multiplanar reconstructions (2D MPR), three-dimensional volume rendering (3D VR) and virtual endoscopy (VE) for the non-invasive evaluation of laryngeal injuries and for treatment planning is discussed. The clinical presentation, biomechanics of injury, diagnostic pitfalls and pearls, common and uncommon findings are reviewed with emphasis of fracture patterns, involvement of laryngeal joints, intra- and extralaryngeal soft tissue injuries, and complications seen in the acute emergency situation. The radiologic appearance of common and less common long-term sequelae, as well as treatment options are equally addressed. PMID:24238937

  12. Maxillofacial Trauma in Children

    PubMed Central

    Mukherjee, Uday

    2012-01-01

    Abstract Pediatric trauma involving the bones of the face is associated with severe injury and disability. Although much is known about the epidemiology of facial fractures in adults, little is known about injury patterns and outcomes in children. The most common facial fractures were mandible, nasal and maxillary/zygoma. The most common mechanisms of injury are motor vehicle collisions, violence and falls. These fracture patterns and mechanisms of injury varies with age. Cranial and central facial injuries are more common among toddlers and infants, and mandible injuries are more common among adolescents. Although bony craniofacial trauma is relatively uncommon among the pediatric population, it remains a substantial source of mortality, morbidity and hospital admissions. Continued efforts toward injury prevention are warranted. An overview of various types of fractures and their management modalities is discussed, with case reports. How to cite this article: Mukherjee CG, Mukherjee U. Maxillofacial Trauma in Children. Int J Clin Pediatr Dent 2012;5(3):231-236. PMID:25206176

  13. Dystonia after head trauma.

    PubMed

    Lee, M S; Rinne, J O; Ceballos-Baumann, A; Thompson, P D; Marsden, C D

    1994-08-01

    Dystonia is a rare consequence of head trauma. We describe 10 such cases and review 19 similar patients reported in the literature. Twenty-two of the 29 patients suffered head injury during the first or second decade of life. There was a variable delay between the head trauma and the onset of dystonia. In 18 cases with severe head injury, this interval (median, 18 months; range, 1 month to 9 years) was longer than in 11 cases with mild head injury (median, 14 days; range, 3 days to 5 years). In our series, nine of the 10 cases started as a focal dystonia and one as a hemidystonia. The dystonia progressed and spread over several months or years. Two cases remained as focal dystonias, but the others developed segmental, hemi-, multifocal, or generalized dystonia. On brain imaging studies (CT or MRI), the most frequent lesion site was in the contralateral basal ganglia or thalamus, but two cases had normal brain scans. Dysfunction of the lenticulothalamic neuronal circuit seems to be related to the development of dystonia following head trauma. PMID:8058132

  14. Abdominal aortic feminism.

    PubMed

    Mortimer, Alice Emily

    2014-01-01

    A 79-year-old woman presented to a private medical practice 2 years previously for an elective ultrasound screening scan. This imaging provided the evidence for a diagnosis of an abdominal aortic aneurysm (AAA) to be made. Despite having a number of recognised risk factors for an AAA, her general practitioner at the time did not follow the guidance set out by the private medical professional, that is, to refer the patient to a vascular specialist to be entered into a surveillance programme and surgically evaluated. The patient became symptomatic with her AAA, was admitted to hospital and found to have a tender, symptomatic, 6 cm leaking AAA. She consented for an emergency open AAA repair within a few hours of being admitted to hospital, despite the 50% perioperative mortality risk. The patient spent 4 days in intensive care where she recovered well. She was discharged after a 12 day hospital stay but unfortunately passed away shortly after her discharge from a previously undiagnosed gastric cancer. PMID:25398912

  15. CT of abdominal tuberculosis.

    PubMed

    Epstein, B M; Mann, J H

    1982-11-01

    Intraabdominal tuberculosis (TB) presents with a wide variety of clinical and radiologic features. Besides the reported computed tomographic (CT) finding of high-density ascites in tuberculous peritonitis, this report describes additional CT features highly suggestive of abdominal tuberculosis in eight cases: (1)irregular soft-tissue densities in the omental area; (2) low-density masses surrounded by thick solid rims; (3) a disorganized appearance of soft-tissue densities, fluid, and bowel loops forming a disorganized appearance of soft-tissue densities, fluid, and bowel loops forming a poorly defined mass; (4) low-density lymph nodes with a multilocular appearance after intravenous contrast administration; and (5) possibly high-density ascites. The differential diagnosis of these features include lymphoma, various forms of peritonitis, peritoneal carcinomatosis, and peritoneal mesothelioma. It is important that the CT features of intraabdominal tuberculosis be recognized in order that laparotomy be avoided and less invasive procedures (e.g., laparoscopy, biopsy, or a trail of antituberculous therapy) be instituted. PMID:6981966

  16. Trauma-related Infections in Battlefield Casualties From Iraq

    PubMed Central

    Petersen, Kyle; Riddle, Mark S.; Danko, Janine R.; Blazes, David L.; Hayden, Richard; Tasker, Sybil A.; Dunne, James R.

    2007-01-01

    Objective: To describe risks for, and microbiology and antimicrobial resistance patterns of, war trauma associated infections from Operation Iraqi Freedom. Background: The invasion of Iraq resulted in casualties from high-velocity gunshot, shrapnel, and blunt trauma injuries as well as burns. Infectious complications of these unique war trauma injuries have not been described since the 1970s. Methods: Retrospective record review of all trauma casualties 5 to 65 years of age evacuated from the Iraqi theatre to U.S. Navy hospital ship, USNS Comfort March to May 2003.War trauma-associated infection was defined by positive culture from a wound or sterile body fluid (ie, blood, cerebrospinal fluid) and at least two of the following infection-associated signs/symptoms: fever, dehiscence, foul smell, peri-wound erythema, hypotension, and leukocytosis. A comparison of mechanisms of injury, demographics, and clinical variables was done using multivariate analysis. Results: Of 211 patients, 56 met criteria for infection. Infections were more common in blast injuries, soft tissue injuries, >3 wound sites, loss of limb, abdominal trauma, and higher Injury Severity Score (ISS). Wound infections accounted for 84% of cases, followed by bloodstream infections (38%). Infected were more likely to have had fever prior to arrival, and had higher probability of ICU admission and more surgical procedures. Acinetobacter species (36%) were the predominant organisms followed by Escherichia coli and Pseudomonas species (14% each). Conclusions: Similar to the Vietnam War experience, gram-negative rods, particularly Acinetobacter species, accounted for the majority of wound infections cared for on USNS Comfort during Operation Iraqi Freedom. Multidrug resistance was common, with the exception of the carbapenem class, limiting antibiotic therapy options. PMID:17457175

  17. Aerobic and anaerobic microbiology of infections after trauma in children.

    PubMed Central

    Brook, I

    1998-01-01

    OBJECTIVE: To review the recovery of aerobic and anaerobic bacteria from infections after trauma in children over a 20 year period. METHODS: Only specimens that were studied for both aerobic and anaerobic bacteria were included in the analysis. They were collected from seven separate centres in which the microbiology laboratories only accepted specimens that were properly collected without contamination and were submitted in appropriate transport media. Anaerobes and aerobic bacteria were cultured and identified using standard techniques. Clinical records were reviewed to identify post-trauma patients. RESULTS: From 1974 to 1994, 175 specimens obtained from 166 children with trauma showed bacterial growth. The trauma included blunt trauma (71), lacerations (48), bites (42), and open fractures (5). Anaerobic bacteria only were isolated in 38 specimens (22%), aerobic bacteria only in 51 (29%), and mixed aerobic-anaerobic flora in 86 (49%); 363 anaerobic (2.1/specimen) and 158 aerobic or facultative isolates (0.9/specimen) were recovered. The predominant anaerobic bacteria included Peptostreptococcus spp (115 isolates), Prevotella spp (68), Fusobacterium spp (52), B fragilis group (42), and Clostridium spp (21). The predominant aerobic bacteria included Staph aureus (51), E coli (13), Ps aeruginosa (12), Str pyogenes (11) and Klebsiella pneumoniae (9). Principal infections were: abscesses (52), bacteraemia (3), pulmonary infections (30, including aspiration pneumonia, tracheostomy associated pneumonia, empyema, and ventilator associated pneumonia), wounds (36, including cellulitis, post-traumatic wounds, decubitus ulcers, myositis, gastrostomy and tracheostomy site wounds, and fasciitis), bites (42, including 23 animal and 19 human), peritonitis (4), osteomyelitis (5), and sinusitis (3). Staph aureus and Str pyogenes were isolated at all sites. However, organisms of the oropharyngeal flora predominated in infections that originated from head and neck wounds and abscesses, and bites, and those from the gastrointestinal tract predominated in infections that originated from peritonitis, abdominal abscesses, and decubitus ulcers. CONCLUSIONS: Many infections that follow trauma in children involve multiple organisms. PMID:9639177

  18. Intraoperative Dexmedetomidine Promotes Postoperative Analgesia in Patients After Abdominal Colectomy

    PubMed Central

    Ge, Dong-Jian; Qi, Bin; Tang, Gang; Li, Jin-Yu

    2015-01-01

    Abstract Surgery-induced acute postoperative pain may lead to prolonged convalescence. The present study was designed to investigate the effects of intraoperative dexmedetomidine on postoperative analgesia following abdominal colectomy surgeries. Eighty patients scheduled for abdominal colectomy surgery under general anesthesia were divided into 2 groups, which were maintained using propofol/remifentanil/dexmedetomidine (PRD) or propofol/remifentanil/saline (PRS). During surgery, patients in the PRD group had a lower bispectral index (BIS) value, which indicated a deeper anesthetic state, and a higher sedation score right after extubation than patients in the PRS group. During the first 24 hours post surgery, PRD patients consumed less morphine in patient-controlled analgesia (PCA) and had a lower score in the visual analog scale (VAS) testing than their controls from the PRS group. Intraoperative administration of dexmedetomidine appears to promote the analgesic property of morphine-based PCA in patients after abdominal colectomy. PMID:26376397

  19. Ogilvie's syndrome following posterior spinal instrumentation in thoraco lumbar trauma

    PubMed Central

    Krishnakumar, R.; Kuzhimattam, Mathew John; Kumar, Gaurav

    2015-01-01

    Objectives: To report unique cases of Ogilvie's syndrome (acute intestinal pseudo-obstruction) following posterior spinal instrumentation in thoraco lumbar trauma. Materials and Methods: A single centre retrospective study. We reviewed the surgical data of 420 patients who underwent thoracolumbar spinal surgery over a period of four years. Two patients who developed post operative Ogilvie's syndromes were identified. Results: The clinical presentation and blood investigations ruled out any infectious pathology. Computed tomography scans ruled out the mechanical obstruction. All patients improved with conservative management. Conclusion: Ogilvie's syndrome should be considered as a differential diagnosis in patients with postoperative significant abdominal distension who had undergone posterior instrumentation for spinal trauma. Early recognition and appropriate conservative treatment would be necessary to prevent complications such as bowel ischemia and perforation. PMID:26692695

  20. Kidney in danger: CT findings of blunt and penetrating renal trauma.

    PubMed

    Alonso, Raquel Cano; Nacenta, Susana Borruel; Martinez, Patricia Diez; Guerrero, Angel Sanchez; Fuentes, Carlos Garcia

    2009-11-01

    Approximately 10% of all significant blunt abdominal traumatic injuries manifest with renal injury, although it is usually minor. However, renal imaging is indicated in cases of gross hematuria, penetrating trauma with gross or microscopic hematuria, and blunt trauma and shock with gross or microscopic hematuria. Contrast material-enhanced computed tomography (CT) is the imaging modality of choice in the evaluation and management of renal trauma. Contrast-enhanced CT is readily available in emergency departments and can quickly and accurately depict renal injuries as well as associated injuries to other abdominal or retroperitoneal organs. In this way, contrast-enhanced CT provides the anatomic and functional information that is essential for accurate staging. In addition, CT can help detect active hemorrhage and urinary extravasation and is very useful in guiding transcatheter embolization and delineating preexisting disease entities that may predispose kidneys to posttraumatic hemorrhage. With the advent of multidetector CT, imaging is characterized by faster scanning times, increased volume coverage, and improved spatial and temporal resolution. The increased use of CT has been partially responsible for a growing trend toward conservative management of renal trauma, except in cases in which extensive urinary extravasation or devitalized areas of renal parenchyma are found and especially in those cases with associated injuries to other abdominal organs; these cases are particularly prone to complications and usually require surgery. PMID:19926761

  1. Embolization of Isolated Lumbar Artery Injuries in Trauma Patients

    SciTech Connect

    Sofocleous, Constantinos T. Hinrichs, Clay R.; Hubbi, Basil; Doddakashi, Satish; Bahramipour, Philip; Schubert, Johanna

    2005-12-15

    Purpose. The purpose of the study was to evaluate the angiographic findings and results of embolotherapy in the management of lumbar artery trauma. Methods. All patients with lumbar artery injury who underwent angiography and percutaneous embolization in a state trauma center within a 10-year period were retrospectively reviewed. Radiological information and procedural reports were reviewed to assess immediate angiographic findings and embolization results. Long-term clinical outcome was obtained by communication with the trauma physicians as well as with chart review. Results. In a 10-year period, 255 trauma patients underwent abdominal aortography. Eleven of these patients (three women and eight men) suffered a lumbar artery injury. Angiography demonstrated active extravasation (in nine) and/or pseudoaneurysm (in four). Successful selective embolization of abnormal vessel(s) was performed in all patients. Coils were used in six patients, particles in one and gelfoam in five patients. Complications included one retroperitoneal abscess, which was treated successfully. One patient returned for embolization of an adjacent lumbar artery due to late pseudoaneurysm formation. Conclusions. In hemodynamically stable patients, selective embolization is a safe and effective method for immediate control of active extravasation, as well as to prevent future hemorrhage from an injured lumbar artery.

  2. Trauma and PTSD Symptoms: Does Spiritual Struggle Mediate the Link?

    PubMed Central

    Wortmann, Jennifer H.; Park, Crystal L.; Edmondson, Donald

    2010-01-01

    Because exposure to potentially traumatic events is common (Kessler, Sonnega, Bromet, & Hughes, 1995), the mechanisms through which post-traumatic stress disorder (PTSD) symptoms develop is a critical area of investigation (Ozer, Best, Lipsey, & Weiss, 2003). Among the mechanisms that may predict PTSD symptoms is spiritual struggle, a set of negative religious cognitions related to understanding or responding to stressful events. Although prominent theories emphasize cognitive factors in the development and maintenance of PTSD symptoms, they have not explicitly addressed spiritual struggle. The present prospective study tested the role of spiritual struggle in the development and maintenance of PTSD symptoms following trauma. We assessed exposure to trauma and non-trauma events during the first year of college, spiritual struggle due to the most stressful event, and PTSD symptoms resulting from the index event. Spiritual struggle partially mediated the relationship between trauma and PTSD symptoms. Interestingly, some individual subscales of spiritual struggle (specifically, Punishing God Reappraisal, Reappraisal of God’s Powers, and Spiritual Discontent) partially mediated the relationship between trauma and PTSD symptoms; however, reappraisal of the event to evil forces did not relate to PTSD symptoms. These results suggest that spiritual struggle is an important cognitive mechanism for many trauma victims and may have relevance for cognitive therapy for PTSD. PMID:22308201

  3. Incentive spirometry after abdominal surgery.

    PubMed

    Davis, Suja P

    Patients face various possible complications after abdominal surgery. This article examines best practice in guiding and teaching them how to use an incentive spirometer to facilitate recovery and prevent respiratory complications. PMID:22866486

  4. Posttraumatic appendicitis: further extending the extended Focused Assessment with Sonography in Trauma examination.

    PubMed

    Derr, Charlotte; Goldner, D Eliot

    2009-06-01

    Several cases of appendicitis after blunt abdominal trauma have been reported in the literature. A 41-year-old man on a cruise ship began to experience acute abdominal pain several hours after cliff diving from a 20-ft height and landing hard against the water on his right side. The patient's symptoms were treated and he remained on the ship until its scheduled arrival in port 2 days later. In the emergency department, a bedside extended Focused Assessment with Sonography in Trauma (eFAST) examination showed no evidence of free fluid in the abdominal cavity, pericardial effusion, or pneumothorax. Next, an ultrasound of the right lower quadrant was performed, which revealed a 1.06 cm, noncompressible appendix consistent with appendicitis. Although physical examination remains the gold standard for evaluation of the acute abdomen, the presentation of acute appendicitis is historically unreliable and delays in its diagnosis can result in significant increases in morbidity and mortality. Ultrasonography has been shown to have clear value in the evaluation of the acute abdomen. It is the authors' opinion that ultrasonography may have an unrealized potential as a diagnostic tool for traumatic appendicitis in the trauma bay and as a triage tool for the cruise ship physician who must evaluate a patient with traumatic abdominal pain and determine the need for medical evacuation. PMID:19497487

  5. Aspects of abuse: abusive head trauma.

    PubMed

    Hinds, Tanya; Shalaby-Rana, Eglal; Jackson, Allison M; Khademian, Zarir

    2015-03-01

    Abusive Head Trauma (AHT) is a form of child physical abuse that involves inflicted injury to the brain and its associated structures. Abusive Head Trauma, colloquially called Shaken Baby Syndrome, is the most common cause of serious or fatal brain injuries in children aged 2 years and younger. The American Academy of Pediatrics recommends the term Abusive Head Trauma, as opposed to Shaken Baby Syndrome, as the former term encompasses multiple forms of inflicted head injury (inertial, contact, and hypoxic-ischemic) and a range of clinical presentations and radiologic findings and their sequelae. Children diagnosed with AHT are 5 times more likely to die compared with accidentally head-injured children, yet signs and symptoms are not always obvious, and therefore the diagnosis can be overlooked. Therefore, the American Academy of Pediatrics has tasked pediatricians with knowing how and when to begin an evaluation of children with signs and symptoms that could possibly be due to AHT. Overall, a detailed history of present illness and medical history, recognition of physical and radiological findings, and careful interpretation of retinal pathology are important aspects of formulating the differential diagnoses and increasing or decreasing the index of suspicion for AHT. PMID:25771265

  6. Haematuria after blunt trauma: the role of pyelography.

    PubMed

    Demetriades, D; Rabinowitz, B; Sofianos, C; Landau, A

    1985-09-01

    This study is a combined prospective and retrospective review of 208 patients presenting with haematuria after blunt abdominal trauma. One hundred and twelve patients had an urgent intravenous pyelogram (IVP) with cystogram performed, while the remaining ninety-six were observed with serial urinalysis without any further investigation. Nineteen of the twenty-three patients with a positive IVP had gross haematuria and the remaining four had microscopic haematuria. Twenty-two of the patients with an abnormal IVP had positive abdominal signs, whilst only one case (with severe head injury) had no abdominal signs. In the 96 cases who were observed without IVP no complications occurred. It is suggested that if certain clinical criteria are observed most patients with post-traumatic microscopic haematuria can safely be spared an IVP. Indications for emergency IVP should include: gross haematuria or microscopic haematuria associated with abdominal signs or severe head injury or fracture of pelvis or spine. Had these criteria been observed during this study, 130 patients (62 per cent) would have avoided the risks and expenses of an IVP, and no significant urological injury would have been missed. PMID:4041738

  7. Abdominal emergencies in the geriatric patient

    PubMed Central

    2014-01-01

    Abdominal pain is one of the most frequent reasons that elderly people visit the emergency department (ED). In this article, we review the deadliest causes of abdominal pain in this population, including mesenteric ischemia, abdominal aortic aneurysm, and appendicitis and potentially lethal non-abdominal causes. We also highlight the pitfalls in diagnosing, or rather misdiagnosing, these clinical entities. PMID:25635203

  8. Trauma in the geriatric population.

    PubMed

    Maxwell, Cathy A

    2015-06-01

    Injury in older adults is a looming public health crisis. This article provides a broad overview of geriatric trauma across the continuum of care. After a review of the epidemiology of geriatric trauma, optimal approaches to patient care are presented for triage and transport, trauma team activation and initial assessment, inpatient management, and injury prevention. Special emphasis is given to assessment of frailty, advanced care planning, and transitions of care. PMID:25981722

  9. Acute Abdominal Pain Caused by an Infected Mesenteric Cyst in a 24-Year-Old Female

    PubMed Central

    Ponten, Joep B.; Zijta, Frank M.

    2016-01-01

    A mesenteric cyst is a rare cause for abdominal pain. This umbrella term includes cystic entities which reside in the mesentery. We present a case of an infected false mesenteric cyst in a 24-year-old female patient without prior surgery or known trauma. Mainstay of treatment involves surgical resection, although less invasive treatments have been described. Prognosis depends on the origin of the cyst. PMID:27190668

  10. Sleep and trauma: an overview.

    PubMed

    Caldwell, Barbara A; Redeker, Nancy

    2005-01-01

    Sleep disturbance is common after traumatic events of various types, such as combat, physical trauma, and sexual abuse, and closely intertwined with Posttraumatic Stress Disorder (PTSD), a common outcome of severe and prolonged trauma. This paper reviews the current literature on the significance and characteristics of sleep disturbance occurring in the context of trauma, examines the relationship between sleep disturbance and PTSD, identifies gaps in knowledge relative to the role of sleep disturbance in trauma and PTSD, and discusses the implications of this body of knowledge for clinical practice. PMID:16126648

  11. Global trauma: the great divide

    PubMed Central

    Paniker, Jayanth; Graham, Simon Matthew; Harrison, James William

    2015-01-01

    Road trauma is an emergent global issue. There is huge disparity between the population affected by road trauma and the resource allocation. If the current trend continues, a predicted extra 5 million lives will be lost in this decade. This article aims to create an awareness of the scale of the problem of road trauma and the inequality in the resources available to address this problem. It also describes the responses from the international organisations and the orthopaedic community in dealing with this issue. The International Orthopaedic community has a unique opportunity and moral obligation to play a part in changing this trend of global trauma.

  12. The epidemiology of reoperations for orthopaedic trauma

    PubMed Central

    Coomber, R; Woolf, K; Prinja, A; Wordsworth, D; Lopez, D; Burtt, S

    2015-01-01

    Introduction The Royal College of Surgeons of England (RCS) has issued guidance regarding the use of reoperation rates in the revalidation of UK-based orthopaedic surgeons. Currently, little has been published concerning acceptable rates of reoperation following primary surgical management of orthopaedic trauma, particularly with reference to revalidation. Methods A retrospective review was conducted of patients undergoing clearly defined reoperations following primary surgical management of trauma between 1 January 2010 and 31 December 2011. A full case note review was undertaken to establish the demographics, clinical course and context of reoperation. A review of the imaging was performed to establish whether the procedure performed was in line with accepted trauma practice and whether the technical execution was acceptable. Results A total of 3,688 patients underwent primary procedures within the time period studied while 70 (1.90%, 99% CI: 1.39–2.55) required an unplanned reoperation. Thirty-nine (56%) of these patients were male. The mean age of patients was 56 years (range: 18–98 years) and there was a median time to reoperation of 50 days (IQR: 13–154 days). Potentially avoidable reoperations occurred in 41 patients (58.6%, 99% CI: 43.2–72.6). This was largely due to technical errors (40 patients, 57.1%, 99% CI: 41.8–71.3), representing 1.11% (99% CI: 0.73–1.64) of the total trauma workload. Within RCS guidelines, 28-day reoperation rates for hip, wrist and ankle fractures were 1.4% (99% CI: 0.5–3.3), 3.5% (99% CI: 0.8%–12.1) and 1.86% (99% CI: 0.4–6.6) respectively. Conclusions We present novel work that has established baseline reoperation rates for index procedures required for revalidation of orthopaedic surgeons. PMID:25519265

  13. Contemporary Trends in the Immediate Surgical Management of Renal Trauma Using A National Database

    PubMed Central

    McClung, Christopher; Hotaling, James M.; Wang, Jin; Wessells, Hunter; Voelzke, Bryan B.

    2013-01-01

    Background The National Trauma Data Bank was utilized to analyze open surgical management of renal trauma during the first 24 hours of hospital admission, excluding those who were treated with conservative measures. A descriptive analysis of initial management trends following renal trauma was also performed as a secondary analysis. Methods Using the NTDB, patients with renal injuries were identified, and AIS codes were stratified to a corresponding AAST renal injury grade. Trends in initial management were assessed using the following initial treatment categories: observation, minimally invasive surgery, and open renal surgery. Analysis of initial open surgery was further examined according to etiology of injury (blunt vs. penetrating), type of open renal surgery, concomitant abdominal surgery, patient demographics, and time to surgery. Results 9,002 renal injuries (0.3%) mapped to an AAST renal grade. Of these, 1,183 patients underwent open surgery for their renal injury in the first 24 hours. There were 773 penetrating and 410 blunt injuries within this cohort. The majority of surgical patients sustained a high-grade renal injury (AAST 4–5: 64%). The overall nephrectomy rate in the first 24 hours was 54% and 83% for the penetrating and blunt groups, respectively. While the overall nephrectomy rate for AAST 1–3 renal injuries in the first 24 hours was low (1.8%), the nephrectomy rate was higher in the setting of an exploratory laparotomy (30%). Of those undergoing renal surgery in the first 24 hours, 86% had concomitant surgery performed for other abdominal injuries. Mean time from ED presentation to surgery was less for penetrating trauma. Conclusions Of patients requiring open surgery for renal trauma within 24 hours of admission, nephrectomy is the most common surgery. Continued effort to reduce nephrectomy rates following abdominal trauma are necessary. Level of Evidence III (exploratory cohort analysis, nonrandomized) PMID:24064872

  14. Rural Trauma: Is Trauma Designation Associated with Better Hospital Outcomes?

    ERIC Educational Resources Information Center

    Bowman, Stephen M.; Zimmerman, Frederick J.; Sharar, Sam R.; Baker, Margaret W.; Martin, Diane P.

    2008-01-01

    Context: While trauma designation has been associated with lower risk of death in large urban settings, relatively little attention has been given to this issue in small rural hospitals. Purpose: To examine factors related to in-hospital mortality and delayed transfer in small rural hospitals with and without trauma designation. Methods: Analysis…

  15. Trauma-Focused CBT for Youth with Complex Trauma

    ERIC Educational Resources Information Center

    Cohen, Judith A.; Mannarino, Anthony P.; Kliethermes, Matthew; Murray, Laura A.

    2012-01-01

    Objectives: Many youth develop complex trauma, which includes regulation problems in the domains of affect, attachment, behavior, biology, cognition, and perception. Therapists often request strategies for using evidence-based treatments (EBTs) for this population. This article describes practical strategies for applying Trauma-Focused Cognitive

  16. Trauma-focused CBT for youth with complex trauma

    PubMed Central

    Mannarino, Anthony P.; Kliethermes, Matthew; Murray, Laura A.

    2013-01-01

    Objectives Many youth develop complex trauma, which includes regulation problems in the domains of affect, attachment, behavior, biology, cognition, and perception. Therapists often request strategies for using evidence-based treatments (EBTs) for this population. This article describes practical strategies for applying Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) for youth with complex trauma. Methods TF-CBT treatment phases are described and modifications of timing, proportionality and application are described for youth with complex trauma. Practical applications include a) dedicating proportionally more of the model to the TF-CBT coping skills phase; b) implementing the TF-CBT Safety component early and often as needed throughout treatment; c) titrating gradual exposure more slowly as needed by individual youth; d) incorporating unifying trauma themes throughout treatment; and e) when indicated, extending the TF-CBT treatment consolidation and closure phase to include traumatic grief components and to generalize ongoing safety and trust. Results Recent data from youth with complex trauma support the use of the above TF-CBT strategies to successfully treat these youth. Conclusions The above practical strategies can be incorporated into TF-CBT to effectively treat youth with complex trauma. Practice implications Practical strategies include providing a longer coping skills phase which incorporates safety and appropriate gradual exposure; including relevant unifying themes; and allowing for an adequate treatment closure phase to enhance ongoing trust and safety. Through these strategies therapists can successfully apply TF-CBT for youth with complex trauma. PMID:22749612

  17. Trauma-Focused CBT for Youth with Complex Trauma

    ERIC Educational Resources Information Center

    Cohen, Judith A.; Mannarino, Anthony P.; Kliethermes, Matthew; Murray, Laura A.

    2012-01-01

    Objectives: Many youth develop complex trauma, which includes regulation problems in the domains of affect, attachment, behavior, biology, cognition, and perception. Therapists often request strategies for using evidence-based treatments (EBTs) for this population. This article describes practical strategies for applying Trauma-Focused Cognitive…

  18. Radiology of skeletal trauma

    SciTech Connect

    Rogers, L.F.

    1982-01-01

    This 1000-page book contains over 1700 illustrations, is presented in two volumes and subdivided into 23 chapters. After brief chapters of Introduction and General Anatomy, a section on Skeletal Biomechanics is presented. The Epidemiology of Fractures chapter examines, among other things, the effects of age on the frequency and distribution of fractures. In the chapter on Classifications of Fractures, the author describes the character of traumatic forces such as angulating, torsional, avulsive, and compressive, and then relates these to the resultant fracture configurations. The Fracture Treatment chapter presents an overview of treatment principles. Other chapters deal with specific problems in pediatric trauma, fracture healing and nonhealing, and fracture complications.

  19. Acute brain trauma.

    PubMed

    Martin, G T

    2016-01-01

    In the 20th century, the complications of head injuries were controlled but not eliminated. The wars of the 21st century turned attention to blast, the instant of impact and the primary injury of concussion. Computer calculations have established that in the first 5 milliseconds after the impact, four independent injuries on the brain are inflicted: 1) impact and its shockwave, 2) deceleration, 3) rotation and 4) skull deformity with vibration (or resonance). The recovery, pathology and symptoms after acute brain trauma have always been something of a puzzle. The variability of these four modes of injury, along with a variable reserve of neurones, explains some of this problem. PMID:26688392

  20. Indexing Images.

    ERIC Educational Resources Information Center

    Rasmussen, Edie M.

    1997-01-01

    Focuses on access to digital image collections by means of manual and automatic indexing. Contains six sections: (1) Studies of Image Systems and their Use; (2) Approaches to Indexing Images; (3) Image Attributes; (4) Concept-Based Indexing; (5) Content-Based Indexing; and (6) Browsing in Image Retrieval. Contains 105 references. (AEF)

  1. Internal abdominal hernia: Intestinal obstruction due to trans-mesenteric hernia containing transverse colon

    PubMed Central

    Crispín-Trebejo, Brenda; Robles-Cuadros, María Cristina; Orendo-Velásquez, Edwin; Andrade, Felipe P.

    2014-01-01

    INTRODUCTION Internal abdominal hernias are infrequent but an increasing cause of bowel obstruction still often underdiagnosed. Among adults its usual causes are congenital anomalies of intestinal rotation, postsurgical iatrogenic, trauma or infection diseases. PRESENTATION OF CASE We report the case of a 63-year-old woman with history of chronic constipation. The patient was hospitalized for two days with acute abdominal pain, abdominal distension and inability to eliminate flatus. The X-ray and abdominal computerized tomography scan (CT scan) showed signs of intestinal obstruction. Exploratory laparotomy performed revealed a trans-mesenteric hernia containing part of the transverse colon. The intestine was viable and resection was not necessary. Only the hernia was repaired. DISCUSSION Internal trans-mesenteric hernia constitutes a rare type of internal abdominal hernia, corresponding from 0.2 to 0.9% of bowel obstructions. This type carries a high risk of strangulation and even small hernias can be fatal. This complication is specially related to trans-mesenteric hernias as it tends to volvulize. Unfortunately, the clinical diagnosis is rather difficult. CONCLUSION Trans-mesenteric internal abdominal hernia may be asymptomatic for many years because of its nonspecific symptoms. The role of imaging test is relevant but still does not avoid the necessity of exploratory surgery when clinical features are uncertain. PMID:24880799

  2. Intra-abdominal gossypiboma: a report of two cases and a review of literature.

    PubMed

    Kpolugbo, J; Alili, U; Abubakar, M

    2010-01-01

    Post operative foreign body in the abdominal cavily, though rare continues to occur in surgical practice. Symptoms may start early with abdominal pain but usually have a varying course, ofter leading 10 the formation of gossypiboma. This is usually a great source of embarrassment to the surgeon and the centre, and of serious detrimental effect to the patient. A case report of a 27-year-old trader with intra-abdominal foreign body is presented to highlig at the similarity in presentation with abdominal lymphoma and the need to explore carefully masses in the abdominal cavity especially in patients who have had surgery in the past. A high index of suspicious is required on the part of the clinician in addition to appropriate radiological and sonologic assessment. Prompt diagnosis and treatment ameliorates the patients suffering and brings them back to life. PMID:23457869

  3. Neuroimaging of childhood trauma.

    PubMed

    Bremner, J Douglas

    2002-04-01

    Childhood abuse is a major public health problem affecting as many as a third of children in this country today at some point before their 18(th) birthday. The effects of childhood trauma on the brain are increasingly an area of interest. In trying to understand the effects of early stressors on the brain we use animal models of early stress to guide the development of hypotheses. An important potential tool in understanding the effects of abuse on the brain is neuroimaging. Neuroimaging studies in traumatized children are in a relative state of infancy. A number of methodological and ethical issues make this a difficult area for research, including problems ranging from patient motion during scanning to the ethical issues of the duty to report abuse and working with child protective services. Some studies have shown that adults abused as children have smaller volume of the hippocampus, a brain area involved in learning and memory, as measured with magnetic resonance imaging (MRI). One study in children with posttraumatic stress disorder (PTSD) did not find smaller hippocampal volume, but did find smaller brain volume and corpus callosum. Functional neuroimaging studies are consistent with alteration in function and structure of medial prefrontal cortex and hippocampus in patients with childhood sexual trauma and PTSD. These initial results suggest that childhood abuse in the setting of PTSD is associated with long-term changes in brain structure and function. PMID:11953934

  4. Computed tomography in facial trauma

    SciTech Connect

    Zilkha, A.

    1982-08-01

    Computed tomography (CT), plain radiography, and conventional tomography were performed on 30 patients with facial trauma. CT demonstrated bone and soft-tissue involvement. In all cases, CT was superior to tomography in the assessment of facial injury. It is suggested that CT follow plain radiography in the evaluation of facial trauma.

  5. Sexual Trauma, Spirituality, and Psychopathology

    ERIC Educational Resources Information Center

    Krejci, Mark J.; Thompson, Kevin M.; Simonich, Heather; Crosby, Ross D.; Donaldson, Mary Ann; Wonderlich, Stephen A.; Mitchell, James E.

    2004-01-01

    This study assessed the association between spirituality and psychopathology in a group of sexual abuse victims and controls with a focus on whether spirituality moderated the association between sexual trauma and psychopathology. Seventy-one sexual trauma victims were compared to 25 control subjects on spiritual well-being, the Eating Disorder…

  6. The epidemiology of renal trauma

    PubMed Central

    Leddy, Laura

    2014-01-01

    Introduction Nonoperative and minimally invasive management techniques for both blunt and penetrating renal trauma have become standard of care over the past decades. We sought to examine the modern epidemiology of renal trauma over the past decade. Methods A systematic review of PubMed from the past decade was conducted to examine adult and pediatric renal trauma. A total of 605 articles were identified. Of these, 15 adult and 5 pediatric articles met our a priori search criteria. Results There is a lack of uniform reporting of the renal trauma demographics precluding accurate assessment. Despite this, we were able to elucidate the following details. Renal trauma predominately affects young adult males, and the etiology is predominantly blunt. Among blunt injuries, motor vehicle crashes are most common among adult and pediatric patients. Nonoperative care was utilized in 94.8% of reviewed manuscripts with a 5.4% nephrectomy rate. Discussion There do not appear to be any startling changes in the presentation of adult and pediatric renal trauma over the past decade. Nonoperative care continues to be utilized as primary therapy. Increased attention on the reporting of renal trauma demographics is necessary to improve detection of trends. Conclusions Increased reporting of the presenting demographics of adult and pediatric renal trauma is encouraged to assist future assessment of epidemiology. PMID:26816762

  7. Sexual Trauma, Spirituality, and Psychopathology

    ERIC Educational Resources Information Center

    Krejci, Mark J.; Thompson, Kevin M.; Simonich, Heather; Crosby, Ross D.; Donaldson, Mary Ann; Wonderlich, Stephen A.; Mitchell, James E.

    2004-01-01

    This study assessed the association between spirituality and psychopathology in a group of sexual abuse victims and controls with a focus on whether spirituality moderated the association between sexual trauma and psychopathology. Seventy-one sexual trauma victims were compared to 25 control subjects on spiritual well-being, the Eating Disorder

  8. Psychiatric diagnoses, trauma, and suicidiality

    PubMed Central

    Floen, Silje K; Elklit, Ask

    2007-01-01

    Background This study aimed to examine the associations between psychiatric diagnoses, trauma and suicidiality in psychiatric patients at intake. Methods During two months, all consecutive patients (n = 139) in a psychiatric hospital in Western Norway were interviewed (response rate 72%). Results Ninety-one percent had been exposed to at least one trauma; 69 percent had been repeatedly exposed to trauma for longer periods of time. Only 7% acquired a PTSD diagnosis. The comorbidity of PTSD and other psychiatric diagnoses were 78%. A number of diagnoses were associated with specific traumas. Sixty-seven percent of the patients reported suicidal thoughts in the month prior to intake; thirty-one percent had attempted suicide in the preceding week. Suicidal ideation, self-harming behaviour, and suicide attempts were associated with specific traumas. Conclusion Traumatised patients appear to be under- or misdiagnosed which could have an impact on the efficiency of treatment. PMID:17448229

  9. Educational inequality in the occurrence of abdominal obesity: Pró-Saúde Study

    PubMed Central

    Alves, Ronaldo Fernandes Santos; Faerstein, Eduardo

    2015-01-01

    OBJECTIVE To estimate the degree of educational inequality in the occurrence of abdominal obesity in a population of non-faculty civil servants at university campi. METHODS In this cross-sectional study, we used data from 3,117 subjects of both genders aged 24 to 65-years old, regarding the baseline of Pró-Saúde Study, 1999-2001. Abdominal obesity was defined according to abdominal circumference thresholds of 88 cm for women and 102 cm for men. A multi-dimensional, self-administered questionnaire was used to evaluate education levels and demographic variables. Slope and relative indices of inequality, and Chi-squared test for linear trend were used in the data analysis. All analyses were stratified by genders, and the indices of inequality were standardized by age. RESULTS Abdominal obesity was the most prevalent among women (43.5%; 95%CI 41.2;45.9), as compared to men (24.3%; 95%CI 22.1;26.7), in all educational strata and age ranges. The association between education levels and abdominal obesity was an inverse one among women (p < 0.001); it was not statistically significant among men (p = 0.436). The educational inequality regarding abdominal obesity in the female population, in absolute terms (slope index of inequality), was 24.0% (95%CI 15.5;32.6). In relative terms (relative index of inequality), it was 2.8 (95%CI 1.9;4.1), after the age adjustment. CONCLUSIONS Gender inequality in the prevalence of abdominal obesity increases with older age and lower education. The slope and relative indices of inequality summarize the strictly monotonous trend between education levels and abdominal obesity, and it described educational inequality regarding abdominal obesity among women. Such indices provide relevant quantitative estimates for monitoring abdominal obesity and dealing with health inequalities. PMID:26465669

  10. Abdominal radiation causes bacterial translocation

    SciTech Connect

    Guzman-Stein, G.; Bonsack, M.; Liberty, J.; Delaney, J.P.

    1989-02-01

    The purpose of this study was to determine if a single dose of radiation to the rat abdomen leads to bacterial translocation into the mesenteric lymph nodes (MLN). A second issue addressed was whether translocation correlates with anatomic damage to the mucosa. The radiated group (1100 cGy) which received anesthesia also was compared with a control group and a third group which received anesthesia alone but no abdominal radiation. Abdominal radiation lead to 100% positive cultures of MLN between 12 hr and 4 days postradiation. Bacterial translocation was almost nonexistent in the control and anesthesia group. Signs of inflammation and ulceration of the intestinal mucosa were not seen until Day 3 postradiation. Mucosal damage was maximal by Day 4. Bacterial translocation onto the MLN after a single dose of abdominal radiation was not apparently dependent on anatomical, histologic damage of the mucosa.

  11. Abdominal actinomycosis mimicking acute appendicitis.

    PubMed

    Conrad, Robert Joseph; Riela, Steven; Patel, Ravi; Misra, Subhasis

    2015-01-01

    A 52-year-old Hispanic woman presented to the emergency department, reporting worsening sharp lower right quadrant abdominal pain for 3 days. CT of the abdomen and pelvis showed evidence of inflammation in the peritoneal soft tissues adjacent to an enlarged and thick-walled appendix, an appendicolith, no abscess formation and a slightly thickened caecum consistent with acute appendicitis. During laparoscopic appendectomy, the caecum was noted to be firm, raising suspicion of malignancy. Surgical oncology team was consulted and open laparotomy with right hemicolectomy was performed. Pathology reported that the ileocaecal mass was not a malignancy but was, rather, actinomycosis. The patient was discharged after 10 days of intravenous antibiotics in the hospital, with the diagnosis of abdominal actinomycosis. Although the original clinical and radiological findings in this case were highly suggestive of acute appendicitis, abdominal actinomycosis should be in the differential for right lower quadrant pain as it may be treated non-operatively. PMID:26611488

  12. Pancreatic and gastrointestinal trauma in children.

    PubMed

    Grosfeld, J L; Cooney, D R

    1975-05-01

    Injuries to the pancreas and gastrointestinal tract following blunt abdominal trauma continue to be a significant cause of morbidity and mortality in the pediatric age group. Optimal treatment of these injuries is frequently hampered by considerable delays in diagnosis. Factors contributing to these delays include the location of much of the duodenum and the pancreas in the retroperitoneum resulting in an absence of initial symptoms and signs, the often trivial nature of some of the responsible blunt traumatic accidents, inappropriate child-parent or child-physician communication, failure to achieve a meaningful physical examination in uncooperative or unconscious patients, and false negative paracentesis. Eighty per cent of these injuries occurred in boys. Eleven of 16 patients with pancreatic trauma had pseudocysts. A persistently elevated serum amylase level was invariably noted and epigastric mass was palpable in eight patients. Significant delays in diagnosis were prevalent and pseudocysts was misdiagnosed as appendicitis in three cases. Internal drainage by cystgastrostomy or cystjejunostomy was effective operative treatment. In instances of acute pancreatic injuries, sump drains, gastrostomy, cholecystostomy, and total parenteral hyperalimentation were useful therapeutic adjuncts. There was one death for a 6.2 per cent mortality rate. Forty patients had gastrointestinal injuries involving the duodenum in 17, jejunum in 14, ileum in seven, and stomach in two. Perforations occured in 65 per cent of cases, obstructing hematomas in 30 per cent, and mesenteric avulsions in 5 per cent. Associated injuries were observed in 15 patients (37.5 per cent). Pain and tenderness were the only consistent findings. Upper gastrointestinal contrast studies were diagnostic of duodenal hematomas. Eighty per cent of perforations were managed by simple closures and 20 per cent by resection and anastomosis. Obstructing hematomas unassociated with other injuries may be expected to resolve without requiring operation in 50 per cent of patients managed conservatively. Complications occurred in 35 per cent of patients and the mortality rate was 12.5 per cent (five deaths). PMID:1124220

  13. Trauma Patients without a Trauma Diagnosis: The Data Gap

    PubMed Central

    Whedon, James M.; Fulton, Gwen; Herr, Charles H.; von Recklinghausen, Friedrich M.

    2010-01-01

    Background Trauma registries may contain records without a codable trauma diagnosis, creating a “data gap” that multiplies the number of invalid registry data fields. We designed an investigation intended to determine the incidence of registry records with non-codable trauma diagnoses, characterize those records, and determine the reasons for inadequate diagnosis data. Methods We utilized a retrospective cohort design. A query of trauma registry records spanning a five-year period yielded 129 records with no injury severity score. Each patient’s medical record was reviewed, sources of diagnostic information were noted and diagnoses were categorized. Results In 57% of cases, we found documentation that the patient had sustained an injury, but the injury was inadequately documented in the discharge summary. In 19% of cases, although the registry record was valid, the diagnosis was not codable as trauma. In 17% of cases, clinical documentation was adequate, but the diagnosis was inadequately recorded in the trauma registry. In 13% of cases, no traumatic injury was sustained, although the registry record was valid. In 2% of cases, the trauma registry record itself was invalid. In 1% of cases, a coding error occurred. Conclusions Particularly prominent among records with inadequate discharge documentation were cases of head and spine injury for which there was no radiographic evidence. The incidence of records with uncodable diagnoses might best be reduced through improved physician documentation, revision of trauma registry inclusion criteria, increased attention by trauma registrars to key sources of documentation, and direct communication with the attending physician when necessary. PMID:19820591

  14. Abdominal aortic aneurysms: case report

    PubMed Central

    Hadida, Camille; Rajwani, Moez

    1998-01-01

    A 71-year-old male presented to a chiropractic clinic with subacute low back pain. While the pain appeared to be mechanical in nature, radiographic evaluation revealed an abdominal aortic aneurysm, which required the patient to have vascular surgery. This case report illustrates the importance of the history and physical examination in addition to a thorough knowledge of the features of abdominal aortic aneurysms. The application of spinal manipulative therapy in patients with (AAA) is also discussed. ImagesFigure 1Figure 2Figure 3

  15. Fibrolipomas masquerading as abdominal hernias

    PubMed Central

    Watson, Hannah Isabella; Saunders, Andrew John

    2013-01-01

    A 15-year-old Caucasian girl presented to her general practitioner with a tender, irreducible mass in the paraumbilical region. On examination, two small masses could be felt. She was referred to general surgery. Ultrasound imaging and MRI were unremarkable. However, clinical suspicion suggested multiple areas of abdominal wall herniation. The patient was admitted for elective surgery to exclude herniation. At operation, three subcutaneous masses were found but with no evidence of abdominal wall herniation. Histopathology results from the specimens showed mature adipose tissue mixed with fibrous deposits. There was no evidence of malignancy. A diagnosis of fibrolipoma was given. PMID:24343803

  16. Postprandial Vomiting and Abdominal Pain.

    PubMed

    Halper; MacKenzie

    1996-10-01

    A 14-year-old Asian female presented with complaints of abdominal pain that was intermittent, crampy, periumbilical, without radiation, and aggravated by eating. She had been vomiting "green-colored" material 4 days earlier, after meals, associated with abdominal pain. On hospital day 3, after no improvement was noted, an upper GI series demonstrated an obstruction at the third portion of the duodenum. She was evaluated for an eating disorder, but further history failed to elicit diagnostic criteria. She responded favorably to total parenteral nutrition and symptoms were relieved with changes in position. Her symptoms and diagnostic studies were consistent with the diagnosis of superior mesenteric artery (SMA) syndrome. PMID:10359987

  17. Prevalence and risk factors of abdominal obesity in Polish rural children.

    PubMed

    Suder, A; Janusz, M; Jagielski, P; Głodzik, J; Pałka, T; Cisoń, T; Pilch, W

    2015-08-01

    Secular trends of body mass index (BMI) and waist circumference indicate greater increase in abdominal obesity compared to general obesity. Determinants of obesity described by BMI are relatively well documented in various populations, unlike abdominal obesity described by waist-to-height ratio (WHtR). The aim of the study was to determine prevalence and abdominal obesity (WHtR) risk factors in a cohort of 3048 rural children aged 7-12 years from southern Poland. Biological, socio-demographic and lifestyle factors were analysed, and odds ratio and 95% confidence interval were calculated using a logistic regression analysis. The prevalence of abdominal obesity in rural boys and girls in the sample was 11% and 9% respectively. Obesity in both parents, irregular breakfasts, irregular meals during the day and regularly consumed tea were significant factors of abdominal obesity risks in rural girls. Being the only child, low number of people in a household, obesity in both parents, high energy-dense food index and no exercise significantly increased the risk of abdominal obesity in rural boys. The study demonstrated tendencies similar to other European countries in the prevalence of abdominal obesity among sexes. Lifestyle behaviours should be changed and adapted to each sex since risk factors differ between the sexes and indicate higher eco-sensitivity in boys. PMID:25796137

  18. Two similar cases of elderly women with moderate abdominal pain and pneumoperitoneum of unknown origin: a surgeon's successful conservative management.

    PubMed

    Vinzens, Fabrizio; Zumstein, Valentin; Bieg, Christian; Ackermann, Christoph

    2016-01-01

    Patients presenting with abdominal pain and pneumoperitoneum in radiological examination usually require emergency explorative laparoscopy or laparotomy. Pneumoperitoneum mostly associates with gastrointestinal perforation. There are very few cases where surgery can be avoided. We present 2 cases of pneumoperitoneum with unknown origin and successful conservative treatment. Both patients were elderly women presenting to our emergency unit, with moderate abdominal pain. There was neither medical intervention nor trauma in their medical history. Physical examination revealed mild abdominal tenderness, but no clinical sign of peritonitis. Cardiopulmonary examination remained unremarkable. Blood studies showed only slight abnormalities, in particular, inflammation parameters were not significantly increased. Finally, obtained CTs showed free abdominal gas of unknown origin in both cases. We performed conservative management with nil per os, nasogastric tube, total parenteral nutrition and prophylactic antibiotics. After 2 weeks, both were discharged home. PMID:27229749

  19. A Comparative Analysis of Diagnostic Accuracy of Focused Assessment With Sonography for Trauma Performed by Emergency Medicine and Radiology Residents

    PubMed Central

    Zamani, Majid; Masoumi, Babak; Esmailian, Mehrdad; Habibi, Amin; Khazaei, Mehdi; Mohammadi Esfahani, Mohammad

    2015-01-01

    Background: Focused assessment with sonography in trauma (FAST) is a method for prompt detection of the abdominal free fluid in patients with abdominal trauma. Objectives: This study was conducted to compare the diagnostic accuracy of FAST performed by emergency medicine residents (EMR) and radiology residents (RRs) in detecting peritoneal free fluids. Patients and Methods: Patients triaged in the emergency department with blunt abdominal trauma, high energy trauma, and multiple traumas underwent a FAST examination by EMRs and RRs with the same techniques to obtain the standard views. Ultrasound findings for free fluid in peritoneal cavity for each patient (positive/negative) were compared with the results of computed tomography, operative exploration, or observation as the final outcome. Results: A total of 138 patients were included in the final analysis. Good diagnostic agreement was noted between the results of FAST scans performed by EMRs and RRs (κ = 0.701, P < 0.001), also between the results of EMRs-performed FAST and the final outcome (κ = 0.830, P < 0.0010), and finally between the results of RRs-performed FAST and final outcome (κ = 0.795, P < 0.001). No significant differences were noted between EMRs- and RRs-performed FASTs regarding sensitivity (84.6% vs 84.6%), specificity (98.4% vs 97.6%), positive predictive value (84.6% vs 84.6%), and negative predictive value (98.4% vs 98.4%). Conclusions: Trained EMRs like their fellow RRs have the ability to perform FAST scan with high diagnostic value in patients with blunt abdominal trauma. PMID:26756009

  20. The surface landmarks of the abdominal wall: a plea for standardization

    PubMed Central

    Cirocchi, Roberto; Boselli, Carlo; Renzi, Claudio; Cagini, Lucio; Boccolini, Andrea; Noya, Giuseppe; Fingerhut, Abe

    2014-01-01

    Despite centuries of anatomical studies, controversies and contradictions still exist in the literature regarding the definition, anatomical terminology and the limits of the abdominal wall. We conducted a systematic research of books published from 1901 until December 2012 in Google Books. After the index screening, 16 remaining books were further assessed for eligibility. We decided to exclude journals. The aim of the study was to focus on surface landmarks and borders of the abdominal cavity. After this revision of the literature, we propose that the surface landmarks of the abdominal wall should be standardized. PMID:25097589

  1. Liver Trauma During Combined Liposuction and Abdominoplasty: A Rare but Potentially Lethal Complication.

    PubMed

    Gialamas, Eleftherios; Oldani, Graziano; Modarressi, Ali; Morel, Philippe; Toso, Christian

    2015-09-01

    Liposuction is a well-established procedure that is generally safe. However, rare complications can occur. The authors report on a 38-year-old woman who underwent combined abdominoplasty and liposuction at a private clinic. Four hours after the procedure, severe hypovolemic shock developed and required emergency transfer to a tertiary-care center. After primary fluid resuscitation, abdominal ultrasonography and computerized tomography revealed severe right-sided liver trauma, with active bleeding and free intra-abdominal fluid. Two attempts at right hepatic artery embolization failed to fully control the bleeding, and surgical hemostasis was required. After a 2-week hospitalization, the patient was discharged, and she returned to work 3 months later. Although it appears that this is the first reported case of liver trauma during liposuction, this potential complication should be kept in mind and identified early to permit efficient and effective management. PMID:26254474

  2. Childhood and adult trauma experiences of incarcerated persons and their relationship to adult behavioral health problems and treatment.

    PubMed

    Wolff, Nancy; Shi, Jing

    2012-05-01

    Rates of childhood and adult trauma are high among incarcerated persons. In addition to criminality, childhood trauma is associated with the risk for emotional disorders (e.g., depression and anxiety) and co-morbid conditions such as alcohol and drug abuse and antisocial behaviors in adulthood. This paper develops rates of childhood and adult trauma and examines the impact of age-of-onset and type-specific trauma on emotional problems and behavior for a sample of incarcerated males (N~4,000). Prevalence estimates for types of trauma were constructed by age at time of trauma, race and types of behavioral health treatment received while incarcerated. HLM models were used to explore the association between childhood and adult trauma and depression, anxiety, substance use, interpersonal problems, and aggression problems (each model estimated separately and controlling for age, gender, race, time incarcerated, and index offense). Rates of physical, sexual, and emotional trauma were higher in childhood than adulthood and ranged from 44.7% (physical trauma in childhood) to 4.5% (sexual trauma in adulthood). Trauma exposure was found to be strongly associated with a wide range of behavioral problems and clinical symptoms. Given the sheer numbers of incarcerated men and the strength of these associations, targeted intervention is critical. PMID:22754481

  3. A Comparison of Methods for Assessing Penetrating Trauma on Retrospective Multi-Center Data

    PubMed Central

    Ahmed, Bilal A.; Matheny, Michael E.; Rice, Phillip L.; Clarke, John R.; Ogunyemi, Omolola I.

    2009-01-01

    Objective TraumaSCAN-Web (TSW) is a computerized decision support system for assessing chest and abdominal penetrating trauma which utilizes 3D geometric reasoning and a Bayesian network with subjective probabilities obtained from an expert. The goal of the present study is to determine whether a trauma risk prediction approach using a Bayesian network with a predefined structure and probabilities learned from penetrating trauma data is comparable in diagnostic accuracy to TSW. Methods Parameters for two Bayesian networks with expert-defined structures were learned from 637 gunshot and stab wound cases from three hospitals, and diagnostic accuracy was assessed using 10-fold cross validation. The first network included information on external wound locations, while the second network did not. Diagnostic accuracy of learned networks was compared to that of TSW on 194 previously evaluated cases. Results For 23 of the 24 conditions modeled by TraumaSCAN-Web, 16 conditions had Areas Under the ROC Curve (AUCs) greater than 0.90 while 21 conditions had AUCs greater than 0.75 for the first network. For the second network, 16 and 20 conditions had AUCs greater than 0.90 and 0.75 respectively. AUC results for learned networks on 194 previously evaluated cases were better than or equal to AUC results for TSW for all diagnoses evaluated except diaphragm and heart injuries. Conclusions For 23 of the 24 penetrating trauma conditions studied, a trauma diagnosis approach using Bayesian networks with predefined structure and probabilities learned from penetrating trauma data was better than or equal in diagnostic accuracy to TSW. In many cases, information on wound location in the first network did not significantly add to predictive accuracy. The study suggests that a decision support approach that uses parameter-learned Bayesian networks may be sufficient for assessing some penetrating trauma conditions. PMID:18929685

  4. CT in aortic trauma

    SciTech Connect

    Heiberg, E.; Wolverson, M.K.; Sundaram, M.; Shields, J.B.

    1983-06-01

    A diagnosis of aortic transection was made at computed tomography (CT) in four of 10 patients with acute multiple trauma suspected of having thoracic aortic injuries. There were no false-negative or false-positive examinations. The CT findings of an injured aorta were (1) false aneurysm, (2) linear lucency within the opacified aortic lumen caused by the torn edge of the aortic wall, (3) marginal irregularity of the opacified aortic lumen, (4) periaortic or intramural aortic hematoma, and (5) dissection. The extent of associated mediastinal hemorrhage and the amount of blood in the pleural space were not useful as indicators of aortic injury. Similarly, shift of the trachea and esophagus or absence thereof was found in patients with or without aortic tear.

  5. Trauma and religiousness.

    PubMed

    Gostečnik, Christian; Repič Slavič, Tanja; Lukek, Saša Poljak; Cvetek, Robert

    2014-06-01

    Victims of traumatic events who experience re-traumatization often develop a highly ambivalent relationship to God and all religiosity as extremely conflictual. On the one hand, they may choose to blame God for not having protected them, for having left them to feel so alone, for having been indifferent to them or they may even turn their wrath upon God, as the source of cruelty. Often though, the traumas experienced by individuals prompt them to turn to God and religion in search of help. This gives reason for the need of new and up-to-date research that can help elucidate why some people choose to seek help in religion and others turn away from it. PMID:23187617

  6. Lightweight Trauma Module - LTM

    NASA Technical Reports Server (NTRS)

    Hatfield, Thomas

    2008-01-01

    Current patient movement items (PMI) supporting the military's Critical Care Air Transport Team (CCATT) mission as well as the Crew Health Care System for space (CHeCS) have significant limitations: size, weight, battery duration, and dated clinical technology. The LTM is a small, 20 lb., system integrating diagnostic and therapeutic clinical capabilities along with onboard data management, communication services and automated care algorithms to meet new Aeromedical Evacuation requirements. The Lightweight Trauma Module is an Impact Instrumentation, Inc. project with strong Industry, DoD, NASA, and Academia partnerships aimed at developing the next generation of smart and rugged critical care tools for hazardous environments ranging from the battlefield to space exploration. The LTM is a combination ventilator/critical care monitor/therapeutic system with integrated automatic control systems. Additional capabilities are provided with small external modules.

  7. Individual Differences in Trauma Disclosure

    PubMed Central

    Bedard-Gilligan, Michele; Jaeger, Jeff; Echiverri-Cohen, Aileen; Zoellner, Lori A.

    2011-01-01

    Background and Objectives Findings on disclosure and adjustment following traumatic events have been mixed. Better understanding of individual differences in disclosure may help us better understand reactions following trauma exposure. In particular, studying disclosure patterns for those with and without psychopathology and for different types of emotional experiences may help clarify the relationship between disclosure, event emotionality, trauma exposure, and PTSD. Methods In this study, 143 men and women with (n = 67) and without (n = 43) chronic PTSD and without trauma exposure (n = 33) provided information on disclosure for a traumatic/severe life event, a negative event, and a positive event. Results Individuals with PTSD reported greater difficulty disclosing their traumatic event compared to those with trauma exposure no PTSD and those with no-trauma exposure. However, individuals with PTSD reported disclosing the traumatic event a similar number of times and with similar levels of detail to those with trauma exposure but no PTSD. Both sexual and childhood trauma were associated with greater disclosure difficulty. Limitations Although control event types (positive, negative) were selected to control for the passage of time and for general disclosure style, they do not control for salience of the event and results may be limited by control events that were not highly salient. Conclusions The present findings point to a dynamic conceptualization of disclosure, suggesting that the differential difficulty of disclosing traumatic events seen in individuals with PTSD is not simply a function of the amount of disclosure or the amount of details provided. PMID:22080869

  8. Childhood trauma in bipolar disorder

    PubMed Central

    Gallagher, Peter; Dougall, Dominic; Porter, Richard; Moncrieff, Joanna; Ferrier, I Nicol; Young, Allan H

    2014-01-01

    Objective: There has been little investigation of early trauma in bipolar disorder despite evidence that stress impacts on the course of this illness. We aimed to compare the rates of childhood trauma in adults with bipolar disorder to a healthy control group, and to investigate the impact of childhood trauma on the clinical course of bipolar disorder. Methods: Retrospective assessment of childhood trauma was conducted using the Childhood Trauma Questionnaire (CTQ) in 60 outpatients with bipolar disorder being treated for a depressive episode and 55 control participants across two centres in north-east England and New Zealand. Results: Significantly higher rates of childhood trauma were observed in patients with bipolar I and bipolar II disorder compared to controls. Logistic regression, controlling for age and sex, identified emotional neglect to be the only significant CTQ subscale associated with a diagnosis of bipolar disorder. Childhood history of sexual abuse was not a significant predictor. Associations with clinical severity or course were less clear. Conclusions: Childhood emotional neglect appears to be significantly associated with bipolar disorder. Limitations include the relatively small sample size, which potentially increases the risk of type II errors. Replication of this study is required, with further investigation into the neurobiological consequences of childhood trauma, particularly emotional neglect. PMID:24343193

  9. External iliac artery occlusion in a paediatric patient following handlebar trauma

    PubMed Central

    Singla, Animesh A.; McPherson, Danielle; Singla, Apresh A; Cross, Jane; Leslie, Anthony

    2015-01-01

    Arterial occlusion following blunt trauma is an uncommon occurrence. We report an unusual case of delayed external iliac artery occlusion in a young male following blunt abdominal injury. He was successfully treated with thromboendarterectomy and saphenous vein patch repair. There have only been a handful of documented cases occurring in the paediatric population. All patients presenting with groin injury from this mechanism should be carefully investigated and monitored for risk of vascular injury. PMID:25733671

  10. Relationship between socio-economic position and general, maxillofacial and dental trauma: A National Trauma Registry Study.

    PubMed

    Levin, Liran; Lin, Shaul; Goldman, Sharon; Peleg, Kobi

    2010-08-01

    Trauma, a major public health problem, has been extensively studied. However, characteristics of maxillofacial and dental injuries and their association with socio-economic position (SEP) have not been thoroughly documented. This study retrospectively investigated the occurrence of maxillofacial, dental and general trauma in Israel, and examined the relationship between socio-economic status and trauma-related hospitalizations. Records were obtained for all trauma patients hospitalized and recorded in the National Israel Trauma Registry (ITR) between January 1, 2003 and December 31, 2005. Maxillofacial and dental injuries were separated and further analyzed by residence locality and SEP. The socio-economic index, developed by the Israel Central Bureau of Statistics, was used to determine the socio-economic status of 50 selected localities. During the study period, 77 072 trauma patients were hospitalized, of whom 3972 (5%) were diagnosed with maxillofacial or dental injuries. Among the selected localities, 42 303 hospitalizations were recorded, of which 1886 (4.5%) involved maxillofacial or dental injuries. For all traumas, lower injury rates were found among residents living in high socio-economic localities. The difference in hospitalization rates for maxillofacial and dental injuries was not significant. The cause of injury differed by age, SEP and category of injury. A fall (35%) or road crash (33%) caused most of the maxillofacial injuries, with 50% of dental injuries because of a road crash. Intentional injuries constituted 22% of the maxillofacial-related hospitalizations and were more prevalent among adults living in low SEP localities. These data should be used to promote injury prevention programs with emphasis directed at high risk populations. PMID:20455914

  11. Right-sided diaphragmatic rupture after blunt trauma. An unusual entity.

    PubMed

    Vilallonga, Ramon; Pastor, Vicente; Alvarez, Laura; Charco, Ramon; Armengol, Manel; Navarro, Salvador

    2011-01-01

    Traumatic injuries of the diaphragm remain an entity of difficult diagnosis despite having been recognised early in the history of surgery, especially when it comes to blunt trauma and injuries of the right diaphragm. We report the case of a patient with blunt trauma with right diaphragmatic rupture that required urgent surgical treatment for hepatothorax and iatrogenic severe liver injury. Blunt trauma can cause substantial diaphragmatic rupture. It must have a high index of suspicion for diaphragmatic injury in patients, victims of vehicle collisions, mainly if they have suffered frontal impacts and/or side precipitates in patients with severe thoracoabdominal trauma. The diagnosis can be performed clinically and confirmation should be radiological. The general measures for the management of multiple trauma patients must be applied. Surgery at the time of diagnosis should restore continuity. PMID:21244704

  12. Functional Abdominal Pain in Children

    MedlinePlus

    ... abdominal pain. The term “functional” refers to the fact that there is no blockage, inflammation or infection causing the discomfort. Nevertheless, the pain is very real, and is due to extra sensitivity of the digestive organs, sometimes combined with changes ...

  13. An ecological view of psychological trauma and trauma recovery.

    PubMed

    Harvey, M R

    1996-01-01

    This paper presents an ecological view of psychological trauma and trauma recovery. Individual differences in posttraumatic response and recovery are the result of complex interactions among person, event, and environmental factors. These interactions define the interrelationship of individual and community and together may foster or impede individual recovery. The ecological model proposes a multidimensional definition of trauma recovery and suggests that the efficacy of trauma-focused interventions depends on the degree to which they enhance the person-community relationship and achieve "ecological fit" within individually varied recovery contexts. In attending to the social, cultural and political context of victimization and acknowledging that survivors of traumatic experiences may recover without benefit of clinical intervention, the model highlights the phenomenon of resiliency, and the relevance of community intervention efforts. PMID:8750448

  14. The trauma-memory argument.

    PubMed

    Kihlstrom, J F

    1995-03-01

    The trauma-memory argument proposes that memories of childhood trauma can affect adult behavior outside awareness and that such unconscious memories can return to awareness even after long delays. Unfortunately, this conclusion is based on case reports of unknown representativeness and on clinical studies which are methodologically flawed or do not consider alternative explanations. Of particular concern is the general lack of independent verification of the ostensibly forgotten memories. The trauma-memory argument is plausible, in at least some respects, given what we know about the processes of remembering and forgetting, but considerably more research is needed before it can serve as a basis for scientifically sound clinical practice. PMID:7497103

  15. [Damage control in vascular trauma].

    PubMed

    Henzan, Eisei

    2002-07-01

    During the era of frequent occurrence of motor vehicle accidents and criminal injuries with lethal weapons, trauma surgeons have accumulated much experience in managing severely injured victims. Very often, efforts to proceed with definitive repair at initial surgery led to patient death despite the control of anatomic bleeding. Damage control methods were thus developed to save patients who otherwise would hove died. Damage control treatment for vascular trauma patients is still in its infancy in Japan. This paper presents an overview of the relevant reports form international journals dealing with the present status of damage control methods in vascular trauma patients. PMID:12143290

  16. Penetrating trauma audit--TRISS analysis.

    PubMed

    Demetriades, D; Sofianos, C

    1992-12-01

    Quality assurance in trauma care is of major importance in assessing the efficacy of a trauma service and in identifying areas for improvement. Trauma scores and the TRISS methodology are at present the most accurate tools for quality assurance purposes. In this prospective study, the TRISS methodology was used to analyse the results in a group of 629 patients with penetrating trauma. PMID:1295094

  17. Computed tomography in trauma: An atlas approach

    SciTech Connect

    Toombs, B.D.; Sandler, C.

    1986-01-01

    This book discussed computed tomography in trauma. The text is organized according to mechanism of injury and site of injury. In addition to CT, some correlation with other imaging modalities is included. Blunt trauma, penetrating trauma, complications and sequelae of trauma, and use of other modalities are covered.

  18. Secondary Trauma in Children and School Personnel

    ERIC Educational Resources Information Center

    Motta, Robert W.

    2012-01-01

    A review of childhood secondary trauma is presented. Secondary trauma involves the transfer and acquisition of negative affective and dysfunctional cognitive states due to prolonged and extended contact with others, such as family members, who have been traumatized. As such, secondary trauma refers to a spread of trauma reactions from the victim…

  19. Advanced Ultrasonic Diagnosis of Extremity Trauma: The Faster Exam

    NASA Technical Reports Server (NTRS)

    Dulchavsky, S. A.; Henry, S. E.; Moed, B. R.; Diebel, L. N.; Marshburn, T.; Hamilton, D. R.; Logan, J.; Kirkpatrick, A. W.; Williams, D. R.

    2002-01-01

    Ultrasound is of prO)len accuracy in abdominal and thoracic trauma and may be useful to diagnose extremity injury in situations where radiography is not available such as military and space applications. We prospectively evaluated the utility of extremity , ultrasound performed by trained, non-physician personnel in patients with extremity trauma, to simulate remote aerospace or military applications . Methods: Patients with extremity trauma were identified by history, physical examination, and radiographic studies. Ultrasound examination was performed bilaterally by nonphysician personnel with a portable ultrasound device using a 10-5 MHz linear probe, Images were video-recorded for later analysis against radiography by Fisher's exact test. The average time of examination was 4 minutes. Ultrasound accurately diagnosed extremity, injury in 94% of patients with no false positive exams; accuracy was greater in mid-shaft locations and least in the metacarpa/metatarsals. Soft tissue/tendon injury was readily visualized . Extremity ultrasound can be performed quickly and accurately by nonphysician personnel with excellent accuracy. Blinded verification of the utility of ultrasound in patients with extremity injury should be done to determine if Extremity and Respiratory evaluation should be added to the FAST examination (the FASTER exam) and verify the technique in remote locations such as military and aerospace applications.

  20. Management of severe abdominal infections.

    PubMed

    Hasper, Dietrich; Schefold, Joerg C; Baumgart, Daniel C

    2009-01-01

    Abdominal infections are associated with significant morbidity and mortality. Nearly all bacteria causing abdominal infections are derived from the endogenous flora of the alimentary tract. The resulting infection is typically polymicrobial and comprised of both aerobic and anaerobic microbes. They can be classified by their severity as uncomplicated and complicated or by their origin as community or hospital acquired. Escherichia coli and Bacteroides fragilis are the most frequently isolated bacteria in community-acquired abdominal infections. Nosocomial infections typically involve a more resistant flora (e.g. Pseudomonas spp., Acinetobacter spp., Gram-negative bacilli producing extended-spectrum beta-lactamases [ESBL], vancomycin-resistant enterococci [VRE] and methicillin-resistant Staphylococcus aureus [MRSA]). Antimicrobial therapy should be guided by microbiological testing and frequently requires other interventions as well. In uncomplicated infections antimicrobial prophylaxis for < 24h may be considered. Patients with underlying or acquired immunodeficiency, i.e. organ transplant recipients and other patients on complex immunosuppressant regimens require special attention and antimicrobial coverage. We discuss the relevant microbiota, a rational diagnostic and therapeutic approach including strategies to handle challenging infections. The application of novel compounds and/or drug classes for abdominal infections such as glycylcyclines (i.e. tigecycline), glycopeptides (i.e. dalbavancin, telavancin, oritavancin), carbapenems (i.e. doripenem), and forth generation cephalosporins (i.e. ceftaroline, ceftobiprole) as well as patents on metalloproteinase and caspase inhibitors, interleukin antagonists, fusion proteins and nitric oxide donators is critically reviewed. The information is summarized in flow charts and algorithms for use in daily clinical practice and the review article also shows the useful information of the patents for the treatment of abdominal infections. PMID:19149697

  1. Asthma May Raise Risk for Abdominal Aneurysm

    MedlinePlus

    ... to be at an increased risk of abdominal aortic aneurysm, a new study suggests. An abdominal aortic aneurysm is a weak spot in the body's main ... those without recent asthma activity. "People with abdominal aortic aneurysm who were diagnosed with asthma within the past ...

  2. Abdominal cocoon secondary to disseminated tuberculosis.

    PubMed

    Puppala, Radha; Sripathi, Smiti; Kadavigere, Rajagopal; Koteshwar, Prakashini; Singh, Jyoti

    2014-01-01

    Abdominal cocoon, also known as sclerosing encapsulating peritonitis, represents a rare entity where a variable length of the small bowel is enveloped by a fibrocollagenous membrane giving the appearance of a cocoon. It may be asymptomatic and is often diagnosed incidentally at laparotomy. We present a rare case of abdominal cocoon due to abdominal tuberculosis. PMID:25239980

  3. Sexual trauma, spirituality, and psychopathology.

    PubMed

    Krejci, Mark J; Thompson, Kevin M; Simonich, Heather; Crosby, Ross D; Donaldson, Mary Ann; Wonderlich, Stephen A; Mitchelle, James E

    2004-01-01

    This study assessed the association between spirituality and psychopathology in a group of sexual abuse victims and controls with a focus on whether spirituality moderated the association between sexual trauma and psychopathology. Seventy-one sexual trauma victims were compared to 25 control subjects on spiritual well-being, the Eating Disorder Examination, the PTSD Symptom Scale, and the SCID-I/P. The data showed that the two groups did not differ in terms of spiritual well-being. Sexual trauma status was associated with most of the psychopathology outcomes, but its impact on psychopathology was largely unmoderated by spirituality. Among sexual trauma victims, the level of spiritual well-being did not alter the probability of current psychopathology. However, increased spiritual well-being was generally associated with lower psychopathology for the entire sample. PMID:15388413

  4. Mechanical Intestinal Obstruction in a Porcine Model: Effects of Intra-Abdominal Hypertension. A Preliminary Study

    PubMed Central

    Sánchez-Margallo, F. M.; Latorre, R.; López-Albors, O.; Wise, R.; Malbrain, M. L. N. G.; Castellanos, G.

    2016-01-01

    Introduction Mechanical intestinal obstruction is a disorder associated with intra-abdominal hypertension and abdominal compartment syndrome. As the large intestine intraluminal and intra-abdominal pressures are increased, so the patient’s risk for intestinal ischaemia. Previous studies have focused on hypoperfusion and bacterial translocation without considering the concomitant effect of intra-abdominal hypertension. The objective of this study was to design and evaluate a mechanical intestinal obstruction model in pigs similar to the human pathophysiology. Materials and Methods Fifteen pigs were divided into three groups: a control group (n = 5) and two groups of 5 pigs with intra-abdominal hypertension induced by mechanical intestinal obstruction. The intra-abdominal pressures of 20 mmHg were maintained for 2 and 5 hours respectively. Hemodynamic, respiratory and gastric intramucosal pH values, as well as blood tests were recorded every 30 min. Results Significant differences between the control and mechanical intestinal obstruction groups were noted. The mean arterial pressure, cardiac index, dynamic pulmonary compliance and abdominal perfusion pressure decreased. The systemic vascular resistance index, central venous pressure, pulse pressure variation, airway resistance and lactate increased within 2 hours from starting intra-abdominal hypertension (p<0.05). In addition, we observed increased values for the peak and plateau airway pressures, and low values of gastric intramucosal pH in the mechanical intestinal obstruction groups that were significant after 3 hours. Conclusion The mechanical intestinal obstruction model appears to adequately simulate the pathophysiology of intestinal obstruction that occurs in humans. Monitoring abdominal perfusion pressure, dynamic pulmonary compliance, gastric intramucosal pH and lactate values may provide insight in predicting the effects on endorgan function in patients with mechanical intestinal obstruction. PMID:26849559

  5. Pretransfer computed tomography delays arrival to definitive care without affecting pediatric trauma outcomes

    PubMed Central

    Fahy, Aodhnait S.; Antiel, Ryan M.; Polites, Stephanie F.; Ishitani, Michael B.; Moir, Christopher R.; Zielinski, Martin D.

    2016-01-01

    Purpose Children with thoracic or abdominal trauma, presenting to referring hospitals, may undergo CT imaging prior to transfer to a pediatric trauma center (PTC). We sought to determine if children who undergo pretransfer imaging experience a delay in definitive care and worse clinical outcomes. Methods Pediatric blunt trauma patients transferred to our level I PTC were identified in this IRB approved study. Those transferred with CT imaging of the chest or abdomen/pelvis prior to transfer were compared to those transferred without imaging. Results Of 246 patients with a mean age of 12.4 ± 5.3 years (64% male), 128 patients (52%) underwent chest (n = 85) and/or abdominal (n = 115) CT studies prior to transfer. Among those patients with pretransfer CT, 14% of CT scans were repeated. On multivariate analysis accounting for distance, time from injury to arrival at our PTC was significantly greater in children who underwent pretransfer CT (320 ± 216 vs. 208 ± 149 minutes, p < 0.001). Median length of stay (3 vs. 3 days) and mortality (3% vs. 3%) were similar between groups (all p > 0.05). Conclusions A substantial number of pediatric blunt trauma patients underwent CT scans prior to transfer, which is associated with a delay in transfer but not worse outcomes. PMID:26778842

  6. Rehabilitation after major extremity trauma.

    PubMed

    Wallace, George F

    2014-10-01

    Physical therapy is an integral part of rehabilitation after foot and ankle trauma. Workman's compensation may play a role in treatment, prognosis, and added bureaucracy. The foot and ankle surgeon needs to be able to determine when maximum medical improvement has been reached. Patients with foot and ankle trauma must have a coordinated care plan, which may include a case manager, a physician conducting an independent medical examination, and possibly, legal counsel. PMID:25281518

  7. Trauma and the wise baby.

    PubMed

    Kilborne, Benjamin

    2011-09-01

    This paper expands upon Ferenczi's concept of the wise baby and explores the dynamics of ignorance and compensatory ideals of wisdom as reactions to trauma and as manifestations of "double conscience," shame dynamics and Oedipal shame. Focusing on feelings of ignorance, of knowing and not knowing and their relation to trauma, the author elaborates on the dynamics of fantasies of wisdom, adumbrating implications for psychoanalytic technique. PMID:21818096

  8. [Airbag-associated ocular trauma].

    PubMed

    Muallem, M; Garzozi, H

    1997-12-15

    Airbags have received widespread recognition as an effective means of enhancing automobile safety. They are particularly effective in frontal and front angle collisions which otherwise would be fatal or cause serious injuries. Inflation of the bag helps protect the driver and front-seat-passenger from hitting the steering wheel, dashboard or windshield. In frontal crashes airbags have reduced driver deaths, hospital admission rates, and incidence of brain injury. On the other hand, an increasing variety of airbag-associated organ injuries has been reported, including blunt ocular and chemical trauma, 2 cases of ocular trauma due to airbags which resulted in choroidal rupture with disastrous outcome in terms of visual acuity are presented. Since the very first report in May 1991 of airbag-associated ocular trauma until June 1996, there has apparently been only 1 case of choroidal rupture due to airbag-associated trauma, presented in 1 sentence of a brief report. Although airbag-related eye trauma may be relatively infrequent, the severity of the injuries incurred, especially when the posterior segment of the eye was involved, warrants research on new airbag design that minimizes the risk of ocular injury. Meanwhile all cases of airbag-associated ocular trauma should be reported, so that medical staff, the general population and car manufacturers will become more aware of this medical issue. PMID:9451872

  9. Perihepatic Packing versus Primary Surgical Repair in Patients with Blunt Liver Trauma; an 8-year Experience

    PubMed Central

    Paydar, Shahram; Mahmoodi, Mojtaba; Jamshidi, Mohammad; Niakan, Hadi; Keshavarz, Mohammad; Moeenvaziri, Nader; Ghorbaninejad, Mohammad Esmaeil; Farrokhnia, Farnaz; Izadi Fard, Forough; Jaafari, Zahra; Golshan, Yalda; Abbasi, Hamidreza; Bolandparvaz, Shahram; Honarvar, Behnam

    2014-01-01

    Objective: To explore the pros and cons of early versus delayed intervention when dealing with severe blunt liver injury with significant hemoperitoneum and hemodynamic instability. Methods: This retrospective cross-sectional study was performed at the Nemazi hospital, Shiraz, Southern Iran, level I trauma Center affiliated with Shiraz University of Medical Sciences. The study population comprised of all patients who were operated with the impression of blunt abdominal trauma and confirmed diagnosis of liver trauma during an 8-year period. All data were extracted from patients’ hospital medical records during the study period. The patients’ outcome was compared between those who underwent perihepatic packing or primary surgical repair. Results: Medical records of 76 patients with blunt abdominal liver trauma who underwent surgical intervention were evaluated. Perihepatic packing was performed more in patients who have been transferred to operation room  due to unstable hemodynamics (p<0.001) as well as in patients with more than 1000 milliliters of hemoperitoneum based on pre-operative imaging studies (e.g. CT/US) (p=0.002). Conclusion: We recommend that trauma surgeons should approach perihepatic packing earlier in patients who have been developed at least two of these three criteria; unstable hemodynamics, more  than  1000 milliliters hemoperitoneum  and  more  than  1600 milliliters of intra-operative  estimated blood  loss. We believe that considering these criteria will help trauma surgeons to diagnose and treat high risk patients in time so significant hemorrhage (e.g. caused by dilatational coagulopathy, hypothermia and acidosis, etc.) can ultimately be prevented and more lives can be saved.

  10. Trauma of the midface

    PubMed Central

    Kühnel, Thomas S.; Reichert, Torsten E.

    2015-01-01

    Fractures of the midface pose a serious medical problem as for their complexity, frequency and their socio-economic impact. Interdisciplinary approaches and up-to-date diagnostic and surgical techniques provide favorable results in the majority of cases though. Traffic accidents are the leading cause and male adults in their thirties are affected most often. Treatment algorithms for nasal bone fractures, maxillary and zygomatic fractures are widely agreed upon whereas trauma to the frontal sinus and the orbital apex are matter of current debate. Advances in endoscopic surgery and limitations of evidence based gain of knowledge are matters that are focused on in the corresponding chapter. As for the fractures of the frontal sinus a strong tendency towards minimized approaches can be seen. Obliteration and cranialization seem to decrease in numbers. Some critical remarks in terms of high dose methylprednisolone therapy for traumatic optic nerve injury seem to be appropriate. Intraoperative cone beam radiographs and preshaped titanium mesh implants for orbital reconstruction are new techniques and essential aspects in midface traumatology. Fractures of the anterior skull base with cerebrospinal fluid leaks show very promising results in endonasal endoscopic repair. PMID:26770280

  11. Post-war trauma.

    PubMed

    Hogan, C

    1995-12-01

    One of the great delights of general practice is the way we are allowed to share people's lives. Another facet is the humbling experience of having a patient intuitively grasp a concept that you have found difficult to understand. As regular readers of these pages are aware, I am no stranger to emergencies and trauma. Consequently I see and experience critical incident stress at first hand. This gives me some understanding of others' experiences and, I hope, might help me prevent critical incident stress developing into the more severe post-traumatic stress disorder (PTSD) in those under my care. How well I recall that it was only the fall of a marble that prevented me from being conscripted for service in Vietnam. Kerry is a long-standing patient and an old friend (in a small community, if your patients aren't your friends, you do not have too many patients!). He was seeing me for something or other when he told me the following story. I was so impressed that I asked him to write it down. It speaks eloquently of the aftermath of war and how mates help each other deal with it. It also reminds us that there continue to be new crops of returned service-men who need our help. PMID:8588756

  12. Trauma and termination.

    PubMed

    Ferraro, F

    1995-02-01

    The author suggests a particular reading of the thesis put forward by Freud in 'Analysis terminable and interminable' that an effective and more definitive conclusion may be expected in analyses of cases with traumatic aetiology. This reading shifts the emphasis from the patient's history to the possibility of its crystallising in focal nuclei emerging within the analytic relationship under the pressure of the termination. The revival of separation anxieties which cannot be worked through, and their crystallisation in precipitating traumatic events, may give rise to decisive psychic work allowing the analysis to be brought to a conclusion. Two case histories are presented to show how the end of the analysis assumes the form of a new trauma, which reactivates in the present, traumatic anxieties from the patient's own infantile history. In the first case a premature birth and in the second a miscarriage, originally experienced as isolated automatic events without time or history, are relived in the terminal phase as vicissitudes of the transference, so that new meaning can be assigned to them and they can be withdrawn from the somatic cycle of repetition. The powerful tendency to act out and the intense countertransference pressure on the analyst are discussed in the light of the specificities of this phase, which is crucial to the success of the analysis. This leads to a re-examination, in the concluding notes, of some theoretical questions inherent in the problem of the termination and, in particular, to a discussion of the ambiguous concept of a natural ending. PMID:7775037

  13. [Abdominal bruit associated with hypertension].

    PubMed

    Fontseré, N; Bonet, J; Bonal, J; Romero, R

    2004-01-01

    First cause of secondary hypertension is renovascular hypertension which presents abdominal bruit in 16 to 20% of cases. This clinical sign is also associated with other vascular disease of the abdomen such as celiac trunk stenosis and/or aneurysms located on the pancreaticoduodenal or gastroduodenal arcs level, with little representation among aneurysm. They usually appear on a context of digestive complications like neoplasias, chronic pancreatitis or gastric obstructions possibly with obstructive icterus, hemorrhage and acute abdomen episodes. Its presentation in other contexts is rare and constitutes a diagnostic challenge. Diagnosis is made by abdominal arteriography which is the best method because you can locate the problem as well as intervene therapeutically with embolization of the aneurysme. We would like to emphasize the importance of a quick diagnosis due to the risk of rupture and the high morbi-mortality associated. PMID:15219082

  14. Acute Abdominal Pain in Children.

    PubMed

    Reust, Carin E; Williams, Amy

    2016-05-15

    Acute abdominal pain accounts for approximately 9% of childhood primary care office visits. Symptoms and signs that increase the likelihood of a surgical cause for pain include fever, bilious vomiting, bloody diarrhea, absent bowel sounds, voluntary guarding, rigidity, and rebound tenderness. The age of the child can help focus the differential diagnosis. In infants and toddlers, clinicians should consider congenital anomalies and other causes, including malrotation, hernias, Meckel diverticulum, or intussusception. In school-aged children, constipation and infectious causes of pain, such as gastroenteritis, colitis, respiratory infections, and urinary tract infections, are more common. In female adolescents, clinicians should consider pelvic inflammatory disease, pregnancy, ruptured ovarian cysts, or ovarian torsion. Initial laboratory tests include complete blood count, erythrocyte sedimentation rate or C-reactive protein, urinalysis, and a pregnancy test. Abdominal radiography can be used to diagnose constipation or obstruction. Ultrasonography is the initial choice in children for the diagnosis of cholecystitis, pancreatitis, ovarian cyst, ovarian or testicular torsion, pelvic inflammatory disease, pregnancy-related pathology, and appendicitis. Appendicitis is the most common cause of acute abdominal pain requiring surgery, with a peak incidence during adolescence. When the appendix is not clearly visible on ultrasonography, computed tomography or magnetic resonance imaging can be used to confirm the diagnosis. PMID:27175718

  15. Trauma-Informed Care in the Massachusetts Child Trauma Project.

    PubMed

    Bartlett, Jessica Dym; Barto, Beth; Griffin, Jessica L; Fraser, Jenifer Goldman; Hodgdon, Hilary; Bodian, Ruth

    2016-05-01

    Child maltreatment is a serious public health concern, and its detrimental effects can be compounded by traumatic experiences associated with the child welfare (CW) system. Trauma-informed care (TIC) is a promising strategy for addressing traumatized children's needs, but research on the impact of TIC in CW is limited. This study examines initial findings of the Massachusetts Child Trauma Project, a statewide TIC initiative in the CW system and mental health network. After 1 year of implementation, Trauma-Informed Leadership Teams in CW offices emerged as key structures for TIC systems integration, and mental health providers' participation in evidence-based treatment (EBT) learning collaboratives was linked to improvements in trauma-informed individual and agency practices. After approximately 6 months of EBT treatment, children had fewer posttraumatic symptoms and behavior problems compared to baseline. Barriers to TIC that emerged included scarce resources for trauma-related work in the CW agency and few mental providers providing EBTs to young children. Future research might explore variations in TIC across service system components as well as the potential for differential effects across EBT models disseminated through TIC. PMID:26564909

  16. Trauma Training and Workload: A National Survey.

    PubMed

    McSorley, K; Quinlan, J

    2015-09-01

    Trauma is a major source of mortality and morbidity throughout Ireland. Training in trauma is dependant on experience gained by trainees within specific posts. Trauma services are a topical issue at present with much discussion about delivery and restructuring. With this in mind we conducted an online survey of trainees in emergency medicine, orthopaedic and general surgery to assess current experience and opinions with regard to trauma. The survey was vetted and distributed by the relevant training bodies. 59(98.33%) respondents believed smaller units should be bypassed for major trauma and 55 (91.67%) believed that larger hospitals receiving major trauma should have a trauma theatre available 24-hours a day. 55 (91.67%) also foresaw themselves covering major trauma as consultants, consequently these trainees will be the consultants developing, moulding and working in this restructured trauma service. PMID:26485831

  17. Confessed abusive blunt head trauma.

    PubMed

    De Leeuw, Marc; Beuls, Emile; Parizel, Paul; Jorens, Philippe; Jacobs, Werner

    2013-06-01

    It is generally accepted that terms referring to specific craniocerebral injury mechanisms must be replaced by the more general term abusive head trauma (AHT). Although blunt impact trauma remains an essential part of AHT, it has received far less attention in the literature than shaken-impact injuries. The current article presents 19 confessed cases of a series of 47 highly suspected AHT cases. Of these, 13 were confessed shaken-impact cases, and the other 6 confessed blunt trauma cases. There were no significant differences in the appearance of subdural hematoma, which was present in each case. Retinal hemorrhage, which was present in 10 of the 13 shaken-impact cases in which an ophthalmologic examination was conducted, occurred in 2 of the 6 blunt trauma cases. In 1 case, retinal hemorrhage probably had of metabolic origin. Skull fractures with an overlying subgaleal hematoma and a subdural hematoma below the fracture side were found in 5 of the blunt trauma cases but was also seen in the 2 shaken-impact cases with a skull fracture. The most important finding was a lucid interval (LI) in 3 blunt AHT cases. An LI does not seem to occur in shaking injuries because of the immediate and persistent effect of brain damage that such injuries involve. Therefore, LI makes it important to conduct a detailed investigation of the clinical course in time in suspected AHT cases. PMID:23629386

  18. Trauma, attachment, and intimate relationships.

    PubMed

    Zurbriggen, Eileen L; Gobin, Robyn L; Kaehler, Laura A

    2012-01-01

    Intimate relationships can both affect and be affected by trauma and its sequelae. This special issue highlights research on trauma, attachment, and intimate relationships. Several themes emerged. One theme is the exploration of the associations between a history of trauma and relational variables, with an emphasis on models using these variables as mediators. Given the significance of secure attachment for healthy relationships, it is not surprising that attachment emerges as another theme of this issue. Moreover, a key component of relationships is trust, and so a further theme of this issue is betrayal trauma (J. J. Freyd, 1996 ). As the work included in this special issue makes clear, intimate relationships of all types are important for the psychological health of those exposed to traumatic events. In order to best help trauma survivors and those close to them, it is imperative that research exploring these issues be presented to research communities, clinical practitioners, and the public in general. This special issue serves as one step toward that objective. PMID:22375803

  19. The study of psychic trauma.

    PubMed

    Bacciagaluppi, Marco

    2011-01-01

    This article starts from the DSM definition of psychic trauma. A central source in this field is the 1992 book by Judith Herman. One line of investigation is the sexual abuse of women and children. In an early phase, both Janet and Freud described dissociation as a reaction to trauma. In 1897, Freud disputed the reality of sexual trauma, a position countered later by Ferenczi. In a later phase, this subject was investigated by the American feminist movement. Studies of physical abuse are then described, followed by mental abuse and neglect. Another line of investigation is combat neurosis. The two lines converged in the definition of PTSD and its incorporation into the DSM in 1980. The views on trauma of John Bowlby and Alice Miller are also discussed. The integration of the relational model in psychoanalysis with the trauma literature is presented. The most recent advances are located in neurobiology. The discussion makes a preliminary investigation of the remote causes of war and sexual violence. PMID:21902510

  20. [Pre- and perimortem bone trauma vs. postmortem damages-- Principles of differentiation].

    PubMed

    Holz, Franziska; Birngruber, Christoph G; Verhoff, Marcel A

    2015-01-01

    In medicolegal practice, evidence of trauma or damage on human skeletons or single bones raises the question whether this was inflicted in an antemortem, perimortem, or postmortem time frame. Trauma that occurred around the time of death, i. e., perimortem trauma, is of special forensic interest, as it can yield clues about the manner and cause of death. Perimortem traumas thus need to be carefully distinguished both from antemortem injuries that were evidently survived (these can still be useful for identification purposes) and from postmortem damage, as may occur during retrieval of remains. This study offers an up-to-date review of the specialist literature, e. g. textbooks and pubmed-listed publications, identifying differentiation criteria for ante- and perimortem traumas and postmortem damage. The results that are useful for practice in actual medicolegal casework are presented, and an overview of all macroscopically visible criteria (including simple magnifications, i. e., magnifying glass) that can be used to distinguish between ante- and perimortem traumas on the one side, and postmortem damage on the other is given. The difficulty of distinguishing antemortem trauma and postmortem damage from perimortem trauma rises sharply the closer in time they were inflicted to the time of the death event. Additional postmortem changes due to exposure of the bones to the surrounding deposition conditions may also occur after the relevant postmortem damage or antemortem trauma was inflicted and further complicate the problem. In this context, the "perimortem interval" and the "Fracture Freshness Index" (FFI) are discussed as means to classify the time frame of traumas. PMID:26399122

  1. Transfusion medicine in trauma patients

    PubMed Central

    Murthi, Sarah B; Dutton, Richard P; Edelman, Bennett B; Scalea, Thomas M; Hess, John R

    2011-01-01

    Injured patients stress the transfusion service with frequent demands for uncrossmatched red cells and plasma, occasional requirements for large amounts of blood products and the need for new and better blood products. Transfusion services stress trauma centers with demands for strict accountability for individual blood component units and adherence to indications in a clinical field where research has been difficult, and guidance opinion-based. New data suggest that the most severely injured patients arrive at the trauma center already coagulopathic and that these patients benefit from prompt, specific, corrective treatment. This research is clarifying trauma system requirements for new blood products and blood-product usage patterns, but the inability to obtain informed consent from severely injured patients remains an obstacle to further research. PMID:21083009

  2. Ventilatory strategies in trauma patients

    PubMed Central

    Arora, Shubhangi; Singh, Preet Mohinder; Trikha, Anjan

    2014-01-01

    Lung injury in trauma patients can occur because of direct injury to lung or due to secondary effects of injury elsewhere for example fat embolism from a long bone fracture, or due to response to a systemic insult such as; acute respiratory distress syndrome (ARDS) secondary to sepsis or transfusion related lung injury. There are certain special situations like head injury where the primary culprit is not the lung, but the brain and the ventilator strategy is aimed at preserving the brain tissue and the respiratory system takes a second place. The present article aims to delineate the strategies addressing practical problems and challenges faced by intensivists dealing with trauma patients with or without healthy lungs. The lung protective strategies along with newer trends in ventilation are discussed. Ventilatory management for specific organ system trauma are highlighted and their physiological base is presented. PMID:24550626

  3. Evoked responses after head trauma.

    PubMed

    Harmony, T; Alvarez, A

    1981-12-01

    A neurological examination, routine EEG and a battery of evoked responses (i. e. to a flash, to a checkerboard pattern, to three different tones and to the electrical stimulation of the median nerves) were performed in 14 patients within 24 hours, after one month, six months and a year after head trauma. The results have shown a significant correlation between the number of low R values in the first study and both severeness of the trauma and the clinical evolution a year later. ERs appeared to be - unlike the native EEG - a powerful measure for recommending prophylactic treatment in those traumas which are generally considered to produce slight brain damage, but may provoke a post-traumatic epilepsy and/or great memory deficits. This correlation also shows that bad prognosis may be anticipated in cases with widespread ERs' abnormalities. PMID:7336873

  4. Internuclear ophthalmoplegia after head trauma.

    PubMed

    Beck, R W; Meckler, R J

    1981-06-01

    Internuclear ophthalmoplegia results from impairment of the medial longitudinal fasciculus. Multiple sclerosis is usually the cause in bilateral cases while a vascular lesion is commonly implicated in unilateral cases. Head trauma is a rare cause. We describe the case of a 52-year-old man who developed unilateral internuclear ophthalmoplegia following a head injury suffered in an automobile accident. Gradual improvement in the internuclear ophthalmoplegia occurred over a six-month follow-up period. Review of the literature reveals only ten previous reports of internuclear ophthalmoplegia secondary to head injury. In seven of these cases the internuclear ophthalmoplegia was the direct result of the trauma and in three it occurred only after subdural hematoma formation. These ten cases are summarized. Several theories for the pathophysiology of trauma-induced internuclear ophthalmoplegia are presented. PMID:7258960

  5. Trauma, stress and multiple sclerosis.

    PubMed

    Martinelli, V

    2000-01-01

    It has been suggested that physical trauma, involving the cervical spinal cord or the brain, and psychological stress may precede MS onset or may influence the disease course, although this hypothesis has mainly come from anecdotal case reports or small uncontrolled or controlled studies. So far there are no studies providing a clear causative relationship between physical trauma (especially head trauma) and MS onset, exacerbation or progression of the disease. On the other hand, recent MRI and experimental studies, supporting the important role of nervous and immune system interactions, particularly by the hypothalamic-pituitary-adrenal axis and by the sympathetic nervous pathways, seem to demonstrate a significant correlation between stress and MS exacerbations. Further frequent MRI and immunological evaluations should be warranted to objectively document the temporal association between stress and clinical and/or sub-clinical disease activity. PMID:11205361

  6. Penetrating ocular trauma associated with blank cartridge

    PubMed Central

    2014-01-01

    Background Blank cartridge guns are generally regarded as being harmless and relative safe. However recent published articles demonstrated that the gas pressure from the exploding propellant of blank cartridge is powerful enough to penetrate the thoracic wall, abdominal muscle, small intestine and the skull. And there has been a limited number of case reports of ocular trauma associated with blank cartridge injury. In addition, no report on case with split extraocular muscle injury with traumatic cataract and penetrating corneoscleral wound associated with blank cartridge has been previously documented. This report describes the case of patient who sustained penetrating ocular injury with extraocular muscle injury by a close-distance blank cartridge that required surgical intervention. Case presentation A 20-year-old man sustained a penetrating globe injury in the right eye while cleaning a blank cartridge pistol. His uncorrected visual acuity at presentation was hand motion and he had a flame burn of his right upper and lower lid with multiple missile wounds. On slit-lamp examination, there was a 12-mm laceration of conjunctiva along the 9 o'clock position with two pinhole-like penetrating injuries of cornea and sclera. There was also a 3-mm corneal laceration between 9 o'clock and 12 o'clock and the exposed lateral rectus muscle was split. Severe Descemet's membrane folding with stromal edema was observed, and numerous yellow, powder-like foreign bodies were impacted in the cornea. Layered anterior chamber bleeding with traumatic cataract was also noted. Transverse view of ultrasonography showed hyperechoic foreign bodies with mild reduplication echoes and shadowing. However, a computed tomographic scan using thin section did not reveal a radiopaque foreign body within the right globe. Conclusion To our best knowledge, this is the first case report of split extraocular muscle injury with traumatic cataract and penetrating ocular injury caused by blank cartridge injury. Intraocular foreign bodies undetectable by CT were identified by B-scan ultrasonography in our patient. This case highlights the importance of additional ultrasonography when evaluating severe ocular trauma. And ophthalmologists should consider the possibility of penetrating injury caused by blank ammunition. PMID:24589340

  7. Computed tomography arterial portography for assessment of portal vein injury after blunt hepatic trauma

    PubMed Central

    Fu, Chen-Ju; Wong, Yon-Cheong; Tsang, Yuk-Ming; Wang, Li-Jen; Chen, Huan-Wu; Ku, Yi-Kang; Wu, Cheng-Hsien; Chen, Huan-Wen; Kang, Shih-Ching

    2015-01-01

    PURPOSE Intrahepatic portal vein injuries secondary to blunt abdominal trauma are difficult to diagnose and can result in insidious bleeding. We aimed to compare computed tomography arterial portography (CTAP), reperfusion CTAP (rCTAP), and conventional computed tomography (CT) for diagnosing portal vein injuries after blunt hepatic trauma. METHODS Patients with blunt hepatic trauma, who were eligible for nonoperative management, underwent CTAP, rCTAP, and CT. The number and size of perfusion defects observed using the three methods were compared. RESULTS A total of 13 patients (seven males/six females) with a mean age of 34.5±14.1 years were included in the study. A total of 36 hepatic segments had perfusion defects on rCTAP and CT, while there were 47 hepatic segments with perfusion defects on CTAP. The size of perfusion defects on CT (239 cm3; interquartile range [IQR]: 129.5, 309.5) and rCTAP (238 cm3; IQR: 129.5, 310.5) were significantly smaller compared with CTAP (291 cm3; IQR: 136, 371) (both, P = 0.002). CONCLUSION Perfusion defects measured by CTAP were significantly greater than those determined by either rCTAP or CT in cases of blunt hepatic trauma. This finding suggests that CTAP is superior to rCTAP and CT in evaluating portal vein injuries after blunt liver trauma. PMID:26268303

  8. Trauma-Informed or Trauma-Denied: Principles and Implementation of Trauma-Informed Services for Women

    ERIC Educational Resources Information Center

    Elliott, Denise E.; Bjelajac, Paula; Fallot, Roger D.; Markoff, Laurie S.; Reed, Beth Glover

    2005-01-01

    In this article, we attempt to bridge the gap between practice (service delivery) and philosophy (trauma theory, empowerment, and relational theory). Specifically, we identify 10 principles that define trauma-informed service, discuss the need for this type of service, and give some characteristics of trauma-informed services in eight different…

  9. Thromboembolic Disease After Orthopedic Trauma.

    PubMed

    Whiting, Paul S; Jahangir, A Alex

    2016-04-01

    Orthopedic trauma results in systemic physiologic changes that predispose patients to venous thromboembolism (VTE). In the absence of prophylaxis, VTE incidence may be as high as 60%. Mechanical and pharmacologic thromboprophylaxis are effective in decreasing rates of VTE. Combined mechanical and pharmacologic thromboprophylaxis is more efficacious for decreasing VTE incidence than either regimen independently. If pharmacologic thromboprophylaxis is contraindicated, mechanical prophylaxis should be used. Patients with isolated lower extremity fractures who are ambulatory, or those with isolated upper extremity trauma, do not require pharmacologic prophylaxis in the absence of other VTE risk factors. PMID:26772942

  10. [Prehospital treatment of severe trauma].

    PubMed

    Kill, Clemens

    2007-10-01

    The prehospital management of patients with severe trauma should focus on stabilization of vital signs. Major goal is the early transport in a specialized trauma center. After immobilization of cervical spine maintenance of oxygen delivery is the primary and most important intervention. Unconscious patients and patients with respiratory distress should receive endotracheal intubation and controlled ventilation on scene. Amounts of Infusion should be decided on blood loss, patients with traumatic brain injury need at least a normotensive blood pressure. Patients with uncontrolled severe bleeding should not receive excessive infusion before urgent surgical treatment can be performed. Prehospital induction of anesthesia must be carefully considered because of the enhanced risk. PMID:17968768

  11. [Polyvagal theory and emotional trauma].

    PubMed

    Leikola, Anssi; Mäkelä, Jukka; Punkanen, Marko

    2016-01-01

    According to the polyvagal theory, the autonomic nervous system can, in deviation from the conventional theory, be divided in three distinct parts that are in hierarchical relationship with each other. The most-primitive autonomic control results in depression of vital functions, the more evolved one in fighting or escape and the most evolved one in social involvement. Practical application of the polyvagal theory has resulted in positive results above all in the treatment of emotional trauma. in Finland, therapy of complex trauma is founded on the theory of structural dissociation of the personality, which together with the polyvagal theory forms a practical frame of reference for psychotherapeutic work. PMID:27044181

  12. [Physical trauma and multiple sclerosis].

    PubMed

    Weilbach, F X; Hartung, H P

    1997-12-01

    Without a more detailed knowledge of etiology and pathogenesis of multiple sclerosis final conclusions regarding an association between physical trauma and the onset or course of multiple sclerosis cannot be drawn. Only a few prospective studies which are appropriately designed to prove a putative correlation have been published. A critical review of these studies and some case reports, in the light of the current pathophysiological concepts of multiple sclerosis, does not indicate a causal relationship between physical trauma and onset of multiple sclerosis or exacerbations. PMID:9465335

  13. Screening for abdominal aortic aneurysm.

    PubMed

    Mussa, Firas F

    2015-09-01

    Guidelines are systematically developed statements to assist patients and providers in choosing appropriate health care for specific clinical conditions. Consensus exists across guidelines on one-time screening of elderly men to detect and treat abdominal aortic aneurysm (AAA) ≥5.5 cm. However, the recommendations regarding other age groups, imaging intervals for small AAAs, inclusion of women, and cost-effectiveness have not been universally adopted. As many countries are considering the initiation of an AAA screening program, this is an overview on the current status of such programs. PMID:26169012

  14. Acoustic Trauma - Hearing Loss in Teenagers

    MedlinePlus

    ... Issues Listen Español Text Size Email Print Share Acoustic Trauma - Hearing Loss in Teenagers Page Content Article ... temporary or permanent hearing loss. This is called acoustic trauma. How loud is 85 decibels? Surprisingly, not ...

  15. Management of ocular, orbital, and adnexal trauma

    SciTech Connect

    Spoor, T.C.; Nesi, F.A.

    1988-01-01

    This book contains 20 chapters. Some of the chapter titles are: The Ruptured Globe: Primary Care; Corneal Trauma, Endophthalmitis; Antibiotic Usage; Radiology of Orbital Trauma; Maxillofacial Fractures; Orbital Infections; and Basic Management of Soft Tissue Injury.

  16. [Abdominal vascular malformations and Down syndrome].

    PubMed

    Nso Roca, A P; García Sánchez, P; Quero Jiménez, J

    2007-04-01

    Malformations of the abdominal venous system are rare vascular disorders. These entities are associated with other malformations and with chromosomal anomalies such as trisomy 21. Abdominal venous malformations are probably the most frequent congenital vascular malformations in Down syndrome. Prenatal diagnosis allows the early follow-up and treatment of complications. We present a case of Down syndrome associated with an abdominal venous malformation diagnosed at the first trimester of pregnancy. PMID:17430719

  17. How regional trauma systems improve outcomes.

    PubMed

    Cole, Elaine

    2015-10-01

    Management of severely injured patients is complex and requires organised, expert care. Regionalised trauma systems are relatively new in the UK and aim to deliver optimal, timely care to injured patients at the most appropriate location. This article discusses the drivers, organisation, processes and outcomes of regionalised trauma care. It also describes the challenges and benefits of working within a trauma system to enable emergency practitioners to reflect on their roles in contemporary trauma care. PMID:26451941

  18. Peritoneal Breach as an Indication for Exploratory Laparotomy in Penetrating Abdominal Stab Injury: Operative Findings in Haemodynamically Stable Patients

    PubMed Central

    Aguirre, Victor; Martin, Kate; Varma, Dinesh; Fitzgerald, Mark; Pilgrim, Charles

    2015-01-01

    Introduction. Management of haemodynamically stable patients with penetrating abdominal injuries varies from nonoperative to operative management. The aim was to investigate whether peritoneal breach when used as an indication for exploratory laparotomy appropriately identified patients with intra-abdominal visceral injury. Methods. We conducted retrospective cohort study of all patients presenting with PAI at a major trauma centre from January 2007 to December 2011. We measured the incidence of peritoneal breach and correlated this with intra-abdominal visceral injury diagnosed at surgery. Results. 252 patients were identified with PAI. Of the included patients, 71 were managed nonoperatively and 118 operatively. The operative diagnoses included nonperitoneal-breaching injuries, intraperitoneal penetration without organ damage, or intraperitoneal injury with organ damage. The presenting trauma CT scan was reported as normal in 63%, 34%, and 2% of these groups, respectively. The total negative laparotomy/laparoscopy rate for all patients presented with PAI was 21%, almost half of whom had a normal CT scan. Conclusion. We found that peritoneal breach on its own does not necessarily always equate to intra-abdominal visceral injury. Observation with sequential examination for PAI patients with a normal CT scan may be more important than exclusion of peritoneal breach via laparoscopy. PMID:26064688

  19. What We Know About Management of Traumatic Abdominal Wall Hernia: Review of the Literature and Case Report

    PubMed Central

    Hamidian Jahromi, Alireza; Skweres, Justin; Sangster, Guillermo; Johnson, Lester; Samra, Navdeep

    2015-01-01

    Traumatic abdominal wall hernia (TAWH) is an uncommon form of hernia caused by blunt traumatic disruption of the abdominal wall musculature/fascia and abdominal organ herniation. Diagnosis of TAWH is challenging and requires a high level of suspicion. This form of hernia seems to be underrepresented in the English-language medical literature. There is currently no consensus on the optimal management for TAWH. In this article, we discuss the management of a 36-year-old motorcycle driver who was involved in a road traffic accident. On evaluation at our trauma center, he was found to have TAWH. Diagnostic criteria, imaging modalities and different management options for TAWH will be discussed. PMID:25692423

  20. Is worst-event trauma type related to PTSD symptom presentation and associated features?

    PubMed

    Smith, Hillary L; Summers, Berta J; Dillon, Kirsten H; Cougle, Jesse R

    2016-03-01

    Posttraumatic stress disorder (PTSD) is generally assessed with reference to a "worst-event" (index) trauma, though little research has examined whether symptom presentation and comorbidity differ across worst-events. Data from individuals meeting lifetime PTSD criteria in the National Comorbidity Survey-Replication (N=398) were used to examine relations between PTSD presentation and comorbidity with the three most commonly reported "worst-event" trauma types: sexual trauma, non-sexual physical violence, and unexpected death of a loved one. Sexual trauma and non-sexual physical violence were associated with more symptomatic presentation of PTSD and lifetime trauma types compared to other worst-events. Non-sexual physical violence was associated with comorbid substance use disorder, and unexpected death of a loved one was associated with comorbid depression. Inclusion of number of lifetime trauma types as a covariate rendered most, but not all associations non-significant. These findings suggest worst-event trauma type is related to some important differences in PTSD presentation. PMID:26826984

  1. Managing Mental Health Disorders Resulting from Trauma through Yoga: A Review

    PubMed Central

    Telles, Shirley; Singh, Nilkamal; Balkrishna, Acharya

    2012-01-01

    There are many and varied types of trauma. The extent to which trauma influences the mental health of an individual depends on the nature of trauma, as well as on the individual's coping capabilities. Often trauma is followed by depression, anxiety, and PTSD. As the pharmacological remedies for these conditions often have undesirable side-effects, nonpharmacological remedies are thought of as a possible add-on treatment. Yoga is one such mind-body intervention. This paper covers eleven studies indexed in PubMed, in which mental health disorders resulting from trauma were managed through yoga including meditation. The aim was to evaluate the use of yoga in managing trauma-related depression, anxiety, PTSD and physiological stress following exposure to natural calamities, war, interpersonal violence, and incarceration in a correctional facility. An attempt has also been made to explore possible mechanisms underlying benefits seen. As most of these studies were not done on persons exposed to trauma that had practiced yoga, this is a definite area for further research. PMID:22778930

  2. Ureteral calculus presenting as generalized abdominal cramps.

    PubMed Central

    Leung, Alexander K. C.; Robson, Wm Lane M.; Ng, Anthony Chi Fai

    2007-01-01

    We describe a 58-year-old man with a left ureteral calculus who presented with normal-looking urine, generalized abdominal cramps and abdominal distension that was thought to be due to acute intestinal obstruction. The diagnosis of ureteral calculus was established with an abdominal radiograph and a nonenhanced helical computed tomography of the abdomen, and the symptoms were promptly relieved by extracorporeal shock wave lithotripsy. Physicians should be vigilant that ureteral calculus may, although very rarely, present with generalized abdominal cramps. Images Figure 1 Figure 2 Figure 3 PMID:17668648

  3. Spontaneous idiopathic bilateral adrenal haemorrhage: a rare cause of abdominal pain.

    PubMed

    Nazir, Salik; Sivarajah, Surendra; Fiscus, Valena; York, Eugene

    2016-01-01

    We describe a case of a 62-year-old woman with a history of chronic obstructive pulmonary disease and gastro-oesophageal reflux disease who presented to the emergency department with left lower quadrant abdominal pain, flank pain with nausea and no history of preceding trauma. The patient had finished a course of azithromycin and oral methylprednisolone 1 day prior to presentation. Abdominal and pelvic CT scan identified changes suggestive of bilateral adrenal haemorrhage. The patient did not show signs of acute adrenal insufficiency but was started on steroid replacement therapy because of concerns about possible disease progression. All recognised causes of adrenal haemorrhage were excluded suggesting this was a case of spontaneous idiopathic bilateral adrenal haemorrhage, a rarely reported phenomenon in the literature. The patient was discharged after clinical improvement following 6 days in hospital, taking oral steroid replacement. PMID:27166002

  4. Cultural Differences in Autobiographical Memory of Trauma

    ERIC Educational Resources Information Center

    Jobson, Laura; O'Kearney, Richard

    2006-01-01

    This study investigated cultural differences in autobiographical memory of trauma. Australian and Asian international students provided self-defining memories, narratives of everyday and trauma memories and self-reports assessing adjustment to the trauma. No cultural distinction was found in how Australian or Asian subjects remembered a personal…

  5. Helpers in Distress: Preventing Secondary Trauma

    ERIC Educational Resources Information Center

    Whitfield, Natasha; Kanter, Deborah

    2014-01-01

    Those in close contact with trauma survivors are themselves at risk for trauma (e.g., Bride, 2007; Figley, 1995). Family, friends, and professionals who bear witness to the emotional retelling and re-enacting of traumatic events can experience what is called "secondary trauma" (Elwood, Mott, Lohr, & Galovski, 2011). The literature…

  6. Facial nerve palsy due to birth trauma

    MedlinePlus

    Seventh cranial nerve palsy due to birth trauma ... these factors do not lead to facial nerve palsy or birth trauma. ... The most common form of facial nerve palsy due to birth trauma ... This part controls the muscles around the lips. The muscle ...

  7. Reclosure of disrupted abdominal incisions.

    PubMed

    Walters, M D; Dombroski, R A; Davidson, S A; Mandel, P C; Gibbs, R S

    1990-10-01

    We evaluated prospectively a technique of delayed reclosure of disrupted abdominal incisions. Forty-one consecutive postoperative obstetric and gynecologic patients with abdominal incisions that had opened because of infection, hematoma, or seroma and had intact fascia participated in the study. All wounds were first managed identically, with surgical drainage and debridement, for a minimum of 4 days. The patients then were randomized to either wound reclosure by a standardized en bloc technique (35) or healing by second intention (six). Reclosure was successful in 30 of 35 cases (85.7%). The mean time to complete healing was 15.8 days in successful cases, 67.2 days in failed cases, and 23.2 days for all patients who were reclosed. Failure to heal after reclosure was due to subcutaneous infection in two patients and seroma in three; these women were significantly heavier than those in whom reclosure was successful. There were no other major complications of wound reclosure. Patients randomized to healing by second intention required a mean of 71.8 days of wound care. The time to complete healing in the wound-reclosure group was significantly shorter compared with the group that healed by second intention (P = .002, log rank test). We conclude that en bloc reclosure of disrupted surgical incisions, compared with nonsurgical treatment, significantly decreases the time required for wound healing and has minimal morbidity. PMID:2216186

  8. Advanced techniques in abdominal surgery.

    PubMed Central

    Monson, J R

    1993-01-01

    Almost every abdominal organ is now amenable to laparoscopic surgery. Laparoscopic appendicectomy is a routine procedure which also permits identification of other conditions initially confused with an inflamed appendix. However, assessment of appendiceal inflammation is more difficult. Almost all colonic procedures can be performed laparoscopically, at least partly, though resection for colonic cancer is still controversial. For simple patch repair of perforated duodenal ulcers laparoscopy is ideal, and inguinal groin hernia can be repaired satisfactorily with a patch of synthetic mesh. Many upper abdominal procedures, however, still take more time than the open operations. These techniques reduce postoperative pain and the incidence of wound infections and allow a much earlier return to normal activity compared with open surgery. They have also brought new disciplines: surgeons must learn different hand-eye coordination, meticulous haemostasis is needed to maintain picture quality, and delivery of specimens may be problematic. The widespread introduction of laparoscopic techniques has emphasised the need for adequate training (operations that were straight-forward open procedures may require considerable laparoscopic expertise) and has raised questions about trainee surgeons acquiring adequate experience of open procedures. Images FIG 9 p1347-a p1347-b p1349-a p1350-a p1350-b PMID:8257893

  9. Endovascular Treatment of Blunt Traumatic Abdominal Aortic Occlusion With Kissing Stent Placement

    SciTech Connect

    Idoguchi, Koji Yamaguchi, Masato; Okada, Takuya; Nomura, Yoshikatsu; Sugimura, Kazuro; Okita, Yutaka; Sugimoto, Koji

    2012-10-15

    Blunt traumatic abdominal aortic dissection is extremely rare and potentially deadly. We present the case of a 62-year-old man involved in a frontal car crash. After emergency undergoing laparotomy for bowel injuries, he was referred to our hospital due to acute ischemia of bilateral lower extremities on day 3 after the trauma. Computed tomography and aortography showed an aortobiiliac dissection with complete occlusion. This injury was successfully treated by endovascular treatment with 'kissing'-technique stent placement, which appears to be a safe, effective, and minimally invasive treatment.

  10. A rare case of chronic traumatic diaphragmatic hernia requiring complex abdominal wall reconstruction

    PubMed Central

    Pakula, Andrea; Jones, Amber; Syed, Javed; Skinner, Ruby

    2015-01-01

    Introduction Traumatic diaphragmatic hernia is a rare and often under recognized complication of penetrating and blunt trauma. These injuries are often missed or there is a delay in diagnosis which can lead to enlargement of the defect and the development of abdominal or respiratory symptoms. Presentation of case We report a case of an otherwise healthy 37 year old male who was involved in a motor vehicle accident at age twelve. He presented 25 years later with vague lower abdominal symptoms and was found to have a large chronic left sided diaphragmatic hernia involving the majority of his intra-abdominal contents. Repair of the defect with a biologic mesh was undertaken and the patient also required complex abdominal wall reconstruction due to loss of intra-abdominal domain from the chronicity of the hernia. A staged closure of the abdomen was performed first with placement of a Wittmann patch. Medical management of intra-abdominal hypertension was successful and the midline fascia was sequentially approximated at the bedside for three days. The final closure was performed with a component separation and implantation of a fenestrated biologic fetal bovine mesh to reinforce the closure. In addition, a lightweight Ultrapro mesh was placed for additional lateral reinforcement. The patient recovered well and was discharged home. Discussion These injuries are rare and diagnosis is challenging. Mechanism and CT scan characteristics can aid clinicians. Conclusion Blunt diaphragmatic injury is rare and remains a diagnostic challenge. Depending on the chronicity of the injury, repair may require complex surgical decision making. PMID:25623756

  11. Transforming Cultural Trauma into Resilience

    ERIC Educational Resources Information Center

    Brokenleg, Martin

    2012-01-01

    One of the biggest challenges facing Aboriginal populations increasingly is being called "intergenerational trauma." Restoring the cultural heritage is a central theme in the book, "Reclaiming Youth at Risk." That work describes the Circle of Courage model for positive development which blends Native child and youth care philosophy with research…

  12. Self-Harm and Trauma

    MedlinePlus

    ... Center for PTSD » Public » Self-Harm and Trauma PTSD: National Center for PTSD Menu Menu PTSD PTSD Home For the Public ... bottom of the page. Share this page Search PTSD Site Choose Section Enter Term and Search Advanced ...

  13. Medicating Relational Trauma in Youth

    ERIC Educational Resources Information Center

    Foltz, Robert

    2008-01-01

    Children who have experienced relational trauma present a host of problems and are often diagnosed with psychiatric disorders and then medicated. But there is evidence that commonly used drugs interfere with oxytocin or vasopressin, the human trust and bonding hormones. Thus, psychotropic drugs may impair interpersonal relationships and impede…

  14. Hypothermia and the trauma patient

    PubMed Central

    Kirkpatrick, Andrew W.; Chun, Rosaleen; Brown, Ross; Simons, Richard K.

    Hypothermia has profound effects on every system in the body, causing an overall slowing of enzymatic reactions and reduced metabolic requirements. Hypothermic, acutely injured patients with multisystem trauma have adverse outcomes when compared with normothermic control patients. Trauma patients are inherently predisposed to hypothermia from a variety of intrinsic and iatrogenic causes. Coagulation and cardiac sequelae are the most pertinent physiological concerns. Hypothermia and coagulopathy often mandate a simplified approach to complex surgical problems. A modification of traditional classification systems of hypothermia, applicable to trauma patients is suggested. There are few controlled investigations, but clinical opinion strongly supports the active prevention of hypothermia in the acutely traumatized patient. Preventive measures are simple and inexpensive, but the active reversal of hypothermia is much more complicated, often invasive and controversial. The ideal method of rewarming is unclear but must be individualized to the patient and is institution specific. An algorithm reflecting newer approaches to traumatic injury and technical advances in equipment and techniques is suggested. Conversely, hypothermia has selected clinical benefits when appropriately used in cases of trauma. Severe hypothermia has allowed remarkable survivals in the course of accidental circulatory arrest. The selective application of mild hypothermia in severe traumatic brain injury is an area with promise. Deliberate circulatory arrest with hypothermic cerebral protection has also been used for seemingly unrepairable injuries and is the focus of ongoing research. PMID:10526517

  15. Rib index.

    PubMed

    Grivas, Theodoros B

    2014-01-01

    This article analyzes the double rib contour sign (DRCS) and the rib index (RI). The analyzed topics are 1. the history of presentations - publication of DRCS-RI, 2. the study source origin: school screening for idiopathic scoliosis (IS), 3. what the DRCS and the RI are- Description, 4. the quantification of the DRCS - RI, 5. a reliability study for RI 6. how much the rib index is affected by the distance between the radiation source and the irradiated individual, 7. the implications on IS aetiology, 8. the applications of Rib index for a. documentation of the deformity, b. assessment of physiotherapy, c. assessment of brace treatment and d. pre- and post-operative assessment; assessment of the rib-cage deformity correction on the transverse plane, 9. the use of RI and implications for screening policies 10. the reference of the RI method in spinal textbooks and finally 11. the citations in Google Scholar. PMID:25635184

  16. Analyzing fat embolism syndrome in trauma patients at AIIMS Apex Trauma Center, New Delhi, India

    PubMed Central

    Gupta, Babita; D’souza, Nita; Sawhney, Chhavi; Farooque, Kamran; Kumar, Ajeet; Agrawal, Pramendra; Misra, M C

    2011-01-01

    Background: Fat embolism syndrome (FES) is a constellation of symptoms and signs subsequent to orthopedic trauma. Materials and Methods: The clinical profile of FES in the trauma population was studied over 2 years and 8 months. Results: The incidence of FES among all patients with long bone and pelvic fractures was 0.7% (12). The mean injury severity score was 10.37 (SD 1.69) (range 9-14). The diagnosis of FES was made by clinical and laboratory criteria. Hypoxia was the commonest presentation (92%). The average days of onset of symptoms were 3.5 (SD1.29) days. Management included ventilator support in 75%, average ventilator days being 7.8 (SD 4.08) days. The average ICU stay and hospital stay were 9.1 days and 29.7 days, respectively. A mortality of 8.3% (1) was observed. Conclusion: Fat embolism remains a diagnosis of exclusion and is a clinical dilemma. Clinically apparent FES is unusual and needs high index of suspicion, especially in long bone and pelvic fractures. PMID:21887021

  17. Nonpathologizing trauma interventions in abnormal psychology courses.

    PubMed

    Hoover, Stephanie M; Luchner, Andrew F; Pickett, Rachel F

    2016-01-01

    Because abnormal psychology courses presuppose a focus on pathological human functioning, nonpathologizing interventions within these classes are particularly powerful and can reach survivors, bystanders, and perpetrators. Interventions are needed to improve the social response to trauma on college campuses. By applying psychodynamic and feminist multicultural theory, instructors can deliver nonpathologizing interventions about trauma and trauma response within these classes. We recommend class-based interventions with the following aims: (a) intentionally using nonpathologizing language, (b) normalizing trauma responses, (c) subjectively defining trauma, (d) challenging secondary victimization, and (e) questioning the delineation of abnormal and normal. The recommendations promote implications for instructor self-reflection, therapy interventions, and future research. PMID:26460794

  18. The increasing incidence of snowboard-related trauma

    PubMed Central

    Hayes, John R.; Groner, Jonathan I.

    2013-01-01

    Purpose To investigate injuries among children and adolescents who participate in downhill sports. Methods We collected trauma registry data (January 1999–May 2006) from a level 1 pediatric trauma center with an average snowfall of 28 in (71 cm)/y. Cases were analyzed for injury mechanism, injury type, organ injured, Injury Severity Score, age, sex, and whether or not an operation was required. Results There were 57 snowboarders and 22 skiers admitted during the study period. Forty-one (72%) of snowboarders and 16 (73%) of skiers required operations; 32 (56%) of snowboarders and 9 (41%) of skiers sustained fractures; and 14 (25%) of snowboarders and 6 (27%) of skiers sustained abdominal injuries. (P = NS for all comparisons). Serious splenic injuries were more common in snowboarders (14% vs 4%), but the difference was not statistically significant. All skiing injuries occurred at recreational facilities (commercial skiing areas), whereas 12% of snowboard injuries occurred at home, other residence, or public parks (P = .08). The most striking finding is the rising number of snowboarding injuries and the relatively stable rate of skiing injuries (see graph). Conclusions As the popularity of snowboarding rises, snowboarding injuries in children are increasing. Pediatric surgeons should be wary of the “snowboard spleen.” PMID:18485968

  19. Torso Computed Tomography Can Be Bypassed after Thorough Trauma Bay Examination of Patients Who Fall from Standing.

    PubMed

    Lavingia, Kedar S; Collins, Jay N; Soult, Michael C; Terzian, W Helman; Weireter, Leonard J; Britt, L D

    2015-08-01

    Reliance on CT imaging in the evaluation of low-impact blunt trauma is a major source of radiation exposure, cost, and resource utilization. This study sought to determine if torso (chest and abdomen) CT could be avoided in patients with ground level falls. This was a retrospective chart review of patients admitted to the trauma service between January 2013 and April 2014. The mechanism of injury was ground level fall or fall from sitting. Patient demographics, physical examination (PE) findings, imaging results, length of stay, and complications were reviewed. History and physical data were based on chief resident or attending documentation. A significant thoracic injury was defined as a hemothorax, a pneumothorax, greater than three rib fractures, or aortic injury. A significant abdominal injury was defined as a solid organ injury, an intra-abdominal hematoma, a hollow viscus injury, aortic injury, or a urologic injury. The trauma service evaluated 156 patients. Nine patients were excluded for intubation or Glasgow Coma Scale (GCS) < 13. Of the 147 remaining, mean age was 69 years, mean GCS was 14.8. A chest CT was obtained in 111 (76%). Eight (7%) had a significant thoracic injury. All patients with significant thoracic injury had positive examination findings. No patient with a normal PE was found to have a significant thoracic injury (negative predictive value of 100%). An abdominal CT was obtained in 86 (59%). Five (6%) were found to have a significant abdominal injury. All patients who had a significant radiographic injury had an abnormal PE (negative predictive value of 100%). In conclusion, thorough history and physical in the trauma bay allow the clinician to obtain selective torso CT imaging. Routine torso CT warrants re-evaluation in low-impact injury mechanisms as there appears to be little benefit compared with the resource utilization and expense. PMID:26215242

  20. Abdominal obesity and chronic stress interact to predict blunted cardiovascular reactivity.

    PubMed

    Singh, Kulwinder; Shen, Biing-Jiun

    2013-10-01

    Abdominal obesity and chronic stress have independent effects on cardiac autonomic regulation, and may also interact to influence cardiovascular reactivity. In addition to main effects, we hypothesized that abdominal obesity and chronic stress would interact and predict blunted cardiovascular reactivity. One hundred and twenty-two undergraduate students engaged in two stressful laboratory tasks while cardiovascular activity was assessed. Results indicated that higher abdominal obesity significantly predicted blunted systolic blood pressure (SBP) and mean arterial pressure (MAP) change, while chronic stress was not directly associated with any measure of cardiovascular reactivity. Furthermore, there was a significant interaction between abdominal obesity and chronic stress on SBP and MAP change such that among participants with higher chronic stress, higher abdominal obesity was significantly associated with reduced SBP and MAP reactivity. In addition, body-mass index (BMI), a measure of overall obesity, also had both main and interaction effects with chronic stress to predict blunted cardiovascular reactivity. These results suggest that abdominally obese individuals may incur difficulty in mounting appropriately-sized cardiovascular responses during acute stress, particularly when under high levels of chronic stress. PMID:23535498

  1. Abdominal aortic pseudoaneurysm secondary to melioidosis.

    PubMed

    Rao, Jaideepraj; Kaushal, A S; Hoong, Chia Kok

    2009-01-01

    Melioidosis is an infective condition which is common in South East Asia. It can present in various forms like cutaneous abscess, pneumonia and severe septicaemia. However, melioidosis causing abdominal aortic pseudoaneurysms is extremely rare and a difficult condition to diagnose and treat. We present our management of two cases of abdominal aortic pseudoaneurysms secondary to melioidosis and their subsequent outcomes. PMID:19321406

  2. Pediatric Abdominal Pain: An Emergency Medicine Perspective.

    PubMed

    Smith, Jeremiah; Fox, Sean M

    2016-05-01

    Abdominal pain is a common complaint that leads to pediatric patients seeking emergency care. The emergency care provider has the arduous task of determining which child likely has a benign cause and not missing the devastating condition that needs emergent attention. This article reviews common benign causes of abdominal pain as well as some of the cannot-miss emergent causes. PMID:27133248

  3. Trauma histories among justice-involved youth: findings from the National Child Traumatic Stress Network

    PubMed Central

    Dierkhising, Carly B.; Ko, Susan J.; Woods-Jaeger, Briana; Briggs, Ernestine C.; Lee, Robert; Pynoos, Robert S.

    2013-01-01

    Background Up to 90% of justice-involved youth report exposure to some type of traumatic event. On average, 70% of youth meet criteria for a mental health disorder with approximately 30% of youth meeting criteria for post-traumatic stress disorder (PTSD). Justice-involved youth are also at risk for substance use and academic problems, and child welfare involvement. Yet, less is known about the details of their trauma histories, and associations among trauma details, mental health problems, and associated risk factors. Objective This study describes detailed trauma histories, mental health problems, and associated risk factors (i.e., academic problems, substance/alcohol use, and concurrent child welfare involvement) among adolescents with recent involvement in the juvenile justice system. Method The National Child Traumatic Stress Network Core Data Set (NCTSN-CDS) is used to address these aims, among which 658 adolescents report recent involvement in the juvenile justice system as indexed by being detained or under community supervision by the juvenile court. Results Age of onset of trauma exposure was within the first 5 years of life for 62% of youth and approximately one-third of youth report exposure to multiple or co-occurring trauma types each year into adolescence. Mental health problems are prevalent with 23.6% of youth meeting criteria for PTSD, 66.1% in the clinical range for externalizing problems, and 45.5% in the clinical range for internalizing problems. Early age of onset of trauma exposure was differentially associated with mental health problems and related risk factors among males and females. Conclusions The results indicate that justice-involved youth report high rates of trauma exposure and that this trauma typically begins early in life, is often in multiple contexts, and persists over time. Findings provide support for establishing trauma-informed juvenile justice systems that can respond to the needs of traumatized youth. PMID:23869252

  4. Impact of Operative Intervention Delay on Pediatric Trauma Outcomes

    PubMed Central

    Davidson, Giana H; Maier, Ronald V; Arbabi, Saman; Goldin, Adam B; Rivara, Frederick P

    2016-01-01

    Background Establishing quality indicators is an essential step in improving mortality and disability among pediatric trauma patients. We hypothesized that timing of craniotomy, intracranial pressure (ICP) monitoring for traumatic brain injury and abdominal operation for solid organ injury correlates with a reduced risk of death, shorter length of stay, and reduced risk of requiring assistance at discharge. Methods This was a retrospective cohort study of 99,513 pediatric trauma patients using the National Trauma Data Bank. Results In patients that had an ICP monitor placed within four hours compared to those whose ICP monitor was delayed, there was no difference in mortality; however, there was a shorter length of stay in the hospital (RR=0.84, 95% confidence interval (CI), 0.72-0.97) and in the intensive care unit (RR= 0.76, 95% CI, 0.66-0.86) in those that survived to discharge. Patients who had craniotomy within 4 hours had higher mortality (RR= 1.98, 95% CI, 1.11-3.51) compared to those that were delayed. After excluding those that died, there was a shorter overall stay (RR=0.69, 95% CI, 0.59-0.81) and intensive care stay (RR= 0.69, 95% CI, 0.57-0.83). Similar length of stay results were seen in pediatric patients with solid organ injuries. Excluding those that died, length of stay (RR=0.58, 95% CI, 0.47 – 0.73) and intensive care stay (RR= 0.52, 95% CI, 0.37-0.74) were shorter. Conclusion Early intervention in those who survive their initial operation is associated with shorter ICU and hospital stay for traumatic brain and solid organ injuries. PMID:22743386

  5. The biology of trauma: implications for treatment.

    PubMed

    Solomon, Eldra P; Heide, Kathleen M

    2005-01-01

    During the past 20 years, the development of brain imaging techniques and new biochemical approaches has led to increased understanding of the biological effects of psychological trauma. New hypotheses have been generated about brain development and the roots of antisocial behavior. We now understand that psychological trauma disrupts homeostasis and can cause both short and long-term effects on many organs and systems of the body. Our expanding knowledge of the effects of trauma on the body has inspired new approaches to treating trauma survivors. Biologically informed therapy addresses the physiological effects of trauma, as well as cognitive distortions and maladaptive behaviors. The authors suggest that the most effective therapeutic innovation during the past 20 years for treating trauma survivors has been Eye Movement Desensitization and Reprocessing (EMDR), a therapeutic approach that focuses on resolving trauma using a combination of top-down (cognitive) and bottom-up (affect/body) processing. PMID:15618561

  6. History of the Dental Trauma Guide.

    PubMed

    Andreasen, Jens Ove; Ahrensburg, Søren Steno

    2012-10-01

    The history of the Dental Trauma Guide dates back to 1965, where guidelines were developed for trauma records and treatment of various trauma entities at the Department of Oral and Maxillofacial Surgery at the University Hospital in Copenhagen. In 1972, a unique possibility came up at the Serum Institute in Copenhagen to test various dental trauma procedures in monkeys, which served as kidney donors in the polio vaccine production. Over the years, 40 000 dental trauma patients were treated at the Trauma Centre according to established guidelines, and 4000 of these have been enrolled in long-term follow-up of various trauma entities. This has resulted in 79 clinical studies, and 64 studies in monkeys have examined the effect of various treatment procedures and the aetiology of most healing complications. PMID:22970995

  7. Kikuchi-Fujimoto’s disease with abdominal pain due to intra-abdominal lymphadenitis

    PubMed Central

    Noda, Ayako; Kenzaka, Tsuneaki; Sakatani, Takashi; Kajii, Eiji

    2014-01-01

    A 29-year-old woman was admitted to our hospital with fever and abdominal pain. Abdominal echogram and CT revealed intra-abdominal lymphadenopathy. Seven days after the onset, she developed cervical lymphadenitis. Kikuchi-Fujimoto’s disease (KFD) was diagnosed on cervical lymph node biopsy. Although KFD with intra-abdominal lymphadenopathy is rare, it should be considered in young adults with intra-abdominal lymphadenitis. Because KFD is a benign, self-limiting disease, we suggest the use of a minimally invasive method of diagnosis such as superficial lymph node biopsy. PMID:24667948

  8. INDEXING MECHANISM

    DOEpatents

    Kock, L.J.

    1959-09-22

    A device is presented for loading and unloading fuel elements containing material fissionable by neutrons of thermal energy. The device comprises a combination of mechanical features Including a base, a lever pivotally attached to the base, an Indexing plate on the base parallel to the plane of lever rotation and having a plurality of apertures, the apertures being disposed In rows, each aperture having a keyway, an Index pin movably disposed to the plane of lever rotation and having a plurality of apertures, the apertures being disposed in rows, each aperture having a keyway, an index pin movably disposed on the lever normal to the plane rotation, a key on the pin, a sleeve on the lever spaced from and parallel to the index pin, a pair of pulleys and a cable disposed between them, an open collar rotatably attached to the sleeve and linked to one of the pulleys, a pin extending from the collar, and a bearing movably mounted in the sleeve and having at least two longitudinal grooves in the outside surface.

  9. Abdominal aortic aneurysms in women.

    PubMed

    Lo, Ruby C; Schermerhorn, Marc L

    2016-03-01

    Abdominal aortic aneurysm (AAA) has long been recognized as a condition predominantly affecting males, with sex-associated differences described for almost every aspect of the disease from pathophysiology and epidemiology to morbidity and mortality. Women are generally spared from AAA formation by the immunomodulating effects of estrogen, but once they develop, the natural history of AAAs in women appears to be more aggressive, with more rapid expansion, a higher tendency to rupture at smaller diameters, and higher mortality following rupture. However, simply repairing AAAs at smaller diameters in women is a debatable solution, as even elective endovascular AAA repair is fraught with higher morbidity and mortality in women compared to men. The goal of this review is to summarize what is currently known about the effect of gender on AAA presentation, treatment, and outcomes. Additionally, we aim to review current controversies over screening recommendations and threshold for repair in women. PMID:26747679

  10. Clinical outcome of abdominal sacrocolpopexy

    PubMed Central

    Rani, Shikha; Pandher, Dilpreet Kaur; Huria, Anju; Mehra, Reeti

    2015-01-01

    Introduction: Vaginal vault prolapse is one of the distressing conditions which occur after hysterectomy. This is due to the weakness or detachment of sacrouterine cardinal ligament complex from the vaginal cuff. Till now, the most accepted procedure for this condition is sacrocolpopexy. Materials and Methods: We present a cohort of patients who underwent abdominal sacrocolpopexy (ASC) from April 2009 to August 2013. These patients were followed till April 2014 and were evaluated for subjective and objective outcomes following ASC. Results: One patient had intraoperative hemorrhage and postoperative hematoma formation. One patient had vault abscess which was managed conservatively. Hundred percent success rate was noted at 1 year. Long-term patient satisfaction score was 85 (70-90). PMID:26903757

  11. [Abdominal tuberculosis in CT imaging].

    PubMed

    Malíková, H; Míková, B

    2007-01-01

    According to WHO declaration, tuberculosis is considered the world health danger. Almost 1% of world population is infected by tuberculosis every year and up to 3 millions of new cases are registered in the south-east Asia only. Prevalence of extra-pulmonary tuberculosis is rising, which is probably caused by the rising prevalence of AIDS. Fifty eight years old man, the immigrant from south-east Asia was accepted in a subileous state at the department of Internal medicine. He had suffered for longer period from the torpidness, tabescence and other non-specific symptoms. Among results of laboratory tests, the higher erythrocyte sedimentation and elevation of liver tests were conspicuous. After the colonoscopy, suspicion on the Crohn's disease was expressed. CT examination revealed several segments of the infected intestine. Both the small and large intestine were affected with skip-lesions; short afflicted segments had not the passage impaired with no ring-like dilatations. Mesenterial, periportal and retroperitoneal lymph nodes were enlarged. In the small pelvis, between the intestine and at the dorsal margin of the liver, some free fluid was visible. Abdominal parenchymatose organs had no obvious focal afflictions. In the differential diagnose, the Crohn's disease and the malignant lymphoma were considered. The probatory laparoscopy gave the correct diagnosis of the abdominal tuberculosis. Prevalence of tuberculosis is rising in the whole world, and in western countries rare cases of extrapulmonary tuberculosis can be found. A higher attention is necessary in cases of immuno-suppressed patients, who earlier lived in countries with endemic tuberculosis, or in cases of patients originating in those countries. PMID:17650598

  12. Abdominal Pain following Gastric Bypass: Suspects & Solutions

    PubMed Central

    Greenstein, Alexander J.; O’Rourke, Robert W.

    2010-01-01

    Introduction Gastric bypass remains the mainstay of surgical therapy for obesity. Abdominal pain after gastric bypass is common, and accounts for up to half of all postoperative complaints and emergency room visits. This manuscript reviews the most important causes of abdominal pain specific to gastric bypass and discusses management considerations. Data Sources The current surgical literature was reviewed using PubMed, with a focus on abdominal pain after gastric bypass and the known pathologies that underlie its pathogenesis. Conclusions The differential diagnosis for abdominal pain after gastric bypass is large and includes benign and life-threatening entities. Its diverse causes require a broad evaluation that should be directed by history and clinical presentation. In the absence of a clear diagnosis, the threshold for surgical exploration in patients with abdominal pain after gastric bypass should be low. PMID:21333269

  13. Trauma care systems in Spain.

    PubMed

    Queipo de Llano, E; Mantero Ruiz, A; Sanchez Vicioso, P; Bosca Crespo, A; Carpintero Avellaneda, J L; de la Torre Prado, M V

    2003-09-01

    Trauma care systems in Spain are provided by the Nacional Health Service in a decentralized way by the seventeen autonomous communities whose process of decentralization was completed in January 2002. Its organisation is similar in all of them. Public sector companies of sanitary emergencies look after the health of citizens in relation to medical and trauma emergencies with a wide range of up to date resources both technical and human. In the following piece there is a description of the emergency response teams divided into ground and air that are responsible for the on site care of the patients in coordination with other public services. They also elaborate the prehospital clinical history that is going to be a valuable piece of information for the teams that receive the patient in the Emergency Hospital Unit (EHU). From 1980 to 1996 the mortality rate per 10.000 vehicles and the deaths per 1.000 accidents dropped significantly: in 1980 6.4 and 96.19% and in 1996, 2.8 and 64.06% respectively. In the intrahospital organisation there are two differentiated areas to receive trauma patients the casualty department and the EHU. In the EHU the severe and multiple injured patients are treated by the emergency hospital doctors; first in the triage or resuscitation areas and after when stabilised they are passed too the observation area or to the Intensive Care Unit (ICU) and from there the EHU or ICU doctors call the appropriate specialists. There is a close collaboration and coordination between the orthopaedic surgeon the EHU doctors and the other specialists surgeons in order to comply with treatment prioritization protocols. Once the patient has been transferred an entire process of assistance continuity is developed based on interdisciplinary teams formed in the hospital from the services areas involved in trauma assistance and usually coordinated by the ICU doctors. There is also mentioned the assistance registry of trauma patients, the ICU professional training in the ATLS and the future guidelines for trauma care in the ICU based on epidemiological studies carried out in both the North Spanish Group and the Southern one to promote development and improvement in several areas. PMID:12951298

  14. Change in Intra-Abdominal Fat Predicts the Risk of Hypertension in Japanese Americans.

    PubMed

    Sullivan, Catherine A; Kahn, Steven E; Fujimoto, Wilfred Y; Hayashi, Tomoshige; Leonetti, Donna L; Boyko, Edward J

    2015-07-01

    In Japanese Americans, intra-abdominal fat area measured by computed tomography is positively associated with the prevalence and incidence of hypertension. Evidence in other populations suggests that other fat areas may be protective. We sought to determine whether a change in specific fat depots predicts the development of hypertension. We prospectively followed up 286 subjects (mean age, 49.5 years; 50.4% men) from the Japanese American Community Diabetes Study for 10 years. At baseline, subjects did not have hypertension (defined as blood pressure ?140/90 mm?Hg) and were not taking blood pressure or glucose-lowering medications. Mid-thigh subcutaneous fat area, abdominal subcutaneous fat area, and intra-abdominal fat area were directly measured by computed tomography at baseline and 5 years. Logistic regression was used to estimate odds of incident hypertension over 10 years in relation to a 5-year change in fat area. The relative odds of developing hypertension for a 5-year increase in intra-abdominal fat was 1.74 (95% confidence interval, 1.28-2.37), after adjusting for age, sex, body mass index, baseline intra-abdominal fat, alcohol use, smoking status, and weekly exercise energy expenditure. This relationship remained significant when adjusted for baseline fasting insulin and 2-hour glucose levels or for diabetes mellitus and pre-diabetes mellitus classification. There were no significant associations between baseline and change in thigh or abdominal subcutaneous fat areas and incident hypertension. In conclusion, in this cohort of Japanese Americans, the risk of developing hypertension is related to the accumulation of intra-abdominal fat rather than the accrual of subcutaneous fat in either the thigh or the abdominal areas. PMID:26063668

  15. The Measurement of Psychological Maltreatment: Early Data on the Child Abuse and Trauma Scale.

    ERIC Educational Resources Information Center

    Sanders, Barbara; Becker-Lausen, Evvie

    1995-01-01

    The Child Abuse and Trauma Scale, a self-report measure yielding a quantitative index of the frequency and extent of negative experiences in childhood and adolescence, was administered to 1,198 college students and 17 subjects with Multiple Personality Disorder. Results revealed the scale's strong internal consistency, test-retest reliability, and…

  16. Is estimated bullet trajectory a reliable predictor of severe injury? Case report of a thoraco-abdominal gunshot with a protracted trajectory managed nonoperatively

    PubMed Central

    2013-01-01

    Background Operative management of all gunshot’s traumas carries a high rate of unwarranted interventions that are known to cause serious complications. Selective nonoperative management is thus being increasingly practiced which has reduced these avoidable interventions. Physical examination and computed tomography scans are most sensitive in assessing need of laparotomy. Assessment of internal injuries on the basis of an estimated bullet trajectory is often practiced but has seldom been studied. We report a case of conservative management of a thoraco abdominal gun shot patient where an estimated bullet trajectory was indicative of serious injuries. To the best of our knowledge this is the first report of a thoraco abdominal gunshot that, despite of a protracted trajectory, had no sequelae and was thus managed nonoperatively. Case presentation A 30 year old male patient having height of 180 cm and weight of 70 kg (Body Mass Index 21.6) presented with complaint of a penetrating injury at left side of upper torso. The patient had no symptoms or obvious bleeding and was vitally stable. On examination a 1 cm × 1 cm entry wound at the left 3rd intercostal space in the mid clavicular line was identified. The chest and abdomen were otherwise unremarkable on examination. The chest radiograph displayed clear lung fields. The abdominal radiographs displayed a bullet in the upper left quadrant of the abdomen lateral to the spine. The bullets estimated trajectory from 3rd intercostal space and its lodgment in the abdomen lateral to the spine indicated severe visceral injury. The computed tomography scan showed that the bullet was lodged postero-medially to the left kidney. All thoracic, intra peritoneal and retroperitoneal visceral structures were identified to be normal. The patient remained clinically and vitally stable, hence was managed nonoperatively being discharged after 48 h of observation. Conclusion From this case we conclude that decision for managing gun shot patients should be based on objective clinical and diagnostic findings. We recommend further investigation of the predictability of estimated trajectory for visceral injuries and consequent operative intervention as we found it to be misleading in this case. PMID:23414905

  17. The evolution of a purpose designed hybrid trauma operating room from the trauma service perspective: the RAPTOR (Resuscitation with Angiography Percutaneous Treatments and Operative Resuscitations).

    PubMed

    Kirkpatrick, Andrew W; Vis, Christine; Dubé, Mirette; Biesbroek, Susan; Ball, Chad G; Laberge, Jason; Shultz, Jonas; Rea, Ken; Sadler, David; Holcomb, John B; Kortbeek, John

    2014-09-01

    Traumatic injury is the leading cause of potentially preventable lost years of life in the Western world and exsanguination is the most potentially preventable cause of post-traumatic death. With mature trauma systems and experienced trauma centres, extra-abdominal sites, such as the pelvis, constitute the most frequent anatomic site of exsanguination. Haemorrhage control for such bleeding often requires surgical adjuncts most notably interventional radiology (IR). With the usual paradigm of surgery conducted within an operating room and IR procedures within distant angiography suites, responsible clinicians are faced with making difficult decisions regarding where to transport the most physiologically unstable patients for haemorrhage control. If such a critical patient is transported to the wrong suite, they may die unnecessarily despite having potentially salvageable injuries. Thus, it seems only logical that the resuscitative operating room of the future would have IR capabilities making it the obvious geographic destination for critically unstable patients, especially those who are exsanguinating. Our trauma programme recently had the opportunity to conceive, design, build, and operationalise a purpose-designed hybrid trauma operating room, designated as the resuscitation with angiographic percutaneous techniques and operative resuscitation (RAPTOR) suite, which we believe to be the first such resource designed primarily to serve the exsanguinating trauma patient. The project was initiated after consultations between the trauma programme and private philanthropists regarding the greatest potential impacts on regional trauma care. The initial capital construction costs were thus privately generated but coincided with a new hospital wing construction allowing the RAPTOR to be purpose-designed for the exsanguinating patient. Many trauma programmes around the world are now starting to navigate the complex process of building new facilities, or else retrofitting existing ones, to address the need for single-site flexible haemorrhage control. This manuscript therefore describes the many considerations in the design and refinement of the physical build, equipment selection, human factors evaluation of new combined treatment paradigms, and the final introduction of a RAPTOR protocol in order that others may learn from our initial efforts. PMID:24560091

  18. Pearls of Mandibular Trauma Management

    PubMed Central

    Koshy, John C.; Feldman, Evan M.; Chike-Obi, Chuma J.; Bullocks, Jamal M.

    2010-01-01

    Mandibular trauma is a common problem seen by plastic surgeons. When fractures occur, they have the ability to affect the patient's occlusion significantly, cause infection, and lead to considerable pain. Interventions to prevent these sequelae require either closed or open forms of reduction and fixation. Physicians determining how to manage these injuries should take into consideration the nature of the injury, background information regarding the patient's health, and the patient's comorbidities. Whereas general principles guide the management of the majority of injuries, special consideration must be paid to the edentulous patient, complex and comminuted fractures, and pediatric patients. These topics are discussed in this article, with a special emphasis on pearls of mandibular trauma management. PMID:22550460

  19. Blast trauma in a child.

    PubMed

    Knapp, J F; Sharp, R J; Beatty, R; Medina, F

    1990-06-01

    In 1986, we cared for a four-year-old boy who was injured in the explosion of an illegal firecracker equivalent to one-third of a stick of dynamite. Although little has been reported on the injuries children sustain in an explosion, we found that this child's injuries were similar to those encountered in adults. This case is presented as illustrative of blast trauma in childhood, and as a review of blast injury. PMID:2371149

  20. Current Epidemiology of Genitourinary Trauma

    PubMed Central

    McGeady, James B.; Breyer, Benjamin N.

    2013-01-01

    Synopsis This article reviews recent publications evaluating the current epidemiology of urologic trauma. It begins by providing a brief explanation of databases that have been recently used to study this patient population, then proceeds to discuss each genitourinary organ individually, discussing the most relevant and up to date information published for each one. The conclusion of the article briefly discusses possible future research and development areas pertaining to the topic. PMID:23905930

  1. Conflict theory/trauma theory.

    PubMed

    Busch, Fred

    2005-01-01

    There has been a tendency in psychoanalysis to view the effects of trauma, and our ways of working with it, as something separate from our understanding and techniques of working with intrapsychic conflict. While appreciating certain differences, the author explores, primarily via clinical examples, how an integrated perspective may be most helpful to our patients, especially in the area of the patient's capacity to reclaim feelings. PMID:15766035

  2. Joseph Beuys: trauma and catharsis.

    PubMed

    Ottomann, C; Stollwerck, P L; Maier, H; Gatty, I; Muehlberger, T

    2010-12-01

    Joseph Beuys was one of the most significant artists of the 20th century. He was a gunner and radio operator in the German Air Force during World War II, and was severely injured several times. In March 1943 he had a life-changing experience after the dive bomber he was assigned to crashed in the Crimean peninsula. This trauma influenced Beuys' entire artistic career, and is known in art history as the 'Tartar Legend' or 'Tartar Myth'. Profoundly affected by the crash, the severe trauma, the near-death experience and his rescue, which he perceived as a "rebirth", Beuys no longer saw himself, other people or society as a whole in the same way as previously. With his new consciousness, he ignored boundaries and created visions whereby all mankind could experience the healing he had undergone. Beuys did not bring society far enough for the turning point towards "the healing of the world" to be visible, yet today it is important to keep his work alive as a record of his extraordinary strength, which arose from trauma and severe injury, and was carried by a passionate commitment to mankind and to life itself. PMID:21393290

  3. Antagonistic implications of sarcopenia and abdominal obesity on physical performance in COPD.

    PubMed

    van de Bool, Coby; Rutten, Erica P A; Franssen, Frits M E; Wouters, Emiel F M; Schols, Annemie M W J

    2015-08-01

    Decreased physical performance due to loss of muscle mass (i.e. sarcopenia) is prevalent in ageing and appears more pronounced in chronic disease. A comprehensive profile of the sarcopenic phenotype in chronic obstructive pulmonary disease (COPD) is not yet available. The aim of the present study was to characterise prevalence, functional implications and predictive value of sarcopenia with or without abdominal obesity in Dutch COPD patients eligible for pulmonary rehabilitation.505 COPD patients (aged 37-87 years; 57% male) underwent assessment of lung function, body composition and physical functioning, before entering pulmonary rehabilitation. Sarcopenia was assessed by appendicular skeletal muscle index (ASMI) and abdominal obesity by android/gynoid percentage fat mass (A/G%FM) using dual energy X-ray absorptiometry.86.5% of patients were sarcopenic and showed lower physical functioning, while coexistent abdominal obesity (78.0%) resulted in higher physical functioning. Implications on endurance were less pronounced in women. The predictive value for physical functioning was higher for the "three-compartment" model (ASMI, bone mineral content and A/G%FM) than the "two-compartment" model (fat-free mass index and fat mass index) or "one-compartment" model (body mass index).In patients eligible for pulmonary rehabilitation, sarcopenia is highly prevalent in all body mass index categories and associated with impaired strength, and in men also with decreased endurance. Abdominal obesity seems to have protective effects on physical functioning. ASMI is a better predictor for physical functioning than fat-free mass index. PMID:25882802

  4. The Performance of Trauma Research Centers of Iran during the Past 10 Years; A Science Monitor Survey

    PubMed Central

    Yadollahi, Mahnaz; Shamsedini, Narges; Shayan, Leila; Rezaianzadeh, Abbas; Bolandparvaz, Shahram

    2014-01-01

    Objective: To compare and evaluation of scores of trauma research center of Shiraz University of Medical Sciences in Iran with other trauma research centers in Iran. Methods: The assessment scores of each center were gathered from Iran medical research and Ministry of Health and Medical Education website. Each score is recorded in helical year which is defined from the 21th of March of every year until the 20th of March of the next. They are ranked and scored by knowledge production, capacity development, and research projects. Results: The total evaluation scores of the trauma research center of Iran's Universities of Medical Sciences have increased from establishment. The highest increase in assessment scores was related to Tehran Trauma Research Center. An upward trend was observed in the total indicators of knowledge production index of all the trauma research centers from 2001/2002 to 2011/2012. An ascending trend was showed in the published articles score of Shiraz and Kashan Trauma Research Centers through the recent years. Conclusion: The increasing trend in scores of trauma research centers in Iran indicated a significant role in the knowledge production but it is need to find barriers of research and doing interventional projects to promote trauma care and prevention.

  5. Introduction of a Simple Technique for Partial Splenectomy in Multiple Trauma Patients

    PubMed Central

    Eskandarlou, Mehdi; Derakhshanfar, Amir

    2013-01-01

    Background: The spleen is the most commonly injured intraperitoneal organ in multiple trauma patients. Total splenectomy results in immunodeficiency and predisposes patients to certain infections. Objectives: Performing partial splenectomy with a safe, simple, and definite technique in trauma patients with hemodynamic instability and accompanying intra-abdominal injury could play an important role in the preservation of immune function and reducing morbidity. Patients and Methods: From 2006 to 2009, a total of 20 patients underwent partial splenectomy, at Mobasher and Be’sat hospitals. Patients with splenic injuries of up to stage IV and grade 3 shocks underwent partial splenectomy. The operations were performed without vascular isolation and by wedge resection of the injured splenic tissue and repair with chromic 2/0 sutures in two rows. Three months later, patients were evaluated by a Tc99 liver-spleen scan, complete blood count, and blood smear. Results: There were 16 male and four female patients with an age range of 4 to 54 years old. Ten patients had additional intra and extra abdominal injuries. The salvaged spleen tissue was approximately 30% in nine patients, 40 to 50% in two, and more than 50% in another nine patients. The operation time was less than three hours and hospital stay was 3 to 15 days for 90% of the patients. No complications occurred after the surgery or during the follow up. For all patients, the complete blood count, peripheral smear, and liver-spleen scan were normal after six months. Conclusions: Partial splenectomy with preserving at least 30% of the splenic tissue can be performed for trauma patients using wedge resection of the injured splenic tissue and repair by chromic 2/0 sutures in two rows. Using this technique, there is no need for vascular isolation or hemostatic materials. Splenic function is presented and associated intra and extra abdominal injuries are not contraindications for partial splenectomy. PMID:24693413

  6. An atypical presentation of small bowel obstruction and perforation secondary to sporadic synchronous intra-abdominal desmoid tumours

    PubMed Central

    Abdalla, Sala; Wilkinson, Michelle; Wilsher, Mark; Uzkalnis, Aleksandras

    2016-01-01

    Introduction Desmoid tumours (DTs) are rare, soft tissue tumours which account for 0.03% of all neoplasms. They are characteristically locally invasive but do not metastasize. There is frequent association with females of reproductive age, a history of abdominal surgery or trauma and a family history of fibromatoses. Intra-abdominal DTs are infrequently sporadic and more commonly associated with inherited disorders such as familial adenomatous polyposis (FAP), attenuated FAP and Gardener’s syndrome. Presentation of case The authors report a rare case of small bowel obstruction and perforation secondary to sporadic, synchronous intra-abdominal DTs in a 54-year old man with atypical symptoms and no risk factors or family history. Discussion Intra-abdominal DTs have a worse prognosis as they can cause intestinal bleeding, obstruction and perforation. Due to the rarity of these tumours there are no clear guidelines on their management and this is instead based on small case series from specialist centres. In the non-acute setting patients with sporadic intra-abdominal DTs should be managed in a specialist sarcoma unit by a multidisciplinary team. In the presence of FAP or other polyposis syndromes patients with DTs should be managed at a specialist colorectal unit. Emergent presentations require emergency surgery in suitable candidates. Conclusion In non-emergency presentations of DTs, it is essential to exclude FAP, AFAP and other hereditary polyposis syndromes since this affects treatment and subsequent follow-up. PMID:26866881

  7. Some observations relating to behind-body armour blunt trauma effects caused by ballistic impact.

    PubMed

    Lidén, E; Berlin, R; Janzon, B; Schantz, B; Seeman, T

    1988-01-01

    Live, anesthetised pigs were used to assess behind-armour blunt trauma effects. The thoraco-abdominal body region was covered with varying thicknesses of Kevlar fabric packets. This soft body armour was applied, either in direct contact with the thoracic wall of the animals, or with different plastic foam sheets, so-called trauma packs, between the armour and the skin. The live animals were surgically evaluated, and then sacrificed. Blocks of soft soap were subjected to equal tests and the behind-armour indentations were measured. The results indicate that serious injury to the body armour-protected chest may be caused by the impact of nonpenetrating bullets and shotgun pellets. Severe pulmonary contusions and lacerations were found when the energy transferred through the body armour was estimated to be high. PMID:3339677

  8. [Cardiac tamponade following sternal puncture. Usefulness of ultrasound focussed assessment with sonography for trauma].

    PubMed

    Magaldi, M; Hervías, A; Perelló, L; Fontanals, J

    2014-03-01

    One of the aims of the medical profession is to be able to detect complications in patients during diagnostic tests and treatments. The early diagnosis of these complications can prevent a fatal outcome. The diagnosis is often based on clinical symptoms and supported by complementary tests. Diagnostic tests have been developed in the last few years that are rapid and easy to use, as well as being cost effective and minimally invasive. Focussed assessment with sonography for trauma ultrasound (echo-FAST) was introduced in the 1990s in the field of resuscitation as a test for the rapid detection of intra-abdominal and pericardial fluid in multiple injury patients, but its uses in other cases not involving trauma still raise doubts and controversy. A case is presented of a patient subjected to a sternal puncture for a bone marrow aspirate, who had a complication of a secondary cardiac tamponade, which was diagnosed early using echo-FAST. PMID:23352376

  9. The Role of Cumulative Trauma, Betrayal, and Appraisals in Understanding Trauma Symptomatology.

    PubMed

    Martin, Christina Gamache; Cromer, Lisa Demarni; Deprince, Anne P; Freyd, Jennifer J

    2013-03-01

    Poor psychological outcomes are common among trauma survivors, yet not all survivors experience adverse sequelae. The current study examined links between cumulative trauma exposure as a function of the level of betrayal (measured by the relational closeness of the survivor and the perpetrator), trauma appraisals, gender, and trauma symptoms. Participants were 273 college students who reported experiencing at least one traumatic event on a trauma checklist. Three cumulative indices were constructed to assess the number of different types of traumas experienced that were low (LBTs), moderate (MBTs), or high in betrayal (HBTs). Greater trauma exposure was related to more symptoms of depression, dissociation, and PTSD, with exposure to HBTs contributing the most. Women were more likely to experience HBTs than men, but there were no gender differences in trauma-related symptoms. Appraisals of trauma were predictive of trauma-related symptoms over and above the effects explained by cumulative trauma at each level of betrayal. The survivor's relationship with the perpetrator, the effect of cumulative trauma, and their combined impact on trauma symptomatology are discussed. PMID:23542882

  10. Abdominal sepsis managed by leaving abdomen open.

    PubMed

    Duff, J H; Moffat, J

    1981-10-01

    Intra-abdominal sepsis and necrotizing infection of the abdominal wall are usually fatal unless adequate drainage and wide debridement are possible. To follow these principles, we managed 18 seriously ill patients with abdominal sepsis by leaving the abdomen completely open. All except two of the patients had severe intra-abdominal sepsis. Eight patients had full-thickness wound infections and intra-abdominal infections refractory to the usual surgical drainage techniques. Two had necrotizing wound infections only. In 12 an upper abdominal incision was managed open, and in six the open incision was lower. As part of the initiating illness, there were eight small bowel and six colon fistulas. They were managed by colostomy in five patients and ileostomy in two. More than one organism was cultured in all patients and 12 of 18 had a positive blood culture. Respiratory failure made mechanical ventilation necessary in 13 patients for an average of 44 days. Previous adhesions, usually present, or an intact greater omentum, were necessary to prevent bowel evisceration, but three patients required paralysis and mechanical ventilation until adhesions became strong enough to prevent evisceration. There were seven deaths (39%), six caused by continuing sepsis and one from hemorrhage. In those surviving, granulation tissue grew over omentum or bowel loops to eventually seal the abdominal cavity. The late management was split-skin grafting in five and secondary closure in two. Four healed by second intention. We conclude that leaving the abdomen completely open facilitates the widest possible drainage, uncompromising debridement of the abdominal wall, and is compatible with good recovery. The ultimate result in survivors is acceptable. This technique is preferable to closing an abdominal wall of questionable viability in the face of intraperitoneal sepsis. PMID:6456563

  11. Effect of an Image Sharing Network on CT Utilization for Transferred Trauma Patients: a five-year experience at a level I trauma center

    PubMed Central

    Psoter, Kevin J.; Roudsari, Bahman S.; Vaughn, Matthew; Fine, Gabriel C.; Jarvik, Jeffrey G.; Gunn, Martin L.

    2013-01-01

    Objectives To evaluate the influence of an image sharing network established between referring hospitals and a level I trauma center on CT utilization at the trauma center. Methods This retrospective study was approved by the local Institutional Review Board. The requirement for informed consent was waived. We linked the Harborview Medical Center’s trauma registry to billing department data and obtained detailed information on all resources utilized during each patient’s hospitalization. We used negative binomial regression to evaluate the body-region specific CT utilization between direct admit and transfer patients after adjustment for potential confounding variables. We paid special attention to 2005 as the year that we established Internet-based image sharing between HMC and referring hospitals. Results A total of 81,159 trauma patients were admitted to HMC (44% transfer) during the study period. The utilization of head CTs slightly increased from 1996 to 2005, with no significant difference between direct admits and transfer patients. Between 2005 and 2010, utilization remained relatively unchanged; however, we observed significantly higher utilization rates for direct admit patients. Relatively similar pattern was observed for pelvic CTs; however, between 2005 and 2010, CT use was greater for direct admits compared to transfer patients. Abdominal and thoracic CTs were relatively unchanged between 2005 and 2010. However, both CTs had significantly higher utilization rates for direct admits. Conclusion The utilization rate of different body regions CT was higher for direct admit trauma patients compared to transfer patients since 2005; however, decreasing utilization trends have been observed in recent years. PMID:23769646

  12. [The morphological characteristic of hepatorrhesis in the subjects with the blunt abdominal injury].

    PubMed

    Pigolkin, Iu I; Dubrovina, I A; Dubrovin, I A; Shestakov, A M; Volod'ko, S N

    2013-01-01

    We have elucidated certain consistent patterns of the development of hepatic lesions associated with blunt abdominal trauma including primary and secondary local and distant ruptures of the liver of different localization, e.g. in the direction of the injurious force (central and anti-shock) and apart from it (peripheral). A kick in the stomach causes local (primary and secondary) or distant ruptures of the liver. A strong impact gives rise to local secondary and distant ruptures. Compression of the body with massive objects is associated with local primary ruptures whereas falling down on the stomach results only in anti-shock ruptures. Local (primary and secondary) as well as distant (anti-shock and peripheral) ruptures of hepatic parenchyma have different morphological properties and surface relief which makes it possible to discriminate between them. The consistent patterns of hepatorrhesis provide a methodological basis for the explanation of the physical nature of liver deformation and destruction of its tissue after a blunt abdominal trauma. PMID:23789404

  13. Abdominal Pain in the Geriatric Patient.

    PubMed

    Leuthauser, Amy; McVane, Benjamin

    2016-05-01

    Abdominal pain in the elderly can be a challenging and difficult condition to diagnose and treat. The geriatric population has significant comorbidities and often takes polypharmacy that can mask symptoms. The presentation of common conditions can be different than that in the younger population, often lacking the traditional indicators of disease, making it of pivotal importance for the clinician to consider a wide differential during their workup. It is also important to consider extra-abdominal abnormality that may manifest as abdominal pain. PMID:27133249

  14. [Internationalization and innovation of abdominal acupuncture].

    PubMed

    Wang, Yong-Zhou

    2013-09-01

    Characteristics of abdominal acupuncture are analyzed through three aspects of inheriting and innovation, collaborated research as well as international visual field. It is pointed that abdominal acupuncture is based on clinical practice, focuses on enhancing the therapeutic effect and expending the clinical application. It also promots the thinking on how to recall the tradition and how to inherit tradition availably. The modern medical problems should be studied and innovation resolutions should be searched, which can help the internationalization and modernization of abdominal acupuncture. PMID:24298780

  15. Vascular injury associated with extremity trauma: initial diagnosis and management.

    PubMed

    Halvorson, Jason J; Anz, Adam; Langfitt, Maxwell; Deonanan, Joel K; Scott, Aaron; Teasdall, Robert D; Carroll, E A

    2011-08-01

    Vascular injury associated with extremity trauma occurs in <1% of patients with long bone fracture, although vascular injury may be seen in up to 16% of patients with knee dislocation. In the absence of obvious signs of vascular compromise, limb-threatening injuries are easily missed, with potentially devastating consequences. A thorough vascular assessment is essential; an arterial pressure index <0.90 is indicative of potential vascular compromise. Advances in CT and duplex ultrasonography are sensitive and specific in screening for vascular injury. Communication between the orthopaedic surgeon and the vascular or general trauma surgeon is essential in determining whether to address the vascular lesion or the orthopaedic injury first. Quality evidence regarding the optimal fixation method is scarce. Open vascular repair, such as direct repair with or without arteriorrhaphy, interposition replacement, and bypass graft with an autologous vein or polytetrafluoroethylene, remains the standard of care in managing vascular injury associated with extremity trauma. Although surgical technique affects outcome, results are primarily dependent on early detection of vascular injury followed by immediate treatment. PMID:21807917

  16. Assessing sexual trauma histories in homeless women.

    PubMed

    Weinrich, Sally; Hardin, Sally; Glaser, Dale; Barger, Mary; Bormann, Jill; Lizarraga, Cabiria; Terry, Micheal; Criscenzo, Jeeni; Allard, Carolyn B

    2016-01-01

    Almost 1 out of every 3 homeless women (32%) in the United States, United Kingdom, and Australia has experienced childhood sexual trauma. We assessed lifetime sexual trauma histories among 29 homeless women from three Southern California community sites: one residential safe house and two safe parking areas. More than half of the women (54%) reported a history of sexual trauma. That rate was higher (86%) among women living at the safe home than among women staying at the safe parking sites (only 42%). All four of the women who had served in the military reported having experienced military sexual trauma. The high percentages of sexual trauma found in homeless women highlight the need for effective interventions for sexual trauma. PMID:26583457

  17. Primary and secondary skeletal blast trauma.

    PubMed

    Christensen, Angi M; Smith, Victoria A; Ramos, Vanessa; Shegogue, Candie; Whitworth, Mark

    2012-01-01

    This study examines primary (resulting from blast wave) and secondary (resulting from disintegrated, penetrating fragments) blast trauma to the skeleton. Eleven pigs were exposed to semi-controlled blast events of varying explosive type, charge size, and distance, including some cases with shrapnel. Skeletal trauma was found to be extensive, presenting as complex, comminuted fractures with numerous small, displaced bone splinters and fragments. Traumatic amputation of the limbs and cranium was also observed. Fractures were concentrated in areas nearer the blast, but there was generally no identifiable point of impact. Fractures were more random in appearance and widespread than those typically associated with gunshot or blunt force injury events. These patterns appear to be uniquely associated with blast trauma and may therefore assist forensic anthropologists and other forensic examiners in the interpretation of skeletal trauma by enabling them to differentiate between blast trauma and trauma resulting from some other cause. PMID:21981586

  18. The Tribolium homeotic gene Abdominal is homologous to abdominal-A of the Drosophila bithorax complex

    NASA Technical Reports Server (NTRS)

    Stuart, J. J.; Brown, S. J.; Beeman, R. W.; Denell, R. E.; Spooner, B. S. (Principal Investigator)

    1993-01-01

    The Abdominal gene is a member of the single homeotic complex of the beetle, Tribolium castaneum. An integrated developmental genetic and molecular analysis shows that Abdominal is homologous to the abdominal-A gene of the bithorax complex of Drosophila. abdominal-A mutant embryos display strong homeotic transformations of the anterior abdomen (parasegments 7-9) to PS6, whereas developmental commitments in the posterior abdomen depend primarily on Abdominal-B. In beetle embryos lacking Abdominal function, parasegments throughout the abdomen are transformed to PS6. This observation demonstrates the general functional significance of parasegmental expression among insects and shows that the control of determinative decisions in the posterior abdomen by homeotic selector genes has undergone considerable evolutionary modification.

  19. Examining the associations between sex trade involvement, rape, and symptomatology of sexual abuse trauma.

    PubMed

    Lutnick, Alexandra; Harris, Jennie; Lorvick, Jennifer; Cheng, Helen; Wenger, Lynn D; Bourgois, Philippe; Kral, Alex H

    2015-07-01

    The high prevalence of rape and sexual trauma symptomatology among women involved in street-based sex trades is well-established. Because prior research has lacked appropriate, non-sex trade involved comparison groups, it is unknown whether differences exist among similarly situated women who do and do not trade sex. This article explores experiences of childhood and adult rape and symptomatology of sexual abuse trauma among a community-based sample of 322 women who use methamphetamine in San Francisco, California, 61% of whom were involved in the sex trade. Study participants were recruited via respondent-driven sampling and eligible if they were cisgender women, aged 18 or older, current methamphetamine users, and sexually active with at least one cisgender man in the past 6 months. The dependent variable was sexual abuse trauma symptomatology, as measured by the Sexual Abuse Trauma Index (SATI) subscale of the Trauma Symptom Checklist-40 (TSC-40), and the explanatory variable was sex trade involvement. Potential covariates were age, current homelessness, methamphetamine dependence, and experiences of childhood and adult rape. Sixty-one percent of participants had a SATI subscale score suggestive of sexual abuse trauma. The overall prevalence of rape in childhood and adulthood was 52% and 73%, respectively. In bivariate analysis, sex trade involvement and all of the potential covariates except for homelessness and age were associated with a SATI score suggestive of sexual abuse trauma. In multivariate models controlling for significant covariates, there was no longer a statistically significant association between sex trade involvement or childhood rape and an elevated SATI score. Elevated levels of psychological dependence on methamphetamine and experiences of rape as an adult were still associated with a high SATI score. These findings highlight that urban poor women, regardless of sex trade involvement, suffer high levels of rape and related trauma symptomatology. PMID:25210029

  20. Examining the Associations Between Sex Trade Involvement, Rape, and Symptomatology of Sexual Abuse Trauma

    PubMed Central

    Lutnick, Alexandra; Harris, Jennie; Lorvick, Jennifer; Cheng, Helen; Wenger, Lynn D.; Bourgois, Philippe; Kral, Alex H.

    2015-01-01

    The high prevalence of rape and sexual trauma symptomatology among women involved in street-based sex trades is well-established. Because prior research has lacked appropriate, non-sex trade involved comparison groups, it is unknown whether differences exist among similarly situated women who do and do not trade sex. This article explores experiences of childhood and adult rape and symptomatology of sexual abuse trauma among a community-based sample of 322 women who use methamphetamine in San Francisco, California, 61% of whom were involved in the sex trade. Study participants were recruited via respondent-driven sampling and eligible if they were cisgender women, aged 18 or older, current methamphetamine users, and sexually active with at least one cisgender man in the past 6 months. The dependent variable was sexual abuse trauma symptomatology, as measured by the Sexual Abuse Trauma Index (SATI) subscale of the Trauma Symptom Checklist–40 (TSC-40), and the explanatory variable was sex trade involvement. Potential covariates were age, current homelessness, methamphetamine dependence, and experiences of childhood and adult rape. Sixty-one percent of participants had a SATI subscale score suggestive of sexual abuse trauma. The overall prevalence of rape in childhood and adulthood was 52% and 73%, respectively. In bivariate analysis, sex trade involvement and all of the potential covariates except for homelessness and age were associated with a SATI score suggestive of sexual abuse trauma. In multivariate models controlling for significant covariates, there was no longer a statistically significant association between sex trade involvement or childhood rape and an elevated SATI score. Elevated levels of psychological dependence on methamphetamine and experiences of rape as an adult were still associated with a high SATI score. These findings highlight that urban poor women, regardless of sex trade involvement, suffer high levels of rape and related trauma symptomatology. PMID:25210029

  1. Trauma therapy for death row families.

    PubMed

    Long, Walter C

    2011-01-01

    The family members of death row inmates undergo unique suffering that includes disenfranchised grief and intense psychological trauma. In Texas, where executions occur at a rate of 1 every 2 weeks, this class of trauma victims presumably is large, a fact that should generate public mental health concern. Yet the class remains virtually unknown to the therapeutic community. Very little has been done to address the trauma healing needs of death row families. This theoretical paper proposes that structural therapy designed to reengage attachment relationships and reempower family members' innate resources to emotionally regulate one another may provide one of the most effective means of helping this population survive trauma. PMID:21967176

  2. Enhancing trauma education worldwide through telemedicine

    PubMed Central

    2012-01-01

    Advances in information and communication technologies are changing the delivery of trauma care and education. Telemedicine is a tool that can be used to deliver expert trauma care and education anywhere in the world. Trauma is a rapidly-evolving field requiring access to readily available sources of information. Through videoconferencing, physicians can participate in continuing education activities such as Grand Rounds, seminars, conferences and journal clubs. Exemplary programs have shown promising outcomes of teleconferences such as enhanced learning, professional collaborations, and networking. This review introduces the concept of telemedicine for trauma education, and highlights efforts of programs that are utilizing telemedicine to unite institutions across the world. PMID:23531408

  3. Advanced technologies in trauma critical care management.

    PubMed

    Cannon, Jeremy W; Chung, Kevin K; King, David R

    2012-08-01

    Care of critically injured patients has evolved over the 50 years since Shoemaker established one of the first trauma units at Cook County Hospital in 1962. Modern trauma intensive care units offer a high nurse-to-patient ratio, physicians and midlevel providers who manage the patients, and technologically advanced monitors and therapeutic devices designed to optimize the care of patients. This article describes advances that have transformed trauma critical care, including bedside ultrasonography, novel patient monitoring techniques, extracorporeal support, and negative pressure dressings. It also discusses how to evaluate the safety and efficacy of future advances in trauma critical care. PMID:22850154

  4. The biological effects of childhood trauma.

    PubMed

    De Bellis, Michael D; Zisk, Abigail

    2014-04-01

    Trauma in childhood is a psychosocial, medical, and public policy problem with serious consequences for its victims and for society. Chronic interpersonal violence in children is common worldwide. Developmental traumatology, the systemic investigation of the psychiatric and psychobiological effects of chronic overwhelming stress on the developing child, provides a framework and principles when empirically examining the neurobiological effects of pediatric trauma. This article focuses on peer-reviewed literature on the neurobiological sequelae of childhood trauma in children and in adults with histories of childhood trauma. PMID:24656576

  5. Abdominal pain - children under age 12

    MedlinePlus

    Stomach pain in children; Pain - abdomen - children; Abdominal cramps in children; Belly ache in children ... this kind of pain when they have a stomach virus, indigestion, gas, or when they become constipated. ...

  6. Genetics Home Reference: abdominal wall defect

    MedlinePlus

    ... size and can usually be diagnosed early in fetal development, typically between the tenth and fourteenth weeks of ... organs at the abdominal wall opening late in fetal development may also contribute to organ injury. Intestinal damage ...

  7. Abdominal aortic aneurysm: A ticking time bomb.

    PubMed

    Howell, Christopher M; Rabener, Michael J

    2016-03-01

    Abdominal aortic aneurysm (AAA) is a clinical challenge in risk assessment, recognition, treatment, and prevention. This article explores the pathogenesis, presentation, diagnosis, treatment, and prevention of AAA. PMID:26840606

  8. Correlation between intra-abdominal pressure and pulmonary volumes after superior and inferior abdominal surgery

    PubMed Central

    de Cleva, Roberto; de Assumpção, Marianna Siqueira; Sasaya, Flavia; Chaves, Natalia Zuniaga; Santo, Marco Aurelio; Fló, Claudia; Lunardi, Adriana C.; Filho, Wilson Jacob

    2014-01-01

    OBJECTIVE: Patients undergoing abdominal surgery are at risk for pulmonary complications. The principal cause of postoperative pulmonary complications is a significant reduction in pulmonary volumes (FEV1 and FVC) to approximately 65-70% of the predicted value. Another frequent occurrence after abdominal surgery is increased intra-abdominal pressure. The aim of this study was to correlate changes in pulmonary volumes with the values of intra-abdominal pressure after abdominal surgery, according to the surgical incision in the abdomen (superior or inferior). METHODS: We prospectively evaluated 60 patients who underwent elective open abdominal surgery with a surgical time greater than 240 minutes. Patients were evaluated before surgery and on the 3rd postoperative day. Spirometry was assessed by maximal respiratory maneuvers and flow-volume curves. Intra-abdominal pressure was measured in the postoperative period using the bladder technique. RESULTS: The mean age of the patients was 56±13 years, and 41.6% 25 were female; 50 patients (83.3%) had malignant disease. The patients were divided into two groups according to the surgical incision (superior or inferior). The lung volumes in the preoperative period showed no abnormalities. After surgery, there was a significant reduction in both FEV1 (1.6±0.6 L) and FVC (2.0±0.7 L) with maintenance of FEV1/FVC of 0.8±0.2 in both groups. The maximum intra-abdominal pressure values were similar (p = 0.59) for the two groups. There was no association between pulmonary volumes and intra-abdominal pressure measured in any of the groups analyzed. CONCLUSIONS: Our results show that superior and inferior abdominal surgery determines hypoventilation, unrelated to increased intra-abdominal pressure. Patients at high risk of pulmonary complications should receive respiratory care even if undergoing inferior abdominal surgery. PMID:25029580

  9. [Intestinal occlusion and abdominal compartment syndrome (ACS)].

    PubMed

    Stagnitti, Franco

    2009-01-01

    Intestinal occlusion is defined as an independent predictive factor of intra-abdominal hypertension (IAH) which represents an independent predictor of mortality. Baggot in 1951 classified patients operated with intestinal occlusion as being at risk for IAH ("abdominal blow-out"), recommending them for open abdomen surgery proposed by Ogilvie. Abdominal surgery provokes IAH in 44.7% of cases with mortality which, in emergency, triples with respect to elective surgery (21.9% vs 6.8%). In particular, IAH is present in 61.2% of ileus and bowel distension and is responsible for 52% of mortality (54.8% in cases with intra-abdominal infection). These patients present with an increasing intra-abdominal pressure (IAP) which, over 20-25 mmHg, triggers an Abdominal Compartment Syndrome (ACS) with altered functions in some organs arriving at Multiple Organ Dysfunction Syndrome (MODS). The intestine normally covers 58% of abdominal volume but when there is ileus distension, intestinal pneumatosis develops (third space) which can occupy up to 90% of the entire cavity. At this moment, Gastro Intestinal Failure (GIF) can appear, which is a specific independent risk factor of mortality, motor of "Organ Failure". The pathophysiological evolution has many factors in 45% of cases: intestinal pneumatosis is associated with mucosal and serous edema, capillary leakage with an increase in extra-cellular volume and peritoneal fluid collections (fourth space). The successive loss of the mucous barrier permits a bacterial translocation which includes bacteria, toxins, pro-inflammatory factors and oxygen free radicals facilitating the passage from an intra-abdominal to inter-systemic vicious cyrcle. IAH provokes the raising of the diaphragm, and vascular and visceral compressions which induce hypertension in the various spaces with compartmental characteristics. These trigger hypertension in the renal, hepatic, pelvic, thoracic, cardiac, intracranial, orbital and lower extremity areas, giving a critical clinical condition of Polycompartment Syndrome. The monitoring of Abdominal Perfusion Pressure (APP) is more correct than the measurement of IAP because it reveals hydrodynamic alterations in the abdominal compartment. The APP (MAP-IAP) depends on arterial flow, venous outflow and capacity of the abdominal compartments response to increased internal volumes. The medical therapy used to decrease IAH and to contrast ACS is intestinal decompression with gastric and rectal tube; colonic endoscopic detention; correction of electrolytic abnormalities and prokinetic agents. Surgery, besides being decompressive and resolutive, must prevent a recurrence of ACS through the "tension-free closure" procedure. PMID:20476671

  10. Trauma-Focused Cognitive Behavioral Therapy: Assessing the Evidence

    PubMed Central

    Ramirez de Arellano, Michael A.; Jobe-Shields, Lisa; George, Preethy; Dougherty, Richard H.; Daniels, Allen S.; Ghose, Sushmita Shoma; Huang, Larke; Delphin-Rittmon, Miriam E.

    2015-01-01

    Objective Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) is a conjoint parent-child treatment developed by Cohen, Mannarino, and Deblinger that uses cognitive-behavioral principles and exposure techniques to prevent and treat posttraumatic stress, depression, and behavioral problems. This review defined TF-CBT, differentiated it from other models, and assessed the evidence base. Methods Authors reviewed meta-analyses, reviews, and individual studies (1995 to 2013). Databases surveyed were PubMed, PsycINFO, Applied Social Sciences Index and Abstracts, Sociological Abstracts, Social Services Abstracts, PILOTS, the ERIC, and the CINAHL. They chose from three levels of research evidence (high, moderate, and low) on the basis of benchmarks for number of studies and quality of their methodology. They also described the evidence of effectiveness. Results The level of evidence for TF-CBT was rated as high on the basis of ten RCTs, three of which were conducted independently (not by TF-CBT developers). TF-CBT has demonstrated positive outcomes in reducing symptoms of posttraumatic stress disorder, although it is less clear whether TF-CBT is effective in reducing behavior problems or symptoms of depression. Limitations of the studies include concerns about investigator bias and exclusion of vulnerable populations. Conclusions TF-CBT is a viable treatment for reducing trauma-related symptoms among some children who have experienced trauma and their nonoffending caregivers. Based on this evidence, TF-CBT should be available as a covered service in health plans. Ongoing research is needed to further identify best practices for TF-CBT in various settings and with individuals from various racial and ethnic backgrounds and with varied trauma histories, symptoms, and stages of intellectual, social, and emotional development. PMID:24638076

  11. Expanding Trauma through Space and Time: Mapping the Rhetorical Strategies of Trauma Carrier Groups

    ERIC Educational Resources Information Center

    Degloma, Thomas

    2009-01-01

    In this article, I detail two rhetorical strategies that trauma carrier groups--including social movement organizations, professional mental health associations, and patient advocacy groups--use to expand the relevance of trauma and Post-Traumatic Stress Disorder (PTSD) through space and time: the social transmission of trauma and the social…

  12. Management of Postoperative Abdominal Wall Pain.

    PubMed

    Sharp, Howard T

    2015-12-01

    Postoperative incisional pain is expected after surgery. However, when a patient is complaining of pain months after surgery, this can be a source of frustration and confusion to the patient and the surgeon. Whether the pain is a result of myofascial pain, incisional hernia, or nerve injury, understanding potential sources of abdominal wall pain can simplify this diagnostic dilemma. This chapter will focus on the diagnosis, treatment, and prevention of postsurgical abdominal wall pain. PMID:26512441

  13. Computed tomography of the postoperative abdominal aorta

    SciTech Connect

    Hilton, S.; Megibow, A.J.; Naidich, D.P.; Bosniak, M.A.

    1982-11-01

    Computed tomography (CT) of the abdomen was performed on 46 patients who had undergone graft replacement of abdominal aortic aneurysms. Twelve post-operative complications were found in nine patients. They included hemorrhage, infection, anastomotic pseudoaneurysms, major vessel occlusion, postoperative pancreatitis, and others. The varied apperance of the normal postoperative graft is also presented. It is concluded that CT is a rapid, sensitive, and noninvasive method for detecting or excluding postoperative complications of abdominal aortic surgery.

  14. A focus on intra-abdominal infections

    PubMed Central

    2010-01-01

    Complicated intra-abdominal infections are an important cause of morbidity and are frequently associated with poor prognosis, particularly in higher risk patients. Well defined evidence-based recommendations for intra-abdominal infections treatment are partially lacking because of the limited number of randomized-controlled trials. Factors consistently associated with poor outcomes in patients with intra-abdominal infections include increased illness severity, failed source control, inadequate empiric antimicrobial therapy and healthcare-acquired infection. Early prognostic evaluation of complicated intra-abdominal infections is important to select high-risk patients for more aggressive therapeutic procedures. The cornerstones in the management of complicated intra-abdominal infections are both source control and antibiotic therapy. The timing and the adequacy of source control are the most important issues in the management of intra-abdominal infections, because inadequate and late control of septic source may have a negative effect on the outcomes. Recent advances in interventional and more aggressive techniques could significantly decrease the morbidity and mortality of physiologically severe complicated intra-abdominal infections, even if these are still being debated and are yet not validated by limited prospective trials. Empiric antimicrobial therapy is nevertheless important in the overall management of intra-abdominal infections. Inappropriate antibiotic therapy may result in poor patient outcomes and in the appearance of bacterial resistance. Antimicrobial management is generally standardised and many regimens, either with monotherapy or combination therapy, have proven their efficacy. Routine coverage especially against Enterococci and candida spp is not always recommended, but can be useful in particular clinical conditions. A de escalation approach may be recommended in patients with specific risk factors for multidrug resistant infections such as immunodeficiency and prolonged antibacterial exposure. Therapy should focus on the obtainment of adequate source control and adequate use of antimicrobial therapy dictated by individual patient risk factors. Other critical issues remain debated and more controversies are still open mainly because of the limited number of randomized controlled trials. PMID:20302628

  15. An iatrogenic complication of closed tube thoracostomy for penetrating chest trauma.

    PubMed

    Andrabi, Syed Amer H; Andrabi, Syed Imran H; Mansha, Muhammad; Ahmed, Muhammad

    2007-01-01

    Penetrating thoracic trauma poses a management challenge to the on-call surgeon. A casual and unwary approach can lead to unforeseen complications in the initial height of management of such patients. We present a case of penetrating thoracic trauma where initial management with closed tube thoracostomy resulted in intubation of the stomach that had herniated into the chest through a diaphragmatic rent. Patients with penetrating injuries to the zone between the abdomen and chest should be managed with a high index of suspicion. PMID:17972991

  16. Effect of rectal distension on abdominal girth.

    PubMed

    Marino, B; Ogliari, C; Basilisco, G

    2004-08-01

    It has been postulated that a viscerosomatic reflex activated by gut distension and inhibiting abdominal wall muscle tone may be one of the mechanisms underlying functional abdominal distension. Any demonstration of such a reflex has to take into account the fact that gut distension may increase abdominal girth as a result of volume displacement. As biomechanical and sensory rectal responses vary at different rates of rectal distension, we hypothesized that different rates of rectal distension might reveal different changes in abdominal girth. Abdominal girth was continuously recorded in 14 healthy subjects using a previously validated extensometer. The rectal distensions were made in a randomized order at rates of 100 mL min(-1) or 10 mL min(-1) up to 150 mL, and sham distensions were used as controls. An increase in abdominal girth was observed at the end of both distensions (P

  17. Susceptibility variants for waist size in relation to abdominal, visceral, and hepatic adiposity in postmenopausal women.

    PubMed

    Lim, Unhee; Ernst, Thomas; Wilkens, Lynne R; Albright, Cheryl L; Lum-Jones, Annette; Seifried, Ann; Buchthal, Steven D; Novotny, Rachel; Kolonel, Laurence N; Chang, Linda; Cheng, Iona; Le Marchand, Loïc

    2012-07-01

    Genome-wide association studies have identified common genetic variants that can contribute specifically to the risk of abdominal adiposity, as measured by waist circumference or waist-to-hip ratio. However, it is unknown whether these genetic risk factors affect relative body fat distribution in the abdominal visceral and subcutaneous compartments. The association between imaging-based abdominal fat mass and waist-size risk variants in the FTO, LEPR, LYPLAL1, MSRA, NRXN3, and TFAP2B genes was investigated. A cross-sectional sample of 60 women was selected among study participants of The Multiethnic Cohort, who were aged 60 to 65 years, of European or Japanese descent, and with a body mass index (calculated as kg/m(2)) between 18.5 and 40. Dual-energy x-ray absorptiometry and abdominal magnetic resonance imaging scans were used to measure adiposity. After adjustments for age, ethnicity, and total fat mass, the FTO variants showed an association with less abdominal subcutaneous fat and a higher visceral-to-subcutaneous abdominal fat ratio, with the variant rs9941349 showing significant associations most consistently (P=0.003 and 0.03, respectively). Similarly, the LEPR rs1137101 variant was associated with less subcutaneous fat (P=0.01) and a greater visceral-to-subcutaneous fat ratio (P=0.03) and percent liver fat (P=0.007). MSRA rs545854 variant carriers had a lower percent of leg fat. Our findings provide initial evidence that some of the genetic risk factors identified for larger waist size might also contribute to disproportionately greater intra-abdominal and liver fat distribution in postmenopausal women. If replicated, these genetic variants can be incorporated with other biomarkers to predict high-risk body fat distribution. PMID:22889634

  18. Genes and Abdominal Aortic Aneurysm

    PubMed Central

    Hinterseher, Irene; Tromp, Gerard; Kuivaniemi, Helena

    2010-01-01

    Abdominal aortic aneurysm (AAA) is a multifactorial disease with a strong genetic component. Since first candidate gene studies were published 20 years ago, nearly 100 genetic association studies using single nucleotide polymorphisms (SNPs) in biologically relevant genes have been reported on AAA. The studies investigated SNPs in genes of the extracellular matrix, the cardiovascular system, the immune system, and signaling pathways. Very few studies were large enough to draw firm conclusions and very few results could be replicated in another sample set. The more recent unbiased approaches are family-based DNA linkage studies and genome-wide genetic association studies, which have the potential of identifying the genetic basis for AAA, if appropriately powered and well-characterized large AAA cohorts are used. SNPs associated with AAA have already been identified in these large multicenter studies. One significant association was of a variant in a gene called CNTN3 which is located on chromosome 3p12.3. Two follow-up studies, however, could not replicate the association. Two other SNPs, which are located on chromosome 9p21 and 9q33 were replicated in other samples. The two genes with the strongest supporting evidence of contribution to the genetic risk for AAA are the CDKN2BAS gene, also known as ANRIL, which encodes an antisense RNA that regulates expression of the cyclin-dependent kinase inhibitors CDKN2A and CDKN2B, and DAB2IP, which encodes an inhibitor of cell growth and survival. Functional studies are now needed to establish the mechanisms by which these genes contribute to AAA pathogenesis. PMID:21146954

  19. A Challenging Penetrating Trauma Case.

    PubMed

    Snoek, Seetal; Butson, Benjamin; Wittenberg, Mark

    2016-01-01

    We present the prehospital management of a 23-year-old Australian Aboriginal man with an isolated knife stab wound to the posterior right chest. The lead author attended to the prehospital management of this young man during tenure as a registrar in retrieval medicine for CareFlight Medical Services (CMS) in North Queensland, Australia. The case is noteworthy because it involved a combination of a life-threatening injury with a superimposed iatrogenic injury. The case will be of interest to physicians and clinicians in prehospital medicine as well as those in low-volume emergency departments or facilities in which major trauma may present infrequently. PMID:27021676

  20. [Perioperative hygiene in trauma surgery].

    PubMed

    Kasperczyk, W J; Tscherne, H

    1996-07-01

    Wound infection is the most significant nosocomial infection in trauma surgery. The acceptance of hygiene measures in the operational sector is generally high with a good educational level of personnel involved. In spite of this, inappropriate hygienic behavior can be observed repeatedly. The cause of this lies, in part, in a mental state of mind and is therefore not accessible to routine discussion. Several routinely relevant psychological aspects of hygiene behavior and motivation are shown. In addition, hygienic measures in the operating theater as they apply to the patient, the personnel and the surgical procedure are discussed. The authors opinion is stated. PMID:8928014

  1. Trauma and Violence in Autism.

    PubMed

    Westphal, Alexander

    2016-06-01

    Comorbidities of autism spectrum disorder are discussed as an introduction to the argument that, although ASD may modify presentation, it does not confer any protection against other disorder, including the negative effects of trauma (e.g., posttraumatic stress disorder). Dr. Im's hypotheses are discussed, and a case example of childhood disintegrative disorder (CDD) is raised to give clinical support to his hypotheses. CDD is a rare form of ASD that is defined by late onset, a traumatic prodrome, onset of behaviors including some with similarities to PTSD, and aggression. PMID:27236175

  2. Experimental Trauma Models: An Update

    PubMed Central

    Frink, Michael; Andruszkow, Hagen; Zeckey, Christian; Krettek, Christian; Hildebrand, Frank

    2011-01-01

    Treatment of polytrauma patients remains a medical as well as socioeconomic challenge. Although diagnostics and therapy improved during the last decades, multiple injuries are still the major cause of fatalities in patients below 45 years of age. Organ dysfunction and organ failure are major complications in patients with major injuries and contribute to mortality during the clinical course. Profound understanding of the systemic pathophysiological response is crucial for innovative therapeutic approaches. Therefore, experimental studies in various animal models are necessary. This review is aimed at providing detailed information of common trauma models in small as well as in large animals. PMID:21331361

  3. Taser-Related Testicular Trauma.

    PubMed

    Theisen, Katherine; Slater, Rick; Hale, Nathan

    2016-02-01

    The Thomas A. Swift's Electric Rifle (Taser) is an electrical weapon designed as a nonlethal means to subdue violent or fleeing subjects. Several reports have been published on the safety and efficacy of, as well as injury profile from, police Tasers. Documented urologic involvement is rare. The sequela of an electrical current from a Taser gun to the testis in regard to both short- and long-term functions is unknown. Herein we present a case of penetrating trauma to the scrotum from a Taser dart. PMID:26592466

  4. The trauma of a recession.

    PubMed

    Murphy, S M; Kieran, I; Shaughnessy, M O

    2011-09-01

    Employment in construction in Ireland fell by 10% from nearly 282,000 in the second quarter of 2007 to 255,000 in the same period of 2008. Our study looks at the differences in soft tissue upper limb trauma dynamics of a pre- and post-recession Ireland. Construction accounted for 330 patients (27%) of all hand injuries in 2006, but only 18 (3%) in 2009. Our data shows a significant drop in hand injuries related to the construction industry, and more home/DIY cases and deliberate self-harm presenting in their stead. PMID:21431394

  5. Migraine, head trauma and sport.

    PubMed

    Ashworth, B

    1985-10-01

    In some people an attack of migraine may be provoked by heading a football or a blow on the face in a rugby tackle. The attack is sometimes alarming and clearly cannot be explained on a basis of trauma alone. Some people only have attacks in this particular circumstance but the majority have spontaneous episodes at other times. The presentation is usually in childhood or early adult life. The syndrome is discussed in relation to reports of seven patients to illustrate the variations which include migraine without headache and persistent features after the attack. The condition is benign but may cause the patient to give up playing football. PMID:4095535

  6. Interactive work place trauma (IWPT).

    PubMed

    Shewchuk, Muriel

    2005-06-01

    Tragically, horizontal violence and bullying behaviour being master minded by nursing colleagues is firmly entrenched in many perioperative environments--just like a serious pathological bacteria. Interactive Workplace Trauma (IWPT) is ugly, mean, destructive, demoralizing and counterproductive to efficient, effective patient care and positive staff performance. Get educated and use astute observations to ensure you clearly understand what is occurring. Make sure the staff feel safe and have the appropriate, necessary protection to deal with unacceptable conduct. Deal effectively with the bullies. Remember if it is not documented, it didn't happen! PMID:16092572

  7. Sexual Trauma in Military May Lead to Homelessness

    MedlinePlus

    ... medlineplus/news/fullstory_158418.html Sexual Trauma in Military May Lead to Homelessness: Study Rates were doubled ... for men than women, a new study finds. Military sexual trauma is the name for psychological trauma ...

  8. Trauma care systems in The Netherlands.

    PubMed

    ten Duis, Henk Jan; van der Werken, Chris

    2003-09-01

    In the late 1980s the Dutch trauma surgeons (Dutch Trauma Society) expressed their concern about the quality of care to the (multi) trauma patients, in the prehospital as well as the in-hospital setting. The following intensive debate with the public health inspectorate and the government became the start point for major improvements in teaching and training (a.o. ATLS), reorganization, regionalization and implementation in which all partners in trauma care were involved. The regionalization of ambulance care, the introduction of mobile medical teams, the availability of trauma helicopters, the categorization of hospitals, the designation of trauma centres, the given responsibility of these centres in the regionalization of trauma care will and already have resulted in an important quality improvement, not only of the individual organizations but for all of the entire chain of trauma care. It has become a major step forward in the philosophy: get the individual trauma patient at the right time at the right hospital. Besides, initiatives have been taken to design a nationwide trauma registration data base in which all in-hospital trauma patients will be included. However serious concerns remain: shortage of intensive care beds, the impossibility to use the helicopter service at night, the shortage in the number of mobile medical teams at night and the slowness in executions of agreements between contracting parties. Many of the remaining problems are a matter of money. Not only (para) medical partners and hospitals but for all government and insurance companies should take their responsibility in this. PMID:12951300

  9. Intraoperative Sac Pressure Measurement During Endovascular Abdominal Aortic Aneurysm Repair

    SciTech Connect

    Ishibashi, Hiroyuki; Ishiguchi, Tsuneo; Ohta, Takashi; Sugimoto, Ikuo; Iwata, Hirohide; Yamada, Tetsuya; Tadakoshi, Masao; Hida, Noriyuki; Orimoto, Yuki; Kamei, Seiji

    2010-10-15

    PurposeIntraoperative sac pressure was measured during endovascular abdominal aortic aneurysm repair (EVAR) to evaluate the clinical significance of sac pressure measurement.MethodsA microcatheter was placed in an aneurysm sac from the contralateral femoral artery, and sac pressure was measured during EVAR procedures in 47 patients. Aortic blood pressure was measured as a control by a catheter from the left brachial artery.ResultsThe systolic sac pressure index (SPI) was 0.87 {+-} 0.10 after main-body deployment, 0.63 {+-} 0.12 after leg deployment (P < 0.01), and 0.56 {+-} 0.12 after completion of the procedure (P < 0.01). Pulse pressure was 55 {+-} 21 mmHg, 23 {+-} 15 mmHg (P < 0.01), and 16 {+-} 12 mmHg (P < 0.01), respectively. SPI showed no significant differences between the Zenith and Excluder stent grafts (0.56 {+-} 0.13 vs. 0.54 {+-} 0.10, NS). Type I endoleak was found in seven patients (15%), and the SPI decreased from 0.62 {+-} 0.10 to 0.55 {+-} 0.10 (P = 0.10) after fixing procedures. Type II endoleak was found in 12 patients (26%) by completion angiography. The SPI showed no difference between type II endoleak positive and negative (0.58 {+-} 0.12 vs. 0.55 {+-} 0.12, NS). There were no significant differences between the final SPI of abdominal aortic aneurysms in which the diameter decreased in the follow-up and that of abdominal aortic aneurysms in which the diameter did not change (0.53 {+-} 0.12 vs. 0.57 {+-} 0.12, NS).ConclusionsSac pressure measurement was useful for instant hemodynamic evaluation of the EVAR procedure, especially in type I endoleaks. However, on the basis of this small study, the SPI cannot be used to reliably predict sac growth or regression.

  10. Ruptured abdominal aortic aneurysm diagnosed through non-contrast MRI

    PubMed Central

    Chatra, Priyank S

    2013-01-01

    Rupture of an aneurysm is a rare complication although it is considered a common cause of death. Some of these patients present with the classic triad of symptoms such as abdominal pain, pulsatile abdominal mass and shock. Most symptoms are misleading and will only present as vague abdominal pain. Here we describe one such patient with an unusual presentation of a misleading abdominal mass which was eventually diagnosed as a ruptured abdominal aortic aneurysm after an emergency MRI. PMID:25003065

  11. WANTED: Fully Automated Indexing.

    ERIC Educational Resources Information Center

    Purcell, Royal

    1991-01-01

    Discussion of indexing focuses on the possibilities of fully automated indexing. Topics discussed include controlled indexing languages such as subject heading lists and thesauri, free indexing languages, natural indexing languages, computer-aided indexing, expert systems, and the need for greater creativity to further advance automated indexing.…

  12. [Update: blast and explosion trauma].

    PubMed

    van de Weyer, P S; Praetorius, M; Tisch, M

    2011-08-01

    In recent decades, acoustic shock and explosion traumas have increased in frequency in the general population. Beside the use of fireworks and firearms, airbag ignitions and explosions caused by terror or suicidal acts are also relevant. Depending on duration and strength of the sound pressure affecting the human ear, isolated inner ear damage or additional ear drum perforation and interruption of the middle ear ossicle chain can result. By means of otoscopy, pure tone audiometry, measurement of otoacoustic emissions, and other neurootological examinations, the severity of the trauma can be determined. With prompt and adequate therapy, permanent hearing loss can be minimized. In particular, the measurement of otoacoustic emissions allows conclusions to be made on the functionality of the outer hair cells which are damaged first in most cases. Histological investigations on noise-exposed cochleas show extensive damage to the outer hair cells in the frequency range between 1.0 and 4.0 kHz, which correlates well with audiometric measurements. PMID:21769579

  13. Management of temporal bone trauma.

    PubMed

    Patel, Alpen; Groppo, Eli

    2010-06-01

    The temporal bones are paired structures located on the lateral aspects of the skull and contribute to the skull base. Trauma is usually the result of blunt head injury and can result in damage to the brain and meninges, the middle and internal ear, and the facial nerve. Complications can include intracranial hemorrhage, cerebral contusion, CSF leak and meningitis, hearing loss, vertigo, and facial paralysis. To prevent these complications, diagnosis followed by appropriate medical and surgical management is critical. Diagnosis relies primarily on physical signs and symptoms as well as radiographic imaging. Emergent intervention is required in situations involving herniation of the brain into the middle ear cavity or hemorrhage of the intratemporal carotid artery. Patients with declining facial nerve function are candidates for early surgical intervention. Conductive hearing loss can be corrected surgically as an elective procedure, while sensorineural hearing loss carries a poor prognosis, regardless of management approach. Children generally recover from temporal bone trauma with fewer complications than adults and experience a markedly lower incidence of facial nerve paralysis. PMID:22110824

  14. Transport of the trauma patient.

    PubMed

    Davies, G; Chesters, A

    2015-07-01

    The transport of the seriously injured patient is associated with risk and requires particular expertise and attention. The aim of this review is to provide a historical overview of transport services available to trauma patients in the UK, describe the various transport platforms that are used, identify risks from a system and disease perspective and how they may be mitigated, and make international comparisons. The transfer of patients requiring medical attention has developed over the years and now includes complex undertakings that undoubtedly confer a degree of risk on the patient. A number of different transport platforms are in regular use in the UK, and a number of different health-care professions of varying training, experience, and seniority undertake these transfers. The general principles are to provide no worse care en route than has been provided at the departure destination and to transport patients to a destination capable of delivering whichever intervention the patient is deemed to require. When deciding to transport an injured patient, there are risks, and appropriate mitigation must be in place, particularly if primary transfer to a major trauma centre involves bypassing a nearer facility. It is clear that those clinicians who undertake medical transfers must be appropriately trained and must have access to local or national guidelines. Medical transfers must be the subject of ongoing research, both to ensure that best practice is in place and to continue to understand the safest way of achieving essential transfers effectively. PMID:26089445

  15. Haemostatic factors, atherosclerosis and risk of abdominal aortic aneurysm.

    PubMed

    Lee, A J; Fowkes, F G; Lowe, G D; Rumley, A

    1996-10-01

    Abdominal aortic aneurysms have traditionally been thought to be a consequence of severe atherosclerosis of the arterial wall. To date, the role of haemostatic factors in aneurysmal disease has not been extensively researched. The aim of this study was to see if such factors were independently related to the occurrence of aortic aneurysm. Furthermore, were the associations maintained after taking into account the presence of underlying atherosclerotic disease? Using data from the Edinburgh Artery Study, a nested case-control design was used involving 40 cases of aortic aneurysm, each being matched to five controls by sex and within a 5-year age band. After adjustment for age and sex, both fibrinogen (P < or = 0.01) and fibrin D-dimer (P < or = 0.001) were each associated with a significant increased risk of aneurysm. Further adjustment for packyears, history of cardiovascular disease and the ankle brachial pressure index resulted in odds ratios of 1.51 (95% CI 1.05 to 2.16, P < or = 0.05) for fibrinogen and 3.75 (95% CI 1.80 to 7.82, P < or = 0.001) for fibrin D-dimer. These associations probably arise as a consequence of fibrin deposition and turnover within the aneurysmal sac, although further prospective studies are needed before thrombotic factors can be used in the identification of a group who are at high risk of developing an abdominal aortic aneurysm. PMID:8958392

  16. Systemic oxidant/antioxidant balance in human abdominal aortic aneurysm.

    PubMed

    Menteşe, Umit; Turan, Ibrahim; Usta, Sefer; Demir, Selim; Koral, Özgür; Öztaş Menteşe, Seda; Çavuşoğlu, Ismail Gökhan; Karahan, Süleyman Caner; Alver, Ahmet; Doğan, Orhan Veli; Aykan, Ahmet Çağrı

    2016-05-01

    The aim of this study was to evaluate the oxidant-antioxidant balance in patients with abdominal aortic aneurysms (AAA). Forty-two consecutive patients with AAA and 46 control subjects were included. Total oxidant status (TOS) and total antioxidant status (TAS) levels were measured and the oxidative stress index (OSI) value determined. Serum TOS and OSI values in patients with AAA were higher than those in the controls (p<0.001, p<0.001, respectively). There was a positive correlation between abdominal aortic diameters, serum TOS levels (r=0.592, p<0.001) and OSI values (r=0.598, p<0.001). A cut-off value of 17.68 µmol H2O2equivalent/L for TOS was associated with 86% sensitivity and 83% specificity and a cut-off value of 1.77 for OSI was associated with 86% sensitivity and 81% specificity for predicting AAA. Systemic oxidative imbalance develops in patients with AAA, particularly as a result of an increase in TOS. PMID:26228275

  17. [Gasless laparoscopic cholecystectomy using retractor of the abdominal wall].

    PubMed

    D'Urbano, C; Fuertes Guiro, F; Sampietro, R

    1996-03-01

    The Authors present a new gasless laparoscopic cholecystectomy method using an abdominal wall elevator with subcutaneous traction ("laparotenser"). Fifty patients between May 1994 and March 1995 were operated by videolaparoscopy using this new gasless method. Twenty of them were operated with Nagai's method while the laparotenser was used in the remaining thirty. The results obtained are similar to those using pneumoperitoneum. It has been observed a global reduction of costs, less postoperative pain, no influence in cardiovascular and metabolic indexes. No complications were reported during the postoperative period but two cases of conversion to laparotomy not related to the method used were needed. Laparoscopic cholecystectomy without pneumoperitoneum using the subcutaneous elevator of the abdominal wall ("laparotenser") has demonstrated that it's possible to operate in a working space similar to that created by the pneumoperitoneum. After an initial period of distrust towards the laparoscopic methods without pneumoperitoneum it has been accepted that gasless methods multiply the indications to minimally invasive surgery in patients with cardiorespiratory problems considered no ideal candidates to laparoscopic cholecystectomy with pneumoperitoneum. PMID:8679422

  18. Central serous chorioretinopathy secondary to trauma

    PubMed Central

    Jackson, Thomas E.; Sood, Vaneeta; Haigh, Paul M.

    2012-01-01

    The first case of central serous chorioretinopathy secondary to blunt trauma is presented. Optical coherence tomography performed on presentation, 3 days after trauma, demonstrated a neurosensory detachment of the macular, thus confirming clinical findings. At 3 months after injury, the retina had spontaneously flattened at the macular and vision had returned to normal. PMID:22557878

  19. Trauma among Street-Involved Youth

    ERIC Educational Resources Information Center

    Bender, Kimberly A.; Thompson, Sanna J.; Ferguson, Kristin M.; Yoder, Jamie R.; Kern, Leah

    2014-01-01

    Previous research documents that street-involved youth experience rates of trauma and posttraumatic stress disorder (PTSD) that are significantly higher than their housed counterparts. Trauma and PTSD are of particular concern for homeless youth as they can negatively affect youths' ability to function adaptively and to transition off the

  20. Healing Trauma, Building Resilience: SITCAP in Action

    ERIC Educational Resources Information Center

    Steele, William; Kuban, Caelan

    2014-01-01

    Childhood trauma is marked by an overwhelming sense of terror and powerlessness. Loss of loving relationships is yet another type of trauma that produces the pain of sadness and grief. The resulting symptoms only reflect the neurological, biological, and emotional coping systems mobilized in the struggle to survive. These young people need new

  1. Partner preferences among survivors of betrayal trauma.

    PubMed

    Gobin, Robyn L

    2012-01-01

    Betrayal trauma theory suggests that social and cognitive development may be affected by early trauma such that individuals develop survival strategies, particularly dissociation and lack of betrayal awareness, that may place them at risk for further victimization. Several experiences of victimization in the context of relationships predicated on trust and dependence may contribute to the development of relational schema whereby abuse is perceived as normal. The current exploratory study investigates interpersonal trauma as an early experience that might impact the traits that are desired in potential romantic partners. Participants in the current study were asked to rate the desirability of several characteristics in potential romantic partners. Although loyalty was desirable to most participants regardless of their trauma history, those who reported experiences of high betrayal trauma rated loyalty less desirable than those who reported experiences of traumas that were low and medium in betrayal. Participants who reported experiences of revictimization (defined as the experience of trauma perpetrated by a close other during 2 different developmental periods) differed from participants who only reported 1 experience of high betrayal trauma in their self-reported desire for a romantic partner who possessed the traits of sincerity and trustworthiness. Preference for a partner who uses the tactic of verbal aggression was also associated with revictimization status. These preliminary findings suggest that victimization perpetrated by close others may affect partner preferences. PMID:22375805

  2. Training Journalism Students To Deal with Trauma.

    ERIC Educational Resources Information Center

    Maxson, Jan

    The School of Communications at the University of Washington initiated the Journalism and Trauma program in 1994 so that all of its journalism graduates would be informed about trauma and would consider how to interview and write about victims without doing further harm to them. The program adapts learning objectives of the pioneer Victims and the…

  3. The Biology of Trauma: Implications for Treatment

    ERIC Educational Resources Information Center

    Solomon, Eldra P.; Heide, Kathleen M.

    2005-01-01

    During the past 20 years, the development of brain imaging techniques and new biochemical approaches has led to increased understanding of the biological effects of psychological trauma. New hypotheses have been generated about brain development and the roots of antisocial behavior. We now understand that psychological trauma disrupts homeostasis

  4. The Biology of Trauma: Implications for Treatment

    ERIC Educational Resources Information Center

    Solomon, Eldra P.; Heide, Kathleen M.

    2005-01-01

    During the past 20 years, the development of brain imaging techniques and new biochemical approaches has led to increased understanding of the biological effects of psychological trauma. New hypotheses have been generated about brain development and the roots of antisocial behavior. We now understand that psychological trauma disrupts homeostasis…

  5. Trauma-Informed Forensic Child Maltreatment Investigations

    ERIC Educational Resources Information Center

    Pence, Donna M.

    2011-01-01

    Trauma-informed child welfare systems (CWSs) are the focus of several recent national and state initiatives. Since 2005 social work publications have focused on systemic and practice changes within CW which seek to identify and reduce trauma to children and families experiencing child maltreatment or other distressing events, as well as to the

  6. Imaging of orthopedic trauma and surgery

    SciTech Connect

    Berquist, T.H.

    1986-01-01

    This book discusses imaging of orthopedia trauma and surgery. A review of the pertinent anatomy, mechanism of injury, and radiology and orthopedic classification is provided for each topic discussed. The book employs recent advances in technique and focuses on adult skeletal trauma, and joint replacement.

  7. Trauma-Informed Forensic Child Maltreatment Investigations

    ERIC Educational Resources Information Center

    Pence, Donna M.

    2011-01-01

    Trauma-informed child welfare systems (CWSs) are the focus of several recent national and state initiatives. Since 2005 social work publications have focused on systemic and practice changes within CW which seek to identify and reduce trauma to children and families experiencing child maltreatment or other distressing events, as well as to the…

  8. Trauma among Street-Involved Youth

    ERIC Educational Resources Information Center

    Bender, Kimberly A.; Thompson, Sanna J.; Ferguson, Kristin M.; Yoder, Jamie R.; Kern, Leah

    2014-01-01

    Previous research documents that street-involved youth experience rates of trauma and posttraumatic stress disorder (PTSD) that are significantly higher than their housed counterparts. Trauma and PTSD are of particular concern for homeless youth as they can negatively affect youths' ability to function adaptively and to transition off the…

  9. Tips for Teachers during Times of Trauma.

    ERIC Educational Resources Information Center

    Adkins, Myrna Ann; Harper, Eric

    This guide for teachers in times of trauma was updated after the events of September 11, 2001--the terrorist attacks on the World Trade Center and the Pentagon. These traumatic events could cause refugees to experience trauma or become re-traumatized. For many refugees, their English-as-a-Second-Language (ESL) programs are the places where they…

  10. Healing Trauma, Building Resilience: SITCAP in Action

    ERIC Educational Resources Information Center

    Steele, William; Kuban, Caelan

    2014-01-01

    Childhood trauma is marked by an overwhelming sense of terror and powerlessness. Loss of loving relationships is yet another type of trauma that produces the pain of sadness and grief. The resulting symptoms only reflect the neurological, biological, and emotional coping systems mobilized in the struggle to survive. These young people need new…

  11. Ocular injuries in patients with major trauma

    PubMed Central

    Guly, C M; Guly, H R; Bouamra, O; Gray, R H; Lecky, F E

    2006-01-01

    Aim To study the epidemiology of ocular injuries in patients with major trauma in the UK, determining the incidence and causes of ocular injuries, and their association with facial fractures. Methods A retrospective analysis of the Trauma Audit Research Network database from 1989 to 2004, looking at data from 39 073 patients with major trauma. Results Of the 39 073 patients with major trauma, 905 (2.3%) patients had associated ocular injuries and 4082 (10.4%) patients had a facial fracture (zygoma, orbit or maxilla). The risk of an eye injury for a patient with a facial fracture is 6.7 times as that for a patient with no facial fracture (95%, confidence interval 5.9 to 7.6). Of the patients with major trauma and an eye injury, 75.1% were men, and the median age was 31 years. 57.3% of ocular injuries were due to road traffic accidents (RTAs). Conclusion The incidence of ocular injuries in patients with major trauma is low, but considerable association was found between eye injuries and facial fractures. Young adults have the highest incidence of ocular injury. RTAs are the leading cause of ocular injuries in patients with major trauma. It is vital that all patients with major trauma are examined specifically for an ocular injury. PMID:17130597

  12. Trauma severity and defensive emotion-regulation reactions as predictors of forgetting childhood trauma.

    PubMed

    Bottoms, Bette L; Najdowski, Cynthia J; Epstein, Michelle A; Badanek, Matthew J

    2012-01-01

    Using a retrospective survey, we studied a sample of 1,679 college women to determine whether reports of prior forgetting of childhood sexual abuse, physical abuse, and other traumas could be explained by trauma severity and individual differences in the use of defensive emotion-regulation reactions (i.e., repressive coping, dissociation, and fantasy proneness). Among victims of physical abuse (but not sexual abuse or other types of trauma), those who experienced severe abuse and used defensive reactions were sometimes more likely to report temporary forgetting of abuse but other times less likely to report forgetting. We also found unanticipated main effects of trauma severity on temporary forgetting. Our results provide an understanding of victims' experiences of forgetting by demonstrating the importance of considering unique effects of trauma type, different aspects of trauma severity, and victims' defensive reactions to trauma. PMID:22545564

  13. Clinical diagnosis of intra-abdominal infections.

    PubMed

    Emmi, V; Sganga, G

    2009-07-01

    Abdominal sepsis results in high morbidity and mortality. Intra-abdominal infectious complications are one of the most common infectious pathologies seen in critically ill patients. Approximately 30% of patients admitted to an ICU with intra-abdominal infection succumb to their illness, and when peritonitis arises as a complication of a previous surgical procedure, or recurs during ICU admission, mortality rates exceed 50%. Thus early detection and treatment are essential to minimize patient complications.Critically ill patients are often clinically unevaluable due to distracting injuries, respiratory failure, obtundation, or other pathology. even when patients can be examined, the clinical exam is frequently unreliable and/or misleading. the diagnostic approach to identifying abdominal problems will differ, depending upon the hemodynamic stability of the patient. Patients who have low systolic blood pressures, who are pressor-dependent, may be too unstable to undergo analyses that require trips away from the ICU or emergency department. intra-abdominal pathology may be detected by ultrasound or diagnostic peritoneal lavage. When critically ill patients are stable enough to undergo some diagnostic evaluation of their abdomen, the approach is somewhat simpler. Overall, computerized tomography (CT) is the imaging modality of choice for most intra-abdominal processes. for diagnosis of intra-abdominal conditions using CT scanning it is optimal if patients receive both oral and intravenous contrast. An exception to the use of CT scanning is evaluation of suspected biliary pathology, which is best imaged by ultrasound. it will identify calculous and acalculous cholecystitis and may show changes in the gallbladder or common bile duct associated with biliary obstruction. PMID:19622446

  14. Factors Associated with the Disposition of Severely Injured Patients Presenting to Non-Trauma Center Emergency Departments: Disparities by Insurance Status

    PubMed Central

    Delgado, M. Kit; Yokell, Michael A.; Staudenmayer, Kristan L.; Spain, David A.; Hernandez-Boussard, Tina; Wang, N. Ewen

    2014-01-01

    Importance Trauma is the leading cause of potential years of life lost before age 65 in the U.S. Timely care in a designated trauma center has been shown to reduce mortality by 25%. However, many severely injured patients are not transferred to trauma centers after initially presenting to non-trauma centers. Objective Determine patient and hospital level factors associated with the decision to admit rather than transfer severely injured patients who present to non-trauma center emergency departments (EDs). We hypothesized that insured patients would be more likely to be admitted than transferred compared to patients without insurance. Design, Setting, and Participants Retrospective analysis of the 2009 Nationwide Emergency Department Sample. We included all ED encounters for major trauma (injury severity score [ISS] > 15) seen at non-trauma centers in patients aged 18–64. We excluded ED discharges and ED deaths. We quantified the absolute risk difference between admission vs. transfer by insurance status while adjusting for age, sex, injury severity, injury mechanism, weekend admission, month, urban-rural status and median income of home zip code, ED volume and teaching status, and U.S. region Main Outcome Measures Inpatient admission vs. transfer to another acute care facility. Results There were 4,513 observations from 636 non-trauma centers for analysis, representing a nationally weighted population of 19,312 non-trauma center ED encounters for major trauma in 2009. In 2009 54.5% were admitted at the non-trauma center. Compared to the uninsured, the adjusted absolute risk of admission vs. transfer was 14.2% higher (95% CI: 9.2, 19.4) for patients with Medicaid and 11.1 % higher (95% CI: 6.9, 15.4) for patients with private insurance. Other factors associated with admission vs. transfer included severe abdominal injuries (risk difference 15.8%,95% CI: 9.3, 22.3) urban teaching hospital vs. non-teaching hospital ((26.2%,15.2, 37.2), and ED volume (3.4% higher (95% CI: 1.6, 5.3%) for every additional 10,000 annual ED visits). Conclusions and Relevance Patients with severe injuries initially evaluated at non-trauma centers were less likely to be transferred if insured, and thus were at risk of receiving sub-optimal trauma care. Monitoring and optimizing trauma interhospital transfers and outcomes at the population level is warranted. PMID:24554059

  15. The Wounded Self in Trauma Treatment.

    PubMed

    Kluft, Richard P

    2016-07-01

    The potential role of hypnosis in the treatment of trauma is both venerable and underappreciated. This article underscores the importance of the wounded-self concept by proposing a Kohutian perspective complimentary to the cognitively-driven model of Alladin (2014a, 2014b) discussed elsewhere in this issue. It explores selected topics that demonstrate (1) the importance of considering the wounds to the sense of self experienced by trauma victims and their implications for individualization of treatment in planning a psychotherapy; (2) the possibility of enhancing access to memories using shame alleviating techniques with minimal suggestive properties; (3) the use of hypnosis to facilitate less disruptive processing of traumatic materials; and (4) the importance of hypnosis in enhancing the safety of the trauma patient between sessions. Absent contraindications, the circumspect use of hypnosis as a facilitator of trauma treatment deserves consideration for inclusion in the mainstream of contemporary trauma treatment. PMID:27196011

  16. One-year treatment costs of trauma care in the USA.

    PubMed

    Weir, Sharada; Salkever, David S; Rivara, Frederick P; Jurkovich, Gregory J; Nathens, Avery B; Mackenzie, Ellen J

    2010-04-01

    Although injuries are a leading cause of morbidity and mortality in the USA, few prior studies exist on the costs of trauma care. This article estimates treatment costs of care for 12 months following injury. Primary and secondary data were collected on over 5000 moderate-to-severely injured patients 18-84 years of age discharged from 69 US hospitals. Acute and post-acute costs of care were estimated from a combination of data sources: UB92 hospital bills, patient surveys, medical record abstracts, and where available, Medicare claims. Key analysis variables were demographic characteristics, insurance status and nature and severity of injury. Mean 1-year cost per patient of trauma care in our population was $75,210. On average, 58% of cost was accounted for by the index hospitalization. Total 1-year treatment cost of adult major trauma in the USA was conservatively estimated to be US$27 billion annually (2005). PMID:20384565

  17. Sex differences in heart rate responses to script-driven imagery soon after trauma and risk of posttraumatic stress disorder

    PubMed Central

    Kleim, Birgit; Wilhelm, Frank H.; Glucksman, Edward; Ehlers, Anke

    2011-01-01

    OBJECTIVE Trauma survivors physiological responses to idiosyncratic trauma reminders may be predictive of later posttraumatic stress disorder (PTSD). The majority of previous studies have been cross-sectional and have produced mixed findings. Sex differences may contribute to this heterogeneity. The present study investigated the predictive validity of heightened physiological responsivity to script-driven imagery and sex for the development of PTSD. METHODS Heart rate (HR) and respiratory sinus arrhythmia (RSA) were measured at two weeks post-trauma in 158 assault survivors during baseline and while listening to an idiosyncratic trauma script. At 6 months, 15.2% of male and 28.1 % of female participants met diagnostic criteria for PTSD. RESULTS GLM and logistic regression analyses showed that HR response to script-driven imagery and sex interacted in predicting PTSD symptom severity at six months. Women had greater PTSD symptom severities overall. Female HR responders to script driven imagery showed the highest PTSD symptom severities, and were almost three times more likely to develop PTSD at six months compared to men and female nonresponders (OR = 2.72, 95% CI= 1.13-6.57). RSA responder type did not predict PTSD, OR = .64, 95%CI = .30 1.33. CONCLUSION Female trauma survivors who respond to trauma reminders with increased HR may be at particular risk of developing PTSD. Physiological reactivity to trauma cues may be a useful index for screening and prevention of PTSD. PMID:20947782

  18. Resuscitative endovascular balloon occlusion of the aorta (REBOA): a population based gap analysis of trauma patients in England and Wales

    PubMed Central

    Barnard, Edward Benjamin Graham; Morrison, Jonathan James; Madureira, Ricardo Mondoni; Lendrum, Robbie; Fragoso-Iñiguez, Marisol; Edwards, Antoinette; Lecky, Fiona; Bouamra, Omar; Lawrence, Thomas; Jansen, Jan Olaf

    2015-01-01

    Introduction Non-compressible torso haemorrhage (NCTH) carries a high mortality in trauma as many patients exsanguinate prior to definitive haemorrhage control. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an adjunct that has the potential to bridge patients to definitive haemostasis. However, the proportion of trauma patients in whom REBOA may be utilised is unknown. Methods We conducted a population based analysis of 2012–2013 Trauma Audit and Research Network (TARN) data. We identified the number of patients in whom REBOA may have been utilised, defined by an Abbreviated Injury Scale score ≥3 to abdominal solid organs, abdominal or pelvic vasculature, pelvic fracture with ring disruption or proximal traumatic lower limb amputation, together with a systolic blood pressure <90 mm Hg. Patients with non-compressible haemorrhage in the mediastinum, axilla, face or neck were excluded. Results During 2012–2013, 72 677 adult trauma patients admitted to hospitals in England and Wales were identified. 397 patients had an indication(s) and no contraindications for REBOA with evidence of haemorrhagic shock: 69% men, median age 43 years and median Injury Severity Score 32. Overall mortality was 32%. Major trauma centres (MTCs) received the highest concentration of potential REBOA patients, and would be anticipated to receive a patient in whom REBOA may be utilised every 95 days, increasing to every 46 days in the 10 MTCs with the highest attendance of this injury type. Conclusions This TARN database analysis has identified a small group of severely injured, resource intensive patients with a highly lethal injury that is theoretically amenable to REBOA. The highest density of these patients is seen at MTCs, and as such a planned evaluation of REBOA should be further considered in these hospitals. PMID:26598631

  19. Abdominal sarcoidosis: cross-sectional imaging findings

    PubMed Central

    Gezer, Naciye Sinem; Başara, Işıl; Altay, Canan; Harman, Mustafa; Rocher, Laurence; Karabulut, Nevzat; Seçil, Mustafa

    2015-01-01

    Sarcoidosis is a multisystem inflammatory disease of unknown etiology. The lungs and the lymphoid system are the most commonly involved organs. Extrapulmonary involvement is reported in 30% of patients, and the abdomen is the most common extrapulmonary site with a frequency of 50%–70%. Although intra-abdominal sarcoidosis is usually asymptomatic, its presence may affect the prognosis and treatment options. The lesions are less characteristic and may mimick neoplastic or infectious diseases such as lymphoma, diffuse metastasis, and granulomatous inflammation. The liver and spleen are the most common abdominal sites of involvement. Sarcoidosis of the gastrointestinal system, pancreas, and kidneys are extremely rare. Adenopathy which is most commonly found in the porta hepatis, exudative ascites, and multiple granulomatous nodules studding the peritoneum are the reported manifestations of abdominal sarcoidosis. Since abdominal sarcoidosis is less common and long-standing, unrecognized disease can result in significant morbidity and mortality. Imaging contributes to diagnosis and management of intra-abdominal sarcoidosis. In this report we reviewed the cross-sectional imaging findings of hepatobiliary, gastrointestinal, and genitourinary sarcoidosis. PMID:25512071

  20. Abdominal sarcoidosis: cross-sectional imaging findings.

    PubMed

    Gezer, Naciye Sinem; Başara, Işıl; Altay, Canan; Harman, Mustafa; Rocher, Laurence; Karabulut, Nevzat; Seçil, Mustafa

    2015-01-01

    Sarcoidosis is a multisystem inflammatory disease of unknown etiology. The lungs and the lymphoid system are the most commonly involved organs. Extrapulmonary involvement is reported in 30% of patients, and the abdomen is the most common extrapulmonary site with a frequency of 50%-70%. Although intra-abdominal sarcoidosis is usually asymptomatic, its presence may affect the prognosis and treatment options. The lesions are less characteristic and may mimick neoplastic or infectious diseases such as lymphoma, diffuse metastasis, and granulomatous inflammation. The liver and spleen are the most common abdominal sites of involvement. Sarcoidosis of the gastrointestinal system, pancreas, and kidneys are extremely rare. Adenopathy which is most commonly found in the porta hepatis, exudative ascites, and multiple granulomatous nodules studding the peritoneum are the reported manifestations of abdominal sarcoidosis. Since abdominal sarcoidosis is less common and long-standing, unrecognized disease can result in significant morbidity and mortality. Imaging contributes to diagnosis and management of intra-abdominal sarcoidosis. In this report we reviewed the cross-sectional imaging findings of hepatobiliary, gastrointestinal, and genitourinary sarcoidosis. PMID:25512071

  1. Primary intra-abdominal synovial sarcoma.

    PubMed

    Wang, Yzu-Jen; Wen, Shi-Chi; Chien, Shang-Tao; Sheu, Jin-Wen; Hsuea, Chao-Wen; Feng, Nan-Hsiung

    2006-10-01

    We report a case of primary intra-abdominal synovial sarcoma of the omentum in a 66-year-old man hospitalized for intermittent abdominal fullness for 1-2 months and tenesmus for 2 weeks. The patient had a palpable mass that was solid, hard and with well-defined thickness within his abdomen. A huge heterogeneous mass lesion over the middle abdomen that started from S2, S3 of the liver to the transverse colon was shown on abdominal computed tomography. The major cell types of the tissue mass were confirmed to be spindle and epithelial cells, which was consistent with biphasic synovial sarcoma according to pathologic and immunohistochemical findings. PMID:17098675

  2. Minimal Invasive Treatment of Abdominal Multiorgan Echinococcosis

    PubMed Central

    Tomuş, Claudiu; Zaharie, Florin; Mocan, Lucian; Bartoş, Dana; Zaharie, Roxana; Iancu, Cornel; Nadim, Al Hajjar

    2013-01-01

    Hydatid disease is a severe zoonosis, exerting a high economic and social impact through its numerous complications, leading to disabilities, even death. Because of technical developments, especially the increasing experience of surgeons, laparoscopic surgery has been extended so that it can be successfully applied to abdominal hydatid cysts. We present the case of a 16-year-old patient who came to our clinic for upper abdominal pain. The abdominal ultrasonography and computed tomography (CT) showed 2 cyst-like tumors, with hydatid features: one affecting the eighth liver segment and the other located at the upper pole of the spleen. We performed the surgical intervention using a laparoscopic approach, with an uneventful postoperative follow-up and the patient was discharged home on postoperative day 4. The postoperative images at 6 and 12 months showed a decrease in size of the remnant cystic cavities. PMID:23438278

  3. [Differential diagnosis of abdominal cysts in children].

    PubMed

    Józsa, Gergő; Mohay, Gabriella; Pintér, András; Vástyán, Attila

    2015-09-13

    19 children were diagnosed with abdominal cysts of different origin in the Surgical Unit of the Department of Pediatrics, Medical University of Pécs, Hungary between 2010 and 2013. The authors discuss the details of representative cases of a parovarial cyst, an intestinal duplication, and an omental cyst with emphasis on the clinical symptoms, diagnostic tools, and surgical interventions. The authors conclude that abdominal cysts often cause mild symptoms only, and they are discovered accidentally by ultrasound imaging performed for other reasons. In some cases, the cyst can cause severe complaints or even acute abdomen requiring emergency surgery. Laporoscopy may be a valuable method both in diagnosis and surgical therapy. Abdominal CT or MRI are not required in the majority of the patients. PMID:26552027

  4. Bioprosthetic Mesh in Abdominal Wall Reconstruction

    PubMed Central

    Baumann, Donald P.; Butler, Charles E.

    2012-01-01

    Mesh materials have undergone a considerable evolution over the last several decades. There has been enhancement of biomechanical properties, improvement in manufacturing processes, and development of antiadhesive laminate synthetic meshes. The evolution of bioprosthetic mesh materials has markedly changed our indications and methods for complex abdominal wall reconstruction. The authors review the optimal properties of bioprosthetic mesh materials, their evolution over time, and their indications for use. The techniques to optimize outcomes are described using bioprosthetic mesh for complex abdominal wall reconstruction. Bioprosthetic mesh materials clearly have certain advantages over other implantable mesh materials in select indications. Appropriate patient selection and surgical technique are critical to the successful use of bioprosthetic materials for abdominal wall repair. PMID:23372454

  5. Abdominal Sarcoidosis May Mimic Peritoneal Carcinomatosis

    PubMed Central

    Gorkem, Umit; Gungor, Tayfun; Bas, Yılmaz; Togrul, Cihan

    2015-01-01

    Sarcoidosis is a multisystem inflammatory disorder of unknown etiology. It shows a great variety of clinical presentation, organ involvement, and disease progression. Lungs and lymphoid system are the most common sites involved with a frequency of 90% and 30%, respectively. Extrapulmonary involvement of sarcoidosis is reported in 30% of patients and abdomen is the most frequent site. Furthermore, peritoneal involvement is extremely rare in sarcoidosis. The case presented here described peritoneal manifestations of sarcoidosis without involvement of lungs. A 78-year-old woman possessing signs of malignancy on blood test and abdominal magnetic resonance imaging underwent laparatomy with a suspicion of ovarian malignancy. The macroscopic interpretation during surgery was peritoneal carcinomatosis. Total abdominal hysterectomy, bilateral salpingo-oophorectomy, peritoneal biopsies, total omentectomy, and appendectomy were performed. Final histopathological result revealed the diagnosis of sarcoidosis. Clinicians must keep in mind that peritoneal sarcoidosis can mimic intra-abdominal malignancies. PMID:26558122

  6. Intraoperative Tension Pneumothorax in a Patient With Remote Trauma and Previous Tracheostomy

    PubMed Central

    Mavarez-Martinez, Ana; Soghomonyan, Suren; Sandhu, Gurneet; Rankin, Demicha

    2016-01-01

    Many trauma patients present with a combination of cranial and thoracic injury. Anesthesia for these patients carries the risk of intraoperative hemodynamic instability and respiratory complications during mechanical ventilation. Massive air leakage through a lacerated lung will result in inadequate ventilation and hypoxemia and, if left undiagnosed, may significantly compromise the hemodynamic function and create a life-threatening situation. Even though these complications are more characteristic for the early phase of trauma management, in some cases, such a scenario may develop even months after the initial trauma. We report a case of a 25-year-old patient with remote thoracic trauma, who developed an intraoperative tension pneumothorax and hemodynamic instability while undergoing an elective cranioplasty. The intraoperative patient assessment was made even more challenging by unexpected massive blood loss from the surgical site. Timely recognition and management of intraoperative pneumothorax along with adequate blood replacement stabilized the patient and helped avoid an unfavorable outcome. This case highlights the risks of intraoperative pneumothorax in trauma patients, which may develop even months after injury. A high index of suspicion and timely decompression can be life saving in this type of situation. PMID:27006957

  7. The World Hip Trauma Evaluation Study 3

    PubMed Central

    Parsons, N.; Achten, J.; Griffin, X. L.; Costa, M. L.; Reed, M. R.

    2016-01-01

    Background Approximately half of all hip fractures are displaced intracapsular fractures. The standard treatment for these fractures is either hemiarthroplasty or total hip arthroplasty. The recent National Institute for Health and Care Excellence (NICE) guidance on hip fracture management recommends the use of ‘proven’ cemented stem arthroplasty with an Orthopaedic Device Evaluation Panel (ODEP) rating of at least 3B (97% survival at three years). The Thompsons prosthesis is currently lacking an ODEP rating despite over 50 years of clinical use, likely due to the paucity of implant survival data. Nationally, adherence to these guidelines is varied as there is debate as to which prosthesis optimises patient outcomes. Design This study design is a multi-centre, multi-surgeon, parallel, two arm, standard-of-care pragmatic randomised controlled trial. It will be embedded within the WHiTE Comprehensive Cohort Study (ISRCTN63982700). The main analysis is a two-way equivalence comparison between Hemi-Thompson and Hemi-Exeter polished taper with Unitrax head. Secondary outcomes will include radiological leg length discrepancy measured as per Bidwai and Willett, mortality, re-operation rate and indication for re-operation, length of index hospital stay and revision at four months. This study will be supplemented by the NHFD (National Hip Fracture Database) dataset. Discussion Evidence on the optimum choice of prosthesis for hemiarthroplasty of the hip is lacking. National guidance is currently based on expert opinion rather than empirical evidence. The incidence of hip fracture is likely to continue to increase and providing high quality evidence on the optimum Cite this article: A. L. Sims. The World Hip Trauma Evaluation Study 3: Hemiarthroplasty Evaluation by Multicentre Investigation – WHITE 3: HEMI – An Abridged Protocol. Bone Joint Res 2016;5:18–25. DOI: 10.1302/2046-3758.51.2000473 PMID:26825319

  8. Coagulopathy after severe pediatric trauma: A review

    PubMed Central

    Russell, Robert T.; Lisco, Steven J.; Kerby, Jeffrey D.; Pittet, Jean-François

    2014-01-01

    Trauma remains the leading cause of morbidity and mortality in the United States among children from the age 1 year to 21 years old. The most common cause of lethality in pediatric trauma is traumatic brain injury (TBI). Early coagulopathy has been commonly observed after severe trauma and is usually associated with severe hemorrhage and/or traumatic brain injury. In contrast to adult patients, massive bleeding is less common after pediatric trauma. The classical drivers of trauma-induced coagulopathy (TIC) include hypothermia, acidosis, hemodilution and consumption of coagulation factors secondary to local activation of the coagulation system following severe traumatic injury. Furthermore, there is also recent evidence for a distinct mechanism of TIC that involves the activation of the anticoagulant protein C pathway. Whether this new mechanism of posttraumatic coagulopathy plays a role in children is still unknown. The goal of this review is to summarize the current knowledge on the incidence and potential mechanisms of coagulopathy after pediatric trauma and the role of rapid diagnostic tests for early identification of coagulopathy. Finally, we discuss different options for treating coagulopathy after severe pediatric trauma. PMID:24569507

  9. Changes in Neuroticism Following Trauma Exposure

    PubMed Central

    Ogle, Christin M.; Rubin, David C.; Siegler, Ilene C.

    2014-01-01

    Objective Using longitudinal data, the present study examined change in midlife neuroticism following trauma exposure. Method Our primary analyses included 670 participants (M age = 60.55, 65.22% male, 99.70% Caucasian) who completed the NEO Personality Inventory at mean age 42 and 50 and reported their lifetime exposure to traumatic events approximately 10 years later. Results No differences in pre-and post-trauma neuroticism scores were found among individuals who experienced all of their lifetime traumas in the interval between the personality assessments. Results were instead consistent with normative age-related declines in neuroticism throughout adulthood. Furthermore, longitudinal changes in neuroticism scores did not differ between individuals with and without histories of midlife trauma exposure. Examination of change in neuroticism following life-threatening traumas yielded a comparable pattern of results. Analysis of facet-level scores largely replicated findings from the domain scores. Supplemental analyses indicated that individuals exposed to life-threatening traumas in childhood or adolescence reported higher midlife neuroticism than individuals who experienced severe traumas in adulthood. Conclusions Overall, our findings suggest that neuroticism does not reliably change following exposure to traumatic events in middle adulthood. Life-threatening traumatic events encountered early in life may have a more pronounced impact on adulthood personality than recent traumatic events. PMID:23550961

  10. A comprehensive model for trauma research design.

    PubMed

    Honarpisheh, Hamid

    2012-01-01

    Concomitant research and education are invaluable for patient care and medical practice in trauma. Elucidation of a foundation for the integration of training and service that can be combined with research in trauma is crucial, and every trauma case should be studied for this purpose. In this study, we investigated the unique features of trauma research to formulate a generic comprehensive model that can be used at any point at which one may desire to develop a research plan. The framework of this model is designed to enable proper trauma research plain in combination with the best routine trauma care. Selection of the appropriate method of study, the corresponding basic questions raised, aims, and the relevant epidemiologic context are factors that are included in this review. Furthermore, suitable sources, proper time for data collection, reliable and valid measures, and criteria for the scaling and quantification of the findings are indicated. In addition, the levels, orders, operational stages, and steps to be taken in planning research projects are logically set based on the principles of cognitive task analysis, and correspond to the entire spectrum of trauma care situations. Lastly, a measure of utility value is assigned in terms of the expected extent of efficiency and presumed level of effectiveness. PMID:24719834

  11. A Comprehensive Model for Trauma Research Design

    PubMed Central

    Honarpisheh, Hamid

    2012-01-01

    Concomitant research and education are invaluable for patient care and medical practice in trauma. Elucidation of a foundation for the integration of training and service that can be combined with research in trauma is crucial, and every trauma case should be studied for this purpose. In this study, we investigated the unique features of trauma research to formulate a generic comprehensive model that can be used at any point at which one may desire to develop a research plan. The framework of this model is designed to enable proper trauma research plain in combination with the best routine trauma care. Selection of the appropriate method of study, the corresponding basic questions raised, aims, and the relevant epidemiologic context are factors that are included in this review. Furthermore, suitable sources, proper time for data collection, reliable and valid measures, and criteria for the scaling and quantification of the findings are indicated. In addition, the levels, orders, operational stages, and steps to be taken in planning research projects are logically set based on the principles of cognitive task analysis, and correspond to the entire spectrum of trauma care situations. Lastly, a measure of utility value is assigned in terms of the expected extent of efficiency and presumed level of effectiveness. PMID:24719834

  12. Blunt pancreatic trauma: A persistent diagnostic conundrum?

    PubMed Central

    Kumar, Atin; Panda, Ananya; Gamanagatti, Shivanand

    2016-01-01

    Blunt pancreatic trauma is an uncommon injury but has high morbidity and mortality. In modern era of trauma care, pancreatic trauma remains a persistent challenge to radiologists and surgeons alike. Early detection of pancreatic trauma is essential to prevent subsequent complications. However early pancreatic injury is often subtle on computed tomography (CT) and can be missed unless specifically looked for. Signs of pancreatic injury on CT include laceration, transection, bulky pancreas, heterogeneous enhancement, peripancreatic fluid and signs of pancreatitis. Pan-creatic ductal injury is a vital decision-making parameter as ductal injury is an indication for laparotomy. While lacerations involving more than half of pancreatic parenchyma are suggestive of ductal injury on CT, ductal injuries can be directly assessed on magnetic resonance imaging (MRI) or encoscopic retrograde cholangio-pancreatography. Pancreatic trauma also shows temporal evolution with increase in extent of injury with time. Hence early CT scans may underestimate the extent of injures and sequential imaging with CT or MRI is important in pancreatic trauma. Sequential imaging is also needed for successful non-operative management of pancreatic injury. Accurate early detection on initial CT and adopting a multimodality and sequential imaging strategy can improve outcome in pancreatic trauma. PMID:26981225

  13. Childhood trauma and obsessive-compulsive symptoms.

    PubMed

    Mathews, Carol A; Kaur, Nirmaljit; Stein, Murray B

    2008-01-01

    Childhood trauma is known to predispose to a variety of psychiatric disorders, including mood, anxiety, eating, and personality disorders. However, the relationship between childhood trauma and obsessive-compulsive symptoms has not been well studied. This study examines the relationship between childhood trauma, personality facets, and obsessive-compulsive symptoms in 938 college students using the Childhood Trauma Questionnaire, the Leyton Obsessional Inventory, and the NEO Personality Inventory-Revised. Between 13 and 30% of subjects met criteria for childhood trauma, with emotional neglect the most commonly reported experience. There was a small but significant association between obsessive-compulsive symptoms and childhood trauma, specifically emotional abuse and physical neglect, all of which was accounted for by co-occurring anxiety symptoms. An independent association was also seen between emotional abuse, physical abuse, and high levels of obsessive-compulsive symptoms ("probable obsessive-compulsive disorder"), which remained significant in the context of co-occurring anxiety symptoms. A similar association was seen between obsessive-compulsive symptoms and conscientiousness, and between emotional neglect and sexual abuse and conscientiousness, suggesting that an indirect role for childhood trauma in the development of obsessive-compulsive symptoms may also exist. PMID:17557315

  14. Addressing childhood trauma in a developmental context

    PubMed Central

    Gregorowski, Claire; Seedat, Soraya

    2013-01-01

    With the anticipated publication of the DSM-5 in May 2013, much reflection and work has been done on reviewing existing psychiatric nomenclature including, but not limited to the field of traumatic exposure. Traditionally, understanding of the psychiatric and psychological effects of trauma have been developed from studies with adults and then applied to trauma-exposed children with some modifications. While this is an important step to understanding the sequelae of trauma in children and adolescents, the adverse developmental effects of traumatic exposures on the rapidly evolving neurological, physical, social and psychological capacities of children calls for a developmentally sensitive framework for understanding, assessing and treating trauma-exposed children. The importance of early attachment relationships in infancy and childhood means that severely disrupted early caregiving relationships may have far-reaching and lifelong developmental consequences and can therefore be considered traumatic. Given the high rates of violence and trauma exposure of South African children and adolescents, the need for a developmentally based understanding of the effects of trauma on child and adolescent mental health becomes even more pronounced. In this paper, we draw on theoretical perspectives to provide a practical, clinically driven approach to the management of developmental trauma. PMID:25104963

  15. Blunt pancreatic trauma: A persistent diagnostic conundrum?

    PubMed

    Kumar, Atin; Panda, Ananya; Gamanagatti, Shivanand

    2016-02-28

    Blunt pancreatic trauma is an uncommon injury but has high morbidity and mortality. In modern era of trauma care, pancreatic trauma remains a persistent challenge to radiologists and surgeons alike. Early detection of pancreatic trauma is essential to prevent subsequent complications. However early pancreatic injury is often subtle on computed tomography (CT) and can be missed unless specifically looked for. Signs of pancreatic injury on CT include laceration, transection, bulky pancreas, heterogeneous enhancement, peripancreatic fluid and signs of pancreatitis. Pan-creatic ductal injury is a vital decision-making parameter as ductal injury is an indication for laparotomy. While lacerations involving more than half of pancreatic parenchyma are suggestive of ductal injury on CT, ductal injuries can be directly assessed on magnetic resonance imaging (MRI) or encoscopic retrograde cholangio-pancreatography. Pancreatic trauma also shows temporal evolution with increase in extent of injury with time. Hence early CT scans may underestimate the extent of injures and sequential imaging with CT or MRI is important in pancreatic trauma. Sequential imaging is also needed for successful non-operative management of pancreatic injury. Accurate early detection on initial CT and adopting a multimodality and sequential imaging strategy can improve outcome in pancreatic trauma. PMID:26981225

  16. Albumin Kinetics in Patients Undergoing Major Abdominal Surgery

    PubMed Central

    Norberg, Åke; Rooyackers, Olav; Segersvärd, Ralf; Wernerman, Jan

    2015-01-01

    Background The drop in plasma albumin concentration following surgical trauma is well known, but the temporal pattern of the detailed mechanisms behind are less well described. The aim of this explorative study was to assess changes in albumin synthesis and transcapillary escape rate (TER) following major surgical trauma, at the time of peak elevations in two well-recognized markers of inflammation. Methods This was a clinical trial of radiolabeled human serum albumin for the study of TER and plasma volume. Ten patients were studied immediately preoperatively and on the 2nd postoperative day after major pancreatic surgery. Albumin synthesis rate was measured by the flooding dose technique employing incorporation of isotopically labelled phenylalanine. Results Fractional synthesis rate of albumin increased from 11.7 (95% CI: 8.9, 14.5) to 15.0 (11.7, 18.4) %/day (p = 0.027), whereas the corresponding absolute synthesis rate was unchanged, 175 (138, 212) versus 150 (107, 192) mg/kg/day (p = 0.21). TER was unchanged, 4.9 (3.1, 6.8) %/hour versus 5.5 (3.9, 7.2) (p = 0.63). Plasma volume was unchanged but plasma albumin decreased from 33.5 (30.9, 36.2) to 22.1 (19.8, 24.3) g/L. (p<0.001). Conclusion Two days after major abdominal surgery, at the time-point when two biomarkers of generalised inflammation were at their peak and the plasma albumin concentration had decreased by 33%, we were unable to show any difference in the absolute synthesis rate of albumin, TER and plasma volume as compared with values obtained immediately pre-operatively. This suggests that capillary leakage, if elevated postoperatively, had ceased at that time-point. The temporal relations between albumin kinetics, capillary leakage and generalised inflammation need to be further explored. Trial Registration clinicaltrialsregister.eu: EudraCT 2010-08529-21 ClinicalTrials.gov NCT01194492 PMID:26313170

  17. Abdominal aortic aneurysm in giant cell arteritis

    PubMed Central

    Kwon, Hyunwook; Han, Youngjin; Son, Da Hye; Cho, Yong-Pil

    2015-01-01

    Aortic complications of giant cell arteritis are a rare cause of abdominal aortic aneurysm. Here, we describe a case of a ruptured aortic aneurysm in a patient with giant call arteritis (GCA) who was preoperatively suspected of having an infectious aortic aneurysm. Intraoperative inspection revealed infectious granulation tissue on the anterior wall of the abdominal aorta. GCA was finally confirmed by pathological diagnosis. Our findings suggest that the surgical and postoperative treatment of nonatheromatous aortic aneurysm should be based on accurate diagnosis. PMID:26448922

  18. CT diagnosis of ruptured abdominal aortic aneurysm

    SciTech Connect

    Rosen, A.; Korobkin, M.; Silverman, P.M.; Moore, A.V. Jr.; Dunnick, N.R.

    1984-08-01

    Abdominal computed tomography was performed in six patients with suspected ruptured abdominal aortic aneurysm but in whom an alternate clinical diagnosis was seriously considered. In each patient, a large aortic aneurysm was demonstrated in association with a retroperitoneal accumulation of high-density blood. The retroperitoneal blood was primarily confined to the extracapsular perinephric space. In four of the six patients, a focal area of the aortic wall was indistinct on the side of the retroperitoneal hemorrhage at the presumed site of rupture. Five of the six patients underwent emergency surgery, which confirmed the site of aneurysm, presence of rupture and the location of fresh retroperitoneal blood.

  19. Imaging for chronic abdominal pain in adults

    PubMed Central

    Mendelson, Richard

    2015-01-01

    Summary Diagnostic imaging is often not indicated in chronic abdominal pain. In particular, undifferentiated abdominal pain is rarely an indication for a CT scan. CT scanning is overused even when imaging is required. Other modalities may be preferable. A normal CT scan does not rule out cancer. Alarm symptoms, including anaemia, blood in the stool, waking at night with gastrointestinal symptoms, and weight loss, should be investigated. The most appropriate modality depends on the symptoms. Clinical information on request forms for CT scans should be specific and include the suspected condition as this helps the radiologist to determine an appropriate imaging protocol. PMID:26648616

  20. Plain abdominal radiography in acute abdominal pain; past, present, and future

    PubMed Central

    Gans, Sarah L; Stoker, Jaap; Boermeester, Marja A

    2012-01-01

    Several studies have demonstrated that a diagnosis based solely on a patient’s medical history, physical examination, and laboratory tests is not reliable enough, despite the fact that these aspects are essential parts of the workup of a patient presenting with acute abdominal pain. Traditionally, imaging workup starts with abdominal radiography. However, numerous studies have demonstrated low sensitivity and accuracy for plain abdominal radiography in the evaluation of acute abdominal pain as well as various specific diseases such as perforated viscus, bowel obstruction, ingested foreign body, and ureteral stones. Computed tomography, and in particular computed tomography after negative ultrasonography, provides a better workup than plain abdominal radiography alone. The benefits of computed tomography lie in decision-making for management, planning of a surgical strategy, and possibly even avoidance of negative laparotomies. Based on abundant available evidence, major advances in diagnostic imaging, and changes in the management of certain diseases, we can conclude that there is no place for plain abdominal radiography in the workup of adult patients with acute abdominal pain presenting in the emergency department in current practice. PMID:22807640