Serious intraabdominal injury due to intraabdominal hemorrhage, gastro-intestinal laceration with peritonitis or incarceration of abdominal organs. The most important question in the management is to ascertain a laparotomy or the diagnostic of a specific organ injury is needed. The peritoneal lavage is a great help in making this decision. The x-ray examinations of thorax, abdomen and bones are required. Adjunctive diagnostic modalities for subtile examination of organs are ultrasound, computed tomography and angiography. These examinations have a limited application. Exploratory laparotomy should be done if there are signs of peritoneal irritation with an increased tendency. 168 patients with blunt abdominal trauma where treated in Charity-hospital of Berlin. The laparotomy was necessary in 78 patients. In 70 cases we found organ injuries. It was pointed to splenic repair, the management of liver injury especially the packing of the laceration and the treatment of the injuries of gastro-intestinal tract, pancreas- and diaphragmatic rupture. PMID:3281391
Wolff, H; Lippert, H
Due to its well protected position within the abdomen, blunt injuries to the abdominal aorta are uncommon. A review of previous reports in the literature, together with four new cases, are presented here. Motor car accidents are the most common cause of this injury, especially if seat belts are worn. Associated gastrointestinal injuries did not lead to any increased mortality; however, delay in the diagnosis was a significant factor in the deaths of several patients. Prompt recognition and early surgical management are essential in the treatment of this problem. PMID:2334357
Frydenberg, M; Royle, J P; Hoare, M
Mesenteric cysts are rare abdominal tumors of unclear histologic origin, usually asymptomatic. Post-traumatic mesenteric cyst usually results as a consequence of a mesenteric lymphangitic rupture or a hematoma followed by absorption and cystic degeneration. The preoperative histological and radiological diagnosis is difficult. We present the case of a 45-year-old male patient with sizable, palpable abdominal tumor, the gradual swelling of which the patient himself combined with the blunt abdominal trauma he acquired from an opponent's knee in a football game 5 months ago. PMID:22096714
Falidas, Evangelos; Mathioulakis, Stavros; Vlachos, Konstantinos; Pavlakis, Emmanouil; Anyfantakis, Georgios; Villias, Constantinos
The morbidity, mortality, and economic costs resulting from trauma in general, and blunt abdominal trauma in particular, are substantial. The "panscan" (computed tomographic [CT] examination of the head, neck, chest, abdomen, and pelvis) has become an essential element in the early evaluation and decision-making algorithm for hemodynamically stable patients who sustained abdominal trauma. CT has virtually replaced diagnostic peritoneal lavage for the detection of important injuries. Over the past decade, substantial hardware and software developments in CT technology, especially the introduction and refinement of multidetector scanners, have expanded the versatility of CT for examination of the polytrauma patient in multiple facets: higher spatial resolution, faster image acquisition and reconstruction, and improved patient safety (optimization of radiation delivery methods). In this article, the authors review the elements of multidetector CT technique that are currently relevant for evaluating blunt abdominal trauma and describe the most important CT signs of trauma in the various organs. Because conservative nonsurgical therapy is preferred for all but the most severe injuries affecting the solid viscera, the authors emphasize the CT findings that are indications for direct therapeutic intervention. PMID:23175542
Soto, Jorge A; Anderson, Stephan W
This article is an appraisal of the use of CT in the management of patients with unstable abdominal trauma. We examined 41 patients with abdominal trauma using noncontrast dynamic CT. In 17 patients a postcontrast dynamic CT was also carried out. On CT, 25 patients had hemoperitoneum. Thirteen patients had splenic, 12 hepatic, 6 pancreatic, 8 bowel and mesenteric, 12 renal and 2 vascular injuries. Seven patients had retroperitoneal and 2 patients adrenal hematomas. All but five lesions (three renal, one pancreatic, and one splenic) were hypodense when CT was performed earlier than 8 h following the injury. Postcontrast studies (n = 17), revealed 4 splenic, 3 hepatic, 1 pancreatic, 3 renal, and 2 bowel and mesenteric injuries beyond what was found on noncontrast CT. Surgical confirmation (n = 21) was obtained in 81.81% of splenic, 66.66% of hepatic, 83.33% of pancreatic, 100% of renal, 100% of retroperitoneal, and 85.71% of bowel and mesenteric injuries. The majority of false diagnoses was obtained with noncontrast studies. Computed tomography is a remarkable method for evaluation and management of patients with hemodynamically unstable abdominal trauma, but only if it is revealed in the emergency room. Contrast injection, when it could be done, revealed lesions that were not suspected on initial plain scans. PMID:10101646
Petridis, A; Pilavaki, M; Vafiadis, E; Palladas, P; Finitsis, S; Drevelegas, A
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
Padlipsky, Patricia S; Brindis, Seth; Young, Kelly D
Background Ultrasonography (US) has become indispensable in assessing the status of the injured patient. Although hand-held US equipment is now commercially available and may expand the availability and speed of US in assessing the trauma patient, it has not been subjected to controlled evaluation in early trauma care. Methods A 2.4-kg hand-held (HH) US device was used to perform focused abdominal sonography for trauma (FAST) on blunt trauma victims at 2 centres. Results were compared with the “truth” as determined through formal FAST examinations (FFAST), CT, operative findings and serial examination. The ability of HHFAST to detect free fluid, intra-abdominal injuries and injuries requiring therapeutic interventions was assessed. Results HHFAST was positive in 80% of 313 patients who needed surgery or angiography. HHFAST test performances (sensitivity, specificity, positive and negative predictive values, likelihood ratios of positive and negative test results) were 77%, 99%, 96%, 94%, 95%, 95 and 0.2, respectively, for free fluid, and 64%, 99%, 96%, 89%, 90%, 74 and 0.4, respectively, for documented injuries. HHFAST missed or gave an indeterminate result in 8 (3%) of 270 patients with injuries who required therapeutic intervention and 25 (9%) of 270 patients who did not require intervention. FFAST performance was comparable. Conclusions HHFAST performed by clinicians detects intraperitoneal fluid with a high degree of accuracy. All FAST examinations are valuable tests when positive. They will miss some injuries, but the majority of the injuries missed do not require therapy. HHFAST provides an early extension of the physical examination but should be complemented by the selective use of CT, rather than formal repeat US. PMID:16417051
Kirkpatrick, Andrew W.; Sirois, Marco; Laupland, Kevin B.; Goldstein, Leanelle; Brown, David Ross; Simons, Richard K.; Dulchavsky, Scott; Boulanger, Bernard R.
Objective Though a number of CT findings of bowel and mesenteric injuries in blunt abdominal trauma are described in literature, no studies on the specific CT signs of a transected bowel have been published. In the present study we describe the incidence and new CT signs of bowel transection in blunt abdominal trauma. Materials and Methods We investigated the incidence of bowel transection in 513 patients admitted for blunt abdominal trauma who underwent multidetector CT (MDCT). The MDCT findings of 8 patients with a surgically proven complete bowel transection were assessed retrospectively. We report novel CT signs that are unique for transection, such as complete cutoff sign (transection of bowel loop), Janus sign (abnormal dual bowel wall enhancement, both increased and decreased), and fecal spillage. Results The incidence of bowel transection in blunt abdominal trauma was 1.56%. In eight cases of bowel transection, percentage of CT signs unique for bowel transection were as follows: complete cutoff in 8 (100%), Janus sign in 6 (100%, excluding duodenal injury), and fecal spillage in 2 (25%). The combination of complete cutoff and Janus sign were highly specific findings in patients with bowel transection. Conclusion Complete cut off and Janus sign are the unique CT findings to help detect bowel transection in blunt abdominal trauma and recognition of these findings enables an accurate and prompt diagnosis for emergency laparotomy leading to reduced mortality and morbidity. PMID:23901318
Cho, Hyun Suk; Hong, Hye-Suk; Park, Mee Hyun; Ha, Hong Il; Yang, Ik; Lee, Yul; Jung, Ah Young; Hwang, Ji-Young
Control of massive hemorrhage from intra-abdominal organs and major vascular structures may tax the ingenuity of the trauma surgeon. It is emphasized, however, that total blood loss and the amount of transfused blood are far less critical than the duration and severity of shock. PMID:2190337
Canizaro, P C; Pessa, M E
The hospital, pharmacy, and antibiotic costs for patients with penetrating abdominal trauma were compared with reimbursement received; these costs were also analyzed to assess the potential impact of a total prospective pricing system (PPS). During a four-year period, 46 patients admitted solely for penetrating abdominal trauma were retrospectively evaluated: their discharge summaries indicated that, for 9 patients, reimbursement was based on diagnosis-related groups (DRGs) under the PPS; 9 patients had private insurance; and 28 were classified as "self-paying/no insurance." All costs, corrected for inflation, were reported in 1989 dollars. Antibiotics represented 22.5%, 1.7%, and 0.5% of pharmacy, hospital, and DRG reimbursement, respectively; pharmacy costs were 8.5% of hospital costs and 2.3% of DRG reimbursement. For all 46 patients, a net loss of $295 per patient was incurred. Four patients accounted for 43% of the hospital costs. If the hospital had been reimbursed for all of these patients by prospective pricing and DRGs, it would have had a median profit of $9730 in 42 of 46 patients. Costs exceeded DRG reimbursement in the remaining four patients by a median of $8210. Antibiotic costs and pharmacy costs represent a small portion of hospital costs and DRG reimbursement for patients with penetrating abdominal trauma; thus, cost containment efforts in these patients should be directed at other ancillary services and length of stay. PMID:1598932
Friedrich, L V; White, R L; Kays, M B; Burgess, D S
Blunt abdominal trauma (BAT) is a frequent emergency and is associated with significant morbidity and mortality in spite of improved recognition, diagnosis and management. Trauma is the second largest cause of disease accounting for 16% of global burden. The World Health Organization estimates that, by 2020, trauma will be the first or second leading cause of years of productive life lost for the entire world population. This study endeavors to evaluate 71 cases of BAT with stress on early diagnosis and management, increase use of non operative management, and time of presentation of patients. A retrospective analysis of 71 patients of BAT who were admitted in Kempegowda Institute of Medical Sciences hospital (KIMS, Bangalore, India) within a span of 18 months was done. Demographic data, mechanism of trauma, management and outcomes were studied. Most of the patients in our study were in the age group of 21-30 years with an M:F ratio of 3.7:1. Motor vehicle accident (53%) was the most common mechanism of injury. Spleen (53%) was the commonest organ injured and the most common surgery performed was splenectomy (30%). Most common extra abdominal injury was rib fracture in 20%. Mortality rate was 4%. Wound sepsis (13%) was the commonest complication. Initial resuscitation measures, thorough clinical examination and correct diagnosis forms the most vital part of management. 70% of splenic, liver and renal injuries can be managed conservatively where as hollow organs need laparotomy in most of the cases. The time of presentation of patients has a lot to do with outcome. Early diagnosis and prompt treatment can save many lives. PMID:25332759
Mehta, Nikhil; Babu, Sudarshan; Venugopal, Kumar
Renal vascular injuries such as transection, thrombosis, dissection, and arteriovenous fistula formation are unusual but well-recognized consequences of blunt abdominal trauma. We discuss a rare case of renal artery pseudoaneurysm presenting 6 weeks after blunt abdominal trauma that was successfully treated with selective embolization. PMID:8601869
Swana, H S; Cohn, S M; Burns, G A; Egglin, T K
Objective. We sought to describe the trend in abdominal CT use in adult trauma patients after a point-of-care emergency ultrasound program was introduced. We hypothesized that abdominal CT use would decrease as FAST use increased. Methods. We performed a retrospective study of 19940 consecutive trauma patients over the age of 18 admitted to our level one trauma center from 2002 through 2011. Data was collected retrospectively and recorded in a trauma registry. We plotted the rate of FAST and abdominal CT utilization over time. Head CT was used as a surrogate for overall CT utilization rates during the study period. Results. Use of FAST increased by an average of 2.3% (95% CI 2.1 to 2.5, P < 0.01) while abdominal CT use decreased by the same rate annually. The percentage of patients who received FAST as the sole imaging modality for the abdomen rose from 2.0% to 21.9% while those who only received an abdominal CT dropped from 21.7% to 2.3%. Conclusions. Abdominal CT use in our cohort declined while FAST utilization grew in the last decade. The rising use of FAST may have played a role in the reduction of abdominal CT performed as decline in CT utilization appears contrary to overall trends. PMID:24073336
Sheng, Alexander Y.; Dalziel, Peregrine; Liteplo, Andrew S.; Fagenholz, Peter; Noble, Vicki E.
Background Abdominal injuries occur relatively infrequently during trauma, and they rarely require surgical intervention. In this era of non-operative management of abdominal injuries, surgeons are seldom exposed to these patients. Consequently, surgeons may misinterpret the mechanism of injury, underestimate symptoms and radiologic findings, and delay definite treatment. Here, we determined the incidence, diagnosis, and treatment of traumatic abdominal injuries at our hospital to provide a basis for identifying potential hazards in non-operative management of patients with these injuries in a low trauma volume hospital. Methods This retrospective study included prehospital and in-hospital assessments of 110 patients that received 147 abdominal injuries from an isolated abdominal trauma (n?=?70 patients) or during multiple trauma (n?=?40 patients). Patients were primarily treated at the University Hospital of Umeå from January 2000 to December 2009. Results The median New Injury Severity Score was 9 (range: 1–57) for 147 abdominal injuries. Most patients (94%) received computed tomography (CT), but only 38% of patients with multiple trauma were diagnosed with CT?60 min after emergency room arrival. Penetrating trauma caused injuries in seven patients. Solid organ injuries constituted 78% of abdominal injuries. Non-operative management succeeded in 82 patients. Surgery was performed for 28 patients, either immediately (n?=?17) as result of operative management or later (n?=?11), due to non-operative management failure; the latter mainly occurred with hollow viscus injuries. Patients with multiple abdominal injuries, whether associated with multiple trauma or an isolated abdominal trauma, had significantly more non-operative failures than patients with a single abdominal injury. One death occurred within 30 days. Conclusions Non-operative management of patients with abdominal injuries, except for hollow viscus injuries, was highly successful in our low trauma volume hospital, even though surgeons receive low exposure to these patients. However, a growing proportion of surgeons lack experience in decision-making and performing trauma laparotomies. Quality assurance programmes must be emphasized to ensure future competence and quality of trauma care at low trauma volume hospitals. PMID:25124882
ObjectiveThe aim of this study was to estimate the sensitivity, specificity, and positive predictive value (PPV) of computed tomography (CT) without oral contrast for diaphragm injuries (DIs) in blunt abdominal trauma.
Todd L. Allen; Brendan F. Cummins; R. Thomas Bonk; Colleen P. Harker; Diana L. Handrahan; Mark H. Stevens
New endoscopic and endovascular therapies have revolutionised the management of complex traumatic visceral aneurysms. A pseudoaneurysm of the gastroduodenal artery following penetrating abdominal trauma was successfully managed by selective angiographic embolisation. PMID:25215953
Adam, Shaun; Bruce, John Lambert; Laing, Grant L; Clarke, Damian L
From 1988 to 1992 more than 5300 patients were admitted to a level I trauma center, with 36 of these patients requiring Silastic abdominal closure. Patients ages ranged from 13 to 75 years with a mean Injury Severity Score (ISS) of 30 (range 13–50). Nineteen patients (53%) suffered penetrating injuries, and 17 (47%) were victims of blunt trauma. Silastic closure
Thomas R. Howdieshell; Karen A. Yeh; Michael L. Hawkins; Jorge I. Cué
Trauma continues to be the most frequent cause of death in the first four decades of life and is a major public health problem in some countries. We performed an epidemiological study of penetrating abdominal trauma (PAT) to describe epidemiological characteristics of patients with PAT. In a cross-sectional study we evaluated patients with PAT admitted to emergency department in six
H. Baradaran; J. Salimi; M. Nassaji-Zavareh; A. Khaji; A. Rabbani
This study aims to determine if a clinical prediction (CP) rule to identify patients at low risk for intra-abdominal injury (IAI) is being utilized in patients undergoing abdominal computed tomography (CT) following blunt abdominal trauma. A retrospective review of adult patients with blunt abdominal trauma undergoing abdominal CT scans was performed. The CP rule was positive if any of the following were present: systolic blood pressure <90 mmHg; urinalysis >25 red blood cells/high power field; Glasgow Coma Scale score <14; abdominal tenderness; costal margin tenderness; femur fracture; hematocrit <30 %; or pneumothorax or rib fracture on chest X-ray. The CP rule was negative if all variables were negative. Acute intervention was defined as therapeutic laparotomy or angiographic embolization. All variables in the CP rule were obtained in 218/262 (83 %; 95 % confidence interval (CI), 78, 88 %) patients. Of the 44 patients without complete CP rule assessment, 1 (2.3 %; 95 % CI, 0.1 %, 12.0 %) had an IAI but did not undergo therapeutic intervention. IAI was present in 11 (6.7 %; 95 % CI, 3.4, 11.6 %) of the 165 patients with at least one CP rule positive and 4 (36 %; 95 % CI, 11, 69 %) underwent therapeutic intervention. In the CP rule-negative patients, IAI was identified in 1/53 (1.9 %; 95 % CI, 0, 10.1 %) and no therapeutic intervention was required. An important percentage of patients undergoing abdominal CT are not assessed for or have a negative CP rule. Improved implementation of this CP rule may reduce unnecessary abdominal CT scans in patients presenting with blunt abdominal trauma. PMID:24838812
Corwin, Michael T; Sheen, Lucas; Kuramoto, Alan; Lamba, Ramit; Parthasarathy, Sudharshan; Holmes, James F
Trauma is the leading cause of death in children in developed countries. In tropical Africa, it is only beginning to assume\\u000a importance as infections and malnutrition are controlled. In developed countries, the availability of advanced imaging modalities\\u000a has now reduced the necessity for laparotomy to less than 10% following blunt abdominal trauma (BAT) in children. This report\\u000a reviews the epidemiology,
E. A. Ameh; L. B. Chirdan; P. T. Nmadu
Several temporary abdominal wall closure techniques have been described in the literature. We present our experience with an inexpensive and efficient method of temporary abdominal closure when bowel edema and distension preclude safe primary closure. Our technique is a variation of the silon (silo) closure used in the repair of gastroschisis and omphalocele, using a pre-gas-sterilized, soft 3-L plastic cystoscopy fluid irrigation bag cut to an oval shape and stapled or sutured to the skin edges of the wound. PMID:8637075
Fernandez, L; Norwood, S; Roettger, R; Wilkins, H E
The aim of the present study was to retrospectively analyze the bacteriology and drug susceptibility of pus flora from abdominal trauma patients with severe intra-abdominal infection (SIAI). A total of 41 patients with SIAI induced by abdominal trauma were enrolled in the study, from which 123 abdominal pus samples were obtained. The results from laboratory microbiology and drug sensitivity were subjected to susceptibility analysis using WHONET software. A total of 297 strains were isolated in which Gram-negative bacteria, Gram-positive bacteria and fungi accounted for 53.5 (159/297), 44.1 (131/297) and 0.7% (2/297), respectively. Anaerobic bacteria accounted for 1.7%. The five predominant bacteria were Escherichia coli (E. coli), Staphylococcus aureus (S. aureus), Klebsiella pneumoniae (K. pneumoniae), Enterococcus faecalis and Pseudomonas aeruginosa (P. aeruginosa). E. coli was highly susceptible to cefoperazone (91%) and imipenem (98%), while Gram-positive cocci were highly susceptible to teicoplanin (100%) and linezolid (100%). S. aureus was 100% susceptible to vancomycin and K. pneumoniae was highly susceptible to imipenem (100%) and amikacin (79%). P. aeruginosa was the most susceptible to ciprofloxacin (90%). Gram-negative bacterial infection was present in the majority of cases of SIAI. However, a large number of patients were infected by Gram-positive bacteria, particularly S. aureus that exhibited significant resistance to penicillin (100%), oxacillin (100%) and a third-generation cephalosporin antibiotic cefotaxime (95%). Amongst the pathogenic bacteria that cause SIAI, both Gram-negative and Gram-positive bacteria account for a high proportion, so high-level and broad-spectrum antibiotics should be initially used. PMID:24940451
ZHANG, SHAOYI; REN, LELE; LI, YOUSHENG; WANG, JIAN; YU, WENKUI; LI, NING; LI, JIESHOU
Renal artery pseudoaneurysm is a very rare complication after blunt trauma injury. We report on a case of a 54-year-old man admitted to our hospital for right flank pain and gross hematuria, 5 days after blunt abdominal trauma. The diagnosis of interlobar renal pseudoaneurysm was established by a computed tomography scan and confirmed by angiography. Successful superselective angioembolization was performed. This radiographic intervention is an effective and minimally invasive technique to stop active bleeding from renal artery pseudoaneurysms, when patients are hemodynamically stable and where technically feasible. A review of the literature was carried out. PMID:24809039
Antunes-Lopes, T; Pinto, R; Morgado, P; Madaleno, P; Silva, J; Silva, C; Cruz, F
In severe abdominal trauma ultrasound provides fast and accurate diagnostics of damages and detect the source of internal bleeding. In the absence of trained professionals (in injury care centre of 2-3rd levels, In emergency situations) it is possible to use by the method of research in the reduced volume. The article presents a comparative analysis of the use of traditional methods and reduced ultrasound diagnostics of abdominal injuries on 56 victims. Concluded that reduced ultrasound is affordable, mobile, fast and accurate method of diagnosis, allowing to use it repeatedly. PMID:25051786
Samokhvalov, I M; Zhabin, A V; Grebnev, A R; Badalov, V I; Trufanov, G E; Suvorov, V V
Ligation for penetrating abdominal vein trauma may have better outcome than a vascular reconstruction in an unstable patient. However, symptoms of chronic venous insufficiency may appear over time. We describe our surgical experience with 4 patients who underwent iliac vein ligation followed by venous bypass with a modified Palma derivation between 48 and 240 hours after sustaining penetrating abdominal trauma with concomitant iliac vein injury. Patients were assessed for venous symptoms and conduit patency with continuous wave Doppler and duplex scanning. One graft occluded acutely and the remaining three remain patent with functioning valves. In order to preserve venous outflow after severe iliac vein injury, we think that venous ligation as a part of damage control surgery followed by a modified Palma operation may prevent chronic symptoms of venous outflow obstruction without compromising an already injured patient. PMID:18727974
Alcocer, Francisco; Aguilar, Jesus; Agraz, Salvador; Jordan, William D
Adult intussusception (AI) following blunt abdominal trauma (BAT) is a rare surgical condition. We present a case of delayed diagnosis of ileocecal junction intussusception with a perforation of small bowel in a 34-year-old male with a history of fall from height. Initial exploratory laparotomy revealed shattered spleen requiring splenectomy. Initial abdominal computerized tomography scanning (CT) scan showed dilated small bowel with no organic obstruction. Patient started to improve with partial distention and was shifted to rehabilitation unit. On the next day, he experienced severe abdominal distention and vomiting. Abdominal CT showed characteristic intussusception at the distal ileum. Secondary exploratory laparotomy revealed severe adhesions of stomach and small bowel to the anterior abdominal wall with dilated small bowel loops and intussusception near the ileocecal junction with perforation of small bowel. The affected area was resected and side-to-side stapled anastomosis was performed. Though small bowel intussusception is a rare event, BAT patients with delayed symptoms of bowel obstruction should be carefully evaluated for missed intussusception. PMID:24455385
Afifi, Ibrahim; Al-Thani, Hassan; Attique, Sajid; Khoschnau, Sherwan; El-Menyar, Ayman; Latifi, Rifat
The histories of 67 patients with a diaphragmatic rupture due to blunt trauma were reviewed in four hospitals. In 45 patients the diagnosis was made within 24 hours after the accident, in the other 22 patients the rupture was diagnosed in a later stage. In the first group there were much abdominal injuries and during emergency laparotomy for some other reasons in 29% of these cases the diaphragmatic rupture was found accidentally. Not recognizing a rupture in the acute phase and therefore delaying operation was caused by the fact that the initial chest X-ray was not thoroughly checked for signs of a diaphragmatic rupture. The reasons for operation in the "delayed" group were mainly typical abnormalities for diaphragmatic rupture of the chest X-rays and other investigations proving the diagnosis. Only in one patient the delay in diagnosis has led to a very serious complication: because of incarceration with gangrene of a part of the small bowel it was necessary to remove this part. The other 21 patients in the group where the diagnosis was initially missed did not suffer from any serious complication. PMID:3424459
van Loenhout, R M; Carol, E J; Lubbers, E J; Reinders, J F; van der Werken, C
Introduction Pancreatic trauma occurs in approximately 4% of all patients sustaining abdominal injuries. The pancreas has an intimate relationship with the major upper abdominal vessels, and there is significant morbidity and mortality associated with severe pancreatic injury. Immediate resuscitation and investigations are essential to delineate the nature of the injury, and to plan further management. If main pancreatic duct injuries are identified, specialised input from a tertiary hepatopancreaticobiliary (HPB) team is advised. Methods A comprehensive online literature search was performed using PubMed. Relevant articles from international journals were selected. The search terms used were: ‘pancreatic trauma’, ‘pancreatic duct injury’, ‘radiology AND pancreas injury’, ‘diagnosis of pancreatic trauma’, and ‘management AND surgery’. Articles that were not published in English were excluded. All articles used were selected on relevance to this review and read by both authors. Results Pancreatic trauma is rare and associated with injury to other upper abdominal viscera. Patients present with non-specific abdominal findings and serum amylase is of little use in diagnosis. Computed tomography is effective in diagnosing pancreatic injury but not duct disruption, which is most easily seen on endoscopic retrograde cholangiopancreaticography or operative pancreatography. If pancreatic injury is suspected, inspection of the entire pancreas and duodenum is required to ensure full evaluation at laparotomy. The operative management of pancreatic injury depends on the grade of injury found at laparotomy. The most important prognostic factor is main duct disruption and, if found, reconstructive options should be determined by an experienced HPB surgeon. Conclusions The diagnosis of pancreatic trauma requires a high index of suspicion and detailed imaging studies. Grading pancreatic injury is important to guide operative management. The most important prognostic factor is pancreatic duct disruption and in these cases, experienced HPB surgeons should be involved. Complications following pancreatic trauma are common and the majority can be managed without further surgery. PMID:23676806
We compared the diagnostic accuracy of emergency medicine residents (EMRs) and radiology residents (RRs) in performing focused abdominal sonography for trauma (FAST). The cohort in this prospective study comprised 200 unstable patients (163 males and 37 females; mean ± standard deviation of age, 34.3 ± 16.4 y) who presented with trauma. These patients were evaluated using FAST, first by EMRs and subsequently by RRs. Patients with positive FAST results underwent further diagnostic procedures such as computed tomography, diagnostic peritoneal lavage and laparotomy. Those with negative FAST results underwent clinical follow-up for 72 h until their condition deteriorated or they were discharged. Sensitivity, specificity, positive and negative predictive values and accuracy in evaluating free intraperitoneal fluid were 80%, 95%, 57%, 98% and 94% when FAST was performed by EMRs and 86%, 95%, 59%, 98% and 94% when FAST was performed by RRs. The level of agreement between EMRs and RRs was moderate (? = 0.525). FAST is a useful screening tool for initial assessment of free abdominal fluid in patients with trauma. Our results indicate that EMRs can perform sonography on trauma patients as successfully as RRs. PMID:24613553
Arhami Dolatabadi, Ali; Amini, Afshin; Hatamabadi, Hamidreza; Mohammadi, Parisa; Faghihi-Kashani, Sara; Derakhshanfar, Hojjat; Tabatabaee, Seyed Morteza; Moghimi, Mehrdad; Kabir, Ali
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
Stengel, D; Bauwens, K; Porzsolt, F; Rademacher, G; Mutze, S; Ekkernkamp, A
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
Pigolkin, Iu I; Dubrovin, I A; Chirkov, R N; Dubrovina, I A; Khachaturian, B S; Mosoian, A S; Dallakian, V F
Bladder injuries are usually reported after blunt trauma to lower abdomen. The pelvic fracture is associated in >80% of the cases. All intraperitoneal bladder tear are managed surgically with open exploration and repair. In stable patients, with no other intra-abdominal injury, laparoscopy acts both as a diagnostic and therapeutic tool. It results in faster recovery, early discharge from the hospital with good cosmetic outcome. We describe a similar case of intraperitoneal bladder rupture managed laparoscopically replicating the open technique of double-layer repair. PMID:22874700
To evaluate the effectiveness of contrast-enhanced ultrasound (CEUS) in the diagnosis and characterization of hepatic, renal and splenic traumatic injuries versus conventional ultrasound (US) and multislice computed tomography (MS-CT). Between January 2005 and January 2007, 78 patients (48 males, 30 females, mean age 56 years) with blunt abdominal trauma were examined by conventional US, CEUS and MS-CT. CEUS employed a low-MI technique using 1.2 to 2.4 ml of SonoVue (Bracco, Italy) i.v. and a multifrequency transducer (2-4 MHz, Siemens, Sequoia, Acuson). CT examinations were performed on a 64 detector CT scanner (Somatom Sensation 16 or 64, Siemens Medical Systems, Forchheim, Germany) before and after administration of 120 ml intravenous contrast agent (Solutrast, Bracco, Milan, Italy) followed by 50 ml saline. The presence of hepatic, renal and splenic injuries was analyzed and the conspicuousness of findings was assessed. In 15 of the 78 patients conventional US identified solid organ injuries: 8 hepatic, 2 renal and 5 splenic injuries. CEUS identified 3 more injuries (2 hepatic and 1 splenic) that had been missed by conventional US. CEUS identified traumatic lesions in 18/78 patients. In one of the 18 patients even active bleeding could be identified by CEUS. In CEUS solid organ injuries appeared hypoechoic. MS-CT identified 18 solid organ injuries in 78 patients, corroborating the CEUS results.CEUS greatly improves the visualization and characterization of hepatic, renal and splenic injuries compared to conventional ultrasound and correlates well with MS-CT. The imaging technique detects even minor blood flow and is able to depict vascular structures in detail. At our institution it is used as an additional examination technique which supplements MS-CT in unclear cases. Owing to its bedside availability, CEUS provides a good alternative to MS-CT, especially in patients with contraindications to CT contrast agents (e.g. due to renal failure or severe allergy) and in hemodynamically compromised patients. PMID:18503121
Clevert, D-A; Weckbach, S; Minaifar, N; Clevert, D-A; Stickel, M; Reiser, M
Ultrasound imaging enhances the physician's ability to evaluate, diagnose, and treat emergency department (ED) patients. Because ultrasound imaging is often time-dependent in the acutely ill or injured patient, the emergency physician is in an ideal position to use this technology. Focused ultrasound examinations provide immediate information and can answer specific questions about the patient's physical condition. We report a case in which blunt trauma to the abdomen and pre-existing pericardial fluid, due to human immunodeficiency virus (HIV), caused pericardial tamponade, diagnosed by bedside ultrasonography, and subsequent cardiac arrest. An ED thoracotomy released this tamponade, and spontaneous cardiac activity returned. The indications for and efficacy of ED thoracotomy have been debated for many years. Multiple studies have shown that patients with isolated penetrating chest trauma have the best outcome and that patients with blunt trauma without signs of life at the scene or in the ED have the poorest. We demonstrate the importance of ultrasound use by emergency physicians to assess trauma patients with pulseless electrical activity and suggest that in specific clinical situations after blunt trauma, an ED thoracotomy can be life saving. PMID:17239739
Menaker, Jay; Cushman, Jeremy; Vermillion, Jon Mark; Rosenthal, Robert E; Scalea, Thomas M
setting. The Focused Assessment with Sonography for Trauma (FAST) examination was developed tasks: 1. Development of patient-specific segmented CT- based models to enable accurate navigation is the latest Image Registered system to be developed by the CIMIT Image Guidance Laboratory; see www
Background. The trauma burden globally accounts for high levels of mortality and morbidity. Blunt abdominal trauma (BAT) contributes significantly to this burden. Patient's evaluation for BAT remains a diagnostic challenge for emergency physicians. SSORTT gives a score that can predict the need for laparotomy. The objective of this study was to assess the accuracy of SSORTT score in predicting the need for a therapeutic laparotomy after BAT. Method. A prospective observational study. Eligible patients were evaluated for shock and the presence of haemoperitoneum using a portable ultrasound machine. Further evaluation of patients following the standard of care (SOC) protocol was done. The accuracy of SSORTT score in predicting therapeutic laparotomy was compared to SOC. Results. In total, 195 patients were evaluated; M?:?F ratio was 6?:?1. The commonest injuries were to the head 80 (42%) and the abdomen 54 (28%). A SSORTT score of >2 appropriately identified patients that needed a therapeutic laparotomy (with sensitivity 90%, specificity 90%, PPV 53%, and NPV 98%). The overall mortality rate was 17%. Conclusion. Patients with a SSORTT score of 2 and above had a high likelihood of requiring a therapeutic laparotomy. SSORTT scoring should be adopted for routine practice in low technology settings. PMID:24688794
Musiitwa, P. C. M.; Galukande, M.; Bugeza, S.; Wanzira, H.; Wangoda, R.
Missed abdominal injuries after blunt abdominal trauma belong to the most frequent causes of death, especially in polytraumatized patients. Primary missing these injuries often is a tragedy due to a mortality-rate up to 50% after delayed treatment compared with a low complication- and mortality-rate after diagnosis in time. We report the case of a patient with a missed spleen lesion to discuss the special problems of the transport stages. Transport and diagnostic procedures are critical stages because of limited diagnostical and therapeutical possibilities. There is a risk of inadequate therapy in case of a sudden debasement of the patient's condition. Therefore sufficient monitoring and the availability of emergency medicals and tools are essential to secure an adequate treatment of secondary decompensation. These conditions are indispensable for the primary transport, innerhospital transfers and also for secondary interhospital transfers. Supervision during the transport stages by a doctor who is able to carry out life-saving emergency treatments is essential. Sudden debasement of the patient's condition often requires short-dated decision making concerning the following diagnostical and therapeutical strategy. PMID:10612210
Ambacher, T; Riesener, K P; Kasperk, R; Schumpelick, V
Background: Bispectral index (BIS) monitoring in multiple trauma patients has become a common practice in monitoring the sedation levels. We aimed to assess the utility of BIS in the trauma intensive care unit (ICU). Methods: A prospective observational study was conducted in the trauma ICU at Hamad General Hospital in Qatar between 2011 and 2012. Patients were divided in two groups: Group I (without BIS monitoring) and Group II (with BIS monitoring). The depth of sedation was clinically evaluated with Ramsey Sedation Scale, changes in vital signs and Glasgow Coma Scale (GCS) level. Use of sedatives, analgesics, and muscle relaxants were also recorded. Data were compared using Chi-square and Student t-tests. Results: A total of 110 mechanically ventilated trauma patients were enrolled with a mean age of 36 ± 14 years. The rate of head injury was greater in Group I when compared with Group II (94% vs. 81%, P = 0.04). In comparison to Group I, patients in Group II had lower GCS and higher mean Injury Severity Score (ISS) (6.3 ± 2.5 vs. 7.4 ± 2.7 and 25.5 ± 8.5 vs. 21.2 ± 4.7, respectively, P = 0.03). The used midazolam dose was less in Group II in comparison to Group I (5.2 ± 2.3 vs. 6.1 ± 2.1, P = 0.03). Also, fentanyl dose was less in Group II (152 ± 58 vs. 187 ± 59, P = 0.004). The rate of agitation, failure of extubation and tracheostomy in Group II were lower than those in Group I, P = 0.001. The length of stay for patients Group I was longer (14.6 ± 7.1 vs. 10.2 ± 5.9 days) in comparison to group II, P = 0.001. Conclusion: Management of multiple trauma patients in the trauma ICU with BIS monitoring was found to be associated with better outcomes. BIS monitoring is a guide for adjusting the dosage of sedative agents. It can also minimize agitation, failure of extubation, and length of stay in ICU. PMID:25317356
Mahmood, Saeed; Parchani, Ashok; El-Menyar, Ayman; Zarour, Ahmad; Al-Thani, Hassan; Latifi, Rifat
Background: This study was performed to determine the demographic and outcome of penetrating abdominal trauma in patients attending to emergency medicine department. Materials and Methods: This was a descriptive cross-sectional study in Imam Hossein Medical Center. Seventy five patients who came to our department with penetrating abdominal trauma during a 1 year period were enroled into this study and their demographic data and outcome (during the hospitalization) were recorded. The study was at Imam Hossein Medical Center, Tehran, Iran, from 2009 to 2010. Results: Our findings indicate these notable results: 84% of patients were less than 40 years old, most patients attended emergency department during the spring and summer, 72 patients (96%) arrived between 7 pm and 7 am, 74 patients (98.7%) had stab wound and one person (1.3%) was shot, eventually 46 patients (61%) had laparatomy performed and 2 patients (2.7%) died. 59 patients out of 75 study cases appealed to police department and legal medicine council. Conclusions: The incidence of abdominal penetrating trauma due to stab wound is much higher than gunshot in our community, which indicates the importance of educating the emergency staff and preparing the emergency department work place to attend to these patients, especially during the night hours. PMID:23977658
Derakhshanfar, Hojjat; Azizkhani, Reza; Masoumi, Babak; Hashempour, Azam; Amini, Afshin
We examined the relationship between body fat and body mass index (BMI) in a multiethnic population of obese children. BMI z-scores were compared to DEXA measures of whole body composition and regional fat distribution. Fat mass index (FMI) was best predicted by the equation: 1/[(0.159- 0.013 x percentile of total abdominal fat)- (0.01 x BMI z-score)], where percentile of abdominal fat ranges from 1 to 5. Predicted FMI had high agreement with FMI measured by DEXA. There were no detectable differences in this relation between different ethnic groups. Both BMI and abdominal fat should be used as a proxy to determine adiposity. PMID:19731772
El Taguri, A; Dabbas-Tyan, M; Goulet, O; Ricour, C
The purpose of this study was to effects of abdominal draw-in maneuver and core exercise with 4 weeks using the musculoskeletal ultrasonography on muscle thickness and disability in subjects with low back pain. Twenty patients with nonspecific back pain (abdominal draw-in maneuver group: n= 10, core exercise group: n= 10) were recruited in the study. Both group received exercise intervention 3 times a week for 4weeks. The test were based on muscle thickness (transversus abdominis; Tra, internal oblique; IO and external oblique; EO), disability (Oswestry disability index; ODI) measured immediately before and after intervention. The data was measured by SPSS program 12.0 version and analyzed by Paired t-test and Independent t-test. The following results were obtained. The thickness of IO, EO for both group significantly improved except for muscle thickness of Tra. The ODI were significant difference for both groups. As the results of this study, we suggest that it may be effective method to apply to increase for the thickness of Tra, EO using abdominal draw-in maneuver and thickness of IO using core exercise. PMID:24278873
Park, Seong-Doo; Yu, Seong-Hun
Introduction Abdominal injuries in abused children are less common than musculoskeletal and craniocerebral injuries; however they carry\\u000a high mortality and morbidity rates. In every case of trauma, regardless of aetiology, radiologists are responsible for the\\u000a documentation and evaluation of injuries.\\u000a \\u000a \\u000a \\u000a \\u000a Injuries Any abdominal injury pattern maybe observed following physical abuse and none is specific for abuse. However, a high index\\u000a of suspicion
Maria Raissaki; Corinne Veyrac; Eleonore Blondiaux; Christiana Hadjigeorgi
The method of estimation of the injury severity and the traumatic disease course prognostication was improved and introduced into practice, trying to optimize the choice of the treatment--diagnostic tactic in injured persons with closed combined abdominal trauma (CCAT). Application of the improved anatomic--functional model permits to estimate severity and to prognosticate the course of the traumatic disease in injured persons with CCAT with trustworthiness (81.7 +/- 4.7)% (P < 0.01). The point criteria of the prognosis gradation of the traumatic disease course were named as "favorable", "doubtful" and "unfavorable". In "unfavorable" prognosis the performance of a staged surgical treatment, according to the "damage control" method, is indicated. PMID:21510365
Zaruts'ky?, Ia L; Denysenko, V M; Trutiak, I R; Oli?nyk, Iu M
Ultrasound examinations in trauma patients should be done in the emergency department using curved-array (3.5-7.5 MHz) probes. Blunt trauma of the abdomen and thorax must be regarded as a single organ injury. Sonography is the imaging technique of first choice and has completely replaced peritoneal lavage. Paramount advantages are its ability to provide rapid information and reproducible results at short intervals and in a noninvasive manner. The sensitivity and specificity of sonography in detecting intraabdominal fluid are 97-100% and 80-90%, respectively. To achieve such good results, though, adequate education in ultrasound and state-of-the-art devices is crucial. Clinical experiences prove that standardized sonography must be part of polytrauma management and should be integrated in advanced trauma life support courses. Technical improvements with better image quality and miniaturization of hardware will contribute to increase the use of this technique. However, ultrasound does not replace computed tomography for follow-up in answering more sophisticated questions in multiple injured patients. PMID:19039569
Wening, J V; Tesch, C; Huhnholz, J; Friemert, B
Ultrasound is an easy to learn and highly efficient diagnostic tool to complete the clinical examination and improve bedside decision-making. In the trauma room, surgeons are often required to make a quick decision as to whether or not a patient needs an emergency intervention or whether further diagnostics are required. For this reason, education of surgeons in performing focused emergency ultrasound is pivotal. The goal of ICAN is to improve and expand the education of surgeons in Switzerland. This article provides a short review of the most frequent surgical pathologies encountered in the emergency room. PMID:24894613
Studer, Maria; Studer, Peter
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 (7 mg/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
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
Walton, David M; MacDermid, Joy C; Pulickal, Mathew; Rollack, Amber; Veitch, Jennifer
Background Rectus abdominis muscle and abdominal subcutaneous fat tissue are useful for reconstruction of the chest wall, and abdominal, vaginal, and perianal defects. Thus, preoperative evaluation of rectus abdominis muscle and abdominal subcutaneous fat tissue is important. This is a retrospective study that measured the thickness of rectus abdominis muscle and abdominal subcutaneous fat tissue using computed tomography (CT) and analyzed the correlation with the patients' age, gestational history, history of laparotomy, and body mass index (BMI). Methods A total of 545 adult women were studied. Rectus abdominis muscle and abdominal subcutaneous fat thicknesses were measured with abdominopelvic CT. The results were analyzed to determine if the thickness of the rectus abdominis muscle or subcutaneous fat tissue was significantly correlated with age, number of pregnancies, history of laparotomy, and BMI. Results Rectus abdominis muscle thicknesses were 9.58 mm (right) and 9.73 mm (left) at the xiphoid level and 10.26 mm (right) and 10.26 mm (left) at the umbilicus level. Subcutaneous fat thicknesses were 24.31 mm (right) and 23.39 mm (left). Rectus abdominismuscle thickness decreased with age and pregnancy. History of laparotomy had a significant negative correlation with rectus abdominis muscle thickness at the xiphoid level. Abdominal subcutaneous fat thickness had no correlation with age, number of pregnancies, or history of laparotomy. Conclusions Age, gestational history, and history of laparotomy influenced rectus abdominis muscle thickness but did not influence abdominal subcutaneous fat thickness. These results are clinically valuable for planning a rectus abdominis muscle flap and safe elevation of muscle flap. PMID:23094250
Kim, Jungmin; Lim, Hyoseob; Lee, Se Il
Background School-based screening and prevention programs for adiposity generally target school children in grades 4 and 6 (age 9–11 years). The aims of this study were to evaluate the validity of body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR) in identifying abdominal adiposity in fifth-grade Japanese school children and to determine optimal cut-off values for anthropometric measures. Methods The target population was fifth-grade school children enrolled in 2 schools in Shizuoka, Japan between 2008 and 2010; 422 of the 466 children participated in the present study. Abdominal adiposity was defined as percent trunk fat in the 95th percentile or higher, as determined by dual-energy x-ray absorptiometry (DXA). We analyzed the validity of BMI, WC, and WHtR using receiver operating characteristic (ROC) curve analysis. The Youden index was used to determine cut-off values of BMI, WC, and WHtR that identify excess abdominal fat. Results Optimal cut-off values to identify abdominal adiposity were 20.8 kg/m2 (BMI), 76.5 cm (WC), and 0.519 (WHtR) for boys, and 19.6 kg/m2 (BMI), 73.0 cm (WC), and 0.499 (WHtR) for girls. Areas under the ROC curve were 0.983 (BMI), 0.987 (WC), and 0.981 (WHtR) for boys, and 0.981 (BMI), 0986 (WC), and 0.992 (WHtR) for girls. Conclusions BMI, WC, and WHtR successfully identified a high proportion of children with excess abdominal fat as measured by DXA, demonstrating that these measures are useful indices for school screening. PMID:21467729
Fujita, Yuki; Kouda, Katsuyasu; Nakamura, Harunobu; Iki, Masayuki
Background The high incidence of metabolic syndrome in patients with psychosis is mainly attributed to antipsychotic treatment. However, it has been suggested that psychological stress also plays a role, by inducing a chronic inflammatory process which may predispose to the development of metabolic abnormalities. We investigated the association between psychosocial stress and inflammatory and metabolic biomarkers in subjects with first-episode psychosis and healthy controls. Methods Body Mass Index (BMI), weight and waist circumference were measured in 96 first-episode psychosis patients and 99 healthy controls. High sensitive C-reactive protein (hsCRP) and leptin were measured in a sub-sample of 37 patients and 49 controls. In all the subjects we collected information on childhood trauma and recent stressors. Results Only patients with childhood trauma had higher BMI (24.9±0.5 kg/m2) and higher hsCRP (0.8±0.3 mg/dl) when compared with healthy controls (23.4±0.4 kg/m2, p=0.018 and 0.2±0.1 mg/dl, p=0.043 respectively). This was specific to childhood sexual abuse; patients who had experienced childhood sexual abuse had higher BMI (26.2±1.0 kg/m2) and hsCRP (1.9±2.5 mg/dl) not only compared with controls, but also compared with patients who had not experienced childhood sexual abuse (24.3±0.5 kg/m2, p=0.055; 0.5±0.2 mg/dl, p=0.001). Conclusions Childhood trauma is cross-sectionally associated with both increased inflammation and worse metabolic profile in first-episode psychosis. Further studies need to confirm the causal relationship between childhood trauma and higher BMI, and whether this is indeed mediated by the increased inflammation. PMID:22260948
Hepgul, Nilay; Pariante, Carmine M.; Dipasquale, Salvatore; DiForti, Marta; Taylor, Heather; Marques, Tiago Reis; Morgan, Craig; Dazzan, Paola; Murray, Robin M.; Mondelli, Valeria
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.
Federle, M.P.; Brant-Zawadzki, M.
Background The sagittal abdominal diameter (SAD) measured in supine position is an alternative adiposity indicator that estimates the quantity of dysfunctional adipose tissue in the visceral depot. However, supine SAD’s distribution and its association with health risk at the population level are unknown. Here we describe standardized measurements of SAD, provide the first, national estimates of the SAD distribution among US adults, and test associations of SAD and other adiposity indicators with prevalent dysglycemia. Methods and Findings In the 2011–2012 National Health and Nutrition Examination Survey, supine SAD was measured (“abdominal height”) between arms of a sliding-beam caliper at the level of the iliac crests. From 4817 non-pregnant adults (age ?20; response rate 88%) we used sample weights to estimate SAD’s population distribution by sex and age groups. SAD’s population mean was 22.5 cm [95% confidence interval 22.2–22.8]; median was 21.9 cm [21.6–22.4]. The mean and median values of SAD were greater for men than women. For the subpopulation without diagnosed diabetes, we compared the abilities of SAD, waist circumference (WC), and body mass index (BMI, kg/m2) to identify prevalent dysglycemia (HbA1c ?5.7%). For age-adjusted, logistic-regression models in which sex-specific quartiles of SAD were considered simultaneously with quartiles of either WC or BMI, only SAD quartiles 3 (p<0.05 vs quartile 1) and 4 (p<0.001 vs quartile 1) remained associated with increased dysglycemia. Based on continuous adiposity indicators, analyses of the area under the receiver operating characteristic curve (AUC) indicated that the dysglycemia model fit for SAD (age-adjusted) was 0.734 for men (greater than the AUC for WC, p<0.001) and 0.764 for women (greater than the AUC for WC or BMI, p<0.001). Conclusions Measured inexpensively by bedside caliper, SAD was associated with dysglycemia independently of WC or BMI. Standardized SAD measurements may enhance assessment of dysfunctional adiposity. PMID:25272003
Kahn, Henry S.; Gu, Qiuping; Bullard, Kai McKeever; Freedman, David S.; Ahluwalia, Namanjeet; Ogden, Cynthia L.
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
Goldsmith, Rachel E; Martin, Christina Gamache; Smith, Carly Parnitzke
Abdominal seat belt marks can be an indication of abdominal wall rupture. The focused assessment with sonography for trauma (FAST) and computed tomography (CT) scanning are the diagnostic tools of choice in hemodynamically stable patients. The typical mechanism of trauma frequently leads to additional intra-abdominal injuries, spinal injuries and in some cases aortic rupture. Abdominal wall injuries of grade IV according to Dennis should be surgically treated. The increasing numbers of obese vehicle occupants and the resulting special risk of injury warrant optimization of technical restraint systems. PMID:23896762
Bachmann, S; Schrem, H; Mommsen, P; Gaulke, R; Klempnauer, J; Bektas, H; Krettek, C; Zeckey, C
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
Tiel Groenestege-Kreb, D; van Maarseveen, O; Leenen, L
The phylosophy of aggressive surgical approach, its complete implementation in liver trauma surgery did not appear efficient. No matter of permanenent development of diagnostic imaging methods, anesthesia, intensive therapy, medical technology and suture materials, operational theater and operative tchniques, major liver resections in trauma had mortality rate up to 60%. With introduction of computerized tomography (CT, 1981) in everyday clinical praxis and with better evaluation of trauma patients, the whole approach to liver trauma patient has been redesigned. Based on AAST-OIS classification, almost 70% of traumatized with grade I, II and III sholud be treated non-operatively, hospitally, with repeating FAST (focused abdominal ultrasound in trauma) and abdominal CT scans. The rest of traumatized patients, with grade IV and V injuries of juxtahepatic structures demand complexive surgical treatment. The modalities of surgical treatment depend on trauma mechanisms, extensivity, anatomical localisation and affection of vascular structures. Hanging Manuevr--the Method of French surgeon Belghiti bases on anterior approach in liver resection is a try for fast solution for fatal bleeding in liver trauma. It consists of placing the elastic cord throughout the anterior surface of VCI or ligamentum venosusm, of upper end of the cord is located in superior part of VCI where hepatic veins are emerging. Lower end of the cord is located in subhepatic part of VCI between 3 Glisonian pedicles. Concerning hepatic veins liver is divided in 3 sections, which derives blood in right hepatic vein RHV, middle hepatic vein MHV and left hepatic vein LHV. Belghiti proposed the usage of hanging maneuver when resecting the right liver, while the cord is placed throughout retrohepatic VCI, lower end between elements of Glisonian pedicle and upper end between hepatic veins. Complications like bleeding from caudal veins are minimal, then speed in liver resection in hemodynamic unstable and ishemic patient, defects like bleeding because compressing tapes or lesions IVC tile mobilazion of liver for conventional resection. PMID:21449137
Djuki?, Vladimir R; Karamarkovi?, Aleksandar B; Radenkovi?, Dejan V; Gregori?, Pavle D; Jeremi?, Vasilije; Ivancevi?, Nenad Dj; Loncar, Zlatibor; Stepi?, Dejan; Mici?, Dusan; Olui?, Branslav; Bajec, Djordje D
PURPOSE: We noted the combination of obstructed defecation or constipation and fecal incontinence, the poor results of abdominal rectopexy for constipation, and the well-known risk of postoperative induction of constipation after rectopexy. We developed a new operation to treat patients with constipation or fecal incontinence (with a concomitant rectocele, internal rectal intussusception, enterocele at dynamic defecography, or all three) or
R. Silvis; H. G. Gooszen; A. van Essen; A. Th. C. M. Kruif; L. W. M. Janssen
Background: Trauma has been identified as a major public health problem in Australia. Maxillofacial trauma constitutes a significant proportion of trauma, although epidemiological studies in Australia are few. The purpose of this study was to assess the prevalence and the epidemiological pattern of maxillofacial trauma occurring in major trauma patients.
FN Shahim; P. Cameron; JJ McNeil
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
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
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
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
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; Zarogoulidis, Paul
Obesity has been suggested to be a risk factor for increase morbidity and mortality after trauma and surgery. Trauma laparotomy provides an opportunity to assess the effect of body mass index (BMI) on patients subjected to both trauma and surgery. We hypothesized that obesity would have a deleterious effect on outcomes. A retrospective review was conducted of all patients 18 years of age or older undergoing laparotomy for trauma between July 2001 and June 2011. Patients were stratified according to BMI into the following four groups: underweight (16 to 22 kg/m(2)), normal (23 to 27 kg/m(2)), overweight (28 to 34 kg/m(2)), and obese (35 kg/m(2) or higher). Data on the patient's hospital course included length of stay, mortality, respiratory failure, infectious complications, wound dehiscence, and organ failure. A total of 1,297 patients underwent laparotomy. Seven per cent of the study group was obese and 24 per cent was underweight. There was no difference among mean Injury Severity Score, percent of patients arriving in shock, and mean number of units of packed red blood cells administered during their hospital stay. Obese patients had longer intensive care unit and hospital lengths of stay. There were no differences in ventilator days or mortality. Using univariate statistics, obese patients had increased rates of respiratory and renal failure, bacteremia with and without septic shock, and abdominal wound dehiscence. Subjecting the data to logistic regression analysis, BMI was no longer an independent predictor of any complication. Although obese trauma patients do have increased infectious morbidity, wound dehiscence, and a prolonged length of stay, increased BMI is not an independent predictor of increased morbidity or mortality after trauma laparotomy. PMID:23461948
Livingston, David H; Lavery, Robert F; N'kanza, Anne; Anjaria, Devashish; Sifri, Ziad C; Mohr, Alicia M; Mosenthal, Anne C
Evaluating and "cleaning" of the uterine cavity is probably the most performed operation in women. It is done for several reasons: abortion, evaluation of irregular bleeding in premenopausal period, and postmenopausal bleeding. Abortion is undoubtedly the number one procedure with more than 44 million pregnancies terminated every year. This procedure should not be underestimated and a careful preoperative evaluation is needed. Ideally a sensitive pregnancy test should be done together with an ultrasound in order to confirm a uterine pregnancy, excluding extra-uterine pregnancy, and to detect genital and/or uterine malformations. Three out of four abortions are performed by surgical methods. Surgical methods include a sharp, blunt, and suction curettage. Suction curettage or vacuum aspiration is the preferred method. Despite the fact that it is a relative safe procedure with major complications in less than one percent of cases, it is still responsible for 13% of all maternal deaths. All the figures have not declined in the last decade. Trauma, perforation, and bleeding are a danger triage. When there is a perforation, a laparoscopy should be performed immediately, in order to detect intra-abdominal lacerations and bleeding. The bleeding should be stopped as soon as possible in order to not destabilize the patient. When there is a perforation in the uterus, this "entrance" can be used to perform the curettage. This is particularly useful if there is trauma of the isthmus and uterine wall, and it is difficult to identify the uterine canal. A curettage is a frequent performed procedure, which should not be underestimated. If there is a perforation in the uterus, then this opening can safely be used for vacuum aspiration. PMID:25134300
Tjalma, W A A
Splenosis is a benign condition among patients with a history of splenic trauma or surgery. Most cases of splenosis are intra abdominal due to direct seeding of surrounding structures, although these heterotopic rests may occur almost anywhere in the body, and its diffuse nature may raise the suspicion of metastatic cancer. The increased prevalence of abdominal trauma due to road accidents and the growing armamentarium of available imaging modalities suggest that abdominal splenosis may be expected more often than ever. We, in this article emphasize the crucial role of taking a thorough patient's medical history concerning splenic trauma in the past and the use of novel non invasive diagnostics modalities that allow accurate diagnosis.
Gupta, Kamini; Ahluwalia, Archana; Jain, Tanica; Saggar, Kavita
Summary Dextromethorphan is an N-methyl-D-aspartate (NMDA) receptor antagonist which has been shown to inhibit the development of cutaneous secondary hyperalgesia after tissue trauma. We studied 60 ASA I-II patients undergoing total abdominal hysterectomy in a randomized, double-blind, placebo-controlled study. Patients received either dextromethorphan 27 mg cap- sules, two doses before operation and three doses in the first 24 h after
P. M. MCCONAGHY; P. MCSORLEY; W. MCCAUGHEY; W. I. CAMPBELL
Long-term responses to captivity trauma were measured in a national sample of American former prisoners of war. Their responses included negative affect, positive affect, and somatic symptoms as assessed by the Cornell Medical Index in 1967 and the Center for Epidemiological Study Depression Scale in 1985. These responses were strongly associated with captivity trauma (as indexed by captivity weight loss,
B. E. Engdahl; A. R. Harkness; R. E. Eberly; W. F. Page; J. Bielinski
Abdominal pain in pregnancy is most commonly caused by complications of the pregnancy, e.g., abortion, ectopic pregnancy and abruptio placentae. A careful history and methodical physical examination and, if necessary, simple ultrasonographic investigations will reveal the cause in most of these conditions. In a few cases of abdominal pain in pregnancy a gynaecological condition, such as torsion of an ovarian cyst, or a nongynaecological (medical or surgical) one is the cause. Some of these conditions are serious, e.g., acute appendicitis, and unless the correct diagnosis is made and the appropriate management promptly instituted both the mother and her baby may suffer tragic consequences. Moreover, these conditions are more likely to be misdiagnosed during pregnancy. This is because the anatomical and physiological changes which occur in pregnancy tend to change and obtund the expected clinical features and laboratory data which are used to diagnose these conditions. Their early diagnosis therefore requires a high index of suspicion together with awareness of the ways in which they may present in pregnancy. PMID:7941766
Klufio, C A; Amoa, A B; Rageau, O
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.
Debi, Uma; Ravisankar, Vasudevan; Prasad, Kaushal Kishor; Sinha, Saroj Kant; Sharma, Arun Kumar
The aim of this work was to describe the model and clinical results obtained by the Niguarda Trauma Team referral center for major trauma, in Milan. The Trauma Team is organized as a trauma service, where general surgeons, anesthesiologists, orthopedic surgeons and neurosurgeons work on a 24 hour rotation. When not in duty in the rotations, specialists work in their specific elective activities. The director of the Trauma Team has the responsibility for discussion and application of protocols, clinical assistance, quality assessment and training. The results of 1334 consecutive cases of major trauma during a 51 month period were reviewed using the trauma registry. 39% overtriage, which increased over the years, and 1.12% undertriage were recorded. Mortality of patients with injury severity scores > 15 was 21%, with a progressive decrease over the years. Blunt trauma accounted for 91.75% and were road-related in most cases. Skeletal injuries were the most frequent findings, but brain and thoraco-abdominal injuries were associated with a higher risk of death. 1476 surgical procedures (16.93% general surgery and 111 interventional angiographic studies) were performed. Quality assessment revealed a significant decrease in preventable deaths within the first 72 hours, after excluding patients admitted in extremis. The results presented in this study demonstrate the possibility of realising a model of organized trauma care in an emergency department in Italy, with patient outcomes comparable to those obtained in Trauma Center in other countries. PMID:19062485
Chiara, Osvaldo; Cimbanassi, Stefania; Andreani, Sara; Sammartano, Fabrizio; Pizzilli, Giacinto; Girotti, Paolo; Mariani, Anna; Bassi, Gabriele; Baticci, Fabio; Fontana, Alfredo; Mariani, Massimo; Massi, Massimo; Pozzi, Carlo; Ardizzone, Marco Vittorio Rossi; Sansonna, Fabio; Vesconi, Sergio; Pugliese, Raffaele
Patients in the intensive care unit (ICU) are at risk of developing of intra abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). Aim: This review seeks to define IAH and ACS, identify the aetiology and presentation of IAH and ACS, identify IAP measurement techniques, identify current management and discuss the implications of IAH and ACS for nursing practice. A search of the electronic databases was supervised by a health librarian. The electronic data bases Cumulative Index of Nursing and Allied Health Literature (CINAHL); Medline, EMBASE, and the World Wide Web was undertaken from 1996- January 2011 using MeSH and key words which included but not limited to: abdominal compartment syndrome, intra -abdominal hypertension, intra-abdominal pressure in adult populations met the search criteria and were reviewed by three authors using a critical appraisal tool. Data derived from the retrieved material are discussed under the following themes: (1) etiology of intra-abdominal hypertension; (2) strategies for measuring intra-abdominal pressure (3) the manifestation of abdominal compartment syndrome; and (4) the importance of nursing assessment, observation and interventions. Intra-abdominal pressure (IAP) and abdominal compartment syndrome (ACS) have the potential to alter organ perfusion and compromise organ function. PMID:24499574
BACKGROUND: Abdominal wall hematoma is due to trauma, coagulation disorders or anticoagulation therapy complications. METHODS: In this report we present a case of a 44-year-old female who suffered from blunt abdominal trauma and presented to the emergency department with sharp abdominal pain and ecchymosis. FAST and abdominal computerized tomography (CT) revealed an abdominal wall hematoma. Treatment with an ultrasound-guided percutaneous drainage was performed successfully. RESULTS: The patient remained under observation for six hours with serial ultrasound scans, and no signs of hematoma recurrence were present. She was discharged the same day with clinical improvement. CONCLUSION: Complete history investigation and clinical examination help to make a correct diagnosis of abdominal wall hematoma, select a prompt treatment, and reduce complications. PMID:25215083
Trujillo, Laura; Naranjo, Sara; Cardozo, Alejandro; Alvarez, Bryan
Traumatic hernia of the abdominal wall is a rare and easily missed injury in the presence of major pelvic and abdominal lesions. We present a radiographically documented case of combined pelvic and acetabular fracture with a major contralateral traumatic hernia with avulsion of the internal oblique, the external oblique and the transverse abdominal muscles diagnosed four months after the initial trauma. To our knowledge no similar case has been described in the current literature. PMID:12584987
Borens, O; Fischer, J F; Bettschart, V; Mouhsine, E
Postmortem computed tomography (PMCT) has become an important complement in investigating forensic cases allowing an accurate detection of gas accumulations. The present study investigated the presence and distribution of gas in a large number of non-putrefied cases of traumatic and non-traumatic deaths. Furthermore the possibility of pneumobilia secondary to blunt abdominal trauma was studied. Retrospectively, 73 cases, underwent a whole-body PMCT prior to autopsy. These were divided into four groups: penetrating trauma (20 gunshot cases, 13 stabbing cases), blunt abdominal trauma (20 cases) and a control group of 20 non-trauma cases. Exclusion criteria were visible signs of decomposition. Each group was screened for gas accumulations in the vascular system, internal organs, soft tissues and body cavities. Gas accumulations were present in 98% of the trauma cases, compared to 80% of the control group. The most affected structures and/or organs in the trauma group were soft tissues, vessels and the liver. In most cases of the trauma group gas was associated with open injuries and lacerations of vessels. Furthermore, in the gunshot group gas was frequently seen in the intracranial cavity. Pneumobilia occurred in one case of the blunt trauma group; in that control group gas was also seen, but less frequently. Gas accumulation showed a strong association with traumatic events, but even the majority of non-trauma cases showed gas accumulations. Despite the exclusion of cases with visible decomposition signs, a putrefactive origin of gas was assumed in some cases. Gas accumulations are a frequent finding in PMCT with a higher incidence in (open) trauma cases. Even though a differentiation between putrefactive and traumatic gas accumulations is still difficult, knowledge of the circumstance surrounding the case may help identify the origin of gas. PMID:22721934
Gebhart, Florin T F; Brogdon, B G; Zech, Wolf-Dieter; Thali, Michael J; Germerott, Tanja
The purpose of this paper is to determine the relative frequency of multi-detector CT (MDCT) findings of pancreatic injury in blunt trauma and to determine their diagnostic accuracy in predicting main pancreatic duct injury. Fifty-three patients (31 male, 22 female; mean 44.1 years) with blunt trauma and admission MDCT findings suspicious for pancreatic injury or who underwent MDCT and had a discharge diagnosis of pancreatic trauma were included in this study. Two radiologists reviewed all images and recorded findings suspicious for pancreatic injury, which were subsequently compared to surgical findings to generate diagnostic accuracy. MDCT imaging findings suggestive of pancreatic injury included low attenuation peripancreatic fluid (n?=?51), hyperattenuating peripancreatic fluid (n?=?13), pancreatic contusion (n?=?7), active hemorrhage (n?=?2), and pancreatic laceration (n?=?16). Diagnostic accuracy of the various imaging findings varied for diagnosing main duct injury; there were highly sensitive, nonspecific imaging findings such as the presence of low attenuation peripancreatic fluid (sensitivity, 100 %; specificity 4.9 %) as well as insensitive, specific findings such as visualizing a pancreatic laceration involving >50 % of the parenchymal width (sensitivity, 50 %; specificity, 95.1 %). In the setting of blunt abdominal trauma, MDCT imaging findings can be grouped into two categories for determining integrity of the main pancreatic duct: indirect, highly sensitive but nonspecific findings and direct, specific but insensitive findings. Awareness of the clinical implications of the various MDCT imaging findings of pancreatic trauma is useful in interpreting their significance. PMID:23604978
Gordon, Robert W; Anderson, Stephan W; Ozonoff, Al; Rekhi, Satinder; Soto, Jorge A
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
Narang, Sandeep; Clarke, Jennifer
Long-term responses to captivity trauma were measured in a national sample of American former prisoners of war. Their responses included negative affect, positive affect, and somatic symptoms as assessed by the Cornell Medical Index in 1967 and the Center for Epidemiological Study Depression Scale in 1985. These responses were strongly associated with captivity trauma (as indexed by captivity weight loss, torture, and disease) and resilience (as indexed by age and education at capture). Symptoms reported in 1967 were related to symptoms reported in 1985, suggesting symptom stability. These results are consistent with a model of trauma response that incorporates both trauma exposure and individual resilience. The findings are interpreted within a theoretical view of trauma response as adaptive when viewed from an evolutionary perspective. PMID:8378805
Engdahl, B E; Harkness, A R; Eberly, R E; Page, W F; Bielinski, J
Although traumatic experiences are relatively common, there is wide variability in individuals’ responses to them. This study\\u000a examined trauma exposure, meaning making efforts (indexed by post-traumatic cognitions), and post-traumatic stress symptoms\\u000a (PTS) in a non-clinical volunteer student sample (N = 631). We further examined the moderating role of gender, the importance of trauma type (interpersonal vs. non-interpersonal),\\u000a and the impact of cumulative
Lisa DeMarni Cromer; Joshua M. Smyth
Patients sustaining traumatic injuries are at risk for development of rhabdomyolysis. The effect of obesity on this risk is unknown. This study attempted to characterize the role of obesity in the development of rhabdomyolysis after trauma. This was a retrospective review of all trauma patients with creatine kinase (CK) levels admitted to the surgical intensive care unit (SICU) at a Level I trauma center from February 2011 until July 2013. Patients were divided based on their body mass index (BMI): overweight/obese group with BMI 25 kg/m(2) or greater and nonoverweight/obese group with BMI less than 25 kg/m(2). Primary outcome was CK greater than 10,000 U/L. During the 30-month study period, 198 trauma patients with available CK levels were admitted to the SICU. The majority (27.8%) of patients were involved in a motor vehicle collision. There were 96 patients (48.4%) with BMI 25 kg/m(2) or greater and 102 (51.5%) with BMI less than 25 kg/m(2). There was no difference in creatinine levels between the two groups (1.5 ± 1.2 mg/dL vs 1.5 ± 1.4 mg/dL, P = 0.83). BMI 25 kg/m(2) or greater was independently associated with the development of CK greater than 10,000 U/L (14.6 vs 4.9%; adjusted odds ratio, 3.03; P = 0.04). Patients with BMI 25 kg/m(2) or greater are at a significantly higher risk for rhabdomyolysis after trauma. Aggressive CK level monitoring to prevent rhabdomyolysis in this population is strongly encouraged. PMID:25264650
Chan, Joshua L; Imai, Taryne; Barmparas, Galinos; Lee, Jonathan B; Lamb, Alex W; Melo, Nicolas; Margulies, Daniel; Ley, Eric J
Abdominal actinomycosis in childhood period is very rare and a relation to trauma is not well established. Herein we report a case that appeared subsequent to abdominal trauma. A 17 years old boy presented with left lower quadrant abdominal mass and signs of acute abdomen. The symptoms of abdominal discomfort began after a fall from height 3 months before admission. There were signs of acute abdomen at physical examination. Ultrasound of abdomen demonstrated a mass; CT scan findings pointed to a suspicious “internal hernia”. An emergency laparotomy was performed. During surgery, a mass located over sigmoid colon and infiltrating the lateral abdominal wall was found. It was removed en bloc with the adjacent omentum. Except for the thickened sigmoid colon, no other pathologies were present at laparotomy. The pathology specimen revealed the actinomyces infection. The patient was treated with oral penicillin after discharge and the follow-up was uneventful. We advocate, keeping the actinomyces infection in mind in cases presenting with abdominal mass of unknown origin in childhood period. PMID:22953271
Ozcan, Rahsan; Mammadov, Emil; Aydin, Emrah; Adaletli, Ibrahim; Esen, Tugce; Dervisoglu, Sergulen
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
Wilson, Kenneth L.; Rosser, James C.
Two cases of congenital hydronephrosis discovered by renal trauma are reported. The first case was a 15-year-old girl. When she was practicing KENDO, her Hakama clung to her legs, and she tumbled. She had emergency operation for abdominal injury. At surgery, no evidence of abdominal injury was detected. Renal trauma was suspected. Right renal angiography revealed hydronephrosis. The second case was a 23-year-old girl, complaining of abdominal pain after stumbling over a block. Intravenous pyelography showed no visualization of the right kidney and CT scan showed an abnormal shadow. Retrograde pyelography and angiography revealed right hydronephrosis. Including our two cases, 47 cases of renal traumata occurring in hydronephrotic kidney in the Japanese literature were reviewed. Thirty five of these cases were males. Many were youths under the age of twenty. Various sports caused many of the renal traumata. 37 of these cases were treated by nephrectomy. PMID:3993488
Mochizuki, A; Ohishi, Y; Arai, Y; Ohnishi, T; Goto, H; Machida, T
Penetrating and blunt force mechanisms frequently result in thoracic trauma. Thoracic injuries cover the spectrum from trivial to lethal, and more than half are associated with head, abdomen or extremity trauma. Fortunately over eighty percent of injuries can be managed non-operatively utilizing tube thoracostomy, appropriate analgesia and aggressive respiratory therapy. Patients requiring emergency thoracotomy are either in shock or have life threatening injuries and, as expected, have significant mortality and morbidity. Injury to the thorax directly accounts for approximately 25% of trauma related mortality and is a contributing factor in another 25%. Early mortality results from haemorrhage, catastrophic injury or associated head or abdominal trauma. Not unexpectedly, late deaths are related to sepsis and organ failure. Blunt injury to the thorax most commonly results from motor vehicle collisions, with motorcycle accidents, pedestrians struck and falls next in frequency. Stab wound and gunshot wounds comprise the vast majority of penetrating injuries. In general the mortality from penetrating injury is higher and related to vascular injury and shock. Mortality from blunt trauma often results from abdominal and, especially, head injury. Rapid assessment and interventions, such as tube thoracostomy and airway control, can be life saving. The patient's haemodynamic status drives early treatment, often necessitating emergency surgery. Detailed imaging studies are reserved for haemodynamically stable patients. The evaluation and treatment of specific thoracic injuries will be discussed, as well as some general principles in treating thoracic trauma. PMID:20433098
O'Connor, J V; Adamski, J
Liver trauma is the most common abdominal emergency with high morbidity and mortality. Now, non-operative management (NOM) is a selective method for liver trauma. The aim of this study was to determine the success rate, mortality and morbidity of NOM for isolated liver trauma. Medical records of 81 patients with isolated liver trauma in our unit were analyzed retrospectively. The success rate, mortality and morbidity of NOM were evaluated. In this series, 9 patients with grade IV-V liver injuries underwent emergent operation due to hemodynamic instability; 72 patients, 6 with grade V, 18 grade IV, 29 grade III, 15 grade II and 4 grade I, with hemodynamic stability received NOM. The overall success rate of NOM was 97.2% (70/72). The success rates of NOM in the patients with grade I-III, IV and V liver trauma were 100%, 94.4% and 83.3%. The complication rates were 10.0% and 45.5% in the patients who underwent NOM and surgical treatment, respectively. No patient with grade I-II liver trauma had complications. All patients who underwent NOM survived. NOM is the first option for the treatment of liver trauma if the patient is hemodynamically stable. The grade of liver injury and the volume of hemoperitoneum are not suitable criteria for selecting NOM. Hepatic angioembolization associated with the correction of hypothermia, coagulopathy and acidosis is important in the conservative treatment for liver trauma. PMID:25308366
Li, Min; Yu, Wen-Kui; Wang, Xin-Bo; Ji, Wu; Li, Jie-Shou; Li, Ning
and to the pouch of Douglas in the female patient because these areas are the most dependent areas of the pelvis and transverse pelvis views to look for free fluid adjacent to the bladder . Although the bladder is not a peritoneal organ, a full bladder greatly enhances the detection of free fluid for the pelvis view (Fig. 5
Case history of a 20-year-old woman subjected to criminal abortion at 14 weeks of gestation is presented. The patient was admitted in a state of shock with manifestations of diffuse peritonitis. Preoperative diagnosis was of criminal septic abortion, uterine perforation, injury of the intestine, and diffuse peritonitis. Laparotomy indicated enlarged uterus, a 10x4 cm perforation of the posterior surface of the uterus opening into the Douglas space, absence of the rectosigmoid segment of the large intestine, absence of the cupula of the cecum, and absence of a 20-cm segment of the ileum. The patient underwent extirpation of the uterus, suturing of the vaginal stump, suturing of the rectum, sigmoidostomy, right hemicolectomy, and formation of the side-to-side ileotransversoanastomosis. Postoperatively, the patient received blood transfusions, and infusions of glucose and electrolyte solutions. Postoperative period was complicated by suppurative paraproctitis treated with antibiotics. The patient was discharged on day 37 postoperatively in a satisfactory condition. PMID:2595938
Zavodskov, V K; Grilikhes, T P; Vikin, S M
The internal organs are designed to move freely and slide over one another during normal body movement. The abdominal organs, however, have a tendency to adhere to the abdominal cavity (peritoneum) and other abdominal ...
Strauss, Julius (Julius Y.)
Endometriosis is a condition in which uterine mucosal tissue is located outside the uterus. Endometriosis may be pelvic or extrapelvic. The term endometrioma is used when endometriosis appears as a circumscribed mass. Abdominal wall endometriomas are usually a secondary process in scars after surgical procedures. A retrospective study of abdominal wall endometrioma, from March 1992 through April 1999 at our
Amit J. Dwivedi; Sunita N. Agrawal; Yvan J. Silva
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
Dvir, Yael; Denietolis, Brian; Frazier, Jean A
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
Richter, Torsten; Ragaller, Maximilian
Abdominal wall hernias are common diseases of the abdomen with a global incidence approximately 4%-5%. They are distinguished in external, diaphragmatic and internal hernias on the basis of their localisation. Groin hernias are the most common with a prevalence of 75%, followed by femoral (15%) and umbilical (8%). There is a higher prevalence in males (M:F, 8:1). Diagnosis is usually made on physical examination. However, clinical diagnosis may be difficult, especially in patients with obesity, pain or abdominal wall scarring. In these cases, abdominal imaging may be the first clue to the correct diagnosis and to confirm suspected complications. Different imaging modalities are used: conventional radiographs or barium studies, ultrasonography and Computed Tomography. Imaging modalities can aid in the differential diagnosis of palpable abdominal wall masses and can help to define hernial contents such as fatty tissue, bowel, other organs or fluid. This work focuses on the main radiological findings of abdominal herniations. PMID:21860678
Lassandro, Francesco; Iasiello, Francesca; Pizza, Nunzia Luisa; Valente, Tullio; Stefano, Maria Luisa Mangoni di Santo; Grassi, Roberto; Muto, Roberto
Abstract\\u000a \\u000a \\u000a Background. Laparostomy is frequently performed in the surgical therapy of mechanical obstruction, peritonitis, or trauma to prevent\\u000a abdominal compartment syndrome (ACS). Extended incisional hernia is inevitable when fascial closure is missed (up to 90% of\\u000a cases). Intra-abdominal pressure (IAP) has not yet been evaluated as a criterion for the feasibility of fascial closure.\\u000a \\u000a \\u000a \\u000a \\u000a Patients and methods. Over 12 months laparostomy
A. Schachtrupp; J. Höer; C. Töns; U. Klinge; U. Reckord; V. Schumpelick
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
Szmigielski, Wojciech; Kumar, Rajendra; Al Hilli, Shatha; Ismail, Mostafa
The Trauma Information Pages, provided by psychologist David Baldwin, provide information about traumatic stress for clinicians and researchers in the field. The pages include information on trauma symptoms, connections to trauma resources including full text articles and an EMDR (eye movement desensitization and reprocessing) bibliography, general support information including grief, stress, and mental health pointers, disaster handouts and links, and links to other trauma and trauma related sites. The Trauma Pages are searchable.
Baldwin, David V.
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.
Lozano, Luis Manuel Barrera; Perel, Pablo; Ker, Katharine; Cirocchi, Roberto; Farinella, Eriberto; Morales, Carlos Hernando
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
Kissoon, N; Dreyer, J; Walia, M
... most helpful information that a doctor uses to determine the cause of abdominal pain. The characteristics of the pain (sharp, dull, cramping, burning, twisting, tearing, penetrating), its location and relation to eating or to having a bowel movement are important ...
Over the last two decades, experimental and clinical data have begun to shape a more discriminating approach to intravascular (IV) fluid infusions in the resuscitation of trauma patients with presumed internal hemorrhage. This approach takes into account the presence of potentially uncontrollable hemorrhage (e.g., deep intra-abdominal or intra-thoracic injury) versus a controllable source (e.g. distal extremity wound). This limitation on fluid resuscitation is particularly applicable in the case of patients with penetrating truncal injury being transported rapidly to a nearby definitive care center. Meanwhile, longstanding debates over the type of fluid that should be infused remain largely unresolved and further complicated by recent clinical trials that did not demonstrate support for either hemoglobin-based oxygen carriers or hypertonic saline. However, there is also growing evidence that does support the increased use of fresh frozen plasma as well as tourniquets, and intra-osseous devices. While a more discriminating approach to fluid infusions have evolved, it has also become clear that positive pressure ventilatory support should be limited in the face of potential severe hemorrhage due to the accompanying reductions in venous return. Controversies over prehospital endotracheal tube placement are confounded by this factor as well as the effects of paramedic deployment strategies and related skills usage. Beyond these traditional areas of focus, a number of very compelling clinical observations and an extensive body of experimental data has generated a very persuasive argument that intravenous estrogen and progesterone may be of value in trauma management, particularly severe traumatic brain injury and burns. PMID:21952600
Wigginton, J G; Roppolo, L; Pepe, P E
Pains after labor can be as severe as those experienced during labor, particularly the commonly occurring lower abdominal\\u000a “after-pains” that are associated with prolonged uterine contractions during breast feeding. Other causes of lower abdominal\\u000a pain may not be physiologically based but are either direct complications of parturition, such as genital infection, or fortuitous,\\u000a such as appendicitis. Although the focus of
Pancreatic trauma is an uncommon injury, occurring in only about 0.2% of blunt abdominal injuries, while duodenal injuries represent approximately 4% of all blunt abdominal injuries. When trauma of the pancreas and duodenum do not permit reparation, pancreatoduodenectomy (PD) is mandatory. In the reconstructive phase, the use of ductal ligation as an alternative to standard pancreaticojejunostomy has been reported by some authors. We report a case of polytrauma with pancreatic and duodenal injury in which the initial diagnosis failed to recognize the catastrophic duodenal and pancreatic situation. The patient was submitted for PD and the pancreatic stump was abandoned in the abdominal cavity after main pancreatic ductal ligation. This technique can minimize the morbidity and mortality of PD in patients with other organs or apparatus involved severely and extensively in trauma. PMID:24847897
Toro, A; Li Destri, G; Mannino, M; Arcerito, M C; Ardiri, A; Politi, A; Bertino, G; Di Carlo, I
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
Hossain, M M; Mohiuddin, A A; Akhanda, A H; Hossain, M I; Islam, M F; Akonjee, A R; Ali, M
Objective: We set out to compare the malpractice lawsuit risk and incidence in trauma surgery, emergency surgery, and elective surgery at a single academic medical center. Summary and Background Data: The perceived increased malpractice risk attributed to trauma patients discourages participation in trauma call panels and may influence career choice of surgeons. When questioned, surgeons cite malpractice risk as a rationale for not providing trauma care. Little data substantiate or refute the perceived high trauma malpractice risk. We hypothesized that the malpractice risk was equivalent between an elective surgical practice and a trauma/emergency practice. Methods: Three prospectively maintained institutional databases were used to calculate and characterize malpractice incidence and risk: a surgical operation database, a trauma registry, and a risk management/malpractice database. Risk groups were divided into elective general surgery (ELECTIVE), urgent/emergent, nontrauma general surgery (URGENT), and trauma surgery (TRAUMA). Malpractice claims incidence was calculated by dividing the total number of filed lawsuits by the total number of operative procedures over a 12-year period. Results: Over the study period, 62,350 operations were performed. A total of 21 lawsuits were served. Seven were dismissed. Three were granted summary judgments to the defendants. Ten were settled with payments to the plaintiffs. One went to trial and resulted in a jury verdict in favor of the defendants. Total paid liability was $4.7 million ($391,667/year). Total legal defense costs were $1.3 million ($108,333/year). The ratio of lawsuits filed/operations performed and incidence in the 3 groups is as follows: ELECTIVE 14/39,080 (3.0 lawsuits/100,000 procedures/year), URGENT 5/17,958, (2.3 lawsuits/100,000 procedures/year), and TRAUMA 2/5312 (3.1/100,000 procedures/year). During the study period, there were an estimated 49,435 trauma patients evaluated. The incidence of malpractice lawsuits using this denominator is 0.34 lawsuits/100,000 patients/year. Conclusions: These data demonstrate no increased risk of lawsuit when caring for trauma patients, and the actual risk of a malpractice lawsuit was low. PMID:15912046
Stewart, Ronald M.; Johnston, Joe; Geoghegan, Kathy; Anthony, Tiffany; Myers, John G.; Dent, Daniel L.; Corneille, Michael G.; Danielson, Daren S.; Root, H David; Pruitt, Basil A.; Cohn, Stephen M.
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
Lin, Ken Y.; Ngai, Philip; Echegoyen, Julio C.; Tao, Jeremiah P.
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.
ERCOLAK, VEHBI; PAYDAS, SEMRA; ERGIN, MELEK; ATES, BERNA T.; DUMAN, BERNA B.; GUNALDI, MERAL; AFSAR, CIGDEM U.
Resuscitation of the pediatric trauma patient involves immediate assessment of ABCs. Interventions are made immediately upon recognition of abnormalities during the primary survey. After initial assessment and management of life-threatening processes, consider the optimal destination for further care and resuscitation. Keep in mind pediatric considerations like anatomical differences and the need for pediatric-sized equipment. Avoid the common errors that occur when resuscitating a pediatric trauma patient. PMID:11066378
Roback, M G
A 28-year-old woman was referred to our hospital because of abdominal pain, weight loss and a palpable intra-abdominal mass. A CT scan revealed a tumor with a diameter of 7 cm with sharp margins, intra-tumoral fatty components and enhancing soft tissue. After initial workup, which suggested an inflammatory myofibroblastic tumor (IMT), she underwent laparotomy with complete resection. Pathological examination indeed revealed IMT. IMT is a rare benign neoplasm and has been described in nearly the entire body. It presents with nonspecific symptoms. The therapy of abdominal IMT consists of radical surgery because of high local recurrence rates. In this case report clinical, surgical, radiological and histological features with a review of the relevant literature are described. PMID:24707245
Groenveld, Roosmarijn L.; Raber, Menno H.; Oosterhof-Berktas, Richard; Eijken, Erik; Klaase, Joost M.
In Western Europe the most frequent cause of multiple injuries is blunt trauma. Only few of us have experience with penetrating trauma, without exception far less than in the USA or South-Africa. In Rotterdam, the Erasmus Medical Centre is a level I trauma centre, situated directly in the town centre. All penetrating traumas are directly presented to our emergency department by a well organized ambulance service supported by a mobile medical team if necessary. The delay with scoop and run principles is very short for these cases, resulting in severely injured reaching the hospital alive in increasing frequency. Although the basic principles of trauma care according to the guidelines of the Advanced Trauma Life Support (ATLS) (1-2) are the same for blunt and penetrating trauma with regard to priorities, diagnostics and primary therapy, there are some pitfalls in the strategy of management in penetrating trauma one should be aware of. Simple algorithms can be helpful, especially in case of limited experience (3). In case of life-saving procedures, the principles of Damage Control Surgery (DCS) must be followed (4-5). This approach is somewhat different from "traditional" surgical treatment. In the Ist phase prompt interventions by emergency thoracotomy and laparotomy are carried out, with only two goals to achieve: surgical control of haemorrhage and contamination. After temporary life-saving procedures, the 2nd phase is characterized by intensive care treatment, dealing with hypothermia, metabolic acidosis and clotting disturbances. Finally in the 3rd phase, within 6-24 hours, definitive surgical care takes place. In this overview, penetrating injuries of neck, thorax, abdomen and extremities will be outlined. Penetrating cranial injuries, as a neurosurgical emergency with poor prognosis, are not discussed. History and physical examination remain the corner stones of good medical praxis. In a work-up according to ATLS principles airway, breathing and circulation should be evaluated with great care. Neurovascular examination related to trauma of the spinal cord, peripheral nerves as well as vascular involvement should be carried out also in extremity injuries. Physical examination should be completed by localization of all stabwounds, in- and outshot openings as well as recto-vaginal examination and inspection of the oropharynx. PMID:14524152
van Vugt, A B
The aim of this study was to prospectively assess the impact of laparoscopy upon the outcome of total abdominal colectomy (TAC). Specifically, patients underwent standard laparotomy with TAC and ileoproctostomy (TAC + IP), TAC and ileoanal reservoir (TAC + IAR), laparoscopically assisted TAC + IP (L-TAC + IP), or laparoscopically assisted TAC + IAR (L-TAC + IAR). Parameters studied included
Steven D. Wexner; Olaf B. Johansen; Juan J. Nogueras; David G. Jagelman
Background A trauma registry is an integral component of modern comprehensive trauma care systems. Trauma registries have not been established in most developing countries, and where they exist are often rudimentary and incomplete. This review describes the role of trauma registries in the care of the injured, and discusses how lessons from developed countries can be applied toward their design and implementation in developing countries. Methods A detailed review of English-language articles on trauma registry was performed using MEDLINE and CINAHL. In addition, relevant articles from non-indexed journals were identified with Google Scholar. Results The history and development of trauma registries and their role in modern trauma care are discussed. Drawing from past and current experience, guidelines for the design and implementation of trauma registries are given, with emphasis on technical and logistic factors peculiar to developing countries. Conclusion Improvement in trauma care depends on the establishment of functioning trauma care systems, of which a trauma registry is a crucial component. Hospitals and governments in developing countries should be encouraged to establish trauma registries using proven cost-effective strategies. PMID:17076896
Nwomeh, Benedict C; Lowell, Wendi; Kable, Renae; Haley, Kathy; Ameh, Emmanuel A
Introduction Abdominal vascular trauma is fairly common in modern civilian life and is a highly lethal injury. However, if the projectile is small enough, if its energy is diminished when passing through the tissue and if the arterial system is elastic enough, the entry wound into the artery may close without exsanguination and therefore may not be fatal. A projectile captured may even travel downstream until it is arrested by the smaller distal vasculature. The occurrence of this phenomenon is rare and was first described by Trimble in 1968. Case presentation Here we present a case of a 29-year-old Albanian man who, due to a gunshot injury to the back, suffered fracture of his twelfth thoracic and first lumbar vertebra, injury to the posterior wall of his abdominal aorta and then bullet embolism to his left external iliac artery. It is interesting that the signs of distal ischemia developed several hours after the exploratory surgery, raising the possibility that the bullet migrated in the interim or that there was a failure to recognize it during the exploratory surgery. Conclusion In all cases where there is a gunshot injury to the abdomen or chest without an exit wound and with no projectile in the area, there should be a high index of suspicion for possible bullet embolism, particularly in the presence of the distal ischemia. PMID:21819587
?The authors have no financial conflicts of interest. Purpose: This research compares the predictive value of the abdominal obesity indicator, waist circumference (WC), and the overall obesity indicator, body mass index (BMI), among men and women with regard to type 2 diabetes. Materials and Methods: This study used data collected from 4,400 households selected by a stratified multistage probability sampling method during the 2001 Korea National Health and Nutrition Examination Survey (KNHANES). The final study sample included 4,684 subjects over 30 years of age who had completed the health examination required for the analysis of the health interview and health behavior surveys. Results: Both men and women showed significant differences in fasting blood glucose (FBG) or HbA1c levels based on abdominal obesity irrespective of BMI. However, the presence of overall obesity among men with abdominal obesity was not significantly correlated with FBG or HbA1c levels, while the presence of overall obesity among women with abdominal obesity was significantly different in
Kyung-won Paek; Ki-hong Chun
Background Trauma is one of the leading causes of death in young adult patients. Many pre-clinical and clinical studies attempt to investigate the immunological pathways involved, however the true mediators remain to be elucidated. Herein, we attempt to describe the immunologic response to systemic trauma in the context of the Danger model. Data Sources A literature search using PubMed was used to identify pertinent articles describing the Danger model in relation to trauma. Conclusions Our knowledge of Danger signals in relation to traumatic injury is still limited. Danger/alarmin signals are the most proximal molecules in the immune response that have many possibilities for effector function in the innate and acquired immune systems. Having a full understanding of these molecules and their pathways would give us the ability to intervene at such an early stage and may prove to be more effective in blunting the post-injury inflammatory response unlike previously failed cytokine experiments. PMID:21676213
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…
Cohen, Judith A.; Mannarino, Anthony P.; Murray, Laura K.
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
Mary R. Harvey
Presented is a 50-year-old female who sustained a rare blunt traumatic chylothorax. Traumatic chylothoracies are usually the result of penetrating trauma and disruption of the thoracic duct. Diagnosis and treatment are discussed. The diagnosis is sometimes difficult in the trauma setting due to the possible presence of an underlying hemothorax or empyema and the usual delayed onset of chylothorax. Increased vigilance will allow physicians to properly diagnose and treat this condition early to avoid having to ligate the thoracic duct. PMID:22754675
Arellano, Jason J.; Takabe, Kazuaki; Barrett, Leonard; Faust, Glenn; Angus, L.D. George
The purpose of this article is to depict the spectrum of scrotal injuries in blunt trauma. Scrotal injuries are not very common and are mostly due to blunt trauma from direct injury, sports injuries or motor vehicle accidents. To minimize complications and ensure testicular salvage, rapid and accurate diagnosis is necessary. High-resolution USG is the investigation of choice, as it is readily available, accurate and has been seen to improve outcomes. An understanding of and familiarity with the sonographic appearance of scrotal injuries on the part of the radiologist/sonographer is therefore of key importance. PMID:23833421
Rao, Meka Srinivasa; Arjun, Kalyanpur
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
Williamson, Kelvin; Ramesh, Ramaiah; Grabinsky, Andreas
We examined relations of posttraumatic stress disorder (PTSD) symptoms with dimensions of trauma, including environment (Domestic vs. Community) and proximity (Indirect vs. Direct trauma) among inner-city youth. Participants (n = 65) reported traumatic events they had experienced on a version of the UCLA PTSD Reaction Index Trauma Exposure Screen, and reported PTSD symptoms with the PTSD Checklist--Civilian version (PCL-C). High rates of trauma and PTSD were found, consistent with other reports of inner-city youth. The 49% of youth surveyed met criteria for PTSD on the PCL-C symptom scale with a score cutoff of 35. Females reported elevated PTSD symptom scores and a higher incidence of Domestic trauma than did males but similar incidence of other trauma types. When males and females were combined, Domestic trauma significantly correlated with each of the PTSD symptom clusters of intrusions, numbing/avoidance, and hyperarousal. When participants with Community trauma were excluded from analyses to reduce confounding environmental influence, Domestic trauma marginally correlated with numbing/avoidance symptoms. Our findings suggest that Domestic trauma may result in more emotional numbing/avoidance symptoms than other types of trauma. Further analyses suggested that Community trauma may result in more intrusions and hyperarousal symptoms rather than emotional numbing. Environmental aspects of trauma, rather than the proximity of trauma, may have greater impact on presentation of PTSD. Future studies with larger samples are needed to confirm these findings. PMID:24834747
Post, Marina; Hanten, Gerri; Li, Xiaoqi; Schmidt, Adam T; Avci, Gunes; Wilde, Elisabeth A; McCauley, Stephen R
INTRODUCTION Heterotopic ossification (HO) refers to the formation of bone in non-ossifying tissue. Heterotopic mesenteric ossification is a rare form of HO that is characterized by the formation of an ossifying pseudotumour at the base of the mesentery, usually following abdominal surgery. PRESENTATION OF CASE We describe a case of mesenteric HO in a young male who presented for elective ventral incisional hernia repair following a stab wound to the abdomen requiring exploratory laparotomy 21 months earlier. Preoperative workup was unremarkable, but a hard, bone-like lesion was noted to encircle the base of the mesentery upon entering the abdomen, consistent with HO. The lesion was excised with close margins, and his hernia was repaired without incident. DISCUSSION Traumatic HO describes the ossification of extra-skeletal tissue that specifically follows a traumatic event. It usually occurs adjacent to skeletal tissue, but has been occasionally described in the abdomen as well, usually in patients who suffer abdominal trauma. Overall the prognosis of HO is good, as it is considered a benign lesion with no malignant potential. However, the major morbidity associated with mesenteric HO is bowel obstruction. CONCLUSION The size, location, and symptoms related to our patient's mesenteric HO put him risk for obstruction in the future. As a result, the mass was surgically excised during his ventral hernia repair with good outcomes. PMID:24981165
Hicks, Caitlin W.; Velopulos, Catherine G.; Sacks, Justin M.
Trauma to abdominal wall blood vessels occurs following 0.2-2% of laparoscopic operations. This prospective observational study assessed the possible role of sonographic localization of abdominal blood vessels prior to laparoscopic surgery in Chinese women and compared the findings reported in a Western group. The inferior epigastric and superficial circumflex iliac vessels were located by color Doppler imaging. Ultrasonography was 100% and 80% successful in locating the inferior epigastric and the superficial circumflex iliac vessels, respectively. The positions of the inferior epigastric vessels were similar to those reported in the Western population whilst the superficial circumflex iliac vessels were found to be situated 1 cm more medially. In our study population, a safe area for entry of lateral ports appeared to be 7 cm from the midline and 5 cm above the pubic symphysis. Sonographic localization of abdominal blood vessels is a potentially useful clinical tool in the prevention of blood vessel trauma. PMID:9511198
Pun, T C; Chau, M T; Lam, C; Tang, G; Leong, L
Bearing witness to trauma stories can evoke in clinicians the confusion and emotional turmoil their clients experience, known as secondary trauma. Given the complexities of trauma work, practitioners need help to clarify issues and feel more effective. The terror attacks of September 11, 2001 further compound the task, as therapists may themselves be feeling the impact of those events. Presented
Janet A. Geller; Libbe H. Madsen; Lynn Ohrenstein
\\u000a Functional abdominal pain (FAP) is a frequent complaint seen in the pediatric primary care setting. Current diagnostic criteria\\u000a for functional gastrointestinal disorders (FGIDs) are defi ned in the Rome III criteria, which outline a positive symptom\\u000a profi le for diagnosis. In addition, clinicians should be aware of specifi c “red fl ag ” rule-out symptoms that may suggest\\u000a organic disease
Lisa Scharff; Laura E. Simons
of political and social violence in post-Mongol Iranian history, we provide evidence to support the Trauma years, Iran and, indeed, other Islamic societies in the Middle East and central Asia, suffered the kind cause of the demise of the Golden Iranian- Islamic civilization. Although Iran was successful
raumatic brain injury (TBI) is a leading cause of mortality and morbidity in the world's population, especially those under age 44. 1 In the United States alone, the cost of head trauma has been estimated to be over 40 billion dollars an- nually. 2 The National Center for Injury Prevention and Con- trol has estimated that approximately 2% of the
Tuong H. Le; Alisa D. Gean
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…
Steele, William; Kuban, Caelan
Head injury in children accounts for a large number of emergency department visits and hospital admissions. Falls are the most common type of injury, followed by motor-vehicle-related accidents. In the present study, we discuss the evaluation, neuroimaging and management of children with head trauma. Furthermore, we present the specific characteristics of each type of pediatric head injury. PMID:21887034
Alexiou, George A; Sfakianos, George; Prodromou, Neofytos
Because it may cause paralysis, injury to the spine is one of the most feared traumas, and spinal cord injury is a major cause of disability. In the USA approximately 10,000 traumatic cervical spine fractures and 4000 traumatic thoracolumbar fractures are diagnosed each year. Although the number of individuals sustaining paralysis is far less than those with moderate or severe
Johan W. M. Van Goethem; Menno Maes; Özkan Özsarlak; Luc van den Hauwe; Paul M. Parizel
The association of sexual abuse and witnessing traumatic incidents with mental health, behavioral problems, and suicidality was examined in 74 teenage boys incarcerated in Oregon. Sexual abuse had strong effects on suicidality and internalizing problems. Witnessing traumatic events had more modest effects. Those with both traumas showed markedly higher rates of suicidality. The effects of sexual abuse remained when controlling
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
Abdominal catastrophe is a serious clinical condition, usually being a complication arising during treatment of intraabdominal nontraumatic disorders or abdominal injuries. Most commonly, inflamation- secondary peritonitis, is concerned. Abdominal catastrophe also includes secondary signs of sepsis, abdominal compartment syndrome and enterocutaneous fistules. Most septic abdominal disorders which show signs of abdominal catastrophy, require surgical intervention and reinterventions--planned or "on demand" laparotomies. During the postoperative period, the patient requires intensive care management, including steps taken to stabilize his/hers condition, management of sepsis and metabolic and nutritional support measures, as well as adequate indication for reoperations. New technologies aimed at prevention of complications in laparostomies and to improve conditions for final laparotomy closure are used in phase procedures for surgical management of intraabdominal infections. Despite the new technologies, abdominal catastrophe has higher morbidity and lethality risk rates. PMID:20731313
Abdominal elephantiasis is a rare entity. Abdominal elephantiasis is an uncommon, but deformative and progressive cutaneous disease caused by chronic lymphedema and recurrent streptococcal or Staphylococcus infections of the abdominal wall. We present 3 cases of patients with morbid obesity who presented to our hospital with abdominal wall swelling, thickening, erythema, and pain. The abdominal wall and legs were edematous, with cobblestone-like, thickened, hyperpigmented, and fissured plaques on the abdomen. Two patients had localised areas of skin erythema, tenderness, and increased warmth. There was purulent drainage from the abdominal wall in one patient. They were managed with antibiotics with some initial improvement. Meticulous skin care and local keratolytic treatment for the lesions were initiated with limited success due to their late presentation. All three patients refused surgical therapy. Conclusion. Early diagnosis is important for the treatment of abdominal elephantiasis and prevention of complications. PMID:23606857
Kohli, Ritesh; Argento, Vivian; Amoateng-Adjepong, Yaw
The immediate death rate for aortic rupture caused by pointed and sharp-edged instruments is very high; however, delayed aortic rupture following the trauma is rarely reported. A patient who had an upper abdominal stab wound was sent to our hospital, and an emergency exploratory laparotomy was performed. No traumatic aortic rupture was found at that time. However, on the fifth day after surgery, aortic rupture occurred, and a large retroperitoneal hematoma was formed. The patient eventually died. Aortic rupture was confirmed by a second emergency exploratory laparotomy and the autopsy. The information from exploratory laparotomies, post-operative observations and treatments, medical imaging reports, and reasons for delayed aortic rupture, as well as the underlying pathophysiological processes, are discussed in this case report.
Yang, Xuefei; Xia, Ligang
Although obesity has been reported to be a potential risk factor for abdominal aortic dilatation, the impact of obstructive sleep apnea (OSA) on the abdominal aortic diameter remains unknown. We retrospectively reviewed 427 patients aged >45 years who underwent polysomnography and abdominal computed tomography from November 2008 to February 2012. Aortic diameters were measured at 3 locations: upper, infrarenal, and lower abdominal aorta. OSA was defined as non-OSA (apnea-hypopnea index [AHI] <10, n = 58), mild to moderate (AHI 10 to 30, n = 167), and severe (AHI ?30, n = 202). Adjusted diameter was not significantly different among OSA severity categories at the upper (21.0, 21.3, and 21.4 mm, respectively) and infrarenal aorta (19.5, 20.2, and 19.9 mm, respectively) but was significantly different at the lower abdominal aorta (17.3, 18.2, and 18.2 mm, respectively, p = 0.006) with larger diameters in patients with OSA. Multivariate linear regression analyses revealed that risk profiles for aortic dilatation varied according to the location and gender and that OSA (AHI ?10) was an independent risk factor for infrarenal and lower abdominal aortic dilatation only in men (? = 0.10 and 0.18, p = 0.049 and 0.001, respectively). In conclusion, OSA may enhance dilatation of the distal abdominal aorta in men. PMID:25086782
Tachikawa, Ryo; Hamada, Satoshi; Azuma, Masanori; Toyama, Yoshiro; Murase, Kimihiko; Tanizawa, Kiminobu; Inouchi, Morito; Handa, Tomohiro; Oga, Toru; Mishima, Michiaki; Chin, Kazuo
The purpose of this paper is to describe brain pathology in neonates after major traffic trauma in utero during the third trimester. Our patient cohort consisted of four neonates born by emergency cesarean section after car accident in the third trimester of pregnancy. The median gestational age ( n=4) was 36 weeks (range: 30-38). Immediate post-natal and follow-up brain imaging consisted of cranial ultrasound ( n=4), computed tomography (CT) ( n=1) and post-mortem magnetic resonance imaging (MRI) ( n=1). Pathology findings were correlated with the imaging findings ( n=3). Cranial ultrasound demonstrated a huge subarachnoidal hemorrhage ( n=1), subdural hematoma ( n=1), brain edema with inversion of the diastolic flow ( n=1) and severe ischemic changes ( n=1). In one case, CT demonstrated the presence and extension of the subarachnoidal hemorrhage, a parietal fracture and a limited intraventricular hemorrhage. Cerebellar hemorrhage and a small cerebral frontal contusion were seen on post-mortem MRI in a child with a major subarachnoidal hemorrhage on ultrasound. None of these four children survived (three children died within 2 days and one child died after 1 month). Blunt abdominal trauma during pregnancy can cause fetal cranial injury. In our cases, skull fracture, intracranial hemorrhage and hypoxic-ischemic encephalopathy were encountered. PMID:15156344
Breysem, Luc; Cossey, V; Mussen, E; Demaerel, P; Van de Voorde, W; Smet, M
BACKGROUND: Waist circumference is a simpler measure of abdominal adiposity than waist\\/hip ratio (WHR), but few studies have directly compared the two measures as predictors of coronary heart disease (CHD) in men. In addition, whether the association of abdominal adiposity is independent of total adiposity as measured by body mass index (BMI) in men remains uncertain.OBJECTIVE: To compare waist circumference
KM Rexrode; JE Buring; JE Manson
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.
Frick, M.P.; Feinberg, S.B.
Trauma has assumed epidemic proportion. 10% of global road accident deaths occur in India. Hypoxia and airway mismanagement are known to contribute up to 34% of pre-hospital deaths in these patients. A high degree of suspicion for actual or impending airway obstruction should be assumed in all trauma patients. Objective signs of airway compromise include agitation, obtundation, cyanosis, abnormal breath sound and deviated trachea. If time permits, one should carry out a brief airway assessment prior to undertaking definitive airway management in these patients. Simple techniques for establishing and maintaining airway patency include jaw thrust maneuver and/or use of oro- and nas-opharyngeal airways. All attempts must be made to perform definitive airway management whenever airway is compromised that is not amenable to simple strategies. The selection of airway device and route- oral or -nasal, for tracheal intubation should be based on nature of patient injury, experience and skill level. PMID:22174462
Khan, Rashid M; Sharma, Pradeep K; Kaul, Naresh
A 35-year-old man with a history of blunt abdominal trauma and splenic rupture was diagnosed with an ampullary adenocarcinoma. At workup, a CT scan showed multiple intra-abdominal lesions similar to peritoneal carcinosis, and the patient was referred for palliative chemotherapy. On clinical suspicion, however, a biopsy was performed on an intra-abdominal lesion, establishing the diagnosis of abdominal splenosis. A radical pancreaticoduodenectomy ad modum Whipple was performed, followed by adjuvant chemotherapy with gemcitabine. At the 18-month follow-up, the patient was free from recurrent disease. We conclude that splenosis should be considered as a differential diagnosis of peritoneal metastases in cancer patients with a history of abdominal trauma and/or splenectomy. Other reports on splenosis in cancer patients and diagnostic workup are discussed. PMID:24163662
Sorensen, Steffen Filskov; Mortensen, Frank Viborg; Hellberg, Ylva; Ladekarl, Morten
Three experiments indexed the effect of various concurrent tasks, while watching a traumatic film, on intrusive memory development. Hypotheses were based on the dual-representation theory of posttraumatic stress disorder (C. R. Brewin, T. Dalgleish, & S. Joseph, 1996). Nonclinical participants viewed a trauma film under various encoding conditions and recorded any spontaneous intrusive memories of the film over the following
Emily A. Holmes; Chris R. Brewin; Richard G. Hennessy
Three experiments indexed the effect of various concurrent tasks, while watching a traumatic film, on intrusive memory development. Hypotheses were based on the dual-representation theory of posttraumatic stress disorder (C. R. Brewin, T. Dalgleish, & S. Joseph, 1996). Nonclinical participants viewed a trauma film under various encoding conditions…
Holmes, Emily A.; Brewin, Chris R.; Hennessy, Richard G.
1. The frequency of eye injuries in children is high. The frequency and severity of at least 90% of these injuries, however, could be prevented. 2. Toys, especially bicycles and BB guns, are a major source of eye injury. Another major cause of ocular trauma is sports-related injuries. 3. Ophthalmic professionals should emphasize the role of spectacles as a protective device for children and advise parents of the advantages of polycarbonate spectacles. PMID:7966381
Kutschke, P J
Pediatric abusive head trauma is a significant contributor to pediatric morbidity and mortality in the United States. Signs and symptoms can be vague, nonspecific, and difficult to recognize. This article increases the healthcare provider's level of suspicion and ability to recognize early warning signs of abuse. It also addresses evidence-based prevention strategies. This information is useful to nurses, advanced practice nurses, and physicians who work with children and families in any capacity. PMID:23659807
Gordy, Carrie; Kuns, Brenda
. We sought evidence of hypercoagulability in 59 seriously injured trauma patients. An extended coagulation profile\\u000a (consisting of tissue plasminogen activator antigen concentration, plasminogen activator inhibitor, serum antithrombin III,\\u000a protein C antigen, functional protein C, protein S antigen, D-dimer, and prothrombin fragment 1.2) was compared to control\\u000a values. Laboratory evidence of hypercoagulability was seen in 85% ( \\u000a n \\u000a = 50)
Daniel T. Engelman; Sheryl G. A. Gabram; Lisa Allen; Gordon E. Ens; Lenworth M. Jacobs
In 2009, 3 years after the foundation of the Trauma Network of the German Society for Trauma (TraumaNetzwerkD DGU), the majority of German hospitals participating in the treatment of seriously injured patients is registered in regional trauma networks (TNW). Currently there are 41 trauma networks with more than 660 hospitals in existence, 18 more are registered but are still in the planning phase. Each Federal State has an average of 39 trauma centres of different levels taking part in the treatment of seriously injured patients and every trauma network has an average catchment area of 8708 km(2). The most favourable geographical infrastructure conditions exist in Nordrhein-Westfalen, the least favourable in Sachsen-Anhalt and Mecklenburg-Vorpommern. A total of 95 hospitals have already fulfilled the first audit of the structural, personnel and qualitative requirements by the certification bodies. Examination of the check lists of 26 hospitals showed shortcomings in the clinical structure so that these hospitals must be rechecked after correction of the shortcomings. A total of 59 hospitals throughout Germany were successfully audited and only one failed to fulfil the requirements. Because of the varying sizes of the trauma networks there are differences in the areas covered by each trauma network and trauma centre. Concerning the process of certification and auditing (together with the company DIOcert) it could be seen that by careful examination of the check lists of each hospital unforeseen problems during the audit could be avoided. The following article will present the current state of development of the Trauma Network of the German Society for Trauma and describe the certification and auditing process. PMID:19756455
Kühne, C A; Mand, C; Sturm, J; Lackner, C K; Künzel, A; Siebert, H; Ruchholtz, S
Chronic abdominal pain is a common pediatric condition affecting 20% of the pediatric population worldwide. Most children with this disorder are found to have no specific organic etiology and are given the diagnosis of functional abdominal pain. Well-designed clinical trials have found hypnotherapy and guided imagery to be the most efficacious treatments for this condition. Hypnotic techniques used for other somatic symptoms are easily adaptable for use with functional abdominal pain. The author discusses 2 contrasting hypnotic approaches to functional abdominal pain and provides implications for further research. These approaches may provide new insights into this common and complex disorder. PMID:21922712
index (PI) and abdominal circumference (AC) in babies with severe early onset fetal growth restriction restriction (FGR) Study Design: rospective multi-center study of FGR monitored with umbilical (UA), middle
MR Elastography (MRE) is an MRI-based technique for quantitatively assessing the mechanical properties of tissues, based on the propagation of shear waves. Multiple studies have described many potential applications of MRE, from characterizing tumors to detecting diffuse disease processes. Studies have shown that MRE can be successfully implemented to assess abdominal organs. The first clinical application MRE to be well documented is the detection and characterization of hepatic fibrosis, which systematically increases the stiffness of liver tissue. In this diagnostic role, offers a safer, and less expensive, and potentially more accurate alternative to invasive liver biopsy. Emerging results suggest that measurements of liver and spleen stiffness may provide an indirect way to assess portal hypertension. Preliminary studies have demonstrated that is possible to use MRE to evaluate the mechanical properties of other abdominal structures, such as the pancreas and kidneys. Steady technical progress in developing practical protocols for applying MRE in the abdomen and pelvis provides opportunities to explore many other potential applications of this emerging technology. PMID:20010062
Yin, Meng; Chen, Jun; Glaser, Kevin J.; Talwalkar, Jayant A.; Ehman, Richard L.
Key Clinical Points Abdominal Aortic Aneurysms Abdominal aortic aneurysms are usually asymptomatic until they rupture, with an ensuing mortality of 85 to 90%. Symptomatic patients require urgent repair. U.S. Preventive Services Task Force recommendations support screening in men 65 to 75 years of age with a history of smoking and selective screening in men 65 to 75 years of age without a smoking history, although the optimal cohort to be screened remains controversial. The usual threshold for elective repair is an aortic diameter of 5.5 cm in men and 5.0 cm in women. Endovascular repair results in lower perioperative morbidity and mortality than open repair, but the two methods are associated with similar mortality in the long term (8 to 10 years). Patients treated with endovascular repair require long-term surveillance owing to a small risk of aneurysm sac reperfusion and late rupture. Decisions regarding prophylactic repair - whether to pursue it and, if so, what type of repair to perform - must take into account anatomy (not all patients have anatomy amenable to endovascular repair), operative risk, and patient preference. PMID:25427112
Kent, K Craig
Age-cohort variation in childhood trauma was examined in the present study. The data were taken from the 1994/95 Canadian National Population Health Survey of household residents (n = 15,106). Childhood trauma was measured by a seven-item index (items reflected physical abuse, fearful experiences, hospitalization, being sent away from home, and parental disturbance). Reported prevalence of childhood trauma increased with each successively younger age-cohort (range = 31% to 60%). Females showed a larger change than males, and age differences grew more pronounced as trauma exposure increased. The data suggest that childhood trauma has been on the increase over the last few decades. This is in accord with findings from other studies which showed that depression and social problems have also been on the rise. This suggests that adult psychiatric sequelae of early trauma can be expected to show an increase in future years. PMID:10927848
Thompson, A H; Cui, X
Intrusive memories are common following traumatic events and among the hallmark symptoms of posttraumatic stress disorder (PTSD). Most studies assess summarized accounts of intrusions retrospectively. We used an ecological momentary approach and index intrusive memories in trauma survivors with and without PTSD using electronic diaries. Forty-six trauma survivors completed daily diaries for 7 consecutive days recording a total of 294 intrusions. Participants with PTSD experienced only marginally more intrusions than those without PTSD, but experienced them with more “here and now quality,” and responded with more fear, helplessness, anger, and shame than those without PTSD. Most frequent intrusion triggers were stimuli that were perceptually similar to stimuli from the trauma. Individuals with PTSD experienced diary-prompted voluntary trauma memories with the same sense of nowness and vividness as involuntary intrusive trauma memories. The findings contribute to a better understanding of everyday experiences of intrusive reexperiencing in trauma survivors with PTSD and offer clinical treatment implications. PMID:24364602
In the era of nonoperative management of abdominal stab wounds, the optimal management of patients with evisceration remains unclear. Furthermore, the role of imaging in guiding management of these patients has not been defined. Patients admitted to a Level I trauma center (2005 to 2012) with evisceration after an abdominal stab wound were retrospectively identified. Demographics, admission vital signs, topography and contents of evisceration, Glasgow Coma Score, indications for exploration, and imaging and operative reports were abstracted. Clinical outcomes measured were: injuries identified on exploration, hospital length of stay, and mortality. Descriptive analysis was performed. Ninety-three patients with evisceration were identified. Ninety-two (98.9%) were male and 60 (64.5%) were Hispanic. Mean age was 31.9 ± 13 years. Forty-seven (50.5%) had evisceration of the omentum, 41 (44.1%) had evisceration of abdominal organs, and two (2.2%) had both. Seventy-four (80.4%) had positive laparotomies. Ten (10.8%) underwent computed tomography (CT) preoperatively. Sixty per cent of CT findings were congruent with operative findings. CT did not impact clinical management. In conclusion, the rate of intra-abdominal injury in patients with evisceration remains high. Even in the age of nonoperative management, evisceration continues to be an indication for immediate laparotomy. The diagnostic yield of CT is low and CT should not impact management of these patients. PMID:25264644
Nicholson, Kristina; Inaba, Kenji; Skiada, Dimitra; Okoye, Obi; Lam, Lydia; Grabo, Daniel; Benjamin, Elizabeth; Demetriades, Demetrios
Summary: Reconstructive surgeons supporting military operations are required to definitively treat severe pediatric abdominal injuries in austere environments. The safety and efficacy of using a components separation technique to treat large ventral hernias in pediatric patients in this setting remains understudied. Components separation technique was required to achieve definitive closure in a 12-month-old pediatric patient in Kandahar, Afghanistan. Her course was complicated by an anastomotic leak after small bowel resection. Her abdominal was successfully reopened, the leak repaired, and closed primarily without incident on postinjury day 9. Abdominal trauma with a large ventral hernia requiring components separation is extremely rare. A pediatric patient treated with components separation demonstrated minimal complications, avoidance of abdominal compartment syndrome, and no mortality.
Sabino, Jennifer; Kumar, Anand
Despite the prevalence of blunt hepatic trauma in humans, there are few rodent models of blunt trauma that can be used to study the associated inflammatory responses. We present a mouse model of blunt hepatic trauma that was created by using a cortical contusion device. Male mice were anesthetized with ketamine–xylazine–buprenorphine and placed in left lateral recumbency. A position of 2 mm ventral to the posterior axillary line and 5 mm caudal to the costal margin on the right side was targeted for impact. An impact velocity of 6 m/s and a piston depth of 12 mm produced a consistent pattern of hepatic injury with low mortality. All mice that recovered from anesthesia survived without complication for the length of the study. Mice were euthanized at various time points (n = 5 per group) until 7 d after injury for gross examination and collection of blood and peritoneal lavage fluids. Some mice were reanesthetized for serial monitoring of hepatic lesions via MRI. At 2 h after trauma, mice consistently displayed laceration, hematoma, and discoloration of the right lateral and caudate liver lobes, with intraabdominal hemorrhage but no other gross injuries. Blood and peritoneal lavage fluid were collected from all mice for cytokine analysis. At 2 h after trauma, there were significant increases in plasma IL10 as well as peritoneal lavage fluid IL6 and CXCL1/KC; however, these levels decreased within 24 h. At 7 d after trauma, the mice had regained body weight, and the hepatic lesions, which initially had increased in size during the first 48 h, had returned to their original size. In summary, this technique produced a reliable, low mortality, murine model that recreates features of blunt abdominal liver injury in human subjects with similar acute inflammatory response. PMID:24210016
Nemzek-Hamlin, Jean A; Hwang, Haejin; Hampel, Joseph A; Yu, Bi; Raghavendran, Krishnan
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
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
Wortmann, Jennifer H.; Park, Crystal L.; Edmondson, Donald
... movement • Cystic fibrosis and chronic lung infections • Previous abdominal surgery COMPLICATIONS A hernia may result in entrapment of other organs (such as the bladder or colon) or nerves, producing constipation or problems with ... of the abdominal cavity) needing surgical removal of part of the ...
Chronic abdominal pain is a common pediatric condition affecting 20% of the pediatric population worldwide. Most children with this disorder are found to have no specific organic etiology and are given the diagnosis of functional abdominal pain. Well-designed clinical trials have found hypnotherapy and guided imagery to be the most efficacious treatments for this condition. Hypnotic techniques used for other
The management of multiple trauma patient in the emergency room is paradoxical because the treatment must be performed as soon as possible, but the precise diagnosis using imaging is time consuming. Multiple trauma might be classified into 3 classes. Patient in class 1 is severely injured with serious neurological, respiratory and/or hemodynamic distress. Imaging procedures only consist on chest x-ray, abdominal ultrasonography and echocardiography if needed, while saving treatments are immediately required such as tracheal intubation and mechanical ventilation in case of severe brain trauma or acute respiratory failure, chest tubing in case of massive pleural effusion, surgery for hemostasis. Class 2 is represented by a patient who is seriously injured but quite stabilized by intensive care such as massive vascular loading. The aim of clinical examination is to choose specific imaging to detect and to treat potential lethal injuries such as abdominal US, chest x-ray (4 views), angiography for embolisation, brain CT scan. Class 3 patient is stabilized because of medical management on the field by MICU (SAMU/SMUR). The best management is to first perform total body CT scan to obtain quick and precise diagnosis of injury and to organize specific imaging procedure or specific surgery. In conclusion, the best management of multiple trauma implies trained medical and paramedical staff including emergency physicians and anesthesiologists in the hospital but also in the fields, efficient medical dispatching to transport the patient in the hospital able to immediately manage the patient, surgeons of several specialties, radiologist. Indeed, the aim is not to transport as quick as possible the patient in the nearest center, but to have a logical strategy in order to have the quickest discharge with the least sequellae as possible. PMID:10642637
Kienlen, J; de La Coussaye, J E
It is well known that injuries and deaths due to penetrating projectiles have become a national and an international epidemic in Western society. The application of biomedical engineering to solve day-to-day problems has produced considerable advances in safety and mitigation/prevention of trauma. The study of penetrating trauma has been largely in the military domain where war-time specific applications were advanced with the use of high-velocity weapons. With the velocity and weapon caliber in the civilian population at half or less compared with the military counterpart, wound ballistics is a largely different problem in today's trauma centers. The principal goal of the study of penetrating injuries in the civilian population is secondary prevention and optimized emergency care after occurrence. A thorough understanding of the dynamic biomechanics of penetrating injuries quantifies missile type, caliber, and velocity to hard and soft tissue damage. Such information leads to a comprehensive assessment of the acute and long-term treatment of patients with penetrating injuries. A review of the relevant military research applied to the civilian domain and presentation of new technology in the biomechanical study of these injuries offer foundation to this field. Relevant issues addressed in this review article include introduction of the military literature, the need for secondary prevention, environmental factors including projectile velocity and design, experimental studies with biological tissues and physical models, and mathematical simulations and analyses. Areas of advancement are identified that enables the pursuit of biomechanics research in order to arrive at better secondary prevention strategies. PMID:9719858
Yoganandan, N; Pintar, F A
The purpose of this article is to help pave the way for more radical counseling with trau- matized individuals, communities, and nations. The author critiques the post-traumatic stress disorder conceptualization and psychiatry fundamentally, builds on and critiques feminist and other radical contributions to trauma theory, suggests directions for femi- nists, theorizes trauma from a radical perspective, and draws implications for
Summary Family medicine physicians in their daily practice meet with a number of diseases and conditions that are the result of stress and physical trauma. One of the most frequent is post-traumatic stress disorder syndrome, which in our terms is a result of the aggression on Bosnia and Herzegovina and in total morbidity occupies more than 30% of all mental illnesses. This paper describes one such case in our practice. Timely diagnosis means the establishment of adequate therapy and relatively successful treatment. PMID:24493983
Pasagic, Almir; Bostandzija, Amela; Pasagic, Omer; Bostandzija, Sanela; Masic, Izet
In this paper, the author sets out to distinguish anew between two concepts that have become sorely entangled--'trauma' and 'narcissism'. Defining 'narcissism' in terms of an interaction between the selfobject and the self that maintains a protective shield, and 'trauma' as attacks on this protective shield, perpetrated by bad objects, he introduces two attractors present in trauma--'the hole attractor' and the structure enveloping it, 'the narcissistic envelope'. The hole attractor pulls the trauma patient, like a 'black hole', into a realm of emotional void, of hole object transference, devoid of memories and where often in an analyst's countertransference there are no reverberations of the trauma patient's experience. In the narcissistic envelope, on the other hand, motion, the life and death drive and fragments of memory do survive. Based on the author's own clinical experience with Holocaust survivors, and on secondary sources, the paper concludes with some clinical implications that take the two attractors into account. PMID:16040309
There is a general decline in penetrating abdominal trauma throughout the western world. As a result of that, there is a significant loss of expertise in dealing with this type of injury particularly when the patient presents to theatre with physiological instability. A significant percentage of these patients will not be operated by a trauma surgeon but, by the "occasional trauma surgeon", who is usually trained as a general surgeon. Most general surgeons have a general knowledge of operating penetrating trauma, knowledge originating from their training years and possibly enhanced by reading operative surgery textbooks. Unfortunately, the details included in most of these books are not extensive enough to provide them with enough armamentaria to tackle the difficult case. In this scenario, their operative dexterity and knowledge cannot be compared to that of their trauma surgeon colleagues, something that is taken for granted in the trauma textbooks. Techniques that are considered basic and easy by the trauma surgeons can be unfamiliar and difficult to general surgeons. Knowing the danger points and pitfalls that will be encountered in penetrating trauma to the abdomen, will help the occasional trauma surgeons to avoid intraoperative errors and improve patient care. This manuscript provides a heuristic approach from surgeons working in a high volume penetrating trauma centers in South African. Some of the statements could be considered heretic by the "accepted" trauma literature. We believe that this heuristic ("rule of thumb" approach, that originating from "try and error" experience) can help surgical trainees or less experienced in penetrating trauma surgeons to improve their surgical decision making and technique, resulting in better patient outcome. PMID:20630100
Yilmaz, Tugba H; Ndofor, Brown C; Smith, Martin D; Degiannis, Elias
? Â· Social--what are the effects of trauma on our relationships and families? Â· Child Abuse--what constitutes child abuse and what are its effects on children? Â· Psychiatric Diagnosis--what are the controversiesPsychology of Trauma Summer 2012 MTWR 12:00-1:50 303 Gerlinger Instructor: Laura Kaehler, lkaehler
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…
Krejci, Mark J.; Thompson, Kevin M.; Simonich, Heather; Crosby, Ross D.; Donaldson, Mary Ann; Wonderlich, Stephen A.; Mitchell, James E.
dvanced age is a well-known risk factor for poor outcomes in trauma patients. Older patients can benefit from the intensive monitoring and aggressive management asso- ciated with trauma team involvement. Several common topics were chosen for dis- cussion in which the treatment options may differ slightly because of the advanced age of the patient. We discuss the following selected topics:
Gregory P. Victorino; Terry J. Chong; Jay D. Pal
Chest pain after thoracic trauma may be a symptom of cardiac injury or myocardial infarction. A 63-year-old healthy man had chest pain after blunt chest trauma in a motor vehicle accident. Chest computed tomography scan showed a displaced sternal fracture, lung contusion in the left upper lobe, atelectasis and consolidation in both lower lobes, and bilateral haemothorax. Electrocardiography showed ST elevation (2 mm) in leads II, III, and aVF and ST depression (2 mm) in leads I and aVL, consistent with acute inferior myocardial infarction. Urgent coronary angiography showed ostial occlusion of the right coronary artery. After the right coronary occlusion was passed with a guide wire, dissection of the right coronary artery was observed and treated with a balloon and stent to reestablish normal flow. This case emphasizes the importance of a high index of suspicion for coronary artery injury and myocardial infarction after blunt chest trauma. PMID:25092198
Kara, H; Avc?, A; Akinci, M; Degirmenci, S; Bayir, A; Ak, A
Individuals with substance use disorders are often plagued by psychiatric comorbidities and histories of physical and/or sexual trauma. Males and females, although different in their rates of expressed trauma and psychiatric symptomatology, experience comparable adverse consequences, including poorer substance abuse treatment outcomes, diminished psychosocial functioning, and severe employment problems. The goal of the current study was to examine the relationships between trauma history, lifetime endorsement of psychiatric symptoms, and gender in a sample of individuals participating in outpatient substance abuse treatment. Study participants (N = 625) from six psychosocial counseling and five methadone maintenance programs were recruited as part of a larger study conducted through the National Institute on Drug Abuse Clinical Trials Network (NIDA CTN). Study measures included lifetime trauma experience (yes/no), type of trauma experienced (sexual, physical, both), lifetime depression/anxiety, and lifetime suicidal thoughts/attempts (as measured by the Addiction Severity Index-Lite [ASI-Lite]). Lifetime endorsement of psychiatric symptoms was compared between individuals with and without trauma history. The role of gender was also examined. Results indicated that the experience of trauma was associated with an increase in lifetime report of psychiatric symptoms. Experience of physical and combined physical and sexual trauma consistently predicted positive report of psychiatric symptoms in both males and females, even when controlling for demographic and treatment-related variables. Employment outcomes, however, were not predicted by self-reported history of lifetime trauma. PMID:24811286
Keyser-Marcus, Lori; Alvanzo, Anika; Rieckmann, Traci; Thacker, Leroy; Sepulveda, Allison; Forcehimes, Alyssa; Islam, Leila Z; Leisey, Monica; Stitzer, Maxine; Svikis, Dace S
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
Mortimer, Alice Emily
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.
Trauma to the optic nerve may be direct, such as from a penetrating object, or indirect, which may result despite lack of direct contact of an object with the nerve. Although indirect injury initially causes no change in the appearance of the nerve head, within a matter of weeks optic atrophy will be manifest. The pathophysiology of nerve damage is incompletely understood. Management is controversial; steroid therapy has been advocated, as has surgical decompression of the nerve. Indirect injuries affecting the optic nerve may also result from torsional rotation of the globe (avulsion) and from subdural or subarachnoid hemorrhage (Terson's syndrome). There is no treatment for optic nerve avulsion; the unaffected eye should be protected with appropriate eyewear. Hemorrhaging in the retina and vitreous in Terson's syndrome should be monitored for resolution and risk of retinal detachment. Computed tomography may be necessary if subarachnoid or intracranial hemorrhages are suspected. PMID:8268699
Dul, M W
... organs), severe bowel or bladder distention, and previous abdominal-pelvic surgery may increase the risk of the procedure. In those situations, an ultrasound-guided paracentesis should be considered. Procedural complications are rare but can include ANALYSIS OF ASCITIC ...
This volume is a new and updated edition of an extensively illustrated text and reference on the capabilities and imaging of gray scale ultrasonography for each major abdominal organ. Each major organ system is treated separately, including liver, gallbladder and bile ducts, pancreas, kidney, retroperitoneum, abdominal vasculature, and more. There are over 500 illustrations and ten pages of full color plates for cross sectional anatomy.
Multi-slice CT provides an efficient imaging modality for trauma imaging. The purpose of this study was to provide absorbed and effective dose data from CT taking into account the patient size and compare such doses with the standard CT dose quantities based on standard geometry. The CT examination data from abdominal and thoracic scan series were collected from 36 trauma patients. The CTDIvol, DLPw and effective dose were determined, and the influence of patient size was applied as a correction factor to calculated doses. The patient size was estimated from the patient weight as the effective radius based on the analysis from the axial images of abdominal and thoracic regions. The calculated mean CTDIvol, DLPw and effective dose were 15.2 mGy, 431 mGy cm and 6.5 mSv for the thorax scan, and 18.5 mGy, 893 mGy cm and 14.8 mSv for the abdomen scan, respectively. The doses in the thorax and abdomen scans taking the patient size into account were 34% and 9% larger than the standard dose quantities, respectively. The use of patient size in dose estimation is recommended in order to provide realistic data for evaluation of the radiation exposure in CT, especially for paediatric patients and smaller adults.
Kortesniemi, M.; Kiljunen, T.; Kangasmäki, A.
Background Nonaccidental head trauma in infants is the leading cause of infant death from injury.\\u000a \\u000a \\u000a \\u000a Results and discussion Clinical features that suggest inflicted head trauma include the triad of the so-called shaken baby syndrome, consisting of\\u000a retinal hemorrhage, subdural, and\\/or subarachnoid hemorrhage in an infant with little signs of external trauma. Studies have\\u000a shown that, in general, the average short fall in
Paula Gerber; Kathryn Coffman
Hypothalamic pituitary adrenal (HPA) axis and subjective stress response to a cold-water immersion task, the cold pressor task (CPT), in individuals (N=89) with post-traumatic stress disorder (PTSD) were examined. All tests were conducted at 08:00h after an overnight hospital stay. Plasma adrenocorticotrophin hormone (ACTH), cortisol, and subjective stress were examined at baseline and five post-task time points in controls (n=31), subjects with PTSD as a result of an index trauma during childhood (i.e. before age 18; n=25), and subjects with PTSD as a result of an index trauma as an adult (n=33). Approximately, 50% of individuals in both trauma groups were alcohol dependent, and the impact of this comorbidity was also examined. Subjects with PTSD, regardless of age of index trauma, had a less robust ACTH response as compared to controls. Regardless of the presence or absence of comorbid alcohol dependence, subjects with childhood trauma had lower cortisol at baseline and at all post-task measurement points and did not demonstrate the decrease in cortisol over the course of the 2h monitoring period seen in subjects with adult index trauma and controls. The findings reveal differences in the neuroendocrine response to the CPT in individuals with PTSD compared to control subjects, and differences in PTSD subjects when examined by age of index trauma. PMID:16413134
Santa Ana, Elizabeth J; Saladin, Michael E; Back, Sudie E; Waldrop, Angela E; Spratt, Eve G; McRae, Aimee L; LaRowe, Steven D; Timmerman, Mary Ann; Upadhyaya, Himanshu; Brady, Kathleen T
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 to those who have close contact with the
Robert W. Motta
The plurality and growing number of responses to cultural trauma theory in postcolonial criticism demonstrate the ongoing appeal of trauma theory despite the fact that it is also increasingly critiqued as inadequate to the research agenda of postcolonial studies. In the dialogue between trauma theory and postcolonial literary studies the central question remains whether trauma theory can be effectively “postcolonialized”
Borderline Personality Disorder (BPD) has been associated with both trauma and insecure attachment styles. Betrayal Trauma Theory proposes survivors of interpersonal trauma may remain unaware of betrayal in order to maintain a necessary attachment. This preliminary study reports on the relations between self-reports of betrayal trauma experiences and borderline personality characteristics in a college sample. Using multiple regression, betrayal was
Laura A. Kaehler; Jennifer J. Freyd
Injury is the fourth leading cause of death in the US, and the leading cause of death in younger age. Trauma is primarily a disease of the young and accounts for more years of productive life lost than any other illness. Consequently, almost every health care provider encounters trauma patients from time to time. Many of these patients are critically ill and pose several challenges in the acute phase, including airway and ventilation, fluid management, intracranial pressure control, etc. In the last decade, several strategies and treatment options have been studied in trauma care along with improvement in technologies. In this review, we will discuss a few of the new developments and updates in trauma care. PMID:22096770
Ramaiah, Ramesh; Grabinsky, Andreas; Williamson, Kelvin; Bhanankar, Sanjay M
Various aspects of trauma to the lower abdomen are discussed. The initial assessment, including appropriate diagnostic tests, are outlined. Principles of management of specific injuries and indications for operation are discussed. PMID:2280422
The management of midface trauma continues to challenge maxillofacial surgeons. The complex local anatomy and functional and cosmetic importance of the region make precise surgical correction and reconstruction essential to success. PMID:23498333
Gentile, Michael A; Tellington, Andrew J; Burke, William J; Jaskolka, Michael S
Background Abdominal wall hematomas are an uncommon cause of acute abdominal pain and are often misdiagnosed. They are more common in elderly individuals, particularly in those under anticoagulant therapy. Most abdominal wall hematomas occur in the rectus sheath, and hematomas within the oblique muscle are very rare and are poorly described in the literature. Here we report the case of an oblique muscle hematoma in a middle-aged patient who was not under anticoagulant therapy. Case presentation A 42-year-old Japanese man presented with a painful, enlarging, lateral abdominal wall mass, which appeared after playing baseball. Abdominal computed tomography and ultrasonography showed a large soft tissue mass located in the patient’s left internal oblique muscle. A diagnosis of a lateral oblique muscle hematoma was made and the patient was treated conservatively. Conclusion Physicians should consider an oblique muscle hematoma during the initial differential diagnosis of pain in the lateral abdominal wall even in the absence of anticoagulant therapy or trauma. PMID:23327472
Damage control laparotomy was first described by Dr. Harlan Stone in 1983 when he suggested that patients with severe trauma should have their primary procedures abbreviated when coagulopathy was encountered. He recommended temporizing patients with abdominal packing and temporary closure to allow restoration of normal physiology prior to returning to the operating room for definitive repair. The term damage control in the trauma setting was coined by Rotondo et al., in 1993. Studies in subsequent years have validated this technique by demonstrating decreased mortality and immediate post-operative complications. The indications for damage control laparotomy have evolved to encompass abdominal compartment syndrome, abdominal sepsis, vascular and acute care surgery cases. The perioperative critical care provided to these patients, including sedation, paralysis, nutrition, and fluid management strategies may improve closure rates and recovery. In the rare cases of inability to primarily close the abdomen, there are a number of reconstructive strategies that may be used in the acute and chronic phases of abdominal closure. PMID:24341602
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
Background Providing anesthesia and managing airways in the electrophysiology suite can be challenging because of its unique setting outside of the conventional operating room. We report our experience of several cases of reported airway trauma including tongue and pharyngeal hematoma and vocal cord paralysis in this setting. Methods We analyzed all of the reported airway trauma cases between December 2009 and January 2011 in our cardiac electrophysiology laboratories, and compared these cases to those without airway trauma. Data from 87 cases, including 16 cases with reported airway trauma (trauma group) and 71 cases without reported airway trauma from the same patient population pool at the same time period (control group), were collected via review of medical records. Results Airway trauma was reported for 16 patients (0.7%) in 14 months among 2434 anesthetic cases. None of these patients had life-threatening airway obstruction. The avoidance of muscle relaxants during induction in patients with a body mass index less than 30 was found to be a significant risk factor for airway trauma (p=0.04, odds ratio 10, 95% confidence interval 1.1 to 482). Tongue or soft tissue bite occurred in two cases where soft bite block was not used during cardioversion. No statistically significant difference was found between the trauma and control groups for preprocedure anticoagulation, anticoagulation during the procedure, or reversal of heparin at the end of the procedure. Conclusion The overall incidence of reported airway trauma was 0.7% in our study population. Tongue injury was the most common airway trauma. The cause seems to have been multifactorial; however, airway management without muscle relaxant emerged as a potential risk factor. Intubation with muscle relaxant is recommended, as is placing a soft bite block and ensuring no soft tissue is between the teeth before cardioversion. PMID:23223101
Yan, Zhe; Tanner, Jonathan W.; Lin, David; Chalian, Ara A.; Savino, Joseph S.; Fleisher, Lee A.; Liu, Renyu
Systemic air embolism is a potentially fatal condition. Although venous embolism is commonly reported after deep sea diving or neurosurgical procedures, arterial embolism is rare. It usually occurs because of lung trauma after biopsy or lung resection but can rarely affect patients of blunt or penetrating trauma to chest managed on positive pressure ventilation. We report a case of road traffic accident with head injury, with normal primary survey of chest and abdomen who developed fatal systemic arterial air embolism immediately after intubation. Postmortem CT scan revealed huge amounts of air in left side of the heart, ascending aorta, arch of aorta, bilateral internal carotids and all right-sided intracranial arteries. In emergency departments of non-specialised centres, such complications are universally fatal. Thus, extreme caution needs to be exercised while managing patients of blunt trauma on mechanical ventilation even if the chest and abdominal examinations are normal. PMID:23417941
Yadav, Siddharth; Jain, Shalabh; Aggarwal, Puneet; Gupta, Ritu
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.
Guzman-Stein, G.; Bonsack, M.; Liberty, J.; Delaney, J.P.
Among solid organ blunt traumas, the liver and spleen are mostly subject to injury. In addition, the liver is also commonly injured in penetrating traumas because of its size, location, and the ease of injury to the "Glisson Capsule". Several enzymes are known to be elevated following trauma. In our study, we evaluated the correlation between the levels of serum aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, and gamma-glutamyl transpeptidase in 57 patients with blunt trauma to the liver and compared these values to the American Association for the Surgery of Trauma trauma grading system. Additionally, we compared the enzyme level elevations in these patients to the enzyme levels of 29 healthy subjects. As expected, we found significant elevations in enzyme levels of trauma patients compared to the control group. The calculated point estimates were not significantly different between grades 1 and 2 trauma. However, grade 3 trauma group showed a significant increase in enzyme levels. PMID:23793528
Arslan, Gozde; Gemici, Aysegul Akdogan; Yirgin, Inci Kizildag; Gulsen, Esma; Inci, Ercan
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
Watson, Hannah Isabella; Saunders, Andrew John
The purpose of this article is to review and illustrate the spectrum of computed tomography (CT) appearances of abdominal tuberculosis. Tuberculosis can affect any organ or tissue in the abdomen, and can be mistaken for other inflammatory or neoplastic conditions. The most common sites of tuberculosis in the abdomen include lymph nodes, genitourinary tract, peritoneal cavity and gastrointestinal tract. The liver, spleen, biliary tract, pancreas and adrenals are rarely affected, but are more likely in HIV-seropositive patients and in miliary tuberculosis. This article should alert the radiologist to consider abdominal tuberculosis in the correct clinical setting to ensure timely diagnosis and enable appropriate treatment. PMID:22212637
Lee, W-K; Van Tonder, F; Tartaglia, C J; Dagia, C; Cazzato, R L; Duddalwar, V A; Chang, S D
Eighty five children with recurrent abdominal pain(RAP) were studied. Organic cause was noticed in 70 cases and non-organic in 15 cases. Giardiasis was the commonest organic cause in 57 (67.0 percent), either alone or with other parasitic infestations. Other organic causes include gallstones (4.7 percent), urinary infections (4.7 percent), esophagitis/gastritis (3.5 percent) and abdominal tuberculosis (2.3 percent). Single parent, school phobia, sibling rivalry, RAP in other family members and nocturnal enuresis are significant factors associated with nonorganic causes PMID:12368527
Buch, Niyaz A; Ahmad, Sheikh Mushtaq; Ahmed, S Zubair; Ali, Syed Wazid; Charoo, B A; Hassan, Masood Ul
Penetrating abdominal injuries have been traditionally managed by routine laparotomy. New understanding of trajectories, potential for organ injury, and correlation with advanced radiographic imaging has allowed a shift towards non-operative management of appropriate cases. Although a selective approach has been established for stab wounds, the management of abdominal gunshot wounds remains a matter of controversy. In this chapter we describe the rationale and methodology of selecting patients for non-operative management. We also discuss additional controversial issues, as related to antibiotic prophylaxis, management of asymptomatic thoracoabdominal injuries, and the use of colostomy vs. primary repair for colon injuries. PMID:19374761
Butt, Muhammad U; Zacharias, Nikolaos; Velmahos, George C
Pyloric exclusion (PEX) has traditionally been used in the management of complicated duodenal injuries to temporarily protect the duodenal repair and prevent septic abdominal complications. We used the American College of Surgeons National Trauma Data Bank (v 5.0) to evaluate adult patients with severe duodenal injuries [American Association for the Surgery of Trauma (AAST) Grade > or = 3] undergoing primary repair only or repair with PEX within 24 hours of admission. Propensity scoring was used to adjust for relevant confounding factors during outcomes comparison. Among 147 patients with severe duodenal injuries, 28 (19.0%) underwent PEX [15.9% (11/69) Grade III vs 34.0% (17/50) Grade IV-V]. Despite similar demographics, PEX was associated with a longer mean hospital stay (32.2 vs 22.2 days, P = 0.003) and was not associated with a mortality benefit. There was a trend toward increased development of septic abdominal complications (intra-abdominal abscess, wound infection, or dehiscence) with PEX that was not statistically significant. After multivariable analysis using propensity score, no statistically significant differences in mortality or occurrence of septic abdominal complications was noted between those patients undergoing primary repair only or PEX. The use of PEX in patients with severe duodenal injuries may contribute to longer hospital stay and confers no survival or outcome benefit. PMID:18942615
DuBose, Joseph J; Inaba, Kenji; Teixeira, Pedro G R; Shiflett, Anthony; Putty, Bradley; Green, D J; Plurad, David; Demetriades, Demetrios
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
De Leeuw, Marc; Beuls, Emile; Parizel, Paul; Jorens, Philippe; Jacobs, Werner
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
BACKGROUND Surgery resident education is based on experiential training, which is influenced by changes in clinical management strategies, technical and technologic advances, and administrative regulations. Trauma care has been exposed to each of these factors, prompting concerns about resident experience in operative trauma. The current study analyzed the reported volume of operative trauma for the last two decades; to our knowledge, this is the first evaluation of nationwide trends during such an extended time line. METHODS The Accreditation Council for Graduate Medical Education (ACGME) database of operative logs was queried from academic year (AY) 1989–1990 to 2009–2010 to identify shifts in trauma operative experience. Annual case log data for each cohort of graduating surgery residents were combined into approximately 5-year blocks, designated Period I (AY1989–1990 to AY1993–1994), Period II (AY1994–1995 to AY1998–1999), Period III (AY1999–2000 to AY2002–2003), and Period IV (AY2003–2004 to AY2009–2010). The latter two periods were delineated by the year in which duty hour restrictions were implemented. RESULTS Overall general surgery caseload increased from Period I to Period II (p < 0.001), remained stable from Period II to Period III, and decreased from Period III to Period IV (p < 0.001). However, for ACGME-designated trauma cases, there were significant declines from Period I to Period II (75.5 vs. 54.5 cases, p < 0.001) and Period II to Period III (54.5 vs. 39.3 cases, p < 0.001) but no difference between Period III and Period IV (39.3 vs. 39.4 cases). Graduating residents in Period I performed, on average, 31 intra-abdominal trauma operations, including approximately five spleen and four liver operations. Residents in Period IV performed 17 intra-abdominal trauma operations, including three spleen and approximately two liver operations. CONCLUSION Recent general surgery trainees perform fewer trauma operations than previous trainees. The majority of this decline occurred before implementation of work-hour restrictions. Although these changes reflect concurrent changes in management of trauma, surgical educators must meet the challenge of training residents in procedures less frequently performed. LEVEL OF EVIDENCE Epidemiologic study, level III; therapeutic study, level IV. PMID:23188243
Drake, Frederick Thurston; Van Eaton, Erik G.; Huntington, Ciara R.; Jurkovich, Gregory J.; Aarabi, Shahram; Gow, Kenneth W.
Severity assessment in trauma patients is mandatory. It started during initial phone call that alerts emergency services when a trauma occurred. On-call physician assesses severity based on witness-provided information, to adapt emergency response (paramedics, emergency physicians). Initial severity assessment is subsequently improved based on first-responder provided informations. Whenever information comes, it helps providing adequate therapeutics and orientating the patient to the appropriate hospital. Severity assessment is based upon pre-trauma medical conditions, mechanism of injury, anatomical lesions and their consequences on physiology. Severity information can be summarized using scores, yet those are not used in France, except for post-hoc scientific purposes. Triage is usually performed using algorithms. Whatever the way triage is performed, triage tools are based on mortality as main judgement criterion. Other criteria should be considered, such as therapeutics requirements. The benefit of biomarkers of ultrasonography at prehospital setting remains to be assessed. PMID:23906735
Raux, M; Vivien, B; Tourtier, J-P; Langeron, O
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
Arora, Shubhangi; Singh, Preet Mohinder; Trikha, Anjan
With a substantial donation from William Dart of Mason, Michigan, the Dart Center for Journalism & Trauma started its work at Michigan State University, and has grown significantly over the past decade and a half. Currently located at the University of Washington, the Center is a Ã¢ÂÂglobal network of journalists, journalism educators and health professionals dedicated to improving media coverage of trauma, conflict and tragedy.Ã¢ÂÂ On their site, visitors can learn about fellowship opportunities, read fact sheets about trauma research, and peruse their in-house blog. Journalists will appreciate the Ã¢ÂÂQuick TipsÃ¢ÂÂ section on the homepage, as it covers a broad range of subjects, such as how to cover disasters, murder, suicide, and domestic violence in a sensitive manner. The site also has a rather impressive series of case studies on reporting on such events as the Columbine massacre and the genocide in Rwanda.
The scope of this study was to determine whether contrast-enhanced ultrasonography (CEUS), compared with basic US, can increase diagnostic confidence and provide relevant information on blunt scrotal trauma. Over a period of 75 months we examined 40 patients seen consecutively for blunt scrotal trauma using high-resolution US, color-power Doppler, low mechanical index CEUS, and power Doppler after IV administration of contrast medium (SonoVue(®)). In the 24 cases that were positive, concordance between basal US and CEUS findings was grade 0 (absent) in 4 cases, grade 1 (low) in 3, grade 2 (moderate) in 8, and grade 3 (high) in 9. The relevance of the additional information provided by CEUS was classified as follows: high in 4/40 (10%), moderate 7/40 (17,5%), low 13/40 (32,5%), none in 14/40 (35%). Our findings demonstrate that CEUS is appreciably more sensitive in detecting damage caused by blunt scrotal trauma, particularly small lesions. It is also useful for differential diagnosis and marginalization of corpuscular fluid collections, fractures, and above all ruptures, which require immediate surgery. In our series 2 out of 3 (67%) patients with testicular rupture were diagnosed only by CEUS. We feel that the use of CEUS can significantly improve diagnostic confidence in cases of closed scrotal trauma although these conclusions need to be confirmed in larger case series. PMID:23396988
Lobianco, R; Regine, R; De Siero, M; Catalano, O; Caiazzo, C; Ragozzino, A
The scope of this study was to determine whether contrast-enhanced ultrasonography (CEUS), compared with basic US, can increase diagnostic confidence and provide relevant information on blunt scrotal trauma. Over a period of 75 months we examined 40 patients seen consecutively for blunt scrotal trauma using high-resolution US, color-power Doppler, low mechanical index CEUS, and power Doppler after IV administration of contrast medium (SonoVue®). In the 24 cases that were positive, concordance between basal US and CEUS findings was grade 0 (absent) in 4 cases, grade 1 (low) in 3, grade 2 (moderate) in 8, and grade 3 (high) in 9. The relevance of the additional information provided by CEUS was classified as follows: high in 4/40 (10%), moderate 7/40 (17,5%), low 13/40 (32,5%), none in 14/40 (35%). Our findings demonstrate that CEUS is appreciably more sensitive in detecting damage caused by blunt scrotal trauma, particularly small lesions. It is also useful for differential diagnosis and marginalization of corpuscular fluid collections, fractures, and above all ruptures, which require immediate surgery. In our series 2 out of 3 (67%) patients with testicular rupture were diagnosed only by CEUS. We feel that the use of CEUS can significantly improve diagnostic confidence in cases of closed scrotal trauma although these conclusions need to be confirmed in larger case series. PMID:23396988
Lobianco, R.; Regine, R.; De Siero, M.; Catalano, O.; Caiazzo, C.; Ragozzino, A.
Background: Incisional hernia is a frequent complication of abdominal surgery. The object of this study was to confirm the safety, efficacy, and feasibility of laparoscopic treatment of abdominal wall defects. Methods: Fifty consecutive laparoscopic abdominal and incisional hernia repairs from September 2001 to May 2003 were compared with 50 open anterior repairs. Results: The 2 groups were not different for age, body mass index, or American Society of Anaesthesiologists scores. Mean operative time was 59 minutes for the laparoscopic group, 164.5 minutes for the open group. Mean hernia diameter was 10.6 cm for the laparoscopic group, 10.5 cm for the open group. Mean length of stay was 2.1 days for the laparoscopic group, 8.1 days for the open group. Complications occurred in 16% of the laparoscopic and 50% of open group. Median follow-up was 9.0 months for the laparoscopic group, 24.5 months for the open group. Recurrence rates were 2% for laparoscopic group and 0% for the open group. Conclusion: Results for laparoscopic abdominal and incisional hernia repair seem to be superior to results for open repair in terms of operative time, length of stay, wound infection, major complications, and overall hospital reimbursement. PMID:15984708
Magnone, Stefano; Erba, Luigi; Bertolini, Aimone; Croce, Enrico
In many respects, craniofacial trauma in children is akin to that in adults. The appearance of fractures and associated injuries is frequently similar. However, the frequencies of different types of fractures and patterns of injury in younger children vary depending on the age of the child. In addition, there are unique aspects that must be considered when imaging the posttraumatic pediatric face. Some of these are based on normal growth and development of the skull base and craniofacial structures, and others on the varying etiologies and mechanisms of craniofacial injury in children, such as injuries related to toppled furniture, nonaccidental trauma, all-terrain vehicle accidents, and impalement injuries. PMID:25086809
Koch, Bernadette L
This study examined officers' perceptions of the traumatic events they encounter on the job. Officers (N = 313) completed a survey asking about their experience with specific types of trauma, as well as what they considered to be their most traumatic event. They were given the opportunity to describe their unique perceptions of these events in response to open-ended questions. The results revealed vast variability in officers' experience with trauma in terms of the number, type, unique perceptions, and impact of these events. Results are discussed in terms of their implications for clinicians who treat officers affected with posttraumatic stress reactions and disorders. PMID:19637496
Colwell, Lori H
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.
Spoor, T.C.; Nesi, F.A.
Trauma resuscitation in children, pregnant women, Jehovah's witnesses or in patients with infectious diseases like HIV is obviously beyond routine. This may result in uncertainty how to manage these patients appropriately. Preparation for such situations is essential. Therefore this article focuses on the specific problems associated with these kinds of patients. PMID:25238014
López, Caroline L; Meyer, Thomas; Heuer, Stefan; Kranke, Peter; Debus, Florian; Wurmb, Thomas; Kühne, Christian A
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
Abdominal pregnancy is relatively rare, with an estimated frequency of 1/3,000 pregnancies in this country. We have described serial sonographic findings in an abdominal pregnancy from 28 weeks to term. Particular emphasis is placed on the pitfalls facing the sonographer in the diagnosis of advanced abdominal pregnancy. PMID:7221666
Ali, V; Saldana, L R; Balat, I Y; Katragadda, R
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
Puppala, Radha; Sripathi, Smiti; Kadavigere, Rajagopal; Koteshwar, Prakashini; Singh, Jyoti
Midline abdominal incisional hernias are common following open repair of abdominal aortic aneurysms. These may be caused by the weakness of connective tissue. This study sought to determine the prevalence of diastasis recti among unoperated Caucasian males with abdominal aortic aneurysm compared to a control group with atherosclerotic lower extremity peripheral arterial disease. Forty-two consecutive white males referred for evaluation
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
Stefano Massimiliano Calderale; Raluca Sandru; Gregorio Tugnoli; Salomone Di Saverio; Mircea Beuran; Sergio Ribaldi; Massimo Coletti; Giorgio Gambale; Sorin Paun; Livio Russo; Franco Baldoni
The effects of trauma on refugees are long-lasting, both physically and mentally. The primary objective of this paper is to\\u000a broaden the scope of theoretical knowledge on refugee trauma by building on refugee, Post-Colonial, Trauma and Feminist theories,\\u000a and emphasizing refugee trauma as a consequence of multiple historical, social and political constraints which are embedded\\u000a in the personal experiences of
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…
Whitfield, Natasha; Kanter, Deborah
. Required Texts: Herman, J. Trauma and Recovery: The aftermath of violence--from domestic abuse to political and clinical viewpoints. We will look at the effects of trauma on children and adults, as well as its effects--what are the effects of trauma on our relationships and families? Child Abuse--what constitutes child abuse and what
. Trauma and Recovery: The aftermath of violence--from domestic abuse to political terror. Basic Books and clinical viewpoints. We will look at the effects of trauma on children and adults, as well as its effects--what are the effects of trauma on our relationships and families? Child Abuse--what constitutes child abuse and what
Complex trauma occurs repeatedly and escalates over its duration. In families, it is exemplified by domestic violence and child abuse and in other situations by war, prisoner of war or refugee status, and human trafficking. Complex trauma also refers to situations such as acute\\/chronic illness that requires intensive medical intervention or a single traumatic event that is calamitous. Complex trauma
Christine A. Courtois
Complex trauma occurs repeatedly and escalates over its duration. In families, it is exemplified by domestic violence and child abuse and in other situations by war, prisoner of war or refugee status, and human trafficking. Complex trauma also refers to situations such as acute\\/chronic illness that requires intensive medical intervention or a single traumatic event that is calamitous. Complex trauma
Christine A. Courtois
Delayed acute abdominal compartment syndrome (ACS) due to retroperitoneal bleeding is rare. Herein, we report the clinical management of such a rare case. A 46-year-old male who fell from a height of 12 meters was admitted to Al-Ain Hospital. He was hemodynamically stable. His abdomen was soft and not distended. Abdominal computed tomography (CT) was normal on admission. On day 7, the patient tolerated enteral feeding. On day 15, he became suddenly hypotensive. CT of the abdomen showed a large retroperitoneal hematoma compressing the inferior vena cava (IVC) associated with contrast blush indicating active bleeding. The abdomen became distended and tense. The patient developed respiratory failure and severe acidosis, increased airway pressure and reduced urine output. A clinical diagnosis of ACS was made. There was dramatic improvement in the hemodynamic and respiratory function directly after laparotomy. Exploration of the retroperitoneal hematoma showed an actively bleeding ligated ileocolic vessel. The abdomen was temporarily closed using saline IV bags sandwiched between two layers of Steri-Drape. The abdomen was closed primarily on day 6. The patient was discharged home on day 50. Life-threatening delayed retroperitoneal bleeding may occur suddenly two weeks after trauma causing ACS. PMID:21644100
Abu-Zidan, Fikri M; Jawas, Ali; Boraie, Mustafa; Ahmed, Misbah U
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…
During the 1970s a paradigm shift occurred in the way that psychological trauma was conceived and managed. Until the Vietnam War, those who broke down following a stressful event were considered inherently vulnerable or subject to a neurosis laid down in childhood. During the Second World War it was recognized that all servicemen have a breaking point, though robust individuals
Edgar Jones; Simon Wessely
This article offers a comprehensive review of colon trauma from World War I to the present. The process of evidence-based medicine was used to analyze the data from the past 25 years and define standards of care in the field. Where data are less compelling, recommendations and suggestions are provided for future research. Topics highlighted include destructive and nondestructive colon
Robert A. Maxwell; Timothy C. Fabian
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…
Fractures and other skeletal injuries are common in childhood. Most are the result of falls, motor vehicle accidents, and other forms of accidental trauma. However, skeletal trauma is present in a significant number of abused children. Age and developmental abilities are key components in raising clinical suspicion for child abuse. Children who are unable to provide their own history because of age or developmental delay require increased attention. Younger children are more likely to have abusive fractures, whereas accidental fractures increase with age and developmental abilities. The consequences of missing abuse are high because children returned to their homes without intervention are likely to face further abuse and have an increased mortality risk. Because of the potentially high cost of undiagnosed child abuse, diagnosis of a skeletal injury is incomplete without diagnosing its etiology. All health providers for children should be able to recognize patterns of skeletal injury secondary to abusive trauma and understand the process for initiating Child Protective Services (CPS) investigations when necessary. Although they can occur accidentally, fractures in nonmobile children should always increase the clinician's concern for abusive trauma. In light of the significant consequences for children when abuse is missed by a primary care provider, abuse should be on the differential diagnosis for all presenting childhood injuries. PMID:24168118
Swoboda, Sara L; Feldman, Kenneth W
We report the case of a 39 year-old woman with many years of intermittent abdominal pain who was found to have cystic masses evocative of cystic lymphangioma involving the posterior mediastinal and retroperitoneum. Worsening abdominal pain led to a recommendation for laparoscopic unroofing and decompression of the cysts. During the postoperative period, hemorrhagic shock required reintervention with excision of the tumoral mass. Pathologic examination revealed lymphangioleiomyomatosis (LAM). On the 15th postoperative day, the patient developed a chylopneumothorax which required prolonged chest tube drainage. The presence of multiple polycystic lesions in the pulmonary parenchyma supported the diagnosis of diffuse LAM with primary extrapulmonary presentation. This diagnosis should be considered preoperatively since it modifies the treatment: a complete excision of the cystic lesions seems to be necessary in order to prevent bleeding and lymphatic extravasation. PMID:19446700
Barbier, L; Ebbo, M; Andrac-Meyer, L; Schneilitz, N; Le Treut, Y-P; Reynaud-Gaubert, M; Hardwigsen, J
The aim of this study was to assess the prevalence of dental trauma as compared to the prevalence of dental caries in children aged 3-59 months. A cross-sectional study was carried out during the National Immunization Day for Polio in Recife, northeast Brazil. The sample comprised 3489 children under the age of 5. The clinical examination was performed by 123 previously trained dental students. The inter-examiner agreement for crown fracture was 90.32% and for tooth discoloration it was 83.87%. The prevalence of dental caries was assessed using the dmf-t index. The statistical methods included descriptive analysis and the chi-square test with a margin of error of 5%. A total of 56 142 teeth were examined and the prevalence of dental trauma was 14.9%. Dental fracture was the most prevalent injury observed in 516 teeth (0.9%), followed by discoloration in 191 (0.9%), intrusion in 12 (0.02%) and extrusion in five (0.008%). The most affected teeth were the upper central incisors. The prevalence of dental trauma increased significantly with age and family income (P < 0.0001). Dental trauma was most prevalent from 2 to 5 years of age. The prevalence of dental caries was 14.3%. This prevalence increased significantly with age (P < 0.0001) and with the reduction in family income (P < 0.0001). The results showed that the prevalence of dental caries and dental trauma was similar, and that both caused the same amount of damage to dental health for the target population. PMID:19290904
Ferreira, Jainara Maria Soares; Fernandes de Andrade, Ednara Mércia; Katz, Cíntia Regina Tornisiello; Rosenblatt, Aronita
The decision to stop or continue resuscitation in a patient with blunt trauma and cardiac arrest arriving pulseless to the hospital has always been controversial. While many authors still believe that it is a futile effort, with no chance of success for complete neurological recovery, some recent reports have challenged the idea. Here we report complete recovery of a severely injured patient following a motor vehicle accident who lost vital signs completely before arrival at our trauma center. No cardiac motion was detected on ultrasound examination on arrival. Emergency department thoracotomy, open cardiac massage, massive blood transfusion, damage control laparotomy with abdominal and pelvic packing, followed by angio-embolization of pelvic bleeding, and staged abdominal exploration were performed. This case is an example showing that resuscitation of patients with blunt trauma and cardiac arrest arriving pulseless to the hospital is not always futile. PMID:24693385
Hamidian Jahromi, Alireza; Northcutt, Ashley; Youssef, Asser M
Background This study was wanted to investigate the prevalence of concomitant injuries among hospitalized acute spinal trauma patients aged 20 and over and the effects of those injuries on medical utilization in Taiwan. Methods Nationwide inpatient datasets of Taiwan's National Health Insurance (NHI) database from between 2000 and 2003 were used. The major inclusion criteria used to select cases admitted due to acute spinal trauma were based on three diagnostic International Classification of Disease, 9th Version (ICD-9) codes items: (1) fracture of vertebral column without mention of spinal cord injury; (2) fracture of vertebral column with spinal cord injury; or (3) spinal cord lesion without evidence of spinal bone injury. To investigate the associated injuries among the eligible subjects, the concomitant ICD-9 diagnosis codes were evaluated and classified into six co-injury categories: (1) head trauma; (2) chest trauma; (3) abdominal trauma; (4) pelvic trauma; (5) upper extremities trauma; (6) lower extremities trauma. Results There were 51,641 cases studied; 27.6% of these subjects suffered from neurological deficit, but only 17.3% underwent a surgical procedure for spinal injury. Among them, the prevalence of associated injuries were as follows: head trauma, 17.2%; chest injury, 2.9%; abdominal trauma, 1.5%; pelvic injury or fracture, 2.5%; upper limb fracture, 4.4%; lower limb fracture, 5.9%. The three major locations of acute spinal injury (cervical, thoracic, or lumbar spine) were found to be combined with unequal distributions of associated injuries. By stepwise multiple linear regression, gender, age, location of spinal injury, neurological deficit, surgical intervention and the six combined injuries were identified significantly as associated factors of the two kinds of medical utilization, length of stay (LOS) and direct medical cost. The combinations of acute spinal trauma with lower extremity injury, pelvic injury, chest injury, abdominal injury and upper extremity injury resulted in of the highest utilization of medical resources, the estimated additional LOS being between 4.3 and 1.2 days, and the extra medical cost calculated as being between $1,230 and $320. Conclusion The occurrence of associated Injuries among hospitalized acute spinal trauma patients in Taiwan is not uncommon, and results in an obvious effect on medical utilization. PMID:19650923
Chu, Dachen; Lee, Yi-Hui; Lin, Ching-Heng; Chou, Pesus; Yang, Nan-Ping
Striving to become the "immigration resource directory on the net," the Immigration Index is a newly launched Website dedicated to news and information about immigration worldwide. Along with breaking headlines from a variety of news sources about immigration-related issues such as asylum, migration, trafficking and women, and much more, the site contains a fully annotated collection of links to immigration materials all around the World Wide Web. Only a month old, some of the categories in the Index's hierarchy still need some filling in. In time, however, the Immigration Index promises to become an invaluable resource for interested parties.
AIM: To investigate the possible reasons and suggest therapeutic plan of stress-induced intestinal necrosis resulting from the severe trauma. METHODS: Three patients in our study were trapped inside collapsed structures for 22, 21 and 37 h, respectively. The patients underwent 3-4 operations after sustaining their injuries. Mechanical ventilation, intermittent hemodialysis and other treatments were also provided. The patients showed signs of peritoneal irritation on postoperative days 10-38. Small intestinal necrosis was confirmed by emergency laparotomy, and for each patient, part of the small bowel was removed. RESULTS: Two patients who all performed 3 operations died of respiratory complications on the first and second postoperative days respectively. The third patient who performed 4 operations was discharged and made a full recovery. Three patients had the following common characteristics: (1) Multiple severe trauma events with no direct penetrating gastrointestinal injury; (2) Multiple surgeries with impaired renal function and intermittent hemodialysis treatment; (3) Progressive abdominal pain and tenderness, and peritoneal irritation was present on post-traumatic days 10-38; (4) Abdominal operations confirmed segment ulcer, necrosis of the small intestine, hyperplasia and stiffness of the intestinal wall; and (5) Pathological examinations suggested submucosal hemorrhage, necrosis, fibrosis and hyalinization of the vascular wall. Pathological examinations of all 3 patients suggested intestinal necrosis with fistulas. CONCLUSION: Intestinal necrosis is strongly asso-ciated with stress from trauma and post-traumatic complications; timely exploratory laparotomy maybe an effective method for preventing and treating stress-induced intestinal necrosis. PMID:22563202
Gong, Jia-Qing; Zhang, Guo-Hu; Tian, Fu-Zhou; Wang, Yong-Hua; Zhang, Lin; Cao, Yong-Kuan; Wang, Pei-Hong
Between July 1987 and December 1990 in Washington, DC, 116 patients sustained 146 fractures and seven dislocations due to an assault with a baseball bat. The ulna was the most common site of trauma (61 fractures), followed by the hand (27 injuries) and the radius (14 injuries). Forty-two of the 146 fractures were significantly displaced and required open reduction and internal fixation to restore satisfactory alignment. Twenty-nine of the 146 fractures were open fractures. Treatment protocol for open fractures consisted of irrigation and debridement, antibiotic therapy, and bone stabilization with either internal or external fixation, or casting. Recognition of the severity of the soft tissue and bone damage is important in the management of musculoskeletal trauma secondary to the baseball bat. Images Figure 1 Figure 2 Figure 3 PMID:1460683
Bryant, D. D.; Greenfield, R.; Martin, E.
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
McGeady, James B.; Breyer, Benjamin N.
Background In the context of increasing obesity prevalence, the relationship between large visceral adipose tissue (VAT) volumes and type 2 diabetes mellitus (T2DM) is unclear. In a clinical sample of severely obese women (mean body mass index [BMI], 46 kg/m2) with fasting normoglycemia (n=40) or dysglycemia (impaired fasting glucose+diabetes; n=20), we sought to determine the usefulness of anthropometric correlates of VAT and associations with dysglycemia. Methods VAT volume was estimated using multi-slice computer tomography; anthropometric surrogates included sagittal abdominal diameter (SAD), waist circumference (WC) and BMI. Insulin sensitivity (Si), and beta-cell dysfunction, measured by insulin secretion (AIRg) and the disposition index (DI), were determined by frequently sampled intravenous glucose tolerance test. Results Compared to fasting normoglycemic women, individuals with dysglycemia had greater VAT (P<0.001) and SAD (P=0.04), but BMI, total adiposity and Si were similar. VAT was inversely associated with AIRg and DI after controlling for ancestry, Si, and total adiposity (standardized beta, ?0.32 and ?0.34, both P<0.05). In addition, SAD (beta=0.41, P=0.02) was found to be a better estimate of VAT volume than WC (beta=0.32, P=0.08) after controlling for covariates. Receiver operating characteristic analysis showed that VAT volume, followed by SAD, outperformed WC and BMI in identifying dysglycemic participants. Conclusions Increasing VAT is associated with beta-cell dysfunction and dysglycemia in very obese women. In the presence of severe obesity, SAD is a simple surrogate of VAT, and an indicator of glucose dysregulation. PMID:23408092
Kahn, Henry S.; Gasevic, Danijela; Liang, Zhe; Frediani, Jennifer K.; Torres, William E.; Ziegler, Thomas R.; Phillips, Lawrence S.; Lin, Edward
Nuclear medicine imaging procedures can play a significant role in evaluating the pulmonary complications that are seen in trauma patients. A quantitative method for measuring increased pulmonary capillary permeability that uses Tc-99m HSA allows early diagnosis of acute respiratory distress syndrome (ARDS) and accurately differentiates this condition from pneumonia or cardiogenic pulmonary edema. This technique may be of great value in following the response to therapy. The use of 133Xe to diagnose inhalation injury remains an important diagnostic tool, particularly at hospitals with specialized burn units. Regional decreases in ventilation-perfusion images reliably localize aspirated foreign bodies. Radionuclide techniques that are used to demonstrate gastropulmonary aspiration remain controversial and require further clinical evaluation. Pulmonary perfusion imaging, although nonspecific, may provide the earliest clue for correct diagnosis of fat embolism, air embolism, contusion, or laceration. Furthermore, the possibility of perfusion abnormality due to these uncommon conditions must be remembered whenever trauma patients are evaluated for pulmonary thromboembolism with scintigraphy. Occasionally, liver or spleen scintigraphy may be the most appropriate procedure when penetrating chest trauma also involves these subdiaphragmatic organs.
Lull, R.J.; Tatum, J.L.; Sugerman, H.J.; Hartshorne, M.F.; Boll, D.A.; Kaplan, K.A.
The operative mortality following conventional abdominal aortic aneurysm (AAA) repair has not fallen significantly over the past two decades. Since its inception in 1991, endovascular aneurysm repair (EVAR) has provided an alternative to open AAA repair and perhaps an opportunity to improve operative mortality. Two recent large randomised trials have demonstrated the short and medium term benefit of EVAR over open AAA repair, although data on the long term efficacy of the technique are still lacking. This review aimed at providing an overview of EVAR and a discussion of the potential benefits and current limitations of the technique. PMID:17267674
Norwood, M G A; Lloyd, G M; Bown, M J; Fishwick, G; London, N J; Sayers, R D
This is a case study presented by the University of Pittsburgh Department of Pathology in which a 65-year-old man is complaining of abdominal pain. Visitors are given the radiology, gross and microscopic descriptions, flow cytometry, and molecular diagnostics, including images, and are given the opportunity to diagnose the patient. This is an excellent resource for students in the health sciences to familiarize themselves with using patient history and laboratory results to diagnose disease. It is also a helpful site for educators to use to introduce or test student learning in hematopathology.
Latulippe, Steven; Ohori, N. P.
This is a case study presented by the University of Pittsburgh Department of Pathology in which a 72-year-old man has abdominal pain, anorexia, and weight loss but no significant past medical history. Visitors are given both the microscopic and gross descriptions, including images, and are given the opportunity to diagnose the patient. This is an excellent resource for students in the health sciences to familiarize themselves with using patient history and laboratory results to diagnose disease. It is also a helpful site for educators to use to introduce or test student learning in autopsy pathology.
Nine, Jeff S.; Weir, Ed
This is the first case report of a ruptured aortic aneurysm presenting with acute right buttock pain. The patient was an 80 year old man. A literature search revealed one report of ruptured internal iliac artery aneurysm presenting with acute hip pain and another of an unruptured aortic aneurysm presenting with chronic hip pain. Thus the present case is another unusual presentation of ruptured abdominal aortic aneurysm and highlights the importance of careful history taking and clinical examination. A high index of clinical suspicion of aneurysm rupture should be maintained in elderly patients presenting with a history of collapse. PMID:15911962
Mahmood, F; Ahsan, F; Hockey, M
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.
Idoguchi, Koji, E-mail: email@example.com; Yamaguchi, Masato; Okada, Takuya [Kobe University Hospital, Department of Radiology and Center for Endovascular Therapy (Japan); Nomura, Yoshikatsu [Kobe University Hospital, Department of Cardiovascular Surgery (Japan); Sugimura, Kazuro [Kobe University Hospital, Department of Radiology and Center for Endovascular Therapy (Japan); Okita, Yutaka [Kobe University Hospital, Department of Cardiovascular Surgery (Japan); Sugimoto, Koji [Kobe University Hospital, Department of Radiology and Center for Endovascular Therapy (Japan)
Background Raoultella planticola was originally considered to be a member of environmental Klebsiella. The clinical significance of R. planticola is still not well known. Case presentation We describe the first case of necrotizing fasciitis involving the chest and abdominal wall caused by R. planticola. The identity of the organism was confirmed using 16S rRNA sequencing. The patient was successfully treated with the appropriate antibiotics combined with operative drainage and debridement. Conclusions R. planticola had been described as environmental species, but should be suspected in extensive necrotizing fasciitis after minor trauma in mild to moderate immunocompromised patients. PMID:22423899
A rare lateral abdominal wall hernia is described in an adult patient. This was diagnosed in a patient with a prominent right\\u000a lateral abdominal wall deformity. The patient had been experiencing pain that increased progressively in severity over time.\\u000a A computerized tomography (CT) scan of the abdomen revealed the location of the lateral abdominal wall defect. The hernia\\u000a defect was
M. Castillo-Sang; B. Gociman; B. Almaroof; J. Fath; F. Cason
Midline abdominal incisional hernias are common following open repair of abdominal aortic aneurysms. These may be caused by the weakness of connective tissue. This study sought to determine the prevalence of diastasis recti among unoperated Caucasian males with abdominal aortic aneurysm compared to a control group with atherosclerotic lower extremity peripheral arterial disease. Forty-two consecutive white males referred for evaluation of abdominal aortic aneurysm (n = 18) or peripheral arterial disease (n = 24) were examined by a single examiner at the Mayo Clinic. Both groups were similar in terms of age and smoking history, 2 major risk factors for both abdominal aortic aneurysm and peripheral arterial disease. Abdominal aortic aneurysm patients ranged in age from 59 to 89 (mean, 73.2) years. Seventeen of 18 (94.4%) had a history of smoking. Peripheral arterial disease patients ranged in age from 52 to 93 (mean, 70.8) years. Twenty-one of 24 (87.5%) had a history of smoking. Diastasis recti were present in 12 of 18 (66.7%) subjects with abdominal aortic aneurysm versus 4 of 24 (16.7%) subjects with peripheral arterial disease (P = .001, 2-tailed Fisher exact test). Diastasis recti are significantly more common in males with abdominal aortic aneurysm than peripheral arterial disease and may provide an important clue to screen for abdominal aortic aneurysm in those at risk. PMID:18550558
One of the key challenges in perioperative care is to reduce postoperative morbidity and mortality. Patients who develop postoperative morbidity but survive to leave hospital have often reduced functional independence and long-term survival. Mechanical ventilation provides a specific example that may help us to shift thinking from treatment to prevention of postoperative complications. Mechanical ventilation in patients undergoing surgery has long been considered only as a modality to ensure gas exchange while allowing maintenance of anesthesia with delivery of inhaled anesthetics. Evidence is accumulating, however, suggesting an association between intraoperative mechanical ventilation strategy and postoperative pulmonary function and clinical outcome in patients undergoing abdominal surgery. Non-protective ventilator settings, especially high tidal volume (VT) (>10-12mL/kg) and the use of very low level of positive end-expiratory pressure (PEEP) (PEEP<5cmH2O) or no PEEP, may cause alveolar overdistension and repetitive tidal recruitment leading to ventilator-associated lung injury in patients with healthy lungs. Stimulated by previous findings in patients with acute respiratory distress syndrome, the use of lower tidal volume ventilation is becoming increasingly more common in the operating room. However, lowering tidal volume, though important, is only part of the overall multifaceted approach of lung protective mechanical ventilation. In this review, we aimed at providing the most recent and relevant clinical evidence regarding the use of mechanical ventilation in patients undergoing abdominal surgery. PMID:25153670
Futier, E; Godet, T; Millot, A; Constantin, J-M; Jaber, S
Penetrating spinal cord injuries are rare but potentially devastating injuries that are associated with significant morbidity. The objective of this study was to assess the impact of abdominal hollow viscus injuries (HVIs) on neurologic and spinal infectious complications in patients sustaining penetrating spinal cord injuries. We performed a 13-year retrospective review of a Level I trauma center database. Variables analyzed included demographics, injury patterns and severity, spine operations, and outcomes. Spine and neurologic infections (SNIs) were defined as paraspinal or spinal abscess, osteomyelitis, and meningitis. Multivariate analysis was performed to identify factors associated with SNI. Of 137 patients, there were 126 males (92%) with a mean age of 27 ± 10 years. Eight patients (6%) underwent operative stabilization of their spine. Fifteen patients (11%) developed SNI. There was a higher incidence of SNI among patients with abdominal HVI compared with those without (eight [26%] vs six [6%], P < 0.001). On multivariate analysis, after controlling for injury severity, solid abdominal injury and HVI, vascular injury, and spine operation, abdominal HVIs were independently associated with an increased risk for SNI (odds ratio, 6.88; 95% confidence interval, 2.14 to 22.09; P = 0.001). Further studies are required to determine the optimal management strategy to prevent and successfully treat these infections. PMID:25264640
Schwed, Alexander C; Plurad, David S; Bricker, Scott; Neville, Angela; Bongard, Fred; Putnam, Brant; Kim, Dennis Y
Urban trauma, often presumed to be an acute episodic event, may actually be a chronic recurrent disease related to the lifestyle, environment, and other factors of its victims. To test this idea an attempt was made to obtain 5-year followup for 501 consecutive survivors of violent trauma seen at one hospital, 1980-1981. Followup information for these patients was obtained from medical records at four local Level I trauma centers, death certificates, Medical Examiner's records, and police crime computer files. Of the 501 patients, 263 had medical followup including 148 patients with one trauma and 115 patients with recurrent trauma. Of these 263 patients, 200 (76%) were unemployed and 164 (62%) abused alcohol or drugs. From 1982-1987 142 out of 263 patients were involved in 133 crimes and 52 died. These data suggest that urban trauma is a chronic disease with a recurrent rate of 44% and a 5-year mortality rate of 20%. PMID:2746704
Sims, D W; Bivins, B A; Obeid, F N; Horst, H M; Sorensen, V J; Fath, J J
The co-occurence of addiction with trauma-based mental health problems forms a toxic feedback loop, creating assessment and treatment challenges for consumers and their healthcare providers. Traditional separation of addiction and mental health treatment has contributed to a high level of recidivism among clients challenged by trauma and addiction problems. A new treatment model rooted in an understanding of trauma re-enactment,
The fiftieth anniversary of the death by assassination of President John Kennedy is an opportunity to pay homage to his memory and also reflect on the important role plastic surgeons have played in the management of trauma. That reflection included a hypothetical scenario, a discussion of the surgical treatment of Kennedy (if he survived) and Governor Connally. The scenario describes the management of cranioplasty in the presence of scalp soft-tissue contracture, reconstruction of the proximal trachea, reconstitution of the abdominal wall, and restoration of a combined radius and soft-tissue defect. The development of diagnostic and therapeutic advances over the past 50 years in the care of maxillofacial trauma is described, including the evolution of imaging, timing of surgery, and operative techniques. Finally, contemporary measures of triage in situations involving mass casualties, as in the Boston Marathon bombings, complete the dedication to President Kennedy. PMID:24165614
Luce, Edward A; Hollier, Larry H; Lin, Samuel J
This case highlights the need for cautious management and serial regular examination of trauma patients. A 22-year-old Caucasian male presented to the emergency department 4 h following an injury sustained during football training. He complained of the immediate onset of severe left upper quadrant and left flank pain. He subsequently developed frank haematuria. On initial review, he was haemodynamically stable. CT of the abdomen and pelvis showed a grade 4 renal trauma. Over the following 36 h, he remained haemodynamically stable. On serial abdominal examinations however, he developed a rigid abdomen and was noted to have a haemoglobin drop. Interval CT scan showed a progression of his injury and the presence of a haemoperitoneum. An emergency laparotomy was performed resulting in a left nephrectomy. He made an uneventful recovery. PMID:22605590
Fanning, Deirdre Mary; Forde, James C; Mohan, Ponnusamy
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
Lidén, E; Berlin, R; Janzon, B; Schantz, B; Seeman, T
In this paper, a normalized abdominal coordinate system is defined for abdominal atlas mapping in CT and MR volume images. This coordinate system is independent of both the abdomen size and the respiratory motion. A real-time atlas mapping algorithm based on this coordinate system is also proposed. The purpose of this algorithm is to provide initial positions for abdominal organ
Hongkai Wang; Jing Bai; Yongxin Zhou; Yonghong Zhang
In cardiac trauma the two main mechanisms of injury are blunt and penetrating trauma. Common cardiac effects of trauma include myocardial rupture, contusion, laceration, pericardial insult, coronary injury, valvular damage, arrhythmias, and conduction abnormalities. Hemodynamic instability can develop rapidly and pose marked risk to patient survival. An adequate level of clinical awareness and timely use of diagnostic techniques such as echocardiography, aortography, and cardiac angiography are essential for rapid identification of cardiac trauma. Once the diagnosis is made, prompt surgical intervention is often the key to survival. PMID:9158386
Olsovsky, M R; Wechsler, A S; Topaz, O
Childhood psychic trauma appears to be a crucial etiological factor in the development of a number of serious disorders both in childhood and in adulthood. Like childhood rheumatic fever, psychic trauma sets a number of different problems into motion, any of which may lead to a definable mental condition. The author suggests four characteristics related to childhood trauma that appear to last for long periods of life, no matter what diagnosis the patient eventually receives. These are visualized or otherwise repeatedly perceived memories of the traumatic event, repetitive behaviors, trauma-specific fears, and changed attitudes about people, life, and the future. She divides childhood trauma into two basic types and defines the findings that can be used to characterize each of these types. Type I trauma includes full, detailed memories, "omens," and misperceptions. Type II trauma includes denial and numbing, self-hypnosis and dissociation, and rage. Crossover conditions often occur after sudden, shocking deaths or accidents that leave children handicapped. In these instances, characteristics of both type I and type II childhood traumas exist side by side. There may be considerable sadness. Each finding of childhood trauma discussed by the author is illustrated with one or two case examples. PMID:1824611
Terr, L C
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
Long, Walter C
Management of massive liver trauma (grades IV-VI) is associated with high morbidity and mortality. It can pose serious challenges to treating physician and requires multimodality interventions. For a successful outcome, timing of intervention is crucial. We report a case of grade V hepatic injury treated successfully with angioembolization, laparoscopic lavage, and endoscopic stenting during a time period from admission to discharge on the 24th day. Angioembolization was performed at admission after resuscitation as CT scan showed active extravasation in the arterial phase. Laparoscopic lavage and drainage was performed on the fifth day as abdominal inflammatory response failed to respond to medical management. There was biliary component of abdominal fluid noticed during laparoscopy, which manifested by postoperative localized biliary fistula; hence endoscopic stenting of the bile duct was performed on the seventh day. The patient recovered well with timely minimal invasive approach and was fine at 1 year follow-up. PMID:24426645
Thapar, Pinky M; Ghawat, Ravindra M; Dalvi, Abhay N; Rokade, Muktachand L; Philip, Roji M; Warawdekar, Gireesh M; Bapat, Mukta R
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
Frink, Michael; Andruszkow, Hagen; Zeckey, Christian; Krettek, Christian; Hildebrand, Frank
The abdominal muscles form part of the expiratory pump in cooperation with the other expiratory muscles, primarily the internal intercostal and triangularis sterni muscles. The discharge of abdominal muscles is divided into four main patterns: augmenting, plateau, spindle and decrementing. The patterns tend to be species-specific and dependent on the state of the central nervous system. Recent studies suggest that the abdominal muscles are more active than classically thought, even under resting conditions. Expiratory bulbospinal neurons (EBSN) in the caudal ventral respiratory group are the final output pathway to abdominal motoneurons in the spinal cord. Electrophysiological and anatomical studies indicated the excitatory monosynaptic inputs from EBSN to the abdominal motoneurons, although inputs from the propriospinal neurons seemed to be necessary to produce useful motor outputs. Respiration-related sensory modulation of expiratory neurons by vagal afferents that monitor the rate of change of lung volume and the end-expiratory lung volume (EELV) play a crucial role in modulating the drive to the abdominal musculature. Studies using in vitro and in situ preparations of neonatal and juvenile rats show bi-phasic abdominal activity, characterized by bursting at the end of expiration, a silent period during the inspiratory period, and another burst that occurs abruptly after inspiratory termination. Since the abdominal muscles rarely show these post-inspiratory bursts in the adult rat, the organization of the expiratory output pathway must undergo significant development alterations. PMID:21255690
The abdominal sacrocolpopexy is an excellent procedure to surgically treat vaginal vault prolapse. A synthetic graft is often used to support the vaginal apex, but has the potential to become infected or erode, requiring its removal or revision. The purpose of this paper is to report our experience in the management of patients with infected synthetic grafts after abdominal sacrocolpopexy.
T. Fleming Mattox; Edward J. Stanford; E. Varner
Abdominal aortic aneurysms (AAA) are an expansion in diameter of the abdominal aorta and their rupture is a leading cause of mortality. One of the treatments for AAA is the implantation of an endograft (also called a stent graft), a combination...
Meyer, Clark A.
This is a case study presented by the University of Pittsburgh Department of Pathology, which describes a 60-year-old woman who presented with a history of marked abdominal distention lasted for several months with associated progressive fatigue, progressive weight loss and fever. Visitors are given patient history along with gross and microscopic descriptions, including images, and are given the opportunity to diagnose the patient. A "Final Diagnosis" section provides a discussion of the findings as well as references. This is an excellent resource for students in the health sciences to familiarize themselves with using patient history and laboratory results to diagnose disease. It is also a helpful site for educators to use to introduce or test student learning in soft tissue pathology.
Rao, Uma N.; Sepulveda, Antonia; Yu, Hongbo
who bear witness to personal and historic traumas, and bythe trauma theorist Cathy Caruth has argued, to bear witnesswitness to incomprehensibility. 14 Since by definition the event that caused psychic trauma—
... should a rural hospital be part of the regional and statewide trauma system? Yes. Given that death ... unnecessary trauma deaths. Where is there information about regional or statewide trauma systems? The best place to ...
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
Serbia, a middle-income country, is located in southeastern Europe, with territory of 88,361 km(2) and 9,400,000 inhabitants. Average month salary is US$542 and the registered unemployment rate is 22%. The country is administratively divided into 30 districts (193 municipalities). The healthcare system is territorially organized. In the state capital there are five clinical hospitals with musculoskeletal traumatology departments, as well as one in each of the four university centers. In addition, there are orthopaedic departments in 40 smaller hospitals throughout the country and in three military hospitals, along with several pediatric surgical departments involved in managing musculoskeletal trauma. There are 524 orthopaedic trauma surgeons (1:18,000 people), with a minor number of additionally trained general and pediatric surgeons who care for musculoskeletal problems. Bonesetters are neither recognized nor included in the healthcare system. Orthopaedic traumatology services are well organized, with variable accessibility depending on the distance between injury site and nearest medical facility. Preventive strategies are well developed and mainly consider agricultural, industrial, and traffic injuries. Distribution of medical institutions is satisfactory. Future activities should include continuing medical education of specialists, exclusion of inappropriate specialists, improvement of preventive strategies and medical transport facilities, as well as standardization of medical equipment, diagnostics, and treatment protocols. PMID:18622666
Vukasinovi?, Zoran; Spasovski, Dusko; Zivkovi?, Zorica
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
Patel, Alpen; Groppo, Eli
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
van de Weyer, P S; Praetorius, M; Tisch, M
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.
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…
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…
Solomon, Eldra P.; Heide, Kathleen M.
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 one every two 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
Walter C. Long
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…
Adkins, Myrna Ann; Harper, Eric
Blunt chest traumas are a clinical challenge, both for diagnosis and treatment. The use of Cardiovascular Magnetic Resonance can play a major role in this setting. We present two cases: a 12-year-old boy and 45-year-old man. Late gadolinium enhancement imaging enabled visualization of myocardial damage resulting from the trauma. PMID:19761581
Huguet, Marina; Tobon-Gomez, Catalina; Bijnens, Bart H; Frangi, Alejandro F; Petit, Marius
The present study sought to explore the relationship between trauma and violence, as measured by the Traumatic Events Questionnaire and the Conflict Tactics Scale. Using Multiple Regression Analysis, several types of traumatic experiences were studied as predictors to violent behavior in 55 graduate students. Results suggest that trauma as a set, as well as being the victim of a violent
Daniel J. Neller; Robert L. Denney; Christina A. Pietz; R. Paul Thomlinson
Background: Ocular trauma is a significant health problem in pediatric patients. Objectives: The aim of this study was to analyze the characteristics of ocular-trauma-related hospitalization of children in Kashan. Patients and Methods: This descriptive, cross-sectional study included 131 children aged less than 16 years with ocular trauma, who were admitted to the Matini Hospital at the Kashan University of Medical Sciences between April 2006 and March 2009. After admission, detailed ocular examination was performed, and their ocular trauma was classified according to the International Ocular Trauma Classification and Birmingham Eye Trauma Terminology systems. Results: Mean age of the patients was 7.8 ± 2.2 years (age range, 0–16 years), and male to female ratio 5:1. The most common cause of admission was hyphema (38.1%), followed by corneoscleral laceration (27.5%). Ocular trauma most commonly occurred at home (43%), and 69% of the patients presented to the emergency room within 24 h of injury. In 30% of the patients, initial visual acuity at the time of presentation was less than 20/200 (Figure 1). Conclusions: Ocular trauma is a major cause of unilateral blindness, especially in young boys, and hence, preventive measures and education is required. PMID:24719840
Aghadoost, Davood; Fazel, Mohammad Reza; Aghadoost, Hamid Reza
Abstract Gr oup interventions for trauma s ur vivor s off er cost- ef ficient oppor tunities f or members to join “fellow str ugglers ” in coping w ith trauma-r elated f eelings of alienation and mistrus t. F or adults, s uppor tive, ps ychodynamic, and cognitive- behavior al models have been described in the liter ature, each
David W. Foy; Cynthia B. Eriksson; Gary A. Trice
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…
Steele, William; Kuban, Caelan
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
Jackson, Thomas E.; Sood, Vaneeta; Haigh, Paul M.
Betrayal trauma theory suggests social and cognitive development may be affected by early trauma such that individuals develop survival strategies, particularly dissociation and lack of betrayal awareness, which 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
Robyn L. Gobin
This article examines an enigma at the heart of Freud's work on trauma: the surprising emergence, from within the theory of the death drive, of the drive to life, a form of survival that both witnesses and turns away from the trauma in which it originates. I analyse in particular the striking juxtaposition, in Freud's founding work Beyond the Pleasure
The objective of this study was to examine the relationships between combat related trauma, insomnia, and alcohol misuse. The author reviewed the standardized tests results from 39 active duty service members, all of whom had recent deployments to either Iraq or Afghanistan. The battery of self-test instruments assessed the effects of military trauma, anxiety, depression, alcohol use, and insomnia. Among the study subjects, the entire group reported significant sleep problems, with bedtime arousals impeding sleep initiation. Male subjects' reported an average AUDIT score of 8.62. Service members with higher trauma scores also reported greater misuse of alcohol. The high trauma scores also correlated with specific pre-sleep cognitive and somatic factors. The findings of this study lend support for the use of standardized instruments for assessing sleep problems, along with similar tests for trauma and substance misuse, which together should help identify high risk military patients. PMID:23244556
Lande, R Gregory
The present study aimed to determine the intra-abdominal pressure during front crawl swimming at different velocities in competitive swimmers and to clarify the relationships between stroke indices and changes in intra-abdominal pressure. The subjects were 7 highly trained competitive collegiate male swimmers. Intra-abdominal pressure was measured during front crawl swimming at 1.0, 1.2 and 1.4?m?·?s(-1) and during the Valsalva maneuver. Intra-abdominal pressure was taken as the difference between minimum and maximum values, and the mean of 6 stable front crawl stroke cycles was used. Stroke rate and stroke length were also measured as stroke indices. There were significant differences in stroke rate among all velocities (P < 0.05). However, there was no significant difference in stroke length by velocity. Significant within-subject correlations between intra-abdominal pressure and stroke rate or stroke length (P < 0.01) were observed, although there were no significant correlations between intra-abdominal pressure and stroke indices when controlling for swimming velocity. These findings do not appear to support the effectiveness of trunk training performed by competitive swimmers aimed at increasing intra-abdominal pressure. PMID:23868677
Moriyama, S; Ogita, F; Huang, Z; Kurobe, K; Nagira, A; Tanaka, T; Takahashi, H; Hirano, Y
Kihlstrom (2005) has recently called attention to the need for prospective longitudinal studies of dissociation. The present study assesses quality of early care and childhood trauma as predictors of dissociation in a sample of fifty-six low income young adults followed from infancy to age 19. Dissociation was assessed with the Dissociative Experiences Scale; quality of early care was assessed by observer ratings of mother-infant interaction at home and in the lab; and childhood trauma was indexed by state-documented maltreatment, self-report, and interviewer ratings of participants’ narratives. Regression analysis indicated that dissociation in young adulthood was significantly predicted by observed lack of parental responsiveness in infancy, while childhood verbal abuse was the only type of trauma that added to the prediction of dissociation. Implications are discussed in the context of previous prospective work also pointing to the important contribution of parental emotional unresponsiveness in the development of dissociation. PMID:19525736
Dutra, Lissa; Bureau, Jean-Francois; Holmes, Bjarne; Lyubchik, Amy; Lyons-Ruth, Karlen
Kihlstrom (2005) has recently called attention to the need for prospective longitudinal studies of dissociation. The present study assesses quality of early care and childhood trauma as predictors of dissociation in a sample of 56 low-income young adults followed from infancy to age 19. Dissociation was assessed with the Dissociative Experiences Scale; quality of early care was assessed by observer ratings of mother-infant interaction at home and in the laboratory; and childhood trauma was indexed by state-documented maltreatment, self-report, and interviewer ratings of participants' narratives. Regression analysis indicated that dissociation in young adulthood was significantly predicted by observed lack of parental responsiveness in infancy, while childhood verbal abuse was the only type of trauma that added to the prediction of dissociation. Implications are discussed in the context of previous prospective work also pointing to the important contribution of parental emotional unresponsiveness in the development of dissociation. PMID:19525736
Dutra, Lissa; Bureau, Jean-Francois; Holmes, Bjarne; Lyubchik, Amy; Lyons-Ruth, Karlen
In this paper we present our experience concerning abdominal tuberculosis. The aim of this study is to evaluate various methods and to establish therapeutic approach to patients with abdominal tuberculosis. There were six patients (3 males and 3 females), aged between 22 and 67 years old, such as: 2 patients developed peritoneal tuberculosis, 3 patients developed intestinal tuberculosis and one patient developed mesenteric lymph node tuberculosis. We concluded that early diagnosis is often impossible and laboratory report was non-specific. Because surgical treatment in abdominal tuberculosis was made in complicate forms, we concluded that enterostomy "a minima" is the best therapeutic method. PMID:15675286
Me?in?, C; Pa?alega, M; Vâlcea, D; Vasile, I
A new art of ''interventional radiology'' has been developed in the past few years. Major applications include postoperative instrumentation of the biliary tract, percutaneous biliary drainage, tumor biopsy, abscess drainage, and intestinal-intubation procedures. Intervention by angiography encompasses injection of such substances as Pitressin (vasopressin), and embolization. These procedures have been of immense value. Fortunately, complications, such as sepsis and bleeding, have been infrequent. Computerized body tomography has also proved extremely important, particularly in the diagnosis of subphrenic abscess and pancreatic and pelvic pathology. /sup 99m/Tc-labeled-erythrocyte scans can be used to detect gastrointestinal bleeding sites. Scans can also identify hepatobiliary disease and splenic injury or differentiate the cause of jaundice. /sup 111/Indium-labeled autologous leukocytes may be useful in differentiating a pancreatic abscess from a pseudocyst. The advantage of indium scans over /sup 67/Ga scans is that a shorter time is required for maximum resolution: gallium requires 48 hours, indium 4. Another advantage is that indium is cleared through the liver and spleen and is not secreted into the bowel. /sup 67/Ga is absorbed by lymphomas and hepatocarcinomas. Nuclear magnetic resonance has many possible uses in abdominal surgery, but so far little information is available. This technique has been used to detect an empyema of the gallbladder that was not diagnosed by ultrasound. Among hepatic lesions, it can easily differentiate tumors from cysts and in that regard is superior to both ultrasound and scan. (JMT)
Welch, C.E.; Malt, R.A.
This systematic review focuses on the 30-day mortality associated with open surgery and fenestrated endografts for short-necked (<15 mm) juxtarenal abdominal aortic aneurysms. A search for studies published in English and indexed in the PubMed and Medline electronic databases from 2002 to 2012 was performed, using “juxtarenal abdominal aortic aneurysm” and “treatment” as the main keywords. Among the 110 potentially relevant studies that were initially identified, eight were in accordance with the inclusion criteria in the analysis. Similar outcomes for open and endovascular repair were observed for 30-day mortality. No differences were observed regarding the secondary outcomes (duration of surgery, hospital stay, postoperative renal dysfunction and late mortality), except that the late mortality rate was significantly higher for the patients treated with open repair after a median follow-up of 24 months. Fenestrated endografting is a viable alternative to conventional surgery in juxtarenal abdominal aortic aneurysms with a proximal neck <15 mm.
Belczak, Sergio Quilici; Lanziotti, Luiz; Botelho, Yuri; Aun, Ricardo; da Silva, Erasmo Simao; Puech-Leao, Pedro; de Luccia, Nelson
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
Gregorowski, Claire; Seedat, Soraya
Using longitudinal data, the present study examined change in midlife neuroticism following trauma exposure. Our primary analyses included 670 participants (M(age) = 60.55; 65.22% male, 99.70% Caucasian) who completed the NEO Personality Inventory at ages 42 and 50 and reported their lifetime exposure to traumatic events approximately 10 years later. 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. Overall, our findings suggest that neuroticism does not reliably change following exposure to traumatic events in middle adulthood. 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. Life-threatening traumatic events encountered early in life may have a more pronounced impact on adulthood personality than recent traumatic events. PMID:23550961
Ogle, Christin M; Rubin, David C; Siegler, Ilene C
By comparing Somali narratives of emotion and suffering with literature about emotion in relation to trauma and "the refugee experience," this paper contributes to the understanding of emotion, suffering, and trauma in different cultural and sociopolitical contexts, and interrogates the roles and methods of ethnographies of trauma in situations of high political, social, and economic stakes. In the mid-1990s, emotional distress among Ethiopian Somali returnees was about social rupture and injustice and not simply about private suffering. Emotion is critical to creating, recognizing, reinforcing, and mobilizing the moral webs on which both individual and collective survival depend. In the aftermath of dispossession and war, and amidst ongoing hunger and destitution, certain expressions of emotion carry a particularly important valence: anger, passion, and rhetorics of demoralization revolving around a collective narrative of dispossession and demands for restitution. "Experience near" descriptions of Somali emotion expressions cannot be conflated with "psychological" analyses or "Posttraumatic Stress Disorder." Somali refugee narratives index and challenge the embodiment in lived experience of local, national, and global institutions' (in)action and inequality. To the extent that academic debates over emotion and trauma help to shape, reinforce, or challenge the assumptions and practices of institutions affecting millions of lives, we researchers must address in our analyses the practical and political implications of how we interpret and write about emotion, trauma, and politics. PMID:15470948
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.
Stuart, J. J.; Brown, S. J.; Beeman, R. W.; Denell, R. E.; Spooner, B. S. (Principal Investigator)
Background and objective Abdominal obesity is associated with the risk of developing disorders, such as diabetes and hypertension. The objective of this study was to investigate the prevalence of abdominal obesity in Abia State, Nigeria. Materials and methods We carried out a cross-sectional study aimed at ascertaining the prevalence of abdominal obesity in Abia State, Nigeria. Participants in the study were recruited from communities in the three senatorial zones in the state. Screening for abdominal obesity was carried out in these subjects using waist circumference (the National Cholesterol Education Program Third Adult Treatment Panel criteria were used). The World Health Organization Stepwise Approach to Surveillance of chronic disease risk factors was used. Body mass index, anthropometric measurements, and other relevant data were also collected. Results Data on waist circumference were obtained from 2,807 subjects. The prevalence of obesity using body mass index in the population was 11.12%. In men and women, it was 7.73%, and 14.37%, respectively. The prevalence of abdominal obesity in the population was 21.75%. In men and women, it was 3.2% and 39.2%, respectively. Conclusion The prevalence of abdominal obesity is high in Nigeria, and needs to be monitored because it is associated with increased cardiovascular risk. PMID:23946664
Ijezie, Innocent Chukwuonye; Chuku, Abali; Onyeonoro, Ugochukwu Uchenna; Okpechi, Ikechi Gareth; Madukwe, Okechukwu Ojoemelam; Umeizudike, Theophilus Ifeanyichukwu; Ogah, Okechukwu Samuel
Radiography has been proved to be a good diagnostic tool in visualization of many radiopaque xenobiotics in clinical toxicology. Zinc is a potentially radiopaque material which is a constituent of the zinc phosphide (ZN2P3) rodenticide. We report two cases of zinc phosphide poisoning with positive abdominal X-rays in whom the diagnosis was confirmed by abdominal imaging. Positive abdominal imaging was an indication for aggressive management; however, aggressive treatment was not lifesaving in one of them. We aim to emphasize the diagnostic value of abdominal X-rays in zinc phosphide-poisoned patients. We also would like to suggest that zinc phosphide (ZP)-poisoned patients with positive X-rays have more chance to become unstable even if they are symptom free on presentation and should be more aggressively managed. PMID:24477450
Hassanian-Moghaddam, Hossein; Shahnazi, Makhtoom; Zamani, Nasim; Bahrami-Motlagh, Hooman
A 5-year-old, female Ragdoll cat was diagnosed with an intra-abdominal mycetoma involving the ileocaecal region. Diagnosis was obtained via histopathological examination following surgical resection of the mass and an ileocolic anastomosis. The initial surgery was complicated by lymphangiectasia, chylous abdominal effusion and mild bacterial leakage from the anastomosis site. A second, exploratory laparotomy was performed to augment the anastomosis with serosal patching and omentalisation and to investigate a cystic structure observed on follow-up abdominal ultrasound. Initial amoxycillin clavulanate (Clavulox; Pfizer Animal Health) therapy was ineffective, but clindamycin (Antirobe; Pfizer Animal Health) proved successful in resolving the infection. Abdominal actinomycetoma in the cat may be an under-diagnosed condition due to its close resemblance to neoplastic disease. Standard diagnostic and therapeutic regimens are commonly ineffective in Actinomyces species infections. Surgical resection along with adjunctive, long-term, selective antimicrobial therapy is effective and prognosis is good for localised lesions. PMID:19181557
Sharman, Mellora J; Goh, Clara S; Kuipers von Lande, Richard G; Hodgson, Jennifer L
Abdominal hernias are common with over 20 million hernia repairs performed worldwide. Inguinal hernias are the most common type of hernia. Inguinal and sports hernia have been discussed at length in recent literature, and therefore, they will not be addressed in this article. The noninguinal hernias are much less common but do occur, and knowledge of these hernias is important when assessing the athlete with abdominal pain. Approximately 25% of abdominal wall hernias are noninguinal, and new data show the order of frequency as umbilical, epigastric, incisional, femoral, and all others (i.e., Spigelian, obturator, traumatic). Return-to-play guidelines need to be tailored to the athlete and the needs of their sport. Using guidelines similar to abdominal strain injuries can be a starting point for the treatment plan. Laparoscopic repair is becoming more popular because of safety and efficacy, and it may lead to a more rapid return to play. PMID:24614421
Cabry, Robert J; Thorell, Erik; Heck, Keith; Hong, Eugene; Berkson, David
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
de Cleva, Roberto; de Assumpcao, Marianna Siqueira; Sasaya, Flavia; Chaves, Natalia Zuniaga; Santo, Marco Aurelio; Flo, Claudia; Lunardi, Adriana C.; Filho, Wilson Jacob
The author analyzes recent developments in trauma theory, made necessary especially after the massive psychic traumas following World War II and the Shoah. The theories of Freud and Ferenczi are analyzed, especially, their different views of reality and their clinical attitude. When working with survivors of any trauma (from incest to genocide) it is necessary to reconstruct the historical details as carefully as possible, with the appropriate timing. Psychoanalysis is therefore viewed as an ethical and political practice similar to testimony, allowing the reconstruction of truth within the community and interrupting the cycle of the death instinct from one generation to the next. PMID:24603171
It's been 30 years since an endovascular technique to control traumatic hemorrhage was first described. Despite major technical advances in both diagnostic and therapeutic technology, and a great deal of experience since then, endovascular techniques are rarely considered as part of frontline management for vascular trauma. This review considers the literature and calls for better planning and implementation of diagnostic and image=guided therapeutic facilities. Endovascular techniques should be an essential part of vascular trauma management along with endovascular specialists, partners in trauma teams.
Nicholson, Anthony A. [Leeds Teaching Hospitals, Dept. of Radiology (United Kingdom)], E-mail: firstname.lastname@example.org
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
Purpose: The technical elements and early results of laparoscopic-assisted abdominal aortic aneurysmectomy are described. Methods: From February 1997 to May 1999, 60 patients underwent elective laparoscopic surgery for infrarenal abdominal aortic aneurysm. Patients ranged in age from 53 to 87 years (mean age, 70.6 years). The mean aneurysm size was 5.7 cm (range, 4.4-8.0 cm). All patients underwent aortography and
John J. Castronuovo; Kevin V. James; Michael Resnikoff; Edward R. McLean; John K. Edoga
The purpose of the trauma team is to provide advanced simultaneous care from relevant specialists to the seriously injured trauma patient. When functioning well, the outcome of the trauma team performance should be greater than the sum of its parts. Trauma teams have been shown to reduce the time taken for resuscitation, as well as time to CT scan, to
Andrew Georgiou; David J Lockey
The purpose of the current study was to examine the role of betrayal trauma in explaining why women report higher rates of posttraumatic stress than men. Betrayal trauma theory posits that cognitive dissociation is adaptive when trauma occurs at the hands of a caregiver (Freyd, 1996). Betrayal trauma has also been linked to poorer outcomes in mental health, including depression,
Sharon Shin Shin Tang; Jennifer J. Freyd
Introduction: The purpose of this study was to identify characteristics and perceptions of trauma recidivists. Information obtained from this study will help health care professionals better understand trauma patients and design more effective trauma prevention programs. Methods: An exploratory descriptive, correlational design was used. A convenience sample of 100 trauma patients entering a midwestern university medical center were studied. A
Vicki Keough; Dorothy Lanuza; Judith Jennrich; Meg Gulanick; Karyn Holm
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
Hinterseher, Irene; Tromp, Gerard; Kuivaniemi, Helena
Functional abdominal pain syndrome is characterised by frequent or continuous abdominal pain associated with a degree of loss of daily activity. It has a reported population prevalence of between 0.5% and 1.7%, with a female preponderance. The pathophysiology of functional abdominal pain is incompletely understood although it has been postulated that peripheral sensitisation of visceral afferents, central sensitisation of the spinal dorsal horn and aberrancies within descending modulatory systems may have an important role. The management of patients with functional abdominal pain requires a tailored multidisciplinary approach in a supportive and empathetic environment in order to develop an effective therapeutic relationship. Patient education directed towards an explanation of the pathophysiology of functional abdominal pain is in our opinion a prerequisite step and provides the rationale for the introduction of interventions. Interventions can usefully be categorised into general measures, pharmacotherapy, psychological interventions and 'step-up' treatments. Pharmacotherapeutic/step-up options include tricyclic antidepressants, serotonin noradrenergic reuptake inhibitors and the gabapentinoids. Psychological treatments include cognitive behavioural therapy and hypnotherapy. However, the objective evidence base for these interventions is largely derived from other chronic pain syndrome, and further research is warranted in adult patients with functional abdominal pain. PMID:25193056
Farmer, Adam D; Aziz, Qasim
INTRODUCTION Abdominal cocoon (sclerosing encapsulating peritonitis) (SEP) is a rare condition, mostly affecting adolescent girls living in tropical/subtropical region. Its etiology is unknown. It may cause acute or sub-acute intestinal obstruction. PRESENTATION OF CASE We report here a 39 year old male who complained of long standing colicky abdominal pain, with significant weight loss. Abdomen CT scan showed clumping of ileal loops at the level of umbilicus, with a thin capsule surrounding it. Laparoscopy revealed abdominal cocoon, biopsy of which showed dense hypocellular fibro-collagenous tissue with no neoplastic or granulomatous process. Excision of fibrous tissue and release of adhesions was done. Patient was symptoms free after five months follow up. DISCUSSION Abdominal exploration is usually needed for the diagnosis and treatment of abdominal cocoon. A thick fibrotic peritoneal wrapping of the bowel is usually found. Complete recovery is the result in majority of cases after surgical removal of the wrap causing the cocoon. CONCLUSION Primary sclerosing encapsulating peritonitis (cocoon abdomen) diagnosis needs a high index of suspicion, as signs and symptoms are nonspecific and imaging findings are not always conclusive. Careful excision of the accessory peritoneal sac and lysis of adhesions between bowels is the best treatment. Prognosis is generally good. PMID:25217877
Al Ani, Amer Hashim; Al Zayani, Najah; Najmeddine, Mohammad; Jacob, Sunitha; Nair, Sunil
Background Africa has 4% of the global vehicles but accounts for about one tenth of global vehicular deaths. Major trauma in Kenya is associated with excess mortality in comparison with series from trauma centers. The determinants of this mortality have not been completely explored. Objectives To determine the factors affecting mortality among road users in Nairobi, Kenya. Methods Cross-sectional study of prospectively collected data of trauma admissions at the Kenyatta National Hospital over a calendar year (2009–2010). Information collected included age, gender, road user type, principal anatomical region of injury, admission status, admission blood pressure and GCS, disposition destination, Injury Severity Score (ISS), injuries sustained, treatment and mortality at two weeks. Major or severe injury was defined as injuries of ISS?>?15. Groups based on in-hospital survival were compared using determinants of mortality using X2 or students t-test as appropriate. Logistic regression was used to assess the independence of predictive variables. Results One thousand six hundred forty seven (1647) patients were admitted for trauma during the study period. Traffic admissions were 1013 (61.7%) and males predominated (79.8%). The average age of patients admitted was 31.7 years. Pedestrians, vehicle occupants and motorcyclists represented 43.3%, 27.2% and 15.2% of the road users injured. The proportion of patients with ISS?>?15 was 10.9%. The overall mortality was 7.7%. Mortality for ISS?>?15 was 27.6%. The following factors significantly predicted mortality on univariate analysis: head injury, abdominal injury, transfer in status, blood transfusion, ICU admission, age?>?60 years, Glasgow coma scale (GCS) and injury severity. GCS (p?=?0.001) and ISS?>?15 (p?0.05) remained significant predictors on regression analysis. Conclusion Trauma mortality rates in this study exceed those from mature trauma systems. Head injury and injury severity based on the ISS are independent predictors of mortality after traffic trauma. Improvements in neurosurgical and critical care services ingrained within wider primary and secondary prevention initiatives are logical targets. PMID:24524582
Objectives Recent evidence suggests depression could result in abdominal obesity in the elderly. Few longitudinal studies are available and none has been conducted outside of the US. Methods To examine the relationship between depressive symptoms and abdominal obesity, data from 3998 community dwelling Chinese elderly men and women aged 65 years and above with 4-year follow up were analyzed. Depression was defined by a Geriatric Depression Scale score of 8 or higher. At baseline and after 4 years, overall obesity measures included body mass index, percentage of body fat and general adiposity or body fat index (BFI) (expressed by total body fat mass measured by DEXA in kilograms divided by the square of stature in metres). Abdominal obesity measures included waist circumference, waist hip ratio and relative truncal fat (ratio of truncal fat mass to total fat mass measured by DEXA). Results After adjustment for socio-demographics, lifestyle and medical factors, the presence of clinically relevant depressive symptoms at baseline was associated with significant decrease in waist circumference at follow up after adjusting for socio-demographic factors, baseline obesity, lifestyle and medical factors (?=?1.801, t=?2.93, df=1564, p=0.0034) although this relationship disappeared in older aged women in further age stratified analysis. Conclusions This study shows that depressive symptoms may result in a decrease in abdominal obesity, suggesting that more research is needed to further explore this relationship. Similar studies conducted in different cultural groups may help to explain these conflicting findings. PMID:21788923
WONG, Samuel YS; LEUNG, Jason C; LEUNG, Ping C; WOO, Jean
morphology has been analyzed using diagnostic criteria from anthropological and current medical literature, with a focus on a radiological interpretation. In addition, bone specimens from modern humans with known trauma from the Mütter Museum (Philadelphia...
Eddie, Diane Marie
Background: Optimizing human re- sources at trauma facilities may increase quality of care. The purpose of this study was to assess whether staffing changes within a Level I trauma center improved mortality and shortened length of stay (LOS) for trauma patients. Methods: Mortality, hospital LOS, and intensive care unit LOS were evalu- ated during three time periods: trauma service coverage
Charles Mains; Kristin Scarborough; Raphael Bar-Or; Allison Hawkes; Jeffery Huber; Pamela Bourg; David Bar-Or
In Italy, a comprehensive regional study of trauma deaths has never been performed. We examined the organization and delivery of trauma care in the city area of Milan, using panel review of trauma deaths. Two panels evaluated the appropriateness of care of all trauma victims occurred during 1 year, applying predefined criteria and judging deaths as not preventable (NP), possible
Osvaldo Chiara; Jane D Scott; Stefania Cimbanassi; Aldo Marini; Riccardo Zoia; Aurelio Rodriguez; Thomas Scalea
Trauma in the workplace can be precipitated by a number of tragedies, but death of an employee is the most common occurrence. Bereavement, mourning, and grief are common reactions. In most cases, people successfully cope with the death within two months, but some develop chronic grief, which is also referred to as complicated grief. Principles of grief counseling are outlined along with the need for employee training on trauma. PMID:24413016
Zanni, Guido R
Hemorrhage and traumatic coagulopathyis are major causes of early death in multiply injured patients. Thrombelastography (TEG) seems to be a fast and accurate coagulation test in trauma care. We suggest that multiply injured trauma patients would benefit the most from an early assessment of coagulation by TEG, mainly RapidTEG, to detect an acute traumatic coagulopathy and especially primary fibrinolysis, which is related with high mortality. This review gives an overview on TEG and its clinical applications. PMID:22046550
Jeger, Victor; Zimmermann, Heinz; Exadaktylos, Aristomenis K.
A chest-trauma management system, tagged as the "Pécs model" in a tertiary referral center is described with extensive references to the state of the art in thoracic trauma. Chest drainage has utmost importance in primary therapy as well as in surgical decision making (diagnosis). Thoracotomy is a general surgical competence, just as damage control is. Definitive treatment and management of sequelae, however, requires competence in thoracic surgery. Multidisciplinarity is underscored. PMID:23086820
Molnár, F Tamás
\\u000a As a result of events such as the terrorist attacks of September 11th, the bombings in Madrid in 2004, and multiple armed\\u000a conflicts throughout the world, the word trauma and the term posttraumatic stress disorder (PTSD) have become a part of the popular lexicon. The word trauma comes from the Greek word for wound and in psychological terms it has
Victoria M. Follette; Aditi Vijay
STUDY OBJECTIVE--The aim was to determine whether abdominal fatness in adult men is associated with retarded growth in fetal life and infancy. DESIGN--This was a follow up study of (1) men born during 1920-30 whose birthweights and weights at one year were recorded at the time by health visitors; and (2) men born during 1935-43 whose size at birth was measured in detail. The main outcome measure was the ratio of waist circumference to hip girth. SETTING--Hertfordshire and Preston, England. SUBJECTS--Subjects were 845 men born in east Hertfordshire who still live there; and 239 men born in Preston who still live in or close to the city. MAIN RESULTS--After allowing for body mass index, mean waist to hip ratio fell with increasing birthweight and rose as the ratio of placental weight to birthweight increased. These trends were independent of duration of gestation and therefore reflected retarded fetal growth. Waist to hip ratio also fell with increasing weight at one year. All these trends were independent of adult height, alcohol consumption, smoking, social class, and age. CONCLUSIONS--The tendency to store fat abdominally, which is known to increase the risk of cardiovascular disease and diabetes independently of obesity, may be a persisting response to adverse conditions and growth failure in fetal life and infancy. PMID:1645067
Law, C M; Barker, D J; Osmond, C; Fall, C H; Simmonds, S J
A series of 101 patients with trauma of the rectum, secondary to homosexual practices, presenting at this hospital and medical center is reviewed. Two patients were injured twice. Thirty-six patients had retained foreign bodies in the rectum, 55 had lacerations of the mucosa, two had disruptions of the anal sphincter and ten had perforations of the rectosigmoid. The majority of retained foreign bodies can be removed on an outpatient basis. If removal is not immediately possible, the patient should be admitted for observation and removal of the foreign body transanally under anesthesia. Routine sigmoidoscopic examination is performed after removal. Removal seldom requires laparotomy. Simple nonbleeding lacerations of the mucosa can be managed on an outpatient basis. Patients with abdominal pain, fever, continued bleeding, large lacerations or tear of the sphincter should be admitted and observed or operated upon, or both, as needed. Serious injuries, secondary to homosexual acts, can and do occur, as evidenced by the mortality reported in this series. Perforations of the rectosigmoid above the peritoneal reflection can be treated by laparotomy, repair of the perforation, removal of gross contamination by irrigation, proximal loop colostomy and appropriate antibiotic therapy. Perforations below the peritoneal reflection are challenging instances which require individualized management. PMID:6836461
Barone, J E; Yee, J; Nealon, T F
Injuries of the lower urinary tract occur in patients with multiple injuries and trauma to the lower abdominal and pelvic region. Injuries of the male urethra including complete ruptures occur in 10% of pelvic fractures in males, while they are a rarity in females. Ruptures of the urinary bladder are either intra- or extraperitoneal. Ureteral injuries are relatively rare in blunt injuries and usually become manifest with infectious symptoms with a delay of days. Intraperitoneal ruptures of the urinary bladder always require urgent surgical repair while extraperitoneal ruptures can mostly be managed conservatively with catheter drainage of the bladder. In male patients with pelvic fractures any attempt of urethral catheterization which can otherwise make an urethral injury worse should be withheld until adequate urological examinations have led to the diagnosis or exclusion of urethral injury. The definitive surgical repair of a disruption of the male urethra should be undertaken with an interval of weeks to months. Long term sequelae of male urethral injury can be impotence and chronic stricture disease. PMID:20373069
Protzel, C; Hakenberg, O W
Background: This study evaluated the outcomes of patients with complex or persistent thoracobiliary fistulae following penetrating liver trauma, who underwent endoscopic biliary intervention at a tertiary referral centre. Methods: All patients who underwent endoscopic retrograde cholangiography (ERC) and endoscopic biliary intervention for traumatic thoracobiliary fistulae between 1992 and 2008 were evaluated. Bile duct injuries were classified according to their biliary anatomic location on cholangiography and type of pulmonary communication. Results: Twenty-two patients had thoracobiliary (pleurobiliary, n = 19; bronchobiliary, n = 3) fistulae. The site of the bile duct injury was identified in 20 patients on cholangiography. These 20 patients underwent either sphincterotomy and biliary stenting (n = 18) or sphincterotomy alone (n = 2). In 17 patients the fistulae resolved after the initial endoscopic intervention. Three patients required secondary stenting with replacement of the initial stent. Three patients developed mild pancreatitis after stenting and one stent migrated and was replaced. All fistulae healed after endoscopic treatment. In 18 patients the stents were removed 4 weeks after bile drainage ceased. Three of the 22 patients required a thoracotomy for infected loculated pleural collections after initial catheter drainage. Conclusions: Endoscopic retrograde cholangiography is an accurate and reliable method of demonstrating post-traumatic thoracobiliary fistulae and endoscopic biliary intervention with sphincterotomy and stenting in this situation is safe and effective. Surgery in patients with thoracobiliary fistulae should be reserved for fistulae which do not heal after endoscopic biliary stenting or for patients who have unresolved pulmonary or intra-abdominal sepsis as a result of bile leak. PMID:19590644
Burmeister, Sean; Krige, Jake E J; Bornman, Philippus C; Nicol, Andrew J; Navsaria, Pradeep
Attempts of treating unstable fractures of the thoracolumbar junction by posterior reduction and fixation alone often result in a significant loss of correction, especially in lesions where a severe destruction of the vertebral body and the intervertebral disc is present. The conventional open approaches like classic thoraco-phreno-lumbotomy produces additional iatrogenic trauma at the lateral chest and abdominal wall which not rarely leads to intercostal neuralgia, as well as post-thoracotomy syndromes. The endoscopic trans-diaphragmatic approach described below opens up the whole thoracolumbar junction to a minimally invasive procedure allowing one to perform all the procedures needed for a full reconstruction of the anterior column of the spine like corpectomy, decompression, vertebral body replacement and anterior plating. The key to address also the subdiaphragmal and retroperitoneal section of the thoracolumbar junction is a partial detachment of the diaphragm which runs along the attachment at the spine and the ribs. The technique was published first in 1998 and has been used now in 650 endoscopic procedures at the thoracolumbar junction out of a total of more than 1300 thoracoscopic operations of the spine in the BG Unfallklinik Murnau, Germany since 1996. PMID:21139778
In a private/institutional setting the prevalence of Postconcussive Syndrome (PCS) symptoms and related etiologic factors was surveyed in 122 concussion and other craniofacial trauma patients (mean age 32 years; 68% male) and 122 uninjured controls (mean age 21 years; 45% males). A Neurobehavioral Symptom Checklist was used to measure 44 self-related symptoms, summed to yield Overall Frequency; number of symptoms rated as 3 or 4 were also summed separately to yield High Frequency scores. The Concussion group had significantly greater Overall Frequency and High Frequency scores than the other patients and the controls. The Brain Damage group had significantly greater High Frequency (but not Overall Frequency) scores than the controls. The presence of litigation, unemployment, or middle-age yielded significantly greater Overall Frequency scores in the patients; these variables in the control group were not measured. The presence of craniofacial fractures had no effect. Results suggest PCS symptoms are greatest in concussion patients with the presence of litigation, unemployment or middle age, and are less affected by injury severity. PMID:11951477
Ozolins, M; Parsons, O; Ozolins, D; Hunter, P D
The objective was to examine whether there were causal links between vitamin D status, parathyroid hormone, insulin resistance (IR)\\/insulin sensitivity (IS) and the metabolic syndrome (MS). A total of 72 Caucasian men and women, aged 55.7±7.57 years, with body mass index 33.4±4.02 kg\\/m2 and abdominal obesity, were assessed for IR\\/IS based on three commonly used indices before and after 12
M J Soares; W Chan She Ping-Delfos; J L Sherriff; D H Nezhad; N K Cummings; Y Zhao
The authors describe a case of abdominal angiostrongyliasis in an adult patient presenting acute abdominal pain caused by jejunal perforation. The case was unusual, as this affliction habitually involves the terminal ileum, appendix, cecum or ascending colon. The disease is caused by the nematode Angiostrongylus costaricensis, whose definitive hosts are forest rodents while snails and slugs are its intermediate hosts. Infection in humans is accidental and occurs via the ingestion of snail or slug mucoid secretions found on vegetables, or by direct contact with the mucus. Abdominal angiostrongyliasis is clinically characterized by prolonged fever, anorexia, abdominal pain in the right-lower quadrant, and peripheral blood eosinophilia. Although usually of a benign nature, its course may evolve to more complicated forms such as intestinal obstruction or perforation likely to require a surgical approach. Currently, no efficient medication for the treatment of abdominal angiostrongyliasis is known to be available. In this study, the authors provide a review on the subject, considering its etiopathogeny, clinical picture, diagnosis and treatment. PMID:10602548
Waisberg, J; Corsi, C E; Rebelo, M V; Vieira, V T; Bromberg, S H; dos Santos, P A; Monteiro, R
Background To summarize the diagnostic and therapeutic experiences on the patients who suffered abdominal complications after cardiovascular surgery with cardiopulmonary bypass(CPB). Methods A total of 2349 consecutive patients submitted to cardiovascular surgery with CPB in our hospital from Jan 2004 to Dec 2010 were involved. The clinical data of any abdominal complication, including its incidence, characters, relative risks, diagnostic measures, medical or surgical management and mortality, was retrospectively analyzed. Results Of all the patients, 33(1.4%) developed abdominal complications postoperatively, including 11(33.3%) cases of paralytic ileus, 9(27.3%) of gastrointestinal haemorrhage, 2(6.1%) of gastroduodenal ulcer perforation, 2(6.1%) of acute calculus cholecystitis, 3(9.1%) of acute acalculus cholecystitis, 4(12.1%) of hepatic dysfunction and 2(6.1%) of ischemia bowel diseases. Of the 33 patients, 26 (78.8%) accepted medical treatment and 7 (21.2%) underwent subsequent surgical intervention. There were 5(15.2%) deaths in this series, which was significantly higher than the overall mortality (2.7%). Positive history of peptic ulcer, advanced ages, bad heart function, preoperative IABP support, prolonged CPB time, low cardiac output and prolonged mechanical ventilation are the risk factors of abdominal complications. Conclusions Abdominal complications after cardiovascular surgery with CPB have a low incidence but a higher mortality. Early detection and prompt appropriate intervention are essential for the outcome of the patients. PMID:23046511
Management of chronic abdominal pain can be challenging. Sometimes patients fail to get adequate response from multiple medications and nerve blocks. We present a patient case report of chronic abdominal pain with a history of multiple surgeries managed successfully by neuromodulation of the transverse abdominis plane (TAP). The TAP block is a procedure in which local anesthetic is injected into the abdominal fascial plane that carries sensory nerves to the abdominal wall in order to block pain sensation. It has been shown to reduce postoperative pain and analgesic dependence after abdominal and gynecological surgeries. A 60-year-old woman presented to us for chronic abdominal pain for which medications provided little relief. She had an extensive history of abdominal surgeries and was also treated for lower back pain with surgery and less invasive procedures in the past. Under our care, she underwent 2 TAP blocks with almost complete resolution of her abdominal pain. Her pain, however, came back within a few of weeks of the procedures. Since our patient found pain relief from the TAP blocks, we proceeded with neurostimulation of the TAP for long-term pain relief. We placed a dorsal column stimulator 16 contact lead for lower back and leg pain and 8 contact leads placed in the TAP under ultrasound guidance. She has had multiple follow-ups since her TAP lead placement procedure with continued and near complete resolution of her abdominal pain. The TAP lead stimulation was helping her abdominal pain and the dorsal column lead stimulation was helping her back and leg pain. PMID:25247911
Gupta, Mayank; Goodson, Robert
Objective Trauma influences on perinatal maternal-child interactions may affect the organization of offspring physiological systems involved in health outcomes. This study used a novel advanced system recently adapted for infants to examine associations of maternal lifetime trauma and related psychological symptoms in the perinatal period with infant cardiorespiratory reactivity and behavioral distress in response to a laboratory stressor. Methods Mothers self-reported lifetime exposure to trauma, perinatal traumatic stress, and current symptoms of posttraumatic stress disorder (PTSD) and depression. Heart rate and indices of respiratory volume, timing, and thoraco-abdominal coordination were continuously recorded using a non-invasive respiratory inductance plethysmography device from 23 infants during the Still-Face Paradigm, a videotaped mother-infant dyadic assessment that included baseline, stressor, and recovery phases. Infant behavioral distress during the procedure was also assessed. Results Infants of mothers with low exposure to trauma and perinatal traumatic stress showed expected increases in behavioral distress and cardiorespiratory activation from baseline to stressor and decreases in these parameters from stressor to recovery. Infants of mothers exposed to multiple traumas and with elevated perinatal traumatic stress showed similar patterns of activation from baseline to stressor but failed to show decreases during recovery. These patterns were maintained after controlling for current maternal PTSD and depressive symptoms. Conclusions Maternal lifetime trauma exposure and traumatic stress during the perinatal period were associated with disrupted infant cardiorespiratory regulation and behavioral distress during a stressor protocol. These results support the concept of perinatal programming and its potential role in physical and mental health outcomes. PMID:19553287
Enlow, Michelle Bosquet; Kullowatz, Antje; Staudenmayer, John; Spasojevic, Jelena; Ritz, Thomas; Wright, Rosalind J.
Background A general trend in orthopedic traumatology is the advent of daily, dedicated orthopedic trauma theatres. Availability of trauma theatres is believed to decrease morbidity and mortality, but this remains unproven. We performed a retrospective review comparing morbidity and mortality outcomes at a single institution before and after the establishment of a dedicated trauma room. The purpose was to determine whether a change in outcomes occurred for a single routine procedure with known outcome expectations (hemiarthroplasty of the hip after femoral neck fracture) with the implementation of a designated trauma theatre. Methods We examined a cohort of 457 elderly patients (245 before and 212 after trauma theatre implementation) who underwent hemiarthroplasty for displaced low-energy subcapital hip fractures. Results Patients in both groups were similar in terms of age, sex ratio and ASA classification. We found statistically significant differences favouring the dedicated trauma room system for postoperative morbidity. Despite this outcome, the average time to surgery for these patients significantly increased. We noted no difference in mortality between the 2 groups. Conclusion The hip fracture population can be treated safely in the context of dedicated trauma room time; however, there needs to be prioritization of hip fractures in a tertiary care centre or other trauma cases will tend to take precedence. PMID:19399201
Lemos, David; Nilssen, Eric; Khatiwada, Bikalpa; Elder, Graham M.; Reindl, Rudolph; Berry, Gregory K.; Harvey, Edward J.
This paper discusses mathematical models of expressing severity of injury and probability of survival following trauma and their use in establishing clinical governance of a trauma system. There are five sections: (i) Historical overview of scoring systems—anatomical, physiological and combined systems and the advantages and disadvantages of each. (ii) Definitions used in official statistics—definitions of ‘killed in action’ and other categories and the importance of casualty reporting rates and comparison across conflicts and nationalities. (iii) Current scoring systems and clinical governance—clinical governance of the trauma system in the Defence Medical Services (DMS) by using trauma scoring models to analyse injury and clinical patterns. (iv) Unexpected outcomes—unexpected outcomes focus clinical governance tools. Unexpected survivors signify good practice to be promulgated. Unexpected deaths pick up areas of weakness to be addressed. Seventy-five clinically validated unexpected survivors were identified over 2 years during contemporary combat operations. (v) Future developments—can the trauma scoring methods be improved? Trauma scoring systems use linear approaches and have significant weaknesses. Trauma and its treatment is a complex system. Nonlinear methods need to be investigated to determine whether these will produce a better approach to the analysis of the survival from major trauma. PMID:21149354
Russell, R. J.; Hodgetts, T. J.; McLeod, J.; Starkey, K.; Mahoney, P.; Harrison, K.; Bell, E.
Families living in urban poverty, enduring chronic and complex traumatic stress, and having difficulty meeting their children's basic needs have significant child maltreatment risk factors. There is a paucity of family focused, trauma-informed evidence-based interventions aimed to alleviate trauma symptomatology, strengthen family functioning, and…
Collins, Kathryn S.; Strieder, Frederick H.; DePanfilis, Diane; Tabor, Maureen; Clarkson Freeman, Pamela A.; Linde, Linnea; Greenberg, Patty
For many survivors of serious road trauma, the physical and psychological consequences are complex and lifelong. The longer-term psychosocial recovery experience for survivors, however, is rarely documented in the social work literature. This article reports on findings from a study of road trauma recovery experiences. The findings are presented…
Harms, Louise; Talbot, Michelle
Background Interpersonal trauma exposure and trauma-related disorders in people with severe mental illness (SMI) are often not recognized in clinical practice. Objective To substantiate the prevalence of interpersonal trauma exposure and trauma-related disorders in people with SMI. Methods We conducted a systematic review of four databases (1980–2010) and then described and analysed 33 studies in terms of primary diagnosis and instruments used to measure trauma exposure and trauma-related disorders. Results Population-weighted mean prevalence rates in SMI were physical abuse 47% (range 25–72%), sexual abuse 37% (range 24–49%), and posttraumatic stress disorder (PTSD) 30% (range 20–47%). Compared to men, women showed a higher prevalence of sexual abuse in schizophrenia spectrum disorder, bipolar disorder, and mixed diagnosis groups labelled as having SMI. Conclusions Prevalence rates of interpersonal trauma and trauma-related disorders were significantly higher in SMI than in the general population. Emotional abuse and neglect, physical neglect, complex PTSD, and dissociative disorders have been scarcely examined in SMI. PMID:23577228
Mauritz, Maria W.; Goossens, Peter J. J.; Draijer, Nel; van Achterberg, Theo
Using a retrospective survey, we studied a sample of 1679 college women to determine whether reports of prior forgetting of 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
Bette L. Bottoms; Cynthia J. Najdowski; Michelle A. Epstein; Matthew J. Badanek
The aim of this study was to investigate the relationship between obesity, insulin resistance and atherosclerosis in type 2 diabetes mellitus (T2DM) patients. Total 530 patients with T2DM were included. To evaluate the severity of atherosclerosis, we measured the coronary artery calcification (CAC) score, intima-media thickness (IMT) of the common carotid artery, and the ankle-brachial pressure index (ABPI). Subjects were classified according to body mass index (BMI), a marker of general obesity, and waist-to-hip ratio (WHR), a marker of regional obesity. The insulin sensitivity index (ISI) was measured by the short insulin tolerance test. All subjects were classified into four groups, according to BMI: the under-weight group, the normal-weight (NW) group, the over-weight (OW) group, and the obese (OB) group. WHR and systolic blood pressure, triglycerides (TG), HDL-cholesterol (HDL-C), free fatty acids (FFA), fibrinogen, and fasting c-peptide levels were significantly different between BMI groups. TG, HDL-C, FFA, fibrinogen and ISI were significantly different between patients with and without abdominal obesity. In the OW group as well as in the NW group, carotid IMT, ABPI and CAC score were significantly different between patients with and without abdominal obesity. This study indicates that abdominal obesity was associated with atherosclerosis in T2DM patients. PMID:18955782
Cho, Minho; Park, Jong Suk; Nam, Jisun; Kim, Chul Sik; Nam, Jae Hyun; Kim, Hai Jin; Cha, Bong Soo; Lim, Sung Kil; Kim, Kyung Rae; Lee, Hyun Chul; Huh, Kap Bum
Introduction Blunt chest wall trauma accounts for over 15% of all trauma admissions to Emergency Departments worldwide. Reported mortality rates vary between 4 and 60%. Management of this patient group is challenging as a result of the delayed on-set of complications. The aim of this study was to develop and validate a prognostic model that can be used to assist in the management of blunt chest wall trauma. Methods There were two distinct phases to the overall study; the development and the validation phases. In the first study phase, the prognostic model was developed through the retrospective analysis of all blunt chest wall trauma patients (n?=?274) presenting to the Emergency Department of a regional trauma centre in Wales (2009 to 2011). Multivariable logistic regression was used to develop the model and identify the significant predictors for the development of complications. The model’s accuracy and predictive capabilities were assessed. In the second study phase, external validation of the model was completed in a multi-centre prospective study (n?=?237) in 2012. The model’s accuracy and predictive capabilities were re-assessed for the validation sample. A risk score was developed for use in the clinical setting. Results Significant predictors of the development of complications were age, number of rib fractures, chronic lung disease, use of pre-injury anticoagulants and oxygen saturation levels. The final model demonstrated an excellent c-index of 0.96 (95% confidence intervals: 0.93 to 0.98). Conclusions In our two phase study, we have developed and validated a prognostic model that can be used to assist in the management of blunt chest wall trauma patients. The final risk score provides the clinician with the probability of the development of complications for each individual patient. PMID:24887537
Imaging is paramount in the setting of blunt trauma and is now the standard of care at any trauma center. Although anteroposterior radiography has inherent limitations, the ability to acquire a radiograph in the trauma bay with little interruption in clinical survey, monitoring, and treatment, as well as radiography's accepted role in screening for traumatic aortic injury, supports the routine use of chest radiography. Chest CT or CT angiography is the gold-standard routine imaging modality for detecting thoracic injuries caused by blunt trauma. There is disagreement on whether routine chest CT is necessary in all patients with histories of blunt trauma. Ultimately, the frequency and timing of CT chest imaging should be site specific and should depend on the local resources of the trauma center as well as patient status. Ultrasound may be beneficial in the detection of pneumothorax, hemothorax, and pericardial hemorrhage; transesophageal echocardiography is a first-line imaging tool in the setting of suspected cardiac injury. In the blunt trauma setting, MRI and nuclear medicine likely play no role in the acute setting, although these modalities may be helpful as problem-solving tools after initial assessment. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. PMID:24603073
Chung, Jonathan H; Cox, Christian W; Mohammed, Tan-Lucien H; Kirsch, Jacobo; Brown, Kathleen; Dyer, Debra Sue; Ginsburg, Mark E; Heitkamp, Darel E; Kanne, Jeffrey P; Kazerooni, Ella A; Ketai, Loren H; Ravenel, James G; Saleh, Anthony G; Shah, Rakesh D; Steiner, Robert M; Suh, Robert D
An employee is diagnosed with cancer or loses a family member unexpectedly. An earthquake destroys an entire section of a city, leaving hundreds dead, injured, or homeless. At time like these, managerial handbooks fail us. After all, leaders can't eliminate personal suffering, nor can they ask employees who are dealing with these crises to check their emotions at the door. But compassionate leadership can facilitate personal as well as organizational healing. Based on research the authors have conducted at the University of Michigan and the University of British Columbia's CompassionLab, this article describes what leaders can do to foster organizational compassion in times of trauma. They recount real-world examples, including a story of personal tragedy at Newsweek, natural disasters that affected Macy's and Malden Mills, and the events of September 11, 2001. During times of collective pain and confusion, compassionate leaders take some form of public action, however small, that is intended to ease people's pain and inspire others to act. By openly demonstrating their own humanity, executives can unleash a compassionate response throughout the whole company, increasing bonds among employees and attachments to the organization. The authors say compassionate leaders uniformly provide two things: a "context for meaning"--creating an environment in which people can freely express and discuss how they feel--and a "context for action"--creating an environment in which those who experience or witness pain can find ways to alleviate their own and others' suffering. A leader's competence in demonstrating and fostering compassion is vital, the authors conclude, to nourishing the very humanity that can make people--and organizations--great. PMID:12964467
Dutton, Jane E; Frost, Peter J; Worline, Monica C; Lilius, Jacoba M; Kanov, Jason M
Spontaneous hemopneumothorax (SHP) is a rare potentially life-threatening condition that occurs in predominantly young adolescents. The resultant massive hemorrhage leading to hypovolemic shock can be a surgical emergency. It constitutes 1-12% of all spontaneous pneumothoraces and presents with two cardinal features, chest pain and dyspnea. However, the pain of SHP may be confined to the abdomen secondary to the irritation of diaphragmatic pleura, which produces signs simulating an acute abdomen. SHP masquerading as an abdominal affection is apparently regarded as extremely rare. We present a case of a 16-year-old male with SHP presenting features simulating acute gallbladder disease. After prompt diagnosis with appropriate surgical intervention, he had an uneventful recovery. Our experience emphasizes the importance of careful and thorough chest examination for each child with atypical pictures for abdominal pain to exclude possible extra-abdominal lesions, even rare as SHP. PMID:23169600
Chen, Tai-Heng; Tseng, Yung-Hao; Tseng, Chien-Ming; Chiang, Hung-Hsing; Lin, Tzeng-Jih
Background Owing to their constant readiness to treat injured patients, trauma centres are essential to regional responses to mass casualty incidents (MCIs). Reviews of recent MCIs suggest that trauma centre preparedness has frequently been limited. We set out to evaluate Canadian trauma centre preparedness and the extent of their integration into a regional response to MCIs. Methods We conducted a survey of Canadian level-1 trauma centres (n = 29) to characterize their existing disaster-response plans and to identify areas where pre-paredness could be improved. The survey was directed to the medical director of trauma at each centre. Descriptive statistics were used to analyze responses. Results Twenty-three (79%) trauma centres in 5 provinces responded. Whereas most (83%) reported the presence of a committee dedicated to disaster preparedness, only half of the medical directors of trauma were members of these committees. Almost half (43%) the institutions had not run any disaster drill in the previous 2 years. Only 70% of trauma centres used communications assets designed to function during MCIs. Additionally, more than half of the trauma directors (59%) did not know if their institutions had the ability to sustain operations for at least 72 hours during MCIs. Conclusion The results of this study suggest important opportunities to better prepare Canadian trauma centers to respond to an MCI. The main areas identified for potential improvement include the need for the standardization of MCI planning and response at a regional level and the implementation of strategies such as stockpiling of resources and novel communication strategies to avoid functional collapse during an MCI. PMID:21251427
Gomez, David; Haas, Barbara; Ahmed, Najma; Tien, Homer; Nathens, Avery
Primary abdominal extraskeletal osteosarcoma (EOS) is a rare carcinoma. The present study reports a case of a primary abdominal EOS involving the greater omentum and also presents a review of the literature on the etiology, diagnosis, differential diagnosis, pathological features, treatment and prognosis of the disease. The patient in the present study underwent laparoscopic surgery. A pathological examination revealed that the tumor tissues contained malignant and primitive spindle cells with varying amounts of neoplastic osteoid and osseous or cartilaginous tissue. The post-operative follow-up appointments were scheduled at three-month intervals for two years. The tumor recurred three months after the surgery. PMID:24137451
WU, ZHIMING; CHU, XIUFENG; MENG, XINGCHENG; XU, CHAOYANG
Objective The aim of this study was to examine the diagnoses and treatment methods and demographical and clinical characteristics of pregnant women who were exposed to trauma and in additon, review of the literature was carried out in this regard. Material and Methods One hundred thirty-nine pregnant women who presented at the Yüzüncü Y?l University between January 2006 and September 2009 with local or general body trauma complaints were analysed retrospectively. Results The average age of the cases was 26.72±6.29 years and the age group ranging from 21–34 composed the majority. When they were studied according to their etiologies, falls during daily activities formed 43.9%. When they were analyzed in terms of their gestational weeks, 64.46% were in the 3rd trimester. Pregnant cases with trauma resulted in maternal (3 cases) and fetal (9 cases) loss. It was found that 19 cases who had imaging techniques involving radiation and whose gestation was continuing had a problem-free gestation period and healthy children. Conclusion It is mandatory to evaluate both mother and fetus together when trauma exposure is in question, the general well-being of the fetus should be provided and the mother should be informed about the presence of advanced trauma life support. PMID:24592020
Karada?, Sevdegül; Gönüllü, Hayriye; Öncü, Mehmet Re?it; Kurdo?lu, Zehra; Canbaz, Yasin
Background: There are studies to prove the role of amylase and lipase estimation as a screening diagnostic tool to detect diseases apart from acute pancreatitis. However, there is sparse literature on the role of serum and urine amylase, lipase levels, etc to help predict the specific intra-abdominal injury after blunt trauma abdomen (BTA). Aim: To elucidate the significance of elevation in the levels of amylase and lipase in serum and urine samples as reliable parameters for accurate diagnosis and management of blunt trauma to the abdomen. Materials and Methods: A prospective analysis was done on the trauma patients admitted in Jai Prakash Narayan Apex Trauma Center, AIIMS, with blunt abdomen trauma injuries over a period of six months. Blood and urine samples were collected on days 1, 3, and 5 of admission for the estimation of amylase and lipase, liver function tests, serum bicarbonates, urine routine microscopy for red blood cells, and complete hemogram. Clinical details such as time elapsed from injury to admission, type of injury, trauma score, and hypotension were noted. Patients were divided into groups according to the single or multiple organs injured and according to their hospital outcome (dead/discharged). Wilcoxon's Rank sum or Kruskal–Wallis tests were used to compare median values in two/three groups. Data analysis was performed using STATA 11.0 statistical software. Results: A total of 55 patients with median age 26 (range, 6-80) years, were enrolled in the study. Of these, 80% were males. Surgery was required for 20% of the patients. Out of 55 patients, 42 had isolated single organ injury [liver or spleen or gastrointestinal tract (GIT) or kidney]. Patients with pancreatic injury were excluded. In patients who suffered liver injuries, urine lipase levels on day 1, urine lipase/amylase ratio along with aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase (ALP) on days 1, 3, and 5, were found to be significant. Day 1 serum amylase, AST, ALT, hemoglobin, and hematocrit levels were found significant in patients who had spleen injury. Serum amylase levels on day 5 and ALP on day 3 were significant in patients who had GIT injury. Urine amylase levels on day 5 were found to be statistically significant in patients who had kidney injury. In patients with isolated organ injury to the liver or spleen, the levels of urine amylase were elevated on day 1 and gradually decreased on days 3 and 5, whereas in patients with injury to GIT, the urine amylase levels were observed to gradually increase on days 3 and 5. Conclusion: Although amylase and lipase levels in the serum and urine are not cost-effective clinical tools for routine diagnosis of extra-pancreatic abdominal injuries in BTA, but when coupled with other laboratory tests such as liver enzymes, they may be significant in predicting specific intra-abdominal injury. PMID:22787343
Kumar, Subodh; Sagar, Sushma; Subramanian, Arulselvi; Albert, Venencia; Pandey, Ravindra Mohan; Kapoor, Nitika
Abdominal gunshot wound (AGSW) is a trauma emergency. The purpose of this report is to describe our experience with managing AGSW largely without modem investigational modalities. Data was collected retrospectively by reviewing the surgical reports and clinical charts of patients admitted to live hospitals dealing with AGSW over a 5-year period. Incomplete files and wounds not involving the abdomen were not included. A total of 86 files were analyzed. Patients ranged in age from 10 to 63 years ivith mean age of 32 years and a sex ratio of 5.5. Most patients (87%) underwent surgical exploration. Laboratory revealed no lesions in 22.5% of cases, minor lesions in 9.5% and major lesions justifying surgical repair in 68%. A total of 86 visceral lesions were found in the patients who underwent surgical exploration. The lesion involved the small intestine in 31.5% of case, colon in 24.5%, liver in 23.5%, spleen in 7%, stomach in 6%, and uterus in 2%. The kidney, pancreas, mesenteries, large momentum, and transverse mescaline each accounted for 1% of lesions. Conventional operative techniques were used with a mortality of 5.5% and morbidity of 4%. Based on our findings we conclude that when investigational tools (CT-scan, peritoneal lavage and laparoscopy) are unavailable prolonged watchful waiting increases the risk of mortality and morbidity in patients presenting AGSW associated with suspicious clinical signs. Prompt surgical treatment improves prognosis but is associated with a high rate of cases showing no lesions. PMID:16555515
Bahebeck, J; Masso-Misse, P; Essomba, A; Takongmo, S; Ngo-Nonga, B; Ngo-Nyeki, A R; Sosso, M; Malong, E
Conservative management of blunt chest trauma reduces morbidity in selected patients. We present a retrospective analysis of 50 patients with blunt chest trauma who were treated in the Respiratory Unit of Groote Schuur Hospital, Cape Town, during 1980. Conservative management was not possible in 21 patients because of severe associated injuries. The remaining 29 patients were treated either with continuous positive pressure ventilation (CPPV) or continuous positive airway pressure (CPAP) by face-mask and thoracic extradural analgesia. The conservatively treated patients spent less time in the Intensive Care Unit and had fewer complications. Thoracic extradural analgesia provides optimal pain relief with resultant increase in vital capacity and an improvement in arterial blood gas levels. Current management of blunt chest trauma is directed at early withdrawal of continuous ventilatory support as soon as this can be replaced either with thoracic extradural analgesia and CPAP by mask, or with CPAP by mask alone. PMID:7046093
Linton, D M; Potgieter, P D
Purpose. To evaluate the use of ocular imaging to enhance management and diagnosis of war-related anterior segment ocular injuries. Methods. This study was a prospective observational case series from an ongoing IRB-approved combat ocular trauma tracking study. Subjects with anterior segment ocular injury were imaged, when possible, using anterior segment optical coherence tomography (AS-OCT), confocal microscopy (CM), and slit lamp biomicroscopy. Results. Images captured from participants with combat ocular trauma on different systems provided comprehensive and alternate views of anterior segment injury to investigators. Conclusion. In combat-related trauma of the anterior segment, adjunct image acquisition enhances slit lamp examination and enables real time In vivo observation of the cornea facilitating injury characterization, progression, and management. PMID:24191191
Ryan, Denise S.; Sia, Rose K.; Colyer, Marcus; Stutzman, Richard D.; Wroblewski, Keith J.; Mines, Michael J.; Bower, Kraig S.
Exposure to intense noises during a short time can be responsible for permanent damage of the inner ear, even after an isolated exposure. Amplified music (discos, concert rooms) is the first cause of acute acoustic traumas among the young people. Acute acoustic traumas need urgent management and treatment. Exposure to high noise levels during a long time can lead to a progressive and insidious impairment of the inner ear, the hearing loss appearing obvious only after several months or years. Noise-induced hearing loss is irreversible. The functional consequences of acoustic traumas can be socially disabling and can have an important psychological impact. The prevention is based on the information of the patients, notably of the youngest ones, and on the wearing of hearing protectors at the time of risky situations. PMID:19552201
Nottet, Jean-Bertrand; Truy, Eric
Fournier gangrene (FG) is a necrotizing soft tissue infection involving the superficial and fascial planes of the perineum. In many cases of FG, debridement of the scrotum is necessary, leaving definitive management of the exposed testicles a significant surgical challenge. Frequent incidental trauma to the testicles can cause severe pain, especially in laborers. Practical surgical solutions are few and not well detailed. Various options exist, including creating a neoscrotum with adjacent thigh tissue, split-thickness skin grafts (STSGs), or even creating a subcutaneous thigh pocket. We describe a case of abdominal implantation of bilateral testicles for persistent testicular pain in a case where STSGs did not provide adequate protection, adjacent thigh skin was not available for creation of a neoscrotum, and significant cord contracture occurred. We detail the advantages and disadvantages of the commonly described techniques, including this approach, and how in select individuals this may be a suitable alternative. PMID:24229025
Chan, Cyrus C.; Shahrour, Khaled; Collier, Ronald D.; Welch, Marlene; Chang, Shiliang; Williams, Mallory
Childhood obesity continues to escalate despite considerable efforts to reverse the current trends. Childhood obesity is a leading public health concern because overweight-obese youth suffer from comorbidities such as type 2 diabetes mellitus, nonalcoholic fatty liver disease, metabolic syndrome, and cardiovascular disease, conditions once considered limited to adults. This increasing prevalence of chronic health conditions in youth closely parallels the dramatic increase in obesity, in particular abdominal adiposity, in youth. Although mounting evidence in adults demonstrates the benefits of regular physical activity as a treatment strategy for abdominal obesity, the independent role of regular physical activity alone (e.g., without calorie restriction) on abdominal obesity, and in particular visceral fat, is largely unclear in youth. There is some evidence to suggest that, independent of sedentary activity levels (e.g., television watching or playing video games), engaging in higher-intensity physical activity is associated with a lower waist circumference and less visceral fat. Several randomized controlled studies have shown that aerobic types of exercise are protective against age-related increases in visceral adiposity in growing children and adolescents. However, evidence regarding the effect of resistance training alone as a strategy for the treatment of abdominal obesity is lacking and warrants further investigation. PMID:19767790
Kim, YoonMyung; Lee, SoJung
The ectopic pregnancy appears in the 10-12% of cases after tubal sterilization and it is usually located in the tube. 1% of ectopic pregnancies are abdominal and the implantation in omentum is a rare condition with only 16 described cases. According to Studdiford, they can be classified as primary or secondary depending on whether they are originated or not in
Elena M. Losa Pajares; Marco A. Arones Collantes; Leyre Gil Martínez-Acacio; Alejandro Pascual Martín; Vicente Almodóvar Rico; Gaspar González de Merlo
Abdominal aortic aneurysms (AAAs) are found in up to 8% of men aged >65 years, yet usually remain asymptomatic until they rupture. Rupture of an AAA and its associated catastrophic physiological insult carries overall mortality in excess of 80%, and 2% of all deaths are AAA-related. Pathologically, AAAs are associated with inflammation, smooth muscle cell apoptosis, and matrix degradation. Once
Ian M. Nordon; Robert J. Hinchliffe; Ian M. Loftus; Matt M. Thompson
Background: Adhesion formation remains an almost inevitable consequence of abdominal procedures, potentially resulting in significant morbidity and mortality. There is an ongoing need to evaluate current understanding of adhesion formation and products aimed at prevention. Failure to keep up to date with adhesion treatment may subject clinicians to a greater medico-legal risk. Design: Review of published studies exploring the problem
Chris I. W. Lauder; Giuseppe Garcea; Andrew Strickland; Guy J. Maddern
We aimed to describe anthropometric differences in weight-related disorders between adults with Down syndrome (DS) and healthy controls, as well as their disparate impact on glucose and lipid metabolism disorders. We underwent a cross-sectional study of 49 consecutively selected, community-residing adults with DS and 49 healthy controls in an outpatient clinic of a tertiary care hospital in Madrid, Spain. Siblings of adults with DS were studied as controls in 42 cases. Epidemiological data (age and gender), anthropometric data (body mass index, waist circumference, and waist-to-height ratio [WHR]), coexisting clinical conditions, and laboratory data (fasting glucose, insulin, glycated hemoglobin, creatinine, thyroid hormones, and lipid profile) were measured and compared between the groups. Adults with DS were significantly younger and more often male, with a higher prevalence of overweight and obesity than controls. Adults with DS also had a higher WHR, and more frequently presented abdominal obesity. Moreover, insulin resistance measured using the homeostatic model assessment was more prevalent among adults with DS and abdominal obesity. However, lipid profiles were similar between groups. The kappa correlation index for the diagnosis of abdominal obesity between waist circumference and WHR was 0.24 (95%CI: 0.13-0.34). We concluded that the prevalence of overweight, obesity, and abdominal obesity was higher in adults with DS than in controls. Adults with DS and abdominal obesity showed higher indexes of insulin resistance than their non-obese peers. WHR was a useful tool for the evaluation of abdominal obesity in this population. PMID:25108610
Real de Asua, Diego; Parra, Pedro; Costa, Ramón; Moldenhauer, Fernando; Suarez, Carmen
Background: Elder abuse and neglect (EAN), intimate partner violence (IPV), and street-based community violence (SBCV) are significant public health problems, which frequently lead to traumatic injury. Trauma centers can provide an effective setting for intervention and referral, potentially interrupting the cycle of violence. Aims: To assess existing institutional resources for the identification and treatment of violence victims among patients presenting with acute injury to statewide trauma centers. Settings and Design: We used a prospective, web-based survey of trauma medical directors at 62 Illinois trauma centers. Nonresponders were contacted via telephone to complete the survey. Materials and Methods: This survey was based on a survey conducted in 2004 assessing trauma centers and IPV resources. We modified this survey to collect data on IPV, EAN, and SBCV. Statistical Analysis: Univariate and bivariate statistics were performed using STATA statistical software. Results: We found that 100% of trauma centers now screen for IPV, an improvement from 2004 (P = 0.007). Screening for EAN (70%) and SBCV (61%) was less common (P < 0.001), and hospitals thought that resources for SBCV in particular were inadequate (P < 0.001) and fewer resources were available for these patients (P = 0.02). However, there was lack of uniformity of screening, tracking, and referral practices for victims of violence throughout the state. Conclusion: The multiplicity of strategies for tracking and referring victims of violence in Illinois makes it difficult to assess screening and tracking or form generalized policy recommendations. This presents an opportunity to improve care delivered to victims of violence by standardizing care and referral protocols. PMID:24550624
Butler, Bennet; Agubuzu, Ogo; Hansen, Luke; Crandall, Marie
The modern era for splenic surgery for injury began in 1892 when Riegner reported a splenectomy in a 14-year-old construction worker who fell from a height and presented with abdominal pain, distension, tachycardia, and oliguria. This report set the stage for routine splenectomy, which was performed for all splenic injury in the next two generations. Despite early reports by Pearce and by Morris and Bullock that splenectomy in animals caused impaired defenses against infection, little challenge to routine splenectomy was made until King and Schumacker in 1952 reported a syndrome of "overwhelming postsplenectomy infection" (OPSI). Many studies have since demonstrated the importance of the spleen in preventing infections, particularly from the encapsulated organisms. Overwhelming postsplenectomy infection occurs in about 0.6% of children and 0.3% of adults. Intraoperative splenic salvage has become more popular and can be achieved safely in most patients by delivering the spleen with the pancreas to the incision, carefully repairing the spleen under direct vision, and using the many adjuncts to suture repair, including hemostatic agents and splenic wrapping. Intraoperative splenic salvage is not indicated in patients actively bleeding from other organs or in the presence of alcoholic cirrhosis. The role of splenic replantation in those patients requiring operative splenectomy needs further study but may provide significant long-term splenic function. Although nonoperative splenic salvage was first suggested more than 100 years ago by Billroth, this modality did not become popular in children until the 1960s or in adults until the latter 1980s. Patients with intrasplenic hematomas or with splenic fractures that do not extend to the hilum as judged by computed tomography usually can be observed successfully without operative intervention and without blood transfusion. Nonoperative splenic salvage is less likely with fractures that involve the splenic hilum and with the severely shattered spleen; these patients usually are treated best by early operative intervention. Following splenectomy for injury, polyvalent pneumococcal vaccine decreases the likelihood of OPSI and should be used routinely. The role of prophylactic penicillin is uncertain but the use of antibiotics for minor infectious problems is indicated after splenectomy. Images Fig. 1. Fig. 2. Fig. 3. Fig. 4. Fig. 5. Fig. 6. Fig. 7. Fig. 8. Fig. 9. Fig. 10. Fig. 11. Fig. 12. PMID:1992948
Lucas, C E
We present the case of a 65 years old pacient which was admitted for the sudden decrease of visual acuity in the left eye, accompanied by ocular pain and conjunctival hiperemia, simptoms appeared after an ocular trauma. After the clinical and paraclinical examination we determined the diagnosis of OS: Penetrating ocular trauma with retention of a foreign body; posttraumatic cataract. Surgical treatement was warrented and we performed OS : Facoemulsification + PFK implant in sulcus + 23 Ga posterior vitrectomy + peeling of the posterior hyaloid membrane + extraction of the foreign body + LASER endofotocoagulation + transscleral cryotherapy + SF6 gas injection. The post-operatory evolution was favorable. PMID:22888689
Musat, O; Ochinciuc, Uliana; Gutu, Tatiana; Cristescu, T R; Coman, Corina
Introduction The incidence and epidemiological causes of maxillofacial (MF) trauma varies widely. The objective of this study is to point out maxillofacial trauma patients’ epidemiological properties and trauma patterns with simultaneous injuries in different areas of the body that may help emergency physicians to deliver more accurate diagnosis and decisions. Methods In this study we analyze etiology and pattern of MF trauma and coexisting injuries if any, in patients whose maxillofacial CT scans was obtained in a three year period, retrospectively. Results 754 patients included in the study consisting of 73.7% male and 26.3% female, and the male-to-female ratio was 2.8:1. Mean age was 40.3?±?17.2 years with a range of 18 to 97. 57.4% of the patients were between the ages of 18–39 years and predominantly male. Above 60 years of age, referrals were mostly woman. The most common cause of injuries were violence, accounting for 39.7% of the sample, followed by falls 27.9% and road traffic accidents 27.2%. The primary cause of injuries were violence between ages 20 and 49 and falls after 50. Bone fractures found in 56,0% of individuals. Of the total of 701 fractured bones in 422 patients the most frequent was maxillary bone 28,0% followed by nasal bone 25,3%, zygoma 20,2%, mandible 8,4%, frontal bone 8,1% and nasoethmoidoorbital bone 3,1%. Fractures to maxillary bone were uppermost in each age group. 8, 9% of the patients had brain injury and only frontal fractures is significantly associated to TBI (p?0.05) if coexisting facial bone fracture occurred. Male gender has statistically stronger association for suffering TBI than female (p?0, 05). Most common cause of TBI in MF trauma patients was violence (47, 8%). 158 of the 754 patients had consumed alcohol before trauma. No statistically significant data were revealed between alcohol consumption gender and presence of fracture. Violence is statistically significant (p?0.05) in these patients. Conclusion Studies subjected maxillofacial traumas yield various etiologic factors, demographic properties and fracture patterns probably due to social, cultural and governmental differences. Young males subjected to maxillofacial trauma more commonly as a result of interpersonal violence. PMID:24484727
Using the National Survey of Homeless Assistance Providers and Clients (NSHAPC), we found that among homeless mothers (n = 588), those living without their children were more likely to: be older than 35 years, unmarried, have been incarcerated, have been homeless for at least 1 year, and to have used psychiatric medication. Many homeless mothers had histories of childhood trauma, but it was the accumulation of adulthood traumas that was associated with not living with one's children. Without mental health treatment, younger homeless mothers living with their children today may become the homeless mothers living without their children in the future. PMID:17143729
Zlotnick, Cheryl; Tam, Tammy; Bradley, Kimberly
Study Objectives: Abdominal obesity, particularly common in centrally obese males, may have a negative impact on upper airway (UA) function during sleep. For example, cranial displacement of the diaphragm with raised intra-abdominal pressure may reduce axial tension exerted on the UA by intrathoracic structures and increase UA collapsibility during sleep. Design: This study aimed to examine the effect of abdominal compression on UA function during sleep in obese male obstructive sleep apnea patients. Setting: Participants slept in a sound-insulated room with physiologic measurements controlled from an adjacent room. Participants: Fifteen obese (body mass index: 34.5 ± 1.1 kg/m2) male obstructive sleep apnea patients (apnea-hypopnea index: 58.1 ± 6.8 events/h) aged 50 ± 2.6 years participated. Interventions: Gastric (PGA) and transdiaphragmatic pressures (PDI), UA closing pressure (UACP), UA airflow resistance (RUA), and changes in end-expiratory lung volume (EELV) were determined during stable stage 2 sleep with and without abdominal compression, achieved via inflation of a pneumatic cuff placed around the abdomen. UACP was assessed during brief mask occlusions. Measurements and Results: Abdominal compression significantly decreased EELV by 0.53 ± 0.24 L (P = 0.045) and increased PGA (16.2 ± 0.8 versus 10.8 ± 0.7 cm H2O, P < 0.001), PDI (11.7 ± 0.9 versus 7.6 ± 1.2 cm H2O, P < 0.001) and UACP (1.4 ± 0.8 versus 0.9 ± 0.9 cm H2O, P = 0.039) but not RUA (6.5 ± 1.4 versus 6.9 ± 1.4 cm H2O·L/s, P = 0.585). Conclusions: Abdominal compression negatively impacts on UA collapsibility during sleep and this effect may help explain strong associations between central obesity and obstructive sleep apnea. Citation: Stadler DL; McEvoy RD; Sprecher KE; Thomson KJ; Ryan MK; Thompson CC; Catcheside PG. Abdominal compression increases upper airway collapsibility during sleep in obese male obstructive sleep apnea patients. SLEEP 2009;32(12):1579-1587. PMID:20041593
Stadler, Daniel L.; McEvoy, R. Doug; Sprecher, Kate E.; Thomson, Kieron J.; Ryan, Melissa K.; Thompson, Courtney C.; Catcheside, Peter G.
Injuries to the great vessels of the torso are commonly seen and managed in busy urban trauma centers. This same injury complex is rarely seen in military conflicts, likely because of the high kinetic energy of weapons causing the wounds seen in this setting. Although most of the great advancements in trauma surgery over the past century have generally resulted from our wartime experience, civilian centers have contributed greatly to the understanding and management of torso vascular injuries. This article reviews the presentation and management of injuries to the great vessels of the torso from major penetrating and blunt trauma. PMID:21810804
Dente, Christopher J; Feliciano, David V
· Tips for College Students: AFTER A DISASTER OR OTHER TRAUMA If you have experienced a disaster such as a hurricane or ... gov | http://store.samhsa.gov 2 TIPS FOR COLLEGE STUDENTS: AFTER A DISASTER OR OTHER TRAUMA ? ? ? ? ? Give ...
memory and trauma through a study of ghostly lineages, blurred gendergender boundaries by Michael Rothberg, Multidirectional Memory:memory and trauma in these works, through a study of ghostly lineages, blurred gender
obtained from the trauma registries of five large trauma research networks. A fractional polynomial was used to model the transfusion-associated probability of death. A logistic regression model for the prediction of massive transfusion, defined as 10...
Stanworth, Simon J; Morris, Timothy P; Gaarder, Christine; Goslings, J Carel; Maegele, Marc; Cohen, Mitchell J; Koenig, Thomas C; Davenport, Ross A; Pittet, Jean-Francois; Johannson, Par I; Allard, Shubha; Johnson, Tony; Brohi, Karim
... Aortic Aneurysm Talk to Your Doctor about Abdominal Aortic Aneurysm The Basics Take Action! Ver en español Content ... with your doctor about your risk for abdominal aortic aneurysm (AAA). If AAA isn't found and treated ...
with sound trauma-informed practice techniques. Children who are sexually abused, veterans returning from multiple tours of duty in active war zones, families whose homes have been swept away in floods, and women for persons serving in the military and veterans, and Dr. Mary Rogge, whose expertise in environmental risks
Grissino-Mayer, Henri D.
Using computed tomography on 19 obese female subjects, we determined abdominal adipose tissue, both subcutaneous and visceral adipose tissue, before and after 2 weeks of a very low caloric diet (VLCD). The following parameters were also determined before and after 15-20 days of VLCD: plasma glucose and insulin levels, oral glucose tolerance test, basal pancreatic insulin secretion estimated by fasting C peptide (Cp), and fasting insulin hepatic clearance calculated by Cp/insulin molar ratio. After VLCD the body weight and body mass index significantly declined (p less than 0.01); whereas abdominal adipose tissue and visceral abdominal tissue (VAT) significantly decreased (p less than 0.01), modifications of subcutaneous abdominal tissue (SAT) were not significant. Fasting insulin levels and plasma glucose response to oral glucose load significantly decreased (p less than 0.05). Insulin response remained unchanged. Cp immunoreactive insulin (IRI) significantly increased (p less than 0.01). A significant positive correlation was found between delta VAT and delta Cp/IRI before and after VLCD (p less than 0.01). Our data seem to suggest that the weight loss induced by VLCD fundamentally involves a decrease in VAT. The reduction in visceral fat could be associated with an increase in hepatic insulin clearance. PMID:2076028
Bosello, O; Zamboni, M; Armellini, F; Zocca, I; Bergamo Andreis, I A; Smacchia, C; Milani, M P; Cominacini, L
Little is known about trauma-related symptoms among runaway adolescents. Precocious departure from familial homes often exposes youth to traumatic victimization. This study examined the extent to which runaway adolescents present trauma symptomotology and assessed factors that predict trauma symptoms. Participants (N = 350) were 12–18 years of age and currently domiciled in youth emergency shelters. Results showed that trauma symptoms were not
Michael D. McCarthy; Sanna J. Thompson
We report a male patient with prolonged post-prandial abdominal distension and a sudden onset of epigastric pain initially diagnosed as acute abdomen. The patient had no history of surgery. Physical examination revealed peritonitis and abdominal computed tomography scan showed upper abdominal mesentery intorsion. The patient then underwent surgical intervention. It was found that the descending mesocolon dorsal root was connected to the ascending colon and formed a membrane encapsulating the small intestine. The membrane also formed an orifice in the ileal pars caeca, from which a 30 cm herniated ileum formed a “C”-shaped loop which was strangulated by the orifice. An abdominal separation was diagnosed after surgery. We liberated the membranous peritoneum which incarcerated the intestinal canal from the root of ileocecal junction to Treitz ligament, and reduced the small intestinal malrotation. The patient had an uneventful recovery after operation with his abdominal distention disappeared during the follow-up. Abdominal separation is a rare situation, which may be related with embryo development. Surgery is a choice of treatment for it. PMID:20614494
Liu, Bao-Lin; Chen, Yang; Liu, Shi-Qing; Zhang, Xiao-Bo; Cui, Dong-Xu; Dai, Xian-Wei
The Terminal Abdominal Ganglion of the Wood Cricket Nemobius sylvestris Teresita C. Insausti Â UniversiteÂ´ FrancÂ¸ois Rabelais, Tours, France ABSTRACT The abdominal cerci of the wood cricket, Nemobius WORDS: cricket; neuroanatomy; giant interneurons; mechanoreceptor projections; terminal abdominal
Giron, David - Institut de Recherche sur la Biologie de l'Insecte, UniversitÃ© FranÃ§ois Rabelais
Many studies have revealed an important relationship between psychosocial trauma and antisocial personality disorder. A multidimensional model is presented which describes the psychopathological route from trauma to antisocial development. A case report is also included that can illustrate the etiological process from trauma to severe antisocial…
Martens, Willem H. J.
BACKGROUND: Trauma is a major health problem in the United Arab Emirates (UAE) as well as worldwide. Trauma registries provide large longitudinal databases for analysis and policy improvement. We aim in this paper to report on the development and evolution of a national trauma registry using a staged approach by developing a single-center registry, a two-center registry, and then a
Sami Shaban; Hani O Eid; Ezedin Barka; Fikri M Abu-Zidan
This article reviews recent reports describing the aetiology of dental trauma from national and international studies as well as the different classi- fications currently used to report dental injuries. It also discusses possible preventive measures to reduce the increasing frequency of dental trauma. Reported studies demonstrate that males tend to experience more dental trauma in the permanent dentition than females,
Elisa B. Bastone; Terry J. Freer; John R. McNamara
In this article, we discuss the nature and role of trauma in relationship to borderline personality disorder and eating disorders. As is clinically evident, trauma can result in a variety of psychological consequences. These consequences include both Axis I and II disorders. Among the Axis II disorders, trauma appears to heighten the risk for the development of borderline, antisocial, avoidant,
Randy A. Sansone; Lori A. Sansone
Empirical research since the year 2000 on trauma and autobiographical memory in adults is reviewed and related to four enduring controversies in the field: Whether traumatic memories are inherently different from other types of autobiographical memory; whether memory for trauma is better or worse than memory for non-traumatic events; whether traumas can be forgotten and then recalled later in life;
Chris R. Brewin
Provides comprehensive definition of psychological trauma and offers guidance to practitioners who are increasingly needed to treat traumatized children. Key therapy considerations are organized around the role of dissociation and repetition compulsion in trauma. Presents treatments in connection with aloneness of trauma experience, dream and…
Munson, Carlton E.
Objective: In contrast to trauma's rela- tionship with the other dissociative disor- ders, the relationship of trauma to deper- sonalization disorder is unknown. The purpose of this study was to systemati- cally investigate the role of childhood in- terpersonal trauma in depersonalization disorder. Method: Forty-nine subjects with DSM-IV depersonalization disorder and 26 healthy comparison subjects who were free of life-
Daphne Simeon; Orna Guralnik; D. James Schmeidler; D. Beth Sirof; M. A. Margaret Knutelska
In cardiac trauma the two main mechanisms of injury are blunt and penetrating trauma. Common cardiac effects of trauma include myocardial rupture, contusion, laceration, pericardial insult, coronary injury, valvular damage, arrhythmias, and conduction abnor malities. Hemodynamic instability can develop rapidly and pose marked risk to patient survival. An adequate level of clinical awareness and timely use of diagnostic techniques such
Mary R. Olsovsky; Andrew S. Wechsler; On Topaz
This study examined whether a history of childhood sexual abuse (CSA) influenced treatment outcome among female veterans with an index trauma of military sexual trauma (MST) receiving residential treatment for posttraumatic stress disorder (PTSD). One hundred and ten female veterans, 61 with a history of CSA and 49 without, were compared on pre-treatment demographic and symptom measures, as well as treatment outcome, which were assessed with the Clinician-Administered PTSD Scale (CAPS), PTSD Checklist-Stressor Specific Version (PCL-S), and Depression Inventory-Second edition (BDI-II). Veterans received cognitive processing therapy (CPT) as the primary trauma-focused treatment. Study findings showed that these two groups did not significantly differ on pre-treatment variables or treatment outcome. Results suggest that CPT delivered in a residential treatment program was effective for female veterans with PTSD related to MST, with and without a history of CSA. PMID:24162758
Walter, Kristen H; Buckley, Amy; Simpson, Jennifer M; Chard, Kathleen M
Background Advances in treatment of acute lymphocytic leukemia increased the likelihood of developing late treatment-associated effects, such as abdominal adiposity, increasing the risk of cardiovascular disease in this population. Cranial radiotherapy is one of the factors that might be involved in this process. The aim of this study was to determine the effect of cranial radiotherapy on adiposity indexes in survivors of acute lymphocytic leukemia. Methods A comparative cross-sectional study of 56 acute lymphocytic leukemia survivors, chronological age between 15 and 24 years, assigned into two groups according to the exposure to cranial radiotherapy (25 irradiated and 31 non-irradiated), assessed according to body fat (dual energy X-ray absorptiometry), computed tomography scan-derived abdominal adipose tissue, lipid profile, and insulin resistance. Results Cranial radiotherapy increased body fat and abdominal adipose tissue and altered lipid panel. Yet, lipids showed no clinical relevance so far. There were significantly more obese patients among those who received cranial radiotherapy (52% irradiated versus 22.6% non-irradiated), based on dual energy X-ray absorptiometry body fat measurements. Nonetheless, no association was observed between cranial radiotherapy and body mass index, waist circumference, waist-to-height ratio or insulin resistance. Conclusions Adolescent and young adult survivors of childhood acute lymphocytic leukemia showed an increase in body fat and an alteration of fat distribution, which were related to cranial radiotherapy. Fat compartment modifications possibly indicate a disease of adipose tissue, and cranial radiotherapy imports in this process. PMID:23433104
This book bridges the communication gap, between the radiologist and the orthopedic surgeon in regard to trauma. It also combines ease of use with authoritative information, and includes in each discussion a review of the pertinent anatomy, mechanism of injury, and radiology and orthopedic classification.
Proposes a mental health treatment model for survivors of torture and war trauma, presenting principles underlying such treatment and a developmental view of such abuse. Describes a Guatemalan project that uses the model to train village women to treat survivors in their communities and a U.S. torture treatment program that treats survivors…
Hanscom, Karen L.
The purpose was to show how anxiety, the perception of the input and predisposing personality factors are interrelated in the generation of the post-traumatic stress disorder (PTSD). After a review of the role of each of these elements in regard to the PTSD, a new conception of anxiety, the core element of trauma, is introduced, grounded in an innovative system
Shulamith Kreitler; Hans Kreitler
This paper presents research and clinical findings regarding how people cope with traumatic events. In the short run people may cope with trauma by trying to maintain the status quo via utilization of familiar behavioral repertoires and defensive behaviors like denial. While this strategy may control initial stress and anxiety, it could eventually lead to long-term maladjustment since it does
Recent years have seen significant advances in knowledge about the effects of exposure to psychological trauma on young children from birth to age 5. This volume brings together leading experts to address practical considerations in working with traumatized young children and their caregivers. State-of-the-art assessment and treatment approaches…
Osofsky, Joy D., Ed.
This in ves ti ga tion fo cuses on dis so ci a tion in a sam ple of pros ti tutes. As part of a larger ex plor atory study in ves ti gat ing the im pact of trauma on mem ory, 33 pros ti tutes were in ter viewed re gard ing the frequency of their past
Barry S. Coo per; M. Alexis Ken nedy; John C. Yuille
There is increasing awareness that many children who present behavioral challenges have experienced relational trauma. These youngsters are not well served by traditional interventions in schools, treatment settings, and communities. Adults responsible for these young people often get drawn into conflict cycles and coercive interventions that only…
Fecser, Frank A.
This article examines racial trauma and highlights strategies for healing and transformation to support the disproportionate number of children and youth of color who fail in school and become trapped in the pipelines of treatment, social service, and justice systems. The difficulty in meeting the needs of these children and youth is failing to…
Hardy, Kenneth V.
A b s t r a c t: The aim of this study is to investigate the correlation between the quality of attachment in early infancy and the effects of child trauma, as well as to introduce some innovative therapeutic approaches. For this reason, a group of 10 children manifesting post-traumatic stress disor- der (PTSD), diagnosed by ICD-10, was selected.
N. Pop-Jordanova; T. Zorcec
In this 36-minute educational video, a play and family therapist elucidates the nature of trauma, how to recognize it clinically, and how to manage its powerful effects upon children's development with the use of specific play materials and techniques. With a reenacted clinical interview, footage from an actual play therapy session, and a detailed…
The notion that development influences children's responses to traumatic stress is not novel. Chronological age and maturity level interact with environmental factors to mediate responses to trauma. Clinicians and researchers have confirmed that children can experience the full range of traumatic stress reactions seen in adults, and many youth…
Garro, Adrienne; Brandwein, David; Calafiore, Tara; Rittenhouse, Nicolette
Chest trauma in children is a marker of injury severity and is associated with a high mortality rate. This retrospective study of 1,356 trauma patients from a private pediatric hospital over a 2.5-year period identified 82 patients with chest injuries and a mortality rate of 22%. Results of Injury Severity Score, Glasgow Coma Scale, and Revised Trauma Score all indicated that children with chest injuries sustained more severe injuries. The presence of any extrathoracic injury was associated with a higher mortality (29%) than chest injury alone (4.3%). The type of extrathoracic injury was important, with head and neck injuries resulting in the highest mortality. Specific chest injuries, such as rib fractures and pulmonary contusions, were not related to increased mortality unless there was an associated extrathoracic injury. Many reports have shown a high mortality associated with chest trauma. This study suggests that it is the associated extrathoracic injury, rather than the chest injury itself, that is the real cause of the high mortality. PMID:8638176
Black, T L; Snyder, C L; Miller, J P; Mann, C M; Copetas, A C; Ellis, D G
The nature and effects of head trauma are discussed. Among the most common deficits noted are impaired cognition, difficulties in oral and written communication, sensory problems, and marked personality changes. Suggestions are offered for dealing with each type of deficit, such as using alarm clocks and other tools to remind the individual about…
Doney, Judith V.
In this study, 58 undergraduate and graduate students at 1 Canadian school of social work voluntarily completed a survey at the conclusion of their academic year consisting of open- and closed-ended questions intended to examine their exposure to trauma during the course of their field practice. The authors discovered that the majority of students…
Didham, Steve; Dromgole, Laura; Csiernik, Rick; Karley, Mary Lou; Hurley, Dermot
Trauma complicates one in 12 pregnancies, and is the leading nonobstetric cause of death among pregnant women. The most common traumatic injuries are motor vehicle crashes, assaults, falls, and intimate partner violence. Nine out of 10 traumatic injuries during pregnancy are classified as minor, yet 60% to 70% of fetal losses after trauma are a result of minor injuries. In minor trauma, four to 24 hours of tocodynamometric monitoring is recommended. Ultrasonography has low sensitivity, but high specificity, for placental abruption. The Kleihauer-Betke test should be performed after major trauma to determine the degree of fetomaternal hemorrhage, regardless of Rh status. To improve the effectiveness of cardiopulmonary resuscitation, clinicians should perform left lateral uterine displacement by tilting the whole maternal body 25 to 30 degrees. Unique aspects of advanced cardiac life support include early intubation, removal of all uterine and fetal monitors, and performance of perimortem cesarean delivery. Proper seat belt use reduces the risk of maternal and fetal injuries in motor vehicle crashes. The lap belt should be placed as low as possible under the protuberant portion of the abdomen and the shoulder belt positioned off to the side of the uterus, between the breasts and over the midportion of the clavicle. All women of childbearing age should be routinely screened for intimate partner violence. PMID:25403036
Murphy, Neil J; Quinlan, Jeffrey D
We report a case of an 18-year-old female who developed an extensive hemothorax after blunt chest trauma. Transesophageal echocardiography (TEE) showed transsection of the aorta at the level of the isthmus and turbulent flows in several places around the aorta. We discuss the contribution of TEE for detecting traumatic injuries to the thoracic aorta. PMID:11466149
Tsoukas, A; Stathoulopoulos, A; Tsatsoulis, P; Geranios, A; Pavlakis, E; Athanasopoulou, A; Papaeliou, I
The growth of the diurnal frequency of appearance of heavy traumas during planetary geomagnetic storms is shown and statistically justified. No effect of short-term geomagnetic disturbances of natural and technogenic nature on the occurrence of acute mental and cardiovascular pathologies was detected on the basis of diurnal data. PMID:11605399
Kuleshova, V P; Pulinets, S A
2 Given the poor outcomes of these children, the prevention of shaken baby syndrome and other forms of head trauma is urgent. How can we prevent shaken baby syndrome? Educating parents is effective. One study compared the rate of shaken baby syndrome between counties in which parents of new- borns received education about the dangers of shaken baby syndrome and
Pediatric trauma presents significant challenges to the anesthesia provider. This review describes the current trends in perioperative anesthetic management, including airway management, choice of anesthesia agents, and fluid administration. The review is based on the PubMed search of literature on perioperative care of severely injured children. PMID:23181208
Ivashkov, Yulia; Bhananker, Sanjay M
Valvular lesions following blunt thoracic trauma are uncommon. Tricuspid valve regurgitation occurs very rarely. We report a successful tricuspid valve reconstruction for rupture of the chordae tendineae in a young man nine years after a motor vehicle accident. The value of echocardiography and transesophageal echocardiography for the diagnosis and quantification of this valve lesion is stressed. PMID:1395792
Kleikamp, G; Schnepper, U; Körtke, H; Breymann, T; Körfer, R
? Child Abuse--what constitutes child abuse and what are its effects on children? Psychiatric Diagnosis the reading. Required Texts: Herman, J. Trauma and Recovery: The aftermath of violence--from domestic abuse on children and adults, as well as its effects on culture and society. Here is a partial list of topics
* R.M. Coupland is the medical adviser on armed violence and the effects of weapons to the legal division of the International Committee of the Red Cross. The opinions expressed are the author’s own and do not represent the views or policy of the International Committee of the Red Cross. Ballistic trauma is perceived, quite reasonably, as being the domain
Robin M. Coupland
Describing traumatic experiences is a routine feature of mental health assessment and treatment it is accepted that in the clinical context this will be distressing to some patients. Research on the experience and sequelae of trauma is also a situation where people may be asked for detailed accounts of traumatic experiences. A common concem voiced by ethics committees is whether
Penny J Brabin; Ellen F Berah
The nature of the refugee phenomenon is examined and the position of mental health professionals is located in relation to it. The various uses of the word ‘trauma’ are explored and its application to the refugee context is examined. It is proposed that refugees’ response to adversity is not limited to being traumatized but includes resilience and Adversity-Activated Development (AAD).
Renos K. Papadopoulos
Witnessing or experiencing a traumatic event affects everyone mentally and emotionally. Each person has a different way of responding emotionally, and this is a normal part of the healing process. This document discusses some of the ways people respond to trauma and how to deal with it. It lists ways to cope with depression, how to help others…
National Depressive and Manic-Depressive Association, Chicago, IL.
The recent plethora of lawsuits involving allegations of iatrogenically implanted memories of satanic ritual abuse and other traumas has highlighted the existence of a unique group of psychiatric patients. Although these patients are often successful at deceiving therapists (and sometimes juries), the case studies in this special issue reveal the chronic nature of their propensity to invent traumatic identities and
Daniel Brown; Alan Scheflin
Summary Subarachnoid hemorrhage following severe trauma to the head is relatively common. In most cases the bleed originates from superficial veins and occasionally from arteries. Following the replacement of cerebral angiography with CT in the diagnostic evaluation of head traumas fewer traumatic aneurysms have been observed. This may indicate that some traumatic aneu-rysms are missed if angiographic procedures are not performed in patients with severe head injury. Trauma patients admitted to our institution are submitted to CT including a bone algorithm. In case of subarachnoid hemorrhage, especially in the basal cisterns, CT- angiography is performed. Digital subtraction angiography is performed as well in cases with uncertain interpretations. During one year 81 patients were admitted with subarachnoid hemorrhage following head trauma. Thirteen (16%) of them underwent CT-angiography and in five (6.2%) with SAH in the basal cistern traumatic aneurysms were found. Four of these cases had a skull base fracture including fractures through the clivus. Four cases were embolized and one very small extradural aneurysm is still not treated. One small pericallosal aneurysm was operated. A traumatic aneurysm should always be suspected n patients with skull base fractures and subarachnoid hemorrhage in the basal cisterns. PMID:20557783
Nakstad, P.Hj.; Gjertsen, Ø.; Pedersen, H.Kr.
Developed out a community participatory research partnership with schools, the Cognitive-Behavioral Intervention for Trauma in Schools Program is a targeted intervention for school children who have experienced a traumatic or violent event and have symptoms of posttraumatic stress disorder. This article describes the original development of the program, with its emphasis on student diversity and school culture. The authors describe
Lisa H. Jaycox; Sheryl H. Kataoka; Bradley D. Stein; Audra K. Langley; Marleen Wong
An ossification of the posterior longitudinal ligament, often presenting asymptomatically, can cause a symptomatic myelopathy after trauma. Keeping this entity in mind in daily clinical routine will help in making the correct diagnosis and in administering the corresponding therapy. PMID:22337517
Schmidt, M; Abächerli, C; Niemann, T
Paramedics are exposed to events involving suffering and tragedy and consequently may experience posttraumatic stress symptoms and depression. Family support is a primary mediator of these reactions, yet family members may be vulnerable to transmitted stress and distress. This qualitative study explores the impact of trauma exposure on spouses of paramedics. Issues identified included managing everyday job stress, safety fears,
The management of severe injured patients requires life-threatening lesions research, especially potential haemorrhagic lesions. The haemorrhagic shock is a rare but serious complication of shoulder girdle traumas. We report in this study the clinical and paraclinical signs that lead us to take care from such evolution. PMID:15904739
Da Costa-Silva, S; Bessereau, J; Ricard-Hibon, A; Juvin, Ph; Marty, J
Background The mechanism and outcome of traumatic abdominal injury (TAI) varies worldwide. Moreover, data comparing TAIs in each abdominal compartment are lacking. We aimed to assess from the academic point of view, TAI based on its anatomical compartments. Patients & methods We conducted a retrospective study for TAI patients between 2008 and 2011 in Qatar. Patients were categorized according to the involved anatomical compartment (C): intrathoracic (ITC), retroperitoneal (RPC), true abdomen (TAC), and pelvic abdomen (PAC) group. Chi Square test, One-Way ANOVA and multivariate regression analysis were appropriately performed. Results Of 6,888 patients admitted to the trauma unit, 1,036 (15%) had TAI that were grouped as ITC (65%), RPC (15%), TAC (13%), and PAC (7%). The mean age was lowest in ITC (29?±?13) and highest in TAC (34?±?11) group, (P?=?0.001). Motor vehicle crash was the main mechanism of injury in all groups except for PAC, in which fall dominated. Vast majority of expatriates had PAC and TAC injuries. The main abdominal injuries included liver (35%; ITC), spleen (32%; ITC) and kidneys (18%; RPC). Extra-abdominal injuries involved the head in RPC and ITC, lung in ITC and RPC and extremities in PAC. Mean ISS was higher in RPC and ITC. Abdominal AIS was higher in TAC injuries. Overall hospital mortality was 10%: RPC (15%), TAC (11%), ITC (9.4%) and PAC (1.5%). Concurrent traumatic brain injury (OR 5.3; P?=?0.001) and need for blood transfusion (OR 3.03; P?=?0.003) were the main independent predictors of mortality. Conclusion In addition to its academic value, the anatomical approach of TAI would be a complementary tool for better understanding and prediction of the pattern and outcome of TAI. This would be possible if further research find accurate, early diagnostic tool for this anatomical classification. PMID:25332723
A mission of the Navy Nurse Corps is to deploy medical support for military forces on short notice. Navy nurses must possess a working knowledge of trauma management, but meeting this clinical experience is a challenge. Peacetime military hospitals do not routinely care for severely injured patients. This article describes how the Navy established a partnership with a Level 1 Trauma Center, the role and expectations for both Navy and civilian nurses, and an evaluation of the experience. PMID:11313625
McNamara, K J; Schulman, C; Jepsen, D; Cuffley, J E
Research traditionally has focused on the development of symptoms in those who experienced trauma directly but overlooked the impact of trauma on the families of victims. In recent years, researchers and clinicians have begun to examine how individual exposure to traumatic events affects the spouses\\/partners, children, and professional helpers of trauma survivors. The current study examines qualitative interview data from
Briana S. Nelson Goff; Allison M. J. Reisbig; Amy Bole; Tamera Scheer; Everett Hayes; Kristy L. Archuleta; Stacey Blalock Henry; Carol B. Hoheisel; Ben Nye; Jamie Osby; Erin Sanders-Hahs; Kami L. Schwerdtfeger; B. Smith; Douglas B. Smith
Purpose We sought to analyze the results of arterial injury management in a busy metropolitan vascular unit and risk factors associated with mortality and morbidity. Patients and methods We analyzed 120 patient with arterial injury treated between year 2000 and 2010 at the University Clinical Center of Kosovo. Seven of these years were prospective and three retrospective study. Results The mechanism of arterial injury was stabbing 46.66%, gunshot wounds in 31.66%, blunt in 13.33%, and landmine in 8.33%. The most frequently injured vessel was the superficial femoral artery (25%), followed by the brachial artery (20.9%), crural arteries (13.1%), forearm arteries (14.3%), iliac arteries (7.5%), abdominal aorta (3.3%), common femoral artery (3.3%) and popliteal artery (3.3%). Associated injuries including bone, nerve and remote injury (affecting the head, chest, or abdomen) were present in 24.2% of patients. The decision to operate was made based on the presence of “hard signs” of vascular trauma. Arterial reconstruction was performed in 90.8% of patients, 5.8% of patients underwent primary amputation and 3.2% died on the operation table. Overall survival rate was 95.8%. Conclusion Injuries to the arteries are associated with significant mortality and morbidity. Mechanism of injury (blunt, gunshot, landmine or stub), hemodynamic stability at the admission, localization of injury, time from injury to flow restitution, associated injuries to the structures in the region and remote organs are critical factors influencing outcome. PMID:22817978
Background Equestrian sports are common outdoor activities that may carry a risk of liver injury. Due to the relative infrequency of equestrian accidents the injury patterns and outcomes associated with liver trauma in these patients have not been well characterized. Methods We examined our experience of the management of equestrian liver trauma in our regional hepatopancreaticobiliary unit at a tertiary referral center. The medical records of patients who sustained liver trauma secondary to equestrian activities were analysed for parameters such as demographic data, liver function tests, patterns of injury, radiological findings, the need for intervention and outcomes. Results 20 patients sustained liver trauma after falling from or being kicked by a horse. The majority of patients were haemodynamically stable on admission. Alanine transaminase (ALT) levels were elevated in all patients and right-sided rib fractures were a frequently associated finding. CT demonstrated laceration of the liver in 12 patients, contusion in 3 and subcapsular haematoma in 2. The right lobe of the liver was most commonly affected. Only two patients required laparotomy and liver resection; the remaining 18 were successfully managed conservatively. Conclusions The risk of liver injury following a horse kick or falling off a horse should not be overlooked. Early CT imaging is advised in these patients, particularly in the presence of high ALT levels and concomitant chest injuries such as rib fractures. Despite significant liver trauma, conservative management in the form of close observation, ideally in a high-dependency setting, is often sufficient. Laparotomy is only rarely warranted and associated with a significantly higher risk of post-operative bile leaks. PMID:25177363
Genital tract trauma is common following vaginal childbirth, and perineal pain is a frequent symptom reported by new mothers. The following techniques and care measures are associated with lower rates of obstetric lacerations and related pain following spontaneous vaginal birth: antenatal perineal massage for nulliparous women, upright or lateral positions for birth, avoidance of Valsalva pushing, delayed pushing with epidural analgesia, avoidance of episiotomy, controlled delivery of the baby's head, use of Dexon (U.S. Surgical; Norwalk, CT) or Vicryl (Ethicon, Inc., Somerville, NJ) suture material, the "Fleming method" for suturing lacerations, and oral or rectal ibuprofen for perineal pain relief after delivery. Further research is warranted to determine the role of prenatal pelvic floor (Kegel) exercises, general exercise, and body mass index in reducing obstetric trauma, and also the role of pelvic floor and general exercise in pelvic floor recovery after childbirth. PMID:17467591
Albers, Leah L; Borders, Noelle
A restriction site indexing method for selectively amplifying any fragment generated by a Class II restriction enzyme includes adaptors specific to fragment ends containing adaptor indexing sequences complementary to fragment indexing sequences near the termini of fragments generated by Class II enzyme cleavage. A method for combinatorial indexing facilitates amplification of restriction fragments whose sequence is not known.
Guilfoyle, Richard A. (Madison, WI); Guo, Zhen (Bellevue, WA)
A restriction site indexing method for selectively amplifying any fragment generated by a Class II restriction enzyme includes adaptors specific to fragment ends containing adaptor indexing sequences complementary to fragment indexing sequences near the termini of fragments generated by Class II enzyme cleavage. A method for combinatorial indexing facilitates amplification of restriction fragments whose sequence is not known.
Guilfoyle, Richard A. (Madison, WI); Guo, Zhen (Bellevue, WA)
We propose a new node centrality measure in networks, the lobby index, which is inspired by Hirsch’s h-index. It is shown that in scale-free networks with exponent ? the distribution of the l-index has power tail with exponent ?(?+1). Properties of the l-index and extensions are discussed.
Korn, A.; Schubert, A.; Telcs, A.
Kennedy Space Center cost Index aids in conceptual design cost estimates. Report discusses development of KSC Cost Index since January 1974. Index since January 1974. Index provides management, design engineers, and estimators an up-to-data reference for local labor and material process. Also provides mount and rate of change in these costs used to predict future construction costs.
Brown, J. A.
Gastrointestinal complications caused by herpes zoster are extremely rare. Here, we described a case of abdominal distention caused by herpes zoster. The patient was a 59-year-old female who suffered from unexplained paroxysmal and a burning pain on the right part of her waist and abdomen, accompanied by abdominal distention. Intestinal pseudo-obstruction was diagnosed by abdominal radiography. Distention of the right abdominal wall was still apparent after one month. In this report, we found that recovery from abdominal distention caused by herpes zoster is difficult and may require surgical intervention. PMID:22969239
Zhou, Su-Rong; Liu, Chuan-Yu
Anesthesia considerations for abdominal wall reconstruction (AWR) are numerous and depend upon the medical status of the patient and the projected procedure. Obesity, sleep apnea, hypertension, and cardiovascular disease are not uncommon in patients with abdominal wall defects; pulmonary functions and cardiac output can be affected by the surgical procedure. Patients with chronic obstructive pulmonary disease are also at a higher risk of coughing during the postoperative awakening process, which can compromise the reconstruction of the fascia. Given the increased complexity of the patients presenting for AWR, and the importance of the anesthesia for these specific procedures, it is important that surgeons are aware of the challenges that anesthesiologists face when treating these patients. Some of these challenges and their resolution are reviewed here. PMID:23372453
Slabach, Rachel; Suyderhoud, Johan P.
Lymphoceles may occur as a result of lymphatic injury during abdominal aortic surgery. These lymphatic collections may occur as a retroperitoneal mass or as groin lymphoceles. Four cases are presented in which persistent retroperitoneal lymphoceles were discovered 2 to 8 years after surgery. Reexploration of the groin and repeated aspirations of lymphatic fluid failed to control the drainage. Reexploration of the retroperitoneum documented lymphatic injury, which was controlled by ligation of the lymphatics with suture. A review of the literature discloses five similar reported cases of retroperitoneal lymphocele and 12 cases of chylous ascites after abdominal aortic surgery. Clearly, avoiding lymphatic injury or immediate repair of any lymphatic injuries will prevent this problem. Once a persistent lymphocele has developed, aspiration will establish the diagnosis. Our experience would suggest that reexploration of the retroperitoneum is required to control the drainage and to prevent possible graft infection. PMID:2778887
Garrett, H E; Richardson, J W; Howard, H S; Garrett, H E
Cigarette smoke has many detrimental effects on health, with consequences such as cardiovascular diseases, respiratory diseases,\\u000a and tumors. In plastic surgery, these effects appear during the wound healing process. This retrospective study showed wound\\u000a healing in 57 patients who had undergone abdominal dermolipectomy surgery. The patients were divided into two groups: smokers\\u000a and nonsmokers. According to the results, smokers face
M. Rogliani; L. Labardi; E. Silvi; F. Maggiulli; M. Grimaldi; V. Cervelli
Background and Objectives: Despite significant advances in laparoscopic instrumentation and techniques, injury to intraabdominal structures remains a potentially serious complication of peritoneal access. Consensus on the best method to obtain peritoneal access is lacking. A safe technique that does not rely on direct visualization of the abdominal layers could shorten the learning curve for surgeons and potentially be adopted by other physicians for a variety of nonsurgical indications for peritoneal entry. Methods: A prospective series of 99 consecutive patients who underwent upper-abdominal laparoscopic surgery performed by a single surgeon between January 2009 and June 2010 was reviewed. The method used to obtain peritoneal access was the fluid-based peritoneal entry indication technique (C-PET) with the EndoTIP trocar. Results: Successful abdominal entry using C-PET was achieved in 90 (90.9%) of the patients; no trocar-related injuries or other injuries associated with peritoneal access occurred. The mean time from incision to confirmed peritoneal access was 21.4 s (range, 12 to 65). Of the 9 cases in which C-PET did not successfully gain entry, 6 occurred during the first 20 surgeries and only 3 in the final 79. Conclusions: C-PET is simple, safe, timely, and effective for gaining peritoneal access during laparoscopic abdominal surgeries. In this series, C-PET produced no complications and proved effective across a wide variety of patients, including the obese and those who had had previous surgery. Furthermore, C-PET does not require visual recognition of anatomic layers and potentially could easily be taught to nonsurgeon physicians who perform peritoneal access. PMID:23484564
Carlson, William H.; Tully, Griffeth; Rajguru, Amit; Burnett, Dan R.
During the past 20 years at the Massachusetts General Hospital the mortality rate for elective resection and grafting of abdominal\\u000a aortic aneurysms (AAA) has fallen from 9.6% to 1.7% in a series of over 1000 patients. The improvement in mortality rate is\\u000a partially the result of earlier diagnosis, better preoperative preparation, routine use of aortography, and increased technical\\u000a experience. Improvements
R. Clement Darling; David C. Brewster
. The objective of this study was to support our hypothesis that surgical resection of abdominal metastases of melanoma, regardless\\u000a of symptomatology, could provide prolonged palliation and improved survival. We performed a retrospective chart review at\\u000a M.D. Anderson Cancer Center. A series of 251 melanoma patients (stages I, II, or III at registration) who developed intraabdominal\\u000a metastases during follow-up were
Haim Gutman; Kenneth R. Hess; John A. Kokotsakis; Merrick I. Ross; Vincent F. Guinee; Charles M. Balch
A double-blind trial of perioperative intravenous metronidazole treatment to prevent infections at the operative site and unexplained fever after abdominal hysterectomy was conducted in 106 patients. Metronidazole prophylaxis reduced the rate of recovery of anaerobes from vaginal swabs for several days and prolonged the high rate of vaginal carriage of enterococci and aerobic gram-negative bacilli following hysterectomy. Although the fever index, calculated from the duration of a temperature above 37.3 degrees C, was significantly lower in the metronidazole-treated group than in the placebo-treated group, the frequency of postoperative infections, the proportion of patients requiring antibiotic treatment and the average duration of hospital stay were similar in the two groups. These results do not support the reported value of perioperative metronidazole prophylaxis in patients undergoing abdominal hysterectomy. PMID:7093856
Vincelette, J.; Finkelstein, F.; Aoki, F. Y.; Ogilvie, R. I.; Richards, G. K.; Seymour, R. J.
We retrospectively analyzed six cases of abdominal cystic lymphangiomas (CL), who had undergone surgical resection. These cases had been evaluated by several modalities: ultrasonography (US), computed tomography (CT), angiography and fine needle aspiration. No age predilection was found. All patients were symptomatic. The most common presenting symptoms were abdominal pain (66%), palpable mass (66%), fever (50%) and vomiting (30%). US showed septations (85%) and unicameral mass (15%); in three cases (50%) echogenic material within the cyst was found, probably due to hemorrhage and infection. CT showed capsular enhancement in all cases. Capsular and septation thickness were slightly increased in cases of infection or bleeding. At CT the contents were usually of fluid attenuation (66%); in 33% the attenuation values were higher, probably because of internal bleeding and infection. US was superior to CT in the demonstration of septations and the internal nature of the cysts. The major role of imaging is to demonstrate the cystic nature of these abdominal masses, because they do not have specific signs or symptoms that could allow a clinical diagnosis. PMID:7601168
Vargas-Serrano, B; Alegre-Bernal, N; Cortina-Moreno, B; Rodriguez-Romero, R; Sanchez-Ortega, F
Most abdominal aortic aneurysms are asymptomatic, being accidentally found on physical examination or in routinely performed imaging studies. They only require surveillance (which is variable according to the aneurism size) and medical therapy in order to achieve risk factor reduction. However, in certain situations, according to the risk of aneurism rupture, elective surgery or endovascular procedure may be necessary. About 80% of the cases of aneurism rupture occur into the retroperitoneal space, with a high mortality rate. There are uncommon presentations of aneurism rupture as the aorto-caval fistula, which also require fast diagnosis and intervention. The authors present the case of a 71-year-old man, with the previous diagnosis of hypertension, acute myocardial infarction 2 months earlier (undergone primary Percutaneous Coronary Intervention) and tabagism, who was admitted at the emergency department with intense 24-hour-evolution epigastric pain. On physical examination, the Blood Pressure values measured at the lower limbs were about half the ones measured at the upper limbs and there was an abdominal pulsatile mass, with a high-intensity murmur. As the authors suspected aortic dissection, aneurysm, coarctation or thrombosis, it was done a Computed Tomography scanning with intravenous contrast, which revealed a ruptured abdominal aorta aneurysm with a mural thrombus. The doppler ultrasound confirmed the presence of a high debit aorto-caval fistula. The patient was immediately transferred to the Vascular Surgery. However he died 2 hours later, during surgery. PMID:22525642
Taborda, Lúcia; Pereira, Laurinda; Amona, Eurides; Pinto, Erique Guedes; Rodrigues, Joaquim
A rare lateral abdominal wall hernia is described in an adult patient. This was diagnosed in a patient with a prominent right lateral abdominal wall deformity. The patient had been experiencing pain that increased progressively in severity over time. A computerized tomography (CT) scan of the abdomen revealed the location of the lateral abdominal wall defect. The hernia defect was through the transversus abdominis and the internal oblique, with the inferior aspect of the 11th rib forming part of the superior border of the defect. A 4-cm bony spur from the inferior aspect of the rib formed part of the lateral margin of the defect. The hernia sac was contained within a space underneath the external oblique muscle. The association of the hernia defect with a bony spur was highly suggestive of a congenital etiology. The hernia was successfully repaired laparoscopically with Parietex mesh (Sofradim, Lyons, France), and the patient had resolution of the symptoms on discharge and follow-up visits. PMID:18949442
Castillo-Sang, M; Gociman, B; Almaroof, B; Fath, J; Cason, F
Abdominal tuberculosis was common in the United Kingdom in the 18th and 19th centuries and in the first half of the 20th century. During the 1950's the recognition of Crohn's disease, the use of streptomycin and other drugs, and the pasteurisation of milk led to the virtual disappearance of abdominal tuberculosis in the western world. During the last two decades a new type, mycobacterium tuberculosis hominis, has appeared mainly in the immigrant population, especially in those from the Indian subcontinent. A retrospective review of 68 patients with abdominal tuberculosis is presented. The pathology, diagnosis and management of these cases is discussed, together with the differential diagnosis of Crohn's disease. It is suggested that the immigrant brings the disease into the United Kingdom in his mesenteric glands and that the disease is reactivated or 'revived' at some later date due to some modification of the immune process. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5 Fig. 6 Fig. 7 PMID:6338801
Addison, N. V.
Purpose Youth in foster care represent a highly traumatized population. However, trauma research on this population has focused primarily on maltreatment rather than the full spectrum of trauma experiences identified within the DSM-IV. The current study aims to fill this gap by reporting the prevalence of exposure to specific types of traumatic events for a large sample of youth with foster care experience. The study also reports the likelihood of lifetime PTSD diagnoses associated with each specific type of trauma. Method Data are from a longitudinal panel study of 732 adolescents aged 17 and 18 who were in foster care. Lifetime trauma exposure and PTSD diagnosis were assessed using the Composite International Diagnostic Interview. Statistical comparisons were made using logistic regressions. Results The majority of respondents had experienced at least one trauma in their lifetime. While overall trauma prevalence did not differ by gender, males were more likely to experience Interpersonal Violence and Environmental Trauma, while females were more likely to experience Sexual Trauma. Caucasian participants reported higher rates of trauma exposure than African-American participants. The types of trauma associated with the highest probability of a lifetime PTSD diagnosis were rape, being tortured or a victim of terrorists, and molestation. Conclusions Youth in foster care are a highly traumatized population and meet diagnostic criteria for PTSD at higher rates than general youth populations. The ongoing impact of trauma may be particularly problematic for these young people given their abrupt transition to independence. PMID:22898825
Salazar, Amy M.; Keller, Thomas E.; Gowen, L. Kris; Courtney, Mark E.
Clinicians seldom assess trauma history in patients who seek treatment for psychological problems, yet trauma exposure is often related to psychological distress. Assessing trauma history can provide valuable information for treatment conceptualization and provision, although patients may not spontaneously share their histories because of embarrassment, avoidance, or other concerns. The authors compared 73 students at a southeastern US medical university who sought counseling and psychological services and completed intake paperwork without a trauma screen with 130 students whose intake procedures included trauma screening. They