Note: This page contains sample records for the topic abdominal trauma index from Science.gov.
While these samples are representative of the content of Science.gov,
they are not comprehensive nor are they the most current set.
We encourage you to perform a real-time search of Science.gov
to obtain the most current and comprehensive results.
Last update: November 12, 2013.
1

Abdominal trauma  

Microsoft Academic Search

Summary  \\u000a While a great part of the Anglo-American medical literature addresses the topic of penetrating trauma the German spreaking\\u000a countries rather publish on blunt abdominal injury. The presented paper discusses the strategic principles of acute clinical\\u000a management of abdominal trauma on the combined basis of own research results and a comprehensive review of the literature.\\u000a \\u000a \\u000a \\u000a Blunt abdominal injuries in most

D. Nast-Kolb; A. Trupka; S. Ruchholtz; L. Schweiberer

1998-01-01

2

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

PubMed Central

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

Morales, Carlos H.; Escobar, Rene M.; Villegas, Maria I.; Castano, Andres; Trujillo, Juliana

2011-01-01

3

[Abdominal penetrating trauma].  

PubMed

A 19-year-old female was brought to the Emergency Room as a trauma patient. During a tilting contest she fell off the horse and was penetrated by a spear used for tilting the ring. She was respiratorically as well as haemodynamically stable. The spear was supported but not removed by the paramedics. The spear penetrated the patient near the left iliac crest pointing at the heart. Further investigation at the Emergency Room is described briefly and guidelines for penetrating, impaled foreign bodies in the (thoraco)abdominal region are outlined. PMID:19671404

Kring, Søren; Helligsøe, Per; Kåg, Lise

2009-06-22

4

Blunt abdominal trauma in children  

Microsoft Academic Search

Despite improved technology and imaging techniques, problems and controversies still exist as to the best methods of diagnosis and management of visceral injuries in children with blunt abdominal trauma. The authors discuss these topics based on their experience with 732 organ injuries in 587 children under 13 years of age during the 11-year period 1978–1988.

S. Cywes; D. H. Bass; H. Rode; A. J. W. Millar

1990-01-01

5

Intra-abdominal abscess after penetrating abdominal trauma.  

PubMed

We reviewed our experience with intra-abdominal abscess after penetrating abdominal trauma. Of a total of 872 laparotomies (1980-1986), 29 patients (0.7% of stab wounds and 6% of gunshot wounds) developed abscesses. Pancreatic and duodenal injuries, in the presence of concomitant colon perforation, were most frequently associated with abscess formation. Fourteen of the 29 patients had multiorgan failure (MOF), Group I, and 15 patients did not have MOF, Group II. Group I had a significantly higher Abdominal Trauma Index (ATI) and Acute Physiology and Chronic Health Evaluation (APACHE II), received greater number of perioperative transfusions and underwent a higher number of reoperations for sepsis than Group II patients. Radiologic imaging techniques were frequently inconclusive for the diagnosis and localization of intra-abdominal abscess in Group I. They were highly accurate in Group II. Fifty per cent of Group I patients died from sepsis and MOF. We conclude that the anatomic (ATI) and the physiologic (APACHE) scores are useful predictors of the potential for uncontrolled sepsis. In the presence of ongoing multiorgan failure, reoperation for sepsis is warranted on clinical grounds alone. PMID:3411646

Ivatury, R R; Zubowski, R; Psarras, P; Nallathambi, M; Rohman, M; Stahl, W M

1988-08-01

6

CT SCANS OF ABDOMINAL TRAUMA IN CHILDREN  

Microsoft Academic Search

CT scans of a child's abdomen after blunt abdominal trauma have become a widely accepted technique for evaluating intra-abdominal organ injuries, because clinical findings of children may not reveal anything in such circumstances. This report reviews the CT findings over a 6 year period of 26 children under 15 years old with blunt abdomi- nal trauma at Maharaj Nakorn Chiang

Nuttaya Pattamapaspong; Pannee Visrutaratna

2005-01-01

7

Computed tomography of pediatric blunt abdominal trauma  

Microsoft Academic Search

Computed tomography (CT) is the imaging method of choice in the evaluation of hemodynamically stable children after blunt abdominal trauma. Evaluation with CT will show whether intraperitoneal fluid or blood is present and whether the liver, spleen, kidneys, and pancreas are intact. Although the principal role of CT after blunt abdominal trauma is the assessment of solid viscus injury, an

Carlos J. Sivit; Aletta A. Frazier; Martin R. Eichelberger

1997-01-01

8

CT of hemodynamically unstable abdominal trauma  

Microsoft Academic Search

.   This article is an appraisal of the use of CT in the management of patients with unstable abdominal trauma. We examined 41\\u000a patients with abdominal trauma using noncontrast dynamic CT. In 17 patients a postcontrast dynamic CT was also carried out.\\u000a On CT, 25 patients had hemoperitoneum. Thirteen patients had splenic, 12 hepatic, 6 pancreatic, 8 bowel and mesenteric,

A. Petridis; M. Pilavaki; E. Vafiadis; P. Palladas; S. Finitsis; A. Drevelegas

1999-01-01

9

CT of abdominal and pelvic trauma  

Microsoft Academic Search

CT is the diagnostic study of choice at most institutions in the evaluation of hemodynamically stable, blunt abdominal trauma. It is highly specific and sensitive in the detection and definition of the extent of most intra-abdominal and pelvic injuries. The clinical examination is the most important factor in the decision regarding whether surgery should be undertaken. However, a progressive and

John L Roberts

1996-01-01

10

Mini-laparoscopy in blunt abdominal trauma  

Microsoft Academic Search

Summary  Blunt abdominal trauma in multiorgan injured or comatose patients always presents a problem. The aim is to assess, in the\\u000a shortest period of time, which organ injury requires priority and whether intra-abdominal bleeding or perforation exists.\\u000a Abdominal lavage proved to be too sensitive. Not every positive case needs exploration. Approximately 15%–20% of the cases\\u000a explored because of positive lavage did

Dennis Wood; George Berci; Leon Morgenstern; Margaret Paz-Partlow; D. Lorenz

1988-01-01

11

[Duodenal perforation after blunt abdominal trauma].  

PubMed

Duodenal perforation after a blunt abdominal trauma is a rare emergency situation that can result in life-threatening complications. We report on a woman who had a perforation of the duodenum after a supposed mild blunt abdominal trauma. Unremarkable at the initial presentation, the patient presented with acute abdominal pain and a retroperitoneal abscess five days after the initial trauma. The duodenal repair was performed with a Roux-Y anastomosis. Difficulties in diagnosis are very common, but the early recognition of the rupture is essential. The contrast-enhanced CT scan is the gold standard for diagnosis. Surgical management depends on the severity of the trauma and must be chosen on an individual basis. PMID:20020392

Schneider, R; Moebius, C; Thelen, A; Jonas, S

2009-12-17

12

Evaluation of abdominal trauma by computed tomography.  

PubMed

Computed tomography (CT) was used in the evaluation of 100 patients suffering abdominal trauma. The type of trauma was blunt in 78 patients, penetrating in eight, and iatrogenic in 14. Forty per cent of cases had normal CT scans, while 60% showed substantial abdominal or retroperitoneal injuries. Surgery, clinical follow-up, and repeated radiologic examinations confirmed the accuracy of CT, and there were no cases in which medical or surgical management was inappropriately guided by CT. A wide variety of injuries was detected, including 19 splenic, eight hepatic, six pancreatic, 13 renal, 13 retroperitoneal or abdominal wall, and one intraperitoneal. CT has major advantages over plain radiography, radionuclide imaging, and angiography in assessment of trauma-induced injuries. PMID:6450962

Federle, M P; Goldberg, H I; Kaiser, J A; Moss, A A; Jeffrey, R B; Mall, J C

1981-03-01

13

Actual Diagnostic Strategies in Blunt Abdominal Trauma  

Microsoft Academic Search

An accurate assessment of patients with potential blunt abdominal trauma should include a safe and reliable method of determining\\u000a the need for operative intervention because the mortality and morbidity of these injuries are directly dependent on the immediately\\u000a valid diagnostic work-up. Since peritoneal signs are often subtle, overshadowed by pain from associated injury or masked by\\u000a head trauma and intoxicants,

Paul L. O. Broos; Herbert Gutermann

2002-01-01

14

Therapeutic laparoscopy for abdominal trauma  

Microsoft Academic Search

  Background: Instead of open laparotomy, laparoscopy can be used safely and effectively for the diagnosis and treatment of\\u000a traumatic abdominal injuries. Methods: Between February 1998 and January 2002, 78 hemodynamically stable patients (49 males\\u000a and 29 females) with suspicious abdominal injuries underwent diagnostic or therapeutic laparoscopy. The patients ranged in\\u000a age from 15 to 79 years (median, 40.9 years). Of

Y. B. Chol; K. S. Lim

2003-01-01

15

Traumatic mesenteric cyst after blunt abdominal trauma  

PubMed Central

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.

Falidas, Evangelos; Mathioulakis, Stavros; Vlachos, Konstantinos; Pavlakis, Emmanouil; Anyfantakis, Georgios; Villias, Constantinos

2011-01-01

16

Abdominal trauma: never underestimate it.  

PubMed

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

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

2011-10-12

17

Focused abdominal sonography for trauma in the emergency department for blunt abdominal trauma  

Microsoft Academic Search

Background  Blunt abdominal trauma (BAT) is a diagnostic challenge to the emergency physician (EP). The introduction of bedside ultrasound\\u000a provides another diagnostic tool for the EP to detect intra-abdominal injuries.\\u000a \\u000a \\u000a \\u000a Aims  To evaluate the performance of EP in a local emergency department in Hong Kong to perform the ‘focused abdominal sonography\\u000a for trauma’ (FAST) in BAT patients.\\u000a \\u000a \\u000a \\u000a Methods  This was a retrospective cohort

Chi Leung Tsui; Hin Tat Fung; Kin Lai Chung; Chak Wah Kam

2008-01-01

18

Contrast-enhanced ultrasound in abdominal trauma.  

PubMed

Increasing evidence supports a role for contrast-enhanced ultrasound in the assessment of blunt abdominal trauma. Accurate definition of organ injury can be demonstrated, as well as extension to solid organ capsule and even vascular injury. Low-dose contrast is needed for renal imaging, to avoid obscuration of deeper structures from intense cortical enhancement. The liver should be evaluated in the arterial phase for active bleeding and in the late phase for lacerations. The spleen is best assessed in the delayed phase, thereby limiting misinterpretation of early heterogeneous contrast uptake. Typical sonographic features of traumatic injuries of the solid abdominal organs are described. Although contrast-enhanced computed tomography is the gold standard modality for imaging abdominal organ traumatic injury, contrast-enhanced ultrasound has developed a role in the emergency setting, particularly in low-energy injuries and in follow-up of traumatic injuries. PMID:21934507

Afaq, Asim; Harvey, Chris; Aldin, Zaid; Leen, Edward; Cosgrove, David

2012-06-01

19

[Luxatio cordis in blunt-trauma thoraco-abdominal injuries].  

PubMed

A 56-year old woman was admitted to the emergency ward after suffering a blunt thoraco-abdominal high-velocity trauma as she hit the wheel when her car drove into a tree. A laparotomy was performed because of haemodynamic instability and radiographic suspicion of a diaphragmatic rupture. Besides haemorrhage from liver and spleen injuries, an abdominal herniation of the heart through a ruptured pericardium and diaphragm was found. Haemostasis of liver, splenectomy and suturing of defects in pericardium and diaphragm resulted in a haemodynamically stable situation. A high index of suspicion of rupture of pericardium and diaphragm with luxation of the heart in the trauma patient is important to reduce morbidity and mortality due to delay of surgical intervention. PMID:10850111

van Brussel, J P; Vles, W J; Leenen, L P

2000-05-27

20

Laparotomy for blunt abdominal trauma in a civilian trauma service.  

PubMed

This report looks at the group of patients who required a laparotomy for blunt torso trauma at a busy metropolitan trauma service in South Africa. Methods. A prospective trauma registry is maintained by the surgical services of the Pietermaritzburg metropolitan complex. This registry is interrogated retrospectively. All patients who required admission for blunt torso trauma over the period September 2006 - September 2007 were included for review. Proformas documenting mechanism of injury, age, vital signs, blood gas, delay in presentation, length of hospital stay, intensive care unit stay and operative details were completed. Results. A total of 926 patients were treated for blunt trauma by the Pietermaritzburg metropolitan services during the period under consideration. A cohort of 65 (8%) required a laparotomy for blunt trauma during this period. There were 17 females in this group. The mechanisms of injury were motor vehicle accident (MVA) (27), pedestrian vehicle accident (PVA) (21), assault (5), fall from a height (3), bicycle accident (6), quad bike accident (1) and tractor-related accident (2). The following isolated injuries were discovered at laparotomy: liver (9), spleen (5), diaphragm (1), duodenum (2), small bowel (8), mesentery (8) bladder (10), gallbladder (1), stomach (2), colon/rectum (2) and retrohepatic vena cava (1). The following combined injuries were discovered: liver and diaphragm (2), spleen and pancreas (1), spleen and liver (2), spleen, aorta and diaphragm (1), spleen and bladder (1) and small bowel and bladder (2). Eighteen patients in the series (26%) required relaparotomy. In 10 patients temporary abdominal containment was needed. The mortality rate was 26% (18 patients). There were 6 deaths from massive bleeding, all within 6 hours of operation, and 3 deaths from renal failure; the remaining 9 patients died of multiple organ failure. There were 8 negative laparotomies (7%). In the negative laparotomy group false-positive computed tomography (CT) scan findings were a problem in 3 cases, in 1 case hypotension and a fractured pelvis on admission prompted laparotomy, and in the other cases clinical findings prompted laparotomy. All patients who underwent negative laparotomy survived. There were 10 pelvic fractures, 5 lower limb fractures, 2 spinal injuries, 4 femur fractures and 2 upper limb fractures. CT scans were done in 25 patients. In 20 patients the systolic blood pressure on presentation was <90 mmHg and in 41 the pulse rate was >110 beats/min. In 16 patients there was a base excess of <-4 on presentation. Conclusion. Laparotomy is needed in less than 10% of patients who sustain blunt abdominal trauma. Solid visceral injury requiring laparotomy presents with haemodynamic instability. Hollow visceral injury has a more insidious presentation and is associated with a delay in diagnosis. CT scan is the most widely used investigation in blunt abdominal trauma. It is both sensitive and specific for solid visceral injury, but its accuracy for the diagnosis of hollow visceral injury is less well defined. Clinical suspicion must be high, and hollow visceral injury needs to be actively excluded. PMID:22622098

Howes, N; Walker, T; Allorto, N L; Oosthuizen, G V; Clarke, D L

2012-03-29

21

Computed tomography and nonoperative treatment for blunt abdominal trauma  

Microsoft Academic Search

Studies were undertaken to determine if computed tomography (CT) could reliably assist physical examination in the initial\\u000a assessment of blunt abdominal trauma, and also to examine how various abdominal injuries were managed with the guidance of\\u000a CT. A total of 255 patients underwent emergency abdominal CT following blunt abdominal trauma over a period of seven years.\\u000a One hundred and fifty

Shinsuke Watanabe; Takashi Ishi; Masahiro Kamachi; Toshio Takahashi

1990-01-01

22

Isolated duodenal rupture due to blunt abdominal trauma  

Microsoft Academic Search

Duodenal rupture following blunt abdominal trauma is rare and it usually seen with other abdominal organ injuries. It represents approximately 2% to 20% of patients with blunt abdominal injury and often occurs after blows to the upper abdomen, or abdominal compression from high-riding seat belts. Two cases of blunt duodenal rupture successfully treated surgically, are presented with their preoperative diagnosis

Atilla Celik; Ediz Altinli; Ender Onur; Aziz Sumer; Neset Koksal

23

Lower gastrointestinal bleeding: an unusual presentation for blunt abdominal trauma.  

PubMed

A case of mesenteric vascular injury secondary to nonpenetrating steering wheel abdominal trauma is presented. Unique to this report is the presentation of blunt abdominal trauma as acute lower gastrointestinal bleeding with demonstration of the lesion preoperatively via selective celiac and superior mesenteric arteriography. PMID:304108

Moore, J B; Moore, E E

1977-12-01

24

Management of kidney injuries in children with blunt abdominal trauma  

Microsoft Academic Search

Background\\/Purpose: The authors analyzed the incidence and the course of renal injuries encountered in a cohort of pediatric patients with blunt abdominal trauma. This review focuses on the early diagnostic and therapeutic approach rather than the long-term outcome and draws conclusions for an effective initial management. Methods: From 1976 to 1996, the charts of 308 children with blunt abdominal trauma

L. M. Wessel; S. Scholz; I. Jester; R. Arnold; C. Lorenz; S. Hosie; H. Wirth; K.-L. Waag

2000-01-01

25

Is adverse pregnancy outcome predictable after blunt abdominal trauma?  

Microsoft Academic Search

Objective: The aim of the study was to evaluate the following: (1) pregnancy outcome after blunt abdominal trauma and (2) factors that may predict preterm birth and adverse peripartum outcomes. Study Design: All women who had noncatastrophic abdominal trauma and came to the labor and delivery suite July 1994-August 1997 were prospectively evaluated and admitted for continuous uterine and fetal

Lisa Leone Pak; E. Albert Reece; Linda Chan

1998-01-01

26

Computed tomography of blunt abdominal trauma in children  

Microsoft Academic Search

Computed tomography (CT) plays a major role in diagnosis of blunt abdominal trauma of haemodynamically-stable children. The purpose of this article is to review the CT findings in children with hepatic, splenic, renal, adrenal, pancreatic, bowel, and mesentery injuries and in children with blunt abdominal trauma and active haemorrhage.

Visrutaratna P; Na-Chiangmai W

27

Laparoscopic diagnosis of blunt abdominal trauma in children  

Microsoft Academic Search

This study evaluates the safety and role of laparoscopy in the diagnosis of blunt abdominal trauma in children. Laparoscopy was performed in five patients aged 3 to 13 years because of persistent abdominal pain after blunt trauma. A laparotomy was not indicated from the physical examination, laboratory data, or radiologic findings. With the patient under general anesthesia, a 10-mm trocar

T. Hasegawa; Y. Miki; Y. Yoshioka; S. Mizutani; T. Sasaki; J. Sumimura

1997-01-01

28

Intestinal stenosis from mesenteric injury after blunt abdominal trauma  

Microsoft Academic Search

.   We report a case in which blunt abdominal trauma resulted in injury to the mesentery with subsequent ischemic stricture of\\u000a the adjacent small bowel. We present CT images at the time of trauma and 5 weeks later when clinical signs of intestinal obstruction\\u000a occurred. We include images of enteroclysis and angiography of this uncommon sequela of blunt abdominal trauma.

A. I. De Backer; A. M. A. De Schepper; W. Vaneerdeweg; P. Pelckmans

1999-01-01

29

Melaena as the presenting symptom of gastric mucosal injury due to blunt abdominal trauma  

PubMed Central

Blunt abdominal trauma is a common cause of admission to the typical trauma centre. Hollow viscus injury from blunt trauma, however, is unusual and rarely involves the stomach. A 15 year old boy sustained a bicycle handle bar injury to the abdomen and presented to the casualty department four days later with melaena. A computed tomography (CT) scan of the abdomen showed normal findings but endoscopy revealed two “kissing” areas of mucosal ulceration on the anterior and posterior wall of the gastric antrum. The patient received a blood transfusion for anaemia but was otherwise treated conservatively and made a full recovery. The authors believe this to be the first reported case of melaena as the primary presenting symptom of gastric ulceration secondary to blunt abdominal trauma. Diagnosis of hollow viscus injuries due to blunt abdominal trauma requires a high index of suspicion and thorough investigation, particularly if the presentation is delayed.

Saeb-Parsy, K; Omer, A; Hall, N R

2006-01-01

30

Melaena as the presenting symptom of gastric mucosal injury due to blunt abdominal trauma.  

PubMed

Blunt abdominal trauma is a common cause of admission to the typical trauma centre. Hollow viscus injury from blunt trauma, however, is unusual and rarely involves the stomach. A 15 year old boy sustained a bicycle handle bar injury to the abdomen and presented to the casualty department four days later with melaena. A computed tomography (CT) scan of the abdomen showed normal findings but endoscopy revealed two "kissing" areas of mucosal ulceration on the anterior and posterior wall of the gastric antrum. The patient received a blood transfusion for anaemia but was otherwise treated conservatively and made a full recovery. The authors believe this to be the first reported case of melaena as the primary presenting symptom of gastric ulceration secondary to blunt abdominal trauma. Diagnosis of hollow viscus injuries due to blunt abdominal trauma requires a high index of suspicion and thorough investigation, particularly if the presentation is delayed. PMID:16627828

Saeb-Parsy, K; Omer, A; Hall, N R

2006-05-01

31

Patterns of diagnostic error in trauma abdominal CT  

Microsoft Academic Search

.   Objective: To define patterns of diagnostic error in the interpretation of trauma abdominal CT. Materials and methods: Two hundred fifty-four out of 1751 abdominal CT scans performed for evaluation of trauma had a definite or equivocal diagnosis\\u000a of an abdominal injury. Cases were re-read initially without reference to the original reports, in which 44 potential diagnostic\\u000a errors were identified.

Clark O. West; Jon Anderson; Jody S. Lee; Christopher W. Finnell; Bharat K. Raval

2002-01-01

32

Thrombosis of the portal venous system following blunt abdominal trauma  

Microsoft Academic Search

A 60-year-old man presented to the accident and emergency department with a 4-day history of abdominal pain following blunt abdominal trauma. An initial CT scan showed thickened walls of the proximal jejunum and thromboses in the portal, splenic and superior mesenteric veins. He was given warfarin and the abdominal pain resolved. A repeat CT scan 1 week later revealed significant

Vikram Rajkomar; Enoch Kyerematen; Prabhakar Mysore; James Penston

2010-01-01

33

Prospective evaluation of hand-held focused abdominal sonography for trauma (FAST) in blunt abdominal trauma  

PubMed Central

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.

Kirkpatrick, Andrew W.; Sirois, Marco; Laupland, Kevin B.; Goldstein, Leanelle; Brown, David Ross; Simons, Richard K.; Dulchavsky, Scott; Boulanger, Bernard R.

2005-01-01

34

CT diagnosis of unsuspected pneumothorax after blunt abdominal trauma  

Microsoft Academic Search

Review of abdominal CT scans for evaluation of blunt abdominal trauma yielded 35 cases of pneumothorax, 10 of which had not been diagnosed before CT by clinical examination of plain radiographs. Of the 10 cases initially diagnosed on CT, seven required tube thoracostomy for treatment of the pneumothorax. CT detection of pneumothorax is especially important if mechanical assisted ventilation or

S. D. Wall; M. P. Federle; R. B. Jeffrey; C. M. Brett

1983-01-01

35

Small Bowel Injury in Peritoneal Encapsulation following Penetrating Abdominal Trauma.  

PubMed

Small bowel encapsulation is a rare entity which is usually found incidentally at autopsy. We report the first case of peritoneal encapsulation encountered serendipitously at laparotomy undertaken for penetrating abdominal trauma and review the literature on peritoneal encapsulation. We also compare this phenomenon to abdominal cocoon and sclerosing encapsulating peritonitis. PMID:23533912

Naidoo, K; Mewa Kinoo, S; Singh, B

2013-02-26

36

Small Bowel Injury in Peritoneal Encapsulation following Penetrating Abdominal Trauma  

PubMed Central

Small bowel encapsulation is a rare entity which is usually found incidentally at autopsy. We report the first case of peritoneal encapsulation encountered serendipitously at laparotomy undertaken for penetrating abdominal trauma and review the literature on peritoneal encapsulation. We also compare this phenomenon to abdominal cocoon and sclerosing encapsulating peritonitis.

Naidoo, K.; Mewa Kinoo, S.; Singh, B.

2013-01-01

37

Unusual late occurrence of bowel obstruction following blunt abdominal trauma.  

PubMed

We report a case of late occurrence of small bowel obstruction due to stricture resulting from blunt abdominal trauma. On initial computed tomography (CT) scan, the patient had a mesenteric hematoma, which was managed conservatively. Approximately two weeks later, he complained of worsening abdominal pain and developed clinical signs of bowel obstruction. A repeat enhanced CT scan showed a stenotic loop of distal ileum adjacent to a large mesenteric mass. The loop was resected. We propose that post-traumatic intestinal stenosis be considered in the differential diagnosis in patients who have experienced blunt abdominal trauma and present later with clinical signs of bowel obstruction. PMID:22324088

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

38

Study of the Diagnostic Value of Ultra Sonography in Blunt Abdominal Traumas  

Microsoft Academic Search

Aims: To evaluate the diagnostic value of ultra sonography in the diagnosis of blunt abdominal trauma. Setting\\/ Patients and Methods: Patients with blunt abdominal trauma referred to Shahid Rahnemoun and Afshar Hospitals of Yazd. Results: Sixty patients suffering from blunt abdominal trauma were seen. The mean age was 30.7 years, and accidents were the leading cause of trauma. Ultra sonography

Mostafa Shiryazdi; Abbas Modir

39

Thrombosis of the portal venous system following blunt abdominal trauma.  

PubMed

A 60-year-old man presented to the accident and emergency department with a 4-day history of abdominal pain following blunt abdominal trauma. An initial CT scan showed thickened walls of the proximal jejunum and thromboses in the portal, splenic and superior mesenteric veins. He was given warfarin and the abdominal pain resolved. A repeat CT scan 1 week later revealed significant resolution of the mural thickening and the portal vein thrombosis. A subsequent thrombophilia screen was negative and he continued taking oral anticoagulants for a total of 6 months. A repeat CT scan 3 months after presentation revealed complete recanalisation the portal venous system. PMID:22767370

Rajkomar, Vikram; Kyerematen, Enoch; Mysore, Prabhakar; Penston, James

2010-08-24

40

Thrombosis of the portal venous system following blunt abdominal trauma  

PubMed Central

A 60-year-old man presented to the accident and emergency department with a 4-day history of abdominal pain following blunt abdominal trauma. An initial CT scan showed thickened walls of the proximal jejunum and thromboses in the portal, splenic and superior mesenteric veins. He was given warfarin and the abdominal pain resolved. A repeat CT scan 1 week later revealed significant resolution of the mural thickening and the portal vein thrombosis. A subsequent thrombophilia screen was negative and he continued taking oral anticoagulants for a total of 6 months. A repeat CT scan 3 months after presentation revealed complete recanalisation the portal venous system.

Rajkomar, Vikram; Kyerematen, Enoch; Mysore, Prabhakar; Penston, James

2010-01-01

41

Epidemiology of Abusive Abdominal Trauma Hospitalizations in United States Children  

ERIC Educational Resources Information Center

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

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

2012-01-01

42

Abdominal CT scanning for trauma: how low can we go?  

Microsoft Academic Search

Purpose: computed tomography (CT) of the abdomen is an established, albeit expensive and perhaps overused, diagnostic modality for the evaluation of the injured patient. We developed a practice management guideline for blunt abdominal trauma intended to reduce the percentage of negative CT scans, yet minimize delayed recognition of injury and non-therapeutic laparotomy. Procedures: between April 1996 and March 1997, 1147

David G Jacobs; Jennifer L Sarafin; John A Marx

2000-01-01

43

Pneumatosis intestinalis and portal vein gas after blunt abdominal trauma  

Microsoft Academic Search

The authors report on a 2-year-old boy in whom pneumatosis intestinalis (PI) and portal vein gas (PVG) resulted from blunt abdominal trauma after child abuse. The presumed pathophysiology of PI and PVG is mechanical in this setting. Its presence establishes mucosal injury but does not necessarily imply intestinal necrosis.

Brooke Gurland; Stephen E Dolgin; Edward Shlasko; Unsup Kim

1998-01-01

44

Rupture of the normal renal pelvis after blunt abdominal trauma  

Microsoft Academic Search

Blunt abdominal trauma with isolated rupture of the normal renal pelvis is an extremely rare clinical entity. The correct preoperative diagnosis may be difficult and challenging because of the insidious onset, lack of blood loss, and frequently, lack of urinary symptoms. Intraoperative inspection of the collecting system is the most accurate method to fully define an extent of injury. The

Maciej Murawski; Andrzej Go??biewski; Leszek Komasara; Piotr Czauderna

2008-01-01

45

Blunt abdominal trauma with transanal small bowel evisceration  

PubMed Central

Small bowel evisceration through the anus can occur spontaneously or post traumatically. Traumatic transanal small bowel evisceration results from iatrogenic injuries, suction injuries, and blunt abdominal trauma (BAT). We report a 48-year-old female who presented with evisceration of small intestinal loops through the anus following BAT and discuss the etiologies and mechanisms of injury of this rare presentation.

Medappil, Noushif; Prashanth, Adiga K; Latheef, Abdul

2013-01-01

46

Blunt abdominal trauma with transanal small bowel evisceration.  

PubMed

Small bowel evisceration through the anus can occur spontaneously or post traumatically. Traumatic transanal small bowel evisceration results from iatrogenic injuries, suction injuries, and blunt abdominal trauma (BAT). We report a 48-year-old female who presented with evisceration of small intestinal loops through the anus following BAT and discuss the etiologies and mechanisms of injury of this rare presentation. PMID:23493429

Medappil, Noushif; Prashanth, Adiga K; Latheef, Abdul

2013-01-01

47

Is Hospital Admission and Observation Required after a Normal Abdominal Computed Tomography Scan in Children with Blunt Abdominal Trauma?  

Microsoft Academic Search

Objectives: The objective was to determine if hospital admission of children with blunt abdominal trauma for observation of possible intraabdominal injury (IAI) is necessary after a normal abdominal computed tomography (CT) scan in the emergency department (ED). Methods: The authors conducted a prospective observational cohort study of children less than 18 years of age with blunt abdominal trauma who underwent

Smita Awasthi; Amy Mao; Sandra L. Wooton-Gorges; David H. Wisner; Nathan Kuppermann; James F. Holmes

2008-01-01

48

CT scanning of children with blunt abdominal trauma – is oral contrast useful?  

Microsoft Academic Search

Purpose: To determine the usefulness of oral contrast in CT scanning of children with blunt abdominal trauma by comparing scans performed\\u000a with and without oral contrast. Methods: CT scans of 273 children with abdominal trauma and 40 without trauma were reviewed. Results: Of the trauma patients, 116 (43 %) were scanned with oral contrast, 157 (57 %) without. Among the

S. P. Ryan; G. Gaisie; R. A. Kraus

2000-01-01

49

Upper abdominal trauma in children: imaging evaluation  

Microsoft Academic Search

One hundred consecutive children with serious blunt upper-abdominal injury were evaluated prospectively to assess the accuracy and usefulness of emergency computed tomography (CT) compared with liver-spleen scintigraphy and sonography. Ninety-five hemodynamically stable patients were imaged. The results of this 20-month study indicated that CT has fewer false negatives and false positives than scintigraphy or sonography, that CT is useful in

Robert A. Kaufman; Richard Towbin; Diane S. Babcock; Michael J. Gelfand; Karen S. Guice; Keith T. Oldham; John Noseworthy

1984-01-01

50

Successful management of a combined abdominal and thoracic trauma with rectal impalement: report of a case.  

PubMed

Introduction. Combined abdominal and thoracic impalement injuries are a rare form of penetrating trauma. Nowadays, they occur more frequently as an accident and not so often as a deliberate violent action. Case Report. A 35-year-old man was admitted to our emergency department with chest pain and respiratory distress after he had reportedly slipped in his bathtub. Abdominal and thoracic imaging, including computed tomography (CT), confirmed a right-sided pneumothorax and a liver laceration without bleeding or further endoperitoneal trauma. A chest tube was placed. During his hospitalization in the first 24-hour period, he complained of abdominal and right shoulder pain accompanied by fever. A new abdominal and thoracic CT scanning revealed a rupture of the rectosigmoid, a rupture of right hemidiaphragm, and a foreign body in the thoracic cavity. The patient admitted that a broomstick was violently placed through his rectum, and he underwent a thoracotomy with an exploratory laparotomy. The foreign object was removed, the diaphragmatic rupture was repaired, and a Hartmann's procedure was performed. The postoperative course was uneventful. Conclusion. In cases of combined thoracoabdominal trauma, high index of suspicion is required when medical history is misleading and the injuries are not obvious immediately. A coordinated team effort in a well-organized trauma center is also very important. PMID:23844309

Kasapas, Konstantinos; Daskalaki, Anna; Kaimasidis, George; Chalkiadakis, George

2013-06-17

51

Minimal pelvic fluid in blunt abdominal trauma in children: The significance of this sonographic finding  

Microsoft Academic Search

Purpose: The aim of this study was to evaluate the significance of the ultrasonographic finding of pelvic fluid after blunt abdominal trauma in children as a predictor of an abdominal organ injury. Methods: The clinical and imaging data of 183 children with blunt abdominal trauma were reviewed retrospectively. All children had an abdominal sonography as the primary screening study. The

Valeria Rathaus; Rivka Zissin; Miriam Werner; Ilan Erez; Myra Shapiro; Michael Grunebaum; Osnat Konen

2001-01-01

52

The Role of Computed Tomography in Blunt Abdominal Trauma  

PubMed Central

Objective: To determine the utility of the computed tomography (CT) scan in blunt abdominal trauma and to compare it with operative findings or clinical outcomes. Methods: A retrospective analysis based on existing, diagnostic CT scan reports taken during a 5 year period from 245 consecutive patients with blunt abdominal trauma. Percentages and types of trauma identified were based on CT scan findings. Recorded data included age, sex, type of injuries and scan results. The CT findings were compared and correlated with the operative findings, or clinical follow-up in conservatively managed cases. Results: Of the total of 245 patients, 113 (46%) underwent surgery. One hundred and thirty two (54%) patients were conservatively managed. There were 12 (4.9%) deaths. Hemoperitoneum were detected in 170 patients. All 52 patients with small hemoperitoneum on CT scan were conservatively managed and all 22 patients with large hemoperitoneum required surgical exploration. There were 95 splenic, 63 renal, 48 hepatic and 13 pancreatic injuries. Twenty one patients had bowel injuries. Five patients had vascular injuries. Twenty three patients had multi-organ injuries. Organ injuries were graded using the OIS (Organ Injury Scale) guidelines. Conclusion: In conjunction with close clinical monitoring, CT was reliable in the evaluation of blunt abdominal trauma in a selected group of patients, with overall sensitivity of 97% and specificity of about 95%. Positive predictive value 82% and negative predictive value 100%.

Hamidi, Mazen I; Aldaoud, Khalid M; Qtaish, Izzeddin

2007-01-01

53

Non operative management of abdominal trauma -- a 10 years review.  

PubMed

INTRODUCTION: Due to high rate of operative mortality and morbidity non-operative management of blunt liver and spleen trauma was widely accepted in stable pediatric patients, but the general surgeons were skeptical to adopt it for adults. The current study is analysis of so far largest sample (1071) of hemodynamically stable blunt liver, spleen, kidney and pancreatic trauma patients managed non operatively irrespective of severity of a single /multiple solid organ injury or other associated injuries with high rate of success. METHODS: Experience of 1071 blunt abdominal trauma patients treated by NOM at a tertiary care National Trauma Centre in Oman (from Jan 2001 to Dec 2011) was reviewed, analyzed to determine the indications, methods and results of NOM. Hemodynamic stability along with ultra sound, CT scan and repeated clinical examination were the sheet anchors of NOM. The patients were grouped as (1) managed by NOM successfully, (2) failure of NOM and (3) directly subjected to surgery. RESULTS: During the 10 year period, 5400 polytrauma patients were evaluated for abdominal trauma of which 1285 had abdominal injuries, the largest sample study till date. Based on initial findings 1071 patients were admitted for NOM. Out of 1071 patients initially selected 963 (89.91%) were managed non operatively, the remaining 108 (10.08%) were subjected to laparotomy due to failure of NOM. Laparotomy was performed on 214(19.98%) patients as they were unstable on admission or had evidence of hollow viscous injury. CONCLUSION: NOM for blunt abdominal injuries was found to be highly successful in 89.98% of the patients in our study. Management depended on clinical and hemodynamic stability of the patient. A patient under NOM should be admitted to intensive care / high dependency for at least 48-72 hours for close monitoring of vital signs, repeated clinical examinations and follow up investigations as indicated. PMID:23561288

Raza, Mohsin; Abbas, Yasser; Devi, Vanitha; Prasad, Kumarapuram Venkatachalam; Rizk, Kameel Narouz; Nair, Permasavaran Padmanathan

2013-04-01

54

Delayed spleen rupture after blunt abdominal trauma (case report).  

PubMed

The aim of the article was to present and discuss the phenomenon of delayed fatal spleen rupture case. A 13-year-old boy was referred to hospital because of his poor general condition, convulsions, tachypnea, shallow breathing, severe paleness, abdominal tenderness, decrease in blood pressure, low blood hemoglobin levels, leukocytosis. Abdominal pain complaints began second day night, after abdominal trauma during soccer game with classmates. Autopsy macroscopic examination revealed coagulated blood in abdominal cavity and large perisplenic haematama. Spleen with a big subcapsular and intrasplenic hematoma was observed on dissection. It is concluded that early diagnosis is the most important measure to reduce mortality. In terms of autopsy examination, proper investigation during forensic autopsy will contribute in understanding the pathophysiology of this phenomenon. PMID:22870831

Eren, Bülent; Türkmen, Nursel; Gündo?mu?, Ümit Naci

2012-05-01

55

Management of intra-abdominal organ injury following blunt abdominal trauma in children  

Microsoft Academic Search

Objective: To evaluate the strategy of a com- bined diagnostic and therapeutic approach in children with intra-abdominal organ injury following blunt ab- dominal trauma. Design: Retrospective clinical study. Setting: Pediatric intensive care unit of an university hos- pital. Patients: 38 children with documented intra-abdominal injury. Intervention: Initial non-surgical treatment by a team of pediatric intensivists, radiologists and surgeons. Measurements and

D. Rossi; J. de Ville de Goyet; S. Clément de Cléty; F. Wese; F. Veyckemans; P. Clapuyt; D. Moulin

1993-01-01

56

Late presentation of small bowel obstruction following blunt abdominal trauma  

Microsoft Academic Search

Background  Motor vehicle accidents have increasingly become a major cause of serious blunt abdominal and chest injury, the pattern and\\u000a mechanism of which has changed in recent years largely due to seatbelt legislation.\\u000a \\u000a \\u000a \\u000a Aim  A case of blunt abdominal and chest trauma is reported which resulted in a mesenteric tear — the small bowel subsequently\\u000a herniated through and strangulated.\\u000a \\u000a \\u000a \\u000a Conclusion  This case highlights

R. G. Casey; J. Ryan; P. Gillen

2002-01-01

57

2. Newer aids in the diagnosis of blunt abdominal trauma.  

PubMed Central

The assessment of a case of blunt abdominal trauma can be complicated by many factors, and the resultant inaccurate or delayed diagnoses have contributed to the unacceptable mortality for this type of injury. Recently several useful diagnostic techniques have been developed that, if applied intelligently, may be instrumental in decreasing the high mortality among patients who present with ambiguous abdominal signs after sustaining blunt trauma. Although hematologic investigation and routine radiography have facilitated detection of intraperitoneal injury, peritoneal lavage has become the single most helpful aid. Scanning procedures are sometimes useful in recognizing splenic and hepatic defects especially; these may be confirmed or clarified by angiography. Although ultrasonography may be no more valuable than scintigraphy in outlining splenic and hepatic abnormalities, it is an important technique, especially in the diagnosis of retroperitoneal masses of traumatic origin. Laparoscopy also may be helpful in investigation if surgeons become more familiar with the procedure. Images FIG. 1 FIG. 2 FIG. 3 FIG. 4

Taylor, B.

1977-01-01

58

Inframesocolic Abdominal Aortic Injury and Lumbar Vertebral Body Fracture Secondary to Hyperextension with Blunt Trauma  

Microsoft Academic Search

\\u000a Abstract\\u000a   This case study describes an abdominal aortic injury and lumbar vertebral body fracture after blunt trauma. Abdominal aortic\\u000a pseudoaneurysm is a rare complication of blunt abdominal trauma. Recent data reveal seven other reports in the literature.\\u000a We describe a case of an inframesocolic abdominal aortic injury and lumbar vertebral body fracture from blunt trauma in a\\u000a 16-year-old male after

Michael Kalina; Melissa Donovan; Frederick Giberson; Glen Tinkoff

2010-01-01

59

Gastrointestinal tract perforation due to blunt abdominal trauma  

Microsoft Academic Search

A retrospective clinical study was performed to evaluate the etiology, diagnosis, and management of gastrointestinal tract\\u000a perforation (GITP) due to blunt abdominal trauma (BAT) in order to find a predictor to avoid delay in diagnosis. Thirty-five\\u000a children with GITP out of 805 BAT victims (4.3%) over a 21-year period formed the study group. Different parameters including\\u000a preoperative (mechanism of injury,

A. O. Ciftci; F. C. Tanyel; A. B. Salman; N. Büyükpamukcu; A. Hiçsönmez

1998-01-01

60

Isolated Gallbladder Injury in a Case of Blunt Abdominal Trauma  

PubMed Central

The diagnosis of blunt injury to the gallbladder may constitute a significant challenge to the diagnostician. There is often a delay in presentation with non-specific clinical symptoms. In the absence of reliable clinical symptoms, diagnostic imaging becomes an invaluable tool in the rapid identification of gallbladder injury. We present a case of isolated gallbladder injury following blunt abdominal trauma which was diagnosed by computed tomography and subsequently confirmed by cholecystectomy.

Birn, Jeffrey; Jung, Melissa; Dearing, Mark

2012-01-01

61

Blunt abdominal trauma treated in an intensive care ward  

PubMed Central

Seventy-two cases of major abdominal trauma with an overall mortality of 29% are reviewed. Only cases of sufficient severity to require nursing in an intensive care unit are included. The incidence of injury to the various viscera is shown. Methods of diagnosis and treatment are discussed. The causes of death in this series are analysed and ways of lowering the mortality figures outlined.

Arthur, G. W.; Lane, B. E.

1969-01-01

62

MRI for the diagnosis of blunt abdominal trauma: a case report  

Microsoft Academic Search

Blunt abdominal trauma is a leading cause of trauma related mortality. Currently, the gold standard in the radiographic evaluation of intra-abdominal injury is computed tomography (CT) with iodinated contrast material. However, in the setting of renal failure or a previous anaphylactic reaction to contrast material, radiographic evaluation of the trauma patient may prove difficult. Without contrast material, the sensitivity of

Traci L. Hedrick; Robert G. Sawyer; Jeffrey S. Young

2005-01-01

63

Value of computed tomography in the evaluation of retroperitoneal organ injury in blunt abdominal trauma  

Microsoft Academic Search

Computed tomography (CT) is widely used in the evaluation of blunt abdominal trauma. One of its purported advantages is in the evaluation of the retroperitoneum. This study was undertaken to determine the utility of CT in diagnosing retroperitoneal organ injury. A retrospective chart review of 466 stable patients with blunt abdominal trauma who received abdominal CT was conducted. Twelve percent

John M Porter; Yuvraj Singh

1998-01-01

64

[Diagnostic possibilities of multilayer computer tomography in blunt abdominal trauma].  

PubMed

The purpose of our study was to determine MDCT diagnostic possibility in blunt abdominal trauma. Our work was based on MDCT results of 84 blunt abdominal trauma patients with stable hemodynamic status (28 (33.3%) female and 56 (66.6%) male). Age ranges from 17 up to 64 years. The CT scan showed obvious organ and system injuries in 82 poly-trauma patients. Injuries of craniocerebral region, also of facial bones, chest and spine were determined in two patients; in one of which, however, it was not possible to differentiate subcapsular spleen hematoma accurately because of left upper joint metallic holder artifacts. In second patient the liver injury was accurately diagnosed, but there were visualization problems caused by the massive retroperitoneal hematoma from right adrenal gland injury. The investigation showed that sensitivity of CT scan data was 98%, specificity-97% and accuracy rate-98%. All above mentioned clearly states the importance of MDCT in the emergency department. MDCT ensures precise diagnosis in maximally short period of time and thereby helps to choose proper treatment and decreases post-traumatic complications. PMID:21436472

Nemsadze, G Sh; Urushadze, O P; Tokhadze, L T; Kipshidze, N N

2011-02-01

65

Rate of intra-abdominal injury after a normal abdominal computed tomographic scan in adults with blunt trauma  

Microsoft Academic Search

ObjectiveThe objective of this study is to determine the rate of intra-abdominal injury (IAI) in adults with blunt abdominal trauma after a normal abdominal computed tomographic (CT) scan. We hypothesize that the risk of subsequent IAI is so low that hospital admission and observation for possible IAI are unnecessary.

James F. Holmes; John P. McGahan; David H. Wisner

66

Perforation of the gall bladder following blunt abdominal trauma.  

PubMed

A 66-year-old man presented after having been involved in a motor vehicle accident. He was not wearing his seatbelt, and his vehicle had a deformed steering wheel after the incident. In the emergency department, his only complaint was mild right lower quadrant abdominal pain without signs of rebound or guarding. His laboratory and radiologic evaluations were unremarkable and he was observed in the intensive care unit. Nine hours after the accident, he developed an acute abdomen; exploratory laparotomy revealed a perforation of the gall bladder. Gall bladder injuries secondary to blunt trauma are infrequent events. PMID:3826818

Greenwald, G; Stine, R J; Larson, R E

1987-04-01

67

Computed Tomography (CT) Imaging of Injuries from Blunt Abdominal Trauma: A Pictorial Essay  

PubMed Central

Blunt abdominal trauma can cause multiple internal injuries. However, these injuries are often difficult to accurately evaluate, particularly in the presence of more obvious external injuries. Computed tomography (CT) imaging is currently used to assess clinically stable patients with blunt abdominal trauma. CT can provide a rapid and accurate appraisal of the abdominal viscera, retroperitoneum and abdominal wall, as well as a limited assessment of the lower thoracic region and bony pelvis. This paper presents examples of various injuries in trauma patients depicted in abdominal CT images. We hope these images provide a resource for radiologists, surgeons and medical officers, as well as a learning tool for medical students.

Hassan, Radhiana; Abd. Aziz, Azian

2010-01-01

68

The use of delayed computerized tomography in the evaluation of blunt abdominal trauma: a preliminary report.  

PubMed

This purpose of this study was to analyze the use of abdominal computed tomography (CT) imaging in patients with possible blunt abdominal trauma. A retrospective analysis of all trauma patients over a 1-year period (1993-1994) was conducted, with prospective study protocol in 52 patients using serial abdominal exam and hematocrits (Hcts) instead of abdominal CT for evaluation of blunt abdominal trauma. Urgent abdominal CT was used as the initial diagnostic test for evaluation of blunt abdominal trauma in 813 patients over this 1-year period. CT was obtained in 379 (46.6%) of these patients who arrived hemodynamically stable (admission systolic blood pressure > or = 90), had a Glasgow Coma Scale > 13, and had admission Hct > or = 35 because of distracting injuries, possible traumatic brain injury, or alcohol/drug use, which might render the abdominal physical exam unreliable. Only 47 CT scans (12.4%) were positive, and three patients (0.8%) required laparotomy. In an effort to more efficiently use abdominal CT, we performed a prospective study in 52 patients with possible blunt abdominal trauma, admission systolic blood pressure > or = 90, Hct > or = 35, Glasgow Coma Scale > 13, and a normal abdominal exam on admission. These patients were followed with serial abdominal examinations and Hcts every 6 hours for 24 hours, and delayed CT, when applicable. CT was obtained in seven patients (13.5%) for evaluation of fall in Hct or abnormal abdominal examination; all were negative for abdominal injury. A protocol using serial abdominal exams, Hcts, and delayed abdominal CT imaging may be useful in select patients to decrease the high number of negative routine abdominal CTs that are obtained in the evaluation of blunt abdominal trauma. PMID:10190366

Stanley, A C; Vittemberger, F; Napolitano, L M; O'Hara, K P; McGinnis, K; Lockhart, D; Silva, W E

1999-04-01

69

Repeat abdominal computed tomography scans after pediatric blunt abdominal trauma: missed injuries, extra costs, and unnecessary radiation exposure  

Microsoft Academic Search

PurposeWe hypothesized that pediatric blunt trauma patients, initially evaluated at nontrauma centers with abdominal computed tomography (CT) scans, often undergo repeat scans after transfer. This study was designed to quantify this phenomenon, assess consequences, and elucidate possible causes.

Steven H. Cook; Julia R. Fielding; J. Duncan Phillips

2010-01-01

70

Hepatic enzymes have a role in the diagnosis of hepatic injury after blunt abdominal trauma  

Microsoft Academic Search

IntroductionDelayed diagnosis of patients with severe liver injuries is associated with an adverse outcome. As computed tomographic (CT) scan is not always available in the management of blunt abdominal trauma worldwide, the present study was undertaken to determine the accuracy of selected haematological markers in predicting the presence of hepatic injury and its severity after blunt abdominal trauma.

Ker-Kan Tan; Shieh-Ling Bang; Appasamy Vijayan; Ming-Terk Chiu

2009-01-01

71

The Value of CT in Detecting Bowel Perforation in Children After Blunt Abdominal Trauma  

Microsoft Academic Search

In this era of conservative management for most infants and children with blunt abdominal trauma, there is a concern that the diagnosis of bowel perforation may be missed or delayed. To determine the sensitivity of CT in the detection of perforated viscus in this population,we reviewed the CT examinations of 547 consecutive children who had had blunt abdominal trauma. Of

Dorothy I. BuIas; George A. Taylor; Martin R. Eichelberger

72

Appendicitis after blunt abdominal trauma in the pediatric patient — fact or fancy?  

Microsoft Academic Search

At the Hospital for Sick Children, Toronto, about 300 children a year are operated on with the diagnosis of acute appendicitis. In four such cases in the last 15 years blunt abdominal trauma preceded the acute appendicitis. The four children (three boys and one girl) ranged from 6 to 15 years. Within 7 days of the blunt abdominal trauma the

Sigmund H. Ein

1987-01-01

73

Blunt Abdominal Trauma Requiring Laparotomy: an Analysis of 342 Polytraumatized Patients  

Microsoft Academic Search

Introduction:  Hemorrhage due to abdominal trauma is one of the most frequent causes of early mortality in polytraumatized patients. Therefore,\\u000a the initial management of abdominal trauma is an important factor in determining the outcome. The aim of this study was to\\u000a evaluate the clinical course in multiple trauma patients who sustained abdominal trauma requiring operative intervention.\\u000a \\u000a \\u000a \\u000a Patients and Methods:  In this retrospective

Frank Hildebrand; Michael Winkler; Martijn van Griensven; Christian Probst; Volker Musahl; Christian Krettek; Hans-Christoph Pape

2006-01-01

74

Bilateral ureteropelvic disruption following blunt abdominal trauma: Case report  

PubMed Central

Background Ureteral injury occurs in less than 1% of blunt abdominal trauma cases, partly because the ureters are relatively well protected in the retroperitoneum. Bilateral ureteral injury is extremely rare, with only 10 previously reported cases. Diagnosis may be delayed if ureteric injury is not suspected, and delay of 36 hours or longer has been observed in more than 50% of patients with ureteric injury following abdominal trauma, leading to increased morbidity. Case presentation A 29-year-old man was involved in a highway motor vehicle collision and was ejected from the front passenger seat even though wearing a seatbelt. He was in a preshock state at the scene of the accident. An intravenous line and left thoracic drain were inserted, and he was transported to our hospital by helicopter. Whole-body, contrast-enhanced computed tomography (CT) scan showed left diaphragmatic disruption, splenic injury, and a grade I injury to the left kidney with a retroperitoneal haematoma. He underwent emergency laparotomy. The left diaphragmatic and splenic injuries were repaired. Although a retroperitoneal haematoma was observed, his renal injury was treated conservatively because the haematoma was not expanding. In the intensive care unit, the patient's haemodynamic state was stable, but there was no urinary output for 9 hours after surgery. Anuresis prompted a review of the abdominal x-ray which had been performed after the contrast-enhanced CT. Leakage of contrast material from the ureteropelvic junctions was detected, and review of the repeat CT scan revealed contrast retention in the perirenal retroperitoneum bilaterally. He underwent cystoscopy and bilateral retrograde pyelography, which showed bilateral complete ureteral disruption, preventing placement of ureteral stents. Diagnostic laparotomy revealed complete disruption of the ureteropelvic junctions bilaterally. Double-J ureteral stents were placed bilaterally and ureteropelvic anastomoses were performed. The patient's postoperative progress was satisfactory and he was discharged on the 23rd day. Conclusion Diagnosis of ureteral injury was delayed, although delayed phase contrast-enhanced CT and abdominal x-rays performed after CT revealed the diagnosis early. Prompt detection and early repair prevented permanent renal damage and the necessity for nephrectomy.

2011-01-01

75

Melaena as the presenting symptom of gastric mucosal injury due to blunt abdominal trauma  

Microsoft Academic Search

Blunt abdominal trauma is a common cause of admission to the typical trauma centre. Hollow viscus injury from blunt trauma, however, is unusual and rarely involves the stomach. A 15 year old boy sustained a bicycle handle bar injury to the abdomen and presented to the casualty department four days later with melaena. A computed tomography (CT) scan of the

K Saeb-Parsy; A Omer; N R Hall

2006-01-01

76

Management of Pancreatic Injuries after Blunt Abdominal Trauma. Experience at a Single Institution  

Microsoft Academic Search

Context Pancreatic injuries after blunt abdominal trauma could result in significant morbidity, and even mortality if missed. Objective Our aim was to review our institution's experience with blunt pancreatic trauma. Setting Our study included all cases of blunt traumatic pancreatic injuries. Patients Sixteen patients (median age 41 years; range: 18-60 years) were treated for blunt pancreatic trauma from December 2002

Ker-Kan Tan; Diana Xinhui Chan; Appasamy Vijayan; Ming-Terk Chiu

77

Computed tomography for pancreatic injuries in pediatric blunt abdominal trauma  

PubMed Central

AIM: To evaluate the efficacy of computed tomography scan in diagnosing and grading the pattern of pancreatic injuries in children. METHODS: We conducted a retrospective study to review medical files of children admitted with blunt pancreatic injuries to the Maternity and Children Hospital Al-Madina Al-Munawwarah, Kingdom of Saudi Arabia. The demographic details and mechanisms of injury were recorded. From the database of the Picture Archiving and Communication System of the radiology department, multidetector computed tomography (MDCT) images of the pancreatic injuries, severity, type of injuries and grading of pancreatic injuries were established. RESULTS: Seven patients were recruited in this study over a period of 5 years; 5 males and 2 females with a mean age of 7 years (age range 5-12 years). Fall from height was the most frequent mechanism of injury, reported in 5 (71%), followed by road traffic accident (1 patient, 14%) and cycle handlebar (1 patient, 14%) injuries. According to the American Association for the Surgery of Trauma grading system, 1 (14%) patient sustained Grade?I, 1 (14%) Grade II, 3 (42%) Grade III and 2 (28%) patients were found to have Grade V pancreatic injuries. This indicated a higher incidence of severe pancreatic injuries; 5 (71.4%) patients were reported to have Grade III and higher on the injury scale. Three (42%) patients had associated abdominal organ injuries. CONCLUSION: Pediatric pancreatic injuries due to blunt abdominal trauma are rare. The majority of the patients sustained extensive pancreatic injuries. MDCT findings are helpful and reliable in diagnosing and grading the pancreatic injuries.

Almaramhy, Hamdi Hameed; Guraya, Salman Yousuf

2012-01-01

78

Computed tomography for blunt abdominal trauma in the ED: A prospective study  

Microsoft Academic Search

A study was undertaken to determine the criteria for ordering abdominal computed tomography (CT) in the emergency department (ED) for stable patients who sustained blunt trauma and to identify a patient population at high risk for having intra-abdominal injury (IAI) utilizing physical examination, decrease in hematocrit, and hematuria. Patients in a university ED who had abdominal CT from April 1995

John R Richards; Robert W Derlet

1998-01-01

79

Duration of antibiotic prophylaxis in high-risk patients with penetrating abdominal trauma: a prospective randomized trial.  

PubMed

To evaluate the effect of varying durations of antibiotic prophylaxis in trauma patients with multiple risk factors for postoperative septic complications, a prospective randomized trial was undertaken at an urban level I trauma center. The inclusion criteria were full-thickness colon injury and one of the following: (1) Penetrating Abdominal Trauma Index > 25, (2) transfusion of 6 units or more of packed red blood cells, or (3) more than 4 hours from injury to operation. Patients were randomly assigned to a short course (24 hours) or a long course (5 days) of antibiotic therapy. All patients received 2 g cefoxitin en route to the operating room and 2 g intravenously piggyback every 6 hours for a total of 1 day vs. 5 days. Sixty-three patients were equally divided into short-course (n = 31) and long-course (n = 32) therapy. This was a high-risk patient population, as assessed by the mean Penetrating Abdominal Trauma Index (33), number of patients with multiple blood transfusions (51 of 63; 81%), number of patients with an Injury Severity Score greater than 15 (37 of 63; 59%), number of patients with destructive colon wounds requiring resection (27 of 63; 43%), and number of patients requiring postoperative critical care (37 of 63; 59%). Differences in intra-abdominal (1-day, 19%; 5-days, 38%) and extra-abdominal (1-day, 45%; 5-days, 25%) infection rates did not achieve statistical significance. There continues to be no evidence that extending antibiotic prophylaxis beyond 24 hours is of benefit, even among the highest risk patients with penetrating abdominal trauma. A large, multi-institutional trial will be necessary to condemn this common practice with statistical validity. PMID:10554373

Cornwell, E E; Dougherty, W R; Berne, T V; Velmahos, G; Murray, J A; Chahwan, S; Belzberg, H; Falabella, A; Morales, I R; Asensio, J; Demetriades, D

80

How many antibiotics are necessary to treat abdominal trauma victims?  

PubMed

We wanted to determine the value of single-versus multiple-antibiotic treatment in cases of penetrating abdominal trauma. Of 357 patients entered into a prospective, randomized, examiner-blinded study, 291 met all protocol criteria; 101 of these patients received cefoperazone alone, 95 were given ceftriaxone with metronidazole, and 95 were placed on metronidazole, gentamicin, and ampicillin. Aerobic and anaerobic bacterial cultures were obtained upon opening and closing the peritoneum. The three groups were found to be similar upon evaluation of key parameters, such as the median number of febrile days, morbidity, incisional wound infection, intra-abdominal abscess, septicemia, other infections, hospital stay, and death. Fifteen of 291 (5%) patients had infectious complications, and 12 (4.1%) developed noninfectious complications. There were six (2.1%) deaths, two in each antibiotic group. Noninfectious complications occurred more frequently in the triple-antibiotic group, which was statistically significant (P = 0.013). There were no therapeutic failures, and therefore, the routine usage of additional antibiotics to cover for enterococcus needs justification. PMID:9168767

Sims, E H; Thadepalli, H; Ganesan, K; Mandal, A K

1997-06-01

81

Focused Assessment with Sonography in Trauma and Abdominal Computed Tomography Utilization in Adult Trauma Patients: Trends over the Last Decade  

PubMed Central

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.

Sheng, Alexander Y.; Dalziel, Peregrine; Liteplo, Andrew S.; Fagenholz, Peter; Noble, Vicki E.

2013-01-01

82

Development and Evaluation of a Triage Index for Penetrating Trauma.  

National Technical Information Service (NTIS)

Several new severity scores, the Triage Score, the Triage Index, and Trauma Score, were evaluated for patients with penetrating injuries. The scores, are composed of measures easily obtained by either medical or paramedical personnel using noninvasive tec...

W. J. Sacco H. R. Champion

1981-01-01

83

Initial ultrasonographic assessment for blunt abdominal trauma: is it a reliable diagnostic modality for emergency laparotomy?  

PubMed

Abdominal ultrasound has been proposed as a tool for the evaluation of blunt abdominal trauma. The aim of this study was to evaluate ultrasound's ability to identify intraabdominal injuries that require surgical treatment. Data from 1463 patients were examined retrospectively during a 2-year time period, which were ultrasonographically evaluated for blunt abdominal injury. Hemoperitoneum and abdominal visceral injury were correctly detected by ultrasound with 88% sensitivity and 96.8% specificity. The results are in accordance with the international literature. PMID:20302035

Vlachos, Konstantinos; Archodovassilis, Fotis; Stefanakos, John; Stergiopoulos, Spyros; Peros, George

84

The role of laparoscopy in abdominal trauma - review of the literature  

PubMed Central

The necessity of urgent explorative laparotomy as a standard procedure in the treatment of abdominal penetrating wounds is controversial. Mandatory surgical intervention for penetrating abdominal trauma yields a high rate of negative laparotomies in the absence of visceral injuries. Laparoscopy is an alternative diagnostic procedure inspecting the peritoneum for signs of perforation and excluding significant intra-abdominal injuries. Following current guidelines, diagnostic laparoscopy should be used with caution only in selected cases due to the limited amount of reliable data confirming the effectiveness of such treatment. We present a review of the literature analysing the role of diagnostic laparoscopy in abdominal trauma.

Sosada, Krystyn; Piecuch, Jerzy; Zurawinski, Wojciech

2011-01-01

85

A combined trauma model of chest and abdominal trauma with hemorrhagic shock--description of a new porcine model.  

PubMed

Despite the high incidence and prognostic relevance of hemorrhagic shock and abdominal and blunt chest trauma in multiply injured patients, there are no animal models combining these injuries. Therefore, we established a new porcine multiple trauma model consisting of blunt chest trauma, penetrating abdominal trauma (two incisions in the right upper liver lobe using a four-edged scalpel and subsequent liver packing), and pressure-controlled hemorrhagic shock with a mean arterial pressure of 30 ± 5 mmHg (a maximum of 45% of the total blood volume). The combined traumatic insult led to severe signs of hemorrhagic shock and impaired pulmonary function. In conclusion, a consistent, reproducible, and clinically relevant porcine model of multisystem injury with controlled (pressure-controlled blood withdrawal) and uncontrolled components of hemorrhage (liver laceration) with the potential for rebleeding was established. PMID:23042201

Hildebrand, Frank; Weuster, Matthias; Mommsen, Philipp; Mohr, Juliane; Fröhlich, Matthias; Witte, Ingo; Keibl, Claudia; Ruchholtz, Steffen; Seekamp, Andreas; Pape, Hans-Christoph; Flohe, Sascha; van Griensven, Martijn

2012-12-01

86

Detection of free intraperitoneal air on computed tomography after blunt abdominal trauma  

Microsoft Academic Search

In patients who have sustained blunt abdominal trauma, detection of free intraperitoneal air on computed tomography (CT) is\\u000a thought to be a fairly specific finding of bowel rupture. We devised a method to determine the accuracy of a radiologist in\\u000a identifying this important finding on CT scans in patients with blunt abdominal trauma.\\u000a \\u000a We retrospectively reviewed 50 CT scans and

Myer H. Roszler; Jonathan Saxe; Kathleen A. McCarroll

1995-01-01

87

Isolated Gallbladder Injury after Blunt Abdominal Trauma: a Case Report and Review  

Microsoft Academic Search

We describe a case of isolated gallbladder contusion after deceleration trauma. On admission, no evident signs of intra-abdominal\\u000a injury were present. However, after 24 h observation an explorative laparotomy was performed because of persistent abdominal\\u000a complaints. A contusion of the gallbladder wall was found with intraluminal haematoma and a cholecystectomy was performed.\\u000a Isolated injury of the gallbladder after blunt trauma

Vera Tudyka; Susan Toebosch; Wietse Zuidema

2008-01-01

88

Isolated Gallbladder Injury after Blunt Abdominal Trauma: a Case Report and Review  

Microsoft Academic Search

We describe a case of isolated gallbladder contusion after deceleration trauma. On admission, no evident signs of intra-abdominal\\u000a injury were present. However, after 24 h observation an explorative laparotomy was performed because of persistent abdominal\\u000a complaints. A contusion of the gallbladder wall was found with intraluminal haematoma and a cholecystectomy was performed.\\u000a Isolated injury of the gallbladder after blunt trauma

Vera Tudyka; Susan Toebosch; Wietse Zuidema

2007-01-01

89

Multidetector CT: Detection of Active Hemorrhage in Patients with Blunt Abdominal Trauma  

Microsoft Academic Search

OBJECTIVE. The aim of this study was to determine the imaging findings and the preva- lence of active hemorrhage on contrast-enhanced multidetector CT in patients with blunt ab- dominal trauma. MATERIALS AND METHODS. Contrast-enhanced multidetector CT images of 165 patients with blunt abdominal trauma were reviewed for the presence of extravasated contrast agent, a finding that represents active hemorrhage. The

Jürgen K. Willmann; Justus E. Roos; Andreas Platz; Thomas Pfammatter; Paul R. Hilfiker; Borut Marincek; Dominik Weishaupt

90

Pancreatic Transection from Blunt Abdominal Trauma: Early versus Delayed Diagnosis and Surgical Management  

Microsoft Academic Search

Background and Aims: Pancreatic trauma is relatively uncommon, but carries high morbidity and mortality rates, especially when diagnosis is delayed or inappropriate surgery is attempted. Patient Material: The clinical course and surgical management of 14 patients with distal pancreatic transection or severe laceration with or without main pancreatic duct (MPD) injury caused by blunt abdominal trauma were analyzed in a

Attila Oláh; Ákos Issekutz; László Haulik; Roland Makay

2003-01-01

91

Clinical recognition and management of pediatric blunt abdominal trauma without ultrasound or computed tomography scan in community hospitals in Mexico  

Microsoft Academic Search

Purpose: The aim of this study was to characterize the evaluation and clinical course of children with blunt abdominal trauma in second-level hospitals.Methods: The authors reviewed the medical records of children, age 1 to 17 years, admitted with blunt abdominal trauma between the years 1988 to 1998. The initial evaluation included a Pediatric Trauma Score (PTS) ABCD clinical assessment, resuscitation,

Giovanni Porras-Ramírez; Francisco Ramírez-Reyes; Maía Helena Hernández-Herrera; Juan Domingo Porras-Hernández

1999-01-01

92

Clinical Predictors of Injuries Not Identified by Focused Abdominal Sonogram for Trauma (FAST) Examinations  

Microsoft Academic Search

This study's objective was to identify clinical characteristics of patients with a blunt traumatic injury that increased the risk of peritoneal or pericardial fluid collections and abdominal organ injuries not identified by a bedside focused abdominal sonogram for trauma (FAST) examination. This observational study used a retrospective chart review of a cohort of patients identified through a query of the

Lance Hoffman; Daniel Pierce; Susan Puumala

2009-01-01

93

Can ultrasonography replace computed tomography in the initial assessment of children with blunt abdominal trauma?  

Microsoft Academic Search

The evaluation of injured children with suspected blunt abdominal trauma (BAT) is clinically challenging. Computed tomography (CT) requires that patients be sedated, stable, and transportable, and even so, it is considered the diagnostic modality of choice for children with BAT. The authors questioned whether abdominal ultrasonography (US) performed during the initial assessment of the injured child is accurate enough to

Schmuel Katz; Ludwig Lazar; Valerie Rathaus; Ilan Erez

1996-01-01

94

Sonography in a Clinical Algorithm for Early Evaluation of 1671 Patients with Blunt Abdominal Trauma  

Microsoft Academic Search

OBJECTIVE. The purpose of this study was to evaluate the efficacy of sonography in our al- gorithm when differentiating patients with blunt abdominal trauma who need immediate surgery from patients who would benefit from further diagnostic workup or who need no treatment. SUBJECTS AND METHODS. We performed abdominal sonography as the primary screening tool in 1671 consecutive patients in our

Paul J. Bode; Michael J. R. Edwards; Mark C. Kruit; Arie B. van Vugt

1999-01-01

95

Abdominal aortic injury in a child: intravenous digital subtraction angiogram (IVDSA) for the diagnosis of pediatric vascular trauma  

Microsoft Academic Search

Abdominal aortic injury due to trauma is a rare entity, especially in the pediatric population. We report a 6-year-old girl with partial transection of the abdominal aorta as a result of a motor vehicle accident. The diagnosis was made with IVDSA. The patient survived the injury. We discuss the imaging findings, mechanisms, and associated injuries of abdominal aortic trauma in

Gregory Soares; Rodolfo Ibarra; Hector Ferral

2003-01-01

96

Temporary Abdominal Closure Using an IV Bag Silo for Severe Trauma  

Microsoft Academic Search

Patients with severe abdominal trauma injuries can have improved outcomes if a priority-oriented approach is taken to surgical intervention. This includes temporary abdominal closure and planned reoperation to complete complex, lengthy procedures when the patient is stabilized. Temporary abdominal closure can be achieved safely and cost-effectively by using a presterilized 3-liter cystoscopy fluid IV bag. This article discusses the rationale

Vicki J. Fox; Julie Miller; A. Meredithe Nix

1999-01-01

97

Tc-99m sulfur colloid scanning in blunt trauma: detection of abdominal bleeding  

SciTech Connect

Tc-99m sulfur colloid scintigraphy can detect and locate active lower gastrointestinal bleeding. The same principles apply to the detection and location of active intra-abdominal or pelvic hemorrhage following blunt abdominal trauma. We report two patients with abdominal bleeding who were correctly diagnosed by this method. As part of the routine examination of all patients having Tc-99m sulfur colloid liver-spleen scans for trauma, 500,000-count images should be made of the rest of the abdomen and pelvis.

Bronfman, H.J.; Kunkel, B.K.; Rabin, H.S.

1981-11-01

98

Rupture of a hepatic adenoma in a young woman after an abdominal trauma: A case report  

PubMed Central

Unlike hepatic haemorrhage following blunt abdominal trauma, spontaneous abdomen bleeding is rare, even in the presence of a hepatocellular adenoma (HA) or carcinoma. However, the diagnosis of a tumour underlying a haematoma after liver trauma is unusual, especially when it occurs more after two years after the accident. Here, we report a case of a ruptured HA due to blunt abdominal trauma. A 36-year-old woman was admitted to our hospital with sudden onset of upper abdominal pain. Her medical history revealed a blunt abdominal trauma two years prior. Initial abdominal computed tomography scan revealed a large haematoma measuring more than 16 cm in diameter in the right lobe of the liver. Magnetic resonance imaging showed haemorrhagic areas and some regions with hepatocyte hyperplasia, suggesting HA. The patient underwent right hepatic lobectomy, and a histopathological examination confirmed a diagnosis of HA. In conclusion, it is important to consider that abdominal trauma may hide old, asymptomatic and not previously detected injuries, as in the case reported.

Cotta-Pereira, Ricardo Lemos; Valente, Luana Ferreira; De Paula, Daniela Goncalves; Eiras-Araujo, Antonio Luis; Iglesias, Antonio Carlos

2013-01-01

99

Combined head and abdominal computed tomography for blunt trauma: which patients with minor head trauma benefit most?  

Microsoft Academic Search

The widespread availability of computed tomography (CT) in the diagnosis and management of blunt trauma has created the possibility of overuse without clear indications. Some clinicians believe that patients with head injury, intoxication, and\\/or distracting injury have an unreliable abdominal examination and should undergo combined head and abdomen CT. The objective of this study was to evaluate which patients with

Sarah R. Wu; Shamim Shakibai; John P. McGahan; John R. Richards

2006-01-01

100

AAST grade III pancreatic injury following blunt abdominal trauma.  

PubMed

Isolated pancreatic trauma with major pancreatic duct disruption is a rare finding; it can present with equivocal clinical signs. Serum amylase levels and diagnostic contrast-enhanced computed tomography can facilitate the diagnostic process. PMID:22856446

Laing, G L; Jeetoo, S D; Oosthuizen, G; Clarke, D

2012-07-11

101

Partial avulsion of common bile duct and duodenal perforation in a blunt abdominal trauma.  

PubMed

Complete or partial avulsion of common bile duct is a very rare injury following blunt abdominal trauma in children. A 7-year old boy presented to ER following blunt abdominal trauma by a moving motorcycle. X ray abdomen revealed free air under diaphragm and CT scan showed pancreatic contusion injury. At operation anterior wall of common bile duct (CBD) along with a 2mm rim of duodenal tissue on either side of anterior wall of CBD were found avulsed from the duodenum. The avulsed portion of CBD and duodenum were reanastomosed and a tube cholecystostomy performed. The patient had an uneventful recovery. PMID:22953262

Mirza, Bilal; Ijaz, Lubna; Iqbal, Shahid; Sheikh, Afzal

2010-12-01

102

Small bowel intussusception with the Meckel's diverticulum after blunt abdominal trauma: a case report  

PubMed Central

Intussusception with the Meckel's diverticulum is a rare but well-known cause of small bowel obstruction in the adult. After blunt abdominal trauma, intussusception is exceedingly rare and has been reported previously only in few cases. We present a case of a previously healthy 28-year-old man developing four days after blunt abdominal trauma signs of small bowel obstruction. Ileo-ileal intussusception was suggested by computed tomography. Exploration revealed ileo-ileal intussusception with Meckel's diverticulum. A diverticulectomy with small bowel resection was performed.

Benjelloun, El Bachir; Ousadden, Abdelmalek; Ibnmajdoub, Karim; Mazaz, Khalid; Taleb, Khalid Ait

2009-01-01

103

Ruptured Meckel’s Mesodiverticulum and Meckel’s Diverticulum following Blunt Abdominal Trauma  

Microsoft Academic Search

Objectives: To present a case of simultaneous rupture of Meckel’s diverticulum and mesodiverticulum with abdominal pain following a blunt trauma to the abdomen, sustained during an automobile accident. Clinical Presentation: Following a head-on automobile collision a 36-year-old man was referred to the emergency room with abdominal pain, guarding and rigidity and was taken to the operating theater with a preoperative

Kourosh Kazemi; Hamed Jalaeian; Mohammad Reza Fattahi; Seyed Vahid Hosseini; Masoud Shafiee; Naghmeh Roshan

2008-01-01

104

The efficacy of serial physical examination in penetrating abdominal trauma  

Microsoft Academic Search

Over a 10-year period we reviewed the records of 370 consecutive patients with potentially penetrating abdominal wounds (48 gunshot and 322 stab wounds). Selective non-operative management for abdominal stab wounds was introduced, guided by serial physical examination. In our study the terms therapeutic and non-therapeutic laparotomies were used, the latter comprising negative as well as insignificant findings.Initially diagnostic peritoneal lavage

Ernst P van Haarst; Bart P. J van Bezooijen; Peter-Paul L. O Coene; Jan S. K Luitse

1999-01-01

105

Using Contrast-Enhanced Helical CT to Visualize Arterial Extravasation After Blunt Abdominal Trauma: Incidence and Organ Distribution  

Microsoft Academic Search

OBJECTIVE. We evaluated the incidence and organ distribution of arterial extravasation identified using contrast-enhanced helical CT in patients who had sustained abdominal vis- ceral injuries and pelvic fractures after blunt trauma. SUBJECTS AND METHODS. Five hundred sixty-five consecutive patients from four level I trauma centers who had CT scans showing abdominal visceral injuries or pelvic frac- tures were included in

Dorcas C. Yao; R. Brooke; Stuart E. Mirvis; Arnold Weekes; Michael P. Federle; Connie Kim; Priya Prabhakar; Philip W. Ralls

106

Free fluid on abdominal computed tomography scan after blunt trauma does not mandate exploratory laparotomy in children  

Microsoft Academic Search

Background\\/Purpose: The isolated finding of free intraperitoneal fluid on abdominal computed tomography (CT) scan after blunt trauma in adults is considered an indication for laparotomy by many trauma surgeons. The authors wished to determine if these guidelines are applicable to children. Methods: A retrospective chart review was conducted. The authors included all children (?12 years of age) sustaining blunt abdominal

Elizabeth A Beierle; Mike K Chen; Thomas V Whalen; Edward J Doolin

2000-01-01

107

Validation of a Prediction Rule for the Identification of Children With Intra-abdominal Injuries After Blunt Torso Trauma  

Microsoft Academic Search

Methods: We conducted a prospective observational study of children with blunt torso trauma who were evaluated for intra-abdominal injury with abdominal computed tomography (CT), diagnostic laparoscopy, or laparotomy at a Level I trauma center during a 3-year period to validate a previously derived prediction rule. The emergency physician providing care documented history and physical examination findings on a standardized data

James F. Holmes; Amy Mao; Smita Awasthi; John P. McGahan; David H. Wisner; Nathan Kuppermann

2009-01-01

108

The results of damage control surgery in abdominal trauma  

Microsoft Academic Search

Damage control surgery has increased as a popular application in patients with a deteriorated general condition due to a severe trauma incident. The purpose of the study is to investigate the mor- bidity and mortality of such patients who were fol- lowed up at our hospital due to a damage control surgery. This research was scheduled as a retrospec- tive

Simsek A; Ozer MT; Eryilmaz M; Ozturk E; Ozerhan IH; Gorgulu S; Peker Y

109

Clinical predictors of intra-abdominal injury in severe blunt trauma patient  

Microsoft Academic Search

Introduction: The early recognition of intra-abdominal injury (IAI) in patients with blunt trauma is essential, yet physical examination is often unreliable. Computed tomography (CT) scans are used widely to further evaluate possible IAI but these require time and expense. IAI may be associated with certain objective risk factors or other specific injuries, but this association has not been widely studied.

PL Goh; MJ Schull

110

Acute direct inguinal hernia resulting from blunt abdominal trauma: Case Report  

Microsoft Academic Search

We report a case of traumatic inguinal hernia following blunt abdominal trauma after a road traffic accident and describe the circumstances and technique of repair. The patient suffered multiple upper limb fractures and developed acute swelling of the right groin and scrotum. CT scan confirmed the acute formation of a traumatic inguinal hernia. Surgical repair was deferred until resolution of

Seema Biswas; Maria Vedanayagam; Gabrielle Hipkins; Andrew Leather

2010-01-01

111

The Role of Follow-up Imaging in Paediatric Blunt Abdominal Trauma  

Microsoft Academic Search

AIM: To assess the role of follow-up imaging in paediatric blunt abdominal trauma. METHOD: All children who underwent CT scanning of their abdomen at our institution following acute blunt injury between January 1997 and December 2000 were included in the study. Case notes where researched for details regarding mechanism of injury, initial clinical presentation, acute management, complications and follow-up until

A Mizzi; A Shabani; A Watt

2002-01-01

112

Successful endoscopic treatment of biliary stricture following mesenteric tear caused by blunt abdominal trauma  

Microsoft Academic Search

Biliary duct injuries are frequently iatrogenic, being associated with surgery for gallbladder stones. However, blunt abdominal trauma such as a motor vehicle crash is a rare cause of extrahepatic biliary stricture. A few reports have been published on biliary strictures treated with endoscopic therapy. In the present study, we describe a suprapancreatic biliary stricture associated with mesenteric tear following road

Dong O Kang; Tae Hyo Kim; Seung Suk You; Hyun Ju Min; Hyun Jin Kim; Woon Tae Jung; Ok Jae Lee

113

Homicidal blunt abdominal trauma with isolated laceration of the small bowel mesentery  

Microsoft Academic Search

Nonpenetrating abdominal trauma rarely causes isolated mesenteric lacerations with fatal hemorrhages. When this does happen, it is often the result of compression by a lap seat belt or a steering wheel, only extremely rarely is it the result of a homicidal act.

A. Eriksson

1984-01-01

114

Preliminary experience with focused abdominal sonography for trauma (FAST) in children: Is it useful?  

Microsoft Academic Search

Background\\/Purpose: Most pediatric surgeons and pediatric radiologists consider computed tomography (CT) the best radiological test for the evaluation of children with suspected intraabdominal injury. The majority of injured children evaluated with CT will be found to have a normal scan. Focused abdominal sonography for trauma (FAST) has been shown to be a useful screening test in the evaluation of adult

K. H Mutabagani; B. D Coley; N Zumberge; D. W McCarthy; G. E Besner; D. A Caniano; D. R Cooney

1999-01-01

115

Effect of abdominal trauma on hemorrhagic shock-induced acute lung injury in rats  

Microsoft Academic Search

AIM: To evaluate the effects of abdominal trauma on hemorrhagic shock-induced acute lung injury in rats. METHODS: Five groups were allocated (n = 8) in the study. Group I was taken as the control group, group II as the hemorrhagic shock group, group III as hemorrhagic shock + laparotomy, group IV as hemor- rhagic shock + splenectomy and group V

Bulent Kilicoglu; Erol Eroglu; Sibel Serin Kilicoglu; Kemal Kismet; Fusun Eroglu; Kilicoglu SS

2006-01-01

116

The value of endoscopic diagnosis and the treatment of pancreas injuries following blunt abdominal trauma  

Microsoft Academic Search

Background: Injuries to the pancreas following blunt abdominal trauma are rare due to its protected retroperitoneal position. Many pancreatic lesions remain unnoticed at first and only become apparent when complications arise or during treatment of other injuries. The mortality rate is between 12 and 30%, and if treatment is delayed it is as high as 60%. Methods: Using medical records

A. Wolf; J. Bernhardt; M. Patrzyk; C.-D. Heidecke

2005-01-01

117

Factors affecting survival of children after abdominal trauma in Lebanese civil war  

Microsoft Academic Search

To evaluate the risk factors affecting the survival of children with war injuries involving the abdomen, 270 children under 16 years of age with abdominal injuries during the civil war in Lebanon were studied. One hundred and ninety (70%) sustained penetrating injuries and 80 (30%) blunt trauma. The overall infection rate was 7.8%. There were 13 deaths (4.8%), 7 early

Michel S. Slim; Charles Her; Samir R. Akel; Omar M. Dajani; Hani A. Hajj; Anis Baraka

1990-01-01

118

The Value of Non-Contrast- Enhanced CT in Blunt Abdominal Trauma  

Microsoft Academic Search

The usefulness of noncontrast CT, limited to the upper abdomen, in conjunction with conventional IV contrast-enhanced scanning was studied prospectively in 190 patients who had sustained blunt abdominal trauma. In 78, visceral injuries were confirmed at surgery or at follow-up CT. Of the patients with injuries, 14 (18%) had hyperdense hematomas on the noncontrast studies that became isodense after IV

James Kelly; Vassilios Raptopoulos; Ashley Davidoff; Richard Waite; Patricia Norton

119

Delayed manifestation of aortic stenosis after blunt abdominal trauma: Report of a case  

Microsoft Academic Search

Delayed manifestation of aortic stenosis caused by abdominal blunt trauma is rare. We report herein the case of a 67-year-old man who was taken to a nearby hospital after being crushed between a heavy truck and a wall. An emergency laparotomy was performed, revealing only a mesenteric tear which was repaired. He was discharged after an uneventful postoperative course; however,

Shunya Shindo; Kouji Ogata; Seiichiro Katahira; Keiji Iyori; Tadao Ishimoto; Masahiro Kobayashi; Osamu Suzuki; Kihachiro Kamiya; Yusuke Tada

1997-01-01

120

Subtle abdominal aortic injury after blunt chest trauma  

Microsoft Academic Search

This case report describes a patient with an intimal flap of the abdominal aorta after a motor vehicle crash. The patient was an unrestrained driver with minimal anterior chest wall pain. This is a rare injury and one that is difficult to find due to its rarity. The lower cut of the chest CT scan found the injury. Its treatment

Geoff M. Crabb; Kennedy K. McQuillen

2006-01-01

121

Perforation of the gallbladder due to blunt abdominal trauma.  

PubMed

Gallbladder perforation due to blunt trauma is an uncommon finding. We report our experience with six patients. The factors predisposing to perforation include a distended gallbladder because of either fasting or alcohol ingestion in normal patients, and obstruction of the cystic in patients with cholelithiasis. The diagnosis of gallbladder perforation after blunt injury may be suspected in patients with signs of an acute abdomen and hypotension that is not explained by blood loss. Peritoneal lavage that contains bile suggests the tentative diagnosis of trauma to the biliary tract or gallbladder, as well as to the liver or upper bowel. A cholecystectomy is the preferred treatment when gallbladder perforation occurs in the traumatized patient. PMID:7082171

Wiener, I; Watson, L C; Wolma, F J

1982-06-01

122

[Management of penetrating abdominal trauma: what we need to know?].  

PubMed

Penetrating traumas are rare in France and mainly due to stabbing. Knives are less lethal than firearms. The initial clinical assessment is the cornerstone of hospital care. It remains a priority and can quickly lead to a surgical treatment first. Urgent surgical indications are hemorrhagic shock, evisceration and peritonitis. Dying patients should be immediately taken to the operating room for rescue laparotomy or thoracotomy. Ultrasonography and chest radiography are performed before damage control surgery for hemodynamic unstable critical patients. Stable patients are scanned by CT and in some cases may benefit from non-operative strategy. Mortality remains high, initially due to bleeding complications and secondarily to infectious complications. Early and appropriate surgery can reduce morbidity and mortality. Non-operative strategy is only possible in selected patients in trained trauma centers and with intensive supervision by experienced staff. PMID:23402982

Hoffmann, C; Goudard, Y; Falzone, E; Leclerc, T; Planchet, M; Cazes, N; Pons, F; Lenoir, B; Debien, B

2013-02-08

123

Management of pancreatic injury in pediatric blunt abdominal trauma  

Microsoft Academic Search

Background\\/Purpose: Nonoperative management of lowgrade pancreatic injury is widely accepted. Management of major pancreatic parenchymal or ductal injury in children remains controversial. This study will review management strategies as they relate to site and type of pancreatic injury and their outcomes.Methods: A total of 11,794 consecutive admissions to a regional pediatric trauma center from 1984 to 1997 were reviewed to

Michael A Jobst; Timothy G Canty; Frank P Lynch

1999-01-01

124

Oral contrast omission in the computed tomographic evaluation of blunt abdominal trauma: a literature review.  

PubMed

The purpose of this review is to examine existing research on oral contrast administrating as it pertains to the computed tomographic (CT) evaluation of blunt abdominal trauma, as well as to determine the necessity of oral contrast as part of a CT scanning universal protocol. Many hospitals routinely administer both oral and intravenous contrast prior to abdominal CT scan. There have been found to be numerous disadvantages and risks associated with oral contrast administration prior to CT scan. There has been a shift in many hospitals over the years from traditional CT scanners to multidetector row helical scanners, which allow for thinner collimation and higher spatial resolution. With the advances in technology, from single detector row to multidetector row helical CT scanners, the question whether oral contrast is necessary, useful, or dangerous presents itself. There is a significant lack of research on this topic over the past 10 years. All of the studies referenced support no longer administering oral contrast for the initial evaluation of the patient with blunt abdominal trauma. However, the findings of the studies cited in this article are based on small sample sizes and low incidences of solid organ, bowel, or mesenteric injuries. The current level of available research has significant limitations to support a recommendation to eliminate the administration of oral contrast before obtaining the initial CT scanning for blunt abdominal trauma. Further research is necessary before any conclusion or practice change can be made. PMID:22415510

Lafferty, Briana

125

Institutional and Individual Learning Curves for Focused Abdominal Ultrasound for Trauma  

PubMed Central

Objective To evaluate both institutional and individual learning curves with focused abdominal ultrasound for trauma (FAST) by analyzing the incidence of diagnostic inaccuracies as a function of examiner experience for a group of trauma surgeons performing the study in the setting of an urban level I trauma center. Summary Background Data Trauma surgeons are routinely using FAST to evaluate patients with blunt trauma for hemoperitoneum. The volume of experience required for practicing trauma surgeons to be able to perform this examination with a reproducible level of accuracy has not been fully defined. Methods The authors reviewed prospectively gathered data for all patients undergoing FAST for blunt trauma during a 30-month period. All FAST interpretations were validated by at least one of four methods: computed tomography, diagnostic peritoneal lavage, celiotomy, or serial clinical evaluations. Cumulative sum (CUSUM) analysis was used to describe the learning curves for each individual surgeon at target accuracy rates of 85%, 90%, and 95% and for the institution as a whole at target examination accuracy rates of 85%, 90%, 95%, and 98%. Results Five trauma surgeons performed 546 FAST examinations during the study period. CUSUM analysis of the aggregate experience revealed that the examiners as a group exceeded 90% accuracy at the outset of clinical examination. The level of accuracy did not improve with either increased frequency of performance or total examination experience. The accuracy rates observed for each trauma surgeon ranged from 87% to 98%. The surgeon with the highest accuracy rate performed the fewest examinations. No practitioner demonstrated improved accuracy with increased experience. Conclusions Trauma surgeons who are newly trained in the use of FAST can achieve an overall accuracy rate of at least 90% from the outset of clinical experience with this modality. Interexaminer variations in accuracy rates, which are observed above this level of performance, are probably related more to issues surrounding patient selection and inherent limitations of the examination in certain populations than to practitioner errors in the performance or interpretation of the study.

McCarter, Freda D.; Luchette, Fred A.; Molloy, Mark; Hurst, James M.; Davis, Kenneth; Johannigman, Jay A.; Frame, Scott B.; Fischer, Josef E.

2000-01-01

126

Isolated hepatic artery injury in blunt abdominal trauma presenting as upper gastrointestinal bleeding: treatment with transcatheter embolisation.  

PubMed

Liver injury in blunt abdominal trauma is common. However, not often does blunt trauma cause injury to the anatomical structures of the porta hepatis. Isolated injury of the hepatic artery has been rarely reported in the literature. Such injury may be lethal and requires immediate diagnosis and management. This report describes an unusual case of blunt abdominal trauma resulting in hepatic and gastroduodenal artery dissection, with pseudoaneurysm formation complicated by active upper gastrointestinal bleeding. The injury was managed by transcatheter embolisation. Awareness of this diagnosis should facilitate management of similar trauma cases. PMID:23162032

Taslakian, Bedros; Ghaith, Ola; Al-Kutoubi, Aghiad

2012-11-15

127

Homicidal blunt abdominal trauma with isolated laceration of the small bowel mesentery.  

PubMed

Nonpenetrating abdominal trauma rarely causes isolated mesenteric lacerations with fatal hemorrhages. When this does happen, it is often the result of compression by a lap seal belt or a steering wheel, only extremely rarely is it the result of a homicidal act. In the present paper, two homicide victims with resulting mesenteric tears and fatal bleeding due to sagittal compression are described. A high blood alcohol concentration may in both cases have contributed to the fatal outcome. The cases support the assumption that direct rather than indirect trauma causes this kind of lesion. PMID:6516601

Eriksson, A

1984-01-01

128

Intraoperative Blood Salvage in Penetrating Abdominal Trauma: a Randomised, Controlled Trial  

Microsoft Academic Search

Background  Blood is a scarce and costly resource. Transfusion is often required after major trauma but blood may not be readily available,\\u000a and concerns remain over the potential adverse consequences of allogeneic blood transfusion. Intraoperative blood salvage\\u000a (IBS) is used extensively after blunt abdominal trauma, but when blood is contaminated by enteric contents its use has been\\u000a considered contraindicated.\\u000a \\u000a \\u000a \\u000a Methods  This was

Douglas M. Bowley; Philip Barker; Kenneth D. Boffard

2006-01-01

129

Abdominal trauma and laparotomy in 158 patients. A comparative study of penetrating and blunt injury.  

PubMed

A comparative study of 158 patients laparotomized for abdominal trauma is presented. 96 had a penetrating and 62 patients a blunt abdominal injury. 95% of the former group was stabbed with a knife and 56% had signs of alcohol intoxication. The blunt trauma patients were in all the studied respects more difficult to handle than those with a penetrating injury. They were older, arrived later at the hospital, were often in shock, more difficult to diagnose and therefore, operated on later, had more severe and associated injuries, had to be given more blood, were more often treated in the I.C.U., developed more severe postoperative complications, were hospitalized longer and had a higher mortality rate. PMID:7136417

Höckerstedt, K; Airo, I; Karaharju, E; Sundin, A

1982-01-01

130

Computed tomographic diagnosis of a “midline package” of abdominal trauma: Two illustrative cases  

Microsoft Academic Search

A “midline package” of abdominal injuries may occur when the anterior mid-abdomen suffers direct blunt trauma. This package\\u000a may include lacerations of the left lobe of the liver, pancreatic lacerations or fractures, and bowel injuries; if high in\\u000a location, it may also be associated with sternal fractures and cardiac injuries. A common cause is motor vehicle accidents\\u000a in which the

Ephraim Hochberg; Robert A. Novelline; James T. Rhea

1995-01-01

131

Cost analysis of diagnostic laparoscopy vs laparotomy in the evaluation of penetrating abdominal trauma  

Microsoft Academic Search

Background: Diagnostic laparoscopy for the evaluation of injuries in patients with penetrating abdominal trauma has been shown to decrease\\u000a the morbidity and mortality associated with mandatory laparotomy. The overall impact on patient care and hospital costs has\\u000a not been thoroughly investigated. The goal of this study was to determine the economic impact of laparoscopy as a diagnostic\\u000a tool in the

J. M. Marks; D. F. Youngelman; T. Berk

1997-01-01

132

Investigation of childhood blunt abdominal trauma: a practical approach using ultrasound as the initial diagnostic modality  

Microsoft Academic Search

During a 5.5-year retrospective study (1979–84) 170 children with blunt abdominal trauma were investigated with intravenous\\u000a urography (IVU), ultrasound (US) and scintigraphy. For the investigation of the last 71 children (after 1982) a 4th generation\\u000a CT scanner was available in the same department. The results of radiologic investigations were compared with clinical outcome\\u000a in 157 and results at laparotomy in

D. Filiatrault; D. Longpré; H. Patriquin; G. Perreault; A. Grignon; J. Pronovost; J. Boisvert

1987-01-01

133

Splanchnic artery pseudo-aneurysms secondary to blunt abdominal trauma in children  

Microsoft Academic Search

Traumatic splanchnic artery pseudo-aneurysms are uncommon; only two cases have been reported among the pediatric population. The authors describe their experience with four patients in whom splanchnic artery pseudo-aneurysms developed after blunt abdominal trauma. Splenic artery pseudo-aneurysms were found in a 6-year-old boy and an 8-year-old girl after blunt splenic injuries. In both cases, spontaneous thrombosis of the pseudo-aneurysms occurred

Kenneth W. Gow; James J. Murphy; Geoffrey K. Blair; David A. Stringer; J. A. Gordon Culham; Graham C. Fraser

1996-01-01

134

Severe pre-eclampsia and HELLP syndrome after massive fetomaternal hemorrhage following blunt abdominal trauma  

Microsoft Academic Search

Severe pre-eclampsia and HELLP syndrome developed within 24h after a 31year old nulliparous woman suffered a blunt abdominal trauma with massive fetomaternal hemorrhage and fetal intracranial bleeding. This is the first case reported of fulminating pre-eclampsia and HELLP syndrome following maternal exposure to a large amount of fetal cells and\\/or fetal cell debris as DNA or microparticles.

V. J. Faber; F. J. Klumper; S. Scherjon; W. J. van Wijngaarden

2011-01-01

135

Massive gastric bleeding from a blunt abdominal trauma: report of a case.  

PubMed

Blunt gastric injury (BGI) is a rare condition that accounts for 0.02%-1.7% of all blunt abdominal trauma cases. Blunt gastric rupture, which occurs in less than 40% of all BGI cases, presents unstable vital signs and symptoms of peritonitis due to massive peritoneal contamination. This article presents the case of a patient with BGI who did not present with symptoms of peritonitis in spite of presenting with persistent hypovolemic shock. PMID:20872201

Miyajima, Mamoru; Iinuma, Yasushi; Hirose, Yasuo; Kumagai, Ken; Tanaka, Toshiharu; Sekiguchi, Hiroshi; Yamazaki, Toshiyuki; Yamamoto, Mutsuo

2010-09-25

136

Massive gastric bleeding from a blunt abdominal trauma: Report of a case  

Microsoft Academic Search

Blunt gastric injury (BGI) is a rare condition that accounts for 0.02%–1.7% of all blunt abdominal trauma cases. Blunt gastric\\u000a rupture, which occurs in less than 40% of all BGI cases, presents unstable vital signs and symptoms of peritonitis due to\\u000a massive peritoneal contamination. This article presents the case of a patient with BGI who did not present with symptoms

Mamoru Miyajima; Yasushi Iinuma; Yasuo Hirose; Ken Kumagai; Toshiharu Tanaka; Hiroshi Sekiguchi; Toshiyuki Yamazaki; Mutsuo Yamamoto

2010-01-01

137

Isolated Superior Mesenteric Vein Injury from Blunt Abdominal Trauma: Report of a Case  

Microsoft Academic Search

Solitary injury of the superior mesenteric vein (SMV) after blunt abdominal trauma is a rare but frequently fatal injury.\\u000a A 63-year-old man was admitted to our hospital after falling on his right side from a height of 5?m. Computed tomography (CT)\\u000a showed blood in the peritoneal cavity, but no liver or spleen injury. Emergency laparotomy revealed complete disruption of\\u000a the

Rodomil Kostka; Marcela Sojáková

2006-01-01

138

Complications following Repair of Extrahepatic Bile Duct Injuries after Blunt Abdominal Trauma  

Microsoft Academic Search

.   Extrahepatic bile duct traumatic injuries are extremely rare and their treatment is difficult and with several controversies.\\u000a The aim of this study was to offer some more clinical information on their surgical repair and outcome. We present seven patients\\u000a with extrahepatic biliary tract lesions after blunt abdominal trauma, (isolated gallbladder lesions were excluded) four males\\u000a and three females from

Jose A. Rodriguez-Montes; Esther Rojo; Luis García-Sancho Martín

2001-01-01

139

Occult abdominal injuries to airbag-protected crash victims: a challenge to trauma systems.  

PubMed

A multidisciplinary, automobile crash investigation team at the University of Miami School of Medicine, William Lehman Injury Research Center of Jackson Memorial Hospital/Ryder Trauma Center in Miami, Florida, is conducting a detailed medical and engineering study. The focus is restrained (seatbelts, airbag, or both) occupants involved in frontal crashes who have been severely injured. More than 60 crashes have been included in the study to date. Analysis of the initial data supports the general conclusion that restraint systems are working to reduce many of the head and chest injuries suffered by unrestrained occupants. However, abdominal injuries among airbag-protected occupants still occur. Some are found among occupants who appeared uninjured at the scene. Case examples are provided to illustrate abdominal injuries associated with airbag-protected crashes. The challenges of recognizing injuries to airbag-protected occupants are discussed. To assist in recognizing the extent of injuries to occupants protected by airbags, it is suggested that evidence from the crash scene be used in the triage decision. For the abdominal injury cases observed in this study, deformation of the steering system was the vehicle characteristic most frequently observed. The presence of steering wheel deformation is an indicator of increased likelihood of internal injury. This may justify transporting the victim to a trauma center for a closer examination for abdominal injuries. PMID:7723087

Augenstein, J S; Digges, K H; Lombardo, L V; Perdeck, E B; Stratton, J E; Malliaris, A C; Quigley, C V; Craythorne, A K; Young, P E

1995-04-01

140

Clinical policy: critical issues in the evaluation of adult patients presenting to the emergency department with acute blunt abdominal trauma.  

PubMed

This clinical policy from the American College of Emergency Physicians is an update of the 2004 clinical policy on the critical issues in the evaluation of adult patients presenting to the emergency department with acute blunt abdominal trauma. A writing subcommittee reviewed the literature as part of the process to develop evidence-based recommendations to address 4 key critical questions: (1) In a hemodynamically unstable patient with blunt abdominal trauma, is ultrasound the diagnostic modality of choice? (2) Does oral contrast improve the diagnostic performance of computed tomography (CT) in blunt abdominal trauma? (3) In a clinically stable patient with isolated blunt abdominal trauma, is it safe to discharge the patient after a negative abdominal CT scan result? (4) In patients with isolated blunt abdominal trauma, are there clinical predictors that allow the clinician to identify patients at low risk for adverse events who do not need an abdominal CT? Evidence was graded and recommendations were based on the available data in the medical literature related to the specific clinical question. PMID:21453818

Diercks, Deborah B; Mehrotra, Abhishek; Nazarian, Devorah J; Promes, Susan B; Decker, Wyatt W; Fesmire, Francis M

2011-04-01

141

Blunt Abdominal Trauma Patients Are at Very Low Risk for Intra-Abdominal Injury after Emergency Department Observation  

PubMed Central

Introduction Patients are commonly admitted to the hospital for observation following blunt abdominal trauma (BAT), despite initially negative emergency department (ED) evaluations. With the current use of screening technology, such as computed tomography (CT) of the abdomen and pelvis, ultrasound, and laboratory evaluations, it is unclear which patients require observation. The objective of this study was to determine the prevalence of intra-abdominal injury (IAI) and death in hemodynamically normal and stable BAT patients with initially negative ED evaluations admitted to an ED observation unit and to define a low-risk subgroup of patients and assess whether they may be discharged without abdominal/pelvic CT or observation. Methods This was a retrospective cohort study performed at an urban level 1 trauma center and included all BAT patients admitted to an ED observation unit as part of a BAT key clinical pathway. All were observed for at least 8 hours as part of the key clinical pathway, and only minors and pregnant women were excluded. Outcomes included the presence of IAI or death during a 40-month follow-up period. Prior to data collection, low-risk criteria were defined as no intoxication, no hypotension or tachycardia, no abdominal pain or tenderness, no hematuria, and no distracting injury. To be considered low risk, patients needed to meet all low-risk criteria. Results Of the 1,169 patients included over the 2-year study period, 29% received a CT of the abdomen and pelvis, 6% were admitted to the hospital from the observation unit for further management, 0.4% (95% confidence interval [CI], 0.1%–1%) were diagnosed with IAI, and 0% (95% CI, 0%–0.3%) died. Patients had a median combined ED and observation length of stay of 9.5 hours. Of the 237 (20%) patients who met low-risk criteria, 7% had a CT of the abdomen and pelvis and 0% (95% CI, 0%–1.5%) were diagnosed with IAI or died. Conclusion Most BAT patients who have initially negative ED evaluations are at low risk for IAI but still require some combination of observation and CT. A subgroup of BAT patients may be safely discharged without CT or observation after the initial evaluation.

Kendall, John L; Kestler, Andrew M; Whitaker, Kurt T; Adkisson, Mette-Margrethe; Haukoos, Jason S

2011-01-01

142

Contrast-enhanced ultrasound for imaging blunt abdominal trauma - indications, description of the technique and imaging review.  

PubMed

Patients with blunt abdominal trauma are initially imaged with ultrasound (US) for the evaluation of free abdominal fluid. However, lacerations of solid organs can be overlooked. Although computed tomography (CT) is the gold standard technique for abdominal trauma imaging, overutilization, ionizing radiation, need to transport the patient and potential artifacts are well known disadvantages. Contrast-enhanced US (CEUS) can be used as an imaging tool between the two methods. It can easily and reliably reveal solid abdominal organ injuries in patients with low-energy localized trauma and decrease the number of CT scans performed. It can be rapidly performed at the patient's bedside with no need for transportation. There are only very few contraindications and anaphylactoid reactions are extremely rare. Altogether, CEUS has proved to be very helpful for the initial imaging of traumatic lesions of the liver, kidney and spleen, as well as for patient follow-up. PMID:22274907

Cokkinos, D; Antypa, E; Stefanidis, K; Tserotas, P; Kostaras, V; Parlamenti, A; Tavernaraki, K; Piperopoulos, P N

2012-01-24

143

Acute direct inguinal hernia resulting from blunt abdominal trauma: Case Report.  

PubMed

We report a case of traumatic inguinal hernia following blunt abdominal trauma after a road traffic accident and describe the circumstances and technique of repair. The patient suffered multiple upper limb fractures and developed acute swelling of the right groin and scrotum. CT scan confirmed the acute formation of a traumatic inguinal hernia. Surgical repair was deferred until resolution of the acute swelling and subcutaneous haematoma. The indication for surgery was the potential for visceral strangulation or ischaemia with the patient describing discomfort on coughing. At surgery there was complete obliteration of the inguinal canal with bowel and omentum lying immediately beneath the attenuated external oblique aponeurosis. A modified prolene mesh hernia repair was performed after reconstructing the inguinal ligament and canal in layers.To our knowledge, this is the first documented case of the formation of an acute direct inguinal hernia caused as a result of blunt abdominal trauma with complete disruption of the inguinal canal. Surgical repair outlines the principles of restoration of normal anatomy in a patient who is physiologically recovered from the acute trauma and whose anatomy is distorted as a result of his injuries. PMID:20537142

Biswas, Seema; Vedanayagam, Maria; Hipkins, Gabrielle; Leather, Andrew

2010-06-10

144

Blunt abdominal trauma. A 5-year analysis of 870 patients requiring celiotomy.  

PubMed

This study represents the experience with blunt trauma to the abdomen of patients from a major regional trauma center. Eight hundred and seventy patients with blunt abdominal trauma are reviewed, representing 12.89% of the total admissions over a 5-year period. The motor vehicle continues to be the major cause (89.5%) of injury to these patients. Thirty per cent had positive blood alcohol. Intra-abdominal injuries in this group necessitating operative intervention were based on the use of peritoneal lavage. Negative celiotomies occurred in 10.2% of these patients. Of the injuries incurred, the spleen was involved 42%, the liver 35.6%, the serosa, diaphragm, bowel, and blood vessels were involved to a lesser extent. Only 0.4% of the patients suffered direct injury to the stomach, duodenum, and pancreas, data which should preclude routine exploration of retroperitoneal structures unless by obvious retroperitoneal injury is noted. Additional surgical intervention for associated injuries was seen in 50.54% of this patient group. PMID:6712323

Cox, E F

1984-04-01

145

Blunt abdominal trauma. A 5-year analysis of 870 patients requiring celiotomy.  

PubMed Central

This study represents the experience with blunt trauma to the abdomen of patients from a major regional trauma center. Eight hundred and seventy patients with blunt abdominal trauma are reviewed, representing 12.89% of the total admissions over a 5-year period. The motor vehicle continues to be the major cause (89.5%) of injury to these patients. Thirty per cent had positive blood alcohol. Intra-abdominal injuries in this group necessitating operative intervention were based on the use of peritoneal lavage. Negative celiotomies occurred in 10.2% of these patients. Of the injuries incurred, the spleen was involved 42%, the liver 35.6%, the serosa, diaphragm, bowel, and blood vessels were involved to a lesser extent. Only 0.4% of the patients suffered direct injury to the stomach, duodenum, and pancreas, data which should preclude routine exploration of retroperitoneal structures unless by obvious retroperitoneal injury is noted. Additional surgical intervention for associated injuries was seen in 50.54% of this patient group.

Cox, E F

1984-01-01

146

Small bowel intussusception following blunt abdominal trauma in an adult patient.  

PubMed

Blunt abdominal trauma is a rare cause of small bowel intussusception in adults. A patient is described who presented with signs and symptoms of intestinal obstruction following a fall from a ladder. A CT scan revealed evidence of ileo-ileal intussusception. Exploratory laparotomy and resection of a necrotic bowel segment were performed. Rare occurrences like intussusception should be kept in mind in similar presentations with careful examination of the pathognomonic CT findings, as early detection and surgical intervention with manual reduction could preclude the need for small bowel resection and its untoward possible complications. PMID:19773508

Karam, J; Khreiss, M; Musallam, K M; Alaeddine, M H; Al-Kutoubi, A; Abi Saad, G S

2009-10-01

147

Jujitsu kick to the abdomen: a case of blunt abdominal trauma resulting in hematochezia and transient ischemic colitis.  

PubMed

Blunt abdominal trauma is a common presentation to the emergency department. Ischemic colitis is a rare complication of this and its possible sequelae are important for an emergency physician to recognize. A 21-year-old man presented to the emergency department with abdominal pain and hourly episodes of bright red blood per rectum shortly after being kicked in the stomach at his jujitsu class. He had no significant medical history, and results of his systems review were otherwise unremarkable. On examination, he appeared well, with normal vital signs. He had mild lower abdominal tenderness, but there were no peritoneal signs present. There was blood on the digital rectal examination. His hemoglobin, platelet, and international normalized ratio levels were normal and his abdominal radiograph was unremarkable. The gastroenterology service was contacted because of the hematochezia and a flexible sigmoidoscopy was performed. The sigmoidoscopy showed erythema, ulceration, and edema of a segment in the left colon, consistent with ischemic colitis. This was later confirmed on biopsy. A computed tomography (CT) scan of the abdomen was conducted, which revealed left colonic inflammation consistent with colonic ischemia. There was no mesenteric vascular thrombosis or mesenteric hematoma found on CT. His hematochezia and abdominal pain subsided spontaneously, and he was discharged home. This case illustrates transient ischemic colitis as a potential presentation of blunt abdominal trauma, and emergency physicians should consider this uncommon diagnosis in the differential diagnosis of patients presenting after abdominal trauma. PMID:21392850

Rosenberg, Hans; Beck, Jeremy

2011-03-09

148

Accuracy of prehospital focused abdominal sonography for trauma after a 1-day hands-on training course  

Microsoft Academic Search

ObjectivesTo establish a training course for Prehospital Focused Abdominal Sonography for Trauma (P-FAST) and to evaluate the accuracy of the participants after the course and at the trauma scene.MethodsA training programme was developed to provide medical staff with the skills needed to perform P-FAST. In order to evaluate the accuracy of P-FAST performed by the students, nine participants (five emergency

Felix Walcher; Thomas Kirschning; Michael P Müller; Christian Byhahn; Mario Stier; Miriam Rüsseler; Franziska Brenner; Jörg Braun; Ingo Marzi; Raoul Breitkreutz

2010-01-01

149

[Haemorrhagic shock after severe abdominal trauma in children: knowing when to change from conservative to surgical management].  

PubMed

Abdominal vascular injuries following a serious falling out are quite rare in children. They can lead to haemorrhagic shock whose etiological diagnosis may be difficult in children in case of multiple trauma. The current management of abdominal injuries in the child is usually conservative, surgery being indicated in haemodynamically unstable patients. We report the case of a 7-year-old girl who presented with abdominal trauma with rupture of the hepatic artery and shredding of the splenic vein following a falling out of 10 meters. Aggressive resuscitation associated with early laparotomy for haemostasis, contrary to usual practices advocated in such a context, have helped control the hemorrhagic shock and stabilize the haemodynamic status of the child. The subsequent evolution was favourable, with full recovery. While a conservative attitude usually prevails in the management of traumatic intra abdominal bleeding in children an interventional attitude with emergency surgery must be sometimes considered. PMID:20399596

Jouffroy, R; Bourdaud, N; Cuttaree, H; Sauvat, F; Carli, P; Orliaguet, G

2010-05-01

150

Non-operative management of blunt abdominal trauma. Is it safe and feasible in a district general hospital?  

PubMed Central

Background To evaluate the feasibility and safety of non-operative management (NOM) of blunt abdominal trauma in a district general hospital with middle volume trauma case load. Methods Prospective protocol-driven study including 30 consecutive patients who have been treated in our Department during a 30-month-period. Demographic, medical and trauma characteristics, type of treatment and outcome were examined. Patients were divided in 3 groups: those who underwent immediate laparotomy (OP group), those who had a successful NOM (NOM-S group) and those with a NOM failure (NOM-F group). Results NOM was applied in 73.3% (22 patients) of all blunt abdominal injuries with a failure rate of 13.6% (3 patients). Injury severity score (ISS), admission hematocrit, hemodynamic status and need for transfusion were significantly different between NOM and OP group. NOM failure occurred mainly in patients with splenic trauma. Conclusion According to our experience, the hemodynamically stable or easily stabilized trauma patient can be admitted in a non-ICU ward with the provision of close monitoring. Splenic injury, especially with multiple-site free intra-abdominal fluid in abdominal computed tomography, carries a high risk for NOM failure. In this series, the main criterion for a laparotomy in a NOM patient was hemodynamic deterioration after a second rapid fluid load.

Giannopoulos, George A; Katsoulis, Iraklis E; Tzanakis, Nikolaos E; Patsaouras, Panayotis A; Digalakis, Michalis K

2009-01-01

151

FAST Exam Versus CT Scan in the Diagnosis of Interperitoneal Injury in a Hemodynamically Stable Patient With Blunt Abdominal Trauma: A Systematic Review  

Microsoft Academic Search

Background: The FAST exam is a tool that trauma physicians can use to evaluate patients with blunt trauma and possible abdominal injury. Currently, FAST has become the method of choice in evaluating hemodynamically unstable patients due to the rapid determination of any life-threatening abdominal injuries. The question that remains is the value of the FAST exam in hemodynamically stable blunt

Heather L Morley

2011-01-01

152

The Impact of Damage Control Surgery on Major Abdominal Vascular Trauma  

PubMed Central

Background Thirty years ago we reported our experience with abdominal vascular trauma, highlighting the critical role of hypothermia, acidosis, and coagulopathy. Damage control surgery was subsequently introduced to address this “lethal triad.” The purpose of this study is to evaluate outcomes from our most recent 6-year experience compared to 30 years ago. Methods Patients with major abdominal vascular injuries were examined; the most recent 6-year period was compared with archived data from a similar 6-year period three decades ago. Results The number of patients with major abdominal vascular injuries decreased from 123 patients (1975–1980) to 64 patients (2004–2009). The mean initial pH decreased from 7.21 to 6.96 (1975–1980 vs. 2004–2009]) for patients with overt coagulopathy. In spite of increasingly protracted acidosis, mortality attributable to refractory coagulopathy has decreased from 46% to 19% (1975–1980 vs. 2004–2009, ?2 = 4.36, p = 0.04). There was no significant difference in mortality due to exsanguinating injuries (43% vs. 62%, 1975–1980 vs. 2004–2009, ?2 = 1.96, p = 0.16). Prehospital transport times were unchanged (22 min vs. 20 min, 1975–1980 vs. 2004–2009). Despite the administration of additional clotting factors and the advent of DCS, the overall mortality remains largely unchanged (37% vs. 33%, 1975–1980 vs. 2004–2009, ?2 = 0.385, p = 0.53). Conclusions Adoption of damage control surgery, including the implementation of a massive transfusion protocol, is associated with a reduction in mortality for abdominal vascular injuries due to coagulopathy, however, patients continue to die from exsanguination.

Sorrentino, Talia A; Moore, Ernest E; Wohlauer, Max V; Biffl, Walter L; Pieracci, Fredric M; Johnson, Jeffrey L; Barnett, Carlton C; Bensard, Denis D; Burlew, Clay Cothren

2012-01-01

153

Findings and limitations of focused ultrasound as a possible screening test in stable adult patients with blunt abdominal trauma: a Greek study  

Microsoft Academic Search

Our objective is to underline the place of FAST (focus assessment by sonography for trauma) ultrasonography (US) in the investigation\\u000a of blunt abdominal trauma. We retrospectively examined the ultrasound findings in 1,999 haemodynamically stable adult patients.\\u000a These people were admitted to the emergency room (ER) for possible blunt abdominal trauma. All were stable at admission and\\u000a a FAST ultrasound examination

Ioannis Kornezos; Achilles Chatziioannou; Ioannis Kokkonouzis; Panagiotis Nebotakis; Hippocrates Moschouris; Spiridon Yiarmenitis; Dimitrios Mourikis; Dimitrios Matsaidonis

2010-01-01

154

A review of computed tomography in the diagnosis of intestinal and mesenteric injury in pediatric blunt abdominal trauma  

Microsoft Academic Search

Objective: To determine the sensitivity, specificity, and positive and negative predictive values of the computed tomography (CT) scan in the diagnosis of clinically significant intestinal and mesenteric injury in pediatric blunt abdominal trauma. Patients: The records of 145 children who presented to a tertiary care pediatric hospital between 1987 and 1994 were reviewed retrospectively. All had experienced single or multiple

John S. Graham; Andrew L. Wong

1996-01-01

155

Congenital cleft spleen with CT scan appearance of high-grade splenic laceration after blunt abdominal trauma  

Microsoft Academic Search

The spiral computed tomography (CT) scan has made the diagnosis of traumatic injury increasingly rapid and accurate, especially in cases of solid parenchymal organ injury that follows blunt abdominal trauma. Nonetheless, this valuable method of diagnosis can be confounded when anatomical variances are encountered in the setting of concomitant associated injuries. We present here a case where a congenitally bi-lobed

Todd V Brennan; Gerald S Lipshutz; Andrew M Posselt; Jan K Horn

2003-01-01

156

A rare case of hepatic duct injury from blunt abdominal trauma  

PubMed Central

Background: A 25 year-old male was brought to the emergency room following an apparent suicide attempt by jumping from the fourth floor. Case Report: Patient had a large abdominal laceration in the right upper quadrant (RUQ). CT scan showed a sub-scapular hematoma of the liver. Due to the repeated episodes of hypotension, a laporotomy was performed and the left hepatic artery was ligated while the ductal injury was managed with a Roux-en-Y left hepatic jejunostomy and stent. Bile leakage was resolved post-operatively by day 5 and the patient was discharged home on day 13 after clearance from psychiatry. Conclusions: While non-iatrogenic extrahepatic biliary trauma is rare, a high degree of suspicion is essential, especially in cases like the one discussed in this report. Diagnosis can be difficult in patients undergoing observation.

Hasaniya, Nahidh W.; Premaratne, Shyamal; Premaratne, Ishani D.; McNamara, J. Judson

2013-01-01

157

Safety and efficacy of mezlocillin: a single-drug therapy for penetrating abdominal trauma.  

PubMed

This study was done to determine if a single drug, mezlocillin (Mezlo), is as safe and as effective as combined clindamycin (Clind) and gentamicin (Gent) in the treatment of penetrating abdominal wounds. One hundred seventy-three patients received either Mezlo or Clind/Gent combined therapy as assigned by computer-generated randomization. Of these, 147 patients were evaluable. Of 73 patients treated with Clind/Gent the mean duration of hospital stay was 8.9 +/- 4.0 days. Infectious complications developed in 18 patients of whom five failed to respond promptly, but only one required change in therapy. Of 74 patients treated with Mezlo, the mean duration of hospital stay was 9.1 +/- 5.0 days. Infectious complications occurred in 17, in whom four patients failed to eliminate their infections, and two needed changes in antibiotic therapy. None of the patients in either antibiotic group failed because of Enterococcus or Pseudomonas infections. There were no deaths. Twelve isolates of Bacteroides were found in peritoneal fluid cultures and all these patients had colon injuries. The overall therapeutic response was excellent to good in 94% on Clind/Gent and 93% on Mezlo. Azotemia developed in one patient on Clind/Genet and one on Mezlo but no other adverse reactions occurred. The differences shown between the two groups were not statistically significant. We conclude that a single drug mezlocillin is as safe and as effective in the treatment of abdominal trauma as combined clindamycin and gentamicin. PMID:3184215

Lou, M A; Thadepalli, H; Mandal, A K

1988-11-01

158

Jejunal perforation caused by blunt abdominal trauma in a patient with Crohn's disease: report of a case.  

PubMed

We report herein the case of a 23-year-old man with Crohn's disease who was found to have a perforated small bowel following blunt abdominal trauma sustained in a traffic accident. The general findings of diffuse peritonitis were identified by physical examination, and a plain X-ray film showed free air in the abdominal cavity. An emergency laparotomy was performed which revealed three perforated ulcers in the affected intestine. An abrupt increase in intraluminal pressure due to the striking force of the steering wheel to the abdomen was assumed to have been the cause of these perforations. PMID:8118127

Tomita, H; Hojo, I; Yasuda, S; Nakamura, T; Takemura, K; Mishima, Y

1993-01-01

159

Intra-abdominal hypertension in the current era of modern trauma resuscitation.  

PubMed

BACKGROUND: ?This study aimed to determine the incidence and outcome of post-traumatic (PT) intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) after the advances in haemostatic resuscitation. METHODS: This is a prospective cohort study from January 2009-December 2011 involving patients with PT haemorrhagic shock. Patients' demographics, fluid resuscitation (<24?h) and damage control laparotomy (DCL), morbidity and mortality were assessed. Patients were divided into group 1 (no DCL) and group 2 (DCL needed). Further, group 1 was subdivided into three subgroups (IA pressure (IAP) <12, 12-20 and >20?mmHg). RESULTS: ?One hundred seventeen patients enrolled in the study (102 in group 1 and 15 in group 2) with a mean age of 35 ± 14, injury severity score (ISS) of 23 ± 10, base deficit of -8.7 ± 2.7?mmol/L, serum lactate of 4.6 ± 2.5?mg/dL and haemoglobin level of 8.8 ± 2. Patients received 7 ± 5 red blood cell units, 6 ± 4.7 fresh frozen plasma units and 8.3 ± 3?L of crystalloid per 24?h. There were significant difference between the two groups regarding crystalloid volume, blood transfusion, base deficit and intensive care unit length of stay. However, mortality was higher in group 2 (20% versus 6%). IAP ? 20?mmHg was reported in 16.7% patients, while 25.5% had IAP < 12 and 57.8% had IAP of 12-20?mmHg. Patients with IAP > 20 had worse metabolic acidosis and received more blood compared with other groups. One patient died because of ACS (0.9%). Overall multiorgan failure and mortality were 5 and 7.7%, respectively. CONCLUSION: With current practice of minimal fluid resuscitation and liberal use of damage control strategies among trauma patients, the IAH was common transient phenomena but the incidence of ACS is remarkably low. PMID:23574113

Mahmood, Ismail; Mahmood, Saeed; Parchani, Ashok; Kumar, Suresh; El-Menyar, Ayman; Zarour, Ahmad; Al-Thani, Hassan; Latifi, Rifat

2013-04-01

160

Paradoxical bradycardia in a patient with haemorrhagic shock secondary to blunt abdominal trauma.  

PubMed

A 47-year-old woman, with no previous medical problems, presented to the Accident and Emergency department with left shoulder pain following a fall onto her left side from a horse. Physical examination was unremarkable and she was discharged with simple analgesia. However, 2 h later, she re-presented with worsening left shoulder pain, dizziness and mild epigastric discomfort. A new examination revealed blood pressure of 100/60 mm Hg, which dropped to 95/65 mm Hg on standing, a Glasgow Coma Scale score of 15 and pulse of 62 beats/min. She was resuscitated with 2 litres of Hartmann's fluid. A focused assessment with sonography for trauma (FAST) scan of her abdomen was negative. Then, 1 h later she experienced generalised abdominal pain and developed postural hypotension. However she remained bradycardic (heart rate 45-60 beats/min). Repeat examination revealed peritonitis. A further FAST scan showed free fluid in the left hypochondrium. A CT scan demonstrated a complex tear of the spleen, for which she underwent an emergency total splenectomy. Her postoperative recovery was uncomplicated. PMID:22778107

Rana, Muhammad Sagheer; Khalid, Usman; Law, Simon

2010-10-06

161

Mechanical Trauma as a Cause of Late Complications after AneuRx(R) Stent Graft Repair of Abdominal Aortic Aneurysms  

PubMed Central

We present a series of 4 patients in whom mechanical trauma was identified as a factor in the development of late complications after AneuR® Stent Graft placement for repair of abdominal aortic aneurysms. In all 4 patients, Type I or III endoleaks (and pseudoaneurysms in 2 patients) were discovered several months after abdominal aortic aneurysm repair with the AneuRx device. Two patients had sustained blunt abdominal trauma in a car accident, one had suffered a traumatic fall, and another had been participating in vigorous rowing activity. In all patients, the trauma had occurred several months before the diagnosis of endoleak or pseudoaneurysm (or both) was established. In all patients, follow-up computed tomographic scans identified the complications. In conclusion, blunt mechanical injury is an unrecognized factor contributing to the late failure of endovascular stent grafts. Vigorous physical activity may also contribute to graft disruption or to the separation of modular components. (Tex Heart Inst J 2003;30:186–93)

Krajcer, Zvonimir; Gupta, Kamal; Dougherty, Kathy G.

2003-01-01

162

Blunt abdominal trauma in adults: role of CT in the diagnosis and management of visceral injuriesPart 1: Liver and spleen  

Microsoft Academic Search

.   Computed tomography is now widely used in the initial diagnostic workup of adult trauma victims with suspected intra-abdominal\\u000a injuries. We review the role of CT in the detection and management of blunt visceral injuries in two parts. In the first part\\u000a we discuss general aspects of performing CT in the setting of abdominal trauma and the diagnostic findings of

C. D. Becker; G. Mentha; F. Terrier

1998-01-01

163

The value of focused assessment with sonography in trauma examination for the need for operative intervention in blunt torso trauma: a rebuttal to “emergency ultrasound-based algorithms for diagnosing blunt abdominal trauma (review)”, from the Cochrane Collaboration  

Microsoft Academic Search

Background and significance  The Cochrane Database of Systematic Reviews published a manuscript critical of the use of the FAST examination. The reference\\u000a is Stengel D. Bauwens K. Sehouli J. Rademacher G. Mutze S. Ekkernkamp A. Porzsolt F. Emergency ultrasound-based algorithms\\u000a for diagnosing blunt abdominal trauma. Cochrane Database of Systematic Reviews. (2):CD004446, 2005. UI: 15846717. The stated objective was the assessment of

Lawrence A. Melniker

2009-01-01

164

Prognostic Factors of Liver Injury in Polytraumatic Patients. Results from 895 Severe Abdominal Trauma Cases  

Microsoft Academic Search

Background and Aims. Prognosis of multiple injured patients is mainly limited by severe haemorrhage. Although mechanisms of altered immune response have been intensively investigated, little is known about the relevance of liver trauma as an independent predictive outcome factor in these patients. Methods. 10,469 patients from the DGU Trauma Registry (1993-2005) were retrospectively analyzed. Primary admitted patients with an injury

Matthias Heuer; Georg Taeger; Gernot M. Kaiser; Dieter Nast-Kolb; Christian A. Kuehne; Steffen Ruchholtz; Rolf Lefering; Andreas Paul; Sven Lendemans

165

Automated Detection of a Blood Pool in Ultrasound Images of Abdominal Trauma  

Microsoft Academic Search

Ultrasound imaging is commonly used for emergency diagnosis of blunt trauma. Portable scanners are able to provide adequate imaging in remote and dangerous areas; however, medical expertise may not be available in the immediate local area to interpret the acquired images. The presence of pooled blood in the abdomen is a critical clinical symptom after trauma. This article describes an

Vladimir Zagrodsky; Michael Phelan; Raj Shekhar

2007-01-01

166

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

Microsoft Academic Search

Background:In the Multiethnic Cohort Study, Japanese Americans (JA) have lower mean body mass index (BMI) compared with Caucasians, but show a higher waist-to-hip ratio at similar BMI values and a greater risk of diabetes and obesity-associated cancers.Objective:We investigated the abdominal, visceral and hepatic fat distribution in these Asian and Caucasian Americans.Design:A cross-sectional sample of 60 female cohort participants (30 JA

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

2011-01-01

167

Performance of abdominal ultrasonography in pediatric blunt trauma patients: a meta-analysis  

Microsoft Academic Search

Objective: The objective of the study was to obtain the best estimates of the test performance of abdominal ultrasonography (US) for identifying children with intraabdominal injuries (IAIs). Methods: We gathered studies on the use of abdominal US in injured children from the following sources: a MEDLINE and Embase search, hand searches of 5 specialty journals and 4 clinical textbooks, the

James F. Holmes; Aaron Gladman; Cindy H. Chang

168

Paediatric case of a large gastric rupture after a blunt abdominal trauma: Report of a case in a District General Hospital  

PubMed Central

INTRODUCTION Isolated gastric rupture after blunt abdominal trauma is rare. In current literature gastric rupture from blunt abdominal trauma ranges between 0.02% and 1.7%. This document reports the first non-motor-vehicle case of an isolated gastric rapture after blunt abdominal injury, which repaired after early diagnosis and aggressive surgical treatment. PRESENTATION OF CASE A 14-year-old boy attended our emergency surgical department after sustained a blunt abdominal trauma following a fall from his bicycle. He presented with pain and left para-umbilical abdominal ecchymoses. Examination revealed subcutaneous emphysema and a palpable abdominal wall dimple. DISCUSSION Radiological examination with CT scan determined the need for exploratory laparotomy. Operation revealed, extensive rupture of the left lateral border of the rectus abdominus muscle, free intra-peritoneal position of the nasogastric tube with gross spillage of gastric contents and pneumo-peritoneum observed with 7-8cm full thickness rupture of anterior stomach wall, from the lesser towards the greater curvature. Primary, two-layer closure was performed. On the 5th post-operative day he developed gastrorrhagia. He was discharged on the 15th postoperative day. CONCLUSION We present this case report focusing on the paediatric patient to illustrate isolated gastric injury in terms of mechanism of injury, clinical presentation, and immediate surgical management.

Pafitanis, Georgios; Koulas, Spiros; Bikos, Stavros; Tsimoyiannis, Evangelos

2012-01-01

169

[The diagnosis of the types of automobile-caused trauma by the nature of the injuries to the internal abdominal organs].  

PubMed

A total of 307 cases of fatal car injuries with traumas of the abdominal organs are analyzed. There were three types of injuries: those caused by collision of a pedestrian with a moving car (96 cases) injuries inflicted inside a car cabin (n = 157), and inflicted by a car wheel crossing the body (n = 54). Differences in the injuries inflicted in different types of car traumas are described. The authors demonstrate the possibility of differential diagnosis of these types of traumas in cases when the circumstances of the accident are unknown. They offer a differential diagnostic table for practical use, based on their findings. PMID:8966744

Solokhin, A A; Tkhakakhov, A A

170

A comparison of diagnostic peritoneal lavage and computed tomography (CT scan) in evaluation of the hemodynamically stable patient with blunt abdominal trauma.  

PubMed

The diagnosis of intraabdominal injury in the patient who is victim of blunt trauma is often problematic. Currently, two procedures, diagnostic peritoneal lavage (DPL) and computed tomography (CT scan) are used to evaluate patients with possible intraabdominal injuries after blunt trauma. Controversy exists as to which of these modalities is more efficacious in this setting. There are advantages and disadvantages of both procedures, however, present evidence suggests that the clinician should not rely on the results of the CT scan. The DPL, on the other hand is a sensitive and specific modality in evaluating the patient with blunt abdominal trauma. PMID:1624738

Bell, C; Coleridge, S T

171

Pictorial review: CT appearances of contrast medium extravasations associated with injury sustained from blunt abdominal trauma.  

PubMed

Contrast-enhanced CT is a valuable imaging modality in detecting extravasation of intravascular, urinary tract of gastrointestinal contrast medium in major blunt trauma victims. This pictorial review illustrates the CT appearance associated with extravasation of contrast medium from these various sites and emphasizes features that differentiate among them. PMID:7889712

Shanmuganathan, K; Mirvis, S E; Reaney, S M

1995-03-01

172

Development and evaluation of a novel, real time mobile telesonography system in management of patients with abdominal trauma: study protocol  

PubMed Central

Background Despite the use of e-FAST in management of patients with abdominal trauma, its utility in prehospital setting is not widely adopted. The goal of this study is to develop a novel portable telesonography (TS) system and evaluate the comparability of the quality of images obtained via this system among healthy volunteers who undergo e-FAST abdominal examination in a moving ambulance and at the ED. We hypothesize that: (1) real-time ultrasound images of acute trauma patients in the pre-hospital setting can be obtained and transmitted to the ED via the novel TS system; and (2) Ultrasound images transmitted to the hospital from the real-time TS system will be comparable in quality to those obtained in the ED. Methods Study participants are three healthy volunteers (one each with normal, overweight and obese BMI category). The ultrasound images will be obtained by two ultrasound-trained physicians The TS is a portable sonogram (by Sonosite) interfaced with a portable broadcast unit (by Live-U). Two UTPs will conduct e-FAST examinations on healthy volunteers in moving ambulances and transmit the images via cellular network to the hospital server, where they are stored. Upon arrival in the ED, the same UTPs will obtain another set of images from the volunteers, which are then compared to those obtained in the moving ambulances by another set of blinded UTPs (evaluators) using a validated image quality scale, the Questionnaire for User Interaction Satisfaction (QUIS). Discussion Findings from this study will provide needed data on the validity of the novel TS in transmitting live images from moving ambulances to images obtained in the ED thus providing opportunity to facilitate medical care of a patient located in a remote or austere setting.

2012-01-01

173

Isolated extrahepatic bile duct rupture: a rare consequence of blunt abdominal trauma. Case report and review of the literature  

PubMed Central

A 16-year-old girl suffered blunt abdominal trauma. Clinically, a severe motor impairment with paraesthesia of the legs was found. Posterior osteosynthesis in T10-L1 with laminectomy in T10-T12 and posterolateral arthrodesis in T11-T12 was performed because of a dorsal traumatic vertebral fracture. On hospital day 7, because of an acute abdomen, surgical laparoscopic exploration showed sterile bloody fluid without any evident hemorrhagic injury. On hospital day 11, the patient was reoperated on by the laparoscopic approach for increasing abdominal pain and fever: a peritoneal biliary fluid was aspirated. After conversion to open surgery, cholecystectomy was performed. Intraoperative cholangiography was considered as normal. On arrival at our institution 13?days after injury, the patient was operated on for a biliary peritonitis. Intraoperatively, a trans-cystic cholangiography showed a biliary leakage of the common bile duct; a T-tube was placed into the common bile duct; a subhepatic drainage was placed too. On postoperative day 30, a T-tube cholangiography showed a normal biliary tree, without any leakage, and the T-tube was subsequently removed. The patient had a complete recovery.

2012-01-01

174

Dissection of the Abdominal Aorta in Blunt Trauma: Management by Percutaneous Stent Placement  

Microsoft Academic Search

We implanted stents in three patients who had traumatic abdominal aortic dissections, complicated by right limb ischemia\\u000a in one case. The circulating false channel extended to the left iliac artery in one case and to both iliac arteries in the\\u000a last case. Diagnosis and radiological follow-up included ultrasound, computed tomography, and arteriography. Two patients\\u000a were treated with Wallstents, one with

Hélène Vernhet; Charles-Henri Marty-Ané; Alvian Lesnik; Régis Chircop; Olivier Serres-Cousiné; Eric Picard; Henry Mary; Jean Paul Senac

1997-01-01

175

[A case of acute occlusion of the left common iliac artery due to blunt abdominal trauma].  

PubMed

A 56-year-old man was involved in an automobile accident and had abdominal blunt injury with the steering wheel. He developed slight abdominal distension and pulseless, cold sensation and peripheral cyanosis of the left lower extremity which suggested acute arterial occlusion. DSA revealed complete obstruction of the common iliac artery near its origin and the leakage of contrast medium at peripheral branch of the SMA. Four and a half hours after injury, surgical exploration was carried out. Laparotomy showed the laceration of the mesentery with accumulation of massive fresh and clotted blood in the abdominal cavity. Obstructed portion of the left common iliac artery was resected and arterial reconstruction was performed with prosthetic graft (8mm Gore-Tex for end to end left common-left external iliac bypass, 6mm Gore-Tex for side to end right common-left hypogastric bypass). A resected specimen demonstrated completely disrupted intima, resulting in the obstruction of the lumen associated with distal fresh thrombosis. The postoperative course was uneventful with successful patency of both grafts. PMID:3600599

Ueno, T; Watanabe, Y; Minato, N; Sakurai, J; Ohteki, H; Natsuaki, M; Itoh, T

1987-05-01

176

Small bowel perforation resulting from blunt abdominal trauma: interval change of radiological characteristics  

Microsoft Academic Search

Purpose  We analyzed radiography and computed tomography (CT) findings of small bowel perforation due to blunt trauma to identify the\\u000a keys to diagnosis.\\u000a \\u000a \\u000a \\u000a Materials and methods  Twelve patients with surgically proven small bowel perforation were retrospectively studied. All patients underwent radiography\\u000a and CT, and five underwent presurgical follow-up CT. Radiological findings were evaluated and correlated to the elapsed time\\u000a from the onset

Madoka Saku; Kengo Yoshimitsu; Junji Murakami; Yusuke Nakamura; Syuuiti Oguri; Tomoyuki Noguchi; Katsuhiko Ayukawa; Hiroshi Honda

2006-01-01

177

Severe renal injuries in children following blunt abdominal trauma: selective management and outcome  

Microsoft Academic Search

Introduction  Blunt trauma accounts for the majority of pediatric renal injuries. Most injuries are often minor and can be managed without\\u000a surgical intervention. We have retrospectively reviewed our series of children with severe (grade IV\\/V) renal injuries, their\\u000a management and outcome.\\u000a \\u000a \\u000a \\u000a \\u000a Materials and methods  Medical records of children less than 18 years with renal injuries were reviewed. The cause of injury, time following

Rajendra B. NerliTanmaya; Tanmaya Metgud; Shivagouda Patil; Ajaykumar Guntaka; P. Umashankar; Murigendra Hiremath; S. N. Suresh

178

Small bowel obstruction secondary to strangulation through a defect in the falciform ligament after blunt abdominal trauma in a pediatric patient.  

PubMed

Obstruction caused by strangulation internal hernia secondary to incarceration within the falciform ligament, although rare, has been previously reported in the literature. These cases, however, were unrelated to trauma. We report on the first case in the pediatric literature of a strangulated internal hernia secondary to incarceration in the falciform ligament precipitated by blunt abdominal trauma. A 12-year-old girl presented to the emergency room less than 24 hours after sustaining a kick to the right upper quadrant. She described sharp, nonradiating, right-upper-quadrant abdominal pain, which was associated with nausea and vomiting. A KUB (kidney, ureter, bladder) view showed a paucity of bowel in the right upper quadrant with distended adjacent bowel. An ultrasound showed a small amount of abdominal ascites and a prominent liver. Computed tomography scan revealed a linear hypodensity at the tip of the right lobe of the liver, suggestive of a laceration. Moderate abdominal and pelvic ascites and multiple collapsed small-bowel loops with diffuse wall thickening and poor enhancement were seen in the right upper quadrant. Significantly, pneumatosis was noted, raising the question of obstruction/volvulus and/or bowel ischemia. An exploratory laparotomy revealed incarcerated small bowel herniated into a defect in the falciform ligament, which was resected. The defect was repaired. Seemingly trivial trauma may play a precipitating role in strangulation in a patient who already has a defect in the falciform ligament. PMID:20531130

Sykes, Joseph A; Norton, Karen I; Bhattacharya, Nishith; Stombaugh, Lauretta

2010-06-01

179

Gallbladder injuries resulting from blunt abdominal trauma: an experience and review.  

PubMed Central

Over a seven-year period from 1973 through 1979, 31 patients with blunt gallbladder trauma were treated at the Maryland Institute for Emergency Medical Services Systems. Twenty patients had contusions, ten patients had avulsions and one patient had a perforation of the gallbladder. None of the gallbladder injuries were suspected preoperatively. Twenty-eight of the 31 patients had a diagnostic peritoneal lavage performed on admission, all were positive for blood; bile was not grossly evident. Among the 30 patients, there were 75 associated intraabdominal injuries; there were 25 liver injuries. Five patients died, none as a result of their gallbladder injury. Cholecystectomy is suggested as the definitive procedure of choice for severe contusions and for perforating and avulsive injuries to the gallbladder. Cholecystostomy is indicated in a few patients and should be regarded as a temporary procedure. A review of the English literature shows a total of 101 patients (including the 31 of this study) with gallbladder injuries secondary to blunt trauma. The most commonly reported injury was perforation. The 20 contusions described in the present study are the first such injuries reported.

Soderstrom, C A; Maekawa, K; DuPriest, R W; Cowley, R A

1981-01-01

180

Biomechanical characterisation of fresh and cadaverous human small intestine: applications for abdominal trauma.  

PubMed

Intestinal injuries are responsible for significant morbidity and mortality arising from trauma to the abdomen. The biomechanical characterisation of the small intestine allows for the understanding of the pathophysiological mechanisms responsible for these injuries. Studies reported in the literature focus principally on quasi-static tests, which do not take into account the stresses experienced during high kinetic trauma. In addition, the use of embalmed human tissue can alter the recorded response. The stress-strain curves from 43 tensile tests performed at 1 m/s were analysed. Samples were prepared from four fresh human intestines and from four embalmed cadaveric intestines. The data indicated a two-phase response, with each response consisting of a quasi-linear increase in the stress followed by an inflection in the curve before a peak preceding the loss of stress. The fresh tissue was more deformable than the embalmed tissue, and its first peak stress was lower (P = 0.034). A complementary histological analysis was performed. The results of the analysis enable an investigation of the response of the intestinal wall layers to stress as a two-layer structure and highlight the high sensitivity of the structure's mechanical behaviour to the speed of loading and the method of preservation. PMID:23054381

Bourgouin, Stéphane; Bège, Thierry; Masson, Catherine; Arnoux, Pierre-Jean; Mancini, Julien; Garcia, Stéphane; Brunet, Christian; Berdah, Stéphane V

2012-10-05

181

Piperacillin monotherapy compared with metronidazole and gentamicin combination in penetrating abdominal trauma.  

PubMed

The therapeutic efficacy and safety of piperacillin (4.5 g, every 6 hours) were compared with combined gentamicin (80 mg, every 8 hours) and metronidazole (500 mg every 6 hours) therapy in 246 patients hospitalized for penetrating abdominal injuries. Sixty-five patients had penetrating injury of the colon, rectum, or terminal ileum. The overall clinical cure rate was about 94% in both treatment groups. Adverse clinical experiences or biochemical abnormalities required discontinuation of therapy in three patients on gentamicin/metronidazole and in no patients on piperacillin. PMID:8459456

Sims, E H; Lou, M A; Williams, S W; Ganesan, N; Thadepalli, H

1993-02-01

182

Measures of abdominal obesity within body mass index categories, 1981 and 2007-2009.  

PubMed

This article describes measures of abdominal obesity--waist circumference, waist-to-hip ratio, and waist-to-height ratio--within body mass index (BMI) categories, using data from two population-based health surveys. Among normal-weight men, the percentages at increased/high health risk based on these three measures were not statistically different in 2007-2009 than in 1981. By contrast, among normal-weight women, increases were observed in the percentage at increased/high health risk based on each of the three measures. The percentage of overweight men at increased/high risk based on waist circumference rose from 49% in 1981 to 62% in 2007-2009, and among overweight women, the percentage at increased/high risk rose for each of the three measures (64% to 93% for waist circumference, 22% to 51% for waist-to-hip ratio, and 68% to 87% for waist-to-height ratio). Although substantial percentages of men and women in obese class I were at increased/high health risk based on abdominal obesity measures in 1981, by 2007-2009, almost everyone in this BMI category was at increased/high risk. PMID:22866538

Shields, Margot; Tremblay, Mark S; Connor Gorber, Sarah; Janssen, Ian

2012-06-01

183

Waist Circumference Adjusted for Body Mass Index and Intra-Abdominal Fat Mass  

PubMed Central

Background The association between waist circumference (WC) and mortality is particularly strong and direct when adjusted for body mass index (BMI). One conceivable explanation for this association is that WC adjusted for BMI is a better predictor of the presumably most harmful intra-abdominal fat mass (IAFM) than WC alone. We studied the prediction of abdominal subcutaneous fat mass (ASFM) and IAFM by WC alone and by addition of BMI as an explanatory factor. Methodology/Principal Findings WC, BMI and magnetic resonance imaging data from 742 men and women who participated in clinical studies in Canada and Finland were pooled. Total adjusted squared multiple correlation coefficients (R2) of ASFM and IAFM were calculated from multiple linear regression models with WC and BMI as explanatory variables. Mean BMI and WC of the participants in the pooled sample were 30 kg/m2 and 102 cm, respectively. WC explained 29% of the variance in ASFM and 51% of the variance in IAFM. Addition of BMI to WC added 28% to the variance explained in ASFM, but only 1% to the variance explained in IAFM. Results in subgroups stratified by study center, sex, age, obesity level and type 2 diabetes status were not systematically different. Conclusion/Significance The prediction of IAFM by WC is not improved by addition of BMI.

Berentzen, Tina Landsvig; Angquist, Lars; Kotronen, Anna; Borra, Ronald; Yki-Jarvinen, Hannele; Iozzo, Patricia; Parkkola, Riitta; Nuutila, Pirjo; Ross, Robert; Allison, David B.; Heymsfield, Steven B.; Overvad, Kim; S?rensen, Thorkild I. A.; Jakobsen, Marianne Uhre

2012-01-01

184

Postoperative course after simple ligation for superior mesenteric vein injury caused by blunt abdominal trauma: report of a case.  

PubMed

Traumatic injury of the superior mesenteric vein (SMV) by blunt trauma is a rare but frequently fatal injury. Although simple ligation should be considered for a patient in unstable condition, its complications have not been reported in detail. A 47-year-old man was struck on the abdomen during a fight. When he was transferred to a local hospital, he complained of severe abdominal pain. Computed tomography (CT) of the abdomen showed fluid accumulation in the peritoneal cavity and a hematoma around the root of the mesentery, with leakage of contrast material. When the patient was transferred to our emergency department, the hemodynamic status did not improve after rapid fluid resuscitation with 1,500 mL of crystalloid. Emergency laparotomy was performed 4 hours after the injury. Two lacerations of the proximal SMV were observed. The SMV was ligated owing to the unstable hemodynamic status. On postoperative day (POD) 5, abdominal radiography showed dilated loops of bowel, suggesting ileus of the small bowel. A CT scan with contrast enhancement showed that the wall of the small bowel was thickened. On POD 11, a CT scan showed that the collateral vessels that drain the mesenteric circulation had not developed. However, collateral vessels were revealed on a 3-dimensional CT scan, and, on POD 23, a CT scan showed that the collateral vessels had developed. The patient was discharged on POD 37. This case demonstrates that simple ligation of the proximal SMV leads to the development of collateral vessels and is useful for preventing side effects and improving outcomes. PMID:21551970

Miyauchi, Masato; Kushimoto, Shigeki; Kawai, Makoto; Yokota, Hiroyuki

2011-01-01

185

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

PubMed Central

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

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

2011-01-01

186

Vascular complications and changes in body mass index in Japanese type 2 diabetic patients with abdominal obesity  

PubMed Central

Background Although many Asian type 2 diabetic patients have been considered to be not obese and have low capacity of insulin secretion, the proportion of obese patients with visceral fat accumulation has increased in recent years. We found previously considerable number of Japanese non-obese subjects (body mass index (BMI) Abdominal obesity represented waist circumference (WC) of ?85 cm for males and ?90 cm for females (corresponding to visceral fat area of 100 cm2). Subjects were divided into two groups; with or without abdominal obesity. Results Hypertension, dyslipidemia and cardiovascular diseases were significantly more in the patients with abdominal obesity. The prevalence of cardiovascular disease in the non-obese patients (BMI abdominal obesity were similar in obese patients (BMI ?25 kg/m2). The mean BMI of the patients with abdominal obesity was abdominal obesity by the time of admission. Conclusion These results emphasize the need to control multiple risk factors and prevent atherosclerotic disease in patients with abdominal obesity. The significant weight gain after 20 years of age in patients with abdominal obesity stresses the importance of lifestyle modification in younger generation, to prevent potential development of type 2 diabetes and future atherosclerotic cardiovascular disease.

2013-01-01

187

Development and preliminary validation of a Function IndeX for Trauma (FIX-IT)  

PubMed Central

Background Assessing fracture healing in clinical trials is subjective. The new Function IndeX for Trauma (FIX-IT) score provides a simple, standardized approach to assess weight-bearing and pain in patients with lower extremity fractures. We conducted an initial validation of the FIX-IT score. Methods We conducted a cross-sectional study involving 50 patients with lower extremity fractures across different stages of healing to evaluate the reliability and preliminary validity of the FIX-IT score. Patients were independently examined by 2 orthopedic surgeons, 1 orthopedic fellow, 2 orthopedic residents and 2 research coordinators. Patients also completed the Short Form-36 version 2 (SF-36v2) questionnaire, and convergent validity was tested with the SF-36v2. Results For interrater reliability, the intraclass correlation coefficents ranged from 0.637 to 0.915. The overall interrater reliability for the total FIX-IT score was 0.879 (95% confidence interval 0.828–0.921). The correlations between the FIX-IT score and the SF-36 ranged from 0.682 to 0.770 for the physical component summary score, from 0.681 to 0.758 for the physical function subscale, and from 0.677 to 0.786 for the role–physical subscale. Conclusion The FIX-IT score had high interrater agreement across multiple examiners. Moreover, FIX-IT scores correlate with the physical scores of the SF-36. Although additional research is needed to fully validate FIX-IT, our results suggest the potential for FIX-IT to be a reliable adjunctive clinician measure to evaluate healing in lower extremity fractures. Level of evidence Diagnostic Study Level I.

Bhandari, Mohit; Wasserman, Scott M.; Yurgin, Nicole; Petrisor, Brad; Sprague, Sheila; Dent, Ricardo E.

2013-01-01

188

[Isolated injury of the gallbladder. A rare cause of hemorrhagic shock after blunt abdominal trauma in a patient with liver cirrhosis].  

PubMed

Isolated injuries to the gallbladder are extremely rare in blunt abdominal trauma, with a reported incidence of less than 2%. We report a case with partial avulsion of the gallbladder and subsequent hemorrhagic shock in a patient with liver cirrhosis. Although the gallbladder injury was demonstrated on CT images (with contrast enhancement in the bed of the gallbladder), the correct diagnosis was not established preoperatively. Emergency laparotomy revealed partial avulsion of the gallbladder and the underlying condition of severe liver cirrhosis with ascites. We estimate that the gallbladder avulsion occurred due to compressional waves of the ascites (during blunt abdominal injury) which may have sheared off the gallbladder from the cirrhotic liver. The patient received cholecystectomy, which is recommended as standard in case of gallbladder injury. PMID:16437229

Sandor, L; Kiss, L

2006-08-01

189

An Index of Trauma Severity Based on Multiattribute Utility: An Illustration of Complex Utility Modeling.  

National Technical Information Service (NTIS)

An application of multiattribute utility assessment to scale the trauma severity of injuries to individuals is presented. Special attention is given to problems not usually present or reported in applications of the assessment techniques. These include no...

D. G. Fryback R. L. Keeney

1981-01-01

190

Abdominal imaging in child abuse  

Microsoft Academic Search

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

2011-01-01

191

Case Study: Correlation between the Seat Belt Sign and Positive Abdominal Computed Tomography Findings in Pediatric Trauma Patients  

Microsoft Academic Search

The seat belt sign is a cutaneous injury caused by a restraint during deceleration. The presence of a seat belt sign during physical exam was correlated with computed tomography findings and the presence of a blunt intestinal injury requiring operative intervention. A retrospective study of the hospital's trauma registry revealed seven pediatric patients who presented with a documented seat belt

JAMES W. KLENA; TODD KIHARA; CYNDY GRAVES

1999-01-01

192

Evaluation of various methods of intravenous contrast enhancement for thoraco-abdominal spiral CT scanning in trauma patients  

Microsoft Academic Search

The purpose of this study was to determine the optimal contrast concentration, volume, and injection rate for helical CT\\u000a imaging of trauma patients requiring evaluation of the chest, abdomen, and pelvis. Two hundred forty patients were randomized\\u000a into six different regimen groups for administration of iohexol nonionic intravenous contrast medium, each regimen containing\\u000a 36 g iodine, with various injection rates,

Karen L. Killeen; Douglas J. Markert; Caroline D. Sherbourne; K. Shanmuganathan; Stuart E. Mirvis; Sean P. Murray

2000-01-01

193

Incision for abdominal laparoscopy (image)  

MedlinePLUS

Abdominal laparoscopy is a useful aid in diagnosing disease or trauma in the abdominal cavity with less scarring than ... as liver and pancreatic resections may begin with laparoscopy to exclude the presence of additional tumors (metastatic ...

194

Intra-abdominal hypertension and abdominal compartment syndrome  

Microsoft Academic Search

Background: The effects of increased intra-abdominal pressure in various organ systems have been noted over the past century. The concept of abdominal compartment syndrome has gained more attention in both trauma and general surgery in the last decade. This article reviews the current understanding and management of intra-abdominal hypertension and abdominal compartment syndrome. Methods: Relevant information was gathered from a

K.-M. Sieh; Kent-Man Chu; John Wong

2001-01-01

195

Bone mineral density, vertebral fractures and body mass index in postmenopausal women with abdominal aortic calcification.  

PubMed

Abstract Background: Evidence suggest that there are connections between osteoporosis and cardiovascular diseases. Objectives: The aim of the study was to analyze the relationship between radiological measurements of abdominal aorta calcifications (AAC) and bone mineral density (BMD) in postmenopausal women. Methods: In this cross-sectional study were included 125 postmenopausal women 50-84 years of age. BMD of the spine and hip was measured by dual energy X-ray absorptiometry (DXA). AAC were assessed by lateral radiographs of lumbar spine (L1-L4), using the antero-posterior severity score (0-24). Vertebral fractures were evaluated from T4 to L4 using Genant's semiquantitative method. Results: Forty-one (32.8%) patients had osteoporosis and 61 (48.8%) had AAC with a mean score of 3.1. Postmenopausal women with AAC were older and had significantly lower femoral neck and trochanteric BMD than subjects without AAC (all p??0.05). In univariate analysis, age, height, weight, femoral and trochanter BMD were significantly associated with the severity of AAC score. In multiple regression analysis, femoral neck BMD, but not lumbar spine, trochanter BMD or age, was an independent predictor of AAC. Conclusions: Reduced femoral neck BMD is negatively associated with the presence of AAC in postmenopausal women. The association between BMD and AAC seems to be age-independent, which suggests a common pathogenesis for bone loss and vascular calcifications. PMID:23650982

Simon, Siao-Pin; Fodor, Daniela; Muntean, Laura; Poanta, Laura; Cristea, Paulina; Rednic, Simona

2013-05-01

196

Therapeutic laparoscopy in trauma  

Microsoft Academic Search

Purpose: To assess the therapeutic potential of emergent laparoscopy in the trauma setting, a retrospective review was performed in a busy urban trauma center.Patients and methods: Between December 1991 and October 1993, 133 hemodynamically stable patients with suspected abdominal injury were evaluated laparoscopically. All laparoscopic procedures were performed in the operating room under general anesthesia. Mechanism of injury was stab

R. Stephen Smith; William R. Fry; Diane J. Morabito; Richard H. Koehler; Claude H. Organ

1995-01-01

197

Thickness of Rectus Abdominis Muscle and Abdominal Subcutaneous Fat Tissue in Adult Women: Correlation with Age, Pregnancy, Laparotomy, and Body Mass Index  

PubMed Central

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.

Kim, Jungmin; Lim, Hyoseob; Lee, Se Il

2012-01-01

198

Laparoscopic Procedures in Trauma Care  

Microsoft Academic Search

\\u000a The modern concept of diagnostic laparoscopy for trauma patients emerged in the early 1970s. The literature shows that a variety\\u000a of laparoscopic techniques are applicable to patients with abdominal trauma. Treatment of abdominal trauma requires a precise\\u000a diagnosis that is not always possible with imaging techniques. As the danger is particularly great that an injury to the diaphragm\\u000a or intestines

Selman Uranues; Abe Fingerhut; Roberto Bergamaschi

199

CT of Blunt Chest Trauma  

Microsoft Academic Search

Although CT is the examination of choice in trauma of the head and abdomen, its role in the evaluation of blunt chest trauma is still evolving. We compared anteroposterior supine chest radiographs with chest and abdominal CT scans ob- tained over a 2-year period in victims of major trauma. CT proved useful in diagnosing unsuspected chest injuries, show- ing their

Scott R. Kerns; Spencer B. Gay

200

Steering System Abdominal Impact Trauma.  

National Technical Information Service (NTIS)

A series of impact tests to the abdomen and thorax of unembalmed cadavers was conducted using a rigid, curved steel bar to simulate the lower portion of the steering wheel rim. The test matrix used involved impacts to different regions of the thorax and a...

G. S. Nusholtz P. S. Kaiker R. J. Lehman

1988-01-01

201

CT Diagnosis and Localization of Rupture of the Bladder in Children with Blunt Abdominal Trauma: Significance of Contrast Material Extravasation in the Pelvis  

Microsoft Academic Search

OBJECTIVE. The purpose of this study was to determine the utility of CT performed with maximal bladder distension in showing extravasation of IV contrast material as a means of detecting and localizing bladder rupture in children after blunt trauma. MATERIALS AND METHODS. Seven of 1500 consecutive children who had IV con- trast-enhanced CT of the abdomen after blunt trauma had

Carlos J. Sivit; Jonathan P. Cutting; Martin R. Eichelberger

202

Acute traumatic abdominal wall hernia.  

PubMed

Although blunt abdominal trauma is frequent, traumatic abdominal wall hernias (TAWH) are rare. We describe a large TAWH with associated intra-abdominal lesions that were caused by high-energy trauma. The diagnosis was missed by clinical examination but was subsequently revealed by a computed tomography (CT) scan. Repair consisted of an open anatomical reconstruction of the abdominal wall layers with reinforcement by an intraperitoneal composite mesh. The patient recovered well and the results of a post-operative CT scan are presented. PMID:20440527

den Hartog, D; Tuinebreijer, W E; Oprel, P P; Patka, P

2010-05-04

203

NONPENETRATING ABDOMINAL INJURIES  

PubMed Central

Nonpenetrating abdominal injuries are commonly seen in a general hospital. High speed traffic accidents are responsible for the majority of these injuries. The mortality rate is high. Deaths were from associated injuries, failure to recognize abdominal trauma, hemorrhage and from acute renal insufficiency. Careful observation of every severely injured person, vigorous treatment of hemorrhagic shock with whole blood, and prompt surgical intervention when indicated will improve the mortality figures.

Brock, William; Cusick, George

1956-01-01

204

Abdominal Injuries: Indications for Surgery  

Microsoft Academic Search

\\u000a This overview addresses the indications for laparotomy following trauma. The authors will suggest algorithms and tenants of\\u000a care, but there is not a cookie-cutter approach that incorporates all trauma patients or their injuries. Laparotomy for trauma\\u000a is an individualized decision based collectively upon clinical evaluation and diagnostic adjuncts. Multiple tools exist within\\u000a the surgeon’s armamentarium, including focused abdominal sonography for

Clay Cothren Burlew; Ernest E. Moore

205

Trauma calls: role of the general surgeon and CT scanning  

Microsoft Academic Search

Background and objective: General surgeons are required in only a minority of trauma call cases to assess for abdominal injuries. Computed tomography (CT) accurately detects blunt abdominal injuries and may have replaced the need for general surgeons at trauma calls. This study evaluated the role of general surgeons at trauma calls and assessed use of CT in cases of suspected

R G Dattani; T Richards; C D Smith; T R Magee

2005-01-01

206

Blunt traumatic abdominal aortic rupture: CT imaging  

Microsoft Academic Search

Blunt abdominal aortic trauma is a rare but potentially lethal event. It is commonly associated with high-speed motor vehicle\\u000a accidents. Intimal flap, thrombosis, and pseudoaneurysm of the abdominal aorta are the more common findings. We present a\\u000a case of blunt abdominal aortic trauma in which CT disclosed free aortic rupture with intraabdominal bleeding and a huge retroperitoneal\\u000a hematoma, an extremely

Gaetano Nucifora; Fjoralba Hysko; Annarosa Vasciaveo

2008-01-01

207

Pediatric blunt splenic trauma: a comprehensive review  

Microsoft Academic Search

Abdominal trauma is a leading cause of death in children older than 1 year of age. The spleen is the most common organ injured\\u000a following blunt abdominal trauma. Pediatric trauma patients present unique clinical challenges as compared to adults, including\\u000a different mechanisms of injury, physiologic responses, and indications for operative versus nonoperative management. Splenic\\u000a salvage techniques and nonoperative approaches are preferred

Karen N. Lynn; Gabriel M. Werder; Rachel M. Callaghan; Ashley N. Sullivan; Zafar H. Jafri; David A. Bloom

2009-01-01

208

The Linear and Nonlinear Associations between Multiple Types of Trauma and IQ Discrepancy Indexes in African American and Iraqi Refugee Adolescents  

Microsoft Academic Search

Extreme stress resulting from various types of trauma is associated with changes in some brain structures that may affect IQ parameters. To assess relationships between multiple types of trauma and traumas, 390 African Americans and Iraqi refugee adolescents were studied. Nonlinear relationship between severe abuse, abandonment, parents divorce, age when adopted, witnessing domestic violence, and decreased verbal IQ, and between

Ibrahim Kira; Linda Lewandowski; Jina Yoon; Cheryl Somers; Lisa Chiodo

2012-01-01

209

[Abdominal compartment syndrome: current view].  

PubMed

In the last few years, physiological changes, symptoms, diagnostic tools, and treatment of abdominal compartment syndrome interest surgeons, trauma surgeons and anaesthetists. Sudden, dangerous basic vital function deterioration in patients managed in the intensive care unit, may be results of abdominal compartment syndrome. Abdominal compartment syndrome is secondary to massive intraabdominal haemorrhages, hepatic or retroperitoneal space "packing", fluid collection in tissues, including abdominal organs. Circulatory, respiratory and kidney dysfunction occur, when intraabdominal pressure measured in urinary bladder is 25 H2O or higher. In this condition, rapid surgical decompression is necessary. During decompression abdominal organs reperfusion may produce arterial hypotension and asystole. Abdominal closure must prevent abdominal hypertension. Temporary plastic patch, simple and cheap is the most popular technique. PMID:11603185

Wysocki, A

2001-01-01

210

Nonoperative trauma management: has the pendulum swung too far? The distinguished Dr. William Matory lecture.  

PubMed Central

Over the last decade, the role of nonoperative management has revolutionized the specialty of trauma. However, this management paradigm has generated substantial controversy in several areas, including penetrating neck and abdominal trauma. Evidence-based analysis will be the ultimate guideline to determine what is optimal management. To prevent the pendulum from swinging too far, there should always exist a high index of suspicion to possible complications associated with the nonoperative approach. Also, the specific choice of management should be institution- and resource dependent.

Britt, L. D.; Cole, Frederic J.; Collins, Jay N.; Weireter, Leonard J.

2003-01-01

211

Outcome and management of blunt liver injuries in multiple trauma patients  

Microsoft Academic Search

Background: In Germany, abdominal trauma in multiple- trauma patients can be observed in about 25–35% of all cases. Due to major bleeding\\u000a complications, the initial treatment of blunt abdominal trauma in multiple-trauma patients has high priority. The aim of this\\u000a study was to discuss management, treatment and outcome of blunt liver injury in multiple-trauma patients treated in our department. Methods:

Emilio Domínguez Fernández; Michael Aufmkolk; Ulf Schmidt; Konstanze Nimtz; Frank Stöblen; Udo Obertacke; Reinhard Lange

1999-01-01

212

CT Diagnosis of Blunt Pancreatic Trauma: Importance of Detecting Fluid  

Microsoft Academic Search

OBJECTIVE. The purpose of this study was to determine the value of detecting fluid between the splenic vein and the pancreas on CT scans in the diagnosis of pancreatic Injury after blunt abdominal trauma. MATERIALS AND METHODS. We retrospectively reviewed the abdominal CT scans of 10 patients with surgical- or autopsy-proved pancreatic injury after blunt abdomi- nal trauma. The finding

Robert E. Mindelzun; Jeet S. Sandhu; Vincent D. McCormick; R. Brooke Jeffrey

213

Diagnosis and management of colonic injuries following blunt trauma  

Microsoft Academic Search

AIM: To retrospectively evaluate the preoperative diagnostic approaches and management of colonic injuries following blunt abdominal trauma. METHODS: A total of 82 patients with colonic injuries caused by blunt trauma between January 1992 and December 2005 were enrolled. Data were collected on clinical presentation, investigations, diagnostic methods, associated injuries, and operative management. Colonic injury-related mortality and abdominal complications were analyzed.

Yi-Xiong Zheng; Li Chen; Si-Feng Tao; Ping Song; Shao-Ming Xu

214

[Laparoscopic interventions in emergency abdominal surgery].  

PubMed

The use of videolaparoscopic methods for the treatment of penetrating stomach and duodenal ulcers, acute cholecystitis, acute pancreatitis, acute appendicitis, intestinal obstruction, acute gynecological diseases and abdominal trauma is analyzed. Laparoscopic methods at urgent abdominal surgery improves the quality of diagnosis and treatment, decrease the rate of postoperative complications and lethality, reduce the hospital stay. PMID:23786014

Abu Shamsiia, R N

2012-12-01

215

What is the utility of the Focused Assessment with Sonography in Trauma (FAST) exam in penetrating torso trauma?  

Microsoft Academic Search

Study objectiveA recent Cochrane Review has demonstrated that emergency ultrasonography decreases the amount of computerised tomographic scans in blunt abdominal trauma.13 However, there is no systematic review that has evaluated the utility of the Focused Assessment with Sonography for Trauma (FAST) exam in penetrating torso trauma. We systematically reviewed the medical literature for the utility of the FAST exam to

Antonia C. Quinn; Richard Sinert

2011-01-01

216

CT features of blunt abdominal aortic injury.  

PubMed

Abdominal aortic injuries are uncommon following blunt trauma, with relatively few reported series in the radiology literature. This study was conducted to identify common locations and imaging features of blunt traumatic abdominal aortic injury, the presence of associated visceral and osseous injuries, and the mechanisms of trauma. A retrospective review of 9,213 trauma registry entries over a 7-year period yielded 103 patients with aortic injuries, 12 of which had direct signs of abdominal segment involvement (dissection flap, focal intimal injury, intramural hematoma, active extravasation of contrast, or pseudoaneurysm formation). The majority (75 %) was isolated to the abdomen-67 % of which was infrarenal, 33 % suprarenal-while the other 25 % was a contiguous extension from a thoracic injury. Abdominal aortic injuries were uncommonly seen in isolation: all but one patient (92 %) demonstrated either retroperitoneal blood or stranding, hemoperitoneum, and/or CT signs of hypoperfusion complex, and only one patient (8 %) had no associated solid organ or skeletal injuries. All patients had a mechanism of injury which involved direct trauma to the abdomen, most commonly a motor vehicle collision. Similar to other recent series, there was an increased rate of abdominal segment injury (11.7 % of all aortic injuries) in this series compared to more remote autopsy series. This difference is likely due to detection of injuries which went undiagnosed before the widespread use of multidetector CT, which has become the standard of care for both acute evaluation following blunt trauma and for follow-up. PMID:22395392

Mellnick, Vincent M; McDowell, Cade; Lubner, Meghan; Bhalla, Sanjeev; Menias, Christine O

2012-03-07

217

Abdominal wall haematoma mimicking visceral injury: the role of CT scanning  

Microsoft Academic Search

Four patients are presented who were thought to have sustained visceral injury following blunt abdominal trauma. However, CT demonstrated abdominal wall haematomata and allowed non-operative management. Similarity between the clinical findings in visceral injury and abdominal wall haematoma can lead to diagnostic difficulty. The cases illustrate the need to consider abdominal wall haematoma as a possible diagnosis in patients with

S. A. Hill; M. A. Jackson; R. FitzGerald

1995-01-01

218

Gastric tonometry and direct intraabdominal pressure monitoring in abdominal compartment syndrome  

Microsoft Academic Search

Background\\/Purpose: Abdominal compartment syndrome (ACS) may complicate abdominal closure in patients with abdominal wall defects, abdominal trauma, intraperitoneal bleeding, and infection. Increased intraabdominal pressure (IAP) leads to respiratory compromise, organ hypoperfusion, and a high mortality rate. This study evaluates the efficacy of continuous direct monitoring of IAP and gastric tissue pH in detecting impending ACS. Methods: Ten mongrel puppies weighing

S. A. Engum; B. Kogon; E. Jensen; J. Isch; C. Balanoff; J. L. Grosfeld

2002-01-01

219

Abdominal exploration  

MedlinePLUS

... RS, Meredith JW. Management of acute trauma. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, ... 18. Squires RA, Postier RG. Acute abdomen. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, ...

220

Pancreatic trauma: acute and late manifestations.  

PubMed

A retrospective analysis of 47 patients with pancreatic trauma is presented. A total of 43 patients presented with acute pancreatic injury, 32 after blunt abdominal trauma. Isolated blunt pancreatic injuries were a considerable diagnostic problem with a mean delay from trauma to operation of 9.4 days. At operation peripancreatic drainage in mild injuries and distal resection in cases of ductal injury were the commonest procedures. The overall mortality was 19 per cent, but only three of the eight deaths were attributable to the pancreatic injury. The overall complication rate was 63 per cent and the pancreatic complication rate was 33 per cent. Four patients presented with chronic pancreatitis resulting from previously untreated blunt abdominal trauma 0.5-21 years earlier. Clinically, they did not differ from the manifestations of chronic pancreatitis of other aetiological origins. PMID:3349308

Leppäniemi, A; Haapiainen, R; Kiviluoto, T; Lempinen, M

1988-02-01

221

Tailbone trauma  

MedlinePLUS

Choi SB, Cwinn AA. Pelvic trauma. In: Marx JA, ed. Rosen’s Emergency Medicine: Concepts and Clinical Practice . 7th ed. Philadelphia, Pa: Mosby Elsevier; 2009:chap 52. Vora A. Coccydynia. In: Frontera, ...

222

Nail Trauma  

MedlinePLUS

... the trauma to the nail injures the nail matrix (the tissue inside the cuticle at the base ... a ridge or split can develop. If the matrix heals normally, this deformity eventually will disappear as ...

223

Bladder Trauma  

Microsoft Academic Search

Of trauma visits to the emergency room (ER), injury to the urinary bladder is not a common occurrence. Major bladder trauma,\\u000a accounts for fewer than 2% of injuries requiring surgical exploration. Mortality can be as high as 22% because of associated\\u000a multiple organ injuries rather than the extent of bladder injury (1). Overall, roughly 60% of injuries are extraperitoneal, 30%

Steven B. Brandes; Jay S. Belani

224

[Spleen trauma during pregnancy (a case report)].  

PubMed

Splenic injury during pregnancy after blunt abdominal trauma is rare. The physiological and anatomical changes during pregnancy modify the clinical, biological and radiological signs. The authors report a case of a 30-year-old-woman in the 32nd week of pregnancy, with an isolate splenic injury after a motor vehicle accident. Splenectomy was realised 4 days after an initial decision of abstaining from surgery. In pregnancy, the frequency of recurrent bleeding, the possibility of concomitant uterine injuries and the risk of foetal loss should modify the surgeon's attitude to splenic rupture after abdominal blunt trauma. PMID:14522395

Badaoui, R; El-Kettani, C; Radji, M; Samkaoui, M-A; Byhet, N; Ossart, M

2003-10-01

225

Prospective evaluation of non-radiologist performed emergency abdominal ultrasound for haemoperitoneum  

Microsoft Academic Search

Objectives: To evaluate non-radiologist performed emergency ultrasound for the detection of haemoperitoneum after abdominal trauma in a British accident and emergency department.Methods: Focused assessment with sonography for trauma (FAST) was performed during the primary survey on adult patients triaged to the resuscitation room with suspected abdominal injury over a 12 month period. All investigations were performed by one of three

A Brooks; B Davies; M Smethhurst; J Connolly

2004-01-01

226

Acute Rupture of the Diaphragm due to Blunt Trauma: Diagnostic Sensitivity and Specificity of CT  

Microsoft Academic Search

OBJECTIVE. The purpose of this study was to determine the diagnostic sensitivity and specificity of CT in detecting acute rupture of the diaphragm after blunt trauma. MATERIALS AND METHODS. Abdominal CT scans taken before surgery of 11 patients with diaphragmatic rupture (eight left and three right) and 21 patients with intact diaphragms after major acute blunt abdominal trauma were independently

John G. Murray; Elaine Caoili; James F. Gruden; Scott J. J. Evans; Robert A. Halvorsen; Robert C. Mackersie

227

Imaging of trauma in a pregnant patient.  

PubMed

Trauma is the number one nonobstetric cause of maternal death. This chapter presents the latest consensus from the literature on the best approach to radiographic imaging of these patients. The central issues of discussion include the rationale and protocols for screening for pregnancy in trauma setting; the effects of radiation and its risks to the fetus; obtaining informed consent; how to estimate fetal dose; and the role of ultrasound, computed tomography, and magnetic resonance imaging, including the intravenous contrast agents used for the assessment of abdominal trauma. The team approach to the management of these patients is also highlighted. PMID:22264901

Puri, Ajay; Khadem, Paryssa; Ahmed, Salman; Yadav, Parul; Al-Dulaimy, Khaldoon

2012-02-01

228

Recent experiences with a multidisciplinary approach to complex hepatic trauma  

Microsoft Academic Search

Background: The selection of an appropriate time to terminate damage control efforts when faced with haemorrhagic shock from severe hepatic trauma can be challenging. At our centre, trauma surgeons have increasingly been favouring an operative approach simply involving early perihepatic packing (without extensive use of intraoperative measures aimed at achieving definitive haemostasis) and temporary abdominal closure. This is often followed

Shawn MacKenzie; John B. Kortbeek; Robert Mulloy; S. Morad Hameed

2004-01-01

229

Intestinal injury mechanisms after blunt abdominal impact.  

PubMed

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

Cripps, N P; Cooper, G J

1997-03-01

230

Zone I retroperitoneal hematoma identified by computed tomography scan as an indicator of significant abdominal injury  

Microsoft Academic Search

Objective: All zone I retroperitoneal hematomas (Z1RPHs) identified at laparotomy for blunt trauma traditionally require exploration. The purpose of this study was to correlate patient outcome after blunt abdominal trauma with the presence of Z1RPH diagnosed on admission computed tomography (CT) scan. Methods: This is a retrospective review of patients with blunt trauma who were admitted to a Level 1

Richard A. Falcone; Fred A. Luchette; K. Ann Choe; Gregory Tiao; Michael Ottaway; Kenneth Davis; James M. Hurst; Jay A. Johannigman; Scott B. Frame

1999-01-01

231

Strategies to Control Massive Abdominal Bleeding  

Microsoft Academic Search

Abdominal trauma is divided into blunt and penetrating causes. Massive intraabdominal hemorrhage after injury represents the most dangerous precipitating factor that can affect survival if not promptly managed. The first target to achieve management of bleeding patients is control of the source, and then adequate resuscitation and optimization of hemostasis. New procoagulant drugs as recombinant activated factor VII (rFVIIa) seem

S. Busani; I. Cavazzuti; M. Marietta; A. Pasetto; M. Girardis

2008-01-01

232

Combined abdominal wall paresis and incisional hernia after laparoscopic cholecystectomy.  

PubMed

A case of combined abdominal wall paresis and incisional hernia after laparoscopic cholecystectomy is reported. The paresis possibly occurred by a lesion of the N. intercostalis when extending the incision for stone extraction. Possibly the paresis was a predisposing factor for the development of an incisional hernia. The causes of abdominal wall paresis are explored with a review of the literature. In spite of minimal trauma to the anterior abdominal wall in laparoscopic procedures, the risk of iatrogenic lesions remains. PMID:10064761

Korenkov, M; Rixen, D; Paul, A; Köhler, L; Eypasch, E; Troidl, H

1999-03-01

233

Use of Computed Tomography of the Head in the Hypotensive Blunt-Trauma Patient  

Microsoft Academic Search

Study objective: To identify patients presenting with hypotension due to blunt trauma who should undergo computed tomography (CT) of the head before urgent chest or abdominal operation.Design: Retrospective registry-based record review. Setting: Urban Level I trauma center. Participants: Consecutive trauma patients with suspected head injury, blunt mechanism of injury, and hypotension who were discharged between January 1, 1989, and December

Robert J Winchell; David B Hoyt; Richard K Simons

1995-01-01

234

Damage control surgery for spine trauma  

Microsoft Academic Search

The concept of “damage control” surgery was originally developed for massive abdominal trauma and also successfully applied to the management of lone bone injuries. More recently this has been extended to severely injured patients with spine injuries. This paper provided an overview of how damage control principles can be applied to multitrauma patients with spine injuries, to patients with isolated

Thomas Kossmann; Larissa Trease; Ilan Freedman; Gregory Malham

2004-01-01

235

Changing treatment of pediatric splenic trauma  

Microsoft Academic Search

A review of splenic injuries at Cincinnati Children's Hospital Medical Center from July 1978 to June 1980 revealed this form of injury in 29 patients. Treatment without surgery was successful in 21 patients. Seven patients required operation. One patient died shortly after admission of severe associated injuries. All patients admitted with blunt abdominal trauma were initially treated conservatively. If the

J. S. Kakkasseril; D. Stewart; J. A. Cox; M. Gelfand

1982-01-01

236

Shock trauma.  

PubMed

Trauma - accidental or intentional injury - is a major health and social problem. It is still the chief cause of death in people between the ages of 1 and 38 years. In the United States, the mortality due to trauma between the ages of 15 and 24 years increased by 13% from 1960 to 1978. During the same period, the mortality for people aged 25 to 64 years declined by 16%. Murders have increased from 8464 in 1960, to 26 000 in 1982. The overall death rate of American teenagers and young adults is 50% higher than that of their counterparts in Britain, Sweden and Japan. Trauma affects young, productive citizens, and the estimated costs for death, disability and loss of productivity exceed $230 million a day. The most tragic statistic is that at least 40% of the deaths are needless and preventable if better treatment and prevention programs were available. Trauma deaths that might be prevented are those due to motor vehicle accidents, homicide, burns, and alcohol and drug abuse. In this paper suggestions for prevention are made. They include improved crash worthiness of motor vehicles, revocation of drunk drivers' licences, use of devices that limit drunk drivers, increased tax on alcohol and random breathalyser tests, and the use of seat belts and motorcycle helmets. Control of hand-guns and burn characteristics of cigarettes could also reduce deaths. The problems and issues in trauma care can be divided into two broad categories: system and professional. System problems include prehospital care, in-hospital care, rehabilitation and prevention. Professional problems include education, research, economics, and quality.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:6478325

Trunkey, D D

1984-09-01

237

Delayed repair for traumatic abdominal wall hernia: is it safe?  

PubMed

Abdominal wall hernias after trauma have been recognized for more than a century, with the first case reported as occurring after a fall. Traumatic abdominal wall hernias (TAWHs) after blunt trauma are uncommon. The timing of definitive repair, early or delayed, is not clear. We report a case on TAWH and mesenteric avulsion, highlighting the reasons for immediate or delayed repair. A single case study can hardly be considered as a basis for profound changes in the management of post traumatic hernias. However, damage to all layers of the abdominal wall indicates high-energy trauma. In such cases, the damage is not, in all probability, limited to the integumentary system. For the moment, the timing of surgery in any TAWH should be considered differently according to the trauma, the wall defect, clinical and radiological findings, associated injuries, and the clinical status of the patient. PMID:19153644

Sall, I; El Kaoui, H; Bouchentouf, S M; Ait Ali, A; Bounaim, A; Hajjouji, A; Baba, H; Fahssi, M; Alhyane, A; Zentar, A; Sair, K

2009-01-20

238

Computed tomography and blunt abdominal injury: patient selection based on examination, haematocrit and haematuria  

Microsoft Academic Search

The criteria for ordering abdominal CT scans in the secondary survey of stable bluntly injured patients was examined. A patient population at high risk for having intra-abdominal injury (IAI) was identified by physical examination, a fall in haematocrit, and haematuria. A total of 444 patients receiving abdominal CT scans at a large urban trauma centre were reviewed. IAI was diagnosed

J. R. Richards; R. W. Derlet

1997-01-01

239

Traumatic abdominal wall injuries: a review.  

PubMed

Traumatic abdominal wall injuries have been described in literature for over 100 years. These injuries involve abdominal wall from skin to the level of fascia. These are often associated with underlying visceral injuries. The diagnosis requires a high index of suspicion and is based on clinical examination and radiologic investigations. Management ranges from conservative management to complex abdominal wall reconstruction. In the following review we describe the incidence, clinical features, diagnosis, management and possible interventions for prevention of these injuries. PMID:23774087

Rathore, A; Murherjee, I; Kumar, P

2013-06-01

240

Lethal intrauterine fetal trauma.  

PubMed

Eight cases of lethal intrauterine fetal trauma secondary to motor vehicle accidents are retrospectively studied. In each instance the mother survived, usually sustaining only minor injuries. Some degree of placental abruption or infarction occurred in each case, but fetal abnormalities were more varied. Significant fetal injuries were limited to the head and included two instances of skull fracture associated with cortical lacerations and contusions. Six of the eight fetuses were stillborn, and the other two died during the first postnatal day. At least five of the mothers were unrestrained at the time of the accident, three of whom experienced abdominal impact against the steering wheel but no external abdominal injuries. Although two mothers were wearing seat belts, in only one instance could the seat belt be implicated in contributing to the fetal injury. This study shows that lethal placental or direct fetal injury can occur even though maternal injuries are minor or insignificant. The findings also support current recommendations for use of three-point restraints. PMID:3407709

Stafford, P A; Biddinger, P W; Zumwalt, R E

1988-08-01

241

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

PubMed Central

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

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

2008-01-01

242

Obesity does not increase morbidity and mortality after laparotomy for trauma.  

PubMed

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

2013-03-01

243

The role of minimally invasive surgery in pediatric trauma: a collective review.  

PubMed

Although minimally invasive surgery (MIS) has been utilized in selective trauma patients, there a relative paucity of literature on its role in both blunt and penetrating trauma in the pediatric population. Our purpose is to review the current literature on the role of MIS in abdominal and thoracic pediatric trauma. A review of the literature, indications, risks, and benefits of MIS in trauma will be presented. Relevant literature was obtained from use of the PubMed database. PMID:23989525

Sharp, Nicole E; Holcomb, George W

2013-10-01

244

Separate and combined associations of body-mass index and abdominal adiposity with cardiovascular disease: collaborative analysis of 58 prospective studies  

PubMed Central

Summary Background Guidelines differ about the value of assessment of adiposity measures for cardiovascular disease risk prediction when information is available for other risk factors. We studied the separate and combined associations of body-mass index (BMI), waist circumference, and waist-to-hip ratio with risk of first-onset cardiovascular disease. Methods We used individual records from 58 cohorts to calculate hazard ratios (HRs) per 1 SD higher baseline values (4·56 kg/m2 higher BMI, 12·6 cm higher waist circumference, and 0·083 higher waist-to-hip ratio) and measures of risk discrimination and reclassification. Serial adiposity assessments were used to calculate regression dilution ratios. Results Individual records were available for 221?934 people in 17 countries (14?297 incident cardiovascular disease outcomes; 1·87 million person-years at risk). Serial adiposity assessments were made in up to 63?821 people (mean interval 5·7 years [SD 3·9]). In people with BMI of 20 kg/m2 or higher, HRs for cardiovascular disease were 1·23 (95% CI 1·17–1·29) with BMI, 1·27 (1·20–1·33) with waist circumference, and 1·25 (1·19–1·31) with waist-to-hip ratio, after adjustment for age, sex, and smoking status. After further adjustment for baseline systolic blood pressure, history of diabetes, and total and HDL cholesterol, corresponding HRs were 1·07 (1·03–1·11) with BMI, 1·10 (1·05–1·14) with waist circumference, and 1·12 (1·08–1·15) with waist-to-hip ratio. Addition of information on BMI, waist circumference, or waist-to-hip ratio to a cardiovascular disease risk prediction model containing conventional risk factors did not importantly improve risk discrimination (C-index changes of ?0·0001, ?0·0001, and 0·0008, respectively), nor classification of participants to categories of predicted 10-year risk (net reclassification improvement ?0·19%, ?0·05%, and ?0·05%, respectively). Findings were similar when adiposity measures were considered in combination. Reproducibility was greater for BMI (regression dilution ratio 0·95, 95% CI 0·93–0·97) than for waist circumference (0·86, 0·83–0·89) or waist-to-hip ratio (0·63, 0·57–0·70). Interpretation BMI, waist circumference, and waist-to-hip ratio, whether assessed singly or in combination, do not importantly improve cardiovascular disease risk prediction in people in developed countries when additional information is available for systolic blood pressure, history of diabetes, and lipids. Funding British Heart Foundation and UK Medical Research Council.

The Emerging Risk Factors Collaboration

2011-01-01

245

Computed tomography of splenic trauma  

SciTech Connect

Fifty patients with abdominal trauma and possible splenic injury were evaluated by computed tomography (CT). CT correctly diagnosed 21 of 22 surgically proved traumatic sesions of the spleen (96%). Twenty-seven patients had no evidence of splenic injury. This was confirmed at operation in 1 patient and clinical follow-up in 26. There were one false negative and one false positive. In 5 patients (10%), CT demonstrated other clinically significant lesions, including hepatic or renal lacerations in 3 and large retroperitoneal hematomas in 2. In adolescents and adults, CT is an accurate, noninvasive method of rapidly diagnosing splenic trauma and associated injuries. Further experience is needed to assess its usefulness in evaluating splenic injuries in infants and small children.

Jeffrey, R.B.; Laing, F.C.; Federle, M.P.; Goodman, P.C.

1981-12-01

246

Structural models of captivity trauma, resilience, and trauma response among former prisoners of war 20 to 40 years after release  

Microsoft Academic Search

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

1993-01-01

247

Abdominal tuberculosis.  

PubMed Central

Tuberculosis has staged a global comeback and forms a dangerous combination with AIDS. The abdomen is one of the common sites of extrapulmonary involvement. Patients with abdominal tuberculosis have a wide range and spectrum of symptoms and signs; the disease is therefore a great mimic. Diagnosis, mainly radiological and supported by endoscopy, is difficult to make and laparotomy is required in a large number of patient. Management involves judicious combination of antitubercular therapy and surgery which may be required to treat complications such as intestinal obstruction and perforation. The disease, though potentially curable, carries a significant morbidity and mortality. Images Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Figure 11 Figure 12 Figure 13

Kapoor, V. K.

1998-01-01

248

Strategies to control massive abdominal bleeding.  

PubMed

Abdominal trauma is divided into blunt and penetrating causes. Massive intraabdominal hemorrhage after injury represents the most dangerous precipitating factor that can affect survival if not promptly managed. The first target to achieve management of bleeding patients is control of the source, and then adequate resuscitation and optimization of hemostasis. New procoagulant drugs as recombinant activated factor VII (rFVIIa) seem to play an interesting role in bleeding control after trauma. Our experience with rFVIIa in six patients who were refractory to standard treatments demonstrated a good survival rate after massive abdominal bleeding. Regardless of new drugs and new technologies, a multidisciplinary approach is the cornerstone of the primary care of the these patients. PMID:18555150

Busani, S; Cavazzuti, I; Marietta, M; Pasetto, A; Girardis, M

2008-05-01

249

Patterns of Errors Contributing to Trauma Mortality  

PubMed Central

Objective: To identify patterns of errors contributing to inpatient trauma deaths. Methods: All inpatient trauma deaths at a high-volume level I trauma center from 1996 to 2004 inclusive were audited. Data were collected with daily trauma registry chart abstraction, weekly morbidity and mortality reports, hospital quality assurance reports, and annual trauma registry analyses of risk of death using TRISS and HARM methodology. Deaths that met criteria for low to medium probability of mortality or those with quality of care concerns were analyzed for errors and then subjected to 3-stage peer review at weekly departmental, monthly hospital, and annual regional forums. Patterns of errors were constructed from the compiled longitudinal data. Results: In 9 years, there were 44,401 trauma patient admissions and 2594 deaths (5.8%), of which 601 met low to medium mortality risks. Sixty-four patients (0.14% admissions, 2.47% deaths) had recognized errors in care that contributed to their death. Important error patterns included: failure to successfully intubate, secure or protect an airway (16%), delayed operative or angiographic control of acute abdominal/pelvic hemorrhage (16%), delayed intervention for ongoing intrathoracic hemorrhage (9%), inadequate DVT or gastrointestinal prophylaxis (9%), lengthy initial operative procedures rather than damage control surgery in unstable patients (8%), over-resuscitation with fluids (5%), and complications of feeding tubes (5%). Resulting data-directed institutional and regional trauma system policy changes have demonstrably reduced the incidence of associated error-related deaths. Conclusions: Preventable deaths will occur even in mature trauma systems. This review has identified error patterns that are likely common in all trauma systems, and for which policy interventions can be effectively targeted.

Gruen, Russell L.; Jurkovich, Gregory J.; McIntyre, Lisa K.; Foy, Hugh M.; Maier, Ronald V.

2006-01-01

250

Imaging of Abdominal and Pelvic Injuries  

Microsoft Academic Search

Trauma to abdominal and pelvic structures often occurs in the setting of multisystemic injury. Rapid and accurate diagnosis\\u000a is a mainstay in reducing mortality and morbidity of these patients. Choice and employment of any particular radiological\\u000a investigation would depend on the radiological armamentarium available and the urgency of demand in the life-threatening situation.\\u000a While US has an important role in

S. Leschka; H. Alkadhi; L. Husmann; S. Wildermuth

251

Non-Invasive Monitoring of Intra-Abdominal Bleeding Rate Using Electrical Impedance Tomography.  

National Technical Information Service (NTIS)

Electrical Impedance Tomography (EIT) may be useful in continuous non-invasive monitoring of suspected abdominal bleeding in battlefield casualties subsequent to blunt trauma. We are developing a novel EIT system involving an electrode array applied only ...

E. A. Ross R. Sadleir

2009-01-01

252

Management of trauma to the parenchymatous organs.  

PubMed

The incidence of abdominal trauma is increasing, and is related to both increased violence in the society and to the increased frequency of road traffic accidents. Injuries to the liver, pancreas with duodenum, and kidneys are almost always associated with other lesions, and we see the multi-traumatized patient. Splenic injuries however, may be solitary. Since the duodenum and pancreas lie in the depth of the abdominal cavity, they are to some extent surrounded and cushioned against impact by the overhanging liver, the lower lateral and posterior rib cage and the vertebral column. The spleen, on the other hand, is attached to its vascular pedicle, but very mobile and susceptible of injuries involving deceleration and direct blunt trauma. PMID:7325588

Aune, S; Hafström, L; Lempinen, M; Solheim, K

1981-01-01

253

Update on managing diaphragmatic rupture in blunt trauma: a review of 208 consecutive cases  

PubMed Central

Background Blunt diaphragmatic rupture (BDR) is a rare event and represents a diagnostic challenge. The purpose of our study was to review our experience with BDR at the Sunnybrook Health Sciences Centre (Sunnybrook), the largest trauma centre in Canada, and to highlight recent changes in the diagnosis and management of the condition. Methods We retrospectively reviewed the cases of patients with BDR who were admitted to Sunnybrook between January 1986 and December 2003 using our trauma registry. We performed Student t and Fisher exact tests to compare our findings on patients with BDR with those on the entire cohort of blunt trauma patients admitted to our centre. Results Most patients with BDR were men (64.4%) with a mean age of 42 years. Left-sided tears were most common (65.0%). Patients with BDR had a very high Injury Severity Score (38) and very high mortality (28.8%). Of those who were injured as a result of motor vehicle collisions (MVCs), a significantly greater percentage of patients in the BDR group than in the entire cohort of blunt trauma patients were drivers or front-seat passengers. Patients with BDR were also significantly less likely to be pedestrians, to have experienced a fall or to be involved in a motorcycle collision. Patients with BDR had a higher chest, abdomen, pelvis and extremity Abbreviated Injury Scale score than all blunt trauma patients in general. Most of our patients underwent laparotomy (93.3%). The most common causes of death among patients with BDR were head injury (25.0%), intra-abdominal bleeding (23.3%) and pelvic hemorrhage (18.3%). Conclusion Blunt diaphragmatic rupture is rare and difficult to diagnose; however, certain MVC characteristics along with severe associated injuries should raise the index of suspicion. These associated injuries include injuries to the head, chest (including the aorta), abdomen and pelvis. Computed tomographic angiography is essential to rule out associated aortic injury and to increase the diagnostic accuracy of BDR.

Chughtai, Talat; Ali, Syed; Sharkey, Phillip; Lins, Marcelo; Rizoli, Sandro

2009-01-01

254

CT of blunt pancreatic trauma—A pictorial essay  

Microsoft Academic Search

Blunt trauma to pancreas is uncommon and clinical features are often non-specific and unreliable leading to possible delays in diagnosis and therefore increased morbidity. CT has been established as the imaging modality of choice for the diagnosis of abdominal solid-organ injury in the blunt trauma patient. The introduction of multidetector-row CT allows for high resolution scans and multiplanar reformations that

Sudhakar Kundapur Venkatesh; John Mun Chin Wan

2008-01-01

255

Low-dose MDCT findings of blunt hepatobiliary trauma  

Microsoft Academic Search

This pictorial essay shows low-dose multi-detector computed tomography (MDCT) findings of blunt hepatobiliary trauma, and\\u000a describes the indications and protocol for MDCT. Given the universal usage of MDCT in assessing the liver in blunt abdominal\\u000a trauma, reduction of patient dose is essential. The new l0se MDCT protocol presented here can achieve up to 50% dose reduction\\u000a while maintaining diagnostic image

Arash Eftekhari; Ahmed Abdulwahab Albuali; Dipinder Keer; Sandro Galea-Soler; Savvas Nicolaou

2011-01-01

256

Acute adrenal hemorrhage after blunt trauma  

Microsoft Academic Search

Objective  To determine the appropriate management of adrenal hemorrhage in patients with severe chest and upper abdominal blunt trauma.\\u000a \\u000a \\u000a \\u000a Materials and Methods  We reviewed 7 patients who suffered from severe traumatic adrenal hemorrhage after a traffic accident (n = 4) or fall (n = 3). Contrast-enhanced CT images were analyzed for multi-organ traumatic injury, hematoma size, extravasation, and pseudoaneurysm\\u000a formation. We also

O. Ikeda; Joji Urata; Yushi Araki; Shunji Yoshimatsu; Shuichi Kume; Yoshitsugu Torigoe; Yasuyuki Yamashita

2007-01-01

257

Modified Opsite(R) Sandwich for Temporary Abdominal Closure: A Non-Traumatic Experience  

PubMed Central

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

Wilde, JM; Loudon, MA

2007-01-01

258

Small bowel rupture after blunt trauma: Computed tomographic signs and their sensitivity  

Microsoft Academic Search

The purpose of this study is to describe the characteristic computed tomographic (CT) signs of small bowel perforation after\\u000a blunt abdominal trauma and to evaluate their sensitivity. Nineteen preoperative CT scans were obtained from 16 patients with\\u000a surgically proven small bowel rupture secondary to blunt abdominal trauma. Only the CT findings described in the original\\u000a CT reports were used. Eleven

Linda Casey; Dan Vu; Allen J. Cohen

1995-01-01

259

Should we measure intra-abdominal pressures in every intensive care patient?  

PubMed

Intra-abdominal pressure (IAP) is seldom measured by default in intensive care patients. This review summarises the current evidence on the prevalence and risk factors of intra-abdominal hypertension (IAH) to assist the decision-making for IAP monitoring.IAH occurs in 20% to 40% of intensive care patients. High body mass index (BMI), abdominal surgery, liver dysfunction/ascites, hypotension/vasoactive therapy, respiratory failure and excessive fluid balance are risk factors of IAH in the general ICU population. IAP monitoring is strongly supported in mechanically ventilated patients with severe burns, severe trauma, severe acute pancreatitis, liver failure or ruptured aortic aneurysms. The risk of developing IAH is minimal in mechanically ventilated patients with positive end-expiratory pressure < 10 cmH2O, PaO2/FiO2 > 300, and BMI < 30 and without pancreatitis, hepatic failure/cirrhosis with ascites, gastrointestinal bleeding or laparotomy and the use of vasopressors/inotropes on admission. In these patients, omitting IAP measurements might be considered.In conclusions, clear guidelines to select the patients in whom IAP measurements should be performed cannot be given at present. In addition to IAP measurements in at-risk patients, a clinical assessment of the signs of IAH should be a part of every ICU patient's bedside evaluation, leading to prompt IAP monitoring in case of the slightest suspicion of IAH development. PMID:22873425

Starkopf, Joel; Tamme, Kadri; Blaser, Annika Reintam

2012-07-05

260

Should we measure intra-abdominal pressures in every intensive care patient?  

PubMed Central

Intra-abdominal pressure (IAP) is seldom measured by default in intensive care patients. This review summarises the current evidence on the prevalence and risk factors of intra-abdominal hypertension (IAH) to assist the decision-making for IAP monitoring. IAH occurs in 20% to 40% of intensive care patients. High body mass index (BMI), abdominal surgery, liver dysfunction/ascites, hypotension/vasoactive therapy, respiratory failure and excessive fluid balance are risk factors of IAH in the general ICU population. IAP monitoring is strongly supported in mechanically ventilated patients with severe burns, severe trauma, severe acute pancreatitis, liver failure or ruptured aortic aneurysms. The risk of developing IAH is minimal in mechanically ventilated patients with positive end-expiratory pressure < 10 cmH2O, PaO2/FiO2 > 300, and BMI < 30 and without pancreatitis, hepatic failure/cirrhosis with ascites, gastrointestinal bleeding or laparotomy and the use of vasopressors/inotropes on admission. In these patients, omitting IAP measurements might be considered. In conclusions, clear guidelines to select the patients in whom IAP measurements should be performed cannot be given at present. In addition to IAP measurements in at-risk patients, a clinical assessment of the signs of IAH should be a part of every ICU patient's bedside evaluation, leading to prompt IAP monitoring in case of the slightest suspicion of IAH development.

2012-01-01

261

Low probability of Significant Intra-Abdominal Injury in Stable Patients with Abdominal ‘‘Seat Belt Sign’’  

Microsoft Academic Search

\\u000a Abstract\\u000a \\u000a \\u000a Study Objective:\\u000a   Our aim was to determine the diagnostic significance of the association between the abdominal skin bruise from a seat belt\\u000a and the presence of intraabdominal injury.\\u000a \\u000a \\u000a \\u000a \\u000a Methods:\\u000a   This was an observational analysis of prospectively collected data on 45 patients who presented with an abdominal seat belt\\u000a sign to a level 1 trauma center following a motor vehicle

Vadim Makrin; Ory Wiesel; Daniel Heller; Joseph M. Klausner; Dror Soffer

2009-01-01

262

How to Test a Medical Technology for Space: Trauma Sonography in Microgravity1  

Microsoft Academic Search

Preventable trauma deaths in remote environments often result from inadequate diagnosis of thoracic and abdominal injuries. Full-time habitation of the International Space Station increases the risk of traumatic injury requiring intervention. This publication describes the evaluation of trauma sonography (TS) as a noninvasive, fast and effective space-based imaging tool for diagnosing intracavity hemorrhage or visceral leakage. The NASA Space Medicine

Shannon Melton; George Beck; Douglas Hamilton; Rosa Chun; Ashot Sargsyan; Andrew W. Kirkpatrick

263

[Delayed splenic rupture 13 days post-trauma after initially inconspicuous computed tomography examination].  

PubMed

Delayed splenic injuries are rare but nevertheless well known and very dangerous complications after blunt abdominal trauma. The highest incidence is reported between four and eight days after trauma; however some cases with a latent period of weeks have been published. We present a case of delayed splenic rupture 13 days after trauma where most computed tomography (CT) examinations were interpreted as normal and present a review of the pathophysiology of delayed rupture, diagnosis and therapy. PMID:22824876

Scheyerer, M J; Schoenborn, V; Andreisek, G; Wanner, G A; Werner, C M L; Simmen, H-P

2013-06-01

264

Common Reactions After Trauma  

MedlinePLUS

... trauma? All kinds of trauma survivors commonly experience stress reactions. This is true for veterans, children, and disaster rescue or relief workers. If you understand what is happening when ...

265

Different immune responses to abdominal surgery in men and women  

Microsoft Academic Search

Background. Animal experiments reveal significant gender differences in the immunological response to surgical trauma. This raises the possibility that gender differences may also exist in patients after major abdominal surgery. Patients and methods. This prospective study included 40 patients (20 men, 20 women) with colorectal diseases requiring surgical intervention. To evaluate the immune response to surgery circulating lymphocyte populations and

Matthias W. Wichmann; Christian Müller; Günther Meyer; Michaela Adam; Martin K. Angele; Simone J. Eisenmenger; Friedrich-Wilhelm Schildberg

2003-01-01

266

Abdominal compartment syndrome in children: Experience with three cases  

Microsoft Academic Search

Background\\/Purpose: Abdominal compartment syndrome (ACS) is defined as cardiopulmonary or renal dysfunction caused by an acute increase in intraabdominal pressure. Although the condition is well described in adults, particularly trauma patients, little is known about ACS in children. Methods: Three girls, ages 4, 5, and 5 years, were treated for ACS by silo decompression. Each child presented in profound shock,

James M DeCou; Randel S Abrams; Richard S Miller; Michael W. L Gauderer

2000-01-01

267

Gas at postmortem computed tomography--an evaluation of 73 non-putrefied trauma and non-trauma cases.  

PubMed

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

2012-06-19

268

Popliteal vasculature injuries in paediatric trauma patients.  

PubMed

Popliteal-artery injuries in the paediatric-trauma patient are uncommon, difficult to diagnose and with prolonged ischaemia lead to substantial complications. We report three cases of popliteal-vasculature injury in paediatric-trauma patients with diverse mechanisms of injury: blunt trauma, penetrating injury and a Salter-Harris I fracture. We present a range of the significant sequelae that can result from paediatric popliteal-artery injury, both physically and psychologically. It is imperative that clinicians have a high index of suspicion when confronted with paediatric patients with trauma around the knee and that popliteal-vasculature injuries are diagnosed early. If insufficiencies are detected, further imaging should be considered, but surgical exploration should not be delayed in the presence of ischaemia. PMID:22776610

Jones, S A; Roberts, D C; Clarke, N M P

2012-07-07

269

CT of blunt trauma to the bowel and mesentery  

Microsoft Academic Search

Injuries to the bowel and mesentery are found in approximately 5% of all patients undergoing laparotomy after blunt abdominal trauma. Bowel and mesenteric injuries are often subtle and difficult to diagnose, and a delay in the diagnosis is associated with increased mortality and morbidity. CT is the best imaging method for diagnosing injuries to the bowel and mesentery. With meticulous

Hanh Vu Nghiem; R. Brooke Jeffrey; Robert E Mindelzun

1995-01-01

270

Isolated rupture of the cisterna chyli after blunt trauma  

Microsoft Academic Search

An 8-year-old boy was evaluated for blunt abdominal trauma after a motor vehicle crash. In the course of his workup, a computed tomography (CT) scan of the abdomen was suspicious for a duodenal injury. At surgery, the duodenum was found to be normal; however, a rupture of the cisterna chyli was identified. This injury was repaired, and the boy made

Casey M Calkins; Ernest E Moore; Scott Huerd; Randall Patten

2000-01-01

271

Massive rectal bleeding distant from a blunt car trauma.  

PubMed

Mesenteric trauma is one of the possible injuries caused by the use of seat belts in case of motor vehicle crash. We report here a rare case of rectal bleeding by rupture of a mesosigmoid haematoma. An emergent laparotomy revealed a mesosigmoid haematoma with a centimetric rectal perforation. The wearing of safety belts added some specific blunt abdominal trauma, which directly depends on lap-and-sash belts. Mesenteric injuries are found out up to 5% of blunt abdominal traumas. "Seat belt mark" leads the surgical team to strongly suspect an intra-abdominal trauma. When "seat belt mark" sign is found, in patients with mild to severe blunt car injuries, CT-scan has to be realised to eliminate intra-abdominal complications, including mesenteric and mesosigmoid ones. In case of proved mesenteric haematoma associated to intestinal bleeding, a surgical treatment must be considered as first choice. Conservative approach remains possible in stable patients but surgical exploration remains necessary in unstable patients with active bleeding. PMID:20638207

Gruden, E; Ragot, E; Arienzo, R; Revaux, A; Magri, M; Grossin, M; Leroy, C; Msika, S; Kianmanesh, R

2010-07-16

272

Management of Blunt Trauma to the Spleen (Part 1)  

Microsoft Academic Search

Spleen is the most frequent solid organ to be injured in blunt abdominal trauma. Considering its important role in providing immunity and preventing infection by a variety of mecha- nisms, every attempt should be made, if possible, to salvage the traumatized spleen at any age particularly in children. Af- ter primary resuscitation, mandatory requirements for non- operative management include absence

Seyed Abbas Banani

2010-01-01

273

Independent predictors of morbidity and mortality in blunt colon trauma  

Microsoft Academic Search

We sought to determine the impact of (1) grade of the colon injury, (2) the formation of an ostomy, and (3) associated injuries on outcomes such as morbidity and mortality after blunt colon injuries. We retrospectively reviewed 16,814 cases of blunt abdominal trauma. Patients with colonic injuries were selected and charts reviewed for demographic, clinical, and outcomes data. Injuries were

Rocco Ricciardi; Craig A. Paterson; Saleem Islam; W. Brian Sweeney; Stephen P. Baker; Timothy C. Counihan

2004-01-01

274

Impact Tolerance - Abdominal Injury.  

National Technical Information Service (NTIS)

In order to provide data on human tolerance to blunt abdominal impact a literature study and laboratory tests were carried out to determine the major causes of abdominal injury, injury mechanisms, a quantitative relationship between input and occurrence o...

D. L. Beckman J. H. McElhaney R. L. Stalnaker V. L. Roberts

1971-01-01

275

Computed tomography in hepatic trauma  

SciTech Connect

Twenty-five patients with hepatic injury from blunt upper abdominal trauma were examined by computed tomography (CT). The spectrum of CT findings was recorded, and the size of the hepatic laceration and the associated hemoperitoneum were correlated with the mode of therapy used in each case (operative vs nonoperative). While the need for surgery correlated roughly with the size of the hepatic laceration, the size of the associated hemoperitoneum was an important modifying factor. Fifteen patients with hepatic lacerations but little or no hemoperitoneum were managed nonoperatively. CT seems to have significant advantages over hepatic scintigraphy, angiography, and diagnostic peritoneal lavage. By combining inforamtion on the clinical state of the patient and CT findings, therapy of hepatic injury can be individualized and the incidence of nontherapeutic laparotomies decreased.

Moon, K.L. Jr.; Federle, M.P.

1983-08-01

276

Abdominal tuberculosis in children  

Microsoft Academic Search

Four boys with abdominal tuberculosis, one of whom had acquired immunodeficiency syndrome, are presented. Abdominal imaging findings on plain radiography, ultrasonography, computed tomography, and gastrointestinal contrast studies included tuberculous peritonitis and ascites in all patients, tuberculous adenopathy in two, gastrointestinal tuberculosis in two, and omental tuberculosis in two. The radiographic features particularly characteristic of abdominal tuberculosis were: (1) low attenuating

D. S. Ablin; K. A. Jain; E. M. Azouz

1994-01-01

277

Inflammatory Patterns and Cellular and Vascular Permeation in Rat Abdominal Wall Defects Using Alloderm, Permacol and CollaMend for Repair  

Microsoft Academic Search

Background: Abdominal wall defects secondary to hernias, trauma or disease are a common problem in surgery. Complications of closing these defects with synthetic meshes include foreign body reactions, infection, and adhesions to abdominal viscera. To minimize these problems, several acellular dermis derived collagen products are being used clinically for tissue replacement\\/reconstruction and repair of abdominal wall defects, including both animal

Joyce K. McIntyre

2008-01-01

278

Clinical presentation of abdominal tuberculosis in HIV seronegative adults  

Microsoft Academic Search

BACKGROUND: The accurate diagnosis of abdominal tuberculosis usually takes a long time and requires a high index of suspicion in clinic practice. Eighty-eight immune-competent patients with abdominal tuberculosis were grouped according to symptoms at presentation and followed prospectively in order to investigate the effect of symptomatic presentation on clinical diagnosis and prognosis. METHODS: Based upon the clinical presentation, the patients

Cengiz Bolukbas; Fusun F Bolukbas; Tulin Kendir; Remzi A Dalay; Nihat Akbayir; Mehmet H Sokmen; Ali T Ince; Mithat Guran; Erkan Ceylan; Guray Kilic; Oya Ovunc

2005-01-01

279

Imaging diagnostics of renal trauma.  

PubMed

The aim of the study is presenting the diagnostic value of different imaging modalities in the evaluation of patients with renal injury. The material comprises a group of 16 patients with blunt abdominal trauma. Six of them were treated surgically. Plain abdominal radiography was performed in 9 patients, urography in 7, US examination in 16 patients and CT in 12 cases. The renal injuries in US were found in 16 cases, 7 of them were isolated and in 9 patients multi-organ injuries were found, with liver injury in 2 of them. The minor injuries were found in 8 cases. In other 8 cases severe renal injuries were found. The perirenal haematomas were visible as non-enhancing areas adjacent to kidney. The parenchymal laceration appeared as linear non-enhancing areas in the renal parenchyma. In the group of minor renal lesion in 3 cases the renal contusion was found and small parenchymal and subcapsular haematomas in 2 cases appearing as hyperdense subcapsular areas, without evident contrast enhancement. In 2 cases CT revealed perirenal extravasations of blood, appearing as perirenal masses (density of 50 HU), and not revealing contrast enhancement. In 2 cases in CT retroperitoneal haematomas were found. The absence of excretion was found in 2 cases, representing severe injury of the renal pedicle. In 3 cases the injury of ureteropelvic system with extravasations of the contrasted urine into perinephric area was found in CT and in urography. That was the most frequent urographic sign of renal laceration. In 3 cases axial sections revealed injuries of renal collecting system, with subtle extravasation of contrasted urine. In 2 other cases of extensive parenchymal injuries US examination revealed irregular areas of inhomogeneous reflectivity. Radiological evaluation of kidney in patients which sustained abdominal trauma is generally indicated in patients with hypotension < 90 mm Hg and hematuria. CT is preferred image method, enabling evaluation of the injury category. CT is essential in qualifying of patients for conservative or surgical management. USG is also useful in initial diagnosis, but usually precise renal evaluation requires additional CT examination. PMID:16146102

Pas?awski, Marek; Ko?ty?, Witold; Z?omaniec, Janusz; Szafranek, Joanna

2004-01-01

280

Delayed Presentation of Isolated Complete Pancreatic Transection as a Result of Sport-Related Blunt Trauma to the Abdomen  

PubMed Central

Introduction Blunt abdominal trauma is a rare but well-recognized cause of pancreatic transection. A delayed presentation of pancreatic fracture following sport-related blunt trauma with the coexisting diagnostic pitfalls is presented. Case Report A 17-year-old rugby player was referred to our specialist unit after having been diagnosed with traumatic pancreatic transection, having presented 24 h after a sporting injury. Despite haemodynamic stability, at laparotomy he was found to have a diffuse mesenteric hematoma involving the large and small bowel mesentery, extending down to the sigmoid colon from the splenic flexure, and a large retroperitoneal hematoma arising from the pancreas. The pancreas was completely severed with the superior border of the distal segment remaining attached to the splenic vein that was intact. A distal pancreatectomy with spleen preservation and evacuation of the retroperitoneal hematoma was performed. Discussion/Conclusion Blunt pancreatic trauma is a serious condition. Diagnosis and treatment may often be delayed, which in turn may drastically increase morbidity and mortality. Diagnostic difficulties apply to both paraclinical and radiological diagnostic methods. A high index of suspicion should be maintained in such cases, with a multi-modality diagnostic approach and prompt surgical intervention as required.

Healey, Andrew J.; Dimarikis, Iannis; Pai, Madhava; Jiao, Long R.

2008-01-01

281

Traumatic abdominal wall hernia: A reappraisal  

Microsoft Academic Search

Traumatic abdominal wall hernia, a rare cause of hernia, has a confusing clinical picture and requires a high index of suspicion for prompt diagnosis and management. Such hernias, if missed, can result in high morbidity and may prove fatal. Distinction from a pre-existing hernia is important as well. We report our experience in two such cases, which had presented in

A. Kumar; P. Hazrah; S. Bal; A. Seth; R. Parshad

2004-01-01

282

Abdominal epilepsy in chronic recurrent abdominal pain  

PubMed Central

Background: Abdominal epilepsy (AE) is an uncommon cause for chronic recurrent abdominal pain in children and adults. It is characterized by paroxysmal episode of abdominal pain, diverse abdominal complaints, definite electroencephalogram (EEG) abnormalities and favorable response to the introduction of anti-epileptic drugs (AED). We studied 150 children with chronic recurrent abdominal pain and after exclusion of more common etiologies for the presenting complaints; workup proceeded with an EEG. We found 111 (74%) children with an abnormal EEG and 39 (26%) children with normal EEG. All children were subjected to AED (Oxcarbazepine) and 139 (92%) children responded to AED out of which 111 (74%) children had an abnormal EEG and 27 (18%) had a normal EEG. On further follow-up the patients were symptom free, which helped us to confirm the clinical diagnosis. Context: Recurrent chronic abdominal pain is a common problem encountered by pediatricians. Variety of investigations are done to come to a diagnosis but a cause is rarely found. In such children diagnosis of AE should be considered and an EEG will confirm the diagnosis and treated with AED. Aims: To find the incidence of AE in children presenting with chronic recurrent abdominal pain and to correlate EEG findings and their clinical response to empirical AEDs in both cases and control. Settings and Design: Krishna Institute of Medical Sciences University, Karad, Maharashtra, India. Prospective analytical study. Materials and Methods: A total of 150 children with chronic recurrent abdominal pain were studied by investigations to rule out common causes of abdominal pain and an EEG. All children were then started with AED oxycarbamezepine and their response to the treatment was noted. Results: 111 (74%) of the total 150 children showed a positive EEG change suggestive of epileptogenic activity and of which 75 (67.56%) were females and 36 (32.43%) were male, majority of children were in the age of group of 9-12 years. Temporal wave discharges were 39 (35.13%) of the total abnormal EEG's. All the children were started on AEDs and those with abnormal EEG showed 100% response to treatment while 27 (18%) children with normal EEG also responded to treatment. Twelve (8%) children did not have any improvement in symptoms. Conclusions: A diagnosis of AE must be considered in children with chronic recurrent abdominal pain, especially in those with suggestive history, and an EEG can save a child from lot of unnecessary investigations and suffering.

Kshirsagar, V. Y.; Nagarsenkar, Suhel; Ahmed, Minhajuddin; Colaco, Sylvia; Wingkar, K. C.

2012-01-01

283

Blunt thoracic trauma.  

PubMed

Blunt thoracic trauma represents a significant portion of trauma admissions to hospitals in the United States. These injuries are encountered by physicians in many specialities such as emergency medicine, pediatrics, general surgery and thoracic surgery. Accurate diagnosis and treatment improves the chances of favorable outcomes and it is desirable for all treating physicians to have current knowledge of all aspects of blunt thoracic trauma. Cardiothoracic surgeons often treat the most severe forms of blunt thoracic injuries and we review the aspects of blunt thoracic trauma that are pertinent to the practicing cardiothoracic surgeon. PMID:18420123

Weyant, Michael J; Fullerton, David A

2008-01-01

284

Ventilation in chest trauma  

PubMed Central

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.

Richter, Torsten; Ragaller, Maximilian

2011-01-01

285

Abdominal decompression in children.  

PubMed

Abdominal compartment syndrome (ACS) increases the risk for mortality in critically ill children. It occurs in association with a wide variety of medical and surgical diagnoses. Management of ACS involves recognizing the development of intra-abdominal hypertension (IAH) by intra-abdominal pressure (IAP) monitoring, treating the underlying cause, and preventing progression to ACS by lowering IAP. When ACS is already present, supporting dysfunctional organs and decreasing IAP to prevent new organ involvement become an additional focus of therapy. Medical management strategies to achieve these goals should be employed but when medical management fails, timely abdominal decompression is essential to reduce the risk of mortality. A literature review was performed to understand the role and outcomes of abdominal decompression among children with ACS. Abdominal decompression appears to have a positive effect on patient survival. However, prospective randomized studies are needed to fully understand the indications and impact of these therapies on survival in children. PMID:22482041

Ejike, J Chiaka; Mathur, Mudit

2012-03-22

286

Abdominal compartment syndrome  

PubMed Central

Intra-abdominal hypertension (IAH) associated with organ dysfunction defines the abdominal compartment syndrome (ACS). Elevated intra-abdominal pressure (IAP) adversely impacts pulmonary, cardiovascular, renal, splanchnic, musculoskeletal/integumentary, and central nervous system physiology. The combination of IAH and disordered physiology results in a clinical syndrome with significant morbidity and mortality. The onset of the ACS requires prompt recognition and appropriately timed and staged intervention in order to optimize outcome. The history, pathophysiology, clinical presentation, and management of this disorder is outlined.

Bailey, Jeffrey; Shapiro, Marc J

2000-01-01

287

Management and outcomes of trauma during pregnancy.  

PubMed

Approximately 1% to 4% of pregnant women are evaluated in emergency/delivery room because of traumatic injury, yet there are few educational strategies targeted toward prevention/management of maternal trauma. Use of illicit drugs and alcohol, domestic abuse, and depression contribute to maternal trauma; thus a high index of suspicion should be maintained when treating injured young women. Treating the mother appropriately is beneficial for both the mother and the fetus. Fetal viability should be assessed after maternal stabilization. Pregnancy-related morbidity occurs in approximately 25% of cases and may include placental abruption, uterine rupture, preterm delivery, and the need for cesarean delivery. PMID:23351540

Einav, Sharon; Sela, Hen Y; Weiniger, Carolyn F

2012-11-20

288

A blunt complex abdominal trauma: total hepatectomy and liver transplantation  

Microsoft Academic Search

A victim of a motor accident was referred to the Emergency Department. He was unconscious, breathing was rapid and shallow, and had a mean arterial pressure of 60 mmHg with a distended abdomen. A peritoneal lavage was positive for blood. An immediate laparotomy showed a massive hepatic injury with bilobar disruptions. After an unsuccessful hepatorrhaphy an extensive perhepatic gauze packing

D. Chiumello; S. Gatti; M. Caspani; M. Savioli; Rainero L. Fassati; L. Gattinoni

2002-01-01

289

Abdominal Compartment Syndrome Secondary to Chronic Constipation  

PubMed Central

Abdominal compartment syndrome (ACS) is defined as an elevated intraabdominal pressure with evidence of organ dysfunction. The majority of published reports of ACS are in neonates with abdominal wall defects and in adults following trauma or burns, but it is poorly described in children. We describe the unusual presentation of an 11-year-old boy with a long history of chronic constipation who developed acute ACS requiring resuscitative measures and emergent disimpaction. He presented with a 2-week history of increasing abdominal pain, nausea, diminished appetite and longstanding encopresis. On exam, he was emaciated with a massively distended abdomen with a palpable fecaloma. Abdominal XR confirmed these findings. Within 24 hours of presentation, he became tachycardic and oliguric with orthostatic hypotension. Following two enemas, he acutely deteriorated with severe hypotension, marked tachycardia, acute respiratory distress, and a declining mental status. Endotracheal intubation, fluid boluses, and vasopressors were commenced, followed by emergent surgical fecal disimpaction. This resulted in rapid improvement in vital signs. He has been thoroughly investigated and no other condition apart from functional constipation has been identified. Although ACS secondary to constipation is extremely unusual, this case illustrates the need to actively treat constipation and what can happen if it is not.

Flageole, Helene; Ouahed, Jodie; Walton, J. Mark; Yousef, Yasmin

2011-01-01

290

Abdominal compartment syndrome secondary to chronic constipation.  

PubMed

Abdominal compartment syndrome (ACS) is defined as an elevated intraabdominal pressure with evidence of organ dysfunction. The majority of published reports of ACS are in neonates with abdominal wall defects and in adults following trauma or burns, but it is poorly described in children. We describe the unusual presentation of an 11-year-old boy with a long history of chronic constipation who developed acute ACS requiring resuscitative measures and emergent disimpaction. He presented with a 2-week history of increasing abdominal pain, nausea, diminished appetite and longstanding encopresis. On exam, he was emaciated with a massively distended abdomen with a palpable fecaloma. Abdominal XR confirmed these findings. Within 24 hours of presentation, he became tachycardic and oliguric with orthostatic hypotension. Following two enemas, he acutely deteriorated with severe hypotension, marked tachycardia, acute respiratory distress, and a declining mental status. Endotracheal intubation, fluid boluses, and vasopressors were commenced, followed by emergent surgical fecal disimpaction. This resulted in rapid improvement in vital signs. He has been thoroughly investigated and no other condition apart from functional constipation has been identified. Although ACS secondary to constipation is extremely unusual, this case illustrates the need to actively treat constipation and what can happen if it is not. PMID:22606517

Flageole, Helene; Ouahed, Jodie; Walton, J Mark; Yousef, Yasmin

2011-08-23

291

Adrenal trauma: medical and surgical emergency.  

PubMed

A 35-year-old man was admitted to hospital in a state of haemorrhagic shock after a road traffic accident. A right adrenal gland injury associated with a retroperitoneal haematoma was diagnosed by CT scan. Haemostatic surgery (without adrenal gland resection) was performed instead of angioembolisation because of an associated abdominal compartment syndrome. The outcome was favourable. The objective of this case report is to illustrate the importance of the early diagnosis of adrenal gland injuries after trauma which, though uncommon and frequently overlooked or discovered fortuitously by CT scan, can be life-threatening. Angioembolisation or surgery may be necessary in cases of uncontrolled bleeding or the development of abdominal compartmental syndrome. PMID:22609698

Untereiner, Olivier; Charpentier, Claire; Grignon, Bruno; Welfringer, Pascal; Garric, Jean; Mertes, Paul Michel

2012-05-19

292

Management of liver trauma in adults.  

PubMed

The liver is one of the most commonly injured organs in abdominal trauma. Recent advancements in imaging studies and enhanced critical care monitoring strategies have shifted the paradigm for the management of liver injuries. Nonoperative management of both low- and high-grade injuries can be successful in hemodynamically stable patients. Direct suture ligation of bleeding parenchymal vessels, total vascular isolation with repair of venous injuries, and the advent of damage control surgery have all improved outcomes in the hemodynamically unstable patient population. Anatomical resection of the liver and use of atriocaval shunt are rarely indicated. PMID:21633579

Ahmed, Nasim; Vernick, Jerome J

2011-01-01

293

Hepatic trauma management and outcome; Our experience  

Microsoft Academic Search

Background  Injuries to the liver have been reported in 35–45% of patients with significant blunt abdominal trauma. Since the introduction\\u000a of ultrasonography and computerized tomography in the evaluation of these patients, there has been an increase in number of\\u000a hepatic injuries diagnosed that previously would not have been apparent.\\u000a \\u000a \\u000a \\u000a \\u000a Aims and objectives  The purpose of this study was to determine the epidemiology

Tanweer Karim; Margaret Topno; Ali Reza; Kundan Patil; Raj Gautam; Manish Talreja; Anupam Tiwari

2010-01-01

294

Management of liver trauma in adults  

PubMed Central

The liver is one of the most commonly injured organs in abdominal trauma. Recent advancements in imaging studies and enhanced critical care monitoring strategies have shifted the paradigm for the management of liver injuries. Nonoperative management of both low- and high-grade injuries can be successful in hemodynamically stable patients. Direct suture ligation of bleeding parenchymal vessels, total vascular isolation with repair of venous injuries, and the advent of damage control surgery have all improved outcomes in the hemodynamically unstable patient population. Anatomical resection of the liver and use of atriocaval shunt are rarely indicated.

Ahmed, Nasim; Vernick, Jerome J

2011-01-01

295

Commentary: Sonography in the evaluation of children following blunt trauma: Is it to be or not be?  

Microsoft Academic Search

Over the past decade CT scanning has become generally accepted in North America as the diagnostic modality of choice for the evaluation of abdominal injury in children following blunt trauma [1–5]. Recently, there has been increasing interest in the use of sonography as the primary screening examination in this area. Initial studies utilizing sonography in the evaluation of trauma patients

C. J. Sivit; R. A. Kaufman

1995-01-01

296

Computed Tomography in the Evaluation of Diaphragmatic Hernia following Blunt Trauma.  

PubMed

Diagnosis of traumatic diaphragmatic hernia due to blunt abdominal trauma requires a high index of suspicion. This study was conducted to assess the accuracy of multidetector computed tomogram (MDCT) in the diagnosis of traumatic diaphragmatic hernia. All patients with thoracoabdominal blunt trauma with diaphragmatic hernia diagnosed on radiologic evaluation during a 3-year period (i.e., from June 2004 to June 2007) were analyzed. Nineteen patients with diaphragmatic injuries in 117 patients with blunt thoracoabdominal injury (16.23%) were studied. Age range was 8-60 years (mean 34 years). Male-female ratio was 18:1. Various features seen on CT scan were diaphragmatic discontinuity in 13 (68.42%), thickened diaphragm in 10 (52.63%), "collar sign" in 8 (42.10%), visceral herniation in 12 (63.15%), dependent viscera sign in 8 (42.10%), and segmental nonrecognition of the diaphragm in 1 patient (5.88%). Two patients presented with delayed rupture. In the rest mean duration between time of injury and performance of CT scan was 44.35 h (range 3-288 h). Fourteen patients underwent operative management. Sensitivity, specificity, and accuracy of MDCT scan were 100, 93, and 95%, respectively. Three patients (15.78%) expired. MDCT is a highly accurate modality for detecting traumatic diaphragmatic hernia. PMID:23904715

Magu, Sarita; Agarwal, Shalini; Singla, Sham

2012-01-10

297

David Baldwin's Trauma Information Pages  

NSDL National Science Digital Library

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.

1997-01-01

298

Major Trauma Outcome Study.  

National Technical Information Service (NTIS)

The American College of Surgeons Committee on Trauma (ASCOT) Major Trauma Outcome Study (MTOS) began in 1982. Since then, more than 150 institutions have submitted data on more than 175,000 patients giving MTOS the largest contemporary description of inju...

C. Frey H. R. Champion

1991-01-01

299

Advances in trauma care  

Microsoft Academic Search

The burden of trauma is increasing worldwide [1], but in a very uneven fashion [2, 3]. It is decreasing in the developed world, to the point that trauma surgery as a career is sought by very few surgical residents\\u000a in the United States [4, 5], while resources are overburdened in the developing world.

F. Plani; J. Goosen

300

Treating childhood trauma.  

PubMed

This review begins with the question "What is childhood trauma?" Diagnosis is discussed next, and then the article focuses on treatment, using 3 basic principles-abreaction, context, and correction. Treatment modalities and complications are discussed, with case vignettes presented throughout to illustrate. Suggestions are provided for the psychiatrist to manage countertransference as trauma therapy proceeds. PMID:23164127

Terr, Lenore C

2013-01-01

301

Trauma in pregnancy.  

PubMed

In the United States, trauma is the leading nonobstetric cause of maternal death. The principal causes of trauma in pregnancy include motor vehicle accidents, falls, assaults, homicides, domestic violence, and penetrating wounds. The managing team evaluating and coordinating the care of the pregnant trauma patient should be multidisciplinary so that it is able to understand the physiologic changes in pregnancy. Blunt trauma to the abdomen increases the risk of placental abruption. Evaluation of the pregnant trauma patient requires a primary and secondary survey with emphasis on airway, breathing, circulation, and disability. The use of imaging studies, invasive hemodynamics, critical care medications, and surgery, if necessary, should be individualized and guided by a coordinating team effort to improve maternal and fetal conditions. A clear understanding of gestational age and fetal viability should be documented in the record. PMID:20393413

Oxford, Corrina M; Ludmir, Jonathan

2009-12-01

302

Trauma: the seductive hypothesis.  

PubMed

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

Reisner, Steven

2003-01-01

303

Recurrent Abdominal Pain  

ERIC Educational Resources Information Center

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

Banez, Gerard A.; Gallagher, Heather M.

2006-01-01

304

Current Experience with Computed Tomographic Cystography andBlunt Trauma  

Microsoft Academic Search

  We present our experience with\\u000a computed tomographic (CT) cystography for the diagnosis of bladder\\u000a rupture in patients with blunt abdominal and pelvic trauma and compare\\u000a the results of CT cystography to operative exploration. We identified\\u000a all blunt trauma patients diagnosed with bladder rupture from\\u000a January 1992 to September 1998. We also reviewed the radiology\\u000a computerized information system (RIS) for all

2001-01-01

305

Referred Pain in Right Arm from Abdominal Wall Pseudoaneurysm  

PubMed Central

Pseudoaneurysm of the abdominal wall is a possible but very rare clinical entity. It is a known complication of surgery, trauma, or arterial puncture, but it is rarely spontaneous. Even though it can usually present with a wide range of local symptoms, it can cause referred pain via spinal cord, which is cross-excited with afferent sympathetic nervous system. We report a case of right arm pain which was referred from a small abdominal pseudoaneurysm like a referred pain from gall bladder. This rare entity should be considered in the differential for pain management in case that the pain does not resolve with medication or interventional pain management.

Ahn, Seon Kyoung; Kim, Hye Young; Shin, Ji Yeon; Min, Sangil

2013-01-01

306

Non-operative management of renal trauma in very young children: experiences from a dedicated South African paediatric trauma unit.  

PubMed

Blunt abdominal trauma results in renal injury in 10% of paediatric cases. Over the last twenty years, the management of paediatric renal trauma has shifted towards a primarily non-operative approach that is now well-established for children up to 18 years old. This retrospective study reviews our experiences of non-operatively managing blunt renal trauma in a very young cohort of patients up to 11 years old. Between June 2006 and June 2010, 118 children presented to the Red Cross War Memorial Children's Hospital in Cape Town with blunt abdominal trauma. 16 patients shown to have sustained renal injury on abdominal computed tomography (CT) scanning were included in this study. Medical records were reviewed for the mechanism of injury, severity of renal injury, clinical presentation, associated injuries, management method and clinical outcomes. All renal injuries were graded (I-V) according to the American Association for the Surgery of Trauma Organ Injury Severity Scale. All renal trauma patients included in this study were aged between 1 and 11 years (mean of 6.5 years). 1 patient sustained grade V injuries; 2 grade IV, 6 grade III and 7 grade I injuries. The majority of injuries (9/16) were caused by motor vehicle crashes, whilst 5 children fell from height, 1 was struck by a falling tree and 1 hit by a moving train. 1 of 16 patients was haemodynamically unstable on presentation as a result of multiple splenic and hepatic lacerations. He was resuscitated and underwent immediate laparotomy. However, his renal injuries were not indications for surgical management. 15 haemodynamically stable patients were non-operatively managed for their renal injuries. Following lengths of admissions ranging from 4 to 132 days, all 16 patients were successfully discharged with no mortalities. No significant complications of renal trauma, such as new-onset hypertension, were detected during their first follow up outpatient appointments. Our findings successfully extend non-operative management of haemodynamically stable renal injuries to a very young cohort up to 11 years old. However, we still advocate immediate resuscitation and surgical intervention for any haemodynamically unstable child who had sustained any abdominal injury. We also argue for a limited role for abdominal CT imaging for diagnosing renal injury and routine follow up, instead recommending a greater emphasis on clinical observations for possible complications. PMID:21269622

Tsui, Alex; Lazarus, John; Sebastian van As, A B

2011-01-26

307

Advances in resuscitative trauma care.  

PubMed

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

2011-10-01

308

Assessment of workload during pediatric trauma resuscitation.  

PubMed

BACKGROUND: Trauma resuscitations are high-pressure, time-critical events during which health care providers form ad hoc teams to rapidly assess and treat injured patients. Trauma team members experience varying levels of workload during resuscitations resulting from the objective demands of their role-specific tasks, the circumstances surrounding the event, and their individual previous experiences. The goal of this study was to determine factors influencing workload experienced by trauma team members during pediatric trauma resuscitations. METHODS: Workload was measured using the National Aeronautics and Space Administration Task Load Index (TLX). TLX surveys were administered to four trauma team roles: charge nurse, senior surgical resident (surgical coordinator), emergency medicine physician, and junior surgical resident or nurse practitioner (bedside clinician). A total of 217 surveys were completed. Univariate and multivariate statistical techniques were used to examine the relationship between workload and patient and clinical factors. RESULTS: Bedside clinicians reported the highest total workload score (208.7), followed by emergency medicine physicians (156.3), surgical coordinators (144.1), and charge nurses (129.1). Workload was higher during higher-level activations (235.3), for events involving intubated patients (249.0), and for patients with an Injury Severity Score greater than 15 (230.4) (p, 0.001 for all). When controlling for potential confounders using multiple linear regression, workload was increased during higher level activations (79.0 points higher, p = 0.01) and events without previous notification (38.9 points higher, p = 0.03). Workload also remained significantly higher for the bedside clinician compared with the other three roles (p ? 0.005 for all). CONCLUSION: Workload during pediatric trauma resuscitations differed by team role and was increased for higher-level activations and events without previous notification. This study demonstrates the validity of the TLX as a tool to measure workload in trauma resuscitation. PMID:23032804

Parsons, Samantha E; Carter, Elizabeth A; Waterhouse, Lauren J; Sarcevic, Aleksandra; O'Connell, Karen J; Burd, Randall S

2012-10-01

309

Pericardial rupture from blunt chest trauma  

PubMed Central

Borrie, J. and Lichter, I. (1974).Thorax, 29, 329-337. Pericardial rupture from blunt chest trauma. Pericardial rupture may occur in two distinct anatomical sites, namely the diaphragmatic pericardium and the pleuropericardium. They may be combined. The problems in each type are different. In ruptured diaphragmatic pericardium the rent may involve the pericardial cavity alone, or may extend into one or both adjoining pleural cavities. Upward herniation of abdominal viscera can occur, with or without strangulation. The presence of a pericardial rent may be suggested by diagnostic pneumoperitoneum, and chest films showing displaced abdominal viscera; its extent may be fully revealed only by thoracotomy. If the rent involves only the diaphragmatic pericardium without lateral spread into a pleural cavity, the presence of a rent may be revealed only by exploratory thoracotomy with pericardiotomy. In ruptured pleuropericardium the rent is usually vertical and may occur on either side, more usually on the left. It may be recognized on chest films in its early stages by the presence of intrapericardial air arising from associated lung trauma. There is serious risk of heart dislocation with or without strangulation. The defect must be surgically repaired and, because of pericardial retraction, it may require a fabric patch. Teflon fabric has proved to be a long-term satisfactory pericardial substitute. Two cases of each type of pericardial rupture are described and illustrate these points. Images

Borrie, J.; Lichter, I.

1974-01-01

310

Trauma and Mobile Radiography  

SciTech Connect

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

Drafke, M.W.

1989-01-01

311

Trauma Surgery Malpractice Risk  

PubMed Central

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.

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.

2005-01-01

312

[Ruptured abdominal aortic aneurysm].  

PubMed

Rupture of the abdominal aortic aneurysm is a high lethal risk pathology, which requires precise diagnosis and urgent and efficient surgical treatment. Despite improved diagnostic capabilities (echoscopy, in specialized departments--angiography, computed tomography, magnetic nucleus resonance), mortality related to this pathology remains high in intensive care units. In the present article data concerning prevalence and clinical outcomes of the rupture of the abdominal aortic aneurysm for 1999-2001 is presented in detail. During this period 22 patients have undergone surgery due to abdominal aortic aneurysm rupture. Described are most prevalent complications, mortality rates and causes, analyzed are treatment strategy and tactics. PMID:12474751

Urbonavicius, Sigitas; Antusevas, Aleksandras

2002-01-01

313

[Ultrasound for abdominal lymphadenopathy].  

PubMed

This CME-review is about the clinical importance of the abdominal lymph node diagnostic with special attention to various ultrasound techniques. This includes innovative techniques like contrast enhanced ultrasound and elastography. The clinical importance of ultrasound in relation to cross sectional imaging will be the target of the article as well as anatomic- topographic aspects. The article deals as well with endosonographic techniques because of the upmost importance of the technique for diagnosing mediastinal and abdominal lymphnode swellings. In conclusion of the article different clinical scenarios and clinical algorithms are presented to help the reader to diagnose abdominal lymphadenopathy correctly in an efficient way. PMID:23633280

Dietrich, C F; Hocke, M; Jenssen, C

2013-04-30

314

Abdominal subcutaneous emphysema: an unusual complication of lumbar epidural block  

Microsoft Academic Search

To the Editor: Subcutaneous emphysema is a rare complication of epidural anaesthesia. Laman and McLeskey first reported a case of cervical and supraclavieular subcutaneous emphysema associated with lumbar epidural block in a parturient. We recently anaesthetized a healthy 20-year-old male who was admitted to the hospital atter a road traffic accident. No signs of abdominal trauma were noted. The patient

Beno Rozenberg; Serio Tischler; Aldo Glick

1988-01-01

315

Traumatic pseudoaneurysm of abdominal aorta in a child  

Microsoft Academic Search

A 6-year-old child sustained blunt abdominal trauma leading to formation of infrarenal aortic pseudoaneurysm eroding the vertebra\\u000a with impairment of blood flow in bilateral lower limbs (absent bilateral femoral pulsations) and paraplegia. Resection of\\u000a aneurysm was done alongwith reconstruction of aorta and iliac arteries with expended Poly-Tetra-Flouro-Ethylene (e PTFE) patch.\\u000a Right common iliac artery was directly anastomosed to left common

Vikas Goyal; Sanjeev Devgarha; Kumar Asnani; Chandra Prakash Srivastava

2009-01-01

316

[Acute surgical diseases and injuries of the abdominal organs in mentally ill patients].  

PubMed

The work analyses the results of treatment of acute surgical diseases and traumas of the abdominal organs in 84 patients 18 to 81 years of age suffering from various mental disorders. Schizophrenia was encountered in 47 patients, the manic-depressive syndrome in 16, epilepsy in 8, reactive psychosis in 8, and senile psychosis in 5 patients. Among 66 patients who were admitted for suspected acute surgical disease of the abdominal organs, in 54 the diagnosis was confirmed. Operation was conducted on 59 of them. Eighteen patients had an abdominal trauma. Fourteen patients were operated on for closed (2) and open (12) abdominal injury. All in all 73 patients were treated by operation. Eight patients died. The causes of death were peritonitis and intoxication (4), thromboembolism of the pulmonary artery (1), acute cardiovascular insufficiency (2), and pulmonary edema (1). The peculiarities of the diagnosis and postoperative management of these patients are discussed. PMID:2811134

Mamedov, I M; Aliev, S A

1989-08-01

317

Men and Sexual Trauma  

MedlinePLUS

... to Women - Return from War - PTSD and Communities - PTSD Research - Mobile Apps - Páginas en Español - Videos - Web Links PROFESSIONAL ABOUT US PTSD Awareness Month Men and Sexual Trauma Men and ...

318

Thoracic cardiovascular trauma.  

PubMed

Trauma is the third leading cause of death in the United States and the leading cause for persons under 40 years of age; chest trauma accounts for more than 25% of these deaths. Rates of trauma to the chest--both blunt and penetrating--are rising because of the continuing development of high-speed transportation and because of increasing inner-city violence combined with ready availability of handguns. But treatment has improved; even injury to the heart is no longer considered invariably lethal. This review describes the spectrum of injuries to the pericardium, heart, aorta, and thoracic arteries and veins, exclusive of iatrogenic trauma and high-velocity gun shot injuries caused by military weapons. The role of imaging is described. PMID:3302291

Godwin, J D; Tolentino, C S

1987-07-01

319

Shock Trauma Studies.  

National Technical Information Service (NTIS)

This citation summarizes a one-page announcement of technology available for utilization. Several mathmatical developments at the Chemical Systems Laboratory have revealed new dimensions in the use of shock trauma data to characterize and evaluate the sev...

1982-01-01

320

Neurological Surgery of Trauma.  

National Technical Information Service (NTIS)

Partial Contents: MIILITARY NEUROSURGERY- HeaD INJURIES, SPINAL CORD INJURIES, Management of Neurosurgical Casualtes in the Korean War- INTRODUCTORY NOTE, HISTORICAL DATA, ORGANIZATIONAL DATA, CRANIOCerebral Trauma-GeNeRAL COnsiderations DiFFerential Diag...

L. D. Heaton

1965-01-01

321

Trauma is Danger.  

National Technical Information Service (NTIS)

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 ...

D. Pannell E. A. Elster N. Porterfield P. F. Hwang T. A. Davis

2011-01-01

322

Imaging in orbital trauma  

PubMed Central

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.

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

2012-01-01

323

Prevention of Perineal Trauma  

Microsoft Academic Search

\\u000a Perineal trauma is a highly prevalent condition. The short- and long-term morbidity associated with perineal repair can lead\\u000a to major physical, psychological, and social problems. Although it would be impossible to completely prevent perineal trauma,\\u000a it could be minimized. Proven strategies include the practice of perineal massage in the antenatal period, delayed pushing\\u000a in the second stage of labor with

Ranee Thakar; Abdul H. Sultan

324

Ultrasound in Paediatric Trauma  

Microsoft Academic Search

Investigation of paediatric skeletal trauma requires careful consideration of not only the site of injury, but the proposed\\u000a mechanism of trauma and the age of the child. Ultrasound is increasingly being used to detect and delineate musculoskeletal\\u000a injury, either as the primary imaging modality or as an adjunct to other modalities, particularly magnetic resonance imaging\\u000a (MRI). The advent of high

James Teh

325

[Role of chest physician in the management of patient with thoracic trauma].  

PubMed

Thoracic traumas are frequent and potentially fatal, because of the associated neurological and abdominal lesions. They are observed in car crashes, combat environments and urban terrorist bombings. The mechanisms of the traumatic injury are complex and account for the diversity of the lesions. The management of a chest trauma patient is a model of multidisciplinary collaboration where the chest physician can make a significant contribution. PMID:20933165

Margery, J; Le Floch, H; Rivière, F; Ngampolo, I; Boddaert, G; Grand, B; Mairovitz, A; Minvielle, F; Marotel, C; Pons, F; Vaylet, F

2010-09-15

326

Successful surgical treatment of chronic inferior vena caval thrombosis following blunt trauma  

Microsoft Academic Search

Posttraumatic inferior vena cava (IVC) thrombosis is extremely rare. We report a case of surgical treatment for chronic inferior\\u000a vena caval thrombosis 4 years after blunt trauma. A 22-year-old man was referred to our hospital for investigation of an inferior\\u000a vena caval thrombosis. He had a history of blunt abdominal trauma at age 18 while dismantling a medium truck and

Teruaki Ushijima; Tsuyoshi Yachi; Yuji Nishida

2007-01-01

327

Common femoral artery injury secondary to bicycle handlebar trauma  

Microsoft Academic Search

Bicycle-related trauma results in more than 500,000 emergency department visits in the United States annu- ally.1 Between 5% and 10% of serious bicycle injuries are caused by impact with the handlebar.2,3 One recognized mechanism of injury occurs when the rider falls onto the end of the bicycle handlebar. The abdominal viscera are most commonly injured during handlebar impact. It is

Mark R. Sarfati; Spencer W. Galt; Gerald S. Treiman; Larry W. Kraiss

2002-01-01

328

Pancreatic pseudocyst in a child due to blunt andominal trauma during a football game  

PubMed Central

Pancreatic pseudocyst in children due to abdominal trauma is a rare entity. We report a 14-year-old boy suffering from acute pancreatitis due to blunt abdominal trauma that occurred during a football game, and resulted in a large pseudocyst formation. The child was treated conservatively for the post traumatic acute pancreatitis for 4 weeks and thereafter he was followed up for another 2 weeks. At the end of the 6 weeks after the first insult, the child underwent an open cystgastrostomy. Postoperative course was uneventful and the child was discharged on the 6th postoperative day.

Giakoustidis, A; Antoniadis, N; Giorgakis, I; Tsoulfas, G; Dimitriadis, E; Giakoustidis, D

2012-01-01

329

Normal Abdominal CT  

NSDL National Science Digital Library

Set of normal abdominal CT images with various important anatomic structures outlined, for cine viewing to gain a 3D view of the structure and its relationship to adjacent organs.Annotated: trueDisease diagnosis: Normal

Shaffer, Kitt

2007-06-05

330

Intra-abdominal pressure, intra-abdominal hypertension, and pregnancy: a review  

PubMed Central

The last several decades have seen many advances in the recognition and prevention of the abdominal compartment syndrome (ACS) and its precursor, intra-abdominal hypertension (IAH). There has also been a relative explosion of knowledge in the critical care, trauma, and surgical populations, and the inception of a society dedicated to its understanding, the World Society of the Abdominal Compartment Syndrome (WSACS). However, there has been almost no recognition or appreciation of the potential presence, influence, and management of intra-abdominal pressure (IAP), IAH, and ACS in pregnancy. This review highlights the importance and relevance of IAP in the critically ill parturient, the current lack of normative IAP values in pregnancy today, along with a review of the potential relationship between IAH and maternal diseases such as preeclampsia-eclampsia and its potential impact on fetal development. Finally, current IAP measurement guidelines are questioned, as they do not take into account the gravid uterus and its mechanical impact on intra-vesicular pressure.

2012-01-01

331

Intra-abdominal pressure, intra-abdominal hypertension, and pregnancy: a review.  

PubMed

The last several decades have seen many advances in the recognition and prevention of the abdominal compartment syndrome (ACS) and its precursor, intra-abdominal hypertension (IAH). There has also been a relative explosion of knowledge in the critical care, trauma, and surgical populations, and the inception of a society dedicated to its understanding, the World Society of the Abdominal Compartment Syndrome (WSACS). However, there has been almost no recognition or appreciation of the potential presence, influence, and management of intra-abdominal pressure (IAP), IAH, and ACS in pregnancy. This review highlights the importance and relevance of IAP in the critically ill parturient, the current lack of normative IAP values in pregnancy today, along with a review of the potential relationship between IAH and maternal diseases such as preeclampsia-eclampsia and its potential impact on fetal development. Finally, current IAP measurement guidelines are questioned, as they do not take into account the gravid uterus and its mechanical impact on intra-vesicular pressure. PMID:22873421

Chun, Rosaleen; Kirkpatrick, Andrew W

2012-07-05

332

Abdominal wall desmoid tumors: A case report  

PubMed Central

Desmoid tumors (DTs) are rare lesions that do not possess any metastatic potential. However, they have a strong tendency to invade locally and recur. They constitute 3% of all soft tissue tumors and 0.03% of all neoplasms. Abdominal DTs occur sporadically or are associated with certain familial syndromes, such as familial adenomatous polyposis (FAP). The single form of this neoplasm most frequently occurs in females of reproductive age and during pregnancy. A female patient with a DT of the abdominal wall who had no relevant family history was admitted to hospital. The patient, who presented with a painless mass in the left anterolateral abdomen, had no history of trauma, surgery or childbearing. According to the medical history, physical examination and CT report, the patient was diagnosed with DT. Radical resection of the affected abdominal wall musculature was performed, and the defect was replaced with a polypropylene mesh. The histological diagnosis was of DT. The patient remains in good health and complete remission without any other treatment following surgery. DTs exhibit aggressive growth and have a high rate of recurrence. Surgery is the optimal treatment, and subsequent radiotherapy may decrease the local recurrence rate. Further research into their aetiology is required combined with multicentre clinical trials of new treatments in order to improve management of this disease. This case report provides general knowledge of DT, and may be used as a guidance for diagnosis and treatment.

MA, JIN-HUI; MA, ZHEN-HAI; DONG, XUE-FENG; YIN, HANG; ZHAO, YONG-FU

2013-01-01

333

Functional Abdominal Pain  

Microsoft Academic Search

Functional abdominal pain syndrome (FAPS) is a relatively less common functional gastrointestinal (GI) disorder defined by\\u000a the presence of constant or frequently recurring abdominal pain that is not associated with eating, change in bowel habits,\\u000a or menstrual periods (Drossman Gastroenterology 130:1377–1390, 2006), which points to a more centrally targeted (spinal and supraspinal) basis for the symptoms. However, FAPS is frequently

Madhusudan Grover; Douglas A. Drossman

2010-01-01

334

Surgical Technique for Extent I, II, and III ThoracoAbdominal Aortic Aneurysms  

Microsoft Academic Search

\\u000a Conventional treatment of thoraco-abdominal aortic aneurysms consists of graft replacement with reattachment of the main aortic\\u000a branches. To improve mortality and morbidity rates, a multimodal approach has gradually evolved to reduce the trauma of surgery\\u000a by maximizing organ protection. From a total of 1,108 patients treated for pathology involving the descending thoracic aorta,\\u000a a type I, II, or III thoraco-abdominal

Roberto Chiesa; Germano Melissano; Efrem Civilini

335

Imaging of abdominal abscesses.  

PubMed

The aim of the study is presenting own experiences in using different diagnostic modalities in evaluating abdominal abscesses. Material comprises a group of nine patients with diagnosed abdominal abscess aged between 22 and 78 years. The plain abdominal radiograms, ultrasound examinations and computed tomography were performed in those patients. The CT examination was performed in 10-mm thick axial sections, before and after administering contrast agent. The perirenal abscesses were found in two patients. In US have showed various, inhomogeneous echogenicity, depending on the stage of the abscess. The contrast CT reveals enhancing septa, thick walls and oval, central area of lower density. The plane radiograms revealed abscesses in three cases. In two of them abscesses were complications of previouscholecystectomy. The large abscesses dislocated intestinal loops. CT was necessary to assess the extent, depth and shape of retroperitoneal fluid collections. Abdominal abscess is life threatening condition requiring quick diagnosis and proper management. The imaging methods are especially important in diagnosis of abscesses. Abscesses may by recognized on plain abdominal radiograms, but US and especially CT are much more sensitive and accurate. CT is imaging modality of choice in revealing abdominal abscess. CT and US are very useful in nonoperative therapies, including US and CT guided drainage. PMID:16146093

Pas?awski, Marek; Szafranek-Pyzel, Joanna; Z?omaniec, Janusz

2004-01-01

336

[The abdominal compartment syndrome].  

PubMed

In two patients, a man aged 67 and a woman aged 80, an abdominal compartment syndrome was diagnosed. The man had been treated surgically for an abdominal aortic aneurysm; he recovered after re-operation. The woman had been treated by sigmoidectomy because of ileus. A Bogota bag and a vacuum-assisted wound-closure system were applied to the abdominal wound. Her condition deteriorated, an intestinal perforation became apparent, of which she did not recover and died. An abdominal compartment syndrome should always be kept in mind when a patient at risk presents with increased intra-abdominal pressure and at least one of the following symptoms: oliguria, decreased cardiac output, increased pulmonary-artery pressure, hypotension and acidosis. Measurement of the bladder pressure remains the method of choice to establish the abdominal pressure level. However, there is a lack of correlation between the measured pressure and the clinical condition of the patient. Therefore, the combination of clinical findings and the observed trend in serial measurements of the bladder pressure is preferred to a single pressure measurement. PMID:16008031

Rozeboom, A L; Havekes, B; Steenvoorde, P; Arbous, M S; Elzo Kraemer, C V; van de Velde, C J H

2005-06-11

337

Helical computed tomography characteristics of splenic and hepatic trauma in children subjected to nonoperative treatment  

Microsoft Academic Search

.   The purpose of this study was to present the radiological characteristics of abdominal computed tomography (CT) in the follow-up\\u000a of splenic and hepatic injury in children. Children (n=24) less than 13 years old who had suffered blunt abdominal trauma and were diagnosed with splenic and hepatic injury by\\u000a CT scan prospectively were enlisted in the study. The CT was

Vivian Resende; Wilson Campos Tavares; Domingos Drumond

2002-01-01

338

Abdominal compartment syndrome in children.  

PubMed

Abdominal compartment syndrome is defined as sustained intra-abdominal pressure greater than 20 mm Hg (with or without abdominal perfusion pressure <60 mm Hg) associated with new organ failure or dysfunction. The syndrome is associated with 90% to 100% mortality if not recognized and treated in a timely manner. Nurses are responsible for accurately measuring intra-abdominal pressure in children with abdominal compartment syndrome and for alerting physicians about important changes. This article provides relevant definitions, outlines risk factors for abdominal compartment syndrome developing in children, and discusses an instructive case involving an adolescent with abdominal compartment syndrome. Techniques for measuring intra-abdominal pressure, normal ranges, and the importance of monitoring in the critical care setting for timely identification of intra-abdominal hypertension and abdominal compartment syndrome also are discussed. PMID:23203955

Newcombe, Jennifer; Mathur, Mudit; Ejike, J Chiaka

2012-12-01

339

Consumption of a high glycemic index diet increases abdominal adiposity but does not influence adipose tissue pro-oxidant and antioxidant gene expression in C57BL\\/6 mice  

Microsoft Academic Search

The hypothesis of this study is that consumption of a high glycemic index (GI) starch will increase adiposity, increase expression of the pro-oxidant enzyme (nicotinamide adenine dinucleotide phosphate [NADPH] oxidase), and decrease expression of the antioxidant enzymes (catalase, glutathione peroxidase [GPx], and superoxide dismutase [SOD]) in adipose tissue of mice. C57BL\\/6 mice (n = 5-8\\/group) were fed a diet containing

Katie Colbert Coate; Kevin W. Huggins

2010-01-01

340

Primary closure of the abdominal wall after "open abdomen" situation.  

PubMed

"Open abdomen" is a strategy used to avoid or treat abdominal compartment syndrome. It has reduced mortality both in trauma and non-trauma abdominal catastrophes but also has created a challenging clinical problem. Traditionally, open abdomen is closed in two phases; primarily with a free skin graft and later with a flap reconstruction. A modern trend is to close the abdomen within the initial hospitalization. This requires multi-professional co-operation. Temporary abdominal closure methods, e.g. negative pressure wound therapy alone or combined with mesh-mediated traction, have been developed to facilitate direct fascial closure. Components separation technique, mesh reinforcement or bridging of the fascial defect with mesh and perforator saving skin undermining can be utilized in the final closure if needed. These techniques can be combined. Choice of the treatment depends on the condition of the patient and size of the fascia and skin defect, and the state of the abdominal contents. In this paper we review the literature on the closure of an open abdomen and present the policy used in our institution in the open abdomen situations. PMID:23628632

Kääriäinen, M; Kuokkanen, H

2013-01-01

341

Toxicological screening in trauma  

PubMed Central

Objectives—To determine the prevalence and patterns of alcohol and drug use in patients with major trauma. Methods—Consecutive trauma patient enrolment, 24 hours a day, was envisaged with anonymised patient data on gender, age band, and mechanism of injury collected. The study group had surplus plasma quantitatively analysed for ethanol concentration, and urine samples were initially screened, via immunoassay, for opiates, cannabinoids, amphetamines, benzodiazepines, cocaine, and methadone. Confirmation and specification of individual positive results was then performed using thin layer or gas-liquid chromatography. Drugs of treatment given in the resuscitation room, if subsequently detected in the urine samples, were excluded from the final results. Results—There were 116 eligible trauma patients assessed and treated in the resuscitation room over a six month period, of which 93 (80%) were enrolled. Altogether 27% of this trauma population had plasma ethanol concentrations greater than 80 mg/dl. There was a significantly higher prevalence of alcohol intoxication in the group not involved in a road traffic accident (RTA) compared with the group who were involved in a RTA. Initial screening of urine for drugs revealed a prevalence of 51%. After 12 exclusions due to iatrogenic administration of opiates, the final confirmed prevalence was 35% in this trauma population. The individual drug prevalence was 13% for cannabinoids, 11% for codeine, 8% for morphine, 6% for amphetamine, 6% for benzodiazepines, 3% for cocaine, 1% for dihydrocodeine, and 1% for methadone. Conclusions—There is a notable prevalence of drug and alcohol use in this British accident and emergency trauma population. A significantly higher prevalence for alcohol intoxication was found in the non-RTA group compared with the RTA group. The patterns of drug usage detected reflect local influences and less cocaine use is seen compared with American studies. The association between alcohol, drugs, and trauma, together with ethically acceptable methods of screening, are discussed.

Carrigan, T; Field, H; Illingworth, R; Gaffney, P; Hamer, D

2000-01-01

342

Efficacy and safety of non-operative management of blunt liver trauma  

Microsoft Academic Search

Background  The liver is the most frequently affected organ during blunt abdominal trauma. Blunt liver trauma management has changed in\\u000a the last two decades with the introduction of the computed tomography (CT) scan and non-operative management of stable patients.\\u000a \\u000a \\u000a \\u000a \\u000a Objective  To determine the incidence, efficacy, and failure rate of blunt liver trauma non-operative management as well as the risk\\u000a factors associated with

C. MoralesL; L. Barrera; M. Moreno; M. Villegas; J. Correa; L. Sucerquia; W. Sanchez

343

Traumatic abdominal wall hernia  

PubMed Central

INTRODUCTION Traumatic abdominal wall hernia (TAWH) is a rare entity. Most cases occur in children, following an injury from the bicycle handle bar. In adults, it usually results from road traffic accidents (RTA). We present one of the largest reported cases of TAWH following RTA managed by delayed mesh repair. PRESENTATION OF CASE A 35 yr old obese male with RTA was diagnosed with TAWH with 19 cm × 15 cm defect in left flank. As there were no intra abdominal injuries and overlying skin was abraded, he was planned for elective repair after 6 months. On exploration a defect of 30 cm × 45 cm was found extending from midline anteriorly to 8 cm short of midline posteriorly in transverse axis and costal margin to iliac crest in craniocaudal axis. After restoration of bowel into abdominal cavity, primary closure or even approximation of muscular defect was not possible thus a mesh closure using 60 cm × 60 cm prolene mesh in subcutaneous plane was done. After 4 months follow up, patient is healthy and has no recurrence. DISCUSSION Emergent surgical management of TAWH is usually favoured due to high incidence of associated intra abdominal injuries. Delayed repair may be undertaken in selected cases. CONCLUSION TAWH, although rare, should be suspected in cases of RTA with abdominal wall swellings. With time, the hernia defect may enlarge and muscles may undergo atrophy making delayed repair difficult.

Yadav, Siddharth; Jain, Sunil K.; Arora, Jainendra K.; Sharma, Piyush; Sharma, Abhinav; Bhagwan, Jai; Goyal, Kaushal; Sahoo, Bhabani S.

2012-01-01

344

Multiple Organ System Trauma: The Regional Trauma Center Approach.  

National Technical Information Service (NTIS)

This paper will review the modern concepts and systems approach to the management of multiple organ systems trauma. This type of trauma usually results from blunt impacts, such as those associated with vehicular accidents and with falls from great heights...

B. D. Browner

1983-01-01

345

Trauma is danger  

PubMed Central

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.

2011-01-01

346

[A seatbelt sign following a car accident: look for internal abdominal injury].  

PubMed

We present three patients, a 55-year-old man, a 69-year-old woman and a 25-year-old man, with a seatbelt sign following a car accident. All 3 patients exhibited various injuries that may occur in the case of a blunt trauma, for example rib fractures. In one patient, however, symptoms of internal abdominal injury occurred several days after the accident. The presence of a seatbelt sign is associated with an increased risk of internal abdominal injury. We therefore advise a CT scan of the abdomen in patients who present with a seatbelt sign, even if abdominal ultrasound does not reveal signs of injury. PMID:21029483

de Jong, Vincent M; van der Vlies, C H Kees; Luitse, Jan; Meier, Mark A; Ponsen, Kees-anJ; Goslings, J Carel

2010-01-01

347

Abdominal compartment syndrome.  

PubMed

Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are frequently encountered in critically ill patients and carry a high morbidity and mortality risk. Despite these facts, IAH/ACS are still overlooked by many physicians and therefore timely diagnosis is not made and treatment is often inadequate. All clinicians should be aware of the risk factors predicting IAH/ACS, the profound implications and derangements on all organ systems, the clinical presentation, the appropriate measurement of intra-abdominal pressure to detect IAH/ACS and the current treatment options for these detrimental syndromes. This comprehensive review provides knowledge about known facts, unresolved issues and future directions for research to improve patient survival and long-term outcome. PMID:20668421

Mayer, D; Veith, F J; Lachat, M; Pfammatter, T; Hechelhammer, L; Rancic, Z

2010-06-01

348

Bullet embolization to the external iliac artery after gunshot injury to the abdominal aorta: a case report  

PubMed Central

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.

2011-01-01

349

Trauma-Focused CBT for Youth who Experience Ongoing Traumas  

PubMed Central

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

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

2011-01-01

350

Trauma-focused CBT for youth who experience ongoing traumas.  

PubMed

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

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

2011-08-19

351

Secondary Trauma: How Working with Trauma Survivors Affects Therapists  

Microsoft Academic Search

Secondary trauma, a relatively recent topic that has emerged in the field of social work, includes the emotional and psychological effects that working with traumatized clients has on therapists. Secondary trauma can seriously impact therapists' personal and professional well-being. Trauma therapists face major ethical dilemmas if their reactions to being traumatized enter into the therapeutic relationship, exposing clients to psychological

Amy R. Hesse

2002-01-01

352

Trauma-Focused CBT for Youth Who Experience Ongoing Traumas  

ERIC Educational Resources Information Center

|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.

2011-01-01

353

Pediatric skeletal trauma.  

PubMed

Children with traumatic injuries present an emotionally and professionally demanding situation for radiologic technologists. A child's fear and anxiety, developmental stage and the psychological impact on parents and caregivers all affect the technologist's ability to perform a rapid but technically excellent exam. This article examines the specific causes and presentations of unintentional (as opposed to abuse-related) skeletal trauma in children, with emphasis on the role of imaging. The differences between children and adults in terms of injury patterns, healing and complications are discussed, along with efforts to reduce the incidence of childhood skeletal trauma. PMID:11269822

Norris, T G

354

Trauma is danger  

Microsoft Academic Search

Background  Trauma is one of the leading causes of death in young adult patients. Many pre-clinical and clinical studies attempt to investigate\\u000a the immunological pathways involved, however the true mediators remain to be elucidated. Herein, we attempt to describe the\\u000a immunologic response to systemic trauma in the context of the Danger model.\\u000a \\u000a \\u000a \\u000a \\u000a Data Sources  A literature search using PubMed was used to

Paul F Hwang; Nancy Porterfield; Dylan Pannell; Thomas A Davis; Eric A Elster

2011-01-01

355

Transfusion protocol in trauma  

PubMed Central

Blood and blood components are considered drugs because they are used in the treatment of diseases. As with any drug, adverse effects may occur, necessitating careful consideration of therapy. Like any other therapeutic decision, the need for transfusion should be considered on the basis of risks and benefits and alternative treatments available to avoid over- and under-transfusion. This review is focused on the blood transfusion protocol in trauma patients with hemorrhagic shock. Besides, issues related to emergency and massive transfusion have also been elaborated. We conducted a comprehensive MEDLINE search and reviewed the relevant literature, with particular reference to emergency medical care in trauma.

Kaur, Paramjit; Basu, Sabita; Kaur, Gagandeep; Kaur, Ravneet

2011-01-01

356

Model Trauma System Planning and Evaluation.  

National Technical Information Service (NTIS)

This living document, Model Trauma System Planning and Evaluation, is a guide to modern statewide trauma system development. It modernizes the HRSA 1992 Model Trauma Care System Plan. The document is designed to provide trauma care professionals, public h...

2006-01-01

357

Medical Simulation for Trauma Management.  

National Technical Information Service (NTIS)

We have continued our work on developing the fundamental simulation technologies needed for battlefield trauma treatment training software. New approaches to including haptic feedback for trauma surgery have been created through the integration of robotic...

G. A. Higgins G. L. Merril D. A. Meglan

1996-01-01

358

Imaging of blunt pancreatic trauma  

Microsoft Academic Search

Blunt pancreatic trauma is an exceedingly rare but life-threatening injury with significant mortality. Computed tomography\\u000a (CT) is commonly employed as the initial imaging modality in blunt trauma patients and affords a timely diagnosis of pancreatic\\u000a trauma. The CT findings of pancreatic trauma can be broadly categorized as direct signs, such as a pancreatic laceration,\\u000a which tend to be specific but

Satinder Rekhi; Stephan W. Anderson; James T. Rhea; Jorge A. Soto

2010-01-01

359

Liver trauma--operative management.  

PubMed

Civilian liver trauma is generally sustained by blunt injury, with management strategies increasingly focusing on selective non-operative strategies and endovascular intervention. Military liver trauma is more often ballistic in nature and almost always requiring operative intervention. This article reviews established and evolving surgical techniques in the operative management of liver trauma. PMID:21805762

Morrison, J J; Bramley, K E; Rizzo, A G

2011-06-01

360

Transactive memory in trauma resuscitation  

Microsoft Academic Search

This paper describes an ethnographic study conducted to explore the possibilities for future design and development of technological support for trauma teams. We videotaped 10 trauma resuscitations and transcribed each event. Using a framework that we developed, we coded each transcript to allow qualitative and quantitative analysis of the trauma teams' collaborative processes. We analyzed teams' tasks, interactions, and communication

Aleksandra Sarcevic; Ivan Marsic; Michael E. Lesk; Randall S. Burd

2008-01-01

361

Teamwork Errors in Trauma Resuscitation  

Microsoft Academic Search

Human errors in trauma resuscitation can have cascading effects leading to poor patient outcomes. To determine the nature of teamwork errors, we conducted an observational study in a trauma center over a two-year period. While eventually successful in treating the patients, trauma teams had problems tracking and integrating information in a longitudinal trajectory, which resulted in inefficiencies and near-miss errors.

Aleksandra Sarcevic; Ivan Marsic; Randal S. Burd

362

Psychiatric diagnoses, trauma, and suicidiality  

Microsoft Academic Search

BACKGROUND: This study aimed to examine the associations between psychiatric diagnoses, trauma and suicidiality in psychiatric patients at intake. METHODS: During two months, all consecutive patients (n = 139) in a psychiatric hospital in Western Norway were interviewed (response rate 72%). RESULTS: Ninety-one percent had been exposed to at least one trauma; 69 percent had been repeatedly exposed to trauma

Silje K Floen; Ask Elklit

2007-01-01

363

Terror, Trauma and Healing  

Microsoft Academic Search

Trauma can be defined as a stressor which overwhelm someone s ability to cope, characterised by feelings of helplessness in the face of some kind of personal danger. This can be the result of nat- ural events, or more often circumstances such as the abuse of power, betrayal of trust, entrapment, pain or loss. It is not overly dramatic to

Steve Vinay Gunther

2006-01-01

364

Trauma and orthopaedic surgeons  

Microsoft Academic Search

The relationship between elective orthopaedic surgery and the acute management of musculoskeletal trauma has never been comfortable: for many reasons, these two aspects of care of the same system are not easy to combine. In some countries these are distinct specialties, which creates other problems. In the United Kingdom an experiment in which the Birmingham Accident Hospital provided all-system care

PHILIP FULFORD

1997-01-01

365

Structured Sensory Trauma Interventions  

ERIC Educational Resources Information Center

|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

2010-01-01

366

Progress in pediatric trauma  

Microsoft Academic Search

The handling of trauma victims in the pediatric age group has undergone change and improvement in a number of ways. First, receiving facilities, emergency rooms, medical centers, and tertiary pediatric care facilities have all been brought together by community, state, regional, and national planning which has taken into account population needs and the resources of each facility. Communication by telephone,

Martin R. Eichelberger; Judson G. Randolph

1985-01-01

367

Types of Trauma  

MedlinePLUS

... Advanced Search Search PILOTS, the largest citation database on PTSD. What is PILOTS? Receive the PTSD Monthly Update, the PTSD Research Quarterly, or Clinician's Trauma Update-Online. War Violence & Abuse Terrorism Disasters A traumatic event is something life-threatening ...

368

Trends in trauma transfusion  

PubMed Central

Trauma is the leading cause of death in young adults and acute blood loss contributes to a large portion of mortality in the early post-trauma period. The recognition of lethal triad of coagulopathy, hypothermia and acidosis has led to the concepts of damage control surgery and resuscitation. Recent experience with managing polytrauma victims from the Iraq and Afghanistan wars has led to a few significant changes in clinical practice. Simultaneously, transfusion practices in the civilian settings have also been extensively studied retrospectively and prospectively in the last decade. Early treatment of coagulopathy with a high ratio of fresh frozen plasma and platelets to packed red blood cells (FFP:platelet:RBC), prevention and early correction of hypothermia and acidosis, monitoring of hemostasis using point of care tests like thromoboelastometry, use of recombinant activated factor VII, antifibrinolytic drugs like tranexamic acid are just some of the emerging trends. Further studies, especially in the civilian trauma centers, are needed to confirm the lessons learned in the military environment. Identification of patients likely to need massive transfusion followed by immediate preventive and therapeutic interventions to prevent the development of coagulopathy could help in reducing the morbidity and mortality associated with uncontrolled hemorrhage in trauma patients.

Bhananker, Sanjay M; Ramaiah, Ramesh

2011-01-01

369

Nuances in pediatric trauma.  

PubMed

Pediatric trauma evaluation mimics adult stabilization in that it is best accomplished with a focused and systematic approach. Attention to developmental differences, anatomic and physiologic nuances, and patterns of injury equip emergency physicians to stabilize and manage pediatric injury. PMID:23915597

Kenefake, Mary Ella; Swarm, Matthew; Walthall, Jennifer

2013-06-27

370

Early Childhood Trauma  

ERIC Educational Resources Information Center

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

National Child Traumatic Stress Network, 2010

2010-01-01

371

Detection of active intraabdominal hemorrhage after blunt trauma: value of delayed CT scanning  

Microsoft Academic Search

Active hemorrhage is a rare finding at CT following blunt abdominal trauma. The time interval between IV contrast administration\\u000a and scanning the abdomen may impact on the ability to visualize active hemorrhage at CT. We report a case of active hemorrhage\\u000a associated with splenic injury that was identified only at delayed CT scanning.

Carlos J. Sivit

2000-01-01

372

Significance of periportal low-attenuation zones following blunt trauma in children  

Microsoft Academic Search

The CT scans of 400 consecutive children evaluated with CT following blunt abdominal trauma were evaluated to determine the frequency of periportal lowattenuation zones, assess patterns of associated intraabdominal injury, and examine clinical outcome. Periportal low-attenuation zones were noted in 60 children (15%). The presence of these zones was associated with a significantly higher incidence of intraabdominal injury (60% versus

C. J. Sivit; G. A. Taylor; M. R. Eichelberger; D. I. Bulas; C. S. Gotschall; D. C. Kushner

1993-01-01

373

Hepatic trauma: CT findings and considerations based on our experience in emergency diagnostic imaging  

Microsoft Academic Search

Abdominal blunt trauma represents the main cause of death in people of age less than 40 years; the liver injury occurs frequently, with an incidence varying from 3 to 10%. Isolated hepatic lesions are rare and in 77–90% of cases, lesions of other organs and viscera are involved.Right hepatic lobe is a frequent site of injury, because it is the

Luigia Romano; Sabrina Giovine; Guido Guidi; Giovanni Tortora; Teresa Cinque; Stefania Romano

2004-01-01

374

A minimally invasive approach to bile duct injury after blunt liver trauma in pediatric patients  

Microsoft Academic Search

A 12-year-old boy presented with a large liver laceration after blunt abdominal trauma. He was treated nonoperatively and subsequently had bile peritonitis from a bile leak. Endoscopic retrograde cholangiopancreatography (ERCP) visualized the bile duct injury and allowed decompression of the biliary tree with an endoscopically placed biliary stent. A drain also was placed over the laceration through a small subcostal

Neal G. Church; Gary May; David L. Sigalet

2002-01-01

375

Laparoscopic total abdominal colectomy  

Microsoft Academic Search

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

1992-01-01

376

Lateral Abdominal Wall Reconstruction  

PubMed Central

Lateral abdominal wall (LAW) defects can manifest as a flank hernias, myofascial laxity/bulges, or full-thickness defects. These defects are quite different from those in the anterior abdominal wall defects and the complexity and limited surgical options make repairing the LAW a challenge for the reconstructive surgeon. LAW reconstruction requires an understanding of the anatomy, physiologic forces, and the impact of deinnervation injury to design and perform successful reconstructions of hernia, bulge, and full-thickness defects. Reconstructive strategies must be tailored to address the inguinal ligament, retroperitoneum, chest wall, and diaphragm. Operative technique must focus on stabilization of the LAW to nonyielding points of fixation at the anatomic borders of the LAW far beyond the musculofascial borders of the defect itself. Thus, hernias, bulges, and full-thickness defects are approached in a similar fashion. Mesh reinforcement is uniformly required in lateral abdominal wall reconstruction. Inlay mesh placement with overlying myofascial coverage is preferred as a first-line option as is the case in anterior abdominal wall reconstruction. However, interposition bridging repairs are often performed as the surrounding myofascial tissue precludes a dual layered closure. The decision to place bioprosthetic or prosthetic mesh depends on surgeon preference, patient comorbidities, and clinical factors of the repair. Regardless of mesh type, the overlying soft tissue must provide stable cutaneous coverage and obliteration of dead space. In cases where the fasciocutaneous flaps surrounding the defect are inadequate for closure, regional pedicled flaps or free flaps are recruited to achieve stable soft tissue coverage.

Baumann, Donald P.; Butler, Charles E.

2012-01-01

377

Abdominal Complications after Severe Burns.  

National Technical Information Service (NTIS)

Abdominal catastrophe in the severely burned patient without abdominal injury has been described. We perceived an alarming recent incidence of this complication in our burn center, both during acute resuscitation and later in the hospital course. We sough...

C. E. White E. M. Renz K. W. Markell L. H. Blackbourne M. E. Albrecht

2009-01-01

378

Abdominal Aortic Aneurysm (AAA) Screening  

MedlinePLUS

... covered? Search Medicare.gov for covered items Abdominal aortic aneurysm screening How often is it covered? Medicare Part B (Medical Insurance) covers a one-time abdominal aortic aneurysm ultrasound. You must get a referral for it ...

379

Management of blunt pancreatic trauma in children.  

PubMed

Blunt trauma to the abdomen accounts for the majority of abdominal injuries in children. Pancreatic injury is the fourth most common solid organ injury, following injuries to the spleen, liver and kidneys. The most common complications are the formation of pancreatic fistulae, pancreatitis and the development of pancreatic pseudocysts, which usually present several weeks after injury. The nonoperative management of minor pancreatic injury is well accepted; however, the treatment of more serious pancreatic injuries with capsular, ductal or parenchymal disruption in pediatric patients remains controversial. Based on the data presented in this literature review, although children with pancreatic injuries (without ductal disruption) do not appear to suffer increased morbidity following conservative management, patients with ductal disruption may benefit from operative intervention. PMID:23982392

Maeda, Kosaku; Ono, Shigeru; Baba, Katsuhisa; Kawahara, Insu

2013-10-01

380

Laparoscopic repair of traumatic abdominal wall hernia from handlebar injury.  

PubMed

A 14-year-old boy was seen at an outside hospital after falling over the handlebar of his bicycle and was discharged home. He was subsequently seen in our emergency department with complaints of persistent abdominal pain. A computed tomography scan of the abdomen revealed disruption of the muscles of the upper right abdominal wall containing the hepatic flexure of the colon, with a small amount of intraperitoneal free fluid noted. The patient underwent laparoscopic exploration using 3 ports (2-5 mm and 1-12 mm) and 2 separate stab incisions. The traumatic abdominal wall hernia was repaired with interrupted sutures placed with an ENDO CLOSE (Covidien, Mansfield, MA) device, and a mesenteric defect in the colon was approximated with intracorporeal sutures. The trocar sites were sutured closed. The patient recovered well and was discharged home. Follow-up examination revealed no abdominal wall defect and resolution of his symptoms. Laparoscopic repair of a traumatic abdominal wall defect and exploratory laparoscopy after trauma is feasible and safe in the pediatric patient. It should be considered as an alternative approach with potentially less morbidity than an exploratory laparotomy for handlebar injuries in a stable patient. PMID:21616228

Rowell, Erin E; Chin, Anthony C

2011-05-01

381

Trauma triage: New York experience.  

PubMed

New York State developed a statewide trauma program in the early 1990s. Designation of trauma centers and prehospital triage of patients by emergency medical services are pillars of the system. Outcomes are evaluated as part of the quality improvement system. New York has a statewide trauma registry with population-based data for all of the state but New York City. Studies made possible because of the trauma registry provided evidence to guide revision of the emergency medical services trauma triage protocol for adult patients. For example, pulse < 50 or > 120 beats/min was retained as a physiologic criteria, while crumple zone and crash speed were eliminated as mechanism criteria. Patients with certain physiologic criteria treated in regional centers showed a considerably reduced mortality rate when compared with patients treated in area trauma centers and noncenters. Other "high-risk" populations were identified for special consideration by emergency medical technicians for trauma center transport because of their associated higher mortality. One "high-risk" group, patients older than 55 years or younger than 5 years, has associated 11% mortality (compare with a statewide average of 7.43%) and represents 41% of all registry patients. Population-based trauma registries and structured prehospital trauma records that accurately record the presence or absence of trauma criteria are essential to evaluate trauma triage criteria; improve quality, efficiency, and access; and guide care. PMID:16801264

Henry, Mark C

382

Autologous closure of giant abdominal wall defects.  

PubMed

Split-thickness skin graft coverage of exposed and granulating intestines within large abdominal wall defects provides a life-saving permanent biologic dressing. The resultant abdominal wall defect often is closed with mesh, which may infect and fistulize. This report describes bilateral advancement flaps of the external oblique and recti muscles in 11 patients treated over 3 years. The defects, which averaged 16 x 24 cm, were due to necrotizing fasciitis subsequent to trauma with bowel perforation (3 patients), multiple ventral herniorrhaphies (2 patients), perforated diverticulitis (4 patients), and perforated peptic ulcer (2 patients). Eight patients were initially treated elsewhere where closure was achieved by split-thickness skin graft in five patients or mesh in 3 patients; 3 developed enterocutaneous fistulae and were transferred for closure while receiving long-term antibiotic and total parenteral nutrition therapy. All 11 patients had successful primary closure. The 8 patients operated on electively had primary healing; 2 developed seromas. Two of the three patients operated on urgently developed superficial wound infections; both healed by second intent without compromise of the primary closure. The following conclusions can be drawn: (1) the linea alba survives despite necrotizing fasciitis, (2) a tension-free primary closure is feasible; (3) morbidity is minimal, and (4) the long-term result is excellent. PMID:9655268

Lucas, C E; Ledgerwood, A M

1998-07-01

383

Exsanguination in trauma: A review of diagnostics and treatment options.  

PubMed

Trauma patients with haemorrhagic shock who only transiently respond or do not respond to fluid therapy and/or the administration of blood products have exsanguinating injuries. Recognising shock due to (exsanguinating) haemorrhage in trauma is about constructing a synthesis of trauma mechanism, injuries, vital signs and the therapeutic response of the patient. The aim of prehospital care of bleeding trauma patients is to deliver the patient to a facility for definitive care within the shortest amount of time by rapid transport and minimise therapy to what is necessary to maintain adequate vital signs. Rapid decisions have to be made using regional trauma triage protocols that have incorporated patient condition, transport times and the level of care than can be performed by the prehospital care providers and the receiving hospitals. The treatment of bleeding patients is aimed at two major goals: stopping the bleeding and restoration of the blood volume. Fluid resuscitation should allow for preservation of vital functions without increasing the risk for further (re)bleeding. To prevent further deterioration and subsequent exsanguinations 'permissive hypotension' may be the goal to achieve. Within the hospital, a sound trauma team activation system, including the logistic procedure as well as activation criteria, is essential for a fast and adequate response. After determination of haemorrhagic shock, all efforts have to be directed to stop the bleeding in order to prevent exsanguinations. A simultaneous effort is made to restore blood volume and correct coagulation. Reversal of coagulopathy with pharmacotherapeutic interventions may be a promising concept to limit blood loss after trauma. Abdominal ultrasound has replaced diagnostic peritoneal lavage for detection of haemoperitoneum. With the development of sliding-gantry based computer tomography diagnostic systems, rapid evaluation by CT-scanning of the trauma patient is possible during resuscitation. The concept of damage control surgery, the staged approach in treatment of severe trauma, has proven to be of vital importance in the treatment of exsanguinating trauma patients and is adopted worldwide. When performing 'blind' transfusion or 'damage control resuscitation', a predetermined fixed ratio of blood components may result in the administration of higher plasma and platelets doses and may improve outcome. The role of thromboelastography and thromboelastometry as point-of-care tests for coagulation in massive blood loss is emerging, providing information about actual clot formation and clot stability, shortly (10min) after the blood sample is taken. Thus, therapy guided by the test results will allow for administration of specific coagulation factors that will be depleted despite administration with fresh frozen plasma during massive transfusion of blood components. PMID:19135193

Geeraedts, L M G; Kaasjager, H A H; van Vugt, A B; Frölke, J P M

2009-01-08

384

Isolated right atrial tear following blunt trauma  

PubMed Central

Cardiac chamber rupture in blunt trauma is uncommon and is associated with a high mortality rate. We report a patient involved in a motor vehicle collision with an isolated right atrial injury resulting in a pericardial effusion associated with hemodynamic compromise. A 20 year-old intoxicated female was transported after sustaining a collision in her vehicle. The patient remained mildly hypotensive and tachycardic despite volume resuscitation. FAST was negative showing good cardiac motion and no fluid in her abdomen. A CT scan revealed a mediastinal hematoma and free intra-abdominal fluid, and trans-thoracic echocardiogram (TTE) identified a mass within the right atrium associated with a pericardial effusion. In the operating room, clot was removed from within the pericardium. Hypothermic circulatory arrest and cardiopulmonary bypass were performed and a single laceration involving the right atrium was repaired after removing a large intra-atrial clot. A negative concurrent exploratory laparotomy was performed. The patient was discharged from the hospital postoperative day 6. This report presents an isolated right atrial tear associated with pericardial tamponade following blunt trauma and we discuss the role of early diagnosis and treatment.

Gajjar, AH; Atherton, JT

2011-01-01

385

Patterns of abdominal injuries in frontal and side impacts.  

PubMed

Public awareness for safety and vehicle improvements has contributed to significant reduction in injuries secondary to motor vehicle crashes. The spectrum of trauma has shifted from one region of the body to another with varying consequences. For example, airbags have minimized head and neck injuries for adults while emphasizing the lower regions of the human body. Studies have concentrated on the changing patterns of these injuries in frontal impacts. However, there is almost a paucity of data with regard to the characterization of abdominal injuries. Consequently, this study was conducted to determine the patterns of abdominal injuries in frontal and side impacts with an emphasis on more recent crashes. In particular, the frequency and severity of trauma were investigated with a focus on the various abdominal organs (e.g., spleen and liver). Results indicate that side crashes contribute to a large percentage of injuries to the abdomen. The liver and spleen organs are most vulnerable; therefore, it may be beneficial to apply concerted efforts to focus on injury biomechanics research and prioritization activities in these areas of the abdomen. These data may be of benefit to develop anthropomorphic dummies with improved biofidelity. PMID:11558081

Yoganandan, N; Pintar, F A; Gennarelli, T A; Maltese, M R

2000-01-01

386

Pilot study of the prevalence, outcomes and detection of occult hypoperfusion in trauma patients  

Microsoft Academic Search

BackgroundOccult hypoperfusion (OH) is defined as hypoperfusion in the presence of normal vital signs. It is associated with increased length of stay (LOS) and increased mortality.ObjectivesTo compare four methods of detecting OH in adult major trauma patients at a level 1 trauma centre—base excess (BE), non-invasive cardiac index (CI), shock index (SI) and rate over pressure evaluation (ROPE).MethodPatients meeting the

Ogilvie Thom; David McD Taylor; Rachel E Wolfe; Paul Myles; Henry Krum; Rory Wolfe

2010-01-01

387

Evaluation of the relationship between pelvic fracture and abdominal compartment syndrome in traumatic patients  

PubMed Central

Introduction: An increase in abdominal pressure can lead to so-called intra–abdominal compartment syndrome (ACS). Multiple factors such as an increase in retroperitoneal volume due to pancreatitis, bleeding and edema as a result of pelvic fracture can lead to compartment syndrome. Prevention is better than cure in compartment syndrome. By measuring the intra-abdominal pressure (IAP) through the bladder, a quick and accurate assessment of abdominal pressure is achieved. Therefore, this study aimed to evaluate the relationship between pelvic fracture and ACS in traumatic patients. Materials and Methods: This research was a descriptive–analytical study conducted on 100 patients referring to the Shiraz Nemazee Hospital in 2010. IAP was monitored every 4 h in patients suspected to be at high risk for ACS, e.g., those undergoing severe abdominal trauma and pelvic fracture. The IAP was measured via the urinary bladder using the procedure described by Kron et al. Data collected were analyzed using SPSS software. Results: The findings showed that ACS occurred in 28 of 100 patients. With regard to the associated injuries with abdominal trauma, 19% of all patients and 46/42% of the patients with ACS had pelvic fracture. Chi-square test revealed a significant relationship between pelvic fracture and incidence rate of ACS (P < 0.001). Conclusions: According to the collected data, pelvic fracture due to a trauma can be one of the important causes of an increase in IAP and ACS. In this lethal condition, prevention is better than cure. Therefore, serial measurement of IAP through the bladder in high-risk patients (those with pelvic fracture by trauma) is recommended to the nurses to diagnose this condition and to decrease the incidence of mortality.

Ali, Sheikhi Rahim; Mohammad, Heidari; Sara, Shahbazi

2013-01-01

388

Trauma Films, Information Processing, and Intrusive Memory Development  

Microsoft Academic Search

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

2004-01-01

389

Pediatric head trauma.  

PubMed

Head trauma is a frequent cause of morbidity and mortality in the pediatric population. The type of injury that results depends on the mechanism of trauma and the age of the patient. Newborns, after difficult delivery, may have posteriorly located subdural hematomas owing to tearing of tentorium and venous structures. Young infants are particularly susceptible to shaking injury because of their weak neck muscles and thus may sustain subdural hematomas, shearing injuries, and diffuse swelling. As the child becomes mobile, falls become the number one cause of accidental injury, frequently producing fractures and contusions. In older children and teenagers, motor vehicle accidents predominate as the cause of severe head injury, particularly DAI. By appreciating these and other pertinent factors, the radiologist knows what to search for in a study; knows which modality, CT or MR, to use; and can frequently indicate the prognosis. Most importantly, the radiologist may be the first one to bring attention to the possibility of child abuse. PMID:8081632

Zimmerman, R A; Bilaniuk, L T

1994-05-01

390

Mysterious Abdominal Pain  

PubMed Central

A man presented to the emergency room with recurrent episodes of abdominal pain. He had a history of coronary artery bypass grafting of the left internal mammary artery (LIMA) to the left anterior descending (LAD) artery and the right gastroepiploic artery to the posterior descending artery. After numerous gastrointestinal evaluations, a stress test was performed, which was positive. Coronary angiography showed a proximal occlusion of the LAD and right coronary artery and a normal functioning LIMA bypass. Aortography showed a 95% stenosis of the celiac trunk. Angioplasty and stent implantation of the celiac trunk was successfully performed. Six months later the patient was completely asymptomatic with a negative stress test. In conclusion, abdominal pain in patients who have undergone coronary artery bypass surgery using the right gastroepiploic artery should raise suspicion not only of a stenosis of the arterial conduit but also of a potential stenosis of the celiac trunk.

Cappelletti, Alberto; Cristell, Nicole; Mazzavillani, Monica; Margonato, Alberto

2011-01-01

391

Mechanisms of blunt liver trauma patterns: An analysis of 53 cases.  

PubMed

Blunt liver trauma is the most dangerous and the second most frequent solid organ trauma that occurs in the abdominal cavity. Management of this life-threatening situation remains a significant challenge. The present study identified that the patterns of blunt liver trauma were closely correlated with the characteristics of the blunt force. Illustrations of findings from this study have been included in the hope that they may aid surgeons in improving the management of this emergency. In total, 53 cases of blunt liver trauma that underwent laparotomy in the First Affiliated Hospital of Wenzhou Medical College between 1999 and 2009 were retrospectively studied. The cause of the injury, the direction and site of the blunt force, surgical records and CT films were carefully studied to obtain information on the patterns and severity of the liver injury and the correlation with blunt forces. Trauma in the right lobe of the liver was mainly caused by acceleration, deceleration and compression of the liver, while in the left lobe of the liver, acceleration was the main cause of the trauma. Liver lacerations were always located close to the attachment sites of the ligaments which bore the majority of the shearing stress. The characteristics of the blunt force play a key role in the different patterns of blunt liver trauma. A thorough understanding of the mechanisms of blunt liver trauma may aid doctors in the management of patients with this condition. PMID:23404632

Jin, Wangxun; Deng, Liming; Lv, Heping; Zhang, Qiyu; Zhu, Jinying

2012-11-27

392

Obesity-Associated Abdominal Elephantiasis  

PubMed Central

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.

Kohli, Ritesh; Argento, Vivian; Amoateng-Adjepong, Yaw

2013-01-01

393

The Abdominal Circulatory Pump  

PubMed Central

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

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

2009-01-01

394

Robotic abdominal surgery  

Microsoft Academic Search

As a whole, abdominal surgeons possess excellent videoendoscopic surgical skills. However, the limitations of laparoscopy—such as reduced range of motion and instrument dexterity and 2-dimensional view of the operative field—have inspired even the most accomplished laparoscopists to investigate the potential of surgical robotics to broaden their application of the minimally invasive surgery paradigm. This review discusses data obtained from articles

Eric J. Hanly; Mark A. Talamini

2004-01-01

395

Cardiopulmonary Resuscitation in Trauma  

Microsoft Academic Search

Cardiopulmonary resuscitation (CPR) in a patient with multiple injuries involves a different approach than in a nontrauma\\u000a patient. Although the basic principles are the same as dealt with in other chapters of this book, CPR in the trauma victim\\u000a has to address prevention of cardiopulmonary failure from problems exclusive to the injured patient. This chapter concentrates\\u000a on these issues and

Rao R. Ivatury; Kevin R. Ward

396

Ocular trauma in children.  

PubMed

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

397

Pediatric abusive head trauma.  

PubMed

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

2013-06-01

398

Ballistic Trauma in Pregnancy  

Microsoft Academic Search

\\u000a During peacetime, trauma is consistently listed as the most common cause of nonobstetric complications of pregnancy leading\\u000a to some degree of morbidity and regrettably mortality in approximately 7% of all pregnancies.1,2 The maternal mortality from penetrating injuries is less in pregnancy-4% as compared with 13% in the nonpregnant state.2 Fetal mortality, however, is high approaching 42–71%, depending on penetrating mechanism

Michael J. Socher; Peter E. Nielsen

399

Amputation in Combat Trauma  

Microsoft Academic Search

\\u000a Despite the advances of modern orthopedic trauma techniques, the amputation rate for injured victims of modern warfare is\\u000a on the rise. Increased devastation from high-velocity missiles and the prevalence of high-energy explosives in combat are\\u000a directly responsible for the rise in extremity injuries. The globalization of disaster response has placed military surgeons\\u000a at the forefront of the acute care provided

Nikolaj Wolfson; Samuel C. Schecter

400

Delayed Presentation of Isolated Complete Pancreatic Transection as a Result of Sport-Related Blunt Trauma to the Abdomen  

Microsoft Academic Search

Introduction: Blunt abdominal trauma is a rare but well-recognized cause of pancreatic transection. A delayed presentation of pancreatic fracture following sport-related blunt trauma with the coexisting diagnostic pitfalls is presented. Case Report: A 17-year-old rugby player was referred to our specialist unit after having been diagnosed with traumatic pancreatic transection, having presented 24 h after a sporting injury. Despite haemodynamic

Andrew J. Healey; Ioannis Dimarakis; Madhava Pai; Long R. Jiao

2008-01-01

401

Functional abdominal pain  

PubMed Central

Functional abdominal pain or functional abdominal pain syndrome (FAPS) is an uncommon functional gut disorder characterised by chronic or recurrent abdominal pain attributed to the gut but poorly related to gut function. It is associated with abnormal illness behaviour and patients show psychological morbidity that is often minimised or denied in an attempt to discover an organic cause for symptoms. Thus the conventional biomedical approach to the management of such patients is unhelpful and a person's symptom experience is more usefully investigated using a biopsychosocial evaluation, which necessarily entails a multidisciplinary system of healthcare provision. Currently the pathophysiology of the disorder is poorly understood but is most likely to involve a dysfunction of central pain mechanisms either in terms of attentional bias, for example, hypervigilance or a failure of central pain modulation/inhibition. Although modern neurophysiological investigation of patients is promising and may provide important insights into the pathophysiology of FAPS, current clinical management relies on an effective physician-patient relationship in which limits on clinical investigation are set and achievable treatment goals tailored to the patient's needs are pursued.

Matthews, P; Aziz, Q

2005-01-01

402

Nonoperative Management of Blunt Splenic Trauma: Also Feasible and Safe in Centers with Low Trauma Incidence and in the Presence of Established Risk Factors  

Microsoft Academic Search

\\u000a Abstract\\u000a \\u000a \\u000a Background:\\u000a   Treatment of blunt splenic trauma has undergone dramatic changes over the last few decades. Nonoperative management (NOM)\\u000a is now the preferred treatment of choice, when possible. The outcome of NOM has been evaluated. This study evaluates the results\\u000a following the management of blunt splenic injury in adults in a Swedish university hospital with a low blunt abdominal trauma

Gustav Norrman; Bobby Tingstedt; Mikael Ekelund; Roland Andersson

2009-01-01

403

Obesity is related to multiple functional abdominal diseases.  

PubMed

Analysis of the body mass index of pediatric patients with gastrointestinal complaints as a whole and by disease subgroup revealed a greater percentage of obese patients with constipation, gastroesophageal reflux, irritable bowel syndrome, encopresis, and functional abdominal pain compared with local and New Jersey control populations. PMID:19874760

Teitelbaum, Jonathan E; Sinha, Prerna; Micale, Maria; Yeung, Steven; Jaeger, Joseph

2009-03-01

404

Has the pendulum swung too far? The impact of missed abdominal injuries in the era of nonoperative management.  

PubMed

Nonoperative management for traumatic injuries has significantly influenced trauma care during the last decade. We undertook this study to assess the impact of nontherapeutic laparotomies for suspected abdominal injuries compared with delayed laparotomies for questionable abdominal injuries for patients with abdominal trauma. The records of patients admitted to the trauma service between 2002 and 2007 who underwent laparotomies deemed nontherapeutic or delayed were retrospectively reviewed. Demographics, severity of injury, management scheme, and outcome data were analyzed. Sixteen patients underwent delayed laparotomies, whereas 26 patients incurred nontherapeutic laparotomies. Injury severity scores, Glasgow coma scale scores, abdominal abbreviated injury scale score (AIS), and age were similar for both populations. Delayed laparotomies occurred an average of 7 +/- 9 days postinjury. Intensive care unit length of stay (26 +/- 24 vs 10 +/- 6 days), hospital length of stay (40 +/- 37 vs 11 +/- 10 days), ventilator days (31 +/- 29 vs 11 +/- 10), and number of abdominal operative procedures (1.9 +/- 1.5 vs 1 +/- 0) were significantly higher in the delayed laparotomies group versus the nontherapeutic laparotomies group, respectively. Delayed diagnosis of intra-abdominal injuries yielded a significantly increased morbidity and mortality. During the evolving era of technological imaging for traumatic injuries, we must not allow the nonoperative pendulum to swing too far. PMID:19655598

Fairfax, Lindsay M; Christmas, A Britton; Deaugustinis, Matthew; Gordon, Latiffany; Head, Karen; Jacobs, David G; Sing, Ronald F

2009-07-01

405

Training nurses in trauma management.  

PubMed

Since major trauma networks were introduced, medical and non-medical staff have been required to undergo trauma training. The recommended training programme is the advanced trauma life support course, but its cost and the difficulties involved in securing study leave can make it unfeasible as a training option. This article discusses the trauma intermediate life support programme, an innovative, one-day programme for staff to acquire knowledge and skills in trauma management. The programme, which focuses on damage-control resuscitation, involves low- and medium-fidelity simulation in trauma or resuscitation rooms. It has been quantitatively reviewed by 50 candidates, who all stated that it has helped them to improve their practice. PMID:23901868

Armstrong, Bruce; Crouch, Rob; Read, Carl; Palfrey, Ros

2013-07-01

406

Diffuse abdominal splenosis mimicking peritoneal metastases in a 35-year-old man with a resectable carcinoma of the ampulla of vater.  

PubMed

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

2013-09-14

407

Diffuse Abdominal Splenosis Mimicking Peritoneal Metastases in a 35-Year-Old Man with a Resectable Carcinoma of the Ampulla of Vater  

PubMed Central

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.

Sorensen, Steffen Filskov; Mortensen, Frank Viborg; Hellberg, Ylva; Ladekarl, Morten

2013-01-01

408

Trauma-related Infections in Battlefield Casualties From Iraq  

PubMed Central

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

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

2007-01-01

409

CT manifestations of adrenal trauma: experience with 73 cases.  

PubMed

Adrenal injuries, although an uncommon consequence of abdominal trauma, are important to recognize. If bilateral, adrenal trauma could result in life-threatening adrenal insufficiency. Furthermore, in the setting of trauma, adrenal injury can point to other concomitant injuries and has been associated with overall increased morbidity and mortality. In the past, before the advent of computed tomography (CT), detection was difficult, and the diagnosis was often made only at surgery or postmortem. Today, the diagnosis of adrenal injuries can be quickly and accurately made with CT. This retrospective review was carried out to identify, describe, and analyze different CT appearances of adrenal injuries and correlated with associated injuries and observed clinical context and outcomes. A patient cohort of CT-detected adrenal injuries was identified through a radiology software research tool by searching for keywords in radiology reports. The identified CT scans were reviewed and correlated with the patients' available clinical chart data and follow-up. Between April 1995 and October 2004, 73 cases of CT-detected adrenal injuries were identified, including 48 men and 25 women, with an age range 6 to 90 years and a mean age of 42.7 years. Of the cases, 77% were right-sided, 15% were left-sided, and 8% were bilateral. The causes of injuries were motor vehicle collisions (75%), falls (14%), sports related (4%), and miscellaneous causes (7%). Associated trauma included injuries of the liver (43%), spleen (23%), lung (19%), and kidney (18%), as well as pneumothoraces/hemothoraces (22%). Skeletal injuries included fractures of the ribs, clavicles, and/or scapulae (39%), pelvis and hips (30%), and the spine (23%). Isolated adrenal trauma was seen in only 4% of the cases. The CT findings of adrenal trauma were focal hematoma (30%), indistinct (27%) or enlarged (18%) adrenal gland, gross (15%) or focal (7%) adrenal hemorrhage, and adrenal mass (11%). Associated CT findings included periadrenal fat stranding (93%), retroperitoneal hemorrhage (22%), and thickened diaphragmatic crura (10%). Active adrenal bleeding was seen in one case (1.4%). The incidence of adrenal trauma was estimated to be 0.86%. Surgical management was required only for the associated injuries. The most common CT manifestations of adrenal trauma include focal hematoma, indistinct or ill-defined adrenal gland, adrenal enlargement or mass, and gross or focal adrenal hemorrhage in a normal-sized gland. Periadrenal stranding is very common. Retroperitoneal hemorrhage and crural thickening are also important associated findings. Operative intervention is typically required only for the associated injuries, which commonly accompany adrenal trauma. PMID:17252249

Sinelnikov, Alex O; Abujudeh, Hani H; Chan, David; Novelline, Robert A

2007-01-25

410

Abdominal wall desmoid tumor mimicking a subserosal uterine leiomyoma  

PubMed Central

Desmoid tumors are cytologically bland fibrous neoplasms originating from musculoaponeurotic structures throughout the body. The cause of desmoid tumors is uncertain, but may be related to trauma or hormonal factors, or may have a genetic association. These tumors can be found in some young women during pregnancy or just after giving birth. We report herein a case of desmoid tumor on the inner aspect of the abdominal wall that mimicked a large subserosal uterine leiomyoma. Initial clinical examination of the patient suggested a large abdominal wall tumor, while the imaging techniques including transabdominal ultrasound and magnetic resonance imaging suggested a large subserosal uterine leiomyoma as the initial diagnosis. This case emphasizes the importance of clinical examination during the diagnostic process.

Al-Jefout, Moamar; Walid, Alabed; Esam, Abomayale; Amin, Alqaisi; Nather, Hawa; Sultan, Nawayse; Maysa, Khadra

2011-01-01

411

Penetrating injuries of the abdominal inferior vena cava.  

PubMed Central

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

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

1996-01-01

412

Imaging manifestations of abdominal fat necrosis and its mimics.  

PubMed

Intraabdominal fat is a metabolically active tissue that may undergo necrosis through a number of mechanisms. Fat necrosis is a common finding at abdominal cross-sectional imaging, and it may cause abdominal pain, mimic findings of acute abdomen, or be asymptomatic and accompany other pathophysiologic processes. Common processes that are present in fat necrosis include torsion of an epiploic appendage, infarction of the greater omentum, and fat necrosis related to trauma or pancreatitis. In addition, other pathologic processes that involve fat may be visualized at computed tomography, including focal lipohypertrophy, pathologic fat paucity (lipodystrophies), and malignancies such as liposarcoma, which may mimic benign causes of fat stranding. Because fat necrosis and malignant processes such as liposarcoma and peritoneal carcinomatosis may mimic one another, knowledge of a patient's clinical history and prior imaging studies is essential for accurate diagnosis. PMID:22084185

Kamaya, Aya; Federle, Michael P; Desser, Terry S

413

Mesothelioma as a rapidly developing Giant Abdominal Cyst  

PubMed Central

The benign cystic mesothelioma of the peritoneum is a rare lesion and is known for local recurrence. This is first case report of a rapidly developing massive abdominal tumor with histological finding of benign cystic mesothelioma (BCM). We describe a BCM arising in the retroperitoneal tis[sue on the right side, lifting ascending colon and cecum to the left side of abdomen. Patient was an active 58-year-old man who noticed a rapid abdominal swelling within a two month time period with a weight gain of 40 pounds. Patient had no risk factors including occupational (asbestos, cadmium), family history, social (alcohol, smoking) or history of trauma. We will discuss the clinical, radiologic, intra-operative, immunohistochemical, pathologic findings, and imaging six months after surgery. Patient has no recurrence and no weight gain on follow up visits and imaging.

2012-01-01

414

[Isolated injuries of the small intestine following blunt abdominal injuries].  

PubMed

Operations were performed on 327 patients for blunt abdominal trauma at the casualty ward of the Istanbul University Hospital, over the past three years. Isolated injuries to small intestines were recorded by laparotomy from 22 of these cases. Peritoneal lavage was applied to 18 patients. Only one patient was operated on with 24-hour delay because of false negative result of lavage. Six of the above 22 patients died (27.2 per cent) despite early surgical action. Five of these six had been admitted to the casualty ward with hypovolaemic shock as well as head and extremity injuries after a traffic accident. PMID:3630442

Belgerden, S; Ozaçmak, I D; Demirkol, K; Kurdo?lu, M

1987-01-01

415

The role of interventional radiology in urologic tract trauma.  

PubMed

The kidney is the third most common abdominal organ to be injured in trauma, following the spleen and liver, respectively. Several classification systems convey the severity of injury to kidneys, ureter, bladder, and urethra. The most commonly used classification scheme is the American Association for the Surgery of Trauma (AAST) classification of blunt renal injuries, which grades renal injury according the size of laceration and its proximity to the renal hilum. Ureteral injury is graded according to its extent relative to the circumference of the ureter and the extent of associated devascularization. Bladder injury is graded according to its location relative to the peritoneum. Urethral injury is graded according to the extent of damage to surrounding anatomic structures. Although these classification schema may not be always used in common parlance, they do help delineate most important features of urologic tract injury that impact patient management and interventions. PMID:23204640

Mani, Naganathan B S; Kim, Lauren

2011-12-01

416

The Role of Interventional Radiology in Urologic Tract Trauma  

PubMed Central

The kidney is the third most common abdominal organ to be injured in trauma, following the spleen and liver, respectively. Several classification systems convey the severity of injury to kidneys, ureter, bladder, and urethra. The most commonly used classification scheme is the American Association for the Surgery of Trauma (AAST) classification of blunt renal injuries, which grades renal injury according the size of laceration and its proximity to the renal hilum. Ureteral injury is graded according to its extent relative to the circumference of the ureter and the extent of associated devascularization. Bladder injury is graded according to its location relative to the peritoneum. Urethral injury is graded according to the extent of damage to surrounding anatomic structures. Although these classification schema may not be always used in common parlance, they do help delineate most important features of urologic tract injury that impact patient management and interventions.

Mani, Naganathan B.S.; Kim, Lauren

2011-01-01

417

Embolization of Isolated Lumbar Artery Injuries in Trauma Patients  

SciTech Connect

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

Sofocleous, Constantinos T., E-mail: constant@pol.net; Hinrichs, Clay R.; Hubbi, Basil; Doddakashi, Satish; Bahramipour, Philip [New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Section of Vascular and Interventional, Department of Radiology (United States); Schubert, Johanna [Memorial Sloan-Kettering Cancer Center, Interventional Radiology and Image Guided Therapies (United States)

2005-12-15

418

Abdominal imaging: An introduction  

SciTech Connect

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.

1986-01-01

419

Pediatric abdominal wall defects.  

PubMed

This article reviews the incidence, presentation, anatomy, and surgical management of abdominal wall defects found in the pediatric population. Defects such as inguinal hernia and umbilical hernia are common and are encountered frequently by the pediatric surgeon. Recently developed techniques for repairing these hernias are aimed at improving cosmesis and decreasing pain while maintaining acceptably low recurrence rates. Less common conditions such as femoral hernia, Spigelian hernia, epigastric hernia, lumbar hernia, gastroschisis, and omphalocele are also discussed. The surgical treatment of gastroschisis and omphalocele has undergone some advancement with the use of various silos and meshes. PMID:24035087

Kelly, Katherine B; Ponsky, Todd A

2013-07-26

420

[Rehabilitation after abdominal surgery].  

PubMed

A combined strategy of anesthetic and surgical care defines postoperative rehabilitation, which aims to accelerate recovery from surgery, shorten convalescence, and reduce postoperative morbidity. Preoperative and early postoperative oral feeding, a relatively "dry" fluid regimen, and the avoidance of or early removal of drains, gastric tubes and bladder catheters all contribute to decreasing postoperative morbidity after abdominal surgery. Postoperative pain control, prevention of nausea and vomiting, shortening the duration of postoperative ileus, and early ambulation can also help to decrease postoperative morbidity. The use of multimodal fast-track clinical rehabilitation programs should improve outcomes and quality of life, reduce hospital stays, and save money. PMID:16783266

Bonnet, Francis; Szymkiewicz, Olga; Marret, Emmanuel; Houry, Sidney

2006-06-01

421

Crossed Renal Ectopia without Fusion--An Unusual Cause of Acute Abdominal Pain: A Case Report  

PubMed Central

Introduction. Crossed renal ectopia is a congenital anomaly which usually goes unnoticed as most cases are asymptomatic. The majority, 90% of these are fused. Case Presentation. We report an unusual presentation of a case of crossed renal ectopia without fusion. Our patient is a 16-year-old adolescent male, previously fit and healthy, who presented with acute onset of abdominal pain. The clinical suspicion was that of an abdominal aortic aneurysm. Computed tomography with intravenous contrast revealed nonfused crossed renal ectopia. Conclusion. Although renal ectopia is an uncommon cause of acute abdominal pain, there should be an index of clinical suspicion in previously healthy individuals presenting with acute abdominal pain.

Ramaema, D. P.; Moloantoa, W.; Parag, Y.

2012-01-01

422

Nonaccidental trauma presenting with respiratory distress and pleural effusion.  

PubMed

Nonaccidental trauma (NAT) is common and presents with varied symptoms. Pleural effusion as a complication of physical abuse has not been described in the past. We report the case of a 10-week-old infant who presented with multiple nonspecific complaints that included respiratory distress, refusal to feed, constipation, and lethargy. Sepsis was the working diagnosis on admission, but a massive pleural effusion and rib fractures seen on chest imaging ultimately led to the diagnosis of nonaccidental trauma. This interesting case highlights the importance of maintaining a high index of suspicion for abuse irrespective of atypical presenting signs. PMID:22217891

Sagar, Malvika; Shukla, Samarth; Bradley-Dodds, Kelly

2012-01-01

423

Radiology of skeletal trauma  

SciTech Connect

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

Rogers, L.F.

1982-01-01

424

[Management of multiple trauma in the emergency room].  

PubMed

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

1999-01-01

425

Duodenal rupture secondary to blunt trauma from a football  

PubMed Central

Duodenal rupture secondary to blunt trauma is a relatively uncommon event and is usually a result of a road traffic accident. As the duodenum is a retroperitoneal organ, delays in diagnosis can occur, as the patient may present with vague abdominal symptoms and other non-specific signs. Computed tomographic scanning is therefore a useful tool in the diagnosis of this condition. We present a 19-year-old girl who was hit in the abdomen with a football and subsequently had a duodenal rupture.

Luther, Alison; Mann, Christopher; Hart, Colin; Khalil, Khalil

2013-01-01

426

Trauma-focused CBT for youth with complex trauma  

PubMed Central

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

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

2013-01-01

427

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

ERIC Educational Resources Information Center

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

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

2008-01-01

428

Hypnosis for functional abdominal pain.  

PubMed

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

Gottsegen, David

2011-07-01

429

[Pathophysiology of abdominal pain].  

PubMed

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

Curatolo, Michele

2011-08-01

430

Dental trauma guidelines.  

PubMed

Guidelines have been developed for management of numerous medical and dental conditions. If carefully developed and based on best available evidence, they serve a very useful purpose in giving information in dealing with health problems to health care providers as well as patients. The history of trauma guidelines is quite limited, but the American Association of Endodontists has been involved since the 1980s. In recent years, the International Association of Dental Traumatology has developed guidelines for management of traumatic dental injuries, with input from specialists in all relevant disciplines of dentistry. These guidelines, first developed and published in 2001 and updated twice since then, have been accepted as reliable recommendations for the urgent care of traumatic dental injuries; the most recent trauma guidelines were completed by the International Association of Dental Traumatology and published in 2012. The application of these guidelines is to provide both patients and practitioners with the best available information about management of such injuries. As with most guidelines, there are limitations that are primarily related to the level of evidence available, which is low. However, they are useful and, when followed, can lead to better outcomes than when no guidelines are used. PMID:23439046

Bakland, Leif K

2013-03-01

431

Dental trauma guidelines.  

PubMed

Guidelines have been developed for management of numerous medical and dental conditions. If carefully developed and based on best available evidence, they serve a very useful purpose in giving information in dealing with health problems to health care providers as well as patients. The history of trauma guidelines is quite limited, but the American Association of Endodontists has been involved since the 1980s. In recent years, the International Association of Dental Traumatology has developed guidelines for management of traumatic dental injuries, with input from specialists in all relevant disciplines of dentistry. These guidelines, first developed and published in 2001 and updated twice since then, have been accepted as reliable recommendations for the urgent care of traumatic dental injuries; the most recent trauma guidelines were completed by the International Association of Dental Traumatology and published in 2012. The application of these guidelines is to provide both patients and practitioners with the best available information about management of such injuries. As with most guidelines, there are limitations that are primarily related to the level of evidence available, which is low. However, they are useful and, when followed, can lead to better outcomes than when no guidelines are used. PMID:23635976

Bakland, Leif K

432

Use of computed tomography in the setting of a tiered trauma team activation system in Australia.  

PubMed

This study aims to describe the patterns in the use of computed tomography (CT) imaging in the setting of a two-tiered trauma team activation system without a mandatory whole-body ("panscan") trauma CT protocol. A prospective study was conducted at a single inner city major trauma centre in Sydney, Australia. Adult patients presenting to the emergency department requiring a trauma team activation were studied over 1 year. Patients in the trauma consult group met predetermined criteria for mechanism of injury without vital sign abnormalities or clinical evidence of major injury. Full trauma team response patients were those who had abnormal predetermined vital signs or evidence of major injury on initial assessment. The outcomes measured were severe injury, multiregion injury and positive CT scans. Of the patients, 1,058 were studied of whom 63 % had at least one CT scan performed. The most common CT studies were CT brain in combination with cervical spines (23 %) and isolated abdominal CT scans (17 %). The full trauma response group was associated with significantly higher rates of severe injury (34 versus 8 %, p?trauma consult group (OR 2.6, 95 % CI 1.7-4.1, p?trauma team activation criteria in combination with trauma team assessment may be used to triage patients requiring CT without the need for mandatory CT protocols based on mechanism alone. PMID:23576264

Dinh, Michael M; Hsiao, Kai H; Bein, Kendall J; Roncal, Susan; Saade, Charbel; Chi, Kee Fung; Waugh, Richard

2013-04-11

433

Imaging of gastrointestinal and abdominal tuberculosis  

Microsoft Academic Search

This article discusses the range of manifestations of tuberculosis (TB) of the abdomen, including involvement of the gastrointestinal tract, the peritoneum, mesentery, omentum, abdominal lymph nodes, solid abdominal organs, the genital system and the abdominal aorta. Abdominal TB is a diagnostic challenge, particularly when pulmonary TB is absent. It may mimic many other abdominal diseases, both clinically and radiologically. An

F. M. Vanhoenacker; A. I. De Backer; B. Op de Beeck; M. Maes; R. Van Altena; D. Van Beckevoort; P. Kersemans; A. M. De Schepper

2004-01-01

434

Vascular emergencies in liver trauma  

Microsoft Academic Search

The use of CT in the diagnosis and management of liver trauma is responsible for the shift from routine surgical versus non-surgical treatment in the management of traumatic liver injuries, even when they are of high grade. The main cause of compli cation and of death in liver trauma is related to vascular injury. The goal of this review focussed

P. Taourel; H. Vernhet; A. Suau; C. Granier; F. M. Lopez; S. Aufort

2007-01-01

435

Trauma care systems in Spain  

Microsoft Academic Search

Trauma care systems in Spain are provided by the Nacional Health Service in a decentralized way by the seventeen autonomous communities whose process of decentralization was completed in January 2002. Its organisation is similar in all of them. Public sector companies of sanitary emergencies look after the health of citizens in relation to medical and trauma emergencies with a wide

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

2003-01-01

436

Management of shock in trauma  

Microsoft Academic Search

Shock is failure of the circulatory system to provide the organ perfusion and tissue oxygenation required to meet cellular metabolic demands. Traumatic shock is most commonly associated with haemorrhage, however the trauma patient may present with non-haemorrhagic shock. The ‘lethal triad’ of acute coagulopathy, metabolic acidosis and hypothermia seen in trauma patients is developing the current approach to management of

Jonathan D. Pearson; Jonathan A. Round; Michael Ingram

2011-01-01

437

Maternal mortality due to trauma.  

PubMed

Maternal mortality is an important indicator of adequacy of health care in our society. Improvements in the obstetric care system as well as advances in technology have contributed to reduction in maternal mortality rates. Trauma complicates up to 7% of all pregnancies and has emerged as the leading cause of maternal mortality, becoming a significant concern for the public health system. Maternal mortality secondary to trauma can often be prevented by coordinated medical care, but it is essential that caregivers recognize the unique situation of providing simultaneous care to 2 patients who have a complex physiologic relationship. Optimal management of the pregnant trauma victim requires a multidisciplinary team, where the obstetrician plays a central role. This review focuses on the incidence of maternal mortality due to trauma, the mechanisms involved in traumatic injury, the important anatomic and physiologic changes that may predispose to mortality due to trauma, and finally, preventive strategies that may decrease the incidence of traumatic maternal death. PMID:22280868

Romero, Vivian Carolina; Pearlman, Mark

2012-02-01

438

Psychiatric diagnoses, trauma, and suicidiality  

PubMed Central

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

Floen, Silje K; Elklit, Ask

2007-01-01

439

How I Manage Abdominal Injuries.  

ERIC Educational Resources Information Center

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

Haycock, Christine E.

1986-01-01

440

Hypnosis for Functional Abdominal Pain  

Microsoft Academic Search

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

David Gottsegen

2011-01-01

441

Thirty years of abdominal pain  

Microsoft Academic Search

In this paper, the author describes a brief psychotherapy with a man who has struggled with abdominal symptoms for most of his adult life. After an unhappy childhood, the patient (Mr A) married and then was witness to the birth of his stillborn child, in a foreign country. Soon after his abdominal symptoms started, and plagued him for the following

2003-01-01

442

Updates on abdominal desmoid tumors  

Microsoft Academic Search

Desmoid tumor is a monoclonal, fi broblastic proliferation arising in musculoaponeurotic structures. This connective tissue hyperplasia infi ltrates locally, recurs frequently after resection but does not metastasize. Abdominal desmoid occurs sporadically, in association with some familial syndromes and often represents a clinical dilemma for surgeons. The enigmatic biology and anatomical location of abdominal desmoids make treatment recommendations diffi cult. This

Bernardino Rampone; Corrado Pedrazzani; Daniele Marrelli; Enrico Pinto; Franco Roviello

2007-01-01

443

Urgent Abdominal Re-Explorations  

Microsoft Academic Search

BACKGROUND: Treatment of a number of complications that occur after abdominal surgeries may require that Urgent Abdominal Re-explorations (UARs), the life-saving and obligatory operations, are performed. The objectives of this study were to evaluate the reasons for performing UARs, outcomes of relaparotomies (RLs) and factors that affect mortality. METHODS: Demographic characteristics; initial diagnoses; information from and complications of the first

Haluk Recai Unalp; Erdinc Kamer; Haldun Kar; Ahmet Bal; Mustafa Peskersoy; Mehmet Ali Onal

2006-01-01

444

Abdominal wall gossypiboma.  

PubMed

A 71-year-old woman, one year following a fleur-de-lis abdominoplasty and incisional hernia repair, presented with two chronic, draining peri-umbilical sinuses. Her immediate postoperative course was complicated by a superficial surgical site infection with central skin breakdown that was treated with vacuum assisted closure (VAC). After the wound had closed completely, two midline sinus tracts developed. A CT scan demonstrated an 8x3x1.6cm thick-walled collection along the anterior abdominal wall containing numerous air bubbles. Surgical debridement revealed a cavity containing an 8x3x1.6cm block of well incorporated VAC foam. With the increasing clinical use of VAC wound therapy, this image serves as an important reminder to include gossypiboma in the differential diagnosis for patients with chronic wound problems who have previously received VAC treatment. PMID:19683975

Huston, Tara L; Grant, Robert T

2009-08-15

445

CT of abdominal tuberculosis  

SciTech Connect

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

Epstein, B.M. (Univ. of the Witwatersrand, Johannesburg, South Africa); Mann, J.H.

1982-11-01

446

Total and subtotal abdominal hysterectomy.  

PubMed

Hysterectomy is one of the most frequently performed operations in the world, accounting for 500,000-600,000 procedures annually in the USA; the abdominal route for hysterectomy is the preferred route in 60-80% of these operations. Although the number of total abdominal hysterectomies performed annually has decreased, the number of subtotal abdominal hysterectomies increased by >400%. The major indications for abdominal hysterectomy include abnormal uterine bleeding, myomata uteri, adenomyosis, endometriosis, neoplasia, and chronic salpingitis. The basis for selection for subtotal versus total hysterectomy has little in the way of factual data to support it and may actually present some significant disadvantages, such as continued menstruation and cervical prolapse. The detailed technique for performing intrafascial abdominal hysterectomy relies heavily on precise knowledge of pelvic anatomy and compulsive detail to tissue handling. The consistent and correct usage of prophylactic antimicrobials, measures to prevent thromboemboli, and procedures to avoid urinary retention are key to the overall success of the surgery. PMID:15985251

Baggish, Michael S

2005-02-05

447

A heuristic approach and heretic view on the technical issues and pitfalls in the management of penetrating abdominal injuries  

PubMed Central

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.

2010-01-01

448

Trauma and Religiousness.  

PubMed

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

Goste?nik, Christian; Slavi?, Tanja Repi?; Lukek, Saša Poljak; Cvetek, Robert

2012-11-28

449

Validity of a new abdominal bioelectrical impedance device to measure abdominal and visceral fat: comparison with MRI  

PubMed Central

Abdominal fat, and in particular, visceral adipose tissue (VAT), is the critical fat depot associated with metabolic aberrations. At present VAT can only be accurately measured by computed tomography (CT) or magnetic resonance imaging (MRI). This study was designed to compare a new abdominal bioelectrical impedance device against total abdominal adipose tissue (TAAT) and VAT area measurements made from an abdominal MRI scan, and to assess it’s reliability and accuracy. 120 participants were recruited, stratified by gender and body mass index (BMI). Participants had triplicate measures of abdominal fat and WC with the AB-140 (Tanita Corp, Tokyo, Japan) and WC measurements using a manual tape measure. A single abdominal MRI scan was performed as the reference method. Triplicate measures with the AB-140 showed excellent precision for ‘visceral fat level’, trunk fat % and WC. AB-140 ‘visceral fat level’ showed significantly stronger correlations with MRI TAAT area than with MRI VAT area (r=0.94 vs. 0.65 in men and 0.92 vs. 0.64 in women). AB-140 WC showed good correlation with manual WC measurements (r=0.95 in men and 0.90 in women). AB-140 and manual WC’s showed comparable correlations with MRI TAAT area (r=0.92 and 0.96 in men and 0.88 and 0.88 in women). AB-140 is a simple, quick and precise technique to measure abdominal fat and WC in healthy adults. It provides a useful proxy for TAAT measured by MRI, comparable to the correlation obtained with manual WC measurements. Neither the AB-140 abdominal fat measures, nor WC measurement appear to provide a useful proxy measure of VAT.

Browning, Lucy M; Mugridge, Owen; Chatfield, Mark; Dixon, Adrian; Aitken, Sri; Joubert, Ilse; Prentice, Andrew M.; Jebb, Susan A

2012-01-01

450

Civilian popliteal artery trauma.  

PubMed

An 18 year experience involved 36 civilian popliteal artery injuries is described. There were no operative or hospital deaths and the amputation rate was 3.6%. Penetrating traumas accounted for 30.6% and blunt traumas for 69.4%. In 20 patients (55.5%) the popliteal artery injury was associated with fracture and/or dislocation of the long bones and/or the knee joint. The average ischaemic time was 7.3 hours and postoperative angiography was performed in 25 patients (69.4%). Surgical reconstruction of the popliteal artery was accomplished by interposition or bypass of autogenous saphenous vein graft in 29 (80.5%), by saphenous vein patch in 5 (13.9%) and by primary end-to-end anastomosis in 1 (2.8%) and by PTFE prosthesis in 1 patient (2.8%). In all cases with bone fracture and/or dislocation bone stabilization was followed by the vascular procedure. The average time of follow-up was 76 months, 28 patients could be evaluated in the postoperative study: in 25 (89.2%) the reconstruction was patent, in 3 (10.8%) occluded. In 13 patients (46.4%) there was a complete success, 7 had a nerve deficit (25.0%), 3 had a claudication (10.7%), in one patient an amputation was necessary (3.6%) and 4 (14.3%) suffered from miscellaneous skeletal problems. Of the 36 patients originally operated, 29 (80.5%) received anticoagulant therapy for at least one year. PMID:3558463

Weimann, S; San Nicolo, M; Sandbichler, P; Hafele, G; Flora, G

451

Clinical practice: dental trauma.  

PubMed

Approximately 50% of children under the age of 15 are victims of various kinds of injuries in the orofacial region. Post-traumatic complications may occur, including crown discolouration, cervical root fracture, ankylosis, root resorption and tooth loss. The most severe complication after dental injury in primary dentition can affect the developing permanent tooth germ, and various consequences may be seen several years later when the permanent tooth erupts. In the permanent dentition, the most severe dental injury affects the surrounding alveolar bone structure and will lead to loss of the tooth. Current literature emphasises that awareness of appropriate triage procedures following dental trauma is unsatisfactory and that delay in treatment is the single most influential factor affecting prognosis. What should a paediatrician know, and more importantly, how should he/she advise parents and caretakers? In an emergency situation such as tooth avulsion, reimplantation within 30 min is the best treatment option at the site of the accident. If reimplantation of the tooth is impossible, milk, saline or even saliva are the preferred transport media. The prognosis for an avulsed tooth depends upon prompt care, which is a determinant factor for successful treatment of the traumatised tooth. In all other dental trauma cases, it is important to refer the child to a paediatric dentist, to follow up the healing process and reduce late post-traumatic complications. With timely interventions and appropriate treatment, the prognosis for healing following most dental injuries is good. In conclusion, it is important that paediatricians are able to inform parents and caretakers about all possible and long-lasting consequences of different dental injuries. PMID:20058022

Emerich, Katarzyna; Wyszkowski, Jacek

2010-01-08

452

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

PubMed

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

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

2012-08-06

453

The role of multislice computed tomography (MSCT) in the detection of blunt traumatic intra abdominal injury: our experience in Hospital Tengku Ampuan Afzan (HTAA), Kuantan, Pahang.  

PubMed

Multislice computed tomography (MSCT) is the imaging modality of choice in assessing clinically stable patients with blunt abdominal trauma. This study assessed the role of MSCT in the detection of intra abdominal injury caused by blunt trauma in our centre within a two-year-period (2008-2009). A total of 151 patients had MSCT abdomen for blunt abdominal trauma within this study period. Positive scan were seen in 126 patients (83.4%). Out of these positive scans, liver, spleen and renal injuries were seen in 42.1% (n = 53), 34.9% (n = 44) and 30.0% (n = 34) of cases respectively. Laparotomies were performed in 45 patients. Out of these 45 laparotomies, 10 patients had surgically significant injuries that were missed on CT scan findings. The injuries were bowel perforation (n = 4), serosal tear of bowel (n = 1), mesenteric injuries with active haemorrhage (n=3), spleen injury (n = 1) and liver injury (n = 1). PMID:23082425

Radhiana, Hassan; Azian, Abd Aziz; Mubarak, Mohd Yusof; Saot, Azlin; Mohd Amran, Abdul Rashid; Jamalludin, A R

2012-06-01

454

Aversive Imagery in Posttraumatic Stress Disorder: Trauma Recurrence, Comorbidity, and Physiological Reactivity  

PubMed Central

Background Posttraumatic stress disorder (PTSD) is characterized as a disorder of exaggerated defensive physiological arousal. The novel aim of the present research was to investigate within PTSD a potential dose-response relationship between past trauma recurrence and current comorbidity and intensity of physiological reactions to imagery of trauma and other aversive scenarios. Methods A community sample of principal PTSD (n = 49; 22 single-trauma exposed, 27 multiple-trauma exposed) and control (n = 76; 46 never-trauma exposed, 30 trauma exposed) participants imagined threatening and neutral events while acoustic startle probes were presented and the eye-blink response (orbicularis occuli) was recorded. Changes in heart rate, skin conductance level, and facial expressivity were also indexed. Results Overall, PTSD patients exceeded control participants in startle reflex, autonomic responding, and facial expressivity during idiographic trauma imagery and, though less pronounced, showed heightened reactivity to standard anger, panic, and physical danger imagery. Concerning subgroups, control participants with and without trauma exposure showed isomorphic patterns. Within PTSD, only the single-trauma patients evinced robust startle and autonomic responses, exceeding both control participants and multiple-trauma PTSD. Despite greater reported arousal, the multiple-trauma relative to single-trauma PTSD group showed blunted defensive reactivity associated with more chronic and severe PTSD, greater mood and anxiety disorder comorbidity, and more pervasive dimensional dysphoria (e.g., depression, trait anxiety). Conclusions Whereas PTSD patients generally show marked physiological arousal during aversive imagery, concordant with self-reported distress, the most symptomatic patients with histories of severe, cumulative traumatization show discordant physiological hyporeactivity, perhaps attributable to sustained high stress and an egregious, persistent negative affectivity that ultimately compromises defensive responding.

McTeague, Lisa M.; Lang, Peter J.; Laplante, Marie-Claude; Cuthbert, Bruce N.; Shumen, Joshua R.; Bradley, Margaret M.

2013-01-01

455

Open partial splenectomy for trauma using GIA-Stapler and FloSeal matrix haemostatic agent  

PubMed Central

A ruptured spleen caused by blunt abdominal injury is often treated by splenectomy. In view of the gravity of the ‘postsplenectomy syndrome,’ a conservative approach has been increasingly used. We present the case of a 29-year-old man with a Grade III splenic lesion for a blunt abdominal trauma after a car accident. We performed a partial splenectomy of the upper pole using GIA-Stapler. A supplemental haemostasis of the stapled line was successfully achieved by the application of FloSeal matrix haemostatic agent. The splenic remnant was fixed into the left-upper quadrant using human fibrin glue.

Costamagna, Daniela; Rizzi, Sabrina; Zampogna, Annunziatino; Alonzo, Amedeo

2010-01-01

456

Management of tracheobronchial injuries following blunt and penetrating trauma.  

PubMed

Disruptions of the trachea and bronchi are an infrequent but a life-threatening injury following trauma. We reviewed our experience with tracheobronchial injury from 1988 to 1996. Out of 12,789 trauma patients treated at a university Level I trauma center, 16 patients (0.13%) with tracheobronchial injuries were seen. Mechanism of injuries involved gunshot wound in eight (50%), stab wound in two (13%), blunt trauma in three (19%), hanging injury from suicide attempt in one (6%), and intubation injury in two (13%). Preoperative diagnostic bronchoscopy was performed in 11 patients. Emergent operative exploration was needed in most penetrating tracheal injuries. All patients with blunt trauma had multisystem involvement with numerous associated injuries. Management of these injuries included early primary repair of the disrupted airway in 12 (75%), stenting of the injured airway in two (13%), and negative pressure mechanical ventilation with the iron lung in one (6%). Nonoperative management was successful in three (19%). Early mortality was 13 per cent. A high index of suspicion is essential for rapid diagnosis and successful surgical intervention in patients with tracheobronchial injuries. PMID:9322668

Huh, J; Milliken, J C; Chen, J C

1997-10-01

457

Childhood and Adult Trauma Experiences of Incarcerated Persons and Their Relationship to Adult Behavioral Health Problems and Treatment  

PubMed Central

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

Wolff, Nancy; Shi, Jing

2012-01-01

458

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

PubMed

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

Wolff, Nancy; Shi, Jing

2012-05-18

459

Individual Differences in Trauma Disclosure  

PubMed Central

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

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

2011-01-01

460

Immigration Index  

NSDL National Science Digital Library

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.

461

Radiation exposure in body computed tomography examinations of trauma patients  

NASA Astrophysics Data System (ADS)

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 examinati