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1

Abdominal trauma by ostrich  

PubMed Central

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

Usurelu, Sergiu; Bettencourt, Vanessa; Melo, Gina

2015-01-01

2

Omental Torsion After Repeated Abdominal Blunt Trauma  

PubMed Central

Omental torsion is caused by the rotation of the greater omentum on its axis which may lead to tissue infarction and necrosis. It is a rare cause of acute abdomen. Signs, symptoms and paraclinical data are not specific. The patients usually undergo laparotomy for acute abdomen of poorly defined origin. High index of suspicious is required for the diagnosis of this entity. The diagnosis is usually confirmed after an explorative laparotomy. We present clinical characteristics and imaging findings of omental torsion in a young man following repeated blunt abdominal trauma. PMID:24396748

Hosseinpour, Mehrdad; Abdollahi, Azadeh; Jazayeri, Hoda; Talari, Hamid Reza; Sadeghpour, Ahmad

2012-01-01

3

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. PMID:22096714

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

2011-01-01

4

Isolated perforation of a duodenal diverticulum following blunt abdominal trauma  

PubMed Central

Only 10% of duodenal diverticula are symptomatic. We present the case of a man who fell from a height of 6 ft, landing on his abdomen and presenting 4 h later with severe back pain and a rigid abdomen. At laparotomy, a perforated retroperitoneal duodenal diverticulum was found and repaired with an omental patch. No other injury was noted. Not only is this perforation unusual, but the absence of other injuries sustained during this minor blunt trauma makes this case unique. This case highlights the need for a high index of suspicion when managing patients with back or abdominal pain following minor trauma. PMID:20165728

Metcalfe, Matthew J; Rashid, Tanwir G; Bird, Richard le R

2010-01-01

5

A historical review of penetrating abdominal trauma.  

PubMed

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

Blank-Reid, Cynthia

2006-09-01

6

[Thoracic and abdominal trauma in children].  

PubMed

Knowledge of the characteristics of thoraco-abdominal trauma in children is important to optimize the imaging work up while keeping radiation exposure to a minimum. Because of the plasticity of the pediatric rib cage, rib fractures are infrequent, and severe parenchymal injuries may be present in the absence of rib fracture. Mediastinal injuries are unusual. The increased mobility of solid intraabdominal organs combined with a weaker abdominal wall are specific to pediatric patients. First-line imaging typically includes chest radiograph and abdominal US with Doppler imaging. Contrast-material enhanced CT is used as a second-line technique, with delayed imaging in patients with urinary tract lesions. Dedicated pediatric acquisition protocols are mandatory. Follow-up is obtained mainly with US. PMID:19106844

Chaumoître, K; Merrot, T; Petit, P; Panuel, M

2008-11-01

7

[Drainage and lavage in abdominal trauma].  

PubMed

Peritoneal lavage is a reliable procedure in diagnosis of posttraumatic intra-abdominal bleeding. The method is extremely sensitive. If the return is found weakly positive, the lavage catheter should be left in position until the situation is cleared. Insufflation of air through the catheter may be used in diagnosis of a ruptured diaphragm. In the first days after trauma, peritoneal lavage may as well be helpful to detect secondary bleeding (for example in delayed rupture of the spleen) in unconscious patients or during mechanical ventilation. Postoperative drainage of the abdomen, too, is of considerable diagnostic value: for assessment of postoperative bleeding and in diagnosis of delayed intestinal perforation or insufficiency of a sutured bowel lesion. In pancreatic trauma, adequate drainage of pancreatic secretions prevents arterial arrosion or the formation of a pseudocyst. Determination of amylase in the drained fluid guides the further therapy: duration of total parenteral nutrition, suppression of pancreatic activity by drugs, removal o the drains. Tactics in draining the abdominal cavity after trauma should take into consideration an optimal removal of blood and secretions as well as the mentioned diagnostic value. In specially indicated cases the drainage system also should allow to perform peritoneal dialysis. PMID:549900

Glinz, W

1979-12-01

8

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

2012-05-01

9

[Management of colon injury in abdominal trauma].  

PubMed

The incidence of colon injury is low but is associated with adverse outcome if managed inadequately.Colostomy and secondary closure has been the traditional management, which is associated with more pain to the patient and a waste of medical resource. Recent studies indicate that physiologic disturbances after trauma is the main risk factor of anastomotic leak , therefore primary repair or resection and anastomosis is feasible if physiological status of the patient is stable as calibrated by New Injury Severity Score and ASA score. For patients with open abdomen or temporary closure,colonic resection can also be performed at definitive abdominal closure in select cases. PMID:23596665

Zhu, Wei-ming; Li, Jie-shou

2012-12-01

10

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

11

Abdominal trauma due to road traffic accidents in Qatar  

Microsoft Academic Search

Objectives: To measure the incidence and severity of abdominal trauma due to road traffic accidents (RTA) in Qatar.Patient and methods: Retrospective analysis of all patients admitted with documented abdominal trauma to the only acute General Hospital in the state of Qatar in the period 1991–1995.Results: In the 5-year period, 3744 patients were admitted following an RTA. Of these, 667 (17.8%)

Ismail Helmi; Abdulazim Hussein; Abdel Hafeez Ali Ahmed

2001-01-01

12

Death due to isolated jejunal tear following blunt abdominal trauma.  

PubMed

Small intestinal injury following blunt abdominal trauma has been widely reported. Isolated jejunal tear which is caused by blunt abdominal trauma is rare and is most often seen in road traffic accidents. Here, we report a case of isolated jejunal tear in a 24-year-old male truck driver. He was admitted to a tertiary care hospital in a South Indian Metropolitan city with complaints of acute abdominal pain and tiredness following alleged accidental blunt trauma sustained to abdomen due to steering wheel impact. An isolated jejunal tear and adjacent mesenteric contusion and tear were missed by the treating physician even after preliminary investigations, and thus, the conservative management was instituted. The condition deteriorated gradually, and he succumbed to death. The autopsy revealed transverse tear of jejunum almost involving whole of its circumference on the antimesenteric border and peritonitis. Proper use of radio-diagnostic techniques and timely undertaken explorative laparotomy would have saved the life. PMID:24547969

Hugar, Basappa S; Yajaman, Girishchandra P; Kainoor, Sunilkumar; Shetty, Akshith Raj S

2014-09-01

13

Intraperitoneal Rupture of Hepatic Hydatid Cyst Following Blunt Abdominal Trauma  

PubMed Central

Peritonitis due to rupture of liver hydatid cyst secondary to blunt abdominal trauma can present with fatal consequences. Timely diagnosis and appropriate surgical management can be life saving. We report a case of ruptured liver hydatid cyst in the peritoneal cavity following trauma and its successful operative management in a preadolescent previously asymptomatic boy. Importance of detailed physical examination and early diagnosis by using appropriate radiological investigations is highlighted. PMID:22953304

Dhua, Anjan Kumar; Sharma, Akshay

2012-01-01

14

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

15

Delayed recognition of diaphragmatic injury caused by penetrating thoraco-abdominal trauma  

PubMed Central

INTRODUCTION Penetrating trauma to the thoraco-abdomen may cause diaphragmatic injury (DI). We present a case which highlights the difficulties of recognizing DI and the limited role of multimodal diagnostic imaging. PRESENTATION OF CASE A 19 year old male presented with stab wounds to his left lateral chest wall. CT was suspicious for diaphragmatic injury but this could not be confirmed despite ultrasound and serial plain radiographs. He was discharged but re-presented with respiratory compromise and diaphragmatic herniation. DISCUSSION We review the clinical features of diaphragmatic injury after penetrating thoraco-abdominal trauma and the various imaging modalities available to clinicians. CONCLUSION A high index of suspicion must be employed for DI in the context of penetrating thoraco-abdominal trauma. Inpatient observation and laparoscopy/thoracoscopy should be considered when radiological findings are ambiguous. Front line physicians should also consider diaphragmatic herniation in stab victims who re-present with respiratory, circulatory, or gastrointestinal symptomology. PMID:22918082

Wilson, Emily; Metcalfe, David; Sugand, Kapil; Sujenthiran, Arunan; Jaiganesh, Thiagarajan

2012-01-01

16

Abdominal Trauma in Durban, South Africa: Factors Influencing Outcome  

PubMed Central

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

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

2012-01-01

17

Isolated bowel injury in blunt abdominal trauma in childhood.  

PubMed

From a total of 734 children with a blunt abdominal trauma admitted to the hospital in the past 15 years, 21 patients (3%) sustained an isolated injury of the bowel (8 duodenal, 9 jejunal and 4 colon ruptures). All patients were laparotomized without a postoperative mortality. Accompanying abdominal injuries were seen only in duodenal ruptures (pancreatitis and one choledochal and pancreatic ruptures). In 85% the blunt violence was caused by bicycle accidents due to the handle bar, in one case by a car accident and in 3 children by falls. Accurate diagnosis was only possible regarding the history, the mechanism of the accident and an exact repeated clinical examination. Despite further investigations of blood chemistry laboratory findings, ultrasound and x-ray, no further confirmation of the diagnosis could be achieved. Complications, occurring in 14% of our patients, were not related to the trauma itself, but caused by a delayed diagnosis and therapy. PMID:1477060

Schimpl, G; Schmidt, B; Sauer, H

1992-12-01

18

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 PMID:608158

Taylor, B.

1977-01-01

19

Admission surgery: the patient with abdominal and thoracic trauma.  

PubMed

1. Epidemiology may affect admission. It is essential to know what types of trauma patients are typically admitted, at what time of day, and on which day of the week. Within trauma systems, one of the major determinants of patient survival is the adequacy of surgical personnel and equipment resources. 2. Assessment of the abdominal and thoracic trauma patient is an active process, requiring constant curious attention. Due to the time-critical nature of these injuries, effective communication is paramount. There may be little or no documentation, and minimal verbal report, consisting of mechanism of injury and vital signs. A stable patient may rapidly deteriorate. 3. Injury severity and location are key in patients' mortality and morbidity. Outcomes for vascular injury surgeries depend on time lag, differences in surgeons' experience, associated injury, site of wounds, type of arterial lesions, and infection. PMID:8342219

Rupp, M

1993-01-01

20

[Ruptura of the thoracic esophagus due to closed abdominal trauma].  

PubMed

The authors present a rare case of closed abdominal trauma in a five year old girl resulting from a washtub fall on her causing three lacerations in the middle third of the esophagus, identified 48 hours after the trauma. The stitcher surgical treatment of the lacerations associated with gastrostomy and lengthy parenteral nutrition did not prevent the recurrence of the esophagus-pleural fistula, and an esophagectomy plus cervical esophagostomy was required. After a 10-month follow-up, the digestive passage was reconstructed by an esophagocoloplasty. At present, after 5 years of follow-up, the patient is cured. The authors discuss the causes of esophagus rupture in children and its etiopathogeny. They propose that preservativement the esophagus is the best initial treatment, in spite of the foot that this procedure was ineffective in the present case. PMID:1965667

Cabral Júnior, A S; Furlanetto, G; Silva, P F; Baratella, J R; Safatle, N F

1990-01-01

21

An Experience with Blunt Abdominal Trauma: Evaluation, Management and Outcome  

PubMed Central

Blunt abdominal trauma (BAT) is a frequent emergency and is associated with significant morbidity and mortality in spite of improved recognition, diagnosis and management. Trauma is the second largest cause of disease accounting for 16% of global burden. The World Health Organization estimates that, by 2020, trauma will be the first or second leading cause of years of productive life lost for the entire world population. This study endeavors to evaluate 71 cases of BAT with stress on early diagnosis and management, increase use of non operative management, and time of presentation of patients. A retrospective analysis of 71 patients of BAT who were admitted in Kempegowda Institute of Medical Sciences hospital (KIMS, Bangalore, India) within a span of 18 months was done. Demographic data, mechanism of trauma, management and outcomes were studied. Most of the patients in our study were in the age group of 21-30 years with an M:F ratio of 3.7:1. Motor vehicle accident (53%) was the most common mechanism of injury. Spleen (53%) was the commonest organ injured and the most common surgery performed was splenectomy (30%). Most common extra abdominal injury was rib fracture in 20%. Mortality rate was 4%. Wound sepsis (13%) was the commonest complication. Initial resuscitation measures, thorough clinical examination and correct diagnosis forms the most vital part of management. 70% of splenic, liver and renal injuries can be managed conservatively where as hollow organs need laparotomy in most of the cases. The time of presentation of patients has a lot to do with outcome. Early diagnosis and prompt treatment can save many lives. PMID:25332759

Mehta, Nikhil; Babu, Sudarshan; Venugopal, Kumar

2014-01-01

22

Role of plasma ammonia level in detecting intra-abdominal hemorrhage following blunt abdominal trauma  

PubMed Central

Background: Blunt abdominal injury is a leading cause of death in trauma patients. A reliable test predicting intra-abdominal hemorrhage would be a novel method. The study objective was to assess the diagnostic accuracy of plasma ammonia in detection of intra-abdominal bleeding in patients with blunt abdominal trauma (BAT). Materials and Methods: In this observational study, all patients suffering from BAT, referred to our university teaching hospital included. The levels of ammonia were measured at the time of emergency department admission and 1 h after initial treatment. Demographic data, vital signs, and venous blood gas reports were recorded. Findings of contrast-enhanced abdominopelvic computed tomography scan and laparotomy were assumed as a gold standard for abdominal injuries. Results: A total of 104 patients was enrolled in the study. 15 patients (14.4%) had intra-abdominal hemorrhage and the mean plasma ammonia level in this group was significantly higher than the other patients on admission time (101.73 ± 5.41 ?g/dL vs. 47.36 ± 26.31 ?g/dL, P < 0.001). On receiver-operator characteristic curve analysis, in cutoff point of 89 ?g/dL, the sensitivity, specificity, positive and negative likelihood ratios were 100% (95% confidence interval [CI], 79.6-100), 93.26% (95% CI, 86-96.8), 14.83 (95% CI, 6.84-32.12), and 0, respectively. Conclusion: The study findings suggest the measurement of ammonia level at the time of admission in the patients with BAT would be a useful test predicting intra-abdominal hemorrhage. Furthermore, decrease in the ammonia level could be a useful marker for monitoring response to treatment in these patients.

Farsi, Davood; Fadaki, Ali Akbar Khademi; Kianmehr, Nahid; Abbasi, Saeed; Rezai, Mahdi; Marashi, Mohammad; Mofidi, Mani

2014-01-01

23

CEUS in abdominal trauma: multi-center study  

Microsoft Academic Search

The objective of this study was to evaluate the concordance of US and contrast-enhanced US (CEUS) with CT in the assessment\\u000a of solid organ injury following blunt trauma. Patients underwent complete US examination, including free fluid search and\\u000a solid organ analysis. CEUS followed, using low-mechanical index techniques and SonoVue. CT was performed within 1 h. Among\\u000a 156 enrolled patients, 91 had

Orlando Catalano; Luca Aiani; Libero Barozzi; Daniela Bokor; Armanda De Marchi; Carlo Faletti; Fabio Maggioni; Nicola Montanari; Paolo Emilio Orlandi; Alfredo Siani; Paul S. Sidhu; Peter K. Thompson; Massimo Valentino; Angelo Ziosi; Alberto Martegani

2009-01-01

24

Blunt Thoracic and Abdominal Vascular Trauma and Organ Injury Caused by Road Traffic Accident  

Microsoft Academic Search

Objectives to analyse the relationship between vascular trauma and associated injuries to intra-thoracic and abdominal organs caused by traffic accidents. Design retrospective study in a university hospital.Materials and methods we investigated 458 consecutive patients who were admitted with blunt thoracic and\\/or abdominal trauma caused by road traffic accidents between 1986 and 1999. Vascular trauma was encountered in 54 patients (12%).Results

H Yasuhara; S Naka; T Kuroda; N Wada

2000-01-01

25

[Intestinal necroses in severely injured patients without abdominal trauma].  

PubMed

Bowel necrosis in the critical trauma patient without abdominal involvement or preexisting vascular disease is a known but rare complication. During 1977-1986 we observed 31 cases in 2530 patients. Symptoms were unspecific, and since most of the patients were artificially ventilated, pain and tenderness were of little diagnostic value. Twenty-three patients presented with paralytic ileus, fifteen with diarrhea, and four with melena. In eleven patients diagnosis was made clinically, and in twenty patients at autopsy. Twenty-three patients died from septic shock, six from cerebral complications, and one from myocardial infarction. Risk factors for bowel necrosis were fluid restriction, hypotension, hypoxemia, venous congestion, vasoconstrictive drugs, paralytic ileus, and constipation. PMID:2777621

Frick, T; Glinz, W

1989-06-01

26

Evaluating blunt abdominal trauma with sonography: a cost analysis.  

PubMed

Ultrasonography (US) is becoming increasingly utilized in the United States for the evaluation of blunt abdominal trauma (BAT). The objective of this study was to assess the cost impact of utilizing US in the evaluation of patients with BAT in a major trauma center. All patients sustaining BAT during a 6-month period before US was used at our institution (Jan-Jun 1993) were compared to BAT patients from a recent period in which US has been utilized (Jan-Jun 1995). The numbers of US, computed tomography (CT), and diagnostic peritoneal lavage (DPL) were tabulated for each group. Financial cost for each of these procedures as determined by our finance department were as follows: US $96, CT $494, DPL $137. These numbers are representative of actual hospital expenditures exclusive of physician fees as calculated in 1994 U.S. dollars. Cost analysis was performed with t test and chi squared test, and significance was defined as P < 0.05. There were 890 BAT admissions in the 1993 study period and 1033 admissions in the 1995 study period. During the 1993 period, 642 procedures were performed on the 890 patients to evaluate the abdomen: 0 US, 466 CT, and 176 DPL (see table) [table: see text]. This compares to 801 procedures on the 1,033 patients in 1995: 552 US, 228 CT, and 21 DPL. Total cost was $254,316 for the 1993 group and $168,501 for the 1995 group. Extrapolated to a 1-year period, a significant (P < 0.05) cost savings of $171,630 would be realized. Cost per patient evaluated was significantly reduced from $285.75 in 1993 to $163.12 in 1995 (P < 0.05). This represents a 43 per cent reduction in per patient expenditure for evaluating the abdomen. By effectively utilizing ultrasonography in the evaluation of patients with blunt abdominal trauma, a significant cost savings can be realized. This effect results chiefly from an eight-fold reduction in the use of DPL, and a two-fold reduction in the use of CT. PMID:11603547

McKenney, M G; McKenney, K L; Hong, J J; Compton, R; Cohn, S M; Kirton, O C; Shatz, D V; Sleeman, D; Byers, P M; Ginzburg, E; Augenstein, J

2001-10-01

27

Abdominal injuries in a low trauma volume hospital - a descriptive study from northern Sweden  

PubMed Central

Background Abdominal injuries occur relatively infrequently during trauma, and they rarely require surgical intervention. In this era of non-operative management of abdominal injuries, surgeons are seldom exposed to these patients. Consequently, surgeons may misinterpret the mechanism of injury, underestimate symptoms and radiologic findings, and delay definite treatment. Here, we determined the incidence, diagnosis, and treatment of traumatic abdominal injuries at our hospital to provide a basis for identifying potential hazards in non-operative management of patients with these injuries in a low trauma volume hospital. Methods This retrospective study included prehospital and in-hospital assessments of 110 patients that received 147 abdominal injuries from an isolated abdominal trauma (n?=?70 patients) or during multiple trauma (n?=?40 patients). Patients were primarily treated at the University Hospital of Umeå from January 2000 to December 2009. Results The median New Injury Severity Score was 9 (range: 1–57) for 147 abdominal injuries. Most patients (94%) received computed tomography (CT), but only 38% of patients with multiple trauma were diagnosed with CT?trauma caused injuries in seven patients. Solid organ injuries constituted 78% of abdominal injuries. Non-operative management succeeded in 82 patients. Surgery was performed for 28 patients, either immediately (n?=?17) as result of operative management or later (n?=?11), due to non-operative management failure; the latter mainly occurred with hollow viscus injuries. Patients with multiple abdominal injuries, whether associated with multiple trauma or an isolated abdominal trauma, had significantly more non-operative failures than patients with a single abdominal injury. One death occurred within 30 days. Conclusions Non-operative management of patients with abdominal injuries, except for hollow viscus injuries, was highly successful in our low trauma volume hospital, even though surgeons receive low exposure to these patients. However, a growing proportion of surgeons lack experience in decision-making and performing trauma laparotomies. Quality assurance programmes must be emphasized to ensure future competence and quality of trauma care at low trauma volume hospitals. PMID:25124882

2014-01-01

28

EPIDEMIOLOGICAL STUDY OF PATIENTS WITH PENETRATING ABDOMINAL TRAUMA IN TEHRAN-IRAN  

Microsoft Academic Search

Trauma continues to be the most frequent cause of death in the first four decades of life and is a major public health problem in some countries. We performed an epidemiological study of penetrating abdominal trauma (PAT) to describe epidemiological characteristics of patients with PAT. In a cross-sectional study we evaluated patients with PAT admitted to emergency department in six

H. Baradaran; J. Salimi; M. Nassaji-Zavareh; A. Khaji; A. Rabbani

29

Splenic trauma during abdominal wall liposuction: a case report  

PubMed Central

Summary A 35-year-old woman collapsed 18 hours after undergoing abdominal wall liposuction. Abdominal CT scan revealed a punctured spleen. She underwent an emergency splenectomy and made an uneventful recovery. PMID:18387911

Harnett, Paul; Koak, Yashwant; Baker, Daryl

2008-01-01

30

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

Microsoft Academic Search

Combined abdominal (AT) and spine (ST) trauma in the multiply traumatized patient (MT) requires optimal clinical management.\\u000a At the Traumacenter Murnau, Germany all multiply injured patients (injury severity score ? 16) are registered in a large prospective\\u000a database (DGU-Tramaregister). From 1 January 2002 until 31 December 2004, 731 multiply injured patients (ISS ? 16) were admitted\\u000a to the Trauma Center

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

2007-01-01

31

The role of CEUS in the assessment of haemodynamically stable patients with blunt abdominal trauma.  

PubMed

Computed tomography (CT) still represents the preferred imaging method in the assessment of patients presenting with multiple trauma. Nevertheless, in patients with low-energy abdominal trauma, the use of CT is debated because of the possible unnecessary radiation exposure. Accordingly, conventional ultrasound (US) imaging has been increasingly employed as the initial imaging modality in the workup of minor traumatic emergency conditions. Focused assessment with sonography for trauma is widely used to detect free intra-abdominal fluid, but its role is controversial, because the absence of free fluid does not exclude the presence of injuries to abdominal organ. Injection of an ultrasound contrast agent (UCA) may give the radiologist relevant additional information to that obtained with conventional US. Thus, in trauma patients, following early assessment with conventional US imaging, a contrast-enhanced US (CEUS) can provide a more reliable evaluation of solid organ injuries and related vascular complications, including active bleeding, pseudoaneurysms, and artero-venous fistulas. CEUS cannot replace abdominal CT, but it represents a noninvasive and repeatable imaging tool capable of providing a reliable assessment of trauma severity and expedite the patient's treatment. PMID:25142944

Pinto, Fabio; Valentino, Massimo; Romanini, Laura; Basilico, Raffaella; Miele, Vittorio

2015-01-01

32

Liver Hydatid Cyst Rupture Into the Peritoneal Cavity After Abdominal Trauma: Case Report and Literature Review  

PubMed Central

The aim of this study was to review the literature regarding the rupture of hydatid cysts into the abdominal cavity after trauma. We present both a new case of hydatid cyst rupture that occurred after blunt abdominal trauma and a literature review of studies published in the English language about hydatid cyst rupture after trauma; studies were accessed from PubMed, Google Scholar, EBSCO, EMBASE, and MEDLINE databases. We identified 22 articles published between 2000 and 2011 about hydatid cyst rupture after trauma. Of these, 5 articles were excluded because of insufficient data, duplication, or absence of intra-abdominal dissemination. The other 17 studies included 68 patients (38 males and 30 females) aged 8 to 76 years who had a ruptured hydatid cyst detected after trauma. The most common trauma included traffic accidents and falls. Despite optimal surgical and antihelmintic therapy, 7 patients developed recurrence. Complications included biliary fistula in 5 patients, incisional hernia in 2 patients, and gastrocutaneous fistula in 1 patient. Death occurred from intraoperative anaphylactic shock in 1 patient and gastrointestinal bleeding and pulmonary failure in 1 patient. Rupture of a hydatid cyst into the peritoneal cavity is rare and challenging for the surgeon. This condition is included in the differential diagnosis of the acute abdomen in endemic areas, especially in young patients. PMID:23113853

Yilmaz, Mehmet; Akbulut, Sami; Kahraman, Aysegul; Yilmaz, Sezai

2012-01-01

33

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

PubMed Central

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

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

2014-01-01

34

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

35

[Results of conservative treatment for solid abdominal organ trauma].  

PubMed

We analyzed 59 cases of intraabdominal solid organ injury treated at the Surgical Emergency Service of Istanbul Medical School between January 1996 and January 2001. Fifty-six of these cases suffered blunt and 3 penetrating trauma. Twenty-three cases had injuries involving the liver, 14 spleen, 5 kidney, 6 liver and spleen, 6 liver and kidney, 6 spleen and kidney and four liver and kidney. In 4 of splenic and 5 of hepatic injuries Grade IV injuries were detected. Among the cases, 21% were Grade I, 45% were Grade II, 19% were Grade III, and 15% were Grade IV. Associated injuries were: head trauma in 34 cases (57.6%--Glasgow Coma Score under 7 in 6 cases), thoracic trauma in 19 cases (32%), pelvic fracture in 6 cases (10%), vertebral compression fracture in 3 cases (5%). One patient with splenic (Grade III) and hepatic (Grade II) injury, and one patient with Grade IV splenic injury required surgery during close follow-up due to hemodynamic instability. Our failure rate for conservative treatment of solid organ injuries is 3.3%. Three patients with polytrauma in the ICU died (5% mortality rate). Conservative management in solid organ injuries is gaining more popularity every day. Our work, and current studies accept physiologic parameters in the follow-up of solid organ injuries. Conservative treatment guided with hemodynamic stability, accounts almost a 98% success rate. PMID:11705076

Ertekin, C; Akyildiz, H; Tavilo?lu, K; Gülo?lu, R; Kurto?lu, M

2001-10-01

36

Use of abdominal computed tomography in blunt trauma: Do we scan too much?  

PubMed Central

Objectives To determine what proportion of abdominal computed tomography (CT) scans ordered after blunt trauma are positive and the applicability and accuracy of existing clinical prediction rules for obtaining a CT scan of the abdomen in this setting. Setting A leading trauma hospital, affiliated with the University of Ottawa. Design A retrospective cohort study. Patients and methods All patients with blunt trauma admitted to hospital over a 1-year period having an Injury Severity Score (ISS) greater than 12 who underwent CT of the abdomen during the initial assessment. Recorded data included age, sex, Glasgow Coma Scale (GCS) score, ISS, type of injuries, number of abdominal CT scans ordered, and scan results. Two clinical prediction rules were found in the literature that identify patients likely to have intra-abdominal injuries. These rules were applied retrospectively to the cohort. The predicted proportion of positive CT scans was compared with the observed proportion, and the sensitivity, specificity, and accuracy were estimated. Results Of the 297 patients entered in the study, 109 underwent abdominal CT. The median age was 32 years, 71% were male and the median ISS was 24. In only 36.7% (40 of 109) of scans were findings suggestive of intra-abdominal injuries. Application of one of the clinical prediction rules gave a sensitivity of 93.8% and specificity of 25.5% but excluded 23% of patients because of a GCS score less than 11. The second prediction rule tested could be applied to all patients and was highly sensitive (92.5%) and specific (100.0%). Conclusions The assessment of the abdomen in blunt trauma remains a challenge. Accuracy in predicting positive scans in equivocal cases is poor. Retrospective application of an existing clinical prediction rule was found to be highly accurate in identifying patients with positive CT findings. Prospective use of such a rule could reduce the number of CT scans ordered without missing significant injuries. PMID:10714252

Garber, Bryan G.; Bigelow, Eric; Yelle, Jean-Denis; Pagliarello, Guiseppe

2000-01-01

37

Bacteriology and drug susceptibility analysis of pus from patients with severe intra-abdominal infection induced by abdominal trauma  

PubMed Central

The aim of the present study was to retrospectively analyze the bacteriology and drug susceptibility of pus flora from abdominal trauma patients with severe intra-abdominal infection (SIAI). A total of 41 patients with SIAI induced by abdominal trauma were enrolled in the study, from which 123 abdominal pus samples were obtained. The results from laboratory microbiology and drug sensitivity were subjected to susceptibility analysis using WHONET software. A total of 297 strains were isolated in which Gram-negative bacteria, Gram-positive bacteria and fungi accounted for 53.5 (159/297), 44.1 (131/297) and 0.7% (2/297), respectively. Anaerobic bacteria accounted for 1.7%. The five predominant bacteria were Escherichia coli (E. coli), Staphylococcus aureus (S. aureus), Klebsiella pneumoniae (K. pneumoniae), Enterococcus faecalis and Pseudomonas aeruginosa (P. aeruginosa). E. coli was highly susceptible to cefoperazone (91%) and imipenem (98%), while Gram-positive cocci were highly susceptible to teicoplanin (100%) and linezolid (100%). S. aureus was 100% susceptible to vancomycin and K. pneumoniae was highly susceptible to imipenem (100%) and amikacin (79%). P. aeruginosa was the most susceptible to ciprofloxacin (90%). Gram-negative bacterial infection was present in the majority of cases of SIAI. However, a large number of patients were infected by Gram-positive bacteria, particularly S. aureus that exhibited significant resistance to penicillin (100%), oxacillin (100%) and a third-generation cephalosporin antibiotic cefotaxime (95%). Amongst the pathogenic bacteria that cause SIAI, both Gram-negative and Gram-positive bacteria account for a high proportion, so high-level and broad-spectrum antibiotics should be initially used. PMID:24940451

ZHANG, SHAOYI; REN, LELE; LI, YOUSHENG; WANG, JIAN; YU, WENKUI; LI, NING; LI, JIESHOU

2014-01-01

38

Early Palma procedure after iliac vein injury in abdominal penetrating trauma.  

PubMed

Ligation for penetrating abdominal vein trauma may have better outcome than a vascular reconstruction in an unstable patient. However, symptoms of chronic venous insufficiency may appear over time. We describe our surgical experience with 4 patients who underwent iliac vein ligation followed by venous bypass with a modified Palma derivation between 48 and 240 hours after sustaining penetrating abdominal trauma with concomitant iliac vein injury. Patients were assessed for venous symptoms and conduit patency with continuous wave Doppler and duplex scanning. One graft occluded acutely and the remaining three remain patent with functioning valves. In order to preserve venous outflow after severe iliac vein injury, we think that venous ligation as a part of damage control surgery followed by a modified Palma operation may prevent chronic symptoms of venous outflow obstruction without compromising an already injured patient. PMID:18727974

Alcocer, Francisco; Aguilar, Jesus; Agraz, Salvador; Jordan, William D

2008-09-01

39

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

40

Isolated rupture of an accessory liver from blunt abdominal trauma in childhood  

Microsoft Academic Search

An accessory liver is uncommonly encountered in surgical practice. It can rarely cause acute abdominal pain. An isolated\\u000a injury to an accessory liver from blunt trauma in a 10-year-old boy caused major intraperitoneal haemorrhage. Laparotomy and\\u000a excision of the lacerated accessory liver lobe was necessary; the patient recovered uneventfully. The literature on accessory\\u000a liver is reviewed.

E. S. Garba; E. A. Ameh

2002-01-01

41

Pseudoaneurysm of the proper hepatic artery with duodenal fistula appearing as a late complication of blunt abdominal trauma.  

PubMed

Posttraumatic pseudoaneurysms of the hepatic artery are rare and usually occur as a complication of open abdominal trauma. Even less common is the coexisting presence of enteric fistulization. We report a patient with upper gastrointestinal hemorrhage occurring 3 years after blunt abdominal trauma resulting from a pseudoaneurysm of the proper hepatic artery with duodenal fistulization. The patient was treated successfully by ligation of the proper hepatic artery and closure of the duodenal opening. PMID:8576975

Aboujaoude, M; Noel, B; Beaudoin, M; Ghattas, G; Lalonde, L; The Bao Bui; Oliva, V L

1996-01-01

42

[The mechanisms of formation of liver injuries associated with the blunt abdominal trauma].  

PubMed

The mechanisms of liver damage associated with the blunt abdominal trauma are considered based on the analysis of the literature publications. The general characteristic of these mechanisms and the processes underlying the development of liver injuries is presented. It is argued that the mechanisms underlying the formation of damages to the liver differ depending on the form of the traumatic impact, the injurious factor, and the processes leading to the destruction of the hepatic tissue. The main forms of traumatic impact in the case of a blunt abdominal trauma include the strike (blow), pressure, and concussion of the organ while the major traumatic factors are deformation, displacement, and "shock-resistant effects". The mechanisms underlying tissue destruction are compression and stretching. These two mechanisms are responsible for the formation of different variants of liver destruction. The results of the study suggest the necessity of the search for other mechanisms of degradation of the hepatic tissue following a blunt abdominal trauma for the improvement of forensic medical diagnostics of its cause and the underlying mechanism. PMID:23008952

Pigolkin, Iu I; Dubrovina, I A; Dubrovin, I A

2012-01-01

43

[Does CT scan for blunt abdominal trauma in children amount to a lot of radiation for little yield?].  

PubMed

Blunt abdominal trauma in children occurs fairly frequently. Although computed tomography scanning is considered by many to be the gold standard, in children who are hemodynamically stable, CT images do not usually result in new perspectives that lead to changes in treatment management. However, the burden of radiation for the child is considerable. CT scanning for blunt abdominal trauma should therefore be avoided in children who are hemodynamically stable. Novel algorithms, using parameters from the patient's history, physical examination, and possibly ultrasound and laboratory tests, seem to be sufficient for ruling out intra-abdominal injury in more than 95% of cases. PMID:24382053

Nellensteijn, David R; El Moumni, Mostafa; Greuter, Marcel J W; Kneyber, Martin C J; Hulscher, Jan B F

2013-01-01

44

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

2010-01-01

45

Blunt abdominal trauma to a pregnant woman resulting in a child with hemiplegic spastic cerebral palsy and permanent eye damage  

PubMed Central

Background In today's life trauma is a common and important complication of pregnancy and remains one of the major contributors to maternal and fetal morbidity and mortality. Case presentation The authors reported a case of 4 years old child with hemiplegic spastic cerebral palsy and permanent left eye damage due to antenatal trauma. He was an off spring to a 33 years old woman gravida 6 para 5 from western Sudan, who sustained a domestic blunt abdominal trauma during her routine daily activities. The abdominal trauma occurred during the third trimester at 36th week gestation of the pregnancy when the mother hit herself by the woody part of an axe non intentionally. Conclusions The findings from this case conclude that relatively minor trauma can have significant adverse effects on the fetus and can be devastating. PMID:24314440

2013-01-01

46

Goal-directed transfusion protocol via thrombelastography in patients with abdominal trauma: a retrospective study  

PubMed Central

Introduction The optimal transfusion protocol remains unknown in the trauma setting. This retrospective cohort study aimed to determine if goal-directed transfusion protocol based on standard thrombelastography (TEG) is feasible and beneficial in patients with abdominal trauma. Methods Sixty adult patients with abdominal trauma who received 2 or more units of red blood cell transfusion within 24 hours of admission were studied. Patients managed with goal-directed transfusion protocol via TEG (goal-directed group) were compared to patients admitted before utilization of the protocol (control group). Results There were 29 patients in the goal-directed group and 31 in the control group. Baseline parameters were similar except for higher admission systolic blood pressure in the goal-directed group than the control group (121.8?±?23.1 mmHg vs 102.7?±?26.5 mmHg, p?abdominal trauma. The novel protocol, compared to conventional transfusion management, has the potential to decrease blood product utilization and prevent exacerbation of coagulation function. PMID:24731406

2014-01-01

47

The use of contrast-enhanced ultrasound in blunt abdominal trauma: advantages and limitations.  

PubMed

Computed tomography (CT) is the imaging method of choice in the assessment of multiple trauma patients. However, in patients who suffered from low-energy abdominal trauma, the use of CT is controversial, since the probability of injury is low and therefore most of the studies are normal. Thus, conventional US imaging has increasingly been employed as the initial imaging modality in the work-up of minor traumatic emergency condition. More recently, the introduction of a new contrast-enhanced ultrasound (CEUS) technique, using second-generation ultrasound contrast agents, has led to a notable increase in the diagnostic accuracy of US in many organs. Therefore, in trauma patients, following assessment with conventional US imaging, a CEUS exam can be performed, to provide a more reliable assessment of solid organ injuries. CEUS has the potential to detect active bleeding from a variety of traumatic origins. Similar to CT, active extravasation is considered when there is evidence of contrast agent collection with echogenicity similar to that of an adjacent vessel. On the other hand, at least some drawbacks have to be addressed, including operator competence and reduced panoramic view. Moreover, CEUS, like conventional US imaging, cannot depict some lesions, such as diaphragmatic ruptures, bowel, and mesenteric traumatic injuries. This technique represents a non-invasive and repeatable method that can be performed at patient's bedside and is therefore extremely helpful for the follow-up of solid organs traumas managed conservatively, especially in pediatric patients and women of fertile age. Moreover, it may reduce the number of CT scans and expedite patient discharge. PMID:24060814

Pinto, Fabio; Miele, Vittorio; Scaglione, Mariano; Pinto, Antonio

2014-09-01

48

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

PubMed Central

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

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

2014-01-01

49

Risk factors for late death of patients with abdominal trauma after damage control laparotomy for hemostasis  

PubMed Central

Introduction In this study, we explored the possible causes of death and risk factors in patients who overcame the initial critical circumstance when undergoing a damage control laparotomy for abdominal trauma and succumbed later to their clinical course. Methods This was a retrospective study. We selected patients who fulfilled our study criteria from 2002 to 2012. The medical and surgical data of these patients were then reviewed. Fifty patients (survival vs. late death, 39 vs. 11) were enrolled for further analysis. Results In a univariable analysis, most of the significant factors were noted in the initial emergency department (ED) stage and early intensive care unit (ICU) stage, while an analysis of perioperative factors revealed a minimal impact on survival. Initial hypoperfusion (pH, BE, and GCS level) and initial poor physiological conditions (body temperature, RTS, and CPCR at ED) may contribute to the patient’s final outcome. An analysis and summary of the causes of death were also performed. Conclusions According to our study, the risk factors for late death in patients undergoing DCL may include both the initial trauma-related status and clinical conditions after DCL. In our series, the cause of death for patients with late mortality included the initial brain insult and later infectious complications. PMID:24387340

2014-01-01

50

Detection of necrosis of the gastric fundus after blunt abdominal trauma by PET-CT.  

PubMed

Positron emission tomography with [(18)F]-fluorodeoxyglucose provides functional and anatomic information by visualising the uptake of radiolabelled glucose in tumour and inflammatory cells. We report delayed diagnosis of necrosis of the gastric fundus after blunt abdominal trauma in a 73-year-old man. After a car accident with head-on collision, the patient was stabilised in our emergency room. His femur was treated by internal fixation, his ellbow was stabilised by a fixateur externe. During surgery his status deteriorated. The patient was in need of high dosage of inotrops during the following days. He had a biventricular pacemaker implanted because of ischemic myocardiopathy, and he suffered from renal insufficiency. Over the next days, his haemodynamics improved. A central venous line had to be removed because of ensuing septic fever. The patient complained of upper abdominal pain and nausea. A sonography and computer tomography without contrast medium were performed with negative result. Because of contamination of the central venous line with Staphylococcus epidermidis the pacemaker was evaluated for infection by transoesophageal echocardiography, again without any findings. Because of ongoing fever and positive inflammatory markers a positron emission tomography was indicated, as a contrast examination and a magnetic resonance examination were not feasible because of the renal insufficiency and the pacemaker, respectively. Prophylactic removal of the pacemaker would have been a substantial risk for the patient due to his underlying myocardiopathy. Positron emission tomography showed an increased tracer uptake in the gastric fundus, which turned out to be necrotic by endoscopy. A laparoscopic resection followed, and drainage of an abscess, which had evolved subsequently between stomach and spleen stopped the inflammatory process. This case report demonstrates that positron emission tomography may be an alternative to computer tomography with contrast medium and magnetic resonance imaging to detect an inflammatory process in patients with pre-existing disease. PMID:25421368

Hofer, A; Kratochwill, H; Pentsch, A; Gabriel, M

2014-11-25

51

Two-layer laparoscopic repair of intraperitoneal bladder rupture in blunt abdominal trauma: a case report with literature review.  

PubMed

Bladder injuries are usually reported after blunt trauma to lower abdomen. The pelvic fracture is associated in >80% of the cases. All intraperitoneal bladder tear are managed surgically with open exploration and repair. In stable patients, with no other intra-abdominal injury, laparoscopy acts both as a diagnostic and therapeutic tool. It results in faster recovery, early discharge from the hospital with good cosmetic outcome. We describe a similar case of intraperitoneal bladder rupture managed laparoscopically replicating the open technique of double-layer repair. PMID:22874700

Kapoor, Rahul

2012-08-01

52

Management of cirrhotic patients with blunt abdominal trauma: Analysis of risk factor of postoperative death with the Model for End-Stage Liver Disease score  

Microsoft Academic Search

IntroductionThe aim of this retrospective study is to analyse the risk factors of mortality in cirrhotic patients with blunt abdominal trauma (BAT) underwent laparotomy and the value of the Model for End-Stage Liver Disease (MELD) score to predict postoperative death is determined.

Being-Chuan Lin; Jen-Feng Fang; Yon-Cheong Wong; Tsann-Long Hwang; Yu-Pao Hsu

53

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. PMID:23249290

2012-01-01

54

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. PMID:22624830

2012-01-01

55

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

56

Development and Validation of the Mortality Risk for Trauma Comorbidity Index  

PubMed Central

Objective The aim of this study was to develop and validate a comorbidity index to predict the risk of mortality associated with chronic health conditions following a traumatic injury. Summary Background Data Currently available comorbidity adjustment tools do not account for certain chronic conditions, which may influence outcome following traumatic injury or they have not been fully validated for trauma. Controlling for comorbidity in trauma patients is becoming increasingly important as the population ages and elderly patients are more active, as well as to adjust for bias in trauma mortality studies. Methods Cohort study using data from the National Study on the Costs and Outcome of Trauma. Subject pool (N = 4644/Weighted Number = 14,069) was randomly divided in half; the first half of subjects was used to derive the risk scale, the second to validate the instrument. To construct the Mortality Risk Score for Trauma (MoRT), univariate analysis and odds ratios were performed to determine relative risk of mortality at hospital discharge comparing those persons with a comorbid condition to those without. Conditions significantly associated with mortality (P < 0.05) were included in the multivariate model. The variables in the final model were used to build the MoRT. The predictive ability of the MoRT and the Charlson Comorbid-ity Index (CCI) for discharge and 1-year mortality were estimated using the c-statistic in the validation sample. Results Six comorbidity factors were independently associated with the risk of mortality and formed the basis for the MoRT: severe liver disease, myocardial infarction, cerebrovascular disease, cardiac arrhythmias, dementia, and depression. The MoRT had a similar overall discrimination as the CCI for mortality at hospital discharge in injured adults (c-statistic: 0.56 vs. 0.56) although neither by itself performed well. The addition of age and gender improved the predictive ability of the MoRT (0.59; 95% CI: 0.56, 0.62) and the CCI (0.59; 0.56, 0.62). Similar results were seen at 1-year postinjury. The further addition of Injury Severity Score significantly improved the predictive ability of the MoRT (0.77, 95% CI: 0.74, 0.79) and the CCI (0.77, 95% CI: 0.75, 0.80). Conclusions The MoRTs primary advantage over current instruments is its parsimony, containing only 6 items. In the present study, the comorbid conditions found to be predictive of mortality had some overlap with the CCI, but this study identified 2 novel predictors: cardiac arrhythmias and depression. Inclusion and reporting of these items within trauma registries would therefore be an important step to allow further validation and use of the MoRT. PMID:20622665

Thompson, Hilaire J.; Rivara, Frederick P.; Nathens, Avery; Wang, Jin; Jurkovich, Gregory J.; Mackenzie, Ellen J.

2011-01-01

57

Augmentation index and aortic pulse wave velocity in patients with abdominal aortic aneurysms  

PubMed Central

Background: Abdominal aortic aneurysm (AAA) is a severe disease that can prove fatal. Factors such as advanced age, male gender, family history and cigarette use increase the risk of AAA. These factors associated with AAA development also increase arterial stiffness. Aortic pulse-wave velocity (PWV) was measured as an index of aortic stiffness. The heart rate-corrected augmentation index (AIx@75) was estimated as a composite marker of wave reflections and arterial stiffness. Elevated arterial stiffness increases the risk of development of cardiovascular events and impairs cardiovascular functions. In this study we investigated whether arterial stiffness rises in patients with AAA by measuring aortic PWV and AIx@75 parameters. Methods: Eighteen patients with AAA (age 69 ± 4 years) and 20 patients with no aneurysm (age 66 ± 6) were included. AAA was diagnosed using computerized tomography. Arterial stiffness was measured non-invasively in all patients using a SphygmoCor device. Aortic PWV and AIx@75 were used as arterial stiffness parameters. Results: There was no significant difference between the two groups in terms of demographic characteristics. AIx@75 (33.2 ± 8.9 vs 25.1 ± 7.8, p=0.008) and aortic PWV (14.8 ± 4.9 vs 10.0 ± 1.7, p=0.002) were significantly elevated in the AAA group compared to the control group. Conclusion: Elevated AIx@75 and aortic PWV shows that arterial stiffness increases in patients with AAA. PMID:24600499

Durmus, Ismet; Kazaz, Zeynep; Altun, Gokalp; Cansu, Aysegul

2014-01-01

58

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 ...

59

[Focused surgical bedside ultrasound: E-FAST (focused assessment with sonography in trauma) - abdominal aortic aneurysm - cholecystolithiasis - acute appendicitis].  

PubMed

Ultrasound is an easy to learn and highly efficient diagnostic tool to complete the clinical examination and improve bedside decision-making. In the trauma room, surgeons are often required to make a quick decision as to whether or not a patient needs an emergency intervention or whether further diagnostics are required. For this reason, education of surgeons in performing focused emergency ultrasound is pivotal. The goal of ICAN is to improve and expand the education of surgeons in Switzerland. This article provides a short review of the most frequent surgical pathologies encountered in the emergency room. PMID:24894613

Studer, Maria; Studer, Peter

2014-06-01

60

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

61

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

PubMed

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

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

2010-12-01

62

Visceral injury in electrical shock trauma: proposed guideline for the management of abdominal electrocution and literature review  

PubMed Central

Victims of electrical burns account for approximately 5% of admissions to major burn centers. The first case of visceral injury caused by electrical burns was described in 1927 by Simonin, who reported perforation of the small intestine. Other rare cases were reported over the following years. The colon and small intestine were the organs most frequently affected. Less frequently involved organs were the heart, esophagus, stomach, pancreas, liver, gallbladder, lung, and kidney. We highlight the potential fatal visceral injuries after the electrical trauma. This study provides a review on this topic and proposes a management flowchart that should be adopted by the multidisciplinary team to treat these patients. Conclusion: Visceral injuries are rare in electrical burns victims, but it can be severe and are associated with high rates of morbidity and mortality, sometimes requiring a more interventional approach. PMID:24624308

Marques, Evelyne GSC; Júnior, Gerson A Pereira; Neto, Bruno F Muller; Freitas, Rodrigo A; Yaegashi, Lygia B; Almeida, Carlos E Fagotti; Júnior, Jayme Adriano Farina

2014-01-01

63

Nuclear cardiac ejection fraction and cardiac index in abdominal aortic surgery  

SciTech Connect

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

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

1983-11-01

64

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

PubMed Central

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

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

2014-01-01

65

Orthopedic trauma: pelvic fracture.  

PubMed

1. The incidence of pelvic fractures has greatly increased; automobile and motorcycle crashes, pedestrian accidents, and falls from great height are the most common causes. Pelvic fractures caused by high-energy trauma often result in significant morbidity and mortality with mortality rates variously reported at 10% to 50%, dependent upon fracture classification and associated injuries. Mortality occurs from associated trauma to viscera, abdominal organs, and abdominal vessels, and from early complications of hemorrhage. 2. The difficulty in management of patients with pelvic fractures is determining whether fractures are stable or unstable. Single breaks with no displacement in the pelvic ring, which includes injuries to the ischium, ilium, pubis, and sacrum, are stable fractures and account for one third of all pelvic fractures. 3. Increasingly widespread use of surgical stabilization internally via rigid fixation of pelvic fractures has helped reduce the morbidity and mortality related to these fractures. Other benefits that have resulted include shortened hospitalization, decreased complications, and earlier mobility. PMID:8342218

Edwards, K P

1993-01-01

66

Systemic trauma.  

PubMed

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

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

2014-01-01

67

Effect of reproductive characteristics, body mass index, and anterior/posterior vaginal compartment defects on the short-term success of abdominal sacrocolpopexy.  

PubMed

Objective. Vaginal vault prolapse is caused by the loss of apical support in the cardinal-uterosacral ligament complex. Abdominal sacrocolpopexy (ASCP) is one means of repairing vaginal vault prolapse. In the present study, we investigated the effects of reproductive factors, body mass index (BMI), and anterior or posterior vaginal compartment defects on short-term outcomes of ASCP. Method. We retrospectively studied 70 women who had undergone ASCP between February 2012 and November 2012 in our clinic. Result. There were no significant differences in the complication rate among menopausal, nonmenopausal women, and grand multiparous patients. Operational success was not significantly affected by menopausal status. The long-term rate of grade ? 2 prolapse in the apical, anterior, or posterior vaginal wall after ASCP did not differ significantly by menopausal status. Correlation analysis showed that BMI was not associated with operational success in the early postoperative period in patients with vaginal prolapse and was not associated with the detection of grade ? 2 prolapse in apical, anterior, and posterior compartments after 1 year. Conclusion. ASCP should be the first-line treatment for obese/overweight, menopausal, or grand multiparous patients with additional anterior or posterior vaginal vault prolapse. PMID:25356618

Ca?lar, Mete; Erkal, Neslihan Boz; Isenlik, Bekir S?tk?; Ozdemir, Ozgür; Yavuzcan, Ali; Ustün, Yusuf; Kumru, Selahattin

2014-10-30

68

Population Distribution of the Sagittal Abdominal Diameter (SAD) from a Representative Sample of US Adults: Comparison of SAD, Waist Circumference and Body Mass Index for Identifying Dysglycemia  

PubMed Central

Background The sagittal abdominal diameter (SAD) measured in supine position is an alternative adiposity indicator that estimates the quantity of dysfunctional adipose tissue in the visceral depot. However, supine SAD’s distribution and its association with health risk at the population level are unknown. Here we describe standardized measurements of SAD, provide the first, national estimates of the SAD distribution among US adults, and test associations of SAD and other adiposity indicators with prevalent dysglycemia. Methods and Findings In the 2011–2012 National Health and Nutrition Examination Survey, supine SAD was measured (“abdominal height”) between arms of a sliding-beam caliper at the level of the iliac crests. From 4817 non-pregnant adults (age ?20; response rate 88%) we used sample weights to estimate SAD’s population distribution by sex and age groups. SAD’s population mean was 22.5 cm [95% confidence interval 22.2–22.8]; median was 21.9 cm [21.6–22.4]. The mean and median values of SAD were greater for men than women. For the subpopulation without diagnosed diabetes, we compared the abilities of SAD, waist circumference (WC), and body mass index (BMI, kg/m2) to identify prevalent dysglycemia (HbA1c ?5.7%). For age-adjusted, logistic-regression models in which sex-specific quartiles of SAD were considered simultaneously with quartiles of either WC or BMI, only SAD quartiles 3 (p<0.05 vs quartile 1) and 4 (p<0.001 vs quartile 1) remained associated with increased dysglycemia. Based on continuous adiposity indicators, analyses of the area under the receiver operating characteristic curve (AUC) indicated that the dysglycemia model fit for SAD (age-adjusted) was 0.734 for men (greater than the AUC for WC, p<0.001) and 0.764 for women (greater than the AUC for WC or BMI, p<0.001). Conclusions Measured inexpensively by bedside caliper, SAD was associated with dysglycemia independently of WC or BMI. Standardized SAD measurements may enhance assessment of dysfunctional adiposity. PMID:25272003

Kahn, Henry S.; Gu, Qiuping; Bullard, Kai McKeever; Freedman, David S.; Ahluwalia, Namanjeet; Ogden, Cynthia L.

2014-01-01

69

Traumatic anterior abdominal wall hernia: A report of three rare cases  

PubMed Central

Traumatic abdominal wall hernia is a rare condition that can follow any blunt trauma. Associated intra-abdominal injuries are infrequent. In this study, we are reporting three cases, diagnosed as abdominal wall hernia associated with herniation of bowel loops due to blunt trauma. In one case, injury of the herniated bowel was seen. In western medical literature, only few cases have been reported especially with intra-abdominal injuries. PMID:21633587

Singal, Rikki; Dalal, Usha; Dalal, Ashwani Kumar; Attri, Ashok Kumar; Gupta, Raman; Gupta, Anupama; Naredi, Bikash; Kenwar, Deepesh Benjamin; Gupta, Samita

2011-01-01

70

Acoustic trauma  

MedlinePLUS

Acoustic trauma is injury to the hearing mechanisms in the inner ear. It is due to very loud noise. ... of sensory hearing loss . Damage to the hearing mechanisms within the inner ear may be caused by: ...

71

Pediatric trauma.  

PubMed

In the United States, trauma continues to be the leading cause of death in children between the ages of 1 and 15 years of age. Children die from trauma at a rate five times greater than from leukemia which is the next leading cause of death in this age group. The acutely injured child is brought to community hospitals as well as university hospitals. The CRNA that is called to care for the injured child, either in the emergency room or the operating room, must be knowledgeable of the anatomic, physiological, and emotional differences between the adult and pediatric trauma patient and their response to treatment. Only with this knowledge will there be a decrease in the morbidity of the traumatized pediatric patient. The CRNA should be able to rapidly assess and gain control of the pediatric airway and assure adequate respiration. Initial assessment of the pediatric trauma patient also includes the restoration or maintenance of hemodynamic stability. PMID:9437948

Kirk, J A

1997-11-01

72

Traumatic abdominal hernia complicated by necrotizing fasciitis.  

PubMed

Necrotizing fasciitis is a critical illness involving skin and soft tissues, which may develop after blunt abdominal trauma causing abdominal wall hernia and representing a great challenge for physicians. A 52-year-old man was brought to the emergency department after a road accident, presenting blunt abdominal trauma with a large non-reducible mass in the lower-right abdomen. A first, CT showed abdominal hernia without signs of complication. Three hours after ICU admission, he developed hemodynamic instability. Therefore, a new CT scan was requested, showing signs of hernia complication. He was moved to the operating room where a complete transversal section of an ileal loop was identified. Five hours after surgery, he presented a new episode of hemodynamic instability with signs of skin and soft tissue infection. Due to the high clinical suspicion of necrotizing fasciitis development, wide debridement was performed. Following traumatic abdominal wall hernia (TAWH), patients can present unsuspected injuries in abdominal organs. Helical CT can be falsely negative in the early moments, leading to misdiagnosis. Necrotizing fasciitis is a potentially fatal infection and, consequently, resuscitation measures, wide-spectrum antibiotics, and early surgical debridement are required. This type of fasciitis can develop after blunt abdominal trauma following wall hernia without skin disruption. PMID:25541927

Martínez-Pérez, Aleix; Garrigós-Ortega, Gonzalo; Gómez-Abril, Segundo Ángel; Martí-Martínez, Eva; Torres-Sánchez, Teresa

2014-11-01

73

Abdominal pain  

MedlinePLUS

Stomach pain; Pain - abdomen; Belly ache; Abdominal cramps; Bellyache; Stomachache ... Almost everyone has pain in the abdomen at some point. Most of the time, it is not serious. How bad your pain is ...

74

Blunt thoracic trauma. Analysis of 515 patients.  

PubMed Central

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

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

1987-01-01

75

Suspension trauma  

PubMed Central

Suspension trauma (also known as “harness?induced pathology” or “orthostatic shock while suspended”) is the development of presyncopal symptoms and loss of consciousness if the human body is held motionless in a vertical position for a period of time. It has been described in experiments of personal fall protection, and has been implicated in causes of death in mountaineering accidents, but it seems neither to be widely known about nor to have been presented to the medical profession. This article highlights the potential existence of suspension trauma and suggests that more robust medical research using modern harnesses and healthy volunteers would be beneficial to assess whether this is purely a theoretical risk. PMID:17384373

Lee, Caroline; Porter, Keith M

2007-01-01

76

Penetrating trauma.  

PubMed

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

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

2014-10-01

77

Penetrating trauma  

PubMed Central

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

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

2014-01-01

78

Abdominal Tuberculosis  

Microsoft Academic Search

. Throughout the world tuberculosis is\\u000a \\u000a associated with poverty, deprivation, and human immunodeficiency virus\\u000a \\u000a infection. Abdominal tuberculosis is usually of insidious onset with\\u000a \\u000a diverse symptoms and signs. A few present with acute complications of\\u000a \\u000a perforation, obstruction, or bleeding. The diagnosis is difficult,\\u000a \\u000a especially in areas where the disease is less common, as many patients\\u000a \\u000a do not have evidence of pulmonary

Niall O. Aston

1997-01-01

79

Kidney (Renal) Trauma  

MedlinePLUS

... trauma. "Trauma" is injury caused by an external force that may be either blunt—such as a ... concerned with the urinary tract in males and females and with the genital tract and reproductive system ...

80

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

2012-10-10

81

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. PMID:21397319

The Emerging Risk Factors Collaboration

2011-01-01

82

Intestinal infarction after nonabdominal trauma; association with cerebral trauma.  

PubMed

Nonocclusive bowel infarction in nonabdominal trauma has been ascribed to periods of hypotension. However, to our knowledge only 17 cases have been reported, and hypotension was not always found. We studied the frequency and possible causes of intestinal infarction in all patients treated at our traumatologic intensive care unit from 1977 through 1986 (n = 2350). Intestinal infarction was diagnosed at the time of surgery or autopsy; patients with pre-existing vascular disease were excluded. We found 12 patients (incidence: 0.5%) of age 45 +/- 20 years (mean +/- SD). All had severe cerebral trauma [Head and Neck Abbreviated Injury Scale (AIS) score: 4-5, admission Glasgow Coma Scale (GCS) score: 6.5 +/- 3.8]. Eight patients suffered from additional injuries. The Injury Severity Score (ISS) was 27 +/- 7. All patients received ventilator assistance continuously before the diagnosis of intestinal infarction or death. The leading symptom of intestinal infarction was sepsis and multiple organ failure with abdominal distention. Five patients with favorable cerebral prognosis underwent surgery: one survived with good cerebral and gastrointestinal recovery. Four patients did not have surgery because of a poor cerebral prognosis. Three patients died of their cerebral trauma before intestinal infarction was clinically manifested. The data show that early diagnosis in ventilated patients with head injuries is extremely difficult because of the heterogenicity of this group of patients, the low frequency of the complication, and the complexity of the clinical picture. Although patients inevitably were exposed to several agents or situations associated with intestinal infarction, the ubiquitous causes were dehydration and diuretic therapy. PMID:1474630

Frick, T W; Käch, K; Sulser, H; Hailemariam, S; Largiadèr, F; Glinz, W

1992-12-01

83

A Traumatic Abdominal Wall Hernia Repair: A Laparoscopic Approach  

PubMed Central

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

Wilson, Kenneth L.; Rosser, James C.

2012-01-01

84

Circulating iFABP Levels as a Marker of Intestinal Damage in Trauma Patients.  

PubMed

Both the initial trauma and the subsequent hemodynamic instability may contribute to intestinal damage, which is of great importance in (immunological) posttrauma complications. This study assesses intestinal damage using the biomarker intestinal Fatty Acid Binding Protein (iFABP) in trauma patients during the first days of their hospital admission and the risk factors involved. Plasma iFABP levels were measured in blood samples obtained from adult multiple trauma patients (n = 93) at the trauma scene by the Helicopter Emergency Medical Services, at arrival at the emergency department (ED), and at days 1, 3, 5, 7, 10, and 14 after trauma and related to injury severity and hemodynamic parameters. Plasma iFABP concentrations showed highest levels immediately after trauma at time points Helicopter Emergency Medical Services and ED. Nonsurvivors demonstrated higher iFABP levels at the ED compared with survivors. Furthermore, iFABP values at the ED correlated with Injury Severity Scores, and patients suffering from abdominal trauma demonstrated significantly higher iFABP concentrations in comparison with patients with other types of trauma or healthy controls. Also, patients presenting with a mean arterial pressure (MAP) less than 70 mmHg at the ED demonstrated significantly higher plasma iFABP concentrations in comparison with patients with a normal (70-99 mmHg) or high (>100 mmHg) MAP or healthy controls. Finally, patients with a low hemoglobin (Hb) (<80% of reference value) displayed significantly higher iFABP concentrations in comparison with patients with a normal Hb or healthy controls. Plasma iFABP levels, indicative of intestinal injury, are increased immediately after trauma in patients with abdominal trauma, low MAP, or low Hb and are related to the severity of the trauma. As intestinal injury is suggested to be related to late complications, such as multiorgan dysfunction syndrome or sepsis in trauma patients, strategies to prevent intestinal damage after trauma could be of benefit to these patients. PMID:25394241

Timmermans, Kim; Sir, Özcan; Kox, Matthijs; Vaneker, Michiel; de Jong, Carmen; Gerretsen, Jelle; Edwards, Michael; Scheffer, Gert Jan; Pickkers, Peter

2015-02-01

85

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

86

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

87

A rare nonincisional lateral abdominal wall hernia  

PubMed Central

A 68-year-old woman presented a rare lateral abdominal wall hernia. Three month before admission to Chungbuk National University Hospital, she found a large protruding mass measuring 8 cm in diameter in the midaxillary line just below the costal margin upon heavy coughing. She had no history of abdominal trauma, infection, or operation previously. The mass was easily reduced manually or by position change to left lateral decubitus. CT scan showed a defect of the right transversus abdominis muscle and internal oblique muscle at the right flank with omental herniation. Its location is different from that of spigelian hernia or lumbar hernia. The peritoneal lining of the hernia sac was smooth and there was no evidence of inflammation or adhesion. The hernia was successfully repaired laparoscopically using Parietex composite mesh with an intraperitoneal onlay mesh technique. The patient was discharged uneventfully and did not show any evidence of recurrence at follow-up visits.

Kim, Dong-Ju

2015-01-01

88

Pattern of ocular trauma.  

PubMed

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

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

2011-07-01

89

Rural trauma telemedicine.  

PubMed

Telemedicine is the ability to provide remote health care to patients with the use of a consultant and 2-way interactive technology and telecommunication. Traumatic injuries occurring in rural areas frequently carry a greater risk of mortality than those same injuries occurring in the urban settings. The purpose of this article was to increase practitioner awareness of the potential for improved outcomes as a result of the use of telemedicine in rural trauma care. The use of trauma telemedicine will help decrease the overall mortality and morbidity, length of stay at the urban trauma centers, patient care cost, and transfer time. PMID:24305081

Wesson, James Bryan; Kupperschmidt, Betty

2013-01-01

90

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. PMID:23961028

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

2012-01-01

91

Primary trauma care.  

PubMed

The Primary Trauma Care programme is a course designed to train anaesthetists, surgeons and others in the systematic review and management of severe trauma victims at the District Hospital. Over the last 10 years, many individuals have been involved in training, empowering and supporting doctors and nurses in a number of countries. Local programmes and training courses are increasingly co-ordinated by regional offices in South America, India, China, Indonesia, the South Pacific and Africa. The Primary Trauma Care Foundation continues to support these regional offices in their need for qualified instructors, fund-raising, and for updating educational material. With anaesthetic support, the Primary Trauma Care Foundation will continue to empower anaesthetists worldwide as they work with their surgical colleagues to treat severely injured patients in areas where, previously, due to inadequate resources and training, comprehensive treatment was not available. PMID:17937716

Wilkinson, D; McDougall, R

2007-12-01

92

Trauma program development.  

PubMed

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

Althausen, Peter L

2014-07-01

93

Head Trauma, First Aid  

MedlinePLUS

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

94

Imaging in orbital trauma.  

PubMed

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

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

2012-10-01

95

Abdominal vacuum lift as an aid to diagnosing abdominal adhesions  

E-print Network

The internal organs are designed to move freely and slide over one another during normal body movement. The abdominal organs, however, have a tendency to adhere to the abdominal cavity (peritoneum) and other abdominal ...

Strauss, Julius (Julius Y.)

2006-01-01

96

Trauma registry reengineered.  

PubMed

A successful trauma registry balances accuracy of abstraction and timeliness of case submissions to achieve quality performance. Staffing to achieve quality performance is a challenge at times based on competitive institutional need. The aim of this performance improvement timing study was to identify trauma registry job responsibilities and redesign the responsibilities to create increased abstraction time and maintain accuracy of data abstraction. The outcome is measured by case submission rates with existing staffing and interrater reliability outcomes. PMID:25397337

Wargo, Christina; Bolig, Nicole; Hixson, Heather; McWilliams, Nate; Rummerfield, Heather; Stratton, Elaine; Woodruff, Tracy

2014-01-01

97

Penetrating Extremity Trauma.  

PubMed

Penetrating extremity trauma (PET) usually becomes less important when present along with multiple truncal injuries. The middle eastern wars documented the terrible mortality and morbidity resulting from PET. Even in civilian trauma, PET can lead to significant morbidity and mortality. There are now well-established principles in the evaluation and management of vascular, bony, soft tissue, and neurologic lesions that will lead to a reduction of the poor outcomes. This review will summarize some of these recent concepts. PMID:25413177

Ivatury, Rao R; Anand, Rahul; Ordonez, Carlos

2014-11-21

98

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

99

Noninvasive ventilation in trauma  

PubMed Central

Trauma patients are a diverse population with heterogeneous needs for ventilatory support. This requirement depends mainly on the severity of their ventilatory dysfunction, degree of deterioration in gaseous exchange, any associated injuries, and the individual feasibility of potentially using a noninvasive ventilation approach. Noninvasive ventilation may reduce the need to intubate patients with trauma-related hypoxemia. It is well-known that these patients are at increased risk to develop hypoxemic respiratory failure which may or may not be associated with hypercapnia. Hypoxemia in these patients is due to ventilation perfusion mismatching and right to left shunt because of lung contusion, atelectasis, an inability to clear secretions as well as pneumothorax and/or hemothorax, all of which are common in trauma patients. Noninvasive ventilation has been tried in these patients in order to avoid the complications related to endotracheal intubation, mainly ventilator-associated pneumonia. The potential usefulness of noninvasive ventilation in the ventilatory management of trauma patients, though reported in various studies, has not been sufficiently investigated on a large scale. According to the British Thoracic Society guidelines, the indications and efficacy of noninvasive ventilation treatment in respiratory distress induced by trauma have thus far been inconsistent and merely received a low grade recommendation. In this review paper, we analyse and compare the results of various studies in which noninvasive ventilation was applied and discuss the role and efficacy of this ventilator modality in trauma. PMID:25685722

Karcz, Marcin K; Papadakos, Peter J

2015-01-01

100

Noninvasive ventilation in trauma.  

PubMed

Trauma patients are a diverse population with heterogeneous needs for ventilatory support. This requirement depends mainly on the severity of their ventilatory dysfunction, degree of deterioration in gaseous exchange, any associated injuries, and the individual feasibility of potentially using a noninvasive ventilation approach. Noninvasive ventilation may reduce the need to intubate patients with trauma-related hypoxemia. It is well-known that these patients are at increased risk to develop hypoxemic respiratory failure which may or may not be associated with hypercapnia. Hypoxemia in these patients is due to ventilation perfusion mismatching and right to left shunt because of lung contusion, atelectasis, an inability to clear secretions as well as pneumothorax and/or hemothorax, all of which are common in trauma patients. Noninvasive ventilation has been tried in these patients in order to avoid the complications related to endotracheal intubation, mainly ventilator-associated pneumonia. The potential usefulness of noninvasive ventilation in the ventilatory management of trauma patients, though reported in various studies, has not been sufficiently investigated on a large scale. According to the British Thoracic Society guidelines, the indications and efficacy of noninvasive ventilation treatment in respiratory distress induced by trauma have thus far been inconsistent and merely received a low grade recommendation. In this review paper, we analyse and compare the results of various studies in which noninvasive ventilation was applied and discuss the role and efficacy of this ventilator modality in trauma. PMID:25685722

Karcz, Marcin K; Papadakos, Peter J

2015-02-01

101

Trauma-associated hyperfibrinolysis.  

PubMed

Trauma-induced coagulopathy (TIC) has been considered for a long time as being due to depletion of coagulation factors secondary to blood loss, dilution and consumption. Dysfunction of the remaining coagulation factors due to hypothermia and acidosis is assumed to additionally contribute to TIC. Recent data suggest that hyperfibrinolysis (HF) represents an additional important confounder to the disturbed coagulation process. Severe shock and major tissue trauma are the main drivers of this HF. The incidence of HF is still speculative. According to visco-elastic testing of trauma patients upon emergency room admission, HF is present in approximately 2.5-7% of all trauma patients. However, visco-elastic tests provide information on severe forms of HF only. Occult HF seems to be much more common but diagnosis is still challenging. Results from a recent randomized, placebo-controlled trial suggest that the early treatment of trauma patients with tranexamic acid may result in a significant reduction of trauma-associated mortality. PMID:22009115

Schöchl, H; Voelckel, W; Maegele, M; Solomon, C

2012-01-01

102

Blunt transection of rectus abdominis following seatbelt related trauma with associated small and large bowel injury?  

PubMed Central

INTRODUCTION Closed rupture of rectus abdominis following seatbelt related trauma is rare. PRESENTATION OF CASE We present the case of a 45 year old female who presented with closed rupture of the rectus abdominis in conjunction with damage to small bowel mesentery and infarction of small and large bowel following a high velocity road traffic accident. Multiple intestinal resections were required resulting in short bowel syndrome and abdominal wall reconstruction with a porcine collagen mesh. Post-operative complications included intra-abdominal sepsis and an enterocutaneous fistula. DISCUSSION The presence of rupture of rectus abdominis muscle secondary to seatbelt injury should raise the suspicion of intra-abdominal injury. CONCLUSION Our case highlights the need for suspicion, investigation and subsequent surgical management of intra-abdominal injury following identification of this rare consequence of seatbelt trauma. PMID:24055917

Patel, K.; Doolin, R.; Suggett, N.

2013-01-01

103

Abdominal hernias: Radiological features  

PubMed Central

Abdominal wall hernias are common diseases of the abdomen with a global incidence approximately 4%-5%. They are distinguished in external, diaphragmatic and internal hernias on the basis of their localisation. Groin hernias are the most common with a prevalence of 75%, followed by femoral (15%) and umbilical (8%). There is a higher prevalence in males (M:F, 8:1). Diagnosis is usually made on physical examination. However, clinical diagnosis may be difficult, especially in patients with obesity, pain or abdominal wall scarring. In these cases, abdominal imaging may be the first clue to the correct diagnosis and to confirm suspected complications. Different imaging modalities are used: conventional radiographs or barium studies, ultrasonography and Computed Tomography. Imaging modalities can aid in the differential diagnosis of palpable abdominal wall masses and can help to define hernial contents such as fatty tissue, bowel, other organs or fluid. This work focuses on the main radiological findings of abdominal herniations. PMID:21860678

Lassandro, Francesco; Iasiello, Francesca; Pizza, Nunzia Luisa; Valente, Tullio; Stefano, Maria Luisa Mangoni di Santo; Grassi, Roberto; Muto, Roberto

2011-01-01

104

Pyogenic vertebral osteomyelitis complicating abdominal penetrating injury: case report and review of the literature  

PubMed Central

Pyogenic vertebral osteomyelitis is a rare condition usually associated with endocarditis or spinal surgery. However, it may also occur following abdominal penetrating trauma with associated gastrointestinal perforation. Diagnosis might be challenging and appropriate treatment is essential to ensure a positive outcome. In trans-abdominal trauma, 48 hours of broad-spectrum antibiotics is generally recommended for prophylaxis of secondary infections. A case report of vertebral osteomyelitis complicating trans-colonic injury to the retroperitoneum is presented and clinical management is discussed in the light of literature review. PMID:24373134

2013-01-01

105

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

106

Maxillofacial trauma in children.  

PubMed

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

Mukherjee, Chitrita Gupta; Mukherjee, Uday

2012-09-01

107

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

108

Transfusion practices in trauma  

PubMed Central

Resuscitation of a severely traumatised patient with the administration of crystalloids, or colloids along with blood products is a common transfusion practice in trauma patients. The determination of this review article is to update on current transfusion practices in trauma. A search of PubMed, Google Scholar, and bibliographies of published studies were conducted using a combination of key-words. Recent articles addressing the transfusion practises in trauma from 2000 to 2014 were identified and reviewed. Trauma induced consumption and dilution of clotting factors, acidosis and hypothermia in a severely injured patient commonly causes trauma-induced coagulopathy. Early infusion of blood products and early control of bleeding decreases trauma-induced coagulopathy. Hypothermia and dilutional coagulopathy are associated with infusion of large volumes of crystalloids. Hence, the predominant focus is on damage control resuscitation, which is a combination of permissive hypotension, haemorrhage control and haemostatic resuscitation. Massive transfusion protocols improve survival in severely injured patients. Early recognition that the patient will need massive blood transfusion will limit the use of crystalloids. Initially during resuscitation, fresh frozen plasma, packed red blood cells (PRBCs) and platelets should be transfused in the ratio of 1:1:1 in severely injured patients. Fresh whole blood can be an alternative in patients who need a transfusion of 1:1:1 thawed plasma, PRBCs and platelets. Close monitoring of bleeding and point of care coagulation tests are employed, to allow goal-directed plasma, PRBCs and platelets transfusions, in order to decrease the risk of transfusion-related acute lung injury. PMID:25535424

Ramakrishnan, V Trichur; Cattamanchi, Srihari

2014-01-01

109

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

110

Abdominal aortic aneurysm  

MedlinePLUS

Aneurysm - aortic; AAA ... pressure Male gender Genetic factors An abdominal aortic aneurysm is most often seen in males over age ... one or more risk factors. The larger the aneurysm, the more likely it is to break open. ...

111

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

112

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

113

Dimensions of trauma and specific symptoms of complex posttraumatic stress disorder in inner-city youth: a preliminary study.  

PubMed

We examined relations of posttraumatic stress disorder (PTSD) symptoms with dimensions of trauma, including environment (Domestic vs. Community) and proximity (Indirect vs. Direct trauma) among inner-city youth. Participants (n = 65) reported traumatic events they had experienced on a version of the UCLA PTSD Reaction Index Trauma Exposure Screen, and reported PTSD symptoms with the PTSD Checklist--Civilian version (PCL-C). High rates of trauma and PTSD were found, consistent with other reports of inner-city youth. The 49% of youth surveyed met criteria for PTSD on the PCL-C symptom scale with a score cutoff of 35. Females reported elevated PTSD symptom scores and a higher incidence of Domestic trauma than did males but similar incidence of other trauma types. When males and females were combined, Domestic trauma significantly correlated with each of the PTSD symptom clusters of intrusions, numbing/avoidance, and hyperarousal. When participants with Community trauma were excluded from analyses to reduce confounding environmental influence, Domestic trauma marginally correlated with numbing/avoidance symptoms. Our findings suggest that Domestic trauma may result in more emotional numbing/avoidance symptoms than other types of trauma. Further analyses suggested that Community trauma may result in more intrusions and hyperarousal symptoms rather than emotional numbing. Environmental aspects of trauma, rather than the proximity of trauma, may have greater impact on presentation of PTSD. Future studies with larger samples are needed to confirm these findings. PMID:24834747

Post, Marina; Hanten, Gerri; Li, Xiaoqi; Schmidt, Adam T; Avci, Gunes; Wilde, Elisabeth A; McCauley, Stephen R

2014-01-01

114

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

115

Secondary Trauma: A Team Approach  

Microsoft Academic Search

Bearing witness to trauma stories can evoke in clinicians the confusion and emotional turmoil their clients experience, known as secondary trauma. Given the complexities of trauma work, practitioners need help to clarify issues and feel more effective. The terror attacks of September 11, 2001 further compound the task, as therapists may themselves be feeling the impact of those events. Presented

Janet A. Geller; Libbe H. Madsen; Lynn Ohrenstein

2004-01-01

116

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

117

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

118

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

119

Delayed aortic rupture following perforating trauma  

PubMed Central

The immediate death rate for aortic rupture caused by pointed and sharp-edged instruments is very high; however, delayed aortic rupture following the trauma is rarely reported. A patient who had an upper abdominal stab wound was sent to our hospital, and an emergency exploratory laparotomy was performed. No traumatic aortic rupture was found at that time. However, on the fifth day after surgery, aortic rupture occurred, and a large retroperitoneal hematoma was formed. The patient eventually died. Aortic rupture was confirmed by a second emergency exploratory laparotomy and the autopsy. The information from exploratory laparotomies, post-operative observations and treatments, medical imaging reports, and reasons for delayed aortic rupture, as well as the underlying pathophysiological processes, are discussed in this case report. PMID:25405156

Yang, Xuefei; Xia, Ligang

2014-01-01

120

[Immunosuppression caused by surgery and severe trauma].  

PubMed

The present prospective study was performed to describe physiological immunosuppressive effects dependent on minor surgical interventions and an immunodeficiency syndrome after major surgery and severe trauma. Parameters of cellular and humoral immunity were monitored in 64 patients of the Department of Surgery of the University Hospital Zurich preoperatively and on days 1, 2, 3 and 4 after selective surgery or polytrauma. 22 patients were multiply traumatized (mean ISS 34.7 +/- 13), 14 patients underwent Y-grafting of the abdominal aorta, 11 resection of colorectal carcinoma, 8 cholecystectomy and 9 inguinal herniotomy. There could be seen a decrease of parameters of cellular immunity (absolute lymphocyte count, CD-4-/CD-8-cell-ratio and release of IL2-receptors), a decrease of humoral defense (immunoglobulins and complement factors) and an increase of macrophage activation (serum levels of neopterin). PMID:2777589

Holch, M; Grob, P J; Fierz, W; Glinz, W; Geroulanos, S

1989-06-01

121

Adverse consequences of internal iliac artery occlusion during endovascular repair of abdominal aortic aneurysms  

Microsoft Academic Search

Objective: Embolization of the internal iliac artery (IIA) may be performed during endovascular abdominal aortic aneurysm (AAA) repair if aneurysmal disease of the common iliac artery precludes graft placement proximal to the IIA orifice. The IIA may also be unintentionally occluded because of iliac trauma or coverage by the endograft. The purpose of this study was to determine the incidence,

Laura A. Karch; Kim J. Hodgson; Mark A. Mattos; William T. Bohannon; Don E. Ramsey; Robert B. McLafferty

2000-01-01

122

Rapid development of intestinal cell damage following severe trauma: a prospective observational cohort study  

PubMed Central

Introduction Loss of intestinal integrity has been implicated as an important contributor to the development of excessive inflammation following severe trauma. Thus far, clinical data concerning the occurrence and significance of intestinal damage after trauma remain scarce. This study investigates whether early intestinal epithelial cell damage occurs in trauma patients and, if present, whether such cell injury is related to shock, injury severity and the subsequent inflammatory response. Methods Prospective observational cohort study in 96 adult trauma patients. Upon arrival at the emergency room (ER) plasma levels of intestinal fatty acid binding protein (i-FABP), a specific marker for damage of differentiated enterocytes, were measured. Factors that potentially influence the development of intestinal cell damage after trauma were determined, including the presence of shock and the extent of abdominal trauma and general injury severity. Furthermore, early plasma levels of i-FABP were related to inflammatory markers interleukin-6 (IL-6), procalcitonin (PCT) and C-reactive protein (CRP). Results Upon arrival at the ER, plasma i-FABP levels were increased compared with healthy volunteers, especially in the presence of shock (P < 0.01). The elevation of i-FABP was related to the extent of abdominal trauma as well as general injury severity (P < 0.05). Circulatory i-FABP concentrations at ER correlated positively with IL-6 and PCT levels at the first day (r2 = 0.19; P < 0.01 and r2 = 0.36; P < 0.001 respectively) and CRP concentrations at the second day after trauma (r2 = 0.25; P < 0.01). Conclusions This study reveals early presence of intestinal epithelial cell damage in trauma patients. The extent of intestinal damage is associated with the presence of shock and injury severity. Early intestinal damage precedes and is related to the subsequent developing inflammatory response. PMID:19505335

de Haan, Jacco J; Lubbers, Tim; Derikx, Joep P; Relja, Borna; Henrich, Dirk; Greve, Jan-Willem; Marzi, Ingo; Buurman, Wim A

2009-01-01

123

Abdominal Inflammatory Myofibroblastic Tumor  

PubMed Central

A 28-year-old woman was referred to our hospital because of abdominal pain, weight loss and a palpable intra-abdominal mass. A CT scan revealed a tumor with a diameter of 7 cm with sharp margins, intra-tumoral fatty components and enhancing soft tissue. After initial workup, which suggested an inflammatory myofibroblastic tumor (IMT), she underwent laparotomy with complete resection. Pathological examination indeed revealed IMT. IMT is a rare benign neoplasm and has been described in nearly the entire body. It presents with nonspecific symptoms. The therapy of abdominal IMT consists of radical surgery because of high local recurrence rates. In this case report clinical, surgical, radiological and histological features with a review of the relevant literature are described. PMID:24707245

Groenveld, Roosmarijn L.; Raber, Menno H.; Oosterhof-Berktas, Richard; Eijken, Erik; Klaase, Joost M.

2014-01-01

124

Fetal abdominal wall defects.  

PubMed

The most common fetal abdominal wall defects are gastroschisis and omphalocele, both with a prevalence of about three in 10,000 births. Prenatal ultrasound has a high sensitivity for these abnormalities already at the time of the first-trimester nuchal scan. Major unrelated defects are associated with gastroschisis in about 10% of cases, whereas omphalocele is associated with chromosomal or genetic abnormalities in a much higher proportion of cases. Challenges in management of gastroschisis are related to the prevention of late intrauterine death, and the prediction and treatment of complex forms. With omphalocele, the main difficulty is the exclusion of associated conditions, not all diagnosed prenatally. An outline of the postnatal treatment of abdominal wall defects is given. Other rarer forms of abdominal wall defects are pentalogy of Cantrell, omphalocele, bladder exstrophy, imperforate anus, spina bifida complex, prune-belly syndrome, body stalk anomaly, and bladder and cloacal exstrophy; they deserve multidisciplinary counselling and management. PMID:24342556

Prefumo, Federico; Izzi, Claudia

2014-04-01

125

Airway management in trauma.  

PubMed

Trauma has assumed epidemic proportion. 10% of global road accident deaths occur in India. Hypoxia and airway mismanagement are known to contribute up to 34% of pre-hospital deaths in these patients. A high degree of suspicion for actual or impending airway obstruction should be assumed in all trauma patients. Objective signs of airway compromise include agitation, obtundation, cyanosis, abnormal breath sound and deviated trachea. If time permits, one should carry out a brief airway assessment prior to undertaking definitive airway management in these patients. Simple techniques for establishing and maintaining airway patency include jaw thrust maneuver and/or use of oro- and nas-opharyngeal airways. All attempts must be made to perform definitive airway management whenever airway is compromised that is not amenable to simple strategies. The selection of airway device and route- oral or -nasal, for tracheal intubation should be based on nature of patient injury, experience and skill level. PMID:22174462

Khan, Rashid M; Sharma, Pradeep K; Kaul, Naresh

2011-09-01

126

Pediatric thoracic trauma.  

PubMed

Although thoracic injuries occur less frequently in children than adults, they remain a source of substantial morbidity and mortality. Disparate problems such as rib fractures, lung injury, hemothorax, pneumothorax, mediastinal injuries, and others may present in isolation or in combination with one another. Knowledge of the manner in which pediatric anatomy, physiology, and injury patterns change with age may expedite the evaluation of the pediatric chest after trauma. Differences in pulmonary functional residual capacity, blood volume, chest wall and spinal soft-tissue mobility, and cardiac function may translate into problems or benefits of important consequence. For example, although more predisposed to hypoxemia, young children may remain well compensated hemodynamically, despite significant blood loss. Rare injuries in children, such as cardiac and great vessel trauma, may remain undiagnosed precisely because of their scarcity and protean symptoms. PMID:12528782

Bliss, David; Silen, Mark

2002-11-01

127

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

128

Maxillofacial Trauma in Children  

PubMed Central

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

Mukherjee, Uday

2012-01-01

129

Rethinking Historical Trauma.  

PubMed

Recent years have seen the rise of historical trauma as a construct to describe the impact of colonization, cultural suppression, and historical oppression of Indigenous peoples in North America (e.g., Native Americans in the United States, Aboriginal peoples in Canada). The discourses of psychiatry and psychology contribute to the conflation of disparate forms of violence by emphasizing presumptively universal aspects of trauma response. Many proponents of this construct have made explicit analogies to the Holocaust as a way to understand the transgenerational effects of genocide. However, the social, cultural, and psychological contexts of the Holocaust and of post-colonial Indigenous "survivance" differ in many striking ways. Indeed, the comparison suggests that the persistent suffering of Indigenous peoples in the Americas reflects not so much past trauma as ongoing structural violence. The comparative study of genocide and other forms of massive, organized violence can do much to illuminate both common mechanisms and distinctive features, and trace the looping effects from political processes to individual experience and back again. The ethics and pragmatics of individual and collective healing, restitution, resilience, and recovery can be understood in terms of the self-vindicating loops between politics, structural violence, public discourse, and embodied experience. PMID:24855142

Kirmayer, Laurence J; Gone, Joseph P; Moses, Joshua

2014-05-22

130

Causes of Trauma in Pregnant Women Referred to Shabih-Khani Maternity Hospital in Kashan  

PubMed Central

Background Trauma occurs in 7% of pregnancies and is a major cause of morbidity and mortality in the mother and fetus. Objectives The present study was conducted in Kashan in 2009–2010 to evaluate the causes of trauma in pregnancy. Patients and Methods This descriptive study analyzed data from 32 pregnant women with trauma who were referred to the maternity hospital from 2009 to 2010. Data included age, gestational age, mother’s occupation, cause of trauma, maternal-fetal complications, gravidity, and parity. The diagnosis of maternal and fetal complications was based on clinical examinations by a gynecologist and results of blood tests, urine analysis tests, and sonography. Data were analyzed as frequency distributions. Results the causes of trauma included falling (9 cases (28.1%)), abdominal trauma (8 cases ( 25%)), spousal feud (3 cases (9.4%)), motorcycle accident (2 cases (6.25%)), car accident (2 cases (6.25%)), falling from a motorcycle (2 cases (6.25%)), falling or fainting resulting in head trauma (1 case (3.1%)), pain from crossing over a bump in the car (1 cases (3.1%)), and unspecified causes (4 cases (12.55%)). The causes of traumas occurred between 5 and 40 weeks of gestation. In 17.2% of the cases, trauma occurred prior to 20 weeks of gestation. However, there was no significant relationship between the cause of trauma and maternal age or gestational age. Vaginal bleeding and retroplacental clots were reported in 2 (6.25%) cases and 1 (3.1%) case, respectively. Conclusions Nearly half of the women presenting with trauma had experienced spousal feud or domestic violence; therefore, it is necessary to recognize spousal abuse and provide adequate support to traumatized pregnant women. PMID:24719837

Mesdaghinia, Elaheh; Sooky, Zahra; Mesdaghinia, Azam

2012-01-01

131

Acute abdominal complications following hip surgery.  

PubMed

Hip surgeries are some of the most common and successful orthopedic procedures. Although rarely, abdominal complications do occur and are associated with unfavorable outcomes.We aimed to identify and describe the severe abdominal complications that appear in patients under-going elective or traumatic hip surgery. A four year retrospective electronic database research identified 408 elective primary hip replacements,51 hip revisions and 1040 intra and extracapsular proximal femur fractures. Out of these, three males and 4 females between 64 - 84 years old were identified to have developed acute abdominal complications: perforated acute ulcer (3),acute cholecystitis (2), volvulus (1), toxic megacolon with peritonitis (1) and acute colonic pseudo-obstruction (1).Complications debuted 3 - 10 days after index orthopedic surgery. Acute perioperative abdominal complications are rarely encountered during orthopedic surgery. When these do occur, they do so almost exclusively in patients with hippathology, comorbidities and most often lead to life threatening situations. We thus emphasize the need for early identification and appropriate management by both orthopedic and general surgery doctors in order to improve patient safety. PMID:24742414

Deleanu, B; Prejbeanu, R; Vermesan, D; Haragus, H; Icma, I; Predescu, V

2014-01-01

132

by Abdominal Obesity versus Overall Obesity  

E-print Network

?The authors have no financial conflicts of interest. Purpose: This research compares the predictive value of the abdominal obesity indicator, waist circumference (WC), and the overall obesity indicator, body mass index (BMI), among men and women with regard to type 2 diabetes. Materials and Methods: This study used data collected from 4,400 households selected by a stratified multistage probability sampling method during the 2001 Korea National Health and Nutrition Examination Survey (KNHANES). The final study sample included 4,684 subjects over 30 years of age who had completed the health examination required for the analysis of the health interview and health behavior surveys. Results: Both men and women showed significant differences in fasting blood glucose (FBG) or HbA1c levels based on abdominal obesity irrespective of BMI. However, the presence of overall obesity among men with abdominal obesity was not significantly correlated with FBG or HbA1c levels, while the presence of overall obesity among women with abdominal obesity was significantly different in

Kyung-won Paek; Ki-hong Chun

2010-01-01

133

Endovascular management of lap belt-related abdominal aortic injury in a 9-year-old child.  

PubMed

Blunt abdominal aortic trauma is a rare occurrence in children with only a few patients having been reported in the literature. Most such cases have been described in the context of lap belt injuries. We report a 9-year-old boy who suffered lap belt trauma to the abdomen during a high-speed road traffic accident resulting to the well-recognized pattern of blunt abdominal injury, that is, the triad of intestinal perforation, fractures of the lumbar spine, and abdominal aortic injury. The latter presented with lower limb ischemia due to dissection of the infrarenal aorta and right common iliac artery. Revascularization was achieved by endovascular means using 2 self-expanding stents in the infrarenal aorta and the right common iliac artery. This case is one of the few reports of lap belt-related acute traumatic abdominal aortic dissection in a young child and highlights the feasibility of endovascular management in the pediatric population. PMID:25463338

Papazoglou, Konstantinos O; Karkos, Christos D; Kalogirou, Thomas E; Giagtzidis, Ioakeim T

2015-02-01

134

OR resuscitation for trauma patients.  

PubMed

1. The results of multiple studies have shown evidence that immediate access to the operating room has significantly contributed to improved outcome in several categories of trauma patients. 2. "Walk through" table top exercises were held in the OR suite to identify problems. These mock resuscitations were particularly helpful in solving logistical and equipment problems. 3. Prehospital care providers were given classes regarding triage criteria and operating room logistics. 4. Continuing education for OR and trauma nurses included videotape review and critique of ORR, trauma-specific inservice programs presented by the trauma coordinators and physicians, and attendance at weekly videotape review and trauma conference presented by the Division of Trauma. Easy recognition of individual team members, an important issue, required the use of name badges. PMID:8342227

Hollingsworth-Fridlund, P; Bernal Hall, J; Dias, J B

1993-01-01

135

Patterns of Abdominal Injuries in Frontal and Side Impacts  

PubMed Central

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, Narayan; Pintar, Frank A.; Gennarelli, Thomas A.; Maltese, Matthew R.

2000-01-01

136

Development of a Murine Model of Blunt Hepatic Trauma  

PubMed Central

Despite the prevalence of blunt hepatic trauma in humans, there are few rodent models of blunt trauma that can be used to study the associated inflammatory responses. We present a mouse model of blunt hepatic trauma that was created by using a cortical contusion device. Male mice were anesthetized with ketamine–xylazine–buprenorphine and placed in left lateral recumbency. A position of 2 mm ventral to the posterior axillary line and 5 mm caudal to the costal margin on the right side was targeted for impact. An impact velocity of 6 m/s and a piston depth of 12 mm produced a consistent pattern of hepatic injury with low mortality. All mice that recovered from anesthesia survived without complication for the length of the study. Mice were euthanized at various time points (n = 5 per group) until 7 d after injury for gross examination and collection of blood and peritoneal lavage fluids. Some mice were reanesthetized for serial monitoring of hepatic lesions via MRI. At 2 h after trauma, mice consistently displayed laceration, hematoma, and discoloration of the right lateral and caudate liver lobes, with intraabdominal hemorrhage but no other gross injuries. Blood and peritoneal lavage fluid were collected from all mice for cytokine analysis. At 2 h after trauma, there were significant increases in plasma IL10 as well as peritoneal lavage fluid IL6 and CXCL1/KC; however, these levels decreased within 24 h. At 7 d after trauma, the mice had regained body weight, and the hepatic lesions, which initially had increased in size during the first 48 h, had returned to their original size. In summary, this technique produced a reliable, low mortality, murine model that recreates features of blunt abdominal liver injury in human subjects with similar acute inflammatory response. PMID:24210016

Nemzek-Hamlin, Jean A; Hwang, Haejin; Hampel, Joseph A; Yu, Bi; Raghavendran, Krishnan

2013-01-01

137

Imaging of blunt chest trauma  

Microsoft Academic Search

.   In western European countries most blunt chest traumas are associated with motor vehicle and sport-related accidents. In\\u000a Switzerland, 39 of 10,000 inhabitants were involved and severely injured in road accidents in 1998. Fifty two percent of them\\u000a suffered from blunt chest trauma. According to the Swiss Federal Office of Statistics, traumas represented in men the fourth\\u000a major cause of

S. Wicky; M. Wintermark; P. Schnyder; P. Capasso; A. Denys

2000-01-01

138

Intra-abdominal cystic lymphangioma.  

PubMed

Cystic lymphangioma is an uncommon intra-abdominal lesion that is an occasional incidental finding. We report herein the case of a 27-year-old woman with a 3-year history of abdominal pain due to a large intra-abdominal cystic lymphangioma. The lesion was removed surgically with a complete resection that is the optimal treatment with excellent prognosis. PMID:16647365

Guinier, David; Denue, Pierre O; Mantion, George A

2006-05-01

139

Pediatric trauma: preparation and management.  

PubMed

1. Trauma causes more than 50% of the deaths in children. The leading cause of pediatric injury is motor vehicle accidents involving children as passengers, pedestrians, or bicycle riders. 2. Trauma is always unexpected; therefore, the most vital aspect of any trauma system is that the system itself never be caught unprepared. Anticipation and preparation are the best first-line defenses against traumatic injury. 3. Because of a child's smaller size, vital organs are in close proximity to one another; multiple organ injuries are common. 4. The team who responds to a pediatric trauma should include nurses and physicians trained in principles of pediatric resuscitation. PMID:8342220

Brown, R C; Ioli, J G; Ferlise, M

1993-01-01

140

The initial management of severe trauma patients at hospital admission.  

PubMed

The initial management of trauma patient is a critical period aiming at: stabilizing the vital functions; following a rigorous injury assessment; defining a therapeutic strategy. This management has to be organized to minimize loss of time that would be deleterious for the patients outcome. Thus, before patient arrival, the trauma team alert should lead to the initiation of care procedures adapted to the announced severity of the patient. Moreover, each individual should know its role in advance and the team should be managed by only one individual (the trauma leader) to avoid conflicts of decision. A rapid trauma injury assessment aims not only at guiding resuscitation (chest drainage, pelvic contention, to define the mean arterial pressure goal) but also to decide a critical intervention in case of hemodynamic instability (laparotomy, thoracotomy, arterial embolisation). This initial assessment includes a chest and a pelvic X-ray, abdominal ultrasound (extended to the lung) and transcranial Doppler (TCD). The whole body scanner with administration of intravenous contrast material is the cornerstone of the injury assessment but can be done for patients stabilized after the initial resuscitation. PMID:23910065

Harrois, A; Hamada, S; Laplace, C; Duranteau, J; Vigué, B

2013-01-01

141

Pneumoperitoneum in a patient with pneumothorax and blunt neck trauma  

PubMed Central

INTRODUCTION Blunt trauma as a cause of pneumoperitoneum is less frequent and its occurrence without a ruptured viscus is rarely seen. PRESENTATION OF CASE We report a case of blunt neck trauma in which a motorcycle rider hit a fixed object causing severe laryngotracheal injury. The patient developed pneumothorax bilaterally and had pneumoperitoneum despite no injury to the internal viscus. Bilateral chest tube drainage and abdominal exploratory laparotomy was performed. CONCLUSION Free air in the abdomen after blunt traumatic neck injury is very rare. If pneumoperitoneum is suspected in the presence of pneumothorax, exploratory laparotomy should be performed to rule out intraabdominal injury. As, there is no consensus for this plan yet, further prospective studies are warrant. Conservative management for pneumoperitoneum in the absence of viscus perforation is still a safe option in carefully selected cases. PMID:25460486

Hakim, Suhail Yaqoob; Abdelrahman, Husham; Mudali, Insolvisagan Natesa; El-Menyar, Ayman; Peralta, Ruben; Al-Thani, Hassan

2014-01-01

142

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

143

Tournament water skiing trauma.  

PubMed

Tournament water skiing is an increasingly popular and internationally successful sport in Great Britain, despite the climate. The kinematics and injury patterns of the three disciplines will be unfamiliar to most clinicians and are described, with estimation of the stresses. Advances in equipment over the last 15 years have reduced the risk of severe injury in the tricks event, while high speed impacts are responsible for the majority of trauma in slalom and jump. There is a surprisingly high incidence of injury to the lumbar spine during the high impact jump event. Comparison with findings in other sports suggests that the spine may be damaged by overuse, particularly before skeletal maturity. PMID:8799590

Roberts, S N; Roberts, P M

1996-06-01

144

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

145

Pediatric craniovertebral junction trauma.  

PubMed

The craniovertebral junction consists of the occiput, atlas, and axis, along with their strong ligamentous attachments. Because of its unique anatomical considerations, trauma to the craniovertebral junction requires specialized care. Children with potential injuries to the craniovertebral junction and cervical spinal cord demand specific considerations compared to adult patients. Prehospital immobilization techniques, diagnostic studies, and spinal injury patterns among young children can be different from those in adults. This review highlights the unique aspects in diagnosis and management of children with real or potential craniovertebral junction injuries. PMID:24265053

Oppenlander, Mark E; Clark, Justin C; Sonntag, Volker K H; Theodore, Nicholas

2014-01-01

146

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

147

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. PMID:23606857

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

2013-01-01

148

Functional Abdominal Pain  

Microsoft Academic Search

\\u000a Functional abdominal pain (FAP) is a frequent complaint seen in the pediatric primary care setting. Current diagnostic criteria\\u000a for functional gastrointestinal disorders (FGIDs) are defi ned in the Rome III criteria, which outline a positive symptom\\u000a profi le for diagnosis. In addition, clinicians should be aware of specifi c “red fl ag ” rule-out symptoms that may suggest\\u000a organic disease

Lisa Scharff; Laura E. Simons

149

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

150

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. PMID:15998821

Matthews, P; Aziz, Q

2005-01-01

151

Imaging in renal trauma  

PubMed Central

Renal injuries are classified, based on the American Association for the Surgery of Trauma classification, in to five grades of injury. Several imaging modalities have been available for assessing the grade of renal injury, each with their usefulness and limitations. Currently, plain radiographs and intravenous urography have no role in the evaluation of patients with suspected renal injury. Ultrasonography (USG) has a limited role in evaluating patients with suspected retroperitoneal injury; however, it plays an important role during follow up in patients with urinoma formation. USG helps to monitor the size of a urinoma and also for the drainage procedure. The role of selective renal arteriography is mainly limited to an interventional purpose rather than for diagnostic utility. Retrograde pyelography is useful in assessing ureteral and renal pelvis integrity in suspected ureteropelvic junction injury and for an interventional purpose, like placing a stent across the site of ureteric injury. Magnetic resonance imaging has no role in acute renal injuries. Multidetector computed tomography is the modality of choice in the evaluation of renal injuries. It is also useful in evaluating traumatic injuries to kidneys with preexisting abnormalities and can help to define the extent of penetrating injuries in patients with stab wounds in the flank region. The combination of imaging findings along with clinical information is important in the management of the individual patient. This article will describe a spectrum of renal injuries encountered in a trauma setting. PMID:24003353

Dayal, Madhukar; Gamanagatti, Shivanand; Kumar, Atin

2013-01-01

152

Insulin Sensitivity, Insulin Secretion, and Abdominal Fat: The Insulin Resistance Atherosclerosis Study (IRAS) Family Study  

Microsoft Academic Search

The relationship between insulin sensitivity and overall obesity is well established. However, there remains debate as to which of the fat depots, visceral abdominal tissue (VAT) or subcutaneous abdominal tissue (SAT), is of greater importance. Also, the relationship between fat distribution and insulin secretion is largely un- known. We studied SI, acute insulin response (AIR), and disposition index (DI), as

Lynne E. Wagenknecht; Carl D. Langefeld; Ann L. Scherzinger; Jill M. Norris; Steven M. Haffner; Mohammed F. Saad; Richard N. Bergman

2003-01-01

153

1317 September 2009, Hamburg, Germany Poster abstracts The relationship between abdominal circumference and  

E-print Network

circumference and middle cerebral artery Doppler z-scores in severe early onset fetal growth restriction A. J index (PI) and abdominal circumference (AC) in babies with severe early onset fetal growth restriction included. Serial MCA Doppler and abdominal circumference measurements were performed to delivery

154

Blunt chest trauma as a cause of acute myocardial infarction.  

PubMed

Chest pain after thoracic trauma may be a symptom of cardiac injury or myocardial infarction. A 63-year-old healthy man had chest pain after blunt chest trauma in a motor vehicle accident. Chest computed tomography scan showed a displaced sternal fracture, lung contusion in the left upper lobe, atelectasis and consolidation in both lower lobes, and bilateral haemothorax. Electrocardiography showed ST elevation (2 mm) in leads II, III, and aVF and ST depression (2 mm) in leads I and aVL, consistent with acute inferior myocardial infarction. Urgent coronary angiography showed ostial occlusion of the right coronary artery. After the right coronary occlusion was passed with a guide wire, dissection of the right coronary artery was observed and treated with a balloon and stent to reestablish normal flow. This case emphasizes the importance of a high index of suspicion for coronary artery injury and myocardial infarction after blunt chest trauma. PMID:25092198

Kara, H; Avc?, A; Akinci, M; Degirmenci, S; Bayir, A; Ak, A

2014-10-01

155

Partial Ureteropelvic Junction Disruption after Blunt Trauma: Case Report  

PubMed Central

Partial ureteropelvic junction disruption as a result of blunt trauma is rare and frequently missed by the initial trauma evaluation. Delays in diagnosis have also been associated with significant morbidity. A high index of suspicion should lead to appropriate investigations, and the management will be determined by the severity of the disruption. We present herein a 24-year-old man who was admitted to the Emergency Room with multiple organ injuries caused by a severe blunt trauma. Emergency celiotomy was performed for massive hemoperitoneum and shattered spleen which led to splenectomy. The diagnosis of partial UPJ disruption was missed preoperatively and suspected in CT scan after appearance of flank tender mass. Confirmation was obtained in retrograde ureteropyelography and treated conservatively with indwelling ureteral stent. We present herein an extensive review of the literature to examine the current status of this entity and to determine if improvements could be made in the diagnosis and treatment. PMID:22606618

El Ammari, Jalal Eddine; Ahallal, Youness; El Fassi, Mohammed Jamal; Farih, M. Hassan

2011-01-01

156

Isolated rupture of the right upper pulmonary vein: a blunt cardiac trauma case.  

PubMed

A 37-year-old woman who sustained blunt chest trauma as a result of a car accident was found unconscious at the accident site with signs of circulatory compromise. Computed tomographic trauma screening excluded thoracic, intracranial, and intra-abdominal bleeding, or other pathologic findings, except a small circumferential hemopericardium. Echocardiography revealed a hemopericardium that was partially clotted and the beginning of compression of the right ventricle. Because of progressive hemodynamic compromise, the decision was made for operative exploration. After a median sternotomy, the resultant excessive bleeding necessitated extracorporeal circulation. Careful inspection revealed isolated rupture of the upper right pulmonary vein, which was successfully repaired. PMID:21440159

Ouda, Ahmed; Kappert, Utz; Ghazy, Tamer; Weise, Matthias; Ebner, Bernd; Tugtekin, Sems-Malte; Matschke, Klaus

2011-04-01

157

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; Repi? Slavi?, Tanja; Lukek, Saša Poljak; Cvetek, Robert

2014-06-01

158

Vascular trauma historical notes.  

PubMed

This article provides a brief historical review of treatment of vascular trauma. Although methods for ligation came into use in the second century, this knowledge was lost during the Dark Ages and did not come back until the Renaissance. Many advances in vascular surgery occurred during the Balkan Wars, World War I, and World War II, although without antibiotics and blood banking, the philosophy of life over limb still ruled. Documenting and repairing both arteries and veins became more common during the Korean and Vietnam conflicts. Increased documentation has revealed that the current conflicts have resulted in more arterial injuries than in previous wars, likely because of improved body armor, improvised explosive device attacks, tourniquet use, and improved medical evacuation time. This brief review emphasizes the great value of mentorship and the legacy of the management of arterial and venous injuries to be passed on. PMID:21502112

Rich, Norman M

2011-03-01

159

Abdominal Perfusion Computed Tomography  

PubMed Central

The purpose of this article is to provide an up to date review on the spectrum of applications of perfusion computed tomography (CT) in the abdomen. New imaging techniques have been developed with the objective of obtaining a structural and functional analysis of different organs. Recently, perfusion CT has aroused the interest of many researchers who are studying the applicability of imaging modalities in the evaluation of abdominal organs and diseases. Per-fusion CT enables fast, non-invasive imaging of the tumor vascular physiology. Moreover, it can act as an in vivo biomarker of tumor-related angiogenesis.

Ogul, Hayri; Bayraktutan, Ummugulsum; Kizrak, Yesim; Pirimoglu, Berhan; Yuceler, Zeynep; Sagsoz, M. Erdem; Yilmaz, Omer; Aydinli, Bulent; Ozturk, Gurkan; Kantarci, Mecit

2013-01-01

160

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. PMID:20630100

2010-01-01

161

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

PubMed Central

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

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

2009-01-01

162

Secondary Trauma in Children and School Personnel  

Microsoft Academic Search

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

Robert W. Motta

2012-01-01

163

Trauma exposure and cigarette smoking: the impact of negative affect and affect-regulatory smoking motives.  

PubMed

Cognitive-affective mechanisms related to the maintenance of smoking among trauma-exposed individuals are largely unknown. Cross-sectional data from trauma-exposed treatment-seeking smokers (n = 283) were utilized to test a series of multiple mediator models of trauma exposure and smoking, as mediated by the sequential effects of negative affect and affect-modulation smoking motives. The sequential effects of both mediators indirectly predicted the effect of greater trauma exposure types on nicotine dependence, a biochemical index of smoking, perceived barriers to smoking cessation, and greater withdrawal-related problems during past quit attempts. Negative affect and affect-modulation motives for smoking may contribute to the trauma-smoking association. PMID:25299617

Farris, Samantha G; Zvolensky, Michael J; Beckham, Jean C; Vujanovic, Anka A; Schmidt, Norman B

2014-01-01

164

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

PubMed

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

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

2013-04-01

165

CT imaging of blunt chest trauma  

Microsoft Academic Search

Background  Thoracic injury overall is the third most common cause of trauma following injury to the head and extremities. Thoracic trauma\\u000a has a high morbidity and mortality, accounting for approximately 25% of trauma-related deaths, second only to head trauma.\\u000a More than 70% of cases of blunt thoracic trauma are due to motor vehicle collisions, with the remainder caused by falls or

Anastasia Oikonomou; Panos Prassopoulos

2011-01-01

166

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

2013-01-01

167

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

168

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

169

Single vessel abdominal arterial disease.  

PubMed

The long-standing discussion concerning the mere existence of single vessel abdominal artery disease can be closed: chronic gastrointestinal ischaemia (CGI) due to single vessel abdominal artery stenosis exists, can be treated successfully and in a safe manner. The most common causes of single vessel CGI are the coeliac artery compression syndrome (CACS) in younger patients, and atherosclerotic disease in elderly patients. The clinical symptoms of single vessel CGI patients are postprandial and exercise-related pain, weight loss, and an abdominal bruit. The current diagnostic approach in patients suspected of single vessel CGI is gastrointestinal tonometry combined with radiological visualisation of the abdominal arteries to define possible arterial stenosis. Especially in single vessel abdominal artery stenosis, gastrointestinal tonometry plays a pivotal role in establishing the diagnosis CGI. First-choice treatment of single vessel CGI remains surgical revascularisation, especially in CACS. In elderly or selected patients endovascular stent placement therapy is an acceptable option. PMID:19258186

van Noord, Désirée; Kuipers, Ernst J; Mensink, Peter B F

2009-01-01

170

Animal models of trauma-induced coagulopathy.  

PubMed

Resurgent study of trauma-induced coagulopathy (TIC) has delivered considerable improvements in survival after injury. Robust, valid and clinically relevant experimental models of TIC are essential to support the evolution of our knowledge and management of this condition. The aims of this study were to identify and analyze contemporary animal models of TIC with regard to their ability to accurately characterize known mechanisms of coagulopathy and/or to test the efficacy of therapeutic agents. A literature review was performed. Structured search of the indexed online database MEDLINE/PubMed in July 2010 identified 43 relevant articles containing 23 distinct animal models of TIC. The main aim of 26 studies was to test a therapeutic and the other 17 were conducted to investigate pathophysiology. A preponderance of porcine models was identified. Three new models demonstrating an endogenous acute traumatic coagulopathy (ATC) have offered new insights into the pathophysiology of TIC. Independent or combined effects of induced hypothermia and metabolic acidosis have been extensively evaluated. Recently, a pig model of TIC has been developed that features all major etiologies of TIC, although not in correct chronological order. This review identifies a general lack of experimental research to keep pace with clinical developments. Tissue injury and hemorrhagic shock are fundamental initiating events that prime the hemostatic system for subsequent iatrogenic insults. New animal models utilizing a variety of species that accurately simulate the natural clinical trajectory of trauma are urgently needed. PMID:22197179

Frith, Daniel; Cohen, Mitchell J; Brohi, Karim

2012-05-01

171

Complete tracheal transection following blunt trauma in a pediatric patient.  

PubMed

Tracheal injury from blunt trauma is a rare, life-threatening condition in pediatric patients. Rapid assessment and identification of the severity of the injury will increase the likelihood of survival. Subcutaneous emphysema, pneumomediastinum, and persistent pneumothoraces after chest tube placement should be considered in the index of suspicion for tracheal injury. Treatment for a complete tracheal transection includes rapid airway securement via endotracheal tube or tracheostomy and careful surgical repair in the operating room in conjunction with bronchoscopy. PMID:25584453

Holmes, Jessica E; Hanson, Carol A

2015-01-01

172

Systemic arterial air embolism: positive pressure ventilation can be fatal in a patient with blunt trauma  

PubMed Central

Systemic air embolism is a potentially fatal condition. Although venous embolism is commonly reported after deep sea diving or neurosurgical procedures, arterial embolism is rare. It usually occurs because of lung trauma after biopsy or lung resection but can rarely affect patients of blunt or penetrating trauma to chest managed on positive pressure ventilation. We report a case of road traffic accident with head injury, with normal primary survey of chest and abdomen who developed fatal systemic arterial air embolism immediately after intubation. Postmortem CT scan revealed huge amounts of air in left side of the heart, ascending aorta, arch of aorta, bilateral internal carotids and all right-sided intracranial arteries. In emergency departments of non-specialised centres, such complications are universally fatal. Thus, extreme caution needs to be exercised while managing patients of blunt trauma on mechanical ventilation even if the chest and abdominal examinations are normal. PMID:23417941

Yadav, Siddharth; Jain, Shalabh; Aggarwal, Puneet; Gupta, Ritu

2013-01-01

173

Laparoscopic repair of a rare acquired abdominal intercostal hernia  

PubMed Central

INTRODUCTION An acquired abdominal intercostal hernia (AIH) is a very rare and sporadically reported entity. Most cases of AIH are secondary to major trauma and the treatment of choice is surgical repair. PRESENTATION OF CASE We present the case of a 58-year-old man who presented with a painless intercostal swelling, which started after previous penetrating trauma to the same area. Radiological assessment was done with CT scan and the hernia was repaired with a laparoscopic approach using mesh. DISCUSSION AIH is a rare entity and trauma has an integral role in the pathophysiology. Surgical repair is the treatment of choice, however, due to the paucity of cases, there is no established method of choice for such repair. We present the first reported case in the Caribbean, which was repaired with the laparoscopic approach. CONCLUSION Although AIH is a rare condition, the pathophysiology seems relatively straightforward and the use of CT scan is recommended to confirm the diagnosis. The laparoscopic approach, with all its established benefits, appears to be a safe and feasible option in its management. PMID:25460469

Dan, Dilip; Ramraj, Parasram; Solomon, Verin; Ramnarine, Malini; Kawal, Trudy; Bascombe, Nigel; Naraynsingh, Vijay

2014-01-01

174

Critical care issues in solid organ injury: Review and experience in a tertiary trauma center  

PubMed Central

Background and Aim: Solid organ (spleen and liver) injuries are dreaded by both surgeons and anesthesiologists because of associated high morbidity and mortality. The purpose of this review is to describe our experience of critical care concerns in solid organ injury, which otherwise has been poorly addressed in the literature. Materials and Methods: Retrospective cohort of solid organ injury (spleen and liver) patients was done from January 2010 to December 2011 in tertiary level trauma Center. Results: Out of 624 abdominal trauma patients, a total of 212 patients (70%) were admitted in intensive care unit (ICU). Their ages ranged from 6 to 74 years (median 24 years). Nearly 89% patients in liver trauma and 84% patients in splenic trauma were male. Mechanism of injury was blunt abdominal trauma in 96% patients and the most common associated injury was chest trauma. Average injury severity score, sequential organ failure assessment, lactate on admission was 16.84, 4.34 and 3.42 mmol/L and that of dying patient were 29.70, 7.73 and 5.09 mmol/L, respectively. Overall mortality of ICU admitted solid organ injury was 15.55%. Major issues of concern in splenic injury were hemorrhagic shock, overwhelming post-splenectomy infection and post-splenectomy vaccination. Issues raised in liver injury are damage control surgery, deadly triad, thromboelastography guided transfusion protocols and hemostatic agents. Conclusions: A protocol-based and multidisciplinary approach in high dependency unit can significantly reduce morbidity and mortality in patients with solid organ injury.

Sawhney, Chhavi; Kaur, Manpreet; Gupta, Babita; Singh, P. M.; Gupta, Amit; Kumar, Subodh; Misra, M. C.

2014-01-01

175

Elongated left lobe of the liver mimicking a subcapsular hematoma of the spleen on the focused assessment with sonography for trauma exam.  

PubMed

The focused assessment with sonography for trauma examination has assumed the role of initial screening examination for the presence or absence of hemoperitoneum in the patient with blunt abdominal trauma. Sonographic pitfalls associated with the examination have primarily been related to mistaking contained fluid collections with hemoperitoneum. We present a case in which an elongated left lobe of the liver was misdiagnosed as a splenic subcapsular hematoma. It is imperative that emergency physicians and trauma surgeons be familiar with this normal variant of the liver and its associated sonographic appearance on the perisplenic window in order to prevent nontherapeutic laparotomies or embolizations. PMID:24556519

Jones, Robert; Tabbut, Matthew; Gramer, Diane

2014-07-01

176

Choreographing trauma resuscitation in the OR.  

PubMed

Survival rates are enhanced if severely injured trauma patients are admitted directly to the OR for resuscitation and surgical intervention. To increase the survivability and decrease the morbidity of trauma patients with penetrating trauma to the chest or abdomen, a hospital in La Jolla, Calif, developed a "direct to the OR" resuscitation program. This program substantially increased the survival rate of these trauma patients. Perioperative nurses respond to all major trauma situations and assist with surgical procedures completed in a trauma resuscitation room or in the OR. PMID:8876921

Wooten, C L; Kusler, D; Kracun, M D; Botsford, J; Lawlor, R

1996-09-01

177

Confessed abusive blunt head trauma.  

PubMed

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

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

2013-06-01

178

Acute incarcerated external abdominal hernia  

PubMed Central

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

Yang, Xue-Fei

2014-01-01

179

Acute incarcerated external abdominal hernia.  

PubMed

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

Yang, Xue-Fei; Liu, Jia-Lin

2014-11-01

180

ACGME case logs: Surgery resident experience in operative trauma for two decades  

PubMed Central

BACKGROUND Surgery resident education is based on experiential training, which is influenced by changes in clinical management strategies, technical and technologic advances, and administrative regulations. Trauma care has been exposed to each of these factors, prompting concerns about resident experience in operative trauma. The current study analyzed the reported volume of operative trauma for the last two decades; to our knowledge, this is the first evaluation of nationwide trends during such an extended time line. METHODS The Accreditation Council for Graduate Medical Education (ACGME) database of operative logs was queried from academic year (AY) 1989–1990 to 2009–2010 to identify shifts in trauma operative experience. Annual case log data for each cohort of graduating surgery residents were combined into approximately 5-year blocks, designated Period I (AY1989–1990 to AY1993–1994), Period II (AY1994–1995 to AY1998–1999), Period III (AY1999–2000 to AY2002–2003), and Period IV (AY2003–2004 to AY2009–2010). The latter two periods were delineated by the year in which duty hour restrictions were implemented. RESULTS Overall general surgery caseload increased from Period I to Period II (p < 0.001), remained stable from Period II to Period III, and decreased from Period III to Period IV (p < 0.001). However, for ACGME-designated trauma cases, there were significant declines from Period I to Period II (75.5 vs. 54.5 cases, p < 0.001) and Period II to Period III (54.5 vs. 39.3 cases, p < 0.001) but no difference between Period III and Period IV (39.3 vs. 39.4 cases). Graduating residents in Period I performed, on average, 31 intra-abdominal trauma operations, including approximately five spleen and four liver operations. Residents in Period IV performed 17 intra-abdominal trauma operations, including three spleen and approximately two liver operations. CONCLUSION Recent general surgery trainees perform fewer trauma operations than previous trainees. The majority of this decline occurred before implementation of work-hour restrictions. Although these changes reflect concurrent changes in management of trauma, surgical educators must meet the challenge of training residents in procedures less frequently performed. LEVEL OF EVIDENCE Epidemiologic study, level III; therapeutic study, level IV. PMID:23188243

Drake, Frederick Thurston; Van Eaton, Erik G.; Huntington, Ciara R.; Jurkovich, Gregory J.; Aarabi, Shahram; Gow, Kenneth W.

2014-01-01

181

Pancreatic trauma: a concise review.  

PubMed

Traumatic injury to the pancreas is rare and difficult to diagnose. In contrast, traumatic injuries to the liver, spleen and kidney are common and are usually identified with ease by imaging modalities. Pancreatic injuries are usually subtle to identify by different diagnostic imaging modalities, and these injuries are often overlooked in cases with extensive multiorgan trauma. The most evident findings of pancreatic injury are post-traumatic pancreatitis with blood, edema, and soft tissue infiltration of the anterior pararenal space. The alterations of post-traumatic pancreatitis may not be visualized within several hours following trauma as they are time dependent. Delayed diagnoses of traumatic pancreatic injuries are associated with high morbidity and mortality. Imaging plays an important role in diagnosis of pancreatic injuries because early recognition of the disruption of the main pancreatic duct is important. We reviewed our experience with the use of various imaging modalities for diagnosis of blunt pancreatic trauma. PMID:24379625

Debi, Uma; Kaur, Ravinder; Prasad, Kaushal Kishor; Sinha, Saroj Kant; Sinha, Anindita; Singh, Kartar

2013-12-21

182

Pancreatic trauma: A concise review  

PubMed Central

Traumatic injury to the pancreas is rare and difficult to diagnose. In contrast, traumatic injuries to the liver, spleen and kidney are common and are usually identified with ease by imaging modalities. Pancreatic injuries are usually subtle to identify by different diagnostic imaging modalities, and these injuries are often overlooked in cases with extensive multiorgan trauma. The most evident findings of pancreatic injury are post-traumatic pancreatitis with blood, edema, and soft tissue infiltration of the anterior pararenal space. The alterations of post-traumatic pancreatitis may not be visualized within several hours following trauma as they are time dependent. Delayed diagnoses of traumatic pancreatic injuries are associated with high morbidity and mortality. Imaging plays an important role in diagnosis of pancreatic injuries because early recognition of the disruption of the main pancreatic duct is important. We reviewed our experience with the use of various imaging modalities for diagnosis of blunt pancreatic trauma. PMID:24379625

Debi, Uma; Kaur, Ravinder; Prasad, Kaushal Kishor; Sinha, Saroj Kant; Sinha, Anindita; Singh, Kartar

2013-01-01

183

Ventilatory strategies in trauma patients  

PubMed Central

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

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

2014-01-01

184

Functional Abdominal Pain in Children  

MedlinePLUS

... be intermittent (recurrent abdominal pain or RAP) or continuous. Although the exact cause is not known, nerve ... fearful, anxious, or depressed child however should be fully assessed by a psychiatrist or psychologist. Some psychological ...

185

JAMA Patient Page: Abdominal Hernia  

MedlinePLUS

... Weight lifting, coughing, straining during bowel movement • Cystic fibrosis and chronic lung infections • Previous abdominal surgery COMPLICATIONS ... hernia recurring, but the mesh material can become infected. In some cases, hernia repairs may be performed ...

186

Abdominal damage control surgery and reconstruction: world society of emergency surgery position paper  

PubMed Central

Damage control laparotomy was first described by Dr. Harlan Stone in 1983 when he suggested that patients with severe trauma should have their primary procedures abbreviated when coagulopathy was encountered. He recommended temporizing patients with abdominal packing and temporary closure to allow restoration of normal physiology prior to returning to the operating room for definitive repair. The term damage control in the trauma setting was coined by Rotondo et al., in 1993. Studies in subsequent years have validated this technique by demonstrating decreased mortality and immediate post-operative complications. The indications for damage control laparotomy have evolved to encompass abdominal compartment syndrome, abdominal sepsis, vascular and acute care surgery cases. The perioperative critical care provided to these patients, including sedation, paralysis, nutrition, and fluid management strategies may improve closure rates and recovery. In the rare cases of inability to primarily close the abdomen, there are a number of reconstructive strategies that may be used in the acute and chronic phases of abdominal closure. PMID:24341602

2013-01-01

187

Macroscopic characteristics of hacking trauma.  

PubMed

Hacking trauma is often encountered in forensic cases, but little experimental research has been conducted that would allow for the recognition of wounds caused by specific weapon types. In this paper, we report the results of a hacking trauma caused by machete, cleaver, and axe weapons and the characteristics of each weapon type on bone. Each weapon type was employed in multiple trials on pig (Sus scrofa) bones and then the wounds were examined macroscopically for several characteristics that serve to differentiate the weapons. PMID:11305423

Humphrey, J H; Hutchinson, D L

2001-03-01

188

Microscopic characteristics of hacking trauma.  

PubMed

The purpose of this study was to determine if it is possible to associate machetes, axes, and cleavers with the microscopic parallel striations they leave on the cut surfaces of the bone. Hacking trauma was experimentally inflicted on pig bones using machetes, axes, and cleavers. Negative impressions of both the cut surfaces of the bone and the weapon blades were analyzed using scanning electron microscopy. The results of this investigation indicate that it is possible to correlate a class of hacking weapons to trauma inflicted on bone by these weapons. PMID:11305424

Tucker, B K; Hutchinson, D L; Gilliland, M F; Charles, T M; Daniel, H J; Wolfe, L D

2001-03-01

189

Updates on abdominal desmoid tumors  

PubMed Central

Desmoid tumor is a monoclonal, fibroblastic proliferation arising in musculoaponeurotic structures. This connective tissue hyperplasia infiltrates 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 difficult. This distinct pathological entity is reviewed with a specific focus on aetiology and management. PMID:18023087

Rampone, Bernardino; Pedrazzani, Corrado; Marrelli, Daniele; Pinto, Enrico; Roviello, Franco

2007-01-01

190

Management of functional abdominal pain  

Microsoft Academic Search

Opinion statement  The diagnosis of functional abdominal pain should be made based on the Rome II symptom criteria with only limited testing\\u000a to exclude other disease. During physical examination the clinician may look for evidence of pain behavior which would be\\u000a supportive of the diagnosis. Reassurance and proper education regarding the clinical entity of functional abdominal pain is\\u000a critical for successful

Yuri A. Saito; Jean C. Fox

2004-01-01

191

Chronic abdominal pain in children.  

PubMed

Chronic abdominal pain, defined as long-lasting intermittent or constant abdominal pain, is a common pediatric problem encountered by primary care physicians, medical subspecialists, and surgical specialists. Chronic abdominal pain in children is usually functional, that is, without objective evidence of an underlying organic disorder. The Subcommittee on Chronic Abdominal Pain of the American Academy of Pediatrics and the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition has prepared this report based on a comprehensive, systematic review and rating of the medical literature. This report accompanies a clinical report based on the literature review and expert opinion. The subcommittee examined the diagnostic and therapeutic value of a medical and psychological history, diagnostic tests, and pharmacologic and behavioral therapy. The presence of alarm symptoms or signs (such as weight loss, gastrointestinal bleeding, persistent fever, chronic severe diarrhea, and significant vomiting) is associated with a higher prevalence of organic disease. There was insufficient evidence to state that the nature of the abdominal pain or the presence of associated symptoms (such as anorexia, nausea, headache, and joint pain) can discriminate between functional and organic disorders. Although children with chronic abdominal pain and their parents are more often anxious or depressed, the presence of anxiety, depression, behavior problems, or recent negative life events does not distinguish between functional and organic abdominal pain. Most children who are brought to the primary care physician's office for chronic abdominal pain are unlikely to require diagnostic testing. Pediatric studies of therapeutic interventions were examined and found to be limited or inconclusive. PMID:15741363

2005-03-01

192

Current status of the open abdomen treatment for intra-abdominal infection.  

PubMed

The open abdomen has become an important approach for critically ill patients who require emergent abdominal surgical interventions. This treatment, originating from the concept of damage control surgery, was first applied in severe traumatic patients. The ultimate goal is to achieve formal abdominal fascial closure by several attempts and adjuvant therapies (fluid management, nutritional support, skin grafting, etc.). Up to the present, open abdomen therapy becomes matured and is multistage-approached in the management of patients with severe trauma. However, its application in patients with intra-abdominal infection still presents great challenges due to critical complications and poor clinical outcomes. This review focuses on the specific use of the open abdomen in such populations and detailedly introduces current concerns and advanced progress about this therapy. PMID:24198827

Yuan, Yujie; Ren, Jianan; He, Yulong

2013-01-01

193

Abdominal emergencies in the geriatric patient  

PubMed Central

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

2014-01-01

194

The "Trauma Coping Inventory" and The "Trauma Coping Resource Inventory"  

ERIC Educational Resources Information Center

In many instances, actual or threatened traumatic events trigger strong reactions for those individuals experiencing them, witnessing them, or learning about a loved one or friend who experienced an unexpected trauma. In addition, those who help traumatized persons can sometimes develop secondary traumatization. This workshop presenter constructed…

Tramonte, Michael Robert

2005-01-01

195

Can Early Childhood Trauma Be Reconstructed From Dreams?: On The Relation of Dreams to Trauma  

Microsoft Academic Search

Dreams are accorded a special position in the analytic reconstruction of early childhood trauma. Because dream content may be influenced by psychic trauma, analytic clinicians can, by interpreting dreams, reconstruct or revive memories of past trauma. In this article, I offer a critical review of the concept of a traumatic dream, the relation between dream content and trauma, and the

C. Brooks Brenneis

1994-01-01

196

Preventing Vicarious Trauma: What Counselors Should Know when Working with Trauma Survivors  

ERIC Educational Resources Information Center

Counselors in all settings work with clients who are survivors of trauma. Vicarious trauma, or counselors developing trauma reactions secondary to exposure to clients' traumatic experiences, is not uncommon. The purpose of this article is to describe vicarious trauma and summarize the recent research literature related to this construct. The…

Trippany, Robyn L.; Kress, Victoria E. White; Wilcoxon, S. Allen

2004-01-01

197

Penetrating ocular trauma associated with blank cartridge  

PubMed Central

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

2014-01-01

198

Air transport of the trauma patient.  

PubMed

Flight nursing is a rapidly growing field in critical care nursing. An understanding of the types of trauma patients that warrant helicopter transport is important to any well functioning trauma system. The assessments and interventions necessary in transporting trauma patients are addressed. Safety, environmental, and psychosocial issues that surround the use of air transport are discussed. PMID:2223312

Higgins, B; Popil, V

1990-11-01

199

Abdominal muscle size and symmetry at rest and during abdominal hollowing exercises in healthy control subjects  

PubMed Central

The symmetry of, and physical characteristics influencing, the thickness of the lateral abdominal muscles at rest and during abdominal exercises were examined in 57 healthy subjects (20 men, 37 women; aged 22–62 years). M-mode ultrasound images were recorded from the abdominal muscles at rest and during abdominal hollowing exercises in hook-lying. The fascial lines bordering the transvs. abdominis, obliquus internus and obliquus externus were digitized and the absolute thickness, relative thickness (% of total lateral thickness) and contraction ratio (thickness during hollowing/thickness at rest), as well as the asymmetry (difference between sides expressed as a percent of the smallest value for the two sides) for each of these parameters were determined for each muscle. Both at rest and during hollowing, obliquus internus was the thickest and transvs. abdominis the thinnest muscle. There were no significant differences between left and right sides for group mean thicknesses of any muscle; however, individual asymmetries were evident, with mean values for the different muscles ranging from 11% to 26%; asymmetry was much less for the contraction ratios (mean % side differences, 5–14% depending on muscle). Body mass was the most significant positive predictor of absolute muscle thickness, for all muscles at rest and during hollowing, accounting for 30–44% variance. Body mass index explained 20–30% variance in transvs. abdominis contraction ratio (negative relationship). The influence of these confounders must be considered in comparative studies of healthy controls and back pain patients, unless groups are very carefully matched. Asymmetries observed in patients should be interpreted with caution, as they are also common in healthy subjects. PMID:19172732

Mannion, A F; Pulkovski, N; Toma, V; Sprott, H

2008-01-01

200

Part 1: early recognition and treatment of birth trauma: injuries to the head and face.  

PubMed

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) Sentinel Event Alert from July 21, 2004 states that there have been 47 cases of birth trauma-related perinatal death or permanent disability reported for JCAHO review since 1996. This report clearly illustrates the importance of birth trauma in clinical practice for neonatal and perinatal nurses. Estimates suggest that birth trauma occurs in 2% to 7% of all deliveries and is associated with an increase in both mortality and morbidity. Birth trauma to the head may result in minor superficial extracranial injuries, such as caput succedaneum and cephalohematoma, or more serious and potentially life threatening lesions such as subgaleal hemorrhages. The potential for deeper intracranial injury, such as subarachnoid or subdural hemorrhage exists; these may be isolated or associated with skull fractures and/or other extracranial injuries. Injury to the eye, nasal structures, and paralysis of the vocal cords may also result from birth trauma during a difficulty delivery. Part 1 of this 2-part article will focus on birth injuries to the head and face. Part 2 of the series will review more systemic birth injuries that may involve abdominal organs, the spine and skeletal system, and peripheral and facial nerves. PMID:16338668

Parker, Leslie A

2005-12-01

201

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

PubMed Central

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

Telles, Shirley; Singh, Nilkamal; Balkrishna, Acharya

2012-01-01

202

Trauma Center Staffing, Infrastructure, and Patient Characteristics that Influence Trauma Center Need  

PubMed Central

Introduction The most effective use of trauma center resources helps reduce morbidity and mortality, while saving costs. Identifying critical infrastructure characteristics, patient characteristics and staffing components of a trauma center associated with the proportion of patients needing major trauma care will help planners create better systems for patient care. Methods We used the 2009 National Trauma Data Bank-Research Dataset to determine the proportion of critically injured patients requiring the resources of a trauma center within each Level I–IV trauma center (n=443). The outcome variable was defined as the portion of treated patients who were critically injured. We defined the need for critical trauma resources and interventions (“trauma center need”) as death prior to hospital discharge, admission to the intensive care unit, or admission to the operating room from the emergency department as a result of acute traumatic injury. Generalized Linear Modeling (GLM) was used to determine how hospital infrastructure, staffing Levels, and patient characteristics contributed to trauma center need. Results Nonprofit Level I and II trauma centers were significantly associated with higher levels of trauma center need. Trauma centers that had a higher percentage of transferred patients or a lower percentage of insured patients were associated with a higher proportion of trauma center need. Hospital infrastructure characteristics, such as bed capacity and intensive care unit capacity, were not associated with trauma center need. A GLM for Level III and IV trauma centers showed that the number of trauma surgeons on staff was associated with trauma center need. Conclusion Because the proportion of trauma center need is predominantly influenced by hospital type, transfer frequency, and insurance status, it is important for administrators to consider patient population characteristics of the catchment area when planning the construction of new trauma centers or when coordinating care within state or regional trauma systems.

Faul, Mark; Sasser, Scott M.; Lairet, Julio; Mould-Millman, Nee-Kofi; Sugerman, David

2015-01-01

203

Intravenous urography and childhood trauma  

Microsoft Academic Search

Results of intravenous urography (IVU) in 33 patients suspected of suffering from renal trauma were reviewed. It was concluded that when haematuria is only detected microscopically and clears within 24 hr then an IVU is not necessary, in the absence of other evidence of significant urinary tract injury.

N. M. Okorie; A. E. MacKinnon

1982-01-01

204

The existential basis of trauma  

Microsoft Academic Search

Undergoing a traumatic experience can be a life-changing event, having a significant impact on individuals, families, communities, workplaces and societies. Traumatology is therefore a complex field of study demanding a sophisticated level of understanding to serve as a theory base. This article explores the potential for existentialist philosophy to make an important contribution to our understanding of trauma and its

Neil Thompson; Mary Walsh

2010-01-01

205

Sagittal abdominal diameter as a practical predictor of visceral fat  

Microsoft Academic Search

OBJECTIVE: To evaluate the relationships between the supine sagittal abdominal diameter (SAD) and visceral fat, as well as to evaluate intra- and inter-observer reliability of sagittal diameter measurement.PATIENTS: Twenty-eight women ranging in age from 27–78 y with a body mass index (BMI) ranging from 16.9–48.1 kg\\/m2 and 23 men ranging in age from 32–75 y with BMI ranging from 20–41.6

M Zamboni; E Turcato; F Armellini; HS Kahn; A Zivelonghi; H Santana; IA Bergamo-Andreis; O Bosello

1998-01-01

206

Varicose vein trauma: a risk for pulmonary embolism.  

PubMed

Pulmonary embolism (PE) is a deceptive condition which is often incorrectly diagnosed leading to high morbidity and mortality. We present a case where symptoms were localised to different areas of the body starting with post-traumatic pain over lower extremity varicosities that migrated sequentially over a month to the knee, hip, back, abdomen and chest finally presenting as syncope. Despite a low pre-test clinical probability, a very high index of suspicion led to a timely diagnosis of a massive bilateral PE that eventually caused a troponin leak. The aetiology is highly suspicious of a thrombus which originated in the veins of the leg due to trauma over varicose veins.The case described here exemplifies the importance of considering trauma to varicosities as a risk factor for embolism when the clinical picture is concerning but other signs and symptoms of PE are not apparent. PMID:25478387

Joy, Parijat S; Marak, Creticus P; Ponea, Anna M; Guddati, Achuta K

2014-10-01

207

Caspofungin for prevention of intra-abdominal candidiasis in high-risk surgical patients  

Microsoft Academic Search

Purpose  Thirty to forty percent of patients with recurrent gastrointestinal perforation\\/anastomotic leakage or acute necrotizing pancreatitis\\u000a develop intra-abdominal invasive candidiasis (IC). A corrected Candida colonization index (CCI) ?0.4 is a powerful predictor of IC. Fluconazole prevents intra-abdominal IC in this setting, but\\u000a azole-resistant Candida species are emerging. The aim of this study was to explore the efficacy and safety of caspofungin

Laurence Senn; Philippe Eggimann; Riadh Ksontini; Andres Pascual; Nicolas Demartines; Jacques Bille; Thierry Calandra; Oscar Marchetti

2009-01-01

208

Initial assessment and management of pediatric trauma patients  

PubMed Central

Injury is the leading cause of death and disability in children. Each year, almost one in six children in the United States require emergency department (ED) care for the treatment of injuries, and more than 10,000 children die from injuries. Severely injured children need to be transported to a facility that is staffed 24/7 by personnel experienced in the management of children, and that has all the appropriate equipment to diagnose and manage injuries in children. Anatomical, physiological, and emotional differences between adults and children mean that children are not just scaled-down adults. Facilities receiving injured children need to be child and family friendly, in order to minimize the psychological impact of injury on the child and their family/carers. Early recognition and treatment of life-threatening airway obstruction, inadequate breathing, and intra-abdominal and intra-cranial hemorrhage significantly increases survival rate after major trauma. The initial assessment and management of the injured child follows the same ATLS® sequence as adults: primary survey and resuscitation, followed by secondary survey. A well-organized trauma team has a leader who designates roles to team members and facilitates clear, unambiguous communication between team members. The team leader stands where he/she can observe the entire team and monitor the “bigger picture.” Working together as a cohesive team, the members perform the primary survey in just a few minutes. Life-threatening conditions are dealt with as soon as they are identified. Necessary imaging studies are obtained early. Constant reassessment ensures that any deterioration in the child's condition is picked up immediately. The secondary survey identifies other injuries, such as intra-abdominal injuries and long-bone fractures, which can result in significant hemorrhage. The relief of pain is an important part of the treatment of an injured child. PMID:23181205

McFadyen, J Grant; Ramaiah, Ramesh; Bhananker, Sanjay M

2012-01-01

209

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

PubMed Central

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

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

2014-01-01

210

[Surgery of abdominal aorta with horseshoe kidney].  

PubMed

Seventy one surgical procedures on abdominal aorta in patients with horseshoe kidney have been reported in literature until 1980. Bergan reviewed 30 operations of abdominal aortic aneurysms (AAA) in these patients until 1974. Of them 3 AAA were ruptured. Gutowitz noticed 57 surgically treated AAA in patients with horseshoe kidney until 1984. Over the period from 1991 to 1996 thirty nine new cases were reported , including 2 ruptured AAA. The surgery of the abdominal aorta in patients with horseshoe kidney is associated with the following major problems: -reservation of anomalous (aberrant) renal arteries; reservation of the kidney excretory system; approach to the abdominal aorta (especially in patients with AAA) and graft placement The aim of the paper is the presentation of 5 new patients operated for abdominal aorta with horseshoe kidney. Over the last 12 years (January 1, 1984 to December 31, 1996) at the Centre of Vascular Surgery of the Institute of Cardiovascular Diseases of the Clinical Centre of Serbia, 5 patients with horseshoe kidney underwent surgery of the abdominal aorta. There were 4 male and one female patients whose average age was 57.8 years (50-70). Patient 1. A 50-year-old male patient was admitted to the hospital for disabling claudication discomforts (Fontan stadium IlI) and with significantly decreased Ankle-Brachial indexes (ABI). The translumbal aortography showed aorto-iliac occlusive disease and horseshoe kidney with two normal and one anomalous renal artery originating from infrarenal aorta (Crawford type II). Intravenous pyelography and retrograde urography showed two separated ureters. The aorto-bifemoral (AFF) bypass with Dacron graft was done with end-to-end (TT) proximal anastomosis just under the anomalous renal artery. The graft was placed behind the isthmus. During a 12-year follow-up renal failure, renovascular hypertension and graft occlusion were not observed. Patient 2. A 53-year-old male patient was admitted to the hospital for symptomatic AAA. Two years before admission the patient underwent coronary artery bypass grafting. The Duplex scan ultrasonography and translumbal aortography showed an infrarenal AAA, aneurysm of the right iliac artery and horseshoe kidney with two normal and one anomalous renal artery originating from the left iliac artery (Crawford type III). Intravenous pyelography and retrograde urography showed two separated ureters. After partial aneurysmectomy, the flow was restaured using bifurcated Dacron graft placed behind the isthmus. The right limb of the bifurcated graft was anastomosed with the common femoral artery and the left limb with left iliac artery just above the origin of the anomalous renal artery. The first day after operation thrombosis of the left common femoral artery with leg ischaemia was observed. (That artery was cannulated for ECC during coronary artery bypass grafting 2 years ago). The revascularisation of the left leg was done with femoro-femoral cross over bypass. During a 11-year follow-up period, the graft was patent and renal failure or revascular hypertension were not observed. Patient 3. A 66-year-old male patient was admitted to the hospital for rest pain (Fontan stadium III) and significantly decreased ABI. The patient had diabetes mellitus and myocardial infarction two months before admission. Translumbar aortography showed an aorto-iliac occlusive disease associated with horseshoe kidney with 5 anomalous renal arteries. (Crawford type III). Due to high risk, the axillo-bifemoral (AxFF) extra-anatomic bypass graft was performed. Five years after the operation the patient died due to new myocardial infarction. During the follow-up period the graft was patent and there were no signs of renal failure and renovascular hypertension. Patient 4. A 50-year old male patient was admitted to the hospital for high asymptomatic AAA. The diagnosis was established by Duplex scan and translumbal aortography. The large infrarenal AAA (transverse diameter 7 cm) associated with horseshoe kidney with two normal renal arteries (Crawford type I) were

Lotina, S L; Davidovi?, L B; Kosti?, D M; Velimirovi?, D V; Petrovi?, P Lj; Perisi?-Savi?, M V; Kovacevi?N S

1997-01-01

211

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

PubMed Central

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

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

2013-01-01

212

Abdominal radiation causes bacterial translocation  

SciTech Connect

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

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

1989-02-01

213

The increasing incidence of snowboard-related trauma  

PubMed Central

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

Hayes, John R.; Groner, Jonathan I.

2013-01-01

214

Penetrating abdominal injuries: management controversies  

PubMed Central

Penetrating abdominal injuries have been traditionally managed by routine laparotomy. New understanding of trajectories, potential for organ injury, and correlation with advanced radiographic imaging has allowed a shift towards non-operative management of appropriate cases. Although a selective approach has been established for stab wounds, the management of abdominal gunshot wounds remains a matter of controversy. In this chapter we describe the rationale and methodology of selecting patients for non-operative management. We also discuss additional controversial issues, as related to antibiotic prophylaxis, management of asymptomatic thoracoabdominal injuries, and the use of colostomy vs. primary repair for colon injuries. PMID:19374761

Butt, Muhammad U; Zacharias, Nikolaos; Velmahos, George C

2009-01-01

215

Chronic abdominal pain in children.  

PubMed

Chronic abdominal pain in children is usually not caused by organic disease. Diagnostic triage focuses on the assessment of alarm symptoms by means of history and physical examination. Additional diagnostic evaluation is not required in children without alarm symptoms. Family characteristics have an important influence on the chronicity of abdominal pain. A specific intervention is not recommended owing to lack of evidence of a beneficial effect. The greatest challenge is to identify children at risk of a prolonged course of pain and its correlated functional disability. The evaluation of family for coping strategies, psychosocial factors and appropriate follow-up can prevent ineffective use of healthcare resources. PMID:22886462

Singh, Utpal Kant; Prasad, Rajniti; Verma, Nishant

2013-02-01

216

Abdominal aortic aneurysms: case report  

PubMed Central

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

Hadida, Camille; Rajwani, Moez

1998-01-01

217

[Trauma of the temporal bone].  

PubMed

Temporal bone fractures are mostly due to high-energy head trauma with high rates of concurrent intracranial and cervical spine injuries and belong to the wider spectrum of lateral skull base trauma. Given that the temporal bone represents the most complex bone structure in the human body, containing a multitude of vital neurovascular structures, variable clinical presentations may arise from such fractures, ranging from asymptomatic courses to serious consequences, such as conductive and/or sensorineural hearing loss, vascular and/or cranial nerve injury as well as cerebrospinal fluid leakage. The present paper presents typical clinical sequelae and provides a detailed illustration of characteristic imaging findings related to temporal bone injury. Last but not least, in the final section of the manuscript the focus is placed on distinct anatomic structures which may mimic fracture lines and, thus, entail a high potential for misclassification as temporal bone fractures. PMID:24706249

Zimmer, A; Reith, W

2014-04-01

218

Pearls of Mandibular Trauma Management  

PubMed Central

Mandibular trauma is a common problem seen by plastic surgeons. When fractures occur, they have the ability to affect the patient's occlusion significantly, cause infection, and lead to considerable pain. Interventions to prevent these sequelae require either closed or open forms of reduction and fixation. Physicians determining how to manage these injuries should take into consideration the nature of the injury, background information regarding the patient's health, and the patient's comorbidities. Whereas general principles guide the management of the majority of injuries, special consideration must be paid to the edentulous patient, complex and comminuted fractures, and pediatric patients. These topics are discussed in this article, with a special emphasis on pearls of mandibular trauma management. PMID:22550460

Koshy, John C.; Feldman, Evan M.; Chike-Obi, Chuma J.; Bullocks, Jamal M.

2010-01-01

219

Interventional radiology for paediatric trauma  

Microsoft Academic Search

Paediatric interventional radiology plays a cornerstone role in the management of paediatric trauma. In the acute setting,\\u000a interventional radiology techniques allow minimally invasive control of haemorrhage or re-establishment of blood flow. Percutaneous\\u000a stenting and drainage can allow disruptions in urinary or biliary systems to heal without the need for further surgery. Interventional\\u000a radiology techniques also have a significant role in

Manrita K. Sidhu; Mark J. Hogan; Dennis W. W. Shaw; Thomas Burdick

2009-01-01

220

Severe and fatal childhood trauma  

Microsoft Academic Search

We wanted to study epidemiology and the outcome of severe childhood trauma. A retrospective study was carried out of 347 severely injured children under 16 years of age, who required intensive care or died during a 10-year period in southern Finland. Of the severely injured children, 65.4 per cent were male. Blunt injuries were the most common (83.0 per cent)

P. Souminen; A. Kivioja; J. Öhman; R. Korpela; R. Rintala; K. T. Olkkola

1998-01-01

221

Trauma care systems in Australia.  

PubMed

The management of orthopaedic trauma in Australia varies from the urban model common to most developed countries to a model determined by the vast distances of the island continent. The effectiveness of this system is largely dependent on the retrieval system and treatment protocols of severe injuries often revolve around prolonged contamination of traumatic wounds. The place of the Royal Flying Doctor Service (RFDS) in providing the "Mantle of Safety" for remote and rural Australia is highlighted. PMID:12951287

Croser, John L

2003-09-01

222

Current Epidemiology of Genitourinary Trauma  

PubMed Central

Synopsis This article reviews recent publications evaluating the current epidemiology of urologic trauma. It begins by providing a brief explanation of databases that have been recently used to study this patient population, then proceeds to discuss each genitourinary organ individually, discussing the most relevant and up to date information published for each one. The conclusion of the article briefly discusses possible future research and development areas pertaining to the topic. PMID:23905930

McGeady, James B.; Breyer, Benjamin N.

2013-01-01

223

Major abdominal evisceration injuries in dogs and cats: 12 cases (1998-2008).  

PubMed

OBJECTIVE- To describe the clinical characteristics, treatment, complications, and outcome of dogs and cats treated surgically for major abdominal evisceration. DESIGN- Retrospective case series. ANIMALS- 8 dogs and 4 cats. PROCEDURES- Medical records from January 1998 through March 2008 were reviewed to identify animals that underwent surgery for major abdominal evisceration. Data regarding cause of evisceration, signalment, physiologic variables, and hematologic variables were collected. Details of treatment, duration of hospitalization, and outcome were recorded. Linear regression analysis was performed to evaluate the association of signalment, physiologic variables, and hematologic variables on the number of days of hospitalization. RESULTS- Major abdominal evisceration was secondary to a traumatic event in 4 animals and to postsurgical dehiscence in 8 animals. All animals had evisceration of the intestines and gross contamination with dirt, leaves, or litter. Two animals eviscerated the spleen, and 1 animal had a perforated colon and was leaking feces into the peritoneal cavity. All animals underwent exploratory abdominal surgery. Surgical procedures performed included resection of compromised intestine, body wall repair, diaphragmatic hernia repair, nephrectomy, splenectomy, and primary colonic repair. All animals survived to discharge from the hospital. Median duration of hospitalization was 4 days (range, 1 to 7 days). Factors associated with an increase in duration of hospitalization included evisceration secondary to trauma, high lactate concentration at time of admission, and small body size. CONCLUSIONS AND CLINICAL RELEVANCE- Despite the dramatic appearance of major abdominal evisceration in cats and dogs, prompt and aggressive medical and surgical intervention can provide a favorable outcome. PMID:19527132

Gower, Sara B; Weisse, Chick W; Brown, Dorothy C

2009-06-15

224

Joseph Beuys: trauma and catharsis.  

PubMed

Joseph Beuys was one of the most significant artists of the 20th century. He was a gunner and radio operator in the German Air Force during World War II, and was severely injured several times. In March 1943 he had a life-changing experience after the dive bomber he was assigned to crashed in the Crimean peninsula. This trauma influenced Beuys' entire artistic career, and is known in art history as the 'Tartar Legend' or 'Tartar Myth'. Profoundly affected by the crash, the severe trauma, the near-death experience and his rescue, which he perceived as a "rebirth", Beuys no longer saw himself, other people or society as a whole in the same way as previously. With his new consciousness, he ignored boundaries and created visions whereby all mankind could experience the healing he had undergone. Beuys did not bring society far enough for the turning point towards "the healing of the world" to be visible, yet today it is important to keep his work alive as a record of his extraordinary strength, which arose from trauma and severe injury, and was carried by a passionate commitment to mankind and to life itself. PMID:21393290

Ottomann, C; Stollwerck, P L; Maier, H; Gatty, I; Muehlberger, T

2010-12-01

225

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

ERIC Educational Resources Information Center

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

Sanders, Barbara; Becker-Lausen, Evvie

1995-01-01

226

Results of Laparoscopic Versus Open Abdominal and Incisional Hernia Repair  

PubMed Central

Background: Incisional hernia is a frequent complication of abdominal surgery. The object of this study was to confirm the safety, efficacy, and feasibility of laparoscopic treatment of abdominal wall defects. Methods: Fifty consecutive laparoscopic abdominal and incisional hernia repairs from September 2001 to May 2003 were compared with 50 open anterior repairs. Results: The 2 groups were not different for age, body mass index, or American Society of Anaesthesiologists scores. Mean operative time was 59 minutes for the laparoscopic group, 164.5 minutes for the open group. Mean hernia diameter was 10.6 cm for the laparoscopic group, 10.5 cm for the open group. Mean length of stay was 2.1 days for the laparoscopic group, 8.1 days for the open group. Complications occurred in 16% of the laparoscopic and 50% of open group. Median follow-up was 9.0 months for the laparoscopic group, 24.5 months for the open group. Recurrence rates were 2% for laparoscopic group and 0% for the open group. Conclusion: Results for laparoscopic abdominal and incisional hernia repair seem to be superior to results for open repair in terms of operative time, length of stay, wound infection, major complications, and overall hospital reimbursement. PMID:15984708

Magnone, Stefano; Erba, Luigi; Bertolini, Aimone; Croce, Enrico

2005-01-01

227

The Role of Cumulative Trauma, Betrayal, and Appraisals in Understanding Trauma Symptomatology  

PubMed Central

Poor psychological outcomes are common among trauma survivors, yet not all survivors experience adverse sequelae. The current study examined links between cumulative trauma exposure as a function of the level of betrayal (measured by the relational closeness of the survivor and the perpetrator), trauma appraisals, gender, and trauma symptoms. Participants were 273 college students who reported experiencing at least one traumatic event on a trauma checklist. Three cumulative indices were constructed to assess the number of different types of traumas experienced that were low (LBTs), moderate (MBTs), or high in betrayal (HBTs). Greater trauma exposure was related to more symptoms of depression, dissociation, and PTSD, with exposure to HBTs contributing the most. Women were more likely to experience HBTs than men, but there were no gender differences in trauma-related symptoms. Appraisals of trauma were predictive of trauma-related symptoms over and above the effects explained by cumulative trauma at each level of betrayal. The survivor’s relationship with the perpetrator, the effect of cumulative trauma, and their combined impact on trauma symptomatology are discussed. PMID:23542882

Martin, Christina Gamache; Cromer, Lisa DeMarni; DePrince, Anne P.; Freyd, Jennifer J.

2012-01-01

228

Abdominal pain - children under age 12  

MedlinePLUS

Stomach pain in children; Pain - abdomen - children; Abdominal cramps in children; Belly ache in children ... When your child complains of abdominal pain, see if they can ... kinds of pain: Generalized pain or pain over more than half ...

229

Abdominal obesity and metabolic syndrome  

Microsoft Academic Search

Metabolic syndrome is associated with abdominal obesity, blood lipid disorders, inflammation, insulin resistance or full-blown diabetes, and increased risk of developing cardiovascular disease. Proposed criteria for identifying patients with metabolic syndrome have contributed greatly to preventive medicine, but the value of metabolic syndrome as a scientific concept remains controversial. The presence of metabolic syndrome alone cannot predict global cardiovascular disease

Jean-Pierre Després; Isabelle Lemieux

2006-01-01

230

Thyroid crisis in the maxillofacial trauma patient.  

PubMed

Thyroid crisis, also known as thyroid storm, is a rare complication of thyrotoxicosis that results in a hypermetabolic and hyperadrenergic state. This condition requires prompt recognition and treatment because the mortality from thyroid crisis approaches 30%. Thyrotoxicosis alone will usually not progress to thyroid crisis. Thyroid crisis will typically be precipitated by some concomitant event such as infection, iodine-containing contrast agents, medications such as amiodarone, pregnancy, or surgery. Trauma is a rare precipitator of thyroid crisis. Several published studies have reported thyroid crisis resulting from blunt or penetrating neck trauma. Significant systemic trauma, such as motor vehicle accidents, has also been reported to precipitate thyroid crisis. It is very unusual for minor trauma to precipitate thyroid crisis. In the present study, we report the case of a patient who had incurred relatively minor maxillofacial trauma and developed thyroid crisis 2 weeks after the initial trauma. PMID:25085805

Weinstock, Robert J; Lewis, Tashorn; Miller, Jared; Clarkson, Earl I

2014-11-01

231

Communication technology in trauma centers: A national survey  

Microsoft Academic Search

The relationship between information and communication technology (ICT) and trauma work coordination has long been recognized. The purpose of the study was to investigate the type and frequency of use of various ICTs to activate and organize trauma teams in level I\\/II trauma centers. In a cross-sectional survey, questionnaires were mailed to trauma directors and clinicians in 457 trauma centers

Yan Xiao; Young-Ju Kim; Sharyn D. Gardner; Samer Faraj; Colin F. MacKenzie

2006-01-01

232

Vaginal mesh erosion after abdominal sacral colpopexy  

Microsoft Academic Search

Objective: Our goal was to compare the prevalence of vaginal mesh erosion between abdominal sacral colpopexy and various sacral colpoperineopexy procedures. Study Design: We undertook a retrospective analysis of all sacral colpopexies and colpoperineopexies performed between March 1, 1992, and February 28, 1999. The patients were divided into the following 4 groups: abdominal sacral colpopexy, abdominal sacral colpoperineopexy, and 2

Anthony G. Visco; Alison C. Weidner; Matthew D. Barber; Evan R. Myers; Geoffrey W. Cundiff; Richard C. Bump; W. Allen Addison

2001-01-01

233

Trauma care systems in The Netherlands  

Microsoft Academic Search

In the late 1980s the Dutch trauma surgeons (Dutch Trauma Society) expressed their concern about the quality of care to the (multi) trauma patients, in the prehospital as well as the in-hospital setting. The following intensive debate with the public health inspectorate and the government became the start point for major improvements in teaching and training (a.o. ATLS), reorganization, regionalization

Henk Jan ten Duis; Chris van der Werken

2003-01-01

234

The Impact of Trauma on Society  

Microsoft Academic Search

\\u000a Knowledge about the impact of trauma on society is essential to adopting a multidisciplinary approach to orthopaedic trauma\\u000a care. Nearly 16,000 people die from injuries each day and for each of these fatalities, several thousand individuals survive\\u000a with permanently disabling injuries. Trauma affects the youngest and most productive members of society, resulting in a wide\\u000a variety of behavioural, psychological and

Farrah Naz Hussain; Mohit Bhandari

235

Evisceration for the management of ocular trauma.  

PubMed

Despite the eye being surrounded by orbital bones and protective mechanisms such as the blink reflex, it is vulnerable to trauma. The two key issues to consider when presented with a case of ocular trauma are the visual potential of the eye and the risk of sympathetic ophthalmia. The Ocular Trauma Score can be used to assess the visual potential of the injured eye. Surgical management may be either repair or removal of the eye (evisceration or enucleation). Herein we describe a case of ocular trauma and the decision-making process in the management of the injury. PMID:24172777

McAlinden, Colm; Saldanha, Mario; Laws, David

2013-01-01

236

The biological effects of childhood trauma.  

PubMed

Trauma in childhood is a psychosocial, medical, and public policy problem with serious consequences for its victims and for society. Chronic interpersonal violence in children is common worldwide. Developmental traumatology, the systemic investigation of the psychiatric and psychobiological effects of chronic overwhelming stress on the developing child, provides a framework and principles when empirically examining the neurobiological effects of pediatric trauma. This article focuses on peer-reviewed literature on the neurobiological sequelae of childhood trauma in children and in adults with histories of childhood trauma. PMID:24656576

De Bellis, Michael D; Zisk, Abigail

2014-04-01

237

Examining the Associations Between Sex Trade Involvement, Rape, and Symptomatology of Sexual Abuse Trauma.  

PubMed

The high prevalence of rape and sexual trauma symptomatology among women involved in street-based sex trades is well-established. Because prior research has lacked appropriate, non-sex trade involved comparison groups, it is unknown whether differences exist among similarly situated women who do and do not trade sex. This article explores experiences of childhood and adult rape and symptomatology of sexual abuse trauma among a community-based sample of 322 women who use methamphetamine in San Francisco, California, 61% of whom were involved in the sex trade. Study participants were recruited via respondent-driven sampling and eligible if they were cisgender women, aged 18 or older, current methamphetamine users, and sexually active with at least one cisgender man in the past 6 months. The dependent variable was sexual abuse trauma symptomatology, as measured by the Sexual Abuse Trauma Index (SATI) subscale of the Trauma Symptom Checklist-40 (TSC-40), and the explanatory variable was sex trade involvement. Potential covariates were age, current homelessness, methamphetamine dependence, and experiences of childhood and adult rape. Sixty-one percent of participants had a SATI subscale score suggestive of sexual abuse trauma. The overall prevalence of rape in childhood and adulthood was 52% and 73%, respectively. In bivariate analysis, sex trade involvement and all of the potential covariates except for homelessness and age were associated with a SATI score suggestive of sexual abuse trauma. In multivariate models controlling for significant covariates, there was no longer a statistically significant association between sex trade involvement or childhood rape and an elevated SATI score. Elevated levels of psychological dependence on methamphetamine and experiences of rape as an adult were still associated with a high SATI score. These findings highlight that urban poor women, regardless of sex trade involvement, suffer high levels of rape and related trauma symptomatology. PMID:25210029

Lutnick, Alexandra; Harris, Jennie; Lorvick, Jennifer; Cheng, Helen; Wenger, Lynn D; Bourgois, Philippe; Kral, Alex H

2014-09-10

238

Demography of penetrating cardiac trauma.  

PubMed Central

All cases of penetrating cardiac trauma in 1985 and 1986 in Jefferson County, Alabama, where patients dying of penetrating trauma received autopsies, were retrospectively reviewed. All hospitals in the county plus the single coroner's office provided the records of the 72 patients comprising this study. Incidents occurred most often in the home or residence (70%) by a known assailant (83%) due to domestic/social disputes (73%). Frequency was greatest in the evening hours (73% between 6:00 PM and 3:00 AM), on weekends in spring and summer. Victims tended to be male (86%), black (72%), married (46%), blue collar workers (62%). There were 41 (57%) gunshot wounds, 3 (4%) shotgun wounds, and 28 (39%) stab wounds with an associated mortality rate of 97%, 100%, and 68%, respectively. Prehospital mortality rate (dead at the scene) was 54.2% (39/72), and death on arrival was 26.4% (19/72), for a combined pretreatment mortality rate of 80.6%. All patients who arrived with no vital signs died. Mortality appeared to be related to mechanism of injury, age, race, sex, vital signs on arrival, number and specific cardiac chambers injured, associated major vascular injury, hematocrit, and mode of transportation. Mortality was not related to caliber of weapon, ethanol level, transport time, time from arrival to operation, or transfusion requirements. There were only ten survivors (1 gunshot wound and 9 stab wounds), all of whom had ventricular injuries and no associated major vascular injuries. The ten survivors represented a 71.4% (10/14) salvage rate for those victims arriving with vital signs. Complications occurred in three patients. Hospitalization averaged 7.3 days in the survivors. Penetrating cardiac trauma remains a serious, socially linked disease with a high rate of mortality. Rapid transport, aggressive resuscitation and cardiorrhaphy remain the best treatment. PMID:2730180

Naughton, M J; Brissie, R M; Bessey, P Q; McEachern, M M; Donald, J M; Laws, H L

1989-01-01

239

Imaging of temporal bone trauma.  

PubMed

Temporal bone trauma is commonly seen in patients with craniofacial injury and can be detected using multidetector computed tomography. A thorough understanding of the different types of temporal bone fracture patterns is needed to accurately describe the trajectory of injury as well as anticipated complications. Fractures should be described based on direction, segment of temporal bone involved, as well as involvement of the otic capsule. More importantly, the radiologist plays an integral role in identifying complications of temporal bone injury, which often have significant clinical implications. PMID:25086807

Kennedy, Tabassum A; Avey, Gregory D; Gentry, Lindell R

2014-08-01

240

Subcutaneous Splenosis of the Abdominal Wall: Report of a Case and Review of the Literature  

PubMed Central

Splenosis is a common benign condition that occurs after splenic rupture via trauma or surgery. The mechanism behind splenic cell autotransplantation begins with the splenic rupture, either from trauma or surgical removal. Splenosis is usually found incidentally and, unless symptomatic, surgical therapy is not indicated. Subcutaneous splenosis is an extremely rare form of splenosis, mostly observed in abdominal surgical scars. We report a case of subcutaneous splenosis, as well as a comprehensive review of the literature. In our case, a 43-year-old woman who had splenectomy after traumatic splenic rupture at the age of 7 years old presented for plastic reconstruction of her postoperative scar. Upon surgery, two asymptomatic subcutaneous nodules were incidentally discovered. The presence of splenic tissue was confirmed by the histological study. The nodules were not excised, as the patient was not symptomatic. PMID:23401837

Papakonstantinou, Evangelia; Kalles, Vasileios; Papapanagiotou, Ioannis; Piperos, Theodoros; Karakaxas, Dimitrios; Bonatsos, Vasileios; Tsoumakas, Konstantinos; Orfanos, Filotheos; Mariolis-Sapsakos, Theodoros

2013-01-01

241

Trauma  

MedlinePLUS

... Wounds1 , a knowledge cooperative that offers information on wound care, including news features, technology reports, searchable databases of the wound-related conditions and possible treatments, and interactive tools ...

242

[Update: blast and explosion trauma].  

PubMed

In recent decades, acoustic shock and explosion traumas have increased in frequency in the general population. Beside the use of fireworks and firearms, airbag ignitions and explosions caused by terror or suicidal acts are also relevant. Depending on duration and strength of the sound pressure affecting the human ear, isolated inner ear damage or additional ear drum perforation and interruption of the middle ear ossicle chain can result. By means of otoscopy, pure tone audiometry, measurement of otoacoustic emissions, and other neurootological examinations, the severity of the trauma can be determined. With prompt and adequate therapy, permanent hearing loss can be minimized. In particular, the measurement of otoacoustic emissions allows conclusions to be made on the functionality of the outer hair cells which are damaged first in most cases. Histological investigations on noise-exposed cochleas show extensive damage to the outer hair cells in the frequency range between 1.0 and 4.0 kHz, which correlates well with audiometric measurements. PMID:21769579

van de Weyer, P S; Praetorius, M; Tisch, M

2011-08-01

243

Huge desmoid tumor of the anterior abdominal wall mimicking an intraabdominal mass in a postpartum woman: a case report  

PubMed Central

Desmoid tumors are benign neoplasms that most often arise from muscle aponeurosis and have been associated with both trauma and pregnancy. The etiology of desmoids has not been determined. We report the case of anterior abdominal wall desmoid tumor in a female patient with previous history of cesarean section. Preoperative ultrasound and computed tomography demonstrated a large mass mimicking a large hematoma or an intraabdominal mass. The tumor was removed by wide excision with safe margins. The abdominal wall defect was reconstructed with polypropylene mesh. Subsequent histology revealed a desmoid tumor. Desmoid tumors in females are often associated with pregnancy or occur post-partum. The reasons behind this association are unclear. The most common sites are in the abdominal muscles. PMID:23593530

Trigui, Khaled; Bouassida, Mahdi; Kilani, Houda; Mighri, Mohamed Mongi; Sassi, Selim; Chebbi, Fathi; Touinsi, Hassen; Sassi, Sadok

2013-01-01

244

Biology, childhood trauma, and murder: Rethinking justice  

Microsoft Academic Search

This article reviews recent findings in the developmental neurophysiology of children subjected to psychological trauma. Studies link extreme neglect and abuse with long-term changes in the nervous and endocrine systems. A growing body of research literature indicates that individuals with severe trauma histories are at higher risk of behaving violently than those without such histories. This article links these two

Kathleen M. Heide; Eldra P. Solomon

2006-01-01

245

Accumulated childhood trauma and symptom complexity  

Microsoft Academic Search

The relationship between accumulated exposure to different types of traumatic events (cumulative trauma) in childhood and the total number of different types of symptomatology reported (symptom complexity) in adulthood was examined in a sample of 2,453 female university students. There was a linear relationship between the number of trauma types experienced by participants before 18 and symptom complexity. This effect

John Briere; Stacey Kaltman; Bonnie L. Green

2008-01-01

246

Psychological Trauma: Theory, Research, Practice, and Policy  

E-print Network

in Childhood. Psychological Trauma: Theory, Research, Practice, and Policy. Advance online publication. doi: 10Psychological Trauma: Theory, Research, Practice, and Policy Physiological Stress Responses Predict in Childhood Cindy M. Meston and Tierney A. Lorenz Online First Publication, March 19, 2012. doi: 10.1037/a

Meston, Cindy

247

Trauma-related deficits in working memory  

Microsoft Academic Search

Introduction. The aim of the study was to evaluate trauma-related impairments of working memory in psychiatric outpatients, and the mediating role of processing speed, anxiety and depression in the cognitive decrements. Methods. This research applied a comprehensive assessment protocol including an evaluation of psychopathological and neuropsychological functioning in psychiatric outpatients. Patients with trauma history (n = 33) were compared to

Wissam El-Hage; Philippe Gaillard; Michel Isingrini; Catherine Belzung

2006-01-01

248

The Biology of Trauma: Implications for Treatment  

ERIC Educational Resources Information Center

During the past 20 years, the development of brain imaging techniques and new biochemical approaches has led to increased understanding of the biological effects of psychological trauma. New hypotheses have been generated about brain development and the roots of antisocial behavior. We now understand that psychological trauma disrupts homeostasis…

Solomon, Eldra P.; Heide, Kathleen M.

2005-01-01

249

Ophthalmic involvement in cranio-facial trauma  

Microsoft Academic Search

Objectives: This is a retrospective descriptive case study which will look into the spectrum of ophthalmic involvement in cases with orbital and eye injuries after cranio-facial trauma and to analyse the visual and motility outcome. Material: One hundred and four cases with ophthalmic involvement after cranio-facial trauma that were referred to and seen in the eye department of a tertiary

Shantha Amrith; Seang Mei Saw; Thiam Chye Lim; Timothy Kam Yiu Lee

2000-01-01

250

Partner Preferences among Survivors of Betrayal Trauma  

Microsoft Academic Search

Betrayal trauma theory suggests social and cognitive development may be affected by early trauma such that individuals develop survival strategies, particularly dissociation and lack of betrayal awareness, which may place them at risk for further victimization. Several experiences of victimization in the context of relationships predicated on trust and dependence may contribute to the development of relational schema whereby abuse

Robyn L. Gobin

2012-01-01

251

Tips for Teachers during Times of Trauma.  

ERIC Educational Resources Information Center

This guide for teachers in times of trauma was updated after the events of September 11, 2001--the terrorist attacks on the World Trade Center and the Pentagon. These traumatic events could cause refugees to experience trauma or become re-traumatized. For many refugees, their English-as-a-Second-Language (ESL) programs are the places where they…

Adkins, Myrna Ann; Harper, Eric

252

Necrotizing fasciitis involving the chest and abdominal wall caused by Raoultella planticola  

PubMed Central

Background Raoultella planticola was originally considered to be a member of environmental Klebsiella. The clinical significance of R. planticola is still not well known. Case presentation We describe the first case of necrotizing fasciitis involving the chest and abdominal wall caused by R. planticola. The identity of the organism was confirmed using 16S rRNA sequencing. The patient was successfully treated with the appropriate antibiotics combined with operative drainage and debridement. Conclusions R. planticola had been described as environmental species, but should be suspected in extensive necrotizing fasciitis after minor trauma in mild to moderate immunocompromised patients. PMID:22423899

2012-01-01

253

Use of the resuscitation room for trauma.  

PubMed Central

This study was designed to assess the use of the resuscitation room for trauma cases, the information being used to identify particular problem areas and put forward possible solutions. One hundred and fifty consecutive resuscitation room trauma patients were studied prospectively, with details being obtained both at the time of admission and 48 h later. The results have highlighted the importance of all patients with major trauma being assessed and treated by senior medical staff. In addition, the presence of more than one doctor when managing any resuscitation room trauma patient was shown to be beneficial. Many cases were seen by SHO only, and there is a need for more senior medical staff to be informed of every trauma patient entering the resuscitation room. Recording of vital signs was found to be less than satisfactory and there is a necessity for a departmental policy on this. PMID:3620060

O'Byrne, G A; Bodiwala, G G

1987-01-01

254

Abdominal hollow viscus injuries are associated with spine and neurologic infections after penetrating spinal cord injuries.  

PubMed

Penetrating spinal cord injuries are rare but potentially devastating injuries that are associated with significant morbidity. The objective of this study was to assess the impact of abdominal hollow viscus injuries (HVIs) on neurologic and spinal infectious complications in patients sustaining penetrating spinal cord injuries. We performed a 13-year retrospective review of a Level I trauma center database. Variables analyzed included demographics, injury patterns and severity, spine operations, and outcomes. Spine and neurologic infections (SNIs) were defined as paraspinal or spinal abscess, osteomyelitis, and meningitis. Multivariate analysis was performed to identify factors associated with SNI. Of 137 patients, there were 126 males (92%) with a mean age of 27 ± 10 years. Eight patients (6%) underwent operative stabilization of their spine. Fifteen patients (11%) developed SNI. There was a higher incidence of SNI among patients with abdominal HVI compared with those without (eight [26%] vs six [6%], P < 0.001). On multivariate analysis, after controlling for injury severity, solid abdominal injury and HVI, vascular injury, and spine operation, abdominal HVIs were independently associated with an increased risk for SNI (odds ratio, 6.88; 95% confidence interval, 2.14 to 22.09; P = 0.001). Further studies are required to determine the optimal management strategy to prevent and successfully treat these infections. PMID:25264640

Schwed, Alexander C; Plurad, David S; Bricker, Scott; Neville, Angela; Bongard, Fred; Putnam, Brant; Kim, Dennis Y

2014-10-01

255

Index Numbers  

Microsoft Academic Search

Index numbers are used to aggregate detailed information on prices and quantities into scalar measures of price and quantity levels or their growth. The paper reviews four main approaches to bilateral index number theory where two price and quantity vectors are to be aggregated: fixed basket and average of fixed baskets, stochastic, test or axiomatic and economic approaches. The paper

Erwin Diewert

2007-01-01

256

Sagittal Abdominal Diameter and Visceral Adiposity  

PubMed Central

Background In the context of increasing obesity prevalence, the relationship between large visceral adipose tissue (VAT) volumes and type 2 diabetes mellitus (T2DM) is unclear. In a clinical sample of severely obese women (mean body mass index [BMI], 46 kg/m2) with fasting normoglycemia (n=40) or dysglycemia (impaired fasting glucose+diabetes; n=20), we sought to determine the usefulness of anthropometric correlates of VAT and associations with dysglycemia. Methods VAT volume was estimated using multi-slice computer tomography; anthropometric surrogates included sagittal abdominal diameter (SAD), waist circumference (WC) and BMI. Insulin sensitivity (Si), and beta-cell dysfunction, measured by insulin secretion (AIRg) and the disposition index (DI), were determined by frequently sampled intravenous glucose tolerance test. Results Compared to fasting normoglycemic women, individuals with dysglycemia had greater VAT (P<0.001) and SAD (P=0.04), but BMI, total adiposity and Si were similar. VAT was inversely associated with AIRg and DI after controlling for ancestry, Si, and total adiposity (standardized beta, ?0.32 and ?0.34, both P<0.05). In addition, SAD (beta=0.41, P=0.02) was found to be a better estimate of VAT volume than WC (beta=0.32, P=0.08) after controlling for covariates. Receiver operating characteristic analysis showed that VAT volume, followed by SAD, outperformed WC and BMI in identifying dysglycemic participants. Conclusions Increasing VAT is associated with beta-cell dysfunction and dysglycemia in very obese women. In the presence of severe obesity, SAD is a simple surrogate of VAT, and an indicator of glucose dysregulation. PMID:23408092

Kahn, Henry S.; Gasevic, Danijela; Liang, Zhe; Frediani, Jennifer K.; Torres, William E.; Ziegler, Thomas R.; Phillips, Lawrence S.; Lin, Edward

2013-01-01

257

Large Abdominal Wall Endometrioma Following Laparoscopic Hysterectomy  

PubMed Central

Background: Endometriosis is a common condition in women that affects up to 45% of patients in the reproductive age group by causing pelvic pain. It is characterized by the presence of endometrial tissue outside the uterine cavity and is rarely found subcutaneously or in abdominal incisions, causing it to be overlooked in patients with abdominal pain. Methods: A 45-year-old woman presented with lower abdominal pain 2 years following a laparoscopic supracervical hysterectomy. She was found to have incidental cholelithiasis and a large abdominal mass suggestive of a significant ventral hernia on CT scan. Results: Due to the peculiar presentation, surgical intervention took place that revealed a large 9cm×7.6cm×6.2cm abdominal wall endometrioma. Conclusion: Although extrapelvic endometriosis is rare, it should be entertained in the differential diagnosis for the female patient who presents with an abdominal mass and pain and has a previous surgical history. PMID:21902990

Borncamp, Erik; Mehaffey, Philip; Rotman, Carlos

2011-01-01

258

Trauma-related Therapeutic Procedures at Shohada Trauma Center in Tabriz  

PubMed Central

Background To decrease the burden of injuries it is essential to have an overview of trauma patterns and its management at regional trauma centers. Objectives The aim of this study was to investigate some patterns of trauma and trauma-related therapeutic interventions at our trauma center. Materials and Methods In a cross-sectional study, 19530 trauma cases admitted to the emergency department and hospital wards of Shohada University Hospital during 2007-2008 were assessed. Results Of the 19530 trauma cases, 14960(76.7%) were males. Mean (SD) of age was 31(19.9) years. The elderly aged 65 and above, comprised 10% (1953) of the participants; while 44 were infants. Falls and traffic injuries were the most common cause of injuries among trauma patients. Most of the mortalities were men comprising 74% of the 57 deaths. Reduction of fractures and dislocations were the most common types of operations among trauma patients. Conclusions Young men form the target group for possible interventions to decrease the burden of trauma following falls and traffic accidents. PMID:24350134

Sadeghi-Bazargani, Homayoun; Azami-Aghdash, Saber; Ziapour, Behrad; Deljavan, Reza

2013-01-01

259

Focused assessment with sonography in trauma (FAST): should its role be reconsidered?  

PubMed

Focused assessment with sonography in trauma (FAST) is a limited ultrasound scan performed in the emergency department to assess patients admitted with blunt abdominal trauma (BAT). It is normally undertaken by emergency physicians in order to identify the presence of free fluid, which may represent haemoperitoneum. This potentially allows prompt referral to further imaging, such as a computed tomography (CT) scan, and/or surgery. FAST has been adopted worldwide, and most major trauma centres now have access to an ultrasound machine. Despite the popularity of FAST, there remains a lack of clarity and evidence around any actual contribution to patient survival. An ability to evaluate the true impact of FAST is complicated by factors such as the operator dependence of ultrasound, the improved access, speed and subsequent use of CT (which has reduced the value of FAST in some centres), a lack of standardisation around education and the most effective methods to ensure competence, and variations in the practice, quality and audit of FAST. Enthusiasm for FAST is undiminished among emergency physicians, and in general, point of care ultrasound is escalating in a range of areas, including the emergency department. Small portable and hand held ultrasound machines improve the accessibility of FAST and its benefits are frequently perceived to be an established and essential part of the emergency department service despite its limitations. Since the introduction of FAST, trauma patients are increasingly managed by non-surgical means if haemodynamically stable, and the presence of intraperitoneal fluid does not necessarily influence this decision. Recent developments in multi-detector CT, and in the use of contrast enhanced ultrasound, have broadened the management options for trauma patients, and can support a faster diagnostic pathway than was previously possible. FAST is a limited triage tool, whose actual value in the diagnostic and treatment pathway of patients with BAT remains questionable, and more data are needed to justify its use in the light of these recent developments. PMID:20364030

Smith, Jane

2010-05-01

260

Extrahepatic Portal Hypertension Following Abdominal Surgery  

Microsoft Academic Search

We present a case of non-cirrhotic extrahepatic portal hypertension in a 31-year-old woman following exten- sive abdominal laparotomy for the drainage of multiple retroperitoneal and liver abscesses following a perfo- rated appendix. Chronic portal, splenic, and mesenteric vein thrombosis with portal hypertension was caused by a hypercoagulable state due to the abdominal infec- tion and abdominal surgery. Various etiological aspects

Ajit Singh Ahluwalia; Joseph J. Mazza; Steven H. Yale

261

Carcinoid abdominal crisis: a case report.  

PubMed

Over the past 40 years, the incidence of neuroendocrine tumors (NETs) has been increasing. Distal small bowel (i.e., midgut) NETs most often cause carcinoid syndrome manifested as cutaneous flushing, diarrhea, bronchial constriction, and cardiac involvement. Carcinoid abdominal crisis occurs when submucosal tumors impede the vascular supply to the gut leading to mesenteric ischemia and worsening abdominal pain. Here, we report the case of a young woman with progressively worsening abdominal pain. PMID:24860963

Jacobs, Ramon E A; Bai, Shuting; Hindman, Nicole; Shah, Paresh C

2014-09-01

262

Pathology Case Study: Abdominal Pain  

NSDL National Science Digital Library

This is a case study presented by the University of Pittsburgh Department of Pathology in which a 72-year-old man has abdominal pain, anorexia, and weight loss but no significant past medical history. Visitors are given both the microscopic and gross descriptions, including images, and are given the opportunity to diagnose the patient. This is an excellent resource for students in the health sciences to familiarize themselves with using patient history and laboratory results to diagnose disease. It is also a helpful site for educators to use to introduce or test student learning in autopsy pathology.

Nine, Jeff S.; Weir, Ed

2007-12-03

263

Pathology Case Study: Abdominal Pain  

NSDL National Science Digital Library

This is a case study presented by the University of Pittsburgh Department of Pathology in which a 65-year-old man is complaining of abdominal pain. Visitors are given the radiology, gross and microscopic descriptions, flow cytometry, and molecular diagnostics, including images, and are given the opportunity to diagnose the patient. This is an excellent resource for students in the health sciences to familiarize themselves with using patient history and laboratory results to diagnose disease. It is also a helpful site for educators to use to introduce or test student learning in hematopathology.

Latulippe, Steven; Ohori, N. P.

2007-12-05

264

[Surgical abdominal pain in children].  

PubMed

Abdominal pain in child could be related to surgical pathologies in 10 to 20 % of cases. The more frequent etiology remains appendicitis. Regarding to clinical presentation, age and medical history, intestinal intussusception, incarcerated hernia, adhesive occlusion and Meckel's diverticulum could be evocated. But the most dreadful diagnosis is malrotation with volvulus, because of mortality and morbidities induced by bowel necrosis. Usually, medical history and clinical exam allowed diagnosis. Ultrasound remains the more helpful exam in children with surgical pathologies and in some selected cases, CT scan and others biological and/or radiological exams could be performed. PMID:21698888

Arnaud, Alexis; Sauvat, Frédérique

2011-05-01

265

Abdominal wall endometriosis: case report.  

PubMed

Abdominal wall endometriosis, also known as scar endometrioma, is a rare condition, in most cases occurring after previous cesarean section or pelvic surgery. The incidence of scar endometrioma is estimated to 0.03%-1.5% of all women with previous cesarean delivery. The predominant clinical picture is cyclic pain. Due to a wide range of mimicking conditions and a relative rarity, a significant delay is often observed from the onset of symptoms to proper treatment. We report on a case of a 36-year-old patient with scar endometrioma after two previous cesarean deliveries. The possible diagnostic pitfalls and treatment options are discussed. PMID:23115952

Eljuga, Damir; Klari?, Petar; Bolanca, Ivan; Grbavac, Ivan; Kuna, Krunoslav

2012-06-01

266

Addressing childhood trauma in a developmental context  

PubMed Central

With the anticipated publication of the DSM-5 in May 2013, much reflection and work has been done on reviewing existing psychiatric nomenclature including, but not limited to the field of traumatic exposure. Traditionally, understanding of the psychiatric and psychological effects of trauma have been developed from studies with adults and then applied to trauma-exposed children with some modifications. While this is an important step to understanding the sequelae of trauma in children and adolescents, the adverse developmental effects of traumatic exposures on the rapidly evolving neurological, physical, social and psychological capacities of children calls for a developmentally sensitive framework for understanding, assessing and treating trauma-exposed children. The importance of early attachment relationships in infancy and childhood means that severely disrupted early caregiving relationships may have far-reaching and lifelong developmental consequences and can therefore be considered traumatic. Given the high rates of violence and trauma exposure of South African children and adolescents, the need for a developmentally based understanding of the effects of trauma on child and adolescent mental health becomes even more pronounced. In this paper, we draw on theoretical perspectives to provide a practical, clinically driven approach to the management of developmental trauma. PMID:25104963

Gregorowski, Claire; Seedat, Soraya

2013-01-01

267

Writing trauma: emotion, ethnography, and the politics of suffering among Somali returnees in Ethiopia.  

PubMed

By comparing Somali narratives of emotion and suffering with literature about emotion in relation to trauma and "the refugee experience," this paper contributes to the understanding of emotion, suffering, and trauma in different cultural and sociopolitical contexts, and interrogates the roles and methods of ethnographies of trauma in situations of high political, social, and economic stakes. In the mid-1990s, emotional distress among Ethiopian Somali returnees was about social rupture and injustice and not simply about private suffering. Emotion is critical to creating, recognizing, reinforcing, and mobilizing the moral webs on which both individual and collective survival depend. In the aftermath of dispossession and war, and amidst ongoing hunger and destitution, certain expressions of emotion carry a particularly important valence: anger, passion, and rhetorics of demoralization revolving around a collective narrative of dispossession and demands for restitution. "Experience near" descriptions of Somali emotion expressions cannot be conflated with "psychological" analyses or "Posttraumatic Stress Disorder." Somali refugee narratives index and challenge the embodiment in lived experience of local, national, and global institutions' (in)action and inequality. To the extent that academic debates over emotion and trauma help to shape, reinforce, or challenge the assumptions and practices of institutions affecting millions of lives, we researchers must address in our analyses the practical and political implications of how we interpret and write about emotion, trauma, and politics. PMID:15470948

Zarowsky, Christina

2004-06-01

268

Perioperative care of the pediatric trauma patient.  

PubMed

Children have specific emotional and physiological needs that are intensified when they sustain injuries that require surgery. Care of pediatric trauma patients includes the physiological considerations of airway management, hemodynamic stability, hypothermia, and physical size. Psychological considerations include enhancing coping skills, caring for children according to their developmental levels, and caring for family members. The perioperative nurse must be familiar with these pediatric trauma nursing principles to effectively meet the needs of children and their family members during times of trauma crisis. PMID:7998798

Davis, J L; Klein, R W

1994-10-01

269

Quality management for trauma patients in the emergency department  

Microsoft Academic Search

The quality of care for trauma patients seems to have dramatically improved in the last decades. Both political and medical changes have influenced these changes. In the Netherlands the organization of a trauma system started in the eighties of last century with the foundation of the Dutch Trauma Society and regionalized care systems. Also the introduction of Advanced Trauma Life

P. H. W. Lubbert

2010-01-01

270

Recurrent abdominal pain in childhood.  

PubMed

Recurrent abdominal pain in childhood is common, and continues to be a diagnostic and therapeutic challenge. It is usually attributed to a functional gastrointestinal disorder rather than an organic disease. In most cases, a comprehensive history and physical examination should enable one to make a positive diagnosis of functional disorder. The presence of alarm symptoms and signs, such as weight loss, gastrointestinal bleeding and chronic severe diarrhoea, warrants further investigations and referral to a paediatric gastrointestinal specialist. The mainstay of therapy in functional abdominal pain is education, reassurance and avoidance of triggering factors. While symptom-based pharmacological therapy may be helpful in patients who do not respond to simple management, it is best used on a time-limited basis due to the lack of good evidence of its efficacy. The primary goal of therapy is a return to normal daily activities rather than complete elimination of pain. In recalcitrant cases, psychological interventions such as cognitive behaviour therapy and relaxation training have proven to be efficacious. PMID:23624445

Chiou, Fang Kuan; How, Choon How; Ong, Christina

2013-04-01

271

Mechanical ventilation in abdominal surgery.  

PubMed

One of the key challenges in perioperative care is to reduce postoperative morbidity and mortality. Patients who develop postoperative morbidity but survive to leave hospital have often reduced functional independence and long-term survival. Mechanical ventilation provides a specific example that may help us to shift thinking from treatment to prevention of postoperative complications. Mechanical ventilation in patients undergoing surgery has long been considered only as a modality to ensure gas exchange while allowing maintenance of anesthesia with delivery of inhaled anesthetics. Evidence is accumulating, however, suggesting an association between intraoperative mechanical ventilation strategy and postoperative pulmonary function and clinical outcome in patients undergoing abdominal surgery. Non-protective ventilator settings, especially high tidal volume (VT) (>10-12mL/kg) and the use of very low level of positive end-expiratory pressure (PEEP) (PEEP<5cmH2O) or no PEEP, may cause alveolar overdistension and repetitive tidal recruitment leading to ventilator-associated lung injury in patients with healthy lungs. Stimulated by previous findings in patients with acute respiratory distress syndrome, the use of lower tidal volume ventilation is becoming increasingly more common in the operating room. However, lowering tidal volume, though important, is only part of the overall multifaceted approach of lung protective mechanical ventilation. In this review, we aimed at providing the most recent and relevant clinical evidence regarding the use of mechanical ventilation in patients undergoing abdominal surgery. PMID:25153670

Futier, E; Godet, T; Millot, A; Constantin, J-M; Jaber, S

2014-01-01

272

UK Index  

NSDL National Science Digital Library

The UK Index provides a searchable index of resources in or about the United Kingdom. The Quick Reference section offers links to News Resources in the UK such as the BBC, weather information, UK record charts, and UK related USENET newsgroups. The Foreign & Commonwealth Office provides good advice for travelers. The search engine allows the selection of categories such as arts or business to restrict the search to pages included in one category or a combination of categories.

273

Detecting the Blind Spot: Complications in the Trauma Registry and Trauma Quality Improvement  

PubMed Central

Background The National Surgical Quality Improvement Program (NSQIP) has reduced complications for surgery patients in the Department of Veterans Affairs Healthcare System. The American College of Surgeons Committee on Trauma maintains the National Trauma Data Bank (NTDB) to track injured patient co-morbidities, complications, and mortality. We sought to apply the NSQIP methodology to collect co-morbidity and outcome data for trauma patients. Data were compared to the NTDB to determine the benefit and validity of using the NSQIP methodology for trauma. Study Design Utilizing the NSQIP methodology, data were collected from 8/1/2004 to 7/31/2005 on all adult patients admitted to the trauma service at a Level 1 trauma center. NSQIP data were collected for general surgery patients during the same time period from the same institution. Data were also extracted from v5.0 of the NTDB for patients ? 18 years old admitted to Level 1 trauma centers. Comparisons between University of Michigan (UM) NSQIP Trauma and UM NSQIP General Surgery patients and between UM NSQIP Trauma and NTDB (2004) patients were performed using univariate and multivariate analysis. Results Prior to risk-adjustment, there was a difference in mortality between the UM NSQIP Trauma and NTDB (2004) groups with univariate analysis (8.4 vs. 5.7%, OR 0.7, 95% CI 0.5–0.9, p=0.01). This survival advantage reversed to favor the UM NSQIP Trauma patient group when risk-adjustment was performed (OR 2.3, 95% CI 1.6–3.4, p<0.001). The UM NSQIP Trauma group had more complications than the UM NSQIP General Surgery patients. Despite having a lower risk-adjusted rate of mortality, the UM NSQIP Trauma patients had significantly higher rates of complications (wound infection, wound disruption, pneumonia, urinary tract infection, deep vein thrombosis, and sepsis) than the NTDB (2004) patients in both univariate and multivariate analysis. Conclusion Complications occurred more frequently in trauma patients than general surgery patients. The UM NSQIP Trauma patients had higher rates of complications than reported in the NTDB. The NTDB data potentially underreports important co-morbidity and outcome data. Application of the NSQIP methodology to trauma may present an improved means of effectively tracking and reducing adverse outcomes in a risk-adjusted manner. PMID:17950334

Hemmila, Mark R.; Jakubus, Jill L.; Wahl, Wendy L.; Arbabi, Saman; Henderson, William G.; Khuri, Shukri F.; Taheri, Paul A.; Campbell, Darrell A.

2007-01-01

274

Aortic Valve Injury Following Blunt Chest Trauma  

PubMed Central

Introduction: Heart valve injury following blunt chest trauma of car accidents is increasing. Although aortic valve involvement is rare, however, in survivors of blunt cardiac trauma it is the most commonly involved valve and the most frequent valve lesion is isolated injury of the noncoronary cusp of aortic valve. Case Presentation: A 31-year-old man with a history of car accident (five months before) was referred to our clinic because of shortness of breath. A holo-diastolic blowing murmur was heard on physical examination. Transesophageal echocardiography demonstrated severe aortic insufficiency secondary to rupture of the left coronary cusp associated with avulsion of aortic valve commissure. Conclusions: Since the aortic valve is rarely affected in blunt cardiac injury, it will be generally undiagnosed during the primary evaluation of a patient with blunt chest trauma. However, any patient presenting dyspnea after chest trauma should be examined for suspected aortic valve injury. PMID:25478541

Esmaeilzadeh, Maryam; Alimi, Hedieh; Maleki, Majid; Hosseini, Saeid

2014-01-01

275

Coping with Unexpected Events: Depression and Trauma  

MedlinePLUS

... know from a variety of studies that the chemistry in the brain changes in response to trauma. ... and allow them to express their feelings and reactions. Respect the fact that others may respond to ...

276

Simulation for trauma and combat casualty care.  

PubMed

Training medical providers to care for traumatically injured patients is a difficult undertaking and currently used training strategies are often suboptimal. The further strains placed on trauma care in the military environment only add to the challenge. Simulation applications ranging from simple physical models to complex, computer-based virtual reality systems have either been developed or are being developed to help support and improve trauma care training. Several of these applications have been shown to be as good as or better than the standard training methods they are designed to replace. Simulators are available for training in the treatment of disorders of the airway, difficulty with breathing, and problems dealing with circulation as well as various non-life-threatening but disabling injuries. Some of these simulators have already drastically changed how the standard Advanced Trauma Life Support course is taught. Advances in both technology and application of simulators will continue to affect trauma skills training for the foreseeable future. PMID:16754168

Matt Ritter, E; Bowyer, Mark W

2005-01-01

277

Trauma and couples: mechanisms in dyadic functioning.  

PubMed

Research traditionally has focused on the development of symptoms in those who experienced trauma directly but overlooked the impact of trauma on the families of victims. In recent years, researchers and clinicians have begun to examine how individual exposure to traumatic events affects the spouses/partners, children, and professional helpers of trauma survivors. The current study reports data from a larger mixed-methodology study that includes qualitative interview data from 17 individuals, coded to identify the mechanisms that may affect the couple's interpersonal functioning when there is a history of trauma exposure in one or both partners. The following primary themes were identified: role in the relationship, boundary issues, intimacy problems, triggers, and coping mechanisms. Areas for future research and clinical implications also are identified. PMID:21745234

Henry, Stacey Blalock; Smith, Douglas B; Archuleta, Kristy L; Sanders-Hahs, Erin; Goff, Briana S Nelson; Reisbig, Allison M J; Schwerdtfeger, Kami L; Bole, Amy; Hayes, Everett; Hoheisel, Carol B; Nye, Ben; Osby-Williams, Jamie; Scheer, Tamera

2011-07-01

278

The Role of Thrombelastography in Multiple Trauma  

PubMed Central

Hemorrhage and traumatic coagulopathyis are major causes of early death in multiply injured patients. Thrombelastography (TEG) seems to be a fast and accurate coagulation test in trauma care. We suggest that multiply injured trauma patients would benefit the most from an early assessment of coagulation by TEG, mainly RapidTEG, to detect an acute traumatic coagulopathy and especially primary fibrinolysis, which is related with high mortality. This review gives an overview on TEG and its clinical applications. PMID:22046550

Jeger, Victor; Zimmermann, Heinz; Exadaktylos, Aristomenis K.

2011-01-01

279

The role of thrombelastography in multiple trauma.  

PubMed

Hemorrhage and traumatic coagulopathyis are major causes of early death in multiply injured patients. Thrombelastography (TEG) seems to be a fast and accurate coagulation test in trauma care. We suggest that multiply injured trauma patients would benefit the most from an early assessment of coagulation by TEG, mainly RapidTEG, to detect an acute traumatic coagulopathy and especially primary fibrinolysis, which is related with high mortality. This review gives an overview on TEG and its clinical applications. PMID:22046550

Jeger, Victor; Zimmermann, Heinz; Exadaktylos, Aristomenis K

2011-01-01

280

Mindfulness for Trauma and Posttraumatic Stress Disorder  

Microsoft Academic Search

\\u000a As a result of events such as the terrorist attacks of September 11th, the bombings in Madrid in 2004, and multiple armed\\u000a conflicts throughout the world, the word trauma and the term posttraumatic stress disorder (PTSD) have become a part of the popular lexicon. The word trauma comes from the Greek word for wound and in psychological terms it has

Victoria M. Follette; Aditi Vijay

281

VAGAL WITHDRAWAL AND RECURRENT ABDOMINAL PAIN  

Microsoft Academic Search

Recurrent abdominal pain (RAP) is a common pediatric problem characterized by recurrent bouts of abdominal pain in children with no identifiable etiology. RAP affects 10 to 15% of the children in elementary school, increasing to nearly 20% in middle and high school. The symptoms are severe enough to cause disruption of daily activities and are associated with learning difficulties, perhaps

Elizabeth Bigham

282

Abdominal Situs inversus in a sheep  

Microsoft Academic Search

ExtractMadam:— Transposition of thoracic and\\/or abdominal viscera is recognised in humans, rats, mice, hamsters, dogs, amphibians and fish, but does not appear to have been previously described in sheep. We report the finding of an apparently complete transposition of abdominal viscera in a nine-month-old castrated male lamb slaughtered at the Tomoana Freezing Works, Hastings

C. Larsen; E. J. Kirk

1987-01-01

283

Hypoadrenalism Following Trauma: Is Sepsis Always Necessary?  

PubMed Central

Purpose of the Study: Trauma patients can exhibit the systemic inflammatory response syndrome (SIRS) without evidence of infection. SIRS from infection has been associated with hypoadrenalism. We hypothesized that hypoadrenalism can accompany SIRS from trauma without infection. To investigate this further, we performed a retrospective study of trauma patients admitted to the ICU at our rural academic level 1 trauma center from October 2003- June 2005, with measurement of blood cortisol in the first 7 days after injury (N=33). We determined the incidence of hypoadrenalism based on serum cortisol levels and performed a univariate analysis to delineate factors associated with hypoadrenalism. Significant Findings: Twelve of 33 (36.6 %) were diagnosed with hypoadrenalism on mean ICU day 2.8. SIRS was documented in 92% of hypoadrenal patients vs. 52% of patients without hypoadrenalism (p=0.021). No patient had evidence of invasive infection. Younger age and higher ISS were also associated with hypoadrenalism. There were no gender differences identified, although most patients in the study were male. There was a trend toward higher etomidate use in the hypoadrenal group, although this was not statistically significant. Conclusions: Trauma patients who demonstrate SIRS early in their ICU course may exhibit hypoadrenalism without infection. Younger age and higher ISS also appear to be associated with this alteration. Further study is needed to determine the true incidence of this condition, and to better delineate which trauma patients are most susceptible. PMID:19079677

Paquette, Ian M.; Burchard, Kenneth W.

2008-01-01

284

21 CFR 884.5225 - Abdominal decompression chamber.  

Code of Federal Regulations, 2010 CFR

...2010-04-01 false Abdominal decompression chamber. 884.5225 Section...Devices § 884.5225 Abdominal decompression chamber. (a) Identification. An abdominal decompression chamber is a hoodlike device...

2010-04-01

285

Abdominal Pain following Gastric Bypass: Suspects & Solutions  

PubMed Central

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

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

2010-01-01

286

Pulmonary complications of abdominal wall defects.  

PubMed

The abdominal wall is an integral component of the chest wall. Defects in the ventral abdominal wall alter respiratory mechanics and can impair diaphragm function. Congenital abdominal wall defects also are associated with abnormalities in lung growth and development that lead to pulmonary hypoplasia, pulmonary hypertension, and alterations in thoracic cage formation. Although infants with ventral abdominal wall defects can experience life-threatening pulmonary complications, older children typically experience a more benign respiratory course. Studies of lung and chest wall function in older children and adolescents with congenital abdominal wall defects are few; such investigations could provide strategies for improved respiratory performance, avoidance of respiratory morbidity, and enhanced exercise ability for these children. PMID:25458796

Panitch, Howard B

2015-01-01

287

Animal Models of Head Trauma  

PubMed Central

Summary: Animal models of traumatic brain injury (TBI) are used to elucidate primary and secondary sequelae underlying human head injury in an effort to identify potential neuroprotective therapies for developing and adult brains. The choice of experimental model depends upon both the research goal and underlying objectives. The intrinsic ability to study injury-induced changes in behavior, physiology, metabolism, the blood/tissue interface, the blood brain barrier, and/or inflammatory- and immune-mediated responses, makes in vivo TBI models essential for neurotrauma research. Whereas human TBI is a highly complex multifactorial disorder, animal trauma models tend to replicate only single factors involved in the pathobiology of head injury using genetically well-defined inbred animals of a single sex. Although such an experimental approach is helpful to delineate key injury mechanisms, the simplicity and hence inability of animal models to reflect the complexity of clinical head injury may underlie the discrepancy between preclinical and clinical trials of neuroprotective therapeutics. Thus, a search continues for new animal models, which would more closely mimic the highly heterogeneous nature of human TBI, and address key factors in treatment optimization. PMID:16389305

Cernak, Ibolja

2005-01-01

288

Resilience, trauma, context, and culture.  

PubMed

This article reviews the relationship between factors associated with resilience, and aspects of the individual's social ecology (environment) that promote and protect against the negative impact of exposure to traumatic events. It is shown that the Environment × Individual interactions related to resilience can be understood using three principles: (1) Resilience is not as much an individual construct as it is a quality of the environment and its capacity to facilitate growth (nurture trumps nature); (2) resilience looks both the same and different within and between populations, with the mechanisms that predict positive growth sensitive to individual, contextual, and cultural variation (differential impact); and (3) the impact that any single factor has on resilience differs by the amount of risk exposure, with the mechanisms that protect against the impact of trauma showing contextual and cultural specificity for particular individuals (cultural variation). A definition of resilience is provided that highlights the need for environments to facilitate the navigations and negotiations of individuals for the resources they need to cope with adversity. The relative nature of resilience is discussed, emphasizing that resilience can manifest as either prosocial behaviors or pathological adaptation depending on the quality of the environment. PMID:23645297

Ungar, Michael

2013-07-01

289

Neuroimaging in repetitive brain trauma.  

PubMed

Sports-related concussions are one of the major causes of mild traumatic brain injury. Although most patients recover completely within days to weeks, those who experience repetitive brain trauma (RBT) may be at risk for developing a condition known as chronic traumatic encephalopathy (CTE). While this condition is most commonly observed in athletes who experience repetitive concussive and/or subconcussive blows to the head, such as boxers, football players, or hockey players, CTE may also affect soldiers on active duty. Currently, the only means by which to diagnose CTE is by the presence of phosphorylated tau aggregations post-mortem. Non-invasive neuroimaging, however, may allow early diagnosis as well as improve our understanding of the underlying pathophysiology of RBT. The purpose of this article is to review advanced neuroimaging methods used to investigate RBT, including diffusion tensor imaging, magnetic resonance spectroscopy, functional magnetic resonance imaging, susceptibility weighted imaging, and positron emission tomography. While there is a considerable literature using these methods in brain injury in general, the focus of this review is on RBT and those subject populations currently known to be susceptible to RBT, namely athletes and soldiers. Further, while direct detection of CTE in vivo has not yet been achieved, all of the methods described in this review provide insight into RBT and will likely lead to a better characterization (diagnosis), in vivo, of CTE than measures of self-report. PMID:25031630

Ng, Thomas Sc; Lin, Alexander P; Koerte, Inga K; Pasternak, Ofer; Liao, Huijun; Merugumala, Sai; Bouix, Sylvain; Shenton, Martha E

2014-01-01

290

[Crush syndrome in severe trauma].  

PubMed

Crush injury or traumatic rhabdomyolysis is caused by crushing of large muscule mass, usually of the femoral and gluteal compartment. Crush syndrome is general manifestation of crush injury with renal failure (ARF). ARF is caused by deposition of myoglobin in distal tubules. The concentration of serum creatin phosphokinase is an indicator of the extent of injured muscule. The serum concentration of myoglobin is an indicator of the extent of injured muscule and the main cause of development of crush syndrome. In a prospective study the concentration of myoglobin and CPK was measured in 81 patients with injuries of lower extremities and pelvis as a part of severe trauma. The increase of CPK concentration above 1000 U/L was measured in all patients. The increase of CPK concentration above 2000 U/L was measured in 78 (96.3%) patients. The increase of myoglobin concentration of >700 mcg/L was measured in 19 (23.5%) patients. In the group of 19 patients with CPK concentration of >2000 U/L and myoglobin concentration of >700 mcg/L crush syndrome developed in 6 (7.4%) patients with oliguria (urin output <50 ml/h) and the increase of serum potassium, phosphate and creatinine concentrations. The decrease of CPK and myoglobin concentrations was achieved in 5 patients during 10-12 days and 1 patient with associated craniocrebral injury died. PMID:18283895

Poznanovi?, Marija Rakari?; Sulen, Nina

2007-01-01

291

Pathology Case Study: Abdominal Distention  

NSDL National Science Digital Library

This is a case study presented by the University of Pittsburgh Department of Pathology, which describes a 60-year-old woman who presented with a history of marked abdominal distention lasted for several months with associated progressive fatigue, progressive weight loss and fever. Visitors are given patient history along with gross and microscopic descriptions, including images, and are given the opportunity to diagnose the patient. A "Final Diagnosis" section provides a discussion of the findings as well as references. This is an excellent resource for students in the health sciences to familiarize themselves with using patient history and laboratory results to diagnose disease. It is also a helpful site for educators to use to introduce or test student learning in soft tissue pathology.

Rao, Uma N.; Sepulveda, Antonia; Yu, Hongbo

2009-03-18

292

Trauma management incorporating focused assessment with computed tomography in trauma (FACTT) - potential effect on survival  

PubMed Central

Background Immediate recognition of life-threatening conditions and injuries is the key to trauma management. To date, the impact of focused assessment with computed tomography in trauma (FACTT) has not been formally assessed. We aimed to find out whether the concept of using FACTT during primary trauma survey has a negative or positive effect on survival. Methods In a retrospective, multicentre study, we compared our time management and probability of survival (Ps) in major trauma patients who received FACTT during trauma resuscitation with the trauma registry of the German Trauma Society (DGU). FACTT is defined as whole-body computed tomography (WBCT) during primary trauma survey. We determined the probability of survival according to the Trauma and Injury Severity Score (TRISS), the Revised Injury Severity Classification score (RISC) and the standardized mortality ratio (SMR). Results We analysed 4.817 patients from the DGU database from 2002 until 2004, 160 (3.3%) were from our trauma centre at the Ludwig-Maximilians-University (LMU) and 4.657 (96.7%) from the DGU group. 73.2% were male with a mean age of 42.5 years, a mean ISS of 29.8. 96.2% had suffered from blunt trauma. Time from admission to FAST (focused assessment with sonography for trauma)(4.3 vs. 8.7 min), chest x-ray (8.1 vs. 16.0 min) and whole-body CT (20.7 vs. 36.6 min) was shorter at the LMU compared to the other trauma centres (p < 0.001). SMR calculated by TRISS was 0.74 (CI95% 0.40-1.08) for the LMU (p = 0.24) and 0.92 (CI95% 0.84-1.01) for the DGU group (p = 0.10). RISC methodology revealed a SMR of 0.69 (95%CI 0.47-0.92) for the LMU (p = 0.043) and 1.00 (95%CI 0.94-1.06) for the DGU group (p = 0.88). Conclusion Trauma management incorporating FACTT enhances a rapid response to life-threatening problems and enables a comprehensive assessment of the severity of each relevant injury. Due to its speed and accuracy, FACTT during primary trauma survey supports rapid decision-making and may increase survival. PMID:20459713

2010-01-01

293

Evaluating initial spine trauma response: injury time to trauma center in PA, USA.  

PubMed

Historical perceptions regarding the severity of traumatic spinal cord injury has led to considerable disparity in triage to tertiary care centers. This article retrospectively reviews a large regional trauma database to analyze whether the diagnosis of spinal trauma affected patient transfer timing and patterns. The Pennsylvania Trauma database was retrospectively reviewed. All acute trauma patient entries for level I and II centers were categorized for diagnosis, mechanism, and location of injury, analyzing transportation modality and its influence on time of arrival. A total of 1162 trauma patients were identified (1014 blunt injuries, 135 penetrating injuries and 12 other) with a mean transport time of 3.9 hours and a majority of patients arriving within 7 hours (>75%). Spine trauma patients had the longest mean arrival time (5.2 hours) compared to blunt trauma (4.2 hours), cranial neurologic injuries (4.35 hours), and penetrating injuries (2.13 hours, p<0.0001). There was a statistically significant correlation between earlier arrivals and both cranial trauma (p=0.0085) and penetrating trauma (p<0.0001). The fastest modality was a fire rescue (0.93 hours) or police (0.63 hours) vehicle with Philadelphia County (1.1 hour) having the quickest arrival times. Most trauma patients arrived to a specialty center within 7 hours of injury. However subsets analysis revealed that spine trauma patients had the greatest transit times. Present research trials for spinal cord injuries suggest earlier intervention may lead to improved recovery. Therefore, it is important to focus on improvement of the transportation triage system for traumatic spinal patients. PMID:24932590

Harrop, James S; Ghobrial, George M; Chitale, Rohan; Krespan, Kelly; Odorizzi, Laura; Fried, Tristan; Maltenfort, Mitchell; Cohen, Murray; Vaccaro, Alexander

2014-10-01

294

Pediatric blunt trauma resulting in major arterial injuries.  

PubMed

Ten children, aged 4 to 14 years, sustaining blunt arterial trauma from motor vehicle collisions (6), bicycle accidents (2), and falls (2) were identified over a 10-year period. The arteries injured included the common iliac (3), abdominal aorta (2), carotid (2), brachial (2), and the subclavian, renal, and femoral artery (1 each). One patient had three arterial injuries. Six patients had associated injuries including a pelvic and lumbar spine fracture, Horner's syndrome, liver laceration, skull fracture, open humerus fracture, small bowel serosal tear, and a brachial plexus injury. Definitive diagnosis was made using arteriography (6), computed tomography (CT) scan (2), and physical examination (2). The types of arterial injuries found included incomplete transection, complete transection with pseudo-aneurysm formation, traumatic arteriovenous (AV) fistulas, complete occlusion, and dissection. Repair was accomplished by hypogastric artery interposition or bypass grafting, synthetic grafting with polytetrafluoroethylene (PTFE), reverse saphenous vein grafting, or primary repair, depending on the circumstances. An AV fistula between the carotid artery and cavernous sinus was embolized. All grafts remained patent with exception of the aorto-renal bypass graft at follow-up ranging from 1 month to 3 years. The principles for repairing vascular injuries in children are slightly different than those in adults. Every effort should be made to use autogenous tissue such as the hypogastric artery or saphenous vein for repair if possible. If not, PTFE grafts can be used, although the long-term patency of these grafts in growing children is not known. PMID:15156954

Milas, Zvonimir L; Dodson, Thomas F; Ricketts, Richard R

2004-05-01

295

Jung Index  

NSDL National Science Digital Library

Compiled by Matthew Clapp of the University of Georgia, the Jung Index is a collection of more than 300 online resources about and related to the life and work of Carl Jung, the Swiss psychologist and psychiatrist who founded analytic psychology. Resources are indexed into ten major topic areas and include sections such as Research Resources, Jungian Psychology, and Psychoanalysis, among others. A What's New? section, a What's Cool? section, and the JungNet Newsletter keep frequent visitors up to date on the latest and greatest resources in analytic psychology. In addition, the site provides a glossary of Jungian terms, a gallery of Jungian images, and a moderated forum for Jungian discussion.

1999-01-01

296

Trauma Registration in a Dutch Trauma Population with Emphasis on Quality of Care  

Microsoft Academic Search

We prospectively evaluated the care of all acutely trauma patients admitted to the St. Elisabeth Hospital, Tilburg, The Netherlands, during 3 consecutive years (1996 through 1998). Data were compiled in a physician operating round the clock available electronic medical record. A total of 2849 patients were included (60% male). More than 95% suffered from a blunt trauma. Out of 2849

Wouter J. Vles; Frank Kroezen; J. Dik Meeuwis; Luke P. H. Leenen

2000-01-01

297

Relations among psychological trauma, dissociative phenomena, and trauma-related distress  

Microsoft Academic Search

Recently, there has been a resurgence of interest in relations among psychological trauma, dissociative phenomena, and various forms of trauma-related distress that has spawned a prolific amount of research. To date, a relatively comprehensive review of this recent research is lacking. Thus, this paper provides such a review to help summarize and synthesize recent findings, illuminate study limitations, and offer

Beth S Gershuny; Julian F Thayer

1999-01-01

298

The Aftermath of Road Trauma: Survivors' Perceptions of Trauma and Growth  

ERIC Educational Resources Information Center

For many survivors of serious road trauma, the physical and psychological consequences are complex and lifelong. The longer-term psychosocial recovery experience for survivors, however, is rarely documented in the social work literature. This article reports on findings from a study of road trauma recovery experiences. The findings are presented…

Harms, Louise; Talbot, Michelle

2007-01-01

299

Geochemistry Index  

NSDL National Science Digital Library

This site is the index of a book used in a geochemistry course taught by W. M. White at Cornell University. There are 15 chapters and a table of contents available. All of the chapters are large PDF files and take some time to download. Figures and exercises accompany the text.

William M. White

300

Emotional Reactions During and After Trauma: A Comparison of Trauma Types  

PubMed Central

Peri- and posttraumatic emotional responses have been understudied, and furthermore, have rarely been compared among trauma types. The current study compared college students’ retrospective self-reports of peri- and posttraumatic responses of fear, shame, guilt, anger, and sadness among four types of traumatic events: sexual assault, physical assault, transportation accident, and illness/injury. Overall emotional responding was generally high for all trauma types, and for those in the sexual assault group, emotion increased sharply from the peri- to posttraumatic time-point. Generally, fear was higher during the trauma compared to after the trauma, whereas the other emotions tended to remain stable or increase posttrauma. The sexual assault group tended to report higher levels of posttrauma emotion than the other trauma type groups. PMID:20046534

Amstadter, Ananda B.; Vernon, Laura L.

2009-01-01

301

Novel thermosensitive hydrogel for preventing formation of abdominal adhesions  

PubMed Central

Adhesions can form after almost any type of abdominal surgery. Postoperative adhesions can be prevented by improved surgical techniques, such as reducing surgical trauma, preventing ischemia, and avoiding exposure of the peritoneal cavity to foreign materials. Although improved surgical techniques can potentially reduce formation of adhesions, they cannot be eliminated completely. Therefore, finding more effective methods to prevent postoperative adhesions is imperative. Recently, we found that a novel thermosensitive hydrogel, ie, poly(?-caprolactone)-poly(ethylene glycol)-poly(?-caprolactone) (PCEC) had the potential to prevent postoperative adhesions. Using the ring-opening polymerization method we prepared a PCEC copolymer which could be dissolved and assembled at 55°C into PCEC micelles with mean size of 25 nm. At body temperature, a solution containing PCEC micelles could convert into a hydrogel. The PCEC copolymer was biodegradable and had low toxicity in vitro and in vivo. We found that most animals in a hydrogel-treated group (n = 10) did not develop adhesions. In contrast, 10 untreated animals developed adhesions that could only be separated by sharp dissection (P < 0.001). The hydrogel could adhere to peritoneal wounds and degraded gradually over 7–9 days, transforming into a viscous fuid that was completely absorbed within 12 days. The injured parietal and visceral peritoneum remesothelialized over about seven and nine days, respectively. This study confirms that PCEC hydrogel has potential application in the prevention of postoperative adhesions. PMID:23885172

Gao, Xiang; Deng, Xiaohui; Wei, Xiawei; Shi, Huashan; Wang, Fengtian; Ye, Tinghong; Shao, Bin; Nie, Wen; Li, Yuli; Luo, Min; Gong, Changyang; Huang, Ning

2013-01-01

302

Population Index  

NSDL National Science Digital Library

Two excellent bibliographic resources for population studies are the "Population Index" from the Office of Population Research at Princeton University, and "Population Organizations: Finder's Guide" from the Center for Demography and Ecology at the University of Wisconsin-Madison. "Population Index" is a quarterly publication that has been available since 1935. It "covers all fields of interest to demographers, including fertility, mortality, population size and growth, migration, nuptiality and the family, research methodology, projections and predictions, historical demography, and demographic and economic interrelations. Input is derived from original publications including monographs, journal articles, other serial publications, working papers, doctoral dissertations, machine-readable data files, and relevant acquisitions lists and bibliographies." About 3,500 citations are produced annually. Full text for the Index is available at the "Population Index" Web site for 1986-present (Vol. 52-present). Indexes can be searched by author, subject matter, geographical region, or publication year. There is now an experimental free text search capability for the 1994-present issues. "Population Organizations: Finder's Guide" is a no frills "practical tool for population professionals who need a single source for the quick location of organizations that publish and distribute or post population or family planning documents." It contains hundreds of citations, providing organization addresses, phone and FAX numbers, and Internet addresses when available. The Guide is updated every six months and is maintained by Ruth Sandor, Director of the Library of the Center for Demography and Ecology. Office of Population Research, Princeton University: http://opr.princeton.edu/ "Population Organizations: Finder's Guide": gopher://cde2.ssc.wisc.edu:70/00/addazlis gopher to: cde2.ssc.wisc.edu select: Population Organizations: Finder's Guide Center for Demography and Ecology, University of Wisconsin-Madison: http://www.ssc.wisc.edu/cde/

1986-01-01

303

Evaluating trauma center process performance in an integrated trauma system with registry data  

PubMed Central

Background: The evaluation of trauma center performance implies the use of indicators that evaluate clinical processes. Despite the availability of routinely collected clinical data in most trauma systems, quality improvement efforts are often limited to hospital-based audit of adverse patient outcomes. Objective: To identify and evaluate a series of process performance indicators (PPI) that can be calculated using routinely collected trauma registry data. Materials and Methods: PPI were identified using a review of published literature, trauma system documentation, and expert consensus. Data from the 59 trauma centers of the Quebec trauma system (1999, 2006; N = 99,444) were used to calculate estimates of conformity to each PPI for each trauma center. Outliers were identified by comparing each center to the global mean. PPI were evaluated in terms of discrimination (between-center variance), construct validity (correlation with designation level and patient volume), and forecasting (correlation over time). Results: Fifteen PPI were retained. Global proportions of conformity ranged between 6% for reduction of a major dislocation within 1 h and 97% for therapeutic laparotomy. Between-center variance was statistically significant for 13 PPI. Five PPI were significantly associated with designation level, 7 were associated with volume, and 11 were correlated over time. Conclusion: In our trauma system, results suggest that a series of 15 PPI supported by literature review or expert opinion can be calculated using routinely collected trauma registry data. We have provided evidence of their discrimination, construct validity, and forecasting properties. The between-center variance observed in this study highlights the importance of evaluating process performance in integrated trauma systems. PMID:23723617

Moore, Lynne; Lavoie, André; Sirois, Marie-Josée; Amini, Rachid; Belcaïd, Amina; Sampalis, John S

2013-01-01

304

Disaster preparedness of Canadian trauma centres: the perspective of medical directors of trauma  

PubMed Central

Background Owing to their constant readiness to treat injured patients, trauma centres are essential to regional responses to mass casualty incidents (MCIs). Reviews of recent MCIs suggest that trauma centre preparedness has frequently been limited. We set out to evaluate Canadian trauma centre preparedness and the extent of their integration into a regional response to MCIs. Methods We conducted a survey of Canadian level-1 trauma centres (n = 29) to characterize their existing disaster-response plans and to identify areas where pre-paredness could be improved. The survey was directed to the medical director of trauma at each centre. Descriptive statistics were used to analyze responses. Results Twenty-three (79%) trauma centres in 5 provinces responded. Whereas most (83%) reported the presence of a committee dedicated to disaster preparedness, only half of the medical directors of trauma were members of these committees. Almost half (43%) the institutions had not run any disaster drill in the previous 2 years. Only 70% of trauma centres used communications assets designed to function during MCIs. Additionally, more than half of the trauma directors (59%) did not know if their institutions had the ability to sustain operations for at least 72 hours during MCIs. Conclusion The results of this study suggest important opportunities to better prepare Canadian trauma centers to respond to an MCI. The main areas identified for potential improvement include the need for the standardization of MCI planning and response at a regional level and the implementation of strategies such as stockpiling of resources and novel communication strategies to avoid functional collapse during an MCI. PMID:21251427

Gomez, David; Haas, Barbara; Ahmed, Najma; Tien, Homer; Nathens, Avery

2011-01-01

305

Prevalence of abdominal obesity in Abia State, Nigeria: results of a population-based house-to-house survey  

PubMed Central

Background and objective Abdominal obesity is associated with the risk of developing disorders, such as diabetes and hypertension. The objective of this study was to investigate the prevalence of abdominal obesity in Abia State, Nigeria. Materials and methods We carried out a cross-sectional study aimed at ascertaining the prevalence of abdominal obesity in Abia State, Nigeria. Participants in the study were recruited from communities in the three senatorial zones in the state. Screening for abdominal obesity was carried out in these subjects using waist circumference (the National Cholesterol Education Program Third Adult Treatment Panel criteria were used). The World Health Organization Stepwise Approach to Surveillance of chronic disease risk factors was used. Body mass index, anthropometric measurements, and other relevant data were also collected. Results Data on waist circumference were obtained from 2,807 subjects. The prevalence of obesity using body mass index in the population was 11.12%. In men and women, it was 7.73%, and 14.37%, respectively. The prevalence of abdominal obesity in the population was 21.75%. In men and women, it was 3.2% and 39.2%, respectively. Conclusion The prevalence of abdominal obesity is high in Nigeria, and needs to be monitored because it is associated with increased cardiovascular risk. PMID:23946664

Ijezie, Innocent Chukwuonye; Chuku, Abali; Onyeonoro, Ugochukwu Uchenna; Okpechi, Ikechi Gareth; Madukwe, Okechukwu Ojoemelam; Umeizudike, Theophilus Ifeanyichukwu; Ogah, Okechukwu Samuel

2013-01-01

306

An experimental model of reproducible liver trauma.  

PubMed

The aim of the study was to create an experimental model of reproducible and controllable liver trauma in pigs. The few reported experimental models of liver trauma use the "clamp and crush" mechanism of injury and do not cause reproducible liver injury. In the present study, force was applied through the thoracic wall to mimic a chest injury. Nine pigs were used as experimental animals. In anaesthetised animals, blunt liver trauma was caused with a crossbow using an arrow with a spherical aluminium head as a projectile. Liver injuries of stages II to III according to liver injury scale were inflicted on all the animals. The stage of liver trauma was proportional to the pressure impulse (ratio between the product of the arrow's mass (m) and the velocity (v) and the contact surface area of the arrow (S)). The presented model of controllable liver injury will enable the study of various aspects of liver trauma since the experiment can be designed in such a way to produce a spectrum of liver injuries. PMID:15993882

Wahl, Milos; Gadzijev, Eldar M; Wahl, Jana; Ravnik, Dean; Pecar, Jani; Pleskovic, Alojz

2005-08-01

307

Effects of high-frequency current therapy on abdominal obesity in young women: a randomized controlled trial  

PubMed Central

[Purpose] The aim of this study was to determine the effects of high-frequency current therapy on the abdominal obesity levels of young women. [Subjects] Twenty-two women with abdominal obesity were randomly allocated to either an experimental group (n1 = 10) or a control group (n2 = 12). [Methods] The experimental group subjects received high-frequency current therapy for the abdominal region 3 times per week for 6 weeks (a total of 18 sessions). Outcome measures were waist circumference, body mass index, and body composition data (abdominal obesity rate, subcutaneous fat mass, and body fat percentage). [Results] Significant main effects of time in the waist circumference, abdominal obesity rate, subcutaneous fat mass, and body fat percentage were found. Significant time-by-group interactions were found for waist circumference, abdominal obesity rate, subcutaneous fat mass, and body fat percentage. [Conclusion] The use of the high-frequency current therapy may be beneficial for reducing the levels of abdominal obesity in young women.

Kim, Jin-seop; Oh, Duck-won

2015-01-01

308

[Abdominal aorta section caused by abdominal stab wound: discussion of two cases].  

PubMed

Abdominal vascular lesions are generally caused by accidents (most frequently car accidents, but also falling from an altitude, etc.) or by aggression with knives and fire arms. Abdominal vascular wounds, especially those involving the aorta, cause high mortality. Many patients die on the way to the hospital due to massive blood losses, their lesions being determined only through necropsy. Mortality is increased when abdominal vascular lesions are associated with abdominal or thoracic visceral lesions. We present two cases of partial sections of the abdominal aorta caused by stab wounds: a 16-year-old male aggressed by a school-mate and a 45-year-old male who aggressed himself. We discuss the necessity of immediate surgery on patients with abdominal stab wounds in order to determine the localization and gravity of the lesions. PMID:17615930

Chicos, S C; Beznea, A; Chebac, Gica Rumina

2007-01-01

309

The Tribolium homeotic gene Abdominal is homologous to abdominal-A of the Drosophila bithorax complex  

NASA Technical Reports Server (NTRS)

The Abdominal gene is a member of the single homeotic complex of the beetle, Tribolium castaneum. An integrated developmental genetic and molecular analysis shows that Abdominal is homologous to the abdominal-A gene of the bithorax complex of Drosophila. abdominal-A mutant embryos display strong homeotic transformations of the anterior abdomen (parasegments 7-9) to PS6, whereas developmental commitments in the posterior abdomen depend primarily on Abdominal-B. In beetle embryos lacking Abdominal function, parasegments throughout the abdomen are transformed to PS6. This observation demonstrates the general functional significance of parasegmental expression among insects and shows that the control of determinative decisions in the posterior abdomen by homeotic selector genes has undergone considerable evolutionary modification.

Stuart, J. J.; Brown, S. J.; Beeman, R. W.; Denell, R. E.; Spooner, B. S. (Principal Investigator)

1993-01-01

310

Religious moral beliefs inversely related to trauma experiences severity and depression severity among war veterans in Bosnia and Herzegovina.  

PubMed

The aim of this study is to determine the association of religious moral beliefs and depression severity of war veterans in Bosnia and Herzegovina. The sample consists of male war veterans who were inpatients with clinically presented depression and those who were observed as healthy, regarding results of previous psychological testing (n=65 both). The Bosnia-Herzegovina versions of Hopkins Symptom Checklist and Harvard Trauma Questionnaire with questionnaire for religious moral beliefs were applied. The religious moral belief index was inversely correlated to depression severity. The religious moral beliefs may help protection of the war veterans' mental health stability after surviving multiple war traumas. PMID:22941062

Hasanovi?, Mevludin; Pajevi?, Izet

2013-09-01

311

Trauma-related papular granuloma annular.  

PubMed

Granuloma annulare (GA) is a benign, granulomatous disease with several clinical manifestations, which include localized, generalized, perforating, subcutaneous, patch, papular, and linear forms. We report a case of papular GA of the dorsal aspects of the hands that arose after repeated, direct trauma to the site of subsequent involvement. Although multiple etiologies for GA have been proposed, which include ultraviolet light, arthropod bites, trauma, tuberculin skin tests, viral infections, and PUVA photochemotherapy, the underlying pathogenesis of the disorder remains unclear. However, owing to the key histopathologic findings of focal collagen and elastic fiber degeneration and mucin deosition in GA, it is not surprising that cutaneous trauma may have played a role in connective tissue injury, subsequent degeneration, and the production of a granulomatous response with increased mucin deposition. PMID:24365010

Hu, Stephanie W; Kaplan, Jennifer; Patel, Rishi R; Kamino, Hideko

2013-12-01

312

Emotional intelligence--essential for trauma nursing.  

PubMed

Patients and their relatives are increasingly considered partners in health and social care decision-making. Numerous political drivers in the UK reflect a commitment to this partnership and to improving the experience of patients and relatives in emergency care environments. As a Lecturer/Practitioner in Emergency Care I recently experienced the London Trauma System as a relative. My dual perspective, as nurse and relative, allowed me to identify a gap in the quality of care akin to emotional intelligence. This paper aims to raise awareness of emotional intelligence (EI), highlight its importance in trauma care and contribute to the development of this concept in trauma nursing and education across the globe. PMID:25438713

Holbery, Natalie

2015-01-01

313

Combined tracheoesophageal transection after blunt neck trauma  

PubMed Central

Survival following tracheoesophageal transection is uncommon. Establishing a secure airway has the highest priority in trauma management. Understanding the mechanism of the incident can be a useful adjunct in predicting the likelihood and severity of specific anatomical patterns of injuries. We discuss published literature on combined tracheoesophageal injuries after blunt neck trauma and their outcome. A search of MEDLINE for papers published regarding tracheoesophageal injury was made. The literature search identified 14 such articles referring to a total of 27 patients. Age ranged from 3-73 years. The mechanism of injury was secondary to a rope/wire in 33%, metal bar in 4% of cases and unspecified in 63%. All of the patients were managed surgically. A number of tissues were used to protect the anastomosis including pleural and sternocleidomastoid muscle flaps. There were no reported mortalities. Patients with combined tracheoesophageal injury after blunt neck trauma require acute management of airway along with concomitant occult injuries. PMID:23723621

Hamid, Umar Imran; Jones, James Mark

2013-01-01

314

Combined tracheoesophageal transection after blunt neck trauma.  

PubMed

Survival following tracheoesophageal transection is uncommon. Establishing a secure airway has the highest priority in trauma management. Understanding the mechanism of the incident can be a useful adjunct in predicting the likelihood and severity of specific anatomical patterns of injuries. We discuss published literature on combined tracheoesophageal injuries after blunt neck trauma and their outcome. A search of MEDLINE for papers published regarding tracheoesophageal injury was made. The literature search identified 14 such articles referring to a total of 27 patients. Age ranged from 3-73 years. The mechanism of injury was secondary to a rope/wire in 33%, metal bar in 4% of cases and unspecified in 63%. All of the patients were managed surgically. A number of tissues were used to protect the anastomosis including pleural and sternocleidomastoid muscle flaps. There were no reported mortalities. Patients with combined tracheoesophageal injury after blunt neck trauma require acute management of airway along with concomitant occult injuries. PMID:23723621

Hamid, Umar Imran; Jones, James Mark

2013-04-01

315

Genetics Home Reference: Abdominal wall defect  

MedlinePLUS

... and Families Resources for Health Professionals What glossary definitions help with understanding abdominal wall defect? acids ; atresia ; ... sporadic ; stomach ; syndrome ; tissue ; trisomy You may find definitions for these and many other terms in the ...

316

Primary abdominal ectopic pregnancy: a case report  

PubMed Central

Introduction We present a case of a 13-week abdominal pregnancy evaluated with ultrasound and magnetic resonance imaging. Case presentation A 34-year-old woman, (gravida 2, para 1) suffering from lower abdominal pain and slight vaginal bleeding was transferred to our hospital. A transabdominal ultrasound and magnetic resonance imaging were performed. The diagnosis of primary abdominal pregnancy was confirmed according to Studdiford’s criteria. A laparatomy was carried out. The placenta was attached to the mesentery of sigmoid colon and to the left abdominal sidewall. The placenta was dissected away completely and safely. No postoperative complications were observed. Conclusion Ultrasound examination is the usual diagnostic procedure of choice. In addition magnetic resonance imaging can be useful to show the localization of the placenta preoperatively. PMID:19918376

Kolusari, Ali; Adali, Fulya; Adali, Ertan; Kurdoglu, Mertihan; Ozgokce, Cagdas; Cim, Numan

2009-01-01

317

Outcomes after severe trauma at a northern Canadian regional trauma centre  

PubMed Central

Objective To evaluate outcomes of trauma patients at a northern community trauma referral centre that does not meet several of the guidelines for a trauma centre. Design A retrospective study. Setting Sudbury General Hospital in northern Ontario. Participants All trauma patients admitted between 1991 and 1994 who had an Injury Severity Score (ISS) greater than 12. Outcome measures Actual survival to discharge was compared to survival predicted by TRISS analysis. Z, W and M scores were calculated by standard TRISS techniques. Results Of 526 patients with an ISS greater than 12, 416 (79%) were suitable for TRISS analysis. Of these 416 patients, 310 (74%) were men. The mean age was 39 years. Two hundred and sixty-one (63%) patients were admitted directly to the Sudbury General Hospital, whereas 155 (37%) were transferred from other hospitals. The leading causes of injury were motor vehicle–traffic accidents in 48%, motor vehicle–nontraffic in 21% and falls in 8%. Overall, there were more unexpected survivors than patients who died. The Z score for survivors was 4.95, and the W score was 5.66. Conclusions In the setting of a geographically isolated, medium-volume trauma centre where blunt injuries predominate, excellent trauma survival can be achieved without meeting all trauma centre guidelines for staffing and facilities. Relaxing stringent requirements for the availability of physicians may facilitate surgical recruitment and retention. PMID:9492748

Allen, David M.; Hicks, Glenda; Bota, Gary W.

1998-01-01

318

Giant Subcutaneous Leiomyosarcoma of Anterior Abdominal Wall  

PubMed Central

Subcutaneous leiomyosarcomas are rare tumors accounting for 1% to 2% of all superficial soft tissue malignancies. Although they may arise anywhere in the body, they most frequently occur in the lower extremities. The incidence of subcutaneous LMS affecting the anterior abdominal wall is very rare. We herein report the case of a patient with a giant subcutaneous leiomyosarcoma arising in the anterior abdominal wall. It was diagnosed by histopathology and immunohistochemistry and treated accordingly. PMID:25506027

2014-01-01

319

Abdominal Pathology in Patients With Diabetes Ketoacidosis.  

PubMed

INTRODUCTION: The objective is to describe the incidence and nature of significant abdominal pathologies in patients with diabetes ketoacidosis (DKA) and abdominal pain. METHODS: Retrospective chart review (N = 86) of patients with DKA from January 1, 2005, to January 31, 2010, was performed. Data included demographics, comorbidities, compliance, chief complaints and physical findings, blood count, metabolic profile, lactic acid, glycosylated hemoglobin (HbA1C), amylase, lipase, anion gap, arterial gases, imaging and final diagnosis. Continuous variables were described as mean ± standard deviation and compared with the Student's t test. Categorical variables were expressed as percentages (%) and compared with the Mantel-Haenszel ? test. Univariate analysis was conducted among patients with and without significant abdominal pain and also with and without significant abdominal pathology. Two lipase strata were created at 400 U. Multivariate model to identify limits (confidence interval) of the estimated risk imposed by the predictor found significant in univariate analysis. A P value of ?0.05 was considered significant. Stat View 5.0 (SAS Institute, Cary, NC) was used for the statistical analysis. RESULTS: In patients with abdominal pain, 17% had significant abdominal pathology mainly acute pancreatitis (AP). Serum amylase and lipase level were found to be an indicator of significant underlying pathology (both P values ?0.001). The logistic model created showed that patients with lipase level ?400 U have a 7% increased risk of having AP with confidence interval of 0.01 to 0.6. CONCLUSIONS: Patients with DKA and abdominal pain with lipase >400 U have an increased risk of significant underlying abdominal pathology (AP). PMID:22270401

Pant, Nicole; Kadaria, Dipen; Murillo, Luis C; Yataco, Jose C; Headley, Arthur S; Freire, Amado X

2012-01-20

320

Exposure to trauma-relevant pictures is associated with tachycardia in victims who had experienced an intense peritraumatic defensive response: the tonic immobility  

PubMed Central

Tonic immobility is an involuntary, last-ditch defensive reaction characterized by physical inactivity in a context of inescapable threat that has been described in many species, including humans. The occurrence of this defensive response is a predictor of the severity of psychiatric disorders and may be considered as an index of an intense reaction to a traumatic event. Here, we investigated whether the retrospective reports of peritraumatic tonic immobility reaction in participants exposed to a traumatic event would modify their cardiac responses to pictures related to their trauma. Using a questionnaire of life-threating events, we selected students who experienced violent crime as their most intense trauma and students who had never experienced a violent crime trauma, but experienced other traumatic events. All participants completed a questionnaire that estimated the intensity of tonic immobility during their most intense trauma. Electrocardiographic recordings were collected during exposure to pictures. Participants viewed emotional pictures (human attack with guns) and neutral pictures. These emotional stimuli were selected to be trauma-relevant to the violent crime group and non trauma-relevant to the no violent crime trauma group. Violent crime group showed a positive correlation between heart rate changes after viewing trauma-related pictures and tonic immobility scores. We observed that low tonic immobility scores were associated with bradycardia and high scores with tachycardia in response to trauma-relevant pictures. For the no violent crime group, no significant correlation was detected. These results suggest that the relevance of the stimuli and the magnitude of the defensive response during a previous trauma event were important factors triggering more intense defensive responses. PMID:25566169

Alves, Rita de Cassia S.; Portugal, Liana C. L.; Fernandes Jr, Orlando; Mocaiber, Izabela; Souza, Gabriela G. L.; David, Isabel de Paula A.; Volchan, Eliane; de Oliveira, Leticia; Pereira, Mirtes G.

2014-01-01

321

Computed tomography-guided preoperative localization of abdominal wall endometrioma.  

PubMed

A multiparous obese patient with prior abdominal surgeries complained of cyclic abdominal pain located near the surgical scar. A 1 cm lesion was identified on imaging. Computed tomography-guided needle localization was performed immediately before surgery. This allowed for complete excision of the abdominal wall endometrioma and resolution of the cyclic, focal abdominal pain. PMID:25218124

Moulder, Janelle K; Hobbs, Kumari A; Stavas, Joseph; Siedhoff, Matthew T

2015-02-01

322

Anorectal avulsion: an exceptional rectal trauma.  

PubMed

Anorectal avulsion is an exceptional rectal trauma in which the anus and sphincter no longer join the perineum and are pulled upward. As a result, they ventrally follow levator ani muscles. We present a rare case of a 29-years old patient who was admitted in a pelvic trauma context; presenting a complete complex anorectal avulsion. The treatment included a primary repair of the rectum and a diverting colostomy so as to prevent sepsis. Closure of the protective sigmoidostomy was performed seven months after the accident and the evolution was marked by an anal stenosis requiring iterative dilatations. PMID:24094142

Ibn Majdoub Hassani, Karim; Ait Laalim, Said; Benjelloun, El Bachir; Toughrai, Imane; Mazaz, Khalid

2013-01-01

323

Myocardial Ischemia with Penetrating Thoracic Trauma  

PubMed Central

Penetrating trauma is a rare cause of myocardial infarction. Our report describes a 47-year-old female who presented with a gunshot wound from a shotgun and had an ST-elevation myocardial infarction. The patient received emergent coronary angiography, which demonstrated no evidence of coronary atherosclerotic disease but did show occlusion of a marginal vessel secondary to a pellet. The patient was managed medically for the myocardial infarction without cardiac sequelae. Patients with penetrating trauma to the chest should be evaluated for myocardial ischemia. Electrocardiography, echocardiography and cardiac angiography play vital roles in evaluating these patients and helping to guide management. PMID:21691532

Elms, Andrew R.; Wong, Garret; Wisner, David; Bair, Aaron

2011-01-01

324

Anorectal avulsion: an exceptional rectal trauma  

PubMed Central

Anorectal avulsion is an exceptional rectal trauma in which the anus and sphincter no longer join the perineum and are pulled upward. As a result, they ventrally follow levator ani muscles. We present a rare case of a 29-years old patient who was admitted in a pelvic trauma context; presenting a complete complex anorectal avulsion. The treatment included a primary repair of the rectum and a diverting colostomy so as to prevent sepsis. Closure of the protective sigmoidostomy was performed seven months after the accident and the evolution was marked by an anal stenosis requiring iterative dilatations. PMID:24094142

2013-01-01

325

Submental Intubation in Maxillofacial Trauma Patients  

PubMed Central

Introduction: To describe a modified technique for submental intubation in severely traumatized maxillofacial patients and to evaluate complications arising from the procedure. Materials and Methods: Submental intubation was performed in twelve patients with maxillofacial trauma ,from 2007-2012, which were operated under general anesthesia for treatment of facial fractures. Results: The patients ranged in age from 14 to 39 years. No complications due to submental intubation, such as infection, hypertrophic scarring, lingual nerve injury, hematoma, bleeding, ranula formation, or orocutaneous fistula, were observed following submental intubation. Conclusion: Submental intubation is a very useful technique in the management of maxillofacial trauma patients, with a low complication rate. PMID:24303414

Rahpeyma, Amin; khajeh Ahmadi, Saeedeh

2013-01-01

326

Assessment of maxillofacial trauma in emergency department  

PubMed Central

Introduction The incidence and epidemiological causes of maxillofacial (MF) trauma varies widely. The objective of this study is to point out maxillofacial trauma patients’ epidemiological properties and trauma patterns with simultaneous injuries in different areas of the body that may help emergency physicians to deliver more accurate diagnosis and decisions. Methods In this study we analyze etiology and pattern of MF trauma and coexisting injuries if any, in patients whose maxillofacial CT scans was obtained in a three year period, retrospectively. Results 754 patients included in the study consisting of 73.7% male and 26.3% female, and the male-to-female ratio was 2.8:1. Mean age was 40.3?±?17.2 years with a range of 18 to 97. 57.4% of the patients were between the ages of 18–39 years and predominantly male. Above 60 years of age, referrals were mostly woman. The most common cause of injuries were violence, accounting for 39.7% of the sample, followed by falls 27.9% and road traffic accidents 27.2%. The primary cause of injuries were violence between ages 20 and 49 and falls after 50. Bone fractures found in 56,0% of individuals. Of the total of 701 fractured bones in 422 patients the most frequent was maxillary bone 28,0% followed by nasal bone 25,3%, zygoma 20,2%, mandible 8,4%, frontal bone 8,1% and nasoethmoidoorbital bone 3,1%. Fractures to maxillary bone were uppermost in each age group. 8, 9% of the patients had brain injury and only frontal fractures is significantly associated to TBI (p?trauma patients was violence (47, 8%). 158 of the 754 patients had consumed alcohol before trauma. No statistically significant data were revealed between alcohol consumption gender and presence of fracture. Violence is statistically significant (p?traumas yield various etiologic factors, demographic properties and fracture patterns probably due to social, cultural and governmental differences. Young males subjected to maxillofacial trauma more commonly as a result of interpersonal violence. PMID:24484727

2014-01-01

327

Left ventricular thrombosis after blunt chest trauma.  

PubMed

A 22-year-old man was admitted to our observation with left ventricular thrombus arising after blunt chest trauma occurring during a ski accident one year before. None was obtained from a review of instrumental and laboratory data at trauma time. Transesophageal echocardiography showed an intraventricular thrombus and severe hypokinesia at the apex. Standard cardiac surgery procedure was performed and postoperative period was uneventful. Echocardiography controls at 6/12 months showed a normal apex kinesia. This case shows the importance of hospitalization, hemodynamics monitorization and late serial echocardiographic controls for timely diagnosis and management of myocardial contusion and consecutive ventricular thrombus formation to prevent life-threatening complications. PMID:11292936

Ruvolo, G; Fattouch, K; Speziale, G; Macrina, F; Tonelli, E; Marino, B

2001-04-01

328

Mechanisms and management of functional abdominal pain.  

PubMed

Functional abdominal pain syndrome is characterised by frequent or continuous abdominal pain associated with a degree of loss of daily activity. It has a reported population prevalence of between 0.5% and 1.7%, with a female preponderance. The pathophysiology of functional abdominal pain is incompletely understood although it has been postulated that peripheral sensitisation of visceral afferents, central sensitisation of the spinal dorsal horn and aberrancies within descending modulatory systems may have an important role. The management of patients with functional abdominal pain requires a tailored multidisciplinary approach in a supportive and empathetic environment in order to develop an effective therapeutic relationship. Patient education directed towards an explanation of the pathophysiology of functional abdominal pain is in our opinion a prerequisite step and provides the rationale for the introduction of interventions. Interventions can usefully be categorised into general measures, pharmacotherapy, psychological interventions and 'step-up' treatments. Pharmacotherapeutic/step-up options include tricyclic antidepressants, serotonin noradrenergic reuptake inhibitors and the gabapentinoids. Psychological treatments include cognitive behavioural therapy and hypnotherapy. However, the objective evidence base for these interventions is largely derived from other chronic pain syndrome, and further research is warranted in adult patients with functional abdominal pain. PMID:25193056

Farmer, Adam D; Aziz, Qasim

2014-09-01

329

Trauma Exposure and Retention in Adolescent Substance Abuse Treatment  

Microsoft Academic Search

Trauma exposure and related symptoms interfere with adult adherence to drug treatment. Whether these findings hold true for adolescents is unknown. We examined trauma exposure, PTSD symptoms, and psychosocial functioning among 212 adolescents upon admission to long-term residential drug treatment and examined retention in treatment at 6 months. Seventy-one percent reported lifetime trauma exposure, and 29% of the trauma-exposed met

Lisa H. Jaycox; Patricia Ebener; Leslie Damesek; Kirsten Becker

2004-01-01

330

Genes and Abdominal Aortic Aneurysm  

PubMed Central

Abdominal aortic aneurysm (AAA) is a multifactorial disease with a strong genetic component. Since first candidate gene studies were published 20 years ago, nearly 100 genetic association studies using single nucleotide polymorphisms (SNPs) in biologically relevant genes have been reported on AAA. The studies investigated SNPs in genes of the extracellular matrix, the cardiovascular system, the immune system, and signaling pathways. Very few studies were large enough to draw firm conclusions and very few results could be replicated in another sample set. The more recent unbiased approaches are family-based DNA linkage studies and genome-wide genetic association studies, which have the potential of identifying the genetic basis for AAA, if appropriately powered and well-characterized large AAA cohorts are used. SNPs associated with AAA have already been identified in these large multicenter studies. One significant association was of a variant in a gene called CNTN3 which is located on chromosome 3p12.3. Two follow-up studies, however, could not replicate the association. Two other SNPs, which are located on chromosome 9p21 and 9q33 were replicated in other samples. The two genes with the strongest supporting evidence of contribution to the genetic risk for AAA are the CDKN2BAS gene, also known as ANRIL, which encodes an antisense RNA that regulates expression of the cyclin-dependent kinase inhibitors CDKN2A and CDKN2B, and DAB2IP, which encodes an inhibitor of cell growth and survival. Functional studies are now needed to establish the mechanisms by which these genes contribute to AAA pathogenesis. PMID:21146954

Hinterseher, Irene; Tromp, Gerard; Kuivaniemi, Helena

2010-01-01

331

Cumulative Index  

E-print Network

CUMULATIVE INDEX I. Articles (i) By Author Abate, Charles J. "Has Dretske Really Refuted Skepticism?", v.4, n.3 (June, 1977), pp. 169- 175. Abugattas, Juan A. "On the Relation Between Morality and the Notion of God". v.7, n.l (November, 1979...), pp. 47-81. Algeo, Donald. "Why Art?", v.7, n.2 (Spring, 1980), pp. 105-129. Austin, James W. "Rorty's Materialism", v.3, n.l (November, 1975), pp. 20-28. Bell, Gary. "A Characterization of Mathematics". v.8, n.2 (Summer, 1981), pp. 96-104. Bell...

1981-12-01

332

Early results on the use of biomaterials as adjuvant to abdominal wall closure following cytoreduction and hyperthermic intraperitoneal chemotherapy  

PubMed Central

Background Hyperthermic chemotherapy applies thermal energy to both abdominal wall as well as the intra-abdominal viscera. The combination of the hyperthemia, chemotherapy and cytoreductive surgery (CRS) is associated with a defined risk of abdominal wall and intestinal morbidity reported to be as high as 15%, respectively to date, no studies have evaluated the use of biomaterial mesh as adjuvant to abdominal wall closure in this group of patients. In the present report, we hypothesized that post HIPEC closure with a biomaterial can reduce abdominal wall morbidity after CRS and hyperthermic intraperitoneal chemotherapy. Materials and methods All patients treated with HIPEC in a tertiary care center over 12 months (2008-2009) period were included. Eight patients received cytoreductive surgery followed by HIPEC for 90 minutes using Mitomycin C (15 mg q 45 minutes × 2). Abdominal wall closure was performed using Surgisis (Cook Biotech.) mesh in an underlay position with 3 cm fascial overlap-closure. Operative time, hospital length of stay (LOS) as well as postoperative outcome with special attention to abdominal wall and bowel morbidity were assessed. Results Eight patients, mean age 59.7 ys (36-80) were treated according to the above protocol. The primary pathology was appendiceal mucinous adenocarcinoma (n = 3) colorectal cancer (n = 3), and ovarian cancer (n = 2). Four patients (50%) presented initially with abdominal wall morbidity including incisional ventral hernia (n = 3) and excessive abdominal wall metastatic implants (n = 1). The mean peritoneal cancer index (PCI) was 8.75. Twenty eight CRS were performed (3.5 CRS/patient). The mean operating time was 6 hours. Seven patients had no abdominal wall or bowel morbidity, the mean LOS for these patients was 8 days. During the follow up period (mean 6.3 months), one patient required exploratory laparotomy 2 weeks after surgery and subsequently developed an incisional hernia and enterocutaneous fistula. Conclusion The use of biomaterial mesh in concert with HIPEC enables the repair of concomitant abdominal wall hernia and facilitates abdominal wall closure following the liberal resection of abdominal wall tumors. Biomaterial mesh prevents evisceration on repeat laparotomy and resists infection in immunocompromised patients even when associated with bowel resection. PMID:20727181

2010-01-01

333

Ruptured abdominal aortic aneurysm diagnosed through non-contrast MRI  

PubMed Central

Rupture of an aneurysm is a rare complication although it is considered a common cause of death. Some of these patients present with the classic triad of symptoms such as abdominal pain, pulsatile abdominal mass and shock. Most symptoms are misleading and will only present as vague abdominal pain. Here we describe one such patient with an unusual presentation of a misleading abdominal mass which was eventually diagnosed as a ruptured abdominal aortic aneurysm after an emergency MRI. PMID:25003065

Chatra, Priyank S

2013-01-01

334

In vivo strain assessment of the abdominal aortic aneurysm.  

PubMed

The only criteria currently used to inform surgical decision for abdominal aortic aneurysms are maximum diameter (>5.5cm) and rate of growth, even though several studies have identified the need for more specific indicators of risk. Patient-specific biomechanical variables likely to affect rupture risk would be a valuable addition to the science of understanding rupture risk and prove to be a life saving benefit for patients. Local deformability of the aorta is related to the local mechanical properties of the wall and may provide indication on the state of weakening of the wall tissue. We propose a 3D image-based approach to compute aortic wall strain maps in vivo. The method is applicable to a variety of imaging modalities that provide sequential images at different phases in the cardiac cycle. We applied the method to a series of abdominal aneurysms imaged using cine-MRI obtaining strain maps at different phases in the cardiac cycle. These maps could be used to evaluate the distensibility of an aneurysm at baseline and at different follow-up times and provide an additional index to clinicians to facilitate decisions on the best course of action for a specific patient. PMID:25497379

Satriano, Alessandro; Rivolo, Simone; Martufi, Giampaolo; Finol, Ender A; Di Martino, Elena S

2015-01-21

335

The Role of Childhood Interpersonal Trauma in Depersonalization Disorder  

Microsoft Academic Search

Objective: In contrast to trauma's rela- tionship with the other dissociative disor- ders, the relationship of trauma to deper- sonalization disorder is unknown. The purpose of this study was to systemati- cally investigate the role of childhood in- terpersonal trauma in depersonalization disorder. Method: Forty-nine subjects with DSM-IV depersonalization disorder and 26 healthy comparison subjects who were free of life-

Daphne Simeon; Orna Guralnik; D. James Schmeidler; D. Beth Sirof; M. A. Margaret Knutelska

2001-01-01

336

Autobiographical memory for trauma: Update on four controversies  

Microsoft Academic Search

Empirical research since the year 2000 on trauma and autobiographical memory in adults is reviewed and related to four enduring controversies in the field: Whether traumatic memories are inherently different from other types of autobiographical memory; whether memory for trauma is better or worse than memory for non-traumatic events; whether traumas can be forgotten and then recalled later in life;

Chris R. Brewin

2007-01-01

337

Understanding Attrition in Sexuai Assauit: Do Trauma Memory and  

E-print Network

Paper (a joint project with the Maddox (2008) study, "The Role of Shame, Self-Blame and PTSD in Trauma Memory 35 Summary: Trauma Memory Formation and Retrieval 36 PTSD 37 Re-experiencing Symptoms 38 Prevalence of PTSD 39 Risk Factors 40 Theories of PTSD 41 Summary: PTSD 44 How may Trauma Memory and Post

Jones, Peter JS

338

Cardiac TraumaDiagnosis, Management, and Current Therapy  

Microsoft Academic Search

In cardiac trauma the two main mechanisms of injury are blunt and penetrating trauma. Common cardiac effects of trauma include myocardial rupture, contusion, laceration, pericardial insult, coronary injury, valvular damage, arrhythmias, and conduction abnor malities. Hemodynamic instability can develop rapidly and pose marked risk to patient survival. An adequate level of clinical awareness and timely use of diagnostic techniques such

Mary R. Olsovsky; Andrew S. Wechsler; On Topaz

1997-01-01

339

Trauma-Sensitive Yoga: Principles, Practice, and Research  

Microsoft Academic Search

Since 2003, the Trauma Center Yoga Program at the Justice Resource Institute in Brookline Massachusetts has been providing Yoga to a variety of trauma survivors, including war veterans, rape survivors, at-risk youth, and survivors of chronic childhood abuse and neglect. Pilot study results have demonstrated the benefits of Yoga for indi - viduals suffering from post-traumatic stress disorder. The Trauma

David Emerson; Ritu Sharma; Serena Chaudhry; Jenn Turner

340

Grief and Trauma Group Therapy for Children After Hurricane Katrina  

Microsoft Academic Search

Theoretical and evidence-based group therapy models that address the interplay of grief and trauma are needed for children postdisaster. This article describes a theoretically informed 10-week grief and trauma group model that was evaluated with children in schools after Hurricane Katrina. The foundation of the grief and trauma intervention includes utilizing developmentally specific methods, an ecological perspective, and culturally relevant

Alison Salloum; Laura W. Garside; C. Louis Irwin; Adrian D. Anderson; Anita H. Francois

2009-01-01

341

Strategies for Reducing Secondary or Vicarious Trauma: Do They Work?  

Microsoft Academic Search

Thiscross-sectional design study sought to assess whether therapists believed and engaged in commonly recommended forms of prevention for secondary and vicarious trauma and whether engaging in these activities resulted in lower levels of distress. In this study of 259 therapists, time spent with counseling trauma victims was the best predictor of trauma scores. Although participants generally believed in the usefulness

Ted Bober; Cheryl Regehr

2006-01-01

342

Role of Appraisals in Expressed Anger after Trauma  

ERIC Educational Resources Information Center

Anger is a common problem in trauma-exposed individuals. This study investigated factors that contribute to post-traumatic anger in civilian trauma survivors. Fifty-one trauma-exposed individuals were assessed for expressed anger, post-traumatic stress disorder (PTSD), daily hassles, maladaptive cognitions and blame. PTSD and non-PTSD participants…

Whiting, Diane; Bryant, Richard A.

2007-01-01

343

Trauma, Binge Eating, and the "Strong Black Woman"  

ERIC Educational Resources Information Center

Objective: The primary goal of this study was to test a culturally specific model of binge eating in African American female trauma survivors, investigating potential mechanisms through which trauma exposure and distress were related to binge eating symptomatology. Method: Participants were 179 African American female trauma survivors who…

Harrington, Ellen F.; Crowther, Janis H.; Shipherd, Jillian C.

2010-01-01

344

Social worker trauma: Building resilience in child protection social workers  

Microsoft Academic Search

Child protection social workers can experience psychological trauma effects as a result of their work. This article considers the utility of the trauma perspective in understanding and intervening when overwhelming events impact social workers. Psychological trauma theory enhances earlier contributions of the stress and burnout literatures in the effort to increase the efficacy and well?being of child protection staff. Resilience

Mark Horwitz

1998-01-01

345

Is it possible to derive a reliable estimate of human visceral and subcutaneous abdominal adipose tissue from simple anthropometric measurements?  

Microsoft Academic Search

The aim of the study was to generate equations predicting visceral (VAT) and subcutaneous (SAT) abdominal adipose tissue (AT) from simple anthropometric measurements. Magnetic resonance imaging (MRI) was used to measure VAT and SAT cross-sectional areas at the level of L4 in 49 subjects (19 men and 30 women) with a large range of age and body mass index (BMI).

Enzo Bonora; Rocco Micciolo; Abraham A. Ghiatas; Jack L. Lancaster; Abdalmajed Alyassin; Michele Muggeo; Ralph A. Defronzo

1995-01-01

346

The prediction of abdominal visceral fat level from body composition and anthropometry: ROC analysis  

Microsoft Academic Search

OBJECTIVE: To evaluate the merit of body mass index (BMI), % body fat, waist circumference and waist-to-hip ratio as predictors of abdominal visceral fat (AVF) level.DESIGN: Cross-sectional measurements obtained from 458 female and 331 male subjects of French Canadian descent with an age range from 18–72 y.MEASUREMENTS: AVF level was assessed by computed tomography. BMI was calculated as weight (in

T Rankinen; S-Y Kim; L Pérusse; J-P Després; C Bouchard; C Bouchard

1999-01-01

347

Trauma-informed cognitive remediation group therapy.  

PubMed

This brief report presents the rationale for the importance of integrating trauma therapy with cognitive remediation in order to enhance both component interventions in the treatment of serious mental illness. It describes a general format that allows the above integration and suggests that future studies should investigate the efficacy of the proposed group design. PMID:24911229

Spei, Ekaterini; Muenzenmaier, Kristina; Conan, Mara; Battaglia, Joseph

2014-07-01

348

Cognitive Behavioral Intervention for Trauma in Schools  

ERIC Educational Resources Information Center

Developed out a community participatory research partnership with schools, the Cognitive-Behavioral Intervention for Trauma in Schools Program is a targeted intervention for school children who have experienced a traumatic or violent event and have symptoms of posttraumatic stress disorder. This article describes the original development of the…

Jaycox, Lisa H.; Kataoka, Sheryl H.; Stein, Bradley D.; Langley, Audra K.; Wong, Marleen

2012-01-01

349

Do topical antibiotics help corneal epithelial trauma?  

PubMed Central

Topical antibiotics are routinely used in emergency rooms to treat corneal trauma, although no published evidence supports this treatment. In a noncomparative clinical trial, 351 patients with corneal epithelial injuries were treated without antibiotics. The infection rate was 0.7%, suggesting that such injuries can be safely and effectively managed without antibiotics. A comparative clinical trial is neither warranted nor feasible. PMID:8268742

King, J. W.; Brison, R. J.

1993-01-01

350

Training nurses and technologists for trauma surgery.  

PubMed

Getting assigned to a trauma for the first time is still stressful for perioperative staff members. However, viewing the video/DVD does seem to help overcome some of the inherent anxiety. In addition, encouraging new or inexperienced staff nurses and technologists to participate on trauma cases with more seasoned staff also seems to alleviate some of those fears. Saying "let's make believe it's an emergency" and setting up quickly for a scheduled case will keep those skills current. Having staff members utilize "what if" scenarios tends to keep them thinking and anticipating. Prioritizing and reviewing all the case actions will allow nurses and technologists to perform these actions/skills in an emergency without even thinking. Although specific internal injuries a trauma patient will have cannot always be predicted, the perioperative staff members must still use their basic training to be ready for anything that comes through the doors to surgery. Making a video seemed like an overwhelming task at first, but the team sought out guidance and support from appropriate resources (videographer, surgeons, etc) in order to collaborate effectively, and the result was a great educational product. The Staff Development team continues to present inservices that are specialty or case specific. The "trauma" aspect of these presentations is also always included to reinforce the topics that were brought out in the video. PMID:17263102

Ross, Cynthia

2006-01-01

351

Biomedical Techniques for Post Head Trauma Victims.  

ERIC Educational Resources Information Center

The nature and effects of head trauma are discussed. Among the most common deficits noted are impaired cognition, difficulties in oral and written communication, sensory problems, and marked personality changes. Suggestions are offered for dealing with each type of deficit, such as using alarm clocks and other tools to remind the individual about…

Doney, Judith V.

352

Spiritual Challenges to Children Facing Violent Trauma.  

ERIC Educational Resources Information Center

Reviews research dealing with the intersection of the developmental psychology of trauma and spirituality. Examines the role of religion in spiritual development and asserts the need to study life paths of violent youth to see role of spirituality in preventing social problems. Uses research with street children and children in war zones. (BGC)

Garbarino, James; Bedard, Claire

1996-01-01

353

[Multi-trauma patients undergoing shock management].  

PubMed

Multi-trauma patients need specific care provided by medical teams and hospitals with a technical platform that optimises emergency care.They also require a special 'shock management' unit with staff members available to welcome these patients and maintain their vital functions. PMID:24218919

Beaux, Juliette; Gaillard, Delphine; Philips, Violaine; Savino, Ingrid

2013-09-01

354

Advanced Trauma Life Support aboard RFA Argus.  

PubMed

The Advanced Trauma Life Support (ATLS) system was adopted for casualty reception and resuscitation. ATLS permitted well-informed triage decisions to be made, coupled with appropriate initial, possibly life-saving, treatment. The training given on board has continued to benefit patients treated by ex-Argus staff in their peacetime roles. PMID:1453364

Greenslade, G L; Taylor, R H

1992-01-01

355

Reiterated Commemoration: Hiroshima as National Trauma  

Microsoft Academic Search

This article examines historical transformations of Japanese collective memory of the atomic bombing of Hiroshima by utilizing a theoretical framework that combines a model of reiterated problem solving and a theory of cultural trauma. I illustrate how the event of the nuclear fallout in March 1954 allowed actors to consolidate previously fragmented commemorative practices into a master frame to define

Hiro Saito

2006-01-01

356

Vicarious Trauma: Proposed Factors That Impact Clinicians  

Microsoft Academic Search

This article provides an overview about vicarious traumatization (VT) seen in military (and civilian) therapists working with combat veterans. Special focus is placed on the impact of VT on therapists on personal and professional levels. In addition, 8 important factors that impact the VT symptom severity are described: (a) the number of combat veterans and severity of combat trauma assigned\\/seen

Karin Jordan

2010-01-01

357

Secondary Trauma and Military Veteran Caregivers  

Microsoft Academic Search

The article focuses on the secondary trauma stressors experienced by those who care for members of the military with special attention to the caregivers of war fighters seeking help from combat stress. Consistent with the theme of the special issue of understanding and preparing for the challenges of combat stress, the authors suggest that military caregiver stress and resilience require

Brian E. Bride; Charles R. Figley

2009-01-01

358

The concept and treatment of psychological trauma  

PubMed Central

Despite a large and rapidly expanding literature on psychological trauma, many fundamental questions remain about its basic nature: Is it a psychological problem or a biological one?; Is it a past event somehow stuck in the present or is it something new which has been triggered and shaped by that event?; Does it reside only within the patient or does it live between the patient and other people (including within the therapeutic relationship)? This presentation will review the history of the concept of psychological trauma and explore the theoretical bases for current evidence-based psychotherapies for PTSD, each of which will be shown to describe psychological trauma as a problem in bringing the past and the present together in memory and cognition. These theories primarily differ on the question of whether a traumatic memory becomes pathogenic, because it cannot be biologically processed or because it must be psychologically avoided. Psychoanalytic concepts of transference and countertransference will be shown to be of practical importance regardless of the type of treatment chosen. If researchers and clinicians can build on what they hold in common rather than become divided by their differences, we can improve our ability to understand and alleviate the effects of psychological trauma. PMID:25511719

Kudler, Harold

2014-01-01

359

Teamwork improvement in emergency trauma departments  

PubMed Central

Background: Interprofessional teamwork is considered as the key to improve the quality of patient management in critical settings such as trauma emergency departments, but it is not fully conceptualized in these areas to guide practice. The aim of this article is to explore interprofessional teamwork and its improvement strategies in trauma emergency departments. Materials and Methods: Participants of this qualitative study consisted of 11 nurses and 6 supervisors recruited from the emergency departments of a newly established trauma center using purposive sampling. Data were generated using two focus group and six in-depth individual interviews, and analyzed using qualitative content analysis. Results: Interprofessional teamwork attributes and improvement strategies were emerged in three main themes related to team, context, and goal. These were categorized as the effective presence of team members, role definition in team framework, managerial and physical context, effective patient management, and overcoming competing goals Conclusions: Interprofessional teamwork in trauma emergency departments is explained as interdependence of team, context, and goal; so, it may be improved by strengthening these themes. The findings also provide a basis to evaluate, teach, and do research on teamwork. PMID:24403932

Khademian, Zahra; Sharif, Farkhondeh; Tabei, Seyed Ziaadin; Bolandparvaz, Shahram; Abbaszadeh, Abbas; Abbasi, Hamid Reza

2013-01-01

360

Genital trauma in children and adolescents.  

PubMed

Traumatic wounds of the female genitalia include accidental straddle injuries or impalement, chemical or thermal burns, insufflation injuries, blunt trauma, or crush injuries. Children and adolescents may be victims of rape, sexual abuse, and female genital mutilation. Information is provided on epidemiology, pathophysiology, and management. Treatment guidelines are offered using the best evidence available, and recommendations are provided when data are limited. PMID:18463455

Merritt, Diane F

2008-06-01

361

Aortic transsection after blunt chest trauma.  

PubMed

We report a case of an 18-year-old female who developed an extensive hemothorax after blunt chest trauma. Transesophageal echocardiography (TEE) showed transsection of the aorta at the level of the isthmus and turbulent flows in several places around the aorta. We discuss the contribution of TEE for detecting traumatic injuries to the thoracic aorta. PMID:11466149

Tsoukas, A; Stathoulopoulos, A; Tsatsoulis, P; Geranios, A; Pavlakis, E; Athanasopoulou, A; Papaeliou, I

2001-07-01

362

Efficacy of a two-tiered trauma team activation protocol in a Norwegian trauma centre  

PubMed Central

Background: A registry-based analysis revealed imprecise informal one-tiered trauma team activation (TTA) in a primary trauma centre. A two-tiered TTA protocol was introduced and analysed to examine its impact on triage precision and resource utilization. Methods: Interhospital transfers and patients admitted by non-healthcare personnel were excluded. Undertriage was defined as the fraction of major trauma victims (New Injury Severity Score over 15) admitted without TTA. Overtriage was the fraction of TTA without major trauma. Results: Of 1812 patients, 768 had major trauma. Overall undertriage was reduced from 28·4 to 19·1 per cent (P < 0·001) after system revision. Overall overtriage increased from 61·5 to 71·6 per cent, whereas the mean number of skilled hours spent per overtriaged patient was reduced from 6·5 to 3·5 (P < 0·001) and the number of skilled hours spent per major trauma victim was reduced from 7·4 to 7·1 (P < 0·001). Increasing age increased risk for undertriage and decreased risk for overtriage. Falls increased risk for undertriage and decreased risk for overtriage, whereas motor vehicle-related accidents showed the opposite effects. Patients triaged to a prehospital response involving an anaesthetist had less chance of both undertriage and overtriage. Conclusion: A two-tiered TTA protocol was associated with reduced undertriage and increased overtriage, while trauma team resource consumption was reduced. Registration number: NCT00876564 (http://www.clinicaltrials.gov). Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. Effective system to deal with local and distant trauma PMID:22190166

Rehn, M; Lossius, H M; Tjosevik, K E; Vetrhus, M; Østebø, O; Eken, T

2012-01-01

363

Somatization symptoms in pediatric abdominal pain patients: Relation to chronicity of abdominal pain and parent somatization  

Microsoft Academic Search

Symptoms of somatization were investigated in pediatric patients with recurrent abdominal pain (RAP) and comparison groups of patients with organic etiology for abdominal pain and well patients. Somatization scores were higher in RAP patients than well patients at the clinic visit, and higher than in either well patients or organic patients at a 3- month followup. Higher somatization scores in

Lynn S. Walker; Judy Garber; John W. Greene

1991-01-01

364

A comparison of rural versus urban trauma care  

PubMed Central

Objective: We compared the survival of trauma patients in urban versus rural settings after the implementation of a novel rural non-trauma center alternative care model called the Model Rural Trauma Project (MRTP). Materials and Methods: We conducted an observational cohort study of all trauma patients brought to eight rural northern California hospitals and two southern California urban trauma centers over a one-year period (1995-1996). Trauma patients with an injury severity score (ISS) of >10 were included in the study. We used logistic regression to assess disparities in odds of survival while controlling for Trauma and Injury Severity Score (TRISS) parameters. Results: A total of 1,122 trauma patients met criteria for this study, with 336 (30%) from the rural setting. The urban population was more seriously injured with a higher median ISS (17 urban and 14 rural) and a lower Glasgow Coma Scale (GCS) (GCS 14 urban and 15 rural). Patients in urban trauma centers were more likely to suffer penetrating trauma (25% urban versus 9% rural). After correcting for differences in patient population, the mortality associated with being treated in a rural hospital (OR 0.73; 95% CI 0.39 to 1.39) was not significantly different than an urban trauma center. Conclusion: This study demonstrates that rural and urban trauma patients are inherently different. The rural system utilized in this study, with low volume and high blunt trauma rates, can effectively care for its population of trauma patients with an enhanced, committed trauma system, which allows for expeditious movement of patients toward definitive care. PMID:24550630

Lipsky, Ari M; Karsteadt, Larry L; Gausche-Hill, Marianne; Hartmans, Sharon; Bongard, Frederick S.; Cryer, Henry Gill; Ekhardt, Patricia B; Loffredo, Anthony J; Farmer, Patricia D; Whitney, Susan C; Lewis, Roger J

2014-01-01

365

Alcohol intoxication/dependence, ethnicity and utilization of health care resources in a level I trauma center  

PubMed Central

Objective To evaluate the potential influence of acute intoxication and dependence to alcohol on extra-utilization of health care resources by ethnic minority trauma patients in a level I trauma center. Methods We analyzed the data of 1,493 patients enrolled in a study that evaluated the effectiveness of brief alcohol intervention among ethnic minority trauma patients. The database included detailed demographic, injury-related and drinking-related characteristics (including acute intoxication and alcohol dependency status). Patients were categorized into the following groups: non-intoxicate/non-dependent (NI/ND), non-intoxicated/dependent (NI/D), intoxicated/non-dependent (I/ND) and intoxicated/dependent (I/D). We compared utilization of several diagnostic and therapeutic procedures among these four categories. We placed special emphasis on ethnicity as a potential effect modifier. Results Relative to NI/ND trauma patients, I/ND patients (relative risk (RR): 1.8, 95% CI: 1.2-2.8) and I/D patients (RR: 2.4, 95% CI: 1.6-3.6) had significantly higher chance of being evaluated by abdominal ultrasound during the first 24 hours of hospital arrival. Similar pattern was observed for head CT scan (with the corresponding RRs of 2.1 and 2.6, respectively). Chance of admission to the intensive care unit (ICU) was not associated with intoxication/dependence status. Length of hospital stay was negatively associated with drinking status with the shortest length of stay for I/D. Including ethnicity in the models, did not change the results and conclusions. Discussion Acute intoxication and dependence to alcohol are both associated with more frequent utilization of selected health care resources and the utilization pattern was not associated with patient ethnicity. This emphasizes on the importance of routine screening for drinking problems among all trauma patients, regardless of their blood alcohol level in the ED. PMID:20106475

Roudsari, Bahman; Caetano, Raul; Field, Craig

2010-01-01

366

Outcomes following liver trauma in equestrian accidents  

PubMed Central

Background Equestrian sports are common outdoor activities that may carry a risk of liver injury. Due to the relative infrequency of equestrian accidents the injury patterns and outcomes associated with liver trauma in these patients have not been well characterized. Methods We examined our experience of the management of equestrian liver trauma in our regional hepatopancreaticobiliary unit at a tertiary referral center. The medical records of patients who sustained liver trauma secondary to equestrian activities were analysed for parameters such as demographic data, liver function tests, patterns of injury, radiological findings, the need for intervention and outcomes. Results 20 patients sustained liver trauma after falling from or being kicked by a horse. The majority of patients were haemodynamically stable on admission. Alanine transaminase (ALT) levels were elevated in all patients and right-sided rib fractures were a frequently associated finding. CT demonstrated laceration of the liver in 12 patients, contusion in 3 and subcapsular haematoma in 2. The right lobe of the liver was most commonly affected. Only two patients required laparotomy and liver resection; the remaining 18 were successfully managed conservatively. Conclusions The risk of liver injury following a horse kick or falling off a horse should not be overlooked. Early CT imaging is advised in these patients, particularly in the presence of high ALT levels and concomitant chest injuries such as rib fractures. Despite significant liver trauma, conservative management in the form of close observation, ideally in a high-dependency setting, is often sufficient. Laparotomy is only rarely warranted and associated with a significantly higher risk of post-operative bile leaks. PMID:25177363

2014-01-01

367

Abdominal adiposity with respect to the proportion of intra-abdominal visceral fat to extra-abdominal fat ( V S ratio) in Japanese childhood obesity  

Microsoft Academic Search

The aim of this study was to assess the influence of intra-abdominal fat accumulation in obese children upon lipids, glucose metabolism, and blood pressure. Intra-abdominal fat accumulation was quantified by the intra-abdominal visceral fat to extra-abdominal fat ratio (VS ratio) using CT scanning. The subjects were simple obese boys (35) and girls (24) aged 10.6 ± 2.1 years. The following

Jin Yamaguchi; Tatsuya Oguni; Kazutaka Konishi; Makoto Mino

1996-01-01

368

Arytenoid Cartilage Dislocation from External Blunt Laryngeal Trauma: Evaluation and Therapy without Laryngeal Electromyography  

PubMed Central

Background Intubation trauma is the most common cause of arytenoid dislocation. The aim of this study was to investigate the diagnosis and treatment of arytenoid cartilage dislocation from external blunt laryngeal trauma in the absence of laryngeal electromyography (LEMG) and to explore the role of early attempted closed reduction in arytenoids cartilage reposition. Material/Methods This 15-year retrospective study recruited 12 patients with suspected arytenoid dislocation from external blunt laryngeal trauma, who were evaluated through 7 approaches: detailed personal history, voice handicap index (VHI) test, indirect laryngoscope, flexible fiberoptic laryngoscope, video strobolaryngoscope, and/or high-resolution computed tomography (CT), and, most importantly, the outcomes after attempted closed reduction under local anesthesia. They were divided into satisfied group (n=9) and dissatisfied group (n=3) based on their satisfied with voice qualities at 1 week after the last closed reduction manipulation. Results Each patient was diagnosed with arytenoid dislocation caused by external blunt laryngeal trauma. In the satisfied group, VHI scores and maximum phonation time (MPT) at 1 week after the last reduction were significantly improved compared with those before the procedure (P<0.05). Normal or improved mobility and length of the affected vocal fold were also noted immediately after the end of the last closed reduction. The median time interval between injury and clinical intervention in satisfied group was 43.44±34.13 days, much shorter than the median time of 157.67±76.07 days in the dissatisfied group (P<0.05). Conclusions Multimodality assessment protocols are essential for suspected arytenoid dislocation after external blunt laryngeal trauma. Early attempted closed reduction should be widely recommended, especially in health facilities without LEMG, mainly, because it could be helpful for early diagnosis and treatment of this disease. In addition, early closed reduction could also improve the success of arytenoid reduction. PMID:25150338

Teng, Yaoshu; Wang, Hui-e; Lin, Zhihong

2014-01-01

369

The role of abdominal compliance, the neglected parameter in critically ill patients - a consensus review of 16. Part 1: definitions and pathophysiology.  

PubMed

Over the last few decades, increasing attention has been paid to understanding the pathophysiology, aetiology, prognosis, and treatment of elevated intra-abdominal pressure (IAP) in trauma, surgical, and medical patients. However, there is presently a relatively poor understanding of intra-abdominal volume (IAV) and the relationship between IAV and IAP (i.e. abdominal compliance). Consensus definitions on Cab were discussed during the 5th World Congress on Abdominal Compartment Syndrome and a writing committee was formed to develop this article. During the writing process, a systematic and structured Medline and PubMed search was conducted to identify relevant studies relating to the topic. According to the recently updated consensus definitions of the World Society on Abdominal Compartment Syndrome (WSACS), abdominal compliance (Cab) is defined as a measure of the ease of abdominal expansion, which is determined by the elasticity of the abdominal wall and diaphragm. It should be expressed as the change in IAV per change in IAP (mL [mm Hg]?¹). Importantly, Cab is measured differently than IAP and the abdominal wall (and its compliance) is only a part of the total abdominal pressure-volume (PV) relationship. During an increase in IAV, different phases are encountered: the reshaping, stretching, and pressurisation phases. The first part of this review article starts with a comprehensive list of the different definitions related to IAP (at baseline, during respiratory variations, at maximal IAV), IAV (at baseline, additional volume, abdominal workspace, maximal and unadapted volume), and abdominal compliance and elastance (i.e. the relationship between IAV and IAP). An historical background on the pathophysiology related to IAP, IAV and Cab follows this. Measurement of Cab is difficult at the bedside and can only be done in a case of change (removal or addition) in IAV. The Cab is one of the most neglected parameters in critically ill patients, although it plays a key role in understanding the deleterious effects of unadapted IAV on IAP and end-organ perfusion. The definitions presented herein will help to understand the key mechanisms in relation to Cab and clinical conditions and should be used for future clinical and basic science research. Specific measurement methods, guidelines and recommendations for clinical management of patients with low Cab are published in a separate review. PMID:25432558

Malbrain, Manu L N G; Roberts, Derek J; De Laet, Inneke; De Waele, Jan J; Sugrue, Michael; Schachtrupp, Alexander; Duchesne, Juan; Van Ramshorst, Gabrielle; De Keulenaer, Bart; Kirkpatrick, Andrew W; Ahmadi-Noorbakhsh, Siavash; Mulier, Jan; Ivatury, Rao; Pracca, Francisco; Wise, Robert; Pelosi, Paolo

2014-01-01

370

Sex-Specific Abdominal Activation Strategies During Landing  

PubMed Central

Context: Control of the trunk segment in landing has been implicated as a contributing factor to the higher incidence of anterior cruciate ligament injuries in females than in males. Investigating the sex-specific abdominal activation strategies during landing lends insight into mechanisms contributing to control of the trunk segment. Objective: To examine the abdominal activation strategies used by males and females during a landing task. Design: Mixed-model (between-subjects and within-subjects) design. Setting: Laboratory. Patients or Other Participants: Healthy, recreationally active males (n = 20, age = 23 ± 4.8 years, height = 1.8 ± 0.1 m, mass = 79.6 ± 9.9 kg, body mass index = 24.8 ± 2.7 kg/ m 2) and females (n = 22, age = 20.8 ± 4.8 years, height = 1.7 ± 0.1 m, mass = 64.1 ± 9.2 kg, body mass index = 22.9 ± 2.6 kg/m 2). Intervention(s): Subjects performed 5 double-leg landings from a box height of 60 cm. Main Outcome Measure(s): Male and female activation amplitudes for the rectus abdominis (RA), external oblique (EO), and transversus abdominis and lower fibers of the internal oblique (TrA-IO) muscles during preactivation (150-millisecond interval just before landing) and after impact (150-millisecond interval immediately after ground contact). Results: Males had greater TrA-IO activation than females ( P < .05). Males preferentially activated the TrA-IO muscles relative to the RA and EO, whereas females demonstrated no significant muscle differences. Males and females also differed by phase, with males having more TrA-IO activation than females during the preactivation landing phase ( P < .05) but not during the postimpact phase. The TrA-IO was the only muscle to significantly differ by landing phase, decreasing from preactivation to postimpact ( P < .05). Conclusions: Males used different abdominal muscle activation strategies than females in landing. The efficacy of these muscle activation strategies to control the trunk should be assessed through trunk kinematic and kinetic measures in future studies. PMID:17273462

Kulas, Anthony S; Schmitz, Randy J; Shultz, Sandra J; Henning, Jolene M; Perrin, David H

2006-01-01

371

Calculating trauma triage precision: effects of different definitions of major trauma  

PubMed Central

Background Triage is the process of classifying patients according to injury severity and determining the priority for further treatment. Although the term “major trauma” represents the reference against which over- and undertriage rates are calculated, its definition is inconsistent in the current literature. This study aimed to investigate the effects of different definitions of major trauma on the calculation of perceived over- and undertriage rates in a Norwegian trauma cohort. Methods We performed a retrospective analysis of patients included in the trauma registry of a primary, referral trauma centre. Two “traditional” definitions were developed based on anatomical injury severity scores (ISS >15 and NISS >15), one “extended” definition was based on outcome (30-day mortality) and mechanism of injury (proximal penetrating injury), one ”extensive” definition was based on the “extended” definition and on ICU resource consumption (admitted to the ICU for >2?days and/or transferred intubated out of the hospital in ?2?days), and an additional four definitions were based on combinations of the first four. Results There were no significant differences in the perceived under- and overtriage rates between the two “traditional” definitions (NISS >15 and ISS >15). Adding “extended” and “extensive” to the “traditional” definitions also did not significantly alter perceived under- and overtriage. Defining major trauma only in terms of the mechanism of injury and mortality, with or without ICU resource consumption (the “extended” and “extensive” groups), drastically increased the perceived overtriage rates. Conclusion Although the proportion of patients who were defined as having sustained major trauma increased when NISS-based definitions were substituted for ISS-based definitions, the outcomes of the triage precision calculations did not differ significantly between the two scales. Additionally, expanding the purely anatomic definition of major trauma by including proximal penetrating injury, 30-day mortality, ICU LOS greater than 2?days and transferred intubated out of the hospital at ?2?days did not significantly influence the perceived triage precision. We recommend that triage precision calculations should include anatomical injury scaling according to NISS. To further enhance comparability of trauma triage calculations, researchers should establish a consensus on a uniform definition of major trauma. PMID:22902009

2012-01-01

372

Metabolic effects of telmisartan in subjects with abdominal obesity: a prospective randomized controlled trial.  

PubMed

BACKGROUND. Abdominal obesity, characterized by ectopic fat deposition in skeletal muscle and liver tissue, has been associated with insulin resistance and increased risk for type 2 diabetes mellitus. The aim of this study was to evaluate whether treatment with the angiotensin II type 1 (AT-1) receptor blocker telmisartan can reduce intramyocellular lipid (IMCL) and hepatic fat storage, thereby improving insulin sensitivity among individuals with abdominal obesity. METHODS. Ninety-five adults with abdominal obesity (body mass index ? 30 kg/m(2) and waist circumference > 102 cm in men and > 88 cm in women) were randomized to double-blind treatment with telmisartan or placebo for 24 weeks. Following 4 weeks of 80 mg telmisartan per day, the dose was increased to 160 mg telmisartan for the duration of the study. Soleus muscle IMCL and liver fat content were assessed by (1)H-magnetic resonance imaging ((1)H-MRI) spectroscopy. Secondary outcomes included changes in body composition, plasma lipids, glucose profiles, insulin sensitivity, beta-cell function and total adiponectin levels. RESULTS. There was no significant effect of telmisartan in abdominally obese individuals consuming either a low or high glycemic diet, on IMCL content (5.73 ± 1.11 vs 6.11 ± 1.11; p = 0.13) or liver fat (0.08 ± 0.05 vs 0.09 ± 0.05; p = 0.60). Body composition, lipid and glucose profiles, insulin sensitivity and adiponectin were likewise unaffected. Beta-cell function, as determined by the insulinogenic index (IGI), improved significantly (19.3 ± 13.7 vs 22.5 ± 17.6; p = 0.03; 16.5% increase from baseline in the telmisartan group). CONCLUSIONS. Telmisartan increased beta-cell function but did not decrease IMCL or liver fat content or other metabolic parameters among individuals with abdominal obesity. PMID:23731019

Chetty, V Tony; Damjanovic, Suzana; Gerstein, Hertzel; Singh, Nina; Yusuf, Salim; Anand, Sonia S; Sharma, Arya M

2014-02-01

373

Abdominal Implantation of Testicles in the Management of Intractable Testicular Pain in Fournier Gangrene  

PubMed Central

Fournier gangrene (FG) is a necrotizing soft tissue infection involving the superficial and fascial planes of the perineum. In many cases of FG, debridement of the scrotum is necessary, leaving definitive management of the exposed testicles a significant surgical challenge. Frequent incidental trauma to the testicles can cause severe pain, especially in laborers. Practical surgical solutions are few and not well detailed. Various options exist, including creating a neoscrotum with adjacent thigh tissue, split-thickness skin grafts (STSGs), or even creating a subcutaneous thigh pocket. We describe a case of abdominal implantation of bilateral testicles for persistent testicular pain in a case where STSGs did not provide adequate protection, adjacent thigh skin was not available for creation of a neoscrotum, and significant cord contracture occurred. We detail the advantages and disadvantages of the commonly described techniques, including this approach, and how in select individuals this may be a suitable alternative. PMID:24229025

Chan, Cyrus C.; Shahrour, Khaled; Collier, Ronald D.; Welch, Marlene; Chang, Shiliang; Williams, Mallory

2013-01-01

374

Survival after trauma in geriatric patients.  

PubMed Central

In contrast to other studies, a recent report from the authors' institution has shown a good prognosis for functional recovery in geriatric patients that survive trauma. Because most survivors regained their pre-injury function, the authors examined factors related to nonsurvival in this population of 82 consecutive blunt trauma victims older than the age of 65. Seventeen patients died (21%). Compared with survivors, nonsurvivors were older, had more severe overall injury, and had more severe head and neck trauma but did not differ in severity of trauma that did not involve the head and neck, number of body regions injured, mechanism of injury, or incidence of surgery after injury. Nonsurvivors experienced more frequent complications (82% vs. 33%, p less than 0.05), including a higher incidence of cardiac complications (53% vs. 15%, p less than 0.05) and ventilator dependence for 5 or more days (41% vs. 14%, p less than 0.05). Mortality rates were increased in patients who were 80 years of age or older compared with those ages 65-79 (46% vs. 10%, p less than 0.01), despite injury of similar severity. More frequent complications may contribute to an increased mortality rate in the older group, including an increased incidence of prolonged mechanical ventilation (36% vs. 12%, p less than 0.025), cardiac complications (54% vs. 10%, p less than 0.01), and pneumonia (36% vs. 16%, p less than 0.06). Severely injured patients (Injury Severity Score [ISS] greater than or equal to 25) older than 80 years old had a mortality rate of 80%, and the survivors required permanent nursing home care. Discriminant analysis yielded a reliable method of differentiating survivors from nonsurvivors based on age, ISS, and the presence of cardiac and septic complications. To assess the accuracy of the discriminant function, 61 consecutive patients admitted during 1985 were reviewed prospectively. Discriminant scoring predicted outcome correctly in 92% of these patients. A Geriatric Trauma Survival Score (GTSS) based on the discriminant function was calculated for each of the 143 patients studied and was highly correlated with mortality rate (r = 0.99, p less than 0.001). Thus, the GTSS may serve as a valuable tool for evaluating death in geriatric trauma victims. Furthermore, because complications are potentially avoidable and contribute to increased mortality rates, routine aggressive care for geriatric patients with moderate overall injury is indicated. PMID:3689009

DeMaria, E J; Kenney, P R; Merriam, M A; Casanova, L A; Gann, D S

1987-01-01

375

Infected abdominal sacrocolpopexies: diagnosis and treatment.  

PubMed

The abdominal sacrocolpopexy is an excellent procedure to surgically treat vaginal vault prolapse. A synthetic graft is often used to support the vaginal apex, but has the potential to become infected or erode, requiring its removal or revision. The purpose of this paper is to report our experience in the management of patients with infected synthetic grafts after abdominal sacrocolpopexy. A review of the patient databases from three specialty gynecology centers was performed from March 1996 to June 2002. Only patients with an infected graft after an abdominal sacrocolpopexy were included in the study; patients with either suture or graft erosion responding to conservative treatment were excluded. Twenty-two women, ages 37-73 years, developed infection of the synthetic graft after an abdominal sacrocolpopexy (1-60 months after their initial surgery, mean 8.8 months). The infected materials included polytetrafluoroethylene (PTFE, Goretex, n =15) and polypropylene (n=7). Nine of the 15 PTFE meshes and four of the seven polypropylene meshes were placed at the time of a contaminated case (abdominal hysterectomy [n=12], colon resection [n=1]). Eighteen (82%) of the infected grafts involved braided permanent suture to attach the graft to the vaginal wall, monofilament/non-braided permanent suture was used in three patients, and suture type could not be determined in one. All graft removals were attempted vaginally, and this was successful in 16 cases (73%). Two patients experienced significant bleeding: the first patient required an emergency laparotomy and the second patient's bleeding was controlled with packing. A rectovaginal fistula occurred 3 weeks postoperatively in one patient. Synthetic graft infection should be considered as the differential diagnosis in a patient who has undergone an abdominal sacrocolpopexy. Transvaginal removal is preferred, but is fraught with potentially serious complications. The use of braided permanent sutures to affix the graft to the vagina may be associated with mesh infections. PMID:15580416

Mattox, T Fleming; Stanford, Edward J; Varner, E

2004-01-01

376

[Abdominal migraine as a cause of chronic recurrent abdominal pain in a 9-years-old girl--case report].  

PubMed

Abdominal migraine is a rarely recognized functional intestinal disorder, manifesting as recurrent paroxysmal abdominal pain of neurogenic origin. The authors describe the 9-years old girl referred to the hospital because of chronic paroxysmal abdominal pain. She did not improve after medication used commonly in functional abdominal disorders (drotaverine, mebeverine, trimebutine). On the ground of various investigations organic causes of abdominal pain were excluded. Carefully completed anamnesis, as well as precise description of the clinical picture of abdominal pain attacks, has lead to the diagnosis of abdominal migraine. According to advice of neurologist the treatment with amitriptyline was introduced. Thereafter a significant improvement was observed. Abdominal migraine has to be taken in to account when diagnosing chronic abdominal pain in children. PMID:16245431

Kwiecie?, Jaros?aw; Piasecki, Leszek; Kasner, Jacek; Karczewska, Krystyna

2005-08-01

377

A tissue-equivalent upper abdominal phantom.  

PubMed

The first prototypes of an abdominal phantom have been constructed. The phantom is intended for eventual use in training diagnostic ultrasound personnel and in demonstrating commercial equipment. It is constructed from plastics believed to be stable and approximately tissue-equivalent at room temperature. Abdominal structures are formed from a dispersion of a polystyrene butadiene plastic in mineral oil. Polyvinyl chloride particles are incorporated to provide the desired attenuation coefficients and scattering levels. B-scans of the phantom produced realistic images, although problems associated with scanning technique and somewhat high phantom attenuation were noted. Very useful phantoms should result from relatively simple improvements in construction techniques. PMID:6632059

Scherzinger, A L; Carson, P L; Clayman, W; Carter, W; Johnson, M L; Rashbaum, C

1983-10-01

378

Synovial Sarcoma of the Abdominal Wall  

PubMed Central

A case report is presented of a synovial sarcoma arising in the abdominal wall. This is the seventh such case to be reported. A brief review of the clinical and pathological features of synovial sarcoma is made. Pre-operative diagnosis of an abdominal wall synovial sarcoma is virtually impossible, but should be considered when a soft tissue swelling is found to show amorphous stippled calcification on X-ray. ImagesFig. 1Figs. 2-3Figs. 4-5 PMID:4319939

Hale, J. E.; Calder, I. M.

1970-01-01

379

A single subcutaneous dose of tramadol for mild to moderate musculoskeletal trauma in the emergency department  

PubMed Central

BACKGROUND: Mild to moderate musculoskeletal trauma is a common cause for an emergency room visit, and frequent pain is one of the cardinal symptoms of consultation. The objective of this study is to assess the perception of a single subcutaneous dose of 50 mg tramadol for pain management in patients with mild to moderate musculoskeletal trauma, likewise to appraise the perception of pain by subcutaneous injection. METHODS: A total of 77 patients, who met inclusion criteria, received a single subcutaneous dose of tramadol. Pain control was evaluated based on the verbal numerical pain scale (0–10) at baseline, 20 and 60 minutes; similarly, pain perception was evaluated secondary to subcutaneous injection of the analgesic. RESULTS: On admission, the average pain perceived by patients was 8; twenty minutes later, 89% of the patients reported five or less, and after sixty minutes, 94% had three or less on the verbal numerical pain scale. Of the patients, 88% reported pain perception by verbal numeric scale of 3 or less by injection of the drug, and 6.5% required a second analgesic for pain control. Two events with drug administration (soft tissue infection and mild abdominal rectus injection) were reported. CONCLUSION: We conclude that a single subcutaneous dose of tramadol is a safe and effective option for the management of patients with mild to moderate pain and musculoskeletal disease in the emergency department.

Cardozo, Alejandro; Silva, Carlos; Dominguez, Luis; Botero, Beatriz; Zambrano, Paulo; Bareno, Jose

2014-01-01

380

Survivors of early childhood trauma: evaluating a two-dimensional diagnostic model of the impact of trauma and neglect  

PubMed Central

Background A two-dimensional diagnostic model for (complex) trauma-related and personality disorders has been proposed to assess the severity and prognosis of the impact of early childhood trauma and emotional neglect. An important question that awaits empirical examination is whether a distinction between trauma-related disorders and personality disorders reflects reality when focusing on survivors of early childhood trauma. And, is a continuum of trauma diagnoses a correct assumption and, if yes, what does it look like? Objective We describe the design of a cross-sectional cohort study evaluating this two-dimensional model of the impact of trauma and neglect. To provide the rationale of our study objectives, we review the existing literature on the impact of early childhood trauma and neglect on trauma-related disorders and personality disorders. Aims of the study are to: (1) quantify the two-dimensional model and test the relation with trauma and neglect; and (2) compare the two study groups. Method A total of 200 consecutive patients referred to two specific treatment programs (100 from a personality disorder program and 100 from a trauma-related disorder program) in the north of Holland will be included. Data are collected at the start of treatment. The assessments include all DSM-5 trauma-related and personality disorders, and general psychiatric symptoms, trauma history, and perceived emotional neglect. Discussion The results will provide an evaluation of the model and an improvement of the understanding of the relationship between trauma-related disorders and personality disorders and early childhood trauma and emotional neglect. This may improve both diagnostic as well as indication procedures. We will discuss possible strengths and limitations of the design. PMID:24711888

Wildschut, Marleen; Langeland, Willemien; Smit, Jan H.; Draijer, Nel

2014-01-01

381

Improvement in outcome from trauma center care.  

PubMed

Survival and death outcomes for patients with blunt injuries treated at one urban hospital were evaluated during a 6-year period of increasing commitment to trauma care, as evidenced by the construction of a resuscitation facility with integrated operating rooms. Patient survival, when controlled for severity mix, showed a trend of improvement during the study period. Improvement in survival outcome was more notable after the opening of the trauma resuscitation facility and among the more severely injured. When data from years 1 and 2 combined were compared with those from years 5 and 6, a statistically significant difference in survival was found, with an average of 13.44 more survivors per 100 patients treated per year with Injury Severity Scores greater than 15. PMID:1550482

Champion, H R; Sacco, W J; Copes, W S

1992-03-01

382

Obesity in orthopedics and trauma surgery.  

PubMed

In 2012, 32.3% of the French population over 18 years of age was considered overweight (25 ? BMI<30 kg/m(2)) and 15% obese (BMI ? 30 kg/m(2)). Worldwide, 2.8 million people die every year from the complications of obesity. In 2008, the prevalence of obesity was almost double that of 1980. Obesity is a genuine concern for the orthopedic surgeon, as it affects bones and soft tissues on the biomechanical and biochemical level. In traumatology, low-energy trauma is more frequent in obese patients and induces complex comminutive fractures of the extremities. In orthopedics, obesity is an independent risk factor for osteoarthritis, particularly for the knee joint. The goals of this review are to describe specific aspects of the care of obese patients in trauma and orthopedics surgery during the pre-, intra- and postoperative periods, as well as the risk-benefit ratio related to the treatment of the obese patients. PMID:24461910

Parratte, S; Pesenti, S; Argenson, J-N

2014-02-01

383

Historical and Current Trends in Colon Trauma  

PubMed Central

The authors discuss the evolution of the evaluation and management of colonic trauma, as well as the debate regarding primary repair versus fecal diversion. Their evidence-based review covers diagnosis, management, surgical approaches, and perioperative care of patients with colon-related trauma. The management of traumatic colon injuries has evolved significantly over the past 50 years; here the authors describe a practical approach to the treatment and management of traumatic injuries to the colon based on the most current research. However, management of traumatic colon injuries remains a challenge and continues to be associated with significant morbidity. Familiarity with the different methods to the approach and management of colonic injuries will allow surgeons to minimize unnecessary complications and mortality. PMID:24294119

Causey, Marlin Wayne; Rivadeneira, David E.; Steele, Scott R.

2012-01-01

384

Effects of dental trauma on the pulp.  

PubMed

Infection of the root canal system following dental trauma induces pulp and periapical disease and prevents healing of previously healthy pulp. A clinical goal in treating trauma is the maintenance of pulp vitality, and clinicians should be aware of factors that influence pulp healing. The learning objective of this article is to review the factors and techniques that influence pulp vitality and examine the influence pulp has on the healing of adjacent tissues. The potential routes for bacterial infection of the root canal system are discussed, with the clinical crown as the primary portal of entry. Uncomplicated and complicated crown fractures, as well as the crown-root and root fractures, are reviewed. Complications in pulp healing include canal obliteration, disturbed root development, apexogenesis, apexification, and the various forms of resorption. PMID:9550069

Love, R M

1997-05-01

385

Complimentary imaging technologies in blunt ocular trauma  

PubMed Central

We describe complimentary imaging technologies in traumatic chorioretinal injury. Color and fundus autofluorescence (FAF) images were obtained with a non-mydriatic retinal camera. Optical coherence tomography (OCT) helped obtain detailed images of retinal structure. Microperimetry was used to evaluate the visual function. A 40-year-old man sustained blunt ocular trauma with a stone. Color fundus image showed a large chorioretinal scar in the macula. Software filters allowed detailed illustration of extensive macular fibrosis. A 58-year-old man presented with blunt force trauma with a tennis ball. Color fundus imaging showed a crescentric area of macular choroidal rupture with fibrosis. FAF imaging delineated an area of hypofluorescence greater on fundus imaging. OCT showed chorioretinal atrophy in the macula. Microperimetry delineated an absolute scotoma with no response to maximal stimuli. Fundus imaging with digital filters and FAF illustrated the full extent of chorioretinal injury, while OCT and microperimetry corroborated the structure and function correlations. PMID:24082670

Kolomeyer, Anton M.; Szirth, Bernard C.; Nayak, Natasha V.; Khouri, Albert S.

2013-01-01

386

Epidemiological Trends of Spine Trauma: An Australian Level 1 Trauma Centre Study  

PubMed Central

Knowledge of current epidemiology and spine trauma trends assists in public resource allocation, fine-tuning of primary prevention methods, and benchmarking purposes. Data on all patients with traumatic spine injuries admitted to the Alfred Hospital, Melbourne between May 1, 2009, and January 1, 2011, were collected from the Alfred Trauma Registry, Alfred Health medical database, and Victorian Orthopaedic Trauma Outcomes Registry. Epidemiological trends were analyzed as a general cohort, with comparison cohorts of nonsurvivors versus survivors and elderly versus nonelderly. Linear regression analysis was utilized to demonstrate trends with statistical significance. There were 965 patients with traumatic spine injuries with 2,333 spine trauma levels. The general cohort showed a trimodal age distribution, male-to-female ratio of 2:2, motor vehicle accidents as the primary spine trauma mechanism, 47.7% patients with severe polytrauma as graded using the Injury Severity Score (ISS), 17.3% with traumatic brain injury (TBI), the majority of patients with one spine injury level, 7% neurological deficit rate, 12.8% spine trauma operative rate, and 5.2% mortality rate. Variables with statistical significance trending toward mortality were the elderly, motor vehicle occupants, severe ISS, TBI, C1–2 dissociations, and American Spinal Injury Association (ASIA) A, B, and C neurological grades. Variables with statistical significance trending toward the elderly were females; low falls; one spine injury level; type 2 odontoid fractures; subaxial cervical spine distraction injuries; ASIA A, B, and C neurological grades; and patients without neurological deficits. Of the general cohort, 50.3% of spine trauma survivors were discharged home, and 48.1% were discharged to rehabilitation facilities. This study provides baseline spine trauma epidemiological data. The trimodal age distribution of patients with traumatic spine injuries calls for further studies and intervention targeted toward the 46- to 55-year age group as this group represents the main providers of financial and social security. The study's unique feature of delineating variables with statistical significance trending toward both mortality and the elderly also provides useful data to guide future research studies, benchmarking, public health policy, and efficient resource allocation for the management of spine trauma. PMID:24436855

Tee, J. W.; Chan, C. H. P.; Fitzgerald, M. C. B.; Liew, S. M.; Rosenfeld, J. V.

2013-01-01

387

BIOPHYSICAL INJURY MECHANISMS IN ELECTRICAL SHOCK TRAUMA  

Microsoft Academic Search

? Abstract Electrical shock trauma,tends to produce,a very complex,pattern of in- jury, mainly because of the multiple modes of frequency-dependent tissue-field interac- tions. Historically, Joule heating was thought to be the only cause of electrical injuries to tissue by commercial-frequency electrical shocks. In the last 15 years, biomedical engineering research has improved,the understanding,of the underlying biophysical in- jury mechanisms. Besides

Raphael C. Lee; Dajun Zhang; Jurgen Hannig

2000-01-01

388

Reno Orthopaedic Trauma Fellowship business curriculum.  

PubMed

The Reno Orthopaedic Center (ROC) Trauma Fellowship business curriculum is designed to provide the fellow with a graduate level business practicum and research experience. The time commitments in a typical 12-month trauma fellowship are significant, rendering a traditional didactic master's in business administration difficult to complete during this short time. An organized, structured, practical business education can provide the trauma leaders of tomorrow with the knowledge and experience required to effectively navigate the convoluted and constantly changing healthcare system. The underlying principle throughout the curriculum is to provide the fellow with the practical knowledge to participate in cost-efficient improvements in healthcare delivery. Through the ROC Trauma Fellowship business curriculum, the fellow will learn that delivering healthcare in a manner that provides better outcomes for equal or lower costs is not only possible but a professional and ethical responsibility. However, instilling these values without providing actionable knowledge and programs would be insufficient and ineffective. For this reason, the core of the curriculum is based on individual teaching sessions with a wide array of hospital and private practice administrators. In addition, each section is equipped with a suggested reading list to maximize the learning experience. Upon completion of the curriculum, the fellow should be able to: (1) Participate in strategic planning at both the hospital and practice level based on analysis of financial and clinical data, (2) Understand the function of healthcare systems at both a macro and micro level, (3) Possess the knowledge and skills to be strong leaders and effective communicators in the business lexicon of healthcare, (4) Be a partner and innovator in the improvement of the delivery of orthopaedic services, (5) Combine scientific and strategic viewpoints to provide an evidence-based strategy for improving quality of care in a cost-efficient manner, (6) Understand the political, economic, and strategic basics of private practice orthopaedics. PMID:24918829

Althausen, Peter L; Bray, Timothy J; Hill, Austin D

2014-07-01

389

[Abusive head trauma: Report of a case].  

PubMed

The abusive head trauma is a form of child abuse. The most frequent injuries are intracranial lesions, such as subdural hematoma, as well as retinal hemorrhages, usually without other external injuries. Due to its complexity, this problem requires a multidisciplinary medical team, where the role of the radiologist is important, since there are multiple diagnostic methods that are complementary in order to arrive at the correct diagnosis. PMID:24853831

Grana, M; Nazar, M; de Luca, S; Casalini, E; Eyheremendy, E

2015-01-01

390

CT of trauma to the abnormal kidney  

SciTech Connect

Traumatic injuries to already abnormal kidneys are difficult to assess by excretory urography and clinical evaluation. Bleeding and urinary extravasation may accompany minor trauma; conversely, underlying tumors, perirenal hemorrhage, and extravasation may be missed on urography. Computed tomography (CT) was performed in eight cases including three neoplasms, one adult polycystic disease, one simple renal cyst, two hydronephrotic kidneys, and one horseshoe kidney. CT provided specific and clinically useful information in each case that was not apparent on excretory urography.

Rhyner, P.; Federle, M.P.; Jeffrey, R.B.

1984-04-01

391

Personal experience with whole-body, low-dosage, digital X-ray scanning (LODOX-Statscan) in trauma  

PubMed Central

Background Lodox-Statscan is a whole-body, skeletal and soft-tissue, low-dose X-ray scanner Anterior-posterior and lateral thoraco-abdominal studies are obtained in 3-5 minutes with only about one-third of the radiation required for conventional radiography. Since its approval by the Food and Drug Administration (FDA) in the USA, several trauma centers have incorporated this technology into their Advanced Trauma Life Support protocols. This review provides a brief overview of the system, and describes the authors' own experience with the system. Methods We performed a PubMed search to retrieve all references with 'Lodox' and 'Stat-scan' used as search terms. We furthermore used the google search engine to identify existing alternatives. To the best of our knowledge, this is the only FDA-approved device of its kind currently used in trauma. Results and Conclusion The intention of our review has been to sensitize the readership that such alternative devices exist. The key message is that low dosage full body radiography may be an alternative to conventional resuscitation room radiography which is usually a prelude to CT scanning (ATLS algorithm). The combination of both is radiation intensive and therefore we consider any reduction of radiation a success. But only the future will show whether LS will survive in the face of low-dose radiation CT scanners and magnetic resonance imaging devices that may eventually completely replace conventional radiography. PMID:19747397

Evangelopoulos, Dimitrios S; Deyle, Simone; Zimmermann, Heinz; Exadaktylos, Aristomenis K

2009-01-01

392

Social support among releasing men prisoners with lifetime trauma experiences.  

PubMed

High rates of lifetime trauma experiences exist among men incarcerated in US state and federal prisons. Because lifetime trauma experiences have been linked to problematic behavioral and psychiatric outcomes for incarcerated populations, trauma-informed interventions could improve post-release well-being of releasing men prisoners with trauma histories. Social support has consistently been found to have a positive impact on trauma-related outcomes in non-incarcerated populations. Therefore, it is reasonable to hypothesize that social support may be an important intervention component for releasing men prisoners with trauma experiences; yet, the relationship between trauma experiences, psychiatric and behavioral factors, and social support has received almost no attention in research with men prisoners. Using a probability sample of 165 soon-to-be-released men, the present study examined differences in certain demographic, criminal justice history, mental health, substance abuse, and social support (type, quality, amount, and source) variables between releasing men prisoners with and without lifetime trauma experiences. Results indicate that men with trauma histories had more negative social support experiences and fewer positive social support resources before prison than their counterparts. Men with trauma histories also had more lifetime experiences with mental health and substance use problems. On further investigation of the subsample of men with trauma histories, those who were older, had substance use disorders, and histories of mental health problems anticipated fewer post-release social support resources. Study findings underscore the nuances of social support for men prisoners with trauma experiences and point to implications for future directions in targeted trauma-informed intervention development for releasing men prisoners. PMID:24666733

Pettus-Davis, Carrie

2014-01-01

393

A case of trauma related Acanthamoeba keratitis.  

PubMed

Acanthamoeba is an uncommon cause of keratitis but one of the most severe because of the prolonged and painful course of the disease and poor visual outcome. Although contact lens use is the principal risk factor, about 10% of cases occur following trauma and exposure to contaminated soil or water. Two cases of Acanthamoeba keratitis involving women contact lens wearers have previously been reported in Malaysia but this is the first time, a non contact lens related Acanthamoeba keratitis is reported. The case involved a 28 year old Indonesian male construction worker who had a trauma of the right eye during work. His eye was struck by sand and dust particles after which he quickly washed with water from an open tank at the construction site. He experienced pain, redness, glaring and blurring of vision of the right eye three days later. The diagnosis was missed at initial presentation but culture of the corneal scraping had proven Acanthamoeba as the aetiological agent. The history and clinical findings of this trauma related Acanthamoeba keratitis are briefly discussed. PMID:16493405

Kamel, A G M; Faridah, H; Yusof, S; Norazah, A; Nakisah, M A

2004-12-01

394

Ventricular septal necrosis after blunt chest trauma  

PubMed Central

Abstract: Ventricular Septal Defect (VSD) after blunt chest trauma is a very rare traumatic affection. We report here a case of blunt chest injury-related VSD and pseudoaneurysm. A 30-year old male truck driver was referred from a trauma center to our hospital seven days after a blunt chest trauma and rib fracture. The patient had severe pulmonary edema and echocardiography showed large VSD. Several mechanisms are involved in the pathogenesis of this affection including an acute compression of the heart muscle between the sternum and the spine, leading to excessive changes in the intrathoracic and most likely the intracardiac pressure after blunt chest injury. Traumatical patients with the same symptoms may be at risk of sudden death. Therefore, a high grade of suspicion is mandatory even without solid evidence of myocardial damage on the initial evaluation. In continue some hidden angles of this case was discussed. Given the prognostic implications of traumatic VSD with associated pseudoaneurysm, its detection has critical value for preventing its clinical sequelae. PMID:22071450

Sabzi, Feridoun; Niazi, Mojtaba; Zokaei, Abdol Hamid; Sahebjamee, Farzad; Bazargan Hejazi, Shahrzad; Ahmadi, Alireza

2012-01-01

395

The Increase of Intra-Abdominal Pressure Can Affect Intraocular Pressure  

PubMed Central

Objective. This study aims to explore the usage of intraocular pressure measurements as the early indicator of the increase in intra-abdominal pressure. Methods. In this prospective study, 40 patients undergoing elective surgery were included. Patients were divided into four groups of 10 patients. The control group (Group C) was not subjected to laparoscopic intervention. Laparoscopic surgery was, respectively, performed with an intra-abdominal pressure of 9, 12, and 15?mmHg in Groups L (low), M (medium), and H (high pressure). Intraocular pressure was measured binocularly in each patient at three different times (before, during, and end of surgery) using a contact tonometer. Results. Patients' gender, age, body mass index (BMI), American Society of Anesthesiology (ASA) class, and operative times were not different among the groups. No complications occurred with either the surgery or measurement of intraocular pressure. Intubation was associated with a severe rise in IOP (P < 0.05). An increase in intraocular pressure was seen in groups M and H (P < 0.05). Conclusion. Intraocular pressure was increased in the groups with an intra-abdominal pressure of 12 mmHg or more. Measuring the intraocular pressure might be a useful method to estimate the intra-abdominal pressure. This trial is registered with NCT02319213. PMID:25648230

Ece, Ilhan; Vatansev, Celalettin; Kucukkartallar, Tevfik; Tekin, Ahmet; Kartal, Adil; Okka, Mehmet

2015-01-01

396

Human thoracic and abdominal aortic aneurysmal tissues: Damage experiments, statistical analysis and constitutive modeling.  

PubMed

Development of aortic aneurysms includes significant morphological changes within the tissue: collagen content increases, elastin content reduces and smooth muscle cells degenerate. We seek to quantify the impact of these changes on the passive mechanical response of aneurysms in the supra-physiological loading range via mechanical testing and constitutive modeling. We perform uniaxial extension tests on circumferentially and axially oriented strips from five thoracic (65.6 years±13.4, mean±SD) and eight abdominal (63.9 years±11.4) aortic fusiform aneurysms to investigate both continuous and discontinuous softening during supra-physiological loading. We determine the significance of the differences between the fitted model parameters: diseased thoracic versus abdominal tissues, and healthy (Weisbecker et al., J. Mech. Behav. Biomed. Mater. 12, 93-106, 2012) versus diseased tissues. We also test correlations among these parameters and age, Body Mass Index (BMI) and preoperative aneurysm diameter, and investigate histological cuts. Tissue response is anisotropic for all tests and the anisotropic pseudo-elastic damage model fits the data well for both primary loading and discontinuous softening which we interpret as damage. We found statistically relevant differences between model parameters fitted to diseased thoracic versus abdominal tissues, as well as between those fitted to healthy versus diseased tissues. Only BMI correlated with fitted model parameters in abdominal aortic aneurysmal tissues. PMID:25460406

Pierce, David M; Maier, Franz; Weisbecker, Hannah; Viertler, Christian; Verbrugghe, Peter; Famaey, Nele; Fourneau, Inge; Herijgers, Paul; Holzapfel, Gerhard A

2014-10-18

397

Abdominal visceral adiposity influences CD4(+) T cell cytokine production in pregnancy.  

PubMed

Women with pre-gravid obesity are at risk for pregnancy complications. While the macrophage response of obese pregnant women categorized by body mass index (BMI) has been documented, the relationship between the peripheral CD4(+) T cell cytokine profile and body fat compartments during pregnancy is unknown. In this study, third trimester peripheral CD4(+) T cell cytokine profiles were measured in healthy pregnant women [n=35; pre-pregnancy BMI: 18.5-40]. CD4(+) T cells were isolated from peripheral blood mononuclear cells and stimulated to examine their capacity to generate cytokines. Between 1 and 3weeks postpartum, total body fat was determined by dual-energy X-ray absorptiometry and abdominal subcutaneous and visceral fat masses were determined by magnetic resonance imaging. Pearson's correlation was performed to assess relationships between cytokines and fat mass. Results showed that greater abdominal visceral fat mass was associated with a decrease in stimulated CD4(+) T cell cytokine expression. IFN-gamma, TNF-alpha, IL-12p70, IL-10 and IL-17A were inversely related to visceral fat mass. Chemokines CCL3 and IL-8 and growth factors G-CSF and FLT-3L were also inversely correlated. Additionally, total body fat mass was inversely correlated with FGF-2 while abdominal subcutaneous fat mass and BMI were unrelated to any CD4(+) T cell cytokine. In conclusion, lower responsiveness of CD4(+) T cell cytokines associated with abdominal visceral fat mass is a novel finding late in gestation. PMID:25458969

Ozias, Marlies K; Li, Shengqi; Hull, Holly R; Brooks, William M; Petroff, Margaret G; Carlson, Susan E

2015-02-01

398

Smoking Is Associated With Abdominal Obesity, Not Overall Obesity, in Men With Type 2 Diabetes  

PubMed Central

Objectives Abdominal obesity increases mortality and morbidity from cardiovascular disease and there is a possibility that smoking effects obesity. However, previous studies concerning the effects of smoking on obesity are inconsistent. The objective of this study was to examine whether smoking is positively related to abdominal obesity in men with type 2 diabetes. Methods Subjects consisted of 2197 type 2 diabetic patients who visited Huh's Diabetes Center from 2003 to 2009. Indices of abdominal obesity were defined as visceral fat thickness (VFT) measured by ultrasonography and waist circumference (WC). Overall obesity was defined as body mass index (BMI). Results Statistically significant differences in WC and VFT by smoking status were identified. However, there was no statistical difference in BMI according to smoking status. Means of WC and VFT were not significantly higher in heavy smokers and lower in mild smokers. Compared to nonsmokers, the BMI confounder adjusted odds ratio and 95% confidence interval for VFT in ex-smokers and current-smokers were 1.70 (1.21 to 2.39) and 1.86 (1.27 to 2.73), respectively. Conclusions Smoking status was positively associated with abdominal obesity in type 2 diabetic patients. PMID:23091657

Yun, Ji Eun; Kimm, Heejin; Choi, Young Ju; Huh, Kap Bum

2012-01-01

399

SEBASTIAN RACLAW ABDOMINAL CANCER FUND COMEDY NIGHT FunDRAISER  

E-print Network

for an evening of laughter! Friday, April 26, 2013 Milwaukee's Comedy Café 615 E. Brady Street, Milwaukee, WI 6 benefit the Sebastian Raclaw Abdominal Cancer Fund The Sebastian Raclaw Abdominal Cancer Fund

400

Small Animal Abdominal Ultrasound Seminar & Wetlab  

E-print Network

: Dr. George Henry Noon­1:00 p.m. Lunch 1:00­5:00 p.m. Hands-on Abdominal Ultrasound Lab 5:00 p.m. Wrap Campbell CMP, UTCVM Continuing Education 2407 River Drive Room A104D, Knoxville, TN 37996-4550 f. 865

Wang, Xiaorui "Ray"

401

Functional bowel disorders and functional abdominal pain  

Microsoft Academic Search

The Rome diagnostic criteria for the functional bowel disorders and functional abdominal pain are used widely in research and practice. A committee consensus approach, including criticism from multinational expert reviewers, was used to revise the diagnostic criteria and update diagnosis and treatment recommendations, based on research results. The terminology was clarified and the diagnostic criteria and management recommendations were revised.

W G Thompson; G F Longstreth; D A Drossman; K W Heaton; E J Irvine; S A Müller-Lissner

1999-01-01

402

Laparoscopic Management of an Abdominal Pregnancy  

PubMed Central

Background. Ectopic pregnancy is one of the leading causes of significant maternal morbidity and mortality. Abdominal surgeries increase the risk of postoperative adhesions. We here present a case of omental ectopic pregnancy in a patient with a prior history of cesarean section. Case. A 20-year-old female presented with a two-day history of crampy lower abdominal pain. Patient was hemodynamically stable with a beta HCG of 1057?mI/mL. Transvaginal ultrasound did not show an intrauterine pregnancy but revealed an ill-defined mass in the midline pelvis extending to the right of the midline. Diagnostic laparoscopy revealed large clots in the pelvis with normal uterus and adnexa. Intra-abdominal survey revealed an omental adhesion close to the right adnexa with a hematoma. Partial omentectomy was completed and the portion of the omentum with the hematoma was sent to pathology for confirmation. Final pathology confirmed the presence of chorionic villi consistent with products of conception. Conclusion. Omental ectopic pregnancy is a rare diagnosis and often missed. We recommend careful intra-abdominal survey for an ectopic pregnancy in the presence of hemoperitoneum with normal uterus and adnexa. This can be safely achieved using laparoscopy in early gestational ages when the patient is hemodynamically stable. PMID:25478262

2014-01-01

403

Fat Segmentation in Abdominal Thomas Hammershaimb Mosbech  

E-print Network

Fat Segmentation in Abdominal MR-scans Thomas Hammershaimb Mosbech Kongens Lyngby 2008 #12 resonance images. The segmentation dis- tinguishes between three types of adipose tissue; visceral adipose boundary is segmented, and the visceral adipose tissue is sepa- rated from the subcutaneous adipose tissue

404

Abdominal fat segmentation using graph cut methods  

E-print Network

Abdominal fat segmentation using graph cut methods Anamaria Marta Sirghie s102133 Kongens Lyngby tissue (SAT) and visceral adipose tissue (VAT) volume from 3D DIXON MRI. The test data used was acquired in finding the sought surface. VAT estimation is conducted using information from both fat and water images

405

Segmentation of male abdominal fat using MRI  

E-print Network

Segmentation of male abdominal fat using MRI Peter Stanley Jørgensen Kongens Lyngby 2006 IMM is done into 3 classes: subcutaneous adipose tissue, visceral adipose tissue and other tissue. The MRI of adipose tissue into the subcutaneous adipose tissue and visceral adipose tissue classes is done using

406

[A woman with acute upper abdominal pain].  

PubMed

A 42-year-old woman came to the emergency department with acute abdominal pain. CT-scan showed an isolated dissection of the A. mesenterica superior and signs of ischaemic colitis. The patient was treated with endovascular stent placement in the artery and partial small bowel resection. PMID:21771373

Urlings, Thijs A J; van Weel, Vincent; van der Linden, Edwin

2011-01-01

407

Abdominal wall repair using human acellular dermis  

Microsoft Academic Search

BackgroundThe surgical repair of abdominal wall defects that cannot be closed primarily in contaminated fields is a difficult problem. The use of nonabsorbable synthetic materials usually is contraindicated in this setting because of the risk for colonization and chronic infection of the mesh. In this study we sought to determine the safety and efficacy of implanted human acellular dermal graft

Charles F. Bellows; Daniel Albo; David H. Berger; Samir S. Awad

2007-01-01

408

Endovascular infrarenal abdominal aortic aneurysm repair  

Microsoft Academic Search

Abdominal aortic aneurysm repair has undergone a revolution since Volodos and Parodi described endoluminal repair in the early 1990s. Subsequent data from large registries have confirmed its efficacy. Randomised controlled trials have shown that although endoluminal repair may not be as cost effective as open repair, it can be performed with a lower mortality in patients fit for open repair.

M Davis; P R Taylor

2008-01-01

409

The Disappearing Abdominal Mass: Mesenteric Pseudocyst  

PubMed Central

Introduction: Mesenteric pseudocyst is a term used to describe an abdominal cystic mass with an unknown abdominal origin. They are rare intra-abdominal masses, with a reported incidence of approximately 1 per 100,000 to 250,000 hospital admissions. Most cysts are benign and they may present differently, such as a disappearing mass or a mass that changes locations, thus posing a diagnostic challenge to the clinician. Case Report: We describe a case of a 29-year-old woman who presented with a 2-year history of feeling a large mass within her abdomen, which would then disappear for several days and would frequently change position and be felt in different quadrants of her abdomen. Computed tomography scan of the abdomen revealed a large cystic structure, and a computed tomography–guided biopsy was inconclusive. Diagnostic laparoscopic surgery revealed a firm mass arising from the jejunal mesentery; the patient underwent an en bloc resection. Histopathologic examination of the resected mass revealed a rare diagnosis of mesenteric pseudocyst. Mesenteric pseudocyst should be should be kept high on the list of differential diagnoses when a patient presents with a disappearing mass and/or an abdominal mass that changes location. PMID:24960500

Orfanou, Paraskevi

2014-01-01

410

Extraosseous Ewing's tumor of lateral abdominal wall  

PubMed Central

Extraosseous Ewings tumor (EES) is a rare entity. Few cases have been reported in literature. There are no specific guidelines for management of this disease. We are reporting a case of EES arising from left lateral abdominal wall. We did wide excision of tumor followed by chemoradiation. Patient is asymptomatic after 8 months of follow up. PMID:24765376

Gupta, Nikhil; Chand, Tirlok; Yadav, Nidhi; Kumar, Rajeev; Chauhan, Devender S.; Chaudhary, Poras; Arora, Mohinder P.

2011-01-01

411

Compartmental anatomical classification of traumatic abdominal injuries from the academic point of view and its potential clinical implication  

PubMed Central

Background The mechanism and outcome of traumatic abdominal injury (TAI) varies worldwide. Moreover, data comparing TAIs in each abdominal compartment are lacking. We aimed to assess from the academic point of view, TAI based on its anatomical compartments. Patients & methods We conducted a retrospective study for TAI patients between 2008 and 2011 in Qatar. Patients were categorized according to the involved anatomical compartment (C): intrathoracic (ITC), retroperitoneal (RPC), true abdomen (TAC), and pelvic abdomen (PAC) group. Chi Square test, One-Way ANOVA and multivariate regression analysis were appropriately performed. Results Of 6,888 patients admitted to the trauma unit, 1,036 (15%) had TAI that were grouped as ITC (65%), RPC (15%), TAC (13%), and PAC (7%). The mean age was lowest in ITC (29?±?13) and highest in TAC (34?±?11) group, (P?=?0.001). Motor vehicle crash was the main mechanism of injury in all groups except for PAC, in which fall dominated. Vast majority of expatriates had PAC and TAC injuries. The main abdominal injuries included liver (35%; ITC), spleen (32%; ITC) and kidneys (18%; RPC). Extra-abdominal injuries involved the head in RPC and ITC, lung in ITC and RPC and extremities in PAC. Mean ISS was higher in RPC and ITC. Abdominal AIS was higher in TAC injuries. Overall hospital mortality was 10%: RPC (15%), TAC (11%), ITC (9.4%) and PAC (1.5%). Concurrent traumatic brain injury (OR 5.3; P?=?0.001) and need for blood transfusion (OR 3.03; P?=?0.003) were the main independent predictors of mortality. Conclusion In addition to its academic value, the anatomical approach of TAI would be a complementary tool for better understanding and prediction of the pattern and outcome of TAI. This would be possible if further research find accurate, early diagnostic tool for this anatomical classification. PMID:25332723

2014-01-01

412

The Convergent Validity of the Trauma Symptom Checklist for Young Children for a Sample of Sexually Abused Outpatients  

Microsoft Academic Search

The convergent validity of the Trauma Symptom Checklist for Young Children (TSCYC) was examined with a sample of 172 sexually abused outpatient treatment-seeking children and their caregivers. The TSCYC evidenced good convergent validity with other parent ratings (e.g., the Child Behavior Checklist, Child Sexual Behavior Inventory, and the University of California at Los Angeles Post-Traumatic Stress Disorder Reaction Index [UCLA

Jeffrey N. Wherry; Lauren E. Graves; Heidi M. Rhodes King

2008-01-01

413

Effect of aeromedical aircraft on care of trauma patients: evaluation using the Revised Trauma Score.  

PubMed

Rotor wing aircraft used in transport of the trauma victim have not been subject to objective means of evaluating their contribution to patient care. A retrospective evaluation of a Bell 206 L-1 and an Aerospatiale 365 N-1 using the Revised Trauma Score Triage (RTS) as an indicator of status in 98 patients transported from the scene of injury was conducted. Ground (GT), flight (FT), and total mission (TMT) times, as well as initial RTS, final RTS, and the difference between them (DRTS) were determined for all patients. Statistical analysis was done using two-way ANOVA. GT, FT, and TMT were significantly lower in patients transported by the 365 N-1. In more severely injured patients (RTS < or = 10), DRTS and final RTS were significantly higher in the 365 N-1; FT was significantly less. The contributions of various aeromedical aircraft to the care of the trauma victim may be assessed using objective indices of patient status. PMID:1439941

Rodenberg, H

1992-11-01

414

Abdominal adenopathy found during a routine follow-up.  

PubMed

During routine follow-up of a 60-year-old man with an endoluminal lesion of the duodenum, we found a persistent reactive abdominal adenopathy of unknown origin, later diagnosed as an abdominal localization of sarcoidosis. This article focuses on the differential diagnosis of abdominal granulomatous lymphadenopathies, the management of abdominal adenopathy of unknown origin, and the difficult decision making about sampling lymph nodes with reactive and inflammatory echographic appearance. PMID:25621963

Carmagnola, Stefania; Venezia, Ludovica; Anderloni, Andrea; Nicali, Roberta; Patrucco, Filippo; Balbo, Piero Emilio

2015-02-01

415

Developing and organizing a trauma system and mass casualty management: some useful observations from the israeli trauma model.  

PubMed

A trauma system is a chain of arrangements and preparedness to provide quality response to injured from the site of injury to the appropriate hospital for the full range of care. Israel has a unique trauma system developed from the experience gained in peace and in war. The system is designed to fit the state's current health system, which is different from the European and American systems. An effective trauma system may potentially manage mass casualty incidence better. The aim of this paper is to discuss learning points to develop a trauma system based on the Israeli trauma model. After participating in a course on developing a trauma system organized by a top Israeli trauma center, a literature search on the topic on the Internet was done using relevant key words like trauma system and disaster management in Israel using the Google search engine in the pubmed, open access journals and websites of trauma organizations. Israel has a unique trauma system of organizing and managing an emergency event, characterized by a central national organization responsible for management, coordination and ongoing quality control. Because of its unique geopolitical situation, the armed forces has a significant role in the system. Investing adequate resources on continuous education, manpower training, motivation, team-work and creation of public volunteers through advocacy is important for capacity building to develop a trauma system. Wisdom, motivation and pragmatism of the Israeli model may be useful to streamline work in skeletal trauma services of developing countries having fewer resources to bring consistency and acceptable standards in trauma care. PMID:23634336

Borgohain, B; Khonglah, T

2013-01-01

416

The impact of shorter prehospital transport times on outcomes in patients with abdominal vascular injuries  

PubMed Central

Background Most deaths in patients with abdominal vascular injuries (ABVI) are caused by exsanguination and irreversible shock. Therefore, time to definitive hemorrhage control is an important factor affecting survival. The study goals were: (1) document current outcomes in patients with ABVI, and (2) compare outcomes to those from the era preceding improvements in an urban prehospital system. Methods A retrospective review of all patients with ABVI at an urban level 1 trauma center was completed. Patients injured prior to prehospital transport improvements (1991–1994) were compared to those following a reduction in transport times (1995–2004). Results Of 388 patients, 70 (18%) arrived prior to prehospital improvements (1991–1994). Patient/injury demographics were similar in both groups (age, sex, penetrating mechanism; p?>?0.05). The number of patients presenting with ABVI increased (23 vs. 35 per year; p?abdominal vascular injuries, (2) the proportion presenting in physiologic extremis, and (3) overall mortality. PMID:24360286

2013-01-01

417

Unnecessary laparotomy by using physical examination and different diagnostic modalities for penetrating abdominal stab wounds  

PubMed Central

Background: The modern management of penetrating abdominal trauma has decreased the incidence of unnecessary laparotomy by using selective non-operative management protocols. However, the real benefits of physical examination and different diagnostic methods are still unclear. Methods: From January 2000 to April 2003, we prospectively collected data on 117 patients with penetrating stab wounds to the thoracoabdominal, anterior abdominal, and back regions who had non-operative management. Clinical examination was the primary tool to differentiate those patients requiring operation. Findings of physical examination, ultrasound, computed tomography, endoscopy, echocardiography, diagnostic peritoneal lavage, and diagnostic laparoscopy were reviewed. The number of therapeutic, non-therapeutic, and negative laparotomies were recorded. Results: Non-operative management was successful in 79% of patients. There were 11 early (within 8 hours of admission) and 14 delayed (more than 8 hours after admission) laparotomies performed, depending on the results of various diagnostic procedures. Non-operative management failed in 21% of patients, and the rate of non-therapeutic laparotomy in early and delayed laparatomy groups was 9% and 14% respectively. There was no negative laparatomy. Conclusions: The use of physical examination alone and/or together with different diagnostic methods allows reduction of non-therapeutic laparotomies and elimination of negative laparatomies. PMID:16244337

Ertekin, C; Yanar, H; Taviloglu, K; Guloglu, R; Alimoglu, O

2005-01-01

418

Lateral abdominal muscle size at rest and during abdominal drawing-in manoeuvre in healthy adolescents.  

PubMed

Lateral abdominal wall muscles in children and adolescents have not been characterised to date. In the present report, we examined the reliability of the ultrasound measurement and thickness of the oblique external muscle (OE), oblique internal muscle (OI) and transverse abdominal muscle (TrA) at rest and during abdominal drawing-in manoeuvre (ADIM) on both sides of the body in healthy adolescents. We also determined possible differences between boys and girls and defined any factors-such as body mass, height and BMI-that may affect the thickness of the abdominal muscles. B-mode ultrasound was used to assess OE, OI and TrA on both sides of the body in the supine position. Ultrasound measurements at rest and during ADIM were reliable in this age group (ICC3,3 > 0.92). OI was always the thickest and TrA the thinnest muscle on both sides of the body. In this group, an identical pattern of the contribution of the individual muscles to the structure of the lateral abdominal wall (OI > OE > TrA) was observed. At rest and during ADIM, no statistically significant side-to-side differences were demonstrated in either gender. The body mass constitutes between 30% and <50% of the thickness differences in all muscles under examination at rest and during ADIM. The structure of lateral abdominal wall in adolescents is similar to that of adults. During ADIM, the abdominal muscles in adolescents react similarly to those in adults. This study provided extensive information regarding the structure of the lateral abdominal wall in healthy adolescents. PMID:25088309

Linek, Pawel; Saulicz, Edward; Wolny, Tomasz; My?liwiec, Andrzej; Kokosz, Miros?aw

2015-02-01

419

Diagnostic yield of oesophagogastroduodenoscopy in children with abdominal pain  

Technology Transfer Automated Retrieval System (TEKTRAN)

Abdominal pain is the most common indication for OGD in children. However, existing studies examining the diagnostic outcomes of OGD in children with abdominal pain are limited. We conducted the current study to examine the diagnostic yield of OGD with biopsy in the evaluation of abdominal pain and ...

420

Relative Activity of Abdominal Muscles during Commonly Prescribed Strengthening Exercises.  

ERIC Educational Resources Information Center

Examined the relative electromyographic (EMG) activity of upper and lower rectus abdominis (LRA) and external oblique (EOA) muscles during five abdominal strengthening exercises. Isometric and dynamic EMG data indicated that abdominal strengthening exercises activated various abdominal muscle groups. For the LRA and EOA muscle groups, there were…

Willett, Gilbert M.; Hyde, Jennifer E.; Uhrlaub, Michael B.; Wendel, Cara L.; Karst, Gregory M.

2001-01-01

421

Metabolic and inflammatory responses after laparoscopic and abdominal hysterectomy  

Microsoft Academic Search

OBJECTIVE: Our purpose was to quantify and compare the metabolic and inflammatory changes after laparoscopic and abdominal hysterectomy.STUDY DESIGN: Forty-four patients with no major medical disease requiring abdominal hysterectomy for benign disorders were randomly assigned to have laparoscopic hysterectomy (n = 20) and abdominal hysterectomy (n = 24). Venous blood and 24-hour urine samples were collected the day before and

Pong Mo Yuen; Tony W. L. Mak; So Fan Yim; Warwick D. Ngan Kee; Christopher W. K. Lam; Michael S. Rogers; Allan M. Z. Chang

1998-01-01

422

[Acute abdominal pain in the emergency department - a clinical algorithm for adult patients].  

PubMed

Acute abdominal pain represents the cardinal symptom behind a vast number of possible under-lying causes including several ones that re-quire surgical treatment. It is the most common sur-gical emergency, the most common cause for a surgical consultation in the emergency department and the most common cause for non-trauma related hospital admissions. The golden mis-sion statement is to rapidly identify whether the underlying cause requires an urgent or even immediate surgical intervention. However, behind the same cardinal symptom one may encounter harmless or non-urgent problems. By employing diagnostic means cost effectively and with the aim to avoid unnecessary exposure of the patient to X-rays in mind, the challenge remains to identify patients with an indication for emergency surgery from those who suffer from a less serious condition and thus can be treated conservatively and without any pressure of time. Dealing with such a highly complex decision-making process calls for a clinical algorithm. Many publications are available that have scrutinised the different aspects of the initial assessment and the emergency management of acute abdominal pain. How-ever, the large body of evidence seems to miss articles that describe a formally correct priority- and problem-based approach. Clinical algorithms apply to complex disease states such as acute abdominal pain and translate them into one clearly laid out, logically coordinated and systematic overall process. Our intention is to devel-op such an algorithm to approach acute abdominal pain from the surgeon's point of view. Based on daily practice and with reference to available literature, it is the aim of this study to define a work flow that simply summarises all steps in-volved and defines the required decision process in order to form the intellectual basis for an evidence-based clinical algorithm. The result is illustrated as a first draft of such an evidence-based algorithm to allow emergency evaluation of adult patients with acute abdominal pain. PMID:21424993

Trentzsch, H; Werner, J; Jauch, K-W

2011-04-01

423

The application of mixed methods designs to trauma research.  

PubMed

Despite the use of quantitative and qualitative data in trauma research and therapy, mixed methods studies in this field have not been analyzed to help researchers designing investigations. This discussion begins by reviewing four core characteristics of mixed methods research in the social and human sciences. Combining these characteristics, the authors focus on four select mixed methods designs that are applicable in trauma research. These designs are defined and their essential elements noted. Applying these designs to trauma research, a search was conducted to locate mixed methods trauma studies. From this search, one sample study was selected, and its characteristics of mixed methods procedures noted. Finally, drawing on other mixed methods designs available, several follow-up mixed methods studies were described for this sample study, enabling trauma researchers to view design options for applying mixed methods research in trauma investigations. PMID:19960518

Creswell, John W; Zhang, Wanqing

2009-12-01

424

The influence of penetrative trauma on the rate of decomposition.  

PubMed

An understanding of the factors affecting decomposition is important for the accurate estimation of postmortem interval. An experimental study on the influence of penetrating trauma on decomposition rate was carried out using the domestic pig, Sus scrofa. The results of this study were: (i) Diptera were preferentially attracted to and oviposited at natural orifices. Trauma sites were not preferentially selected for oviposition; (ii) no differences between trauma and non-trauma groups were found in time to skeletonization, weight loss (p = 0.906), total body score (p = 0.824), body temperature (p = 0.967), or changes in soil pH (p = 0.684); and (iii) the effect of investigator disturbance was significant when decomposition was measured as weight loss (p = 0.000). This study suggests that penetrating trauma of the type used in this study cannot be considered a major factor in the rate of decomposition and time to skeletonization of a gunshot trauma victim. PMID:20141561

Cross, Peter; Simmons, Tal

2010-03-01

425

Childhood trauma, posttraumatic stress disorder, and alcohol dependence.  

PubMed

Early-childhood trauma is strongly associated with developing mental health problems, including alcohol dependence, later in life. People with early-life trauma may use alcohol to help cope with trauma-related symptoms. This article reviews the prevalence of early-childhood trauma and its robust association with the development of alcohol use disorders and posttraumatic stress disorder. It also examines the potential biological mechanisms by which early adverse experiences can result in long-lasting changes in neurobiology underlying this vulnerability, as well as pharmacological and behavioral interventions. Recent investigations highlight the importance of assessing trauma among patients with alcohol use disorders and the positive benefits associated with the application of integrative psychosocial interventions that target both trauma-related symptoms and alcohol dependence. PMID:23584107

Brady, Kathleen T; Back, Sudie E

2012-01-01

426

Alterations in empathic responding among women with posttraumatic stress disorder associated with childhood trauma  

PubMed Central

Objective Although studies increasingly point toward problems with social cognition among individuals with posttraumatic stress disorder (PTSD), few studies have assessed empathic responding. The aim of the current study was to investigate empathic responding in women with PTSD related to childhood trauma, and the contribution of parental bonding to empathic abilities in this sample. Methods Participants with PTSD (n = 29) and sex- and age-matched healthy controls (n = 20) completed two self-report empathy measures, the Interpersonal Reactivity Index (IRI) and the Toronto Empathy Questionnaire (TEQ), and a self-report measure of attachment, the Parental Bonding Instrument (PBI). Results Women with PTSD, relative to controls, reported significantly lower levels of empathic concern (r = 0.29) and perspective taking (r = 0.30), yet significantly higher levels of personal distress (r = 0.45) on the IRI. Women with PTSD also reported elevated scores on the TEQ (?2 = 0.13). Levels of paternal care on the PBI, rather than childhood trauma severity or PTSD symptom severity best predicted perspective taking scores on the IRI in the PTSD sample (R2 = 0.20). Conclusion Women with PTSD associated with childhood trauma reported alterations among different domains of empathic functioning that may be related to low levels of paternal care. PMID:24944867

Parlar, Melissa; Frewen, Paul; Nazarov, Anthony; Oremus, Carolina; MacQueen, Glenda; Lanius, Ruth; McKinnon, Margaret C

2014-01-01

427

Telepresence and telemedicine in trauma and emergency care management.  

PubMed

The use of telemedicine is long-standing, but only recently has been applied to the specialties of trauma, emergency care, and surgery. Subsequently the concepts of teletrauma, telepresence, and telesurgery have evolved and are being integrated into modern care of trauma and surgical patients. This chapter will review the current applications and future endeavors of telemedicine and telepresence to trauma and emergency care as the new frontiers of telemedicine application. PMID:15747979

Latifi, Rifat; Peck, Kim; Porter, John M; Poropatich, Ron; Geare, Ted; Nassi, Richard B

2004-01-01

428

A Study of Collaborative Information Behavior in Trauma Resuscitation  

Microsoft Academic Search

In high-reliability work settings, most human work is performed by teams of workers who often engage in collaborative information behavior to solve complex problems. In this paper, we examine collaborative information behavior of trauma teams during trauma resuscitation, a team-dependent, fast-paced and information-laden process of evaluating critically injured patients early after injury. We identify trauma teams' tasks in which collaborative

Aleksandra Sarcevic

429

Extremity CT angiography: application to trauma using 64MDCT  

Microsoft Academic Search

Evolving multi-row detector computed tomography (MDCT) technology has resulted in increasing utility of CT angiography (CTA)\\u000a in extremity vascular trauma diagnosis and characterization. Given the widespread availability as well as the ease of acquiring\\u000a CTA in the trauma setting, CTA is increasingly being used as the initial diagnostic evaluation in extremity vascular trauma,\\u000a replacing digital subtraction angiography in many institutions.

Neil Shah; Stephan W. Anderson; Michelle Vu; Sabrina Pieroni; James T. Rhea; Jorge A. Soto

2009-01-01

430

Differentiation of perimortem and postmortem trauma using taphonomic indicators.  

PubMed

Skeletal remains discovered at a construction site in Georgia display classic "butterfly" fractures on several long bones. Although this fracture pattern is usually associated with perimortem trauma, in this case taphonomic indicators demonstrate that they can also occur on dry defleshed bone. Variations in bone color at the fracture sites indicate recent postmortem trauma. Analysis of the directions of force and points of impact indicates that the bones were most likely disarticulated when the trauma occurred. PMID:7782760

Ubelaker, D H; Adams, B J

1995-05-01

431

Craniofacial trauma and double epidural hematomas from horse training?  

PubMed Central

INTRODUCTION A case of complex poly-trauma requiring multi-service management of rare, diagnoses is reviewed. PRESENTATION OF CASE A healthy 20 year old female suffered double epidural hematoma, base of, skull fracture, traumatic cranial nerve X palsy, benign positional paroxysmal vertigo and supraorbital, neuralgia following equestrian injury. DISCUSSION Epidemiology, differential diagnosis, and principles of management for each condition, are reviewed. CONCLUSION Coordinated trauma care is well suited to address the complex poly trauma following, equestrian injury. PMID:24291680

Baugh, Aaron D.; Baugh, Reginald F.; Atallah, Joseph N.; Gaudin, Daniel; Williams, Mallory

2013-01-01

432

Abdominal obesity is associated with heart disease in dogs  

PubMed Central

Background The relationship between overall obesity and fat distribution in dogs and the development of heart disease is unclear. In the present study we evaluated the association between overall obesity and fat distribution and clinical heart disease by morphometric and computed tomography (CT)-based measurements. Body condition score (BCS), modified body mass index (MBMI, kg/m2), waist-to-hock-to-stifle distance ratio (WHSDR), waist-to-ilium wing distance ratio (WIWDR), and waist-to-truncal length ratio (WTLR) were compared between dogs with (n?=?44) and without (n?=?43) heart disease using receiver operating characteristic (ROC) analysis. Intra-abdominal fat (IAF) and subcutaneous fat (SQF) were measured in dogs with (n?=?8) and without (n?=?9) heart disease at the center of the fourth and fifth lumbar vertebrae by CT. Results BCS was similar between heart disease and healthy groups (3.6?±?0.2 vs. 3.3?±?0.1, P?=?0.126). The following morphometric measurements were greater in the heart disease group compared with healthy canines: MBMI (65.0?±?4.5 vs. 52.5?±?3.7 kg/m2, respectively, P?=?0.035); WIWDR (4.1?±?0.1 vs. 3.1?±?0.1, P?abdominal obesity, rather than overall obesity, is associated with heart disease in dogs. Measurements of both WIWDR and WTLR are particular useful for detection of an abdominal obesity in dogs. PMID:24923277

2014-01-01

433

Index des mots-cls Keywords index  

E-print Network

Index des mots-clés Keywords index A Abies, 823 Abies alba, 265 acacia, 93 Acacia cyanophylla Lindl., 335 Acacia mearnsii De Wild., 833 acclimation, 19 AFLP, 627 AFLP, SSR, EST markers, 637 Agrobacterium

Boyer, Edmond

434

Cumulative effects of childhood traumas: polytraumatization, dissociation, and schizophrenia.  

PubMed

The study objective was to measure and compare the presence of childhood trauma and dissociative symptoms in a convenience sample of healthy controls and a probabilistic sample of outpatients with a diagnosis of schizophrenia. Patients reported more childhood trauma and more polytraumatization than the controls, and had a higher average dissociation score. In both cases and controls, the presence of childhood trauma was related to the intensity of the dissociation observed. Childhood trauma, clinical dissociation and schizophrenia are closely related, particularly when the patient has been the victim of more than one type of abuse. PMID:25022912

Álvarez, María-José; Masramon, Helga; Peña, Carlos; Pont, Marina; Gourdier, Caroline; Roura-Poch, Pere; Arrufat, Francesc

2015-01-01

435

Trauma History and PTSD Symptoms in Juvenile Offenders on Probation  

PubMed Central

Detained and incarcerated juveniles are found to have heightened rates of trauma and posttraumatic stress disorder (PTSD). Less is known about probation youth, who represent the majority of juveniles in the criminal justice system. This study examined trauma history and PTSD and associations with behavioral health problems among 13–17 year-old juveniles on probation (N=61). Most (93%) reported at least one traumatic event, and 12% met diagnostic criteria for PTSD. Trauma exposure and PTSD symptoms were associated with mental health problems but not substance use or risky sexual behavior. Findings underscore the importance of addressing trauma history in probation youth. PMID:24273468

Wilson, Helen W.; Berent, Elizabeth; Donenberg, Geri R.; Emerson, Erin M.; Rodriguez, Erin M.; Sandesara, Anand

2013-01-01

436

Paramedics' and pre-hospital physicians' assessments of anatomic injury in trauma patients: a cohort study  

PubMed Central

Background The pre-hospital assessment of a blunt trauma is difficult. Common triage tools are the mechanism of injury (MOI), vital signs, and anatomic injury (AI). Compared to the other tools, the clinical assessment of anatomic injury is more subjective than the others, and, hence, more dependent on the skills of the personnel. The aim of the study was to estimate whether the training and qualifications of the personnel are associated with the accuracy of prediction of anatomic injury and the completion of pre-hospital procedures indicated by local guidelines. Methods Adult trauma patients met by a trauma team at Helsinki University Trauma Centre during a 12-month period (n = 422) were retrospectively analysed. To evaluate the accuracy of prediction of anatomic injury, clinically assessed pre-hospital injuries in six body regions were compared to injuries assessed at hospital in two patient groups, the patients treated by pre-hospital physicians (group 1, n = 230) and those treated by paramedics (group 2, n = 190). Results The groups were comparable in respect to age, sex, and MOI, but the patients treated by physicians were more severely injured than those treated by paramedics [ISS median (interquartile range) 16 (6-26) vs. 6 (2-10)], thus rendering direct comparison of the groups ineligible. The positive predictive values (95% confidence interval) of assessed injury were highest in head injury [0,91 (0,84-0,95) in group 1 and 0,86 (0,77-0,92) in group 2]. The negative predictive values were highest in abdominal injury [0,85 (0,79-0,89) in group 1 and 0,90 (0,84-0,93) in group 2]. The measurements of agreement between injuries assessed pre- and in-hospitally were moderate in thoracic and extremity injuries. Substantial kappa values (95% confidence interval) were achieved in head injury, 0,67 (0,57-0,77) in group 1 and 0,63 (0,52-0,74) in group 2. The rate of performing the pre-hospital procedures as indicated by the local instructions was 95-99%, except for decompression of tension pneumothorax. Conclusion Accurate prediction of anatomic injury is challenging. No conclusive differences were seen in the ability of pre-hospital physicians and paramedics to predict anatomic injury in the respective patient populations. PMID:21092167

2010-01-01

437

Altered subcutaneous abdominal adipose tissue lipid synthesis in obese, insulin-resistant humans  

PubMed Central

The purpose of this study was to evaluate the variability of subcutaneous abdominal adipose tissue (AT) dynamics in obese subjects with a wide range of insulin sensitivity (IS) and the correlation between these two metabolic measures. Ten obese (BMI 30–40 kg/m2) nondiabetic subjects with (n = 6) and without (n = 4) the metabolic syndrome were studied following a 12-wk 2H2O labeling period. Subcutaneous abdominal AT biopsies were collected. Deuterium incorporation into triglyceride (TG)-glycerol and TG-palmitate were measured by gas chromatography-mass spectrometry for the calculation of fractional TG synthesis (fTG) and fractional de novo lipogenesis (fDNL). Muscle IS and insulin-mediated nonesterified fatty acid (NEFA) suppression (a measure for adipose IS) indexes were derived from the oral glucose tolerance test (OGTT). The ability of subcutaneous abdominal AT to synthesize lipids varied significantly in obese subjects (fTG range 7–28%, fDNL range 1.1–4.6%) with significantly lower values (>35% reduction) for both parameters in obese with the metabolic syndrome. fTG correlated positively with muscle IS (r = 0.64, P = 0.04) and inversely with NEFA suppression during the OGTT (r = ?0.69, P = 0.03). These results demonstrate a large variability in subcutaneous abdominal AT lipid turnover in obesity. Moreover, a reduced capacity for subcutaneous abdominal AT fat storage is associated with muscle and adipose tissue insulin resistance as well as with the metabolic syndrome, thus identifying a form of obesity at heightened risk for type 2 diabetes and cardiovascular disease. PMID:23982159

Tuvdendorj, Demidmaa; Chandalia, Manisha; Batbayar, Tumurbaatar; Saraf, Manish; Beysen, Carine; Murphy, Elizabeth J.

2013-01-01

438

Surface Electromyographic Activity of the Abdominal Muscles During Pelvic-Tilt and Abdominal-Hollowing Exercises  

PubMed Central

Objective: To investigate surface electromyographic (EMG) activity of the rectus abdominus and external oblique abdominus muscles during pelvic-tilt and abdominal-hollowing exercises performed in different positions. Design and Setting: 2 × 3 (exercise by position) within-subjects design with repeated measures on both factors. All testing was performed in a university laboratory. Subjects: Twenty-six healthy, active young adult females. Measurements: Surface EMG activity was recorded from the left and right rectus abdominus and external oblique muscles while the 2 exercises (pelvic tilt and abdominal hollowing) were performed in different positions (standard, legs supported, and legs unsupported). The standard position was supine in the crook-lying position, the supported position was with hips and knees flexed to 90° and legs supported on a platform, and the unsupported position was with hips and knees flexed to 90° without external support. Peak EMG activity was normalized to a maximum voluntary isometric contraction for each muscle. Results: For the rectus abdominus, there was an interaction between position and activity. Abdominal hollowing produced significantly less activity than the pelvic tilt in all positions. The difference between the 2 exercises with the legs unsupported was of a greater magnitude than the other 2 positions. For the external obliques, there was significantly lower activity during the abdominal hollowing compared with the pelvic tilting. The greatest muscle activity occurred with the legs-unsupported position during both exercises. Conclusions: Abdominal-hollowing exercises produced less rectus abdominus and external oblique activity than pelvic-tilting exercises. Abdominal hollowing may be performed with minimal activation of the large global abdominal muscles. PMID:15085209

Drysdale, Cheri L.; Earl, Jennifer E.

2004-01-01

439

A Design for Evaluation of the Trauma Apportionment in Cerebral Infarction after Trauma  

PubMed Central

Objective Posttraumatic cerebral infarction (CI) is a well-known complication of traumatic brain injury (TBI). However, the causation and apportionment of trauma in patients with CI after TBI is not easy. There is a scoring method, so-called trauma apportionment score (TAS) for CI, consisted with the age, the interval, and the severity of the TBI. We evaluated the reliability of this score. Methods We selected two typical cases of traumatic CI. We also selected consecutive 50 patients due to spontaneous CI. We calculated TAS in both patients with traumatic and spontaneous CI. To enhance the reliability, we revised TAS (rTAS) adding three more items, such as systemic illness, bad health habits, and doctor's opinion. We also calculated rTAS in the same patients. Results Even in 50 patients with spontaneous CI, the TAS was 4 in 44 patients, and 5 in 6 patients. TAS could not assess the apportionment of trauma efficiently. We recalculated the rTAS in the same patients. The rTAS was not more than 11 in more than 70% of the spontaneous CI. Compared to TAS, rTAS definitely enhanced the discriminating ability. However, there were still significant overlapping areas. Conclusion TAS alone is insufficient to differentiate the cause or apportionment of trauma in some obscure cases of CI. Although the rTAS may enhance the reliability, it also should be used with cautions.

Kim, Tae-Hoon; Park, Hae-Ran; Shim, Jae-Joon; Yoon, Seok-Mann; Doh, Jae-Won

2015-01-01

440

Trauma experience in children and adolescents: an assessment of the effects of trauma type and role of interpersonal proximity.  

PubMed

The psychiatric sequelae associated with childhood experience(s) of trauma is complex and distinguishable from that of adult trauma exposure. Categories of impairment associated with experiences of early trauma include internalizing and externalizing emotional and behavioral problems, posttraumatic stress symptomatology, and dissociation. The present study assessed the relationship between the type of trauma experience (i.e., non-interpersonal or interpersonal) and the manifestation of a wide range of psychiatric symptomatology using prospective longitudinal data from a community sample of ethnically diverse children and adolescents (N=1676; ages 4-18). The study also examined the relationship between different types of trauma experiences (e.g., direct, vicarious, interpersonal) and levels of various symptom domains (e.g., anxiety, posttraumatic stress, conduct problems). A number of factors relevant to the relationship between early trauma experience and subsequent impairment including temperament, socioeconomic status, sex, and age were included in the analyses. Results indicated that interpersonal traumas involving significant interpersonal proximity were associated with externalizing problems (i.e., oppositional defiant and conduct problems). Direct trauma experiences and emotionality were positively associated with almost all symptom domains. Implications for the relationship between trauma and developmental psychopathology are discussed. PMID:24064334

Price, Maggi; Higa-McMillan, Charmaine; Kim, Sunyoung; Frueh, B Christopher

2013-10-01

441

Comparing premodern melancholy/mania and modern trauma: an argument in favor of historical experiences of trauma.  

PubMed

Historians and psychiatrists have repeatedly looked to both real and imagined individuals of the past, like Achilles and Samuel Pepys, and found evidence that they were suffering from symptoms of trauma and posttraumatic stress disorder. The assumptions that allow such historical "diagnoses" have, however, recently been called into question by philosophers such as lan Hacking, anthropologists like Allan Young and psychiatrists such as Patrick Bracken. These scholars have all suggested in various ways that experiences of trauma could not have occurred until the diagnosis of trauma and its symptoms had been formalized and the language of trauma had been developed in the late 19th century. This article attempts to resolve this bifurcation of opinion on the universality of the mind and historical experiences of trauma in two ways. First, it argues for the necessity of applying modern categories of analysis to further present understandings of the past. Second, it considers discussions of"melancholia" and "mania" in premodern medical literature and argues that there are enough similarities between the causes and symptoms of these premodern disorders and modern trauma to suggest that experiences of trauma may not be wholly culturally bound to the modern world, as the above scholars have suggested. While melancholy or mania cannot simply be understood as premodern names for trauma, and it is not always correct to "diagnose" a premodern person who exhibits symptoms of these illnesses with trauma, such an assumption is not always ahistorical or incorrect either. PMID:21688753

Trembinski, Donna

2011-02-01

442

Null Association between Abdominal Muscle and Calcified Atherosclerosis in Community-Living Persons Without Clinical Cardiovascular Disease: the Multi-Ethnic Study of Atherosclerosis  

PubMed Central

Objective Detrimental effects of lean muscle loss have been hypothesized to explain J-shaped relationships of body mass index (BMI) with cardiovascular disease (CVD), yet associations of muscle mass with CVD are largely unknown. We hypothesized that low abdominal lean muscle area would be associated with greater calcified atherosclerosis, independent of other CVD risk factors. Materials/Methods We investigated 1020 participants from the Multi-Ethnic Study of Atherosclerosis who were free of clinical CVD. Computed tomography (CT) scans at the 4th and 5th lumbar disk space were used to estimate abdominal lean muscle area. Chest and abdominal CT scans were used to assess coronary artery calcification(CAC), thoracic aortic calcification (TAC), and abdominal aortic calcification (AAC). Results The mean age was 64±10 years, 48% were female, and mean BMI was 28±5 kg/m2. In models adjusted for demographics, physical activity, caloric intake, and traditional CVD risk factors, there was no inverse association of abdominal muscle mass with CAC(Prevalence Ratio [PR] 1.02 [95% CI 0.95,1.10]), TAC (PR 1.13 [95%CI 0.92, 1.39]) or AAC (PR 0.99 [95%CI 0.94, 1.04]) prevalence. Similarly, there was no significant inverse relationship between abdominal lean muscle area and CAC, TAC, and AAC severity. Conclusion In community-living individuals without clinical CVD, greater abdominal lean muscle area is not associated with less calcified atherosclerosis. PMID:23916063

Jensky, Nicole E.; Allison, Matthew A.; Loomba, Rohit; Carnethon, Mercedes R.; de Boer, Ian H.; Budoff, Matthew J.; Burke, Greg L.; Criqui, Michael H.; Ix, Joachim H.

2013-01-01

443

Imaging strategies for detection of urgent conditions in patients with acute abdominal pain: diagnostic accuracy study  

PubMed Central

Objective To identify an optimal imaging strategy for the accurate detection of urgent conditions in patients with acute abdominal pain. Design