Chronic Obstructive Pulmonary Disease (COPD) is now the main cause of disability in the developed world. The advance of COPD is related to increasing breathlessness, disability, and periodic hospitalizations. An aging population in the developed world and increasing cigarette consumption in developing countries expand the global impact of this condition. The disorder associated with COPD leads to a decrease in physical activity and failure of functional independence. The aim of this study was to evaluate the effects of PR in patients with normal exercise capacity on health-related quality of life and exercise capacity. The mean FEV1/FVC was 59.4± 14.1%, and the mean FEV1 was 64.8± 23.0% as expected. Most topics had mild to moderate COPD. The PImax and PEmax were normal. These subjects had no previous participation in home-based or hospital-based PR. All the subjects had normal maximal V˙O2 and work rate before PR. After PR there were still considerable improvements in maximal V˙O2 (mean increase of 101.3 mL/min, p <0.001) and work rate (mean increase of 8.2 watts, p<0.001). Ventilation, heart rate, and mean blood pressure were constant following PR. The maximum oxygen pulse at maximum exercise was significantly increased with PR (p<0.02). The SpO2 and end-tidal PCO2 at peak exercise did not significantly improve after PR. Although dyspnea scores at rest were low and did not improve significantly with PR, dyspnea at end-exercise was significantly improved after PR (p=0.01). PR should be the responsibility of the clinical management of patients with COPD, even for those with normal exercise capacity. However, the benefits of disease progression, hospitalization, and survival for these patients remain unknown. The main role in the management of any chronic disease, including lung disease, is to improve the quality of life (QL) in patients. Conclusion; Although strongly recommended by scientific societies pulmonary rehabilitation programs still need to be more widely implemented. PR programs have shown a high level of evidence of benefits in chronic respiratory patients, particularly those with COPD.
{"title":"Pulmonary Rehabilitation for Chronic Lung Diseases.","authors":"Ledi Neçaj","doi":"10.32391/ajtes.v7i2.340","DOIUrl":"https://doi.org/10.32391/ajtes.v7i2.340","url":null,"abstract":"Chronic Obstructive Pulmonary Disease (COPD) is now the main cause of disability in the developed world. The advance of COPD is related to increasing breathlessness, disability, and periodic hospitalizations. An aging population in the developed world and increasing cigarette consumption in developing countries expand the global impact of this condition. The disorder associated with COPD leads to a decrease in physical activity and failure of functional independence. \u0000The aim of this study was to evaluate the effects of PR in patients with normal exercise capacity on health-related quality of life and exercise capacity. \u0000The mean FEV1/FVC was 59.4± 14.1%, and the mean FEV1 was 64.8± 23.0% as expected. Most topics had mild to moderate COPD. The PImax and PEmax were normal. These subjects had no previous participation in home-based or hospital-based PR. All the subjects had normal maximal V˙O2 and work rate before PR. \u0000After PR there were still considerable improvements in maximal V˙O2 (mean increase of 101.3 mL/min, p <0.001) and work rate (mean increase of 8.2 watts, p<0.001). Ventilation, heart rate, and mean blood pressure were constant following PR. The maximum oxygen pulse at maximum exercise was significantly increased with PR (p<0.02). The SpO2 and end-tidal PCO2 at peak exercise did not significantly improve after PR. \u0000 Although dyspnea scores at rest were low and did not improve significantly with PR, dyspnea at end-exercise was significantly improved after PR (p=0.01). PR should be the responsibility of the clinical management of patients with COPD, even for those with normal exercise capacity. However, the benefits of disease progression, hospitalization, and survival for these patients remain unknown. \u0000The main role in the management of any chronic disease, including lung disease, is to improve the quality of life (QL) in patients. \u0000Conclusion; Although strongly recommended by scientific societies pulmonary rehabilitation programs still need to be more widely implemented. PR programs have shown a high level of evidence of benefits in chronic respiratory patients, particularly those with COPD.","PeriodicalId":32905,"journal":{"name":"Albanian Journal of Trauma and Emergency Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42161717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
F. Yılmaz, Erdi Akça, Bora Baltacıoğlu, İffet Tiftikçi, E. Arslan, C. Kavalci, I. Beydilli
Background: There is an ongoing debate if ketamine exerts any effect on intracranial pressure (ICP). ICP can be evaluated noninvasively by means of optic nerve sheath diameter (ONSD) measurement. In the present study, we aimed to determine if ketamine has any perceivable effect on ICP using ONSD. Material and Methods: In this single-center observational study, we prospectively enrolled patients who were admitted to the ED and received intravenous ketamine for induction, analgesia, procedural sedation for any procedure (ie, fracture reduction, laceration repair, pacemaker implantation). ONSD was used to rate ICP changes noninvasively both before and after ketamine application. Results: There were a total of 75 patients with a mean age of 59.8 ± 20.5 years. The majority of patients were applied Procedural Sedation (53.3%). In patients who were administered ketamine for induction, the median ONSD before and after ketamine were 5.10 (IQR: 1) mm and 5.00 (IQR: 1.30) mm, respectively. There occurred no significant diameter change (p=0.832). In patients who were administered ketamine for analgesia, the median ONSD 3.70 (IQR: 0.40) mm and 3.65 (IQR: 0.23) mm prior to and after the procedure, respectively. There occurred no significant diameter change (p=0.549). In patients who were administered ketamine for procedural sedation, the median ONSD before and after the procedure were 4.05 (IQR:0.67) mm and 3.97 (IQR: 0.69) mm, respectively. This time, however, ONSD was significantly reduced after ketamine administration (p=0.001). Conclusions: In this patient population, ketamine did not cause any incremental effect on ONSD, a surrogate marker of ICP.
{"title":"Bedside Ultrasonographic Assessment of the Optic Nerve Sheath Diameter to Assess Intracranial Pressure in Patients Given Ketamine in Emergency Department","authors":"F. Yılmaz, Erdi Akça, Bora Baltacıoğlu, İffet Tiftikçi, E. Arslan, C. Kavalci, I. Beydilli","doi":"10.32391/ajtes.v7i2.333","DOIUrl":"https://doi.org/10.32391/ajtes.v7i2.333","url":null,"abstract":"Background: There is an ongoing debate if ketamine exerts any effect on intracranial pressure (ICP). ICP can be evaluated noninvasively by means of optic nerve sheath diameter (ONSD) measurement. In the present study, we aimed to determine if ketamine has any perceivable effect on ICP using ONSD. \u0000Material and Methods: In this single-center observational study, we prospectively enrolled patients who were admitted to the ED and received intravenous ketamine for induction, analgesia, procedural sedation for any procedure (ie, fracture reduction, laceration repair, pacemaker implantation). ONSD was used to rate ICP changes noninvasively both before and after ketamine application. \u0000Results: There were a total of 75 patients with a mean age of 59.8 ± 20.5 years. The majority of patients were applied Procedural Sedation (53.3%). In patients who were administered ketamine for induction, the median ONSD before and after ketamine were 5.10 (IQR: 1) mm and 5.00 (IQR: 1.30) mm, respectively. There occurred no significant diameter change (p=0.832). In patients who were administered ketamine for analgesia, the median ONSD 3.70 (IQR: 0.40) mm and 3.65 (IQR: 0.23) mm prior to and after the procedure, respectively. There occurred no significant diameter change (p=0.549). In patients who were administered ketamine for procedural sedation, the median ONSD before and after the procedure were 4.05 (IQR:0.67) mm and 3.97 (IQR: 0.69) mm, respectively. This time, however, ONSD was significantly reduced after ketamine administration (p=0.001). \u0000Conclusions: In this patient population, ketamine did not cause any incremental effect on ONSD, a surrogate marker of ICP.","PeriodicalId":32905,"journal":{"name":"Albanian Journal of Trauma and Emergency Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49357988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background; Coccygodynia is a musculoskeletal disease that affects quality of life. The main complaint of coccygodynia is nociceptive and/or neuropathic pain. Vitamin D deficiency has been associated with the development of pain in various diseases. Aims; In this study we aimed investigate the pain types (nociceptive, neuropathic, mixed) and the relationship between pain types and Vitamin D level in patients with coccygodynia. Study design; Observational study Materials and Methods; A total of 54 patients diagnosed with coccygodynia were included. Pain intensity, disablity and pain type were evaluated by Visual Analogue Scale (VAS), the Oswestry Disability Index (ODI), and the PainDETECT questionnaire, respectively. All participants had their vitamin D levels measured. Results; Neuropathic pain was detected in 27.8% of the patients with coccygodynia. Vitamin D was determined to be insufficient or deficient in 81.5% of the patients. A statistical significant correlation was found between neuropathic pain and prolongation of coccygodynia and increased ODI values (p<0.05). The Vitamin D values were determined to show statistically similar distribution in the nociceptive, mixed type, and neuropathic pain groups (p=0.532). Conclusion; The frequency of neuropathic pain in coccygodynia increases with increasing disability and disease duration. Although vitamin deficiency or insufficiency is common in coccygodynia, it is not associated with the type of pain.
{"title":"Different Pain Types at Coccygodynia and its Relation with Vitamin D Level","authors":"Emel Güler, Hanzade aybuke Unal","doi":"10.32391/ajtes.v7i2.331","DOIUrl":"https://doi.org/10.32391/ajtes.v7i2.331","url":null,"abstract":"Background; Coccygodynia is a musculoskeletal disease that affects quality of life. The main complaint of coccygodynia is nociceptive and/or neuropathic pain. Vitamin D deficiency has been associated with the development of pain in various diseases. \u0000Aims; In this study we aimed investigate the pain types (nociceptive, neuropathic, mixed) and the relationship between pain types and Vitamin D level in patients with coccygodynia. \u0000Study design; Observational study \u0000Materials and Methods; A total of 54 patients diagnosed with coccygodynia were included. Pain intensity, disablity and pain type were evaluated by Visual Analogue Scale (VAS), the Oswestry Disability Index (ODI), and the PainDETECT questionnaire, respectively. All participants had their vitamin D levels measured. \u0000Results; Neuropathic pain was detected in 27.8% of the patients with coccygodynia. Vitamin D was determined to be insufficient or deficient in 81.5% of the patients. A statistical significant correlation was found between neuropathic pain and prolongation of coccygodynia and increased ODI values (p<0.05). The Vitamin D values were determined to show statistically similar distribution in the nociceptive, mixed type, and neuropathic pain groups (p=0.532). \u0000Conclusion; The frequency of neuropathic pain in coccygodynia increases with increasing disability and disease duration. Although vitamin deficiency or insufficiency is common in coccygodynia, it is not associated with the type of pain.","PeriodicalId":32905,"journal":{"name":"Albanian Journal of Trauma and Emergency Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49469257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Ramp lesions correspond to posterior meniscocapsular tears of the medial meniscus and are common with anterior cruciate ligament (ACL) tears. They cannot be recognized easily on preoperative magnetic resonance imaging (MRI) scans and are difficult to visualize even using standard arthroscopic approaches. We aim to (1) characterize and evaluate the prevalence of ramp lesions in pediatric patients at a major tertiary children's hospital, providing important insights into demographics, diagnosis, treatment, and functional disability and (2) evaluate the efficacy of MRI in its diagnosis. Materials and Methods: We retrospectively reviewed patients under 21 years old undergoing posterior medial meniscal injuries and anterior cruciate ligament ruptures with arthroscopic examination and positive ramp lesions from 2018 to 2021. Patient demographics (including gender and age), initial presentation, physical examination findings, mechanism of injury, pre-operative radiologic findings, and treatment were collected and reviewed via electronic medical record. Exclusion criteria included patients over 18 years old, patients, that did not have an MRI, and patients that were not treated surgically. Results: There were 117 patients that met the inclusion criteria out of 690 patients. The mean age at diagnosis was 15.6±1.6 years and the mean BMI was 26.7±6.4. 83% of injuries occurred secondary to sporting activities. Ramp lesions were only detected on preoperative MRI in 63% of cases, suspected in 3%, and not detected in 33%. The sensitivity of the MRI was 63%. Conclusions: Ramp lesions were found in 117/690 (16.9%) of patients undergoing ACL reconstruction. MRI had a low sensitivity rate of 63%. During ACL reconstruction, a careful review of the posteromedial compartment is important to recognize less obvious trauma. Lack of treatment may lead to continued instability and risk of complications in these patients.
{"title":"Characterization and Prevalence of Pediatric Ramp Lesions Associated with Anterior Cruciate Ligament Tears.","authors":"Neritan Borici, E. Ezeokoli, N. G. Loyd, S. McKay","doi":"10.32391/ajtes.v7i2.332","DOIUrl":"https://doi.org/10.32391/ajtes.v7i2.332","url":null,"abstract":"Background: Ramp lesions correspond to posterior meniscocapsular tears of the medial meniscus and are common with anterior cruciate ligament (ACL) tears. They cannot be recognized easily on preoperative magnetic resonance imaging (MRI) scans and are difficult to visualize even using standard arthroscopic approaches. We aim to (1) characterize and evaluate the prevalence of ramp lesions in pediatric patients at a major tertiary children's hospital, providing important insights into demographics, diagnosis, treatment, and functional disability and (2) evaluate the efficacy of MRI in its diagnosis. \u0000Materials and Methods: We retrospectively reviewed patients under 21 years old undergoing posterior medial meniscal injuries and anterior cruciate ligament ruptures with arthroscopic examination and positive ramp lesions from 2018 to 2021. Patient demographics (including gender and age), initial presentation, physical examination findings, mechanism of injury, pre-operative radiologic findings, and treatment were collected and reviewed via electronic medical record. Exclusion criteria included patients over 18 years old, patients, that did not have an MRI, and patients that were not treated surgically. \u0000Results: There were 117 patients that met the inclusion criteria out of 690 patients. The mean age at diagnosis was 15.6±1.6 years and the mean BMI was 26.7±6.4. 83% of injuries occurred secondary to sporting activities. Ramp lesions were only detected on preoperative MRI in 63% of cases, suspected in 3%, and not detected in 33%. The sensitivity of the MRI was 63%. \u0000Conclusions: Ramp lesions were found in 117/690 (16.9%) of patients undergoing ACL reconstruction. MRI had a low sensitivity rate of 63%. During ACL reconstruction, a careful review of the posteromedial compartment is important to recognize less obvious trauma. Lack of treatment may lead to continued instability and risk of complications in these patients.","PeriodicalId":32905,"journal":{"name":"Albanian Journal of Trauma and Emergency Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44639876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction; Dental trauma can be defined as an injuryto the oral region including the lips, teeth, periodontal tissues, tongue and/or alveolar processes. The aims of management will depend on the age of the patient, type of tooth (primary or permanent) and the extent of the injuries. The treatment varies from preserving the tooth,extraction of the tooth and immediate implant placement. Immediate implantation is defined as placement of the implant into alveolus of the extracted teeth immediately after extraction. Materials and methods; A 45-year-old patient, suffered teethand dental bridge fracture and injury during car accident.Immediate teeth extraction was performed and immediate implantation with bone ridge preservation was performed, to rehabilitate the lost teeth. Patient underwent successfully for prosthetic rehabilitation 8 months after these procedures. Conclusion; Affected traumatized teeth often have areduced prognosis and, in some instances, may requireextraction. The majority of dental trauma is initially seenwithin a primary rather than secondary care setting. General dental practitioners should therefore be able to effectively manage the most common dental injuries, and to referthe complicated ones to oral surgeon. Dental implants are reliable to replace teeth lost because of traumatic dental injury. The timing of implant placement may be immediate,early, conventional, or late and is determined by the extent of the trauma, remaining growth, and conditions of the hardand soft tissues.
{"title":"Post-traumatic Implant Surgical Rehabilitation of the Alveolar Ridge of the upper Jaw","authors":"Danco Bizevski, Jetmire Jakupi - Alimani, M.M. Isak, Enes Bajramov","doi":"10.32391/ajtes.v7i1.310","DOIUrl":"https://doi.org/10.32391/ajtes.v7i1.310","url":null,"abstract":"Introduction; Dental trauma can be defined as an injuryto the oral region including the lips, teeth, periodontal tissues, tongue and/or alveolar processes. \u0000The aims of management will depend on the age of the patient, type of tooth (primary or permanent) and the extent of the injuries. The treatment varies from preserving the tooth,extraction of the tooth and immediate implant placement. Immediate implantation is defined as placement of the implant into alveolus of the extracted teeth immediately after extraction. \u0000Materials and methods; A 45-year-old patient, suffered teethand dental bridge fracture and injury during car accident.Immediate teeth extraction was performed and immediate implantation with bone ridge preservation was performed, to rehabilitate the lost teeth. Patient underwent successfully for prosthetic rehabilitation 8 months after these procedures. \u0000Conclusion; Affected traumatized teeth often have areduced prognosis and, in some instances, may requireextraction. The majority of dental trauma is initially seenwithin a primary rather than secondary care setting. General dental practitioners should therefore be able to effectively manage the most common dental injuries, and to referthe complicated ones to oral surgeon. Dental implants are reliable to replace teeth lost because of traumatic dental injury. The timing of implant placement may be immediate,early, conventional, or late and is determined by the extent of the trauma, remaining growth, and conditions of the hardand soft tissues.","PeriodicalId":32905,"journal":{"name":"Albanian Journal of Trauma and Emergency Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48538637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Fagu, Ormir Shurdha, Nevila Çaushi, Ketjon Menkshi, Dervish Hasi, M. Siqeca
Coronary total occlusions are routinely found in patients suffering from chronic coronary artery disease. Their prevalence is between 20-50% and is higher in patients with prior coronary artery bypass surgery. Patients with CTOs have a higher risk profile, higher Syntax scores and in approximately 80% of the cases, a multi-vessel disease. Advances in technology that supports CTO-PCI and the increasing operator experience in high volume centers has raised important questions about the revascularization strategy. In the majority of cases, the treatment strategy for this group of patients should aim at achieving full revascularization. In this context CABG should be considered the first choice and percutaneous coronary intervention can be considered for patients with less advanced disease. It is not clear, whether successful CTO revascularization (CABG or PCI) have an impact on long-term outcomes. For these reasons, the treatment of patients in the presence of CTOs should be based on the current evidence on the treatment of multivessel coronary disease.
{"title":"Morphological Aspects and Treatment Strategies for Chronic Total Occlusions of the Coronary Arteries.","authors":"A. Fagu, Ormir Shurdha, Nevila Çaushi, Ketjon Menkshi, Dervish Hasi, M. Siqeca","doi":"10.32391/ajtes.v7i1.295","DOIUrl":"https://doi.org/10.32391/ajtes.v7i1.295","url":null,"abstract":"Coronary total occlusions are routinely found in patients suffering from chronic coronary artery disease. Their prevalence is between 20-50% and is higher in patients with prior coronary artery bypass surgery. Patients with CTOs have a higher risk profile, higher Syntax scores and in approximately 80% of the cases, a multi-vessel disease. Advances in technology that supports CTO-PCI and the increasing operator experience in high volume centers has raised important questions about the revascularization strategy. In the majority of cases, the treatment strategy for this group of patients should aim at achieving full revascularization. In this context CABG should be considered the first choice and percutaneous coronary intervention can be considered for patients with less advanced disease. It is not clear, whether successful CTO revascularization (CABG or PCI) have an impact on long-term outcomes. For these reasons, the treatment of patients in the presence of CTOs should be based on the current evidence on the treatment of multivessel coronary disease.","PeriodicalId":32905,"journal":{"name":"Albanian Journal of Trauma and Emergency Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42546555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: The management of penetrating neck trauma (PNT) evolved from a policy of mandatory exploration to one of selective non-operative management (SNOM) based on clinical examination, and the liberal use of Computed Tomography Angiography (CTA) irrespective of the zone of injury for those patients who are stable on presentation. Methods: A retrospective audit of patients with penetrating neck injuries managed at Chris Hani Baragwanath Academic Hospital (CHBAH) Trauma Unit, from 2010 to 2015 was conducted. Statistical analysis was performed for all collected variables. A p-value of ≤ 0.05 was considered statistically significant. Results: The results of treatment of 594 patients were reviewed. There was a predominance of young males (93.4%) with a median age of 28 years (IQR 18-67) presenting with injuries in zone 2, left side of the neck, commonly due to stab wounds (89.3%). Immediate surgical exploration was needed in 145(24.4%), while the remaining (75.4%) were investigated with CTA. CTA showed a sensitivity and specificity of over 90% for vascular injuries and more than 80% for aerodigestive injuries. Major vascular injuries were the most common surgical finding. The overall negative exploration rate was 6%, and the mortality 2.5%. Conclusions: Our unit’s SNOM protocol relies on liberal CTA use. Despite the obvious limitations of a retrospective study our results showed an acceptable negative and non-therapeutic exploration rate and a low incidence of complications and mortality.
{"title":"Results of Selective Non-Operative Management for Penetrating Neck Trauma in 594 patients.","authors":"Naadiyah Laher, B. Monzon, M. Mauser","doi":"10.32391/ajtes.v7i1.302","DOIUrl":"https://doi.org/10.32391/ajtes.v7i1.302","url":null,"abstract":"Background: The management of penetrating neck trauma (PNT) evolved from a policy of mandatory exploration to one of selective non-operative management (SNOM) based on clinical examination, and the liberal use of Computed Tomography Angiography (CTA) irrespective of the zone of injury for those patients who are stable on presentation. \u0000Methods: A retrospective audit of patients with penetrating neck injuries managed at Chris Hani Baragwanath Academic Hospital (CHBAH) Trauma Unit, from 2010 to 2015 was conducted. Statistical analysis was performed for all collected variables. A p-value of ≤ 0.05 was considered statistically significant. \u0000Results: The results of treatment of 594 patients were reviewed. There was a predominance of young males (93.4%) with a median age of 28 years (IQR 18-67) presenting with injuries in zone 2, left side of the neck, commonly due to stab wounds (89.3%). Immediate surgical exploration was needed in 145(24.4%), while the remaining (75.4%) were investigated with CTA. CTA showed a sensitivity and specificity of over 90% for vascular injuries and more than 80% for aerodigestive injuries. Major vascular injuries were the most common surgical finding. The overall negative exploration rate was 6%, and the mortality 2.5%. \u0000Conclusions: Our unit’s SNOM protocol relies on liberal CTA use. Despite the obvious limitations of a retrospective study our results showed an acceptable negative and non-therapeutic exploration rate and a low incidence of complications and mortality.","PeriodicalId":32905,"journal":{"name":"Albanian Journal of Trauma and Emergency Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45401573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. Bejko, Hatjona Takaj, Stavri Llazo, Esmerilda Bulku, J. Burimi, A. Ibrahimi, S. Kuçi
Background: Aspiration pneumonitis also called as Mendelson's syndrome is a lung injury from acute inflammation that occurs after chemical burns in the airways and lung parenchyma, caused by the inhalation of gastric content. Depending on the quantity, nature of the aspirated material, and the host factors, the damage can lead to acute respiratory distress with a mortality rate up to 70%. Case report: A 73-year-old male, was admitted from the emergency department to cardiovascular surgery ICU, diagnosed with ruptured abdominal aortic aneurysm. The patient presented with severe hypotension, tachycardic with altered mental status and was immediately sent to the operating room. At the moment of shifting to the operating table, the patient had cardiocirculatory arrest, large amount of gastric content came out of the patient’s mouth. While the patient was assisted with chest compressions, suction was immediately done in the oropharyngeal cavity, the patient was intubated with direct laryngoscopy, the tube cuff had its adequate pressure assured to prevent further aspiration.Bronchial lavage was performed before patient ventilation. The cardiac rhythm was restored, and the surgical incision started. Within 30 minutes from the aspiration, during the surgery the patient appeared symptoms of Mendelson’s syndrome. The arterial blood gas test was presented with hypoxemia in 100% with retention. Empiric antibiotic and corticosteroid were administered. After the surgery the patient was transferred to the ICU and was ventilated according to the ARDS protocol. The patient had other complications during his stay in ICU and was extubated after nine days and was discharged home after 19 days. Discussion: Regardless of the measures taken to avoid aspiration pneumonia during emergency surgery, it is sometimes inevitable and it is important to know how to act and treat the patient according to the primary underlying condition. Conclusions: Treatment with early, empiric, broad-spectrum antibiotics should be administered then selection of pathogen specific antibiotics or decision to stop or continue the use of antibiotics is made based on quantitative bacteriology
{"title":"Aspiration Pneumonitis.","authors":"E. Bejko, Hatjona Takaj, Stavri Llazo, Esmerilda Bulku, J. Burimi, A. Ibrahimi, S. Kuçi","doi":"10.32391/ajtes.v7i1.321","DOIUrl":"https://doi.org/10.32391/ajtes.v7i1.321","url":null,"abstract":"Background: Aspiration pneumonitis also called as Mendelson's syndrome is a lung injury from acute inflammation that occurs after chemical burns in the airways and lung parenchyma, caused by the inhalation of gastric content. Depending on the quantity, nature of the aspirated material, and the host factors, the damage can lead to acute respiratory distress with a mortality rate up to 70%. \u0000Case report: A 73-year-old male, was admitted from the emergency department to cardiovascular surgery ICU, diagnosed with ruptured abdominal aortic aneurysm. The patient presented with severe hypotension, tachycardic with altered mental status and was immediately sent to the operating room. At the moment of shifting to the operating table, the patient had cardiocirculatory arrest, large amount of gastric content came out of the patient’s mouth. While the patient was assisted with chest compressions, suction was immediately done in the oropharyngeal cavity, the patient was intubated with direct laryngoscopy, the tube cuff had its adequate pressure assured to prevent further aspiration.Bronchial lavage was performed before patient ventilation. The cardiac rhythm was restored, and the surgical incision started. Within 30 minutes from the aspiration, during the surgery the patient appeared symptoms of Mendelson’s syndrome. The arterial blood gas test was presented with hypoxemia in 100% with retention. Empiric antibiotic and corticosteroid were administered. After the surgery the patient was transferred to the ICU and was ventilated according to the ARDS protocol. The patient had other complications during his stay in ICU and was extubated after nine days and was discharged home after 19 days. \u0000Discussion: Regardless of the measures taken to avoid aspiration pneumonia during emergency surgery, it is sometimes inevitable and it is important to know how to act and treat the patient according to the primary underlying condition. \u0000Conclusions: Treatment with early, empiric, broad-spectrum antibiotics should be administered then selection of pathogen specific antibiotics or decision to stop or continue the use of antibiotics is made based on quantitative bacteriology","PeriodicalId":32905,"journal":{"name":"Albanian Journal of Trauma and Emergency Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47039126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: The tibial collateral ligament, also known as the medial collateral ligament (MCL), is a ligament extending from the medial epicondyle of the femur to the posteromedial crest of the tibia. The ligament is a broad and strong band that mainly functions to stabilize the knee joint in the coronal plane on the medial side Since MCL calcification is not a frequent knee pain manifestation, exclusion of other confusing clinical mimicries is of paramount importance. Here, in this report, we describe a well-circumscribed calcific deposit in the left femoral condylar attachment of MCL reported very rarely in the medical literature. Case Report: A 37-year-old laborer presented to the Outpatient department with pain and flexion deformity of the Right knee for 6 months. He walked on a flexed knee with a limping gait. A plain radiograph of the right was taken in AP and Lateral view which showed a massive well-defined calcification at the medial side of the knee joint. Considering the large size of the lesion, surgical treatment was chosen. Intra-operatively, as the MCL was involved a reconstruction was done using the semitendinosus tendon. Conclusion: Chronic pain located at the medial side of the knee is not always osteoarthritic pain. Thorough clinical and radiological investigation with plain radiographs and MRI in some cases is mandatory. Calcification or ossification of the medial collateral ligament of the knee responds well to conservative treatment. Surgical resection is needed in some cases with larger lesions.
{"title":"Medial Collateral Ligament Calcification, Presenting as Knee Pain. An unusual Case Report","authors":"N. Antao, Clevio Desouza","doi":"10.32391/ajtes.v7i1.294","DOIUrl":"https://doi.org/10.32391/ajtes.v7i1.294","url":null,"abstract":"Background: The tibial collateral ligament, also known as the medial collateral ligament (MCL), is a ligament extending from the medial epicondyle of the femur to the posteromedial crest of the tibia. The ligament is a broad and strong band that mainly functions to stabilize the knee joint in the coronal plane on the medial side Since MCL calcification is not a frequent knee pain manifestation, exclusion of other confusing clinical mimicries is of paramount importance. Here, in this report, we describe a well-circumscribed calcific deposit in the left femoral condylar attachment of MCL reported very rarely in the medical literature. Case Report: A 37-year-old laborer presented to the Outpatient department with pain and flexion deformity of the Right knee for 6 months. He walked on a flexed knee with a limping gait. A plain radiograph of the right was taken in AP and Lateral view which showed a massive well-defined calcification at the medial side of the knee joint. Considering the large size of the lesion, surgical treatment was chosen. Intra-operatively, as the MCL was involved a reconstruction was done using the semitendinosus tendon. Conclusion: Chronic pain located at the medial side of the knee is not always osteoarthritic pain. Thorough clinical and radiological investigation with plain radiographs and MRI in some cases is mandatory. Calcification or ossification of the medial collateral ligament of the knee responds well to conservative treatment. Surgical resection is needed in some cases with larger lesions.","PeriodicalId":32905,"journal":{"name":"Albanian Journal of Trauma and Emergency Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44178480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Alimehmeti, A. Seferi, Florian Dashi, Aurora Muça, E. Petrela, Arba Cecia, K. Pilika, G. Braçe
Importance: Ulnar neuropathy at the elbow is the second most frequent entrapment neuropathy, affecting 6% of the population. Surgical criteria are based on a general agreement but remain controversial about which procedure is associated with the best results and the fewest complications. This data can help evaluate the effectiveness of operative techniques in symptomatic cure. Material and Methods: The study analysis included 26 out of 35 patients with 'Ulnar neuropathy at elbow' diagnosis, treated between January 2017- March 2022 at the Department of Neurosciences, University Service of Neurosurgery, University Hospital Center “Mother Theresa”, Tirana, Albania. 9 patients from the time period January-June 2018 were excluded from this study analysis due to lack of access to data. Data sources such as medical records and documentation copies of instrumental examinations were extracted from archives of Statistics Service and Hospital Registers, University Hospital Center “Mother Theresa”, Tirana, Albania. Phone follow-up was applied as well. Results: We report 26 patients analyzed retrospectively (female: male ratio 1:2.71). 29 operated extremities were studied: 26 with Cubital Tunnel Syndrome, of which 2 presented with ipsilateral Carpal Tunnel Syndrome and 1 bilateral; 2 with contralateral Carpal Tunnel Syndrome. There were 11 patients gr. II McGowan and 15 patients gr. III McGowan. There are no positive elbow flexion-extension test cases, indicative of the transposition technique. All patients were clinically evaluated at a distance of 1-3 years post-operatively and 19% presented objective symptoms. Long-term follow-up shows the motor and sensory improvement for gr. II McGowan patients, while gr. III McGowan patients show only sensory and grip improvement, with the persistence of muscular atrophy. The most frequent cause of compression was determined fibrosis and hypertrophy around the Osborne ligament (13/26). Conclusions: Clinical stage of neuropathy is the decisive factor influencing prognosis. Simple decompression in situ is sufficient in most cases. Dynamic intraoperative testing of sulcus competence, to assess (sub)luxation of the ulnar after decompression, determines the final operative technique.
{"title":"Ulnar Nerve Entrapment at Elbow, a Retrospective Clinical Observational Study.","authors":"R. Alimehmeti, A. Seferi, Florian Dashi, Aurora Muça, E. Petrela, Arba Cecia, K. Pilika, G. Braçe","doi":"10.32391/ajtes.v7i1.314","DOIUrl":"https://doi.org/10.32391/ajtes.v7i1.314","url":null,"abstract":"Importance: Ulnar neuropathy at the elbow is the second most frequent entrapment neuropathy, affecting 6% of the population. Surgical criteria are based on a general agreement but remain controversial about which procedure is associated with the best results and the fewest complications. This data can help evaluate the effectiveness of operative techniques in symptomatic cure. \u0000Material and Methods: The study analysis included 26 out of 35 patients with 'Ulnar neuropathy at elbow' diagnosis, treated between January 2017- March 2022 at the Department of Neurosciences, University Service of Neurosurgery, University Hospital Center “Mother Theresa”, Tirana, Albania. \u00009 patients from the time period January-June 2018 were excluded from this study analysis due to lack of access to data. Data sources such as medical records and documentation copies of instrumental examinations were extracted from archives of Statistics Service and Hospital Registers, University Hospital Center “Mother Theresa”, Tirana, Albania. Phone follow-up was applied as well. \u0000Results: We report 26 patients analyzed retrospectively (female: male ratio 1:2.71). 29 operated extremities were studied: 26 with Cubital Tunnel Syndrome, of which 2 presented with ipsilateral Carpal Tunnel Syndrome and 1 bilateral; 2 with contralateral Carpal Tunnel Syndrome. There were 11 patients gr. II McGowan and 15 patients gr. III McGowan. \u0000There are no positive elbow flexion-extension test cases, indicative of the transposition technique. All patients were clinically evaluated at a distance of 1-3 years post-operatively and 19% presented objective symptoms. Long-term follow-up shows the motor and sensory improvement for gr. II McGowan patients, while gr. III McGowan patients show only sensory and grip improvement, with the persistence of muscular atrophy. \u0000The most frequent cause of compression was determined fibrosis and hypertrophy around the Osborne ligament (13/26). \u0000Conclusions: Clinical stage of neuropathy is the decisive factor influencing prognosis. Simple decompression in situ is sufficient in most cases. Dynamic intraoperative testing of sulcus competence, to assess (sub)luxation of the ulnar after decompression, determines the final operative technique.","PeriodicalId":32905,"journal":{"name":"Albanian Journal of Trauma and Emergency Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44477306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：