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The Efficacy of Surgicel Compared with Simple Gauze Packing in Grade IV Liver Laceration; A New Hope for Trauma Patients: An Experimental Study 外科手术与单纯纱布填塞治疗IV级肝裂伤的疗效比较创伤患者的新希望:一项实验研究
Pub Date : 2017-08-04 DOI: 10.4172/2167-1222.1000387
H. Khoshmohabat, A. Makarem, M. Karami, H. Rasouli, Z. Danial, Golnoosh Mahmoodizade, Rohallah Rezaei, Shahram Paydar, Seyede Niloofar Dastgheib, Seyed Ali Hossein Zahraei, Z. Shayan
Background: The useful surgical hemostasis agent using in patients with grade 4 of the liver laceration is a challenging problem. This study assessed a topical hemostatic agent (Surgicel) using a partial hepatic laceration hemorrhage model. This experimental study compared the hemostatic effects of Surgicel and conventional gauze packing in hepatic parenchymal bleedings. Methods: Twenty male Wistar albino rats (weight 250 ± 50 g) were randomly divided into two groups. Within each treatment group, surgicel or gauze packing (GP) (n=10/group) was applied to the liver laceration site that was created in the large lobe of the liver. Results: There was statistically significant difference between two groups regarding the changes of before and after operation of HCO3 (P=0.019). Across two groups, rats receiving surgicel lost less blood and formed clots more frequently than GP (p<0.001). Conclusion: Surgicel may be useful to treat hemorrhage from Liver lacerations in trauma patients.
背景:在4级肝裂伤患者中使用有效的手术止血剂是一个具有挑战性的问题。本研究使用局部肝裂伤出血模型评估局部止血剂(Surgicel)。本实验研究比较了外科纱布与常规纱布填塞在肝实质出血中的止血效果。方法:雄性Wistar白化大鼠20只,体重250±50 g,随机分为两组。在每个治疗组中,在肝大叶形成的肝裂伤部位应用外科手术或纱布填充物(GP) (n=10/组)。结果:两组患者术前、术后HCO3变化差异有统计学意义(P=0.019)。在两组中,接受手术的大鼠失血量更少,形成血栓的频率高于GP (p<0.001)。结论:手术治疗创伤性肝裂伤出血是有效的。
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引用次数: 0
Tissue Performance Characteristics: Closing the Fidelity Gap in Medical Simulations 组织性能特征:缩小医疗模拟中的保真度差距
Pub Date : 2017-07-29 DOI: 10.4172/2167-1222.1000386
Jack Norfleet, E. Stern, Y. Bai
Medical simulations often lack the fidelity necessary to train higher-level procedures such as surgery. To work around these gaps, organizations with a training mission like the Department of Defense (DoD) often resort to biologic tissues from cadavers and animals.
医学模拟往往缺乏训练更高级别程序(如手术)所需的保真度。为了弥补这些差距,像国防部这样有训练任务的组织经常使用尸体和动物的生物组织。
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引用次数: 1
Brachial Artery Tear Occurring Concurrently with A Distal Biceps Injury Led to A Diagnosis of Ehlers-Danlos Syndrome Type IV 肱动脉撕裂同时发生二头肌远端损伤导致诊断为Ehlers-Danlos综合征IV型
Pub Date : 2017-07-24 DOI: 10.4172/2167-1222.1000385
G. González, R. Dayal, Lee Andy, A. Golant
Ehlers-Danlos Syndrome (EDS) type IV is a connective tissue disorder with autosomal dominant inheritance. It can be potentially life-threatening due to increased risk of arterial rupture. The diagnosis is based on clinical findings including thin, translucent skin; bleeding propensity, rupture of vessels, and viscera. Isolated peripheral vascular injury may be the first presenting complaint, leading to eventual diagnosis in patients who often experience minimal trauma. We present a case of a brachial artery rupture requiring surgical reconstruction, eventually leading to the diagnosis of EDS type IV after a non-contact, low-energy injury to the arm of an adolescent.
埃勒斯-丹洛斯综合征(EDS)IV型是一种常染色体显性遗传的结缔组织疾病。由于动脉破裂的风险增加,它可能会危及生命。诊断是基于临床发现,包括薄,半透明的皮肤;出血倾向、血管破裂和内脏。孤立的外周血管损伤可能是首次出现的主诉,最终诊断为创伤最小的患者。我们报告了一例需要手术重建的肱动脉破裂病例,最终诊断为青少年手臂非接触性低能量损伤后的EDS IV型。
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引用次数: 0
Seizing over the Conundrums of SAH Seizure Prophylaxis 预防蛛网膜下腔出血发作的核心
Pub Date : 2017-07-20 DOI: 10.4172/2167-1222.1000383
Mohammad Sistanizad, M. Mokhtari
Aneurysmal subarachnoid hemorrhage (SAH), a potentially catastrophic stroke, which occurs at a relatively younger age (median 55 years), afflicts over 30,000 patients a year in the USA. It accounts for 3% to 5% of all strokes and 4.4% of deaths from stroke belong to this group of patients. It carries high rate of morbidity (25%) and case fatality (35%) in most series.
动脉瘤性蛛网膜下腔出血(SAH)是一种潜在的灾难性中风,发生在相对较年轻的年龄(中位年龄为55岁),在美国每年有超过30,000名患者受到影响。它占所有中风的3%至5%,4.4%的中风死亡属于这类患者。它在大多数系列中具有高发病率(25%)和病死率(35%)。
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引用次数: 0
Partial Zone II Resuscitative Endovascular Balloon Occlusion of the Aorta in Management of Multiple Trauma with Combined Abdominal and Pelvic Injury 部分II区复苏血管内球囊阻断主动脉在多重创伤合并腹部和骨盆损伤治疗中的应用
Pub Date : 2017-07-19 DOI: 10.4172/2167-1222.1000382
E. Gamberini, N. Fabbri, A. Taioli, C. Martino, M. Barozzi, M. Bisulli, E. Russo, Vittorio Albarello, V. Agnoletti
Introduction: Resuscitative endovascular balloon occlusion of the aorta has been used in various clinical settings to elevate blood pressure in the setting of shock, even if the evidence base is weak with no clear indications. Case presentation: We report a case of traumatic hemorrhagic shock in which this technique was used in an unusual manner, treating obvious arterial abdominal bleeding associated with suspected pelvic arterial bleeding, in a Trauma Center where hybrid angiographic-surgical suite is not available. A 35-year-old man was involved in a traffic accident within 2 trucks. He was transported to the Major Trauma Center of an Integrated Trauma System where emergent laparotomy confirmed massive hepatic rupture and a bleeding control was obtained by large abdominal packing. Trauma team decided to considerate Resuscitative Endovascular Balloon Occlusion of the Aorta, positioning a deflated balloon in zone III to eventually manage a pelvic arterial hemorrhage, while performing Bogota Bag. Suddenly a new abdominal arterial bleeding was noted through Bogota Bag. Because Pringle maneuver was considered too difficult in this case because of liver hilum injury, the balloon was moved cranially with the aim to reach zone I. Introducer sheath displacement occurred at this time, and the balloon was then only partially inflated in zone II, usually considered too dangerous, and immediately the target systolic blood pressure of 90 mmHg was obtained. Transfer the patient into interventional radiology suite was then feasible and embolization of active bleeding by right hepatic artery and superior mesenteric artery branch, missed during first laparotomy, were performed. Balloon was definitely deflated after 50 minutes. The patient was discharged by the hospital 113 days later, fully recovered with long lasting motor rehabilitation program. Discussion: Partial zone II Resuscitative Endovascular Balloon Occlusion of the Aorta in this particular case allowed overcoming procedural mistakes without major complications and with good clinical outcome. Conclusion: Judicious manage of REBOA inflation time and amount, together with multidisciplinary contemporary damage control strategy with clear and effective team leading, is the key to effectively resuscitate multiple trauma shocked patients.
导论:复苏血管内球囊阻断主动脉已在各种临床环境中用于提高休克情况下的血压,即使证据基础薄弱,没有明确的适应症。病例介绍:我们报告了一例外伤性失血性休克,在创伤中心,这种技术以一种不寻常的方式用于治疗明显的动脉性腹部出血,并伴有疑似盆腔动脉出血,该中心没有混合血管造影-外科套房。一名35岁的男子在两辆卡车内发生交通事故。他被送往综合创伤系统的创伤中心,在那里紧急剖腹手术证实了大面积的肝破裂,并通过大腹部填充物控制了出血。创伤小组决定考虑复苏血管内球囊阻断主动脉,在进行波哥大袋手术时,将一个泄气的球囊放置在III区,最终处理盆腔动脉出血。突然,通过波哥大袋发现了新的腹部动脉出血。由于本例肝门损伤,认为Pringle操作过于困难,因此将球囊向颅骨移动,目的是到达i区。此时,引入器鞘发生位移,球囊仅在II区部分膨胀,通常认为过于危险,立即获得目标收缩压90 mmHg。将患者转入介入放射室,并对首次开腹手术中遗漏的活动性出血行肝右动脉和肠系膜上动脉分支栓塞。50分钟后气球就瘪了。患者于113天后出院,经长期运动康复治疗后完全康复。讨论:在这个特殊的病例中,部分II区复苏血管内球囊闭塞主动脉克服了手术错误,没有重大并发症,临床结果良好。结论:合理管理REBOA充气时间和数量,结合多学科的现代损伤控制策略和明确有效的团队领导,是有效抢救多发创伤休克患者的关键。
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引用次数: 1
Epidemiology of Delayed Union of Long Bones 长骨延迟愈合的流行病学
Pub Date : 2017-07-07 DOI: 10.4172/2167-1222.1000370
M. Mehmood, S. Deshp, Sohael M. Khan, P. Singh, B. Patil, Romil Rathi
Aim: To study the epidemiology of delayed union of long bones. Introduction: In India, the availability of fracture healing therapies to the general public is limited. The infrastructure of the health system in India, involving both public and private sector does not provide adequate opportunity for rural and low-income inhabitants to access the needed care. Due to these reasons, majority of the global burden of injuries are borne by low and middle-income countries. Material and methods: Patients getting admitted in AVBRH hospital above the age of 18 years of either sex with radiological features of delayed union. Study was a prospective, case control observational type carried out in a rural health setup at AVBRH. It comprised of 153 patients out of which 43 patients had delayed union of a long bone, 53 patients had non-union. These patients were compared with 57 patients that had postoperative fracture union which were included as a control group who had the same risk factors for delayed union. Results: Aging, female gender, comminuted and segmental fractures, higher grades of soft tissue injury, smoking, and infection were found to be independent risk factors for delayed union in long bone fractures. Among the risk factors, smoking and infection can be controlled to decrease the prevalence of delayed union. Conclusion: It is necessary that we create awareness about the importance of primary treatment like immobilization and wound debridement, as patients should reach as early as possible. Patient’s relative’s moral support is necessary in order to get early hospitalization so as to reduce the risk of delayed union among patients and so that appropriate modality of treatment (surgical and conservative) with use of bone regeneration substitutes such as bone grafting and PRP can be done to promote faster healing keeping infection in control.
目的:研究长骨延迟愈合的流行病学。导言:在印度,骨折愈合疗法对公众的可用性是有限的。印度卫生系统的基础设施,包括公共和私营部门,没有为农村和低收入居民提供获得所需保健的充分机会。由于这些原因,全球伤害负担的大部分由低收入和中等收入国家承担。材料和方法:在AVBRH医院住院的18岁以上、影像学表现为延迟愈合的患者,男女不限。研究是在AVBRH的农村卫生机构进行的前瞻性病例对照观察型研究。153例患者中43例为长骨延迟愈合,53例为不愈合。将这些患者与具有相同延迟愈合危险因素的57例术后骨折愈合患者作为对照组进行比较。结果:年龄、女性、粉碎性骨折、节段性骨折、软组织损伤程度较高、吸烟、感染是长骨骨折延迟愈合的独立危险因素。在危险因素中,控制吸烟和感染可降低延迟愈合的发生率。结论:我们有必要提高对固定和伤口清创等初级治疗的重要性的认识,患者应尽早到达。患者亲属的精神支持是必要的,以便尽早住院,以减少患者延迟愈合的风险,并采用适当的治疗方式(手术和保守),使用骨移植和PRP等骨再生替代品,以促进更快的愈合,并控制感染。
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引用次数: 7
The Effect of Trauma Severity on Borderline Personality: Self-Esteem as Mediator 创伤严重程度对边缘型人格的影响:自尊的中介作用
Pub Date : 2017-06-10 DOI: 10.4172/2167-1222.1000381
Jae Woo Park
The aim of this study was to examine the effect of trauma experience severity on borderline personality characteristics and to examine as well the mediation effect of self-esteem. To measure traumatic experience severity, the Trauma Experience Questionnaire-Revised (TEQ-R) was developed and validated. The TEQ-R, Rosenberg Self-Esteem Scale, and the personality assessment inventory-borderline features scale (PAI-BOR) were administered to 400 normal subjects. According to structural equation model analysis, trauma experience severity was positively associated with borderline characteristics, and the mediation effect of self-esteem was significant. Both trauma severity and borderline characteristics were negatively related to self-esteem. Thus, self-esteem seemed to have a buffering effect on the path between trauma and borderline personality.
本研究的目的是检验创伤经历严重程度对边缘人格特征的影响,并检验自尊的中介作用。为了衡量创伤经历的严重程度,制定并验证了创伤经历问卷修订版(TEQ-R)。对400名正常受试者采用TEQ-R、Rosenberg自尊量表和人格评估量表(PAI-BOR)。根据结构方程模型分析,创伤经历的严重程度与边缘特征呈正相关,自尊的中介作用显著。创伤严重程度和边缘特征均与自尊呈负相关。因此,自尊似乎对创伤和边缘人格之间的路径有缓冲作用。
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引用次数: 3
Relationship between Intracranial Pressure or Cerebral PerfusionPressure and Prognosis in Patients with Severe Traumatic Brain InjuryTreated with Mild Hypothermia 亚低温治疗重型颅脑损伤患者的颅内压或脑灌注压与预后的关系
Pub Date : 2017-06-09 DOI: 10.4172/2167-1222.1000380
Koichi Hayakawa, O. Tasaki, Hiromu Iwamura, Daiki Wada, Fukuki Saitou, Jiro Iba, Kazuhisa Yoshiya, H. Ikegawa, T. Shiozaki, Y. Nakamori, S. Fujimi, T. Shimazu, Y. Kuwagata
Aims: The purpose of this study was to predict the clinical course by intracranial pressure (ICP) or cerebral perfusion pressure (CPP) in the acute phase and prognosis in patients with severe head trauma who underwent therapeutic mild hypothermia (HT). Methods: A consecutive 143 patients treated with HT for intracranial hypertension (ICH) in two trauma centers were included in this study. The pressure measured after computed tomography scanning was defined as the initial ICP or CPP. Outcome was assessed at 6 months according to the Glasgow Outcome Scale. ROC analysis was performed to clarify the threshold value of ICP/CPP predictive of ICP uncontrollable by HT. Results: The cutoff value of ICP for uncontrollable ICP obtained from ROC analysis was 32.5 mmHg (sensitivity: 0.545, specificity: 0.875), and that for CPP was 56.5 mmHg (sensitivity: 0.813, specificity: 0.663). Fifty-three (96.4%) of 55 patients whose initial ICP was greater than 32.5 mmHg and 67 (95.7%) of 70 patients whose initial CPP was less than 56.5 mmHg had developed uncontrollable ICP. Conclusion: The cutoff values predictive of ICP uncontrollable by HT from ROC analysis were 32.5 mmHg for ICP and 56.5 mmHg for CPP. For those patients with initial ICP greater than the cutoff value or an initial CPP less than the cutoff value, it may be harmful to prolong HT. The knowledge obtained from this study may be useful for considering the treatment strategy for severe traumatic brain injury.
目的:本研究旨在通过急性期颅内压(ICP)或脑灌注压(CPP)预测重度颅脑外伤患者行治疗性亚低温(HT)治疗后的临床病程及预后。方法:对连续143例在两家外伤中心接受HT治疗的颅内高压(ICH)患者进行研究。计算机断层扫描后测量的压力被定义为初始ICP或CPP。根据格拉斯哥结果量表在6个月时评估结果。采用ROC分析明确ICP/CPP阈值预测HT无法控制的ICP。结果:ROC分析所得不可控ICP的ICP临界值为32.5 mmHg(敏感性0.545,特异性0.875),CPP的ICP临界值为56.5 mmHg(敏感性0.813,特异性0.663)。55例初始ICP大于32.5 mmHg的患者中53例(96.4%)发生了不可控的ICP, 70例初始ICP小于56.5 mmHg的患者中67例(95.7%)发生了不可控的ICP。结论:ROC分析预测ICP不可控的临界值ICP为32.5 mmHg, CPP为56.5 mmHg。对于初始ICP大于临界值或初始CPP小于临界值的患者,延长HT可能是有害的。本研究结果可为重型颅脑外伤的治疗策略提供参考。
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引用次数: 0
Relevance of Functional Emotion Regulation Processes for SustainingMental Health After History of Early Psychological Trauma 早期心理创伤史后功能性情绪调节过程与维持心理健康的相关性
Pub Date : 2017-06-06 DOI: 10.4172/2167-1222.1000369
J. Holl, S. Barnow
It is well evidenced that exposure to early psychological trauma in childhood or adolescence represents a substantial risk factor for an adult psychopathological development. In particular, so called type II trauma events, i.e. repeated or chronic interpersonal traumatic experiences like emotional, physical, sexual abuse, and physical, emotional neglect are associated with the development of a wide range of mental disorders.
有充分的证据表明,在儿童或青少年时期暴露于早期心理创伤是成年精神病理学发展的一个重要风险因素。特别是,所谓的II型创伤事件,即反复或长期的人际创伤经历,如情感、身体、性虐待和身体、情感忽视,与广泛的精神障碍的发展有关。
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引用次数: 0
Admiral Horatio Lord Nelson's Death at the Battle of Trafalgar: ANeurosurgeon's Forensic Medical Analysis 海军上将霍雷肖·纳尔逊在特拉法加战役中的死亡:欧洲外科医生的法医学分析
Pub Date : 2017-06-05 DOI: 10.4172/2167-1222.1000379
D. Nijensohn
Admiral Horatio Lord Nelson, the greatest British naval hero, was fatally wounded during the Battle of Trafalgar. Conventional theory holds that he died mainly of an injury to a major blood vessel in the chest. However, a review of the empirical evidence-with the benefit of modern medical science-, suggests that the primary cause of death was a spinal neurogenic shock from transection of the mid thoracic spinal cord. These conditions do not necessarily exclude each other.
海军上将霍雷肖·纳尔逊,英国最伟大的海军英雄,在特拉法加战役中受了致命伤。传统理论认为,他主要死于胸部主要血管损伤。然而,一项基于现代医学的经验证据综述表明,死亡的主要原因是胸中脊髓横断引起的脊髓神经源性休克。这些条件并不一定相互排斥。
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引用次数: 2
期刊
Journal of trauma & treatment
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