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1.
Radiographics ; 43(9): e230040, 2023 09.
Artigo em Inglês | MEDLINE | ID: mdl-37590162

RESUMO

According to the Centers for Disease Control and Prevention, trauma is the leading cause of fatal injuries for Americans aged 1-44 years old and the fourth leading overall cause of death. Accurate and early diagnosis, including grading of solid organ injuries after blunt abdominal trauma (BAT), is crucial to guide management and improve outcomes. The American Association for the Surgery of Trauma (AAST) Organ Injury Scale (OIS) is the most widely accepted BAT scoring system at CT both within the United States and internationally, and its uses include stratification of injury severity, thereby guiding management, and facilitation of clinical research, billing, and coding. Furthermore, this system also plays a role in the credentialing process for trauma centers in the United States. The newly revised 2018 OIS provides criteria for grading solid organ damage into three groups: imaging, operation, and pathology. The final grade is based on the highest of the three criteria. If multiple lower-grade (I or II) injuries are present in a single organ, one grade is advanced to grade III. The most substantial change in the revised 2018 AAST-OIS is incorporation of multidetector CT findings of vascular injury, including pseudoaneurysm and arteriovenous fistula. The authors outline the main revised aspects of grading organ injury using the AAST-OIS for the spleen, liver, and kidney after BAT, particularly the role of multidetector CT and alternative imaging in organ injury detection, the importance of vascular injuries in grade change, and the impact of these changes on patient management and in prediction of operative treatment success and in-hospital mortality. ©RSNA, 2023 Supplemental material and the slide presentation from the RSNA Annual Meeting are available for this article. Quiz questions for this article are available through the Online Learning Center.


Assuntos
Traumatismos Abdominais , Lesões do Sistema Vascular , Ferimentos não Penetrantes , Humanos , Lactente , Pré-Escolar , Criança , Adolescente , Adulto Jovem , Adulto , Baço/diagnóstico por imagem , Fígado/diagnóstico por imagem , Rim/diagnóstico por imagem , Traumatismos Abdominais/diagnóstico por imagem , Ferimentos não Penetrantes/diagnóstico por imagem
2.
J Pediatr Urol ; 20(2): 254.e1-254.e7, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38030428

RESUMO

PURPOSE: Testicular salvage rates for torsion are time-dependent1. Door to detorsion time has been identified as an independent testicular survival factor2. We describe an initiative to reduce door to incision (DTI) time for pediatric testicular torsion. MATERIALS AND METHODS: An institutional multidisciplinary quality improvement initiative with a primary outcome of reducing DTI time for pediatric testicular torsion was developed with multidisciplinary stakeholders. Several process and balancing measures were used as secondary outcomes to help interpret and verify the observed change in DTI time. Interventions were implemented in cycles. Initial interventions standardized assessment of suspected torsion by Emergency Medicine utilizing a validated scoring system. A threshold Testicular Workup for Ischemia and Suspected Torsion (TWIST) score led to parallel notification of essential services for rapid assessment and case prioritization3. Subsequently, bedside ultrasound in the Emergency Department was implemented. Progress was tracked in a live dashboard and analyzed with X-mR process control charts and Nelson rules. These tools are used in quality improvement and process control to demonstrate the significance of changes as they are being implemented, prior to when traditional hypothesis testing would be able to do so. We aimed to increase the proportion of cases with DTI times under 4 h from 64% to >90% within one year. RESULTS: We observed 22 torsion cases prior to and 62 following initial implementation. The percentage of cases with DTI times under 4 h improved from 64% to 95%. At week 29, a shift identified a significant change on the X chart, with reduction in mean DTI time from 221 to 147 min. At the same time, a shift on the mR chart identified reduction in patient-to-patient variation. Mean time from arrival to Urology evaluation decreased from 140 to 56 min, mean time from arrival to scrotal ultrasound decreased from 70 to 36 min, and mean time from scrotal ultrasound to surgical incision decreased from 128 to 80 min. These improvements highlight the two key successes of our project: application of the TWIST score and bedside ultrasound for rapid assessment of suspected testicular torsions, and parallel processing of the evaluation and management. CONCLUSIONS: Implementation of a protocol for pediatric testicular torsion increased the proportion of cases with DTI time <4 h to 95%, decreased mean DTI time, and decreased variation. Our protocol provides a model to improve timeliness of care in treating pediatric testicular torsion.

3.
Can J Plast Surg ; 20(3): 178-80, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-23997585

RESUMO

BACKGROUND: Seroma formation is one of the most common complications following abdominoplasty. Fibrin sealant/glue has shown mixed results in seroma prevention when used in a variety of procedures. Limited information is available on its effectiveness during postbariatric abdominoplasty. METHODS: A retrospective chart analysis of 65 consecutive patients who underwent postbariatric abdominoplasty over a course of 16 months by a single surgeon was performed. Two sequential groups either receiving or not receiving fibrin sealant treatment were defined. Seroma formation and initial 24 h drain output volumes were recorded. RESULTS: Three patients in group 1 (9.1%) receiving fibrin sealant developed seroma. Twelve patients in group 2 (28.1%) not receiving fibrin sealant developed seroma; this was statistically significant (P=0.006). Twenty-four hour drain output was also statistically different, with higher initial output in the fibrin sealant group (222.2 mL versus 140.0 mL; P=0.047). CONCLUSION: Fibrin sealant was a useful adjunct during surgical wound closure and significantly decreased seroma formation in patients undergoing postbariatric abdominoplasty.


HISTORIQUE: La formation de sérome est l'une des principales complications après une abdominoplastie. La colle de fibrine, utilisée dans diverses interventions, donne des résultats mitigés dans la prévention du sérome. L'information relative à son efficacité lors d'une abdominoplastie après une chirurgie bariatrique est limitée. MÉTHODOLOGIE: Les chercheurs ont procédé à l'analyse rétrospective des dossiers de 65 patients consécutifs qui, sur une période de 16 mois, ont subi une abdominoplastie après une chirurgie bariatrique. Ils ont défini deux groupes séquentiels, l'un recevant un traitement à la colle de fibrine et l'autre pas. Ils ont enregistré la formation de sérome et les volumes d'écoulement par le drain dans les 24 premières heures. RÉSULTATS: Trois patients du groupe 1 (9,1 %) qui ont reçu de la colle de fibrine ont développé un sérome. Douze patients du groupe 2 (28,1 %) qui n'en avaient pas reçu en ont également développé un, ce qui est statistiquement significatif (P=0,006). L'écoulement par le drain sur 24 heures était également différent sur le plan statistique, l'écoulement initial étant plus important dans le groupe ayant reçu de la colle de fibrine (222,2 mL par rapport à 140,0 mL; P=0,047). CONCLUSION: La colle de fibrine était un ajout utile pendant la fermeture chirurgicale de la plaie et réduisait considérablement la formation de sérome chez les patients qui subissaient une abdominoplastie après une chirurgie bariatrique.

4.
Clin J Pain ; 26(5): 435-44, 2010 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-20473053

RESUMO

Hidradenitis suppurativa (HS) is a chronically relapsing skin disorder characterized by recurring inflammatory lesion in hair and apocrine gland-bearing skin creases in the axilla; groin or perineum, buttocks, and/or breast. HS may lead to painful eruptions and malodorous discharge significantly detracting from quality of life. HS causes a high degree of morbidity with the highest scores obtained for the level of pain caused by the disease. The majority of patients rated their pain on a Numerical Rating Scale-11 ranging from 4/10 to 10/10 and described it at various times as hot, burning, pressure, stretching, cutting, sharp, taut, splitting, gnawing, pressing, sore, throbbing, and aching. Despite the severe pain associated with this disease, HS has been essentially ignored in the pain medicine literature. It is hoped that greater understanding of the diagnosis, pathophysiology, and potential treatment options available for patients with HS, may help put pain specialists in a better position to contribute to the overall care of patients with significantly painful HS. This article reviews HS and pain. Potential mechanisms of modulating nociceptive processes in the skin are presented. A greater understanding of the diagnosis, pathophysiology, and potential treatment options for HS patients may help providers to be better able to contribute to care of patients with painful hidradenitis suppurativa.


Assuntos
Hidradenite Supurativa/diagnóstico , Hidradenite Supurativa/complicações , Hidradenite Supurativa/fisiopatologia , Hidradenite Supurativa/terapia , Humanos , Dor/complicações , Medição da Dor , Qualidade de Vida
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