Novel coronavirus and trauma surgery: successful infection control from a level I trauma centre.

PURPOSE: In the absence of effective treatment options, the recent SARS-CoV2 pandemic poses a great challenge to the health and social sectors worldwide. Hereby, we would like to share our proposals in the hope that it will prove helpful for our colleagues in this difficult time. METHODS: The present recommendations are based on the opinion of experts as well as the experience of a group of traumatologists directly involved in the organization of traumatology wards. The reassignment of the healthcare personnel, the separation of the potentially infected patients and the different levels of restriction on the trauma care are all key elements of our protocol. RESULTS: Since the first SARS-CoV2-positive case was confirmed in Hungary, our trauma surgeons were able to avoid contamination with the help of the new guidelines, without reducing the quality of trauma care. CONCLUSION: Reasonably adjusted patient care protocols in every medical field are key to contain the spread of infection and to avoid public health crisis. Sharing experience can be an important element of a successful fight against the recent pandemic.

[Successful treatment of retrohepatic inferior vena cava injury: report of two cases]. / Retrohepaticus vena cava sérülés két sikeresen operált esete.

UNLABELLED: Authors present two cases of successfully operated patients with retrohepatic inferior vena cava (IVC) injury. In the first case a 79 year old female patient suffered from multiple stab wounds in the area of the 4th segment of the right lung as well as in the retrohepatic region in close proximity to the IVC. At the time of the first surgery the IVC injury was not identified. During a second operation, however, the IVC was isolated from the liver using an anterior dissection of the parenchyma with finger-fracture technique and the injury was oversawn finally. Successful haemostasis of the liver was achieved by packing of the perihepatic space, which was removed three days later. In the second case a 25 year-old male patient had suffered blunt abdominal trauma. He underwent laparotomy and packing on the site of the hepatic injury, which had to be repeated seven more times. Later on, another urgent laparotomy was carried out for recurring intraabdominal bleeding and bile leakage, and cholecystectomy was performed due to gallbladder perforation. Another two days later a further emergency laparotomy was indicated for ongoing intraabdominal bleeding, when the bleeding source - an injury (3 mm in diameter) of the retrohepatic IVC - was oversawn. After relatively long postoperative stay both patients were fully recovered and discharged from hospital. CONCLUSIONS: penetrating injuries of the IVC are associated with high mortality rate of approximately 78%. Proper management of these injuries requires experience in both vascular and liver surgery. Retrohepatic IVC injury needs to be considered in the differential diagnosis of ongoing bleeding in penetrating or blunt liver trauma. Packing of the liver is a reliable haemostatic method if bleeding persists due to division of the liver parenchyma.

[The role of VATS in the treatment of blunt thoracic injuries]. / A VATS szerepe a tompa mellkasi serülések kezelésében.

AIMS: Video assisted thoracoscopy (VATS) is a more and more frequently used method in the diagnosis and treatment of blunt thoracic trauma. In some cases it has diagnostic and in others therapeutic effect. The authors analyze the role of VATS in the diagnosis and the treatment of 83 patients treated with haemothorax. PATIENTS AND METHODS: There were 83 patients treated (60 male, 23 female, mean age of 54.4 years) with haemothorax caused by blunt thoracic trauma. Chest tube drainage was used in 31 (37.3%) cases. Urgent thoracotomy was performed in only two (2.4%) cases. Elective, planned VATS was used in 11 (13.3) cases. All of these 3 were diagnostic and 8 were therapeutic procedures. In three cases rupture of the diaphragm was diagnosed with the use of VATS which were treated through thoracotomy. In the remaining 8 cases haematoma evacuation and in 3 cases intercostal artery bleeding were treated with VATS. RESULTS: No complications related to the procedure were observed. The thoracotomy in all 3 cases verified the diaphragmatic injuries. The 8 patients undergone therapeutic VATS recovered. The mean hospital stay after VATS was 7.8 days and 11.3 days after thoracotomy in the patients with diaphragmatic injury. CONCLUSIONS: The VATS has a significant role in the diagnosis of blunt thoracic, especially of diaphragmatic, injuries. In other cases the VATS has good therapeutic effect.

[Effect of the introduction of quality control on the working standards of specialist outpatient clinics]. / Minoségi kontroll bevezetésének hatása a szakorvosi rendelo muködésére.

The Traumatology Department of the University of Debrecen Medical and Health Science Center and that of the Kenezy Gyula Hospital of Hajdu Bihar County guarantees 24 hour service for outpatient trauma patients, which makes up around one hundred thousand cases per year. A very important element of the quality control is the continual assessment and supervision of the specialist performance, and the indicator is the change in the number of selected, incorrectly treated cases. The supervised cases make up a total of 24% of the total outpatient turnover. In 2003, 24313 injury cases, and in 2004, 23705 cases were examined with respect to documentation, and x-ray films. During the supervision, the treatment of the chosen cases are assessed weekly and discussed in conference. The case discussion is one of the valuable pillars of residence training. Our method contributes to the safeguarding of an appropriate standard for specialist work in an outpatient setting, and for this reason we wish to present it.

[Comparative hematologic and immunologic studies of patients with splenectomy and spleen autotransplantation]. / Splenectomizált és lép autotranszplantált betegek összehasonlító haematologiai és immunologiai vizsgálatai.

We compared changes in haematological and immunological parameters of patients with splenectomy (n=24), splenectomy plus spleen autotransplantation (n=12) and healthy controls (n=23). In the autotransplantation group pieces of the removed spleen were placed into the omentum with good visible circulation. Significant alterations in the hematological status and in some immunological parameters were observed in both groups of patients who were operated on compared to those in the control group. There was no difference, however, between the results of the two groups of operated patients. Therefore, we emphasize the importance of vaccination in patients with spleen autotransplantation in order to prevent potential sepsis. In addition, we recommend the possible further use of spleen autotransplantation.

Hip fractures in Hungary and Sweden - differences in treatment and rehabilitation.

Data of 1,337 consecutive hip fracture patients were registered during 1 year within a prospective comparative multicenter study comparing osteosynthesis techniques and rehabilitation results in Budapest, Hungary, in Sundsvall, northern Sweden, and in Lund, southern Sweden. In Budapest the mean age was 4-5 years lower than in Sweden, and more patients lived in their own home (91% versus 70% and 62%). Less intracapsular (41% versus 54% and 54%) and more trochanteric fractures (52% versus 40% and 35%) were observed in Budapest. Many more Hungarian patients returned home (68% versus 54% and 33%); however, their mortality rate 4 months later significantly exceeded that of the Swedish centres (24% versus 15% and 13%), and more had severe pain in the operated hip (27% versus 17% and 15%). Four months after double nail osteosynthesis of displaced cervical fractures, more patients (28%) had severe hip pain than after hemiarthroplasty (16%) in Budapest as compared to Lund or Sundsvall (19% and 22%). Mortality rate after 4 months following hemiarthroplasty and nailing (36% and 20%) was significantly higher than in the Swedish centres (14% and 11%).