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1.
Radiol Clin North Am ; 58(5): 965-979, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32792127

RESUMO

Blunt trauma accounts for more than 95% of traumatic renal injury and results from shear forces from rapid acceleration or deceleration and/or collision against the spine or ribs. The use of multiphasic contrast-enhanced computed tomography (CT) has proven pivotal in the evaluation and management of traumatic kidney injury, and CT imaging features provide the basis for nonsurgical staging. This article describes the epidemiology and mechanisms of blunt and penetrating traumatic renal injury and reviews the range of findings from various imaging modalities, with a particular emphasis on contrast-enhanced CT.


Assuntos
Rim/lesões , Imagem Multimodal/métodos , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos Penetrantes/diagnóstico por imagem , Humanos , Rim/diagnóstico por imagem , Imagem por Ressonância Magnética , Tomografia Computadorizada por Raios X , Ultrassonografia
2.
Am Surg ; 86(5): 493-498, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32684037

RESUMO

BACKGROUND: Isolated diaphragm injury (IDI) occurs in up to 30% of penetrating left thoracoabdominal injuries. Laparoscopic abdominal procedures have demonstrated improved outcome including decreased postoperative pain and length of stay (LOS) compared to open surgery. However, there is a paucity of data on this topic for penetrating IDI. The aim of this study was to examine the prevalence and outcome of laparoscopic diaphragmatic repair versus open diaphragmatic repair (LDR vs ODR) of IDI. METHODS: The Trauma Quality Improvement Program (2010-2016) was queried for patients with IDI who underwent ODR versus LDR. A bivariate analysis using Pearson chi-square and Mann-Whitney test was performed to determine LOS among the two groups. RESULTS: From 2039 diaphragm injuries, 368 patients had IDI; 281 patients (76.4%) underwent ODR and 87 (23.6%) underwent LDR. Compared to LDR, the ODR patients were older (median, 31 vs 25 years, P < .001) and had a higher injury severity score (mean, 11.2 vs 9.6, P = .03) but had similar rates of intensive care unit LOS, unplanned return to the operating room, ventilator days, and complications (P > .05). Patients undergoing ODR had a longer LOS (5 vs 4 days, P = .01), compared to LDR. There were no deaths in either group. CONCLUSIONS: Trauma patients presenting with IDI undergoing ODR had a longer hospital LOS compared to patients undergoing LDR with no difference in complications or mortality. Therefore, we recommend when possible an LDR should be employed to decrease hospital LOS. Further research is needed to examine other benefits of laparoscopy such as postoperative pain, incisional hernia, and wound-related complications.


Assuntos
Diafragma/lesões , Diafragma/cirurgia , Laparoscopia , Tempo de Internação/estatística & dados numéricos , Ferimentos Penetrantes/cirurgia , Adulto , Feminino , Humanos , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
4.
No Shinkei Geka ; 48(7): 607-613, 2020 Jul.
Artigo em Japonês | MEDLINE | ID: mdl-32694230

RESUMO

Herein, we report a rare case of penetrating transorbital cavernous sinus injury caused by a bamboo stick, treated by craniotomy in a hybrid operating room. A 63-year-old gardener presented at our hospital with right upper orbital injury after falling on a bamboo basket. Neurological examination revealed right II, III, IV, and VI cranial nerve palsies. CT and MRI revealed a right transorbital penetrating injury by a small sharp wooden foreign body, extending from the orbit to the cavernous sinus via the superior orbital fissure. Preoperative digital subtraction angiography revealed partial occlusion of the right cavernous sinus by the foreign body and no internal carotid artery(ICA)injury. There was a nine-day waiting period after the injury because the patient was on dual antiplatelet therapy for ischemic heart disease. Subsequently, the bamboo stick was completely removed through the right fronto-temporo-orbito-zygomatic approach in a hybrid operating room. To treat the potential massive hemorrhage, a five-French balloon catheter was inserted in the right ICA at its origin via the right transfemoral approach before the craniotomy. The bamboo stick was completely removed with minor hemorrhage in the cavernous sinus; this was controlled using hemostatic materials. The postoperative course was uneventful. The patient was discharged with blindness and total ophthalmoplegia in the right eye but he was able to return to his prior job. This is the first report of such a treatment of a transorbital penetrating injury in a hybrid operating room.


Assuntos
Seio Cavernoso/cirurgia , Ferimentos Penetrantes/cirurgia , Craniotomia , Humanos , Masculino , Pessoa de Meia-Idade , Salas Cirúrgicas , Órbita/cirurgia
5.
Medicine (Baltimore) ; 99(28): e20935, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664091

RESUMO

During ganglion impar block, the needle may approach the presacral space and the sacrum may be penetrated during caudal anesthesia. Because the rectum is in front of the sacrococcyx and is thus at risk for puncture, it is important to determine the distance between the sacrococcyx and rectum, as well as the thickness of the sacrococcyx.Computed tomography was used to measure the distance between the rectum and sacrococcyx, as well as the thickness of the sacrococcyx. The distances between the coccyx and rectum, sacrococcygeal joint and rectum, sacral level 5 ('sacrum 5') and rectum, and 'sacrum 4 to 5 junction' and rectum were measured. The results were compared based on the presence or absence of stools in the rectum. The thickness of the sacrococcyx was measured at the sacrum 4 to 5 junction and sacrococcygeal joint.In total, 1264 patients were included in this study. All distances were less than 1 mm in both males and females, with the exception of the distance between the coccyx and rectum in males. In both males and females, there was no significant difference in distance between the sacrococcyx and rectum according to the presence or absence of feces in the rectum, but there was a difference in the distance between sacrum 5 and the rectum in males (P = .048). Several male and female patients showed thicknesses of less than 5 mm at the sacrococcygeal joint.Some patients have a distance of less than 1 mm between the sacrum and rectum. Practitioners should exercise caution when applying a needle to the presacral space. If the sacrum is accidentally penetrated during caudal block, rectum puncture cannot be ruled out. Excretion of feces does not influence the distance between the sacrococcyx and rectum in females.


Assuntos
Anestesia Caudal/instrumentação , Cóccix/anatomia & histologia , Agulhas , Reto/anatomia & histologia , Reto/lesões , Sacro/anatomia & histologia , Ferimentos Penetrantes/etiologia , Ferimentos Penetrantes/prevenção & controle , Adulto , Idoso , Pesos e Medidas Corporais , Cóccix/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Sacro/diagnóstico por imagem , Tomografia Computadorizada por Raios X
7.
Soud Lek ; 65(2): 27-29, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32493020

RESUMO

Traumatic injury due to crossbows is a rare occurrence these days. The aim of this study is to present a case of perforating chest injury caused by a bolt shot from a crossbow in suicidal intent which occurred “live“ during a telephone conversation. The autopsy revealed perforation of the heart and left lungs with massive bleeding to the left pleural cavity which caused haemorrhagic shock. The motive of the mans suicide was the breakup with his girlfriend.


Assuntos
Suicídio , Traumatismos Torácicos , Ferimentos Penetrantes , Humanos , Ideação Suicida , Traumatismos Torácicos/etiologia , Armas
8.
World Neurosurg ; 141: 402-405, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32561491

RESUMO

BACKGROUND: Nonmissile penetrating injuries to the craniocervical junction caused by a glass fragment are rare, and a standard management strategy has not been established. CASE DESCRIPTION: A 75-year-old Japanese man was brought into our emergency department after receiving a left retroauricular stab wound by broken glass fragments. After spinal immobilization, a computed tomography (CT) scan revealed glass fragments penetrating at the right craniocervical junction to the interatlantooccipital subarachnoid space. CT angiography showed that both vertebral arteries were not injured. Magnetic resonance imaging demonstrated that the glass fragments did not penetrate the cervical cord or medulla oblongata. These glass fragments were removed via a midline incision from the external occipital protuberance to the C7 and with laminectomy without suboccipital craniectomy. Five of the glass fragments were found and removed in total. The dural defect was patched with a free fascia autograft. His postoperative course was uneventful. Postoperative CT angiography showed that both vertebral arteries were intact and the glass fragments had been removed completely. CONCLUSIONS: CT graphical diagnosis is useful for the management of penetrating craniocervical junction trauma, and it should be considered in the evaluation of patients who have suffered craniocervical penetrating injury even in the absence of major wounds or bleeding. Spinal immobilization of patients with craniocervical penetrating injuries is crucial to avoid not only secondary neurologic damage but also secondary critical vascular damage. Incomplete or inadequate assessment of craniocervical stab wounds results in unexpected hazards that are preventable.


Assuntos
Articulação Atlantoccipital/lesões , Infecções por Coronavirus , Vidro , Pandemias , Pneumonia Viral , Espaço Subaracnóideo/lesões , Traumatismos do Sistema Nervoso/complicações , Traumatismos do Sistema Nervoso/cirurgia , Idoso , Articulação Atlantoccipital/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Espaço Subaracnóideo/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Traumatismos do Sistema Nervoso/diagnóstico por imagem , Ferimentos Penetrantes/complicações , Ferimentos Penetrantes/cirurgia , Ferimentos Perfurantes/terapia
9.
Medicine (Baltimore) ; 99(16): e19853, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32312008

RESUMO

RATIONALE: Kidney is the most frequently injured organ of the genitourinary system during trauma. Bilateral penetrating renal trauma (BPRT) is extremely rare and sporadically reported in the previous literature. Here, we reported a unique case of BPRT. PATIENT CONCERNS: A 43-year-old man, with no medical history, was accidentally penetrated by a wooden stick and presented with sharp pain in the left flank. DIAGNOSIS: Laboratory tests revealed microscopic hematuria, mildly elevated leucocyte and amylase, normal hemoglobin (145 g/L) and creatinine (1.05 mg/dl). Computed tomography demonstrated bilateral penetrating renal injuries with perinephric/subcapsular hematoma, fracture of the second lumbar vertebra and 10th rib. INTERVENTIONS: An emergency exploratory laparotomy was executed immediately. According to the American Association for the Surgery of Trauma Organ Injury Scale grading system, grade V and III injuries were considered for the left and right kidney, respectively. Nephrectomy and renorrhaphy were performed on the left and right kidney, respectively. OUTCOMES: The postoperative course was uneventful. Eleven days after the surgery, the patient discharged with no complications. LESSONS: We present a rare and challenging case which was handled successfully, and it may provide useful information for the management of BPRT.


Assuntos
Dor no Flanco/etiologia , Rim/lesões , Ferimentos Penetrantes/complicações , Adulto , Dor no Flanco/diagnóstico , Hematoma , Hematúria/diagnóstico , Humanos , Rim/diagnóstico por imagem , Rim/patologia , Laparotomia/métodos , Masculino , Nefrectomia/métodos , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Ferimentos e Lesões/complicações , Ferimentos Penetrantes/diagnóstico por imagem , Ferimentos Penetrantes/patologia
11.
J Surg Res ; 250: 59-69, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32018144

RESUMO

BACKGROUND: Previous studies have shown that a notable portion of patients who are readmitted for reinjury after penetrating trauma present to a different hospital. The purpose of this study was to identify the risk factors for reinjury after penetrating trauma including reinjury admissions to different hospitals. METHODS: The 2010-2014 Nationwide Readmissions Database was queried for patients surviving penetrating trauma. E-codes identified patients subsequently admitted with a new diagnosis of blunt or penetrating trauma. Univariable analysis was performed using 44 injury, patient, and hospital characteristics. Multivariable logistic regression using significant variables identified risk factors for the outcomes of reinjury, different hospital readmission, and in-hospital mortality after reinjury. RESULTS: There were 443,113 patients identified. The reinjury rate was 3.5%. Patients presented to a different hospital in 30.0% of reinjuries. Self-inflicted injuries had a higher risk of reinjury (odds ratio [OR]: 2.66, P < 0.05). Readmission to a different hospital increased risk of mortality (OR: 1.62, P < 0.05). Firearm injury on index admission increased risk of mortality after reinjury (OR: 1.94, P < 0.05). CONCLUSIONS: This study represents the first national finding that one in three patients present to a different hospital for reinjury after penetrating trauma and have a higher risk of mortality due to this fragmentation of care. These findings have implications for quality and cost improvements by identifying areas to improve continuity of care and the implementation of penetrating injury prevention programs.


Assuntos
Continuidade da Assistência ao Paciente/organização & administração , Necessidades e Demandas de Serviços de Saúde , Readmissão do Paciente/estatística & dados numéricos , Ferimentos Penetrantes/epidemiologia , Adolescente , Adulto , Idoso , Continuidade da Assistência ao Paciente/economia , Bases de Dados Factuais/estatística & dados numéricos , Feminino , Mortalidade Hospitalar , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/economia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Ferimentos Penetrantes/diagnóstico , Ferimentos Penetrantes/economia , Ferimentos Penetrantes/cirurgia , Adulto Jovem
12.
J Surg Res ; 250: 112-118, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32044507

RESUMO

BACKGROUND: The benefits of the Affordable Care Act (ACA) for trauma patients have been well established. However, the ACA's impact on penetrating trauma patients (PTPs), a population that is historically young and uninsured, has not been defined. We hypothesized that PTPs in the post-ACA era would have better outcomes. MATERIAL AND METHODS: The National Trauma Data Bank (NTDB) was queried for all PTPs from 2009 (pre-ACA) and 2011-2014 (post-ACA). Subset analysis was performed in patients aged 19-25 y, as this group was eligible for the ACA's dependent care provision (DCP). RESULTS: There were 9,714,471 patients in the study, with 2,053,501 (21.1%) pre-ACA and 7,660,970 (78.9%) post-ACA. When compared to pre-ACA, patients in the post-ACA cohort were more likely to have commercial/private insurance, less likely to have Medicaid, and more likely to be uninsured. On logistic regression, the pre-ACA era was associated with mortality (HR: 1.02, 95% CI: 1.01-1.04, P = 0.004). Being uninsured was associated with mortality (HR: 1.89, 95% CI: 1.87-1.92, P < 0.001). On subset analysis of the DCP age group, post-ACA patients were more likely to be uninsured (24.1% versus 17.6%; P < 0.001). In addition, for the DCP age group, pre-ACA era was not associated with mortality (HR: 1.03, 95% CI: 0.99-1.06, P = 0.20). CONCLUSIONS: Although the ACA provided a survival benefit to PTPs overall, it did not increase insurance coverage for this population. In addition, the DCP of the ACA did not improve insurance access for PTP in the eligible age group. Further efforts are needed to extend insurance access to this population.


Assuntos
Acesso aos Serviços de Saúde/economia , Cobertura do Seguro/estatística & dados numéricos , Patient Protection and Affordable Care Act/legislação & jurisprudência , Ferimentos Penetrantes/cirurgia , Adulto , Feminino , Acesso aos Serviços de Saúde/legislação & jurisprudência , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Cobertura do Seguro/economia , Cobertura do Seguro/legislação & jurisprudência , Masculino , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Pessoa de Meia-Idade , Patient Protection and Affordable Care Act/economia , Estudos Retrospectivos , Estados Unidos , Ferimentos Penetrantes/economia , Ferimentos Penetrantes/mortalidade
13.
J Trauma Acute Care Surg ; 89(1): 208-214, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32068716

RESUMO

BACKGROUND: Community violence remains a clinical concern for urban hospitals nationwide; however, research on resilience and posttraumatic growth (PTG) among survivors of violent injury is lacking. This study intends to assess survivors of violent injury for resilience and PTG to better inform mental health interventions. METHODS: Adults who presented with nonaccidental penetrating trauma to an urban level 1 trauma center and were at least 1 month, but no more than 12 months, from treatment were eligible. Participants completed the Connor-Davidson Resiliency Scale, Posttraumatic Growth Inventory (PTGI), Primary Care Posttraumatic Stress Disorder screen, and a community violence exposure screen. Additional demographic, injury, and treatment factors were collected from medical record. RESULTS: A total of 88 patients participated. The mean resiliency score was 83.2, with 71.1% scoring higher than the general population and 96.4% scoring higher than the reported scores of those seeking treatment for posttraumatic stress disorder (PTSD). Participants demonstrated a mean PTGI score of 78 (SD, 20.4) with 92.4% scoring above the significant growth threshold of 45. In addition, 60.5% of patients screened positive for significant PTSD symptoms, approximately eight times higher than general population. Exposure to other traumatic events was high; an overwhelming 94% of participants stated that they have had a family member or a close friend killed, and 42% had personally witnessed a homicide. Higher resilience scores correlated with PTGI scores (p < 0.001) and lower PTSD screen (p = 0.02). CONCLUSION: Victims of violent injury experience a myriad of traumatic events yet are highly resilient and exhibit traits of growth across multiple domains. Resiliency can coexist with posttraumatic stress symptoms. Practitioners should assess for resiliency and PTG in addition to PTSD. Further investigation is needed to clarify the relational balance between resilience and posttraumatic stress. LEVEL OF EVIDENCE: Epidemiological study type, Level II.


Assuntos
Vítimas de Crime , Resiliência Psicológica , Transtornos de Estresse Pós-Traumáticos/psicologia , Ferimentos Penetrantes/psicologia , Ferimentos Penetrantes/terapia , Adulto , Feminino , Humanos , Masculino , Centros de Traumatologia
14.
World Neurosurg ; 137: e263-e268, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32004739

RESUMO

BACKGROUND: The surgical management of penetrating spinal injury (PSI) has been widely debated in the literature, and the benefit of decompressive surgery for neurological function remains controversial. No national guidelines exist for the PSI population, and surgical practice patterns are unknown. We studied regional and institutional trends in the surgical management of PSI in the United States from 1988 to 2011. METHODS: The National Inpatient Sample database was accessed to identify a 20% stratified sample of PSI admissions to US hospitals from 1988 to 2011. PSI patients were divided into surgical (SXPSI) and nonsurgical (NSXPSI) groups, and these groups were analyzed across several regional, institutional, and patient-related variables. RESULTS: A total of 6632 PSI admissions were identified between 1988 and 2011. Decreased age (P = 0.002) and male gender (P = 0.015) were significantly more common in SXPSI than NSXPSI. Surgical rates were higher in teaching hospitals (P < 0.001), large hospitals (P = 0.012), and non-Northeast region hospitals (P < 0.020). Surgical management was associated with decreased mortality, increased length of stay, and increased total hospital charges (P < 0.001). CONCLUSIONS: Decompressive surgery rates for PSI differ significantly across regions and institutions in the United States. Institutional bias, patient preferences, and regional practice patterns all influence decision-making in PSI. A lack of large outcome studies in PSI and the absence of national guidelines contribute to variation in practice patterns. Our study indicates the need for future studies to better describe outcomes in patients with PSI.


Assuntos
Descompressão Cirúrgica/estatística & dados numéricos , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Traumatismos da Medula Espinal/cirurgia , Ferimentos Penetrantes/cirurgia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos
15.
J Trauma Acute Care Surg ; 88(5): 579-587, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32039976

RESUMO

BACKGROUND: Traumatic injury can lead to a compromised intestinal epithelial barrier, decreased gut perfusion, and inflammation. While recent studies indicate that the gut microbiome (GM) is altered early following traumatic injury, the impact of GM changes on clinical outcomes remains unknown. Our objective of this follow-up study was to determine if the GM is associated with clinical outcomes in critically injured patients. METHODS: We conducted a prospective, observational study in adult patients (N = 67) sustaining severe injury admitted to a level I trauma center. Fecal specimens were collected on admission to the emergency department, and microbial DNA from all samples was analyzed using the Quantitative Insights Into Microbial Ecology pipeline and compared against the Greengenes database. α-Diversity and ß-diversity were estimated using the observed species metrics and analyzed with t tests and permutational analysis of variance for overall significance, with post hoc pairwise analyses. RESULTS: Our patient population consisted of 63% males with a mean age of 44 years. Seventy-eight percent of the patients suffered blunt trauma with 22% undergoing penetrating injuries. The mean body mass index was 26.9 kg/m. Significant differences in admission ß-diversity were noted by hospital length of stay, intensive care unit hospital length of stay, number of days on the ventilator, infections, and acute respiratory distress syndrome (p < 0.05). ß-Diversity on admission differed in patients who died compared with patients who lived (mean time to death, 8 days). There were also significantly less operational taxonomic units in samples from patients who died versus those who survived. A number of species were enriched in the GM of injured patients who died, which included some traditionally probiotic species such as Akkermansia muciniphilia, Oxalobacter formigenes, and Eubacterium biforme (p < 0.05). CONCLUSION: Gut microbiome diversity on admission in severely injured patients is predictive of a variety of clinically important outcomes. While our study does not address causality, the GM of trauma patients may provide valuable diagnostic and therapeutic targets for the care of injured patients. LEVEL OF EVIDENCE: Prognostic and epidemiological, level III.


Assuntos
Microbioma Gastrointestinal/fisiologia , Ferimentos não Penetrantes/mortalidade , Ferimentos Penetrantes/mortalidade , Adulto , Idoso , Serviço Hospitalar de Emergência/estatística & dados numéricos , Fezes/microbiologia , Feminino , Seguimentos , Mortalidade Hospitalar , Humanos , Escala de Gravidade do Ferimento , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Centros de Traumatologia/estatística & dados numéricos , Ferimentos não Penetrantes/diagnóstico , Ferimentos não Penetrantes/microbiologia , Ferimentos Penetrantes/diagnóstico , Ferimentos Penetrantes/microbiologia
16.
J Trauma Acute Care Surg ; 88(5): 696-703, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32068717

RESUMO

INTRODUCTION: The United States and United Kingdom (UK) had differing approaches to the surgical skill mix within deployed medical treatment facilities (MTFs) in support of the military campaigns in Iraq and Afghanistan. METHODS: The US and UK combat trauma registries were scrutinized for patients with penetrating neck injury (PNI) at deployed coalition MTF between March 2003 and October 2011. A multivariate mixed effects logistic regression model (threshold, p < 0.05) was used stratified by MTF location and year of injury. The dependent variable was fatality on leaving Role 3, and the independent variables were ISS on arrival, nationality, MTF nationality, and presence of head and neck surgeon. RESULTS: A total of 3,357 (4.9%) of 67,586 patients who arrived alive at deployed military MTF were recorded to have sustained neck injuries; of which 2,186 (83%) were PNIs and the remainder were blunt injuries. When service members killed in action were included, the incidence of neck injury rose from 4.9% to 10%. Seven hundred nine (32%) of 2,186 patients with PNI underwent neck exploration; 555 patients were recorded to have sustained cervical vascular injury, 230 (41%) of 555 underwent vascular ligation or repair. Where it was recorded, PNI directly contributed to death in 64 (28%) of 228 of patients. Fatality status was positively associated with ISS on arrival (odds ratio, 1.05; 95% confidence interval, 1.04-1.06; p < 0.001) and the casualty being a local national (odds ratio, 1.74; 95% confidence interval, 1.28-2.38; p < 0.001). CONCLUSION: Significant differences in the treatment and survival of casualties with PNI were identified between nations in this study; this may reflect differing cervical protection, management protocols, and surgical capability and is worthy of further study. In an era of increasing specialization within surgery, neck exploration remains a skill that must be retained by military surgeons deploying to Role 2 and Role 3 MTF. LEVEL OF EVIDENCE: Retrospective cohort study, level III.


Assuntos
Medicina Militar/métodos , Lesões do Pescoço/terapia , Lesões Relacionadas à Guerra/terapia , Ferimentos Penetrantes/terapia , Adolescente , Adulto , Campanha Afegã de 2001- , Afeganistão/epidemiologia , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Iraque/epidemiologia , Guerra do Iraque 2003-2011 , Masculino , Pessoa de Meia-Idade , Medicina Militar/estatística & dados numéricos , Lesões do Pescoço/etiologia , Lesões do Pescoço/mortalidade , Sistema de Registros/estatística & dados numéricos , Análise de Sobrevida , Reino Unido/epidemiologia , Estados Unidos/epidemiologia , Lesões Relacionadas à Guerra/etiologia , Lesões Relacionadas à Guerra/mortalidade , Guerra/estatística & dados numéricos , Ferimentos Penetrantes/etiologia , Ferimentos Penetrantes/mortalidade , Adulto Jovem
17.
Chin J Traumatol ; 23(1): 5-9, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32014343

RESUMO

Traumatic peripheral vascular injury is a significant cause of disability and death either in civilian environments or on the battlefield. Penetrating trauma and blunt trauma are the most common forms of vascular injuries. Besides, iatrogenic arterial injury (IAI) is another pattern of vascular trauma. The management of peripheral vascular injuries has been improved in different environments and wars. There are different types of vascular injuries, such as vasospasm, contusion, intimal flaps, intimal disruption or hematoma, external compression, laceration, transection and focal wall defects, etc. The main clinical manifestations of vascular injuries are shock following massive hemorrhage and limb necrosis due to tissue and organ ischemia. Ultrasound, computed tomography angiography (CTA) and magnetic resonance angiography (MRA) are most valuable for assessment of peripheral vascular injuries. Angiography remains the gold standard for diagnosing vascular trauma. Immediate hemorrhage control and rapid restoration of blood flow are the primary goals of vascular trauma treatment. There are many operative treatment methods for vascular injuries, such as vascular suture or ligation, vascular wall repair and vascular reconstruction with blood vessel prostheses or vascular grafts. Embolization, balloon dilation and covered stent implantation are the main endovascular techniques. Surgical operation is still the primary treatment for vascular injuries. Endovascular treatment is a promising alternative, proved to be safe and effective, and preferred selection for patients. In summary, rapid diagnosis and timely surgical intervention remain the mainstays of the treatment. However, many issues need to be resolved by further studies.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos/métodos , Procedimentos Cirúrgicos Vasculares/métodos , Lesões do Sistema Vascular , Implante de Prótese Vascular/métodos , Angiografia por Tomografia Computadorizada , Diagnóstico Precoce , Procedimentos Endovasculares/métodos , Hemorragia/etiologia , Hemorragia/terapia , Humanos , Doença Iatrogênica , Angiografia por Ressonância Magnética , Lesões do Sistema Vascular/classificação , Lesões do Sistema Vascular/complicações , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/cirurgia , Ferimentos não Penetrantes , Ferimentos Penetrantes
19.
World Neurosurg ; 137: 389-392, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32084620

RESUMO

BACKGROUND: Pediatric isolated penetrating traumatic vertebral artery injuries require urgent multidisciplinary management as they may lead to potentially fatal posterior circulation ischemia. CASE DESCRIPTION: We present a 19-month-old patient with an isolated penetrating vertebral artery injuries at the V2 segment of the right vertebral artery and report our strategy for her endovascular treatment which involved simultaneous coil embolization and foreign body removal. CONCLUSION: Endovascular treatment can be considered first line treatment of oral penetrating injuries to the vertebral artery, where the penetrating object has an anterior to posterior trajectory.


Assuntos
Procedimentos Endovasculares/métodos , Corpos Estranhos/cirurgia , Orofaringe/cirurgia , Lesões do Sistema Vascular/cirurgia , Artéria Vertebral/cirurgia , Ferimentos Penetrantes/cirurgia , Angiografia por Tomografia Computadorizada , Feminino , Corpos Estranhos/diagnóstico por imagem , Humanos , Lactente , Orofaringe/diagnóstico por imagem , Artéria Vertebral/lesões
20.
Can Assoc Radiol J ; 71(2): 231-237, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32062986

RESUMO

PURPOSE: This study aims to evaluate the overall diagnostic accuracy of preoperative multidetector computed tomography (MDCT) in penetrating abdominal and pelvic injuries (PAPI). METHOD AND MATERIALS: We used our hospitals' trauma registry to retrospectively identify patients with PAPI from January 1, 2006, to December 31, 2016. Only patients who had a 64-MDCT scan at presentation and subsequently underwent laparotomy or laparoscopy were included in our study cohort. Each finding noted on MDCT was rated using a 5-point scale to indicate certainty of injury, with a score of 0 being definitive. Using surgical findings as the gold standard, the accuracy of radiology reports was analyzed in 2 ways. A κ statistic was calculated to evaluate each pair of values for absolute agreement, and ratings for all organ systems were analyzed using a repeated measures analysis of variance (ANOVA) to determine whether radiology and surgical findings were similar enough to be clinically meaningful. Qualitative review of the radiology and surgical reports focused on the gastrointestinal (GI) tract was conducted. RESULTS: Our cohort consisted of 38 males and 4 females with a median age of 29 years and a median injury severity score of 15.6. For this study, 12 different organ groups were categorized and analyzed. Of those organ groups, absolute agreement between MDCT and surgical findings was found only for liver and spleen (κ values ranging from 0.2 to 0.5). Additionally, the ANOVA revealed an interaction between finding type and organ system (F 1, 33 = 7.4, P < .001). The most clinically significant discrepancies between MDCT and surgical findings were for gallbladder, bowel, mesenteric, and diaphragmatic injuries. Qualitative review of the GI tract revealed that radiologists can detect significant findings such as presence of injury, however, localization and extent of injury pose a challenge. CONCLUSION: The detection of clinically significant injuries to solid organs in trauma patients with PAPI on 64-MDCT is adequate. However, detection of injury to the remaining organ groups on MDCT, especially bowel, mesentery, and diaphragm, remains a challenge.


Assuntos
Traumatismos Abdominais/diagnóstico por imagem , Sistema Digestório/diagnóstico por imagem , Sistema Digestório/lesões , Tomografia Computadorizada Multidetectores , Pelve/lesões , Ferimentos Penetrantes/diagnóstico por imagem , Traumatismos Abdominais/cirurgia , Adolescente , Adulto , Idoso , Diafragma/diagnóstico por imagem , Diafragma/lesões , Feminino , Vesícula Biliar/diagnóstico por imagem , Vesícula Biliar/lesões , Humanos , Escala de Gravidade do Ferimento , Intestinos/diagnóstico por imagem , Intestinos/lesões , Fígado/diagnóstico por imagem , Fígado/lesões , Masculino , Mesentério/diagnóstico por imagem , Mesentério/lesões , Pessoa de Meia-Idade , Pelve/diagnóstico por imagem , Pelve/cirurgia , Período Pré-Operatório , Estudos Retrospectivos , Sensibilidade e Especificidade , Baço/diagnóstico por imagem , Baço/lesões , Ferimentos Penetrantes/cirurgia , Adulto Jovem
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