The European Trauma Course: Transforming systems through training.

The European Trauma Course (ETC) exemplifies an innovative approach to multispecialty trauma education. This initiative was started as a collaborative effort among the European Society for Emergency Medicine, the European Society for Trauma and Emergency Surgery, and the European Society of Anaesthesiology under the auspices of the European Resuscitation Council. With the robust support of these societies, the project has evolved into the independent European Trauma Course Organisation. Over the past 15 years, the ETC has transcended traditional training by integrating team dynamics and non-technical skills into a scenario-based simulation course, helping to shape trauma care practice and education. A distinctive feature of the ETC is its training of doctors and allied healthcare professionals, fostering a collaborative and holistic approach to trauma care. The ETC stands out for its unique team-teaching approach, which has gained widespread recognition as the standard for in-hospital trauma care training not only in Europe but also beyond. Since its inception ETC has expanded geographically from Finland to Sudan and from Brazil to the Emirates, training nearly 20,000 healthcare professionals and shaping trauma care practice and education across 25 countries. Experiencing exponential growth, the ETC continues to evolve, reflecting its unmet demand in trauma team education. This review examines the evolution of the ETC, its innovative team-teaching methodology, national implementation strategies, current status, and future challenges. It highlights its impact on trauma care, team training, and the effect on other life support courses in various countries.

Case report; successful treatment of traumatic ischaemic hemiplegia secondary to blunt carotid injury associating high grade liver trauma.

INTRODUCTION AND IMPORTANCE: Blunt carotid injury (BCI) injury is a rare sequel of trauma and could result in ischemic complication if not detected and treated early. The presence of high-grade solid organ injury with ongoing bleeding represents additional challenge in treating BCI. CASE PRESENTATION: A 25-year-old victim of motor vehicle collision resulted in grade IV liver, grade III left kidney and grade I spleen injury. He underwent an urgent laparotomy with transient liver packing at local hospital. A full body Contrast-Enhanced Computer Tomography (CECT) upon arrival revealed right internal carotid intimal tear with intra and extra-cranial thrombosis and a 3 cm aneurysm. With a decreased level of consciousness, the patient showed a GCS of 13 and left-sided hemiplegia. After complex multidisciplinary treatment sessions, patient recovered with a partial regain of left-sided muscle power. CLINICAL DISCUSSION: Selective embolization of active liver bleeding was a turning point in the management of our patient as it deferred the need for a second operative intervention. It was a necessary step before endovascular stenting and recanalization of the BCI to restore the circulation to the right cerebral hemisphere. Dual anti-platelet therapy (DAPT) was necessary to prevent thrombosis of the stent and continuity of carotid recanalization. CONCLUSION: BCI with traumatic ischaemic hemiplegia associating a sum of life-threatening multiple injuries including high grade liver trauma with ongoing bleeding could still be managed non-operatively with acceptable outcome in the presence of a comprehensive specialized multidisciplinary service.

Blunt Abdominal Trauma Leading to an Incidental Finding of Duplicate Inferior Vena Cava (DIVC): A Case Report and Literature Review.

BACKGROUND With a prevalence of about 2% to 3%, duplication is the most common anomaly associated with the inferior vena cava (IVC). In general, systemic venous anomalies are being more frequently diagnosed in asymptomatic patients. We report the case of a young man with an incidental finding of an asymptomatic duplicated IVC, along with a literature review. CASE REPORT A 36-year-old man was brought to our Emergency Department (ED) following a high-speed motor vehicle collision (MVC), reporting right flank and hip pain. Upon examination, the "seatbelt sign" was noticed, along with abrasions over his right side. He sustained a small-bowel mesenteric injury, for which he was admitted and was treated conservatively. A CT scan incidentally revealed a duplicate IVC (DIVC). He later underwent a laparotomy with limited right hemi-colectomy and was discharged home in good condition. CONCLUSIONS Undiscovered and asymptomatic DIVCs pose a potential risk to patients during clinical interventions. Advancements in diagnostic imaging contribute greatly to the incidental discoveries of inferior vena cava duplication.

Acid suppression increases rates of Barrett's esophagus and esophageal injury in the presence of duodenal reflux.

BACKGROUND: The contribution of gastric acid to the toxicity of alkaline duodenal refluxate on the esophageal mucosa is unclear. This study compared the effect of duodenal refluxate when acid was present, decreased by proton pump inhibitors (PPI), or absent. METHODS: We randomized 136 Sprague-Dawley rats into 4 groups: group 1 (n = 33) were controls; group 2 (n = 34) underwent esophagoduodenostomy promoting "combined reflux"; group 3 (n = 34) underwent esophagoduodenostomy and PPI treatment to decrease acid reflux; and group 4, the 'gastrectomy' group (n = 35) underwent esophagoduodenostomy and total gastrectomy to eliminate acid in the refluxate. Esophaguses were examined for inflammatory, Barrett's, and other histologic changes, and expression of proliferative markers Ki-67, proliferating cell nuclear antigen (PCNA), and epidermal growth factor receptor (EGFR). RESULTS: In all reflux groups, the incidence of Barrett's mucosa was greater when acid was suppressed (group C, 62%; group D, 71%) than when not suppressed (group B, 27%; P = 0.004 and P < .001). Erosions were more frequent in the PPI and gastrectomy groups than in the combined reflux group. Edema (wet weight) and ulceration was more frequent in the gastrectomy than in the combined reflux group. Acute inflammatory changes were infrequent in the PPI group (8%) compared with the combined reflux (94%) or gastrectomy (100%) groups, but chronic inflammation persisted in 100% of the PPI group. EGFR levels were greater in the PPI compared with the combined reflux group (P = .04). Ki-67, PCNA, and combined marker scores were greater in the gastrectomy compared with the combined reflux group (P = .006, P = .14, and P < .001). CONCLUSION: Gastric acid suppression in the presence of duodenal refluxate caused increased rates of inflammatory changes, intestinal metaplasia, and molecular proliferative activity. PPIs suppressed acute inflammatory changes only, whereas chronic inflammatory changes persisted.

Cyclosporine-A therapy-induced multiple bilateral breast and accessory axillary breast fibroadenomas: a case report.

INTRODUCTION: Breast adenoma is common. However, in the setting of post-transplantation immune suppression it may be expressed differently. CASE PRESENTATION: A 35-year-old Sudanese woman, with a history of renal transplantation two and half years prior to presentation, was on a single immune suppression therapy in the form of cyclosporine-A since the transplantation. During a regular follow-up visit, she was noticed to have gingival hypertrophy and bilateral breast and axillary swellings. She underwent successful surgical resection of the bilateral fibroadenomas. CONCLUSIONS: Cyclosporine-A therapy post renal transplantation is associated with an increased incidence of benign breast changes as fibroadenoma. Regular follow-up and appropriate selection of immunosuppressant therapy are essential in the post transplantation management of these patients.

Role of jejunostomy feeding catheter as a model for nutritional support.

INTRODUCTION: The advancement in oesophageal cancer care during the last two decades has resulted in a decrease in the use of feeding jejunostomy catheter to maintain adequate nutrition. We aim to examine the validity of feeding jejunostomy catheter in maintaining adequate nutrition for patients with oesophageal cancer. PATIENTS AND METHODS: A prospective longitudinal study was conducted on oesophageal cancer patients presenting to Khartoum Teaching Hospital with complete dysphagia between June 2005 and September 2007. Nutritional assessment was performed pre- and post-insertion of the feeding jejunostomy catheter and data were tested for any significant difference. RESULTS: Among 99 patients enrolled in the study, 48 had the feeding catheter inserted during oesophagectomy, 41 prior to neoadjuvant therapy and 10 as a palliative measure. Catheter dislodgement occurred in 3% of patients while blockage occurred in 10% and migration in only 1%. The mean ± SD of patients' weight pre-insertion was 48.08 ± 10.29, while the mean ± SD weight on day 10 post-insertion was 48.41 ± 10.27 and on day 30 was 48.14 ± 10.29. Patients on jejunostomy catheter feeding were considered optimised to receive neoadjuvant therapy based on clinical assessment, mobility and sense of well being. The post-resection mortality rate was 11.5% vs 10% compared to patients on oral feeding. CONCLUSION: Jejunostomy feeding catheter provided nutritional access to oesophageal cancer patients with complete dysphagia using a locally prepared formula. Patients managed to maintain their weight up to 30 days post-insertion of the feeding catheter. Feeding jejunostomy catheter in combination with a locally prepared feeding formula provided a reliable nutritional option for oesophageal cancer patients in developing countries.

Vaginal herniation: case report and review of the literature.

OBJECTIVE: The purpose of this study was to discuss the treatment of a case of spontaneous intestinal herniation per vagina in a patient who had undergone previous transabdominal hysterectomy and to review the related literature. STUDY DESIGN: A computer-based search of the English literature from January 1900 to October 2004 with the use of the terms vaginal herniation, vaginal evisceration, and vaginal trauma/injury was performed. Causes, presentation, and treatment were discussed and compared with a recent case that was treated locally in our hospital. RESULTS: Vaginal evisceration was described in the literature as early as 1864; since then <100 cases have been reported in the literature. It is more common in menopausal women with previous hysterectomy pelvic or vaginal surgery. Vaginal trauma, as in rough coitus, instrumentation, obstetric injury, is a recognized cause in premenopausal women. CONCLUSION: Vaginal evisceration is a rare, distressing emergency that requires aggressive resuscitation and urgent surgical intervention.

Lipoma of the cord and round ligament: an overlooked diagnosis?

Lipoma of the cord, once considered rare and insignificant, has been cast in a new light by laparoscopic pre-peritoneal surgery, with diagnostic and therapeutic implications. This study aimed to determine the incidence, significance and association of spermatic cord lipomas to inguinal hernias. A retrospective review was performed for all hernia operations carried out between January 1999 and November 2002. The incidence of cord lipomas and their relation to inguinal hernias were evaluated. There were 123 repairs performed on 111 patients, 90 of which were laparoscopic via the pre-peritoneal approach, 29 were open and 4 converted from laparoscopic to open in the early part of the series. All but two cases were male (neither female had associated lipoma of the round ligament). Twenty-six lipomas of the cord were identified with an incidence of 21%. Sixteen were associated with hernia and only 10 were pure cord lipoma, an incidence of 8%. Thirteen repairs represented recurrent hernias, two of which had pure cord lipoma, one had an associated sac. Only two lipomas were suspected clinically prior to surgery. Lipoma of the cord is a poorly recognised entity that can be present with groin symptoms and clinical findings indistinguishable from inguinal hernia. Its incidence was poorly appreciated prior to the laparoscopic era.