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1.
J Surg Res ; 282: 129-136, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36272231

RESUMO

INTRODUCTION: Bladder and ureteral injuries are uncommon in trauma patients but are associated with increased morbidity and mortality. Patients presenting with such injuries may undergo either open surgical repair or laparoscopic repair. We aimed to compare outcomes of open surgical approach and laparoscopy in trauma patients with isolated bladder and ureteral injury. We hypothesized that laparoscopy is associated with improved outcomes. METHODS: We performed a 2017 review of American College of Surgeons Trauma Quality Improvement Program and identified trauma patients with bladder and ureteral injury who underwent open surgical repair or laparoscopy. A 1:1 propensity score matching was performed adjusting for demographics, emergency department vitals (systolic blood pressure, heart rate, Glasgow Coma Scale), mechanism of injury, Injury Severity Score, each body region Abbreviated Injury Scale score, and transfusion units. Outcomes were rates of in-hospital major complications and mortality. RESULTS: Of the 1,004,440 trauma patients, 384 patients (open: 192 and laparoscopy: 192) were matched and included. The mean age was 36 ± 15 y, Injury Severity Score was 27 [27-48], 77% were males, and 56% of patients had a blunt mechanism of injury, and 44% had penetrating injuries. Overall mortality was 7.3%. On univariate analysis, mortality was lower in the open group as compared to the laparoscopy group (10.4% versus 4.2%, P = 0.019) and survivor-only hospital length of stay was longer in the open group (8 [8-9] versus 7 [5-11], P = 0.008). There was no difference in overall major complications (23% versus 21%, P = 0.621). On multivariate analysis, open surgical repair was independently associated with lower odds of mortality (adjusted odds ratio: 0.405, 95% confidence interval: [0.17-0.95], P-value = 0.038) CONCLUSIONS: In our analysis open surgical repair of bladder and ureteral injuries was associated with lower mortality with other outcomes being similar when compared to laparoscopy. Laparoscopic surgical repair may not have an advantage over the open surgical repair for bladder and ureteral injuries. Further prospective studies are needed to delineate the ideal surgical approach for these injuries.


Assuntos
Traumatismos Abdominais , Laparoscopia , Doenças Urológicas , Masculino , Humanos , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Feminino , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Procedimentos Cirúrgicos Minimamente Invasivos , Escala de Gravidade do Ferimento , Pontuação de Propensão , Laparoscopia/efeitos adversos , Estudos Retrospectivos , Resultado do Tratamento
2.
J Surg Res ; 282: 270-279, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36332306

RESUMO

INTRODUCTION: Trauma patients with blunt abdominal solid organ injuries are at high risk for venous thromboembolism (VTE), but the optimal time to safely administer chemical thromboprophylaxis is controversial, especially for patients who are managed nonoperatively due to increased risk of hemorrhage. We sought to compare failure of nonoperative management (NOM) and VTE events based on timing of chemical thromboprophylaxis initiation. METHODS: A systematic review was conducted in PubMed and Embase databases. Studies were included if they evaluated timing of initiation of chemical thromboprophylaxis in trauma patients who underwent NOM of blunt solid organ injuries. Outcomes included failure of NOM and incidence of VTE. A random-effects meta-analysis was performed comparing patients who received late (>48 h) versus early thromboprophylaxis initiation. RESULTS: Twelve retrospective cohort studies, comprising 21,909 patients, were included. Three studies, including 6375 patients, provided data on adjusted outcomes. Pooled adjusted analysis demonstrated no difference in failure of NOM in patients receiving late versus early thromboprophylaxis (odds ratio [OR] 0.92, 95% confidence interval [CI]:0.4-2.14). When including all unadjusted studies, even those at high risk of bias, there remained no difference in failure of NOM (OR 1.16, 95% CI:0.72-1.86). In the adjusted analysis for VTE events, which had 6259 patients between two studies, patients receiving late chemical thromboprophylaxis had a higher risk of VTE compared with those who received early thromboprophylaxis (OR 1.89, 95% CI:1.15-3.12). CONCLUSIONS: Based on current observational evidence, initiation of prophylaxis before 48 h is associated with lower VTE rates without higher risk of failure of NOM.


Assuntos
Traumatismos Abdominais , Tromboembolia Venosa , Ferimentos não Penetrantes , Humanos , Tromboembolia Venosa/etiologia , Tromboembolia Venosa/prevenção & controle , Tromboembolia Venosa/epidemiologia , Anticoagulantes/uso terapêutico , Estudos Retrospectivos , Ferimentos não Penetrantes/complicações , Ferimentos não Penetrantes/terapia , Traumatismos Abdominais/complicações
3.
Medicine (Baltimore) ; 101(47): e31807, 2022 Nov 25.
Artigo em Inglês | MEDLINE | ID: mdl-36451489

RESUMO

BACKGROUND: Proton-pump inhibitors (PPIs) and vonoprazan are recommended as first-line therapies for erosive esophagitis (EE). However, it is uncertain how the magnitude of efficacy and safety of first-line therapy, the choice of individual PPIs or vonoprazan in the treatment of EE remains controversial. This study aimed to evaluate the efficacy and safety of vonoprazan and PPIs in healing esophageal mucosal injury in patients with EE. METHODS: Relevant databases were searched to collect randomized controlled trials of proton pump inhibitors and vonoprazan in the treatment of reflux esophagitis up to December 2021. Studies on standard-dose PPIs or vonoprazan that were published in Chinese or English and assessed healing effects in EE were included in the analysis. Stata16.0 was used to conduct a network Meta-analysis to evaluate the efficacy and safety of the treatment. RESULTS: A total of 41 literatures were included with 11,592 enrolled patients. For the endoscopic cure rate, all the PPIs and vonoprazan significantly improve compared to Placebo; Based on the surface under the cumulative ranking curve, Ilaprazole ranked first, followed by esomeprazole, vonoprazan, pantoprazole, lansoprazole, omeprazole, rabeprazole and placebo therapy ranked the last. For the rate of adverse events, there was no significant difference among all the PPIs, vonoprazan, and placebo. CONCLUSIONS: Ilaprazole, esomeprazole and vonoprazan have more advantages in mucosal erosion healing, there was no significant difference in the comparative safety among all interventions.


Assuntos
Traumatismos Abdominais , Esofagite Péptica , Úlcera Péptica , Humanos , Inibidores da Bomba de Prótons/efeitos adversos , Esomeprazol , Metanálise em Rede , Rabeprazol , Esofagite Péptica/tratamento farmacológico
4.
PLoS One ; 17(11): e0277453, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36445874

RESUMO

BACKGROUND: Submaximal endurance exercise has been shown to cause elevated gastrointestinal permeability, injury, and inflammation, which may negatively impact athletic performance and recovery. Preclinical and some clinical studies suggest that flavonoids, a class of plant secondary metabolites, may regulate intestinal permeability and reduce chronic low-grade inflammation. Consequently, the purpose of this study was to determine the effects of supplemental flavonoid intake on intestinal health and cycling performance. MATERIALS AND METHODS: A randomized, double-blind, placebo-controlled crossover trial was conducted with 12 cyclists (8 males and 4 females). Subjects consumed a dairy milk-based, high or low flavonoid (490 or 5 mg) pre-workout beverage daily for 15 days. At the end of each intervention, a submaximal cycling trial (45 min, 70% VO2max) was conducted in a controlled laboratory setting (23°C), followed by a 15-minute maximal effort time trial during which total work and distance were determined. Plasma samples were collected pre- and post-exercise (0h, 1h, and 4h post-exercise). The primary outcome was intestinal injury, assessed by within-subject comparison of plasma intestinal fatty acid-binding protein. Prior to study start, this trial was registered at ClinicalTrials.gov (NCT03427879). RESULTS: A significant time effect was observed for intestinal fatty acid binding protein and circulating cytokines (IL-6, IL-10, TNF-α). No differences were observed between the low and high flavonoid treatment for intestinal permeability or injury. The flavonoid treatment tended to increase cycling work output (p = 0.051), though no differences were observed for cadence or total distance. DISCUSSION: Sub-chronic supplementation with blueberry, cocoa, and green tea in a dairy-based pre-workout beverage did not alleviate exercise-induced intestinal injury during submaximal cycling, as compared to the control beverage (dairy-milk based with low flavonoid content).


Assuntos
Traumatismos Abdominais , Flavonoides , Feminino , Masculino , Humanos , Animais , Estudos Cross-Over , Bebidas , Permeabilidade , Inflamação , Leite
5.
Afr Health Sci ; 22(Spec Issue): 108-113, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-36321119

RESUMO

Background: Trauma is a major contributor to pediatric morbidity and mortality. Injury and violence are a major killer of children throughout the world. Unintentional injuries account for almost 90% of these cases. They are the leading cause of death for children aged 10-19 years. More than 95% of all injury deaths in children occur in low income and middle-income countries. Abdominal trauma is present in approximately 25% of pediatric patients with major trauma and is the most common cause of unrecognized fatal injury in children. Objectives: To describe the patterns, the management and outcomes of pediatric abdominal trauma.This was a descriptive retrospective study. Data was extracted from the Pediatric surgery Unit database from January 2012 to July 2019 on all abdominal trauma admissions to the unit. Results: Falls were the commonest (51.3%) mechanism for trauma on the unit. Most (84%) of the admissions had blunt abdominal trauma, with the majority (77%) managed non operatively. Only 16% had penetrating trauma, with the majority (84%) of these managed operatively. The average length of hospital stay for most (71.9%) of the patients was less than 7 days, with 96.1% of all admitted patients being discharged upon recovery. Conclusion: Blunt abdominal trauma is the most common pattern of pediatric abdominal trauma, with majority of these patients being managed non-operatively with good outcomes. Selective non-operative management for penetrating pediatric abdominal trauma has good patient outcomes as well.


Assuntos
Traumatismos Abdominais , Ferimentos não Penetrantes , Criança , Humanos , Estudos Retrospectivos , Ferimentos não Penetrantes/etiologia , Ferimentos não Penetrantes/cirurgia , Tempo de Internação , Hospitais , Encaminhamento e Consulta
6.
J Wound Care ; 31(11): 924-929, 2022 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-36367800

RESUMO

A 59-year-old male patient presented with abdominal necrotising fasciitis secondary to a bowel perforation through a previous drain site that he had waited at home with for two weeks. Enteric contents were found within the abdominal wall. Surgery required extensive abdominal wall debridement and the formation of a double-barrel ileostomy within the debrided area. The resulting abdominal wound was large, initially covering an area of approximately 424cm2, and had continuous contamination from enteric leakage that could not be isolated. Achieving wound healing was challenging due to the enteric output and resultant continuous contamination of the wound bed.


Assuntos
Traumatismos Abdominais , Parede Abdominal , Fasciite Necrosante , Perfuração Intestinal , Masculino , Humanos , Pessoa de Meia-Idade , Fasciite Necrosante/cirurgia , Cicatrização , Parede Abdominal/cirurgia , Desbridamento/métodos
7.
BMC Surg ; 22(1): 380, 2022 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-36335342

RESUMO

BACKGROUND: Seventy percent of ureteric injuries result from iatrogenic causes with about 75% of these diagnosed in the postoperative period. It may have fatal complications such as sepsis and or renal functional damage increasing morbidity and treatment cost. OBJECTIVE: The study aimed to identify the risk factors for iatrogenic ureteric injuries from open surgical procedures and the intervention outcome in a resource-poor setting. PATIENTS AND METHODS: This was a multi-centre study. The clinical records of patients with iatrogenic ureteric injuries seen between 2015-2021 who were managed at the urology units of the Margaret Marquart Catholic Hospital, and the Ho Teaching Hospital, in the Volta region of Ghana, were retrieved. The data extracted included patients' demographic factors, the clinical presentation, the primary surgery details, the time from surgery to presentation, the intervention offered, and the outcomes. The data were analysed using the Statistical Package for Social Scientists (SPSS) version 24.0. RESULTS: Twelve patients aged between 24-54 years with a total of 19 ureteric injuries were managed. The injuries resulted from a hysterectomy in 10 cases (83.3%), and one each from emergency caesarean section and inguinal hernia repair with traction and transection injuries respectively (16.7%). Seven out of 12 cases were diagnosed 48 h after surgery. Bilateral injuries occurred in 7 cases (14/19 injuries). Intraoperative recognition was common in unilateral injuries and surgeries performed by specialist surgeons. Ureteroneocystostomy (14/19), uretero-ureterostomy (1/19), and open suture release were the management procedures performed as in the intervention. CONCLUSION: Open hysterectomy (83.7%) was the most common procedure leading to iatrogenic ureteric injuries in this study. Intra-operative recognition occurred when trained specialist surgeons performed the surgery. Late presentation with more severe morbidity was found amongst non-specialist surgeons. Thus, improvement in training to allow intra-operative diagnosis should be encouraged in general practitioners to reduce morbidity and improve outcomes.


Assuntos
Traumatismos Abdominais , Ureter , Humanos , Gravidez , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Estudos Retrospectivos , Cesárea , Ureter/cirurgia , Histerectomia , Traumatismos Abdominais/cirurgia , Doença Iatrogênica , Estudos Multicêntricos como Assunto
8.
Ann Afr Med ; 21(4): 327-338, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36412331

RESUMO

Background: Splenic trauma has emerged as a major global health burden, especially in developing nations with limited diagnostic and therapeutic facilities. The current trend toward nonoperative management (NOM) and adoption of splenic salvage whenever feasible calls for local evaluation of our current practice. The aim of this study was to document the epidemiology and outcomes of management of splenic injuries in our setting. Patients and Methods: This was a multicenter, prospective study of epidemiology and outcomes of patients with splenic injuries recruited over 10 years in southeast Nigeria. Results: Approximately 66% of all patients with abdominal injuries sustained splenic trauma. A total of 313 patients with splenic trauma were recruited; 226 (72.2%) were managed operatively (OM) and 87 (27.8%) conservatively (NOM). Majority (75.7%) had blunt abdominal trauma (BAT), while 24.3% sustained penetrating injuries. Sonographic grading showed that 46 (14.7%), 58 (18.5%), 79 (25.2%), 106 (33.9%), and 24 (7.7%) patients had grades I, II, III, IV, and V injuries, respectively. Isolated splenic injuries occurred in 172 (55%) patients, and the rest (141, 45%) had associated intra-abdominal injuries. Two-thirds (67.1%) were aged 16-45 years. In the OM group, 178 (78.7%) had total splenectomy, while 48 (21.3%) had splenic salvage. There was a statistically significant difference (P = 0.022) in the rate of postoperative complications between the splenectomy and splenorrhaphy groups. The overall mortality rate was 4.5%. Major predictors of morbidity and mortality were high-grade splenic injuries, total splenectomy, multiple injuries, advanced age, and comorbidities. Conclusion: Splenic injuries complicate approximately two-thirds of all abdominal injuries in our environment and majority of these injuries were due to BAT. In this study, majority had OM and splenic salvage rate was relatively low.


Résumé Contexte: Le traumatisme splénique est devenu un fardeau mondial majeur de santé, en particulier dans les pays en développement avec des installations diagnostiques et thérapeutiques limitées. La tendance actuelle vers la gestion non opératoire (NOM) et l'adoption du sauvetage splénique chaque fois que cela appelle à l'évaluation locale de notre pratique actuelle. Le but de cette étude était de documenter l'épidémiologie et les résultats de la gestion des blessures spléniques dans notre contexte. Patients et méthodes: Il s'agissait d'une étude prospective multicentrique de l'épidémiologie et des résultats de patients souffrant de blessures spléniques recrutés sur 10 ans dans le sud-est du Nigéria. Résultats: Environ 66% de tous les patients atteints de blessures abdominales ont subi un traumatisme splénique. Au total, 313 patients atteints de traumatisme splénique ont été recrutés; 226 (72,2%) ont été gérés de manière opératoire (OM) et 87 (27,8%) de manière conservatrice (NOM). La majorité (75,7%) avait un traumatisme abdominal émoussé (BAT), tandis que 24,3% ont subi des blessures pénétrantes. Classement échographique ont montré que 46 (14,7%), 58 (18,5%), 79 (25,2%), 106 (33,9%) et 24 (7,7%) avaient respectivement des grades I, II, III, IV et V, respectivement. Des lésions spléniques isolées se sont produites chez 172 (55%) patients, et le reste (141, 45%) avait des lésions intra-abdominales associées. Les deux tiers (67,1%) étaient âgés de 16 à 45 ans. Dans le groupe OM, 178 (78,7%) avaient une splénectomie totale, tandis que 48 (21,3%) avaient un récupération splénique. Il y avait une différence statistiquement significative (p = 0,022) dans le taux de complications postopératoires entre les groupes de splénectomie et de splénorrhaphie. Le taux de mortalité global était de 4,5%. Les principaux prédicteurs de la morbidité et de la mortalité étaient les blessures spléniques de haut niveau, la splénectomie totale, les blessures multiples, l'âge avancé et les comorbidités. Conclusion: Les blessures spléniques compliquent environ les deux tiers de toutes les blessures abdominales dans notre environnement et la majorité de ces blessures étaient dues à BAT. Dans cette étude, la majorité avait le taux de récupération OM et splénique était relativement faible. Mots-clés: Abdomen, urgence, laparotomie, mortalité, rate, traumatisme.


Assuntos
Traumatismos Abdominais , Ferimentos não Penetrantes , Humanos , Estudos Prospectivos , Nigéria/epidemiologia , Traumatismos Abdominais/terapia , Traumatismos Abdominais/cirurgia , Esplenectomia , Ferimentos não Penetrantes/epidemiologia , Ferimentos não Penetrantes/terapia , Resultado do Tratamento
9.
Medicina (Kaunas) ; 58(11)2022 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-36363553

RESUMO

Background and Objectives: Abdominal trauma among severely injured patients with an injury severity score (ISS) of 16 and above can lead to potentially life-threatening injuries that might need immediate surgical intervention. Traumatic injuries to the diaphragm (TID) are a challenging condition often accompanied by other injuries in the thoracoabdominal region. Materials and Methods: We retrospectively analyzed the occurrence and clinical course of TID among severely injured patients treated at our center between 2008 and 2019 and compared them to other groups of severely injured patients without TID. Results: Thirty-five patients with TID and a median ISS of 41 were treated in the period mentioned above. They were predominantly middle-aged men and mostly victims of blunt trauma as a consequence of motor vehicle accidents. A total of 70.6% had left-sided TID, and in 69.6%, the size of defect was larger than 10 cm. The diagnosis was made with computed tomography (CT) in 68.6% of the cases, while in 25.8%, it was made intraoperatively or delayed by a false-negative initial CT scan, and in 5.7%, an intraoperative diagnosis was made without preoperative CT imaging. Surgical repair was mostly conducted via laparotomy, performing a direct closure with continuous suture. A comparison to 191 patients that required laparotomy for abdominal injuries other than TID revealed significantly higher rates of concomitant injuries to several abdominal organs among patients suffering from TID. Compared to all other severely injured patients treated in the same period (n = 1377), patients suffering from TID had a significantly higher median ISS and a longer mean duration of hospital stay. Conclusions: Our findings show that TID can be seen as an indicator of particularly severe thoracoabdominal trauma that requires increased attention from the treatment team so as not to miss relevant concomitant injuries that require immediate intervention.


Assuntos
Traumatismos Abdominais , Ferimentos não Penetrantes , Pessoa de Meia-Idade , Masculino , Humanos , Escala de Gravidade do Ferimento , Estudos Retrospectivos , Traumatismos Abdominais/diagnóstico , Traumatismos Abdominais/epidemiologia , Traumatismos Abdominais/cirurgia , Ferimentos não Penetrantes/diagnóstico , Ferimentos não Penetrantes/cirurgia , Acidentes de Trânsito
10.
N Z Med J ; 135(1565): 113-119, 2022 11 11.
Artigo em Inglês | MEDLINE | ID: mdl-36356275

RESUMO

Spearfishing is a popular sport in New Zealand. While there have been a few reported self-inflicted speargun injuries causing fatal intracranial damage, accidental speargun injuries while fishing are less common. Intra-abdominal speargun injuries are even less common. Its occurrence in a 30-year-old male patient reported here highlights the potential risk of life-threatening injuries. A 30-year-old male sustained an accidental speargun injury, with the spear passing through central small bowel loops and its pointed tip penetrating the left iliac wing. The patient underwent laparotomy, and the spear was removed in an antegrade fashion with primary closure of small bowel enterotomies and repair of the mesenteric defects. He had a re-look laparotomy 48 hours later with resection and anastomosis of two primary small bowel repairs and was eventually discharged after 12 days. Information obtained by radiological evaluation using computed tomography (CT) scan and angiography regarding the spear trajectory, injured organs, vasculature and spear tip mechanism is important to decide the best surgical approach. The spear should be removed in an antegrade fashion, because pulling the spear in the retrograde direction can cause further tissue and/or vascular injury. Currently, there is no legislation regarding the use of spearguns and users do not require a license, despite the potential for severe penetrating trauma similar to that caused by firearms. Spearguns can produce life-threatening injuries and the removal of the spear depends on the location of the tip in relation to adjacent structures and whether the flapper is open. It often requires a multidisciplinary team approach. Safety guidelines need to be published and widely available, and the potential risks of speargun injuries should be included in fishing rules. Introducing license requirement for possession and handling of this firearm-like weapon also needs to be considered.


Assuntos
Traumatismos Abdominais , Ferimentos Penetrantes , Masculino , Humanos , Adulto , Caça , Nova Zelândia , Traumatismos Abdominais/diagnóstico por imagem , Traumatismos Abdominais/cirurgia , Ferimentos Penetrantes/diagnóstico por imagem , Ferimentos Penetrantes/etiologia , Ferimentos Penetrantes/cirurgia , Laparotomia
11.
Khirurgiia (Mosk) ; (11): 55-60, 2022.
Artigo em Russo | MEDLINE | ID: mdl-36398956

RESUMO

Non-penetrating gunshot abdominal wounds are rare in peacetime and mainly caused by firearm traumatic weapons. The main therapeutic measure in this case is primary surgical debridement with adequate drainage. At the same time, such injuries may be accompanied by damage to internal organs. Timely diagnosis of these lesions may be difficult, and surgical treatment may be necessary. We report a patient with combined gunshot injury, damage to superficial femoral artery and non-penetrating abdominal wound followed by contusion and necrosis of small bowel. When providing medical care in patients with non-penetrating gunshot abdominal wounds, one should remember possible damage to internal organs due to high kinetic energy of the wounding projectile resulting contusion-induced necrosis.


Assuntos
Traumatismos Abdominais , Contusões , Lesões dos Tecidos Moles , Ferimentos por Arma de Fogo , Humanos , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/cirurgia , Traumatismos Abdominais/complicações , Traumatismos Abdominais/diagnóstico , Traumatismos Abdominais/cirurgia , Ferimentos por Arma de Fogo/complicações , Ferimentos por Arma de Fogo/diagnóstico , Ferimentos por Arma de Fogo/cirurgia , Contusões/complicações , Necrose/complicações
12.
Sci Rep ; 12(1): 19871, 2022 Nov 18.
Artigo em Inglês | MEDLINE | ID: mdl-36400820

RESUMO

Delayed bleeding is a major issue in patients with high-grade splenic injuries who receive non-operative management (NOM). While only few studies addressed the clinical manifestations of delayed bleeding in these patients. We reviewed the patients with high-grade splenic injuries presented with delayed bleeding, defined as the need for salvage procedures following NOM. There were 138 patients received NOM in study period. Fourteen of 107 patients in the SAE group and 3 of 31 patients in the non-embolization group had delayed bleeding. Among the 17 delayed bleeding episodes, 6 and 11 patients were salvaged by splenectomy and SAE, respectively. Ten (58.9%, 10/17) patients experienced bleeding episodes in the intensive care unit (ICU), whereas seven (41.1%, 7/17) experienced those in the ward or at home. The clinical manifestations of delayed bleeding were a decline in haemoglobin levels (47.1%, 8/17), hypotension (35.3%, 6/17), tachycardia (47.1%, 8/17), new abdominal pain (29.4%, 5/17), and worsening abdominal pain (17.6%, 3/17). For the bleeding episodes detected in the ICU, a decline in haemoglobin (60%, 6/10) was the main manifestation. New abdominal pain (71.43%, 5/7) was the main presentation when the patients left the ICU. In conclusion, abdominal pain was the main early clinical presentation of delayed bleeding following discharge from the ICU or hospital.


Assuntos
Traumatismos Abdominais , Embolização Terapêutica , Ferimentos não Penetrantes , Humanos , Ferimentos não Penetrantes/terapia , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/métodos , Baço/lesões , Traumatismos Abdominais/terapia , Hemorragia/etiologia , Hemorragia/terapia , Dor Abdominal/etiologia , Ruptura
13.
Artigo em Russo | MEDLINE | ID: mdl-36385053

RESUMO

The article analyzes the main aspects of the development of various approaches and methods in the provision of medical care to patients with closed abdominal trauma with damage to the liver and spleen. The most important stages of improving approaches, the impact of scientific and technological progress on the introduction of modern technologies in this area of surgery are described. The modern views of various authors on the existing problem are considered.


Assuntos
Traumatismos Abdominais , Ferimentos não Penetrantes , Humanos , Baço/cirurgia , Baço/lesões , Ferimentos não Penetrantes/terapia , Traumatismos Abdominais/cirurgia
14.
Dis Markers ; 2022: 2970257, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36193496

RESUMO

Objective: To assess the treatment efficacy of laparoscopic totally extraperitoneal repair for inguinal hernia. Methods: Between November 2018 and May 2020, 130 patients with inguinal hernias diagnosed and treated in our hospital were randomly recruited and assigned to receive either tension-free hernia repair (control group) or laparoscopic totally extraperitoneal repair (study group) at the random method. All patients received routine care including external traditional Chinese medicine (TCM) application. Outcome measures included surgical indices, numeric rating scale (NRS) scores, infections, and postoperative complications. Results: Laparoscopic surgery is associated with a shorter operation duration, time-lapse before postoperative off-bed activity, and hospital stay, as well as less intraoperative hemorrhage volume compared to tension-free hernia repair in the control group. Patients in the study group had considerably lower NRS ratings after therapy than those in the control group. (P < 0.05). After treatment, the levels of blood cell count (WBC), C-reactive protein (CRP), and procalcitonin (PCT) in the study group were lower than those in the control group (P < 0.05). In the control group, there were 0 cases of hematoma, 3 cases of subcutaneous effusion, 4 cases of urinary retention, 5 cases of scrotal effusion, and 1 case of bladder injury. In the study group, there were 0 cases of hematoma, 1 case of subcutaneous fluid, 1 case of urinary retention, 0 cases of scrotal fluid, and 0 cases of bladder injury. Laparoscopic surgery resulted in a lower incidence of postoperative complications versus traditional surgery (P <0.05). Conclusion: Laparoscopic totally extraperitoneal repair for inguinal hernia improves the intraoperative indices, mitigates postoperative pain, and reduces the risks of infections and complications, with the advantages of short operation duration, less hemorrhage volume, and shorter hospital stay. It shows great potential for clinical promotion.


Assuntos
Traumatismos Abdominais , Hérnia Inguinal , Laparoscopia , Retenção Urinária , Traumatismos Abdominais/cirurgia , Proteína C-Reativa , Hematoma/cirurgia , Hérnia Inguinal/cirurgia , Humanos , Laparoscopia/métodos , Complicações Pós-Operatórias , Pró-Calcitonina , Estudos Retrospectivos , Resultado do Tratamento , Retenção Urinária/cirurgia
15.
J Med Case Rep ; 16(1): 379, 2022 Oct 18.
Artigo em Inglês | MEDLINE | ID: mdl-36258260

RESUMO

BACKGROUND: An acute abdomen can have a variety of causes. A commonly missed cause of abdominal pain is direct substance abuse and its sequelae. The use of methamphetamine is rising in the United States resulting in significant morbidity and mortality. There has been no reported case of methamphetamine-induced adrenal infarction based on an extensive review of available literature. CASE PRESENTATION: We present a case of a 34-year-old Hispanic man who presented with acute abdominal pain secondary to adrenal infarction in the setting of methamphetamine use. Left paraumbilical tenderness was present on abdominal examination. Contrast-enhanced CT of the abdomen and pelvis revealed internal hypoenhancement of the left adrenal gland, consistent with acute left adrenal infarction. The patient was managed with enoxaparin and apixaban. CONCLUSION: Substance abuse, especially among young patients, can at times present with acute abdomen. This mandates physicians to be vigilant and take into consideration the history of substance abuse and relevant investigations. Timely diagnosis and management can prevent life-threatening complications.


Assuntos
Abdome Agudo , Traumatismos Abdominais , Doenças das Glândulas Suprarrenais , Metanfetamina , Masculino , Humanos , Adulto , Metanfetamina/efeitos adversos , Enoxaparina , Doenças das Glândulas Suprarrenais/diagnóstico , Traumatismos Abdominais/complicações , Dor Abdominal/induzido quimicamente , Infarto/induzido quimicamente , Infarto/diagnóstico por imagem
16.
Medicine (Baltimore) ; 101(40): e30900, 2022 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-36221428

RESUMO

Angiography and embolization are part of trauma management protocols for various injuries. This study examines the use of angiography and embolization use in trauma care across Trauma Centers in the United States. We used the National Trauma Data Bank (NTDB) 2017 dataset in this retrospective observational study. Adult trauma patients (≥16 years) who underwent conventional angiography with or without embolization were included. A univariate analysis was carried out to describe patients' demographic and injury characteristics as well as the time to angiography, angiography details, complications, and outcome (survival to hospital discharge: yes/no). One-year period prevalence proportion of angiography procedure was determined. A total of 4242 patients were included. The 1-year period prevalence proportion of angiography procedure with or without embolization was 0.53% (95% confidence intervals: 0.527-0.529). The median age was 41 years (interquartile range: 27-58) with most patients being in the age group 16 to 64 (83.8%) and males (72.6%). Over half of the patients, 55.4% had an embolization procedure performed in addition to angiography. The mean time to angiography was 263.77 ±â€…750.19 minutes. The most common embolization sites were the pelvis (24.9%), spleen (11.8%), and liver (9%). This study described angiography and embolization utilization in adult trauma patients in Trauma Centers in the US. Its findings provide the basis for future studies to examine more closely angiography/embolization utilization in specific subpopulations, and to create standardized risk stratification tools for trauma patients who are candidates for this procedure.


Assuntos
Traumatismos Abdominais , Embolização Terapêutica , Ferimentos não Penetrantes , Traumatismos Abdominais/terapia , Adulto , Angiografia , Embolização Terapêutica/métodos , Humanos , Masculino , Estudos Retrospectivos , Baço/lesões , Centros de Traumatologia , Estados Unidos , Ferimentos não Penetrantes/terapia
17.
Sci Rep ; 12(1): 17132, 2022 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-36224357

RESUMO

Penetrating abdominal injury is a major cause of death in trauma. Sodium alginate hydrogel, a hemostatic agent, offers a platform for targeting both mechanical and biological injuries. The current study assessed the effect of Very Low Viscosity (high) G (VLVG) alginate following abdominal trauma in a swine model of penetrating abdominal injury. Seven anesthetized pigs were instrumented with invasive monitoring catheters and abdominal trauma was introduced by laparoscopic hepatectomy. Ten minutes after the induction of hypovolemic shock, three animals were intra-abdominally administered with VLVG alginate (study group) and four animals with saline (control group). During 8 h of continuous monitoring, various hemodynamic and biochemical variables were measured and liver biopsies for histological evaluation were taken. Hemodynamically, VLVG alginate-treated animals were more stable than controls, as reflected by their lower heart rate and higher blood pressure (p < 0.05 for both). They also had lower levels of liver enzymes and lactate, and less histopathological damage. We show that VLVG alginate might be a promising new agent for reducing penetrating intra-abdominal injury, with hemostatic and biocompatibility efficiency, and tissue preserving properties. Future effort of integrating it with a dispersal device may turn it into a valuable pre-hospital emergency tool to improve survival of trauma casualties.


Assuntos
Traumatismos Abdominais , Hemostáticos , Ferimentos Penetrantes , Traumatismos Abdominais/tratamento farmacológico , Traumatismos Abdominais/cirurgia , Alginatos , Animais , Estudos de Viabilidade , Hemostáticos/farmacologia , Hemostáticos/uso terapêutico , Hidrogéis , Lactatos , Suínos , Ferimentos Penetrantes/tratamento farmacológico
18.
Sud Med Ekspert ; 65(5): 58-63, 2022.
Artigo em Russo | MEDLINE | ID: mdl-36196842

RESUMO

Currently, mechanical trauma is the most significant cause of violent death. The injuries caused by sharp objects rank high in the structure of mechanical trauma. The study objective is to review domestic and foreign literature on the study of stab/cut injuries, identify the main issues and consider new promising diagnostic methods. The stab/cut wound morphology is widely described in the available literature, but little attention has been paid to their study of late postmortem changes. This issue requires consideration since putrefactive corpses (hidden by placing the corpse in water, burying it in the ground, etc.) are often the object of forensic medical examination. New methods for assessing stab/cut injuries are also considered: computed tomography, multilayer computed tomography, scanning electron microscopy, and energy dispersive x-ray spectroscopy. Each of the diagnostic methods has its undeniable advantages and prospects for widespread use in expert practice, but they cannot completely replace the main methods and are intended only to supplement them.


Assuntos
Traumatismos Abdominais , Ferimentos Perfurantes , Cadáver , Patologia Legal/métodos , Humanos , Tomografia Computadorizada por Raios X , Água , Ferimentos Perfurantes/diagnóstico
19.
Rozhl Chir ; 101(9): 421-427, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36257800

RESUMO

Iatrogenic bile duct injury still represents a serious complication mostly connected with minimally invasive cholecystectomy. This complication has an important impact both on short- and long-term morbidity and is associated with non-negligible mortality. The objective of our study was to provide a comprehensive summary of information based on the most recent guidelines with recommendations for how to prevent a bile duct injury, how to reach an early diagnosis and finally, how to proceed should they occur in order to minimize further damage. We also present ATOM, a new classification of bile duct injuries that provides clear information not only about the extent of anatomical damage, but also about the time and mechanism of its occurrence.


Assuntos
Traumatismos Abdominais , Doenças dos Ductos Biliares , Colecistectomia Laparoscópica , Humanos , Ductos Biliares/cirurgia , Ductos Biliares/lesões , Colecistectomia Laparoscópica/efeitos adversos , Doença Iatrogênica/prevenção & controle , Doenças dos Ductos Biliares/etiologia , Doenças dos Ductos Biliares/cirurgia , Colecistectomia/efeitos adversos , Traumatismos Abdominais/cirurgia
20.
BMC Gastroenterol ; 22(1): 440, 2022 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-36284270

RESUMO

OBJECTIVE: To establish a prediction model for acute gastrointestinal injury (AGI) in patients with prolonged disorder of consciousness (pDOC) and to evaluate and apply the prediction model.  METHODS: The clinical data of 165 patients with pDOC admitted to the hyperbaric oxygen department from January 2021 to December 2021 were retrospectively reviewed, and the patients were divided into an AGI group (n = 91) and an N-AGI group (n = 74) according to whether AGI occurred. A prediction model was built by fitting multiple independent influencing factors through logistic regression. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of the model, the Hosmer-Lemeshow (H-L) test was used to evaluate the goodness-of-fit of the model, and the ROC curve and calibration curve were drawn to evaluate the predictive performance. A nomogram was plotted to visualize the prediction model. RESULTS: According to the multivariate logistic regression analysis results, the prediction model was finally constructed with the CRS-R score, DAO, PCT, ALB, and I-FABP, and a nomogram was generated. The area under the ROC curve (AUC) of the prediction model was 0.931, the sensitivity was 83.5%, and the specificity was 93.2%. The data were divided into 5 groups for the H-L test (χ2 = 2.54, P = 0.468 > 0.05) and into 10 groups for the H-L test (χ2 = 9.98, P = 0.267 > 0.05). A calibration curve was drawn based on the test results, indicating that the prediction model has a good goodness-of-fit and good prediction stability. CONCLUSION: The prediction model for AGI in pDOC patients constructed in this study can be used in clinical practice and is helpful to predict the occurrence of AGI in pDOC patients.


Assuntos
Traumatismos Abdominais , Estado de Consciência , Humanos , Estudos Retrospectivos , Prognóstico , Curva ROC , Nomogramas
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