American journal of surgery
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The contribution of rib fractures to prolonged pain and disability may be underappreciated and undertreated. Clinicians are traditionally taught that the pain and disability of rib fractures resolves in 6 to 8 weeks. ⋯ Prolonged chest wall pain is common, and the contribution of rib fractures to disability is greater than traditionally expected. Further investigation into more effective therapies that prevent prolonged pain and disability after rib fractures is needed.
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Comparative Study Clinical Trial
Correlation of conventional thrombelastography and rapid thrombelastography in trauma.
Conventional thrombelastography has been in use for over 6 decades and provides a functional assay of coagulation. Rapid thrombelastography was developed to provide more rapid comprehensive analysis of coagulation status in an emergency setting. The purpose of this study was to determine the correlation of rapid thrombelastographic values with conventional thrombelastographic values in trauma patients. ⋯ Overall, there is a strong correlation between rapid thrombelastography and conventional thrombelastography in terms of overall clot strength and platelet function. There is a moderate correlation in assessing the degree of fibrin cross-linking and a poor correlation in evaluating thrombolysis. These correlations should be considered when evaluating coagulation status using rapid thrombelastography.
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Little is known about the reliability of data collected by abstractors without professional medical training. This investigation sought to determine the level of agreement among untrained volunteer abstractors as part of a study to evaluate the risk assessment of venous thromboembolism in patients who have undergone trauma. ⋯ The performance of volunteers showed outstanding inter-rater reliability; however, limitations of interpretation can influence reliability.
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Comparative Study
Chitosan based advanced hemostatic dressing is associated with decreased blood loss in a swine uncontrolled hemorrhage model.
The purpose of this study was to compare standard gauze (SG) and advanced hemostatic dressings in use by military personnel in a no-hold model. ⋯ XG demonstrated shorter application time and decreased secondary blood loss in comparison with both SG and CG. These differences may be of potential benefit in a care-under-fire scenario.
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Surgical excision remains the primary and only potentially curative treatment for melanoma. Although current guidelines recommend excisional biopsy as the technique of choice for evaluating lesions suspected of being primary melanomas, other biopsy types are commonly used. We sought to determine the impact of biopsy type (excisional, shave, or punch) on outcomes in melanoma. ⋯ Both shave and punch biopsies demonstrated a significant risk of finding residual tumor in the WLE, with pathologic upstaging of the WLE. Punch biopsy also led to a larger mean WLE area compared with other biopsy types. However, biopsy type did not impact SLNB accuracy or results, tumor recurrence, or disease-specific survival (DSS). Punch and shave biopsies, when used appropriately, should not be discouraged for the diagnosis of melanoma.