Annali italiani di chirurgia
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It has been two decades since Maggiore Hospital Trauma Center started its formal activity focused on improving and developing Trauma management and Surgery of Trauma. Whilst evaluating the results of the last year, we can not avoid to look behind at the beginning, comparing the actual activity with the settings we have started from, in 1989. Before this date in our hospital all the Emergency and Trauma Surgery was managed by General Surgeons. ⋯ Last but least needs to be mentioned our scientific and research activity, including several published articles and scientific presentations at Italian, European and International Conferences. Finally we organize since 8 years a nationally relevant educational event: the "Corso Teorico-Pratico di Chirurgia del Politrauma". It is a theoretic and practical Trauma Surgery Course for Consultant/Attending Surgeons and Senior Registrars/Residents who want to improve their skills in Trauma Surgery and Management, and is now running its XIX edition.
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Review Case Reports
Transorbital stab penetrating brain injury. Report of a case.
Penetrating injury of the skull and brain is relatively uncommon, representing about 0.4% of head injuries. In this paper the Authors describe a case of patient victim of transorbital stab with brain injury with good recovery and review the literature about cranial stab wound. ⋯ In patients conscents with no surgical lesion like our patient, the hospital discharge must occur after the angiogram have excluded intracranial vascular lesion.
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Thoracobiliary fistulas (bronchobiliary and pleurobiliary) are rare complications of thoracoabdominal trauma. Owing to their rarity, there is little consensus on the optimal management. The diagnostic suspicion however must be considered and it's important the correct selection of diagnostic imaging techniques. ⋯ The optimal treatment of bronchobiliary fistulas is operative, in order to prevent their dramatic consequences. For pleurobiliary fistulas, a light aggressive conservative approach is an appealing option in the beginning. Newer endoscopic techniques increase the non-operative approach.
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The Abdominal Compartment Syndrome (ACS) is a "condition in which increased tissue pressure in a confined anatomic space, causes decreased blood flow leading to ischaemia and organic dysfunction and may lead to permanent impairment of function". ⋯ ACS can be considered a reliable predictive factor for aneurysm surgery outcome. Prevention of the ACS, with early recognition of rising IAP and urgent intervention to decompress the tense abdomen can lead to mortality reduction after aneurysm repair. The measurement of IAP is simple and non-invasive, and should be a routine component of physiological monitoring in patients following ruptured aneurysm repair in association with hypotensive hemostasis.
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Polytrauma, or the condition of victim affected by two or more lesions compromising vital parameters, is the third cause of death (0.6/l1000/year), and the first one of mortality for subjects 44 year-younger, responsible of 26000 annual deaths, (60% for car accidents). ⋯ The complexity of polytrauma is related to the various pathologies affecting the victims, either neurological ones, or thoracic, abdominal, vascular and orthopedic ones, emphasizing the role of diagnostic and therapeutic timely approach.