Eur J Trauma Emerg S
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Osteoporosis is a disease that leads to fragility fractures due to the loss of bone mass and bone microstructure. This review presents an update on the fundamental pathophysiological and pathomorphological mechanisms of bone loss. Pathomorphological characteristics such as perforations and microcallus formations are explained. ⋯ Hormones, such as estrogen, follicle stimulating hormone, and leptin, transcription factors, such as Runx2 and osterix, and the wnt signaling pathway are discussed in terms of their roles in bone cell differentiation and function. On the basis of current knowledge, osteoporosis can be diagnosed and treated and fractures can be prevented. However, it is likely that new and even more effective diagnostic and therapeutic strategies will emerge as our understanding of the remodeling process that controls osteoblast and osteoclast function increases.
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Eur J Trauma Emerg S · Dec 2008
Should Echogenic Material in the Urinary Bladder Noticed on FAST Preclude Urinary Catheter Insertion in a Trauma Patient Until Further Evaluation?
Serious urethral and bladder injuries are most often associated with severe blunt trauma. The most common diagnostic tool used to assess lower urinary tract injuries is a retrograde urethrogram. However, the decision to place a Foley catheter is often made on clinical grounds during initial stabilization phase of a trauma victim. If there is a clinical suspicion of a urethral injury, a Foley catheter should not be introduced until further evaluation is made. Focused abdominal sonography for trauma (FAST) is a major tool for primary evaluation of trauma victims. Treating trauma patients, we encountered an unusual "pick up", namely, blood clots in the urinary bladder in two patients. ⋯ We report on two cases of severely traumatized patients on which FAST examination detected an echogenic material in the bladder. This correlated with severe injuries to the urethra and urinary bladder. Moreover, ignorance of this finding in a patient without obvious clinical signs of urethral injury (Patient 1) led to a Foley catheter insertion, and as a consequence, a complex jatrogenic injury to the urethra. On the basis of this study, we hypothesize that the presence of an echogenic material on FAST examination should be considered blood until proven otherwise, and a urinary bladder catheter should not be passed, even in the absence of clinical signs of urethral injury. Since urogenital trauma is rare, this concept should be validated in the prospective study in a high-volume trauma center.
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Eur J Trauma Emerg S · Dec 2008
Bogota-VAC - A Newly Modified Temporary Abdominal Closure Technique.
We present Bogota-VAC, a newly modified temporary abdominal closure (TAC) technique for open abdomen condition after abdominal compartment syndrome (ACS). ⋯ The advantage of the presented Bogota-VAC is leak tightness, wound conditioning (soft tissue/fascia), skin protection and facilitation of nursing in combination with highest volume reserve capacity (VRC), thus preventing recurrent increased intra-abdominal and intracranial pressure in the initial phase after decompression of ACS compared to other TAC techniques.
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To assess the current stage of trauma system development and trauma surgery training in Europe. ⋯ Despite the great variation from country to country, three trends in developing trauma care and education can be identified: trauma system development based exclusively on major (life-threatening) trauma care (the old United States model), combining trauma and emergency surgery into a single regionalized system (the acute care surgery model), or maintaining the orthopedic surgery-orientated all-inclusive trauma care model as practiced in most central European countries today. Although each country and region might proceed along their own line depending on local circumstances, some kind of general guidelines and recommendations at least at the European Union level would be urgently needed.
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Eur J Trauma Emerg S · Dec 2008
Helsinki Trauma Outcome Study 2005: Audit on Outcome in Trauma Management in Adult Patients in Southern Part of Finland.
The outcome performance of the adult patients trauma care in Helsinki University Hospital was compared with a sample of English hospitals. This was a first time such an audit on trauma care was conducted in Finland. Helsinki University Hospital submitted the Trauma Audit and Research Network (TARN, UK) data of adult trauma patients during 1 year period (from 1 September 2004 to 31 August 2005). ⋯ The patients were older and the mean ISS was higher in Helsinki (mean ISS in Helsinki 14 vs. 11 in England). The standardized W statistic (a measure of survival variation from the expected mean, per 100 patients) was + 3.0 (confidence intervals + 2.3 to + 3.8) for Helsinki University Hospital and + 0.2 (confidence intervals -0.1 to 0.4) for English hospitals. These results suggest that the organization of trauma care in Helsinki University Hospital area is more effective in preventing death after trauma in adults than that covering the present sample of English hospitals.