Eur J Trauma Emerg S
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Eur J Trauma Emerg S · Apr 2011
Blunt traumatic carotid artery dissection still a pitfall? The rationale for aggressive screening.
The optimal diagnostic strategy for carotid dissection following blunt trauma is yet unclear. The rationale for aggressive screening will be discussed based on a consecutive case series of blunt traumatic carotid artery dissection (CAD). ⋯ Screening may increase the rate of early CAD diagnosis, but it is unclear if screening will also result in early detection of a treatable lesion. Trials have to provide the answer to whether initiating therapy will lead to improvements in the outcome in traumatic CAD. We therefore believe that screening is a basic condition for initiation of future clinical trials.
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Eur J Trauma Emerg S · Apr 2011
Isolated blunt chest injury leads to transient activation of circulating neutrophils.
The acute respiratory distress syndrome (ARDS) is a severe and frequently seen complication in multi-trauma patients. ARDS is caused by an excessive innate immune response with a clear role for neutrophils. As ARDS is more frequently seen in trauma patients with chest injury, we investigated the influence of chest injury on the systemic neutrophil response and the development of ARDS. ⋯ Blunt chest trauma caused a systemic inflammatory reaction with transient activation of neutrophils and mobilization of young neutrophils into the circulation. Isolated chest injury, however, was not abundant enough to cause ARDS, so a second hit appears crucial.
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Polytrauma patients usually suffer from both life-threatening injuries, where early intervention is mandatory in order to prevent mortality from uncontrollable haemorrhage-especially during the "golden hour", and secondary injuries of lower priority which receive delayed referral or treatment. Non-life-threatening injuries can sometimes be overlooked and so remain untreated until a much later stage. The aim of this study was to investigate the incidence of eye (ocular and orbital) injuries in polytrauma (injury severity score >15) patients and describe their complexities and outcomes. ⋯ Polytrauma patients are at high risk for vision-threatening injuries, and an early multidisciplinary approach is essential for early detection and treatment.
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Eur J Trauma Emerg S · Apr 2011
Anterior column reconstruction in thoracolumbar injuries utilizing a computer-assisted navigation system.
Discectomy, corpectomy, and resection of isolated posterior wall fragments are technically demanding steps requiring maximum surgical precision during anterior reconstruction of the unstable thoracolumbar spine. ⋯ Computer-aided guidance in anterior reconstruction of the thoracolumbar spine is a technically feasible option that may aid in the performance of disc- and corpectomy, as well as the resection of isolated posterior wall fragments in cases with initial neurological compromise. However, total time for surgery is significantly prolongated by this technique. There were no differences in the precision of cage positioning between groups. However, during discectomy, the use of computer navigation may aid in the protection of adjacent endplates, as there was a trend towards fewer cases with cage subsidence in the navigated group.
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Eur J Trauma Emerg S · Apr 2011
3D-based navigation in posterior stabilisations of the cervical and thoracic spine: problems and benefits. Results of 451 screws.
Navigated procedures in spinal surgery have been established due to an increasing demand for precision. Especially, 3D C-arms connected to navigation systems are being used more often and can be utilised intraoperatively for the planning and controlling of screw positions. This prospective study analyses our experiences with 3D-based navigation in posterior stabilisations in the cervical and thoracic spine. ⋯ Intraoperative 3D imaging navigation for posterior spinal stabilisations is technically feasible and reliable in clinical use. The image quality depends on the individual bone density. With undisturbed visibility of the vertebral body, the reliability of 3D-based navigation is comparable to that of CT-based procedures. Additionally, it has the advantage of skipping the preoperative acquisition of data as well as the matching process, with reduced radiation doses.