Eur J Trauma Emerg S
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Gastrointestinal bleeding is a common life-threatening problem, causing significant mortality, costs and resource allocation. Its management requires a dynamic multidisciplinary approach that directs diagnostic and therapeutic priorities appropriately. ⋯ Management of gastrointestinal bleeding requires a dynamic multidisciplinary approach. The mentioned advances in management of hemorrhagic shock must be considered in resuscitation and monitoring of patients with GI bleeding.
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Eur J Trauma Emerg S · Aug 2011
Pitfalls of lateral external fixation for supracondylar humeral fractures in children.
Closed reduction and percutaneous pinning is a standard treatment for dislocated supracondylar humeral fractures in children. However, the management of these fractures remains challenging. The aim of this study was to evaluate lateral external fixation as a treatment alternative for these fractures. ⋯ Lateral external fixation is an alternative method for the treatment of displaced or unstable supracondylar fractures in children, facilitating reduction and improving fracture stability. However, iatrogenic radial nerve injury is a risk, and we therefore strongly recommend inserting the proximal pin under direct vision within 2 cm from the fracture line using a drill sleeve.
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Eur J Trauma Emerg S · Aug 2011
One-year outcome and course of recovery after severe traumatic brain injury.
To describe the outcome of patients with severe traumatic brain injury (TBI) 3, 6 and 12 months after trauma. ⋯ Of the 1,172 patients, 37% died in the intensive care unit (ICU) and 8.5% died after ICU discharge. At 12 months after trauma, almost half of the outcomes (46.6%) were classified as "favourable" (33% "good recovery", 13.6% "moderate disability") and 7.9% were classified as "unfavourable" (6.1% "severe disability", 1.8% "vegetative status"). As in previous studies, long-term outcomes were influenced by age, severity of trauma, first GCS score, pupillary status and CT findings (e.g. subdural haematoma and closed basal cistern on the first CT scan). Patients with "good recovery" had a high likelihood to remain in that category (91%). Patients with "moderate disability" had a 50% chance to improve to "good recovery". Patients with "severe disability" had a 40% chance to improve and had a 4% chance of death. Patients with "vegetative status" were more likely to die (42%) than to improve (31%). Changes were more likely to occur during the first than during the second half-year after trauma.
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Eur J Trauma Emerg S · Aug 2011
Radiographic techniques for the localization and treatment of gastrointestinal bleeding of obscure origin.
Acute gastrointestinal bleeding (GIB) is an emergency with high mortality rates, which requires a quick localization and treatment of the bleeding site. In this article, we give a summary of the diagnostic and interventional treatment of acute GIB with an emphasis on radiological methods. ⋯ Managing obscure acute GIB remains a challenge. The best patient care is achieved with a multidisciplinary team of endoscopists, experienced surgeons, and interventional radiologists. If emergency endoscopy fails, a CTA has to be done, which is more sensitive than conventional angiography. Based on CTA findings, a decision must be made between TAE and surgical intervention.
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Eur J Trauma Emerg S · Aug 2011
Comparison of two different matrix-based autologous chondrocyte transplantation systems: 1 year follow-up results.
The treatment of full-thickness cartilage defects of the knee is a common problem in orthopaedic surgery. Autologous chondrocyte transplantation (ACT) is one of the few reliable treatment options of cartilage defects with good long-term outcomes. The improvement of ACT led to the matrix-based ACT (MACT). The purpose of the study was to compare two different commercially available MACT systems. ⋯ The study showed that MACT is a good therapeutic option for full-size defects of the femoral condyle. The MACI(®) implant seems to be easier to handle which is reflected by smaller incisions and a shorter operation time.