Eur J Trauma Emerg S
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Eur J Trauma Emerg S · Apr 2013
The impact of early diagnostic laparoscopy on the prognosis of patients with suspected acute mesenteric ischemia.
To assess the impact of early diagnostic laparoscopy in patients with suspected acute mesenteric ischemia in whom other diagnostic studies are inconclusive or unavailable. ⋯ Diagnostic laparoscopy is a safe and reliable diagnostic tool that can have a positive impact on the prognosis of patients with suspected acute mesenteric ischemia if carried out in a timely manner when radiological diagnostic studies are inconclusive or unavailable.
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Eur J Trauma Emerg S · Apr 2013
Penetrating peripheral vascular injury management in a Sri Lankan military hospital.
Vascular injuries in austere military conflict settings are a challenging problem. The goal of the current study was to analyze the unique features associated with the management and early outcome of penetrating vascular injuries resulting from the conflict in Sri Lanka. ⋯ Vascular reconstruction using vein, combined with a wound management strategy and early fasciotomy, resulted in a high limb salvage rate and remarkably low infection, delayed amputation, and mortality rates. Management of combat vascular injuries based on clinical guidance is feasible and leads to good outcome in a minimally equipped setting during local military conflicts. Surgeons in military hospitals should be trained in vascular injury repair to save the lives and functional limbs of patients.
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Eur J Trauma Emerg S · Apr 2013
No additional value of routine check X-rays after internal fixation of hip fractures.
Annually approximately 18,044 patients are admitted to Dutch hospitals with hip fractures. This is an increasing demand for medical care due to the increasing amount of elderly people. Although previous studies showed that routine check of X-rays following hip fracture surgery is unnecessary, it remains routine in most clinics in the Netherlands. In addition to the radiation exposure to the patient, it is painful and leads to unnecessary costs. This study aims to establish if routine check X-rays 1 day after internal fixation for hip fracture with adequate image intensifier guidance influence postoperative management. ⋯ A check X-ray following internal fixation of hip fractures after adequate peroperative image intensifier guidance is not useful. Dismissing this unuseful medical investigation, leads to less radiation exposure, less pain and less costs.
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Eur J Trauma Emerg S · Apr 2013
Rhabdomyolysis: risk factors and incidence in polytrauma patients in the absence of major disasters.
Rhabdomyolysis is a syndrome caused by musculoskeletal tissue damage that leads to the release of large amounts of intracellular elements, which particularly affect renal function. The most common causes are severe trauma, ischemia, surgical procedures, and drug abuse. We aimed to determine the incidence of rhabdomyolysis by measuring muscle injury markers (CK, myoglobin), to identify pre/post-admission as well as iatrogenic risk factors for rhabdomyolysis in severe polytrauma, to clarify the relevance of orthopedic injuries and surgical treatment in the onset/worsening of rhabdomyolysis, and to correlate risk factors with its main complication-acute renal failure (ARF). ⋯ We found that a large number of factors are implicated in CK and Mb variations. Rhabdomyolysis is a very frequent complication, but increase in CK marker alone does not seem to be correlated with the incidence of ARF. Therefore, Mb level should be considered in this group of patients.
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Eur J Trauma Emerg S · Apr 2013
Risk factors and management of anticoagulant-induced intramural hematoma of the gastrointestinal tract.
Intramural intestinal hematoma is considered a rare complication of overanticoagulation in elderly patients. Nevertheless, this clinical entity is increasingly being reported in the literature, and its incidence is predicted to increase further as a result of the wide use of long-term anticoagulation in an aging population. However, data regarding the risk factors and optimal management of this unusual complication in patients on phenprocoumon/warfarin are scarce. ⋯ Intramural hematoma of the gastrointestinal tract should be suspected in any patient with abdominal pain or intestinal obstruction under anticoagulant therapy. Emergency physicians and surgeons should be aware of this rare complication, as most such cases will resolve spontaneously under conservative measures without the need for surgery.