Eur J Trauma Emerg S
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Eur J Trauma Emerg S · Jun 2011
Uncommon acquired fistulae involving the digestive system: summary of data.
Most gastrointestinal fistulae commonly occur following surgery. A minority is caused by a myriad of other etiologies and is termed by some as "uncommon fistulae". The aim of this study was to review these fistulae and their treatment. ⋯ The anatomic features of the fistula and the etiology usually dictate the approach. Most patients will eventually need surgery to resolve this pathology.
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Eur J Trauma Emerg S · Jun 2011
Characteristics of polytrauma patients with posttraumatic stress disorder in a level 1 trauma center.
The aims of this study were to determine if the severity of injury is related to the prevalence of posttraumatic stress disorder (PTSD) in polytrauma patients and to review the personality traits of patients with PTSD. ⋯ An increased level of neuroticism, negative cognitions regarding themselves, and active dealing were found to be significant predictors of PTSD. However, we found no relation between the injury severity score and the prevalence of PTSD.
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Eur J Trauma Emerg S · Jun 2011
Telesurgical evaluation of stable thoracic trauma patients: a feasibility study.
We evaluated a robotic telesurgical platform in managing thoracic trauma in an animal model. ⋯ A robotic telesurgical approach to the evaluation of stable thoracic trauma patients is safe and feasible in a porcine model. Diaphragmatic injuries can be repaired but require repositioning of the robot.
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Fistulas are abnormal communications between two epithelial surfaces, either between two portions of the intestine, between the intestine and some other hollow viscus, or between the intestine and the skin of the abdominal wall. The etiology of intestinal fistulas is in most cases a result of multiple contributing factors. Despite significant advances in their management over the past decades, intestinal fistulas remain a major clinical problem, with a high overall mortality rate of up to 30% due to the high rate of complications. This paper aims to describe classification systems based on the anatomy, physiology and etiology that may be helpful in the clinical management of intestinal fistulas. ⋯ Fistula formation can cause a number of serious or debilitating complications ranging from disturbance of fluid and electrolyte balance to sepsis and even death. They still remain an important complication following gastrointestinal surgery.
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The historical highlights of the management of fistulas of the gastrointestinal tract during the past century are presented briefly, together with the significant lessons learned from the studies published in the literature. ⋯ The optimal metabolic and nutritional management of patients with gastrointestinal tract fistulas is an extraordinary and daunting challenge which has yet to be perfected, demonstrated, and applied universally. Much education, research, motivation, proficiency, and concerted conscientious effort will be required in order to achieve this elusive but noble goal. Some suggestions for achieving success in this endeavor are proffered, consistent with the senior author's philosophy, which has evolved during a half-century of experience and endeavor in this vital area.