Scand J Surg
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Four or twelve months' follow-up in the evaluation of functional outcome after hip fracture surgery?
As a rule, follow-up for at least one year is recommended for fracture studies. This is considered the shortest reliable interval. Still, in the case of hip fractures of the elderly, shorter follow-up might be more practical, since the life expectancy of these patients is often short. The aim of this study was to see if a short four months follow-up period would be acceptable in hip fracture surveys. ⋯ Due to high mortality and age-related deterioration of functioning, no steady state i.e. "final result" is ever reached after hip fracture in the elderly. Four-month follow-up is justified as the shortest possible period, because the socioeconomically most important variable, i.e. place of living, and most of the ADL functions do not change significantly after that.
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Burn injuries still produce a significant morbidity and mortality in Iran. A 3-year retrospective review of burn victims hospitalized at a major burn center was conducted to determine the etiology and outcome of patients in Tabriz. ⋯ In our opinion, social factors are the main drive leading to an unacceptably high rate of burn injuries in our societies. Most of the burn injuries were caused by domestic accidents and were, therefore, preventable; educational programs might reduce the incidence of burn injuries.
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The readiness of our healthcare facilities to respond to terrorist acts or naturally occurring epidemics and disasters has been at the center of public attention since September 11, 2001. The many other tragic events that have occurred throughout the world since then further reinforce the need for all healthcare facilities and medical personnel to increase their level of preparedness if they wish to optimize outcomes. Maximizing survival rates and minimizing disability during any MCI hinges on rapid, seamless, and coordinated response between first responders and first receivers. ⋯ In the interim, we can develop and modify our response plans based on the "lessons learned" from past experience. Prior events have demonstrated that general surgeons and surgical subspecialists are critical components to a successful hospital response for the vast majority of all mass casualty incidents. Thus, surgeons must take responsibility for increasing their knowledge and understanding of basic disaster management principles and must play an active role in developing their institutional disaster plans.
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Albumin may enhance and hydroxyethyl starch (HES) may impair haemostasis. While the effects are also dependent on haemodilution we minimized it by early structured transfusion therapy, and compared albumin and HES regarding blood loss and coagulation parameters in hip arthroplasty patients. ⋯ Administration of albumin or HES 1200 ml (500-2000 and 500-1800) [median (range) respectively] did not affect blood loss. The vWF antigen was higher in the albumin group (p = 0.04) postoperatively. Haematocrit value, platelet count, bleeding time, prothrombin time value, activated thromboplastin time, FV activity and fibrinogen concentration were comparable between the groups. Long operation time was associated with great blood loss (p < 0.001). In hip arthroplasty patients with near normal levels of haematocrit albumin enhanced coagulation without altering blood loss.
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To assess the impact of unsuccessful revascularization in relation to poststernotomy mediastinitis (PSM), which affects long-term outcome after coronary artery bypass grafting (CABG). ⋯ Technical failures of revascularization during CABG may delay recovery from PSM.