Zentralblatt für Chirurgie
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Emergency ultrasound has established itself as a key procedure of primary diagnostic work-up for blunt abdominal and multiple trauma. However, in a systematic review published in 2001 ultrasonography turned out to provide an unexpectedly low sensitivity. We conducted an update of this analysis to investigate if test characteristics will be maintained including recent studies. ⋯ In pediatric trauma, ultrasound showed even worse test characteristics (negative LR = 0.43). Thus, in case of a 35% prevalence, the post-test probability has to estimated at 19%. Emergency ultrasound provides high specificity but insufficient sensitivity to reliably rule out intraabdominal injury.
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CRPS I represents a frequent complication following distal radial fractures. Early diagnosis may prevent chronification of the disease. However posttraumatic pain, swelling and motor disturbances render the differentiation from normal fracture patients more difficult. The incidence of CRPS I in patients at risk and the diagnostic value of clinical evaluation, radiography and thermography in the early posttraumatic phase are analysed. ⋯ The results of the study support the importance of clinical evaluation in the early diagnosis of CRPS I. Plain radiographs facilitate the diagnosis as soon as bony changes develop.
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Injuries and irritation of extensor tendons are common problems in the treatment of fractures of the distal radius when plating is used via a dorsal approach. By the development of locking compression plates the possibility of palmar plating for dorsally displaced fractures of the distal radius is available. In this study our first clinical experiences using the 3.5 mm radius locking compression plate (LCP) are reported. ⋯ No irritation of the median nerve, no infection was observed. In one case a screw which was placed intraarticularly was removed prematurely. The palmar locking compression plate has been proven as a safe and effective implant for the treatment of dorsally displaced fractures of the distal radius.
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Hospital-acquired infections affect 7% to 10% of hospitalized patients and account for approximately 80,000 deaths per year in the United States. Of all infections acquired in the hospital, more than 20% occur in intensive care unit patients. ⋯ The focus of this paper is to review the epidemiology of hospital-acquired infections that occur in the surgical ICU, particularly ventilator associated pneumonia, catheter-associated urinary tract infection, and catheter-related bloodstream infection, and to discuss ICU-related prevention strategies. By implementing effective preventative measures and maintaining strict surveillance of ICU infections, we hope to affect the associated morbidity, mortality, and cost that our patients and society bare.