ANZ journal of surgery
-
ANZ journal of surgery · Jun 2009
Serum-mediated osteogenic effect in traumatic brain-injured patients.
Patients with a traumatic brain injury (TBI) and bone fractures often show an enhanced fracture healing, as well as an increased incidence of heterotopic ossifications (HO). It has been suggested that unknown osteoinductive factors may be released by the injured brain into the systemic blood circulation and act peripherally on the affected tissues. The aim of this study was to investigate whether serum from TBI patients is osteoinductive. ⋯ The study results strongly support a humoral mechanism in enhanced fracture healing and the induction of HO after TBI. Increased proliferation of osteoblastic cells and an accelerated differentiation of osteoprogenitor cells may be responsible for increased osteogenesis in TBI.
-
ANZ journal of surgery · Jun 2009
Review Meta AnalysisNeedlescopic versus laparoscopic cholecystectomy: a meta-analysis.
To systematically analyse clinical trials on needlescopic (NC) versus laparoscopic cholecystectomy (LC) that evaluated the effectiveness of both procedures for the management of cholelithiasis. ⋯ NC is a safe and effective procedure for the management of gallstone disease. NC is as effective as LC for perioperative complications and total stay in hospital. NC is superior to LC for less post-operative pain and better cosmetic results. NC is associated with longer operative time and higher conversion rate.
-
ANZ journal of surgery · Jun 2009
Epidemiology of post-injury multiple organ failure in an Australian trauma system.
The epidemiology of post-injury multiple organ failure (MOF) is reported internationally to have gone through changes over the last 15 years. The purpose of this study is to describe the epidemiology of post-injury MOF in Australia. ⋯ The incidence of MOF in Australia is consistent with the international data. In Australia MOF continues to cause significant late mortality and morbidity in trauma patients. MOF patients have longer ICU stay than high-risk non MOF patients, and use significant resources. Our preliminary data challenges the timeliness of the 10-year-old independent predictors of post-injury MOF. The epidemiology, the clinical presentation and the independent predictors of post-injury MOF require larger scale reassessment for the Australian context.
-
ANZ journal of surgery · Jun 2009
Performance and consistency of care in admitted trauma patients: our next great opportunity in trauma care?
Few studies have prospectively analysed the delivery of care in trauma patients. This study undertook a prospective analysis of performance and consistency of care at a Level 1 trauma centre. A 3-month prospective study was undertaken of all admitted trauma patients at Liverpool Hospital. ⋯ This study has shown that while 61.4% of admitted trauma patients receive optimal care, errors are frequent, resulting in a spectrum of outcomes from near misses to death. The majority of errors result from the activity of unsupervised trainees and relate to errors in judgement and delays in diagnosis. Clearly, there is room for improvement of the delivery of trauma care.