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Sanna Antonio - - 2013
The obstructive sleep apnoea (OSA) shows a very high prevalence in the middle-age work force population and, between all diseases and medical conditions, is the major risk factor for motor vehicle accidents (MVAs). OSA can be diagnosed and treated, with resultant reduction in MVAs to those seen in the healthy ...
Tapia Nicole M - - 2013
For nearly a decade, our center performed thromboelastograms (TEGs) to analyze coagulation profiles, allowing rapid data-driven blood component therapy. After consensus recommendations for massive transfusion protocols (MTPs), we implemented an MTP in October 2009 with 1:1:1 ratio of blood (red blood cells [RBC]), plasma (fresh-frozen plasma [FFP]), and platelets. We ...
Savage Stephanie A - - 2013
The massive transfusion (MT) concept (>10-U packed red blood cells per 24 hours) is retrospective, arbitrary, and prone to survivor bias. Accounting for rate and timing is a more accurate conceptual framework. We redefined MT as a critical administration threshold (CAT) of 3 U/h, which is clinically pertinent and reflects ...
Harvin John A - - 2013
Failure to achieve fascial closure after damage control laparotomy (DCL) is associated with increased morbidity and long-term disability. In addition, early closure is associated with reduces infectious, wound, and pulmonary complications. We hypothesized that hypertonic saline (HTS), which attenuates resuscitation-induced intestinal edema in animals, would improve early primary fascial closure ...
Dirkmann Daniel - - 2013
Hypothermia and acidosis have been suggested as key initiators of trauma-induced coagulopathy, and severe bleeding caused by hyperfibrinolysis (HF) predicts mortality. We tested in vitro (1) whether clinically relevant grades of hypothermia, acidosis, and their combination impact on recombinant tissue-type plasminogen activator (r-tPA)-evoked HF and assessed (2) the efficacy of ...
Weckbach Sebastian - - 2013
The exact alterations of the immune system after polytrauma leading to sepsis and multiple-organ failure are poorly understood. Thus, the early local and systemic inflammatory and apoptotic response was characterized in a new polytrauma model and compared with the alterations seen after single or combined injuries. Anesthetized C57BL/6 mice were ...
Sawant Devendra A - - 2013
Microvascular hyperpermeability following conditions such as hemorrhagic shock occurs mainly owing to disruption of the adherens junctional protein complex in endothelial cells. The objective of this study was to examine the action of staurosporine, a potent activator of endogenous caspase 3 on the adherens junction and the cellular pathway through ...
Recknagel Stefan - - 2013
We recently demonstrated that a blunt chest trauma, a strong inducer of the posttraumatic systemic inflammatory response and one of the most critical injuries in polytrauma patients, significantly delayed fracture healing in rats, possibly by the interaction of the systemic inflammation with early regeneration processes locally at the fracture site. ...
Olthof Dominique C - - 2013
Contradictory findings are reported in the literature concerning prognostic factors for failure of nonoperative management (NOM) in the treatment of adults with blunt splenic injury. The objective of this systematic review was to identify prognostic factors for failure of NOM, with or without angiography and embolization. MEDLINE, Embase, and the ...
Bandle Jesse - - 2013
Venous duplex surveillance (VDS) is commonly used in trauma patients considered at risk for deep venous thrombosis. Economic evaluations have not addressed the quality of either the process of care or the outcomes achieved through the use of VDS. We sought to determine the value (quality/cost) of VDS in trauma ...
Yan Hede - - 2013
Degloving injuries are severe and frequently underestimated lesions. Lower extremities are the most commonly affected limbs. This injury is associated with a high morbidity and mortality if mismanaged. The treatment of such patients still varies, clinical indicators for its prognosis are scarce, and some technical protocols are also controversial. Between ...
Lingsma Hester - - 2013
Several prognostic models to predict outcome in traumatic brain injury (TBI) have been developed, but few are externally validated. We aimed to validate the International Mission on Prognosis and Analysis of Clinical Trials in TBI (IMPACT) prognostic models in a recent unselected patient cohort and to assess the additional prognostic ...
Croce Martin A - - 2013
Since its introduction by the Institute for Healthcare Improvement, the ventilator bundle (VB) has been credited with a reduction in ventilator-associated pneumonia (VAP). The VB consists of stress ulcer prophylaxis, deep venous thrombosis prophylaxis, head-of-bed elevation, and daily sedation vacation with weaning assessment. While there is little compelling evidence that ...
Fabricant Loic - - 2013
During preservation, donated liquid red blood cells (RBCs) experience multiple functional and structural changes known as the storage lesion. Increased RBC age is associated with increased infection rates, organ failure, and mortality. This prospective, randomized, double-blinded pilot study enrolled stable trauma patients who required RBC transfusion. Patients were randomly assigned ...
Guidry Chrissy - - 2013
Resuscitation strategies in patients with severe hemorrhage have evolved throughout the years. Optimal resuscitation ratios for civilian exsanguinating vascular injuries has not been determined. We hypothesize improved outcomes in patients with exsanguinating vascular injuries when an aggressive hemostatic resuscitation is used with an inverse ratio of fresh frozen plasma (FFP) ...
Yamakawa Kazuma - - 2013
The role of mitochondrial dysfunction has not been thoroughly clarified in the pathogenesis of critically ill patients. The objective of this study was to investigate mitochondrial membrane potential (ΔΨm) and apoptosis in circulating platelets in patients with systemic inflammatory response syndrome (SIRS). This prospective observational study was conducted from May ...
Sharpe John P - - 2013
Operative management at our institution for all colon injuries have followed a defined algorithm (ALG) based on risk factors originally identified for penetrating injuries. The purpose of this study was to evaluate the applicability of the ALG to blunt colon injuries. Patients with blunt colon injuries during 13 years were ...
Seamon Mark J - - 2013
Although many surgeons leave laparotomy incisions open after colon injury to prevent surgical site infection (SSI), other injured patient subsets are also at risk. We hypothesized that leaving trauma laparotomy skin incisions open in high-risk patients with any enteric injury or requiring damage control laparotomy (DCL) would not affect superficial ...
Valdez Carrie - - 2013
Limb compartment syndrome (CS) is a difficult diagnosis. Accurate measurement of compartment pressure is user dependent, and there is no consensus on values to define CS. Given the prevalence of extremity CS, difficulty in timely diagnosis, and ramifications of a delay in diagnosis, a precise and reliable means for early ...
Malinoski Darren - - 2013
Catheter-associated deep venous thromboses (CADVTs) are a common occurrence in the surgical intensive care unit (SICU), necessitating central venous catheter (CVC) removal and replacement. Previous studies evaluating risk factors for CADVT in SICU patients are limited, and most lack a true denominator of all CVC days. We sought to determine ...
Coleman Jamie J - - 2013
Concern over lack of resident interest caused by the nonoperative nature and compromised lifestyle associated with a career as a "trauma surgeon" has led to the emergence of a new acute care surgery (ACS) specialty. This study examined the opinions of current general surgical residents about training and careers in ...
Gatson Joshua W - - 2013
Following a mild traumatic brain injury (TBI) event, the secondary brain injury that persists after the initial blow to the head consists of excitotoxicity, decreased cerebral glucose levels, oxidant injury, mitochondrial dysfunction, inflammation, and neuronal cell death. To date, there are no effective interventions used at decreasing secondary brain injury ...
Lee Tim H - - 2013
Deep vein thrombosis (DVT) is common after trauma. Pulmonary embolism (PE) is a feared complication of DVT. Standard doses of low-molecular-weight heparin (LMWH) are commonly used to prevent and treat DVT and PE. There is variable bioavailability of LMWH with standard therapy. The traditional concept that below-knee DVT is associated ...
Bach Harold H HH - - 2013
Several lines of evidence suggest that proteasomes, the major nonlysosomal proteases in eukaryotes, are involved in the pathophysiology of various disease processes, including ischemia-reperfusion injury and trauma. Recently, we demonstrated that 26S proteasome activity is negatively regulated by adenosine triphosphate (ATP) and that proteasome activation during ischemia contributes to myocardial ...
Wu Xiaojing - - 2013
Dexmedetomidine is a new and highly selective α2-adrenoreceptor agonist with potent anti-inflammatory capacity. This study explored the effects of dexmedetomidine on regulating hemodynamics, the plasma tumor necrosis factor α (TNF-α) and interleukin 1β (IL-1β) levels, immunohistochemical localization of nuclear factor κB (NF-κB) from blunt chest trauma-induced pulmonary contusion in rats. ...
Inaba Kenji - - 2013
The purpose of this study was to evaluate the long-term efficacy and safety of kaolin- and chitosan-based hemostatic agents for hemorrhage control in a 14-day survival, damage-control swine model of Grade IV liver injury. A total of 48 anesthetized pigs (40 kg) underwent a 35% total blood volume bleed, cooling ...
Hardee Miranda Jo - - 2013
Appropriate imaging in renal trauma can avoid delayed recognition of collecting system injuries, allowing for prompt intervention and less morbidity. Current recommendations include obtaining abdominal and pelvic computed tomographic scans with intravenous contrast, followed by excretory images for high-grade injury or perinephric fluid. The purpose of this study was to ...
van der Wilden Gwendolyn M - - 2013
Staffing of attending intensivists 24 hours per day, 7 days per week (24/7) in the surgical intensive care unit (SICU) has unknown benefits. We hypothesized that 24/7 attending intensivist staffing in the SICU would improve outcomes and processes of care. We retrospectively reviewed 26 months of admissions to our 20-bed ...
Quigley Matthew R - - 2013
Mild traumatic brain injury is a clinical diagnosis predicated on a patient's neurologic status and encompasses a variety of pathologies on computed tomography. We wondered whether isolated traumatic subarachnoid hemorrhage (iSAH) without other intracranial pathologic diagnosis is a more benign form of minor head injury that does not warrant extensive ...
Golden Robert D - - 2013
Measures of pubic symphyseal widening are used by at least two classification systems as determinants of injury grade. Recent work has challenged the commonly used parameter of 2.5 cm of pubic symphysis as an accurate marker of pelvic injury grade and has suggested a role of rotation in the flexion-extension ...
Stahel Philip F - - 2013
In contrast to the established principles of "damage-control orthopedics" for temporary external fixation of long bone or pelvic fractures, the "ideal" timing and modality of fixation of unstable spine fractures in severely injured patients remains controversial. A prospective cohort study was designed to evaluate the safety and efficacy of a ...
de Mestral Charles - - 2013
The management of a mangled lower extremity is complex and requires consideration of a patient's injury pattern, medical history, social context, and preference. The Lower Extremity Assessment Project provides the highest level of evidence guiding management; however, the Lower Extremity Assessment Project cohort was recruited 15 years ago and was ...
Ballian Nikiforos - - 2013
The surgical treatment of acute colonic diverticulitis is associated with significant morbidity and mortality. However, patient and operative characteristics associated with mortality in this patient population are unclear. We hypothesize that demographic and perioperative variables can be used to predict postoperative mortality.The purpose of this study was to identify perioperative ...
Kelleher Deirdre C - - 2013
Exposure and environmental control are essential components of the advanced trauma life support primary survey, especially during the resuscitation of pediatric patients. Proper exposure aids in early recognition of injuries in patients unable to communicate their injuries, while warming techniques, such as the use of blankets, assist in maintaining normothermia. ...
Charyk Stewart Tanya - - 2013
This study was initiated was initiated to describe pediatric rear-occupant motor vehicle collision (MVC) injuries, including injury patterns and outcomes as well as characteristics associated with severe injury to the head and abdomen. A retrospective cohort of severely injured (Injury Severity Score [ISS] > 12) pediatric (age <18 years) patients ...
Leis Carmen Camacho - - 2013
Several studies recommend not initiating advanced life support in traumatic cardiac arrest (TCA), mainly owing to the poor prognosis in several series that have been published. This study aimed to analyze the survival of the TCA in our series and to determine which factors are more frequently associated with recovery ...
Fatovich Daniel M - - 2013
We examined the association between age, mechanism of injury, and Injury Severity Score (ISS) on mortality in major trauma. We used 9 years of population-based linked major trauma (ISS >15) registry data for Western Australia (N = 4,411). These were categorized using the Sampalis classification of injury severity: survivable (ISS ...
Muller Michael J - - 2013
Major burn injuries cause devastating physical and psychosocial morbidity, combined with significant health care and community costs. The aim of this study was to evaluate the effectiveness of a targeted burn prevention message on burn safety knowledge and behavior. An 11-year retrospective review of patients admitted to an adult tertiary ...
Sahin Atalay - - 2013
Foreign body (FB) inhalation into airways of the respiratory system is a life-threatening condition and can be fatal. The purpose of this survey was to evaluate the types and characteristics of inhaled foreign bodies, the age distribution of children, and the outcome. We outlined a retrospective review of hospital data ...
Kelleher Deirdre C - - 2013
Alcohol misuse is an important source of preventable injuries in the adolescent population. While alcohol screening and brief interventions are required at American College of Surgeons-accredited trauma centers, there is no standard screening method. To develop guidelines for testing, we reviewed available evidence regarding adolescent alcohol screening after injury, focusing ...
Bakker Adam - - 2013
Patients can experience devastating injuries when an upper extremity travels out of a window during a motor vehicle collision. These injuries are typically very severe and may even result in loss of the affected limb. The purposes of this retrospective study were to determine the clinical fate of these extremities ...
Kuhls Deborah A - - 2013
Surgical education is changing owing to workforce and economic demands. Simulation and other technical teaching methods are used to acquire skills transferable to the operating room. Operative management of traumatic injuries has declined, making it difficult to acquire and maintain competence. The ASSET course was developed by the Committee on ...
Wafaisade Arasch - - 2013
Despite poor evidence and high costs, fibrinogen concentrate (FC) represents one of the most frequently used hemostatic agents in exsanguinating trauma. The aim was to assess whether the administration of FC in severely injured patients was associated with improved outcomes. Patients documented in the Trauma Registry of the German Society ...
Minshall Christian Todd - - 2013
Ventilator-associated pneumonia is a problem in trauma and emergency general surgery patients. Our hospital-acquired infection prevention committee approved the use of early nonbronchoscopic bronchoalveolar lavage (screening-BAL) in the surgical intensive care unit (SICU) to identify ventilated patients with bronchiolar bacteria before 48 hours. We reviewed the results of this quality ...
Woitek R - - 2013
Diagnosis and differential diagnosis of fetal thoracic and abdominal malformations. Ultrasound and magnetic resonance imaging (MRI). In cases of suspected pathologies based on fetal ultrasound MRI can be used for more detailed examinations and can be of assistance in the differential diagnostic process. Improved imaging of anatomical structures and of ...
Joshi G P - - 2013
The aim of this systematic review was to evaluate the available literature on the management of pain after laparoscopic colorectal surgery. Randomized studies, published in English between January 1995 and July 2011, assessing analgesic and anaesthetic interventions in adults undergoing laparoscopic colorectal surgery, and reporting pain scores, were retrieved from ...
Stein Deborah M - - 2013
Adrenal insufficiency (AI) has been extensively described in sepsis but not in acute hemorrhage. We sought to determine the incidence of hyperacute AI (HAI) immediately after hemorrhage and its association with mortality. Patients with acute traumatic hemorrhagic shock presenting to the R Adams Cowley Shock Trauma Center prospectively had serum ...
Kosova Ethan C EC Department of Medicine, Brigham and Women’s Hospital, Boston, MA, - - 2013
The consumption of sugar-sweetened beverages has been implicated as a major contributor to the development of obesity and cardiometabolic disease. To evaluate the relationships between sugar-sweetened beverage intake and cardiometabolic markers in young children. A cross-sectional analysis of the National Health and Nutrition Examination Survey data collected by the National ...
Dellinger R Phillip RP Cooper University Hospital, Camden, New Jersey, USA. - - 2013
To provide an update to the "Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock," last published in 2008. A consensus committee of 68 international experts representing 30 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). ...
Goldfarb Shari B SB Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. - - 2013
Understanding sexual health issues in cancer patients is integral to care for the continuously growing cancer survivor population. To create a national network of active clinicians and researchers focusing on the prevention and treatment of sexual problems in women and girls with cancer. Interdisciplinary teams from the University of Chicago ...
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