Eur J Trauma Emerg S
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Eur J Trauma Emerg S · Jun 2007
Gluteal Soft Tissue Necrosis After Transcatheter Angiographic Embolization for Pelvic Fracture: a Report of Two Cases.
In this paper, two cases of the gluteal soft tissue necrosis after pelvic fractures will be discussed. In the case of a 29-year-old man, a localized area of skin necrosis on the buttock appeared after transcatheter arterial embolization (TAE) of the right internal iliac artery (IIA). ⋯ In both cases, complete excision of the necrotic tissue and reconstructive flap surgery were imperative. Gluteal soft tissue necrosis is clinically important as one of the serious complications of TAE.
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Eur J Trauma Emerg S · Jun 2007
Guidelines for Quality Management of Apallic Syndrome / Vegetative State.
Epidemiology in Europe shows constantly increasing figures for the apallic syndrome (AS)/vegetative state (VS) as a consequence of advanced rescue, emergency services, intensive care treatment after acute brain damage and high-standard activating home nursing for completely dependent end-stage cases secondary to progressive neurological disease. Management of patients in irreversible permanent AS/VS has been the subject of sustained scientific and moral-legal debate over the past decade. ⋯ Management of AS aims at the social reintegration of patients or has to guarantee humanistic active nursing if treatment fails. Outcome depends on the cause and duration of AS/VS as well as patient's age. There is no single AS/VS specific laboratory investigation, no specific regimen or stimulating intervention to be recommended for improving higher cerebral functioning. Quality management requires at least 3 years of advanced training and permanent education to gain approval of qualification for AS/VS treatment and expertise. Sine qua non areas covering AS/VS institutions for early and long-term rehabilitation are required on a population base (prevalence of 2/100.000/year) to quicken functional restoration and to prevent or treat complications. Caring homes are needed for respectful humane nursing including basal sensor-motor stimulating techniques. Passive euthanasia is considered an act of mercy by physicians in terms of withholding treatment; however, ethical and legal issues with regard to withdrawal of nutrition and hydration and end of life discussions raise deep concerns. The aim of the guideline is to provide management guidance (on the best medical evidence class II and III or task force expertise) for neurologists, neurosurgeons, other physicians working with AS/VS patients, neurorehabilitation personnel, patients, next-of-kin, and health authorities.
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Eur J Trauma Emerg S · Jun 2007
The Finnish Forward Surgical Team Experience During EUFOR Operation RD Congo in 2006.
The army Forward Surgical Team (FST) is a mobile surgical asset designed to provide life- and limbsaving combat surgery in remote and austere terrains. Operation EUFOR RDC in Democratic Republic of the Congo (DRC) in 2006 was the first one planned and conducted solely by the European Union Forces (EUFOR). The first two European FSTs reported in the present article were established by the Finnish Defence Forces. ⋯ All trauma cases were of noncombat origin, and only one of them was severe. The European FST concept should be developed for future missions regarding the experiences gained during the reported deployment, the main goals being the mobility and the lightness of the unit. This kind of special trauma surgical asset, designed for remote theatres, will possibly be useful also in other emergency operations taking place in non-conventional circumstances; a concept of FST could easily be deployed in short notice to various accidental and natural disasters.
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Eur J Trauma Emerg S · Jun 2007
Traumatic Hemipelvectomy: A Case Report and a Review of the Literature.
Traumatic hemipelvectomy is a life threatening, devastating pelvic injury with very low survival rates. Excessive loss of blood, related systemic problems and additional injuries about the gastrointestinal and genitourinary systems increase mortality of this severe sort of injury. A young, male farmer injured violently by an agricultural heavy machine; a survivor of traumatic hemipelvectomy is described in this case report.
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Eur J Trauma Emerg S · Jun 2007
Pressure Ulcers and Prolonged Hospital Stay in Hip Fracture Patients Affected by Time-to-Surgery.
Hip fractures are associated with high morbidity. Pressure ulcer formation after hip surgery is often related to delayed patient mobilization. The objectives of this study were to determine whether time-to-surgery affects development of pressure ulcers postoperatively and, thus, length of hospital stay. ⋯ Of the 722 patients enrolled, 488 patients (68%) received surgery at 12 h after admission. Approximately 30% (n = 214) developed pressure ulcers during admission, whilst 19% of patients operated within 12 h of admission developed pressure ulcers. Time-to-surgery was an independent predictor of both development of pressure ulcers (OR = 1.7, 95% confidence interval [CI] = 1.2-2.6; p = 0.008) and length of hospital stay (11.3 vs 13.3 days in the early and the late surgery group, respectively, p = 0.050). Furthermore, development of pressure ulcers was associated with prolonged postoperative hospital stay (19.5 vs 11.1 days for patients with and without pressure ulcers, respectively, p = 0.001) INTERPRETATION: : In hip fracture patients, time-to-surgery was an independent predictor of both postoperative pressure ulcer development and prolonged hospital stay. These data suggest that the implementation of an early surgery protocol following admission for hip fractures may reduce both the postoperative complications and overall hospital stay.