J Trauma
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Review Case Reports
Traumatic thoracobiliary fistula: report of a case successfully managed conservatively, with an overview of current diagnostic and therapeutic options.
Thoracobiliary fistula is a rare complication of hepatic trauma that may present a diagnostic and therapeutic challenge. We report a case of a thoracobiliary fistula complicating thoracoabdominal trauma. ⋯ Conservative therapy consists of a safe temporizing measure during the workup and may, on occasion, be the only therapy that is necessary provided that controlled drainage of the fistula is achieved. The current recommendation would be the exhaustion of nonoperative therapeutic modalities before resorting to surgical intervention.
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Randomized Controlled Trial Comparative Study Clinical Trial
The role of presacral drainage in the management of penetrating rectal injuries.
To compare in a randomized, prospective manner infectious complication rates associated with presacral drainage versus no drainage in the presence of penetrating rectal injury. ⋯ We conclude that presacral drainage for penetrating rectal injuries has no effect on infectious complications associated with the rectal injuries.
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Randomized Controlled Trial Comparative Study Clinical Trial
Kapandji pinning or closed reduction for extra-articular distal radius fractures.
In a randomized prospective trial, closed reduction and plaster application was compared with Kapandji pinning. Closed reduction and plaster cast application was performed in 50 patients, Kapandji pinning in 48 patients. ⋯ In terms of maintenance of reduction and functional outcome at 1-year follow-up, no statistically significant differences were found between the two groups. We conclude, therefore, that both techniques can be applied to extra-articular fractures of the distal radius according to the characteristics of the forearm and the surgeon's or the patient's need.
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More than 20 years ago, critical care workers first observed that oxygenation improved when patients with acute respiratory distress syndrome were ventilated in the prone position. In recent reports, on turning prone, from 50 to 100% of patients improve oxygenation to a degree sufficient to allow a reduction in the level of positive end-expiratory pressure or fraction of inspired oxygen. ⋯ Although many questions regarding the role of prone ventilation are unanswered, of greatest importance is whether this technique reduces morbidity and mortality of patients with acute respiratory failure. Only carefully conducted, randomized trials can answer this question.
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Since 1992, the Consultative Committee on Road Traffic Fatalities in Victoria, Australia, has identified problems including those contributing to death and the potential preventability of deaths in road fatalities who survived until at least the arrival of ambulance services. The present analysis examines the outcomes at a Level I trauma center compared with other hospital groups in Victoria. ⋯ Management of patients with major trauma at a Level I trauma center was associated with fewer problems contributing to death and fewer preventable and potentially preventable deaths than at the different hospital groups. A trauma system in Victoria, including bypass of major trauma patients to designated hospitals with 24-hour trauma services, is likely to decrease the frequency of problems, including the preventable death rates.