J Trauma
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Comparative Study
Investigation of computed tomographic scan concurrent criterion validity in doubtful scaphoid fracture of the wrist.
Rapid diagnosis of scaphoid bone fracture in the wrist is important so that appropriate treatment can be started. If a fracture is clinically suspected without being visible on radiography, further investigation has to be conducted to reveal a fracture or to rule it out. The objective of this study was to investigate the validity of computed tomographic (CT) scanning and bone scintigraphy compared with the clinical fracture rate during follow-up of 1 year for examining patients with a suspected scaphoid fracture. ⋯ CT scanning is a rapid, simple, valid method for demonstrating or ruling out a scaphoid fracture and is superior to bone scintigraphy.
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Comparative Study
Bilateral lower leg replantation versus prosthetic replacement: long-term outcome of amputation after an occupational railroad accident.
This retrospective study investigated three very similar cases of bilateral lower leg amputation. The aim was to determine which of two therapeutical procedures is associated with better long-term outcome: replantation or primary treatment of the stumps and subsequent prosthetic replacement. ⋯ The decision between replantation and prosthetic replacement after bilateral lower leg amputation is case related and cannot be generalized. Patients who have undergone these procedures require long-term psychological and physiotherapeutic care to achieve a good long-term surgical outcome.
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Comparative Study
Modified rapid deployment hemostat bandage terminates bleeding in coagulopathic patients with severe visceral injuries.
We recently reported that a new dressing, the Modified Rapid Deployment Hemostat (MRDH) controlled bleeding in hypothermic coagulopathic swine after traumatic liver avulsion. The purpose of this study was to evaluate the MRDH in coagulopathic trauma patients undergoing abbreviated laparotomy. ⋯ The Modified Rapid Deployment Hemostat terminates bleeding from severe visceral injuries in coagulopathic patients undergoing abbreviated laparotomy.
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Comparative Study
Decompressive laparotomy to treat intractable intracranial hypertension after traumatic brain injury.
Increases in intra-abdominal pressure (IAP) can cause increases in intracranial pressure (ICP). Recently, we noticed that abdominal fascial release could be useful in treating intracranial hypertension (ICH) after traumatic brain injury (TBI). We added this as an option in our treatment of TBI. ⋯ Decompressive laparotomy can be a useful adjunct in the treatment of ICH failing maximal therapy following TBI. More work will need to be done to precise the exact indications for this therapy.
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Comparative Study
Cardiac troponin I as a predictor of arrhythmia and ventricular dysfunction in trauma patients with myocardial contusion.
Myocardial contusion during blunt chest trauma is common and may lead to potentially fatal cardiac complications. Therefore, it is useful to identify a serum marker reflecting the myocardial damage that can predict risk for cardiac complications. In this study, the authors determined the strength of the association between cardiac troponin I (cTnI) levels and the risk of arrhythmia or the development of left ventricular dysfunction in a cohort of patients with blunt chest trauma. ⋯ Levels of cTnI below 1.05 microg/L in asymptomatic patients at admission and within the first 6 hours after admission rule out myocardial injury, whereas positive cTn levels above 1.05 microg/L mandate further cardiologic workup for the detection and management of myocardial injury. Furthermore, the dynamics and peak levels of pathologic cTnI levels allow estimation of arrhythmia risk and left ventricular dysfunction in trauma patients with myocardial contusion.