J Trauma
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Blunt Bowel and Mesenteric injuries (BBMI) can present diagnostic difficulties and are occasionally recognized in a delayed fashion. Most studies evaluating these injuries predate multidetector Computerized Tomography (CT) scan technology. We set out to analyze whether the current era of multislice CT scanning has led to changes in the incidence of missed injuries in BBMI or altered the patterns of diagnosis. ⋯ Missed injuries remain common in BBMI even in the current era of multislice CT scanners. Free fluid w/o solid organ injury, though not specific, continues to be an important finding. Adjuncts to CT continue to be necessary for the optimal diagnosis of bowel injuries.
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Although the "open abdomen" has likely contributed to improved outcomes in trauma patients, the challenge of subsequent fascial closure has emerged. Since mid 2004, we have incorporated Wittmann Patch staged abdominal closure into our management of the open abdomen. The purpose of this study was to evaluate the impact of this device on our incidence of fascial closure versus planned ventral hernia. ⋯ Incorporating the Wittmann Patch into a clinical pathway for management of the open abdomen has contributed to an increased incidence of delayed fascial closure. Abdominal complications were similar in both groups, suggesting that the device is not only efficacious, but also relatively safe.
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It was the purpose of this study to review equestrian-related injuries using a large nation wide database and analyze predictors of significant injury. ⋯ The largest number of equestrian injuries occur in white females in the 2nd, 4th, and 5th decades of life. Serious injuries are due to falling or being bucked off a horse and most commonly occur at home or at a recreational/sporting facility. Prevention strategies (educational and passive protection equipment) should be especially targeted to this high risk group.