J Trauma
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A national survey in 1996 showed insufficient routines for management of patients with mild head injuries in Norwegian hospitals. Since then, the Scandinavian Guidelines for Management of Mild Head Injuries have been published. ⋯ The Scandinavian Guidelines for Management of Mild Head Injuries have had a significant impact on management practice in Norwegian hospitals.
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Few population-based analyses of spinal cord injuries exist from which to base Canadian prevention initiatives. This study aimed to calculate rates of traumatic spinal cord injury for the province of Ontario and describe these injuries by several epidemiologic parameters. ⋯ The results indicate the relative importance of several external causes of injury and are useful in establishing rational priorities for prevention.
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Circulating monocytes and polymorphonuclear leukocytes (PMNLs) are considered as central regulators controlling systemic inflammatory response after severe insults. Recently, activated monocytes and PMNLs have been reported to produce microparticles (MPs) in vitro. The objective of this study was to evaluate production of MPs and changes of cytoskeleton in monocytes from severe systemic inflammatory response syndrome (SIRS) patients, and to compare them with those in PMNLs. ⋯ The changes of MP formation and cytoskeleton in circulating monocytes and PMNLs were paradoxically different in severe SIRS patients.
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The purpose of this study was to determine whether serial computed tomographic (CT) scans of the head serve to prompt operative intervention. After the initial and 24- to 48-hour repeat scans, if no operative intervention has been performed, further serial scans are ordered on a planned basis or on the basis of changes in clinical status. ⋯ In severe head-injured patients who are nonneurosurgical candidates on the basis of initial and repeat CT scans, serial head CT scans have little clinical efficacy and do not lead to urgent operative intervention.
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Angiographic embolization (AE) is a safe and effective method for controlling hemorrhage in both blunt and penetrating liver injuries. Improved survival after hepatic injuries has been documented using a multimodality approach; however, patients still have significant long-term morbidity. This study examines further the role of AE in both blunt and penetrating liver injuries and the outcomes of its use. ⋯ There is increasing adjunctive use of AE in patients managed both operatively and nonoperatively. Intra-abdominal complications are common in these salvaged patients with severe liver injuries. Those patients that underwent early-AE received significantly fewer blood transfusions and more commonly had sterile hepatic collections. Only 26% of patients required liver-related surgery after AE. Therefore, the integration of AE as an adjunctive modality for patients with high-grade liver injuries is a safe and effective therapeutic option.