J Trauma
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Randomized Controlled Trial Multicenter Study
Improved survival of critically ill trauma patients treated with recombinant human erythropoietin.
A randomized, double-blind, placebo-controlled, multicenter trial (EPO-2, N = 1,302) in anemic critically ill patients demonstrated a 29-day survival benefit in the trauma subgroup receiving epoetin alfa (mortality 8.9% vs. 4.1%). A second similarly designed trial (EPO-3, N = 1,460) confirmed this survival benefit in the epoetin alfa-treated trauma cohort (mortality 6.7% vs. 3.5%). This analysis presents trauma cohort data from both trials for evaluation of the impact of baseline factors including trauma-specific variables on outcomes. ⋯ Epoetin alfa demonstrated a survival advantage in both of the critically ill trauma patient cohorts of two prospective, randomized clinical trials, which was not affected by baseline factors including trauma-specific variables. A definitive study in trauma subjects is warranted.
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Randomized Controlled Trial Comparative Study
Temporary abdominal closure techniques: a prospective randomized trial comparing polyglactin 910 mesh and vacuum-assisted closure.
The options for abdominal coverage after damage control laparotomy or abdominal compartment syndrome vary by institution, surgeon preference, and type of patient. Some advocate polyglactin mesh (MESH), while others favor vacuum-assisted closure (VAC). We performed a single institution prospective randomized trial comparing morbidity and mortality differences between MESH and VAC. ⋯ MESH and VAC are both useful methods for abdominal coverage, and are equally likely to produce delayed primary closure. The fistula rate for VAC is most likely due to continued bowel manipulation with VAC changes with a feeding tube in place-enteral feeds should be administered via nasojejunal tube. Neither method precludes secondary abdominal wall reconstruction.
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Randomized Controlled Trial Comparative Study
Prospective randomized comparative study of antegrade and retrograde locked nailing for middle humeral shaft fracture.
Humeral shaft fractures can be effectively treated by either antegrade or retrograde locked intramedullary nailing, but these two methods have not been adequately compared. The present study compared the effectiveness and potential risks of these two approaches on middle humeral shaft fractures using the same locked nails. ⋯ With proper patient selection, antegrade and retrograde nailing have similar treatment results, including healing rate and eventual functional recovery for middle humeral fractures. It is recommended that retrograde nailing be used in patients with a wide medullary canal or preexisting shoulder problems and antegrade nailing be used in patients with young age or a small medullary canal. In critically ill patients, antegrade nailing is preferred because of shorter operation time.
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Randomized Controlled Trial Multicenter Study
HBOC-201 as an alternative to blood transfusion: efficacy and safety evaluation in a multicenter phase III trial in elective orthopedic surgery.
The ability of hemoglobin based oxygen carrier-201 (HBOC-201) to safely reduce and/or eliminate perioperative transfusion was studied in orthopedic surgery patients. ⋯ HBOC-201 eliminated transfusion in the majority of subjects. The between arms (H vs. R) safety analysis was unfavorable and likely related to patient age, volume overload, and undertreatment and was isolated to patients that could not be managed by HBOC-201 alone. However, patients <80 years old with moderate clinical need may safely avoid transfusion when treated with up to 10 units of HBOC-201.
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Randomized Controlled Trial Comparative Study
Anterior knee pain after intramedullary nailing of fractures of the tibial shaft: an eight-year follow-up of a prospective, randomized study comparing two different nail-insertion techniques.
Anterior knee pain is the most common complication after intramedullary nailing of the tibia. Dissection of the patellar tendon and its sheath during transtendinous nailing is thought to be a contributing cause of chronic anterior knee pain. The purpose of this long-term follow-up of a prospective, randomized study was to assess whether the prevalence and intensity of anterior knee pain after intramedullary nailing of a tibial shaft fracture is different in transtendinous versus paratendinous incision technique. ⋯ Compared with a transpatellar tendon approach, a paratendinous approach for nail insertion does not reduce the prevalence of chronic anterior knee pain or functional impairment after intramedullary nailing of a tibial shaft fracture. In long term, anterior knee pain seems to disappear from many patients.