Articles: trauma.
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Chylothorax is a rare form of pleural effusion that can be associated with both traumatic and non-traumatic causes. Thoracic duct ligation is often the treatment of choice in postsurgical patients; however the optimal treatment of this disease process after traumatic injury remains unclear 1. We present a rare case of a thoracic duct injury secondary to a blunt thoracic spine fracture and subluxation which was successfully treated non-operatively. ⋯ This unusual and complex blunt thoracic duct injury required a multidisciplinary approach. Although the spine injury required surgical fixation, successful resolution of the chyle leak was achieved without surgical intervention.
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Ther Hypothermia Temp Manag · Jan 2011
A review of clinical trials of hypothermia treatment for severe traumatic brain injury.
Clinical trials of hypothermia treatment of traumatic brain injury can be divided into (1) trials designed to abort the biochemical cascade after injury-neuroprotection, (2) trials primarily designed to test the effect of hypothermia in reducing elevated intracranial pressure (ICP), and (3) trials with features of both neuroprotection and elevated ICP control. Three of the four clinical trials testing hypothermia induction after failure of conventional means of ICP control showed decreased mortality rate, though sample sizes were small and findings were not always statistically significant. Nine randomized trials have tested hypothermia as a neuroprotectant, inducing it from 2.5 to 15 hours after injury and continuing it for a predetermined period of time regardless of ICP. ⋯ All found improved outcome and reduced ICP. Based on these findings and the negative results of neuroprotection trials that extended hypothermia for a defined period of time, it is likely that the mechanism of protection in these combined mechanism trials was early control of ICP. This literature suggests the need for clinical trials with two distinct objectives-(1) testing hypothermia for ICP control when conventional means (sedation and paralysis, mannitol, hyperventilation, and cerebrospinal fluid drainage) fail and (2) testing early induction of hypothermia before hematoma evacuation individualizing the duration of hypothermia to the patient's ICP responses.
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A 15- year-old boy was referred to Imam Reza Hospital with a right chest tube and chylothorax for 40 days. The patient had respiratory distress and undergone refractory treatment for chylothorax. The fluid content was chyle-rich in lipids. ⋯ One year follow up of the patient showed excellent result. In our knowledge, thoracic duct cyst occurring as a result of a delayed chylothorax and chyloperitoneum has not been reported in the literature. Surgical thoracic duct ligation can be the treatment of choice.
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J Emerg Trauma Shock · Jan 2011
Isolated traumatic head injury in children: Analysis of 276 observations.
To determine predictive factors of mortality among children after isolated traumatic brain injury. ⋯ In Tunisia, head injury is a frequent cause of hospital admission and is most often due to road traffic injuries. Short-term prognosis is influenced by demographic, clinical, radiological, and biochemical factors. The need to put preventive measures in place is underscored.
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In the care of patients with traumatic injuries, focus is placed on hypothermia secondary to its deleterious impact on the coagulation cascade. However, there is scant information on the mortality effect of hyperthermia. ⋯ Care of the victim with traumatic injuries emphasizes avoidance of hypothermia; however, hyperthermia is also detrimental. The presence of hypothermia or hyperthermia should be considered in the initial treatment of the patient with traumatic injuries.