Articles: trauma.
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Controversy surrounds the administration of blood products to severely traumatized patients before they arrive in the hospital in order to compensate for early blood loss and/or to correct coagulation disturbances that arise shortly after the traumatic event. A number of terrestrial and air rescue services have begun to provide this kind of treatment. ⋯ The studies that have been published to date yield no clear evidence either for or against the early pre-hospital administration of blood products. Any treatment of this kind should be accompanied by scientific evaluation.
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J Neurosurg Anesthesiol · Oct 2023
ReviewCerebral Autoregulation-guided Management of Adult and Pediatric Traumatic Brain Injury.
Cerebral autoregulation (CA) plays a vital role in maintaining cerebral blood flow in response to changes in systemic blood pressure. Impairment of CA following traumatic brain injury (TBI) may exacerbate the injury, potentially impacting patient outcomes. ⋯ We examine the feasibility and safety of CA assessment, its association with clinical outcomes, and the potential for reversing deranged CA following TBI. Finally, we discuss how the knowledge of CA status may affect TBI management and outcomes.
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The risk-benefit balance of antithrombotic therapy administration for blunt cerebrovascular injuries (BCVI) patients with concomitant injuries at high risk for bleeding is an ongoing therapeutic conundrum for trauma clinicians. We performed a systematic review to assess the reported efficacy and safety of treatment in this population with respect to prevention of ischemic stroke and risk of hemorrhagic complications. ⋯ In BCVI patients with concomitant injuries at high risk for bleeding, antithrombotic use reduces the risk of ischemic strokes with a low reported risk of serious hemorrhagic complications.
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Many strides have been made in neurosurgery during times of war, helping to improve the outcomes of patients in dire circumstances. World War I introduced the concepts of early operation for trauma, forward-operating hospitals, and galeal sutures as well as techniques for careful debridement. It laid the groundwork for neurosurgery to become a specialty within medicine as well. ⋯ In the post-Vietnam period, we have seen significant technological advances allowing neurosurgeons to move farther ahead than most throughout history could have imagined. The significance of secondary brain injury, vascular injury, and the underlying pathophysiology of traumatic insults has been elucidated over the years since the Vietnam War, allowing for great advances in the care of our patients. Each major war throughout history has contributed greatly to the specialty of neurosurgery, each with its own innovations culminating in guidelines, strategies, and standards of practice that allow us to deliver the highest standard of care to our patients.
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Review Case Reports
Video-assisted thoracoscopic surgery for Andersson lesion in ankylosing spondylitis: A case report and literature review.
Andersson lesion (AL), a phenomenon initially described by Andersson nearly 80 years ago, has been the subject of extensive research and various treatment modalities. The ongoing debate surrounding the need for anterior surgery in AL cases has spurred numerous proposed approaches. Despite the demonstrated efficacy of anterior surgery in achieving fusion and stabilization, its implementation is associated with prolonged operation time and heightened intraoperative bleeding. ⋯ We utilized video-assisted thoracoscopic surgery technology for anterior bone graft fusion in a patient with AL to minimize the trauma of secondary surgery. However, the 3-year follow-up showed insufficient bony fusion at the fracture site. Nevertheless, the patient maintained spinal stability with posterior internal fixation and no significant kyphosis or symptoms. Thus, standalone posterior fixation may suffice for favorable clinical outcomes in patients with AL.