Sodium Alginate as Treatment for Penetrating Abdominal Trauma- Feasibility Study.

Abstract Introduction: Penetrating abdominal injury is a major cause of death in trauma. It may cause hypovolemia leading to tissue hypoperfusion, direct organ damage and cytokine activation that cause inflammatory damage, all of which lead to death. Alginate is a natural anionic polysaccharide typically derived from brown algae. Sodium alginate hydrogel, a hemostatic agent, offers a platform for targeting both mechanical and biological injuries. The current study assessed the effect of a sodium alginate denoted VLVG (Very Low Viscosity (high) G alginate) following abdominal trauma in a swine model of penetrating abdominal injury. Methods: Seven anesthetized pigs were instrumented with catheters and abdominal trauma was introduced by laparoscopic hepatectomy. Ten minutes after the induction of hypovolemic shock, three animals were intra-abdominally administered with VLVG and four animals with saline (controls). During 8h of continuous monitoring, various hemodynamic and biochemical variables were measured and liver biopsies for histological evaluation were taken. In order to compare the study group to the control in a specific time a-parametric Mann-Whitney test was used, assessment of tendency during time Friedman's test for a-parametric variables was used. In order to compare the effect of the treatment (i.e. normal saline VS VLVG alginate) repeated measures ANOVA model was used, and the p value was calculated based on the Greenhouse-Geiser test. This research was approved by the Hebrew University of Jerusalem ethics Committee number: MD16148533. Results: VLVG-treated animals were more hemodynamically stable vs controls as reflected by their lower heart rate and higher blood pressure. They also had lower levels of liver enzymes and lactate and tissue damage. Conclusions: Our results in this pilot abdominal injury model show that VLVG might be a promising new agent. The superior hemostatic and biocompatibility efficiency along with its tissue preserving properties may turn VLVG in the future to a device that could be used in the pre-hospital setting to improve survival of abdominal trauma injuries.

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A Review of Posttraumatic Bowel Injuries in Ibadan

ISRN Surgery ◽

10.5402/2011/478042 ◽

2011 ◽

Vol 2011 ◽

pp. 1-4 ◽

Cited By ~ 4

Author(s):

A. E. Dongo ◽

E. B. Kesieme ◽

D. O. Irabor ◽

J. K. Ladipo

Keyword(s):

Abdominal Trauma ◽

Developed Countries ◽

Bowel Injury ◽

Abdominal Injury ◽

Surgical Operation ◽

Diagnostic Challenge ◽

Simple Closure ◽

Blunt Abdominal Injury ◽

Penetrating Abdominal Injury ◽

Ibadan Nigeria

Background. Bowel injuries are a leading cause of morbidity and mortality following trauma. Evaluating patients who sustained abdominal trauma with bowel injury may pose a significant diagnostic challenge to the surgeon. Prompt recognition and timely intervention is necessary to improve outcome. Aim. This study was undertaken to evaluate treatment and outcome of patients with bowel trauma. Methods. A 5-year retrospective study of all patients presenting with abdominal trauma requiring surgical intervention seen in the UCH Ibadan, Nigeria was undertaken. Results. There were 71 patients (59 males and 12 females). The majority of cases (70%) occurred between the 3rd and 5th decades of life. Some 37 patients (52%) sustained blunt abdominal injury, while 34 patients (48%) sustained penetrating abdominal injury. There were 27 patients with bowel injuries (38%). Isolated bowel injuries occurred in 19 patients (27%). The most common surgical operation performed was simple closure. There were 3 deaths in patients with bowel injuries. Conclusion. Most cases of bowel injury can be managed by simple closure, a technique that is not so technically demanding for surgeons in less-developed countries. This study has also incidentally identified a “rule of six” for patients with bowel injuries and abdominal trauma.

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Development and application of a swine model for training ultrasonography-guided central venous access

Revista do Colégio Brasileiro de Cirurgiões ◽

10.1590/0100-6991e-20202530 ◽

2020 ◽

Vol 47 ◽

Author(s):

JACKSON VINÍCIUS DE LIMA BERTUOL ◽

NATASHA LURE BUENO CAMARGO ◽

FERNANDO ANTONIO CAMPELO SPENCER NETTO ◽

ANDRÉ PEREIRA WESTPHALEN

Keyword(s):

Porcine Model ◽

Low Cost ◽

Central Venous Access ◽

Training Session ◽

Hospital Setting ◽

Venous Access ◽

Human Anatomy ◽

Swine Model ◽

Central Venous ◽

Hands On

ABSTRACT Introduction: simulation based teaching is a powerful tool in medical education, allowing hands on practice under a controlled environment and with repeated maneuvers. Central venous access venipuncture is one of the most frequent procedures carried out in the hospital setting, due to its various clinical indications and, when performed with the help of ultrasonography, the risk of adverse events is minimized. Aim: to develop, to describe and to test a porcine model that simulates the central venous access puncture aided by ultrasonography. Method: a low cost porcine model was developed to train medical students and residents on central venous access guided by ultrasonography. Both students and medical residents underwent a theoretical training regarding the model, followed by a hands-on training session. Afterwards, the participants assessed the model by answering a questionnaire. Results: there were 51 participants. The average score regarding the similarity between the model and the human anatomy was 9.15. When the characteristics were separately assessed, the mean scores regarding the similarity of the vessels, anatomic disposition and ultrasonographic characteristics as well as the venipuncture were, respectively, 9.27; 9.31; 9.54 and 8.86. Conclusion: The model was approved and considered appropriate for the training of central venous venipuncture by all the participants. Furthermore, it is a low cost, simple and reproducible model, that presents high similarity with the human anatomy. Therefore, it may be used as an aid to train people on ultrasonography guided central venous access.

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Role of multidetector computed tomography in evaluation of abdominal trauma in Sothern Rajasthan, India

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20192526 ◽

2019 ◽

Vol 7 (6) ◽

pp. 2350

Author(s):

Puran . ◽

Narendra Kumar Kardam

Keyword(s):

Computed Tomography ◽

Multidetector Computed Tomography ◽

Abdominal Trauma ◽

Imaging Modality ◽

Abdominal Injury ◽

Male Predominance ◽

Ct Findings ◽

Highly Sensitive

Background: Abdominal injury constitutes a significant portion of all blunt and penetrating body injuries. Computed tomography is an important and fast technique which gives rapid information on the type of abdominal injury and helps in management of the patient accordingly. The aim of the present study was to evaluate the usefulness of Multidetector Computed Tomography (MDCT) in detection of intra-abdominal injury in patients with blunt abdominal trauma and to provide information that could accurately determine choice of management (non- operative versus operative). And to correlate the computed tomography (CT) findings with either clinical observation, follow up CT scan (if required) or surgical findings (wherever applicable).Methods: A total of 50 patients with abdominal trauma who underwent computed tomography (CT) examination were included. CT findings were compared with surgical findings in operated cases, and in the rest CT findings were compared by clinical outcome.Results: Among the 50 cases studied, all 50 had positive CT findings of abdominal trauma, out of which 24 patients underwent surgery and the remaining were managed conservatively. The age group of the patients was ranging from 8 to 66 years with male predominance. In this study the commonest organs affected were liver and spleen accounting for 48% and 44% respectively.Conclusions: Computed tomography is an important and highly sensitive imaging modality for diagnosis of organ injuries in patients with abdominal trauma and accordingly deciding the management of patient.

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Penetrating abdominal injury: UK military experience from the Afghanistan conflict

Journal of The Royal Naval Medical Service ◽

10.1136/jrnms-102-90 ◽

2016 ◽

Vol 102 (2) ◽

pp. 90-94 ◽

Cited By ~ 1

Author(s):

MJ Leong ◽

I Edgar ◽

M Terry

Keyword(s):

Injury Severity ◽

Abdominal Injury ◽

Anatomical Distribution ◽

New Injury Severity Score ◽

Medical Treatment Facility ◽

Improved Outcomes ◽

Penetrating Abdominal Injury ◽

The Uk ◽

Hepatic Injuries ◽

Military Patients

AbstractAimsTo identify the prevalence, injury patterns and mortality of penetrating abdominal injury in patients treated at the UK Role 3 Medical Treatment Facility (MTF) in Camp Bastion, Afghanistan.MethodsAll patients with a penetrating abdominal injury were identified from the UK Joint Theatre Trauma Registry (JTTR). Demographics, predicted survival and observed mortality were compared. Sub-group analyses of UK military patients were conducted, comparing changes in survival as the campaign progressed and identifying the anatomical distribution of abdominal injuries.ResultsBetween June 2006 and June 2013, 1331 of the 8558 (16%) patients recorded on the JTTR had a penetrating abdominal injury; 393 were UK military, of whom 175 (45%) survived. 71% of UK military fatalities had the maximum New Injury Severity Score (NISS) of 75 compared to 4.6% of UK military survivors. The survival rate of UK military patients increased in the later stages of the campaign. Fatal injury in UK military patients was associated with significant vascular or hepatic injuries.ConclusionsThis study has defined the epidemiology of penetrating abdominal injury in a modern conflict. Continued training and further research into injury prevention and management will help to ensure that the improved outcomes observed in Afghanistan continue on future operations.

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Penetrating Abdominal Injury (Case 36)

Surgery: A Competency-Based Companion ◽

10.1016/b978-1-4160-3747-7.50066-6 ◽

2009 ◽

pp. 417-423

Author(s):

Mark J. Seamon ◽

Brian P. Smith

Keyword(s):

Abdominal Injury ◽

Penetrating Abdominal Injury

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Pediatric Thoraco-Abdominal Trauma

Pediatric Emergencies ◽

10.1093/med/9780190073879.003.0036 ◽

2020 ◽

pp. 405-409

Author(s):

Christopher S. Amato

Keyword(s):

Abdominal Trauma ◽

Thoracic Trauma ◽

Pediatric Trauma ◽

Medical Personnel ◽

Abdominal Injury ◽

Morbidity And Mortality ◽

High Morbidity ◽

Common Cause ◽

Thoracic And Abdominal ◽

Trauma Deaths

In children, injury is the most common cause of death. Thoracic and abdominal trauma are both associated with high morbidity and mortality, and they warrant a thorough evaluation. Abdominal trauma occurs in 25% of children with major trauma and is responsible for 9% of all trauma deaths. Because it can delay care, lack of recognition of intra-abdominal injury increases morbidity and mortality. Thoracic trauma comprises only 4–6% of pediatric trauma but is related to 14% of pediatric trauma-related deaths and is the second most common cause of mortality in pediatric trauma. This chapter discusses the keys to the evaluation of the pediatric trauma patient with thoraco-abdominal injury, including the evidence-based approach and algorithms to be utilized by medical personnel.

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1335. A Translational Nephrotoxicity Model to Probe Acute Kidney Injury with Vancomycin and Piperacillin–Tazobactam

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1199 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S483-S483

Author(s):

Gwendolyn M Pais ◽

Jiajun Liu ◽

Sean N Avedissian ◽

Danielle Hiner ◽

Theodoros Xanthos ◽

...

Keyword(s):

Acute Kidney Injury ◽

Repeated Measures ◽

Hospital Setting ◽

Kidney Injury ◽

Urinary Biomarkers ◽

Urinary Output ◽

Plasma Creatinine ◽

Sprague Dawley ◽

Research Support ◽

Drug Dosing

Abstract Background Vancomycin and piperacillin–tazobactam (VAN+TZP) are two of the most commonly utilized antibiotics in the hospital setting and are reported in clinical studies to increase acute kidney injury (AKI). However, no clinical study has demonstrated that synergistic AKI occurs, only that serum creatinine increases with VAN+TZP. Previous preclinical work demonstrated that novel urinary biomarkers and histopathologic scores were not increased in the VAN+TZP group compared with VAN alone. The purpose of this study was to assess changes in urinary output and plasma creatinine between VAN, TZP, and VAN+TZP treatments. Methods Male Sprague–Dawley rats (n = 32) received either saline, VAN 150 mg/kg/day intravenously, TZP 1,400 mg/kg/day intraperitoneally, or VAN+TZP for 3 days. Animals were placed in metabolic cages pre-study and on drug dosing days 1–3. Urinary output, plasma creatinine, urinary biomarkers were compared daily and kidney histopathology was compared at the end of therapy between the groups. Mixed-effects, repeated-measures models were employed to assess differences between the groups. Results In the VAN-treated rats, urinary output was increased on days 1, 2 and 3 compared with baseline and saline (P < 0.01 for all), whereas it increased later for VAN+TZP (i.e., day 2 and 3 compared with saline, P < 0.001). No changes in urinary output were observed with saline and TZP alone. Plasma creatinine rose for VAN on days 1, 2, and 3 from baseline and VAN+TZP on day 3 (P < 0.02 for all), but no treatment group was different from saline. In the VAN-treated rats, urinary KIM-1 and clusterin were increased on days 1, 2, and 3 compared with controls (P < 0.001). Elevations were seen only after 3 days of treatment with VAN+TZP (P < 0.001 KIM-1, P < 0.05 clusterin). No changes in urinary biomarkers output were observed with saline and TZP alone. Histopathology was only elevated in the VAN group compared with saline (P < 0.002). No histopathology changes were noted with VAN+TZP. Conclusion All groups with VAN demonstrated kidney injury; however, VAN+TZP did not cause more kidney injury than VAN alone in a rat model of VIKI when using plasma creatinine, urinary output, or urinary biomarkers as outcomes. Histopathology data suggest that adding TZP did not worsen VAN-induced AKI and may even be protective. Disclosures Kevin J. Downes, MD, Merck: Grant/Research Support, Research Grant; Pfizer: Grant/Research Support.

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