scholarly journals Effectiveness of No-Zone Approach for Management of Isolated Penetrating Neck Injuries Among Hemodynamically Stable Patients. A Longitudinal Retrospective Study.

2020 ◽  
Author(s):  
Ahmed Gaber Hassanein ◽  
Mohammed Hazem Elmoshneb ◽  
Wael A. Ahmad ◽  
Ahmed Abdel Kahaar Aldardeer ◽  
Osama A. Ismail
Keyword(s):  
Nerve Repair ◽  
Vascular Complications ◽  
Neurological Complications ◽  
Neck Injuries ◽  
Standard Management ◽  
Management Protocol ◽  
Treatment Plans ◽  
Tomographic Angiography ◽  
Traditional Approaches ◽  
No Zone Approach

Abstract Background: Routine neck exploration for isolated penetrating neck injuries (PNIs) in hemodynamically stable patients increases the frequency of nontherapeutic surgeries, and complications. Current management protocol involves the no zone approach which uses physical examination and computerized tomographic angiography to guide treatment plans. This work aimed to study the effectiveness and reliability of no-zone approach for management of isolated PNIs in hemodynamically stable patients. Methods: cases of isolated PNIs in hemodynamically stable patients were managed using no zone approach. Detected injuries were managed accordingly. Results: This study included 106 patients. 34.9% of patients were managed conservatively while surgery was done at 65.09%. Vascular management was done in 40.57%, laryngotracheal repair in 29.2%, tracheostomy in 17%, pharyngeal repair in 7.55%, esophageal repair in 6.6%, and accessory nerve repair in 2.83%. Complications occurred in 16.04% of cases in the form of vascular complications (7.5%), respiratory complications (5.7%), pharyngoesophageal complications (1.9%), infections (12.3%), and neurological complications (7.5%). The survivors were 91.5% while deaths were 8.5%. Conclusion: The no-zone approach offers the ideal management for isolated PNIs in hemodynamically stable patients. It is advantageous over traditional approaches. Further studies are required to augment the evidence for its use as the gold standard management for such cases. Trial registration: the study was retrospectively registered at research registry with Research Registry UIN researchregistry5385 on February 26, 2020. Keywords: no zone approach, isolated penetrating neck injuries, hemodynamically stable patients, vascular injuries, laryngotracheal injury.

scholarly journals Validity of no-zone approach for management of isolated penetrating neck injuries in hemodynamically stable patients

2021 ◽  
Author(s):  
Kamal A. M. Hassanein ◽  
Osama A. Ismail ◽  
Islam A. Amer ◽  
Ahmed Abdel Kahaar Aldardeer ◽  
Tarek Elsayed Ftohy ◽  
...  
Keyword(s):  
Neck Exploration ◽  
Neck Injuries ◽  
Current Management ◽  
Missed Injuries ◽  
Safe Management ◽  
Management Protocol ◽  
Tomographic Angiography ◽  
Complications And Mortality ◽  
No Zone Approach ◽  
Rule Out

Background: Routine neck exploration for isolated penetrating neck injuries (PNIs) in hemodynamically stable patients increases the frequency of unnecessary interventions and complications. Current management protocol involves the no zone approach which uses physical examination and computerized tomographic angiography (CTA) to guide treatment. The aim was to assess the validity of the no-zone approach in the management of isolated PNIs in hemodynamically stable patients.Methods: This retrospective study included patients with isolated PNIs with soft signs who were hemodynamically stable. They were classified into patients with negative CTA findings and were managed conservatively and patients with positive CTA findings suspecting aerodigestive tract injuries (ADTIs) who were submitted to further selective investigations to confirm or rule out these injuries. Detected injuries were managed accordingly.Results: This study included 106 PNIs patients who had soft signs and were hemodynamic stable. 37 cases (34.9%) had negative CTA findings and were managed conservatively. Sixty nine patients (65.1%) had positive CTA findings and were subjected to subsequent selective investigations and revealed 3 patients with negative endoscopic findings who passed without need for any surgical intervention. Therefore, 40 (37.7%) patients were saved from surgery with no missed injuries. Patients with definitive injuries (66 patients) underwent neck exploration and managed accordingly. No missed injuries were recorded in this study. Complications were detected in 6 cases (5.7%) while death was recorded in 2 cases (1.9%).Conclusions: No-zone approach offers a safe management protocol for isolated PNIs in hemodynamically stable patients. It provides no missed injuries, negligible rates of negative exploration and minimal complications and mortality.

scholarly journals Management of Ankle Fractures with Syndesmotic Disruption: A Survey of Orthopaedic Surgeons

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0040
Author(s):  
Ryan G. Rogero ◽  
Emmanuel M. Illical ◽  
Daniel Corr ◽  
Steven M. Raikin ◽  
James Krieg ◽  
...  
Keyword(s):  
Gold Standard ◽  
Ankle Fracture ◽  
Management Strategies ◽  
Ankle Fractures ◽  
Multinomial Regression ◽  
Orthopaedic Surgeons ◽  
Suture Button ◽  
Standard Management ◽  
Management Protocol ◽  
Usage Patterns

Category: Ankle; Trauma Introduction/Purpose: With an increasing frequency of syndesmotic fixation during ankle fracture ORIF and no current gold standard management protocol, it is important for surgeons to understand the frequency and usage patterns of the various techniques among other orthopaedic surgeons. The purposes of this study are to determine how orthopaedic surgeons currently manage ankle fractures with concomitant syndesmotic disruption and to identify surgeon demographics predictive of syndesmotic management. Methods: An 18-question survey, including 10 specific syndesmotic management questions was sent to the Orthopaedic Trauma Association (OTA) and Canadian Orthopaedic Association (COA), as well as sent to email addresses of foot and ankle-fellowship trained surgeons. Surgeon demographic questions included years, country, and type of practice, fellowship(s) completed, setting of ankle fracture surgery, and number of ankle fractures operated on per year. Multinomial regression analysis was performed to determine if surgeon demographics were predictive of syndesmotic management. Results: One-hundred ten orthopaedic surgeons completed our survey. Selected predictors of syndesmotic management included: private practice with academic appointments (0.077 [0.007, 0.834]; p=0.035) being predictive of not using screws through an ORIF plate; foot & ankle fellowship (9.981 [1.787, 55.764]; p=0.009) and trauma fellowship (6.644 [1.302, 33.916]; p=0.023) predictive of utilizing screws through a plate; no fellowship (14.886 [1.226, 180.695]; p=0.034) predictive of only using 1 screw; and surgeons practicing in the U.S. were more likely to not use screws across just 3 cortices (0.031 [0.810, 3.660]; p=0.009). Additionally, among those utilizing suture-button devices, foot & ankle fellowship-trained surgeons were more likely to implement suture-button through plate (7.676 [1.286, 45.806]; p=0.025). Conclusion: Several surgeon factors influence decision making in the management of ankle fractures with syndesmotic disruption. This study raises awareness of differences in management strategies that should be used for further discussion when determining a potential gold standard for management of these complex injuries.

scholarly journals Clinical Pattern and Management of Acute Pancreatitis – Our Experience

2014 ◽  
Vol 31 (3) ◽  
pp. 122-127
Author(s):  
MM Hasan ◽  
SZ Laila ◽  
MH Mamun
Keyword(s):  
Acute Pancreatitis ◽  
Gall Stone ◽  
Multiple Organ ◽  
High Serum ◽  
Military Hospital ◽  
Average Hospital ◽  
Systemic Involvement ◽  
Standard Management ◽  
Management Protocol ◽  
Upper Abdomen

Background: Acute pancreatitis (AP) is an acute inflammatory condition of the pancreas that may extend to local and distant extrapancreatic tissues. It is a life threatening disease that has many causes, few effective treatments, numerous serious complications, and an often unpredictable course. The objectives of this study are to develop our knowledge about presentation and diagnosis of acute pancreatitis, to assess the patient with acute pancreatitis accurately and to develop a standard management protocol. Methods: This observational study was carried out in Combined Military Hospital (CMH) Dhaka, CMH Momenshahi and CMH Ghatail during the period of June 2007 to December 2010. A total 25 patients of Acute Pancreatitis were studied retrospectively, evaluated and managed.Results: In this study 25 patients 19 (76%) were male (male : female = 3.17:1), age range 08 to 55 years, Mean age – 38.92 years. Maximum number of the patients fall into fourth and fifth decades. All patients presented with abdominal pain, specially in upper abdomen. Laboratory test revealed leucocytosis and high serum and urinary amylase, positive findings in Ultrasonogram and CT scan found in all patients. Gall stone was the leading cause 14 (56%). 20 (80%) patient developed some form of complications. 24 patients were treated conservatively. Average hospital stay was 15.52 days. Serious regional and systemic involvement in Acute Pancreatitis causes multiple organ or system failure. Conclusion: Early diagnosis and effective treatment can significantly reduce the morality and morbidity. DOI: http://dx.doi.org/10.3329/jbcps.v31i3.20977 J Bangladesh Coll Phys Surg 2013; 31: 122-127

Outcomes of surgical repair of a single digital nerve in adults

2019 ◽  
Vol 44 (6) ◽  
pp. 560-565 ◽  
Author(s):  
Abhilash Jain ◽  
Rebecca Dunlop ◽  
Tim Hems ◽  
Jin Bo Tang
Keyword(s):  
Surgical Repair ◽  
Nerve Repair ◽  
Hand Dominance ◽  
Digital Nerve ◽  
Current Standard ◽  
Recent Systematic Review ◽  
Standard Management ◽  
Nerve Recovery ◽  
Sensory Recovery ◽  
Improved Function

Current standard management of a cut digital nerve is end-to-end microsurgical nerve coaptation where possible. A recent systematic review of adult digital nerve injuries that were either repaired or left unrepaired showed that the evidence for good nerve recovery or improved function following nerve repair is poor. In the 30 studies included, only 24% of repaired nerves regained sensory recovery close to or equivalent to estimated pre-injury levels. Neuroma rates were the same in those nerves repaired (4.6%) and those not repaired (5%). Questions under debate include proper assessment methods of outcomes, decision making for repair or no repair to different fingers or the thumb, levels of injury, age, and hand dominance. This review summarizes the major evidence available and debates the surgical dogma that surrounds this injury.

Utility of Screening for Blunt Vascular Neck Injuries with Computed Tomographic Angiography

2006 ◽  
Vol 60 (1) ◽  
pp. 209-216 ◽  
Author(s):  
Nathan P Schneidereit ◽  
Richard Simons ◽  
Savvas Nicolaou ◽  
Douglas Graeb ◽  
D Ross Brown ◽  
...  
Keyword(s):  
Computed Tomographic Angiography ◽  
Neck Injuries ◽  
Computed Tomographic ◽  
Tomographic Angiography

scholarly journals Management of infective endocarditis in patients with post-stroke brain damages

2019 ◽  
pp. 84-96
Author(s):  
V. V. Fedko ◽  
S. P. Spysarenko ◽  
T. O. Malysheva ◽  
D. V. Pochynock
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Ischemic Stroke ◽  
Cardiopulmonary Bypass ◽  
Infective Endocarditis ◽  
Hospital Mortality ◽  
Neurological Impairment ◽  
Neurological Complications ◽  
Cerebrovascular Complications ◽  
Management Protocol

This study evaluated the effectiveness of anesthesiological management in sur-gical treatment of infective endocarditis with cerebrovascular complications. The aim of the study was to decrease neurological complications and hospital mortality after surgical inter-ventions with the use of cardiopulmonary bypass in patients with infective endocarditis. The main preoperative risk factors of endocardit-associated cerebrovascular complications, which influenced the immediate results of cardiac surgery were: sepsis, systemic inflammatory response, disorders of systemic hemodynamics, high risk of recurrent cerebrovascular events, anemia and carbohydrate disorders. New anesthesiological management protocol was de-veloped and improved. Intraoperative risk factors for hospital mortality were associated with: total protein at the end of surgery less than 49 g/l; maximum blood glucose during surgery more than 10.7 mmol/l; anemia and hemodilution – hemoglobin level less than 58.8 g/l in the period of complete bypass and less than 79.4 g/l at the end of the surgery; positive water balance at the end of the operation. Determination of preoperative blood S100? protein level may be recommended to determine the prognosis of postoperative neurological complications, since the level above 0.13 µg/l was associated with postoperative neurological impairment. The implemented changes in the anesthetic management permitted to decrease neuro-logical complication rate from 22.2% to 9.6% and thirty-day mortality from 19.0% to 2.7% after surgical treatment of infective endocarditis with the use of cardiopulmonary bypass in patients with cerebrovascular complications. In order to achieve maximum effectiveness of anesthesiological management and to re-duce the level of postoperative neurological complications the optimal timing for surgery was 2–3 days after development of cerebrovascular impairment. In case of ischemic stroke in the most acute phase of the course (the first 72 hours), emergency cardiac surgery was advisable (except the cases of brain coma or total volume of myocardial infarction exceeding 31.5 cm3). In the case of ischemic stroke, more than 72 hours after the onset, and in the absence of progression of acute heart failure, the recommended timing for cardiac surgery was 4 weeks after the manifestation of cerebrovascular impairment. In the case of hemorrhagic or mixed type of neurological impairment, cardiac surgery was postponed for 1.4–2 months (since the development of the stroke).

scholarly journals Outcomes of Snakebite Envenomation in Children

1970 ◽  
Vol 31 (3) ◽  
pp. 192-197 ◽  
Author(s):  
BM Shrestha
Keyword(s):  
Risk Factors ◽  
Case Fatality ◽  
Medical Emergency ◽  
Close Monitoring ◽  
Night Time ◽  
Systemic Complications ◽  
Standard Management ◽  
Management Protocol ◽  
Management Of Complications ◽  
Public Health Hazards

Introduction: Snakebite is a medical emergency, and is considered to be one of the major public health hazards in the Terai and inner-Terai regions of Nepal. Very few studies have been conducted so far in Nepal to highlight the epidemiology of snakebite in children. Aim: To review the pattern and characteristics of snakebites in children, focusing primarily on the outcomes, fatality and risk factors for death. Settings: An emergency department of a 136-bedded secondary care-referral hospital (Lumbini Zonal Hospital) situated at Butwal in the Western Nepal. Methodology: The study was carried out in 152 children aged < 15 years old, who got anti-snake venom (ASV) over a period of 48 months. Diagnosis of snakebite envenomation was based on clinical ground. Results: Children over 5 years of age constituted the highest number (87%) of cases. Peak incidence of poisoning (71%) was observed during the months of Asadh- Bhadra (June-September). Most of the bites (61%) were by unidentified snakes, most commonly (91%) on the extremities. Snakebite envenomation occurred more frequently (52%) during night time. 85% of children had local or systemic complications, commonest being respiratory paralysis(92/152).Case fatality rate (CFR) was 28%. Risk factors for death were: age < 5 years; bites by unidentified snakes and kraits and bites on ears & unknown sites. Conclusion: Compared with adults, children with snake envenomation have higher morbidity and mortality, which can be minimized by early diagnosis, appropriate treatment and close monitoring of children on ventilation for the timely management of complications. Emphasis should be given on developing a standard management protocol in children. Keywords: Snakebite; Envenomation; Children; Outcomes; Nepal DOI: http://dx.doi.org/10.3126/jnps.v31i3.5358 J Nep Paedtr Soc 2011;31(3):192-197  

scholarly journals Stenosis Caused by Suture-Mediated Vascular Closure Device in an Angiographic Normal Common Femoral Artery: Its Mechanism and Management

2018 ◽  
Vol 53 (1) ◽  
pp. 58-61
Author(s):  
Young Jin Youn ◽  
Salman Khalid ◽  
Michael Azrin ◽  
Juyong Lee
Keyword(s):  
Femoral Artery ◽  
Vascular Complications ◽  
Bed Rest ◽  
Common Femoral Artery ◽  
Artery Stenosis ◽  
Closure Device ◽  
Standard Management ◽  
Percutaneous Coronary ◽  
Coronary Procedure ◽  
Femoral Puncture

Vascular closing devices (VCDs) are widely used to replace manual compression at the femoral puncture site and to reduce the discomfort of patients undergoing percutaneous coronary procedure by shortening bed rest. Among the vascular complications related to these devices, the femoral artery stenosis or occlusion is rarely reported, and its standard management is not well established. We report a case of symptomatic femoral artery stenosis caused by suture-mediated VCD and managed using rotational atherectomy device and balloon angioplasty. In addition, we propose the possible mechanisms for this complication.

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