scholarly journals Hirursko lecenje povreda jetre - petogodisnje iskustvo

2010 ◽  
Vol 57 (4) ◽  
pp. 9-14
Author(s):  
Djordje Bajec ◽  
Dejan Radenkovic ◽  
Pavle Gregoric ◽  
Vasilije Jeremic ◽  
Vladimir Djukic ◽  
...  
Keyword(s):  
Penetrating Trauma ◽  
Gunshot Wounds ◽  
Mortality Rates ◽  
Liver Trauma ◽  
Organ Injury ◽  
Specific Complication ◽  
Liver Injuries ◽  
Severity Of Injury ◽  
Significant Difference ◽  
Methods Of Treatment

Due to improved methods of treatment and management of hemorrhage, the mortality from liver injuries has decreased significantly over the past few decades. In spite of that, liver injuries still represent diagnostic and therapeutic challenge. This retrospective study included 197 patients surgically treated because of trauma of the liver at The Clinic for Emergency Surgery, during the period 2004-2009. The results showed significant difference in mortality rates in cases of penetrating wounds compared to blunt trauma and gunshot wounds. The severity of injury evaluated by Organ Injury Scale was significantly higher in gunshot wounds compared to blunt and penetrating trauma. The correlation of severity of injuries and mortality rates showed that the mortality is significantly lower in patients with grade 1, 2, and 3 injuries compared to grades 4 and 5 (p=0.016). Specific complication rate was 28.4%, while mortality rate was 21.8%. The results reflect diagnostic and treatment problems, as well as the importance of multidisciplinary approach to the patients with liver trauma.

Injuries to the Spleen and Diaphragm

2020 ◽  
Author(s):  
Andrea M. Long ◽  
Preston R Miller ◽  
J. Jason Hoth
Keyword(s):  
Motor Vehicle ◽  
Gunshot Wounds ◽  
Organ Injury ◽  
Trauma Patients ◽  
Left Hemithorax ◽  
Stab Wounds ◽  
Computed Tomographic ◽  
Abdominal Organs ◽  
Left Diaphragm ◽  
Liver Injuries

The spleen is one of the most commonly injured abdominal organs in blunt trauma patients. The mechanisms of injury are similar to those seen with liver injuries: motor vehicle collisions, automobile-pedestrian collisions, falls, and any type of penetrating injury. Stab wounds to the abdomen are less likely to cause spleen injury compared with liver injury due to the spleen’s protected location. Stab wounds to the spleen typically result in direct linear tears, whereas gunshot wounds result in significant cavitary injuries. This review covers injuries to the spleen and injuries to the diaphragm. Figures show findings on imaging that may be associated with failure of nonoperative management for splenic injuries, intraparenchymal splenic blush noted on an initial computed tomographic scan, the first step in mobilizing the spleen by making an incision in the peritoneum and the endoabdominal fascia, beginning at the inferior pole and continuing posteriorly and superiorly, splenorrhaphy performed using interrupted mattress sutures through pledgets along the raw edge of the spleen, left diaphragm ruptures evident with the gastric bubble located in the left hemithorax, whereas right-sided ruptures present with the appearance of an elevated hemidiaphragm, and the use of Allis clamps to approximate the diaphragmatic edges, with the defect closed with a running No. 1 polypropylene suture. The table lists American Association for the Surgery of Trauma organ injury scales for diaphragm and spleen. This review contains 6 figures, 1 table, and 55 references Keywords: spleen, injury grading, angioembolization, splenorrhaphy, splenic salvage

Solid Organ Injury Grading in Trauma: Accuracy of Grading by Surgical Residents

2012 ◽  
Vol 78 (8) ◽  
pp. 834-836 ◽  
Author(s):  
William F. Powers ◽  
L. Neal Beard ◽  
Ashley Adams ◽  
Cyrus A. Kotwall ◽  
Thomas V. Clancy ◽  
...  
Keyword(s):  
Interobserver Agreement ◽  
Organ Injury ◽  
Solid Organ ◽  
Test Analysis ◽  
Surgical Residents ◽  
Liver Injuries ◽  
Significant Difference ◽  
Computed Tomography Scans ◽  
Injury Grade ◽  
The Impact

The American Association for the Surgery of Trauma developed an Organ Injury Scale for management of patients with splenic, kidney, or liver injuries. Despite widespread use of the guidelines, the person who determines the injury grade varies among institutions. Our purpose was to determine the accuracy and interobserver agreement between surgical residents and a radiologist in grading solid organ injuries. We retrospectively reviewed patients with solid organ injuries from January 2009 to May 2010 and compared the grade of solid organ injuries by a single resident with grades by a single blinded radiologist using a paired t test, analysis of variance, or Kruskal-Wallis. Computed tomography scans of 58 patients with splenic injuries, 43 with liver injuries, and 16 with kidney injuries were reviewed. Average grades for splenic injuries were 2.5 and 2.4 (radiologist/resident); liver injuries, 2.6 and 2.1; and kidney injuries, 2.7 and 2.8. There were no significant differences in grading by the radiologist and resident for splenic and kidney injuries; however, equal values were only achieved in 43 and 38 per cent, respectively. There was a significant difference (average rating difference 0.54, P = 0.0002) in grading between the radiologist and resident for liver injuries with only 35 per cent having equal values and the radiologist grading on average 0.5 points higher than the resident. No demographic, injury, or outcome variables were significantly associated with interobserver variability ( P > 0.05). Despite a significant difference for liver injury grading, interobserver agreement between residents and a single radiologist was low. Clinical implications and the impact on outcomes related to interobserver variations require further study.

scholarly journals Classification of Liver Trauma

HPB Surgery ◽  
1996 ◽  
Vol 9 (4) ◽  
pp. 235-238 ◽  
Author(s):  
Sandro B. Rizoli ◽  
Frederick D. Brenneman ◽  
Sherif S. Hanna ◽  
Kamyar Kahnamoui
Keyword(s):  
Classification Scheme ◽  
American Association ◽  
Liver Trauma ◽  
Trauma Centre ◽  
Organ Injury ◽  
Trauma Patients ◽  
Liver Injuries ◽  
The Mean ◽  
Related Mortality

The classification of liver injuries is important for clinical practice, clinical research and quality assurance activities. The Organ Injury Scaling (OIS) Committee of the American Association for the Surgery of Trauma proposed the OIS for liver trauma in 1989. The purpose ofthe present study was to apply this scale to a cohort ofliver trauma patients managed at a single Canadian trauma centre from January 1987 to June 1992.170 study patients were identified and reviewed. The mean age was 30, with 69% male and a mean ISS of 33.90% had a blunt mechanism ofinjury. The 170 patients were categorized into the 60IS grades ofliver injury. The number of units of blood transfused, the magnitude of the operative treatment required, the liver-related complications and the liver-related mortality correlated well with the OIS grade. The OIS grade was unable to predict the need for laparotomy or the length of stay in hospital. We conclude that the OIS is a useful, practical and important tool for the categorization of liver injuries, and it may prove to be the universally accepted classification scheme in liver trauma.

Open Balloon Tamponade and Hepatic Angiography for Hemorrhage Control of Transhepatic Gunshot Wounds in a Hybrid Trauma Operating Room Environment

2021 ◽  
Vol 4 (2) ◽  
Author(s):  
Melike N Harfouche ◽  
Jonathan Morrison ◽  
Rishi Kundi ◽  
Joseph J DuBose ◽  
Thomas M Scalea
Keyword(s):  
Operating Room ◽  
Gunshot Wounds ◽  
Mortality Rates ◽  
Liver Trauma ◽  
Penetrating Injuries ◽  
Hybrid Operating Room ◽  
Hemorrhage Control ◽  
Balloon Tamponade ◽  
Hepatic Angiography ◽  
Hybrid Management

The management of high-grade liver trauma is challenging and mortality rates are high. Balloon tamponade is a valuable tool for control of transhepatic penetrating injuries. We report three cases of hybrid management of penetrating liver trauma with balloon tamponade and hepatic angiography in a hybrid operating room environment. The combination of balloon tamponade with hepatic angioembolization provides an enhanced approach for the management of these injuries. 

Diagnostic performance of CT and the use of GI contrast material for detection of hollow viscus injury after penetrating abdominal trauma. Experience from a level 1 Nordic trauma center

2020 ◽  
Vol 61 (10) ◽  
pp. 1309-1315
Author(s):  
Sigurveig Thorisdottir ◽  
Gudrun L Oladottir ◽  
Mari T Nummela ◽  
Seppo K Koskinen
Keyword(s):  
Abdominal Trauma ◽  
Contrast Material ◽  
Penetrating Trauma ◽  
Gunshot Wounds ◽  
Hollow Viscus ◽  
Penetrating Abdominal Trauma ◽  
Stab Wounds ◽  
Significant Difference ◽  
Hollow Viscus Injury ◽  
Local Trauma

Background Use of gastrointestinal (GI) contrast material for computed tomography (CT) diagnosis of hollow viscus injury (HVI) after penetrating abdominal trauma is still controversial. Purpose To assess the sensitivity of CT and GI contrast material use in detecting HVI after penetrating abdominal trauma. Material and Methods Retrospective analysis (2013–2016) of patients with penetrating abdominal trauma. Data from the local trauma registry, medical records, and imaging from PACS were reviewed. CT and surgical findings were compared. Results Of 636 patients with penetrating trauma, 177 (163 men, 14 women) had abdominal trauma (mean age 34 years, age range 16–88 years): 155/177 (85%) were imaged with CT on arrival; 128/155 (83%) were stab wounds and 21/155 (14%) were gunshot wounds; 47/155 (30%) had emergent surgery after CT. Two patients were imaged using oral, rectal and i.v. contrast; 23 with rectal and i.v. contrast; and 22 with i.v. contrast only. Surgery revealed HVI in 26 patients. CT had an overall sensitivity 69.2%, specificity 90.5%, PPV 90.0%, and NPV 70.4%. CT with oral and/or rectal contrast (n = 25) had sensitivity 66.7%, specificity 71.4%, PPV 85.7%, and NPV 45.5%. CT with i.v. contrast only (n = 22) had 75% sensitivity, 100% specificity, PPV 100%, and NPV 87.5%. No statistically significant difference was found between sensitivity of CT with GI contrast material and i.v. contrast only ( P = 1). Conclusion Stab wounds were the most common cause of penetrating abdominal trauma. CT had 69.2% sensitivity and 90.5% specificity in detecting HVI. CT with GI contrast had similar sensitivity as CT with i.v. contrast only.

Analysis of Mortality in Traumatically Injured Patients Based on Body Mass Index and Mechanism Reveals Highest Mortality among the Underweight in Comparison with the Ideal Weight Patients

2017 ◽  
Vol 83 (4) ◽  
pp. 341-347
Author(s):  
Kevin Treto ◽  
Karen Safcsak ◽  
David Chesire ◽  
Indermeet S. Bhullar
Keyword(s):  
Body Mass Index ◽  
Blunt Trauma ◽  
Body Mass ◽  
Injury Severity ◽  
Traumatic Injury ◽  
Penetrating Trauma ◽  
Gunshot Wounds ◽  
Protective Role ◽  
Ideal Weight ◽  
Significant Difference

The purpose of this study was to evaluate the effect of body mass index (BMI) on mortality after traumatic injury. The records of patients from 2012 to 2015 were retrospectively reviewed. The patients were stratified into the following groups based on admission BMI (kg/m2): underweight (UW) (BMI <19), ideal weight (IW) (BMI = 19–24.9), overweight (OW) (BMI = 25–29.9), obese (OB) (BMI = 30–39.9), and morbid obese (MO) (BMI >40). The groups were well matched with no significant differences in demographics and Injury Severity Score. Morality for the IW group was compared with the remaining BMI groups. A total of 6049 patients were identified. In comparison with IW group, the UW mortality was significantly higher (IW vs UW, 4.1% vs 8.8%, P = 0.001); however, the there was no significant difference with remaining groups. There was also no significant difference in mortality between IW and the remaining groups for patients that went directly to the operating room or for patients that had penetrating trauma (stab wounds and gunshot wounds). However, for blunt trauma, the mortality was significantly higher for UW (IW vs UW, 4.3% vs 9.4%, P = 0.001), no different for IW vs OW (4.3% vs 3.7%, P = 0.3), and significantly lower for IW vs OB (4.3% vs 2.8%, P = 0.04) and for IW vs MO (4.3% vs 1.0%, P = 0.03). After traumatic injuries, it is the underweight patients (BMI <19) and not the obese, that are at a significantly higher risk for overall mortality; this difference is especially evident after blunt trauma where obesity may actually confer a protective role.

Surgical Management of Complex Liver Trauma: A Single Liver Transplant Center Experience

2012 ◽  
Vol 78 (1) ◽  
pp. 20-25 ◽  
Author(s):  
Sergio Li Petri ◽  
Salvatore Gruttadauria ◽  
Duilio Pagano ◽  
Gabriel J. Echeverri ◽  
Fabrizio Di Francesco ◽  
...  
Keyword(s):  
Liver Resection ◽  
Liver Injury ◽  
Damage Control ◽  
Length Of Hospital Stay ◽  
Operative Management ◽  
Liver Trauma ◽  
Organ Injury ◽  
Transplant Center ◽  
Liver Injuries ◽  
Mechanism Of Trauma

Complex liver trauma often presents major diagnostic and management problems. Current operative management is mainly centered on packing, damage control, and early utilization of interventional radiology for angiography and embolization. In this retrospective observational study of patients admitted to the Mediterranean Institute for Transplantation and Advanced Specialized Therapies, Palermo, Italy, from 1999 to 2010, we included patients that underwent hepatic resection for complex liver injuries (grade I to Vaccording to the American Association for the Surgery of Trauma-Organ Injury Scale). Age, gender, mechanism of trauma, type of resection, surgical complications, length of hospital stay, and mortality were the variables analyzed. A total of 53 adult patients were admitted with liver injury and 29 underwent surgical treatment; the median age was 26.7 years. Mechanism was blunt in 52 patients. The overall morbidity was 30 per cent, morbidity related to liver resection was 15.3 per cent. Mortality was 2 per cent in the series of patients undergoing liver resection for complex hepatic injury, whereas in the nonoperative group, morbidity was 17 per cent and mortality 2 per cent. Liver resection should be considered a serious surgical option, as initial or delayed management, in patients with complex liver injury and can be accomplished with low mortality and liver-related morbidity when performed in specialized liver surgery/transplant centers.

scholarly journals Comparative Analysis of the Outcomes of Carotid Stenting and Carotid Endarterectomy in the Management of Carotid Stenosis

2019 ◽  
Vol 34 (4) ◽  
pp. 306-314
Author(s):  
Hasan I. Fadel Saad ◽  
Mustafa Noom ◽  
Khalid Shnab ◽  
Abdel Magid El Osta
Keyword(s):  
Carotid Stenosis ◽  
Carotid Stenting ◽  
Mortality Rates ◽  
High Morbidity ◽  
Specific Complication ◽  
Significant Difference ◽  
Cranial Nerve Injuries ◽  
Almost All ◽  
Surgery Department ◽  
Periprocedural Stroke

Carotid Stenosis is an important cause of stroke (20%) which is associated with high morbidity and mortality rates. The management is mainly by surgery or carotid stenting. This study reviews 3 years of experience and the outcomes in the treatment of carotid stenosis by the two methods. The study aimed to evaluate and compare the outcomes of both procedures during a 3yr period at a vascular Surgery department of the Cisanello Hospital. 302 pts were retrospectively analyzed; 151 pts assigned for each procedure. The average intervention time was significantly higher for the CEA group O.R: 0.556; 95% C.I; 0.349- 0.886, P: 0.014 but technical successes were achieved in 100% of CEA pts, whereas were achieved in 91.39% of the CAS group. The periprocedural stroke was nonsignificant between the two procedures. The Periprocedural TIA were show significant difference with more incidences in CAS pts [O.R: 7.292, 95% C.I; 1.150- 45.856, P: 0.032] but almost all pts improved. The cranial nerve injuries were a specific complication of CEA [11.9%]. The recurrent stenosis was seen only in CAS pts [2.9%] with O.R: 0.493, 95% C.I; 0.104- 2.345, P: 0.410. Both procedures are effective and comparable in outcomes in the management of carotid Stenosis.

A comparative study of the acute effects of knee brace vs. kinesiotape on selected isokinetic strength variables of the knee muscles

2021 ◽  
pp. 1-6
Author(s):  
Ali Kerim Yilmaz ◽  
Mehmet Vural ◽  
Mustafa Özdal ◽  
Menderes Kabadayi
Keyword(s):  
Knee Injuries ◽  
Knee Extension ◽  
Acute Effects ◽  
Post Injury ◽  
Kinesio Tape ◽  
Knee Strength ◽  
Significant Difference ◽  
S Peak ◽  
Male Subjects ◽  
Methods Of Treatment

BACKGROUND: Different methods of treatment for preventing knee injuries, enhancing knee strength and minimising post-injury risks have been explored. Among these methods, Kinesio tape (KT) and knee braces (KB) are commonly used. OBJECTIVE : To investigate the acute effects of KT and KB on isokinetic knee strength parameters. METHODS: A total of 15 healthy sedentary male subjects voluntarily participated in the study. Concentric isokinetic knee extension (EX) and flexion (FLX) strength were measured at three sessions: 1. Baseline 2. with KT (’KT’) 3. with KB (’KB’). Tests were performed at 60, 180 and 240∘/s. Peak moment (PM), Hamstring/Quadriceps ratio (HQR), and joint angle at peak moment (JAPM) were measured. RESULTS: ‘KT’ and ‘KB’ were associated with increase in PMEX, PMFLX, HQR at 60 and 240∘/s (p< 0.05) and increased JAPMEX. No significant difference was observed at 180∘/s (p> 0.05). CONCLUSION: In healthy individuals, ‘I’ shape KT and KB positively affect EX and FLX strengths and HQR, especially at low angular velocity.

INR Response to Low-Dose Vitamin K in Warfarin Patients

2021 ◽  
pp. 106002802199323
Author(s):  
Caitlin E. Kulig ◽  
A. Joshua Roberts ◽  
A. Shaun Rowe ◽  
Hahyoon Kim ◽  
William E. Dager
Keyword(s):  
Vitamin K ◽  
Primary Outcome ◽  
Low Dose ◽  
International Normalized Ratio ◽  
Mortality Rates ◽  
Observational Cohort Study ◽  
Significant Difference ◽  
Observational Cohort ◽  
Reduction Effect ◽  
Retrospective Observational Cohort Study

Background Literature suggests that 2 mg of vitamin K intravenously (IV) provides a similar effect as 10 mg to reverse warfarin. Doses <5 mg haven’t been studied in depth. Objective The objective was to determine the international normalized ratio (INR) reduction effect of ultra low-dose (ULD) IV vitamin K. Methods This retrospective, observational cohort study compared IV vitamin K doses of 0.25-0.5 mg (ULD) versus 1-2 mg (standard low dose [SLD]). The primary outcome assessed ΔINR at 36 hours; secondary outcomes assessed ΔINR at 12 hours and 30-day venous thromboembolism (VTE) and mortality rates. Results Of 88 patients identified (median baseline INR [IQR], 5.1 [3.1, 7.3] vs 4.5 [2.8, 8.2], ULD vs SLD, respectively), 59 had an INR at 12 hours. The ULD had fewer 12-hour INR values <2, with no statistical difference in the ΔINR at 12 hours between the ULD and SLD cohorts (median ΔINR, 2.2 [1.1, 3.4] vs 2.2 [1.1, 6.3]; P = 0.54; median INR, 2.3 vs 1.8). A total of 41 patients had both a 12- and 36-hour INR. No significant difference in the ΔINR between the 12- and 36-hour values occurred (median ΔINR, 0.52 [0.2, 0.91] vs ΔINR, 0.46 [0.18, 0.55]; P = 0.61), suggesting no rebound or excessive reversal and no difference in 30-day rates of VTE ( P > 0.99) or death ( P = 0.38). Conclusion and Relevance ULD IV vitamin K reversed INR similarly to doses of 1-2 mg without rebound. A ULD strategy may be considered in patients requiring more cautious reversal.

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