Minimal Injuries Research Articles

Outcomes of thoracic endovascular aortic repair in patients with concomitant blunt thoracic aortic injury and traumatic brain injury from the Aortic Trauma Foundation global registry

BackgroundTraumatic brain injury (TBI) and blunt thoracic aortic injury (BTAI) are the top two leading causes of death after blunt force trauma. Patients presenting with concomitant BTAI and TBI pose a specific challenge with respect to management strategy, because the optimal hemodynamic parameters are conflicting between the two pathologies. Early thoracic endovascular aortic repair (TEVAR) is often performed, even for minimal aortic injuries, to allow for the higher blood pressure parameters required for TBI management. However, the optimal timing of TEVAR for the treatment of BTAI in patients with concomitant TBI remains an active matter of controversy. MethodsThe Aortic Trauma Foundation international prospective multicenter registry was used to identify all patients who had undergone TEVAR for BTAI in the setting of TBI from 2015 to 2020. The primary outcomes included delayed ischemic or hemorrhagic stroke, in-hospital mortality, and aortic-related mortality. The outcomes were examined among patients who had undergone TEVAR at emergent (<6 vs ≥6 hours) or urgent (<24 vs ≥24 hours) intervals. ResultsA total of 100 patients (median age, 43 years; 79% men; median injury severity score, 41) with BTAI (Society for Vascular Surgery BTAI grade 1, 3%; grade 2, 10%; grade 3, 78%; grade 4, 9%) and concomitant TBI who had undergone TEVAR were identified. Emergent repair was performed for 51 patients (51%). Comparing emergent repair (<6 hours) to urgent repair (≥6 hours), no difference was found in delayed cerebral ischemic events (2.0% vs 4.1%; P = .614), in-hospital mortality (15.7% vs 22.4%; P = .389), or aortic-related mortality (2.0% vs 2.0%; P = .996) and no patient had experienced delayed hemorrhagic stroke. Likewise, repairs conducted in an urgent (<24 hours) setting showed no differences compared with those completed in an emergent (≥24 hours) setting regarding delayed ischemic stroke (2.6% vs 4.3%; P = .548), in-hospital mortality (18.2% vs 21.7%; P = .764), or aortic-related mortality (1.3% vs 4.3%; P = .654), and no patient had experienced delayed hemorrhagic stroke. ConclusionsIn contrast to prior retrospective efforts, results from the Aortic Trauma Foundation international prospective multicenter registry have demonstrated that neither emergent nor urgent TEVAR for patients with concomitant BTAI and TBI was associated with delayed stroke, in-hospital mortality, or aortic-related mortality. In these patients, the timing of TEVAR did not have an effect on the outcomes. Therefore, the decision to intervene should be guided by individual patient factors rather than surgical timing.

Decompression Using Minimally Invasive Surgery for Lumbar Spinal Stenosis Associated with Degenerative Spondylolisthesis: A Review.

Lumbar spinal stenosis (LSS), which often occurs concurrently with degenerative spondylolisthesis (DS), is a common disease in the elderly population, affecting the quality of life of aged people significantly. Notwithstanding the frequently good effect of conservative therapy on LSS, a minority of the patients ultimately require surgery. Surgery for LSS aims to decompress the narrowed spinal canals with preservation of spinal stability. Traditional open surgery, either pure decompression or decompression with fusion, was considered effective for the treatment of LSS with or without DS. However, the long-term clinical outcomes of traditional open surgery are still unclear. Moreover, the disadvantages of conventional open surgery are extensive, examples including tissue injuries or secondary instability, with limited outcomes and significant reoperation rates. With the development and improvement of surgical tools, various minimally invasive spine surgery (MISS) methods, including indirect decompression techniques of interspinous process devices (IPDs) and direct decompression techniques such as microscopic spine surgery or endoscopic spine surgery (ESS), have been updated with enhancement. IPDs, such as Superion devices, were reported to behave with comparable physical function, disability, and symptoms outcomes to laminectomy decompression. As an emerging technique of MISS, ESS has beneficial hallmarks including minimal tissue injuries, reduced complication rates, and shortened recovery periods, thus gaining popularity in recent years. ESS can be classified in terms of endoscopic hallmarks and approaches. Predictably, with the continuous development and gradual maturity, MISS is expected to replace traditional open surgery widely in the surgical treatment of LSS associated with DS in the future.

Minimally Invasive Surgery for Anterior Pubic Rami Fractures Under Fluoro-Navigation Using the Medtronic O Arm System and Calcium Phosphate for Internal Fixation

Introduction: The incidence of anterior pubic rami fractures in elderly female patients over the age of 65 has been reported to be 64 %. Osteoporosis plays a role with these fractures, as they are caused by minimal low energy injuries from a fall. Indications for internal fixation of anterior pelvic ring are controversial because of the etiology being low energy trauma and the location being a non-weight bearing surface. In contrast to conventional open pelvic surgery, percutaneous screw fixation has gained popularity in the treatment of pelvic fractures, mainly because of minimal soft tissue damage, less operative blood loss, early surgical intervention, and comfortable mobilization of the patient. The use of calcium phosphate as a form of internal fixation further advances the advantages of minimally invasive surgery for internal fixation with less morbidity by the use of screw fixation. The incorporation of fluoro-navigation is a new surgical technique in orthopedic trauma surgery. (Figure 1) This study is to report our clinical results of fluoro-navigation surgery in anterior pelvic pubic rami fractures using calcium phosphate as the fixation of choice. This is the first report of this method of treatment using a new combination of visualization and internal fixation. Materials and Methods: From April 2018 to December 2019, 30 patients with anterior pubic rami fractures were treated with percutaneous cannulated calcium phosphate delivery under Medtronic O arm (fluoro-navigation) control. There were 5 male and 25 females, with a mean age of 84.6 years (range 80-104) for females and mean age of 90 years (84 – 99) for the 5 males. According to the AO and Orthopedic Trauma Association classification, all were considered lateral compression types of fractures. All patients were operated on when their general medical condition stabilized after emergency management and admission. The pain score on admission was reported as 10/10 in all cases. Plain standard pelvic x-rays were obtained on admission as well as CT scans of the pelvis. All the anterior pubic rami fractures were fixed using percutaneous delivery of calcium phosphate with the Zimmer trocar system by one senior surgeon. The Medtronics O arm fluoro-navigation was used in all cases. The surgeon was familiar with the navigation system and had much experience in the computer-assisted percutaneous placement of the trocars. Results: A total of 30 patients were treated with this new combination of surgical treatment of anterior pubic rami fractures. No screws were inserted or found to be necessary for fracture treatment. Each case used 2 trocars from the kits supplied from Zimmer. One end delivery trocar was directed to the inferior pubic ramus fracture and the second which was a side delivery trocar was used for the superior pubic ramus fracture. A total of 10 cc of calcium phosphate was used in each case, 5 cc per trocar. The position of the trocars were placed using the fluoro-navigation control of the O arm. Once the trocars were properly placed the calcium phosphate was delivered and viewed under flouro control and then again viewed with the spin sequence using the Medtronics O arm. Total patient time in the operating room was 56 minutes; Total surgery time was 26 minutes. Anesthesia in most cases was MAC or light sedation with local skin infiltration using 1% lidocaine. Blood loss during the operation was considered very minimal with derma bond used to cover the percutaneous sites as well as a small band-aid. No superficial or deep infections occurred. No patient sustained recognized neurologic, vascular, or urologic injury because of the percutaneous pubic rami fixation with calcium phosphate. Extravasation of the calcium phosphate from the fracture’s sites did not pose any sequelae with soft tissue injury or with fracture healing. All patients were encouraged to get out of bed and weight bear according to comfort on post-op day 1. All fractures united at the last follow-up. Conclusions: This study presented for the first time two new techniques for the operative treatment of pubic rami fractures of the pelvis. The delivery of calcium phosphate for fracture fixation of pubic rami fractures has been found to be safe, minimally invasive, providing pain relief and stability permitting early mobilization. The addition of intra-operative fluoro- navigation technique makes the fracture treatment an accurate, and rapid method for the treatment of pubic rami fractures. Consistency of the operative procedure and teaching are mandatory for the success of this procedure. The learning curve for most orthopedists should be very short. The outcomes have been shown to benefit patient mobilization, decrease morbidity and decrease hospital stay

Management of Moderate Blunt Thoracic Aortic Injuries in Patients with Intracranial Hemorrhage

Blunt thoracic aortic injuries (BTAIs) are the second most common cause of death due to blunt-force trauma in the United States. Patients with minimal injuries do not typically require surgical repair, whereas patients with severe injuries are treated emergently. Moderate aortic injuries are repaired in a semielective fashion, but the optimal management of patients with moderate BTAI with associated intracranial hemorrhage (ICH) is unknown. We sought to analyze the management and outcomes of patients presenting with concomitant moderate BTAI and ICH. Consecutive patients who received a thoracic endovascular aortic repair (TEVAR) at our institution for treatment of moderate BTAI between January 2014 and December 2017 were retrospectively reviewed as part of an institutional review board-approved protocol. Patients were classified by our BTAI classification into "minimal", "moderate", or "severe". ICH was identified on computed tomography scan and its severity determined by the neurosurgical team. Outcome measures included surgical timing and surgical outcomes. Fifty-two patients had a moderate BTAI and underwent TEVAR, 20 (38 %) of whom presented with ICH. Median time from admission to surgery was 58.5hr for patients with ICH and 26.5hr for non-ICH patients. Intraoperative heparin was administered in all patients without ICH and in 19 of 20 (95%) patients with ICH after the ICH met criteria for stability. Protamine reversal was utilized in 80% of patients with ICH and 75% of non-ICH patients. No patient developed ischemic stroke or spinal cord ischemia. Worsening ICH was seen in only one patient, who also received heparin infusion for pulmonary embolus 24hr before TEVAR. There were no aortic-related mortalities in either group. Thirty-day all-cause mortality was 5% for patients with ICH and 3% for non-ICH patients. Patients with moderate BTAI and stable ICH are not at increased risk of TEVAR-related complications. Administration of intraoperative heparin during TEVAR appears to be safe and does not worsen ICH.

Modified netting technique for capturing gazelles in Serengeti, Ngorongoro and Loliondo, Tanzania

Modified netting technique for capturing gazelles in Serengeti, Ngorongoro and Loliondo, Tanzania

Topical 5-fluorouracil application in management of odontogenic keratocysts

Aim & objectivesThe aim of this study was to evaluate the efficacy of topical application of 5-fluorouracil (5-FU) after peripheral ostectomy, and compare it with other treatment modalities in the management of odontogenic keratocyst (OKC). Materials &methodsThis prospective study was conducted in the OMFS department for last seven years, wherein twenty seven patients of OKC were included and randomly allocated to the three treatment groups. Nine were treated by enucleation followed by application of modified carnoy solution (CS), eleven by peripheral ostectomy followed by application of 5-FU and eleven by segmental resection (SR). Follow-up ranged from 2 to 4 years to assess bone healing and record any recurrence of lesion. ResultsAmongst twenty seven patients, eighteen were males and nine females, age range 20–66 years. The most common location of OKC was posterior mandible. Complications included nerve injury, swelling, infection, and recurrence (66.6% after modified CS). Functional and aesthetic compromise was seen in resection patients whereas application of 5-FU had minimal nerve injuries, infection, swelling, no recurrence with no compromise in aesthetics and function. ConclusionManagement of OKC by 5-FU is a novel surgical method having less morbidity, minimal recurrence, low cost, no functional or cosmetic deformity.

Effect of Dynamic Postural Control Activities on Balance in Amateur Indian Taekwondo Players

Background: Taekwondo is a technique of unarmed self-defense that involves skillful application of techniques which include punching, jumping, kicks, blocks and dodges. Beside speed, response to the opponent’s actions along with good balance appear to be key elements for victory. Hence a good balance is required for excellent performance with minimal injuries Method: A total of 60 players were selected based on inclusion and exclusion criteria. The aim and objectives of the study were explained to them and their written consent was taken. Balance was assessed using single legged stance test and community balance and mobility scale. The players were divided into two groups of 30 players each. A four week intervention program consisting of dynamic postural control activities was given to the players in group Athrice a week for four consecutive weeks and those in group B received conventional exercises including stretching and drilling. The pre and post values were recorded on 1st and 12th day respectively and the data obtained was statistically analyzed. Results:The average CBM scale score before intervention were 74/96 in group A and 72/96 in group B. These were improved to an average of 91.2/96 and 80.32/96 in group A and group B respectively after intervention showing a value of p&lt;0.0001. Also, significant improvement is seen in single legged stance test scores in group A as compared to group B. Conclusion: Dynamic postural control activities are effective in improving the balance thereby improving the performance in amateur Indian Taekwondo players.

Trauma service use for minimal injuries increases cost, decreases value

Trauma service use for minimal injuries increases cost, decreases value

Validation of the scandinavian guidelines for initial management of minor and moderate head trauma in children

BackgroundHead trauma in children is common, with a low rate of clinically important traumatic brain injury. CT scan is the reference standard for diagnosis of traumatic brain injury, of which the increasing use is alarming because of the risk of induction of lethal malignancies. Recently, the Scandinavian Neurotrauma Committee derived new guidelines for the initial management of minor and moderate head trauma. Our aim was to validate these guidelines.MethodsWe applied the guidelines to a population consisting of children with mild and moderate head trauma, enrolled in the study: “Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study” by Kuppermann et al. (Lancet 374(9696):1160–1170, https://doi.org/10.1016/S0140-6736(09)61558-0, 2009). We calculated the negative predictive values of the guidelines to assess their ability to distinguish children without clinically-important traumatic brain injuries and traumatic brain injuries on CT scans, for whom CT could be omitted.ResultsWe analysed a population of 43,025 children. For clinically-important brain injuries among children with minimal head injuries, the negative predictive value was 99.8% and the rate was 0.15%. For traumatic findings on CT, the negative predictive value was 96.9%. Traumatic finding on CT was detected in 3.1% of children with minimal head injuries who underwent a CT examination, which accounts for 0.45% of all children in this group.ConclusionChildren with minimal head injuries can be safely discharged with oral and written instructions. Use of the SNC-G will potentially reduce the use of CT.

Association of mechanism of injury with overtriage of injured youth patients as trauma alerts

BackgroundTrauma alert criteria include physiologic and anatomic criteria, although field triage based on injury mechanism is common. This analysis evaluates injury mechanisms associated with pediatric trauma alert overtriage and estimates...

Modifying the surface of a titanium alloy with an electron beam and a-C:H:SiOx coating deposition to reduce hemolysis in cardiac assist devices

The use of implantable mechanical pumps to support stable heart function saves lives to a large number of patients. The priority goal of research in this area is to develop advanced pumps that will ensure minimal injuries and fractures of blood cells. A combined method of modifying the surface of disk pump parts made of titanium alloy VT-6 has been developed to reduce blood hemolysis. The method includes material pretreatment with a high-current low-energy electron beam and plasma-enhanced chemical vapor deposition of a-C:H:SiOx coating. The effect of such electron beam parameters as the energy density and the number of pulses on the surface morphology, hardness, plasticity index, friction coefficient and wear rate of the titanium alloy was studied. The effect of the 1.6-μm-thick a-C:H:SiOx coating on the surface morphology, mechanical and tribological properties of VT-6 samples subjected to preliminary electron beam processing was also investigated. Parts of the disk pump were modified according to the proposed technology and pump was tested on the degree of red blood cell destruction. After modifying the surface of pump parts, the destruction of red blood cells did not occur during the 4-h experiment, unlike a similar pump without surface modification. It is shown that the physical properties of the surface are one of the most important factors affecting hemolysis in mechanical pumps to support stable heart function.

Prospective Validation of the Scandinavian Guidelines for Initial Management of Minimal, Mild, and Moderate Head Injuries in Adults.

The Scandinavian Guidelines for Initial Management of Minimal, Mild, and Moderate Head Injuries in Adults (Scandinavian guidelines) are the first to incorporate serum measurement of the S100 astroglial calcium-binding protein B (S100B) to emergency department (ED) triage of patients with head injury (HI). This prospective validation study was conducted in the ED of the Tampere University Hospital, Finland, between November 2015 and November 2016. All consecutive adult patients with HI presenting to the ED within 24 h from injury were eligible for inclusion. Venous blood for S100B sampling was drawn from all patients, and the result was available at the ED. Computed tomography (CT) scans of the head were performed according to the on-call physician's evaluation. Only the samples collected within 6 h after injury were used. A one-week follow-up was conducted to identify possible HI-related complications. A total of 295 patients (median age, 67.0 years, range, 18-100; women, 48.8%) were enrolled. Of those, 196 (66.4%) underwent scanning. Acute traumatic lesions were detected on 31 (15.8%) of the scans. Two of the CT-positive patients were scanned without a guidelines-based indication. These lesions did not require any specific treatment or repeated imaging. The guidelines-based sensitivity was 0.94 (95% confidence interval [CI], 0.77-0.99) and specificity 0.19 (95% CI, 0.13-0.26) for predicting traumatic intracranial CT abnormalities. The positive and negative predictive value for positive head CT was 0.18 (95% CI, 0.12-0.25) and 0.94 (95% CI, 0.78-0.99), respectively. In the mild-low risk group, no false negative S100B values were recorded. Thirteen patients (4.4%) were re-admitted to the ED, and two patients (0.7%) died one week after the primary HI. The deaths were unrelated to the injury. None of these adverse events were directly caused by a primarily undiagnosed intracranial injury. The Scandinavian guidelines incorporated with S100B are a valid means of screening clinically significant acute traumatic lesions after HI and have the potential to reduce unnecessary CT scanning.

Involving research-invested clinicians in data collection affects injury incidence in youth football.

It is well established that differences in injury definition and recording methodology restrict comparisons between injury surveillance programmes. There is, however, little documentation of the variation that can exist between data recorders. The aim of this study was, therefore, to explore the effect on reported injuries when team recorders or supervisors are involved in research. Injury data collected prospectively over five seasons for the U16, U17, and U18 age groups in a youth football (soccer) academy were used to compare different recording settings based on the research involvement of the clinicians. A research-invested team physiotherapist reported an 8.8 times greater incidence (P<0.001) of non-time-loss injuries and a 2.5 times greater incidence (P<0.001) of minimal injuries (1-3days lost) compared to a setting where neither the team physiotherapists nor the supervisor relied on the collected data for research purposes. When team physiotherapists were not invested in research themselves but were supervised by a researcher, the incidence of non-time-loss injuries and minimal injuries was 2.5 times (P<0.001) and 2.0 times greater (P<0.01) than in the non-invested setting, respectively. However, there were no differences between recording settings for overall incidence of time-loss injuries. The results from this study demonstrate that involving clinicians that are relying on the collected data for research purposes can significantly affect the reported rates of non-time-loss and minimal injuries. Time-loss injuries overall were not affected by research investment, and should therefore be preferred for comparisons between teams and seasons.

Anteromedial ankle approach for talus fracture

Objective To investigate the therapeutic effect of anteromedial ankle approach for talus fracture. Methods From January 2012 to October 2018, the data of 28 cases of talus fracture treated by anteromedial ankle approach were retrospectively analyzed, including 26 males and 2 females, aged 24-61 years with an average of 38.6 years. All 25 cases of closed injuries and 3 cases of open injuries were fresh injuries. There were 16 cases of traffic injuries, 8 falling injuries, 2 heavy object injuries and 2 sprains. Among the 28 patients, 17 were talus neck fractures, and according to Hawkins talus neck fracture classification, there were 1 case of type I, 12 type II, and 4 type III. There were 11 cases of talus fracture, which were classified according to Sneppen talus fracture types: 2 cases of type I, 8 cases of type II and 1 case of type V. Among them, 2 cases of talus neck fracture complicated with T12 vertebral body fractures and 2 cases complicated with calcaneal fractures. The time from injury to operation for 3 patients with open fracture was 3-6 hours. 25 cases of closed fracture injuries took 2-10 hours to operate, with an average time of 5.6 hours. All patients were fixed with cannulated screws through the anteromedial ankle approach. The weight-bearing time and strength of lower limbs were determined according to fracture healing after surgery. The ankle function was evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) Score. Results All 28 patients were followed up for 23 to 82 months, with an average of 37.5 months. All fractures healed. The healing time of talus neck fracture was 3.5-8 months, with an average of 5 months. The healing time of talus fracture was 3-7 months, averaging 4.5 months. At the latest follow-up, AOFAS score ranged from 68 to 100, with an average of 82.5 points, including excellent in 15 cases, good in 8 cases, fair in 4 cases and poor in 1 case, with the excellent and good rate of 82.1% (23/28). There were no signs of fracture displacement, malunion, loosening and prolapse of internal fixation, fracture and ischemic necrosis of talus after operation. Traumatic arthritis occurred in 9 patients, with an incidence rate of 32.1% (9/28). Tibial joint was involved in 5 cases, talus joint in 3 cases, tibialis in 1 case and talus joint in 1 case. Among them, traumatic arthritis occurred in 2 cases of open injury. Nine patients (32.1%) suffered from traumatic arthritis 6-10 months after operation, with an average of 8 months. According to conservative treatments such as weight control, ankle immobilization, physiotherapy, anti-inflammatory and analgesic, nutrition of articular cartilage drugs, joint traction and plasty were given. The patients' conditions improved to different degrees and could tolerate walking and normal life and work. Conclusion The anteromedial ankle approach has the advantages of minimal vessel injuries, clear exposure for direct reduction, low rate of necrosis of talus and satisfactory curative effect. Key words: Talus; Fractures, bone; Fracture fixation, internal

Is endovascular repair the first choice for all blunt aortic injury? A real-world assessment.

Blunt thoracic aortic injury (BTAI) represents an infrequently encountered but lethal traumatic injury. Minimal aortic injuries are appropriately treated by medical management, while more severe injuries require endovascular or open repair. Rapidly evolving endovascular technology has largely supplanted open repair as first line operative intervention, however, the complexity of the severely injured blunt trauma patient can complicate management decisions. The development and implementation of an optimal consensus grading system and treatment algorithm for the management of BTAI is necessary and will require multi-institutional study.

American eel state of buoyancy and barotrauma susceptibility associated with hydroturbine passage

American eel are likely to encounter and pass through hydropower turbines, particularly during the downstream spawning migration, where exposure to stressors can potentially lead to injuries and mortality. Previous research has recovered dead eels downstream of hydropower facilities and, for some fish, injuries were easily attributed to blade strike; however, others showed no external signs of injury suggesting that other stressors, such as rapid decompression may be a potential source of mortality. For this research, yellow– and silver-phase American eel were held and allowed to acclimate to 172 kPa (absolute pressure) in hyper/hypobaric hydro-chambers for about 1 d. After acclimation, the state of buoyancy was determined prior to exposure to a rapid decompression simulating pressures encountered during hydroturbine passage. Fish were then examined for signs of barotrauma. Eel did not attain a state of neutral buoyancy but rather maintained negative buoyancy suggesting that eels, and possibly other benthic species, likely maintain a state of negative buoyancy to facilitate occupancy on or near the substrate. Additionally, eel were found to be resilient to rapid decompression, displaying no instantaneous mortality and minimal injuries, suggesting that barotrauma is not likely a major concern for American eel passing downstream through hydroturbines.

Novel Therapeutic Strategy for Pharyngoesophageal Stricture following Total Laryngectomy.

Current therapeutic strategies for pharyngoesophageal stricture, while effective in the short term, are protracted and costly in the longer term. Conceptually, if a stricture can be dilated with minimal tissue injuries, the rate of fibrosis and the resultant stricture recurrence could be reduced. We evaluated a prototype computer-controlled syringe pump device programmed to distend a commercially available balloon dilator at variable rate, asserting incremental lumen distension pressures tailored to the resistive force encountered within the stricture. We completed 17 graded dilatation procedures among 4 total laryngectomy patients. All patients had a short-term response (1 month), with a mean decrement (improvement) in Sydney Swallow Questionnaire score of 448 (total score range, 0-1700; normal <234). The overall procedural tolerability and safety were encouraging; the only complication was the displacement of the voice prosthesis during 1 dilatation. From a technical viewpoint, the main challenge was to maintain the balloon in position during dilatation.

Utility and effectiveness of the Scandinavian guidelines to exclude computerized tomography scanning in mild traumatic brain injury - a prospective cohort study

BackgroundIn 2013 the Scandinavian Neurotrauma Committee (SNC) published updated guidelines for the initial management of minimal, mild and moderate traumatic head injuries (MTHI) that included serum analysis of protein S100B as a marker for brain tissue damage. This study reviews the effectiveness of the new guidelines in a clinical setting.MethodsFor all patients admitted to Akershus University Hospital (AHUS) from June 30th 2014 to December 15th 2014 with MTHI a separate form was filled in recording the time, indication and result of any S100B sampling and/or head computer tomography (CT) examinations. Data from these forms were compared to information derived from the electronic patient records for patients with MTHI and related diagnoses and data from the laboratory for all patients that had undergone the S100B analysis within the same period.ResultsFive hundred seventy-five patients were identified with MTHI, S100B sampling was indicated for 223 (38.8%) patients and carried out for 188 (84.3%) of these patients. 69 (36.7%) of the patients had a negative S100B test, but a head CT scan was still performed in 31 cases despite the negative S100B test. In total the guidelines were followed for 362 of 575 patients (63.0%). 180 (31.3%) of the MTHI cases were discharged without further observation or CT examinations, including 38 (21.1%) as a direct result of S100B testing. No re-admissions or missed initial traumatic brain injuries were observed.ConclusionThe implementation of the updated SNC guidelines resulted in direct discharge of more than one third of the MTHI cases without further observation or CT examinations. One in five of these discharges was a direct result of S100B testing. However, compliance to the guidelines were poor and the guidelines were only followed in 40%. While this study showed benefits of implementing SNC guidelines to reduce the number of CT scans, additional training is needed for optimal use.

Structural and Functional Fundamentals of Alcoholic Disease

Aim. To suggest a new perspective on chronic alcohol intoxication by means of investigating the associated severe multiple organ pathology, which frequently becomes the cause of lethal outcome in patients suffering from drunkenness and alcoholism.Key points. The empirical basis of the study consisted in the analysis of autopsy results obtained from 1,115 corpses of persons having abused alcohol during their lifetime. In addition, 800 experiments on rats were carried out. As a result, a concept of alcoholic disease (AD) is proposed. AD is defined as a condition, in which chronic ethanol intoxication leads to the development of morphological changes in organs and systems: from minimal injuries of the microcirculatory pathway to a multiple organ pathology showing signs of alcoholism. AD pathogenesis is demonstrated to undergo 3 major stages, from (1) episodic alcohol intoxication, through (2) drunkenness and to (3) alcoholism. It is noted that, while the morphological changes are considered to be reversible during the first two stages, they become irreversible at the stage of alcoholism.Conclusion. It is concluded that the forms of the disease that involve the described morphological changes in organs and systems should be primarily treated by physicians, not by psychiatrists and narcology practitioners who are only capable of dealing with the psychological aspect of the problem.

External validation of the Scandinavian guidelines for management of minimal, mild and moderate head injuries in children

BackgroundClinical decision rules (CDRs) aid in the management of children with traumatic brain injury (TBI). Recently, the Scandinavian Neurotrauma Committee (SNC) has published practical, evidence-based guidelines for children with Glasgow Coma Scale (GCS) scores of 9–15. This study aims to validate these guidelines and to compare them with other CDRs.MethodsA large prospective cohort of children (< 18 years) with TBI of all severities, from ten Australian and New Zealand hospitals, was used to assess the SNC guidelines. Firstly, a validation study was performed according to the inclusion and exclusion criteria of the SNC guideline. Secondly, we compared the accuracy of SNC, CATCH, CHALICE and PECARN CDRs in patients with GCS 13–15 only. Diagnostic accuracy was calculated for outcome measures of need for neurosurgery, clinically important TBI (ciTBI) and brain injury on CT.ResultsThe SNC guideline could be applied to 19,007/20,137 of patients (94.4%) in the validation process. The frequency of ciTBI decreased significantly with stratification by decreasing risk according to the SNC guideline. Sensitivities for the detection of neurosurgery, ciTBI and brain injury on CT were 100.0% (95% CI 89.1–100.0; 32/32), 97.8% (94.5–99.4; 179/183) and 95% (95% CI 91.6–97.2; 262/276), respectively, with a CT/admission rate of 42% (mandatory CT rate of 5%, 18% CT or admission and 19% only admission). Four patients with ciTBI were missed; none needed specific intervention. In the homogenous comparison cohort of 18,913 children, the SNC guideline performed similar to the PECARN CDR, when compared with the other CDRs.ConclusionThe SNC guideline showed a high accuracy in a large external validation cohort and compares well with published CDRs for the management of paediatric TBI.