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At least 793 records · Page 44Linked to original sources
PubMed1986

[A method for relieving tinnitus complaints in long-enlisted soldiers with multiple acoustic traumas--external electrostimulation].

The effect of external electrostimulation (EES) on tinnitus in soldiers with multiple blast trauma was assessed in a controlled study. There was no change in the tinnitus in the untreated control group during an observing period of 5 weeks. However the noise resolved completely within 28 days of therapy in 20% of treated soldiers, in some patients the symptoms were improved. The repeated application of EES is effective in recurrent complaints. This method can be carried out on an out-patient basis and scarcely has any side-effects. It is not suitable for treating tinnitus after acute acoustic trauma.

Adult↗
PubMed2006

Multiple, simultaneous trauma patients: Are they worse off?

BACKGROUND: The simultaneous management of multiple severely injured patients has the potential to overwhelm trauma center resources. We hypothesize that trauma patients presenting in clusters of two or more patients within a short time period have worse outcomes. METHODS: From the registry at our urban Level I trauma center, we reviewed 4,619 "major" trauma patients admitted during a span of 5.5 years (January 1998 through June 2003). A multidisciplinary team led by an in-house trauma surgery attending evaluated all patients. Pairs of two patients presenting less than 10 minutes apart (PAIRS) and clusters of three patients presenting within 30 minutes (CLUSTERS) were compared with patients arriving alone presenting over 4 hours apart (ALONE) and to other patients that did not meet any of the above criteria (OTHER). Multivariate regression was performed to determine differences in likelihood of direct operating room admissions, hospital, and intensive care unit (ICU) length of stay, and mortality. RESULTS: PAIRS made up 8.9% (413) and CLUSTERS made up 2.7% (126) of patients; 42% (1,939) arrived ALONE; 48.3% (2,229) of patients were classified as OTHER. Multivariate regression showed no significant differences in ICU or hospital length of stay, or mortality for PAIRS or CLUSTERS compared with patients presenting ALONE. PAIR and CLUSTER patients were more likely to undergo immediate surgery than the ALONE group (odds ratio 1.37, 95% confidence interval 1.03-1.83 and 1.61, 95% CI 1.00-2.58, respectively). CONCLUSIONS: When PAIRS or CLUSTERS of seriously injured patients arrive in close time proximity, they are more likely to be directly admitted to the operating room than patients arriving ALONE. This difference in management does not appear to affect patient outcomes.

Adult↗
PubMed1999

Relationship between serum glucose and injury severity score in childhood trauma.

PURPOSE: The aim of this study was to examine the relationship between initial serum glucose and injury severity score (ISS) in children with multiple trauma. METHODS: Charts from all patients 0 to 19 years of age admitted to a children's hospital in 1995 with acute multiple trauma were reviewed. Data collected included initial serum glucose level, heart rate (HR), systolic blood pressure (SBP), Injury Severity Score (ISS), age, gender, location of trauma, and need for intravenous fluids or epinephrine. Data were analyzed using multiple linear regression. RESULTS: A total of 185 charts were reviewed. The mean ISS was 11.3; the mean glucose was 162.8 mg/dL. After adjusting for age, gender, HR, SBP, and administration of epinephrine or fluid bolus, a significant direct relationship between serum glucose and ISS was found (r = 0.52, P < .01). A stronger relationship was found in children less than 2 years old (r = 0.60, P = .04). CONCLUSIONS: A significant direct relationship exists between glucose and ISS in children with multiple trauma. High glucose values may indicate more severe injury, especially in children less than 2 years old.

Adolescent↗
PubMed2003

Survival analysis of the factors affecting in mortality in injured patients requiring dialysis due to acute renal failure during the Marmara earthquake: survivors vs non-survivors.

BACKGROUND: We reviewed medical records of dialyzed patients admitted to our hospital after the Marmara earthquake and evaluated the factors affecting mortality in survivors and non-survivors according to the survival times. PATIENTS AND METHODS: Crush syndrome (CS) was diagnosed in 110 patients. Dialysis treatment was initiated in 60 patients; 21 of all died. The patients were divided into 2 groups which consisted of 39 survivors (Group A, 25 male, 14 female, mean age: 31 +/- 2.2 years) and 21 non-survivors (Group B, 9 male, 12 female, mean age: 27 +/- 3.0 years). Victims treated by any form of renal replacement therapy, including daily or intermittant hemodialysis and/or continuous venovenous hemodiafiltration. Clinical and laboratory findings were recorded regularly. Statistical analysis was performed with Kaplan-Meier method, log rank test and Cox regression analysis for the survival functions. RESULTS: APACHE II scores were 13.5 +/- 0.5 for Group A and 13 +/- 0.9 for Group B. Dialysis support was started to patients in Group A in a mean period of 2.8 +/- 0.2 days and in Group B in a mean period of 3.7 +/- 0.6 days after the earthquake (p > 0.05). The most frequent site of trauma was lower extremity (61.5%) and upper + lower extremities (23%) in Group A, and lower extremity (38.1%) and trunk + lower extremity (23.8%) in Group B. The frequencies of abdominal trauma, pelvic fracture and thoracic trauma in Group B were 23.8%, 19% and 14.2%, respectively. Multiple trauma was more frequent in Group B than in Group A (42.8% vs 2.5%). The rates of fasciotomy, amputation and surgery were similar in both groups. The frequency of sepsis was higher in non-survivors. In our center, the overall mortality rate was 8%, mortality rate in CS was 21% and in dialyzed patients it was 35%. Mortality was mainly associated with sepsis. Survival periods (52.3 +/- 4.0 days) in Group A were longer than in Group B (17.3 +/- 2.5 days). With Cox regression analysis, the parameters such as systolic hypotension on admission, female gender, high serum peak creatine kinase (> 20,000 U/l) and multiple trauma including thoracic and abdominal regions, were factors increasing risk of mortality. CONCLUSION: As a result, sepsis, multiple trauma and severe crush injury were the main factors increasing mortality risk in dialyzed injuries after the earthquake.

Acute Kidney Injury↗
PubMed2003

Does trauma trigger multiple sclerosis? 1: A controversy.

The potential role of trauma in the development of multiple sclerosis is important but controversial. Patients commonly ask about this and it has important medicolegal ramifications. In addressing such issues this article will consider both physical and psychological trauma, examine pathogenic mechanisms, and discuss the evidence for and against a relationship.

Blood-Brain Barrier↗
PubMed2003

Pulmonary contusion in severe head trauma patients: impact on gas exchange and outcome.

STUDY OBJECTIVE: To evaluate the impact on morbidity and mortality of pulmonary contusion in multiple-trauma patients with severe head trauma. DESIGN: Matched-paired, case-control study SETTING: ICU at a tertiary university hospital. PATIENTS: During a 3-year period, 313 consecutive multiple-trauma patients with severe head trauma (Glasgow coma scale [GCS], </= 8) who were admitted to the ICU. INTERVENTIONS: Case-control matching criteria were as follows: (1) age difference within 5 years; (2) sex; (3) GCS in two categories; (4) similar pattern of injury; and (5) simplified acute physiology score II in five categories. A pulmonary contusion, defined by the clinical context and the result of a chest CT scan, was diagnosed in 90 patients. Analysis was performed on 90 pairs who were matched with 100% success. RESULTS: Ninety patients (29%) presented a diagnosis of pulmonary contusion. The presence of pulmonary contusion had an impact on the PaO(2)/fraction of inspired oxygen (FIO(2)) ratio, which was significantly reduced in patients with a pulmonary contusion. The ICU stay, the occurrence of complications such as nosocomial pneumonia or ARDS, the Glasgow outcome scale, and the mortality rate did not significantly differ between case patients and control subjects. Mortality also was not affected when patients were stratified according to the severity of the PaO(2)/FIO(2) ratio. CONCLUSION: In the study patients, pulmonary contusion alters gas exchange but does not appear to increase the morbidity and mortality of multiple-trauma patients with head trauma. A sample-size effect may limit the interpretation of the study.

APACHE↗
PubMed1991

[Does covered tibial intramedullary nailing promote formation of a compartment syndrome? Perioperative and intraoperative continuous monitoring of compartmental pressure in covered tibial intramedullary nailing].

Between October 1988 and October 1989 we performed a continuously pressure monitoring with the infusion technique in the tibialis anterior and deep posterior compartment of the lower leg during the nailing of the tibia in complete fractures of the lower leg in 16 patients. We set up 2 groups of patients because of different pathophysiological conditions: patients, who were operated on a few days after trauma (Group A) and patients operated on months after the trauma (Group B) because of non-union of the tibia. The effects of the preoperative, intraoperative, and postoperative manipulations were recorded. In no case we saw a beginning compartmental syndrome, although very high pressures of 100 mmHg in Group A and 55 mmHg in Group B in the deep posterior compartment during reduction of the fracture were registrated. The registrated pressures correlated very well with the manipulations during the operation and were absolutely reversible after the ending of these manipulations. In our observation the closed tibia nailing does not favorize the development of a compartmental syndrome, if not done during the vulnerable phase after the first days after trauma, in blunt multiple trauma patients and during bleeding complications.

Adult↗
PubMed1995

[Current place of thr perihepatic absorbable mesh. Apropos of a series of 105 traumas of the liver].

From October 1987 to June 1993, 105 patients with liver trauma including 71 patients with multiple trauma were admitted to the emergency unit of the Hôpital Sud in Marseilles. Mean age was 32 +/- 15 years, ranging from 16 to 77 years. 77 were male and 28 were female. 83 cases presented with closed trauma, and there were 11 by knife wounds and 11 gun shot injuries. 22 patients, including 10 with multiple trauma, were not operated. Operation was decided immediately in 38 cases for hypovolemia or during the following six hours because of unstable blood pressure after four units of blood transfusion. The absorbable perihepatic mesh was used by 3 surgeons and 3 others used classical procedures (sutures, packing). Global mortality was 15%. The morbidity (31%) was not different from other reports but was significantly lower when using the mesh (p = 0.002). This technique can achieve rapid and lasting hemostasis and bilistasis without any increase of cholestasis or hepatic cytolysis compared to conventional procedures, and without any alteration of laboratory parameters, as shown by specific laboratory tests and follow-up liver biopsies. The mesh also avoids compression of the adjacent organs, compared to packing, thereby avoiding respiratory and renal impairment and reoperation. It can be used in a septic context and in combination with all kinds of radiologic follow-up and percutaneous aspiration and drainage.

Adolescent↗
PubMed2004

[Possibilities of whole-body MRI for investigating musculoskeletal diseases].

This contribution outlines possibilities and limitations of whole-body MRI for investigating musculoskeletal diseases. Benefits and drawbacks of the novel whole-body MRI technology are discussed and a possible whole-body MRI sequence protocol for musculoskeletal examinations is proposed. Muscle, joint and bone diseases are discussed in which the application of whole-body MRI may be of advantage. Particularly, polymyositis, muscledystrophy, rheumatoid arthritis, spondylitis ancylosans, multiple trauma, skeletal metastases, multiple myeloma and malignant lymphoma are mentioned. Whole-body MRI opens new advantages for the examination of multifocal musculoskeletal diseases. The clinical benefit of this method for particular diseases has to be evaluated in further studies, however.

Acquired Hyperostosis Syndrome↗
PubMed1992

Multiple significant trauma diagnosis related groups: analysis and national projections based on the first year in an all-payor prospective payment system.

To assess the effect of diagnosis related group (DRG) changes on reimbursement for trauma care in New York State (NYS), 840 trauma patients were studied over a 2-year period. Average costs increased moderately ($10,338 vs. $11,646) while average revenues increased dramatically ($6,934 vs. $9,115), leading to a 21% reduction in operating losses ($1,310,625 vs. $1,032,733). This was largely a result of new multiple significant trauma (MST) DRGs. The impact of 1990/1991 DRG changes was assessed; a 39% reduction in operating losses occurred. Regression analysis of 1989 DRG case weight on cost indicated that MST DRGs were better predictors of resource utilization than other trauma DRGs. Review of NYS data affirmed that only 10% of trauma patients were assigned MST DRGs and 63% of trauma patients were discharged from community hospitals. On a national level, the effect of the new Medicare MST DRGs would be minimal, since only 5% of Medicare patients were assigned MST DRGs. Although improvements have been made, reimbursement for trauma care must be addressed further.

Adolescent↗
PubMed1992

[Thoracopulmonary complications of fresh fractures of the thoracic spine with neurologic damage].

The number of thoracic injuries associated to traumatic fractures of the spine is increasing. The multiple trauma rate in this retrospective study of 253 spinal injuries with neurological damage, which needed admission to the Intensive Care Unit, was of 55%. Blunt chest trauma was found in 86% of the multiple trauma group, especially in combination with fractures of the upper and middle thoracic spine (up to 100%), while head injuries appeared in only 58%. Hemopneumothorax was diagnosed in 88%, pulmonary contusion in 48% of the cases, leading to a high rate of recidivating atelectasis and pneumonia. Emergent chest computed tomography should therefore be obligatory in thoracic spine fractures.

Adolescent↗
PubMed1997

[Physical trauma and multiple sclerosis].

Without a more detailed knowledge of etiology and pathogenesis of multiple sclerosis final conclusions regarding an association between physical trauma and the onset or course of multiple sclerosis cannot be drawn. Only a few prospective studies which are appropriately designed to prove a putative correlation have been published. A critical review of these studies and some case reports, in the light of the current pathophysiological concepts of multiple sclerosis, does not indicate a causal relationship between physical trauma and onset of multiple sclerosis or exacerbations.

Central Nervous System↗