WorldWideScience

Sample records for complex hand trauma

  1. Trauma to the nail complex

    Directory of Open Access Journals (Sweden)

    Jefferson Braga Silva

    2014-04-01

    Full Text Available OBJECTIVE: to analyze the results from surgical intervention to treat trauma of the nail complex.METHODS: we retrospectively reviewed a series of 94 consecutive patients with trauma of the nail complex who were treated between 2000 and 2009. In 42 patients, nail bed suturing was performed. In 27 patients, nail bed suturing was performed subsequent to osteosynthesis of the distal phalanx. In 15, immediate grafting was performed, and in 10, late-stage grafting of the nail bed. The growth, size and shape of the nail were evaluated in comparison with the contralateral finger. The results were obtained by summing scores and classifying them as good, fair or poor.RESULTS: the results were considered to be good particularly in the patients who underwent nail bed suturing or nail bed suturing with osteosynthesis of the distal phalanx. Patients who underwent immediate or late-stage nail grafting had poor results.CONCLUSION: trauma of the nail complex without loss of substance presented better results than did deferred treatment for reconstruction of the nail complex.

  2. Trauma-Focused CBT for Youth with Complex Trauma

    Science.gov (United States)

    Cohen, Judith A.; Mannarino, Anthony P.; Kliethermes, Matthew; Murray, Laura A.

    2012-01-01

    Objectives: Many youth develop complex trauma, which includes regulation problems in the domains of affect, attachment, behavior, biology, cognition, and perception. Therapists often request strategies for using evidence-based treatments (EBTs) for this population. This article describes practical strategies for applying Trauma-Focused Cognitive…

  3. Hand trauma: A prospective observational study reporting diagnostic concordance in emergency hand trauma which supports centralised service improvements.

    Science.gov (United States)

    Miranda, B H; Spilsbury, Z P; Rosala-Hallas, A; Cerovac, S

    2016-10-01

    Hand injuries are common, contributing up to 30% of accident and emergency (A&E) attendances. The aim of this study was to prospectively analyse the pathological demographics of hand injuries in a level 1 trauma centre with a Hand Trauma Unit and direct A&E links, and compare clinical and intra-operative findings. The null hypothesis was that there would be no differences between clinical and intra-operative findings (100% diagnostic concordance). Data were prospectively collected for referrals during 2012. Referral diagnosis, additional pathologies found on clinical assessment and intra-operative findings were documented on a live database accessible from both the Hand Unit and associated operating theatres. Odds ratios were calculated using SAS. Injuries (1526) were identified in 1308 patients included in the study. Diagnostic concordance between Hand Unit clinical examination and intra-operative findings was 92.5% ± 2.85% (mean ± SEM); this was lower for flexor tendon injuries (56.3%) because a greater number of additional pathologies were found intra-operatively (2.25 ± 0.10). This 'trend' was noted across multiple referral pathologies including phalangeal fractures (1.28 ± 0.02; 82.9%), lacerations (1.33 ± 0.04; 79.1%), extensor tendon injuries (1.30 ± 0.05; 87.8%) and dislocations (1.18 ± 0.05; 87.8%). Odds ratio analysis indicated a relationship between primary referral diagnoses that were more or less likely to be associated with additional injuries (p management of hand trauma. Our findings, coupled with the presented relevant literature reports, lead us to advocate that A&E departments should move towards a system wherein links to specialist hand trauma services are in place; we hereby present useful data for hospitals implementing such services. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

  4. [Algorithms for treatment of complex hand injuries].

    Science.gov (United States)

    Pillukat, T; Prommersberger, K-J

    2011-07-01

    The primary treatment strongly influences the course and prognosis of hand injuries. Complex injuries which compromise functional recovery are especially challenging. Despite an apparently unlimited number of injury patterns it is possible to develop strategies which facilitate a standardized approach to operative treatment. In this situation algorithms can be important guidelines for a rational approach. The following algorithms have been proven in the treatment of complex injuries of the hand by our own experience. They were modified according to the current literature and refer to prehospital care, emergency room management, basic strategy in general and reconstruction of bone and joints, vessels, nerves, tendons and soft tissue coverage in detail. Algorithms facilitate the treatment of severe hand injuries. Applying simple yes/no decisions complex injury patterns are split into distinct partial problems which can be managed step by step.

  5. Investigation of hand function among children diagnosed with autism spectrum disorder with upper extremity trauma history.

    Science.gov (United States)

    Huri, Meral; Şahin, Sedef; Kayıhan, Hülya

    2016-11-01

    The present study was designed to compare hand function in autistic children with history of upper extremity trauma with that of autistic children those who do not have history of trauma. The study group included total of 65 children diagnosed with autism spectrum disorder (ASD) and was divided into 2 groups: children with trauma history (Group I) and control group (Group II) (Group I: n=28; Group II: n=37). Hand function was evaluated with 9-Hole Peg Test and Jebsen Hand Function Test. Somatosensory function was evaluated using somatosensory subtests of Sensory Integration and Praxis Test. Results were analyzed with Student's t-test and Mann-Whitney U test using SPSS version 20 software. Hand function and somatosensory perception test scores were statistically significantly better in children without upper extremity trauma history (pManual Form Perception and Localization of Tactile Stimuli Test results (p<0.05). Autistic children with upper extremity trauma history had poor somatosensory perception and hand function. It is important to raise awareness among emergency service staff and inform them about strong relationship between somatosensory perception, hand function, and upper extremity trauma in children with ASD in order to develop appropriate rehabilitation process and prevent further trauma.

  6. [Optimising care structures for severe hand trauma and replantation and chances of launching a national network].

    Science.gov (United States)

    Haas, E M; Volkmer, E; Holzbach, T; Wallmichrath, J; Engelhardt, T O; Giunta, R E

    2013-12-01

    Severe hand traumata have a significant impact on our health system and on insurance companies, respectively. It is estimated that 33% of all occupational injuries and 9% of all invalidity pensions are due to severe hand trauma. Unfortunately, these high numbers are not only due to the severity of the trauma but to organisational deficiencies. Usually, the patient is treated at the general surgical emergency in the first place and only then forwarded to a microsurgeon. This redirection increases the time that is required for the patient to finally arrive at an expert for hand surgery. On the one hand, this problem can be explained by the population's lack of awareness for distinguished experts for hand and microsurgery, on the other hand, the emergency network, or emergency doctors in particular are not well informed about where to take a patient with a severe hand trauma - clearly a problem of communication between the hospitals and the ambulance. It is possible to tackle this problem, but put participating hand trauma centres have to work hand in hand as a network and thus exploit synergy effects. The French system "FESUM" is a good example for such a network and even comprises centres in Belgium and Switzerland. To improve the treatment of severe hand trauma, a similar alliance was initiated in Germany just recently. The pilot project "Hand Trauma Alliance" (www.handverletzung.com) was started in April 2013 and currently comprises two hospitals within the region of upper Bavaria. The network provides hand trauma replantation service on a 24/7 basis and aims at shortening the way from the accident site to the fully qualified hand surgeon, to improve the therapy of severe hand injuries and to optimise acute patient care in general. In order to further increase the alliance's impact it is intended to extend the project's scope from regional to national coverage - nevertheless, such an endeavour can only be done in collaboration with the German Society for Hand

  7. Therapeutic Doll Making in Art Psychotherapy for Complex Trauma

    Science.gov (United States)

    Stace, Sonia M.

    2014-01-01

    Therapeutic doll making can hold diverse functions for clients in therapy, particularly for those clients who are working through complex trauma histories. Recent literature pertaining to the treatment of complex trauma suggests that talking treatments have their limits; supplementary therapeutic approaches that focus on sensory, physical,…

  8. Cumulative trauma and symptom complexity in children: a path analysis.

    Science.gov (United States)

    Hodges, Monica; Godbout, Natacha; Briere, John; Lanktree, Cheryl; Gilbert, Alicia; Kletzka, Nicole Taylor

    2013-11-01

    Multiple trauma exposures during childhood are associated with a range of psychological symptoms later in life. In this study, we examined whether the total number of different types of trauma experienced by children (cumulative trauma) is associated with the complexity of their subsequent symptomatology, where complexity is defined as the number of different symptom clusters simultaneously elevated into the clinical range. Children's symptoms in six different trauma-related areas (e.g., depression, anger, posttraumatic stress) were reported both by child clients and their caretakers in a clinical sample of 318 children. Path analysis revealed that accumulated exposure to multiple different trauma types predicts symptom complexity as reported by both children and their caretakers. Copyright © 2013 Elsevier Ltd. All rights reserved.

  9. Hand cumulative trauma disorders in Nigerian custom tailors: the need for redesign of manual scissors.

    Science.gov (United States)

    Adeleye, Adedoyin Abiodun; Akanbi, Olusegun Gabriel

    2015-01-01

    Cutting scissors are important working tools for Nigerian custom tailors (CTs) but its usage apparently does not meet the ergonomics need of these artisans. A survey was carried out amongst CTs using questionnaires to obtain their background social-occupational demographics and observation methods to study their work performance, use of scissors and any cumulative trauma disorder (CTD) in their hands. Thicknesses of various fabrics were measured and comparison between Western world's custom tailoring job and the Nigerian type was done. The results showed some CTD risk factors with finger contusions on the 71 CTs evaluated. The right-hand contusions were traced to the constant usage of unpadded manual scissors with ungloved hands. Disparity between Western and Nigerian tailoring practice may account for the high occurrence of disorders in Nigerian CTs. Since hand dimensions are crucial in the design of hand tools, it is therefore concluded that hand anthropometry of Nigerian CTs and soft padding of manual scissors may mitigate CTD burdens on CTs' hands. Cumulative trauma disorders on the hands of low-income Nigerian CTs needed investigation. This was done via self-assessment and observational methods of the artisans’ work system. Frequent usage of unpadded manual scissors with un-gloved hands cause and exacerbate the problem. Hand anthropometry of users is crucial in scissors manufacturing.

  10. A sticky situation: methaemaglobinaemia in a hand trauma patient.

    Science.gov (United States)

    Sheena, Yezen; Baston, Emma Louise; Downs, Andrew; Chester, Darren L

    2012-11-11

    We describe a case of methaemoglobinaemia (MtHb) in a previously healthy 39-year-old gentleman who presented with a traumatic glass laceration to his right wrist that required emergency surgery to control bleeding and repair his ulnar artery. The MtHb was noted on blood gas analysis by the anaesthetist after the patient had a drop in arterial oxygen saturation under general anaesthetic. We initially suspected the lidocaine local anaesthetic injected proximal to his wound for pain control in the emergency department an hour preoperatively, but then discovered that the patient was a recreational user of 'poppers' and had in fact been using these drugs just before his injury and hospitalisation. The patient's condition stabilised overnight with conservative management. Given how commonly hand surgeons and other clinical staff use local anaesthetics, we reviewed the literature on this uncommon, but potentially fatal, complication, its causes and evidence-based management.

  11. Maxillofacial trauma: managing potentially dangerous and disfiguring complex injuries [digest].

    Science.gov (United States)

    Das, Devjani; Salazar, Lea; Zaurova, Milana

    2017-04-22

    Patients with maxillofacial trauma require a careful evaluation due to the anatomical proximity of the maxillofacial region to the head and neck. Facial injuries can range from soft-tissue lacerations and nondisplaced nasal fractures to severe, complex fractures, eye injuries, and possible brain injury. Though the Advanced Trauma Life Support (ATLS) guidelines provide a framework for the management of trauma patients, they do not provide a detailed reference for many subtle or complex facial injuries. This issue adds a more comprehensive and systematic approach to the secondary survey of the maxillofacial area and emergency department management of injuries to the face. In addition to an overall review of maxillofacial trauma pathophysiology, associated injuries, and physical examination, this review will also discuss relevant imaging, treatment, and disposition plans. [Points & Pearls is a digest of Emergency Medicine Practice].

  12. "Homelessness and trauma go hand-in-hand": pathways to homelessness among women veterans.

    Science.gov (United States)

    Hamilton, Alison B; Poza, Ines; Washington, Donna L

    2011-01-01

    Veterans comprise a disproportionate fraction of the nation's homeless population, with women veterans up to four times more likely to be homeless than non-veteran women. This paper provides a grounded description of women veterans' pathways into homelessness. Three focus groups were held in Los Angeles, California, with a total of 29 homeless women veterans. Five predominant "roots" (precipitating experiences) initiated pathways toward homelessness: 1) childhood adversity, 2) trauma and/or substance abuse during military service, 3) post-military abuse, adversity, and/or relationship termination, 4) post-military mental health, substance abuse, and/or medical problems, and 5) unemployment. Contextual factors, which promoted development of homelessness in the setting of primary roots, included women veterans' "survivor instinct," lack of social support and resources, sense of isolation, pronounced sense of independence, and barriers to care. These contextual factors also reinforced persistence of the roots of post-military adversity and mental health and substance abuse problems, serving to maintain cycles of chronic homelessness. Collectively, these multiple, interacting roots and contextual factors form a "web of vulnerability" that is a target for action. Multiple points along the pathways to homelessness represent critical junctures for VA and community-based organizations to engage in prevention or intervention efforts on behalf of women veterans. Considering the multiple, interconnected challenges that these women veterans described, solutions to homelessness should address multiple risk factors, include trauma-informed care that acknowledges women veterans' traumatic experiences, and incorporate holistic responses that can contribute to healing and recovery. Published by Elsevier Inc.

  13. Reliability of the "Ten Test" for assessment of discriminative sensation in hand trauma.

    Science.gov (United States)

    Berger, Michael J; Regan, William R; Seal, Alex; Bristol, Sean G

    2016-10-01

    "Ten Test" (TT) is a bedside measure of discriminative sensation, whereby the magnitude of abnormal sensation to moving light touch is normalized to an area of normal sensation on an 11-point Likert scale (0-10). The purposes of this study were to determine reliability parameters of the TT in a cohort of patients presenting to a hand trauma clinic with subjectively altered sensation post-injury and to compare the reliability of TT to that of the Weinstein Enhanced Sensory Test (WEST). Study participants (n = 29, mean age = 37 ± 12) comprised patients presenting to an outpatient hand trauma clinic with recent hand trauma and self reported abnormal sensation. Participants underwent TT and WEST by two separate raters on the same day. Interrater reliability, response stability and responsiveness of each test were determined by the intraclass correlation coefficient (ICC: 2, 1), standard error of measurement (SEM) with 95% confidence intervals (CI) and minimal detectable difference score, with 95% CI (MDD95), respectively. The TT displayed excellent interrater reliability (ICC = 0.95, 95% CI 0.89-0.97) compared to good reliability for WEST (ICC = 0.78, 95% CI 0.58-0.89). The range of true scores expected with 95% confidence based on the SEM (i.e. response stability), was ±1.1 for TT and ±1.1 for WEST. MDD95 scores reflecting test responsiveness were 1.5 and 1.6 for TT and WEST, respectively. The TT displayed excellent reliability parameters in this patient population. Reliability parameters were stronger for TT compared to WEST. These results provide support for the use of TT as a component of the sensory exam in hand trauma. Copyright © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  14. Percussion hemoglobinuria - a novel term for hand trauma-induced mechanical hemolysis: a case report

    Directory of Open Access Journals (Sweden)

    Hariharan Sundaram

    2011-10-01

    Full Text Available Abstract Introduction Extracorpuscular hemolysis caused by mechanical trauma has been well described in relation to lower extremity use, such as in soldiers and runners. Terms such as "march hemoglobinuria", "foot strike hemolysis" and "runners hemoglobinuria" have previously been coined and are easily recalled. Newer cases, however, are being identified in individuals vigorously using their upper extremities, such as drum players who use their hands to strike the instrument. Given the increased recognition of upper extremity-related mechanical hemolysis and hemoglobinuria in drummers, and the use of hand drumming worldwide, we would like introduce a novel term for this condition and call it "percussion hemoglobinuria". Case presentation A 24-year-old Caucasian man presented with reddish brown discoloration of his urine after playing the djembe drum. Urine examination after a rigorous practice session revealed blood on the dipstick, and 0 to 2 red blood cells per high power field microscopically. The urine sample was negative for myoglobulin. Other causes of hemolysis and hematuria were excluded and cessation of drum playing resulted in resolution of his symptoms. Conclusions The association of mechanical trauma-induced hemoglobinuria and playing hand percussion instruments is increasingly being recognized. We, however, feel that the true prevalence is higher than what has been previously recorded in the literature. By coining the term "percussion hemoglobinuria" we hope to raise the awareness of screening for upper extremity trauma-induced mechanical hemolysis in the evaluation of a patient with hemoglobinuria.

  15. The Complex Trauma Questionnaire (ComplexTQ:Development and preliminary psychometric properties of an instrument for measuring early relational trauma

    Directory of Open Access Journals (Sweden)

    Carola eMaggiora Vergano

    2015-09-01

    Full Text Available Research on the etiology of adult psychopathology and its relationship with childhood trauma has focused primarily on specific forms of maltreatment. This study developed an instrument for the assessment of childhood and adolescence trauma that would aid in identifying the role of co-occurring childhood stressors and chronic adverse conditions. The Complex Trauma Questionnaire (ComplexTQ, in both clinician and self-report versions, is a measure for the assessment of multi-type maltreatment: physical, psychological, and sexual abuse; physical and emotional neglect as well as other traumatic experiences, such rejection, role reversal, witnessing domestic violence, separations, and losses. The four-point Likert scale allows to specifically indicate with which caregiver the traumatic experience has occurred. A total of 229 participants, a sample of 79 nonclinical and that of 150 high-risk and clinical participants, were assessed with the ComplexTQ clinician version applied to Adult Attachment Interview (AAI transcripts. Initial analyses indicate acceptable inter-rater reliability. A good fit to a 6-factor model regarding the experience with the mother and to a 5-factor model with the experience with the father was obtained; the internal consistency of factors derived was good. Convergent validity was provided with the AAI scales. ComplexTQ factors discriminated normative from high-risk and clinical samples. The findings suggest a promising, reliable, and valid measurement of early relational trauma that is reported; furthermore, it is easy to complete and is useful for both research and clinical practice.

  16. Skeletal scintigraphy of the hands and wrists: Trauma, tumors, infections, and other inflammation

    International Nuclear Information System (INIS)

    Lecklitner, M.L.; Douglas, K.P.

    1986-01-01

    Evaluation of metastatic disease continues to be the most frequent indication for bone scintigraphy; however, the role of skeletal scintigraphy has been expanded within the past 5 to 10 years to evaluate more and more conditions of benignity. Understandably, detailed static images of the hands and wrists have rarely been considered an integral part of scintigraphic skeletal surveys for metastases. Several recent reports have emphasized static detailed hand views in the evaluation of trauma and endocrinopathies. First-pass and recirculation imaging has been popularized in the past several years as an indicator of vascular and extravascular disease. Within the context of triple-phase imaging, many reports have focused on the hand and wrist. Most recently, hemodynamic artifacts during hand scintievaluation have been reported to result from induced ischemia of the upper extremity. The purpose of this paper is to bring together current knowledge concerning the indications for hand scintigraphy, to furnish a background of epidemiology and pathogenesis concerning selected disease states of the hand, and to share the authors' experience as illustrated by patient studies in which skeletal scintigraphic imaging is established or is being currently investigated

  17. [Complex Trauma-related Disorders in Research and Practice].

    Science.gov (United States)

    Metzner, Franka; Pahlke, Stephanie; Diesing, Alice; Marin, Nina; Klasen, Fionna; Pawils, Silke; Schulte-Markwort, Michael; Richter-Appelt, Hertha

    2018-03-01

    Complex Trauma-related Disorders in Research and Practice Frequent traumata in childhood and adolescence are long-term or repeated interpersonal traumata caused by perpetrators in the close environment of the minors. For the description of the extensive symptoms after interpersonal Type II traumata, the complex trauma-related disorders Complex Posttraumatic Stress Disorder (CPTSD) or Disorder of Extreme Stress Not Otherwise Specified (DESNOS) and the Developmental Trauma Disorder (DTD) are being discussed for inclusion in the classification systems for mental disorders. Scientific knowledge and practical experiences regarding CPTSD, DESNOS and DTD in children and adolescents up to 18 years were examined by 1) a Systematic Review of 1,070 publications identified by database research and additional search strategies, and 2) a nationwide online survey of 374 psychotherapists and psychiatrists for children and adolescents in Germany. Of 13 included empirical studies (8 CPTSD or DESNOS, 5 DTD), 9 were conducted in the USA, 4 based on file coding and 3 on secondary data analysis and only 7 reported diagnosis rates (range: 0-78 %). Of the interviewed therapists, 100 % considered the CPTSD as being met with at least one patient with interpersonal traumata up to 18 years of age in 2014 and 99 % gave this estimate for the DTD. Two thirds of therapists rated the diagnostic option CPTSD and DTD as "very often" or "often" helpful for their therapeutic work with children and adolescents. While empirical data available is to be considered insufficient and characterized by methodological limitations, the relevance of complex trauma-related disorders is perceived as high by practitioners.

  18. Finger functionality and joystick design for complex hand control

    NARCIS (Netherlands)

    Grinten, M.P. van der; Krause, F.

    2006-01-01

    Joysticks and similar multi-directional controls are increasingly applied in machines, instruments and consumer goods. Operational complexity rises through miniaturization and additional control functions on the joystick. With this the effort for the finger, hand and arm, and for the perceptive and

  19. Complex sequelae of psychological trauma among Kosovar civilian war victims.

    Science.gov (United States)

    Morina, Nexhmedin; Ford, Julian D

    2008-09-01

    The impact of war trauma on civilians may include, but also extend beyond, post-traumatic stress disorder (PTSD) to include complex sequelae such as those described by the syndrome of Disorders of Extreme Stress Not Otherwise Specified (DESNOS). In the present study, 102 civilian war victims were interviewed in Kosovo, assessing traumatic life events, PTSD, DESNOS, and depression. Full DESNOS rarely occurred (2% prevalence), however, clinically significant DESNOS symptoms of somatization, altered relationships, and altered systems of meaning were reported by between 24-42% of respondents. Although DESNOS symptoms were correlated with PTSD symptoms, DESNOS symptoms were associated with poorer overall psychological functioning, self-evaluations, satisfaction with life, and social support independent of the effects of PTSD. The findings suggest that DESNOS warrants attention in addition to PTSD in the assessment and treatment of civilians who have been exposed to war and genocide.

  20. EthoHand: A dexterous robotic hand with ball-joint thumb enables complex in-hand object manipulation

    OpenAIRE

    Konnaris, C; Gavriel, C; Thomik, AAC; Aldo Faisal, A

    2016-01-01

    Our dexterous hand is a fundmanetal human feature that distinguishes us from other animals by enabling us to go beyond grasping to support sophisticated in-hand object manipulation. Our aim was the design of a dexterous anthropomorphic robotic hand that matches the human hand's 24 degrees of freedom, under-actuated by seven motors. With the ability to replicate human hand movements in a naturalistic manner including in-hand object manipulation. Therefore, we focused on the development of a no...

  1. Decision-Making in Management of the Complex Trauma Patient: Changing the Mindset of the non-trauma Surgeon.

    Science.gov (United States)

    Sonesson, Linda; Boffard, Kenneth; Lundberg, Lars; Rydmark, Martin; Karlgren, Klas

    2018-01-16

    European surgeons are frequently subspecialized and trained primarily in elective surgical techniques. As trauma leaders, they may occasionally have to deal with complex polytrauma, advanced management techniques, differing priorities, and the need for multidisciplinary care. There is a lack of expertise, experience, and a low trauma volume, as well as a lack of research, with limited support as to the decision-making and teaching challenges present. We studied what experienced trauma experts describe as the challenges that are specific to the advanced surgical decision-making required, whether civilian, humanitarian, or military. Design-based research using combined methods including interviews, reviews of authentic trauma cases, and video-recorded resuscitations performed at a high-volume civilian academic trauma center. Several educational dilemmas were identified: (1) thinking physiologically, (2) the application of damage control resuscitation and surgery, (3) differing priorities and time management, (4) impact of environment, (5) managing limited resources, (6) lack of general surgical skills, (7) different cultural behavior, and (8) ethical issues. The challenges presented, and the educational domains identified, constitute a basis for improved development of education and training in complex surgical decision-making. This study contributes new knowledge about the mindset required for decision-making in patients with complex multisystem trauma and competing priorities of care. This is, especially important in countries having a low intensity of trauma in both military and civilian environments, and consequential limited skills, and lack of expertise. Guidelines focused on the same decision-making process, using virtual patients and blended learning, can be developed.

  2. Fusarium dimerum Species Complex (Fusarium penzigii) Keratitis After Corneal Trauma.

    Science.gov (United States)

    do Carmo, Anália; Costa, Esmeralda; Marques, Marco; Quadrado, Maria João; Tomé, Rui

    2016-12-01

    We report a case of a keratitis associated with a Fusarium penzigii-a Fusarium dimerum species complex (FDSC)-in a 81-year-old woman after a corneal trauma with a tree branch. At patient admittance, slit lamp biomicroscopy revealed an exuberant chemosis, an inferior corneal ulcer with an associated inflammatory infiltrate, a central corneal abscess, bullous keratopathy and posterior synechiae. Corneal scrapes were obtained for identification of bacteria and fungi, and the patient started antibiotic treatment on empirical basis. Few days later, the situation worsened with the development of hypopyon. By that time, Fusarium was identified in cultures obtained from corneal scrapes and the patient started topical amphotericin B 0.15 %. Upon the morphological identification of the Fusarium as a FDSC, and since there was no clinical improvement, the treatment with amphotericin B was suspended and the patient started voriconazole 10 mg/ml, eye drops, hourly and voriconazole 200 mg iv, every 12 h for 1 month. The hypopyon resolved and the inflammatory infiltrate improved, but the abscess persisted at the last follow-up visit. The molecular identification revealed that the FDSC was a F. penzigii.

  3. TRAUMA

    African Journals Online (AJOL)

    trauma and on most vascular injuries. South Africa is one of the few .... scan of the brain and abdomen showed a sliver of left subdural and subarachnoid .... and especially on RT. In the event of a life-threatening condition, the rapid response ...

  4. TRAUMA

    African Journals Online (AJOL)

    2017-11-04

    Nov 4, 2017 ... However, the physical and financial resources to manage this massive burden of disease are inadequate. This is especially the case in terms of access to critical care facilities. The development of an electronic trauma registry at our institution has allowed us to capture data in real time on all patients and.

  5. TRAUMA

    African Journals Online (AJOL)

    2017-11-04

    Nov 4, 2017 ... unit in Durban, and to correlate it with injury severity, length of hospital stay ... and via a password protected mobile application program within 6 ..... usage and costs performed in larger numbers on major trauma patients will ...

  6. Developmental trauma, complex PTSD, and the current proposal of DSM-5

    Directory of Open Access Journals (Sweden)

    Vedat Sar

    2011-03-01

    Full Text Available This paper evaluates representation of clinical consequences of developmental psychological trauma in the current proposal of DSM-5. Despite intensive efforts by its proponents for two decades, it is not known yet if Complex PTSD will take a place in the final version of DSM-5. Recognition of dissociative character of several symptom dimensions and introduction of items about negative affects such as shame and guilt imply an indirect improvement toward better coverage of the consequences of developmental trauma in the existing category of PTSD. As disorders with highest prevalence of chronic traumatization in early years of life, dissociative disorders and personality disorder of borderline type are maintained as DSM-5 categories; however, recognition of a separate type of trauma-related personality disorder is unlikely. While a preschooler age variant of PTSD is under consideration, the proposed diagnosis of Developmental Trauma Disorder (child version of Complex PTSD has not secured a place in the DSM-5 yet. We welcome considerations of subsuming Adjustment Disorders, Acute Stress Disorder, PTSD, and Dissociative Disorders under one rubric, i.e., Section of Trauma, Stress, or Event Related Disorders. Given the current conceptualization of DSM-5, this paper proposes Complex PTSD to be a subtype of the DSM-5 PTSD. Composition of a trauma-related disorders section would facilitate integration of knowledge and expertise about interrelated and overlapping consequences of trauma.For the abstract or full text in other languages, please see Supplementary files under Reading Tools online

  7. Trauma complexity and child abuse: A qualitative study of attachment narratives in adult refugees with PTSD.

    Science.gov (United States)

    Riber, Karin

    2017-01-01

    The present study aimed to identify trauma types over the life course among adult refugees and to explore their accounts of childhood maltreatment. A sample of 43 Arabic-speaking refugees with posttraumatic stress disorder (PTSD) attending a treatment context in Denmark were interviewed. Using a "Trauma Coding Manual" developed for this study, trauma types were identified in interview transcripts. In both men and women with Iraqi and Palestinian-Lebanese backgrounds, high levels of trauma complexity and high rates of childhood maltreatment were found (63%, n = 27). A number of concepts and categories emerged in the domains childhood physical abuse (CPA), childhood emotional abuse (CEA), and neglect. Participants articulated wide personal impacts of child abuse in emotional, relational, and behavioral domains in their adult lives. These narratives contribute valuable clinical information for refugee trauma treatment providers.

  8. Trauma complexo e suas implicações diagnósticas Complex trauma and diagnostic implications

    Directory of Open Access Journals (Sweden)

    Thiago Wendt Viola

    2011-01-01

    Full Text Available A exposição prolongada a múltiplos eventos traumáticos de natureza interpessoal, sobretudo durante o desenvolvimento, tem demonstrado consequências e sintomas psiquiátricos não considerados pelo atual diagnóstico de transtorno de estresse pós-traumático (TEPT. Essas situações negativas e crônicas durante a infância e adolescência evidenciam a existência de uma síndrome psicopatológica associada a complexas (desadaptações a efeitos traumáticos diversos. A ausência de um diagnóstico coeso e fidedigno para essas vítimas interfere negativamente na identificação sintomatológica e no método de tratamento. O presente trabalho visa revisar a definição de trauma, apresentando o conceito de trauma complexo, explorando suas implicações clínicas, bem como as categorias diagnósticas derivadas desse constructo. Importantes questões são levantadas acerca das diferenças entre trauma complexo e TEPT, investigando os sintomas e transtornos comórbidos ao diagnóstico de TEPT, assim como as limitações inerentes a esse diagnóstico. Considerando o impacto psicopatológico relacionado ao trauma complexo, discute-se a possível inserção de uma nova categoria diagnóstica na 5ª versão do Manual Diagnóstico e Estatístico dos Transtornos Mentais, adjunta ao espectro de psicopatologias pós-traumáticas.Prolonged exposure to multiple traumatic events of an interpersonal nature, particularly during development, has shown psychological consequences and symptoms not included among the current diagnostic criteria of post-traumatic stress disorder (PTSD. These negative and chronic situations during childhood and adolescence provide further evidence of the existence of a psychopathological syndrome associated with complex (disadaptations to a number of traumatic effects. The absence of a cohesive and reliable diagnosis for these patients negatively affects symptom identification and treatment planning. The aim of the present study

  9. Measuring acute rehabilitation needs in trauma: preliminary evaluation of the Rehabilitation Complexity Scale.

    Science.gov (United States)

    Hoffman, Karen; West, Anita; Nott, Philippa; Cole, Elaine; Playford, Diane; Liu, Clarence; Brohi, Karim

    2013-01-01

    Injury severity, disability and care dependency are frequently used as surrogate measures for rehabilitation requirements following trauma. The true rehabilitation needs of patients may be different but there are no validated tools for the measurement of rehabilitation complexity in acute trauma care. The aim of the study was to evaluate the potential utility of the Rehabilitation Complexity Scale (RCS) version 2 in measuring acute rehabilitation needs in trauma patients. A prospective observation study of 103 patients with traumatic injuries in a Major Trauma Centre. Rehabilitation complexity was measured using the RCS and disability was measured using the Barthel Index. Demographic information and injury characteristics were obtained from the trauma database. The RCS was closely correlated with injury severity (r=0.69, p<0.001) and the Barthel Index (r=0.91, p<0.001). However the Barthel was poor at discriminating between patients rehabilitation needs, especially for patients with higher injury severities. Of 58 patients classified as 'very dependent' by the Barthel, 21 (36%) had low or moderate rehabilitation complexity. The RCS correlated with acute hospital length of stay (r=0.64, p=<0.001) and patients with a low RCS were more likely to be discharged home. The Barthel which had a flooring effect (56% of patients classified as very dependent were discharged home) and lacked discrimination despite close statistical correlation. The RCS outperformed the ISS and the Barthel in its ability to identify rehabilitation requirements in relation to injury severity, rehabilitation complexity, length of stay and discharge destination. The RCS is potentially a feasible and useful tool for the assessment of rehabilitation complexity in acute trauma care by providing specific measurement of patients' rehabilitation requirements. A larger longitudinal study is needed to evaluate the RCS in the assessment of patient need, service provision and trauma system performance

  10. Experience of a national campaign for hand trauma prevention in France.

    Science.gov (United States)

    Bellemere, P; Guimberteau, J C

    2013-12-01

    In France, hand injuries are the number one cause of all accidents referred to our hospital casualty departments. Their human and economic consequences are very serious. Two thirds of these accidents arise during everyday living activities and a third of them happen at work. The specific prevention of hand injuries in each of these domains has not been sufficiently developed. The authors present the national prevention campaign recently set up by the FESUM. The campaign took place in the form of events held in different towns in France. Each event, lasting from a minimum of 2 days to 10 days maximum, included press conferences, prevention workshops specific to hand injuries, theatrical animation for youngsters, conferences for the general public, meetings in industrial or training college environments, photography and video exhibitions, and the publication of pamphlets and posters. These manifestations were carried out in partnership with the association APAVC and the voluntary involvement of surgeons from the FESUM hand centres in each town visited. Over a period of 2 years, 22 large or medium-sized towns were able to hold these campaign events. By this means, thousands of people - adults, schoolchildren or young, professional apprentices - were made aware of hand injuries and how to prevent them. We were able to reinforce the broadcasting of simple prevention messages launched by the campaign, particularly with regard to wearing gloves for all manual activities, with the help of heavy local, regional and national media coverage. This campaign was the first widespread action of its kind, aimed specifically at the prevention of hand injuries. Furthermore, it was a way of strengthening the credibility of the FESUM hand emergency centres with the health authorities and to promote the services available to patients. © Georg Thieme Verlag KG Stuttgart · New York.

  11. Epidemiology of Hand Injuries in Children Presenting to an Orthopedic Trauma Center in Southeast of Iran

    Directory of Open Access Journals (Sweden)

    Maryam Mirzaie

    2014-09-01

    Full Text Available Background:  Hand injuries are among the most common childhood injuries. No study has been performed regarding the epidemiology of hand injuries in the pediatric population of Iran. This study aimed to examine the epidemiology of hand injuries among children in southeast of Iran.   Methods:  This cross-sectional study was performed via census sampling on patients, aged 16 years or less, with a final diagnosis of hand injury. Patients presenting to the orthopedic department of Khatam-al-Anbia General Hospitalof Zahedan, Iran, were selected from March 2012 to December 2013. Data were analyzed  trospectively, using a chart review. Results:  Two-hundred patients (136 males and 64 females with the mean age of 13±2.8 years with 205 hand injuries were included in this study. As the results indicated, door-related injuries were the most common type (25%, accounting for 24% and 28% of injuries in male and female patients, respectively (P=0.016. Most injuries occurred at home (64% and the lowest number was reported at school(22% (P=0.012. Compared to boys, girls were more likely to be injured at home (78% vs. 57% (P=0.13. In addition, the dominant hand was mostly injured by doors (28%. The most common type of injury was laceration(81% and the least common type was finger amputation (7%; also, children with finger amputation were significantly younger than those with other types of hand injuries (P

  12. Therapeutic Assessment of Complex Trauma: A Single-Case Time-Series Study.

    Science.gov (United States)

    Tarocchi, Anna; Aschieri, Filippo; Fantini, Francesca; Smith, Justin D

    2013-06-01

    The cumulative effect of repeated traumatic experiences in early childhood incrementally increases the risk of adjustment problems later in life. Surviving traumatic environments can lead to the development of an interrelated constellation of emotional and interpersonal symptoms termed complex posttraumatic stress disorder (CPTSD). Effective treatment of trauma begins with a multimethod psychological assessment and requires the use of several evidence-based therapeutic processes, including establishing a safe therapeutic environment, reprocessing the trauma, constructing a new narrative, and managing emotional dysregulation. Therapeutic Assessment (TA) is a semistructured, brief intervention that uses psychological testing to promote positive change. The case study of Kelly, a middle-aged woman with a history of repeated interpersonal trauma, illustrates delivery of the TA model for CPTSD. Results of this single-case time-series experiment indicate statistically significant symptom improvement as a result of participating in TA. We discuss the implications of these findings for assessing and treating trauma-related concerns, such as CPTSD.

  13. Epidemiology of Hand Injuries in Children Presenting to an Orthopedic Trauma Center in Southeast of Iran

    Directory of Open Access Journals (Sweden)

    Maryam Mirzaie

    2014-09-01

     Two-hundred patients (136 males and 64 females with the mean age of 13±2.8 years with 205 hand injuries were included in this study. As the results indicated, door-related injuries were the most common type (25%, accounting for 24% and 28% of injuries in male and female patients, respectively (P=0.016. Most injuries occurred at home (64% and the lowest number was reported at school(22% (P=0.012. Compared to boys, girls were more likely to be injured at home (78% vs. 57% (P=0.13. In addition, the dominant hand was mostly injured by doors (28%. The most common type of injury was laceration(81% and the least common type was finger amputation (7%; also, children with finger amputation were significantly younger than those with other types of hand injuries (P

  14. Spacesuit Glove-Induced Hand Trauma and Analysis of Potentially Related Risk Variables

    Science.gov (United States)

    Charvat, Chacqueline M.; Norcross, Jason; Reid, Christopher R.; McFarland, Shane M.

    2015-01-01

    Injuries to the hands are common among astronauts who train for extravehicular activity (EVA). When the gloves are pressurized, they restrict movement and create pressure points during tasks, sometimes resulting in pain, muscle fatigue, abrasions, and occasionally more severe injuries such as onycholysis. Glove injuries, both anecdotal and recorded, have been reported during EVA training and flight persistently through NASA's history regardless of mission or glove model. Theories as to causation such as glove-hand fit are common but often lacking in supporting evidence. Previous statistical analysis has evaluated onycholysis in the context of crew anthropometry only. The purpose of this study was to analyze all injuries (as documented in the medical records) and available risk factor variables with the goal to determine engineering and operational controls that may reduce hand injuries due to the EVA glove in the future. A literature review and data mining study were conducted between 2012 and 2014. This study included 179 US NASA crew who trained or completed an EVA between 1981 and 2010 (crossing both Shuttle and ISS eras) and wore either the 4000 Series or Phase VI glove during Extravehicular Mobility Unit (EMU) spacesuit EVA training and flight. All injuries recorded in medical records were analyzed in their association to candidate risk factor variables. Those risk factor variables included demographic characteristics, hand anthropometry, glove fit characteristics, and training/EVA characteristics. Utilizing literature, medical records and anecdotal causation comments recorded in crewmember injury data, investigators were able to identify several risk factors associated with increased risk of glove related injuries. Prime among them were smaller hand anthropometry, duration of individual suited exposures, and improper glove-hand fit as calculated by the difference in the anthropometry middle finger length compared to the baseline EVA glove middle finger length.

  15. Is there Complex Trauma Experience typology for Australian's experiencing extreme social disadvantage and low housing stability?

    Science.gov (United States)

    Keane, Carol A; Magee, Christopher A; Kelly, Peter J

    2016-11-01

    Traumatic childhood experiences predict many adverse outcomes in adulthood including Complex-PTSD. Understanding complex trauma within socially disadvantaged populations has important implications for policy development and intervention implementation. This paper examined the nature of complex trauma experienced by disadvantaged individuals using a latent class analysis (LCA) approach. Data were collected through the large-scale Journeys Home Study (N=1682), utilising a representative sample of individuals experiencing low housing stability. Data on adverse childhood experiences, adulthood interpersonal trauma and relevant covariates were collected through interviews at baseline (Wave 1). Latent class analysis (LCA) was conducted to identify distinct classes of childhood trauma history, which included physical assault, neglect, and sexual abuse. Multinomial logistic regression investigated childhood relevant factors associated with class membership such as biological relationship of primary carer at age 14 years and number of times in foster care. Of the total sample (N=1682), 99% reported traumatic adverse childhood experiences. The most common included witnessing of violence, threat/experience of physical abuse, and sexual assault. LCA identified six distinct childhood trauma history classes including high violence and multiple traumas. Significant covariate differences between classes included: gender, biological relationship of primary carer at age 14 years, and time in foster care. Identification of six distinct childhood trauma history profiles suggests there might be unique treatment implications for individuals living in extreme social disadvantage. Further research is required to examine the relationship between these classes of experience, consequent impact on adulthood engagement, and future transitions though homelessness. Copyright © 2016 Elsevier Ltd. All rights reserved.

  16. “I can't tell whether it's my hand”: a pilot study of the neurophenomenology of body representation during the rubber hand illusion in trauma-related disorders

    Directory of Open Access Journals (Sweden)

    Daniela Rabellino

    2016-11-01

    Full Text Available Background: Early traumatic experiences are thought to be causal factors in the development of trauma-related dissociative experiences, including depersonalization and derealization. The rubber hand illusion (RHI, a well-known paradigm that measures multi-sensorial integration of a rubber hand into one's own body representation, has been used to investigate alterations in the experience of body ownership and of body representation. Critically, however, it has never been studied in individuals with trauma-related disorders. Objective: To investigate body representation distortions occurring in trauma-related disorders in response to the RHI. Method: The RHI was administered to three individuals with the dissociative subtype of posttraumatic stress disorder (PTSD, and subjective, behavioral, cardiovascular and skin conductance responses were recorded. Results: Participants’ subjective experiences of the RHI were differentiated and complex. The illusion was induced following both synchronous and asynchronous brushing and variably evoked subjective distress, depersonalization and derealization experiences, tonic immobility, increased physiological arousal and flashbacks. Conclusions: The present findings point towards the RHI as a strong provocation stimulus that elicits individual patterns of symptom presentation, including experiences of distress and dissociation, in individuals with trauma-related disorders, including the dissociative subtype of PTSD. Highlights of the article:

  17. Complex tasks force hand laterality and technological behaviour in naturalistically housed chimpanzees: inferences in hominin evolution.

    Science.gov (United States)

    Mosquera, M; Geribàs, N; Bargalló, A; Llorente, M; Riba, D

    2012-01-01

    Clear hand laterality patterns in humans are widely accepted. However, humans only elicit a significant hand laterality pattern when performing complementary role differentiation (CRD) tasks. Meanwhile, hand laterality in chimpanzees is weaker and controversial. Here we have reevaluated our results on hand laterality in chimpanzees housed in naturalistic environments at Fundació Mona (Spain) and Chimfunshi Wild Orphanage (Zambia). Our results show that the difference between hand laterality in humans and chimpanzees is not as great as once thought. Furthermore, we found a link between hand laterality and task complexity and also an even more interesting connection: CRD tasks elicited not only the hand laterality but also the use of tools. This paper aims to turn attention to the importance of this threefold connection in human evolution: the link between CRD tasks, hand laterality, and tool use, which has important evolutionary implications that may explain the development of complex behaviour in early hominins.

  18. The rubber hand illusion in complex regional pain syndrome: preserved ability to integrate a rubber hand indicates intact multisensory integration.

    Science.gov (United States)

    Reinersmann, Annika; Landwehrt, Julia; Krumova, Elena K; Peterburs, Jutta; Ocklenburg, Sebastian; Güntürkün, Onur; Maier, Christoph

    2013-09-01

    In patients with complex regional pain syndrome (CRPS) type 1, processing of static tactile stimuli is impaired, whereas more complex sensory integration functions appear preserved. This study investigated higher order multisensory integration of body-relevant stimuli using the rubber hand illusion in CRPS patients. Subjective self-reports and skin conductance responses to watching the rubber hand being harmed were compared among CRPS patients (N=24), patients with upper limb pain of other origin (N=21, clinical control group), and healthy subjects (N=24). Additionally, the influence of body representation (body plasticity [Trinity Assessment of Body Plasticity], neglect-like severity symptoms), and clinical signs of illusion strength were investigated. For statistical analysis, 1-way analysis of variance, t test, Pearson correlation, with α=0.05 were used. CRPS patients did not differ from healthy subjects and the control group with regard to their illusion strength as assessed by subjective reports or skin conductance response values. Stronger left-sided rubber hand illusions were reported by healthy subjects and left-side-affected CRPS patients. Moreover, for this subgroup, illness duration and illusion strength were negatively correlated. Overall, severity of neglect-like symptoms and clinical signs were not related to illusion strength. However, patients with CRPS of the right hand reported significantly stronger neglect-like symptoms and significantly lower illusion strength of the affected hand than patients with CRPS of the left hand. The weaker illusion of CRPS patients with strong neglect-like symptoms on the affected hand supports the role of top-down processes modulating body ownership. Moreover, the intact ability to perceive illusory ownership confirms the notion that, despite impaired processing of proprioceptive or tactile input, higher order multisensory integration is unaffected in CRPS. Copyright © 2013 International Association for the Study

  19. Creating a Safe Space: A Case Study of Complex Trauma and a Call for Proactive Comprehensive Psychoeducational Assessments and Reviews

    Science.gov (United States)

    Mainwaring, Debra J.

    2015-01-01

    This article advocates for proactive, dynamic and comprehensive psycho-educational assessments for children and young people who have a history of complex trauma, because of its known effects on development and learning. A case study is shared of a young woman with a history of complex trauma because of exposure to parental neglect, multiple…

  20. Evidence of Complex Posttraumatic Stress Disorder (CPTSD) across populations with prolonged trauma of varying intensity and ages of exposure

    DEFF Research Database (Denmark)

    Palic, Sabina; Zerach, G; Shevlin, Mark

    2016-01-01

    , with a "Dissociative PTSD-subtype" class. ICD-11's CPTSD was not exclusively associated with childhood abuse, but also with exposure to adulthood trauma of severe interpersonal intensity. Furthermore, all types of prolonged trauma were equally associated with the "Anxiety symptoms" class. Finally, of all the classes......The ICD-11 proposes different types of prolonged trauma as risk factors for complex PTSD (CPTSD). However, CPTSD's construct validity has only been examined in childhood abuse, and single trauma exposure samples. Thus, the extent to which CPTSD applies to other repeatedly traumatized populations...... is unknown. This study examined ICD-11's PTSD and CPTSD across populations with prolonged trauma of varying interpersonal intensity and ages of exposure, including: 1) childhood sexual abuse, 2) adulthood trauma of severe interpersonal intensity (refugees and ex-prisoners of war), and 3) adulthood trauma...

  1. A Pseudoaneurysm of the Deep Palmar Arch After Penetrating Trauma to the Hand: Successful Exclusion by Ultrasound Guided Percutaneous Thrombin Injection

    Directory of Open Access Journals (Sweden)

    A. Bosman

    Full Text Available : Introduction: Pseudoaneurysm of the hand is a rare condition; most are treated surgically. Ultrasound guided thrombin injection has not previously been reported as a treatment option for pseudoaneurysms of the deep palmar arch. Report: A man was referred to the emergency department with a swollen, painful hand after penetrating trauma. On physical examination, a pulsating tumor was found on the dorsum of the hand. Imaging revealed a pseudoaneurysm vascularized by the deep palmar arch. Ultrasound guided percutaneous thrombin injection was successfully performed. Conclusion: Thrombin injection might be a safe alternative option in the treatment of pseudoaneurysm of the deep palmar arch. Keywords: Deep palmar arch, Pseudoaneurysm, Thrombin injection

  2. Three-stage management of complex pancreatic trauma with gastroduodenopancreatectomy: A case report

    Directory of Open Access Journals (Sweden)

    Sergio Henrique Bastos Damous

    Full Text Available Introduction: Severe injuries of the pancreatic head and duodenum in haemodynamically unstable patients are complex management. The purpose of this study is to report a case of complex pancreatic trauma induced by gunshot and managed with surgical approaches at three different times. Presentation of case: Exploratory laparotomy was indicated after initial emergency room care, with findings of cloudy blood-tinged fluid and blood clots on the mesentery near the hepatic angle, on the region of the 2nd portion of the duodenum and at the pancreatic head. Gastroduodenopancreatectomy was performed with right hemicolectomy and the peritoneal cavity was temporarily closed by a vacuum peritoneostomy. Surgical reopening occurred on the fifth postoperative day, and the patient was subjected to single-loop reconstruction of the intestinal transit with telescoping pancreaticojejunal anastomosis, biliodigestive anastomosis with termino-lateral hepaticojejunal anastomosis with a Kehr drain and gastroenteroanastomosis in 2 planes. The terminal ileostomy was maintained. After 2 days, the patient was subjected to abdominal wall closure without complications, which required relaxing Gibson incisions and wound closure with polypropylene mesh placement in a pre-aponeurotic position closed with multiple stitches. Results: The patient was discharged on the 40th post-trauma day without drains, with a functioning ileostomy and with a scheduled reconstruction of intestinal transit. Conclusion: In the presence of multiple associated injuries, hemodynamic instability and the need for an extensive surgical procedure such as duodenopancreatectomy, damage control surgery performed in stages as reported here enables the clinical stabilization of the patient for definitive treatment, achieving better survival results. Keywords: Pancreatic trauma, Complex trauma, Damage control, Trauma, Gastroduodenopancreatectomy

  3. Are online learning modules an effective way to deliver hand trauma management continuing medical education to emergency physicians?

    Science.gov (United States)

    Williams, Jason G

    2014-01-01

    The enormity of modern medical knowledge and the rapidity of change have created increased need for ongoing or continuing medical education (CME) for physicians. Online CME is attractive for its availability at any time and any place, low cost and potentially increased effectiveness compared with traditional face-to-face delivery. To determine whether online CME modules are an effective method for delivering plastic surgery CME to primary care physicians. A needs assessment survey was conducted among all emergency and family physicians in Nova Scotia. Results indicated that this type of program was appealing, and that hand trauma related topics were most desired for CME. 7 Lesson Builder (SoftChalk LLC, www.softchalk.com) was used to construct a multimedia e-learning module that was distributed along with a pretest, post-test and feedback questionnaire. Quantitative (pre- and post-test scores) and qualitative (feedback responses) data were analyzed. The 32 participants who completed the study indicated that it was a positive and enjoyable experience, and that there was a need for more resources like this. Compared with pretest scores, there was a significant gain in knowledge following completion of the module (P=0.001). The present study demonstrated that an e-learning format is attractive for this population and effective in increasing knowledge. This positive outcome will lead to development of additional modules.

  4. A Complex Facial Trauma Case with Multiple Mandibular Fractures and Dentoalveolar Injuries

    Directory of Open Access Journals (Sweden)

    Yeliz Guven

    2015-01-01

    Full Text Available The principles of management of mandibular fractures differ in children when compared to adults and depend on the specific age-related status of the growing mandible and the developing dentition. This paper presents a case report with a complex facial trauma affecting the mandibular body and condyle region and dentoalveolar complex. Clinical examination revealed soft tissue injuries, limited mouth opening, lateral deviation of the mandible, an avulsed incisor, a subluxated incisor, and a fractured crown. CBCT examination revealed a nondisplaced fracture and an oblique greenstick fracture of the mandibular body and unilateral fracture of the condyle. Closed reduction technique was chosen to manage fractures of the mandible. Favorable healing outcomes on multiple fractures of the mandible throughout the 6-year follow-up period proved the success of the conservative treatment. This case report is important since it presents a variety of pathological sequelae to trauma within one case.

  5. Therapeutic Assessment of Complex Trauma: A Single-Case Time-Series Study

    OpenAIRE

    Tarocchi, Anna; Aschieri, Filippo; Fantini, Francesca; Smith, Justin D.

    2013-01-01

    The cumulative effect of repeated traumatic experiences in early childhood incrementally increases the risk of adjustment problems later in life. Surviving traumatic environments can lead to the development of an interrelated constellation of emotional and interpersonal symptoms termed complex posttraumatic stress disorder (CPTSD). Effective treatment of trauma begins with a multimethod psychological assessment and requires the use of several evidence-based therapeutic processes, including es...

  6. Complex pelvic ring injuries associated with floating knee in a poly-trauma patient

    OpenAIRE

    Zhou, Yuebin; Guo, Honggang; Cai, Zhiwei; Zhang, Yuan

    2017-01-01

    Abstract Rationale: Complex pelvic ring fracture associated with floating knee is comparatively rare which usually results from high-energy trauma including vehicle-related accidence, falls from height, and earthquake-related injury. To our knowledge, few literatures have documented such injuries in the individual patient. Management of both injuries present challenges for surgical management and postoperative care. The purpose of this study is to prove the feasibility and benefits of damage ...

  7. STARS experiential group intervention: a complex trauma treatment approach for survivors of human trafficking.

    Science.gov (United States)

    Hopper, Elizabeth K; Azar, Naomi; Bhattacharyya, Sriya; Malebranche, Dominique A; Brennan, Kelsey E

    2018-01-01

    This is the abstract that was submitted online with the paper: Despite the fact that many survivors of human trafficking have experienced complex trauma, there are no established interventions designed to specifically address these impacts. Leaders in the field of complex trauma have advocated for the need for somatic approaches to intervention. This paper presents STARS Experiential Group treatment, the first structured bodybased group intervention that has been designed to address complex trauma in survivors of human trafficking. Three pilot groups were run in residential settings with adolescent and adult survivors of sex trafficking. Two adaptations were utilized, with one focusing on application of expressive arts modalities and the other incorporating theater games. Qualitative results, using thematic analysis, identified several themes related to challenges and potential benefits of these groups. Potential benefits of the STARS groups were found in the areas of Interpersonal Relationships, Regulation, and Self/ Identity, with fourteen sub-themes further describing positive impacts. Challenges within these areas are explored, to inform the development of group interventions for trafficking survivors. The results of this paper suggest that experiential, somatically-oriented group treatment shows promise as an important element of holistic intervention with trafficking survivors.

  8. Narrative exposure therapy: an evidence-based treatment for multiple and complex trauma

    Directory of Open Access Journals (Sweden)

    Ruud A. Jongedijk

    2014-12-01

    Full Text Available Narrative exposure therapy (NET is a recently developed, short-term treatment for patients with a posttraumatic stress disorder (PTSD as a result of multiple trauma. NET can be applied very successfully in patients with complex trauma complaints (Jongedijk, 2014; Schauer, Neuner, & Elbert, 2011.An important feature of NET is that trauma processing is never an isolated event but is always embedded in the context of a traumatic event and in the life history as a whole. At the start, the lifeline is laid. The lifeline is made up of a rope, with flowers (happy events, stones (traumatic events, sometimes candles (grief, or recently also sticks for aggressive acts (NET for offenders; see Stenmark, Cuneyt Guzey, Elbert, & Holen, 2014. These symbols are laid down along the rope, in chronological order. Subsequently, in the subsequent therapy sessions the lifeline is processed in chronological order, giving attention to all the important events a person has experienced in his or her life, both the adverse as well as the pleasurable ones. The narration ends with a written testimony.To date, there is good evidence NET is effective in the treatment of PTSD patients, with support from 18 RCTs (N=950. For culturally diverse populations, NET is recommended as the most evidence-based trauma treatment, besides culturally adapted CBT. NET has been investigated in different populations in Africa, Europe, and Asia. In Asia, research has been carried out in Sri Lanka as well as in China. In China, NET was conducted and investigated with survivors of the Sichuan earthquake (Zang, Hunt, & Cox, 2013, 2014. NET is understandable, even appealing and also supportive for patients with multiple trauma. In this presentation, the treatment principles and the practice of NET will be explained.

  9. Complex Hand Dexterity: A Review of Biomechanical Methods for Measuring Musical Performance

    Directory of Open Access Journals (Sweden)

    Cheryl Diane Metcalf

    2014-05-01

    Full Text Available Complex hand dexterity is fundamental to our interactions with the physical, social and cultural environment. Dexterity can be an expression of creativity and precision in a range of activities, including musical performance. Little is understood about complex hand dexterity or how virtuoso expertise is acquired, due to the versatility of movement combinations available to complete any given task. This has historically limited progress of the field because of difficulties in measuring movements of the hand. Recent developments in methods of motion capture and analysis mean it is now possible to explore the intricate movements of the hand and fingers. These methods allow us insights into the neurophysiological mechanisms underpinning complex hand dexterity and motor learning. They also allow investigation into the key factors that contribute to injury, recovery and functional compensation.The application of such analytical techniques within musical performance provides a multidisciplinary framework for purposeful investigation into the process of learning and skill acquisition in instrumental performance. These highly skilled manual and cognitive tasks present the ultimate achievement in complex hand dexterity. This paper will review methods of assessing instrumental performance in music, focusing specifically on biomechanical measurement and the associated technical challenges faced when measuring highly dexterous activities.

  10. Comparing Treatment Outcome of Guided Imagery and Music and Psychodynamic Imaginative Trauma Therapy for Women with Complex PTSD

    DEFF Research Database (Denmark)

    Maack, Carola

    2013-01-01

    To investigate whether the use of recorded music enhances therapy outcome in psychodynamic trauma therapy for women with Complex PTSD, outcome measures of three groups of patients were compared. One group received 50 hours of outpatient trauma therapy with the Bonny Method of Guided Imagery and M....... Participants treated with GIM showed significantly better outcome in all measurements than participants treated with PITT. This indicates that the use of music is beneficial for women with Complex PTSD treated with psychodynamic trauma therapy.......To investigate whether the use of recorded music enhances therapy outcome in psychodynamic trauma therapy for women with Complex PTSD, outcome measures of three groups of patients were compared. One group received 50 hours of outpatient trauma therapy with the Bonny Method of Guided Imagery...... and Music (GIM), another group received 50 hours of outpatient trauma therapy with Psychodynamic Imaginative Trauma Therapy (PITT). The third group was a waiting-list control group of women who had to wait at least nine months for therapy. The participants filled out questionnaires measuring symptoms...

  11. Validation of post-traumatic stress disorder (PTSD) and complex PTSD using the International Trauma Questionnaire.

    Science.gov (United States)

    Hyland, P; Shevlin, M; Brewin, C R; Cloitre, M; Downes, A J; Jumbe, S; Karatzias, T; Bisson, J I; Roberts, N P

    2017-09-01

    The 11th version of the International Classification of Diseases (ICD-11) has proposed two related trauma diagnoses: Post-traumatic stress disorder (PTSD) and Complex PTSD (CPTSD). Using a newly developed, disorder-specific measure of PTSD and CPTSD called the International Trauma Questionnaire (ITQ) the current study will (i) assess the factorial validity of ICD-11 PTSD and CPTSD; (ii) provide the first test of the discriminant validity of these constructs; and (iii) provide the first comparison of ICD-11, and Diagnostic and Statistical Manual, Fifth Edition (DSM-5), PTSD diagnostic rates using disorder-specific measures. ICD-11 and DSM-5 PTSD-specific measures were completed by a British clinical sample of trauma-exposed patients (N = 171). The structure and validity of ICD-11 PTSD and CPTSD were assessed by means of factor analysis and assessing relationships with criterion variables. Diagnostic rates under ICD-11 were significantly lower than those under DSM-5. A two-factor second-order model reflecting the distinction between PTSD and CPTSD best represented the data from the ITQ; and the PTSD and CPTSD factors differentially predicted multiple psychological variables. The factorial and discriminant validity of ICD-11 PTSD and CPTSD was supported, and ICD-11 produces fewer diagnostic cases than DSM-5. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  12. Entropic Movement Complexity Reflects Subjective Creativity Rankings of Visualized Hand Motion Trajectories

    Science.gov (United States)

    Peng, Zhen; Braun, Daniel A.

    2015-01-01

    In a previous study we have shown that human motion trajectories can be characterized by translating continuous trajectories into symbol sequences with well-defined complexity measures. Here we test the hypothesis that the motion complexity individuals generate in their movements might be correlated to the degree of creativity assigned by a human observer to the visualized motion trajectories. We asked participants to generate 55 novel hand movement patterns in virtual reality, where each pattern had to be repeated 10 times in a row to ensure reproducibility. This allowed us to estimate a probability distribution over trajectories for each pattern. We assessed motion complexity not only by the previously proposed complexity measures on symbolic sequences, but we also propose two novel complexity measures that can be directly applied to the distributions over trajectories based on the frameworks of Gaussian Processes and Probabilistic Movement Primitives. In contrast to previous studies, these new methods allow computing complexities of individual motion patterns from very few sample trajectories. We compared the different complexity measures to how a group of independent jurors rank ordered the recorded motion trajectories according to their personal creativity judgment. We found three entropic complexity measures that correlate significantly with human creativity judgment and discuss differences between the measures. We also test whether these complexity measures correlate with individual creativity in divergent thinking tasks, but do not find any consistent correlation. Our results suggest that entropic complexity measures of hand motion may reveal domain-specific individual differences in kinesthetic creativity. PMID:26733896

  13. Maggot therapy in treatment of a complex hand injury complicated by mycotic infection.

    Science.gov (United States)

    Bohac, M; Cambal, M; Zamborsky, R; Takac, P; Fedeles, J

    2015-01-01

    Complex injuries of the hand remain a therapeutic challenge for surgeons. We present the case of a male who suffered a devastating injury of the hand caused by a conveyor belt. The patient developed a progressive Absidia corymbifera infection of the affected soft tissues. Initial treatments with serial surgical debridement and topical and intravenous itraconazole were unsuccessful in eliminating the infection. We decided to use maggot debridement therapy in a new special design to debride all necrotic, devitalized tissue and preserve only healthy tissue and functioning structures. This maneuverer followed by negative pressure therapy allowed progressive healing. In such complex hand injuries, maggot debridement combined with negative pressure therapy could be considered to achieve effective and considerable results, although future functional morbidity may occur (Fig. 4, Ref. 18).

  14. [Comparative efficiency of nootropic drugs in complex treatment of patients with remote consequences of closed craniocereberal trauma].

    Science.gov (United States)

    Hliebova, O S; Tkachenko, O V

    2008-01-01

    Main data of the research were data obtained after a complex treatment of 120 persons with late consequences of closed craniocereberal trauma (CCRCT). The treatment included administration of one of nootropic agents (noophen, aminolon or entropil), magnesium sulfate, group B vitamins. All patients have passed a complex examination: specially developed questionnaire, anamnesis gathering, neurologic status, neuropsychological status with the use of multiple-aspect scales and questionnaires, examination of fundus of eye, rheoencephalography, echoencephalography, brain MRT. Results of a complex examination proved positive effect of the use of nootropic agents, in particular noophen, entropil and aminolon in complex treatment of late consequences of closed craniocereberal trauma. For optimisation of the use of nootropic agents in the treatment of late consequences of closed craniocereberal trauma it is recommended to consider features of influence of nootropic agents on certain clinical aspects of the disease.

  15. [Family violence and mental health in adolescence: complex trauma as a developmental disorder].

    Science.gov (United States)

    Ricciutello, Cosimo; Cheli, Mariagnese; Montenegro, Maria Elena; Campieri, Michela; Fini, Andrea; Pincanelli, Francesca

    2012-01-01

    To highlight the harmfulness and pervasive of early and repeated exposure to family violence from the theoretical perspective of complex trauma as a developmental disorder. A study carried out on a sample of 22 adolescents between the ages of 15 and 18, who have been entrusted to Il Faro Bologna, a Specialist Centre for child abuse and neglect. Specific areas of psychological functioning were examined. According to the NCTSN these areas are considered vulnerable to violence in primary relationships and crucial for future mental health. They are attachment, self-concept, affect regulation, cognition and behavioural control. The data was correlated with the different forms of maltreatment and the main risk factors detected in the family environment and was collected by means of clinical interviews, family and social histories, structured interviews and self-reports recommended by the NASMHPD. The data highlights a correlation between the psychic functions examined and exposure to family violence, distortion of parental empathy and parental responsibility failure. The study indicates the need: a) to raise clinical awareness of the consequences of complex trauma on development; b) to adopt specific diagnostic tools for evaluating post-traumatic outcomes; c) to carry out regular screening in order to explore histories of maltreatment in patients cared for by mental health services.

  16. The deployed medical director: managing the challenges of a complex trauma system.

    Science.gov (United States)

    Mahoney, P F; Hodgetts, T J; Hicks, I

    2011-09-01

    Contemporary combat casualty care has never been more sophisticated or effective, which is matched by an unprecedented level of clinical complexity. The management of this complexity has demanded the evolution of a more direct clinical leadership model in the field hospital: the Deployed Medical Director (DMD). The DMD has a central co-ordinating role in reducing the friction generated by individuals' unfamiliarity in a rapidly developing clinical environment that has diverged from the NHS; in cementing interoperability within a multinational medical treatment facility working at high intensity; and in maintaining and developing the highest clinical standards within the deployed trauma system. This article describes the evolution of the DMD role and illustrates the challenges through a series of vignettes. Particular emphasis is given to the organisational risk that the role carries through necessary ethical choices, the requirement to integrate multi-national cultural differences and the challenge of dealing with interpersonal frictions amongst senior staff.

  17. Hand-assisted Approach as a Model to Teach Complex Laparoscopic Hepatectomies: Preliminary Results.

    Science.gov (United States)

    Makdissi, Fabio F; Jeismann, Vagner B; Kruger, Jaime A P; Coelho, Fabricio F; Ribeiro-Junior, Ulysses; Cecconello, Ivan; Herman, Paulo

    2017-08-01

    Currently, there are limited and scarce models to teach complex liver resections by laparoscopy. The aim of this study is to present a hand-assisted technique to teach complex laparoscopic hepatectomies for fellows in liver surgery. Laparoscopic hand-assisted approach for resections of liver lesions located in posterosuperior segments (7, 6/7, 7/8, 8) was performed by the trainees with guidance and intermittent intervention of a senior surgeon. Data as: (1) percentage of time that the senior surgeon takes the surgery as main surgeon, (2) need for the senior surgeon to finish the procedure, (3) necessity of conversion, (4) bleeding with hemodynamic instability, (5) need for transfusion, (6) oncological surgical margins, were evaluated. In total, 12 cases of complex laparoscopic liver resections were performed by the trainee. All cases included deep lesions situated on liver segments 7 or 8. The senior surgeon intervention occurred in a mean of 20% of the total surgical time (range, 0% to 50%). A senior intervention >20% was necessary in 2 cases. There was no need for conversion or reoperation. Neither major bleeding nor complications resulted from the teaching program. All surgical margins were clear. This preliminary report shows that hand-assistance is a safe way to teach complex liver resections without compromising patient safety or oncological results. More cases are still necessary to draw definitive conclusions about this teaching method.

  18. Attachment Patterns and Complex Trauma in a Sample of Adults Diagnosed with Gender Dysphoria

    Directory of Open Access Journals (Sweden)

    Guido Giovanardi

    2018-02-01

    Full Text Available The current study investigated attachment representations and complex trauma in a sample of gender dysphoric adults. Although it has been proven that the psychological wellbeing of gender diverse persons is largely mediated by family acceptance and support, research on their relationships with parental figures is scarce. A total of 95 adults took part in the study. The attachment distribution was as follows: 27% secure, 27% insecure and 46% disorganized. Regarding early traumas, 56% experienced four or more traumatic forms. Further, gender dysphoric adults showed significantly higher levels of attachment disorganization and polyvictimisation, relative to controls. Comparisons of subgroups, defined by natal gender, showed that trans women, compared to control males, had more involving and physically and psychologically abusive fathers, and were more often separated from their mothers; trans men, relative to female controls, had more involving mothers and were more frequently separated from and neglected by their fathers. The research has several implications for treatment, clinical health psychology, family support and education.

  19. Eye tracking a self-moved target with complex hand-target dynamics

    Science.gov (United States)

    Landelle, Caroline; Montagnini, Anna; Madelain, Laurent

    2016-01-01

    Previous work has shown that the ability to track with the eye a moving target is substantially improved when the target is self-moved by the subject's hand compared with when being externally moved. Here, we explored a situation in which the mapping between hand movement and target motion was perturbed by simulating an elastic relationship between the hand and target. Our objective was to determine whether the predictive mechanisms driving eye-hand coordination could be updated to accommodate this complex hand-target dynamics. To fully appreciate the behavioral effects of this perturbation, we compared eye tracking performance when self-moving a target with a rigid mapping (simple) and a spring mapping as well as when the subject tracked target trajectories that he/she had previously generated when using the rigid or spring mapping. Concerning the rigid mapping, our results confirmed that smooth pursuit was more accurate when the target was self-moved than externally moved. In contrast, with the spring mapping, eye tracking had initially similar low spatial accuracy (though shorter temporal lag) in the self versus externally moved conditions. However, within ∼5 min of practice, smooth pursuit improved in the self-moved spring condition, up to a level similar to the self-moved rigid condition. Subsequently, when the mapping unexpectedly switched from spring to rigid, the eye initially followed the expected target trajectory and not the real one, thereby suggesting that subjects used an internal representation of the new hand-target dynamics. Overall, these results emphasize the stunning adaptability of smooth pursuit when self-maneuvering objects with complex dynamics. PMID:27466129

  20. Aberrant Functional Connectivity of the Amygdala Complexes in PTSD during Conscious and Subconscious Processing of Trauma-Related Stimuli.

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    Daniela Rabellino

    Full Text Available Post-traumatic stress disorder (PTSD is characterized by altered functional connectivity of the amygdala complexes at rest. However, amygdala complex connectivity during conscious and subconscious threat processing remains to be elucidated. Here, we investigate specific connectivity of the centromedial amygdala (CMA and basolateral amygdala (BLA during conscious and subconscious processing of trauma-related words among individuals with PTSD (n = 26 as compared to non-trauma-exposed controls (n = 20. Psycho-physiological interaction analyses were performed using the right and left amygdala complexes as regions of interest during conscious and subconscious trauma word processing. These analyses revealed a differential, context-dependent responses by each amygdala seed during trauma processing in PTSD. Specifically, relative to controls, during subconscious processing, individuals with PTSD demonstrated increased connectivity of the CMA with the superior frontal gyrus, accompanied by a pattern of decreased connectivity between the BLA and the superior colliculus. During conscious processing, relative to controls, individuals with PTSD showed increased connectivity between the CMA and the pulvinar. These findings demonstrate alterations in amygdala subregion functional connectivity in PTSD and highlight the disruption of the innate alarm network during both conscious and subconscious trauma processing in this disorder.

  1. Complex trauma and mental health in children and adolescents placed in foster care: findings from the National Child Traumatic Stress Network.

    Science.gov (United States)

    Greeson, Johanna K P; Briggs, Ernestine C; Kisiel, Cassandra L; Layne, Christopher M; Ake, George S; Ko, Susan J; Gerrity, Ellen T; Steinberg, Alan M; Howard, Michael L; Pynoos, Robert S; Fairbank, John A

    2011-01-01

    Many children in the child welfare system (CWS) have histories of recurrent interpersonal trauma perpetrated by caregivers early in life often referred to as complex trauma. Children in the CWS also experience a diverse range of reactions across multiple areas of functioning that are associated with such exposure. Nevertheless, few CWSs routinely screen for trauma exposure and associated symptoms beyond an initial assessment of the precipitating event. This study examines trauma histories, including complex trauma exposure (physical abuse, sexual abuse, emotional abuse, neglect, domestic violence), posttraumatic stress, and behavioral and emotional problems of 2,251 youth (age 0 to 21; M = 9.5, SD = 4.3) in foster care who were referred to a National Child Traumatic Stress Network site for treatment. High prevalence rates of complex trauma exposure were observed: 70.4% of the sample reported at least two of the traumas that constitute complex trauma; 11.7% of the sample reported all 5 types. Compared to youth with other types of trauma, those with complex trauma histories had significantly higher rates of internalizing problems, posttraumatic stress, and clinical diagnoses, and differed on some demographic variables. Implications for child welfare practice and future research are discussed.

  2. Three-stage management of complex pancreatic trauma with gastroduodenopancreatectomy: A case report.

    Science.gov (United States)

    Damous, Sergio Henrique Bastos; Darce, George Felipe Bezerra; Leal, Renato Silveira; Costa, Adilson Rodrigues; Ferreira, Pedro Henrique Alves; de Oliveira Bernini, Celso; Utiyama, Edivaldo Massazo

    2018-01-01

    Severe injuries of the pancreatic head and duodenum in haemodynamically unstable patients are complex management. The purpose of this study is to report a case of complex pancreatic trauma induced by gunshot and managed with surgical approaches at three different times. Exploratory laparotomy was indicated after initial emergency room care, with findings of cloudy blood-tinged fluid and blood clots on the mesentery near the hepatic angle, on the region of the 2nd portion of the duodenum and at the pancreatic head. Gastroduodenopancreatectomy was performed with right hemicolectomy and the peritoneal cavity was temporarily closed by a vacuum peritoneostomy. Surgical reopening occurred on the fifth postoperative day, and the patient was subjected to single-loop reconstruction of the intestinal transit with telescoping pancreaticojejunal anastomosis, biliodigestive anastomosis with termino-lateral hepaticojejunal anastomosis with a Kehr drain and gastroenteroanastomosis in 2 planes. The terminal ileostomy was maintained. After 2 days, the patient was subjected to abdominal wall closure without complications, which required relaxing Gibson incisions and wound closure with polypropylene mesh placement in a pre-aponeurotic position closed with multiple stitches. The patient was discharged on the 40th post-trauma day without drains, with a functioning ileostomy and with a scheduled reconstruction of intestinal transit. In the presence of multiple associated injuries, hemodynamic instability and the need for an extensive surgical procedure such as duodenopancreatectomy, damage control surgery performed in stages as reported here enables the clinical stabilization of the patient for definitive treatment, achieving better survival results. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

  3. Reconstruction after complex facial trauma: achieving optimal outcome through multiple contemporary surgeries.

    Science.gov (United States)

    Jaiswal, Rohit; Pu, Lee L Q

    2013-04-01

    Major facial trauma injuries often require complex repair. Traditionally, the reconstruction of such injuries has primarily utilized only free tissue transfer. However, the advent of newer, contemporary procedures may lead to potential reconstructive improvement through the use of complementary procedures after free flap reconstruction. An 18-year-old male patient suffered a major left facial degloving injury resulting in soft-tissue defect with exposed zygoma, and parietal bone. Multiple operations were undertaken in a staged manner for reconstruction. A state-of-the-art free anterolateral thigh (ALT) perforator flap and Medpor implant reconstruction of the midface were initially performed, followed by flap debulking, lateral canthopexy, midface lift with redo canthopexy, scalp tissue expansion for hairline reconstruction, and epidermal skin grafting for optimal skin color matching. Over a follow-up period of 2 years, a good and impressive reconstructive result was achieved through the use of multiple contemporary reconstructive procedures following an excellent free ALT flap reconstruction. Multiple staged reconstructions are essential in producing an optimal outcome in this complex facial injury that would likely not have been produced through a 1-stage traditional free flap reconstruction. Utilizing multiple, sequential contemporary surgeries may substantially improve outcome through the enhancement and refinement of results based on possibly the best initial soft-tissue reconstruction.

  4. Fracture dislocation of the capitate following major trauma: A case report and literature review

    Directory of Open Access Journals (Sweden)

    Michael James Grant

    2017-12-01

    Conclusion: More patients are surviving major trauma events and have multiple complex limb injuries. We underscore the importance of having a high index of suspicion for complex injuries in high energy trauma and also the importance of appropriate and prompt management of such cases at specialized institutions. [Hand Microsurg 2017; 6(3.000: 146-149

  5. Reported exposure to trauma among adult patients referred for psychological services at the Free State Psychiatric Complex, Bloemfontein

    Directory of Open Access Journals (Sweden)

    Laurisa van Zyl

    2017-10-01

    Objective: The study aimed to explore and describe the extent and nature of reported potentially traumatic events and associated variables in adult patients referred for psychological services at the Free State Psychiatric Complex (FSPC, Bloemfontein. Methods: In this cross-sectional study, demographic information, diagnostic morbidity and co-morbidity, and presence and type of reported trauma exposure reported by patients during the initial assessment were obtained from files of adult patients seen during a one-year period (2010 at the out-patient unit and the in-patient affective ward at the FSPC. Data were captured on data record forms by the researchers and analysed by means of descriptive statistics, univariate analysis and logistic regression (SAS version 9.1. Results: Of the 192 adults (71.9% White and 67.2% female referred for psychological services,75.5% were diagnosed with mood disorders, 17.2% with anxiety disorders, 22.4% with substance-related disorders and 20.9% with cluster B personality disorders or traits. A total of 145 (75.5% reported past trauma exposure. The most frequently reported types of trauma exposure were traumatic death/injury of a loved one (37.0%, physical assault (24.5%, witnessed/threatened violence (19.3%, and sexual assault (17.7%. Women were more likely to have been exposed to trauma than men (OR 4.02, 95% CI 1.87–8.62, in particular to traumatic death of a loved one (OR 3.13, physical assault (OR 4.08, or sexual assault (OR 5.43. Conclusions: The findings of this study contribute to current data regarding the prevalence of exposure to trauma and its possible association with mental illness. The importance of comprehensive trauma exposure screening in routine psychiatric interviewing practices is highlighted.

  6. [Examination of the Prevention of Severe Hand Trauma Injury Cases due to Occupational Accidents--An Expert Opinion Gathering Meeting].

    Science.gov (United States)

    Zenke, Yukichi; Kajiki, Shigeyuki; Yoshikawa, Toru; Nakao, Toyoki; Yoshikawa, Etsuko; Shoji, Takurou; Fukumoto, Keizo; Sakai, Akinori

    2015-12-01

    We gathered seven specialists from various fields who are interested in worker injury prevention programs, based on cases of patients who had suffered refractory injuries requiring hand surgery because of industrial accidents. The patients were asked to write their thoughts and ideas on the theme, "Measures that must be implemented to prevent arm injuries." The content obtained was classified into different categories, using the KJ method, and was scripted to sort out the items. As a result, the following eleven points were identified as measures to prevent serious hand surgery-related injuries: 1. Purchase safe machinery, 2. Create a list of machines that require caution, 3. Enclose a machine's various rotating parts, 4. Carry out periodic maintenance work on the machines, 5. Indicate dangerous areas by putting up signs that attract attention, 6. Illuminate the rotating parts more brightly and avoid placing objects around them, 7. Systematically carry out safety education that creates a strong impact, 8. Encourage workers to look after their own health, 9. Announce policies on health and safety, 10. Re-examine the operational procedures, and 11. Be prepared in case an accident occurs. A perspective based on the results of this research is deemed important in creating a workplace improvement manual in the future.

  7. [Complex surgical procedures in orthopedics and trauma surgery. A contribution to the proposal procedure for the DRG system in 2009].

    Science.gov (United States)

    Flohé, S; Nabring, J; Luetkes, P; Nast-Kolb, D; Windolf, J

    2008-10-01

    Since the DRG system was introduced in 2003/2004 the system for remuneration has been continually modified in conjunction with input from specialized medical associations. As part of this development of the payment system, the criteria for classification of a diagnosis-related group were further expanded and new functions were added. This contribution addresses the importance of the complex surgical procedures as criteria for subdivision of the DRG case-based lump sums in orthopedics and trauma surgery.

  8. Methodology for designing and manufacturing complex biologically inspired soft robotic fluidic actuators: prosthetic hand case study.

    Science.gov (United States)

    Thompson-Bean, E; Das, R; McDaid, A

    2016-10-31

    We present a novel methodology for the design and manufacture of complex biologically inspired soft robotic fluidic actuators. The methodology is applied to the design and manufacture of a prosthetic for the hand. Real human hands are scanned to produce a 3D model of a finger, and pneumatic networks are implemented within it to produce a biomimetic bending motion. The finger is then partitioned into material sections, and a genetic algorithm based optimization, using finite element analysis, is employed to discover the optimal material for each section. This is based on two biomimetic performance criteria. Two sets of optimizations using two material sets are performed. Promising optimized material arrangements are fabricated using two techniques to validate the optimization routine, and the fabricated and simulated results are compared. We find that the optimization is successful in producing biomimetic soft robotic fingers and that fabrication of the fingers is possible. Limitations and paths for development are discussed. This methodology can be applied for other fluidic soft robotic devices.

  9. Demonstration of the Effectiveness of Augmented Reality Telesurgery in Complex Hand Reconstruction in Gaza

    Science.gov (United States)

    Luck, Joshua; Billingsley, Michael L.; Heyes, Richard; Smith, Oliver J.; Mosahebi, Afshin; Khoussa, Abu; Abu-Sittah, Ghassan; Hachach-Haram, Nadine

    2018-01-01

    Summary: Augmented reality (AR) is defined as “a technology that superimposes a computer-generated image on a user’s view of the real world, thus providing a composite view.”1 This case report describes how emerging AR telesurgery technologies may be used to facilitate international surgeon–surgeon collaboration and training. Here, we illustrate how a remote surgeon in Beirut, Lebanon, was able to offer assistance to a surgeon in Gaza, Palestine, during a complex hand reconstruction case following a bomb-blast injury in an 18-year-old male. We discuss the implications of AR technology on the future of global surgery and how it may be used to reduce structural inequities in access to safe surgical care. PMID:29707463

  10. Demonstration of the Effectiveness of Augmented Reality Telesurgery in Complex Hand Reconstruction in Gaza

    Directory of Open Access Journals (Sweden)

    Max J. Greenfield, BSc

    2018-03-01

    Full Text Available Summary:. Augmented reality (AR is defined as “a technology that superimposes a computer-generated image on a user’s view of the real world, thus providing a composite view.”1 This case report describes how emerging AR telesurgery technologies may be used to facilitate international surgeon–surgeon collaboration and training. Here, we illustrate how a remote surgeon in Beirut, Lebanon, was able to offer assistance to a surgeon in Gaza, Palestine, during a complex hand reconstruction case following a bomb-blast injury in an 18-year-old male. We discuss the implications of AR technology on the future of global surgery and how it may be used to reduce structural inequities in access to safe surgical care.

  11. Working in the Field of Complex Psychological Trauma: A Framework for Personal and Professional Growth, Training, and Supervision.

    Science.gov (United States)

    Coleman, Anne Marie; Chouliara, Zoë; Currie, Kay

    2018-03-01

    The aim of this article is to explore the positive and negative impacts of working therapeutically in complex psychological trauma (CPT), particularly the field of gender-based violence (GBV) and childhood sexual abuse (CSA), from the clinicians' perspective. The focus was on the prospect of positive gains and growth for therapists. Twenty-one clinicians ( n = 21; counselors/psychotherapists and psychologists) from National Health Service (NHS) specialist trauma services, a community mental health team, and specialist sexual assault counseling organization participated. Interpretative phenomenological analysis (IPA) was utilized to conduct single one-off interviews and analysis. Six themes were identified: Called to the work; Connection, Separation, and Oneness; Into and out of the darkness; Chaos into meaning; Reparation not repetition; and Expansion and growth. The first "Therapist Led Framework of Growth in Trauma Work" is presented. Vicarious posttraumatic growth (VPTG) was a key finding, with CPT therapists experiencing a "challenge/benefit/change" growth process. Adoption of actively relational strategies to enhance clinicians' growth process through trauma work is being proposed. The benefits of conceptualizing both the positive and negative impacts of such work for supervision, training, shaping the formal curricula, service management, and continuing professional development (CPD) are being discussed. The need for good practice guidelines on self-care internationally is highlighted.

  12. Gas tonometry for evaluation of gastrointestinal mucosal perfusion: experimental models of trauma, shock and complex surgical maneuvers - Part 1

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    Figueiredo Luiz Francisco Poli de

    2002-01-01

    Full Text Available Substantial clinical and animal evidences indicate that the mesenteric circulatory bed, particularly the gut mucosa, is highly vulnerable to reductions in oxygen supply and prone to early injury in the course of hemodynamic changes induced by trauma, shock, sepsis and several complex surgical maneuvers. Gut hypoxia or ischemia is one possible contributing factor to gastrointestinal tract barrier dysfunction that may be associated with the development of systemic inflammatory response and multiple organ dysfunction syndrome, a common cause of death after trauma, sepsis or major surgeries. Monitoring gut perfusion during experiments may provide valuable insights over new interventions and therapies highly needed to reduce trauma and sepsis-related morbidity and mortality. We present our experience with gas tonometry as a monitor of the adequacy of gastrointestinal mucosal perfusion in clinical and experimental models of trauma, shock and surgical maneuvers associated with abrupt hemodynamic changes, such as aortic occlusion and hepatic vascular exclusion. Next issue we will be presenting our experience with gas tonometry in experimental and clinical sepsis.

  13. [Intensive care treatment of traumatic brain injury in multiple trauma patients : Decision making for complex pathophysiology].

    Science.gov (United States)

    Trimmel, H; Herzer, G; Schöchl, H; Voelckel, W G

    2017-09-01

    Traumatic brain injury (TBI) and hemorrhagic shock due to uncontrolled bleeding are the major causes of death after severe trauma. Mortality rates are threefold higher in patients suffering from multiple injuries and additionally TBI. Factors known to impair outcome after TBI, namely hypotension, hypoxia, hypercapnia, acidosis, coagulopathy and hypothermia are aggravated by the extent and severity of extracerebral injuries. The mainstays of TBI intensive care may be, at least temporarily, contradictory to the trauma care concept for multiple trauma patients. In particular, achieving normotension in uncontrolled bleeding situations, maintenance of normocapnia in traumatic lung injury and thromboembolic prophylaxis are prone to discussion. Due to an ongoing uncertainty about the definition of normotensive blood pressure values, a cerebral perfusion pressure-guided cardiovascular management is of key importance. In contrast, there is no doubt that early goal directed coagulation management improves outcome in patients with TBI and multiple trauma. The timing of subsequent surgical interventions must be based on the development of TBI pathology; therefore, intensive care of multiple trauma patients with TBI requires an ongoing and close cooperation between intensivists and trauma surgeons in order to individualize patient care.

  14. Current Trends in the Management of Ballistic Fractures of the Hand and Wrist: Experiences of a High-Volume Level I Trauma Center.

    Science.gov (United States)

    Ghareeb, Paul A; Daly, Charles; Liao, Albert; Payne, Diane

    2018-03-01

    Ballistic fractures of the carpus and hand are routinely treated in large urban centers. These injuries can be challenging due to many factors. Various treatment options exist for these complicated injuries, but there are limited data available. This report analyzes patient demographics, treatments, and outcomes at a large urban trauma center. All ballistic fractures of the hand and wrist of the patients who presented to a single center from 2011 to 2014 were retrospectively reviewed. Patient demographics, injury mechanism, treatment modalities, and outcomes were analyzed. Seventy-seven patients were identified; 70 were male, and 7 were female. Average age of the patients was 29.6 years. Seventy-five injuries were low velocity, whereas 2 were high velocity. Sixty-seven patients had fractures of a metacarpal or phalanx, whereas 4 had isolated carpal injuries. Six had combined carpal and metacarpal or phalanx fractures. Thirty-six patients had concomitant tendon, nerve, or vascular injuries requiring repair. Sixty-three patients underwent operative intervention, with the most common intervention being percutaneous fixation. Sixteen patients required secondary surgery. Eighteen complications were reported. The majority of patients in this report underwent early operative intervention with percutaneous fixation. Antibiotics were administered in almost all cases and can usually be discontinued within 24 hours after surgery. It is important to consider concomitant nerve, vascular, or tendon injuries requiring repair. We recommend early treatment of these injuries with debridement and stabilization. Due to lack of follow-up and patient noncompliance, early definitive treatment with primary bone grafting should be considered.

  15. An Index of Trauma Severity Based on Multiattribute Utility: An Illustration of Complex Utility Modeling.

    Science.gov (United States)

    1981-10-01

    measure for Central Nervus System is the Glasgow Cons Score (GCS), a scale of brain and spinal cord injury (Langfitt [1978]), and is itself an additive...concerns directly relating to the injury itself were identified. These were: 1. Ventilation Severity 2 Circulation Severity 3. Central Nervous System ...interacting system within which these concerns represent interacting parts. Most trauma involves only one of these systems , but more than one may be

  16. Facial trauma.

    Science.gov (United States)

    Peeters, N; Lemkens, P; Leach, R; Gemels B; Schepers, S; Lemmens, W

    Facial trauma. Patients with facial trauma must be assessed in a systematic way so as to avoid missing any injury. Severe and disfiguring facial injuries can be distracting. However, clinicians must first focus on the basics of trauma care, following the Advanced Trauma Life Support (ATLS) system of care. Maxillofacial trauma occurs in a significant number of severely injured patients. Life- and sight-threatening injuries must be excluded during the primary and secondary surveys. Special attention must be paid to sight-threatening injuries in stabilized patients through early referral to an appropriate specialist or the early initiation of emergency care treatment. The gold standard for the radiographic evaluation of facial injuries is computed tomography (CT) imaging. Nasal fractures are the most frequent isolated facial fractures. Isolated nasal fractures are principally diagnosed through history and clinical examination. Closed reduction is the most frequently performed treatment for isolated nasal fractures, with a fractured nasal septum as a predictor of failure. Ear, nose and throat surgeons, maxillofacial surgeons and ophthalmologists must all develop an adequate treatment plan for patients with complex maxillofacial trauma.

  17. Glycemic Control, Hand Activity, and Complexity of Biological Signals in Diabetes Mellitus

    Directory of Open Access Journals (Sweden)

    Hsien-Tsai Wu

    2017-01-01

    Full Text Available Both glycemic control and handgrip strength affect microvascular function. Multiscale entropy (MSE of photoplethysmographic (PPG pulse amplitudes may differ by diabetes status and hand activity. Of a middle-to-old aged and right-handed cohort without clinical cardiovascular disease, we controlled age, sex, and weight to select the unaffected (no type 2 diabetes, n=36, the well-controlled diabetes (HbA1c < 8%, n=22, and the poorly controlled diabetes (HbA1c ≥ 8%, n=22 groups. MSEs were calculated from consecutive 1,500 PPG pulse amplitudes of bilateral index fingertips. The small-,  medium-, and large-scale MSEs were defined as the average of scale 1 (MSE1, scales 2–4 (MSE2–4, and scales 5–10 (MSE5–10, respectively. Intra- and intergroups were compared by one- and two-sample t-tests, respectively. The dominant hand MSE5–10 was lower in the poorly controlled diabetes group than the well-controlled diabetes and the unaffected (1.28 versus 1.52 and 1.56, p=0.019 and 0.001, resp. groups, whereas the nondominant hand MSE5–10 was lower in the well- and poorly controlled diabetes groups than the unaffected group (1.35 and 1.29 versus 1.58, p=0.008 and 0.005, resp.. The MSE1 of dominant hand was higher than that of nondominant hand in the well-controlled diabetes (1.35 versus 1.10, p=0.048. In conclusion, diabetes status and hand dominance may affect the MSE of PPG pulse amplitudes.

  18. A CRPS-IgG-transfer-trauma model reproducing inflammatory and positive sensory signs associated with complex regional pain syndrome.

    Science.gov (United States)

    Tékus, Valéria; Hajna, Zsófia; Borbély, Éva; Markovics, Adrienn; Bagoly, Teréz; Szolcsányi, János; Thompson, Victoria; Kemény, Ágnes; Helyes, Zsuzsanna; Goebel, Andreas

    2014-02-01

    The aetiology of complex regional pain syndrome (CRPS), a highly painful, usually post-traumatic condition affecting the limbs, is unknown, but recent results have suggested an autoimmune contribution. To confirm a role for pathogenic autoantibodies, we established a passive-transfer trauma model. Prior to undergoing incision of hind limb plantar skin and muscle, mice were injected either with serum IgG obtained from chronic CRPS patients or matched healthy volunteers, or with saline. Unilateral hind limb plantar skin and muscle incision was performed to induce typical, mild tissue injury. Mechanical hyperalgesia, paw swelling, heat and cold sensitivity, weight-bearing ability, locomotor activity, motor coordination, paw temperature, and body weight were investigated for 8days. After sacrifice, proinflammatory sensory neuropeptides and cytokines were measured in paw tissues. CRPS patient IgG treatment significantly increased hind limb mechanical hyperalgesia and oedema in the incised paw compared with IgG from healthy subjects or saline. Plantar incision induced a remarkable elevation of substance P immunoreactivity on day 8, which was significantly increased by CRPS-IgG. In this IgG-transfer-trauma model for CRPS, serum IgG from chronic CRPS patients induced clinical and laboratory features resembling the human disease. These results support the hypothesis that autoantibodies may contribute to the pathophysiology of CRPS, and that autoantibody-removing therapies may be effective treatments for long-standing CRPS. Copyright © 2013 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  19. [Chest trauma].

    Science.gov (United States)

    Freixinet Gilart, Jorge; Ramírez Gil, María Elena; Gallardo Valera, Gregorio; Moreno Casado, Paula

    2011-01-01

    Chest trauma is a frequent problem arising from lesions caused by domestic and occupational activities and especially road traffic accidents. These injuries can be analyzed from distinct points of view, ranging from consideration of the most severe injuries, especially in the context of multiple trauma, to the specific characteristics of blunt and open trauma. In the present article, these injuries are discussed according to the involvement of the various thoracic structures. Rib fractures are the most frequent chest injuries and their diagnosis and treatment is straightforward, although these injuries can be severe if more than three ribs are affected and when there is major associated morbidity. Lung contusion is the most common visceral lesion. These injuries are usually found in severe chest trauma and are often associated with other thoracic and intrathoracic lesions. Treatment is based on general support measures. Pleural complications, such as hemothorax and pneumothorax, are also frequent. Their diagnosis is also straightforward and treatment is based on pleural drainage. This article also analyzes other complex situations, notably airway trauma, which is usually very severe in blunt chest trauma and less severe and even suitable for conservative treatment in iatrogenic injury due to tracheal intubation. Rupture of the diaphragm usually causes a diaphragmatic hernia. Treatment is always surgical. Myocardial contusions should be suspected in anterior chest trauma and in sternal fractures. Treatment is conservative. Other chest injuries, such as those of the great thoracic and esophageal vessels, are less frequent but are especially severe. Copyright © 2011 Sociedad Española de Neumología y Cirugía Torácica. Published by Elsevier Espana. All rights reserved.

  20. Experience with esthetic reconstruction of complex facial soft tissue trauma: application of the pulsed dye laser.

    Science.gov (United States)

    Ebrahimi, Ali; Kazemi, Hossein Mohammad; Nejadsarvari, Nasrin

    2014-08-01

    Facial soft tissue injury can be one of the most challenging cases presenting to the plastic surgeon. The life quality and self-esteem of the patients with facial injury may be compromised temporarily or permanently. Immediate reconstruction of most defects leads to better restoration of form and function as well as early rehabilitation. The aim of this study was to present our experience in management of facial soft tissue injuries from different causes. We prospectively studied patients treated by plastic surgeons from 2010 to 2012 suffering from different types of blunt or sharp (penetrating) facial soft tissue injuries to the different areas of the face. All soft tissue injuries were treated primarily. Photography from all patients before, during, and after surgical reconstruction was performed and the results were collected. We used early pulsed dye laser (PDL) post-operatively. In our study, 63 patients including 18 (28.5%) women and 45 (71.5%) men aged 8-70 years (mean 47 years) underwent facial reconstruction due to soft tissue trauma in different parts of the face. Sharp wounds were seen in 15 (23%) patients and blunt trauma lacerations were seen in 52 (77%) patients. Overall, 65% of facial injuries were repaired primary and the remainder were reconstructed with local flaps or skin graft from adjacent tissues. Postoperative PDL therapy done two weeks following surgery for all scars yielded good results in our cases. Analysis of the injury including location, size, and depth of penetration as well as presence of associated injuries can aid in the formulation of a proper surgical plan. We recommend PDL in the early post operation period (two weeks) after suture removal for better aesthetic results.

  1. 复杂地层条件下的人工挖孔桩%HAND-DUG PILES IN THE COMPLEX LAYER

    Institute of Scientific and Technical Information of China (English)

    李奋强

    2001-01-01

    介绍了几种复杂条件下人工挖孔桩的施工工艺和措施,提供了一个标准厂房基础流砂层处理的实例。%The paper presented the construction and treatment of the hand-dug piles in several kind of complex layer,also gave a case how to treat a quick sand layer under the foundation of normal workshop building.

  2. Teaching complex trauma care in a curriculum challenges critical thinking and clinical judgment--how nurses can help.

    Science.gov (United States)

    West, Margaret Mary; Bross, Gina; Snyder, Melissa

    2007-01-01

    Incorporating complex content into a nursing curriculum presents students with the knowledge and thinking skills necessary to enter a career in nursing. A level 1 trauma center is a prefect environment to advance these thinking skills. Nurses act as professional role models and teachers as they clarify and explain their thinking to a student. When experienced nurses show invitational behaviors to students and share their knowledge with them, they ignite a strong desire within the student to progress. Caring, communication, and inclusion are key components that synergize the teaching/learning experience. The development of critical thinking is a continuous process that is best achieved through collaboration between the student, faculty, and professional, experienced nurses.

  3. Complex PTSD as Proposed for ICD-11: Validation of a New Disorder in Children and Adolescents and Their Response to Trauma-Focused Cognitive Behavioral Therapy

    Science.gov (United States)

    Sachser, Cedric; Keller, Ferdinand; Goldbeck, Lutz

    2017-01-01

    Background: To evaluate whether the symptoms of children and adolescents with clinically significant posttraumatic stress symptoms (PTSS) form classes consistent with the diagnostic criteria of complex PTSD (CPTSD) as proposed for the ICD-11, and to relate the emerging classes with treatment outcome of Trauma-Focused Cognitive Behavioral Therapy…

  4. Development of a symptoms questionnaire for complex regional pain syndrome and potentially related illnesses: the Trauma Related Neuronal Dysfunction Symptoms Inventory

    NARCIS (Netherlands)

    Collins, S.; van Hilten, J.J.; Marinus, J.J.; Zuurmond, W.W.A.; de Lange, J.J.; Perez, R.S.G.M.

    2008-01-01

    Collins S, van Hilten JJ, Marinus J, Zuurmond WW, de Lange JJ, Perez RS. Development of a symptoms questionnaire for complex regional pain syndrome and potentially related illnesses: the Trauma Related Neuronal Dysfunction Symptoms Inventory. Objective: To develop a questionnaire to evaluate

  5. Tropical diabetic hand syndrome: a case report.

    Science.gov (United States)

    Yeika, Eugene Vernyuy; Tchoumi Tantchou, Jacques Cabral; Foryoung, Joyce Bei; Tolefac, Paul Nkemtendong; Efie, Derrick Tembi; Choukem, Siméon Pierre

    2017-02-13

    Tropical diabetic hand syndrome describes a complex hand sepsis affecting patients with diabetes across the tropics and often results from a trivial hand trauma. The clinical presentation of this syndrome is variable and ranges from localised swelling and cellulitis, with or without ulceration of the hand to progressive fulminant hand sepsis, and gangrene affecting the entire limb which may be fatal. Tropical diabetic hand syndrome could lead to permanent disability and death as a result of delay in presentation, late diagnosis and late medical and surgical intervention. This indexed case acts as an eye opener for physicians to the existence of this hand sepsis. We report the case of a 57 year-old black African female diabetic who was referred to our centre for the management of a suppurating ulcer and swelling of the left hand of two weeks duration. On examination and work-up, the patient was found to have Lawal Group III left diabetic hand syndrome and was managed with parenteral antibiotics, radical debridement and the hand was eventually amputated. She died 7 days following amputation from overwhelming sepsis. Though tropical diabetic hand syndrome is a relatively rare complication of diabetes, it can be fatal as in this case report. Early diagnosis and proper management would yield better outcome. Initial management should include aggressive intravenous broad-spectrum antibiotics with anaerobic coverage. Classification of tropical diabetic hand syndrome will assist physicians and surgeons in decision making, proper management and easy communication.

  6. Emergency management of major bleeding in a case of maxillofacial trauma and anticoagulation: utility of prothrombin complex concentrates in the shock room

    Directory of Open Access Journals (Sweden)

    Alessandro Morotti

    2015-03-01

    Full Text Available Life-threatening bleeding in anticoagulation with Warfarin is an emergency challenging issue. Several approaches are available to treat bleeding in either over-anticoagulation or propeanticoagulation, including vitamin K, fresh frozen plasma and prothrombin complex concentrates (PCC administration. In coexisting trauma-induced bleeding and anticoagulation, reversal of anticoagulation must be a rapid and highly effective procedure. Furthermore the appropriate treatment must be directly available in each shock rooms to guarantee the rapid management of the emergency. PCC require a simple storage, rapid accessibility, fast administration procedures and high effectiveness. Here we report the utility of PCC in management of a craniofacial trauma in proper-anticoagulation.

  7. A new method of surgical navigation for orthognathic surgery: optical tracking guided free-hand repositioning of the maxillomandibular complex.

    Science.gov (United States)

    Li, Biao; Zhang, Lei; Sun, Hao; Shen, Steve G F; Wang, Xudong

    2014-03-01

    In bimaxillary orthognathic surgery, the positioning of the maxilla and the mandible is typically accomplished via 2-splint technique, which may be the sources of several types of inaccuracy. To overcome the limitations of the 2-splint technique, we developed a new navigation method, which guided the surgeon to free-hand reposition the maxillomandibular complex as a whole intraoperatively, without the intermediate splint. In this preliminary study, the feasibility was demonstrated. Five patients with dental maxillofacial deformities were enrolled. Before the surgery, 3-dimensional planning was conducted and imported into a navigation system. During the operation, a tracker was connected to the osteotomized maxillomandibular complex via a splint. The navigation system tracked the movement of the complex and displayed it on the screen in real time to guide the surgeon to reposition the complex. The postoperative result was compared with the plan by analyzing the measured distances between the maxillary landmarks and reference planes, as determined from computed tomography data. The mean absolute errors of the maxillary position were clinically acceptable (<1.0 mm). Preoperative preparation time was reduced to 100 minutes on average. All patients were satisfied with the aesthetic results. This navigation method without intraoperative image registration provided a feasible means of transferring virtual planning to the real orthognathic surgery. The real-time position of the maxillomandibular complex was displayed on a monitor to visually guide the surgeon to reposition the complex. In this method, the traditional model surgery and the intermediate splint were discarded, and the preoperative preparation was simplified.

  8. HAND INJURIES IN VOLLEYBALL

    NARCIS (Netherlands)

    BHAIRO, NH; NIJSTEN, MWN; VANDALEN, KC; TENDUIS, HJ

    We studied the long-term sequelae of hand injuries as a result of playing volleyball. In a retrospective study, 226 patients with injuries of the hand who were seen over a 5-year period at our Trauma Department, were investigated. Females accounted for 66 % of all injuries. The mean age was 26

  9. Mentalization of complex emotions in borderline personality disorder: The impact of parenting and exposure to trauma on the performance in a novel cartoon-based task.

    Science.gov (United States)

    Brüne, Martin; Walden, Sarah; Edel, Marc-Andreas; Dimaggio, Giancarlo

    2016-01-01

    Borderline personality disorder (BPD) is characterized by a range of interpersonal difficulties, which are, in part, related to adverse experiences during childhood. Unresponsive parenting and traumatization may cause functional impairment of mentalization, i.e. the ability to reflect upon own and others' mental states. However, the relationship of poor parenting, trauma and mentalization in BPD has not exhaustively been studied. Thirty patients diagnosed with BPD and 30 matched control subjects were asked to sequence a novel cartoon-based mentalization task involving complex emotions such as jealousy, shame, guilt etc. In addition, they were required to reason about cognitive and affective mental states of the cartoon characters. The quality of parental care was assessed using a self-report measure for recalled parental rearing style, and childhood trauma was measured in retrospect using the Childhood Trauma Questionnaire. Patients with BPD performed more poorly in all aspects of the cartoon task. Mentalizing skills, particularly relating to affective mental states, were uniquely associated with the quality of recalled parental care and childhood trauma. Together, the quality of parental care and the experience of childhood trauma negatively impact on mentalization in BPD, even in an experimental "offline" task. Copyright © 2015 Elsevier Inc. All rights reserved.

  10. Affect dysregulation, psychoform dissociation, and adult relational fears mediate the relationship between childhood trauma and complex posttraumatic stress disorder independent of the symptoms of borderline personality disorder.

    Science.gov (United States)

    van Dijke, Annemiek; Hopman, Juliette A B; Ford, Julian D

    2018-01-01

    Objective : Complex posttraumatic stress disorder (CPTSD) as defined by the Disorders of Extreme Stress Not Otherwise Specified (DESNOS) formulation is associated with childhood relational trauma and involves relational impairment, affect dysregulation, and identity alterations. However, the distinct contributions of relational impairment (operationalized in the form fears of closeness or abandonment), affect dysregulation (operationalized in the form of overregulation and under-regulation of affect), and identity alterations (operationalized in the form of positive or negative psychoform or somatoform dissociation) to the relationship between childhood trauma and CPTSD/DESNOS have not been systematically tested. Method and Results : In a clinical sample of adults diagnosed with severe and chronic psychiatric and personality disorders ( n  = 472; M  = 34.7 years, SD  = 10.1), structural equation modelling with bootstrap 95% confidence intervals demonstrated that the association between childhood trauma and CPTSD/DESNOS symptoms in adulthood was partially mediated by under-regulation of affect, negative psychoform dissociation, and adult relational fears of closeness and of abandonment. These results also were independent of the effects of borderline personality disorder (BPD) symptoms. Conclusions : Some, but not all, hypothesized components of the DESNOS formulation of CPTSD statistically mediate the relationship between childhood trauma and adult CPTSD/DESNOS. These relationships appear specific to CPTSD/DESNOS and not to the effects of another potential sequelae of childhood trauma BPD. Replication with prospective longitudinal studies is needed.

  11. Childhood trauma and complex posttraumatic stress disorder symptoms in older adults: A study of direct effects and social-interpersonal factors as potential mediators.

    Science.gov (United States)

    Krammer, Sandy; Kleim, Birgit; Simmen-Janevska, Keti; Maercker, Andreas

    2016-01-01

    Childhood traumatic events may lead to long-lasting psychological effects and contribute to the development of complex posttraumatic sequelae. These might be captured by the diagnostic concept of complex posttraumatic stress disorder (CPTSD) as an alternative to classic posttraumatic stress disorder (PTSD). CPTSD comprises a further set of symptoms in addition to those of PTSD, namely, changes in affect, self, and interpersonal relationships. Previous empirical research on CPTSD has focused on middle-aged adults but not on older adults. Moreover, predictor models of CPTSD are still rare. The current study investigated the association between traumatic events in childhood and complex posttraumatic stress symptoms in older adults. The mediation of this association by 2 social-interpersonal factors (social acknowledgment as a survivor and dysfunctional disclosure) was investigated. These 2 factors focus on the perception of acknowledgment by others and either the inability to disclose traumatic experiences or the ability to do so only with negative emotional reactions. A total of 116 older individuals (age range = 59-98 years) who had experienced childhood traumatic events completed standardized self-report questionnaires indexing childhood trauma, complex trauma sequelae, social acknowledgment, and dysfunctional disclosure of trauma. The results showed that traumatic events during childhood were associated with later posttraumatic stress symptoms but with classic rather than complex symptoms. Social acknowledgment and dysfunctional disclosure partially mediated this relationship. These findings suggest that childhood traumatic stress impacts individuals across the life span and may be associated with particular adverse psychopathological consequences.

  12. Management of duodenal trauma

    OpenAIRE

    CHEN Guo-qing; YANG Hua

    2011-01-01

    【Abstract】Duodenal trauma is uncommon but nowadays seen more and more frequently due to the increased automobile accidents and violent events. The management of duodenal trauma can be complicated, especially when massive injury to the pancreatic-duodenal-biliary complex occurs simultaneously. Even the patients receive surgeries in time, multiple postoperative complications and high mortality are common. To know and manage duodenal trauma better, we searched the recent related literature...

  13. Lower Bounds for Number-in-Hand Multiparty Communication Complexity, Made Easy

    DEFF Research Database (Denmark)

    Phillips, Jeff; Verbin, Elad; Zhang, Qin

    2012-01-01

    ; the technique seems applicable to a wide range of other problems as well. The obtained communication lower bounds imply new lower bounds in the functional monitoring model [11] (also called the distributed streaming model). All of our lower bounds allow randomized communication protocols with two-sided error......In this paper we prove lower bounds on randomized multiparty communication complexity, both in the blackboard model (where each message is written on a blackboard for all players to see) and (mainly) in the message-passing model, where messages are sent player-to-player. We introduce a new...... technique for proving such bounds, called symmetrization, which is natural, intuitive, and often easy to use. For example, for the problem where each of k players gets a bit-vector of length n, and the goal is to compute the coordinate-wise XOR of these vectors, we prove a tight lower bounds of Ω...

  14. Complex pelvic ring injuries associated with floating knee in a poly-trauma patient: A case report.

    Science.gov (United States)

    Zhou, Yuebin; Guo, Honggang; Cai, Zhiwei; Zhang, Yuan

    2017-12-01

    Complex pelvic ring fracture associated with floating knee is comparatively rare which usually results from high-energy trauma including vehicle-related accidence, falls from height, and earthquake-related injury. To our knowledge, few literatures have documented such injuries in the individual patient. Management of both injuries present challenges for surgical management and postoperative care. The purpose of this study is to prove the feasibility and benefits of damage control orthopedics (DCO). Our case involved a 45-year-old lady who was hit by a dilapidated building. The patient was anxious, pale and hemodynamically stable at the initial examination. The pelvis was unstable and there were obvious deformities in the left lower extremities. Significant degloved injuries in the left leg were noted. Her radiographs and physical examination verified the above signs. Unstable pelvic fractures, multiple fractures of bilateral lower limbs with floating knee injury, multiple pelvic and rib fractures and multiple degloving injuries and soft tissue contusion formed the characteristics of the multiple-injury. The algorithm of DCO was determined as the treatment. Early simplified procedures such as wound debridement, pelvis fixation, closed reduction and EF of the right shoulder joint, and chest wall fixation were conducted as soon as possible. After a period of time, internal fixations were applied to the fracture sites. The subsequent functional exercise was also conducted in accordance with this algorithm. This patient got recovery after the treatments which were guided by the criterion of DCO. The restoration of limb functional and the quality of life greatly improved. The DCO plays a decisive role in the first aid and follow-up treatment of this patient. The guidelines of management of complex pelvic ring injuries and floating knee should be established by authorities.

  15. Management of duodenal trauma

    Directory of Open Access Journals (Sweden)

    CHEN Guo-qing

    2011-02-01

    Full Text Available 【Abstract】Duodenal trauma is uncommon but nowadays seen more and more frequently due to the increased automobile accidents and violent events. The management of duodenal trauma can be complicated, especially when massive injury to the pancreatic-duodenal-biliary complex occurs simultaneously. Even the patients receive surgeries in time, multiple postoperative complications and high mortality are common. To know and manage duodenal trauma better, we searched the recent related literature in PubMed by the keywords of duodenal trauma, therapy, diagnosis and abdomen. It shows that because the diagnosis and management are complicated and the mortality is high, duodenal trauma should be treated in time and tactfully. And application of new technology can help improve the management. In this review, we discussed the incidence, diagnosis, management, and complications as well as mortality of duodenal trauma. Key words: Duodenum; Wounds and injuries; Diagnosis; Therapeutics

  16. An emerging etiological factor for hand injuries in the pediatric population: public exercise equipment.

    Science.gov (United States)

    Akşam, Berrak; Akşam, Ersin; Ceran, Candemir; Demirseren, Mustafa Erol

    2016-01-01

    The purpose of this study was to describe the role of public exercise equipment in pediatric hand traumas as a preventable etiological factor. Pediatric patients with hand injuries referred from the emergency department were evaluated retrospectively. Age and gender of the patients, timing, etiology, mechanism of hand trauma, localization of the injury, diagnoses of the patients, and hospitalization rates were reviewed. Amongst the 310 pediatric patients evaluated, 31 patients (10%) experienced injury related to public exercise equipment. Within this group of patients, most were between 5 to 9 years of age, and all injuries were blunt and crush type. Lacerations and fractures were the main diagnoses. Complex injuries that required inpatient care were reported in 19.3% of the patients. Public exercise equipment-related injuries are increasingly prevalent in pediatric hand traumas. Preventive actions such as shielding the moving parts should be taken to reduce these rates.

  17. Complex posttraumatic stress disorder: The need to consolidate a distinct clinical syndrome or to reevaluate features of psychiatric disorders following interpersonal trauma?

    Science.gov (United States)

    Giourou, Evangelia; Skokou, Maria; Andrew, Stuart P; Alexopoulou, Konstantina; Gourzis, Philippos; Jelastopulu, Eleni

    2018-03-22

    Complex posttraumatic stress disorder (Complex PTSD) has been recently proposed as a distinct clinical entity in the WHO International Classification of Diseases, 11 th version, due to be published, two decades after its first initiation. It is described as an enhanced version of the current definition of PTSD, with clinical features of PTSD plus three additional clusters of symptoms namely emotional dysregulation, negative self-cognitions and interpersonal hardship, thus resembling the clinical features commonly encountered in borderline personality disorder (BPD). Complex PTSD is related to complex trauma which is defined by its threatening and entrapping context, generally interpersonal in nature. In this manuscript, we review the current findings related to traumatic events predisposing the above-mentioned disorders as well as the biological correlates surrounding them, along with their clinical features. Furthermore, we suggest that besides the present distinct clinical diagnoses (PTSD; Complex PTSD; BPD), there is a cluster of these comorbid disorders, that follow a continuum of trauma and biological severity on a spectrum of common or similar clinical features and should be treated as such. More studies are needed to confirm or reject this hypothesis, particularly in clinical terms and how they correlate to clinical entities' biological background, endorsing a shift from the phenomenologically only classification of psychiatric disorders towards a more biologically validated classification.

  18. Blood levels of histone-complexed DNA fragments are associated with coagulopathy, inflammation and endothelial damage early after trauma

    DEFF Research Database (Denmark)

    Johansson, Pär I; Windeløv, Nis A; Rasmussen, Lars S

    2013-01-01

    Tissue injury increases blood levels of extracellular histones and nucleic acids, and these may influence hemostasis, promote inflammation and damage the endothelium. Trauma-induced coagulopathy (TIC) may result from an endogenous response to the injury that involves the neurohumoral, inflammatory...

  19. Operative management and outcomes in 103 AAST-OIS grades IV and V complex hepatic injuries: trauma surgeons still need to operate, but angioembolization helps.

    Science.gov (United States)

    Asensio, Juan A; Roldán, Gustavo; Petrone, Patrizio; Rojo, Esther; Tillou, Areti; Kuncir, Eric; Demetriades, Demetrios; Velmahos, George; Murray, James; Shoemaker, William C; Berne, Thomas V; Chan, Linda

    2003-04-01

    American Association for the Surgery of Trauma (AAST) Organ Injury Scale (OIS) grades IV and V complex hepatic injuries are highly lethal. Our objectives were to review experience and identify predictors of outcome and to evaluate the role of angioembolization in decreasing mortality. This was a retrospective 8-year study of all patients sustaining AAST-OIS grades IV and V hepatic injuries managed operatively. Statistical analysis was performed using univariate and multivariate logistic regression. The main outcome measure was survival. The study included 103 patients, with a mean Revised Trauma Score of 5.61 +/- 2.55 and a mean Injury Severity Score of 33 +/- 9.5. Mechanism of injury was penetrating in 80 (79%) and blunt in 23 (21%). Emergency department thoracotomy was performed in 21 (25%). AAST grade IV injuries occurred in 51 (47%) and grade V injuries occurred in 52 (53%). Mean estimated blood loss was 9,414 mL. Overall survival was 43%. Adjusted overall survival rate after emergency department thoracotomy patients were excluded was 58%. Results stratified to AAST-OIS injury grade were as follows: grade IV, 32 of 51 (63%); grade V, 12 of 52 (23%); grade IV versus grade V (p Trauma Score (adjusted p hepatic veins (adjusted p hepatic injuries.

  20. Evidence of distinct profiles of Posttraumatic Stress Disorder (PTSD) and Complex Posttraumatic Stress Disorder (CPTSD) based on the new ICD-11 Trauma Questionnaire (ICD-TQ).

    Science.gov (United States)

    Karatzias, Thanos; Shevlin, Mark; Fyvie, Claire; Hyland, Philip; Efthymiadou, Erifili; Wilson, Danielle; Roberts, Neil; Bisson, Jonathan I; Brewin, Chris R; Cloitre, Marylene

    2017-01-01

    The WHO International Classification of Diseases, 11th version (ICD-11), has proposed two related diagnoses following exposure to traumatic events; Posttraumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD). We set out to explore whether the newly developed ICD-11 Trauma Questionnaire (ICD-TQ) can distinguish between classes of individuals according to the PTSD and CPTSD symptom profiles as per ICD-11 proposals based on latent class analysis. We also hypothesized that the CPTSD class would report more frequent and a greater number of different types of childhood trauma as well as higher levels of functional impairment. Methods Participants in this study were a sample of individuals who were referred for psychological therapy to a National Health Service (NHS) trauma centre in Scotland (N=193). Participants completed the ICD-TQ as well as measures of life events and functioning. Overall, results indicate that using the newly developed ICD-TQ, two subgroups of treatment-seeking individuals could be empirically distinguished based on different patterns of symptom endorsement; a small group high in PTSD symptoms only and a larger group high in CPTSD symptoms. In addition, CPTSD was more strongly associated with more frequent and a greater accumulation of different types of childhood traumatic experiences and poorer functional impairment. Sample predominantly consisted of people who had experienced childhood psychological trauma or been multiply traumatised in childhood and adulthood. CPTSD is highly prevalent in treatment seeking populations who have been multiply traumatised in childhood and adulthood and appropriate interventions should now be developed to aid recovery from this debilitating condition. Copyright © 2016 Elsevier B.V. All rights reserved.

  1. [Prevalence and Co-prevalence of Complex Regional Pain Syndrome (CRPS) and Carpal Tunnel Syndrome (CTS) in Hand Rehabilitation].

    Science.gov (United States)

    Neubrech, F; Gentzsch, T; Kotsougiani, D; Bickert, B; Kneser, U; Harhaus, L

    2016-06-01

    In the current literature, there are reports of associations between complex regional pain syndromes (CRPS) and carpal tunnel syndromes (CTS). The aim of this study was to determine the prevalence of both disease patterns in hand rehabilitation patients and to investigate whether there is a correlation between CTS and CRPS. Furthermore, differences in the healing process of patients with and without additional CTS, and the effectiveness of the rehabilitative therapy for both diseases, were investigated. The computerised medical records of 791 patients in the years 2009-2015 who had been in hand rehabilitation were retrospectively analysed. At the beginning and end of rehabilitation, measurements were made of pain by visual analogue scales (VAS, 0-10), grip strength and finger mobility (mean distance from finger pulp to palmar D2-D5). The clinical course was statistically analysed. CRPS diagnosis was confirmed clinically by a pain therapist, CTS diagnosis was confirmed by neurological and neurophysiological examination. Surgical therapy was performed despite CRPS diagnosis. The prevalence of CRPS was 161/1000 and of CTS 62/1000; the co-prevalence of the 2 diagnoses was 24/1000 (pCRPS group, after a mean of 8 (1-21) weeks of rehabilitative therapy, mean pain was reduced from 5 (1-10) to 3 (0-9), grip strength improved from 10 (0-39)kg to 18.5 (2.5-45.5)kg and finger mobility increased from 2.9 (0-7.6)cm to 1.8 (0-7.8)cm. In the CRPS+CTS group, after a mean of 6.8 (3-23) weeks of rehabilitative therapy, mean pain was reduced from 5 (0-8) to 2.6 (0-5), grip strength improved from 9.7 (2.4-25.5)kg to 17.4 (0.9-47.4)kg and finger mobility increased from 2.7 (0-5.3)cm to 1.7 (0-5.3)cm. Improvement over the period of rehabilitation was significant in both groups, though the period of therapy was significantly shorter in the CRPS+CTS group. CRPS and CTS are often associated. Rehabilitative therapy was effective for CRPS- and CRPS+CTS patients. © Georg Thieme Verlag KG

  2. TRAUMA SURGERY

    African Journals Online (AJOL)

    interest in developing an appropriate and sustainable trauma system in South ... trauma evolved with the social instability which accompanied political change in the ... increased use of military style assault weapons resulted in severe injuries ...

  3. Dental Trauma Guide

    DEFF Research Database (Denmark)

    Andreasen, Jens Ove; Lauridsen, Eva Fejerskov; Christensen, Søren Steno Ahrensburg

    2012-01-01

    Diagnose and treatment of traumatic dental injuries is very complex due to the multiple trauma entities represented by 6 lunation types and 9 fracture types affecting both the primary and the permanent dentition. When it is further considered that fracture and lunation injuries are often combined...... problems in selecting proper treatment for some of these trauma types. To remedy this situation, an internet based knowledge base consisting of 4000 dental trauma cases with long term follow up is now available to the public and professionals, on the internet using the address www...

  4. Dental Trauma Guide

    DEFF Research Database (Denmark)

    Andreasen, Jens Ove; Lauridsen, Eva; Gerds, Thomas Alexander

    2012-01-01

    Diagnosis and treatment for traumatic dental injuries are very complex owing to the multiple trauma entities represented by six luxation types and nine fracture types affecting both the primary and the permanent dentition. When it is further considered that fracture and luxation injuries are often...... problems in selecting proper treatment for some of these trauma types. To remedy this situation, an Internet-based knowledge base consisting of 4000 dental trauma cases with long-term follow up is now available to the public and the professions on the Internet using the address http://www.Dental...

  5. Facial trauma

    Science.gov (United States)

    Maxillofacial injury; Midface trauma; Facial injury; LeFort injuries ... Hockberger RS, Walls RM, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice . 8th ed. Philadelphia, PA: Elsevier ...

  6. Diagnostic imaging of the hand. 3. rev. and enl. ed.; Bildgebende Diagnostik der Hand

    Energy Technology Data Exchange (ETDEWEB)

    Schmitt, Rainer [Herz und Gefaessklinik GmbH, Bad Neustadt (Germany). Klinik fuer Diagnostische und Interventionelle Radiologie; Lanz, Ulrich

    2015-07-01

    The book on diagnostic imaging of the hand covers the following issues: projection radiography, cinematography, MRT and CR arthrography, arthroscopy, arteriography, skeleton scintiscanning, sonography, computerized tomography, magnetic resonance tomography, anatomy of forearm and carpus, anatomy of metacarpus and fingers, carpal function and morphometry, postoperative X-ray diagnostic, growing hand skeleton, normative variants, malformations and deformities, trauma of the distal forearm, lesions of the ulnocarpal complex (TFCC), scaphoid fractures, scaphoid arthrosis, fractures of other carpus bones, carpal luxations and luxation fractures, carpal instabilities, fractures of the metacarpalla, finger fractures, arthrosis deformans, enthesiopathies, sport induced soft tissue lesions, osteonecrosis, impingement syndromes, osteopenic skeletal diseases, metabolis diseases, crystal-induced osteoarthropaties, rheumatoid arthritis, spondyloarthritis, rheumatic fever, collagenoses, infective arthritis, osteomyelitis, soft tissue infections, cystoids bone lesions, skeletal tumors, soft tissue tumors, carpal tunnel syndrome, nerve compression syndrome, arterial perfusion disturbances, differential diagnostic tables on hand lesions.

  7. Simulation of Major Histocompatibility Complex (MHC Structure and Peptide Loading into an MHC Binding Pocket with Teachers’Hands

    Directory of Open Access Journals (Sweden)

    Mojtaba Sankian

    2013-10-01

    Full Text Available Molecular understanding of three-dimensional (3D peptide: MHC models require both basic knowledge of computational modeling and skilled visual perception, which are not possessed by all students. The present model aims to simulate MHC molecular structure with the hands and make a profound impression on the students.

  8. The Progressive Approach to EMDR Group Therapy for Complex Trauma and Dissociation: A Case-Control Study

    Directory of Open Access Journals (Sweden)

    Ana I. Gonzalez-Vazquez

    2018-02-01

    Full Text Available Eye Movement Desensitization and Reprocessing is a psychotherapeutic approach with recognized efficiency in treating post-traumatic stress disorder (PTSD, which is being used and studied in other psychiatric diagnoses partially based on adverse and traumatic life experiences. Nevertheless, there is not enough empirical evidence at the moment to support its usefulness in a diagnosis other than PTSD. It is commonly accepted that the use of EMDR in severely traumatized patients requires an extended stabilization phase. Some authors have proposed integrating both the theory of structural dissociation of the personality and the adaptive information processing model guiding EMDR therapy. One of these proposals is the Progressive Approach. Some of these EMDR procedures will be evaluated in a group therapy format, integrating them along with emotional regulation, dissociation, and trauma-oriented psychoeducational interventions. Patients presenting a history of severe traumatization, mostly early severe and interpersonal trauma, combined with additional significant traumatizing events in adulthood were included. In order to discriminate the specific effect of EMDR procedures, two types of groups were compared: TAU (treatment as usual: psychoeducational intervention only vs. TAU+EMDR (the same psychoeducational intervention plus EMDR specific procedures. In pre-post comparison, more variables presented positive changes in the group including EMDR procedures. In the TAU+EMDR group, 4 of the 5 measured variables presented significant and positive changes: general health (GHQ, general satisfaction (Schwartz, subjective well-being, and therapy session usefulness assessment. On the contrary, only 2 of the 5 variables in the TAU group showed statistically significant changes: general health (GHQ, and general satisfaction (Schwartz. Regarding post-test inter-group comparison, improvement in subjective well-being was related to belonging to the group that

  9. Stiff Hands

    Science.gov (United States)

    ... All Topics A-Z Videos Infographics Symptom Picker Anatomy Bones Joints Muscles Nerves Vessels Tendons About Hand Surgery What is a Hand Surgeon? What is a Hand Therapist? Media Find a Hand Surgeon Home Anatomy Stiff Hands Email to a friend * required fields ...

  10. Hand Infections

    Science.gov (United States)

    ... All Topics A-Z Videos Infographics Symptom Picker Anatomy Bones Joints Muscles Nerves Vessels Tendons About Hand Surgery What is a Hand Surgeon? What is a Hand Therapist? Media Find a Hand Surgeon Home Anatomy Hand Infections Email to a friend * required fields ...

  11. Reconstructive surgery for complex midface trauma using titanium miniplates: Le Fort I fracture of the maxilla, zygomatico-maxillary complex fracture and nasomaxillary complex fracture, resulting from a motor vehicle accident.

    Science.gov (United States)

    Nicholoff, T J; Del Castillo, C B; Velmonte, M X

    Maxillofacial injuries resulting from trauma can be a challenge to the Maxillo-Facial Surgeon. Frequent causes of these injuries are attributed to automobile accidents, physical altercations, gunshot wounds, home accidents, athletic injuries, work injuries and other injuries. Motor vehicle accidents tend to be the primary cause of most midface fractures and lacerations due to the face hitting the dashboard, windshield and steering wheel or the back of the front seat for passengers in the rear. Seatbelts have been shown to drastically reduce the incidence and severity of these injuries. In the United States seatbelt laws have been enacted in several states thus markedly impacting on the reduction of such trauma. In the Philippines rare is the individual who wears seat belts. Metro city traffic, however, has played a major role in reducing daytime MVA related trauma, as usually there is insufficient speed in traffic areas to cause severe impact damage, the same however cannot be said for night driving, or for driving outside of the city proper where it is not uncommon for drivers to zip into the lane of on-coming traffic in order to overtake the car in front ... often at high speeds. Thus, the potential for severe maxillofacial injuries and other trauma related injuries increases in these circumstances. It is however unfortunate that outside of Metro Manila or other major cities there is no ready access to trauma or tertiary care centers, thus these injuries can be catastrophic if not addressed adequately. With the exception of Le Fort II and III craniofacial fractures, most maxillofacial injuries are not life threatening by themselves, and therefore treatment can be delayed until more serious cerebral or visceral, potentially life threatening injuries are addressed first. Our patient was involved in an MVA in Zambales, seen and stabilized in a provincial primary care center initially, then referred to a provincial secondary care center for further stabilization

  12. Imaging of vertebral trauma

    International Nuclear Information System (INIS)

    Daffner, R.H.

    1999-01-01

    This translation of the toolbook published in the 'US-ART' series, offers invaluable help to medical radiologists in the diagnostic imaging and evaluation of complex vertebral traumas which are on the rise, inter alia due to increasingly dangerous leisure sports. (orig./CB) [de

  13. The Efficacy of Eye Movement Desensitization and Reprocessing in Children and Adults Who Have Experienced Complex Childhood Trauma: A Systematic Review of Randomized Controlled Trials.

    Science.gov (United States)

    Chen, Runsen; Gillespie, Amy; Zhao, Yanhui; Xi, Yingjun; Ren, Yanping; McLean, Loyola

    2018-01-01

    Background: Survivors of complex childhood trauma (CT) such as sexual abuse show poorer outcomes compared to single event trauma survivors. A growing number of studies investigate Eye Movement Desensitization and Reprocessing (EMDR) treatment for posttraumatic stress disorder (PTSD), but no systematic reviews have focused on EMDR treatment for CT as an intervention for both adults and children. This study therefore systematically reviewed all randomized controlled trials (RCTs) evaluating the effect of EMDR on PTSD symptoms in adults and children exposed to CT. Methods: Databases including PubMed, Web of Science, and PsycINFO were searched in October 2017. Randomized controlled trials which recruited adult and children with experience of CT, which compared EMDR to alternative treatments or control conditions, and which measured PTSD symptoms were included. Study methodology quality was evaluated with Platinum Standard scale. Results: Six eligible RCTs of 251 participants were included in this systematic review. The results indicated that EMDR was associated with reductions in PTSD symptoms, depression and/or anxiety both post-treatment and at follow-up compared with all other alternative therapies (cognitive behavior therapy, individual/group therapy and fluoxetine) and control treatment (pill placebo, active listening, EMDR delayed treatment, and treatment as usual). However, studies suffered from significant heterogeneity in study populations, length of EMDR treatment, length of follow-up, comparison groups, and outcome measures. One study had a high risk of bias. Discussion: This systematic review suggests that there is growing evidence to support the clinical efficacy of EMDR in treating CT in both children and adults. However, conclusions are limited by the small number of heterogenous trials. Further RCTs with standardized methodologies, as well as studies addressing real world challenges in treating CT are required.

  14. The Efficacy of Eye Movement Desensitization and Reprocessing in Children and Adults Who Have Experienced Complex Childhood Trauma: A Systematic Review of Randomized Controlled Trials

    Directory of Open Access Journals (Sweden)

    Runsen Chen

    2018-04-01

    Full Text Available Background: Survivors of complex childhood trauma (CT such as sexual abuse show poorer outcomes compared to single event trauma survivors. A growing number of studies investigate Eye Movement Desensitization and Reprocessing (EMDR treatment for posttraumatic stress disorder (PTSD, but no systematic reviews have focused on EMDR treatment for CT as an intervention for both adults and children. This study therefore systematically reviewed all randomized controlled trials (RCTs evaluating the effect of EMDR on PTSD symptoms in adults and children exposed to CT.Methods: Databases including PubMed, Web of Science, and PsycINFO were searched in October 2017. Randomized controlled trials which recruited adult and children with experience of CT, which compared EMDR to alternative treatments or control conditions, and which measured PTSD symptoms were included. Study methodology quality was evaluated with Platinum Standard scale.Results: Six eligible RCTs of 251 participants were included in this systematic review. The results indicated that EMDR was associated with reductions in PTSD symptoms, depression and/or anxiety both post-treatment and at follow-up compared with all other alternative therapies (cognitive behavior therapy, individual/group therapy and fluoxetine and control treatment (pill placebo, active listening, EMDR delayed treatment, and treatment as usual. However, studies suffered from significant heterogeneity in study populations, length of EMDR treatment, length of follow-up, comparison groups, and outcome measures. One study had a high risk of bias.Discussion: This systematic review suggests that there is growing evidence to support the clinical efficacy of EMDR in treating CT in both children and adults. However, conclusions are limited by the small number of heterogenous trials. Further RCTs with standardized methodologies, as well as studies addressing real world challenges in treating CT are required.

  15. Hepatic trauma: a 21-year experience.

    Science.gov (United States)

    Zago, Thiago Messias; Pereira, Bruno Monteiro; Nascimento, Bartolomeu; Alves, Maria Silveira Carvalho; Calderan, Thiago Rodrigues Araujo; Fraga, Gustavo Pereira

    2013-01-01

    To evaluate the epidemiological aspects, behavior, morbidity and treatment outcomes for liver trauma. We conducted a retrospective study of patients over 13 years of age admitted to a university hospital from 1990 to 2010, submitted to surgery or nonoperative management (NOM). 748 patients were admitted with liver trauma. The most common mechanism of injury was penetrating trauma (461 cases, 61.6%), blunt trauma occurring in 287 patients (38.4%). According to the degree of liver injury (AAST-OIS) in blunt trauma we predominantly observed Grades I and II and in penetrating trauma, Grade III. NOM was performed in 25.7% of patients with blunt injury. As for surgical procedures, suturing was performed more frequently (41.2%). The liver-related morbidity was 16.7%. The survival rate for patients with liver trauma was 73.5% for blunt and 84.2% for penetrating trauma. Mortality in complex trauma was 45.9%. trauma remains more common in younger populations and in males. There was a reduction of penetrating liver trauma. NOM proved safe and effective, and often has been used to treat patients with penetrating liver trauma. Morbidity was high and mortality was higher in victims of blunt trauma and complex liver injuries.

  16. Trauma Africa

    Directory of Open Access Journals (Sweden)

    Victor Y. Kong

    2013-11-01

    Full Text Available “Major Trauma. Dr. Kong, please come to the Trauma Unit immediately. Dr. Kong, please come to the Trauma Unit immediately.” Even though I have been working at Edendale Hospital as a trauma registrar for over a year, whenever I hear this announcement over the hospital intercom system, my heart beats just a little faster than normal. When I first arrived at Edendale my colleagues told me that the adrenaline rush I would experience after being called out to attend a new emergency would decrease over time, and indeed they were right. However, it is also true to say that on some occasions more than others, it is still felt more strongly than ever.

  17. Tailbone trauma

    Science.gov (United States)

    For tailbone trauma when no spinal cord injury is suspected: Relieve pressure on the tailbone by sitting on an inflatable rubber ring or cushions. Take acetaminophen for pain. Take a stool softener to avoid constipation. If you suspect injury ...

  18. Paediatric trauma

    African Journals Online (AJOL)

    Trauma Unit, Red Cross War Memorial Children's Hospital, Cape Town ... projects, educational initiatives and advocacy roles on child safety initiatives regarding child injuries as well as child abuse. ... The development of the total body digital.

  19. Hand Fractures

    Science.gov (United States)

    ... All Topics A-Z Videos Infographics Symptom Picker Anatomy Bones Joints Muscles Nerves Vessels Tendons About Hand Surgery What is ... Hand Therapist? Media Find a Hand Surgeon Home Anatomy ... DESCRIPTION The bones of the hand serve as a framework. This framework supports the muscles that make the wrist and fingers move. When ...

  20. Replication-mediated disassociation of replication protein A-XPA complex upon DNA damage: implications for RPA handing off.

    Science.gov (United States)

    Jiang, Gaofeng; Zou, Yue; Wu, Xiaoming

    2012-08-01

    RPA (replication protein A), the eukaryotic ssDNA (single-stranded DNA)-binding protein, participates in most cellular processes in response to genotoxic insults, such as NER (nucleotide excision repair), DNA, DSB (double-strand break) repair and activation of cell cycle checkpoint signalling. RPA interacts with XPA (xeroderma pigmentosum A) and functions in early stage of NER. We have shown that in cells the RPA-XPA complex disassociated upon exposure of cells to high dose of UV irradiation. The dissociation required replication stress and was partially attributed to tRPA hyperphosphorylation. Treatment of cells with CPT (camptothecin) and HU (hydroxyurea), which cause DSB DNA damage and replication fork collapse respectively and also leads to the disruption of RPA-XPA complex. Purified RPA and XPA were unable to form complex in vitro in the presence of ssDNA. We propose that the competition-based RPA switch among different DNA metabolic pathways regulates the dissociation of RPA with XPA in cells after DNA damage. The biological significances of RPA-XPA complex disruption in relation with checkpoint activation, DSB repair and RPA hyperphosphorylation are discussed.

  1. Replication-mediated disassociation of replication protein A–XPA complex upon DNA damage: implications for RPA handing off

    Science.gov (United States)

    Jiang, Gaofeng; Zou, Yue; Wu, Xiaoming

    2013-01-01

    RPA (replication protein A), the eukaryotic ssDNA (single-stranded DNA)-binding protein, participates in most cellular processes in response to genotoxic insults, such as NER (nucleotide excision repair), DNA, DSB (double-strand break) repair and activation of cell cycle checkpoint signalling. RPA interacts with XPA (xeroderma pigmentosum A) and functions in early stage of NER. We have shown that in cells the RPA–XPA complex disassociated upon exposure of cells to high dose of UV irradiation. The dissociation required replication stress and was partially attributed to tRPA hyperphosphorylation. Treatment of cells with CPT (camptothecin) and HU (hydroxyurea), which cause DSB DNA damage and replication fork collapse respectively and also leads to the disruption of RPA–XPA complex. Purified RPA and XPA were unable to form complex in vitro in the presence of ssDNA. We propose that the competition-based RPA switch among different DNA metabolic pathways regulates the dissociation of RPA with XPA in cells after DNA damage. The biological significances of RPA–XPA complex disruption in relation with checkpoint activation, DSB repair and RPA hyperphosphorylation are discussed. PMID:22578086

  2. [Trauma in the elderly].

    Science.gov (United States)

    de Souza, José Antonio Gomes; Iglesias, Antonio Carlos R G

    2002-01-01

    The populational growth of the elderly, associated to a healthier and more active life, make this group of people more exposed to accidents. In some countries, trauma in the elderly is responsible for a high mortality rate, disproportionately higher than in the adults. This fact consumes a great portion of health care resources and implies in a high social cost. The distinct physiologic characteristics of the elderly and the frequent presence of associated diseases make that these patients behave differently and in a more complex way than patients of other ages. These particularities make that health care to the elderly victims of trauma have to be different. The present revision is about aspects of epidemiology, prevention, physiology, health care and rehabilitation of the elderly victims of trauma.

  3. Organización en el tratamiento del traumatismo panfacial y de las fracturas complejas del tercio medio Organization of treatment in panfacial trauma and complex midfacial fractures

    Directory of Open Access Journals (Sweden)

    J. Muñoz i Vidal

    2009-03-01

    between 2005 and 2006. There were 14 patients with midface high energy trauma, 4 of those associated to mandible or upper face subunit fractures. Extraocular motility, air way, correct oclussal relationship, minimum aesthetic sequel and correct recreating of facial dimensions define our goals. A multidisciplinary approach to these patients is imperative. Due to the complexity of these cases, there is not place allowed for improvisation and a previous accurate anamnesis, exploration and order of treatment is absolutely required. This leads to a proper management, an anatomic bone threedimensional reconstruction, preservation of soft structures according to previous patient's anthropometry and minimum aesthetic sequel in a single surgery time.

  4. Male genital trauma

    International Nuclear Information System (INIS)

    Jordan, G.H.; Gilbert, D.A.

    1988-01-01

    We have attempted to discuss genital trauma in relatively broad terms. In most cases, patients present with relatively minimal trauma. However, because of the complexity of the structures involved, minimal trauma can lead to significant disability later on. The process of erection requires correct functioning of the arterial, neurologic, and venous systems coupled with intact erectile bodies. The penis is composed of structures that are compliant and distensible to the limits of their compliance. These structures therefore tumesce in equal proportion to each other, allowing for straight erection. Relatively minimal trauma can upset this balance of elasticity, leading to disabling chordee. Likewise, relatively minimal injuries to the vascular erectile structures can lead to significantly disabling spongiofibrosis. The urethra is a conduit of paramount importance. Whereas the development of stricture is generally related to the nature of the trauma, the extent of stricture and of attendant complications is clearly a function of the immediate management. Overzealous debridement can greatly complicate subsequent reconstruction. A delicate balance between aggressive initial management and maximal preservation of viable structures must be achieved. 38 references

  5. Geriatric trauma.

    Science.gov (United States)

    Adams, Sasha D; Holcomb, John B

    2015-12-01

    The landscape of trauma is changing due to an aging population. Geriatric patients represent an increasing number and proportion of trauma admissions and deaths. This review explores recent literature on geriatric trauma, including triage criteria, assessment of frailty, fall-related injury, treatment of head injury complicated by coagulopathy, goals of care, and the need for ongoing education of all surgeons in the care of the elderly. Early identification of high-risk geriatric patients is imperative to initiate early resuscitative efforts. Geriatric patients are typically undertriaged because of their baseline frailty being underappreciated; however, centers that see more geriatric patients do better. Rapid reversal of anticoagulation is important in preventing progression of brain injury. Anticipation of difficult disposition necessitates early involvement of physical therapy for rehabilitation and case management for appropriate placement. Optimal care of geriatric trauma patients will be based on the well established tenets of trauma resuscitation and injury repair, but with distinct elements that address the physiological and anatomical challenges presented by geriatric patients.

  6. Abdominal trauma

    International Nuclear Information System (INIS)

    Giordany, B.R.

    1985-01-01

    Abdominal injury is an important cause of morbidity and mortality in childhood. Ten percent of trauma-related deaths are due to abdominal injury. Thousands of children are involved in auto accidents annually; many suffer severe internal injury. Child abuse is a second less frequent but equally serious cause of internal abdominal injury. The descriptions of McCort and Eisenstein and their associates in the 1960s first brought to attention the frequency and severity of visceral injury as important manifestations of the child abuse syndrome. Blunt abdominal trauma often causes multiple injuries; in the past, many children have been subjected to exploratory surgery to evaluate the extent of possible hidden injury. Since the advent of noninvasive radiologic imaging techniques including radionuclide scans and ultrasound and, especially, computed tomography (CT), the radiologist has been better able to assess (accurately) the extent of abdominal injury and thus allow conservative therapy in many cases. Penetrating abdominal trauma occurs following gunshot wounds, stabbing, and other similar injury. This is fortunately, a relatively uncommon occurrence in most pediatric centers and will not be discussed specifically here, although many principles of blunt trauma diagnosis are valid for evaluation of penetrating abdominal trauma. If there is any question that a wound has extended intraperitonelly, a sinogram with water-soluble contrast material allows quick, accurate diagnosis. The presence of large amounts of free intraperitoneal gas suggests penetrating injury to the colon or other gas-containing viscus and is generally considered an indication for surgery

  7. Hand Therapy

    Science.gov (United States)

    ... from conditions such as carpal tunnel syndrome and tennis elbow , as well as from chronic problems such as ... Tools Advice from a Certified Hand Therapist on Tennis Elbow Advice from a Certified Hand Therapist: Living with( ...

  8. A psychometric assessment of Disturbances in Self-Organization symptom indicators for ICD-11 Complex PTSD using the International Trauma Questionnaire.

    Science.gov (United States)

    Shevlin, Mark; Hyland, Philip; Roberts, Neil P; Bisson, Jonathan I; Brewin, Chris R; Cloitre, Marylene

    2018-01-01

    Background : Two 'sibling disorders' have been proposed for the 11 th version of the International Classification of Diseases (ICD-11): Posttraumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD). To date, no research has attempted to identify the optimal symptom indicators for the 'Disturbances in Self-Organization' (DSO) symptom cluster. Objective : The aim of the current study was to assess the psychometric performance of scores of 16 potential DSO symptom indicators from the International Trauma Questionnaire (ITQ). Criteria relating to score variability and their ability to discriminate were employed. Method : Participants ( N  = 1839) were a nationally representative household sample of non-institutionalized adults currently residing in the US. Item scores from the ITQ were examined in relation to basic criteria associated with interpretability, variability, homogeneity, and association with functional impairment. The performance of the DSO symptoms was also assessed using 1- and 2-parameter item response theory (IRT) models. Results : The distribution of responses for all DSO indicators met the criteria associated with interpretability, variability, homogeneity, and association with functional impairment. The 1-parameter graded response model was considered the best model and indicated that each set of indictors performed very similarly. Conclusions : The ITQ contains 16 DSO symptom indicators and they perform well in measuring their respective symptom cluster. There was no evidence that particular indicators were 'better' than others, and it was concluded that the indicators are essentially interchangeable.

  9. Pancreatic trauma.

    Science.gov (United States)

    Lahiri, R; Bhattacharya, S

    2013-05-01

    Pancreatic trauma occurs in approximately 4% of all patients sustaining abdominal injuries. The pancreas has an intimate relationship with the major upper abdominal vessels, and there is significant morbidity and mortality associated with severe pancreatic injury. Immediate resuscitation and investigations are essential to delineate the nature of the injury, and to plan further management. If main pancreatic duct injuries are identified, specialised input from a tertiary hepatopancreaticobiliary (HPB) team is advised. A comprehensive online literature search was performed using PubMed. Relevant articles from international journals were selected. The search terms used were: 'pancreatic trauma', 'pancreatic duct injury', 'radiology AND pancreas injury', 'diagnosis of pancreatic trauma', and 'management AND surgery'. Articles that were not published in English were excluded. All articles used were selected on relevance to this review and read by both authors. Pancreatic trauma is rare and associated with injury to other upper abdominal viscera. Patients present with non-specific abdominal findings and serum amylase is of little use in diagnosis. Computed tomography is effective in diagnosing pancreatic injury but not duct disruption, which is most easily seen on endoscopic retrograde cholangiopancreaticography or operative pancreatography. If pancreatic injury is suspected, inspection of the entire pancreas and duodenum is required to ensure full evaluation at laparotomy. The operative management of pancreatic injury depends on the grade of injury found at laparotomy. The most important prognostic factor is main duct disruption and, if found, reconstructive options should be determined by an experienced HPB surgeon. The diagnosis of pancreatic trauma requires a high index of suspicion and detailed imaging studies. Grading pancreatic injury is important to guide operative management. The most important prognostic factor is pancreatic duct disruption and in these cases

  10. Hand Anatomy

    Science.gov (United States)

    ... All Topics A-Z Videos Infographics Symptom Picker Anatomy Bones Joints Muscles Nerves Vessels Tendons About Hand Surgery What is ... Hand Therapist? Media Find a Hand Surgeon Home Anatomy Bones Joints Muscles Nerves Vessels Tendons Anatomy The upper extremity is ...

  11. Splenic Trauma

    International Nuclear Information System (INIS)

    Cortes Diaz, Fabio F; Buitrago Mejia, Francisco; Ulloa Guerrero, Luis Heber

    2001-01-01

    The spleen is the organ that is injured during the closed trauma with more frequency and it is the cause more common of foregone death in the patients with wounded abdominal. At the present time the complications of the splenic trauma are related with their severity, associate wounds, diagnostic fail or inadequate treatments. The lesions that are diagnosed in early form are managed quick and satisfactorily, but the forgotten wounds or the diagnoses and late treatments take for themselves high rates of morbid-mortality. The paper includes their phyto pathology, diagnoses, classification and treatment

  12. Ballistic trauma

    Directory of Open Access Journals (Sweden)

    Parvathi Devi Munishwar

    2016-01-01

    Full Text Available Gunshot injuries are rather serious but uncommon type of trauma in India. Radiologists can contribute substantially in the evaluation and treatment of patients with gunshot wounds. Foreign bodies that enter a patient as a result of trauma are contaminated and produce a range of symptoms. Oral and maxillofacial gunshot injuries are usually fatal due to close proximity with vital structures. Here, we report a case in which radiographic evidence of foreign bodies in the right orofacial region exposed a history of a gunshot injury. The patient did not have any major complaints except for reduced mouth opening. These foreign bodies were clinically silent for approximately 12 years.

  13. Thoracic Trauma.

    Science.gov (United States)

    Dennis, Bradley M; Bellister, Seth A; Guillamondegui, Oscar D

    2017-10-01

    Management of chest trauma is integral to patient outcomes owing to the vital structures held within the thoracic cavity. Understanding traumatic chest injuries and appropriate management plays a pivotal role in the overall well-being of both blunt and penetrating trauma patients. Whether the injury includes rib fractures, associated pulmonary injuries, or tracheobronchial tree injuries, every facet of management may impact the short- and long-term outcomes, including mortality. This article elucidates the workup and management of the thoracic cage, pulmonary and tracheobronchial injuries. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Trauma pattern in a level I east-European trauma center

    Directory of Open Access Journals (Sweden)

    Bogdan Stoica

    2015-10-01

    Conclusions: Our trauma pattern profile is similar to the one found in west-European countries, with a predominance of traffic-related injuries and falls. The severity and anatomical puzzle for trauma lesions were more complex secondary to motorcycle or bicycle-to-auto vehicles collisions. A trauma registry, with prospective enrollment of patients, is a very effective tool for constant improvements in trauma care.

  15. Complex PTSD as proposed for ICD-11: validation of a new disorder in children and adolescents and their response to Trauma-Focused Cognitive Behavioral Therapy.

    Science.gov (United States)

    Sachser, Cedric; Keller, Ferdinand; Goldbeck, Lutz

    2017-02-01

    To evaluate whether the symptoms of children and adolescents with clinically significant posttraumatic stress symptoms (PTSS) form classes consistent with the diagnostic criteria of complex PTSD (CPTSD) as proposed for the ICD-11, and to relate the emerging classes with treatment outcome of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). Latent classes analysis (LCA) was used to explore the symptom profiles of the clinical baseline assessment of N = 155 children and adolescents participating in a randomized controlled trial of TF-CBT. The treatment outcomes of patients with posttraumatic stress disorder (PTSD) and of patients with CPTSD were compared by a t-test for depended samples and a repeated-measures ANOVA. The LCA revealed two distinct classes: a PTSD class characterized by elevated core symptoms of PTSD (n = 62) and low symptoms of disturbances in self-organization versus a complex PTSD class with elevated PTSD core symptoms and elevated symptoms of disturbances in self-organization (n = 93). The Group × Time interaction regarding posttraumatic stress symptoms was not significant. Pre-post effect sizes regarding posttraumatic stress symptoms were large for both groups (PTSD: d = 2.81; CPTSD: d = 1.37). For disturbances in self-organization in the CPTSD class, we found medium to large effect sizes (d = 0.40-1.16) after treatment with TF-CBT. The results provide empirical evidence of the ICD-11 CPTSD and PTSD distinction in a clinical sample of children and adolescents. In terms of relative improvement from their respective baseline posttraumatic stress symptoms, patients with PTSD and CPTSD responded equally to TF-CBT; however, those with CPTSD ended treatment with clinically and statistically greater symptoms than those with PTSD. © 2016 Association for Child and Adolescent Mental Health.

  16. Management of dental trauma in primary care: a postal survey of general dental practitioners.

    Science.gov (United States)

    Jackson, N G; Waterhouse, P J; Maguire, A

    2005-03-12

    To determine the self-perceived knowledge and attitudes of general dental practitioners (GDPs) concerning management of dental trauma in primary care. To identify potential barriers to the management of dental trauma in primary care. A self-completion postal questionnaire survey of 417 GDPs in six local health authority districts in northeast England. Likert scale responses to 20 statements designed to test self-perceived knowledge and attitudes. Following descriptive statistical analysis. Factor analysis with principle components analysis was undertaken to identify areas of correlation in questionnaire responses, followed by Chi squared test, Spearman's Rank Correlation and analysis of variance (ANOVA) to measure association between variables. The response rate was 74%. Enamel and dentine fractures were the most common injury, with 45% of GDPs responding seeing more than 10 cases of dental trauma in the preceding year and 53% of respondents seeing one to three cases of complicated crown fracture. Seventy-eight per cent believed that NHS remuneration was inadequate, but only 8% would refer patients with dental trauma to secondary care for this reason. Half of the GDPs believed that trauma could be treated more effectively in practice if NHS payments were greater. GDPs were significantly more likely to agree with this statement if they had previously undertaken a postgraduate course in the treatment of dental trauma (p=0.002). Single handed GDPs were statistically significantly more likely to agree with the statements 'I would not treat dental trauma cases at my practice because the NHS payment is inadequate' (p=0.008) and 'Treating dental trauma at my practice requires too much of my clinical time to be worthwhile' (p=0.002). Ninety-six per cent of GDPs disagreed that treatment of dental trauma rested solely within secondary care. Ninety-six per cent of GDPs agreed that they had a responsibility to provide initial emergency treatment for trauma patients prior to

  17. Trauma no idoso Trauma in the elderly

    Directory of Open Access Journals (Sweden)

    JOSÉ ANTONIO GOMES DE SOUZA

    2002-03-01

    Full Text Available O crescimento populacional de idosos, associado a uma forma de vida mais saudável e mais ativa, deixa este grupo de pessoas mais exposto ao risco de acidentes. Em alguns países, o trauma do idoso responde por uma elevada taxa de mortalidade, a qual se apresenta de forma desproporcionalmente maior do que a observada entre a população de adultos jovens. Tal fato acarreta um grande consumo de recursos financeiros destinados à assistência da saúde e um elevado custo social. As características fisiológicas próprias do idoso, assim como a presença freqüente de doenças associadas, faz com que estes pacientes se comportem diferentemente e de forma mais complexa do que os demais grupos etários. Estas particularidades fazem com que o atendimento ao idoso vítima de trauma se faça de forma diferenciada. A presente revisão aborda aspectos da epidemiologia, da prevenção, da fisiologia, do atendimento e da reabilitação do idoso vítima de trauma.The populational growth of the elderly, associated to a healthier and more active life, make this group of people more exposed to accidents. In some countries, trauma in the elderly is responsible for a high mortality rate, desproportionately higher than in the adults. This fact consumes a great portion of health care resources and implies in a high social cost. The distinct physiologic characteristics of the elderly and the frequent presence of associated diseases make that these patients behave diferently and in a more complex way than patients of other ages. These particularities make that health care to the elderly victims of trauma have to be different. The present revision is about aspects of epidemiology, prevention, physiology, health care and reabilitation of the elderly victims of trauma.

  18. Traumatismos oculares Ocular traumas

    Directory of Open Access Journals (Sweden)

    Gelen Welch Ruiz

    2007-12-01

    Full Text Available Se realizó un estudio descriptivo de tipo retrospectivo longitudinal cuyo universo estuvo constituido por 72 ojos de 72 pacientes con traumatismos oculares mecánicos que fueron hospitalizados en el Hospital Militar Central “Dr. Carlos J. Finlay” desde enero de 1999 hasta enero de 2005. Para el análisis estadístico de la información se utilizó el programa automatizado SPSS versión 11.5 en el cual también se conformó la base de datos y se realizaron los cálculos de acuerdo con el tipo de variable analizada. Se utilizaron medidas de resumen, tendencia central y asociación estadística con un nivel de significación de p A retrospective longitudinal and descriptive study was carried out in 72 eyes from 72 patients with mechanical occular traumas, who had been hospitalized in “Dr. Carlos J. Finlay” Military Hospital from December 1999 to January 2005. For the statistical data analysis, an automated program (SPSS 11.5 version was used to create the database and estimations were made according to the variable types. Summary measures, central tendency measures and statistical association with significance level equal to p < 0.05 were employed. Males prevailed (95.8%, the average age was 30.26 years with a minimum rate of 17 years and maximum rate of 82 years. The most frequent mechanisms of trauma were aggressions (23. 6% and injures from secondary projectiles (13.9%. The anterior segment traumas were more frequent (61, 1% than posterior segment traumas (6.94%. Both segments of the eyeball were affected in 39, 1% of eyes which evinced the worst visual acuity. The most common associated injures were hyphema (54, 2% and vitreous hemorrhage (16.6%. Closed trauma (contusions were more common and most of the eyes had better final visual acuity (45, 2% with vision range of 0.6-1.0 and 26.2% with vision range of 0.59-0.1. On the other hand, eyes affected by open trauma (simple wound, contusion-wound, wound with intraocular foreign body and

  19. [Hand osteoarthritis].

    Science.gov (United States)

    Šenolt, Ladislav

    Hand osteoarthritis (OA) is a common chronic disorder causing pain and limitation of mobility of affected joints. The prevalence of hand OA increases with age and more often affects females. Clinical signs obviously do not correlate with radiographic findings - symptomatic hand OA affects approximately 26 % of adult subjects, but radiographic changes can be found in up to two thirds of females and half of males older than 55 years.Disease course differ among individual patients. Hand OA is a heterogeneous disease. Nodal hand OA is the most common subtype affecting interphalangeal joints, thumb base OA affects first carpometacarpal joint. Erosive OA represents a specific subtype of hand OA, which is associated with joint inflammation, more pain, functional limitation and erosive findings on radiographs.Treatment of OA is limited. Analgesics and nonsteroidal anti-inflammatory drugs are the only agents reducing symptoms. New insights into the pathogenesis of disease should contribute to the development of novel effective treatment of hand OA.

  20. Diagnostic imaging of the hand. 3. rev. and enl. ed.

    International Nuclear Information System (INIS)

    Schmitt, Rainer; Lanz, Ulrich

    2015-01-01

    The book on diagnostic imaging of the hand covers the following issues: projection radiography, cinematography, MRT and CR arthrography, arthroscopy, arteriography, skeleton scintiscanning, sonography, computerized tomography, magnetic resonance tomography, anatomy of forearm and carpus, anatomy of metacarpus and fingers, carpal function and morphometry, postoperative X-ray diagnostic, growing hand skeleton, normative variants, malformations and deformities, trauma of the distal forearm, lesions of the ulnocarpal complex (TFCC), scaphoid fractures, scaphoid arthrosis, fractures of other carpus bones, carpal luxations and luxation fractures, carpal instabilities, fractures of the metacarpalla, finger fractures, arthrosis deformans, enthesiopathies, sport induced soft tissue lesions, osteonecrosis, impingement syndromes, osteopenic skeletal diseases, metabolis diseases, crystal-induced osteoarthropaties, rheumatoid arthritis, spondyloarthritis, rheumatic fever, collagenoses, infective arthritis, osteomyelitis, soft tissue infections, cystoids bone lesions, skeletal tumors, soft tissue tumors, carpal tunnel syndrome, nerve compression syndrome, arterial perfusion disturbances, differential diagnostic tables on hand lesions.

  1. Trauma Theory

    DEFF Research Database (Denmark)

    Pedersen, Bodil Maria

    There are two main trends in psychological approaches to human suffering related to what we term trauma. Although they have their respective limitations both approaches may help us explore and alleviate human suffering. One trend, primarily using concepts like traumatic events and traumatisation ...

  2. The hand and wrist

    International Nuclear Information System (INIS)

    Wood, M.B.; Berquist, T.H.

    1985-01-01

    Trauma is the most common etiologic factor leading to disability in the hand and wrist. Judicious radiographic evaluation is required for accurate assessment in practically all but the most minor of such injuries. Frequently serial radiographic evaluation is essential for directing the course of treatment and for following the healing process. A meaningful radiographic evaluation requires a comprehensive knowledge of the normal radiographic anatomy, an overview of the spectrum of pathology, and an awareness of the usual mechanisms of injury, appropriate treatment options, and relevant array of complications

  3. Illness representations in patients with hand injury.

    LENUS (Irish Health Repository)

    Chan, Jeffrey C Y

    2009-07-01

    Differences in illness perception about hand injury may partly explain the variation in health behaviours such as adherence to post-operative therapy, coping strategy, emotional response and eventual clinical outcome. This study examined the illness perception of patients with hand injuries in the acute trauma setting.

  4. Trauma Imaging: A Literature Review.

    Science.gov (United States)

    Vela, Jason Heath; Wertz, Christopher Ira; Onstott, Kimberly L; Wertz, Joss R

    2017-01-01

    To inform radiologic technologists about which imaging modalities and examinations are best suited for evaluating specific anatomical structures in patients who have sustained a traumatic injury. Two scholarly research databases were searched to identify articles focused on trauma imaging of the head, cervical spine, thorax, abdomen, and pelvis. Articles focused on trauma diagnosis were excluded. Thirty-two articles were selected for analysis. Physical examination and plain-film radiographs typically are used to assess nasal bone fracures. Computed tomography (CT) can be used to assess zygomaticomaxillary complex, mandibular, and temporal bone fractures. Traumatic brain injuries are difficult to assess, and broad classifications are used. Depending on the severity of cervical spine trauma, plain-film radiographs or CT imaging is adequate, with magnetic resonance imaging used as a means for further evaluation. Trauma to the thorax typically is assessed with radiography and CT, and CT is recommended for assesment of abdominal and pelvic trauma. The literature was consistent regarding which examinations to perform to best evaluate suspected injuries to the chest, abdomen, and pelvis. The need for, and correct use of, imaging in evaluating trauma to the head and cervical spine is more controversial. Despite the need for additional research, emergency department care providers should be familiar with the structures most commonly injured during trauma and the role of medical imaging for diagnosis.

  5. [Pancreatic trauma].

    Science.gov (United States)

    Arvieux, C; Guillon, F; Létoublon, Ch; Oughriss, M

    2003-10-01

    Early diagnosis of pancreatic trauma has always been challenging because of the lack of correlation between the initial clinical symptomatology, radiologic and laboratory findings, and the severity of the injury. Thanks to the improved performance of spiral CT scanning and magnetic resonance pancreatography, it is now often possible to make an early diagnosis of pancreatic contusion, to localize the site of the injury, and (most importantly) to identify injury to the main pancreatic duct which has major implications for the management of the case. When the trauma victim is unstable, radiologic work-up may be impossible and urgent laparotomy is required. Control of hemorrhage is the primary concern here and a damage control approach with packing may be appropriate; if the pancreatic head has been destroyed, a pancreaticoduodenectomy with delayed reconstruction may be required. If the trauma victim is stable, the treatment strategy will be governed by a variety of parameters--age, clinical condition, associated local anatomic findings (pancreatitis, injury to the duodenum or biliary tract), involvement of the pancreatic duct, and localization of the injury within the gland (to right or left of the mesenteric vessels).

  6. Trauma complexity and child abuse

    DEFF Research Database (Denmark)

    Riber, Karin

    2017-01-01

    and categories emerged in the domains childhood physical abuse (CPA), childhood emotional abuse (CEA), and neglect. Participants articulated wide personal impacts of child abuse in emotional, relational, and behavioral domains in their adult lives. These narratives contribute valuable clinical information...

  7. Impact of Sexual Trauma on HIV Care Engagement: Perspectives of Female Patients with Trauma Histories in Cape Town, South Africa.

    Science.gov (United States)

    Watt, Melissa H; Dennis, Alexis C; Choi, Karmel W; Ciya, Nonceba; Joska, John A; Robertson, Corne; Sikkema, Kathleen J

    2017-11-01

    South African women have disproportionately high rates of both sexual trauma and HIV. To understand how sexual trauma impacts HIV care engagement, we conducted in-depth qualitative interviews with 15 HIV-infected women with sexual trauma histories, recruited from a public clinic in Cape Town. Interviews explored trauma narratives, coping behaviors and care engagement, and transcripts were analyzed using a constant comparison method. Participants reported multiple and complex traumas across their lifetimes. Sexual trauma hindered HIV care engagement, especially immediately following HIV diagnosis, and there were indications that sexual trauma may interfere with future care engagement, via traumatic stress symptoms including avoidance. Disclosure of sexual trauma was limited; no women had disclosed to an HIV provider. Routine screening for sexual trauma in HIV care settings may help to identify individuals at risk of poor care engagement. Efficacious treatments are needed to address the psychological and behavioral sequelae of trauma.

  8. Robotic Hand

    Science.gov (United States)

    1993-01-01

    The Omni-Hand was developed by Ross-Hime Designs, Inc. for Marshall Space Flight Center (MSFC) under a Small Business Innovation Research (SBIR) contract. The multiple digit hand has an opposable thumb and a flexible wrist. Electric muscles called Minnacs power wrist joints and the interchangeable digits. Two hands have been delivered to NASA for evaluation for potential use on space missions and the unit is commercially available for applications like hazardous materials handling and manufacturing automation. Previous SBIR contracts resulted in the Omni-Wrist and Omni-Wrist II robotic systems, which are commercially available for spray painting, sealing, ultrasonic testing, as well as other uses.

  9. Combat Casualty Hand Burns: Evaluating Impairment and Disability during Recovery

    Science.gov (United States)

    2008-06-01

    impairment guidelines would correlate with disability as mea- sured by the DASH. However, a study by Mink van der Molen et al. found only a weak correlation (r...Mink van der Molen AB, Ettema AM, Hovius SER. Outcome of hand trauma: the hand injury severity scoring system (HISS) and subsequent impairment and...0.38) between AMA and DASH scores at six months after hand trauma.16 In another study, van Oosterom et al. reported no statistically significant

  10. Urethral trauma

    International Nuclear Information System (INIS)

    Carrington, B.M.; Hricak, H.; Dixon, C.; McAninch, J.W.

    1990-01-01

    This paper evaluates the role of MR imaging in posterior urethral trauma. Fifteen patients with posttraumatic membranous urethral strictures underwent prospective MR imaging with a 1.5-T unit before open urethroplasty. All patients had transaxial T1-weighted (500/20) and T2-weighted (2,500/70) spin-echo images and T2-weighted sagittal and coronal images (matrix, 192 x 256; section thickness, 4 mm with 20% gap). Conventional retrograde and cystourethrography were performed preoperatively. Compared with conventional studies, MR imaging defined the length and location of the urethral injury and provided additional information regarding the direction and degree of prostatic and urethral dislocation

  11. Images in kidney trauma

    International Nuclear Information System (INIS)

    Rodriguez, Jose Luis; Rodriguez, Sonia Pilar; Manzano, Ana Cristina

    2007-01-01

    A case of a 3 years old female patient, who suffered blunt lumbar trauma (horse kick) with secondary kidney trauma, is reported. Imaging findings are described. Renal trauma classification and imaging findings are reviewed

  12. The trauma of a recession.

    LENUS (Irish Health Repository)

    Murphy, S M

    2011-09-01

    Employment in construction in Ireland fell by 10% from nearly 282,000 in the second quarter of 2007 to 255,000 in the same period of 2008. Our study looks at the differences in soft tissue upper limb trauma dynamics of a pre- and post-recession Ireland. Construction accounted for 330 patients (27%) of all hand injuries in 2006, but only 18 (3%) in 2009. Our data shows a significant drop in hand injuries related to the construction industry, and more home\\/DIY cases and deliberate self-harm presenting in their stead.

  13. The trauma of a recession.

    Science.gov (United States)

    Murphy, S M; Kieran, I; Shaughnessy, M O

    2011-09-01

    Employment in construction in Ireland fell by 10% from nearly 282,000 in the second quarter of 2007 to 255,000 in the same period of 2008. Our study looks at the differences in soft tissue upper limb trauma dynamics of a pre- and post-recession Ireland. Construction accounted for 330 patients (27%) of all hand injuries in 2006, but only 18 (3%) in 2009. Our data shows a significant drop in hand injuries related to the construction industry, and more home/DIY cases and deliberate self-harm presenting in their stead.

  14. Surgeons’ and Emergency Physicians’ Perceptions of Trauma Management and Training

    Directory of Open Access Journals (Sweden)

    Hemphill, Robin R

    2009-08-01

    Full Text Available Objective: The study objective was to determine whether surgeons and emergency medicine physicians (EMPs have differing opinions on trauma residency training and trauma management in clinical practice.Methods: A survey was mailed to 250 EMPs and 250 surgeons randomly selected.Results: Fifty percent of surgeons perceived that surgery exclusively managed trauma compared to 27% of EMPs. Surgeons were more likely to feel that only surgeons should manage trauma on presentation to the ED. However, only 60% of surgeons currently felt comfortable with caring for the trauma patient, compared to 84% of EMPs. Compared to EMPs, surgeons are less likely to feel that EMPs can initially manage the trauma patient (71% of surgeons vs. 92% of EMPs.Conclusion: EMPs are comfortable managing trauma while many surgeons do not feel comfortable with the complex trauma patient although the majority of surgeons responded that surgeons should manage the trauma.[WestJEM. 2009;10:144-149.

  15. Reported exposure to trauma among adult patients referred for ...

    African Journals Online (AJOL)

    Reported exposure to trauma among adult patients referred for psychological services at the Free State Psychiatric Complex, Bloemfontein. ... trauma exposure screening in routine psychiatric interviewing practices is highlighted. Keywords: Trauma exposure, Mental illness, Screening, Post-traumatic stress disorder ...

  16. TRAUMA SURGERY

    African Journals Online (AJOL)

    meet the criteria for damage control surgery, and ligation of the AVC is a .... There were two vertebral body fractures, one penetrating brain injury from a gunshot wound to the head, one ... two hand fractures, three haemothoraces, one pelvic fracture, .... One patient with an intimal flap injury to his left common iliac artery ...

  17. Hand eczema

    DEFF Research Database (Denmark)

    Ibler, K.S.; Jemec, G.B.E.; Flyvholm, M.-A.

    2012-01-01

    Background. Healthcare workers are at increased risk of developing hand eczema. Objectives. To investigate the prevalence and severity of self-reported hand eczema, and to relate the findings to demographic data, occupation, medical speciality, wards, shifts, and working hours. Patients/materials......Background. Healthcare workers are at increased risk of developing hand eczema. Objectives. To investigate the prevalence and severity of self-reported hand eczema, and to relate the findings to demographic data, occupation, medical speciality, wards, shifts, and working hours. Patients...... dermatitis, younger age, male sex (male doctors), and working hours. Eighty nine per cent of subjects reported mild/moderate lesions. Atopic dermatitis was the only factor significantly related to severity. Sick leave was reported by 8% of subjects, and notification to the authorities by 12%. Conclusions...... or severity, but cultural differences between professions with respect to coping with the eczema were significant. Atopic dermatitis was related to increased prevalence and severity, and preventive efforts should be made for healthcare workers with atopic dermatitis....

  18. Hand Osteoblastoma

    Directory of Open Access Journals (Sweden)

    M. Farzan

    2006-06-01

    Full Text Available Background and Aim: Osteoblastoma is one of the rarest primary bone tumors. Although, small bones of the hands and feet are the third most common location for this tumor, the hand involvement is very rare and few case observations were published in the English-language literature. Materials and Methods: In this study, we report five cases of benign osteoblastoma of the hand, 3 in metacarpals and two in phalanxes. The clinical feature is not specific. The severe nocturnal, salicylate-responsive pain is not present in patients with osteoblastoma. The pain is dull, persistent and less localized. The clinical course is usually long and there is often symptoms for months before medical attention are sought. Swelling is a more persistent finding in osteoblastoma of the hand that we found in all of our patients. The radiologic findings are indistinctive, so preoperative diagnosis based on X-ray appearance is difficult. In all of our 5 cases, we fail to consider osteoblastoma as primary diagnosis. Pathologically, osteoblastoma consisting of a well-vascularized connective tissue stroma in which there is active production of osteoid and primitive woven bone. Treatment depends on the stage and localization of the tumor. Curettage and bone grafting is sufficient in stage 1 or stage 2, but in stage 3 wide resection is necessary for prevention of recurrence. Osteosarcoma is the most important differential diagnosis that may lead to inappropriate operation.

  19. Management of adult blunt hepatic trauma.

    Science.gov (United States)

    Kozar, Rosemary A; McNutt, Michelle K

    2010-12-01

    To review the nonoperative and operative management of blunt hepatic injury in the adult trauma population. Although liver injury scale does not predict need for surgical intervention, a high-grade complex liver injury should alert the physician to a patient at increased risk of hepatic complications following nonoperative management. Blunt hepatic injury remains a frequent intraabdominal injury in the adult trauma population. The management of blunt hepatic injury has undergone a major paradigm shift from mandatory operative exploration to nonoperative management. Hemodynamic instability with a positive focused abdominal sonography for trauma and peritonitis are indications for emergent operative intervention. Although surgical intervention for blunt hepatic trauma is not as common as in years past, it is imperative that the current trauma surgeon be familiar with the surgical skill set to manage complex hepatic injuries. This study represents a review of both nonoperative and operative management of blunt hepatic injury.

  20. Head Trauma: First Aid

    Science.gov (United States)

    First aid Head trauma: First aid Head trauma: First aid By Mayo Clinic Staff Most head trauma involves injuries that are minor and don't require ... 21, 2015 Original article: http://www.mayoclinic.org/first-aid/first-aid-head-trauma/basics/ART-20056626 . Mayo ...

  1. Management of liver trauma.

    LENUS (Irish Health Repository)

    Badger, S A

    2012-02-01

    BACKGROUND: Blunt and penetrating liver trauma is common and often presents major diagnostic and management problems. METHODS: A literature review was undertaken to determine the current consensus on investigation and management strategies. RESULTS: The liver is the most frequently injured organ following abdominal trauma. Immediate assessment with ultrasound has replaced diagnostic peritoneal lavage in the resuscitation room, but computerised tomography remains the gold standard investigation. Nonoperative management is preferred in stable patients but laparotomy is indicated in unstable patients. Damage control techniques such as perihepatic packing, hepatotomy plus direct suture, and resectional debridement are recommended. Major complex surgical procedures such as anatomical resection or atriocaval shunting are now thought to be redundant in the emergency setting. Packing is also recommended for the inexperienced surgeon to allow control and stabilisation prior to transfer to a tertiary centre. Interventional radiological techniques are becoming more widely used, particularly in patients who are being managed nonoperatively or have been stabilised by perihepatic packing. CONCLUSIONS: Management of liver injuries has evolved significantly throughout the last two decades. In the absence of other abdominal injuries, operative management can usually be avoided. Patients with more complex injuries or subsequent complications should be transferred to a specialist centre to optimise final outcome.

  2. Advanced Implant-Prosthetic Rehabilitation: How to Obtain a Correct Restoration of Both Functions and Aesthetics in Patients with Complex Combined Dental and Maxillofacial Trauma: A Case Report and Topical Review of the Literature.

    Science.gov (United States)

    Figliuzzi, M M; Giudice, A; Fortunato, L

    2017-01-01

    Aim . This study aims to explain the main steps that characterize the implant-prosthetic rehabilitation in complex combined dental and maxillofacial trauma. Material and Methods . A 20-year-old patient reported an extensive facial trauma which also involved the alveolar process of the maxillary bone. The patient reported a maxillofacial fracture and the loss of teeth 1.3, 1.2, 1.1, and 2.1. A "Le Fort" type 2 fracture was also reported, with the malar bone involvement. After reduction and containment of bone fractures, through appropriate mounting plates, appropriate functional and aesthetic rehabilitation of the patient were replaced thanks to a temporary removable prosthesis. After 6 months, the patient performed numerous clinical investigations, aimed at a proper planning of implant-prosthetic rehabilitation of the upper dental arch. Conclusion . With the planning of the case, as well as respecting the surrounding biological structures, the surgery of implants can be carried out with the most appropriate procedure. Lastly, new dental implants with highly bioactive surfaces have been developed, providing an excellent and rapid bone integration.

  3. Trauma facilities in Denmark

    DEFF Research Database (Denmark)

    Weile, Jesper; Nielsen, Klaus; Primdahl, Stine C

    2018-01-01

    Background: Trauma is a leading cause of death among adults aged challenge. Evidence supports the centralization of trauma facilities and the use multidisciplinary trauma teams. Because knowledge is sparse on the existing distribution of trauma facilities...... and the organisation of trauma care in Denmark, the aim of this study was to identify all Danish facilities that care for traumatized patients and to investigate the diversity in organization of trauma management. Methods: We conducted a systematic observational cross-sectional study. First, all hospitals in Denmark...... were identified via online services and clarifying phone calls to each facility. Second, all trauma care manuals on all facilities that receive traumatized patients were gathered. Third, anesthesiologists and orthopedic surgeons on call at all trauma facilities were contacted via telephone...

  4. Tratamiento quirúrgico de la falange distal bífida por traumatismo de mano en la infancia Tratamento cirurgico de falange distal bifida pós traumatismo de mão na infância Surgical treatment of distal bifid phalanx post of hand trauma in childhood

    Directory of Open Access Journals (Sweden)

    F. Passos da Rocha

    2011-03-01

    Full Text Available La extremidad distal de los dedos es la parte de la mano que más frecuentemente se lesiona. Las principales complicaciones que pueden derivar de ese tipo de lesiones traumáticas incluyen: infecciones, retracciones de la piel, deformidades óseas y amputaciones. El presente artículo tiene como objetivo presentar el tratamiento quirúrgico seguido en un pacientes de 16 años que sufrió traumatismo sobre la falange distal del segundo dedo de la mano derecha a los 2 años de edad, a consecuencia del cual se produjo deformidad ósea y falange bífida asociada a retracción de la piel en el punto de la lesión.A extremidade distal dos dedos é a parte da mão mais freqüentemente lesionada. As principais complicações que podem ocorrer como conseqüências dessas lesões traumáticas incluem: as infecções, as retrações da pele, as deformidades ósseas e as amputações. O presente trabalho tem como objetivo relatar o tratamento cirúrgico de um paciente de 16 anos que sofreu um trauma na falange distal do segundo dedo da mão direita aos dois anos de idade, resultando em deformidade óssea e falange distal bífida associada a retração de pele no local onde ocorreu a lesão.The distal extremity of the fingers of the hand is the most frequently injured. The main complications that can occur as a result of these traumatic injuries include: infections, retraction of the skin, bone deformities and amputations. This article aims to report the surgical treatment of a 16 years old patient who suffered a trauma in the distal phalanx of the second finger of right hand when he was 2 years old, resulting in bone deformity and distal phalanx bifid associated with retraction of the skin at the site where the injury occurred.

  5. The Plastic Surgery Hand Curriculum.

    Science.gov (United States)

    Silvestre, Jason; Levin, L Scott; Serletti, Joseph M; Chang, Benjamin

    2015-12-01

    Designing an effective hand rotation for plastic surgery residents is difficult. The authors address this limitation by elucidating the critical components of the hand curriculum during plastic surgery residency. Hand questions on the Plastic Surgery In-Service Training Exam for six consecutive years (2008 to 2013) were characterized by presence of imaging, vignette setting, question taxonomy, answer domain, anatomy, and topic. Answer references were quantified by source and year of publication. Two hundred sixty-six questions were related to hand surgery (22.7 percent of all questions; 44.3 per year) and 61 were accompanied by an image (22.9 percent). Vignettes tended to be clinic- (50.0 percent) and emergency room-based (35.3 percent) (p < 0.001). Questions required decision-making (60.5 percent) over interpretation (25.9 percent) and recall skills (13.5 percent) (p < 0.001). Answers focused on interventions (57.5 percent) over anatomy/pathology (25.2 percent) and diagnoses (17.3 percent) (p < 0.001). Nearly half of the questions focused on the digits. The highest yield topics were trauma (35.3 percent), reconstruction (24.4 percent), and aesthetic and functional problems (14.2 percent). The Journal of Hand Surgery (American volume) (20.5 percent) and Plastic and Reconstructive Surgery (18.0 percent) were the most-cited journals, and the median publication lag was 7 years. Green's Operative Hand Surgery was the most-referenced textbook (41.8 percent). These results will enable trainees to study hand surgery topics with greater efficiency. Faculty can use these results to ensure that tested topics are covered during residency training. Thus, a benchmark is established to improve didactic, clinical, and operative experiences in hand surgery.

  6. Computed tomography in trauma

    International Nuclear Information System (INIS)

    Toombs, B.D.; Sandler, C.M.

    1987-01-01

    This book begins with a chapter dealing with the epidemiology and mechanisms of trauma. Trauma accounts for more lives lost in the United States than cancer and heart disease. The fact that 30%-40% of trauma-related deaths are caused by improper or delayed diagnoses or treatment emphasizes the importance of rapid and accurate methods to establish a diagnosis. Acute thoracic, abdominal, and pelvic trauma and their complications are discussed. A chapter on high-resolution CT of spinal and facial trauma and the role of three-dimensional reconstruction images is presented

  7. Computed tomography in trauma

    Energy Technology Data Exchange (ETDEWEB)

    Toombs, B.D.; Sandler, C.M.

    1987-01-01

    This book begins with a chapter dealing with the epidemiology and mechanisms of trauma. Trauma accounts for more lives lost in the United States than cancer and heart disease. The fact that 30%-40% of trauma-related deaths are caused by improper or delayed diagnoses or treatment emphasizes the importance of rapid and accurate methods to establish a diagnosis. Acute thoracic, abdominal, and pelvic trauma and their complications are discussed. A chapter on high-resolution CT of spinal and facial trauma and the role of three-dimensional reconstruction images is presented.

  8. 3D Printed Robotic Hand

    Science.gov (United States)

    Pizarro, Yaritzmar Rosario; Schuler, Jason M.; Lippitt, Thomas C.

    2013-01-01

    Dexterous robotic hands are changing the way robots and humans interact and use common tools. Unfortunately, the complexity of the joints and actuations drive up the manufacturing cost. Some cutting edge and commercially available rapid prototyping machines now have the ability to print multiple materials and even combine these materials in the same job. A 3D model of a robotic hand was designed using Creo Parametric 2.0. Combining "hard" and "soft" materials, the model was printed on the Object Connex350 3D printer with the purpose of resembling as much as possible the human appearance and mobility of a real hand while needing no assembly. After printing the prototype, strings where installed as actuators to test mobility. Based on printing materials, the manufacturing cost of the hand was $167, significantly lower than other robotic hands without the actuators since they have more complex assembly processes.

  9. Secondary reconstruction of maxillofacial trauma.

    Science.gov (United States)

    Castro-Núñez, Jaime; Van Sickels, Joseph E

    2017-08-01

    Craniomaxillofacial trauma is one of the most complex clinical conditions in contemporary maxillofacial surgery. Vital structures and possible functional and esthetic sequelae are important considerations following this type of trauma and intervention. Despite the best efforts of the primary surgery, there are a group of patients that will have poor outcomes requiring secondary reconstruction to restore form and function. The purpose of this study is to review current concepts on secondary reconstruction to the maxillofacial complex. The evaluation of a posttraumatic patient for a secondary reconstruction must include an assessment of the different subunits of the upper face, middle face, and lower face. Virtual surgical planning and surgical guides represent the most important innovations in secondary reconstruction over the past few years. Intraoperative navigational surgery/computed-assisted navigation is used in complex cases. Facial asymmetry can be corrected or significantly improved by segmentation of the computerized tomography dataset and mirroring of the unaffected side by means of virtual surgical planning. Navigational surgery/computed-assisted navigation allows for a more precise surgical correction when secondary reconstruction involves the replacement of extensive anatomical areas. The use of technology can result in custom-made replacements and prebent plates, which are more stable and resistant to fracture because of metal fatigue. Careful perioperative evaluation is the key to positive outcomes of secondary reconstruction after trauma. The advent of technological tools has played a capital role in helping the surgical team perform a given treatment plan in a more precise and predictable manner.

  10. Ultrasonography in trauma

    DEFF Research Database (Denmark)

    Weile, Jesper; Nielsen, Klaus; Primdahl, Stine C

    2017-01-01

    BACKGROUND: The Focused Assessment with Sonography in Trauma (FAST) protocol is considered beneficial in emergent evaluation of trauma patients with blunt or penetrating injury and has become integrated into the Advanced Trauma Life Support (ATLS) protocol. No guidelines exist as to the use...... of ultrasonography in trauma in Denmark. We aimed to determine the current use of ultrasonography for assessing trauma patients in Denmark. METHODS: We conducted a nation-wide cross-sectional investigation of ultrasonography usage in trauma care. The first phase consisted of an Internet-based investigation....... Twenty-one (95.5%) of the guidelines included and recommended FAST as part of trauma assessment. The recommended person to perform the examination was the radiologist in n = 11 (50.0%), the surgeon in n = 6 (27.3%), the anesthesiologist in n = 1 (4.5%), and unspecified in n = 3 (13.6%) facilities. FAST...

  11. Psychological Trauma in the Context of Familial Relationships: A Concept Analysis.

    Science.gov (United States)

    Isobel, Sophie; Goodyear, Melinda; Foster, Kim

    2017-01-01

    Many forms of psychological trauma are known to develop interpersonally within important relationships, particularly familial. Within the varying theoretical constructs of psychological traumas, and distinct from the processes of diagnosis, there is a need to refine the scope and definitions of psychological traumas that occur within important familial relationships to ensure a cohesive evidence base and fidelity of the concept in application to practice. This review used a philosophical inquiry methodology of concept analysis to identify the definitions, antecedents, characteristics, and consequences of the varying conceptualizations of psychological trauma occurring within important relationships. Interactions between concepts of interpersonal trauma, relational trauma, betrayal trauma, attachment trauma, developmental trauma, complex trauma, cumulative trauma, and intergenerational trauma are presented. Understanding of the discrete forms and pathways of transmission of psychological trauma between individuals, including transgenerationally within families, creates opportunities for prevention and early intervention within trauma-focused practice. This review found that concepts of psychological trauma occurring within familial relationships are not exclusive of each other but overlap in their encompassment of events and circumstances as well as the effect on individuals of events in the short term and long term. These traumas develop and are transmitted in the space between people, both purposefully and incidentally, and have particularly profound effects when they involve a dependent infant or child. Linguistic and conceptual clarity is paramount for trauma research and practice.

  12. Challenges in treating post-traumatic stress disorder and attachment trauma.

    Science.gov (United States)

    Allen, Jon G

    2003-06-01

    Treating women suffering from trauma poses significant challenges. The diagnostic prototype of post-traumatic stress disorder (PTSD) is based on single-event trauma, such as sexual assault in adulthood. Several effective cognitive- behavioral treatments for such traumas have been developed, although many treated patients continue to experience residual symptoms. Even more problematic is the complex developmental psychopathology stemming from a lifetime history of multiple traumas, often beginning with maltreatment in early attachment relationships. A history of attachment trauma undermines the development of capacities to regulate emotional distress and thereby complicates the treatment of acute trauma in adulthood. Such complex trauma requires a multifaceted treatment approach that must balance processing of traumatic memories with strategies to contain the intense emotions this processing evokes. Moreover, conducting such treatment places therapists at risk for secondary trauma such that trauma therapists also must process this stressful experience and implement strategies to regulate their own distress.

  13. Clean Hands Count

    Medline Plus

    Full Text Available ... has been rented. This feature is not available right now. Please try again later. Published on May ... 34 How The Clean Hands - Safe Hands System Works - Duration: 3:38. Clean Hands-Safe Hands 5, ...

  14. A case of bilateral lower cranial nerve palsies after base of skull trauma with complex management issues: case report and review of the literature.

    Science.gov (United States)

    Lehn, Alexander Christoph; Lettieri, Jennie; Grimley, Rohan

    2012-05-01

    Fractures of the skull base can cause lower cranial nerve palsies because of involvement of the nerves as they traverse the skull. A variety of syndromes have been described, often involving multiple nerves. These are most commonly unilateral, and only a handful of cases of bilateral cranial nerve involvement have been reported. We describe a 64-year-old man with occipital condylar fracture complicated by bilateral palsies of IX and X nerves associated with dramatic physiological derangement causing severe management challenges. Apart from debilitating postural hypotension, he developed dysphagia, severe gastrointestinal dysmotility, issues with airway protection as well as airway obstruction, increased oropharyngeal secretions and variable respiratory control. This is the first report of a patient with traumatic bilateral cranial nerve IX and X nerve palsies. This detailed report and the summary of all 6 previous case reports of traumatic bilateral lower cranial nerve palsies illustrate clinical features, treatment strategies, and outcomes of these rare events.

  15. Prevalence of interpersonal trauma exposure and trauma-related disorders in severe mental illness

    Directory of Open Access Journals (Sweden)

    Maria W. Mauritz

    2013-04-01

    Full Text Available Background: Interpersonal trauma exposure and trauma-related disorders in people with severe mental illness (SMI are often not recognized in clinical practice. Objective: To substantiate the prevalence of interpersonal trauma exposure and trauma-related disorders in people with SMI. Methods: We conducted a systematic review of four databases (1980–2010 and then described and analysed 33 studies in terms of primary diagnosis and instruments used to measure trauma exposure and trauma-related disorders. Results: Population-weighted mean prevalence rates in SMI were physical abuse 47% (range 25–72%, sexual abuse 37% (range 24–49%, and posttraumatic stress disorder (PTSD 30% (range 20–47%. Compared to men, women showed a higher prevalence of sexual abuse in schizophrenia spectrum disorder, bipolar disorder, and mixed diagnosis groups labelled as having SMI. Conclusions: Prevalence rates of interpersonal trauma and trauma-related disorders were significantly higher in SMI than in the general population. Emotional abuse and neglect, physical neglect, complex PTSD, and dissociative disorders have been scarcely examined in SMI.

  16. Prevalence of interpersonal trauma exposure and trauma-related disorders in severe mental illness.

    Science.gov (United States)

    Mauritz, Maria W; Goossens, Peter J J; Draijer, Nel; van Achterberg, Theo

    2013-01-01

    Interpersonal trauma exposure and trauma-related disorders in people with severe mental illness (SMI) are often not recognized in clinical practice. To substantiate the prevalence of interpersonal trauma exposure and trauma-related disorders in people with SMI. We conducted a systematic review of four databases (1980-2010) and then described and analysed 33 studies in terms of primary diagnosis and instruments used to measure trauma exposure and trauma-related disorders. Population-weighted mean prevalence rates in SMI were physical abuse 47% (range 25-72%), sexual abuse 37% (range 24-49%), and posttraumatic stress disorder (PTSD) 30% (range 20-47%). Compared to men, women showed a higher prevalence of sexual abuse in schizophrenia spectrum disorder, bipolar disorder, and mixed diagnosis groups labelled as having SMI. Prevalence rates of interpersonal trauma and trauma-related disorders were significantly higher in SMI than in the general population. Emotional abuse and neglect, physical neglect, complex PTSD, and dissociative disorders have been scarcely examined in SMI.

  17. The human hand as an inspiration for robot hand development

    CERN Document Server

    Santos, Veronica

    2014-01-01

    “The Human Hand as an Inspiration for Robot Hand Development” presents an edited collection of authoritative contributions in the area of robot hands. The results described in the volume are expected to lead to more robust, dependable, and inexpensive distributed systems such as those endowed with complex and advanced sensing, actuation, computation, and communication capabilities. The twenty-four chapters discuss the field of robotic grasping and manipulation viewed in light of the human hand’s capabilities and push the state-of-the-art in robot hand design and control. Topics discussed include human hand biomechanics, neural control, sensory feedback and perception, and robotic grasp and manipulation. This book will be useful for researchers from diverse areas such as robotics, biomechanics, neuroscience, and anthropologists.

  18. Pearls of mandibular trauma management.

    Science.gov (United States)

    Koshy, John C; Feldman, Evan M; Chike-Obi, Chuma J; Bullocks, Jamal M

    2010-11-01

    Mandibular trauma is a common problem seen by plastic surgeons. When fractures occur, they have the ability to affect the patient's occlusion significantly, cause infection, and lead to considerable pain. Interventions to prevent these sequelae require either closed or open forms of reduction and fixation. Physicians determining how to manage these injuries should take into consideration the nature of the injury, background information regarding the patient's health, and the patient's comorbidities. Whereas general principles guide the management of the majority of injuries, special consideration must be paid to the edentulous patient, complex and comminuted fractures, and pediatric patients. These topics are discussed in this article, with a special emphasis on pearls of mandibular trauma management.

  19. About Military Sexual Trauma

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  1. About Military Sexual Trauma

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  2. [Trauma registry and injury].

    Science.gov (United States)

    Shapira, S C

    2001-10-01

    The trauma registry network constitutes an essential database in every injury prevention system. In order to rationally estimate the extent of injury in general, and injuries from traffic accidents in particular, the trauma registry systems should contain the most comprehensive and broad database possible, in line with the operational definitions. Ideally, the base of the injury pyramid should also include mild injuries and even "near-misses". The Israeli National Trauma Registry has come a long way in the last few years. The eventual inclusion of all trauma centers in Israel will enable the establishment of a firm base for the allocation of resources by decision-makers.

  3. About Military Sexual Trauma

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  4. Performing Allen's test in immobile hand: The Esmarch bandage method

    Directory of Open Access Journals (Sweden)

    Nebil Yesiloglu

    2015-12-01

    Full Text Available In this study, an alternative method of assessing hand vascular flow using a modification of Allen's test is presented. This technique may be helpful for patients who have immobile hands due to severe trauma, patients scheduled for free tissue transfer reconstruction, patients under general anesthesia in intensive care units that require serial arterial blood gas analyses, and emergency coronary by-pass candidates who decided to receive radial arterial grafts. [Hand Microsurg 2015; 4(3.000: 83-85

  5. Second-hand signals

    DEFF Research Database (Denmark)

    Bergenholtz, Carsten

    2014-01-01

    Studies of signaling theory have traditionally focused on the dyadic link between the sender and receiver of the signal. Within a science‐based perspective this framing has led scholars to investigate how patents and publications of firms function as signals. I explore another important type...... used by various agents in their search for and assessment of products and firms. I conclude by arguing how this second‐hand nature of signals goes beyond a simple dyadic focus on senders and receivers of signals, and thus elucidates the more complex interrelations of the various types of agents...

  6. Survivors of early childhood trauma: evaluating a two-dimensional diagnostic model of the impact of trauma and neglect

    Directory of Open Access Journals (Sweden)

    Marleen Wildschut

    2014-04-01

    Full Text Available Background: A two-dimensional diagnostic model for (complex trauma-related and personality disorders has been proposed to assess the severity and prognosis of the impact of early childhood trauma and emotional neglect. An important question that awaits empirical examination is whether a distinction between trauma-related disorders and personality disorders reflects reality when focusing on survivors of early childhood trauma. And, is a continuum of trauma diagnoses a correct assumption and, if yes, what does it look like? Objective: We describe the design of a cross-sectional cohort study evaluating this two-dimensional model of the impact of trauma and neglect. To provide the rationale of our study objectives, we review the existing literature on the impact of early childhood trauma and neglect on trauma-related disorders and personality disorders. Aims of the study are to: (1 quantify the two-dimensional model and test the relation with trauma and neglect; and (2 compare the two study groups. Method: A total of 200 consecutive patients referred to two specific treatment programs (100 from a personality disorder program and 100 from a trauma-related disorder program in the north of Holland will be included. Data are collected at the start of treatment. The assessments include all DSM-5 trauma-related and personality disorders, and general psychiatric symptoms, trauma history, and perceived emotional neglect. Discussion: The results will provide an evaluation of the model and an improvement of the understanding of the relationship between trauma-related disorders and personality disorders and early childhood trauma and emotional neglect. This may improve both diagnostic as well as indication procedures. We will discuss possible strengths and limitations of the design.

  7. Prospects after Major Trauma

    NARCIS (Netherlands)

    Holtslag, H.R.

    2007-01-01

    Introduction. After patients survived major trauma, their prospects, in terms of the consequences for functioning, are uncertain, which may impact severely on patient, family and society. The studies in this thesis describes the long-term outcomes of severe injured patients after major trauma. In

  8. Trauma and the truth

    NARCIS (Netherlands)

    Meeter, Martijn

    2016-01-01

    Witnessing horrible things may leave a person scarred for life — an effect usually referred to as psychological trauma. We do not know exactly what it does or how it worms its way into our psyche, but psychological trauma has been linked to a wide range of fear- and depression-related symptoms

  9. Radiology in chest trauma

    International Nuclear Information System (INIS)

    Wenz, W.; Kloehn, I.; Wolfart, W.; Freiburg Univ.

    1979-01-01

    In chest trauma, a routine chest film, preferably in the lateral as well as the frontal projection, is the basic part of the work-up. Occasionally valuable additional methods are fluoroscopy, tomography, bronchography, contrast studies of the GI Tract and angiography and angiocardiography. In 679 chest trauma patients, traffic accidents and falls were the main reason for the trauma. There were 248 fractures; then - in order of frequency - hemopneumothorax (76), lung contusion (58), subcutaneous emphysema (33) cardiac (16) and vascular trauma (12) and damage to other organs. While 20-30% mistakes are made in diagnosing rib fractures in acute trauma, there is high accuracy in the diagnosis of the other injuries. Many cases are shown to demonstrate the value of diagnostic radiology. (orig.) [de

  10. [Blast injuries of the hands in precarious health situation].

    Science.gov (United States)

    Allah, K C; Kossoko, H; Assi Djè Bi Djè, V; Yéo, S; Bonny, R; Richard Kadio, M

    2014-06-01

    The hands of "blast" resulting from the handling of unstable explosives. Their repercussion is functional and vital in trauma patients. The authors report their experience of care from the hands of blast in precarious health situation. Between 2001 and 2012, 33 hand blasts were supported in 30 injured civilians and military, received emergency, during and after armed conflict. Two women (6.7%) and 28 men (93.3%) were received, including four teenagers (13.3%) and 26 adults (86.7%). During the war, 15 officers weapon (50%) and three civilians (10%) underwent surgery, or 60% of hand injuries. In peacetime, civilians were mostly operated in 33.3% of cases, against 6.7% of cases of agents' weapon. Nineteen hands blast (57.6%) were observed during the war and 14 in peacetime, or 42.4% of cases. The average age was 25.2 years, with extremes of 12 and 50 years. Thirteen left hands (39.4%) and 20 right hands (60.6%) were operated. The lesion concerned all the anatomical structures of the hand. It was unilateral in 27 cases (81.9%) and bilateral in three cases (9.1%). Three types of hand trauma were observed and were as follows: trauma patients with injuries of the hand (18.2%), trauma of severe and isolated proximal hand or finger amputations (75.7%), and trauma of the hand without apparent seriousness (6.1%). The associated lesion was eye (one case), chest (one case), abdominal (five cases). Debridement was performed immediate emergency (93.9%) and delayed (6.1%). The treatment was surgical hemostasis, made mainly of amputations (69.7%) and regularization of digital stumps (12.1%). The repair was performed in 18.2% of cases. One death has been reported in a polytrauma patient with chest blast. Blast injuries of the hand are common in times of war in armed agents. The young people, manual workers and children are paying a heavy price in peacetime. As land mines which affect feet, instable hand grenades are left exposed in nature. In precarious health situation, instead of

  11. [Firework-related eye trauma from 2005 to 2013].

    Science.gov (United States)

    Unterlauft, J D; Wiedemann, P; Meier, P

    2014-09-01

    Fireworks combusted during New Year's Eve festivities can cause different eye traumas which often need complex reconstructive surgery. It was our aim to systematically analyse these eye trauma cases which were treated at our clinic during the last eight years. Age, gender, side, trauma mechanism, treatment methods and outcome were analysed for all eye trauma cases caused by fireworks during the New Year's Eve celebrations from 2006 to 2013. For statistical analysis all trauma cases were divided into two groups of major and non-major eye trauma. The total number of patients treated was 122 (28 women, 94 men, mean age 26.2±13.0 years) with 137 traumatised eyes (77 right, 60 left). 24.6% of patients were ≤18 years of age. 76.2% were bystanders. 50 eyes from 46 patients (37.7%) suffered from major eye trauma. 26 patients (21.3%) were hospitalised. 8 eyes (5.8%) suffered from a penetrating injury or globe rupture and underwent primary reconstructive surgery. Further 16 eyes (11.7%) suffered from major eye trauma without open globe injury. In the aftermath 11 eyes (8.0%) went blind (visual acuityfireworks. However older patients suffer from major eye trauma more often. More education and prophylaxis of eye trauma caused by fireworks is desirable. Georg Thieme Verlag KG Stuttgart · New York.

  12. Using metaphor and narrative ideas in trauma and family therapy

    Directory of Open Access Journals (Sweden)

    Mike N. Witney

    2012-09-01

    Full Text Available Everyday people living in South Africa experience trauma, either first hand through accidents, crime, violence and abuse or through being witnesses to the traumatic event. This results in people in South Africa suffering from anxiety, depression, post-traumatic stress disorder (PTSD and other severe mental health issues. One only has to read a newspaper, watch or listen to the news to get a glimpse of the landscape of trauma in our country. In this article I looked at using narrative ideas and metaphor in therapy with trauma and family therapy.

  13. Hand Surgery: Anesthesia

    Science.gov (United States)

    ... All Topics A-Z Videos Infographics Symptom Picker Anatomy Bones Joints Muscles Nerves Vessels Tendons About Hand Surgery What is a Hand Surgeon? What is a Hand Therapist? Media Find a Hand Surgeon Home Anatomy Hand Surgery Anesthesia Email to a friend * required ...

  14. Hand-it-on”

    DEFF Research Database (Denmark)

    Dieckmann, Gerhard Peter; Graae Zeltner, Louise; Helsø, Anne-Mette

    2016-01-01

    Non-technical skills (NTS) are an integral part of the abilities healthcare professionals need to optimally care for patients. Integrating NTS into the already complex tasks of healthcare can be a challenge for clinicians. Integrating NTS into simulation-based training increases the demands...... and where they can apply them in their work. It complements existing approaches to teaching NTS by limiting the complexity of the game and by removing medical content, allowing learners to concentrate on NTS. Hand-it-on is relevant for groups and teams working across the range of different healthcare...... and the replication of Hand-it-on by many simulation teams support its value....

  15. Treatment with vacuum-assisted closure and cryo-preserved homologous de-epidermalised dermis of complex traumas to the lower limbs with loss of substance, and bones and tendons exposure.

    Science.gov (United States)

    Brandi, C; Grimaldi, L; Nisi, G; Silvestri, A; Brafa, A; Calabrò, M; D'Aniello, C

    2008-12-01

    Lower-limb injuries with loss of tissue and exposure of bones and tendons are an increasing problem. The condition of the wound locally and the patient in general does not always allow immediate and adequate coverage of the structures exposed by the trauma. Therefore, new therapeutic solutions are needed. A reduction in the time that bones and tendons are exposed is essential to achieve complete healing of bone fractures, with reduced risks of infection and less disabling outcomes. The effectiveness of vacuum-assisted closure (VAC) therapy in supporting wound healing and of cryopreserved homologous de-epidermalised dermis (DED) in providing an effective template for re-epithelialisation has been previously reported. We carried out a study to evaluate the effectiveness of the synergistic and combined use of the two methodologies. Eighteen patients with traumatic loss of tissue in the lower limbs, involving exposure of bone and tendon structures, were enrolled in the study. All participants had local, general contraindications to first-instance reconstructions, or both. All patients received a combination of VAC therapy and DED implants. Granulation tissue was obtained in all wounds, with complete coverage of exposed structures. No infections were detected in the cohort, and all patients were prepared for further necessary reconstructive treatments. In our experience, the combination of VAC therapy and DED could, in selected cases, constitute an effective treatment for complex lower limb traumatic injuries with bone and tendon exposure.

  16. Power of magic hands: parent-driven application of habit reversal to treat complex stereotypy in a 3-year-old.

    Science.gov (United States)

    Freeman, Kurt A; Duke, Danny C

    2013-08-01

    The authors assessed the effectiveness of habit reversal training (HRT) to treat a complex motor stereotypy in a healthy 3-year-old female. This data-based case study involved training parents in HRT to deliver the parent-driven intervention to the child. The frequency of the child's behaviors was estimated daily in 30-min intervals by her parents. Outcomes supported the effectiveness of the intervention, with the estimated frequency of the stereotypy decreasing from occurring during approximately 85% of recorded intervals to less than 2% over a period of 4 weeks. Further record keeping over 19 weeks suggested treatment gains were generally maintained over time. The current case study provides preliminary evidence supporting the effectiveness of modified HRT to reduce stereotypies in young children. Further, data suggest that the intervention may be extended to younger ages by teaching parents how to facilitate treatment delivery. PsycINFO Database Record (c) 2013 APA, all rights reserved.

  17. Multiscale Convolutional Neural Networks for Hand Detection

    Directory of Open Access Journals (Sweden)

    Shiyang Yan

    2017-01-01

    Full Text Available Unconstrained hand detection in still images plays an important role in many hand-related vision problems, for example, hand tracking, gesture analysis, human action recognition and human-machine interaction, and sign language recognition. Although hand detection has been extensively studied for decades, it is still a challenging task with many problems to be tackled. The contributing factors for this complexity include heavy occlusion, low resolution, varying illumination conditions, different hand gestures, and the complex interactions between hands and objects or other hands. In this paper, we propose a multiscale deep learning model for unconstrained hand detection in still images. Deep learning models, and deep convolutional neural networks (CNNs in particular, have achieved state-of-the-art performances in many vision benchmarks. Developed from the region-based CNN (R-CNN model, we propose a hand detection scheme based on candidate regions generated by a generic region proposal algorithm, followed by multiscale information fusion from the popular VGG16 model. Two benchmark datasets were applied to validate the proposed method, namely, the Oxford Hand Detection Dataset and the VIVA Hand Detection Challenge. We achieved state-of-the-art results on the Oxford Hand Detection Dataset and had satisfactory performance in the VIVA Hand Detection Challenge.

  18. The Black Cloud Phenomenon in Hand Surgery.

    Science.gov (United States)

    Zhao, Emily; Tiedeken, Nathan; Wang, William; Fowler, John

    2018-04-01

    The term black cloud for a surgeon is generally used to describe someone who is unusually busy compared with his or her counterparts, and it is a superstition that tends to pervade the medical world. The purpose of this study is to investigate whether black clouds exist in hand surgery. We examined one academic year's worth of hand surgery-specific call at a level I trauma center and tabulated the number of hand-related patient transfers and add-on cases per surgeon. Each surgeon was given a black cloud rating by the fellows who were in training that year. Correlations were made between the black cloud rating and the surgeons' call volume. There were 12 surgeons who shared 365 days of hand call, and 5 of them are hand surgery fellowship trained. Those 5 surgeons tended to be busier on their call days, with more cases added on overnight and the next day, and also had worse black cloud ratings than the 7 non-hand fellowship trained surgeons. In regard to hand surgery, while true emergencies occur and require emergent intervention, how busy hand surgeons may be during call may be influenced by a variety of factors not related to their patients' problems but rather their daily schedules, their hospitals' ability to facilitate add-on cases, and their rapport with their fellow surgeons to share case loads.

  19. Sexual Abuse Trauma Among Chinese Survivors.

    Science.gov (United States)

    Luo, Tsun-yin Echo

    1998-01-01

    This study conducted interviews with 19 survivors of sexual abuse and three social workers in Taiwan. It found sexual stigmatization and feelings of disempowerment and betrayal as the most pervasive trauma complex among the abuse survivors. Effects of cultural attitudes toward sexual victimization of women and Chinese patriarchal familialism are…

  20. Urological injuries following trauma

    International Nuclear Information System (INIS)

    Bent, C.; Iyngkaran, T.; Power, N.; Matson, M.; Hajdinjak, T.; Buchholz, N.; Fotheringham, T.

    2008-01-01

    Blunt renal trauma is the third most common injury in abdominal trauma following splenic and hepatic injuries, respectively. In the majority, such injuries are associated with other abdominal organ injuries. As urological injuries are not usually life-threatening, and clinical signs and symptoms are non-specific, diagnosis is often delayed. We present a practical approach to the diagnosis and management of these injuries based on our experience in a busy inner city trauma hospital with a review of the current evidence-based practice. Diagnostic imaging signs are illustrated

  1. Urological injuries following trauma

    Energy Technology Data Exchange (ETDEWEB)

    Bent, C. [Department of Diagnostic Imaging, Barts and The London NHS Trust, London (United Kingdom)], E-mail: clare.bent@bartsandthelondon.nhs.uk; Iyngkaran, T.; Power, N.; Matson, M. [Department of Diagnostic Imaging, Barts and The London NHS Trust, London (United Kingdom); Hajdinjak, T.; Buchholz, N. [Department of Urology, Barts and The London NHS Trust, London (United Kingdom); Fotheringham, T. [Department of Diagnostic Imaging, Barts and The London NHS Trust, London (United Kingdom)

    2008-12-15

    Blunt renal trauma is the third most common injury in abdominal trauma following splenic and hepatic injuries, respectively. In the majority, such injuries are associated with other abdominal organ injuries. As urological injuries are not usually life-threatening, and clinical signs and symptoms are non-specific, diagnosis is often delayed. We present a practical approach to the diagnosis and management of these injuries based on our experience in a busy inner city trauma hospital with a review of the current evidence-based practice. Diagnostic imaging signs are illustrated.

  2. Life Stories and Trauma

    DEFF Research Database (Denmark)

    Kongshøj, Inge Lise Lundsgaard; Bohn, Annette; Berntsen, Dorthe

    Research has shown a connection between Posttraumatic Stress Disorder (PTSD) and integration of traumatic experiences into the life story. Furthermore, empirical evidence suggests that life story formation begins in mid to late adolescence. Following these findings, the present study investigated...... whether experiencing trauma in youth was associated with a greater risk to integrate the trauma into the life story compared to adult traumatic exposure. Life stories were collected from 115 participants recruited via Amazon Mechanical Turk. Moreover, participants filled out questionnaires regarding...... often integrate the trauma into their life story? Results will be discussed in relation to theories of development of life stories and of PTSD....

  3. Trauma Induced Coagulopathy

    DEFF Research Database (Denmark)

    Genét, Gustav Folmer; Johansson, Per; Meyer, Martin Abild Stengaard

    2013-01-01

    It remains debated whether traumatic brain injury (TBI) induces a different coagulopathy compared to non-TBI. This study investigated traditional coagulation tests, biomarkers of coagulopathy and endothelial damage in trauma patients with and without TBI. Blood from 80 adult trauma patients were...... sampled (median of 68 min (IQR 48-88) post-injury) upon admission to our trauma centre. Plasma/serum were retrospectively analysed for biomarkers reflecting sympathoadrenal activation (adrenaline, noradrenaline), coagulation activation/inhibition and fibrinolysis (protein C, activated protein C, tissue...

  4. CT of chest trauma

    International Nuclear Information System (INIS)

    Goodman, P.C.

    1986-01-01

    There appears to be a limited role for computed tomography in the evaluation of chest trauma. The literature contains few papers specifically addressing the use of CT in the setting of chest trauma. Another series of articles relates anecdotal experiences in this regard. This paucity of reports attests to the remarkable amount of information present on conventional chest radiographs as well as the lack of clear indications for CT in the setting of chest trauma. In this chapter traumatic lesions of various areas of the thorax are discussed. The conventional radiographic findings are briefly described and the potential or proven application of CT is addressed

  5. Platelet aggregation following trauma

    DEFF Research Database (Denmark)

    Windeløv, Nis A; Sørensen, Anne M; Perner, Anders

    2014-01-01

    We aimed to elucidate platelet function in trauma patients, as it is pivotal for hemostasis yet remains scarcely investigated in this population. We conducted a prospective observational study of platelet aggregation capacity in 213 adult trauma patients on admission to an emergency department (ED...... severity score (ISS) was 17; 14 (7%) patients received 10 or more units of red blood cells in the ED (massive transfusion); 24 (11%) patients died within 28 days of trauma: 17 due to cerebral injuries, four due to exsanguination, and three from other causes. No significant association was found between...... aggregation response and ISS. Higher TRAP values were associated with death due to cerebral injuries (P 

  6. Urological injuries following trauma.

    Science.gov (United States)

    Bent, C; Iyngkaran, T; Power, N; Matson, M; Hajdinjak, T; Buchholz, N; Fotheringham, T

    2008-12-01

    Blunt renal trauma is the third most common injury in abdominal trauma following splenic and hepatic injuries, respectively. In the majority, such injuries are associated with other abdominal organ injuries. As urological injuries are not usually life-threatening, and clinical signs and symptoms are non-specific, diagnosis is often delayed. We present a practical approach to the diagnosis and management of these injuries based on our experience in a busy inner city trauma hospital with a review of the current evidence-based practice. Diagnostic imaging signs are illustrated.

  7. Trauma patient discharge and care transition experiences: Identifying opportunities for quality improvement in trauma centres.

    Science.gov (United States)

    Gotlib Conn, Lesley; Zwaiman, Ashley; DasGupta, Tracey; Hales, Brigette; Watamaniuk, Aaron; Nathens, Avery B

    2018-01-01

    Challenges delivering quality care are especially salient during hospital discharge and care transitions. Severely injured patients discharged from a trauma centre will go either home, to rehabilitation or another acute care hospital with complex management needs. This purpose of this study was to explore the experiences of trauma patients and families treated in a regional academic trauma centre to better understand and improve their discharge and care transition experiences. A qualitative study using inductive thematic analysis was conducted between March and October 2016. Telephone interviews were conducted with trauma patients and/or a family member after discharge from the trauma centre. Data collection and analysis were completed inductively and iteratively consistent with a qualitative approach. Twenty-four interviews included 19 patients and 7 family members. Participants' experiences drew attention to discharge and transfer processes that either (1) Fostered quality discharge or (2) Impeded quality discharge. Fostering quality discharge was ward staff preparation efforts; establishing effective care continuity; and, adequate emotional support. Impeding discharge quality was perceived pressure to leave the hospital; imposed transfer decisions; and, sub-optimal communication and coordination around discharge. Patient-provider communication was viewed to be driven by system, rather than patient need. Inter-facility information gaps raised concern about receiving facilities' ability to care for injured patients. The quality of trauma patient discharge and transition experiences is undermined by system- and ward-level processes that compete, rather than align, in producing high quality patient-centred discharge. Local improvement solutions focused on modifiable factors within the trauma centre include patient-oriented discharge education and patient navigation; however, these approaches alone may be insufficient to enhance patient experiences. Trauma patients

  8. About Military Sexual Trauma

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  9. Trauma and Coagulation

    Directory of Open Access Journals (Sweden)

    Murat Yılmaz

    2011-08-01

    Full Text Available Bleeding and coagulation disorders related to trauma are pathological processes which are frequently seen and increase mortality. For the purpose, trauma patients should be protected from hypoperfusion, hypothermia, acidosis and hemodilution which may aggravate the increase in physiological responses to trauma as anticoagulation and fibrinolysis. Performing damage control surgery and resuscitation and transfusion of adequate blood and blood products in terms of amount and content as stated in protocols may increase the rate of survival. Medical treatments augmenting fibrin formation (fibrinogen, desmopressin, factor VIIa or preventing fibrin degradation (tranexamic acid have been proposed in selected cases but the efficacy of these agents in trauma patients are not proven. (Journal of the Turkish Society Intensive Care 2011; 9:71-6

  10. Acute coagulopathy of trauma

    DEFF Research Database (Denmark)

    Johansson, P I; Ostrowski, S R

    2010-01-01

    Acute coagulopathy of trauma predicts a poor clinical outcome. Tissue trauma activates the sympathoadrenal system resulting in high circulating levels of catecholamines that influence hemostasis dose-dependently through immediate effects on the two major compartments of hemostasis, i.......e., the circulating blood and the vascular endothelium. There appears to be a dose-dependency with regards to injury severity and the hemostatic response to trauma evaluated in whole blood by viscoelastic assays like thrombelastography (TEG), changing from normal to hypercoagulable, to hypocoagulable and finally......, is an evolutionary developed response that counterbalances the injury and catecholamine induced endothelial activation and damage. Given this, the rise in circulating catecholamines in trauma patients may favor a switch from hyper- to hypocoagulability in the blood to keep the progressively more procoagulant...

  11. About Military Sexual Trauma

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  12. About Military Sexual Trauma

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    Full Text Available ... it free Find out why Close About Military Sexual Trauma Veterans Health Administration Loading... Unsubscribe from Veterans ... is Cognitive Processing Therapy (CPT) [for posttraumatic stress disorder]? - Duration: 2:01. Veterans Health Administration 27,844 ...

  13. About Military Sexual Trauma

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    Full Text Available ... Try it free Find out why Close About Military Sexual Trauma Veterans Health Administration Loading... Unsubscribe from ... 5:31 Get Fit for Life (8) Strength/Balance Training - Duration: 32:02. Veterans Health Administration 2, ...

  14. About Military Sexual Trauma

    Science.gov (United States)

    ... Try it free Find out why Close About Military Sexual Trauma Veterans Health Administration Loading... Unsubscribe from ... 5:31 Get Fit for Life (8) Strength/Balance Training - Duration: 32:02. Veterans Health Administration 2, ...

  15. Suspension Trauma / Orthostatic Intolerance

    Science.gov (United States)

    ... Suspension Trauma/Orthostatic Intolerance Safety and Health Information Bulletin SHIB 03-24-2004, updated 2011 This Safety ... the harness, the environmental conditions, and the worker's psychological state all may increase the onset and severity ...

  16. Anaesthesia for trauma patients

    African Journals Online (AJOL)

    casualty incident, or a natural disaster. ... Exposure/environmental control: completely undress the ... E. Figure 1: Advance Trauma Life Support® management priorities ..... requiring operative intervention: the patient too sick to anesthetize.

  17. Blunt chest trauma.

    Science.gov (United States)

    Stewart, Daphne J

    2014-01-01

    Blunt chest trauma is associated with a wide range of injuries, many of which are life threatening. This article is a case study demonstrating a variety of traumatic chest injuries, including pathophysiology, diagnosis, and treatment. Literature on the diagnosis and treatment was reviewed, including both theoretical and research literature, from a variety of disciplines. The role of the advance practice nurse in trauma is also discussed as it relates to assessment, diagnosis, and treatment of patients with traumatic chest injuries.

  18. Osteoarthritis of the Hand

    Science.gov (United States)

    ... All Topics A-Z Videos Infographics Symptom Picker Anatomy Bones Joints Muscles Nerves Vessels Tendons About Hand Surgery What is a Hand Surgeon? What is a Hand Therapist? Media Find a Hand Surgeon Home Anatomy Osteoarthritis Email to a friend * required fields From * ...

  19. Hands in Systemic Disease

    Science.gov (United States)

    ... All Topics A-Z Videos Infographics Symptom Picker Anatomy Bones Joints Muscles Nerves Vessels Tendons About Hand Surgery What is ... Hand Therapist? Media Find a Hand Surgeon Home Anatomy ... hands, being composed of many types of tissue, including blood vessels, nerves, skin and skin-related tissues, bones, and muscles/tendons/ligaments, may show changes that reflect a ...

  20. Quality of trauma care and trauma registries.

    Science.gov (United States)

    Pino Sánchez, F I; Ballesteros Sanz, M A; Cordero Lorenzana, L; Guerrero López, F

    2015-03-01

    Traumatic disease is a major public health concern. Monitoring the quality of services provided is essential for the maintenance and improvement thereof. Assessing and monitoring the quality of care in trauma patient through quality indicators would allow identifying opportunities for improvement whose implementation would improve outcomes in hospital mortality, functional outcomes and quality of life of survivors. Many quality indicators have been used in this condition, although very few ones have a solid level of scientific evidence to recommend their routine use. The information contained in the trauma registries, spread around the world in recent decades, is essential to know the current health care reality, identify opportunities for improvement and contribute to the clinical and epidemiological research. Copyright © 2014 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

  1. [Establishement for regional pelvic trauma database in Hunan Province].

    Science.gov (United States)

    Cheng, Liang; Zhu, Yong; Long, Haitao; Yang, Junxiao; Sun, Buhua; Li, Kanghua

    2017-04-28

    To establish a database for pelvic trauma in Hunan Province, and to start the work of multicenter pelvic trauma registry.
 Methods: To establish the database, literatures relevant to pelvic trauma were screened, the experiences from the established trauma database in China and abroad were learned, and the actual situations for pelvic trauma rescue in Hunan Province were considered. The database for pelvic trauma was established based on the PostgreSQL and the advanced programming language Java 1.6.
 Results: The complex procedure for pelvic trauma rescue was described structurally. The contents for the database included general patient information, injurious condition, prehospital rescue, conditions in admission, treatment in hospital, status on discharge, diagnosis, classification, complication, trauma scoring and therapeutic effect. The database can be accessed through the internet by browser/servicer. The functions for the database include patient information management, data export, history query, progress report, video-image management and personal information management.
 Conclusion: The database with whole life cycle pelvic trauma is successfully established for the first time in China. It is scientific, functional, practical, and user-friendly.

  2. [Orthopedic and trauma surgery in the German DRG system. Recent developments].

    Science.gov (United States)

    Franz, D; Schemmann, F; Selter, D D; Wirtz, D C; Roeder, N; Siebert, H; Mahlke, L

    2012-07-01

    Orthopedics and trauma surgery are subject to continuous medical advancement. The correct and performance-based case allocation by German diagnosis-related groups (G-DRG) is a major challenge. This article analyzes and assesses current developments in orthopedics and trauma surgery in the areas of coding of diagnoses and medical procedures and the development of the 2012 G-DRG system. The relevant diagnoses, medical procedures and G-DRGs in the versions 2011 and 2012 were analyzed based on the publications of the German DRG Institute (InEK) and the German Institute of Medical Documentation and Information (DIMDI). Changes were made for the International Classification of Diseases (ICD) coding of complex cases with medical complications, the procedure coding for spinal surgery and for hand and foot surgery. The G-DRG structures were modified for endoprosthetic surgery on ankle, shoulder and elbow joints. The definition of modular structured endoprostheses was clarified. The G-DRG system for orthopedic and trauma surgery appears to be largely consolidated. The current phase of the evolution of the G-DRG system is primarily aimed at developing most exact descriptions and definitions of the content and mutual delimitation of operation and procedures coding (OPS). This is an essential prerequisite for a correct and performance-based case allocation in the G-DRG system.

  3. Airway management in trauma.

    Science.gov (United States)

    Langeron, O; Birenbaum, A; Amour, J

    2009-05-01

    Maintenance of a patent and prevention of aspiration are essential for the management of the trauma patient, that requires experienced physicians in airway control techniques. Difficulties of the airway control in the trauma setting are increased by the vital failures, the risk of aspiration, the potential cervical spine injury, the combative patient, and the obvious risk of difficult tracheal intubation related to specific injury related to the trauma. Endotracheal intubation remains the gold standard in trauma patient airway management and should be performed via the oral route with a rapid sequence induction and a manual in-line stabilization maneuver, to decrease the risks previously mentioned. Different techniques to control the airway in trauma patients are presented: improvement of the laryngoscopic vision, lighted stylet tracheal intubation, retrograde technique for orotracheal intubation, the laryngeal mask and the intubating laryngeal mask airways, the combitube and cricothyroidotomy. Management of the airway in trauma patients requires regular training in these techniques and the knowledge of complementary techniques allowing tracheal intubation or oxygenation to overcome difficult intubation and to prevent major complications as hypoxemia and aspiration.

  4. Imaging of thoracic trauma

    International Nuclear Information System (INIS)

    Uffmann, M.; Herold, C.J.; Fuchs, M.

    1998-01-01

    Blunt trauma to the chest results from transfer of kinetic energy to the human body. It may cause a wide range of mostly life-threatening injuries, including fractures of the thoracic skeleton, disintegration of the pleural space, contusion or laceration of pulmonary parenchyma and damage to the mediastinal structures. For a systematic approach it may be helpful to follow an organ-based evaluation of thoracic trauma. However, it should be borne in mind that subtle injuries may be associated with serious complications. Trauma to the chest may affect different anatomic compartments at the same time, requiring and extending diagnostic approach. Conventional radiography plays a major role in diagnosting thoracic trauma, complemented by ultrasound examination of the pleura and abdomen. It is well documented that CT scanning represents a major technological improvement for assessment of thoracic trauma. With the advent of fast helical CT scanning this method becomes more applicable for severly traumatized patients and potentially replaces other time-consuming procedures. State-of-the-art imaging of both projection and cross-sectional techniques provides useful information for immediate and appropriate treatment mandatory in patients with thoracic trauma. (orig.) [de

  5. Pseudofracture: an acute peripheral tissue trauma model.

    Science.gov (United States)

    Darwiche, Sophie S; Kobbe, Philipp; Pfeifer, Roman; Kohut, Lauryn; Pape, Hans-Christoph; Billiar, Timothy

    2011-04-18

    Following trauma there is an early hyper-reactive inflammatory response that can lead to multiple organ dysfunction and high mortality in trauma patients; this response is often accompanied by a delayed immunosuppression that adds the clinical complications of infection and can also increase mortality. Many studies have begun to assess these changes in the reactivity of the immune system following trauma. Immunologic studies are greatly supported through the wide variety of transgenic and knockout mice available for in vivo modeling; these strains aid in detailed investigations to assess the molecular pathways involved in the immunologic responses. The challenge in experimental murine trauma modeling is long term investigation, as fracture fixation techniques in mice, can be complex and not easily reproducible. This pseudofracture model, an easily reproduced trauma model, overcomes these difficulties by immunologically mimicking an extremity fracture environment, while allowing freedom of movement in the animals and long term survival without the continual, prolonged use of anaesthesia. The intent is to recreate the features of long bone fracture; injured muscle and soft tissue are exposed to damaged bone and bone marrow without breaking the native bone. The pseudofracture model consists of two parts: a bilateral muscle crush injury to the hindlimbs, followed by injection of a bone solution into these injured muscles. The bone solution is prepared by harvesting the long bones from both hindlimbs of an age- and weight-matched syngeneic donor. These bones are then crushed and resuspended in phosphate buffered saline to create the bone solution. Bilateral femur fracture is a commonly used and well-established model of extremity trauma, and was the comparative model during the development of the pseudofracture model. Among the variety of available fracture models, we chose to use a closed method of fracture with soft tissue injury as our comparison to the

  6. Denmark: HAND in HAND Policy Questionnaire

    DEFF Research Database (Denmark)

    Laursen, Hilmar Dyrborg; Nielsen, Birgitte Lund

    2018-01-01

    Som del af det internationale EU finansierede projekt Hand in Hand, der fokuserer på de såkaldte SEI-kompetencer (Social, Emotional, Intercultural), er dansk policy i relation til elevernes sociale, emotionelle og interkulturelle læring kortlagt i denne rapport. Der refereres bl.a. til "elevernes...

  7. Trauma team activation: Not just for trauma patients

    Directory of Open Access Journals (Sweden)

    Phoenix Vuong

    2017-01-01

    Full Text Available Specialized trauma teams have been shown to improve outcomes in critically injured patients. At our institution, an the American College of Surgeons Committee on trauma level I Trauma center, the trauma team activation (TTA criteria includes both physiologic and anatomic criteria, but any attending physician can activate the trauma team at their discretion outside criteria. As a result, the trauma team has been activated for noninjured patients meeting physiologic criteria secondary to nontraumatic hemorrhage. We present two cases in which the trauma team was activated for noninjured patients in hemorrhagic shock. The utilization of the TTA protocol and subsequent management by the trauma team are reviewed as we believe these were critical factors in the successful recovery of both patients. Beyond the primary improved survival outcomes of severely injured patients, trauma center designation has a “halo effect” that encompasses patients with nontraumatic hemorrhage.

  8. Current trauma care system and trauma care training in China

    Directory of Open Access Journals (Sweden)

    Lian-Yang Zhang

    2018-04-01

    Full Text Available Trauma is a life-threatening “modern disease”. The outcomes could only be optimized by cost-efficient and prompt trauma care, which embarks on the improvement of essential capacities and conceptual revolution in addition to the disruptive innovation of the trauma care system. According to experiences from the developed countries, systematic trauma care training is the cornerstone of the generalization and the improvement on the trauma care, such as the Advance Trauma Life Support (ATLS. Currently, the pre-hospital emergency medical services (EMS has been one of the essential elements of infrastructure of health services in China, which is also fundamental to the trauma care system. Hereby, the China Trauma Care Training (CTCT with independent intellectual property rights has been initiated and launched by the Chinese Trauma Surgeon Association to extend the up-to-date concepts and techniques in the field of trauma care as well to reinforce the generally well-accepted standardized protocols in the practices. This article reviews the current status of the trauma care system as well as the trauma care training. Keywords: Trauma care system, Trauma care training, China

  9. Intensive care nurses' perceptions of Inter Specialty Trauma Nursing Rounds to improve trauma patient care-A quality improvement project.

    Science.gov (United States)

    Jennings, Fiona L; Mitchell, Marion

    2017-06-01

    Trauma patient management is complex and challenging for nurses in the Intensive Care Unit. One strategy to promote quality and evidence based care may be through utilising specialty nursing experts both internal and external to the Intensive Care Unit in the form of a nursing round. Inter Specialty Trauma Nursing Rounds have the potential to improve patient care, collaboration and nurses' knowledge. The purpose of this quality improvement project was to improve trauma patient care and evaluate the nurses perception of improvement. The project included structured, weekly rounds that were conducted at the bedside. Nursing experts and others collaborated to assess and make changes to trauma patients' care. The rounds were evaluated to assess the nurse's perception of improvement. There were 132 trauma patients assessed. A total of 452 changes to patient care occurred. On average, three changes per patient resulted. Changes included nursing management, medical management and wound care. Nursing staff reported an overall improvement of trauma patient care, trauma knowledge, and collaboration with colleagues. Inter Specialty Trauma Nursing Rounds utilizes expert nursing knowledge. They are suggested as an innovative way to address the clinical challenges of caring for trauma patients and are perceived to enhance patient care and nursing knowledge. Copyright © 2017 Elsevier Ltd. All rights reserved.

  10. Combating terror: a new paradigm in student trauma education.

    Science.gov (United States)

    Rivkind, Avraham I; Faroja, Mouhammad; Mintz, Yoav; Pikarsky, Alon J; Zamir, Gideon; Elazary, Ram; Abu-Gazala, Mahmoud; Bala, Miklosh

    2015-02-01

    Other than the Advanced Trauma Life Support course, usually run for postgraduate trainees, there are few trauma courses available for medical students. It has been shown that trauma teaching for medical students is sadly lacking within the undergraduate curriculum. We stated that students following formal teaching, even just theory and some practice in basic skills significantly improved their management of trauma patients. Hadassah-Hebrew University in Israel runs an annual 2-week trauma course for final-year medical students. The focus is on hands-on practice in resuscitation, diagnosis, procedures, and decision making. After engaging a combination of instructional and interactive teaching methods including practice on simulated injuries that students must assess and treat through the 2 weeks, the course culminates in a disaster drill where students work alongside the emergency services to rescue, assess, treat, and transfer patients. The course is evaluated with a written precourse and postcourse test, an Objective Structured Clinical Examination and detailed feedback from the drill. We analyzed student feedback at the end of each course during a 6-year period from 2007 to 2012. Correct answers for the posttest results were higher each year with good reliability as assessed by Chronbach's α and with significant variation from pretest scores assessed using paired-samples t tests. Best scores were achieved in knowledge acquisition and practical skills gained. Students were also asked whether the course contributed to self-preparedness in treating trauma patients, and this consistently achieved high scores. We believe that students benefit substantially from the course and gain lasting skills and confidence in trauma management, decision making, and organizational skills. The course provides students with the opportunity to learn and ingrain trauma principles along Advanced Trauma Life Support guidelines and prepares them for practice as safe doctors. We advocate

  11. Hand Grasping Synergies As Biometrics.

    Science.gov (United States)

    Patel, Vrajeshri; Thukral, Poojita; Burns, Martin K; Florescu, Ionut; Chandramouli, Rajarathnam; Vinjamuri, Ramana

    2017-01-01

    Recently, the need for more secure identity verification systems has driven researchers to explore other sources of biometrics. This includes iris patterns, palm print, hand geometry, facial recognition, and movement patterns (hand motion, gait, and eye movements). Identity verification systems may benefit from the complexity of human movement that integrates multiple levels of control (neural, muscular, and kinematic). Using principal component analysis, we extracted spatiotemporal hand synergies (movement synergies) from an object grasping dataset to explore their use as a potential biometric. These movement synergies are in the form of joint angular velocity profiles of 10 joints. We explored the effect of joint type, digit, number of objects, and grasp type. In its best configuration, movement synergies achieved an equal error rate of 8.19%. While movement synergies can be integrated into an identity verification system with motion capture ability, we also explored a camera-ready version of hand synergies-postural synergies. In this proof of concept system, postural synergies performed well, but only when specific postures were chosen. Based on these results, hand synergies show promise as a potential biometric that can be combined with other hand-based biometrics for improved security.

  12. Hand Grasping Synergies As Biometrics

    Directory of Open Access Journals (Sweden)

    Ramana Vinjamuri

    2017-05-01

    Full Text Available Recently, the need for more secure identity verification systems has driven researchers to explore other sources of biometrics. This includes iris patterns, palm print, hand geometry, facial recognition, and movement patterns (hand motion, gait, and eye movements. Identity verification systems may benefit from the complexity of human movement that integrates multiple levels of control (neural, muscular, and kinematic. Using principal component analysis, we extracted spatiotemporal hand synergies (movement synergies from an object grasping dataset to explore their use as a potential biometric. These movement synergies are in the form of joint angular velocity profiles of 10 joints. We explored the effect of joint type, digit, number of objects, and grasp type. In its best configuration, movement synergies achieved an equal error rate of 8.19%. While movement synergies can be integrated into an identity verification system with motion capture ability, we also explored a camera-ready version of hand synergies—postural synergies. In this proof of concept system, postural synergies performed well, but only when specific postures were chosen. Based on these results, hand synergies show promise as a potential biometric that can be combined with other hand-based biometrics for improved security.

  13. Patterns of ocular trauma

    International Nuclear Information System (INIS)

    Babar, T.F.; Khan, M.T.; Marwat, M.; Shah, A.; Murad, Y.; Khan, M.D.

    2007-01-01

    To describe the patterns of ocular trauma, cause of injury and its effects on eye. A retrospective case series. Medical records of 1105 patients admitted with ocular trauma were reviewed. The details of patients regarding age, gender, literacy, cause of injury and its effects on eye were entered into specially-designed performa. Sample selection consisted of all patients with history of ocular trauma and who were admitted to hospital. Population details consisted patients who were referred to the hospital from all parts of N.W.F.P. Thus, the frequency of trauma in the hospital admissions was analysed. Ophthalmic trauma comprised 6.78% of the hospital admission. One thousand one hundred and five patients presented with eye injuries. Out of them, 21 patients suffered from trauma to both eyes. Almost 80% patients were male and 69% patients were below 30 years of age. Delayed presentation was more common and 63.61% patients presented after one week. Open globe injuries were more common (520 eyes (46.18%)) than closed globe injuries (484 eyes (42.98%)). 23.26% of open globe injuries were associated with intraocular and intra-orbital foreign bodies. Superficial non-perforating, eyelid and adnexal and burns were seen in 122 eyes (10.83%). Among the complications, lens damage and hyphema was seen in more than 50% of the patients, 16.60% eyes were infected at the time of admission and 4.88% of eyes needed enucleation or evisceration. The common causes of injury were violence in 37.37%, occupational in 24.43% and domestic accidents in 19.18%. Ophthalmic trauma is a major public health problem. Majority of the involved are male and under 30 years of age. Delayed presentation is more common. Open globe injuries are more frequent. Violence and occupational injuries are the major causes. (author)

  14. Intrinsic contractures of the hand.

    Science.gov (United States)

    Paksima, Nader; Besh, Basil R

    2012-02-01

    Contractures of the intrinsic muscles of the fingers disrupt the delicate and complex balance of intrinsic and extrinsic muscles, which allows the hand to be so versatile and functional. The loss of muscle function primarily affects the interphalangeal joints but also may affect etacarpophalangeal joints. The resulting clinical picture is often termed, intrinsic contracture or intrinsic-plus hand. Disruption of the balance between intrinsic and extrinsic muscles has many causes and may be secondary to changes within the intrinsic musculature or the tendon unit. This article reviews diagnosis, etiology, and treatment algorithms in the management of intrinsic contractures of the fingers. Copyright © 2012 Elsevier Inc. All rights reserved.

  15. Robotic hand project

    OpenAIRE

    Karaçizmeli, Cengiz; Çakır, Gökçe; Tükel, Dilek

    2014-01-01

    In this work, the mechatronic based robotic hand is controlled by the position data taken from the glove which has flex sensors mounted to capture finger bending of the human hand. The angular movement of human hand’s fingers are perceived and processed by a microcontroller, and the robotic hand is controlled by actuating servo motors. It has seen that robotic hand can simulate the movement of the human hand that put on the glove, during tests have done. This robotic hand can be used not only...

  16. Epidemiology of severe trauma.

    Science.gov (United States)

    Alberdi, F; García, I; Atutxa, L; Zabarte, M

    2014-12-01

    Major injury is the sixth leading cause of death worldwide. Among those under 35 years of age, it is the leading cause of death and disability. Traffic accidents alone are the main cause, fundamentally in low- and middle-income countries. Patients over 65 years of age are an increasingly affected group. For similar levels of injury, these patients have twice the mortality rate of young individuals, due to the existence of important comorbidities and associated treatments, and are more likely to die of medical complications late during hospital admission. No worldwide, standardized definitions exist for documenting, reporting and comparing data on severely injured trauma patients. The most common trauma scores are the Abbreviated Injury Scale (AIS), the Injury Severity Score (ISS) and the Trauma and Injury severity Score (TRISS). Documenting the burden of injury also requires evaluation of the impact of post-trauma impairments, disabilities and handicaps. Trauma epidemiology helps define health service and research priorities, contributes to identify disadvantaged groups, and also facilitates the elaboration of comparable measures for outcome predictions. Copyright © 2014 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  17. Is the hand to speech what speech is to the hand?

    Science.gov (United States)

    Mildner, V

    2000-01-01

    Interference between the manual and the verbal performance on two types of concurrent verbal-manual tasks was studied on a sample of 48 female right-handers. The more complex verbal task (storytelling) affected both hands significantly, the less complex (essentially phonemic) task affected only the right hand, with insignificant negative influence on the left-hand performance. No significant reciprocal effects of the motor task on verbalization were found.

  18. Glass Foreign Body Hand Radiograph

    Directory of Open Access Journals (Sweden)

    Hamid Ehsani-Nia, DO

    2018-04-01

    Full Text Available History of present illness: A 27-year-old female sustained an injury to her left hand after she tripped and fell on a vase. She presented to the emergency department (ED complaining of pain over the laceration. Upon examination, patient presented with multiple small abrasions of the medial aspect of the left 5thdigit that are minimally tender. Additionally, she has one 0.5cm linear laceration of the medial aspect of the 5thmetacarpal with severe tenderness in the area and palpable underlying foreign body. Significant findings: Left hand plain radiography demonstrated a subcutaneous foreign body medial to the 5thmetacarpal that is radiopaque, trapezoidal in shape, and measures approximately 11mm x 3mm. Discussion: Laceration repairs are amongst the most common procedures in the emergency department; however, consideration for foreign body is often underdiagnosed. Imaging is performed in only about 11% of all traumatic wounds in the ED.1 Of those injuries relating to the hand that are subsequently imaged, about 15% are found to have a foreign body.2,3 Additionally, it is estimated that foreign bodies are present in 7% to 8.7% of all wounds caused by glass objects.4,5 Glass is among the most common foreign bodies in lacerations, and fortunately they are radiopaque and relatively well visualized radiographically. It has been demonstrated that 2mm glass foreign bodies have a 99% detection rate with radiography, and 1mm glass foreign bodies an 83% detection rate.6 Patient perception of foreign body has a positive predictive value of 31%, making it a poor source in influencing clinical decision-making to obtain wound radiographs.3 Clinicians should have a high suspicion for foreign body in lacerations, particularly those caused by glass, and utilize close physical examination and imaging for evaluation. Topics: Radiography, glass, foreign body, trauma

  19. Acute burns of the hands – physiotherapy perspective.

    African Journals Online (AJOL)

    University of KwaZulu-Natal, Occupational therapy Department. Abstract: ... trajectory of the trauma care continuum. Keywords: Burns ... challenges during their recovery process.1 Hand burn in- ... major teaching institutions situated within a metropolitan area and .... education and motivation and provide basic counselling.

  20. Clean Hands Count

    Medline Plus

    Full Text Available ... to promote or encourage adherence to CDC hand hygiene recommendations. It is a component of the Clean ... aims to address myths and misperceptions about hand hygiene and empower patients to play a role in ...

  1. Clean Hands Count

    Medline Plus

    Full Text Available ... intended to promote or encourage adherence to CDC hand hygiene recommendations. It is a component of the Clean ... also aims to address myths and misperceptions about hand hygiene and empower patients to play a role in ...

  2. Clean Hands Count

    Science.gov (United States)

    ... intended to promote or encourage adherence to CDC hand hygiene recommendations. It is a component of the Clean ... also aims to address myths and misperceptions about hand hygiene and empower patients to play a role in ...

  3. Wash Your Hands

    Science.gov (United States)

    ... hand sanitizers might not remove harmful chemicals like pesticides and heavy metals from hands. Be cautious when ... Health Promotion Materials Fact Sheets Podcasts Posters Stickers Videos Web Features Training & Education Our Partners Publications, Data & ...

  4. Hand hygiene strategies

    OpenAIRE

    Yazaji, Eskandar Alex

    2011-01-01

    Hand hygiene is one of the major players in preventing healthcare associated infections. However, healthcare workers compliance with hand hygiene continues to be a challenge. This article will address strategies to help improving hand hygiene compliance. Keywords: hand hygiene; healthcare associated infections; multidisciplinary program; system change; accountability; education; feedback(Published: 18 July 2011)Citation: Journal of Community Hospital Internal Medicine Perspectives 2011, 1: 72...

  5. Transfusion practices in trauma

    Directory of Open Access Journals (Sweden)

    V Trichur Ramakrishnan

    2014-01-01

    Full Text Available Resuscitation of a severely traumatised patient with the administration of crystalloids, or colloids along with blood products is a common transfusion practice in trauma patients. The determination of this review article is to update on current transfusion practices in trauma. A search of PubMed, Google Scholar, and bibliographies of published studies were conducted using a combination of key-words. Recent articles addressing the transfusion practises in trauma from 2000 to 2014 were identified and reviewed. Trauma induced consumption and dilution of clotting factors, acidosis and hypothermia in a severely injured patient commonly causes trauma-induced coagulopathy. Early infusion of blood products and early control of bleeding decreases trauma-induced coagulopathy. Hypothermia and dilutional coagulopathy are associated with infusion of large volumes of crystalloids. Hence, the predominant focus is on damage control resuscitation, which is a combination of permissive hypotension, haemorrhage control and haemostatic resuscitation. Massive transfusion protocols improve survival in severely injured patients. Early recognition that the patient will need massive blood transfusion will limit the use of crystalloids. Initially during resuscitation, fresh frozen plasma, packed red blood cells (PRBCs and platelets should be transfused in the ratio of 1:1:1 in severely injured patients. Fresh whole blood can be an alternative in patients who need a transfusion of 1:1:1 thawed plasma, PRBCs and platelets. Close monitoring of bleeding and point of care coagulation tests are employed, to allow goal-directed plasma, PRBCs and platelets transfusions, in order to decrease the risk of transfusion-related acute lung injury.

  6. About Hand Surgery

    Science.gov (United States)

    ... Find a hand surgeon near you. © 2009 American Society for Surgery of the Hand. Definition developed by ASSH Council. Other Links CME Mission Statement and Disclaimer Policies and Technical Requirements Exhibits and Partners ASSH 822 W. Washington Blvd. ... 2018 by American Society for Surgery of the Hand × Search Tips Tip ...

  7. Guideline Implementation: Hand Hygiene.

    Science.gov (United States)

    Goldberg, Judith L

    2017-02-01

    Performing proper hand hygiene and surgical hand antisepsis is essential to reducing the rates of health care-associated infections, including surgical site infections. The updated AORN "Guideline for hand hygiene" provides guidance on hand hygiene and surgical hand antisepsis, the wearing of fingernail polish and artificial nails, proper skin care to prevent dermatitis, the wearing of jewelry, hand hygiene product selection, and quality assurance and performance improvement considerations. This article focuses on key points of the guideline to help perioperative personnel make informed decisions about hand hygiene and surgical hand antisepsis. The key points address the necessity of keeping fingernails and skin healthy, not wearing jewelry on the hands or wrists in the perioperative area, properly performing hand hygiene and surgical hand antisepsis, and involving patients and visitors in hand hygiene initiatives. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures. Copyright © 2017 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  8. Robotic hand and fingers

    Science.gov (United States)

    Salisbury, Curt Michael; Dullea, Kevin J.

    2017-06-06

    Technologies pertaining to a robotic hand are described herein. The robotic hand includes one or more fingers releasably attached to a robotic hand frame. The fingers can abduct and adduct as well as flex and tense. The fingers are releasably attached to the frame by magnets that allow for the fingers to detach from the frame when excess force is applied to the fingers.

  9. Sonography of scrotal trauma

    International Nuclear Information System (INIS)

    Rao, Meka Srinivasa; Arjun, Kalyanpur

    2012-01-01

    The purpose of this article is to depict the spectrum of scrotal injuries in blunt trauma. Scrotal injuries are not very common and are mostly due to blunt trauma from direct injury, sports injuries or motor vehicle accidents. To minimize complications and ensure testicular salvage, rapid and accurate diagnosis is necessary. High-resolution USG is the investigation of choice, as it is readily available, accurate and has been seen to improve outcomes. An understanding of and familiarity with the sonographic appearance of scrotal injuries on the part of the radiologist/sonographer is therefore of key importance

  10. Sonography of scrotal trauma

    Directory of Open Access Journals (Sweden)

    Meka Srinivasa Rao

    2012-01-01

    Full Text Available The purpose of this article is to depict the spectrum of scrotal injuries in blunt trauma. Scrotal injuries are not very common and are mostly due to blunt trauma from direct injury, sports injuries or motor vehicle accidents. To minimize complications and ensure testicular salvage, rapid and accurate diagnosis is necessary. High-resolution USG is the investigation of choice, as it is readily available, accurate and has been seen to improve outcomes. An understanding of and familiarity with the sonographic appearance of scrotal injuries on the part of the radiologist/sonographer is therefore of key importance.

  11. Blunt cardiac trauma

    OpenAIRE

    Alvarado, Camilo; Vargas, Fernando; Guzmán, Fernando; Zárate, Alejandro; Correa, José L.; Ramírez, Alejandro; M. Quintero, Diana; Ramírez, Erika M.

    2016-01-01

    El trauma cardiaco constituye una de las primeras causas de mortalidad en la población general. Requiere alto índice de sospecha en trauma cerrado severo, mecanismo de desaceleración y en presencia de signos indirectos como: equimosis, huella del volante o del cinturón en el tórax anterior. Las lesiones incluyen: conmoción cardiaca, ruptura cardiaca, lesión cardiaca indirecta como la trombosis coronaria aguda, lesión aórtica, lesión del pericardio y herniación cardiaca. Entre las manifestacio...

  12. Trauma cardiaco cerrado

    OpenAIRE

    Camilo Alvarado; Fernando Vargas; Fernando Guzmán; Alejandro Zárate; José L. Correa; Alejandro Ramírez; Diana M. Quintero; Erika M. Ramírez

    2016-01-01

    El trauma cardiaco constituye una de las primeras causas de mortalidad en la población general. Requiere alto índice de sospecha en trauma cerrado severo, mecanismo de desaceleración y en presencia de signos indirectos como: equimosis, huella del volante o del cinturón en el tórax anterior. Las lesiones incluyen: conmoción cardiaca, ruptura cardiaca, lesión cardiaca indirecta como la trombosis coronaria aguda, lesión aórtica, lesión del pericardio y herniación cardiaca. Entre las manifestacio...

  13. Radiology of thoracic trauma

    International Nuclear Information System (INIS)

    Stark, P.

    1987-01-01

    This course provides an overview of the radiologic manifestations of trauma to the chest. The basic mechanisms of injury are discussed. The effect of trauma on the chest wall, the lung parenchyma, and the pleural space is described. Rib fractures, sternal fractures, lung contusion, lung hematoma, lung laceration, post-traumatic atelectasis, hemothorax, chylothorax, pneumothorax, and adult respiratory distress syndrome are discussed and illustrated. Injuries to the tracheobronchial tree, the aorta and brachiocephalic vessels, the esophagus, the diaphragm, and the heart are also presented. The purpose of the lecture is to familiarize the audience with common and unusual radiologic presentations of traumatic injury to the thorax

  14. Eye trauma in boxing.

    Science.gov (United States)

    Corrales, Gustavo; Curreri, Anthony

    2009-10-01

    In boxing, along with a few other sports, trauma is inherent to the nature of the sport; therefore it is considered a high-risk sport for ocular injuries. The long-term morbidity of ocular injuries suffered by boxers is difficult to estimate due to the lack of structured long-term follow-up of these athletes. Complications of blunt ocular trauma may develop years after the athlete has retired from the ring and is no longer considered to be at risk for boxing-related injuries. This article describes the wide range of eye injuries a boxer can sustain, and their immediate and long-term clinical management.

  15. Splenic trauma: Is splenectomy redundant?

    Directory of Open Access Journals (Sweden)

    S Tandon

    2013-01-01

    Full Text Available 41 year old male, serving air warrior sustained blunt abdominal trauma, CECT revealed grade III splenic injury. He was managed conservatively with good clinical outcome. Conservatism is the new approach to splenic trauma.

  16. Emergency Department Management of Trauma

    DEFF Research Database (Denmark)

    MacKenzie, Colin; Lippert, Freddy

    1999-01-01

    Initial assessment and management of severely injured patients may occur in a specialized area of an emergency department or in a specialized area of a trauma center. The time from injury until definitive management is of essence for survival of life-threatening trauma. The initial care delivered...... injured patients after these patients reach a hospital emergency department or a trauma center....

  17. Complex regional pain syndrome type I following pacemaker implantation

    Directory of Open Access Journals (Sweden)

    Sangita Kamath

    2015-12-01

    Full Text Available A 70-year-old woman presented with burning pain and swelling over dorsum of right hand and small joints of the fingers, associated with redness, feeling of warmth, and stiffness of the fingers, with inability to bend the fingers since 2 months. The symptoms were progressively increasing in intensity for the past 1 month. There was no history of fever or trauma to the hand. Two months before her symptoms started, she had permanent pacemaker implanted for complete heart block with syncope. She was hypertensive and was on regular medication. Her X-ray of right hand showed decreased bone density (demineralisation, suggestive of osteopenia. A diagnosis of reflex sympathetic dystrophy syndrome or complex regional pain syndrome type I induced by pacemaker insertion was made. She was treated with amitriptyline and steroids, after which her symptoms improved dramatically.

  18. Gênero e trauma Gender and trauma

    Directory of Open Access Journals (Sweden)

    Gláucio Ary Dillon Soares

    2005-04-01

    Full Text Available As conseqüências sociais e psicológicas da violência urbana sobre os parentes e amigos de pessoas vitimadas por mortes violentas (homicídio, suicídio ou acidentes são analisadas à luz das diferenças de gênero. A literatura especializada nesta área propõe que mulheres e homens vivenciam experiências traumáticas de forma peculiar. Porém, os traumas típicos são diferentes em cada gênero, deixando em aberto a questão sobre quanto das diferenças entre as respostas se devem a gênero e quanto se devem ao tipo de trauma. Testamos a hipótese de que as mulheres são mais suscetíveis à desordem de estresse pós-trauma (DEPT numa situação traumática comum, usando dados qualitativos e quantitativos. Comparamos os sintomas do trauma e as percepções sobre o significado da perda de seus entes queridos. A amostra, de 425 mulheres (62% e 265 homens (38%, foi retirada de uma lista de parentes de pessoas que sofreram morte violenta na cidade do Rio de Janeiro. Incluímos trinta relatos de parentes e amigos próximos das vítimas diretas. Os resultados revelaram que 54% das mulheres e 41% dos homens tiveram o cotidiano alterado depois da morte de um parente/amigo. Há diferenças estatisticamente significativas nos problemas de saúde e na diversão. Essa área foi a mais afetada, atingindo metade dos entrevistados. Uma variável intimamente correlacionada com os sintomas da DEPT é o contato com o corpo: controlando a extensão do contato (fez o reconhecimento do corpo; viu, mas não reconheceu e nem viu nem reconheceu. Em cada uma dessas categorias, as mulheres foram mais afetadas do que os homens. O artigo conclui que as mulheres sentem mais as perdas do que os homens, mas que parte das diferenças não são internas aos gêneros, mas externas a eles, dependendo das interações e dos contatos pessoais.The social and psychological consequences endured by friends and relatives of people victimized by violent death (homicide, suicide or

  19. [Study on an Exoskeleton Hand Function Training Device].

    Science.gov (United States)

    Hu, Xin; Zhang, Ying; Li, Jicai; Yi, Jinhua; Yu, Hongliu; He, Rongrong

    2016-02-01

    Based on the structure and motion bionic principle of the normal adult fingers, biological characteristics of human hands were analyzed, and a wearable exoskeleton hand function training device for the rehabilitation of stroke patients or patients with hand trauma was designed. This device includes the exoskeleton mechanical structure and the electromyography (EMG) control system. With adjustable mechanism, the device was capable to fit different finger lengths, and by capturing the EMG of the users' contralateral limb, the motion state of the exoskeleton hand was controlled. Then driven by the device, the user's fingers conducting adduction/abduction rehabilitation training was carried out. Finally, the mechanical properties and training effect of the exoskeleton hand were verified through mechanism simulation and the experiments on the experimental prototype of the wearable exoskeleton hand function training device.

  20. About Military Sexual Trauma

    Medline Plus

    Full Text Available ... Get YouTube Red. Working... Not now Try it free Find out why Close About Military Sexual Trauma ... MST. http://www.mentalhealth.va.gov/msthom... Category Education License Standard YouTube License Show more Show less ...

  1. Haemostatic resuscitation in trauma

    DEFF Research Database (Denmark)

    Stensballe, Jakob; Ostrowski, Sisse Rye; Johansson, Par I.

    2016-01-01

    of a ratio driven strategy aiming at 1 : 1 : 1, using tranexamic acid according to CRASH-2, and applying haemostatic monitoring enabling a switch to a goal-directed approach when bleeding slows. Haemostatic resuscitation is the mainstay of trauma resuscitation and is associated with improved survival...

  2. Trauma Aware & Safety Ready

    Science.gov (United States)

    Paterson, Jim

    2017-01-01

    The interwoven issues of trauma and safety have swept through college campuses over the last decade, and they've arrived at doors of admission offices, encouraging officials to think more carefully about those concerns and take a closer look at how they handle them. Experts recommend in this atmosphere that admission offices discuss these topics…

  3. Understanding Child Trauma

    Science.gov (United States)

    ... help of a trained professional. When needed, a mental health professional trained in evidence-based trauma treatment can help children and families cope and move toward recovery. Ask your pediatrician, family physician, school counselor, or clergy member for a referral. Visit ...

  4. Obesity in pediatric trauma.

    Science.gov (United States)

    Witt, Cordelie E; Arbabi, Saman; Nathens, Avery B; Vavilala, Monica S; Rivara, Frederick P

    2017-04-01

    The implications of childhood obesity on pediatric trauma outcomes are not clearly established. Anthropomorphic data were recently added to the National Trauma Data Bank (NTDB) Research Datasets, enabling a large, multicenter evaluation of the effect of obesity on pediatric trauma patients. Children ages 2 to 19years who required hospitalization for traumatic injury were identified in the 2013-2014 NTDB Research Datasets. Age and gender-specific body mass indices (BMI) were calculated. Outcomes included injury patterns, operative procedures, complications, and hospital utilization parameters. Data from 149,817 pediatric patients were analyzed; higher BMI percentiles were associated with significantly more extremity injuries, and fewer injuries to the head, abdomen, thorax and spine (p values Obese children also had significantly longer lengths of stay and more frequent ventilator requirement. Among children admitted after trauma, increased BMI percentile is associated with increased risk of death and potentially preventable complications. These findings suggest that obese children may require different management than nonobese counterparts to prevent complications. Level III; prognosis study. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. When Trauma Hinders Learning

    Science.gov (United States)

    Barr, Donald A.

    2018-01-01

    Many kindergarten teachers have encountered children who enter school lacking the ability to control their behavior, but they may not understand the social and biological processes behind these children's disruptive behavior. The author reviews research into early childhood brain development to explain how trauma and chronic stress can make it…

  6. About Military Sexual Trauma

    Medline Plus

    Full Text Available ... count__/__total__ Find out why Close About Military Sexual Trauma Veterans Health Administration Loading... Unsubscribe from Veterans ... MST. http://www.mentalhealth.va.gov/msthom... Category Education License Standard YouTube License Show more Show less ...

  7. Early Childhood Trauma

    Science.gov (United States)

    National Child Traumatic Stress Network, 2010

    2010-01-01

    Early childhood trauma generally refers to the traumatic experiences that occur to children aged 0-6. Because infants' and young children's reactions may be different from older children's, and because they may not be able to verbalize their reactions to threatening or dangerous events, many people assume that young age protects children from the…

  8. Skeleton scintigraphy in trauma

    International Nuclear Information System (INIS)

    Ansari, M.

    2002-01-01

    Skeletal trauma is common and presents both an opportunity and a problem in skeletal scintigraphy. The opportunity arises in the ability of skeletal scintigraphy to demonstrate abnormalities early after direct trauma. It is well recognized that the early detection of fractures in some sites cannot be reliably achieved by standard radiography, especially in the femoral neck and scaphoid bone. The problem comes in recognizing the effects of skeletal trauma when using skeletal scintigraphy for another purpose, such as the detection of metastatic disease. iatrogenic trauma to either the skeleton or soft tissues may be manifest scintigraphic ally. For example Craniotomy typically leaves a rim pattern at the surgical margin. Rib Retraction during thoracotomy can elicit periosteal reaction. Areas of the skeletal receiving curative levels of ionizing radiation (typically 4000 rads or greater) characteristically demonstrate decreased uptake within 6 months to 1 year after therapy. The generally high sensitivity of the skeletal scintigraphy seems to make it an ideal survey test in cases of suspected child abuse especially in which radiographs are unrevealing. Because of difficulties in obtaining a history of trauma from a preschool child or even eliciting a satisfactory description of the location and nature of the pain, skeletal scintigraphy provides a simple and reliable investigation in these children. Subtle trauma, such as that from stress fractures is often difficult to visualize on a plain radiograph. Skeletal scintigraphy is frequently positive at the time of clinical presentation. Skeletal scintigraphy is exquisitely sensitive to the remodeling process and typically shows abnormalities 1 to 2 weeks or more before the appearance of radiographic changes in stress fractures. The periosteal reaction can be visualized within hours of the injury. Insufficiency and fatigue fractures such as vertebral compression fracture, which is probably the most common consequence of

  9. MANAGEMENT OF LIVER TRAUMA

    Directory of Open Access Journals (Sweden)

    Dova Subba

    2016-03-01

    Full Text Available AIM To estimate the incidence of Liver Trauma injuries and grade their severity of injury. To assess the factors responsible for morbidity and mortality after Liver Trauma. To study the postoperative complications and the management of Liver Trauma. MATERIALS AND METHODS The present prospective study was conducted on 100 patients who were admitted to Department of General Surgery for treatment who were managed operatively or non-operatively for abdominal trauma and having liver injury forms the material of the study. This study was conducted over a span of 24 months from June 2013 to November 2015. RESULTS Maximum number of patients are in the age group of 21-30 years (46%. 85% patients (85/100 are males and 15% of patients (15/100 are females. Lapse time of injury and admission varied from 25 minutes to 66 hours and 30 minutes. 75 % of the patients (75/100 presented within 24 hours after injury. Death rate of patients who reached hospital after 24 hours of injury was higher than the patients who reached hospital within 24 hours of injury. 28% of patients (28/100 had associated bony injuries, out of which 5% of patients (5/100 expired due to primary haemorrhage of fractured femur. More than one segment was injured in many patients. Segment V is involved commonly making 55% (55/100 of patients. Next common segment involved is segment VII, making 39% (39/100. CONCLUSION Mechanism of injury is the important factor which is responsible for morbidity in liver injury. Nonoperative management proved to be safe and effective and often has been used to treat patients with liver trauma.

  10. Penetrating ureteral trauma

    Directory of Open Access Journals (Sweden)

    Gustavo P. Fraga

    2007-04-01

    Full Text Available OBJECTIVE: The purpose of this series is to report our experience in managing ureteral trauma, focusing on the importance of early diagnosis, correct treatment, and the impact of associated injuries on the management and morbid-mortality. MATERIALS AND METHODS: From January 1994 to December 2002, 1487 laparotomies for abdominal trauma were performed and 20 patients with ureteral lesions were identified, all of them secondary to penetrating injury. Medical charts were analyzed as well as information about trauma mechanisms, diagnostic routine, treatment and outcome. RESULTS: All patients were men. Mean age was 27 years. The mechanisms of injury were gunshot wounds in 18 cases (90% and stab wounds in two (10%. All penetrating abdominal injuries had primary indication of laparotomy, and neither excretory urography nor computed tomography were used in any case before surgery. The diagnosis of ureteric injury was made intra-operatively in 17 cases (85%. Two ureteral injuries (10% were initially missed. All patients had associated injuries. The treatment was dictated by the location, extension and time necessary to identify the injury. The overall incidence of complications was 55%. The presence of shock on admission, delayed diagnosis, Abdominal Trauma Index > 25, Injury Severity Score > 25 and colon injuries were associated to a high complication rate, however, there was no statistically significant difference. There were no mortalities in this group. CONCLUSIONS: A high index of suspicion is required for diagnosis of ureteral injuries. A thorough exploration of all retroperitoneal hematoma after penetrating trauma should be an accurate method of diagnosis; even though it failed in 10% of our cases.

  11. Imaging in spinal trauma

    International Nuclear Information System (INIS)

    Goethem, J.W.M. van; Maes, Menno; Oezsarlak, Oezkan; Hauwe, Luc van den; Parizel, Paul M.

    2005-01-01

    Because it may cause paralysis, injury to the spine is one of the most feared traumas, and spinal cord injury is a major cause of disability. In the USA approximately 10,000 traumatic cervical spine fractures and 4000 traumatic thoracolumbar fractures are diagnosed each year. Although the number of individuals sustaining paralysis is far less than those with moderate or severe brain injury, the socioeconomic costs are significant. Since most of the spinal trauma patients survive their injuries, almost one out of 1000 inhabitants in the USA are currently being cared for partial or complete paralysis. Little controversy exists regarding the need for accurate and emergent imaging assessment of the traumatized spine in order to evaluate spinal stability and integrity of neural elements. Because clinicians fear missing occult spine injuries, they obtain radiographs for nearly all patients who present with blunt trauma. We are influenced on one side by fear of litigation and the possible devastating medical, psychologic and financial consequences of cervical spine injury, and on the other side by pressure to reduce health care costs. A set of clinical and/or anamnestic criteria, however, can be very useful in identifying patients who have an extremely low probability of injury and who consequently have no need for imaging studies. Multidetector (or multislice) computed tomography (MDCT) is the preferred primary imaging modality in blunt spinal trauma patients who do need imaging. Not only is CT more accurate in diagnosing spinal injury, it also reduces imaging time and patient manipulation. Evidence-based research has established that MDCT improves patient outcome and saves money in comparison to plain film. This review discusses the use, advantages and disadvantages of the different imaging techniques used in spinal trauma patients and the criteria used in selecting patients who do not need imaging. Finally an overview of different types of spinal injuries is given

  12. Imaging in spinal trauma

    Energy Technology Data Exchange (ETDEWEB)

    Goethem, J.W.M. van [Universitair Ziekenhuis Antwerpen, University of Antwerp, Belgium, Department of Radiology, Edegem (Belgium); Algemeen Ziekenhuis Maria Middelares, Department of Radiology, Sint-Niklaas (Belgium); Maes, Menno; Oezsarlak, Oezkan; Hauwe, Luc van den; Parizel, Paul M. [Universitair Ziekenhuis Antwerpen, University of Antwerp, Belgium, Department of Radiology, Edegem (Belgium)

    2005-03-01

    Because it may cause paralysis, injury to the spine is one of the most feared traumas, and spinal cord injury is a major cause of disability. In the USA approximately 10,000 traumatic cervical spine fractures and 4000 traumatic thoracolumbar fractures are diagnosed each year. Although the number of individuals sustaining paralysis is far less than those with moderate or severe brain injury, the socioeconomic costs are significant. Since most of the spinal trauma patients survive their injuries, almost one out of 1000 inhabitants in the USA are currently being cared for partial or complete paralysis. Little controversy exists regarding the need for accurate and emergent imaging assessment of the traumatized spine in order to evaluate spinal stability and integrity of neural elements. Because clinicians fear missing occult spine injuries, they obtain radiographs for nearly all patients who present with blunt trauma. We are influenced on one side by fear of litigation and the possible devastating medical, psychologic and financial consequences of cervical spine injury, and on the other side by pressure to reduce health care costs. A set of clinical and/or anamnestic criteria, however, can be very useful in identifying patients who have an extremely low probability of injury and who consequently have no need for imaging studies. Multidetector (or multislice) computed tomography (MDCT) is the preferred primary imaging modality in blunt spinal trauma patients who do need imaging. Not only is CT more accurate in diagnosing spinal injury, it also reduces imaging time and patient manipulation. Evidence-based research has established that MDCT improves patient outcome and saves money in comparison to plain film. This review discusses the use, advantages and disadvantages of the different imaging techniques used in spinal trauma patients and the criteria used in selecting patients who do not need imaging. Finally an overview of different types of spinal injuries is given

  13. The impact of specialist trauma service on major trauma mortality.

    Science.gov (United States)

    Wong, Ting Hway; Lumsdaine, William; Hardy, Benjamin M; Lee, Keegan; Balogh, Zsolt J

    2013-03-01

    Trauma services throughout the world have had positive effects on trauma-related mortality. Australian trauma services are generally more consultative in nature rather than the North American model of full trauma admission service. We hypothesized that the introduction of a consultative specialist trauma service in a Level I Australian trauma center would reduce mortality of the severely injured. A 10-year retrospective study (January 1, 2002-December 31, 2011) was performed on all trauma patients admitted with an Injury Severity Score (ISS) > 15. Patients were identified from the trauma registry, and data for age, sex, mechanism of injury, ISS, survival to discharge, and length of stay were collected. Mortality was examined for patients with severe injury (ISS > 15) and patients with critical injury (ISS > 24) and compared for the three periods: 2002-2004 (without trauma specialist), 2005-2007 (with trauma specialist), and 2008-2011 (with specialist trauma service). A total of 3,869 severely injured (ISS > 15) trauma patients were identified during the 10-year period. Of these, 2,826 (73%) were male, 1,513 (39%) were critically injured (ISS > 24), and more than 97% (3,754) were the victim of blunt trauma. Overall mortality decreased from 12.4% to 9.3% (relative risk, 0.75) from period one to period three and from 25.4% to 20.3% (relative risk, 0.80) for patients with critical injury. A 0.46% per year decrease (p = 0.018) in mortality was detected (odds ratio, 0.63; p 24), the trend was (0.61% per year; odds ratio, 0.68; p = 0.039). The introduction of a specialist trauma service decreased the mortality of patients with severe injury, the model of care should be considered to implement state- and nationwide in Australia. Epidemiologic study, level III.

  14. Childhood trauma in the graphic memoir

    OpenAIRE

    Beskow, Sara H.

    2011-01-01

    In this thesis I examine why the graphic memoir has become such a popular platform for authors to explore their childhood, and how these authors use graphic memoirs in an attempt to understand any trauma that they experienced during their formative years. Graphic memoirs in this context allow for a dual outlet to express these complex traumatic events, both through vivid illustrations and descriptive text. To illustrate how graphic memoirs are used as an outlet for traumatic experiences I hav...

  15. The Avocado Hand

    LENUS (Irish Health Repository)

    Rahmani, G

    2017-11-01

    Accidental self-inflicted knife injuries to digits are a common cause of tendon and nerve injury requiring hand surgery. There has been an apparent increase in avocado related hand injuries. Classically, the patients hold the avocado in their non-dominant hand while using a knife to cut\\/peel the fruit with their dominant hand. The mechanism of injury is usually a stabbing injury to the non-dominant hand as the knife slips past the stone, through the soft avocado fruit. Despite their apparent increased incidence, we could not find any cases in the literature which describe the “avocado hand”. We present a case of a 32-year-old woman who sustained a significant hand injury while preparing an avocado. She required exploration and repair of a digital nerve under regional anaesthesia and has since made a full recovery.

  16. Sexual Issues in Treating Trauma Survivors.

    Science.gov (United States)

    Zoldbrod, Aline P

    The effect of interpersonal trauma on sexuality can be profound. The field of sexual trauma is complex empirically and clinically, with contradictory theories and conflicting data. Research definitions and treatment protocols for child sexual abuse are very imprecise. There are no firm, empirically proven guidelines for treating men and women who have been sexually abused as children or adolescents. Overt sexual abuse (OSA) in children and adolescents is defined here as molestation, rape, or incest. Research has shown that OSA may, but does not necessarily, lead to sexual dysfunction in adulthood. The effects of OSA are worsened by concurrent types of family of origin abuse, such as emotional abuse or physical abuse. One factor that seems related to the varying impact of OSA on adult sexuality is the patients' family of origin experience with nonsexual Milestones of Sexual Development. Without positive experiences with touch, trust and empathy, the ability to relax and be soothed, and power, the effects of OSA are potentiated and complicated. Sexuality is embodied, so experiences with touch are particularly important when working with OSA. A three-color Body Map technique which assesses stored associations to touch is provided. The concept of developmental sexual trauma (DST) is introduced as a way to label traumagenic family events which potentiate OSA or negatively effect sex but which are not explicitly sexual in origin. Strategies to assess and treat OSA are reviewed. Body Maps are recommended to assess and treat sexual trauma.

  17. Hand eczema classification

    DEFF Research Database (Denmark)

    Diepgen, T L; Andersen, Klaus Ejner; Brandao, F M

    2008-01-01

    of the disease is rarely evidence based, and a classification system for different subdiagnoses of hand eczema is not agreed upon. Randomized controlled trials investigating the treatment of hand eczema are called for. For this, as well as for clinical purposes, a generally accepted classification system...... A classification system for hand eczema is proposed. Conclusions It is suggested that this classification be used in clinical work and in clinical trials....

  18. Diagnostic imaging of the hand

    Energy Technology Data Exchange (ETDEWEB)

    Schmitt, Rainer [Hospital for Cardiovascular Diseases, Bad Neustadt an der Saale (Germany). Dept. of Radiology; Lanz, Ulrich [Perlach Hospital, Munich (Germany). Dept. of Hand Surgery

    2008-07-01

    With its complex anatomy and specialized biomechanics, the human hand has always presented physicians with a unique challenge when it comes to diagnosing and treating the diseases that afflict it. And while recent decades have seen a rapid increase in the number of therapeutic options, many diseases and injuries of the hand are still commonly misinterpreted. In diagnostic imaging of the hand, an interdisciplinary team, comprisingspecialists in radiology, surgery, and rheumatology, presents a comprehensive,reliable guide to this topographically intricate area. Highlights include: - More than 1000 high-quality illustrations - All state-of-the-art imaging modalities-including multidetector CT, with 2D displays and 3D reconstructions, and contrast-enhanced MRI with multi-channel, phased-array coils - An overview of all currently used methods of examination - A detailed presentation of the anatomic and functional foundations necessary for diagnosis - Full coverage of all disorders of the hand - Systematic treatment of each disease's definition, pathogenesis, and clinical symptoms, according to a graduated diagnostic plan - Easy-to-use format, featuring crisp images and line drawings seamlessly integrated with concise text, summary tables, and handy checklists - A heavily cross-referenced appendix of differential diagnosis tables - Emphasis on interdisciplinary consultation throughout designed to help both radiologists and clinicians develop the most efficient and effective strategies for evaluating and treating patients, Diagnostic imaging of the hand will leave specialists of all levels with a fresh appreciation for - and a richer understanding of - the expanding array of cutting-edge alternatives for diagnosing and treating disorders of the hand. (orig.)

  19. Diagnostic imaging of the hand

    International Nuclear Information System (INIS)

    Schmitt, Rainer; Lanz, Ulrich

    2008-01-01

    With its complex anatomy and specialized biomechanics, the human hand has always presented physicians with a unique challenge when it comes to diagnosing and treating the diseases that afflict it. And while recent decades have seen a rapid increase in the number of therapeutic options, many diseases and injuries of the hand are still commonly misinterpreted. In diagnostic imaging of the hand, an interdisciplinary team, comprisingspecialists in radiology, surgery, and rheumatology, presents a comprehensive,reliable guide to this topographically intricate area. Highlights include: - More than 1000 high-quality illustrations - All state-of-the-art imaging modalities-including multidetector CT, with 2D displays and 3D reconstructions, and contrast-enhanced MRI with multi-channel, phased-array coils - An overview of all currently used methods of examination - A detailed presentation of the anatomic and functional foundations necessary for diagnosis - Full coverage of all disorders of the hand - Systematic treatment of each disease's definition, pathogenesis, and clinical symptoms, according to a graduated diagnostic plan - Easy-to-use format, featuring crisp images and line drawings seamlessly integrated with concise text, summary tables, and handy checklists - A heavily cross-referenced appendix of differential diagnosis tables - Emphasis on interdisciplinary consultation throughout designed to help both radiologists and clinicians develop the most efficient and effective strategies for evaluating and treating patients, Diagnostic imaging of the hand will leave specialists of all levels with a fresh appreciation for - and a richer understanding of - the expanding array of cutting-edge alternatives for diagnosing and treating disorders of the hand. (orig.)

  20. Trauma care system in Iran

    Directory of Open Access Journals (Sweden)

    Zargar Moussa

    2011-06-01

    Full Text Available 【Abstract】Objective: The high burden of injuries in Iran necessitates the establishment of a comprehensive trauma care system. The purpose of this paper is to de- scribe the current status of trauma system regarding the components and function. Methods: The current status of trauma system in all components of a trauma system was described through ex- pert panels and semi-structured interviews with trauma spe- cialists and policy makers. Results: Currently, various organizations are involved in prevention, management and rehabilitation of injuries, but an integrative system approach to trauma is rather deficient. There has been ongoing progress in areas of pub- lic education through media, traffic regulation reinforcement, hospital care and prehospital services. Meanwhile, there are gaps regarding financing, legislations and education of high risk groups. The issues on education and training stan- dards of the front line medical team and continuing educa- tion and evaluation are yet to be addressed. Trauma regis- try has been piloted in some provinces, but as it needs the well-developed infrastructure (regarding staff, maintenance, financial resources, it is not yet established in our system of trauma care. Conclusions: It seems that one of the problems with trauma care in Iran is lack of coordination among trauma system organizations. Although the clinical management of trauma patients has improved in our country in the recent decade, decreasing the burden of injuries necessitates an organized approach to prevention and management of trauma in the context of a trauma system. Key words: Emergency medical services; Trauma centers; Wounds and injuries

  1. Coordination of hand shape.

    Science.gov (United States)

    Pesyna, Colin; Pundi, Krishna; Flanders, Martha

    2011-03-09

    The neural control of hand movement involves coordination of the sensory, motor, and memory systems. Recent studies have documented the motor coordinates for hand shape, but less is known about the corresponding patterns of somatosensory activity. To initiate this line of investigation, the present study characterized the sense of hand shape by evaluating the influence of differences in the amount of grasping or twisting force, and differences in forearm orientation. Human subjects were asked to use the left hand to report the perceived shape of the right hand. In the first experiment, six commonly grasped items were arranged on the table in front of the subject: bottle, doorknob, egg, notebook, carton, and pan. With eyes closed, subjects used the right hand to lightly touch, forcefully support, or imagine holding each object, while 15 joint angles were measured in each hand with a pair of wired gloves. The forces introduced by supporting or twisting did not influence the perceptual report of hand shape, but for most objects, the report was distorted in a consistent manner by differences in forearm orientation. Subjects appeared to adjust the intrinsic joint angles of the left hand, as well as the left wrist posture, so as to maintain the imagined object in its proper spatial orientation. In a second experiment, this result was largely replicated with unfamiliar objects. Thus, somatosensory and motor information appear to be coordinated in an object-based, spatial-coordinate system, sensitive to orientation relative to gravitational forces, but invariant to grasp forcefulness.

  2. Trauma Tactics: Rethinking Trauma Education for Professional Nurses.

    Science.gov (United States)

    Garvey, Paula; Liddil, Jessica; Eley, Scott; Winfield, Scott

    2016-01-01

    According to the National Trauma Institute (2015), trauma accounts for more than 180,000 deaths each year in the United States. Nurses play a significant role in the care of trauma patients and therefore need appropriate education and training (L. ). Although several courses exist for trauma education, many nurses have not received adequate education in trauma management (B. ; L. ). Trauma Tactics, a 2-day course that focuses on high-fidelity human patient simulation, was created to meet this educational need. This descriptive study was conducted retrospectively to assess the effectiveness of the Trauma Tactics course. Pre- and postsurveys, tests, and simulation performance were used to evaluate professional nurses who participated in Trauma Tactics over a 10-month period. Fifty-five nurses were included in the study. Pre- and postsurveys revealed an increase in overall confidence, test scores increased by an average of 2.5 points, and simulation performance scores increased by an average of 16 points. Trauma Tactics is a high-quality course that provides a valuable and impactful educational experience for nurses. Further research is needed to evaluate the long-term effects of Trauma Tactics and its impacts on quality of care and patient outcomes.

  3. The upper hand on compartment syndrome.

    LENUS (Irish Health Repository)

    Dolan, Roisin T

    2012-11-01

    Metacarpal fractures are common injuries, accounting for approximately 30% to 40% of all hand fractures and with a lifetime incidence of 2.5%. Traditionally regarded as an innocuous injury, metacarpal fractures tend to be associated with successful outcomes after closed reduction and immobilization. Hand compartment syndrome (HCS) is a rare clinical entity with potential devastating consequences in terms of loss of function and quality-of-life outcomes. We discuss the case of a 44-year-old woman presenting with multiple closed metacarpal fractures as a result of low-energy trauma, complicated by acute HCS. We review the presentation, clinical assessment, and optimal surgical management of acute HCS with reference to international literature.

  4. Design of an exercise glove for hand rehabilitation using spring mechanism

    NARCIS (Netherlands)

    Serbest, K.; Ates, Sedar; Stienen, Arno; Isler, Y.

    2017-01-01

    Hand muscles do not perform their functions because of different reasons such as disease, injury and trauma. It is implemented some treatments for the hand therapy at hospitals and rehabilitation centers. One of these is using orthotic or robotic devices for rehabilitation. One of the important

  5. Computer-assisted trauma care prototype.

    Science.gov (United States)

    Holzman, T G; Griffith, A; Hunter, W G; Allen, T; Simpson, R J

    1995-01-01

    Each year, civilian accidental injury results in 150,000 deaths and 400,000 permanent disabilities in the United States alone. The timely creation of and access to dynamically updated trauma patient information at the point of injury is critical to improving the state of care. Such information is often non-existent, incomplete, or inaccurate, resulting in less than adequate treatment by medics and the loss of precious time by medical personnel at the hospital or battalion aid station as they attempt to reassess and treat the patient. The Trauma Care Information Management System (TCIMS) is a prototype system for facilitating information flow and patient processing decisions in the difficult circumstances of civilian and military trauma care activities. The program is jointly supported by the United States Advanced Research Projects Agency (ARPA) and a consortium of universities, medical centers, and private companies. The authors' focus has been the human-computer interface for the system. We are attempting to make TCIMS powerful in the functions it delivers to its users in the field while also making it easy to understand and operate. To develop such a usable system, an approach known as user-centered design is being followed. Medical personnel themselves are collaborating with the authors in its needs analysis, design, and evaluation. Specifically, the prototype being demonstrated was designed through observation of actual civilian trauma care episodes, military trauma care exercises onboard a hospital ship, interviews with civilian and military trauma care providers, repeated evaluation of evolving prototypes by potential users, and study of the literature on trauma care and human factors engineering. This presentation at MedInfo '95 is still another avenue for soliciting guidance from medical information system experts and users. The outcome of this process is a system that provides the functions trauma care personnel desire in a manner that can be easily and

  6. Hand-held medical robots.

    Science.gov (United States)

    Payne, Christopher J; Yang, Guang-Zhong

    2014-08-01

    Medical robots have evolved from autonomous systems to tele-operated platforms and mechanically-grounded, cooperatively-controlled robots. Whilst these approaches have seen both commercial and clinical success, uptake of these robots remains moderate because of their high cost, large physical footprint and long setup times. More recently, researchers have moved toward developing hand-held robots that are completely ungrounded and manipulated by surgeons in free space, in a similar manner to how conventional instruments are handled. These devices provide specific functions that assist the surgeon in accomplishing tasks that are otherwise challenging with manual manipulation. Hand-held robots have the advantages of being compact and easily integrated into the normal surgical workflow since there is typically little or no setup time. Hand-held devices can also have a significantly reduced cost to healthcare providers as they do not necessitate the complex, multi degree-of-freedom linkages that grounded robots require. However, the development of such devices is faced with many technical challenges, including miniaturization, cost and sterility, control stability, inertial and gravity compensation and robust instrument tracking. This review presents the emerging technical trends in hand-held medical robots and future development opportunities for promoting their wider clinical uptake.

  7. CT of splenic trauma

    International Nuclear Information System (INIS)

    Griffiths, B.G.; Federle, M.P.; Minagi, H.; Jeffrey, R.B.

    1986-01-01

    Fifty-five consecutive cases of surgically proved splenic injuries were evaluated by CT. CT correctly identified 54 splenic injuries, with one false-negative and three false-positive studies. In the single false-negative study and in two of the three false-positive studies, CT correctly indicated the presence of a large hemoperitoneum and other abdominal visceral lacerations and so correctly indicated the need for surgery. Of the 55 proved cases of splenic injury, CT revealed hemoperitoneum in 54 (99%), perisplenic clot in 47 (85%), splenic laceration in 39 (71%), and subcapsular hematoma in 13 (24%). Perisplenic clot can be distinguished from lysed blood in the peritoneal cavity and is a sensitive and specific sign of splenic trauma, even in the absence of visible splenic laceration. The authors conclude that CT is highly reliable means of evaluating splenic trauma

  8. Trauma of the chest

    International Nuclear Information System (INIS)

    Reuter, M.

    1996-01-01

    This paper describes the typical radiologic findings in chest trauma, and the value of conventional radiography, CT, MRI, and aortography is discussed. Conventional radiography rather than cross-sectional imaging is the mainstay in diagnosing thoracic trauma. During the critical phase with often concomitant shock, pelvic and spinal injuries tailored raiographic views or even upright chest radiographs are impractical. The severely traumatized patient is usually radiographed in the supine position and suboptimal roentgenograms may have to be accepted for several reasons. It is well documented that many abnormalities detected on CT were not apparent on conventional radiographs, but CT is reserved for hemodynamical stable patients. Nevertheless certain situations like aortic rupture require further evaluation by CT and aortography. (orig./MG)

  9. ABDOMINAL TRAUMA- CLINICAL STUDY

    Directory of Open Access Journals (Sweden)

    Vanaja Ratnakumari Billa

    2017-08-01

    Full Text Available BACKGROUND In the recent times there has been increased incidence of abdominal trauma cases due to several causes. Quick and prompt intervention is needed to decrease the mortality of the patients. So we conducted a study to assess the cause and the management of abdominal trauma cases in our institution. The aim of this study was to know the incidence of blunt and penetrating injuries and their causes, age and sex incidence, importance of various investigations, mode of treatment offered and post-operative complications. To study the cause of death and evolve better management. MATERIALS AND METHODS The present study comprises of patients admitted to and operated in various surgical units in the Department of Surgery at Government General Hospital, attached to Guntur Medical College Guntur, from August 2014 to October 2016. RESULTS Increase incidence seen in age group 20-29 years (30%. Male predominance 77.5%. Mechanism of injury–road traffic accidents 65%. Isolated organ injury–colon and rectum 40%. Other associated injuries–chest injuries with rib fractures 7.5%. Complications–wound infection 17.5%. Duration of hospital stay 8–14 days. Bowel injury management–closure of perforation 84.6%. Resection anastomosis 15.38%. CONCLUSION Thorough clinical examination, diagnostic paracentesis, plain X-ray erect abdomen and ultrasound proved to be very helpful in the diagnosis of intra-abdominal injuries. Spleen is the commonest organ involved in blunt trauma and colon is the commonly injured organ in penetrating abdominal trauma, many patients have associated extremity and axial skeleton injuries. With advances in diagnosis and intensive care technologies, most patients of solid visceral injuries with hemodynamic stability can be managed conservatively. Surgical site infection is the most common complication following surgery. The mortality is high; reason might be patient reaching the hospital late, high incidence of postoperative septic

  10. Radiology of orbital trauma

    International Nuclear Information System (INIS)

    Kelly, J.K.; Lazo, A.; Metes, J.J.

    1988-01-01

    Computed tomography has become the gold standard against which to measure orbital imaging modalities. The simultaneous display of bone, soft tissues, paranasal sinuses, and intracranial structures is a unique advantage. Radiation dose and cost have been cited as disadvantages. These would suggest that CT be reserved for the patient with significant orbital injury or difficult diagnostic problems. Magnetic resonance is limited in the investigation of orbital trauma

  11. Emergency strategies and trends in the management of liver trauma.

    Science.gov (United States)

    Jiang, Hongchi; Wang, Jizhou

    2012-09-01

    The liver is the most frequently injured organ during abdominal trauma. The management of hepatic trauma has undergone a paradigm shift over the past several decades, with mandatory operation giving way to nonoperative treatment. Better understanding of the mechanisms and grade of liver injury aids in the initial assessment and establishment of a management strategy. Hemodynamically unstable patients should undergo focused abdominal sonography for trauma, whereas stable patients may undergo computed tomography, the standard examination protocol. The grade of liver injury alone does not accurately predict the need for operation, and nonoperative management is rapidly becoming popular for high-grade injuries. Hemodynamic instability with positive focused abdominal sonography for trauma and peritonitis is an indicator of the need for emergent operative intervention. The damage control concept is appropriate for the treatment of major liver injuries and is associated with significant survival advantages compared with traditional prolonged surgical techniques. Although surgical intervention for hepatic trauma is not as common now as it was in the past, current trauma surgeons should be familiar with the emergency surgical skills necessary to manage complex hepatic injuries, such as packing, Pringle maneuver, selective vessel ligation, resectional debridement, and parenchymal sutures. The present review presents emergency strategies and trends in the management of liver trauma.

  12. Clean Hands Count

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    Full Text Available ... 585 views 3:10 Wash 'Em - Hand Hygiene Music Video - Duration: 5:46. Jefferson Health 413,097 ... 089,212 views 4:50 Hand hygiene FULL music video - Duration: 2:33. AlfredHealthTV 26,032 views ...

  13. Mind the hand

    DEFF Research Database (Denmark)

    Davidsen, Jacob; Christiansen, Ellen Tove

    2014-01-01

    Apart from touching the screen, what is the role of the hands for children collaborating around touchscreens? Based on embodied and multimodal interaction analysis of 8- and 9-year old pairs collaborating around touchscreens, we conclude that children use their hands to constrain and control acce...

  14. Clean Hands Count

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    Full Text Available ... 024 views 2:58 Wash 'Em - Hand Hygiene Music Video - Duration: 5:46. Jefferson Health 412,404 ... 2,805 views 3:13 Hand hygiene FULL music video - Duration: 2:33. AlfredHealthTV 25,574 views ...

  15. Clean Hands Count

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    Full Text Available ... 585 views 3:10 Wash 'Em - Hand Hygiene Music Video - Duration: 5:46. Jefferson Health 412,760 ... 536,963 views 1:46 Hand hygiene FULL music video - Duration: 2:33. AlfredHealthTV 25,574 views ...

  16. Clean Hands Count

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    Full Text Available ... today; no cure tomorrow - Duration: 3:10. World Health Organization 74,478 views 3:10 Wash 'Em - Hand Hygiene Music Video - Duration: 5:46. Jefferson Health 411,292 views 5:46 Hand Washing Technique - ...

  17. Clean Hands Count

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    Full Text Available ... 029 views 3:10 Wash 'Em - Hand Hygiene Music Video - Duration: 5:46. Jefferson Health 412,404 ... 081,511 views 4:50 Hand hygiene FULL music video - Duration: 2:33. AlfredHealthTV 25,194 views ...

  18. Clean Hands Count

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    Full Text Available ... today; no cure tomorrow - Duration: 3:10. World Health Organization 75,362 views 3:10 Wash 'Em - Hand Hygiene Music Video - Duration: 5:46. Jefferson Health 412,404 views 5:46 Hand Washing Technique - ...

  19. Clean Hands Count

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  20. Clean Hands Count

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    Full Text Available ... 453 views 3:10 Wash 'Em - Hand Hygiene Music Video - Duration: 5:46. Jefferson Health 413,702 ... 28,656 views 3:40 Hand hygiene FULL music video - Duration: 2:33. AlfredHealthTV 26,480 views ...

  1. Clean Hands Count

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    Full Text Available ... 362 views 3:10 Wash 'Em - Hand Hygiene Music Video - Duration: 5:46. Jefferson Health 412,404 ... 219,427 views 1:27 Hand hygiene FULL music video - Duration: 2:33. AlfredHealthTV 25,194 views ...

  2. Clean Hands Count

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    Full Text Available ... 03. R Mayer 371,490 views 4:03 The psychological trick behind getting people to say yes - Duration: 8:06. PBS NewsHour 606,671 views 8:06 Should You Really Wash Your Hands? - Duration: 4:51. Gross Science 57,828 views 4:51 Healthcare Worker Hand ...

  3. Clean Hands Count

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    Full Text Available ... 585 views 3:10 Wash 'Em - Hand Hygiene Music Video - Duration: 5:46. Jefferson Health 413,097 ... 28,656 views 3:40 Hand hygiene FULL music video - Duration: 2:33. AlfredHealthTV 26,032 views ...

  4. Clean Hands Count

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    Full Text Available ... 5 Moments of Hand Hygiene - Duration: 1:53. Salem Health 13,972 views 1:53 Hand Hygiene ... Mode: Off History Help Loading... Loading... Loading... About Press Copyright Creators Advertise Developers +YouTube Terms Privacy Policy & ...

  5. Imaging of laryngeal trauma

    International Nuclear Information System (INIS)

    Becker, Minerva; Leuchter, Igor; Platon, Alexandra; Becker, Christoph D.; Dulguerov, Pavel; Varoquaux, Arthur

    2014-01-01

    External laryngeal trauma is a rare but potentially life-threatening situation in the acutely injured patient. Trauma mechanism and magnitude, maximum focus of the applied force, and patient related factors, such as age and ossification of the laryngeal cartilages influence the spectrum of observed injuries. Their correct diagnosis and prompt management are paramount in order to avoid patient death or long-term impairment of breathing, swallowing and speaking. The current review provides a comprehensive approach to the radiologic interpretation of imaging studies performed in patients with suspected laryngeal injury. It describes the key anatomic structures that are relevant in laryngeal trauma and discusses the clinical role of multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) in the acute emergency situation. The added value of two-dimensional multiplanar reconstructions (2D MPR), three-dimensional volume rendering (3D VR) and virtual endoscopy (VE) for the non-invasive evaluation of laryngeal injuries and for treatment planning is discussed. The clinical presentation, biomechanics of injury, diagnostic pitfalls and pearls, common and uncommon findings are reviewed with emphasis of fracture patterns, involvement of laryngeal joints, intra- and extralaryngeal soft tissue injuries, and complications seen in the acute emergency situation. The radiologic appearance of common and less common long-term sequelae, as well as treatment options are equally addressed

  6. Rethinking historical trauma.

    Science.gov (United States)

    Kirmayer, Laurence J; Gone, Joseph P; Moses, Joshua

    2014-06-01

    Recent years have seen the rise of historical trauma as a construct to describe the impact of colonization, cultural suppression, and historical oppression of Indigenous peoples in North America (e.g., Native Americans in the United States, Aboriginal peoples in Canada). The discourses of psychiatry and psychology contribute to the conflation of disparate forms of violence by emphasizing presumptively universal aspects of trauma response. Many proponents of this construct have made explicit analogies to the Holocaust as a way to understand the transgenerational effects of genocide. However, the social, cultural, and psychological contexts of the Holocaust and of post-colonial Indigenous "survivance" differ in many striking ways. Indeed, the comparison suggests that the persistent suffering of Indigenous peoples in the Americas reflects not so much past trauma as ongoing structural violence. The comparative study of genocide and other forms of massive, organized violence can do much to illuminate both common mechanisms and distinctive features, and trace the looping effects from political processes to individual experience and back again. The ethics and pragmatics of individual and collective healing, restitution, resilience, and recovery can be understood in terms of the self-vindicating loops between politics, structural violence, public discourse, and embodied experience. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  7. Imaging of laryngeal trauma

    Energy Technology Data Exchange (ETDEWEB)

    Becker, Minerva, E-mail: Minerva.Becker@hcuge.ch [Department of Radiology, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14 (Switzerland); Leuchter, Igor, E-mail: Igor.Leuchter@hcuge.ch [Department of Otorhinolaryngology and Cervico-facial Surgery, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14 (Switzerland); Platon, Alexandra, E-mail: Alexandra.Platon@hcuge.ch [Department of Radiology, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14 (Switzerland); Becker, Christoph D., E-mail: Christoph.Becker@hcuge.ch [Department of Radiology, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14 (Switzerland); Dulguerov, Pavel, E-mail: Pavel.Dulguerov@hcuge.ch [Department of Otorhinolaryngology and Cervico-facial Surgery, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14 (Switzerland); Varoquaux, Arthur, E-mail: Arthur.Varoquaux@hcuge.ch [Department of Radiology, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14 (Switzerland)

    2014-01-15

    External laryngeal trauma is a rare but potentially life-threatening situation in the acutely injured patient. Trauma mechanism and magnitude, maximum focus of the applied force, and patient related factors, such as age and ossification of the laryngeal cartilages influence the spectrum of observed injuries. Their correct diagnosis and prompt management are paramount in order to avoid patient death or long-term impairment of breathing, swallowing and speaking. The current review provides a comprehensive approach to the radiologic interpretation of imaging studies performed in patients with suspected laryngeal injury. It describes the key anatomic structures that are relevant in laryngeal trauma and discusses the clinical role of multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) in the acute emergency situation. The added value of two-dimensional multiplanar reconstructions (2D MPR), three-dimensional volume rendering (3D VR) and virtual endoscopy (VE) for the non-invasive evaluation of laryngeal injuries and for treatment planning is discussed. The clinical presentation, biomechanics of injury, diagnostic pitfalls and pearls, common and uncommon findings are reviewed with emphasis of fracture patterns, involvement of laryngeal joints, intra- and extralaryngeal soft tissue injuries, and complications seen in the acute emergency situation. The radiologic appearance of common and less common long-term sequelae, as well as treatment options are equally addressed.

  8. Trauma da Veia Porta

    Directory of Open Access Journals (Sweden)

    Gustavo Pereira Fraga

    Full Text Available OBJETIVO: O trauma da veia porta é raro e freqüentemente fatal por causa de exsanguinação e alta incidência de lesões de estruturas adjacentes. Devido às pecualiaridades desta lesão e diferentes condutas propostas na literatura, o objetivo dos autores é relatar a experiência neste tipo de lesão. MÉTODO: Estudo retrospectivo, de janeiro de 1994 e dezembro de 2001, de 1370 pacientes submetidos à laparotomia devido trauma abdominal. Entre esses, 15 pacientes apresentavam lesão da veia porta. As lesões foram classificadas conforme a sua extensão e localização. RESULTADOS: O mecanismo de trauma predominante foi o penetrante. O diagnóstico da lesão foi realizado no intraoperatório. Os procedimentos executados foram: sutura, anastomose término-terminal e ligadura da veia porta. A mortalidade foi de 53,3%. CONCLUSÃO: A lesão da veia porta possui alta taxa de mortalidade e o atendimento adequado está diretamente relacionado à sobrevida.

  9. "Puffy hand syndrome".

    Science.gov (United States)

    Chouk, Mickaël; Vidon, Claire; Deveza, Elise; Verhoeven, Frank; Pelletier, Fabien; Prati, Clément; Wendling, Daniel

    2017-01-01

    Intravenous drug addiction is responsible for many complications, especially cutaneous and infectious. There is a syndrome, rarely observed in rheumatology, resulting in "puffy hands": the puffy hand syndrome. We report two cases of this condition from our rheumatologic consultation. Our two patients had intravenous drug addiction. They presented with an edema of the hands, bilateral, painless, no pitting, occurring in one of our patient during heroin intoxication, and in the other 2 years after stopping injections. In our two patients, additional investigations (biological, radiological, ultrasound) were unremarkable, which helped us, in the context, to put the diagnosis of puffy hand syndrome. The pathophysiology, still unclear, is based in part on a lymphatic toxicity of drugs and their excipients. There is no etiological treatment but elastic compression by night has improved edema of the hands in one of our patients. Copyright © 2016 Société française de rhumatologie. Published by Elsevier SAS. All rights reserved.

  10. Sonography of pathological changes in the hand

    Directory of Open Access Journals (Sweden)

    Anna Dębek

    2014-03-01

    Full Text Available Everyday medical practice shows that most common problems within the hand result from overload, injuries and degeneration. Dorsal side pathologies such as de Quervain’s and Wartenberg’s disease, intersection syndrome or degenerative lesions of carpometacarpal joint of the thumb discussed in the paper can be accurately diagnosed and differentiated by means of ultrasound examination. Ultrasound is similarly powerful in detection and grading of traumatic lesions involving extensor tendons and their sagittal bands or the flexor tendons and their pulleys. In the case of carpal tunnel syndrome one can not only visualize the median nerve but also other structures of the tunnel that may cause compression. Similarly ulnar nerve compression within the Guyon’s canal can be well evaluated. In cases of nerve trauma one can precisely define the level, and in cases of nerve discontinuity, the distance between stumps can be measured which is important in surgery planning. Often nerve trauma is a sequelae of tendon reconstruction. In such cases scars and nerve entrapment can be depicted. Tumors within a hand are usually benign, of which the most common are ganglia. On ultrasound examination a connection between a ganglion and its source (usually a joint or sheath can frequently be defined. The relationship of tumors to nerves, tendon sheaths or vessels may suggest their nature. Ultrasound with dynamic tissue assessment is a very valuable adjunct to clinical examination.

  11. Interdisciplinary trauma room management: staff-related apparative and logistic concepts in three level trauma centers in Europe

    International Nuclear Information System (INIS)

    Kroetz, M.; Linsenmaier, U.; Pfeifer, K.J.; Reiser, M.; Bode, P.J.; Haeuser, H.

    2002-01-01

    Objective. To analyse common and divergent features of staff-related, equipmental and spatial/logistical concepts of three large trauma centers of highest health care level.Methods. The health care mandate as well as the staff management, the organisational and the constructional-spacial structure of trauma room diagnostics and therapy of the trauma centers of the Universities of Leiden and Munich (Innenstadt) and the Zentralklinikum Augsburg are described. In particular the technical equipment and the process of the radiological diagnostic procedures in the trauma room are outlined.Results. Staff availability and basic technical equipment of the trauma rooms are comparable between the three hospitals. Divergent concepts exist concerning the complexity of the initial radiologic examination protocols. Spacial connection and importance of computed tomography are also discussed controversially. Urgent interventional procedures are increasingly performed within the trauma room. Magnetic-resonance-tomography does not play a role in early care from multiple injured patients.Conclusion. Trauma centers have to meet certain personnel and technical prerequisites to guarantee a temporally optimised care for multiple injured patients. Differences between the three centers concerning the logistic sequence and the radiologic examination techniques used are mainly due to variable emphasis put on CT in the initial phase of patient care. (orig.) [de

  12. Constraint Study for a Hand Exoskeleton: Human Hand Kinematics and Dynamics

    Directory of Open Access Journals (Sweden)

    Fai Chen Chen

    2013-01-01

    Full Text Available In the last few years, the number of projects studying the human hand from the robotic point of view has increased rapidly, due to the growing interest in academic and industrial applications. Nevertheless, the complexity of the human hand given its large number of degrees of freedom (DoF within a significantly reduced space requires an exhaustive analysis, before proposing any applications. The aim of this paper is to provide a complete summary of the kinematic and dynamic characteristics of the human hand as a preliminary step towards the development of hand devices such as prosthetic/robotic hands and exoskeletons imitating the human hand shape and functionality. A collection of data and constraints relevant to hand movements is presented, and the direct and inverse kinematics are solved for all the fingers as well as the dynamics; anthropometric data and dynamics equations allow performing simulations to understand the behavior of the finger.

  13. Childhood trauma and compulsive buying.

    Science.gov (United States)

    Sansone, Randy A; Chang, Joy; Jewell, Bryan; Rock, Rachel

    2013-02-01

    Childhood trauma has been empirically associated with various types of self-regulatory difficulties in adulthood. However, according to the extant literature, no study has examined relationships between various types of childhood trauma and compulsive buying behavior in adulthood. Using a self-report survey methodology in a cross-sectional consecutive sample of 370 obstetrics/gynecology patients, we examined five types of childhood trauma before the age of 12 years (i.e. witnessing violence, physical neglect, emotional abuse, physical abuse, sexual abuse) in relationship to compulsive buying as assessed by the Compulsive Buying Scale (CBS). All forms of trauma demonstrated statistically significant correlations with the CBS. Using a linear regression analysis, both witnessing violence and emotional abuse significantly contributed to CBS scores. Further analyses indicated that race did not moderate the relationship between childhood trauma and compulsive buying. Findings indicate that various forms of childhood trauma are correlated with compulsive buying behavior, particularly witnessing violence and emotional abuse.

  14. Grip Strength Survey Based on Hand Tool Usage

    Directory of Open Access Journals (Sweden)

    Erman ÇAKIT

    2016-12-01

    Full Text Available Hand grip strength is broadly used for performing tasks involving equipment in production and processing activities. Most professionals in this field rely on grip strength to perform their tasks. There were three main aims of this study: i determining various hand grip strength measurements for the group of hand tool users, ii investigating the effects of height, weight, age, hand dominance, body mass index, previous Cumulative Trauma Disorder (CTD diagnosis, and hand tool usage experience on hand grip strength, and iii comparing the obtained results with existing data for other populations. The study groups comprised 71 healthy male facility workers. The values of subjects’ ages was observed between 26 and 74 years. The data were statistically analyzed to assess the normality of data and the percentile values of grip strength. The results of this study demonstrate that there were no significance differences noted between dominant and non-dominant hands. However, there were highly significant differences between the CTD group and the other group. Hand grip strength for the dominant hand was positively correlated to height, weight, and body mass index, and negatively correlated to age and tool usage experience. Hand dominance, height, weight, body mass index, age and tool usage experience should be considered when establishing normal values for grip strength.

  15. Trauma Systems. An Era of Development

    NARCIS (Netherlands)

    Lansink, K.W.W.

    2017-01-01

    The introduction of an inclusive trauma system in the Netherlands during last decade of the past century, has led to an improvement in Dutch trauma care. Eleven trauma regions were formed nationwide each surrounding a level I trauma center. All hospitals in a trauma region were assigned levels I, II

  16. (In)Visible Hand(s)

    OpenAIRE

    Predrag Zima

    2007-01-01

    In this paper, the author discusses the regulatory role of the state and legal norms, in market economy, especially in so-called transition countries. Legal policy, and other questions of the state and free market economy are here closely connected, because the state must ensure with legal norms that economic processes are not interrupted: only the state can establish the legal basis for a market economy. The free market’s invisible hand is acting in questions such as: what is to be produced,...

  17. Trauma and the endocrine system.

    Science.gov (United States)

    Mesquita, Joana; Varela, Ana; Medina, José Luís

    2010-12-01

    The endocrine system may be the target of different types of trauma with varied consequences. The present article discusses trauma of the hypothalamic-pituitary axes, adrenal glands, gonads, and pancreas. In addition to changes in circulating hormone levels due to direct injury to these structures, there may be an endocrine response in the context of the stress caused by the trauma. Copyright © 2010 SEEN. Published by Elsevier Espana. All rights reserved.

  18. Trauma Studies: prospettive e problemi

    Directory of Open Access Journals (Sweden)

    Rachele Branchini

    2013-12-01

    Full Text Available The trauma paradigm pervades contemporary life. In newspapers, on television, on the web, even in ordinary conversation, experiences of every kind (both figurative and positive ones are described as “traumatic”. Thus the very meaning of the term is often overturned. This article seeks to reshape the limits of the concept of trauma by tracing its evolution from the psychological debate of the early nineteenth century to the recent setting up of the specific discipline of Trauma Studies.

  19. Prevention of hand eczema

    DEFF Research Database (Denmark)

    Fisker, Maja H; Ebbehøj, Niels E; Vejlstrup, Søren Grove

    2018-01-01

    Objective Occupational hand eczema has adverse health and socioeconomic impacts for the afflicted individuals and society. Prevention and treatment strategies are needed. This study aimed to assess the effectiveness of an educational intervention on sickness absence, quality of life and severity...... of hand eczema. Methods PREVEX (PreVention of EXema) is an individually randomized, parallel-group superiority trial investigating the pros and cons of one-time, 2-hour, group-based education in skin-protective behavior versus treatment as usual among patients with newly notified occupational hand eczema...

  20. The value of trauma registries.

    Science.gov (United States)

    Moore, Lynne; Clark, David E

    2008-06-01

    Trauma registries are databases that document acute care delivered to patients hospitalised with injuries. They are designed to provide information that can be used to improve the efficiency and quality of trauma care. Indeed, the combination of trauma registry data at regional or national levels can produce very large databases that allow unprecedented opportunities for the evaluation of patient outcomes and inter-hospital comparisons. However, the creation and upkeep of trauma registries requires a substantial investment of money, time and effort, data quality is an important challenge and aggregated trauma data sets rarely represent a population-based sample of trauma. In addition, trauma hospitalisations are already routinely documented in administrative hospital discharge databases. The present review aims to provide evidence that trauma registry data can be used to improve the care dispensed to victims of injury in ways that could not be achieved with information from administrative databases alone. In addition, we will define the structure and purpose of contemporary trauma registries, acknowledge their limitations, and discuss possible ways to make them more useful.

  1. Vascular changes of the hand in professional baseball players with emphasis on digital ischemia in catchers.

    Science.gov (United States)

    Ginn, T Adam; Smith, Adam M; Snyder, Jon R; Koman, L Andrew; Smith, Beth P; Rushing, Julia

    2005-07-01

    Repetitive trauma to the hand is a concern for baseball players. The present study investigated the effects of repetitive trauma and the prevalence of microvascular pathological changes in the hands of minor league professional baseball players. In contrast to previous investigators, we documented the presence of abnormalities in younger, asymptomatic individuals. Thirty-six baseball players on active minor league rosters underwent a history and physical examination of both hands as well as additional specialized tests, including Doppler ultrasound, a timed Allen test, determination of digital brachial pressure indices, and ring sizing of fingers. Data were compared between gloved hands and throwing hands, hitters and nonhitters, and players at four different positions (catcher [nine subjects], outfielder [seven subjects], infielder [five subjects], and pitcher [fifteen subjects]). Digital brachial indices in the ring fingers of the gloved (p healthy professional baseball players in all positions, with a significantly higher prevalence in catchers, prior to the development of clinically important ischemia. Repetitive trauma resulting from the impact of the baseball also leads to digital hypertrophy in the index finger of the gloved hand of catchers. Gloves currently used by professional catchers do not adequately protect the hand from repetitive trauma.

  2. Clean Hands Count

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  5. Tropical Diabetic Hand Syndrome

    African Journals Online (AJOL)

    2015 Annals of Medical and Health Sciences Research | Published by Wolters Kluwer - Medknow. 473. Introduction ... diabetes.[2,3] Tropical diabetic hand syndrome is a terminology .... the importance of seeking medical attention immediately.

  6. Clean Hands Count

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    Full Text Available ... now. Please try again later. Published on May 5, 2017 This video for healthcare providers is intended ... 36 Wash 'Em - Hand Hygiene Music Video - Duration: 5:46. Jefferson Health 413,702 views 5:46 ...

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    Full Text Available ... reminding healthcare providers to clean their hands. See: https://www.cdc.gov/handhygiene/campa... . Comments on this ... are allowed in accordance with our comment policy: http://www.cdc.gov/SocialMedia/Tools/... This video can ...

  8. Clean Hands Count

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    Full Text Available ... empower patients to play a role in their care by asking or reminding healthcare providers to clean ... It's in your hands - prevent sepsis in health care' A 5 May 2018 advocacy message from WHO - ...

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    Full Text Available ... Published on May 5, 2017 This video for healthcare providers is intended to promote or encourage adherence ... role in their care by asking or reminding healthcare providers to clean their hands. See: https://www. ...

  13. Trauma und Terror

    OpenAIRE

    Szyszkowitz, T. (Tessa)

    2007-01-01

    1. Einleitung Ausgehend von der Fragestellung, warum gerade bei Tschetschenen und Palästinensern der Selbstmordterrorismus in den letzten Jahren so populär geworden ist, analysiert die Autorin die Geschichte dieser beiden Völker. Einer der Gründe ist bisher wenig beachtet worden. Der Einfluss eines kollektiven Traumas, das als solches nicht anerkannt, behandelt und auch nicht einer politischen Lösung zugeführt wurde. 2. Geschichte der Palästinenser und Tschetschenen Im Zuge der Err...

  14. Management of liver trauma

    Directory of Open Access Journals (Sweden)

    Hanan M Alghamdi

    2017-01-01

    Full Text Available In the last 30 years, the management of liver injury has evolved significantly. The advancement of imaging studies has played an important role in the conservative approach for management. A shift from operative to nonoperative management for most hemodynamically stable patients with hepatic injury has been prompted by speed and sensitivity of diagnostic imaging and by advances in critical care monitoring. In this review article, the up-to-date recommendation on the management approach of liver trauma will be discussed.

  15. Circuit For Control Of Electromechanical Prosthetic Hand

    Science.gov (United States)

    Bozeman, Richard J., Jr.

    1995-01-01

    Proposed circuit for control of electromechanical prosthetic hand derives electrical control signals from shoulder movements. Updated, electronic version of prosthesis, that includes two hooklike fingers actuated via cables from shoulder harness. Circuit built around favored shoulder harness, provides more dexterous movement, without incurring complexity of computer-controlled "bionic" or hydraulically actuated devices. Additional harness and potentiometer connected to similar control circuit mounted on other shoulder. Used to control stepping motor rotating hand about prosthetic wrist to one of number of angles consistent with number of digital outputs. Finger-control signals developed by circuit connected to first shoulder harness transmitted to prosthetic hand via sliprings at prosthetic wrist joint.

  16. Bridging Body and Mind: Considerations for Trauma-Informed Yoga.

    Science.gov (United States)

    Justice, Lauren; Brems, Christiane; Ehlers, Karrie

    2018-02-08

    Individuals who suffer from trauma-related symptoms are a unique population that could benefit from the mind-body practice of yoga-or have their symptoms reactivated by it, depending on the type of yoga. Trauma-informed yoga (TIY), that is, yoga adapted to the unique needs of individuals working to overcome trauma, may ameliorate symptoms by creating a safe, tailored practice for students to learn how to respond, rather than react, to symptoms and circumstances. Yoga not thus adapted, on the other hand, may increase reactivity and activate symptoms such as hyperarousal or dissociation. This article reports on expert input about adapting yoga for individuals with trauma, with special considerations for military populations. Eleven experts, recruited based on literature review and referrals, were interviewed in person or via telephone and asked seven questions about trauma-informed yoga. Verbatim transcripts were subjected to open-coding thematic analysis and a priori themes. Findings revealed that TIY needs to emphasize beneficial practices (e.g., diaphragmatic breath and restorative postures), consider contraindications (e.g., avoiding sequences that overly engage the sympathetic nervous system), adapt to limitations and challenges for teaching in unconventional settings (e.g., prisons, VA hospitals), and provide specialized training and preparation (e.g., specialized TIY certifications, self-care of instructors/therapists, adaptions for student needs). TIY for veterans must additionally consider gender- and culture-related barriers, differing relationships to pain and injury, and medication as a barrier to practice.

  17. Hands of early primates.

    Science.gov (United States)

    Boyer, Doug M; Yapuncich, Gabriel S; Chester, Stephen G B; Bloch, Jonathan I; Godinot, Marc

    2013-12-01

    Questions surrounding the origin and early evolution of primates continue to be the subject of debate. Though anatomy of the skull and inferred dietary shifts are often the focus, detailed studies of postcrania and inferred locomotor capabilities can also provide crucial data that advance understanding of transitions in early primate evolution. In particular, the hand skeleton includes characteristics thought to reflect foraging, locomotion, and posture. Here we review what is known about the early evolution of primate hands from a comparative perspective that incorporates data from the fossil record. Additionally, we provide new comparative data and documentation of skeletal morphology for Paleogene plesiadapiforms, notharctines, cercamoniines, adapines, and omomyiforms. Finally, we discuss implications of these data for understanding locomotor transitions during the origin and early evolutionary history of primates. Known plesiadapiform species cannot be differentiated from extant primates based on either intrinsic hand proportions or hand-to-body size proportions. Nonetheless, the presence of claws and a different metacarpophalangeal [corrected] joint form in plesiadapiforms indicate different grasping mechanics. Notharctines and cercamoniines have intrinsic hand proportions with extremely elongated proximal phalanges and digit rays relative to metacarpals, resembling tarsiers and galagos. But their hand-to-body size proportions are typical of many extant primates (unlike those of tarsiers, and possibly Teilhardina, which have extremely large hands). Non-adapine adapiforms and omomyids exhibit additional carpal features suggesting more limited dorsiflexion, greater ulnar deviation, and a more habitually divergent pollex than observed plesiadapiforms. Together, features differentiating adapiforms and omomyiforms from plesiadapiforms indicate increased reliance on vertical prehensile-clinging and grasp-leaping, possibly in combination with predatory behaviors in

  18. Management of Colorectal Trauma

    Science.gov (United States)

    2011-01-01

    Although the treatment strategy for colorectal trauma has advanced during the last part of the twentieth century and the result has improved, compared to other injuries, problems, such as high septic complication rates and mortality rates, still exist, so standard management for colorectal trauma is still a controversial issue. For that reason, we designed this article to address current recommendations for management of colorectal injuries based on a review of literature. According to the reviewed data, although sufficient evidence exists for primary repair being the treatment of choice in most cases of nondestructive colon injuries, many surgeons are still concerned about anastomotic leakage or failure, and prefer to perform a diverting colostomy. Recently, some reports have shown that primary repair or resection and anastomosis, is better than a diverting colostomy even in cases of destructive colon injuries, but it has not fully established as the standard treatment. The same guideline as that for colonic injury is applied in cases of intraperitoneal rectal injuries, and, diversion, primary repair, and presacral drainage are regarded as the standards for the management of extraperitoneal rectal injuries. However, some reports state that primary repair without a diverting colostomy has benefit in the treatment of extraperitoneal rectal injury, and presacral drainage is still controversial. In conclusion, ideally an individual management strategy would be developed for each patient suffering from colorectal injury. To do this, an evidence-based treatment plan should be carefully developed. PMID:21980586

  19. Urinary tract trauma

    Energy Technology Data Exchange (ETDEWEB)

    Campbell, J.E. (Sunnybrook Medical Centre, Toronto, Ontario (Canada))

    1983-09-01

    From a practical point of view, a woman who has blunt injury to the pelvic area with hematuria from the lower urinary tract, has a contused or ruptured bladder. In a man, such a situation calls for retrograde urethrography to determine if the injury is in the urethra or the bladder because the two organs are investigated differently. In both sexes, such injuries are usually associated with pelvic fractures. Massive bladder displacement and severe hemorrhage should alert one to the need for pelvic angiography to find and embolize the bleeding site within the first 24 hours after injury. For blunt trauma to the upper urinary tract an intravenous urogram with tomography is still the main examination. However, a normal intravenous urogram does not exclude serious injury. Therefore, if signs or symptoms persist, a computerized tomographic (CT) examination should be performed if available. Otherwise, a radionuclide study is advisable. Non-excretion on intravenous urography with tomography calls for selective renal arteriography to delineate the etiology. There can be serious renal trauma in the absence of hematuria, which may occur with renal pedicle injury or avulsion of the ureter. Minor forniceal ruptures may occasionally mask severe posterior renal lacerations.

  20. [Cervical spine trauma].

    Science.gov (United States)

    Yilmaz, U; Hellen, P

    2016-08-01

    In the emergency department 65 % of spinal injuries and 2-5 % of blunt force injuries involve the cervical spine. Of these injuries approximately 50 % involve C5 and/or C6 and 30 % involve C2. Older patients tend to have higher spinal injuries and younger patients tend to have lower injuries. The anatomical and development-related characteristics of the pediatric spine as well as degenerative and comorbid pathological changes of the spine in the elderly can make the radiological evaluation of spinal injuries difficult with respect to possible trauma sequelae in young and old patients. Two different North American studies have investigated clinical criteria to rule out cervical spine injuries with sufficient certainty and without using imaging. Imaging of cervical trauma should be performed when injuries cannot be clinically excluded according to evidence-based criteria. Degenerative changes and anatomical differences have to be taken into account in the evaluation of imaging of elderly and pediatric patients.

  1. Practical X-ray diagnostics orthopedics and trauma surgery. Indication, adjustment technique and radiation protection

    International Nuclear Information System (INIS)

    Flechtenmacher, Johannes; Sabo, Desiderius

    2014-01-01

    The book on X-ray diagnostics in orthopedics and trauma surgery includes the following chapters: 1. Introduction: radiation protection, equipment technology radiological diagnostics of skeleton carcinomas, specific aspects of trauma surgery, special aspects of skeleton radiology for children. 2. X-ray diagnostics of different anatomical regions: ankle joint, knee, hips and pelvis, hand and wrist joint, elbow, shoulder, spinal cord. 3. Appendix: radiation protection according to the X-ray regulations.

  2. Computed tomography in facial trauma

    International Nuclear Information System (INIS)

    Zilkha, A.

    1982-01-01

    Computed tomography (CT), plain radiography, and conventional tomography were performed on 30 patients with facial trauma. CT demonstrated bone and soft-tissue involvement. In all cases, CT was superior to tomography in the assessment of facial injury. It is suggested that CT follow plain radiography in the evaluation of facial trauma

  3. Spinal trauma. An imaging approach

    International Nuclear Information System (INIS)

    Cassar-Pullicino, V.N.; Imhof, H.

    2006-01-01

    The diagnosis of trauma to the spine - where the slightest oversight may have catastrophic results - requires a thorough grasp of the spectrum of resultant pathology as well as the imaging modalities used in making an accurate diagnosis. In Spinal Trauma, the internationally renowned team of experts provides a comprehensive, cutting-edge exposition of the current vital role of imaging in the diagnosis and treatment of injuries to the axial skeleton. Beginning with a valuable clinical perspective of spinal trauma, the book offers the reader a unique overview of the biomechanics underlying the pathology of cervical trauma. Acute trauma topics include: - Optimization of imaging modalities - Malalignment - signs and significance - Vertebral fractures - detection and implications - Classification of thoraco-lumbar fractures - rationale and relevance - Neurovascular injury. Distilling decades of clinical and teaching expertise, the contributors further discuss the current role of imaging in special focus topics, which include: - The pediatric spine - Sports injuries - The rigid spine - Trauma in the elderly - Vertebral collapse, benign and malignant - Spinal trauma therapy - Vertebral fractures and osteoporosis - Neuropathic spine. All throughout the book, the focus is on understanding the injury, and its implications and complications, through 'an imaging approach'. Lavishly illustrated with hundreds of superb MR images and CT scans, and clear full-color drawings, the authors conclude with a look into the future, defining clinical trends and research directions. Spinal Trauma - with its broad scope, practical imaging approach, and current focus - is designed to enhance confidence and accuracy, making it essential reading for clinicians and radiologists at all levels. (orig.)

  4. Bone scintigraphy in children: trauma

    International Nuclear Information System (INIS)

    Harcke, H.T.

    1983-01-01

    The sensitivity of radionuclide imaging in identifying skeletal trauma in children has been established. Growth plates present a set of problems unique to pediatric studies and diagnotic accuracy is very technique dependent. Imaging for sports injuries and suspected child abuse has been productive. An expanding role for bone scintigraphy in the management of orthopedic problems post-trauma is developing [fr

  5. Waterless Hand Rub Versus Traditional Hand Scrub Methods for Preventing the Surgical Site Infection in Orthopedic Surgery.

    Science.gov (United States)

    Iwakiri, Kentaro; Kobayashi, Akio; Seki, Masahiko; Ando, Yoshiyuki; Tsujio, Tadao; Hoshino, Masatoshi; Nakamura, Hiroaki

    2017-11-15

    MINI: Fourteen hundred consecutive patients were investigated for evaluating the utility of waterless hand rub before orthopaedic surgery. The risk in the surgical site infection incidence was the same, but costs of liquids used for hand hygiene were cheaper and the hand hygiene time was shorter for waterless protocol, compared with traditional hand scrub. A retrospective cohort study with prospectively collected data. The aim of this study was to compare SSI incidences, the cost of hand hygiene agents, and hand hygiene time between the traditional hand scrub and the waterless hand rub protocols before orthopedic surgery. Surgical site infections (SSI) prolong hospitalization and are a leading nosocomial cause of morbidity and a source of excess cost. Recently, a waterless hand rub protocol comprising alcohol based chlorhexidine gluconate for use before surgery was developed, but no studies have yet examined its utility in orthopedic surgery. Fourteen hundred consecutive patients who underwent orthopedic surgery (spine, joint replacement, hand, and trauma surgeries) in our hospital since April 1, 2012 were included. A total of 712 cases underwent following traditional hand scrub between April 1, 2012 and April 30, 2013 and 688 cases underwent following waterless hand rub between June 1, 2013 and April 30, 2014. We compared SSI incidences within all and each subcategory between two hand hygiene protocols. All patients were screened for SSI within 1 year after surgery. We compared the cost of hand hygiene agents and hand hygiene time between two groups. The SSI incidences were 1.3% (9 of 712) following the traditional protocol (2 deep and 7 superficial infections) and 1.1% (8 of 688) following the waterless protocol (all superficial infections). There were no significant differences between the two groups. The costs of liquids used for one hand hygiene were about $2 for traditional hand scrub and less than $1 for waterless hand rub. The mean hand hygiene time was 264

  6. Trauma and Memory in Magical Realism: Eden Robinson’s Monkey Beach as Trauma Narrative

    Directory of Open Access Journals (Sweden)

    Anja Mrak

    2013-06-01

    Full Text Available The fundamental characteristic of magical realism is its duality, which enables alternative representations of society and history. Its specific narrative devices make magical realism a viable form for rendering traumatic experience and memories. Monkey Beach (2000 by Eden Robinson, a member of the Haisla and Heiltsuk First Nations in Canada, is a repository of memories, triggered and fuelled by trauma. Fragmented temporality, mixing of discourses, shifts in focalization, wordplays, repetition, and the magical are some of the devices the novel uses to address the complex landscape of trauma and memory. By unveiling personal memories, Monkey Beach gives way to the unconscious to enter the narrative structure, gradually revealing a much larger issue of the mistreatment of the Haisla people in Canada—and the resulting collective trauma. As trauma cannot be integrated into the narrative, it can only be uncovered indirectly and through a double distancing: firstly through the techniques of magical realism, and secondly, through the seemingly detached point of view of the narrator, who ultimately realises that her life is also encumbered with the dark stain of colonialism.

  7. Skull wounds linked with blunt trauma (hammer example). A report of two depressed skull fractures--elements of biomechanical explanation.

    Science.gov (United States)

    Delannoy, Yann; Becart, Anne; Colard, Thomas; Delille, Rémi; Tournel, Gilles; Hedouin, Valéry; Gosset, Didier

    2012-09-01

    The lesions of the skull following perforating traumas can create complex fractures. The blunt traumas can, according to the swiftness and the shape of the object used, create a depressed fracture. The authors describe through two clinical cases the lesional characteristic of the blunt traumas, perforating the skull using a hammer. In both cases the cranial lesions were very typical: they were geometrical, square shaped, of the same size than the tool (head and tip of the hammer). On the outer table of the skull, the edges of the wounds were sharp and regular. On the inner table, the edges of the wounds were beveled and irregular. The bony penetration in the depressed fracture results from a rupture of the outer table of the bone under tension, in periphery, by the bend of the bone to the impact (outbending) and then, from the inner table with comminuted bony fragmentation. Breeding on the fractures of the size and the shape of the blunt objects used is inconstant and differs, that it is the objects of flat surface or wide in opposition to those of small surface area. Fractures morphologies depend on one hand on these extrinsic factors and on the other hand, of intrinsic factors (structure of the bone). To identify them, we had previously conducted experimental work on cranial bone samples. The bone was submitted to a device for three-point bending. This work had shown properties of thickness and stiffness of the various areas of the vault. Our cases are consistent with these results and illustrate the variability of bone lesions according to region and mode of use of blunt weapons. Many studies have identified criteria for identification of the weapons and the assistance of digital and biomechanical models will be an invaluable contribution with this aim in the future. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  8. [Hand injuries in the ready-made clothing industry].

    Science.gov (United States)

    Khelil, E; Hichem, C; Saïd, B; Moez, B; Mahdi, D; Lamjed, T; Hichem, B

    1999-11-01

    We collect during 1997, 30 work accidents in the ready-wade clothe sector. These accidents have concerned 28 females and 2 males with a mean age of 21 years. Injury affect predominatly the left hand (17 patients) and the finger of pince. Severity of the lesions was variable according to the traumatic cause. In the distal fingers trauma, skin cicatrisation have been observed after 21 days and bone consolidation within 45 days.

  9. The sequential pathway between trauma-related symptom severity and cognitive-based smoking processes through perceived stress and negative affect reduction expectancies among trauma exposed smokers.

    Science.gov (United States)

    Garey, Lorra; Cheema, Mina K; Otal, Tanveer K; Schmidt, Norman B; Neighbors, Clayton; Zvolensky, Michael J

    2016-10-01

    Smoking rates are markedly higher among trauma-exposed individuals relative to non-trauma-exposed individuals. Extant work suggests that both perceived stress and negative affect reduction smoking expectancies are independent mechanisms that link trauma-related symptoms and smoking. Yet, no work has examined perceived stress and negative affect reduction smoking expectancies as potential explanatory variables for the relation between trauma-related symptom severity and smoking in a sequential pathway model. Methods The present study utilized a sample of treatment-seeking, trauma-exposed smokers (n = 363; 49.0% female) to examine perceived stress and negative affect reduction expectancies for smoking as potential sequential explanatory variables linking trauma-related symptom severity and nicotine dependence, perceived barriers to smoking cessation, and severity of withdrawal-related problems and symptoms during past quit attempts. As hypothesized, perceived stress and negative affect reduction expectancies had a significant sequential indirect effect on trauma-related symptom severity and criterion variables. Findings further elucidate the complex pathways through which trauma-related symptoms contribute to smoking behavior and cognitions, and highlight the importance of addressing perceived stress and negative affect reduction expectancies in smoking cessation programs among trauma-exposed individuals. (Am J Addict 2016;25:565-572). © 2016 American Academy of Addiction Psychiatry.

  10. Hand eczema: An update

    Directory of Open Access Journals (Sweden)

    Chembolli Lakshmi

    2012-01-01

    Full Text Available Eczema, the commonest disorders afflicting the hands, is also the commonest occupational skin disease (OSD. In the dermatology outpatient departments, only the severe cases are diagnosed since patients rarely report with early hand dermatitis. Mild forms are picked up only during occupational screening. Hand eczema (HE can evolve into a chronic condition with persistent disease even after avoiding contact with the incriminated allergen / irritant. The important risk factors for hand eczema are atopy (especially the presence of dermatitis, wet work, and contact allergy. The higher prevalence in women as compared to men in most studies is related to environmental factors and is mainly applicable to younger women in their twenties. Preventive measures play a very important role in therapy as they enable the affected individuals to retain their employment and livelihood. This article reviews established preventive and therapeutic options and newer drugs like alitretinoin in hand eczema with a mention on the etiology and morphology. Identifying the etiological factors is of paramount importance as avoiding or minimizing these factors play an important role in treatment.

  11. Prehospital Trauma Care in Singapore.

    Science.gov (United States)

    Ho, Andrew Fu Wah; Chew, David; Wong, Ting Hway; Ng, Yih Yng; Pek, Pin Pin; Lim, Swee Han; Anantharaman, Venkataraman; Hock Ong, Marcus Eng

    2015-01-01

    Prehospital emergency care in Singapore has taken shape over almost a century. What began as a hospital-based ambulance service intended to ferry medical cases was later complemented by an ambulance service under the Singapore Fire Brigade to transport trauma cases. The two ambulance services would later combine and come under the Singapore Civil Defence Force. The development of prehospital care systems in island city-state Singapore faces unique challenges as a result of its land area and population density. This article defines aspects of prehospital trauma care in Singapore. It outlines key historical milestones and current initiatives in service, training, and research. It makes propositions for the future direction of trauma care in Singapore. The progress Singapore has made given her circumstances may serve as lessons for the future development of prehospital trauma systems in similar environments. Key words: Singapore; trauma; prehospital emergency care; emergency medical services.

  12. Psychiatric diagnoses, trauma, and suicidiality

    Directory of Open Access Journals (Sweden)

    Elklit Ask

    2007-04-01

    Full Text Available Abstract Background This study aimed to examine the associations between psychiatric diagnoses, trauma and suicidiality in psychiatric patients at intake. Methods During two months, all consecutive patients (n = 139 in a psychiatric hospital in Western Norway were interviewed (response rate 72%. Results Ninety-one percent had been exposed to at least one trauma; 69 percent had been repeatedly exposed to trauma for longer periods of time. Only 7% acquired a PTSD diagnosis. The comorbidity of PTSD and other psychiatric diagnoses were 78%. A number of diagnoses were associated with specific traumas. Sixty-seven percent of the patients reported suicidal thoughts in the month prior to intake; thirty-one percent had attempted suicide in the preceding week. Suicidal ideation, self-harming behaviour, and suicide attempts were associated with specific traumas. Conclusion Traumatised patients appear to be under- or misdiagnosed which could have an impact on the efficiency of treatment.

  13. An interpretation of Babette's Feast as a parable of trauma.

    Science.gov (United States)

    Waldron, Sharn

    2010-09-01

    In this paper I use the film Babette's Feast as a parable to portray the impasse that often arises out of the experience of complex trauma. The experience of such trauma invokes a crisis of reality. It overflows the boundaries of rational containment. There are no mechanisms with which to apprehend such an event, and consequently it cannot be comprehended; because it cannot be comprehended it cannot be processed. The film Babette's Feast encapsulates the predicament of the individual ensnared in the web of trauma. Although removed from the location and events of her trauma, Babette remains the resident of an austere and colourless environment, her gifts repressed, her brilliance unseen. Healing comes to Babette through her willingness to revisit her true self, a self that has been crushed under the weight of grief and trauma. This revisiting costs her all she has. Yet, it is in this revisiting that she not only frees herself from the austerity of her environment but also engenders purpose and hope within the community who have taken her in. The dissonance of her life is paralleled by the dissonance of the life of the community in which she lives; it is the harmonizing of these dissonances which cannot be spoken that finally gives articulation to the incoherence of Babette's trauma. © 2010, The Society of Analytical Psychology.

  14. High resolution CT of temporal bone trauma

    International Nuclear Information System (INIS)

    Youn, Eun Kyung

    1986-01-01

    Radiographic studies of the temporal bone following head trauma are indicated when there is cerebrospinal fluid otorrhea or rhinorrhoea, hearing loss, or facial nerve paralysis. Plain radiography displays only 17-30% of temporal bone fractures and pluridirectional tomography is both difficult to perform, particularly in the acutely ill patient, and less satisfactory for the demonstration of fine fractures. Consequently, high resolution CT is the imaging method of choice for the investigation of suspected temporal bone trauma and allows special resolution of fine bony detail comparable to that attainable by conventional tomography. Eight cases of temporal bone trauma examined at Korea General Hospital April 1985 through May 1986. The results were as follows: Seven patients (87%) suffered longitudinal fractures. In 6 patients who had purely conductive hearing loss, CT revealed various ossicular chain abnormality. In one patient who had neuro sensory hearing loss, CT demonstrated intract ossicular with a fracture nearing lateral wall of the lateral semicircular canal. In one patient who had mixed hearing loss, CT showed complex fracture.

  15. Hand-arm vibration syndrome: A rarely seen diagnosis.

    Science.gov (United States)

    Campbell, Rebecca A; Janko, Matthew R; Hacker, Robert I

    2017-06-01

    Hand-arm vibration syndrome (HAVS) is a collection of sensory, vascular, and musculoskeletal symptoms caused by repetitive trauma from vibration. This case report demonstrates how to diagnose HAVS on the basis of history, physical examination, and vascular imaging and its treatment options. A 41-year-old man who regularly used vibrating tools presented with nonhealing wounds on his right thumb and third digit. Arteriography revealed occlusions of multiple arteries in his hand with formation of collaterals. We diagnosed HAVS, and his wounds healed after several weeks with appropriate treatment. HAVS is a debilitating condition with often irreversible vascular damage, requiring early diagnosis and treatment.

  16. Hand-arm vibration syndrome: A rarely seen diagnosis

    Directory of Open Access Journals (Sweden)

    Rebecca A. Campbell, BA

    2017-06-01

    Full Text Available Hand-arm vibration syndrome (HAVS is a collection of sensory, vascular, and musculoskeletal symptoms caused by repetitive trauma from vibration. This case report demonstrates how to diagnose HAVS on the basis of history, physical examination, and vascular imaging and its treatment options. A 41-year-old man who regularly used vibrating tools presented with nonhealing wounds on his right thumb and third digit. Arteriography revealed occlusions of multiple arteries in his hand with formation of collaterals. We diagnosed HAVS, and his wounds healed after several weeks with appropriate treatment. HAVS is a debilitating condition with often irreversible vascular damage, requiring early diagnosis and treatment.

  17. Sensing human hand motions for controlling dexterous robots

    Science.gov (United States)

    Marcus, Beth A.; Churchill, Philip J.; Little, Arthur D.

    1988-01-01

    The Dexterous Hand Master (DHM) system is designed to control dexterous robot hands such as the UTAH/MIT and Stanford/JPL hands. It is the first commercially available device which makes it possible to accurately and confortably track the complex motion of the human finger joints. The DHM is adaptable to a wide variety of human hand sizes and shapes, throughout their full range of motion.

  18. Hand Hygiene: When and How

    Science.gov (United States)

    Hand Hygiene When and How August 2009 How to handrub? How to handwash? RUB HANDS FOR HAND HYGIENE! WASH HANDS WHEN VISIBLY SOILED Duration of the ... its use. When? YOUR 5 MOMENTS FOR HAND HYGIENE 1 BEFORETOUCHINGA PATIENT 2 B P ECFLOER R ...

  19. Radiology of trauma to kidney and lower urinary tract

    International Nuclear Information System (INIS)

    Dorph, S.

    1995-01-01

    The contents are trauma to kidney, imaging of kidney trauma, management of renal trauma, delayed complications, trauma to the lower urinary tract, trauma to urinary bladder, radiologic diagnosis, ethiology of blunt bladder injury, urethal injury (6 refs.)

  20. Radiology of trauma to kidney and lower urinary tract

    Energy Technology Data Exchange (ETDEWEB)

    Dorph, S [Herlev University Hospital, Copenhagen (Denmark). Dept. of Radiology

    1996-12-31

    The contents are trauma to kidney, imaging of kidney trauma, management of renal trauma, delayed complications, trauma to the lower urinary tract, trauma to urinary bladder, radiologic diagnosis, ethiology of blunt bladder injury, urethal injury (6 refs.).

  1. Penetrating abdominal trauma.

    Science.gov (United States)

    Henneman, P L

    1989-08-01

    The management of patients with penetrating abdominal trauma is outlined in Figure 1. Patients with hemodynamic instability, evisceration, significant gastrointestinal bleeding, peritoneal signs, gunshot wounds with peritoneal violation, and type 2 and 3 shotgun wounds should undergo emergency laparotomy. The initial ED management of these patients includes airway management, monitoring of cardiac rhythm and vital signs, history, physical examination, and placement of intravenous lines. Blood should be obtained for initial hematocrit, type and cross-matching, electrolytes, and an alcohol level or drug screen as needed. Initial resuscitation should utilize crystalloid fluid replacement. If more than 2 liters of crystalloid are needed to stabilize an adult (less in a child), blood should be given. Group O Rh-negative packed red blood cells should be immediately available for a patient in impending arrest or massive hemorrhage. Type-specific blood should be available within 15 minutes. A patient with penetrating thoracic and high abdominal trauma should receive a portable chest x-ray, and a hemo- or pneumothorax should be treated with tube thoracostomy. An unstable patient with clinical signs consistent with a pneumothorax, however, should receive a tube thoracostomy prior to obtaining roentgenographic confirmation. If time permits, a nasogastric tube and Foley catheter should be placed, and the urine evaluated for blood (these procedures can be performed in the operating room). If kidney involvement is suspected because of hematuria or penetrating trauma in the area of a kidney or ureter in a patient requiring surgery, a single-shot IVP should be performed either in the ED or the operating room. An ECG is important in patients with possible cardiac involvement and in patients over the age of 40 going to the operating room. Tetanus status should be updated, and appropriate antibiotics covering bowel flora should be given. Operative management should rarely be delayed

  2. Trauma cardiaco cerrado

    Directory of Open Access Journals (Sweden)

    Camilo Alvarado

    2016-01-01

    Full Text Available El trauma cardiaco constituye una de las primeras causas de mortalidad en la población general. Requiere alto índice de sospecha en trauma cerrado severo, mecanismo de desaceleración y en presencia de signos indirectos como: equimosis, huella del volante o del cinturón en el tórax anterior. Las lesiones incluyen: conmoción cardiaca, ruptura cardiaca, lesión cardiaca indirecta como la trombosis coronaria aguda, lesión aórtica, lesión del pericardio y herniación cardiaca. Entre las manifestaciones clínicas están: la angina refractaria a nitratos, el dolor pleurítico, la hipotensión arterial, la taquicardia, la ingurgitación yugular que aumenta con la inspiración, el galope por tercer ruido, el frote pericárdico, los soplos de reciente aparición, los estertores crepitantes por edema pulmonar. El electrocardiograma es el primer eslabón en el algoritmo diagnóstico con hallazgos como: la taquicardia sinusal, los complejos ventriculares prematuros, la fibrilación auricular, el bloqueo de rama derecha y los bloqueos auriculoventriculares. La radiografía de tórax ayuda a descartar lesiones adicionales óseas y pulmonares. La troponina I tiene un valor predictivo negativo del 93% para el trauma cardiaco, otras enzimas como la creatina quinasa total y la creatina quinasa fracción MB son menos específicas. El ecocardiograma está indicado en caso de hipotensión persistente, electrocardiograma con alteraciones o falla cardiaca aguda. El tratamiento incluye la estabilización inicial y un manejo específico de las lesiones. Entre las complicaciones se incluyen: el taponamiento cardiaco, la contusión miocárdica, el síndrome coronario agudo, las arritmias cardíacas y la lesión aórtica. El pronóstico se determina en mayor medida por los signos vitales al ingreso y la presencia de paro cardiaco durante el abordaje inicial.

  3. Pancreatic trauma: Universities of Melbourne HPB Group.

    Science.gov (United States)

    Fleming, W R; Collier, N A; Banting, S W

    1999-05-01

    Pancreatic trauma is uncommon, but carries high morbidity and mortality rates, especially when diagnosis is delayed or inappropriate surgery is attempted. Although the retroperitoneal position of the pancreas confers it some immunity to injury, the force required to do so often results in severe associated injuries to other organs, which may be life threatening. Diagnosis may be difficult and surgery can be a considerable technical challenge. All patients with pancreatic trauma who attended one of three Melbourne teaching hospitals from 1977 to 1998 were identified. Injuries were graded and the method of diagnosis and treatment studied. The incidence and causation of postoperative morbidity and mortality was identified. Thirty-eight patients (26 men and 12 women) were studied. Blunt trauma was responsible in 30 patients, stab wounds in five, gunshot wounds in two and iatrogenic injury in one. Injuries to other organs occurred in 30 patients. Surgical procedures were undertaken in 34 patients, resulting in the death of five and complications in 25. Complications and death are related to the associated injuries, as much as to the pancreatic injury itself. In this study, we review the experience of the management of pancreatic trauma in three large teaching hospitals in Melbourne over a 21-year period, and suggest a strategy for dealing with these difficult patients. Adherence to the basic concepts of control of bleeding from associated vascular injury, minimization of contamination, accurate pancreatic assessment, judicious resection and adequate drainage can diminish the risk. By approaching the problem in a systematic way and adopting a generally conservative management plan, complications and deaths can be minimized in these complex cases.

  4. Trauma-affected refugees

    DEFF Research Database (Denmark)

    Sonne, Charlotte Kærgaard

    2016-01-01

    received the same manual-based Cognitive Behavioural Therapy (CBT) as well as social counselling. The mean length of the treatment course was 6.3 months. The primary outcome measure was self-reported PTSD symptoms assessed on the Harvard Trauma Questionnaire (HTQ). Other outcome measures were self......-reported depression and anxiety symptoms measured on Hopkins Symptom Check List-25 (HSCL-25), self-reported social functioning measured on the Social Adjustment Scale Self Report, short version (SAS-SR), and observer-rated depression and anxiety symptoms assessed on the Hamilton Depression and Anxiety Ratings Scales...... (HAM D+A ). Social support was assessed on the Crisis Support Scale (CSS), level of functioning assessed on the Sheehan Disability Scale (SDS), quality of life was assessed on the WHO-5, the somatisation items of the Symptom Checklist-90 (SCL-90), pain in four different body areas measured on Visual...

  5. Panhypopituitarism after multisystem trauma.

    Science.gov (United States)

    Wiechecka, Joanna; Krzewska, Aleksandra; Droń, Izabela; Beń-Skowronek, Iwona

    2013-01-01

    The pituitary gland plays a key role in hormonal regulation in the organism, contributing to maintenance of balance of basic vital functions. To emphasise the need for assessment of pituitary function after head injury, as correct diagnosis and hormone replacement therapy prove to be a life-saving therapy accelerating the recovery process. A healthy, normally developing 9-year-old girl, a child of young and healthy parents, was struck by a falling tree. The results of severe head trauma included adrenal crisis, hypothyroidism, and diabetes insipidus as manifestations of damage to the anterior and posterior pituitary gland. Administration of hormone replacement therapy, i.e. hydrocortisone, L-thyroxine, and desmopressin greatly improved the patient´s condition and facilitated effective rehabilitation. Determination of pituitary hormones in children after severe head injury should be an important part of diagnosis allowing identification of an early stage of acute hypopituitarism and acceleration of recovery through hormone replacement therapy.

  6. MRI in head trauma

    Energy Technology Data Exchange (ETDEWEB)

    Hong, Jin Kyo [Shin Wha Hospital, Seoul (Korea, Republic of)

    1986-02-15

    In the diagnosis of head injury, Magnetic Resonance Imaging (MRI), like CT, is an effective method of distinguishing between intracerebral and extracerebral lesions. In our experience of MRI, early hematomas are almost isointense by Saturation Recovery (SR) method, so these must be performed with Spin Echo (SE) method for better visualization of hematomas. Isodense subdural hematomas, which is a diagnostic dilemma on CT images, are clearly seen on MRI. Delayed hematomas or residual parenchymal lesions are better demonstrated on MRI than on CT. Direct cornal, sagittal images and multiplanar facility of MRI provides excellent visualization of the the location and shape of extracerebral collection of hematoma. For the screening of head traumas, SE method is a technique of choice because of its excellent sensitivity within limited time.

  7. MRI in head trauma

    International Nuclear Information System (INIS)

    Hong, Jin Kyo

    1986-01-01

    In the diagnosis of head injury, Magnetic Resonance Imaging (MRI), like CT, is an effective method of distinguishing between intracerebral and extracerebral lesions. In our experience of MRI, early hematomas are almost isointense by Saturation Recovery (SR) method, so these must be performed with Spin Echo (SE) method for better visualization of hematomas. Isodense subdural hematomas, which is a diagnostic dilemma on CT images, are clearly seen on MRI. Delayed hematomas or residual parenchymal lesions are better demonstrated on MRI than on CT. Direct cornal, sagittal images and multiplanar facility of MRI provides excellent visualization of the the location and shape of extracerebral collection of hematoma. For the screening of head traumas, SE method is a technique of choice because of its excellent sensitivity within limited time.

  8. Head trauma and CT

    International Nuclear Information System (INIS)

    Samejima, Kanji; Yoshii, Nobuo; Tobari, Chitoshi

    1979-01-01

    In our cases of acute and subacute subdural hematoma, the use of CT was evaluated. In our department of surgery, acute subdural hematoma was found in 46 of 388 patients of head trauma who underwent CT. Acute subdural hematoma, like epidural hematoma was usually visualized as a high-density area along the cranial inner table, and this was easily differenciated from epidural hematoma because of difference in shape from the other. The picture of acute subdural hematoma was occasionally confused with that of intracerebral hematoma or cerebral contusion. Single use of CT does not differenciate subacute subdural hematoma from chronic subdural hematoma. However, CT usually visualized acute hematoma as a high-density area, showing the extent of hematoma. Comparison of the thickness of hematoma with the axis deviation of the median part such as the 3rd cerebral ventricle suggested severity of cerebral edema. CT also revealed bilateral or multiple lesions of cerebral contusion or intracerebral hematoma. (Ueda, J.)

  9. Predicting significant torso trauma.

    Science.gov (United States)

    Nirula, Ram; Talmor, Daniel; Brasel, Karen

    2005-07-01

    Identification of motor vehicle crash (MVC) characteristics associated with thoracoabdominal injury would advance the development of automatic crash notification systems (ACNS) by improving triage and response times. Our objective was to determine the relationships between MVC characteristics and thoracoabdominal trauma to develop a torso injury probability model. Drivers involved in crashes from 1993 to 2001 within the National Automotive Sampling System were reviewed. Relationships between torso injury and MVC characteristics were assessed using multivariate logistic regression. Receiver operating characteristic curves were used to compare the model to current ACNS models. There were a total of 56,466 drivers. Age, ejection, braking, avoidance, velocity, restraints, passenger-side impact, rollover, and vehicle weight and type were associated with injury (p < 0.05). The area under the receiver operating characteristic curve (83.9) was significantly greater than current ACNS models. We have developed a thoracoabdominal injury probability model that may improve patient triage when used with ACNS.

  10. CT of laryngeal trauma

    International Nuclear Information System (INIS)

    Jeffrey, R.B.

    1986-01-01

    Computed tomography has made a significant contribution to the radiologic assessment of the injured larynx. CT is an accurate, noninvasive modality that can rapidly diagnose both soft tissue and cartilaginous injuries. CT of the larynx involves a minimal degree of patient manipulation and discomfort and can be performed in conjunction with CT evaluation of intracranial or facial injuries. Conventional radiologic studies (anteroposterior and lateral soft tissue films of the neck, tomograms, or xerograms) are capable of demonstrating some cartilaginous fractures but are of limited value in defining the extent of soft tissue injury. In the acute trauma setting, laryngography is often technically difficult to perform because of patient discomfort and inability to cooperate. Although the overall experience is somewhat limited, CT appears to overcome many of the limitations of these conventional radiologic methods. The following is a discussion of the role of CT scanning in evaluating injuries to the larynx and cervical soft tissues

  11. Telemedicine for Trauma, Emergencies, and Disaster Management

    CERN Document Server

    Latifi, Rifat

    2010-01-01

    Telemedicine has evolved to become an important field of medicine and healthcare, involving everything from simple patient care to actual performance of operations at a distance. This groundbreaking volume addresses the complex technical and clinical development in the management of trauma, disaster, and emergency situations using telemedicine. The book explains how telemedicine and related technologies can be used to effectively handle a wide range of scenarios, from a situation as small as a car crash, to major disasters such as an earthquake. Professionals find critical discussions on the p

  12. [The Academy of Trauma Surgery (AUC). Service provider and management organization of the DGU].

    Science.gov (United States)

    Sturm, J A; Hoffmann, R

    2016-02-01

    At the beginning of this century the German Trauma Society (DGU) became extensively active with an initiative on quality promotion, development of quality assurance and transparency regarding treatment of the severely injured. A white book on "Medical care of the severely injured" was published, focusing on the requirements on structural quality and especially procedural quality. The impact of the white book was immense and a trauma network with approved trauma centers, structured and graded for their individual trauma care performance, was developed. In order to monitor and document the required quality of care, a registry was needed. Furthermore, for cooperation within the trauma networks innovative methods for digital transfer of radiological images and patient documents became necessary. Finally, the auditing criteria for trauma centers had and still have to be completed with advanced medical education and training programs. In order to realize the implementation of such a broad spectrum of economically relevant and increasingly complex activities the Academy of Trauma Surgery (AUC) was established as a subsidiary of the DGU in 2004. The AUC currently has four divisions: 1) networks and health care structures, 2) registries and research management, 3) telemedicine, 4) medical education and training, all of which serve the goal of the initiative. The AUC is a full service provider and management organization in compliance with the statutes of the DGU. According to these statutes the business operations of the AUC also cover projects for numerous groups of patients, projects for the joint society the German Society for Orthopedics and Trauma (DGOU) as well as other medical institutions. This article describes the success stories of the trauma network (TraumaNetzwerk DGU®), the TraumaRegister DGU®, the telecooperation platform TKmed®, the new and fast-growing orthogeriatric center initiative (AltersTraumaZentrum DGU®) and the division of medical education and

  13. EPIDEMOLOGY OF TRAUMA GLOBALY

    Directory of Open Access Journals (Sweden)

    Nur Yuniarti

    2013-10-01

    Full Text Available Normal 0 false false false EN-US X-NONE X-NONE MicrosoftInternetExplorer4 This study describes the epidemiology of trauma globaly. Trauma can cause death, burden of disease and economic losses. Traffic accidents are the most common cause of injury in the whole world. Riskesdes 2007, the proportion of the highest injury of Yogyakarta, experienced by adult age group, higher in male, the high levels of injury increasing the proportion of respondents. Found in the work as an employee, in the upper midle economic level. Lower limb (leg is part most affected by injuries. Based on the types of injuries classified as serious in a row that a head injury. Traffic accidents are often caused by four factors: road user, drivers, pedestrian, and vehicle. Because the victim of traffic accident is quite high and high health costs incurred. By him that there are three phases of stage traffic accident prevention, the prevention of the pre-crash phase, the phase of the accident, when the accident occur, to minimize the injuries. /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;}

  14. Management of pancreatic trauma.

    Science.gov (United States)

    Girard, E; Abba, J; Arvieux, C; Trilling, B; Sage, P Y; Mougin, N; Perou, S; Lavagne, P; Létoublon, C

    2016-08-01

    Pancreatic trauma (PT) is associated with high morbidity and mortality; the therapeutic options remain debated. Retrospective study of PT treated in the University Hospital of Grenoble over a 22-year span. The decision for initial laparotomy depended on hemodynamic status as well as on associated lesions. Main pancreatic duct lesions were always searched for. PT lesions were graded according to the AAST classification. Of a total of 46 PT, 34 were grades II or I. Hemodynamic instability led to immediate laparotomy in 18 patients, for whom treatment was always drainage of the pancreatic bed; morbidity was 30%. Eight patients had grade III injuries, six of whom underwent immediate operation: three underwent splenopancreatectomy without any major complications while the other three who had simple drainage required re-operation for peritonitis, with one death related to pancreatic complications. Four patients had grades IV or V PT: two pancreatoduodenectomies were performed, with no major complication, while one patient underwent duodenal reconstruction with pancreatic drainage, complicated by pancreatic and duodenal fistula requiring a hospital stay of two months. The post-trauma course was complicated for all patients with main pancreatic duct involvement. Our outcomes were similar to those found in the literature. In patients with distal PT and main pancreatic duct involvement, simple drainage is associated with high morbidity and mortality. For proximal PT, the therapeutic options of drainage versus pancreatoduodenectomy must be weighed; pancreatoduodenectomy may be unavoidable when the duodenum is injured as well. Two-stage (resection first, reconstruction later) could be an effective alternative in the emergency setting when there are other associated traumatic lesions. Copyright © 2016. Published by Elsevier Masson SAS.

  15. Clean Hands Count

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    Full Text Available ... CDC) 97,825 views 5:12 CDC Flu Education Video - Duration: 10:26. Nicole Shelton 213 views ... Infection Control Video - Duration: 20:55. Paramedical Services Education Page 4,735 views 20:55 Hand Washing ...

  16. Hand Eczema: Treatment options

    DEFF Research Database (Denmark)

    Lund, Tamara Theresia; Agner, Tove

    2017-01-01

    Hand eczema is a common disease, it affects young people, is often work-related, and the burden of the disease is significant for the individual as well as for society. Factors to be considered when choosing a treatment strategy are, among others, whether the eczema is acute or chronic, the sever...

  17. Clean Hands Count

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    Full Text Available ... Queue __count__/__total__ It’s YouTube. Uninterrupted. Loading... Want music and videos with zero ads? Get YouTube Red. ... 824 views 1:36 Wash 'Em - Hand Hygiene Music Video - Duration: 5:46. Jefferson Health 409,492 ...

  18. Clean Hands Count

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    Full Text Available ... Queue __count__/__total__ It’s YouTube. Uninterrupted. Loading... Want music and videos with zero ads? Get YouTube Red. ... 786 views 1:36 Wash 'Em - Hand Hygiene Music Video - Duration: 5:46. Jefferson Health 413,702 ...

  19. Clean Hands Count

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    Full Text Available ... Queue __count__/__total__ It’s YouTube. Uninterrupted. Loading... Want music and videos with zero ads? Get YouTube Red. ... 414 views 3:10 Wash 'Em - Hand Hygiene Music Video - Duration: 5:46. Thomas Jefferson University & Jefferson ...

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  1. Wash Your Hands

    Centers for Disease Control (CDC) Podcasts

    2010-03-08

    This video shows kids how to properly wash their hands, one of the most important steps we can take to avoid getting sick and spreading germs to others.  Created: 3/8/2010 by Centers for Disease Control and Prevention (CDC).   Date Released: 3/8/2010.

  2. Clean Hands Count

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    Full Text Available ... no cure tomorrow - Duration: 3:10. World Health Organization 75,585 views 3:10 Wash 'Em - Hand ... soap and water - Duration: 1:27. World Health Organization 224,180 views 1:27 The five moments ...

  3. Clean Hands Count

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    Full Text Available ... Queue __count__/__total__ It’s YouTube. Uninterrupted. Loading... Want music and videos with zero ads? Get YouTube Red. ... 460 views 3:10 Wash 'Em - Hand Hygiene Music Video - Duration: 5:46. Thomas Jefferson University & Jefferson ...

  4. Clean Hands Count

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    Full Text Available ... action today; no cure tomorrow - Duration: 3:10. World Health Organization 75,362 views 3:10 Wash ' ... handwash? With soap and water - Duration: 1:27. World Health Organization 219,427 views 1:27 Hand ...

  5. Clean Hands Count

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    Full Text Available ... action today; no cure tomorrow - Duration: 3:10. World Health Organization 74,478 views 3:10 Wash your Hands - ... handwash? With soap and water - Duration: 1:27. World Health Organization 215,487 views 1:27 Infection Control Video - ...

  6. Clean Hands Count

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    Full Text Available ... Queue __count__/__total__ It’s YouTube. Uninterrupted. Loading... Want music and videos with zero ads? Get YouTube Red. ... 741 views 3:10 Wash 'Em - Hand Hygiene Music Video - Duration: 5:46. Jefferson Health 410,052 ...

  7. Matching hand radiographs

    NARCIS (Netherlands)

    Kauffman, J.A.; Slump, Cornelis H.; Bernelot Moens, H.J.

    2005-01-01

    Biometric verification and identification methods of medical images can be used to find possible inconsistencies in patient records. Such methods may also be useful for forensic research. In this work we present a method for identifying patients by their hand radiographs. We use active appearance

  8. Clean Hands Count

    Medline Plus

    Full Text Available ... today; no cure tomorrow - Duration: 3:10. World Health Organization 72,885 views 3:10 Wash 'Em - Hand Hygiene Music Video - Duration: 5:46. Jefferson Health 410,052 views 5:46 'It's in your ...

  9. Clean Hands Count

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    Full Text Available ... Queue __count__/__total__ It’s YouTube. Uninterrupted. Loading... Want music and videos with zero ads? Get YouTube Red. ... 029 views 3:10 Wash 'Em - Hand Hygiene Music Video - Duration: 5:46. Jefferson Health 411,974 ...

  10. Clean Hands Count

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    Full Text Available ... no cure tomorrow - Duration: 3:10. World Health Organization 78,256 views 3:10 Wash 'Em - Hand ... message from WHO - Duration: 10:07. World Health Organization 9,045 views 10:07 A very serious ...

  11. Hands-On Calculus

    Science.gov (United States)

    Sutherland, Melissa

    2006-01-01

    In this paper we discuss manipulatives and hands-on investigations for Calculus involving volume, arc length, and surface area to motivate and develop formulae which can then be verified using techniques of integration. Pre-service teachers in calculus courses using these activities experience a classroom in which active learning is encouraged and…

  12. Clean Hands Count

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    Full Text Available ... action today; no cure tomorrow - Duration: 3:10. World Health Organization 78,256 views 3:10 Wash ... handwash? With soap and water - Duration: 1:27. World Health Organization 230,361 views 1:27 Hand ...

  13. Hands-on Humidity.

    Science.gov (United States)

    Pankiewicz, Philip R.

    1992-01-01

    Presents five hands-on activities that allow students to detect, measure, reduce, and eliminate moisture. Students make a humidity detector and a hygrometer, examine the effects of moisture on different substances, calculate the percent of water in a given food, and examine the absorption potential of different desiccants. (MDH)

  14. Clean Hands Count

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    Full Text Available ... Queue __count__/__total__ It’s YouTube. Uninterrupted. Loading... Want music and videos with zero ads? Get YouTube Red. ... 396 views 3:10 Wash 'Em - Hand Hygiene Music Video - Duration: 5:46. Thomas Jefferson University & Jefferson ...

  15. Clean Hands Count

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    Full Text Available ... Queue __count__/__total__ It’s YouTube. Uninterrupted. Loading... Want music and videos with zero ads? Get YouTube Red. ... 094 views 1:19 Wash 'Em - Hand Hygiene Music Video - Duration: 5:46. Jefferson Health 411,974 ...

  16. Clean Hands Count

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    Full Text Available ... starting stop Loading... Watch Queue Queue __count__/__total__ It’s YouTube. Uninterrupted. Loading... Want music and videos with ... ads? Get YouTube Red. Working... Not now Try it free Find out why Close Clean Hands Count ...

  17. Clean Hands Count

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    Full Text Available ... today; no cure tomorrow - Duration: 3:10. World Health Organization 69,414 views 3:10 Hand Washing ... Video - Duration: 5:46. Thomas Jefferson University & Jefferson Health 408,436 views 5:46 83 videos Play ...

  18. Clean Hands Count

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    Full Text Available ... Queue __count__/__total__ It’s YouTube. Uninterrupted. Loading... Want music and videos with zero ads? Get YouTube Red. ... 319 views 3:10 Wash 'Em - Hand Hygiene Music Video - Duration: 5:46. Jefferson Health 410,052 ...

  19. Clean Hands Count

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    Full Text Available ... Queue __count__/__total__ It’s YouTube. Uninterrupted. Loading... Want music and videos with zero ads? Get YouTube Red. ... 585 views 3:10 Wash 'Em - Hand Hygiene Music Video - Duration: 5:46. Jefferson Health 413,097 ...

  20. Clean Hands Count

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    Full Text Available ... 14. Lake Health 14,415 views 3:14 Safety Demo: The Importance of Hand Washing - Duration: 2: ... Copyright Creators Advertise Developers +YouTube Terms Privacy Policy & Safety Send feedback Test new features Loading... Working... Sign ...

  1. Clean Hands Count

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    Full Text Available ... action today; no cure tomorrow - Duration: 3:10. World Health Organization 72,319 views 3:10 Wash 'Em - Hand ... handwash? With soap and water - Duration: 1:27. World Health Organization 205,878 views 1:27 Germ Smart - Wash ...

  2. Hands On Earth Science.

    Science.gov (United States)

    Weisgarber, Sherry L.; Van Doren, Lisa; Hackathorn, Merrianne; Hannibal, Joseph T.; Hansgen, Richard

    This publication is a collection of 13 hands-on activities that focus on earth science-related activities and involve students in learning about growing crystals, tectonics, fossils, rock and minerals, modeling Ohio geology, geologic time, determining true north, and constructing scale-models of the Earth-moon system. Each activity contains…

  3. Clean Hands Count

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    Full Text Available ... Queue __count__/__total__ It’s YouTube. Uninterrupted. Loading... Want music and videos with zero ads? Get YouTube Red. ... 384 views 1:19 Wash 'Em - Hand Hygiene Music Video - Duration: 5:46. Thomas Jefferson University & Jefferson ...

  4. Clean Hands Count

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    Full Text Available ... Queue __count__/__total__ It’s YouTube. Uninterrupted. Loading... Want music and videos with zero ads? Get YouTube Red. ... 285 views 1:36 Wash 'Em - Hand Hygiene Music Video - Duration: 5:46. Jefferson Health 410,052 ...

  5. Clean Hands Count

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    Full Text Available ... Gorin 243,451 views 2:57 Hand Hygiene Dance - Duration: 3:15. mohd hafiz 34,146 views ... Language: English Location: United States Restricted Mode: Off History Help Loading... Loading... Loading... About Press Copyright Creators ...

  6. Clean Hands Count

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    Full Text Available ... YouTube. Uninterrupted. Loading... Want music and videos with zero ads? Get YouTube Red. Working... Not now Try ... Wash your Hands - it just makes sense. - Duration: 1:36. Seema Marwaha 400,493 views 1:36 ...

  7. Clean Hands Count

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    Full Text Available ... Queue __count__/__total__ It’s YouTube. Uninterrupted. Loading... Want music and videos with zero ads? Get YouTube Red. ... 033 views 1:36 Wash 'Em - Hand Hygiene Music Video - Duration: 5:46. Jefferson Health 410,052 ...

  8. Clean Hands Count

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    Full Text Available ... Em - Hand Hygiene Music Video - Duration: 5:46. Thomas Jefferson University & Jefferson Health 408,436 views 5: ... Prevention (CDC) 97,277 views 5:12 Loading more suggestions... Show more Language: English Location: United States ...

  9. Hands-On Hydrology

    Science.gov (United States)

    Mathews, Catherine E.; Monroe, Louise Nelson

    2004-01-01

    A professional school and university collaboration enables elementary students and their teachers to explore hydrology concepts and realize the beneficial functions of wetlands. Hands-on experiences involve young students in determining water quality at field sites after laying the groundwork with activities related to the hydrologic cycle,…

  10. Clean Hands Count

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    Full Text Available ... Queue __count__/__total__ It’s YouTube. Uninterrupted. Loading... Want music and videos with zero ads? Get YouTube Red. ... 043 views 1:36 Wash 'Em - Hand Hygiene Music Video - Duration: 5:46. Jefferson Health 411,292 ...

  11. Clean Hands Count

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    Full Text Available ... News 581,131 views 18:49 Just Good Music 24/7 ● Classic Live Radio classics. 1,406 ... 611,013 views 1:46 Hand hygiene FULL music video - Duration: 2:33. AlfredHealthTV 26,798 views ...

  12. Clean Hands Count

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    Full Text Available ... 52 Hand Sanitizers and Soaps Put to the Test - Duration: 2:26. ABC News 42,006 views ... Developers +YouTube Terms Privacy Policy & Safety Send feedback Test new features Loading... Working... Sign in to add ...

  13. [Surgical tactics in duodenal trauma].

    Science.gov (United States)

    Ivanov, P A; Grishin, A V

    2004-01-01

    Results of surgical treatment of 61 patients with injuries of the duodenum are analyzed. The causes of injuries were stab-incised wounds in 24 patients, missile wound -- in 7, closed abdominal trauma -- in 26, trauma of the duodenum during endoscopic papillosphincterotomy -- in 4. All the patients underwent surgery. Complications were seen in 32 (52.5%) patients, 21 patients died, lethality was 34.4%. Within the first 24 hours since the trauma 7 patients died due to severe combined trauma, blood loss, 54 patients survived acute period of trauma, including 28 patients after open trauma, 26 -- after closed and 4 -- after trauma of the duodenum during endoscopic papillosphincterotomy. Diagnostic and surgical policies are discussed. Results of treatment depending on kind and time of surgery are regarded. It is demonstrated that purulent complications due to retroperitoneal phlegmona, traumatic pancreatitis, pneumonia are the causes of significant number of unfavorable outcomes. Therefore, it is important to adequately incise and drainage infected parts of retroperitoneal fat tissue with two-lumen drainages. Decompression through duodenal tube is the effective procedure for prophylaxis of suture insufficiency and traumatic pancreatitis. Suppression of pancreatic and duodenal secretion with octreotid improves significantly surgical treatment results.

  14. Vascular emergencies in liver trauma

    Energy Technology Data Exchange (ETDEWEB)

    Taourel, P. [Centre Hospitalier Universitaire Lapeyronie, Montpellier (France)], E-mail: p-taourel@chu-montpellier.fr; Vernhet, H. [Centre Hospitalier Universitaire Arnaud de Villeneuve, Montpellier (France); Suau, A.; Granier, C. [Centre Hospitalier Universitaire Lapeyronie, Montpellier (France); Lopez, F.M. [Centre Hospitalier Universitaire, Nimes (France); Aufort, S. [Centre Hospitalier Universitaire Lapeyronie, Montpellier (France)

    2007-10-15

    The use of CT in the diagnosis and management of liver trauma is responsible for the shift from routine surgical versus non-surgical treatment in the management of traumatic liver injuries, even when they are of high grade. The main cause of compli cation and of death in liver trauma is related to vascular injury. The goal of this review focussed on the vascular complications of liver trauma is to describe the elementary lesions shown by CT in liver trauma including laceration, parenchymal hematoma and contusions, partial devascularisation, subcapsular hematomas, hemoperitoneum, active bleeding, pseudoaneurysm of the hepatic artery, bile leak, and periportal oedema, to illustrate the possible pitfalls in CT diagnosis of liver trauma and to underline the key-points which may absolutely be present in a CT report of liver trauma. Then we will remind the grading system based on the CT features and we will analyze the interest and limitations of such grading systems. Last we will discuss the diagnostic strategy at the early phase in patients with suspected liver trauma according to their clinical conditions and underline the conditions of arterial embolization, and then we will discuss the diagnosis strategy at the delayed phase according to the suspected complications.

  15. Vascular emergencies in liver trauma

    International Nuclear Information System (INIS)

    Taourel, P.; Vernhet, H.; Suau, A.; Granier, C.; Lopez, F.M.; Aufort, S.

    2007-01-01

    The use of CT in the diagnosis and management of liver trauma is responsible for the shift from routine surgical versus non-surgical treatment in the management of traumatic liver injuries, even when they are of high grade. The main cause of compli cation and of death in liver trauma is related to vascular injury. The goal of this review focussed on the vascular complications of liver trauma is to describe the elementary lesions shown by CT in liver trauma including laceration, parenchymal hematoma and contusions, partial devascularisation, subcapsular hematomas, hemoperitoneum, active bleeding, pseudoaneurysm of the hepatic artery, bile leak, and periportal oedema, to illustrate the possible pitfalls in CT diagnosis of liver trauma and to underline the key-points which may absolutely be present in a CT report of liver trauma. Then we will remind the grading system based on the CT features and we will analyze the interest and limitations of such grading systems. Last we will discuss the diagnostic strategy at the early phase in patients with suspected liver trauma according to their clinical conditions and underline the conditions of arterial embolization, and then we will discuss the diagnosis strategy at the delayed phase according to the suspected complications

  16. Propeller flaps for lower-limb trauma | Rogers | South African ...

    African Journals Online (AJOL)

    The propeller flap has become a versatile and important component in our reconstructive algorithm following complex lower limb trauma. First described by Hyakusoku in 1991, it has since been adapted and modified by Hallock and Teo. This article outlines our experience specifically with perforator pedicled propeller flaps ...

  17. Trauma Tapping Technique: Practical First Aid for Stress and Trauma

    African Journals Online (AJOL)

    Epidemiological studies on posttraumatic stress disorder (PTSD) show a lifetime ... include re-experiencing the traumatic event, avoidant behavior for the memories of ... Methods. Trauma tapping technique (TTT) is a procedure that uses touch ...

  18. The Dental Trauma Internet Calculator

    DEFF Research Database (Denmark)

    Gerds, Thomas Alexander; Lauridsen, Eva Fejerskov; Christensen, Søren Steno Ahrensburg

    2012-01-01

    Background/Aim Prediction tools are increasingly used to inform patients about the future dental health outcome. Advanced statistical methods are required to arrive at unbiased predictions based on follow-up studies. Material and Methods The Internet risk calculator at the Dental Trauma Guide...... provides prognoses for teeth with traumatic injuries based on the Copenhagen trauma database: http://www.dentaltraumaguide.org The database includes 2191 traumatized permanent teeth from 1282 patients that were treated at the dental trauma unit at the University Hospital in Copenhagen (Denmark...

  19. Emergency Department Management of Trauma

    DEFF Research Database (Denmark)

    MacKenzie, Colin; Lippert, Freddy

    1999-01-01

    services (EMS) response times and advanced prehospital care increase the number of critically injured patients surviving sufficiently long to reach a hospital “in extremis.” Both scenarios provide challenges in the management of traumatized patients. This article addresses the management of severely......Initial assessment and management of severely injured patients may occur in a specialized area of an emergency department or in a specialized area of a trauma center. The time from injury until definitive management is of essence for survival of life-threatening trauma. The initial care delivered...... injured patients after these patients reach a hospital emergency department or a trauma center....

  20. The impact of trauma on the psyche of the individual using the film Belleville Rendez-vous as an illustrative vehicle.

    Science.gov (United States)

    Waldron, Sharn

    2008-09-01

    Using the film Belleville Rendez-vous as a vehicle for discussion, this paper argues that whilst a traumatic complex may bring about dissociation of the psyche, this is not the only possibility, nor is dissociation necessarily to be seen solely as a difficulty to be overcome. If trauma is experienced within the context of support and validation, the experience of trauma may generate integration not only of the trauma but also of the growth potential that the trauma has previously inhibited.

  1. Staphylococcus aureus and hand eczema severity

    DEFF Research Database (Denmark)

    Haslund, P; Bangsgaard, N; Jarløv, J O

    2009-01-01

    BACKGROUND: The role of bacterial infections in hand eczema (HE) remains to be assessed. OBJECTIVES: To determine the prevalence of Staphylococcus aureus in patients with HE compared with controls, and to relate presence of S. aureus, subtypes and toxin production to severity of HE. METHODS......: Bacterial swabs were taken at three different visits from the hand and nose in 50 patients with HE and 50 controls. Staphylococcus aureus was subtyped by spa typing and assigned to clonal complexes (CCs), and isolates were tested for exotoxin-producing S. aureus strains. The Hand Eczema Severity Index...... and in the nose in all cases, and between visits in 90% of cases. Ten different CC types were identified, no association with severity was found, and toxin-producing strains were not found more frequently in patients with HE than in controls. CONCLUSIONS: Staphylococcus aureus was present on hands in almost half...

  2. INCIDENCE OF OCULAR TRAUMA IN A TERTIARY HOSPITAL IN VISAKHAPATNAM

    Directory of Open Access Journals (Sweden)

    Venkata Madusudanarao Kanukollu

    2017-07-01

    Full Text Available BACKGROUND Ocular trauma is a major cause of preventable ocular blindness in the world. The present available data represents the tip of iceberg. The data pertaining to ocular trauma is just hospital based data which does not accurately represent the population at risk. The ocular morbidity may be disproportionate to the severity of injury. Though eyes represent only 0.21% of body surface area and 4% of facial area, they are the third most common trauma exposed areas after hands and feet. MATERIALS AND METHODS Our study group consisted of 341 patients who attended ophthalmology OPD with history of ocular trauma of whom 221 were males and 121 were females. The study was conducted over a period of one year. A complete anterior and posterior segment evaluation of all the patients was done. Other accessory ocular and systemic investigations wherever essential were done. RESULTS The ocular trauma was more common in males (64.52% predominantly affecting patients of 20-40 years age group (36.07%. Most often the injuries were occupation related (73.90% and the most common work related injury observed was extraocular foreign body in 134 patients (39.29%. Closed globe injuries were more common as compared to open globe injuries. Eyes with better visual acuity at presentation had better visual prognosis. Blinding trauma was observed in 29 patients (8.50%. CONCLUSION Ocular injuries are more commonly occupation related and mostly effect young males who are the main work force of our society. Stringent implementation of preventive norms in industries to all the workers and safety precautions during sports, driving need to be enforced.

  3. Strategy and your stronger hand.

    Science.gov (United States)

    Moore, Geoffrey A

    2005-12-01

    There are two kinds of businesses in the world, says the author. Knowing what they are--and which one your company is--will guide you to the right strategic moves. One kind includes businesses that compete on a complex-systems model. These companies have large enterprises as their primary customers. They seek to grow a customer base in the thousands, with no more than a handful of transactions per customer per year (indeed, in some years there may be none), and the average price per transaction ranges from six to seven figures. In this model, 1,000 enterprises each paying dollar 1 million per year would generate dollar 1 billion in annual revenue. The other kind of business competes on a volume-operations model. Here, vendors seek to acquire millions of customers, with tens or even hundreds of transactions per customer per year, at an average price of relatively few dollars per transaction. Under this model, it would take 10 million customers each spending dollar 8 per month to generate nearly dollar 1 billion in revenue. An examination of both models shows that they could not be further apart in their approach to every step along the classic value chain. The problem, though, is that companies in one camp often attempt to create new value by venturing into the other. In doing so, they fail to realize how their managerial habits have been shaped by the model they've grown up with. By analogy, they have a "handedness"--the equivalent of a person's right- or left-hand dominance--that makes them as adroit in one mode as they are awkward in the other. Unless you are in an industry whose structure forces you to attempt ambidexterity (in which case, special efforts are required to manage the inevitable dropped balls), you'll be far more successful making moves that favor your stronger hand.

  4. CT evaluation of abdominal trauma

    International Nuclear Information System (INIS)

    Huang Ruiting

    2004-01-01

    Objective: An evaluation of CT diagnosis of abdominal trauma. Methods: CT appearance of abdominal trauma was analyzed retrospectively in 95 cases. thirty-three patients were cured by operation, and the other 59 patients received conservative treatment. Fifty-one patients out of 59 were seen healed or improved by a follow up CT scan after the conservative treatment. Results: The study included: 31 cases of splenic contusion, accompanying with hemoperitoneum in 25 cases; 3 cases of hepatic laceration; 33 cases of liver and spleen compound trauma accompanying with hemoperitoneum; 18 cases of renal contusion, with subcapsular hemorrhage in 12 cases; 4 cases of midriff colic; 3 cases of mesentery breach; 3 cases of digestive tract perforation. Conclusion: CT is sensitive and precise in evaluating abdominal trauma, providing important information for treatment. (author)

  5. Epidemiology of acute wrist trauma

    DEFF Research Database (Denmark)

    Larsen, C F; Lauritsen, Jens

    1993-01-01

    Epidemiological data on wrist injuries in a population can be used for planning by applying them to criteria for care and thus deriving estimates of provisions for care according to currently desirable standards. In a 1-year study all patients > or = 15 years with acute wrist trauma and treated...... in the emergency room were examined according to an algorithm until a diagnosis was established. The overall incidence of wrist trauma was 69 per 10,000 inhabitants per year. Incidence of wrist trauma requiring x-ray examination was 58 per 10,000 per year. The incidence of distal radius fractures was 27 per 10...... using data from a population-based study. A completeness rate of 0.56 (95% confidence interval: 0.31-0.78) was found. An x-ray had been taken for all patients reporting a fracture thus justifying the use of fractures as an incidence measure when comparing groups of patients with wrist trauma....

  6. The management of neglected trauma

    African Journals Online (AJOL)

    more patients could be treated in the peripheral hospitals. .... most of the inovement from Perkins exercises will occur at the fracture site .... neglected femoral neck fracture in the elderly. ... The best treatment of neglected trauma is prevention.

  7. Imaging of blunt chest trauma

    International Nuclear Information System (INIS)

    Prosch, H.; Negrin, L.

    2014-01-01

    Blunt chest trauma is associated with high morbidity and mortality. Consequently, all patients should be evaluated radiologically after blunt chest trauma to allow timely and appropriate treatment. Conventional chest radiographs and computed tomography (CT) are proven modalities with which to evaluate patients after blunt chest trauma. Over the last several years extended focused assessment with sonography for trauma (eFAST) has gained increasing importance for the initial assessment of seriously injured patients. In the acute phase of severely injured patients eFAST examinations are helpful to exclude pneumothorax, hemothorax and hemopericardium. Chest radiographs may also be used to diagnose a pneumothorax or hemothorax; however, the sensitivity is limited and CT is the diagnostic modality of choice to evaluate severely injured patients. (orig.) [de

  8. [Current treatment of hepatic trauma].

    Science.gov (United States)

    Silvio-Estaba, Leonardo; Madrazo-González, Zoilo; Ramos-Rubio, Emilio

    2008-05-01

    The therapeutic and diagnostic approach of liver trauma injuries (by extension, of abdominal trauma) has evolved remarkably in the last decades. The current non-surgical treatment in the vast majority of liver injuries is supported by the accumulated experience and optimal results in the current series. It is considered that the non-surgical treatment of liver injuries has a current rate of success of 83-100%, with an associated morbidity of 5-42%. The haemodynamic stability of the patient will determine the applicability of the non-surgical treatment. Arteriography with angioembolisation constitutes a key technical tool in the context of liver trauma. Patients with haemodynamic instability will need an urgent operation and can benefit from abdominal packing techniques, damage control and post-operative arteriography. The present review attempts to contribute to the current, global and practical management in the care of liver trauma.

  9. Compact Dexterous Robotic Hand

    Science.gov (United States)

    Lovchik, Christopher Scott (Inventor); Diftler, Myron A. (Inventor)

    2001-01-01

    A compact robotic hand includes a palm housing, a wrist section, and a forearm section. The palm housing supports a plurality of fingers and one or more movable palm members that cooperate with the fingers to grasp and/or release an object. Each flexible finger comprises a plurality of hingedly connected segments, including a proximal segment pivotally connected to the palm housing. The proximal finger segment includes at least one groove defining first and second cam surfaces for engagement with a cable. A plurality of lead screw assemblies each carried by the palm housing are supplied with power from a flexible shaft rotated by an actuator and output linear motion to a cable move a finger. The cable is secured within a respective groove and enables each finger to move between an opened and closed position. A decoupling assembly pivotally connected to a proximal finger segment enables a cable connected thereto to control movement of an intermediate and distal finger segment independent of movement of the proximal finger segment. The dexterous robotic hand closely resembles the function of a human hand yet is light weight and capable of grasping both heavy and light objects with a high degree of precision.

  10. Leadership and Teamwork in Trauma and Resuscitation.

    Science.gov (United States)

    Ford, Kelsey; Menchine, Michael; Burner, Elizabeth; Arora, Sanjay; Inaba, Kenji; Demetriades, Demetrios; Yersin, Bertrand

    2016-09-01

    Leadership skills are described by the American College of Surgeons' Advanced Trauma Life Support (ATLS) course as necessary to provide care for patients during resuscitations. However, leadership is a complex concept, and the tools used to assess the quality of leadership are poorly described, inadequately validated, and infrequently used. Despite its importance, dedicated leadership education is rarely part of physician training programs. The goals of this investigation were the following: 1. Describe how leadership and leadership style affect patient care; 2. Describe how effective leadership is measured; and 3. Describe how to train future physician leaders. We searched the PubMed database using the keywords "leadership" and then either "trauma" or "resuscitation" as title search terms, and an expert in emergency medicine and trauma then identified prospective observational and randomized controlled studies measuring leadership and teamwork quality. Study results were categorized as follows: 1) how leadership affects patient care; 2) which tools are available to measure leadership; and 3) methods to train physicians to become better leaders. We included 16 relevant studies in this review. Overall, these studies showed that strong leadership improves processes of care in trauma resuscitation including speed and completion of the primary and secondary surveys. The optimal style and structure of leadership are influenced by patient characteristics and team composition. Directive leadership is most effective when Injury Severity Score (ISS) is high or teams are inexperienced, while empowering leadership is most effective when ISS is low or teams more experienced. Many scales were employed to measure leadership. The Leader Behavior Description Questionnaire (LBDQ) was the only scale used in more than one study. Seven studies described methods for training leaders. Leadership training programs included didactic teaching followed by simulations. Although programs

  11. Helicopter overtriage in pediatric trauma.

    Science.gov (United States)

    Michailidou, Maria; Goldstein, Seth D; Salazar, Jose; Aboagye, Jonathan; Stewart, Dylan; Efron, David; Abdullah, Fizan; Haut, Elliot R

    2014-11-01

    Helicopter Emergency Medical Services (HEMS) have been designed to provide faster access to trauma center care in cases of life-threatening injury. However, the ideal recipient population is not fully characterized, and indications for helicopter transport in pediatric trauma vary dramatically by county, state, and region. Overtriage, or unnecessary utilization, can lead to additional patient risk and expense. In this study we perform a nationwide descriptive analysis of HEMS for pediatric trauma and assess the incidence of overtriage in this group. We reviewed records from the American College of Surgeons National Trauma Data Bank (2008-11) and included patients less than 16 years of age who were transferred from the scene of injury to a trauma center via HEMS. Overtriage was defined as patients meeting all of the following criteria: Glasgow Coma Scale (GCS) equal to 15, absence of hypotension, an Injury Severity Score (ISS) less than 9, no need for procedure or critical care, and a hospital length of stay of less than 24 hours. A total of 19,725 patients were identified with a mean age of 10.5 years. The majority of injuries were blunt (95.6%) and resulted from motor vehicle crashes (48%) and falls (15%). HEMS transported patients were predominately normotensive (96%), had a GCS of 15 (67%), and presented with minor injuries (ISS<9, 41%). Overall, 28 % of patients stayed in the hospital for less than 24 hours, and the incidence of overtriage was 17%. Helicopter overtriage is prevalent among pediatric trauma patients nationwide. The ideal model to predict need for HEMS must consider clinical outcomes in the context of judicious resource utilization. The development of guidelines for HEMS use in pediatric trauma could potentially limit unnecessary transfers while still identifying children who require trauma center care in a timely fashion. Copyright © 2014. Published by Elsevier Inc.

  12. CT findings of chest trauma

    International Nuclear Information System (INIS)

    Kim, Young Tong; Kim Young Il

    1998-01-01

    Trauma is the third leading cause of death, irrespective of age, and the leading cause of death in persons under 40 persons under 40 years of age. Most pleural, pulmonary, mediastinal, and diaphragmatic injuries are not seen on conventional chest radiographs, or are underestimated. In patients with chest trauma, CT scanning is an effective and sensitive method of detecting thoracic injuries and provides accurate information regarding their pattern and extent. (author). 5 refs., 17 figs

  13. Blunt cerebrovascular injuries in trauma.

    Science.gov (United States)

    Eastham, Shannon

    2016-09-01

    Blunt cerebrovascular injury (BCVI) includes trauma to the carotid or vertebral vessels and is noted in 0.1% of hospitalized trauma patients without an initial screening system in place. Several important topics must be addressed including determination of the appropriate screening population, the best modality of screening for diagnosis, treatment types, and required follow-up of blunt cerebrovascular injuries. Copyright © 2015 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  14. Spinal trauma. An imaging approach

    Energy Technology Data Exchange (ETDEWEB)

    Cassar-Pullicino, V.N. [The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire (United Kingdom). Dept. of Radiology; Imhof, H. [University and General Hospital Vienna (Austria). Dept. of Radiodiagnostics

    2006-07-01

    The diagnosis of trauma to the spine - where the slightest oversight may have catastrophic results - requires a thorough grasp of the spectrum of resultant pathology as well as the imaging modalities used in making an accurate diagnosis. In Spinal Trauma, the internationally renowned team of experts provides a comprehensive, cutting-edge exposition of the current vital role of imaging in the diagnosis and treatment of injuries to the axial skeleton. Beginning with a valuable clinical perspective of spinal trauma, the book offers the reader a unique overview of the biomechanics underlying the pathology of cervical trauma. Acute trauma topics include: - Optimization of imaging modalities - Malalignment - signs and significance - Vertebral fractures - detection and implications - Classification of thoraco-lumbar fractures - rationale and relevance - Neurovascular injury. Distilling decades of clinical and teaching expertise, the contributors further discuss the current role of imaging in special focus topics, which include: - The pediatric spine - Sports injuries - The rigid spine - Trauma in the elderly - Vertebral collapse, benign and malignant - Spinal trauma therapy - Vertebral fractures and osteoporosis - Neuropathic spine. All throughout the book, the focus is on understanding the injury, and its implications and complications, through 'an imaging approach'. Lavishly illustrated with hundreds of superb MR images and CT scans, and clear full-color drawings, the authors conclude with a look into the future, defining clinical trends and research directions. Spinal Trauma - with its broad scope, practical imaging approach, and current focus - is designed to enhance confidence and accuracy, making it essential reading for clinicians and radiologists at all levels. (orig.)

  15. Arthritis of the hand - Rheumatoid

    Science.gov (United States)

    ... All Topics A-Z Videos Infographics Symptom Picker Anatomy Bones Joints Muscles Nerves Vessels Tendons About Hand Surgery What is a Hand Surgeon? What is a Hand Therapist? Media Find a Hand Surgeon Home Anatomy Rheumatoid Arthritis Email to a friend * required fields ...

  16. Taxonomy of Trauma Leadership Skills: A Framework for Leadership Training and Assessment.

    Science.gov (United States)

    Leenstra, Nico F; Jung, Oliver C; Johnson, Addie; Wendt, Klaus W; Tulleken, Jaap E

    2016-02-01

    Good leadership is essential for optimal trauma team performance, and targeted training of leadership skills is necessary to achieve such leadership proficiency. To address the need for a taxonomy of leadership skills that specifies the skill components to be learned and the behaviors by which they can be assessed across the five phases of trauma care, the authors developed the Taxonomy of Trauma Leadership Skills (TTLS). Critical incident interviews were conducted with trauma team leaders and members from different specialties-emergency physicians, trauma surgeons, anesthesiologists, and emergency ward nurses-at three teaching hospitals in the Netherlands during January-June 2013. Data were iteratively analyzed for examples of excellent leadership skills at each phase of trauma care. Using the grounded theory approach, elements of excellent leadership skills were identified and classified. Elements and behavioral markers were sorted and categorized using multiple raters. In a two-round verification process in late 2013, the taxonomy was reviewed and rated by trauma team leaders and members from the multiple specialties for its coverage of essential items. Data were gathered from 28 interviews and 14 raters. The TTLS details 5 skill categories (information coordination, decision making, action coordination, communication management, and coaching and team development) and 37 skill elements. The skill elements are captured by 67 behavioral markers. The three-level taxonomy is presented according to five phases of trauma care. The TTLS provides a framework for teaching, learning, and assessing team leadership skills in trauma care and other complex, acute care situations.

  17. Service Usage Typologies in a Clinical Sample of Trauma-Exposed Adolescents: A Latent Class Analysis.

    Science.gov (United States)

    Choi, Kristen R; Briggs, Ernestine C; Seng, Julia S; Graham-Bermann, Sandra A; Munro-Kramer, Michelle L; Ford, Julian D

    2017-11-27

    The purpose of this study is to describe typologies of service utilization among trauma-exposed, treatment-seeking adolescents and to examine associations between trauma history, trauma-related symptoms, demographics, and service utilization. Latent class analysis was used to derive a service utilization typologies based on 10 service variables using a sample of 3,081 trauma-exposed adolescents ages 12 to 16 from the National Child Traumatic Stress Network Core Dataset. Services used 30 days prior to the initial assessment from 5 sectors were examined (health care, mental health, school, social services, and juvenile justice). A 5-class model was selected based on statistical fit indices and substantive evaluation of classes: (a) High intensity/multisystem, 9.5%; (b) Justice-involved, 7.2%; (c) Low intensity/multisystem, 19.9%; (d) Social service and mental health, 19.9%; and (e) Low service usage/reference, 43.5%. The classes could be differentiated based on cumulative trauma, maltreatment history, PTSD, externalizing and internalizing symptoms, and age, gender, race/ethnicity and place of residence. This study provides new evidence about patterns of service utilization by trauma exposed, treatment seeking adolescents. Most of these adolescents appear to be involved with at least 2 service systems prior to seeking trauma treatment. Higher cumulative exposure to multiple types of trauma was associated with greater service utilization intensity and complexity, but trauma symptomatology was not. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  18. Trauma in Auckland: an overview.

    Science.gov (United States)

    Streat, S J; Donaldson, M L; Judson, J A

    1987-07-22

    Data are presented on all 569 subjects who, as a result of trauma, either died or were admitted to hospital in Auckland over a four week period. Median age was 23 with an overall 3:2 male:female ratio. Median injury severity score (ISS) was five with 9% of subjects having an ISS of 16 or more (major trauma). Blunt trauma accounted for 84% of all injuries. Life threatening injuries were most commonly to the head, thorax and abdomen while the largest number of less severe injuries were to the extremities. Eight subjects died before admission to hospital and a further six in hospital. Definitive care was given to 98% of patients at Middlemore and Auckland hospitals (including the onsite Princess Mary paediatric facility) but 26% had presented first to other hospitals and 43% of all patients were transferred from one hospital to another. The 561 patients used 6380 hospital days (including 314 intensive care days) and the following services--operating room 63%, orthopaedic ward 45%, plastic surgical ward 17%, paediatric ward 15%, neurosurgical ward 10%, general surgical ward 5%, intensive care 5% and CT scanner 4%. Only one hospital death was judged potentially preventable. This study reveals areas where trauma care could be improved, demonstrates the large amount of hospital resources required to treat trauma and particularly highlights the urgent need for studies into strategies for trauma prevention in New Zealand.

  19. Endovascular interventions for multiple trauma

    International Nuclear Information System (INIS)

    Kinstner, C.; Funovics, M.

    2014-01-01

    In recent years interventional radiology has significantly changed the management of injured patients with multiple trauma. Currently nearly all vessels can be reached within a reasonably short time with the help of specially preshaped catheters and guide wires to achieve bleeding control of arterial und venous bleeding. Whereas bleeding control formerly required extensive open surgery, current interventional methods allow temporary vessel occlusion (occlusion balloons), permanent embolization and stenting. In injured patients with multiple trauma preinterventional procedural planning is performed with the help of multidetector computed tomography whenever possible. Interventional radiology not only allows minimization of therapeutic trauma but also a considerably shorter treatment time. Interventional bleeding control has developed into a standard method in the management of vascular trauma of the chest and abdomen as well as in vascular injuries of the upper and lower extremities when open surgical access is associated with increased risk. Additionally, pelvic trauma, vascular trauma of the superior thoracic aperture and parenchymal arterial lacerations of organs that can be at least partially preserved are primarily managed by interventional methods. In an interdisciplinary setting interventional radiology provides a safe and efficient means of rapid bleeding control in nearly all vascular territories in addition to open surgical access. (orig.) [de

  20. Blunt abdominal trauma in children.

    Science.gov (United States)

    Schonfeld, Deborah; Lee, Lois K

    2012-06-01

    This review will examine the current evidence regarding pediatric blunt abdominal trauma and the physical exam findings, laboratory values, and radiographic imaging associated with the diagnosis of intra-abdominal injuries (IAI), as well as review the current literature on pediatric hollow viscus injuries and emergency department disposition after diagnosis. The importance of the seat belt sign on physical examination and screening laboratory data remains controversial, although screening hepatic enzymes are recommended in the evaluation of nonaccidental trauma to identify occult abdominal organ injuries. Focused Assessment with Sonography for Trauma (FAST) has modest sensitivity for hemoperitoneum and IAI in the pediatric trauma patient. Patients with concern for undiagnosed IAI, including bowel injury, may be considered for hospital admission and serial abdominal exams without an increased risk of complications, if an exploratory laparotomy is not performed emergently. Although the FAST exam is not recommended as the sole screening tool to rule out IAI in hemodynamically stable trauma patients, it may be used in conjunction with the physical exam and laboratory findings to identify children at risk for IAI. Children with a normal physical exam and normal abdominal CT may not require routine hospitalization after blunt abdominal trauma.

  1. Imaging of blunt chest trauma

    International Nuclear Information System (INIS)

    Wicky, S.; Wintermark, M.; Schnyder, P.; Capasso, P.; Denys, A.

    2000-01-01

    In western European countries most blunt chest traumas are associated with motor vehicle and sport-related accidents. In Switzerland, 39 of 10,000 inhabitants were involved and severely injured in road accidents in 1998. Fifty two percent of them suffered from blunt chest trauma. According to the Swiss Federal Office of Statistics, traumas represented in men the fourth major cause of death (4 %) after cardiovascular disease (38 %), cancer (28 %), and respiratory disease (7 %) in 1998. The outcome of chest trauma patients is determined mainly by the severity of the lesions, the prompt appropriate treatment delivered on the scene of the accident, the time needed to transport the patient to a trauma center, and the immediate recognition of the lesions by a trained emergency team. Other determining factors include age as well as coexisting cardiac, pulmonary, and renal diseases. Our purpose was to review the wide spectrum of pathologies related to blunt chest trauma involving the chest wall, pleura, lungs, trachea and bronchi, aorta, aortic arch vessels, and diaphragm. A particular focus on the diagnostic impact of CT is demonstrated. (orig.)

  2. Radiographic evaluation of hepatic trauma

    International Nuclear Information System (INIS)

    Federle, M.P.

    1985-01-01

    The incidence of significant abdominal trauma continues to rise and accounts currently for approximately 10 percent of the annual 130,000 trauma-related deaths in the United States. Over 60 percent of patients are from 10 to 40 years of age, with a striking predominance of males. Children are mostly victims of blunt trauma, while some large reviews of liver trauma in adults show a prevalence of penetrating injuries. Injury to the liver is second only to the spleen in incidence of intraperitoneal injuries. Morbidity and mortality from hepatic trauma are related to the mechanism and extent of injury. Penetrating injuries generally have a lower mortality, about 5 percent, especially if they are due to stab wounds or low velocity gunshot wounds. Shotgun and high velocity gunshot wounds may cause massive fragmentation of the liver and are associated with proportionately greater mortality. The mortality from blunt trauma is from 15 to 45 percent in many large series. Death from isolated liver injury is uncommon, but is usually due to uncontrolled hemorrhage. Injury to other abdominal organs is associated in many cases, as are injuries to the head, chest, and limbs. The extraabdominal injuries are frequently more apparent clinically, but may mask potentially life-threatening abdominal visceral injuries

  3. Multiple trauma in children: critical care overview.

    Science.gov (United States)

    Wetzel, Randall C; Burns, R Cartland

    2002-11-01

    Multiple trauma is more than the sum of the injuries. Management not only of the physiologic injury but also of the pathophysiologic responses, along with integration of the child's emotional and developmental needs and the child's family, forms the basis of trauma care. Multiple trauma in children also elicits profound psychological responses from the healthcare providers involved with these children. This overview will address the pathophysiology of multiple trauma in children and the general principles of trauma management by an integrated trauma team. Trauma is a systemic disease. Multiple trauma stimulates the release of multiple inflammatory mediators. A lethal triad of hypothermia, acidosis, and coagulopathy is the direct result of trauma and secondary injury from the systemic response to trauma. Controlling and responding to the secondary pathophysiologic sequelae of trauma is the cornerstone of trauma management in the multiply injured, critically ill child. Damage control surgery is a new, rational approach to the child with multiple trauma. The selection of children for damage control surgery depends on the severity of injury. Major abdominal vascular injuries and multiple visceral injuries are best considered for this approach. The effective management of childhood multiple trauma requires a combined team approach, consideration of the child and family, an organized trauma system, and an effective quality assurance and improvement mechanism.

  4. CT of laryngotracheal trauma

    International Nuclear Information System (INIS)

    Lupetin, A.R.; Daffner, R.H.

    1991-01-01

    This paper evaluates the usefulness of CT for the diagnosis of traumatic laryngotracheal abnormalities. The authors retrospectively evaluated the neck CT studies of 50 patients (36 males, 14 females; age range, 16-75 years) who presented to a level I trauma center after suffering a blunt or penetrating laryngotracheal injury. CT results were correlated with endoscopic or surgical findings in 43 cases. Three groups emerge. CT positive: hyloid bone or laryngotracheal cartilage injury; CT positive: soft-tissue injury only; and CT negative. In group 1, CT demonstrated all bony or cartilaginous injuries proved at surgery or suggested at endoscopy. CT failed to demonstrate laryngotracheal separation in 1 case. In group 2, CT demonstrated all soft-tissue injuries suggested at endoscopy. In group 3, CT findings agreed with those of endoscopy in 7 cases, but minor soft-tissue findings seen at endoscopy were missed in 3 cases. Seven patients were studied only with CT. Ct is an accurate technique for detecting bony or cartilaginous laryngotracheal traumatic abnormalities. However, laryngotracheal separation and minor soft-tissue injuries can be missed

  5. Trauma and termination.

    Science.gov (United States)

    Ferraro, F

    1995-02-01

    The author suggests a particular reading of the thesis put forward by Freud in 'Analysis terminable and interminable' that an effective and more definitive conclusion may be expected in analyses of cases with traumatic aetiology. This reading shifts the emphasis from the patient's history to the possibility of its crystallising in focal nuclei emerging within the analytic relationship under the pressure of the termination. The revival of separation anxieties which cannot be worked through, and their crystallisation in precipitating traumatic events, may give rise to decisive psychic work allowing the analysis to be brought to a conclusion. Two case histories are presented to show how the end of the analysis assumes the form of a new trauma, which reactivates in the present, traumatic anxieties from the patient's own infantile history. In the first case a premature birth and in the second a miscarriage, originally experienced as isolated automatic events without time or history, are relived in the terminal phase as vicissitudes of the transference, so that new meaning can be assigned to them and they can be withdrawn from the somatic cycle of repetition. The powerful tendency to act out and the intense countertransference pressure on the analyst are discussed in the light of the specificities of this phase, which is crucial to the success of the analysis. This leads to a re-examination, in the concluding notes, of some theoretical questions inherent in the problem of the termination and, in particular, to a discussion of the ambiguous concept of a natural ending.

  6. Head trauma and CT

    International Nuclear Information System (INIS)

    Samejima, Kanji; Yoshii, Nobuo; Tobari, Chitoshi

    1979-01-01

    It has been said that chronic subdural hematoma cannot be diagnosed by CT. In our cases, CT was used, and the results were described. According to the density of the picture, CT findings of chronic subdural hematoma could be classified into 3 types, those of higher density than that of the cerebral paranchyma, those of isodensity, and those of lower density than that of the cerebral parenchyma. The difference among them appeared to be due to variation in the fluid in hematoma, especially that in hemoglobin concentration. Chronic subdural hematoma was found in 27 of 388 cases of head trauma in which CT was undertaken in our department of surgery for last 2 years. It is difficult to differenciate this disease from subdural edema or subarachnoideal retention of the cerebrospinal fluid. In many cases, use of contrast medium added no change to the CT picture. Cerebral angiography is necessary for definite diagnosis of the disease. Chronic subdural hematoma gives more varieties of findings than other intracranial hematomas. However, if the film is very carefully read, CT is still useful for diagnosing this disease in spite of initially remarked difficulties. (Ueda, J.)

  7. [Prevention of hand injuries - current situation in Europe].

    Science.gov (United States)

    Leixnering, M; Quadlbauer, S; Szolarcz, C; Schenk, C; Leixnering, S; Körpert, K

    2013-12-01

    Hand injuries are a frequent occurrence and account for 41% of all occupational injuries. In general such accidents are the result of stress, inattention, tiredness, use of defective or poorly maintained machinery. However, artention must equally be directed at the large number of accidents occurring in leisure time activities since the inability to work due to a leisure time accident is similarly cost-intensive. Throughout Europe attempts have been made in the past 10 years to improve prevention. At the initiative of the Hand Trauma Committee (HTC) of FESSH prevention conferences were stated in 2009. These have in part reduced the number of hand injuries in -Europe. In Austria a special controlling committee was founded by the Austrian Workers' Compensation Board (AUVA) with the specific objective of reducing the number of hand injuries. Similarly the "Circle for Leisure Time Hand Injury Prevention" was created to specifically deal with hand injuries occurring during leisure time activities. Through the cooperation of these 2 committees and implementation of the thus decided measures, a reduction in the number of accidents involving the hand is to be expected with a concomitant reduction in the associated costs. © Georg Thieme Verlag KG Stuttgart · New York.

  8. Can guilt lead to psychological growth following trauma exposure?

    Science.gov (United States)

    Dekel, Sharon; Mamon, Daria; Solomon, Zahava; Lanman, Olivia; Dishy, Gabriella

    2016-02-28

    With the growing interest in posttraumatic growth (PTG) and its predictors, this study examined the relationship between trauma-related guilt and PTG in a sample of veterans over time. Self-reported guilt, PTG, and posttraumatic stress disorder (PTSD) symptoms were measured in combat veterans and prisoners of war (POWs). Positive correlations were found between guilt, PTSD, and PTG levels. Hierarchical regression revealed that initial guilt levels predicted subsequent PTG controlling for initial PTSD in combat veterans but not in POWs. The findings suggest that posttraumatic growth can be facilitated by trauma-related guilt, underscoring the complex relationship between positive and negative trauma outcomes. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  9. Establishment of a course for Focused Assessment Sonography for Trauma

    International Nuclear Information System (INIS)

    Abu-Zidan, Fikri M.; Kazzam, Elsadig E.; Czechowski, Janusz J.; Dittrich, Kenneth

    2005-01-01

    Focused Assessment Sonography for Trauma (FAST) is not widely practiced by Trauma Surgeons in the Middle East despite its international acceptance. A FAST course was established by the Trauma Group at the Faculty of Medicine and Health Sciences at United Arab Emirates (UAE) University aiming to introduce doctors who have limited experience of ultrasound to the basics of FAST. This article summarizes the content of the course; the evaluation of the participants and their recommendations. An 8 hour FAST course was offered to 18 participants in May 2004 in the Faculty of Medicine and Health Sciences, UAE University, Al-Ain, UAE. Lectures with syllabus material were used to cover the following topics: basic ultrasound physics, knobology and sonographic orientation, the FAST scan, chest and cardiac trauma sonographic evaluation, training and credentialing issues. Each participant received 3 hours of hands-on ultrasound instruction. On completion of the course participants responded anonymously to an evaluation questionnaire. All participants responded to the questionnaire (100% response rate). Delegates found the course well organized, relevant, met their needs and encourages them to use FAST in their own practice. The course objectives were met. Participants suggested that including actual patients and the use of animal models improve the practical sessions. Organizing a FAST course is an important step towards recognizing and implementing it in practice. Nevertheless, there is a need for appropriate quality assurance and credentialing guidelines before commencing. (author)

  10. CT in the evaluation of pelvic trauma

    International Nuclear Information System (INIS)

    Federle, M.P.

    1986-01-01

    Pelvic fractures from motor vehicle accidents are a cause of substantial morbidity and permanent disability, and are the third leading cause of death following blunt trauma. Associated extremity fractures are common, and injury to abdominal and pelvic viscera may occur. Difficulty in establishing the source of hemorrhage may be encountered, especially since pelvic fractures with extraperitoneal bleeding may result in intraperitoneal bleeding through torn fascial planes. The difficulty in properly diagnosing and managing complex fractures of the pelvis and acetabulum is well documented. Prognosis is influenced by the type and extent of pelvic fracture and associated soft tissue injuries. Computed tomography (CT) has proved to be a valuable tool in evaluation of these complex and life-threatening injuries

  11. Radiologic findings of thoracic trauma

    Directory of Open Access Journals (Sweden)

    Akgul Ozmen C

    2017-08-01

    Full Text Available Cihan Akgul Ozmen,1 Serdar Onat,2 Delal Aycicek3 1Department of Radiology, 2Department of Chest Surgery, Dicle University School of Medicine, Diyarbakir, 3Radiology Unit, Siirt State Hospital, Siirt, Turkey Introduction: Chest trauma may be blunt or penetrating and the chest is the third most common trauma region. It is a significant cause of mortality. Multidetector computed tomography (MDCT has been an increasingly used method to evaluate chest trauma because of its high success in detecting tissue and organ injuries. Herein, we aimed to present MDCT findings in patients with blunt and penetrating chest trauma admitted to our department. Methods: A total of 240 patients admitted to the emergency department of our hospital between April 2012 and July 2013 with a diagnosis of chest trauma who underwent MDCT evaluations were included. Most of the patients were male (83.3% and victims of a blunt chest trauma. The images were analyzed with respect to the presence of fractures of bony structures, hemothorax, pneumothorax, mediastinal organ injury, and pulmonary and vascular injuries. Results: MDCT images of the 240 patients yielded a prevalence of 41.7% rib fractures, 11.2% scapular fractures, and 7.5% clavicle fractures. The prevalence of thoracic vertebral fracture was 13.8% and that of sternal fracture was 3.8%. The prevalence of hemothorax, pneumothorax, pneumomediastinum, and subcutaneous emphysema was 34.6%, 62.1%, 9.6%, and 35.4%, respectively. The prevalence of rib, clavicle, and thoracic vertebral fractures and pulmonary contusion was higher in the blunt trauma group, whereas the prevalence of hemothorax, subcutaneous emphysema, diaphragmatic injury, and other vascular lacerations was significantly higher in the penetrating trauma group than in the blunt trauma group (p<0.05. Conclusion: MDCT images may yield a high prevalence of fracture of bony structures, soft tissue lacerations, and vascular lesions, which should be well understood by

  12. Performance Comparison Between FEDERICA Hand and LARM Hand

    OpenAIRE

    Carbone, Giuseppe; Rossi, Cesare; Savino, Sergio

    2015-01-01

    This paper describes two robotic hands that have been\\ud developed at University Federico II of Naples and at the\\ud University of Cassino. FEDERICA Hand and LARM Hand\\ud are described in terms of design and operational features.\\ud In particular, careful attention is paid to the differences\\ud between the above-mentioned hands in terms of transmission\\ud systems. FEDERICA Hand uses tendons and pulleys\\ud to drive phalanxes, while LARM Hand uses cross four-bar\\ud linkages. Results of experime...

  13. Childhood trauma and resilience in psoriatic patients: A preliminary report.

    Science.gov (United States)

    Crosta, Maria Luigia; De Simone, Clara; Di Pietro, Salvatore; Acanfora, Mariateresa; Caldarola, Giacomo; Moccia, Lorenzo; Callea, Antonino; Panaccione, Isabella; Peris, Ketty; Rinaldi, Lucio; Janiri, Luigi; Di Nicola, Marco

    2018-03-01

    Psoriasis is a chronic inflammatory skin disease with a complex etiology, involving the immune system, genetic factors, and external/internal triggers, with psychosomatic aspects. The aim of the study was to investigate childhood trauma and resilience in a psoriatic sample compared with healthy controls. Correlations between childhood trauma, resilience, quality of life, clinical data and psoriatic features were also evaluated. Seventy-seven psoriatic patients and seventy-six homogeneous healthy controls were enrolled. We used the Psoriasis Area and Severity Index (PASI) to assess the severity of psoriasis and the Skindex-29 to measure health-related quality of life. The psychometric battery included the Childhood Trauma Questionnaire (CTQ) and the Connor-Davidson Resilience Scale (CD-Risc) to assess trauma exposure and resilience, respectively. Psoriatic patients showed a significant prevalence of childhood trauma and a lower resilience level compared to healthy controls. Associations between traumatic experiences, low resilience and reduced quality of life in psoriatic subjects were also observed. A multidisciplinary approach is helpful to investigate clinical aspects, trigger factors and psychophysiological stress response in psoriatic subjects. Improving resilience with an early psychological intervention focused on self-motivation and strengthening of self-efficacy could facilitate the management of psoriasis. Copyright © 2018 Elsevier Inc. All rights reserved.

  14. [Hands well - all's well : Prevention campaign of the Austrian General Accident Insurance Institution (AUVA) to reduce hand injuries].

    Science.gov (United States)

    Leixnering, M; Pezzei, C; Schenk, C; Szolarz, C; Jurkowitsch, J; Quadlbauer, S

    2017-06-01

    Overall, 41% of all work-related accidents lead to a hand injury. In the younger generation, the incidence rate even rises to 50%. In Austria, these accidents result in approximately half a million sick leave days per annum, an average of 12.5 days per accident. In comparison, leisure-time hand injuries show a significantly higher accident rate: 60% of hand injuries occur during leisure time. Far fewer safety measures are taken and a lack of adequate training and a disregard for safety recommendations are observed.This large number of hand injuries led to the launch of a campaign in Austria in 2014-2015 called "Hände gut - Alles Gut", (Hands well - all's well). This campaign was aimed at reducing the costs, a sum of 309 million Euros, incurred solely from work-related hand accidents, by at least 5-10%.These exorbitantly high costs are not only due to severe hand trauma, most result from a multitude of slight and superficial wounds.

  15. Hand grip strength

    DEFF Research Database (Denmark)

    Frederiksen, Henrik; Gaist, David; Petersen, Hans Christian

    2002-01-01

    in life is a major problem in terms of prevalence, morbidity, functional limitations, and quality of life. It is therefore of interest to find a phenotype reflecting physical functioning which has a relatively high heritability and which can be measured in large samples. Hand grip strength is known......-55%). A powerful design to detect genes associated with a phenotype is obtained using the extreme discordant and concordant sib pairs, of whom 28 and 77 dizygotic twin pairs, respectively, were found in this study. Hence grip strength is a suitable phenotype for identifying genetic variants of importance to mid...

  16. Impaired hand size estimation in CRPS.

    Science.gov (United States)

    Peltz, Elena; Seifert, Frank; Lanz, Stefan; Müller, Rüdiger; Maihöfner, Christian

    2011-10-01

    A triad of clinical symptoms, ie, autonomic, motor and sensory dysfunctions, characterizes complex regional pain syndromes (CRPS). Sensory dysfunction comprises sensory loss or spontaneous and stimulus-evoked pain. Furthermore, a disturbance in the body schema may occur. In the present study, patients with CRPS of the upper extremity and healthy controls estimated their hand sizes on the basis of expanded or compressed schematic drawings of hands. In patients with CRPS we found an impairment in accurate hand size estimation; patients estimated their own CRPS-affected hand to be larger than it actually was when measured objectively. Moreover, overestimation correlated significantly with disease duration, neglect score, and increase of two-point-discrimination-thresholds (TPDT) compared to the unaffected hand and to control subjects' estimations. In line with previous functional imaging studies in CRPS patients demonstrating changes in central somatotopic maps, we suggest an involvement of the central nervous system in this disruption of the body schema. Potential cortical areas may be the primary somatosensory and posterior parietal cortices, which have been proposed to play a critical role in integrating visuospatial information. CRPS patients perceive their affected hand to be bigger than it is. The magnitude of this overestimation correlates with disease duration, decreased tactile thresholds, and neglect-score. Suggesting a disrupted body schema as the source of this impairment, our findings corroborate the current assumption of a CNS involvement in CRPS. Copyright © 2011 American Pain Society. Published by Elsevier Inc. All rights reserved.

  17. Back to basics: hand hygiene and surgical hand antisepsis.

    Science.gov (United States)

    Spruce, Lisa

    2013-11-01

    Health care-associated infections (HAIs) are a significant issue in the United States and throughout the world, but following proper hand hygiene practices is the most effective and least expensive way to prevent HAIs. Hand hygiene is inexpensive and protects patients and health care personnel alike. The four general types of hand hygiene that should be performed in the perioperative environment are washing hands that are visibly soiled, hand hygiene using alcohol-based products, surgical hand scrubs, and surgical hand scrubs using an alcohol-based surgical hand rub product. Barriers to proper hand hygiene may include not thinking about it, forgetting, skin irritation, a lack of role models, or a lack of a safety culture. One strategy for improving hand hygiene practices is monitoring hand hygiene as part of a quality improvement project, but the most important aspect for perioperative team members is to set an example for other team members by following proper hand hygiene practices and reminding each other to perform hand hygiene. Copyright © 2013 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  18. Case Report: 84 year-old woman with alien hand syndrome [version 1; referees: 2 approved, 1 approved with reservations

    Directory of Open Access Journals (Sweden)

    Ihtesham Aatif Qureshi

    2016-07-01

    Full Text Available Background: Alien hand syndrome [AHS] is a rare and ill-defined neurological disorder. It produces complex, goal-directed motion of one hand that is involuntarily instigated. This syndrome characteristically arises after brain trauma, brain surgery, stroke or encephalitis. We describe a case of AHS in a patient who had a previous episode of subarachnoid hemorrhage affecting the left frontal lobe and corpus callosum. Case presentation: An 84-year-old woman presented to the emergency department complaining of headaches and several episodes of her left arm moving as if it was groping around trying to grab at her own body. A computed tomography scan of the head demonstrated an acute left superior frontal hemorrhage with compression of the corpus callosum. Transcranial Doppler report showed no significant abnormality in the insonated vessels. After being stabilized for the acute bleed, she was treated with clonazepam 0.5 mgat night for the uncontrolled hand movements. Her movements resolved by her next month follow up. The diagnosis of AHS was made based on her clinical presentation, characterization of the movement and localization correlating with findings in neuroimaging. Conclusion: We document a rare neurologic disorder seen in patients presenting with a history of previous strokes and a typical description of involuntary and unintentional, uncontrolled unilateral arm movements with repetitive grasping. The present case has a combination of frontal and callosal lesions.  These findings appear to support a potential destruction leading to the rare syndrome.

  19. Genetic basis of resistance to trauma in inbred strains of mice

    International Nuclear Information System (INIS)

    Radojicic, C.; Andric, B.; Simovic, M.; Dujic, A.; Marinkovic, D.

    1990-01-01

    In this study the resistance to mechanical, thermal, and radiation trauma in four inbred strains of mice (AKR, BALB/c, CBA, and C57Bl/6) was compared with the degree of genetic resemblance, by analyzing the allozyme variabilities of these strains. It was shown that the highest degree of genetic resemblance was among CBA and AKR strains, which correlated with a similar degree of resistance to trauma. On the other hand, BALB/c and C57Bl/6 strains expressed significant differences, both genetically and with respect to the responses to trauma. The hypothesis is introduced that the genetic determination of the resistance to trauma is based on: (a) a polygenic control of general physiological homeostasis, with the possibility that (b) some specific genes or single loci may contribute more than others to such adaptations of the strains tested

  20. Lower Urinary Tract Injuries Following Blunt Trauma: A Review of Contemporary Management

    Science.gov (United States)

    Kong, Jennifer P. L; Bultitude, Matthew F; Royce, Peter; Gruen, Russell L; Cato, Alex; Corcoran, Niall M

    2011-01-01

    Lower urinary tract trauma, although relatively uncommon in blunt trauma, can lead to significant morbidity when diagnosed late or left untreated; urologists may only encounter a handful of these injuries in their career. This article reviews the literature and reports on the management of these injuries, highlighting the issues facing clinicians in this subspecialty. Also presented is a structured review detailing the mechanisms, classification, diagnosis, management, and complications of blunt trauma to the bladder and urethra. The prognosis for bladder rupture is excellent when treated. Significant intraperitoneal rupture or involvement of the bladder neck mandates surgical repair, whereas smaller extraperitoneal lacerations may be managed with catheterization alone. With the push for management of trauma patients in larger centers, urologists in these hospitals are seeing increasing numbers of lower urinary tract injuries. Prospective analysis may be achieved in these centers to address the current lack of Level 1 evidence. PMID:22114545

  1. History of the Dental Trauma Guide

    DEFF Research Database (Denmark)

    Andreasen, Jens Ove; Christensen, Søren Steno Ahrensburg

    2012-01-01

    The history of the Dental Trauma Guide dates back to 1965, where guidelines were developed for trauma records and treatment of various trauma entities at the Department of Oral and Maxillofacial Surgery at the University Hospital in Copenhagen. In 1972, a unique possibility came up at the Serum...... Institute in Copenhagen to test various dental trauma procedures in monkeys, which served as kidney donors in the polio vaccine production. Over the years, 40 000 dental trauma patients were treated at the Trauma Centre according to established guidelines, and 4000 of these have been enrolled in long...

  2. Appendicitis following blunt abdominal trauma.

    Science.gov (United States)

    Cobb, Travis

    2017-09-01

    Appendicitis is a frequently encountered surgical problem in the Emergency Department (ED). Appendicitis typically results from obstruction of the appendiceal lumen, although trauma has been reported as an infrequent cause of acute appendicitis. Intestinal injury and hollow viscus injury following blunt abdominal trauma are well reported in the literature but traumatic appendicitis is much less common. The pathophysiology is uncertain but likely results from several mechanisms, either in isolation or combination. These include direct compression/crush injury, shearing injury, or from indirect obstruction of the appendiceal lumen by an ileocecal hematoma or traumatic impaction of stool into the appendix. Presentation typically mirrors that of non-traumatic appendicitis with nausea, anorexia, fever, and right lower quadrant abdominal tenderness and/or peritonitis. Evaluation for traumatic appendicitis requires a careful history and physical exam. Imaging with ultrasound or computed tomography is recommended if the history and physical do not reveal an acute surgical indication. Treatment includes intravenous antibiotics and surgical consultation for appendectomy. This case highlights a patient who developed acute appendicitis following blunt trauma to the abdomen sustained during a motor vehicle accident. Appendicitis must be considered as part of the differential diagnosis in any patient who presents to the ED with abdominal pain, including those whose pain begins after sustaining blunt trauma to the abdomen. Because appendicitis following trauma is uncommon, timely diagnosis requires a high index of suspicion. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Hand Matters: Left-Hand Gestures Enhance Metaphor Explanation

    Science.gov (United States)

    Argyriou, Paraskevi; Mohr, Christine; Kita, Sotaro

    2017-01-01

    Research suggests that speech-accompanying gestures influence cognitive processes, but it is not clear whether the gestural benefit is specific to the gesturing hand. Two experiments tested the "(right/left) hand-specificity" hypothesis for self-oriented functions of gestures: gestures with a particular hand enhance cognitive processes…

  4. Terrorism, Trauma, and Tragedies: A Counselor's Guide to Preparing and Responding.

    Science.gov (United States)

    Bass, Debra D., Ed.; Yep, Richard, Ed.

    Conceived as a resource for counselors, teachers, administrators, parents and others, this is a hands-on book that provides useful information and guidance on strategies, techniques and plans that have worked well in addressing the trauma of a tragic event. This book is a collection of original material, news stories, handouts, and even…

  5. Classification of hand eczema

    DEFF Research Database (Denmark)

    Agner, T; Aalto-Korte, K; Andersen, K E

    2015-01-01

    BACKGROUND: Classification of hand eczema (HE) is mandatory in epidemiological and clinical studies, and also important in clinical work. OBJECTIVES: The aim was to test a recently proposed classification system of HE in clinical practice in a prospective multicentre study. METHODS: Patients were...... recruited from nine different tertiary referral centres. All patients underwent examination by specialists in dermatology and were checked using relevant allergy testing. Patients were classified into one of the six diagnostic subgroups of HE: allergic contact dermatitis, irritant contact dermatitis, atopic...... system investigated in the present study was useful, being able to give an appropriate main diagnosis for 89% of HE patients, and for another 7% when using two main diagnoses. The fact that more than half of the patients had one or more additional diagnoses illustrates that HE is a multifactorial disease....

  6. Wide Awake Hand Surgery.

    Science.gov (United States)

    Lied, Line; Borchgrevink, Grethe E; Finsen, Vilhjalmur

    2017-09-01

    "Wide awake hand surgery", where surgery is performed in local anaesthesia with adrenaline, without sedation or a tourniquet, has become widespread in some countries. It has a number of potential advantages and we wished to evaluate it among our patients. All 122 patients treated by this method during one year were evaluated by the surgeons and the patients on a numerical scale from 0 (best/least) to 10 (worst/most). Theatre time was compared to that recorded for a year when regional or general anaesthesia had been used. The patients' mean score for the general care they had received was 0.1 (SD 0.6), for pain during lidocaine injection 2.4 (SD 2.2), for pain during surgery 0.9 (SD 1.5), and for other discomfort during surgery 0.5 (SD 1.4). Eight reported that they would want general anaesthesia if they were to be operated again. The surgeons' mean evaluation of bleeding during surgery was 1.6 (SD 1.8), oedema during surgery 0.4 (SD 1.1), general disadvantages with the method 1.0 (SD 1.6) and general advantages 6.5 (SD 4.3). The estimation of advantages was 9.9 (DS 0.5) for tendon suture. 28 patients needed intra-operative additional anaesthesia. The proportion was lower among trained hand surgeons and fell significantly during the study period. Non-surgical theatre time was 46 (SD 15) minutes during the study period and 55 (SD 22) minutes during the regional/general period (p theatre.

  7. Modeling and control of an anthropomorphic robotic hand

    OpenAIRE

    Bensalah, Choukri

    2016-01-01

    Mención Europea en el título de doctor This thesis presents methods and tools for enabling the successful use of robotic hands. For highly dexterous and/or anthropomorphic robotic hands, these methods have to share some common goals, such as overcoming the potential complexity of the mechanical design and the ability of performing accurate tasks with low and efficient computational cost. A prerequisite for dexterity is to increase the workspace of the robotic hand. For th...

  8. Rheumatoid arthritis and hand surgery

    DEFF Research Database (Denmark)

    Peretz, Anne Sofie Rosenborg; Madsen, Ole Rintek; Brogren, Elisabeth

    2017-01-01

    Rheumatoid arthritis results in characteristic deformities of the hand. Medical treatment has undergone a remarkable development. However, not all patients achieve remission or tolerate the treatment. Patients who suffer from deformities and persistent synovitis may be candidates for hand surgery...

  9. Fractures and dislocations of the hand in polytrauma patients: Incidence, injury pattern and functional outcome.

    Science.gov (United States)

    Ferree, Steven; van der Vliet, Quirine M J; van Heijl, Mark; Houwert, Roderick M; Leenen, Luke P H; Hietbrink, Falco

    2017-04-01

    Injuries of the hand can cause significant functional impairment, diminished quality of life and delayed return to work. However, the incidence and functional outcome of hand injuries in polytrauma patients is currently unknown. The aim of this study was to determine the incidence, distribution and functional outcome of fractures and dislocation of the hand in polytrauma patients. A single centre retrospective cohort study was performed at a level 1 trauma centre. Polytrauma was defined as patients with an Injury Severity Score of 16 or higher. Fractures and dislocations to the hand were determined. All eligible polytrauma patients with hand injuries were included and a Quick Disability of Arm, Shoulder and Hand questionnaire (QDASH) and Patient-Rated Wrist/Hand Evaluation (PRWHE) were administered. Patients were contacted 1-6 years after trauma. In a cohort of 2046 polytrauma patients 72 patients (3.5%) suffered a hand injury. The functional outcome scores of 52 patients (72%) were obtained. The Metacarpal (48%) and carpal (33%) bones were the most frequently affected. The median QDASH score for all patients with hand injury was 17 (IQR 0-31) and the PRWHE 14 (IQR 0-41). Patients with a concomitant upper extremity injury (p=0.002 for PRWHE, p0.006 for QDASH) and those with higher ISS scores (p=0.034 for PRWHE, QDASH not significant) had worse functional outcome scores. As an example, of the 5 patients with the worst outcome scores 3 suffered an isolated phalangeal injury, all had concomitant upper extremity injury or neurological injuries (3 plexus injuries, 1 severe brain injury). The incidence of hand injuries in polytrauma patients is 3.5%, which is relatively low compared to a general trauma population. Metacarpal and carpal bones were most frequently affected. The functional extremity specific outcome scores are highly influenced by concomitant injuries (upper extremity injuries, neurological injuries and higher ISS). Copyright © 2017 Elsevier Ltd. All

  10. Management of Acute Skin Trauma

    Institute of Scientific and Technical Information of China (English)

    Joel W. Beam

    2010-01-01

    @@ Acute skin trauma (ie, abrasions, avulsions, blisters, incisions, lacerations, and punctures) is common among individuals involved in work, recreational, and athletic activities. Appropriate management of these wounds is important to promote healing and lessen the risk of cross-contamination and infection. Wound management techniques have undergone significant changes in the past 40 years but many clinicians continue to manage acute skin trauma with long-established, traditional techniques (ie, use of hydrogen peroxide, adhesive strips/patches, sterile gauze, or no dressing) that can delay healing and increase the risk of infection. The purpose of this review is to discuss evidence-based cleansing, debridement, and dressing techniques for the management of acute skin trauma.

  11. Temporal bone trauma and imaging

    International Nuclear Information System (INIS)

    Turetschek, K.; Czerny, C.; Wunderbaldinger, P.; Steiner, E.

    1997-01-01

    Fractures of the temporal bone result from direct trauma to the temporal bone or occur as one component of a severe craniocerebral injury. Complications of temporal trauma are hemotympanon, facial nerve paralysis, conductive or sensorineur hearing loss, and leakage of cerebrospinal fluid. Erly recognition and an appropiate therapy may improve or prevent permanent deficits related to such complications. Only 20-30% of temporal bone fractures can be visualized by plain films. CT has displaced plain radiography in the investigation of the otological trauma because subtle bony details are best evaluated by CT which even can be reformatted in multiple projections, regardless of the original plane of scanning. Associated epidural, subdural, and intracerebral hemorrhagic lesions are better defined by MRI. (orig.) [de

  12. Cerebral infarcts resulting from trauma

    International Nuclear Information System (INIS)

    Busch, G.

    1985-01-01

    Vascular occlusions due to cerebral trauma have always been regarded as great rarities. However, we have found hypo-dense foci of vascular distribution in 3.5% of 3500 CT examinations for trauma during the late phase. Lesions in the vascular territory of the posterior cerebral artery are usually the result of supratentorial pressure rise from epidural and subdural haematomas, leading to compression of the vessels against the edge of the tentorium. Typical infacts in the territory of the medial and anterior cerebral arteries were found only rarely by CT after cerebral trauma. Infarcts at the watersheds between the three vascular territories were found with surprising frequency and small infarcts were found in the basal ganglia. It is assumed that these were due to ischaemic or hypoxic events due to cardiac or pulmonary complications during the initial phase. (orig.) [de

  13. Trauma, suffering and resilience

    DEFF Research Database (Denmark)

    de Casas Soberón, Elena; Berliner, Peter

    2011-01-01

    The article discusses the challenge of using a conceptual framework to understand traumatic stress and still be open to listening to the stories of suffering, of lamentation, grief, hope, and values of people being oppressed by organised violence. The complexity of responses to the losses caused ...

  14. Failure to differentiate between threat-related and positive emotion cues in healthy adults with childhood interpersonal or adult trauma.

    Science.gov (United States)

    Chu, Denise A; Bryant, Richard A; Gatt, Justine M; Harris, Anthony W F

    2016-07-01

    Enhanced threat-related processing is associated with both elevated anxiety and childhood exposure to trauma. Given the paucity of evidence regarding the effects of childhood and adult trauma exposure on subsequent psychophysiological processes in the absence of psychopathology, we investigated the relative impacts of childhood interpersonal and non-interpersonal trauma, as well as adult trauma exposure on neural processing of threat in healthy adults. We measured peak amplitudes of the N170 face-sensitive visual ERP component response to non-conscious and conscious Angry (threat) versus Happy (non-threat, positive) and Neutral (non-threat baseline) faces at temporo-occipital sites (right-T6; left-T5) in 489 psychiatrically asymptomatic adults (aged 18-70 years, 54% women, 94% right-handed). N170 peak amplitude differences between Angry vs Happy or Neutral faces were calculated and subjected to hierarchical multiple regression analysis, with trauma types (childhood interpersonal, childhood non-interpersonal and adult trauma) entered as predictors of interest. After controlling for sociodemographic and health factors, N170 peak amplitudes for non-conscious Angry vs Happy faces were inversely associated with childhood interpersonal trauma at T6 and adult trauma exposure at T5. Post-hoc repeated measures ANOVA indicated that unlike adults without trauma exposure, trauma-exposed adults failed to show significantly reduced N170 responses to Happy relative to Angry faces during non-conscious processing. This suggests that childhood interpersonal and adult trauma exposure are associated with a failure to differentiate between non-threat or positive and threat-related emotion cues. This is consistent with generalised hypervigilance seen in PTSD, and suggests trauma exposure is associated with a generalized heightened responsivity to non-conscious non-threat or positive as well as threat-related emotion cues in psychiatrically healthy adults. Copyright © 2016 Elsevier Ltd

  15. Evaluation of Resources Necessary for Provision of Trauma Care in Botswana: An Initiative for a Local System.

    Science.gov (United States)

    Mwandri, Michael B; Hardcastle, Timothy C

    2018-06-01

    Developing countries face the highest incidence of trauma, and on the other hand, they do not have resources for mitigating the scourge of these injuries. The World Health Organization through the Essential Trauma Care (ETC) project provides recommendations for improving management of the injured and building up of systems that are effective in low-middle-income countries (LMICs). This study uses ETC project recommendations and other trauma-care guidelines to evaluate the current status of the resources and organizational structures necessary for optimal trauma care in Botswana; an African country with relatively good health facilities network, subsidized public hospital care and a functioning Motor Vehicle Accident fund covering road traffic collision victims. A cross-sectional descriptive design employed convenience sampling for recruiting high-volume trauma hospitals and selecting candidates. A questionnaire, checklist, and physical verification of resources were utilized to evaluate resources, staff knowledge, and organization-of-care and hospital capabilities. Results are provided in plain descriptive language to demonstrate the findings. Necessary consumables, good infrastructure, adequate numbers of personnel and rehabilitation services were identified all meeting or exceeding ETC recommendations. Deficiencies were noted in staff knowledge of initial trauma care, district hospital capability to provide essential surgery, and the organization of trauma care. The good level of resources available in Botswana may be used to improve trauma care: To further this process, more empowering of high-volume trauma hospitals by adopting trauma-care recommendations and inclusive trauma-system approaches are desirable. The use of successful examples on enhanced surgical skills and capabilities, effective trauma-care resource management, and leadership should be encouraged.

  16. hand- dug well

    African Journals Online (AJOL)

    Misrak

    wells at the vicinity of three major refuse dumpsite taking measurement of depth of the well, diameter, volume of water, distance ... The total coliform bacteria count shows that the water is exposed to serious and complex contaminations, which .... Bacterial plate count was carried out using the pour plate method with nutrient ...

  17. Perioperative care of a pregnant trauma victim: a review of ...

    African Journals Online (AJOL)

    Adele

    2004-05-03

    May 3, 2004 ... (until proven otherwise) in any female trauma patient of child- ... The perioperative management of pregnant trauma victims re- ... trauma, abdominal trauma, head injury, cervical spine injury, fetal injury, gun shot wounds, blunt.

  18. Termination of life support after major trauma.

    Science.gov (United States)

    Sullivan, D J; Hansen-Flaschen, J

    2000-06-01

    As the population continues to age, greater numbers and more severely injured elderly patients require care in ICUs. With the attendant increase in the medical complexity of such patients, investigators anticipate that trauma and critical care resources will become increasingly stretched. Because of economic and societal forces, it will become increasingly important for trauma surgeons to appropriately counsel patients and their families regarding the outcome from their injuries and to become comfortable approaching families about withdrawal of support when medical futility is recognized. The authors propose the following guidelines for discussing limitation or termination of life support with patients and their families. Physicians should (1) discuss the patient's wishes regarding life support on admission or early in the hospital course; (2) at the initial discussion, establish who the decision maker will be if the patient is or becomes incapacitated; (3) maintain regular communication and continuity of care; and (4) inevitably, when conflict occurs, involve consultants and a hospital ethics committee for assistance in its resolution.

  19. Management of thoracolumbar spine trauma An overview

    Directory of Open Access Journals (Sweden)

    S Rajasekaran

    2015-01-01

    Full Text Available Thoracolumbar spine fractures are common injuries that can result in significant disability, deformity and neurological deficit. Controversies exist regarding the appropriate radiological investigations, the indications for surgical management and the timing, approach and type of surgery. This review provides an overview of the epidemiology, biomechanical principles, radiological and clinical evaluation, classification and management principles. Literature review of all relevant articles published in PubMed covering thoracolumbar spine fractures with or without neurologic deficit was performed. The search terms used were thoracolumbar, thoracic, lumbar, fracture, trauma and management. All relevant articles and abstracts covering thoracolumbar spine fractures with and without neurologic deficit were reviewed. Biomechanically the thoracolumbar spine is predisposed to a higher incidence of spinal injuries. Computed tomography provides adequate bony detail for assessing spinal stability while magnetic resonance imaging shows injuries to soft tissues (posterior ligamentous complex [PLC] and neurological structures. Different classification systems exist and the most recent is the AO spine knowledge forum classification of thoracolumbar trauma. Treatment includes both nonoperative and operative methods and selected based on the degree of bony injury, neurological involvement, presence of associated injuries and the integrity of the PLC. Significant advances in imaging have helped in the better understanding of thoracolumbar fractures, including information on canal morphology and injury to soft tissue structures. The ideal classification that is simple, comprehensive and guides management is still elusive. Involvement of three columns, progressive neurological deficit, significant kyphosis and canal compromise with neurological deficit are accepted indications for surgical stabilization through anterior, posterior or combined approaches.

  20. The research agenda for trauma critical care.

    Science.gov (United States)

    Asehnoune, Karim; Balogh, Zsolt; Citerio, Giuseppe; Cap, Andre; Billiar, Timothy; Stocchetti, Nino; Cohen, Mitchell J; Pelosi, Paolo; Curry, Nicola; Gaarder, Christine; Gruen, Russell; Holcomb, John; Hunt, Beverley J; Juffermans, Nicole P; Maegele, Mark; Midwinter, Mark; Moore, Frederick A; O'Dwyer, Michael; Pittet, Jean-François; Schöchl, Herbert; Schreiber, Martin; Spinella, Philip C; Stanworth, Simon; Winfield, Robert; Brohi, Karim

    2017-09-01

    In this research agenda on the acute and critical care management of trauma patients, we concentrate on the major factors leading to death, namely haemorrhage and traumatic brain injury (TBI). In haemostasis biology, the results of randomised controlled trials have led to the therapeutic focus moving away from the augmentation of coagulation factors (such as recombinant factor VIIa) and towards fibrinogen supplementation and administration of antifibrinolytics such as tranexamic acid. Novel diagnostic techniques need to be evaluated to determine whether an individualised precision approach is superior to current empirical practice. The timing and efficacy of platelet transfusions remain in question, while new blood products need to be developed and evaluated, including whole blood variants, lyophilised products and novel red cell storage modalities. The current cornerstones of TBI management are intracranial pressure control, maintenance of cerebral perfusion pressure and avoidance of secondary insults (such as hypotension, hypoxaemia, hyperglycaemia and pyrexia). Therapeutic hypothermia and decompressive craniectomy are controversial therapies. Further research into these strategies should focus on identifying which subgroups of patients may benefit from these interventions. Prediction of the long-term outcome early after TBI remains challenging. Early magnetic resonance imaging has recently been evaluated for predicting the long-term outcome in mild and severe TBI. Novel biomarkers may also help in outcome prediction and may predict chronic neurological symptoms. For trauma in general, rehabilitation is complex and multidimensional, and the optimal timing for commencement of rehabilitation needs investigation. We propose priority areas for clinical trials in the next 10 years.

  1. [Trauma & the reproductive lifecycle in women].

    Science.gov (United States)

    Born, Leslie; Phillips, Shauna Dae; Steiner, Meir; Soares, Claudio N

    2005-10-01

    Women are at significantly higher risk for developing post-traumatic stress disorder (PTSD) than men, resulting in increased psychosocial burden and healthcare related costs. Recent research has shown complex interactions between the impact of traumatic experiences, and the reproductive lifecycle in women. For example, women suffering from premenstrual dysphoric disorder (PMDD) who also report a history of sexual or physical abuse are more likely to present with different neuroendocrine reactivity to stressors, when compared to premenstrual dysphoric disorder subjects without prior history of trauma or abuse or non-premenstrual dysphoric disorder subjects. In addition, women with a history of abuse or trauma may experience re-emergence of symptoms during pregnancy. Lastly, females who experience miscarriage may present with even higher prevalence rates of post-traumatic stress disorder symptoms. In this manuscript we examine the existing data on gender differences in post-traumatic stress disorder, with particular focus on psychological and physiological factors that might be relevant to the development of symptoms after exposure to traumatic events associated with the reproductive life cycle. Current options available for the treatment of such symptoms, including group and counselling therapies and debriefing are critically reviewed.

  2. Management of Atopic Hand Dermatitis

    DEFF Research Database (Denmark)

    Halling-Overgaard, Anne-Sofie; Zachariae, Claus; Thyssen, Jacob P

    2017-01-01

    This article provides an overview of clinical aspects of hand eczema in patients with atopic dermatitis. Hand eczema can be a part of atopic dermatitis itself or a comorbidity, for example, as irritant or allergic contact dermatitis. When managing hand eczema, it is important to first categorize...

  3. Hand Washing: Do's and Dont's

    Science.gov (United States)

    ... hands frequently can help limit the transfer of bacteria, viruses and other microbes. Always wash your hands before: Preparing food or eating Treating wounds or caring for a sick person Inserting or removing contact lenses Always wash your hands after: Preparing food Using ...

  4. Hand aperture patterns in prehension.

    Science.gov (United States)

    Bongers, Raoul M; Zaal, Frank T J M; Jeannerod, Marc

    2012-06-01

    Although variations in the standard prehensile pattern can be found in the literature, these alternative patterns have never been studied systematically. This was the goal of the current paper. Ten participants picked up objects with a pincer grip. Objects (3, 5, or 7cm in diameter) were placed at 30, 60, 90, or 120cm from the hands' starting location. Usually the hand was opened gradually to a maximum immediately followed by hand closing, called the standard hand opening pattern. In the alternative opening patterns the hand opening was bumpy, or the hand aperture stayed at a plateau before closing started. Two participants in particular delayed the start of grasping with respect to start of reaching, with the delay time increasing with object distance. For larger object distances and smaller object sizes, the bumpy and plateau hand opening patterns were used more often. We tentatively concluded that the alternative hand opening patterns extended the hand opening phase, to arrive at the appropriate hand aperture at the appropriate time to close the hand for grasping the object. Variations in hand opening patterns deserve attention because this might lead to new insights into the coordination of reaching and grasping. Copyright © 2011 Elsevier B.V. All rights reserved.

  5. Leadership and Teamwork in Trauma and Resuscitation

    Directory of Open Access Journals (Sweden)

    Michael Menchine

    2016-09-01

    Full Text Available Introduction: Leadership skills are described by the American College of Surgeons’ Advanced Trauma Life Support (ATLS course as necessary to provide care for patients during resuscitations. However, leadership is a complex concept, and the tools used to assess the quality of leadership are poorly described, inadequately validated, and infrequently used. Despite its importance, dedicated leadership education is rarely part of physician training programs. The goals of this investigation were the following: 1. Describe how leadership and leadership style affect patient care; 2. Describe how effective leadership is measured; and 3. Describe how to train future physician leaders.  Methods: We searched the PubMed database using the keywords “leadership” and then either “trauma” or “resuscitation” as title search terms, and an expert in emergency medicine and trauma then identified prospective observational and randomized controlled studies measuring leadership and teamwork quality. Study results were categorized as follows: 1 how leadership affects patient care; 2 which tools are available to measure leadership; and 3 methods to train physicians to become better leaders. Results: We included 16 relevant studies in this review. Overall, these studies showed that strong leadership improves processes of care in trauma resuscitation including speed and completion of the primary and secondary surveys. The optimal style and structure of leadership are influenced by patient characteristics and team composition. Directive leadership is most effective when Injury Severity Score (ISS is high or teams are inexperienced, while empowering leadership is most effective when ISS is low or teams more experienced. Many scales were employed to measure leadership. The Leader Behavior Description Questionnaire (LBDQ was the only scale used in more than one study. Seven studies described methods for training leaders. Leadership training programs

  6. Leadership and Teamwork in Trauma and Resuscitation

    Science.gov (United States)

    Ford, Kelsey; Menchine, Michael; Burner, Elizabeth; Arora, Sanjay; Inaba, Kenji; Demetriades, Demetrios; Yersin, Bertrand

    2016-01-01

    Introduction Leadership skills are described by the American College of Surgeons’ Advanced Trauma Life Support (ATLS) course as necessary to provide care for patients during resuscitations. However, leadership is a complex concept, and the tools used to assess the quality of leadership are poorly described, inadequately validated, and infrequently used. Despite its importance, dedicated leadership education is rarely part of physician training programs. The goals of this investigation were the following: 1. Describe how leadership and leadership style affect patient care; 2. Describe how effective leadership is measured; and 3. Describe how to train future physician leaders. Methods We searched the PubMed database using the keywords “leadership” and then either “trauma” or “resuscitation” as title search terms, and an expert in emergency medicine and trauma then identified prospective observational and randomized controlled studies measuring leadership and teamwork quality. Study results were categorized as follows: 1) how leadership affects patient care; 2) which tools are available to measure leadership; and 3) methods to train physicians to become better leaders. Results We included 16 relevant studies in this review. Overall, these studies showed that strong leadership improves processes of care in trauma resuscitation including speed and completion of the primary and secondary surveys. The optimal style and structure of leadership are influenced by patient characteristics and team composition. Directive leadership is most effective when Injury Severity Score (ISS) is high or teams are inexperienced, while empowering leadership is most effective when ISS is low or teams more experienced. Many scales were employed to measure leadership. The Leader Behavior Description Questionnaire (LBDQ) was the only scale used in more than one study. Seven studies described methods for training leaders. Leadership training programs included didactic teaching

  7. Trauma from a global perspective.

    Science.gov (United States)

    Ray, Susan L

    2008-01-01

    Trauma from widespread collective violence such as genocide and ethnic cleansing has not been discussed from a global perspective. It will be argued that the Western medical model of diagnostic labeling is inadequate for understanding victims of collective violence from around the world. Phenomenology and liberation philosophy will be discussed as alternatives to understanding trauma from collective violence that move beyond the Western medical model of diagnostic labeling. The insights gained from these alternative approaches will contribute to the development of nursing education, research, and practice relevant to the health of victims of collective violence around the globe.

  8. Childhood trauma and hippocampal and amygdalar volumes in first-episode psychosis.

    Science.gov (United States)

    Hoy, Katrina; Barrett, Suzanne; Shannon, Ciaran; Campbell, Clodagh; Watson, David; Rushe, Teresa; Shevlin, Mark; Bai, Feng; Cooper, Stephen; Mulholland, Ciaran

    2012-11-01

    A history of childhood trauma is common in individuals who later develop psychosis. Similar neuroanatomical abnormalities are observed in people who have been exposed to childhood trauma and people with psychosis. However, the relationship between childhood trauma and such abnormalities in psychosis has not been investigated. This study aimed to explore the association between the experience of childhood trauma and hippocampal and amygdalar volumes in a first-episode psychosis (FEP) population. The study employed an observational retrospective design. Twenty-one individuals, who had previously undergone magnetic resonance imaging procedures as part of the longitudinal Northern Ireland First-Episode Psychosis Study, completed measures assessing traumatic experiences and were included in the analysis. Data were subject to correlation analyses (r and r (pb)). Potential confounding variables (age at FEP and delay to scan from recruitment) were selected a priori for inclusion in multiple regression analyses. There was a high prevalence of lifetime (95%) and childhood (76%) trauma in the sample. The experience of childhood trauma was a significant predictor of left hippocampal volume, although age at FEP also significantly contributed to this model. There was no significant association between predictor variables and right hippocampal volume. The experience of childhood trauma was a significant predictor of right and total amygdalar volumes and the hippocampal/amygdalar complex volume as a whole. The findings indicate that childhood trauma is associated with neuroanatomical measures in FEP. Future research controlling for childhood traumatic experiences may contribute to explaining brain morphology in people with psychosis.

  9. Trauma, Development and Peacebuilding : Toward an Integrated ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Trauma, Development and Peacebuilding : Toward an Integrated Psychological Approach. Some experts have begun to ... The psychosocial approach is an alternative way of thinking about trauma following political violence. ... Date de début.

  10. Management of ocular, orbital, and adnexal trauma

    International Nuclear Information System (INIS)

    Spoor, T.C.; Nesi, F.A.

    1988-01-01

    This book contains 20 chapters. Some of the chapter titles are: The Ruptured Globe: Primary Care; Corneal Trauma, Endophthalmitis; Antibiotic Usage; Radiology of Orbital Trauma; Maxillofacial Fractures; Orbital Infections; and Basic Management of Soft Tissue Injury

  11. Cultural Trauma and Life Stories / Ene Kõresaar

    Index Scriptorium Estoniae

    Kõresaar, Ene

    2007-01-01

    Aili Aarelaid-Tarti 15-aastase uuringu tulemused raamatus "Cultural Trauma and Life Stories", Hesinki, Kikimora Publications, 2006. Uuritud on kolme suurt rahvusgruppi 1940-test tingitud trauma kontekstis: eestlased kodumaal, eestlased eksiilis ja venekeelne rahvusgrupp Eestis postsovetlikus diskursuses

  12. Unimanual SNARC Effect: Hand Matters.

    Science.gov (United States)

    Riello, Marianna; Rusconi, Elena

    2011-01-01

    A structural representation of the hand embedding information about the identity and relative position of fingers is necessary to counting routines. It may also support associations between numbers and allocentric spatial codes that predictably interact with other known numerical spatial representations, such as the mental number line (MNL). In this study, 48 Western participants whose typical counting routine proceeded from thumb-to-little on both hands performed magnitude and parity binary judgments. Response keys were pressed either with the right index and middle fingers or with the left index and middle fingers in separate blocks. 24 participants responded with either hands in prone posture (i.e., palm down) and 24 participants responded with either hands in supine (i.e., palm up) posture. When hands were in prone posture, the counting direction of the left hand conflicted with the direction of the left-right MNL, whereas the counting direction of the right hand was consistent with it. When hands were in supine posture, the opposite was true. If systematic associations existed between relative number magnitude and an allocentric spatial representation of the finger series within each hand, as predicted on the basis of counting habits, interactions would be expected between hand posture and a unimanual version of the spatial-numerical association of response codes (SNARC) effect. Data revealed that with hands in prone posture a unimanual SNARC effect was present for the right hand, and with hands in supine posture a unimanual SNARC effect was present for the left hand. We propose that a posture-invariant body structural representation of the finger series provides a relevant frame of reference, a within-hand directional vector, that is associated to simple number processing. Such frame of reference can significantly interact with stimulus-response correspondence effects, like the SNARC, that have been typically attributed to the mapping of numbers on a left

  13. Unimanual SNARC Effect: Hand Matters

    Directory of Open Access Journals (Sweden)

    Marianna eRiello

    2011-12-01

    Full Text Available A structural representation of the hand embedding information about the identity and relative position of fingers is necessary to counting routines. It may also support associations between numbers and allocentric spatial codes that predictably interact with other known numerical spatial representations, such as the mental number line. In this study, 48 Western participants whose typical counting routine proceeded from thumb-to-little on both hands performed magnitude and parity binary judgments. Response keys were pressed either with the right index and middle fingers or with the left index and middle fingers in separate blocks. 24 participants responded with either hands in prone posture (i.e. palm down and 24 participants responded with either hands in supine (i.e. palm up posture. When hands were in prone posture, the counting direction of the left hand conflicted with the direction of the left-right mental number line, whereas the counting direction of the right hand was consistent with it. When hands were in supine posture, the opposite was true. If systematic associations existed between relative number magnitude and an allocentric spatial representation of the finger series within each hand, as predicted on the basis of counting habits, interactions would be expected between hand posture and a unimanual version of the Spatial-Numerical Association of Response Codes (SNARC effect. Data revealed that with hands in prone posture a unimanual SNARC effect was present for the right hand, and with hands in supine posture a unimanual SNARC effect was present for the left hand. We propose that a posture-invariant body structural representation of the finger series provides a relevant frame of reference, a within-hand directional vector, that is associated to simple number processing. Such frame of reference can significantly interact with stimulus-response correspondence effects that have been attributed to the mapping of numbers on a mental

  14. Disseminated intravascular coagulation or acute coagulopathy of trauma shock early after trauma? A prospective observational study

    DEFF Research Database (Denmark)

    Johansson, Per Ingemar; Sorensen, Anne Marie; Perner, Anders

    2011-01-01

    the prevalence of overt DIC and ACoTS in trauma patients and characterized these conditions based on their biomarker profiles. METHODS: Observational study at a single Level I Trauma Centre. Inclusion of 80 adult trauma patients ([greater than or equal to]18 years) who met criteria for full trauma team...

  15. Prevalence of interpersonal trauma exposure and trauma-related disorders in severe mental illness

    NARCIS (Netherlands)

    Mauritz, M.W.; Goossens, P.J.J.; Draijer, N.; Achterberg, T. van

    2013-01-01

    BACKGROUND: Interpersonal trauma exposure and trauma-related disorders in people with severe mental illness (SMI) are often not recognized in clinical practice. OBJECTIVE: To substantiate the prevalence of interpersonal trauma exposure and trauma-related disorders in people with SMI. METHODS: We

  16. Prevalence of interpersonal trauma exposure and trauma-related disorders in severe mental illness

    NARCIS (Netherlands)

    Mauritz, M.W.; Goossens, P.J.J.; Draijer, N.; van Achterberg, T.

    2013-01-01

    Background: Interpersonal trauma exposure and trauma-related disorders in people with severe mental illness (SMI) are often not recognized in clinical practice. Objective: To substantiate the prevalence of interpersonal trauma exposure and trauma-related disorders in people with SMI. Methods: We

  17. External validation of the Emergency Trauma Score for early prediction of mortality in trauma patients

    NARCIS (Netherlands)

    Joosse, Pieter; de Jong, Willem-Jan J.; Reitsma, Johannes B.; Wendt, Klaus W.; Schep, Niels W.; Goslings, J. Carel

    2014-01-01

    The Emergency Trauma Score has been developed for early estimation of mortality risk in adult trauma patients with an Injury Severity Score of 16 or higher. Emergency Trauma Score combines four early predictors available at the trauma resuscitation room: age, Glasgow Coma Scale, base excess, and

  18. External Validation of the Emergency Trauma Score for Early Prediction of Mortality in Trauma Patients

    NARCIS (Netherlands)

    Joosse, Pieter; de Jong, Willem-Jan J.; Wendt, Klaus W.; Schep, Niels W.; Goslings, J. Carel; Reitsma, J.

    Objectives: The Emergency Trauma Score has been developed for early estimation of mortality risk in adult trauma patients with an Injury Severity Score of 16 or higher. Emergency Trauma Score combines four early predictors available at the trauma resuscitation room: age, Glasgow Coma Scale, base

  19. The Quality of Cost-Utility Analyses in Orthopedic Trauma.

    Science.gov (United States)

    Nwachukwu, Benedict U; Schairer, William W; O'Dea, Evan; McCormick, Frank; Lane, Joseph M

    2015-08-01

    As health care in the United States transitions toward a value-based model, there is increasing interest in applying cost-effectiveness analysis within orthopedic surgery. Orthopedic trauma care has traditionally underemphasized economic analysis. The goals of this review were to identify US-based cost-utility analysis in orthopedic trauma, to assess the quality of the available evidence, and to identify cost-effective strategies within orthopedic trauma. Based on a review of 971 abstracts, 8 US-based cost-utility analyses evaluating operative strategies in orthopedic trauma were identified. Study findings were recorded, and the Quality of Health Economic Studies (QHES) instrument was used to grade the overall quality. Of the 8 studies included in this review, 4 studies evaluated hip and femur fractures, 3 studies analyzed upper extremity fractures, and 1 study assessed open tibial fracture management. Cost-effective interventions identified in this review include total hip arthroplasty (over hemiarthroplasty) for femoral neck fractures in the active elderly, open reduction and internal fixation (over nonoperative management) for distal radius and scaphoid fractures, limb salvage (over amputation) for complex open tibial fractures, and systems-based interventions to prevent delay in hip fracture surgery. The mean QHES score of the studies was 79.25 (range, 67-89). Overall, there is a paucity of cost-utility analyses in orthopedic trauma; however, the available evidence suggests that certain operative interventions can be cost-effective. The quality of these studies, however, is fair, based on QHES grading. More attention should be paid to evaluating the cost-effectiveness of operative intervention in orthopedic trauma. Copyright 2015, SLACK Incorporated.

  20. The management of colonic trauma in the damage control era.

    Science.gov (United States)

    Shazi, B; Bruce, J L; Laing, G L; Sartorius, B; Clarke, D L

    2017-01-01

    INTRODUCTION The purpose of this study was to audit our current management of colonic trauma, and to review our experience of colonic trauma in patients who underwent initial damage control (DC) surgery. METHODS All patients treated for colonic trauma between January 2012 and December 2014 by the Pietermaritzburg Metropolitan Trauma Service were included in the study. Data reviewed included mechanism of injury, method of management (primary repair [PR], primary diversion [PD] or DC) and outcome (complications and mortality rate). Results A total of 128 patients sustained a colonic injury during the study period. Ninety-seven per cent of the injuries were due to penetrating trauma. Of these cases, 56% comprised stab wounds (SWs) and 44% were gunshot wounds (GSWs). Management was by PR in 99, PD in 20 and DC surgery in 9 cases. Among the 69 SW victims, 57 underwent PR, 9 had PD and 3 required a DC procedure. Of the 55 GSW cases, 40 were managed with PR, 9 with PD and 6 with DC surgery. In the PR group, there were 16 colonic complications (5 cases of breakdown and 11 of wound sepsis). Overall, nine patients (7%) died. CONCLUSIONS PR of colonic trauma is safe and should be used for the majority of such injuries. Persistent acidosis, however, should be considered a contraindication. In unstable patients with complex injuries, the optimal approach is to perform DC surgery. In this situation, formal diversion is contraindicated, and the injury should be controlled and dropped back into the abdomen at the primary operation. At the repeat operation, if the physiological insult has been reversed, then formal repair of the colonic injury is acceptable.