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Sample records for failed trauma treatment

  1. Treatment strategy for hepatic trauma

    Institute of Scientific and Technical Information of China (English)

    Wu-Yong Yu; Qu-Jin Li; Jian-Ping Gong

    2016-01-01

    Liver is one of the organs with the highest injury rate,and in recent decades,the guidelines for the treatment of liver trauma have changed considerably.Now,there is a growing consensus that the most important step is diagnosis and depending upon the degree of severity,non-operative therapy is the main treatment method for hepatic trauma if conditions permit.For serious hepatic trauma patients such as those with hemodynamic instability,they should be operated upon as soon as possible.Regardless of the surgical options,doctors should control damage to patients and try to prevent complications.New therapies such as hepatic artery embolization and liver transplantation have been more and more used for the treatment of serious hepatic damage in clinics.

  2. Addressing Trauma in Substance Abuse Treatment

    Science.gov (United States)

    Giordano, Amanda L.; Prosek, Elizabeth A.; Stamman, Julia; Callahan, Molly M.; Loseu, Sahar; Bevly, Cynthia M.; Cross, Kaitlin; Woehler, Elliott S.; Calzada, Richard-Michael R.; Chadwell, Katie

    2016-01-01

    Trauma is prevalent among clients with substance abuse issues, yet addictions counselors' training in trauma approaches is limited. The purpose of the current article is to provide pertinent information regarding trauma treatment including the use of assessments, empirically supported clinical approaches, self-help groups and the risk of vicarious…

  3. Treatment of 336 cases of chest trauma

    Directory of Open Access Journals (Sweden)

    ZHANG Jing

    2012-06-01

    Full Text Available 【Abstract】Objective: To summarize the clinical features, diagnosis and treatment of chest trauma. Methods: A retrospective analysis was conducted among 336 cases of chest trauma admitted to our hospital from January 2009 to May 2011. Results: Out of all cases, 325 were cured, accounting for 96.7%; 11 died, accounting for 3.3%. Among the dead cases, one died of hemorrhagic shock, three of acute respi-ratory distress syndrome, three of multiple organ failure, and four of severe multiple traumas. Conclusions: (1 For patients with severe chest trauma, early emergency treatment is crucial to save life. (2 Open thoracic surgery is needed for acute cardiac tamponade, intrapulmonary vascular injuries, progressive intrathoracic bleeding, lung laceration, tracheal breakage, and diaphrag-matic injury. In addition, operative timing and method should be well chosen. (3 Pulmonary contusion is one of common complications in chest trauma, for which the com-bination of strong anti-infection therapy and mechanical ventilation is an effective treatment strategy. Key words: Thoracic injuries; Thoracotomy; Emer-gency treatment

  4. Treatment of 336 cases of chest trauma

    Institute of Scientific and Technical Information of China (English)

    ZHANG Jing; CHU Xiang-yang; LIU Yi; WANG Yun-xi

    2012-01-01

    Objective: To summarize the clinical features,diagnosis and treatment of chest trauma.Methods: A retrospective analysis was conducted among 336 cases of chest trauma admitted to our hospital from January 2009 to May 2011.Results:Out of all cases,325 were cured,accounting for 96.7%; 11 died,accounting for 3.3%.Among the dead cases,one died of hemorrhagic shock,three of acute respiratory distress syndrome,three of multiple organ failure,and four of severe multiple traumas.Conclusions:(1) For patients with severe chest trauma,early emergency treatment is crucial to save life.(2) Open thoracic surgery is needed for acute cardiac tamponade,intrapulmonary vascular injuries,progressive intrathoracic bleeding,lung laceration,tracheal breakage,and diaphragmatic injury.In addition,operative timing and method should be well chosen.(3) Pulmonary contusion is one of common complications in chest trauma,for which the combination of strong anti-infection therapy and mechanical ventilation is an effective treatment strategy.

  5. Clinical Considerations in Orthodontic Treatment of Teeth with Dentoalveolar Trauma

    OpenAIRE

    2014-01-01

    Dentoalveolar trauma is a very common public health problem. Its influence goes beyond accidents and their impact on teeth, because in the future it becomes a decisive factor if orthodontic treatment is required, because these traumas tend to lead to complications such as root resorption and pulp necrosis. Proper treatment of teeth with a medical history of trauma is essential for successful orthodontic treatment. Los traumas dentoalveolares son un problema de salud pública muy común. La i...

  6. Overview of Diagnosis and Treatment of Psychological Trauma in Children.

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    Munson, Carlton E.

    1995-01-01

    Provides comprehensive definition of psychological trauma and offers guidance to practitioners who are increasingly needed to treat traumatized children. Key therapy considerations are organized around the role of dissociation and repetition compulsion in trauma. Presents treatments in connection with aloneness of trauma experience, dream and…

  7. Palmitoylethanolamide in the Treatment of Failed Back Surgery Syndrome

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    Antonella Paladini

    2017-01-01

    Full Text Available Introduction. This observational study was designed to evaluate the efficacy of ultramicronized palmitoylethanolamide (um-PEA (Normast® administration, as add-on therapy for chronic pain, in the management of pain-resistant patients affected by failed back surgery syndrome. Methods. A total of 35 patients were treated with tapentadol (TPD and pregabalin (PGB. One month after the start of standard treatment, um-PEA was added for the next two months. Pain was evaluated by the Visual Analogue Scale (VAS at the time of enrollment (T0 and after one (T1, two (T2, and three (T3 months. Results. After the first month with TDP + PGB treatment only, VAS score decreased significantly from 5.7±0.12 at the time of enrollment (T0 to 4.3 ± 0.11 (T1 (p<0.0001; however, it failed to provide significant subjective improvement in pain symptoms. Addition of um-PEA led to a further and significant decrease in pain intensity, reaching VAS scores of 2.7 ± 0.09 (T2 and 1.7 ± 0.11 (T3, end of treatment (p<0.0001 without showing any side effects. Conclusions. This observational study provides evidence, albeit preliminary, for the efficacy and safety of um-PEA (Normast as part of a multimodal therapeutic regimen in the treatment of pain-resistant patients suffering from failed back surgery syndrome.

  8. Our Treatment Approaches in Severe Maxillofacial Injuries Occurring After Failed Suicide Attempts Using Long-Barreled Guns.

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    Kucuker, Ismail; Şimşek, Tekin; Keles, Musa Kemal; Yosma, Engin; Aksakal, Ibrahim Alper; Demir, Ahmet

    2016-03-01

    Maxillofacial traumas with long-barreled guns may sometimes cause catastrophic results by means of smashing in facial structures. In these patients, reconstruction strategies of both fragmented/lost soft and hard tissues still remain controversial. In their clinic, the authors treated 5 patients with severely injured face after failed suicide attempt between 2008 and 2013. In this study, the authors aimed to present their clinical experiences on these severely injured maxillofacial gunshot traumas and offer a treatment algorithm to gain a result as possible as satisfactory in terms of functionality and appearance.

  9. The Biology of Trauma: Implications for Treatment

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    Solomon, Eldra P.; Heide, Kathleen M.

    2005-01-01

    During the past 20 years, the development of brain imaging techniques and new biochemical approaches has led to increased understanding of the biological effects of psychological trauma. New hypotheses have been generated about brain development and the roots of antisocial behavior. We now understand that psychological trauma disrupts homeostasis…

  10. Surgical management of vestibular schwannomas after failed radiation treatment.

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    Nonaka, Yoichi; Fukushima, Takanori; Watanabe, Kentaro; Friedman, Allan H; Cunningham, Calhoun D; Zomorodi, Ali R

    2016-04-01

    Increasing numbers of patients with vestibular schwannoma (VS) have been treated with focused-beam stereotactic radiation treatment (SRT) including Gamma knife, CyberKnife, X-knife, Novalis, or proton beam therapy. The purpose of this study was to document the incidence of tumor regrowth or symptoms that worsened or first developed following SRT and to discuss surgical strategies for patients who have failed SRT for VS. A consecutive series of 39 patients with SRT failed VS were surgically treated. Clinical symptoms, tumor regrowth at follow-up, intraoperative findings, and surgical outcome were evaluated. There were 15 males and 24 females with a mean age of 51.8 years. Thirty-six patients (92.3%) demonstrated steady tumor growth after SRT. Two (5.1%) patients with slight increase of the mass underwent surgical resection because of development of unbearable facial pain. Symptoms that worsened or newly developed following SRT in this series were deafness (41%), dizziness (35.9%), facial numbness (25.6%), tinnitus (20.5%), facial nerve palsy (7.7%), and facial pain (7.7%). Intraoperative findings demonstrated fibrous changes of the tumor mass, cyst formation, and brownish-yellow or purple discoloration of the tumor capsule. Severe adhesions between the tumor capsule and cranial nerves, vessels, and the brainstem were observed in 69.2%. Additionally, the facial nerve was more fragile and irritable in all cases. Gross total resection (GTR) was achieved in 33.3% of patients, near-total resection (NTR) in 35.9%, and subtotal resection (STR) in 30.8% of patients. New facial nerve palsy was seen in seven patients (19.4%) postoperatively. Our findings suggest that patients with VS who fail SRT with either tumor progression or worsening of clinical symptoms will have an increased rate of adhesions to the neurovascular structures and may have radiation-influenced neuromalacia. Salvage surgery of radiation-failed tumors is more difficult and will have a higher risk of

  11. Dental Trauma Guide: a source of evidence-based treatment guidelines for dental trauma.

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    Andreasen, Jens Ove; Lauridsen, Eva; Gerds, Thomas Alexander; Ahrensburg, Søren Steno

    2012-10-01

    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 combined, the result is that more than 100 trauma scenarios exist, when the two dentitions are combined. Each of these trauma scenarios has a specific treatment demand and prospect for healing. With such a complexity in diagnosis and treatment, it is obvious that even experienced practitioners may have 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.DentalTraumaGuide.org. It is the aspiration that the use of this Guide may lead the practitioner to offer an evidence-based diagnosis and treatment.

  12. Prior Trauma Exposure for Youth in Treatment Foster Care

    Science.gov (United States)

    Dorsey, Shannon; Burns, Barbara J.; Southerland, Dannia G.; Cox, Julia Revillion; Wagner, H. Ryan; Farmer, Elizabeth M. Z.

    2012-01-01

    Very little research has focused on rates of trauma exposure for youth in treatment foster care (TFC). Available research has utilized record review for assessing exposure, which presents limitations for the range of trauma types examined, as records are predominantly focused on abuse and neglect. The current study examines exposure rates and…

  13. [Blood reinfusion in treatment of thoracic and abdominal trauma].

    Science.gov (United States)

    Baramiia, N M; Antoniuk, M H; Dorosh, V M; Zavorits'kyĭ, O O; Sheptyts'kyĭ, V V; Pachkoriia, A V

    2001-01-01

    The experience of application of the blood reinfusion in complex of reanimational measures in treatment of 280 injured persons with thoracoabdominal damage in an acute period of trauma was summarized. Reinfusion was done in 42.8% of operated injured persons, promoting to preserve 243.1 l of preserved blood and simplifying rendering the assistance in an acute period of trauma.

  14. Cone beam CT for diagnosis and treatment planning in trauma cases.

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    Palomo, Leena; Palomo, J Martin

    2009-10-01

    Three-dimensional imaging offers many advantages in making diagnoses and planning treatment. This article focuses on cone beam CT (CBCT) for making diagnoses and planning treatment in trauma-related cases. CBCT equipment is smaller and less expensive than traditional medical CT equipment and is tailored to address challenges specific to the dentoalveolar environment. Like medical CT, CBCT offers a three-dimensional view that conventional two-dimensional dental radiography fails to provide. CBCT combines the strengths of medical CT with those of conventional dental radiography to accommodate unique diagnostic and treatment-planning applications that have particular utility in dentoalveolar trauma cases. CBCT is useful, for example, in identifying tooth fractures relative to surrounding alveolar bone, in determining alveolar fracture location and morphology, in analyzing ridge-defect height and width, and in imaging temporomandibular joints. Treatment-planning applications include those involving extraction of fractured teeth, placement of implants, exposure of impacted teeth, and analyses of airways.

  15. Psychosocial predictors of treatment outcome for trauma-affected refugees

    DEFF Research Database (Denmark)

    Sonne, Charlotte; Carlsson, Jessica; Bech, Per

    2016-01-01

    BACKGROUND: The effects of treatment in trials with trauma-affected refugees vary considerably not only between studies but also between patients within a single study. However, we know little about why some patients benefit more from treatment, as few studies have analysed predictors of treatment...... outcome. OBJECTIVE: The objective of the study was to examine possible psychosocial predictors of treatment outcome for trauma-affected refugees. METHOD: The participants were 195 adult refugees with posttraumatic stress disorder (PTSD) who were enrolled in a 6- to 7-month treatment programme...

  16. Psychosocial predictors of treatment outcome for trauma-affected refugees

    DEFF Research Database (Denmark)

    Sonne, Charlotte; Carlsson, Jessica; Bech, Per

    2016-01-01

    Background The effects of treatment in trials with trauma-affected refugees vary considerably not only between studies but also between patients within a single study. However, we know little about why some patients benefit more from treatment, as few studies have analysed predictors of treatment...... outcome. Objective The objective of the study was to examine possible psychosocial predictors of treatment outcome for trauma-affected refugees. Method The participants were 195 adult refugees with posttraumatic stress disorder (PTSD) who were enrolled in a 6- to 7-month treatment programme...

  17. SPLEEN CLOSED TRAUMA: SURGICAL TREATMENT VERSUS CONSERVATIVE TREATMENT

    Directory of Open Access Journals (Sweden)

    M. Lo Gatto

    2012-01-01

    Full Text Available Introduction. In closed trauma of the most frequent causes of injuries are haemoperitoneus of parenchymatous organs such as liver and spleen. Patients and methods. Clinical Case No.1. R.F. (spleen injury: 2nd degree sec. Moore, 1st degree sec. Buntain WL, Tc-based score of 2 is subject to clinical monitoring with ultrasound control, tc, and several blood exams with a satisfactory clinical outcome. Clinical Case No.2. A.C. presents a clinical picture attributable to 3rd grade sec. Moore and the 2nd grade sec. Buntain WL with a Tc-based score of 4, therefore, performed emergency splenectomy was not delayed, thus saving the patient at the death. Results. The rupture of the spleen is the most frequent complication of closed abdominal trauma (contusion or direct backlash. It appears as isolated lesion in 30-70% of cases. Conclusions. In our experience individual spleen injuries, undercapslular that does not involve the hilum and without spillage of liquid peritoneal deserve a conservative, on the other hand, the spleen injury in excess of 4 cm, manyfragments, with spreading of free peritoneal fluid in need of treatment Surgical sudden.

  18. Psychosocial predictors of treatment outcome for trauma-affected refugees

    DEFF Research Database (Denmark)

    Sonne, Charlotte; Carlsson, Jessica; Bech, Per

    2016-01-01

    outcome. OBJECTIVE: The objective of the study was to examine possible psychosocial predictors of treatment outcome for trauma-affected refugees. METHOD: The participants were 195 adult refugees with posttraumatic stress disorder (PTSD) who were enrolled in a 6- to 7-month treatment programme......BACKGROUND: The effects of treatment in trials with trauma-affected refugees vary considerably not only between studies but also between patients within a single study. However, we know little about why some patients benefit more from treatment, as few studies have analysed predictors of treatment...... situation. The primary outcome measure was PTSD symptoms measured on the Harvard Trauma Questionnaire (HTQ). Other outcome measures included the Hopkins Symptom Check List-25, the WHO-5 Well-being Index, Sheehan Disability Scale, Hamilton Depression and Anxiety Scales, the somatisation scale of the Symptoms...

  19. [EMDR: method of psychotherapy for the treatment of trauma].

    Science.gov (United States)

    Havelka, Judit

    2010-01-01

    Eye Movement Desensitization and Reprocessing (EMDR) is a method of psychotherapy that has been extensively researched for the treatment of trauma. The current treatment guidelines of the American Psychiatric Association and the International Society for Traumatic Stress Studies designate EMDR as an effective treatment for PTSD.In this article the author writes about the history of this "breakthrough therapy" and describes EMDR as a standardized protocol. In the second part describes trauma recovery where she uses EMDR in treating post-traumatic stress disorder in a case study about a 25 year old woman, who has been a rubbery survivor.

  20. Trauma in patients with temporomandibular disorders: frequency and treatment outcome.

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    De Boever, J A; Keersmaekers, K

    1996-02-01

    Controversy exists on the aetiological importance and the effect of jaw macrotrauma (fractures excluded) on the occurrence of temporomandibular joint disorders (TMD). The purpose of this study was to assess the incidence of jaw injury in TMD patients and to compare the severity of the symptoms, the clinical characteristics and the treatment outcome in TMD patients with or without a history of trauma to the head and neck region directly linked to the onset of symptoms. The study sample included 400 consecutive TMD clinical patients. In 24.5% of patients the onset of the pain and dysfunction could be linked directly to the trauma, mainly whiplash accidents. No significant differences could be found between the two groups in daily recurrent headache, dizziness, neck pain, joint crepitation and pain in the joints. Maximal mouth opening was less than 20 mm in 14.3% of patients with a history of trauma and in 4.1% of those without such a history. According to the Helkimo dysfunction index (DI), more trauma than non-trauma TMD patients belonged to the severe dysfunction groups (DI 4 and 5) at first examination. The outcome of a conservative treatment procedure (counselling, occlusal splint, physiotherapy, occasionally occlusal therapy and non-steroidal anti-inflammation drugs was not different between the two groups at the 1 year evaluation. The degree of maximal opening was similar: less than 20 mm in 3.7% and 2.2% in trauma and non-trauma patients respectively. Forty percent and 41% respectively were symptom free or had DI = 1. The results suggest that external trauma to the joint or to the jaw in general is an important initiating factor in the aetiology of TMD but also that the prognosis is favourable.

  1. Exsanguination in trauma: A review of diagnostics and treatment options.

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    Geeraedts, L M G; Kaasjager, H A H; van Vugt, A B; Frölke, J P M

    2009-01-01

    Trauma patients with haemorrhagic shock who only transiently respond or do not respond to fluid therapy and/or the administration of blood products have exsanguinating injuries. Recognising shock due to (exsanguinating) haemorrhage in trauma is about constructing a synthesis of trauma mechanism, injuries, vital signs and the therapeutic response of the patient. The aim of prehospital care of bleeding trauma patients is to deliver the patient to a facility for definitive care within the shortest amount of time by rapid transport and minimise therapy to what is necessary to maintain adequate vital signs. Rapid decisions have to be made using regional trauma triage protocols that have incorporated patient condition, transport times and the level of care than can be performed by the prehospital care providers and the receiving hospitals. The treatment of bleeding patients is aimed at two major goals: stopping the bleeding and restoration of the blood volume. Fluid resuscitation should allow for preservation of vital functions without increasing the risk for further (re)bleeding. To prevent further deterioration and subsequent exsanguinations 'permissive hypotension' may be the goal to achieve. Within the hospital, a sound trauma team activation system, including the logistic procedure as well as activation criteria, is essential for a fast and adequate response. After determination of haemorrhagic shock, all efforts have to be directed to stop the bleeding in order to prevent exsanguinations. A simultaneous effort is made to restore blood volume and correct coagulation. Reversal of coagulopathy with pharmacotherapeutic interventions may be a promising concept to limit blood loss after trauma. Abdominal ultrasound has replaced diagnostic peritoneal lavage for detection of haemoperitoneum. With the development of sliding-gantry based computer tomography diagnostic systems, rapid evaluation by CT-scanning of the trauma patient is possible during resuscitation. The concept

  2. Racial Differences in Treatment Approaches and Mortality Following Arterial Trauma.

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    Moreira, Carla C; Farber, Alik; Rybin, Denis; Doros, Gheorghe; Kalish, Jeffrey; Eberhardt, Robert T; Siracuse, Jeffrey J; Hamburg, Naomi M

    2015-10-01

    We sought to evaluate the impact of race on treatment approaches and mortality following arterial trauma. The National Trauma Data Bank (version 7.2, American College of Surgeons) was queried from 2002 to 2012 to identify patients aged 18 to 65 years with arterial trauma. The association between race (white, black, and Hispanic) and mortality following arterial injury was assessed, stratified by penetrating or blunt injury. Temporal trends in the use of open and endovascular procedures were evaluated across the racial groups. Multivariable regression models adjusting for patient demographics, injury severity, hospital characteristics, insurance status, and type of intervention performed were used to evaluate potential contributors to the association of race with mortality. The study cohort consisted of 58 626 patients (52% white, 31% black, and 17% Hispanic). A majority (57%) of patients had penetrating injuries, with black and Hispanic patients being more likely to sustain penetrating injuries (80% and 65%, respectively) compared to white patients (41%, P trauma. This finding was similar across all groups studied. In multivariable analysis, black race was found to be associated with higher mortality compared to white for both penetrating (odds ratio [OR] 1.52, 95% confidence interval [CI] 1.33-1.75, P trauma. Even after adjusting for potential confounders, minority patients had increased odds of mortality following arterial trauma compared to their white counterparts. Further studies are needed to understand and to eliminate these observed disparities in outcome. © The Author(s) 2015.

  3. Impact of childhood trauma on treatment outcome in the Treatment for Adolescents with Depression Study (TADS).

    Science.gov (United States)

    Lewis, Cara C; Simons, Anne D; Nguyen, Lananh J; Murakami, Jessica L; Reid, Mark W; Silva, Susan G; March, John S

    2010-02-01

    The impact of childhood trauma was examined in 427 adolescents (54% girls, 74% Caucasian, mean = 14.6, SD = 1.5) with major depressive disorder participating in the Treatment for Adolescents with Depression Study (TADS). TADS compared the efficacy of cognitive behavioral therapy (CBT), fluoxetine (FLX), their combination (COMB), and placebo (PBO). Teens were separated into four trauma history groups: (1) no trauma; (2) trauma, no abuse; (3) physical abuse; (4), and sexual abuse. The effects of treatment and trauma history on depression severity across 12 weeks of acute treatment, as measured by the Children's Depression Rating Scale-Revised (CDRS-R), were examined. A significant trauma-by-treatment-by-time interaction indicated that trauma history moderated treatment. The Week 12 primary efficacy findings previously reported by TADS were replicated in the no trauma group (n = 201): COMB = FLX > CBT = PBO. No significant differences in treatment arms were observed among the trauma, no abuse, or physical abuse group. Teens with a history of sexual abuse treated with COMB, FLX, and PBO showed significant and equivalent improvement on the CDRS-R (mean 45). Baseline suicidality and self-reported depression were significantly related to a history of sexual abuse. The study was limited by the level of detail regarding childhood traumatic experiences. Results are discussed in terms of the implications for treating depressed adolescents with traumatic backgrounds.Clinical Trials Registry Information: Treatment for Adolescents with Depression Study; http://www.clinicaltrials.gov, NCT00006286.

  4. Factors associated with the use of evidence-based practices to treat psychological trauma by psychotherapists with trauma treatment expertise.

    Science.gov (United States)

    Craig, Carlton D; Sprang, Ginny

    2010-10-01

    This paper investigates 10 socio-demographic and case characteristic variables as predictors of use of evidence-based practice and non-evidence-based practice in the treatment of psychological trauma. A national random sample of 2,400 trauma treatment specialists in all 50 states and the District of Columbia were sent surveys with a response rate of 29.6% (N = 711) usable surveys returned. Stepwise regressions conducted on evidence-based practice use indicated that special trauma training, older age, and higher percentage of PTSD on the case load were the only significant predictors of evidence-based practice use. Implications for trauma practices are indicated.

  5. Experiences of Stress in a Trauma Treatment Course

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    Shannon, Patricia J.; Simmelink-McCleary, Jennifer; Im, Hyojin; Becher, Emily; Crook-Lyon, Rachel E.

    2014-01-01

    This study explores the reactions of social work students in a course on trauma treatment and how those reactions changed over time. Consensual qualitative research methods were used to analyze 17 participant journals submitted at 4 times during the course. Findings indicate that students experienced a range of responses to traumatic material,…

  6. Developing Self-Care Practices in a Trauma Treatment Course

    Science.gov (United States)

    Shannon, Patricia J.; Simmelink-McCleary, Jennifer; Im, Hyojin; Becher, Emily; Crook-Lyon, Rachel E.

    2014-01-01

    This article describes the development of self-care practices of social work students who were part of a larger study of students' experiences in a graduate course on the treatment of trauma. Consensual qualitative research methods were used to analyze 17 participant journals submitted at 4 times during the course. Findings indicated that…

  7. Experiences of Stress in a Trauma Treatment Course

    Science.gov (United States)

    Shannon, Patricia J.; Simmelink-McCleary, Jennifer; Im, Hyojin; Becher, Emily; Crook-Lyon, Rachel E.

    2014-01-01

    This study explores the reactions of social work students in a course on trauma treatment and how those reactions changed over time. Consensual qualitative research methods were used to analyze 17 participant journals submitted at 4 times during the course. Findings indicate that students experienced a range of responses to traumatic material,…

  8. Research domain criteria and the study of trauma in children: Implications for assessment and treatment research.

    Science.gov (United States)

    Stover, Carla Smith; Keeshin, Brooks

    2016-11-09

    By definition, the Diagnostic and Statistical Manual (DSM) diagnosis of posttraumatic stress disorder (PTSD) requires exposure to a traumatic event. Yet, the DSM diagnostic requirements for children and adolescents for PTSD may fail to capture traumatized youth with significant distress and functional impairment. Many important studies have utilized PTSD diagnosis as a mechanism for grouping individuals for comparative studies examining brain functioning, neuroendocrinology, genetics, attachment, and cognition; however, focusing only on those with the diagnosis of PTSD can miss the spectrum of symptoms and difficulties that impact children who experience trauma and subsequent impairment. Some studying child trauma have focused on examining brain and biology of those with exposure and potential impairment rather than only those with PTSD. This line of inquiry, complementary to PTSD specific studies, has aided our understanding of some of the changes in brain structure and neuroregulatory systems at different developmental periods following traumatic exposure. Application of the Research Domain Criteria (RDoC) framework proposed by NIMH to the study of child trauma exposure and subsequent impairment is an opportunity to examine domains of function and how they are impacted by trauma. Research to date has focused largely in the areas of negative valence, regulatory, and cognitive systems, however those studying complex or developmental trauma have identified an array of domains that are impacted which map onto many of the RDoC categories. This paper will review the relevant literature associated with child trauma as it relates to the RDoC domains, outline areas of needed research, and describe their implications for treatment and the advancement of the field. Copyright © 2016. Published by Elsevier Ltd.

  9. Diagnosis and Treatment of Hyperfibrinolysis in Trauma (A European Perspective).

    Science.gov (United States)

    Gall, Lewis S; Brohi, Karim; Davenport, Ross A

    2017-03-01

    Fibrinolysis activation occurs almost universally after severe trauma. Systemic hyperfibrinolysis is a key component of acute traumatic coagulopathy and associated with poor clinical outcomes, although controversy exists over optimal treatment strategies. The mechanistic drivers and dynamics of fibrinolytic activation in response to injury and trauma resuscitation are currently unclear. Furthermore, therapeutic triggers are compounded by the lack of a sensitive and rapid diagnostic tool, with discrepancy between hyperfibrinolysis diagnosed by viscoelastic hemostatic assays versus biomarkers for fibrinolysis. Rotational thromboelastometry and thromboelastography appear capable of detecting the severest forms of hyperfibrinolysis but are relatively insensitive to moderate, yet clinically significant fibrinolytic activation. Rapid evaluation of the current status of the fibrinolytic system remains a challenge and therefore the decision whether to administer an antifibrinolytic agent should be based on available evidence from clinical trials. In line with current European guidelines, we recommend that all bleeding trauma patients, and in particular, severely injured patients with evidence of hemorrhagic shock, should receive early empiric tranexamic acid. This review explains our current knowledge of the pathophysiological pathways which induce hyperfibrinolysis in trauma hemorrhage, evaluates the available diagnostic modalities, and describes current treatment strategies.

  10. Treatment algorithms for high-energy traumas of lower extremities

    Directory of Open Access Journals (Sweden)

    Jovanović Mladen

    2002-01-01

    Full Text Available Introduction High-energy traumas are open or closed injuries caused by force (missile, traffic injuries, crush or blust injuries, falling from heights, affecting the body surface and transferring high amount of kinetic energy inducing great damage to the tissue. Management of such lower extremity injuries has evolved over past several decades, but still remains a difficult task for every surgical team. Specific anatomic and functional characteristics combined with extensive injuries demands specific treatment protocols. Multiple injuries In a multiple injured patient the first priority is management of life-threatening trauma. Despite other injuries, surgical treatment of limb-threatening injuries must start as soon as life-threatening condition has been managed. Treatment algorithms Algorithms are especially beneficial in management of severely injured, but salvageable extremities and in making decision on amputation. Insight into mechanisms of injury, as well as systematic examination of the affected limb, should help us understand the extensiveness of trauma and make an adequate management plan. Prevention of infection and surgical approach Prevention of wound infection and surgical approach to high- energy limb trauma, which includes wound extension, wound excision, skeletal stabilization and if necessary muscle compartment release, should be done in the first 6 hours after injury. Methods of soft tissue reconstruction Commonly used methods for soft tissue defects must provide wound coverage in less than five days following injury. Rehabilitation Early passive and active mobilization and verticalization of patients is very important for successful treatment. Conclusion Good and timely evaluation of the injured and collaboration between plastic and orthopedic surgeons from the beginning of treatment, are crucial for final outcome.

  11. Psychosocial predictors of treatment outcome for trauma-affected refugees

    Directory of Open Access Journals (Sweden)

    Charlotte Sonne

    2016-05-01

    Full Text Available Background: The effects of treatment in trials with trauma-affected refugees vary considerably not only between studies but also between patients within a single study. However, we know little about why some patients benefit more from treatment, as few studies have analysed predictors of treatment outcome. Objective: The objective of the study was to examine possible psychosocial predictors of treatment outcome for trauma-affected refugees. Method: The participants were 195 adult refugees with posttraumatic stress disorder (PTSD who were enrolled in a 6- to 7-month treatment programme at the Competence Centre for Transcultural Psychiatry (CTP, Denmark. The CTP Predictor Index used in the study included 15 different possible outcome predictors concerning the patients’ past, chronicity of mental health problems, pain, treatment motivation, prerequisites for engaging in psychotherapy, and social situation. The primary outcome measure was PTSD symptoms measured on the Harvard Trauma Questionnaire (HTQ. Other outcome measures included the Hopkins Symptom Check List-25, the WHO-5 Well-being Index, Sheehan Disability Scale, Hamilton Depression and Anxiety Scales, the somatisation scale of the Symptoms Checklist-90, Global Assessment of Functioning scales, and pain rated on visual analogue scales. The relations between treatment outcomes and the total score as well as subscores of the CTP Predictor Index were analysed. Results: Overall, the total score of the CTP Predictor Index was significantly correlated to pre- to post treatment score changes on the majority of the ratings mentioned above. While employment status was the only single item significantly correlated to HTQ-score changes, a number of single items from the CTP Predictor Index correlated significantly with changes in depression and anxiety symptoms, but the size of the correlation coefficients were modest. Conclusions: The total score of the CTP Predictor Index correlated significantly

  12. Trauma.

    Science.gov (United States)

    Cobb, A B

    1991-03-01

    The need for planning and development of statewide trauma prevention and trauma service systems is or should be a high priority--if one sets priorities on criteria that address important factors such as cost to benefits in reduction of life years lost and reduction of disability and costs of long-term rehab services, etc. Prevention of injury and first class trauma care will lessen our heavy human burdens (loss of life and disability) and reduce our long-term outlays for rehabilitation, etc. Obviously our first line of intervention should be prevention--all educational, regulatory and automatic protectors (seat belts, gun restrictions, air bags) that will lower injury rates. A state trauma system must be planned for the larger universe than individual institutions or communities. We must educate our public that the only practical way to provide services for major trauma is through regionalized systems that they somehow must help support. The recent emphasis on making the health services industry a "competitive market" has discouraged public interest and support for regionalized health systems. Our best chances for funding such systems are probably through user fees, sin taxes and surcharges on fines, etc. We need the elements or principles of a plan and present it to the public and to their representatives in the courthouses, city halls and state capital of our state. We need to generate public discussion and understanding on the problem, the potential for saving lives and preventing disability. To do any less would mean our failure to meet our duties as health professionals and public health officials.

  13. Diversity in clinical management and protocols for the treatment of major bleeding trauma patients across European level I Trauma Centres

    DEFF Research Database (Denmark)

    Schäfer, Nadine; Driessen, Arne; Fröhlich, Matthias

    2015-01-01

    BACKGROUND: Uncontrolled haemorrhage is still the leading cause of preventable death after trauma and the primary focus of any treatment strategy should be related to early detection and control of blood loss including haemostasis. METHODS: For assessing management practices across six European...... level I trauma centres with academic interest and research in the field of coagulopathy an online survey was conducted addressing local management practice for bleeding trauma patients including algorithms for detection, management and monitoring coagulation disorders and immediate interventions. Each...... centre provided their locally applied massive transfusion protocol. RESULTS: All participating trauma centres have developed and implemented a local algorithm and protocol for the bleeding trauma patient. These are uniformly activated by clinical triggers and deactivated once the bleeding has stopped...

  14. Trauma treatment across Europe: where do we stand now from a perspective of seven countries

    Directory of Open Access Journals (Sweden)

    Evaldas Kazlauskas

    2016-03-01

    Full Text Available There is a lack of knowledge about the state of affairs of the trauma treatments in Europe. To start to fill in this gap, key persons from seven European countries—Georgia, Germany, Lithuania, the Netherlands, Poland, Switzerland, and Turkey—accepted the invitation to give their expert opinion on the state of affairs in their country at an invited panel discussion at the XIV 2015 ESTSS Conference in Vilnius, Lithuania. Brief reports from the seven countries reveal significant diversities among different European countries in terms of awareness of health problems related to trauma, the availability of trauma treatments, and treatment approaches. Political and economic differences across the European countries contribute to the diversities in the developments of trauma treatments. European national psychotrauma societies are active in establishing training curricula and dissemination of trauma-focused treatments. Despite the growing acknowledgment of trauma and dissemination of trauma-focused treatments, there is a lack of Europe-wide policies to ensure availability of trauma treatment in Europe for trauma survivors. The need for more detailed analysis of trauma treatment in all European countries and development of European-level trauma-informed health care policies is outlined.

  15. Mesiodens as a risk factor in treatment of trauma cases.

    Science.gov (United States)

    Alaçam, Alev; Bani, Mehmet

    2009-04-01

    The presence of mesiodens often results in complications including retention of primary teeth and delayed eruption of permanent teeth, closure of eruption path, rotations, retention, root resorption, pulp necrosis, and diastema as well as nasal eruption and formation of dentigerous and primordial cysts. Less common complications involving the permanent incisors include dilaceration of the developing roots and loss of tooth vitality. Therefore, early diagnosis of mesiodens has particular importance in terms of preventing such complications. However, with respect to surgical removal of mesiodens, ideal timing of intervention - immediate or delayed intervention - remains to be a highly controversial issue. While predisposing factors of dental trauma such as open bite, increasing overjet with protrusion of upper incisors, and insufficient lip closure have been well documented in the literature, there is limited evidence indicating mesiodens as a risk factor in trauma. In this report of two cases, it is aimed to emphasize mesiodens as a risk factor in the treatment of dental trauma besides its effect on prognosis.

  16. Evaluation of selective treatment of penetrating abdominal trauma.

    Science.gov (United States)

    Schmelzer, Thomas M; Mostafa, Gamal; Gunter, Oliver L; Norton, H James; Sing, Ronald F

    2008-01-01

    In penetrating abdominal trauma, diagnostic imaging and the application of selective clinical management may avoid negative celiotomy and improve outcome. We prospectively observed patients with penetrating abdominal trauma over 15 months and recorded demographics, presentation, imaging, surgical procedure, and outcome. Patients who underwent immediate laparotomy were compared with patients who were observed and/or had a computed tomography (CT) scan. Outcomes of negative versus positive and immediate versus delayed celiotomy were compared. Chi-square and Student t tests were used. A p value of less than 0.05 was considered significant. A level 1 trauma center. Adult patients who presented with penetrating abdominal injury. In all, 100 consecutive patients (mean age, 32 years) were included (male:female, 91:9; gunshot wound:stab wound, 65:35). Overall, 60 immediate and 10 delayed laparotomies were performed; 30 patients did not undergo surgery. Predictors of immediate celiotomy were hypotension (p = 0.03), anteriorly located entrance wounds (p = 0.0005), and transaxial wounds (p = 0.03). Overall morbidity and mortality was 32% and 2%, respectively. The negative celiotomy rate was 25%. Patients with a positive celiotomy had higher morbidity (p = 0.006) and longer hospital length of stay (p = 0.003) compared with negative celiotomy. A CT scan was employed in 32% of patients, with 100% sensitivity and 94% specificity. Delayed celiotomy (10%) did not adversely impact morbidity (p = 0.70) and was 100% therapeutic, with no deaths. Nonselective immediate celiotomy for penetrating abdominal trauma results in a high rate of unnecessary surgery. Hemodynamically stable patients can safely be observed and/or have contrast CT scans and undergo delayed celiotomy, if indicated. This selective treatment had no adverse effect on patient outcomes and can potentially improve overall outcome.

  17. A controlled study into the (cognitive) effects of exposure treatment on trauma therapists

    NARCIS (Netherlands)

    Minnen, A. van; Keijsers, G.P.J.

    2000-01-01

    Several researchers have reported on therapists' symptoms as a result of trauma treatment, such as disruptions in cognitive schemata and symptoms resembling PTSD-symptoms. Thus far, however, no studies compared the symptoms of trauma therapists and non-trauma therapists. In the present study, both

  18. Pharmacological treatment of refugees with trauma-related disorders

    DEFF Research Database (Denmark)

    Sonne, Charlotte; Lohmann, Jessica Mariana Carlsson; Bech, Per

    2017-01-01

    There is a dearth of evidence on the effectiveness of pharmacological treatment for refugees with trauma-related disorders. The present paper provides an overview of available literature on the subject and discusses the transferability of results from studies on other groups of patients with post...... traumatic stress disorder (PTSD). We conducted a systematic review of published treatment outcome studies on PTSD and depression among refugees. Fifteen studies were identified and reviewed. Most studies focused on the use of antidepressants. Included studies differed widely in method and quality....... The majority were observational studies and case studies. Small sample sizes limited the statistical power. Few studies reported effect sizes, confidence intervals, and statistical significance of findings. No specific pharmacological treatment for PTSD among refugees can be recommended on the basis...

  19. Surgical treatment of cervical spine trauma: Our experience and results

    Science.gov (United States)

    Dobran, Mauro; Iacoangeli, Maurizio; Nocchi, Niccolò; Di Rienzo, Alessandro; di Somma, Lucia Giovanna Maria; Nasi, Davide; Colasanti, Roberto; Al-Fay, Mohuammad; Scerrati, Massimo

    2015-01-01

    Objective and Background: The objective of this study is to evaluate how the neurological outcome in patients operated for cervical spinal cord injury (SCI) is influenced by surgical timing, admission American Spinal Injury Association (ASIA) grading system, and age. Materials and Methods: From January 2004 to December 2011, we operated 110 patients with cervical SCI. Fifty-seven of them (44 males and 13 females) with preoperative neurological deficit, were included in this study with a complete follow-up. Age, sex, associated comorbidities (evaluated with Charlson comorbidity index [CCI]), mechanism of trauma, preoperative and follow-up ASIA score, time elapsed from injury to surgical treatment, preoperative cervical computed tomography scan or magnetic resonance imaging, type of fractures, and surgical procedure were evaluated for each patient. The patient population was divided into two groups related to the timing of surgery: Ultra-early surgery group (within 12 h from the trauma, 27 patients) and early surgery (within 12–72 h from the trauma, 30 patients). Statistical Analysis Used: The univariate analysis of data was carried out by the Chi-square test for discrete variables, the t-test for the continuous ones. Logistic regression was used for the multivariate analysis. Results: Neurological outcome was statistically better in ultra-early surgery group (<12 h) than in patient underwent surgery within 12–72 h (82.14% vs. 31%, multivariate analysis P = 0.005). The neurological improvement was also correlated with the age and the ASIA grade at admission in the univariate analysis (P = 0.006 and P = 0.017 respectively) and in the multivariate 1 (P = 0.037 and P = 0.006 respectively) while the CCI was correlated with the improvement only in the univariate analysis (P = 0.007). Conclusion: Nowadays, in patients with cervical SCI early surgery could be associated with improved outcome, most in case of young people with mild neurological impairment. PMID:26396608

  20. Exsanguination in trauma: A review of diagnostics and treatment options.

    NARCIS (Netherlands)

    Geeraedts, L.M.G.; Kaasjager, H.A.; Vugt, A.B. van; Frolke, J.P.M.

    2009-01-01

    Trauma patients with haemorrhagic shock who only transiently respond or do not respond to fluid therapy and/or the administration of blood products have exsanguinating injuries. Recognising shock due to (exsanguinating) haemorrhage in trauma is about constructing a synthesis of trauma mechanism, inj

  1. Complications of paediatric elbow trauma treatment by traditional bonesetters.

    Science.gov (United States)

    Butt, Mohammad Farooq; Dhar, Shabir Ahmad; Gani, Naseem Ul; Kawoosa, Altaf A

    2009-04-01

    This is a retrospective review of paediatric elbow trauma, which was initially treated by bonesetters and subsequently reported to the hospital for management. This paper describes the pattern of trauma and the complications of unscientific management. The report also recommends a basic training program for the bonesetters so as to make them aware of the potential complications involved in managing paediatric elbow trauma.

  2. Exsanguination in trauma: A review of diagnostics and treatment options.

    NARCIS (Netherlands)

    Geeraedts, L.M.G.; Kaasjager, H.A.; Vugt, A.B. van; Frolke, J.P.M.

    2009-01-01

    Trauma patients with haemorrhagic shock who only transiently respond or do not respond to fluid therapy and/or the administration of blood products have exsanguinating injuries. Recognising shock due to (exsanguinating) haemorrhage in trauma is about constructing a synthesis of trauma mechanism,

  3. Treatment of sexual trauma dissolves contamination fear: case report

    Directory of Open Access Journals (Sweden)

    Mirjam J. Nijdam

    2013-01-01

    Full Text Available Background: In patients with co-morbid obsessive–compulsive disorder (OCD and posttraumatic stress disorder (PTSD, repetitive behavior patterns, rituals, and compulsions may ward off anxiety and often function as a coping strategy to control reminders of traumatic events. Therefore, addressing the traumatic event may be crucial for successful treatment of these symptoms. Objective: In this case report, we describe a patient with comorbid OCD and PTSD who underwent pharmacotherapy and psychotherapy. Methods: Case Report. A 49-year-old Dutch man was treated for severe PTSD and moderately severe OCD resulting from anal rape in his youth by an unknown adult man. Results: The patient was treated with paroxetine (60 mg, followed by nine psychotherapy sessions in which eye movement desensitization and reprocessing (EMDR and exposure and response prevention (ERP techniques were applied. During psychotherapy, remission of the PTSD symptoms preceded remission of the OCD symptoms. Conclusions: This study supports the idea of a functional connection between PTSD and OCD. Successfully processing the trauma results in diminished anxiety associated with trauma reminders and subsequently decreases the need for obsessive–compulsive symptoms.

  4. Modulating Wnt Signaling Pathway to Enhance Allograft Integration in Orthopedic Trauma Treatment

    Science.gov (United States)

    2014-04-01

    TITLE: Modulating Wnt Signaling Pathway to Enhance Allograft Integration in Orthopedic Trauma Treatment PRINCIPAL INVESTIGATOR: Amarjit S...Integration in Orthopedic Trauma Treatment 5b. GRANT NUMBER W81XWH-10-1-1054 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) Amarjit S. Virdi, PhD...practical means of enhancing repair of large bone defects in orthopedic trauma and can be translated into clinical practice in the near future. Figures

  5. Reverse translation of failed treatments can help improving the validity of preclinical animal models

    NARCIS (Netherlands)

    't Hart, Bert A.

    2015-01-01

    A major challenge in translational research is to reduce the currently high proportion of new candidate treatment agents for neuroinflammatory disease, which fail to reproduce promising effects observed in animal models when tested in patients. This disturbing situation has raised criticism against

  6. Treatment of a woman with emetophobia: a trauma focused approach

    Directory of Open Access Journals (Sweden)

    Ad de Jongh

    2012-01-01

    Full Text Available A disproportionate fear of vomiting, or emetophobia, is a chronic and disabling condition which is characterized by a tendency to avoid a wide array of situations or activities that might increase the risk of vomiting. Unlike many other subtypes of specific phobia, emetophobia is fairly difficult to treat. In fact, there are only a few published cases in the literature. This paper presents a case of a 46-year old woman with emetophobia in which a trauma-focused treatment approach was applied; that is, an approach particularly aimed at processing disturbing memories of a series of events which were considered to be causal in the etiology of her condition. Four therapy sessions of Eye Movement Desensitization and Reprocessing (EMDR produced a lasting decrease in symptomatology. A 3-year follow up showed no indication of relapse.

  7. Treatment of a woman with emetophobia: a trauma focused approach.

    Science.gov (United States)

    de Jongh, Ad

    2012-07-26

    A disproportionate fear of vomiting, or emetophobia, is a chronic and disabling condition which is characterized by a tendency to avoid a wide array of situations or activities that might increase the risk of vomiting. Unlike many other subtypes of specific phobia, emetophobia is fairly difficult to treat. In fact, there are only a few published cases in the literature. This paper presents a case of a 46-year old woman with emetophobia in which a trauma-focused treatment approach was applied; that is, an approach particularly aimed at processing disturbing memories of a series of events which were considered to be causal in the etiology of her condition. Four therapy sessions of Eye Movement Desensitization and Reprocessing (EMDR) produced a lasting decrease in symptomatology. A 3-year follow up showed no indication of relapse.

  8. Psychosocial predictors of treatment outcome for trauma-affected refugees

    DEFF Research Database (Denmark)

    Sonne, Charlotte; Carlsson, Jessica; Bech, Per;

    2016-01-01

    Checklist-90, Global Assessment of Functioning scales, and pain rated on visual analogue scales. The relations between treatment outcomes and the total score as well as subscores of the CTP Predictor Index were analysed. RESULTS: Overall, the total score of the CTP Predictor Index was significantly...... and anxiety symptoms, but the size of the correlation coefficients were modest. CONCLUSIONS: The total score of the CTP Predictor Index correlated significantly with outcomes on most of the rating scales, but correlations were modest in size, possibly due to the number of different factors influencing...... situation. The primary outcome measure was PTSD symptoms measured on the Harvard Trauma Questionnaire (HTQ). Other outcome measures included the Hopkins Symptom Check List-25, the WHO-5 Well-being Index, Sheehan Disability Scale, Hamilton Depression and Anxiety Scales, the somatisation scale of the Symptoms...

  9. CO2 laser surface treatment of failed dental implants for re-implantation: an animal study.

    Science.gov (United States)

    Kasraei, Shahin; Torkzaban, Parviz; Shams, Bahar; Hosseinipanah, Seyed Mohammad; Farhadian, Maryam

    2016-07-01

    The aim of the present study was to evaluate the success rate of failed implants re-implanted after surface treatment with CO2 laser. Despite the widespread use of dental implants, there are many incidents of failures. It is believed that lasers can be applied to decontaminate the implant surface without damaging the implant. Ten dental implants that had failed for various reasons other than fracture or surface abrasion were subjected to CO2 laser surface treatment and randomly placed in the maxillae of dogs. Three failed implants were also placed as the negative controls after irrigation with saline solution without laser surface treatment. The stability of the implants was evaluated by the use of the Periotest values (PTVs) on the first day after surgery and at 1, 3, and 6 months post-operatively. The mean PTVs of treated implants increased at the first month interval, indicating a decrease in implant stability due to inflammation followed by healing of the tissue. At 3 and 6 months, the mean PTVs decreased compared to the 1-month interval (P implant stability. The mean PTVs increased in the negative control group compared to baseline (P implants were significantly lower than control group at 3 and 6 months after implant placement (P implantation of failed implants in Jack Russell Terrier dogs after CO2 laser surface debridement is associated with a high success rate in terms of implant stability.

  10. North-American Conference Highlights the Treatment of Trauma Utilizing Guided Imagery and Music

    DEFF Research Database (Denmark)

    Scott-Montcrieff, Suzannah; Beck, Bolette Daniels; Montgomery, Erin

    2015-01-01

    A report on the 2015 Association for Music and Imagery conference highlights papers that address clinical practice and research using Guided Imagery and Music for the treatment of trauma.......A report on the 2015 Association for Music and Imagery conference highlights papers that address clinical practice and research using Guided Imagery and Music for the treatment of trauma....

  11. Follow-up study of the treatment outcomes at a psychiatric trauma clinic for refugees

    DEFF Research Database (Denmark)

    Buhmann, Cæcilie; Lykke Mortensen, Erik; Nordentoft, Merete

    2015-01-01

    PURPOSE: To describe change in mental health after treatment with antidepressants and trauma-focused cognitive behavioral therapy. METHODS: Patients receiving treatment at the Psychiatric Trauma Clinic for Refugees in Copenhagen completed self-ratings of level of functioning, quality of life...

  12. Trauma-focused treatment in PTSD patients with psychosis : symptom exacerbation, adverse events, and revictimization

    NARCIS (Netherlands)

    van den Berg, D.P.G.; de Bont, P.A.J.M.; van der Vleugel, B.M.; de Roos, C.; de Jongh, A.; van Minnen, A.; van der Gaag, M.

    2016-01-01

    Objectives: Most clinicians refrain from trauma treatment for patients with psychosis because they fear symptom exacerbation and relapse. This study examined the negative side effects of trauma-focused (TF) treatment in patients with psychosis and posttraumatic stress disorder (PTSD). Methods: Analy

  13. Trauma-focused treatment in PTSD patients with psychosis: Symptom exacerbation, adverse events, and revictimization

    NARCIS (Netherlands)

    Berg, D.P.G. van den; Bont, P.A.J.M. de; Vleugel, B.M. van der; Roos, C.J.A.M. de; Jongh, A. de; Minnen, A. van; Gaag, M. van der

    2016-01-01

    Objectives: Most clinicians refrain from trauma treatment for patients with psychosis because they fear symptom exacerbation and relapse. This study examined the negative side effects of trauma-focused (TF) treatment in patients with psychosis and posttraumatic stress disorder (PTSD). Methods:

  14. Follow-up study of the treatment outcomes at a psychiatric trauma clinic for refugees

    DEFF Research Database (Denmark)

    Buhmann, Christine Cæcilie Böck; Mortensen, Erik Lykke; Nordentoft, Merete;

    2015-01-01

    PURPOSE: To describe change in mental health after treatment with antidepressants and trauma-focused cognitive behavioral therapy. METHODS: Patients receiving treatment at the Psychiatric Trauma Clinic for Refugees in Copenhagen completed self-ratings of level of functioning, quality of life...

  15. Impact of Childhood Trauma on Treatment Outcome in the Treatment for Adolescents with Depression Study (TADS)

    Science.gov (United States)

    Lewis, Cara C.; Simons, Anne D.; Nguyen, Lananh J.; Murakami, Jessica L.; Reid, Mark W.; Silva, Susan G.; March, John S.

    2010-01-01

    Objective: The impact of childhood trauma was examined in 427 adolescents (54% girls, 74% Caucasian, mean = 14.6, SD = 1.5) with major depressive disorder participating in the Treatment for Adolescents with Depression Study (TADS). Method: TADS compared the efficacy of cognitive behavioral therapy (CBT), fluoxetine (FLX), their combination (COMB),…

  16. Impact of Childhood Trauma on Treatment Outcome in the Treatment for Adolescents with Depression Study (TADS)

    Science.gov (United States)

    Lewis, Cara C.; Simons, Anne D.; Nguyen, Lananh J.; Murakami, Jessica L.; Reid, Mark W.; Silva, Susan G.; March, John S.

    2010-01-01

    Objective: The impact of childhood trauma was examined in 427 adolescents (54% girls, 74% Caucasian, mean = 14.6, SD = 1.5) with major depressive disorder participating in the Treatment for Adolescents with Depression Study (TADS). Method: TADS compared the efficacy of cognitive behavioral therapy (CBT), fluoxetine (FLX), their combination (COMB),…

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

    OpenAIRE

    Ruud A. Jongedijk

    2014-01-01

    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 ...

  18. The anti-inflammatory selective melanocortin receptor subtype 4 agonist, RO27-3225, fails to prevent acoustic trauma-induced tinnitus in rats.

    Science.gov (United States)

    Zheng, Yiwen; McPherson, Kate; Reid, Peter; Smith, Paul F

    2015-08-15

    In preliminary studies we have observed a massive microglial activation in the cochlear nucleus following acoustic trauma-induced tinnitus in rats, which suggests that inflammatory responses within the central auditory system may be involved in the development and maintenance of tinnitus. Recently, the anti-inflammatory properties of melanocortins (MCs), have gained increasing interest in pharmacology due to their promising therapeutic potential in the treatment of inflammatory-mediated diseases. Among the five subtypes of the MC receptor, MC3 and MC4 receptors are the predominant brain receptors and are thought to play an important role in brain inflammation and neuroprotection. Importantly, MC4 receptors have been found in the mouse and rat central auditory systems. In this study we investigated whether the MC4 receptor agonist, RO27-3225, injected s.c at a dose of 90 or 180µg/kg, 30min before acoustic trauma and then every 12h for 10 days, could prevent the development of acoustic trauma-induced tinnitus in rats, using a conditioned behavioural suppression model. Although evidence of tinnitus developed in the exposed-vehicle group compared to the sham-vehicle group (P≤0.03), in response to a 32kHz tone, there were no significant drug effects from treatment with RO27-3225, indicating that it did not confer any protection against the development of tinnitus in this animal model. This result suggests that the anti-inflammatory effects of MC4 receptor agonists may not be sufficient to prevent tinnitus.

  19. Cognitive behavioral psychotherapeutic treatment at a psychiatric trauma clinic for refugees

    DEFF Research Database (Denmark)

    Buhmann, Cæcilie; Andersen, Ida; Mortensen, Erik Lykke

    2015-01-01

    INTRODUCTION: Cognitive behavioural therapy (CBT) with trauma focus is the most evidence supported psychotherapeutic treatment of PTSD, but few CBT treatments for traumatized refugees have been described in detail. PURPOSE: To describe and evaluate a manualized cognitive behavioral therapy...

  20. Predictors of treatment completion in a sample of youth who have experienced physical or sexual trauma.

    Science.gov (United States)

    Murphy, Robert A; Sink, Holli E; Ake, George S; Carmody, Karen Appleyard; Amaya-Jackson, Lisa M; Briggs, Ernestine C

    2014-01-01

    Despite significant advances in knowledge and availability of evidence-based models for child traumatic stress, many children simply do not complete treatment. There remain notable gaps in the services research literature about treatment completion among youth, particularly those who have experienced trauma and related sequelae. This study investigated the linkages among child physical and sexual trauma, posttraumatic stress disorder (PTSD) symptomatology, and treatment completion utilizing a clinical sample drawn from a large database from community treatment centers across the United States specializing in childhood trauma. Results from regression analyses indicated that neither the experience of sexual nor physical trauma directly predicted successful treatment completion. The links between sexual trauma and treatment completion, however, were mediated by PTSD avoidance symptoms. Children and youth experiencing sexual trauma reported higher levels of avoidance symptoms that were, in turn, significantly associated with a lower likelihood of completing trauma-focused mental health treatment. Practice implications are discussed and include strategies for clinicians to intervene during pivotal points of treatment to improve rates of service utilization and treatment completion.

  1. [Application of damage control theory on the trauma orthopaedic treatment].

    Science.gov (United States)

    Wang, Jing-bo; Jin, Hong-bin

    2009-07-01

    The treatment of severely traumatic patients was changing from total care treament to the damage control surgery, as a result in the inflammatory reaction caused by trauma, in which the inflammatory marks, such as interleukin-6 and serum procalcitonin in the blood increased, and caused hypothermia, acidosis, and disturbance of blood coagulation, and resulted in the acute respiratory distress syndrome and multiple organs failure. A long-term operation as the second hit made the disease worse. In the patients, the femoral fracture was treated with external fixator; the pelvic fracture was treated with external fixator, and the uncontrolled haemorrhage in the pelvis was treated through direct hemostasis, angiography and embolism of arteries, and the tamponade of pelvis; the purpose of treatment of spinal fracture was keeping the stability of spine, avoiding the secondary injury on the spinal cord. It must pay attention to the injury of the adjacent organs and infection in the opening spinal injury. The result of operation was better in the incomplete spinal cord injury.

  2. Endovascular treatment of iatrogenic penetrating trauma of the carotid artery: case report

    Directory of Open Access Journals (Sweden)

    Eduardo Lichtenfels

    2014-04-01

    Full Text Available Carotid trauma demands early diagnosis and treatment. Open repair may be technically challenging if the trauma is at the base of the neck. We present a case of iatrogenic penetrating carotid trauma caused by insertion of a hemodialysis catheter. Treatment was accomplished by placement of a covered stent-graft in the common carotid artery, covering the puncture site. This case suggests that placement of a covered stent-graft is a good option for treatment of iatrogenic injury to the carotid artery.

  3. A Novel Therapeutic for the Treatment and Prevention of Hearing Loss from Acoustic Trauma

    Science.gov (United States)

    2015-05-01

    Award Number: W81XWH-14-1-0077 TITLE: A NOVEL THERAPEUTIC FOR THE TREATMENT AND PREVENTION OF HEARING LOSS FROM ACOUSTIC TRAUMA PRINCIPAL...2015 4. TITLE AND SUBTITLE A Novel Therapeutic for the Treatment and Prevention of Hearing Sa. CONTRACT NUMBER: Loss from Acoustic Trauma WB l XW...Quad Chart is submitted as an appendix. 9. APPENDICES Quad Chart 6 A Novel Therapeutic for the Treatment and Prevention of Hearing Loss from

  4. [The TraumaRegister DGU® as the basis of medical quality management. Ten years experience of a national trauma centre exemplified by emergency room treatment].

    Science.gov (United States)

    Helm, M; Bitzl, A; Klinger, S; Lefering, R; Lampl, L; Kulla, M

    2013-07-01

    The trauma register of the German Society of Trauma Surgery (TraumaRegister DGU®/TR-DGU) has been proven to be a valuable tool for external assessment of quality in the treatment of patients with major trauma. This publication shows for the first time how the quality of trauma treatment in a level I trauma centre could be improved over a period of almost ten years with the help of continuous quality management, i.e. recognizing a problem, developing a solution and evaluating its effect. Tracer parameters and indicators of quality are presented in four periods over a total study period from 1st January 1989 to 31st March 2007. The division into four periods is due to major changes in the trauma treatment algorithms or structural changes in the trauma room. The results are displayed for all patients treated in the trauma room and for those patients with an injury severity score (ISS)≥16. Over all four periods a total number of n=2,239 patients were admitted to the trauma room. Based on the results of the trauma register a number of changes were made, not only structural changes, such as the introduction of point-of-care diagnostics, initially conventional X-ray, then digital X-ray and finally multislice computed tomography (CT) scanning in the trauma room but also changes in the way personnel participating in the trauma treatment are trained. Advanced trauma life support (ATLS®) has become the standard training for doctors and prehospital trauma life support (PHTLS®) for nurses. Time efficient treatment algorithms were introduced. All measures led to changes in several parameters which are chosen as indicators for good treatment quality. It was for instance possible to reduce the average total trauma treatment time for patients with an ISS≥16 from initially 90.9±48.6 min to 37.4±18.  min in the final study period. The external quality management performed by the TR-DGU has proved to be a constant source of inspiration. The effects of the changes made can

  5. [Interdisciplinary treatment of severely injured patients in the trauma resuscitation room].

    Science.gov (United States)

    Wurmb, Thomas; Müller, Thorben; Jansen, Hendrik; Ruchholtz, Steffen; Roewer, Norbert; Kühne, Christian A

    2010-06-01

    The trauma resuscitation room in emergency departments is an important link between preclinical treatment and clinical management of patients with multiple trauma. For the trauma team (Trauma Surgery, Anaesthesiology, Radiology) to respond adequately, a high degree of training and standardisation is required. With arrival of the patient, the trauma team starts with priority orientated resuscitation. After life-threatening problems have been resolved, the diagnostic work is started with plain films of the chest and the pelvis and FAST. Additional plain films are made depending on further suspected injuries. Reassessment of the patient is done and necessary emergency interventions are performed before the patient is transferred to the radiology department for organ focused computed tomography. CT has gained importance in the early diagnostic phase of trauma care. The development of Multislice Helical Computed Tomography (MSCT) has led to substantial refinement in the diagnostic work-up. For many institutions it has become an essential part of the imaging of the traumatized patient. Delayed and insufficient medical interventions have a high impact on negative patient outcome. Anticipating and dealing with critical situations might reduce preventable errors in the treatment process and can be achieved by implementation of an algorithm-based structured workflow. In that context some elements of quality management are well established in clinical practice. In the presented paper we describe the effort that needs to be done to provide optimal care for multiple trauma patients after admission to a designed trauma centre.

  6. Treating refractory obsessive-compulsive disorder: what to do when conventional treatment fails?

    Directory of Open Access Journals (Sweden)

    Adelar Pedro Franz

    2013-01-01

    Full Text Available Obsessive-compulsive disorder (OCD is a chronic and impairing condition. A very small percentage of patients become asymptomatic after treatment. The purpose of this paper was to review the alternative therapies available for OCD when conventional treatment fails. Data were extracted from controlled clinical studies (evidence-based medicine published on the MEDLINE and Science Citation Index/Web of Science databases between 1975 and 2012. Findings are discussed and suggest that clinicians dealing with refractory OCD patients should: 1 review intrinsic phenomenological aspects of OCD, which could lead to different interpretations and treatment choices; 2 review extrinsic phenomenological aspects of OCD, especially family accommodation, which may be a risk factor for non-response; 3 consider non-conventional pharmacological approaches; 4 consider non-conventional psychotherapeutic approaches; and 5 consider neurobiological approaches.

  7. Treating refractory obsessive-compulsive disorder: what to do when conventional treatment fails?

    Science.gov (United States)

    Franz, Adelar Pedro; Paim, Mariana; Araújo, Rafael Moreno de; Rosa, Virgínia de Oliveira; Barbosa, Ísis Mendes; Blaya, Carolina; Ferrão, Ygor Arzeno

    2013-01-01

    Obsessive-compulsive disorder (OCD) is a chronic and impairing condition. A very small percentage of patients become asymptomatic after treatment. The purpose of this paper was to review the alternative therapies available for OCD when conventional treatment fails. Data were extracted from controlled clinical studies (evidence-based medicine) published on the MEDLINE and Science Citation Index/Web of Science databases between 1975 and 2012. Findings are discussed and suggest that clinicians dealing with refractory OCD patients should: 1) review intrinsic phenomenological aspects of OCD, which could lead to different interpretations and treatment choices; 2) review extrinsic phenomenological aspects of OCD, especially family accommodation, which may be a risk factor for non-response; 3) consider non-conventional pharmacological approaches; 4) consider non-conventional psychotherapeutic approaches; and 5) consider neurobiological approaches.

  8. Guided bone regeneration: A novel approach in the treatment of pediatric dentoalveolar trauma

    National Research Council Canada - National Science Library

    Murthy, Prashanth Sadashiva; Shivamallu, Avinash Bettahalli; Deshmukh, Seema; Nandlal, Bhojraj; Thotappa, Srilatha K

    2015-01-01

    .... This emergency treatment requires proper planning so as to achieve favorable results. Trauma causing severe dentoalveolar injuries, especially in children, needs an interdisciplinary approach so as to retain normal functional anatomy for that age...

  9. Statistic analysis in treatment of complications of vertebral-spinal trauma (by MSE data

    Directory of Open Access Journals (Sweden)

    Pedachenko Ye.H.

    2013-03-01

    Full Text Available The analysis of treatment of 130 patients with the complicated spinal trauma by the data of medical-social expertise was conducted. In the majority of patients (64%, because of the complicated spinal trauma the conservative methods of treatment were applied. In more than half (51% of patients treated con¬servatively, there was the unremoved compression of spinal cord or its radices, 24% patients were operated in the sharp period of the complicated spinal trauma, 4% of them were re-operated over course of time. Due to unremoved compression 12% were operated in the period of rehabilitation.

  10. Women's Perceptions of Immediate and Long-Term Effects of Failed Infertility Treatment on Marital and Sexual Satisfaction.

    Science.gov (United States)

    Pepe, Margaret V.; Byrne, T. Jean

    1991-01-01

    Examined immediate and long-term effects of infertility treatment on the marital and sexual relationship, as perceived by women (n=40) who failed to become pregnant during treatment. Results indicated infertility treatment significantly affected both marital and sexual satisfaction after treatment was terminated, as well as during treatment. (ABL)

  11. Dentists' level of knowledge of the treatment plans for periodontal ligament injuries after dentoalveolar trauma

    OpenAIRE

    2011-01-01

    This study investigated the level of knowledge held by dentists about the possible treatment plan procedures for periodontal ligament injuries after dentoalveolar trauma. A 5-item self-applied questionnaire was prepared with questions referring to the professional profile of the interviewees and to the treatment plan they would propose for periodontal ligament injuries secondary to dentoalveolar trauma. The questionnaires were filled out by 693 dentists attending the 23rd Annual Meeting of th...

  12. Healing the Hidden Wounds of Racial Trauma

    Science.gov (United States)

    Hardy, Kenneth V.

    2013-01-01

    This article examines racial trauma and highlights strategies for healing and transformation to support the disproportionate number of children and youth of color who fail in school and become trapped in the pipelines of treatment, social service, and justice systems. The difficulty in meeting the needs of these children and youth is failing to…

  13. Healing the Hidden Wounds of Racial Trauma

    Science.gov (United States)

    Hardy, Kenneth V.

    2013-01-01

    This article examines racial trauma and highlights strategies for healing and transformation to support the disproportionate number of children and youth of color who fail in school and become trapped in the pipelines of treatment, social service, and justice systems. The difficulty in meeting the needs of these children and youth is failing to…

  14. Dropout among patients in qualified alcohol detoxification treatment: the effect of treatment motivation is moderated by Trauma Load.

    Science.gov (United States)

    Odenwald, Michael; Semrau, Peter

    2013-03-21

    Motivation to change has been proposed as a prerequisite for behavioral change, although empirical results are contradictory. Traumatic experiences are frequently found amongst patients in alcohol treatment, but this has not been systematically studied in terms of effects on treatment outcomes. This study aimed to clarify whether individual Trauma Load explains some of the inconsistencies between motivation to change and behavioral change. Over the course of two months in 2009, 55 patients admitted to an alcohol detoxification unit of a psychiatric hospital were enrolled in this study. At treatment entry, we assessed lifetime Trauma Load and motivation to change. Mode of discharge was taken from patient files following therapy. We tested whether Trauma Load moderates the effect of motivation to change on dropout from alcohol detoxification using multivariate methods. 55.4% dropped out of detoxification treatment, while 44.6% completed the treatment. Age, gender and days in treatment did not differ between completers and dropouts. Patients who dropped out reported more traumatic event types on average than completers. Treatment completers had higher scores in the URICA subscale Maintenance. Multivariate methods confirmed the moderator effect of Trauma Load: among participants with high Trauma Load, treatment completion was related to higher Maintenance scores at treatment entry; this was not true among patients with low Trauma Load. We found evidence that the effect of motivation to change on detoxification treatment completion is moderated by Trauma Load: among patients with low Trauma Load, motivation to change is not relevant for treatment completion; among highly burdened patients, however, who a priori have a greater risk of dropping out, a high motivation to change might make the difference. This finding justifies targeted and specific interventions for highly burdened alcohol patients to increase their motivation to change.

  15. Dental implant treatment following trauma: An investigation into the failure to complete Accident Compensation Corporation funded care.

    Science.gov (United States)

    Kennedy, R; Murray, C; Leichter, J

    2016-03-01

    Among other restorative strategies, the Accident Compensation Corporation (ACC) provides benefits for dental implant treatment to replace teeth lost as a result of trauma. While ACC has funded over 15,000 dental implants since 2002, the outcomes of this treatment and patient perceptions of this treatment have not been investigated. The aim of this study was to investigate the perceptions of the dental implant treatment outcomes and reasons for failure to complete restorative treatment in patients who had undergone trauma-related implant surgery funded by ACC between February 2006 and September 2009, but had not completed the prosthetic component of the treatment. A randomly selected sample of 399 patients, who had undergone dental implant surgery but not completed the crown restoration, was identified from the ACC database. These individuals were contacted by mail for expressions of interest and 181 clients were interviewed by telephone. Responses to open-ended questions were entered into an Excel spreadsheet and analysed using a general inductive technique. A common emergent theme was the high level of satisfaction expressed by participants with the implant process, however just under half of those responding felt they had been pushed into having implants and were given the impression that this was the only treatment ACC paid for. The cost of the prosthetic phase of the treatment and surgical complications were identified as the primary reasons why participants failed to complete the restorative phase of treatment, after completing the surgical phase. The results highlighted the need to better inform patients of their treatment options and to allow time for them to process this information before progressing with care. A patient decision tool may help to give greater ownership of the treatment options. Newly implemented protocols to assist dentists to better assess treatment needs may also assist in achieving improvements in perceived treatment outcomes for

  16. Psychosocial predictors of treatment outcome for trauma-affected refugees

    DEFF Research Database (Denmark)

    Sonne, Charlotte; Carlsson, Jessica; Bech, Per;

    2016-01-01

    situation. The primary outcome measure was PTSD symptoms measured on the Harvard Trauma Questionnaire (HTQ). Other outcome measures included the Hopkins Symptom Check List-25, the WHO-5 Well-being Index, Sheehan Disability Scale, Hamilton Depression and Anxiety Scales, the somatisation scale of the Symptoms...

  17. Clinical Holistic Medicine: Holistic Treatment of Rape and Incest Trauma

    Directory of Open Access Journals (Sweden)

    Søren Ventegodt

    2005-01-01

    Full Text Available Studies indicate that at least 15% of the female population in western countries has experienced sexual abuse and severe sexual traumas. This paper explains how even serious sexual abuse and trauma can be healed when care and resources encourage the patient to return to the painful life events. When the physician cares and receives the trust of the patient, emotional holding and processing will follow quite naturally. Spontaneous regression seems to be an almost pain-free way of integrating the severe traumas from earlier experiences of rape and incest. This technique is a recommended alternative to classical timeline therapy using therapeutic commands. When traumatized patients distance themselves from their soul (feelings, sexuality, and existential depth, they often lose their energy and enjoyment of life. However, this does not mean that they are lost to life. Although it may seem paradoxical, a severe trauma may be a unique opportunity to regain enjoyment of life. The patient will often be richly rewarded for the extensive work of clearing and sorting out in order to experience a new depth in his or her existence and emotional life, with a new ability to understand life in general and other people in particular. So what may look like a tragedy can be transformed into a unique gift; if the patient gets sufficient support, there is the possibility of healing and learning. Consciousness-based medicine seems to provide severely traumatized patients with the quality of support and care needed for their soul to heal.

  18. Oral health: treatment of dental trauma and pain.

    Science.gov (United States)

    Martonffy, Andrea Ildiko

    2015-01-01

    Dental trauma is common among adults and children. As children become mobile, they frequently experience trauma to their primary teeth because of falls. Injuries to permanent teeth are common results of falls, motor vehicle accidents, sports injuries, and violence. Trauma can affect the tooth enamel, dentin, pulp, root, periodontal ligament, gum, or alveolar bone. Avulsions are characterized by complete displacement of the tooth from the socket. Avulsed primary teeth should not be replanted because replantation is associated with a risk of damage to the developing permanent tooth. Avulsed permanent teeth are considered a dental emergency and should be replanted by the first individual capable of doing so. If immediate replantation is not possible, the tooth should be stored in cold animal or human milk; it also can be stored in the mouth, adjacent to the buccal mucosa, if the patient is capable of doing so. Water should be avoided as a storage medium because it impedes healing of the periodontal ligament, but storage in water is superior to dry storage. Intruded teeth (ie, pushed into the jaw) may need immediate extraction, depending on their orientation. All patients with dental trauma should follow up promptly with a dentist. Patients presenting with chronic dental pain without an obvious treatable etiology will benefit from ongoing support from their family physicians. Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.

  19. Family Therapy of Terroristic Trauma: Psychological Syndromes and Treatment Strategies.

    Science.gov (United States)

    Miller, Laurence

    2003-01-01

    Reviews pertinent literature on terroristic trauma and combines this information with the author's experience in treating adults, children, and family victims and survivors of recent terrorist attacks. Describes the psychological syndromes resulting from terrorism and discusses the relevant individual and family therapy modalities for treating…

  20. The immune response to surgery and trauma: Implications for treatment.

    Science.gov (United States)

    Marik, Paul E; Flemmer, Mark

    2012-10-01

    Infection after surgery and trauma is a major cause of increased morbidity, mortality, and cost. Alterations of the hosts immune system following these insults is believed to be responsible for the increased risk of infection. The hosts' immune response to tissue injury is widely believed to follow a bimodal response, with the systemic inflammatory response syndrome (SIRS) followed by the compensated anti-inflammatory response syndrome (CARS). Recent data, however, suggests that his paradigm may not be correct. We reviewed the literature to describe the immunological changes following surgery and trauma and possible therapeutic interventions to limit this process. Physical injury related to trauma and surgery increase the expression of T-helper 2 (Th2) lymphocytes which cause impaired cell mediated immunity (CMI). Activation of the hypothalamic-pituitary-adrenal (HPA) axis and sympathoadrenal system (SAS) with the release of cortisol and catecholamines appear to be responsible for altering the Th1/Th2 balance. Decreased expression and signalling of interleukin-12 (IL-12) and increased expression of T regulatory cells (Tregs) appear to play a central role in mediating this immune depression. Furthermore, Th2 cytokines increase the expression of arginase-1 (ARG1) in myeloid-derived suppressor cells (MDSC's) causing an arginine deficient state, which further impairs lymphocyte function. Immunomodulating diets (IMDs) containing supplemental arginine and omega-3 fatty acids have been demonstrated to restore the Th1/Th2 balance after surgical trauma and to reduce the risk of infectious complications. β-adrenergic receptor blockage reverses the Th-1 to Th2 shift and preliminary data suggests that such therapy may be beneficial. Tissue injury following surgery and trauma results in depressed CMI leading to an increased risk of infections. The peri-operative use of IMDs appear to reverse this immunosuppression and decrease the risk of postoperative complications. While

  1. Acute costs and predictors of higher treatment costs of trauma in New South Wales, Australia.

    Science.gov (United States)

    Curtis, Kate; Lam, Mary; Mitchell, Rebecca; Black, Deborah; Taylor, Colman; Dickson, Cara; Jan, Stephen; Palmer, Cameron S; Langcake, Mary; Myburgh, John

    2014-01-01

    Accurate economic data are fundamental for improving current funding models and ultimately in promoting the efficient delivery of services. The financial burden of a high trauma casemix to designated trauma centres in Australia has not been previously determined, and there is some evidence that the episode funding model used in Australia results in the underfunding of trauma. To describe the costs of acute trauma admissions in trauma centres, identify predictors of higher treatment costs and cost variance in New South Wales (NSW), Australia. Data linkage of admitted trauma patient and financial data provided by 12 Level 1 NSW trauma centres for the 08/09 financial year was performed. Demographic, injury details and injury scores were obtained from trauma registries. Individual patient general ledger costs (actual trauma patient costs), Australian Refined Diagnostic Related Groups (AR-DRG) and state-wide average costs (which form the basis of funding) were obtained. The actual costs incurred by the hospital were then compared with the state-wide AR-DRG average costs. Multivariable multiple linear regression was used for identifying predictors of costs. There were 17,522 patients, the average per patient cost was $10,603 and the median was $4628 (interquartile range: $2179-10,148). The actual costs incurred by trauma centres were on average $134 per bed day above AR-DRG costs-determined costs. Falls, road trauma and violence were the highest causes of total cost. Motor cyclists and pedestrians had higher median costs than motor vehicle occupants. As a result of greater numbers, patients with minor injury had comparable total costs with those generated by patients with severe injury. However the median cost of severely injured patients was nearly four times greater. The count of body regions injured, sex, length of stay, serious traumatic brain injury and admission to the Intensive Care Unit were significantly associated with increased costs (ptrauma costing study

  2. Failing Failed States

    DEFF Research Database (Denmark)

    Holm, Hans-Henrik

    2002-01-01

    When states are failing, when basic state functions are no longer carried out, and when people have no security, humanitarian crises erupt. In confronting this problem, the stronger states have followed an ad hoc policy of intervention and aid. In some cases, humanitarian disasters have resulted ...

  3. Failing Failed States

    DEFF Research Database (Denmark)

    Holm, Hans-Henrik

    2002-01-01

    When states are failing, when basic state functions are no longer carried out, and when people have no security, humanitarian crises erupt. In confronting this problem, the stronger states have followed an ad hoc policy of intervention and aid. In some cases, humanitarian disasters have resulted...

  4. The treatment of nonmelancholic depression: when antidepressants fail, does psychotherapy work?

    Science.gov (United States)

    Parker, Gordon; Graham, Rebecca; Sheppard, Elizabeth

    2014-07-01

    Treatment-resistant depression (TRD) is used as a descriptive or diagnostic term and has generated many management guidelines weighting antidepressant (AD) therapy, but which may be an inappropriate paradigm for the nonmelancholic disorders where psychotherapy may be a more salient modality. This study sought to evaluate the effectiveness of psychological therapy in patients whose nonmelancholic depressive condition had been resistant to at least 2 ADs. Principal analyses compared 32 patients, diagnosed with a nonmelancholic depression who received 12 weeks of psychological therapy, with a small control group. Comparative analyses failed to find a distinct therapeutic effect, leading to an extension study pursuing candidate explanatory factors for this lack of response, including psychosocial factors. While our sample showed a 41% response and 22% remission rate to psychotherapy, their improvement pattern was similar to the control group, thus arguing against any specific therapeutic benefit. Explanatory factors nominated by the treating psychologist weighted personality issues for 35% of the patients, distal stressors for 22%, and comorbid anxiety conditions for 18%. When sample members were compared with an age- and sex-matched sample of patients with nonmelancholic depression who improved distinctly during a similar 12-week period, rates of such putative personality, stress, and anxiety risk factors did not differ, arguing against the likelihood of these factors compromising improvement. Patients with nonmelancholic TRD also failed to demonstrate a clear response to a psychotherapeutic approach, while our pursuit of clinically explanatory variables was not supported empirically.

  5. Innovations in Implementation of Trauma-Informed Care Practices in Youth Residential Treatment: A Curriculum for Organizational Change

    Science.gov (United States)

    Hummer, Victoria Latham; Dollard, Norin; Robst, John; Armstrong, Mary I.

    2010-01-01

    Children in the child welfare system frequently experience trauma within the caregiving relationship. These traumatic experiences may be compounded by system trauma and place these children at high risk of emotional disorders and placement in out-of-home (OOH) mental health treatment programs. This article reviews the literature on trauma and…

  6. Innovations in Implementation of Trauma-Informed Care Practices in Youth Residential Treatment: A Curriculum for Organizational Change

    Science.gov (United States)

    Hummer, Victoria Latham; Dollard, Norin; Robst, John; Armstrong, Mary I.

    2010-01-01

    Children in the child welfare system frequently experience trauma within the caregiving relationship. These traumatic experiences may be compounded by system trauma and place these children at high risk of emotional disorders and placement in out-of-home (OOH) mental health treatment programs. This article reviews the literature on trauma and…

  7. Surgical treatment of noniatrogenic trauma of the femoral arteries.

    Science.gov (United States)

    Wolosker, N; Guadêncio, A; Kuzniec, S; Rosoky, R A; Kalume, C; Neves, C A; Aun, R; Langer, B

    1996-01-01

    Trauma to the femoral arteries corresponds to 30 percent of all arterial traumas. The authors reviewed 74 patients with noniatrogenic trauma of the femoral arteries treated from January 1991 to December 1993. Ages ranged from 11 to 50 years, with a mean of 24. Seventy-one patients were male and three female. Fifty-two patients (70.2 percent) were white, 20 (27 percent) were black and two (2.8 percent) were Asian. Trauma due to firearms had the highest incidence, with 61 cases (82.4 percent). Absence of pulse was the most frequent clinical symptom (62.5 percent). Severe ischemia, with risk of loss of limb, was found in 66.2 percent of the cases. The superficial femoral artery was impaired in 77 percent of the cases. A preoperative arteriography was performed on only five patients, victims of multiple penetrating trauma or an asymptomatic penetrating wound along a vessel passage. In six cases, arterial and venous ligature was the chosen procedure. In three cases, a primary arterial anantomosis was performed. Simple arterriorraphy was feasible in one patient. In 64 of the patients, a venous graft was undertaken using a segment of the inverted great saphenous vein withdrawn from the other lower limb. Fasciotomoy was used in 32 patients (43.2 percent), all of whom exhibited pasting of the lower limb muscles at admission. One patient died during the immediate postoperative period as the result of multiple organ failure caused by polytraumatism. Preservation of the limb was attained in 72 patients (97.3 percent) Severe, previously-incurred ischemia was responsible for the only two amputations, aggravated by an exceedingly long delay between the time of injury and surgery. One of these patients, in addition to severe ischemia, had extensive injuries to the soft tissues. We conclude that trauma of the femoral arteries, attended while the limb still maintains its vitality, has a positive clinical outcome with a high rate of limb preservation. Mortality usually results from

  8. Surgical treatment of noniatrogenic trauma of the femoral arteries

    Directory of Open Access Journals (Sweden)

    Nelson Wolosker

    Full Text Available Trauma to the femoral arteries corresponds to 30 percent of all arterial traumas. The authors reviewed 74 patients with noniatrogenic trauma of the femoral arteries treated from January 1991 to December 1993. Ages ranged from 11 to 50 years, with a mean of 24. Seventy-one patients were male and three female. Fifty-two patients (70.2 percent were white, 20 (27 percent were black and two (2.8 percent were Asian. Trauma due to firearms had the highest incidence, with 61 cases (82.4 percent. Absence of pulse was the most frequent clinical symptom (62.5 percent. Severe ischemia, with risk of loss of limb, was found in 66.2 percent of the cases. The superficial femoral artery was impaired in 77 percent of the cases. A preoperative arteriography was performed on only five patients, victims of multiple penetrating trauma or an asymptomatic penetrating wound along a vessel passage. In six cases, arterial and venous ligature was the chosen procedure. In three cases, a primary arterial anantomosis was performed. Simple arterriorraphy was feasible in one patient. In 64 of the patients, a venous graft was undertaken using a segment of the inverted great saphenous vein withdrawn from the other lower limb. Fasciotomoy was used in 32 patients (43.2 percent, all of whom exhibited pasting of the lower limb muscles at admission. One patient died during the immediate postoperative period as the result of multiple organ failure caused by polytraumatism. Preservation of the limb was attained in 72 patients (97.3 percent Severe, previously-incurred ischemia was responsible for the only two amputations, aggravated by an exceedingly long delay between the time of injury and surgery. One of these patients, in addition to severe ischemia, had extensive injuries to the soft tissues. We conclude that trauma of the femoral arteries, attended while the limb still maintains its vitality, has a positive clinical outcome with a high rate of limb preservation. Mortality usually

  9. Successfully Climbing the "STAIRs": Surmounting Failed Translation of Experimental Ischemic Stroke Treatments.

    Science.gov (United States)

    Kahle, Michael P; Bix, Gregory J

    2012-01-01

    The Stroke Therapy Academic Industry Roundtable (STAIR) provided initial (in 1999) and updated (in 2009) recommendations with the goal of improving preclinical stroke therapy assessment and to increase the translational potential of experimental stroke treatments. It is important for preclinical stroke researchers to frequently consider and revisit these concepts, especially since promising experimental stroke treatments continue to fail in human clinical trials. Therefore, this paper will focus on considerations for several key aspects of preclinical stroke studies including the selection and execution of the animal stroke model, drug/experimental treatment administration, and outcome measures to improve experimental validity and translation potential. Specific points of interest discussed include the incorporation of human comorbid conditions and drugs, the benefits of defining a proposed mechanism of action, replication of results using multiple methods, using clinically relevant routes of administration and treatment time windows, and performing and reporting good experimental methods to reduce bias such as, as suggested by the updated STAIR recommendations, sample size calculations, randomization, allocation concealment, blinding, and appropriate inclusion/exclusion criteria. It is our hope that reviewing and revisiting these considerations will benefit researchers in their investigations of stroke therapies and increase the likelihood of translational success in the battle against stroke.

  10. Successfully Climbing the “STAIRs”: Surmounting Failed Translation of Experimental Ischemic Stroke Treatments

    Directory of Open Access Journals (Sweden)

    Michael P. Kahle

    2012-01-01

    Full Text Available The Stroke Therapy Academic Industry Roundtable (STAIR provided initial (in 1999 and updated (in 2009 recommendations with the goal of improving preclinical stroke therapy assessment and to increase the translational potential of experimental stroke treatments. It is important for preclinical stroke researchers to frequently consider and revisit these concepts, especially since promising experimental stroke treatments continue to fail in human clinical trials. Therefore, this paper will focus on considerations for several key aspects of preclinical stroke studies including the selection and execution of the animal stroke model, drug/experimental treatment administration, and outcome measures to improve experimental validity and translation potential. Specific points of interest discussed include the incorporation of human comorbid conditions and drugs, the benefits of defining a proposed mechanism of action, replication of results using multiple methods, using clinically relevant routes of administration and treatment time windows, and performing and reporting good experimental methods to reduce bias such as, as suggested by the updated STAIR recommendations, sample size calculations, randomization, allocation concealment, blinding, and appropriate inclusion/exclusion criteria. It is our hope that reviewing and revisiting these considerations will benefit researchers in their investigations of stroke therapies and increase the likelihood of translational success in the battle against stroke.

  11. Follow-up study of the treatment outcomes at a psychiatric trauma clinic for refugees

    DEFF Research Database (Denmark)

    Buhmann, Cæcilie; Lykke Mortensen, Erik; Nordentoft, Merete;

    2015-01-01

    PURPOSE: To describe change in mental health after treatment with antidepressants and trauma-focused cognitive behavioral therapy. METHODS: Patients receiving treatment at the Psychiatric Trauma Clinic for Refugees in Copenhagen completed self-ratings of level of functioning, quality of life......, and symptoms of PTSD, depression and anxiety before and after treatment. Changes in mental state and predictors of change were evaluated in a sample that all received well-described and comparable treatment. RESULTS: 85 patients with PTSD or depression were included in the analysis. Significant improvement...

  12. Drawing Invisible Wounds: War Comics and the Treatment of Trauma.

    Science.gov (United States)

    Leone, Joshua M

    2017-04-08

    Since the Vietnam War, graphic novels about war have shifted from simply representing it to portraying avenues for survivors to establish psychological wellness in their lives following traumatic events. While modern diagnostic medicine often looks to science, technology, and medications to treat the psychosomatic damage produced by trauma, my article examines the therapeutic potential of the comics medium with close attention to war comics. Graphic novels draw trauma in a different light: because of the medium's particular combination of words and images in sequence, war comics represent that which is typically unrepresentable, and these books serve as useful tools to promote healing among the psychologically wounded. Graphic narratives, both fictional and non-fictional, illuminate the ways that the unseen wounds of traumatic experience affect public health by compromising the ability of communities, individuals, and survivors to create and maintain meaningful relationships with others.

  13. The variation of acute treatment costs of trauma in high-income countries

    Directory of Open Access Journals (Sweden)

    Willenberg Lynsey

    2012-08-01

    Full Text Available Abstract Background In order to assist health service planning, understanding factors that influence higher trauma treatment costs is essential. The majority of trauma costing research reports the cost of trauma from the perspective of the receiving hospital. There has been no comprehensive synthesis and little assessment of the drivers of cost variation, such as country, trauma, subgroups and methods. The aim of this review is to provide a synthesis of research reporting the trauma treatment costs and factors associated with higher treatment costs in high income countries. Methods A systematic search for articles relating to the cost of acute trauma care was performed and included studies reporting injury severity scores (ISS, per patient cost/charge estimates; and costing methods. Cost and charge values were indexed to 2011 cost equivalents and converted to US dollars using purchasing power parities. Results A total of twenty-seven studies were reviewed. Eighty-one percent of these studies were conducted in high income countries including USA, Australia, Europe and UK. Studies either reported a cost (74.1% or charge estimate (25.9% for the acute treatment of trauma. Across studies, the median per patient cost of acute trauma treatment was $22,448 (IQR: $11,819-$33,701. However, there was variability in costing methods used with 18% of studies providing comprehensive cost methods. Sixty-three percent of studies reported cost or charge items incorporated in their cost analysis and 52% reported items excluded in their analysis. In all publications reviewed, predictors of cost included Injury Severity Score (ISS, surgical intervention, hospital and intensive care, length of stay, polytrauma and age. Conclusion The acute treatment cost of trauma is higher than other disease groups. Research has been largely conducted in high income countries and variability exists in reporting costing methods as well as the actual costs. Patient populations studied

  14. Randomized clinical trial for treatment of chronic nightmares in trauma-exposed adults.

    Science.gov (United States)

    Davis, Joanne L; Wright, David C

    2007-04-01

    Nightmares and sleep disturbance are fundamental concerns for victims of trauma. This study examined the efficacy of a manualized cognitive-behavioral treatment (CBT) for chronic nightmares in trauma-exposed individuals via a randomized clinical trial. Participants were randomly assigned to a treatment group or wait-list control group, with 27 participants completing the treatment. At the 6-month follow-up assessment, 84% of treated participants reported an absence of nightmares in the previous week. Significant decreases were also reported in symptoms of depression and posttraumatic stress, fear of sleep, and number of sleep problems, while sleep quality and quantity improved. The present study adds to the growing literature indicating this brief CBT as a first-line treatment for trauma-exposed individuals with chronic nightmares.

  15. Impact of trauma and surgical treatment on the quality of life of patients with facial fractures.

    Science.gov (United States)

    Conforte, J J; Alves, C P; Sánchez, M del P R; Ponzoni, D

    2016-05-01

    This study assessed the impact of oral and maxillofacial trauma and surgical treatment on the quality of life of patients. The study included 66 patients (age range 18-65 years) with facial fractures; 33 required surgical treatment and 33 required conservative (non-surgical) treatment. Quality of life was evaluated by applying the Oral Health Impact Profile questionnaire (OHIP-14) immediately after diagnosis of the trauma (T1), 30 days after surgery or trauma (T2), and 90 days after surgery or trauma (T3). For the control group (conservative treatment), there was a change in quality of life at T1 and T2. A change in quality of life was found for all of the surgical patients, regardless of the type of fracture and the observation period analyzed. There was no statistical difference when T1, T2, and T3 were compared in cases of zygomatic, Le Fort I, and nasal fractures, however there was an improvement in the quality of life of patients with mandibular fractures (P=0.0102) and multiple facial fractures (P=0.0097) at T3. Facial trauma caused the greatest impact on the quality of life of surgical patients at T1. The surgical treatment significantly improved quality of life for patients with mandibular and multiple facial fractures.

  16. Grief responses and coping strategies among infertile women after failed in vitro fertilization treatment.

    Science.gov (United States)

    Lee, Shu-Hsin; Wang, Shu-Chuan; Kuo, Ching-Pyng; Kuo, Pi-Chao; Lee, Maw-Sheng; Lee, Meng-Chih

    2010-09-01

    Reproductive technology has increased the childbearing potential for many infertile women, but in vitro fertilization (IVF) failures are common, which often trigger grief responses and coping strategies to manage the stressful life event. The present cross-sectional study investigated 66 women who had experienced at least one failure with IVF treatment. The data were gathered by a self-administered structured questionnaire, and included the participant's personal profile, grief responses and the Jalowiec's coping scale. The most common grief response among the respondents was bargaining, followed by acceptance, depression, anger, denial, and isolation. The order of coping strategies used, from highest-to-lowest, were confrontative, optimistic, self-reliant, fatalistic, supportive, evasive, palliative, and emotive. Use and self-perceived effectiveness among all coping strategies had a high correlation, except emotion. Bargaining, the most common grief response, was associated with a variety of coping strategies. All coping strategies were correlated with grief responses. The results of identifying the grief responses and associated coping strategies of women who have undergone failed IVF treatment may assist nurses and other health care professionals in their efforts to provide appropriate information, care and psychological support.

  17. Luxation of Eye ball following trauma: Novel simple treatment

    Directory of Open Access Journals (Sweden)

    Essam A Osman

    2014-01-01

    Full Text Available Luxation of the eye globe is a rare occasion but it carries a risk of threat to permanent vision loss especially when associated with very high intraocular pressure. Appropriate intervention should be undertaken instantly. Predisposing factors include; eyes as in shallow orbital sockets, floppy eyelid syndrome, and exophthalmos. Prompt reduction results in restoration of full anatomical and visual recovery in otherwise healthy eyes. We report a case of globe luxation following trauma by door handle in a 65-year-old female, who recovered completely after reposition of the globe using Desmarres Lid Retractors.

  18. Increased Mindfulness Skills as Predictors of Reduced Trauma-Related Guilt in Treatment-Seeking Veterans.

    Science.gov (United States)

    Held, Philip; Owens, Gina P; Monroe, J Richard; Chard, Kathleen M

    2017-08-01

    The present study examined the predictive role of increased self-reported mindfulness skills on reduced trauma-related guilt in a sample of veterans over the course of residential treatment for posttraumatic stress disorder (PTSD; N = 128). The residential treatment consisted of seven weeks of intensive cognitive processing therapy (CPT) for PTSD, as well as additional psychoeducational groups, including seven sessions on mindfulness skills. Increased mindfulness skills describing, acting with awareness, and accepting without judgment were significantly associated with reductions in trauma-related guilt over the course of treatment. Increases in the ability to act with awareness and accept without judgment were significantly associated with reductions in global guilt, R(2) = .26, guilt distress, R(2) = .23, guilt cognitions, R(2) = .23, and lack of justification, R(2) = .11. An increase in the ability to accept without judgment was the only self-reported mindfulness skill that was associated with reductions in hindsight bias, β = -.34 and wrongdoing, β = -.44. Increases in self-reported mindfulness skills explained 15.1 to 24.1% of the variance in reductions in trauma-related guilt, suggesting that mindfulness skills may play a key role in reducing the experience of trauma-related guilt during psychotherapy. Our results provide preliminary support for the use of mindfulness groups as an adjunct to traditional evidence-based treatments aimed at reducing trauma-related guilt, though this claim needs to be tested further using experimental designs. Copyright © 2017 International Society for Traumatic Stress Studies.

  19. Do Persons with Intellectual Disability and Limited Verbal Capacities Respond to Trauma Treatment?

    Science.gov (United States)

    Mevissen, Liesbeth; Lievegoed, Reinout; Seubert, Andrew; De Jongh, Ad

    2011-01-01

    Background: There is not one case report of successful trauma treatment with the use of an evidence-based treatment method in people with substantially limited verbal capacities. This paper assessed the applicability of eye movement desensitisation and reprocessing (EMDR) in two clients with moderate ID, serious behavioural problems, and histories…

  20. Implementing Trauma-Informed Treatment for Youth in a Residential Facility: First-Year Outcomes

    Science.gov (United States)

    Greenwald, Ricky; Siradas, Lynn; Schmitt, Thomas A.; Reslan, Summar; Fierle, Julia; Sande, Brad

    2012-01-01

    Training in the Fairy Tale model of trauma-informed treatment was provided to clinical and direct care staff working with 53 youth in a residential treatment facility. Compared to the year prior to training, in the year of the training the average improvement in presenting problems was increased by 34%, time to discharge was reduced by 39%, and…

  1. Do persons with intellectual disability and limited verbal capacities respond to trauma treatment?

    NARCIS (Netherlands)

    Mevissen-Renckens, E.H.M.; Lievegoed, R.; Seubert, A; de Jongh, A.

    2011-01-01

    Background There is not one case report of successful trauma treatment with the use of an evidence-based treatment method in people with substantially limited verbal capacities. This paper assessed the applicability of eye movement desensitisation and reprocessing (EMDR) in two clients with moderate

  2. Usefulness of a trauma-focused treatment approach for travel phobia

    NARCIS (Netherlands)

    de Jongh, A.; Holmshaw, M.; Carswell, W.; van Wijk, A.

    2011-01-01

    Despite its prevalence and potential impact on functioning, there are surprisingly little data regarding the treatment responsiveness of travel phobia. The purpose of this non-randomized study was to evaluate the usefulness of a trauma-focused treatment approach for travel phobia, or milder travel a

  3. Treatment of trauma-affected refugees with venlafaxine versus sertraline combined with psychotherapy

    DEFF Research Database (Denmark)

    Sonne, Charlotte; Lohmann, Jessica Mariana Carlsson; Bech, Per

    2016-01-01

    Background: The prevalence of trauma-related psychiatric disorders is high among refugees. Despite this, little is known about the effect of pharmacological treatment for this patient group. The objective of the present study was therefore to examine differences in the effects of venlafaxine...... and sertraline on Post-Traumatic Stress Disorder (PTSD), depression and functional impairment in trauma-affected refugees. Methods: The study was a randomised pragmatic trial comparing venlafaxine and sertraline in combination with psychotherapy and social counselling. PTSD symptoms were measured on the Harvard......: Two hundred seven adult refugee patients were included in the trial (98 in the venlafaxine and 109 in the sertraline group). Of these, 195 patients were eligible for intention-to-treat analyses. Small but significant pre-treatment to post-treatment differences were found on the Harvard Trauma...

  4. Perceptions of hospitalization-related trauma and treatment participation among individuals with psychotic disorders

    Science.gov (United States)

    Paksarian, D.; Mojtabai, R.; Kotov, R.; Cullen, B.; Nugent, K.L.; Bromet, E.J.

    2014-01-01

    Objective The purpose of this study was to assess the extent to which psychiatric hospitalizations are perceived as traumatic and associations of such experiences with treatment participation. Methods First-admissions (n=395) with psychotic disorders participating in the Suffolk County Mental Health Project were interviewed at 10-year follow-up. We examined associations of perceived trauma and distressing or coercive experiences over 10 years with patient characteristics and treatment participation. Results Sixty-nine percent of participants perceived at least one hospitalization as traumatic or extremely distressing. Perceived trauma was more common among females than males and homemakers compared with full-time workers. Trauma perception was not associated with treatment-seeking or time in treatment. However, reporting forced medication was associated with reduced time in treatment, especially for participants with schizophrenia spectrum disorders. Conclusions Although perceptions of trauma during psychiatric hospitalization are common, they may be unrelated to treatment participation. However, we found modest evidence of a link between coercive experiences and reduced time treatment. PMID:24492906

  5. The systemic immune response to trauma: an overview of pathophysiology and treatment.

    Science.gov (United States)

    Lord, Janet M; Midwinter, Mark J; Chen, Yen-Fu; Belli, Antonio; Brohi, Karim; Kovacs, Elizabeth J; Koenderman, Leo; Kubes, Paul; Lilford, Richard J

    2014-10-18

    Improvements in the control of haemorrhage after trauma have resulted in the survival of many people who would otherwise have died from the initial loss of blood. However, the danger is not over once bleeding has been arrested and blood pressure restored. Two-thirds of patients who die following major trauma now do so as a result of causes other than exsanguination. Trauma evokes a systemic reaction that includes an acute, non-specific, immune response associated, paradoxically, with reduced resistance to infection. The result is damage to multiple organs caused by the initial cascade of inflammation aggravated by subsequent sepsis to which the body has become susceptible. This Series examines the biological mechanisms and clinical implications of the cascade of events caused by large-scale trauma that leads to multiorgan failure and death, despite the stemming of blood loss. Furthermore, the stark and robust epidemiological finding--namely, that age has a profound influence on the chances of surviving trauma irrespective of the nature and severity of the injury--will be explored. Advances in our understanding of the inflammatory response to trauma, the impact of ageing on this response, and how this information has led to new and emerging treatments aimed at combating immune dysregulation and reduced immunity after injury will also be discussed.

  6. Terazosin for the treatment of trauma-related nightmares: a report of 4 cases.

    Science.gov (United States)

    Nirmalani-Gandhy, Anjali; Sanchez, Deborah; Catalano, Glenn

    2015-01-01

    The selective α1-adrenergic antagonist prazosin has been shown in multiple studies to be effective in targeting trauma-related nightmares in posttraumatic stress disorder. There are limited data regarding the effectiveness of another selective α1-adrenergic antagonist terazosin for the treatment of trauma-related nightmares. We present 4 cases in which terazosin was effectively used to treat nightmares as a second-line agent after prazosin failure. Further studies are needed to validate terazosin as an alternative to prazosin for the treatment of posttraumatic stress disorder-related nightmares.

  7. Treatment of trauma-affected refugees with venlafaxine versus sertraline combined with psychotherapy

    DEFF Research Database (Denmark)

    Sonne, Charlotte; Lohmann, Jessica Mariana Carlsson; Bech, Per

    2016-01-01

    and sertraline on Post-Traumatic Stress Disorder (PTSD), depression and functional impairment in trauma-affected refugees. Methods: The study was a randomised pragmatic trial comparing venlafaxine and sertraline in combination with psychotherapy and social counselling. PTSD symptoms were measured on the Harvard......: Two hundred seven adult refugee patients were included in the trial (98 in the venlafaxine and 109 in the sertraline group). Of these, 195 patients were eligible for intention-to-treat analyses. Small but significant pre-treatment to post-treatment differences were found on the Harvard Trauma...

  8. Cognitive behavioral psychotherapeutic treatment at a psychiatric trauma clinic for Refugees

    DEFF Research Database (Denmark)

    Buhmann, Christine Cæcilie Böck; Andersen, Ida; Mortensen, Erik Lykke

    2015-01-01

    for traumatized refugees incorporating exposure therapy, mindfulness and acceptance and commitment therapy. MATERIAL AND METHODS: 85 patients received six months' treatment at a Copenhagen Trauma Clinic for Refugees and completed self-ratings before and after treatment. The treatment administered to each patient...... and the observed change. CONCLUSION: The study suggests that CBT treatment incorporating mindfulness and acceptance and commitment therapy is promising for traumatized refugees and punctures the myth that this group of patients are unable to participate fully in structured CBT. However, treatment methods must......INTRODUCTION: Cognitive behavioural therapy (CBT) with trauma focus is the most evidence supported psychotherapeutic treatment of PTSD, but few CBT treatments for traumatized refugees have been described in detail. PURPOSE: To describe and evaluate a manualized cognitive behavioral therapy...

  9. Cognitive behavioral psychotherapeutic treatment at a psychiatric trauma clinic for refugees

    DEFF Research Database (Denmark)

    Buhmann, Cæcilie; Andersen, Ida; Mortensen, Erik Lykke

    2015-01-01

    for traumatized refugees incorporating exposure therapy, mindfulness and acceptance and commitment therapy. MATERIAL AND METHODS: 85 patients received six months' treatment at a Copenhagen Trauma Clinic for Refugees and completed self-ratings before and after treatment. The treatment administered to each patient...... and the observed change. CONCLUSION: The study suggests that CBT treatment incorporating mindfulness and acceptance and commitment therapy is promising for traumatized refugees and punctures the myth that this group of patients are unable to participate fully in structured CBT. However, treatment methods must......INTRODUCTION: Cognitive behavioural therapy (CBT) with trauma focus is the most evidence supported psychotherapeutic treatment of PTSD, but few CBT treatments for traumatized refugees have been described in detail. PURPOSE: To describe and evaluate a manualized cognitive behavioral therapy...

  10. Cognitive behavioral psychotherapeutic treatment at a psychiatric trauma clinic for Refugees

    DEFF Research Database (Denmark)

    Buhmann, Christine Cæcilie Böck; Andersen, Ida; Mortensen, Erik Lykke;

    2015-01-01

    INTRODUCTION: Cognitive behavioural therapy (CBT) with trauma focus is the most evidence supported psychotherapeutic treatment of PTSD, but few CBT treatments for traumatized refugees have been described in detail. PURPOSE: To describe and evaluate a manualized cognitive behavioral therapy...... for traumatized refugees incorporating exposure therapy, mindfulness and acceptance and commitment therapy. MATERIAL AND METHODS: 85 patients received six months' treatment at a Copenhagen Trauma Clinic for Refugees and completed self-ratings before and after treatment. The treatment administered to each patient...... and the observed change. CONCLUSION: The study suggests that CBT treatment incorporating mindfulness and acceptance and commitment therapy is promising for traumatized refugees and punctures the myth that this group of patients are unable to participate fully in structured CBT. However, treatment methods must...

  11. Nasal birth trauma: a review of appropriate treatment.

    LENUS (Irish Health Repository)

    Cashman, E C

    2012-02-01

    The aetiology of nasal deformity has frequently included birth trauma. There is no consensus in the literature as to whether nasal surgery, in the form of closed reduction, is indicated in neonates. The majority of studies in the literature that advocate intervention have inadequate followup periods and there is a paucity of evidence for the adverse effects of conservative management. This case highlights the therapeutic dilemma posed by such nasal injuries in the neonate and, to the best of the authors\\' knowledge, at the time of writing, represents the earliest reported case in the literature of nasal deformity in the neonate. The term nasal deformity is used to denote deformity of the nasal pyramid, soft tissue, and septum. Three main aspects of neonatal nasal deformity are addressed including, firstly, if nasal deformity at birth needs to be addressed, secondly, if left unaltered, what the long-term effects are and, finally, if intervention alters the normal course of midfacial development.

  12. Nasal Birth Trauma: A Review of Appropriate Treatment

    Directory of Open Access Journals (Sweden)

    E. C. Cashman

    2010-01-01

    Full Text Available The aetiology of nasal deformity has frequently included birth trauma. There is no consensus in the literature as to whether nasal surgery, in the form of closed reduction, is indicated in neonates. The majority of studies in the literature that advocate intervention have inadequate followup periods and there is a paucity of evidence for the adverse effects of conservative management. This case highlights the therapeutic dilemma posed by such nasal injuries in the neonate and, to the best of the authors' knowledge, at the time of writing, represents the earliest reported case in the literature of nasal deformity in the neonate. The term nasal deformity is used to denote deformity of the nasal pyramid, soft tissue, and septum. Three main aspects of neonatal nasal deformity are addressed including, firstly, if nasal deformity at birth needs to be addressed, secondly, if left unaltered, what the long-term effects are and, finally, if intervention alters the normal course of midfacial development.

  13. Evaluation of the Effects of Standard Rescue Procedure on Severe Trauma Treatment in China

    Institute of Scientific and Technical Information of China (English)

    Xiao-Feng Yin; Tian-Bing Wang; Pei-Xun Zhang; Yu-Hui Kou; Dian-Ying Zhang; Kai Yu; De-Cheng Lyu

    2015-01-01

    Background:This study aimed to evaluate the effects of standard rescue procedure (SRP) in improving severe trauma treatments in China.Methods:This study was conducted in 12 hospitals located in geographically and industrially different cities in China.A standard procedure on severe trauma rescue was established as a general rule for staff training and patient treatment.A regional network (system) efficiently integrating prehospital rescue,emergency room treatments,and hospital specialist treatments was built under the rule for information sharing and improving severe trauma treatments.Treatment outcomes were compared between before and I year after the implementation of the SRP.Results:The outcomes of a total of 74,615 and 12,051 trauma cases were collected from 12 hospitals before and after the implementation of the SRP.Implementation of the SRP led to efficient cooperation and information sharing of different treatment services.The emergency response time,prehospital transit time,emergency rescue time,consultation call time,and mortality rate of patients were 24.24 ± 4.32 min,45.69 ± 3.89 min,6.38 ± 1.05 min,17.53 ± 0.72 min,and 33.82% ± 3.87% (n =441),respectively,before the implementation of the standardization and significantly reduced to 10.11 ± 3.21 min,22.39 ± 4.32 min,3.26 ± 0.89 min,3.45 ± 0.45 min,and 20.49% ± 3.11%,separately (n =495,P < 0.05) after that.Conclusions:Staff training and SRP can significantly improve the efficiency of severe trauma treatments in China.

  14. Overgeneralized Beliefs, Accommodation, and Treatment Outcome in Youth Receiving Trauma-Focused Cognitive Behavioral Therapy for Childhood Trauma.

    Science.gov (United States)

    Ready, C Beth; Hayes, Adele M; Yasinski, Carly W; Webb, Charles; Gallop, Robert; Deblinger, Esther; Laurenceau, Jean-Philippe

    2015-09-01

    Inhibition of fear generalization with new learning is an important process in treatments for anxiety disorders. Generalization of maladaptive cognitions related to traumatic experiences (overgeneralized beliefs) have been demonstrated to be associated with posttraumatic stress disorder (PTSD) in adult populations, whereas more balanced, accommodated beliefs are associated with symptom improvement. It is not yet clear whether (a) overgeneralization and accommodation are associated with PTSD treatment outcome in youth, or (b whether accommodated beliefs can interact with or inhibit cognitive overgeneralization, as has been demonstrated in research on behavior-based fear generalization. The current study examined the relationships between overgeneralized and accommodated beliefs, child age, and symptom reduction in a sample of 81 youth (age 7-17 years), who received Trauma-Focused Cognitive Behavioral Therapy. Overgeneralized and accommodated beliefs expressed during the exposure phase of treatment were coded in audio-recorded therapy sessions. Overgeneralization predicted (a) higher internalizing symptom scores at posttreatment, particularly for younger children, and less improvement over treatment, and (b) higher externalizing scores at 1-year follow-up and steeper symptom increases over this period. In contrast, accommodation was associated with (a) lower posttreatment internalizing symptoms and greater improvement over treatment, and (b) lower externalizing scores at 1-year follow-up, particularly for younger children. High levels of accommodation moderated the relationship between overgeneralization and worse symptom outcomes, except when predicting the slope of internalizing scores over treatment, and age did not moderate these effects. There were no significant predictors of child-reported PTSD-specific symptoms, although PTSD symptoms did decrease significantly over the course of treatment and maintain 1year after treatment.

  15. A Behavioral Perspective of Childhood Trauma and Attachment Issues: Toward Alternative Treatment Approaches for Children with a History of Abuse

    Science.gov (United States)

    Prather, Walter; Golden, Jeannie A.

    2009-01-01

    Attachment theory provides a useful conceptual framework for understanding trauma and the treatment of children who have been abused. This article examines childhood trauma and attachment issues from the perspective of behavior analysis, and provides a theoretical basis for two alternative treatment models for previously abused children and their…

  16. Childhood and Adult Trauma Experiences of Incarcerated Persons and Their Relationship to Adult Behavioral Health Problems and Treatment

    Directory of Open Access Journals (Sweden)

    Jing Shi

    2012-05-01

    Full Text Available Rates of childhood and adult trauma are high among incarcerated persons. In addition to criminality, childhood trauma is associated with the risk for emotional disorders (e.g., depression and anxiety and co-morbid conditions such as alcohol and drug abuse and antisocial behaviors in adulthood. This paper develops rates of childhood and adult trauma and examines the impact of age-of-onset and type-specific trauma on emotional problems and behavior for a sample of incarcerated males (N~4,000. Prevalence estimates for types of trauma were constructed by age at time of trauma, race and types of behavioral health treatment received while incarcerated. HLM models were used to explore the association between childhood and adult trauma and depression, anxiety, substance use, interpersonal problems, and aggression problems (each model estimated separately and controlling for age, gender, race, time incarcerated, and index offense. Rates of physical, sexual, and emotional trauma were higher in childhood than adulthood and ranged from 44.7% (physical trauma in childhood to 4.5% (sexual trauma in adulthood. Trauma exposure was found to be strongly associated with a wide range of behavioral problems and clinical symptoms. Given the sheer numbers of incarcerated men and the strength of these associations, targeted intervention is critical.

  17. Technological Advances in the Treatment of Trauma: A Review of Promising Practices

    Science.gov (United States)

    Paul, Lisa A.; Hassija, Christina M.; Clapp, Joshua D.

    2012-01-01

    Given the availability of empirically supported practices for addressing posttraumatic stress disorder and other forms of trauma-related distress, the development and implementation of new technology to deliver these treatments is exciting. Technological innovations in this literature aim to expand availability of empirically based intervention,…

  18. The world is a scary place? INvestigating Treatments and Assessment for Children after Trauma

    NARCIS (Netherlands)

    Diehle, J.

    2014-01-01

    This dissertation provides new insights about treatments and assessment for children who experienced traumatic events. We investigated the comparative effectiveness of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) and Eye Movement Desensitization and Reprocessing (EMDR) by means of a

  19. Piece Work: Fabric Collage as a Neurodevelopmental Approach to Trauma Treatment

    Science.gov (United States)

    Homer, Eliza S.

    2015-01-01

    This article describes the use of collaborative fabric collage based on a neurodevelopmental adaptation for an adult who was being treated for trauma. The case demonstrates the value of thinking about neurodevelopmental factors when creating art therapy interventions. A biologically respectful treatment that offers relational, relevant,…

  20. The world is a scary place? INvestigating Treatments and Assessment for Children after Trauma

    NARCIS (Netherlands)

    Diehle, J.

    2014-01-01

    This dissertation provides new insights about treatments and assessment for children who experienced traumatic events. We investigated the comparative effectiveness of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) and Eye Movement Desensitization and Reprocessing (EMDR) by means of a randomiz

  1. Piece Work: Fabric Collage as a Neurodevelopmental Approach to Trauma Treatment

    Science.gov (United States)

    Homer, Eliza S.

    2015-01-01

    This article describes the use of collaborative fabric collage based on a neurodevelopmental adaptation for an adult who was being treated for trauma. The case demonstrates the value of thinking about neurodevelopmental factors when creating art therapy interventions. A biologically respectful treatment that offers relational, relevant,…

  2. Endoscopic treatment of spinal trauma at the thoracolumbar junction

    Directory of Open Access Journals (Sweden)

    Beisse Rudolf

    2007-01-01

    Full Text Available Attempts of treating unstable fractures of the thoracolumbar junction by posterior reduction and fixation alone often result in a significant loss of correction, especially in lesions where a severe destruction of the vertebral body and the intervertebral disc is present. The conventional open approaches like classic thoraco-phreno-lumbotomy produces additional iatrogenic trauma at the lateral chest and abdominal wall which not rarely lead to intercostal neuralgia, as well as post-thoracotomy syndromes. The endoscopic trans-diaphragmatic approach described below opens up the whole thoracolumbar junction to a minimally invasive procedure allowing one to perform all the procedures needed for a full reconstruction of the anterior column of the spine like corpectomy, decompression, vertebral body replacement and anterior plating. The key to address also the subdia-phragmal and retroperitoneal section of the thoracolumbar junction is a partial detachment of the diaphragm which runs along the attachment at the spine and the ribs. The technique was published first in 1998 and has been used now in 650 endoscopic procedures at the thoracolumbar junction out of a total of more than 1300 thoracoscopic operations of the spine in the BG Unfallklinik Murnau, Germany since 1996.

  3. Treatment for severe craniocerebral trauma combined with transtentorial hernia in children

    Institute of Scientific and Technical Information of China (English)

    梁艺湖; 麦洁文; 李林繁

    2004-01-01

    Objective: To explore the treating method for severe craniocerebral trauma combined with transtentorial hernia in children.Methods: We treated 58 children with severe craniocerebral trauma combined with transtentorial hernia through evacuating the hematomas, incising the tentorium but preserving the floating bone flap between January 1996 and January 2002.Results: GCS was 3-5 in 17 cases and 6-8 in 41 cases. After treatment, 46 patients (79.30%) recovered well, 6 (10.30%) suffered from mild disability, 1 (1.72%) suffered from severe disability, 1 (1.72%) was in vegetative state, and 4 (6.90%) died.Conclusions: Evacuating hematomas and incising tentorium can effectively treat the child patients with severe craniocerebral trauma combined with transtentorial hernia, which can decrease the disability and mortality rates greatly, preserve the skull, exempt reoperation for cranioplasty and relieve the psychologic and physiologic burden of the child patients.

  4. THE PECULIARITIES OF TREATMENT OF UNCOMPLICATED AND COMPLICATED DENTAL INJURIES CAUSED BY TRAUMA.

    Science.gov (United States)

    Mamaladze, M; Nizharadze, N; Vadachkoria, O

    2017-01-01

    Trauma related injuries of permanent teeth occur frequently and are the most pressing issue the dentists are facing today. In different age groups the same type of trauma affects the teeth with different frequencies. For instance, accident related dental trauma in children and adults affected permanent teeth in 30% and deciduous teeth in 20%, respectively. It should also be noted that front teeth are more susceptible to traumatic injuries compared to the incisors. Upper front teeth were injured in 72% of cases, while lower central, upper lateral incisors, canines and premolars only in 6-8%. The severity of dental injury depends on the type and extent of the trauma. Dental injury can be result of either direct or indirect trauma. A strong, «fast as lightning» impact most often affects the dental crown. A weak and dull impact (thump) extends toward the root apical direction resulting in avulsion of the tooth and root fracture. Dental injury caused by trauma has been always considered as an emergency condition. It requires prompt complex treatment methods from maintaining pulp vitality to tooth extraction option. Treatment plan always depends on the type and severity of the injury and on current clinical condition of tooth. In all cases, the combined treatment includes: care of visible wound, fixation of teeth, performance of surgical manipulations, determining of the need of endodontic treatment, restorations and orthodontic consultation. The recorded clinical cases include descriptions of dental injuries of various types, as well as performed diagnostic and treatment procedures. In both cases root was fractured by impact. In Clinical Case 1 the tooth 2.1 vertical partial displacement of the tooth (extrusion) with root fracture in the apical third was observed; Clinical Case 2 - 1.1 dental root fracture in its middle third and vertical extrusion. Treatment strategy is dictated by pulp condition (Assessment of pulp vitality and status). In both cases, the

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

    Science.gov (United States)

    Jongedijk, Ruud A

    2014-01-01

    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.

  6. 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.

  7. One-stage dorsal lingual mucosal graft urethroplasty for the treatment of failed hypospadias repair

    Directory of Open Access Journals (Sweden)

    Hong-Bin Li

    2016-01-01

    Full Text Available The aim of this study was to retrospectively investigate the outcomes of patients who underwent one-stage onlay or inlay urethroplasty using a lingual mucosal graft (LMG after failed hypospadias repairs. Inclusion criteria included a history of failed hypospadias repair, insufficiency of the local skin that made a reoperation with skin flaps difficult, and necessity of an oral mucosal graft urethroplasty. Patients were excluded if they had undergone a failed hypospadias repair using the foreskin or a multistage repair urethroplasty. Between January 2008 and December 2012, 110 patients with failed hypospadias repairs were treated in our center. Of these patients, 56 underwent a one-stage onlay or inlay urethroplasty using LMG. The median age was 21.8 years (range: 4-45 years. Of the 56 patients, one-stage onlay LMG urethroplasty was performed in 42 patients (group 1, and a modified Snodgrass technique using one-stage inlay LMG urethroplasty was performed in 14 (group 2. The median LMG urethroplasty length was 5.6 ± 1.6 cm (range: 4-13 cm. The mean follow-up was 34.7 months (range: 10-58 months, and complications developed in 12 of 56 patients (21.4%, including urethrocutaneous fistulas in 7 (6 in group 1, 1 in group 2 and neourethral strictures in 5 (4 in group 1, 1 in group 2. The total success rate was 78.6%. Our survey suggests that one-stage onlay or inlay urethroplasty with LMG may be an effective option to treat the patients with less available skin after failed hypospadias repairs; LMG harvesting is easy and safe, irrespective of the patient′s age.

  8. Contradictions in the treatment of traumatic dental injuries and ways to proceed in dental trauma research

    DEFF Research Database (Denmark)

    Andreasen, Jens Ove; Lauridsen, Eva Fejerskov; Andreasen, Francis

    2010-01-01

    Almost all treatment procedures used for dental traumas are still today not evidence-based, a fact, which makes it difficult to analyse the long-term outcome of healing and its relationship to treatment. Crown fractures with extensive dentin exposure represent a dominant injury in the permanent...... and application of splints in certain cases add extra damage to the pulp and periodontal ligament. In case of root fractures with dislocation, fast and optimal repositioning and rigid long-term splinting (i.e. 3 months) have been considered the principle of treatment. However, a recent clinical study has shown...... derived from experimental studies in animals. However, their importance could not be verified in large clinical studies. Ideally, randomized clinical studies are needed in the future for selected trauma types. The influences of repositioning, splinting and the role of infection and antibiotics should...

  9. Mandibular trauma treatment: a comparison of two protocols

    NARCIS (Netherlands)

    Boffano, P.; Kommers, S.C.; Roccia, F.; Forouzanfar, T.

    2015-01-01

    Objectives:The aim of this study was to evaluate the treatment of mandibular fractures treated in two European centre in 10 years. Study Design: This study is based on 2 systematic computer-assisted databases that have continuously recorded patients hospitalized with maxillofacial fractures in two c

  10. Mandibular trauma treatment: a comparison of two protocols

    NARCIS (Netherlands)

    Boffano, P.; Kommers, S.C.; Roccia, F.; Forouzanfar, T.

    2015-01-01

    Objectives:The aim of this study was to evaluate the treatment of mandibular fractures treated in two European centre in 10 years. Study Design: This study is based on 2 systematic computer-assisted databases that have continuously recorded patients hospitalized with maxillofacial fractures in two c

  11. [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.

  12. Disruptive technology in the treatment of thoracic trauma.

    Science.gov (United States)

    Smith, R Stephen

    2013-12-01

    The care of patients with thoracic injuries has undergone monumental change over the past 25 years. Advances in technology have driven improvements in care, with obvious benefits to patients. In many instances, new or "disruptive" technologies have unexpectedly displaced previously established standards for the diagnosis and treatment of these potentially devastating injuries. Examples of disruptive technology include the use of ultrasound technology for the diagnosis of cardiac tamponade and pneumothorax; thoracoscopic techniques instead of thoracotomy, pulmonary tractotomy, and stapled lung resection; endovascular repair of thoracic aortic injury; operative fixation of flail chest; and the enhanced availability of extracorporeal lung support for severe respiratory failure. Surgeons must be prepared to recognize the benefits, and limits, of novel technologies and incorporate these methods into day-to-day treatment protocols. Copyright © 2013 Elsevier Inc. All rights reserved.

  13. Phantom limb pain after lower limb trauma: origins and treatments.

    Science.gov (United States)

    Foell, Jens; Bekrater-Bodmann, Robin; Flor, Herta; Cole, Jonathan

    2011-12-01

    Phantom sensations, that is, sensations perceived in a body part that has been lost, are a common consequence of accidental or clinical extremity amputations. Most amputation patients report a continuing presence of the limb, with some describing additional sensations such as numbness, tickling, or cramping of the phantom limb. The type, frequency, and stability of these phantom sensations can vary immensely. The phenomenon of painful phantom sensations, that is, phantom limb pain, presents a challenge for practitioners and researchers and is often detrimental to the patient's quality of life. In addition to the use of conventional therapies for chronic pain disorders, recent years have seen the development of novel treatments for phantom limb pain, based on an increasing body of research on neurophysiological changes after amputation. This article describes the current state of research in regard to the demographics, causal factors, and treatments of phantom limb pain.

  14. Dentists' level of knowledge of the treatment plans for periodontal ligament injuries after dentoalveolar trauma

    Directory of Open Access Journals (Sweden)

    Denise Pedrini

    2011-08-01

    Full Text Available This study investigated the level of knowledge held by dentists about the possible treatment plan procedures for periodontal ligament injuries after dentoalveolar trauma. A 5-item self-applied questionnaire was prepared with questions referring to the professional profile of the interviewees and to the treatment plan they would propose for periodontal ligament injuries secondary to dentoalveolar trauma. The questionnaires were filled out by 693 dentists attending the 23rd Annual Meeting of the Brazilian Society for Dental Research, and the data obtained were subjected to descriptive analysis. Either the chi-square test or Fisher's exact test was applied to assess associations among variables, at a 5% level of significance. The results revealed that dentists experienced difficulty in establishing a treatment plan for subluxation, and for extrusive, lateral and intrusive luxations. In general, holding a dental specialty degree had no influence on the knowledge about treatment plan procedures for the most severe injuries. It could be concluded that the dentists participating in this study, whether specialists or not, did not have sufficient knowledge to treat most of the periodontal ligament injuries resulting from dentoalveolar trauma adequately.

  15. [Essential measures for prehospital treatment of severely injured patients: The trauma care bundle].

    Science.gov (United States)

    Matthes, G; Trentzsch, H; Wölfl, C G; Paffrath, T; Flohe, S; Schweigkofler, U; Ekkernkamp, A; Schulz-Drost, S

    2015-08-01

    In order to ensure adequate treatment and to avoid complications, care bundles are increasingly being implemented. These are comprehensive and evidence-based procedures for the treatment of individual diseases or injuries which should be carried out for every patient. The aim of this study was to define a care bundle for the prehospital treatment of severely injured patients. The scientific contents of the bundle were gathered from the interdisciplinary evidence-based S3 guidelines for the treatment of severely injured patients by the German Trauma Society. The ABCDE scheme suggested by the prehospital trauma life support (PHTLS®) and the advanced trauma life support (ATLS®) functioned as a matrix for the individual elements in the bundles. The identified elements were finalized by a consensus process. A bundle of six elements was suggested and a comprehensive summary of key items during prehospital management of severely injured patients was identified. In a next step the effectiveness of the care bundle should be evaluated in a clinical trial.

  16. Dentists' level of knowledge of the treatment plans for periodontal ligament injuries after dentoalveolar trauma.

    Science.gov (United States)

    Pedrini, Denise; Panzarini, Sônia Regina; Poi, Wilson Roberto; Sundefeld, Maria Lúcia Marçal Mazza; Tiveron, Adelisa Rodolfo Ferreira

    2011-01-01

    This study investigated the level of knowledge held by dentists about the possible treatment plan procedures for periodontal ligament injuries after dentoalveolar trauma. A 5-item self-applied questionnaire was prepared with questions referring to the professional profile of the interviewees and to the treatment plan they would propose for periodontal ligament injuries secondary to dentoalveolar trauma. The questionnaires were filled out by 693 dentists attending the 23rd Annual Meeting of the Brazilian Society for Dental Research, and the data obtained were subjected to descriptive analysis. Either the chi-square test or Fisher's exact test was applied to assess associations among variables, at a 5% level of significance. The results revealed that dentists experienced difficulty in establishing a treatment plan for subluxation, and for extrusive, lateral and intrusive luxations. In general, holding a dental specialty degree had no influence on the knowledge about treatment plan procedures for the most severe injuries. It could be concluded that the dentists participating in this study, whether specialists or not, did not have sufficient knowledge to treat most of the periodontal ligament injuries resulting from dentoalveolar trauma adequately.

  17. Failed endotracheal intubation

    Directory of Open Access Journals (Sweden)

    Sheykhol Islami V

    1995-07-01

    Full Text Available The incidence of failed intubation is higher in obstetric than other surgical patients. Failed intubation was the 2nd commonest cause of mortality during anesthesia. Bearing in mind that failre to intubate may be unavoidable in certain circumstances, it is worth reviewing. The factors, which may contribute to a disastrous out come. Priorities of subsequent management must include maintaining oxygenation and preventing aspiration of gastric contents. Fiber optic intubation is now the technique of choice with a high success rate and with least trauma to the patient.

  18. The injury profile and acute treatment costs of major trauma in older people in New South Wales.

    Science.gov (United States)

    Curtis, Kate; Chan, Daniel Leonard; Lam, Mary Kit; Mitchell, Rebecca; King, Kate; Leonard, Liz; D'Amours, Scott; Black, Deborah

    2014-12-01

    To Describe injury profile and costs of older person trauma in New South Wales; quantify variations with peer group costs; and identify predictors of higher costs. Nine level 1 New South Wales trauma centres provided data on major traumas (aged ≥ 55 years) during 2008-2009 financial year. Trauma register and financial data of each institution were linked. Treatment costs were compared with peer group Australian Refined Diagnostic Related Groups costs, on which hospital funding is based. Variables examined through multivariate analyses. Six thousand two hundred and eighty-nine patients were admitted for trauma. Most common injury mechanism was falls (74.8%) then road trauma (14.9%). Median patient cost was $7044 (Q1-3: $3405-13 930) and total treatment costs $76 694 252. Treatment costs were $5 813 975 above peer group average. Intensive care unit admission, age, injury severity score, length of stay and traumatic brain injury were independent predictors of increased costs. Older person trauma attracts greater costs and length of stay. Cost increases with age and injury severity. Hospital financial information and trauma registry data provides accurate cost information that may inform future funding. © 2013 ACOTA.

  19. Efficacy of a sedo-analgesia protocol in pre-hospital trauma treatment

    Directory of Open Access Journals (Sweden)

    Savino Occhionorelli

    2013-06-01

    Full Text Available Pre-hospital trauma treatment is an important situation in which pain should be appropriately assessed and treated, but there is a great lack of studies about it. Literature has widely pointed out that the underanalgesia problem is spread to all groups of patients. The objective of the study is to verify the efficacy of a sedation-analgesia protocol based on the use of NSAIDs, Fentanyl and Midazolam, for prehospital treatment of trauma patients. The protocol was tested in three Emergency Medical Services for a four month period, in which 30 patients were included in the study. Results evidenced a good management of both pain and anxiety in the majority of patients treated, with the achievement of analgesia target in 80% of the patients and sedation target in 100% of the patients.

  20. Endovascular Therapy is Effective Treatment for Focal Stenoses in Failing Infrapopliteal Vein Grafts

    Science.gov (United States)

    Westin, Gregory G.; Armstrong, Ehrin J.; Javed, Usman; Balwanz, Christopher R.; Saeed, Haseeb; Pevec, William C.; Laird, John R.; Dawson, David L.

    2014-01-01

    Objective To evaluate the efficacy of endovascular therapy for maintaining patency and preserving limbs among patients with failing infrapopliteal bypass grafts. Methods We gathered data from a registry of catheter-based procedures for peripheral artery disease. Of 1554 arteriograms performed from 2006 to 2012, 30 patients had interventions for failing bypass vein grafts to infrapopliteal target vessels. The first intervention for each patient was used in this analysis. Duplex ultrasonography was used within 30 days after intervention and subsequently at 3-6 month intervals for graft surveillance. Results Interventions were performed for duplex ultrasonography surveillance findings in 21 patients and for symptoms of persistent or recurrent critical limb ischemia in 9 patients. Procedural techniques included cutting balloon angioplasty (83%), conventional balloon angioplasty (7%), and stent placement (10%). Procedural success was achieved in all cases. There were no procedure-related complications, amputations, or deaths within 30 days. By Kaplan-Meier analysis, 37% were free from graft restenosis at 12 months and 31% were at 24 months. Receiver operating characteristic analysis indicated that a lesion length of 1.75 cm best predicted freedom from restenosis (C statistic: 0.74). Residual stenosis (P=0.03), patency without reintervention (P=0.01), and assisted patency with secondary intervention (P=0.02) rates were superior for short lesions compared to long lesions. The cohort had acceptable rates of adverse clinical outcomes, with 96% of patients free from amputation at both 12 and 24 months; clinical outcomes were also better in patients with short lesions. Conclusions In this single-center experience with endovascular therapies to treat failing infrapopliteal bypass grafts, rates of limb preservation were high, but the majority of patients developed graft restenosis within 12 months. Grafts with longer stenoses fared poorly by comparison. These data suggest that

  1. Percutaneous Treatment of Failed Native Dialysis Fistulas: Use of Pulse-Spray Pharmacomechanical Thrombolysis as the Primary Mode of Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Sung Ki; Shin, Sung Wook; Do, Young Soo; Park, Kwang Bo; Choo, Sung Wook; Choo, In Wook [Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Han, Heon; Kim, Sam Soo; Lee, Ji Yeon [Kangwon National University College of Medicine, Kangreung (Korea, Republic of)

    2006-09-15

    To determine the efficacy and outcome of percutaneous treatment in restoring the function of failed native arteriovenous fistulas (AVFs) where pulse-spray pharmacomechanical thrombolysis was used as the primary mode of therapy. From June 2001 to July 2005, 14 patients who had thrombosis of native AVFs underwent percutaneous restoration following 20 episodes of thrombosis. These included 6 repeated episodes in one forearm AVF and two episodes in another forearm AVF. All patients except one were treated with urokinase injection utilizing the pulse-spray technique and had subsequent balloon angioplasty. One patient was treated by percutaneous angioplasty alone. We retrospectively evaluated the feasibility of percutaneous treatment in restoring the function of the failed AVFs. The primary and secondary patencies were calculated by using a Kaplan-Meier analysis. Both technical and clinical success were achieved in 15 (75%) of 20 AVFs. Four of the five technical failures resulted from a failure to cross the occluded segment. One patient refused further participation in the trial through a brachial artery access following failure to cross the occluded segment via an initial retrograde venous puncture. There were no major procedure related complications observed. Including the initial technical failures, primary patency rates at six and 12 months were 64% and 55%, respectively. Secondary patency rates at six and 12 months were 71% and 63%, respectively. Pulse-spray pharmacomechanical thrombolysis for treatment of the thrombosed AVFs is safe, effective and durable. This procedure should be considered as an option for the management of failed AVFs prior to surgical intervention.

  2. Microbial water quality before and after the repair of a failing onsite wastewater treatment system adjacent to coastal waters

    Science.gov (United States)

    Conn, K.E.; Habteselassie, M.Y.; Denene, Blackwood A.; Noble, R.T.

    2012-01-01

    Aims: The objective was to assess the impacts of repairing a failing onsite wastewater treatment system (OWTS, i.e., septic system) as related to coastal microbial water quality. Methods and Results: Wastewater, groundwater and surface water were monitored for environmental parameters, faecal indicator bacteria (total coliforms, Escherichia coli, enterococci) and the viral tracer MS2 before and after repairing a failing OWTS. MS2 results using plaque enumeration and quantitative reverse transcriptase polymerase chain reaction (qRT-PCR) often agreed, but inhibition limited the qRT-PCR assay sensitivity. Prerepair, MS2 persisted in groundwater and was detected in the nearby creek; postrepair, it was not detected. In groundwater, total coliform concentrations were lower and E.??coli was not detected, while enterococci concentrations were similar to prerepair levels. E.??coli and enterococci surface water concentrations were elevated both before and after the repair. Conclusions: Repairing the failing OWTS improved groundwater microbial water quality, although persistence of bacteria in surface water suggests that the OWTS was not the singular faecal contributor to adjacent coastal waters. A suite of tracers is needed to fully assess OWTS performance in treating microbial contaminants and related impacts on receiving waters. Molecular methods like qRT-PCR have potential but require optimization. Significance and Impact of Study: This is the first before and after study of a failing OWTS and provides guidance on selection of microbial tracers and methods. ?? 2011 The Authors. Journal of Applied Microbiology ?? 2011 The Society for Applied Microbiology.

  3. Civilian casualties of terror-related explosions: The impact of vascular trauma on treatment and prognosis.

    Science.gov (United States)

    Heldenberg, Eitan; Givon, Adi; Simon, Daniel; Bass, Arie; Almogy, Gidon; Peleg, Kobi

    2016-09-01

    A high prevalence (10%) of vascular trauma (VT) was previously described in terror-related trauma as compared with non-terror-related trauma (1%), in a civilian setting. No data regarding outcome of VT casualties of improvised explosive device (IED) explosions, in civilian settings, are available. The aim of the current study is to present the prognosis of civilian casualties of IED explosions with and without VT. A retrospective analysis of the Israeli National Trauma Registry was performed. All patients in the registry from September 2000 to December 2005 who were victims of explosions were included. These patients were subdivided into patients with VT (n = 109) and non-VT (NVT) (n = 1,152). Both groups were analyzed according to mechanism of trauma, type and severity of injury, and treatment. Of 1,261 explosion casualties, there were 109 VT victims (8.6%). Patients with VT tended to be more complex, with a higher injury severity score (ISS): 17.4% with ISS 16 to 24 as compared with only 10.5%. In the group of critically injured patients (ISS, 25-75), 51.4% had VT compared with only 15.5% of the NVT patients. As such, a heavy share of hospitals' resources were used-trauma bay admission (62.4%), operating rooms (91.7%), and intensive care unit beds (55.1%). The percentage of VT patients who were admitted for more than 15 days was 2.3 times higher than that observed among the NVT patients. Lower-extremity VT injuries were the most prevalent. Although many resources are being invested in treating this group of patients, their mortality rate is approximately five times more than NVT (22.9% vs. 4.9%). Vascular trauma casualties of IED explosions are more complex and have poorer prognosis. Their higher ISS markedly increases the hospital's resource utilization, and as such, it should be taken into consideration either upon the primary evacuation from the scene or when secondary modulation is needed in order to reduce the burden of the hospitals receiving the casualties

  4. A History of Childhood Trauma and Response to Treatment With Antipsychotics in First-Episode Schizophrenia Patients: Preliminary Results.

    Science.gov (United States)

    Misiak, Błażej; Frydecka, Dorota

    2016-10-01

    In this study, we aimed to investigate whether a history of childhood trauma (CT) can help predict early response to antipsychotic treatment in patients with first-episode schizophrenia (FES). We recruited 64 FES patients who were followed up after 12 weeks of treatment with second-generation antipsychotics. Symptomatic manifestation was examined using the Positive and Negative Syndrome Scale (PANSS). Childhood adversities were assessed using the Early Trauma Inventory Self-Report-Short Form. Nonresponders had significantly higher general trauma score, emotional abuse score, total trauma score, and baseline PANSS negative factor score. A history of CT was significantly more frequent among nonresponders. Logistic regression analysis revealed that positive history of CT, higher emotional abuse score, and higher baseline PANSS negative factor score are significant predictors of poor response to treatment. Our results indicate that a history of CT, especially emotional abuse, and higher severity of negative symptoms are independent predictors of poor response to treatment with antipsychotics.

  5. Contradictions in the treatment of traumatic dental injuries and ways to proceed in dental trauma research.

    Science.gov (United States)

    Andreasen, Jens Ove; Lauridsen, Eva; Andreasen, Frances Meriam

    2010-02-01

    Almost all treatment procedures used for dental traumas are still today not evidence-based, a fact, which makes it difficult to analyse the long-term outcome of healing and its relationship to treatment. Crown fractures with extensive dentin exposure represent a dominant injury in the permanent dentition. Accepted treatment philosophy is dentin coverage (dental liner and/or dentin bonded restoration) to prevent bacteria penetration into the pulp. Today there is, apart from deep proximal fractures, no evidence that this treatment is necessary to protect the pulp. In case of luxation injuries, the accepted treatment principles appear to be anatomically correct repositioning, stabilization with a splint and sometimes antibiotic coverage. In clinical studies, these principles could not be proven to optimize either periodontal or pulpal healing, the explanation possibly being that both reposition and application of splints in certain cases add extra damage to the pulp and periodontal ligament. In case of root fractures with dislocation, fast and optimal repositioning and rigid long-term splinting (i.e. 3 months) have been considered the principle of treatment. However, a recent clinical study has shown that short-term splinting with a semi-rigid splint appears to optimize fracture healing. In tooth avulsion with subsequent replantation, cleansing of the root surface for contamination and systemic antibiotics has been considered essential for pulp and periodontal healing. These treatment concepts have been derived from experimental studies in animals. However, their importance could not be verified in large clinical studies. Ideally, randomized clinical studies are needed in the future for selected trauma types. The influences of repositioning, splinting and the role of infection and antibiotics should be further investigated. However, for ethical reasons, it will be difficult to perform randomized studies on trauma victims and we will be forced in the future to rely on

  6. Guided bone regeneration: A novel approach in the treatment of pediatric dentoalveolar trauma

    Science.gov (United States)

    Murthy, Prashanth Sadashiva; Shivamallu, Avinash Bettahalli; Deshmukh, Seema; Nandlal, Bhojraj; Thotappa, Srilatha K.

    2015-01-01

    Traumatic injuries in the primary dentition pose major challenges for management. This emergency treatment requires proper planning so as to achieve favorable results. Trauma causing severe dentoalveolar injuries, especially in children, needs an interdisciplinary approach so as to retain normal functional anatomy for that age. This article describes a clinical innovative technique, which utilizes a resorbable membrane in management of pediatric dentoalveolar trauma. The membrane was shaped to cover the multiple alveolar bone fracture, thereby favoring the healing of the bone defects. The use of this resorbable membrane maintained a secluded space for the bone growth and prevented overgrowth of the soft tissue in the region of the defect. This resulted in uneventful healing leading to well-maintained functional bone contour, which further favored the esthetic rehabilitation as well as protected the underlying permanent tooth buds. PMID:26005471

  7. Guided bone regeneration: A novel approach in the treatment of pediatric dentoalveolar trauma.

    Science.gov (United States)

    Murthy, Prashanth Sadashiva; Shivamallu, Avinash Bettahalli; Deshmukh, Seema; Nandlal, Bhojraj; Thotappa, Srilatha K

    2015-01-01

    Traumatic injuries in the primary dentition pose major challenges for management. This emergency treatment requires proper planning so as to achieve favorable results. Trauma causing severe dentoalveolar injuries, especially in children, needs an interdisciplinary approach so as to retain normal functional anatomy for that age. This article describes a clinical innovative technique, which utilizes a resorbable membrane in management of pediatric dentoalveolar trauma. The membrane was shaped to cover the multiple alveolar bone fracture, thereby favoring the healing of the bone defects. The use of this resorbable membrane maintained a secluded space for the bone growth and prevented overgrowth of the soft tissue in the region of the defect. This resulted in uneventful healing leading to well-maintained functional bone contour, which further favored the esthetic rehabilitation as well as protected the underlying permanent tooth buds.

  8. The effectiveness of art therapy in the treatment of traumatized adults: a systematic review on art therapy and trauma.

    Science.gov (United States)

    Schouten, Karin Alice; de Niet, Gerrit J; Knipscheer, Jeroen W; Kleber, Rolf J; Hutschemaekers, Giel J M

    2015-04-01

    Art therapy has often been applied in the treatment of traumatized adults, and good results in clinical practice have been reported. However, although art therapy experts underline these benefits, the effectiveness of art therapy in trauma treatment has not been established by systematic review. The aim of this systematic review is to identify and evaluate empirical evidence of the effectiveness of art therapy for trauma treatment. As a result of the systematic review, six controlled, comparative studies on art therapy for trauma in adult patients were found. In half of the included studies, a significant decrease in psychological trauma symptoms was found in the treatment groups, and one study reported a significant decrease in depression. Although there are limitations in the number of included studies, the number of participants, the heterogeneity of included studies, and their methodological quality, the results contribute to insight into the effectiveness of art therapy in trauma treatment and form an evidence base for the urgent need for further research on art therapy and trauma treatment. © The Author(s) 2014.

  9. Exposing therapists to trauma-focused treatment in psychosis: effects on credibility, expected burden, and harm expectancies

    Directory of Open Access Journals (Sweden)

    David P. G. van den Berg

    2016-09-01

    Full Text Available Background: Despite robust empirical support for the efficacy of trauma-focused treatments, the dissemination proves difficult, especially in relation to patients with comorbid psychosis. Many therapists endorse negative beliefs about the credibility, burden, and harm of such treatment. Objective: This feasibility study explores the impact of specialized training on therapists’ beliefs about trauma-focused treatment within a randomized controlled trial. Method: Therapist-rated (n=16 credibility, expected burden, and harm expectancies of trauma-focused treatment were assessed at baseline, post-theoretical training, post-technical training, post-supervised practical training, and at 2-year follow-up. Credibility and burden beliefs of therapists concerning the treatment of every specific patient in the trial were also assessed. Results: Over time, therapist-rated credibility of trauma-focused treatment showed a significant increase, whereas therapists’ expected burden and harm expectancies decreased significantly. In treating posttraumatic stress disorder (PTSD in patients with psychotic disorders (n=79, pre-treatment symptom severity was not associated with therapist-rated credibility or expected burden of that specific treatment. Treatment outcome had no influence on patient-specific credibility or burden expectancies of therapists. Conclusions: These findings support the notion that specialized training, including practical training with supervision, has long-term positive effects on therapists’ credibility, burden, and harm beliefs concerning trauma-focused treatment.

  10. The evolution of a purpose designed hybrid trauma operating room from the trauma service perspective: the RAPTOR (Resuscitation with Angiography Percutaneous Treatments and Operative Resuscitations).

    Science.gov (United States)

    Kirkpatrick, Andrew W; Vis, Christine; Dubé, Mirette; Biesbroek, Susan; Ball, Chad G; Laberge, Jason; Shultz, Jonas; Rea, Ken; Sadler, David; Holcomb, John B; Kortbeek, John

    2014-09-01

    Traumatic injury is the leading cause of potentially preventable lost years of life in the Western world and exsanguination is the most potentially preventable cause of post-traumatic death. With mature trauma systems and experienced trauma centres, extra-abdominal sites, such as the pelvis, constitute the most frequent anatomic site of exsanguination. Haemorrhage control for such bleeding often requires surgical adjuncts most notably interventional radiology (IR). With the usual paradigm of surgery conducted within an operating room and IR procedures within distant angiography suites, responsible clinicians are faced with making difficult decisions regarding where to transport the most physiologically unstable patients for haemorrhage control. If such a critical patient is transported to the wrong suite, they may die unnecessarily despite having potentially salvageable injuries. Thus, it seems only logical that the resuscitative operating room of the future would have IR capabilities making it the obvious geographic destination for critically unstable patients, especially those who are exsanguinating. Our trauma programme recently had the opportunity to conceive, design, build, and operationalise a purpose-designed hybrid trauma operating room, designated as the resuscitation with angiographic percutaneous techniques and operative resuscitation (RAPTOR) suite, which we believe to be the first such resource designed primarily to serve the exsanguinating trauma patient. The project was initiated after consultations between the trauma programme and private philanthropists regarding the greatest potential impacts on regional trauma care. The initial capital construction costs were thus privately generated but coincided with a new hospital wing construction allowing the RAPTOR to be purpose-designed for the exsanguinating patient. Many trauma programmes around the world are now starting to navigate the complex process of building new facilities, or else retrofitting

  11. Treatment of penetrating trauma of the extremities: Ten years' experience at a dutch level 1 trauma center

    NARCIS (Netherlands)

    O.J.F. van Waes (Oscar); E.M.M. van Lieshout (Esther); W. Hogendoorn (Wouter); J.A. Halm (Jens); J. Vermeulen (Jefrey)

    2013-01-01

    textabstractBackground: A selective non-operative management (SNOM) has found to be an adequate and safe strategy to assess and treat patients suffering from penetrating trauma of the extremities (PTE). With this SNOM comes a strategy in which adjuvant investigations or interventions are not

  12. Retaliation against reporters of unequal treatment: Failing employee protection in The Netherlands

    NARCIS (Netherlands)

    Svensson, J.S.; Genugten, van M.L.

    2013-01-01

    Purpose – Equal treatment in the workplace is considered one of the most fundamental rights of employees. This right also implies that employees must be able to address any form of unequal treatment freely and effectively, without fear of retaliation. The purpose of this paper is to investigate the

  13. Contradictions in the treatment of traumatic dental injuries and ways to proceed in dental trauma research

    DEFF Research Database (Denmark)

    Andreasen, Jens Ove; Lauridsen, Eva; Andreasen, Frances Meriam

    2010-01-01

    Almost all treatment procedures used for dental traumas are still today not evidence-based, a fact, which makes it difficult to analyse the long-term outcome of healing and its relationship to treatment. Crown fractures with extensive dentin exposure represent a dominant injury in the permanent...... dentition. Accepted treatment philosophy is dentin coverage (dental liner and/or dentin bonded restoration) to prevent bacteria penetration into the pulp. Today there is, apart from deep proximal fractures, no evidence that this treatment is necessary to protect the pulp. In case of luxation injuries...... that short-term splinting with a semi-rigid splint appears to optimize fracture healing. In tooth avulsion with subsequent replantation, cleansing of the root surface for contamination and systemic antibiotics has been considered essential for pulp and periodontal healing. These treatment concepts have been...

  14. Pulsed Nd:YAG laser treatment for failing dental implants due to peri-implantitis

    Science.gov (United States)

    Nicholson, Dawn; Blodgett, Kris; Braga, Charles; Finkbeiner, Larry; Fourrier, Jeanne; George, John; Gregg, Robert; Honigman, Allen; Houser, Bruce; Lamas, William; Lehrman, Neal; Linden, Eric; McCarthy, Delwin; McCawley, Tom; McCormick, Randy; Marcus, Ed; Noraian, Kirk; Rubelman, Peter; Salama, Maurice; Saunders, Steven; Seamons, Brandon; Thein, David; Toms, Michael; Vassos, George; Harris, David M.

    2014-02-01

    A large percentage of dental implants experience complications, most commonly, infection leading to peri-implantitis and peri-mucositis, inflammatory disease involving pathogen contamination. It presents with radiographic findings of crestal bone loss. At this time there appears to be no compelling evidence for an effective intervention. The LANAP protocol is a FDA cleared surgical protocol that produces new attachment and bone regeneration when applied to periodontally infected natural teeth. The LANAP protocol and laser dosimetry have been modified to treat ailing and failing implants. Twenty-one clinicians who have been trained to perform the LANAP protocol and the LAPIPTM protocol have volunteered 26 LAPIP case reports. The time from implant to intervention ranges from 3 months to 16 years. Post-LAPIP radiographs range from 2-48 months. Ten cases were excluded for technical reasons. All 16 remaining cases provide radiographic evidence of increase in crestal bone mass around the implant and, when reported, probe depth reductions. All treating clinicians report control of the infection, reversal of bone loss and rescue of the incumbent implant. Although the success/failure rate cannot be judged from these data, any successes in this area deserve reporting and further study.

  15. Utility of Glissonean Pedicle Transection for Surgical Treatment of Severe Liver Trauma

    Directory of Open Access Journals (Sweden)

    Satoshi Koizumi

    2017-04-01

    Full Text Available The most common initial strategy for treatment of severe liver trauma is damage control in which hemostasis is achieved by perihepatic gauze packing and/or vascular embolization. However, we encounter patients in whom this strategy alone is not adequate. We have applied the principles of Glissonean pedicle transection, a technique that was originally devised to ensure safe and quick performance of planned hepatectomy for liver cancer, to 3 cases of severe liver trauma. We performed Glissonean pedicle ligation during damage control surgery in 2 patients and Glissonean pedicle transection during the definitive surgery in 1 patient. We describe the approaches and our experience with them, including operation times and outcomes. From our experience thus far, it seems that 8–12 h after the damage control procedure is appropriate for performing the definitive surgery. Although there are some problems posed by this strategy and cases to which it will not be applicable, the method seems to be particularly useful for cases of severe liver trauma in which the damage is extensive and involves the Glissonean pedicles near the hepatic hilus. We describe our 3 cases in detail and review our experience in light of the available literature.

  16. Tranylcypromine vs. lamotrigine in the treatment of refractory bipolar depression : a failed but clinically useful study

    NARCIS (Netherlands)

    Nolen, W. A.; Kupka, R. W.; Hellemann, G.; Frye, M. A.; Altshuler, L. L.; Leverich, G. S.; Suppes, T.; Keck, P. E.; McElroy, S.; Grunze, H.; Mintz, J.; Post, R. M.

    2007-01-01

    Objective: To compare the efficacy and tolerability of tranylcypromine vs. lamotrigine in bipolar depression not responding to conventional antidepressants. Method: Bipolar depressed patients received open randomized treatment with tranylcypromine or lamotrigine as add-on to a mood stabilizer during

  17. SURGICAL TREATMENT OF UPPER AND MIDDLE FACIAL ZONE TRAUMAS IN PROGRESS OF CONCOMITANT TRAUMATIC CRANIOFACIAL INJURIES.

    Science.gov (United States)

    Lagvilava, G; Gvenetadze, Z; Toradze, G; Devidze, I; Gvenetadze, G

    2015-09-01

    In 2012-2015, 207 patients with concomitant craniofacial injuries, who underwent surgical treatment, were observed; among them 176 were men and 31- women. Age of the patients ranged from 16 to 60 years. According to localization and severity of trauma and a priority of surgical intervention, the patients conventionally were divided into 3 groups by the authors: I group (65 patients) - craniofacial injuries; the skull as well as upper and middle areas of face (subcranial and frontobasal fractures) were affected (fractured). II group (80 patients) - severe traumatic injuries of upper and especially middle zones of the face, accompanied with closed craniocerebral trauma, no need in neurosurgery. III group (62 patients) -on the background of serious head traumas, the injuries of face bones were less severe (injury of one or two anatomic areas with displacement of fractured fragments but without bone tissue defects) According to the obtained results a priority was always given to the neurosurgery (vital testimony).The reconstructive surgeries on face skeleton was conducted in combination involving neurosurgeons (I group patients). Reconstructive surgeries of facial bones were conducted in the patients of II group, immediately or at primary deferred period of time but in the patients of III group the surgical procedures for removal of early secondary or traumatic residual fractures have been performed. Reposition of the fractured facial bone fragments was performed in an open way and fixation was carried out by titanium plates and mesh cage (at bone tissue defect). For prevention and elimination of post-traumatic inflammatory processes, the final stage of surgical intervention was: sanation of nasal accessory sinuses and catheterization (5-7 days) of external carotid arteries for administration of antibiotics and other medical preparations. Early and differentiated approach to face injuries, worsening in the course of craniocephalic trauma was not revealed in any patient

  18. Failing Decision

    DEFF Research Database (Denmark)

    Knudsen, Morten

    2014-01-01

    as a controlled cost for achieving organizational goals. Decisions must fail so the organization can succeed. This chapter uses two cases to elaborate on these ideas. By way of introduction, I will reflect on the notion of ‘failing decisions’ within organization and decision theory. This chapter is also propelled...... deals not with traffic delays, but with failing decisions in organizations. The assumption of this chapter is that failing decisions today are as normal as delayed trains. Instead of being the exception, failure is part of the everyday reproduction of organizations – as an uncontrolled effect but also...... by an interest in failure as one way of improving understanding of present-day decision making in organizations....

  19. Treatment outcomes for women with substance abuse and PTSD who have experienced complex trauma.

    Science.gov (United States)

    Cohen, Lisa R; Hien, Denise A

    2006-01-01

    This study assessed the effect of cognitive-behavioral therapy on a range of problems associated with complex trauma in a sample of women with comorbid substance use disorders and posttraumatic stress disorder (PTSD). A total of 107 women with current or subthreshold PTSD and a current substance use disorder from an urban, low-income area were recruited from both community and clinical populations. Participants were recruited between 1997 and 2000. A quasi-experimental design was used, and participants who received cognitive-behavioral therapy (N=75) were compared with those in a control group who received no active study treatment (N=32). All participants were given the same list of community treatment resources and told that they could pursue services while participating in the study if they wished. At the end of treatment (three months postbaseline), compared with participants in the control group, those in the active treatment group showed significant reductions in symptoms of PTSD and alcohol use disorders, with a trend toward reductions in symptoms of drug use disorders. No significant differences were found between the groups on depression, dissociation, and social and sexual functioning outcomes. These findings underscore the challenge and necessity of addressing the unique and wide-ranging needs of women with substance use disorder who have been exposed to early and multiple interpersonal traumas.

  20. Combination of peg ylated interferon and lamivudine for patients with chronic hepatitis B who have failed treatment

    Institute of Scientific and Technical Information of China (English)

    Shiv K. Sarin; Manoj Kumar; Syed Hissar; Barjesh C. Sharma

    2006-01-01

    BACKGROUND: Treatment of chronic hepatitis B (CHB) alone with interferon or lamivudine alone or in combination is effective in only a small proportion of patients. Treatment of patients in whom antiviral therapy fails is challenging. This study was made to determine the efifcacy of combined pegylated interferon alpha (peg-IFN) and lamivudine in patients with CHB who had failed to respond to antiviral treatment. METHODS: Twenty patients with CHB proven by liver biopsy, with ALT levels>1.5×ULN, HBV DNA levels>141 500 copies/ml, and previous treatment failure with an adequate regimen were treated with a combination of peg-IFN 1.5 μg/kg and lamivudine 100 mg/day for 52 weeks and followed up for a further 24 weeks. Biochemical response was deifned as normalization of ALT and DNA response as HBV DNA RESULTS: Twenty patients were treated, of whom 16 were HBeAg positive. At 52 weeks, normal ALT was seen in 10 (50%) (8 of 16 HBeAg+ and 2 of 4 HBeAg-), HBV DNA response in 5 (25%) (5 of 16 in HBeAg+ and none in HBeAg-), and HBeAg loss with appearance of anti-HBe in 5 (31.3%) of the 16 HBeAg positive patients. At 76 weeks, 8 (80%) of the 10 patients with normal ALT at 52 weeks relapsed, with normal ALT only in 2 (10%) (1 of 16 HBeAg+and 1 of 4 HBeAg-), and all 5 patients who had a DNA response at 52 weeks relapsed at 76 weeks and had no DNA response. HBeAg loss with appearance of anti-HBe was seen in 1 (6.3%) of 16 HBeAg-positive patients. None of the patients lost HBsAg. CONCLUSIONS:The combination of peg-IFN and lamivudine for 52 weeks is not effective for treatment of CHB patients with a failed treatment. New treatment strategies need to be developed.

  1. Memory of childhood trauma before and after long-term psychological treatment of borderline personality disorder.

    Science.gov (United States)

    Kremers, I P; Van Giezen, A E; Van der Does, A J W; Van Dyck, R; Spinhoven, Ph

    2007-03-01

    The present study investigated the consistency of self-reports of childhood traumatic events in a sample of 50 patients with a borderline personality disorder (BPD) before and after 27 months of intensive treatment with schema focused therapy or transference focused psychotherapy. The mean number of reported sexual, physical and emotional traumatic events did not change following treatment. Test-retest correlations of the trauma-interview also indicated high stability of the total number of sexual, physical and emotional events reported. The majority of the patients, however, did no longer report at least one of the 33 listed events after psychotherapy, and the majority reported at least one event that they had not mentioned before the start of treatment. These findings were not related to type of treatment or changes in suppression, intrusions, avoidance of intrusions, dissociative symptoms, depressive symptoms, and borderline symptoms.

  2. The “one size fits all” approach to trauma treatment: should we be satisfied?

    Directory of Open Access Journals (Sweden)

    Marylene Cloitre

    2015-05-01

    Full Text Available There have been significant advances in the treatment of posttraumatic stress disorder in the last two decades. Further improvements in outcomes will be supported by recognition of the heterogeneity of symptoms in trauma populations and the development of treatments that promote the tailoring of interventions according to patient needs. Collaboration with patients regarding preferences about treatment structure, process, and outcomes is critical and will benefit the effectiveness and quality of treatments as well as the speed of their dissemination. New research methodologies are required that can incorporate important variables such as patient preferences and symptom heterogeneity without necessarily extending already lengthy study times or further complicating study designs. An example of alternative methodology is proposed.

  3. Causes, Treatment, and Outcome in Private School Children Admitted to Emergency Department with Eye Trauma

    Directory of Open Access Journals (Sweden)

    Aydın Yıldırım

    2014-05-01

    Full Text Available Objectives: To analyze the causes, treatment, and outcome in the private school children admitted to emergency department (ED for eye injury. Material and Methods: The recordings of 57 children with eye traumas were examined retrospectively. Examination, treatment, and follow-up files of the children were recorded. Results: The age of the 57 children varied between 8 and 16 years. The trauma causes were impact during playing in 35.1% (20 of cases, hit by ball in 31.5% (18 of cases, injury by paper objects in 7.1% (4 of cases, injury by pencil in 5.3% (3 of cases, and injuries by other foreign objects (glass, rubber, branch of tree, and racket in 21.0% (12 of cases. Cornea erosion in 54.3% (31 of cases, conjunctival erosion and irritation in 19.2% (11 of cases, eyelid laceration in 8.8% (5 of cases, subconjunctival hemorrhage in 8.8% (5 of cases, eyelid edema in 5.3% (3 of cases, hyphema in 1.8% (1 of cases, and iridocyclitis in 1.8% (1 of cases were found. Repair of eyelid was performed in 3 cases. Conclusion: Eye traumas are very commonly seen in private school children. While most of the cases are simple injuries, significant problems such as lid lacerations that necessitate repair can also encountered in a few cases. A fast and efficient treatment usually minimizes the risk of sequel development. (Turk J Ophthalmol 2014; 44: 216-8

  4. Treatment utilisation and trauma characteristics of child and adolescent inpatients with posttraumatic stress disorder

    Directory of Open Access Journals (Sweden)

    A. Traut

    2002-09-01

    Full Text Available Objective. Few empirical studies have addressed the impact of trauma exposure and posttraumatic stress disorder (PTSD on treatment utilisation and outcome in South African youth. This study was undertaken to document demographic, clinical, and treatment characteristics of child and adolescent inpatients with PTSD. Design. A retrospective chart study of all patients presenting to a child and adolescent inpatient unit was conducted between 1994-1996. For children and adolescents diagnosed with PTSD; demographic, diagnostic and treatment variables, including trauma type, family history, and delays in treatment seeking, were documented. Setting. Child and Adolescent Psychiatric Inpatient Unit, Tygerberg Hospital, Cape Town. Subjects. Children and adolescents (2 to 18 years presenting to an inpatient unit (n=737. Results. 10.3% (n=76 met diagnostic criteria for PTSD. Gender differences were clearly evident: PTSD was six times more prevalent in girls (65 with PTSD were female and 11 were male; girls were most likely to have experienced rape or sexual abuse while boys were most likely to have witnessed a killing. Psychotherapy was the most common intervention for PTSD, followed by treatment with a tricyclic antidepressant. 97.4% of children and adolescents who were treated demonstrated significant improvement. Delays in seeking treatment and problems with the primary support group were highly prevalent. Conclusion. PTSD is a common disorder that is responsive to treatment with psychotherapy and/or tricyclic antidepressants in child and adolescent inpatients. These findings underscore the importance of early identification and treatment of childhood PTSD in mental health settings, in particular tertiary service institutions.

  5. Integration of TB and ART services fails to improve TB treatment ...

    African Journals Online (AJOL)

    [7,8] These delays could negatively influence TB ... [9-11]. In recent years, the SA National Department of Health (NDoH) .... Treatment was received 7 days per ... building. Included in this definition were both partially integrated services that ...

  6. Improved Attachment Style for Female Veterans Who Graduated Warrior Renew Sexual Trauma Treatment.

    Science.gov (United States)

    Katz, Lori S; Park, Sam E; Cojucar, Geta; Huffman, Cristi; Douglas, Sarah

    2016-01-01

    The Warrior Renew sexual trauma treatment program proposes to target perceived attachment style and the internal working models of interpersonal relationships. This study examined scores on the Relationships Scales Questionnaire and Brief Symptom Inventory pre- and posttreatment in a sample of 62 female veterans who graduated the program. Findings revealed that graduates of Warrior Renew reported significant decreases in fearful and dismissive insecure attachment and significant increases in secure attachment. Scores were significantly correlated with symptoms. Findings lend support to an upward spiral hypothesis associated with long-term positive outcomes found in previous research on Warrior Renew.

  7. Contributions of psychodynamic approaches to treatment of PTSD and trauma: a review of the empirical treatment and psychopathology literature.

    Science.gov (United States)

    Schottenbauer, Michele A; Glass, Carol R; Arnkoff, Diane B; Gray, Sheila Hafter

    2008-01-01

    Reviews of currently empirically supported treatments for post-traumatic stress disorder (PTSD) show that despite their efficacy for many patients, these treatments have high nonresponse and dropout rates. This article develops arguments for the value of psychodynamic approaches for PTSD, based on a review of the empirical psychopathology and treatment literature. Psychodynamic approaches may help address crucial areas in the clinical presentation of PTSD and the sequelae of trauma that are not targeted by currently empirically supported treatments. They may be particularly helpful when treating complex PTSD. Empirical and clinical evidence suggests that psychodynamic approaches may result in improved self-esteem, increased ability to resolve reactions to trauma through improved reflective functioning, increased reliance on mature defenses with concomitant decreased reliance on immature defenses, the internalization of more secure working models of relationships, and improved social functioning. Additionally, psychodynamic psychotherapy tends to result in continued improvement after treatment ends. Additional empirical studies of psychodynamic psychotherapy for PTSD are needed, including randomized controlled outcome studies.

  8. Pharmacological treatment of refugees with trauma-related disorders: What do we know today?

    Science.gov (United States)

    Sonne, Charlotte; Carlsson, Jessica; Bech, Per; Mortensen, Erik Lykke

    2017-04-01

    There is a dearth of evidence on the effectiveness of pharmacological treatment for refugees with trauma-related disorders. The present paper provides an overview of available literature on the subject and discusses the transferability of results from studies on other groups of patients with post traumatic stress disorder (PTSD). We conducted a systematic review of published treatment outcome studies on PTSD and depression among refugees. Fifteen studies were identified and reviewed. Most studies focused on the use of antidepressants. Included studies differed widely in method and quality. The majority were observational studies and case studies. Small sample sizes limited the statistical power. Few studies reported effect sizes, confidence intervals, and statistical significance of findings. No specific pharmacological treatment for PTSD among refugees can be recommended on the basis of the available literature. There is a need for well-designed clinical trials, especially with newer antidepressants and antipsychotics. Until such studies are available, clinical practice and design of trials can be guided by results from studies of other groups of PTSD patients, although differences in pharmacogenetics, compliance, and trauma reactions may affect the direct transferability of results from studies on nonrefugee populations.

  9. Severe male infertility after failed ICSI treatment-a phenomenological study of men's experiences

    Directory of Open Access Journals (Sweden)

    Hellström Anna-Lena

    2011-02-01

    Full Text Available Abstract Background Male-factor infertility underlies approximately 30% of infertility in couples seeking treatment; of which 10% is due to azoospermia. The development of assisted reproductive technology (ART, enabling the use of epididymal or testicular sperm for fertilization of the partner's oocytes, has made biological fatherhood possible for men with obstructive azoospermia. There is limited knowledge of men's experience of their own infertility. The aim of this study was to describe men's experiences of obstructive azoospermia infertility. Methods Eight men with obstructive azoospermia, who had terminated Swedish public health system ART treatment two years previously without subsequent childbirth, were interviewed using a descriptive phenomenological method. Results The essence of the phenomenon is expressed with a metaphor: climbing a mountain step by step with the aim of reaching the top, i.e. having a child and thus a family with a child. Four constituents are included (1 inadequacy followed by a feeling of redress (2 marginalisation, (3 chivalry (4 extension of life and starting a family as driving forces. Conclusions Knowledge of men's experiences of their own infertility is important as a supporting measure to increase the quality of care of infertile couples. By adopting this facet of gender perspective in fertility treatment guidelines, care can hopefully be optimized.

  10. New chemical treatment options in second-line hepatocellular carcinoma: what to do when sorafenib fails?

    Science.gov (United States)

    Woo, Hyun Young; Yoo, So Young; Heo, Jeong

    2017-01-01

    There have been no therapies available for patients who experience disease progression after sorafenib treatment. Regorafenib inhibits multiple kinases involved in tumor proliferation and neoangiogenesis, which has produced a survival benefit in hepatocellular carcinoma (HCC) after sorafenib failure. Other active candidate agents are c-Met inhibitors and immune checkpoint inhibitors. Areas covered: This paper presents an updated summary of the preclinical and clinical experience with regorafenib, c-Met inhibitors (tivantinib, cabozantinib and tepotinib), and a checkpoint inhibitor (nivolumab, pembrolizumab) in HCC. The reported data were obtained from abstracts of international conferences and journal articles published up to August 2016 and found in a PubMed search. Expert opinion: Based on favorable data from preclinical and clinical trials, regorafenib, c-Met inhibitor, and checkpoint inhibitors are promising agents for HCC after sorafenib failure. However, further efforts to maximize the survival benefit and minimize adverse events of these drugs in the treatment of HCC are still necessary. Additionally, searching for predictors of good responders could allow these new drugs to be applied in personalized treatments of HCC.

  11. Why treatment centres failed to prevent cholera deaths among Rwandan refugees in Goma, Zaire.

    Science.gov (United States)

    Siddique, A K; Salam, A; Islam, M S; Akram, K; Majumdar, R N; Zaman, K; Fronczak, N; Laston, S

    1995-02-11

    In July, 1994, in one of the worst cholera outbreaks in recent times, an estimated 12,000 Rwandan refugees died in Goma in eastern Zaire. The Vibrio cholerae strains were resistant to tetracycline and doxycycline, the commonly used drugs for cholera treatment. Despite the efforts of international organisations, which provided medical relief by establishing treatment centres in Goma, mortality from the disease was much higher than expected. In the area of Muganga camp, which had the largest concentration of refugees and where most of the medical aid organisations were active, the highest reported case-fatality ratio for a single day was 48%. The slow rate of rehydration, inadequate use of oral rehydration therapy, use of inappropriate intravenous fluids, and inadequate experience of health workers in management of severe cholera are thought to be some of the factors associated with the failure to prevent so many deaths during the epidemic. In one of the temporary treatment centres with the worst case-fatality record, our team showed that improvement of these factors could increase the odds of survival of cholera patients even in a disaster setting.

  12. Response to microneedling treatment in men with androgenetic alopecia who failed to respond to conventional therapy

    Directory of Open Access Journals (Sweden)

    Rachita Dhurat

    2015-01-01

    Full Text Available Introduction: The efficacy of conventional therapy viz. finasteride and minoxidil in androgenetic alopecia (AGA that is based on both preventing hair loss and promoting new hair growth, varies between 30% and 60%. This has led to a large number of patients unsatisfied who demand for a better cosmetic coverage over the scalp. Microneedling has recently been reported to be promising, effective and a safe treatment modality in the treatment of AGA. This augments the response of conventional therapy. Materials and Methods: Four men with AGA were on finasteride and 5% minoxidil solution since 2 to 5 years. Though there was no worsening in their respective AGA stages with the therapy, they showed no new hair growth. They were subjected to microneedling procedure over a period of 6 months along with their ongoing therapy. Patients were assessed with the use of the standardized 7-point evaluation scale and patients′ subjective hair growth assessment scale. The patients were followed up for 18 months post microneedling procedure to assess the sustainability of the response. Results: All patients showed a response of + 2 to + 3 on standardized 7-point evaluation scale. The response in the form of new hair growth started after 8-10 sessions. The patients′ satisfaction was more than 75% in three patients and more 50% in one patient, on patients′ subjective hair growth assessment scale. The obtained results were sustained post procedure during 18 months follow-up period. Conclusion : Treatment with microneedling showed an accelerated response with addition of microneedling procedure leading to significant scalp density. This is the first case series to report the boosting effect of microneedling with respect to new hair follicle stimulation in patients with androgenetic alopecia who were poor responders to conventional therapy.

  13. Impact of time to treatment intensification on glycemic goal attainment among patients with type 2 diabetes failing metformin monotherapy.

    Science.gov (United States)

    Rajpathak, Swapnil N; Rajgopalan, Srini; Engel, Samuel S

    2014-01-01

    Patients with type 2 diabetes on metformin monotherapy frequently require treatment intensification with another anti-hyperglycemic medication over time. Previous studies have indicated that a high proportion of patients with diabetes have a significant delay in the initiation of oral add-on therapy after metformin alone fails to achieve targeted glycemic control. In this study, we evaluated the impact of the timing of treatment intensification with oral add-on drug on glycemic goal attainment among diabetic patients failing metformin monotherapy. Using the General Electric (GE) Centricity Electronic Medical Record database (January 2004 through December 2009), we identified 5,870 patients with type 2 diabetes with treatment failure on metformin monotherapy - defined by a glycosylated hemoglobin (HbA1c) of ≥7.5% (index date). This cut-off of ≥7.5% (trigger HbA1c) was chosen rather than that of >7.0% to ensure that selected patients were more likely to be indicated for treatment intensification with add-on drug. Continuous enrollment of one year prior and two years after index date was required to be included in the study. Add-on treatment was defined as prescription of second oral agent from any available therapeutic classes while continuing metformin. Early treatment intensification was defined as initiation of oral add-on therapy within 3 months (n=1,012) of index date while late intensification was defined as add-on initiation between 10 and 15 months after index date (n=461). The study outcome was defined as glycemic goal attainment (HbA1cgender, trigger HbA1c level, Charlson comorbidity index, anti-hypertensive and anti-hyperlipidemic drug use and history of cardiovascular disease, the adjusted odds ratio (OR) for glycemic goal attainment was 1.36 (95% confidence intervals [CI]: 1.09-1.72) comparing early add-on to late add-on treatment. This association was stronger among patients with higher trigger HbA1c at baseline; ORs of 1.53 (95% CI: 1.08-2.19) for

  14. [Treatment strategies for mass casualty incidents and terrorist attacks in trauma and vascular surgery : Presentation of a treatment concept].

    Science.gov (United States)

    Friemert, B; Franke, A; Bieler, D; Achatz, A; Hinck, D; Engelhardt, M

    2017-08-11

    The treatment of patients in the context of mass casualty incidents (MCI) represents a great challenge for the participating rescue workers and clinics. Due to the increase in terrorist activities it is necessary to become familiar with this new kind of threat to civilization with respect to the medical treatment of victims of terrorist attacks. There are substantial differences between a "normal" MCI and a terrorist MCI with respect to injury patterns (blunt trauma vs. penetrating/perforating trauma), the type and form of the incident (MCI=static situation vs. terrorist attack MCI= dynamic situation) and the different security positions (rescue services vs. police services). This article is concerned with question of which changes in the surgical treatment of patients are made necessary by these new challenges. In this case it is necessary that physicians are familiar with the different injury patterns, whereby priority must be given to gunshot and explosion (blast) injuries. Furthermore, altered strategic and tactical approaches (damage control surgery vs. tactical abbreviated surgical care) are necessary to ensure survival for as many victims of terrorist attacks as possible and also to achieve the best possible functional results. It is only possible to successfully counter these new challenges by changing the mindset in the treatment of terrorist MCI compared to MCI incidents. An essential component of this mindset is the acquisition of a maximum of flexibility. This article would like to make a contribution to this problem.

  15. [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.

  16. Successful treatment of corrosive esophageal strictures after failed esophageal reconstructions with colon and jejunum

    Institute of Scientific and Technical Information of China (English)

    ZHOU Jing-hai; JIANG Yao-guang; WANG Ru-wen; ZHAO Yun-ping; GONG Tai-qian; TAN Qun-you; MA Zheng; LIN Yi-dan; DENG Bo

    2006-01-01

    Dense and extensive esophageal strictures after caustic agent ingestion require surgical treatment. Colon, stomach and jejunum can be used to reconstruct esophagus. Here, we report an unusual patient with corrosive esophageal stricture who had received unsuccessful esophageal replacements twice at other hospitals. Colon interposition had been first performed 6 months after corrosive esophageal burn,but the colon graft necrosis occurred. Esophageal reconstruction had been carried out 10 years later in another hospital. However, the graft necrosis developed again 5 months later. A salvage operation was performed to remove the necrotic transplant in our hospital. Then as much food as possible had been given to expand the stomach through the gastrostomy since the procedure. The patient underwent esophagectomy and concomitant gastroesophagostomy in the neck 1.5 years later. Esophageal dilations had been performed to prevent recurrent anastomotic stricture for 1 year. He has eaten a normal diet since being discharged.

  17. Treatment and restoration of adult dentoalveolar trauma: A clinical case report.

    Science.gov (United States)

    Serra-Pastor, Blanca; Penarrocha-Diago, Miguel; Penarrocha-Diago, María; Agustín-Panadero, Rubén

    2016-12-01

    Adult dentoalveolar trauma most often occurs in the context of sports activities and traffic accidents. Coronal fractures are the most common type of lesion, followed by tooth luxation. We present the case of a 25-year-old woman who suffered alveolar bone damage and coronal fractures of the upper incisors, with extrusive luxation of the right central incisor, as the result of a fall. On the first visit, manual reduction of the buccal plate was carried out under local anesthesia, with repositioning of the right central incisor and splinting to the neighboring teeth. Composites were used to restore the coronal fractures. After one month, both upper central incisors and the right lateral incisor were subjected to endodontic treatment. Internal bleaching of the right lateral incisor was also carried out, due to pigmentation secondary to pulp necrosis. At follow-up 5 months later, the alveolar bone fracture was seen to have healed. Definitive anterior restorative treatment with porcelain veneers was therefore carried out. After two years the patient remains asymptomatic and in good dental condition. Key words:Dental trauma, extrusive luxation, dento-alveolar fracture, esthetic restoration.

  18. Treatment and restoration of adult dentoalveolar trauma: A clinical case report

    Science.gov (United States)

    Penarrocha-Diago, Miguel; Penarrocha-Diago, María; Agustín-Panadero, Rubén

    2016-01-01

    Adult dentoalveolar trauma most often occurs in the context of sports activities and traffic accidents. Coronal fractures are the most common type of lesion, followed by tooth luxation. We present the case of a 25-year-old woman who suffered alveolar bone damage and coronal fractures of the upper incisors, with extrusive luxation of the right central incisor, as the result of a fall. On the first visit, manual reduction of the buccal plate was carried out under local anesthesia, with repositioning of the right central incisor and splinting to the neighboring teeth. Composites were used to restore the coronal fractures. After one month, both upper central incisors and the right lateral incisor were subjected to endodontic treatment. Internal bleaching of the right lateral incisor was also carried out, due to pigmentation secondary to pulp necrosis. At follow-up 5 months later, the alveolar bone fracture was seen to have healed. Definitive anterior restorative treatment with porcelain veneers was therefore carried out. After two years the patient remains asymptomatic and in good dental condition. Key words:Dental trauma, extrusive luxation, dento-alveolar fracture, esthetic restoration. PMID:27957283

  19. The effectiveness of art therapy in the treatment of traumatized adults: A systematic review on art therapy and trauma

    NARCIS (Netherlands)

    Schouten, K.A.; Niet, G.J. De; Knipscheer, J.W.; Kleber, R.J.; Hutschemaekers, G.J.M.

    2015-01-01

    Art therapy has often been applied in the treatment of traumatized adults, and good results in clinical practice have been reported. However, although art therapy experts underline these benefits, the effectiveness of art therapy in trauma treatment has not been established by systematic review. The

  20. The effectiveness of art therapy in the treatment of traumatized adults: A systematic review on art therapy and trauma

    NARCIS (Netherlands)

    Schouten, K.A.; Niet, G.J. De; Knipscheer, J.W.; Kleber, R.J.; Hutschemaekers, G.J.M.

    2015-01-01

    Art therapy has often been applied in the treatment of traumatized adults, and good results in clinical practice have been reported. However, although art therapy experts underline these benefits, the effectiveness of art therapy in trauma treatment has not been established by systematic review. The

  1. Exposing therapists to trauma-focused treatment in psychosis: effects on credibility, expected burden, and harm expectancies

    Science.gov (United States)

    van den Berg, David P. G.; van der Vleugel, Berber M.; de Bont, Paul A.J.M.; Thijssen, Gwen; de Roos, Carlijn; de Kleine, Rianne; Kraan, Tamar; Ising, Helga; de Jongh, Ad; van Minnen, Agnes; van der Gaag, Mark

    2016-01-01

    Background Despite robust empirical support for the efficacy of trauma-focused treatments, the dissemination proves difficult, especially in relation to patients with comorbid psychosis. Many therapists endorse negative beliefs about the credibility, burden, and harm of such treatment. Objective This feasibility study explores the impact of specialized training on therapists’ beliefs about trauma-focused treatment within a randomized controlled trial. Method Therapist-rated (n=16) credibility, expected burden, and harm expectancies of trauma-focused treatment were assessed at baseline, post-theoretical training, post-technical training, post-supervised practical training, and at 2-year follow-up. Credibility and burden beliefs of therapists concerning the treatment of every specific patient in the trial were also assessed. Results Over time, therapist-rated credibility of trauma-focused treatment showed a significant increase, whereas therapists’ expected burden and harm expectancies decreased significantly. In treating posttraumatic stress disorder (PTSD) in patients with psychotic disorders (n=79), pre-treatment symptom severity was not associated with therapist-rated credibility or expected burden of that specific treatment. Treatment outcome had no influence on patient-specific credibility or burden expectancies of therapists. Conclusions These findings support the notion that specialized training, including practical training with supervision, has long-term positive effects on therapists’ credibility, burden, and harm beliefs concerning trauma-focused treatment. Highlights of the article Specialized training improved therapists’ credibility, burden, and harm beliefs. Patients’ symptom severity and treatment outcome did not affect these beliefs. Replication of our findings in larger cohorts with a control group is warranted. PMID:27606710

  2. Application of revised trauma evaluation program in emergency treatment of multiple injuries

    Institute of Scientific and Technical Information of China (English)

    JIN Jing-fen; SHAO Ju-fang; HE Xiao-jun; YAO Mei-qi

    2006-01-01

    @@ Recently, with the rapid development of highway and high-rise buildings, trauma shows a tendency to increase continuously. The proportion of trauma patients with multiple injuries has increased and trauma arising from multiple injuries has become "the first public hazard".

  3. Vancomycin intermittent dosing versus continuous infusion for treatment of ventilator-associated pneumonia in trauma patients.

    Science.gov (United States)

    Schmelzer, Thomas M; Christmas, A Britton; Norton, H James; Heniford, B Todd; Sing, Ronald F

    2013-11-01

    Current guidelines for the empiric treatment of ventilator-associated pneumonia (VAP) recommend that vancomycin is dosed 15 mg/kg and administered twice daily for a target trough level of 15 to 20 μg/mL. This study compared conventional intermittent vancomycin infusion (IVI) with continuous vancomycin infusion (CVI). Our prospective, randomized study compared CVI with IVI in trauma patients with suspected VAP. The primary outcome measure was a serum vancomycin level within the target level 48 hours after initiation of therapy. Treatment groups were compared using standard statistical methods. The study included 73 patients, 36 IVI and 37 CVI. Eighteen patients were withdrawn from the study as a result of discontinuation of the drug before 48 hours or failure to draw levels at the appropriate time, resulting in 27 IVI and 28 CVI study patients. There were no differences between treatment groups in gender (P = 0.97), Injury Severity Score (P = 0.70), total body weight (P = 0.36), or age (P = 0.81). The mean serum vancomycin level for the IVI group was 8.9 ± 3.9 μg/mL, and the CVI level was 19.8 ± 6.13 μg/mL (P < 0.0001). Two patients in the IVI group (7.4%) were in the therapeutic range compared with 16 (57.1%) in the CVI group (P < 0.0001). Six patients in the CVI group (21.4%) and none of the IVI patients had supratherapeutic levels. Four patients developed renal insufficiency, three IVI (11.1%) and one CVI (3.6%) (P = 0.36). The current American Trauma Society dosing recommendations for vancomycin for presumptive VAP treatment are inadequate. Continuous vancomycin infusion should be adopted as the standard dosing strategy.

  4. Aesthetic treatment on anterior teeth crown fracture caused by dental trauma

    Directory of Open Access Journals (Sweden)

    Nanik Zubaidah

    2012-12-01

    Full Text Available Background: Complicated crown fracture is a tooth fracture that involve enamel, dentine and pulp. The incidence of complicated crown fracture ranges from 2% to 13% of all dental injuries and the most commonly involved teeth are the maxillary central incisors. Various treatment modalities are available depending on the clinical, physiological and radiographic examination of the involved teeth. Purpose: The aim of this case report is to present the management of crown fractures with pulpal exposure caused by traumatic injury, through endorestoration approach to reconstruct the shape and function of the teeth. Case: A 17 years old male with complicated crown fractures of anterior teeth #11 #21 and #22. The patient wish for aesthetic dental treatment in both of its form and function. Case management: Crown fractures of anterior teeth with exposed pulp caused by traumatic injury were reconstructed by endorestoration approach. The endodontic treatment with post and core insertion in the root canal which will increase its retention and porcelain fused to metal crown which will aesthetically recover its original form and function. After restoration the patient feel very glad and confident with the result. Conclusion: Endorestoration treatment on anterior teeth with complicated crown fractures and exposed pulp is able to recover the normal form, function and dental aesthetic in accordance with stomatognatic system and self confidence.Latar belakang: Fraktur mahkota kompleks (complicated adalah fraktur pada mahkota gigi yang melibatkan enamel, dentin dan pulpa. Kejadian dari fraktur mahkota kompleks bervariasi antara 2-13% dari semua trauma gigi dan sebagian besar gigi yang terkena adalah gigi insisif pertama rahang atas. Berbagai macam cara perawatan yang dilakukan tergantung pada hasil pemeriksaan klinis, psikologis dan radiografis dari gigi yang terkena. Tujuan: Laporan kasus ini menjelaskan penatalaksanaan fraktur mahkota gigi dengan pulpa terbuka

  5. HIV drug resistance in adults failing early antiretroviral treatment: results from the HIV Prevention Trials Network 052 trial

    Science.gov (United States)

    Fogel, Jessica M.; Hudelson, Sarah E.; Ou, San-San; Hart, Stephen; Wallis, Carole; Morgado, Mariza G.; Saravanan, Shanmugam; Tripathy, Srikanth; Hovind, Laura; Piwowar-Manning, Estelle; Sabin, Devin; McCauley, Marybeth; Gamble, Theresa; Zhang, Xinyi Cindy; Eron, Joseph J.; Gallant, Joel E.; Kumwenda, Johnstone; Makhema, Joseph; Kumarasamy, Nagalingeswaran; Chariyalertsak, Suwat; Hakim, James; Badal-Faesen, Sharlaa; Akelo, Victor; Hosseinipour, Mina C.; Santos, Breno Riegel; Godbole, Sheela V.; Pilotto, Jose Henrique; Grinsztejn, Beatriz; Panchia, Ravindre; Mayer, Kenneth H.; Chen, Ying Q.; Cohen, Myron S.; Eshleman, Susan H.

    2016-01-01

    Early initiation of antiretroviral therapy (ART) reduces HIV transmission and has health benefits. HIV drug resistance can limit treatment options and compromise use of ART for HIV prevention. We evaluated drug resistance in 85 participants in the HPTN 052 trial who started ART at CD4 counts of 350–550 cells/mm3 and failed ART by May 2011; 8.2% had baseline resistance and 35.3% had resistance at ART failure. High baseline viral load and less education were associated with emergence of resistance at ART failure. Resistance at ART failure was observed in 7/8 (87.5%) participants who started ART at lower CD4 cell counts. PMID:26859828

  6. Molecular analysis of Filifactor alocis, Tannerella forsythia, and treponema denticola associated with primary endodontic infections and failed endodontic treatment.

    Science.gov (United States)

    Gomes, Brenda P F A; Jacinto, Rogério C; Pinheiro, Ericka T; Sousa, Ezilmara L R; Zaia, Alexandre A; Ferraz, Caio C R; Souza-Filho, Francisco J

    2006-10-01

    The aim of this study was to investigate the presence of strict anaerobes such as Filifactor alocis, Tannerella forsythia, and Treponema denticola in primary and secondary root-infected canals with periapical lesions by molecular analysis and the association of these species with specific endodontic signs and symptoms. Microbial samples were taken from 100 root canals, 50 with necrotic pulp tissues (NPT, primary infection), and 50 with failed endodontic treatment (FET, secondary infection). DNA was extracted from the samples, which were analyzed for the presence of three endodontic pathogens using species-specific primers and PCR. F. alocis were isolated from 23 canals with NPT and 12 canals with FET; T. forsythia from 12 canals with NPT and three canals with FET; T. denticola from 19 canals with NPT and 12 canals with TEP. Suggested associations were found between primary infection and the presence of F. alocis and T. forsythia (both p < 0.05). In particular, associations were found between: pain and F. alocis; swelling and F. alocis; tenderness to percussion and T. forsythia; mobility and T. forsythia and T. denticola; wet canals and F. alocis, T. forsythia, and T. denticola; purulent exsudate and F. alocis, T. forsythia and T. denticola; abscess and F. alocis, T. forsythia, and T. denticola (all p < 0.05). The findings of this study indicated that F. alocis, T. forsythia, and T. denticola seem to be associated with endodontic signs and symptoms. Additionally, F. alocis and T. forsythia were detected more frequently in teeth with necrotic pulp than in teeth with failing endodontic treatment.

  7. Outcomes of surgical treatment in women with anal incontinence secondary to trauma of delivery

    Directory of Open Access Journals (Sweden)

    Akın Önder

    2011-12-01

    Full Text Available Objectives: Anal incontinence is the involuntary loss of flatus and feces and often occurs, as a reason of trauma due to the vaginal delivery in women. In this study, we aimed to evaluate the results of the patients, who underwent surgery, with anal incontinence due to the vaginal delivery.Materials and methods: Between January 2005 and December 2010, 15 patients, who had anal incontinence due to the vaginal delivery and underwent overlapping sphincteroplasty, were analyzed retrospectively.Results: The mean age was 34.7 (range 18-49 years. Sphincter injuries were grade 4 in all patients. The time for the surgery after the formation of vaginal tear varies between the first day after injury and 17 years. Wound infection developed in 2 of the patients. Anal incontinence was revealed in 4 patients in the postoperative period, 3 of them had incontinence of the flatus and 1 of them had flatal and fecal incontinence. Total continence was achieved in 11 patients.Conclusion: The sphincter injuries due to the vaginal delivery traumas can be easily defined with a detailed physical examination and careful questioning of the medical history. Satisfactory results can be achieved with the surgical treatment.

  8. Effectiveness of Physical Therapy as an Adjunctive Treatment for Trauma-induced Chronic Torticollis in Raptors.

    Science.gov (United States)

    Nevitt, Benjamin N; Robinson, Narda; Kratz, Gail; Johnston, Matthew S

    2015-03-01

    Management of trauma-induced chronic torticollis in raptors has historically been challenging. Euthanasia is common in affected birds because of their inability to maintain normal cervical position, although they may be able to function normally. To assess effectiveness of physical therapy of the neck and head as an adjunct treatment for this condition, a case-control study was done in raptors admitted to the Rocky Mountain Raptor Program from 2003 to 2010. Eleven cases were identified with a diagnosis of chronic torticollis resulting from traumatic brain injury. Five cases were treated with physical therapy of the head and neck, and 6 control cases did not receive any physical therapy for the torticollis. Of the control cases, 0 of 6 had resolution of the torticollis, 0 of 6 were released, and 5 of 6 were euthanatized. Of the treated cases, 4 of 5 had complete resolution of the torticollis and 5 of 5 were released. Resolution of torticollis differed significantly between cases receiving physical therapy and controls. These results indicate that physical therapy should be used as an adjunctive therapy in cases of chronic torticollis induced by trauma in raptors because it results in better resolution of the torticollis and increased likelihood of release.

  9. [Standardisation of the Initial Treatment of Severely Burned Patients: The Necessary Transfer of Concepts from Trauma Care].

    Science.gov (United States)

    Münzberg, M; Harbers, T; Kneser, U; Grützner, P A; Reichert, B; Kremer, T; Wölfl, C G; Horter, J; Hirche, C

    2016-12-01

    The initial treatment of severely burned patients remains a huge challenge for first responders in emergency services as well as emergency doctors who do not work in a centre for severe burn injuries. The reason for this is the low number of cases in developed countries and a lack of training concepts for the specific aspects of the initial treatment of severe burn injuries. Because of guidelines with limited evidence (S1, S2k) and a lack of structured treatment approaches, uncertainties with respect to initial treatment are still visible. Even within the professional societies and on international comparison, controversial aspects remain. In contrast, optimised and standardised procedures are available for the treatment of severely injured (trauma) patients, based on PHTLS® (Pre Hospital Trauma Life Support) for preclinical and ATLS® (Advanced Trauma Life Support) for in-hospital first aid. This article takes stock of the current structure of care and the relevant evidence for the initial treatment of severe burns. Also it discusses a possible transfer and further development of concepts for primary trauma care by all disciplines involved. Nine essential steps in the primary care of burned patients are identified and evaluated. The need for the introduction of a uniform treatment algorithm is illustrated. The treatment algorithm presented in this article addresses all first responders who are faced with initial treatment in the first 24 hours outside of burn centres. As an essential, new aspect, it offers a transfer and adaptation of concepts from trauma care to standardise the care of severely burned patients.

  10. Implementation and effectiveness of integrated trauma and addiction treatment for incarcerated men.

    Science.gov (United States)

    Wolff, Nancy; Huening, Jessica; Shi, Jing; Frueh, B Christopher; Hoover, Donald R; McHugo, Gregory

    2015-03-01

    A controlled trial of Seeking Safety (SS) and Male-Trauma Recovery Empowerment Model (M-TREM) examined implementation and effectiveness of integrated group therapy for comorbid post-traumatic stress disorder (PTSD) and substance use disorder (SUD) on PTSD and mental health symptoms plus self-esteem and efficacy for incarcerated men. The study sample (n=230) was male inmates 18 years or older who were primarily non-white, high school graduates or equivalents, had childhood trauma histories, committed violent crimes, had serious mental illnesses, and resided in a maximum security prison. Incarcerated men, who screened positive for PTSD and SUD, were assigned randomly (n=142) or by preference (n=88) to receive SS or M-TREM, with a waitlist group of (n=93). Manualized interventions were group-administered for 14 weeks. Primary outcomes were PTSD and other mental health symptoms. Secondary outcomes were self-esteem, coping, and self-efficacy. SUD outcomes cannot be measured in a correctional setting. Implementation feasibility was exhibited by the ability to recruit, screen, assign, and retain participants. Effectiveness findings depended on sample, design, and method for analysis. Using a waitlist control group and no follow-up period, we found no aggregate effect of treatment on PTSD symptoms, although, when disaggregated, M-TREM was found to improve PTSD severity and SS improved general mental health symptoms and psychological functioning. Using intent-to-treat and completer analyses, no significant differences were found in the relative performance between SS and M-TREM on primary or secondary outcomes. When longitudinal data were maximized and modeled in ways that reflect the hierarchical nature of the data, we found that SS and M-TREM performed better than no treatment on PTSD severity and secondary outcomes, and that treatment benefits endured. Findings cautiously support implementing either Seeking Safety or M-TREM to treat incarcerated men with co-morbid PTSD

  11. Novel treatment of a failed quadriceps tendon repair in a diabetic patient using a patella-quadriceps tendon allograft.

    Science.gov (United States)

    Druskin, Sasha C; Rodeo, Scott A

    2013-07-01

    Recurrent quadriceps tendon rupture is a debilitating condition that may be challenging to treat, especially in the presence of systemic disease such as diabetes mellitus (Bedi et al., J Shoulder Elbow Surg 19:978-988, 2010; Chbnou and Frenette, Am J Physiol Regul Integr Comp Physiol 5:R952-R957, 2004; Chen et al., J Shoulder Elbow Surg 5:416-421, 2003). Many surgical treatment protocols have been proposed (Azar, in Canale and Beatty, eds., Campbell's Operative Orthopedics, Mosby/Elsevier, Philadelphia, PA, 2008; Ilan et al., J Am Acad Orthop Surg 3:192-200, 2003; Rodeo and Izawa, in Garrett et al., eds., Principles and Practice of Orthopedic Sports Medicine, Lippincott Williams & Wilkins, Philadelphia, PA, 2000). We report the case of a diabetic male with multiple treatment failures. He ultimately sustained a good outcome following treatment with a novel surgical technique that utilized a patella quadriceps tendon allograft. Tendon allograft-to-native bone healing had previously failed in this patient, so we used a bone-tendon construct allograft to provide an allograft bone-to-native bone healing site. Now, 13 months postoperative, the patient has increased strength, minimal pain, 20 ° of extensor lag and 130 ° of flexion.

  12. Testosterone treatment fails to accelerate disease in a transgenic mouse model of spinal and bulbar muscular atrophy

    Directory of Open Access Journals (Sweden)

    Erica S. Chevalier-Larsen

    2012-01-01

    Evidence from multiple animal models demonstrates that testosterone plays a crucial role in the progression of symptoms in spinal and bulbar muscular atrophy (SBMA, a condition that results in neurodegeneration and muscle atrophy in affected men. Mice bearing a transgene encoding a human androgen receptor (AR that contains a stretch of 112 glutamines (expanded polyglutamine tract; AR112Q mice reproduce several aspects of the human disease. We treated transgenic male AR112Q mice with testosterone for 6 months. Surprisingly, testosterone treatment of AR112Q males did not exacerbate the disease. Although transgenic AR112Q males exhibited functional deficits when compared with non-transgenics, long-term testosterone treatment had no effect on motor function. Testosterone treatment also failed to affect cellular markers of disease, including inclusion formation (the accumulation of large nuclear aggregates of mutant AR protein and levels of unphosphorylated neurofilament heavy chain. These data suggest that the mechanism of disease in SBMA saturates at close to endogenous hormone levels and that individuals with SBMA who take, or have taken, testosterone for its putative therapeutic properties are unlikely to suffer adverse effects.

  13. 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...... of Complex PTSD, structural and somatoform dissociation, interpersonal problems, and factors promoting health before treatment and after 50 therapy hours or before and after waiting. Results showed significant differences in all scores when either of the treatment conditions was compared to the control group....... 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....

  14. Evaluation of Dentoalveolar Trauma in Children and Adolescents: a Modified Classification System and Surgical Treatment Strategies for Its Management.

    Science.gov (United States)

    Theologie-Lygidakis, Nadia; Schoinohoriti, Ourania K; Leventis, Minas; Iatrou, Ioannis

    2017-06-01

    To retrospectively analyze dentoalveolar trauma in pediatric patients, propose a modified classification, and delineate an approach for its urgent care from the surgeon's perspective. Clinical records of patients, attended at the 'A. and P. Kyriakou' Children's Hospital Department of Oral and Maxillofacial Surgery from 2000 to 2015, were retrieved and data were analyzed. A total of 365 cases of dentoalveolar trauma, affecting 363 children and adolescents (221 males and 142 females), with an age range from 1 to 15 years, were treated in the authors' department. The most common injury mechanism was falls. The trauma was graded as class II in most patients (41.65%). The anterior maxilla was injured in the majority of the patients (78.35%). In 230 patients (63%) the trauma involved the primary dentition. Two hundred eighty-nine of the patients were treated with local anesthesia on an emergency basis, while in the rest 76 patients general anesthesia was considered mandatory. Accurate diagnosis, timely treatment, and follow-up are critical for the management of dentoalveolar trauma in pediatric patients. A modified more detailed and severity-specific classification and guidelines for its surgical management may assist practitioners in decision making and effective treatment planning.

  15. [Preclinical treatment of severe burn trauma due to an electric arc on an overhead railway cable].

    Science.gov (United States)

    Spelten, O; Wetsch, W A; Hinkelbein, J

    2013-09-01

    Severe burns due to electrical accidents occur rarely in Germany but represent a challenge for emergency physicians and their team. Apart from extensive burns cardiac arrhythmia, neurological damage caused by electric current and osseous injury corresponding to the trauma mechanism are also common. It is important to perform a survey of the pattern of injuries and treat acute life-threatening conditions immediately in the field. Furthermore, specific conditions related to burns must be considered, e.g. fluid resuscitation, thermal management and analgesia. In addition, a correct strategy for further medical care in an appropriate hospital is essential. Exemplified by this case guidelines for the treatment of severe burns and typical pitfalls are presented.

  16. Guide of maxillofacial trauma intervention for diagnosis and treatment of facial burns

    Directory of Open Access Journals (Sweden)

    Eduardo Duarte Marrero

    2010-07-01

    Full Text Available The guide for maxillofacial trauma intervention for diagnosis and treatment of facial burns has been developed on the basis of the results obtained in a retrospective descriptive study of a series of patients for facial burns, were treated in serving Burned Cienfuegos University General Hospital "Dr. Gustavo Lima Aldereguía "between January 2005 and September 2007. The document describes the set of diagnostic and therapeutic procedures, both general and local, to treat patients with facial burns depending on the extent and depth of burns, also describes some special considerations depending on their location in central facial structures (eyelids, flag ear, nose, mouth, neck. It took into account national guidelines and the Pan American Health Organization, were also consulted experts and specialists in the field. The guide was approved by the scientific council of the institution cited above.

  17. Trauma exposure and refugee status as predictors of mental health outcomes in treatment-seeking refugees.

    Science.gov (United States)

    Knipscheer, Jeroen W; Sleijpen, Marieke; Mooren, Trudy; Ter Heide, F Jackie June; van der Aa, Niels

    2015-08-01

    Aims and method This study aimed to identify predictors of symptom severity for post-traumatic stress disorder (PTSD) and depression in asylum seekers and refugees referred to a specialised mental health centre. Trauma exposure (number and domain of event), refugee status and severity of PTSD and depression were assessed in 688 refugees. Results Symptom severity of PTSD and depression was significantly associated with lack of refugee status and accumulation of traumatic events. Four domains of traumatic events (human rights abuse, lack of necessities, traumatic loss, and separation from others) were not uniquely associated with symptom severity. All factors taken together explained 11% of variance in PTSD and depression. Clinical implications To account for multiple predictors of symptom severity including multiple traumatic events, treatment for traumatised refugees may need to be multimodal and enable the processing of multiple traumatic memories within a reasonable time-frame.

  18. Treatment of trauma-affected refugees with venlafaxine versus sertraline combined with psychotherapy

    DEFF Research Database (Denmark)

    Sonne, Charlotte; Carlsson, Jessica; Bech, Per;

    2016-01-01

    network), Sheehan Disability Scale (disability in three areas of functioning), Hamilton Depression and Anxiety scale, the somatisation items of the Symptoms Checklist-90, Global Assessment of Functioning scales and the summarised score of pain in four body areas rated on visual analogue scales. Results...... Trauma Questionnaire – part IV, which was the primary outcome measure. Other outcome measures included: Hopkins Symptom Check List-25 (depression and anxiety), Social Adjustment Scale – short version (social functioning), WHO-5 Well-being Index (quality of life), Crisis Support Scale (support from social...... Questionnaire and a number of other ratings in both groups. On the primary outcome measure, no difference was found in treatment effect between the sertraline and venlafaxine group. A significant group difference was found in favour of sertraline on the Sheehan Disability Scale. Conclusion: Sertraline had...

  19. Classification and Treatment of Clinical Analysis of Renal Trauma%临床分析肾外伤的分级与治疗

    Institute of Scientific and Technical Information of China (English)

    兰征科

    2015-01-01

    目的临床分析肾外伤的分级与治疗。方法选取从2011年4月~2014年3月来我院接受治疗的肾外伤患者52例,对损伤程度进行分级,并据此选择最适合的治疗方案。结果轻度肾损伤(挫伤、部分裂伤)34例,行保守治疗,32例成功,2例继发出血,行肾切除术治疗;重度肾损伤(肾蒂伤、粉碎伤、全层裂伤)18例,行肾切除术治疗。32例保守治疗,痊愈26例,失败6例。20例肾切除术全部痊愈。结论对肾外伤进行分级,有利于选择最合适的治疗方法,减少肾切除,提升患者的生活质量。%Objective Classification and treatment of clinical analysis of renal trauma. Methods 52 patients with renal trauma from 2011 April to 2014 March in our hospital treated patients, to classify the degree of injury, and then choose the most appropriate treatment. Results Mild renal damage (contusion, laceration in 34 cases, partial) received conservative treatment, 32 cases were successful, 2 cases of secondary hemor hage, nephrectomy treatment;severe kidney damage (renal pedicle injury, crush injury, laceration) in 18 cases, nephrectomy treatment. Conservative treatment of 32 cases, 26 cases were cured, 6 cases failed. 20 cases of nephrectomy cured. Conclusion The classification of renal trauma, facilitates the selection of the most appropriate treatment, reduce renal resection, enhance the quality of life of patients.

  20. Influence of deposit stage and failed ESWT on the surgical results of arthroscopic treatment of calcifying tendonitis of the shoulder.

    Science.gov (United States)

    Lorbach, O; Kusma, M; Pape, D; Kohn, D; Dienst, M

    2008-05-01

    The purpose of the present study is the evaluation of a possible influence of the preoperative deposit stage, the postoperative deposit elimination and failed preoperative extracorporeal shockwave therapy on the surgical outcome of arthroscopic treatment of tendinosis calcarea. From 1997 to 2004, 65 patients underwent arthroscopic resection of calcific deposits of the shoulder after failed conservative treatment. Patients with rotator cuff tears, major cartilage damage, or previous surgery were excluded. Out of 50 patients 45 (17 men, 28 women) that could be contacted with a mean age of 49 +/- 8 years could be followed-up with a mean of 36 months (14-89) after surgery. A total of 24 patients (53.3%) underwent preoperative extracorporeal shock-wave therapy (ESWT). For the clinical evaluation the Constant and Murley Score, the Simple Shoulder Test, the Western Ontario Rotator Cuff Index (WORC) and visual analog scales for pain, function and satisfaction were used. For the radiological evaluation, the classifications according to Gaertner and Bosworth were used. Statistical analysis was done with the Wilcoxon test, the Mann-Whitney test and ANOVA. The Constant and Murley Score improved significantly from preoperative 63.5 +/- 11.4 to postoperative 93.9 +/- 9.9 points (P < .0001) at follow-up, the Simple Shoulder Test from 1.7 +/- 2 to 9.9 +/- 2.8 points (P < .0001), the WORC score from 1,591.2 +/- 337.4 to 345.4 +/- 392 points (P < .0001). The visual analog scales for pain, function and patient satisfaction also significantly improved (P < .0001). Preoperative radiological evaluation according to the Gaertner classification revealed 37 type I deposits, 6 type II and 2 type III deposits; postoperative no calcific deposits were seen in 37 patients, 6 type I and 2 type III deposits. According to the Bosworth classification 13 type I, 19 type II and 13 type III deposits were seen preoperatively. Postoperative X-rays showed 6 type I and 1 type II and III deposits. There

  1. Endovascular treatment of intramural hematoma of internal carotid artery after blunt trauma of neck inflicted with the seatbelt.

    Science.gov (United States)

    Stanisic, M; Winckiewicz, M; Juszkat, R; Gabriel, M; Jawien, A; Staniszewski, R

    2009-08-01

    Blunt trauma of the neck caused by a seatbelt may cause dissection with intramural hematoma of the internal carotid artery. The following case report discusses the differential diagnosis and the potential of endovascular treatment of symptomatic intramural hematoma of the internal carotid artery.

  2. Evidence-based treatments for children with trauma-related psychopathology as a result of childhood maltreatment: a systematic review.

    Science.gov (United States)

    Leenarts, Laura E W; Diehle, Julia; Doreleijers, Theo A H; Jansma, Elise P; Lindauer, Ramón J L

    2013-05-01

    This is a systematic review of evidence-based treatments for children exposed to childhood maltreatment. Because exposure to childhood maltreatment has been associated with a broad range of trauma-related psychopathology (e.g., PTSD, anxiety, suicidal ideation, substance abuse) and with aggressive and violent behavior, this review describes psychotherapeutic treatments which focus on former broad range of psychopathological outcomes. A total of 26 randomized controlled clinical trials and seven non-randomized controlled clinical trials published between 2000 and 2012 satisfied the inclusionary criteria and were included. These studies dealt with various kinds of samples, from sexually abused and maltreated children in child psychiatric outpatient clinics or in foster care to traumatized incarcerated boys. A total of 27 studies evaluated psychotherapeutic treatments which used trauma-focused cognitive, behavioral or cognitive-behavioral techniques; only two studies evaluated trauma-specific treatments for children and adolescents with comorbid aggressive or violent behavior; and four studies evaluated psychotherapeutic treatments that predominantly focused on other mental health problems than PTSD and used non-trauma focused cognitive, behavioral or cognitive-behavioral techniques. The results of this review suggest that trauma-focused cognitive-behavioral therapy (TF-CBT) is the best-supported treatment for children following childhood maltreatment. However, in line with increased interest in the diagnosis of complex PTSD and given the likely relationship between childhood maltreatment and aggressive and violent behavior, the authors suggest that clinical practice should address a phase-oriented approach. This review concludes with a discussion of future research directions and limitations.

  3. Attach importance to the early diagnosis and treatment of acute coagulation dysfunction after major war trauma

    OpenAIRE

    Li, Jie-Shou; You-sheng LI

    2013-01-01

    Coagulation dysfunction after major war trauma is conventionally attributed to consumption and dilution of coagulation factors. However, recent studies have identified an acute coagulation dysfunction at the early stage after trauma. This coagulation dysfunction due to endogenous coagulation disturbance at the early stage after trauma is called acute traumatic coagulation dysfunction (ATCD), and the patients with ATCD would have an increased complication rate and mortality. Standard coagulati...

  4. 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.

  5. Angiographic embolization in the treatment of intrahepatic arterial bleeding in patients with blunt abdominal trauma

    Institute of Scientific and Technical Information of China (English)

    Ya-Lin Kong; Hong-Yi Zhang; Xiao-Jun He; Gang Zhao; Cheng-Li Liu; Mei Xiao and Yu-Ying Zhen

    2014-01-01

    BACKGROUND: Angiographic embolization (AE) as an adjunct non-operative treatment of intrahepatic arterial bleeding has been widely used. The present study aimed to evaluate the efifcacy of selective AE in patients with hepatic trauma. METHODS: Seventy patients with intrahepatic arterial bleeding after blunt abdominal trauma who had undergone selective AE in 10 years at this institution were retrospectively reviewed. The  criteria  for  selective  AE  included  active  extravasation on  contrast-enhanced  CT,  an  episode  of  hypotension  or a  decrease  in  hemoglobin  level  during  the  non-operative treatment. The data of the patients included demographics, grade of liver injuries, mechanism of blunt abdominal trauma, associated  intra-abdominal  injuries,  indications  for  AE, angiographic ifndings, type of AE, and AE-related hepatobiliary complications. RESULTS: In the 70 patients, 32 (45.71%) had high-grade liver injuries. Extravazation during the early arterial phase mainly involved the right hepatic segments. Thirteen (18.57%) patients underwent  embolization  of  intrahepatic  branches  and  the extrahepatic trunk and these patients all developed AE-related hepatobiliary complications. In 19 patients with AE-related complications, 14 received minimally invasive treatment and recovered without severe sequelae. CONCLUSIONS: AE is an adjunct treatment for liver injuries. Selective and/or super-selective AE should be advocated to decrease the incidence and severity of AE-related hepatobiliary complications.

  6. Surgical treatment of traumatic cloaca Tratamento cirúrgico da cloaca pós-trauma

    Directory of Open Access Journals (Sweden)

    Roberta Lages das Mercês

    2008-01-01

    Full Text Available PURPOSE: To assess the functional results of surgical treatment of traumatic cloaca by a technique including reconstructive plastic surgery of the perineal body and of the rectovaginal septum using the puborectal and external sphincter muscles. METHODS: Six female patients were submitted to surgical treatment for correction of the cloaca over a period of 5 years (2002 to 2007. Loop sigmoidostomy was parformed in two patients. The mean duration of symptoms before surgical treatment was 97.5 months (4 months to 36 years, mean patient age was 36 years (17 to 58 years and the follow-up period was 14.6 months (6 months to 2 years. RESULTS: Five patients (83.3% regained fecal and flatus continence and one patient had flatus incontinence. DISCUSSION: Surgical treatment yields good results, is safe and involves low rates of complications.INTRODUÇÃO: A causa mais comum da cloaca é o trauma obstétrico. O objetivo desse trabalho é avaliar os resultados do tratamento cirúrgico empregando-se plástica reconstrutiva do corpo perineal e do septo reto vaginal. MÉTODOS: Foram operadas seis mulheres, num período de 5 anos (2002-2007. Sigmoidostomia em alça foi realizada em duas pacientes. O tempo médio de duração dos sintomas no pré-operatório foi de 97,5 meses (4 meses a 36 anos, a faixa etária média foi de 36 anos (17-58 e o período de seguimento foi de 14,6 meses (6 meses - 2 anos. RESULTADOS: Cinco pacientes (83,3% recuperaram a continência anal para fezes e flatos e uma paciente permaneceu com incontinência para gases. DISCUSSÃO: O tratamento cirúrgico da cloaca pós-trauma apresentou bons resultados, sendo considerado um procedimento seguro, com baixo índice de complicação.

  7. How do patients who fail first-line TB treatment but who are not placed on an MDR-TB regimen fare in South India?

    Directory of Open Access Journals (Sweden)

    Sharath Burugina Nagaraja

    Full Text Available SETTING: Seven districts in Andhra Pradesh, South India. OBJECTIVES: To a determine treatment outcomes of patients who fail first line anti-TB treatment and are not placed on an multi-drug resistant TB (MDR-TB regimen, and b relate the treatment outcomes to culture and drug susceptibility patterns (C&DST. DESIGN: Retrospective cohort study using routine programme data and Mycobacterium TB Culture C&DST between July 2008 and December 2009. RESULTS: There were 202 individuals given a re-treatment regimen and included in the study. Overall treatment outcomes were: 68 (34% with treatment success, 84 (42% failed, 36 (18% died, 13 (6.5% defaulted and 1 transferred out. Treatment success for category I and II failures was low at 37%. In those with positive cultures, 81 had pan-sensitive strains with 31 (38% showing treatment success, while 61 had drug-resistance strains with 9 (15% showing treatment success. In 58 patients with negative cultures, 28 (48% showed treatment success. CONCLUSION: Treatment outcomes of patients who fail a first-line anti-TB treatment and who are not placed on an MDR-TB regimen are unacceptably poor. The worst outcomes are seen among category II failures and those with negative cultures or drug-resistance. There are important programmatic implications which need to be addressed.

  8. 腹部创伤的诊断与治疗%Diagnosis and treatment of abdominal trauma

    Institute of Scientific and Technical Information of China (English)

    张连阳

    2014-01-01

    腹部创伤患者救治中如何降低漏诊率和阴性探查率仍然是临床难题.本文基于血流动力学和致伤机制提出诊断与治疗流程,进一步阐述该流程中涉及的体格检查、创伤重点超声评估(FAST)、CT检查和诊断性腹腔灌洗(DPL)等腹部创伤伤情评估技术,钝性伤和穿透伤手术指征等紧急救治策略,以及腹腔镜下和剖腹时的探查技术.%Reducing the misdiagnosis rate and negative exploratory rate is still a challenge in the diagnosis and treatment process for abdominal trauma.In this article,the diagnosis and treatment are processed based on the hemodynamic and injury mechanism,and the injury evaluation techniques including physical examination,focused abdominal sonography for trauma,computed tomography,diagnostic peritoneal lavage and urgent treatment strategies for blunt trauma and penetrating trauma,as well as the exploratory techniques in the laparoscopy and laparotomy are introduced.

  9. Depression and Psychological Trauma: An Overview Integrating Current Research and Specific Evidence of Studies in the Treatment of Depression in Public Mental Health Services in Chile

    Directory of Open Access Journals (Sweden)

    Verónica Vitriol

    2014-01-01

    Full Text Available In the last two decades, different research has demonstrated the high prevalence of childhood trauma, including sexual abuse, among depressive women. These findings are associated with a complex, severe, and chronic psychopathology. This can be explained considering the neurobiological changes secondary to early trauma that can provoke a neuroendocrine failure to compensate in response to challenge. It suggests the existence of a distinguishable clinical-neurobiological subtype of depression as a function of childhood trauma that requires specific treatments. Among women with depression and early trauma receiving treatment in a public mental health service in Chile, it was demonstrated that a brief outpatient intervention (that screened for and focused on childhood trauma and helped patients to understand current psychosocial difficulties as a repetition of past trauma was effective in reducing psychiatric symptoms and improving interpersonal relationships. However, in this population, this intervention did not prevent posttraumatic stress disorder secondary to the extreme earthquake that occurred in February 2010. Therefore in adults with depression and early trauma, it is necessary to evaluate prolonged multimodal treatments that integrate pharmacotherapy, social support, and interpersonal psychotherapies with trauma focused interventions (specific interventions for specific traumas.

  10. Surgical Treatment After Failed Primary Correction of Urogenital Sinus in Female Patients with Virilizing Congenital Adrenal Hyperplasia.

    Directory of Open Access Journals (Sweden)

    Maria Helena Palma Sircili

    2016-10-01

    Full Text Available Purpose: Genital reconstruction in female patients with virilizing congenital adrenal hyperplasia (CAH is very challenging. Our aim was to evaluate the techniques employed to treat complications after failure of primary urogenital sinus (UGS surgery, as well as the result of these reoperations.Patients and Methods: Twenty girls with virilizing CAH who were previously submitted to genitoplasty in our service and elsewhere had recurrent UGS stenosis and vaginal introitus stenosis that required surgical treatment. The main symptoms were recurrent urinary tract infection (UTI in nine, dyspareunia in six and hematocolpos in three (two associated with sepsis. The anatomical findings were the persistence of UGS with stenosis in 17 patients and vaginal introitus stenosis in three. The mean age at procedure was 15.2 yrs., averaging 13.1 yrs. after the first surgery. The surgical techniques employed were: isolated perineal flap in 17 patients and perineal flap with partial mobilization of UGS in three. The mean follow-up after the procedure was 4.8 years (varying from 1 to 17yrs.Results: Vaginal dilations were performed after surgery in 15 patients. Good functional and anatomical results were obtained in 15 patients, with vaginal introitus amenable to dilators of 3.0 cm in diameter. Five patients with high vaginal insertion had recurrent vaginal stenosis and required a surgical revision. No patients presented menstrual obstruction or UTI after surgery. Eight of the 15 adult patients are sexually active. Conclusion: The reoperation to treat failed primary UGS treatment using Y-V flap and partial mobilization techniques associated to vaginal dilations, promoted good anatomical and functional results with low morbidity in 75% of the patients.□

  11. Comparison of the trauma degree after retroperitoneoscopy and percutaneous nephtoscopy treatment of complicated upper ureteral calculi

    Institute of Scientific and Technical Information of China (English)

    Shu-Run Zhao; Zhan-Peng Lu

    2016-01-01

    Objective:To compare the trauma degree after retroperitoneoscopy and percutaneous nephtoscopy treatment of complicated upper ureteral calculi.Methods:A total of 82 cases of patients with complicated upper ureteral calculi who received surgical treatment in our hospital from July 2013 to January 2015 were included for study. According to the different surgical methods, included subjects were randomly divided into observation group 41 cases and control group 41 cases. Control group received percutaneous nephtoscopy treatment, observation group received retroperitoneoscopy treatment, and then differences in early postoperative coagulation indicators, blood glucose and insulin levels, stress protein levels as well as PI3K/Akt and p38MAPK signaling pathway expression were compared between two groups.Results:Early postoperative PLCR, PDW, APTT and D-D values of observation group were lower than those of control group while Ca2+ value was higher than that of control group; early postoperative GLU, fasting lactate, fasting lactate/pyruvic acid and HOMA-IR values of observation group were lower than those of control group while HOMA-β value was higher than that of control group; early postoperative HSP70, DNA ligaseⅣ, JAB1 and ATF4 expression levels of observation group were higher than those of control group whileβ-tubulin and IFIT1 expression levels were lower than those of control group; early postoperative p38MAPK mRNA and protein expression levels of observation group were lower than those of control group while PI3K and Akt mRNA and protein expression levels were higher than those of control group.Conclusion: Retroperitoneoscopy treatment of patients with complicated upper ureteral calculi causes less injury to patients and less effect on internal environment, and helps to patients’ early postoperative rehabilitation.

  12. Optimising diagnosis and treatment of coagulopathy in severely injured trauma patients

    NARCIS (Netherlands)

    Balvers, K.

    2016-01-01

    Trauma has a profound impact on public health around the world. Yearly approximately 5 million people die due to traumatic injury, which is 1 out of every 3 severely injured patients. Therefore, improving survival after trauma is a major challenge in which timely therapy is of great importance. In t

  13. Total Hip Arthroplasty Using Modular Trabecular Metal Acetabular Components for Failed Treatment of Acetabular Fractures: A Mid-term Follow-up Study

    Institute of Scientific and Technical Information of China (English)

    De-Yong Huang; Liang Zhang; Yi-Xin Zhou; Chun-Yu Zhang; Hui Xu; Yong Huang

    2016-01-01

    Background:Porous-coated cups have been widely used in acetabular reconstruction after failed treatment of acetabular fractures,and good results have been reported with the use of these cups;however,the durability and functionality of modular trabecular metal (TM) acetabular components in acetabular reconstruction after failed treatment of acetabular fractures remain unclear.This study aimed to examine the radiographic and clinical outcomes associated with the use of modular TM acetabular components for failed treatment of acetabular fractures to assess the durability and functionality of these components in acetabular reconstruction after failed treatment of acetabular fractures.Methods:A total of 41 patients (41 hips) underwent total hip arthroplasty (THA) using modular TM acetabular components for failed treatment of acetabular fractures at our hospital between January 2007 and December 2012.Among these patients,two were lost to follow-up.Therefore,39 patients (39 hips) were finally included in this study.The Harris hip score before and after the surgery,satisfaction level of the patients,and radiographic results were assessed.Results:The mean Harris hip score increased from 34 (range,8-52) before surgery to 91 (range,22-100) at the latest follow-up examination (P < 0.001).The results were excellent for 28 hips,good for six,fair for three,and poor for two.Among the 39 patients,25 (64%) and 10 (26%) were very satisfied and somewhat satisfied,respectively.All cups were found to be fully incorporated,and no evidence of cup migration or periacetabular osteolysis was noted.Conclusions:Despite the technically demanding nature of the procedure,THA using modular TM acetabular components showed good durability and functionality and may be an effective reconstruction option for failed treatment of acetabular fractures.

  14. SURGICAL TREATMENT OF BLUNT CARDIAC TRAUMA IN CHHDREN: REPORT OF 2 CASES AND REVIEW OF LITERATURES

    Institute of Scientific and Technical Information of China (English)

    朱宏斌; 苏肇伉; 丁文祥; 郑景浩

    2005-01-01

    Objective Summarizing the clinical experience of surgical treatment in 2 cases of blunt cardiac trauma and reviewing the relevant literatures. Methods A 6-year-old girl was diagnosed muscular ventricular septal defect and left ventricular aneurysm 2d after automobile accident and underwent ventricular septal defect repair 2 weeks after injury. Another 9-year-old boy was diagnosed severe mitral regurgitation resulted from rupture of posterior papillary muscle 9d after automobile accident and underwent mitral valvuloplasty 2 weeks after injury.Results Heart function of the first patient was in New York Heart Association ( NYHA ) class Ⅰ , echocardiography showed no residual septal defect and the size of left ventricular aneurysm reduced. Heart function of the second patient is in NYHA class Ⅱ, echocardiography showed mild mitral regurgitation. Conclusion Blunt traumatic heart disease occurs either because of heart compression between sternum and the spine and/or because of myocardi-al contusion; A more aggressive strategy with surgical treatment earlier before deterioration of heart function is advocated; Earlier surgical correction of anatomic deformity will achieve a good result and a long time follow-up is necessary.

  15. The change of prefrontal QEEG theta cordance as a predictor of response to bupropion treatment in patients who had failed to respond to previous antidepressant treatments.

    Science.gov (United States)

    Bares, Martin; Brunovsky, Martin; Novak, Tomas; Kopecek, Miloslav; Stopkova, Pavla; Sos, Peter; Krajca, Vladimir; Höschl, Cyril

    2010-07-01

    The aim of the study was to examine whether the reduction of theta prefrontal quantitative EEG (QEEG) cordance after one week of bupropion administration is a predictor of response to a 4-week treatment in patients that had failed to respond to previous antidepressant treatments. EEG data of 18 inpatients were monitored at baseline and after one week. QEEG cordance was computed at 3 frontal electrodes (Fp1, Fp2, Fz). Response to treatment was defined as a >/=50% reduction of MADRS score. Nine of the eleven responders and one of the seven non-responders showed decreased prefrontal cordance value after the first week of treatment (p=0.01). Positive and negative predictive values of cordance reduction for the prediction of response to the treatment were 0.9 and 0.75, respectively. Similar to other antidepressants, the reduction of prefrontal QEEG cordance might be helpful in the prediction of the acute outcome of bupropion treatment. Copyright 2010 Elsevier B.V. and ECNP. All rights reserved.

  16. 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...... combined, the result is that more than 100 trauma scenarios exist, when the two dentitions are combined. Each of these trauma scenarios has a specific treatment demand and prospect for healing. With such a complexity in diagnosis and treatment, it is obvious that even experienced practitioners may have...... 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.DentalTrauma...

  17. Emergency treatment of dentoalveolar trauma: essential tips for treating active patients.

    Science.gov (United States)

    Honsik, Kenneth A

    2004-09-01

    Dentoalveolar trauma in sports is common. One third of dental injuries in the United States occur in sports-related activities, so team physicians should be able to recognize and properly treat dental injuries on the field. Tooth fracture, luxation, avulsion, and socket injury are the main types of dentoalveolar trauma. In many cases, other maxillofacial trauma can be associated with dental injuries, so physicians who examine these patients should be aware of additional associated injuries. Tooth injury is often preventable with the appropriate use of properly fitted mouth guards. Physicians should be familiar with different types and be able to suggest the correct mouth guard for a given activity.

  18. Laparoscopic treatment of biliary peritonitis following nonoperative management of blunt liver trauma

    Directory of Open Access Journals (Sweden)

    Bachellier Philippe

    2010-09-01

    Full Text Available Abstract Introduction Nonoperative management (NOM of hemodynamically stable patients with blunt hepatic injuries is considered the current standard of care. However, it is associated with several in-hospital complications. In selected cases laparoscopy could be proposed as diagnostic and therapeutic means. Case report A 28 years-old male was admitted in the Emergency Unit following a motor vehicle crash. CT-scan showed an isolated stade II hepatic injury at the level of the segment IV. Firstly a NOM was decided. Laparoscopic exploration was then performed at day 4 due to a biliary peritonitis. Intraoperative trans-cystic duct cholangiography showed a biliary leaks of left hepatic biliary tract, involving sectioral pedicle to segment III. Cholecystectomy, trans-cystic biliary drainage, application of surgical tissue sealing patch and abdominal drainage were performed. Postoperative outcome was uneventful, with fast patient recovery. Conclusion Laparoscopy has gained a role as diagnostic and therapeutic means in treatment of complications following NOM of blunt liver trauma. This approach seems feasible and safety, with satisfactory postoperative outcome.

  19. Reinforced composite restoration following trauma to a mandibular tooth: technique and follow-up treatment.

    Science.gov (United States)

    Smidt, Ami; Sharon, Eldad; Adler, Mordekhai Lipovetsky

    2012-10-01

    The loss of an entire tooth in the anterior region is accompanied by impairment of esthetics, function, phonetics, and self-esteem. It is common knowledge that treatment with implants during childhood or early adolescence is not an option. Splinting of adjacent teeth during growth and development may interfere with the independent process of teeth realignment and repositioning during that phase of life. Other creative solutions must be offered, such as free-standing composite buildup restorations on compromised broken teeth or single wing/cantilevered restorations adhered to one neighboring tooth during the growth period. The positive effects of reinforced composite materials were researched and presented in the literature. Their use is clearly indicated for interim and economical restorations. Long-term follow-up on a mandibular incisor that experienced trauma, losing its clinical crown and vitality when the patient was 12 years of age, is discussed with all the various aspects of material selection, future considerations, and long-term follow-up to adulthood, when a conventional crown was prepared and delivered.

  20. Popliteal artery injuries in an urban trauma center with a rural catchment area: do delays in definitive treatment affect amputation?

    Science.gov (United States)

    Simmons, Jon D; Gunter, Joseph W; Schmieg, Robert E; Manley, Justin D; Rushton, Fred W; Porter, John M; Mitchell, Marc E

    2011-11-01

    Extended length of time from injury to definitive vascular repair is considered to be a predictor of amputation in patients with popliteal artery injuries. In an urban trauma center with a rural catchment area, logistical issues frequently result in treatment delays, which may affect limb salvage after vascular trauma. We examined how known risk factors for amputation after popliteal trauma are affected in a more rural environment, where patients often experience delays in definitive surgical treatment. All adult patients admitted to the Level I trauma center, the University of Mississippi Medical Center, with a popliteal artery injury between January 2000 and December of 2007 were identified. Demographic information management and outcome data were collected. Body mass index, mangled extremity severity score (MESS), Guistilo open fracture score, injury severity score, and time from injury to vascular repair were examined. Fifty-one patients with popliteal artery injuries (53% blunt and 47% penetrating) were identified, all undergoing operative repair. There were nine amputations (17.6%) and one death. Patients requiring amputation had a higher MESS, 7.8 versus 5.3 (P score, Guistilo open fracture score, or time from injury to repair were not different between the two groups. Patients with a blunt mechanism of injury had a slightly higher amputation rate compared with those with penetrating trauma, 25.9 per cent versus 8.3 per cent (P = non significant). MESS, though not perfect, is the best predictor of amputation in patients with popliteal artery injuries. Morbid obesity is not a significant predictor for amputation in patients with popliteal artery injuries. Time from injury to repair of greater than 6 hours was not predictive of amputation. This study further demonstrates that a single scoring system should be used with caution when determining the need for lower extremity amputation.

  1. Treatment Outcomes for Women With Substance Abuse and PTSD Who Have Experienced Complex Trauma

    National Research Council Canada - National Science Library

    Cohen, Lisa R; Hien, Denise A

    2006-01-01

    OBJECTIVE: This study assessed the effect of cognitive-behavioral therapy on a range of problems associated with complex trauma in a sample of women with comorbid substance use disorders and posttraumatic stress disorder (PTSD). METHODS...

  2. Acupuncture Treatment of Facial Paralysis Caused by Craniocerebral Trauma in 50 Cases

    Institute of Scientific and Technical Information of China (English)

    赵建平

    2003-01-01

    @@ Cooperating with doctors in the Department of Brain Surgery, the author have treated 50 cases of facial paralysis caused by craniocerebral trauma in recent 3 years. The results are reported as follows.

  3. Principles of organization, diagnostics and treatment of children with associated trauma

    Directory of Open Access Journals (Sweden)

    Khilola Alimova

    2011-03-01

    Full Text Available Pediatric multiple trauma victims present a unique set of problems to the emergency physician, pediatrician, or surgeon. Children rarely sustain lethal injury; delayed recognition and inappropriate management of the common problems encountered in the pediatric trauma patient can lead to a poor outcome.This study was designed as a retrospective descriptive review of medical records of 289 injured children. All children were admitted in age from 1 to 15 years to the Republican Research Center of Emergency Medicine (Uzbekistan and its branches during 2000-2009.Caring for pediatric trauma patients requires an understanding of the distinct anatomy and pathophysiology of the pediatric population. Initial evaluation, management, and resuscitation require a multidisciplinary approach including trauma surgeons, anesthesiologists, and pediatric intensive care physicians.

  4. Dentoalveolar trauma.

    Science.gov (United States)

    Olynik, Christopher R; Gray, Austin; Sinada, Ghassan G

    2013-10-01

    Dentoalveolar injuries are an important and common component of craniomaxillofacial trauma. The dentition serves as a vertical buttress of the face and fractures to this area may result in malalignment of facial subunits. Furthermore, the dentition is succedaneous with 3 phases-primary dentition, mixed dentition, and permanent dentition-mandating different treatment protocols. This article is written for nondental providers to diagnose and treat dentoalveolar injuries.

  5. Treating childhood trauma.

    Science.gov (United States)

    Terr, Lenore C

    2013-01-01

    This review begins with the question "What is childhood trauma?" Diagnosis is discussed next, and then the article focuses on treatment, using 3 basic principles-abreaction, context, and correction. Treatment modalities and complications are discussed, with case vignettes presented throughout to illustrate. Suggestions are provided for the psychiatrist to manage countertransference as trauma therapy proceeds.

  6. 外伤换药及护理%Trauma treatment and nursing

    Institute of Scientific and Technical Information of China (English)

    徐克菊

    2015-01-01

    目的:介绍伤口换药的基本操作过程,清洁伤口,保护创面,促进愈合。动态地观察伤口变化,及时调整伤口护理方案;改善伤口环境,施敷有效的药物,控制感染。保护新生的肉芽组织,促进伤口愈合。方法随机抽取来院治疗的180例外伤包扎患者作为研究对象,回顾性分析所有病例临床治疗资料。结论患者外伤伤口采用妥当的外伤换药及个体化的综合护理干预措施能够促进伤口愈合。%Objective: to introduce the basic operation, wound dressing the wound clean, protect the wound and healing. dynamic observation of changes in the wound, wound care and timely adjustment plan; improve the wound environment, the medicine is applied effectively, control of infection. the protection of; neonatal granulation tissue, promote wound healing. Methods: a random sample of 180 cases of traumatic hospital bandaged patients as the research object, a retrospective analysis of clinical data of all patients. Results:180 cases of trauma patients after reasonable treatment to alleviate the symptoms rapidly.

  7. Cerebrovascular trauma

    Energy Technology Data Exchange (ETDEWEB)

    Krings, Timo [Hopital de Bicetre, Service de Neuroradiologie Diagnostique et Therapeutique, Paris (France); University Hospital Aachen, Department of Neuroradiology, Aachen (Germany); University Hospital, University of Technology, Aachen (DE), Departments of Neuroradiology and Neurosurgery, Aachen (Germany); Univ. of Technology, Aachen (Germany) Dept. of Neurosurgery; Geibprasert, Sasikhan [Hopital de Bicetre, Service de Neuroradiologie Diagnostique et Therapeutique, Paris (France); Ramathibodi Hospital Bangkok, Department of Radiology, Bangkok (Thailand); Lasjaunias, Pierre L. [Hopital de Bicetre, Service de Neuroradiologie Diagnostique et Therapeutique, Paris (France)

    2008-08-15

    Vascular injury of the head and neck region is a rare and often life-threatening complication of head or neck trauma and is due to two major pathomechanisms: penetrating or blunt trauma. Both the arterial and the venous site of the CNS vasculature can be involved, the latter one being often overlooked. Concerning arterial lesions, depending on how many layers of the arterial vessel are affected and on the spatial relationship to adjacent structures, dissections, false aneurysms or arteriovenous fistulae may develop. On the venous side, dural tears, compressive effects on pial veins and a deranged clotting system may lead to delayed venous thrombosis. In this review we describe clinical and imaging findings, as well as diagnostic and treatment strategies in these lesions. (orig.)

  8. Modification of Anxious Behavior after Psychogenic Trauma and Treatment with Galanin Receptor Antagonist.

    Science.gov (United States)

    Lyudyno, V I; Tsikunov, S G; Abdurasulova, I N; Kusov, A G; Klimenko, V M

    2015-07-01

    Effects of blockage of central galanin receptors on anxiety manifestations were studied in rats with psychogenic trauma. Psychogenic trauma was modeled by exposure of a group of rats to the situation when the partner was killed by a predator. Antagonist of galanin receptors was intranasally administered before stress exposure. Animal behavior was evaluated using the elevated-plus maze test, free exploratory paradigm, and open-field test. Psychogenic trauma was followed by an increase in anxiety level and appearance of agitated behavior. Blockage of galanin receptors aggravated behavioral impairment, which manifested in the pathological anxious reactions - manifestations of hypervigilance and hyperawareness. The results suggest that endogenous pool of galanin is involved into prevention of excessive CNS response to stressful stimuli typical of posttraumatic stress disorder.

  9. Integration of cognitive and personality-based conceptualization and treatment of psychological trauma.

    Science.gov (United States)

    Everly, George S; Lating, Jeffrey M

    2005-01-01

    In the wake of the numerous terrorist attacks and horrific natural disasters that have occurred beginning on September 11, 2001, there has been increased interest in the effects of trauma, including posttraumatic stress disorder (PTSD). The purpose of this article is to provide an overview of a synergistic multicomponent approach to therapy that incorporates the integrated use of cognitive and personality-guided approaches to conceptualizing and treating psychological trauma. With Millon's personality classification system serving as a foundation, a case example is provided along with an explanation of the therapeutic stages beginning with establishing the therapeutic alliance to decreasing hyperarousal to restoring assumptive worldviews.

  10. 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......, the result is, that more than 100 trauma scenario exist when the two dentitions are combined. Each of these trauma scenarios have a specific treatment demand and prospect for healing. With such a complexity in diagnose and treatment it is obvious that even experienced practitioners may have problems may have...... 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...

  11. Outcome after vascular trauma in a deployed military trauma system.

    Science.gov (United States)

    Stannard, A; Brown, K; Benson, C; Clasper, J; Midwinter, M; Tai, N R

    2011-02-01

    Military injuries to named blood vessels are complex limb- and life-threatening wounds that pose significant difficulties in prehospital and surgical management. The aim of this study was to provide a comprehensive description of the epidemiology, treatment and outcome of vascular injury among service personnel deployed on operations in Afghanistan and Iraq. Data from the British Joint Theatre Trauma Registry were combined with hospital records to review all cases of vascular trauma in deployed service personnel over a 5-year interval ending in January 2008. Of 1203 injured service personnel, 110 sustained injuries to named vessels; 66 of them died before any surgical intervention. All 25 patients who sustained an injury to a named vessel in the abdomen or thorax died; 24 did not survive to undergo surgery and one casualty in extremis underwent a thoracotomy, but died. Six of 17 patients with cervical vascular injuries survived to surgical intervention; two died after surgery. Of 76 patients with extremity vascular injuries, 37 survived to surgery with one postoperative death. Interventions on 38 limbs included 19 damage control procedures (15 primary amputations, 4 vessel ligations) and 19 definitive limb revascularization procedures (11 interposition vein grafts, 8 direct repairs), four of which failed necessitating three amputations. In operable patients with extremity injury, amputation or ligation is often required for damage control and preservation of life. Favourable limb salvage rates are achievable in casualties able to withstand revascularization. Despite marked progress in contemporary battlefield trauma care, torso vascular injury is usually not amenable to surgical intervention.

  12. How Trauma and Attachment Can Impact Neurodevelopment: Informing Our Understanding and Treatment of Sexual Behaviour Problems

    Science.gov (United States)

    Creeden, Kevin

    2009-01-01

    Over the last several years there has been a notable increase in neurological and neurodevelopmental research, with a keen interest in applying this research to our understanding of everyday human learning and behaviour. One aspect of this research has examined how the experience of trauma in childhood can affect neurodevelopment with implications…

  13. Compassion satisfaction, compassion fatigue, and burnout in a national sample of trauma treatment therapists.

    Science.gov (United States)

    Craig, C D; Sprang, G

    2010-05-01

    For behavioral health professionals working with traumatized clients, continuous and prolonged exposure to the stress of working with the myriad of trauma-related stressors experienced by their clients can lead to various responses including burnout, compassion fatigue, and compassion satisfaction. The present study investigates the impact of using evidence-based practices on compassion fatigue, burnout, and compassion satisfaction in a random, national sample of self-identified trauma specialists (N=532). The 30-item Professional Quality of Life Scale (Stamm, 2005) and the 19-item Trauma Practices Questionnaire (Craig & Sprang, 2009) were included in a survey to licensed social workers and psychologists from professional membership rosters. Age and years of experience proved to be powerful predictors of only two of the three criterion variables, with younger professionals reporting higher levels of burnout and more experienced providers endorsing higher levels of compassion satisfaction. The utilization of evidence-based practices predicted statistically significant decreases in compassion fatigue and burnout, and increases in compassion satisfaction. The utility of these findings in understanding the process of trauma transmission between therapist and client as well as directions for future research are discussed.

  14. Duration of antibiotic treatment in surgical infections of the abdomen. Blunt abdominal trauma.

    Science.gov (United States)

    Melcher, G A; Rüedi, T P

    1996-01-01

    Blunt abdominal trauma is associated with a low risk of injury to the microorganism-containing hollow viscera. Therefore, routine pre-operative administration of antibiotics is not necessary. Antibiotics are given intraoperatively, if laparotomy discloses transmural injury of a hollow organ and peritoneal contamination. If intervention is early (injuries should be treated with antibiotics for a maximum of 5 days.

  15. A novel brain trauma model in the mouse : effects of dexamethasone treatment

    NARCIS (Netherlands)

    Hortobágyi, Tibor; Hortobagyi, S; Gorlach, C; Harkany, T; Benbyo, Z; Gorogh, T; Nagel, W; Wahl, M

    2000-01-01

    We describe a novel methodological approach for inducing cold lesion in the mouse as a model of human cortical contusion trauma. To validate its reproducibility and reliability, dexamethasone (Dxm) was repeatedly applied to demonstrate possible antioedematous drug effects. Following tho induction of

  16. Brief Trauma and Mental Health Assessments for Female Offenders in Addiction Treatment

    Science.gov (United States)

    Rowan-Szal, Grace A.; Joe, George W.; Bartholomew, Norma G.; Pankow, Jennifer; Simpson, D. Dwayne

    2012-01-01

    Increasing numbers of women in prison raise concerns about gender-specific problems and needs severity. Female offenders report higher trauma as well as mental and medical health complications than males, but large inmate populations and limited resources create challenges in administering proper diagnostic screening and assessments. This study…

  17. A novel brain trauma model in the mouse : effects of dexamethasone treatment

    NARCIS (Netherlands)

    Hortobágyi, Tibor; Hortobagyi, S; Gorlach, C; Harkany, T; Benbyo, Z; Gorogh, T; Nagel, W; Wahl, M

    2000-01-01

    We describe a novel methodological approach for inducing cold lesion in the mouse as a model of human cortical contusion trauma. To validate its reproducibility and reliability, dexamethasone (Dxm) was repeatedly applied to demonstrate possible antioedematous drug effects. Following tho induction of

  18. Brief Trauma and Mental Health Assessments for Female Offenders in Addiction Treatment

    Science.gov (United States)

    Rowan-Szal, Grace A.; Joe, George W.; Bartholomew, Norma G.; Pankow, Jennifer; Simpson, D. Dwayne

    2012-01-01

    Increasing numbers of women in prison raise concerns about gender-specific problems and needs severity. Female offenders report higher trauma as well as mental and medical health complications than males, but large inmate populations and limited resources create challenges in administering proper diagnostic screening and assessments. This study…

  19. Trauma exposure and refugee status as predictors of mental health outcomes in treatment-seeking refugees

    NARCIS (Netherlands)

    Knipscheer, Jeroen W; Sleijpen, Marieke; Mooren, Trudy; Ter Heide, F Jackie June; van der Aa, Niels

    2015-01-01

    Aims and method This study aimed to identify predictors of symptom severity for post-traumatic stress disorder (PTSD) and depression in asylum seekers and refugees referred to a specialised mental health centre. Trauma exposure (number and domain of event), refugee status and severity of PTSD and de

  20. Analysis of Enterococcus faecalis in samples from Turkish patients with primary endodontic infections and failed endodontic treatment by real-time PCR SYBR green method

    Directory of Open Access Journals (Sweden)

    Selcuk M. Ozbek

    2009-10-01

    Full Text Available OBJECTIVE: The aims of this study were to investigate the presence of Enterococcus faecalis in primary endodontic infections and failed endodontic treatments using real-time PCR and to determine the statistical importance of the presence of E. faecalis in a Turkish population with endodontic infections. MATERIAL AND METHODS: E. faecalis was investigated from 79 microbial samples collected from patients who were treated at the Endodontic Clinic of the Dental School of Atatürk University (Erzurum, Turkey. Microbial samples were taken from 43 patients (Group 1 with failed endodontic treatments and 36 patients (Group 2 with chronic apical periodontitis (primary endodontic infections. DNA was extracted from the samples by using a QIAamp® DNA mini-kit and analyzed with real-time PCR SYBR Green. RESULTS: E. faecalis was detected in 41 out of 79 patients, suggesting that it exists in not less than 61% of all endodontic infections when the proportion test (z= -1.645, failed endodontic treatments than primary endodontic infections.

  1. Treatment of mice with sepsis following irradiation and trauma with antibiotics and synthetic trehalose dicorynomycolate (S-TDCM)

    Energy Technology Data Exchange (ETDEWEB)

    Madonna, G.S.; Ledney, G.D.; Moore, M.M.; Elliott, T.B.; Brook, I. (Armed Forces Radiobiology Research Institute, Bethesda, MD (USA))

    1991-03-01

    Compromise of antimicrobial defenses by irradiation can result in sepsis and death. Additional trauma can further predispose patients to infection and thus increase mortality. We recently showed that injection of synthetic trehalose dicorynomycolate (S-TDCM) significantly augments resistance to infection and increases survival of mice compromised either by whole-body irradiation with gamma radiation or equal mixtures of fission neutron and gamma radiation. In this study, C3H/HeN mice were given a lethal dose of gamma radiation (8.0 Gy) and an open wound (15% total body surface area (TBSA)) 1 hr later while anesthetized. Irradiated/wounded mice became more severely leukopenic and thrombocytopenic than mice exposed to radiation alone, and died from natural wound infection and sepsis within 7 days. S-TDCM given 1 hr postirradiation increased survival of mice exposed to radiation alone. However, this treatment did not increase survival of the irradiated/wounded mice. Systemic antibiotic therapy with gentamicin or ofloxacin for 10 days significantly increased survival time compared with untreated irradiated/wounded mice (p less than 0.01). Combination therapy with topical gentamicin cream and systemic oxacillin increased survival from 0% to 100%. Treatment with S-TDCM combined with the suboptimal treatment of topical and systemic gentamicin increased survival compared with antibiotic treatment alone. These studies demonstrate that post-trauma therapy with S-TDCM and antibiotics augments resistance to infection in immunocompromised mice. The data suggest that therapies which combine stimulation of nonspecific host defense mechanisms with antibiotics may increase survival of irradiated patients inflicted with accidental or surgical trauma.

  2. Epidemiological analysis of demographic characteristics and type of injuries in patients with multiple trauma with respect to conclusive treatment outcome

    Directory of Open Access Journals (Sweden)

    Zagorac Slaviša

    2008-01-01

    Full Text Available Introduction Multiple trauma is one of the leading causes of mortality and morbidity in the population of people under 45 years of age. The consequences of multiple trauma have huge epidemiological, social and economic significance. Objective The aim of the paper was to analyze the conclusive treatment outcome of multiply traumatized patients with respect to their sex, age, injury mechanism and type. METHOD This retrospective study included 100 patients with multiple injuries (ISS>16 treated in the Emergency Room of the Clinical Centre of Serbia in the course of 2004. Clinical, X-ray, laboratory and numerical presentation methods - scores (ISS and GCS were used to show the injury severity. Results Most of the injured were males (80%, and the average age was 40±20 (5-83. Out of the total number of patients who died, 23 (82% were males, and 5 (18% were females. The average age of the patients with fatal outcomes was 48±21 (8-86. Traffic accidents were the leading cause of injury (59%. The median GCS was 10±3 (3-15. The average ISS was 30 (20-66 in the surviving patients, and 53 (27-77 in those who died. Conclusion With respect to sex, in most cases multiple trauma affects males (p<0.01, with the average age of about 40. With respect to injury mechanism, the main cause of the occurrence of multiple trauma is traffic accidents (p<0.01. There is a statistically significant difference in the values of GCS and ISS relative to the definitive outcome (p<0.01. Statistical data processing indicated that there was a statistically significant correlation between mortality and type of injury in a given organic system (p<0.01, but that there was no statistically significant correlation between mortality and age. .

  3. Hyperbaric oxygen therapy for acute acoustic trauma.

    Science.gov (United States)

    Pilgramm, M; Schumann, K

    1985-01-01

    We conducted a study on the effect of hyperbaric oxygen therapy on 122 soldiers following acute acoustic trauma. The patients included in this study, after the effect of spontaneous recovery had largely been excluded, were randomly allocated to four treatment groups. The results of our studies show that hyperbaric oxygen therapy shortens the course of healing with respect to high-pitch perception dysacusis. The results of treatment after an observation period of 6 weeks is also more favorable when patients are treated with oxygen when compared to patients given infusions or vasoactive substances. Similarly, the use of hyperbaric oxygen therapy also reduces the frequency of relapse following discharge from hospital. In contrast, the vasoactive substance chosen in our studies (betahistine) failed to have a favorable effect on the course of healing. Our study has also shown that no method can compare with hyperbaric therapy in eliminating tinnitus following acoustic trauma.

  4. Current advances in the diagnosis and treatment for abdominal trauma%腹部创伤的诊治进展

    Institute of Scientific and Technical Information of China (English)

    田伏洲; 程龙

    2013-01-01

    Abdominal trauma is one of the most commonest events in warfare and other contingencies . There are many examining means for the diagnosis of abdominal trauma with the development of new advanced e -quipment.However,fast examination and diagnosis is critical for saving the lives of patients .During the last two decades ,we have made great progress in the appropriate application of preserved therapy ,minimally invasive therapy and damage control surgery in the treatment for abdominal trauma .These treatments are based on the conception that optimal treatment effectiveness should be obtained with minimal secondary attack .%腹部创伤是战时及意外事故中最常发生的事件之一。尽管随着新设备、新技术的开发应用,腹部创伤的检查手段增多,但利用体格检查和简单设备实现快速检诊仍是影响伤者预后甚至挽救生命的关键。在过去20年,非手术治疗、微创治疗、损伤控制外科技术在腹部创伤中的合理应用取得了重要进展。但无论是非手术治疗,还是微创治疗,还是损伤控制外科技术,其宗旨就是在保证伤者血液动力学稳定的基础上,以最小的二次创伤获得最佳的治疗效果。

  5. Trauma-Focused CBT for Youth Who Experience Ongoing Traumas

    Science.gov (United States)

    Cohen, Judith A.; Mannarino, Anthony P.; Murray, Laura K.

    2011-01-01

    Many youth experience ongoing trauma exposure, such as domestic or community violence. Clinicians often ask whether evidence-based treatments containing exposure components to reduce learned fear responses to historical trauma are appropriate for these youth. Essentially the question is, if youth are desensitized to their trauma experiences, will…

  6. Trauma-Focused CBT for Youth Who Experience Ongoing Traumas

    Science.gov (United States)

    Cohen, Judith A.; Mannarino, Anthony P.; Murray, Laura K.

    2011-01-01

    Many youth experience ongoing trauma exposure, such as domestic or community violence. Clinicians often ask whether evidence-based treatments containing exposure components to reduce learned fear responses to historical trauma are appropriate for these youth. Essentially the question is, if youth are desensitized to their trauma experiences, will…

  7. [Bisegmental anterior interbody spondylodesis, using rigid plates, in surgical treatment of cervical vertebral column traumas and diseases].

    Science.gov (United States)

    Barysh, A E; Kozyrev, S A

    2015-02-01

    Results of surgical treatment of 34 patients, suffering cervical vertebral column traumas and diseases, are analyzed. In all the patients bisegmental anterior interbody spondylodesis was conducted, using cervical rigid plates and vertical cylindrical net implants. The existing and newly obtained information about changes in the radiological indices dynamics while the method application by its authors is presented. The interbody synostosis was achieved in 82.4% patients in 1 yr after the operation. The complications rate while the implants application have constituted 23.3%, and the total rate of complications--29.1%.

  8. Results of hemihypoglossal-facial nerve anastomosis in the treatment of facial nerve paralysis after failed stereotactic radiosurgery for vestibular schwannoma.

    Science.gov (United States)

    Dziedzic, Tomasz A; Kunert, Przemysław; Marchel, Andrzej

    2017-04-01

    Vestibular schwannoma treatment with stereotactic radiosurgery (SRS) carries a risk of facial nerve (CNVII) palsy that is lower than that with microneurosurgery. The results of hemihypoglossal-facial nerve anastomosis (HHFA) have not been described yet in CNVII palsy after failed stereotactic radiosurgery (SRS). Here we report a case series of the first four consecutive patients (three women; average age 58.5, age range: 46-74), who underwent HHFA due to failed SRS. All patients were admitted because of progressive peripheral facial nerve palsy. Three patients received retrosigmoid craniotomy due to tumor enlargement that resulted in facial nerve paralysis. All patients achieved satisfactory (House-Brackmann grade III) CNVII regeneration. No or minimal tongue atrophy occurred on the side of the anastomosis. Patients reported no problems with phonation or swallowing, except for the patients with preexisting lower cranial nerve deficits. HHFA effectively treats facial palsy after failed SRS with minimal risk of tongue atrophy and minimal morbidity. The results of the treatment are comparable to those achieved with patients without previous SRS.

  9. Redo sternotomy for extra-anatomical correction of aortic coarctation and mitral repair in an adult after failed endovascular treatment.

    Science.gov (United States)

    Ozker, E; Saritas, B; Vuran, C; Yoruker, U; Kocyigit, O I; Turkoz, R

    2011-07-01

    Recently, extra-anatomical bypass surgery has been widely used in complicated adult aortic coarctation cases with concomitant intracardiac repair. Stent implantation has been widely used for primary aortic coarctation as well. The procedure has been shown to be effective with long term follow ups. However, failed stent implantations like stent fracture and dislodgement may complicate the clinical status and subsequent surgical procedure. Extra-anatomic bypass can provide effective results and lower morbidity in cases with concomitant intracardiac problems and stent failure. Here we present an adult aortic coarctation patient who had undergone a Bentall operation and two unsuccessful stent implantations for recurrent aortic coarctation. The patient then got an extra-anatomic bypass for aortic coarctation and concomitant mitral valve commissurotomy through median sternotomy.

  10. Prazosin treatment of trauma nightmares and sleep disturbance in soldiers deployed in Iraq.

    Science.gov (United States)

    Calohan, Jess; Peterson, Kris; Peskind, Elaine R; Raskind, Murray A

    2010-10-01

    Trauma nightmares and sleep disturbance impair combat soldiers' functioning. The alpha-1 adrenoreceptor antagonist prazosin has been demonstrated effective for these symptoms in Vietnam veterans. Thirteen soldiers seeking relief from distressing trauma nightmares impairing military function in northern Iraq in 2006 received prazosin alone or in combination with other psychotropics. Mean prazosin dose was 4.1 (SD = 2.2) mg before bed. Six soldiers improved markedly and 3 moderately on the Clinical Global Impression of Change Ratings of distressing dreams decreased from an average of 7.0 (SD = 0.7) to 2.9 (SD = 3.0, p < .001) and those of disturbed sleep from 6.7 (SD = 0.9) to 3.7 (SD = 2.4, p < .001). Prazosin appears effective and well tolerated in the desert warfare environment.

  11. Can countertransference at the early stage of trauma care predict patient dropout of psychiatric treatment? Contratransferência no atendimento inicial de vítimas de trauma pode predizer o abandono do tratamento psiquiátrico?

    Directory of Open Access Journals (Sweden)

    Érico de Moura Silveira Júnior

    2011-12-01

    Full Text Available OBJECTIVES: To investigate the association between feelings of countertransference (CT at the early psychiatric care provided to trauma victims and treatment outcome. METHOD: The Assessment of Countertransference Scale was used to access CT after the first medical appointment. Fifty psychiatric residents cared for 131 trauma victims of whom 83% were women, aged 15 to 64 years. Patients had been consecutively selected over 4 years. Were evaluated the clinical and demographic characteristics of patients and the correlation with the therapists' CT feelings. Patients were followed-up during treatment to verify the association between initial CT and treatment outcome, defined as discharge and dropout. RESULTS: The median number of appointments was 5 [4; 8], absences 1 [0; 1], and the dropout rate was 34.4%. Both groups, namely the discharge group and the dropout group, shared similar clinical and demographic characteristics. A multivariate analysis identified that patients with a reported history of childhood trauma were 61% less likely to dropout from treatment than patients with no reported history of childhood trauma (OR = 0.39, p = 0.039, CI95% 0.16-0.95. There was no association between initial CT and treatment outcome. CONCLUSIONS: In this sample, CT in the initial care of trauma victims was not associated with treatment outcome. Further studies should assess changes in CT during treatment, and how such changes impact treatment outcome.OBJETIVOS: Investigar a associação entre contratransferência (CT no atendimento psiquiátrico inicial de vítimas de trauma e desfechos do tratamento. MÉTODO: A contratransferência de 50 terapeutas foi avaliada através da Assessment of Countertransference Scale após o primeiro atendimento de 131 vítimas de trauma (83% mulheres, idade entre 15 e 64 anos selecionadas consecutivamente durante 4 anos. Foram avaliadas características demográficas e clínicas dos pacientes, e investigaram-se seus correlatos

  12. Treatment and restoration of adult dentoalveolar trauma: A clinical case report

    OpenAIRE

    2016-01-01

    Adult dentoalveolar trauma most often occurs in the context of sports activities and traffic accidents. Coronal fractures are the most common type of lesion, followed by tooth luxation. We present the case of a 25-year-old woman who suffered alveolar bone damage and coronal fractures of the upper incisors, with extrusive luxation of the right central incisor, as the result of a fall. On the first visit, manual reduction of the buccal plate was carried out under local anesthesia, with repositi...

  13. [The role of psychological debriefing in the treatment of victims of trauma].

    Science.gov (United States)

    Devilly, Grant J; Wright, Renée; Gist, Richard

    2003-06-01

    The application of psychological debriefing has become an expected and widespread intervention following exposure to trauma. This article assesses the wisdom of such an approach and reports upon expert consensus regarding its use. Meta-analytic and narrative reviews are summarised and areas of agreement and disagreement are outlined. In sum, it was concluded that the majority of people do not become traumatised from stressful events; that generic psychological debriefing, when applied to individuals, appears to have little impact on functioning; that a specific form of debriefing called Critical Incident Stress Debriefing holds the possibility of noxious effects for some participants and that those most deleteriously affected by debriefing appear to be those most distressed by the initial trauma; that there is no randomised controlled trial evidence to support the validity of group debriefing approaches; and that early intervention using Cognitive Behavioural techniques for those with clinically significant presentations appears the most promising approach. A generic set of guidelines for intervention following trauma is provided.

  14. Limitation of life-sustaining treatment in severe trauma in the elderly after admission to an intensive care unit.

    Science.gov (United States)

    Peñasco, Y; González-Castro, A; Rodríguez Borregán, J C; Ortiz-Lasa, M; Jáuregui Solórzano, R; Sánchez Arguiano, M J; Escudero Acha, P

    2017-05-18

    To analyze the factors associated to limitation of life-sustaining treatment (LLST) measures in elderly patients admitted to an intensive care unit (ICU) due to trauma. A retrospective, descriptive, observational study was carried out. ICU. A total of 149 patients aged 65 years or older admitted to the ICU due to trauma. Hospital mortality, the decision to limit life-sustaining treatment and the factors associated to these measures were analyzed. None. The mean patient age was 76.3±6.36 years. The average APACHE II and ISS scores were 15.9±7.4 and 19.6±11.4 points, respectively. LLST were used in 37 patients (24.8%). Factors associated to the use of these measures were patient age (OR 1.16; 95% CI 1.08 to 1.25], APACHE II score (OR 1.11; 95% CI 1.05-1.67), ISS score (OR 1.03; 95% CI 1.01 to 1.06), admission due to neurological impairment (OR 19.17; 95% CI 2.33 to 157.83) and traumatic brain injury (OR 2.89; 95% CI 1.05 to 7.96). LLST is frequently established in elderly patients admitted to the ICU due to trauma, and is associated to hospital mortality. Factors associated with the use of these measures are patient age, higher APACHE II and ISS scores, admission due to neurological impairment, and the presence of head injuries. Copyright © 2017 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  15. Trauma renal Renal trauma

    Directory of Open Access Journals (Sweden)

    Gerson Alves Pereira Júnior

    1999-02-01

    Full Text Available Apresentamos uma revisão sobre trauma renal, com ênfase na avaliação radiológica, particularmente com o uso da tomografia computadorizada, que tem se tornado o exame de eleição, ao invés da urografia excretora e arteriografia. O sucesso no tratamento conservador dos pacientes com trauma renal depende de um acurado estadiamento da extensão da lesão, classificado de acordo com a Organ Injury Scaling do Colégio Americano de Cirurgiões. O tratamento conservador não-operatório é seguro e consiste de observação contínua, repouso no leito, hidratação endovenosa adequada e antibioti- coterapia profilática, evitando-se uma exploração cirúrgica desnecessária e possível perda renal. As indicações para exploração cirúrgica imediata são abdome agudo, rápida queda do hematócrito ou lesões associadas determinadas na avaliação radiológica. Quando indicada, a exploração renal após controle vascular prévio é segura, permitindo cuidadosa inspeção do rim e sua reconstrução com sucesso, reduzindo a probabilidade de nefrectomia.We present a revision of the renal trauma with emphasis in the radiographic evaluation, particularly CT scan that it has largely replaced the excretory urogram and arteriogram in the diagnostic worh-up and management of the patient with renal trauma. The successful management of renal injuries depends upon the accurate assessment of their extent in agreement with Organ Injury Scaling classification. The conservative therapy managed by careful continuous observation, bed rest, appropriate fluid ressuscitation and prophylactic antibiotic coverage after radiographic staging for severely injured kidneys can yield favorable results and save patients from unnecessary exploration and possible renal loss. The indications for immediate exploratory laparotomy were acute abdomen, rapidly dropping hematocrit or associated injuries as determinated from radiologic evaluation. When indicated, renal exploration

  16. Acceptance and commitment therapy for psychosis and trauma: Improvement in psychiatric symptoms, emotion regulation, and treatment compliance following a brief group intervention.

    Science.gov (United States)

    Spidel, Alicia; Lecomte, Tania; Kealy, David; Daigneault, Isabelle

    2017-10-04

    Acceptance and Commitment Therapy (ACT) has shown effectiveness for individuals with psychosis and individuals with a history of childhood trauma, but has not been investigated with people with psychosis who also have a history of childhood trauma. This study aims at determining the efficacy of a mindfulness-based ACT with this clientele in diminishing psychiatric symptoms, trauma-related symptoms, as well as in improving treatment adherence. Fifty participants meeting our inclusion criteria were recruited and randomized to take part in either 10 sessions of ACT group, or Treatment as Usual (TAU). Using RCT it was found that symptom severity, for both overall symptoms (BPRS) and anxiety (GAD), decreased over the course of the treatment, and participants' ability to regulate their emotional reactions (i.e., accept them) increased. The study also found that treatment engagement increased with regards to help-seeking for those in the ACT group, compared with the TAU controls. Acceptance and Commitment Therapy offered in a group appears a promising treatment for those with psychosis and history of trauma. To understand the benefits of ACT with those who suffer from psychosis and a history of trauma. To further the understanding of the effectiveness of ACT. © 2017 The British Psychological Society.

  17. The clinical efficacy and prognosis of hemisphere skull bone flap decompression and mild hypothermia treatment for severe craniocerebral trauma

    Directory of Open Access Journals (Sweden)

    YANG Hua-tang

    2013-10-01

    Full Text Available In this study, 1626 patients with severe craniocerebral trauma were assessed by Glasgow Coma Scale (GCS, 886 patients of 3-5 score and 740 of 6-8 score. Patients were divided into 2 groups. Ninety hundred and eleven patients (496 of 3-5 score and 415 of 6-8 score underwent hemisphere calvarial bone flap decompression with auxiliary mild hypothermia (experiment group, and 715 patients (390 of 3-5 score and 325 of 6-8 score underwent traditional frontal, temporal, parietal large traumatic craniotomy (control group. After operation the treatment of 2 groups was basically the same. Compared with control group, the intracranial pressure of experiment group on the 1st, 3rd, 5th and 7th days after surgery decreased significantly (P < 0.05, for all; the consciousness recovery time was significantly shorter (P < 0.05, for all; the prognosis after 3 months was better (P < 0.05, for all. Hemisphere calvarial bone flap decompression with auxiliary mild hypothermia treatment could significantly reduce the morbidity and mortality, and improve the quality of life and prognosis of patients with severe craniocerebral trauma.

  18. Mesenchymal stem cell-based treatments for stroke, neural trauma, and heat stroke.

    Science.gov (United States)

    Hsuan, Yogi Chang-Yo; Lin, Cheng-Hsien; Chang, Ching-Ping; Lin, Mao-Tsun

    2016-10-01

    Mesenchymal stem cell (MSC) transplantation has been reported to improve neurological function following neural injury. Many physiological and molecular mechanisms involving MSC therapy-related neuroprotection have been identified. A review is presented of articles that pertain to MSC therapy and diverse brain injuries including stroke, neural trauma, and heat stroke, which were identified using an electronic search (e.g., PubMed), emphasize mechanisms of MSC therapy-related neuroprotection. We aim to discuss neuroprotective mechanisms that underlie the beneficial effects of MSCs in treating stroke, neural trauma, and heatstroke. MSC therapy is promising as a means of augmenting brain repair. Cell incorporation into the injured tissue is not a prerequisite for the beneficial effects exerted by MSCs. Paracrine signaling is believed to be the most important mediator of MSC therapy in brain injury. The multiple mechanisms of action of MSCs include enhanced angiogenesis and neurogenesis, immunomodulation, and anti-inflammatory effects. Microglia are the first source of the inflammatory cascade during brain injury. Cytokines, including tumor necrosis factor-α, interleukin-1β, and interleukin-6, are significantly produced by microglia in the brain after experimental brain injury. The proinflammatory M1 phenotype of microglia is associated with tissue destruction, whereas the anti-inflammatory M2 phenotype of microglia facilitates repair and regeneration. MSC therapy may improve outcomes of ischemic stroke, neural trauma, and heatstroke by inhibiting the activity of M1 phenotype of microglia but augmenting the activity of M2 phenotype of microglia. This review offers a testable platform for targeting microglial-mediated cytokines in clinical trials based upon the rational design of MSC therapy in the future. MSCs that are derived from the placenta provide a great choice for stem cell therapy. Although targeting the microglial activation is an important approach to

  19. Transforming Trauma: The Relational Unconscious and "Chemistry" in the Treatment of a Paraplegic Patient.

    Science.gov (United States)

    Steinberger, Claire Beth

    2014-06-01

    Therapeutic action with a traumatized paraplegic patient highlights the evocative-and transformative-influence of the relational unconscious. The patient's triumphant resolution suggests that formative bipersonal dynamics (including transference, countertransference, and mutual projective identifications) create an ongoing intersubjective enactment and relational chemistry pivotal to psychic shift. A broad systems perspective highlights contextual communication and the interweaving of the analyst's etiological contributions and subjective experience of trauma. Ultimately, an unconscious, co-created dynamic challenges traumatic fixations, supporting a reintegration of narcissistic, gender, and erotic representations and ego capacities. An eclectic perspective that illuminates the analyst's role-receptivity encompasses classical, object relations, relational, systems, and self psychological paradigms.

  20. Sequelae of closed craniocerebral trauma and the efficacy of piracetam in its treatment in adolescents.

    Science.gov (United States)

    Zavadenko, N N; Guzilova, L S

    2009-05-01

    The efficacy of piracetam in treating the sequelae of moderate and severe closed craniocerebral trauma (CCT) in adolescents was evaluated in studies of 42 patients aged 12-18 years who had suffered CCT 1.5-5 years prior to the study. Adolescents of the experimental group (20 individuals) received piracetam (Nootropil) at doses of 40-50 mg/kg (daily daily 1600-2400 mg) for one month; patients of group 2 (22 individuals) served as controls. Piracetam was found to have positive therapeutic effects on impairments to higher mental (memory, attention, executive) and motor (coordination) functions and on measures of the speeds of cognitive and motor operations.

  1. Exploratory Network Meta Regression Analysis of Stroke Prevention in Atrial Fibrillation Fails to Identify Any Interactions with Treatment Effect

    Science.gov (United States)

    Batson, Sarah; Sutton, Alex; Abrams, Keith

    2016-01-01

    Background Patients with atrial fibrillation are at a greater risk of stroke and therefore the main goal for treatment of patients with atrial fibrillation is to prevent stroke from occurring. There are a number of different stroke prevention treatments available to include warfarin and novel oral anticoagulants. Previous network meta-analyses of novel oral anticoagulants for stroke prevention in atrial fibrillation acknowledge the limitation of heterogeneity across the included trials but have not explored the impact of potentially important treatment modifying covariates. Objectives To explore potentially important treatment modifying covariates using network meta-regression analyses for stroke prevention in atrial fibrillation. Methods We performed a network meta-analysis for the outcome of ischaemic stroke and conducted an exploratory regression analysis considering potentially important treatment modifying covariates. These covariates included the proportion of patients with a previous stroke, proportion of males, mean age, the duration of study follow-up and the patients underlying risk of ischaemic stroke. Results None of the covariates explored impacted relative treatment effects relative to placebo. Notably, the exploration of ‘study follow-up’ as a covariate supported the assumption that difference in trial durations is unimportant in this indication despite the variation across trials in the network. Conclusion This study is limited by the quantity of data available. Further investigation is warranted, and, as justifying further trials may be difficult, it would be desirable to obtain individual patient level data (IPD) to facilitate an effort to relate treatment effects to IPD covariates in order to investigate heterogeneity. Observational data could also be examined to establish if there are potential trends elsewhere. The approach and methods presented have potentially wide applications within any indication as to highlight the potential benefit

  2. Trauma: the seductive hypothesis.

    Science.gov (United States)

    Reisner, Steven

    2003-01-01

    In much of contemporary culture, "trauma" signifies not so much terrible experience as a particular context for understanding and responding to a terrible experience. In therapy, in the media, and in international interventions, the traumatized are seen not simply as people who suffer and so are deserving of concern and aid; they are seen also as people who suffer for us, who are given special dispensation. They are treated with awe if they tell a certain kind of trauma story, and are ignored or vilified if they tell another. Trauma has become not simply a story of pain and its treatment, but a host of sub-stories involving the commodification of altruism, the justification of violence and revenge, the entry point into "true experience," and the place where voyeurism and witnessing intersect. Trauma is today the stuff not only of suffering but of fantasy. Historically, trauma theory and treatment have shown a tension, exemplified in the writings of Freud and Janet, between those who view trauma as formative and those who view it as exceptional. The latter view, that trauma confers exceptional status deserving of special privilege, has gained ground in recent years and has helped to shape the way charitable dollars are distributed, how the traumatized are presented in the media, how governments justify and carry out international responses to trauma, and how therapists attend to their traumatized patients. This response to trauma reflects an underlying, unarticulated belief system derived from narcissism; indeed, trauma has increasingly become the venue, in society and in treatment, where narcissism is permitted to prevail.

  3. Ear trauma.

    Science.gov (United States)

    Eagles, Kylee; Fralich, Laura; Stevenson, J Herbert

    2013-04-01

    Understanding basic ear anatomy and function allows an examiner to quickly and accurately identify at-risk structures in patients with head and ear trauma. External ear trauma (ie, hematoma or laceration) should be promptly treated with appropriate injury-specific techniques. Tympanic membrane injuries have multiple mechanisms and can often be conservatively treated. Temporal bone fractures are a common cause of ear trauma and can be life threatening. Facial nerve injuries and hearing loss can occur in ear trauma.

  4. Zinc Oxide Eugenol-Formocresol Root Canal Treatment Fails to Treat a Deciduous Tooth with Dentoalveolar Abcess

    Directory of Open Access Journals (Sweden)

    Arifa Pediarahma

    2015-05-01

    Full Text Available Irreversible pulp infection can lead to dentoalveolar abscess. Root canal treatment in deciduous teeth is indicated in irreversible pulp infection to maintain children’s health and deciduous teeth until its exfoliation period. Success rate of endodontic treatment in deciduous teeth can be enhanced by using antimicrobial root canal filling material. Combination of ZOE-formocresol as root canal filling material has a superior antimicrobial property. Unfortunately, based on some research it is also toxic to the tissue. This case report will discuss about failure of root canal treatment in deciduous tooth with dentoalveolar abscess using combination of ZOE-formocresol as obturating material. There are some factors that possibly cause the failure: complexity of deciduous molar anatomy, the choice of root canal filling material, application of root canal filling material that is not adequate, or an extend pathological condition.DOI:10.14693/jdi.v21i3.230

  5. GnRH treatment at artificial insemination in beef cattle fails to increase plasma progesterone concentrations or pregnancy rates.

    Science.gov (United States)

    Perry, G A; Perry, B L

    2009-03-15

    Treatment with GnRH at the onset of standing estrus increased pregnancy percentages and circulating concentrations of progesterone in repeat breeder dairy cows. The objective of this study was to determine the effect of treatment with GnRH at AI on concentrations of progesterone and conception rates in beef cattle that exhibited estrus. Two hundred ninety-three heifers at four locations were synchronized with the Select Synch plus CIDR protocol (given GnRH and a CIDR was placed into the vagina, and 7 d later, given PGF(2alpha) and CIDR removed; n=253) or the 14-19 melengestrol acetate (MGA) protocol (MGA fed at 0.5mg/head/d for 14 d, with PGF(2alpha) 19 d after MGA withdrawal n=40) and AI was done after detection of estrus. At Location 1, blood samples were collected on Day 2, 4, 6, 10, 15, and 18 after AI (Day 0=AI). Two hundred and fifty postpartum cows at two locations were synchronized with the Select Synch plus CIDR protocol, and AI was performed after detection of estrus. At AI, cattle were alternately assigned to one of two treatments: (1) treatment with GnRH (100microg) at AI (n=127 heifers and n=108 cows); or (2) non-treated control (n=120 heifers and n=119 cows). Concentrations of progesterone tended to be greater in control heifers compared to GnRH-treated heifers on Days 6 (P=0.08), 10 (P=0.07), and 15 (P=0.11). Overall conception rates were 68% and 66% for GnRH treated and control, respectively, and were not different between treatments (P=0.72). In summary, treatment with GnRH at time of AI had no influence on conception rates in cattle that had exhibited estrus.

  6. A Treatment-Refractory Case of Social Anxiety Disorder: Lessons Learned from a Failed Course of Cognitive-Behavioral Therapy

    Science.gov (United States)

    Brozovich, Faith A.; Heimberg, Richard G.

    2011-01-01

    Over the past 25 years researchers have made enormous strides in the implementation of cognitive-behavioral therapy (CBT) for social anxiety disorder (SAD), although considerable work remains to be done. The present paper discusses a treatment refractory case seen in our clinic. The young man presented numerous interrelated obstacles, such as low…

  7. A Treatment-Refractory Case of Social Anxiety Disorder: Lessons Learned from a Failed Course of Cognitive-Behavioral Therapy

    Science.gov (United States)

    Brozovich, Faith A.; Heimberg, Richard G.

    2011-01-01

    Over the past 25 years researchers have made enormous strides in the implementation of cognitive-behavioral therapy (CBT) for social anxiety disorder (SAD), although considerable work remains to be done. The present paper discusses a treatment refractory case seen in our clinic. The young man presented numerous interrelated obstacles, such as low…

  8. Short- and long-term subjective medical treatment outcome of trauma surgery patients: the importance of physician empathy

    Directory of Open Access Journals (Sweden)

    Steinhausen S

    2014-09-01

    Full Text Available Simone Steinhausen,1 Oliver Ommen,2 Sunya-Lee Antoine,1 Thorsten Koehler,3 Holger Pfaff,4 Edmund Neugebauer11Institute for Research in Operative Medicine (IFOM, Witten/Herdecke University, Campus Cologne-Merheim, Germany; 2Federal Centre for Health Education (BZgA, Cologne, Germany; 3Institute for Applied Social Sciences (infas, Bonn, Germany; 4Institute for Medical Sociology, Health Services Research and Rehabilitation Science (IMVR, Faculty of Human Science and Faculty of Medicine, University of Cologne, Germany Purpose: To investigate accident casualties’ long-term subjective evaluation of treatment outcome 6 weeks and 12 months after discharge and its relation to the experienced surgeon’s empathy during hospital treatment after trauma in consideration of patient-, injury-, and health-related factors. The long-term results are compared to the 6-week follow-up outcomes.Patients and methods: Two hundred and seventeen surgery patients were surveyed at 6 weeks, and 206 patients at 12 months after discharge from the trauma surgical general ward. The subjective evaluation of medical treatment outcome was measured 6 weeks and 12 months after discharge with the respective scale from the Cologne Patient Questionnaire. Physician Empathy was assessed with the Consultation and Relational Empathy Measure. The correlation between physician empathy and control variables with the subjective evaluation of medical treatment outcome 12 months after discharge was identified by means of logistic regression analysis under control of sociodemographic and injury-related factors.Results: One hundred and thirty-six patients were included within the logistic regression analysis at the 12-month follow-up. Compared to the 6-week follow-up, the level of subjective evaluation of medical treatment outcome was slightly lower and the association with physician empathy was weaker. Compared to patients who rated the empathy of their surgeon lower than 31 points, patients

  9. Vicarious trauma and first responders: a case study utilizing eye movement desensitization and reprocessing (EMDR) as the primary treatment modality.

    Science.gov (United States)

    Keenan, Paul; Royle, Liz

    2007-01-01

    Traumatic events can occur and adversely affect people during their lifetime. Natural disasters such as the earthquake in Pakistan in 2005 or the Tsunami in Asia in 2004, terrorist atrocities around the world, or personal events such as physical or sexual assault, can result in psychological difficulties for those people directly affected by these events. The diagnostic term Posttraumatic Stress Disorder (PTSD; Diagnostic and Statistical Manual of Mental Disorders, 4th edition, DSM IV 1994) is generally used to explain the often-severe psychological sequalae (van der Kolk, 1996; Servan-Schreiber 2004; Shapiro, 1995) that people may exhibit when directly affected by trauma. However, what of those people not directly involved in the trauma, but those who have borne witness to it, either by listening to the stories of survivors, or in the case of the helping professionals (such as police officers, nurses, doctors, psychotherapists, fire-fighters), actively working with survivors in psychological distress? This paper examines the potential psychological consequences for those in helping professions who are working with traumatized clients. This paper then focuses on a specific treatment intervention, EMDR, utilizing a case study by way of explanation.

  10. Comparison of trauma extent between transurethral plasmakinetic resection of the prostate and holmium laser enucleation treatment of BPH

    Institute of Scientific and Technical Information of China (English)

    Ying-Shu Zhen

    2016-01-01

    Objective:To study the trauma extent of transurethral plasmakinetic resection of the prostate and holmium laser enucleation treatment of BPH. Methods:A total of 134 cases of patients with benign prostatic hyperplasia were selected for study and randomly divided into PKRP group who received transurethral plasmakinetic resection of the prostate and HoLEP group who received transurethral holmium laser enucleation of the prostate, and serum prostate-specific antigen, cortin and medulla hormone as well as thyroid hormone content were detected. Results:1 d after operation, serum t-PSA and f-PSA content of both groups were higher than those before operation and serum t-PSA and f-PSA content of HoLEP group were lower than those of PKRP group, serum ACTH, COR, FC, CBG, NE, E and rT3 content of HoLEP group were significantly lower than those of PKRP group, FT3, TT3, FT4 and TT4 content were significantly higher than those of PKRP group, and TSH content was without significant difference;6 months after operation, serum t-PSA and f-PSA content of both groups were lower than those before operation and serum t-PSA and f-PSA content of HoLEP group were not different from those of PKRP group. Conclusion:Both transurethral plasmakinetic resection of the prostate and holmium laser enucleation can effectively remove hyperplastic prostate tissue, and the surgical trauma of HoLEP is less.

  11. Apyrase treatment of myocardial infarction according to a clinically applicable protocol fails to reduce myocardial injury in a porcine model

    Directory of Open Access Journals (Sweden)

    Otto Andreas

    2010-01-01

    Full Text Available Abstract Background Ectonucleotidase dependent adenosine generation has been implicated in preconditioning related cardioprotection against ischemia-reperfusion injury, and treatment with a soluble ectonucleotidase has been shown to reduce myocardial infarct size (IS when applied prior to induction of ischemia. However, ectonucleotidase treatment according to a clinically applicable protocol, with administration only after induction of ischemia, has not previously been evaluated. We therefore investigated if treatment with the ectonucleotidase apyrase, according to a clinically applicable protocol, would reduce IS and microvascular obstruction (MO in a large animal model. Methods A percutaneous coronary intervention balloon was inflated in the left anterior descending artery for 40 min, in 16 anesthetized pigs (40-50 kg. The pigs were randomized to 40 min of 1 ml/min intracoronary infusion of apyrase (10 U/ml, n = 8 or saline (0.9 mg/ml, n = 8, twenty minutes after balloon inflation. Area at risk (AAR was evaluated by ex vivo SPECT. IS and MO were evaluated by ex vivo MRI. Results No differences were observed between the apyrase group and saline group with respect to IS/AAR (75.7 ± 4.2% vs 69.4 ± 5.0%, p = NS or MO (10.7 ± 4.8% vs 11.4 ± 4.8%, p = NS, but apyrase prolonged the post-ischemic reactive hyperemia. Conclusion Apyrase treatment according to a clinically applicable protocol, with administration of apyrase after induction of ischemia, does not reduce myocardial infarct size or microvascular obstruction.

  12. Is reverse total shoulder arthroplasty a feasible treatment option for failed shoulder arthroplasty? A retrospective study of 44 cases with special regards to stemless and stemmed primary implants.

    Science.gov (United States)

    Holschen, M; Franetzki, B; Witt, K-A; Liem, D; Steinbeck, J

    2017-08-01

    Is reverse total shoulder arthroplasty a feasible treatment option for failed shoulder arthroplasty? A retrospective study of 44 cases with special regards to stemless and stemmed primary implants. Due to humeral or glenoid bone-loss and rotator cuff insufficiency reverse total shoulder arthroplasty often means the only remaining treatment option in revision shoulder arthroplasty. This study investigates the clinical outcome of patients treated with a reverse total shoulder in revision cases with special regard to stemless and stemmed primary implants. From 2010 to 2012 60 failed shoulder arthroplasties were converted to reverse total shoulder arthroplasty. Forty-four patients were available for follow-up after a mean of 24 months. Patients were assessed with X-rays, Constant- and ASES Score and a questionnaire about their subjective satisfaction. The total number of observed complications was seven (16%). Ninety-eight percent of the patients were satisfied with their clinical result. Patients achieved a mean normalized constant score of 70.2% and a mean ASES Score of 65.3. Patients with stemless primary implants achieved a higher normalized constant score than patients with stemmed primary implants (82 vs. 61.8%; p = 0009). Reverse total shoulder arthroplasty provides satisfactory clinical results and a high patient satisfaction in revision shoulder arthroplasty. The complication rate needs to be considered and discussed with the patient prior to surgery. Presence or absence of a stem of revised shoulder arthroplasties interferes with the outcome. LEVEL OF EVIDENCE IV: (Retrospective study).

  13. Results of psychodynamically oriented trauma-focused inpatient treatment for women with complex posttraumatic stress disorder (PTSD) and borderline personality disorder (BPD).

    Science.gov (United States)

    Sachsse, Ulrich; Vogel, Christina; Leichsenring, Falk

    2006-01-01

    In a naturalistic outcome study, the authors evaluated the results of a specific psychodynamically oriented trauma-focused inpatient treatment for women with complex posttraumatic stress disorder and concomitant borderline personality disorder, self-mutilating behavior, and depression. At admission, the frequency of self-mutilating behavior and the amount of inpatient treatment (an average of 68 days annually) of the sample was high, characterizing this patient group as "previously therapy resistant." Treatment outcome was assessed both at the end of treatment and in a 1-year follow-up. In comparison with a treatment-as-usual control group, the treatment program brought about significant and stable improvements both in trauma-specific symptoms (e.g. dissociation, intrusion, avoidance) and in general psychiatric symptoms (e.g., general symptom distress, frequency of self-mutilating behavior, number of hospitalizations). The frequency of inpatient treatments (hospitalizations) decreased dramatically (< 10 days annually; effect size: d = 2.88).

  14. Jaw locking after maxillofacial trauma

    Directory of Open Access Journals (Sweden)

    David B. Kamadjaja

    2007-09-01

    Full Text Available The purpose of this report is to present two cases of jaw locking with two different etiologies. In case #1, jaw locking occured 5.5 months after a surgical reduction and internal fixation on the fractured maxilla and mandible. Some plain radiographic x-ray were made but failed to give adequate information in establishing the cause of trismus. The three dimensional computed tomography (3D-CT was finally made and able to help guide the pre-operative diagnosis and treatment. Two-steps gap arthroplasty were done comprising a gap arthroplasty leading to acceptable outcome. An adult patient in case #2 with a history of trauma at his childhood and bird-like face apprearance clinically, was unable to open the mouth since the time of accident. The patient was diagnosed with bilateral ankylosis of temporomandibular joints. One side (right gap arthroplasty was done and resulted in normal mouth opening.

  15. Systemic trauma.

    Science.gov (United States)

    Goldsmith, Rachel E; Martin, Christina Gamache; Smith, Carly Parnitzke

    2014-01-01

    Substantial theoretical, empirical, and clinical work examines trauma as it relates to individual victims and perpetrators. As trauma professionals, it is necessary to acknowledge facets of institutions, cultures, and communities that contribute to trauma and subsequent outcomes. Systemic trauma-contextual features of environments and institutions that give rise to trauma, maintain it, and impact posttraumatic responses-provides a framework for considering the full range of traumatic phenomena. The current issue of the Journal of Trauma & Dissociation is composed of articles that incorporate systemic approaches to trauma. This perspective extends conceptualizations of trauma to consider the influence of environments such as schools and universities, churches and other religious institutions, the military, workplace settings, hospitals, jails, and prisons; agencies and systems such as police, foster care, immigration, federal assistance, disaster management, and the media; conflicts involving war, torture, terrorism, and refugees; dynamics of racism, sexism, discrimination, bullying, and homophobia; and issues pertaining to conceptualizations, measurement, methodology, teaching, and intervention. Although it may be challenging to expand psychological and psychiatric paradigms of trauma, a systemic trauma perspective is necessary on both scientific and ethical grounds. Furthermore, a systemic trauma perspective reflects current approaches in the fields of global health, nursing, social work, and human rights. Empirical investigations and intervention science informed by this paradigm have the potential to advance scientific inquiry, lower the incidence of a broader range of traumatic experiences, and help to alleviate personal and societal suffering.

  16. Clinical and functional outcomes and treatment options for paediatric elbow dislocations: Experiences of three trauma centres.

    Science.gov (United States)

    Subasi, M; Isik, M; Bulut, M; Cebesoy, O; Uludag, A; Karakurt, L

    2015-07-01

    Although elbow dislocations are seen rarely in children, their management remains controversial. In this study, over a 7 years period, we evaluated retrospectively the clinical and functional results of paediatric elbow dislocations managed in three different trauma centres. Pure dislocations and dislocations with associated injuries were evaluated separately. In total 56 patients met the inclusion criteria. The number of patients without additional injury was 22 out of which according to the Robert's criteria, 15 children (68%) had an excellent, four (18%) a good, one (5%) a fair, and two (9%) a poor outcome. From the thirty-four patients that had associated injuries, two (6%) had an excellent, 6 (18%) a good, 10 (29%) a fair and 16 (47%) a poor result. Overall, patients with pure dislocation were found to have a better range of motion compared to patients with dislocation and associated injuries. Prolonged follow ups, and effective rehabilitation programs are required in order to expect good outcomes.

  17. Neural interconnections between portio minor and portio major at the porus trigeminus: application to failed surgical treatment of trigeminal neuralgia.

    Science.gov (United States)

    Tubbs, R Shane; Griessenauer, Christoph J; Hogan, Elizabeth; Loukas, Marios; Cohen-Gadol, Aaron A

    2014-01-01

    Recalcitrant trigeminal neuralgia following surgical treatment can be a life-altering condition. To explore alternative anatomic reasons for such a complication, the authors examined the potential for nerve connections between the sensory and motor roots of the trigeminal nerve at the opening of Meckel's cave (porus trigeminus). In 15 embalmed adult cadavers (30 sides), the authors performed microdissection of the skull base and specifically at the opening of Meckel's cave. Two sides (6.67%) were found to have interneural connections between the sensory and motor roots at Meckel's cave. These occurred in one male and one female cadaver, both on right sides. Both connections were histologically verified to be neural and were 0.5 mm in diameter and 2.2 and 3.2 mm in length, respectively. Both connections traveled in an oblique fashion from the portio major to the portio minor. On the basis of authors' findings, the sensory and motor components of the trigeminal nerve at the opening of Meckel's cave may be interconnected with a neural anastomosis. Such findings may be of use during the surgical treatment of trigeminal neuralgia or other surgery of the posterior fossa so that inadvertent transection or traction does not occur.

  18. Analysis of injuries and treatment of 3 401 inpatients in 2008 Wenchuan earthquake based on Chinese Trauma Databank

    Institute of Scientific and Technical Information of China (English)

    QIU Jun; LIU Guo-dong; WANG Su-xing; ZHANG Xiu-zhu; ZHANG Liang; LI Yang; YUAN Dan-feng; YANG Zhi-huan; ZHOU Ji-hong

    2010-01-01

    Objective: A catastrophic earthquake struck Wenchuan region of West China on May 12, 2008and caused more than 69 225 deaths. This study was to analyze injury characteristics and treatment of the seismic patients based on Chinese Trauma Databank, which will be helpful for improvement of future medical rescue in potential disasters.Methods: Based on inpatients' medical records of seismic patients admitted into 11 hospitals, data were registered with Trauma Database System Version 3.0. Patients'general information, causes, clinical characteristics and treatment of injuries were studied.Results: Main causes for seismic injuries were blunt strike (68.2%), crush/burying (18.7%) and slip/falling (11.5%).Slip/falling was the main cause for spinal injuries and accounted for 19.1%, which was higher than the percentage for other body part. Extremity injuries accounted for 54.8%of all injuries. Fractures accounted for 53.1%. Lower extremity fracture accounted for 70.1% of lower extremity injury and spinal fracture accounted for 85.9% of spinal injury.The proportion of spinal injuries with AIS ≥ 4 was higher than that of other injured locations except for the abdomen.Debridement and suturation for single injury and multiple injury patients accounted for 64.7% and 42.9% of their operations respectively.Conclusions: Blunt strike, crush/burying and slip/falling are the main causes for seismic injuries. The most frequently injured site is extremity. The main injury type is fracture, especially for the lower extremities and the spine.Multiple injury patients were mainly treated by operation,including debridement and suturation, closed reduction and external fixation, etc.

  19. A combination of methylprednisolone and quercetin is effective for the treatment of cardiac contusion following blunt chest trauma in rats

    Energy Technology Data Exchange (ETDEWEB)

    Demir, F. [Department of Pediatric Cardiology, Faculty of Medicine, Dicle University, Diyarbakır (Turkey); Güzel, A. [Department of Pediatrics, Faculty of Medicine, Ondokuz Mayıs University, Samsun (Turkey); Katı, C. [Department of Emergency Medicine, Faculty of Medicine, Ondokuz Mayıs University, Samsun (Turkey); Karadeniz, C. [Pediatric Cardiology Services, Behçet Uz Children' s Hospital, İzmir (Turkey); Akdemir, U. [Department of Emergency Medicine, Faculty of Medicine, Ondokuz Mayıs University, Samsun (Turkey); Okuyucu, A. [Department of Medical Biochemistry, Faculty of Medicine, Ondokuz Mayıs University, Samsun (Turkey); Gacar, A. [Department of Pathology, Faculty of Veterinary Medicine, Ondokuz Mayıs University, Samsun (Turkey); Özdemir, S. [Department of Pediatrics, Faculty of Medicine, Ondokuz Mayıs University, Samsun (Turkey); Güvenç, T. [Department of Pathology, Faculty of Veterinary Medicine, Ondokuz Mayıs University, Samsun (Turkey)

    2014-08-01

    Cardiac contusion is a potentially fatal complication of blunt chest trauma. The effects of a combination of quercetin and methylprednisolone against trauma-induced cardiac contusion were studied. Thirty-five female Sprague-Dawley rats were divided into five groups (n=7) as follows: sham, cardiac contusion with no therapy, treated with methylprednisolone (30 mg/kg on the first day, and 3 mg/kg on the following days), treated with quercetin (50 mg·kg{sup −1}·day{sup −1}), and treated with a combination of methylprednisolone and quercetin. Serum troponin I (Tn-I) and tumor necrosis factor-alpha (TNF-α) levels and cardiac histopathological findings were evaluated. Tn-I and TNF-α levels were elevated after contusion (P=0.001 and P=0.001). Seven days later, Tn-I and TNF-α levels decreased in the rats treated with methylprednisolone, quercetin, and the combination of methylprednisolone and quercetin compared to the rats without therapy, but a statistical significance was found only with the combination therapy (P=0.001 and P=0.011, respectively). Histopathological degeneration and necrosis scores were statistically lower in the methylprednisolone and quercetin combination group compared to the group treated only with methylprednisolone (P=0.017 and P=0.007, respectively). However, only degeneration scores were lower in the combination therapy group compared to the group treated only with quercetin (P=0.017). Inducible nitric oxide synthase positivity scores were decreased in all treatment groups compared to the untreated groups (P=0.097, P=0.026, and P=0.004, respectively). We conclude that a combination of quercetin and methylprednisolone can be used for the specific treatment of cardiac contusion.

  20. Modifications to the Trauma Recovery and Empowerment Model (TREM) for Substance-Abusing Women with Histories of Violence: Outcomes and Lessons Learned at a Colorado Substance Abuse Treatment Center

    Science.gov (United States)

    Toussaint, Danielle W.; VanDeMark, Nancy R.; Bornemann, Angela; Graeber, Carla J.

    2007-01-01

    A growing body of literature demonstrates the co-occurrence of posttraumatic stress disorder and substance use disorder for females seeking substance abuse treatment. Nonetheless, relatively few trauma-specific treatments have been implemented or evaluated with this population. In this quasi-experimental study (N = 170), the Trauma Recovery and…

  1. Testing a DSM-5 reformulation of posttraumatic stress disorder: impact on prevalence and comorbidity among treatment-seeking civilian trauma survivors

    NARCIS (Netherlands)

    van Emmerik, A.A.P.; Kamphuis, J.H.

    2011-01-01

    The authors investigated a recent reformulation (Brewin, Lanius, Novac, Schnyder, & Galea, 2009) of posttraumatic stress disorder (PTSD) in treatment-seeking civilian trauma survivors. Diagnostic data from a randomized controlled trial (N = 170) were subjected to the criteria according to the Diagno

  2. Trauma-related dissociation and altered states of consciousness: a call for clinical, treatment, and neuroscience research

    OpenAIRE

    2015-01-01

    The primary aim of this commentary is to describe trauma-related dissociation and altered states of consciousness in the context of a four-dimensional model that has recently been proposed (Frewen & Lanius, 2015). This model categorizes symptoms of trauma-related psychopathology into (1) those that occur within normal waking consciousness and (2) those that are dissociative and are associated with trauma-related altered states of consciousness (TRASC) along four dimensions: (1) time; (2) ...

  3. Trauma as a Predictive Indicator of Clinical Outcome in Residential Treatment

    Science.gov (United States)

    Boyer, Susan N.; Hallion, Lauren S.; Hammell, Carrie L.; Button, Suzanne

    2009-01-01

    The present study was conducted to identify predictors of residential treatment outcome for youth. Data were collected and analyzed on multiple variables including each subject's psychiatric diagnoses, previous treatment attempts and success or failure in these respective settings, length of stay in prior treatment settings, past psychiatric…

  4. A treatment-refractory spinal dural arteriovenous fistula sharing arterial origin with the Artery of Adamkiewicz: Repeated endovascular treatment after failed microsurgery

    Directory of Open Access Journals (Sweden)

    Johanna Eneling

    2014-01-01

    Full Text Available Background: Effective management of a spinal dural arteriovenous fistula (SDAVF can be accomplished with either microsurgery or endovascular embolization, but there is a consensus that in patients in whom a radiculomedullary artery supplying the anterior spinal artery (ASA originates from the same feeding artery as the SDAVF, the endovascular approach is to be avoided. Case Description: The patient was a 46-year-old woman with progressive lower limb paraparesis, sensory deficit, and sphincter dysfunction. Magnetic resonance imaging (MRI and spinal angiography showed an SDAVF fed by a branch from the left second lumbar segmental artery, and the artery of Adamkiewicz (AA, a major ASA supplier, originating from the same segmental artery just proximal to the SDAVF. Microsurgical disconnection of the SDAVF was attempted, but failed. Embolization with cyanoacrylates was done in two occasions, the first time through a microcatheter placed just distal to the origin of the AA and the second time through another feeder coming from the same segmental artery that could not be visualized in the previous angiographies. All procedures were neurologically uncomplicated. Magnetic resonance imaging (MRI 1 month after the last embolization showed resolution of the spinal cord edema. MRI scan taken 68 months after embolization revealed a slightly atrophic spinal cord with visible central canal and no recurrence of medullary edema. The patient presented good, but incomplete neurological improvement. Conclusion: Microsurgery is the first choice for an SDAVF branching off the same radiculomedullary artery supplying the ASA, but uncomplicated embolization can be feasible after failed surgery.

  5. Isolated hepatic artery injury in blunt abdominal trauma presenting as upper gastrointestinal bleeding: treatment with transcatheter embolisation.

    Science.gov (United States)

    Taslakian, Bedros; Ghaith, Ola; Al-Kutoubi, Aghiad

    2012-11-15

    Liver injury in blunt abdominal trauma is common. However, not often does blunt trauma cause injury to the anatomical structures of the porta hepatis. Isolated injury of the hepatic artery has been rarely reported in the literature. Such injury may be lethal and requires immediate diagnosis and management. This report describes an unusual case of blunt abdominal trauma resulting in hepatic and gastroduodenal artery dissection, with pseudoaneurysm formation complicated by active upper gastrointestinal bleeding. The injury was managed by transcatheter embolisation. Awareness of this diagnosis should facilitate management of similar trauma cases.

  6. The trauma report nurse: a trauma triage process improvement project.

    Science.gov (United States)

    Jelinek, Lisa; Fahje, Carol; Immermann, Carol; Elsbernd, Terri

    2014-09-01

    Accurate trauma triage is imperative to facilitate appropriate resource mobilization for severely injured trauma patients. A critical window of opportunity exists to prevent secondary injury or death. Timely assessment with a multidisciplinary trauma team is essential to facilitate rapid diagnosis and treatment. However, consistent and accurate trauma triage proved daunting at our institution, resulting in instances of undertriage. A process improvement strategy aimed at improving trauma triage accuracy was implemented. An innovative role, the trauma report nurse (TRN), was created and became the trauma nurse expert. The TRN was responsible for assigning a trauma triage level to all incoming adult and pediatric trauma patients. In parallel, improvements were made to the prehospital report format, increasing standardization and clarifying hand-off verbiage. Undertriage rates dropped from 14% to 4.8%. Qualitative data demonstrated acceptance and support of the TRN role among physicians, nurses and nursing and ancillary staff. Designating trauma triage to an ED registered nurse proved to reduce undertriage rates. By providing staff education, infrastructure improvements, and leadership support, the role continues to thrive, resulting in improved care for severely injured trauma patients. Copyright © 2014 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

  7. EARLY AND LONG-TERM RESULTS OF SURGICAL TREATMENT OF THE THORACIC AND LUMBAR VERTEBRAL AND SPINAL TRAUMA

    Directory of Open Access Journals (Sweden)

    V. D. Usikov

    2014-01-01

    Full Text Available The article demonstrates the outcomes of operative treatment of 190 patients with spinal cord injuryof thoracic and lumbar spine for 10 years. Associated injuries were revealed in 96 patients, the mean ISS score being27.5. All patients underwent decompressive and stabilizing interventions using a transpedicular system of “Synthes” production (Saint Petersburg. Ventral interventions were performed in 27 (14.2% patients. In all cases, decompression of the spinal canalcontents at the level of damage was achieved. In those patients who were operated within two weeks after trauma, transpedicular system allowed for recovery of a form and size of the spinal canal and the damaged vertebral body. The fractures of transpedicular system were observed in patients operated both with only rear and with combined access. The errors and complications, which happened during surgery, did not influence the outcomes of treatment. The outcomes of treatment were assessed according to the neurological statusdynamics (ASIA score, recovery of support ability of the spine, the presence of pain, and patients’ recovery (Е Denis score. Favorable outcomes were achieved in 114 (61.3% patients, satisfactoryin 53 (28.5%,and poor in 19 (10.2 %.

  8. Initial experience with extreme angle cervical screw for treatment of trauma and cervical spondylosis.

    Science.gov (United States)

    Mehta, Ankit I; Babu, Ranjith; Bagley, Carlos A; Grossi, Peter M; Gottfried, Oren N

    2014-03-01

    In this study, we have described our initial experience and surgical technique of extreme angle screw placement in the cervical and upper thoracic spine of a cohort of patients undergoing posterior fusion. This extreme angle screw facilitates rod placement without need for any coronal contouring of the rod or offset connectors despite the varied entry site locations for posterior instrumentation and the different trajectories and pathways of these screws. From ruary 2011 to July 2011, extreme angle screws were placed in twenty consecutive adult patients who underwent posterior cervical, occipital-cervical or cervical-thoracic fusions. The primary diagnosis was cervical spondylotic myelopathy (13), trauma (4), and pseudoarthrosis with stenosis (3). Eight patients had gross instability. A total of 196 screws were placed; half of the cases involved instrumentation at or within the C3-7 segments (10) and the others included constructs extending to occipital bone, C2, T1, or T2 (10). Of all twenty cases, there were no perioperative hardware complications. At long-term follow-up, two patients required reoperation, one for hardware failure and the other for single level symptomatic pseudoarthrosis. We conclude that extreme angle screw use in the posterior cervical spine provides an evolution in posterior instrumentation that maximizes the biomechanical strength of a construct, allows for easy rod placement, and may improve the restoration of sagittal alignment. Overall, extreme angle screws facilitate rod placement even for screws offset from the natural plane of the rod, thereby avoiding the need for coronal contouring or placement of offset connectors.

  9. Histological Analysis of Failed Cartilage Repair after Marrow Stimulation for the Treatment of Large Cartilage Defect in Medial Compartmental Osteoarthritis of the Knee

    Directory of Open Access Journals (Sweden)

    Sakata,Kenichiro

    2013-02-01

    Full Text Available Bone marrow-stimulating techniques such as microfracture and subchondral drilling are valuable treatments for full-thickness cartilage defects. However, marrow stimulation-derived reparative tissues are not histologically well-documented in human osteoarthritis. We retrospectively investigated cartilage repairs after marrow stimulation for the treatment of large cartilage defects in osteoarthritic knees. Tissues were obtained from patients who underwent total knee arthroplasty (TKA after arthroscopic marrow stimulation in medial compartmental osteoarthritis. Clinical findings and cartilage repair were assessed. Sections of medial femoral condyles were histologically investigated by safranin O staining and anti-type II collagen antibody. Marrow stimulation decreased the knee pain in the short term. However, varus leg alignment gradually progressed, and TKA conversions were required. The grade of cartilage repair was not improved. Marrow stimulations resulted in insufficient cartilage regeneration on medial femoral condyles. Safranin O-stained proteoglycans and type II collagen were observed in the deep zone of marrow-stimulated holes. This study demonstrated that marrow stimulation resulted in failed cartilage repair for the treatment of large cartilage defects in osteoarthritic knees. Our results suggest that arthroscopic marrow stimulation might not improve clinical symptoms for the long term in patients suffering large osteoarthritic cartilage defects.

  10. Revision of Failed Artroscopic Bankart Repairs

    Science.gov (United States)

    Muiño, José María Silberberg; Gimenez, Martín Alejandro; Salvucci, Mauro Gabriel Maroa; Ferro, Diego; Rullan, Ramón Muiña

    2017-01-01

    Objectives: To present our functional outcomes from patients treated arthroscopically for a failed Bankart repair, using suture anchors and capsulolabral tissue only. Methods: Series of 22 patients presented with a recurrence of instability after a previous stabilization surgery (3 Latarjet, Bankart 19). We treated them by a an all-arthroscopic procedure, avoiding bone grafts, when glenoid track was found to be enough to proceed. The failure was associated with trauma in 11 patients, a non-anatomic repair in 6 patients, capsular laxity in 4 patients and a non-union of the coracoid graft in 1 patient. Revision surgery included: Bankart repair with anchors in 17 cases, a posterior-inferior capsulo-labral plication in one case, and 5 remplissages. In 4 cases subscapularis augmentation was used because of poor capsular quality. Screw removal was necessary when treating the non-union case. Patients were followed-up by a minimum of 23 months (range 23-26), and evaluated by the UCLA Test, SS test and Rowe score. Results: Thirteen patients had an excellent result, 6 good, 2 satisfactory and one bad result, according to UCLA score. The mean Rowe score was 90.4, at final follow up. The Simple Shoulder Test went from an 8 preoperative to an 11 postoperative, mean scores. 19 of 22 patients returned to the same level of activity prior to the injury. Complications: recurrence in 2 cases, subluxation in 2 and one shoulder stiffness that required an arthrolysis. Conclusion: An arthroscopic revision surgery, after a failed Bankart repair, presents satisfactory results in selected patients. Arthroscopic vision allows a correct diagnosis of injuries as possible causes of failure and subsequent treatment.

  11. Effectiveness of trauma-focused treatment for patients with psychosis with and without the dissociative subtype of post-traumatic stress disorder.

    Science.gov (United States)

    van Minnen, A; van der Vleugel, B M; van den Berg, D P G; de Bont, P A J M; de Roos, C; van der Gaag, M; de Jongh, A

    2016-10-01

    This study presents secondary analyses of a recently published trial in which post-traumatic stress disorder (PTSD) patients with psychosis (n = 108) underwent 8 sessions of trauma-focused treatment, either prolonged exposure (PE) or eye movement desensitisation and reprocessing (EMDR) therapy. 24.1% fulfilled the criteria for the dissociative subtype, a newly introduced PTSD subtype in DSM-5. Treatment outcome was compared for patients with and without the dissociative subtype of PTSD. Patients with the dissociative subtype of PTSD showed large reductions in clinician-administered PTSD scale (CAPS) score, comparable with patients without the dissociative subtype of PTSD. It is concluded that even in a population with severe mental illness, patients with the dissociative subtype of PTSD do benefit from trauma-focused treatments without a pre-phase of emotion regulation skill training and should not be excluded from these treatments. © The Royal College of Psychiatrists 2016.

  12. The treatment of acute soft tissue trauma in Danish emergency rooms

    DEFF Research Database (Denmark)

    Johannsen, F; Langberg, Henning

    1997-01-01

    Rest, ice, compression, elevation (RICE) is the most recommended treatment for acute traumatic soft tissue injuries. A questionnaire was given to all Danish emergency rooms (n = 5) regarding their routines for acute treatment of ankle sprains and muscle contusions. Complete answers were received ...

  13. Treatment of Human-Caused Trauma: Attrition in the Adult Outcomes Research

    Science.gov (United States)

    Matthieu, Monica; Ivanoff, Andre

    2006-01-01

    Attrition or dropout is the failure of a participant to complete, comply, or the prematurely discontinuation or discharge from treatment, resulting in lost data and affecting outcomes. This review of 10 years of adult posttraumatic stress disorder (PTSD) treatment outcome literature specific to Criterion A events of human origin examines how…

  14. Failing the market, failing deliberative democracy

    DEFF Research Database (Denmark)

    Lippert, Ingmar

    2016-01-01

    Corporate carbon footprint data has become ubiquitous. This data is also highly promissory. But as this paper argues, such data fails both consumers and citizens. The governance of climate change seemingly requires a strong foundation of data on emission sources. Economists approach climate chang...

  15. Imagery rescripting and eye movement desensitisation and reprocessing for treatment of adults with childhood trauma-related post-traumatic stress disorder: IREM study design.

    Science.gov (United States)

    Boterhoven de Haan, Katrina L; Lee, Christopher W; Fassbinder, Eva; Voncken, Marisol J; Meewisse, Mariel; Van Es, Saskia M; Menninga, Simone; Kousemaker, Margriet; Arntz, Arnoud

    2017-05-04

    Post-traumatic stress disorder (PTSD) that originates from childhood trauma experiences can develop into a chronic condition that has lasting effects on an individual's functioning and quality of life. While there are evidence-based guidelines for treating adult onset PTSD, treatments for adults with childhood trauma-related PTSD (Ch-PTSD) are varied and subject to ongoing debate. This study will test the effectiveness of two trauma-focused treatments, imagery rescripting (ImRs) and eye movement desensitisation and reprocessing (EMDR) in participants with Ch-PTSD. Both have been found effective in treatment of adult PTSD or mixed onset PTSD and previous research indicates they are well-tolerated treatments. However, we know less about their effectiveness for treating Ch-PTSD or their underlying working mechanisms. IREM is an international multicentre randomised controlled trial involving seven sites across Australia, Germany and the Netherlands. We aim to recruit 142 participants (minimum of n = 20 per site), who will be randomly assigned to treatment condition. Assessments will be conducted before treatment until 1-year follow-up. Assessments before and after the waitlist will assess change in time only. The primary outcome measure is change in PTSD symptom severity from pre-treatment to 8-weeks post-treatment. Secondary outcome measures include change in severity of depression, anger, trauma-related cognitions, guilt, shame, dissociation and quality of life. Underlying mechanisms of treatment will be assessed on changes in vividness, valence and encapsulated belief of a worst trauma memory. Additional sub-studies will include qualitative investigation of treatment experiences from the participant and therapists' perspective, changes in memory and the impact of treatment fidelity on outcome measures. The primary aims of this study are to compare the effectiveness of EMDR and ImRs in treating Ch-PTSD and to investigate the underlying working mechanisms of the two

  16. Type of treatment, prognosis, and estimation of time spent to manage dental trauma in late presentation cases at a dental teaching hospital: a longitudinal and retrospective study.

    Science.gov (United States)

    Al-Jundi, Suhad H

    2004-02-01

    Traumatic dental injuries are emergencies that must be treated promptly and properly in order to reduce the suffering, costs, and time for patients, parents, and health care providers. The aim of this study was to investigate the treatment, long-term prognosis, and number of visits needed to manage cases resulting from complications of late presentation of traumatic dental injuries. The sample consisted of 195 children, all presented with complications of dental trauma at the Pediatric Dentistry Clinics in the Dental Teaching Hospital of Jordan University of Science and Technology in Irbid city, Jordan. Retrospective data relied on trauma forms as well the clinical notes and radiographs in the patients' records. Prospective data was collected by examining patients at recall appointments. The treatment of traumatized teeth in this sample ranged from no active treatment to extraction and prosthetic replacement. It was estimated that the number of visits needed to carry out the planned treatment for these patients ranged between 3 and 17.2 visits according to the type of treatment. Apexification procedure was the most time consuming. Thirty-two per cent of teeth with apexification ended up with root fracture mainly subsequent to another minor trauma episode (in 85%), the rest were reported to be spontaneous fractures. Almost half of the teeth with luxation injuries became necrotic after 3 years. Teeth with avulsion actually kept on deteriorating even at the 36-month follow-up appointment. The long-term prognosis of teeth with middle root fracture was favorable in (80%) of the teeth in the sample, despite the fact that they were splinted late. Luxation injuries led to more necrotic teeth (50%) than uncomplicated crown fractures. Multiple dental trauma episodes (MDTE) were reported in about 30% of the patients in the sample and were responsible for some of the complications noticed in this report. As all cases followed up in this report are late presentation of dental

  17. Trauma-related dissociation and altered states of consciousness: a call for clinical, treatment, and neuroscience research.

    Science.gov (United States)

    Lanius, Ruth A

    2015-01-01

    The primary aim of this commentary is to describe trauma-related dissociation and altered states of consciousness in the context of a four-dimensional model that has recently been proposed (Frewen & Lanius, 2015). This model categorizes symptoms of trauma-related psychopathology into (1) those that occur within normal waking consciousness and (2) those that are dissociative and are associated with trauma-related altered states of consciousness (TRASC) along four dimensions: (1) time; (2) thought; (3) body; and (4) emotion. Clinical applications and future research directions relevant to each dimension are discussed. Conceptualizing TRASC across the dimensions of time, thought, body, and emotion has transdiagnostic implications for trauma-related disorders described in both the Diagnostic Statistical Manual and the International Classifications of Diseases. The four-dimensional model provides a framework, guided by existing models of dissociation, for future research examining the phenomenological, neurobiological, and physiological underpinnings of trauma-related dissociation.

  18. Trauma-related dissociation and altered states of consciousness: a call for clinical, treatment, and neuroscience research

    Directory of Open Access Journals (Sweden)

    Ruth A. Lanius

    2015-05-01

    Full Text Available The primary aim of this commentary is to describe trauma-related dissociation and altered states of consciousness in the context of a four-dimensional model that has recently been proposed (Frewen & Lanius, 2015. This model categorizes symptoms of trauma-related psychopathology into (1 those that occur within normal waking consciousness and (2 those that are dissociative and are associated with trauma-related altered states of consciousness (TRASC along four dimensions: (1 time; (2 thought; (3 body; and (4 emotion. Clinical applications and future research directions relevant to each dimension are discussed. Conceptualizing TRASC across the dimensions of time, thought, body, and emotion has transdiagnostic implications for trauma-related disorders described in both the Diagnostic Statistical Manual and the International Classifications of Diseases. The four-dimensional model provides a framework, guided by existing models of dissociation, for future research examining the phenomenological, neurobiological, and physiological underpinnings of trauma-related dissociation.

  19. 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 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....... 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....

  20. 严重创伤救治若干新进展%Some new progress in the treatment of severe trauma

    Institute of Scientific and Technical Information of China (English)

    赵小纲

    2013-01-01

    随着创伤事件日渐增多,形成有效的救治策略以提高对严重创伤的综合反应能力越来越受重视.在不影响结局的前提下,遵循标准化的评估策略对创伤进行评估能高效率的实现早期的明确诊断.对于有活动性出血的创伤失血性休克建议损伤控制限制性液体复苏,同时应早期识别和重视创伤凝血病的发生.对血流动力学不稳定骨盆骨折的处理,应能实现有效的止血,且重视多学科团队协作在其中的作用.各创伤机构应能发挥自身优势,建立区域创伤救治体系,组建一支高素质的专业队伍,最终提高严重创伤的救治水平.%With the development of efficient strategies for the treatment of severe trauma ,enhancing the a— bility of associated comprehensive reactions has been increasingly appreciated with the fast -growing trauma events.A standardized strategy for trauma assessment is helpful and efficient for early and definite diagnosis.For bleeding trauma patients with hemorrhagic shock ,limited fluid resuscitation is recommended to decrease physical derange — ments before definite hemostasis.It' s essential to identify and manage acute ,traumatic coagulopathy in the very early stage.Control of bleeding resources plays pivotal role in the outcome of he mo dynamic ally unstable pelvic frac — tures,treatment decisions should be based on multidisciplinary teamwork.Trauma centers are mandated to improve their ability of responses to severe trauma ,by making use of their conventional advantages and developing regional trauma systems and multi-professional trauma teams.

  1. Does surgical treatment within 4 hours after trauma have an influence on neurological remission in patients with acute spinal cord injury?

    Directory of Open Access Journals (Sweden)

    Biglari B

    2016-08-01

    Full Text Available Bahram Biglari,1 Christopher Child,2 Timur Mert Yildirim,2 Tyler Swing,2 Tim Reitzel,1 Arash Moghaddam2 1Department of Paraplegiology and Technical Orthopedics, BG Trauma Centre, Ludwigshafen, Germany; 2Heidelberg Trauma Research Group, Center for Orthopedics, Trauma Surgery and Spinal Cord injury, Heidelberg University Hospital, Heidelberg, Germany Background: The proper timing for surgery in patients with acute spinal cord injury is controversial. This study was conducted to detect if there is an advantage in early (within the first 4 hours after trauma compared to late (between 4 and 24 hours after trauma surgery on neurological outcome.Methods: In this single institution prospective cohort study, data were analyzed from 51 spinal cord injured patients with an average age of 43.4 (±19.2 years. The influence of early (29 patients within the first 4 hours as opposed to late (22 patients between 4 and 24 hours decompression was evaluated by comparing data for neurological outcome. Patients of the study collectively suffered acute spinal fractures from C2 to L3 (cervical 39.2%, thoracic 29.4%, and lumbal 21.6% or nonosseous lesions (9.8%. American Spinal Injury Association (ASIA Impairment Scale (AIS grades were assessed at time of admission and 6 months after trauma or longer depending on the time of release. Surgical treatment included early stabilization and decompression within 24 hours.Results: No significant difference between improved neurological function, measured with the AIS, and an early or late surgery time can be seen (P=0.402. Furthermore, binary logistic regression shows no significant difference between sex or age, and AIS improvement as possible confounders.Conclusion: In our study, all patients with spinal cord injury were treated with spine stabilization and decompression within the first 24 hours after trauma. Surgical decompression within the first 4 hours after trauma was not associated with improved neurological outcome

  2. Imagery rescripting and reprocessing therapy after failed prolonged exposure for post-traumatic stress disorder following industrial injury.

    Science.gov (United States)

    Grunert, Brad K; Weis, Jo M; Smucker, Mervin R; Christianson, Heidi F

    2007-12-01

    Prolonged exposure (PE) has been reported to be effective for improving post-traumatic stress symptoms in 60-65% of trauma victims suffering from post-traumatic stress disorder (PTSD). This study examined the results of adding an imagery-based, cognitive restructuring component (imagery rescripting and reprocessing therapy, IRRT) to the treatment of 23 Type I trauma victims suffering from PTSD, all of whom failed to improve with PE alone. With the added treatment component, 18 of 23 clients showed a full recovery from their PTSD symptoms, and no longer met criteria for PTSD after 1-3 sessions of IRRT. It was noteworthy that non-FEAR emotions (e.g., guilt, shame, anger) were found to be predominant for all 23 PE failures examined in this study, suggesting that a simple habituation model (on which PE is based) is not sufficient to address non-FEAR emotions in PTSD. By contrast, IRRT, a cognitive restructuring treatment, was much more effective in PTSD symptom reduction for these clients. It was proposed that more detailed, individualized trauma assessments be conducted for each patient that focus on (1) identifying the predominant trauma-related emotions and cognitions that maintain the PTSD response, and (2) finding the best CBT "treatment fit" for the specific trauma characteristics of each patient.

  3. Trauma na infância e adolescência: epidemiologia, tratamento e aspectos econômicos em um hospital público Epidemiology, treatment and economical aspects of multiple trauma in children and adolescents in a public hospital

    Directory of Open Access Journals (Sweden)

    Carlos Eduardo da Silveira Franciozi

    2008-01-01

    Full Text Available INTRODUÇÃO: A realização deste trabalho foi motivada pela escassez de artigos encontrados na literatura que estudam o politrauma na infância e na adolescência.. O objetivo é descrever o perfil epidemiológico das lesões traumáticas na infância tratadas num centro de trauma, avaliar os aspectos econômicos relacionados com o gasto hospitalar e o tempo de internação de acordo com o tratamento realizado. MATERIAIS E MÉTODOS: analisamos todos os prontuários do hospital Geral de Pirajussara no período de dezembro de 2005 a dezembro de 2006. Obtivemos 182 pacientes, sendo 71% do sexo masculino e 29% do feminino; 48% brancos e 52% não brancos. RESULTADOS: houve predominância dos indivíduos do sexo masculino com 71% dos pacientes. O mecanismo de trauma mais freqüente foi a queda (36%. A média de dias de internação foi 4,1 dias, com gasto estimado de R$ 649,50 para cada paciente. A taxa de mortalidade foi de 2,74%, sendo o traumatismo crânio-encefálico responsável por 80% da mortalidade e os maus tratos presentes em 40% dos óbitos. CONCLUSÃO: a população pediátrica tem particularidades que a tornam distinta da população adulta em relação à epidemiologia e manejo das lesões.INTRODUCTION: the motivation to conduct this study was the reduced number of articles in literature correlating multiple trauma in childhood and infancy. The objective here was to describe the epidemiological profile of traumatic injuries treated in a trauma center, evaluating the economic aspects associated with hospitalized patients' costs and the period of hospital stay according to the treatment provided. MATERIAL AND METHODS: we assessed all Pirajussara Hospital patients' files in the period of December of 2005 to December 2006. We selected 182 patients, 129 (71% males and 53 (29% females; 88 (48% Caucasian and 94 (52% non-Caucasian children. RESULTS: male patients were prevalent, with 129 (71% cases. The most frequent trauma mechanism was fall

  4. Treatment of Chronic Phantom Limb Pain Using a Trauma-Focused Psychological Approach

    OpenAIRE

    Roos, C.; AC Veenstra; de Jongh, A.; ME den Hollander-Gijsman; NJA van der Wee; Zitman FG; YR van Rood

    2010-01-01

    BACKGROUND: Chronic phantom limb pain (PLP) is a disabling chronic pain syndrome for which regular pain treatment is seldom effective. Pain memories resulting from long-lasting preamputation pain or pain flashbacks, which are part of a traumatic memory, are reported to be powerful elicitors of PLP.OBJECTIVE: To investigate whether a psychological treatment directed at processing the emotional and somatosensory memories associated with amputation reduces PLP.METHODS: Ten consecutive participan...

  5. Clinical Study on Ocular Trauma in Children

    Institute of Scientific and Technical Information of China (English)

    Zicai Huang; Hongni Li; Yixia Huang; Zhongxia Zhou

    2002-01-01

    Purpose: To investigate the clinical characteristics of ocular trauma in children and put forward the major treatment and prevention of ocular trauma in children.Methods: To analyze the clinical data by 77 eyes in 77 cases of ocular trauma in children from April 1999 to February 2002. Results: The male and female were in the ratio of 2.21: 1. Right eye ocular traumas were more than left ones. Ocular penetrating trauma was 83.12% and blunt trauma 12.99%. 41 cases (53.25%) were injured by themselves while 33 cases by others. 90.91% patients came from the countryside.Conclusion: The rate of blindness of children with ocular trauma could be reduced by prompt treatment. The study indicated that ocular trauma preventive publicity should be faced in the countryside in order to improve the understanding of the severity of ocular trauma and treat it as a social problem.

  6. Challenging aspects of treatment strategies in heart failure with preserved ejection fraction: “Why did recent clinical trials fail?”

    Institute of Scientific and Technical Information of China (English)

    Peter; Moritz; Becher; Nina; Fluschnik; Stefan; Blankenberg; Dirk; Westermann

    2015-01-01

    Heart failure(HF) is the leading cause of hospitalization among older adults and the prevalence is growing with the aging populations in the Western countries. Epidemiologic reports suggest that approximately 50% of patients who have signs or symptoms of HF have preserved left ventricular ejection fraction. This HF type predominantly affects women and the elderly with other co-morbidities, such as diabetes, hypertension, and overt volume status. Most of the current treatment strategies are based on morbidity benefits such as quality of life and reduction of clinical HF symptoms. Treatment of patients with HF with preserved ejection fraction displayed disappointing results from several large randomized controlled trials. The heterogeneity of HF with preserved ejection fraction, understood as complex syndrome, seems to be one of the primary reasons. Here, we present an overview of the current management strategies with available evidence and new therapeutic approach from drugs currently in clinical trials, which target diastolic dysfunction, chronotropic incompetence, and risk factor management. We provide an outline and interpretation of recent clinical trials that failed to improve outcome and survival in patients with HF with preserved ejection fraction.

  7. Strategy of diagnosis and treatment for liver trauma%肝脏损伤的诊断治疗策略

    Institute of Scientific and Technical Information of China (English)

    杨俊

    2016-01-01

    肝脏损伤手术治疗有较高的并发症发生率和死亡率,其治疗策略在过去几十年发生了转变,非手术治疗越来越多地被接受。但对创伤超声重点评估法( FAST)评估腹腔积血并伴有血流动力学状态不稳定、有明显腹膜炎症状的患者需行急诊剖腹探查术。非手术治疗肝脏损伤分级在Ⅳ~Ⅴ级的患者有较高的并发症发生率,需及早地发现并相应处理。手术治疗严重肝脏损伤成功的关键在于合理选择手术方式和及时运用损害控制理念和策略。肝后静脉损伤的主要对策是全肝血流阻断或转流下肝切除或肝切开显露和修补肝后静脉;难以耐受此术式时,肝周填塞是明智的选择。%Surgical intervention of liver trauma has a high liver-related morbidity and mortality, and nonop-erative methods have been more and more accepted as therapeutic strategies in the past decades.However,emergen-cy exploratory laparotomy should be performed if there is unstable hemodynamics and obvious peritonitis indicated by focused abdominal sonography for trauma(FAST).Non-operative treatment of liver injury in patients with Ⅳ-Ⅴgrade had a higher incidence of complications,which should be early discovered and properly treated.The key of surgical treatment for severe liver injury is reasonably selecting surgical approach and timely applying damage control concepts and strategies.The main measure for hepatic vein injury is total hepatic blood flow blockage or liver resec-tion through by-pass procedure or hepatotomy to expose and repair retrohepatic vein.If patients are not able to toler-ate this surgery,it is wise to apply peri-hepatic packing.

  8. Trauma Fact Sheet

    Science.gov (United States)

    ... Home > Science Education > Physical Trauma Fact Sheet Physical Trauma Fact Sheet Tagline (Optional) Middle/Main Content Area ... of physical trauma. Credit: iStock. What is physical trauma? Physical trauma is a serious injury to the ...

  9. 高压氧综合治疗中、重度颅脑外伤68例%Effect of hyperbaric oxygen in the treatment of moderate and severe head trauma in 68 cases

    Institute of Scientific and Technical Information of China (English)

    周宏图; 王建宏; 袁建国; 张雪春

    2003-01-01

    @@ INTRODUCTION Neurotrophic drugs,resting treatment,and proper physical therapy are generally suggested for rehabilitation after head trauma.In recent years,hyperbaric oxygen a new,safe and effective therapy had been used for rehabilitation following head trauma,which is safe,and effective.

  10. Spinal cord trauma in dogs and cats: revision of pathophysiology and medical treatment/ Trauma medular em cães e gatos: revisão da fisiopatologia e do tratamento médico

    Directory of Open Access Journals (Sweden)

    Eduardo Alberto Tudury

    2007-07-01

    Full Text Available Spinal cord trauma is one of the most frequent and serious neurologic entity in clinical practice, due to its production of lesions. Acute spinal cord injury initiates a sequence of vascular, biochemical and inflammatory events that can take to disastrous and frequently irreversible consequences to the motor and sensorial function of the animal. Acute spinal cord trauma should be considered an emergency and fast and appropriate intervention, in an appropriate interval of time, can limit the extension of the damage to the neuronal tissue, favoring neurological recovery. In general, the treatment of spinal cord involves the use of neuroprotective agents to control secondary lesions; and to perform surgery aiming decompression of the injured spinal cord, accomplishing or not the stabilization of the spine. Chronic spinal cord compression may be secondary to diseases that develops gradually, or refers to the effects of spinal cord trauma in the months to years after the acute injury. The main purpose of this paper was to revise the pathophysiology of spinal cord trauma, the medical treatment available, the options for the future and the controversies about the use of some drugs.O trauma medular é uma das entidades neurológicas mais freqüentes e mais graves na prática clínica. A lesão medular aguda inicia uma seqüência de eventos vasculares, bioquímicos e inflamatórios que resultam no desenvolvimento de lesões teciduais secundárias, levando à destruição progressiva do tecido neuronal com conseqüências desastrosas e freqüentemente irreversíveis às funções motora e sensorial do animal. Esta afecção deve ser considerada emergencial, visto que a intervenção rápida e adequada em intervalo de tempo apropriado, pode limitar a extensão dos danos ao tecido neuronal, favorecendo assim a recuperação neurológica do paciente. Em geral, no tratamento da lesão medular aguda são utilizados agentes neuroprotetores, visando o controle

  11. [Interdisciplinary management of trauma patients : Update 3 years after implementation of the S3 guidelines on treatment of patients with severe and multiple injuries].

    Science.gov (United States)

    Donaubauer, B; Fakler, J; Gries, A; Kaisers, U X; Josten, C; Bernhard, M

    2014-11-01

    The recommendations still have to be implemented 3 years after publication of the S3 guidelines on the treatment of patients with severe and multiple injuries. This article reiterates some of the essential core statements of the S3 guidelines and also gives an overview of new scientific studies. In a selective literature search new studies on airway management, traumatic cardiac arrest, shock classification, coagulation therapy, whole-body computed tomography, air rescue and trauma centers were identified and are discussed in the light of the S3 guideline recommendations. The recommendations on airway management are up to date; however, recommendations on difficult airway evaluation tools, e.g. the LEMON law, should be included. The first pass success (i.e. intubation success at the first attempt) must be considered as a quality marker in the future. Video laryngoscopy is identified as a leading airway procedure in order to reach this aim. Recently estimated learning curves for endotracheal intubation and supraglottic airway devices should be implemented in qualification statements. Life-saving emergency interventions have to be performed in the prehospital setting as they do not prolong the complete treatment period for severely injured patients up to discharge from the resuscitation room. The outcome of patients suffering from traumatic cardiac arrest is better than expected. Recently developed algorithms for trauma patients have to be implemented. The prehospital trauma life support (PHTLS) and advanced trauma life support (ATLS) shock classification does not reflect the clinical reality; therefore, lactate, lactate clearance and base deficit should be used for evaluating the shock state in the resuscitation room. Concerning coagulation therapy, tranexamic acid is easy to administer, safe and effective as an antifibrinolytic therapy and should not be restricted to the most severely injured patients. Numerous studies have shown the positive effect of whole

  12. Diagnosis and treatment of duodenal trauma%十二指肠损伤的诊断与治疗

    Institute of Scientific and Technical Information of China (English)

    艾涛; 高劲谋; 胡平; 赵山红; 王建柏

    2014-01-01

    Objective To assess the experience in the diagnosis and treatment of duodenal trauma.Methods The clinical data of 58 patients with duodenal trauma who were admitted to the Chongqing Emergency Medical Center from March 1994 to March 2013 were retrospectively analyzed.There were 47 patients with blunt injury and 11 with penetrating injury.The surgical procedure was selected by patient's condition and extent of injury combined with the clinical symptoms,imaging examination,abdominal puncture and the Organ Injury Scale grading system of the American Association for the Surgery of Trauma (AAST-OIS).All patients were followed up through outpatient examination and telephone interview till September 2013.Results Seventeen patients were diagnosed as with duodenal trauma before operation,and 41 patients were diagnosed during the operation.The injury of the first part of the duodenum was observed in 7 patients,second part in 28 patients,third part in 17 patients and fourth part in 6 patients.According to the AAST-OIS,7 patients were with grade Ⅰ injury,17 in grade Ⅱ,20 in grade m,9 in grade Ⅳ and 5 in grade Ⅴ.The 58 patients received operation,including 23 with simple suture,4 with serosa section,hematoma evacuation and repair,7 with pedicled ileal flap to repair duodenal defect,5 with resection of ruptured intestine and end-to-end anastomosis,12 with Roux-en-Y duodenojejunostomy,2 with gastrojejunostomy,4 with pancreaticoduodenectomy,1 with doudenal,choledochal and pancreatic duct extensive drainage.Forty-eight patients were cured successfully and 10 patients died,including 4 died of complications of the duodenal trauma.The duodenal stenosis,duodenal fistula and abdominal abscess were the main complications.Six patients were lost to follow-up and 42 patients were followed up from 6 to 36 months.There were 3 patients with gastrointestinal tract defect and obstructive symtoms,with a missing of complications at postoperative month 6 to 12.One patient with

  13. Systematic Outpatient Treatment of Sexual Trauma in Women: Application of Cognitive and Behavioral Protocols

    Science.gov (United States)

    Castillo, Diane T.

    2004-01-01

    Effective therapies for treating posttraumatic stress disorder (PTSD) have been described in the literature, particularly cognitive and behavioral interventions, and have consistently demonstrated a reduction in PTSD symptoms. However, the applied versions of cognitive and behavioral treatments offered in most programs diverge from the forms of…

  14. Ozone treatment of alveolar bone in the cape chacma baboon does not enhance healing following trauma.

    Science.gov (United States)

    Kotze, Marthinus; Bütow, Kürt-W; Olorunju, Steve A; Kotze, Harry F

    2014-06-01

    In the international literature, the role of Ozone (O3) in the advancement in alveolar bone healing in the absence of bone pathology was not tested before. The purpose of this study was to evaluate alveolar bone regeneration after a bone defect was created and treated with a single topical administration of O3. Alveolar bone defects were created on five healthy chacma baboons. One side of the maxilla and mandible was topically treated with a single treatment of an O3/O2 mixture (3,5-4 % O3), while the opposite sides were not treated and thus served as control. Regeneration was measured radiologically, using a standardized gray scale, as the increase in bone density in the treatment area at 3 and 6 weeks post-operative and was statistically analyzed using multivariate analysis of variance (MANOVA). There were no significant differences in densities observed between the O3/O2 mixture treatment and the control (p > 0.05). A single O3 treatment did not increase alveolar bone healing over a 3- and 6-week period in the mandible and the maxilla.

  15. The value of surgical treatment in abdominal emergencies : fulminant clostridium difficile colitis and severe abdominal trauma

    NARCIS (Netherlands)

    Wilden, Gwendolyn Mariëtta

    2014-01-01

    This thesis is a combination of traumatic and non-traumatic events in the abdomen, and the optimization of treatment in both entities. The first part describes the very prevalent infection caused by the bacterium Clostridium difficile. The colitis caused by this infection can be severe and complicat

  16. Treatment of Chronic Phantom Limb Pain Using a Trauma-Focused Psychological Approach

    Directory of Open Access Journals (Sweden)

    C de Roos

    2010-01-01

    Full Text Available BACKGROUND: Chronic phantom limb pain (PLP is a disabling chronic pain syndrome for which regular pain treatment is seldom effective. Pain memories resulting from long-lasting preamputation pain or pain flashbacks, which are part of a traumatic memory, are reported to be powerful elicitors of PLP.

  17. Treatment of chronic phantom limb pain using a trauma-focused psychological approach

    NARCIS (Netherlands)

    de Roos, C.; Veenstra, M.A.; de Jongh, A.; den Hollander-Gijsman, M.E.; van der Weer, N.J.A.; Zitman, F.G.; van Rood, Y.R.

    2010-01-01

    BACkgRound: Chronic phantom limb pain (PLP) is a disabling chronic pain syndrome for which regular pain treatment is seldom effective. Pain memories resulting from long-lasting preamputation pain or pain flashbacks, which are part of a traumatic memory, are reported to be powerful elicitors of PLP.

  18. Psychosocial Trauma, Defense Strategies and Treatment Considerations in Cancer Patients and Their Families.

    Science.gov (United States)

    Singer, Barton A.

    1983-01-01

    Discusses the psychosocial impact of cancer on patients and families. Notes that group treatment is especially effective because of curative factors intrinsic to group experience, e.g., installation of hope, universality, and cohesiveness, that allow group members to lower their defensiveness and deal more adaptively with emotional and…

  19. The value of surgical treatment in abdominal emergencies : fulminant clostridium difficile colitis and severe abdominal trauma

    NARCIS (Netherlands)

    Wilden, Gwendolyn Mariëtta

    2014-01-01

    This thesis is a combination of traumatic and non-traumatic events in the abdomen, and the optimization of treatment in both entities. The first part describes the very prevalent infection caused by the bacterium Clostridium difficile. The colitis caused by this infection can be severe and complicat

  20. Efficacy of a trauma-focused treatment approach for dental phobia: a randomized clinical trial

    NARCIS (Netherlands)

    Doering, S.; Ohlmeier, M.C.; de Jongh, A.; Hofmann, A.; Bisping, V.

    2013-01-01

    It has been hypothesized that treatment specifically focused on resolving memories of negative dental events might be efficacious for the alleviation of anxiety in patients with dental phobia. Thirty-one medication-free patients who met the Diagnostic and Statistical Manual of Mental Disorders (DSM-

  1. 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…

  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. Childhood trauma predicts antidepressant response in adults with major depression: data from the randomized international study to predict optimized treatment for depression.

    Science.gov (United States)

    Williams, L M; Debattista, C; Duchemin, A-M; Schatzberg, A F; Nemeroff, C B

    2016-05-03

    Few reliable predictors indicate which depressed individuals respond to antidepressants. Several studies suggest that a history of early-life trauma predicts poorer response to antidepressant therapy but results are variable and limited in adults. The major goal of the present study was to evaluate the role of early-life trauma in predicting acute response outcomes to antidepressants in a large sample of well-characterized patients with major depressive disorder (MDD). The international Study to Predict Optimized Treatment for Depression (iSPOT-D) is a randomized clinical trial with enrollment from December 2008 to January 2012 at eight academic and nine private clinical settings in five countries. Patients (n=1008) meeting DSM-IV criteria for MDD and 336 matched healthy controls comprised the study sample. Six participants withdrew due to serious adverse events. Randomization was to 8 weeks of treatment with escitalopram, sertraline or venlafaxine with dosage adjusted by the participant's treating clinician per routine clinical practice. Exposure to 18 types of traumatic events before the age of 18 was assessed using the Early-Life Stress Questionnaire. Impact of early-life stressors-overall trauma 'load' and specific type of abuse-on treatment outcomes measures: response: (⩾50% improvement on the 17-item Hamilton Rating Scale for Depression, HRSD17 or on the 16-item Quick Inventory of Depressive Symptomatology-Self-Rated, QIDS_SR16) and remission (score ⩽7 on the HRSD17 and ⩽5 on the QIDS_SR16). Trauma prevalence in MDD was compared with controls. Depressed participants were significantly more likely to report early-life stress than controls; 62.5% of MDD participants reported more than two traumatic events compared with 28.4% of controls. The higher rate of early-life trauma was most apparent for experiences of interpersonal violation (emotional, sexual and physical abuses). Abuse and notably abuse occurring at ⩽7 years of age predicted poorer outcomes

  4. Undetected hangman's fracture in a patient referred for physical therapy for the treatment of neck pain following trauma.

    Science.gov (United States)

    Ross, Michael D; Cheeks, John M

    2008-01-01

    This case report describes a patient referred for physical therapy treatment of neck pain who had an underlying hangman's fracture that precluded physical therapy intervention. This case involved a 61-year-old man who had a sudden onset of neck pain after a motor vehicle accident 8 weeks before his initial physical therapy visit. Conventional radiographs of his cervical spine taken on the day of the accident did not reveal any abnormalities. Based on the findings at his initial physical therapy visit, the physical therapist ordered conventional radiographs of the cervical spine to rule out the possibility of an undetected fracture. The radiographs revealed bilateral C2 pars interarticularis defects consistent with a hangman's fracture. The patient was referred to a neurosurgeon for immediate review. Based on a normal neurological examination, a relatively low level of pain, and the results of radiographic flexion and extension views of the cervical spine (which revealed no evidence of instability), the neurosurgeon recommended that the patient continue with nonsurgical management. In patients with neck pain caused by trauma, physical therapists should be alert for the presence of cervical spine fractures. Even if the initial radiographs are negative for a fracture, additional diagnostic imaging may be necessary for a small number of patients, because they may have undetected injuries that would necessitate medical referral and preclude physical therapy intervention.

  5. [The dynamics of the individual profiles of brain asymmetry in patients with craniocerebral trauma under the influence of emoxipin treatment].

    Science.gov (United States)

    Fedulov, A S; Teterkina, T I; Oleshkevich, F V

    1992-01-01

    The authors studied the effect of the drug emoxypin on the brain functional asymmetry (A) in 36 patients with craniocerebral trauma attended by occurrence of focal traumatic injuries (FTI) to the brain (experimental group). The control group consisted of 61 patients who received the traditional intensive therapy for FTI (isolated brain contusion of moderate and severe degree, intracerebral hematomas measuring 30-50 cm3 in volume in the contusion focus). Favorable changes of the brain FA indices in the individual asymmetry profiles were noted, respectively, in 76.7% and 40.9% of patients given and not given emoxypin. Complete normalization of brain FA indices by the 25th-30th day after the beginning of treatment was recorded in 60.9% of patients in the control group and in 37% of those in the experimental group. The dynamics of individual asymmetry profiles in patients with FTI provides evidence that emoxypin improves the attention, mental efficiency, memory capacity, and selectivity of mnemonic processes.

  6. Endovascular stent graft treatment of acute thoracic aortic transections due to blunt force trauma.

    LENUS (Irish Health Repository)

    Bjurlin, Marc A

    2012-02-01

    Endovascular stent graft treatment of acute thoracic aortic transections is an encouraging minimally invasive alternative to open surgical repair. Between 2006 and 2008, 16 patients with acute thoracic aortic transections underwent evaluation at our institution. Seven patients who were treated with an endovascular stent graft were reviewed. The mean Glasgow Coma Score was 13.0, probability of survival was .89, and median injury severity score was 32. The mean number of intensive care unit days was 7.7, mean number of ventilator support days was 5.4, and hospital length of stay was 10 days. Mean blood loss was 285 mL, and operative time was 143 minutes. Overall mortality was 14%. Procedure complications were a bleeding arteriotomy site and an endoleak. Endovascular treatment of traumatic thoracic aortic transections appears to demonstrate superior results with respect to mortality, blood loss, operative time, paraplegia, and procedure-related complications when compared with open surgical repair literature.

  7. Mid- and Long-Term Results of Endovascular Treatment in Thoracic Aorta Blunt Trauma

    Directory of Open Access Journals (Sweden)

    Luigi Irace

    2012-01-01

    Full Text Available Study Aim. Evaluation of results in blunt injury of the thoracic aorta (BAI endovascular treatment. Materials and Methods. Sixteen patients were treated for BAI. Thirteen patients had associated polytrauma, 4 of these had a serious hypotensive status and 4 had an hemothorax. In the remaining 3, two had a post-traumatic false aneurysm of the isthmus and 1 had a segmental dissection. In those 13 patients a periaortic hematoma was associated to hemothorax in 4. All patients were submitted to an endovascular treatment, in two cases the subclavian artery ostium was intentionally covered. Results. One patient died for disseminated intravascular coagulation. No paraplegia was recorded. No ischemic complications were observed. A type I endoleak was treated by an adjunctive cuff. During the followup (1–9 years 3 patients were lost. A good patency and no endoleaks were observed in all cases. One infolding and 1 migration of the endografts were corrected by an adjunctive cuff. Conclusion. The medium and long term results of the endovascular treatment of BAI are encouraging with a low incidence rate of mortality and complications. More suitable endo-suite and endografts could be a crucial point for the further improvement of these results.

  8. Trauma-affected refugees

    DEFF Research Database (Denmark)

    Sonne, Charlotte Kærgaard

    2016-01-01

    Introduction and aim: There is a lack of evidence for evaluating which types of treatment approaches are the most efficient for trauma-affected refugees, especially when it comes to pharmacological treatment. Additionally, only a very few studies have been published on predictors of treatment...... outcomes for this patient group. This omission in evidence constitutes a problem for patients and clinicians as well as for society. Accordingly, this PhD thesis aims to generate new knowledge on pharmacological treatment and predictors of treatment outcome for trauma-affected refugees in order to optimise...... treatment outcome for this patient group. Methods: This thesis includes four papers based on two studies – a literature review and a randomised trial called PTF3: The aim of the literature review was to provide an overview of the existing literature on the pharmacological treatment of refugees with PTSD and...

  9. Trauma-related dissociation and altered states of consciousness: a call for clinical, treatment, and neuroscience research

    National Research Council Canada - National Science Library

    Lanius, Ruth A

    2015-01-01

    The primary aim of this commentary is to describe trauma-related dissociation and altered states of consciousness in the context of a four-dimensional model that has recently been proposed (Frewen & Lanius, 2015...

  10. 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.

  11. TRAUMA SURGERY

    African Journals Online (AJOL)

    utilisation of multiple resources, including blood products, anaesthetic ... surgical management of AVC injuries in the trauma centre at ... Sciences Human Research Ethics Committee. ..... Karinos N, Hayes PM, Nicol AJ, Kahn D. Avoiding futile.

  12. Warfare facial trauma: who will treat?

    Science.gov (United States)

    Holmes, D K

    1996-09-01

    Most of the facial trauma in the United States is treated in trauma centers in large urban or university medical centers, with limited trauma care taking place in our military medical treatment facilities. In many cases, active duty facial trauma surgeons may lack the current experience necessary for the optimal care of facial wounds of our inquired military personnel in the early stages of the conflict. Consequently, the skills of the reservist trauma surgeons who staff our civilian trauma centers and who care for facial trauma victims daily will be critical in caring for our wounded. These "trauma-current" reservists may act as a cadre of practiced surgeons to aid those with less experience. A plan for refresher training of active duty facial trauma surgeons is presented.

  13. THE STUDY OF RESULTS OF SURGICAL TREATMENT OF PATIENTS WITH VERTEBRAL-SPINAL TRAUMA

    Directory of Open Access Journals (Sweden)

    B. Sh. Minasov

    2010-01-01

    Full Text Available A study of the efficacy of medical rehabilitation of 170 patients with spinal-cord injury through the application of modern rehabilitation and surgical technologies was conducted. Patients of I (control group received standard set of conservative treatment and rehabilitation. Patients of II (main group the rehabilitation was supplemented with therapeutic exercises with the use of loop complex «Hope» and the rate of adaptation to the stress of hypoxia in the late period of injury. Patient of III (control group surgical treatment and the conventional range of rehabilitation were performed. Patients of IV (main group the rehabilitation was completed with early activation using espandernogo complex «Hope» and the rate of adaptation to the stress of hypoxia in the late period of injury. It is proved that the developed complex rehabilitation of patients with spinal-cord injury using an early stable functional osteosynthesis with the minimum extent necessary, the use of complex «Hope» can improve the functional results at the expense of early motor activation, preventing the formation of contractures and muscle atrophy. The use of adaptation to the stress of hypoxia in the late period of vertebro-spinal cord injury improves overall health, reduces the severity of autonomic reactions, emotional stress, can cut pain syndromes.

  14. Long-Term Course of Failed Back Surgery Syndrome (FBSS) Patients Receiving Integrative Korean Medicine Treatment: A 1 Year Prospective Observational Multicenter Study

    Science.gov (United States)

    Lee, Jinho; Shin, Joon-Shik; Lee, Yoon Jae; Kim, Me-riong; Choi, Areum; Lee, Jun-Hwan; Shin, Kyung-Min; Shin, Byung-Cheul; Cho, Jae-Heung

    2017-01-01

    Background With increase of spine surgeries, failed back surgery syndrome (FBSS) prevalence is also rising. While complementary and alternative medicine (CAM) is commonly used for low back pain (LBP), there are no studies reporting use of integrative Korean medicine in FBSS patients. Methods Patients with pain continuing after back surgery or recurring within 1 year and visual analogue scale (VAS) of LBP or leg pain of ≥6 (total n = 120) were recruited at 2 hospital sites from November 2011 to September 2014. Weekly sessions of integrative Korean medicine treatment were conducted for 16 weeks (herbal medicine, acupuncture/electroacupuncture, pharmacopuncture/bee venom pharmacopuncture, and Chuna manual therapy) with additional follow-ups at 24 weeks and 1 year. Outcome measures included VAS of LBP and leg pain (primary outcome), Oswestry Disability Index (ODI), Short-Form 36 (SF-36), medical use, and patient global impression of change (PGIC). Results VAS of LBP and leg pain improved at 6 months (LBP from 6.1±2.0 at baseline to 2.9±2.3; and leg pain from 5.4±2.6 to 2.4±2.5, respectively). Eighty patients (66.7%) showed improvement of 50% or more in main pain of LBP or leg pain from baseline. Disability and quality of life also improved at 6 months (ODI from 41.3±12.3 at baseline to 23.6±13.6; and SF-36 from 42.8±14.5 to 62.7±16.8). At 1 year follow-up, conventional medical management use decreased, improvement in pain and disability was maintained, and 79.2% reported improvement of PGIC. Conclusions Despite limitations as an observational study, integrative Korean medicine treatment showed positive results in pain, function, and quality of life of FBSS patients. PMID:28129399

  15. A Retrospective Study of Capecitabine/Temozolomide (CAPTEM Regimen in the Treatment of Metastatic Pancreatic Neuroendocrine Tumors (pNETs after Failing Previous Therapy

    Directory of Open Access Journals (Sweden)

    Muhammad Wasif Saif

    2013-09-01

    Full Text Available Context Pancreatic neuroendocrine tumors (pNETs are notoriously resistant to currently available chemotherapy agents.Preclinical data has suggested synergy between temozolomide and capecitabine. Objective To report a retrospective data on the efficacy and safety of capecitabine and temozolomide (CAPTEM regimen in patients with metastatic pancreaticneuroendocrine tumors (pNETs who have failed prior therapies. Methods We reviewed the medical records of 7 patientswith metastatic pNETs who had had progressive cancer prior to treatment despite therapy, including long-acting releaseoctreotide (60 mg/month, chemotherapy and hepatic chemoembolization. Capecitabine was administered at a flat dose of1,000 mg orally twice daily on days 1-14 and temozolomide 200 mg/m2 was given in two divided doses daily on days 10-14of a 28-day cycle. Tumor assessments were repeated every two cycles and serum tumor markers were measured every cycle. Response to treatment was assessed using Response Evaluation Criteria in Solid Tumors (RECIST parameters, and toxicity was graded using the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE, version 3.0. Results Among 7 patients treated, three patients achieved a partial response, and two patients had stable disease. Totalresponse rate was 43%, and clinical benefit (responders and stable disease was 71%. Median duration of response was 8months (range: 4-12 months. Grade 3 and 4 toxicities included grade 3 thrombocytopenia in one patient and grade 3 fatigue in one patient. The most common toxicities were grade 1 and 2 neutropenia, grade 1 fatigue, grade 1 and 2 hand-foot syndrome. Conclusions Our retrospective study showed that modified CAPTEM regimen was well-tolerated and produced comparable response to historical data in neuroendocrine tumors, including pNETs. Our study is unique as it only included patients with pNETs. Further prospective studies are warranted to evaluate the combination of

  16. The use of urinary bladder matrix in the treatment of trauma and combat casualty wound care.

    Science.gov (United States)

    Valerio, Ian L; Campbell, Paul; Sabino, Jennifer; Dearth, Christopher L; Fleming, Mark

    2015-01-01

    Treatment of combat injuries and resulting wounds can be difficult to treat due to compromised and evolving tissue necrosis, environmental contaminants, multidrug resistant microbacterial and/or fungal infections, coupled with microvascular damage and/or hypovascularized exposed vital structures. Our group has developed surgical care algorithms with identifiable salvage techniques to achieve stable, definitive wound coverage often with the aid of certain regenerative medicine biologic scaffold materials and advanced wound care to facilitate tissue coverage and healing. This case series reports on the role of urinary bladder matrix scaffolds in the wound care and reconstruction of traumatic and combat wounds. Urinary bladder matrix was found to facilitate definitive soft tissue reconstruction by establishing a neovascularized soft tissue base acceptable for second stage wound and skin coverage options within traumatic and combat-related wounds.

  17. The use of virtual surgical planning and navigation in the treatment of orbital trauma

    Directory of Open Access Journals (Sweden)

    Alan Scott Herford

    2017-02-01

    Full Text Available Virtual surgical planning (VSP has recently been introduced in craniomaxillofacial surgery with the goal of improving efficiency and precision for complex surgical operations. Among many indications, VSP can also be applied for the treatment of congenital and acquired craniofacial defects, including orbital fractures. VSP permits the surgeon to visualize the complex anatomy of craniofacial region, showing the relationship between bone and neurovascular structures. It can be used to design and print using three-dimensional (3D printing technology and customized surgical models. Additionally, intraoperative navigation may be useful as an aid in performing the surgery. Navigation is useful for both the surgical dissection as well as to confirm the placement of the implant. Navigation has been found to be especially useful for orbit and sinus surgery. The present paper reports a case describing the use of VSP and computerized navigation for the reconstruction of a large orbital floor defect with a custom implant.

  18. Outcomes and National Trends for the Surgical Treatment of Lumbar Spine Trauma

    Science.gov (United States)

    Nuno, Miriam; Shweikeh, Faris; Vaccaro, Alexander R.; Baron, Eli; Kim, Terrence T.; Johnson, J. Patrick

    2016-01-01

    Introduction. Operative treatment of lumbar spine compression fractures includes fusion and/or cement augmentation. Our aim was to evaluate postoperative differences in patients treated surgically with fusion, vertebroplasty, or kyphoplasty. Methods. The Nationwide Inpatient Sample Database search for adult vertebral compression fracture patients treated 2004–2011 identified 102,316 surgical patients: 30.6% underwent spinal fusion, 17.1% underwent kyphoplasty, and 49.9% underwent vertebroplasty. Univariate analysis of patient and hospital characteristics, by treatment, was performed. Multivariable analysis was used to determine factors associated with mortality, nonroutine discharge, complications, and patient safety. Results. Average patient age: fusion (46.2), kyphoplasty (78.5), vertebroplasty (76.7) (p < .0001). Gender, race, household income, hospital-specific characteristics, and insurance differences were found (p ≤ .001). Leading comorbidities were hypertension, osteoporosis, and diabetes. Risks for higher mortality (OR 2.0: CI: 1.6–2.5), nonroutine discharge (OR 1.6, CI: 1.6–1.7), complications (OR 1.1, CI: 1.0–1.1), and safety related events (OR 1.1, CI: 1.0–1.1) rose consistently with increasing age, particularly among fusion patients. Preexisting comorbidities and longer in-hospital length of stay were associated with increased odds of nonroutine discharge, complications, and patient safety. Conclusions. Fusion patients had higher rates of poorer outcomes compared to vertebroplasty and kyphoplasty cohorts. Mortality, nonroutine discharge, complications, and adverse events increased consistently with older age. PMID:27403423

  19. Outcomes and National Trends for the Surgical Treatment of Lumbar Spine Trauma

    Directory of Open Access Journals (Sweden)

    Doniel Drazin

    2016-01-01

    Full Text Available Introduction. Operative treatment of lumbar spine compression fractures includes fusion and/or cement augmentation. Our aim was to evaluate postoperative differences in patients treated surgically with fusion, vertebroplasty, or kyphoplasty. Methods. The Nationwide Inpatient Sample Database search for adult vertebral compression fracture patients treated 2004–2011 identified 102,316 surgical patients: 30.6% underwent spinal fusion, 17.1% underwent kyphoplasty, and 49.9% underwent vertebroplasty. Univariate analysis of patient and hospital characteristics, by treatment, was performed. Multivariable analysis was used to determine factors associated with mortality, nonroutine discharge, complications, and patient safety. Results. Average patient age: fusion (46.2, kyphoplasty (78.5, vertebroplasty (76.7 (p<.0001. Gender, race, household income, hospital-specific characteristics, and insurance differences were found (p≤.001. Leading comorbidities were hypertension, osteoporosis, and diabetes. Risks for higher mortality (OR 2.0: CI: 1.6–2.5, nonroutine discharge (OR 1.6, CI: 1.6–1.7, complications (OR 1.1, CI: 1.0–1.1, and safety related events (OR 1.1, CI: 1.0–1.1 rose consistently with increasing age, particularly among fusion patients. Preexisting comorbidities and longer in-hospital length of stay were associated with increased odds of nonroutine discharge, complications, and patient safety. Conclusions. Fusion patients had higher rates of poorer outcomes compared to vertebroplasty and kyphoplasty cohorts. Mortality, nonroutine discharge, complications, and adverse events increased consistently with older age.

  20. Assessment of degree of trauma and levator ani muscle contraction function after pelvic floor reconstruction and traditional surgical treatment of pelvic organ prolapse

    Institute of Scientific and Technical Information of China (English)

    Chun-Hua Zhu; Yu-Fei Ni

    2016-01-01

    Objective:To study the degree of trauma and levator ani muscle contraction function after pelvic floor reconstruction and traditional surgical treatment of pelvic organ prolapse. Methods:Patients with III-IV pelvic organ prolapse who received surgical treatment in our hospital between May 2011 and October 2015 were randomly divided into observation group who received vaginal hysterectomy combined with pelvic floor reconstruction and control group who received vaginal hysterectomy combined with colporrhaphy, and then the degree of trauma, urodynamics and levator ani muscle contraction function were compared between two groups of patients.Results: Operating time, intraoperative blood loss as well as serum CRP, IL-1β, TNF-α, Ins, NE and E content were not significantly different between two groups (P>0.05); 2 weeks after operation, maximum bladder volume and QMax of observation group were significantly higher than those of control group, PdetQMax, PdetMax and PVR were significantly lower than those of control group (P0.05), LAT under Valsalva maneuver was significantly more than that of control group while LHS under Valsalva maneuver was significantly less than that of control group (P<0.05).Conclusions:Pelvic floor reconstruction treatment of pelvic organ prolapse has equivalent degree of surgical trauma to traditional surgery, and has better effect on improving the urination function and levator ani muscle contraction function than traditional surgery.

  1. Higher FKBP5, COMT, CHRNA5, and CRHR1 allele burdens are associated with PTSD and interact with trauma exposure: implications for neuropsychiatric research and treatment

    Directory of Open Access Journals (Sweden)

    Boscarino JA

    2012-03-01

    interacts with risk allele count, such that PTSD is increased in those with higher risk allele counts and higher trauma exposures. Since the single nucleotide polymorphisms studied encompass stress circuitry and addiction biology, these findings may have implications for neuropsychiatric research and treatment.Keywords: posttraumatic stress disorder, genetic association study, single nucleotide polymorphism, risk alleles, trauma exposure, neuroticism, childhood adversity

  2. Experience in the surgical treatment of 16 cases of cardiac rupture caused by blunt chest trauma%闭合性胸部外伤致心脏破裂16例

    Institute of Scientific and Technical Information of China (English)

    李晓峰; 马建欣; 刘建伟; 雷威

    2012-01-01

    Objective To retrospectively analyze the experience in the treatment of cardiac rupture caused by blunt chest trauma and to explore the approaches and methods to improve patient survival.Methods From 2004 to 2010,16 cases of closed chest trauma caused by cardiac rupture,who were treated in our hospital,were treated by heart repair using median sternotomy incision approach.Results Except for 1 patient occurred cardiac arrest before the establishment of CPB,who was failed for cardiopulmonary resuscitation after surgical repair,the remaining 15 patients were all successfully treated.Conclusion The diagnosis of cardiac rupture should be made as soon as possible once it occurs.Timely and decisive rescue and emergency surgery should be given.Heart repair can greatly improve the patient's survival.%目的 探讨闭合性胸部外伤致心脏破裂的手术抢救入路与方法.方法 2004年1月至2010年12月我院抢救闭合性胸部外伤致心脏破裂患者16例,均采用胸骨正中切口行心脏破裂修补术,分析其效果.结果 除1例在体外循环建立前出现心跳停止、手术修补后心肺复苏失败外,余15例全部救治成功.结论 闭合性胸部外伤致心脏破裂应及时果断进行抢救和急诊手术,心脏破裂修补术可以提高患者的存活率.

  3. [Psychosocial treatment of psychological post trauma in post-conflict countries].

    Science.gov (United States)

    Liscia, T; Milleliri, J

    2011-04-01

    Violence and armed conflict situations besetting numerous developing countries inflict a heavy toll on populations, especially in terms of posttraumatic mental disorders. In addition to upsetting the well-being and psychic balance of people, violent political instability prevents development of the country as a whole not only economically but also individually and socially. After being confronted with this reality for years, humanitarian workers have implemented actions aimed at treating and helping traumatized people to recover their mental health as a first step to achieving effective and durable development. However, despite the availability of effective low-cost treatment for post-traumatic mental disorders, officials in developing countries as well as in international organizations continue to ignore or neglect this crucial issue. This article is based on a study carried out by "Crisis prevention and post-conflict unit" of the Agence Française de Développement. The purpose is to underline the need and describe available methods for management of post-traumatic stress disorders in populations of post-conflict countries, as prerequisite for sustainable reconstruction and development.

  4. Development of an interactive dental trauma guide

    DEFF Research Database (Denmark)

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

    2009-01-01

    resulting in 54 trauma scenarios of which many have specific requirements for treatment The situation is further complicated by the fact that the two dentitions have very different treatment demands. As a result it's impossible even for experienced practitioners to provide evidence-based treatment...... be available on the internet at: "www.DentalTraumaGuide.org". We hope that the Dental Trauma Guide can help improve the knowledge about dental traumatology worldwide and hereby improve the quality of treatment....

  5. Development of an interactive dental trauma guide

    DEFF Research Database (Denmark)

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

    2009-01-01

    resulting in 54 trauma scenarios of which many have specific requirements for treatment The situation is further complicated by the fact that the two dentitions have very different treatment demands. As a result it's impossible even for experienced practitioners to provide evidence-based treatment...... be available on the internet at: "www.DentalTraumaGuide.org". We hope that the Dental Trauma Guide can help improve the knowledge about dental traumatology worldwide and hereby improve the quality of treatment....

  6. Endodontic treatment of trauma-induced necrotic immature teeth using a tricalcium silicate-based bioactive cement. A report of 3 cases with 24-month follow-up.

    Science.gov (United States)

    Martens, L; Rajasekharan, S; Cauwels, R

    2016-03-01

    Pulp necrosis is the second most common complication after traumatic dental injuries and occurs mostly within the first 6-24 months of follow-up period, depending on the type of dental trauma. Three cases with endodontic treatment scenarios of trauma-induced necrosis in immature permanent anterior teeth. All cases were treated by full canal obturation with Biodentine (Septodont, Saint Maur des Fosses, France) and documented for a follow-up period of 24 months. Copious irrigation of the root canal, minimal mechanical preparation, use of calcium hydroxide for a short period of time and complete obturation of these immature teeth with a bioactive cement with superior mechanical properties such as Biodentine were the prominent reasons attributed to the success of these three cases.

  7. 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.

  8. Oral and maxillofacial trauma, 194 cases of clinical treatment experience%口腔颌面外伤194例临床治疗体会

    Institute of Scientific and Technical Information of China (English)

    吴龑

    2015-01-01

    Objective Analysis of oral and maxillofacial trauma, clinical treatment experience. methods Review of 194 patients admitted in our hospital in May 2010 to October 2012, oral and maxillofacial trauma patients clinical data, and take corresponding measures according to actual situation, analysis of patients with curative effect.Results 194 patients with oral and maxillofacial trauma cured by corresponding treatment, 102 cases of stage I wound healing, the patients with injury of soft tissue wound skin graft patients recovered well after 2 cases; Patients with maxillofacial bone fracture occlusal function returned to normal after treatment 87 cases, the recovery of facial appearance is good, two and a half to open mouth degrees. Teeth trauma patients with dental arch splint fixation treatment of 5 cases, demolition of plywood for teeth were fixed.Conclusion Oral and maxillofacial trauma patients with damage based on the actual situation, soft tissue injuries should be early debridement suture, should fracture reduction and ifxation, early early postoperative exercise activities, to try to restore the jaw joints function.%目的:分析口腔颌面外伤临床治疗体会。方法回顾我院2010年5月~2012年10月收治的口腔颌面外伤患者194例临床资料,并根据实际情况采取相应处理措施,分析患者疗效。结果194例口腔颌面外伤患者经相应处理治愈,软组织损伤患者伤口Ⅰ期愈合102例,创面后植皮患者恢复良好2例;颌面骨骨折患者治疗后咬合功能恢复正常87例,面部外观恢复良好,张口度两指半。牙外伤患者经牙弓夹板固定治疗5例,拆除夹板后患牙均固定。结论口腔颌面外伤患者经根据损伤实际情况,软组织损伤者需尽早清创缝合,骨折部位应早期复位固定,术后早期作活动锻炼,以此尽量恢复颞颌关节功能。

  9. Clinical management of abdominal trauma

    Institute of Scientific and Technical Information of China (English)

    FANG Guo-en; LUO Tian-hang; DU Cheng-hui; BI Jian-wei; XUE Xu-chao; WEI Guo; WENG Zhao-zhang; MA Li-ye; HUA Ji-de

    2008-01-01

    Objective: To improve the prognosis of patients with abdominal trauma. Methods: Between January 1993 and December 2005, 415 patients were enrolled in this research. The patients consisted of 347 males and 68 females with mean age of 36 years ranging from 3-82 years. All abdominal traumas consisted of closed traumas 360 cases, 86.7% and open traumas 55 cases, 13.3%. Results: Atotal of 407 cases 98.1% were fully recovered from trauma and the other 8 cases 1.9% died of multiple injuries. The mean injury severity score ISS of all patients was 22 while the mean ISS of the patients who died in hospital was 42. Postoperative complications were seen in 9 patients such as infection of incisional wounds 6 cases, pancreatic fistula 2 cases and intestinal fistula 1 case. All these postoperative complications were cured by the conservative treatment. Conclusion: Careful case history inquisition and physical examination are the basic methods to diagnose abdomi- nal trauma. Focused abdominal ultrasonography is always the initial imaging examination because it is non-invasive and can be performed repeatedly with high accuracy. The doctors should consider the severity of local injuries and the general status of patients during the assessment of abdominal trauma. The principle of treatment is to save lives at first, then to cure the injuries. Unnecessary laparotomy should be avoided to reduce additional surgical trauma.

  10. Children and Facial Trauma

    Science.gov (United States)

    ... an ENT Doctor Near You Children and Facial Trauma Children and Facial Trauma Patient Health Information News ... staff at newsroom@entnet.org . What is facial trauma? The term facial trauma means any injury to ...

  11. IVIG – A cure to severe refractory NAP-1 Clostridium difficile colitis? A case of successful treatment of severe infection, which failed standard therapy including fecal microbiota transplants and fidaxomicin

    Directory of Open Access Journals (Sweden)

    Kelley Coffman

    2017-01-01

    Full Text Available The mainstay treatment of Clostridium difficile infections (CDI is antimicrobials with growing support for fecal microbiota transplants. We report the first case of an elderly man with severe refractory NAP-1 pseudomembranous CDI who failed all medical therapy and two fecal transplants with response only seen after administration of intravenous immunoglobulin.

  12. Encapsulated living choroid plexus cells: potential long-term treatments for central nervous system disease and trauma

    Science.gov (United States)

    Skinner, S. J. M.; Geaney, M. S.; Lin, H.; Muzina, M.; Anal, A. K.; Elliott, R. B.; Tan, P. L. J.

    2009-12-01

    In neurodegenerative disease and in acute brain injury, there is often local up-regulation of neurotrophin production close to the site of the lesion. Treatment by direct injection of neurotrophins and growth factors close to these lesion sites has repeatedly been demonstrated to improve recovery. It has therefore been proposed that transplanting viable neurotrophin-producing cells close to the trauma lesion, or site of degenerative disease, might provide a novel means for continuous delivery of these molecules directly to the site of injury or to a degenerative region. The aim of this paper is to summarize recent published information and present new experimental data that indicate that long-lasting therapeutic implants of choroid plexus (CP) neuroepithelium may be used to treat brain disease. CP produces and secretes numerous biologically active neurotrophic factors (NT). New gene microarray and proteomics data presented here indicate that many other anti-oxidant, anti-toxin and neuronal support proteins are also produced and secreted by CP cells. In the healthy brain, these circulate in the cerebrospinal fluid through the brain and spinal cord, maintaining neuronal networks and associated cells. Recent publications describe how transplanted CP cells and tissue, either free or in an immunoprotected encapsulated form, can effectively deliver therapeutic molecules when placed near the lesion or site of degenerative disease in animal models. Using simple techniques, CP neuroepithelial cell clusters in suspension culture were very durable, remaining viable for 6 months or more in vitro. The cell culture conditions had little effect on the wide range and activity of genes expressed and proteins secreted. Recently, completed experiments show that implanting CP within alginate-poly-ornithine capsules effectively protected these xenogeneic cells from the host immune system and allowed their survival for 6 months or more in the brains of rats, causing no adverse effects

  13. Comparison of the effectiveness of trauma-focused cognitive behavioral therapy and paroxetine treatment in PTSD patients: Design of a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Polak A

    2012-10-01

    Full Text Available Abstract Background The two most common interventions for Posttraumatic Stress Disorder (PTSD are pharmacological treatment with SSRIs such as paroxetine and psychological treatment such as Trauma-Focused Cognitive Behavioral Therapy (TF-CBT. International guidelines recommend trauma-focused psychological interventions for all PTSD patients as first-line treatment (NICE. However, no clear-cut evidence is available to support this recommendation. Methods/design In order to compare pharmacological treatment (paroxetine and psychological treatment (TF-CBT in (cost- effectiveness on the short and the long term, we will randomize 90 patients with chronic PTSD to either paroxetine (24 weeks or TF-CBT (10–12 weeks. We will assess symptom severity and costs before and after the intervention with the Clinician Administered PTSD Scale (CAPS, the Clinical Global Impression Scale (CGI and the Trimbos/iMTA questionnaire for Costs associated with Psychiatric Illness (TiC-P. Discussion This study is unique for its direct comparison of the most commonly used psychological intervention (TF-CBT and pharmacological intervention (paroxetine on (cost- effectiveness on the short and the long term. The anticipated results will provide relevant evidence concerning long-term effects and relapse rates and will be beneficial in reducing societal costs. It may also provide information on who may benefit most from which type of intervention. Some methodological issues will be discussed. Trial Registration Dutch Trial registration: NTR2235

  14. Absence of verbal recall or memory for symptom acquisition in fear and trauma exposure: a conceptual case for fear conditioning and learned nonuse in assessment and treatment.

    Science.gov (United States)

    Seifert, A Ronald

    2012-01-01

    Absence of memory or verbal recall for symptom acquisition in fear and trauma exposure, as well as absence of successful coping behavior for life events, is associated with a number of diagnoses, including traumatic brain injury, posttraumatic stress disorder, pain, and anxiety. The difficulty with diagnosis and treatment planning based on the absence of recall, memory, and successful coping behavior is threefold: (1) these assessments do not distinguish between disruption of behavior and lack of capacity, (2) the absence of verbal recall and memory complicates cognitive-based treatment, and (3) a confounding issue is the same absent behavior can be observed at different times and contexts. While memory of the specific details of the initial traumatic event(s) may not be available to verbal report, the existence of time- and context-dependent relationships for the initial as well as subsequent experiences is arguable. The absence of memory or lack of verbal recall does not rule out measurable physiological bodily responses for the initial trauma(s), nor does it help to establish the effects of subsequent experiences for symptom expression. Also, the absence of memory must include the prospect of fear-based learning that does not require or involve the cortex. It is posited that the literatures of fear conditioning and learned nonuse provide complementary illustrations of how the time and context of the initial trauma(s) and subsequent experiences affect behavior, which is not dependent on the effected individual being able to provide a memory-based verbal report. The replicated clinical application demonstrates that, without scientific demonstration, neither neuroanatomy nor verbal report can be assumed sufficient to predict overt behavior or physiologic responses. For example, while commonly assumed to be predictively so, autonomic nervous system innervation is insufficient to define the unique stimulus- and context-dependent physiological responses of an

  15. 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...

  16. Trauma Ultrasound.

    Science.gov (United States)

    Wongwaisayawan, Sirote; Suwannanon, Ruedeekorn; Prachanukool, Thidathit; Sricharoen, Pungkava; Saksobhavivat, Nitima; Kaewlai, Rathachai

    2015-10-01

    Ultrasound plays a pivotal role in the evaluation of acute trauma patients through the use of multi-site scanning encompassing abdominal, cardiothoracic, vascular and skeletal scans. In a high-speed polytrauma setting, because exsanguinations are the primary cause of trauma morbidity and mortality, ultrasound is used for quick and accurate detection of hemorrhages in the pericardial, pleural, and peritoneal cavities during the primary Advanced Trauma Life Support (ATLS) survey. Volume status can be assessed non-invasively with ultrasound of the inferior vena cava (IVC), which is a useful tool in the initial phase and follow-up evaluations. Pneumothorax can also be quickly detected with ultrasound. During the secondary survey and in patients sustaining low-speed or localized trauma, ultrasound can be used to help detect abdominal organ injuries. This is particularly helpful in patients in whom hemoperitoneum is not identified on an initial scan because findings of organ injuries will expedite the next test, often computed tomography (CT). Moreover, ultrasound can assist in detection of fractures easily obscured on radiography, such as rib and sternal fractures.

  17. The Process of the Treatment of Cognitive Dysfunction after Craniocerebral Trauma%颅脑外伤后认知功能障碍的治疗进展

    Institute of Scientific and Technical Information of China (English)

    江玥; 张安仁

    2015-01-01

    认知功能障碍是颅脑损伤后常见的功能障碍,可表现为注意力困难、记忆力降低、执行功能、推理、判断、思维等各种能力的缺失。脑外伤后认知功能障碍的程度与康复训练的疗效直接相关,本文回顾近年文献,从药物治疗、针灸治疗、中药治疗、高压氧疗法、重复经颅磁刺激、康复训练等方面总结颅脑外伤后认知功能障碍的治疗进展。%Cognitive dysfunction is a common dysfunction after craniocerebral trauma, which can be expressed as attention difficulty, memory reduc-tion and the lack of abilities such as executive function, reasoning, judgement and thinking. The degree of cognitive dysfunction after craniocerebral trauma is directly related to the efficacy of rehabilitation training, this article would review the literatures in recent years, summarize the process of treatment of cognitive dysfunction after craniocerebral trauma from aspects such as medication, acupuncture therapy, herbal medication, hyperbaric oxygenation therapy, repetitive transcranial magnetic stimulation and rehabilitation trainning.

  18. The association between detected drug resistance mutations and CD4(+) T-cell decline in HIV-positive individuals maintained on a failing treatment regimen

    DEFF Research Database (Denmark)

    Schultze, Anna; Paredes, Roger; Sabin, Caroline

    2017-01-01

    BACKGROUND: To analyse the effect of drug resistance mutations (DRM) on CD4 cell trends in HIV-positive people maintained on virologically failing antiretroviral therapy (ART). METHODS: Individuals from two large cohorts experiencing virological failure (VF) while maintained on ART with >1 CD4 co...

  19. Essential Trauma Care: strengthening trauma systems round the world.

    Science.gov (United States)

    Joshipura, Manjul; Mock, Charles; Goosen, Jacques; Peden, Margie

    2004-09-01

    Injury has become a major cause of death and disability world-wide. Systematic approaches to its prevention and treatment are needed. In terms of treatment, there are many low-cost improvements that could be made particularly in low- and middle-income countries to strengthen their trauma systems. These can be formalised under "Essential Trauma Care" programme, similar to other global programmes for major public health problems. World Health Organisation (WHO), leading the initiative in this direction, convened a meeting at Geneva in June 2002, involving Injuries and Violence Prevention Department of the WHO, the Working Group for Essential Trauma Care of the International Association for Trauma and Surgical Intensive Care (IATSIC), representatives of other organisations and trauma care clinicians representing Africa, Asia, and Latin America. The meeting developed a preliminary list of Essential Trauma Care services and a model template for the skills and equipment needed to assure them. It is intended to be used to assist individual countries in planning their own trauma care services.

  20. History of the Dental Trauma Guide.

    Science.gov (United States)

    Andreasen, Jens Ove; Ahrensburg, Søren Steno

    2012-10-01

    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-term follow-up of various trauma entities. This has resulted in 79 clinical studies, and 64 studies in monkeys have examined the effect of various treatment procedures and the aetiology of most healing complications.

  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......-term follow-up of various trauma entities. This has resulted in 79 clinical studies, and 64 studies in monkeys have examined the effect of various treatment procedures and the aetiology of most healing complications....

  2. 严重钝性胸部外伤伴大量血胸的手术治疗%Blunt thoracic trauma partner massive hemothoraxes surgery treatment

    Institute of Scientific and Technical Information of China (English)

    邹恭道; 苏永红; 李鸣

    2012-01-01

    Objective To introduce the clinical experience the surgical operation treats the serious blunt thoracic trauma partner massive hemothoraxes. Methods Scases at the shock condition the serious blunt thoracic trauma partner massive hemo-thoraxes patient while anti- shock, the emergency medical treatment execution chest operation stops bleeding the surgery. Results 4 cases cure leave the hospital. After the operation the 5-10th day wiping out chest cavity drainage tube, 1 case once appeared separately stress ulcer, convalesced after the just right for the illness treatment; 1 case appears the pyothorax, but died because of the economical difficult giving up treatment. Conclusion The serious blunt thoracic trauma patient which continues the chest cavity internal hemorrhage should accumulate thoracotomy.%目的 介绍外科手术治疗严重钝性胸部外伤伴大量血胸的临床经验.方法 对5例处于休克状态的严重钝性胸部外伤伴大量血胸的患者在抗休克的同时,急诊施行剖胸止血手术.结果 4例均治愈出院,分别在术后第5~10天拔除胸腔引流管,其中1例曾出现应激性溃疡,经对症治疗后痊愈;1例出现脓胸,因经济困难放弃治疗而出院.结论 伴有持续胸腔内出血的严重钝性胸部外伤患者,应积极行剖胸探查术.

  3. 睾丸外伤35例临床分析%Diagnosis and treatment of 35 cases of testicular trauma

    Institute of Scientific and Technical Information of China (English)

    杨金成; 陈征儒

    2012-01-01

      Objective To improve the diagnosis and treatment of testicular trauma. The method of analysis of the comparative testicular trauma surgery and conservative treatment. Results of surgical repair in 26 cases of testicular scrotal fall pain disappeared in only two cases (9%) more than three and one cases of blood testosterone decreased, semen is normal, patients with bilateral testicular trauma reduction of sperm. Behind the conservative treatment group of nine cases in the scrotum falling pain in March mitigate or disappeared in 5 cases, 5 cases of testicular atrophy (56%), of which four cases of examination of sperm, one cases of sperm reduction. Conclusion early surgical exploration to remove the hematoma, removal of the testicular tissue of the prominent albuginea outside trim, stitching albuginea, place an effective drainage, can effectively eliminate the symptoms and reduce the possibility of testicular atrophy and orchiectomy.%  目的:提高睾丸外伤的诊治水平及预后。方法:分析比较睾丸外伤手术及保守治疗的效果。结果:手术修补睾丸26例中阴囊坠痛感超过3个月消失者仅2例(9%),保守治疗组9例中阴囊坠痛感3月后方减轻或消失者5例,5例睾丸萎缩(56%),其中4例检查无精子,1例精子量减少。结论:早期手术探查,阴囊血肿的清除引流、坏死组织的切除及白膜缝合修补,能有效降低睾丸萎缩及睾丸切除可能性。

  4. 刘寿山筋伤手法治疗运动性腰部筋伤临床治验%Application of the Eight Treatment Methods of Tendon Trauma Established bv Liu Shou.shan on Treating Exercise - Induced Tendon Trauma of Waist

    Institute of Scientific and Technical Information of China (English)

    姜幸福; 张雅薇

    2011-01-01

    目的:总结著名中医骨伤学家刘寿山先生独特的"刘氏治筋八法"并将之运用于临床.方法:运用刘老的"拔、戳、捻、散、捋、顺、归、合"八种手法的综合方法治疗运动性腰部筋伤.结果与结论:刘寿山先生的"治筋八法"具有和缓细腻,柔中寓刚,刚中藏巧的特点,运用于运动员腰部筋伤具有满意的临床效果.%Objective:To summarize the" eight treatment methods of tendon trauma" established by Liu Shou-shan who was the famous physician in orthopedics department of Traditional Chinese Medicine,then to use it in clinical practice. Methods:To treat Exercise -induced tendon trauma of waist by comprehensive of the eight treatment methods of tendon trauma. Results and Conclusion: Liu Shoushan' s treatment methods of tendon trauma showed the features that were gentleness, combination with heaviness and lightness. It has good clinical efficacy in the treatment of tendon trauma of waist of athletes.

  5. EAU Guidelines on Urethral Trauma.

    Science.gov (United States)

    Martínez-Piñeiro, Luis; Djakovic, Nenad; Plas, Eugen; Mor, Yoram; Santucci, Richard A; Serafetinidis, Efraim; Turkeri, Levent N; Hohenfellner, Markus

    2010-05-01

    These guidelines were prepared on behalf of the European Association of Urology (EAU) to assist urologists in the management of traumatic urethral injuries. To determine the optimal evaluation and management of urethral injuries by review of the world's literature on the subject. A working group of experts on Urological Trauma was convened to review and summarize the literature concerning the diagnosis and treatment of genitourinary trauma, including urethral trauma. The Urological Trauma guidelines have been based on a review of the literature identified using on-line searches of MEDLINE and other source documents published before 2009. A critical assessment of the findings was made, not involving a formal appraisal of the data. There were few high-powered, randomized, controlled trials in this area and considerable available data was provided by retrospective studies. The Working Group recognizes this limitation. The full text of these guidelines is available through the EAU Central Office and the EAU website (www.uroweb.org). This article comprises the abridged version of a section of the Urological Trauma guidelines. Updated and critically reviewed Guidelines on Urethral Trauma are presented. The aim of these guidelines is to provide support to the practicing urologist since urethral injuries carry substantial morbidity. The diversity of urethral injuries, associated injuries, the timing and availability of treatment options as well as their relative rarity contribute to the controversies in the management of urethral trauma. Copyright © 2010 European Association of Urology. Published by Elsevier B.V. All rights reserved.

  6. When physical intuition fails

    OpenAIRE

    Singh, Chandralekha

    2016-01-01

    We analyze the problem solving strategies of physics professors in a case where their physical intuition fails. A non-intuitive introductory-level problem was identified and posed to twenty physics professors. The problem placed the professors in a situation often encountered by students, and their response highlights the importance of intuition and experience in problem solving. While professors had difficulty in solving the problem under the time constraint, they initially employed a system...

  7. [First aid and management of multiple trauma: in-hospital trauma care].

    Science.gov (United States)

    Boschin, Matthias; Vordemvenne, Thomas

    2012-11-01

    Injuries remain the leading cause of death in children and young adults. Management of multiple trauma patients has improved in recent years by quality initiatives (trauma network, S3 guideline "Polytrauma"). On this basis, strong links with preclinical management, structured treatment algorithms, training standards (ATLS®), clear diagnostic rules and an established risk- and quality management are the important factors of a modern emergency room trauma care. We describe the organizational components that lead to successful management of trauma in hospital.

  8. Who fails lantern tests?

    Science.gov (United States)

    Cole, B L; Vingrys, A J

    1983-05-01

    A battery of clinical colour vision tests was given to a group of 100 observers with abnormal colour vision who were also tested on the Farnsworth lantern and the Holmes-Wright lanterns types A and B. It was found that clinical colour vision tests are imperfect predictors of lantern test performance. However, observers classified as having a 'severe' colour vision defect were found to fail the lantern tests but only one half to two-thirds of those who fail the lantern tests can be identified in this way. It is not possible to identify with certainty any of the people likely to pass the lantern tests: about one-third to two-thirds of observers classified as being mildly affected fail the lantern tests. The Farnsworth D-15 and City University tests were found to be the best predictors of lantern test performance but other tests such as the Nagel anomaloscope, the H-16, L'Anthony's desaturated test can also be used. The lack of a strong correlation between clinical tests and the recognition of the small coloured stimuli presented by the lantern tests suggests that clinical tests do not test the same aspect of colour vision that is important to the recognition of signal lights. For this reason lantern tests should be retained for occupational testing of colour vision.

  9. Operative care and surveillance in severe trauma patients. Interference between resuscitation treatments and anaesthesiology, and consequence on immunity.

    Science.gov (United States)

    Cinotti, R; Roquilly, A; Mahé, P-J; Demeure-Dit-Latte, D; Chupin, A-M; Josse-Chatel, N; Peneau, C; Paulus, J; Lejus, C; Asehnoune, K

    2013-01-01

    Major trauma remains a worldwide cause of morbi-mortality. Early mortality is the consequence of hemorrhagic shock and traumatic brain injury. During early resuscitation, anaesthesia is often mandatory to perform surgery. It is mandatory to master the hemodynamic effects of hypnotic drugs in order to anticipate their potential deleterious effects in the setting of hemorrhagic shock. After early resuscitation, trauma patients present a high prevalence of nosocomial pneumonia, which sustains major morbidity. Nosocomial pneumonia are the consequence of an overwhelming systemic inflammatory response syndrome (SIRS) as well as a trauma-related immunosuppression. The administration of hemisuccinate of hydrocortisone modulates the SIRS and reduces the risk of nosocomial pneumonia as well as the length of mechanical ventilation. Finally in the operating theatre, fighting against hypothermia and un-anatomical positions, which can aggravate rhabdomyolysis, are both mandatory. Copyright © 2013 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier SAS. All rights reserved.

  10. Dental Trauma. A Case Report

    Directory of Open Access Journals (Sweden)

    Alain Soto Ugalde

    2015-06-01

    Full Text Available Dental traumas in children are common; therefore the dentist should be trained to solve them. This paper presents the diagnosis, treatment and outcome of a child with a 12 mm overjet, mouth breathing habit and bilabial incompetence who suffered a severe trauma to tooth number 11, causing its mobility. A splint was applied to the affected tooth and subsequently, a root canal filling was performed, all with a satisfactory outcome. Although these traumas are common, the presentation of this case is important due to its use in the teaching context.

  11. Interventional radiology for paediatric trauma

    Energy Technology Data Exchange (ETDEWEB)

    Sidhu, Manrita K. [Everett Clinic, AIC, Seattle Radiologists, Seattle, WA (United States); University of Washington School of Medicine, Radiology Department, Children' s Hospital and Regional Medical Center, Seattle, WA (United States); Hogan, Mark J. [The Ohio State University, Section of Vascular and Interventional Radiology, Nationwide Children' s Hospital, Columbus, OH (United States); Shaw, Dennis W.W. [University of Washington School of Medicine, Radiology Department, Children' s Hospital and Regional Medical Center, Seattle, WA (United States); Burdick, Thomas [University of Washington School of Medicine, Interventional Radiology, Harborview Medical Center, Seattle, WA (United States)

    2009-05-15

    Paediatric interventional radiology plays a cornerstone role in the management of paediatric trauma. In the acute setting, interventional radiology techniques allow minimally invasive control of haemorrhage or re-establishment of blood flow. Percutaneous stenting and drainage can allow disruptions in urinary or biliary systems to heal without the need for further surgery. Interventional radiology techniques also have a significant role in treating delayed complications of trauma, including embolization of arterial pseudoaneurysms and pulmonary embolism prophylaxis in individuals immobilized due to the trauma or its operative treatment. (orig.)

  12. Chest wall, lung, and pleural space trauma.

    Science.gov (United States)

    Miller, Lisa A

    2006-03-01

    Chest radiographs frequently underestimate the severity and extent of chest trauma and, in some cases, fail to detect the presence of injury. CT is more sensitive than chest radiography in the detection of pulmonary, pleural, and osseous abnormalities in the patient who has chest trauma. With the advent of multidetector CT (MDCT), high-quality multiplanar reformations are obtained easily and add to the diagnostic capabilities of MDCT. This article reviews the radiographic and CT findings of chest wall, pleural, and pulmonary injuries that are seen in the patient who has experienced blunt thoracic trauma.

  13. Substance Abuse and Trauma.

    Science.gov (United States)

    Simmons, Shannon; Suárez, Liza

    2016-10-01

    There is a strong, bidirectional link between substance abuse and traumatic experiences. Teens with cooccurring substance use disorders (SUDs) and posttraumatic stress disorder (PTSD) have significant functional and psychosocial impairment. Common neurobiological foundations point to the reinforcing cycle of trauma symptoms, substance withdrawal, and substance use. Treatment of teens with these issues should include a systemic and integrated approach to both the SUD and the PTSD.

  14. CRANIOROFACIAL TRAUMA - RADIODIAGNOSIS

    Directory of Open Access Journals (Sweden)

    Zambrano JCR

    2013-09-01

    Full Text Available Clinical examination of Craniorofacial injuries are often limited in patients with trauma to the head and neck region due to obscuration by overlying edema, hematoma, hemorrhage, and soft-tissue injury. Craniorofacial injuries require accurate and prompt diagnosis for management. For Proper clinical examination and treatment plan, high resolution radiographs are always essential which will indirectly contribute to render a good medical care to the patients.

  15. 急诊外伤患者清创方法及护理%Emergency Trauma Patients Debridement Treatment Method and Nursing care

    Institute of Scientific and Technical Information of China (English)

    李敏

    2015-01-01

    Objective To explore the emergency trauma patients debridement treatment method and nursing care. Methods A retrospective analysis of 194 patients in our hospitaldebridement patients data.Results In 194 patients, 182 cases were healed,phase II healing in 12 cases,1 cases of stage III non healing wounds,24 h in no infection symptoms,debridement effect is good.Conclusion For emergency trauma victims,treatment and nursing quality remains to be improved,the nurse should strictly folow the nursing path,good symptomatic care,family communication, with emphasis on team.%目的:探讨急诊外伤患者清创处理方法及护理。方法回顾性分析我院收治的194例清创患者资料。结果194例患者中,Ⅰ期愈合182例,Ⅱ期愈合12例,无1例Ⅲ期愈合,24 h内创面未出现感染症状,清创效果较好。结论对于急诊外伤患者而言,治疗与护理质量尚有待提高,护士应严格遵照护理路径,做好对症护理、家属沟通工作,注重团队配合。

  16. Estudio comparativo del tratamiento ortésico en las fracturas toraco-lumbosacras según la gravedad del trauma Estudo comparativo do tratamento ortótico nas fraturas toraco-lombosacro segundo a gravidade do trauma Comparative study on orthotic treatment of thoraco-lumbo-sacral fractures according to severity of trauma

    Directory of Open Access Journals (Sweden)

    Patricio Manzone

    2011-01-01

    diferença significativa entre medições iniciais e seguimento. A única diferença significativa entre os grupos foi a cifose inicial da coluna vertebral. Sempre houve dife renças na comparação dos parâmetros geométricos do grupo controle e os grupos A e B, e entre o grupo controle e cada tipo (AO/Denis subdividido em alta ou baixa energia. As pontuações dos parâmetros funcionais finais sempre foram boas, com variações significativas entre os grupos A e B. CONCLUSÕES: É possível um bom resultado funcional em lesões toraco-lombo-sacrais estáveis, selecionando o tipo de órteses de acordo com a energia cinética do trauma. Esses resultados parecem ser melhores em traumas de alta energia tratados com dispositivos ortopédicos feitos à medida. No entanto, o tratamento ortésico diferenciado de acordo com a energia do trauma não altera os parâmetros radiológicos sagitais.OBJECTIVE: To determine whether the severity of stable thoraco-lumbo-sacral trauma is useful for deciding the selection of brace type in orthopedic treatment. METHODS: Retrospective study (16 years length. Inclusion criteria: 1 Minimum follow-up: 2 years. 2 Complete conventional radiologic studies. 3 no litigation. 4 TLSO custom-made treatment for high kinetic energy trauma and pre-fabricated orthoses for low energy one. 5 Treatment performed or supervised by the senior author. Evaluation by independent observers of geometric Parameters (sagittal Cobb, vertebral kyphosis, anterior vertebral collapse initially and at follow-up, and Functional Parameters (SRS pain scale, Oswestry Index, Return to Previous Activity. Subdivision of different fractures types (of AO and Denis classifications in High (group A and Low Energy (group b according to the amount of kinetic energy of trauma. Comparison with a control group. Statistical analysis: chi square and Student t-test. RESULTS: Forty-one patients were studied (44 fractures, 23 females/18 males, 25 fractures group A and 19 group b. Average age: 46

  17. Failed theories of superconductivity

    CERN Document Server

    Schmalian, Joerg

    2010-01-01

    Almost half a century passed between the discovery of superconductivity by Kammerlingh Onnes and the theoretical explanation of the phenomenon by Bardeen, Cooper and Schrieffer. During the intervening years the brightest minds in theoretical physics tried and failed to develop a microscopic understanding of the effect. A summary of some of those unsuccessful attempts to understand superconductivity not only demonstrates the extraordinary achievement made by formulating the BCS theory, but also illustrates that mistakes are a natural and healthy part of the scientific discourse, and that inapplicable, even incorrect theories can turn out to be interesting and inspiring.

  18. Abortion: Strong's counterexamples fail

    DEFF Research Database (Denmark)

    Di Nucci, Ezio

    2009-01-01

    This paper shows that the counterexamples proposed by Strong in 2008 in the Journal of Medical Ethics to Marquis's argument against abortion fail. Strong's basic idea is that there are cases--for example, terminally ill patients--where killing an adult human being is prima facie seriously morally......'s scenarios have some valuable future or admitted that killing them is not seriously morally wrong. Finally, if "valuable future" is interpreted as referring to objective standards, one ends up with implausible and unpalatable moral claims....

  19. Analysis of Surgical Treatment of Different Types of Nasal Facial Trauma%不同类型鼻面部外伤手术疗效分析

    Institute of Scientific and Technical Information of China (English)

    邓伟; 李树华; 王杰

    2014-01-01

    Objective To discuss surgical treatment of different types of nasal facial trauma. Methods 85 patients of na-sal facial trauma, according to my department in 2002~2010, type I and type II(49cases)using traditional methods reset, type III and type IV(36 cases)diagnosis and treatment of early endoscopy combined with nasal surgery, postoperative follow-up of 0. 5~8 years. Results Patients’ effective rate with type I and type II nasal facial trauma is 100%, type III and type IV facial trauma pa-tients with Nasal Endoscopy combined with nasal surgery, effective rate is 91. 67%. Conclusion Type I and type II traditional surgery and type ⅢandⅣin the early joint surgery can do nose cone shape restoration and reconstruction of the nasal cavity to a-chieve a satisfactory outcome, and avoid the second-stage surgery in patients with type III and type IV.%目的:探讨不同类型鼻面部外伤手术疗效情况。方法根据我科室2002年至2010年85例患者鼻面部外伤,Ⅰ型和Ⅱ型(49例)采用传统方式复位,Ⅲ型和Ⅳ型(36例)型早期鼻内镜联合手术诊治情况,术后随访0.5~8年。结果Ⅰ型和Ⅱ型鼻面部外伤患者有效率为100%,Ⅲ型和Ⅳ型鼻面部外伤患者早期鼻内镜联合手术,有效率为91.67%。结论Ⅰ型和Ⅱ型传统手术及Ⅲ型和Ⅳ型早期联合手术使大多数鼻锥外形整复与鼻腔功能重建达到满意效果,避免了Ⅲ型和Ⅳ型患者二期手术。

  20. 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...... and situated meanings and practices related to suffering and resilience connected to ‘traumatic’ events. This presentation is based on a large qualitative research project. Inspired by this study it will explore the possibilities of developing the theoretical understanding of personal meanings of violent and...

  1. Comparison of the Prehospital Trauma Life Support recommendations and the German national guideline on treatment of patients with severe and multiple injuries.

    Science.gov (United States)

    Häske, David; Stuke, Lance; Bernhard, Michael; Heller, Axel R; Schweigkofler, Uwe; Gliwitzky, Bernhard; Münzberg, Matthias

    2016-08-01

    The Prehospital Trauma Life Support (PHTLS) concept is well established throughout the world. The aim is to improve prehospital care for patients with major trauma. In 2011, a German Level 3 (S3) evidence- and consensus-based guideline on the treatment of patients with severe and multiple injuries was published. The scope of this study was the systematic comparison between the educational content of the worldwide PHTLS concept and the German S3 Guideline. A total of 62 key recommendations of the German S3 Guideline were compared with the content of the English PHTLS manual (eighth edition). Depending on the level of agreement, the recommendations were categorized as (1) agreement, (2) minor variation, or (3) major variation. Comparison was done via a rating system by a number of international experts in the field of out-of-hospital trauma care. The Delphi method was used to get the final statements by indistinct or board-ranged ratings. Overall, there was no conformity in 12%. In 68% a total agreement and in 88% conformity with slight differences of minor variations were found between the key recommendations of the guideline and the PHTLS manual. The PHTLS primary assessment has a large conformity for the following individual priorities: airway, 92%; breathing, 92%; circulation, 63%; disability, 100%; exposure, 89%. According to our comparison, the PHTLS manual is largely compatible with the German S3 Guideline from 2011. The 12% divergent statements concern mainly fluid resuscitation. Minor deviations in the prehospital care are due to a national guideline with an emergency medical service with emergency physicians (S3 Guideline) and a global PHTLS concept.

  2. Clinical diagnosis and treatment analysis of severe oral and maxillofacial trauma%重度口腔颌面部外伤临床诊治分析

    Institute of Scientific and Technical Information of China (English)

    赵金荣

    2015-01-01

    Objective:To investigate the clinical characteristics and treatment effect of severe oral and maxillofacial trauma. Methods:The clinical data of 30 patients with severe oral and maxillofacial trauma were analyzed retrospectively.Results:All patients had normal jaw occlusal relations and facial morphology recovered well.The reexamination of X-ray showed fracture alignment and 29 cases had primary wound healing,the primary healing rate was 96.7%.Conclusion:The clinical characteristics of severe oral and maxillofacial trauma were that male incidence rate was high and the traffic injury,violent injury,falling injury, sports injury were the main pathogenic factors.%目的:探讨重度口腔颌面部外伤的临床特点及治疗效果.方法:回顾性分析重度口腔颌面部外伤患者30例的临床资料.结果:所有患者颌骨咬合关系恢复正常,面部形态恢复良好.X线复检显示骨折对位良好,伤口Ⅰ期愈合29例,Ⅰ期愈合率96.7%.结论:重度口腔颌面部外伤的临床特点是男性发病率高,交通伤、暴力伤、坠落伤、运动伤是主要致病因素.

  3. 口腔颌面创伤诊治专家系统在颌面创伤PBL教学中的应用%Application of maxillofacial trauma diagnosis and treatment expert system in maxillofacial trauma PBL teaching

    Institute of Scientific and Technical Information of China (English)

    田磊; 商洪涛; 秦卓; 封兴华

    2011-01-01

    Objective Oral and Maxillofacial trauma Diagnosis and Treatment Expert system (OMDTES)was used in maxillofacial trauma PBL teaching to improve the quality of PBL teaching,and perfeet the assessment criteria, Methods OMDTES was applied in two procedures of maxillofacial injury PBL teaching activity:the preparation of lesson plan and assessment criteria.Then a questionnaire was designed to assess the effect of this new mode of PBL teaching.Results The new teaching model is welcomed by students and can improve students'interest in learning,the satisfaction of teaching and ameliorate method of assessment of PBL teaching.Conclusion Applying OMDTES in oral and maxinofacial injury PBL teaching has special advantages in raising the leavnevs'activity of learning,training their ability of chnical thinking and analysis.And it is worthy of further research and amelioration.%目的 将口腔颌面创伤诊治专家系统应用于颌面创伤PBL教学,以完善PBL教学评价体系、提高教学质量.方法 将口腔颌面创伤诊治专家系统应用于颌面创伤PBL教学中的教案准备和考核与评价两个环节,通过学员问卷调查的方式进行结果评价.结果 口腔颌面创伤诊治专家系统应用于颌面部创伤PBL教学有助于学员的理论知识学习和提高其学习积极性,学员对PBL教学的考核方法更加满意.结论 该系统应用于PBL教学在提升教学质量、完善考核评价方法、提高教学满意度方面具有优势,值得进一步探究.

  4. RECOMBINANT FACTOR VIIa – NEW TREATMENT OPTION FOR CONTROL OF INTRACTABLE BLEEDING IN SURGICAL AND TRAUMA PATIENTS AND IN OTHER HAEMOSTASIS DISORDERS

    Directory of Open Access Journals (Sweden)

    Samo Zver

    2004-12-01

    Full Text Available Background. Recombinant factor VIIa (rFVIIa, which is currently registered only for the treatment of haemophilia A and B patients with inhibitors, is seen increasingly as a possible universal haemostatic agent in untractable bleedings. One possible mechanism for the efficacy rFVIIa may be a consequence of it’s from the tissue factor (TF and from the level of disfunction in haemostatic system independant activity, which generates »thrombin burst« formation. It seems that rFVIIa remains active only at the site of tissue injury/bleeding.Conclusions. There are two components of bleeding in surgery and trauma patients. One is bleeding from large calibre arteries and veins which requires surgical intervention. The other, which goes along with the first one, is coagulopathic bleeding. The latter is a consequence of consumptional and dilutional coagulopathy, hypothermia, multitransfusion syndrom and metabolic disbalances in patients. rFVIIa effects coagulopathic component of the bleeding. For effective treatment with rFVIIa in such patients, replacement therapy with erythrocytes, platelets and fresh frozen plasma is mandatory and requires a haematologist assistance in the treatment strategy.Most reported cases of effective rFVIIa usage are from the field of traumatology. Until now, there have been no universal recommendations when to start treatment with rFVIIa in a bleeding trauma patient. Most experience with rFVIIa are from Israel and their recommendations are perhaps the most valuable ones. rFVIIa was used several times during intra-operative and post-operative bleeding episodes. There are reports of clinical studies and usage in patients with/ after prostate surgery, cardiovascular operations and liver transplants.There are data about effective rFVIIa usage in neurology and neurosurgery patients (intracranial haemorrhages, obstetrics and gynecology field. Possible future indications are thrombocytopenias, thrombocytopathias (Glanzmann

  5. 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.

  6. Imaging of laryngeal trauma.

    Science.gov (United States)

    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. Copyright © 2013 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

  7. The Trauma Collaborative Care Study (TCCS).

    Science.gov (United States)

    Wegener, Stephen T; Pollak, Andrew N; Frey, Katherine P; Hymes, Robert A; Archer, Kristin R; Jones, Clifford B; Seymour, Rachel B; OʼToole, Robert V; Castillo, Renan C; Huang, Yanjie; Scharfstein, Daniel O; MacKenzie, Ellen J

    2017-04-01

    Previous research suggests that the care provided to trauma patients could be improved by including early screening and management of emotional distress and psychological comorbidity. The Trauma Collaborative Care (TCC) program, which is based on the principles of well-established models of collaborative care, was designed to address this gap in trauma center care. This article describes the TCC program and the design of a multicenter study to evaluate its effectiveness for improving patient outcomes after major, high-energy orthopaedic trauma at level 1 trauma centers. The TCC program was evaluated by comparing outcomes of patients treated at 6 intervention sites (n = 481) with 6 trauma centers where care was delivered as usual (control sites, n = 419). Compared with standard treatment alone, it is hypothesized that access to the TCC program plus standard treatment will result in lower rates of poor patient-reported function, depression, and posttraumatic stress disorder.

  8. When physical intuition fails

    CERN Document Server

    Singh, Chandralekha

    2016-01-01

    We analyze the problem solving strategies of physics professors in a case where their physical intuition fails. A non-intuitive introductory-level problem was identified and posed to twenty physics professors. The problem placed the professors in a situation often encountered by students, and their response highlights the importance of intuition and experience in problem solving. While professors had difficulty in solving the problem under the time constraint, they initially employed a systematic approach, e.g., visualizing the problem, considering various conservation laws, and examining limiting cases. After finding that familiar techniques were not fruitful, they made incorrect predictions based on one of two equally important factors. By contrast, other more familiar problems that require the consideration of two important principles (e.g., conservation of both energy and momentum for a ballistic pendulum) are quickly solved by the same professors. The responses of students who were given the same problem...

  9. 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

    2016-11-19

    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.

  10. 一体化创伤救治体系对危重创伤患者病死率的影响%Impact of trauma integration treatment system on the mortality of patients with severe trauma

    Institute of Scientific and Technical Information of China (English)

    孙明伟; 李世军; 江华; 王志晖; 冯金周; 杨浩; 蔡斌; 曾俊

    2016-01-01

    均大于0.05).2010、2011、2012年患者病死率分别为11.9%(19/159)、11.2% (21/187)、7.4%(14/190),呈下降趋势,但差异无统计学意义(x2 =2.43,P>0.05).3年间危重创伤患者死亡相关风险因素为患者年龄、ISS、APACHEⅡ评分、首日尿量、血小板计数、白蛋白和血钠.2010、2011、2012年患者调整病死率O/E比值(95%CI)分别为0.727 (0.460 ~1.180)、0.718(0.460 ~1.230)、0.460(0.270 ~0.840),呈逐年下降趋势.结论 一体化创伤救治体系有助于提高危重创伤患者救治质量.%Objective To quantitatively evaluate the treatment quality of trauma integration treatment system in the patients with severe trauma.Methods Records of patients with severe trauma hospitalized in our department from January 2010 to December 2012 were extracted from trauma database and analyzed, including gender, age, basic situation after admission [including systolic pressure, diastolic pressure, axillary temperature, heart rate, Injury Severity Score (ISS), Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ score, Glasgow Coma Score, and urine volume on the first day] , the first time determination values of physiological and biochemical indexes after admission (including pH value, base excess, PaCO2, PaO2, standard bicarbonate ion, leucocyte count, neutrophile granulocyte, hemoglobin, platelet count, albumin, urea nitrogen, lactic acid, blood glucose, and blood sodium), surgical situation, length of ICU stay, occurrence of major complications [including infection, acute respiratory distress syndrome (ARDS), multiple organ dysfunction syndrome (MODS)/multiple organ failure (MOF)], and death.Single factor analysis was used to screen death-associated exposure factors, then the exposure factors were brought into multivariate Logistic regression to establish adjustment mortality models to calculate observation/expectation (O/E) ratio of adjustment mortality of patients in these three years, and Poisson distribution

  11. 肛管直肠外伤46例诊治疗效%Clinical experience of diagnosis and treatment of 46 cases of anorectal trauma

    Institute of Scientific and Technical Information of China (English)

    李涛

    2014-01-01

    Objective To explore the clinical treatment and efficacy of anorectal trauma. Methods A retrospective analysis of the clinical data of forty-six cases of anorectal trauma admitted from January 2010 to December 2013 in our hospital was carried out. Results The patients were given an average fasting time of 3.5 to 8 days postoperatively. Four cases had postoperative wound infection, 2 inflammatory in small bowel obstruction, 2 decreased controlled ability of anus, and 3 had mild anal stenosis. After timely operations and postoperative treatment, no serious complications occurred. Conclusion Timely diagnosis and reasonable treatment of anorectal trauma can effectively improve the clinical cure rate, and decrease the incidence of postoperative complications.%目的:探讨肛管直肠外伤的临床处置方法及治疗效果。方法回顾性分析商丘市第一人民医院2010年1月至2013年12月收治的46例肛门直肠外伤患者的临床资料。结果46例患者术后禁食时间3.5~8(5.5±2.0)d;术后发生切口感染4例,炎性肠梗阻2例,肛门精细控制能力下降2例,肛门轻度狭窄3例,经保守治疗后恢复;无肛瘘等严重并发症出现。出院后随访6~36(19.5±4.5)个月,未出现大便失禁、肛门狭窄等并发症。结论肛管直肠外伤患者明确诊断后及时合理的针对性手术处理可以有效地提高临床治愈率、减少术后并发症的发生率。

  12. 肝外伤的诊治体会(附55例报告)%Diagnosis and treatment of hepatic trauma: a report of 55 cases

    Institute of Scientific and Technical Information of China (English)

    张吉成; 陈燕凌

    2009-01-01

    目的 总结肝外伤的诊断和治疗经验.方法 回顾55例肝外伤患者的临床资料.结果 55例肝外伤中Ⅰ~Ⅱ级18例,Ⅲ级15例,Ⅳ级17例,Ⅴ级5例;采用非手术治疗31例,均痊愈;于术治疗24例,痊愈22例,自动出院2例.结论 肝外伤诊断以伞腹B超和腹腔穿刺为首选检杏,血液动力学稳定时可行腹部CT平扫或加增强扫描对判断是否行于术治疗彳丁帮助.目前,肝外伤的治疗主要考虑两个方面:血液动力学的稳定性和外伤的性质:钝挫伤或贳通伤;在判断是否行保守治疗时,血液动力学稳定性比肝外伤分级相对更重要.对血液动力学稳定的Ⅰ级、Ⅱ级和部分Ⅲ级钝性肝外伤可存严密连续临测下行非于术治疗;根据m液动力学变化和伤情判断及时中转于术;对血液动力学不稳定的部分Ⅲ级、Ⅳ级和Ⅴ级严重肝外伤以下术治疗为宜.早期复苏、有效止血、充分引流和防治术后并发症足降低严重肝外伤病死率的关键.%Objective To summarize the experiences of the diagnostic and therapeutiec approach of hepatic trauma.Methods Referencing to the literature of recent years,we retrospectively analyzed the clinieal data of 55 cases of liver trauma.Results Among the 55 cases.18 eases of stage Ⅰ~Ⅱ.1 5 cases of stage Ⅲ,17 eases of stage Ⅳ and 5 cases of stage V,Thirty-one cases received non-operative treatment.and 24 cases reeeived operative therapy.In non-operative treatment group,the cure rate was 100%.In operation Ireatmenl group the cure rate was 91.7%.Conclusions Focused abdominal sonography for trauma (FAST) and diagnostic peritoneal paraeentesis are the initial methods for diagnosis of liver trauma and are largely used nowadays.When the patient is hemodynamically stable,CT scan or simuhaneous contrast-enhanced scan are important to decide for conservative ur surgical treatment.Today.treatment of hepatic lesions takes in account mainly two aspects

  13. Eye Movement Desensitization and Reprocessing (EMDR Versus Treatment as Usual for Non-Specific Chronic Back Pain Patients with Psychological Trauma: A Randomized Controlled Pilot Study

    Directory of Open Access Journals (Sweden)

    Andreas Gerhardt

    2016-12-01

    Full Text Available Objective: Eye-Movement-Desensitization and Reprocessing (EMDR – an evidence-based approach to eliminate emotional distress from traumatic experiences – was recently suggested for the treatment of chronic pain. Aim of this study was to estimate preliminary efficacy of a pain-focused EMDR intervention for the treatment of non-specific chronic back pain.Design: Randomized controlled pilot study.Methods: Forty non-specific chronic back pain patients reporting previous experiences of psychological trauma were consecutively recruited from outpatient tertiary-care pain centers. After baseline assessment, patients were randomized to intervention or control group (1:1. The intervention group received ten sessions standardized pain-focused EMDR in addition to treatment-as-usual. The control group received treatment-as-usual alone.The primary outcome was preliminary efficacy, measured by pain intensity, disability, and treatment satisfaction from the patients' perspective. Clinical relevance of changes was determined according to established recommendations. Assessments were conducted at the baseline, post-treatment, and at a 6-month follow-up. Intention-to-treat-analysis with last-observation-carried-forward method was used. Registered with ClinicalTrials.gov (NCT01850875.Results: Estimated effect sizes (between-group, pooled standard deviation for pain intensity and disability were d=0.79 (CI95%: 0.13, 1.42 and d=0.39 (CI95%: -0.24, 1.01 post-treatment, and d=0.50 (CI95%: 0.14, 1.12 and d=0.14 (CI95%: -0.48, 0.76 at 6-month follow-up. Evaluation on individual patient basis showed that about 50% of the patients in the intervention group improved clinically relevant and also rated their situation as clinically satisfactory improved, compared to zero patients in the control group.Conclusions: There is preliminary evidence that pain-focused EMDR might be useful for non-specific chronic back pain patients with previous experiences of psychological trauma

  14. When physical intuition fails

    Science.gov (United States)

    Singh, Chandralekha

    2002-11-01

    We analyze the problem-solving strategies of physics professors in a case where their physical intuition fails. A nonintuitive introductory-level problem was identified and posed to twenty physics professors. The problem placed the professors in a situation often encountered by students, and their response highlights the importance of intuition and experience in problem solving. Although professors had difficulty in solving the problem under the time constraint, they initially employed a systematic approach, for example, visualizing the problem, considering various conservation laws, and examining limiting cases. After finding that familiar techniques were not fruitful, they made incorrect predictions based on one of two equally important factors. In contrast, other more familiar problems that require the consideration of two important principles (for example, conservation of both energy and momentum for a ballistic pendulum) were quickly solved by the same professors. The responses of students who were given the same problem reflected no overarching strategies or systematic approaches, and a much wider variety of incorrect responses were given. This investigation highlights the importance of teaching effective problem-solving heuristics, and suggests that instructors assess the difficulty of a problem from the perspective of beginning students.

  15. Treatment of mice with sepsis following irradiation and trauma with antibiotics and synthetic trehalose dicorynomycolate (S-TDCM). (Reannouncement with new availability information)

    Energy Technology Data Exchange (ETDEWEB)

    Madonna, G.S.; Ledney, G.D.; Moore, M.M.; Elliott, T.B.; Brook, I.

    1991-12-31

    Compromise of antimicrobial defenses by irradiation can result in sepsis and death. Additional trauma can further predispose patients to infection and thus increase mortality. The authors recently showed that injection of synthetic trehalose dicorynomycolate (S-TDCM) significantly augments resistance to infection and increases survival of mice compromised either by whole-body irradiation with gamma radiation or equal mixtures of fission neutron and gamma radiation. In this study, C3H/HeN mice were given a lethal dose of gamma radiation (8.0 Gy) and an open wound (15% total body surface area TBSA) 1 hr later while anesthetized. Irradiated/wounded mice became more severely leukopenic and thrombocytopenic than mice exposed to radiation alone. However, this treatment did not increase survival of the irradiated/wounded mice.

  16. EAU guidelines on iatrogenic trauma.

    Science.gov (United States)

    Summerton, Duncan J; Kitrey, Noam D; Lumen, Nicolaas; Serafetinidis, Efraim; Djakovic, Nenad

    2012-10-01

    The European Association of Urology (EAU) Trauma Guidelines Panel presents an updated iatrogenic trauma section of their guidelines. Iatrogenic injuries are known complications of surgery to the urinary tract. Timely and adequate intervention is key to their management. To assess the optimal evaluation and management of iatrogenic injuries and present an update of the iatrogenic section of the EAU Trauma Guidelines. A systematic search of the literature was conducted, consulting Medline and the Cochrane Register of Systematic reviews. No time limitations were applied, although the focus was on more recent publications. The expert panel developed statements and recommendations. Statements were rated according to their level of evidence, and recommendations received a grade following a rating system modified from the Oxford Centre for Evidence-based Medicine. Currently, only limited high-powered studies are available addressing iatrogenic injuries. Because the reporting of complications or sequelae of interventions is now increasingly becoming a standard requirement, this situation will likely change in the future. This section of the trauma guidelines presents an updated overview of the treatment of iatrogenic trauma that will be incorporated in the trauma guidelines available at the EAU Web site (http://www. uroweb.org/guidelines/online-guidelines/). Copyright © 2012 European Association of Urology. Published by Elsevier B.V. All rights reserved.

  17. Geographic distribution of severely injured patients: implications for trauma system development.

    Science.gov (United States)

    Ciesla, David J; Pracht, Etienne E; Cha, John Y; Langland-Orban, Barbara

    2012-09-01

    Despite decades of trauma system development, many severely injured patients fail to reach a trauma center for definitive care. The purpose of this study was to define the regions served by Florida's designated trauma centers and define the geographic distribution of severely injured patients who do not access the state's trauma system. Severely injured patients discharged from Florida hospitals were identified using the 2009 Florida Agency for Health Care Administration database. The home zip codes of patients discharged from trauma and nontrauma center hospitals were used as a surrogate for injury location and plotted on a map. A radial distance containing 75% of trauma center discharges defined trauma center catchment area. Only 52% of severely injured patients were discharged from trauma centers. The catchment areas varied from 204 square miles to 12,682 square miles and together encompassed 92% state's area. Although 93% of patients lived within a trauma center catchment area, the proportion treated at a trauma center in each catchment area varied from 13% to 58%. Mapping of patient residences identified regions of limited access to the trauma system despite proximity to trauma centers. The distribution of severely injured patients who do not reach trauma centers presents an opportunity for trauma system improvement. Those in proximity to trauma centers may benefit from improved and secondary triage guidelines and interfacility transfer agreements, whereas those distant from trauma centers may suggest a need for additional trauma system resources. Epidemiologic study, level III.

  18. 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.)

  19. Effects of Nursing Care Based on Watson’s Theory of Human Caring on Anxiety, Distress, And Coping, When Infertility Treatment Fails: A Randomized Controlled Trial

    National Research Council Canada - National Science Library

    Yeter Durgun Ozan; Hülya Okumuş

    2017-01-01

    ...: Watson's theory of human caring is recommended as a guide to nursing patients with infertility treatment to decrease levels of anxiety and distress, and to increase the positive coping style among infertile women...

  20. Trauma during pregnancy.

    Science.gov (United States)

    Tweddale, Carla J

    2006-01-01

    Trauma is the leading nonobstetrical cause of maternal death. The effect of trauma on the pregnant woman and unborn fetus can be devastating. The major causes of maternal injury are blunt trauma, penetrating trauma, burns, falls, and assaults. There are specific changes associated with pregnancy that are important for the clinician to consider when providing care to these patients. Initial management of traumatic injuries during pregnancy is essential for maternal and fetal well-being. This review outlines common causes of maternal trauma, the initial assessment of the pregnant trauma patient, and ongoing care for the pregnant trauma patient and unborn fetus.

  1. The Link: Trauma and Substance Abuse

    Directory of Open Access Journals (Sweden)

    Leslie Dawn Culpepper

    2016-03-01

    Full Text Available Trauma “is categorized as an overwhelming life-changing experience (and is typically a physical and/or emotional shock to the very fiber of one’s being.”It is a priority that those who experience trauma in their lives seek help from a licensed professional to deal with the emotional damage caused by the trauma(s and to be taught necessary coping skills to prevent them from seeking solace in unhealthy ways like abusing drugs and/or alcohol. Research proposes that all types of trauma and the aftermath that follows will likely impact the “exposed population’s behavioral health, resulting in an increase in mental and substance use disorders, along with a decline in perceived quality of life” [1]. Survey results teach us that more than 70% adolescents receiving treatment for substance abuse across the country have a history of trauma in their lives.

  2. 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

    Full Text Available El manejo del traumatismo panfacial y del tercio medio facial requiere, no sólo del conocimiento de los principios y técnicas básicas de osteosíntesis, sino de un protocolo de actuación reglado antes del acto quirúrgico y adaptado a cada paciente. En este artículo ilustramos la reducción y osteosíntesis de las fracturas, la secuencia quirúrgica y el manejo postoperatorio del traumatismo panfacial y de las fracturas complejas de tercio medio facial en nuestro hospital. Analizamos un total de 102 pacientes tratados durante los años 2005 y 2006; de ellos, 14 pacientes mostraban fracturas complejas de tercio medio facial, 4 asociadas a otras fracturas de mandíbula o tercio superior facial producidas por fuerzas de alta energía. El grado de éxito lo determinamos por la ausencia de limitación de la motilidad ocular, vía aérea permeable, la correcta mordida-oclusión con mínima secuela estética y la no alteración final de las dimensiones craneofaciales. La prioridad absoluta será enfocar estos pacientes de manera multidisciplinar. La complejidad de estos casos da poco margen a la improvisación por lo que realizar una correcta anamnesis, exploración y planificación prequirúrgica es absolutamente necesario. Todo esto nos permitirá lograr una reconstrucción anatómica ósea tridimensional, la estabilidad de los focos de fractura y la preservación de los órganos en ellos contenidos o implicados, de acuerdo con las medidas antropométricas previas del paciente, con una mínima consecuencia estética y en un único tiempo quirúrgico.Managing of Panfacial and midface trauma requires not only basic knowledge of osteosintesis principles; an order of treatment should be developed by surgeon before surgery and it must be made for each patient. In this article we report the methodology of reduction, fixation and treatment planning of panfacial and midface trauma in our hospital. We analyse 102 facial trauma treated by our department

  3. Resultados del tratamiento quirúrgico de la catarata traumática Results of the surgical treatment of the trauma cataract

    Directory of Open Access Journals (Sweden)

    Yamirka Rodríguez Alonso

    2011-12-01

    Full Text Available Objetivo: Describir los resultados del tratamiento quirúrgico de pacientes con catarata traumática, que acudieron a la consulta de urgencias oftalmológicas del Hospital General “Dr. Juan Bruno Zayas Alfonso” de Santiago de Cuba en el año 2008. Métodos: Se realizó un estudio observacional, descriptivo y transversal, donde se analizaron variables como: edad, sexo, tipo de trauma, alteraciones oculares asociadas, agudeza visual mejor corregida preoperatoria y posoperatoria, conducta quirúrgica y complicaciones. La información obtenida se procesó mediante el paquete estadístico SPSS-11,6. Se utilizó las frecuencias absolutas y relativas como medida de resumen. Resultados: Hubo un predominio de los pacientes entre 25 y 34 años (50 %, el sexo masculino (80,8 % y los traumas a globo cerrado (76,9 % con subluxación del cristalino en un 30,8 %. El 69,2 % de los pacientes antes de la intervención quirúrgica presentaban una agudeza visual mejor corregida entre 0,01 a 0,09 y el 84,6 % obtuvo una posoperatoria entre 0,4 y 1,0. A 100 % de los pacientes se les realizó extracción extracapsular del cristalino por la técnica de Blumenthal. El 69,2 % no requirieron vitrectomía anterior y se les colocó un lente en cámara posterior al 53,8 % de los casos. La opacidad de cápsula posterior se presentó en el 34,6 % de los operados. Conclusión: El tratamiento quirúrgico de la catarata traumática, si es planificado y se realiza oportunamente, conlleva al buen pronóstico visual de los pacientes. Esto reduce el número de complicaciones y secuelas invalidantes, y logra la reincorporación del paciente a la sociedad.Objective: To describe the results of surgical treatment of traumatic cataract patients who were seen at the ocular emergency service of “Dr. Juan Bruno Zayas Alfonso” general hospital in Santiago de Cuba, in 2008. Methods: An observational, descriptive, cross-sectional study was conducted to analyze variables such as age, sex

  4. Treatment of uncomplicated malaria with artesunate plus sulfadoxine-pyrimethamine is failing in Somalia: evidence from therapeutic efficacy studies and Pfdhfr and Pfdhps mutant alleles.

    Science.gov (United States)

    Warsame, Marian; Hassan, Abdillahi Mohamed; Barrette, Amy; Jibril, Ali Mohamed; Elmi, Husein Haji; Arale, Abdulkadir Mohamed; Mohammady, Hanan El; Nada, Rania A; Amran, Jamal Ghilan Hefzullah; Muse, Abdikarim; Yusuf, Fahmi Essa; Omar, Abdiqani Sheikh

    2015-04-01

    Artesunate plus sulfadoxine-pyrimethamine (AS + SP) has been Somalia's national treatment policy since 2006. Routine monitoring of first-line malaria treatment is needed to ensure appropriate national malaria treatment policy and early detection of drug resistance. For this purpose, we conducted therapeutic efficacy studies of AS + SP for the treatment of uncomplicated malaria in Somalia in 2011. Studies were conducted in three sentinel sites. Eligible patients were evaluated for clinical and parasitological outcomes according to the WHO standard protocol. Molecular surveillance was conducted on resistance conferring mutations in the P.falciparum dihydrofolate reductase (dfhr) and dihydropteroate synthase (dhps) genes. The proportion of PCR-corrected treatment failures was high in Jamame (22%, 95% CI: 13.7-32.8%) and low (<5%) in Janale and Jowhar. All patients cleared parasites by day 3. Molecular markers associated with SP resistance were detected in all three sites. Treatment failure was associated with the presence of the double mutant dhps A437G/K540E (OR = 22.4, 95% CI: 5.1-98.1), quadruple mutant dhfr N51I/S108N+dhps A437G/K540E (OR = 5.5, 95% CI: 2.3-13.6), quintuple mutant dhfr N51I/C59R/S108N+dhps A437G/K540E (OR = 3.5, 95% CI: 1.4-8.8) and younger age (OR=0.86, 95% CI: 0.76-0.96). The high treatment failure rate observed in Jamame, together with the presence of molecular mutations associated with SP resistance, indicates P. falciparum resistance to SP. In Jowhar, high treatment failure rates were absent despite the presence of molecular mutations; signs of resistance in vivo may have been masked by the stronger immunity of the older study population. The study underscores the need to update Somalia's national malaria treatment policy. © 2015 John Wiley & Sons Ltd.

  5. Cardiac injuries in blunt chest trauma

    Directory of Open Access Journals (Sweden)

    Tobon-Gomez Catalina

    2009-09-01

    Full Text Available Abstract Blunt chest traumas are a clinical challenge, both for diagnosis and treatment. The use of Cardiovascular Magnetic Resonance can play a major role in this setting. We present two cases: a 12-year-old boy and 45-year-old man. Late gadolinium enhancement imaging enabled visualization of myocardial damage resulting from the trauma.

  6. Safety and short-term outcomes of laparoscopic sleeve gastrectomy as a revisional approach for failed laparoscopic adjustable gastric banding in the treatment of morbid obesity.

    Science.gov (United States)

    Acholonu, Emeka; McBean, Etwar; Court, Ismael; Bellorin, Omar; Szomstein, Samuel; Rosenthal, Raul J

    2009-12-01

    Laparoscopic sleeve gastrectomy (LSG) has been used as a first step of a two-stage approach in bariatric surgery for high-risk patients. Recently, LSG is being utilized as a primary and final procedure for morbid obesity with acceptable short-term results. The aim of this study is to investigate the effectiveness of LSG as a revisional procedure for patients with unsatisfactory outcomes after laparoscopic adjustable gastric band (LAGB). A retrospective review of a prospectively maintained database was performed. Data were reviewed for all patients undergoing revision from LAGB to LSG during the period May 2005 and May 2009. Data collected included demographics, indication for revision, operative time, length of stay, postoperative complications, and degree of weight reduction. Fifteen patients (three males and 12 females) had revisional surgery converting a LAGB to a LSG. The indication in four patients (26.66%) was weight regains and in five patients (33.33%) was poor weight loss; four patients (26.66%) had a band slippage and symptoms of gastroesophageal reflux, and one patient (6.66%) had poor weight loss, band slippage, and reflux. In one patient (6.66%), the indication was slippage and duodenal fistula. One-step revision procedure was done in 13 patients (86.66%), while two-step procedure was done in two patients (13.33%). Mean preoperative weight and BMI were 233.02 (181.4-300) lb and 38.66 (29.7-49.3) kg/m2, respectively. Mean weight loss at 2, 6, 12, 18, and 24 months postoperatively was 20.7, 48.3, 57.2, 60.1, and 13.5 lb, respectively. Mean % excess BMI loss was 28.9%, 64.2%, 65.3%, 65.7%, and 22.25% at 2, 6, 12, 18, and 24 months, respectively. There was one major complication (staple line leak) and one postoperative acute gastric outlet obstruction. We had no mortality. Thirteen patients were followed up postoperatively. The number decreased as follow-up time progressed. LSG could provide short-term weight loss after previously failed LABG, but prone to

  7. A Lower Extremity Musculoskeletal and Vascular Trauma Protocol in a Children's Hospital May Improve Treatment Response Times and Appropriate Microvascular Coverage.

    Science.gov (United States)

    Gans, Itai; Baldwin, Keith D; Levin, L Scott; Nance, Michael L; Chang, Benjamin; Kovach, Stephen J; Serletti, Joseph M; Flynn, John M

    2015-05-01

    Pediatric lower extremity (LE) vascular injuries present many issues: microvascular surgeons are usually unavailable to stand-alone pediatric institutions, and the rate of morbidity including limb loss can be high if revascularization is delayed beyond the critical period of 8 hours. We assessed if time to revascularization was impacted by institution of a lower extremity vascular trauma protocol (LEVP). Level II retrospective prognostic. Level I pediatric trauma center. Pediatric patients presenting with ischemic lower extremities requiring urgent management (2000-2013). LEVP-a team of specialized microvascular surgeons, who have developed and manage a call schedule for our pediatric trauma center to offer care 24 h-1·d-1, 7 d-1·wk-1, and 365 d-1·y-1 to our children's hospital. Treatment team expertise, time to revascularization, and use of time-delaying preoperative radiographic vascular studies performed before and after initiation of LEVP. We identified 22 patients with ischemic LEs (16 patients treated before/6 patients treated after LEVP initiation). Mean time from admission to definitive vascular care was 6.4 hours preprotocol (20% > 8 hours)/4.6 hours postprotocol (0% > 8 hours). Before protocol initiation, 38% of LE vascular injuries were treated by LE microvascular repair-capable surgeons, and 37.5% had a preoperative radiographic vascular study compared with 100% and 0%, respectively, postprotocol initiation. Before protocol initiation, 37.5% had a preoperative radiographic vascular study compared with 0% after protocol initiation. Since LEVP initiation, we have required no preoperative radiographic vascular studies, there has not been a revascularization delay of >8 hours, and with appropriate staff surgeon coverage, the flow of care has improved with the new ability to address and care for these challenging injuries. To potentially improve the timeliness of vascular care and better match the skills of the practitioner to the injury, pediatric

  8. Outcome predictors for treatment success with 5% lidocaine medicated plaster in low back pain with neuropathic components and neuropathic pain after surgical and nonsurgical trauma

    Science.gov (United States)

    Nicolaou, Andrew; Nicholson, Bruce; Hans, Guy; Brasseur, Louis

    2011-01-01

    Five percent lidocaine medicated plaster has been proven efficacious for the symptomatic relief of neuropathic pain in diverse pain conditions which might be attributed to a common localized symptomatology in these indications, possibly with common predictors of treatment success. To discuss potential symptoms and other factors predicting response to treatment with lidocaine plaster for the indications of low back pain with neuropathic components and neuropathic pain after surgical and nonsurgical trauma, 44 pain specialists from 17 countries attended a two-day conference meeting in December 2009. Discussions were based on the retrospective analysis of case reports (sent in by participants in the four weeks prior to the meeting) and the practical experience of the participants. The results indicate some predictors for success with 5% lidocaine medicated plaster for the two indications. Localized pain, hyperalgesia and/or allodynia, and other positive sensory symptoms, such as dysesthesia, were considered positive predictors, whereas widespread pain and negative sensory symptoms were regarded as negative predictors. Paresthesia, diagnosis, and site of pain were considered to be of no predictive value. Common symptomatology with other neurologic pathologies suggests that treatment of localized neuropathic pain symptoms with the plaster can be considered across different neuropathic pain indications. PMID:21386952

  9. Case Report: Urgent endovascular treatment of subclavian artery injury after blunt trauma [v1; ref status: indexed, http://f1000r.es/4x8

    Directory of Open Access Journals (Sweden)

    Taka-aki Nakada

    2014-12-01

    Full Text Available Subclavian arterial injury is rare and potentially life-threatening, particularly when it leads to arterial occlusion, causing limb ischemia, retrograde thromboembolization and cerebral infarction within hours after injury. Here we report a blunt trauma case with subclavian arterial injury, upper extremity ischemia, and the need for urgent treatment to salvage the limb and prevent cerebral infarction. A 41-year-old man had a left, open, mid-shaft clavicle fracture and left subclavian artery injury accompanied by a weak pulse in the left radial artery, decreased blood pressure of the left arm compared to the right, and left hand numbness. Urgent debridement and irrigation of the open clavicle fracture was followed by angiography for the subclavian artery injury. The left distal subclavian artery had a segmental dissection with a thrombus. Urgent endovascular treatment using a self-expanding nitinol stent successfully restored the blood flow and blood pressure to the left upper extremity. Endovascular treatment is a viable option for cases of subclavian artery injury where there is a risk of extremity ischemia and cerebral infarction.

  10. A Framework for Treating Cumulative Trauma with Art Therapy

    Science.gov (United States)

    Naff, Kristina

    2014-01-01

    Cumulative trauma is relatively undocumented in art therapy practice, although there is growing evidence that art therapy provides distinct benefits for resolving various traumas. This qualitative study proposes an art therapy treatment framework for cumulative trauma derived from semi-structured interviews with three art therapists and artistic…

  11. A Framework for Treating Cumulative Trauma with Art Therapy

    Science.gov (United States)

    Naff, Kristina

    2014-01-01

    Cumulative trauma is relatively undocumented in art therapy practice, although there is growing evidence that art therapy provides distinct benefits for resolving various traumas. This qualitative study proposes an art therapy treatment framework for cumulative trauma derived from semi-structured interviews with three art therapists and artistic…

  12. To fail or not to fail : clinical trials in depression

    NARCIS (Netherlands)

    Santen, Gijs Willem Eduard

    2008-01-01

    To fail or not to fail – Clinical trials in depression investigates the causes of the high failure rate of clinical trials in depression research. Apart from the difficulties in the search for new antidepressants during drug discovery, faulty clinical trial designs hinder their evaluation during dru

  13. Drug-eluting versus plain balloon angioplasty for the treatment of failing dialysis access: Final results and cost-effectiveness analysis from a prospective randomized controlled trial (NCT01174472)

    Energy Technology Data Exchange (ETDEWEB)

    Kitrou, Panagiotis M., E-mail: panoskitrou@gmail.com [Department of Interventional Radiology, Patras University Hospital, School of Medicine, Rion 26504 (Greece); Katsanos, Konstantinos [Department of Interventional Radiology, Guy' s and St. Thomas’ Hospitals, NHS Foundation Trust, King' s Health Partners, London SE1 7EH (United Kingdom); Spiliopoulos, Stavros; Karnabatidis, Dimitris; Siablis, Dimitris [Department of Interventional Radiology, Patras University Hospital, School of Medicine, Rion 26504 (Greece)

    2015-03-15

    Highlights: •1-Year target lesion primary patency significantly higher after PCB application compared to plain balloon angioplasty in the failing dialysis access. •Significant difference in favor of PCB in cumulative primary patency of AVGs at 1 year. •No significant difference in cumulative primary patency of AVFs treated with PCB at 1 year. •Cost effectiveness analysis performed. •Paclitaxel-coated balloon angioplasty proves to be a cost-effective option for treating dialysis access. -- Abstract: Objective: To report the final results and cost-effectiveness analysis of a prospective randomized controlled trial investigating drug-eluting balloon (DEB) versus plain balloon angioplasty (BA) for the treatment of failing dialysis access ( (NCT01174472)). Methods: 40 patients were randomized to angioplasty with either DEB (n = 20) or BA (n = 20) for treatment of significant venous stenosis causing a failing dialysis access. Both arteriovenous fistulas (AVF) and synthetic arteriovenous grafts (AVG) were included. Angiographic follow up was scheduled every two months. Primary endpoints were technical success and target lesion primary patency at 1 year. Cumulative and survival analysis was performed. Incremental net benefit (INB) and incremental cost effectiveness ratio (ICER) were calculated and the cost-effectiveness acceptability curve (CEAC) was drawn. Results: Baseline variables were equally distributed between the two groups. At 1 year, cumulative target lesion primary patency was significantly higher after DEB application (35% vs. 5% after BA, p < 0.001). Overall, median primary patency was 0.64 years in case of DEB vs. 0.36 years in case of BA (p = 0.0007; unadjusted HR = 0.27 [95%CI: 0.13–0.58]; Cox adjusted HR = 0.23 [95%CI: 0.10–0.50]). ICER was 2198 Euros (€) per primary patency year of dialysis access gained. INB was 1068€ (95%CI: 31–2105€) for a willingness-to-pay (WTP) threshold of 5000€ (corresponding acceptability probability >97

  14. Why chemotherapy can fail?

    Science.gov (United States)

    Król, M; Pawłowski, K M; Majchrzak, K; Szyszko, K; Motyl, T

    2010-01-01

    There are many reasons that lead to failure of cancer chemotherapy. Cancer has the ability to become resistant to many different types of drugs. Increased efflux of drug, enhanced repair/increased tolerance to DNA damage, high antiapoptotic potential, decreased permeability and enzymatic deactivation allow cancer cell survive the chemotherapy. Treatment can lead to the death of most tumor cells (drug-sensitive), but some of them (drug-resistant) survive and grow again. These tumor cells may arise from stem cells. There are many studies describing human experiments with multidrug resistance, especially in breast cancer. Unfortunately, studies of canine or feline ABC super family members are not as extensive as in human or mice and they are limited to several papers describing PGP in mammary cancer, cutaneous mast cell tumors and lymphoma. Multidrug resistance is one of the most significant problems in oncology today. The involvement of many different, not fully recognized, mechanisms in multidrug resistance of cancer cells makes the development of effective methods of therapy very difficult. Understanding the mechanisms of drug resistance in cancer cells may improve the results of treatment. This review article provides a synopsis of all aspects that refer to cancer cell resistance to antitumor drugs.

  15. 急性脊柱创伤的临床诊断与治疗观察%Observation Clinical Diagnosis and Treatment of Acute Spinal Trauma

    Institute of Scientific and Technical Information of China (English)

    尹所; 李畅; 贺冬

    2015-01-01

    目的观察急性脊柱创伤患者的病情,研究对患者的临床诊断与治疗方法。方法对我院3年间收治的123位急性脊柱创伤患者进行回顾性分析,患者住院后全部安排X线平片、CT、MRI等一般检测,确认病情后采用后路椎弓根螺钉内固定术进行治疗。结果123例患者入院诊断后,手术所用时间(137.87±5.78)min、手术中出血量(118.76±11.45)ml、疼痛评分(3.30±1.47)分,经过手术随访,有2例轻微型并发症,经治疗后均痊愈。结论对急性脊柱创伤患者诊断后进行后路椎弓根螺钉内固定手术,对提高术后生存有很好的帮助。%Objective To observe the condition of patients with acute spinal trauma, clinical diagnosis and treatment of patients.Methods Selected 123 patients with acute spinal trauma in three years admitted to hospital were retrospectively analyzed after all the arrangements X-ray, general detection CT, MRI, and so on. after confirming the disease using posterior pedicle screw ifxation treatment.Results123 cases of patients admitted to hospital after diagnosis, surgery with time were (137.87±5.78) minutes, blood loss were (118.76±11.45) ml, pain scores were (3.30±1.47) hours after surgery follow-up, there are two cases of minimal complications after treatment were cured.Conclusion The acute spine pedicle screw ifxation surgery in patients with post-traumatic diagnosis, improve patient survival have good help.

  16. Advanced airway management is necessary in prehospital trauma patients.

    Science.gov (United States)

    Lockey, D J; Healey, B; Crewdson, K; Chalk, G; Weaver, A E; Davies, G E

    2015-04-01

    Treatment of airway compromise in trauma patients is a priority. Basic airway management is provided by all emergency personnel, but the requirement for on-scene advanced airway management is controversial. We attempted to establish the demand for on-scene advanced airway interventions. Trauma patients managed with standard UK paramedic airway interventions were assessed to determine whether airway compromise had been effectively treated or whether more advanced airway management was required. A prospective observational study was conducted to identify trauma patients requiring prehospital advanced airway management attended by a doctor-paramedic team. The team assessed and documented airway compromise on arrival, interventions performed before and after their arrival, and their impact on airway compromise. Four hundred and seventy-two patients required advanced airway intervention and received 925 airway interventions by ground-based paramedics. Two hundred and sixty-nine patients (57%) still had airway compromise on arrival of the enhanced care team; no oxygen had been administered to 52 patients (11%). There were 45 attempted intubations by ground paramedics with a 64% success rate and 11% unrecognized oesophageal intubation rate. Doctor-paramedic teams delivering prehospital anaesthesia achieved definitive airway management for all patients. A significant proportion of severely injured trauma patients required advanced airway interventions to effectively treat airway compromise. Standard ambulance service interventions were only effective for a proportion of patients, but might not have always been applied appropriately. Complications of advanced airway management occurred in both provider groups, but failed intubation and unrecognized oesophageal intubation were a particular problem in the paramedic intubation group. © The Author 2014. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions

  17. Spinal trauma.

    Science.gov (United States)

    Hernández-Fernández, A; Massó, A; Beristain, M; G Esnal, I; Pardo, E; Carrillo, I; Lersundi, A

    2016-04-01

    The treatment of a patient with a vertebral fracture requires an accurate diagnosis and categorization of the problem. Treatment decisions must be based on clinical data and information about the lesion itself, which is provided by imaging studies and their interpretation.

  18. Pseudoaneurisma de carótida comum secundário a trauma contuso: opção de tratamento por cirurgia a céu aberto Pseudoaneurysm of common carotid due to trauma: treatment option for open sky surgery

    Directory of Open Access Journals (Sweden)

    Edson Pedroza dos Santos Junior

    2011-09-01

    Full Text Available Relato de caso de paciente feminina, com 44 anos de idade, vítima de trauma cervical em acidente de trânsito, que apresentou massa cervical dolorosa, rouquidão e disfagia associados, três semanas após o trauma. Exames complementares identificaram pseudoaneurisma de carótida comum em zona II. Optou-se pelo tratamento por meio de cirurgia convencional a céu aberto com excelente resultado imediato. Foi realizado um exame de controle após sete meses do procedimento cirúrgico, e os resultados confirmaram o sucesso terapêutico.Case report of a female patient, 44 years-old, victim of cervical trauma in a traffic accident, who had painful cervical mass, associated with hoarseness and dysphagia three weeks after trauma. Additional tests identified the pseudoaneurysm of common carotid artery in zone II. We opted for treatment through the open conventional surgery with excellent immediate result. Control examination was performed seven months after surgery, and the results confirmed the therapeutic success.

  19. Comparison of quality control for trauma management between Western and Eastern European trauma center

    Directory of Open Access Journals (Sweden)

    Gambale Giorgio

    2008-11-01

    Full Text Available Abstract Background Quality control of trauma care is essential to define the effectiveness of trauma center and trauma system. To identify the troublesome issues of the system is the first step for validation of the focused customized solutions. This is a comparative study of two level I trauma centers in Italy and Romania and it has been designed to give an overview of the entire trauma care program adopted in these two countries. This study was aimed to use the results as the basis for recommending and planning changes in the two trauma systems for a better trauma care. Methods We retrospectively reviewed a total of 182 major trauma patients treated in the two hospitals included in the study, between January and June 2002. Every case was analyzed according to the recommended minimal audit filters for trauma quality assurance by The American College of Surgeons Committee on Trauma (ACSCOT. Results Satisfactory yields have been reached in both centers for the management of head and abdominal trauma, airway management, Emergency Department length of stay and early diagnosis and treatment. The main significant differences between the two centers were in the patients' transfers, the leadership of trauma team and the patients' outcome. The main concerns have been in the surgical treatment of fractures, the outcome and the lacking of documentation. Conclusion The analyzed hospitals are classified as Level I trauma center and are within the group of the highest quality level centers in their own countries. Nevertheless, both of them experience major lacks and for few audit filters do not reach the mmum standard requirements of ACS Audit Filters. The differences between the western and the eastern European center were slight. The parameters not reaching the minimum requirements are probably occurring even more often in suburban settings.

  20. 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.

  1. A função do debriefing psicológico no tratamento de vítimas de trauma The role of psychological debriefing in the treatment of victims of trauma

    Directory of Open Access Journals (Sweden)

    Grant J Devilly

    2003-06-01

    Full Text Available A aplicação do chamado debriefing psicológico (DP tornou-se uma intervenção disseminada e esperada após a exposição ao trauma. Este artigo avalia a validade desse enfoque e relata o consenso entre os especialistas em relação ao seu uso. Revisões sistemáticas e narrativas são resumidas e as áreas de acordo e desacordo são delineadas. Em resumo, conclui-se que a maioria das pessoas não fica traumatizada devido a eventos estressantes; que o DP parece ter pequeno impacto; que uma forma de DP chamada de "debriefing sobre o incidente crítico (DICE" pode exercer efeitos nocivos em certos indivíduos e que aqueles com efeitos mais negativos devido ao DP parecem ser os que mais sofreram com o trauma inicial. Não há ensaios clínicos randomizados que sustentem a validade do DP em grupo. A intervenção precoce Cognitivo-Comportamental parece ser o enfoque mais promissor em pacientes com apresentações clínicas bem definidas. É oferecido um conjunto genérico de diretrizes para a intervenção pós-trauma.The application of psychological debriefing has become an expected and widespread intervention following exposure to trauma. This article assesses the wisdom of such an approach and reports upon expert consensus regarding its use. Meta-analytic and narrative reviews are summarised and areas of agreement and disagreement are outlined. In sum, it was concluded that the majority of people do not become traumatised from stressful events; that generic psychological debriefing, when applied to individuals, appears to have little impact on functioning; that a specific form of debriefing called Critical Incident Stress Debriefing holds the possibility of noxious effects for some participants and that those most deleteriously affected by debriefing appear to be those most distressed by the initial trauma; that there is no randomised controlled trial evidence to support the validity of group debriefing approaches; and that early intervention

  2. Late Prosthetic Shoulder Hemiarthroplasty after Failed Management of Complex Proximal Humeral Fractures

    Directory of Open Access Journals (Sweden)

    A. Panagopoulos

    2013-01-01

    Full Text Available Background. The purpose of this study was to report our experience with shoulder hemiarthroplasty in the context of old trauma. Methods. 33 patients with failed treatment for a complex proximal humeral fracture underwent prosthetic hemiarthroplasty. There were 15 men and 18 women with a mean age of 58.1 years. The average period from initial treatment was 14.9 months. Sequelae included 11 malunions, 4 nonunions, 15 cases with avascular necrosis (AVN and 3 neglected posterior locked dislocations. Follow up investigation included radiological assessment and clinical evaluation using the Constant score and a visual analogue pain scale. Results. After a mean follow up of 82.5 months the median Constant score was 75.7 points, improved by 60% in comparison to preoperative values. Greater tuberosity displacement, large cuff tears and severe malunion were the factors most affected outcome. No cases of stem loosening or severe migration were noted. 60% of the patients were able to do activities up to shoulder level compared with 24% before reconstruction. Conclusions. Late shoulder hemiarthroplasty is technically difficult and the results are inferior to those reported for acute humeral head replacement, nonetheless remains a satisfactory reconstructive option when primary treatment fails.

  3. Demographics, nature and treatment of orthopaedic trauma injuries occurring in an agricultural context in the West of Ireland.

    LENUS (Irish Health Repository)

    Byrne, F J

    2011-03-01

    Farming is a major industry in the West of Ireland. This prospective study examined the age profile, nature and treatment of orthopaedic injuries occurring in agricultural surroundings presenting at the Orthopaedic Unit of Merlin Park Hospital, Galway.

  4. Suspension Trauma / Orthostatic Intolerance

    Science.gov (United States)

    ... of Science and Technology Assessment Printer Friendly Version Suspension Trauma/Orthostatic Intolerance Safety and Health Information Bulletin ... information about the hazards of orthostatic intolerance and suspension trauma when using fall arrest systems. This bulletin: ...

  5. About Military Sexual Trauma

    Medline Plus

    Full Text Available ... total__ Find out why Close About Military Sexual Trauma Veterans Health Administration Loading... Unsubscribe from Veterans Health ... 10 VA HSR&D Investigator Insights: Military Sexual Trauma - Duration: 3:27. Veterans Health Administration 898 views ...

  6. 严重肝外伤的外科急诊救治及预后因素分析%Emergency surgical treatment and prognostic factors analysis of severe liver trauma

    Institute of Scientific and Technical Information of China (English)

    朱斌; 严栋梁; 邵伟斌

    2012-01-01

    目的 探讨严重肝外伤的外科急诊救治方法及预后相关因素.方法 采用单因素分析18例AASTⅢ级及以上严重肝外伤患者临床资料.结果 18例严重肝外伤患者中存活12例,死亡6例 .单因素分析结果显示,休克时间、失血量,手术时间等与患者顸后有关.结论 严重的肝外伤的外科急诊救治必须遵循个体化治疗原则,快速的绿色通道,恰当的手术方式以及介入技术的协助,往往能够极大提高肝外伤抢救的成功率.%Objective To explore serious liver trauma surgical emergency treatment methods and prognosis - related factors of severe hepatic trauma. Methods Single factor analysis was conducted to the clinical data of 18 AAST 111 or above patients with severe liver trauma. Results Among 19 patients, 12 survived and 6 died. The results of single factor analysis showed that shock time, blood loss, operating duration were related with the prognosis of the patients. Conclusion Severe liver trauma emergency surgical treatment must follow the principle of individualized treatment. Fast and easy access, the proper operation and interventional technique can greatly enhance the success rate of liver trauma rescue.

  7. Primary cutaneous mucormycosis in trauma patients.

    Science.gov (United States)

    Johnson, P C; Satterwhite, T K; Monheit, J E; Parks, D

    1987-04-01

    Primary cutaneous mucormycosis in trauma patients has been rarely reported. We describe three cases occurring in noncompromised hosts and review the literature. Prompt diagnosis and aggressive treatment with vigorous local care and appropriate antibiotics are recommended.

  8. Nonoperative management for patients with grade IV blunt hepatic trauma

    Directory of Open Access Journals (Sweden)

    Zago Thiago

    2012-08-01

    Full Text Available Abstract Introduction The treatment of complex liver injuries remains a challenge. Nonoperative treatment for such injuries is increasingly being adopted as the initial management strategy. We reviewed our experience, at a University teaching hospital, in the nonoperative management of grade IV liver injuries with the intent to evaluate failure rates; need for angioembolization and blood transfusions; and in-hospital mortality and complications. Methods This is a retrospective analysis conducted at a single large trauma centre in Brazil. All consecutive, hemodynamically stable, blunt trauma patients with grade IV hepatic injury, between 1996 and 2011, were analyzed. Demographics and baseline characteristics were recorded. Failure of nonoperative management was defined by the need for surgical intervention. Need for angioembolization and transfusions, in-hospital death, and complications were also assessed Results Eighteen patients with grade IV hepatic injury treated nonoperatively during the study period were included. The nonoperative treatment failed in only one patient (5.5% who had refractory abdominal pain. However, no missed injuries and/or worsening of bleeding were observed during the operation. None of the patients died nor need angioembolization. No complications directly related to the liver were observed. Unrelated complications to the liver occurred in three patients (16.7%; one patient developed a tracheal stenosis (secondary to tracheal intubation; one had pleural effusion; and one developed an abscess in the pleural cavity. The hospital length of stay was on average 11.56 days. Conclusions In our experience, nonoperative management of grade IV liver injury for stable blunt trauma patients is associated with high success rates without significant complications.

  9. Resultados del tratamiento quirúrgico en un traumatismo pancreaticoduodenal Results of the surgical treatment in a pancreaticoduodenal trauma

    Directory of Open Access Journals (Sweden)

    Agustín Alberto Jiménez Carrazana

    2011-12-01

    Full Text Available Introducción: la ruptura del páncreas y el duodeno es un evento poco común, cuyas cifras oscilan entre el 2 y el 4 % de los traumatismos abdominales. La mayoría ocurre en heridas abdominales penetrantes y en traumatismos compresivos en accidentes de tránsito. Métodos: se presenta una serie de 19 pacientes operados por traumatismo pancreaticoduodenal, en 5 hospitales clinicoquirúrgicos de Ciudad de La Habana, desde 2008 a 2010. Se realizó un estudio retrospectivo, mediante el uso de encuestas diseñadas a tal efecto, aplicadas a los cirujanos actuantes en el período estudiado. Resultados: el 63 % de los pacientes fueron por traumatismos cerrados, con predominio de accidentes de tránsito, la mayoría clasificados como grado I (15 pacientes, y 2 pacientes como grado II. Ambos grupos acumularon el 90 % de las lesiones. El procedimiento quirúrgico más frecuentemente empleado fue la pancreatectomía distal con esplenectomía. Se complicaron 8 pacientes (42 %, y la más frecuente fue la fístula pancreática externa en 4 pacientes, seguida por la peritonitis en 2; fallecieron 3 (15 %, distribuidos de la manera siguiente: de 13 pacientes clasificados como grado I, falleció 1 (7 %, y 2 pacientes clasificados como grado III (100 %. Conclusiones: para obtener resultados favorables en este tipo de paciente es necesaria una clasificación acertada según la localización y severidad de las lesiones, así como una adecuada selección del procedimiento quirúrgico.Introduction: rupture of pancreas and duodenum is a uncommon event, whose figures fluctuate between the 2 and the 4 % of the abdominal traumata. Most occur in penetrating abdominal wounds and in compressive traumata in road accidents. Methods: a total of 19 patients were operated on due to a pancreaticoduodenal trauma in five clinical surgical hospitals of Ciudad de La Habana from 2008 to 2010. A retrospective study was conducted using the surveys designed to that end, applied to acting

  10. Cognitive-behavioral treatment for chronic nightmares in trauma-exposed persons: assessing physiological reactions to nightmare-related fear.

    Science.gov (United States)

    Rhudy, Jamie L; Davis, Joanne L; Williams, Amy E; McCabe, Klanci M; Bartley, Emily J; Byrd, Patricia M; Pruiksma, Kristi E

    2010-04-01

    Cognitive-behavioral treatments (CBTs) that target nightmares are efficacious for ameliorating self-reported sleep problems and psychological distress. However, it is important to determine whether these treatments influence objective markers of nightmare-related fear, because fear and concomitant physiological responses could promote nightmare chronicity and sleep disturbance. This randomized, controlled study (N=40) assessed physiological (skin conductance, heart rate, facial electromyogram) and subjective (displeasure, fear, anger, sadness, arousal) reactions to personally relevant nightmare imagery intended to evoke nightmare-related fear. Physiological assessments were conducted at pretreatment as well as 1-week, 3-months, and 6-months posttreatment. Results of mixed effects analysis of variance models suggested treatment reduced physiological and subjective reactions to nightmare imagery, gains that were generally maintained at the 6-month follow-up. Potential implications are discussed.

  11. Re-authoring life narratives of trauma survivors: Spiritual perspective

    Directory of Open Access Journals (Sweden)

    Charles Manda

    2015-02-01

    Full Text Available Traditionally, the exploration of the impact of trauma on trauma survivors in South Africa has been focused mainly on the bio-psychosocial aspects. The bio-psychosocial approach recognises that trauma affects people biologically, socially and psychologically. In this article, the author explores a holistic understanding of the effects of trauma on people from communities historically affected by political violence in KwaZulu-Natal, South Africa. Using a participatory action research design (PAR as a way of working through trauma, a longitudinal study was conducted in Pietermaritzburg from 2009–2013. At the end of the study, life narratives were documented and published. The textual analysis of these life narratives reveals that, besides the bio-psychosocial effects that research participants experienced during and after the trauma, they also sustained moral and spiritual injuries. Trauma took its toll in their lives emotionally, psychologically, spiritually, morally and in their relationships with themselves, others and God. From these findings, the author argues that the bio-psychosocial approach is incomplete for understanding the holistic effects of trauma on the whole person. Therefore, he recommends the integration of the moral and spiritual aspects of trauma to come up with a holistic model of understanding the effects of trauma on traumatised individuals. The holistic model will enhance the treatment, healing and recovery of trauma survivors. This, in turn, will alleviate the severe disruption of many aspects of psychological functioning and well-being of trauma survivors caused by the effects of trauma.

  12. Trauma resuscitation time.

    NARCIS (Netherlands)

    Olden, G.D.J. van; Vugt, A.B. van; Biert, J.; Goris, R.J.A.

    2003-01-01

    Documenting the timing and organisation of trauma resuscitation can be utilised to assess performance standards, and to ensure a high quality of trauma resuscitation procedures. Since there is no European literature available on trauma resuscitation time (TRT) in the emergency room, the aim of this

  13. Trauma Facts for Educators

    Science.gov (United States)

    National Child Traumatic Stress Network, 2008

    2008-01-01

    This paper offers facts which can help educators deal with children undergoing trauma. These include: (1) One out of every 4 children attending school has been exposed to a traumatic event that can affect learning and/or behavior; (2) Trauma can impact school performance; (3) Trauma can impair learning; (4) Traumatized children may experience…

  14. Trauma resuscitation time.

    NARCIS (Netherlands)

    Olden, G.D.J. van; Vugt, A.B. van; Biert, J.; Goris, R.J.A.

    2003-01-01

    Documenting the timing and organisation of trauma resuscitation can be utilised to assess performance standards, and to ensure a high quality of trauma resuscitation procedures. Since there is no European literature available on trauma resuscitation time (TRT) in the emergency room, the aim of this

  15. [Psychotherapeutic treatment of accompanied and unaccompanied minor refugees and asylum seekers with trauma-related disorders in Germany].

    Science.gov (United States)

    Metzner, Franka; Reher, Cornelia; Kindler, Heinz; Pawils, Silke

    2016-05-01

    Germany is one of the most important host countries for minor refugees and asylum seekers in Europe. The number of children who leave their home country has significantly risen worldwide in recent years; a further rise is to be expected due to the increasing number of crisis zones. A literature review demonstrates the state of research on traumatization, post-traumatic stress disorders and psychotherapy in minor refugees and asylum seekers. Many minor refugees and asylum seekers have made mainly interpersonal traumatic experiences within their home country or during their flight and develop simple or complex post-traumatic stress disorders. Left untreated, there is a risk of chronification. The psychotherapeutic treatment of minor refugees and asylum seekers in Germany takes place primarily in specialized psychosocial treatment centers. For an involvement of therapists in private practices, a reduction of organizational barriers as well as evidence-based treatment methods for interpreter-aided psychotherapy of minor refugees and asylum seekers that also consider their developmental state, are still lacking. In research, as well as in practice, there is further need for an early and systematic identification and treatment of minor refugees and asylum seekers with post-traumatic stress disorders or high risk of disease in Germany.

  16. Trauma-focused treatment for posttraumatic stress disorder combined with CBT for severe substance use disorder: a randomized controlled trial

    NARCIS (Netherlands)

    van Dam, D.; Ehring, T.; Vedel, E.; Emmelkamp, P.M.G.

    2013-01-01

    Background: This randomized controlled trial (RCT) investigated the effectiveness of a combined treatment for co-morbid Posttraumatic Stress Disorder (PTSD) and severe Substance Use Disorder (SUD). Methods: Structured Writing Therapy for PTSD (SWT), an evidence-based traumafocused intervention, was

  17. Contemporary evaluation and management of renal trauma.

    Science.gov (United States)

    Chouhan, Jyoti D; Winer, Andrew G; Johnson, Christina; Weiss, Jeffrey P; Hyacinthe, Llewellyn M

    2016-04-01

    Renal trauma occurs in approximately 1%-5% of all trauma cases. Improvements in imaging and management over the last two decades have caused a shift in the treatment of this clinical condition. A systematic search of PubMed was performed to identify relevant and contemporary articles that referred to the management and evaluation of renal trauma. Computed tomography remains a mainstay of radiological evaluation in hemodynamically stable patients. There is a growing body of literature showing that conservative, non-operative management of renal trauma is safe, even for Grade IV-V renal injuries. If surgical exploration is planned due to other injuries, a conservative approach to the kidney can often be utilized. Follow up imaging may be warranted in certain circumstances. Urinoma, delayed bleeding, and hypertension are complications that require follow up. Appropriate imaging and conservative approaches are a mainstay of current renal trauma management.

  18. Trauma Focused CBT for Children with Co-Occurring Trauma and Behavior Problems

    Science.gov (United States)

    Cohen, Judith A.; Berliner, Lucy; Mannarino, Anthony

    2010-01-01

    Objective: Childhood trauma impacts multiple domains of functioning including behavior. Traumatized children commonly have behavioral problems that therapists must effectively evaluate and manage in the context of providing trauma-focused treatment. This manuscript describes practical strategies for managing behavior problems in the context of…

  19. Trauma Focused CBT for Children with Co-Occurring Trauma and Behavior Problems

    Science.gov (United States)

    Cohen, Judith A.; Berliner, Lucy; Mannarino, Anthony

    2010-01-01

    Objective: Childhood trauma impacts multiple domains of functioning including behavior. Traumatized children commonly have behavioral problems that therapists must effectively evaluate and manage in the context of providing trauma-focused treatment. This manuscript describes practical strategies for managing behavior problems in the context of…

  20. Diagnostic accuracy of a step-up imaging strategy in pediatric patients with blunt abdominal trauma

    Energy Technology Data Exchange (ETDEWEB)

    Schuppen, J. van [Department of Radiology, Academic Medical Centre, Amsterdam (Netherlands); Olthof, D.C. [Trauma Unit Department of Surgery, Academic Medical Centre, Amsterdam (Netherlands); Wilde, J.C.H. [Department of Paediatric Surgery, Emma' s Children Hospital/Academic Medical Centre, Amsterdam (Netherlands); Beenen, L.F.M.; Rijn, R.R. van [Department of Radiology, Academic Medical Centre, Amsterdam (Netherlands); Goslings, J.C., E-mail: j.c.goslings@amc.nl [Trauma Unit Department of Surgery, Academic Medical Centre, Amsterdam (Netherlands)

    2014-01-15

    Introduction: Blunt abdominal trauma (BAT) is an important but often unrecognized cause of death in children. Imaging plays a vital role in the early detection of abdominal trauma. The exact role of imaging in the management of BAT in children is still under research. The aim of this study was to assess diagnostic accuracy of a step-up imaging strategy, where the decision to observe or to perform an intervention depends on the vital parameters of the patient, in combination with the presence or absence of free fluid at Focused Assessment with Sonography for Trauma (FAST) and the findings on CT (performed selectively), for pediatric patients presenting to the ED with a blunt abdominal trauma. Methods: Consecutive patients aged ≤16 years admitted between January 2008 and December 2012 to a Dutch level 1 trauma centre were included in this retrospective study. Sensitivity, negative predictive value (NPV) and the negative likelihood ratio (LR−) of the imaging strategy were calculated. Results: The cohort consisted of 122 patients; 66 (54%) patients were discharged home after primary survey, 51 (41%) patients were admitted and observed, 3 (2%) patients underwent transarterial embolization and 2 (2%) patients underwent surgery. Treatment failed in 1 patient, initially selected for observation. The sensitivity of the imaging strategy was 0.833 (0.446–0.990). The NPV and LR− were 0.991 (0.963–1.000) and 0.167 (0.028–0.997), respectively. Conclusion: The step-up imaging strategy that is applied in our academic level 1 trauma centre has a high sensitivity and a high negative predictive value. No clinically relevant injuries were missed without doing unnecessary harm, e.g. radiation or an intervention.

  1. [Standardised primary care of multiple trauma patients. Prehospital Trauma Life Support und Advanced Trauma Life Support].

    Science.gov (United States)

    Wölfl, C G; Gliwitzky, B; Wentzensen, A

    2009-10-01

    Standardised management improves treatment results in seriously injured patients. For conditions like stroke or acute coronary syndrome (ACS) there are set treatment pathways which have been established for prehospital and primary hospital care. The treatment of critical trauma patients, however, follows varying procedures in both the prehospital and primary hospital phases. From an analysis of the trauma register of the German Society for Trauma Surgery (DGU), we know that a seriously injured patient remains on the road for 70 min on average before transferral to hospital. This requires improvement. With the 2003 introduction of the ATLS programme in Germany, the initial clinical phase could be improved upon simply by means of standardised training. PHTLS und ATLS complement one another. PHTLS und ATLS represent training concepts which teach standardised, priority-based prehospital and hospital trauma management. The aim is to make an initial rapid and accurate assessment of the patient's condition, thereby identifying the"critical" patient. The concepts also make priority-based treatment possible and facilitate decision-making as to whether patients can receive further on-the-spot treatment or whether immediate transport is necessary. The procedure is identical in the shock room. The primary consideration is to prevent secondary damage, not to lose track of time and to ensure consistent quality of care. The courses teach systematic knowledge, techniques, skills and conduct in diagnosis and therapy. The courses are oriented to all medical specialities associated with trauma care. With the support of the German Society for Trauma Surgery (DGU) and the German Society for Anesthesiology and Intensive Medicine (DGAI), the German Professional Organisation of Rescue Services (DBRD) has adopted the PHTLS course system on licence from the National Association of Emergency Medical Technicians (NAEMT) and the American College of Surgeons (ACS) and has been offering it in

  2. Early Surgery versus Initial Conservative Treatment in Patients with Traumatic Intracerebral Hemorrhage (STITCH[Trauma]): The First Randomized Trial.

    Science.gov (United States)

    Mendelow, A David; Gregson, Barbara A; Rowan, Elise N; Francis, Richard; McColl, Elaine; McNamee, Paul; Chambers, Iain R; Unterberg, Andreas; Boyers, Dwayne; Mitchell, Patrick M

    2015-09-01

    Intraparenchymal hemorrhages occur in a proportion of severe traumatic brain injury TBI patients, but the role of surgery in their treatment is unclear. This international multi-center, patient-randomized, parallel-group trial compared early surgery (hematoma evacuation within 12 h of randomization) with initial conservative treatment (subsequent evacuation allowed if deemed necessary). Patients were randomized using an independent randomization service within 48 h of TBI. Patients were eligible if they had no more than two intraparenchymal hemorrhages of 10 mL or more and did not have an extradural or subdural hematoma that required surgery. The primary outcome measure was the traditional dichotomous split of the Glasgow Outcome Scale obtained by postal questionnaires sent directly to patients at 6 months. The trial was halted early by the UK funding agency (NIHR HTA) for failure to recruit sufficient patients from the UK (trial registration: ISRCTN19321911). A total of 170 patients were randomized from 31 of 59 registered centers worldwide. Of 82 patients randomized to early surgery with complete follow-up, 30 (37%) had an unfavorable outcome. Of 85 patients randomized to initial conservative treatment with complete follow-up, 40 (47%) had an unfavorable outcome (odds ratio, 0.65; 95% confidence interval, CI 0.35, 1.21; p=0.17), with an absolute benefit of 10.5% (CI, -4.4-25.3%). There were significantly more deaths in the first 6 months in the initial conservative treatment group (33% vs. 15%; p=0.006). The 10.5% absolute benefit with early surgery was consistent with the initial power calculation. However, with the low sample size resulting from the premature termination, we cannot exclude the possibility that this could be a chance finding. A further trial is required urgently to assess whether this encouraging signal can be confirmed.

  3. Regional cerebral glucose metabolism differentiates danger- and non-danger-based traumas in post-traumatic stress disorder.

    Science.gov (United States)

    Ramage, Amy E; Litz, Brett T; Resick, Patricia A; Woolsey, Mary D; Dondanville, Katherine A; Young-McCaughan, Stacey; Borah, Adam M; Borah, Elisa V; Peterson, Alan L; Fox, Peter T

    2016-02-01

    Post-traumatic stress disorder (PTSD) is presumably the result of life threats and conditioned fear. However, the neurobiology of fear fails to explain the impact of traumas that do not entail threats. Neuronal function, assessed as glucose metabolism with (18)fluoro-deoxyglucose positron emission tomography, was contrasted in active duty, treatment-seeking US Army Soldiers with PTSD endorsing either danger- (n = 19) or non-danger-based (n = 26) traumas, and was compared with soldiers without PTSD (Combat Controls, n = 26) and Civilian Controls (n = 24). Prior meta-analyses of regions associated with fear or trauma script imagery in PTSD were used to compare glucose metabolism across groups. Danger-based traumas were associated with higher metabolism in the right amygdala than the control groups, while non-danger-based traumas associated with heightened precuneus metabolism relative to the danger group. In the danger group, PTSD severity was associated with higher metabolism in precuneus and dorsal anterior cingulate and lower metabolism in left amygdala (R(2 )= 0.61). In the non-danger group, PTSD symptom severity was associated with higher precuneus metabolism and lower right amygdala metabolism (R(2 )= 0.64). These findings suggest a biological basis to consider subtyping PTSD according to the nature of the traumatic context.

  4. Evaluation and management of acute vascular trauma.

    Science.gov (United States)

    Salazar, Gloria M M; Walker, T Gregory

    2009-06-01

    With the technical advances and the increasing availability of sophisticated imaging equipment, techniques, and protocols, and with continually evolving transcatheter endovascular therapies, minimally invasive imaging and treatment options are being routinely used for the clinical management of trauma patients. Thus, the primary treatment algorithm for managing acute vascular trauma now increasingly involves the interventional radiologist or other endovascular specialist. Endovascular techniques represent an attractive option for both stabilizing and definitively treating patients who have sustained significant trauma, with resultant vascular injury. Endovascular treatment frequently offers the benefit of a focused definitive therapy, even in the presence of massive hemorrhage that allows for preservation of major vessels or injured solid organs and serves as an alternative to an open surgical intervention. This article presents an overview of various endovascular techniques that can be used for trauma patients presenting with vascular injuries.

  5. Vascular Injury in Orthopedic Trauma.

    Science.gov (United States)

    Mavrogenis, Andreas F; Panagopoulos, George N; Kokkalis, Zinon T; Koulouvaris, Panayiotis; Megaloikonomos, Panayiotis D; Igoumenou, Vasilios; Mantas, George; Moulakakis, Konstantinos G; Sfyroeras, George S; Lazaris, Andreas; Soucacos, Panayotis N

    2016-07-01

    Vascular injury in orthopedic trauma is challenging. The risk to life and limb can be high, and clinical signs initially can be subtle. Recognition and management should be a critical skill for every orthopedic surgeon. There are 5 types of vascular injury: intimal injury (flaps, disruptions, or subintimal/intramural hematomas), complete wall defects with pseudoaneurysms or hemorrhage, complete transections with hemorrhage or occlusion, arteriovenous fistulas, and spasm. Intimal defects and subintimal hematomas with possible secondary occlusion are most commonly associated with blunt trauma, whereas wall defects, complete transections, and arteriovenous fistulas usually occur with penetrating trauma. Spasm can occur after either blunt or penetrating trauma to an extremity and is more common in young patients. Clinical presentation of vascular injury may not be straightforward. Physical examination can be misleading or initially unimpressive; a normal pulse examination may be present in 5% to 15% of patients with vascular injury. Detection and treatment of vascular injuries should take place within the context of the overall resuscitation of the patient according to the established principles of the Advanced Trauma Life Support (ATLS) protocols. Advances in the field, made mostly during times of war, have made limb salvage the rule rather than the exception. Teamwork, familiarity with the often subtle signs of vascular injuries, a high index of suspicion, effective communication, appropriate use of imaging modalities, sound knowledge of relevant technique, and sequence of surgical repairs are among the essential factors that will lead to a successful outcome. This article provides a comprehensive literature review on a subject that generates significant controversy and confusion among clinicians involved in the care of trauma patients. [Orthopedics. 2016; 39(4):249-259.].

  6. 面部外伤的急诊整形外科治疗研究%Surgical treatment of facial trauma emergency orthopedic

    Institute of Scientific and Technical Information of China (English)

    张羽森

    2015-01-01

    Objective To study the clinical effect of facial plastic surgery on repairment of the emergency trauma.Methods Two hundred patients with facial trauma from March 2012 to June 2013 were selected,orthopedic emergency repair first assessment of the injury was given,and then depending on the choice of anesthesia and fix the situation and thoroughly cleaned before surgery,and given reasonable nursing post-operative.Patients were followed up for 1 year,and the postoperative complications,functional restoration and scar formation were observed.Results Operative incision of 200 cases were primary healing,with no significant complications.Six patients were lost to followed-up,of the rest 194 patients,63 patients (32.5%) without obvious scar tissue and no dislocation,the healing effect was satisfactory; 9 patients with obvious scar,need to repair again.Conclusions Emergency orthopedic treatment of facial trauma,can effectively restore the patient' s facial features,but also maximize the recovery form,function and aesthetics into account,it is worth promoting.%目的 研究整形外科急诊修复治疗面部外伤的临床效果.方法 随机抽取郑州人民医院颐和医院2012年3月至2013年6月收治的面部创伤患者200例,对其进行整形外科急诊修复,先评估伤情,再视情况选择麻醉和修复方法,并在术前彻底清创,术后合理护理.术后随访1年,观察患者的术后并发症、功能修复以及瘢痕增生情况.结果 200例患者术后切口Ⅰ期愈合,无一例出现明显并发症.随访中共6例失访,余194例患者中63例(32.5%)术后无明显瘢痕,且组织无错位现象,愈合效果满意,仅9例患者存在明显瘢痕,需行二期修复.结论 急诊整形外科治疗面部外伤,既能有效恢复患者的面部功能,又能最大程度地恢复期形态,功能和美观兼顾,值得推广.

  7. Relationships between Trauma, Posttraumatic Stress Disorder Symptoms, Dissociative Symptoms, and Lifetime Heroin Use among Individuals Who Abuse Substances in Residential Treatment

    Science.gov (United States)

    Horton, E. Gail; Diaz, Naelys; Peluso, Paul R.; Mullaney, Donald; Weiner, Michael; McIlveen, John W.

    2009-01-01

    This study explored the relationships between trauma, posttraumatic stress disorder symptoms, dissociation, and lifetime heroin use among inpatient clients who abused substances. Results indicate important implications for practice and directions for future research. (Contains 1 figure and 1 table.)

  8. Citation classics in trauma.

    Science.gov (United States)

    Ollerton, Joanne Emma; Sugrue, Michael

    2005-02-01

    The evolution of trauma may be analyzed by review of articles most frequently cited by scientific articles worldwide. This study identified the "trauma classics" by reviewing the most-cited articles ever published in The Journal of Trauma. The Science Citation Index of the Institute for Scientific Information was searched for the 50 most-cited articles in The Journal of Trauma. Of the 12,672 articles published since 1961, 80 were cited over 100 times and 17 over 200 times. The most-cited article was by Baker, a hallmark publication on injury scoring published in 1974. Feeding postinjury, bacterial translocation, and multiple organ failure were common themes. Overall, 32% involved gastrointestinal topics and 18% involved injury scoring, with institutions in the United States publishing 80% of the articles. This study identified the trauma classics from the last 42 years of The Journal of Trauma. Citation analysis has recognized limitations but gives a fascinating insight into the evolution of trauma care.

  9. 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...

  10. Post-evaluation of the neurophaties treatment post-trauma with therapeutic laser. Model in sciatic nerve of frog

    Science.gov (United States)

    Escobar, Antonio S.; Ocampo, Arcelia F. M.; Hernández, María G. H.; Jasso, José L. C.; Lira, Maricela O. F.; Flores, Mariana A.; Balderrama, Vicente L.

    2010-05-01

    The purpose of this study was to evaluate the compound nerve action potential amplitude and latency measured to determine the degree of myelination and the number of fibers stimulated in a model of stimulated frog sciatic nerve laser at 810 nm as perioperative treatment after injury. It used 30 bullfrogs (Rana catesbeiana) to obtain 60 sciatic nerves forming four groups, groups 1 and 2 worked with nerves in vitro, were dissected in humid chambers for placing isolated organ, was recorded on compound nerve action potential, the second group laser was applied at 24, 48, 72, 96 and 120 hours and at the same time were placed in 10% formalin. Groups 3 and 4 are worked in vivo localizing the nerve and causing damage through compression, occurred over the compound nerve action potential to assess the degree of myelination and the number of fibers stimulated, the group 4 was applied to 810 nm laser (500 Hz, 10 J, 200 mW) after injury, after 48 hours, three frogs were sacrificed by introducing the nerves in 10% formalin. The latency recorded by stimulating the sciatic nerve of frog to 0.5 mA and 100 ms in groups 1 and 2 show significant differences (p000), as to the extent, if any statistically significant difference. (p<0.001 and p<0.000). The laser produces a favorable response in the treatment of paresthesia (post-traumatic neuropathy).

  11. The influence of shame on posttrauma disorders: have we failed to see the obvious?

    Directory of Open Access Journals (Sweden)

    Terry F. Taylor

    2015-09-01

    Full Text Available Background: While fear is known to be the dominant affect associated with posttraumatic stress disorder (PTSD, the presence and possible influence of other emotions is less well explored. Recent changes to diagnostic criteria have added anger, guilt and shame alongside fear as significant emotional states associated with the disorder. This article suggests that shame is a frequent, often poorly recognised sequel to trauma, occurring as a result of the meaning the individual places on the traumatic experience and on subsequent interpersonal and environmental events. Methods: The article reviews the literature on the socio-interpersonal aspects of the posttraumatic experience with particular emphasis on the emotion of shame as both primary and secondary emotion, in its intrapersonal and interpersonal contexts, and in adaptive and maladaptive forms. Results: The review suggests that posttrauma shame, and maladaptive shame regulation strategies, often manifesting as anger, substance abuse, social withdrawal or depression, may play an important role in the maintenance or exacerbation of the symptoms of PTSD and the development of co-morbidities. Conclusion: The recognition of shame and maladaptive shame regulation strategies in PTSD treatment and management is critical. However, because shame is frequently considered a painful and discomforting emotion, it may fail to be addressed in the therapeutic setting by both client and therapist. Examination of potential shame-related changes in self-concept, close interpersonal relationships and social inclusion are recommended for individuals who have experienced a range of traumas to identify and address any underlying unacknowledged shame.

  12. Dialectical behaviour therapy and an added cognitive behavioural treatment module for eating disorders in women with borderline personality disorder and anorexia nervosa or bulimia nervosa who failed to respond to previous treatments. An open trial with a 15-month follow-up.

    Science.gov (United States)

    Kröger, Christoph; Schweiger, Ulrich; Sipos, Valerija; Kliem, Sören; Arnold, Ruediger; Schunert, Tanja; Reinecker, Hans

    2010-12-01

    There is evidence from case studies suggesting that adapted dialectical behavior therapy (DBT) for borderline personality disorder (BPD) and eating disorders (ED) might improve disorder related complaints. Twenty-four women with BPD (9 with comorbid anorexia nervosa [AN] and 15 with bulimia nervosa [BN]), who already had failed to respond to previous eating-disorder related inpatient treatments were consecutively admitted to an adapted inpatient DBT program. Assessment points were at pre-treatment, post-treatment, and 15-month follow-up. At follow-up, the remission rate was 54% for BN, and 33% for AN. Yet 44% of women with AN crossed over to BN and one woman additionally met the criteria of AN. For women with AN, the mean weight was not significantly increased at post-treatment, but had improved at follow-up. For women with BN, the frequency of binge-eating episodes was reduced at post-treatment as well as at follow-up. Self-rated eating-related complaints and general psychopathology, as well as ratings on global psychosocial functioning, were significantly improved at post-treatment and at follow-up. Although these findings support the assumption that the adapted DBT inpatient program is a potentially efficacious treatment for those who failed to respond to previous eating-disorder related inpatient treatments, remission rates and maintained eating-related psychopathology also suggest that this treatment needs further improvement.

  13. Emergency Plastic Surgery Treatment of 35 Cases with Seawater Immersed Facial Trauma%35例面部外伤合并海水浸泡的临床救治体会

    Institute of Scientific and Technical Information of China (English)

    丛斌; 张峰平; 张义敏; 姜群; 钟丽红

    2012-01-01

    目的:回顾35例面部外伤合并海水浸泡的治疗.方法:对35例病人采取包括清水、庆大霉素溶液清洗和抗感染等治疗.观察创面的感染情况和临床治疗结果.结果:35例患者外伤愈合良好,无感染、血肿,随访未发生瘢痕增生等并发症.结论:在面部损伤急诊处理中,应用整形外科技术对患者面部功能及形态的恢复有很大的帮助.%Objective: To review the 35 cases with Seawater Immersed Facial Trauma. Methods: A total of 35 cases with Seawater Immersed Facial Trauma underwent combined treatment including repeated wash of wounds with freshwater and Gentamicin solution, anti-infection. The infection of wounds and clinical treatment were observed. Results: 35 cases with Seawater Immersed Facial Trauma healed well, without infection, hematoma, follow-up without complications such as scar formation. Conclusion: In the emergency treatment of facial injuries with Seawater Immersion, it will be of great help to apply facial plastic surgery to restore function and morphology.

  14. 33例急性四肢血管损伤的诊治体会%Diagnosis and Treatment of Acute Trauma in Extremity Vascular

    Institute of Scientific and Technical Information of China (English)

    余立权; 高涌; 宋涛; 孙勇

    2011-01-01

    目的 探讨急性四肢血管损伤的诊断和治疗方法 .方法 回顾性分析33例四肢血管损伤病例的诊断、急救、血管修复重建治疗和术后处理方法 .注意患者全身生命体征变化,利用体检、影像学检查等手段,了解肢体的局部缺血情况.有效快速地术前准备,纠正休克,抢救患者生命,坚持保生命第一、保肢体第二的原则.采用人工血管移植损伤血管段4例,取自体大隐静脉行血管重建术20例,5例修剪损伤段直接吻合术,4例直接修补术.其中11例行动静脉Fogarty导管取栓术,行骨筋膜室切开减压术6例.对于合并骨折及神经损伤者请骨科医生手术台上会诊行骨折固定和神经修复.结果 肢体保留30例,术后26例肢体运动感觉功能良好.2例术后出现肢体严重感染坏死而行截肢术,3例肢体部分功能障碍,1例骨外露较多行皮瓣转移术,1例出现多器官功能障碍死亡.结论 血管损伤的早期准确诊断、及时修复重建血管和有效的术后处理可抢救患者的生命和肢体.%Objective To evaluate diagnosis and surgical treatment of acute trauma in extremity vascular. Methods The diagnosis and emergency treatment and revascularization and postoperative treatment methods of 33 patients with acute trauma in extremity vascular were analyzed retrospectively. The diversity vital sign of all over the body in patients was noticed. Extremity ischemia was diagnosed by medical examination and imageology. Preoperative preparation was effective and volant. Life was protected primary and extremity was protected secondary. The damaged blood vessel was adopted vasotransplantation with vascular prosthesis in 4 cases. Reconstructive vascular operation was adopted with self saphenous vein in 20 cases. Damaged blood vessel section was trimmed, and then vascular anastomosis was used directly with 5 cases. Blood vessel neoplasty was adopted directly with 4 cases. Embolectomy of artery and vein was

  15. Research status of otolaryngology head and neck trauma and the expectation of digital treatment%耳鼻咽喉头颈战创伤研究现状及数字化救治展望

    Institute of Scientific and Technical Information of China (English)

    陈继川

    2013-01-01

    Because of the special anatomical and physiological characteristics ,otolaryngology head and neck trauma is frequently found in multiply injured patients .Otolaryngology head and neck trauma may cause permanent derangement of functions ,destroy of facial appearance,and social psychological dysfunction ,which is different from injuries in other regions.But otolaryngology head and neck trauma is characterized by pain ,bleeding,and dysfunc-tion,similar to other regions.Based on the feature and research direction of the modern trauma rescue work ,apply-ing digital technology in treatment of otolaryngology head and neck trauma is the development direction in this field .%耳鼻咽喉头颈位于浅表处,解剖位置特殊,防护薄弱,无论平时战时,易受创伤,遭受创伤后,不仅对生理功能产生破坏,威胁生命,且常因头面部形貌的损毁而导致社会心理障碍。耳鼻咽喉头颈部战创伤根据各种因素不同,其临床表现各异,但具有疼痛、出血、功能障碍等共同点,而根据现代战伤救治工作的特点和研究方向,应用数字化高新技术来加强对耳鼻咽喉头颈部创伤救治方法和策略的研究正是这一领域的发展方向。

  16. Art and trauma.

    Science.gov (United States)

    Laub, D; Podell, D

    1995-10-01

    The authors of this paper attempt to show that 'the art of trauma', because of its indirect, unaestheticised and dialogic nature, may be the only possible medium for effective representations of trauma. The real witnessing presence created in the art of trauma can act as an antidote to the annihilation of the internal 'other' that occurs in the traumatic experience and to the resulting absence, which both constitutes the core of trauma and precludes its representation. Important elements of the art of trauma are illustrated using the work of Paul Celan, Anselm Kiefer, Claude Lanzmann, Art Spiegelman, and Anne-Marie Levine and texts by Aharon Appelfeld. Examining more closely what Holocaust survivors say in their testimonies, the authors contend that survival itself should be considered as a type of art of trauma when it is made possible by a creative comprehension of reality analogous to that which characterises more conventional forms of the art of trauma. The authors proceed to explore both the possible limits to the extent that trauma may be represented and the continuous struggle involved in attempting to 'know' trauma. They also discuss how art dealing with trauma may circumscribe a double locus: one of witnessing as well as one of emptiness or execution.

  17. Injuries, Sequelae, and Treatment of Lightning-Induced Injuries: 10 Years of Experience at a Swiss Trauma Center

    Directory of Open Access Journals (Sweden)

    Carmen A. Pfortmueller

    2012-01-01

    Full Text Available Principals. Lightning is one of the most powerful and spectacular natural phenomena. Lightning strikes to humans are uncommon but can cause devastating injuries. We analyzed lightning-related admissions to our emergency department from January 2000 to December 2010 to review and highlight the main features of lightning-related injuries. Methods. All data were collected prospectively and entered in the emergency department’ database (Qualicare Switzerland and retrospectively analyzed. Results. Nine patients with lightning-related injuries presented to our emergency department. Four were female, and five were male. The most common site of injury was the nervous system (6 out of 9 patients followed by the cardiovascular system (5 out of 9 patients. The third most common injuries occurred to the skin (3 out of 9 patients. Four of the patients had to be hospitalized for further observation. Conclusion. Reports of lightning strikes and related injuries are scarce. The establishment of an international register would therefore benefit the understanding of their injury patterns and facilitate specific treatment.

  18. Surgical Treatment for Occipital Condyle Fracture, C1 Dislocation, and Cerebellar Contusion with Hemorrhage after Blunt Head Trauma

    Directory of Open Access Journals (Sweden)

    Shigeo Ueda

    2016-01-01

    Full Text Available Occipital condyle fractures (OCFs have been treated as rare traumatic injuries, but the number of reported OCFs has gradually increased because of the popularization of computed tomography (CT and magnetic resonance imaging (MRI. The patient in this report presented with OCFs and C1 dislocation, along with traumatic cerebellar hemorrhage, which led to craniovertebral junction instability. This case was also an extremely rare clinical condition in which the patient presented with traumatic lower cranial nerve palsy secondary to OCFs. When the patient was transferred to our hospital, the occipital bone remained defective extensively due to surgical treatment of cerebellar hemorrhage. For this reason, concurrent cranioplasty was performed with resin in order to fix the occipital bone plate strongly. The resin-made occipital bone was used to secure a titanium plate and screws enabled us to perform posterior fusion of the craniovertebral junction. Although the patient wore a halo vest for 3 months after surgery, lower cranial nerve symptoms, including not only neck pain but also paralysis of the throat and larynx, improved postoperatively. No complications were detected during outpatient follow-up, which continued for 5 years postoperatively.

  19. Urogenital trauma: imaging upper GU trauma

    Energy Technology Data Exchange (ETDEWEB)

    Goldman, Stanford M. E-mail: Stanford.M.Goldman@uth.tmc.edu; Sandler, Carl M

    2004-04-01

    Objectives: This article will define the current controversies and concepts in the classification, clinical presentation, imaging approaches and management of upper urinary tract trauma. Materials and methods, results: This review will include the experience of the authors in the field of renal trauma over a 32-year period. Current thinking accepts the view that significant renal trauma is generally present when there is gross hematuria, signs of shock, or other clinical signs of severe injury. In most patients, suspected renal injury will be evaluated as a part of the overall assessment of the patient for suspected intraperitoneal injury. The authors will stress some exceptions to the rule. Conclusions: Most trauma experts now advocate conservative management, unless the patient is unstable or a renal vascular thrombosis or avulsion is suspected. Similarly, penetrating trauma to the kidney in and of itself no longer requires mandatory surgery. In the United States, computed tomography (CT), especially spiral CT, is considered the best diagnostic study, if available. Intravenous pyelography (IVP) is adequate if this is the only imaging modality available and if no concomitant injuries to the abdominal structure are suspected. Ultrasound, although strongly advocated in some countries, can lead to some significant false negatives. The diagnosis and management of unusual problems such as the traumatic AV fistula, the patient with an absent kidney or injury to the congenitally abnormal kidney, the serendipitous renal tumor in a patient with trauma, or serious bleeding after an apparent minor injury (i.e., spontaneous hemorrhage) are also reviewed in this article.

  20. 衢州地区急性颅脑创伤患者院前及急诊救治现状分析%Analysis on pre-hospital care and emergency treatment of craniocerebral trauma patients in Quzhou district

    Institute of Scientific and Technical Information of China (English)

    黄强; 戴伟民; 揭园庆; 聂俊; 王小芳; 胡永亮; 余小明; 宋光太; 金涛

    2013-01-01

    Objective To study an epidemiological research and analysis on current status of craniocerebral trauma patients'pre-hospital care and emergency treatment.Methods In order to achieve the objective,factors,including age,sex,cause of injury,injury date and time,on-site emergency treatment,transport mode,time period from injury to specialist treatment,time period from injury to first-time head examine,emergency room treatment status,treatment outcomes,etc.,are analyzed based on statistics of craniocerebral trauma in-patients of Quzhou district in 2009.Results Young men are the high risk population of acute craniocerebral trauma.Traffic accident is the main cause of trauma,mines and factories are closely related places.The relative percentages of on-site professional emergency treatment and ambulance transportation are quite low.Township hospitals have the shortest time period from injury to hospital treatment,but also have the longest time period from injury to specialist treatment or first-time head CT examine.raniocerebral trauma are mainly closed injuries,while the most common emergency room treatments are debridement and suturing.Conclusion Craniocerebral trauma is a dangerous kind of traumatic diseases with high risk and incidence rate.The incidence rate of the trauma can be reduced by strengthening the enforcement of related laws and regulations as well as the popularization and education of related knowledge.The mortality rate and disability rate can be reduced by training the doctors and nurses as well as improving the medical equipment of hospitals,especially the primary hospitals.%目的 对颅脑创伤患者的院前急救和急诊室救治现状进行流行病学调查和研究.方法 以2009年衢州地区颅脑创伤住院病人为研究对象,对年龄、性别、致伤原因、致伤日期和时间、现场急救、伤员转运方式、受伤-急诊专科救治时间、受伤-首次头颅检查时间、急诊室急救现状和治疗结

  1. Experiences of Treatment in 14 Patients with Penetrating Cardiac Trauma%心脏穿透伤的临床救治(附14例分析)

    Institute of Scientific and Technical Information of China (English)

    尹宏建; 秦勤

    2015-01-01

    Objective To summarize the experience of treatment in the patients with penetrating cardiac trauma. Methods From June 2006 to May 2014, 14 cases of penetrating cardiac trauma had been treated in our hospital.Ac-cording to the history of trauma and surface wound and clinical manifestations for early diagnosis, all received the emer-gency surgery.Results 11 cases recovered, 1 case died of uncontrolled hemorrhagic shock in the operation, 1 case died of cardiac failure in the operation.1 case died of respiratory and circulatory failure the thirty-ninth day after opera-tion.Conclusions penetrating cardiac trauma is critical condition,and the key point to successful treatment is the rap-idly clear diagnosis,timely surgery to control bleeding,quickly relieve cardiac tamponade and reasonable postoperative treatment.%目的:总结心脏穿透伤的救治经验。方法对救治心脏穿透伤14例,根据外伤史、体表伤口及临床征象进行早期诊断,均急诊手术。结果11例痊愈,1例术中死于失血性休克,1例术中死于心力衰竭,1例手术后39天死于呼吸循环衰竭。结论心脏穿透伤病情危急,快速明确诊断、迅速及时手术控制出血解除心脏压塞及术后合理治疗是成功救治的关键。

  2. Microglial activation induced by brain trauma is suppressed by post-injury treatment with a PARP inhibitor

    Directory of Open Access Journals (Sweden)

    d'Avila Joana C

    2012-02-01

    Full Text Available Abstract Background Traumatic brain injury (TBI induces activation of microglia. Activated microglia can in turn increase secondary injury and impair recovery. This innate immune response requires hours to days to become fully manifest, thus providing a clinically relevant window of opportunity for therapeutic intervention. Microglial activation is regulated in part by poly(ADP-ribose polymerase-1 (PARP-1. Inhibition of PARP-1 activity suppresses NF-kB-dependent gene transcription and thereby blocks several aspects of microglial activation. Here we evaluated the efficacy of a PARP inhibitor, INO-1001, in suppressing microglial activation after cortical impact in the rat. Methods Rats were subjected to controlled cortical impact and subsequently treated with 10 mg/kg of INO-1001 (or vehicle alone beginning 20 - 24 hours after the TBI. Brains were harvested at several time points for histological evaluation of inflammation and neuronal survival, using markers for microglial activation (morphology and CD11b expression, astrocyte activation (GFAP, and neuronal survival (NeuN. Rats were also evaluated at 8 weeks after TBI using measures of forelimb dexterity: the sticky tape test, cylinder test, and vermicelli test. Results Peak microglial and astrocyte activation was observed 5 to 7 days after this injury. INO-1001 significantly reduced microglial activation in the peri-lesion cortex and ipsilateral hippocampus. No rebound inflammation was observed in rats that were treated with INO-1001 or vehicle for 12 days followed by 4 days without drug. The reduced inflammation was associated with increased neuronal survival in the peri-lesion cortex and improved performance on tests of forelimb dexterity conducted 8 weeks after TBI. Conclusions Treatment with a PARP inhibitor for 12 days after TBI, with the first dose given as long as 20 hours after injury, can reduce inflammation and improve histological and functional outcomes.

  3. Early PTSD symptom trajectories: persistence, recovery, and response to treatment: results from the Jerusalem Trauma Outreach and Prevention Study (J-TOPS.

    Directory of Open Access Journals (Sweden)

    Isaac R Galatzer-Levy

    Full Text Available CONTEXT: Uncovering heterogeneities in the progression of early PTSD symptoms can improve our understanding of the disorder's pathogenesis and prophylaxis. OBJECTIVES: To describe discrete symptom trajectories and examine their relevance for preventive interventions. DESIGN: Latent Growth Mixture Modeling (LGMM of data from a randomized controlled study of early treatment. LGMM identifies latent longitudinal trajectories by exploring discrete mixture distributions underlying observable data. SETTING: Hadassah Hospital unselectively receives trauma survivors from Jerusalem and vicinity. PARTICIPANTS: Adult survivors of potentially traumatic events consecutively admitted to the hospital's emergency department (ED were assessed ten days and one-, five-, nine- and fifteen months after ED admission. Participants with data at ten days and at least two additional assessments (n = 957 were included; 125 received cognitive behavioral therapy (CBT between one and nine months. APPROACH: We used LGMM to identify latent parameters of symptom progression and tested the effect of CBT on these parameters. CBT consisted of 12 weekly sessions of either cognitive therapy (n = 41 or prolonged exposure (PE, n = 49, starting 29.8±5.7 days after ED admission, or delayed PE (n = 35 starting at 151.8±42.4 days. CBT effectively reduced PTSD symptoms in the entire sample. MAIN OUTCOME MEASURE: Latent trajectories of PTSD symptoms; effects of CBT on these trajectories. RESULTS: THREE TRAJECTORIES WERE IDENTIFIED: Rapid Remitting (rapid decrease in symptoms from 1- to 5-months; 56% of the sample, Slow Remitting (progressive decrease in symptoms over 15 months; 27% and Non-Remitting (persistently elevated symptoms; 17%. CBT accelerated the recovery of the Slow Remitting class but did not affect the other classes. CONCLUSIONS: The early course of PTSD symptoms is characterized by distinct and diverging response patterns that are centrally relevant to

  4. Early PTSD Symptom Trajectories: Persistence, Recovery, and Response to Treatment: Results from the Jerusalem Trauma Outreach and Prevention Study (J-TOPS)

    Science.gov (United States)

    Galatzer-Levy, Isaac R.; Ankri, Yael; Freedman, Sara; Israeli-Shalev, Yossi; Roitman, Pablo; Gilad, Moran; Shalev, Arieh Y.

    2013-01-01

    Context Uncovering heterogeneities in the progression of early PTSD symptoms can improve our understanding of the disorder's pathogenesis and prophylaxis. Objectives To describe discrete symptom trajectories and examine their relevance for preventive interventions. Design Latent Growth Mixture Modeling (LGMM) of data from a randomized controlled study of early treatment. LGMM identifies latent longitudinal trajectories by exploring discrete mixture distributions underlying observable data. Setting Hadassah Hospital unselectively receives trauma survivors from Jerusalem and vicinity. Participants Adult survivors of potentially traumatic events consecutively admitted to the hospital's emergency department (ED) were assessed ten days and one-, five-, nine- and fifteen months after ED admission. Participants with data at ten days and at least two additional assessments (n = 957) were included; 125 received cognitive behavioral therapy (CBT) between one and nine months. Approach We used LGMM to identify latent parameters of symptom progression and tested the effect of CBT on these parameters. CBT consisted of 12 weekly sessions of either cognitive therapy (n = 41) or prolonged exposure (PE, n = 49), starting 29.8±5.7 days after ED admission, or delayed PE (n = 35) starting at 151.8±42.4 days. CBT effectively reduced PTSD symptoms in the entire sample. Main Outcome Measure Latent trajectories of PTSD symptoms; effects of CBT on these trajectories. Results Three trajectories were identified: Rapid Remitting (rapid decrease in symptoms from 1- to 5-months; 56% of the sample), Slow Remitting (progressive decrease in symptoms over 15 months; 27%) and Non-Remitting (persistently elevated symptoms; 17%). CBT accelerated the recovery of the Slow Remitting class but did not affect the other classes. Conclusions The early course of PTSD symptoms is characterized by distinct and diverging response patterns that are centrally relevant to understanding the disorder

  5. Management of duodenal trauma

    Institute of Scientific and Technical Information of China (English)

    CHEN Guo-qing; YANG Hua

    2011-01-01

    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.

  6. Post-trauma and postoperative painful neuropathy

    OpenAIRE

    Fonseca,Paulo Renato Barreiros da; Gatto,Bruno Emanuel Oliva; Tondato,Vinicius Alves

    2016-01-01

    ABSTRACT BACKGROUND AND OBJECTIVES: Peripheral nerve injuries caused by accidental trauma, surgeries or diseases, may evolve to persistent, severe and refractory neuropathic pain, being a major economic and social problem because it often affects most productive population group causing sometimes devastating incapacities. In this brief review, aspects of the prevalence of neuropathic pain by trauma injury of peripheral nerves and its treatment will be evaluated. CONTENTS: After evaluating n...

  7. Management of trauma to supporting dental structures.

    Science.gov (United States)

    Elias, Husam; Baur, Dale A

    2009-10-01

    Teeth, periodontium, and supporting alveolar bone are frequently involved in trauma and account for approximately 15% of all emergency room visits. The cause of the dentoalveolar trauma varies in different demographics but generally results from falls, playground accidents, domestic violence, bicycle accidents, motor vehicle accidents, assaults, altercations, and sports injuries. Dentoalveolar injuries should be considered an emergency situation because successful management of the injury requires proper diagnosis and treatment within a limited time to achieve better outcomes.

  8. 腹腔镜在腹部外伤诊治中的应用(附326例报告)%Application of laparoscopy in diagnosis and treatment of abdominal trauma: A report of 326 cases

    Institute of Scientific and Technical Information of China (English)

    杨志奇; 王光链; 孙振纲

    2011-01-01

    目的 探讨腹腔镜在腹部外伤诊治中的临床意义.方法 1994年3月至2011年4月对326例腹部外伤病人使用腹腔镜诊治,并根据镜检结果选择腹腔镜手术或中转开腹手术.结果 腹部外伤病人腹腔镜探查及明确诊断326例,腹腔镜下手术284例,中转开腹42例.结论 腹腔镜诊治腹部外伤安全、可行、有效,并可早期正确诊断,减少不必要的剖腹手术.%Objective To explore clinical significance of laparoscopy in diagnosis and treatment of abdominal trauma. Methods A retrospective study from March 1994 to April 2011 was performed on 326 cases of abdominal trauma which was diagnosed and treated with laparoscopy. Laparoscopic surgery or open surgical operation was carried. Results Three hundred and twenty-six cases were definitely explored and diagnosed through laparoscopic surgery. Two hundred and eighty-four cases received laparoscopic surgery, and 42 cases were converted to open surgical operatioa All cases were diagnosed definitely. Conclusion Laparoscopic surgery is a safe, feasible and effective procedure for the early diagnosis and treatment of abdominal trauma.

  9. Trauma e temporalidade

    Directory of Open Access Journals (Sweden)

    Ana Maria Rudge

    Full Text Available O trauma tem sido abordado na literatura psicanalítica especialmente como um trauma infantil de natureza sexual. A neurose traumática é tomada como modelo para a circunscrição de uma acepção de trauma que não se confunde com o trauma estrutural eficaz na constituição do psiquismo, e cuja sintomatologia não pode ser diretamente remetida à experiência infantil de natureza sexual.

  10. About Military Sexual Trauma

    Medline Plus

    Full Text Available ... out why Close About Military Sexual Trauma Veterans Health Administration Loading... Unsubscribe from Veterans Health Administration? Cancel Unsubscribe Working... Subscribe Subscribed Unsubscribe 15K ...

  11. About Military Sexual Trauma

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    Full Text Available ... out why Close About Military Sexual Trauma Veterans Health Administration Loading... Unsubscribe from Veterans Health Administration? Cancel Unsubscribe Working... Subscribe Subscribed Unsubscribe 12, ...

  12. About Military Sexual Trauma

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    Full Text Available ... why Close About Military Sexual Trauma Veterans Health Administration Loading... Unsubscribe from Veterans Health Administration? Cancel Unsubscribe Working... Subscribe Subscribed Unsubscribe 15K Loading... ...

  13. [Scrotal trauma: management strategy].

    Science.gov (United States)

    Culty, T; Ravery, V

    2006-04-01

    Scrotal traumas are rare. Most are blunt traumas caused by a direct blow on the scrotum. The testicle is projected against the pubic arch. Early surgical investigation has considerably improved the prognosis of testicular trauma, and reduced orchidectomy rate. ULtrasonography has also improved the management of scrotal trauma. But there is a controversy about accuracy of ultrasonography in predicting presence or absence of testicular disruption. ULtrasonography should not challenge the dogma regarding systematic surgical investigation of hematocele and enlarged scrotum. Long term outcomes (testicular atrophy, infertility) may be more frequent as previously thought and should be detected.

  14. Levosimendan no tratamento da contusão miocárdica grave pós-trauma torácico fechado: relato de caso = Levosimendan treatment for severe myocardial contusion after blunt chest trauma: case report

    OpenAIRE

    Benincasa,Cristian Chassot

    2007-01-01

    Introdução: a contusão miocárdica é causada usualmente por trauma torácico fechado, principalmente em pacientes com história de acidente de carro ou moto. Os pacientes com manifestações clínicas graves devem manejados com intubação, reposição volêmica, vasopressor e inotrópicos. O levosimendan é uma nova droga com ação inodilatadora, que age sensibilizando os canais de cálcio. O objetivo deste relato é documentar o tratamento de um caso de choque cardiogênico secundário a contusão miocárdica,...

  15. Transfemoral amputation after failed knee arthroplasty

    DEFF Research Database (Denmark)

    Gottfriedsen, Tinne B; Morville Schrøder, Henrik; Odgaard, Anders

    2016-01-01

    BACKGROUND: Transfemoral amputation is considered the last treatment option for failed knee arthroplasty. The extent to which this procedure is performed is not well known. The purpose of this study was to identify the incidence and causes of amputation following failure of knee arthroplasty...... in a nationwide population. METHODS: Data were extracted from the Danish Civil Registration System, the Danish National Patient Register, and the Danish Knee Arthroplasty Register. With use of individual data linkage, 92,785 primary knee arthroplasties performed from 1997 to 2013 were identified. Of these, 258...... for causes related to failed knee arthroplasty. The 15-year cumulative incidence of amputation was 0.32% (95% confidence interval [CI], 0.23% to 0.48%). The annual incidence of amputation following arthroplasties performed from 1997 to 2002 was 0.025% compared with 0.018% following arthroplasties performed...

  16. DECOFF Probabilities of Failed Operations

    DEFF Research Database (Denmark)

    Gintautas, Tomas

    A statistical procedure of estimation of Probabilities of Failed Operations is described and exemplified using ECMWF weather forecasts and SIMO output from Rotor Lift test case models. Also safety factor influence is investigated. DECOFF statistical method is benchmarked against standard Alpha...

  17. Heterotopic Pregnancy in a Natural Conception Following Failed ...

    African Journals Online (AJOL)

    2011-02-23

    Feb 23, 2011 ... Heterotopic Pregnancy in a Natural Conception Following Failed. Contraceptive Practice ... her husband vehemently rejected surgical treatment of the ectopic pregnancy ... He also posited that her doctor only referred her for.

  18. 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,…

  19. 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,…

  20. Effects of Prior Psychosocial Trauma on Subsequent Immune Response After Experimental Thorax Trauma.

    Science.gov (United States)

    Langgartner, Dominik; Palmer, Annette; Rittlinger, Anne; Reber, Stefan O; Huber-Lang, Markus

    2017-08-25

    Overshooting inflammation during the early phase after blunt thorax trauma promotes the development of acute respiratory distress syndrome, multiple organ failure and subsequent mortality. Given that individuals diagnosed with stress-related disorders are characterized by chronic low-grade inflammation, we hypothesize that "psychosocial traumatic preload" poses a risk factor for the above mentioned complications following thorax trauma.Here, we employed the chronic subordinate colony housing (CSC) paradigm to induce "psychosocial traumatic preload" and systemic low-grade immune activation in male mice, indicated by elevated plasma concentrations of different inflammatory mediators. Subsequent thorax trauma was induced in anaesthetized mice by a single blast wave centered on the thorax; SHAM animals were exposed to anesthesia only. Mice were sacrificed 2 h, 6 h, and 24 h after thorax trauma or SHAM treatment.Independent of thorax trauma, CSC caused an increase in adrenal weight, and a decrease in thymus weight, indicating that the stress paradigm worked reliably. Moreover, CSC exposure aggravated the early immune response after thorax trauma, indicated by elevated myeloperoxidase lung concentrations in thorax trauma-exposed CSC versus thorax trauma-exposed single housed control (SHC) mice (2 h), but no histological differences. Furthermore, thorax trauma caused an increase in total bronchoalveolar lavage fluid (BAL) protein (24 h), BAL C5a (2 h), BAL cell counts (24 h) and BAL keratinocyte chemoattractant (6 h, 24 h) in CSC but not SHC mice.Our data indicate that repeated psychosocial traumatization during adulthood moderately aggravates the local immune response towards thorax trauma, but overall may be considered as a rather minor risk factor in terms of thorax trauma-associated complications.

  1. [Trauma-Informed Peer Counselling in the Care of Refugees with Trauma-Related Disorders].

    Science.gov (United States)

    Wöller, Wolfgang

    2016-09-01

    Providing adequate culture-sensitive care for a large number of refugees with trauma-related disorders constitutes a major challenge. In this context, peer support and trauma-informed peer counselling can be regarded as a valuable means to complement the psychosocial care systems. In recent years, peer support and peer education have been successfully implemented e. g. in health care education, in psychiatric care, and in the treatment of traumatized individuals. Only little research data is available for traumatized refugees. However, results are encouraging. A program is presented which integrates trauma-informed peer educators (TIP) with migration background in the care of traumatized refugees. Peers' responsibility includes emotional support and understanding the refugees' needs, sensitizing for trauma-related disorders, providing psychoeducation, and teaching trauma-specific stabilization techniques under supervision of professional psychotherapists. © Georg Thieme Verlag KG Stuttgart · New York.

  2. Analysis of the Revised Trauma Score (RTS in 200 victims of different trauma mechanisms

    Directory of Open Access Journals (Sweden)

    BRUNO DURANTE ALVAREZ

    Full Text Available ABSTRACT Objective: to analyze the epidemiological profile and mortality associated with the Revised Trauma Score (RTS in trauma victims treated at a university hospital. Methods: we conducted a descriptive, cross-sectional study of trauma protocols (prospectively collected from December 2013 to February 2014, including trauma victims admitted in the emergency room of the Cajuru University Hospital. We set up three groups: (G1 penetrating trauma to the abdomen and chest, (G2 blunt trauma to the abdomen and chest, and (G3 traumatic brain injury. The variables we analyzed were: gender, age, day of week, mechanism of injury, type of transportation, RTS, hospitalization time and mortality. Results: we analyzed 200 patients, with a mean age of 36.42 ± 17.63 years, and 73.5% were male. The mean age was significantly lower in G1 than in the other groups (p <0.001. Most (40% of the visits occurred on weekends and the most common pre-hospital transport service (58% was the SIATE (Emergency Trauma Care Integrated Service. The hospital stay was significantly higher in G1 compared with the other groups (p <0.01. Regarding mortality, there were 12%, 1.35% and 3.95% of deaths in G1, G2 and G3, respectively. The median RTS among the deaths was 5.49, 7.84 and 1.16, respectively, for the three groups. Conclusion: the majority of patients were young men. RTS was effective in predicting mortality in traumatic brain injury, however failing to predict it in patients suffering from blunt and penetrating trauma.

  3. 口腔颌面创伤骨折65例临床治疗与回顾%Treatment of 65 cases of oral and maxilofacial trauma fracture

    Institute of Scientific and Technical Information of China (English)

    张虎

    2012-01-01

      目的回顾性分析口腔颌面创伤骨折的临床具体治疗情况.方法对65例口腔颌面创伤骨折患者根据具体骨折情况分别采用合理的治疗方式,比较分析单一型骨折与复合型,以及合并颅脑损伤与未合并颅脑损伤患者治疗后的整体情况.结果单一型骨折总优良率94.2%,复合型骨折总优良率75.9%;另外,合并颅脑损伤患者总优良率66.7%,未合并颅脑损伤总优良率94.7%.结论口腔颌面创伤骨折应根据具体骨折情况采取合理的治疗方式,对于合并颅脑损伤严重的患者应及抢救后,再行骨折治疗.%  Objective: Retrospectly analyze the clinical effect of treatment for oral and maxilofacial trauma fracture. Methods: Choosed 65 patients of oral and maxilofacial trauma fracture to use rational treatment, compared unitary fracture and complex fracture, and combined craniocerebral injury with unconsolidated craniocerebral injury patients overal situation after treatment. Results: The total effective rate of unitary fracture was 94.2%, complex fracture was 75.9%, combined craniocerebral injury was 66.7%, uncombined craniocerebral injury was 94.7%. Conclusion: We should take reasonable treatment for patients with oral and maxilofacial trauma fractures according toconcrete fracture situation folowed by fracture treatment.

  4. Diagnosis and treatment of liver trauma complicated with intra-abdominal infections%肝脏外伤并发腹腔感染的分析及诊治

    Institute of Scientific and Technical Information of China (English)

    张雯雯; 何蕾; 万涛; 吕少诚; 徐明月; 刘同友; 路辉; 史宪杰

    2013-01-01

    OBJECTIVE To explore the measures for diagnosis and treatment of liver trauma complicated with intraabdominal infections so as to guide the prevention and treatment of intra-abdominal infections.METHODS We retrospectively analyzed the clinical data of 64 patients with liver trauma between Jan 2000 and Sep 2012,including 7 cases of conservative treatment and 57 cases of surgical treatment,and all the cases were treated with prevention of infections,liver protection,and nutritional support.RESULTS Of the 64 cases of patients,there were 23 cases of peritoneal infections with the infection rate of 35.9 %.No simple liver trauma patients suffered from complicating intrabdominal infection,while among the patients with gastrointestinal trauma the incidence of peritoneal infections was 85.7%,and the incidence of the patients with the AAST grading Ⅳ was 51.5%.Totally 41 strains of pathogens were isolated,among which there were 15 (36.6%) strains of Escherichia coli,10 (24.4%) strains of Enterococcus faecalis,and 8 (19.5%) strains of Enterococcus faecium,which ranked the top three species of the pathogens.Of totally 23 cases of patients with peritoneal infections,22 cases were cured with the cure rate of 95.65 %.CONCLUSION The incidence of intraabdominal infections is high in the patients with complex liver trauma,especially the patients with multi-organ trauma.The integrated treatment with micro-invasive operations on the basis of trauma-control surgery idea can effectively cure the intraabdominal infections and decrease the mortality.%目的 探讨肝脏外伤并发腹腔感染的诊治方法,以期为肝脏外伤并发腹腔感染的预防治疗起到指导作用.方法 回顾性分析医院2000年1月-2012年9月64例肝脏外伤患者的临床资料,其中7例行保守治疗,57例行手术治疗,均予预防性抗感染、保肝、营养等治疗方法.结果 64例患者中23例出现腹腔感染,感染率为35.9%,其中单纯性肝脏外伤患者无

  5. 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.

  6. Negative body experience in women with early childhood trauma: associations with trauma severity and dissociation.

    Science.gov (United States)

    Scheffers, Mia; Hoek, Maike; Bosscher, Ruud J; van Duijn, Marijtje A J; Schoevers, Robert A; van Busschbach, Jooske T

    2017-01-01

    Background: A crucial but often overlooked impact of early life exposure to trauma is its far-reaching effect on a person's relationship with their body. Several domains of body experience may be negatively influenced or damaged as a result of early childhood trauma. Objective: The aim of this study was to investigate disturbances in three domains of body experience: body attitude, body satisfaction, and body awareness. Furthermore, associations between domains of body experience and severity of trauma symptoms as well as frequency of dissociation were evaluated. Method: Body attitude was measured with the Dresden Body Image Questionnaire, body satisfaction with the Body Cathexis Scale, and body awareness with the Somatic Awareness Questionnaire in 50 female patients with complex trauma and compared with scores in a non-clinical female sample (n = 216). Patients in the clinical sample also filled out the Davidson Trauma Scale and the Dissociation Experience Scale. Results: In all measured domains, body experience was severely affected in patients with early childhood trauma. Compared with scores in the non-clinical group, effect sizes in Cohen's d were 2.7 for body attitude, 1.7 for body satisfaction, and 0.8 for body awareness. Associations between domains of body experience and severity of trauma symptoms were low, as were the associations with frequency of dissociative symptoms. Conclusions: Early childhood trauma in women is associated with impairments in self-reported body experience that warrant careful assessment in the treatment of women with psychiatric disorders.

  7. The role of trauma scoring in developing trauma clinical governance in the Defence Medical Services

    Science.gov (United States)

    Russell, R. J.; Hodgetts, T. J.; McLeod, J.; Starkey, K.; Mahoney, P.; Harrison, K.; Bell, E.

    2011-01-01

    This paper discusses mathematical models of expressing severity of injury and probability of survival following trauma and their use in establishing clinical governance of a trauma system. There are five sections: (i) Historical overview of scoring systems—anatomical, physiological and combined systems and the advantages and disadvantages of each. (ii) Definitions used in official statistics—definitions of ‘killed in action’ and other categories and the importance of casualty reporting rates and comparison across conflicts and nationalities. (iii) Current scoring systems and clinical governance—clinical governance of the trauma system in the Defence Medical Services (DMS) by using trauma scoring models to analyse injury and clinical patterns. (iv) Unexpected outcomes—unexpected outcomes focus clinical governance tools. Unexpected survivors signify good practice to be promulgated. Unexpected deaths pick up areas of weakness to be addressed. Seventy-five clinically validated unexpected survivors were identified over 2 years during contemporary combat operations. (v) Future developments—can the trauma scoring methods be improved? Trauma scoring systems use linear approaches and have significant weaknesses. Trauma and its treatment is a complex system. Nonlinear methods need to be investigated to determine whether these will produce a better approach to the analysis of the survival from major trauma. PMID:21149354

  8. 医用臭氧治疗腰背部术后疼痛综合征的临床疗效观察%Clinical efficacy of medical ozone in treatment of failed back surgery syndrome

    Institute of Scientific and Technical Information of China (English)

    项廷淼; 殷世武; 高宗根; 张惠林; 王菊

    2011-01-01

    目的:探讨经皮穿刺医用臭氧注射治疗腰背部术后疼痛综合征(FBSS)的疗效.方法:24例FBSS患者在数字减影血管造影交易额透视下,采用经皮穿刺椎间盘内及椎旁间隙注射医用臭氧(45 μg/ml)20 ml,观察临床症状缓解情况.结果:24例术后随访2~57个月,临床总有效率62.5%,其中显效8例,有效7例,无效9例.除1例出现咳嗽及胸闷症状外,其他患者无任何并发症发生.结论:经皮穿刺医用臭氧注射治疗FBSS效果满意.%Objective: To investigate the effect of medical ozone in treatment of failed back surgery syndrome (FBSS) through percutaneous puncture injection. Methods:Under digital subtraction angiography fluoroscopic guidance ,24 FBSS patients were injected 20 mi medical ozone(45 μg/ml) through percutaneous puncture in inter-vertebral disc and paravertebral space. The relief of clinical symptoms was also observed. Results: After 2 to 57 months of follow-up in the 24 patients, the total effective rate was 62.5 % ,including 8 significant effective cases and 7 improved cases. Except for I case with cough and chest tightness, the other patients had no complications. Conclusions:Medical ozone is effective for FBSS treatment through percutaneous puncture injection.

  9. ANATOMIC RESEARCH OF SUPERIOR CLUNIAL NERVE TRAUMA

    Institute of Scientific and Technical Information of China (English)

    1999-01-01

    In order to find the mechanism of superior clunial nerve (SCN) trauma, we dissected and revealed SCN from 12 corpses (24 sides). Combining 100 sides of SCN trauma, we inspected the course of SCN, the relation between SCN and it's neighbour tissues with the situation of SCN when being subjected to force. We found that the following special anatomic characteristics and mechanical elements such as the course of SCN, it's turning angles, the bony fibrous tube at the iliac crest, the posterior layer of the lumbodorsal fascia and SCN neighbour adipose tissue, are the causes of external force inducing SCN trauma. The anatomic revealment is the guidance of SCN trauma treatment with edged needle.

  10. Ultrasound in trauma.

    Science.gov (United States)

    Rippey, James C R; Royse, Alistair G

    2009-09-01

    Point-of-care ultrasound is well suited for use in the emergency setting for assessment of the trauma patient. Currently, portable ultrasound machines with high-resolution imaging capability allow trauma patients to be imaged in the pre-hospital setting, emergency departments and operating theatres. In major trauma, ultrasound is used to diagnose life-threatening conditions and to prioritise and guide appropriate interventions. Assessment of the basic haemodynamic state is a very important part of ultrasound use in trauma, but is discussed in more detail elsewhere. Focussed assessment with sonography for Trauma (FAST) rapidly assesses for haemoperitoneum and haemopericardium, and the Extended FAST examination (EFAST) explores for haemothorax, pneumothorax and intravascular filling status. In regional trauma, ultrasound can be used to detect fractures, many vascular injuries, musculoskeletal injuries, testicular injuries and can assess foetal viability in pregnant trauma patients. Ultrasound can also be used at the bedside to guide procedures in trauma, including nerve blocks and vascular access. Importantly, these examinations are being performed by the treating physician in real time, allowing for immediate changes to management of the patient. Controversy remains in determining the best training to ensure competence in this user-dependent imaging modality.

  11. Advances in forefoot trauma.

    Science.gov (United States)

    Clements, J Randolph; Schopf, Robert

    2013-07-01

    Forefoot traumas, particularly involving the metatarsals, are commonly occurring injuries. There have been several advances in management of these injuries. These advances include updates in operative technique, internal fixation options, plating constructs, and external fixation. In addition, the advances of soft tissue management have improved outcomes. This article outlines these injuries and provides an update on techniques, principles, and understanding of managing forefoot trauma.

  12. Virtual Trauma Team

    NARCIS (Netherlands)

    Jones, Valerie M.; Bults, Richard G.A.

    2001-01-01

    The clinical motivation for Virtual Trauma Team is to improve quality of care in trauma care in the vital first "golden hour" where correct intervention can greatly improve likely health outcome. The motivation for Virtual Homecare Team is to improve quality of life and independence for patients by

  13. ATLS® and damage control in spine trauma

    Directory of Open Access Journals (Sweden)

    Gosse Andreas

    2009-03-01

    Full Text Available Abstract Substantial inflammatory disturbances following major trauma have been found throughout the posttraumatic course of polytraumatized patients, which was confirmed in experimental models of trauma and in vitro settings. As a consequence, the principle of damage control surgery (DCS has developed over the last two decades and has been successfully introduced in the treatment of severely injured patients. The aim of damage control surgery and orthopaedics (DCO is to limit additional iatrogenic trauma in the vulnerable phase following major injury. Considering traumatic brain and acute lung injury, implants for quick stabilization like external fixators as well as decided surgical approaches with minimized potential for additional surgery-related impairment of the patient's immunologic state have been developed and used widely. It is obvious, that a similar approach should be undertaken in the case of spinal trauma in the polytraumatized patient. Yet, few data on damage control spine surgery are published to so far, controlled trials are missing and spinal injury is addressed only secondarily in the broadly used ATLS® polytrauma algorithm. This article reviews the literature on spine trauma assessment and treatment in the polytrauma setting, gives hints on how to assess the spine trauma patient regarding to the ATLS® protocol and recommendations on therapeutic strategies in spinal injury in the polytraumatized patient.

  14. Maxillofacial trauma in the emergency department: a review.

    Science.gov (United States)

    Tuckett, J W; Lynham, A; Lee, G A; Perry, M; Harrington, U

    2014-04-01

    In 1978 the Advanced Trauma Life Support guidelines were first implemented and are viewed by many as the gold standard of care in the emergency setting. It may not be immediately obvious where assessment and management of maxillofacial injuries fits within these trauma guidelines. This article aims to provide a concise, contemporary guide for the treatment of maxillofacial trauma in the emergency setting. An electronic database search was conducted in PubMed and Science Direct on articles from 1970 to the present day. The key search terms were Maxillofacial, Trauma, ATLS, Advanced Trauma Life Support, EMST, Early Management of Severe Trauma, Airway, Eye, Ophthalmic and Management. The findings were compiled into a review article. The article was then reviewed by experts in the fields of Maxillofacial Surgery and Ophthalmology to ensure content and contextual accuracy. Physicians are becoming increasingly exposed to major maxillofacial injuries. Resuscitative measures can be complex and require prompt decisions especially in gaining a secure airway. A proposed treatment algorithm for maxillofacial trauma patients has been devised by the authors. It is imperative that sight preserving assessment and interventions are not forgotten in the emergency management of maxillofacial trauma. We propose an algorithm for the management of maxillofacial trauma, and recommend the use of CT as a powerful adjunct to clinical examination in patients with maxillofacial trauma. Copyright © 2013 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. All rights reserved.

  15. 创伤超声重点评估在胸腹部创伤急救中的应用%Application of focused assessment with sonography for trauma in emergency treatment of chest and abdominal injuries

    Institute of Scientific and Technical Information of China (English)

    罗小敏; 王栋锋; 魏捷

    2015-01-01

    Since the first use of ultrasound in diagnosis of abdominal injuries in 1970s,great advances have been made in the application of sonography in the field of trauma emergency treatment .Based on this, the concept of Focused Assessment with Sonography for Trauma ( FAST) has been put forward .This paper mainly reviewed arti-cles about the application of FAST in the evaluation of chest and abdominal injuries and aimed to promote the devel -opment of FAST in our country .%从20世纪70年代超声应用于腹部创伤诊断开始,超声检查在创伤急救领域得到不断应用和发展,并在此基础上提出了创伤超声重点评估( focused assessment with sonography for trauma ,FAST)的概念。本文主要综述近年来关于FAST在胸腹部创伤评估方面的应用现状,以促进FAST在我国的应用普及与发展。

  16. Trauma-induced coagulopathy.

    Science.gov (United States)

    Katrancha, Elizabeth D; Gonzalez, Luis S

    2014-08-01

    Coagulopathy is the inability of blood to coagulate normally; in trauma patients, it is a multifactorial and complex process. Seriously injured trauma patients experience coagulopathies during the acute injury phase. Risk factors for trauma-induced coagulopathy include hypothermia, metabolic acidosis, hypoperfusion, hemodilution, and fluid replacement. In addition to the coagulopathy induced by trauma, many patients may also be taking medications that interfere with hemostasis. Therefore, medication-induced coagulopathy also is a concern. Traditional laboratory-based methods of assessing coagulation are being supported or even replaced by point-of-care tests. The evidence-based management of trauma-induced coagulopathy should address hypothermia, fluid resuscitation, blood components administration, and, if needed, medications to reverse identified coagulation disorders.

  17. Haemostatic resuscitation in trauma

    DEFF Research Database (Denmark)

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

    2016-01-01

    PURPOSE OF REVIEW: To discuss the recent developments in and evolvement of next generation haemostatic resuscitation in bleeding trauma. RECENT FINDINGS: Mortality from major trauma is a worldwide problem, and massive haemorrhage remains a major cause of potentially preventable deaths. Development...... of coagulopathy further increases trauma mortality emphasizing that coagulopathy is a key target in the phase of bleeding. The pathophysiology of coagulopathy in trauma reflects at least three distinct mechanisms that may be present isolated or coexist: acute traumatic coagulopathy, coagulopathy associated...... with the lethal triad, and consumptive coagulopathy. The concepts of 'damage control surgery' and 'damage control resuscitation' have been developed to ensure early control of bleeding and coagulopathy to improve outcome in bleeding trauma. Haemostatic resuscitation aims at controlling coagulopathy and consists...

  18. Survival probability in patients with liver trauma.

    Science.gov (United States)

    Buci, Skender; Kukeli, Agim

    2016-08-01

    Purpose - The purpose of this paper is to assess the survival probability among patients with liver trauma injury using the anatomical and psychological scores of conditions, characteristics and treatment modes. Design/methodology/approach - A logistic model is used to estimate 173 patients' survival probability. Data are taken from patient records. Only emergency room patients admitted to University Hospital of Trauma (former Military Hospital) in Tirana are included. Data are recorded anonymously, preserving the patients' privacy. Findings - When correctly predicted, the logistic models show that survival probability varies from 70.5 percent up to 95.4 percent. The degree of trauma injury, trauma with liver and other organs, total days the patient was hospitalized, and treatment method (conservative vs intervention) are statistically important in explaining survival probability. Practical implications - The study gives patients, their relatives and physicians ample and sound information they can use to predict survival chances, the best treatment and resource management. Originality/value - This study, which has not been done previously, explores survival probability, success probability for conservative and non-conservative treatment, and success probability for single vs multiple injuries from liver trauma.

  19. Treating refractory obsessive-compulsive disorder: what to do when conventional treatment fails? Tratando o transtorno obsessivo-compulsivo refratário: o que fazer quando tratamentos convencionais falham?

    Directory of Open Access Journals (Sweden)

    Adelar Pedro Franz

    2013-01-01

    Full Text Available Obsessive-compulsive disorder (OCD is a chronic and impairing condition. A very small percentage of patients become asymptomatic after treatment. The purpose of this paper was to review the alternative therapies available for OCD when conventional treatment fails. Data were extracted from controlled clinical studies (evidence-based medicine published on the MEDLINE and Science Citation Index/Web of Science databases between 1975 and 2012. Findings are discussed and suggest that clinicians dealing with refractory OCD patients should: 1 review intrinsic phenomenological aspects of OCD, which could lead to different interpretations and treatment choices; 2 review extrinsic phenomenological aspects of OCD, especially family accommodation, which may be a risk factor for non-response; 3 consider non-conventional pharmacological approaches; 4 consider non-conventional psychotherapeutic approaches; and 5 consider neurobiological approaches.O transtorno obsessivo-compulsivo (TOC é uma doença crônica e incapacitante. Uma pequena porcentagem de pacientes se torna assintomática após o tratamento. O objetivo deste trabalho foi revisar as alternativas terapêuticas para o tratamento de TOC quando os tratamentos convencionais falham. Os dados foram extraídos de estudos clínicos controlados (medicina baseada em evidências publicados nas bases de dados MEDLINE e Science Citation Index/Web of Science entre 1975 e de 2012. Os resultados são discutidos e sugerem as seguintes abordagens para profissionais que lidam com TOC refratário: 1 rever aspectos fenomenológicos intrínsecos ao TOC, o que pode levar a entendimentos diferenciados e à escolhas terapêuticas distintas; 2 rever aspectos fenomenológicos extrínsecos ao TOC, principalmente acomodação familiar, que pode ser fator de risco para a não resposta; 3 considerar abordagens farmacológicas não convencionais; 4 considerar abordagens psicoterapêuticas não convencionais; e 5 considerar

  20. Liver Trauma: Operative and Non-operative Management

    Directory of Open Access Journals (Sweden)

    Moosa Zargar

    2010-04-01

    Full Text Available Background: The liver is the second most commonly injured organ in abdominal trauma, but liver damage is the most common cause of death after abdominal injury. Although urgent surgery continues to be the standard for hemodynamically compromised patients with hepatic trauma, there has been a paradigm shift in the management of patients who have stable hemodynamic. A marked change toward a more conservative approach in the treatment of abdominal trauma has been noted during the last decades. Modern treatment of liver trauma is increasingly non-operative.Purpose: To find the epidemiology, etiologies and managements of liver trauma in a population based study in Iran.Material and Method: A study including 16,287 trauma patients referred to the main hospitals of seven cities with different geographic patterns was done in Iran. Eighty-four patients with hepatic trauma during the 1-year period ending March 2000 included in this Cross-Sectional study. We determined the incidence, etiology and management of the patients suffering liver injury. Analysis was done using SPSS 18. Statistical significance was set at PResults: Out of 16287 trauma patients 84 (0.5% had hepatic trauma with male predominance 68(81%. The most type of trauma was blunt and the main cause was motor vehicle crashes. Thirty patients (35.7% managed non-operatively. There was no significant difference in hospital stay between patients operated and managed non-operatively. There was no mortality in the patients managed non-surgically.Conclusion: In this study hepatic trauma was in 3.7% of abdominal trauma patients. This study concluded non-operative management of hepatic injuries is associated with a low overall morbidity and does not result in increases in length of stay. Non-operative management is a safe approach for the patients of liver trauma with stable hemodynamic.