Journal of Trauma & Treatment

Introduction: Transarterial embolization (TAE) has been used as an essential technique in the nonoperative management (NOM) of severe blunt hepatic injuries (BHI) but has a possible risk of tissue ischemia and necrosis, which may affect hepatic recovery. The injured liver tissue gets encapsulated and absorbed by intact liver tissue; therefore, the healing process requires the formation of a wall surrounding the injured tissue. In this study, we determined the impact of TAE on the hepatic healing process.
Patients and methods: We reviewed hemodynamically stable patients (n=35; males, 23; females, 12; mean age, 32 years), admitted to our hospitals over a 10-year period, who underwent NOM of severe BHI (American Association for the Surgery of Trauma Organ Injury Scale, grades IV and V). Data collected included demographic information, serial CT findings, severity of hepatic injuries showing lacerations (Couinaud's liver segment classification), TAE performed for active hepatic bleeding, and the amount of hemoperitoneum. Extrahepatic factors were evaluated using the Abbreviated Injury Scale for injuries to the head, face, thorax, and extremities. Time taken by injured segments to encapsulate was individually obtained from serial CTs. Cox regression and Kaplan-Meier analyses were used to identify risk factors associated with delayed healing among the hepatic and extrahepatic factors mentioned above.
Results: Risk factors were independently and significantly associated with TAE (odds ratio, 2.45; 95% confidence interval, 1.01-5.92; p=0.047). Multivariate analysis indicated that patients who underwent TAE took 2.45-times longer time to attain liver encapsulation than those who did not undergo TAE and that extrahepatic factors did not correlate with the time to encapsulation.
Conclusion: TAE for active liver hemorrhage resulted in a delayed recovery from BHI, regardless of extrahepatic factors.

Traumatic brain injury (TBI) is a very usual event, associated with very high morbidity’s rate. Moreover, the mild TBI consume a lot of resources, both human and financial. The target of this study was to describe a large series of adult patients suffering mild TBI, treated at the University Hospital of Getafe, between 2010 and 2015 (n=2480), studying the epidemiological profile and analyzing the diagnosis and treatment, to establish the main prognostic factors that influence the final result. We performed a retrospective study, reviewing medical history. Mild TBI is more common in men, and the most common causative mechanism is the traffic accident, in our region. We propose a model for classifying patients according to risk groups, which divided them into low, intermediate or high risk, which correlates well with the final result. We study the indication of skull radiography and computed tomography (CT), as well as hospital admission for clinical observation.

In this study, the presence of neurological focus on clinical examination, the existence of fracture on plain radiographs, the age and the coagulation disorders are associated with increased likelihood of developing intracranial, and worse prognosis in patients that suffer traumatic injuries. The Glasgow Coma Scale is deficient in determining the outcome of the patient suffering TBI, because do not consider factors such as amnesia or loss of consciousness, very common in patients suffering mild head trauma.

Introduction: While Restless leg syndrome (RLS) is a common sleep related movement disorder with a negative impact on sleep, quality of life and health, it may remain underdiagnosed for years. This study aims to evaluate RLS in military veterans with post-traumatic stress disorder (PTSD) suffering from sleep disturbances.

Material and methods: Thirty-One Iranian male military veterans diagnosed with PTSD entered this study. None of them had diabetes, Parkinson’s disease and renal failure or were taking medications affecting RLS. Daytime sleepiness, anxiety and depression, RLS severity and the risk of obstructive sleep apnea (OSA) were assessed by standard questionnaires.

Results: The mean age was 51.6 ± 6.1 years. The most common complaint was difficulty falling asleep. Eight individuals (25.5% of participants) had RLS. All of them had evidence of OSA based on the STOP-BANG questionnaire. The severity of RLS was not associate with sleepiness, depressive symptoms and body mass index (BMI), but with anxiety symptoms.

Conclusion: RLS should be taken into consideration in veterans with PTSD, particularly in those with sleep disturbances including insomnia, sleep related movements and sleep apnea.

Were examined 89 patients with ischemic stroke (IS) (mean age 58.54 (55.05, 64.73)), 42 of them with systemic thrombolytic therapy (TLT) (mean age 64.26 )60.58; 68,06)) and 47 patients with IS without TLT (54,52 (47,48, 60,83)). In the subgroup of moderate severity (from 7 to 14 points in NIHSS) included 13 patients after TLT, of severe severity (more than 15 points for NIHSS) included 29 patients after TLT. The determination of platelet hemostasis was carried out by the method of Born and O'Brien with the determination of aggregation, sizes of platelet aggregates for adrenaline, аdenosine diphosphate (ADP), ristomycin, spontaneous aggregation and fibrinogen concentrations on days 1, 7 and 14. Clinical evaluation of the severity of the condition was carried out according to the NIHSS scale. Specific features of changes in platelet hemostasis in inducers (adrenaline, ristomycin, ADP) in patients with IS after TLT at 1, 7 and 14 days in comparison with the indices of patients without TLT and their relationship with the dynamics of neurologic deficit, which allow to clarify the features of the vascular flow process, its forecast.

Introduction: War injured patients from Syria are constantly being transferred to Lebanon for management after rudimentary primary closure of their wounds is done at the combat zone.

Case presentation: The cases presented below represent some of the extreme cases of delayed presentation of peri-ocular trauma and the adaptations reconstructive surgeons had to make for conventional techniques.

Conclusion: We describe in our paper modified techniques in reconstructing delayed presentations of peri-ocular injuries secondary to war trauma in Lebanon and Syria.

Introduction: Revascularization is new treatment modality and is very valuable treatment option for immature necrotic teeth with open apex.
Methods: An 8-year-old boy with traumatized upper right central incisor. The clinical and radiographical examinations revealed uncomplicated crown fracture, tenderness and periapical radiolucency with immature root. Revascularization was planned to treat the tooth. The tooth root canal was irrigated 2.5% NaOCl, followed by 2 weeks of triple antibiotic (metronidazole, ciprofloxacin and minocycline) paste. Then antibiotic paste was removed, bleeding was induced, and cavity was sealed with MTA.
Results: In clinical and radiographical examinations in follow up visits the tooth was asymptomatic and functional, periapical radiolucency was healed, and root continued to develop with apical foramen became narrower.
Conclusion: Revascularization is an effective treatment for immature necrotic teeth. In addition, triple antibiotic paste provides sterile environment for regeneration.

Referred to as a “silent epidemic,” traumatic brain injuries (TBI) are disruptions in normal brain functions caused by an external force to the head (Center for Disease Control, 2017). Ranging from mild to severe in nature, TBI’s can result in physical, cognitive, emotional, social, personality, adaptive, and behavioral changes in an individual. These devastating symptoms render individuals with TBI’s disproportionately likely to become involved in the criminal justice system. Once arrested, the symptoms of TBI make it difficult to make important legal decisions, stand trial, and meet the conditions of probation, which results in an elevated risk for rearrests relative to those individuals without a TBI. Despite these difficulties, probation officers have the potential to help improve outcomes for clients with TBI. In particular, these professionals can help ensure that clients with TBI are referred to proper assessment and diagnosis, individualized supervision that accounts for their strengths and weaknesses, and receive appropriate treatment and medical assistance. As such, this article is intended to raise awareness of the challenges of TBI in a probation setting and offer tips, strategies, and solutions for probation officers working with this clientele.

Carper’s theory is used to explicate and illustrate ways of knowing in psychotherapy and clinical practice. White and Munhall’s expansion of Carper’s theory, particularly the pattern of unknowing, is highlighted to explore psychotherapeutic intervention to illustrate context, intersubjectivity, and new perspectives leading to confidence and change. A creative encounter using poetry in psychotherapy with a bereaved caregiver who subsequently becomes a widow provides a lesson in hope versus hopelessness and is used to elucidate the process of how one struggles with despair to yield to the return of hope. The potential for growth through mutuality and reciprocity for both the patient and the nurse as embedded with the context of healing relationships is explored. Integrated case narrative and analysis includes the expertise of a psychiatric nurse practitioner over a one-year period.

Rucksack palsy is an uncommon injury presumably caused by prolonged traction of the straps of a backpack on the brachial plexus. We present a patient with painless weakness and loss of sensation in her arm. Familiarity with the differential diagnosis of insidious, painless shoulder weakness is essential in managing patients with rucksack palsy. These patients should be treated expectantly and monitored closely.

Background: Among trauma patients, genitourinary injury occurs in 2%-5% of cases; with the kidney having the highest incidence of involvement. Grade IV/V renal injuries are typically associated with findings that necessitate intervention. However, non-operative management has been described even in severe cases. Our objective is to present our renal trauma experience in the blunt trauma patient population.

Methods: We performed a retrospective chart review of all trauma patients from April 1, 2010-March 31, 2015. Those sustaining renal trauma were identified and patient demographics, injury parameters (grade of injury, injury severity score-ISS, cause and mechanism of injury), operative vs. non-operative management, outcomes (hospital length of stay-HLOS, ICU length of stay-ILOS) and discharge (mortality or disposition) were captured.

Results: 8,054 patients were admitted to MDMC, with 112 meeting our inclusion criteria with 94 graded renal injuries. Renal operative management was noted in 6% of patients with ureteral stent placement (one Grade I), nephrorrhaphy (one Grade II), nephrectomy (two grade Vs, one grade IV) and renal vein repair (one grade IV). Nonoperative management of the renal injury occurred in 94% of cases.

Conclusion: Low-grade injuries do well with non-operative management. However, Grade IV/V injuries can be challenging to manage. A significant concern is seen with the presence of major vascular or pelvicalyceal injury. Minimally invasive techniques by interventional radiology, vascular or urology surgery are ideal when possible. In conclusion, non-operative management for all grades of kidney injuries, despite the severity, is appropriate for the hemodynamically stable trauma patient.

Aim: This prospective analysis of the findings of bone scans done for skeletal fracture assessment was undertaken to compare the findings of the Triple phase Bone scan and the Scintimetric Characterization by Dr.V.Siva’s retention ratio in the assessment and evaluation of the skeletal fracture.
Materials and Method: In this total study population of 39, had 19 males and 20 females. The 3 phases were acquired immediately after the intra-venous injection of 25 mCi of Tc99m MDP in a dynamic fashion centering over the fracture site. The dual head gamma camera e-Cam was used. The static Skeletal phase image and the 4 h whole body bone scan images were acquired 4 h after injection. The images were processed, and the results were tabulated. The 24 h static Skeletal phase image was acquired the next day. The 4/24 h Dr.V.Siva’s retention ratios were calculated using the region ratio protocol and tabulated.
Results: The 3phase bone scan analysis revealed that 18/39 46 % were of malignant nature and 21/39 54% were of benign or non-malignant causes. The Scintimetric Characterization of the malignant lesions by Dr.V.Siva’s retention ratio was 12.8 +/- 1.79 and that of the Non- malignant lesions was 5.8 +/- 2.41 indicating the gross difference between the two groups. The statistical analysis also confirmed the significant difference between the two groups. There was absolute concordance between the Triple phase bone scan findings and the Scintimetric Characterization by Dr.V.Siva’s retention ration in 30/39=77% of patients and the discordant between the two was noted in 9/39=23 % patients.
Conclusion: It can be concluded that the Scintimetric Characterization of fracture site by Dr.V.Siva’s Retention ratio along with the Triple phase bone scan findings helps in the proper identification of the underlying pathological process in as high as 23% of the study.