The journal of cardiothoracic trauma最新文献_第5页

Colonic injury during delayed surgical stabilization of rib fractures for flail chest: A case report and literature review 连枷胸肋骨骨折延迟手术稳定过程中的结肠损伤:1例报告并文献复习

The journal of cardiothoracic trauma Pub Date : 2019-01-01 DOI: 10.4103/jctt.jctt_6_19

Heather M. Grant, A. Doben

引用次数: 0

Rib Fractures in Geriatric Patients: An Observational Study of Surgical Management 老年患者肋骨骨折:外科治疗的观察性研究

The journal of cardiothoracic trauma Pub Date : 2019-01-01 DOI: 10.4103/jctt.jctt_9_19

J. Hughes, M. Berning, Alexander W. Hunt, Brian D. Kim, Mariela Rivera, D. Morris, H. Schiller, M. Zielinski

{"title":"Rib Fractures in Geriatric Patients: An Observational Study of Surgical Management","authors":"J. Hughes, M. Berning, Alexander W. Hunt, Brian D. Kim, Mariela Rivera, D. Morris, H. Schiller, M. Zielinski","doi":"10.4103/jctt.jctt_9_19","DOIUrl":"https://doi.org/10.4103/jctt.jctt_9_19","url":null,"abstract":"Background: Due to increased frailty and comorbidities, surgeons may be reluctant to perform surgical stabilization of rib fractures (SSRF) in geriatric (≥65yr) and super-geriatric (≥80yr) patients. We hypothesized that elderly patients would have delayed time to operation and more complications. We aimed to determine whether advanced age was a factor in deciding to proceed with SSRF and presented a risk for mortality. Methods: Single-institution review of rib fracture (RF) patients from 8/2009-2/2017. Univariate analysis was performed for groups age ≤64yr, 65-79yr, and ≥80yr, and SSRF vs non-SSRF. Baseline injury characteristics were compared for all age groups. Results: We identified 3098 non-SSRF patients (≤64yr, n=1770; 65-79yr, n=706; ≥80yr, n= 622) and 277 SSRF (≤64yr, n=162pt; 65-79yr, n=73pt; ≥80yr, n=42pt). For SSRF, there were no differences in sex or race, time from admission to operation, number of RF, or SSRF indications between any age group. Mortality was greater for non-SSRF patients overall [155/3098 (5%) vs 4/277 (1.4%), P < 0.01], for non-SSRF patients less than 65 years old [63/1770 (3.6%) vs 0/159, P < 0.01], and between 65-79 years old [35/706 (5%) vs 0/76, P = 0.03] but similar between non-SSRF and SSRF patients in the 80 and older cohort [57/622 (9.2%) vs 4/42(9.2%), P = 0.9]. In analysis of injury characteristics, for SSRF≥80yr greater mortality was associated with GCS <14 vs GCS≥14 (1/3 vs 0/39, P < 0.01), and more RF [median 20RF in pts with mortality (IQR:5-13) vs 10RF in patients without mortality (IQR:10-29), P = 0.02). Conclusions: Age was not associated with longer time to OR nor with difference in injury pattern or severity as indication for SSRF. Although mortality increases for RF after 80yr, among appropriately selected super-geriatric patients SSRF is a safe and effective treatment. Level of Evidence: IV Study type: Therapeutic.","PeriodicalId":92962,"journal":{"name":"The journal of cardiothoracic trauma","volume":"4 1","pages":"23 - 27"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70788299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 2

Controversies in cardiac trauma 心脏创伤的争议

The journal of cardiothoracic trauma Pub Date : 2018-01-01 DOI: 10.4103/JCTT.JCTT_7_17

K. Mattox

引用次数: 0

A nationwide survey of practice on available services and current clinical input to the care of patients with rib fractures 一项全国范围内对肋骨骨折患者护理的可用服务和当前临床投入的实践调查

The journal of cardiothoracic trauma Pub Date : 2018-01-01 DOI: 10.4103/JCTT.JCTT_1_18

H. Ingoe, C. McDaid, W. Eardley, A. Rangan, C. Hewitt

{"title":"A nationwide survey of practice on available services and current clinical input to the care of patients with rib fractures","authors":"H. Ingoe, C. McDaid, W. Eardley, A. Rangan, C. Hewitt","doi":"10.4103/JCTT.JCTT_1_18","DOIUrl":"https://doi.org/10.4103/JCTT.JCTT_1_18","url":null,"abstract":"Context: Increasing use of rib fracture fixation, despite lack of robust evidence of its effectiveness, has led to calls for large well-designed randomized controlled trials (RCTs). Aims: The aim of this survey is to ascertain the current clinical care of patients with rib fractures, identify pathways to aid patient selection, and establish whether clinicians would be willing to randomize patients into a surgical trial. Subjects and Methods: An electronic survey was distributed to trauma unit (TU) and major trauma center (MTC) leads were identified by the trauma network managers in England and Wales. Institutional ethical approval granted. Results: Most national health service (NHS) trusts have an emergency department chest trauma protocol (n = 34, 81%); seven (88%) MTCs provide a rib fracture surgery service. General surgery is the lead specialty in TUs (TUs: n = 26, 77% vs. MTCs: n = 2, 25%) and thoracic surgery in MTCs (n = 26, 77% vs. n = 3, 38%). When intubation is required, intensive care medicine leads this care (n = 19, 56% vs. n = 3, 38%). Specialist physiotherapy (n = 17, 41%) and rehabilitation consultants (n = 7, 17%) were available in some hospitals. Clinicians reported that they would be willing to take part or identify patients for an RCT of flail chest fixation (n = 34, 81%) and multiple rib fracture fixation (n = 35, 83%). Conclusions: Care of rib fracture patients involves both MTCs and TUs with variation in care protocols, referral pathways, lead specialties, and rehabilitation services. Several challenges are highlighted that would need consideration in the design and delivery of a clinical trial of surgical fixation of rib fractures. A feasibility trial is required in the first instance.","PeriodicalId":92962,"journal":{"name":"The journal of cardiothoracic trauma","volume":"3 1","pages":"5 - 10"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48711739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The First International Congress of the World Society for Cardiothoracic Trauma: Lessons learned 世界心胸创伤学会第一届国际大会:经验教训

The journal of cardiothoracic trauma Pub Date : 2018-01-01 DOI: 10.4103/JCTT.JCTT_9_18

M. Rashid

引用次数: 0

The symptomless tension pneumothorax 无症状紧张性气胸

The journal of cardiothoracic trauma Pub Date : 2018-01-01 DOI: 10.4103/jctt.jctt_6_18

M. Rashid

引用次数: 0

Blunt thoracic aortic injury 钝性胸主动脉损伤

The journal of cardiothoracic trauma Pub Date : 2018-01-01 DOI: 10.4103/JCTT.JCTT_7_18

Tara Talaie, J. Morrison, J. O'connor

{"title":"Blunt thoracic aortic injury","authors":"Tara Talaie, J. Morrison, J. O'connor","doi":"10.4103/JCTT.JCTT_7_18","DOIUrl":"https://doi.org/10.4103/JCTT.JCTT_7_18","url":null,"abstract":"Blunt thoracic aortic injury (BTAI) is a significant problem in cardiothoracic trauma. It is a leading cause of prehospital death from high energy motor vehicle crashes. Injuries can be classified into one of four grades: grade I – intimal tear; grade II – intra-mural hematoma; grade III – pseudoaneurysm and grade IV – uncontained rupture. Clinical symptoms and signs are often limited, especially in minor injury grades. Left sided hemothorax and a widened mediastinum on chest radiography are concerning features suggestive of BTAI. Computed scanning is now an indispensable tool used to evaluate patients and has largely replaced aortography. The aim of management is to control hemorrhage (if present) and to reduce the risk of delayed aortic rupture. Patients with pseudoaneurysm can undergo semi-elective repair, provided blood pressure can be controlled which is critical to preventing lesion progression and rupture. Patients presenting with an uncontained rupture require emergent repair. The preferred method of intervention is no longer operative repair (with bypass for distal perfusion), but thoracic endovascular aneurysm repair (TEVAR). An endovascular approach is associated with a lower morality and lower rates of spinal cord ischemia. The aim of this review is present the history of management and the supporting evidence along with an overview of current practice from a busy US trauma center.","PeriodicalId":92962,"journal":{"name":"The journal of cardiothoracic trauma","volume":"3 1","pages":"11 - 18"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43815646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 3

Tension pneumothorax: Are current techniques and guidelines safe? 张力性气胸:目前的技术和指南安全吗?

The journal of cardiothoracic trauma Pub Date : 2018-01-01 DOI: 10.4103/JCTT.JCTT_5_18

M. Rashid

引用次数: 0

Thoracic trauma by black caiman's bite in the Amazon region 亚马逊地区被黑凯门鳄咬伤胸部

The journal of cardiothoracic trauma Pub Date : 2018-01-01 DOI: 10.4103/JCTT.JCTT_3_18

João Corrêa Bergamasco, R. Pereira, J. Rios Rodriguez, Brígida Fernandes Cabral

引用次数: 1

When bleeding wins clotting: The surgical dilemma in life-threatening hemothorax in hemophilia 当出血赢得凝血：血友病危及生命的血胸的外科困境

The journal of cardiothoracic trauma Pub Date : 2018-01-01 DOI: 10.4103/JCTT.JCTT_2_18

N. Jain, S. Balasundaram, J. Rao

引用次数: 0