OBJECTIVETo investigate the indication of non-operative management of adult blunt splenic injuries.

METHODSA retrospective review was performed on all adult patients (age>15 years) with blunt splenic injuries admitted to the department of vascular surgery of Pellegrin hospital in France from 1999 to 2003. We managed splenic injuries non-operatively in all appropriate patients without regard to age.

RESULTSDuring the 4 years, 54 consecutive adult patients with blunt splenic injuries were treated in the hospital. A total of 27 patients with stable hemodynamic status were treated non-operatively at first, of which 2 patients were failed to non-operative treatment. The successful percentage of non-operative management was 92.6%. In the 54 patients, 7 of 8 patients older than 55 years were treated with non-operative management. Two cases developing postoperatively subphrenic infection were healed by proper treatment. In the series, there was no death.

CONCLUSIONSNon-operative management of low-grade splenic injuries can be accomplished with an acceptable low-failure rate. If the clinical and laboratory parameters difficult for surgeons to make decisions, they can depend on Resciniti's CT (computed tomography) scoring system to select a subset of adults with splenic trauma who are excellent candidates for a trial of non-operative management. The patients older than 55 years are not absolutely inhibited to receive non-operative management.

Adolescent ; Adult ; Aged ; Female ; Hematocrit ; Humans ; Male ; Middle Aged ; Multiple Trauma ; therapy ; Retrospective Studies ; Spleen ; injuries ; surgery ; Wounds, Nonpenetrating ; surgery ; therapy

Adolescent ; Adult ; Female ; Humans ; Lacerations ; surgery ; Lower Extremity ; injuries ; surgery ; Male ; Middle Aged ; Surgical Flaps

OBJECTIVETo discuss the diagnosis and treatment of multiple trauma with mainly thoracic and abdominal injuries.

METHODSA retrospective analysis was performed on data of multiple trauma cases with mainly thoracic and/or abdominal injuries.

RESULTSOf 1166 cases, 72.3% were found with shock. The operation rates of thoracic and abdominal injuries were 14.8% (119/804) and 83.5% (710/850) respectively (X(2) equal to 780.683, P less than 0.01). The operation rates of blunt and penetrating thoracic injuries was 6.8% (42/617) and 40.6% (76/187) respectively (X(2) equal to 131.701, P less than 0.01). The operation rates of blunt and penetrating abdominal injuries were 77.1% (434/563) and 96.1% (276/287) respectively (X(2) equal to 50.302, P less than 0.01). The operation rates of blunt thoracio-abdominal injuries were 6.8% (42/617) in thoracic region and 77.1% (434/563) in abdomen respectively (X(2) equal to 544.043, P less than 0.01). Among the cases of abdominal injuries, 41 received arteriography embolism, with the efficacy of 95.1% (39/41). Total mortality rate was 6.1%. The mortality rates of blunt and penetrating injuries were 7.3% (62/854) and 2.9% (9/312) (X(2) equal to 6.51, P less than 0.005). The deaths were mainly due to large volume of blood loss.

CONCLUSIONSWhen both thoracic and abdominal injuries exist, laparotomy is frequently required rather than thoracotomy. Laparotomy is seldomly used for blunt thoracic injuries, but usually used for penetrating thoracic and abdominal injuries. Mortality rate of penetrating thoracic and abdominal injuries is markedly lower than that of blunt injuries. Surgical operation is still important for those patients with penetrating thoracic or abdominal injuries.

Abdominal Injuries ; surgery ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Female ; Humans ; Male ; Middle Aged ; Multiple Trauma ; surgery ; Retrospective Studies ; Thoracic Injuries ; surgery ; Wounds, Nonpenetrating ; surgery ; Wounds, Penetrating ; surgery ; Young Adult

OBJECTIVETo probe the approach of emergency management for severe pelvic fracture associated with injuries of adjacent viscera and evaluate the therapeutic effect.

METHODSThe data of 79 patients with severe pelvic fracture associated with injuries of adjacent viscera were retrospectively studied, and the study covered a period of 14 years.

RESULTSLigation of internal iliac arteries was performed in 33 cases for ceasing massive bleeding due to pelvic fracture, and angioembolization in 8. Of 42 patients with cystic or/and urethral injury, 35 underwent cystostomy and delayed reconstruction, and 7 received a primary realignment. All of 17 patients with injury of retroperitoneal rectum underwent diverting colostomy of the proximal end of sigmoid with presacral drainage, but 4 received primary repair without colostomy. In 22 patients with intraperitoneal colorectal injury, 19 were managed with primary repair or anastomosis while 3 received a colostomy. The overall mortality rate was 9% (7/79); The main causes were hemorrhagic shock and associated injury. The complications included urethro-rectal fistula in 4, thrombosis of right common iliac artery in 1, acute respiratory distress syndrome (ARDS) following chest trauma in 1, and paraplegia in 1. Except the patient with paraplegia, all of them were cured.

CONCLUSIONSPrompt diagnosis and proper treatment were the key of the success. Devascularization of internal iliac arteries with external fixation cage of pelvis, cystostomy and proximal sigmoidostomy were effective procedures frequently used in the emergency treatment of the severe pelvic fracture patients.

Abdominal Injuries ; diagnosis ; etiology ; surgery ; Adolescent ; Adult ; Aged ; Colostomy ; Female ; Fractures, Bone ; complications ; diagnosis ; surgery ; Humans ; Male ; Middle Aged ; Pelvic Bones ; injuries ; Retrospective Studies ; Urinary Diversion

OBJECTIVETo investigate the approach of emergency management for severe pelvic fracture associated with injuries of adjacent viscera and evaluate the therapeutic effect.

METHODSThe data of 79 patients with severe pelvic fracture associated with injuries of adjacent viscera were retrospectively studied, and the study covered a period of 14 years.

RESULTSTo cease massive bleeding due to pelvic fracture, ligation of internal iliac arteries was performed on 33 cases, and angioembolization on 8. Of 42 patients with cystic or/and urethral injury, 35 underwent cystostomy and delayed reconstruction, and 7 received a primary realignment. All of 17 patients with injury of retroperitoneal rectum underwent diverting colostomy of the proximal end of sigmoid with presacral drainage, but 4 received primary repair without colostomy. In 22 patients with intraperitoneal colorectal injury, 19 were managed with primary repair or anastomosis while 3 received a colostomy. The overall mortality rate was 8.86% (7/79); the main causes were hemorrhagic shock and associated injury. The complications included urethro-rectal fistula in 4 cases, thrombosis of right common iliac artery in 1, ARDS following chest trauma in 1, and paraplegia in 1. Except the patient with paraplegia, all of them were cured.

CONCLUSIONSPrompt diagnosis and proper treatment are the key to success. Devascularization of internal iliac arteries with external fixation cage of the pelvis, cystostomy and proximal sigmoidostomy are effective procedures in emergency treatment of the critical patients.

Abdominal Injuries ; complications ; therapy ; Adolescent ; Adult ; Aged ; Female ; Fractures, Bone ; complications ; therapy ; Hemorrhage ; etiology ; therapy ; Humans ; Male ; Middle Aged ; Pelvic Bones ; injuries ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo investigate the early diagnosis and treatment of polytrauma patients with thoracic and/or abdominal injuries.

METHODSThe data of all polytrauma patients with thoracic and/or abdominal injuries during the past 10 years were studied retrospectively.

RESULTSIn the present study, there were 1 540 polytrauma patients, accounting for 65.0% of all 2 368 trauma patients. Of these patients, 62.4% were in shock state on admission. The operative rates were 15.0% (181/1 206) and 79.9% (612/766) in patients with thoracic and abdominal injury (P<0.01), 5.2% (39/758) and 31.7% (142/448) in patients with blunt and penetrating chest trauma (P<0.01), and 72.45% (359/496) and 93.7% (253/270) in patients with blunt and penetrating abdominal injuries (P<0.01), respectively. To deal with abdominal injury, angioembolization was performed in 43 cases, with 42 cured. The overall mortality rate was 6.2%. And in the blunt and penetrating subgroups, the mortalities were 7.9% (75/950) and 3.6% (21/590), respectively (P<0.01). Most patients died from exsanguination.

CONCLUSIONSThe first "golden hour" after trauma should be grasped, since the treatment in this hour can determine greatly whether the critically-injured victim could survive. Prompt diagnosis and proper treatment contribute more greatly to the survival of the victim than the severity of injury.

Abdominal Injuries ; diagnosis ; surgery ; therapy ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; China ; epidemiology ; Female ; Humans ; Male ; Middle Aged ; Multiple Trauma ; diagnosis ; epidemiology ; therapy ; Retrospective Studies ; Thoracic Injuries ; diagnosis ; surgery ; therapy

OBJECTIVETo investigate the diagnostic and therapeutic effect of bronchofiberscopy in the management of severe thoracic trauma.

METHODSA retrospective study was conducted on 207 consecutive patients with severe thoracic trauma enrolled in our hospital between January 2008 and June 2012. During the period, 488 bronchofiberscopies and lavages were done. The bronchofiberscope was inserted through tracheal incision (282), nasal cavity (149) and oral cavity (57). Intensive SaO2 monitoring as well as blood gas analysis were performed pre-, intra- and postoperatively. Simultaneously oxygen therapy or ventilatory support was given. Sputum culture was done intraoperatively.

RESULTSDiagnosis in 207 cases was confirmed by bronchofiberscopy. The result of sputum culture was positive in 78 cases. Lavage was performed on 156 cases. SaO2 significantly increased after bronchofiberscopies as well as lavages and PaO2 obviously improved 2 h after surgery (both P less than 0.05). Heart rate and respiratory rate decreased. There was no bronchofiberscopy-related death.

CONCLUSIONBronchofiberscopy plays an important role in the diagnosis and treatment of severe thoracic trauma, which can not only timely diagnose bronchial injury and collect deep tracheal sputum for bacterial culture but also effectively remove foreign body, secretion, blood and sputum crust in the airway, manage obstructive atelectasis and pneumonia, and significantly improve respiratory function and treatment outcome.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Bronchoalveolar Lavage ; Bronchoscopy ; Female ; Fiber Optic Technology ; Humans ; Injury Severity Score ; Male ; Middle Aged ; Retrospective Studies ; Thoracic Injuries ; diagnosis ; etiology ; surgery ; Treatment Outcome

PURPOSETraumatic diaphragmatic rupture (TDR) needs early diagnosis and operation. However, the early diagnosis is usually difficult, especially in the patients without diaphragmatic hernia. The objective of this study was to explore the early diagnosis and treatment of TDR.

METHODSData of 256 patients with TDR treated in our department between 1994 and 2013 were analyzed retrospectively regarding to the diagnostic methods, percentage of preoperative judgment, incidence of diaphragmatic hernia, surgical procedures and outcome, etc. Two groups were set up according to the mechanism of injury (blunt or penetrating).

RESULTSOf 256 patients with a mean age of 32.4 years (9-84), 218 were male. The average ISS was 26.9 (13-66); and shock rate was 62.9%. There were 104 blunt injuries and 152 penetrating injuries. Preoperatively diagnostic rate was 90.4% in blunt injuries and 80.3% in penetrating, respectively, P < 0.05. The incidence of diaphragmatic hernia was 94.2% in blunt and 15.1% in penetrating respectively, P < 0.005. Thoracotomy was performed in 62 cases, laparotomy in 153, thoracotomy plus laparotomy in 29, and combined thoraco-laparotomy in 12. Overall mortality rate was 12.5% with the average ISS of 41.8; and it was 21.2% in blunt injuries and 6.6% in penetrating, respectively, P < 0.005. The main causes of death were hemorrhage and sepsis.

CONCLUSIONSDiagnosis of blunt TDR can be easily obtained by radiograph or helical CT scan signs of diaphragmatic hernia. For penetrating TDR without hernia, "offside sign" is helpful as initial assessment. CT scan with coronal/sagittal reconstruction is an accurate technique for diagnosis. All TDR require operation. Penetrating injury has a relatively better prognosis.

Abdominal Injuries ; diagnostic imaging ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Diaphragm ; diagnostic imaging ; injuries ; Female ; Humans ; Male ; Middle Aged ; Multiple Trauma ; diagnostic imaging ; Retrospective Studies ; Rupture ; Thoracic Injuries ; diagnostic imaging ; Tomography, X-Ray Computed ; Wounds, Nonpenetrating ; diagnostic imaging ; Wounds, Penetrating ; diagnostic imaging

AIM To explore the effects of Buyang Huanwu Decoction on mitochondrial oxidative damage and PKCε-Nampt pathway in rats following cerebral ischemia reperfusion(I/R).METHODS The rats were randomly divided into the sham operation group,the model group,Buyang Huanwu Decoction group(14.3 g/kg)and edaravone group(3 mg/kg).Except those of the sham operation group,SD rats of other groups were induced into models of brain I/R injury by MCAO method,followed by corresponding drug administration 24 hours after operation.After 7 days of administration,the rats had their neurological deficit evaluated by neurological function scoring;thier expression of neuron marker MAP-2 detected by immunofluorescence staining;their neuron damage observed and the oxidative damage evaluated through assessment of their ROS levels and MDA and SOD activities;their changes of mitochondrial membrane potential detected by fluorescent probe JC-1;their ratio of NAD+/NADH detected using modified enzyme circulation method;their expressions of PKCε,p-PKCε and Nampt proteins detected with Western blot;and their positive expressions of p-PKCε and Nampt proteins detected with immunohistochemistry method.RESULTS Compared with the model group,Buyang Huanwu Decoction group shared decreased cerebral infarction volume and neurological function score(P<0.05);increased cerebral fluorescence intensity of MAP-2(P<0.05);reduced neuronal damage,decreased cerebral levels of ROS and MDA(P<0.05);increased SOD activity,mitochondrial membrane potential and NAD+/NADH ratio(P<0.05);and increased protein expressions of p-PKCε and Nampt(P<0.05).CONCLUSION Buyang Huanwu Decoction can improve mitochondrial function and reduce brain I/R injury in rats by activating their PKCε-Nampt signaling pathway.

OBJECTIVETo investigate the polymorphisms of myeloid differentiation-2 (MD-2) gene promoters, and to explore whether such polymorphisms are associated with the susceptibility to multiple organ dysfunction syndrome (MODS) and sepsis in Chinese Han population.

METHODSUsing polymerase chain reaction-restriction fragment length polymorphism method, the authors detected the single nucleotide polymorphisms of the promoter region of MD-2 gene at position - 1625C/G in 105 severe trauma patients (42 with sepsis). The organ function was scored.

RESULTSThe frequency of CC genotype in MD-2 gene promoter region at position - 1625 was 0.5 (21/42) in septic patients and 0.7 (44/63) in non-septic patients. The frequency of CG genotype was 0.38 (16/42) in septic patients and 0.27 (17/63) in non-septic patients. The frequency of GG genotype was 0.12 (5/42) in septic patients and 0.03 (2/63) in non-septic patients. The MODS scores in trauma patients carrying G allele at position - 1625 were significantly higher than those carrying C allele (P<0.001 for dominant effect, and P>0.05 for recessive effect). Moreover, trauma patients carrying G allele appeared to have higher risk of sepsis comparing to those carrying C allele (OR 0.477, 95% CI 0.266-0.855, P<0.05). Sepsis morbidity was significantly different between subjects with C and G alleles (P<0.05 for dominant effect, P>0.05 for recessive effect).

CONCLUSIONSThe polymorphisms of the promoter region of MD-2 gene at position - 1625 C/G is correlated with MODS and sepsis after severe trauma in Chinese Han population. The people with - 1625 G allele in the promoter region of MD-2 gene may be a risk factor of severe complications.

Asian Continental Ancestry Group ; China ; Genetic Predisposition to Disease ; Humans ; Lymphocyte Antigen 96 ; genetics ; Multiple Organ Failure ; etiology ; genetics ; Polymorphism, Genetic ; Promoter Regions, Genetic ; Sepsis ; etiology ; genetics ; Wounds and Injuries ; complications ; genetics