PURPOSE: Non-operative management (NOM) has been validated for blunt liver and splenic injuries. Literature on continuous intra-abdominal pressure (IAP) monitoring as a part of NOM remains to be equivocal. The study aimed to find any correlation between clinical parameters and IAP, and their effect on the NOM of patients with blunt liver and splenic injury. METHOD: A prospective cross-sectional study conducted at a level I trauma center from October 2018 to January 2020 including 174 patients who underwent NOM following blunt liver and splenic injuries. Hemodynamically unstable patients or those on ventilators were excluded, as well as patients who suffered significant head, spinal cord, and/or bladder injuries. The study predominantly included males (83.9%) with a mean age of 32.5 years. IAP was monitored continuously and the relation of IAP with various parameters, interventions, and outcomes were measured. Data were summarized as frequency (percentage) or mean ± SD or median (Q₁, Q₃) as indicated. χ² or Fisher's exact test was used for categorical variables, while for continuous variables parametric (independent t-test) or nonparametric tests (Wilcoxon rank sum test) were used as appropriate. Clinical and laboratory correlates of IAP < 12 with p < 0.200 in the univariable logistic regression analysis were included in the multivariable analysis. A p < 0.05 was used to indicate statistical significance. RESULTS: Intra-abdominal hypertension (IAH) was seen in 19.0% of the study population. IAH was strongly associated with a high injury severity score (p < 0.001), and other physiological parameters like respiratory rate (p < 0.001), change in abdominal girth (AG) (p < 0.001), and serum creatinine (p < 0.001). IAH along with the number of solid organs involved, respiratory rate, change in AG, and serum creatinine was associated with the intervention, either operative or non-operative (p = 0.001, p = 0.002, p < 0.001, p < 0.001, p = 0.013, respectively). On multivariable analysis, IAP (p = 0.006) and the mean change of AG (p = 0.004) were significantly associated with the need for intervention. CONCLUSION As a part of NOM, IAP should be monitored as a continuous vital. However, the decision for any intervention, either operative or non-operative cannot be guided by IAP values alone.
Humans ; Male ; Adult ; Female ; Wounds, Nonpenetrating/physiopathology* ; Spleen/injuries* ; Prospective Studies ; Cross-Sectional Studies ; Liver/injuries* ; Middle Aged ; Monitoring, Physiologic/methods* ; Pressure ; Abdominal Injuries/physiopathology* ; Intra-Abdominal Hypertension ; Young Adult

Objective: Patients with severe symptomatic aortic stenosis are assessed for coronary artery disease (CAD) prior to transcatheter aortic valve implantation (TAVI) with treatment implications. Invasive coronary angiography (ICA) is the recommended modality but is associated with peri-procedural complications. Integrating machine learning (ML)-based computed tomography-derived fractional flow reserve (CT-FFR) into existing TAVI-planning CT protocol may aid exclusion of significant CAD and thus avoiding ICA in selected patients. Materials and Methods: A single-center, retrospective study was conducted, 41 TAVI candidates with both TAVI-planning CT and ICA performed were analyzed. CT datasets were evaluated by a ML-based CT-FFR software. Beta-blocker and nitroglycerin were not administered in these patients. The primary outcome was to identify significant CAD. The diagnostic performance of CT-FFR was compared against ICA. Results: On per-patient level, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy were 89%, 94%, 80%, 97% and 93%, respectively. On per-vessel level, the sensitivity, specificity, PPV, NPV and diagnostic accuracy were 75%, 94%, 67%, 96% and 92%, respectively. The area under the receiver operative characteristics curve per individual coronary vessels yielded overall 0.90 (95% confidence interval 85%–95%). ICA may be avoided in up to 80% of patients if CT-FFR results were negative. Conclusion ML-based CT-FFR can provide accurate screening capabilities for significant CAD thus avoiding ICA. Its integration to existing TAVI-planning CT is feasible with the potential of improving the safety and efficiency of pre-TAVI CAD assessment.

Background: Tooth hypersensitivity presents a significant clinical challenge in managing molar-incisal hypomineralization (MIH), potentially compromising the effectiveness of restorative treatments. Cryotherapy has emerged as a promising approach to reduce pain and inflammation. This study aimed to evaluate and compare the effects of cryotherapy as an adjuvant to nerve blocks in reducing operative pain and sensitivity in patients. Methods: A split-mouth randomized controlled trial was conducted in 28 patients with MIH of the right and left lower molars. ie, 56 teeth. Group (1) control group (n = 28) was administered an Inferior Alveolar Nerve block and group (2) was administered cryotherapy spray after the Inferior Alveolar Nerve block. The Visual Analog Scale (VAS) and Legs, Activity, Cry, Consolability (FLACC) scales were used to compare intraoperative pain. The Mann-Whitney U test was used to test the significance across the study groups, and the chi-square test was used to compare success rates between the two groups; a value of less than 0.05 was considered significant. Results: For VAS scale, the mean value in Group A is 8.89 ± 0.79, whereas in Group B, the values are 4.71 ± 1.46. For the FLACC scale, Group A scores were 7.14 ± 1.04, and Group B scores were 4.48 ± 1.37.When intergroup values were compared, the FLACC and VAS scores were statistically significant at P < 0.001. Conclusion Within the limitations of this study, applying cryotherapy to tooth surfaces following an Inferior Alveolar Nerve block effectively reduces pain and sensitivity in teeth affected by MIH.

Seat belt-related injuries are frequent and are often associated with a specific injury pattern known as “seat belt syndrome.” The presence of the seat belt sign can facilitate the early identification of seat belt injuries, which can help prevent the delayed or missed diagnosis of certain intestinal injuries, such as obstructions. We report the case of a 39-year-old man who sustained a bone fracture and a seat belt injury that led to an intestinal stricture. This condition manifested as delayed acute small bowel obstruction, necessitating laparoscopic intestinal resection and side-to-side anastomosis with a linear stapler. In polytrauma patients with seat belt syndrome, abdominal pain may be overshadowed by the pain from extra-abdominal injuries. Nevertheless, this pain should not be overlooked and must be thoroughly evaluated during regular follow-up visits to prevent complications.