急诊胸腹创伤手术后切口感染的相关因素调查

目的研究急诊胸腹创伤手术后切口感染的危险因素。方法将该院于2017年9月—2018年9月收治的114例急诊胸腹创伤手术患者作为研究对象,根据患者是否发生术后切口感染分为研究组(发生术后切口感染)和对照组(未发生术后切口感染),统计并比较两组患者的一般资料及临床资料,同时分析导致急诊胸腹创伤手术患者发生术后切口感染的危险因素。结果患者年龄大、损伤后失血量多、合并低蛋白血症、未使用抗菌药物、开放性损伤以及合并糖尿病,均是急诊胸腹创伤手术患者术后并发切口感染的危险因素(P<0.05)。结论患者年龄大、损伤后失血量多、合并低蛋白血症、未使用抗菌药物、开放性损伤以及合并糖尿病,均是急诊胸腹创伤手术患者术后并发切口感染的危险因素。     

Management of major trauma

Trauma is one of the leading cause of deaths in those <35 years old in the UK. It also has a significant morbidity burden with a subsequent economic impact. There is also a realisation that trauma is having an increasing impact in the elderly population. In the last two decades there have been changes in both the structure of trauma care across the UK, and also in clinical aspects from pre-hospital care to rehabilitation. This article will review the changes that have occurred, including the reasons, and give a broad overview of the immediate management of the critically ill trauma patient.     

Investigation and management of adrenal tumours

Disorders of the adrenal gland are rare and complex, with many potential pitfalls in management. An understanding of embryology, anatomy, physiology and biochemistry is crucial. There has been a dramatic increase in the incidental detection of adrenal lesions on cross sectional imaging in recent years. Surgical treatment may be required for syndromes of hormonal excess and/or suspicion of malignancy.     

Understanding and helping children who have experienced maltreatment

Children who experience maltreatment from within their families can suffer trauma that is devastating to their physical and psychological development. The label developmental trauma has developed to describe this trauma and to guide diagnosis. This has been expanded to describe seven domains of impairment. Together these help the clinician to provide a formulation of a child's difficulties which avoids multiple diagnoses and can guide treatment planning. Dyadic Developmental Psychotherapy and Practice (DDP) is an intervention model that can meet the therapeutic needs of the children alongside the support needs of parents and practitioners caring for them. The attitude of PACE (playfulness, acceptance, curiosity and empathy) is central within DDP interventions, used by therapists, parents and practitioners who together make up the network around the child. Tailoring DDP interventions can be guided by a pyramid of need developed by the author. This helps clinicians develop flexible intervention packages tailored to the needs of the child, family and practitioner. Within the paper these ideas are explored illustrated by the fictional example of Janice. She was maltreated in early childhood and now lives in foster care with Mary and Simeon.     

Consequences of physical distancing emanating from the COVID-19 pandemic: An Australian perspective

The sobering reality of the COVID-19 pandemic is that it has brought people together at home at a time when we want them apart in the community. This will bring both benefits and challenges. It will affect people differently based upon their age, health status, resilience, family support structures, and socio-economic background. This article will assess the impact in high income countries like Australia, where the initial wave of infection placed the elderly at the greatest risk of death whilst the protective measures of physical distancing, self-isolation, increased awareness of hygiene practices, and school closures with distance learning has had considerable impact on children and families acutely and may have ramifications for years to come.     

Manejo de la rotura de la membrana de Descemet secundaria a traumatismo por fórceps durante el parto

To describe the clinical signs and management of Descemet membrane (DM) detachment after forceps-related trauma during birth. A 2-day-old term infant presented with right eye corneal clouding and history of forceps assisted delivery. Ophthalmic assessment was consistent for corneal trauma and anterior segment optical coherence tomography (AS-OCT Visante®) revealed DM detachment. Prolonged topical treatment considerably reduced edema, but after four months of treatment superior DM detachment persisted, anterior chamber air injection at this point also failed to achieve apposition. Central visual axis remained partially spared in the months to follow, and intensive amblyopia treatment was indicated. Prolonged topical treatment may be helpful to reduce edema and risk of severe amblyopia in DM tears secondary to forceps traumatism at birth, but insufficient in cases of large DM detachment.